{"id":29987,"date":"2023-05-01T22:51:02","date_gmt":"2023-05-01T15:51:02","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29987"},"modified":"2023-05-01T22:51:02","modified_gmt":"2023-05-01T15:51:02","slug":"benh-van-dong-mach-phoi","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/01\/benh-van-dong-mach-phoi\/","title":{"rendered":"B\u1ec7nh van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng"},"content":{"rendered":"

B\u1ec7nh van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i<\/a> l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd tim m\u1ea1ch nguy hi\u1ec3m, khi\u1ebfn cho van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i b\u1ecb suy tho\u00e1i v\u00e0 kh\u00f4ng th\u1ec3 ho\u1ea1t \u0111\u1ed9ng b\u00ecnh th\u01b0\u1eddng. B\u1ec7nh n\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn suy tim, \u0111\u1ed9t qu\u1ef5 ho\u1eb7c th\u1eadm ch\u00ed t\u1eed vong. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n b\u1ec7nh van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i kh\u00e1 kh\u00f3 kh\u0103n v\u00e0 th\u01b0\u1eddng \u0111\u00f2i h\u1ecfi nhi\u1ec1u b\u01b0\u1edbc ki\u1ec3m tra v\u00e0 x\u00e9t nghi\u1ec7m.<\/strong><\/p>\n

\"B\u1ec7nh<\/p>\n

B\u1ec7nh van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i<\/strong><\/p>\n

1.H\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i<\/h2>\n

1.1 Nguy\u00ean nh\u00e2n<\/strong><\/h3>\n

B\u1ea9m sinh (h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p), carcinoid, th\u1ea5p tim, ho\u1eb7c do ch\u00e8n \u00e9p.<\/p>\n

1.2 Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng<\/h3>\n

H\u1ea7u nh\u01b0 kh\u00f4ng c\u00f3. N\u1ebfu h\u1eb9p van n\u1eb7ng k\u00e9o d\u00e0i c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n kh\u00f3 th\u1edf khi g\u1eafng s\u1ee9c, \u0111au \u0111\u1ea7u, ng\u1ea5t (do kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng t\u0103ng cung l\u01b0\u1ee3ng tim). Cu\u1ed1i c\u00f9ng c\u00f3 th\u1ec3 g\u00e2y tri\u1ec7u ch\u1ee9ng h\u1edf van ba l\u00e1 do suy th\u1ea5t ph\u1ea3i.<\/p>\n

1.2 Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3<\/h3>\n

S\u00f3ng \u2018a’ n\u1ed5i tr\u1ed9i trong s\u00f3ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1ea3nh, th\u1ea5t ph\u1ea3i. \u0110\u00f4i khi c\u00f3 rung \u1edf khoang li\u00ean s\u01b0\u1eddn 2 tr\u00e1i. Nghe ti\u1ebfng T2 t\u00e1ch \u0111\u00f4i (do van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u0111\u00f3ng mu\u1ed9n h\u01a1n), ti\u1ebfng \u0111\u00f3ng van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u00eam d\u1ecbu h\u01a1n (ngo\u1ea1i tr\u1eeb h\u1eb9p tr\u00ean van), ti\u1ebfng th\u1ed5i t\u00e2m thu t\u1ed1ng m\u00e1u nghe \u0111\u01b0\u1ee3c b\u1edd tr\u00ean x\u01b0\u01a1ng \u1ee9c b\u00ean tr\u00e1i, r\u00f5 nh\u1ea5t th\u00ec h\u00edt v\u00e0o.<\/p>\n

1.3.C\u1eadn l\u00e2m s\u00e0ng<\/h3>\n
    \n
  • \u0110i\u1ec7n t\u00e2m \u0111\u1ed3: <\/strong>D\u00e0y th\u1ea5t ph\u1ea3i v\u00e0 gi\u00e3n nh\u0129 ph\u1ea3i.<\/li>\n
  • X-quang ng\u1ef1c th\u1eb3ng: <\/strong>\u0110\u1ed9ng m\u1ea1ch ph\u1ed5i gi\u00e3n, \u0111\u00f4i khi c\u00f3 v\u00f4i ho\u00e1 van, n\u1ebfu n\u1eb7ng g\u00e2y gi\u1ea3m t\u01b0\u1edbi m\u00e1u ph\u1ed5i.<\/li>\n
  • Si\u00eau \u00e2m tim: <\/strong>X\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111\u00e1nh gi\u00e1 v\u1ecb tr\u00ed h\u1eb9p (t\u1ea1i van, tr\u00ean van ho\u1eb7c \u0111\u01b0\u1eddng ra th\u1ea5t ph\u1ea3i) v\u00e0 m\u1ee9c \u0111\u1ed9 h\u1eb9p. H\u1eb9p van \u0110M ph\u1ed5i n\u1eb7ng: v\u1eadn t\u1ed1c d\u00f2ng ch\u1ea3y qua v\u1ecb tr\u00ed h\u1eb9p >4 m\/s ho\u1eb7c ch\u00eanh \u00e1p t\u1ed1i \u0111a > 60 mmHg. C\u00f3 th\u1ec3 ph\u1ed1i h\u1ee3p v\u1edbi t\u1ed5n th\u01b0\u01a1ng kh\u00e1c nh\u01b0 th\u00f4ng li\u00ean nh\u0129, c\u00f2n \u1ed1ng \u0111\u1ed9ng m\u1ea1ch, Fallot.<\/li>\n
  • Th\u00f4ng tim: <\/strong>\u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 t\u1eafc ngh\u1ebdn v\u00e0 \u1ea3nh h\u01b0\u1edfng huy\u1ebft \u0111\u1ed9ng.<\/li>\n<\/ul>\n

    1.4.\u0110i\u1ec1u tr\u1ecb<\/strong><\/h3>\n
      \n
    • \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa v\u1edbi h\u1ed7 tr\u1ee3 gi\u1ea3m tri\u1ec7u ch\u1ee9ng suy th\u1ea5t ph\u1ea3i bao g\u1ed3m l\u1ee3i ti\u1ec3u, h\u1ea1n ch\u1ebf d\u1ecbch.<\/li>\n
    • Can thi\u1ec7p x\u00e2m l\u1ea5n \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o khi:<\/li>\n
    • Ch\u00eanh \u00e1p trung b\u00ecnh qua van tr\u00ean > 64 mmHg tr\u00ean si\u00eau \u00e2m tim ho\u1eb7c >40 mmHg khi ngh\u1ec9 (tr\u00ean th\u00f4ng tim)<\/li>\n
    • H\u1eb9p van \u0110MP v\u1eeba – n\u1eb7ng c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a h\u1eb9p van \u0110MP ho\u1eb7c suy th\u1ea5t ph\u1ea3i.<\/li>\n
    • Nong van b\u1eb1ng b\u00f3ng l\u00e0 l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb n\u1ebfu h\u1eb9p t\u1ea1i van, hi\u1ec7u qu\u1ea3 cao, an to\u00e0n, k\u1ebft qu\u1ea3 l\u00e2u d\u00e0i t\u1ed1t; h\u1edf van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i kh\u00e1 ph\u1ed5 bi\u1ebfn sau nong van nh\u01b0ng hi\u1ebfm khi g\u00e2y h\u1eadu qu\u1ea3 l\u00e2m s\u00e0ng nghi\u00eam tr\u1ecdng.<\/li>\n
    • Ph\u0201u thu\u1eadt s\u1eeda van th\u01b0\u1eddng c\u00f3 hi\u1ec7u qu\u1ea3 v\u1edbi t\u1ef7 l\u1ec7 t\u00e1i ph\u00e1t th\u1ea5p. Thay van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh n\u1ebfu kh\u00f4ng th\u00edch h\u1ee3p v\u1edbi c\u00e1c \u0111i\u1ec1u tr\u1ecb tr\u00ean ho\u1eb7c h\u1edf van \u0110M ph\u1ed5i nghi\u00eam tr\u1ecdng sau s\u1eeda van.<\/li>\n<\/ul>\n

      2. H\u1edf van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i<\/h2>\n

      2.1 Nguy\u00ean nh\u00e2n<\/strong><\/h3>\n

      B\u1ea5t k\u1ef3 nguy\u00ean nh\u00e2n n\u00e0o c\u1ee7a t\u0103ng \u00e1p l\u1ef1c m\u1ea1ch ph\u1ed5i (g\u00e2y gi\u00e3n v\u00f2ng van), vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n, b\u1ec7nh m\u00f4 li\u00ean k\u1ebft (b\u1ec7nh Marfan), do th\u1ee7 thu\u1eadt (sau nong van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i qua da), carcinoid.<\/p>\n

      2.2 \u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng<\/h3>\n

      Tri\u1ec7u ch\u1ee9ng xu\u1ea5t hi\u1ec7n khi t\u0103ng \u00e1p l\u1ef1c m\u1ea1ch ph\u1ed5i ho\u1eb7c suy th\u1ea5t ph\u1ea3i g\u1ed3m kh\u00f3 th\u1edf khi g\u1eafng s\u1ee9c, ph\u00f9 ngo\u1ea1i vi, \u0111au b\u1ee5ng, l\u01a1 m\u01a1.<\/p>\n

      2.3 Kh\u00e1m l\u00e2m s\u00e0ng<\/h3>\n

      Th\u1ea5t ph\u1ea3i l\u1edbn, \u0111\u00f4i khi c\u00f3 rung miu v\u00f9ng van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i. Nghe ti\u1ebfng T2 \u0111\u1ebfn mu\u1ed9n, m\u1ea1nh (khi c\u00f3 t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i) ho\u1eb7c \u00eam (khi c\u00f3 h\u1eb9p van ph\u1ed5i). Ti\u1ebfng th\u1ed5i c\u1ee7a h\u1edf van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i nghe r\u00f5 nh\u1ea5t khoang li\u00ean s\u01b0\u1eddn 3 – 4 b\u00ean tr\u00e1i x\u01b0\u01a1ng \u1ee9c, trong th\u00ec h\u00edt v\u00e0o.<\/p>\n

      2.4 C\u1eadn l\u00e2m s\u00e0ng<\/h3>\n
        \n
      • \u0110i\u1ec7n t\u00e2m \u0111\u1ed3: <\/strong>D\u00e0y th\u1ea5t ph\u1ea3i (n\u1ebfu c\u00f3 t\u0103ng \u00e1p l\u1ef1c m\u1ea1ch ph\u1ed5i), block nh\u00e1nh ph\u1ea3i\/ d\u1ea1ng rsR \u1edf V1.<\/li>\n
      • X-quang ng\u1ef1c: <\/strong>\u0110\u1ed9ng m\u1ea1ch ph\u1ed5i v\u00e0 th\u1ea5t ph\u1ea3i l\u1edbn.<\/li>\n
      • Si\u00eau \u00e2m tim: <\/strong>Si\u00eau \u00e2m 2D cho th\u1ea5y gi\u00e3n, ph\u00ec \u0111\u1ea1i th\u1ea5t ph\u1ea3i. V\u00e1ch li\u00ean th\u1ea5t di \u0111\u1ed9ng ngh\u1ecbch th\u01b0\u1eddng n\u1ebfu qu\u00e1 t\u1ea3i th\u1ec3 t\u00edch th\u1ea5t ph\u1ea3i. H\u1edf \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u00f3 th\u1ec3 th\u1ea5y \u0111\u01b0\u1ee3c b\u1eb1ng Doppler m\u00e0u v\u00e0 \u0111\u1ecbnh l\u01b0\u1ee3ng Doppler xung. H\u1edf van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i n\u1eb7ng v\u1edbi d\u00f2ng m\u00e0u tr\u00e0o ng\u01b0\u1ee3c l\u1ea5p \u0111\u1ea7y \u0111\u01b0\u1eddng ra th\u1ea5t ph\u1ea3i.<\/li>\n<\/ul>\n

        2.5 \u0110i\u1ec1u tr\u1ecb<\/h3>\n
          \n
        • \u0110i\u1ec1u tr\u1ecb suy tim ph\u1ea3i theo ph\u00e1c \u0111\u1ed3 th\u00f4ng th\u01b0\u1eddng.<\/li>\n
        • N\u1ebfu h\u1edf van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i do gi\u00e3n v\u00f2ng van th\u1ee9 ph\u00e1t do t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, \u0111i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a h\u1edf van \u0110M ph\u1ed5i (v\u00ed d\u1ee5 ph\u0201u thu\u1eadt thay van hai l\u00e1).<\/li>\n
        • N\u1ebfu c\u00f3 tri\u1ec7u ch\u1ee9ng suy th\u1ea5t ph\u1ea3i v\u1edbi h\u1edf van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i n\u1eb7ng, thay van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc. Ch\u1ec9 \u0111\u1ecbnh thay van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng c\u00f2n ch\u01b0a r\u00f5 r\u00e0ng.<\/li>\n<\/ul>\n

          3. T\u1ed5ng k\u1ebft<\/h2>\n

          B\u1ec7nh van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd tim m\u1ea1ch nguy hi\u1ec3m, khi\u1ebfn cho van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i b\u1ecb suy tho\u00e1i v\u00e0 kh\u00f4ng th\u1ec3 ho\u1ea1t \u0111\u1ed9ng b\u00ecnh th\u01b0\u1eddng. \u0110\u00e2y l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd kh\u00f3 ch\u1ea9n \u0111o\u00e1n v\u00e0 th\u01b0\u1eddng c\u1ea7n nhi\u1ec1u b\u01b0\u1edbc ki\u1ec3m tra v\u00e0 x\u00e9t nghi\u1ec7m \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c.<\/p>\n

          C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i bao g\u1ed3m kh\u00f3 th\u1edf, m\u1ec7t m\u1ecfi, \u0111au th\u1eaft ng\u1ef1c, ho\u1eb7c ng\u1ea5t x\u1ec9u. \u0110\u1ec3 ch\u1ea9n \u0111o\u00e1n b\u1ec7nh, c\u00e1c b\u00e1c s\u0129 th\u01b0\u1eddng s\u1eed d\u1ee5ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p nh\u01b0 si\u00eau \u00e2m tim, ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh (CT) ho\u1eb7c c\u1ed9ng h\u01b0\u1edfng t\u1eeb h\u1ea1t nh\u00e2n (MRI). Ngo\u00e0i ra, x\u00e9t nghi\u1ec7m m\u00e1u c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 suy gi\u1ea3m c\u1ee7a van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.<\/p>\n

          \u0110i\u1ec1u tr\u1ecb cho b\u1ec7nh van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh. Tuy nhi\u00ean, trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng, ph\u1eabu thu\u1eadt thay van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i ho\u1eb7c ph\u1eabu thu\u1eadt gh\u00e9p van c\u00f3 th\u1ec3 c\u1ea7n thi\u1ebft. C\u00e1c nghi\u00ean c\u1ee9u khoa h\u1ecdc \u0111\u00e3 ch\u1ee9ng minh r\u1eb1ng b\u1ec7nh van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u00f3 li\u00ean quan \u0111\u1ebfn nhi\u1ec1u y\u1ebfu t\u1ed1 nh\u01b0 di truy\u1ec1n, m\u00f4i tr\u01b0\u1eddng s\u1ed1ng v\u00e0 l\u1ed1i s\u1ed1ng kh\u00f4ng l\u00e0nh m\u1ea1nh. Hi\u1ec3u r\u00f5 v\u1ec1 b\u1ec7nh van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i s\u1ebd gi\u00fap ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh k\u1ecbp th\u1eddi, t\u1eeb \u0111\u00f3 gi\u1ea3m thi\u1ec3u nguy c\u01a1 c\u00e1c bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m.<\/p>\n

          T\u00f3m l\u1ea1i, b\u1ec7nh van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd tim m\u1ea1ch nguy hi\u1ec3m, \u0111\u00f2i h\u1ecfi s\u1ef1 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi \u0111\u1ec3 gi\u1ea3m thi\u1ec3u c\u00e1c bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m.<\/p>\n","protected":false},"excerpt":{"rendered":"

          B\u1ec7nh van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd tim m\u1ea1ch nguy hi\u1ec3m, khi\u1ebfn cho van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i b\u1ecb suy tho\u00e1i v\u00e0 kh\u00f4ng th\u1ec3 ho\u1ea1t \u0111\u1ed9ng b\u00ecnh th\u01b0\u1eddng. B\u1ec7nh n\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn suy tim, \u0111\u1ed9t qu\u1ef5 ho\u1eb7c th\u1eadm ch\u00ed t\u1eed vong. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n b\u1ec7nh van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i kh\u00e1 kh\u00f3 kh\u0103n […]<\/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":"\nB\u1ec7nh van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u1ec7nh van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd tim m\u1ea1ch nguy hi\u1ec3m, khi\u1ebfn cho van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i b\u1ecb suy tho\u00e1i v\u00e0 kh\u00f4ng th\u1ec3 ho\u1ea1t \u0111\u1ed9ng b\u00ecnh th\u01b0\u1eddng.\" \/>\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=\"B\u1ec7nh van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng - 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