{"id":29829,"date":"2023-04-30T20:45:12","date_gmt":"2023-04-30T13:45:12","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29829"},"modified":"2023-04-30T20:45:12","modified_gmt":"2023-04-30T13:45:12","slug":"dieu-tri-noi-ngoai-khoa-trong-hep-van-hai-la","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/30\/dieu-tri-noi-ngoai-khoa-trong-hep-van-hai-la\/","title":{"rendered":"H\u1eb9p van hai l\u00e1 \u0111i\u1ec1u tr\u1ecb t\u1eeb n\u1ed9i khoa \u0111\u1ebfn ngo\u1ea1i khoa"},"content":{"rendered":"

H\u1eb9p van hai l\u00e1<\/a> (HHL) v\u1eabn c\u00f2n l\u00e0 b\u1ec7nh r\u1ea5t ph\u1ed5 bi\u1ebfn \u1edf n\u01b0\u1edbc ta cho d\u00f9 t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh n\u00e0y \u0111\u00e3 gi\u1ea3m nhi\u1ec1u \u1edf c\u00e1c n\u01b0\u1edbc \u0111\u00e3 ph\u00e1t tri\u1ec3n kh\u00e1c. B\u00ecnh th\u01b0\u1eddng di\u1ec7n t\u00edch l\u1ed7 van 2 la l\u00e0 4-6 cm2<\/sup>. Khi di\u1ec7n t\u00edch l\u1ed7 van 2 l\u00e1 < 2.5cm2<\/sup>, d\u00f2ng ch\u1ea3y qua van 2 l\u00e1 b\u1ecb c\u1ea3n tr\u1edf t\u1ea1o th\u00e0nh ch\u00eanh \u00e1p qua van 2 l\u00e1 gi\u1eefa nh\u0129 tr\u00e1i v\u00e0 th\u1ea5t tr\u00e1i trong th\u1eddi k\u1ef3 t\u00e2m tr\u01b0\u01a1ng.<\/span><\/strong><\/p>\n

1.Nguy\u00ean nh\u00e2n<\/strong><\/h2>\n

Nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u l\u00e0 th\u1ea5p tim. C\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c \u00edt g\u1eb7p, bao g\u1ed3m:<\/p>\n

    \n
  • B\u1ea9m sinh: T\u1ed5n th\u01b0\u01a1ng \u0111\u01a1n \u0111\u1ed9c ho\u1eb7c ph\u1ed1i h\u1ee3p v\u1edbi th\u00f4ng li\u00ean nh\u0129 (h\u1ed9i ch\u1ee9ng Lutembacher).<\/li>\n
  • V\u00f4i h\u00f3a v\u00f2ng van hai l\u00e1. B\u1ec7nh tim carcinoid.<\/li>\n
  • Vi\u00eam van tim trong b\u1ec7nh lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng.<\/li>\n
  • B\u1ec7nh l\u1eafng \u0111\u1ecdng mucopolysaccharidoses (h\u1ed9i c h\u1ee9ng Hurler).<\/li>\n
  • X\u01a1 chun h\u00f3a n\u1ed9i t\u00e2m m\u1ea1c.<\/li>\n<\/ul>\n

    H\u1eb9p van hai l\u00e1 v\u1edbi t\u1ed5n th\u01b0\u01a1ng \u1edf 3 m\u1ee9c: D\u00e2y ch\u1eb1ng (k\u1ebft d\u00ednh, d\u00e0y l\u00ean v\u00e0 r\u00fat ng\u1eafn), l\u00e1 van (ban \u0111\u1ea7u cu\u1ed9n l\u1ea1i, sau \u0111\u00f3 d\u00e0y l\u00ean v\u00e0 cu\u1ed1i c\u00f9ng v\u00f4i h\u00f3a) v\u00e0 m\u00e9p van (d\u00ednh l\u1ea1i).<\/p>\n

    2.Sinh l\u00fd b\u1ec7nh h\u1ecdc<\/h2>\n

    T\u0103ng \u00e1p l\u1ef1c nh\u0129 tr\u00e1i \u0111\u1ec3 \u0111\u1ea9y d\u00f2ng m\u00e1u qua l\u1ed7 van b\u1ecb h\u1eb9p, g\u00e2y t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch ph\u1ed5i d\u0201n \u0111\u1ebfn kh\u00f3 th\u1edf khi g\u1eafng s\u1ee9c, ph\u00f9 ph\u1ed5i, cu\u1ed1i c\u00f9ng l\u00e0 ph\u00ec \u0111\u1ea1i v\u00e0 suy th\u1ea5t ph\u1ea3i.<\/p>\n

    Th\u1ea5t tr\u00e1i l\u00fac \u0111\u1ea7u ch\u01b0a b\u1ecb \u1ea3nh h\u01b0\u1edfng. Tuy nhi\u00ean, do gi\u1ea3m d\u00f2ng m\u00e1u \u0111\u1ed5 \u0111\u1ea7y n\u00ean cung l\u01b0\u1ee3ng tim kh\u00f4ng \u0111\u01b0\u1ee3c duy tr\u00ec, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi g\u1eafng s\u1ee9c, khi xu\u1ea5t hi\u1ec7n rung nh\u0129 m\u1edbi.<\/p>\n

    3. \u0110i\u1ec1u tr\u1ecb<\/h2>\n

    3.1 \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa<\/strong><\/h3>\n

    \u0110i\u1ec1u tr\u1ecb ph\u00f2ng th\u1ea5p th\u1ee9 ph\u00e1t .<\/p>\n

    N\u1ebfu tri\u1ec7u ch\u1ee9ng nh\u1eb9: H \u1ea1n ch\u1ebf mu\u1ed1i, l\u1ee3i ti\u1ec3u (n\u00ean th\u1eadn tr\u1ecdng). Thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng kh\u00e1ng vitamin K :<\/p>\n

      \n
    • M\u1ee5c ti\u00eau PT-INR: 2 – 3, trung b\u00ecnh 2,5<\/li>\n<\/ul>\n

      Ch\u1ec9 \u0111\u1ecbnh \u1edf b\u1ec7nh nh\u00e2n h\u1eb9p van hai l\u00e1 v\u1eeba \u0111\u1ebfn n\u1eb7ng k\u00e8m theo \u00edt nh\u1ea5t m\u1ed9t trong c\u00e1c t\u00ecnh tr\u1ea1ng sau: Rung nh\u0129, ti\u1ec1n s\u1eed huy\u1ebft kh\u1ed1i – t\u1eafc m\u1ea1ch, nh\u0129 tr\u00e1i > 50 mm ho\u1eb7c th\u1ec3 t\u00edch nh\u0129 tr\u00e1i tr\u00ean 60 mL\/m 2 , c\u00f3 huy\u1ebft kh\u1ed1i nh\u0129 tr\u00e1i.<\/p>\n

        \n
      • Ki\u1ec3m so\u00e1t nh\u1ecbp tim.<\/li>\n
      • N\u1ebfu c\u00f3 rung nh\u0129: Digoxin, ch\u1eb9n beta giao c\u1ea3m, ho\u1eb7c ch\u1eb9n k\u00eanh canxi (Verapamil ho\u1eb7c Diltiazem) \u0111\u1ec3 ki\u1ec3m so\u00e1t t\u1ea7n s\u1ed1.<\/li>\n<\/ul>\n

        3.2 \u0110i\u1ec1u tr\u1ecb can thi\u1ec7p<\/h3>\n

        Nong van hai l\u00e1 qua da ho\u1eb7c ph\u0201u thu\u1eadt thay van hai l\u00e1 ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 h\u1eb9p van hai l\u00e1 m\u1ee9c \u0111\u1ed9 trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng (di\u1ec7n t\u00edch l\u1ed7 van \u2264 1,5 cm2 ).<\/p>\n

        \"X\u1eed<\/p>\n

        X\u1eed tr\u00ed h\u1eb9p van hai l\u00e1 h\u1eadu th\u1ea5p<\/strong><\/p>\n

        3.1.1 Nong van hai l\u00e1 b\u1eb1ng b\u00f3ng qua da<\/h4>\n

        \u01afu \u0111i\u1ec3m:<\/strong><\/p>\n

          \n
        • T\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng cao, \u00edt bi\u1ebfn ch\u1ee9ng, \u00edt x\u00e2m l\u1ea5n, th\u1eddi gian n\u1eb1m vi\u1ec7n ng\u1eafn. C\u1ea3 i thi\u1ec7n \u0111\u00e1ng k\u1ec3 t\u00ecnh tr\u1ea1ng huy\u1ebft \u0111\u1ed9ng v\u00e0 di\u1ec7n t\u00edch l\u1ed7 van.<\/li>\n
        • Th\u1ef1 c hi\u1ec7n trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t: Ph\u1ee5 n\u1eef c\u00f3 thai, suy tim n\u1eb7ng, b\u1ec7nh nh\u00e2n trong t\u00ecnh tr\u1ea1ng c\u1ea5p c\u1ee9u.<\/li>\n<\/ul>\n

          \u0110\u1eb7c \u0111i\u1ec3m kh\u00f4ng thu\u1eadn l\u1ee3i cho nong van hai l\u00e1 b\u1eb1ng b\u00f3ng:<\/strong><\/p>\n

          \u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng: Tu\u1ed5i cao, ti\u1ec1n s\u1eed \u0111\u00e3 t\u1eebng s\u1eeda van hai l\u00e1, kh\u00f3 th\u1edf NYHA IV, rung nh\u0129 dai d\u1eb3ng, t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i n\u1eb7ng.<\/p>\n

          \u0110\u1eb7c \u0111i\u1ec3m gi\u1ea3i ph\u0201u: Wilkins tr\u00ean si\u00eau \u00e2m \u2265 9, di\u1ec7n t\u00edch l\u1ed7 van hai l\u00e1 r\u1ea5t nh\u1ecf, h\u1edf van ba l\u00e1 n\u1eb7ng.<\/p>\n

          Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee7a nong van hai l\u00e1 b\u1eb1ng b\u00f3ng qua da:<\/strong><\/p>\n

            \n
          • Huy\u1ebft kh\u1ed1i nh\u0129 tr\u00e1i.<\/li>\n
          • H\u1edf van hai l\u00e1 t\u1eeb m\u1ee9c \u0111\u1ed9 v\u1eeba tr\u1edf l\u00ean. V\u00f4i h\u00f3a n\u1eb7ng ho\u1eb7c v\u00f4i h\u00f3a hai m\u00e9p van. Kh\u00f4ng d\u00ednh m\u00e9p van.<\/li>\n
          • B\u1ec7nh van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 n\u1eb7ng k\u00e8m theo, ho\u1eb7c h\u1eb9p h\u1edf van ba l\u00e1 n\u1eb7ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh ph\u0201u thu\u1eadt.<\/li>\n
          • B\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh k\u00e8m theo c\u00f3 ch\u1ec9 \u0111\u1ecbnh m\u1ed5 b\u1eafc c\u1ea7u ch\u1ee7 v\u00e0nh. M\u1edbi c\u00f3 bi\u1ebfn c\u1ed1 t\u1eafc m\u1ea1ch trong v\u00f2ng 3 th\u00e1ng.<\/li>\n<\/ul>\n

            Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh t\u01b0\u01a1ng \u0111\u1ed1i: \u0110ang trong t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng ch\u01b0a kh\u1ed1ng ch\u1ebf \u0111\u01b0\u1ee3c, r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u…<\/p>\n

            Bi\u1ebfn ch\u1ee9ng sau nong van:<\/strong><\/p>\n

              \n
            • H\u1edf van hai l\u00e1 l\u00e0 bi\u1ebfn ch\u1ee9ng hay g\u1eb7p nh\u1ea5t. T\u1eafc m\u1ea1ch ph\u00eda xa, \u0111\u1eb7c bi\u1ec7t t\u1eafc m\u1ea1ch n\u00e3o.<\/li>\n
            • C\u00f2n shunt t\u1ed3n l\u01b0u sau ch\u1ecdc v\u00e1ch li\u00ean nh\u0129, th\u01b0\u1eddng s\u1ebd t\u1ef1 \u0111\u00f3ng sau 6 th\u00e1ng.<\/li>\n
            • \u00c9p tim c\u1ea5p do th\u1ee7ng th\u00e0nh nh\u0129 ho\u1eb7c th\u1ee7ng th\u00e0nh th\u1ea5t hay g\u1eb7p khi ch\u1ecdc v\u00e1ch li\u00ean nh\u0129 kh\u00f4ng ch\u00ednh x\u00e1c ho\u1eb7c khi nong b\u1eb1ng b\u00f3ng ho\u1eb7c d\u1ee5ng c\u1ee5 kim lo\u1ea1i. T\u1eed vo ng < 1% do \u00e9p tim c\u1ea5p ho\u1eb7c \u0111\u1ed9t qu\u1ef5 n\u00e3o.<\/li>\n<\/ul>\n

              Theo d\u00f5i sau th\u1ee7 thu\u1eadt<\/strong><\/p>\n

                \n
              • Sau nong van hai l\u00e1 l\u00e0m l\u1ea1i si\u00eau \u00e2m tim \u0111\u00e1nh gi\u00e1 bi\u1ebfn ch\u1ee9ng: H\u1edf van hai l\u00e1, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i, shunt t\u1ed3n l\u01b0u qua ch\u1ecdc v\u00e1ch li\u00ean nh\u0129, n\u1ebfu bi\u1ebfn ch\u1ee9ng n\u1eb7ng c\u1ea7n c\u00e2n nh\u1eafc ph\u0201u thu\u1eadt s\u1edbm.<\/li>\n
              • Theo d\u00f5i sau NVHL \u00edt nh\u1ea5t 1 n\u0103m\/l\u1ea7n, ho\u1eb7c s\u1edbm h\u01a1n n\u1ebfu c\u00f3 d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng.<\/li>\n<\/ul>\n

                3.1.2 Ph\u1eabu thu\u1eadt van hai l\u00e1 C\u00e1c ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt<\/h4>\n
                  \n
                • T\u00e1ch van k\u00edn: M \u00e9p van b\u1ecb d\u00ednh \u0111\u01b0\u1ee3c t\u00e1ch b\u1eb1ng d\u1ee5ng c\u1ee5 qua m\u1ecfm th\u1ea5t tr\u00e1i ( kh\u00f4ng c\u00f2n \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o hi\u1ec7n nay ).<\/li>\n
                • S\u1eeda van hai l\u00e1: \u00c1 p d\u1ee5ng trong h\u1eb9p van hai l\u00e1 do th\u1ea5p tim m\u00e0 t\u1ed5n th\u01b0\u01a1ng v\u00f4i h\u00f3a ch\u01b0a qu\u00e1 n\u1eb7ng, c\u00f3 th\u1ec3 d\u00f9ng nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p s\u1eeda van kh\u00e1c nhau t\u00f9y theo t\u1ed5n th\u01b0\u01a1ng.<\/li>\n<\/ul>\n

                  Thay van hai l\u00e1 n\u1ebfu kh\u00f4ng th\u1ec3 s\u1eeda: Thay van hai l \u00e1 c\u01a1 h\u1ecdc ho\u1eb7c sinh h\u1ecdc. <\/strong><\/p>\n

                  2 – 4% nguy c\u01a1 b\u1ecb c\u00e1c bi\u1ebfn c\u1ed1 t\u1eafc m\u1ea1ch ho\u1eb7c xu\u1ea5t huy\u1ebft, bao g\u1ed3m \u0111\u1ed9t qu\u1ef5 \u1edf b\u1ec7nh nh\u00e2n van hai l\u00e1 c\u01a1 h\u1ecdc (cao h\u01a1n nhi\u1ec1u \u1edf b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i), v\u00e0 m\u1ed9t t\u1ef7 l\u1ec7 nh\u1ecf ph\u0201u thu\u1eadt l\u1ea1i do r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng van.<\/p>\n

                  Van hai l \u00e1 sinh h\u1ecdc c\u00f3 \u0111\u1ed9 b\u1ec1n ph\u1ee5 thu\u1ed9c v\u00e0o tu\u1ed5i b\u1ec7nh nh\u00e2n: K ho\u1ea3ng 80% kh\u00f4ng b\u1ecb tho\u00e1i h\u00f3a van sau 10 n\u0103m \u1edf b\u1ec7nh nh\u00e2n 40 – 50 tu\u1ed5i, so v\u1edbi 90% kh\u00f4ng b\u1ecb tho\u00e1i h\u00f3a van sau 10 n\u0103m \u1edf b\u1ec7nh nh\u00e2n > 65 tu\u1ed5i.<\/p>\n

                  Ph\u0201u thu\u1eadt \u0111\u1ed1t rung nh\u0129 (ph\u0201u thu\u1eadt Maze) c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p ngay khi ti\u1ebfn h\u00e0nh m\u1ed5 thay\/s \u1eeda van hai l\u00e1.<\/p>\n

                  Nguy c\u01a1 c\u1ee7a ph\u0201u thu\u1eadt: M\u1ed9t t\u1ef7 l\u1ec7 t\u1eeb 1 – 2% b\u1ec7nh nh\u00e2n tr\u00ean 65 tu\u1ed5i t\u1eed vong ho\u1eb7c \u0111\u1ed9t qu\u1ef5 sau ph\u0201u thu\u1eadt van hai l\u00e1, ch\u1ee7 y\u1ebfu x\u1ea3y ra v\u1edbi b\u1ec7nh nh\u00e2n ch\u1ee9c n\u0103ng tim th\u1ea5p ho\u1eb7c \u0111\u1ed3ng m\u1eafc nhi\u1ec1u b\u1ec7nh n\u1eb7ng kh\u00e1c.<\/p>\n","protected":false},"excerpt":{"rendered":"

                  H\u1eb9p van hai l\u00e1 (HHL) v\u1eabn c\u00f2n l\u00e0 b\u1ec7nh r\u1ea5t ph\u1ed5 bi\u1ebfn \u1edf n\u01b0\u1edbc ta cho d\u00f9 t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh n\u00e0y \u0111\u00e3 gi\u1ea3m nhi\u1ec1u \u1edf c\u00e1c n\u01b0\u1edbc \u0111\u00e3 ph\u00e1t tri\u1ec3n kh\u00e1c. B\u00ecnh th\u01b0\u1eddng di\u1ec7n t\u00edch l\u1ed7 van 2 la l\u00e0 4-6 cm2. Khi di\u1ec7n t\u00edch l\u1ed7 van 2 l\u00e1 < 2.5cm2, d\u00f2ng ch\u1ea3y qua […]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[],"yoast_head":"\nH\u1eb9p van hai l\u00e1 \u0111i\u1ec1u tr\u1ecb t\u1eeb n\u1ed9i khoa \u0111\u1ebfn ngo\u1ea1i khoa - Vinmec<\/title>\n<meta name=\"description\" content=\"H\u1eb9p van hai l\u00e1 (HHL) v\u1eabn c\u00f2n l\u00e0 b\u1ec7nh r\u1ea5t ph\u1ed5 bi\u1ebfn \u1edf n\u01b0\u1edbc ta cho d\u00f9 t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh n\u00e0y \u0111\u00e3 gi\u1ea3m nhi\u1ec1u \u1edf c\u00e1c n\u01b0\u1edbc \u0111\u00e3 ph\u00e1t tri\u1ec3n kh\u00e1c.\" \/>\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=\"H\u1eb9p van hai l\u00e1 \u0111i\u1ec1u tr\u1ecb t\u1eeb n\u1ed9i khoa \u0111\u1ebfn ngo\u1ea1i khoa - 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