Vai trò thở máy áp lực dương liên tục trong điều trị suy tim nặng cho bệnh nhân tim bẩm sinh có tăng lưu lượng máu lên phổi

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Thị Linh Đoàn, Hồng Quang Lê, Thanh Huyền Ngô, Ngọc Sáng Nguyễn, Thị Vân Anh Nguyễn, Thị Ngọc Anh Phạm

Ngôn ngữ: vie

Ký hiệu phân loại: 612.24 Human physiology

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2023

Mô tả vật lý: 188-192

Bộ sưu tập: Metadata

ID: 502442

Thêm vào giỏ

Đánh giá hiệu quả của thở máy áp lực dương liên tục đường mũi (N-CPAP) trong điều trị bệnh nhân suy tim nặng do bệnh tim bẩm sinh nhóm tăng lưu lượng máu lên phổi. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang kết hợp can thiệp (E ko rõ co nên sử dụng cái này ko: Nghiên cứu bán thực nghiệm một nhóm) được tiến hành từ tháng 08 năm 2021 đến tháng 07 năm 2022 để đánh giá tính hiệu quả của liệu pháp điều trị suy tim nằng (độ IV) sử dụng N-CPAP cho tất cả các bệnh nhân từ 2 tháng đến 16 tuổi chẩn đoán mắc tim bẩm sinh nhóm tăng lưu lượng máu lên phổi tại đơn nguyên Điều trị tích cực Tim mạch Nội khoa- Khoa Nội tim mạch - Trung tâm Tim mạch - Bệnh viện Nhi Trung ương. Kết quả: Tổng số có 42 bệnh nhân được nghiên cứu, tuổi từ 2 tháng đến 60 tháng tuổi, tuổi trung bình là 5.49 ± 4,6 tháng, cân nặng trung bình 8,32 ± 5,67 kg. Bệnh thường gặp nhất là thông liên thất (33,2%). Tỷ lệ thở N-CPAP thành công là 29 bệnh nhân (69%), thất bại là 13 bệnh nhân (31%), với thời gian nằm viện trung bình 7,26 ± 5,67 ngày với nhóm thành công và 14,2 ± 2,8 ngày với nhóm thất bại. Tỷ lệ bệnh nhân suy tim độ IV giảm từ 100% xuống 21,4 % sau điều trị bằng N-CPAP. Tần số tim trước 150,26 ± 19,50 nhịp/phút, sau 125,99 ± 17,07 nhịp/phút, nhịp thở trước là 58,84 ± 4,90 nhịp/phút, sau là 39,96 ± 4,68 nhịp/phút, chỉ số SpO2 trước là 72,93 ± 9,52%, sau là 95,20 ± 7,07 (p <
0,01). Chỉ số khí máu: pH trước là 7,25 ± 0,07 mmHg, sau là 7,38 ± 0,05 mmHg (p <
0,001). Có 2 biến chứng do thở N-CPAP là loét mũi do cố định canuyn là 16,7% và chướng bụng là 11,9%. Kết luận: Thở máy áp lực dương liên tục qua mũi giúp cải thiện mức độ suy tim nặng cho bệnh nhân mắc bệnh tim bẩm sinh nhóm tăng lưu lượng máu lên phổiTo investigate the role of N-CPAP ventilation in treating severe heart failure for children having CHD with increased pulmonary blood flow. Methods: A one-group quasi-experimental study design was employed to examine the effectiveness of N-CPAP ventilation on the treatment of severe heart failure for a convenience sample of 42 eligible children from August 2021 to July 2022. All children (ages ranging from 2 months to 16 years of age) who had a diagnosis of severe heart failure (class IV) caused by CHD with increased pulmonary blood flow received treatment-CPAP ventilation at Heart Center, the National Children's Hospital. Results: Among 42 children, ages ranged from 2 months to 16 years of age with the mean age at 5.49 months (SD = 4.6). The mean weight of these children (n=42) was 8.32 kg (SD = 5.67). Children with ventricular septal defect (n = 14) held the largest propotion with 33.2%. About 29 children (69%) had their heart failure successfully treated using N-CPAP ventilation in compared to a number of 13 children (31%) who did not recover from the administration of this treatment. The children who had successful treatment using N-CPAP ventilation had shorter mean hospital stay (M = 7.26, SD = 5.67) than those did not (M = 14.2, SD = 2.8). The percentage of children with severe heart failure after the administration of N-CPAP ventilation dramatically decreased from 100% to 21.4%. There were significant drops of heart rate (p<
.01), respiratory rate (p<
.01), oxygen saturation (p<
.01) and pH (p<
.001) in this population before and after the application of N-CPAP ventilation. Only seven children (16.7%) and about five children (11.9%) presented with mild complications of N-CPAP ventilation, including nasal pressure ulcer and abdominal distension,. Conclusions: The administration of N-CPAP ventilation may contribute to the improvement of clinical symptoms of severe heart failure among children having CHD with increased pulmonary blood flow.

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