{"id":19520,"date":"2023-04-13T12:11:47","date_gmt":"2023-04-13T05:11:47","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=19520"},"modified":"2023-04-13T16:26:12","modified_gmt":"2023-04-13T09:26:12","slug":"chan-doan-va-dieu-tri-benh-thong-lien-nhi","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/chan-doan-va-dieu-tri-benh-thong-lien-nhi\/","title":{"rendered":"Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh th\u00f4ng li\u00ean nh\u0129"},"content":{"rendered":"<p><strong>Th\u00f4ng li\u00ean nh\u0129 (TLN) chi\u1ebfm 5-10% c\u00e1c b\u1ec7nh tim b\u1ea9m sinh. L\u1ed7 th\u00f4ng nh\u1ecf kh\u00f4ng a\u0309nh h\u01b0\u1edfng \u0111\u1ebfn huy\u1ebft \u0111\u1ed9ng h\u1ecdc. L\u1ed7 th\u00f4ng l\u1edbn g\u00e2y t\u0103ng g\u00e1nh th\u1ea5t pha\u0309i v\u00e0 t\u0103ng l\u01b0u l\u01b0\u1ee3ng m\u00e1u ph\u1ed5i. <b>B\u1ec7nh g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ee9c kh\u1ecfe v\u00e0 s\u1ef1 ph\u00e1t tri\u1ec3n to\u00e0n di\u1ec7n c\u1ee7a tr\u1ebb. Tuy nhi\u00ean, n\u1ebfu \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n s\u1edbm, \u0111i\u1ec1u tr\u1ecb \u0111\u00fang c\u00e1ch, tr\u1ebb s\u1ebd c\u00f3 th\u1ec3 ph\u00e1t tri\u1ec3n b\u00ecnh th\u01b0\u1eddng.<\/b><\/strong><\/p>\n<h2><strong>1. Gi\u1ea3i ph\u1eabu v\u00e0 sinh b\u1ec7nh h\u1ecdc th\u00f4ng li\u00ean nh\u0129:<\/strong><\/h2>\n<p><span style=\"font-weight: 400;\">\u00a0TLN l\u00e0 khuy\u1ebft v\u00e1ch li\u00ean nh\u0129, th\u01b0\u1eddng g\u1eb7p nh\u1ea5t n\u1eb1m \u1edf tr\u00ean v\u00e1ch li\u00ean nh\u0129 th\u1ee9 ph\u00e1t, t\u1ea1i v\u1ecb <\/span><span style=\"font-weight: 400;\">tr\u00ed l\u1ed7 b\u1ea7u d\u1ee5c g\u1ecdi l\u00e0 TLN l\u1ed7 th\u1ee9 ph\u00e1t. C\u0169ng c\u00f3 th\u1ec3 g\u1eb7p \u1edf v\u1ecb tr\u00ed r\u1ea5t cao, gi\u1eefa t\u0129nh m\u1ea1ch ph\u1ed5i ph\u1ea3i tr\u00ean v\u00e0 t\u0129nh m\u1ea1ch ch\u1ee7 tr\u00ean \u0111\u1ed5 v\u00e0o nh\u0129, ho\u1eb7c r\u1ea5t th\u1ea5p g\u1ea7n ch\u1ed7 t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi \u0111\u1ed5 v\u00e0o nh\u0129 (TLN \u1edf xoang t\u0129nh m\u1ea1ch). Hi\u1ebfm g\u1eb7p nh\u1ea5t l\u00e0 TLN \u1edf xoang v\u00e0nh, t\u1ea1i ch\u1ed7 \u0111\u1ed5 v\u00e0o nh\u0129 ph\u1ea3i c\u1ee7a xoang v\u00e0nh.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0&#8211; TLN g\u00e2y lu\u1ed3ng th\u00f4ng tr\u00e1i-ph\u1ea3i c\u00f3 khi r\u1ea5t l\u1edbn g\u00e2y t\u0103ng \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i. T\u0103ng g\u00e1nh t\u00e2m tr\u01b0\u01a1ng nh\u0129 ph\u1ea3i v\u00e0 th\u1ea5t ph\u1ea3i, \u0111\u00e1nh gi\u00e1 d\u1ef1a tr\u00ean s\u1ef1 gi\u00e3n c\u1ee7a nh\u0129 ph\u1ea3i, th\u1ea5t ph\u1ea3i tr\u00ean si\u00eau \u00e2m<\/span><\/p>\n<h4><strong>&#8211; Th\u1ec3 gi\u1ea3i ph\u1eabu:<\/strong><\/h4>\n<p><span style=\"font-weight: 400;\">Th\u00f4ng li\u00ean nh\u0129 c\u00f3 4 th\u1ec3 th\u01b0\u1eddng g\u1eb7p: l\u1ed7 th\u1ee9 ph\u00e1t, nguy\u00ean ph\u00e1t, xoang t\u0129nh m\u1ea1ch, xoang v\u00e0nh.<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">TLN l\u1ed7 th\u1ee9 ph\u00e1t: 50-70%, t\u1ed5n th\u01b0\u01a1ng \u1edf fossa ovalis. B\u1ea5t th\u01b0\u1eddng t\u0129nh m\u1ea1ch ph\u1ed5i v\u1ec1 tim k\u00e8m theo kho\u1ea3ng 10%.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">TLN l\u1ed7 nguy\u00ean ph\u00e1t: 30%, hay k\u00e8m ch\u1ebb van 2 l\u00e1.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">TLN xoang t\u0129nh m\u1ea1ch: chi\u1ebfm 10%, th\u01b0\u1eddng x\u1ea3y ra t\u1ea1i n\u01a1i t\u0129nh m\u1ea1ch ch\u1ee7 tr\u00ean \u0111\u1ed5 v\u00e0o nh\u0129 ph\u1ea3i, hi\u1ebfm khi x\u1ea3y ra t\u1ea1i v\u1ecb tr\u00ed t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi, th\u01b0\u1eddng k\u00e8m b\u1ea5t th\u01b0\u1eddng t\u0129nh m\u1ea1ch ph\u1ed5i v\u1ec1 tim (t\u0129nh m\u1ea1ch ph\u1ed5i ph\u1ea3i v\u1ec1 nh\u0129 ph\u1ea3i hay \u0111\u1ed5 v\u00e0o t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi).<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Khi\u1ebfm khuy\u1ebft c\u1ea5u tr\u00fac xoang v\u00e0nh (unroofed coronary sinus): th\u00f4ng th\u01b0\u01a1ng hi\u1ebfm khi x\u1ea3y ra gi\u1eefa xoang v\u00e0nh v\u00e0 nh\u0129 tr\u00e1i.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Sa van 2 l\u00e1 x\u1ea3y ra 20% b\u1ec7nh nh\u00e2n TLN l\u1ed7 th\u1ee9 ph\u00e1t hay xoang t\u0129nh m\u1ea1ch. <\/span><span style=\"font-weight: 400;\">Shunt tr\u00e1i \u2013 ph\u1ea3i, m\u1ee9c \u0111\u1ed9 t\u00f9y thu\u1ed9c k\u00edch th\u01b0\u1edbc v\u00e0 compliance 2 th\u1ea5t. <\/span><span style=\"font-weight: 400;\">Gi\u00e3n tim ph\u1ea3i, t\u0103ng l\u01b0\u1ee3ng m\u00e1u l\u00ean ph\u1ed5i, kh\u00f4ng gi\u00e3n nh\u0129 tr\u00e1i. <\/span><span style=\"font-weight: 400;\">Shunt qua TLN 2 th\u00ec t\u00e2m thu v\u00e0 t\u00e2m tr\u01b0\u01a1ng.<\/span><\/p>\n<h2><strong>2. Kh\u00e1m l\u00e2m s\u00e0ng <\/strong><strong>th\u00f4ng li\u00ean nh\u0129:<\/strong><\/h2>\n<p><strong>&#8211; TLN l\u1ed7 nh\u1ecf<\/strong><span style=\"font-weight: 400;\"><br \/>\n<\/span> <span style=\"font-weight: 400;\">+ L\u00e2m s\u00e0ng: Kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng. Nghe tim th\u01b0\u1eddng kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c ti\u1ebfng<\/span> <span style=\"font-weight: 400;\">th\u1ed5i, ti\u1ebfng T<\/span><span style=\"font-weight: 400;\">2 <\/span><span style=\"font-weight: 400;\">g\u1ea7n nh\u01b0 b\u00ecnh th\u01b0\u1eddng.<\/span><\/p>\n<p><strong>&#8211; TLN l\u1ed7 l\u1edbn<\/strong><\/p>\n<p><span style=\"font-weight: 400;\">+ L\u00e2m s\u00e0ng: Tr\u1ebb c\u00f3 th\u1ec3 h\u01a1i ch\u1eadm l\u1edbn, m\u1ec7t khi g\u1eafng s\u1ee9c, vi\u00eam ph\u1ed5i t\u00e1i \u0111i t\u00e1i l\u1ea1i. Nghe tim th\u1ea5y<\/span> <span style=\"font-weight: 400;\">1 ti\u1ebfng th\u1ed5i t\u00e2m thu nh\u1eb9 kho\u1ea3ng 2\/6 k\u00e8m v\u1edbi T<\/span><span style=\"font-weight: 400;\">2 <\/span><span style=\"font-weight: 400;\">m\u1ea1nh t\u00e1ch \u0111\u00f4i \u1edf \u1ed5 van \u00d0MP, ti\u1ebfng T<\/span><span style=\"font-weight: 400;\">1 <\/span><span style=\"font-weight: 400;\">m\u1ea1nh<\/span> <span style=\"font-weight: 400;\">v\u00e0 rung t\u00e2m tr\u01b0\u01a1ng do t\u0103ng l\u01b0u l\u01b0\u1ee3ng qua van 3 l\u00e1.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ Kh\u00e1m: T2 t\u00e1ch \u0111\u00f4i r\u1ed9ng v\u00e0 c\u1ed1 \u0111\u1ecbnh v\u00e0 \u00e2m th\u1ed5i t\u00e2m thu t\u1ed1ng m\u00e1u 2-3\/6 l\u00e0 d\u1ea5u hi\u1ec7u \u0111\u1eb7c hi\u1ec7u.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Shunt l\u1edbn: r\u00f9 gi\u1eefa t\u00e2m tr\u01b0\u01a1ng do h\u1eb9p 3 l\u00e1 t\u01b0\u01a1ng \u0111\u1ed1i.<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Tri\u1ec7u ch\u1ee9ng nghe \u0111\u1eb7c hi\u1ec7u c\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 \u1edf tr\u1ebb nh\u0169 nhi v\u00e0 tr\u1ebb nh\u1ecf ngay c\u1ea3 khi c\u00f3 TLN l\u1edbn (compliance th\u1ea5t ph\u1ea3i k\u00e9m).<\/span><\/li>\n<\/ul>\n<h2>3. C\u1eadn l\u00e2m s\u00e0ng<\/h2>\n<h3><strong>3.1. ECG<\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">\u0110i\u1ec7n tim: Th\u00f4ng li\u00ean nh\u0129 l\u1ed7 th\u1ee9 hai v\u00e0 type xoang t\u0129nh m\u1ea1ch: ph\u00ec th\u1ea5t pha\u0309i <\/span><span style=\"font-weight: 400;\">v\u1edbi qsR\u2019 \u1edf aVR v\u00e0 chuy\u1ec3n \u0111\u1ea1o tr\u01b0\u1edbc ng\u1ef1c pha\u0309i, S s\u00e2u \u1edf D1 v\u00e0 chuy\u1ec3n \u0111\u1ea1o ng\u1ef1c tr\u00e1i; <\/span><span style=\"font-weight: 400;\">P cao, tr\u1ee5c QRS l\u1ec7ch pha\u0309i, \u0111\u00f4i khi block nh\u0129 th\u1ea5t \u0111\u1ed9 I. Th\u00f4ng li\u00ean nh\u0129 l\u1ed7 th\u1ee9 nh\u1ea5t: c\u00e1c <\/span><span style=\"font-weight: 400;\">d\u1ea5u hi\u1ec7u tr\u00ean \u0111i\u1ec7n tim nh\u01b0 tr\u00ean, tr\u1eeb tr\u1ee5c QRS l\u1ec7ch qua tr\u00e1i.<\/span><span style=\"font-weight: 400;\">.<\/span><\/p>\n<h3><strong>3.2. X-quang<\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">B\u00f3ng tim to, l\u1edbn nh\u0129 ph\u1ea3i, l\u1edbn th\u1ea5t ph\u1ea3i.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u0110\u1ed9ng m\u1ea1ch ph\u1ed5i gi\u00e3n, t\u0103ng tu\u1ea7n ho\u00e0n ph\u1ed5i, r\u1ed1n ph\u1ed5i \u0111\u1eadm, m\u1ea1ch m\u00e1u ra 1\/2 ngo\u00e0i ph\u1ebf tr\u01b0\u1eddng.\u00a0<\/span><\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"aligncenter wp-image-19796 size-medium\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/tln-300x143.jpg\" alt=\"minh-hoa-benh-thong-lien-nhi\" width=\"300\" height=\"143\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/tln-300x143.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/tln.jpg 656w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/p>\n<h3>3.3. Si\u00eau \u00e2m tim<\/h3>\n<ul>\n<li><span style=\"font-weight: 400;\">Si\u00eau \u00e2m 2D: v\u1ecb tr\u00ed, k\u00edch th\u01b0\u1edbc, quan s\u00e1t t\u1ed1t nh\u1ea5t \u1edf m\u1eb7t c\u1eaft 4 bu\u1ed3ng d\u01b0\u1edbi s\u01b0\u1eddn. TLN l\u1ed7 th\u1ee9 ph\u00e1t, th\u1ea5y hi\u1ec7n t\u01b0\u1ee3ng \u201cm\u1ea5t\u201d ( dropout ) \u1edf gi\u1eefa v\u00e1ch li\u00ean nh\u0129. TLN l\u1ed7 nguy\u00ean ph\u00e1t, khuy\u1ebft v\u00f9ng th\u1ea5t ngay v\u1ecb tr\u00ed van nh\u0129 th\u1ea5t. TLN xoang t\u0129nh m\u1ea1ch, t\u1ed5n th\u01b0\u01a1ng v\u00f9ng sau d\u01b0\u1edbi v\u00e1ch li\u00ean nh\u0129.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">D\u1ea5u hi\u1ec7u gi\u00e1n ti\u1ebfp: l\u1edbn th\u1ea5t ph\u1ea3i, nh\u0129 ph\u1ea3i, gi\u00e3n \u0110M ph\u1ed5i k\u1ebft h\u1ee3p v\u1edbi gia t\u0103ng v\u1eadn t\u1ed1c qua van \u0110M ph\u1ed5i. C\u00e1c d\u1ea5u hi\u1ec7u n\u00e0y li\u00ean quan \u0111\u1ebfn t\u1ea7m quan tr\u1ecdng c\u1ee7a shunt.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Doppler xung c\u00f3 th\u1ec3 th\u1ea5y shunt tr\u00e1i ph\u1ea3i l\u1edbn nh\u1ea5t trong th\u00ec t\u00e2m tr\u01b0\u01a1ng. Doppler m\u00e0u \u0111\u00e1nh gi\u00e1 chi\u1ec1u shunt.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Si\u00eau \u00e2m M mode: chuy\u1ec3n \u0111\u1ed9ng ngh\u1ecbch th\u01b0\u1eddng v\u00e1ch li\u00ean th\u1ea5t, th\u1ea5t ph\u1ea3i l\u1edbn.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Tr\u1ebb l\u1edbn v\u00e0 ng\u01b0\u1eddi l\u1edbn c\u00f3 th\u1ec3 kh\u00f3 th\u1ea5y TLN. Si\u00eau \u00e2m th\u1ef1c qu\u1ea3n c\u1ea7n th\u1ef1c hi\u1ec7n n\u1ebfu nghi ng\u1edd, hay th\u1ef1c hi\u1ec7n \u0111\u00f3ng TLN qua th\u00f4ng tim.<\/span><\/li>\n<\/ul>\n<h2><strong>4. Di\u1ec5n bi\u1ebfn th\u00f4ng li\u00ean nh\u0129<\/strong><\/h2>\n<p><span style=\"font-weight: 400;\">B\u00e1o c\u00e1o tr\u01b0\u1edbc \u0111\u00e2y, TLN c\u00f3 th\u1ec3 t\u1ef1 \u0111\u00f3ng kho\u1ea3ng 40% (14-55%) trong 4 n\u0103m \u0111\u1ea7u, k\u00edch th\u01b0\u1edbc c\u00f3 th\u1ec3 gi\u1ea3m theo th\u1eddi gian \u1edf 1 s\u1ed1 b\u1ec7nh nh\u00e2n. G\u1ea7n \u0111\u00e2y, t\u1ef1 \u0111\u00f3ng kho\u1ea3ng 87%. B\u1ec7nh nh\u00e2n v\u1edbi TLN d\u01b0\u1edbi 3mm \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n tr\u01b0\u1edbc 3 th\u00e1ng tu\u1ed5i, \u0111\u00f3ng 100% v\u00e0o l\u00fac 1 \u00bd tu\u1ed5i v\u00e0 k\u00edch th\u01b0\u1edbc 3-8mm t\u1ef1 \u0111\u00f3ng 80% l\u00fac 1 \u00bd tu\u1ed5i . TLN l\u1ed7 l\u1edbn h\u01a1n 8mm hi\u1ebfm khi t\u1ef1 \u0111\u00f3ng.<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng, suy tim trong giai \u0111o\u1ea1n s\u01a1 sinh \u00edt g\u1eb7p.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">N\u1ebfu shunt kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb, suy tim v\u00e0 cao \u00e1p ph\u1ed5i di\u1ec5n ti\u1ebfn t\u1eeb t\u1eeb \u0111\u1ebfn 20-30 tu\u1ed5i.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">R\u1ed1i lo\u1ea1n nh\u1ecbp nh\u0129 (rung hay cu\u1ed3ng nh\u0129) c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf ng\u01b0\u1eddi l\u1edbn.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m tr\u00f9ng kh\u00f4ng x\u1ea3y ra \u1edf b\u1ec7nh nh\u00e2n TLN \u0111\u01a1n thu\u1ea7n.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Tai bi\u1ebfn m\u1ea1ch m\u00e1u n\u00e3o do thuy\u00ean t\u1eafc m\u1ea1ch m\u00e1u n\u00e3o hi\u1ebfm khi g\u1eb7p.<\/span><\/li>\n<\/ul>\n<h2><strong>5. <a href=\"https:\/\/vinmec.com\/vi\/tim-mach\/thong-tin-suc-khoe\/3-phuong-phap-dieu-tri-thong-lien-nhi\/\">\u0110i\u1ec1u tr\u1ecb<\/a> th\u00f4ng li\u00ean nh\u0129<\/strong><\/h2>\n<h3><strong>5.1 N\u1ed9i khoa:<\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">\u0110i\u1ec1u tr\u1ecb suy tim n\u1ebfu c\u00f3.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Ph\u00f2ng vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c kh\u00f4ng c\u1ea7n thi\u1ebft ngo\u1ea1i tr\u1eeb b\u1ec7nh nh\u00e2n c\u00f3 sa van 2 l\u00e1, TLN l\u1ed7 nguy\u00ean ph\u00e1t, hay c\u00f3 ph\u1ed1i h\u1ee3p v\u1edbi b\u1ec7nh tim kh\u00e1c.<\/span><\/p>\n<h3><strong>5.2 \u0110\u00f3ng TLN b\u1eb1ng th\u00f4ng tim can thi\u1ec7p:<\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">\u0110\u00f3ng TLN qua th\u00f4ng tim can thi\u1ec7p \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng r\u1ed9ng r\u00e3i. C\u00f3 nhi\u1ec1u d\u1ee5ng c\u1ee5 c\u1ee7a c\u00e1c h\u00e3ng kh\u00e1c nhau. Tuy nhi\u00ean, Amplatzer ASD Occlusion device \u0111\u01b0\u1ee3c d\u00f9ng r\u1ed9ng r\u00e3i nh\u1ea5t.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ Ch\u1ec9 \u0111\u1ecbnh : TLN th\u1ee9 ph\u00e1t 5mm-32mm, c\u00f3 r\u00eca \u0111\u1ee7 r\u1ed9ng (4mm) \u0111\u1ec3 c\u00e1nh d\u1ee5ng c\u1ee5 b\u00e1m v\u00e0o. \u0110i\u1ec1u quan tr\u1ecdng l\u00e0 xem x\u00e9t kh\u1ea3 n\u0103ng t\u1ef1 \u0111\u00f3ng c\u1ee7a TLN, kh\u00f4ng th\u1ec3 \u0111\u00f3ng TLN khi b\u1ec7nh nh\u00e2n kh\u00f4ng tri\u1ec7u ch\u1ee9ng v\u00e0 c\u00f3 kh\u1ea3 n\u0103ng t\u1ef1 \u0111\u00f3ng.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ Thu\u1eadn l\u1ee3i: tr\u00e1nh bi\u1ebfn ch\u1ee9ng c\u1ee7a ch\u1ea1y tim ph\u1ed5i nh\u00e2n t\u1ea1o c\u1ee7a m\u1ed5 tim h\u1edf, th\u1eddi gian n\u1eb1m vi\u1ec7n ng\u1eafn (24 gi\u1edd), th\u1eddi gian th\u1ef1c hi\u1ec7n ng\u1eafn (t\u00f9y k\u00edch th\u01b0\u1edbc, v\u1ecb tr\u00ed, kinh nghi\u1ec7m).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ Theo d\u00f5i sau th\u1ee7 thu\u1eadt: H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng qu\u00e1 m\u1ee9c, u\u1ed1ng Aspirin 81mg\/ng\u00e0y trong 6 th\u00e1ng.D\u00f9ng kh\u00e1ng sinh ph\u00f2ng ng\u1eeba vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m tr\u00f9ng.\u00a0 Si\u00eau \u00e2m ki\u1ec3m tra shunt t\u1ed3n l\u01b0u, t\u1eafc ngh\u1ebdn d\u00f2ng ch\u1ea3y c\u1ee7a t\u0129nh m\u1ea1ch ph\u1ed5i, t\u0129nh m\u1ea1ch ch\u1ee7 tr\u00ean, d\u01b0\u1edbi, xoang v\u00e0nh v\u00e0 ch\u1ee9c n\u0103ng van nh\u0129 th\u1ea5t.<\/span><\/p>\n<h3>5.3 Ph\u1eabu thu\u1eadt<\/h3>\n<h4>Ch\u1ec9 \u0111\u1ecbnh:<\/h4>\n<ul>\n<li>Shunt tr\u00e1i ph\u1ea3i v\u1edbi Qp\/Qs \u2265 1.5\/1 v\u00e0 n\u1ebfu \u0111\u00f3ng b\u1eb1ng d\u1ee5ng c\u1ee5 kh\u00f4ng th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c (v\u1ec1 m\u1eb7t k\u0129 thu\u1eadt hay t\u00e0i ch\u00ednh). Th\u1eddi \u0111i\u1ec3m: ch\u1edd 3-4 tu\u1ed5i, v\u00ec kh\u1ea3 n\u0103ng t\u1ef1 \u0111\u00f3ng v\u00e0 dung n\u1ea1p t\u1ed1t.<\/li>\n<li>N\u1ebfu b\u1ec7nh nh\u00e2n nh\u0169 nhi b\u1ecb suy tim kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa, hay tr\u1ebb lo\u1ea1n s\u1ea3n ph\u1ebf qu\u1ea3n ph\u1ed5i ph\u1ea3i c\u1ea7n oxy tr\u1ecb li\u1ec7u v\u00e0 c\u00e1c \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa kh\u00e1c c\u00f3 th\u1ec3 ph\u1eabu thu\u1eadt \u1edf giai \u0111o\u1ea1n nh\u0169 nhi.<\/li>\n<li>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh: kh\u00e1ng l\u1ef1c m\u00e1u ph\u1ed5i cao ( \u2265 10 units\/m2, &gt; 7 units\/m2 v\u1edbi d\u00e3n m\u1ea1ch)<\/li>\n<\/ul>\n<h4>Ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt:<\/h4>\n<ul>\n<li>R\u1ea1ch ng\u1ef1c \u0111\u01b0\u1eddng gi\u1eefa, ch\u1ea1y m\u00e1y tim ph\u1ed5i nh\u00e2n t\u1ea1o, v\u00e1 l\u1ed7 th\u00f4ng b\u1eb1ng m\u00e0ng ng\u00f2ai tim hay Teflon.<\/li>\n<li>T\u1eed vong: &lt; 1%. T\u1ec9 l\u1ec7 cao h\u01a1n, n\u1ebfu b\u1ec7nh nh\u00e2n nh\u0169 nhi, c\u00f3 kh\u00e1ng l\u1ef1c m\u1ea1ch m\u00e1u ph\u1ed5i cao.<\/li>\n<li>Bi\u1ebfn ch\u1ee9ng: tai bi\u1ebfn m\u1ea1ch m\u00e1u n\u00e3o v\u00e0 lo\u1ea1n nh\u1ecbp sau ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 x\u1ea3y ra ngay sau ph\u1eabu thu\u1eadt.<\/li>\n<li><span style=\"font-weight: 400;\">Tim to \/ XQ v\u00e0 th\u1ea5t ph\u1ea3i l\u1edbn \/ SA, T2 t\u00e1ch \u0111\u00f4i c\u00f3 th\u1ec3 t\u1ed3n t\u1ea1i 1-2 n\u0103m sau.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">R\u1ed1i lo\u1ea1n nh\u1ecbp nh\u0129, nh\u1ecbp n\u00fat kho\u1ea3ng 7-20% sau ph\u1eabu thu\u1eadt, th\u1ec9nh tho\u1ea3ng suy n\u00fat xoang, \u0111\u1eb7c bi\u1ec7t sau ph\u1eabu thu\u1eadt TLN xoang t\u0129nh m\u1ea1ch.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">\u0110i\u1ec1u tr\u1ecb lo\u1ea1n nh\u1ecbp: thu\u1ed1c, m\u00e1y t\u1ea1o nh\u1ecbp hay c\u1ea3 hai.<\/span><\/li>\n<\/ul>\n<p><strong>Theo d\u00f5i sau ph\u1eabu thu\u1eadt:<\/strong><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Tim to \/ XQ v\u00e0 th\u1ea5t ph\u1ea3i l\u1edbn \/ SA, T2 t\u00e1ch \u0111\u00f4i c\u00f3 th\u1ec3 t\u1ed3n t\u1ea1i 1-2 n\u0103m sau.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">R\u1ed1i lo\u1ea1n nh\u1ecbp nh\u0129, nh\u1ecbp n\u00fat kho\u1ea3ng 7-20% sau ph\u1eabu thu\u1eadt, th\u1ec9nh tho\u1ea3ng suy n\u00fat xoang, \u0111\u1eb7c bi\u1ec7t sau ph\u1eabu thu\u1eadt TLN xoang t\u0129nh m\u1ea1ch.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">\u0110i\u1ec1u tr\u1ecb lo\u1ea1n nh\u1ecbp: thu\u1ed1c, m\u00e1y t\u1ea1o nh\u1ecbp hay c\u1ea3 hai.<\/span><\/li>\n<\/ul>\n<p><strong>T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/strong><\/p>\n<ol>\n<li>Gi\u00e1o tr\u00ecnh nhi khoa &#8211; \u0110\u1ea1i h\u1ecdc Y D\u01b0\u1ee3c Hu\u1ebf<\/li>\n<li>Batisse A (1993): \u201cCardiologie p\u00e9diatrique pratique\u201d. Doin \u00e9diteurs-Paris.<\/li>\n<li>Dupuis C, Kachaner J, Payot M, Freedom R.M, (1991): \u201cCardiologie p\u00e9diatrique\u201d.Davignon A. Ed. Flammarion M\u00e9dicine-Sciences.<\/li>\n<li>Philippe F (1994): \u201cCardiopathies cong\u00e9nitales\u201d. In: Cardiologie. ELLIPSES\/ AUPELF, p. 416-420.<\/li>\n<li>Moss and Adams (1995): \u201cHeart disease in Infants, Children, and Adolescents including the Fetus and Young Adult\u201d. 5th Ed. Baltimore Williams and Wilkins.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Th\u00f4ng li\u00ean nh\u0129 (TLN) chi\u1ebfm 5-10% c\u00e1c b\u1ec7nh tim b\u1ea9m sinh. L\u1ed7 th\u00f4ng nh\u1ecf kh\u00f4ng a\u0309nh h\u01b0\u1edfng \u0111\u1ebfn huy\u1ebft \u0111\u1ed9ng h\u1ecdc. L\u1ed7 th\u00f4ng l\u1edbn g\u00e2y t\u0103ng g\u00e1nh th\u1ea5t pha\u0309i v\u00e0 t\u0103ng l\u01b0u l\u01b0\u1ee3ng m\u00e1u ph\u1ed5i. B\u1ec7nh g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ee9c kh\u1ecfe v\u00e0 s\u1ef1 ph\u00e1t tri\u1ec3n to\u00e0n di\u1ec7n c\u1ee7a tr\u1ebb. Tuy nhi\u00ean, n\u1ebfu \u0111\u01b0\u1ee3c ph\u00e1t [&hellip;]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh th\u00f4ng li\u00ean nh\u0129 - Vinmec<\/title>\n<meta name=\"description\" content=\"Th\u00f4ng li\u00ean nh\u0129 (TLN) chi\u1ebfm 5-10% c\u00e1c b\u1ec7nh tim b\u1ea9m sinh. 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B\u1ec7nh g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ee9c kh\u1ecfe v\u00e0 s\u1ef1 ph\u00e1t tri\u1ec3n to\u00e0n di\u1ec7n c\u1ee7a tr\u1ebb.L\" \/>\n<meta property=\"og:url\" content=\"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/chan-doan-va-dieu-tri-benh-thong-lien-nhi\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-13T05:11:47+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-04-13T09:26:12+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/tln-300x143.jpg\" \/>\n<meta name=\"author\" content=\"Dai Tran Van\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Dai Tran Van\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"7 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/chan-doan-va-dieu-tri-benh-thong-lien-nhi\/\",\"url\":\"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/chan-doan-va-dieu-tri-benh-thong-lien-nhi\/\",\"name\":\"Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh th\u00f4ng li\u00ean nh\u0129 - Vinmec\",\"isPartOf\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-04-13T05:11:47+00:00\",\"dateModified\":\"2023-04-13T09:26:12+00:00\",\"author\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/b99bd843f29d91903ec9b6d18e47b0e2\"},\"description\":\"Th\u00f4ng li\u00ean nh\u0129 (TLN) chi\u1ebfm 5-10% c\u00e1c b\u1ec7nh tim b\u1ea9m sinh. 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