{"id":23647,"date":"2023-04-17T21:47:42","date_gmt":"2023-04-17T14:47:42","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=23647"},"modified":"2023-04-18T10:50:46","modified_gmt":"2023-04-18T03:50:46","slug":"loc-tach-dong-mach-chu-va-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/loc-tach-dong-mach-chu-va-dieu-tri\/","title":{"rendered":"L\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 type A v\u00e0 type B: Tri\u1ec7u ch\u1ee9ng, nguy\u00ean nh\u00e2n v\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"<p><strong>L\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u00e0 t\u00ecnh tr\u1ea1ng c\u1ea5p c\u1ee9u, do r\u00e1ch l\u1edbp n\u1ed9i m\u1ea1c t\u1ea1o th\u00f4ng n\u1ed1i hay kh\u1ed1i m\u00e1u t\u1ee5 gi\u1eefa l\u1edbp n\u1ed9i m\u1ea1c v\u00e0 l\u1edbp gi\u1eefa c\u1ee7a th\u00e0nh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7. C\u00e1c bi\u1ebfn ch\u1ee9ng kh\u00e1c bao g\u1ed3m: tr\u00e0n m\u00e1u, ch\u00e8n \u00e9p tim, h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, h\u1ed9i ch\u1ee9ng gi\u1ea3m t\u01b0\u1edbi m\u00e1u ph\u1ea7n g\u1ea7n v\u00e0 xa.<\/strong><\/p>\n<h2>1.\u0110\u1ecbnh ngh\u0129a<\/h2>\n<p>L\u00e0 t\u00ecnh tr\u1ea1ng c\u1ea5p c\u1ee9u, do r\u00e1ch l\u1edbp n\u1ed9i m\u1ea1c t\u1ea1o th\u00f4ng n\u1ed1i hay kh\u1ed1i m\u00e1u t\u1ee5 gi\u1eefa l\u1edbp n\u1ed9i m\u1ea1c v\u00e0 l\u1edbp gi\u1eefa c\u1ee7a th\u00e0nh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, h\u00ecnh th\u00e0nh l\u00f2ng th\u1eadt v\u00e0 l\u00f2ng gi\u1ea3.G\u1ecdi l\u00e0 c\u1ea5p t\u00ednh n\u1ebfu xu\u1ea5t hi\u1ec7n &lt;14 ng\u00e0y; b\u00e1n c\u1ea5p n\u1ebfu 15-90 ng\u00e0y v\u00e0 m\u1ea1n t\u00ednh n\u1ebfu &gt;90 ng\u00e0y.<\/p>\n<p>Ph\u1ea7n l\u1edbn tr\u01b0\u1eddng h\u1ee3p l\u00f3c t\u00e1ch kh\u1edfi ph\u00e1t t\u1eeb s\u1ef1 r\u00e1ch l\u1edbp \u00e1o trong (n\u1ed9i m\u1ea1c) d\u1eabn \u0111\u01b0\u1eddng cho m\u00e1u \u0111i v\u00e0o l\u1edbp \u00e1o gi\u1eefa g\u00e2y l\u00f3c t\u00e1ch, l\u00f3c t\u00e1ch c\u00f3 th\u1ec3 \u0111i ng\u01b0\u1ee3c chi\u1ec1u ho\u1eb7c xu\u00f4i chi\u1ec1u, c\u00f3 th\u1ec3 l\u00e0m v\u1ee1 \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 n\u1ebfu ph\u00e1 v\u1ee1 l\u1edbp \u00e1o ngo\u00e0i ho\u1eb7c l\u00f3c t\u00e1ch v\u00e0o l\u1ea1i l\u00f2ng m\u1ea1ch th\u00f4ng qua m\u1ed9t ch\u1ed7 r\u00e1ch n\u1ed9i m\u1ea1c th\u1ee9 2. C\u00e1c bi\u1ebfn ch\u1ee9ng kh\u00e1c bao g\u1ed3m: tr\u00e0n m\u00e1u, ch\u00e8n \u00e9p tim, h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, h\u1ed9i ch\u1ee9ng gi\u1ea3m t\u01b0\u1edbi m\u00e1u ph\u1ea7n g\u1ea7n v\u00e0 xa.<\/p>\n<h2>2.Ph\u00e2n lo\u1ea1i:<\/h2>\n<p>B\u1ec7nh su\u1ea5t, t\u1eed su\u1ea5t\u00a0 v\u00e0 \u0111i\u1ec1u tr\u1ecb t\u00f9y thu\u1ed9c v\u00e0o c\u00f3 hay kh\u00f4ng l\u00f3c t\u00e1ch \u0111\u1ebfn \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ng\u1ef1c \u0111o\u1ea1n l\u00ean, do \u0111\u00f3 ph\u00e2n lo\u1ea1i t\u00f9y theo c\u00f3 li\u00ean quan \u0111\u1ebfn \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u0111o\u1ea1n l\u00ean hay kh\u00f4ng.<\/p>\n<h3><strong>2.1 Ph\u00e2n lo\u1ea1i DeBakey:<\/strong><\/h3>\n<ul>\n<li>Lo\u1ea1i I (50% l\u00f3c t\u00e1ch): T\u1ed3n th\u01b0\u01a1ng l\u00f3c t\u00e1ch n\u00e0y b\u1eaft \u0111\u1ea7u t\u1eeb \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u00ean v\u00e0 k\u00e9o d\u00e0i \u00edt nh\u1ea5t \u0111\u1ebfn quai \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 \u0111\u00f4i khi v\u01b0\u1ee3t qu\u00e1 quai \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.<\/li>\n<li>Lo\u1ea1i II (35%): T\u1ed5n th\u01b0\u01a1ng l\u00f3c t\u00e1ch b\u1eaft \u0111\u1ea7u v\u00e0 n\u1eb1m trong \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u00ean (g\u1ea7n v\u1edbi th\u00e2n \u0111\u1ed9ng m\u1ea1ch c\u00e1ch tay \u0111\u1ea7u ho\u1eb7c \u0111\u1ed9ng m\u1ea1ch v\u00f4 danh).<\/li>\n<li>Lo\u1ea1i III (15%): L\u00f3c t\u00e1ch b\u1eaft \u0111\u1ea7u t\u1eeb \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 xu\u1ed1ng ngay d\u01b0\u1edbi ch\u1ed7 xu\u1ea5t ph\u00e1t c\u1ee7a \u0111\u1ed9ng m\u1ea1ch d\u01b0\u1edbi \u0111\u00f2n tr\u00e1i v\u00e0 c\u00f3 th\u1ec3 k\u00e9o d\u00e0i xu\u1ed1ng ph\u00eda d\u01b0\u1edbi, m\u1ed9t s\u1ed1 \u00edt tr\u01b0\u1eddng h\u1ee3p ti\u1ebfn tri\u1ec3n lan v\u1ec1 ph\u00eda \u0111\u1ea7u g\u1ea7n. L\u00f3c t\u00e1ch lo\u1ea1i IIIa b\u1eaft \u0111\u1ea7u t\u1eeb d\u01b0\u1edbi ch\u1ed7 chia nh\u00e1nh \u0111\u1ed9ng m\u1ea1ch d\u01b0\u1edbi \u0111\u00f2n v\u00e0 t\u1ed5n th\u01b0\u01a1ng ch\u1ec9 \u1edf \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ng\u1ef1c. T\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 lo\u1ea1i IIIb b\u1eaft \u0111\u1ea7u t\u1eeb d\u01b0\u1edbi ch\u1ed7 chia ra \u0111\u1ed9ng m\u1ea1ch d\u01b0\u1edbi \u0111\u00f2n tr\u00e1i v\u00e0 k\u00e9o d\u00e0i xu\u1ed1ng d\u01b0\u1edbi c\u01a1 ho\u00e0nh.<\/li>\n<\/ul>\n<h3><strong>2.2 Ph\u00e2n lo\u1ea1i Stanford<\/strong><\/h3>\n<ul>\n<li>Stanford Type A: T\u1ed5n th\u01b0\u01a1ng c\u00f3 li\u00ean quan \u0111\u1ebfn \u0110MC l\u00ean v\u00e0 cung \u0110MC v\u00e0 c\u00f3 th\u1ec3 \/ kh\u00f4ng li\u00ean quan \u0110MC xu\u1ed1ng.<\/li>\n<li>Stanford Type B: T\u1ed5n th\u01b0\u01a1ng li\u00ean quan \u0111\u1ebfn \u0110MC xu\u1ed1ng ph\u00eda xa c\u1ee7a \u0111\u1ed9ng m\u1ea1ch d\u01b0\u1edbi \u0111\u00f2n tr\u00e1i.<\/li>\n<\/ul>\n<p>Ph\u00e2n lo\u1ea1i Stanford \u0111\u00e3 thay th\u1ebf ph\u00e2n lo\u1ea1i DeBakey.<\/p>\n<p>Ph\u01b0\u01a1ng th\u1ee9c \u0111i\u1ec1u tr\u1ecb c\u1ee7a 2 nh\u00f3m r\u1ea5t kh\u00e1c nhau:<\/p>\n<ul>\n<li>Stanford Type A: \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i khoa ho\u1eb7c can thi\u1ec7p n\u1ed9i m\u1ea1ch .<\/li>\n<li>Stanford Type B : \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa ( n\u1ebfu kh\u00f4ng ph\u1ee9c t\u1ea1p).<\/li>\n<\/ul>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone wp-image-23663\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Stanford-and-DeBakey-classifications-of-aortic-dissection-Figure-from-61-Aortic-300x205.png\" alt=\"Ph\u00e2n lo\u1ea1i l\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7\" width=\"401\" height=\"274\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Stanford-and-DeBakey-classifications-of-aortic-dissection-Figure-from-61-Aortic-300x205.png 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Stanford-and-DeBakey-classifications-of-aortic-dissection-Figure-from-61-Aortic-768x526.png 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Stanford-and-DeBakey-classifications-of-aortic-dissection-Figure-from-61-Aortic.png 850w\" sizes=\"(max-width: 401px) 100vw, 401px\" \/><\/p>\n<p><strong>H\u00ecnh 1: Ph\u00e2n lo\u1ea1i ph\u00ecnh l\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.<\/strong><\/p>\n<h2>3.Nguy\u00ean nh\u00e2n<\/h2>\n<ul>\n<li>L\u00f3c t\u00e1ch th\u01b0\u1eddng \u1edf v\u1ecb tr\u00ed ph\u00ecnh v\u00e0 do \u0111\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 g\u00e2y ph\u00ecnh v\u00e0 l\u00f3c t\u00e1ch t\u01b0\u01a1ng t\u1ef1 nhau, v\u00ed d\u1ee5: cao tu\u1ed5i, t\u0103ng huy\u1ebft \u00e1p, b\u1ec7nh van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 2 m\u1ea3nh, h\u1ed9i ch\u1ee9ng Marfan, ti\u1ec1n s\u1eed gia \u0111\u00ecnh ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ng\u1ef1c hay l\u00f3c t\u00e1ch. Tuy nhi\u00ean, l\u00f3c t\u00e1ch c\u00f3 th\u1ec3 x\u1ea3y ra nh\u1eefng \u0111o\u1ea1n \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 kh\u00f4ng ph\u00ecnh.<\/li>\n<li>Nh\u1eefng th\u1ee7 thu\u1eadt li\u00ean quan \u0111\u1ebfn \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 nh\u01b0 th\u00f4ng tim, b\u00f3ng \u0111\u1ed1i xung trong \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, ph\u1eabu thu\u1eadt tim.<\/li>\n<li>Cocain c\u00f3 th\u1ec3 kh\u1edfi ph\u00e1t l\u00f3c t\u00e1ch.<\/li>\n<li>T\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 do ch\u1ea5n th\u01b0\u01a1ng \u0111i\u1ec3n h\u00ecnh c\u00f3 th\u1ec3 g\u00e2y \u0111\u1ee9t ngang d\u1eabn \u0111\u1ebfn l\u00f3c t\u00e1ch.<\/li>\n<\/ul>\n<h2>4.Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng:<\/h2>\n<p>\u0110au l\u00e0 tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t(90%). C\u1ea7n h\u1ecfi \u0111\u1eb7c \u0111i\u1ec3m c\u01a1n \u0111au v\u1ec1 kh\u1edfi ph\u00e1t, \u0111\u1ed9 n\u1eb7ng, ki\u1ec3u \u0111au, h\u01b0\u1edbng lan c\u00f3 th\u1ec3 gi\u00fap \u00edch.<\/p>\n<ul>\n<li>Kh\u1edfi ph\u00e1t m\u1ed9t c\u00e1ch \u0111\u1ed9t ng\u1ed9t chi\u1ebfm 84% s\u1ed1 ca. \u0110i\u1ec3n h\u00ecnh \u0111au nhi\u1ec1u nh\u1ea5t l\u00fac kh\u1edfi \u0111\u1ea7u, kh\u00f4ng \u0111i\u1ec3n h\u00ecnh trong h\u1ed9i ch\u1ee9ng m\u1ea1ch v\u00e0nh c\u1ea5p.<\/li>\n<li>\u0110au d\u1eef d\u1ed9i 90% s\u1ed1 ca.<\/li>\n<li>Ki\u1ec3u \u0111au nh\u01b0 x\u00e9 r\u00e1ch, b\u1ecb c\u1eaft hay dao \u0111\u00e2m c\u0169ng th\u01b0\u1eddng g\u1eb7p.<\/li>\n<li>V\u1ecb tr\u00ed \u0111au c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn v\u1ecb tr\u00ed l\u00f3c t\u00e1ch v\u00e0 h\u01b0\u1edbng lan ph\u1ea7n xa b\u1ecb l\u00f3c t\u00e1ch: Type A \u0111au ph\u00eda tr\u01b0\u1edbc nhi\u1ec1u h\u01a1n g\u1ea5p 2 l\u1ea7n so v\u1edbi sau l\u01b0ng.Type B \u0111au sau l\u01b0ng chi\u1ebfm 2\/3 s\u1ed1 ca, nh\u01b0ng \u0111au ng\u1ef1c c\u0169ng c\u00f3 th\u1ec3 x\u1ea3y ra.<\/li>\n<\/ul>\n<ul>\n<li>\u0110au b\u1ee5ng c\u0169ng c\u00f3 th\u1ec3 l\u00e0 bi\u1ec3u hi\u1ec7n \u0111\u01a1n \u0111\u1ed9c c\u1ee7a l\u00f3c t\u00e1ch v\u00e0 \u0111au c\u0169ng c\u00f3 th\u1ec3 khu tr\u00fa \u1edf c\u1ed5, th\u1eaft l\u01b0ng hay c\u00e1c chi.<\/li>\n<li>C\u01a1n \u0111au th\u01b0\u1eddng li\u00ean t\u1ee5c nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 gi\u1ea3m \u0111i<\/li>\n<li>Khi kh\u00f4ng c\u00f3 c\u01a1n \u0111au , b\u1ec7nh nh\u00e2n th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n ng\u1ea5t, \u0111\u1ed9t qu\u1ef5 hay suy tim.<\/li>\n<li>Huy\u1ebft \u00e1p: L\u00fac \u0111\u1ea7u, kho\u1ea3ng 1\/3 b\u1ec7nh nh\u00e2n c\u00f3 t\u0103ng huy\u1ebft \u00e1p, kho\u1ea3ng 1\/7 b\u1ec7nh nh\u00e2n c\u00f3 t\u1ee5t huy\u1ebft \u00e1p v\u00e0 1\/7 c\u00f3 s\u1ed1c. T\u0103ng huy\u1ebft \u00e1p th\u01b0\u1eddng \u1edf type B. Huy\u1ebft \u00e1p ph\u1ea3i \u0111o 2 tay, th\u01b0\u1eddng xuy\u00ean \u0111o c\u1ea3 2 tay v\u00e0 2 ch\u00e2n, \u0111\u1ec3 nh\u1eadn bi\u1ebft t\u1ee5t huy\u1ebft \u00e1p gi\u1ea3 t\u1ea1o, hay huy\u1ebft \u00e1p th\u1ea5p do l\u00f3c t\u00e1ch \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn m\u1ed9t nh\u00e1nh \u0111\u1ed9ng m\u1ea1ch. S\u1ef1 kh\u00e1c bi\u1ec7t &gt;20mmHg \u0111\u01b0\u1ee3c xem l\u00e0 c\u00f3 \u00fd ngh\u0129a.<\/li>\n<li>Ng\u1ea5t th\u01b0\u1eddng x\u1ea3y ra \u1edf type A, kh\u00f4ng th\u01b0\u1eddng g\u1eb7p \u1edf type B.<\/li>\n<\/ul>\n<p>Khi m\u1ed9t lo\u1ea1t tri\u1ec7u ch\u1ee9ng tim m\u1ea1ch, th\u1ea7n kinh, b\u1ee5ng k\u1ebft h\u1ee3p m\u00e0 kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c, h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 c\u1ea5p ph\u1ea3i \u0111\u01b0\u1ee3c ngh\u0129 \u0111\u1ebfn.<\/p>\n<h2>5.\u0110i\u1ec1u tr\u1ecb:<\/h2>\n<h3>5.1 \u0110i\u1ec1u tr\u1ecb l\u00f3c t\u00e1ch type A:<\/h3>\n<ul>\n<li>Type A t\u1eed vong 1-2% \/ gi\u1edd sau khi kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng, 90% n\u1ebfu kh\u00f4ng \u0111i\u1ec1u tr\u1ecb, 40% n\u1ebfu c\u00f3 \u0111i\u1ec1u tr\u1ecb. T\u1eed vong th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn tr\u00e0n m\u00e1u m\u00e0ng tim v\u00e0 ch\u00e8n \u00e9p tim, v\u1ee1 hay l\u00f3c t\u00e1ch lan r\u1ed9ng. S\u1ed1ng c\u00f2n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n n\u1ebfu ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1edbm.<\/li>\n<li>Ph\u1eabu thu\u1eadt s\u1eeda ch\u1eefa kh\u1ea9n \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh b\u00f3c tach type A ( Class IA-ESC 2014)<\/li>\n<li>M\u1ee5c ti\u00eau ph\u1eabu thu\u1eadt l\u00e0 thay th\u1ebf \u0111o\u1ea1n \u0110MC l\u00ean b\u1ecb l\u00f3c t\u00e1ch, ph\u00f2ng \u0111\u1ed9t t\u1eed do r\u00e1ch \u0110MC.<\/li>\n<li>Ph\u1eabu thu\u1eadt k\u00e8m thay van \u0110MC khi l\u00f3c t\u00e1ch lan \u0111\u1ebfn \u00edt nh\u1ea5t 1 xoang Valsava.<\/li>\n<li>B\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng gi\u1ea3m t\u01b0\u1edbi m\u00e1u t\u1ea1ng v\u00e0 th\u1eadn th\u01b0\u1eddng c\u00f3 \u0111\u01b0\u1eddng v\u00e0o c\u1ee7a l\u00f3c t\u00e1ch \u1edf \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 xu\u1ed1ng v\u00e0 th\u01b0\u1eddng \u0111\u01b0\u1ee3c l\u00e0m ph\u1eabu thu\u1eadt n\u00e2ng cao nh\u01b0 ph\u1ed1i h\u1ee3p thay \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u00ean, \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ngang, \u0111\u1eb7t stent graft \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 xu\u1ed1ng c\u00f9ng m\u1ed9t th\u00ec \u0111\u1ec3 \u0111\u00f3ng \u0111\u01b0\u1eddng v\u00e0o v\u00e0 gi\u1ea3i \u00e1p cho l\u00f2ng th\u1eadt, l\u00fd t\u01b0\u1edfng n\u00ean th\u1ef1c hi\u1ec7n trong ph\u00f2ng m\u1ed5 \u201chybrid\u201d \u0111\u1ec3 c\u00f3 th\u1ec3 ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ngay sau ph\u1eabu thu\u1eadt \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 c\u1ee7a ph\u1eabu thu\u1eadt.<\/li>\n<li>Ch\u1ee5p m\u1ea1ch v\u00e0nh tr\u01b0\u1edbc ph\u1eabu thu\u1eadt kh\u00f4ng co ch\u1ec9 \u0111\u1ecbnh do l\u00e0m tr\u00ec ho\u00e3n kh\u00f4ng c\u1ea7n thi\u1ebft cho vi\u1ec7c ph\u1eabu thu\u1eadt.<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa n\u00ean ti\u1ebfp t\u1ee5c trong khi ch\u1edd ph\u1eabu thu\u1eadt.<\/li>\n<li>M\u1ee5c ti\u00eau ki\u1ec3m so\u00e1t nh\u1ecbp tim &lt;60 l\u1ea7n\/ph\u00fat l\u00e0 m\u1ee5c ti\u00eau ch\u00ednh, m\u1ee5c ti\u00eau th\u1ee9 2 l\u00e0 huy\u1ebft \u00e1p t\u00e2m thu&lt;100-120mmHg.<\/li>\n<li>Thu\u1ed1c ch\u1eb9n beta( propranolon,metoprolol) n\u00ean b\u1eaft \u0111\u1ea7u s\u1edbm \u0111\u1ec3 tr\u00e1nh ph\u1ea3n x\u1ea1 t\u0103ng t\u1ea7n s\u1ed1 tim do thu\u1ed1c d\u00e3n m\u1ea1ch. Khi ch\u1eb9n beta ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, xem x\u00e9t d\u00f9ng Diltiazem hay verapamil.<\/li>\n<li>Nitropusside c\u0169ng c\u00f3 th\u1ec3 d\u00f9ng \u0111\u1ec3 gi\u1ea3m nhanh v\u00e0 c\u1ea9n th\u1eadn ch\u1ec9nh li\u1ec1u theo huy\u1ebft \u00e1p.<\/li>\n<li>Gi\u1ea3m \u0111au c\u1ea7n thi\u1ebft \u0111\u1ec3 gi\u1ea3m s\u1ef1 gia t\u0103ng t\u1ea7n s\u1ed1 tim v\u00e0 huy\u1ebft \u00e1p li\u00ean quan \u0111\u1ebfn \u0111au.<\/li>\n<li>T\u1ee5t huy\u1ebft \u00e1p: n\u1ebfu do ch\u00e8n \u00e9p tim, \u0111i\u1ec1u tr\u1ecb b\u00f9 d\u1ecbch v\u00e0 ph\u1eabu thu\u1eadt c\u1ea5p c\u1ee9u, ch\u1ecdc d\u00f2 d\u1ecbch m\u00e0ng tim kh\u00f4ng c\u00f3 l\u1ee3i v\u00e0 th\u1ef1c t\u1ebf gia t\u0103ng t\u1eed vong.<\/li>\n<\/ul>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone size-medium wp-image-23668\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/aorta_dissection_repair-1-300x232.jpg\" alt=\"\u0110i\u1ec1u tr\u1ecb trong l\u00f3c t\u00e1ch type A\" width=\"300\" height=\"232\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/aorta_dissection_repair-1-300x232.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/aorta_dissection_repair-1.jpg 480w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/p>\n<p><strong>H\u00ecnh 2: \u0110i\u1ec1u tr\u1ecb ph\u00ecnh l\u00f3c t\u00e1ch type A<\/strong><\/p>\n<h2>5.2 \u0110i\u1ec1u tr\u1ecb l\u00f3c t\u00e1ch type B<\/h2>\n<ul>\n<li>L\u00f3c t\u00e1ch type B kh\u00f4ng ph\u1ee9c t\u1ea1p c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa, v\u00e0 huy\u1ebft \u00e1p nh\u01b0 \u0111\u00e3 n\u00eau tr\u00ean.<\/li>\n<li>Can thi\u1ec7p ch\u1ec9 \u0111\u1ecbnh khi c\u00f3 bi\u1ebfn ch\u1ee9ng, bao g\u1ed3m: h\u1ed9i ch\u1ee9ng t\u01b0\u1edbi m\u00e1u k\u00e9m, \u0111au dai d\u1eb3ng, t\u0103ng huy\u1ebft \u00e1p, ph\u00ecnh l\u1edbn hay v\u1ee1.<\/li>\n<li>Can thi\u1ec7p n\u1ed9i m\u1ea1ch \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u01b0u ti\u00ean, h\u01a1n ph\u1eabu thu\u1eadt h\u1edf \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb boc t\u00e1ch type B v\u00ec t\u1ef7 l\u1ec7 t\u1eed vong 30 ng\u00e0y th\u1ea5p h\u01a1n.<\/li>\n<li>Tuy nhi\u00ean, t\u00e1c \u0111\u1ed9ng l\u00e2u d\u00e0i stent-graft tr\u00ean l\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 xu\u1ed1ng c\u1ea5p v\u1eabn kh\u00f4ng r\u00f5.<\/li>\n<li>Tr\u00ean l\u00fd thuy\u00eat, stent-graft s\u1edbm tr\u00ean l\u00f3c t\u00e1ch type B c\u00f3 th\u1ec3 h\u1ea1n ch\u1ebf bi\u1ebfn ch\u1ee9ng mu\u1ed9n hay ph\u00ecnh l\u1edbn h\u01a1n, nh\u01b0ng ch\u01b0a c\u00f3 d\u1eef li\u1ec7u h\u1ed7 tr\u1ee3 ph\u01b0\u01a1ng ph\u00e1p n\u00e0y.<\/li>\n<\/ul>\n<p><a href=\"https:\/\/www.vinmec.com\/\"><strong>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 m\u1ea1ch, \u0111\u1eb7c bi\u1ec7t l\u00e0 Ph\u1eabu thu\u1eadt tim m\u1ea1ch.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>L\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u00e0 t\u00ecnh tr\u1ea1ng c\u1ea5p c\u1ee9u, do r\u00e1ch l\u1edbp n\u1ed9i m\u1ea1c t\u1ea1o th\u00f4ng n\u1ed1i hay kh\u1ed1i m\u00e1u t\u1ee5 gi\u1eefa l\u1edbp n\u1ed9i m\u1ea1c v\u00e0 l\u1edbp gi\u1eefa c\u1ee7a th\u00e0nh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7. C\u00e1c bi\u1ebfn ch\u1ee9ng kh\u00e1c bao g\u1ed3m: tr\u00e0n m\u00e1u, ch\u00e8n \u00e9p tim, h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, h\u1ed9i ch\u1ee9ng gi\u1ea3m t\u01b0\u1edbi m\u00e1u [&hellip;]<\/p>\n","protected":false},"author":7,"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>L\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 \u0111i\u1ec1u tr\u1ecb<\/title>\n<meta name=\"description\" content=\"L\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 \u0111i\u1ec1u tr\u1ecb l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p t\u1ea1i \u0111\u01a1n v\u1ecb c\u1ea5p c\u1ee9u ho\u1eb7c Khoa ph\u1eabu thu\u1eadt tim m\u1ea1ch ng\u01b0\u1eddi l\u1edbn.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"L\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 \u0111i\u1ec1u tr\u1ecb\" \/>\n<meta property=\"og:description\" content=\"L\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 \u0111i\u1ec1u tr\u1ecb l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p t\u1ea1i \u0111\u01a1n v\u1ecb c\u1ea5p c\u1ee9u ho\u1eb7c Khoa ph\u1eabu thu\u1eadt tim m\u1ea1ch ng\u01b0\u1eddi l\u1edbn.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/loc-tach-dong-mach-chu-va-dieu-tri\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-17T14:47:42+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-04-18T03:50:46+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Stanford-and-DeBakey-classifications-of-aortic-dissection-Figure-from-61-Aortic-300x205.png\" \/>\n<meta name=\"author\" content=\"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i\" \/>\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\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/loc-tach-dong-mach-chu-va-dieu-tri\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/loc-tach-dong-mach-chu-va-dieu-tri\/\",\"name\":\"L\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 \u0111i\u1ec1u tr\u1ecb\",\"isPartOf\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-04-17T14:47:42+00:00\",\"dateModified\":\"2023-04-18T03:50:46+00:00\",\"author\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/dded5c0d4cb1bb77d05cf29ab5f85629\"},\"description\":\"L\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 \u0111i\u1ec1u tr\u1ecb l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p t\u1ea1i \u0111\u01a1n v\u1ecb c\u1ea5p c\u1ee9u ho\u1eb7c Khoa ph\u1eabu thu\u1eadt tim m\u1ea1ch ng\u01b0\u1eddi l\u1edbn.\",\"breadcrumb\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/loc-tach-dong-mach-chu-va-dieu-tri\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/loc-tach-dong-mach-chu-va-dieu-tri\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/loc-tach-dong-mach-chu-va-dieu-tri\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"http:\/\/noithathoaphat.in\/ctv\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"L\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 type A v\u00e0 type B: Tri\u1ec7u ch\u1ee9ng, nguy\u00ean nh\u00e2n v\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb\"}]},{\"@type\":\"WebSite\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/\",\"name\":\"Vinmec\",\"description\":\"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"http:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/dded5c0d4cb1bb77d05cf29ab5f85629\",\"name\":\"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/\",\"url\":\"http:\/\/2.gravatar.com\/avatar\/50f51f67852bc7e49c0b8b60a1fefe3e?s=96&d=mm&r=g\",\"contentUrl\":\"http:\/\/2.gravatar.com\/avatar\/50f51f67852bc7e49c0b8b60a1fefe3e?s=96&d=mm&r=g\",\"caption\":\"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i\"},\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/viettai304-304gmail-com\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"L\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 \u0111i\u1ec1u tr\u1ecb","description":"L\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 \u0111i\u1ec1u tr\u1ecb l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p t\u1ea1i \u0111\u01a1n v\u1ecb c\u1ea5p c\u1ee9u ho\u1eb7c Khoa ph\u1eabu thu\u1eadt tim m\u1ea1ch ng\u01b0\u1eddi l\u1edbn.","robots":{"index":"noindex","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"og_locale":"en_US","og_type":"article","og_title":"L\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 \u0111i\u1ec1u tr\u1ecb","og_description":"L\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 \u0111i\u1ec1u tr\u1ecb l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p t\u1ea1i \u0111\u01a1n v\u1ecb c\u1ea5p c\u1ee9u ho\u1eb7c Khoa ph\u1eabu thu\u1eadt tim m\u1ea1ch ng\u01b0\u1eddi l\u1edbn.","og_url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/loc-tach-dong-mach-chu-va-dieu-tri\/","og_site_name":"Vinmec","article_published_time":"2023-04-17T14:47:42+00:00","article_modified_time":"2023-04-18T03:50:46+00:00","og_image":[{"url":"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Stanford-and-DeBakey-classifications-of-aortic-dissection-Figure-from-61-Aortic-300x205.png"}],"author":"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i","twitter_card":"summary_large_image","twitter_misc":{"Written by":"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i","Est. reading time":"7 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/loc-tach-dong-mach-chu-va-dieu-tri\/","url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/loc-tach-dong-mach-chu-va-dieu-tri\/","name":"L\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 \u0111i\u1ec1u tr\u1ecb","isPartOf":{"@id":"http:\/\/noithathoaphat.in\/ctv\/#website"},"datePublished":"2023-04-17T14:47:42+00:00","dateModified":"2023-04-18T03:50:46+00:00","author":{"@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/dded5c0d4cb1bb77d05cf29ab5f85629"},"description":"L\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 \u0111i\u1ec1u tr\u1ecb l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p t\u1ea1i \u0111\u01a1n v\u1ecb c\u1ea5p c\u1ee9u ho\u1eb7c Khoa ph\u1eabu thu\u1eadt tim m\u1ea1ch ng\u01b0\u1eddi l\u1edbn.","breadcrumb":{"@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/loc-tach-dong-mach-chu-va-dieu-tri\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/loc-tach-dong-mach-chu-va-dieu-tri\/"]}]},{"@type":"BreadcrumbList","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/loc-tach-dong-mach-chu-va-dieu-tri\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"http:\/\/noithathoaphat.in\/ctv\/"},{"@type":"ListItem","position":2,"name":"L\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 type A v\u00e0 type B: Tri\u1ec7u ch\u1ee9ng, nguy\u00ean nh\u00e2n v\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb"}]},{"@type":"WebSite","@id":"http:\/\/noithathoaphat.in\/ctv\/#website","url":"http:\/\/noithathoaphat.in\/ctv\/","name":"Vinmec","description":"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"http:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/dded5c0d4cb1bb77d05cf29ab5f85629","name":"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/","url":"http:\/\/2.gravatar.com\/avatar\/50f51f67852bc7e49c0b8b60a1fefe3e?s=96&d=mm&r=g","contentUrl":"http:\/\/2.gravatar.com\/avatar\/50f51f67852bc7e49c0b8b60a1fefe3e?s=96&d=mm&r=g","caption":"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i"},"url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/viettai304-304gmail-com\/"}]}},"_links":{"self":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/23647"}],"collection":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/comments?post=23647"}],"version-history":[{"count":3,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/23647\/revisions"}],"predecessor-version":[{"id":23957,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/23647\/revisions\/23957"}],"wp:attachment":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/media?parent=23647"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/categories?post=23647"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/tags?post=23647"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}