{"id":29063,"date":"2023-04-29T18:24:55","date_gmt":"2023-04-29T11:24:55","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29063"},"modified":"2023-04-29T18:24:55","modified_gmt":"2023-04-29T11:24:55","slug":"nguyen-tac-co-ban-trong-chup-cong-huong-tu-tim","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/nguyen-tac-co-ban-trong-chup-cong-huong-tu-tim\/","title":{"rendered":"Nguy\u00ean t\u1eafc c\u01a1 b\u1ea3n trong ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb tim"},"content":{"rendered":"

C\u1ed9ng h\u01b0\u1edfng t\u1eeb tim<\/a> (CMR) l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh r\u1ea5t linh ho\u1ea1t cho ph\u00e9p \u0111\u00e1nh gi\u00e1 c\u1ea5u tr\u00fac v\u00e0 ch\u1ee9c n\u0103ng c\u1ee7a tim v\u1edbi \u0111\u1ed9 ph\u00e2n gi\u1ea3i kh\u00f4ng gian cao v\u00e0 kh\u00f4ng gi\u1edbi h\u1ea1n m\u1eb7t ph\u1eb3ng kh\u1ea3o s\u00e1t, m\u00e0 kh\u00f4ng s\u1eed d\u1ee5ng b\u1ee9c x\u1ea1 ion h\u00f3a.<\/strong><\/p>\n

\"C\u1ed9ng<\/p>\n

C\u1ed9ng h\u01b0\u1edfng t\u1eeb tim<\/strong><\/p>\n

1.Nguy\u00ean t\u1eafc ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb tim<\/h2>\n

B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u1eb7t trong m\u1ed9t t\u1eeb tr\u01b0\u1eddng m\u1ea1nh, 1,5 – 3 Tesla (T). \u0110i\u1ec1u n\u00e0y bu\u1ed9c t\u1ea5t c\u1ea3 c\u00e1c nguy\u00ean t\u1eed Hidro trong b\u1ec7nh nh\u00e2n ph\u1ea3i x\u1ebfp song song c\u00f9ng h\u01b0\u1edbng ho\u1eb7c ng\u01b0\u1ee3c h\u01b0\u1edbng v\u1edbi t\u1eeb tr\u01b0\u1eddng b\u00ean ngo\u00e0i.<\/p>\n

Xung c\u1ed9ng h\u01b0\u1edfng t\u1eeb l\u00e0m t\u1eeb h\u00f3a c\u00e1c nguy\u00ean t\u1eed Hidro, khi\u1ebfn ch\u00fang b\u1ecb t\u00e1ch ra kh\u1ecfi h\u01b0\u1edbng ban \u0111\u1ea7u. Khi n\u00f3 ph\u00e2n r\u00e3 tr\u1edf l\u1ea1i tr\u1ea1ng th\u00e1i th\u01b0 gi\u00e3n s\u1ebd ph\u00e1t ra n\u0103ng l\u01b0\u1ee3ng t\u1ea7n s\u1ed1 v\u00f4 tuy\u1ebfn.<\/p>\n

Th\u1eddi gian th\u01b0 gi\u00e3n \u0111\u1ec3 ph\u1ee5c h\u1ed3i t\u1eeb h\u00f3a d\u1ecdc v\u00e0 s\u1ef1 ph\u00e2n r\u00e3 c\u1ee7a t\u1eeb h\u00f3a ngang b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi m\u00f4i tr\u01b0\u1eddng xung quanh c\u1ee7a c\u00e1c nguy\u00ean t\u1eed Hidro.<\/p>\n

C\u00e1c t\u00edn hi\u1ec7u t\u1ea1o ra \u0111\u1ec3 t\u1ea1o d\u1ef1ng h\u00ecnh \u1ea3nh. C\u00e1c chu\u1ed7i c\u00e1c xung v\u00e0 \u0111\u1ed9 d\u1ed1c t\u1eeb tr\u01b0\u1eddng kh\u00e1c nhau c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 nh\u1ea5n m\u1ea1nh c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m m\u00f4 kh\u00e1c nhau ho\u1eb7c l\u00e0m n\u1ed5i b\u1eadt c\u00e1c chi ti\u1ebft gi\u1ea3i ph\u0201u c\u1ee5 th\u1ec3.<\/p>\n

C\u00e1c m\u00f4 \u00edt nguy\u00ean t\u1eed Hidro (V\u00ed d\u1ee5: ph\u1ed5i ch\u1ee9a \u0111\u1ea7y kh\u00ed) cho ch\u1ea5t l\u01b0\u1ee3ng h\u00ecnh \u1ea3nh CHT kh\u00f4ng r\u00f5 n\u00e9t.<\/p>\n

2.C\u00e1c ch\u1ec9 \u0111\u1ecbnh ch\u00ednh cho c\u1ed9ng h\u01b0\u1edfng t\u1eeb tim bao g\u1ed3m:<\/h2>\n
    \n
  • \u0110\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng t\u00e2m th\u1ea5t ( ti\u00eau chu\u1ea9n v\u00e0ng ).<\/li>\n
  • \u0110\u00e1nh gi\u00e1 b\u1ec7nh c\u01a1 tim .<\/li>\n
  • \u0110\u00e1nh gi\u00e1 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 v\u00e0 kh\u1ea3 n\u0103ng s\u1ed1ng c\u00f2n c\u1ee7a c\u01a1 tim . \u0110\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng \u1ee9 s\u1eaft c\u1ee7a tim.<\/li>\n
  • \u0110\u00e1nh gi\u00e1 b\u1ec7nh tim b\u1ea9m sinh.<\/li>\n
  • \u0110\u00e1nh gi\u00e1 b\u1ec7nh van tim.<\/li>\n
  • Ch\u1ea9n \u0111o\u00e1n v\u00e0 theo d\u00f5i b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.<\/li>\n
  • \u0110\u00e1nh gi\u00e1 b\u1ec7nh m\u00e0ng ngo\u00e0i tim v\u00e0 kh\u1ed1i u tim.<\/li>\n<\/ul>\n

    3.Y\u00eau c\u1ea7u khi ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb tim<\/h2>\n

    Cung c\u1ea5p c\u00e0ng nhi\u1ec1u th\u00f4ng tin v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 l\u00e2m s\u00e0ng c\u1ea7n \u0111\u00e1nh gi\u00e1 tr\u01b0\u1edbc khi ch\u1ee5p c\u00e0ng t\u1ed1t. T\u00ednh linh ho\u1ea1t c\u1ee7a CHT cho ph\u00e9p \u00e1p d\u1ee5ng nhi\u1ec1u lo\u1ea1i k\u1ef9 thu\u1eadt kh\u00e1c nhau \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 c\u00e1c m\u1ee5c ti\u00eau kh\u00e1c nhau. C\u1ea7n \u0111\u00e1nh gi\u00e1 c\u00e1c v\u1ea5n \u0111\u1ec1 l\u00e2m s\u00e0ng chi ti\u1ebft \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh m\u1ee5c ti\u00eau, t\u1eeb \u0111\u00f3 x\u00e2y d\u1ef1ng m\u1ed9t ph\u01b0\u01a1ng th\u1ee9c h\u00ecnh \u1ea3nh ph\u00f9 h\u1ee3p.<\/p>\n

    \u0110\u00e1nh gi\u00e1 c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tuy\u1ec7t \u0111\u1ed1i tr\u01b0\u1edbc khi ch\u1ee5p.<\/p>\n

    Trong \u0111\u00e1nh gi\u00e1 b\u1ec7nh c\u01a1 tim v\u00e0 b\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9, d\u00f9ng \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 khi ngh\u1ec9 \u0111\u1ec3 c\u00f3 th\u00eam g\u1ee3i \u00fd.<\/p>\n

    Trong \u0111\u00e1nh gi\u00e1 b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i, ph\u1ea3i xem x\u00e9t c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c c\u00f3 th\u1ec3 g\u00e2y ph\u00ec \u0111\u1ea1i c\u01a1 tim, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng, th\u1eddi gian k\u00e9o d\u00e0i b\u1ec7nh, v\u00e0 m\u1ee9c \u0111\u1ed9 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p. V\u1edbi c\u00e1c th\u0103m d\u00f2 \u0111\u00e1nh gi\u00e1 s\u1ed1ng c\u00f2n c\u01a1 tim, c\u1ea7n cung c\u1ea5p th\u00f4ng tin chi ti\u1ebft v\u1ec1 ti\u1ec1n s\u1eed can thi\u1ec7p tim m\u1ea1ch, k\u1ebft qu\u1ea3 ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh ho\u1eb7c c\u1ea7u n\u1ed1i ch\u1ee7 v\u00e0nh n\u1ebfu c\u00f3, \u0111i\u1ec1u n\u00e0y s\u1ebd t\u1ea1o thu\u1eadn l\u1ee3i nhi\u1ec1u cho vi\u1ec7c \u0111\u00e1nh gi\u00e1 k\u1ebft qu\u1ea3.<\/p>\n

    \u0110\u1ed1i v\u1edbi c\u00e1c th\u0103m d\u00f2 v\u1ec1 van tim c\u1ea7n c\u00f3 c\u00e1c b\u1ea3n \u0111\u00e1nh gi\u00e1 si\u00eau \u00e2m tim.<\/p>\n

    Khi c\u00f3 r\u00e0o c\u1ea3n ng\u00f4n ng\u1eef (ng\u01b0\u1eddi d\u00e2n t\u1ed9c, ng\u01b0\u1eddi n\u01b0\u1edbc ngo\u00e0i), c\u1ea7n c\u00f3 ng\u01b0\u1eddi phi\u00ean d\u1ecbch, v\u00ec khi b\u1ec7nh nh\u00e2n kh\u00f4ng h\u1ee3p t\u00e1c t\u1ed1t , nh\u1ea5t l\u00e0 giai \u0111o\u1ea1n n\u00edn th\u1edf th\u00ec s\u1ebd kh\u00f4ng thu \u0111\u01b0\u1ee3c ch\u1ea5t l\u01b0\u1ee3ng h\u00ecnh \u1ea3nh t\u1ed1t.<\/p>\n

    B\u1ec7nh nh\u00e2n ph\u1ea3i n\u1eb1m y\u00ean trong kho\u1ea3ng 1 gi\u1edd v\u00e0 c\u00f3 kh\u1ea3 n\u0103ng n\u00edn th\u1edf theo y\u00eau c\u1ea7u.<\/p>\n

    N\u1ebfu \u0111\u00e1nh gi\u00e1 g\u1eafng s\u1ee9c c\u01a1 tim b\u1eb1ng adenosine c\u1ea7n ki\u00eang c\u00e0 ph\u00ea trong 24 gi\u1edd tr\u01b0\u1edbc khi l\u00e0m. T\u01b0\u01a1ng t\u1ef1 v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n l\u00e0m nghi\u1ec7m ph\u00e1p v\u1edbi dobutamine, c\u1ea7n d\u1eebng thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m ho\u1eb7c thu\u1ed1c ch\u1eb9n k\u00eanh canxi.<\/p>\n

    \u0110\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1eadn c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u1ec3 c\u00f3 bi\u1ec7n ph\u00e1p d\u1ef1 ph\u00f2ng v\u00e0 \u0111i\u1ec1u tr\u1ecb t\u1ed5n th\u01b0\u01a1ng th\u1eadn do thu\u1ed1c \u0111\u1ed1i quang t\u1eeb gadolinium.<\/p>\n

    \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n b\u00e9o ph\u00ec, \u0111\u00e1nh gi\u00e1 li\u1ec7u b\u00e0n ch\u1ee5p v\u00e0 m\u00e1y qu\u00e9t c\u00f3 an to\u00e0n cho b\u1ec7nh nh\u00e2n hay kh\u00f4ng.<\/p>\n

    \u0110\u00e1nh gi\u00e1 b\u1eb1ng phim X-quang nh\u1eefng b\u1ec7nh nh\u00e2n nghi ng\u1edd c\u00f3 d\u1ecb v\u1eadt kim lo\u1ea1i trong m\u1eaft\/\u1ed5 m\u1eaft (ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tuy\u1ec7t \u0111\u1ed1i v\u1edbi CHT).<\/p>\n

    3.1 Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tuy\u1ec7t \u0111\u1ed1i v\u1edbi ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb tim<\/h3>\n
      \n
    • B\u1ec7nh nh\u00e2n c\u00f3 c\u1ea5y m\u00e1y t\u1ea1o nh\u1ecbp v\u0129nh vi\u1ec5n\/m\u00e1y ph\u00e1 rung ( ICD ) m\u00e0 kh\u00f4ng c\u00f3 ch\u1ee9c n\u0103ng ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb ho\u1eb7c d\u00e2y d\u0201n t\u1ea1o nh\u1ecbp c\u00f2n l\u01b0u l\u1ea1i\/b\u1ecb g\u00e3y. Kim lo\u1ea1i trong m\u1eaft\/\u1ed5 m\u1eaft.<\/li>\n
    • Clip ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch n\u00e3o b\u1eb1ng kim lo\u1ea1i. C\u1ea5y gh\u00e9p \u1ed1c tai \u0111i\u1ec7n t\u1eed.<\/li>\n
    • B\u01a1m insulin.<\/li>\n
    • Kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 t\u00e1c h\u1ea1i c\u1ee7a CHT trong thai k\u1ef3. Tuy nhi\u00ean, n\u00ean tr\u00e1nh ch\u1ec9 \u0111\u1ecbnh trong thai k\u1ef3, \u0111\u1eb7c bi\u1ec7t l\u00e0 trong qu\u00fd \u0111\u1ea7u, tr\u1eeb khi b\u1eaft bu\u1ed9c (l\u1ee3i \u00edch l\u00e2m s\u00e0ng v\u00e0 vi\u1ec7c ch\u1ee5p CHT kh\u00f4ng th\u1ec3 tr\u00ec ho\u00e3n).<\/li>\n
    • Ph\u1ee5 n\u1eef \u0111ang cho con b\u00fa n\u00ean \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o v\u1eaft b\u1ecf s\u1eefa m\u1eb9 trong 24 gi\u1edd sau khi ti\u00eam thu\u1ed1c \u0111\u1ed1i quang t\u1eeb gadolinium.<\/li>\n<\/ul>\n

      3.2 An to\u00e0n<\/h3>\n

      Khi \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u00fang v\u00e0 lo\u1ea1i tr\u1eeb c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, CHT l\u00e0 k\u1ef9 thu\u1eadt ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh r\u1ea5t an to\u00e0n. Tuy nhi\u00ean, c\u00e1c tr\u01b0\u1eddng t\u1eeb t\u00ednh m\u1ea1nh 1,5T ho\u1eb7c 3T c\u00f3 th\u1ec3 h\u00fat v\u1eadt s\u1eaft trong c\u01a1 th\u1ec3 v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ch\u1ebft ng\u01b0\u1eddi. T\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc khi ch\u1ee5p CHT n\u00ean \u0111\u01b0\u1ee3c ki\u1ec3m tra c\u00f3 v\u1eadt li\u1ec7u c\u1ea5y gh\u00e9p ch\u1ee9a s\u1eaft t\u1eeb v\u00e0 thi\u1ebft b\u1ecb kh\u00f4ng \u0111\u01b0\u1ee3c coi l\u00e0 an to\u00e0n trong t\u1eeb tr\u01b0\u1eddng.<\/p>\n

      C\u00e1c xung t\u1ea7n s\u1ed1 v\u00f4 tuy\u1ebfn \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh c\u00f3 th\u1ec3 t\u1ea1o ra hi\u1ec7u \u1ee9ng l\u00e0m n\u00f3ng d\u00e2y d\u0201n ho\u1eb7c v\u1eadt li\u1ec7u c\u1ea5y gh\u00e9p trong c\u01a1 th\u1ec3 g\u00e2y t\u1ed5n th\u01b0\u01a1ng nhi\u1ec7t t\u1ea1i c\u00e1c \u0111i\u1ec3m ti\u1ebfp x\u00fac. C\u00e1c mi\u1ebfng d\u00e1n \u0111i\u1ec7n c\u1ef1c \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 c\u00f3 th\u1ec3 b\u1ecb \u0111\u1ed1t n\u00f3ng v\u00e0 \u0111\u1ed1t ch\u00e1y theo c\u01a1 ch\u1ebf t\u01b0\u01a1ng t\u1ef1. C\u1ea7n thay th\u1ebf b\u1eb1ng mi\u1ebfng d\u00e1n carbon an to\u00e0n v\u1edbi t\u1eeb tr\u01b0\u1eddng.<\/p>\n

      Ngo\u00e0i t\u1eeb tr\u01b0\u1eddng ch\u00ednh, c\u00e1c t\u1eeb tr\u01b0\u1eddng gradient \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u00e0 thay \u0111\u1ed5i ch\u1ebf \u0111\u1ed9 b\u1eadt, t\u1eaft nhanh ch\u00f3ng trong qu\u00e1 tr\u00ecnh ch\u1ee5p \u1ea3nh \u0111\u1ec3 t\u1ea1o ra c\u00e1c chu\u1ed7i t\u00edn hi\u1ec7u li\u00ean ti\u1ebfp cho ph\u00e9p \u0111\u1ecbnh v\u1ecb theo kh\u00f4ng gian. \u0110i\u1ec1u n\u00e0y t\u1ea1o ra ti\u1ebfng \u1ed3n r\u1ea5t l\u1edbn (> 100 dB) v\u00e0 c\u00f3 th\u1ec3 g\u00e2y m\u1ea5t th\u00ednh l\u1ef1c . T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n v\u00e0 b\u1ea5t c\u1ee9 ai c\u00f3 m\u1eb7t trong ph\u00f2ng ch\u1ee5p ph\u1ea3i \u0111eo tai nghe ho\u1eb7c n\u00fat tai b\u1ea3o v\u1ec7. Chuy\u1ec3n \u0111\u1ed5i gradient nhanh c\u0169ng c\u00f3 th\u1ec3 k\u00edch th\u00edch th\u1ea7n kinh ngo\u1ea1i bi\u00ean g\u00e2y kh\u00f3 ch\u1ecbu.<\/p>\n

      3.3 Thi\u1ebft b\u1ecb c\u1ea5y gh\u00e9p<\/h3>\n

      C\u00e1c bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba c\u1ea7n thi\u1ebft ph\u1ee5 thu\u1ed9c v\u00e0o th\u00e0nh ph\u1ea7n v\u1eadt li\u1ec7u c\u1ee7a thi\u1ebft b\u1ecb c\u1ea5y gh\u00e9p, v\u00e0 n\u1ebfu c\u00f3 nghi ng\u1edd, n\u00ean h\u1ecfi t\u01b0 v\u1ea5n nh\u00e0 s\u1ea3n xu\u1ea5t. Trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 d\u1eef li\u1ec7u \u0111\u1ec3 h\u01b0\u1edbng d\u0201n, c\u00e1c r\u1ee7i ro v\u00e0 l\u1ee3i \u00edch c\u1ee7a vi\u1ec7c ch\u1ee5p CHT ph\u1ea3i \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc c\u1ea9n th\u1eadn. \u0110\u1ed1i v\u1edbi c\u00e1c thi\u1ebft b\u1ecb s\u1eaft t\u1eeb t\u00ednh y\u1ebfu, c\u1ea7n quan t\u00e2m \u0111\u1ebfn s\u1ef1 bi\u1ebfn d\u1ea1ng c\u1ee7a thi\u1ebft b\u1ecb. \u0110\u1eb7c bi\u1ec7t, n\u1ebfu kh\u00f4ng ph\u1ea3i l\u00e0 t\u00ecnh tr\u1ea1ng kh\u1ea9n c\u1ea5p, n\u00ean ch\u1ee5p \u00edt nh\u1ea5t 6 tu\u1ea7n sau khi c\u1ea5y gh\u00e9p \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o thi\u1ebft b\u1ecb \u0111\u01b0\u1ee3c c\u1ed1 \u0111\u1ecbnh t\u1ed1t.<\/p>\n

      Stent m\u1ea1ch v\u00e0nh v\u00e0 m\u1ea1ch m\u00e1u th\u01b0\u1eddng c\u00f3 s\u1eaft t\u1eeb r\u1ea5t y\u1ebfu . Ch\u1ee5p CHT c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n m\u1ed9t c\u00e1ch an to\u00e0n trong ph\u1ea7n l\u1edbn c\u00e1c tr\u01b0\u1eddng h\u1ee3p. T\u01b0\u01a1ng t\u1ef1, ph\u1ea7n l\u1edbn c\u00e1c van tim v\u00e0 v\u00f2ng van nh\u00e2n t\u1ea1o an to\u00e0n v\u1edbi CHT. Nh\u1eefng v\u1eadt li\u1ec7u kh\u00e1c \u0111\u01b0\u1ee3c coi l\u00e0 an to\u00e0n c\u00f3 \u0111i\u1ec1u ki\u1ec7n, t\u1ee9c l\u00e0 kh\u00f4ng c\u00f3 nguy hi\u1ec3m trong c\u00e1c \u0111i\u1ec1u ki\u1ec7n c\u1ee5 th\u1ec3. \u0110\u00f3 l\u00e0 c\u00e1c thi\u1ebft b\u1ecb b\u00edt ho\u1eb7c g\u00e2y t\u1eafc m\u1ea1ch, l\u01b0\u1edbi l\u1ecdc t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi ho\u1eb7c coil n\u00fat m\u1ea1ch.<\/p>\n

      Ch\u1ec9 bu\u1ed9c x\u01b0\u01a1ng \u1ee9c v\u00e0 d\u00e2y d\u0201n t\u1ea1o nh\u1ecbp m\u00e0ng ngo\u00e0i tim l\u00e0 an to\u00e0n; tuy nhi\u00ean, ch\u00fang c\u00f3 th\u1ec3 g\u00e2y c\u1ea3n tr\u1edf vi\u1ec7c ph\u00e2n t\u00edch h\u00ecnh \u1ea3nh.<\/p>\n

      3.4 M\u00e1y t\u1ea1o nh\u1ecbp tim\/m\u00e1y ph\u00e1 rung t\u1ef1 \u0111\u1ed9ng<\/h3>\n

      M\u00e1y t\u1ea1o nh\u1ecbp tim th\u1ebf h\u1ec7 c\u0169 c\u00f3 th\u1ec3 kh\u00f4ng ph\u00f9 h\u1ee3p v\u1edbi ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb do \u1ea3nh h\u01b0\u1edfng c\u1ee7a t\u1eeb tr\u01b0\u1eddng l\u00ean v\u1ecf m\u00e1y v\u00e0 \u0111i\u1ec7n c\u1ef1c c\u00f3 th\u1ec3 l\u00e0m h\u1ecfng \u0111i\u1ec7n c\u1ef1c v\u00e0 di chuy\u1ec3n m\u00e1y. Nh\u1eefng m\u00e1y t\u1ea1o nh\u1ecbp tim th\u1ebf h\u1ec7 m\u1edbi hi\u1ec7n nay \u0111\u00e3 v\u00e0 \u0111ang \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i v\u1edbi c\u1ea5u tr\u00fac m\u1edbi an to\u00e0n khi ti\u1ebfn h\u00e0nh ch\u1ee5p CHT. Do \u0111\u00f3 tr\u01b0\u1edbc khi ch\u1ee5p CHT c\u1ea7n tham kh\u1ea3o k\u0129 \u00fd ki\u1ebfn c\u1ee7a b\u00e1c s\u0129 r\u1ed1i lo\u1ea1n nh\u1ecbp v\u1ec1 t\u00ednh an to\u00e0n c\u1ee7a m\u00e1y, c\u0169ng nh\u01b0 c\u1ea7n l\u1eadp tr\u00ecnh l\u1ea1i m\u00e1y tr\u01b0\u1edbc v\u00e0 sau khi ch\u1ee5p \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o ch\u1ed1ng nhi\u1ec5u trong qua tr\u00ecnh ch\u1ee5p.<\/p>\n

      M\u00e1y ph\u00e1 rung t\u1ef1 \u0111\u1ed9ng (ICD) tr\u01b0\u1edbc \u0111\u00e2y \u0111\u01b0\u1ee3c cho l\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tuy\u1ec7t \u0111\u1ed1i ch\u1ee5p CHT. Ng\u00e0y nay c\u00e1c m\u00e1y ICD th\u1ebf h\u1ec7 m\u1edbi \u0111\u01b0\u1ee3c thi\u1ebft k\u1ebf an to\u00e0n \u0111\u1ed1i v\u1edbi ch\u1ee5p CHT. C\u00e1c d\u1eef li\u1ec7u theo d\u00f5i l\u00e2m s\u00e0ng tr\u00ean nhi\u1ec1u trung t\u00e2m tr\u00ean th\u1ebf gi\u1edbi \u0111\u00e3 cho th\u1ea5y t\u00ednh an to\u00e0n c\u1ee7a ICD trong khi ch\u1ee5p MRI. C\u1ea7n l\u01b0u \u00fd tham kh\u1ea3o \u00fd ki\u1ebfn chuy\u00ean gia v\u1ec1 r\u1ed1i lo\u1ea1n nh\u1ecbp<\/p>\n

      tr\u01b0\u1edbc khi ch\u1ee5p CHT, b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c l\u1eadp tr\u00ecnh m\u00e1y ICD tr\u01b0\u1edbc v\u00e0 sau khi ch\u1ee5p. \u0110\u1ed3ng th\u1eddi theo d\u00f5i s\u00e1t trong qu\u00e1 tr\u00ecnh ch\u1ee5p \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o an to\u00e0n cho b\u1ec7nh nh\u00e2n v\u00e0 ch\u1eafc ch\u1eafn kh\u00f4ng c\u00f3 b\u1ea5t th\u01b0\u1eddng g\u00ec \u1ea3nh h\u01b0\u1edfng t\u1edbi thi\u1ebft b\u1ecb.<\/p>\n

      Thi\u1ebft b\u1ecb ghi \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 li\u00ean t\u1ee5c c\u1ea5y d\u01b0\u1edbi da c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c coi l\u00e0 an to\u00e0n c\u00f3 \u0111i\u1ec1u ki\u1ec7n khi ch\u1ee5p CHT. Ch\u00fang t\u1ea1o ra h\u00ecnh nhi\u1ec5u v\u00e0 theo l\u00fd thuy\u1ebft, hi\u1ec7u su\u1ea5t c\u1ee7a m\u00e1y c\u00f3 th\u1ec3 b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi t\u1eeb tr\u01b0\u1eddng m\u1ea1nh. Do \u0111\u00f3, m\u00e1y ghi \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 c\u1ea5y gh\u00e9p n\u00ean \u0111\u01b0\u1ee3c tham v\u1ea5n tr\u01b0\u1edbc khi ti\u1ebfn h\u00e0nh ch\u1ee5p, sau \u0111\u00f3 x\u00f3a b\u1ed9 \u0111\u1ec7m b\u1ea5t k\u1ef3 d\u1eef li\u1ec7u nh\u00e2n t\u1ea1o kh\u00f4ng ph\u00f9 h\u1ee3p n\u00e0o c\u00f3 th\u1ec3 t\u00edch l\u0169y trong qu\u00e1 tr\u00ecnh ch\u1ee5p.<\/p>\n

      3.5 Thu\u1ed1c \u0111\u1ed1i quang t\u1eeb Gadolinium<\/h3>\n

      Hai nguy c\u01a1 ch\u00ednh khi d\u00f9ng gadolinium l\u00e0 s\u1ed1c ph\u1ea3n v\u1ec7 v\u1edbi gadolinium chelate ho\u1eb7c m\u1ed9t trong c\u00e1c t\u00e1 d\u01b0\u1ee3c c\u1ee7a n\u00f3 v\u00e0 b\u1ec7nh x\u01a1 h\u00f3a h\u1ec7 th\u1ed1ng ngu\u1ed3n g\u1ed1c th\u1eadn (NSF: nephrogenic systemic fibrosis).<\/p>\n

      Ch\u1ea5t \u0111\u1ed1i quang t\u1eeb trong ch\u1ee5p CHT ho\u00e0n to\u00e0n kh\u00e1c bi\u1ec7t v\u1edbi c\u00e1c ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n i-\u1ed1t \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh tia X, do \u0111\u00f3, d\u1ecb \u1ee9ng v\u1edbi m\u1ed9t lo\u1ea1i kh\u00f4ng g\u00e2y d\u1ecb \u1ee9ng v\u1edbi lo\u1ea1i kh\u00e1c tr\u1eeb khi n\u00f3 l\u00e0 t\u00e1 d\u01b0\u1ee3c th\u00f4ng th\u01b0\u1eddng.<\/p>\n

      Thu\u1ed1c \u0111\u1ed1i quang t\u1eeb kh\u00f4ng g\u00e2y suy th\u1eadn ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng th\u1eadn do thu\u1ed1c c\u1ea3n quang; tuy nhi\u00ean, \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb suy th\u1eadn \u0111\u00e1ng k\u1ec3 (m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn (eGFR) < 30 mL\/min\/1,73m\u00b2 ), c\u00f3 nguy c\u01a1 m\u1eafc x\u01a1 h\u00f3a h\u1ec7 th\u1ed1ng ngu\u1ed3n g\u1ed1c th\u1eadn – m\u1ed9t t\u00ecnh tr\u1ea1ng \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 ph\u00e1t tri\u1ec3n x\u01a1 h\u00f3a c\u1ee7a da v\u00e0 \u0111a n\u1ed9i t\u1ea1ng, th\u01b0\u1eddng trong v\u00f2ng v\u00e0i ng\u00e0y \u0111\u1ebfn v\u00e0i tu\u1ea7n . X\u1ea5p x\u1ec9 5% b\u1ec7nh nh\u00e2n ti\u1ebfn tri\u1ec3n \u00e1c t\u00ednh.<\/p>\n

      C\u00e1c chelate gadolinium v\u00f2ng an to\u00e0n h\u01a1n \u0111\u00e1ng k\u1ec3 so v\u1edbi c\u00e1c ch\u1ea5t \u0111\u1ed1i quang th\u1ebf h\u1ec7 c\u0169.<\/p>\n

      Trong m\u1ed9t nghi\u00ean c\u1ee9u \u1edf b\u1ec7nh nh\u00e2n suy th\u1eadn giai \u0111o\u1ea1n cu\u1ed1i cho th\u1ea5y t\u1ef7 l\u1ec7 g\u1eb7p b\u1ec7nh x\u01a1 ho\u00e1 h\u1ec7 th\u1ed1ng ngu\u1ed3n g\u1ed1c th\u1eadn kho\u1ea3ng 2,4%. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 eGFR < 30 mL\/min\/1,73m 2 ho\u1eb7c \u1edf nh\u1eefng ng\u01b0\u1eddi \u0111ang th\u1eadn nh\u00e2n t\u1ea1o chu k\u1ef3, n\u00ean c\u00e2n nh\u1eafc gi\u1eefa l\u1ee3i \u00edch v\u00e0 nguy c\u01a1 tr\u01b0\u1edbc khi \u0111\u01b0a quy\u1ebft \u0111\u1ecbnh. N\u1ebfu c\u00f3 d\u00f9ng thu\u1ed1c \u0111\u1ed1i quang t\u1eeb, n\u00ean d\u00f9ng li\u1ec1u thu\u1ed1c th\u1ea5p nh\u1ea5t c\u00f3 th\u1ec3 v\u00e0 n\u00ean d\u00f9ng lo\u1ea1i gadolinium chelate. B\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb thay th\u1ebf th\u1eadn n\u00ean \u0111\u01b0\u1ee3c ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o ngay sau khi ch\u1ee5p.<\/p>\n

      Th\u1eadn tr\u1ecdng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb suy th\u1eadn c\u00e1c m\u1ee9c \u0111\u1ed9 \u0111ang ch\u1edd \u0111\u1ee3i ho\u1eb7c g\u1ea7n \u0111\u00e2y \u0111\u00e3 \u0111\u01b0\u1ee3c gh\u00e9p gan, v\u00ec nguy c\u01a1 m\u1eafc h\u1ed9i ch\u1ee9ng gan th\u1eadn.<\/p>\n

      3.6 B\u1ec7nh nh\u00e2n kh\u00f4ng \u1ed5n \u0111\u1ecbnh<\/p>\n

      Kh\u00f4ng n\u00ean \u0111\u01b0a b\u1ec7nh nh\u00e2n c\u00f3 huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh v\u00e0o m\u00e1y ch\u1ee5p do thi\u1ebft b\u1ecb theo d\u00f5i v\u00e0 h\u1ed3i s\u1ee9c kh\u00f4ng \u0111\u1ea3m b\u1ea3o an to\u00e0n trong khi ch\u1ee5p. B\u1ec7nh nh\u00e2n c\u1ea7n h\u1ed3i s\u1ee9c tim ph\u1ed5i (CPR) ph\u1ea3i \u0111\u01b0\u1ee3c chuy\u1ec3n ra kh\u1ecfi m\u00e1y ch\u1ee5p ngay l\u1eadp t\u1ee9c. Ch\u1ee5p CHT kh\u00f4ng d\u00e0nh cho c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh.<\/p>\n

      C\u1ed9ng h\u01b0\u1edfng t\u1eeb tim trong m\u1ed9t nghi\u00ean c\u1ee9u \u0111\u01a1n l\u1ebb cho th\u1ea5y l\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n kh\u00f4ng x\u00e2m l\u1ea5n, ch\u00ednh x\u00e1c, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng t\u00e1i \u0111\u00e1nh gi\u00e1 kh\u1ed1i l\u01b0\u1ee3ng c\u01a1 th\u1ea5t tr\u00e1i v\u00e0 b\u1ec1 d\u00e0y th\u00e0nh tim, th\u1ec3 t\u00edch th\u1ea5t tr\u00e1i v\u00e0 th\u1ea5t ph\u1ea3i, \u0111\u00e1nh gi\u00e1 t\u01b0\u1edbi m\u00e1u c\u01a1 tim c\u0169ng nh\u01b0 kh\u1ea3 n\u0103ng ph\u00e1t hi\u1ec7n x\u01a1 h\u00f3a c\u01a1 tim hay t\u00ecnh tr\u1ea1ng vi\u00eam. V\u00ec v\u1eady CHT tim l\u00e0 ph\u01b0\u01a1ng ti\u1ec7n h\u1eefu \u00edch \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 v\u00e0 theo d\u00f5i nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd c\u01a1 tim.<\/p>\n

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

      C\u1ed9ng h\u01b0\u1edfng t\u1eeb tim (CMR) l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh r\u1ea5t linh ho\u1ea1t cho ph\u00e9p \u0111\u00e1nh gi\u00e1 c\u1ea5u tr\u00fac v\u00e0 ch\u1ee9c n\u0103ng c\u1ee7a tim v\u1edbi \u0111\u1ed9 ph\u00e2n gi\u1ea3i kh\u00f4ng gian cao v\u00e0 kh\u00f4ng gi\u1edbi h\u1ea1n m\u1eb7t ph\u1eb3ng kh\u1ea3o s\u00e1t, m\u00e0 kh\u00f4ng s\u1eed d\u1ee5ng b\u1ee9c x\u1ea1 ion h\u00f3a. C\u1ed9ng h\u01b0\u1edfng t\u1eeb tim 1.Nguy\u00ean […]<\/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":"\nNguy\u00ean t\u1eafc c\u01a1 b\u1ea3n trong ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb tim - Vinmec<\/title>\n<meta name=\"description\" content=\"Nguy\u00ean t\u1eafc c\u01a1 b\u1ea3n trong ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb tim l\u00e0 v\u1ea5n \u0111\u1ec1 \u0111\u01b0\u1ee3c \u0111\u1eb7t ra khi th\u1ef1c hi\u1ec7n ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb tim.\" \/>\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=\"Nguy\u00ean t\u1eafc c\u01a1 b\u1ea3n trong ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb tim - 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