{"id":20750,"date":"2023-04-15T10:23:16","date_gmt":"2023-04-15T03:23:16","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=20750"},"modified":"2023-04-17T15:12:27","modified_gmt":"2023-04-17T08:12:27","slug":"chan-doan-va-dieu-tri-tu-chung-fallot","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/chan-doan-va-dieu-tri-tu-chung-fallot\/","title":{"rendered":"Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb t\u1ee9 ch\u1ee9ng Fallot"},"content":{"rendered":"

T\u1ee9 ch\u1ee9ng Fallot (Tetralogy of Fallot : TOF) l\u00e0 t\u1eadt tim b\u1ea9m sinh t\u00edm th\u01b0\u1eddng g\u1eb7p nh\u1ea5t, chi\u1ebfm kho\u1ea3ng 5-10% c\u00e1c tr\u01b0\u1eddng h\u1ee3p tim b\u1ea9m sinh. T\u1ea7n su\u1ea5t m\u1eafc \u1edf tr\u1ebb nam v\u00e0 tr\u1ebb n\u1eef nh\u01b0 nhau. Bao g\u1ed3m 4 t\u1eadt: Th\u00f4ng li\u00ean th\u1ea5t (VSD) r\u1ed9ng, t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra th\u1ea5t ph\u1ea3i, ph\u00ec \u0111\u1ea1i th\u1ea5t ph\u1ea3i v\u00e0 \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 c\u01b0\u1ee1i ng\u1ef1a tr\u00ean v\u00e1ch li\u00ean th\u1ea5t..<\/strong><\/p>\n

Hai b\u1ea5t th\u01b0\u1eddng ch\u00ednh: VSD l\u1edbn nh\u1eb1m c\u00e2n b\u1eb1ng 2 th\u1ea5t v\u00e0 h\u1eb9p \u0111\u01b0\u1eddng tho\u00e1t th\u1ea5t ph\u1ea3i. D\u00e0y th\u1ea5t ph\u1ea3i l\u00e0 th\u1ee9 ph\u00e1t sau th\u00f4ng li\u00ean th\u1ea5t v\u00e0 h\u1eb9p th\u1ea5t ph\u1ea3i. M\u1ee9c \u0111\u1ed9 c\u1ee7a c\u01b0\u1ee1i ng\u1ef1a v\u00e1ch li\u00ean th\u1ea5t thay \u0111\u1ed5i.<\/strong><\/p>\n

1. Gi\u1ea3i ph\u1eabu v\u00e0 b\u1ec7nh h\u1ecdc<\/strong><\/h2>\n

\u00a0 \u00a0VSD th\u01b0\u1eddng l\u00e0 ph\u1ea7n m\u00e0ng lan ph\u1ea7n tho\u00e1t. H\u1eb9p \u0111\u01b0\u1eddng tho\u00e1t th\u1ea5t: d\u01b0\u1edbi van (45%), t\u1ea1i van (10%), d\u01b0\u1edbi van v\u00e0 t\u1ea1i van 30%, teo van trong tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng (15%). Ph\u1ea7n l\u1edbn v\u00f2ng van v\u00e0 \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i b\u1ecb gi\u1ea3m s\u1ea3n, h\u1eb9p t\u1ea1i g\u1ed1c nh\u00e1nh tr\u00e1i hay g\u1eb7p, tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 ch\u1ee7 ph\u1ed5i (n\u1ebfu h\u1eb9p n\u1eb7ng).<\/span><\/p>\n

K\u00eanh nh\u0129 th\u1ea5t to\u00e0n ph\u1ea7n chi\u1ebfm 2% b\u1ec7nh nh\u00e2n TOF, hay g\u1eb7p nh\u1ea5t l\u00e0 hc Down.<\/span><\/p>\n

M\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a h\u1eb9p \u0111\u01b0\u1eddng tho\u00e1t th\u1ea5t ph\u1ea3i x\u00e1c \u0111\u1ecbnh chi\u1ec1u lu\u1ed3ng shunt v\u00e0 t\u1ea7m quan tr\u1ecdng c\u1ee7a shunt:<\/span><\/p>\n

+ H\u1eb9p nh\u1eb9 shunt l\u00e0 tr\u00e1i ph\u1ea3i, gi\u1ed1ng VSD. C\u00f2n g\u1ecdi l\u00e0 TOF h\u1ed3ng.<\/span><\/p>\n

+ N\u1eb7ng h\u01a1n shunt ph\u1ea3i tr\u00e1i : TOF t\u00edm<\/span><\/p>\n

–<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>TOF h\u1ed3ng: tu\u1ea7n ho\u00e0n ph\u1ed5i t\u0103ng nh\u1eb9, ECG lu\u00f4n l\u1edbn th\u1ea5t ph\u1ea3i, th\u1ec9nh tho\u1ea3ng l\u1edbn th\u1ea5t tr\u00e1i. \u00c2m th\u1ed5i do VSD v\u00e0 h\u1eb9p ph\u1ed5i, b\u1edfi v\u1eady tr\u1ebb c\u00f3 l\u00e2m s\u00e0ng v\u00e0 XQ gi\u1ed1ng VSD nh\u1ecf nh\u01b0ng n\u1ebfu c\u00f3 l\u1edbn th\u1ea5t ph\u1ea3i hay 2 th\u1ea5t \/ ECG th\u00ec g\u1ee3i \u00fd TOF h\u1ed3ng h\u01a1n l\u00e0 VSD. N\u1ebfu c\u00f3 cung ph\u1ea3i c\u00e0ng x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n.<\/span><\/p>\n

–<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>TOF t\u00edm v\u1edbi shunt ph\u1ea3i tr\u00e1i v\u00e0 tu\u1ea7n ho\u00e0n ph\u1ed5i gi\u1ea3m. \u00c2m th\u1ed5i l\u00e0 do h\u1eb9p \u0111\u01b0\u1eddng tho\u00e1t th\u1ea5t ph\u1ea3i, nghe r\u00f5 \u1edf b\u1edd tr\u00e1i \u1ee9c cao (h\u1eb9p van) v\u00e0 th\u1ea5p h\u01a1n (h\u1eb9p d\u01b0\u1edbi van), c\u01b0\u1eddng \u0111\u1ed9 v\u00e0 th\u1eddi gian t\u00f9y thu\u1ed9c m\u1ee9c \u0111\u1ed9 h\u1eb9p ph\u1ed5i.<\/span><\/p>\n

\u00a0TOF kh\u00f4ng g\u00e2y suy tim v\u00ec kh\u00f4ng bu\u1ed3ng tim n\u00e0o ch\u1ecbu qu\u00e1 t\u1ea3i th\u1ec3 t\u00edch v\u00e0 \u00e1p l\u1ef1c \u0111\u1eb7t l\u00ean th\u1ea5t ph\u1ea3i th\u00ec \u0111\u01b0\u1ee3c gi\u1ea3i tho\u00e1t qua VSD kh\u00e1 l\u1edbn. T\u1ec9 l\u1ec7 gi\u1eefa m\u00e1u ph\u1ed5i v\u00e0 h\u1ec7 th\u1ed1ng t\u00f9y thu\u1ed9c v\u00e0o kh\u00e1ng l\u1ef1c h\u1ec7 th\u1ed1ng v\u00e0 m\u1ee9c \u0111\u1ed9 c\u1ea3n tr\u1edf \u0111\u01b0\u1eddng tho\u00e1t th\u1ea5t ph\u1ea3i. S\u1ef1 gia t\u0103ng kh\u00e1ng tr\u1edf ph\u1ed5i hay gi\u1ea3m kh\u00e1ng l\u1ef1c h\u1ec7 th\u1ed1ng g\u00e2y t\u0103ng shunt ph\u1ea3i tr\u00e1i, g\u00e2y gi\u1ea3m \u0111\u1ed9 b\u00e3o h\u00f2a oxy m\u00e1u.<\/span><\/p>\n

\u00a0 \u00a0 \u00a02. <\/strong><\/span>L\u00e2m s\u00e0ng t\u1ee9 ch\u1ee9ng Fallot:<\/strong><\/h2>\n

+ T\u00edm: l\u00e0 d\u1ea5u hi\u1ec7u ch\u00ednh, th\u01b0\u1eddng d\u1ec5 th\u1ea5y nh\u1ea5t. Trong nh\u1eefng th\u1ec3 n\u1eb7ng t\u00edm xu\u1ea5t hi\u1ec7n s\u1edbm t\u1eeb l\u00fac<\/span> sinh ho\u1eb7c tr\u01b0\u1edbc 6 th\u00e1ng. trong nh\u1eefng th\u1ec3 nh\u1eb9 t\u00edm xu\u1ea5t hi\u1ec7n mu\u1ed9n h\u01a1n sau 1 tu\u1ed5i ho\u1eb7c l\u00fac b\u1eaft<\/span> \u0111\u1ea7u bi\u1ebft \u0111i. T\u00edm d\u1ec5 th\u1ea5y \u1edf m\u00f4i, m\u00f3ng tay, m\u00f3ng ch\u00e2n.<\/span>
\n<\/span> + Ng\u00f3n tay ng\u00f3n ch\u00e2n d\u00f9i tr\u1ed1ng: th\u1ea5y r\u00f5 nh\u1ea5t \u1edf ng\u00f3n tay c\u00e1i, ng\u00f3n ch\u00e2n c\u00e1i.<\/span>
\n<\/span> + Ng\u1ed3i x\u1ed5m: \u0111\u00e2y l\u00e0 t\u01b0 th\u1ebf tr\u1ebb Fallot th\u01b0\u1eddng d\u00f9ng \u0111\u1ec3 ch\u1ed1ng l\u1ea1i kh\u00f3 th\u1edf v\u00e0 t\u00edm nhi\u1ec1u khi g\u1eafng<\/span> s\u1ee9c. Trong t\u01b0 th\u1ebf n\u00e0y l\u00e0m t\u0103ng \u00e1p l\u1ef1c trong \u00d0MC, l\u00e0m t\u0103ng \u00e1p l\u1ef1c trong th\u1ea5t tr\u00e1i, l\u00e0m h\u1ea1n ch\u1ebf<\/span> lu\u1ed3ng th\u00f4ng ph\u1ea3i-tr\u00e1i qua l\u1ed7 TLT, l\u00e0m t\u0103ng l\u01b0\u1ee3ng m\u00e1u l\u00ean ph\u1ed5i.<\/span>
\n<\/span> + C\u01a1n thi\u1ebfu oxy c\u1ea5p: th\u01b0\u1eddng x\u1ea3y ra \u1edf l\u1ee9a tu\u1ed5i b\u00fa m\u1eb9. Trong c\u01a1n tr\u1ebb c\u00f3 bi\u1ec3u hi\u1ec7n t\u00edm t\u0103ng l\u00ean,<\/span> th\u1edf nhanh, h\u1ed1t ho\u1ea3ng, ti\u1ebfng th\u1ed5i t\u00e2m thu c\u1ee7a h\u1eb9p \u00d0MP gi\u1ea3m ho\u1eb7c bi\u1ebfn m\u1ea5t do gi\u1ea3m d\u00f2ng m\u00e1u<\/span> qua ph\u1ed5i. C\u01a1n thi\u1ebfu oxy c\u1ea5p c\u00f3 th\u1ec3 d\u1eabn t\u1edbi ng\u1ea5t, co gi\u1eadt, h\u00f4n m\u00ea, th\u1eadm ch\u00ed t\u1eed vong n\u1ebfu kh\u00f4ng<\/span> x\u1eed tr\u00ed k\u1ecbp th\u1eddi.<\/span><\/p>\n

+ Nghe tim: th\u1ea5y c\u00f3 ti\u1ebfng th\u1ed5i t\u00e2m thu d\u1ea1ng t\u1ed1ng m\u00e1u m\u1ea1nh \u2265 3\/6 \u1edf gian s\u01b0\u1eddn 2-3 c\u1ea1nh \u1ee9c<\/span> tr\u00e1i. Ti\u1ebfng T2 m\u1edd ho\u1eb7c m\u1ea5t trong tr\u01b0\u1eddng h\u1ee3p h\u1eb9p van \u00d0MP. C\u00f3 th\u1ec3 nghe th\u1ea5y th\u1ed5i li\u00ean t\u1ee5c \u1edf<\/span> ph\u00eda tr\u01b0\u1edbc ho\u1eb7c sau l\u01b0ng do c\u00f2n \u00d4\u00d0M ho\u1eb7c tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 ph\u1ebf qu\u1ea3n.<\/span><\/p>\n

Ch\u00fa \u00fd: Tr\u1ebb s\u01a1 sinh t\u00edm n\u1eb7ng do TOF th\u1ec3 teo van th\u01b0\u1eddng kh\u00f4ng nghe \u00e2m th\u1ed5i t\u00e2m thu m\u00e0 th\u1ec9nh tho\u1ea3ng nghe \u00e2m th\u1ed5i li\u00ean t\u1ee5c c\u1ee7a c\u00f2n \u1ed1ng \u0111\u1ed9ng m\u1ea1ch. \u1ede th\u1ec3 kh\u00f4ng t\u00edm c\u00f3 th\u1ec3 nghe \u00e2m th\u1ed5i t\u00e2m thu d\u00e0i do VSD v\u00e0 h\u1eb9p ph\u1ed5i.<\/span><\/p>\n

\u00a0 \u00a0 \u00a03. C\u1eadn l\u00e2m s\u00e0ng t\u1ee9 ch\u1ee9ng Fallot<\/strong><\/h2>\n

3.1 X Quang<\/h3>\n