{"id":29056,"date":"2023-04-29T18:19:29","date_gmt":"2023-04-29T11:19:29","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29056"},"modified":"2023-04-29T18:19:29","modified_gmt":"2023-04-29T11:19:29","slug":"chup-cat-lop-vi-tinh-tim","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/chup-cat-lop-vi-tinh-tim\/","title":{"rendered":"Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh tim"},"content":{"rendered":"

\u00a0Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh<\/a> (CLVT) l\u00e0 bi\u1ec7n ph\u00e1p th\u0103m d\u00f2 kh\u00f4ng x\u00e2m l\u1ea5n h\u1eefu hi\u1ec7u trong \u0111\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.<\/p>\n

\"Ch\u1ee5p<\/p>\n

Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh tim<\/strong><\/p>\n

1.\u0110\u00e1nh gi\u00e1 \u0111i\u1ec3m v\u00f4i h\u00f3a m\u1ea1ch v\u00e0nh<\/h2>\n

M\u1ea3ng x\u01a1 v\u1eefa v\u00f4i h\u00f3a chi\u1ebfm kho\u1ea3ng 20% <\/strong>g\u00e1nh n\u1eb7ng x\u01a1 v\u1eefa to\u00e0n b\u1ed9 m\u1ea1ch v\u00e0nh. Do v\u1eady c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 t\u1ed5ng th\u1ec3 m\u1ee9c \u0111\u1ed9 x\u01a1 v\u1eefa m\u1ea1ch v\u00e0nh gi\u00e1n ti\u1ebfp qua vi\u1ec7c cho \u0111i\u1ec3m m\u1ee9c \u0111\u1ed9 canxi h\u00f3a m\u1ea1ch v\u00e0nh. \u0110i\u1ec3m v\u00f4i h\u00f3a c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111o th\u00f4ng qua ch\u1ee5p b\u1ee9c x\u1ea1 th\u1ea5p kh\u00f4ng \u0111\u1ed1i quang <\/strong>(v\u00ed d\u1ee5 kh\u00f4ng s\u1eed d\u1ee5ng thu\u1ed1c c\u1ea3n quang ch\u1ee9a iod). M\u1ee9c \u0111\u1ed9 canxi h\u00f3a c\u1ee7a m\u1ed7i \u0111\u1ed9ng m\u1ea1ch v\u00e0nh \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n b\u1eb1ng m\u1ed9t con s\u1ed1 v\u00e0 t\u00ednh t\u1ed5ng l\u00e0 \u0111i\u1ec3m v\u00f4i h\u00f3a chung c\u1ee7a c\u1ea3 h\u1ec7 m\u1ea1ch v\u00e0nh, th\u01b0\u1eddng l\u00e0 s\u1eed d\u1ee5ng thang \u0111i\u1ec3m Agatston:<\/strong><\/p>\n

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  • 0 \u0111i\u1ec3m: <\/strong>kh\u00f4ng m\u1ea3ng v\u00f4i h\u00f3a<\/li>\n
  • 1- 99 \u0111i\u1ec3m: <\/strong>v\u00f4i h\u00f3a nh\u1eb9 (nguy c\u01a1 th\u1ea5p, t\u1ef7 l\u1ec7 t\u1eed vong ho\u1eb7c nh\u1ed3i m\u00e1u c\u01a1 tim h\u00e0ng n\u0103m < 1%)<\/li>\n
  • 100 – 399: <\/strong>v\u00f4i h\u00f3a trung b\u00ecnh (nguy c\u01a1 trung b\u00ecnh, t\u1ef7 l\u1ec7 t\u1eed vong ho\u1eb7c nh\u1ed3i m\u00e1u c\u01a1 tim h\u00e0ng n\u0103m 1 – 3%)<\/li>\n
  • \u2265400 \u0111i\u1ec3m <\/strong>: v\u00f4i h\u00f3a n\u1eb7ng (nguy c\u01a1 cao, t\u1ef7 l\u1ec7 t\u1eed vong ho\u1eb7c nh\u1ed3i m\u00e1u c\u01a1 tim h\u00e0ng n\u0103m > 3%).<\/li>\n<\/ul>\n

    C\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng \u0111\u00e3 ch\u1ee9ng minh \u0111\u00e1nh gi\u00e1 \u0111i\u1ec3m v\u00f4i h\u00f3a m\u1ea1ch v\u00e0nh cung c\u1ea5p th\u00eam c\u00e1c th\u00f4ng tin cho ph\u00e2n t\u1ea7ng nguy c\u01a1 tim m\u1ea1ch ngo\u00e0i c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 c\u01a1 b\u1ea3n nh\u01b0 tu\u1ed5i, gi\u1edbi, t\u0103ng huy\u1ebft \u00e1p, ti\u1ec1n s\u1eed gia \u0111\u00ecnh, t\u0103ng lipid m\u00e1u v\u00e0 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/p>\n

    2.K\u1ef9 thu\u1eadt ch\u1ee5p CLVT \u0111\u1ed9ng m\u1ea1ch v\u00e0nh<\/h2>\n

    Ch\u1ee5p CLVT \u0111\u1ed9ng m\u1ea1ch v\u00e0nh \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1eb1ng c\u00e1ch ti\u00eam thu\u1ed1c c\u1ea3n quang ch\u1ee9a iod v\u00e0o t\u0129nh m\u1ea1ch ngo\u1ea1i bi\u00ean. Khi n\u1ed3ng \u0111\u1ed9 thu\u1ed1c c\u1ea3n quang trong \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u0111\u1ea1t \u0111\u1ebfn m\u1ee9c \u0111\u1ed9 nh\u1ea5t \u0111\u1ecbnh, m\u00e1y s\u1ebd qu\u00e9t v\u00e0 h\u00ecnh \u1ea3nh \u0111\u01b0\u1ee3c ghi nh\u1eadn.<\/p>\n

    C\u00e1c h\u00ecnh \u1ea3nh \u0111\u01b0\u1ee3c ph\u00e2n t\u00edch b\u1eb1ng ph\u1ea7n m\u1ec1m m\u00e1y t\u00ednh, cho ph\u00e9p t\u00e1i t\u1ea1o h\u00ecnh \u1ea3nh 2D v\u00e0 d\u1ef1ng h\u00ecnh \u1ea3nh 3D c\u1ee7a \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, c\u00e1c bu\u1ed3ng tim, c\u0169ng nh\u01b0 cho bi\u1ebft c\u00e1c th\u00f4ng s\u1ed1 th\u1ec3 t\u00edch .<\/p>\n

    2.1 L\u01b0u \u00fd v\u1ec1 k\u1ef9 thu\u1eadt<\/h3>\n
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    • \u0110\u1ed9 ph\u00e2n gi\u1ea3i theo th\u1eddi gian: <\/strong>Th\u00e1ch th\u1ee9c c\u01a1 b\u1ea3n c\u1ee7a vi\u1ec7c d\u1ef1ng h\u00ecnh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh b\u1eb1ng CLVT l\u00e0 \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u1ed9 ph\u00e2n gi\u1ea3i th\u1eddi gian cao. \u0110\u1ed9 ph\u00e2n gi\u1ea3i th\u1eddi gian \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 th\u1eddi gian c\u1ea7n thi\u1ebft \u0111\u1ec3 ghi \u0111\u01b0\u1ee3c m\u1ed9t \u1ea3nh. Do tim \u0111\u1eadp n\u00ean c\u1ea7n c\u00f3 th\u1eddi gian tim \u201c\u0111\u00f4ng c\u1ee9ng\u201d \u0111\u1ec3 thu nh\u1eadn h\u00ecnh \u1ea3nh. S\u1ef1 di \u0111\u1ed9ng l\u00e0 l\u1edbn nh\u1ea5t trong th\u00ec t\u00e2m thu v\u00e0 t\u01b0\u01a1ng \u0111\u1ed1i t\u0129nh trong th\u00ec t\u00e2m tr\u01b0\u01a1ng, do v\u1eady l\u1ea5y h\u00ecnh \u1ea3nh \u0111\u01b0\u1ee3c ghi trong th\u00ec t\u00e2m tr\u01b0\u01a1ng cho ch\u1ea5t l\u01b0\u1ee3ng cao h\u01a1n v\u00e0 ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c h\u01a1n. Do \u0111\u00f3 m\u00e1y CLVT y\u00eau c\u1ea7u ph\u1ea3i c\u00f3 kh\u1ea3 n\u0103ng thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh nhanh trong th\u00ec t\u00e2m tr\u01b0\u01a1ng khi qu\u1ea3 tim \u00edt chuy\u1ec3n \u0111\u1ed9ng.<\/li>\n
    • \u0110\u1ed9 ph\u00e2n gi\u1ea3i theo kh\u00f4ng gian : <\/strong>H\u00ecnh \u1ea3nh c\u1ee7a c\u00e1c c\u1ea5u tr\u00fac nh\u1ecf nh\u01b0 \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u00f3 y\u00eau c\u1ea7u cao v\u1ec1 \u0111\u1ed9 ph\u00e2n gi\u1ea3i kh\u00f4ng gian. \u0110\u1ed9 ph\u00e2n gi\u1ea3i kh\u00f4ng gian \u0111\u1ecbnh ngh\u0129a l\u00e0 kho\u1ea3ng c\u00e1ch nh\u1ecf nh\u1ea5t gi\u1eefa 2 ph\u1ea7n m\u00e0 c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c b\u1edfi \u0111\u1ea7u d\u00f2. \u0110\u1ed9 ph\u00e2n gi\u1ea3i kh\u00f4ng gian c\u1ee7a ch\u1ee5p CLVT \u0111\u01b0\u1ee3c quy\u1ebft \u0111\u1ecbnh b\u1edfi k\u00edch th\u01b0\u1edbc \u0111i\u1ec3m \u1ea3nh (v\u00ed d\u1ee5 \u0111i\u1ec3m \u1ea3nh 3D).<\/li>\n
    • Ki\u1ec3m so\u00e1t nh\u1ecbp tim:<\/strong> Th\u1eddi gian t\u00e2m thu t\u01b0\u01a1ng \u0111\u1ed1i nh\u01b0 nhau \u1edf b\u1ec7nh nh\u00e2n c\u00f3 t\u1ea7n s\u1ed1 tim kh\u00e1c nhau, nh\u01b0ng th\u1eddi gian t\u00e2m tr\u01b0\u01a1ng thay \u0111\u1ed5i r\u1ea5t l\u1edbn. T\u1ea7n s\u1ed1 tim th\u1ea5p (t\u1ee9c l\u00e0 < 65 nh\u1ecbp\/ph\u00fat l\u00e0 th\u00edch h\u1ee3p v\u00e0 \u0111\u1ea3m b\u1ea3o ghi h\u00ecnh \u1ea3nh kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi chuy\u1ec3n \u0111\u1ed9ng c\u1ee7a \u0111\u1ed9ng m\u1ea1ch v\u00e0nh). B\u1ec7nh nh\u00e2n th\u01b0\u1eddng \u0111\u01b0\u1ee3c u\u1ed1ng thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m 1 – 2 gi\u1edd tr\u01b0\u1edbc khi ch\u1ee5p CLVT. Ngo\u00e0i ra, ti\u00eam t\u0129nh m\u1ea1ch thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m (metoprolol) b\u1ed5 sung nhi\u1ec1u l\u1ea7n cho b\u1ec7nh nh\u00e2n \u0111ang trong m\u00e1y ch\u1ee5p l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p an to\u00e0n, nhanh v\u00e0 hi\u1ec7u qu\u1ea3 \u0111\u1ec3 ki\u1ec3m so\u00e1t nh\u1ecbp tim. U\u1ed1ng thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m trong 2 ng\u00e0y (ng\u00e0y ch\u1ee5p CLVT v\u00e0 ng\u00e0y tr\u01b0\u1edbc \u0111\u00f3) c\u0169ng hi\u1ec7u qu\u1ea3 v\u00e0 h\u1ea1n ch\u1ebf ph\u1ea3i truy\u1ec1n metoprolol t\u0129nh m\u1ea1ch trong th\u1eddi gian ch\u1ee5p.<\/li>\n<\/ul>\n

      Thu\u1ed1c ch\u1eb9n k\u00eanh canxi, thu\u1ed1c ch\u1eb9n k\u00eanh If (ivabradine) <\/strong>c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ecdn thay th\u1ebf \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi ch\u1eb9n beta.<\/p>\n

      V\u1edbi c\u00e1c m\u00e1y ch\u1ee5p c\u1eaft l\u1edbp th\u1ebf h\u1ec7 m\u1edbi: 256, 320, 512 d\u00e3y, kh\u00f4ng y\u00eau c\u1ea7u b\u1eaft bu\u1ed9c t\u1ea7n s\u1ed1 tim th\u1ea5p, tuy nhi\u00ean, ch\u1ea5t l\u01b0\u1ee3ng h\u00ecnh \u1ea3nh c\u00e0ng gia t\u0103ng khi t\u1ea7n s\u1ed1 tim gi\u1ea3m.<\/p>\n

      2.2 Chi\u1ebfn l\u01b0\u1ee3c \u0111\u1ec3 gi\u1ea3m li\u1ec1u ph\u00f3ng x\u1ea1<\/h3>\n

      M\u1ed9t s\u1ed1 chi\u1ebfn l\u01b0\u1ee3c \u0111\u00e3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng \u0111\u1ec3 gi\u1ea3m li\u1ec1u hi\u1ec7u qu\u1ea3 c\u1ee7a ph\u00f3ng x\u1ea1 ion h\u00f3a trong m\u1ed7i l\u1ea7n ch\u1ee5p:<\/p>\n

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      • Gi\u1ea3m tr\u01b0\u1eddng quan s\u00e1t (t\u1eeb m\u1ecfm tim \u0111\u1ebfn \u0111\u00e1y tim).<\/li>\n
      • Gi\u1ea3m \u0111i\u1ec7n \u00e1p \u1edf c\u00e1c b\u1ec7nh nh\u00e2n kh\u00f4ng b\u00e9o ph\u00ec (t\u1eeb 120 kV gi\u1ea3m xu\u1ed1ng 100 kV).<\/li>\n
      • \u0110i\u1ec1u ch\u1ec9nh d\u00f2ng \u0111i\u1ec7n b\u1eb1ng \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 (d\u00f2ng \u0111i\u1ec7n gi\u1ea3m trong th\u00ec t\u00e2m thu v\u00e0 t\u0103ng trong th\u00ec t\u00e2m tr\u01b0\u01a1ng).<\/li>\n
      • \u0110i\u1ec1u ch\u1ec9nh c\u1ed5ng ch\u1ee5p b\u1eb1ng \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 (\u1ed1ng ch\u1ec9 b\u1eadt l\u00ean trong c\u00e1c th\u00ec c\u1ed1 \u0111\u1ecbnh c\u1ee7a chu k\u1ef3 tim, th\u01b0\u1eddng l\u00e0 gi\u1eefa k\u1ef3 t\u00e2m tr\u01b0\u01a1ng ho\u1eb7c 75% kho\u1ea3ng R – R).<\/li>\n
      • B\u1eb1ng c\u00e1ch k\u1ebft h\u1ee3p c\u00e1c k\u1ef9 thu\u1eadt n\u00e0y, li\u1ec1u hi\u1ec7u qu\u1ea3 ch\u1ee5p CLVT \u0111\u1ed9ng m\u1ea1ch v\u00e0nh g\u1ea7n \u0111\u00e2y \u0111\u00e3 \u0111\u1ea1t t\u1edbi 1 mSv (milli – Sievert).<\/li>\n<\/ul>\n

        a.\u0110\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u<\/h3>\n

        CLVT t\u1eeb 64 d\u00e3y tr\u1edf l\u00ean c\u00f3 \u0111\u1ed9 nh\u1ea1y cao (95%) v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao (83%). V\u00ec th\u1ebf, CLVT \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u00f3 gi\u00e1 tr\u1ecb d\u1ef1 b\u00e1o \u00e2m t\u00ednh r\u1ea5t cao <\/strong>(l\u00ean t\u1edbi 95%). \u1ee8ng d\u1ee5ng ch\u00ednh c\u1ee7a CLVT \u0111\u1ed9ng m\u1ea1ch v\u00e0nh l\u00e0 \u0111\u1ec3 lo\u1ea1i tr\u1eeb c\u00e1c b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh n\u1eb7ng \u1edf c\u00e1c b\u1ec7nh nh\u00e2n nguy c\u01a1 tim m\u1ea1ch th\u1ea5p \u0111\u1ebfn trung b\u00ecnh.<\/strong><\/p>\n

        b.\u1ee8ng d\u1ee5ng l\u00e2m s\u00e0ng c\u1ee7a ch\u1ee5p CLVT<\/h3>\n
          \n
        • So s\u00e1nh v\u1edbi ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh (\u0110MV) qua da: <\/strong>Ch\u1ee5p \u0110MV qua da v\u0201n l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng trong ch\u1ea9n \u0111o\u00e1n c\u00e1c b\u1ec7nh l\u00fd \u0110MV do c\u00f3 \u0111\u1ed9 ph\u00e2n gi\u1ea3i v\u01b0\u1ee3t tr\u1ed9i. H\u01a1n n\u1eefa, ch\u1ee5p \u0110MV qua da cho ph\u00e9p ti\u1ebfn h\u00e0nh can thi\u1ec7p \u0110MV n\u1ebfu t\u1ed5n th\u01b0\u01a1ng c\u00f3 \u00fd ngh\u0129a. Tuy nhi\u00ean, \u0111\u00e2y v\u0201n l\u00e0 m\u1ed9t th\u0103m d\u00f2 x\u00e2m l\u1ea5n v\u00e0 ti\u1ec1m \u1ea9n nguy c\u01a1 b\u1ecb c\u00e1c bi\u1ebfn ch\u1ee9ng m\u1ea1ch m\u00e1u <\/strong>bao g\u1ed3m nh\u1ed3i m\u00e1u c\u01a1 tim, \u0111\u1ed9t qu\u1ef5 n\u00e3o v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng t\u1ea1i m\u1ea1ch m\u00e1u \u0111\u01b0\u1eddng v\u00e0o. M\u00e1y ch\u1ee5p CLVT 256 – 512 d\u00e3y c\u00f3 th\u1ec3 gia t\u0103ng \u0111\u1ed9 bao ph\u1ee7 \u0111\u1ed3ng th\u1eddi gi\u1ea3m th\u1eddi gian qu\u00e9t xu\u1ed1ng d\u01b0\u1edbi 0,5 gi\u00e2y, cho ph\u00e9p ghi h\u00ecnh to\u00e0n b\u1ed9 tim trong m\u1ed9t nh\u00e1t b\u00f3p. So v\u1edbi ch\u1ee5p m\u1ea1ch truy\u1ec1n th\u1ed1ng, ch\u1ee5p CLVT c\u00f3 \u0111\u1ed9 ph\u00e2n gi\u1ea3i kh\u00f4ng gian th\u1ea5p h\u01a1n (0,4 – 0,6 mm so v\u1edbi 0,2 mm) v\u00e0 \u0111\u1ed9 ph\u00e2n gi\u1ea3i th\u1eddi gian th\u1ea5p h\u01a1n (60 – 220 ms so v\u1edbi 8 ms).<\/li>\n
        • So s\u00e1nh v\u1edbi c\u00e1c nghi\u1ec7m ph\u00e1p th\u0103m d\u00f2 ch\u1ee9c n\u0103ng: <\/strong>Trong l\u1ecbch s\u1eed, c\u00e1c nghi\u1ec7m ph\u00e1p th\u0103m d\u00f2 ch\u1ee9c n\u0103ng kh\u00f4ng x\u00e2m nh\u1eadp (v\u00ed d\u1ee5 nh\u01b0 nghi\u1ec7m ph\u00e1p g\u1eafng s\u1ee9c, si\u00eau \u00e2m tim g\u1eafng s\u1ee9c, h\u00ecnh \u1ea3nh h\u1ecdc h\u1ea1t nh\u00e2n, ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb \u0111\u00e1nh gi\u00e1 t\u01b0\u1edbi m\u00e1u) \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ch\u1ecdn l\u1ecdc nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 trung b\u00ecnh, hay n\u00f3i c\u00e1ch kh\u00e1c l\u00e0 nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng c\u00f3 th\u1ec3 c\u1ea7n ph\u1ea3i ch\u1ee5p v\u00e0 can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh qua da. Tuy nhi\u00ean, \u0111a s\u1ed1 th\u0103m d\u00f2 tr\u00ean \u0111\u00f2i h\u1ecfi nhi\u1ec1u c\u00f4ng s\u1ee9c \u0111\u1ec3 th\u1ef1c hi\u1ec7n v\u00e0 kh\u00f4ng s\u1eb5n c\u00f3 t\u1ea1i nhi\u1ec1u b\u1ec7nh vi\u1ec7n. H\u01a1n n\u1eefa, h\u1ea1n ch\u1ebf ch\u00ednh c\u1ee7a c\u00e1c th\u0103m d\u00f2 n\u00e0y l\u00e0 t\u1ef7 l\u1ec7 d\u01b0\u01a1ng t\u00ednh gi\u1ea3 <\/strong>d\u0201n t\u1edbi m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n ph\u1ea3i th\u00f4ng tim ch\u1ea9n \u0111o\u00e1n kh\u00f4ng c\u1ea7n thi\u1ebft.<\/li>\n<\/ul>\n

          3.Ch\u1ec9 \u0111\u1ecbnh ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh tim<\/h2>\n

          3.1 Ch\u1ec9 \u0111\u1ecbnh<\/strong><\/h3>\n

          Ch\u1ec9 \u0111\u1ecbnh ch\u00ednh c\u1ee7a ch\u1ee5p CLVT tim trong c\u00e1c khuy\u1ebfn c\u00e1o th\u1ef1c h\u00e0nh hi\u1ec7n nay l\u00e0 lo\u1ea1i tr\u1eeb <\/strong>ho\u1eb7c ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh. Ch\u1ee5p CLVT \u0111\u1eb7c bi\u1ec7t hi\u1ec7u qu\u1ea3 \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 c\u00e1c b\u1ea5t th\u01b0\u1eddng gi\u1ea3i ph\u1eabu \u0111\u1ed9ng m\u1ea1ch v\u00e0nh <\/strong>c\u0169ng nh\u01b0 c\u1ea7u n\u1ed1i <\/strong>ch\u1ee7 v\u00e0nh.<\/p>\n

          \u01afu ti\u00ean CLVT \u0111\u1ed9ng m\u1ea1ch v\u00e0nh trong h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n t\u00ednh, c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 kh\u1ea3 n\u0103ng m\u1eafc b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh th\u1ea5p v\u00e0 trung b\u00ecnh (ESC 2019).<\/p>\n\n\n\n
          * C\u00e1c ch\u1ec9 \u0111\u1ecbnh b\u1ed5 sung bao g\u1ed3m:<\/strong><\/p>\n
            \n
          • T\u1ea7m so\u00e1t b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch v\u00e0nh (v\u00ed d\u1ee5: \u0110i\u1ec3m v\u00f4i h\u00f3a).<\/li>\n
          • \u0110\u00e1nh gi\u00e1 c\u1ea7u n\u1ed1i ch\u1ee7 v\u00e0nh.<\/li>\n
          • \u0110\u00e1nh gi\u00e1 c\u00e1c b\u1ea5t th\u01b0\u1eddng gi\u1ea3i ph\u0201u \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.<\/li>\n
          • L\u1eadp b\u1ea3n \u0111\u1ed3 c\u00e1c t\u0129nh m\u1ea1ch ph\u1ed5i tr\u01b0\u1edbc c\u00e1c th\u0103m d\u00f2 \u0111i\u1ec7n sinh l\u00fd v\u00e0 tri\u1ec7t \u0111\u1ed1t. \u0110\u00e1nh gi\u00e1 gi\u1ea3i ph\u0201u trong c\u00e1c b\u1ec7nh l\u00fd tim b\u1ea9m sinh.<\/li>\n
          • \u0110\u00e1nh gi\u00e1 c\u00e1c kh\u1ed1i b\u1ea5t th\u01b0\u1eddng trong l\u00f2ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.<\/li>\n
          • \u0110\u00e1nh gi\u00e1 \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 trong tr\u01b0\u1eddng h\u1ee3p theo d\u00f5i t\u00e1ch th\u00e0nh \u0110MC. \u0110\u00e1nh gi\u00e1 stent \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.<\/li>\n
          • \u0110\u00e1nh gi\u00e1 h\u00ecnh th\u00e1i m\u1ea3ng x\u01a1 v\u1eefa – m\u1ec1m\/v\u00f4i h\u00f3a\/h\u1ed7n h\u1ee3p.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

            3.1 \u01afu \u0111i\u1ec3m v\u00e0 nh\u01b0\u1ee3c \u0111i\u1ec3m c\u1ee7a ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh tim<\/h3>\n

            3.1.1 \u01afu \u0111i\u1ec3m:<\/h4>\n
              \n
            • Nhanh ch\u00f3ng.<\/li>\n
            • Kh\u00f4ng x\u00e2m nh\u1eadp (tr\u00e1nh \u0111\u01b0\u1ee3c c\u00e1c bi\u1ebfn c\u1ed1 m\u1ea1ch m\u00e1u do ch\u1ee5p m\u1ea1ch x\u00e2m nh\u1eadp).<\/li>\n
            • Kh\u00f4ng qu\u00e1 \u0111\u1eaft ti\u1ec1n.<\/li>\n
            • \u0110\u00e1nh gi\u00e1 chi ti\u1ebft c\u1ea7u n\u1ed1i ch\u1ee7 v\u00e0nh \u0111i\u1ec3m \u0111\u1ea7u\/\u0111i\u1ec3m cu\u1ed1i\/c\u1ea7u n\u1ed1i.<\/li>\n
            • \u0110\u00e1nh gi\u00e1 \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a m\u1ea3ng x\u01a1 v\u1eefa – CLVT c\u00f3 kh\u1ea3 n\u0103ng \u0111\u00e1nh gi\u00e1 m\u1ea3ng x\u01a1 v\u1eefa kh\u00f4ng ch\u1ec9 trong l\u00f2ng m\u1ea1ch m\u00e0 c\u1ea3 th\u00e0nh m\u1ea1ch (x\u01a1 v\u1eefa m\u1ec1m\/v\u00f4i h\u00f3a\/h\u1ed7n h\u1ee3p).<\/li>\n<\/ul>\n

              3.1.2 Nh\u01b0\u1ee3c \u0111i\u1ec3m:<\/h4>\n
                \n
              • Ph\u01a1i nhi\u1ec5m v\u1edbi b\u1ee9c x\u1ea1 ion h\u00f3a.<\/li>\n
              • Kh\u00f3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 h\u1eb9p m\u1ea1ch n\u1ebfu m\u1ee9c \u0111\u1ed9 v\u00f4i h\u00f3a m\u1ea1ch v\u00e0nh \u0111\u00e1ng k\u1ec3 . <\/strong>Kh\u00f3 \u0111\u00e1nh gi\u00e1 trong l\u00f2ng stent <\/strong>c\u0169ng nh\u01b0 m\u1ee9c \u0111\u1ed9 th\u00f4ng tho\u00e1ng c\u1ee7a stent. Kh\u00f3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 h\u1eb9p c\u1ea7u n\u1ed1i ch\u1ee7 v\u00e0nh t\u1ea1i v\u1ecb tr\u00ed mi\u1ec7ng n\u1ed1i.<\/li>\n
              • \u0110\u00f2i h\u1ecfi b\u1ec7nh nh\u00e2n c\u00f3 nh\u1ecbp tim ch\u1eadm v\u00e0 \u0111\u1ec1u.<\/strong><\/li>\n<\/ul>\n

                3.1.3 \u1ee8ng d\u1ee5ng m\u1edbi c\u1ee7a ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh tim Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh t\u01b0\u1edbi m\u00e1u<\/h3>\n

                C\u00e1c k\u1ef9 thu\u1eadt m\u1edbi c\u1ee7a ch\u1ee5p CLVT cho ph\u00e9p kh\u1ea3o s\u00e1t gi\u1ea3i ph\u0201u h\u1ec7 \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u00f9ng v\u1edbi th\u00f4ng s\u1ed1 ch\u1ee9c n\u0103ng. Thu\u1ed1c c\u1ea3n quang \u0111\u01b0\u1ee3c ti\u00eam t\u0129nh m\u1ea1ch v\u00e0 c\u01a1 tim \u0111\u01b0\u1ee3c qu\u00e9t nhi\u1ec1u l\u1ea7n trong m\u1ed9t th\u1eddi kho\u1ea3ng. Thu\u1ed1c c\u1ea3n quang ngay khi \u0111i qua v\u00f9ng c\u01a1 tim c\u1ea7n \u0111\u00e1nh gi\u00e1 s\u1ebd \u0111\u01b0\u1ee3c \u0111\u00e1nh d\u1ea5u v\u00e0 ghi th\u00e0nh \u0111\u01b0\u1eddng cong th\u1eddi gian – t\u1ef7 tr\u1ecdng, r\u1ed3i sau \u0111\u00f3 \u0111\u01b0\u1ee3c phi\u00ean gi\u1ea3i \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh t\u01b0\u1edbi m\u00e1u m\u00f4. Tuy nhi\u00ean, v\u1edbi c\u00f4ng ngh\u1ec7 ch\u1ee5p CLVT hi\u1ec7n t\u1ea1i, r\u00e0o c\u1ea3n ch\u00ednh c\u1ee7a vi\u1ec7c \u00e1p d\u1ee5ng ch\u1ee5p CLVT t\u01b0\u1edbi m\u00e1u m\u1ed9t c\u00e1ch th\u01b0\u1eddng quy l\u00e0 li\u1ec1u ph\u00f3ng x\u1ea1 cao.<\/strong><\/p>\n

                C\u00e1c k\u1ef9 thu\u1eadt ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh \u0111a ph\u01b0\u01a1ng th\u1ee9c (hybrid)<\/p>\n

                M\u1ed9t k\u1ef9 thu\u1eadt thay th\u1ebf cho ch\u1ee5p CLVT t\u01b0\u1edbi m\u00e1u l\u00e0 phi\u00ean gi\u1ea3i c\u00e1c th\u00f4ng tin gi\u1ea3i ph\u0201u t\u1eeb ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh m\u1ea1ch m\u00e1u c\u00f9ng nh\u1eefng th\u00f4ng tin v\u1ec1 ch\u1ee9c n\u0103ng t\u1eeb si\u00eau \u00e2m tim g\u1eafng s\u1ee9c, ch\u1ee5p c\u1eaft l\u1edbp b\u1eb1ng b\u1ee9c x\u1ea1 \u0111\u01a1n photon (SPECT), PET ho\u1eb7c ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb t\u01b0\u1edbi m\u00e1u. C\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng ch\u1ec9 ra r\u1eb1ng ph\u1ed1i h\u1ee3p th\u00f4ng tin v\u1ec1 m\u1eb7t gi\u1ea3i ph\u0201u v\u00e0 ch\u1ee9c n\u0103ng s\u1ebd l\u00e0m n\u00e2ng cao \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u so v\u1edbi t\u1eebng k\u1ef9 thu\u1eadt ch\u1ea9n \u0111o\u00e1n ri\u00eang l\u1ebb.<\/p>\n","protected":false},"excerpt":{"rendered":"

                \u00a0Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh (CLVT) l\u00e0 bi\u1ec7n ph\u00e1p th\u0103m d\u00f2 kh\u00f4ng x\u00e2m l\u1ea5n h\u1eefu hi\u1ec7u trong \u0111\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh. Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh tim 1.\u0110\u00e1nh gi\u00e1 \u0111i\u1ec3m v\u00f4i h\u00f3a m\u1ea1ch v\u00e0nh M\u1ea3ng x\u01a1 v\u1eefa v\u00f4i h\u00f3a chi\u1ebfm kho\u1ea3ng 20% g\u00e1nh n\u1eb7ng x\u01a1 v\u1eefa to\u00e0n b\u1ed9 m\u1ea1ch v\u00e0nh. Do v\u1eady […]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[88,33],"tags":[],"yoast_head":"\nCh\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh tim - Vinmec<\/title>\n<meta name=\"description\" content=\"Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh timl\u00e0 bi\u1ec7n ph\u00e1p th\u0103m d\u00f2 kh\u00f4ng x\u00e2m l\u1ea5n h\u1eefu hi\u1ec7u trong \u0111\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh. 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