{"id":30001,"date":"2023-05-01T22:56:10","date_gmt":"2023-05-01T15:56:10","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30001"},"modified":"2023-05-01T22:56:10","modified_gmt":"2023-05-01T15:56:10","slug":"van-tim-nhan-tao-va-luu-y-trong-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/01\/van-tim-nhan-tao-va-luu-y-trong-dieu-tri\/","title":{"rendered":"Van tim nh\u00e2n t\u1ea1o v\u00e0 l\u01b0u \u00fd trong \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

Van tim nh\u00e2n t\u1ea1o<\/a> l\u00e0 m\u1ed9t thi\u1ebft b\u1ecb y t\u1ebf \u0111\u01b0\u1ee3c c\u1ea5y gh\u00e9p v\u00e0o trong c\u01a1 th\u1ec3 \u0111\u1ec3 thay th\u1ebf van tim b\u1ecb h\u1ecfng. Van tim nh\u00e2n t\u1ea1o gi\u00fap duy tr\u00ec l\u01b0u l\u01b0\u1ee3ng m\u00e1u v\u00e0 \u0111\u1ea3m b\u1ea3o ho\u1ea1t \u0111\u1ed9ng c\u1ee7a tim. Thi\u1ebft b\u1ecb n\u00e0y \u0111\u00e3 gi\u00fap nhi\u1ec1u b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 s\u1ed1ng s\u00f3t v\u00e0 kh\u00f4i ph\u1ee5c s\u1ee9c kh\u1ecfe sau khi ph\u1eabu thu\u1eadt thay van tim.<\/strong><\/p>\n

1.C\u00e1c d\u1ea1ng van nh\u00e2n t\u1ea1o<\/h2>\n

Van c\u01a1 h\u1ecdc<\/em><\/strong>: Ph\u1ed5 bi\u1ebfn nh\u1ea5t hi\u1ec7n nay l\u00e0 d\u1ea1ng van hai c\u00e1nh (St Jude Medical, Carbomedic). Ngo\u00e0i ra c\u00f2n c\u00f3 d\u1ea1ng van bi l\u1ed3ng (Starr-Edwards) ho\u1eb7c van \u0111\u0129a (Medtronic Hall)<\/p>\n

Van sinh h\u1ecdc<\/em><\/strong>: Van tim l\u1ee3n c\u00f3 gi\u00e1 \u0111\u1ee1 hay kh\u00f4ng c\u00f3 gi\u00e1 \u0111\u1ee1 (Van Porcine) ho\u1eb7c van c\u1ea5u t\u1ea1o t\u1eeb m\u00e0ng tim b\u00f2 (Carpentier- Edwards).<\/p>\n

Van ng\u01b0\u1eddi: <\/em><\/strong>Van ng\u01b0\u1eddi t\u1eeb ng\u01b0\u1eddi hi\u1ebfn t\u1ea1ng \u0111\u01b0\u1ee3c b\u1ea3o qu\u1ea3n, van t\u1ef1 th\u00e2n (van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i – ph\u0201u thu\u1eadt Ross).<\/p>\n

\"Van<\/p>\n

Van tim nh\u00e2n t\u1ea1o<\/strong><\/p>\n

1.1 Van c\u01a1 h\u1ecdc<\/h3>\n

Nguy c\u01a1 h\u1ecfng c\u1ea5u tr\u00fac van l\u00e0 r\u1ea5t nh\u1ecf. Nguy c\u01a1 ph\u0201u thu\u1eadt l\u1ea1i kh\u00f4ng do h\u1ecfng c\u1ea5u tr\u00fac van kho\u1ea3ng 5% su\u1ed1t \u0111\u1eddi k\u1ec3 t\u1eeb l\u00fac thay van.<\/p>\n

Nguy c\u01a1 g\u00e2y huy\u1ebft kh\u1ed1i, do v\u1eady y\u00eau c\u1ea7u d\u00f9ng ch\u1ed1ng \u0111\u00f4ng kh\u00e1ng vitamin K su\u1ed1t \u0111\u1eddi v\u00e0 c\u00f3 th\u1ec3 ph\u1ea3i d\u00f9ng th\u00eam aspirin n\u1ebfu nguy c\u01a1 huy\u1ebft kh\u1ed1i cao. Th\u1eadm ch\u00ed v\u1edbi PT-INR \u0111\u1ea1t \u0111\u00edch \u0111i\u1ec1u tr\u1ecb, v\u0201n c\u00f3 t\u1ef7 l\u1ec7 kho\u1ea3ng 2 – 4% h\u00e0ng n\u0103m, c\u00f3 nguy c\u01a1 b\u1ecb huy\u1ebft kh\u1ed1i ho\u1eb7c xu\u1ea5t huy\u1ebft bao g\u1ed3m c\u1ea3 \u0111\u1ed9t qu\u1ef5 n\u00e3o.<\/p>\n

1.2 Van sinh h\u1ecdc<\/h3>\n

Van nh\u00e2n t\u1ea1o sinh h\u1ecdc ho\u1eb7c van ng\u01b0\u1eddi kh\u00f4ng y\u00eau c\u1ea7u ch\u1ed1ng \u0111\u00f4ng nh\u01b0ng kh\u00f4ng b\u1ec1n nh\u01b0 van c\u01a1 h\u1ecdc. T\u1ef7 l\u1ec7 b\u1ecb suy ch\u1ee9c n\u0103ng van, h\u1ecfng van sau 15 n\u0103m l\u00e0 5 – 20%. T\u1ef7 l\u1ec7 n\u00e0y ph\u1ee5 thu\u1ed9c \u0111\u1ed9 tu\u1ed5i b\u1ec7nh nh\u00e2n, b\u1ec1n nh\u1ea5t \u1edf ng\u01b0\u1eddi gi\u00e0.<\/p>\n

Nguy c\u01a1 huy\u1ebft kh\u1ed1i h\u00e0ng n\u0103m l\u00e0 0,5%. Van sinh h\u1ecdc hay b\u1ecb ch\u00eanh \u00e1p cao qua van sau ph\u0201u thu\u1eadt nhi\u1ec1u h\u01a1n van c\u01a1 h\u1ecdc \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng van k\u00edch th\u01b0\u1edbc nh\u1ecf.<\/p>\n

C\u00e1c lo\u1ea1i van nh\u00e2n t\u1ea1o kh\u00e1c nhau c\u00f3 c\u1ea5u t\u1ea1o ri\u00eang bi\u1ec7t v\u00e0 di\u1ec7n t\u00edch l\u1ed7 hi\u1ec7u d\u1ee5ng kh\u00e1c nhau.<\/p>\n

2. M\u1ee5c ti\u00eau PT-INR<\/strong><\/h2>\n

\u00a0M\u1ee5c ti\u00eau PT-INR trong van c\u01a1 h\u1ecdc<\/strong><\/p>\n\n\n\n\n\n\n\n
\u00a0<\/strong><\/p>\n

Nguy c\u01a1 huy\u1ebft kh\u1ed1i van c\u01a1 h\u1ecdc<\/strong><\/td>\n

Y\u1ebfu t\u1ed1 nguy c\u01a1 li\u00ean quan \u0111\u1ebfn b\u1ec7nh nh\u00e2n<\/strong><\/td>\n<\/tr>\n
Kh\u00f4ng<\/strong><\/td>\n\u22651 y\u1ebfu t\u1ed1<\/strong><\/td>\n<\/tr>\n
\u00a0<\/strong><\/p>\n

Th\u1ea5p<\/strong><\/td>\n

\u00a0<\/strong><\/p>\n

2,5<\/td>\n

\u00a0<\/strong><\/p>\n

3,0<\/td>\n<\/tr>\n

\u00a0<\/strong><\/p>\n

Trung b\u00ecnh<\/strong><\/td>\n

\u00a0<\/strong><\/p>\n

3,0<\/td>\n

\u00a0<\/strong><\/p>\n

3,5<\/td>\n<\/tr>\n

\u00a0<\/strong><\/p>\n

Cao<\/strong><\/td>\n

\u00a0<\/strong><\/p>\n

3,5<\/td>\n

\u00a0<\/strong><\/p>\n

4,0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Y\u1ebfu t\u1ed1 nguy c\u01a1 li\u00ean quan \u0111\u1ebfn b\u1ec7nh nh\u00e2n: Van hai l\u00e1, van ba l\u00e1 c\u01a1 h\u1ecdc, ti\u1ec1n s\u1eed huy\u1ebft kh\u1ed1i, thuy\u00ean t\u1eafc, rung nh\u0129, h\u1eb9p van hai l\u00e1 c\u00e1c m\u1ee9c \u0111\u1ed9, LVEF < 35%.<\/em><\/p>\n

Nguy c\u01a1 huy\u1ebft kh\u1ed1i th\u1ea5p: Van Carbomedics, Medtronic Hall, ATS, Medtronic Open-Pivot, St Jude Medical, On-X, Sorin Bicarbon.<\/em><\/p>\n

Nguy c\u01a1 huy\u1ebft kh\u1ed1i trung b\u00ecnh: Nh\u1eefng van hai c\u00e1nh kh\u00e1c ch\u01b0a \u0111\u1ee7 d\u1eef li\u1ec7u nghi\u00ean c\u1ee9u. Nguy c\u01a1 huy\u1ebft kh\u1ed1i cao: Van Lillehei-Kaster, Omniscience, Starr-Edwards Bjork-Shiley.<\/em><\/p>\n

\u00a03. <\/em>X\u1eed tr\u00ed qu\u00e1 m\u1ee9c ch\u1ed1ng \u0111\u00f4ng v\u00e0 ch\u1ea3y m\u00e1u li\u00ean quan \u0111\u1ebfn thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng kh\u00e1ng Vitamin K (VKA)<\/strong><\/h2>\n

Thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng kh\u00e1ng Vitamin K gi\u00fap duy tr\u00ec ho\u1ea1t \u0111\u1ed9ng c\u1ee7a van tim nh\u00e2n t\u1ea1o, v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c duy tr\u00ec \u1edf m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb m\u1ed9t c\u00e1ch \u1ed5n \u0111\u1ecbnh. Khi ch\u1ec9 s\u1ed1 PT-INR t\u0103ng cao > 6,0 th\u01b0\u1eddng l\u00e0m t\u0103ng cao t\u1ef7 l\u1ec7 xu\u1ea5t huy\u1ebft v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i s\u00e1t.<\/p>\n

Nguy\u00ean t\u1eafc c\u01a1 b\u1ea3n trong x\u1eed tr\u00ed bao g\u1ed3m \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng ch\u1ea3y m\u00e1u n\u1ebfu c\u00f3, v\u00e0 \u0111\u00e1nh gi\u00e1 c\u00e2n b\u1eb1ng gi\u1eefa nguy c\u01a1 xu\u1ea5t huy\u1ebft v\u00e0 nguy c\u01a1 huy\u1ebft kh\u1ed1i c\u00f3 th\u1ec3 g\u00e2y k\u1eb9t van c\u01a1 h\u1ecdc ho\u1eb7c c\u00e1c bi\u1ebfn ch\u1ee9ng kh\u00e1c li\u00ean quan \u0111\u1ebfn huy\u1ebft kh\u1ed1i.<\/p>\n

3.1 N\u1ebfu \u0111ang c\u00f3 ch\u1ea3y m\u00e1u<\/h3>\n

C\u1ea7n \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng m\u1ee9c \u0111\u1ed9 ch\u1ea3y m\u00e1u, v\u1ecb tr\u00ed ch\u1ea3y m\u00e1u v\u00e0 nguy c\u01a1 t\u00e1i ph\u00e1t. \u0110\u1ed1i v\u1edbi nh\u1eefng ch\u1ea3y m\u00e1u n\u1eb7ng, \u0111e d\u1ecda t\u00ednh m\u1ea1ng (v\u00ed d\u1ee5: Ch\u1ea3y m\u00e1u n\u00e3o, xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a n\u1eb7ng) c\u1ea7n ph\u1ea3i c\u00f3 th\u00e1i \u0111\u1ed9 x\u1eed tr\u00ed c\u1ea5p c\u1ee9u<\/p>\n

C\u1ea7n ng\u1eebng VKA:<\/strong><\/p>\n

    \n
  • Li\u1ec1u 5 – 10 mg Vitamin K1 \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch (\u0111\u1ec3 tr\u00e1nh nguy c\u01a1 ph\u1ea3n v\u1ec7, n\u00ean pha lo\u00e3ng trong kho\u1ea3ng 50 mL NaCl 0,9% ho\u1eb7c Glucose 5% v\u00e0 truy\u1ec1n TM ch\u1eadm trong \u00edt nh\u1ea5t 20 ph\u00fat).<\/li>\n
  • Truy\u1ec1n t\u0129nh m\u1ea1ch 2 – 4 \u0111\u01a1n v\u1ecb huy\u1ebft t\u01b0\u01a1ng t\u01b0\u01a1i \u0111\u00f4ng l\u1ea1nh c\u00f9ng nh\u00f3m.<\/strong><\/li>\n
  • Ki\u1ec3m tra PT-INR <\/strong>h\u00e0ng ng\u00e0y cho \u0111\u1ebfn khi ng\u1eebng ch\u1ea3y m\u00e1u.<\/li>\n<\/ul>\n

    Trong tr\u01b0\u1eddng h\u1ee3p xu\u1ea5t huy\u1ebft nhi\u1ec1u v\u00e0 \u1ed3 \u1ea1t, c\u1ea7n thi\u1ebft l\u1eadp \u0111\u01b0\u1eddng truy\u1ec1n trung t\u00e2m, \u0111\u1ea3m b\u1ea3o huy\u1ebft \u0111\u1ed9ng. Truy\u1ec1n b\u1ed5 sung h\u1ed3ng c\u1ea7u. Ti\u1ebfn h\u00e0nh c\u00e1c bi\u1ec7n ph\u00e1p c\u1ea7m m\u00e1u n\u1ebfu c\u00f3 th\u1ec3 (N\u1ed9i soi d\u1ea1 d\u00e0y c\u1ea7m mau…).<\/p>\n

    Th\u1eddi \u0111i\u1ec3m s\u1eed d\u1ee5ng l\u1ea1i thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng sau xu\u1ea5t huy\u1ebft n\u1eb7ng ch\u01b0a c\u00f3 khuy\u1ebfn c\u00e1o c\u1ee5 th\u1ec3 m\u00e0 ph\u1ee5 thu\u1ed9c v\u00e0o nguy c\u01a1 t\u00e1i ph\u00e1t, v\u1ecb tr\u00ed xu\u1ea5t huy\u1ebft, nguy\u00ean nh\u00e2n g\u00e2y xu\u1ea5t huy\u1ebft c\u0169ng nh\u01b0 nguy c\u01a1 huy\u1ebft kh\u1ed1i.<\/p>\n

    3.2 N\u1ebfu kh\u00f4ng c\u00f3 ch\u1ea3y m\u00e1u<\/h3>\n
      \n
    • PT-INR <6,0: T\u1ea1m ng\u1eebng VKA trong 1 – 2 ng\u00e0y. Sau \u0111\u00f3 b\u1eaft \u0111\u1ea7u l\u1ea1i v\u1edbi li\u1ec1u th\u1ea5p h\u01a1n.<\/li>\n
    • PT-INR: 6 – 10: T\u1ea1m ng\u1eebng VKA \u00edt nh\u1ea5t 1 – 2 ng\u00e0y. C\u00f3 th\u1ec3 cho Vitamin K \u0111\u01b0\u1eddng u\u1ed1ng 1 – 2,5 mg n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 ch\u1ea3y m\u00e1u cao. U\u1ed1ng l\u1ea1i VKA v\u1edbi li\u1ec1u th\u1ea5p h\u01a1n khi th\u1ea5y PT-INR v\u1ec1 kho\u1ea3ng m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng.<\/li>\n
    • PT-INR > 10 T\u1ea1m ng\u1eebng thu\u1ed1c VKA v\u00e0i ng\u00e0y. C\u00f3 th\u1ec3 cho Vitamin K \u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c ti\u00eam Vitamin K1 t\u0129nh m\u1ea1ch 1 – 2,5 mg n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 ch\u1ea3y m\u00e1u cao. U\u1ed1ng l\u1ea1i VKA v\u1edbi li\u1ec1u th\u1ea5p h\u01a1n khi PT-INR v\u1ec1 kho\u1ea3ng m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng.<\/li>\n<\/ul>\n

      L\u01b0u \u00fd<\/u><\/em>: \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n mang van tim nh\u00e2n t\u1ea1o, n\u00ean tr\u00e1nh d\u00f9ng Vitamin K1 \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch tr\u1eeb khi \u0111ang c\u00f3 xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd \u0111e d\u1ecda t\u00ednh m\u1ea1ng, v\u00ec Vitamin K1 l\u00e0m t\u0103ng nguy c\u01a1 huy\u1ebft kh\u1ed1i van nh\u00e2n t\u1ea1o sau \u0111\u00f3. Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, n\u00ean d\u00f9ng huy\u1ebft t\u01b0\u01a1ng t\u01b0\u01a1i \u0111\u00f4ng l\u1ea1nh.<\/em><\/p>\n

      3.3 \u0110i\u1ec1u ch\u1ec9nh thu\u1ed1c VKA \u1edf van nh\u00e2n t\u1ea1o c\u01a1 h\u1ecdc quanh ph\u1eabu thu\u1eadt\/th\u1ee7 thu\u1eadt c\u00f3 chu\u1ea9n b\u1ecb<\/h3>\n

      Ph\u0201u thu\u1eadt\/th\u1ee7 thu\u1eadt nh\u1ecf, nguy c\u01a1 ch\u1ea3y m\u00e1u th\u1ea5p ho\u1eb7c d\u1ec5 ki\u1ec3m so\u00e1t (V\u00ed d\u1ee5: Nh\u1ed5 r\u0103ng, thay th\u1ee7y tinh th\u1ec3), kh\u00f4ng khuy\u1ebfn c\u00e1o d\u1eebng VKA quanh ph\u0201u thu\u1eadt\/th\u1ee7 thu\u1eadt.<\/p>\n

      V\u1edbi ph\u0201u thu\u1eadt l\u1edbn y\u00eau c\u1ea7u PT-INR < 1,5. D\u1eebng VKA tr\u01b0\u1edbc ph\u0201u thu\u1eadt, b\u1eafc c\u1ea7u b\u1eb1ng UFH (APTTs 1,5 – 2,0) ho\u1eb7c LMWH (anti-Xa 0,8 – 1,2).<\/p>\n","protected":false},"excerpt":{"rendered":"

      Van tim nh\u00e2n t\u1ea1o l\u00e0 m\u1ed9t thi\u1ebft b\u1ecb y t\u1ebf \u0111\u01b0\u1ee3c c\u1ea5y gh\u00e9p v\u00e0o trong c\u01a1 th\u1ec3 \u0111\u1ec3 thay th\u1ebf van tim b\u1ecb h\u1ecfng. Van tim nh\u00e2n t\u1ea1o gi\u00fap duy tr\u00ec l\u01b0u l\u01b0\u1ee3ng m\u00e1u v\u00e0 \u0111\u1ea3m b\u1ea3o ho\u1ea1t \u0111\u1ed9ng c\u1ee7a tim. Thi\u1ebft b\u1ecb n\u00e0y \u0111\u00e3 gi\u00fap nhi\u1ec1u b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 s\u1ed1ng s\u00f3t v\u00e0 kh\u00f4i […]<\/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":"\nVan tim nh\u00e2n t\u1ea1o v\u00e0 l\u01b0u \u00fd trong \u0111i\u1ec1u tr\u1ecb - Vinmec<\/title>\n<meta name=\"description\" content=\"Van tim nh\u00e2n t\u1ea1o \u0111\u01b0\u1ee3c c\u1ea5y gh\u00e9p v\u00e0o trong c\u01a1 th\u1ec3 \u0111\u1ec3 thay th\u1ebf van tim b\u1ecb h\u1ecfng, gi\u00fap duy tr\u00ec l\u01b0u l\u01b0\u1ee3ng m\u00e1u v\u00e0 \u0111\u1ea3m b\u1ea3o ho\u1ea1t \u0111\u1ed9ng c\u1ee7a 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=\"Van tim nh\u00e2n t\u1ea1o v\u00e0 l\u01b0u \u00fd trong \u0111i\u1ec1u tr\u1ecb - 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