H\u00c0NH CH\u00cdNH:<\/b><\/p>\n
1. T\u00ean m\u00f4n h\u1ecdc: Nhi c\u01a1 s\u1edf<\/p>\n
2. T\u00ean b\u00e0i h\u1ecdc: \u0110\u1eb6C \u0110I\u1ec2M H\u1ec6 TU\u1ea6N HO\u00c0N TR\u1eba EM<\/p>\n
3. B\u00e0i gi\u1ea3ng: L\u00fd thuy\u1ebft<\/p>\n
4. \u0110\u1ed1i t\u01b0\u1ee3ng: Sinh vi\u00ean Y4 + CT3<\/p>\n
5. Th\u1eddi gian: 1 ti\u1ebft<\/p>\n
6. \u0110\u1ecba \u0111i\u1ec3m: Gi\u1ea3ng \u0111\u01b0\u01a1ng<\/p>\n
M\u1ee5c ti\u00eau:<\/b><\/p>\n
1. N\u00eau \u0111\u01b0\u1ee3c \u0111\u1eb7c \u0111i\u1ec3m tu\u1ea7n ho\u00e0n b\u00e0o thai v\u00e0 s\u1ef1 th\u00edch nghi c\u1ee7a h\u1ec7 tu\u1ea7n ho\u00e0n sau khi tr\u1ebb ra \u0111\u1eddi.<\/p>\n
2. Tr\u00ecnh b\u00e0y \u0111\u01b0\u1ee3c \u0111\u1eb7c \u0111i\u1ec3m gi\u1ea3i ph\u1eabu c\u1ee7a tim v\u00e0 m\u1ea1ch m\u00e1u \u1edf tr\u1ebb em.<\/p>\n
3. \u0110\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c nh\u1eefng ch\u1ec9 s\u1ed1 huy\u1ebft \u0111\u1ed9ng c\u01a1 b\u1ea3n b\u00ecnh th\u01b0\u01a1ng \u1edf tr\u1ebb em.<\/p>\n
1.\u00a0\u0110\u1eb6C \u0110I\u1ec2M H\u1ec6 TU\u1ea6N HO\u00c0N B\u00c0O THAI V\u00c0 S\u01a0 SINH SAU \u0110\u1eba<\/b><\/p>\n
1.1. Tu\u1ea7n ho\u00e0n b\u00e0o thai<\/p>\n
Tim v\u00e0 m\u1ea1ch m\u00e1u c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb trung m\u00f4. Ng\u00e0y th\u1ee9 22 c\u1ee7a ph\u00f4i, tim \u0111\u00e3 b\u1eaft \u0111\u1ea7u co b\u00f3p.<\/p>\n
\u1ede b\u00e0o thai, th\u1ea5t ph\u1ea3i v\u00e0 th\u1ea5t tr\u00e1i t\u1ed3n t\u1ea1i v\u00f2ng tu\u1ea7n ho\u00e0n song song, kh\u00e1c h\u1eb3n v\u1edbi tr\u1ebb s\u01a1 sinh v\u00e0 ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh l\u00e0 v\u00f2ng tu\u1ea7n ho\u00e0n li\u00ean t\u1ee5c. Trong b\u00e0o thai s\u1ef1 trao \u0111\u1ed5i kh\u00ed v\u00e0 ch\u1ea5t dinh d\u01b0\u1ee1ng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi rau thai. Ph\u1ed5i kh\u00f4ng \u0111\u1ea3m nhi\u1ec7m ch\u1ee9c n\u0103ng trao \u0111\u1ed5i kh\u00ed v\u00e0 m\u1ea1ch m\u00e1u \u1edf ph\u1ed5i co nh\u1ecf. \u0110\u1ed1i v\u1edbi b\u00e0o thai c\u00e1c c\u1ea5u tr\u00fac tim m\u1ea1ch duy nh\u1ea5t r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 duy tr\u00ec tu\u1ea7n ho\u00e0n song song l\u00e0: \u1ed1ng t\u0129nh m\u1ea1ch, l\u1ed7 b\u1ea7u d\u1ee5c v\u00e0 \u1ed1ng \u0111\u1ed9ng m\u1ea1ch.<\/p>\n
S\u1ef1 tu\u1ea7n ho\u00e0n m\u00e1u \u1edf thai \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n qua rau thai. Thai nh\u1eadn m\u00e1u c\u00f3 oxy qua t\u0129nh m\u1ea1ch r\u1ed1n c\u00f3 \u0111\u1ed9 b\u00e3o h\u00f2a oxy kho\u1ea3ng 80%. Khi t\u1edbi gan m\u00e1u \u1ea5y \u0111\u01b0\u1ee3c tr\u1ed9n l\u1eabn v\u1edbi m\u00e1u \u0111\u00e3 gi\u1ea3m b\u00e3o ho\u00e0 oxy t\u1eeb h\u1ec7 t\u0129nh m\u1ea1ch c\u1eeda t\u1edbi gan. T\u1eeb gan, m\u00e1u \u0111\u00e3 \u0111\u01b0\u1ee3c tr\u1ed9n l\u1eabn \u1ea5y \u0111\u01b0\u1ee3c d\u1eabn tr\u1ef1c ti\u1ebfp t\u1edbi t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi qua \u1ed1ng Arantius. \u1ede \u0111o\u1ea1n g\u1ea7n tim c\u1ee7a t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi, c\u00f3 s\u1ef1 pha tr\u1ed9n m\u00e1u l\u1ea7n th\u1ee9 2 gi\u1eefa m\u00e1u n\u00e0y v\u1edbi m\u00e1u t\u1eeb chi d\u01b0\u1edbi, th\u1eadn v\u00e0 t\u1eeb v\u00f9ng \u0111\u00e1y ch\u1eadu t\u1edbi.<\/p>\n
T\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi d\u1eabn m\u00e1u t\u1edbi t\u00e2m nh\u0129 ph\u1ea3i. T\u1ea1i \u0111\u00e2y ngo\u00e0i t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi, c\u00f2n c\u00f3 t\u0129nh m\u1ea1ch ch\u1ee7 tr\u00ean v\u00e0 t\u0129nh m\u1ea1ch v\u00e0nh \u0111\u1ed5 v\u00e0o. T\u1eeb t\u00e2m nh\u0129 ph\u1ea3i, m\u00e1u c\u00f3 2 con \u0111\u01b0\u1eddng ti\u1ebfp t\u1ee5c \u0111i: m\u1ed9t l\u00e0 t\u1edbi t\u00e2m th\u1ea5t ph\u1ea3i qua van 3 l\u00e1, hai l\u00e0 \u0111i qua l\u1ed7 b\u1ea7u d\u1ee5c (l\u1ed7 Botal) \u0111\u1ec3 sang t\u00e2m nh\u0129 tr\u00e1i. V\u00ec l\u1ed7 b\u1ea7u d\u1ee5c n\u1eb1m \u0111\u1ed1i di\u1ec7n v\u1edbi l\u1ed7 t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi, n\u00ean kho\u1ea3ng 1\/3 l\u01b0\u1ee3ng m\u00e1u t\u1eeb t\u0129nh m\u1ea1ch n\u00e0y t\u1edbi t\u00e2m nh\u0129 ph\u1ea3i, s\u1ebd ch\u1ea3y th\u1eb3ng qua l\u1ed7 b\u1ea7u d\u1ee5c \u0111\u1ec3 sang t\u00e2m nh\u0129 tr\u00e1i v\u00e0 pha tr\u1ed9n v\u1edbi m\u00e1u t\u0129nh m\u1ea1ch ph\u1ed5i \u0111\u00e3 m\u1ea5t b\u00e3o h\u00f2a oxy tr\u01b0\u1edbc khi \u0111\u1ed5 xu\u1ed1ng th\u1ea5t tr\u00e1i. 2\/3 l\u01b0\u1ee3ng m\u00e1u c\u00f2n l\u1ea1i c\u1ee7a t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi s\u1ebd tr\u1ed9n l\u1eabn v\u1edbi m\u00e1u \u0111\u00e3 m\u1ea5t b\u00e3o h\u00f2a oxy t\u1eeb t\u0129nh m\u1ea1ch ch\u1ee7 tr\u00ean v\u00e0 t\u0129nh m\u1ea1ch v\u00e0nh tr\u01b0\u1edbc khi \u0111\u1ed5 xu\u1ed1ng th\u1ea5t ph\u1ea3i. Nh\u01b0 v\u1eady c\u00f3 s\u1ef1 pha tr\u1ed9n m\u00e1u l\u1ea7n th\u1ee9 3 t\u1ea1i 2 t\u00e2m nh\u0129.<\/p>\n
M\u00e1u r\u1eddi t\u00e2m th\u1ea5t ph\u1ea3i v\u00e0o \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i (\u0110MP). V\u00ec ph\u1ed5i ch\u01b0a \u0111\u1ea3m tr\u00e1ch ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p, l\u00f2ng ph\u1ebf nang ch\u01b0a gi\u00e3n, th\u00e0nh c\u1ee7a c\u00e1c \u0110MP c\u00f2n d\u00e0y, l\u00f2ng c\u1ee7a ch\u00fang h\u1eb9p, \u00e1p l\u1ef1c trong c\u00e1c \u0110MP l\u1edbn. Do \u0111\u00f3 ph\u1ea7n l\u1edbn m\u00e1u trong \u0110MP s\u1ebd \u0111i qua \u1ed1ng \u0111\u1ed9ng m\u1ea1ch \u0111\u1ec3 v\u00e0o \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 (\u0110MC) xu\u1ed1ng v\u00e0 tr\u1ed9n l\u1eabn v\u1edbi m\u1ed9t ph\u1ea7n c\u00f2n l\u1ea1i c\u1ee7a m\u00e1u t\u1eeb quai \u0110MC \u0111\u1ebfn, t\u1ee9c l\u00e0 m\u00e1u t\u1eeb t\u00e2m th\u1ea5t tr\u00e1i t\u1edbi. \u00d0\u00f3 l\u00e0 s\u1ef1 pha tr\u1ed9n m\u00e1u l\u1ea7n th\u1ee9 4. K\u1ebft qu\u1ea3 l\u00e0 \u0110MC xu\u1ed1ng mang m\u1ed9t ph\u1ea7n l\u1edbn m\u00e1u d\u00e0nh cho s\u1ef1 tu\u1ea7n ho\u00e0n ph\u1ed5i. T\u1eeb \u0110MC xu\u1ed1ng, m\u1ed9t ph\u1ea7n m\u00e1u \u0111\u01b0\u1ee3c ph\u00e2n b\u1ed1 cho c\u00e1c t\u1ea1ng, m\u1ed9t ph\u1ea7n \u0111\u01b0\u1ee3c d\u1eabn \u0111i b\u1edfi \u0111\u1ed9ng m\u1ea1ch r\u1ed1n \u0111\u1ec3 t\u1edbi rau.<\/p>\n
Nh\u1eefng \u0111i\u1ec3m c\u1ea7n ch\u00fa \u00fd \u1edf tu\u1ea7n ho\u00e0n thai:<\/p>\n
\u0081 \u00c1p l\u1ef1c trong nh\u0129 ph\u1ea3i l\u1edbn h\u01a1n nh\u0129 tr\u00e1i gi\u00fap m\u00e1u ch\u1ea3y qua l\u1ed7 Botal v\u00e0o nh\u0129 tr\u00e1i. \u00c1p l\u1ef1c m\u00e1u trong t\u00e2m th\u1ea5t tr\u00e1i v\u00e0 ph\u1ea3i c\u0169ng nh\u01b0 trong \u0110MC v\u00e0 \u0110MP ngang b\u1eb1ng nhau gi\u00fap cho m\u00e1u trong 2 \u0111\u1ed9ng m\u1ea1ch n\u00e0y c\u00f9ng ch\u1ea3y v\u00e0o \u0110MC xu\u1ed1ng theo 1 h\u01b0\u1edbng.<\/p>\n
\u0082 Cung l\u01b0\u1ee3ng tim trong th\u1ea5t ph\u1ea3i l\u1edbn g\u1ea5p \u0111\u00f4i trong th\u1ea5t tr\u00e1i n\u00ean th\u1ea5t ph\u1ea3i l\u00e0m vi\u1ec7c nhi\u1ec1u h\u01a1n th\u1ea5t tr\u00e1i g\u00e2y ra hi\u1ec7n t\u01b0\u1ee3ng d\u00e0y th\u1ea5t ph\u1ea3i sinh l\u00fd.<\/p>\n
\u0083 Th\u1ea5t tr\u00e1i ch\u1ee9a m\u00e1u c\u00f3 \u0111\u1ed9 b\u00e3o h\u00f2a cao (65%) cung c\u1ea5p m\u00e1u cho \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, \u0111\u1ed9ng m\u1ea1ch c\u00e1nh tay \u0111\u1ea7u v\u00e0 \u0111\u1ed9ng m\u1ea1ch d\u01b0\u1edbi \u0111\u00f2n tr\u00e1i. M\u00e1u c\u1ee7a th\u1ea5t ph\u1ea3i c\u00f3 \u0111\u1ed9 b\u00e3o h\u00f2a oxy th\u1ea5p h\u01a1n (55%) qua \u1ed1ng \u0111\u1ed9ng m\u1ea1ch \u0111i nu\u00f4i c\u00e1c t\u1ea1ng kh\u00e1c.<\/p>\n
1.2. Tu\u1ea7n ho\u00e0n sau sinh<\/p>\n
Khi tr\u1ebb ra \u0111\u1eddi s\u1ef1 tu\u1ea7n ho\u00e0n c\u00f3 nh\u1eefng bi\u1ebfn \u0111\u1ed5i quan tr\u1ecdng v\u00e0 \u0111\u1ed9t ng\u1ed9t do ph\u1ed5i \u0111\u1ea3m nhi\u1ec7m ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p v\u00e0 h\u1ec7 tu\u1ea7n ho\u00e0n rau m\u1ea5t \u0111i.<\/p>\n
Khi ph\u1ed5i b\u1eaft \u0111\u1ea7u h\u00f4 h\u1ea5p, c\u00e1c ph\u1ebf nang gi\u00e3n ra, l\u00f2ng c\u00e1c mao m\u1ea1ch m\u00e1u trong ph\u1ed5i c\u0169ng gi\u00e3n ra, s\u1ee9c c\u1ea3n c\u00e1c \u0110MP gi\u1ea3m xu\u1ed1ng \u0111\u1ed9t ng\u1ed9t t\u1edbi tr\u1ecb s\u1ed1 r\u1ea5t th\u1ea5p do \u0111\u00f3 \u00e1p l\u1ef1c m\u00e1u trong \u0110MP c\u0169ng nh\u01b0 trong t\u00e2m th\u1ea5t v\u00e0 t\u00e2m nh\u0129 ph\u1ea3i gi\u1ea3m \u0111i. V\u00ec d\u00e2y r\u1ed1n b\u1ecb b\u1ecb c\u1eaft n\u00ean m\u1ed9t l\u01b0\u1edbi mao m\u1ea1ch r\u1ed9ng l\u1edbn c\u1ee7a rau tr\u01b0\u1edbc kia nh\u1eadn ph\u1ea7n l\u1edbn m\u00e1u t\u1eeb \u0110MC thai c\u0169ng m\u1ea5t \u0111i l\u00e0m \u00e1p l\u1ef1c m\u00e1u trong \u0110MC c\u0169ng nh\u01b0 trong th\u1ea5t tr\u00e1i v\u00e0 nh\u0129 tr\u00e1i t\u0103ng l\u00ean. K\u1ebft qu\u1ea3 l\u00e0 \u00e1p l\u1ef1c trong t\u00e2m nh\u0129 tr\u00e1i c\u1ee7a tr\u1ebb m\u1edbi ra \u0111\u1eddi cao h\u01a1n nh\u0129 ph\u1ea3i l\u00e0m v\u00e1ch li\u00ean nh\u0129 ti\u00ean ph\u00e1t b\u1ecb \u0111\u1ea9y v\u1ec1 ph\u00eda v\u00e1ch th\u1ee9 ph\u00e1t \u0111\u1ec3 kh\u00e9p l\u1ed1i th\u00f4ng li\u00ean nh\u0129. V\u1ec1 m\u1eb7t gi\u1ea3i ph\u1eabu, s\u1ef1 b\u1ecbt l\u1ed1i th\u00f4ng n\u00e0y ch\u1ec9 b\u1eaft \u0111\u1ea7u x\u1ea3y ra v\u00e0o kho\u1ea3ng gi\u1eefa tu\u1ea7n th\u1ee9 6 v\u00e0 tu\u1ea7n th\u1ee9 10 sau khi tr\u1ebb ra \u0111\u1eddi.<\/p>\n
S\u1ef1 gi\u1ea3m \u00e1p l\u1ef1c m\u00e1u trong \u0110MP l\u00e0m ng\u1eebng s\u1ef1 l\u01b0u th\u00f4ng m\u00e1u qua \u1ed1ng \u0111\u1ed9ng m\u1ea1ch. \u00d0\u1ed3ng th\u1eddi l\u1edbp c\u01a1 tr\u01a1n c\u1ee7a th\u00e0nh \u1ed1ng \u0111\u1ed9ng m\u1ea1ch co l\u1ea1i l\u00e0m h\u1eb9p l\u00f2ng \u1ed1ng. L\u1edbp \u00e1o trong c\u1ee7a \u1ed1ng \u0111\u1ed9ng m\u1ea1ch c\u0169ng t\u0103ng sinh \u0111\u1ec3 b\u1ecbt \u1ed1ng l\u1ea1i. S\u1ef1 b\u1ecbt \u1ed1ng v\u1ec1 m\u1eb7t gi\u1ea3i ph\u1eabu ph\u1ea3i sau 3-4 th\u00e1ng sau khi tr\u1ebb ra \u0111\u1eddi m\u1edbi ho\u00e0n th\u00e0nh, \u1ed1ng \u0111\u1ed9ng m\u1ea1ch s\u1ebd bi\u1ebfn th\u00e0nh d\u00e2y ch\u1eb1ng \u0111\u1ed9ng m\u1ea1ch.<\/p>\n
\u00d0\u1ed9ng m\u1ea1ch r\u1ed1n sau 2-3 th\u00e1ng s\u1ebd x\u01a1 ho\u00e1 bi\u1ebfn th\u00e0nh d\u00e2y treo b\u00e0ng quang. T\u0129nh m\u1ea1ch r\u1ed1n v\u00e0 \u1ed1ng Arantius s\u1ebd bi\u1ebfn th\u00e0nh th\u00e0nh d\u00e2y ch\u1eb1ng tr\u00f2n c\u1ee7a gan.<\/p>\n
S\u1ef1 kh\u00e1c bi\u1ec7t c\u01a1 b\u1ea3n gi\u1eefa tu\u1ea7n ho\u00e0n s\u01a1 sinh v\u00e0 tr\u1ebb l\u01a1n bao g\u1ed3m:<\/p>\n
\u0081 Shunt tr\u00e1i \u2013 ph\u1ea3i ho\u1eb7c ph\u1ea3i \u2013 tr\u00e1i c\u00f3 th\u1ec3 t\u1ed3n t\u1ea1i qua l\u1ed7 b\u1ea7u d\u1ee5c.<\/p>\n
\u0082 Khi c\u00f3 b\u1ec7nh tim \u2013 ph\u1ed5i, \u1ed1ng \u0111\u1ed9ng m\u1ea1ch ti\u1ebfp t\u1ee5c t\u1ed3n t\u1ea1i v\u1edbi shunt tr\u00e1i \u2013 ph\u1ea3i, ph\u1ea3i \u2013 tr\u00e1i, 2 chi\u1ec1u.<\/p>\n
\u0083 M\u1ea1ch m\u00e1u ph\u1ed5i s\u01a1 sinh co m\u1ea1nh khi thi\u1ebfu oxy, t\u0103ng th\u00f4ng kh\u00ed, toan m\u00e1u.<\/p>\n
\u0084 \u0110\u1ed9 d\u00e0y th\u00e0nh th\u1ea5t tr\u00e1i v\u00e0 ph\u1ea3i \u1edf tr\u1ebb s\u01a1 sinh t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nhau.<\/p>\n
\u0085 S\u01a1 sinh ti\u00eau th\u1ee5 oxy cao h\u01a1n li\u00ean quan \u0111\u1ebfn cung l\u01b0\u1ee3ng tim t\u0103ng.<\/p>\n
2. \u00d0\u1eb6C \u0110I\u1ec2M V\u1ec0 H\u00ccNH TH\u1ec2 SINH L\u00dd C\u1ee6A TIM V\u00c0 M\u1ea0CH M\u00c1U<\/b><\/p>\n
Tim v\u00e0 m\u1ea1ch m\u00e1u \u1edf tr\u1ebb nh\u1ecf c\u00f3 nhi\u1ec1u \u0111\u1eb7c \u0111i\u1ec3m kh\u00e1c v\u1edbi ng\u01b0\u1eddi l\u1edbn. Khi tr\u1ebb 12 tu\u1ed5i tr\u1edf \u0111i th\u00ec c\u1ea5u t\u1ea1o v\u00e0 ch\u1ee9c n\u0103ng tim m\u1ea1ch gi\u1ed1ng v\u1edbi ng\u01b0\u1eddi l\u1edbn.<\/p>\n
2.1. Tim<\/b>
\n2.1.1.\u00a0V\u1ecb tr\u00ed<\/i>:<\/p>\n
– Nh\u1eefng th\u00e1ng \u0111\u1ea7u: tim n\u1eb1m ngang do c\u01a1 ho\u00e0nh cao. Khi n\u00e0y m\u1ecfm tim \u1edf khoang li\u00ean s\u01b0\u1eddn 4 tr\u00e1i, 1-2 cm ngo\u00e0i \u0111\u01b0\u1eddng v\u00fa tr\u00e1i.
\n– 1 tu\u1ed5i: ch\u00e9o nghi\u00eang, do tr\u1ebb bi\u1ebft \u0111i. M\u1ecfm tim \u1edf khoang li\u00ean s\u01b0\u1eddn 5, 1 cm ngo\u00e0i \u0111\u01b0\u1eddng v\u00fa tr\u00e1i.
\n– 4 tu\u1ed5i: th\u1eb3ng nh\u01b0 ng\u01b0\u1eddi l\u1edbn, do l\u1ed3ng ng\u1ef1c ph\u00e1t tri\u1ec3n v\u00e0 c\u01a1 ho\u00e0nh h\u1ea1 th\u1ea5p.
\n2.1.2.\u00a0Tr\u1ecdng l\u01b0\u1ee3ng<\/i>:
\n– \u1ede tr\u1ebb s\u01a1 sinh tr\u1ecdng l\u01b0\u1ee3ng tim b\u1eb1ng 0,9% tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3, ng\u01b0\u1eddi l\u1edbn b\u1eb1ng 0,5%.
\n– Tim ph\u00e1t tri\u1ec3n nhanh trong 2 n\u0103m \u0111\u1ea7u v\u00e0 trong l\u1ee9a tu\u1ed5i d\u1eady th\u00ec, sau \u0111\u00f3 ph\u00e1t tri\u1ec3n ch\u1eadm d\u1ea7n:<\/p>\n
M\u1edbi \u0111\u1ebb : 20-25 gram.<\/p>\n
G\u1ea5p 2 l\u00fac 6 th\u00e1ng.<\/p>\n
G\u1ea5p 3 l\u00fac 1-2 tu\u1ed5i.<\/p>\n
G\u1ea5p 4 l\u00fac 5 tu\u1ed5i.<\/p>\n
G\u1ea5p 6 l\u1ea7n l\u00fac 10 tu\u1ed5i.<\/p>\n
G\u1ea5p 11 l\u1ea7n l\u00fac 16 tu\u1ed5i.
\n2.1.3.\u00a0H\u00ecnh th\u1ec3<\/i>:
\n– Tim tr\u1ebb s\u01a1 sinh h\u01a1i tr\u00f2n, sau \u0111\u00f3 ph\u00e1t tri\u1ec3n \u0111\u1ec3 b\u1ec1 d\u00e0i > b\u1ec1 ngang.
\n– Th\u00e0nh t\u00e2m th\u1ea5t ph\u1ea3i ph\u00e1t tri\u1ec3n ch\u1eadm h\u01a1n th\u1ea5t tr\u00e1i, t\u1ef7 l\u1ec7 b\u1ec1 d\u00e0y l\u1edbn nh\u1ea5t c\u1ee7a th\u00e0nh t\u00e2m th\u1ea5t tr\u00e1i\/t\u00e2m th\u1ea5t ph\u1ea3i:<\/p>\n
Tu\u1ed5i<\/p>\n
T\u1ec9 l\u1ec7<\/p>\n
Thai nhi 7 th\u00e1ng<\/p>\n
1:1<\/p>\n
S\u01a1 sinh<\/p>\n
1,4:1<\/p>\n
4 th\u00e1ng<\/p>\n
2:1<\/p>\n
15 tu\u1ed5i<\/p>\n
2,8:1<\/p>\n
2.1.4.\u00a0C\u1ea5u t\u1ea1o m\u00f4 h\u1ecdc c\u1ee7a c\u01a1 tim<\/i>:
\nC\u01a1 tim tr\u1ebb em m\u1ecfng v\u00e0 ng\u1eafn h\u01a1n \u1edf ng\u01b0\u1eddi l\u1edbn, c\u00e1c th\u1edb c\u01a1 n\u1eb1m s\u00e1t nhau, m\u00f4 li\u00ean k\u1ebft \u1edf gi\u1eefa c\u00e1c th\u1edb c\u01a1 v\u00e0 m\u00f4 \u0111\u00e0n h\u1ed3i ph\u00e1t tri\u1ec3n k\u00e9m. S\u1ee3i c\u01a1 c\u00f3 nhi\u1ec1u nh\u00e2n tr\u00f2n. Tu\u1ed5i c\u00e0ng l\u1edbn s\u1ed1 s\u1ee3i c\u01a1 tim c\u00e0ng gi\u1ea3m, tr\u00e1i l\u1ea1i s\u1ee3i c\u01a1 v\u00e0 nh\u00e2n to th\u00eam, m\u00f4 li\u00ean k\u1ebft ph\u00e1t tri\u1ec3n nhi\u1ec1u h\u01a1n, do \u0111\u00f3 c\u00e1c s\u1ee3i c\u01a1 l\u1ea1i t\u00e1ch r\u1eddi nhau ra. C\u01a1 tim tr\u1ebb em c\u00f3 nhi\u1ec1u m\u1ea1ch m\u00e1u \u0111\u1ea3m b\u1ea3o vi\u1ec7c dinh d\u01b0\u1ee1ng t\u1ed1t cho tim.
\n2.1.5.\u00a0Di\u1ec7n tim \u0111\u1ed1i v\u1edbi l\u1ed3ng ng\u1ef1c theo tu\u1ed5i<\/i>:<\/p>\n
L\u1ee9a tu\u1ed5i<\/p>\n
0-1 tu\u1ed5i<\/p>\n
2-7 tu\u1ed5i<\/p>\n
7-12 tu\u1ed5i<\/p>\n
M\u1ecfm tim<\/p>\n
1-2 cm ngo\u00e0i \u0111\u01b0\u1eddng v\u00fa tr\u00e1i, khoang li\u00ean s\u01b0\u1eddn IV<\/p>\n
1 cm ngo\u00e0i \u0111\u01b0\u1eddng v\u00fa tr\u00e1i, khoang li\u00ean s\u01b0\u1eddn V<\/p>\n
Tr\u00ean, trong \u0111\u01b0\u1eddng v\u00fa tr\u00e1i, khoang li\u00ean s\u01b0\u1eddn V<\/p>\n
Di\u1ec7n \u0111\u1ee5c tuy\u1ec7t \u0111\u1ed1i<\/p>\n
B\u1edd tr\u00ean<\/p>\n
X\u01b0\u01a1ng s\u01b0\u1eddn III<\/p>\n
Li\u00ean s\u01b0\u1eddn III<\/p>\n
X\u01b0\u01a1ng s\u01b0\u1eddn III<\/p>\n
B\u1edd tr\u00e1i<\/p>\n
Gi\u1eefa \u0111\u01b0\u1eddng v\u00fa tr\u00e1i v\u00e0 \u0111\u01b0\u1eddng c\u1ea1nh \u1ee9c<\/p>\n
B\u1edd ph\u1ea3i<\/p>\n
\u0110\u01b0\u1eddng c\u1ea1nh \u1ee9c tr\u00e1i<\/p>\n
\u0110\u01b0\u1eddng k\u00ednh ngang<\/p>\n
2-3 cm<\/p>\n
4 cm<\/p>\n
5 cm<\/p>\n
Di\u1ec7n \u0111\u1ee5c t\u01b0\u01a1ng \u0111\u1ed1i<\/p>\n
B\u1edd tr\u00ean<\/p>\n
X\u01b0\u01a1ng s\u01b0\u1eddn III<\/p>\n
Li\u00ean s\u01b0\u1eddn III<\/p>\n
X\u01b0\u01a1ng s\u01b0\u1eddn III<\/p>\n
B\u1edd tr\u00e1i<\/p>\n
1-2 cm \u0111\u01b0\u1eddng v\u00fa tr\u00e1i<\/p>\n
Tr\u00ean \u0111\u01b0\u1eddng v\u00fa tr\u00e1i, khoang li\u00ean s\u01b0\u1eddn V<\/p>\n
B\u1edd ph\u1ea3i<\/p>\n
Gi\u1eefa \u0111\u01b0\u1eddng \u1ee9c v\u00e0 c\u1ea1nh \u1ee9c ph\u1ea3i<\/p>\n
\u0110\u01b0\u1eddng c\u1ea1nh \u1ee9c ph\u1ea3i<\/p>\n
0,5-1 cm ngo\u00e0i \u0111\u01b0\u1eddng c\u1ea1nh \u1ee9c ph\u1ea3i<\/p>\n
\u0110\u01b0\u1eddng k\u00ednh ngang<\/p>\n
6-9 cm<\/p>\n
8-12 cm<\/p>\n
9-14 cm<\/p>\n
– \u1ee8ng d\u1ee5ng l\u00e2m s\u00e0ng:
\n+ Di\u1ec7n \u0111\u1ee5c tuy\u1ec7t \u0111\u1ed1i: ch\u1ecdc d\u00f2 m\u00e0ng ngo\u00e0i tim.
\n+ Di\u1ec7n \u0111\u1ee5c t\u01b0\u01a1ng \u0111\u1ed1i, X quang l\u1ed3ng ng\u1ef1c: gi\u00fap x\u00e1c \u0111\u1ecbnh tim to, b\u1ecb \u0111\u1ea9y ho\u1eb7c b\u1ecb k\u00e9o l\u1ec7ch.
\n2.1.6.\u00a0C\u00e1c v\u1ecb tr\u00ed van tim<\/i>:
\n– \u1ed4 van \u0110MC: g\u1ed3m 2 \u1ed5, \u1ed5 \u1edf gian s\u01b0\u1eddn 2 c\u1ea1nh \u1ee9c ph\u1ea3i v\u00e0 \u1ed5 gian s\u01b0\u1eddn 3 c\u1ea1nh \u1ee9c tr\u00e1i.
\n– \u1ed4 van \u0110MP : \u1edf gian s\u01b0\u1eddn 2 c\u1ea1nh \u1ee9c tr\u00e1i.
\n– \u1ed4 van 3 l\u00e1 : \u1edf ph\u1ea7n d\u01b0\u1edbi x\u01b0\u01a1ng \u1ee9c.
\n– \u1ed4 van 2 l\u00e1 : \u1edf gian s\u01b0\u1eddn 5 tr\u00e1i tr\u00ean \u0111\u01b0\u1eddng trung \u0111\u00f2n.
\n2.2. M\u1ea1ch m\u00e1u:<\/b><\/p>\n
\u1ede tr\u1ebb nh\u1ecf, k\u00edch th\u01b0\u1edbc \u0111\u1ed9ng m\u1ea1ch t\u01b0\u01a1ng \u0111\u1ed1i l\u01a1n h\u01a1n ng\u01b0\u1eddi l\u1edbn. Tr\u1ebb s\u01a1 sinh \u0111\u01b0\u1eddng k\u00ednh \u0111\u1ed9ng m\u1ea1ch b\u1eb1ng t\u0129nh m\u1ea1ch. C\u00e0ng l\u1edbn l\u00ean, t\u0129nh m\u1ea1ch c\u00e0ng ph\u00e1t tri\u1ec3n nhanh h\u01a1n \u0111\u1ed9ng m\u1ea1ch, \u1edf ng\u01b0\u1eddi l\u1edbn l\u00f2ng t\u0129nh m\u1ea1ch r\u1ed9ng g\u1ea5p 2 \u0111\u1ed9ng m\u1ea1ch.
\n– T\u1ef7 l\u1ec7 \u0111\u01b0\u1eddng k\u00ednh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \/\u0111\u1ed9ng m\u1ea1ch ph\u1ed5i thay \u0111\u1ed5i theo tu\u1ed5i.
\n+ < 10 tu\u1ed5i: \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i > \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.
\n+ 10-12 tu\u1ed5i: \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i = \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.
\n+ D\u1eady th\u00ec: \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i < \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.
\n– H\u1ec7 mao m\u1ea1ch \u1edf tr\u1ebb s\u01a1 sinh v\u00e0 tr\u1ebb nh\u1ecf: phong ph\u00fa v\u00e0 r\u1ed9ng h\u01a1n ng\u01b0\u1eddi l\u1edbn do nhu c\u1ea7u d\u01b0\u1ee1ng kh\u00ed cao, ph\u00e1t tri\u1ec3n nh\u1ea5t trong 2 n\u0103m \u0111\u1ea7u v\u00e0 tu\u1ed5i d\u1eady th\u00ec.
\n3. C\u00c1C CH\u1ec8 S\u1ed0 C\u01a0 B\u1ea2N V\u1ec0 HUY\u1ebeT \u0110\u1ed8NG<\/b>
\n3.1. Ti\u1ebfng tim:<\/b>
\n– Ti\u00eang tim \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh b\u1edfi hi\u1ec7n t\u01b0\u1ee3ng \u0111\u00f3ng c\u00e1c van. Ti\u1ebfng T1 do \u0111\u00f3ng van nh\u0129 th\u1ea5t. Ti\u1ebfng T2 do \u0111\u00f3ng van t\u1ed5 chim.<\/p>\n
– Tr\u1ebb em: ti\u1ebfng tim nghe r\u00f5 v\u00e0 ng\u1eafn h\u01a1n \u1edf ng\u01b0\u1eddi l\u1edbn.<\/p>\n
+ \u1ede m\u1ecfm tim: T1 lu\u00f4n nghe r\u00f5 h\u01a1n T2<\/p>\n
+ \u1ede \u0111\u00e1y tim t\u00f9y v\u00e0o \u0111\u1ed9 tu\u1ed5i : <1 tu\u1ed5i ti\u1ebfng T1r\u00f5 h\u01a1n ; 12 \u2013 18 th\u00e1ng T1 nghe b\u1eb1ng T2 ; >18 th\u00e1ng T2 r\u00f5 h\u01a1n T1.<\/p>\n
– S\u1ef1 thay \u0111\u1ed5i b\u1ea5t th\u01b0\u1eddng c\u1ee7a ti\u1ebfng T2 r\u1ea5t c\u00f3 gi\u00e1 tr\u1ecb trong vi\u1ec7c \u0111\u00e1nh gi\u00e1 \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i tr\u00ean l\u00e2m s\u00e0ng.
\n– Tr\u1ebb s\u01a1 sinh: do th\u1eddi k\u1ef3 t\u00e2m thu v\u00e0 t\u00e2m tr\u01b0\u01a1ng ng\u1eafn n\u00ean ti\u1ebfng tim nghe nh\u01b0 nh\u1ecbp tim thai.
\n3.2. M\u1ea1ch:<\/b>
\n– Tr\u1ebb c\u00e0ng nh\u1ecf, m\u1ea1ch c\u00e0ng nhanh, c\u00e0ng d\u1ec5 thay \u0111\u1ed5i (do k\u00edch th\u00edch, kh\u00f3c, g\u1eafng s\u1ee9c, s\u1ed1t…). V\u00ec nhu c\u1ea7u chuy\u1ec3n h\u00f3a c\u01a1 b\u1ea3n c\u1ee7a tr\u1ebb em cao h\u01a1n ng\u01b0\u1eddi l\u1edbn v\u00e0 h\u1ec7 giao c\u1ea3m ch\u01b0a tr\u01b0\u1edfng th\u00e0nh
\n– C\u1ea7n l\u1ea5y m\u1ea1ch l\u00fac ng\u1ee7, y\u00ean t\u0129nh, g\u1eafng s\u1ee9c, l\u1ea5y c\u1ea3 1 ph\u00fat.<\/p>\n
3.3. Huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch:<\/b>
\n– Huy\u1ebft \u00e1p thay \u0111\u00f4i theo l\u1ee9a tu\u1ed5i v\u00e0 li\u00ean quan \u0111\u1ebfn chi\u1ec1u cao, c\u00e2n n\u1eb7ng. Tr\u1ebb c\u00e0ng nh\u1ecf huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch c\u00e0ng th\u1ea5p.<\/p>\n
– Huy\u1ebft \u00e1p \u1edf tr\u1ebb em th\u1ea5p h\u01a1n ng\u01b0\u1eddi l\u1edbn do l\u00f2ng m\u1ea1ch \u1edf tr\u1ebb em t\u01b0\u01a1ng \u0111\u1ed1i r\u1ed9ng h\u01a1n, tr\u01b0\u01a1ng l\u1ef1c th\u00e0nh m\u1ea1ch th\u1ea5p h\u01a1n.
\n– Huy\u1ebft \u00e1p t\u1ed1i \u0111a (HAT\u00d0):
\n+ S\u01a1 sinh = 75 mmHg
\n+ 3-12 th\u00e1ng: 75-80 mmHg.
\n+ Tr\u00ean 1 tu\u1ed5i: t\u00ednh theo c\u00f4ng th\u1ee9c Molchanov: HAT\u00d0 = 80 + 2n (n = s\u1ed1 tu\u1ed5i).
\n– Huy\u1ebft \u00e1p t\u1ed1i thi\u1ec3u (HATT): HATT = HAT\u00d0\/2 + 10 – 15 mmHg.
\n3.4. Kh\u1ed1i l\u01b0\u1ee3ng tu\u1ea7n ho\u00e0n:<\/b>
\n– S\u01a1 sinh: 110-150 ml\/kg.
\n– < 1 tu\u1ed5i: 75-100 ml\/kg.
\n– > 7 tu\u1ed5i: 50-90 ml\/kg.<\/p>\n","protected":false},"excerpt":{"rendered":"
H\u00c0NH CH\u00cdNH: 1. T\u00ean m\u00f4n h\u1ecdc: Nhi c\u01a1 s\u1edf 2. T\u00ean b\u00e0i h\u1ecdc: \u0110\u1eb6C \u0110I\u1ec2M H\u1ec6 TU\u1ea6N HO\u00c0N TR\u1eba EM 3. B\u00e0i gi\u1ea3ng: L\u00fd thuy\u1ebft 4. \u0110\u1ed1i t\u01b0\u1ee3ng: Sinh vi\u00ean Y4 + CT3 5. Th\u1eddi gian: 1 ti\u1ebft 6. \u0110\u1ecba \u0111i\u1ec3m: Gi\u1ea3ng \u0111\u01b0\u01a1ng M\u1ee5c ti\u00eau: 1. N\u00eau \u0111\u01b0\u1ee3c \u0111\u1eb7c \u0111i\u1ec3m tu\u1ea7n ho\u00e0n b\u00e0o thai v\u00e0 …<\/p>\n","protected":false},"author":15,"featured_media":1014,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[68,69],"tags":[],"class_list":["post-1708","post","type-post","status-publish","format-standard","has-post-thumbnail","","category-nhi-khoa","category-nhi-1"],"_links":{"self":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/1708","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/users\/15"}],"replies":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/comments?post=1708"}],"version-history":[{"count":1,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/1708\/revisions"}],"predecessor-version":[{"id":1709,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/1708\/revisions\/1709"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media\/1014"}],"wp:attachment":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media?parent=1708"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/categories?post=1708"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/tags?post=1708"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}