{"id":30202,"date":"2023-05-01T22:47:12","date_gmt":"2023-05-01T15:47:12","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30202"},"modified":"2023-05-01T22:47:12","modified_gmt":"2023-05-01T15:47:12","slug":"benh-mang-ngoai-tim-tai-phat-va-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/01\/benh-mang-ngoai-tim-tai-phat-va-dieu-tri\/","title":{"rendered":"B\u1ec7nh m\u00e0ng ngo\u00e0i tim t\u00e1i ph\u00e1t v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

B\u1ec7nh m\u00e0ng ngo\u00e0i tim<\/a> bao g\u1ed3m nhi\u1ec1u h\u00ecnh th\u00e1i l\u00e2m s\u00e0ng kh\u00e1c nhau, c\u00f3 th\u1ec3 l\u00e0 b\u1ec7nh l\u00fd \u0111\u01a1n \u0111\u1ed9c c\u1ee7a m\u00e0ng ngo\u00e0i tim ho\u1eb7c n\u1eb1m trong b\u1ec7nh c\u1ea3nh c\u1ee7a b\u1ec7nh l\u00fd to\u00e0n th\u00e2n.<\/strong><\/p>\n

1.B\u1ec7nh m\u00e0ng ngo\u00e0i tim<\/h2>\n

B\u1ec7nh l\u00fd m\u00e0ng ngo\u00e0i tim bao g\u1ed3m nhi\u1ec1u h\u00ecnh th\u00e1i l\u00e2m s\u00e0ng kh\u00e1c nhau, c\u00f3 th\u1ec3 l\u00e0 b\u1ec7nh l\u00fd \u0111\u01a1n \u0111\u1ed9c c\u1ee7a m\u00e0ng ngo\u00e0i tim ho\u1eb7c n\u1eb1m trong b\u1ec7nh c\u1ea3nh c\u1ee7a b\u1ec7nh l\u00fd to\u00e0n th\u00e2n.<\/p>\n

Vi\u00eam m\u00e0ng ngo\u00e0i tim <\/strong>l\u00e0 b\u1ec7nh l\u00fd m\u00e0ng ngo\u00e0i tim hay g\u1eb7p nh\u1ea5t tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng, chi\u1ebfm kho\u1ea3ng 0,1% t\u1ed5ng s\u1ed1 b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n v\u00e0 kho\u1ea3ng 5% trong t\u1ed5ng s\u1ed1 b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n c\u1ea5p c\u1ee9u v\u00ec \u0111au ng\u1ef1c. Nam gi\u1edbi \u0111\u1ed9 tu\u1ed5i t\u1eeb 16 \u0111\u1ebfn 65 c\u00f3 nguy c\u01a1 m\u1eafc vi\u00eam m\u00e0ng ngo\u00e0i tim cao h\u01a1n so v\u1edbi n\u1eef gi\u1edbi c\u00f9ng \u0111\u1ed9 tu\u1ed5i v\u00e0 so v\u1edbi qu\u1ea7n th\u1ec3 n\u00f3i chung.<\/p>\n

C\u00e1c h\u1ed9i ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p <\/strong>trong b\u1ec7nh l\u00fd m\u00e0ng ngo\u00e0i tim: Ph\u1ea3n \u1ee9ng c\u1ee7a m\u00e0ng ngo\u00e0i tim v\u1edbi c\u00e1c qu\u00e1 tr\u00ecnh b\u1ec7nh l\u00fd kh\u00e1c nhau c\u00f3 th\u1ec3 chia l\u00e0m 4 h\u00ecnh th\u00e1i l\u00e2m s\u00e0ng ch\u00ednh:<\/p>\n

    \n
  • Vi\u00eam m\u00e0ng ngo\u00e0i tim (c\u1ea5p, b\u00e1n c\u1ea5p, m\u1ea1n t\u00ednh v\u00e0 t\u00e1i ph\u00e1t). Tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim.<\/li>\n
  • \u00c9p tim.<\/li>\n
  • Vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft.<\/li>\n<\/ul>\n

    2. Nguy\u00ean nh\u00e2n<\/h2>\n

    C\u00f3 nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau. Do \u0111\u00f3 vi\u1ec7c ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n c\u1ea7n d\u1ef1a v\u00e0o b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng, c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m v\u1ec1 d\u00e2n s\u1ed1 v\u00e0 d\u1ecbch t\u1ec5 h\u1ecdc.<\/p>\n

    C\u00e1ch ti\u1ebfp c\u1eadn \u0111\u01a1n gi\u1ea3n nh\u1ea5t l\u00e0 b\u1ec7nh m\u00e0ng ngo\u00e0i tim do nhi\u1ec5m tr\u00f9ng v\u00e0 b\u1ec7nh m\u00e0ng ngo\u00e0i tim kh\u00f4ng do nhi\u1ec5m tr\u00f9ng. T\u1ea1i c\u00e1c n\u01b0\u1edbc ph\u00e1t tri\u1ec3n, nguy\u00ean nh\u00e2n\u00a0 do nhi\u1ec5m tr\u00f9ng hay g\u1eb7p nh\u1ea5t l\u00e0 do virus<\/strong>, trong khi \u1edf c\u00e1c n\u01b0\u1edbc \u0111ang ph\u00e1t tri\u1ec3n, th\u01b0\u1eddng g\u1eb7p l\u00e0 do vi khu\u1ea9n lao.<\/strong><\/p>\n

    C\u00e1c nguy\u00ean nh\u00e2n tim kh\u00f4ng do nhi\u1ec5m tr\u00f9ng th\u01b0\u1eddng g\u1eb7p l\u00e0: Ung th\u01b0, b\u1ec7nh t\u1ef1 mi\u1ec5n, b\u1ec7nh m\u00e0ng ngo\u00e0i tim do t\u0103ng ure m\u00e1u, nh\u1ed3i m\u00e1u c\u01a1 tim.<\/p>\n

    2.1 Nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh m\u00e0ng ngo\u00e0i tim do nhi\u1ec5m tr\u00f9ng<\/h3>\n

    2.1.1 Vi khu\u1ea9n<\/strong><\/h4>\n

    C\u00e1c vi khu\u1ea9n hay g\u1eb7p bao g\u1ed3m: Lao, li\u00ean c\u1ea7u, ph\u1ebf c\u1ea7u, t\u1ee5 c\u1ea7u, l\u1eadu c\u1ea7u, n\u00e3o m\u00f4 c\u1ea7u, Mycoplasma, Chlamydia, Legionella, Leptospira, Haemophilus.<\/p>\n

    2.1.2 Virus<\/h4>\n

    C\u00e1c Virus\u00a0 th\u01b0\u1eddng g\u1eb7p g\u1ed3m: Enterovirus (Coxsackie virus, Echovirus), Herpes virus (EBV, CMV, HHV-6), Adenovirus, Parvovirus…<\/p>\n

    2.1.3 N\u1ea5m<\/h4>\n

    Do n\u1ea5m r\u1ea5t hi\u1ebfm g\u1eb7p, th\u01b0\u1eddng ch\u1ec9 g\u1eb7p \u1edf \u0111\u1ed1i t\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch. C\u00e1c lo\u1ea1i n\u1ea5m th\u01b0\u1eddng g\u00e2y b\u1ec7nh\u00a0 g\u1ed3m: Histoplasma, Aspergillus, Blastomyces, Candida…<\/p>\n

    2.1.4 K\u00fd sinh tr\u00f9ng<\/h4>\n

    R\u1ea5t hi\u1ebfm g\u1eb7p, c\u00e1c lo\u1ea1i k\u00fd sinh tr\u00f9ng g\u00e2y b\u1ec7nh m\u00e0ng tim hay g\u1eb7p nh\u01b0: Echinococcus,Toxoplasma, Am\u00edp<\/p>\n

    2.2 Nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh m\u00e0ng ngo\u00e0i tim kh\u00f4ng do nhi\u1ec5m tr\u00f9ng<\/h3>\n

    2.2.1 B\u1ec7nh l\u00fd t\u1ef1 mi\u1ec5n<\/strong><\/h4>\n

    B\u1ec7nh l\u00fd \u0111\u00e1p \u1ee9ng vi\u00eam h\u1ec7 th\u1ed1ng <\/strong>: Lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng, vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p, x\u01a1 c\u1ee9ng b\u00ec, vi\u00eam da c\u01a1…<\/p>\n

    Vi\u00eam m\u1ea1ch h\u1ec7 th\u1ed1ng <\/strong>: B\u1ec7nh Horton (vi\u00eam \u0111\u1ed9ng m\u1ea1ch to\u00e0n th\u00e2n, ch\u1ee7 y\u1ebfu bi\u1ec3u hi\u1ec7n \u1edf \u0111\u1ed9ng m\u1ea1ch th\u00e1i d\u01b0\u01a1ng n\u00f4ng), B\u1ec7nh Takayasu (vi\u00eam \u0111\u1ed9ng m\u1ea1ch l\u1edbn v\u00e0 v\u1eeba, g\u00e2y h\u1eb9p t\u1eafc v\u00e0 ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch), H\u1ed9i ch\u1ee9ng Behcet (g\u00e2y vi\u00eam to\u00e0n b\u1ed9 h\u1ec7 th\u1ed1ng m\u1ea1ch m\u00e1u trong c\u01a1 th\u1ec3, ch\u1ee7 y\u1ebfu l\u00e0 t\u0129nh m\u1ea1ch, th\u01b0\u1eddng g\u00e2y t\u1ed5n th\u01b0\u01a1ng m\u1eaft v\u00e0 lo\u00e9t ni\u00eam m\u1ea1c)…<\/p>\n

    B\u1ec7nh l\u00fd t\u1ef1 mi\u1ec5n kh\u00e1c <\/strong>: B\u1ec7nh sarcoidosis, s\u1ed1t \u0110\u1ecba Trung H\u1ea3i c\u00f3 t\u00ednh ch\u1ea5t gia \u0111\u00ecnh, b\u1ec7nh Still (bi\u1ec3u hi\u1ec7n b\u1eb1ng s\u1ed1t k\u00e9o d\u00e0i, vi\u00eam kh\u1edbp v\u00e0 ph\u00e1t ban)…<\/p>\n

    2.2.2 B\u1ec7nh l\u00fd \u00e1c t\u00ednh<\/h4>\n

    Ung th\u01b0 nguy\u00ean ph\u00e1t <\/strong>(Ung th\u01b0 t\u1ea1i m\u00e0ng ngo\u00e0i tim): Hi\u1ebfm g\u1eb7p, hay g\u1eb7p nh\u1ea5t l\u00e0 ung<\/p>\n

    th\u01b0 trung bi\u1ec3u m\u00f4 m\u00e0ng ngo\u00e0i tim, sarcoma, fibroma, lipoma.<\/p>\n

    Ung th\u01b0 th\u1ee9 ph\u00e1t <\/strong>(Ung th\u01b0 t\u1eeb c\u01a1 quan kh\u00e1c di c\u0103n \u0111\u1ebfn m\u00e0ng tim): Hay g\u1eb7p h\u01a1n, th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 ung th\u01b0 ph\u1ed5i, ung th\u01b0 v\u00fa, lymphoma, l\u01a1 x\u00ea mi,…<\/p>\n

    3.B\u1ec7nh m\u00e0ng ngo\u00e0i tim t\u00e1i ph\u00e1t<\/h2>\n

    Ch\u1ea9n \u0111o\u00e1n n\u1ebfu b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc \u0111\u00e2y \u0111\u00e3 t\u1eebng vi\u00eam m\u00e0ng ngo\u00e0i tim c\u1ea5p, \u0111\u00e3 h\u1ebft tri\u1ec7u ch\u1ee9ng trong v\u00f2ng 4 – 6 tu\u1ea7n ho\u1eb7c d\u00e0i h\u01a1n v\u00e0 xu\u1ea5t hi\u1ec7n l\u1ea1i c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng th\u1ecfa m\u00e3n ti\u00eau chu\u1ea9n vi\u00eam m\u00e0ng ngo\u00e0i tim c\u1ea5p \u0111\u00e3 k\u1ec3 tr\u00ean.<\/p>\n

    X\u00e9t nghi\u1ec7m CRP, ch\u1ee5p CLVT ho\u1eb7c CHT tim v\u1edbi h\u00ecnh \u1ea3nh d\u00e0y v\u00e0 t\u0103ng s\u00e1ng c\u00f3 th\u1ec3 gi\u00fap h\u1ed7 tr\u1ee3 ch\u1ea9n \u0111o\u00e1n trong tr\u01b0\u1eddng h\u1ee3p VMNT kh\u00f4ng \u0111i\u1ec3n h\u00ecnh ho\u1eb7c nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u00f3 nghi ng\u1edd cao nh\u01b0ng ch\u01b0a \u0111\u1ee7 ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n.<\/p>\n

    T\u1ef7 l\u1ec7 VMNT t\u00e1i ph\u00e1t sau \u0111\u1ee3t c\u1ea5p chi\u1ebfm kho\u1ea3ng 15 – 30%, g\u1eb7p ph\u1ea7n l\u1edbn \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi colchicine ho\u1eb7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng corticosteroid. C\u0103n nguy\u00ean th\u01b0\u1eddng kh\u00f4ng x\u00e1c \u0111\u1ecbnh, c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn c\u00e1c trung gian mi\u1ec5n d\u1ecbch. Ch\u1ec9 c\u00f3 kho\u1ea3ng 20% c\u00e1c tr\u01b0\u1eddng h\u1ee3p khi l\u00e0m x\u00e9t nghi\u1ec7m tr\u00ean d\u1ecbch v\u00e0 m\u00f4\u00a0 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c lo\u1ea1i virus g\u00e2y b\u1ec7nh.<\/p>\n

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

    B\u1ec7nh m\u00e0ng ngo\u00e0i tim t\u00e1i ph\u00e1t<\/strong><\/p>\n

    3.1 \u0110i\u1ec1u tr\u1ecb:<\/h3>\n

    Li\u1ec1u d\u00f9ng:<\/strong><\/p>\n

    Li\u1ec1u l\u01b0\u1ee3ng c\u00e1c thu\u1ed1c aspirin, ibuprofen, indomethacin v\u00e0 colchicine ‘t\u01b0\u01a1ng t\u1ef1 nh\u01b0 trong \u0111i\u1ec1u tr\u1ecb VMNT c\u1ea5p; tuy nhi\u00ean, th\u1eddi gian th\u01b0\u1eddng k\u00e9o d\u00e0i v\u00e0i tu\u1ea7n \u0111\u1ebfn v\u00e0i th\u00e1ng, colchicine c\u1ea7n d\u00f9ng \u00edt nh\u1ea5t 6 th\u00e1ng.<\/p>\n

    N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 k\u00e8m theo thi\u1ebfu m\u00e1u c\u01a1 tim v\u00e0 \u0111i\u1ec1u tr\u1ecb v\u1edbi aspirin l\u00e0 b\u1eaft bu\u1ed9c th\u00ec li\u1ec1u aspirin n\u00ean c\u00e2n nh\u1eafc \u1edf m\u1ee9c 1 – 2,4 g\/24h.<\/p>\n

    N\u1ebfu c\u00e1c tri\u1ec7u ch\u1ee9ng xu\u1ea5t hi\u1ec7n l\u1ea1i ho\u1eb7c n\u1eb7ng l\u00ean khi \u0111ang \u0111i\u1ec1u tr\u1ecb li\u1ec7u ph\u00e1p xu\u1ed1ng thang, kh\u00f4ng n\u00ean t\u0103ng li\u1ec1u glucocorticoid m\u00e0 n\u00ean c\u00e2n nh\u1eafc t\u0103ng li\u1ec1u t\u1ed1i \u0111a aspirin ho\u1eb7c NSAIDs (chia \u0111\u1ec1u m\u1ed7i 8 gi\u1edd), n\u1ebfu c\u1ea7n c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch; ph\u1ed1i h\u1ee3p th\u00eam v\u1edbi colchicine v\u00e0 c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au.<\/p>\n

    Gi\u1ea3m li\u1ec1u glucocorticoid ( \u0111\u1ed1i v\u1edbi prednisone)<\/p>\n\n\n\n\n\n\n\n
    Li\u1ec1u kh\u1edfi \u0111\u1ea7u 0,25 – 0,5 mg\/kg\/24 gi\u1edd<\/td>\nGi\u1ea3m li\u1ec1u<\/td>\n<\/tr>\n
    > 50 mg\/24 gi\u1edd<\/td>\n10 mg\/ng\u00e0y m\u1ed7i 1 – 2 tu\u1ea7n<\/td>\n<\/tr>\n
    25 – 50 mg\/24 gi\u1edd<\/td>\n5- 10 mg\/ng\u00e0y m\u1ed7i 1 – 2 tu\u1ea7n<\/td>\n<\/tr>\n
    15 – 25 mg\/24 gi\u1edd<\/td>\n2,5 mg\/ng\u00e0y m\u1ed7i 2 – 4 tu\u1ea7n<\/td>\n<\/tr>\n
    < 15 mg\/24 gi\u1edd<\/td>\n1,25 – 2,5 mg\/ng\u00e0y m\u1ed7i 2 – 6 tu\u1ea7n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Tr\u00e1nh d\u00f9ng glucocorticoid li\u1ec1u cao h\u01a1n tr\u1eeb c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t, v\u00e0 ch\u1ec9 n\u00ean d\u00f9ng trong v\u00f2ng v\u00e0i ng\u00e0y, gi\u1ea3m li\u1ec1u nhanh 25 mg\/24h. Prednisone 25 mg t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi methylprednisolone 20 mg.<\/p>\n

    Ch\u1ec9 gi\u1ea3m li\u1ec1u khi b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f2n tri\u1ec7u ch\u1ee9ng v\u00e0 CRP b\u00ecnh th\u01b0\u1eddng, \u0111\u1eb7c bi\u1ec7t khi b\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng li\u1ec1u < 25 mg\/24h.<\/p>\n

    B\u1ed5 sung canxi 1200 – 1500 mg\/24h v\u00e0 vitamin D 800 – 1000 UI\/24h cho b\u1ec7nh nh\u00e2n \u0111ang s\u1eed d\u1ee5ng glucocorticoid.<\/p>\n

    Ngo\u00e0i ra, bisphosphonate \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ec3 tr\u00e1nh lo\u00e3ng x\u01b0\u01a1ng \u1edf c\u00e1c b\u1ec7nh nh\u00e2n nam gi\u1edbi > 50 tu\u1ed5i v\u00e0 ph\u1ee5 n\u1eef m\u00e3n kinh \u0111i\u1ec1u tr\u1ecb l\u00e2u d\u00e0i v\u1edbi li\u1ec1u prednisone kh\u1edfi \u0111\u1ea7u<\/p>\n

    > 5,0 – 7,5 mg\/24h ho\u1eb7c li\u1ec1u t\u01b0\u01a1ng \u0111\u01b0\u01a1ng.<\/p>\n

    Ti\u00ean l\u01b0\u1ee3ng:<\/strong><\/p>\n

    C\u00e1c bi\u1ebfn ch\u1ee9ng n\u1eb7ng c\u1ee7a VMNT t\u00e1i ph\u00e1t v\u00f4 c\u0103n kh\u00f4ng th\u01b0\u1eddng g\u1eb7p. T\u00ecnh tr\u1ea1ng \u00e9p tim v\u00f4 c\u00f9ng hi\u1ebfm v\u00e0 th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n trong nh\u1eefng ng\u00e0y \u0111\u1ea7u ti\u00ean c\u1ee7a b\u1ec7nh.<\/p>\n

    T\u1ef7 l\u1ec7 bi\u1ebfn ch\u1ee9ng li\u00ean quan ch\u1eb7t ch\u1ebd \u0111\u1ebfn c\u0103n nguy\u00ean g\u00e2y b\u1ec7nh v\u00e0 kh\u00f4ng li\u00ean quan \u0111\u1ebfn s\u1ed1 l\u1ea7n t\u00e1i ph\u00e1t. Ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 b\u1ecb \u1ea3nh h\u01b0\u1edfng nghi\u00eam tr\u1ecdng n\u1ebfu b\u1ec7nh t\u00e1i ph\u00e1t nhi\u1ec1u \u0111\u1ee3t, xu\u1ea5t hi\u1ec7n c\u00e1c \u0111\u1ee3t b\u00e1n c\u1ea5p v\u00e0 dai d\u1eb3ng hay nh\u1eefng ng\u01b0\u1eddi b\u1ecb ph\u1ee5 thu\u1ed9c v\u00e0o glucocorticoid.<\/p>\n","protected":false},"excerpt":{"rendered":"

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