{"id":30119,"date":"2023-05-01T22:53:52","date_gmt":"2023-05-01T15:53:52","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30119"},"modified":"2023-05-01T22:53:52","modified_gmt":"2023-05-01T15:53:52","slug":"benh-co-tim-phi-dai-va-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/01\/benh-co-tim-phi-dai-va-dieu-tri\/","title":{"rendered":"B\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

B\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i<\/a> \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 s\u1ef1 t\u0103ng \u0111\u1ed9 d\u00e0y b\u1ea5t th\u01b0\u1eddng (ph\u00ec \u0111\u1ea1i) c\u1ee7a th\u00e0nh th\u1ea5t tr\u00e1i m\u00e0 kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c b\u1eb1ng c\u00e1c t\u00ecnh tr\u1ea1ng t\u0103ng g\u00e1nh huy\u1ebft \u0111\u1ed9ng, t\u1ef7 l\u1ec7 b\u1ec7nh l\u00e0 1:500 d\u00e2n. \u0110\u00e2y l\u00e0 lo\u1ea1i b\u1ec7nh l\u00fd c\u01a1 tim \u0111a d\u1ea1ng c\u1ea3 v\u1ec1 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng, c\u1ea5u tr\u00fac tim v\u00e0 di\u1ec5n bi\u1ebfn t\u1ef1 nhi\u00ean.<\/strong><\/p>\n

1.\u0110\u1ecbnh ngh\u0129a<\/h2>\n

B\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 s\u1ef1 t\u0103ng \u0111\u1ed9 d\u00e0y b\u1ea5t th\u01b0\u1eddng (ph\u00ec \u0111\u1ea1i) c\u1ee7a th\u00e0nh th\u1ea5t tr\u00e1i <\/strong>m\u00e0 kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c b\u1eb1ng c\u00e1c t\u00ecnh tr\u1ea1ng t\u0103ng g\u00e1nh huy\u1ebft \u0111\u1ed9ng, t\u1ef7 l\u1ec7 b\u1ec7nh l\u00e0 1:500 d\u00e2n. \u0110\u00e2y l\u00e0 lo\u1ea1i b\u1ec7nh l\u00fd c\u01a1 tim \u0111a d\u1ea1ng c\u1ea3 v\u1ec1 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng, c\u1ea5u tr\u00fac tim v\u00e0 di\u1ec5n bi\u1ebfn t\u1ef1 nhi\u00ean. \u0110a s\u1ed1 ng\u01b0\u1eddi m\u1eafc c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n g\u1ea7n nh\u01b0 b\u00ecnh th\u01b0\u1eddng trong su\u1ed1t cu\u1ed9c \u0111\u1eddi, tuy nhi\u00ean b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i \u0111\u01b0\u1ee3c ghi nh\u1eadn l\u00e0 nguy\u00ean nh\u00e2n \u0111\u1ed9t t\u1eed do tim li\u00ean quan \u0111\u1ebfn g\u1eafng s\u1ee9c ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf ng\u01b0\u1eddi d\u01b0\u1edbi 35 tu\u1ed5i.<\/p>\n

2. Ch\u1ea9n \u0111o\u00e1n tr\u00ean si\u00eau \u00e2m tim<\/h2>\n

Si\u00eau \u00e2m tim v\u0201n l\u00e0 th\u0103m d\u00f2 ti\u00eau chu\u1ea9n v\u00e0ng do t\u00ednh ph\u1ed5 bi\u1ebfn r\u1ed9ng r\u00e3i. Si\u00eau \u00e2m tim gi\u00fap x\u00e1c \u0111\u1ecbnh, \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 v\u00e0 v\u1ecb tr\u00ed v\u00f9ng th\u1ea5t tr\u00e1i ph\u00ec \u0111\u1ea1i c\u0169ng nh\u01b0 t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i. C\u00e1c d\u1ea5u hi\u1ec7u \u0111\u1eb7c tr\u01b0ng tr\u00ean si\u00eau \u00e2m tim bao g\u1ed3m:<\/p>\n

    \n
  • Ph\u00ec \u0111\u1ea1i l\u1ec7ch t\u00e2m \u1edf v\u00f9ng v\u00e1ch li\u00ean th\u1ea5t (> 15 mm): V\u00e1ch li\u00ean th\u1ea5t ph\u00ec \u0111\u1ea1i nhi\u1ec1u so v\u1edbi th\u00e0nh sau th\u1ea5t tr\u00e1i, gi\u1ea3m v\u1eadn \u0111\u1ed9ng v\u00e1ch li\u00ean th\u1ea5t. Tuy nhi\u00ean, b\u1ea5t k\u1ef3 ki\u1ec3u h\u00ecnh ph\u00ec \u0111\u1ea1i n\u00e0o c\u0169ng c\u00f3 th\u1ec3 g\u1eb7p.<\/li>\n
  • Bu\u1ed3ng th\u1ea5t tr\u00e1i nh\u1ecf.<\/li>\n
  • D\u1ea5u hi\u1ec7u SAM (Systolic Anterior Motion): S\u1ef1 di chuy\u1ec3n ra tr\u01b0\u1edbc c\u1ee7a van hai l\u00e1 trong th\u00ec t\u00e2m thu.<\/li>\n
  • \u0110\u00f3ng van \u0110M ch\u1ee7 gi\u1eefa t\u00e2m thu v\u00e0 rung c\u00e1nh van \u0110M ch\u1ee7.<\/li>\n<\/ul>\n

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

    B\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i<\/strong><\/p>\n

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

    Kho\u1ea3ng 50% s\u1ed1 ca b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i \u0111\u1ed9t t\u1eed x\u1ea3y ra trong ho\u1eb7c ngay sau khi g\u1eafng s\u1ee9c th\u1ec3 l\u1ef1c m\u1ea1nh. Do \u0111\u00f3, b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n tr\u00e1nh nh\u1eefng m\u00f4n th\u1ec3 thao \u0111\u1ed1i kh\u00e1ng <\/em>c\u00f3 c\u01b0\u1eddng \u0111\u1ed9 cao. \u0110i\u1ec1u tr\u1ecb b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i bao g\u1ed3m:<\/p>\n

      \n
    • Gi\u1ea3m nh\u1eb9 tri\u1ec7u ch\u1ee9ng bao g\u1ed3m g i\u1ea3i ph\u00f3ng t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i.<\/li>\n
    • \u0110i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n nh\u1ecbp.<\/li>\n
    • X\u00e1c \u0111\u1ecbnh nh \u1eef ng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 \u0111\u1ed9t t\u1eed \u0111\u1ec3 x\u00e9t ch\u1ec9 \u0111\u1ecbnh c\u1ea5y m\u00e1y ph\u00e1 rung t\u1ef1 \u0111\u1ed9ng (ICD).<\/li>\n
    • S\u00e0ng l\u1ecdc h\u1ecd h\u00e0ng b\u1eadc 1 c\u1ee7a b\u1ec7nh nh\u00e2n b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i.<\/li>\n<\/ul>\n

      3.1 \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng<\/h3>\n

      3.1.1 Thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m<\/h4>\n

      Trong b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i, thu\u1ed1c ch\u1eb9n ch\u1ecdn l\u1ecdc beta 1 giao c\u1ea3m (nebivolol, bisoprolol, metoprolol\u2026 l\u00e0 nh\u00f3m \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng \u0111au th\u1eaft ng\u1ef1c, kh\u00f3 th\u1edf, ch\u00f3ng m\u1eb7t v\u00e0 ng\u1ea5t. Nh\u00f3m thu\u1ed1c n\u00e0y l\u00e0m gi\u1ea3m nhu c\u1ea7u ti\u00eau th\u1ee5 oxy c\u1ee7a c\u01a1 tim v\u00e0 c\u1ea3i thi\u1ec7n<\/p>\n

      \u0111\u1ed5 \u0111\u1ea7y t\u00e2m tr\u01b0\u01a1ng, do \u0111\u00f3 c\u00f3 hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng \u0111au th\u1eaft ng\u1ef1c v\u00e0 kh\u00f3 th\u1edf khi g\u1eafng s\u1ee9c, tuy nhi\u00ean c\u00f3 th\u1ec3 ph\u1ea3i d\u00f9ng thu\u1ed1c v\u1edbi li\u1ec1u cao.<\/p>\n

      3.1.2 Thu\u1ed1c ch\u1eb9n k\u00eanh canxi<\/h3>\n

      C\u00e1c thu\u1ed1c ch\u1eb9n k\u00eanh canxi nh\u00f3m nondihydropyridine (verapamil v\u00e0 diltiazem) c\u00f3 hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m v\u00e0 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng dung n\u1ea1p ho\u1eb7c c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m. C\u1ea7n theo d\u00f5i s\u00e1t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i n\u1eb7ng <\/strong>(ch\u00eanh \u00e1p \u2265100 mmHg) ho\u1eb7c t\u0103ng \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i t\u00e2m thu b\u1edfi c\u00f3 th\u1ec3 g\u00e2y ph\u00f9 ph\u1ed5i.<\/strong><\/p>\n

      3.1.3 C\u00e1c thu\u1ed1c gi\u00e3n m\u1ea1ch<\/h3>\n

      N\u00ean tr\u00e1nh t\u1ed1i \u0111a c\u00f3 th\u1ec3 c\u00e1c thu\u1ed1c gi\u00e3n t\u0129nh m\u1ea1ch v\u00e0 \u0111\u1ed9ng m\u1ea1ch (bao g\u1ed3m c\u1ea3 c\u00e1c thu\u1ed1c nh\u00f3m nitrate v\u00e0 c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf phosphodiesterase) \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i c\u00f3 k\u00e8m h\u1eb9p \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i.<\/p>\n

      3.1.4 C\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u<\/h3>\n

      Thu\u1ed1c l\u1ee3i ti\u1ec3u quai v\u00e0 l\u1ee3i ti\u1ec3u nh\u00f3m thiazide c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng \u1edf b\u1ec7nh nh\u00e2n c\u00f3 h\u1eb9p \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i s\u00e1t trong tr\u01b0\u1eddng h\u1ee3p \u0111i\u1ec1u tr\u1ecb gi\u1ea3m tri\u1ec7u ch\u1ee9ng kh\u00f3 th\u1edf khi g\u1eafng s\u1ee9c.<\/p>\n

      Digoxin <\/strong>l\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh <\/strong>trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 h\u1eb9p \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i.<\/p>\n

      3.2 \u0110i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n nh\u1ecbp tim:<\/h3>\n

      Ch\u1eb9n beta giao c\u1ea3m v\u00e0 amiodarone l\u00e0 nh\u1eefng thu\u1ed1c ch\u1ed1ng r\u1ed1i lo\u1ea1n nh\u1ecbp \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn cho c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp tr\u00ean th\u1ea5t. Amiodarone c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m t\u1ea7n su\u1ea5t t\u00e1i ph\u00e1t c\u1ee7a c\u00e1c c\u01a1n nh\u1ecbp nhanh th\u1ea5t kh\u00f4ng b\u1ec1n b\u1ec9 c\u0169ng nh\u01b0 nhu c\u1ea7u c\u1eaft c\u01a1n nh\u1ecbp nhanh b\u1eb1ng m\u00e1y t\u1ea1o nh\u1ecbp.<\/p>\n

      Ki\u1ec3m so\u00e1t t\u1ea7n s\u1ed1 \u0111\u00e1p \u1ee9ng th\u1ea5t \u1edf b\u1ec7nh nh\u00e2n rung nh\u0129: D\u00f9ng thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m ho\u1eb7c thu\u1ed1c ch\u1eb9n k\u00eanh canxi nh\u00f3m non-dihydropyridine. N\u1ebfu kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c t\u1ea7n s\u1ed1 \u0111\u00e1p \u1ee9ng th\u1ea5t b\u1eb1ng thu\u1ed1c, c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc ch\u1ec9 \u0111\u1ecbnh tri\u1ec7t \u0111\u1ed1t n\u00fat nh\u0129 th\u1ea5t v\u00e0 c\u1ea5y m\u00e1y t\u1ea1o nh\u1ecbp.<\/p>\n

      \u0110i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng huy\u1ebft kh\u1ed1i t\u01b0\u01a1ng t\u1ef1 nh\u01b0 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p rung nh\u0129 kh\u00e1c.<\/p>\n

      3.3 Gi\u1ea3i ph\u00f3ng t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i<\/h3>\n

      T\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c, ph\u0201u thu\u1eadt ho\u1eb7c can thi\u1ec7p l\u00e0m m\u1ecfng v\u00e1ch li\u00ean th\u1ea5t b\u1eb1ng ti\u00eam c\u1ed3n.<\/p>\n

      \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa: <\/strong>C\u00e1c thu\u1ed1c \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn g\u1ed3m ch\u1eb9n beta giao c\u1ea3m v\u00e0 verapamil. C\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh th\u00eam d isopyramide, m\u1ed9t thu\u1ed1c inotrope \u00e2m t\u00ednh \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ch\u00eanh \u00e1p l\u1edbn qua \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i g\u00e2y tri\u1ec7u ch\u1ee9ng.<\/p>\n

      Ph\u1eabu thu\u1eadt c\u1eaft g\u1ecdt v\u00e1ch li\u00ean th\u1ea5t: <\/strong>Ph\u0201u thu\u1eadt c\u1eaft g\u1ecdt v\u00e1ch li\u00ean th\u1ea5t (ph\u0201u thu\u1eadt Morrow) tr\u1ef1c ti\u1ebfp l\u00e0m m\u1ecfng \u0111o\u1ea1n g\u1ea7n c\u1ee7a v\u00e1ch li\u00ean th\u1ea5t. Ph\u0201u thu\u1eadt n\u00e0y c\u00f3 nguy c\u01a1 g\u00e2y block nh\u0129 th\u1ea5t \u0111\u1ed9 cao ph\u1ea3i c\u1ea5y m\u00e1y t\u1ea1o nh\u1ecbp v\u0129nh vi\u1ec5n, v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng m\u1ea1n t\u00ednh nh\u01b0 h\u1edf ch\u1ee7.<\/p>\n

      Can thi\u1ec7p l\u00e0m m\u1ecfng v\u00e1ch li\u00ean th\u1ea5t b\u1eb1ng c\u1ed3n: <\/strong>G \u00e2y nh\u1ed3i m\u00e1u c\u01a1 tim t\u1ea1i \u0111o\u1ea1n g\u1ea7n c\u1ee7a v\u00e1ch li\u00ean th\u1ea5t b\u1eb1ng c\u00e1ch ti\u00eam c\u1ed3n v\u00e0o nh\u00e1nh v\u00e1ch th\u1ee9 nh\u1ea5t ho\u1eb7c th\u1ee9 hai c\u1ee7a \u0111\u1ed9ng m\u1ea1ch li\u00ean th\u1ea5t tr\u01b0\u1edbc. Ban \u0111\u1ea7u, th\u1ee7 thu\u1eadt n\u00e0y cho k\u1ebft qu\u1ea3 r\u1ea5t h\u1ee9a h\u1eb9n; tuy nhi\u00ean m\u1ed9t t\u1ef7 l\u1ec7 \u0111\u00e1ng k\u1ec3 (20 – 25%) b\u1ec7nh nh\u00e2n b\u1ecb block nh\u0129 th\u1ea5t ho\u00e0n to\u00e0n v\u00e0 ph\u1ea3i c\u1ea5y m\u00e1y t\u1ea1o nh\u1ecbp v\u0129nh vi\u1ec5n. Ngo\u00e0i ra, v\u1ea5n \u0111\u1ec1 li\u00ean quan \u0111\u1ebfn th\u1ee7 thu\u1eadt n\u00e0y c\u00f2n c\u00f3 nh\u1eefng \u1ea3nh h\u01b0\u1edfng l\u00e2u d\u00e0i do nh\u1ed3i m\u00e1u c\u01a1 tim, \u0111\u1eb7c bi\u1ec7t l\u00e0 qu\u00e1 tr\u00ecnh t\u00e1i c\u1ea5u tr\u00fac th\u1ea5t tr\u00e1i v\u00e0 nguy c\u01a1 r\u1ed1i lo\u1ea1n nh\u1ecbp nguy hi\u1ec3m.<\/p>\n

      C\u1ea5y m\u00e1y t\u1ea1o nh\u1ecbp: <\/strong>C\u1ea5y m\u00e1y t\u1ea1o nh\u1ecbp 2 bu\u1ed3ng v\u1edbi th\u1eddi gian d\u0201n truy\u1ec1n nh\u0129 th\u1ea5t ng\u1eafn cho th\u1ea5y c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng c\u0169ng nh\u01b0 ch\u00eanh \u00e1p \u1edf m\u1ed9t nh\u00f3m nh\u1ecf c\u00e1c b\u1ec7nh nh\u00e2n.<\/p>\n

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

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