{"id":30283,"date":"2023-05-01T22:41:22","date_gmt":"2023-05-01T15:41:22","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30283"},"modified":"2023-05-01T22:41:22","modified_gmt":"2023-05-01T15:41:22","slug":"viem-dong-mach-chu","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/01\/viem-dong-mach-chu\/","title":{"rendered":"Vi\u00eam \u0111\u1ed9ng m\u1ea1ch ch\u1ee7"},"content":{"rendered":"

Vi\u00eam \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/a> l\u00e0 thu\u1eadt ng\u1eef chung d\u00f9ng \u0111\u1ec3 ch\u1ec9 t\u00ecnh tr\u1ea1ng vi\u00eam x\u1ea3y ra t\u1ea1i th\u00e0nh \u0110M ch\u1ee7. Nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t g\u00e2y vi\u00eam m\u1ea1ch kh\u00f4ng do nhi\u1ec5m tr\u00f9ng l\u00e0 vi\u00eam m\u1ea1ch t\u1ebf b\u00e0o kh\u1ed5ng l\u1ed3 (vi\u00eam \u0111\u1ed9ng m\u1ea1ch th\u00e1i d\u01b0\u01a1ng) v\u00e0 vi\u00eam m\u1ea1ch Takayasu.<\/strong><\/p>\n

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

Vi\u00eam \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/strong><\/p>\n

1. \u0110\u1ecbnh ngh\u0129a, ph\u00e2n lo\u1ea1i v\u00e0 ch\u1ea9n \u0111o\u00e1n<\/h2>\n

Vi\u00eam \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u00e0 thu\u1eadt ng\u1eef chung d\u00f9ng \u0111\u1ec3 ch\u1ec9 t\u00ecnh tr\u1ea1ng vi\u00eam x\u1ea3y ra t\u1ea1i th\u00e0nh \u0110M ch\u1ee7. Nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t g\u00e2y vi\u00eam m\u1ea1ch kh\u00f4ng do nhi\u1ec5m tr\u00f9ng l\u00e0 vi\u00eam m\u1ea1ch t\u1ebf b\u00e0o kh\u1ed5ng l\u1ed3 (vi\u00eam \u0111\u1ed9ng m\u1ea1ch th\u00e1i d\u01b0\u01a1ng) v\u00e0 vi\u00eam m\u1ea1ch Takayasu. M\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd hi\u1ebfm g\u1eb7p h\u01a1n nh\u01b0 b\u1ec7nh Bechet, b\u1ec7nh Buerger, b\u1ec7nh Kawasaki, vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp v\u00e0 b\u1ec7nh Reiter.<\/p>\n

Vi\u00eam \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 nhi\u1ec5m tr\u00f9ng m\u1eb7c d\u00f9 \u00edt ph\u1ed5 bi\u1ebfn, th\u01b0\u1eddng do t\u1ee5 c\u1ea7u, Salmonella v\u00e0 mycobacteria, giang mai.<\/p>\n

2. Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng<\/h2>\n

2.1 Vi\u00eam m\u1ea1ch t\u1ebf b\u00e0o kh\u1ed5ng l\u1ed3<\/strong><\/h3>\n

Vi\u00eam m\u1ea1ch t\u1ebf b\u00e0o kh\u1ed5ng l\u1ed3 hay g\u1eb7p \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i, nam nhi\u1ec1u h\u01a1n n\u1eef. Th\u01b0\u1eddng g\u1eb7p ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ng\u1ef1c d\u00f9 trong y v\u0103n ghi nh\u1eadn \u0111\u1ed9ng m\u1ea1ch th\u00e1i d\u01b0\u01a1ng v\u00e0\/ho\u1eb7c c\u00e1c \u0111\u1ed9ng m\u1ea1ch trong s\u1ecd kh\u00e1c \u0111\u1ec1u c\u00f3 th\u1ec3 t\u1ed5n th\u01b0\u01a1ng. T\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 c\u00e1c nh\u00e1nh ch\u00ednh g\u1eb7p \u1edf kho\u1ea3ng 10 – 18%. Gi\u00e3n g\u1ed1c \u0110M ch\u1ee7 v\u00e0 \u0111o\u1ea1n \u0110M ch\u1ee7 l\u00ean c\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n th\u00e0nh l\u00f3c t\u00e1ch ho\u1eb7c v\u1ee1 \u0110M ch\u1ee7.<\/p>\n

Khi nghi ng\u1edd vi\u00eam \u0110M th\u00e1i d\u01b0\u01a1ng c\u1ea7n ph\u1ea3i l\u00e0m si\u00eau \u00e2m tim, CLVT ho\u1eb7c ch\u1ee5p CHT \u0110M ch\u1ee7. Th\u00e0nh \u0111\u1ed9ng m\u1ea1ch d\u00e0y tr\u00ean CLVT ho\u1eb7c CHT ch\u1ec9 ra r\u1eb1ng c\u00f3 t\u00ecnh tr\u1ea1ng vi\u00eam \u1edf \u0110M ch\u1ee7 v\u00e0 b\u1ec7nh \u0111ang \u1edf giai \u0111o\u1ea1n ho\u1ea1t \u0111\u1ed9ng. Nghi\u00ean c\u1ee9u b\u1eb1ng PET ch\u1ec9 ra r\u1eb1ng c\u00f3 qu\u00e1 tr\u00ecnh vi\u00eam th\u1ea7m l\u1eb7ng t\u1ea1i \u0110M ch\u1ee7 k\u1ec3 c\u1ea3 khi kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng. N\u00ean \u0111\u1ecbnh l\u01b0\u1ee3ng interleukin – 1 \u1edf c\u00e1c b\u1ec7nh nh\u00e2n nghi ng\u1edd vi\u00eam \u0110M th\u00e1i d\u01b0\u01a1ng ngo\u00e0i c\u00e1c d\u1ea5u \u1ea5n vi\u00eam sinh h\u1ecdc th\u00f4ng th\u01b0\u1eddng.<\/p>\n

2.2 Vi\u00eam \u0111\u1ed9ng m\u1ea1ch Takayasu<\/h3>\n

Kh\u00e1 hi\u1ebfm g\u1eb7p v\u00e0 bi\u1ec3u hi\u1ec7n b\u1eb1ng t\u00ecnh tr\u1ea1ng vi\u00eam c\u00e1c m\u1ea1ch l\u1edbn, th\u01b0\u1eddng g\u1eb7p \u1edf n\u1eef gi\u1edbi tr\u1ebb tu\u1ed5i, \u0111\u1eb7c bi\u1ec7t l\u00e0 khu v\u1ef1c ch\u00e2u \u00c1. T\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh l\u00e0 2,6\/1 tri\u1ec7u d\u00e2n. C\u01a1 ch\u1ebf b\u1ec7nh sinh hi\u1ec7n v\u0201n ch\u01b0a \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh..<\/p>\n

\u0110\u1ed9ng m\u1ea1ch ch\u1ee7 ng\u1ef1c v\u00e0 c\u00e1c nh\u00e1nh l\u1edbn c\u1ee7a n\u00f3 th\u01b0\u1eddng b\u1ecb t\u1ed5n th\u01b0\u01a1ng, sau \u0111\u00f3 l\u00e0 \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng. \u1ede giai \u0111o\u1ea1n \u0111\u1ea7u, bi\u1ec3u hi\u1ec7n b\u1ec7nh l\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a t\u00ednh tr\u1ea1ng vi\u00eam h\u1ec7 th\u1ed1ng. \u1ede giai \u0111o\u1ea1n m\u1ea1n t\u00ednh l\u00e0 t\u1ed5n th\u01b0\u01a1ng c\u00e1c m\u1ea1ch m\u00e1u. Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng r\u1ea5t thay \u0111\u1ed5i t\u1eeb \u0111au b\u1ee5ng – \u0111au l\u01b0ng k\u00e8m s\u1ed1t cao cho \u0111\u1ebfn tri\u1ec7u ch\u1ee9ng c\u1ee7a h\u1eb9p \u0110M ch\u1ee7 ho\u1eb7c t\u00ecnh c\u1edd ph\u00e1t hi\u1ec7n kh\u1ed1i ph\u00ecnh l\u1edbn \u1edf \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ng\u1ef1c.<\/p>\n

\u0110au c\u00e1ch h\u1ed3i chi tr\u00ean, \u0111\u1ed9t qu\u1ef5, hoa m\u1eaft ch\u00f3ng m\u1eb7t ho\u1eb7c ng\u1ea5t th\u01b0\u1eddng do nguy\u00ean nh\u00e2n t\u1eafc ngh\u1ebdn c\u00e1c m\u1ea1ch m\u00e1u \u1edf ph\u1ea7n tr\u00ean \u0110M ch\u1ee7. THA \u00e1c t\u00ednh g\u1ee3i \u00fd h\u1eb9p \u0110M ch\u1ee7 ho\u1eb7c \u0110M th\u1eadn. H\u1ed9i ch\u1ee9ng \u0110M ch\u1ee7 c\u1ea5p bao g\u1ed3m l\u00f3c t\u00e1ch \u0110M ch\u1ee7 ho\u1eb7c v\u1ee1 c\u0169ng c\u00f3 th\u1ec3 x\u1ea3y ra. Huy\u1ebft kh\u1ed1i trong l\u00f2ng \u0110M ch\u1ee7 c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c bi\u1ebfn c\u1ed1 thuy\u00ean t\u1eafc ph\u00eda xa.<\/p>\n

Khi nghi ng\u1edd vi\u00eam m\u1ea1ch Takayasu, c\u1ea7n kh\u1ea3o s\u00e1t h\u00ecnh \u1ea3nh to\u00e0n b\u1ed9 h\u1ec7 \u0110M ch\u1ee7 \u0111\u1ec3 \u0111\u01b0a ra ch\u1ea9n \u0111o\u00e1n. T\u1ea5t c\u1ea3 c\u00e1c ph\u01b0\u01a1ng ti\u1ec7n ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh \u0111\u1ec1u c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng.<\/p>\n

Si\u00eau \u00e2m, CHT v\u00e0 CLVT cho th\u1ea5y s\u1ef1 d\u00e0y l\u00ean c\u1ee7a th\u00e0nh \u0110M ch\u1ee7 v\u00e0 m\u1ea5t t\u00ednh tr\u01a1n nh\u1eb5n c\u1ee7a l\u1edbp n\u1ed9i m\u1ea1c. Tuy nhi\u00ean c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n nh\u1ea7m l\u00e0 t\u1ee5 m\u00e1u trong th\u00e0nh \u0110M ch\u1ee7. So v\u1edbi si\u00eau \u00e2m, CHT v\u00e0 CLVT c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 to\u00e0n b\u1ed9 \u0110M ch\u1ee7 v\u00e0 \u0111\u1ea7u g\u1ea7n c\u1ee7a c\u00e1c nh\u00e1nh. CHT c\u00f2n th\u1ea5y \u0111\u01b0\u1ee3c d\u1ea5u hi\u1ec7u ho\u1ea1t \u0111\u1ed9ng c\u1ee7a b\u1ec7nh khi c\u00f3 h\u00ecnh \u1ea3nh ph\u00f9 n\u1ec1 trong th\u00e0nh m\u1ea1ch.<\/p>\n

\u1ede giai \u0111o\u1ea1n m\u1ea1n t\u00ednh c\u1ee7a b\u1ec7nh, th\u00e0nh \u0110M ch\u1ee7 c\u00f3 th\u1ec3 tr\u1edf n\u00ean b\u1ecb canxi h\u00f3a v\u00e0 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 t\u1ed1t nh\u1ea5t b\u1edfi CLVT. Ch\u1ee5p PET c\u0169ng c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00e1t hi\u1ec7n t\u00ednh tr\u1ea1ng vi\u00eam m\u1ea1ch khi k\u1ebft h\u1ee3p c\u00f9ng v\u1edbi c\u00e1c ph\u01b0\u01a1ng ti\u1ec7n ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh c\u1eaft l\u1edbp truy\u1ec1n th\u1ed1ng (CLVT, CHT).<\/p>\n

C\u00e1c ch\u1ea5t ch\u1ec9 \u0111i\u1ec3m vi\u00eam sinh h\u1ecdc nh\u01b0 CRPs v\u00e0 t\u1ed1c \u0111\u1ed9 m\u00e1u l\u1eafng t\u0103ng trong kho\u1ea3ng 70% s\u1ed1 b\u1ec7nh nh\u00e2n trong giai \u0111o\u1ea1n c\u1ea5p v\u00e0 50% \u1edf giai \u0111o\u1ea1n m\u1ea1n t\u00ednh c\u1ee7a b\u1ec7nh. \u0110\u1ecbnh l\u01b0\u1ee3ng Pentraxin – 3 c\u00f3 th\u1ec3 gi\u00fap ph\u00e2n bi\u1ec7t giai \u0111o\u1ea1n c\u1ea5p c\u1ee7a vi\u00eam m\u1ea1ch Takayasu t\u1ed1t h\u01a1n.<\/p>\n

2.3 Vi\u00eam \u0110M ch\u1ee7 do nhi\u1ec5m tr\u00f9ng<\/h3>\n

R\u1ea5t kh\u00f3 \u0111\u1ec3 x\u00e1c l\u1eadp ch\u1ea9n \u0111o\u00e1n vi\u00eam \u0110M ch\u1ee7 do nguy\u00ean nh\u00e2n nhi\u1ec5m khu\u1ea9n. B\u1ec7nh th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi cao tu\u1ed5i v\u1edbi ti\u1ec1n s\u1eed b\u1ec7nh l\u00fd \u0110M ch\u1ee7 tr\u01b0\u1edbc \u0111\u00f3.<\/p>\n

C\u00e1c tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p l\u00e0 \u0111au l\u01b0ng ho\u1eb7c \u0111au b\u1ee5ng \u00b1 t\u00ecnh tr\u1ea1ng nhi\u1ec5m khu\u1ea9n huy\u1ebft. N\u1ebfu nghi ng\u1edd, c\u1ea7n ch\u1ee5p CLVT ho\u1eb7c CHT \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u0111\u1ec3 lo\u1ea1i tr\u1eeb kh\u1ea3 n\u0103ng vi\u00eam \u0110M ch\u1ee7 nhi\u1ec5m khu\u1ea9n.<\/p>\n

Ch\u1ea9n \u0111o\u00e1n vi\u00eam \u0110M ch\u1ee7 do nhi\u1ec5m khu\u1ea9n ho\u1eb7c ph\u00ecnh \u0110M ch\u1ee7 h\u00ecnh n\u1ea5m r\u1ea5t quan tr\u1ecdng nguy c\u01a1 bi\u1ebfn ch\u1ee9ng v\u1ee1 cao v\u00e0 t\u1eed vong. Ch\u1ea9n \u0111o\u00e1n vi\u00eam \u0110M ch\u1ee7 do lao c\u0169ng r\u1ea5t kh\u00f3 kh\u0103n b\u1edfi ch\u00fang c\u1ef1c k\u1ef3 hi\u1ebfm g\u1eb7p v\u00e0 c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n gi\u1ed1ng vi\u00eam m\u1ea1ch Takayasu, g\u00e2y ch\u1eadm tr\u1ec5 trong ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb. C\u1ea7n ngh\u0129 t\u1edbi kh\u1ea3 n\u0103ng vi\u00eam \u0110M ch\u1ee7 do lao \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n vi\u00eam \u0110M ch\u1ee7 ho\u1eb7c ph\u00ecnh \u0110M ch\u1ee7 kh\u00f4ng \u0111i\u1ec3n h\u00ecnh c\u00f3 ti\u1ec1n s\u1eed lao ph\u1ed5i ho\u1eb7c lao ngo\u00e0i ph\u1ed5i, t\u00ecnh tr\u1ea1ng \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch m\u1ea1n t\u00ednh, ho\u1eb7c c\u00f3 k\u00e8m theo t\u1ed5n th\u01b0\u01a1ng d\u1ea1ng hang \u1edf ph\u1ed5i, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i ho\u1eb7c vi\u00eam h\u1ea1ch b\u1ea1ch huy\u1ebft. C\u1ea7n lo\u1ea1i tr\u1eeb vi\u00eam \u0110M ch\u1ee7 do lao c\u1ea7n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng glucocorticoid.<\/p>\n

3.C\u00e1c th\u0103m d\u00f2 ch\u1ea9n \u0111o\u00e1n<\/h2>\n

3.1 Si\u00eau \u00e2m<\/strong><\/h3>\n

Kh\u00f4ng ph\u1ea3i l\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u00ednh \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n vi\u00eam \u0110M ch\u1ee7<\/strong>. Si\u00eau \u00e2m \u1ed5 b\u1ee5ng, si\u00eau \u00e2m tim qua th\u00e0nh ng\u1ef1c\/ qua th\u1ef1c qu\u1ea3n c\u00f3 th\u1ec3 quan s\u00e1t th\u1ea5y h\u00ecnh \u1ea3nh d\u00e0y th\u00e0nh \u0110M ch\u1ee7, \u0111\u1ed3ng th\u1eddi \u0111\u00e1nh gi\u00e1 g\u1ed1c \u0110M ch\u1ee7 v\u00e0 van \u0110M ch\u1ee7 trong b\u1ec7nh c\u1ea3nh vi\u00eam \u0110M ch\u1ee7 l\u00ean c\u00f3 k\u00e8m theo h\u1edf van \u0110M ch\u1ee7 ho\u1eb7c ph\u00ecnh \u0110M ch\u1ee7.<\/p>\n

Si\u00eau \u00e2m Doppler m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean c\u0169ng c\u00f3 \u00edch trong ch\u1ea9n \u0111o\u00e1n v\u00e0 theo d\u00f5i vi\u00eam \u0110M t\u1ebf b\u00e0o kh\u1ed5ng l\u1ed3 v\u00e0 vi\u00eam m\u1ea1ch Takayasu. D\u1ea5u hi\u1ec7u qu\u1ea7ng gi\u1ea3m \u00e2m quanh l\u00f2ng \u0110M th\u00e1i d\u01b0\u01a1ng tr\u00ean si\u00eau \u00e2m Doppler m\u00e0u c\u00f3 s\u1ef1 li\u00ean quan v\u1edbi t\u00ecnh tr\u1ea1ng vi\u00eam \u0111ang ho\u1ea1t \u0111\u1ed9ng tr\u00ean sinh thi\u1ebft \u0110M th\u00e1i d\u01b0\u01a1ng. Kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u \u201cqu\u1ea7ng s\u00e1ng\u201d \u1edf \u0110M th\u00e1i d\u01b0\u01a1ng c\u00f3 gi\u00e1 tr\u1ecb d\u1ef1 b\u00e1o \u00e2m t\u00ednh 92 – 96% khi sinh thi\u1ebft. D\u1ea5u hi\u1ec7u n\u00e0y gi\u1ea3m ho\u1eb7c m\u1ea5t ho\u00e0n to\u00e0n khi b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng glucocorticoid.<\/p>\n

Vi\u00eam m\u1ea1ch Takayasu c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n d\u00e0y th\u00e0nh m\u1ea1ch \u0111\u1ed3ng t\u00e2m tr\u00ean si\u00eau \u00e2m t\u01b0\u01a1ng \u1ee9ng v\u1edbi \u0111\u00e1p \u1ee9ng vi\u00eam c\u1ee7a th\u00e0nh m\u1ea1ch. H\u00ecnh \u1ea3nh d\u00e0y th\u00e0nh m\u1ea1ch th\u01b0\u1eddng s\u00e1ng h\u01a1n d\u1ea5u hi\u1ec7u \u201cqu\u1ea7ng s\u00e1ng\u201d trong vi\u00eam \u0110M t\u1ebf b\u00e0o kh\u1ed5ng l\u1ed3 v\u00e0 \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 d\u1ea5u hi\u1ec7u \u201cm\u00ec \u1ed1ng\u201d. Th\u00e0nh m\u1ea1ch d\u00e0y l\u00ean \u0111\u00e1ng k\u1ec3 \u1edf ph\u1ee9c h\u1ee3p \u00e1o trong-\u00e1o gi\u1eefa th\u01b0\u1eddng \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y \u1edf \u0110M d\u01b0\u1edbi \u0111\u00f2n v\u00e0 \u0110M c\u1ea3nh chung \u1edf c\u1ea3 hai b\u00ean. Si\u00eau \u00e2m Doppler c\u0169ng x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c khu v\u1ef1c c\u00f3 c\u00f3 h\u1eb9p ho\u1eb7c t\u1eafc ngh\u1ebdn \u0110M.<\/p>\n

3.2 Ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 kh\u00f4ng x\u00e2m l\u1ea5n (CLVT v\u00e0 CHT)<\/h3>\n

CLVT k\u00e9m nh\u1ea1y h\u01a1n c\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00e1c trong vi\u1ec7c \u0111\u00e1nh gi\u00e1 s\u1ef1 d\u00e0y l\u00ean c\u1ee7a th\u00e0nh \u0110M ch\u1ee7 v\u00e0 vi\u00eam quanh \u0110M ch\u1ee7 trong b\u1ec7nh c\u1ea3nh vi\u00eam \u0110M ch\u1ee7 c\u1ea5p. CLVT cho ph\u00e9p \u0111\u00e1nh gi\u00e1 ch\u00ednh x\u00e1c t\u1ed5n th\u01b0\u01a1ng h\u1eb9p c\u1ee7a \u0110M ch\u1ee7 v\u00e0 c\u00e1c m\u1ea1ch m\u00e1u l\u1edbn, c\u00e1c \u0111o\u1ea1n ph\u00ecnh \u0110M ch\u1ee7 v\u00ec v\u1eady \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 theo d\u00f5i d\u00e0i h\u1ea1n \u1edf b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb vi\u00eam \u0110M ch\u1ee7.<\/p>\n

CHT c\u00f3 s\u1eed d\u1ee5ng thu\u1ed1c \u0111\u1ed1i quang t\u1eeb ch\u1ee9a gadolinium, l\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh kh\u00f4ng x\u00e2m l\u1ea5n \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam \u0110M ch\u1ee7<\/strong>, \u0111\u1eb7c bi\u1ec7t c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u00eam \u0110M t\u1ebf b\u00e0o kh\u1ed5ng l\u1ed3 v\u00e0 vi\u00eam m\u1ea1ch Takayasu… C\u00e1c h\u00ecnh \u1ea3nh quan s\u00e1t \u0111\u01b0\u1ee3c t\u01b0\u01a1ng t\u1ef1 nh\u01b0 phim ch\u1ee5p CLVT nh\u01b0ng c\u00f3 \u0111\u1ed9 nh\u1ea1y cao h\u01a1n v\u00e0 b\u1ec7nh nh\u00e2n kh\u00f4ng ph\u1ea3i ch\u1ecbu b\u1ee9c x\u1ea1, v\u00ec v\u1eady \u0111\u01b0\u1ee3c \u01b0u ti\u00ean trong theo d\u00f5i l\u00e2u d\u00e0i \u1edf c\u00e1c b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i.<\/p>\n

Hi\u1ec7n nay, vi\u1ec7c ch\u1ec9 s\u1eed d\u1ee5ng 18-fluorodeoxyglucose (18<\/sup>F-FDG) PET ho\u1eb7c ph\u1ed1i h\u1ee3p v\u1edbi CLVT, CHT l\u00e0 c\u00f4ng c\u1ee5 ti\u1ec1m n\u0103ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n b\u01b0\u1edbc \u0111\u1ea7u v\u00e0 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 ho\u1ea1t \u0111\u1ed9ng c\u1ee7a vi\u00eam \u0110M ch\u1ee7..<\/p>\n

3.3 Ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p x\u00e2m l\u1ea5n<\/h3>\n

Ch\u1ee5p \u0110M ch\u1ee7 x\u00e2m l\u1ea5n t\u1eebng l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n vi\u00eam \u0110M ch\u1ee7. Tuy nhi\u00ean, CLVT v\u00e0 CHT \u0111\u00e3 d\u1ea7n thay th\u1ebf vai tr\u00f2 c\u1ee7a ch\u1ee5p \u0110M ch\u1ee7 th\u00f4ng th\u01b0\u1eddng. Ch\u1ee5p \u0110M ch\u1ee7 x\u00e2m l\u1ea5n th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng khi ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng \u0110M ch\u1ee7 c\u1ea5p m\u00e0 c\u00e1c th\u0103m d\u00f2 h\u00ecnh \u1ea3nh kh\u00f4ng x\u00e2m l\u1ea5n kh\u00f4ng r\u00f5 r\u00e0ng ho\u1eb7c c\u1ea7n ti\u1ebfn h\u00e0nh t\u00e1i can thi\u1ec7p n\u1ed9i m\u1ea1ch \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 gi\u1ea3i ph\u0201u ph\u00f9 h\u1ee3p.<\/p>\n

4. X\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n<\/h2>\n

Tuy ch\u1ea9n \u0111o\u00e1n vi\u00eam \u0110M ch\u1ee7 th\u01b0\u1eddng d\u1ef1a v\u00e0o tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh, m\u1ed9t s\u1ed1 x\u00e9t nghi\u1ec7m c\u0169ng c\u00f3 \u00edch trong x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n:<\/p>\n

C\u00e1c d\u1ea5u \u1ea5n vi\u00eam sinh h\u1ecdc b\u1eb1ng c\u00e1c x\u00e9t nghi\u1ec7m t\u1ed1c \u0111\u1ed9 m\u00e1u l\u1eafng, CRP; c\u00f4ng th\u1ee9c m\u00e1u; ch\u1ee9c n\u0103ng gan, th\u1eadn; c\u1ea5y m\u00e1u.<\/p>\n

C\u00e1c x\u00e9t nghi\u1ec7m b\u1ec7nh t\u1ef1 mi\u1ec5n bao g\u1ed3m kh\u00e1ng th\u1ec3 kh\u00e1ng nh\u00e2n, kh\u00e1ng th\u1ec3 kh\u00e1ng b\u00e0o t\u01b0\u01a1ng b\u1ea1ch c\u1ea7u h\u1ea1t trung t\u00ednh, y\u1ebfu t\u1ed1 d\u1ea1ng th\u1ea5p; x\u00e9t nghi\u1ec7m v\u1ec1 lao, giang mai n\u1ebfu nghi ng\u1edd.<\/p>\n

Tr\u01b0\u1eddng h\u1ee3p vi\u00eam \u0110M ch\u1ee7 c\u00f3 x\u01a1 h\u00f3a sau ph\u00fac m\u1ea1c, c\u1ea7n t\u00ecm c\u00e1c nguy\u00ean nh\u00e2n th\u1ee9 ph\u00e1t nh\u01b0 u lympho v\u00e0 sinh thi\u1ebft n\u1ebfu c\u00f3 nghi ng\u1edd b\u1ec7nh l\u00fd \u00e1c t\u00ednh tr\u00ean l\u00e2m s\u00e0ng v\u00e0 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh.<\/p>\n

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

\u0110i\u1ec1u tr\u1ecb theo nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh. M\u1ee5c ti\u00eau: 1) h\u1ea1n ch\u1ebf t\u00ecnh tr\u1ea1ng vi\u00eam \u0110M ch\u1ee7, ho\u1eb7c \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng, 2) theo d\u00f5i v\u00e0 ki\u1ec3m so\u00e1t bi\u1ebfn ch\u1ee9ng t\u1ea1i \u0110M ch\u1ee7 v\u00e0 c\u00e1c m\u1ea1ch kh\u00e1c.<\/p>\n

5.1 \u0110i\u1ec1u tr\u1ecb ch\u1ed1ng vi\u00eam, ch\u1ed1ng nhi\u1ec5m tr\u00f9ng<\/h3>\n

\u0110i\u1ec1u tr\u1ecb b\u1eb1ng glucocorticoid v\u0201n l\u00e0 li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb chu\u1ea9n ban \u0111\u1ea7u \u0111\u1ed1i v\u1edbi vi\u00eam m\u1ea1ch kh\u00f4ng do nhi\u1ec5m tr\u00f9ng. Li\u1ec1u kh\u1edfi \u0111\u1ea7u prednisone 0,5 – 1 mg\/kg\/24h, gi\u1ea3m d\u1ea7n li\u1ec1u khi b\u1ec7nh nh\u00e2n \u0111\u00e1p \u1ee9ng. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb t\u1eeb 1 – 2 n\u0103m nh\u1eb1m m\u1ee5c \u0111\u00edch tr\u00e1nh t\u00e1i ph\u00e1t. Tuy nhi\u00ean c\u00f3 \u0111\u1ebfn 50% b\u1ec7nh nh\u00e2n s\u1ebd t\u00e1i ph\u00e1t v\u00e0 \u0111\u00f2i h\u1ecfi s\u1eed d\u1ee5ng th\u00eam c\u00e1c li\u1ec7u ph\u00e1p \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch kh\u00e1c nh\u01b0 bao g\u1ed3m methotrexate, azathioprine, ch\u1ed1ng y\u1ebfu t\u1ed1 ho\u1ea1i t\u1eed u TNFa. Trong tr\u01b0\u1eddng h\u1ee3p t\u00e1i ph\u00e1t, c\u1ea7n \u0111\u00e1nh gi\u00e1 b\u1eb1ng c\u1ea3 c\u00e1c ch\u1ec9 \u0111i\u1ec3m sinh h\u1ecdc c\u0169ng nh\u01b0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh \u0111\u00e3 n\u00eau \u1edf tr\u00ean.<\/p>\n

C\u1ea7n \u0111\u00e1nh gi\u00e1 to\u00e0n b\u1ed9 h\u1ec7 m\u1ea1ch m\u00e1u trong m\u1ed7i l\u1ea7n th\u0103m kh\u00e1m k\u1ebft h\u1ee3p v\u1edbi theo d\u00f5i b\u1eb1ng c\u00e1c ch\u1ea5t ch\u1ec9 \u0111i\u1ec3m vi\u00eam, \u0111\u00e1nh gi\u00e1 \u0111\u1ecbnh k\u1ef3 b\u1eb1ng c\u00e1c ph\u01b0\u01a1ng ti\u1ec7n ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh n\u1ebfu c\u00f3 s\u1ef1 xu\u1ea5t hi\u1ec7n ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng v\u00e0 \u0110M ch\u1ee7 ng\u1ef1c.<\/p>\n

N\u1ebfu nghi ng\u1edd vi\u00eam \u0110M ch\u1ee7 do nhi\u1ec5m tr\u00f9ng y\u00eau c\u1ea7u nhanh ch\u00f3ng l\u00e0m ch\u1ea9n \u0111o\u00e1n v\u00e0 s\u1eed d\u1ee5ng kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch (\u0111\u1eb7c bi\u1ec7t l\u00e0 t\u1ee5 c\u1ea7u v\u00e0 vi khu\u1ea9n gram \u00e2m).<\/p>\n

5.2 Ph\u1eabu thu\u1eadt v\u00e0 can thi\u1ec7p n\u1ed9i m\u1ea1ch<\/h3>\n

Ch\u1ec9 \u0111\u1ecbnh t\u00e1i th\u00f4ng m\u1ea1ch ch\u1ee7 b\u1ecb h\u1eb9p ho\u1eb7c ph\u00ecnh m\u1ea1ch t\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u00e1c b\u1ec7nh nh\u00e2n kh\u00f4ng do vi\u00eam. B\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng nghi\u00eam tr\u1ecdng do h\u1eb9p t\u1eafc \u0110M ch\u1ee7 ho\u1eb7c c\u00e1c m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean nh\u01b0 t\u0103ng huy\u1ebft \u00e1p th\u1ee9 ph\u00e1t, \u0111au c\u00e1ch h\u1ed3i \u1edf tay ho\u1eb7c ch\u00e2n c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p ph\u0201u thu\u1eadt ho\u1eb7c t\u00e1i th\u00f4ng m\u1ea1ch m\u00e1u qua \u0111\u01b0\u1eddng \u1ed1ng th\u00f4ng.<\/p>\n

Ph\u0201u thu\u1eadt m\u1ed5 m\u1edf l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ti\u00eau chu\u1ea9n \u0111\u1ed1i v\u1edbi ph\u00ecnh \u0110M ch\u1ee7 do vi\u00eam tuy nhi\u00ean can thi\u1ec7p n\u1ed9i m\u1ea1ch c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o. \u1ede m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, ph\u0201u thu\u1eadt b\u1eafc c\u1ea7u gi\u00fap k\u1ebft qu\u1ea3 d\u00e0i h\u1ea1n t\u1ed1t h\u01a1n so v\u1edbi can thi\u1ec7p n\u1ed9i m\u1ea1ch \u1edf b\u1ec7nh nh\u00e2n vi\u00eam m\u1ea1ch Takayasu. Nguy c\u01a1 th\u1ea5t b\u1ea1i cao h\u01a1n khi can thi\u1ec7p \u1edf b\u1ec7nh nh\u00e2n c\u00f3 t\u00ecnh tr\u1ea1ng vi\u00eam \u0111ang ho\u1ea1t \u0111\u1ed9ng. V\u00ec v\u1eady, n\u00ean \u0111i\u1ec1u tr\u1ecb b\u1eb1ng li\u1ec7u ph\u00e1p \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch \u0111\u1ec3 l\u00e0m gi\u1ea3m t\u00ecnh tr\u1ea1ng vi\u00eam tr\u01b0\u1edbc khi ph\u0201u thu\u1eadt<\/p>\n","protected":false},"excerpt":{"rendered":"

Vi\u00eam \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u00e0 thu\u1eadt ng\u1eef chung d\u00f9ng \u0111\u1ec3 ch\u1ec9 t\u00ecnh tr\u1ea1ng vi\u00eam x\u1ea3y ra t\u1ea1i th\u00e0nh \u0110M ch\u1ee7. Nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t g\u00e2y vi\u00eam m\u1ea1ch kh\u00f4ng do nhi\u1ec5m tr\u00f9ng l\u00e0 vi\u00eam m\u1ea1ch t\u1ebf b\u00e0o kh\u1ed5ng l\u1ed3 (vi\u00eam \u0111\u1ed9ng m\u1ea1ch th\u00e1i d\u01b0\u01a1ng) v\u00e0 vi\u00eam m\u1ea1ch Takayasu. Vi\u00eam \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 1. \u0110\u1ecbnh ngh\u0129a, […]<\/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":"\nVi\u00eam \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 - Vinmec<\/title>\n<meta name=\"description\" content=\"Vi\u00eam \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u0111\u1ec3 ch\u1ec9 t\u00ecnh tr\u1ea1ng vi\u00eam x\u1ea3y ra t\u1ea1i th\u00e0nh \u0110M ch\u1ee7. 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