4. Botella-Estrada R, Sanmartin O, Oliver V et al (1994). Erythroderma: a clinicopathological study of 56 cases. Arch Dermatol; 130: 1503-1507
5. Pal S, Haroon TS (1998). Erythroderma:
a clinieo-efiologic study of 90 cases, Int J Dermatol; 37: 104-107.
6. Rym BM, Mourad M, Bechir Z et al (2005). Erythroderma in adults: a report of 80 cases. Internafional Journal of Dermatology;
44 (9): 731-735.
7. Sehgal VN, Srivastava G, Sardana K (2004). Erythroderma /exfoliative dermatifis: a synopsis. Internafional Journal Dermatol; 43 (1): 39-47.
8. Thestrup-Pedersen K, Halkier- Sorensen L, Sogaard H, Zachariae H (1988).
The red man syndrome: exfoliafive dermatitis of unknown etiology: a description and follow-up.
Summary
LABORATORY CHARACTERISTICS OF IDIOPATHIC ERYTHRODERMA
The study was caried to invesfigate characteristics of laboratory indicators in idiopathic erythroderma. The results showed that, from October, 2008 to July. 2009, there were 57 patients with diagnosis of idiopathic erythroderma hospitalized in the National Hospital of Dermatology and Venereology, Hanoi, Vietnam. The common changes in laboratory indicators found were anemia (82.5%), low level of serum protein (54.4%) and albumin (21,1%), eosinophilia (35.1%). elevated erythrocyte sedimentafion rate (33.3%), high level of serum IgE (94.7%). The histopathology of idiopathic erythroderma was shown to be nonspecific dermatitis (80.7%); S. aureus was found in the skin through culture (43.9%). Seszary cells were not found in any pafient of the study. In conclusion, in idiopathic erythroderma, the changes in laboratory indicators were usually non-specific.
Key words: idiopathic erythroderma, laboratory characteristics
SUY THAT P H A I C A P DO TANG AP DONG MACH P H 6 | SAU
P H A U THUAT BENH TIM B A M SINH TAI BENH VIEN TIM H A NOI
* • • • • •
Ngg Vdn Thanh, Nguyin Vdn Mdo, Trln Mai Hiing va CS Bdnh vidn Tim Ha Np/
Nghidn cuv dwac thwc hidn nhim tim hiiu nhdng biin ddi dp Iwc ddng mpch phdi (ALDMP) vd mOt so dpc diim suy thit phdi cip do tdng dp ddng mpch phdi (TADMP) sau phiu thudt Kit qud cho thiy ALDMP giam PAPs td 79,5 ±13 cdn 44 ± 16,1mmHg (p < 0.001), PAPm tw 54,9 ± 11.8 cdn 33,1 ± 13,2mmHg (p < 0.001), PAPd tw 38,3 ±13,4 cdn 24,4 ±11,3mmHg (p < 0.001) sau phiu thudt Suy thit phdi dp do TADMP 5/27 bdnh nhdn (18,5%), tmng dd 1 bdn.i nhdn td vong sau md xwang uc (3.7%). Td dd cd thi kM lupn, suy tim phdi cip do can tdng dp ddng mpch phdi cd nguy ca tw vong cao sau phiu thudt bdnh tim bim sinh tdng dp ddng mpch phdi ndng.
Tu khoa: bfnh tim bim sinh, can tdng dp phdi nguy clp, phdu thudt tim
TAP CHf NGHllN CLPU Y HQC
I. OAT VAN D^
Tdng dp dpng mach phdi Id mft nhdm benh dac tru-ng bdi sg tdng, filn triln khdng trd mach phdi d i n tdi suy tim phai vd tu- vong sdm [4]. Ddi sdng trung binh cua ngudi bfnh k l tip liic ehln dodn TADMP khdng rd cdn nguyen (fien phat) Id 2,8 ndm [4], Bfnh fim bam sinh (TBS) gay TADMP chilm 50% cdc tru'dng hgp [7], TADMP trong TBS cd ludng thdng chii phdi gay suy fim phai, giai dogn mufn gay hfi chung Eisenmenger vdi ddc dilm Shunt dao chieu, tim vd suy fim todn bf [2]. Tren t h i gidi, cd tdi 5 -10% bfnh nhdn TBS khdng dugc can thifp, phiu thuft hodc cd can thifp, phiu thuft nhung mufn [6]. 0 Vift Nam, sd bfnh nhdn TBS tdng ALDMP nang d n phiu thudt cdn khd Idn vd nguy ca tu- vong cao sau md. Tai bfnh vien Tim Hd Nfi da cd BN suy tim phai c l p do TADMP vd tu- vong sau phiu thudt. Hilu bilt ve suy fim phai d p vd v l n d l TADMP sau phiu thudt tim khdng nhilu, vi vay nghien cuu dugc thgc hien nhdm muc tieu: theo ddi biln ddi ALDMP vd mot sd dac dilm lam sang ciia suy thit phai c l p do can tang dp dfng mach phdi sau phiu thudt.
II. D 6 I TUONG VA PHUONG PHAP
1. o d i t u g n g
Chung tdi tiln hdnh nghien cuu trdn 27 benh nhdn dugc dieu trj phiu thudt tai bfnh vifn Tim Ha Noi (tu thang 3 ndm 2009 d i n thang 8 nam 2010).
Tieu chuin Iga chpn: benh nhdn bj TBS cd kit qua thdng fim hoac sidu am (SA) ed dp Igc trung binh ddng mach phdi (PAPm) > 45mmHg.
Dat catheter dpng maeh phdi qua thanh nggc trong phiu thuat d l theo ddi ALDMP
Tieu chuin loai tru: TADMP khdng do TBS; khdng do ALDMP xam lln.
2. Phuang phdp: Ddy Id NC tiln cii-u, md ta so sdnh cfp, theo ddi doc theo thdi gian (SLP dgngSPSS.16),
3. Quy trinh, chi tieu nghien cii-u vd ddnh gid
Philu thu thfp thdng fin gdm ho tdn, tudi, gidi, dia chi, bilu hifn Idm sdng, efn Idm sdng (sidu dm, thdng fim, XQ Idng nggc, difn fim) trudc md; chin dodn; cdch th^c md, thdi gian chgy mdy, cfp dfng mgch chu, thay ddi ALDMP, ylu td khdi phdt vd dfc dilm can TADMP gdy suy fim phai d p ,
Phdn loai TADMP nfng khi PAPm > 45 mmHg, TADMP trung binh khi PAPm 35 45 mmHg vd TADMP nhe neu PAPm 25 - 35 mmHg [5, 8], Can tdng dp phdi d p (pulmonary hy- pertensive crisis) du-gc djnh nghTa Id finh trang tdng ALDMP >75% huylt dp hf thdng. Suy fim phai d p do can TADMP thudng xay ra sau phiu thuat fim giai doan hdi sue vdi dac dilm ALDMP-cao, tgt Sp02, tgt huylt dp hf thdng vd cudi ciing mach chfm, suy fim toan bo [7]. Tinh trang tang dp phdi keo ddi (persistent pulmonary hypertension) sau phiu thudt du-gc djnh nghTa la finh trang ALDMP tdm thu Idn han 50% huylt dp tam thu hf thdng va keo dai tren 6 gid sau phiu thuat [5].
Ky thudt ddt catheter dpng mach phdi trong phiu thudt: Catheter tmh mach trung tdm ddt vdo dfng mach phdi qua phlu thit phai ndi vdi he thdng do huylt dp xdm lan. Catheter thudng dugc riit sau 72 gid hodc khi khdng cdn chl djnh theo ddi ALDMP lidn tgc.
III. K^T QUA
Bfnh canh TLT Id chu y l u 21/27. trong do TLT Idn dan thuin gdp nhilu nhit (48,1%).
Tudi-gidi: Ty If nam/nu- (12/15), tudi nhd nhat la 3 thdng cao nhat Id 35 tudi.
Sieg dm vd thdng fim trudc phiu thuat: SA fim qua thdnh nggc ALDMP (±SD) tdm thu.
Vidm phdi phai nhfp vifn dilu trj trudc dd (12/27 trudng hgp).
Bdng 1. Phdn bd theo logi b f n h
STT B f n h tlm b i m sinh %
Thdng lidn thit Idn dan thuin 13 48,1%
Thdng lidn nhT (TLN) 7,4%
1
2 3 4 5
Thdng lidn nhT vd dng dfng mgch
, i Hpp eo dfng mgch chu vd dng dfng mgch hgp vdi Hd van 2 Id b i m sinh
Cdn dng dfng mgch
Thit phdi 2 dudng ra, khdng hpp phdi Thdng sdn nhT thit t h i todn phin
Cipa sd p h i chu
Thdng lidn nhT vd cdn dng dfng mach TTnh mach phdi dd ve b i t thudng kem TLN
2
3
3,7%
3,7%
7,4%
3,7%
3,7%
11,1%
3.7%
3.7%
3,7%
Tdng sd 27 100%
(PAPs) 88,3 ± 14,5mmHg, trung binh (PAPm) 54 ± 9,5 mmHg vd tdm truang (PAPd) 35,9 ± 10,7mmHg. 12/27 BN dugc thdng tim trudc phdu thuft (44,4%), PVR trung binh (±SD) 4,6 ±2,3 dan V! wood/m^ (thap nhat 1,2 cao nhit 8,9).
100 80 60 40 20
93.5 87.4
79.5 63.4 61
45.8 44 ' 4 . 3
54.9
l3J_ 38.3 )4.4
D trudc phlu thuft D sau phlu thudt
PAs PAm PAd PAPs PAPm PAPd Bilu dd 1. Thay ddi ALDMP ngay sau phdu thuat
ChO thich: PAs: huyit dp tdh) thu. PAm: huyit dp trung binh, PAd: huyit dp tdm trwang, PAPs:
ALDMP tdm thu, PAPm: ALDMP trung binh, PAPd: ALDMP tdm tnrong tinh bing mmHg.
Huylt dp tdm thu 93,5 ± 14,5 trudc, 87,4 ±17,6mmHg sau; huylt dp trung binh 63,4 ± 9,7 trudc, 61 ± 13mmHg sau vd huylt dp tdi thilu 45,8 ±11,7 trudc, 44 ± 12,7mmHg ngay sau phau thudt (p > 0,35). PAPs =79,5 ± 13 mmHg cdn 44,3 ± 16,1mmHg (p<0.001), PAPm tu 54,9 ± 11,8
TAP CHf NGHllN CLPU Y HQC mmHg cdn 33,1 ± 13,2mmHg (p < 0,001) vd PAPd tu- 38,3 ± 13,4 cdn 24,4 ± 11,3mmHg (p< 0.001).
Bang 2. B i l n ddi ALDMP trong giai dogn hdi sii'C STT B i l n ddi ALDMP sau md
Khdng cd can tdng dp 1 Khdng cdn tang dp phdi
Can tdng dp phdi d p Khdng cd can tdng d p 2 Cdn tdng ap phoi
Cd can TADMP vd suy fim phai Tong sd
n 11
1 11
4 27
% 40,7
3,7 40,7
14,8 100 Can TADMP gdy suy fim phai d p xay ra 5/27 bfnh nhdn (18,5%), 1 bfnh nhdn tu- vong sau md xuang uc (3,7%). Trong dd 4/15 bfnh nhdn cd can d p trdn n l n finh trang tdng dp phdi sau phiu thuft, chl cd 1/11 benh nhdn xult hifn can TADMP nguy c l p xay ra ngay sau ngung fim phdi may. Tinh trang tang dp phdi tdn tgi sau phiu thudt cd lien quan d i n TLT tdn lu-u 1 trudng hgp, 1 trudng hgp cdn hd van 2 Id, xep phdi vd viem phdi 11 trudng hgp vd 2 trudng hgp co PVR > 7 dan vi wood/m^
IV. BAN LUAN
Tinh trang lam sang t r u a c p h l u thuat Ty If nam/nu- (12/15) khdng cd sg khac biet trong nghien cuu nay. Theo Rich (1987):
bfnh tang dp phdi fien phat cd ty If nam/nu- Id 1/1,7 cd sg khac bift [9]. Benh nhan thudng cd finh trang viem p h i quin. viem phdi phai nhap vien dilu trj tai diln. Dilu ddc biet Id cac BN nay ed dp tudi tu 3 thdng d i n 4 tudi (12/27 trudng hgp). Bfnh fim b i m sinh cd ludng thdng chu phdi lam eho mau len phdi qua nhilu. dilu nay la y l u td thuan Igi gdy bfi nhiem viem phdi. Trong trudng hgp ndy ca t h i tg bao v f bdng cdch biln ddi d u trOc mgch phdi nhim han c h l mdu len phdi. Dilu ndy dugc Health vd Edwards md ta bing 6 giai doan biln ddi d u true maeh phdi (nam 1958) (Df I: Phi dgi Idp giti-a cua dpng mach, D f 11: Tdng sinh ldp npi mac, D f 111: Xa hod (fibrin hod) ldp ndi mac cae biln ddi nay cd
the hdi phgc. D6 IV: Gian ddng mach phdi. Dp V: Hinh thdnh huylt khdi. Dp VI: Hoai tii' Idp npi mac va ldp trung mac cdc biln ddi ndy khong hdi phgc). Giai doan tdn thuang khdng hdi phgc tuang ung tren lam sang vdi hoi chung Eisenmenger vd Itic nay luu lugng mdu len phdi bdng hoac it han luu lu-gng chu [2].
Trong nghien cuu nay Qp/Qs Id 3,6 ± 1,6 (thdp nhit 1,3 cao hhit 6,2). Luu lugng phdi vd luu lugng hf thdng thay ddi theo kich thudc ludng thdng chu phdi vd sue d n . Mft phan ca c h l TADMP thu phdt do TBS Id luu lugng mdu len phdi. Do vdy bfnh TBS c6 ludng thdng trdi phai n l u cd finh trang suy fim, suy hd hip, vidm phdi tdi diln d n dugc phau thudt cdng sdm cdng tdt [1]. Trdn T h i gidi cd 5 -10% bfnh nhdn TBS khdng dugc can thifp, phiu thudt hofc ed can thifp, phau thudt nhung mufn [6]. Tgi Vift Nam ty If ndy cao han do nhilu ly do, trong dd kinh t l cd vai trd quan trpng. Nlu chu-a cd dieu kifn can thifp.
phiu thu^t khOng nOn dung cac ch6 phim gay gian mach ph6i (nhy sildenafil, trCp Bosentan vl cO ca ch6 tac dgng khac sildenafil) do lam thay doi su-c can ph6i, thay d6i Qp/Qs, lygng mau len ph6i tang di^u nay cO th4 lam cho tinh trang bOnh trim trong ban.
Trong nghiOn CLPU nay, ty 10 kich thyO'c thit phai/ thIt trai trong thi tam tryang, tryO'c phiu thu^t la 20,7/40,1mm (52%). Mac du ALOMP rat cao tryO'c dO (PAPm > 45mmHg) nhyng thIt phai gian rit It. ThIt phli gian, hinh trang khuy^t thiy rO trOn mat c i t tryc dpc 4 bu6ng tLP mom. Ty 10 diOn tich RV/LV cO gia trj tCp 0,6-
1 cho biet thIt phai giSn nh?, gian n$ng khi ty 10 nay > 1 [3].
Thay d6i ALDMP ngay tru-d-c va sau phlu thuat
So sanh cap tryO-c/sau phiu thuat giya buyOt ap va ALDMP xam lln (bieu do 1) cho thay huyet ap he thong thay doi khOng c6 y nghTa thOng ke (T-test). ALDMP giam cO y nghTa thOng ke (p < 0.001). Theo Matthias (2010), ALDMP trung binh giam xuong cOn 27,11 ± 9,88 mmHg sau phiu thuat tim [7].
Nhu' vay phiu thuat su-a TBS la phu-ang phap diOu trj dy phOng va triet de TADMP thii- phat.
Tuy nhien, phai chap nhan bien chu-ng chung cua phiu thuat va bien chCpng riOng cua bOnh canh TADMP Trong dO can TADMP gay suy tim phai cap la mOt bien chLPng thyO'ng gay ty vong sau phiu thuat tim [7].
Mot sd d a c d i l m va y3u td kho-i phat can TA DMP gay suy tim phai d p sau phiu thuat
Tru'O'ng ho'p nghi ngo' do protamine Bang 2, bOnh nhan nam 35 tuoi, TLT lO'n.
Kit qua thOng tim PVR: 4.1 wu, Qp/Qs:
2.78/1. Do huyet ap xam lan tru'O'c va TLT la 97/68/54 mmHg, ap lye dOng mach phoi:
71/48/36 mmHg. Sau va TLT, huylt ap 1^
106/70/54 mmHg; Ap lye phoi 26/23/21 mmHg. Truyen protamine. DOt nhiOn nhjp tim tang, PAP tang d i n lOn 100/79/70 va huy^t ap tyt 66/55/45mmHg, thanh dOng mach phoi cang, thIt phli gian (ThIy du'gc cac bi^u hiOn nay vi chya dOng ngyc, m$c du ngay tryO-c do ALOMP thip). Sau dO rIt nhanh: mach cham xu6ng 40-501/p, huylt ap tgt phai chay lai tim ph6i may h6 trg 30 phut. Ve hoi SLPC: ALOMP khOng cao, khOng xult hiOn can TA phoi. Nhu- v$y can TADMP do protamin vO-i dac diem xay ra ngay sau ngu-ng tim phoi may, dang trung hOa heparin, ALOMP tang dan va cao han huylt ap gay suy thIt phai cap.
Protamine la thuoc trung hOa heparine cO the gay tang ap phoi va suy tim phai d p day la mOt trong nhyng bien chyng cua phiu thuat tim ha, theo Ocal (2005) can tang ap phoi d p do protamine chiem 1,78% cac bien chiing cua phiu thuat tim ha [8].
Tru'O'ng hap xay ra tren nOn ALDMP cao sau phlu thuat
4/5 tru'O'ng hgp (bang 2). Trong do 3 tryO'ng hgp cO PVR < 7 dv Wood, ALDMP trung binh sau phiu thuat cua 3 bOnh nhSn nay >35mmHg, 1 bOnh nhan suy thIt phai khOng h6i phye, suy da tang va cuoi cung ti) vong. V^ mat thO'i gian cO 4/5 bOnh nhan xuat hiOn can TADMP trong vOng 12 giO', cO 1 bOnh nhan sau 48 giO- ve hoi SLPC. ChCing tOi thIy ring y6u t6 kho'i phat liOn quan tO'i hut NKQ, tinh klch thieh, run sau mo. Sau khi dien ra can d i u tiOn, cac can TADMP d§ xuat hiOn ban vO'i cac kich thich (it nhlt 3 can nhieu nhlt 16 can chung tOi ghi nhan dygc). Do vay an than, giam dau du tryO'c cac hogt dOng cham sOc tich eye la phyang phap dy phong can TADMP rIt tot. Ve diOn bien lam sang, can tang ap dOng mach phoi 6- nhyng benh nhan nay la ALDMP tang cung vdi mach
TAP CHI NGHIEN CLFU Y HQC nhanh (thO'i gian rIt ngin 30 giay den 1 phut),
sau dO cham lai, Sp02 va huyet ap hO thong tut, ap lye dyO'ng tha tang cao, bOp bOng thIy nang tay. Nghe phoi thOng khi v i n d^u hai bOn va hut NKQ thIy khO ho^c rIt it dO'm. Oac diem ve hO hap va huyet dOng nay rIt giong tryO'ng hgp tran khi mang ph6i ap lye, hen phi quan, tuOt hoac t i c NKQ. Vi vay can chin doan phan biet de cO xu- tri t6i yu nhlt. Bieu hien tren cO the giai thich nhu- sau: Co thIt mach phoi gay giam dO dan hoi phoi d i n d i n can tro- thOng khi va tyO'i mau ph6i tam tang ap lye trong buOng thIt phai (bieu hiOn HoBL tang), suy thIt phai, giam tien tai thIt trai, giam cung lu-gng tim, tyt huylt ap (hypotension), thiOu mau ca tim, roi loan nhjp va cuoi cung la shock tim.
Tru'ang hap tip vong: vai bOnh canh that phai hai du'O'ng ra khOng hep phoi, sau phiu thuat can TADMP gay suy tim phai, suy tim toan bO chung tOi quylt djnh ma xu'ang LPC hO trg thIt phai, sau dO suy da tang do hoi chyng giam cung iLPang tim keo dai. Hien tu-ang dap LPng viem, thilu mau va tai tu-O-i mau sau chay tim phoi may anh hu'O'ng tO'i PVR va kha nang CO bOp cua ca tim sau phiu thuat Day la yOu to thuan Igi gay suy that phai d p o' hau hit cac tru'O'ng hgp TALDMP sau phiu thuat.
Tru'O'ng hgp de Shunt tang nhT: dy phOng a benh nhan cO PVR > 7 dan vi Wood. Trong can TADMP d p khOng thIy nhjp cham khi ap lye phoi tang len blng hoac han huyet ap h§
thing, tuy nhien Sp02 tut xuong rIt nhanh.
Dieu nay cO the do that phai du-gc xa bdt ap lye qua van 3 la va shunt tang nhT. Nhu- v$y tao shunt tang nhT khOng dy phOng can TADMP d p ma lam giam bO-t ganh nang cua thIt phai khi can dp'xay ra.
Thai dO diOu trj hoi su-c benh nhan co nguy ca xult hien can TADMP d p dO la khOng de can TADMP d p xay ra; neu TADMP thi
khOng de suy thIt phai d p xay ra. Ngoai viOc dilu tri blng cac thu6c gian mach phoi, trg tim, an thin giam dau, tho- may tang thOng khi thi XLP tri d p blng bOp bOng oxy 100% cOng v6i Op tim ngoai l6ng ngyc neu xult hiOn nhjp cham to ra rIt hiOu qua giup bOnh nhan thoat khoi suy thIt phai d p . Thai dO XLP tri la khan d p khi cO bilu hiOn suy that phai d p hoSc roi loan huyet dOng, la d p CLPU khi ap lye dOng mach ph6i cao > 75% huyet ap. Can chin doan nguyOn nhan, loai bo nguyen nhan va cac yeu t6 anh hu-O-ng, an thin giam dau, gian ca du, tha may thich hgp, dieu trj thu6c dan mach phoi, trg tim phai, nang huyet ap hO thing dam bao tu-O-i mau vanh du va de pH mau kiem 10 nhu-ng lu-u y cho cOc bac sy
h o i SLPC.
Tinh trang tang ap phOi keo dai sau phlu thuat: chu yOu do ton thu-ang phoi (viem phoi, xep phoi) va tro- lai binh thu-gng khi tinh trang phoi on djnh. CO 2 tru-O-ng hgp do PVR cao > 7 dan vi Wood/m^ tru-O-c phiu thuat.
Theo Matthias (2010): PVR tru-O-c phiu thuat
> 11 dan vi wood/m^ PAPm > 45 mmHg sau mo [7]. MOt tru'O'ng hap TLT da 6 ton lu-u phIn ca xult hien can TADMP nguy d p , sau khi thOng tim bit 10 TLT ALDMP giam xuong vO benh nhan on djnh ra vien sau dO 2 tuln. Mot tryO-ng hgp ho- van 2 10. CO 4/15 tryO-ng hgp xult hien can TADMP nguy d p . Nhy vOy, neu sau phiu thuat benh nhan cOn tinh trang TADMP phai eO chien lu-gc dy phOng suy thIt phai d p va tim can nguyen gay nOn tinh trang ton tai ALDMP cao de dieu trj triOt de.
Suy tim do phoi 10 hOu qua nang ne nhlt cua tang ap phoi va la nguyOn nhan chinh gay tu- vong 6- bOnh nhan tang ap dOng mach phoi sau phiu thuat. Do vOy, phat hien va loai trip cac yeu to gay TADMP la ca ban de tranh suy tim va ty vong cho bOnh nhan eO nguy ca sau phiu thuat tim.
V. K^T LUAN
Qua theo ddi bfnh nhdn fim b i m sinh tdng dp dfng mach phdi nfng bdng catheter dfng mach phdi sau phiu thuft tgi bfnh vifn Tim Hd Nfi chimg tdi cd mft sd nhfn xdt sau:
Suy fim phdi c l p do can TADMP cd nguy ca tii- vong cao xdy ra sau phiu thuft bfnh fim bim sinh tdng dp dfng mach phdi nfng.
Can TADMP c l p sau phiu thuft cd nguyun nhdn rd, thudng trong vdng 48 gid v l hdi sue.
Suy thit phdi do can tdng dp dfng mgch phdi sau phdu thuf't cd diln biln Idm sdng dfc trung gdm ALDMP tdng cao, Sp02 tgt, dp Igc dudng thd cao, tgt huylt dp hf thdng cudi cung Id mgch chfm vd shock fim. Thdi df dilu tri la khdng dk can TA DMP c l p xay ra, nlu cd TADMP thi khdng d l suy that phai d p .
TAI LIEU THAM
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Respiratory Medicine, xx : 1-13.
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Summary
ACUTE RIGHT VETRICULAR FAILURE DUE TO PULMONARY HYPERTENSION CRISIS AFTER SURGERY OF CONGENITAL HEART
DISEASES IN HANOI HEART HOSPITAL
The aims of this study was monitor the changes of pulmonary artery pressure, and clinical of acute right ventricular failure due to pulmonary hypertension crisis after cardiac surgery. The results showed that, all patients had a positive response, results in a mean (± SD) decrease of PAPs from 79.5 ± 13 to 44 ± 16.1 mmHg (p < 0.001), PAPm from 54.9 ± 11.8 to 33.1 ± 13.2 mmHg
TAP CHf NGHllN CLPU Y HQC (p < 0.001), PAPd from 38.3 ±13.4 to 24.4 ± 11.3mmHg (p < 0.001). 5/27 patients had been to acute right ventricula failure due to pulmonary hypertension crisis (18.5%), 1 pafient had died after opened sternum (3.7%). In conclusion, acute right ventricular failure due to pulmonary hypertension crisis may be caused death postoperative
Key words: congenital heart disease, pulmonary hypertension crisis, cardiac surgery
K^T QUA DI^U TRI TI^N S A N G I A T D 6 I V Q I SU'C K H 6 E
• •
CUA TRE s a SINH TAI BENH VIEN PHU S A N TRUNG LPQNG
Le Thifn Thai Bdnh vi$n Phu san Trung wang Nghidn cdu nhdm ddnh gid kit qua diiu th tien sdn gidt cua cdc bd mp ddi vdi sue khod sa sinh. Kit qua nghien cuv cho thiy, chiiu ddi ca thi la binh thwdng la 48,4 ± 3,05 em, vdng dau Id 32.0 ± 2.98 em, vdng ngwc Id 33,7 ± 2,73 cm. ty Id de non dwdi 37 tuin tuoi chiim 51,7%. ty lp tre sinh ra bj suy dinh dwdng chiim 49,3%. Ty Id tre sa sinh mie vidm phdi 2%. Ty lp thai chit luv la 3,5%. Kit qua dieu trj tien sin gipt la rit kha quan ddi vdi sdc khoe cua trd sa sinh ve ehi sd apgar, chiiu dai thai, vdng dau va vdng ngwc cung nhw eac chl sd vi bdnh tpt cung nhw tw vong.
Tu khoa: tiln san gift, si>c khoe sa sinh
I. DAT
V A N D ^Tiln san gift Id finh trang phu nu mang thai cd cdc trifu chung phii, tdng huyet dp vd protein nifu. Tiln san gift khdng chi cd tdc hai d i n sue khoe me md cdn tdc hai d i n sgc khoe tre sa sinh n l u khdng dugc dilu trj dung phdc dd. Cdc nghidn cuu tren t h i gidi cho thiy ring ode rdi logn tdng huylt dp trong filn san gift d i n d i n suy tuin hodn tip cung rau vd hdu qua la thilu oxy d i n tdi thai cd t h i chdm phdt triln trong tu- cung hodc chit luu, chit chu sinh [2. 4]. Nhilu trudng hgp thai suy mdn trong tir cung phai dlnh chi thai nghdn, cung nhu nhu-ng trudng hgp de non do biln Chung ciia tiln san gift nang, do dd Idm cho ty If de non r i t eao 30 - 40% [4].
Mac dil dd cd nhu-ng tiln bf ddng k l trong vide nudi dudng tre sa sinh non thdng, nhung nhu-ng dii-a tre sinh ra qua non vd cdn nang
thap cd t h i cd cham phat trien t h i Igc vd tri tuf. Tai Vift Nam chua cd nhilu cdng trinh nghien cuu ve hifu qua cua phac dd dieu trj tien san gift ddi vdi sue khoe vd bfnh tft cua con. Do vdy, d l tai nay dugc thgc hifn nhdm muc tieu ddnh gid kit qua dilu trj filn san gift ddi vdi sue khoe sa sinh.
II. D 6 | TUONG VA PHUONG PHAP
1. Ddi tugng
Cdc thai phg sinh con vdi chin dodn filn san gift, cd mft trong cdc trifu chung sau:
tdng huylt dp (tdm thu tu 140mmHg trd ldn vd tdm truang tu- 90mmHg trd ldn), phCi d cdc muc df khde nhau, protein nifu d cdc muc d f khde nhau. Loai trg cac thai phg cd fien su- mic bfnh fim, thfn, tdng huylt dp, filu dudng, bfnh gan vd Basedow.
2. Phuang phap