{"id":30448,"date":"2023-05-03T15:11:12","date_gmt":"2023-05-03T08:11:12","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30448"},"modified":"2023-05-03T15:11:12","modified_gmt":"2023-05-03T08:11:12","slug":"hep-eo-dong-mach-chu","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/hep-eo-dong-mach-chu\/","title":{"rendered":"H\u1eb9p eo \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

H\u1eb9p eo \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 s\u1ef1 thu h\u1eb9p c\u1ee7a \u0110M ch\u1ee7 \u1edf g\u1ea7n v\u1ecb tr\u00ed c\u1ee7a d\u00e2y ch\u1eb1ng \u0111\u1ed9ng m\u1ea1ch ngay ph\u00eda xa nguy\u00ean \u1ee7y c\u1ee7a \u0110M d\u01b0\u1edbi \u0111\u00f2n tr\u00e1i, g\u00e2y c\u1ea3n tr\u1edf d\u00f2ng m\u00e1u tr\u01b0\u1edbc ch\u1ed7 h\u1eb9p, d\u1ea7n t\u1edbi t\u0103ng \u00e1p l\u1ef1c, ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i v\u00e0 suy tim.<\/strong><\/p>\n

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

H\u1eb9p eo \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/a> \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 s\u1ef1 thu h\u1eb9p c\u1ee7a \u0110M ch\u1ee7 \u1edf g\u1ea7n v\u1ecb tr\u00ed c\u1ee7a d\u00e2y ch\u1eb1ng \u0111\u1ed9ng m\u1ea1ch ngay ph\u00eda xa nguy\u00ean \u1ee7y c\u1ee7a \u0110M d\u01b0\u1edbi \u0111\u00f2n tr\u00e1i, g\u00e2y c\u1ea3n tr\u1edf d\u00f2ng m\u00e1u tr\u01b0\u1edbc ch\u1ed7 h\u1eb9p, d\u1ea7n t\u1edbi t\u0103ng \u00e1p l\u1ef1c, ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i v\u00e0 suy tim. Ch\u1ed7 h\u1eb9p eo c\u00f3 th\u1ec3 l\u00e0 th\u1eaft h\u1eb9p ho\u1eb7c h\u1eb9p h\u00ecnh \u1ed1ng tr\u00ean \u0111o\u1ea1n d\u00e0i v\u00e0 c\u00f3 tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7. C\u00e1c b\u1ea5t th\u01b0\u1eddng \u0111i k\u00e8m th\u01b0\u1eddng g\u1eb7p l\u00e0 van \u0110M ch\u1ee7 hai l\u00e1 van, c\u00f2n \u1ed1ng \u0111\u1ed9ng m\u1ea1ch ho\u1eb7c th\u00f4ng li\u00ean th\u1ea5t.<\/p>\n

2. D\u1ecbch t\u1ec5 h\u1ecdc<\/h2>\n
    \n
  • T\u1ef7 l\u1ec7 hi\u1ec7n m\u1eafc h\u1eb9p eo \u0110M ch\u1ee7 kho\u1ea3ng 4\/10.000 tr\u1ebb m\u1edbi sinh v\u00e0 6 – 8% tr\u01b0\u1eddng h\u1ee3p tim b\u1ea9m sinh, t\u1ef7 l\u1ec7 nam n\u1eef l\u00e0 1,7:1.<\/li>\n
  • Di truy\u1ec1n: M\u1eb7c d\u00f9 kh\u00f4ng c\u00f3 \u0111\u1ed9t bi\u1ebfn gen \u0111\u1eb7c hi\u1ec7u n\u00e0o \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh, tuy nhi\u00ean \u0111\u00e3 c\u00f3 nh\u1eefng b\u00e1o c\u00e1o v\u1ec1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p h\u1eb9p eo \u0110M ch\u1ee7 c\u00f3 t\u00ednh ch\u1ea5t gia \u0111\u00ecnh. H\u1eb9p eo \u0110M ch\u1ee7 c\u00f3 th\u1ec3 g\u1eb7p trong h\u1ed9i ch\u1ee9ng Williams-Beuren, h\u1ed9i ch\u1ee9ng Sturge-Weber. 30% b\u1ec7nh nh\u00e2n h\u1ed9i ch\u1ee9ng Turner c\u00f3 h\u1eb9p eo \u0110M ch\u1ee7 v\u00e0 5 – 15% b\u1ec7nh nh\u00e2n n\u1eef h\u1eb9p eo \u0110M ch\u1ee7 c\u00f3 h\u1ed9i ch\u1ee9ng Turner.<\/li>\n
  • C\u00f3 th\u1ec3 g\u1eb7p h\u1eb9p eo \u0110M ch\u1ee7 m\u1eafc ph\u1ea3i do qu\u00e1 tr\u00ecnh vi\u00eam trong m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd nh\u01b0 vi\u00eam m\u1ea1ch Takayasu ho\u1eb7c x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch.<\/li>\n<\/ul>\n

    3. Sinh l\u00fd b\u1ec7nh<\/h2>\n

    C\u01a1 ch\u1ebf sinh l\u00fd b\u1ec7nh ch\u00ednh x\u00e1c v\u0201n ch\u01b0a r\u00f5 r\u00e0ng. Hai gi\u1ea3 thuy\u1ebft ch\u00ednh \u0111\u01b0\u1ee3c \u0111\u01b0a ra: gi\u1ea3m d\u00f2ng m\u00e1u t\u1edbi t\u1eed cung d\u0201n t\u1edbi k\u00e9m ph\u00e1t tri\u1ec3n quai \u0110M ch\u1ee7 c\u1ee7a b\u00e0o thai v\u00e0 s\u1ef1 lan r\u1ed9ng b\u1ea5t th\u01b0\u1eddng c\u1ee7a m\u00f4 t\u1eeb \u1ed1ng \u0110M v\u00e0o th\u00e0nh \u0110M ch\u1ee7 c\u1ee7a thai nhi.<\/p>\n

    Trong h\u1eb9p eo \u0110M ch\u1ee7, th\u00e0nh \u0110M ch\u1ee7 c\u00f3 nh\u1eefng b\u1ea5t th\u01b0\u1eddng nh\u01b0 ho\u1ea1i t\u1eed d\u1ea1ng nang l\u1edbp \u00e1o gi\u1eefa, t\u0103ng \u0111\u1ed9 c\u1ee9ng v\u00e0 gi\u1ea3m kh\u1ea3 n\u0103ng co gi\u00e3n, t\u0103ng cao th\u00e0nh ph\u1ea7n collagen v\u00e0 gi\u1ea3m kh\u1ed1i l\u01b0\u1ee3ng c\u01a1 tr\u01a1n \u1edf \u0111o\u1ea1n tr\u01b0\u1edbc h\u1eb9p.<\/p>\n

    \"h\u1eb9p<\/p>\n

    H\u1eb9p eo \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/strong><\/p>\n

    4. Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng<\/h2>\n

    Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a h\u1eb9p eo \u0110M ch\u1ee7 ph\u1ee5 thu\u1ed9c v\u00e0o th\u1eddi gian ph\u00e1t hi\u1ec7n b\u1ec7nh, m\u1ee9c \u0111\u1ed9 h\u1eb9p eo \u0110M ch\u1ee7 v\u00e0 s\u1ef1 ph\u00e1t tri\u1ec3n tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7.<\/p>\n

    Tr\u1ebb s\u01a1 sinh c\u00f3 h\u1eb9p eo \u0110M ch\u1ee7 n\u1eb7ng c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng suy tim v\u00e0\/ho\u1eb7c s\u1ed1c khi \u1ed1ng \u0110M \u0111\u00f3ng l\u1ea1i. Tr\u1ebb c\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng n\u1ebfu h\u1eb9p eo \u0110M ch\u1ee7 m\u1ee9c \u0111\u1ed9 kh\u00f4ng n\u1eb7ng ho\u1eb7c t\u1ed3n t\u1ea1i \u1ed1ng \u0110M.<\/p>\n

    \u0110\u1ebfn tu\u1ed5i tr\u01b0\u1edfng th\u00e0nh h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng. Tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng kh\u1edfi ph\u00e1t khi c\u00f3 t\u0103ng huy\u1ebft \u00e1p nhi\u1ec1u: \u0111au \u0111\u1ea7u, c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a suy tim ho\u1eb7c t\u00e1ch th\u00e0nh \u0110M ch\u1ee7. \u0110au chi d\u01b0\u1edbi c\u00e1ch h\u1ed3i c\u00f3 th\u1ec3 g\u1eb7p khi ho\u1ea1t \u0111\u1ed9ng g\u1eafng s\u1ee9c.<\/p>\n

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

    5.1 H\u1eb9p eo \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u1edf tr\u1ebb s\u01a1 sinh<\/strong><\/h3>\n

    Tr\u1ebb s\u01a1 sinh c\u00f3 h\u1eb9p eo \u0110M ch\u1ee7 n\u1eb7ng c\u00f3 nguy c\u01a1 suy tim v\u00e0 t\u1eed vong khi \u1ed1ng \u0110M \u0111\u00f3ng l\u1ea1i. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb bao g\u1ed3m:<\/p>\n

    Truy\u1ec1n t\u0129nh m\u1ea1ch prostaglandin E1 \u0111\u1ec3 duy tr\u00ec \u1ed1ng \u0111\u1ed9ng m\u1ea1ch. Ch\u1ec9 \u0111\u1ecbnh ph\u0201u thu\u1eadt khi t\u00ecnh tr\u1ea1ng b\u1ec7nh nh\u00e2n \u1ed5n \u0111\u1ecbnh.<\/p>\n

    5.2 H\u1eb9p eo \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u1edf ng\u01b0\u1eddi l\u1edbn<\/h3>\n

    \u0110i\u1ec1u tr\u1ecb THA: B\u1eb1ng thu\u1ed1c \u01afCMC, \u01afCTT ho\u1eb7c ch\u1eb9n beta giao c\u1ea3m. C\u1ea7n theo d\u00f5i l\u00e2u d\u00e0i b\u1edfi b\u00e1c s\u0129 chuy\u00ean khoa v\u1ec1 tim b\u1ea9m sinh.<\/p>\n

    Sau ph\u0201u thu\u1eadt, ch\u1ee5p CLVT ho\u1eb7c CHT \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u0111\u00e1nh gi\u00e1 v\u1ecb tr\u00ed s\u1eeda ch\u1eefa 1 n\u0103m sau ph\u0201u thu\u1eadt v\u00e0 sau m\u1ed7i 5 n\u0103m ho\u1eb7c \u00edt h\u01a1n t\u00f9y theo gi\u1ea3i ph\u0201u \u0111\u1ec3 ph\u00e1t hi\u1ec7n nh\u1eefng bi\u1ebfn ch\u1ee9ng mu\u1ed9n.<\/p>\n

    5.3 Ph\u1eabu thu\u1eadt v\u00e0 can thi\u1ec7p h\u1eb9p eo \u0110M ch\u1ee7 qua \u0111\u01b0\u1eddng \u1ed1ng th\u00f4ng<\/h3>\n

    H\u1eb9p eo \u0110M ch\u1ee7 c\u00f3 th\u1ec3 ph\u0201u thu\u1eadt ho\u1eb7c nong b\u1eb1ng b\u00f3ng qua da v\u00e0\/ho\u1eb7c \u0111\u1eb7t stent. L\u1ef1a ch\u1ecdn bi\u1ec7n ph\u00e1p can thi\u1ec7p d\u1ef1a tr\u00ean h\u00ecnh \u1ea3nh \u0110M ch\u1ee7 v\u00e0 th\u1ea3o lu\u1eadn b\u1edfi c\u00e1c b\u00e1c s\u0129 n\u1ed9i khoa, b\u00e1c s\u0129 can thi\u1ec7p v\u00e0 b\u00e1c s\u0129 ph\u0201u thu\u1eadt tim m\u1ea1ch c\u00f3 kinh nghi\u1ec7m \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tim b\u1ea9m sinh.<\/p>\n

    Ph\u0201u thu\u1eadt s\u1eeda ch\u1eefa c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf tr\u1ebb s\u01a1 sinh ho\u1eb7c tr\u1ebb nh\u1ecf nh\u1eb1m ng\u0103n ng\u1eeba nh\u1eefng bi\u1ebfn ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eeda ch\u1eefa bao g\u1ed3m: THA, b\u1ec7nh \u0110M v\u00e0nh, \u0111\u1ed9t qu\u1ef5 n\u00e3o, suy tim v\u00e0 t\u00e1ch th\u00e0nh \u0110M ch\u1ee7.<\/p>\n

    Khuy\u1ebfn c\u00e1o can thi\u1ec7p theo H\u01b0\u1edbng d\u0201n \u0111i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd tim b\u1ea9m sinh \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh c\u1ee7a ACC\/AHA n\u0103m 2008:<\/p>\n

    Ch\u00eanh \u00e1p t\u1ed1i \u0111a \u0111\u1ec9nh – \u0111\u1ec9nh qua v\u1ecb tr\u00ed h\u1eb9p eo > 20 mmHg (M\u1ee9c \u0111\u1ed9 b\u1eb1ng ch\u1ee9ng C) Ch\u00eanh \u00e1p t\u1ed1i \u0111a \u0111\u1ec9nh-\u0111\u1ec9nh qua v\u1ecb tr\u00ed h\u1eb9p eo < 20 mmHg v\u00e0 c\u00f3 b\u1eb1ng ch\u1ee9ng h\u00ecnh \u1ea3nh gi\u1ea3i ph\u0201u h\u1eb9p eo \u0110M ch\u1ee7 \u0111\u00e1ng k\u1ec3 c\u00f9ng v\u1edbi tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 (M\u1ee9c \u0111\u1ed9 b\u1eb1ng ch\u1ee9ng C).<\/p>\n

    C\u00e1c khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb kh\u00e1c bao g\u1ed3m: H\u1eb9p eo \u0110M ch\u1ee7 c\u00f3 bi\u1ebfn ch\u1ee9ng nh\u01b0 t\u0103ng huy\u1ebft \u00e1p chi tr\u00ean, suy tim.<\/p>\n

    Lo\u1ea1i h\u00ecnh ph\u1eabu thu\u1eadt:<\/strong><\/p>\n

    C\u00e1c l\u1ef1a ch\u1ecdn bao g\u1ed3m: C\u1eaft b\u1ecf \u0111o\u1ea1n h\u1eb9p eo v\u00e0 n\u1ed1i t\u1eadn – t\u1eadn, m\u1ed5 b\u1eafc c\u1ea7u n\u1ed1i qua \u0111o\u1ea1n h\u1eb9p eo, t\u1ea1o h\u00ecnh eo \u0110M ch\u1ee7 b\u1eb1ng \u0110M d\u01b0\u1edbi \u0111\u00f2n v\u00e0 t\u1ea1o h\u00ecnh eo \u0110M ch\u1ee7 b\u1eb1ng mi\u1ebfng v\u00e1 nh\u00e2n t\u1ea1o.<\/p>\n

    Ph\u0201u thu\u1eadt \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh khi \u0111o\u1ea1n h\u1eb9p eo d\u00e0i, ph\u00ecnh ho\u1eb7c gi\u1ea3 ph\u00ecnh \u0110M ch\u1ee7, thi\u1ec3u s\u1ea3n quai \u0110M ch\u1ee7.<\/p>\n

    Ph\u0201u thu\u1eadt cho hi\u1ec7u qu\u1ea3 gi\u1ea3m ch\u00eanh \u00e1p t\u00e2m thu t\u1ed1i \u0111a t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi can thi\u1ec7p qua da.<\/p>\n

    L\u1ef1a ch\u1ecdn nong h\u1eb9p eo \u0110M ch\u1ee7 b\u1eb1ng b\u00f3ng qua da v\u00e0 \/ho\u1eb7c \u0111\u1eb7t stent<\/p>\n

    Nong b\u00f3ng \u0111\u01b0\u1ee3c \u01b0u ti\u00ean h\u01a1n \u1edf nh\u1eefng tr\u01b0\u1eddng h\u1ee3p t\u00e1i h\u1eb9p eo, h\u1eb9p ki\u1ec3u th\u1eaft.<\/p>\n

    \u0110\u1eb7t stent \u0110M ch\u1ee7 \u1edf tr\u1ebb em c\u1ea7n l\u00ean k\u1ebf ho\u1ea1ch can thi\u1ec7p l\u1ea1i \u0111\u1ec3 nong gi\u00e3n stent khi \u0111\u1ee9a tr\u1ebb l\u1edbn l\u00ean. Hi\u1ec7n t\u1ea1i \u0111\u00e3 c\u00f3 th\u1ebf h\u1ec7 stent m\u1edbi c\u00f3 th\u1ec3 nong nhi\u1ec1u l\u1ea7n khi \u0111\u1ee9a tr\u1ebb l\u1edbn l\u00ean. Nh\u1eefng bi\u1ebfn ch\u1ee9ng c\u1ee7a can thi\u1ec7p nong v\u00e0 \u0111\u1eb7t stent h\u1eb9p eo \u0110M ch\u1ee7 kh\u00e1 cao (15%) bao g\u1ed3m: ch\u00eanh \u00e1p t\u1ed3n d\u01b0, t\u00e1i h\u1eb9p, t\u00e1ch th\u00e0nh \u0110M ch\u1ee7, h\u00ecnh th\u00e0nh ph\u00ecnh m\u1ea1ch v\u00e0 bi\u1ebfn ch\u1ee9ng t\u1ea1i \u0110M \u0111\u00f9i<\/p>\n

    5.4 Theo d\u00f5i<\/h3>\n

    T\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n h\u1eb9p eo \u0110M ch\u1ee7 \u0111\u00e3 ph\u0201u thu\u1eadt ho\u1eb7c can thi\u1ec7p qua \u0111\u01b0\u1eddng \u1ed1ng th\u00f4ng n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i s\u00e1t nh\u1eb1m ph\u00e1t hi\u1ec7n v\u00e0 ki\u1ec3m so\u00e1t t\u0103ng huy\u1ebft \u00e1p c\u0169ng nh\u01b0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 tim m\u1ea1ch kh\u00e1c. N\u00ean \u0111\u00e1nh gi\u00e1 l\u1ea1i t\u00ecnh tr\u1ea1ng tim m\u1ea1ch h\u00e0ng n\u0103m.<\/p>\n

    C\u1ea7n c\u00f3 s\u1ef1 th\u1ea3o lu\u1eadn gi\u1eefa b\u00e1c s\u0129 tim m\u1ea1ch v\u00e0 chuy\u00ean gia v\u1ec1 tim b\u1ea9m sinh \u1edf ng\u01b0\u1eddi l\u1edbn ngay t\u1eeb l\u1ea7n kh\u00e1m \u0111\u1ea7u ti\u00ean \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh nh\u1eefng y\u1ebfu t\u1ed1 nguy c\u01a1, \u0111\u1eb7c bi\u1ec7t c\u00e1c t\u1ed5n th\u01b0\u01a1ng gi\u1ea3i ph\u0201u c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u0111i k\u00e8m kh\u00e1c.<\/p>\n

    B\u1ec7nh nh\u00e2n sau s\u1eeda ch\u1eefa h\u1eb9p eo \u0110M ch\u1ee7 n\u00ean \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 l\u1ea1i b\u1eb1ng ch\u1ee5p CLVT ho\u1eb7c CHT \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 sau 5 n\u0103m ho\u1eb7c \u00edt h\u01a1n t\u00f9y thu\u1ed9c v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m gi\u1ea3i ph\u0201u tr\u01b0\u1edbc v\u00e0 sau s\u1eeda ch\u1eefa.<\/p>\n","protected":false},"excerpt":{"rendered":"

    H\u1eb9p eo \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 s\u1ef1 thu h\u1eb9p c\u1ee7a \u0110M ch\u1ee7 \u1edf g\u1ea7n v\u1ecb tr\u00ed c\u1ee7a d\u00e2y ch\u1eb1ng \u0111\u1ed9ng m\u1ea1ch ngay ph\u00eda xa nguy\u00ean \u1ee7y c\u1ee7a \u0110M d\u01b0\u1edbi \u0111\u00f2n tr\u00e1i, g\u00e2y c\u1ea3n tr\u1edf d\u00f2ng m\u00e1u tr\u01b0\u1edbc ch\u1ed7 h\u1eb9p, d\u1ea7n t\u1edbi t\u0103ng \u00e1p l\u1ef1c, ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i v\u00e0 suy tim. 1. 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