{"id":24336,"date":"2023-04-19T21:44:02","date_gmt":"2023-04-19T14:44:02","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24336"},"modified":"2023-04-20T17:21:22","modified_gmt":"2023-04-20T10:21:22","slug":"tom-tat-ve-giai-phau-va-sinh-ly-dong-chay-dong-mach-vanh","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/tom-tat-ve-giai-phau-va-sinh-ly-dong-chay-dong-mach-vanh\/","title":{"rendered":"T\u00f3m t\u1eaft v\u1ec1 gi\u1ea3i ph\u1eabu v\u00e0 sinh l\u00fd d\u00f2ng ch\u1ea3y \u0111\u1ed9ng m\u1ea1ch v\u00e0nh"},"content":{"rendered":"

Hi\u1ec3u r\u00f5 v\u1ec1 gi\u1ea3i ph\u1eabu v\u00e0 sinh l\u00fd d\u00f2ng ch\u1ea3y \u0111\u1ed9ng m\u1ea1ch v\u00e0nh l\u00e0 r\u1ea5t quan tr\u1ecdng trong vi\u1ec7c ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe c\u1ee7a tim v\u00e0 ph\u00f2ng ng\u1eeba c\u00e1c v\u1ea5n \u0111\u1ec1 li\u00ean quan \u0111\u1ebfn \u0111\u1ed9ng m\u1ea1ch v\u00e0nh<\/a>.<\/strong><\/p>\n

1.Gi\u1edbi thi\u1ec7u<\/h2>\n

T\u1ea7m quan tr\u1ecdng c\u1ee7a vi\u1ec7c hi\u1ec3u gi\u1ea3i ph\u1eabu \u0111\u1ed9ng m\u1ea1ch v\u00e0nh l\u00e0 gi\u00fap c\u00e1c chuy\u00ean gia y t\u1ebf hi\u1ec3u r\u00f5 h\u01a1n v\u1ec1 c\u1ea5u tr\u00fac v\u00e0 ch\u1ee9c n\u0103ng c\u1ee7a \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, t\u1eeb \u0111\u00f3 ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c v\u1ea5n \u0111\u1ec1 li\u00ean quan \u0111\u1ebfn s\u1ef1 c\u1ed1 v\u1ec1 \u0111\u1ed9ng m\u1ea1ch v\u00e0nh. N\u1ebfu kh\u00f4ng c\u00f3 ki\u1ebfn th\u1ee9c v\u1ec1 gi\u1ea3i ph\u1eabu \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, c\u00e1c chuy\u00ean gia y t\u1ebf kh\u00f3 c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c v\u1ecb tr\u00ed c\u1ee7a c\u00e1c t\u1ed5n th\u01b0\u01a1ng ho\u1eb7c t\u1eafc ngh\u1ebdn \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, g\u00e2y kh\u00f3 kh\u0103n trong vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh.<\/p>\n

Sinh l\u00fd d\u00f2ng ch\u1ea3y \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u0169ng l\u00e0 y\u1ebfu t\u1ed1 quan tr\u1ecdng trong vi\u1ec7c hi\u1ec3u v\u00e0 ph\u00f2ng ng\u1eeba c\u00e1c v\u1ea5n \u0111\u1ec1 li\u00ean quan \u0111\u1ebfn \u0111\u1ed9ng m\u1ea1ch v\u00e0nh. Vi\u1ec7c duy tr\u00ec d\u00f2ng ch\u1ea3y m\u00e1u t\u1ed1t trong \u0111\u1ed9ng m\u1ea1ch v\u00e0nh l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 cung c\u1ea5p \u0111\u1ee7 m\u00e1u v\u00e0 oxy cho c\u01a1 tim, gi\u00fap duy tr\u00ec ch\u1ee9c n\u0103ng c\u1ee7a c\u01a1 tim. N\u1ebfu d\u00f2ng ch\u1ea3y b\u1ecb ng\u01b0ng tr\u1ec7 ho\u1eb7c gi\u1ea3m s\u00fat, c\u01a1 tim c\u00f3 th\u1ec3 b\u1ecb t\u1ed5n th\u01b0\u01a1ng v\u00e0 d\u1eabn \u0111\u1ebfn c\u00e1c v\u1ea5n \u0111\u1ec1 s\u1ee9c kh\u1ecfe nghi\u00eam tr\u1ecdng.<\/p>\n

Vi\u1ec7c hi\u1ec3u r\u00f5 v\u1ec1 gi\u1ea3i ph\u1eabu v\u00e0 sinh l\u00fd d\u00f2ng ch\u1ea3y \u0111\u1ed9ng m\u1ea1ch v\u00e0nh l\u00e0 r\u1ea5t quan tr\u1ecdng trong vi\u1ec7c ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe c\u1ee7a tim.<\/p>\n

 <\/p>\n

2.S\u01a1 l\u01b0\u1ee3c gi\u1ea3i ph\u1eabu h\u1ec7 \u0111\u1ed9ng m\u1ea1ch v\u00e0nh<\/strong><\/h2>\n
\"Gi\u1ea3i
Gi\u1ea3i ph\u1eabu t\u1ed5ng qu\u00e1t tu\u1ea7n ho\u00e0n m\u1ea1ch v\u00e0nh<\/figcaption><\/figure>\n

B\u00ecnh th\u01b0\u1eddng qu\u1ea3 tim \u0111\u01b0\u1ee3c nu\u00f4i d\u01b0\u1ee1ng b\u1edfi 2 \u0111\u1ed9ng m\u1ea1ch v\u00e0nh: \u0111\u1ed9ng m\u1ea1ch v\u00e0nh ph\u1ea3i v\u00e0 \u0111\u1ed9ng m\u1ea1ch v\u00e0nh tr\u00e1i. Hai \u0111\u1ed9ng m\u1ea1ch \u00a0n\u00e0y xu\u1ea5t ph\u00e1t t\u1eeb g\u1ed1c c\u1ee7a \u0111\u1ed9ng m\u1ea1ch \u00a0ch\u1ee7 v\u00e0 nh\u1eadn m\u00e1u t\u1eeb \u0111\u1ed9ng m\u1ea1ch \u00a0ch\u1ee7 qua c\u00e1c xoang Valsalva, ch\u1ea1y tr\u00ean b\u1ec1 m\u1eb7t c\u1ee7a tim (gi\u1eefa c\u01a1 tim v\u00e0 l\u1edbp th\u01b0\u1ee3ng t\u00e2m m\u1ea1c).<\/p>\n

– \u0111\u1ed9ng m\u1ea1ch v\u00e0nh tr\u00e1i:<\/p>\n

\u0111\u1ed9ng m\u1ea1ch v\u00e0nh tr\u00e1i xu\u1ea5t ph\u00e1t t\u1eeb xoang Valsalva tr\u01b0\u1edbc tr\u00e1i, sau khi ch\u1ea1y m\u1ed9t \u0111o\u1ea1n ng\u1eafn gi\u1eefa \u0111\u1ed9ng m\u1ea1ch H \u00a0ph\u1ed5i v\u00e0 nh\u0129 tr\u00e1i (g\u1ecdi l\u00e0 th\u00e2n chung <\/em>\u0111\u1ed9ng m\u1ea1ch \u00a0v\u00e0nh tr\u00e1i<\/em>) s\u1ebd chia ra th\u00e0nh hai nh\u00e1nh: \u0111\u1ed9ng m\u1ea1ch li\u00ean th\u1ea5t tr\u01b0\u1edbc (\u0111\u1ed9ng m\u1ea1ch LTT) <\/em>v\u00e0 \u0111\u1ed9ng m\u1ea1ch m\u0169 (\u0111\u1ed9ng m\u1ea1ch M)<\/em>.<\/p>\n

    \n
  • Th\u00e2n chung \u0111\u1ed9ng m\u1ea1ch v\u00e0nh tr\u00e1i b\u00ecnh th\u01b0\u1eddng d\u00e0i kho\u1ea3ng 10 mm, \u0111\u00f4i khi gi\u1ea3i ph\u1eabu h\u1ec7 m\u1ea1ch v\u00e0nh c\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 th\u00e2n chung, \u0111\u1ed9ng m\u1ea1ch li\u00ean th\u1ea5t tr\u01b0\u1edbc v\u00e0 m\u0169 xu\u1ea5t ph\u00e1t t\u1eeb hai l\u1ed7 ri\u00eang bi\u1ec7t.<\/li>\n
  • \u0110\u1ed9ng m\u1ea1ch LTT ch\u1ea1y d\u1ecdc theo r\u00e3nh li\u00ean th\u1ea5t tr\u01b0\u1edbc v\u1ec1 ph\u00eda m\u1ecfm tim, th\u00e0nh nh\u1eefng nh\u00e1nh v\u00e1ch v\u00e0 nh\u00e1nh ch\u00e9o. Kho\u1ea3ng 37% c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 nh\u00e1nh trung gian v\u00e0 \u0111\u01b0\u1ee3c coi nh\u01b0 l\u00e0 nh\u00e1nh ch\u00e9o th\u1ee9 nh\u1ea5t.<\/li>\n<\/ul>\n

    – Nh\u1eefng nh\u00e1nh v\u00e1ch ch\u1ea1y xuy\u00ean v\u00e0o v\u00e1ch li\u00ean th\u1ea5t, c\u00f3 s\u1ed1 l\u01b0\u1ee3ng v\u00e0 k\u00edch th\u01b0\u1edbc r\u1ea5t thay \u0111\u1ed5i.<\/p>\n

    – Nh\u1eefng nh\u00e1nh ch\u00e9o ch\u1ea1y sang th\u00e0nh tr\u01b0\u1edbc b\u00ean, c\u00f3 t\u1eeb 1-3 nh\u00e1nh, c\u00f3 th\u1ec3 ph\u00e1t tri\u1ec3n nhi\u1ec1u hay \u00edt.<\/p>\n

    – \u0110\u1ed9ng m\u1ea1ch LTT c\u1ea5p m\u00e1u cho kho\u1ea3ng 45-55% th\u1ea5t tr\u00e1i, g\u1ed3m th\u00e0nh tr\u01b0\u1edbc b\u00ean, m\u1ecfm tim v\u00e0 v\u00e1ch li\u00ean th\u1ea5t.<\/p>\n

    \u0110\u1ed9ng m\u1ea1ch M ch\u1ea1y trong r\u00e3nh nh\u0129 th\u1ea5t tr\u00e1i cho 2-3 nh\u00e1nh b\u1edd, cung c\u1ea5p m\u00e1u cho th\u00e0nh b\u00ean th\u1ea5t tr\u00e1i. \u0110\u1ed9ng m\u1ea1ch M c\u1ea5p m\u00e1u kho\u1ea3ng 15-25% th\u1ea5t tr\u00e1i (tr\u1eeb trong tr\u01b0\u1eddng h\u1ee3p \u0111\u1ed9ng m\u1ea1ch M \u01b0u n\u0103ng, c\u1ea5p m\u00e1u kho\u1ea3ng 40-50% th\u1ea5t tr\u00e1i) g\u1ed3m v\u00f9ng sau b\u00ean v\u00e0 tr\u01b0\u1edbc b\u00ean th\u1ea5t tr\u00e1i<\/p>\n

      \n
    • \n

      \"Gi\u1ea3i
      Gi\u1ea3i ph\u1eabu \u0111\u1ed9ng m\u1ea1ch v\u00e0nh tr\u00e1i<\/figcaption><\/figure><\/li>\n<\/ul>\n

       <\/p>\n

      \u0110\u1ed9ng m\u1ea1ch v\u00e0nh ph\u1ea3i:<\/p>\n

      \u0110\u1ed9ng m\u1ea1ch v\u00e0nh ph\u1ea3i xu\u1ea5t ph\u00e1t t\u1eeb xoang Valsalva tr\u01b0\u1edbc ph\u1ea3i, ch\u1ea1y trong r\u00e3nh nh\u0129 th\u1ea5t ph\u1ea3i, \u1edf \u0111o\u1ea1n g\u1ea7n chia nh\u00e1nh v\u00e0o nh\u0129 ph\u1ea3i (\u0111\u1ed9ng m\u1ea1ch\u00a0n\u00fat xoang), v\u00e0 th\u1ea5t ph\u1ea3i (\u0111\u1ed9ng m\u1ea1ch\u00a0H \u00a0n\u00f3n) r\u1ed3i v\u00f2ng ra b\u1edd ph\u1ea3i c\u1ee7a tim, \u0111i t\u1edbi \u0111\u1ea7u sau c\u1ee7a r\u00e3nh li\u00ean th\u1ea5t sau chia l\u00e0m hai nh\u00e1nh \u0111\u1ed9ng m\u1ea1ch\u00a0li\u00ean th\u1ea5t sau v\u00e0 nh\u00e1nh qu\u1eb7t ng\u01b0\u1ee3c th\u1ea5t tr\u00e1i.<\/p>\n

      <\/h2>\n
      \"Gi\u1ea3i
      Gi\u1ea3i ph\u1eabu \u0111\u1ed9ng m\u1ea1ch v\u00e0nh ph\u1ea3i<\/strong><\/figcaption><\/figure>\n

      – C\u00e1ch g\u1ecdi t\u00ean \u0111\u1ed9ng m\u1ea1ch v\u00e0nh theo CASS (Coronary Artery Surgery Study):<\/p>\n

      – \u0110\u1ed9ng m\u1ea1ch v\u00e0nh ph\u1ea3i chia l\u00e0m ba \u0111o\u1ea1n:<\/p>\n

        \n
      • \u0110o\u1ea1n g\u1ea7n (I): 1\/2 \u0111\u1ea7u ti\u00ean t\u1eeb l\u1ed7 \u0111\u1ed9ng m\u1ea1ch t\u1edbi nh\u00e1nh th\u1ea5t ph\u1ea3i.<\/li>\n
      • \u0110o\u1ea1n gi\u1eefa (II): gi\u1eefa \u0111o\u1ea1n g\u1ea7n v\u00e0 \u0111o\u1ea1n xa.<\/li>\n
      • \u0110o\u1ea1n xa (III): t\u1eeb nh\u00e1nh b\u1edd ph\u1ea3i t\u1edbi \u0111\u1ed9ng m\u1ea1ch H li\u00ean th\u1ea5t sau.<\/li>\n<\/ul>\n

        – Th\u00e2n chung \u0111\u1ed9ng m\u1ea1ch v\u00e0nh tr\u00e1i t\u1eeb l\u1ed7 \u0111\u1ed9ng m\u1ea1ch v\u00e0nh tr\u00e1i cho t\u1edbi ch\u1ed7 chia th\u00e0nh \u0111\u1ed9ng m\u1ea1ch LTT v\u00e0 \u0111\u1ed9ng m\u1ea1ch M.<\/p>\n

        – \u0110\u1ed9ng m\u1ea1ch LTT chia l\u00e0m ba \u0111o\u1ea1n:<\/p>\n

          \n
        • \u0110o\u1ea1n g\u1ea7n (I): t\u1eeb ch\u1ed7 chia cho t\u1edbi nh\u00e1nh v\u00e1ch \u0111\u1ea7u ti\u00ean.<\/li>\n
        • \u0110o\u1ea1n gi\u1eefa (II): t\u1eeb nh\u00e1nh v\u00e1ch \u0111\u1ea7u ti\u00ean t\u1edbi nh\u00e1nh ch\u00e9o th\u1ee9 hai.<\/li>\n
        • \u0110o\u1ea1n xa (III): t\u1eeb sau nh\u00e1nh ch\u00e9o th\u1ee9 hai.<\/li>\n<\/ul>\n

          – \u0110\u1ed9ng m\u1ea1ch M chia l\u00e0m hai \u0111o\u1ea1n:<\/p>\n

            \n
          • \u0110o\u1ea1n g\u1ea7n (I): t\u1eeb ch\u1ed7 chia t\u1edbi nh\u00e1nh b\u1edd 1.<\/li>\n
          • \u0110o\u1ea1n xa (II): t\u1eeb sau nh\u00e1nh b\u1edd 1 ch\u1ea1y trong r\u00e3nh nh\u0129 th\u1ea5t tr\u00e1i.<\/li>\n<\/ul>\n

            3. Sinh l\u00fd t\u01b0\u1edbi m\u00e1u c\u1ee7a tu\u1ea7n ho\u00e0n v\u00e0nh<\/h2>\n

            Tu\u1ea7n ho\u00e0n v\u00e0nh di\u1ec5n ra tr\u00ean m\u1ed9t kh\u1ed1i c\u01a1 r\u1ed7ng co b\u00f3p nh\u1ecbp nh\u00e0ng n\u00ean t\u01b0\u1edbi m\u00e1u c\u1ee7a tu\u1ea7n ho\u00e0n v\u00e0nh c\u0169ng thay \u0111\u1ed5i nh\u1ecbp nh\u00e0ng. T\u01b0\u1edbi m\u00e1u cho t\u00e2m th\u1ea5t tr\u00e1i ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong th\u00ec t\u00e2m tr\u01b0\u01a1ng trong khi t\u00e2m th\u1ea5t ph\u1ea3i \u0111\u01b0\u1ee3c t\u01b0\u1edbi m\u00e1u \u0111\u1ec1u h\u01a1n c\u1ea3 hai th\u00ec, tuy v\u1eady trong th\u00ec t\u00e2m thu c\u0169ng b\u1ecb h\u1ea1n ch\u1ebf.<\/p>\n

            C\u00f3 r\u1ea5t \u00edt h\u1ec7 th\u1ed1ng n\u1ed1i th\u00f4ng (b\u00e0ng h\u1ec7) gi\u1eefa c\u00e1c \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, v\u00ec v\u1eady n\u1ebfu m\u1ed9t \u0111\u1ed9ng m\u1ea1ch v\u00e0nh n\u00e0o b\u1ecb t\u1eafc th\u00ec s\u1ef1 t\u01b0\u1edbi m\u00e1u cho v\u00f9ng c\u01a1 tim \u0111\u00f3 s\u1ebd b\u1ecb ng\u1eebng tr\u1ec7, v\u00e0 n\u1ebfu t\u1eafc ngh\u1ebdn k\u00e9o d\u00e0i s\u1ebd g\u00e2y ho\u1ea1i t\u1eed c\u01a1 tim. C\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 s\u1ef1 t\u01b0\u1edbi m\u00e1u cho c\u01a1 tim \u1edf l\u1edbp d\u01b0\u1edbi n\u1ed9i t\u00e2m m\u1ea1c v\u00e0 l\u1edbp d\u01b0\u1edbi th\u01b0\u1ee3ng t\u00e2m m\u1ea1c. Trong th\u00ec t\u00e2m thu, c\u01a1 tim co l\u00e0m t\u0103ng \u00e1p su\u1ea5t ri\u00eang ph\u1ea7n trong c\u01a1 tim. C\u00f3 m\u1ed9t b\u1eadc thang \u00e1p su\u1ea5t t\u0103ng d\u1ea7n t\u1eeb ngo\u00e0i v\u00e0o trong v\u00e0 m\u1ea1nh nh\u1ea5t \u1edf l\u1edbp d\u01b0\u1edbi n\u1ed9i t\u00e2m m\u1ea1c, v\u00ec v\u1eady trong th\u00ec t\u00e2m thu d\u00f2ng m\u00e1u \u0111\u1ebfn l\u1edbp d\u01b0\u1edbi n\u1ed9i t\u00e2m m\u1ea1c r\u1ea5t \u00edt so v\u1edbi l\u1edbp d\u01b0\u1edbi th\u01b0\u1ee3ng t\u00e2m m\u1ea1c.<\/p>\n

            B\u00ecnh th\u01b0\u1eddng l\u01b0u l\u01b0\u1ee3ng m\u00e1u qua \u0111\u1ed9ng m\u1ea1ch v\u00e0nh kho\u1ea3ng 60 – 80ml\/ph\u00fat\/100 gam c\u01a1 tim (250ml\/ph\u00fat), chi\u1ebfm 4,6% l\u01b0u l\u01b0\u1ee3ng tu\u1ea7n ho\u00e0n c\u1ee7a to\u00e0n c\u01a1 th\u1ec3. D\u1ef1 tr\u1eef oxy c\u1ee7a c\u01a1 tim h\u1ea7u nh\u01b0 kh\u00f4ng c\u00f3. Chuy\u1ec3n h\u00f3a c\u1ee7a c\u01a1 tim ch\u1ee7 y\u1ebfu l\u00e0 \u00e1i kh\u00ed n\u00ean khi c\u00f3 t\u0103ng nhu c\u1ea7u oxy c\u01a1 tim th\u00ec ph\u1ea3i \u0111\u00e1p \u1ee9ng b\u1eb1ng t\u0103ng cung l\u01b0\u1ee3ng v\u00e0nh \u0111\u1ebfn l\u1edbp d\u01b0\u1edbi n\u1ed9i t\u00e2m m\u1ea1c r\u1ea5t \u00edt so v\u1edbi l\u1edbp d\u01b0\u1edbi th\u01b0\u1ee3ng t\u00e2m m\u1ea1c.<\/p>\n","protected":false},"excerpt":{"rendered":"

            Hi\u1ec3u r\u00f5 v\u1ec1 gi\u1ea3i ph\u1eabu v\u00e0 sinh l\u00fd d\u00f2ng ch\u1ea3y \u0111\u1ed9ng m\u1ea1ch v\u00e0nh l\u00e0 r\u1ea5t quan tr\u1ecdng trong vi\u1ec7c ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe c\u1ee7a tim v\u00e0 ph\u00f2ng ng\u1eeba c\u00e1c v\u1ea5n \u0111\u1ec1 li\u00ean quan \u0111\u1ebfn \u0111\u1ed9ng m\u1ea1ch v\u00e0nh. 1.Gi\u1edbi thi\u1ec7u T\u1ea7m quan tr\u1ecdng c\u1ee7a vi\u1ec7c hi\u1ec3u gi\u1ea3i ph\u1eabu \u0111\u1ed9ng m\u1ea1ch v\u00e0nh l\u00e0 gi\u00fap c\u00e1c chuy\u00ean gia […]<\/p>\n","protected":false},"author":25,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[3],"yoast_head":"\nT\u00f3m t\u1eaft v\u1ec1 gi\u1ea3i ph\u1eabu v\u00e0 sinh l\u00fd d\u00f2ng ch\u1ea3y \u0111\u1ed9ng m\u1ea1ch v\u00e0nh -<\/title>\n<meta name=\"description\" content=\"Hi\u1ec3u r\u00f5 gi\u1ea3i ph\u1eabu v\u00e0 sinh l\u00fd d\u00f2ng ch\u1ea3y 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