{"id":30297,"date":"2023-05-01T22:40:54","date_gmt":"2023-05-01T15:40:54","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30297"},"modified":"2023-05-01T22:40:54","modified_gmt":"2023-05-01T15:40:54","slug":"ton-thuong-xo-vua-cua-dong-mach-chu","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/01\/ton-thuong-xo-vua-cua-dong-mach-chu\/","title":{"rendered":"T\u1ed5n th\u01b0\u01a1ng x\u01a1 v\u1eefa c\u1ee7a \u0111\u1ed9ng m\u1ea1ch ch\u1ee7"},"content":{"rendered":"

T\u1ed5n th\u01b0\u01a1ng x\u01a1 v\u1eefa c\u1ee7a \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd nguy hi\u1ec3m c\u1ee7a h\u1ec7 th\u1ed1ng tim m\u1ea1ch. B\u1ec7nh n\u00e0y l\u00e0 do qu\u00e1 tr\u00ecnh t\u00edch t\u1ee5 m\u1ed9t ch\u1ea5t b\u00e9o v\u00e0 c\u00e1c t\u1ea1p ch\u1ea5t kh\u00e1c tr\u00ean th\u00e0nh c\u1ee7a \u0111\u1ed9ng m\u1ea1ch, d\u1eabn \u0111\u1ebfn vi\u1ec7c \u0111\u1ed9ng m\u1ea1ch b\u1ecb co r\u00fat v\u00e0 c\u1ea3n tr\u1edf l\u01b0u th\u00f4ng m\u00e1u, g\u00e2y ra c\u00e1c bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m nh\u01b0 \u0111\u1ed9t qu\u1ef5, suy tim v\u00e0 t\u1eed vong.<\/strong><\/p>\n

1.B\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 do thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i<\/h2>\n

B\u1ec7nh \u0110M ch\u1ee7 do thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a b\u1ec7nh l\u00fd x\u01a1 v\u1eefa m\u1ea1ch m\u00e1u, th\u00f4ng qua qu\u00e1 tr\u00ecnh t\u00edch t\u1ee5 c\u00e1c h\u1ea1t m\u1ee1 (lipid) v\u00e0o l\u1edbp \u00e1o trong c\u1ee7a th\u00e0nh \u0110M ch\u1ee7 d\u0201n t\u1edbi qu\u00e1 tr\u00ecnh vi\u00eam th\u1ee9 ph\u00e1t, l\u1eafng \u0111\u1ecdng m\u00f4 x\u01a1 v\u00e0 s\u1ef1 lo\u00e9t b\u1ec1 m\u1eb7t v\u1edbi h\u1eadu qu\u1ea3 cu\u1ed1i c\u00f9ng l\u00e0 thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i (thromboembolic) ho\u1eb7c thuy\u00ean t\u1eafc m\u1ea3ng x\u01a1 v\u1eefa (cholesterol crystal).<\/p>\n

Thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i <\/strong>c\u00f3 th\u1ec3 r\u1ea5t l\u1edbn v\u00e0 c\u00f3 th\u1ec3 l\u00e0m t\u1eafc nh\u1eefng \u0111\u1ed9ng m\u1ea1ch trung b\u00ecnh ho\u1eb7c l\u1edbn g\u00e2y \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u c\u00e1c c\u01a1 quan ph\u1ee7 t\u1ea1ng ( n\u00e3o, th\u1eadn..) ho\u1eb7c c\u00e1c m\u1ea1ch ngo\u1ea1i bi\u00ean. Thuy\u00ean t\u1eafc m\u1ea3ng x\u01a1 v\u1eefa <\/strong>th\u01b0\u1eddng l\u00e0m t\u1eafc ngh\u1ebdn c\u00e1c \u0111\u1ed9ng m\u1ea1ch nh\u1ecf ho\u1eb7c c\u00e1c ti\u1ec3u \u0111\u1ed9ng m\u1ea1ch th\u1ec3 g\u00e2y n\u00ean h\u1ed9i ch\u1ee9ng \u201cng\u00f3n ch\u00e2n xanh\u201d ho\u1eb7c s\u1ef1 xu\u1ea5t hi\u1ec7n\/ x\u1ea5u \u0111i t\u00ecnh tr\u1ea1ng ch\u1ee9c n\u0103ng th\u1eadn, thi\u1ebfu m\u00e1u m\u1ea1c treo.<\/p>\n

\"T\u1ed5n<\/p>\n

T\u1ed5n th\u01b0\u01a1ng x\u01a1 v\u1eefa c\u1ee7a \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/strong><\/p>\n

1.1 D\u1ecbch t\u1ec5 h\u1ecdc<\/h3>\n

Y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i \u0110M ch\u1ee7 gi\u1ed1ng y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a b\u1ec7nh l\u00fd x\u01a1 v\u1eefa c\u00e1c m\u1ea1ch m\u00e1u kh\u00e1c bao g\u1ed3m tu\u1ed5i, gi\u1edbi, t\u0103ng huy\u1ebft \u00e1p, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, t\u0103ng cholesterol m\u00e1u, l\u1ed1i s\u1ed1ng \u00edt v\u1eadn \u0111\u1ed9ng, h\u00fat thu\u1ed1c l\u00e1 v\u00e0 nhi\u1ec5m tr\u00f9ng. Trong nghi\u00ean c\u1ee9u c\u00e1c th\u1ebf h\u1ec7 Framingham, m\u1ea3ng x\u01a1 v\u1eefa \u0110M ch\u1ee7 c\u00f3 \u1edf 46% b\u1ec7nh nh\u00e2n c\u00f3 HA b\u00ecnh th\u01b0\u1eddng khi ch\u1ee5p MRI v\u00e0 g\u1eb7p nhi\u1ec1u h\u01a1n \u1edf n\u1eef gi\u1edbi. D\u00f9 v\u1eady, THA c\u00f3 xu h\u01b0\u1edbng l\u00e0m t\u0103ng g\u00e1nh n\u1eb7ng x\u01a1 v\u1eefa \u0110M ch\u1ee7.<\/p>\n

M\u1ea3ng x\u01a1 v\u1eefa \u0110M ch\u1ee7 c\u00f3 li\u00ean quan v\u1edbi c\u00e1c bi\u1ebfn c\u1ed1 thuy\u00ean t\u1eafc m\u1ea1ch ngo\u1ea1i bi\u00ean v\u00e0 m\u1ea1ch n\u00e3o. M\u1ed1i li\u00ean quan v\u1edbi bi\u1ebfn c\u1ed1 thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i m\u1ea1ch n\u00e3o \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y \u1edf c\u00e1c tr\u01b0\u1eddng h\u1ee3p gi\u1ea3i ph\u0201u t\u1eed thi v\u00e0 c\u00e1c nghi\u00ean c\u1ee9u tr\u00ean b\u1ec7nh nh\u00e2n b\u1ecb \u0111\u1ed9t qu\u1ef5 n\u00e3o kh\u00f4ng t\u1eed vong ho\u1eb7c bi\u1ebfn c\u1ed1 m\u1ea1ch ngo\u1ea1i bi\u00ean c\u0169ng gi\u1ed1ng nh\u01b0 nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao b\u1eb1ng si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n v\u00e0 si\u00eau \u00e2m trong l\u00fac ph\u0201u thu\u1eadt.<\/p>\n

Trong nghi\u00ean c\u1ee9u SPAF, b\u1ec7nh nh\u00e2n c\u00f3 m\u1ea3ng x\u01a1 v\u1eefa \u0110M ch\u1ee7 ph\u1ee9c t\u1ea1p (\u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 m\u1ea3ng x\u01a1 v\u1eefa c\u00f3 huy\u1ebft kh\u1ed1i di \u0111\u1ed9ng ho\u1eb7c lo\u00e9t ho\u1eb7c c\u00f3 b\u1ec1 d\u00e0y > 4 mm b\u1eb1ng si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n) c\u00f3 nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 cao g\u1ea5p 4 l\u1ea7n khi so s\u00e1nh v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 m\u1ea3ng x\u01a1 v\u1eefa.<\/p>\n

Trong nghi\u00ean c\u1ee9u FAPS, nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 m\u1ea3ng x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 > 4 mm l\u00e0 y\u1ebfu t\u1ed1 ti\u00ean l\u01b0\u1ee3ng \u0111\u1ed9c l\u1eadp l\u00e0m t\u0103ng 3,8 l\u1ea7n nguy c\u01a1 t\u00e1i nh\u1ed3i m\u00e1u c\u01a1 tim v\u00e0 t\u0103ng 3,5 l\u1ea7n nguy c\u01a1 c\u00e1c bi\u1ebfn c\u1ed1 m\u1ea1ch m\u00e1u kh\u00e1c. T\u1ef7 l\u1ec7 c\u1ee7a m\u1ea3ng x\u01a1 v\u1eefa n\u1eb7ng cung \u0110M ch\u1ee7 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb \u0111\u1ed9t qu\u1ef5 n\u00e3o c\u1ea5p > 20% so v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 c\u00f9ng c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 nh\u01b0 rung nh\u0129 v\u00e0 x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh. H\u01a1n n\u1eefa, h\u1ea7u h\u1ebft c\u00e1c nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y \u0111\u1ec1u ch\u1ee9ng minh r\u1eb1ng s\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a c\u00e1c m\u1ea3ng x\u01a1 v\u1eefa \u0111\u1ec1u li\u00ean quan v\u1edbi nhi\u1ec1u bi\u1ebfn c\u1ed1 m\u1ea1ch m\u00e1u h\u01a1n.<\/p>\n

Bi\u1ebfn c\u1ed1 thuy\u00ean t\u1eafc c\u00f3 th\u1ec3 x\u1ea3y ra trong qu\u00e1 tr\u00ecnh th\u1ef1c hi\u1ec7n c\u00e1c th\u1ee7 thu\u1eadt th\u00f4ng tim can thi\u1ec7p, trong \u0111\u1eb7t b\u00f3ng \u0111\u1ed1i xung \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 ph\u0201u thu\u1eadt tim m\u1ea1ch. Trong m\u1ed9t nghi\u00ean c\u1ee9u t\u1ed5ng h\u1ee3p, nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 d\u01b0\u1eddng nh\u01b0 th\u1ea5p h\u01a1n khi th\u1ef1c hi\u1ec7n \u0111\u01b0\u1eddng v\u00e0o b\u1eb1ng m\u1ea1ch quay so v\u1edbi m\u1ea1ch \u0111\u00f9i tuy nhi\u00ean s\u1ef1 kh\u00e1c bi\u1ec7t n\u00e0y kh\u00f4ng c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea (0.1 v\u00e0 0.5, p = 0,22). X\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u00ean l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 ch\u00ednh cho \u0111\u1ed9t qu\u1ef5 sau ph\u0201u thu\u1eadt. M\u1ee9c \u0111\u1ed9 nguy c\u01a1 ph\u1ee5 thu\u1ed9c v\u00e0o v\u1ecb tr\u00ed v\u00e0 m\u1ee9c \u0111\u1ed9 x\u01a1 v\u1eefa. Trong m\u1ed9t nghi\u00ean c\u1ee9u g\u1ed3m 921 b\u1ec7nh nh\u00e2n tr\u1ea3i qua ph\u0201u thu\u1eadt tim m\u1ea1ch, t\u1ef7 l\u1ec7 bi\u1ebfn c\u1ed1 \u0111\u1ed9t qu\u1ef5 \u1edf b\u1ec7nh nh\u00e2n c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 b\u1ec7nh l\u00fd x\u01a1 v\u1eefa c\u1ee7a \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u00ean l\u1ea7n l\u01b0\u1ee3t 8,7% v\u00e0 1,8%, (p < 0.0001).<\/p>\n

Nghi\u1ec7m ph\u00e1p ch\u1ea9n \u0111o\u00e1n v\u00e0 c\u00e1c th\u1ee7 thu\u1eadt tr\u01b0\u1edbc, trong m\u1ed5 nh\u01b0 \u0111\u1eb7t l\u01b0\u1edbi l\u1ecdc trong l\u00f2ng \u0110M ch\u1ee7, ph\u0201u thu\u1eadt b\u1eafc c\u1ea7u ch\u1ee7 v\u00e0nh kh\u00f4ng s\u1eed d\u1ee5ng tim – ph\u1ed5i nh\u00e2n t\u1ea1o, k\u1eb9p \u0110M ch\u1ee7 \u0111\u01a1n thu\u1ea7n c\u00f3 th\u1ec3 gi\u1ea3m t\u1ef7 l\u1ec7 bi\u1ebfn c\u1ed1 thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i.<\/p>\n

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

M\u1ea3ng x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c chia th\u00e0nh m\u1ea3ng x\u01a1 v\u1eefa nh\u1ecf, trung b\u00ecnh v\u00e0 l\u1edbn.<\/p>\n

Si\u00eau \u00e2m tim qua th\u00e0nh ng\u1ef1c c\u00f3 th\u1ec3 cho nh\u1eefng h\u00ecnh \u1ea3nh r\u00f5 n\u00e9t v\u1ec1 \u0111\u1ea7u g\u1ea7n \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u00ean v\u00e0 g\u1ed1c \u0110M ch\u1ee7. Si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p kh\u00f4ng x\u00e2m l\u1ea5n c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 g\u00e1nh n\u1eb7ng x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch ch\u1ee7. Si\u00eau \u00e2m th\u1ef1c qu\u1ea3n 3D c\u00f2n cho nh\u1eefng h\u00ecnh \u1ea3nh c\u00f3 ch\u1ea5t l\u01b0\u1ee3ng t\u1ed1t h\u01a1n. Si\u00eau \u00e2m \u0110M ch\u1ee7 2D ho\u1eb7c 3D trong l\u00fac ph\u0201u thu\u1eadt c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0a ra nh\u1eefng th\u00f4ng tin c\u00f3 gi\u00e1 tr\u1ecb.<\/p>\n

Ch\u1ee5p CLVT \u0111a d\u00e3y cho nh\u1eefng h\u00ecnh \u1ea3nh kh\u00e1 r\u00f5 n\u00e9t v\u1ec1 m\u1ea3ng x\u01a1 v\u1eefa, c\u0169ng nh\u01b0 gi\u1ea3i ph\u0201u v\u00e0 m\u1ee9c \u0111\u1ed9 canxi h\u00f3a \u0110M ch\u1ee7. Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb c\u00f3 th\u1ec3 \u0111\u01b0a ra nh\u1eefng th\u00f4ng tin r\u00f5 n\u00e9t nh\u1ea5t v\u1ec1 c\u1ea5u tr\u00fac m\u1ea3ng x\u01a1 v\u1eefa.<\/p>\n

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

Thu\u1ed1c ch\u1ed1ng huy\u1ebft kh\u1ed1i (kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u v\u00e0 kh\u00e1ng vitamin K)<\/strong><\/p>\n

\u0110\u1ec3 gi\u1ea3m thi\u1ec3u nguy c\u01a1 thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i, thu\u1ed1c kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u v\u00e0 thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u1ec1u c\u00f3 th\u1ec3 xem x\u00e9t s\u1eed d\u1ee5ng. Tuy nhi\u00ean nh\u1eefng nghi\u00ean c\u1ee9u v\u1ec1 s\u1eed d\u1ee5ng c\u1ea3 2 li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u00e0y c\u00f2n r\u1ea5t \u00edt v\u00e0 ch\u1ee7 y\u1ebfu l\u00e0 c\u00e1c nghi\u00ean c\u1ee9u nh\u1ecf, kh\u00f4ng ng\u0201u nhi\u00ean. Wafarin \u0111\u00e3 \u0111\u01b0\u1ee3c d\u00f9ng cho m\u1ee5c \u0111\u00edch d\u1ef1 ph\u00f2ng ti\u00ean ph\u00e1t ho\u1eb7c th\u1ee9 ph\u00e1t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 m\u1ea3ng x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch ch\u1ee7. Nghi\u00ean c\u1ee9u Patent Foramen Ovale in Cryptogenic Stroke study (PICSS) cho th\u1ea5y t\u1ef7 l\u1ec7 xu\u1ea5t hi\u1ec7n bi\u1ebfn c\u1ed1 trong to\u00e0n b\u1ed9 nh\u00f3m b\u1ec7nh nh\u00e2n nghi\u00ean c\u1ee9u (n = 516, v\u00e0 c\u00f3 337 b\u1ec7nh nh\u00e2n c\u00f3 m\u1ea3ng x\u01a1 v\u1eefa \u0110M ch\u1ee7) l\u00e0 nh\u01b0 nhau gi\u1eefa 2 nh\u00f3m s\u1eed d\u1ee5ng warfarin v\u00e0 aspirin (16,4% so v\u1edbi 15,8%, p = 0,43<\/em>) v\u00e0 kh\u00f4ng c\u00f3 m\u1ed1i li\u00ean quan gi\u1eefa vi\u1ec7c s\u1eed d\u1ee5ng warfarin ho\u1eb7c s\u1ef1 c\u00f3 m\u1eb7t c\u1ee7a m\u1ea3ng x\u01a1 v\u1eefa l\u1edbn l\u00ean nguy c\u01a1 xu\u1ea5t hi\u1ec7n c\u00e1c bi\u1ebfn c\u1ed1.<\/p>\n

Trong nghi\u00ean c\u1ee9u Stroke Prevention in Atrial Fibrillation III, b\u1ec7nh nh\u00e2n rung nh\u0129 c\u00f3 k\u00e8m m\u1ea3ng x\u01a1 v\u1eefa \u0110M ch\u1ee7 c\u00f3 nguy c\u01a1 cao xu\u1ea5t hi\u1ec7n bi\u1ebfn c\u1ed1 thuy\u00ean t\u1eafc. V\u00ec v\u1eady, m\u1ea3ng x\u01a1 v\u1eefa \u0110M ch\u1ee7 \u0111\u01b0\u1ee3c coi l\u00e0 b\u1ec7nh m\u1ea1ch m\u00e1u v\u00e0 c\u00f3 m\u1eb7t trong thang \u0111i\u1ec3m CHA2DS2- VASc l\u01b0\u1ee3ng gi\u00e1 nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 \u1edf b\u1ec7nh nh\u00e2n rung nh\u0129 kh\u00f4ng do b\u1ec7nh van tim.<\/p>\n

C\u00e1c thu\u1ed1c h\u1ea1 lipid m\u00e1u<\/strong><\/p>\n

Hi\u1ec7n t\u1ea1i ch\u01b0a c\u00f3 b\u1eb1ng ch\u1ee9ng n\u00e0o \u1ee7ng h\u1ed9 vai tr\u00f2 c\u1ee7a statin \u0111\u1ed1i v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 do nguy\u00ean nh\u00e2n thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i. Statin l\u00e0m gi\u1ea3m g\u00e1nh n\u1eb7ng x\u01a1 v\u1eefa khi \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 b\u1eb1ng CHT ho\u1eb7c gi\u1ea3m qu\u00e1 tr\u00ecnh vi\u00eam khi \u0111\u00e1nh gi\u00e1 b\u1eb1ng PET.<\/p>\n

C\u1ea7n c\u00f3 c\u00e1c th\u00eam nghi\u00ean c\u1ee9u nh\u1eb1m \u0111\u00e1nh gi\u00e1 vai tr\u00f2 c\u1ee7a statin trong gi\u1ea3m nguy c\u01a1 tai bi\u1ebfn m\u1ea1ch n\u00e3o \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 m\u1ea3ng x\u01a1 v\u1eefa l\u1edbn \u0111\u1ed9ng m\u1ea1ch ch\u1ee7. Trong m\u1ed9t nghi\u00ean c\u1ee9u h\u1ed3i c\u1ee9u tr\u00ean 519 b\u1ec7nh nh\u00e2n c\u00f3 x\u01a1 v\u1eefa n\u1eb7ng \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng statin, nguy c\u01a1 xu\u1ea5t hi\u1ec7n c\u00e1c bi\u1ebfn c\u1ed1 gi\u1ea3m 70%.<\/p>\n

Can thi\u1ec7p v\u00e0 ph\u1eabu thu\u1eadt<\/strong><\/p>\n

Hi\u1ec7n t\u1ea1i kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng r\u00f5 r\u00e0ng v\u1ec1 vai tr\u00f2 c\u1ee7a ph\u0201u thu\u1eadt b\u00f3c m\u1ea3ng x\u01a1 v\u1eefa ho\u1eb7c can thi\u1ec7p \u0111\u1eb7t stent quai \u0110M ch\u1ee7 trong d\u1ef1 ph\u00f2ng nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 n\u00e3o \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y. Trong khi \u0111\u00f3 ph\u0201u thu\u1eadt v\u00f9ng quai \u0110M ch\u1ee7 l\u00e0 m\u1ed9t ph\u0201u thu\u1eadt nguy c\u01a1 cao v\u00e0 v\u00ec v\u1eady hi\u1ec7n t\u1ea1i kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o.<\/p>\n

2. Huy\u1ebft kh\u1ed1i \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 di \u0111\u1ed9ng<\/h2>\n

Huy\u1ebft kh\u1ed1i \u0110M ch\u1ee7 di \u0111\u1ed9ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n tr\u1ebb kh\u00f4ng c\u00f3 b\u1ec7nh l\u00fd x\u01a1 v\u1eefa lan t\u1ecfa \u0111\u00e3 b\u1eaft \u0111\u1ea7u \u0111\u01b0\u1ee3c ghi nh\u1eadn t\u1eeb khi si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ebfn c\u1ed1 thuy\u00ean t\u1eafc m\u1ea1ch n\u00e3o v\u00e0 m\u1ea1ch ngo\u1ea1i vi, h\u1ea7u h\u1ebft \u1edf v\u1ecb tr\u00ed quai \u0110M ch\u1ee7.<\/p>\n

Sinh l\u00fd b\u1ec7nh c\u1ee7a nh\u1eefng t\u1ed5n th\u01b0\u01a1ng n\u00e0y c\u0169ng ch\u01b0a \u0111\u01b0\u1ee3c hi\u1ec3u r\u00f5, c\u00e1c b\u1eb1ng ch\u1ee9ng v\u1ec1 t\u01b0\u01a1ng quan v\u1edbi t\u00ecnh tr\u1ea1ng t\u0103ng \u0111\u00f4ng c\u0169ng kh\u00f4ng r\u00f5 r\u00e0ng. M\u1ed9t nghi\u00ean c\u1ee9u ghi nh\u1eadn trong s\u1ed1 23 b\u1ec7nh nh\u00e2n c\u00f3 huy\u1ebft kh\u1ed1i di \u0111\u1ed9ng \u1edf quai \u0110M ch\u1ee7 th\u00ec ch\u1ec9 c\u00f3 4 b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n t\u00ecnh tr\u1ea1ng t\u0103ng \u0111\u00f4ng.<\/p>\n

Huy\u1ebft kh\u1ed1i c\u00f3 th\u1ec3 g\u00e2y t\u00ecnh tr\u1ea1ng t\u1eafc m\u1ea1ch ngh\u1ecbch th\u01b0\u1eddng qua l\u1ed7 b\u1ea7u d\u1ee5c.<\/p>\n

\u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa (d\u00f9ng heparin), \u0111\u1eb7t stent n\u1ed9i m\u1ea1ch ho\u1eb7c ph\u0201u thu\u1eadt \u0111\u1ec1u \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u01b0a ra tuy nhi\u00ean v\u0201n ch\u01b0a c\u00f3 c\u00e1c d\u1eef li\u1ec7u \u0111\u1ee7 \u0111\u1ec3 \u0111\u01b0a ra khuy\u1ebfn c\u00e1o v\u1ec1 ph\u01b0\u01a1ng th\u1ee9c \u0111i\u1ec1u tr\u1ecb n\u00e0y.<\/p>\n

3. T\u1eafc \u0110M ch\u1ee7 do x\u01a1 v\u1eefa m\u1ea1ch<\/h2>\n

Kh\u00e1 hi\u1ebfm g\u1eb7p v\u00e0 c\u00f3 th\u1ec3 d\u0201n \u0111\u1ebfn nguy c\u01a1 c\u1eaft c\u1ee5t chi v\u00e0 t\u1eed vong. S\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m nguy c\u01a1 thi\u1ebfu m\u00e1u c\u1ea5p t\u00ednh n\u1ebfu qu\u00e1 tr\u00ecnh t\u1eafc ngh\u1ebdn ti\u1ebfn tri\u1ec3n t\u1eeb t\u1eeb.<\/p>\n

C\u00e1c y\u1ebfu t\u1ed1 b\u1ec7nh sinh bao g\u1ed3m: k\u00edch th\u01b0\u1edbc m\u1ea1ch nh\u1ecf, huy\u1ebft kh\u1ed1i t\u1eeb tim, l\u00f3c t\u00e1ch \u0110M<\/p>\n

ch\u1ee7, h\u1eb9p eo \u0110M ch\u1ee7 ph\u1ea7n xa, t\u00ecnh tr\u1ea1ng t\u0103ng \u0111\u00f4ng.<\/p>\n

B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng ho\u1eb7c c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng \u0111au c\u00e1ch h\u1ed3i \u0111\u1ed9t ng\u1ed9t. Tri\u1ec7u ch\u1ee9ng c\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n n\u1eb7ng h\u01a1n khi tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 b\u1ecb t\u1eafc ngh\u1ebdn v\u00e0 ph\u1ee5 thu\u1ed9c v\u00e0o v\u1ecb tr\u00ed v\u00e0 m\u1ee9c \u0111\u1ed9 t\u1eafc ngh\u1ebdn c\u00f3 th\u1ec3 g\u00e2y n\u00ean t\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u n\u1eb7ng 2 chi d\u01b0\u1edbi, t\u1ee7y s\u1ed1ng, ru\u1ed9t, th\u1eadn.<\/p>\n

Ch\u1ea9n \u0111o\u00e1n ch\u1ee7 y\u1ebfu d\u1ef1a v\u00e0o si\u00eau \u00e2m Doppler. C\u00e1c ph\u01b0\u01a1ng ti\u1ec7n ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh kh\u00e1c nh\u01b0 CT v\u00e0 MRI cho c\u00e1c th\u00f4ng tin chi ti\u1ebft h\u01a1n \u0111\u1ec3 h\u01b0\u1edbng d\u0201n l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb.<\/p>\n

C\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u0201u thu\u1eadt b\u1eafc c\u1ea7u, ph\u0201u thu\u1eadt b\u00f3c t\u00e1ch \u0110M ch\u1ee7 – ch\u1eadu, can thi\u1ec7p n\u1ed9i m\u1ea1ch c\u0169ng c\u00f3 th\u1ec3 xem x\u00e9t.<\/p>\n

4. Canxi h\u00f3a \u0110M ch\u1ee7<\/h2>\n

Th\u01b0\u1eddng x\u1ea3y ra \u1edf l\u1edbp \u00e1o gi\u1eefa, m\u1ee9c \u0111\u1ed9 canxi h\u00f3a tr\u1ef1c ti\u1ebfp li\u00ean quan \u0111\u1ebfn m\u1ee9c \u0111\u1ed9 x\u01a1 v\u1eefa m\u1ea1ch. X\u01a1 v\u1eefa \u0110M ch\u1ee7 n\u1eb7ng th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n h\u00ecnh \u1ea3nh \u201cv\u1ecf tr\u1ee9ng\u201d tr\u00ean xquang (\u0110M ch\u1ee7 s\u1ee9). V\u00f4i h\u00f3a \u0110M ch\u1ee7 \u1ea3nh h\u01b0\u1edfng nhi\u1ec1u \u0111\u1ebfn c\u00e1c ph\u0201u thu\u1eadt, th\u1ee7 thu\u1eadt li\u00ean quan \u0111\u1ebfn \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, k\u1eb9p clamp trong ph\u0201u thu\u1eadt \u0110M ch\u1ee7, ph\u0201u thu\u1eadt b\u1eafc c\u1ea7u ch\u1ee7 – v\u00e0nh, l\u00e0m t\u0103ng nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 n\u00e3o v\u00e0 thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i \u0111o\u1ea1n xa.<\/p>\n

5. \u0110\u1ed9ng m\u1ea1ch ch\u1ee7 d\u1ea1ng \u201csan h\u00f4\u201d<\/h2>\n

L\u00e0 m\u1ed9t th\u1ec3 b\u1ec7nh r\u1ea5t hi\u1ebfm g\u1eb7p. Bi\u1ec3u hi\u1ec7n b\u1eb1ng t\u00ecnh tr\u1ea1ng canxi h\u00f3a v\u00e0 h\u1eb9p \u0110M ch\u1ee7 \u1edf v\u1ecb tr\u00ed quanh th\u1eadn v\u00e0 tr\u00ean th\u1eadn. Trong 1 b\u00e1o c\u00e1o \u1edf tr\u00ean 80 ca c\u00f3 \u0110M ch\u1ee7 d\u1ea1ng san h\u00f4, b\u1ec7nh ch\u1ee7 y\u1ebfu g\u1eb7p \u1edf n\u1eef gi\u1edbi v\u00e0 tr\u00ean 24 tu\u1ed5i.<\/p>\n

\u0110M ch\u1ee7 d\u1ea1ng \u201csan h\u00f4\u201d \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 b\u1eb1ng h\u00ecnh \u1ea3nh canxi h\u00f3a nh\u01b0 \u0111\u00e1 trong l\u00f2ng \u0110M ch\u1ee7 v\u00e0 c\u00e1c m\u1ea1ch t\u1ea1ng. Nh\u1eefng t\u1ed5n th\u01b0\u01a1ng canxi h\u00f3a n\u00e0y t\u0103ng d\u1ea7n v\u1ec1 k\u00edch th\u01b0\u1edbc v\u00e0 m\u1ee9c \u0111\u1ed9 lan t\u1ecfa, g\u00e2y h\u1eb9p ti\u1ebfn tri\u1ec3n nhi\u1ec1u l\u00f2ng m\u1ea1ch v\u00e0 h\u1eadu qu\u1ea3 l\u00e0 t\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u ru\u1ed9t, suy th\u1eadn,t\u0103ng huy\u1ebft \u00e1p th\u1ee9 ph\u00e1t.<\/p>\n

Nguy\u00ean nh\u00e2n v\u00e0 c\u01a1 ch\u1ebf sinh b\u1ec7nh h\u1ecdc c\u1ee7a b\u1ec7nh v\u0201n c\u00f2n ch\u01b0a r\u00f5 r\u00e0ng. Ph\u0201u thu\u1eadt \u0111\u00e3 t\u1eebng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong qu\u00e1 kh\u1ee9, tuy nhi\u00ean g\u1ea7n \u0111\u00e2y can thi\u1ec7p n\u1ed9i m\u1ea1ch d\u1ea7n \u0111\u00f3ng vai tr\u00f2 l\u1edbn h\u01a1n \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao v\u1edbi nhi\u1ec1u b\u1ec7nh l\u00fd k\u00e8m theo.<\/p>\n","protected":false},"excerpt":{"rendered":"

T\u1ed5n th\u01b0\u01a1ng x\u01a1 v\u1eefa c\u1ee7a \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd nguy hi\u1ec3m c\u1ee7a h\u1ec7 th\u1ed1ng tim m\u1ea1ch. 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