TRNG I HC Y H NI

Sc tim TE

NGUYN NHN, MT S
C IM LM SNG, CN LM
SNG V NHN XT KT QU IU
TR BAN U SC TIM TR EM TI
KHOA HSCC
BNH VIN NHI TRUNG NG
Bo co: NGUYN TH THU H
Hng dn khoa hc: PGS. TS PHM VN THNG

T VN

Sc tim l 1 trong 3 loi sc ph bin nht

TE.

Theo V.V Sot (2002-2007- BV Nhi TW): T l

t vong l 6,3%.

Nguyn nhn a dng, triu chng d nhm

vi cc loi sc khc-> thch thc trong chn
on sm.
Sc tim TE

MC TIU NGHIN CU
1.

Tm hiu nguyn nhn, c im lm sng

v cn lm sng ca sc tim.

2.

Nhn xt kt qu iu tr ban u sc tim

ti Khoa HSCC, BV Nhi T.

Sc tim TE

TNG QUAN

CO

C ch thn
kinh- th dch

Sc tim TE

BACKGROUND

nhp
tim
tin
gnh
hu
gnh

-tiu thu oxy c tim.

-nhu cu oxy c tim

Suy
tim
tin
trin

- ti mu mch
vnh

Sc tim

NGUYN NHN GY SC TIM

IU TR SC TIM

8-12
mmHg
> 65 v < 90
mmHg

Khn
g

>
70%

< 8 mmHg
< 65, > 90
mmHg
ScvO2 <
70%
ScvO2 >
70%

ScvO2 <
70%

I TNG V PHNG PHP NGHIN

CU
1.

Gm 36 BN

2.

Tui: > 1 thng 15 tui

3.

Thi gian: 8/2008 - 10/2013

4.

Nghin cu m t, hi cu, tin cu, phn

tch.
Sc tim TE

I TNG V PHNG PHP NGHIN

CU
1.

Tiu chun la chn: sc + suy tim cp

2.

Tiu chun loi tr: sc nhim khun, sc gim th

tch tun hon, sc phn v v BN tui s sinh.

3.

Ni dung nghin cu:

Nguyn nhn, c im lm sng, cn lm sng sc

tim

Nhn xt kt qu iu tr ban u v mt s yu t
lin quan n kt qu iu tr
Sc tim TE

KT QU V BN LUN

Watson RS (2003)
P.V.Thng (2008)

Sc tim TE

KT QU V BN LUN

Scott

Sc tim TE

KT QU V BN LUN

Nhp tim
(ln/pht)
Nhp nga phi
HAT (mmHg)
CVP (mmHg)
Bi niu
(ml/kg/gi)

Nhanh
Bnh thng
Chm
Khng
C
Khng o c
Gim
Bnh thng
<5 mmHg
5-10 mmHg
10 mmHg
V niu
Thiu niu
Sc tim TE
Bnh thng

N
31
5
0
24
12
2
33
1
11
10
13
14
16
6

%
86,1
13,9
0
66,7
33,3
5,6
91,7
2,7
32,4
29,4
38,2
38,9
44,4
16,7

KT QU V BN LUN

pH
Bicarbonate
mmol/l
Kim thiu
ht (mmol/l)
ScvO2 (%)
Lactat
(mmol/l)

<7,2
7,2
10
10-20
>20
<5
5-10
>10
<70
>70
<2,5
2,5-5
>5

N
19
17
10
17
9
7
11
16
10
4
3
11
20

%
52,8
47,2
27,8
47,2
25
18,9
32,4
48,7
71,4
28,6
8,8
32,4
58,8
Sc tim
TE

M (SD)
7,15
(0,18)
15,43
(7,04)
10,06
(8,78)
56,43
(14,72)
7,84
(5,28)

KT QU V BN LUN
Mt s c im x.quang v SA tim ca BN sc tim khi
vo khoa HSCC
N

T l %

Ch s tim

Tng

18

51,4

ngc

Bnh thng

17

48,3

huyt

13

36,1

phi
Siu m

Khng

22

63,9

50

27

84,35

>50

15,65

tim:
EF %

Sc tim TE

KT QU V BN LUN

Sc tim TE

KT QU V BN LUN

Sc tim TE

KT QU V BN LUN
Lin quan ca nhm tui v kt qu
iu tr

Tui

Thot sc
N (%)

12 thng

10 (38,5)

> 12 thng

16 (61,5)

Khng thot
sc
N (%)

8 (80)
2 (20)
Sc tim TE

P < 0,05;
OR = 6,4

KT QU V BN LUN
Lin quan gia mc nhim toan v kt qu iu tr

pH

Thot sc
N (%)

Khng thot
sc
N (%)

< 7,2

11 (30,6)

8 (22,2)

P < 0,05;
7,2

15 (41,7)

2 (5,6)
Sc tim TE

OR =5,46

KT QU V BN LUN
Lin quan gia kali mu v kt qu iu tr

K
mmol/l

Thot sc
N(%)

Khng thot
sc
N(%)

19 (52,8)

3 (8,3)

>5

7 (19,4)

7 (19,4)

Sc tim TE

P = 0,024
OR = 6,33

KT QU V BN LUN
1. Tui < 12 thng
2. pH < 7,2
3. Kali mu > 5
mmol/l
Phn tch a bin
Nhm tui < 12 thng
lin quan n kt qu
iu tr
OR = 13,64;
95% CI:1,17-158,9
Sc tim TE

KT LUN
1. Nguyn nhn, LS v CLS sc tim
*Nguyn nhn: HFMD (42%), vim c tim (22%) v
BCTG (17%).
*LS: sc mt b nng: 97% HA gim, mch nhanh,
nh, tim nhp nga phi, CVP bnh thng hoc tng.
*CLS: gim ti mu t chc, toan chuyn ha nng.
Sc tim TE

KT LUN
2. Nhn xt kt qu iu tr ban u
Kt qu:

Thot sc 72%; t l t vong 33% (16% trong 24

gi u)

Yu t lin quan kt qu iu tr
Tr < 12 thng tin lng p ng iu tr km.
Sc tim TE

N
M

C
N
TR
NG

R
T

V
U
Q

S U

M M

HUE
2014

Sc tim TE