{"id":30419,"date":"2023-05-03T15:12:12","date_gmt":"2023-05-03T08:12:12","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30419"},"modified":"2023-05-03T15:12:12","modified_gmt":"2023-05-03T08:12:12","slug":"phinh-dong-mach-chu-bung","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/phinh-dong-mach-chu-bung\/","title":{"rendered":"Ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng"},"content":{"rendered":"

Ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng<\/a> \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 \u0111\u01b0\u1eddng k\u00ednh \u0110M ch\u1ee7 b\u1ee5ng gi\u00e3n tr\u00ean 50% so v\u1edbi \u0111\u01b0\u1eddng k\u00ednh \u0110M ch\u1ee7 tham chi\u1ebfu \u1edf ng\u01b0\u1eddi c\u00f9ng gi\u1edbi, c\u00f9ng l\u1ee9a tu\u1ed5i. <\/strong><\/p>\n

1.T\u1ed5ng quan<\/h2>\n

Ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 \u0111\u01b0\u1eddng k\u00ednh \u0110M ch\u1ee7 b\u1ee5ng gi\u00e3n tr\u00ean 50% so v\u1edbi \u0111\u01b0\u1eddng k\u00ednh \u0110M ch\u1ee7 tham chi\u1ebfu \u1edf ng\u01b0\u1eddi c\u00f9ng gi\u1edbi, c\u00f9ng l\u1ee9a tu\u1ed5i. T\u1ed5n th\u01b0\u01a1ng x\u1ea3y ra \u1edf c\u1ea3 3 l\u1edbp \u00e1o c\u1ee7a th\u00e0nh \u0110M ch\u1ee7. \u1ede ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng, \u0111\u01b0\u1eddng k\u00ednh \u0110M ch\u1ee7 b\u1ee5ng th\u01b0\u1eddng nh\u1ecf h\u01a1n 30 mm.<\/p>\n

2. Ph\u00e2n lo\u1ea1i<\/h2>\n

2.1 Theo k\u00edch th\u01b0\u1edbc:<\/strong><\/h3>\n
    \n
  • Ph\u00ecnh nh\u1ecf: \u0110\u01b0\u1eddng k\u00ednh < 40 mm.<\/li>\n
  • Ph\u00ecnh trung b\u00ecnh: \u0110\u01b0\u1eddng k\u00ednh 40 – 55 mm. Ph\u00ecnh l\u1edbn: \u0110\u01b0\u1eddng k\u00ednh > 55 mm.<\/li>\n
  • Ph\u00ecnh r\u1ea5t l\u1edbn: \u0110\u01b0\u1eddng k\u00ednh > 60 mm.<\/li>\n<\/ul>\n

    2.2 Theo v\u1ecb tr\u00ed:<\/h3>\n
      \n
    • Ph\u00ecnh \u0110M ch\u1ee7 \u0111o\u1ea1n tr\u00ean th\u1eadn: Kh\u1ed1i ph\u00ecnh bao g\u1ed3m 1 ho\u1eb7c nhi\u1ec1u m\u1ea1ch t\u1ea1ng, nh\u01b0ng kh\u00f4ng lan l\u00ean tr\u00ean c\u01a1 ho\u00e0nh.<\/li>\n
    • Ph\u00ecnh \u0110M ch\u1ee7 \u0111o\u1ea1n quanh th\u1eadn: Kh\u1ed1i ph\u00ecnh n\u1eb1m quanh v\u1ecb tr\u00ed xu\u1ea5t ph\u00e1t c\u1ee7a \u0110M th\u1eadn, nh\u01b0ng kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng \u0110M m\u1ea1c treo tr\u00e0ng tr\u00ean k\u00e8m theo.<\/li>\n
    • Ph\u00ecnh \u0110M ch\u1ee7 \u0111o\u1ea1n d\u01b0\u1edbi th\u1eadn: Kh\u1ed1i ph\u00ecnh xu\u1ea5t ph\u00e1t d\u01b0\u1edbi ch\u1ed7 chia \u0110M th\u1eadn.<\/li>\n<\/ul>\n

      3. Y\u1ebfu t\u1ed1 nguy c\u01a1<\/h2>\n
        \n
      • Tu\u1ed5i cao. Nam gi\u1edbi. H\u00fat thu\u1ed1c l\u00e1.<\/li>\n
      • X\u01a1 v\u1eefa m\u1ea1ch m\u00e1u.<\/li>\n
      • T\u0103ng huy\u1ebft \u00e1p.<\/li>\n
      • Ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi b\u1ecb ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng.<\/li>\n<\/ul>\n

        4. Ti\u1ebfn tri\u1ec3n t\u1ef1 nhi\u00ean<\/h2>\n
          \n
        • Ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng ti\u1ebfn tri\u1ec3n v\u1edbi t\u1ed1c \u0111\u1ed9 trung b\u00ecnh 1 – 6 mm\/n\u0103m. Kh\u1ed1i ph\u00ecnh c\u00f3 xu h\u01b0\u1edbng ti\u1ebfn tri\u1ec3n nhanh h\u01a1n \u1edf ng\u01b0\u1eddi nghi\u1ec7n thu\u1ed1c l\u00e1.<\/li>\n
        • Nguy c\u01a1 v\u1ee1 t\u0103ng l\u00ean n\u1ebfu \u0111\u01b0\u1eddng k\u00ednh kh\u1ed1i ph\u00ecnh v\u01b0\u1ee3t qu\u00e1 55 mm, ho\u1eb7c t\u1ed1c \u0111\u1ed9 gi\u00e3n qu\u00e1 5 mm\/6 th\u00e1ng.<\/li>\n
        • Nguy c\u01a1 v\u1ee1 kh\u1ed1i ph\u00ecnh \u1edf n\u1eef gi\u1edbi cao h\u01a1n nam gi\u1edbi.<\/li>\n<\/ul>\n

          5. S\u00e0ng l\u1ecdc<\/h2>\n
            \n
          • C\u00e1c b\u1ec7nh nh\u00e2n c\u1ea7n ti\u1ebfn h\u00e0nh s\u00e0ng l\u1ecdc ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng b\u1eb1ng si\u00eau \u00e2m bao g\u1ed3m: Nam gi\u1edbi > 65 tu\u1ed5i.<\/li>\n
          • Nh\u1eefng ng\u01b0\u1eddi c\u00f3 b\u1ed1 m\u1eb9 hay anh ch\u1ecb em ru\u1ed9t b\u1ecb ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng. C\u00e2n nh\u1eafc n\u1ebfu n\u1eef gi\u1edbi > 65 tu\u1ed5i c\u00f3 ti\u1ec1n s\u1eed nghi\u1ec7n thu\u1ed1c l\u00e1.<\/li>\n
          • Kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh s\u00e0ng l\u1ecdc \u1edf n\u1eef gi\u1edbi kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed gia \u0111\u00ecnh ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng, v\u00e0 kh\u00f4ng h\u00fat thu\u1ed1c l\u00e1.<\/li>\n<\/ul>\n

            6. L\u00e2m s\u00e0ng<\/h2>\n
              \n
            • Th\u01b0\u1eddng kh\u00f4ng tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng \u0111\u1eb7c bi\u1ec7t. 30% b\u1ec7nh nh\u00e2n s\u1edd th\u1ea5y kh\u1ed1i ph\u00ecnh \u0111\u1eadp \u1edf b\u1ee5ng.<\/li>\n
            • \u0110au nhi\u1ec1u v\u00f9ng b\u1ee5ng g\u1ee3i \u00fd ph\u00ecnh \u0110M ch\u1ee7 d\u1ecda v\u1ee1.<\/li>\n
            • Thi\u1ebfu m\u00e1u chi: N\u1ebfu m\u1ea3ng x\u01a1 v\u1eefa, huy\u1ebft kh\u1ed1i t\u1eeb kh\u1ed1i ph\u00ecnh b\u1eafn \u0111i g\u00e2y t\u1eafc m\u1ea1ch.<\/li>\n
            • V\u1ee1 ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng: \u0110au b\u1ee5ng d\u1eef d\u1ed9i, \u0111\u1ed9t ng\u1ed9t, d\u1ea5u hi\u1ec7u s\u1ed1c m\u1ea5t m\u00e1u n\u1ebfu t\u00ecnh tr\u1ea1ng ch\u1ea3y m\u00e1u kh\u00f4ng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t.<\/li>\n<\/ul>\n

              \"H\u00ecnh,<\/p>\n

              H\u00ecnh, \u1ea3nh kh\u1ed1i ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng v\u1ee1<\/strong><\/p>\n

              7. C\u1eadn l\u00e2m s\u00e0ng<\/h2>\n

              Si\u00eau \u00e2m \u1ed5 b\u1ee5ng: \u0110\u1ed9 nh\u1ea1y 98%, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 99% trong ph\u00e1t hi\u1ec7n ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng. Ch\u1ee5p MSCT \u0110M ch\u1ee7 b\u1ee5ng c\u00f3 s\u1eed d\u1ee5ng thu\u1ed1c c\u1ea3n quang: N\u1ebfu ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng c\u00f3 tri\u1ec7u ch\u1ee9ng.<\/p>\n

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

              8.1 Theo d\u00f5i<\/strong><\/h3>\n
                \n
              • C\u00f3 th\u1ec3 theo d\u00f5i \u0111\u1ecbnh k\u1ef3 n\u1ebfu \u0111\u01b0\u1eddng k\u00ednh kh\u1ed1i ph\u00ecnh < 55 mm ho\u1eb7c t\u1ed1c \u0111\u1ed9 ti\u1ebfn tri\u1ec3n < 10 mm\/n\u0103m<\/li>\n
              • \u0110\u01b0\u1eddng k\u00ednh kh\u1ed1i ph\u00ecnh 25 – 29 mm: Theo d\u00f5i b\u1eb1ng si\u00eau \u00e2m 4 n\u0103m 1 l\u1ea7n \u0110\u01b0\u1eddng k\u00ednh kh\u1ed1i ph\u00ecnh 30 – 39 mm: Theo d\u00f5i b\u1eb1ng si\u00eau \u00e2m 3 n\u0103m 1 l\u1ea7n \u0110\u01b0\u1eddng k\u00ednh kh\u1ed1i ph\u00ecnh 40 – 44 mm: Theo d\u00f5i b\u1eb1ng si\u00eau \u00e2m 2 n\u0103m 1 l\u1ea7n \u0110\u01b0\u1eddng k\u00ednh kh\u1ed1i ph\u00ecnh > 45 mm: Theo d\u00f5i b\u1eb1ng si\u00eau \u00e2m m\u1ed7i n\u0103m 1 l\u1ea7n<\/li>\n<\/ul>\n

                8.2 Ki\u1ec3m so\u00e1t y\u1ebfu t\u1ed1 nguy c\u01a1<\/h3>\n
                  \n
                • H\u00fat thu\u1ed1c l\u00e0 l\u00e0m t\u0103ng nhanh k\u00edch th\u01b0\u1edbc kh\u1ed1i ph\u00ecnh, t\u0103ng g\u1ea5p hai l\u1ea7n so v\u1edbi ng\u01b0\u1eddi \u0111\u00e3 b\u1ecf ho\u1eb7c kh\u00f4ng h\u00fat thu\u1ed1c.<\/li>\n
                • Kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng n\u00e0o v\u1ec1 t\u00e1c d\u1ee5ng c\u1ee7a thay \u0111\u1ed5i ch\u1ebf \u0111\u1ed9 \u0103n v\u00e0 l\u1ed1i s\u1ed1ng l\u00ean s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a kh\u1ed1i ph\u00ecnh, nh\u01b0ng c\u00e1c bi\u1ec7n ph\u00e1p tr\u00ean n\u00ean \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao c\u1ee7a ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng.<\/li>\n<\/ul>\n

                  8.3 \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa<\/h3>\n
                    \n
                  • Thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n, ch\u1eb9n beta giao c\u1ea3m, ch\u1eb9n k\u00eanh canxi…<\/li>\n
                  • Nghi\u00ean c\u1ee9u S\u1ee9c kh\u1ecfe Tim m\u1ea1ch \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng > 30 mm cho th\u1ea5y nguy c\u01a1 t\u1eed vong do nh\u1ed3i m\u00e1u c\u01a1 tim trong 10 n\u0103m l\u00e0 38% cao h\u01a1n so v\u1edbi t\u1ef7 l\u1ec7 t\u1eed vong li\u00ean quan \u0111\u1ebfn ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng (ch\u1ec9 c\u00f3 2%). Trong th\u1eed nghi\u1ec7m UKSAT, \u0111\u01b0\u1eddng k\u00ednh kh\u1ed1i ph\u00ecnh l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 d\u1ef1 \u0111o\u00e1n \u0111\u1ed9c l\u1eadp v\u1ec1 t\u1ef7 l\u1ec7 t\u1eed vong do tim m\u1ea1ch (t\u0103ng th\u00eam l\u1ea7n l\u01b0\u1ee3t l\u00e0 1,34 v\u00e0 1,31 l\u1ea7n cho m\u1ed7i 8 mm ti\u1ebfn tri\u1ec3n trong qu\u00e1 tr\u00ecnh theo d\u00f5i v\u00e0 sau ph\u0201u thu\u1eadt). Do \u0111\u00f3, \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa ph\u00ecnh nh\u1ecf \u0110M ch\u1ee7 b\u1ee5ng g\u1ed3m ba m\u1ee5c ti\u00eau: ng\u0103n ng\u1eeba c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch, h\u1ea1n ch\u1ebf t\u0103ng k\u00edch th\u01b0\u1edbc kh\u1ed1i ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng v\u00e0 chu\u1ea9n b\u1ecb b\u1ec7nh nh\u00e2n m\u1ed9t c\u00e1ch t\u1ed1i \u01b0u \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 can thi\u1ec7p, ph\u0201u thu\u1eadt khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh. Nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y \u0111\u1ec1u c\u00f3 nguy c\u01a1 bi\u1ebfn c\u1ed1 tim m\u1ea1ch r\u1ea5t cao, v\u00ec v\u1eady t\u1ea5t c\u1ea3 c\u00e1c bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba bi\u1ebfn c\u1ed1 tim m\u1ea1ch th\u1ee9 ph\u00e1t \u0111\u1ec1u ph\u1ea3i \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng, d\u00f9 ch\u01b0a c\u00f3 th\u1eed nghi\u1ec7m c\u1ee5 th\u1ec3 n\u00e0o tr\u00ean nh\u00f3m b\u1ec7nh nh\u00e2n c\u00f3 ph\u00ecnh nh\u1ecf \u0110M ch\u1ee7 b\u1ee5ng.<\/li>\n
                  • M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u nh\u1ecf \u0111\u00e1nh gi\u00e1 c\u00e1c nh\u00f3m thu\u1ed1c kh\u00e1c nhau nh\u1eb1m gi\u1ea3m s\u1ef1 t\u0103ng k\u00edch th\u01b0\u1edbc kh\u1ed1i ph\u00ecnh \u0110M ch\u1ee7 v\u1edbi c\u01a1 ch\u1ebf gi\u1ea3 thuy\u1ebft l\u00e0 gi\u1ea3m \u00e1p l\u1ef1c l\u00ean th\u00e0nh m\u1ea1ch ho\u1eb7c gi\u1ea3m \u0111\u00e1p \u1ee9ng qu\u00e1 tr\u00ecnh vi\u00eam. Theo h\u01b0\u1edbng d\u0201n ESC m\u1edbi nh\u1ea5t v\u1ec1 \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p, thu\u1ed1c ch\u1eb9n beta l\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u tay cho b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p c\u00f3 k\u00e8m theo ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng. D\u1eef li\u1ec7u v\u1ec1 l\u1ee3i \u00edch c\u1ee7a statin v\u00e0 aspirin trong vi\u1ec7c gi\u1ea3m t\u1ed1c \u0111\u1ed9 t\u0103ng k\u00edch th\u01b0\u1edbc kh\u1ed1i ph\u00ecnh c\u00f2n ch\u01b0a r\u00f5 r\u00e0ng, tuy nhi\u00ean h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n c\u00f3 ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng \u0111\u1ec1u c\u00f3 nguy c\u01a1 b\u1ecb c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch do x\u01a1 v\u1eefa.<\/li>\n<\/ul>\n

                    8.4 Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb<\/h3>\n

                    Ch\u1ec9 \u0111\u1ecbnh: \u0110\u01b0\u1eddng k\u00ednh kh\u1ed1i ph\u00ecnh > 55 mm ho\u1eb7c t\u1ed1c \u0111\u1ed9 ti\u1ebfn tri\u1ec3n > 10 mm\/n\u0103m (\u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n Ch\u00e2u \u00c1 th\u00ec k\u00edch th\u01b0\u1edbc kh\u1ed1i ph\u00ecnh > 50 mm n\u00ean \u0111\u01b0\u1ee3c x\u1eed tr\u00ed).<\/p>\n

                    Bi\u1ec7n ph\u00e1p:<\/p>\n

                      \n
                    • Ph\u0201u thu\u1eadt thay \u0111o\u1ea1n \u0110M ch\u1ee7 b\u1ee5ng nh\u00e2n t\u1ea1o.<\/li>\n
                    • Can thi\u1ec7p n\u1ed9i m\u1ea1ch (EVAR) \u0111\u1eb7t stent-Graft n\u1ebfu gi\u1ea3i ph\u0201u t\u1ed5n th\u01b0\u01a1ng ph\u00f9 h\u1ee3p.<\/li>\n
                    • Ph\u0201u thu\u1eadt s\u1eeda ch\u1eefa c\u00f3 nguy c\u01a1 cao (>5%) v\u1edbi c\u00e1c bi\u1ebfn ch\u1ee9ng tim m\u1ea1ch xung quanh cu\u1ed9c m\u1ed5 (t\u1eed vong, nh\u1ed3i m\u00e1u c\u01a1 tim, \u0111\u1ed9t qu\u1ef5). Can thi\u1ec7p n\u1ed9i m\u1ea1ch \u0110M ch\u1ee7 nguy c\u01a1 th\u1ea5p h\u01a1n (1-5%) so v\u1edbi ph\u0201u thu\u1eadt m\u1edf. Tuy nhi\u00ean hi\u1ec7u qu\u1ea3 l\u00e2u d\u00e0i c\u1ee7a EVAR v\u0201n c\u00f2n l\u00e0 v\u1ea5n \u0111\u1ec1 \u0111\u00e1ng quan t\u00e2m b\u1edfi c\u00e1c bi\u1ebfn ch\u1ee9ng mu\u1ed9n bao g\u1ed3m endoleak, di l\u1ec7ch stent v\u00e0 v\u1ee1 ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng. C\u1ea7n ph\u00e2n t\u1ea7ng nguy c\u01a1 tr\u01b0\u1edbc khi th\u1ef1c hi\u1ec7n can thi\u1ec7p s\u1eeda ch\u1eefa ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng d\u1ef1a v\u00e0o lo\u1ea1i th\u1ee7 thu\u1eadt ti\u1ebfn h\u00e0nh (can thi\u1ec7p n\u1ed9i m\u1ea1ch hay ph\u0201u thu\u1eadt), \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng, c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 v\u00e0 b\u1ec7nh l\u00fd \u0111i k\u00e8m c\u1ee7a m\u1ed7i b\u1ec7nh nh\u00e2n.<\/li>\n<\/ul>\n

                      X\u1eed tr\u00ed ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng v\u1ee1 ho\u1eb7c d\u1ecda v\u1ee1:<\/p>\n

                        \n
                      • Ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng v\u1ee1: Ph\u0201u thu\u1eadt c\u1ea5p c\u1ee9u l\u00e0 ch\u1ec9 \u0111\u1ecbnh tuy\u1ec7t \u0111\u1ed1i.<\/li>\n
                      • Ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng d\u1ecda v\u1ee1: ph\u0201u thu\u1eadt c\u1ea5u c\u1ee9u ho\u1eb7c stent Graft c\u1ea5p c\u1ee9u.<\/li>\n<\/ul>\n

                        9 . Ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng v\u1ee1<\/h2>\n

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

                        H\u1ed9i ch\u1ee9ng kinh \u0111i\u1ec3n tr\u00ean l\u00e2m s\u00e0ng bao g\u1ed3m b\u1ee5ng \u0111au v\u00e0 ch\u01b0\u1edbng b\u1ee5ng, t\u1ee5t huy\u1ebft \u00e1p ch\u1ec9 g\u1eb7p trong kho\u1ea3ng 50% tr\u01b0\u1eddng h\u1ee3p. C\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00e1c tri\u1ec7u ch\u1ee9ng c\u00f3 the kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7.<\/p>\n

                        B\u1ec7nh nh\u00e2n ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng v\u1ee1 t\u1ef1 c\u1ea7m c\u00f3 th\u1ec3 ch\u1ec9 c\u00f3 tri\u1ec7u \u0111au b\u1ee5ng ho\u1eb7c \u0111au l\u01b0ng.<\/p>\n

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

                        Khi v\u1ee1 ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng s\u1ebd h\u00ecnh th\u00e0nh kh\u1ed1i m\u00e1u t\u1ee5 xung quanh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 c\u00f3\/kh\u00f4ng c\u00f3 h\u00ecnh \u1ea3nh d\u1ecbch t\u1ef1 do trong \u1ed5 b\u1ee5ng v\u00e0 d\u1ec5 d\u00e0ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n b\u1eb1ng si\u00eau \u00e2m. Ch\u1ee5p CLVT l\u00e0 ph\u01b0\u01a1ng ti\u1ec7n ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng. C\u00e1c d\u1ea5u hi\u1ec7u g\u1ee3i \u00fd nh\u01b0 t\u0103ng k\u00edch th\u01b0\u1edbc kh\u1ed1i ph\u00ecnh, huy\u1ebft kh\u1ed1i, m\u1ea5t t\u00ednh li\u00ean t\u1ee5c c\u1ee7a v\u00f2ng v\u00f4i ho\u00e1 c\u1ee7a th\u00e0nh \u0110M ch\u1ee7, m\u00e1u t\u1ee5 sau ph\u00fac m\u1ea1c<\/p>\n

                        9.3 \u0110i\u1ec1u tr\u1ecb ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u1ee1<\/h3>\n

                        Chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb \u0111\u1ed1i v\u1edbi ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng v\u1ee1 \u0111ang \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng. Th\u1eed nghi\u1ec7m Amsterdam Acute Aneurysm (AJAX) k\u1ebft lu\u1eadn kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea v\u1ec1 k\u1ebft c\u1ee5c ch\u00ednh, bao g\u1ed3m t\u1ef7 l\u1ec7 t\u1eed vong v\u00e0 c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch ch\u00ednh trong 30 ng\u00e0y gi\u1eefa EVAR v\u00e0 ph\u0201u thu\u1eadt m\u1edf. Nghi\u00ean c\u1ee9u IMPROVE k\u1ebft lu\u1eadn kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c nhau v\u1ec1 t\u1ef7 l\u1ec7 t\u1eed vong sau 30 ng\u00e0y gi\u1eefa can thi\u1ec7p n\u1ed9i m\u1ea1ch v\u00e0 ph\u0201u thu\u1eadt (35,4 so v\u1edbi 37,4%, p = 0,62).<\/p>\n","protected":false},"excerpt":{"rendered":"

                        Ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 \u0111\u01b0\u1eddng k\u00ednh \u0110M ch\u1ee7 b\u1ee5ng gi\u00e3n tr\u00ean 50% so v\u1edbi \u0111\u01b0\u1eddng k\u00ednh \u0110M ch\u1ee7 tham chi\u1ebfu \u1edf ng\u01b0\u1eddi c\u00f9ng gi\u1edbi, c\u00f9ng l\u1ee9a tu\u1ed5i. 1.T\u1ed5ng quan Ph\u00ecnh \u0110M ch\u1ee7 b\u1ee5ng \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 \u0111\u01b0\u1eddng k\u00ednh \u0110M ch\u1ee7 b\u1ee5ng gi\u00e3n tr\u00ean 50% so v\u1edbi \u0111\u01b0\u1eddng k\u00ednh \u0110M […]<\/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":"\nPh\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng - Vinmec<\/title>\n<meta name=\"description\" content=\"Ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng l\u00e0 \u0111\u01b0\u1eddng k\u00ednh \u0110M ch\u1ee7 b\u1ee5ng gi\u00e3n tr\u00ean 50% so v\u1edbi \u0111\u01b0\u1eddng k\u00ednh \u0110M ch\u1ee7 tham chi\u1ebfu \u1edf ng\u01b0\u1eddi c\u00f9ng gi\u1edbi, c\u00f9ng l\u1ee9a tu\u1ed5i.\" \/>\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=\"Ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng - 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