{"id":26053,"date":"2023-04-21T14:13:38","date_gmt":"2023-04-21T07:13:38","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=26053"},"modified":"2023-04-21T18:03:15","modified_gmt":"2023-04-21T11:03:15","slug":"tong-quan-ve-dieu-tri-hep-van-hai-la","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/tong-quan-ve-dieu-tri-hep-van-hai-la\/","title":{"rendered":"T\u1ed5ng quan v\u1ec1 \u0111i\u1ec1u tr\u1ecb h\u1eb9p van hai l\u00e1"},"content":{"rendered":"

H\u1eb9p van hai l\u00e1 l\u00e0 m\u1ed9t b\u1ec7nh kh\u00e1 ph\u1ed5 bi\u1ebfn \u1edf n\u01b0\u1edbc ta chi\u1ebfm kho\u1ea3ng 40,3% c\u00e1c\u00a0 b\u1ec7nh tim m\u1eafc ph\u1ea3i. Van hai l\u00e1 n\u1ed1i li\u1ec1n nh\u0129 tr\u00e1i v\u00e0 th\u1ea5t tr\u00e1i, gi\u00fap m\u00e1u di chuy\u1ec3n theo m\u1ed9t h\u01b0\u1edbng t\u1eeb nh\u0129 xu\u1ed1ng th\u1ea5t, bao g\u1ed3m 2 l\u00e1 van: l\u00e1 van l\u1edbn (hay l\u00e1 van tr\u01b0\u1edbc) v\u00e0 l\u00e1 van nh\u1ecf (hay l\u00e1 van sau). V\u00e0o k\u1ef3 t\u00e2m tr\u01b0\u01a1ng di\u1ec7n t\u00edch m\u1edf van (DTMV) trung b\u00ecnh t\u1eeb 4 – 6cm2. \u0110\u01b0\u1ee3c coi l\u00e0 h\u1eb9p van 2 l\u00e1<\/a> khi di\u1ec7n t\u00edch m\u1edf van d\u01b0\u1edbi hay b\u1eb1ng 2cm2 (1,18cm2\/ m2 di\u1ec7n t\u00edch c\u01a1 th\u1ec3 (DTCT) ). H\u1eb9p kh\u00edt n\u1eb7ng khi DTMV < 1cm2 (0,6 cm2\/m DTCT).<\/strong><\/p>\n

1. \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa h\u1eb9p van hai l\u00e1<\/em><\/h2>\n

Ch\u1ec9 c\u00f3 t\u00e1c d\u1ee5ng t\u1ed1t khi h\u1eb9p van hai l\u00e1 m\u1ee9c \u0111\u1ed9 nh\u1eb9 v\u00e0 trung b\u00ecnh. N\u1ebfu h\u1eb9p kh\u00edt, v\u1edbi\u00a0 di\u1ec7n t\u00edch l\u1ed7 van <1.5 cm2 th\u00ec \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i khoa m\u1edbi c\u00f3 t\u00e1c d\u1ee5ng.<\/p>\n

1.1. \u0110i\u1ec1u tr\u1ecb suy tim\u00a0\u00a0<\/strong><\/p>\n

1.1.1 Ch\u1ebf \u0111\u1ed9 sinh ho\u1ea1t \u0103n u\u1ed1ng<\/p>\n

H\u1ea1n ch\u1ebf lao \u0111\u1ed9ng n\u1eb7ng, \u0103n l\u1ea1t, \u0111i\u1ec1u tr\u1ecb ph\u00f2ng th\u1ea5p t\u00e1i ph\u00e1t, ph\u00f2ng ng\u1eeba Osler.<\/p>\n

1.1.2. L\u1ee3i ti\u1ec3u<\/p>\n

Khi c\u01a1 th\u1ec3 t\u0103ng kho\u1ea3ng 2 kg so v\u1edbi tr\u01b0\u1edbc.<\/p>\n

Furosemid 40 mg x 1-2 vi\u00ean\/ng\u00e0y.<\/p>\n

Trong c\u01a1n suy tim c\u1ea5p c\u00f3 th\u1ec3 d\u00f9ng Lasix 20 mg ti\u00eam t\u0129nh m\u1ea1ch ch\u1eadm. Ch\u00fa \u00fd khi\u00a0 d\u00f9ng l\u1ee3i ti\u1ec3u c\u1ea7n d\u00f9ng th\u00eam kali (n\u00ean cho lo\u1ea1i mu\u1ed1i K+ h\u1eefu c\u01a1 t\u1ed1t h\u01a1n v\u00f4 c\u01a1, nh\u01b0 K+, Mg++ aspartate bi\u1ec7t d\u01b0\u1ee3c Panangin) \u0111\u1ec1 ph\u00f2ng h\u1ea1 kali m\u00e1u, d\u1ec5 ng\u1ed9 \u0111\u1ed9c Digital.<\/p>\n

1.1.3. Digital<\/p>\n

\u00cdt c\u00f3 t\u00e1c d\u1ee5ng trong suy tim do h\u1eb9p hai l\u00e1, ngay c\u1ea3 khi c\u00f3 suy tim ph\u1ea3i. Digital c\u00f3 t\u00e1c\u00a0 d\u1ee5ng t\u1ed1t trong suy tim do h\u1eb9p hai l\u00e1 c\u00f3 bi\u1ebfn ch\u1ee9ng rung nh\u0129 \u0111\u1ec3 ng\u0103n ng\u1eeba c\u00e1c c\u01a1n\u00a0 rung nh\u0129 c\u00f3 nh\u1ecbp th\u1ea5t nhanh, l\u00e0m n\u1eb7ng th\u00eam t\u00ecnh tr\u1ea1ng suy tim, c\u00f3 th\u1ec3 d\u00f9ng li\u1ec1u ng\u1ea5m\u00a0 \u0111\u1ee7 ch\u1eadm. Digital 0,25 mg x 1 vi\u00ean\/ ng\u00e0y trong 5 ng\u00e0y, ngh\u1ec9 2 ng\u00e0y r\u1ed3i d\u00f9ng l\u1ea1i. Ho\u1eb7c\u00a0 Digital 0,25 mg x 1 vi\u00ean \/ ng\u00e0y trong 3 ng\u00e0y, ngh\u1ec9 3 ng\u00e0y r\u1ed3i d\u00f9ng l\u1ea1i.<\/p>\n

Khi \u0111i\u1ec1u tr\u1ecb Digital c\u1ea7n l\u01b0u \u00fd d\u1ea5u ch\u1ee9ng ng\u1ed9 \u0111\u1ed9c Digital nh\u01b0:<\/p>\n

– B\u1ec7nh nh\u00e2n n\u00f4n m\u1eefa, \u0111au b\u1ee5ng, m\u1edd m\u1eaft, nh\u00ecn \u0111\u00f4i, \u0111i c\u1ea7u ph\u00e2n l\u1ecfng.\u00a0 – Ngo\u1ea1i t\u00e2m thu th\u1ea5t nh\u1ecbp \u0111\u00f4i hay \u00e1c t\u00ednh.<\/p>\n

– Ho\u1eb7c nh\u1ecbp tim t\u0103ng v\u1ecdt l\u00ean (trong khi \u0111ang d\u00f9ng Digital) ho\u1eb7c ch\u1eadm l\u1ea1i v\u1edbi Bl\u1ed1c nh\u0129 th\u1ea5t c\u00e1c c\u1ea5p, ho\u1eb7c nh\u1ecbp b\u1ed9 n\u1ed1i.<\/p>\n

– N\u1ebfu xu\u1ea5t hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng tr\u00ean n\u00ean ng\u1eebng Digital v\u00e0 cho t\u0103ng c\u01b0\u1eddng th\u00eam Kali\u00a0 b\u1eb1ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch ho\u1eb7c \u0111\u01b0\u1eddng u\u1ed1ng, ch\u00fa \u00fd b\u1ed5 sung th\u00eam Mg++.<\/p>\n

1.1.4. C\u00e1c thu\u1ed1c gi\u00e3n m\u1ea1ch<\/p>\n

– \u0110\u01b0\u1ee3c s\u1eed d\u1ee5ng nhi\u1ec1u trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y. Thu\u1ed1c gi\u00e3n m\u1ea1ch c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb li\u00ean t\u1ee5c, k\u00e9o d\u00e0i. Thu\u1ed1c gi\u00e3n m\u1ea1ch c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3m ti\u1ec1n g\u00e1nh, h\u1eadu g\u00e1nh gi\u00fap cho\u00a0 suy tim h\u1ed3i ph\u1ee5c t\u1ed1t.<\/p>\n

– \u0110\u1ed1i v\u1edbi suy tim trong h\u1eb9p hai l\u00e1 t\u1ed1t nh\u1ea5t l\u00e0 nh\u00f3m Nitrat v\u00e0 d\u1eabn xu\u1ea5t nh\u1ea5t l\u00e0 khi h\u1eb9p\u00a0 hai l\u00e1 c\u00f3 t\u0103ng \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, ph\u00f9 ph\u1ed5i m\u1ea1n t\u00ednh v\u00e0 c\u1ea5p t\u00ednh. Risordan LP 20\u00a0 mg x 1-2 vi\u00ean \/ ng\u00e0y, ho\u1eb7c Imdur (mononitrate Isosorbid) 60 mg x 1\/2 – 1 vi\u00ean \/ ng\u00e0y.<\/p>\n

1.2. \u0110i\u1ec1u tr\u1ecb ph\u00f2ng t\u1eafc \u0111\u1ed9ng m\u1ea1ch h\u1ec7 th\u1ed1ng\u00a0\u00a0<\/strong><\/p>\n

– T\u1eafc m\u1ea1ch c\u00f3 th\u1ec3: \u0111\u1ed9ng m\u1ea1ch n\u00e3o, \u0111\u1ed9ng m\u1ea1ch m\u1ea1c treo, \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i v\u1ecb, \u0111\u1ed9ng\u00a0 m\u1ea1ch l\u00e1ch, \u0111\u1ed9ng m\u1ea1ch th\u1eadn, \u0111\u1ed9ng m\u1ea1ch v\u00e0nh…..<\/p>\n

– Bi\u1ebfn ch\u1ee9ng t\u1eafc m\u1ea1ch gia t\u0103ng \u1edf b\u1ec7nh nh\u00e2n h\u1eb9p van hai l\u00e1 c\u00f3 bi\u1ebfn ch\u1ee9ng rung nh\u0129 v\u00e0 suy tim, \u0111\u1eb7c bi\u1ec7t khi m\u1edbi xu\u1ea5t hi\u1ec7n rung nh\u0129.<\/p>\n

– h\u1eb9p van hai l\u00e1 c\u00f3 bi\u1ebfn ch\u1ee9ng t\u1eafc m\u1ea1ch nhi\u1ec1u h\u01a1n h\u1edf van hai l\u00e1. 20-60% t\u1eafc l\u1ea1i l\u1ea7n\u00a0 th\u1ee9 hai sau t\u1eafc l\u1ea7n th\u1ee9 nh\u1ea5t trong 6-12 th\u00e1ng n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c d\u1ef1 ph\u00f2ng h\u1eefu hi\u1ec7u\u00a0 b\u1eb1ng c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb t\u1eafc m\u1ea1ch c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t:<\/p>\n

+ Heparin 10.000 – 20.000 UI \/ ng\u00e0y x 5 – 10 ng\u00e0y. C\u00f3 th\u1ec3 d\u00f9ng Heparin c\u00f3 tr\u1ecdng\u00a0 l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p \u0111\u1eb7c bi\u1ec7t \u0111\u1ed1i v\u1edbi t\u1eafc m\u1ea1ch n\u00e3o. Sau \u0111\u00f3 d\u00f9ng c\u00e1c thu\u1ed1c kh\u00e1ng\u00a0 \u0111\u00f4ng lo\u1ea1i kh\u00e1ng Vitamin K nh\u01b0 Sintrom, Previscan, Dicoumarin g\u1ed1i \u0111\u1ea7u 48-72 gi\u1edd tr\u01b0\u1edbc khi ng\u1eebng Heparin duy tr\u00ec t\u1ef7 Prothrombin c\u00f2n kho\u1ea3ng 30-35% ho\u1eb7c IRN 2,5-3\u00a0 l\u00e0 t\u1ed1t nh\u1ea5t.<\/p>\n

+ Sau khi chuy\u1ec3n rung nh\u0129 v\u1ec1 nh\u1ecbp xoang b\u1eb1ng thu\u1ed1c ho\u1eb7c s\u1ed1c \u0111i\u1ec7n, nong van hai l\u00e1\u00a0 l\u00e0 ph\u01b0\u01a1ng ph\u00e1p d\u1ef1 ph\u00f2ng t\u1eafc m\u1ea1ch t\u00e1i ph\u00e1t t\u1ed1t nh\u1ea5t. Ho\u1eb7c \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n\u00a0 kh\u00f4ng c\u00f3 \u0111i\u1ec1u ki\u1ec7n nong van, ph\u1eabu thu\u1eadt s\u01b0\u1ea3 van, thay van c\u00f3 th\u1ec3 u\u1ed1ng thu\u1ed1c d\u1ef1 ph\u00f2ng t\u1eafc m\u1ea1ch k\u00e9o d\u00e0i nhi\u1ec1u n\u0103m \u1edf li\u1ec1u th\u1ea5p 100 – 500 mg \/ ng\u00e0y b\u1eb1ng Aspirin\u00a0 (aspegic 100mg), dipiridamole vv…<\/p>\n

1.3. \u0110i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng\u00a0\u00a0<\/strong><\/p>\n

– Ph\u00f2ng th\u1ea5p t\u00e1i ph\u00e1t b\u1eb1ng Benzathylpenixilin 1,2 tri\u1ec7u \u0111\u01a1n v\u1ecb m\u1ed7i 15-20 ng\u00e0y, ti\u00eam\u00a0 b\u1eafp s\u00e2u sau khi th\u1eed test.<\/p>\n

– Ngo\u00e0i ra \u0111\u1ec1 ph\u00f2ng b\u1ed9i nhi\u1ec5m ph\u1ed5i ho\u1eb7c Osler b\u1eb1ng kh\u00e1ng sinh Penixilin nhanh\u00a0 ho\u1eb7c Erythromycin 0,5g tr\u01b0\u1edbc c\u00e1c can thi\u1ec7p nh\u01b0 nh\u1ed5 r\u0103ng, x\u1ebb nh\u1ecdt ngo\u00e0i da vv… Khi\u00a0 c\u00f3 d\u1ea5u hi\u1ec7u vi\u00eam t\u0129nh m\u1ea1ch chi d\u01b0\u1edbi c\u00f3 th\u1ec3 ph\u00f2ng t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i b\u1eb1ng c\u00e1ch \u0111\u1eb7t\u00a0 l\u01b0\u1edbi l\u1ecdc t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi.<\/p>\n

2. \u0110i\u1ec1u tr\u1ecb ngo\u1ea1i khoa\u00a0\u00a0<\/em><\/h2>\n

\u0110i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt van hai l\u00e1 \u0111\u00e3 c\u00f3 nhi\u1ec1u ti\u1ebfn b\u1ed9. Nong van hai l\u00e1 b\u1eb1ng tay ho\u1eb7c\u00a0 b\u1eb1ng d\u1ee5ng c\u1ee5 ho\u1eb7c b\u1eb1ng b\u00f3ng (catheter baloon).<\/p>\n

2.1. Nong van hai l\u00e1 b\u1eb1ng b\u00f3ng\u00a0\u00a0<\/strong><\/p>\n

\u0110\u01b0a \u1ed1ng th\u00f4ng qua \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch \u0111\u00f9i \u0111i v\u00e0o nh\u0129 ph\u1ea3i, xuy\u00ean qua v\u00e1ch li\u00ean nh\u0129 v\u00e0o nh\u0129 tr\u00e1i \u0111\u1ec3 nong van 2 l\u00e1 b\u1eb1ng b\u00f3ng. K\u1ef9 thu\u1eadt n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n t\u1ea1i Vi\u1ec7t\u00a0Nam. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i <40, h\u1eb9p van hai l\u00e1\u00a0 \u0111\u01a1n thu\u1ea7n, van c\u00f2n m\u1ec1m m\u1ea1i, t\u1ed5 ch\u1ee9c d\u01b0\u1edbi van ch\u01b0a h\u01b0 bi\u1ebfn nhi\u1ec1u, kh\u00f4ng c\u00f3 c\u1ee5c\u00a0 m\u00e1u \u0111\u00f4ng \u1edf nh\u0129 tr\u00e1i ho\u1eb7c ti\u1ec3u nh\u0129. Bi\u1ebfn ch\u1ee9ng c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p n\u00e0y l\u00e0 ch\u1ecdc th\u1ee7ng\u00a0 th\u00e0nh t\u00e2m nh\u0129 tr\u00e1i g\u00e2y ra tr\u00e0n m\u00e1u m\u00e0ng ngo\u00e0i tim c\u1ea5p, g\u00e2y ch\u00e8n \u00e9p tim c\u1ea5p.<\/p>\n

2.2. Nong van hai l\u00e1 k\u00edn (close mitral commissurotomy)\u00a0\u00a0<\/strong><\/p>\n

– B\u1eb1ng tay ho\u1eb7c d\u1ee5ng c\u1ee5: th\u1ef1c hi\u1ec7n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n: c\u00f3 di\u1ec7n t\u00edch l\u1ed7 van hai l\u00e1\u00a0 h\u1eb9p <1.5 cm2, van c\u00f2n m\u1ec1m ho\u1eb7c x\u01a1 ho\u00e1, ch\u01b0a c\u00f3 v\u00f4i ho\u00e1 nh\u1ecbp xoang hay rung nh\u0129,\u00a0 nh\u01b0ng kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed t\u1eafc m\u1ea1ch, kh\u00f4ng c\u00f3 b\u1ec7nh van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, ho\u1eb7c h\u1edf van\u00a0 hai l\u00e1 (n\u1ebfu h\u1edf van hai l\u00e1 nh\u1eb9 <2\/4 th\u00ec kh\u00f4ng ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh), tu\u1ed5i < 40, kh\u00f4ng b\u1ecb b\u1ed9i\u00a0 nhi\u1ec5m ph\u1ed5i ho\u1eb7c th\u1ea5p tim \u0111ang ti\u1ebfn tri\u1ec3n, kh\u00f4ng b\u1ecb Osler.<\/p>\n

– K\u1ebft qu\u1ea3 sau nong c\u00f3 5-10% tr\u01b0\u1eddng h\u1ee3p h\u1ebft tri\u1ec7u ch\u1ee9ng h\u1eb9p van hai l\u00e1, tri\u1ec7u ch\u1ee9ng\u00a0 t\u0103ng \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i gi\u1ea3m d\u1ea7n v\u00e0 tr\u1edf v\u1ec1 b\u00ecnh th\u01b0\u1eddng. M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n\u00a0 nong van hai l\u00e1 kh\u00f4ng k\u1ebft qu\u1ea3 ho\u1eb7c th\u1ea5p tim t\u00e1i ph\u00e1t g\u00e2y d\u00ednh l\u1ea1i c\u00e1c m\u00e9p van ph\u1ea3i\u00a0 nong l\u1ea1i l\u1ea7n 2 nh\u01b0ng k\u1ebft qu\u1ea3 th\u00e0nh c\u00f4ng th\u1ea5p h\u01a1n v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong cao h\u01a1n 10 l\u1ea7n l\u00fac\u00a0 ban \u0111\u1ea7u.<\/p>\n

– Bi\u1ebfn ch\u1ee9ng khi nong van v\u00e0 sau khi nong<\/p>\n

+ Suy tim v\u00e0 r\u1ed1i lo\u1ea1n nh\u1ecbp sau ph\u1eabu thu\u1eadt<\/p>\n

+ S\u1ed1t<\/p>\n

+ H\u1ed9i ch\u1ee9ng sau nong van<\/p>\n

+ Tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim<\/p>\n

+ T\u1eafc \u0111\u1ed9ng m\u1ea1ch n\u00e3o tho\u00e1ng qua.<\/p>\n

+ H\u1edf van hai l\u00e1 sau khi nong th\u01b0\u1eddng g\u1eb7p \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb v\u00f4i ho\u00e1 van h\u01b0 bi\u1ebfn\u00a0 nhi\u1ec1u t\u1ed5 ch\u1ee9c d\u01b0\u1edbi van.<\/p>\n

+ Ng\u1eebng tim khi \u0111ang nong<\/p>\n

+ Hen tim, ph\u00f9 ph\u1ed5i c\u1ea5p<\/p>\n

+ Lo\u1ea1n nh\u1ecbp tim (ngo\u1ea1i t\u00e2m thu th\u1ea5t, nh\u0129, rung cu\u1ed3ng nh\u0129, nh\u1ecbp nhanh k\u1ecbch ph\u00e1t tr\u00ean\u00a0 th\u1ea5t v\u00e0 th\u1ea5t, rung nh\u1ea5t)<\/p>\n

+ Osler g\u00e2y \u0111\u1ee9t d\u00e2y ch\u1eb1ng, sa van hai l\u00e1<\/p>\n

2.3. M\u1ed5 tim h\u1edf\u00a0<\/strong><\/p>\n

C\u1ea7n c\u00f3 tim ph\u1ed5i nh\u00e2n t\u1ea1o<\/p>\n

– S\u1eeda van hai l\u00e1: ph\u1eabu thu\u1eadt vi\u00ean c\u00f3 th\u1ec3 m\u1edf r\u1ed9ng ho\u1eb7c thu h\u1eb9p v\u00f2ng van hai l\u00e1, c\u1eaft\u00a0 b\u1ecf ph\u1ea7n b\u1ecb s\u00f9i lo\u00e9t, v\u00f4i ho\u00e1 ho\u1eb7c l\u1ea5y c\u1ee5c m\u00e1u \u0111\u00f4ng \u1edf nh\u0129, th\u1ea5t, v\u00e0 c\u00e1c l\u1ed7 th\u0169ng tr\u00ean\u00a0 m\u1eb7t l\u00e1 van kh\u00e2u n\u1ed1i c\u00e1c tr\u1ee5 c\u01a1 v\u00e0 d\u00e2y ch\u1eb1ng b\u1ecb \u0111\u1ee9t. B\u1ec7nh nh\u00e2n kh\u00f4ng ph\u1ea3i thay van\u00a0 n\u00ean gi\u1ea3m \u0111\u01b0\u1ee3c nguy c\u01a1 mi\u1ec5n d\u1ecbch th\u1ea3i gh\u00e9p, gi\u1ea3m nguy c\u01a1 v\u00f4i ho\u00e1, t\u1eafc m\u1ea1ch n\u00ean\u00a0 vi\u1ec7c ch\u1ed1ng \u0111\u00f4ng \u0111\u01a1n gi\u1ea3n h\u01a1n thay van, gi\u1ea3m nguy c\u01a1 v\u00f4i ho\u00e1, t\u1eafc m\u1ea1ch n\u00ean li\u1ec7u\u00a0 ph\u00e1p ch\u1ed1ng \u0111\u00f4ng \u0111\u01a1n gi\u1ea3n h\u01a1n.<\/p>\n

\"minh-hoa-hep-van-hai-la\"<\/p>\n

– Ph\u1eabu thu\u1eadt thay van: \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p<\/p>\n

+ h\u1eb9p van hai l\u00e1 t\u1ed5 ch\u1ee9c van x\u01a1 d\u00e0y v\u00f4i ho\u00e1 n\u1eb7ng<\/p>\n

+ H\u1eb9p k\u1ebft h\u1ee3p h\u1edf van hai l\u00e1 n\u1eb7ng hay h\u1edf van hai l\u00e1 \u0111\u01a1n thu\u1ea7n.<\/p>\n

+ S\u00f9i lo\u00e9t van do Osder<\/p>\n

– Van hai l\u00e1 sinh h\u1ecdc: Ph\u1ee5c h\u1ed3i m\u1ed9t c\u00e1ch c\u01a1 b\u1ea3n huy\u1ebft \u0111\u1ed9ng, kh\u00f4ng b\u1ecb nhi\u1ec5m khu\u1ea9n,\u00a0 kh\u00f4ng t\u1ea1o c\u1ee5c m\u00e1u \u0111\u00f4ng, kh\u00f4ng b\u1ecb th\u1ee7ng \u0111\u1ee9t v\u00f2ng van sau th\u1eddi gian d\u00e0i ph\u1ea9u thu\u1eadt,\u00a0 v\u00ec v\u1eady n\u00f3 m\u1edf ra tri\u1ec3n v\u1ecdng ph\u00e1t tri\u1ec3n sau n\u00e0y.<\/p>\n

2.4. Bi\u1ebfn ch\u1ee9ng sau khi thay van\u00a0\u00a0<\/strong><\/p>\n

Ngo\u00e0i c\u00e1c bi\u1ebfn ch\u1ee9ng nh\u01b0 nong van c\u00f2n c\u00f3 th\u00eam c\u00e1c bi\u1ebfn ch\u1ee9ng.\u00a0 – \u0110\u1ed9t t\u1eed trong khi ph\u1eabu thu\u1eadt<\/p>\n

– \u0110\u1ed9t t\u1eed do ho\u1ea1t \u0111\u1ed9ng c\u1ee7a van b\u1ecb r\u1ed1i lo\u1ea1n.<\/p>\n

– D\u00ednh k\u1ebft Fibrin, sau \u0111\u00f3 v\u00f4i ho\u00e1 t\u1ea1i van v\u00e0 quanh van m\u1ea1n.<\/p>\n

– Osler do vi khu\u1ea9n v\u00e0 n\u1ea5m.<\/p>\n

– Abces quanh v\u00f2ng van.<\/p>\n

– H\u1edf quanh v\u00f2ng van hai l\u00e1.<\/p>\n

– Block nh\u0129 th\u1ea5t c\u1ea5p cao ho\u1eb7c bloc b\u00f3 His (do c\u1eaft c\u00e1c tr\u1ee5 c\u01a1)<\/p>\n

– H\u1eb9p ho\u1eb7c h\u1edf \u0110MC th\u1ee9 ph\u00e1t sau thay van hai l\u00e1<\/p>\n

– Gi\u1ea3m kh\u1ea3 n\u0103ng b\u00f9 \u0111\u1eafp tu\u1ea7n ho\u00e0n khi g\u1eafng s\u1ee9c.<\/p>\n

– Kh\u00f3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p s\u1ed1c \u0111i\u1ec7n, t\u1ea1o nh\u1ecbp khi c\u1ea7n thi\u1ebft.\u00a0 \u0110i\u1ec1u tr\u1ecb nong van hai l\u00e1 hay ph\u1eabu thu\u1eadt tim k\u00edn hay h\u1edf c\u1ea7n ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb ph\u00f2ng\u00a0 th\u1ea5p, ph\u00f2ng Osler, \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng, suy tim th\u00ec m\u1edbi k\u00e9o d\u00e0i cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh\u00a0 nh\u00e2n.<\/p>\n

T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/strong> B\u00e0i gi\u1ea3ng n\u1ed9i khoa – \u0110\u1ea1i h\u1ecdc Y Khoa Ph\u1ea1m Ng\u1ecdc Th\u1ea1ch<\/p>\n","protected":false},"excerpt":{"rendered":"

H\u1eb9p van hai l\u00e1 l\u00e0 m\u1ed9t b\u1ec7nh kh\u00e1 ph\u1ed5 bi\u1ebfn \u1edf n\u01b0\u1edbc ta chi\u1ebfm kho\u1ea3ng 40,3% c\u00e1c\u00a0 b\u1ec7nh tim m\u1eafc ph\u1ea3i. Van hai l\u00e1 n\u1ed1i li\u1ec1n nh\u0129 tr\u00e1i v\u00e0 th\u1ea5t tr\u00e1i, gi\u00fap m\u00e1u di chuy\u1ec3n theo m\u1ed9t h\u01b0\u1edbng t\u1eeb nh\u0129 xu\u1ed1ng th\u1ea5t, bao g\u1ed3m 2 l\u00e1 van: l\u00e1 van l\u1edbn (hay l\u00e1 van tr\u01b0\u1edbc) v\u00e0 […]<\/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":"\nT\u1ed5ng quan v\u1ec1 \u0111i\u1ec1u tr\u1ecb h\u1eb9p van hai l\u00e1 - Vinmec<\/title>\n<meta name=\"description\" content=\"H\u1eb9p van hai l\u00e1 l\u00e0 m\u1ed9t b\u1ec7nh kh\u00e1 ph\u1ed5 bi\u1ebfn \u1edf n\u01b0\u1edbc ta. \u0110\u01b0\u1ee3c coi l\u00e0 h\u1eb9p van 2 l\u00e1 khi di\u1ec7n t\u00edch m\u1edf van d\u01b0\u1edbi hay b\u1eb1ng 2cm2.\" \/>\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=\"T\u1ed5ng quan v\u1ec1 \u0111i\u1ec1u tr\u1ecb h\u1eb9p van hai l\u00e1 - Vinmec\" \/>\n<meta property=\"og:description\" content=\"H\u1eb9p van hai l\u00e1 l\u00e0 m\u1ed9t b\u1ec7nh kh\u00e1 ph\u1ed5 bi\u1ebfn \u1edf n\u01b0\u1edbc ta. \u0110\u01b0\u1ee3c coi l\u00e0 h\u1eb9p van 2 l\u00e1 khi di\u1ec7n t\u00edch m\u1edf van d\u01b0\u1edbi hay b\u1eb1ng 2cm2.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/tong-quan-ve-dieu-tri-hep-van-hai-la\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-21T07:13:38+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-04-21T11:03:15+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/4-2-300x169.webp\" \/>\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=\"8 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\/21\/tong-quan-ve-dieu-tri-hep-van-hai-la\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/tong-quan-ve-dieu-tri-hep-van-hai-la\/\",\"name\":\"T\u1ed5ng quan v\u1ec1 \u0111i\u1ec1u tr\u1ecb h\u1eb9p van hai l\u00e1 - Vinmec\",\"isPartOf\":{\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-04-21T07:13:38+00:00\",\"dateModified\":\"2023-04-21T11:03:15+00:00\",\"author\":{\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/b99bd843f29d91903ec9b6d18e47b0e2\"},\"description\":\"H\u1eb9p van hai l\u00e1 l\u00e0 m\u1ed9t b\u1ec7nh kh\u00e1 ph\u1ed5 bi\u1ebfn \u1edf n\u01b0\u1edbc ta. \u0110\u01b0\u1ee3c coi l\u00e0 h\u1eb9p van 2 l\u00e1 khi di\u1ec7n t\u00edch m\u1edf van d\u01b0\u1edbi hay b\u1eb1ng 2cm2.\",\"breadcrumb\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/tong-quan-ve-dieu-tri-hep-van-hai-la\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/tong-quan-ve-dieu-tri-hep-van-hai-la\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/tong-quan-ve-dieu-tri-hep-van-hai-la\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/noithathoaphat.in\/ctv\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"T\u1ed5ng quan v\u1ec1 \u0111i\u1ec1u tr\u1ecb h\u1eb9p van hai l\u00e1\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#website\",\"url\":\"https:\/\/noithathoaphat.in\/ctv\/\",\"name\":\"Vinmec\",\"description\":\"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/b99bd843f29d91903ec9b6d18e47b0e2\",\"name\":\"Dai Tran Van\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/\",\"url\":\"http:\/\/1.gravatar.com\/avatar\/104f3ddcb78816cdc9f1340c38ade413?s=96&d=mm&r=g\",\"contentUrl\":\"http:\/\/1.gravatar.com\/avatar\/104f3ddcb78816cdc9f1340c38ade413?s=96&d=mm&r=g\",\"caption\":\"Dai Tran Van\"},\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/tranvandai2791995gmail-com\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"T\u1ed5ng quan v\u1ec1 \u0111i\u1ec1u tr\u1ecb h\u1eb9p van hai l\u00e1 - Vinmec","description":"H\u1eb9p van hai l\u00e1 l\u00e0 m\u1ed9t b\u1ec7nh kh\u00e1 ph\u1ed5 bi\u1ebfn \u1edf n\u01b0\u1edbc ta. \u0110\u01b0\u1ee3c coi l\u00e0 h\u1eb9p van 2 l\u00e1 khi di\u1ec7n t\u00edch m\u1edf van d\u01b0\u1edbi hay b\u1eb1ng 2cm2.","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":"T\u1ed5ng quan v\u1ec1 \u0111i\u1ec1u tr\u1ecb h\u1eb9p van hai l\u00e1 - Vinmec","og_description":"H\u1eb9p van hai l\u00e1 l\u00e0 m\u1ed9t b\u1ec7nh kh\u00e1 ph\u1ed5 bi\u1ebfn \u1edf n\u01b0\u1edbc ta. \u0110\u01b0\u1ee3c coi l\u00e0 h\u1eb9p van 2 l\u00e1 khi di\u1ec7n t\u00edch m\u1edf van d\u01b0\u1edbi hay b\u1eb1ng 2cm2.","og_url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/tong-quan-ve-dieu-tri-hep-van-hai-la\/","og_site_name":"Vinmec","article_published_time":"2023-04-21T07:13:38+00:00","article_modified_time":"2023-04-21T11:03:15+00:00","og_image":[{"url":"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/4-2-300x169.webp"}],"author":"Dai Tran Van","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Dai Tran Van","Est. reading time":"8 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/tong-quan-ve-dieu-tri-hep-van-hai-la\/","url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/tong-quan-ve-dieu-tri-hep-van-hai-la\/","name":"T\u1ed5ng quan v\u1ec1 \u0111i\u1ec1u tr\u1ecb h\u1eb9p van hai l\u00e1 - Vinmec","isPartOf":{"@id":"https:\/\/noithathoaphat.in\/ctv\/#website"},"datePublished":"2023-04-21T07:13:38+00:00","dateModified":"2023-04-21T11:03:15+00:00","author":{"@id":"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/b99bd843f29d91903ec9b6d18e47b0e2"},"description":"H\u1eb9p van hai l\u00e1 l\u00e0 m\u1ed9t b\u1ec7nh kh\u00e1 ph\u1ed5 bi\u1ebfn \u1edf n\u01b0\u1edbc ta. \u0110\u01b0\u1ee3c coi l\u00e0 h\u1eb9p van 2 l\u00e1 khi di\u1ec7n t\u00edch m\u1edf van d\u01b0\u1edbi hay b\u1eb1ng 2cm2.","breadcrumb":{"@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/tong-quan-ve-dieu-tri-hep-van-hai-la\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/tong-quan-ve-dieu-tri-hep-van-hai-la\/"]}]},{"@type":"BreadcrumbList","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/tong-quan-ve-dieu-tri-hep-van-hai-la\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/noithathoaphat.in\/ctv\/"},{"@type":"ListItem","position":2,"name":"T\u1ed5ng quan v\u1ec1 \u0111i\u1ec1u tr\u1ecb h\u1eb9p van hai l\u00e1"}]},{"@type":"WebSite","@id":"https:\/\/noithathoaphat.in\/ctv\/#website","url":"https:\/\/noithathoaphat.in\/ctv\/","name":"Vinmec","description":"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/b99bd843f29d91903ec9b6d18e47b0e2","name":"Dai Tran Van","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/","url":"http:\/\/1.gravatar.com\/avatar\/104f3ddcb78816cdc9f1340c38ade413?s=96&d=mm&r=g","contentUrl":"http:\/\/1.gravatar.com\/avatar\/104f3ddcb78816cdc9f1340c38ade413?s=96&d=mm&r=g","caption":"Dai Tran Van"},"url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/tranvandai2791995gmail-com\/"}]}},"_links":{"self":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/26053"}],"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\/16"}],"replies":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/comments?post=26053"}],"version-history":[{"count":4,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/26053\/revisions"}],"predecessor-version":[{"id":26162,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/26053\/revisions\/26162"}],"wp:attachment":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/media?parent=26053"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/categories?post=26053"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/tags?post=26053"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}