{"id":26226,"date":"2023-04-21T22:50:08","date_gmt":"2023-04-21T15:50:08","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=26226"},"modified":"2023-04-24T23:02:33","modified_gmt":"2023-04-24T16:02:33","slug":"tong-quan-chan-doan-va-dieu-tri-ho-van-hai-la","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/tong-quan-chan-doan-va-dieu-tri-ho-van-hai-la\/","title":{"rendered":"T\u1ed5ng quan ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb h\u1edf van hai l\u00e1"},"content":{"rendered":"

H\u1edf van hai l\u00e1 do b\u1ea5t th\u01b0\u1eddng ho\u1eb7c b\u1ec7nh l\u00fd \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn b\u1ea5t k\u1ef3 m\u1ed9t ho\u1eb7c nhi\u1ec1u th\u00e0nh ph\u1ea7n ch\u1ee9c n\u0103ng c\u1ee7a b\u1ed9 m\u00e1y van hai l\u00e1 (l\u00e1 van, v\u00f2ng van, th\u1eebng g\u00e2n, c\u01a1 tr\u1ee5, v\u00e0 c\u01a1 tim l\u00e2n c\u1eadn).<\/strong> H\u1edf van hai l\u00e1 (HoHL) g\u00e2y ra d\u00f2ng ch\u1ea3y t\u1eeb th\u1ea5t tr\u00e1i (LV) v\u00e0o nh\u0129 tr\u00e1i trong th\u00ec t\u00e2m thu. H\u1edf hai l\u00e1<\/a> c\u00f3 th\u1ec3 l\u00e0 nguy\u00ean ph\u00e1t (nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p l\u00e0 sa van hai l\u00e1 v\u00e0 th\u1ea5p tim) ho\u1eb7c th\u1ee9 ph\u00e1t do th\u1ea5t tr\u00e1i gi\u00e3n ho\u1eb7c nh\u1ed3i m\u00e1u.\u00a0<\/strong><\/p>\n

1. Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng h\u1edf van hai l\u00e1<\/h2>\n

HoHL c\u1ea5p, b\u00e1n c\u1ea5p ho\u1eb7c m\u1ea1n t\u00ednh
\n– HoHLc\u1ea5p n\u1eb7ng th\u01b0\u1eddng do thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9, vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c ho\u1eb7c \u0111\u1ee9t d\u00e2y ch\u1eb1ng van. B\u1ec7nh nh\u00e2n h\u1edf van hai l\u00e1 c\u1ea5p n\u1eb7ng th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n v\u1edbi ph\u00f9 ph\u1ed5i v\u00e0 cho\u00e1ng tim. Ti\u00ean l\u01b0\u1ee3ng x\u1ea5u, tr\u1eeb khi b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u1ed5n \u0111\u1ecbnh nhanh ch\u00f3ng \u0111\u1ec3 can thi\u1ec7p ph\u1eabu thu\u1eadt ngay l\u1eadp t\u1ee9c.
\n– HoHL b\u00e1n c\u1ea5p th\u01b0\u1eddng x\u1ea3y ra khi c\u00f3 m\u1ed9t bi\u1ebfn c\u1ed1 c\u1ea5p nh\u01b0 \u0111\u1ee9t d\u00e2y ch\u1eb1ng
\nch\u1ed3ng l\u00ean m\u1ed9t h\u1edf van hai l\u00e1 m\u1ea1n t\u00ednh, th\u00fac \u0111\u1ea9y c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a h\u1edf van hai l\u00e1
\nm\u1ea1n t\u00ednh \u0111i k\u00e8m n\u1eb7ng l\u00ean nh\u01b0ng \u00edt c\u00f3 bi\u1ec3u hi\u1ec7n k\u1ecbch ph\u00e1t nh\u01b0 h\u1edf van hai l\u00e1 n\u1eb7ng
\nc\u1ea5p.
\n– HoHL\u00a0 m\u1ea1n th\u01b0\u1eddng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng trong tr\u01b0\u1eddng h\u1ee3p nh\u1eb9 t\u1edbi trung b\u00ecnh v\u1edbi ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i b\u1ea3o t\u1ed3n. Trong tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng h\u01a1n v\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 suy ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i, h\u1edf van hai l\u00e1 m\u1ea1n bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng c\u1ee7a suy tim tr\u00e1i bao g\u1ed3m kh\u00f3 th\u1edf t\u0103ng d\u1ea7n, l\u00fac \u0111\u1ea7u l\u00e0 kh\u00f3 th\u1edf khi g\u1eafng s\u1ee9c, v\u1ec1 sau kh\u00f3 th\u1edf k\u1ecbch ph\u00e1t v\u1ec1 \u0111\u00eam v\u00e0 cu\u1ed1i c\u00f9ng l\u00e0 kh\u00f3 th\u1edf khi n\u1eb1m. B\u1ec7nh nh\u00e2n c\u0169ng than phi\u1ec1n v\u1ec1 m\u1ec7t m\u1ecfi v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c c\u1ee7a suy tim \u1ee9 huy\u1ebft nh\u01b0 ph\u00f9.<\/p>\n

2. Kh\u00e1m th\u1ef1c th\u1ec3 HoHL<\/h2>\n

– M\u1ea1ch c\u00f3 th\u1ec3 lo\u1ea1n nh\u1ecbp ho\u00e0n to\u00e0n do rung nh\u0129.
\n– Nh\u1ecbp \u0111\u1eadp m\u1ecfm tim r\u1ed9ng, d\u1eddi xu\u1ed1ng d\u01b0\u1edbi v\u00e0 ra ngo\u00e0i (b\u1eb1ng ch\u1ee9ng c\u1ee7a gi\u00e3n v\u00e0 ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i).
\n– Tri\u1ec7u ch\u1ee9ng sung huy\u1ebft ph\u1ed5i (ran \u1ea9m, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i)
\n– Ti\u1ebfng T1 th\u01b0\u1eddng nh\u1ecf do van hai l\u00e1 b\u1ecb h\u1edf n\u00ean \u0111\u00f3ng k\u00e9m.
\n– Ti\u1ebfng T2 t\u00e1ch \u0111\u00f4i r\u1ed9ng do van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u0111\u00f3ng s\u1edbm. Th\u00e0nh ph\u1ea7n P2 m\u1ea1nh \u1edf b\u1ec7nh nh\u00e2n c\u00f3 t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.
\n– Ti\u1ebfng T3 th\u01b0\u1eddng g\u1eb7p do qu\u00e1 t\u1ea3i th\u1ec3 t\u00edch th\u1ea5t tr\u00e1i nh\u01b0ng kh\u00f4ng nh\u1ea5t thi\u1ebft ph\u1ea3i c\u00f3 suy tim.
\n– Ti\u1ebfng T4 \u00edt g\u1eb7p tr\u1eeb khi c\u00f3 t\u0103ng huy\u1ebft \u00e1p v\u00e0 b\u1ec7nh m\u1ea1ch v\u00e0nh \u0111i k\u00e8m.
\n– \u00c2m th\u1ed5i \u0111\u1eb7c tr\u01b0ng c\u1ee7a HoHL\u00a0 m\u1ea1n l\u00e0 \u00e2m th\u1ed5i to\u00e0n t\u00e2m thu d\u1ea1ng tr\u00e0n, nghe r\u00f5 nh\u1ea5t \u1edf m\u1ecfm v\u00e0 lan ra n\u00e1ch. \u0110\u00f4i khi b\u1ec7nh nh\u00e2n khi\u1ebfm khuy\u1ebft l\u00e1 sau van hai l\u00e1, h\u01b0\u1edbng lan c\u1ee7a \u00e2m th\u1ed5i c\u00f3 th\u1ec3 lan ra ph\u00eda tr\u01b0\u1edbc v\u00e0 nghe r\u00f5 \u1edf \u1ed5 van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.
\n– B\u1ec7nh nh\u00e2n sa van hai l\u00e1, c\u00f3 ti\u1ebfng cl\u00edc gi\u1eefa t\u00e2m thu \u0111i tr\u01b0\u1edbc \u00e2m th\u1ed5i t\u00e2m thu mu\u1ed9n
\nv\u00e0 t\u0103ng d\u1ea7n.
\n– Tri\u1ec7u ch\u1ee9ng c\u1ee7a suy th\u1ea5t ph\u1ea3i:
\no T\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i (+)
\no T\u0103ng \u0111\u1ed9ng th\u1ea5t ph\u1ea3i
\no Gan to
\no Ph\u1ea3n h\u1ed3i gan t\u0129nh m\u1ea1ch c\u1ed5 (+)
\no Ph\u00f9 ngo\u1ea1i bi\u00ean.<\/p>\n

3. C\u1eadn l\u00e2m s\u00e0ng<\/strong><\/h2>\n

3.1. <\/em><\/strong>X-<\/em><\/strong>quang<\/em><\/strong><\/p>\n

– B\u00f3ng tim c\u00f2n b\u00ecnh th\u01b0\u1eddng n\u1ebfu H\u1edf hai l\u00e1 nh\u1eb9 v\u00e0 v\u1eeba.<\/p>\n

– Trong giai \u0111o\u1ea1n ti\u1ebfn tri\u1ec3n ho\u1eb7c H\u1edf hai l\u00e1 n\u1eb7ng: Gi\u00e3n th\u1ea5t tr\u00e1i v\u1edbi cung d\u01b0\u1edbi tr\u00e1i l\u1edbn, m\u1ecfm tim ch\u00fac xu\u1ed1ng, nh\u0129 tr\u00e1i l\u1edbn, m\u1ea5t kho\u1ea3ng s\u00e1ng sau tim.<\/p>\n

3.2. \u0110i\u1ec7n t\u00e2m \u0111\u1ed3<\/em><\/strong><\/p>\n

– Th\u01b0\u1eddng ch\u01b0a thay \u0111\u1ed5i n\u1ebfu H\u1edf hai l\u00e1 nh\u1eb9 v\u00e0 v\u1eeba.<\/p>\n

– \u0110\u1ed1i v\u1edbi HoHL ti\u1ebfn tri\u1ec3n ho\u1eb7c HoHL n\u1eb7ng: Tr\u1ee5c tr\u00e1i, d\u00e0y nh\u0129 tr\u00e1i (P>0.12s \u1edf D1<\/sub>, D2<\/sub>, c\u00e1c chuy\u1ec3n \u0111\u1ea1o tr\u01b0\u1edbc tim ph\u1ea3i), d\u00e0y th\u1ea5t tr\u00e1i v\u1edbi nhi\u1ec1u ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n (th\u01b0\u1eddng RV5<\/sub>>25mm, sokolow-Lyon>35mm…), r\u1ed1i lo\u1ea1n t\u00e1i c\u1ef1c c\u1ee7a t\u0103ng g\u00e1nh th\u1ea5t tr\u00e1i t\u00e2m tr\u01b0\u01a1ng (s\u00f3ng q v\u00e0 T d\u01b0\u01a1ng) mu\u1ed9n h\u01a1n v\u1edbi t\u0103ng g\u00e1nh t\u00e2m thu-t\u00e2mtr\u01b0\u01a1ng (s\u00f3ng q, T \u00e2m). Giai \u0111o\u1ea1n n\u1eb7ng th\u00ec d\u00e0y hai th\u1ea5t (t\u0103ng \u00e1p \u0110MP).<\/p>\n

3.3. Si\u00eau \u00e2m Doppler tim<\/em><\/strong><\/p>\n

Cho ph\u00e9p th\u0103m d\u00f2 h\u00ecnh th\u00e1i c\u1ee7a van, ki\u1ec3u t\u1ed5n th\u01b0\u01a1ng gi\u1ea3i ph\u1eabu, m\u1ee9c \u0111\u1ed9 h\u1edf, ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i, \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i v\u00e0 c\u00e1c b\u1ec7nh l\u00fd van, c\u01a1 tim ph\u1ed1i h\u1ee3p, kh\u1ea3 n\u0103ng \u0111i\u1ec1u tr\u1ecb n\u1ed9i hay ngo\u1ea1i khoa.<\/p>\n

3.4. C\u00e1c th\u0103m d\u00f2 kh\u00e1c<\/em><\/strong><\/p>\n

Nh\u01b0 th\u00f4ng tim, c\u1ed9ng h\u01b0\u1edfng t\u1eeb h\u1ea1t nh\u00e2n… c\u0169ng cho p\u00e9p ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 h\u1edf van…<\/p>\n

3.5. Ch\u1ea9n \u0111o\u00e1n<\/em><\/strong><\/p>\n

– Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh: L\u00e2m s\u00e0ng th\u01b0\u1eddng \u0111\u1ee7 \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n, ngo\u1ea1i tr\u1eeb si\u00eau \u00e2m tim th\u1ea5y d\u00f2ng h\u1edf \u0111i d\u1ecdc v\u00e1ch li\u00ean nh\u0129 c\u00f3 th\u1ec3 nh\u1ea7m v\u1edbi h\u1edf van ba l\u00e1, nh\u01b0ng d\u1ef1a v\u00e0o tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a suy tim tr\u00e1i gi\u00fap ch\u1ea9n \u0111o\u00e1n trong tr\u01b0\u1eddng h\u1ee3p kh\u00f3 c\u1ea7n d\u1ef1a v\u00e0o c\u1eadn l\u00e2m s\u00e0ng.<\/p>\n

– Ch\u1ea9n \u0111o\u00e1n gi\u00e1n bi\u1ec7t: Th\u00f4ng li\u00ean th\u1ea5t th\u1ea5p (ph\u1ea7n c\u01a1), d\u1ec5 ch\u1ea9n \u0111o\u00e1n v\u00ec \u0111\u1eb7c tr\u01b0ng c\u1ee7a TTT.<\/p>\n

4. \u0110i\u1ec1u tr\u1ecb h\u1edf van hai l\u00e1<\/h2>\n

Nguy\u00ean t\u1eafc<\/strong><\/p>\n

    \n
  • Ph\u1ee5c h\u1ed3i van hai l\u00e1 \u01b0u ti\u00ean cho MR ch\u00ednh<\/li>\n
  • \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa ho\u1eb7c thay van hai l\u00e1 \u0111\u1ed1i v\u1edbi MR th\u1ee9 ph\u00e1t<\/li>\n
  • Thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng cho b\u1ec7nh nh\u00e2n rung nh\u0129<\/li>\n<\/ul>\n

    4.1. H\u1edf van hai l\u00e1 c\u1ea5p
    \n<\/strong>Trong khi ch\u1edd \u0111\u1ee3i ph\u1ea9u thu\u1eadt, gi\u1ea3m h\u1eadu t\u1ea3i t\u00edch c\u1ef1c b\u1eb1ng nitroprusside truy\u1ec1n t\u0129nh m\u1ea1ch ho\u1eb7c \u0111\u1eb7t b\u00f3ng \u0111\u1ed1i xung \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u00e0m gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng h\u1edf van hai l\u00e1 v\u00e0 \u1ed5n \u0111\u1ecbnh b\u1ec7nh nh\u00e2n do t\u1ea1o thu\u1eadn l\u1ee3i cho d\u00f2ng m\u00e1u \u0111i v\u1ec1 ph\u00eda tr\u01b0\u1edbc v\u00e0 gi\u1ea3m ph\u00f9 ph\u1ed5i
    \n4.2. HoHL l\u00e1 m\u1ea1n
    \n<\/strong>4.2.1. \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa
    \n<\/strong>– Thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n v\u00e0 \u1ee9c ch\u1ebf b\u00eata \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0m gi\u1ea3m t\u1eed vong v\u00e0
    \n\u0111\u1ed9 n\u1eb7ng c\u1ee7a HoHL.
    \n– M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n \u0111\u1eb7t m\u00e1y t\u1ea1o nh\u1ecbp t\u00e1i \u0111\u1ed3ng b\u1ed9 tim (CRT: cardiac resynchronization therapy) c\u0169ng l\u00e0m gi\u1ea3m \u0111\u1ed9 n\u1eb7ng c\u1ee7a h\u1edf van hai l\u00e1
    \n4.2.2. S\u1eeda van hai l\u00e1 qua da
    \n4.2.3. \u0110i\u1ec1u tr\u1ecb ph\u1ea9u thu\u1eadt
    \n<\/strong>H\u01b0\u1edbng d\u1eabn c\u1ee7a ACC\/AHA \u2013 ch\u1ec9 \u0111\u1ecbnh nh\u00f3m I c\u1ee7a ph\u1ea9u thu\u1eadt h\u1edf van hai l\u00e1
    \n– HoHL c\u1ea5p n\u1eb7ng c\u00f3 tri\u1ec7u ch\u1ee9ng
    \n– HoHL m\u1ea1n n\u1eb7ng v\u00e0 c\u00f3 tri\u1ec7u ch\u1ee9ng \u0111\u1ed9 II, III, IV theo NYHA m\u00e0 kh\u00f4ng c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i n\u1eb7ng (EF < 30% v\u00e0\/ ho\u1eb7c \u0111\u01b0\u1eddng k\u00ednh cu\u1ed1i t\u00e2m thu > 55 mm)
    \n– HoHL\u00a0 n\u1eb7ng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i nh\u1eb9 – trung b\u00ecnh ( EF 30 – 60% v\u00e0\/ ho\u1eb7c \u0111\u01b0\u1eddng k\u00ednh cu\u1ed1i t\u00e2m thu \u2265 40 mm)
    \n– Khuy\u00ean s\u1eeda van hai l\u00e1 h\u01a1n l\u00e0 thay van hai l\u00e1 \u1edf \u0111a s\u1ed1 b\u1ec7nh nh\u00e2n h\u1edf van hai l\u00e1 m\u1ea1n n\u1eb7ng c\u1ea7n ph\u1ea9u thu\u1eadt, v\u00e0 b\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u \u0111\u1ebfn m\u1ed9t trung t\u00e2m ph\u1ea9u thu\u1eadt c\u00f3 kinh nghi\u1ec7m s\u1eeda van hai l\u00e1
    \n\"minh-hoa-ho-van-hai-la\"<\/p>\n

    T\u00e0i li\u1ec7u: PGS.TS Ph\u1ea1m Nguy\u1ec5n Vinh<\/p>\n","protected":false},"excerpt":{"rendered":"

    H\u1edf van hai l\u00e1 do b\u1ea5t th\u01b0\u1eddng ho\u1eb7c b\u1ec7nh l\u00fd \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn b\u1ea5t k\u1ef3 m\u1ed9t ho\u1eb7c nhi\u1ec1u th\u00e0nh ph\u1ea7n ch\u1ee9c n\u0103ng c\u1ee7a b\u1ed9 m\u00e1y van hai l\u00e1 (l\u00e1 van, v\u00f2ng van, th\u1eebng g\u00e2n, c\u01a1 tr\u1ee5, v\u00e0 c\u01a1 tim l\u00e2n c\u1eadn). 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