{"id":29045,"date":"2023-04-28T08:18:28","date_gmt":"2023-04-28T01:18:28","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29045"},"modified":"2023-04-30T22:23:53","modified_gmt":"2023-04-30T15:23:53","slug":"sieu-am-tim-qua-thuc-quan-trong-benh-ly-van-hai-la-nhan-tao","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/28\/sieu-am-tim-qua-thuc-quan-trong-benh-ly-van-hai-la-nhan-tao\/","title":{"rendered":"Si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n trong b\u1ec7nh l\u00fd van hai l\u00e1 nh\u00e2n t\u1ea1o"},"content":{"rendered":"

Si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n<\/a> (S\u00c2TQTQ) l\u00e0 ph\u01b0\u01a1ng ph\u00e1p th\u0103m d\u00f2 si\u00eau \u00e2m – Doppler tim v\u00e0 c\u00e1c m\u1ea1ch m\u00e1u l\u1edbn trong trung th\u1ea5t b\u1eb1ng \u0111\u1ea7u d\u00f2 \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o trong l\u00f2ng th\u1ef1c qu\u1ea3n v\u00e0 d\u1ea1 d\u00e0y gi\u00fap ch\u1ea9n \u0111o\u00e1n c\u00e1c b\u1ec7nh tim m\u1ea1ch: van tim, c\u01a1 tim, m\u00e0ng ngo\u00e0i tim, c\u00e1c m\u1ea1ch m\u00e1u c\u1ea1nh tim, b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, c\u00e1c b\u1ec7nh tim b\u1ea9m sinh,… v\u1edbi \u0111\u1ed9 ch\u00ednh x\u00e1c cao do \u01b0u \u0111i\u1ec3m ch\u00ednh l\u00e0 \u0111\u1ed9 ph\u00e2n gi\u1ea3i h\u00ecnh \u1ea3nh r\u1ea5t cao.<\/span><\/strong><\/p>\n

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

Si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n<\/a> (S\u00c2TQTQ) l\u00e0 ph\u01b0\u01a1ng ph\u00e1p th\u0103m d\u00f2 si\u00eau \u00e2m – Doppler tim v\u00e0 c\u00e1c m\u1ea1ch m\u00e1u l\u1edbn trong trung th\u1ea5t b\u1eb1ng \u0111\u1ea7u d\u00f2 \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o trong l\u00f2ng th\u1ef1c qu\u1ea3n v\u00e0 d\u1ea1 d\u00e0y gi\u00fap ch\u1ea9n \u0111o\u00e1n c\u00e1c b\u1ec7nh tim m\u1ea1ch: van tim, c\u01a1 tim, m\u00e0ng ngo\u00e0i tim, c\u00e1c m\u1ea1ch m\u00e1u c\u1ea1nh tim, b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, c\u00e1c b\u1ec7nh tim b\u1ea9m sinh,… v\u1edbi \u0111\u1ed9 ch\u00ednh x\u00e1c cao do \u01b0u \u0111i\u1ec3m ch\u00ednh l\u00e0 \u0111\u1ed9 ph\u00e2n gi\u1ea3i h\u00ecnh \u1ea3nh r\u1ea5t cao.<\/span>
\n– \u01afu \u0111i\u1ec3m ch\u00ednh: ch\u1ea5t l\u01b0\u1ee3ng h\u00ecnh \u1ea3nh t\u1ed1t do ch\u00f9m tia S\u00c2 kh\u00f4ng b\u1ecb c\u1ea3n tr\u1edf (th\u00e0nh ng\u1ef1c, ph\u1ed5i, m\u1ee1…), \u0111\u1ea7u d\u00f2 si\u00eau \u00e2m c\u00f3 t\u1ea7n s\u1ed1 cao (5-7 MHz) \u0111\u1ec3 th\u0103m d\u00f2 g\u1ea7n, do v\u1eady cho h\u00ecnh \u1ea3nh v\u1edbi \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao. Nh\u01b0ng c\u0169ng c\u00f3 nh\u1eefng h\u1ea1n ch\u1ebf l\u00e0: \u0111\u1ea7u d\u00f2 si\u00eau \u00e2m th\u1ef1c qu\u1ea3n r\u1ea5t \u0111\u1eaft: 20.000 – 35.000 USD, r\u1ea5t d\u1ec5 h\u1ecfng; m\u00e1y si\u00eau \u00e2m ph\u1ea3i c\u00f3 ph\u1ea7n m\u1ec1m ch\u1ee9c n\u0103ng chuy\u00ean d\u1ee5ng (\u0111\u1eaft); \u0111\u00e0o t\u1ea1o ng\u01b0\u1eddi l\u00e0m SATQTQ ph\u1ea3i c\u00f3 ch\u01b0\u01a1ng tr\u00ecnh ri\u00eang, th\u1eddi gian d\u00e0i; ng\u01b0\u1eddi b\u1ec7nh ph\u1ea3i r\u1ea5t c\u1ea9n th\u1eadn v\u00e0 k\u1ef9 thu\u1eadt b\u00e1n \u201cx\u00e2m\u201d, c\u00f3 th\u1ec3 c\u00f3 bi\u1ebfn ch\u1ee9ng, tuy r\u1ea5t hi\u1ebfm.<\/span><\/p>\n

\"Si\u00eau<\/p>\n

Si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n trong van tim nh\u00e2n t\u1ea1o<\/strong><\/p>\n

2.Ch\u1ec9 \u0111\u1ecbnh<\/span><\/b><\/h2>\n

2.1. C\u00e1c b\u1ec7nh nh\u00e2n m\u00e0 si\u00eau \u00e2m qua th\u00e0nh ng\u1ef1c cho h\u00ecnh \u1ea3nh kh\u00f4ng r\u00f5:<\/span><\/b><\/h3>\n

– B\u00e9o ph\u00ec, c\u00f3 b\u1ec7nh ph\u1ed5i m\u1ea1n t\u00ednh, m\u1edbi m\u1ed5 x\u01b0\u01a1ng \u1ee9c ho\u1eb7c v\u00f9ng th\u01b0\u1ee3ng v\u1ecb.<\/span>
\n– T\u00ecm c\u00e1c kh\u1ed1i u; huy\u1ebft kh\u1ed1i nh\u0129, ti\u1ec3u nh\u0129 (tr\u01b0\u1edbc m\u1ed5 tim k\u00edn, h\u1eb9p hai l\u00e1, s\u1ed1c \u0111i\u1ec7n).<\/span>
\n– Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m tr\u00f9ng \u1edf van tim t\u1ef1 nhi\u00ean ho\u1eb7c van tim nh\u00e2n t\u1ea1o.<\/span>
\n– C\u00e1c \u00e1p xe c\u1ea1nh van, h\u1edf c\u1ea1nh van, huy\u1ebft kh\u1ed1i g\u00e2y k\u1eb9t van tim nh\u00e2n t\u1ea1o.<\/span>
\n– B\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.<\/span>
\n– B\u1ec7nh l\u00fd van tim: c\u1ea7n \u0111\u00e1nh gi\u00e1 ch\u00ednh x\u00e1c th\u00e0nh ph\u1ea7n n\u00e0o b\u1ecb t\u1ed5n th\u01b0\u01a1ng, m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng \u0111\u1ec3 c\u00f3 ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p.<\/span>
\n– B\u1ec7nh tim b\u1ea9m sinh:<\/span>
\n+ \u0110\u1ec3 kh\u1ea3o s\u00e1t c\u00e1c c\u1ea5u tr\u00fac ph\u00eda sau (t\u0129nh m\u1ea1ch ph\u1ed5i, th\u00e2n v\u00e0 c\u00e1c nh\u00e1nh \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, ti\u1ec3u nh\u0129).<\/span>
\n+ H\u1eb9p eo \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/span>
\n+ Th\u00f4ng li\u00ean nh\u0129, th\u00f4ng li\u00ean th\u1ea5t<\/span>
\n+ B\u1ec7nh nh\u00e2n b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o nghi ng\u1edd do nguy\u00ean nh\u00e2n t\u1ed3n t\u1ea1i l\u1ed7 b\u1ea7u d\u1ee5c<\/span><\/p>\n

2.2. Si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n trong can thi\u1ec7p tim m\u1ea1ch:<\/span><\/b><\/h3>\n

– X\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed \u1ed1ng th\u00f4ng khi c\u1ea7n ch\u1ecdc xuy\u00ean v\u00e1ch tim(v\u00e1ch li\u00ean th\u1ea5t, v\u00e1ch li\u00ean nh\u0129).<\/span>
\n– C\u00e1c th\u1ee7 thu\u1eadt v\u1ec1 van tim: Nong van b\u1eb1ng b\u00f3ng, TAVI. MitraClip.<\/span>
\n– H\u1ee7y \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n ho\u1eb7c \u1ed5 ngo\u1ea1i v\u1ecb b\u1eb1ng \u0111i\u1ec7n.<\/span><\/p>\n

2.3. Si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n trong h\u1ed3i s\u1ee9c<\/span><\/b><\/h3>\n

– B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u00f3 nh\u1eefng nghi ng\u1edd v\u1ec1 tim m\u1ea1ch nh\u01b0ng si\u00eau \u00e2m qua th\u00e0nh ng\u1ef1c kh\u00f4ng cung c\u1ea5p \u0111\u1ee7 th\u00f4ng tin v\u00e0 si\u00eau \u00e2m qua th\u1ef1c qu\u1ea3n c\u00f3 kh\u1ea3 n\u0103ng mang l\u1ea1i nh\u1eefng th\u00f4ng tin c\u00f3 th\u1ec3 l\u00e0m thay \u0111\u1ed5i \u0111i\u1ec1u tr\u1ecb.<\/span><\/p>\n

2.4. Si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n trong m\u1ed5 tim<\/span><\/b><\/h3>\n

3. Si\u00eau \u00e2m tim qua th\u1ef1c qua h\u1edf van hai l\u00e1 nh\u00e2n t\u1ea1o<\/h2>\n

Si\u00eau \u00e2m qua th\u1ef1c qu\u1ea3n \u0111\u1eb7c bi\u1ec7t nh\u1ea1y trong ph\u00e1t hi\u1ec7n h\u1edf van hai l\u00e1 nh\u00e2n t\u1ea1o<\/strong>, v\u00ec khi \u0111\u00f3 h\u00ecnh \u1ea3nh nh\u0129 tr\u00e1i \u0111\u01b0\u1ee3c th\u1ea5y r\u00f5 do \u0111\u00f3 s\u1ebd tr\u00e1nh \u0111\u01b0\u1ee3c nhi\u1ec5u sinh ra b\u1edfi c\u00e1c th\u00e0nh ph\u1ea7n kim lo\u1ea1i c\u1ee7a van nh\u00e2n t\u1ea1o.<\/p>\n

3.1 H\u1edf c\u1ea1nh van hai l\u00e1 nh\u00e2n t\u1ea1o<\/h3>\n

V\u00f2ng van nh\u00e2n t\u1ea1o bi\u1ec3u hi\u1ec7n l\u00e0 m\u1ed9t v\u00f2ng t\u0103ng s\u00e1ng g\u1eafn \u1edf v\u1ecb tr\u00ed v\u00f2ng van hai l\u00e1. N\u1ebfu m\u1ed9t ph\u1ea7n \u0111\u00e1ng k\u1ec3 c\u1ee7a v\u00f2ng van b\u1ecb bong ra, d\u1ea5u hi\u1ec7u \u201cvan rung l\u1eafc\u201d s\u1ebd xu\u1ea5t hi\u1ec7n – \u0111\u00e2y l\u00e0 d\u1ea5u hi\u1ec7u \u0111\u1eb7c tr\u01b0ng.<\/p>\n

    \n
  • C\u00e1c m\u1eb7t c\u1eaft ch\u00ednh<\/li>\n
  • C\u1ea7n kh\u1ea3o s\u00e1t v\u00f2ng van hai l\u00e1 nh\u00e2n t\u1ea1o tr\u00ean si\u00eau \u00e2m 2D \u0111\u1ed3ng th\u1eddi kh\u1ea3o s\u00e1t v\u1edbi Doppler m\u00e0u v\u00e0 Doppler li\u00ean t\u1ee5c.<\/li>\n
  • M\u1eb7t c\u1eaft 4 bu\u1ed3ng gi\u1eefa th\u1ef1c qu\u1ea3n \u1edf v\u1ecb tr\u00ed 0\u00b0 M\u1eb7t c\u1eaft 2 bu\u1ed3ng gi\u1eefa th\u1ef1c qu\u1ea3n \u1edf v\u1ecb tr\u00ed 90\u00b0<\/li>\n
  • M\u1eb7t c\u1eaft tr\u1ee5c d\u1ecdc gi\u1eefa th\u1ef1c qu\u1ea3n \u1edf v\u1ecb tr\u00ed 120\u00b0 quan s\u00e1t van hai l\u00e1<\/li>\n
  • Ph\u1ea3i \u0111\u00e1nh gi\u00e1 di \u0111\u1ed9ng c\u1ee7a van c\u01a1 h\u1ecdc \u1edf m\u1eb7t c\u1eaft tr\u1ee5c d\u1ecdc gi\u1eefa th\u1ef1c qu\u1ea3n t\u1ea1i v\u1ecb tr\u00ed 120\u00b0 \u0111\u1ec3 ch\u1eafc ch\u1eafn r\u1eb1ng c\u00e1c \u0111\u0129a (v\u1edbi van \u0111\u0129a) ho\u1eb7c vi\u00ean bi (v\u1edbi van bi – l\u1ed3ng) di \u0111\u1ed9ng t\u1ed1t.<\/li>\n
  • H\u1edf c\u1ea1nh van nh\u00e2n t\u1ea1o (s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a d\u00f2ng ch\u1ea3y b\u00ean ngo\u00e0i v\u00f2ng van nh\u00e2n t\u1ea1o) l\u00e0 kh\u00f4ng b\u00ecnh th\u01b0\u1eddng, m\u1eb7c d\u00f9 \u0111\u00f4i khi nh\u1eefng d\u00f2ng h\u1edf nh\u1ecf <\/em>c\u0169ng c\u00f3 th\u1ec3 th\u1ea5y \u1edf giai \u0111o\u1ea1n s\u1edbm ngay sau khi ph\u0201u thu\u1eadt thay van. H\u1edf c\u1ea1nh van nh\u00e2n t\u1ea1o l\u00e0 do v\u00f2ng van nh\u00e2n t\u1ea1o kh\u00f4ng \u0111\u01b0\u1ee3c kh\u00e2u ch\u1eafc v\u00e0o v\u1ecb tr\u00ed v\u00f2ng van hai l\u00e1 c\u1ee7a b\u1ec7nh nh\u00e2n, c\u00f3 th\u1ec3 do l\u1ed7i k\u1ef9 thu\u1eadt ho\u1eb7c do vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n . <\/em>H\u1edf c\u1ea1nh van nh\u00e2n t\u1ea1o th\u01b0\u1eddng c\u0169ng hay x\u1ea3y ra \u1edf b\u1ec7nh nh\u00e2n b\u1ecb v\u00f4i h\u00f3a v\u00f2ng van hai l\u00e1.<\/li>\n<\/ul>\n

    3.2 H\u1edf trong van nh\u00e2n t\u1ea1o<\/h3>\n

    Van nh\u00e2n t\u1ea1o c\u01a1 h\u1ecdc c\u00f3 d\u00f2ng ph\u1ee5t ng\u01b0\u1ee3c trong th\u1eddi k\u1ef3 \u0111\u00f3ng c\u1ee7a van v\u1ecb tr\u00ed b\u00ean trong v\u00f2ng van nh\u00e2n t\u1ea1o (h\u1edf trong van sinh l\u00fd). Nh\u1eefng \u201cd\u00f2ng ph\u1ee5t th\u00ec \u0111\u00f3ng\u201d n\u00e0y l\u00e0 m\u1ed9t bi\u1ec3u hi\u1ec7n b\u00ecnh th\u01b0\u1eddng v\u00e0 kh\u00f4ng n\u00ean b\u1ecb nh\u1ea7m v\u1edbi h\u1edf b\u1ec7nh l\u00fd. N\u00f3i chung, ch\u00fang c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e2n bi\u1ec7t d\u1ec5 d\u00e0ng v\u1edbi d\u00f2ng h\u1edf b\u1ec7nh l\u00fd. Nguy\u00ean nh\u00e2n g\u00e2y h\u1edf trong van b\u1ec7nh l\u00fd bao g\u1ed3m \u201cpannus\u201d ho\u1eb7c huy\u1ebft kh\u1ed1i l\u00e0m c\u1ea3n tr\u1edf c\u00e1nh van \u0111\u00f3ng.<\/p>\n

    C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a nh\u1eefng d\u00f2ng h\u1edf trong van sinh l\u00fd:<\/p>\n

      \n
    • D\u00f2ng h\u1edf ng\u1eafn c\u00f3 chi\u1ec1u d\u00e0i < 3 cm<\/li>\n
    • G\u1ed1c c\u1ee7a d\u00f2ng h\u1edf nh\u1ecf (\u0111\u00e1y h\u1eb9p) < 5 mm<\/li>\n<\/ul>\n

      Th\u01b0\u1eddng ch\u1ec9 x\u1ea3y ra \u1edf \u0111\u1ea7u th\u00ec t\u00e2m thu <\/strong>h\u01a1n l\u00e0 to\u00e0n t\u00e2m thu.<\/p>\n

      3.3 Van hai l\u00e1 nh\u00e2n t\u1ea1o sinh h\u1ecdc<\/h3>\n

      Van hai l\u00e1 sinh h\u1ecdc \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 t\u01b0\u01a1ng t\u1ef1 van hai l\u00e1 c\u01a1 h\u1ecdc. L\u00e1 van sinh h\u1ecdc n\u00ean \u0111\u01b0\u1ee3c ki\u1ec3m tra c\u00e1c d\u1ea5u hi\u1ec7u sau:<\/p>\n

        \n
      • Sa l\u00e1 van<\/li>\n
      • Tr\u00f4i l\u00e1 van<\/li>\n
      • D\u00e0y l\u00e1 van ( > 3 mm – nguy c\u01a1 tho\u00e1i h\u00f3a van cao h\u01a1n)<\/li>\n
      • T\u00edn hi\u1ec7u Doppler c\u1ee7a tr\u00f4i l\u00e1 van c\u00f3 h\u00ecnh \u1ea3nh \u201cs\u1ecdc ng\u1ef1a v\u1eb1n\u201d r\u1ea5t \u0111\u1eb7c tr\u01b0ng.<\/li>\n<\/ul>\n

        4 H\u1eb9p van hai l\u00e1 nh\u00e2n t\u1ea1o<\/h2>\n

        H\u1eb9p van c\u00f3 th\u1ec3 x\u1ea3y ra do s\u1ef1 h\u00ecnh th\u00e0nh \u201cpannus\u201d ho\u1eb7c huy\u1ebft kh\u1ed1i. Ch\u1ea9n \u0111o\u00e1n d\u1ef1a tr\u00ean c\u00e1c d\u1ea5u hi\u1ec7u sau:<\/p>\n

          \n
        • H\u1ea1n ch\u1ebf di \u0111\u1ed9ng c\u1ee7a c\u00e1nh van ho\u1eb7c vi\u00ean bi;<\/li>\n
        • D\u1ea5u hi\u1ec7u v\u1ec1 huy\u1ebft \u0111\u1ed9ng: T\u0103ng ch\u00eanh \u00e1p t\u1ed1i \u0111a qua van hai l\u00e1 (v\u1eadn t\u1ed1c t\u1ed1i \u0111a > 2,5 m\/s) ho\u1eb7c th\u1eddi gian b\u00e1n gi\u1ea3m \u00e1p l\u1ef1c k\u00e9o d\u00e0i (th\u1eddi gian b\u00e1n gi\u1ea3m \u00e1p l\u1ef1c: PHT > 200 ms).<\/li>\n
        • Gi\u1edbi h\u1ea1n tr\u00ean c\u1ee7a th\u1eddi gian b\u00e1n gi\u1ea3m \u00e1p l\u1ef1c (PHT) v\u1edbi nh\u1eefng lo\u1ea1i van ph\u1ed5 bi\u1ebfn<\/li>\n<\/ul>\n

          \u00a0<\/strong><\/p>\n\n\n\n\n\n\n\n\n
          Lo\u1ea1i van<\/td>\nPHT t\u1ed1i \u0111a (ms)<\/td>\n<\/tr>\n
          Starr-Edwards \u00ae<\/td>\n170<\/td>\n<\/tr>\n
          St Jude \u00ae<\/td>\n131<\/td>\n<\/tr>\n
          CarboMedics \u00ae<\/td>\n117<\/td>\n<\/tr>\n
          Carpentier-Edwards \u00ae<\/td>\n171<\/td>\n<\/tr>\n
          Van t\u1ef1 nhi\u00ean<\/td>\n60<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n","protected":false},"excerpt":{"rendered":"

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