{"id":30403,"date":"2023-05-04T21:30:55","date_gmt":"2023-05-04T14:30:55","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30403"},"modified":"2023-05-04T21:30:55","modified_gmt":"2023-05-04T14:30:55","slug":"can-lam-sang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/can-lam-sang\/","title":{"rendered":"C\u1eadn l\u00e2m s\u00e0ng b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi m\u1ea1n t\u00ednh-Ph\u1ea7n 2"},"content":{"rendered":"

B\u1ec7nh \u0111\u1ed9ng <\/span><\/span>m\u1ea1ch chi d\u01b0\u1edbi<\/span><\/span><\/a> m\u1ea1n t\u00ednh l\u00e0 t\u00ecnh tr\u1ea1ng t\u1eafc ngh\u1ebdn ho\u1eb7c th\u1eaft l\u01b0ng c\u1ee7a \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean, g\u00e2y ra c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 \u0111au khi \u0111i b\u1ed9, \u0111au khi n\u1eb1m xu\u1ed1ng v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 kh\u00e1c li\u00ean quan \u0111\u1ebfn b\u00e0n ch\u00e2n. <\/span>\u0110\u1ec3 kh\u00e1m ph\u00e1 v\u00e0 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a b\u1ec7nh m\u1ea1ch chi d\u01b0\u1edbi m\u1ea1n t\u00ednh, c\u00e1c th\u0103m d\u00f2 c\u1eadn l\u00e2m s\u00e0ng b\u1ec7nh m\u1ea1ch chi d\u01b0\u1edbi m\u1ea1n t\u00ednh c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111\u01b0\u1ee3c. <\/span>Trong b\u00e0i vi\u1ebft n\u00e0y, ch\u00fang ta s\u1ebd xem x\u00e9t c\u00e1c ph\u01b0\u01a1ng ph\u00e1p th\u0103m d\u00f2 c\u1eadn l\u00e2m s\u00e0ng th\u00f4ng tin \u1ee9ng d\u1ee5ng trong b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi m\u1ea1n t\u00ednh.<\/span><\/span><\/strong><\/p>\n

<\/div>\n
\"C\u1eadn
C\u1eadn l\u00e2m s\u00e0ng b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi<\/figcaption><\/figure>\n

4. Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh m\u1ea1ch m\u00e1u (CLVT)\u00a0<\/span><\/span><\/h2>\n

CLVT cho ph\u00e9p d\u1ef1ng h\u00ecnh \u1ea3nh 3D c\u1ee7a t\u1ed5n th\u01b0\u01a1ng v\u00e0 to\u00e0n b\u1ed9 m\u1ea1ch m\u00e1u, cung c\u1ea5p th\u00f4ng tin v\u1ec1 v\u1ecb tr\u00ed, chi\u1ec1u d\u00e0i v\u00e0 m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng t\u1eeb \u0111\u00f3 h\u01b0\u1edbng d\u1eabn can thi\u1ec7p qua da, c\u0169ng nh\u01b0 \u0111\u00e1nh gi\u00e1 v\u00e0 theo d\u00f5i sau can thi\u1ec7p. <\/span>Ngo\u00e0i ra, CLVT m\u1ea1ch m\u00e1u cho th\u00f4ng tin chi ti\u1ebft v\u1ec1 gi\u1ea3i ph\u1eabu v\u00e0 gi\u1ea3i ph\u1eabu b\u1ea5t th\u01b0\u1eddng m\u1ea1ch, t\u0129nh m\u1ea1ch: Ph\u00ecnh, gi\u1ea3 d\u1ed1i, d\u1ecb d\u1ea1ng m\u1ea1ch m\u00e1u, r\u00f2 \u0111\u1ed9ng-t\u0129nh m\u1ea1ch, v\u1ecb tr\u00ed gi\u1ea3i ph\u1eabu b\u1ea5t th\u01b0\u1eddng, \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c tr\u1ea1ng th\u00e1i th\u00e0nh m\u1ea1ch, c\u00e1c th\u00f4ng tin v\u1ec1 m\u00f4 m\u1ec1m. Tuy nhi\u00ean, ch\u1ee5p CLVT c\u00f3 nh\u1eefng h\u1ea1n ch\u1ebf li\u00ean quan \u0111\u1ebfn Chi\u1ebfu tia x\u1ea1, thu\u1ed1c kh\u00e1ng quang, suy tim, suy th\u1eadn. <\/span>\u0110\u1ed3ng th\u1eddi h\u1ea1n ch\u1ebf \u0111\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng khi th\u00e0nh \u0111\u1ed9ng m\u1ea1ch c\u00f3 stent, h\u00f3a ch\u1ea5t n\u1eb7ng v\u00e0 \u0111\u00e1nh gi\u00e1 \u0111\u1ed9ng m\u1ea1ch nh\u1ecf (\u0111\u1ed9ng m\u1ea1ch v\u00f9ng c\u1eb3ng ch\u00e2n). <\/span>Ngo\u00e0i<\/span><\/span>
\nra, t\u1ed1c \u0111\u1ed9 d\u00f2ng ch\u1ea3y \u0111\u1ebfn h\u1ea1 l\u01b0u gi\u1ea3m khi c\u00f3 t\u00ecnh tr\u1ea1ng h\u00f4n m\u00ea, t\u1eafc ph\u00eda tr\u00ean c\u0169ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn k\u1ebft qu\u1ea3 nghi ng\u1edd.Ch\u1ee5p CLVT hi\u1ec7n l\u00e0 m\u1ed9t th\u0103m d\u00f2 \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn \u0111\u1ea7u ti\u00ean trong ph\u00f2ng ch\u1ed1ng v\u00e0 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 thi\u1ec7t h\u1ea1i M\u1ea1ch chi d\u01b0\u1edbi gi\u00fap quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u ki\u1ec7n t\u1ed1i \u01b0u.<\/span><\/span><\/p>\n

5. Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb m\u1ea1ch m\u00e1u<\/span><\/span><\/h2>\n

Ch\u1ee5p m\u1ea1ch c\u1ed9ng h\u01b0\u1edfng t\u1eeb cho h\u00ecnh \u1ea3nh t\u1ed5ng quan v\u1ec1 h\u1ec7 th\u1ed1ng m\u1ea1ch m\u00e1u, x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh, chi\u1ec1u d\u00e0i v\u00e0 m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng, c\u1ed9ng h\u01b0\u1edfng t\u1eeb thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh t\u1ed1t c\u1ee7a m\u1ea1ch m\u00e1u n\u1ed9i nh\u00e3n v\u00e0 l\u00f2ng m\u1ea1ch. <\/span>Ngo\u00e0i ra, ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb c\u00f2n cho ph\u00e9p \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng t\u1ed1t c\u1ee7a ph\u1ea7n m\u1ec1m xung quanh. <\/span>Do \u0111\u00f3, tr\u00ean l\u00e2m s\u00e0ng, ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb m\u1ea1ch m\u00e1u c\u00f3 ti\u00eam thu\u1ed1c \u0111\u1ed1i quang t\u1eeb gadolinium ch\u1ec9 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh khi c\u1ea7n \u0111\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u k\u1ebft h\u1ee3p \u0111\u00e1nh gi\u00e1 c\u00e1c c\u1ea5u tr\u00fac li\u00ean quan v\u00e0 t\u1ed5n th\u01b0\u01a1ng ph\u1ea7n m\u1ec1m xung quanh. <\/span><\/span>
\nTuy nhi\u00ean, ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb m\u1ea1ch m\u00e1u c\u00f3 gi\u1edbi h\u1ea1n ch\u1ebf \u0111\u1ed9 l\u00e0 m\u00e1y c\u1ed9ng h\u01b0\u1edfng t\u1eeb ph\u1ea3i c\u00f3 l\u1ef1c cao (> 1,5 TESLA), gi\u00e1 th\u00e0nh ng\u01b0\u1ee1ng, d\u1ec5 g\u00e2y nhi\u1ec5u \u1ea3nh, kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ee5p khi c\u00f3 v\u1eadt li\u1ec7u kim lo\u1ea1i trong ng\u01b0\u1eddi , \u0111\u00e1nh gi\u00e1 gi\u1edbi h\u1ea1n trong khi t\u00ecm ki\u1ebfm kho\u1ea3ng c\u00e1ch l\u1edbn, th\u1eddi gian ch\u1ee5p <\/span><\/span>
\nd\u00e0i.<\/span><\/span><\/p>\n

6. Ch\u1ee5p m\u1ea1ch m\u00e1u qua s\u1ed1 h\u00f3a x\u00f3a n\u1ec1n (DSA)<\/span><\/span><\/h2>\n

Ch\u1ee5p m\u1ea1ch m\u00e1u x\u00e2m nh\u1eadp b\u1eb1ng h\u1ec7 th\u1ed1ng ch\u1ee5p m\u1ea1ch s\u1ed1 h\u00f3a x\u00f3a n\u1ec1n l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng nghi ng\u1edd b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u.<\/span><\/span><\/p>\n

6.1. Ch\u1ec9 \u0111\u1ecbnh<\/span><\/span><\/h3>\n


\n<\/em>\u0110\u1ec3 tr\u00e1nh nghi ng\u1edd: DSA gi\u00fap nghi ng\u1edd ch\u00ednh x\u00e1c c\u00e1c lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng, h\u00ecnh th\u00e1i, v\u1ecb tr\u00ed v\u00e0 m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng h\u1ec7 th\u1ed1ng. <\/span>Ch\u1ee5p DSA th\u01b0\u1eddng ch\u1ec9 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh khi c\u00f3 k\u1ebf ho\u1ea1ch ph\u00e1t sinh \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi (n\u1ebfu c\u00f3 th\u1ec3). <\/span>Ch\u1ec9 ch\u1ee5p DSA \u0111\u01a1n thu\u1ea7n l\u00e0 nghi <\/span><\/span>
\nng\u1edd khi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p d\u00f2 t\u00ecm h\u00ecnh \u1ea3nh kh\u00e1c nhau kh\u00f4ng \u0111\u01b0\u1ee3c th\u1ea3o lu\u1eadn ho\u1eb7c c\u00f3 s\u1ef1 b\u1ea5t \u0111\u1ed3ng gi\u1eefa c\u00e1c k\u1ebft qu\u1ea3. <\/span><\/span>
\nKhi ch\u1ee5p DSA th\u01b0\u1eddng k\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ec9 \u0111\u1ecbnh can thi\u1ec7p b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch ho\u1eb7c t\u0129nh m\u1ea1ch d\u1ef1a v\u00e0o l\u00e2m s\u00e0ng v\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p th\u0103m d\u00f2 h\u00ecnh \u1ea3nh kh\u00f4ng x\u00e2m l\u1ea5n: nong b\u00f3ng, \u0111\u1eb7t stent, ngh\u1eb9t coil, ng\u1ea1t d\u00f9, \u0111\u1eb7t l\u01b0\u1edbi l\u1ecdc…<\/span><\/span><\/p>\n

6.2. <\/span>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh t\u01b0\u01a1ng \u0111\u1ed1i<\/span><\/span><\/h3>\n


\n<\/em>D\u1ecb \u1ee9ng v\u1edbi ch\u1ea5t c\u1ea3n quang c\u00f3 ch\u1ee9a i-\u1ed1t <\/span><\/span>
\nSuy th\u1eadn n\u1eb7ng, suy tim sung huy\u1ebft v\u00e0 thi\u1ebfu m\u00e1u n\u1eb7ng. <\/span><\/span>
\nT\u00ecnh tr\u1ea1ng nhi\u1ec5m \u0111\u1ed9c \u0111ang ph\u00e1t tri\u1ec3n, kh\u00f4ng ti\u1ebfn h\u00e0nh \u0111\u01b0\u1ee3c c\u00e1c th\u0103m d\u00f2 g\u00e2y ra m\u00e1u<\/span><\/span><\/p>\n

6.3. <\/span>\u0110\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng<\/span><\/span><\/h3>\n


\n<\/em>T\u1ed5n th\u01b0\u01a1ng c\u01a1\/t\u1eafc m\u1ea1ch h\u1ec7 th\u1ed1ng: \u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a t\u1ed5n th\u01b0\u01a1ng tr\u00ean phim ch\u1ee5p m\u1ea1ch s\u1ed1 h\u00f3a x\u00f3a n\u1ec1n l\u00e0 h\u00ecnh n\u1ec1n thu\u1ed1c gi\u1ea3m \u0111au quang l\u00e0m gi\u1ea3m kh\u1ea9u k\u00ednh \u0111\u1ed9t ng\u1ed9t t\u1ea1i v\u1ecb tr\u00ed c\u01a1 s\u1edf ho\u1eb7c kh\u00f4ng nh\u00ecn th\u1ea5y bi\u1ec3u hi\u1ec7n m\u1ea1ch m\u00e1u l\u00e0m t\u1eafc ngh\u1ebdn ho\u00e0n to\u00e0n to\u00e0n, c\u00f3 th\u1ec3 <\/span><\/span>
\nquan s\u00e1t th\u1ea5y \u0111o\u1ea1n xa sau t\u1eafc nh\u1edd h\u1ec7 th\u1ed1ng tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 th\u1ed1ng. <\/span><\/span>
\nTrong t\u1ed5n th\u01b0\u01a1ng c\u01a1, ch\u00eanh \u00e1p qua ch\u1ed7 t\u1ed5n th\u01b0\u01a1ng tr\u00ean 20 mmHg l\u00e0 m\u1ed9t s\u1ed1 \u0111\u00e1ng tin c\u1eady duy nh\u1ea5t v\u1ec1 t\u1ed5n th\u01b0\u01a1ng c\u00f3 \u00fd ngh\u0129a v\u1ec1 m\u1eb7t huy\u1ebft \u0111\u1ed9ng.<\/span><\/span><\/p>\n

7. \u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 b\u1ec7nh\u00a0<\/span><\/span><\/h2>\n


\n<\/em><\/strong>Vi\u1ec7c \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng, giai \u0111o\u1ea1n t\u1ed5n th\u01b0\u01a1ng l\u00e0 r\u1ea5t quan tr\u1ecdng gi\u00fap th\u1ea7y thu\u1ed1c ra quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi, ch\u00ednh x\u00e1c, t\u1ed1t nh\u1ea5t l\u00e0 l\u1ef1a ch\u1ecdn bi\u1ec7n ph\u00e1p t\u00e1i sinh th\u00f4ng m\u1ea1ch v\u00e0 ch\u1ec9 c\u1eaft c\u1ee5t chi. <\/span>C\u00e1c ph\u00e2n lo\u1ea1i, thang \u0111i\u1ec3m \u0111\u01b0\u1ee3c th\u1ed1ng nh\u1ea5t s\u1eed d\u1ee5ng trong B\u0110MCD bao g\u1ed3m Ph\u00e2n lo\u1ea1i giai \u0111o\u1ea1n b\u1ec7nh theo l\u00e2m s\u00e0ng theo Fontaine v\u00e0 Rutherford; <\/span>thang \u0111i\u1ec3m ph\u00e2n lo\u1ea1i \u0111\u00e1nh gi\u00e1 nguy c\u01a1 c\u1eaft c\u1ee5t chi b\u00ean d\u01b0\u1edbi H\u1ec7 th\u1ed1ng ph\u00e2n lo\u1ea1i WIFI v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m h\u00ecnh th\u00e1i t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch \u2013 khoeo theo TASC<\/span><\/span><\/p>\n

8. T\u1ed5ng k\u1ebft\u00a0<\/span><\/span><\/h2>\n

L\u1ef1a ch\u1ecdn l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tra th\u0103m d\u00f2 th\u00edch h\u1ee3p ph\u1ee5 thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng v\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n, chi ph\u00ed v\u00e0 t\u00e0i nguy\u00ean y t\u1ebf c\u00f3 s\u1eb5n. <\/span>M\u1ed9t s\u1ed1 ph\u01b0\u01a1ng ph\u00e1p nh\u01b0 \u0111o ch\u1ec9 s\u1ed1 ch\u00e2n v\u00e0 si\u00eau \u00e2m Doppler l\u00e0 nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p \u0111\u01a1n gi\u1ea3n v\u00e0 d\u1ec5 ti\u1ebfp c\u1eadn h\u01a1n so v\u1edbi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00e1c nh\u01b0 MRI v\u00e0 CT scan.<\/span><\/span><\/p>\n

T\u1ea7m quan tr\u1ecdng c\u1ee7a vi\u1ec7c th\u0103m d\u00f2 c\u1eadn l\u00e2m s\u00e0ng b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi m\u1ea1n t\u00ednh kh\u1ea3 d\u1ee5ng trong vi\u1ec7c kh\u00e1m ph\u00e1 v\u00e0 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a PAD l\u00e0 v\u00f4 c\u00f9ng quan tr\u1ecdng. <\/span>Vi\u1ec7c tr\u00e1nh \u0111o\u00e1n s\u1edbm v\u00e0 theo d\u00f5i th\u01b0\u1eddng xuy\u00ean c\u00f3 th\u1ec3 gi\u00fap ng\u0103n ng\u1eeba ho\u1eb7c gi\u1ea3m thi\u1ec3u c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a PAD, gi\u00fap b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng t\u1ed1t h\u01a1n.<\/span><\/span><\/p>\n

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

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