{"id":28051,"date":"2023-04-24T22:09:57","date_gmt":"2023-04-24T15:09:57","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28051"},"modified":"2023-04-24T22:09:57","modified_gmt":"2023-04-24T15:09:57","slug":"danh-gia-chuc-nang-tam-truong-that-trai-trong-sieu-am-tim","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/24\/danh-gia-chuc-nang-tam-truong-that-trai-trong-sieu-am-tim\/","title":{"rendered":"\u0110\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng th\u1ea5t tr\u00e1i trong si\u00eau \u00e2m tim"},"content":{"rendered":"

\u0110\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng th\u1ea5t tr\u00e1i trong si\u00eau \u00e2m tim l\u00e0 k\u1ef9 thu\u1eadt quan tr\u1ecdng, b\u00e0i vi\u1ebft cung c\u1ea5p th\u00f4ng tin chi ti\u1ebft v\u1ec1 k\u1ef9 thu\u1eadt n\u00e0y.<\/strong><\/p>\n

1.Gi\u1edbi thi\u1ec7u v\u1ec1 si\u00eau \u00e2m qua th\u00e0nh ng\u1ef1c.<\/a><\/h2>\n

M\u1eb7c d\u00f9 c\u00e1c k\u1ef9 thu\u1eadt C\u0110HA tim m\u1ea1ch m\u1edbi \u0111\u00e3 c\u00f3 nh\u1eefng ti\u1ebfn b\u1ed9 v\u01b0\u1ee3t b\u1eadc, si\u00eau \u00e2m tim v\u0201n l\u00e0 ph\u01b0\u01a1ng ph\u00e1p C\u0110HA quan tr\u1ecdng nh\u1ea5t trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. \u0110\u01b0\u1ee3c ph\u00e1t tri\u1ec3n b\u1edfi Edler v\u00e0 Herz g\u1ea7n n\u0103m th\u1eadp k\u1ef7 tr\u01b0\u1edbc, si\u00eau \u00e2m tim \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng th\u01b0\u1eddng quy trong l\u00e2m s\u00e0ng v\u00e0 \u0111\u00e3 ph\u00e1t tri\u1ec3n th\u00e0nh m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p tr\u1ef1c quan, d\u1ec5 hi\u1ec3u, d\u1ec5 th\u1ef1c h\u00e0nh, cho ph\u00e9p \u0111\u00e1nh gi\u00e1 nhanh ch\u00f3ng v\u00e0 c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n nhi\u1ec1u l\u1ea7n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 h\u00ecnh th\u00e1i v\u00e0 ch\u1ee9c n\u0103ng tim. \u0110\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ed9t c\u00e1ch ch\u00ednh x\u00e1c k\u1ebft qu\u1ea3 si\u00eau \u00e2m tim, y\u00eau c\u1ea7u \u0111\u1ea7u ti\u00ean l\u00e0 c\u1ea7n hi\u1ec3u r\u00f5 nh\u1eefng nguy\u00ean t\u1eafc v\u1eadt l\u00fd – c\u01a1 s\u1edf cho c\u00e1c ph\u01b0\u01a1ng th\u1ee9c k\u1ef9 thu\u1eadt kh\u00e1c nhau.<\/p>\n

2. Ti\u1ebfp c\u1eadn \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng th\u1ea5t tr\u00e1i<\/strong><\/h2>\n

C\u00f3 r\u1ea5t nhi\u1ec1u y\u1ebfu t\u1ed1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng: tu\u1ed5i, tri\u1ec7u ch\u1ee9ng, nh\u1ecbp tim v\u00e0 t\u1ea7n s\u1ed1 tim, ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i, th\u1ec3 t\u00edch nh\u0129 tr\u00e1i, ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i.<\/p>\n

Trong \u0111\u00f3, ph\u00e2n s\u1ed1 t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i l\u00e0 y\u1ebfu t\u1ed1 quan tr\u1ecdng: C\u00e1c th\u00f4ng s\u1ed1 si\u00eau \u00e2m \u0111\u00e1nh gi\u00e1 thay \u0111\u1ed5i r\u1ea5t nhi\u1ec1u gi\u1eefa b\u1ec7nh nh\u00e2n c\u00f3 ph\u00e2n s\u1ed1 t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i gi\u1ea3m so v\u1edbi th\u00f4ng s\u1ed1 th\u1ea5t tr\u00e1i c\u00f2n b\u1ea3o t\u1ed3n.<\/p>\n

2.1 \u0110\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng th\u1ea5t tr\u00e1i \u1edf b\u1ec7nh nh\u00e2n c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i c\u00f2n b\u1ea3o t\u1ed3n<\/h3>\n

L\u01b0u \u00fd tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng g\u1ee3i \u00fd v\u00e0 nh\u1eefng thay \u0111\u1ed5i c\u1ea5u tr\u00fac tim tr\u00ean si\u00eau \u00e2m 2D g\u1ee3i \u00fd r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng: D\u00e0y th\u1ea5t tr\u00e1i, gi\u00e3n nh\u0129 tr\u00e1i, gi\u1ea3m s\u1ee9c c\u0103ng theo chi\u1ec1u d\u1ecdc c\u01a1 tim th\u1ea5t tr\u00e1i…<\/p>\n

\u0110\u00e1nh gi\u00e1 4 th\u00f4ng s\u1ed1 c\u01a1 b\u1ea3n v\u00e0 gi\u00e1 tr\u1ecb gi\u1edbi h\u1ea1n c\u1ee7a c\u00e1c th\u00f4ng s\u1ed1 n\u00e0y:<\/p>\n

    \n
  • S\u00f3ng e ‘: e ‘ v\u00e1ch < 7 cm\/ s ; e ‘ th\u00e0nh b\u00ean < 10 cm\/ s<\/li>\n
  • T\u1ef7 l\u1ec7 E\/e’: E\/e’ trung b\u00ecnh > 14; ho\u1eb7c E\/e’ th\u00e0nh b\u00ean > 13 ho\u1eb7c E\/e’ v\u00e1ch > 15 \u0111\u01b0\u1ee3c coi l\u00e0 b\u1ea5t th\u01b0\u1eddng<\/li>\n
  • LAVi > 34 mL\/m\u00b2<\/li>\n
  • V\u1eadn t\u1ed1c \u0111\u1ec9nh c\u1ee7a d\u00f2ng h\u1edf van ba l\u00e1 (TRV max) > 2,8 m\/ s<\/li>\n
  • Ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng th\u1ea5t tr\u00e1i b\u00ecnh th\u01b0\u1eddng n\u1ebfu > 2\/4 c\u00e1c th\u00f4ng s\u1ed1 tr\u00ean kh\u00f4ng v\u01b0\u1ee3t qua gi\u1edbi h\u1ea1n cho ph\u00e9p. N\u1ebfu \u0111\u00fang 2\/4 c\u00e1c th\u00f4ng s\u1ed1 tr\u00ean v\u01b0\u1ee3t qu\u00e1 gi\u1edbi h\u1ea1n cho ph\u00e9p, ch\u01b0a \u0111\u1ee7 \u0111\u1ec3 k\u1ebft lu\u1eadn r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng (trung gian).<\/li>\n
  • \u0110\u00e1nh gi\u00e1 giai \u0111o\u1ea1n r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng , ch\u1ee7 y\u1ebfu d\u1ef1a tr\u00ean E\/A v\u00e0 e ‘ :<\/li>\n<\/ul>\n

    2.2 \u0110\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng \u1edf b\u1ec7nh nh\u00e2n c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i gi\u1ea3m<\/strong><\/h3>\n

    N\u1ebfu ph\u00e2n s u\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i gi\u1ea3m ( < 50%) ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng s\u1ebd r\u1ed1i lo\u1ea1n \u1edf c\u00e1c m\u1ee9c \u0111\u1ed9 kh \u00e1c nhau. M \u1ee5c ti\u00eau \u0111\u00e1nh gi\u00e1 : X \u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng v\u00e0 t\u00ecnh tr\u1ea1ng t\u0103ng \u00e1p l\u1ef1c \u0111\u1ed5 \u0111\u1ea7y th\u1ea5t.<\/p>\n

    Si\u00eau \u00e2m Doppler d\u00f2ng ch\u1ea3y qua VHL \u0111\u1ee7 <\/strong>\u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00e0 ph\u00e2n \u0111\u1ed9 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y.<\/p>\n

      \n
    • Tr\u00e1nh nh\u1ea7m l\u0201n gi\u1eefa h\u00ecnh th\u00e1i \u201cgi\u1ea3 b\u00ecnh th\u01b0\u1eddng\u201d (r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng giai \u0111o\u1ea1n II) v\u1edbi b\u00ecnh th\u01b0\u1eddng.<\/li>\n
    • E\/A < 0,8: <\/strong>\u00c1p l\u1ef1c \u0111\u1ed5 \u0111\u1ea7y th\u1ea5t tr\u00e1i kh\u00e1 b\u00ecnh th\u01b0\u1eddng, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng giai \u0111o\u1ea1n I. Bi\u00ean \u0111\u1ed9 s\u00f3ng E th\u01b0\u1eddng < 50 cm\/s.<\/li>\n
    • E\/A > 2,0: <\/strong>G\u1ee3i \u00fd t\u0103ng \u00e1p l\u1ef1c \u0111\u1ed5 \u0111\u1ea7y th\u1ea5t tr\u00e1i, t\u01b0\u01a1ng \u1ee9ng v\u1edbi r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng giai \u0111o\u1ea1n III ho\u1eb7c IV. DT th\u01b0\u1eddng < 140 ms.<\/li>\n
    • E\/A t\u1eeb 0,8 – 2,0: <\/strong>C\u1ea7n \u0111\u00e1nh gi\u00e1 th\u00eam c\u00e1c th\u00f4ng s\u1ed1 kh\u00e1c: E\/e’ trung b\u00ecnh, LAVi, TRV max (E\/e’ trung b\u00ecnh > 14 ho\u1eb7c E\/e’ th\u00e0nh b\u00ean > 12 g\u1ee3i \u00fd c\u00f3 t\u0103ng \u00e1p l\u1ef1c \u0111\u1ed5 \u0111\u1ea7y th\u1ea5t tr\u00e1i).<\/li>\n<\/ul>\n

      2.3 \u0110\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng th\u1ea5t tr\u00e1i trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t<\/h3>\n

      2.3.1 B\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i<\/strong><\/h4>\n

      C\u00e1c th\u00f4ng s\u1ed1 c\u1ea7n kh\u1ea3o s\u00e1t: E\/ e ‘ > 14; LAVi > 34 m L \/m\u00b2 ; hi\u1ec7u th\u1eddi kho\u1ea3ng Ar – A \u2265 30 ms v\u00e0 TRV max > 2,8 cm\/s.<\/p>\n

      N\u1ebfu c\u00f3 \u00edt nh\u1ea5t 3\/4 ti\u00eau chu\u1ea9n tr\u00ean : T\u0103ng \u00e1p l\u1ef1c nh\u0129 tr\u00e1i.<\/p>\n

      2.3.2 B\u1ec7nh van tim<\/h4>\n
        \n
      • H\u1eb9p van hai l\u00e1 : IVRT < 60 m s n\u1ebfu k\u00e8m theo v\u1eadn t\u1ed1c s\u00f3ng A > 1 , 5 m\/s cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng : t\u0103ng \u00e1p l\u1ef1c nh\u0129 tr\u00e1i , E\/ e ‘ kh\u00f4ng h\u1eefu \u00edch.<\/li>\n
      • H\u1edf hai l\u00e1: HoHL v\u1eeba – nhi\u1ec1u v\u1edbi EF b\u00ecnh th\u01b0\u1eddng, E\/ e ‘ kh\u00f4ng c\u00f3 gi\u00e1 tr\u1ecb; v\u1edbi EF g i\u1ea3m , s\u1eed d\u1ee5ng E\/ e ‘ \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 \u00e1p l\u1ef1c cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng.<\/li>\n<\/ul>\n

        2.3.3 V\u00f4i h\u00f3a v\u00f2ng van hai l\u00e1<\/h4>\n

        Kh\u00f3 \u01b0\u1edbc t\u00ednh \u00e1p l\u1ef1c \u0111\u1ed5 \u0111\u1ea7y th\u1ea5t.<\/p>\n

        2.3.4 B\u1ec7nh c\u01a1 tim h\u1ea1n ch\u1ebf<\/h4>\n
          \n
        • R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng giai \u0111o\u1ea1n III: E\/A > 2; DT < 150 ms; IVRT < 50 ms; v\u1eadn t\u1ed1c s\u00f3ng e’ gi\u1ea3m \u0111\u00e1ng k\u1ec3.<\/li>\n
        • Ph\u00e2n bi\u1ec7t v\u1edbi vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft: e’ v\u00e1ch > e’ th\u00e0nh b\u00ean<\/li>\n<\/ul>\n

          Ph\u00e2n bi\u1ec7t vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft v\u00e0 b\u1ec7nh c\u01a1 tim h\u1ea1n ch\u1ebf<\/p>\n\n\n\n\n\n\n\n\n\n
          <\/td>\nVi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft<\/strong><\/td>\nB\u1ec7nh c\u01a1 tim h\u1ea1n ch\u1ebf<\/strong><\/td>\n<\/tr>\n
          Th\u1ec3 t\u00edch nh\u0129 tr\u00e1i<\/strong><\/td>\nGi\u00e3n<\/td>\nGi\u00e3n nhi\u1ec1u<\/td>\n<\/tr>\n
          Co b\u00f3p th\u1ea5t tr\u00e1i<\/strong><\/td>\nB\u00ecnh th\u01b0\u1eddng<\/td>\nB\u00ecnh th\u01b0\u1eddng\/gi\u1ea3m nh\u1eb9<\/td>\n<\/tr>\n
          E\/A<\/strong><\/td>\n> 1,5<\/td>\n> 1,5<\/td>\n<\/tr>\n
          \u0110\u00e1p \u1ee9ng v\u1edbi nghi\u1ec7m ph\u00e1p Valsalva<\/strong><\/td>\nE thay \u0111\u1ed5i > 25%<\/td>\nR\u1ea5t \u00edt thay \u0111\u1ed5i theo h\u00f4 h\u1ea5p<\/td>\n<\/tr>\n
          DT (ms)<\/strong><\/td>\n< 160<\/td>\n> 160<\/td>\n<\/tr>\n
          e’ v\u00e1ch (cm\/s)<\/strong><\/td>\n> 8<\/td>\n< 8<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

          2.3.5 Gh\u00e9p tim<\/h4>\n
            \n
          • Th\u01b0\u1eddng g\u1eb7p r\u1ed1i lo\u1ea1n ki\u1ec3u h\u1ea1n ch\u1ebf d\u00f9 ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng b\u00ecnh th\u01b0\u1eddng v\u00ec tim \u0111\u01b0\u1ee3c hi\u1ebfn t\u1eeb nh\u1eefng ng\u01b0\u1eddi tr\u1ebb h\u01a1n.<\/li>\n
          • Kh\u00f4ng c\u00f3 th\u00f4ng s\u1ed1 si\u00eau \u00e2m \u0111\u01a1n l\u1ebb n\u00e0o c\u00f3 gi\u00e1 tr\u1ecb ti\u00ean l\u01b0\u1ee3ng kh\u1ea3 n\u0103ng th\u1ea3i gh\u00e9p.<\/li>\n<\/ul>\n

            2.3.6 Rung nh\u0129<\/h4>\n

            E\/ e ‘ v\u00e1ch > 10 v\u00e0 IVRT ng\u1eafn : t\u0103ng \u00e1p l\u1ef1c \u0111\u1ed5 \u0111\u1ea7y th\u1ea5t.<\/p>\n

            3. T\u00f3m t\u1eaft:<\/h2>\n

            C\u00e1c d\u1ea5u hi\u1ec7u r\u1ed1i lo\u1ea1n th\u01b0 gi\u00e3n th\u1ea5t tr\u00e1i: G i\u1ea3m v\u1eadn t\u1ed1c E v\u00e0 e ‘, th\u01b0\u1eddng k\u00e8m theo t\u0103ng v\u1eadn t\u1ed1c A v\u00e0 A’ b\u00f9 tr\u1eeb , gi\u1ea3m v\u1eadn t\u1ed1c s\u00f3ng D ( d\u00f2ng ch\u1ea3y TM ph\u1ed5i) , gi\u1ea3m Vp .<\/p>\n

            T\u0103ng \u00e1p l\u1ef1c \u0111\u1ed5 \u0111\u1ea7y th\u1ea5t tr\u00e1i d\u0201n t\u1edbi h\u00ecnh \u1ea3nh E\/A gi\u1ea3 b\u00ecnh th\u01b0\u1eddng nh\u01b0ng \u00edt \u1ea3nh h\u01b0\u1edfng khi l\u00e0m nghi\u1ec7m ph\u00e1p Valsalva v\u00e0 si\u00eau \u00e2m Doppler m\u00f4.<\/p>\n

            N\u1ebfu E\/e’ <8 v\u00e0 k\u00edch th\u01b0\u1edbc nh\u0129 tr\u00e1i b\u00ecnh th\u01b0\u1eddng: \u00edt kh\u1ea3 n\u0103ng suy tim t\u00e2m tr\u01b0\u01a1ng.<\/p>\n

            Kh\u00f4ng \u0111\u01b0\u1ee3c b\u1ecf s\u00f3t vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft ( Xem th\u00eam Ch\u01b0\u01a1ng 8: B\u1ec7nh m\u00e0ng ngo\u00e0i tim, M\u1ee5c 7. Vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft ), t\u00ecm c\u00e1c d\u1ea5u hi\u1ec7u:<\/p>\n

              \n
            • D\u1ea5u hi\u1ec7u gi\u1eadt v\u00e1ch li\u00ean th\u1ea5t<\/li>\n
            • Gi\u00e3n t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi<\/li>\n
            • \u0110\u1ea3o ng\u01b0\u1ee3c d\u00f2ng ch\u1ea3y t\u0129nh m\u1ea1ch gan do h\u00f4 h\u1ea5p<\/li>\n<\/ul>\n

               <\/p>\n","protected":false},"excerpt":{"rendered":"

              \u0110\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng th\u1ea5t tr\u00e1i trong si\u00eau \u00e2m tim l\u00e0 k\u1ef9 thu\u1eadt quan tr\u1ecdng, b\u00e0i vi\u1ebft cung c\u1ea5p th\u00f4ng tin chi ti\u1ebft v\u1ec1 k\u1ef9 thu\u1eadt n\u00e0y. 1.Gi\u1edbi thi\u1ec7u v\u1ec1 si\u00eau \u00e2m qua th\u00e0nh ng\u1ef1c. 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