{"id":30458,"date":"2023-05-03T15:11:30","date_gmt":"2023-05-03T08:11:30","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30458"},"modified":"2023-05-03T15:11:30","modified_gmt":"2023-05-03T08:11:30","slug":"ton-thuong-dong-mach-chu-do-chan-thuong","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/ton-thuong-dong-mach-chu-do-chan-thuong\/","title":{"rendered":"T\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 do ch\u1ea5n th\u01b0\u01a1ng"},"content":{"rendered":"

T\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/a> do ch\u1ea5n th\u01b0\u01a1ng hi\u1ebfm x\u1ea3y ra nh\u01b0ng c\u00f3 nguy c\u01a1 t\u1eed vong cao. Trong hai th\u1eadp k\u1ef7 g\u1ea7n \u0111\u00e2y, nh\u1eefng ti\u1ebfn b\u1ed9 v\u1ec1 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh, ph\u00e2n lo\u1ea1i v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u00e3 c\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb t\u1ed5n th\u01b0\u01a1ng \u0110M ch\u1ee7 do ch\u1ea5n th\u01b0\u01a1ng.\u00a0<\/strong><\/p>\n

1. Gi\u1edbi thi\u1ec7u<\/h2>\n

M\u1eb7c d\u00f9 t\u1ef7 l\u1ec7 m\u1eafc chung < 1%, ch\u1ea5n th\u01b0\u01a1ng \u0110M ch\u1ee7 ng\u1ef1c l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y t\u1eed vong \u0111\u1ee9ng h\u00e0ng th\u1ee9 hai trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p ch\u1ea5n th\u01b0\u01a1ng do \u0111\u1ee5ng d\u1eadp. Tai n\u1ea1n giao th\u00f4ng l\u00e0 nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t (> 70%). Kho\u1ea3ng 80% b\u1ec7nh nh\u00e2n t\u1eed vong tr\u01b0\u1edbc khi t\u1edbi b\u1ec7nh vi\u1ec7n v\u00e0 nh\u1eefng b\u1ec7nh nh\u00e2n s\u1ed1ng s\u00f3t th\u01b0\u1eddng nh\u1eadp vi\u1ec7n trong b\u1ec7nh c\u1ea3nh \u0111a ch\u1ea5n th\u01b0\u01a1ng (tim m\u1ea1ch, g\u00e3y x\u01b0\u01a1ng s\u01b0\u1eddn, tr\u00e0n m\u00e1u m\u00e0ng ph\u1ed5i v\u00e0 ch\u1ea5n th\u01b0\u01a1ng b\u1ee5ng k\u00edn). V\u00ec v\u1eady \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb th\u00e0nh c\u00f4ng c\u1ea7n ti\u1ebfp c\u1eadn to\u00e0n di\u1ec7n v\u1ec1 c\u1ea3 ch\u1ea9n \u0111o\u00e1n v\u00e0 chi\u1ebfn l\u01b0\u1ee3c x\u1eed tr\u00ed.<\/p>\n

2. Sinh l\u00fd b\u1ec7nh, ph\u00e2n lo\u1ea1i<\/h2>\n

C\u01a1 ch\u1ebf g\u00e2y ra t\u1ed5n th\u01b0\u01a1ng \u0110M ch\u1ee7 trong ch\u1ea5n th\u01b0\u01a1ng \u0111\u01b0\u1ee3c \u0111\u01b0a ra nh\u01b0 \u0111\u1ee9t, xo\u1eafn v\u1eb7n, gi\u1eb1ng k\u00e9o v\u00e0 l\u1ef1c qu\u00e1n t\u00ednh. Tuy v\u1eady, tr\u00ean th\u1ef1c t\u1ebf th\u01b0\u1eddng do s\u1ef1 ph\u1ed1i h\u1ee3p c\u1ee7a nhi\u1ec1u c\u01a1 ch\u1ebf \u0111\u01b0\u1ee3c li\u1ec7t k\u00ea ph\u00eda tr\u00ean. H\u01a1n 60% ch\u1ea5n th\u01b0\u01a1ng \u0110M ch\u1ee7 ng\u1ef1c x\u1ea3y ra \u1edf ph\u1ea7n eo do \u0111\u00e2y l\u00e0 v\u1ecb tr\u00ed n\u1ed1i gi\u1eefa \u0111o\u1ea1n \u0110M ch\u1ee7 xu\u1ed1ng t\u01b0\u01a1ng \u0111\u1ed1i c\u1ed1 \u0111\u1ecbnh v\u1edbi \u0111o\u1ea1n quai \u0110M ch\u1ee7 di \u0111\u1ed9ng h\u01a1n, do \u0111\u00f3 \u0111o\u1ea1n n\u1ed1i n\u00e0y ch\u1ecbu s\u1ee9c c\u0103ng, gi\u1eb1ng x\u00e9 \u0111\u00e1ng k\u1ec3 khi c\u00f3 s\u1ef1 gi\u1ea3m t\u1ed1c \u0111\u1ed9t ng\u1ed9t. C\u00e1c \u0111o\u1ea1n kh\u00e1c c\u1ee7a \u0110M ch\u1ee7 c\u0169ng c\u00f3 th\u1ec3 b\u1ecb t\u1ed5n th\u01b0\u01a1ng bao g\u1ed3m \u0110M ch\u1ee7 l\u00ean (8 – 27 %), quai \u0110M ch\u1ee7 (8 – 18 %), \u0111o\u1ea1n xa \u0110M ch\u1ee7 xu\u1ed1ng v\u00e0 \u0110M ch\u1ee7 b\u1ee5ng (11 – 21 %).<\/p>\n

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

Ph\u00e2n \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 do ch\u1ea5n th\u01b0\u01a1ng<\/strong><\/p>\n

Hi\u1ec7n nay ph\u00e2n lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 do ch\u1ea5n th\u01b0\u01a1ng d\u1ef1a tr\u00ean l\u1edbp \u00e1o gi\u1ea3i ph\u0201u b\u1ecb t\u1ed5n th\u01b0\u01a1ng: R\u00e1ch l\u1edbp \u00e1o trong (\u0111\u1ed9 I), t\u1ee5 m\u00e1u trong th\u00e0nh \u0110M ch\u1ee7 (\u0111\u1ed9 II), gi\u1ea3 ph\u00ecnh \u0110M ch\u1ee7 (\u0111\u1ed9 III) v\u00e0 v\u1ee1 \u0110M ch\u1ee7 (\u0111\u1ed9 IV). Hi\u1ec3u r\u00f5 h\u01a1n v\u1ec1 sinh l\u00fd b\u1ec7nh gi\u00fap qu\u00e1 tr\u00ecnh ch\u1ea9n \u0111o\u00e1n, ph\u00e2n lo\u1ea1i, \u0111i\u1ec1u tr\u1ecb ch\u1ea5n th\u01b0\u01a1ng \u0110M ch\u1ee7 t\u1ed1i \u01b0u h\u01a1n.<\/p>\n

3. Ch\u1ea9n \u0111o\u00e1n<\/h2>\n

C\u1ea7n khai th\u00e1c b\u1ec7nh s\u1eed v\u00e0 th\u0103m kh\u00e1m l\u00e2m s\u00e0ng, \u0111\u00e1nh gi\u00e1 ban \u0111\u1ea7u theo h\u01b0\u1edbng d\u0201n ATLS (Advanced Trauma Life Support). B\u1ec7nh s\u1eed n\u00ean t\u1eadp trung v\u00e0o khai th\u00e1c c\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng v\u00e0 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng. C\u1ea7n h\u1ecfi k\u1ef9 lo\u1ea1i tai n\u1ea1n (giao th\u00f4ng? sinh ho\u1ea1t?), nh\u1eefng chi ti\u1ebft li\u00ean quan \u0111\u1ebfn va ch\u1ea1m (v\u00ed d\u1ee5 nh\u01b0 \u0111\u1ea7u xe, ph\u00eda b\u00ean, ho\u1eb7c ph\u00eda sau), s\u1eed d\u1ee5ng d\u00e2y an to\u00e0n, bung t\u00fai kh\u00ed, bi\u1ebfn d\u1ea1ng tay l\u00e1i, thi\u1ec7t h\u1ea1i c\u1ee7a ph\u01b0\u01a1ng ti\u1ec7n v\u00e0 n\u1ed7 l\u1ef1c tho\u00e1t ra r\u1ea5t quan tr\u1ecdng. N\u1ebfu c\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng do ng\u00e3, ph\u1ea3i ghi nh\u1eadn ng\u00e3 t\u1eeb \u0111\u1ed9 cao bao nhi\u00eau.<\/p>\n

Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 r\u1ea5t \u0111a d\u1ea1ng, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u1ed5n \u0111\u1ecbnh v\u1ec1 m\u1eb7t huy\u1ebft \u0111\u1ed9ng ho\u1eb7c r\u01a1i v\u00e0o s\u1ed1c, c\u00f3 th\u1ec3 n\u00f3i \u0111au ng\u1ef1c lan ra sau l\u01b0ng ho\u1eb7c kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng. Nh\u1eefng th\u0103m kh\u00e1m quan tr\u1ecdng c\u1ea7n t\u00ecm d\u1ea5u hi\u1ec7u t\u0129nh m\u1ea1ch c\u1ed5 x\u1eb9p, ti\u1ebfng tim m\u1edd, l\u1ec7ch kh\u00ed qu\u1ea3n, tr\u00e0n kh\u00ed d\u01b0\u1edbi da, th\u00e0nh ng\u1ef1c m\u1ea5t v\u1eefng ho\u1eb7c b\u1ea7m t\u1ee5 m\u00e1u, \u00e2m th\u1edf b\u1ea5t th\u01b0\u1eddng v\u00e0 m\u1ea1ch ngo\u1ea1i bi\u00ean b\u1eaft k\u00e9m.<\/p>\n

Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong ch\u1ea9n \u0111o\u00e1n ch\u1ea5n th\u01b0\u01a1ng \u0110M ch\u1ee7 ng\u1ef1c. Xquang ng\u1ef1c l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u0111\u1ea7u ti\u00ean. C\u00e1c d\u1ea5u hi\u1ec7u g\u1ee3i \u00fd tr\u00ean phim Xquang bao g\u1ed3m trung th\u1ea5t r\u1ed9ng\/b\u1ea5t th\u01b0\u1eddng (th\u01b0\u1eddng g\u1eb7p), tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i b\u00ean tr\u00e1i, g\u00e3y x\u01b0\u01a1ng s\u01b0\u1eddn th\u1ee9 nh\u1ea5t ho\u1eb7c th\u1ee9 hai, l\u1ec7ch kh\u00ed qu\u1ea3n, ph\u1ebf qu\u1ea3n ch\u00ednh tr\u00e1i b\u1ecb \u0111\u00e8 \u00e9p, \u0111\u00e1m m\u1edd \u1edf \u0110M ch\u1ee7 ho\u1eb7c \u0111\u1ec9nh ph\u1ed5i.<\/p>\n

Ch\u1ee5p CLVT \u0110M ch\u1ee7 n\u1ebfu tr\u00ean l\u00e2m s\u00e0ng nghi ng\u1edd c\u00f3 ch\u1ea5n th\u01b0\u01a1ng \u0110M ch\u1ee7 ng\u1ef1c (\u0111\u1ed9 nh\u1ea1y 95% \u0111\u1ebfn 100%, gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n \u00e2m t\u00ednh 99% \u0111\u1ebfn 100%). Ngo\u00e0i ch\u1ea9n \u0111o\u00e1n nhanh v\u00e0 ch\u00ednh x\u00e1c, CLVT c\u00f2n cung c\u1ea5p nh\u1eefng ph\u00e2n t\u00edch chi ti\u1ebft h\u01a1n v\u1ec1 t\u1ed5n th\u01b0\u01a1ng \u0110M ch\u1ee7 v\u00e0 qua \u0111\u00f3 gi\u00fap \u0111\u1ecbnh h\u01b0\u1edbng ph\u00e2n lo\u1ea1i v\u00e0 \u0111i\u1ec1u tr\u1ecb.<\/p>\n

Si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n l\u00e0 x\u00e9t nghi\u1ec7m kh\u00f4ng x\u00e2m l\u1ea5n c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n t\u1ea1i gi\u01b0\u1eddng ho\u1eb7c trong ph\u00f2ng m\u1ed5. \u0110\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u c\u1ee7a si\u00eau \u00e2m qua th\u1ef1c qu\u1ea3n trong ch\u1ea9n \u0111o\u00e1n ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u00e0 100% v\u00e0 98% n\u00f3 ch\u1ec9 kh\u00f3 ph\u00e1t hi\u1ec7n trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p v\u1ebft r\u00e1ch n\u1ed9i m\u1ea1c nh\u1ecf.<\/p>\n

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

Chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u0110M ch\u1ee7 do ch\u1ea5n th\u01b0\u01a1ng \u0111\u00e3 c\u00f3 nhi\u1ec1u thay \u0111\u1ed5i, d\u0201n t\u1edbi c\u00e1c h\u1ec7 th\u1ed1ng ph\u00e2n lo\u1ea1i m\u1edbi v\u1ec1 t\u1ed5n th\u01b0\u01a1ng \u0110M ch\u1ee7 do ch\u1ea5n th\u01b0\u01a1ng c\u0169ng nh\u01b0 \u1ee9ng d\u1ee5ng can thi\u1ec7p n\u1ed9i m\u1ea1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 (TEVAR) trong ch\u1ea5n th\u01b0\u01a1ng. Tr\u01b0\u1edbc \u0111\u00e2y hi\u1ec7p h\u1ed9i ph\u0201u thu\u1eadt ch\u1ea5n th\u01b0\u01a1ng Hoa K\u1ef3 (AAST) ph\u00e2n lo\u1ea1i ch\u1ea5n th\u01b0\u01a1ng \u0110M ch\u1ee7 d\u1ef1a v\u00e0o v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng v\u00e0 c\u00e1c nh\u00e1nh \u0111\u1ed9ng m\u1ea1ch li\u00ean quan. Theo ph\u00e2n lo\u1ea1i c\u1ee7a AAST, t\u1ea5t c\u1ea3 nh\u1eefng t\u1ed5n th\u01b0\u01a1ng \u1edf \u0110M ch\u1ee7 xu\u1ed1ng \u0111\u1ec1u \u0111\u01b0\u1ee3c x\u1ebfp v\u00e0o m\u1ee9c IV. Tuy nhi\u00ean ph\u00e2n lo\u1ea1i n\u00e0y c\u00f3 nh\u01b0\u1ee3c \u0111i\u1ec3m l\u00e0 kh\u00f4ng ch\u1ec9 r\u00f5 m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng \u0110M ch\u1ee7. M\u1ed9t h\u1ec7 th\u1ed1ng ph\u00e2n lo\u1ea1i c\u1ea3i ti\u1ebfn kh\u00e1c \u0111\u01b0\u1ee3c \u0111\u01b0a ra v\u00e0o n\u0103m 2009 d\u1ef1a v\u00e0o c\u1ea5u tr\u00fac gi\u1ea3i ph\u0201u c\u1ee7a th\u00e0nh \u0110M ch\u1ee7 – l\u1edbp n\u1ed9i m\u1ea1c (\u0111\u1ed9 I), t\u1ee5 m\u00e1u trong th\u00e0nh (\u0111\u1ed9 II), gi\u1ea3 ph\u00ecnh (\u0111\u1ed9 III), v\u1ee1 \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 (\u0111\u1ed9 IV) – v\u00e0 tr\u1ef1c ti\u1ebfp \u0111\u1ecbnh h\u01b0\u1edbng l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng th\u1ee9c \u0111i\u1ec1u tr\u1ecb cho t\u1ed5n th\u01b0\u01a1ng \u0110M ch\u1ee7 do ch\u1ea5n th\u01b0\u01a1ng.<\/p>\n

Lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u00e0 y\u1ebfu t\u1ed1 quy\u1ebft \u0111\u1ecbnh th\u1eddi gian c\u1ea7n x\u1eed tr\u00ed. B\u1ec7nh nh\u00e2n v\u1ee1 \u0110M ch\u1ee7 ho\u1eb7c t\u1ee5 m\u00e1u l\u1edbn xung quanh \u0110M ch\u1ee7 c\u1ea7n \u0111\u01b0\u1ee3c x\u1eed tr\u00ed c\u1ea5p c\u1ee9u ngay, nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u00e1c c\u00f3 th\u1ec3 tr\u00ec ho\u00e3n trong v\u00f2ng 24 gi\u1edd \u0111\u1ec3 \u1ed5n \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng chung c\u1ee7a b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc khi x\u1eed tr\u00ed.<\/p>\n

4.1 \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa<\/h3>\n

\u0110\u1ea7u ti\u00ean c\u1ea7n ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p v\u00e0 t\u1ea7n s\u1ed1 tim ch\u1eb7t ch\u1ebd. M\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng quy\u1ebft \u0111\u1ecbnh \u0111\u00e2y l\u00e0 bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb ch\u00ednh hay l\u00e0 t\u1ea1m th\u1eddi. M\u1ee5c \u0111\u00edch c\u1ee7a vi\u1ec7c ki\u1ec3m so\u00e1t t\u1ed1t huy\u1ebft \u00e1p \u0111\u00f3 l\u00e0 ng\u0103n ch\u1eb7n s\u1ef1 ti\u1ebfn tri\u1ec3n th\u00eam v\u00e0 gi\u1ea3m s\u1ee9c c\u0103ng l\u00ean th\u00e0nh \u0110M ch\u1ee7.<\/p>\n

Theo Hi\u1ec7p h\u1ed9i Ph\u0201u thu\u1eadt m\u1ea1ch m\u00e1u (SVS), \u0111\u1ed1i v\u1edbi c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9 I<\/em>, <\/strong>ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p v\u00e0 t\u1ea7n s\u1ed1 tim l\u00e0 \u0111i\u1ec1u tr\u1ecb ch\u1ee7 y\u1ebfu, v\u00ec ph\u1ea7n l\u1edbn c\u00e1c t\u1ed5n th\u01b0\u01a1ng n\u00e0y c\u00f3 th\u1ec3 t\u1ef1 l\u00e0nh.. Nguy c\u01a1 v\u1ee1 s\u1ebd gi\u1ea3m t\u1eeb 12% xu\u1ed1ng 1,5% c\u00f9ng v\u1edbi vi\u1ec7c ki\u1ec3m so\u00e1t t\u1ea7n s\u1ed1 tim hi\u1ec7u qu\u1ea3. M\u1eb7c d\u00f9 ch\u01b0a c\u00f3 nh\u1eefng khuy\u1ebfn c\u00e1o v\u1ec1 huy\u1ebft \u00e1p m\u1ee5c ti\u00eau, tuy nhi\u00ean m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u \u0111\u00e3 \u0111\u01b0a ra m\u1ee5c ti\u00eau ki\u1ec3m so\u00e1t HA l\u00e0 \u2264 100 mmHg, HA trung b\u00ecnh \u2264 80 mmHg v\u00e0 t\u1ea7n s\u1ed1 tim \u2264 100 nh\u1ecbp\/ph\u00fat. Th\u01b0\u1eddng s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch (vd: esmolol, labetalol), c\u00f3 th\u1ec3 ph\u1ed1i h\u1ee3p c\u00e1c thu\u1ed1c gi\u00e3n m\u1ea1ch n\u1ebfu ch\u01b0a \u0111\u1ea1t \u0111\u01b0\u1ee3c t\u1ea7n s\u1ed1 tim v\u00e0 HA m\u1ee5c ti\u00eau.<\/p>\n

Ki\u1ec3m so\u00e1t HA theo m\u1ee5c ti\u00eau c\u1ea7n \u0111\u01b0\u1ee3c c\u00e1 th\u1ec3 h\u00f3a theo t\u1eebng b\u1ec7nh nh\u00e2n v\u00e0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng kh\u00e1c k\u00e8m theo. Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p khi ki\u1ec3m so\u00e1t HA qu\u00e1 ch\u1eb7t c\u00f3 th\u1ec3 c\u00f3 h\u1ea1i. Ch\u1eb3ng h\u1ea1n, nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng n\u00e3o ho\u1eb7c t\u1ee7y s\u1ed1ng c\u1ea7n duy tr\u00ec \u1edf m\u1ee9c HA cao h\u01a1n \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o \u0111\u1ee7 t\u01b0\u1edbi m\u00e1u m\u00f4. Do \u0111\u00f3 \u0111i\u1ec1u tr\u1ecb t\u1ed5n th\u01b0\u01a1ng \u0110M ch\u1ee7 \u1edf b\u1ec7nh nh\u00e2n c\u00f3 \u0111a ch\u1ea5n th\u01b0\u01a1ng \u0111\u00f2i h\u1ecfi s\u1ef1 ti\u1ebfp c\u1eadn to\u00e0n di\u1ec7n v\u00e0 \u0111a chuy\u00ean khoa.<\/p>\n

\u0110\u1ed1i v\u1edbi c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9 II, III, IV c\u1ea7n can thi\u1ec7p kh\u1ea9n tr\u01b0\u01a1ng<\/strong>.<\/p>\n

4.2 Can thi\u1ec7p n\u1ed9i m\u1ea1ch<\/h3>\n

TEVAR \u0111\u01b0\u1ee3c ch\u1ee9ng minh c\u00f3 nhi\u1ec1u \u01b0u th\u1ebf trong \u0111i\u1ec1u tr\u1ecb c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u0110M ch\u1ee7 do ch\u1ea5n th\u01b0\u01a1ng. Can thi\u1ec7p c\u00f3 ch\u01b0\u01a1ng tr\u00ecnh cho ph\u00e9p ki\u1ec3m so\u00e1t nh\u1eefng t\u1ed5n th\u01b0\u01a1ng k\u00e8m theo v\u00e0 t\u1ed1i \u01b0u h\u00f3a b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc can thi\u1ec7p (tr\u1eeb c\u00e1c t\u1ed5n th\u01b0\u01a1ng thu\u1ed9c \u0111\u1ed9 IV c\u1ea7n ph\u0201u thu\u1eadt c\u1ea5p c\u1ee9u).<\/p>\n

Li\u1ec1u heparin trong can thi\u1ec7p n\u00ean \u0111\u01b0\u1ee3c t\u00ednh theo c\u00e2n n\u1eb7ng, c\u1ea7n s\u1eed d\u1ee5ng li\u1ec1u th\u1ea5p h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng n\u1eb7ng ho\u1eb7c c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh. Trong h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p, s\u1eed d\u1ee5ng thi\u1ebft b\u1ecb d\u00e0i 10 cm l\u00e0 \u0111\u1ee7 che ph\u1ee7 t\u1ed5n th\u01b0\u01a1ng, c\u1ea7n \u0111o \u0111\u1ea1c c\u1ea9n th\u1eadn k\u00edch th\u01b0\u1edbc stent graft \u0111\u1ec3 h\u1ea1n ch\u1ebf t\u1ed1i thi\u1ec3u nguy c\u01a1 thi\u1ebfu m\u00e1u t\u1ee7y s\u1ed1ng. C\u00f3 \u0111\u1ebfn 40% b\u1ec7nh nh\u00e2n c\u1ea7n ph\u1ea3i che ph\u1ee7 \u0111\u1ed9ng m\u1ea1ch d\u01b0\u1edbi \u0111\u00f2n tr\u00e1i \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o \u0111\u1ee7 \u201clanding zone\u201d. C\u1ea7n \u0111\u1ea3m b\u1ea3o vi\u1ec7c che ph\u1ee7 \u0111\u1ed9ng m\u1ea1ch d\u01b0\u1edbi \u0111\u00f2n tr\u00e1i kh\u00f4ng l\u00e0m \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn v\u00f9ng t\u01b0\u1edbi m\u00e1u ch\u1ee9c n\u0103ng.<\/p>\n

4.3 Can thi\u1ec7p b\u1eb1ng ph\u1eabu thu\u1eadt<\/h3>\n

Trong tr\u01b0\u1eddng h\u1ee3p TEVAR kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng th\u1ef1c hi\u1ec7n ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng gi\u1ea3i ph\u0201u kh\u00f4ng ph\u00f9 h\u1ee3p v\u1edbi TEVAR, c\u1ea7n ti\u1ebfn h\u00e0nh ph\u0201u thu\u1eadt.<\/p>\n

Ti\u1ebfp c\u1eadn \u0110M ch\u1ee7 ng\u1ef1c th\u01b0\u1eddng th\u00f4ng qua \u0111\u01b0\u1eddng m\u1edf ng\u1ef1c sau b\u00ean c\u1ee7a khoang li\u00ean s\u01b0\u1eddn th\u1ee9 4 b\u1edfi v\u1ecb tr\u00ed n\u00e0y gi\u00fap t\u1ed1i \u01b0u h\u00f3a kh\u1ea3 n\u0103ng ti\u1ebfp c\u1eadn \u0111\u01b0\u1ee3c v\u00f9ng eo \u0110M ch\u1ee7. Ki\u1ec3m so\u00e1t m\u1ea1ch \u0111\u1ea7u g\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1eb1ng k\u1eb9p clamp \u0110M ch\u1ee7 \u1edf v\u1ecb tr\u00ed gi\u1eefa \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh chung tr\u00e1i v\u00e0 \u0111\u1ed9ng m\u1ea1ch d\u01b0\u1edbi \u0111\u00f2n. Ki\u1ec3m so\u00e1t \u0111\u1ea7u xa b\u1eb1ng c\u00e1ch k\u1eb9p clamp tr\u00ean v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng. M\u1eb7c d\u00f9 k\u1ebft qu\u1ea3 nh\u1ea5t th\u1eddi c\u1ee7a ph\u0201u thu\u1eadt s\u1eeda ch\u1eefa \u0110M ch\u1ee7 \u0111\u00e3 c\u1ea3i thi\u1ec7n, tuy nhi\u00ean t\u1ef7 l\u1ec7 t\u1eed vong chung v\u00e0 t\u1eed vong do nguy\u00ean nh\u00e2n \u0110M ch\u1ee7 v\u0201n c\u00f2n cao.<\/p>\n","protected":false},"excerpt":{"rendered":"

T\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 do ch\u1ea5n th\u01b0\u01a1ng hi\u1ebfm x\u1ea3y ra nh\u01b0ng c\u00f3 nguy c\u01a1 t\u1eed vong cao. Trong hai th\u1eadp k\u1ef7 g\u1ea7n \u0111\u00e2y, nh\u1eefng ti\u1ebfn b\u1ed9 v\u1ec1 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh, ph\u00e2n lo\u1ea1i v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u00e3 c\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb t\u1ed5n th\u01b0\u01a1ng \u0110M ch\u1ee7 do ch\u1ea5n th\u01b0\u01a1ng.\u00a0 1. Gi\u1edbi thi\u1ec7u M\u1eb7c […]<\/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":"\nT\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 do ch\u1ea5n th\u01b0\u01a1ng - Vinmec<\/title>\n<meta name=\"description\" content=\"T\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 do ch\u1ea5n th\u01b0\u01a1ng c\u00f3 nguy c\u01a1 t\u1eed vong cao, nh\u1eefng ti\u1ebfn b\u1ed9 v\u1ec1 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u00e3 c\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb\" \/>\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=\"T\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 do ch\u1ea5n th\u01b0\u01a1ng - 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