4.2.3. Kh6 tho xay ra c1¢tng¢t, d[l d¢; "';,

Tuy thea mire d9 nang hoac nhe rna can kho thd bi~u hien cua can hen
tim hoac phil ph6i cap.
'.

- Ho ra mau la bi~u
hien ph6i bi u mau
trong
benh tim:~
~
-~. .
,

.

- Ho ra m au khi giing sue, lucng mau it d~ nh arn vdi kh ai huyet trong
lao phoi.
.

,,

- Ho ra mau gap trong benh hep tim 2 la (hep hai la -7 ho r~ mau).
- Xung huyet ph6i -7 ho khac ra mau .
- Nh5i mau ph6i -7 ho + khac ra mau.

.'

4.4. Xanh tim
- Xanh tim la dau hieu phan anh tinh trang thieu oxy, lam cho da va
niern mac xanh tim.

.
Liic d~u xanh tim khu tru d rnoi, cac d~u chi.
- Khi suy tim nang xanh tim bi§u hien d mat va toanthan,
4.5. Danh tr6'ng ngl:/'c
Danh trong nguc la cam thay trdng nguc ,d~p ron rang. Do la tieng
d~p cua tim d6n d~p, tim d~p m~nh rna d ngudi binh thudng chi khi cam
d9ng, h6i h9P ho?c giing suc nhi€u mQi co
Tri~u chung nay c6 th~ giftptrong b~nh: thieu mau, cudng tuyen giap tr?ng.
4.6. Dau vting trU'Gctim
- Dau vung truoc tim la cam giac dau nh6i d vung truoc tim voi muc d9
khac nhau.
- Dau xay' r~ d9t ng9t, c6 cam giac d ngl,tc va nhu bi de ngh~t sau
xliong uc, ngudi b~nh hoang s<;lcam thuy nhu minh siip chet.
- D6 la can dau thiit ngl,tc hoiftc can dau tim, tfnh chat dau am 1 ho?c
dau tung can. Dau Ian len c6 hoiftc dau xliong vai canh tay trai, can
dau keo dai vai phut den hang gid.
- Nguyen nhan: g?P trong b~nh:
+ Co thiit d9ng m~ch vanh.
+ Nh5i mau cd tim.
+ Viem mang ngoai tim.

99


4.7. Ngat

- N gat 13.tinh trang mat tri gi ac, mat cam giac trong thci gian ngan
1-2 phut, lam giarn heat dong twin hoan h6 hap trong mot thoi gian
nh at dinh,
Ngat xay ra d9t ng9t, truce khi ngat benh nhan thay hoa mat chong

m at, toat m6 hoi, tim dap nhanh, riga xuong hoi goi kh6ng biet gi.
- Tim dap nhe hoac kh6ng dap, mach nhanh nhung kh6 bat.
- Mat nhot nhat, narn bat dong.
- Huyet ap giam,
5. Trieu chirnq thirc th~ trong b~nh tim mach
5. 1. Kham toen than
- 'I'oan trang gfly hay beo cao hay thap (can nang, do ch ieu cao).
- Da niern mac binh thucng hay xanh nhot nhat hay tim tai,
- Hach ngoai bien tuyen giap co to hay kh6ng.
- Ngon tay ngcn chan co dui trfing khong (g~p trong suy tim).
- Tam phe' man, tim b&m sinh.
- Mong tay khum g$p trong viern mang trong tim.
5.2. Khem mech mtiu

Tinh mach canh c6 n6i kh6ng.
- Nghi~m phap phan h6i gan . TInh m?ch ctta co kh6ng, nghi~m phap
dUdng tinh g~p trong suy tim phai.
- D9ng m?ch canh co d~p m?nh khong.
- Do huyet ap d9ng m?ch

va huyet

ap tinh m?ch.

5.3. Kham tim bang phuO'ng phap nhin, set, go, nghe
5.4. Kham c~n lam sang
5.4.1. ChVP tim

d hai


.

tu the':

- Th£ng.
- Nghieng: ch\lP. phftt hi~n tim binh thudng hay b~nh ly, phat hi~n
cung tim c6 thay d6i kh6ng.
5.4.2. f)if?n

tam do

Phflt hi~n
100

vi tri t6n

thlidng trong tim, di~n tich t6n thlidng.


6.Phanlo~ib~nhtimm~ch

- Khi dieu tri phuc h6i benh nhan tim mach can nam viing nguyen
nhan gay benh, trieu chung benh, dien bien cua benh va cac bien
chirng co th€ xay ra.
- Theo H9i tim mach NEW YORK '(NEW YO:R:it'lIe"art association)
xuat nhirng bang phan loai benh tim mach sau day:
6.1. Bang phan 10;# b~nh

de'


Iy

La bang ph an loai benh tim mach thea nguyen .nhan. '
- Vi du: benh tim do cao huyet up, do xo cung d9ng mach, benh tim
b~m sinh.
6.2" Bang phan toe! ctusc nang
La bang phan loai thea trieu chung sinh

1y g6m 4 cap:

. CapI: benh tim chua lam giarn sut kha nang ho?t d9ng th€ luc:
berih nhan v~n heat d9ng binh thuong kh6ng gay rnet moi, h6i
h9P kh6 tho, dau nguc,
.'
Cap II: benh tim da lam giam sut nhe kha nang heat dong th€ luc,
- Benh nh~n thoai mai khi nghi ngoi va lam cong viec nhe. ".
- Nhung cam thay m~t moi, h6i h9P, kh6 thd, dau ng\ic k'hi g~~g suc,
. Cap III: b~nh tim da lam giam sut nhieu kha nang ho?t d9ng' th~l\1c,
Khi nghi ngoi thi khong thay cac tri~u chung suy tim.
- Ho~t d9ng th€ l\ic nh~ cung thay m~t moi h6i h9P, kh6 thd va dau
thllt ng\ic.
'
Cap IV: b~nh tim da lam cho ngudi b~nh hoi 'gllng suc da c6 tri~u
chung suy tim, khi nghi ngoi cling thay ngudi' m~t' moi kh6 thd,
dau ngl,ic.
Luqng gia ngudi bi b~nh tim thudng do thap khop cap, h~p van 2 la,
hd van 2 lao Lo?n nhip tim do rung nhI.
7. Nguyen t~c dieu trj VLTL b~nh tim m~ch ,
7.1. Khi nao ca'n die'u trj b~nh tim
- Nhung b~nh nhan chua co r6i lo<:tntim m<:tch.

- Nhung b~nh nhan moi bi giam sut nh~ kha nang ho?t d9ng th€ h;ic.101


..

- Benh nhan mdi bi kh6 thd nhe, kh6 thd khi gl'ing sue thi chi can nghi
ngoi, uong thuoc an than, an han che muoi nude, chua can dieu tri
thuoc men.
- Nhirrig benh nhan da bi~u hien suy tim thi phai dieu tr] bang:
+ Th uoc tro tim.
+ Thucc lei ti~ul

+ Th uoc
+

An

an than.

nhat.

+ Kh6 tho phai thr) oxy.
7.2. SL/ nghi ngo'i

Tuy thea muc d9 nang nhe cua suy tim rna thuc hien che d9 nghi
ngoi eho hop ly,
Nghi ngci tuyet doi tai giuong: chi dinh cho cac trucng hop suy tim
nang hoac suy tim cap, thoi gian chi dinh nghi ngoi tuyet doi can han
che' tdi muc toi thi~u vi narn tren giucng qua dai se lam u mau tai
ph6i, d~ xuat hien viern ph6i, t~o thu~n leji cho viem tl'ie tinh m~ch,

giam trudng Ive ed, suy S\lP tinh th§.n ngudi b~nh.
- Nghi ngdi tudng dOlt~i giudng: chI dinh cho cae trudng h<;Jp suy tim nh~:
7.3. Chlf

dp

dinh duong

- Khong h~n che uong nuoe, khong uong nuoe c6 muoi (nh:1t la nuoc
khoang).
- Ion Na+ la yeu to ehinh dieu hall dich ngoai te bao, dich nay tang khi
Na+ giam, trong suy tim, Na+ bi th~n giu l~i trong cd th~ vi v~y c~n
phai giam Na+ trong thuc an khi suy tim e6 phu phai giam toi muc
chi dung O,5g/ ngay.
- Cfln ?ieu tri them vitamin Bl lieu eao se lam eho Hnh tr?ng cua tim
kha len.
7.4. Thuoc men
Dieu tri thtioc m\lc ruch tang clidng cung lUejng tim va giam u huyet
ngo?i bien.
7.4. 1. Thuoc cLli:Jng tim
Tac d\lng tim d~p deu m?nh va nhip ch~m.
Digitalin

102

(bi~t dU9c Digitoxin, Digoxin).


- Strophantin


(Uabain).

7.4.2. Thuoc tot tieu

- Thuoc lei ti§u c6 thuy ngan: Novurit.
- Hoac lei ti§u Sulfamid, Furosemid .
.7.5. Thu6c an thfin

va

tam Iy ngiiiti b~nh

- Benh nhan tim mach thuong 10 lang xuS dong deu anh hucng den
benh tat.
- Cftn coi md vdi benh nhan, d9ng vien benh nhan gat bo 10 au ve benh,
yen tam chua benh va thuc hien ke hoach trong tuong lai cua ho,
- Neu benh nang, dip tinh mdi dung thuoc an thftn;' cq th~ dung d~n
xuat cua morphin hoac gardenan.
7.6. Oxy Ii~u phap

Chi dinh dung oxy khi c6 suy tim nang, suy tim cap, kh6 tho, xanh
tim, benh nhan v:%ttva, me sang.
7.7. Phuc h6'i chuc nang ngLf&i b~nh

- 'I'ruoc khi phuc h6i chuc nang benh nhan suy tim can lucng gia lam
sang vdi cac dli kien,
+ Do mach, huyet .ap, nhip tho, dau hieu xanh tim, di~n tim, kham
toan than cua b~nh nhan.
.
+ Cac du ki~n tren 6n dinh mdi t:%tpluy~n v:%tnd9ng duqc.


+ Khi dang t~p luy~n b~nh nhan xuat hi~n cac tri~u chung: dau ng\l'c,
kh6 thd, tim tai, toat me)hoi thi ngung t:%tpluy~n ngay. '
LUQNG GIA
1. Trinh bay nhling tri~u chung cd nang cua b~nh tim m~ch.
2. Trinh bay cach ph an lo~i b~nh tim m::}.ch.
3. Trinh bay nguyen d.c dieu tri VLTL b~nh tim m~ch.

103


VAT
. LY TRI-..LIEU BENH rANG HUYET

Ap

Ml)C TIEU
l. Trinh bay duoc dinh nghia, ph an loai, nguyen nhan tang h uyet ap,

2. Trinh bay duoc tri~u chung tang huyet ap, tien tri~n, bien chirng
va dieu tr] tang huyet ap,
3. Trinh bay ducc muc dich, phuong phap phuc hoi chuc nang tung
huyet ap tai b~nh vien va tai nha.
NQIDUNG
1. Dinh nqhla
Tang huyet ap la tinh trang huyet ap d<)ng mach toi da tren 150
mmHg (21,3 Kpa) va huyet ap d<)ng mach toi thieu tren 90 mmHg (12,7
Kpa) va c6 th~ gay bien chung tim, than, than kinh, m:'it.
2. Huyet ap binh thltdng va tinh hinh m~c b~nh tang huyet ap
Theo T6 chuc Y te The gioi:

2.1. Huyet ap binh thU'iing

- Huyet ap d<)ng mach toi da tir: 90 mmHg - 140 mmHg (Huyet ap tam
thu).

- Huye t

ap dong m~ch to'i thi~u tu: 60 mmHg

- 90mmHg (Huyet ap

tam trudng).
- Huyet ap d9ng m~ch kh6ng co' dinh rna thay d6i trong ngay. Ban dem
huyet ap thf.lp hdn ban ngay.
)21)
Theo tu6i:' huyet
ap clla ngudi tre thap han clla ngudi gia.
,
- Theo gioi: huyet

ap clla

nil thap han cua nam.

- Huyet ap hic d6i thap hon huyet ap hic an no.
2.2. Tinh hinh mac b~nh tang huyet

ap 6' tren

thl§' gici'i va Vi~t Nam



3. Phan leal va nguyen nhan tang huyet ap
3.1. Phen tos! tang huyet ep: tang huyet ap duoc chia lam 3 loai,

3.1.1. Tang huye't ap thuang xuyen
- Trong loai nay chung ta clin phan biet: ' .
+ Tang huyet ap lanh tinh.

+ Tang huyet ap ac tfnh.

.~.

3. 1.2. Tang huyet ap con

. Tren

sd huyet ap binh thucng hoac g~n binh thuong benh nhan xuat
hien ct9t ng9t nhimg con tang huyet ap va khi d6 c6 th~ co tai hien xay ra.
cd

I

3.1.3. Tang huy{it ap aoo o¢ng
Huyet {lp bcnh nhiin luc tiing hie giarn, ca huyet ap t6i da va t6i thieu,
3.2. Nguyen nhan tang huyet

3.2.1. Tang huye't ap
huyet ap trieu chung.


co

ap

nguyen nhan: (tang 'huyet ap thu phat) hoac cao

- Do benh th{).n:

+ Viem c~u th~n cf{p

+ Viem th~n cf{p.

+ Viem eliu th~n m~n.

+ Soi th{).n.

+ Lao th~n,
+ Xd cling d9ng m~ch th~n.

+ H~p d9ng m~ch th~n.
+ Th~n da nang.

+ Teo m9t ben th~n bflm sinh.

+ V nUDeb~ th~n.

- Do b~nh tim m~ch:
+ Hd van d9ng m~ch chu (huyet ap t6i da tang cao, huyet ap t6i thi~u

gi~m),


'

+ H~p eo d<)ng m~ch chu (huyet ap t6i da, huyet ap t6i thi~u d tay

cao, giam d chan).
- Do b~nh n9i tiet:

+ U tuyen th uqng th~n.
+ CUdng vo thuqng th~n.

+ Tien man kinh (huyet ap tang d giai do~n tien man kinh sau do

6n

dinh va binh thudng),
+ H9i chllng Cushing,'to

d~l.l chi.
)

105


3.2.2. Bent: tang huye't ep (tang huyet ap nguyen phat hoac tang huyet ap

chua ro nguyen nhan)
-- Lam viec trf 6c qua sue chiern 70% - 80%.
- Stress than kinh (chan thuong tinh than, hoac 10 lang qua muc, xuc
cam qua muc).

..
-'- Ngl.idi cao tu6i.
- Xo cung d9ng mach (h~ thong ti~u d9ng mach co lai gay cao huyet ap).
- Yeu to gia dinh (trong gia dinh: ong ba bo me bi tang huyet ap).
4. Trieu chung
4.1. Giai doen cao huyet

ap tiem timg

Vao narn dfiu khi mdi bi tang huyet ap benh nhan sinh heat binh
thuong, dai khi thay bieu hien trieu chung co nang:

Benh nhan nhuc dfiu hai ben thai ducng, sau gay va dinh dfiu.
- Chong mat.
- Hoa mat.
- Do huyet ap hie tang, hie giarn tdi muc gidi han.

- 0 tai.
- D6i khi do tinh cd di kham sue khoe mdi phat hi$n ra tang huyet ap.
4.2. Giai do~n cao huyet

ap lam sang

4.2. 1. Tri~u chung cO nang
- Nhuc dfiu hai ben thai du'dng.
- Nhuc dfiu sau gay ho~c dinh dfiu.

- 0 tai,

hoa m~t, chong m~t.


- Trf nho giam hay quen.
- Dai khi c6 tru'dng hQp chay mau mlii (chay mau cam).
4.2. 2. Tri~u chung thl/C the
+ Do huyet ap: Huyet ap toi da tang tren 160mmHg.
Huyet ap toi thi~u tang tren 90mmHg.
+ Sd d9ng ml;lch thai du'dng, d9ng ml;lch quay, d9ng ml;lch canh (Xd
cling ngo:1n .ngheo).
+ Nghe tim: tieng tim d9ng m~ch d Il}~l1ltim ya van d9ng ill:l;lchchu. ~~
106


4.2.3. Trieu ~hung cen lam sang

_ Xet ngh iern mau: u re rnau: binh thucng (0,2-0,4 g/lit) hoac hoi tang.
cholesterol tang tren 5,1 7mmol/lit.
Xet ngh iern nude ti~u c6: Protein ducng tfnh
H6ng cftu +
Bach cflu +
Tru hat +
Soi day mat: c6 hien tuong xuat huyet vong mac (Dongmach
ph an arih tinh trang dong mach nao). ' ~ !

day mat

_ X quang tim: giai dean dflu binh thuong, giai dean sau tim to.
X quang ph6i: binh thuong.
4.3. Giai do~n tang huyet

ap


i

bien chLi'ng

Do huyet ap toi da tang tren 160mmHg, huyet ap toi thi§u'tang
90 mmHg. Benh nhan c6 th~ xuflt hien cac bien chung Sq_U:

tren

4.3.1. BifI/n chung mtJt

-

Phu gai mat.
Xuat huydt vong mac, phu day mat.
Dau hieu Gun (dong mach bat cheo tinh mach),

4.3.2. Bien chung tim

-

Suy tim (that trai gian ~ suy tim trai ~ suy tim toan bo),

-

Con da u thii t ngVc.

-


Nh6i mau cd tim.

4.3.3. Bien chung th?n: chiem 20%,

co th§ gay:

Viem cflu th~n cflp tinh, m?n Hnh.
- Suy th~n m~n (ure mau tang).
4.3.4. Bien chung than kinh

- Neu nh~: gay co thiit d9ng m?ch nao, tiic d9ng m?ch nao, huyet khoi
Q9ng m~ch trong S9.
- Neu n~ng: gay nhun nao, xuflt huyet nao ~ li~t nlta ngtidi.
107


5. Tien trien, bien chirnq
5.1.

Tien trie'n: theo

3 giai doen

5.1.1. Giai doen I: huyet ap dao d9ng .

. - Huyet ap hie tang, hie giarn toi mire binh thuong. Vi du:
+ Huyet ap tang:
HA toi da tren 170mmHg.
HA toi thi~u.,tren 95mmHg.


+ Huyat ~p giam:
HA t6'i da duoi 140mmHg.
HA toi thi~u dudi 80mmHg.
5. -1.2. Giai doen II: huyet ap gioi han (huyet ap gidi han la huyet ap d9ng
mach t6i da tu 140 :. 160 mmHg, huyet ap d9ng mach toi thieu tu 90 . 95
mmHg).
Huyet ap dongmach tang sau d6 giam xuong tdi mire gioi han va c6 th~
c6 bien chung d mlit nhu phu yang mac, xUllt huyet yang mac, phu gai thi,
5.1.3. Giai aoen III: huyet ap cao thucng xuyen.
- Luc nao huyet up cling cao. Huyet ap toi da tren 165mmHg, huyet ap
toi thi~u tren 95 mmHg.
C6 th~ c6 bien chung: tim, th~n, m:1t, th:1n kinh.
5.2. Bien cht.i'ng

- MAt:

Ph\) gai mAt, chay mau yang m?c.

- Tim:

Can dau th:1t ng\fc.
Th{(t trai gian to ~ suy tim.

+ Suy tim trai ~ suy tim toan b9.
+ Nh6i mau co tim.
Th~n:

+ Viem c:1u th~n cap
+ Viem c~u th~n m?n.


+ Suy th~n.
- Thlin kinh: + Co th:1t d9ng m?ch nao.
+ T:1c d9ng ~:;tch nao.
108


+ Nhim nao.

~.:. .

~

'"

~

:';

~

,·1.•.

"

_'.

-...
/.

-


+ Xw1t huyet nao ~ liet nua nguoi.
6. Dieu tr]
6.1.

ouo trj

tricu chUng

6.1.1. fJieu tti tang huy{/t ap nh£?- vue

_ Nghi ngci hoan toan, kh6ng gihig sire ve th~ luc, khong cang th~ng
tinh than.
- An han che muoi, n tick.
Dung thuoc gian mach: Papaverin ha huyet up.
- Dung thuoc an than: Seduxeh 5·10mg/ngay.
6.1.2. Dh31l trf tang huyet ep thuong xuyen

- Dung thuoc ha huyet ap,
- Thuoc loi ti~u.
Thuoc an than.
- Thuoc chong xc cung dong mach.
Thuoc gian mach.
6.2. fJie'u trj nguyen nhan

Tuy thuoc vao nguyen nhan rna co cac phucng phap dieu tri khac nhau.·
7. Ph6ng b~nh (5 bi~n phap phong b~nh tang huyet ap)
o

,


1. Tranh ding thang than kinh.
2. An han che mu6i va chfft kich thich (rU<;1u,ca phe, thuoc la).
3. T6 chuc kham suc khoe dinh ky cho ngudi 45 tu6i trd len). D~
pha t hi~n h uye't ap cao.
4. Dieu tri tich cvc khi phat hi~n du<;1C
tang huye't ap.
5. Lao dQng chan tay ke't h<;1pvoi lao d(mg tri 6c h<;1p15'.
8. Thea doi - cham soc tang huyet ap
8.1. Theo d6i

- M~ch, nhi~t dQ, huyet ap, nhip thd ngay 1 llin.

- Xet nghi~m nuoc ti~u, ure mau, cholesterol mau tu§.n 1 l:in.
Theo d6i bien chu~g d~ x{t tri kip thdi.

109

I'::


B.2. Cham soc

8.2. 1. Ch{; cJ(; nghi ngo;
- Ngu nghi dung gid quy dinh.
- Kh6ng thuc khuya day sdm.
- Lao d9ng chan tay ket hop voi lao d9ng trf DC.
- Khorig lam viec cang thiing.
8.2.2. Che' a(; an u6ng


An han che' muoi,

rna d9ng

vat.

- An du chat va IU<;Jng.
- Kh6ng dung chat kich thfch (ruou, bia, ca phe, che, thuoc la),
8.2.3. Che' a¢ thu6d men

- Dung thuoc dung lieu, dung chi dinh, bao gam:
+ Thuoc ha huyet ap, loi ti~u, chong xo cung d9ng mach, tro tim, an than,
9. V~t

Iy trj li~u

9,1. ML}c dich
- H~ huyet ap,
- Cui th ien tuan hoan nao, chi treri, chi dudi.
- Chong xo cung mach.
- Th u gian toan than.
9.2. Phu,(1ng phap VL TL

- T~p thd bung, thd nguc
- Van dong' nhe nhang cac chi
Xoa bop dftu mat c6
- Dien phan dan thuoc.
LUQNG GIA
1. Trinh bay nguyen nhan gay cao huyet ap thu phat va nguyen phat.
2. Trinh bay tri~u chung, bien chung tang huyet ap.

3. M\lc dfch, phuong phap VLTL/PHCN
phong tang huyet ap:
110

tang huyet ap va bi~n phap
__
, ~._~._. __ . _~ __


PHUC. HOI CHUC NANG SUY TIM
~~.. -_ .._-_.,:-

Ml)C TIEU

1. Nguyen nhan, trieu chung, tien tri~n suy tirrt phai, suy tim trai,

suy tim toan b9.
2. M\lC dich va cac phuong phap phuc h6i chuc nang ... -.
NQIDUNG
1. D\)i cU'dng

_ Suy tim la benh thuong g~p, la giai dean cu6i cua benh tim mach, la
hau qua cua nhieu nguyen nhan, vi v~y BUY tim rat phuc tap.
- Suy tim la tim kh6ng du kha nang cung cap mau cho cac co quan
trong co th@, gay kh6 thd, phu, u mau ngoai bien, anh huong den tim,
phoi, than, lach....
. ,,' '

- Ve phan


loai suy tim: do vi tri, cau true, chuc nang cua tim phai va
tim trai khac nhau nen chi a ra suy tim phai va suy tim trai, m6i loai
c6 nguyen nhan rieng, d:liccti@mva trieu chung khac nhau.

- Ve Him sang:

luc dftu suy tim phai hoac suy tim trai.

- Dan dan c6 th@ suy tim toan bo.
2. Trieu chang cua suy tim
2.1. Suy tim trei

2. 1. 1. Nguyen nhan
G6m cac b~nh gay u mau trong that trai lam cho that trai' phai lam
vi~c nhieu nen gian that trai r6i suy tim.
Do b~nh tang huye't ap
- Do b~nh van tim: h21van 2 la, hd hof;lc h~p 16 van d9ng m~ch chu.
- B~nhtim b~m sinh: h~p eo d9ng m~ch chu bftm sinh, con 6ng d9ng m~ch.
- T6n thudng cd tim: nh6i mau cd tim, viem cd tim.
2.1.2. Tri{Ju chang

- Tri~u chung cd nang: tim trai suy, ti&u tUfrn hoan,bi It mau, b9 ph?n
chiu anh hUdng dfru tienla ph6i, n6ib~t len la tri~.u chung_~~i'ph§i..'
111

.


Kh6 the: hie dciu kh6 thd khi gilng sue, ve sau kh6 tho nhieu,
n ha n ph ai ng6i cho de the, khi suy tim nang kh6 thd th uong xuyen.


Benh

+ Su kh6 thd c6 th~ tu tu, c6 th~ kh6 tho tung can.

+ Sau khi kh6 thd benh nha n ho va khac it dorn rnau hong.
+ Can kh6 tho c6 th~ xay ra d9t ngot nguy kich d6 la can phu phci
cap, kern .theo dau nguc, cam 'giac nhu bi b6p chet va de nghen sau
xuong ire, cam giac nhu silp'tilt tho d6ng thci khac ra dom mau
hong c6 bot chua nhieu albumin.
Dau nguc: benh nhan dau nguc, cam -giac nhu bi b6p nghen sau xuong
UC, cam thay nhu ngat the,
- Tr ieu chung thuc th~:
+ Mom tim d?p lech sang trai.
+ N ghe tim: nhip tim nhanh,
mom tim.

tieng tim mo, c6 tieng th6i tam thu d

+ Do huyet ap: huyet ap toi da giam, huyet ap toi thi~u binh thudng,
so huyet ap chenh l~ch nho.
- Tri~u chung c?n lam sang:
Di~n tam d6:

+ Day that trai va nhi tnli.
+ Tr\lc tim l~ch trai.
X quang tim ph6i:
+ Cung du6i ben trai phinh to.
+ Tim trai to.
+ Ron ph6i d?m do u mau.

2.2. Suy tim phai'
2.2.1. Nguyen nhan

N6i b?t la tri~u chung u mau ngo:;ti bien, gan 1a b9 ph?n d~u tien chiu
imh hudng u mau.
Suy tim phai khong c6 cdn kich phat.
B~nh dien bien tu tu ngay cang n~ng len.
- Do nhung b~nh can trd mau ve tim va tu tim len ph6i.
- Chli yeu 1a cac b~nh clla ph6i.

112


+ Benh ph6i man tfnh: hen phe' quan, viern ph{ quan man, gian phe
quan, lao ph6i, gu, veo c9t s6ng.
+ Benh van tim: hep van 2 la, hep van 3 la, hep van d9ng mach ph6i.
+ Benh tim b£m sinh: thong lien nhi, thong lien th~t.
2.2.2. Tri~u chung

a. Trieu cluing

cd

nang:

- Xanh tim va kh6 tho:
+ Xanh tim: muc d9 rihe chi tim d moi, benh nirt~g:tim d mat, cac d:iu
chi va toan than.
+ Kh6 thd tu tu thuong xuyen tang dan, kh6ng cocon kh6 thd kich phat.
b. Trieu. chung thia: the':

Tinh mach c6 nf)i rfi: dau hieu phan h6i gan tinh mach c6 duong tinh.
_ Gan to dudi bd suon phai: mat gan nhan, bd tu, mat d9 mern, an vao
gan dau tuc.
+ Khi mdi dieu trj gan nho l~i gQila gan dan xe'p.
+ D:in d:in u mau lau, gan kh6ng thu nho du<;jc.Gan trd nen cung.
_ Phu: hie d:iu phu d mi miit, mirtt, d:in d:in phu 2 chan va phli toan .
than (c6 th~ phli mang tim, mang b\lng, mang tinh hoan)..
.
:'

/

Mang ph6i: u nuoc mang ph6i.
Tim m~ch:
+ M~ch

ct~p nhanh

> 100 l/phut.

+ Huye't ap t6i da binh thudng, huye't ap t6i thi~u tang, so' chenh
l~ch nho.
+ Nghe tim: tie'ng th6i tam thu d van 2 la, tie'ng rung tam trudng d
van 2la.-'
c. C¢n lam sang:
- Di~n tam d6:
+ Trvc tim l~ch phai.
+ Day that phai, day that trai.
- X Quang tim ph6i:
+ Cung duoi ben phai phinh to.

+ Tim phai to.
+ R6~·-ph6i d~m do u mau.
113
TB-VLTL_.


2.3. Suy tim toen br).

2.3.1. Nguyen nhtm
- Ngoai nhirng nguyen nhan suy tim phai va suy tim trai.

- Con them mot so nguyen nh an: viern tim toan bo, thoai hoa co tim,
cucrig tuyen giap trang, thieu mau nang, benh Basedow, thieu
vitamin B1•
2.3.2.

tneo chung

a. Trieu chang

cd

nang: n6i bat la trieu chung cua suy tim phai.

- Xanh tim d maio
- Neu benh nang thi xanh tim d mat, d~u chi va toan than.
- Kh6 thd tu tu thuong xuyen tang dan, nam ngtii deu kh6 tho,

b. Trieu chang thuc the:'
-- Gan to dudi bo siren phai.

- Tinh mach c6 n6i, dau hieu phan h6i gan tinh mach c6 ducng tinh.
- Phu mi mat, mat, dan dan benh nang phu d hai chan va toan than.

- U nude

mang phci, mang tim, mang bung va mang tinh hoan.

- Nghe tim: c6 tieng th6i tam thu hoac tieng rung tam trucng d mom tim.
- Do huyet ap: huyet ap t6i da giam, huyet ap toi thi~u tang.
c. Tri?u chung c¢n lam sang:
- Di~n tam d6: thftt phai va that trai day. Day nhi trai.
- X quang tim to toan b9.
3. Tien trie;'n
- Suy tim trai hay c6 bu'dC chuy~n bftt ngd, c6 cdn kh6 thd d9t ng9t c6
th~ xuftt hi~n cdn hen tim ho~c phu ph6i cap.
- Suy tim phai: kh6 thd tu tu, b9nh tien tri~n ch~m nhu'ng ngay cang
nf,tng.
- Suy tim tien tri~n qua nhieu giai do:;tn cuoi cung dftn den suy tim
kh6ng h6i ph\lc ..
4. Nguyen t~c dieu tri, cham soc va phong b~nh suy tim
4.1. Chl]'

d9

nghi ngo'i

- Kh6ng lam vi~c n~ng.
114



- Kh6ng heat dong giing sue. .
I,

,

- Nghi ngci tai giuong tuy thea ~~c de)suy tim.
4.2.

cnsa« an u6'ng
An nhat hoan toan khi phu nhieu,
An han ~he'muoi (1· 2g/ngay). '
- Kh6ng an uong cac chat kich, thich:
ca phe, thuoc lao
.r'i
"-.--'
.. ~:~ £'.

- An
4.3.

du luong

;..

!:'.',:"

....

darn duong md va vitamin.


ens d9 thuoc
Dung thuoc tro tim.
Dung thuoc lei ti~u.
Th uoc an than.

5. Phuc hoi chirc nang suy tim
5.1. MlIC diet: phuc ho"j chU'c nang

- Tang cuong luong mau cho tim.

u tr~ tuan hoan ngoai bien.

Chong

Chong kh6 thd.

- Th u gian toan than.
5.2. Phuong phap VL TL

- Tap thd bung, thd nguc,
- Van dong nhe nhang cac chi.
- Xoa bop chan tay.
?

LLfQNG

GIA

1. Trinh bay nguyen nhan, trieu chung, tien tri~n suy tim phai, suy
tim trai, suy tim toan be).

2. Trinh bay rnuc dfch va cac phucng phap phuc h6i chuc nang suy tim.

115


VAT
. LV TRI..LIEU - PHUC. HOI CHIIC NANG
NHOI MAu CO TIM
Ml)C TIEU
l. Nguyen nhan, trieu chung tien tri~n, bien chung cua nhdi rnau co tim.

2. Muc dieh, chuong trinh VLTL-PHCN cho benh nhan nhdi mau co tim.
NQIDUNG

1. Dinh nghia
Nhoi rnau eU tim la hien tuorig hoai tli met phan co tim do thieu mau
cue b9 va t&e mot hoac nhieu nhanh d9ng mach vanh nu6i dudng vung d6.
2. Nguyen nhan
2.1. Nguyen nhan cbinn
- H uyet khdi tai mot vung cua d9ng mach vanh da bi hep do xo vfra
dorig mach d~n den thieu mau nuoi dudng gay hoai tli.
- Xuat huyet duci mang trong dong mach vanh cua mang xo vua
- T&c dong mach vanh do nghen mach, do C\lC rnau tir xa dua tdi (gap
trong viern n9i tam mac, trong h~p van 2 la)
2.2. Yeu to'thu?n 19'i: (lam nh5i mau co tim xuat hi~n).
- Soc, huyet ap giam d9t ng9t.

- Sau ph~u thu?t.

- B~nh ly van tim, co tim.


- Beo phi, cholesterol mau tang cao.

- Coonnhip nhar:h, lo~n nhip hoan toano
- Lam vi~c tri ~c qua cang th~ng, xuc d9ng m~nh.
- B~nh g?P d nam gidi nhieu hdn nil gidi, tu 50 tu6i trd len, tuy nhien
v~n c6 th~ g?P d ngudi tre.
3. Giai ph~u b~nh va sinh

19 b~nh

3. 1. Giai phau b?nh
- Ch6 nh5i mau cd tim bi xuat huyet, h5ng cflu xuyen thanh m~ch ra
. ngoai rat nhieu, co tim nhQt nh~t, phu ne. SQi cd tim bi dlit lam
nhi€u manh, xung quanh ehB nh5i mau c6 phan ling b~ch cflu. -----' .,---...._
116


- Vai tuan sau vung hoai tti se trd thanh mot seo ~d kern viing chac,
vach tim mong (co th€ tao thanh mot phinh vach d~ vd dudi sue bop
cua tim lam nguoi benh tti vong nhanh ch6ng .
3.2. Sinh

.....

Iy b~nh

-, ~"

r •


'-',.1,(.\...

:..d A'',.,i

- Nh6i mau co tim lam giarn heat dong cua co tim. ben trai,
- Luu luong mau giarn, huyet ap dong mach giam.
4. Trieu chLrng
4.1. Tri~u chung lam sang

4. 1. 1. Tri~u chung CO ntlng
Dau vung truce tim la trieu chung quan trong nhat:
Benh nhan dot ngot dau nguc trai du dQL·
- Nguc dau nhu bi bop nghet, de chen sau xuong uc.
Dau Ian ra canh tay trai.
Da u Ian len c6, len hum duoi.
- Da u khien benh nhan phai narn yen kh6ng giarn cti dQng. Benh nhan
hoang sc;1,10 l~ng, h6i hQP, b5n ch6n, va m5h6i, kern thea non mi'ta.
- Dung thuoc gian m~ch vanh
amylnitrit).

kh6ng

da: (nitroglyxerin,
.

trinitrin,

.


Kh6 thd nhanh n6ng:
Nhip thd tren 30 19tn/phlit.
4. 1. 2. Tri~u chung toan thEm
- B~nh nhan bi soc: s~c ml1itnhQt nhq.t, chan tay lsmh.
M~ch nharth nho, tren 100 l~n/ phlit.
- Huyet ap t6i da va huyet ap t6i thi~u giam.
- Nhunggid

d~u b~nh nhan kh6ng co sot.

- Til 2 deri 3 ngay sau b~nh nhan sot tang nhi~t dQ ttt 38°C - 38,50C,
trd l~i binh th1,.idngsau 7 den 10 ngay.
4.1.3. Tri~u chung thl/c the: nghe tim:
Tieng tim yeu, nhat lEt tieng thu nhat d mom tim.
- Nghetieng

th6i tam thu d van-2 lao
117


Cue vitamin

nang cao th~ tr ang.

5.2. Giai doen ban cap + men tfnh

Thuoc giarn dau.:
,

5.3. Phau thu?t cat mimg boet djch neu thoel hoa

5.4. Dieu tr] VL TL - PHCN
6. V~t

Iy

tr] li~u

6.1. MLJc dfch

- Giarn dau (do co co cling).
- Duy tri tarn van dong khop vai.
- Ngan ngira teo co, cling khdp, dinh khdp vai.
- Bao v~ chuc nang ban tay.
6.2. Phu'O'ng phap

Nhiet trj lieu,
Dien tri lieu,
Vat d9ng tri lieu.
- Xoa bop tri lieu,
LVQNG GIA

1. Trinh bay nguyen nhan, trieu chung, tien tri~n viern quanh khdp vai.
2. Trinh bay muc dich, phucng phap PHCN viern quanh khdp vai.

VAT
. LV THI..LIEU - HOI. CHUNG CO VAl
.

Ml)C TIEU
l. Trinh bay duoc nguyen nhan, tri~u chung, h9i chung dau c6 vai.


2. Muc dich phucng phap vat ly tri lieu h9i chung dau c6 vai.

138


NQIDUNG

.. "'.

..

1. Dlnh nghia
La hoi
. chung dau c6 vai gay kern theo t6n thuong cac, mo mern quanh
khdp vai.
2. Nguyen nhan

- Do sang chan vung c6 vai: tai nan lao' dong, 'tai nan giao thong, tai
nan sinh hoa t.
'
- Do berih nghe nghiep: vac nang, dQi nang.
- Do sai lech tu te: nam nghierig mot ben trong thoi gian lau,
Do thoi tiet: lanh, ~m dQt ngQt keo dai. '
- Do benh tat: sau thoai hoa cQt song, c6, viern quanh khdp vai.
3. Trieu chung
3.1. Trieu chUng lam simg

a. Dau uicng cd vai
- Dau vung c6 vai, dau mom cling vai, dau co den tao

- Dau Ian xuorig canh tay, ding tay.
C6 th~ dau xuyen len gay.
- 'I'Inh chat dau: dau am i, nhuc nhoi. Giai doan dftu dau It, dan dan
da u tang len.

b. Han che'cci df)ng hhdp vai
- Han che eli dong g~p-du6i, dang -ap, xoay trong- xoay ngoai khdp vai.
- Co th~ han che eli dQng khdp cQt song c6.
"

,',

S(i ndn cd quanh khdp vai cb cung. An cdc cd tren gai; cd thang, cd
den ta, cd xoay ngoai cdnh tay rrit dau.
C.

3.2. Tri~u chUng c?n lam sang

- Ch\lp X quang khdp vai binh thlidng.
- Xet nghi~m mau binh thlidng.'
4. Tien tri~n

- Duc;Jcdigu tri b~nh c6 th~ khoi tu 2-3 twin.
- D€; tai phat neu g?P digu ki~n thu~n lc;Ji:ll;lnh :lm.

139


5. £lieu tr]


cap

tinh

5.2. Die'u tr] giai doen ban

cap

5. 1. DhJu tr] giai doen

va men tinh .

Giarn dau.

- Ket hop vdi VLTL/PHCN.
6. V~t Iy tr] li~u/PHCN
6.1. Ml.Jc dich

Giarn dati.
Tang tarn van dong khdp vai, khop C9t song

c6.

('

- Giarn co cung co quanh khop vai.
6.2. Phuong phap

. _.


jlty[,

- Nhiet tr] lieu,

r
,

b,6

- Dien tri lieu.
- V~t dong trj lieu.

I

(jD

):09
J>

Xoa bop tri lieu,
- Hoat dong tr] lieu.
- Keo gian C9t song

c6.

LUQNG GIA

c6 vai.
2. Muc dich phuong phap VL'I'L - PHCN h9i chung ciS vai.
1. Trinh bay nguyen nhan, trieu chung, hoi chung


.7 -i )';; ~~
"

-1"",--,,,_1
:;

Ilj"

140