NICARDIPIN TRONG iU TR BNH NHN TiN SN GiT

Bs Nguyn Th Hng Vn

Ho va ten: BUI TH KIM H

Chan oan: Tin Sn Git nng, Phu phoi cap. Benh s: BN nhap vien trong tnh trang huyet ap cao 16/12 cmHg, l , nhc au, phu (++), ho khan. Sau 3 ngay ieu tr tai khoa san A BN kho th, tm tai, bc rt,vat va, phu toan than, HA 20/12 cmHg, phoi ay ran am, ran no. Chuyn Hi sc

32 tuoi

Dch te hoc@ Tan suat TSG = 6 8% cac trng hp mang thai 1 @ Tan suat san giat = 5/10.000 trng hp sinh @ Nguyen nhan th 3 dan au cua t vong me 2,3 Hoa Ky : 1995-7Anh: : 2003-5 (Nguyen nhan trc tiep)

1. Am J Obstet Gynecol 2000;183:S1-22 2. MacKay AP et al. Paediatr Perinat Epidem. 2005; 19: 206-14 3. Confidential Enquiries into Maternal Death 2003-5; UK

Cac nh ngha tien san giat 1. Tang HA

Sau 20 tuan tuoi thaiHA tam thu 140 mm Hg HA tam trng 90 mm Hg

o moi 4 gi

HA tam thu 160 mm Hg HA tam trng 110 mm Hg

Tang HA nang :

Cac nh ngha tien san giat 2. Tieu am300 mg protein trong nc tieu /24 g hay (Ton tai 1+ que th nc tieu dipstick: Mau nc tieu ngau nhien moi 4-6 g) Bai tiet nc tieu co protein : thay oi Nang : >5 g protein

Tieu chuan cua TSG nangLAM SANG

@ HA > 160/110 @ Tieu am nghiem trong @ Thieu nieu ( 160 mmHg

HUYT P TM THU > 180 mmHg hay HUYT P TRUNG BNH > 140 mmHg IU TR TN CNG NICARDIPINE IV * Bolus 0,5 - 1 mg sau * Truyn: 1-3 mg trong vng 1 gi

HUYT P TM THU < 180 mmHg hay HUYT P TRUNG BNH < 140 mmHg IU TR DUY TR NICARDIPINE IV: 1 - 3mg / gi hay LABETALOL IV: 5 - 20 mg / gi

NH GI HIU QU & P NG IU TR SAU 30 PHTHA TM THU < 140 mmHg HA TM TB< 100 mmHg 140 < HA TM THU < 160 mmHg 100 < HA TM < 120 mmHg HA TM THU > 160 hay HA TM TB < 120 mmHg Cc tc dng ngoi (nhc u, hi hp) 1. Gim liu Nicardipine v 2. Phi hp vi: hoc Labetalol: 5 - 20 ml / gi hoc Clonidine: 15 - 40 g / gi

Gim liu v ngng iu tr

iu tr duy trNicardipine IV: 1 - 3 mg / gi hay Labetalol IV: 5 - 20 mg / gi

iu tr phi hp:Nicardipine IV: 1-3 mg / gi phi hp vi hoc Labetalol: 5 - 20 mg / gi hoc Clonidine: 15 - 40 g / gi

NH GI HIU QA SAU 30 PHT SAU SAU MI Gi

Mo luc 22h be can nang 1500 gr, Apgar 1 phut = 5; 5 phut = 6. Sau mo: benh nhan bt tm tai, t th oxy qua mask, tnh tao, tiep xuc c, HA on nh. SpO2 99%, con ho khan, phoi con ran am. BN c ieu tr vi khang sinh lieu cao, dan mach vanh, duy tr h HA vi Nicardipin.

TNG TC THUCThuc Dantrolene Tng tc Rung tht iu tr Chng ch nh

Chn betaRifampicine

Gy tt HA, tt HA t thGim nhng nh hng ln tim mch

Kim sot tt HAp ung theo liu

Cc thuc chng ng kinh,an thnCyclosporine

Gy tt HA do tng tc, iu tr triu chng tt HA t thLm tng nng trong huyt tng Tng HA ti pht p ng theo thuc

Corticoid

p ng ln iu tr sau

Thn trng khi dngNguy c s dng trong thai k:Thuc nhm c C theo FDA Khng s dng trong 2 tam c nguyt u thai k, c th s dng trong tam c nguyt 3. t qua sa m. Cho php s dng trong vng mt tun sau sanh m khng nh hng trn thai nhi

Thn trng khi dngGim liu trn nhng bnh nhn suy gan- suy thn. Trnh dng nicardipine trong mt thng sau khi b nhi mu c tim.

CHN THNH CM N