{"id":11665,"date":"2023-09-19T19:36:24","date_gmt":"2023-09-19T11:36:24","guid":{"rendered":"https:\/\/docquity.com\/?post_type=articles&p=11665"},"modified":"2025-02-11T13:36:59","modified_gmt":"2025-02-11T05:36:59","slug":"esh-2023-huong-dan-kiem-soat-tang-huyet-ap-o-phu-nu-mang-thai","status":"publish","type":"articles","link":"https:\/\/docquity.com\/vi\/articles\/esh-2023-huong-dan-kiem-soat-tang-huyet-ap-o-phu-nu-mang-thai\/","title":{"rendered":"ESH 2023: H\u01b0\u1edbng d\u1eabn ki\u1ec3m so\u00e1t t\u0103ng huy\u1ebft \u00e1p \u1edf ph\u1ee5 n\u1eef mang thai"},"content":{"rendered":"\n

Ti\u1ebfp n\u1ed1i b\u00e0i vi\u1ebft ESH 2023: H\u01b0\u1edbng d\u1eabn ki\u1ec3m so\u00e1t t\u0103ng huy\u1ebft \u00e1p<\/a>, \u0111\u1ed9i ng\u0169 Docquity xin gi\u1edbi thi\u1ec7u v\u1edbi qu\u00fd v\u1ecb \u0111\u1ed3ng nghi\u1ec7p c\u00e1c khuy\u1ebfn c\u00e1o ki\u1ec3m so\u00e1t t\u0103ng huy\u1ebft \u00e1p \u1edf ph\u1ee5 n\u1eef mang thai c\u1ee7a Hi\u1ec7p h\u1ed9i T\u0103ng huy\u1ebft \u00e1p Ch\u00e2u \u00c2u (ESH) n\u0103m 2023.<\/p>\n\n\n\n

T\u0102NG HUY\u1ebeT \u00c1P \u1ede PH\u1ee4 N\u1eee MANG THAI<\/strong><\/p>\n\n\n\n

C\u00f3 kho\u1ea3ng 10% ph\u1ee5 n\u1eef mang thai tr\u00ean to\u00e0n th\u1ebf gi\u1edbi m\u1eafc t\u0103ng huy\u1ebft \u00e1p. T\u0103ng huy\u1ebft \u00e1p c\u0169ng l\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh c\u1ee7a g\u00e1nh n\u1eb7ng b\u1ec7nh t\u1eadt v\u00e0 nguy c\u01a1 t\u1eed vong cho thai ph\u1ee5, thai nhi v\u00e0 tr\u1ebb s\u01a1 sinh. T\u0103ng huy\u1ebft \u00e1p c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn m\u1ed9t s\u1ed1 nguy c\u01a1 \u1edf thai ph\u1ee5 ch\u1eb3ng h\u1ea1n nh\u01b0 nhau bong non, \u0111\u1ed9t qu\u1ef5, ph\u00f9 ph\u1ed5i, bi\u1ebfn c\u1ed1 huy\u1ebft kh\u1ed1i, suy \u0111a t\u1ea1ng v\u00e0 huy\u1ebft kh\u1ed1i r\u1ea3i r\u00e1c trong l\u00f2ng m\u1ea1ch. Thai nhi c\u00f3 nguy c\u01a1 cao b\u1ecb ch\u1eadm ph\u00e1t tri\u1ec3n trong t\u1eed cung, sinh non v\u00e0 ch\u1ebft l\u01b0u trong t\u1eed cung.<\/p>\n\n\n\n

\"\"
H\u00ecnh 1.<\/strong> T\u00f3m t\u1eaft khuy\u1ebfn c\u00e1o cho ki\u1ec3m so\u00e1t t\u0103ng huy\u1ebft \u00e1p \u1edf ph\u1ee5 n\u1eef mang thai<\/p>\n\n\n\n

\u0110\u1ecaNH NGH\u0128A V\u00c0 PH\u00c2N LO\u1ea0I T\u0102NG HUY\u1ebeT \u00c1P THAI K\u1ef2<\/strong><\/p>\n\n\n\n

\u0110\u1ecbnh ngh\u0129a t\u0103ng huy\u1ebft \u00e1p thai k\u1ef3 d\u1ef1a tr\u00ean gi\u00e1 tr\u1ecb huy\u1ebft \u00e1p \u0111o trong ph\u00f2ng kh\u00e1m, c\u1ee5 th\u1ec3 v\u1edbi gi\u00e1 tr\u1ecb huy\u1ebft \u00e1p t\u00e2m thu \u2265 140 mmHg v\u00e0 huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng \u2265 90 mmHg. Huy\u1ebft \u00e1p thai k\u1ef3 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i nh\u1eb9 v\u1edbi gi\u00e1 tr\u1ecb huy\u1ebft \u00e1p 140 \u2013 159\/90 \u2013 109 mmHg ho\u1eb7c nghi\u00eam tr\u1ecdng v\u1edbi gi\u00e1 tr\u1ecb huy\u1ebft \u00e1p \u2265 160\/110 mmHg (h\u00ecnh 2).<\/p>\n\n\n\n


H\u00ecnh 2.<\/strong> Ph\u00e2n \u0111\u1ed9 t\u0103ng huy\u1ebft \u00e1p<\/p>\n\n\n\n

T\u0103ng huy\u1ebft \u00e1p thai k\u1ef3 c\u00f2n \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i d\u1ef1a tr\u00ean th\u1eddi gian kh\u1edfi ph\u00e1t c\u1ee7a t\u0103ng huy\u1ebft \u00e1p. T\u0103ng huy\u1ebft \u00e1p \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n tr\u01b0\u1edbc tu\u1ea7n thai th\u1ee9 20 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem l\u00e0 huy\u1ebft \u00e1p m\u1ea1n t\u00ednh tr\u01b0\u1edbc khi mang thai, t\u0103ng huy\u1ebft \u00e1p \u00e1o cho\u00e0ng tr\u1eafng v\u00e0 t\u0103ng huy\u1ebft \u00e1p \u1ea9n d\u1ea5u. T\u0103ng huy\u1ebft \u00e1p m\u1edbi t\u1ea1i th\u1eddi \u0111i\u1ec3m ho\u1eb7c sau th\u1eddi \u0111i\u1ec3m tu\u1ea7n thai th\u1ee9 20 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i l\u00e0 t\u0103ng huy\u1ebft \u00e1p thai k\u1ef3, t\u0103ng huy\u1ebft \u00e1p thai k\u1ef3 tho\u00e1ng qua ho\u1eb7c ti\u1ec1n s\u1ea3n gi\u1eadt m\u1edbi ho\u1eb7c \u0111\u01b0\u1ee3c m\u1eafc k\u00e8m v\u1edbi t\u0103ng huy\u1ebft \u00e1p m\u1ea1n t\u00ednh tr\u01b0\u1edbc khi mang thai. \u0110o l\u01b0\u1eddng huy\u1ebft \u00e1p trong k\u1ef3 tam c\u00e1 nguy\u1ec7t \u0111\u1ea7u ti\u00ean n\u00ean \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh \u0111\u1ec3 tr\u00e1nh ph\u00e2n lo\u1ea1i nh\u1ea7m l\u1eabn t\u0103ng huy\u1ebft \u00e1p thai k\u1ef3. G\u00eda tr\u1ecb huy\u1ebft \u00e1p \u0111o \u0111\u01b0\u1ee3c \u1edf k\u1ef3 tam c\u00e1 nguy\u00ean th\u1ee9 2 \u1edf thai ph\u1ee5 ch\u01b0a \u0111\u01b0\u1ee3c \u0111o huy\u1ebft \u00e1p tr\u01b0\u1edbc \u0111\u00f3 n\u00ean \u0111\u01b0\u1ee3c gi\u1ea3i tr\u00ecnh th\u1eadn tr\u1ecdng.<\/p>\n\n\n\n

H\u01b0\u1edbng d\u1eabn n\u00e0y s\u1eed d\u1ee5ng \u0111\u1ecbnh ngh\u0129a ti\u1ec1n s\u1ea3n gi\u1eadt \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng th\u1ef1c b\u1edfi Hi\u1ec7p h\u1ed9i Nghi\u00ean c\u1ee9u T\u0103ng huy\u1ebft \u00e1p Thai k\u1ef3 Qu\u1ed1c t\u1ebf. Theo \u0111\u00f3, ti\u1ec1n s\u1ea3n gi\u1eadt l\u00e0 t\u00ecnh tr\u1ea1ng t\u0103ng huy\u1ebft \u00e1p thai k\u1ef3 v\u1edbi s\u1ef1 c\u00f3 m\u1eb7t c\u1ee7a \u2265 1 t\u00ecnh tr\u1ea1ng m\u1eafc m\u1edbi v\u00e0o th\u1eddi \u0111i\u1ec3m ho\u1eb7c sau th\u1eddi \u0111i\u1ec3m tu\u1ea7n thai th\u1ee9 20 (b\u1ea3ng 1).<\/p>\n\n\n\n

\"\"D\u1ef0 \u0110O\u00c1N V\u00c0 PH\u00d2NG NG\u1eeaA TI\u1ec0N S\u1ea2N GI\u1eacT<\/strong><\/p>\n\n\n\n

Thai ph\u1ee5 c\u00f3 nguy c\u01a1 cao ho\u1eb7c trung b\u00ecnh m\u1eafc ti\u1ec1n s\u1ea3n gi\u1eadt n\u00ean \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb s\u1eed d\u1ee5ng 100 \u2013 150 mg aspirin\/ng\u00e0y (v\u00e0o gi\u1edd ng\u1ee7). Th\u1eddi gian b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb \u01b0u ti\u00ean tr\u01b0\u1edbc tu\u1ea7n thai th\u1ee9 16, l\u00fd t\u01b0\u1edfng l\u00e0 t\u1eeb tu\u1ea7n thai 11 \u2013 14 v\u00e0 k\u00e9o d\u00e0i cho \u0111\u1ebfn tu\u1ea7n thai th\u1ee9 36.<\/p>\n\n\n\n

\"\"
H\u00ecnh 3.<\/strong> Y\u1ebfu t\u1ed1 nguy c\u01a1 cao ti\u1ec1n s\u1ea3n gi\u1eadt<\/p>\n\n\n\n


H\u00ecnh 4.<\/strong> Y\u1ebfu t\u1ed1 nguy c\u01a1 trung b\u00ecnh ti\u1ec1n s\u1ea3n gi\u1eadt<\/p>\n\n\n\n

CAN THI\u1ec6P L\u1ed0I S\u1ed0NG<\/strong><\/p>\n\n\n\n

Tr\u1eeb khi b\u1ecb ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, thai ph\u1ee5 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o n\u00ean th\u1ef1c h\u00e0nh c\u00e1c b\u00e0i t\u1eadp aerobic v\u1edbi t\u1ea7n su\u1ea5t 3 \u2013 4 l\u1ea7n\/tu\u1ea7n, m\u1ed7i l\u1ea7n 30 \u2013 60 ph\u00fat cho \u0111\u1ebfn khi sinh \u0111\u1ec3 duy tr\u00ec c\u00e2n n\u1eb7ng l\u00fd t\u01b0\u1edfng v\u00e0 gi\u1ea3m nguy c\u01a1 g\u1eb7p c\u00e1c bi\u1ebfn ch\u1ee9ng b\u1ea5t l\u1ee3i c\u1ee7a thai k\u1ef3, bao g\u1ed3m t\u0103ng huy\u1ebft \u00e1p. Ph\u1ee5 n\u1eef mang thai c\u0169ng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb n\u00ean s\u1eed d\u1ee5ng c\u00e1c ch\u1ebf ph\u1ea9m b\u1ed5 sung calci v\u1edbi li\u1ec1u t\u1ed1i thi\u1ec3u 1 g\/ng\u00e0y \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 ti\u1ec1n s\u1ea3n gi\u1eadt \u1edf ph\u1ee5 n\u1eef \u0111\u01b0\u1ee3c n\u1ea1p \u00edt calci (< 600 mg\/ng\u00e0y). Ch\u1ebf \u0111\u1ed9 \u0103n h\u1ea1n ch\u1ebf mu\u1ed1i kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb \u0111\u1ec3 l\u00e0m gi\u1ea3m huy\u1ebft \u00e1p \u1edf ph\u1ee5 n\u1eef mang thai, tuy nhi\u00ean v\u1edbi ph\u1ee5 n\u1eef b\u1ecb t\u0103ng huy\u1ebft \u00e1p m\u1ea1n t\u00ednh tr\u01b0\u1edbc thai k\u1ef3 th\u00ec v\u1eabn n\u00ean ti\u1ebfp t\u1ee5c duy tr\u00ec ch\u1ebf \u0111\u1ed9 \u0103n h\u1ea1n ch\u1ebf mu\u1ed1i.<\/p>\n\n\n\n

\"\"H\u00ecnh 5.<\/strong> Can thi\u1ec7p l\u1ed1i s\u1ed1ng \u1edf ph\u1ee5 n\u1eef mang thai b\u1ecb t\u0103ng huy\u1ebft \u00e1p<\/p>\n\n\n\n

KI\u1ec2M SO\u00c1T T\u0102NG HUY\u1ebeT \u00c1P THAI K\u1ef2<\/strong><\/p>\n\n\n\n

T\u0103ng huy\u1ebft \u00e1p m\u1ea1n t\u00ednh tr\u01b0\u1edbc thai k\u1ef3 m\u1ee9c \u0111\u1ed9 nh\u1eb9<\/strong><\/p>\n\n\n\n

Trong th\u1eddi k\u1ef3 tam c\u00e1 nguy\u1ec7t \u0111\u1ea7u ti\u00ean, c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf h\u1ec7 renin-angiotensin (thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n angiotensin \u2013 ACEI, ch\u1ea5t ch\u1eb9n th\u1ee5 th\u1ec3 angiotensin \u2013 ARB ho\u1eb7c ch\u1ea5t \u1ee9c ch\u1ebf tr\u1ef1c ti\u1ebfp renin) n\u00ean \u0111\u01b0\u1ee3c ng\u01b0ng ho\u00e0n to\u00e0n. Quy\u1ebft \u0111\u1ecbnh ng\u01b0ng ho\u1eb7c ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c h\u1ea1 \u00e1p trong th\u1eddi k\u1ef3 tam c\u00e1 nguy\u1ec7t \u0111\u1ea7u ti\u00ean ho\u1eb7c giai \u0111o\u1ea1n s\u1edbm c\u1ee7a th\u1eddi k\u1ef3 tam c\u00e1 nguy\u1ec7t th\u1ee9 2 n\u00ean \u0111\u01b0\u1ee3c c\u00e1 nh\u00e2n h\u00f3a d\u1ef1a tr\u00ean:<\/p>\n\n\n\n

    \n
  1. m\u1ee9c \u0111\u1ed9 huy\u1ebft \u00e1p ch\u01b0a \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t;<\/li>\n\n\n\n
  2. gi\u00e1 tr\u1ecb huy\u1ebft \u00e1p \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb trong th\u1eddi k\u1ef3 tam c\u00e1 nguy\u1ec7t \u0111\u1ea7u ti\u00ean;<\/li>\n\n\n\n
  3. s\u1ef1 c\u00f3 m\u1eb7t c\u1ee7a t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan do t\u0103ng huy\u1ebft \u00e1p v\u00e0<\/li>\n\n\n\n
  4. gi\u00e1 tr\u1ecb huy\u1ebft \u00e1p sau giai \u0111o\u1ea1n ng\u1eafn th\u1eed cai thu\u1ed1c h\u1ea1 \u00e1p \u1edf tr\u01b0\u1eddng h\u1ee3p ch\u1ecdn l\u1ecdc.<\/li>\n<\/ol>\n\n\n\n

    Trong giai \u0111o\u1ea1n s\u1edbm c\u1ee7a th\u1eddi k\u1ef3 tam c\u00e1 nguy\u1ec7t \u0111\u1ea7u ti\u00ean, \u0111\u1ed1i v\u1edbi thai ph\u1ee5 c\u00f3 huy\u1ebft \u00e1p < 130\/80 mmHg, \u0111i\u1ec1u tr\u1ecb h\u1ea1 \u00e1p c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ng\u01b0ng ho\u1eb7c xu\u1ed1ng thang, ph\u1ed1i h\u1ee3p v\u1edbi vi\u1ec7c theo d\u00f5i ch\u1eb7t ch\u1ebd gi\u00e1 tr\u1ecb huy\u1ebft \u00e1p cho \u0111\u1ebfn tu\u1ea7n thai th\u1ee9 16. N\u00ean b\u1eaft \u0111\u1ea7u l\u1ea1i thu\u1ed1c h\u1ea1 \u00e1p n\u1ebfu huy\u1ebft \u00e1p > 140\/90 mmHg \u1edf th\u1eddi k\u1ef3 tam c\u00e1 nguy\u1ec7t b\u1ea5t k\u1ef3. \u0110\u1ed1i v\u1edbi thai ph\u1ee5 b\u1ecb t\u0103ng huy\u1ebft \u00e1p m\u1ea1n t\u00ednh tr\u01b0\u1edbc thai k\u1ef3, kh\u00f4ng \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p m\u1ee9c \u0111\u1ed9 nh\u1eb9 b\u1eb1ng thu\u1ed1c h\u1ea1 \u00e1p trong giai \u0111o\u1ea1n s\u1edbm c\u1ee7a th\u1eddi k\u1ef3 tam c\u00e1 nguy\u1ec7t th\u1ee9 2 c\u00f3 th\u1ec3 ph\u00f2ng ng\u1eeba t\u00ecnh tr\u1ea1ng h\u1ea1 huy\u1ebft \u00e1p qu\u00e1 nhi\u1ec1u, d\u1eabn \u0111\u1ebfn nguy c\u01a1 s\u1ea9y thai ti\u1ec1m t\u00e0ng cho t\u00ecnh tr\u1ea1ng h\u1ea1 huy\u00eat \u00e1p sinh l\u00fd trong thai k\u1ef3.<\/p>\n\n\n\n

    ESH khuy\u1ebfn ngh\u1ecb ng\u01b0\u1ee1ng huy\u1ebft \u00e1p \u0111\u1ec3 b\u1eaft \u0111\u1ea7u thu\u1ed1c h\u1ea1 \u00e1p l\u00e0 \u2265 140\/90 mmHg. Labetalol v\u00e0 alpha-methyldopa l\u00e0 l\u1ef1a ch\u1ecdn \u0111\u1ea7u tay \u0111\u1ec3 ki\u1ec3m so\u00e1t t\u0103ng huy\u1ebft \u00e1p \u1edf ph\u1ee5 n\u1eef b\u1ecb t\u0103ng huy\u1ebft \u00e1p m\u1ea1n t\u00ednh tr\u01b0\u1edbc khi mang thai. Thu\u1ed1c thay th\u1ebf c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc l\u00e0 nifedipine ph\u00f3ng th\u00edch k\u00e9o d\u00e0i. Tuy nhi\u00ean, vi\u1ec7c s\u1eed d\u1ee5ng labetalol \u1edf ph\u1ee5 n\u1eef mang thai c\u00f2n c\u00f3 nhi\u1ec1u tranh c\u00e3i v\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c xem l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn \u1edf nhi\u1ec1u qu\u1ed1c gia v\u00ec ho\u1ea1t ch\u1ea5t n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c thu h\u1ed3i kh\u1ecfi th\u1ecb tr\u01b0\u1eddng c\u00e1ch \u0111\u00e2y 30 n\u0103m v\u00ec \u0111\u1ed9c t\u00ednh tr\u00ean gan.<\/p>\n\n\n\n

    Huy\u1ebft \u00e1p thai k\u1ef3 m\u1ee9c \u0111\u1ed9 nh\u1eb9<\/strong><\/p>\n\n\n\n

    G\u00eda tr\u1ecb huy\u1ebft \u00e1p h\u1ee3p l\u00fd \u0111\u1ec3 kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p l\u00e0 \u2265 140\/90 mmHg, tuy nhi\u00ean huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o kh\u00f4ng n\u00ean \u0111\u01b0\u1ee3c h\u1ea1 xu\u1ed1ng < 80 mmHg. L\u1ef1a ch\u1ecdn thu\u1ed1c h\u1ea1 \u00e1p t\u01b0\u01a1ng t\u1ef1 \u0111\u1ed1i v\u1edbi ph\u1ee5 n\u1eef mang thai b\u1ecb t\u0103ng huy\u1ebft \u00e1p m\u1ea1n t\u00ednh tr\u01b0\u1edbc khi mang thai.<\/p>\n\n\n\n

    Ti\u1ec1n s\u1ea3n gi\u1eadt<\/strong><\/p>\n\n\n\n

    Thai ph\u1ee5 m\u1eafc ti\u1ec1n s\u1ea3n gi\u1eadt n\u00ean \u0111\u01b0\u1ee3c nh\u1eadp vi\u1ec7n v\u00e0 theo d\u00f5i ch\u1eb7t ch\u1ebd k\u1ec3 t\u1eeb l\u1ea7n ch\u1ea9n \u0111o\u00e1n \u0111\u1ea7u ti\u00ean. Ch\u1ea9n \u0111o\u00e1n ti\u1ec1n s\u1ea3n gi\u1eadt t\u1ea1i th\u1eddi \u0111i\u1ec3m ho\u1eb7c sau th\u1eddi \u0111i\u1ec3m tu\u1ea7n thai th\u1ee9 37 nh\u1ea5n m\u1ea1nh nhu c\u1ea7u c\u1ee7a vi\u1ec7c ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p v\u00e0 sinh n\u1edf nhanh. Thai ph\u1ee5 m\u1eafc ti\u1ec1n s\u1ea3n gi\u1eadt c\u00f3 t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng \u1ed5n \u0111\u1ecbnh tr\u01b0\u1edbc tu\u1ea7n thai th\u1ee9 37 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t ngo\u1ea1i tr\u00fa. Tuy nhi\u00ean, m\u1eb7c d\u00f9 \u0111\u00e3 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p t\u1ed1i \u01b0u b\u1eb1ng thu\u1ed1c, sinh n\u1edf c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh ngay c\u1ea3 tr\u01b0\u1edbc tu\u1ea7n thai 37, b\u1ea5t c\u1ee9 khi n\u00e0o t\u0103ng huy\u1ebft \u00e1p \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i nghi\u00eam tr\u1ecdng. Sinh tr\u01b0\u1edbc tu\u1ea7n thai th\u1ee9 37 c\u0169ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o v\u1edbi tr\u01b0\u1eddng h\u1ee3p (i) bi\u1ec3u hi\u1ec7n b\u1ea5t th\u01b0\u1eddng \u1edf thai ph\u1ee5 (th\u1ea7n kinh, huy\u1ebft h\u1ecdc ho\u1eb7c tim m\u1ea1ch) ho\u1eb7c (ii) kh\u00f4ng ch\u1eafc ch\u1eafn v\u1ec1 t\u00ecnh tr\u1ea1ng c\u1ee7a thai nhi.<\/p>\n\n\n\n

    Ki\u1ec3m so\u00e1t t\u0103ng huy\u1ebft \u00e1p \u1edf thai ph\u1ee5 m\u1eafc ti\u1ec1n s\u1ea3n gi\u1eadt b\u1ecb t\u0103ng huy\u1ebft \u00e1p m\u1ee9c \u0111\u1ed9 nh\u1eb9 ho\u1eb7c trung b\u00ecnh kh\u00f4ng kh\u00e1c bi\u1ec7t so v\u1edbi thai ph\u1ee5 kh\u00f4ng m\u1eafc ti\u1ec1n s\u1ea3n gi\u1eadt. Thai ph\u1ee5 m\u1eafc ti\u1ec1n s\u1ea3n gi\u1eadt v\u1edbi bi\u1ec3u hi\u1ec7n nghi\u1ec7m tr\u1ecdng (t\u0103ng huy\u1ebft \u00e1p nghi\u00eam tr\u1ecdng k\u00e8m ho\u1eb7c kh\u00f4ng k\u00e8m theo protein ni\u1ec7u, t\u0103ng huy\u1ebft \u00e1p ph\u00e2n \u0111\u1ed9 b\u1ea5t k\u1ef3 v\u1edbi c\u00e1c bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh, huy\u1ebft h\u1ecdc ho\u1eb7c tim m\u1ea1ch, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng gan ho\u1eb7c th\u1eadn) n\u00ean \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t v\u1edbi MgSO4<\/sub> \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch \u0111\u1ec3 ph\u00f2ng ng\u1eeba s\u1ea3n gi\u1eadt. Truy\u1ec1n MgSO4<\/sub> h\u1eadu s\u1ea3n c\u0169ng \u0111\u01b0\u1ee3c xem l\u00e0 h\u1ee3p lsy \u0111\u1ec3 ph\u00f2ng ng\u1eeba. MgSO4<\/sub> c\u0169ng l\u00e0 l\u1ef1a ch\u1ecdn ph\u00f9 h\u1ee3p \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9ng kinh s\u1ea3n gi\u1eadt. \u0110\u1ec3 ki\u1ec3m so\u00e1t t\u0103ng huy\u1ebft \u00e1p c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn labetalol \u0111\u01a1n tr\u1ecb ho\u1eb7c ph\u1ed1i h\u1ee3p labetalol\/nifedipine ph\u00f3ng th\u00edch k\u00e9o d\u00e0i v\u00e0 ho\u1eb7c alpha-methyldopa.<\/p>\n\n\n\n

    T\u0103ng huy\u1ebft \u00e1p m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng<\/strong><\/p>\n\n\n\n

    \u0110\u1ed1i v\u1edbi thai ph\u1ee5 b\u1ecb t\u0103ng huy\u1ebft \u00e1p nghi\u00eam tr\u1ecdng, nh\u1eadp vi\u1ec7n l\u00e0 b\u1eaft bu\u1ed9c \u0111\u1ec3 h\u1ea1 \u00e1p t\u1eeb t\u01b0 xu\u1ed1ng < 160\/105 mmHg v\u00e0 lo\u1ea1i tr\u1eeb t\u00ecnh tr\u1ea1ng ti\u1ec1n s\u1ea3n gi\u1eadt. Theo d\u00f5i b\u1eb1ng m\u00e1y ghi nh\u1ecbp tim thai v\u00e0 co th\u1eaft t\u1eed cung li\u00ean t\u1ee5c c\u0169ng \u0111\u01b0\u1ee3c xem l\u00e0 b\u1eaft bu\u1ed9c. L\u1ef1a ch\u1ecdn thu\u1ed1c h\u1ea1 \u00e1p v\u00e0 \u0111\u01b0\u1eddng d\u00f9ng thu\u1ed1c ph\u1ee5 thu\u1ed9c v\u00e0o<\/p>\n\n\n\n

      \n
    1. ch\u1ea9n \u0111o\u00e1n ban \u0111\u1ea7u<\/li>\n\n\n\n
    2. th\u1eddi gian sinh d\u1ef1 ki\u1ebfn v\u00e0<\/li>\n\n\n\n
    3. s\u1ef1 c\u00f3 m\u1eb7t\/v\u1eafng m\u1eb7t c\u1ee7a ti\u1ec1n s\u1ea3n gi\u1eadt v\u00e0 \u00fd ki\u1ebfn c\u1ee7a c\u00e1c chuy\u00ean gia.<\/li>\n<\/ol>\n\n\n\n

      K\u1ebft qu\u1ea3 m\u1ed9t ph\u00e2n t\u00edch g\u1ed9p cho th\u1ea5y r\u1eb1ng nifedipine c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ec3 ki\u1ec3m so\u00e1t t\u0103ng huy\u1ebft \u00e1p \u1edf ph\u1ee5 n\u1eef mang thai b\u1ecb t\u0103ng huy\u1ebft \u00e1p nghi\u00eam tr\u1ecdng, trong khi \u0111\u00f3 labetalol v\u00e0 hydralazine l\u1ea1i c\u00f3 hi\u1ec7u l\u1ef1c h\u1ea1n ch\u1ebf. Tuy nhi\u00ean, \u0111\u1ed1i v\u1edbi thai ph\u1ee5 m\u1eafc ti\u1ec1n s\u1ea3n gi\u1eadt nghi\u00eam tr\u1ecdng, t\u0103ng huy\u1ebft \u00e1p nghi\u00eam tr\u1ecdng dai d\u1eb3ng ho\u1eb7c t\u0103ng huy\u1ebft \u00e1p n\u1eb7ng t\u00e1i ph\u00e1t m\u1eb7c d\u00f9 \u0111\u00e3 ki\u1ec3m so\u00e1t b\u1eb1ng thu\u1ed1c \u0111\u01b0\u1eddng u\u1ed1ng\/ti\u00eam t\u0129nh m\u1ea1ch, n\u00ean l\u1ef1a ch\u1ecdn labetalol ho\u1eb7c urapidil tr\u01b0\u1edbc, trong v\u00e0 sau sinh th\u01b0\u1eddng xuy\u00ean.<\/p>\n\n\n\n

      \u0110\u1ed1i v\u1edbi thai ph\u1ee5 m\u1eafc ti\u1ec1n s\u1ea3n gi\u1eadt kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n nghi\u00eam tr\u1ecdng ho\u1eb7c t\u0103ng huy\u1ebft \u00e1p nghi\u00eam tr\u1ecdng m\u00e0 kh\u00f4ng b\u1ecb ti\u1ec1n s\u1ea3n gi\u1eadt, n\u00ean \u0111i\u1ec1u tr\u1ecb chi\u1ebfn l\u01b0\u1ee3c ph\u1ed1i h\u1ee3p c\u00e1c thu\u1ed1c h\u1ea1 \u00e1p hi\u1ec7u qu\u1ea3 v\u00e0 l\u00ean thang t\u1eeb t\u1eeb. Tr\u01b0\u1edbc khi sinh, n\u00ean tr\u00e1nh vi\u1ec7c l\u1ef1a ch\u1ecdn hydralazine v\u00ec hydrapazine c\u00f3 li\u00ean quan \u0111\u1ebfn nhi\u1ec1u t\u00e1c d\u1ee5ng ph\u1ee5 chu sinh. Hydralazine ch\u1ec9 n\u00ean \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u0111\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p labetalol ho\u1eb7c urapidil kh\u00f4ng kh\u1ea3 d\u1ee5ng, \u0111i\u1ec1u tr\u1ecb th\u1ea5t b\u1ea1i, block nh\u0129 th\u1ea5t \u0111\u1ed9 II ho\u1eb7c III, suy tim n\u1eb7ng, hen suy\u1ec5n, nh\u1ecbp ch\u1eadm ho\u1eb7c t\u0103ng huy\u1ebft \u00e1p n\u1eb7ng sau sinh. Natri nitroprusside n\u00ean \u0111\u01b0\u1ee3c xem l\u00e0 l\u1ef1a ch\u1ecdn cu\u1ed1i c\u00f9ng v\u00ec l\u00e0m t\u0103ng nguy c\u01a1 ng\u1ed9 \u0111\u1ed9c xyanua cho thai nhi khi s\u1eed d\u1ee5ng k\u00e9o d\u00e0i. Khi ti\u1ec1n s\u1ea3n gi\u1eadt c\u00f3 li\u00ean quan \u0111\u1ebfn ph\u00f9 ph\u1ed5i, nitroglycerin n\u00ean \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn v\u1edbi ch\u1ebf \u0111\u1ed9 li\u1ec1u 5 mg\/ph\u00fat \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch, t\u0103ng li\u1ec1u d\u1ea7n d\u1ea7n sau m\u1ed7i 3 – 5 ph\u00fat cho \u0111\u1ebfn li\u1ec1u t\u1ed1i \u0111a l\u00e0 100 mg\/ph\u00fat.<\/p>\n\n\n\n

      T\u0103ng huy\u1ebft \u00e1p th\u1ee9 ph\u00e1t tr\u01b0\u1edbc khi mang thai<\/strong><\/p>\n\n\n\n

      Ph\u1ee5 n\u1eef c\u00f3 ti\u1ec1n s\u1eed t\u0103ng huy\u1ebft \u00e1p n\u00ean \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n tr\u01b0\u1edbc khi mang thai. Si\u00eau \u00e2m Doppler th\u1eadn n\u00ean \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh \u1edf ph\u1ee5 n\u1eef b\u1ecb t\u0103ng huy\u1ebft \u00e1p c\u00f3 k\u1ebf ho\u1ea1ch mang thai. \u1ede ph\u1ee5 n\u1eef \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n m\u1eafc ch\u1ee9ng lo\u1ea1n s\u1ea3n x\u01a1 c\u01a1 (FMD) tr\u01b0\u1edbc khi mang thai, n\u00ean \u0111\u00e1nh gi\u00e1 th\u00eam m\u1ea1ch m\u00e1u kh\u00e1c \u0111\u1ec3 lo\u1ea1i tr\u1eeb t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch b\u1ed5 sung b\u1ea5t k\u1ef3. Ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p t\u1ed1i \u01b0u v\u00e0 t\u00e1i t\u01b0\u1edbi m\u00e1u \u0111\u1ed9ng m\u1ea1ch th\u1eadn (n\u1ebfu \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh) \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u01b0\u1edbc khi th\u1ee5 thai.<\/p>\n\n\n\n

      Ph\u1ee5 n\u1eef m\u1eafc b\u1ec7nh c\u01b0\u1eddng aldosterone nguy\u00ean ph\u00e1t kh\u00f4ng n\u00ean mang thai. X\u00e9t nghi\u1ec7m sinh h\u00f3a n\u00ean \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh \u1edf ph\u1ee5 n\u1eef \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n c\u01b0\u1eddng aldosterone tr\u01b0\u1edbc khi mang thai ho\u1eb7c nghi ng\u1edd c\u01b0\u1eddng aldosterone trong giai \u0111o\u1ea1n s\u1edbm c\u1ee7a thai k\u1ef3. Sau tam c\u00e1 nguy\u1ec7t th\u1ee9 2, eplerenone k\u1ebft h\u1ee3p v\u1edbi ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb h\u1ea1 huy\u1ebft \u00e1p th\u00f4ng th\u01b0\u1eddng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem x\u00e9t \u0111\u1ec3 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p (c\u00f3 ho\u1eb7c kh\u00f4ng k\u00e8m theo h\u1ea1 kali m\u00e1u).<\/p>\n\n\n\n

      U t\u1ee7y th\u01b0\u1ee3ng th\u1eadn trong thai k\u1ef3 l\u00e0 t\u00ecnh tr\u1ea1ng \u0111e d\u1ecda t\u00ednh m\u1ea1ng c\u1ee7a thai ph\u1ee5 v\u00e0 thai nhi. \u0110\u1ed1i v\u1edbi c\u00e1c x\u00e9t nghi\u1ec7m sinh h\u00f3a, n\u1ed3ng \u0111\u1ed9 metanephrine trong huy\u1ebft t\u01b0\u01a1ng ho\u1eb7c n\u01b0\u1edbc ti\u1ec3u l\u00e0 x\u00e9t nghi\u1ec7m \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn nh\u1edd v\u00e0o \u0111\u1ed9 nh\u1ea1y cao v\u00e0 \u0111\u1ed9 sai l\u1ec7ch th\u1ea5p. \u0110\u1ec3 \u0111\u1ecbnh v\u1ecb ch\u00ednh x\u00e1c, MRI l\u00e0 k\u1ef9 thu\u1eadt ph\u00f9 h\u1ee3p nh\u1ea5t v\u1edbi \u0111\u1ed9 nh\u1ea1y tr\u00ean 90%. Khi thai ph\u1ee5 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n u t\u1ee7y th\u01b0\u1ee3ng th\u1eadn, ph\u1eabu thu\u1eadt c\u1eaft tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn n\u1ed9i soi n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n sau 10\u201314 ng\u00e0y \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c nh\u01b0 \u1edf ph\u1ee5 n\u1eef kh\u00f4ng mang thai (ch\u1eb9n th\u1ee5 th\u1ec3 alpha-adrenergic ph\u1ed1i h\u1ee3p v\u1edbi ch\u1eb9n beta-adrenergic v\u00e0i ng\u00e0y sau \u0111\u00f3). N\u1ebfu u t\u1ee7y th\u01b0\u1ee3ng th\u1eadn \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n trong th\u1eddi k\u1ef3 tam c\u00e1 nguy\u1ec7t th\u1ee9 3, th\u00ec thai ph\u1ee5 n\u00ean \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t cho \u0111\u1ebfn khi c\u00f3 th\u1ec3 sinh (s\u1eed d\u1ee5ng ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c t\u01b0\u01a1ng t\u1ef1 nh\u01b0 \u0111\u1ec3 chu\u1ea9n b\u1ecb cho ph\u1eabu thu\u1eadt). M\u1ed5 b\u1eaft con v\u00e0 ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf kh\u1ed1i u n\u00ean \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh c\u00f9ng th\u1eddi \u0111i\u1ec3m, ho\u1eb7c ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf kh\u1ed1i u \u1edf giai \u0111o\u1ea1n mu\u1ed9n h\u01a1n n\u1ebfu sinh qua \u0111\u01b0\u1eddng \u00e2m \u0111\u1ea1o.<\/p>\n\n\n\n

      \n\n\n\n

      T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/strong><\/p>\n\n\n\n

        \n
      1. Mancia Chairperson G, Kreutz Co-Chair R, etal; Authors\/Task Force Members:. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens. 2023 Jun 21. doi: 10.1097\/HJH.0000000000003480.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

        Ti\u1ebfp n\u1ed1i b\u00e0i vi\u1ebft ESH 2023: H\u01b0\u1edbng d\u1eabn ki\u1ec3m so\u00e1t t\u0103ng huy\u1ebft \u00e1p, \u0111\u1ed9i ng\u0169 Docquity xin gi\u1edbi thi\u1ec7u v\u1edbi qu\u00fd v\u1ecb \u0111\u1ed3ng nghi\u1ec7p c\u00e1c khuy\u1ebfn c\u00e1o ki\u1ec3m so\u00e1t t\u0103ng huy\u1ebft \u00e1p \u1edf ph\u1ee5 n\u1eef mang thai c\u1ee7a Hi\u1ec7p h\u1ed9i T\u0103ng huy\u1ebft \u00e1p Ch\u00e2u \u00c2u (ESH) n\u0103m 2023. T\u0102NG HUY\u1ebeT \u00c1P \u1ede PH\u1ee4 N\u1eee MANG THAI …<\/p>\n

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