Y HOC VI ET NAM SO DAC BIET — THANG 11 /2010 CO thdi gian gay me, phlu thuat, thdi gian
n5m hoi siic keo dai ciing nhu dung lgi tilu tnrdc, trong va sau md cdn dugc theo doi ning do Mg chat che va dilu tri thich hgp mot khi CO ha Mg mau.
TAI LIEU THAM KHAO
1. Chernow B, Bamberger S, Stoiko M, Vadnais M, Mills S, Hoellerich V, Warsha-w AL. Hypomagnesemia in patients in postoperative intensive care. Chest.
1989;95:391-7.
2. Deshmukh CT, Rane SA, Gurav MN.
Hypomagnesaemia in paediatric population in an intensive care unit. J Postgrad Med.
2000;46:179.
3. Fawcett WJ, Haxhy EJ and Male DA.
Magnesium: physiology and pharmacology.
BrJ Anaesth 1999;83:302-20.
4. Martin KJ, Gonzalez EA and Slatopolsky E. Clinical Consequences and Management of Hypomagnesemia. J Am Soc Nephrol.
2008;19:1-5.
5. Mencia S, de Lucas N, Lopez - Herce J, Munoz R, Carrillo A, Garrido G.
Magnesium metabolism after cardiac surgery in children. Pediatric Critical Care Medicine.
2002;3:158-62.
6. Saleem AF and Haque A. On admission hypomagnesemia in critically ill children:
Risk factors and outcome. Indian Journal of Pediatrics. 2009;76:1227-1230.
7. Whang R. Magnesium deficiency:
pathogenesis, prevalence, and clinical implications. Am J Med. 1987;82:24-9.
KET QUA BUOC OAU OAT
TINHMACH CANH TRONG 6 TRE EM DU6l sa HUbNG DAN CUA SIEU AM TAI TRUNG TAM TIM MACH HUE
Biii Diic Phii, Huynh Van Minh, Nguyen Tat Dung, Dang The Uyen, Vo Dai Quyen, Pham Dang Chinh, Le Quang Thihi (*)
TOM TAT
Cd sd: Muc tieu ciia nghien ciTu nay nham ghi nhan ket qua ciia viec dat catheter vao tinh mach canh trong d tre em vdi sU hUdng dan cua sieu am va vdi phUdng phap co dien hudng dan hu'dng choc tinh mach canh trong nhd cac mdc ben ngoai.
Phu'dng phap nghien cu'u: Nghien ciru cat ngang tien hanh tren 104 tre em md tim dUdc dat tinh mach canh trong dUdi sU hudng din ciia sieu am, n= 50 (nhdm 1) va tien hanh
(*) Benh vien Trung uang Hue
thii thuat nhd vao cac diem mdc ben ngoai, n=
54 (nhdm 2).
Ket qua: Ty le thanh cdng chung la 98%
ddi vdi nhdm 1 cd dimg sieu am hUdng dan, d nhom 2 la 89% (p<0,05). Chpc kim dUdc vao trong long mach trong lan dau tien la 95% d nhdm 1 va 38,9% d nhdm 2, (p<0,001). Tong thdi gian chpc vao dung long mach la 10,4± 5,2 giay d nhdm cd hUdng dan sieu am va 125,5+
100,3 giay d nhdm diing mdc giai phau ben ngoai, (p<0,001). Ty le chpc nham dpng mach va khdi mau tu d nhdm cd diing sieu am deu la
CHUYEN DE: PHAU THUAT TIM MACH VA LONG NGUC VIET NAM 2% so vdi 9% va 12,7% d nhdm 2, (p<0,01).
Ket luan: DUdi sU hUdng dan ciia sieu am, thdi gian dat catheter tmh mach canh trong da dUdc cai thien, tang ty le thanh cong va giam nguy cd bi bien chu'ng. Chiing toi khuyen cao dung sieu am de hUdng dan viec dat catheter tTnh mach canh trong cho tre em.
SUMMARY
INITIAL RESULTS OF ULTRASOUND- ASSISTED CANNULATION OF THE INTERNAL JUGULAR VEIN IN CHILDREN AT
HUE CARDIOVASCULAR CENTRE
Background: Central venous access remains an essential component in most cardiac practices and is usually achieved with a blinded, external landmark- guided technique. The purpose of this study is to evaluate whether an ultrasound technique can improve the traditional method.
Methods: A cross- study evaluated an ultrasound- guided method in 50 pediatric cardiac patients undergoing internal jugular venous cannulation and compared the results with 54 patients in whom an external landmark- guided technique was used
Results: Cannulation of the internal jugular vein was achieved in 98% of patients using ultrasound (group 1) and 89% using the landmark- guided technique(group 2) (p<0,05).
The vein was entered on the first attemp in 94%
of patients in group 1 and 38,9% in group 2 (p<0,001). Access time was 10,4±5,2 seconds by the ultrasound approach and 125,5±100,3 seconds by the landmark approach (p<0,001).
Using ultrasound, puncture of the carotid artery and hematoma both occurred in 2% of patients, meanwhile the rate of the complications in external landmark group was 9,2% and 12,7%
respectively (p<0,01).
Conclusions: Ultrasound guidance for access of the internal jugular vein significant
minimizes procedure time, reduces complications and provides a very high success rate. These results suggest that this technique may be preferred in children.
I. OAT VAN OE
Dat catheter vao tinh mach trung tam la mgt chi dinh bat buoc de theo doi huySt dong benh nhan trong cac cuoc phdu thuat ldn va khi dieu tri cac benh nhan nang tai phong h6i siic tang cudng. Co nhieu phucmg phap va vi tri de dat catheter vao tmh mach trung tam.
TTnh mach canh trong la mgt trong nhimg con dudng dugc chgn nhieu nhat trong h6i sue benh nhan, dac biet trong phau thuat tim mach. Bien chimg chii yeu la chgc nhdm vao dgng mach canh, khoi mau tu tai co va trung that, ton thuong dam roi than kinh canh tay va tran khi mang phoi. C) tre em cang de xay ra bien chiing nhieu hon. Hien nay, d Vi?t nam, de dat dugc catheter vao trong long tinh mach canh trong ngudi ta van con diing cac moc giai phau ben ngoai de xac djnh vj tri tinh mach khi chgc. Ty le thanh cong tiiy thuoc vao kha nang va kinh nghiem ciia thu thuat vien. Tuy nhien, cd nhieu trudng hgp kho xac dinh vi tri chinh xac ciia tinh mach canh trong nen ty le that bai ciing con kha cao va ddi hoi phai chgc nhieu lan mdi dat dugc catheter vao dimg trong long tinh mach, nhat la doi voi tre em.
Vao nam 1984, ISn dau tien ngudi ta sir dung sieu am de dat catheter vao tinh mach canh trong va hien nay da dugc nhieu b?nh vien tren the giod chap nhan nhu mgt ky thuat thudng quy de dat catheter vao tinh mach canh trong. Ci Viet Nam, ky thuat nay van chua dugc img dung rgng rai. Tai Trung tam Tim mach - Benh vien Trung uong Hue, ky thuat nay da diing lan dau tien vao nam 2006 va den dau nam 2008 mdi bat dau duac sir
Y HOC VIET NAM SO DAC BIET-THANG 11/2010
dung ngay moi nhiSu hon dl dat catheter vao tinh mach canh trong. , <,>
Chiing toi tien hanh nghien cuu nay nh5m muc deu:
• Danh gia thdi gian tiSn hanh thii thuat, ty le thanh cong cua phuong phap nay
• So sanh ty le bien chung cua phuong phap nay vod phuang phap dat tinh mach canh trong dua vao cac moc giai phlu ben ngoai.
II. OOI JlSONG VA PHUaNG PHAP NGHIEN CU'U
2.L Doi tuong nghien cihi:
104 benh nhi dugc phau thuat tim dugc dat catheter vao tinh mach canh trong tai phong md, chia thanh 2 nhdm
Nhdm 1: 50 benh nhan dugc dat catheter tinh mach canh trong dudi su hudng dan ciia sieu am 2 chieu
Nhdm 2: 54 benh nhan dugc dat catheter tinh mach canh theo phuong phap co diln dua tren cac moc giai phau ben ngoai
Tieu ehudn chon benh: Benh nhi dugc mo tim hd va kin tai phong mo tim- Benh vien Trung uong Hue
Tieu ehudn loai trie: Nhirng benh nhan chong chi dinh dat catheter tMi mach canh trong
2.2. Phucmg phap nghien cu'u
2.2.1. Thiet ke nghien citu Day la mgt nghien cim thuc nghiem lam sang, cat ngang.
B?nh nhi dugc dat catheter tinh mach canh trong sau khi khdi me. Danh gia thdi gian dat catheter, ghi nhan ty le thanh cong chung, ty Ie dua dugc kim vao tinh mach trong lan choc dau tien, so lan chgc den khi dat dugc catheter vao long mach va cac bien chiing lien quan nhu chgc nham vao dgng mach va khoi mau tu.
2.2.2. Tiin hdnh dat catheter tinh maeh cdnh trong dua theo moe gidi phdu ben ngodi (Theo ky thuat Boulanger)
Diem chgc da d vi tri bd trong ca iic ddn chdm, d vi tri tren cao cua bd tren cua sun giap nhan.
- Kim chgc hudng nghieng xudng dudi va d phia ngoai theo mgt goc khoang 50° so vdi bd trong co lie don chiim, hudng kim thang den diem ndi 1/3 giua va trong ciia xuong don. Chgc kim vao sau tilp tuyen di sat mat sau ciia co.
- O vi tri nay, bom tiem thudng cham vao xuong ham dudi, vi vay dSu benh nhan can nghieng ve phia doi dien va ngira nhilu de kim tien len dugc de dang hon, tinh mach nam tuong ddi nong; cin phai kilm tra kim khong cd di trong be day cua co.
- Tinh mach dugc chgc sau mgt khoang dudng tir 2 cm den 3 cm, can phai khep gdc kim vdi bd trong cua co iic don chiim, bang each di sat trong true cua tinh mach canh trong va dam bao mgt vi tri tot cua kim trong mach mau.
2.2.3. Tiin hdnh dat catheter tinh mgch ednh trong dudi su hudng ddn eua sieu dm
May sieu am xach tay de dat kim vao long mach Dymax Corp. Site Rite II voi d§u do 7,5 MHz va 9 MHz. Cho gel sieu am len tren dau do roi dat vao bao bang nylon. Dau do gan vao may sieu am hai chieu. May nay diing pin sac nang khoang 6 pound, vdi man hinh 2 x 2 inch. Chinh giiia dau do co mgt phan ldi len. Bgc dau do bang bao nylon nhu vay se rat tien lgi vi khong can phai tiet trimg dau do va co the dimg ngay cho benh nhan tiep theo. Benh nhan nam ngira, dau nghieng sang ben doi dien. Sat triing va trai khan vo khuan. Dat dau dd ngay tren ranh giira bd ddn va bd lie cua co iic don chiim. Do la vi tri de thay dgng mach canh va tTnh mach canh trong tren sieu am. Dat dau do tren mat da sao cho hinh anh tinh mach canh trong nam chinh giira man hinh sieu am. Chgn kim
s6 20G va 22G cho tre em. Chgc kim qua da ngay vi tri chinh giiia phan ldi cua dau do.
C6 thi thiy kim lam tinh mach xep lai trude khi tiln vao trong long mach. Liic nay hiit thir se thiy mau xuat hien trong bom tiem.
2.3. Thu thap d u lieu: Thdi gian chgc dugc la thdi gian ke tir khi kim dam vao da din khi hiit ra co mau tmh mach. Khi chgc di chgc lai nhilu lin thi tinh thdi gian ke tir lan kim dam vao da lan dau tien. Tinh nhu vay mdi CO su so sanh khach quan giiia hai ky thuat. N I U tinh toan bg thdi gian thuc hien thii thuat thi c6 thi bi lam lan do nhieu yeu to anh hudng chang ban thdi gian chuan bi thu
thuat. Thdi gian chuan bi cho ca hai phuong phap gan bing nhau, mat thdi gian de boc dau dd sieu am bang bao vd khuan bii lai boi su dinh vi tinh mach nhanh hem so vdi kj thuat dua tren moc giai phau ben ngoai. Thai gian dugc tinh bang giay nhd ngudi phu gay me bam gid. Ghi lai so lan chgc de den khi dat dau kim vao dugc tinh mach canh trong, dong thdi ghi nhan cac bien chiing cua ky thuat chgc nay (chgc nham vao dgng mach, khoi mau tu).
2.4. Xir ly so lieu: Bang phan mem Microsoft Excel vdi Student t- test de so sanh su khac biet giiia hai nhdm.
III. KET QUA
Bang 1: Dac diem benh nhan
Nam/ NiT Tudi
Trong lUdng (kg) Chieu cao (cm) Loai benh Mo tim hd Md tim kin
Nhom 1 (n=50) 24/26 4,5 ± 3,8 10,6+ 6,8 87,5 + 32,2
41 9
Nhom 2 (n=54) 26/28 4,9 + 3,6 10, 4± 5,4 88,3 ±31,2
45 9
P
>0,05
>0,05
>0,05
>0,05
Bang 2: Ty le thanh cdng chung
Ty le thanh cong
Nhom l ( n = 5 0 ) 49 (98%)
Nhom 2(n=54) 48 (89%)
P
<0,05
Bang 3: So lan chgc va thanh conj
Sd lan choc Thanh cong lan 1 Thanh cong lan 2
Nhom l(n=50) 1,2±0,8 47 (94%)
1 (2%)
I trong lan chgc dau va cac lan sau Nhom 2 (n=54)
3,4±2,5 21 (38,9%)
32,2%
P
<0,05
<0,001
<0,001 Bang 4: Thdi gian chgc dugc vao long mach
Thdi gian choc kim (giay)
Nhdm 1 10,4± 5,2
Nhom 2 125,5± 100,3
D
<0,01
Y HOC VIET NAM SO DAC BIET-THANG 11/2010
Bang 5: Cac bien chiing
Cac bien chii'ng Choc vao dpnq mach Khdi mau tu
Nhom 1 fn=50) 1 (2%) 1 (2%)
Nhom 2 (n=54) 5 (9,2%) 7(12,7%)
P
<0,01
<0,001
IV. BAN LUAN
Khong cd su khac biet giiia tuoi, gidi, chieu cao, can nang, miic do nang cua benh, cac loai benh. (p>0,05)
Vdi ket qua ban diu thuc hien tren 104 benh nhi trong mo tim da chiing minh hieu qua ro ret ciia ky thuat dat tinh mach canh trong dudi su hudng dan cua sieu am.
Nhieu tac gia da thong ke ve ty le thanh cong, bien chiing, so lan chgc, ciing nhu thoi gian chgc tinh mach theo ky thuat dua tren moc giai phau ben ngoai. Trong nghien cim ciia chiing toi, viec sir dung sieu am de hudng dan chgc kim vao long tinh mach da giam dang ke thdi gian tien hanh thii thuat 10,4± 5,2 giay so vdi 125,5± 100,3 giay (p
<0,01). Day la mgt lgi ich ro rang cua phuang phap diing sieu am de hudng dan dat catheter tmh mach canh trong vi viec nit ngdn thdi gian thu thuat se lam giam rd ty le nhiem trung.
Trong nghien cuu tren 100 benh nhan, Daily va CS da ghi nhan ty le that bai ciia dat tinh mach canh trong ben phai la 9%. Trong 9 benh nhan nay cd mgt ngudi that bai khi dat tinh mach canh trong ben trai. Cac tac gia da bao cao them la "thinh thoang" cd chgc nham dgng mach va gay mau tu den tan trung that trong 1 trudng hgp (1%). Trong mgt so lugng ldn din 1125 benh nhan, Schwartz va cong su ghi nhan den 95,3% trudng hgp thanh cong trong dat tTnh mach canh trong, va cd 4,5% trudng hgp chgc nham dgng mach canh. Cd din 5 trucmg hgp tac gia da dua 6ng thong cimg nong mach mau cd 8F nhim vao dgng mach canh. Trong nghien
ciiu d 1000 benh nhan. Goldfarb va Lebrec da bao cao thanh cong den 99,3%, nhung cd 4,3%) trudng hgp thanh cong khi dat tinh mach canh trong ben trai khi dat ben phai that bai. Ty le dat thanh cong cao din nhu vay do chgc nhieu lan mdi dat dugc vao trong tinh mach canh trong, chi cd 57,3%) thanh cong trong lan chgc dau va thii hai (43,3%) cho lan chgc dau va 14%) cho lin chgc thii hai). Ty le chgc nham vao dgng mach canh la 7,4%o, bi khoi mau tu la Wo, tran mau mang phdi va hgi chimg Homer la 0,2%, khd nudt la 1 %. Trong nghien ciiu cua chiing toi 54 benh nhan dugc dat tinh mach canh trong dua vao cac moc giai phau ben ngoai vdi ky thuat Boulanger. Dudi su hudng dan ciia sieu am, ty le chgc thanh cong rat cao den 98% vai 2 lan chgc (lan 1: 95%, lan hai 2%). Nhiing nghien ciiu khac cho thay ty le that bai la 7- 19,4 %, tiiy theo kinh nghiem cua thii thuat vien. Ty le that bai den 11 % da dugc ghi nhan vdi nhdm dimg moc giai phau ben ngoai de djnh vi tinh mach canh trong trong nghien ciiu cua chiing toi. Sznajder va cong su bao cao ty le bien chiing thay doi tiiy kinh nghiem ngudi chgc: chgc nham dgng mach 6,7- 3,3%); tran khi mang phoi 1,7- 0,8%; khdi mau tu 2,6- 1,1%. Ty le chgc nham dgng mach trong nghien ciiu cua chiing toi la 9,2% d nhom dung moc giai phau ben ngoai gan bang nhieu nghien cim khac. Cd mgt so nghien ciiu ghi nhan ty le chgc nham dgng mach canh thap hon nghien ciiu cua chiing toi. Bdi vi trong nhimg nghien ciiu nay, ngudi ta dimg kim tiem nho de tham do vi tri tinh mach canh trong truoe khi dat
catheter cd lon vao. Dimg sieu am hudng dan chgc lam ty le chgc nham vao dgng mach giam rit thip (2%). Nhd cd sieu am hudng din nhu vay nen ciing da lam giam ty le bien chiing khac xuong rat thap do cd the nhan ro vi tri cua dgng mach canh va tinh mach canh trong. Khong cd trudng hgp nao dua nham day thep va ong luon vao dgng mach canh.
C6 mgt so trudng hgp chgc nham vao dgng mach canh, chiing toi nhan thay co su thay ddi vi tri tuong quan giiia dgng mach va tinh mach canh rat ro: dgng mach nam len tren tTnh mach chii khong chay ben canh nhu thudng le. Vi tTnh mach canh trong bi ep xep xuong khi ta vira mdi chgc kim qua da nen khi day kim vao tiep da lam ton thuong thanh dgng mach canh. Riit kinh nghiem tir nhiing trudng hgp nay, chung tdi chgc vao tTnh mach tir phia ben de tranh chgc vao dgng mach canh. Cac ton thuong dam roi than kinh canh tay (dau lan tda xuong canh tay trong khi thao tac) chua dugc danh gia trong nghien cim nay. Cac khdi mau tu nho xay ra trong ca hai nhom benh nhan nhung it ban nhieu d nhdm diing sieu am (2% so voi 12,7%, p<0,001). Trong toan bg nghien ciiu ciia chiing toi tren 104 trudng hgp khong cd bien chiing tran khi mang phdi vi vi tri chgc kim rat cao va khong sir dung kim dai.
O nhieu trung tam tim mach, viec sir dung sieu am de dinh vj va de dat tTnh mach canh trong va tTnh mach dudi ddn da trd thanh thudng quy. Sieu am giiip danh gia vj tri lien quan giira dgng mach canh va tTnh mach canh trong, nhan ra ca dam rdi thin kinh canh tay nen da lam giam biln chimg va tai bien. Tuy nhien, trong mgt s6 cac nghien ciiu nay ngudi ta bao cao it vl kinh nghiem chgc va khong bao cao du vl tin suit thit bai va bien chiing. Mgt nghien ciiu gin day so sanh viec sir dung sieu am vdi dimg cac mdc
giai phau ben ngoai de chgc tinh mach canh trong tren 27 benh nhan nang tai phong h6i siic tang cudng. Mac dii chi vdi mgt s6 lugng it benh nhan ciing da td ro uu viet cua sieu am so vdi phuong phap djnh vj nhd cac m6c giai phiu co dien. Mgt thuan lgi khac cua img dung sieu am cho viec chgc tTnh mach canh trong la c6 the van chuyen va su dung de dang. Malloy va cong su da bao cao \q\
ich cua dimg sieu am de hudng dan dat tTnh mach canh trong cho cac benh nhan nang va benh nhan nguy co cao: dimg cac rale giai phau ben ngoai thi cd den 24,8% s6 benh nhan can hon 2 lan chgc de vao dugc tinh mach so vdi ty le 7,3%) d nhom diing sieu am. Dii chi mdi iing dung tren 104 benh nhan cua nghien ciiu nay, chiing toi nhan thiy ro rang lgi ich thiet thuc cua viec dimg sieu am de hudng dan dat tTnh mach canh trong.
V. KET LUAN
Tdm lai, dudi sir huong dan cua sieu am, thdi gian dat catheter tTnh mach canh trong da giam dang ke, tang ty le thanh cong va giam nguy co bj bien chimg. Chung toi khuyen cao diing sieu am de huang dan vi?c dat catheter tTnh mach canh trong de theo doi trong mo tim tre em.
TAI LIEU THAM KHAO
1. Daily PO, Griepp RB, Shumway NE:
Percutaneous internal jugular vein cannulation. Am J Surg 1970; 101: 534-536.
2. Goldfarh G, Lehrec D: Percutaneous cannulation of the internal jugular vein in patients with coagulopathies: An experience based on 1,000 attempts. Anesthesiology 1982;56:321-323.
3. Hayashi H, Amano M. Does ultrasound imaging before puncture facilitate internal jugular vein cannulation? Prospective
randomized comparison with landmark-
Y HOC VIET NAM SO DAC BIET-THANG 11/2010
guided puncture in ventilated patients. J Cardiothorac Vase Anesth. 2002 Oct; 16(5):
572-5. 6.
Malloy DL, McGee WT, Shawker TH, Brenner M, Bailey KR, Evans RG, Parker MM, Farmer JC, Parillo JE: Ultrasound guidance improves the success rate of internal jugular vein cannulation: sticks for successful cannulation A prospective, 7.
randomized trial. Chest 1990;98:157-160.
Pirotte T. Ultrasound-guided vascular access in adults and children: beyond the internal
jugular vein puncture. Acta Anaesthesiol Belg.2008;59(3): 157-66.
Schwartz AJ, Jobes DR, Greenhow DE, Stephenson LW, Carotid artery puncture with internal jugular cannulation using the Seldinger technique: Incidence, recognition, treatment and prevention. Anesthesiology
;979; 51: s 160.
Sznajder HI, Zveibil FR, Bitterman H, Weiner P, Busztein S: Central vein catheter- ization: Failure and complication rates by three percutaneous approaches. Arch Intern Med 1986;146:259-261.
KHAO SAT TINH TRANG TIEU SOI HUYET O BENH NHAN TIM BAM SINH MO TIM HO TAI BENH VIEN TRUNG UONG HUE ^
Dong ST Sang, Biii Dure Phu, Nguyin Duy Thang, Nguyin Ngoc Minh, Doan Dure Hodng, Ddng The Uyen, Duong Dang Hoa, Nguyin Tat Dung, Tran Hoai An, Le Quang Thiiru, Nguyin Thj Bach Yen (*)
TOMTAT
Dat van de. Mo tim hd dUdi tuan hoan ngoai cd the (THNCT) gay ra nhieu bat thudng cam mau dan den hau qua chay mau qua mirc sau mo.
MLJC tieu: Khao sat tinh trang tieu sdi huyet tru'dc - sau THNCT va chay mau sau mo.
Phu'dng phap: Nghien ciTu d 60 benh nhan tim bam sinh (TBS) gom 30 cd tim, 30 khdng tim va 30 ngUdi chiTng khoe manh. Cac xet nghiem dem te bao mau va tieu sdi huyet dUdc tien hanh 1 ngay trUdc md, 15 phut sau khi trung hoa heparin, 2 gid va 6 gid sau md d phong hdi siTc tim. Dan lUu dng ngUc trung that (DLONTT) du'dc do trong vong 6 gid dau hau phau.
Ketqua:Trifdc md, nhdm Fallot khac biet cd y nghia ve hong cau, Hb, Het, D-Dlmers, FDPs, von Kaulla so vdi nhdm TBS khdng tim va nhdm chiTng. Khdng cd sU khac biet ve fibrinogen trUdc md d ca 3 nhdm. Hau het cac chi sd huyet hoc giam cd y nghla va cac do dac tieu sdi huyet tiep tuc keo dai 6 gid sau md d ca hai nhdm TBS (p<0,05). Mau DLNTT khac biet cd y nghTa d hai nhdm TBS (p<0,01).
Ket luan: Nhom Fallot bieu hien tieu sdi huyet nhe trUdc md va tieu sdi huyet manh keo dai sau md cd the gdp phan vao bien chiTng chay mau qua miTc sau md.
Td khda: Tieu sdi huyet, tim bam sinh, md tim hd, chay mau qua miTc sau md.
(*) Trung tdm lim mgch - TT Huyet hQC truyin mdu - BV Trung vang Hui
