{"id":29843,"date":"2023-04-30T20:44:58","date_gmt":"2023-04-30T13:44:58","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29843"},"modified":"2023-04-30T20:44:58","modified_gmt":"2023-04-30T13:44:58","slug":"ho-van-hai-la-va-dieu-tri-noi-ngoai-khoa","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/30\/ho-van-hai-la-va-dieu-tri-noi-ngoai-khoa\/","title":{"rendered":"H\u1edf van hai l\u00e1 v\u00e0 \u0111i\u1ec1u tr\u1ecb n\u1ed9i, ngo\u1ea1i khoa"},"content":{"rendered":"

H\u1edf van hai l\u00e1 c\u1ea5p<\/a>\u00a0lu\u00f4n c\u00f3 nh\u1eefng tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng n\u1eb7ng n\u1ec1. Kh\u00e1m l\u00e2m s\u00e0ng \u1edf m\u1ecfm tim th\u01b0\u1eddng d\u1ec5 b\u1ecf s\u00f3t, do th\u1ea5t tr\u00e1i v\u1edbi k\u00edch th\u01b0\u1edbc b\u00ecnh th\u01b0\u1eddng kh\u00f4ng h\u1ec1 g\u00e2y m\u1ecfm tim \u0111\u1eadp t\u0103ng \u0111\u1ed9ng. Ti\u1ebfng th\u1ed5i t\u00e2m thu do h\u1edf van hai l\u00e1 c\u1ea5p t\u00ednh nhi\u1ec1u khi kh\u00f4ng k\u00e9o d\u00e0i h\u1ebft th\u00ec t\u00e2m thu th\u1eadm ch\u00ed c\u00f3 l\u00fac kh\u00f4ng nghe th\u1ea5y. Si\u00eau \u00e2m tim qua th\u00e0nh ng\u1ef1c gi\u00fap ch\u1ea9n \u0111o\u00e1n m\u1ee9c \u0111\u1ed9 h\u1edf van hai l\u00e1, c\u01a1 ch\u1ebf h\u1edf van, \u0111a\u0301nh gia\u0301 ch\u01b0\u0301c na\u0306ng th\u1ea5t tr\u00e1i, ch\u01b0\u0301c na\u0306ng th\u1ea5t ph\u1ea3i v\u00e0 a\u0301p l\u01b0\u0323c \u0111\u1ecd\u0302ng ma\u0323ch ph\u00f4\u0309i\u2026.<\/strong><\/p>\n

1.Nguy\u00ean nh\u00e2n<\/strong><\/h2>\n
    \n
  • Sau nh\u1ed3i m\u00e1u c\u01a1 tim<\/li>\n
  • Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n Sau th\u1ee7 thu\u1eadt nong van hai l\u00e1 \u0110\u1ee9t d\u00e2y ch\u1eb1ng do tho\u00e1i h\u00f3a.<\/li>\n<\/ul>\n

    2.Ch\u1ea9n \u0111o\u00e1n v\u00e0 theo d\u00f5i Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng:<\/h2>\n

    Th\u01b0\u1eddng n\u1eb7ng n\u1ec1, bi\u1ec3u hi\u1ec7n b\u1eb1ng tri\u1ec7u ch\u1ee9ng suy tim c\u1ea5p, kh\u00f3 th\u1edf: H\u1edf van hai l\u00e1 c\u1ea5p g\u00e2y t\u0103ng \u0111\u1ed9t ng\u1ed9t th\u1ec3 t\u00edch nh\u0129 tr\u00e1i, khi\u1ebfn \u00e1p l\u1ef1c nh\u0129 tr\u00e1i t\u0103ng nhanh d\u0201n \u0111\u1ebfn sung huy\u1ebft ph\u1ed5i.<\/p>\n

    Ph\u00f9 ph\u1ed5i c\u1ea5p c\u00f3 th\u1ec3 g\u1eb7p khi\u1ebfn cho b\u1ec7nh c\u1ea3nh c\u00e0ng th\u00eam n\u1eb7ng n\u1ec1. Th\u00eam v\u00e0o \u0111\u00f3, do d\u00f2ng m\u00e1u ph\u1ee5t ng\u01b0\u1ee3c tr\u1edf v\u1ec1 nh\u0129 tr\u00e1i th\u00f4ng qua d\u00f2ng h\u1edf van hai l\u00e1 khi\u1ebfn cho cung l\u01b0\u1ee3ng tim b\u1ecb gi\u1ea3m \u0111\u1ed9t ng\u1ed9t, l\u01b0u l\u01b0\u1ee3ng m\u00e1u qua van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 gi\u1ea3m, t\u01b0\u1edbi m\u00e1u ngo\u1ea1i bi\u00ean gi\u1ea3m d\u0201n \u0111\u1ebfn t\u1ee5t huy\u1ebft \u00e1p, th\u1eadm ch\u00ed s\u1ed1c tim.<\/p>\n

    Kh\u00e1m l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n ti\u1ebfng th\u1ed5i t\u00e2m thu \u1edf m\u1ecfm tim, lan ra n\u00e1ch, tuy nhi\u00ean ti\u1ebfng th\u1ed5i c\u00f3 th\u1ec3 nh\u1ecf, kh\u00f4ng r\u00f5 r\u00e0ng do s\u1ef1 b\u1ea5t t\u01b0\u01a1ng \u0111\u1ed3ng gi\u1eefa \u00e1p l\u1ef1c nh\u0129 tr\u00e1i t\u0103ng nhanh v\u00e0 \u00e1p l\u1ef1c th\u1ea5t tr\u00e1i ch\u01b0a thay \u0111\u1ed5i khi\u1ebfn cho ch\u00eanh \u00e1p qua van hai l\u00e1 kh\u00f4ng l\u1edbn. Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 ti\u1ebfng th\u1ed5i t\u00e2m thu do \u00e1p l\u1ef1c gi\u1eefa nh\u0129 tr\u00e1i v\u00e0 th\u1ea5t tr\u00e1i l\u00e0 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nhau.<\/p>\n

    \"H\u1edf<\/p>\n

    H\u1edf van hai l\u00e1 c\u1ea5p<\/strong><\/p>\n

    2.1 Si\u00eau \u00e2m tim qua th\u00e0nh ng\u1ef1c:<\/h3>\n

    Vai tr\u00f2 quan tr\u1ecdng trong ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh , \u0111\u1ed3ng th\u1eddi gi\u00fap \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i, th\u1ea5t ph\u1ea3i, \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i v\u00e0 c\u01a1 ch\u1ebf h\u1edf van hai l\u00e1.<\/p>\n

    Gi\u00fap x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n g\u00e2y h\u1edf van hai l\u00e1 c\u1ea5p nh\u01b0 t\u00ecnh tr\u1ea1ng vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n, r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng v\u00f9ng do nh\u1ed3i m\u00e1u c\u01a1 tim, \u0111\u1ee9t c\u00e1c d\u00e2y ch\u1eb1ng van tim do tho\u00e1i h\u00f3a…<\/p>\n

    Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p nh\u01b0 d\u00f2ng h\u1edf van tim l\u1ec7ch t\u00e2m v\u00e0 h\u1eb9p van tim k\u00e8m theo, si\u00eau \u00e2m tim qua th\u00e0nh ng\u1ef1c c\u00f3 th\u1ec3 g\u1eb7p kh\u00f3 kh\u0103n trong x\u00e1c \u0111\u1ecbnh c\u01a1 ch\u1ebf c\u0169ng nh\u01b0 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a h\u1edf van, si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n c\u00f3 th\u1ec3 h\u1eefu \u00edch \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh v\u00e0 ch\u1ea9n \u0111o\u00e1n c\u01a1 ch\u1ebf h\u1edf van.<\/p>\n

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

    3.1 \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa<\/h3>\n
      \n
    • C\u00e1c thu\u1ed1c gi\u00e3n m\u1ea1ch nh\u01b0 nitroglycerin ho\u1eb7c nitroprusside \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch: Vai tr\u00f2 quan tr\u1ecdng trong \u0111i\u1ec1u tr\u1ecb trong pha c\u1ea5p. C\u00e1c thu\u1ed1c gi\u00e3n m\u1ea1ch l\u00e0m gi\u1ea3m kh\u00e1ng tr\u1edf d\u00f2ng \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, gi\u00fap t\u0103ng l\u01b0u l\u01b0\u1ee3ng qua van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng qua d\u00f2ng h\u1edf van l\u00ean nh\u0129 tr\u00e1i, do \u0111\u00f3 c\u1ea3i thi\u1ec7n cung l\u01b0\u1ee3ng tim, gi\u1ea3m \u00e1p l\u1ef1c nh\u0129 tr\u00e1i. Tuy nhi\u00ean s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c gi\u00e3n m\u1ea1ch b\u1ecb h\u1ea1n ch\u1ebf b\u1edfi ph\u1ee5 thu\u1ed9c huy\u1ebft \u00e1p h\u1ec7 th\u1ed1ng. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p t\u1ee5t huy\u1ebft \u00e1p ho\u1eb7c s\u1ed1c tim.<\/li>\n
    • B\u01a1m b\u00f3ng \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ng\u01b0\u1ee3c d\u00f2ng (IABP) c\u0169ng c\u00f3 th\u1ec3 h\u1eefu \u00edch \u0111\u1ed1i v\u1edbi nh\u1eefng tr\u01b0\u1eddng h\u1ee3p h\u1edf 2 l\u00e1 n\u1eb7ng do l\u00e0m gi\u1ea3m h\u1eadu g\u00e1nh th\u1ea5t tr\u00e1i, t\u0103ng \u00e1p l\u1ef1c cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng v\u00e0 h\u1ed7 tr\u1ee3 tu\u1ea7n ho\u00e0n h\u1ec7 th\u1ed1ng.<\/li>\n
    • C\u00e1c nh\u00f3m thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u00fap gi\u1ea3m sung huy\u1ebft ph\u1ed5i, gi\u1ea3m tri\u1ec7u ch\u1ee9ng kh\u00f3 th\u1edf v\u00e0 suy tim c\u1ea5p.<\/li>\n
    • C\u00f3 th\u1ec3 c\u1ea7n c\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch h\u1ed7 tr\u1ee3 trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p huy\u1ebft \u00e1p th\u1ea5p ho\u1eb7c s\u1ed1c tim.<\/li>\n
    • Ti\u00ean l\u01b0\u1ee3ng c\u1ee7a b\u1ec7nh nh\u00e2n h\u1edf van hai l\u00e1 th\u1ee9 ph\u00e1t do b\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 x\u1ea5u h\u01a1n \u0111\u00e1ng k\u1ec3 so v\u1edbi ti\u00ean l\u01b0\u01a1\u0323ng cu\u0309a b\u1ec7nh nh\u00e2n h\u1edf van hai l\u00e1 th\u01b0\u0301 pha\u0301t do nguy\u00ean nh\u00e2n kh\u00e1c.<\/li>\n
    • B\u00ean c\u1ea1nh si\u00eau \u00e2m tim gi\u00fap x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n v\u00e0 \u0111\u1ed9 n\u1eb7ng h\u1edf van, m\u1ee9c \u0111\u1ed9 r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng v\u00f9ng v\u00e0 ch\u1ee9c n\u0103ng to\u00e0n b\u1ed9 th\u1ea5t tr\u00e1i, c\u00e1c ph\u01b0\u01a1ng ti\u1ec7n c\u1eadn l\u00e2m s\u00e0ng kh\u00e1c gi\u00fap kh\u1ea3o s\u00e1t nguy\u00ean nh\u00e2n v\u00e0 \u0111\u00e1nh gi\u00e1 s\u1ed1ng c\u00f2n c\u01a1 tim nh\u01b0: si\u00eau \u00e2m tim g\u1eafng s\u1ee9c, MRI tim, MSCT m\u1ea1ch v\u00e0nh, th\u00f4ng tim v\u00e0 ch\u1ee5p m\u1ea1ch v\u00e0nh ca\u0309n quan<\/li>\n<\/ul>\n

      3.2 \u0110i\u1ec1u tr\u1ecb ngo\u1ea1i khoa<\/h3>\n

      Ph\u0201u thu\u1eadt van hai l\u00e1 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ed1i v\u1edbi nh\u1eefng tr\u01b0\u1eddng h\u1ee3p h\u1edf van hai l\u00e1 nguy\u00ean ph\u00e1t c\u1ea5p m\u1ee9c \u0111\u1ed9 n\u1eb7ng v\u00e0 c\u00f3 tri\u1ec7u ch\u1ee9ng. Th\u00f4ng th\u01b0\u1eddng m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a h\u1edf van hai l\u00e1 c\u1ea5p kh\u00e1 thay \u0111\u1ed5i, tuy nhi\u00ean nh\u1eefng tr\u01b0\u1eddng h\u1ee3p h\u1edf van hai l\u00e1 c\u1ea5p m\u1ee9c \u0111\u1ed9 v\u1eeba th\u01b0\u1eddng c\u00f3 th\u1ec3 th\u00edch nghi b\u1eb1ng c\u00e1ch gi\u00e3n c\u00e1c bu\u1ed3ng th\u1ea5t tr\u00e1i v\u00e0 suy tim c\u00f3 t\u0103ng cung l\u01b0\u1ee3ng tim.<\/p>\n

      H\u1edf van hai l\u00e1 c\u1ea5p m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u00f3 tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng kh\u00f3 th\u00edch nghi v\u00e0 c\u1ea7n can thi\u1ec7p s\u1edbm \u0111\u1ec3 gi\u1ea3m tri\u1ec7u ch\u1ee9ng.<\/p>\n

      \u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng c\u01a1 nh\u00fa, d\u00e2y ch\u1eb1ng c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc s\u1eeda ch\u1eefa van tim \u01b0u ti\u00ean h\u01a1n so v\u1edbi thay van tim. Nh\u1eefng t\u1ed5n th\u01b0\u01a1ng nhi\u1ec5m khu\u1ea9n t\u1ea1i h\u1ec7 th\u1ed1ng van v\u00e0 d\u01b0\u1edbi van c\u1ea7n c\u00e2n nh\u1eafc thay van tim nh\u00e2n t\u1ea1o .<\/p>\n

      Th\u1eddi \u0111i\u1ec3m ph\u0201u thu\u1eadt ph\u1ee5 thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng v\u00e0 nguy\u00ean nh\u00e2n g\u00e2y h\u1edf van tim c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

      Khuy\u00ea\u0301n ca\u0301o can thi\u00ea\u0323p trong h\u1edf van hai l\u00e1 th\u1ee9 ph\u00e1t (theo ACC\/AHA 2020).<\/p>\n\n\n\n\n\n
      Nh\u00f3m<\/strong><\/td>\n\u00a0\u00a0\u00a0\u00a0 Khuy\u1ebfn c\u00e1o<\/strong><\/td>\n<\/tr>\n
      2a<\/td>\n1.\u00a0\u00a0\u00a0\u00a0\u00a0 Ph\u00e2\u0303u thu\u1ea1\u0302t van hai la\u0301 la\u0300 h\u01a1\u0323p ly\u0301 \u01a1\u0309 b\u1eb9\u0302nh nha\u0302n h\u01a1\u0309 van hai la\u0301 th\u01b0\u0301 pha\u0301t n\u1ea1\u0306ng (giai \u0111o\u1ea1n C, D) c\u00e2\u0300n ph\u1eabu thu\u1eadt b\u0103\u0301c c\u00e2\u0300u n\u00f4\u0301i chu\u0309-va\u0300nh \u0111\u00ea\u0309 \u0111i\u00ea\u0300u tri\u0323 thi\u00ea\u0301u ma\u0301u cu\u0323c b\u00f4\u0323 tim.2.\u00a0\u00a0\u00a0\u00a0\u00a0 \u01a0\u0309 b\u1eb9\u0302nh nha\u0302n co\u0301 h\u01a1\u0309 van hai la\u0301 th\u01b0\u0301 pha\u0301t n\u1ea1\u0306ng do r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i (PSTM <50%) v\u00e2\u0303n co\u0300n tri\u1eb9\u0302u ch\u01b0\u0301ng m\u1ea1\u0306c du\u0300 \u0111a\u0303 \u0111i\u00ea\u0300u tri\u0323 n\u1ecd\u0302i khoa t\u00f4\u0301i u\u031bu, xem xe\u0301t can thi\u1eb9\u0302p ke\u0323p van hai l\u00e1 qua da n\u1ebfu h\u00ecnh th\u00e1i van tr\u00ean si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n ph\u00f9 h\u1ee3p (PSTM 20-50%, LVESD \u2264 70 mm, PASP \u2264 70 mmHg).<\/td>\n<\/tr>\n
      2b<\/td>\n1.\u00a0\u00a0\u00a0\u00a0\u00a0 Co\u0301 th\u00ea\u0309 xem xe\u0301t ph\u00e2\u0303u thu\u1ea1\u0302t van hai la\u0301 \u01a1\u0309 b\u1eb9\u0302nh nha\u0302n co\u0301 h\u01a1\u0309 van hai la\u0301 th\u01b0\u0301 pha\u0301t n\u1ea1\u0306ng do d\u00e3n nh\u0129 tr\u00e1i c\u00f3 ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i b\u1ea3o t\u1ed3n (PSTM \u226550%) v\u00e2\u0303n co\u0300n tri\u1eb9\u0302u ch\u01b0\u0301ng m\u1ea1\u0306c du\u0300 \u0111a\u0303 \u0111i\u00ea\u0300u tri\u0323 n\u1ecd\u0302i khoa t\u00f4\u0301i u\u031bu suy tim, rung nh\u0129 v\u00e0 c\u00e1c b\u1ec7nh l\u00fd k\u1ebft h\u1ee3p kh\u00e1c.2.\u00a0\u00a0\u00a0\u00a0\u00a0 Co\u0301 th\u00ea\u0309 xem xe\u0301t ph\u00e2\u0303u thu\u1ea1\u0302t van hai la\u0301 \u01a1\u0309 b\u1eb9\u0302nh nha\u0302n co\u0301 h\u01a1\u0309 van hai la\u0301 th\u01b0\u0301 pha\u0301t n\u1ea1\u0306ng do r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i (PSTM <50%) v\u00e2\u0303n co\u0300n tri\u1eb9\u0302u ch\u01b0\u0301ng m\u1ea1\u0306c du\u0300 \u0111a\u0303 \u0111i\u00ea\u0300u tri\u0323 n\u1ecd\u0302i khoa t\u00f4\u0301i u\u031bu suy tim.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

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

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