{"id":19429,"date":"2023-04-14T21:06:59","date_gmt":"2023-04-14T14:06:59","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=19429"},"modified":"2023-04-17T15:20:04","modified_gmt":"2023-04-17T08:20:04","slug":"chi-dinh-dieu-tri-thong-lien-nhi-phau-thuat-hay-can-thiep-qua-da","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/chi-dinh-dieu-tri-thong-lien-nhi-phau-thuat-hay-can-thiep-qua-da\/","title":{"rendered":"Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb th\u00f4ng li\u00ean nh\u0129: ph\u1eabu thu\u1eadt hay can thi\u1ec7p qua da."},"content":{"rendered":"

Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb th\u00f4ng li\u00ean nh\u0129 l\u00e0 m\u1ed9t ch\u1ee7 \u0111\u1ec1 quan tr\u1ecdng trong l\u0129nh v\u1ef1c tim m\u1ea1ch. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb bao g\u1ed3m ph\u1eabu thu\u1eadt ho\u1eb7c can thi\u1ec7p qua da. Quy\u1ebft \u0111\u1ecbnh ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u01b0a ra d\u1ef1a tr\u00ean \u0111\u00e1nh gi\u00e1 to\u00e0n di\u1ec7n c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 li\u00ean quan \u0111\u1ebfn t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe.<\/strong><\/p>\n

1.Sinh l\u00fd b\u1ec7nh:<\/strong><\/h2>\n

V\u00e1ch li\u00ean nh\u0129 \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh b\u1edfi v\u00e1ch ng\u0103n ri\u00eang bi\u1ec7t trong giai \u0111o\u1ea1n ph\u00f4i thai, t\u1ea1o th\u00e0nh m\u1ed9t khuy\u1ebft nh\u01b0 n\u1eafp h\u1ed9p cho ph\u00e9p d\u00f2ng m\u00e1u ch\u1ea3y t\u1eeb b\u00ean ph\u1ea3i sang b\u00ean tr\u00e1i nh\u01b0 m\u1ed9t ph\u1ea7n c\u1ee7a tu\u1ea7n ho\u00e0n thai nhi. Sau khi sinh, v\u00e1ch ng\u0103n tr\u1edf n\u00ean k\u00edn \u0111\u00e1o, t\u1ea1o th\u00e0nh m\u1ed9t v\u00e1ch ng\u0103n nh\u0129 nguy\u00ean v\u1eb9n. \u1ede 25% b\u1ec7nh nh\u00e2n, v\u00e1ch ng\u0103n v\u1eabn c\u00f2n m\u1edf, \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 th\u00f4ng li\u00ean nh\u0129 l\u1ed7 nh\u1ecf(PFO). Nguy c\u01a1 c\u1ee7a PFO li\u00ean quan \u0111\u1ebfn d\u00f2ng ch\u1ea3y t\u1eeb b\u00ean ph\u1ea3i sang b\u00ean tr\u00e1i khi \u00e1p su\u1ea5t \u1edf nh\u0129 tr\u00e1i th\u1ea5p h\u01a1n \u00e1p su\u1ea5t \u1edf nh\u0129 ph\u1ea3i. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c nh\u1eadn th\u1ea5y trong qu\u00e1 tr\u00ecnh n\u00e2ng v\u1eadt n\u1eb7ng v\u00e0 ho, nh\u01b0ng c\u00f3 th\u1ec3 c\u00f3 m\u1eb7t \u1edf h\u01a1n m\u1ed9t n\u1eeda s\u1ed1 b\u1ec7nh nh\u00e2n khi \u1edf tr\u1ea1ng th\u00e1i ngh\u1ec9.<\/p>\n

M\u1ed9t s\u1ed1 nh\u1ecf b\u1ec7nh nh\u00e2n b\u1ecb d\u1ecb t\u1eadt v\u00e1ch li\u00ean nh\u0129 b\u1ea9m sinh (ASD) s\u1ebd s\u1ed1ng \u0111\u1ebfn tu\u1ed5i tr\u01b0\u1edfng th\u00e0nh v\u1edbi lu\u1ed3ng th\u00f4ng t\u1eeb tr\u00e1i sang ph\u1ea3i c\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng trong nhi\u1ec1u th\u1eadp k\u1ef7. D\u00f2ng ch\u1ea3y qua l\u1ed7 th\u1ee7ng l\u00e0m t\u0103ng k\u00edch th\u01b0\u1edbc b\u00ean nh\u0129 ph\u1ea3i v\u00e0 b\u00ean th\u1ea5t ph\u1ea3i, d\u1eabn \u0111\u1ebfn t\u0103ng \u00e1p ph\u1ed5i, rung nh\u0129 v\u00e0 h\u1edf van. M\u1ed9t ASD l\u1edbn ch\u01b0a \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb s\u1ebd d\u1eabn \u0111\u1ebfn s\u1ef1 \u0111\u1ea3o ng\u01b0\u1ee3c d\u00f2ng ch\u1ea3y, t\u00ecnh tr\u1ea1ng kh\u00f4ng th\u1ec3 m\u1ed5 \u0111\u01b0\u1ee3c.<\/p>\n

2.Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng:<\/strong><\/h2>\n

H\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh nh\u00e2n b\u1ecb th\u00f4ng li\u00ean nh\u0129 l\u1ed7 nh\u1ecf(PFO) \u0111\u1ec1u kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng th\u01b0\u1eddng l\u00e0 c\u01a1n thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 t\u1ea1m th\u1eddi (TIA) ho\u1eb7c \u0111\u1ed9t qu\u1ef5, ho\u1eb7c \u0111au \u0111\u1ea7u gi\u1ed1ng nh\u01b0 ch\u1ee9ng \u0111au n\u1eeda \u0111\u1ea7u. Trong m\u1ed9t nghi\u00ean c\u1ee9u, PFO v\u00e0\/ho\u1eb7c ASA c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh \u1edf kho\u1ea3ng 30% s\u1ed1 b\u1ec7nh nh\u00e2n <55 tu\u1ed5i v\u00e0 40% s\u1ed1 b\u1ec7nh nh\u00e2n >55 tu\u1ed5i \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n \u0111\u1ed9t qu\u1ef5 b\u1ea5t k\u1ef3 nguy\u00ean nh\u00e2n. D\u00f2ng ch\u1ea3y qua l\u1ed7 th\u1ee7ng t\u00e2m nh\u0129 \u0111\u01b0\u1ee3c cho l\u00e0 c\u01a1 ch\u1ebf g\u00e2y ra suy h\u00f4 h\u1ea5p v\u00e0 thi\u1ebfu oxy khi ng\u1ed3i ho\u1eb7c \u0111\u1ee9ng l\u00ean t\u1eeb t\u01b0 th\u1ebf n\u1eb1m ngh\u1ec9.<\/p>\n

T\u00f9y thu\u1ed9c v\u00e0o k\u00edch th\u01b0\u1edbc c\u1ee7a ASD, m\u1ee9c \u0111\u1ed9 d\u00f2ng ch\u1ea3y qua l\u1ed7 th\u1ee7ng v\u00e0 s\u1ef1 c\u00f3 m\u1eb7t c\u1ee7a d\u00f2ng ch\u1ea3y t\u0129nh m\u1ea1ch ph\u1ed5i b\u1ea5t th\u01b0\u1eddng, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u00f3 tri\u1ec7u ch\u1ee9ng kh\u00f3 th\u1edf, m\u1ec7t m\u1ecfi, kh\u00f3 kh\u0103n khi t\u1eadp th\u1ec3 d\u1ee5c.<\/p>\n

3.\u0110\u00e1nh gi\u00e1 th\u00f4ng li\u00ean nh\u0129:<\/strong><\/h2>\n

N\u00ean ti\u1ebfn h\u00e0nh si\u00eau \u00e2m tim \u0111\u1ec3 ph\u00e1t hi\u1ec7n d\u00f2ng ch\u1ea3y t\u1eeb ph\u1ea3i sang tr\u00e1i qua l\u1ed7 th\u1ee7ng t\u00e2m nh\u0129.<\/p>\n

M\u1ed9t si\u00eau \u00e2m tim c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed v\u00e0 k\u00edch th\u01b0\u1edbc c\u1ee7a d\u1ecb t\u1eadt v\u00e1ch ng\u0103n, t\u1eeb \u0111\u00f3 \u0111\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng th\u1ef1c hi\u1ec7n \u0111\u00f3ng th\u00f4ng li\u00ean nh\u0129 qua da. N\u00f3 c\u0169ng c\u00f3 th\u1ec3 t\u00ednh to\u00e1n m\u1ee9c \u0111\u1ed9 d\u00f2ng ch\u1ea3y t\u1eeb tr\u00e1i sang ph\u1ea3i v\u00e0 \u0111\u00e1nh gi\u00e1 t\u0103ng k\u00edch th\u01b0\u1edbc b\u00ean nh\u0129 ph\u1ea3i v\u00e0 b\u00ean th\u1ea5t ph\u1ea3i, suy gi\u1ea3m ch\u1ee9c n\u0103ng b\u00ean th\u1ea5t ph\u1ea3i v\u00e0 m\u1ee9c \u0111\u1ed9 t\u0103ng \u00e1p ph\u1ed5i.<\/p>\n

4.Ch\u1ec9 \u0111\u1ecbnh can thi\u1ec7p:<\/strong><\/h2>\n

Kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh can thi\u1ec7p ph\u00f2ng ng\u1eeba \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng v\u00e0 th\u00f4ng li\u00ean nh\u0129 l\u1ed7 nh\u1ecf, n\u00f3 kh\u00f4ng ph\u1ea3i l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u1ed9c l\u1eadp cho \u0111\u1ed9t qu\u1ef5.<\/p>\n

Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u1ed1i \u01b0u cho b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed c\u01a1n thi\u1ebfu m\u00e1u n\u00e3o tho\u00e1ng qua(TIA) ho\u1eb7c \u0111\u1ed9t qu\u1ef5 b\u1ea5t\u00a0 k\u1ef3 nguy\u00ean nh\u00e2n li\u00ean quan \u0111\u1ebfn PFO \u0111ang tranh c\u00e3i. C\u00f3 th\u1ec3 khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb v\u1edbi aspirin v\u00e0\/ho\u1eb7c warfarin, v\u00ec nguy c\u01a1 t\u00e1i ph\u00e1t \u0111\u1ed9t qu\u1ef5 kh\u00e1 th\u1ea5p (kho\u1ea3ng 2,5% trong 4 n\u0103m). Tuy nhi\u00ean, sau khi m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u cho th\u1ea5y kh\u00f4ng c\u00f3 l\u1ee3i \u00edch c\u1ee7a vi\u1ec7c \u0111\u00f3ng PFO trong vi\u1ec7c ph\u00f2ng ng\u1eeba \u0111\u1ed9t qu\u1ef5 t\u00e1i ph\u00e1t, m\u1ed9t l\u01b0\u1ee3ng l\u1edbn b\u1eb1ng ch\u1ee9ng cho th\u1ea5y vi\u1ec7c s\u1eed d\u1ee5ng thi\u1ebft b\u1ecb \u0111\u00f3ng th\u00f4ng li\u00ean nh\u0129 l\u1ed7 nh\u1ecf(PFO) qua da, ch\u1eb3ng h\u1ea1n nh\u01b0 thi\u1ebft b\u1ecb Amplatzer PFO Occluder, c\u00f3 hi\u1ec7u qu\u1ea3 h\u01a1n so v\u1edbi li\u1ec7u ph\u00e1p ch\u1ed1ng \u0111\u00f4ng m\u00e1u \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 t\u00e1i ph\u00e1t \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn.<\/p>\n

M\u1ed9t ASD c\u00f3 tri\u1ec7u ch\u1ee9ng, t\u0103ng k\u00edch th\u01b0\u1edbc b\u00ean nh\u0129 ph\u1ea3i v\u00e0 b\u00ean th\u1ea5t ph\u1ea3i (th\u1eadm ch\u00ed n\u1ebfu kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng). Ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng ch\u1ee9c n\u0103ng c\u1ee7a b\u1ec7nh nh\u00e2n v\u1edbi gi\u1ea3m th\u1ec3 t\u00edch v\u00e0 \u00e1p l\u1ef1c b\u00ean th\u1ea5t ph\u1ea3i, m\u1eb7c d\u00f9 kh\u00f4ng c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng t\u00e2m thu b\u00ean th\u1ea5t ph\u1ea3i. \u0110\u00f3ng ASD c\u0169ng c\u00f3 th\u1ec3 g\u00e2y ra gi\u1ea3m nh\u1eb9 trong th\u1ec3 t\u00edch t\u00e2m thu b\u00ean tr\u00e1i c\u00f9ng v\u1edbi c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng t\u00e2m thu b\u00ean tr\u00e1i.<\/p>\n

5.Can thi\u1ec7p<\/strong><\/h2>\n

\u0110\u00f3ng qua da c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ed1i v\u1edbi PFO v\u00e0 ASD th\u1ee9 ph\u00e1t c\u00f3 k\u00edch th\u01b0\u1edbc nh\u1ecf h\u01a1n 38 mm v\u00e0 c\u00f3 v\u00e0nh m\u00f4 \u0111\u1ea1t y\u00eau c\u1ea7u. Ch\u1ed1ng \u0111\u00f4ng b\u1eb1ng li\u1ec7u ph\u00e1p kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u (aspirin +\/\u2212 clopidogrel) \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong s\u00e1u th\u00e1ng sau.<\/p>\n

Ph\u1eabu thu\u1eadt \u0111\u00f3ng k\u00edn, th\u01b0\u1eddng b\u1eb1ng m\u1ed9t mi\u1ebfng v\u00e1, \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong c\u00e1c ASD th\u1ee9 ph\u00e1t l\u1edbn kh\u00f4ng c\u00f3 th\u1ec3 \u0111\u00f3ng qua da v\u00e0 cho t\u1ea5t c\u1ea3 c\u00e1c ASD kh\u00f4ng ph\u1ea3i th\u1ee9 ph\u00e1t, bao g\u1ed3m khi\u1ebfm khuy\u1ebft xoang t\u0129nh m\u1ea1ch g\u1ea7n t\u0129nh m\u1ea1ch ch\u1ee7 tr\u00ean v\u1edbi ph\u1ed5i b\u1ea5t th\u01b0\u1eddng li\u00ean quan h\u1ed3i l\u01b0u t\u0129nh m\u1ea1ch.<\/p>\n

B\u1ec7nh vi\u1ec7n \u0110a khoa Qu\u1ed1c t\u1ebf Vinmec<\/strong><\/a> \u0111\u00e3 \u0111\u01b0a h\u1ec7 th\u1ed1ng m\u00e1y m\u00f3c, thi\u1ebft b\u1ecb hi\u1ec7n \u0111\u1ea1i \u0111\u1ea1t chu\u1ea9n v\u00e0o c\u00f4ng t\u00e1c th\u0103m kh\u00e1m, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 c\u00e1c b\u1ec7nh l\u00fd v\u1ec1 tim b\u1ea9m sinh.<\/p>\n","protected":false},"excerpt":{"rendered":"

Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb th\u00f4ng li\u00ean nh\u0129 l\u00e0 m\u1ed9t ch\u1ee7 \u0111\u1ec1 quan tr\u1ecdng trong l\u0129nh v\u1ef1c tim m\u1ea1ch. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb bao g\u1ed3m ph\u1eabu thu\u1eadt ho\u1eb7c can thi\u1ec7p qua da. Quy\u1ebft \u0111\u1ecbnh ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u01b0a ra d\u1ef1a tr\u00ean \u0111\u00e1nh gi\u00e1 to\u00e0n di\u1ec7n c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 […]<\/p>\n","protected":false},"author":7,"featured_media":19434,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[3],"yoast_head":"\nCh\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb th\u00f4ng li\u00ean nh\u0129: ph\u1eabu thu\u1eadt hay can thi\u1ec7p qua da.<\/title>\n<meta name=\"description\" content=\"Ph\u1eabu thu\u1eadt hay can thi\u1ec7p qua da trong \u0111i\u1ec1u tr\u1ecb l\u00e0 v\u1ea5n \u0111\u1ec1 \u0111\u01b0\u1ee3c quan t\u00e2m trong th\u00f4ng li\u00ean nh\u0129. 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