{"id":30234,"date":"2023-05-01T22:46:01","date_gmt":"2023-05-01T15:46:01","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30234"},"modified":"2023-05-01T22:46:01","modified_gmt":"2023-05-01T15:46:01","slug":"cac-the-viem-mang-ngoai-tim-chan-doan-va-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/01\/cac-the-viem-mang-ngoai-tim-chan-doan-va-dieu-tri\/","title":{"rendered":"C\u00e1c th\u1ec3 vi\u00eam m\u00e0ng ngo\u00e0i tim ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

Vi\u00eam m\u00e0ng ngo\u00e0i tim<\/a> l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd nguy hi\u1ec3m g\u00e2y ra s\u1ef1 vi\u00eam nhi\u1ec5m v\u00e0 s\u01b0ng ph\u1ed3ng c\u1ee7a m\u00e0ng ngo\u00e0i tim, g\u00e2y ra \u0111au th\u1eaft ng\u1ef1c, kh\u00f3 th\u1edf v\u00e0 h\u01a1i th\u1edf nhanh. C\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c bao g\u1ed3m s\u1ed1t, m\u1ec7t m\u1ecfi v\u00e0 \u0111au c\u01a1.<\/strong><\/p>\n

\"vi\u00eam<\/p>\n

Vi\u00eam m\u00e0ng ngo\u00e0i tim<\/strong><\/p>\n

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

Vi\u00eam m\u00e0ng ngo\u00e0i tim do lao kh\u00e1 ph\u1ed5 bi\u1ebfn \u1edf c\u00e1c n\u01b0\u1edbc \u0111ang ph\u00e1t tri\u1ec3n. B\u1ec7nh c\u00f3 3 bi\u1ec3u hi\u1ec7n h\u00ecnh th\u00e1i l\u00e2m s\u00e0ng: tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim, vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft v\u00e0 vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft – tr\u00e0n d\u1ecbch. Trong \u0111\u00f3, tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim th\u01b0\u1eddng g\u1eb7p nh\u1ea5t.<\/p>\n

2.Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng v\u00e0 ch\u1ea9n \u0111o\u00e1n<\/h2>\n

2.1 Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/strong><\/h3>\n

Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a vi\u00eam m\u00e0ng ngo\u00e0i tim<\/p>\n

Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a lao ho\u1ea1t \u0111\u1ed9ng: s\u1ed1t, th\u01b0\u1eddng v\u1ec1 chi\u1ec1u t\u1ed1i, ho k\u00e9o d\u00e0i, ho ra m\u00e1u, ra m\u1ed3 h\u00f4i tr\u1ed9m… v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng t\u1ea1i c\u01a1 quan b\u1ecb b\u1ec7nh.<\/p>\n

2.1 Ch\u1ea9n \u0111o\u00e1n: <\/strong><\/h3>\n

c\u00f3 b\u1eb1ng ch\u1ee9ng ho\u1ea1t \u0111\u1ed9ng c\u1ee7a vi khu\u1ea9n lao qua b\u1ec7nh ph\u1ea9m d\u1ecbch m\u00e0ng ngo\u00e0i tim, m\u00f4 m\u00e0ng ngo\u00e0i tim b\u1eb1ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p AFB, nu\u00f4i c\u1ea5y, PCR, GeneXpert.<\/p>\n

3. \u0110i\u1ec1u tr\u1ecb v\u00e0 ti\u00ean l\u01b0\u1ee3ng<\/h2>\n

\u0110i\u1ec1u tr\u1ecb c\u0103n nguy\u00ean nhi\u1ec5m lao<\/strong>: Hi\u1ec7n nay \u0111ang \u00e1p d\u1ee5ng ph\u1ed5 bi\u1ebfn ph\u00e1c \u0111\u1ed3 4 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb lao g\u1ed3m: Rifampicin, isoniazid, pyrazinamide v\u00e0 ethambutol trong \u00edt nh\u1ea5t 2 th\u00e1ng, sau \u0111\u00f3 duy tr\u00ec isoniazid v\u00e0 rifampicin. T\u1ed5ng th\u1eddi gian \u0111i\u1ec1u tr\u1ecb l\u00e0 6 th\u00e1ng . Rifampicin c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3m t\u1ef7 l\u1ec7 ti\u1ebfn tri\u1ec3n th\u00e0nh VMNT co th\u1eaft t\u1eeb 17-40%.<\/p>\n

\u0110i\u1ec1u tr\u1ecb c\u00e1c th\u1ec3 c\u1ee7a b\u1ec7nh c\u1ee5 th\u1ec3 <\/strong>c\u1ee7a vi\u00eam m\u00e0ng ngo\u00e0i tim do lao t\u01b0\u01a1ng t\u1ef1 nh\u01b0 nh\u01b0 vi\u00eam\u00a0 m\u00e0ng ngo\u00e0i tim kh\u00e1c.<\/p>\n

Ngo\u00e0i ra, hai bi\u1ec7n ph\u00e1p can thi\u1ec7p kh\u00e1c c\u0169ng c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc gi\u00fap l\u00e0m gi\u1ea3m nguy c\u01a1 ti\u1ebfn tri\u1ec3n th\u00e0nh VMNT co th\u1eaft l\u00e0 ti\u00eau s\u1ee3i huy\u1ebft v\u1edbi urokinase trong khoang m\u00e0ng ngo\u00e0i tim v\u00e0 li\u1ec7u ph\u00e1p glucocorticoid li\u1ec1u cao. S\u1eed d\u1ee5ng glucocorticoid trong v\u00f2ng 6 tu\u1ea7n \u0111\u01b0\u1ee3c ch\u1ee9ng minh gi\u00fap gi\u1ea3m t\u1ef7 l\u1ec7 nh\u1eadp vi\u1ec7n v\u00e0 t\u1ef7 l\u1ec7 xu\u1ea5t hi\u1ec7n VMNT co th\u1eaft. Tuy nhi\u00ean, kh\u00f4ng s\u1eed d\u1ee5ng v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 HIV d\u01b0\u01a1ng t\u00ednh v\u00ec t\u0103ng nguy c\u01a1 \u00e1c t\u00ednh.<\/p>\n

Ph\u0201u thu\u1eadt c\u1eaft b\u1ecf m\u00e0ng ngo\u00e0i tim \u0111\u01b0\u1ee3c \u0111\u1eb7t ra khi b\u1ec7nh nh\u00e2n xu\u1ea5t hi\u1ec7n VMNT co th\u1eaft v\u00e0 t\u00ecnh tr\u1ea1ng b\u1ec7nh kh\u00f4ng c\u1ea3i thi\u1ec7n ho\u1eb7c x\u1ea5u \u0111i sau 4-8 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa v\u1edbi thu\u1ed1c lao.<\/p>\n

Ti\u00ean l\u01b0\u1ee3ng<\/em><\/strong>: T\u1ef7 l\u1ec7 t\u1eed vong c\u1ee7a VMNT do lao nh\u00ecn chung t\u1eeb 17 – 40%, ti\u00ean l\u01b0\u1ee3ng x\u1ea5u h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb HIV k\u00e8m theo.<\/p>\n

Kho\u1ea3ng 15% b\u1ec7nh nh\u00e2n c\u1ea7n ch\u1ecdc h\u00fat d\u1ecbch m\u00e0ng tim nhi\u1ec1u l\u1ea7n v\u00e0 kho\u1ea3ng 10% c\u1ea7n ph\u0201u thu\u1eadt c\u1eaft m\u00e0ng ngo\u00e0i tim trong 2 n\u0103m theo d\u00f5i.<\/p>\n

2.Vi\u00eam m\u1ee7 m\u00e0ng ngo\u00e0i tim<\/h2>\n

Vi\u00eam m\u1ee7 m\u00e0ng ngo\u00e0i tim kh\u00e1 hi\u1ebfm g\u1eb7p, t\u1ef7 l\u1ec7 ch\u01b0a \u0111\u1ebfn 1% c\u00e1c tr\u01b0\u1eddng h\u1ee3p. Nguy\u00ean nh\u00e2n g\u00e2y tr\u00e0n m\u1ee7 m\u00e0ng ngo\u00e0i tim th\u01b0\u1eddng g\u1eb7p l\u00e0 t\u1ee5 c\u1ea7u, li\u00ean c\u1ea7u v\u00e0 ph\u1ebf c\u1ea7u; th\u01b0\u1eddng li\u00ean quan v\u1edbi t\u1ed5n th\u01b0\u01a1ng vi\u00eam m\u1ee7 m\u00e0ng ph\u1ed5i v\u00e0 vi\u00eam ph\u1ed5i. V\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch ho\u1eb7c sau ph\u0201u thu\u1eadt, th\u01b0\u1eddng g\u1eb7p c\u0103n nguy\u00ean do t\u1ee5 c\u1ea7u v\u00e0ng (30%) v\u00e0 n\u1ea5m (20%). C\u00e1c c\u0103n nguy\u00ean kh\u00e1c c\u00f3 th\u1ec3 g\u1eb7p: vi khu\u1ea9n k\u1ecb kh\u00ed \u0111\u01b0\u1eddng h\u1ea7u h\u1ecdng, n\u00e3o m\u00f4 c\u1ea7u, lao.<\/p>\n

2.1 Tri\u1ec7u ch\u1ee9ng v\u00e0 ch\u1ea9n \u0111o\u00e1n<\/h3>\n

N\u1ed5i b\u1eadt v\u00e0 r\u1ea7m r\u1ed9 l\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng: s\u1ed1t cao, \u0111au ng\u1ef1c, m\u00f4i kh\u00f4, l\u01b0\u1ee1i b\u1ea9n, m\u1ec7t m\u1ecfi, ch\u00e1n \u0103n, g\u1ea7y s\u00fat c\u00e2n.<\/p>\n

Ngo\u00e0i ra, c\u00f2n c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim, vi\u00eam m\u00e0ng ngo\u00e0i tim. T\u00ednh ch\u1ea5t d\u1ecbch m\u00e0ng ngo\u00e0i tim:<\/p>\n

M\u00e0u s\u1eafc: Th\u01b0\u1eddng c\u00f3 m\u00e0u tr\u1eafng, v\u00e0ng, xanh ho\u1eb7c n\u00e2u socola; \u0111\u1ee5c, \u0111\u1eb7c qu\u00e1nh.<\/p>\n

Sinh h\u00f3a d\u1ecbch: Ch\u1ec9 s\u1ed1 \u0111\u01b0\u1eddng th\u1ea5p < 30 mg\/dl, s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u t\u0103ng cao c\u00f3 th\u1ec3 t\u1eeb 6000 – 24.000\/ml.<\/p>\n

Nu\u00f4i c\u1ea5y t\u00ecm vi khu\u1ea9n, n\u1ea5m, tr\u1ef1c khu\u1ea9n lao, amip<\/p>\n

C\u00e1c x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng to\u00e0n th\u00e2n v\u00e0 t\u1ed5n th\u01b0\u01a1ng \u1edf c\u00e1c c\u01a1 quan kh\u00e1c: C\u00f4ng th\u1ee9c m\u00e1u, m\u00e1u l\u1eafng, CRP, c\u1ea5y m\u00e1u, XQ\/CLVT ph\u1ed5i, si\u00eau \u00e2m \u1ed5 b\u1ee5ng…<\/p>\n

2.2 \u0110i\u1ec1u tr\u1ecb<\/h3>\n

Vi\u00eam m\u1ee7 m\u00e0ng ngo\u00e0i tim c\u00f3 t\u1ef7 l\u1ec7 t\u1eed vong cao n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb; ng\u01b0\u1ee3c l\u1ea1i, n\u1ebfu \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c, c\u00f3 \u0111\u1ebfn 85% c\u00e1c tr\u01b0\u1eddng h\u1ee3p h\u1ed3i ph\u1ee5c t\u01b0\u01a1ng \u0111\u1ed1i t\u1ed1t.<\/p>\n

D\u0201n l\u01b0u m\u00e0ng ngo\u00e0i tim l\u00e0 \u0111i\u1ec1u b\u1eaft bu\u1ed9c, c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t. C\u00e2n nh\u1eafc m\u1edf m\u00e0ng tim v\u00e0 b\u01a1m r\u1eeda theo \u0111\u01b0\u1eddng d\u01b0\u1edbi m\u0169i \u1ee9c.<\/p>\n

Li\u1ec7u ph\u00e1p kh\u00e1ng sinh \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch theo kinh nghi\u1ec7m cho \u0111\u1ebfn khi c\u00f3 b\u1eb1ng ch\u1ee9ng vi khu\u1ea9n h\u1ecdc.<\/p>\n

Ph\u0201u thu\u1eadt c\u1eaft b\u1ecf m\u00e0ng ngo\u00e0i tim \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 d\u00e0y d\u00ednh m\u00e0ng ngo\u00e0i tim, tr\u00e0n m\u1ee7 m\u00e0ng ngo\u00e0i tim t\u00e1i ph\u00e1t k\u00e8m theo c\u00f3 \u00e9p tim, nhi\u1ec5m tr\u00f9ng dai d\u1eb3ng v\u00e0 ti\u1ebfn tri\u1ec3n \u0111\u1ebfn VMNT co th\u1eaft.<\/p>\n

3. Vi\u00eam m\u00e0ng ngo\u00e0i tim do n\u1ea5m<\/h2>\n

Nguy\u00ean nh\u00e2n do n\u1ea5m th\u01b0\u1eddng l\u00e0 nhi\u1ec5m tr\u00f9ng c\u01a1 h\u1ed9i \u1edf b\u1ec7nh nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch (\u0111i\u1ec1u tr\u1ecb thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, HIV\/AIDS). T\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh l\u00e0 c\u00e1c lo\u1ea1i n\u1ea5m th\u01b0\u1eddng g\u1eb7p (Histoplasma, Coccidioides), n\u1ea5m c\u01a1 h\u1ed9i kh\u00f4ng th\u01b0\u1eddng g\u1eb7p (Candida, Aspergillus, Blastomyces) v\u00e0 b\u00e1n n\u1ea5m (Nocardia, Actinomyces).<\/p>\n

3.1 L\u00e2m s\u00e0ng v\u00e0 ch\u1ea9n \u0111o\u00e1n<\/h3>\n

Bi\u1ec3u hi\u1ec7n do n\u1ea5m c\u00f3 th\u1ec3 gi\u1ed1ng v\u1edbi do lao. C\u00e1c x\u00e9t nghi\u1ec7m d\u1ecbch m\u00e0ng tim: Nhu\u1ed9m soi, nu\u00f4i c\u1ea5y v\u00e0 sinh thi\u1ebft m\u00e0ng tim l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n.<\/p>\n

3.2 \u0110i\u1ec1u tr\u1ecb<\/h3>\n

Thu\u1ed1c ch\u1ed1ng n\u1ea5m: Fluconazole, ketoconazole, itraconazole, amphotericin B. NSAIDs ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng.<\/p>\n

Sulphonamides \u0111\u01b0\u1ee3c d\u00f9ng trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m Nocardia. Ph\u1ed1i h\u1ee3p 3 kh\u00e1ng sinh trong \u0111\u00f3 c\u00f3 penicillin \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong \u0111i\u1ec1u tr\u1ecb Actinomyces.<\/p>\n

4.Vi\u00eam m\u00e0ng ngo\u00e0i tim do amip<\/h2>\n

Vi\u00eam m\u00e0ng ngo\u00e0i tim do Amip (Entamoeba histolytica) x\u1ea3y ra ch\u1ee7 y\u1ebfu \u1edf v\u00f9ng c\u00f3 d\u1ecbch t\u1ec5 v\u00e0 \u1edf b\u1ec7nh nh\u00e2n du l\u1ecbch \u0111\u1ebfn v\u00f9ng c\u00f3 amip (th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n nhi\u1ec1u n\u0103m sau khi ph\u01a1i nhi\u1ec5m v\u1edbi Amip). Amip th\u01b0\u1eddng t\u1eeb \u00e1p xe gan ph\u1ea3i ho\u1eb7c \u00e1p xe ph\u1ed5i. Nguy c\u01a1 t\u1eed vong cao, \u0111\u1eb7c bi\u1ec7t khi ch\u1ea9n \u0111o\u00e1n mu\u1ed9n ho\u1eb7c b\u1ecf qua ch\u1ea9n \u0111o\u00e1n.<\/p>\n

4.1 Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng C\u00f3 2 th\u1ec3:<\/h3>\n

Th\u1ec3 gan:<\/u> <\/em>Kh\u1ed1i \u00e1p xe g\u1ea7n m\u00e0ng ngo\u00e0i tim, ch\u01b0a v\u1ee1, g\u00e2y ph\u1ea3n \u1ee9ng vi\u00eam m\u00e0ng tim, c\u00f3 th\u1ec3 nghe th\u1ea5y ti\u1ebfng c\u1ecd m\u00e0ng tim, tr\u00e0n d\u1ecbch m\u00e0ng tim kh\u00f4ng m\u1ee7.<\/p>\n

Th\u1ec3 tim:<\/u> <\/em>\u00c1p xe gan v\u1ee1 v\u00e0o m\u00e0ng tim d\u0201n \u0111\u1ebfn vi\u00eam m\u1ee7 m\u00e0ng tim. Kh\u1edfi ph\u00e1t c\u00f3 th\u1ec3 c\u1ea5p t\u00ednh v\u1edbi s\u1ed1c v\u00e0 t\u1eed vong trong th\u1eddi gian ng\u1eafn ho\u1eb7c c\u00f3 th\u1ec3 t\u1eeb t\u1eeb v\u1edbi d\u1ea5u hi\u1ec7u c\u1ee7a \u00e9p tim do tr\u00e0n d\u1ecbch m\u00e0ng tim.<\/p>\n

4.2 Ch\u1ea9n \u0111o\u00e1n<\/h3>\n

Th\u01b0\u1eddng kh\u00f3 kh\u0103n, do b\u1ec7nh c\u1ea3nh kh\u00f4ng r\u00f5 r\u00e0ng, hay l\u0201n v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng \u1edf gan.<\/p>\n

N\u00ean nghi ng\u1edd vi\u00eam m\u00e0ng ngo\u00e0i tim do amip \u1edf b\u1ec7nh nh\u00e2n tr\u00e0n m\u1ee7 m\u00e0ng tim, k\u00e8m c\u00e1c bi\u1ec3u hi\u1ec7n c\u1ee7a \u00e1p xe gan nghi do amip.<\/p>\n

Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh khi: Ch\u1ecdc h\u00fat d\u1ecbch m\u00e0ng tim (\u0111i\u1ec3n h\u00ecnh l\u00e0 d\u1ecbch m\u1ee7 s\u00f4c\u00f4la), nu\u00f4i c\u1ea5y v\u00e0 test huy\u1ebft thanh d\u01b0\u01a1ng t\u00ednh v\u1edbi amip.<\/p>\n

4.3 \u0110i\u1ec1u tr\u1ecb<\/h3>\n

Th\u1ec3 gan<\/u><\/em>: \u0110i\u1ec1u tr\u1ecb \u00e1p xe gan s\u1ebd kh\u1ecfi vi\u00eam m\u00e0ng tim.<\/p>\n

Th\u1ec3 tim<\/u><\/em>: D\u0201n l\u01b0u m\u00e0ng tim v\u00e0 \u0111i\u1ec1u tr\u1ecb kh\u00e1ng amip, kh\u00e1ng sinh metronidazole ho\u1eb7c tinidazole.<\/p>\n

5. H\u1ed9i ch\u1ee9ng m\u00e0ng ngo\u00e0i tim sau t\u1ed5n th\u01b0\u01a1ng tim<\/h2>\n

H\u1ed9i ch\u1ee9ng m\u00e0ng ngo\u00e0i tim sau t\u1ed5n th\u01b0\u01a1ng tim (hay g\u1ecdi t\u1eaft l\u00e0 h\u1ed9i ch\u1ee9ng sau t\u1ed5n th\u01b0\u01a1ng ba h\u00ecnh th\u00e1i l\u00e2m s\u00e0ng:<\/p>\n

    \n
  • H\u1ed9i ch\u1ee9ng sau m\u1edf m\u00e0ng ngo\u00e0i tim<\/li>\n
  • Vi\u00eam m\u00e0ng ngo\u00e0i tim sau ch\u1ea5n th\u01b0\u01a1ng tim<\/li>\n
  • Vi\u00eam m\u00e0ng ngo\u00e0i tim sau nh\u1ed3i m\u00e1u c\u01a1 tim<\/li>\n<\/ul>\n

    6. H\u1ed9i ch\u1ee9ng sau t\u1ed5n th\u01b0\u01a1ng tim<\/h2>\n

    Vi\u00eam m\u00e0ng ngo\u00e0i tim sau t\u1ed5n th\u01b0\u01a1ng tim<\/strong><\/p>\n

    – Tri\u1ec7u ch\u1ee9ng:<\/u><\/em><\/strong><\/p>\n

    \u0110au ng\u1ef1c ki\u1ec3u m\u00e0ng (\u0111au ch\u00f3i, t\u0103ng l\u00ean khi h\u00edt v\u00e0o, ho, thay \u0111\u1ed5i t\u01b0 th\u1ebf), k\u00e8m theo s\u1ed1t. Nghe tim c\u00f3 ti\u1ebfng c\u1ecd m\u00e0ng ngo\u00e0i tim.<\/p>\n

    T\u0103ng c\u00e1c marker vi\u00eam<\/p>\n

    \u0110i\u1ec7n t\u00e2m \u0111\u1ed3: ST ch\u00eanh l\u00ean ki\u1ec3u cong l\u00f5m, \u0111o\u1ea1n PR ch\u00eanh xu\u1ed1ng; chuy\u1ec3n \u0111\u1ea1o aVR, h\u00ecnh \u1ea3nh c\u1ee7a ST v\u00e0 aVR ng\u01b0\u1ee3c l\u1ea1i.<\/p>\n

    C\u00f3 th\u1ec3 k\u00e8m theo tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim v\u00e0 tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, vi\u00eam ph\u1ed5i.<\/p>\n

    – Ch\u1ea9n \u0111o\u00e1n:<\/u><\/em><\/strong><\/p>\n

    Ti\u1ec1n s\u1eed c\u00f3 t\u1ed5n th\u01b0\u01a1ng tim k\u00e8m theo c\u00f3 \u00edt nh\u1ea5t 2 trong 5 ti\u00eau chu\u1ea9n sau (theo ESC 2015):<\/p>\n

      \n
    • S\u1ed1t m\u00e0 kh\u00f4ng c\u00f3 nguy\u00ean nh\u00e2n kh\u00e1c<\/li>\n
    • \u0110au ng\u1ef1c ki\u1ec3u m\u00e0ng tim Ti\u1ebfng c\u1ecd m\u00e0ng tim ho\u1eb7c ph\u1ed5i<\/li>\n
    • B\u1eb1ng ch\u1ee9ng c\u1ee7a tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim v\u1edbi CRP t\u0103ng<\/li>\n
    • B\u1eb1ng ch\u1ee9ng c\u1ee7a tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i v\u1edbi CRP t\u0103ng<\/li>\n<\/ul>\n

      – \u0110i\u1ec1u tr\u1ecb:<\/u><\/strong><\/p>\n

      N\u1ebfu c\u00f3 bi\u1ec3u hi\u1ec7n vi\u00eam r\u00f5, \u0111i\u1ec1u tr\u1ecb nh\u01b0 vi\u00eam m\u00e0ng ngo\u00e0i tim c\u1ea5p v\u1edbi thu\u1ed1c NSAID v\u00e0 colchicine trong th\u1eddi gian 3 – 4 tu\u1ea7n. N\u1ebfu kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng c\u1ee7a vi\u00eam th\u00ec kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng v\u00ec nguy c\u01a1 t\u0103ng t\u00e1c d\u1ee5ng ph\u1ee5 li\u00ean quan \u0111\u1ebfn NSAID.<\/p>\n

      – D\u1ef1 ph\u00f2ng:<\/strong><\/p>\n

      Colchicine \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng sau ph\u0201u thu\u1eadt tim v\u1edbi m\u1ee5c \u0111\u00edch ng\u0103n ng\u1eeba s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a h\u1ed9i ch\u1ee9ng sau m\u1edf m\u00e0ng ngo\u00e0i tim. V\u1edbi li\u1ec1u 0,5 mg\/24 gi\u1edd v\u1edbi b\u1ec7nh nh\u00e2n \u2264 70 kg ho\u1eb7c 0,5 mg 2 l\u1ea7n\/24 gi\u1edd n\u1ebfu > 70 kg, trong v\u00f2ng 1 th\u00e1ng sau khi ph\u0201u thu\u1eadt tim n\u1ebfu kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 b\u1ec7nh nh\u00e2n dung n\u1ea1p t\u1ed1t. C\u1ea7n ch\u00fa \u00fd c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5,\u0111\u1eb7c bi\u1ec7t l\u00e0 t\u00e1c d\u1ee5ng ph\u1ee5 tr\u00ean \u0111\u01b0\u1eddng ti\u00eau h\u00f3a c\u1ee7a colchicine.<\/p>\n

      Tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim sau ph\u1eabu thu\u1eadt tim<\/strong><\/p>\n

      Tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim l\u00e0 t\u00ecnh tr\u1ea1ng kh\u00e1 ph\u1ed5 bi\u1ebfn sau ph\u0201u thu\u1eadt tim, th\u01b0\u1eddng bi\u1ebfn m\u1ea5t trong v\u00f2ng 7 – 10 ng\u00e0y. Tuy nhi\u00ean, m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p t\u1ed3n l\u1ea1i l\u00e2u h\u01a1n v\u00e0 c\u00f3 th\u1ec3 nguy hi\u1ec3m. Kho\u1ea3ng 22% b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng tr\u00ean l\u00e2m s\u00e0ng.<\/p>\n

      Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh (bold) b\u1eb1ng s\u1ef1 t\u1ed3n l\u1ea1i c\u1ee7a d\u1ecbch m\u00e0ng ngo\u00e0i tim sau ph\u0201u thu\u1eadt tim.<\/p>\n

      \u0110i\u1ec1u tr\u1ecb: <\/em><\/strong>D\u0201n l\u01b0u d\u1ecbch m\u00e0ng ngo\u00e0i tim n\u1ebfu c\u00f3 \u00e9p tim. NSAID kh\u00f4ng c\u00f3 vai tr\u00f2 n\u1ebfu kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng c\u1ee7a vi\u00eam m\u00e0ng ngo\u00e0i tim c\u1ea5p k\u00e8m theo. D\u1ef1 ph\u00f2ng b\u1eb1ng colchicine sau ph\u0201u thu\u1eadt tim gi\u00fap ng\u0103n ng\u1eeba s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a h\u1ed9i ch\u1ee9ng sau m\u1edf m\u00e0ng ngo\u00e0i tim<\/p>\n

      Ti\u00ean l\u01b0\u1ee3ng: <\/em><\/strong>th\u01b0\u1eddng t\u1ed1t \u0111\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p tr\u00e0n d\u1ecbch nh\u1eb9; tr\u00e0n d\u1ecbch v\u1eeba \u0111\u1ebfn nhi\u1ec1u chi\u1ebfm kho\u1ea3ng 1\/3 s\u1ed1 tr\u01b0\u1eddng h\u1ee3p v\u00e0 10% c\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n \u0111\u1ebfn \u00e9p tim sau 1 th\u00e1ng ph\u0201u thu\u1eadt. N\u1ebfu t\u00ecnh tr\u1ea1ng \u00e9p tim x\u1ea3y ra ngay trong nh\u1eefng gi\u1edd \u0111\u1ea7u ti\u00ean sau ph\u0201u thu\u1eadt th\u01b0\u1eddng do ch\u1ea3y m\u00e1u trong khoang m\u00e0ng ngo\u00e0i tim, t\u00ecnh hu\u1ed1ng n\u00e0y b\u1eaft bu\u1ed9c ph\u1ea3i ph\u0201u thu\u1eadt l\u1ea1i.<\/p>\n","protected":false},"excerpt":{"rendered":"

      Vi\u00eam m\u00e0ng ngo\u00e0i tim l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd nguy hi\u1ec3m g\u00e2y ra s\u1ef1 vi\u00eam nhi\u1ec5m v\u00e0 s\u01b0ng ph\u1ed3ng c\u1ee7a m\u00e0ng ngo\u00e0i tim, g\u00e2y ra \u0111au th\u1eaft ng\u1ef1c, kh\u00f3 th\u1edf v\u00e0 h\u01a1i th\u1edf nhanh. C\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c bao g\u1ed3m s\u1ed1t, m\u1ec7t m\u1ecfi v\u00e0 \u0111au c\u01a1. Vi\u00eam m\u00e0ng ngo\u00e0i tim 1.\u0110\u1ecbnh ngh\u0129a Vi\u00eam m\u00e0ng ngo\u00e0i tim […]<\/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":"\nC\u00e1c th\u1ec3 vi\u00eam m\u00e0ng ngo\u00e0i tim ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb - Vinmec<\/title>\n<meta name=\"description\" content=\"Vi\u00eam m\u00e0ng ngo\u00e0i tim g\u00e2y ra s\u1ef1 vi\u00eam nhi\u1ec5m v\u00e0 s\u01b0ng ph\u1ed3ng c\u1ee7a m\u00e0ng ngo\u00e0i tim, g\u00e2y ra \u0111au th\u1eaft ng\u1ef1c, kh\u00f3 th\u1edf v\u00e0 h\u01a1i th\u1edf nhanh.\" \/>\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=\"C\u00e1c th\u1ec3 vi\u00eam m\u00e0ng ngo\u00e0i tim ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb - 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