{"id":30527,"date":"2023-05-03T15:07:13","date_gmt":"2023-05-03T08:07:13","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30527"},"modified":"2023-05-03T15:07:13","modified_gmt":"2023-05-03T08:07:13","slug":"sieu-am-he-tinh-mach","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/sieu-am-he-tinh-mach\/","title":{"rendered":"Si\u00eau \u00e2m h\u1ec7 t\u0129nh m\u1ea1ch"},"content":{"rendered":"

Si\u00eau \u00e2m h\u1ec7 t\u0129nh m\u1ea1ch l\u00e0 th\u0103m d\u00f2 c\u1eadn l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn nh\u1ea5t trong ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u t\u0129nh m\u1ea1ch .Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y cho ph\u00e9p ph\u00e2n t\u00edch v\u1ec1 gi\u1ea3i ph\u1eabu c\u0169ng nh\u01b0 huy\u1ebft \u0111\u1ed9ng c\u1ee7a t\u1ed5n th\u01b0\u01a1ng, g\u00f3p ph\u1ea7n ph\u00e2n lo\u1ea1i v\u00e0 x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh l\u00fd.<\/strong><\/p>\n

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

Si\u00eau \u00e2m Doppler l\u00e0 th\u0103m d\u00f2 c\u1eadn l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn nh\u1ea5t trong ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y cho ph\u00e9p ph\u00e2n t\u00edch v\u1ec1 gi\u1ea3i ph\u1eabu c\u0169ng nh\u01b0 huy\u1ebft \u0111\u1ed9ng c\u1ee7a t\u1ed5n th\u01b0\u01a1ng, g\u00f3p ph\u1ea7n ph\u00e2n lo\u1ea1i v\u00e0 x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh l\u00fd.<\/p>\n

2. Si\u00eau \u00e2m h\u1ec7 t\u0129nh m\u1ea1ch b\u00ecnh th\u01b0\u1eddng<\/h2>\n

2.1 Si\u00eau \u00e2m 2D:<\/strong><\/p>\n

Tr\u00ean m\u1eb7t c\u1eaft ngang cho th\u1ea5y t\u0129nh m\u1ea1ch c\u00f3 h\u00ecnh b\u1ea7u d\u1ee5c v\u1edbi tr\u1ee5c d\u00e0i n\u1eb1m ngang. Tr\u00ean m\u1eb7t c\u1eaft d\u1ecdc, th\u00e0nh tr\u01b0\u1edbc v\u00e0 th\u00e0nh sau kh\u00f4ng song song, th\u00e0nh m\u1ea1ch th\u01b0\u1eddng n\u1eb1m r\u1ea1p theo khu\u00f4n c\u1ee7a c\u00e1c c\u1ea5u tr\u00fac xung quanh. C\u1ea5u tr\u00fac 3 l\u1edbp c\u1ee7a t\u0129nh m\u1ea1ch kh\u00f4ng nh\u00ecn r\u00f5 do th\u00e0nh qu\u00e1 m\u1ecfng. \u0110\u01b0\u1eddng k\u00ednh t\u0129nh m\u1ea1ch thay \u0111\u1ed5i theo bi\u1ebfn thi\u00ean d\u00f2ng ch\u1ea3y, x\u1eb9p ho\u00e0n to\u00e0n khi \u1ea5n.<\/p>\n

C\u1ea5u tr\u00fac van: M\u1eb7t c\u1eaft d\u1ecdc th\u1ea5y h\u00ecnh \u1ea3nh 2 l\u00e1 van m\u1ea3nh, g\u1eafn v\u00e0o th\u00e0nh m\u1ea1ch, m\u00e9p van xu\u00f4i theo chi\u1ec1u d\u00f2ng ch\u1ea3y. Khi van m\u1edf, m\u00e9p van \u00e1p s\u00e1t th\u00e0nh m\u1ea1ch, khi van \u0111\u00f3ng, hai m\u00e9p van ch\u1ea1m v\u00e0o nhau v\u00e0 k\u00edn.<\/p>\n

M\u00e1u tron g l\u00f2ng t\u0129nh m\u1ea1ch l\u00e0 r\u1ed7ng \u00e2m, tuy nhi\u00ean c\u00f3 th\u1ec3 nh\u00ecn th\u1ea5y \u00e2m cu\u1ed9n \u1edf m\u1ed9t s\u1ed1 v\u1ecb tr\u00ed v\u00e0 thay \u0111\u1ed5i theo h\u00f4 h\u1ea5p ho\u1eb7c khi l\u00e0m c\u00e1c nghi\u1ec7m ph\u00e1p huy\u1ebft \u0111\u1ed9ng.<\/p>\n

2.2 Si\u00eau \u00e2m Doppler m\u00e0u:<\/h3>\n

C\u00e1c t\u0129nh m\u1ea1ch g\u1ea7n tim: M\u00e0u d\u00f2ng ch\u1ea3y bi\u1ebfn \u0111\u1ed5i<\/p>\n

C\u00e1c t\u0129nh m\u1ea1ch n go\u1ea1i vi: D \u00f2ng ch\u1ea3y mang \u0111\u1eb7c t\u00ednh c\u1ee7a d\u00f2ng ch\u1ea3y t\u1edbi.<\/p>\n

2.3 Si\u00eau \u00e2m Doppler xung:<\/h3>\n

\u00c2m thanh: \u00c2m s\u1eafc tr\u1ea7m, bi\u1ebfn \u0111\u1ed5i theo h\u00f4 h\u1ea5p v\u00e0 nh\u1ecbp tim, nghe r\u00ec r\u00e0o nh\u01b0 s\u00f3ng v\u1ed7 v\u00e0o b\u1edd<\/p>\n

C\u00e1c t\u0129nh m\u1ea1ch g\u1ea7n tim: M\u00e0u d\u00f2ng ch\u1ea3y bi\u1ebfn \u0111\u1ed5i theo h\u00f4 h\u1ea5p v\u00e0 nh\u1ecbp tim<\/p>\n

C\u00e1c t\u0129nh m\u1ea1ch xa tim (t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi v\u00e0 chi d\u01b0\u1edbi): Bi\u1ebfn \u0111\u1ed5i theo h\u00f4 h\u1ea5p.<\/p>\n

\"Si\u00eau<\/p>\n

Si\u00eau \u00e2m h\u1ec7 t\u0129nh m\u1ea1ch<\/strong><\/p>\n

 <\/p>\n

3. M\u1ed9t s\u1ed1 ch\u1ec9 \u0111\u1ecbnh si\u00eau \u00e2m m\u1ea1ch m\u00e1u ph\u1ed5 bi\u1ebfn<\/h2>\n

3.1 Ch\u1ec9 \u0111\u1ecbnh si\u00eau \u00e2m h\u1ec7 \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh – \u0111\u1ed1t s\u1ed1ng<\/strong><\/h3>\n
    \n
  • B\u1ec7nh nh\u00e2n tai bi\u1ebfn m\u1ea1ch m\u00e1u n\u00e3o ho\u1eb7c tai bi\u1ebfn m\u1ea1ch m\u00e1u n\u00e3o tho\u00e1ng qua. Nghi ng\u1edd t\u00e1ch th\u00e0nh \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh, t\u00e1ch th\u00e0nh \u0111\u1ed9ng m\u1ea1ch \u0111\u1ed1t s\u1ed1ng.<\/li>\n
  • B\u1ec7nh nh\u00e2n c\u00f3 ti\u1ebfng th\u1ed5i m\u1ea1ch c\u1ea3nh.<\/li>\n
  • S\u00e0ng l\u1ecdc b\u1ec7nh l\u00fd m\u1ea1ch c\u1ea3nh cho b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi v\u00e0\/ho\u1eb7c b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.<\/li>\n
  • B\u1ec7nh nh\u00e2n b\u1ecb t\u1eafc \u0111\u1ed9ng m\u1ea1ch trung t\u00e2m v\u00f5ng m\u1ea1c.<\/li>\n
  • Ki\u1ec3m tra tr\u01b0\u1edbc m\u1ed5 \u0111\u1ed1i v\u1edbi nh\u1eefng ph\u0201u thu\u1eadt nguy c\u01a1 \u1ea3nh h\u01b0\u1edfng t\u1edbi th\u1ea7n kinh -m\u1ea1ch m\u00e1u.<\/li>\n
  • B\u1ec7nh nh\u00e2n c\u00f3 huy\u1ebft \u00e1p ch\u00eanh l\u1ec7ch gi\u1eefa hai tay.<\/li>\n
  • Ch\u00f3ng m\u1eb7t \u0111\u01a1n \u0111\u1ed9c.<\/li>\n
  • C\u00e1c tri\u1ec7u ch\u1ee9ng \u00f9 tai ki\u1ec3u m\u1ea1ch \u0111\u1eadp.<\/li>\n
  • \u0110\u00e1nh gi\u00e1 v\u00e0 theo d\u00f5i ti\u1ebfn tri\u1ec3n h\u1eb9p m\u1ea1ch \u1edf nh\u1eefng b\u1ec7nh l\u00fd x\u01a1 v\u1eefa v\u00e0 nh\u1eefng b\u1ec7nh l\u00fd kh\u00f4ng x\u01a1 v\u1eefa.<\/li>\n<\/ul>\n

    3.2 Ch\u1ec9 \u0111\u1ecbnh si\u00eau \u00e2m h\u1ec7 t\u0129nh m\u1ea1ch c\u1ea3nh – s\u1ed1ng n\u1ec1n v\u00e0 h\u1ec7 t\u0129nh m\u1ea1ch chi tr\u00ean<\/h3>\n

    Ph\u00e1t hi\u1ec7n huy\u1ebft kh\u1ed1i c\u00e1c t\u0129nh m\u1ea1ch n\u00f4ng v\u00e0 t\u0129nh m\u1ea1ch s\u00e2u chi tr\u00ean (sau \u0111\u1eb7t catheter, h\u1ed9i\u00a0\u00a0\u00a0\u00a0 ch\u1ee9ng ch\u00e8n \u00e9p t\u0129nh m\u1ea1ch ch\u1ee7 tr\u00ean).<\/p>\n

    X\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1eddng v\u00e0o \u0111\u1ec3 \u0111\u1eb7t bu\u1ed3ng ti\u00eam truy\u1ec1n. Ph\u00e1t hi\u1ec7n di ch\u1ee9ng huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch.<\/p>\n

    Ki\u1ec3m tra tr\u01b0\u1edbc m\u1ed5 c\u1ea7u n\u1ed1i \u0111\u1ed9ng – t\u0129nh m\u1ea1ch.<\/p>\n

    3.3 Ch\u1ec9 \u0111\u1ecbnh si\u00eau \u00e2m h\u1ec7 m\u1ea1ch m\u00e1u th\u1eadn<\/h3>\n

    3.3.1 B\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u th\u1eadn:<\/h3>\n

    \u0110\u1ed9ng m\u1ea1ch:<\/strong> H\u1eb9p, t\u1eafc, ph\u00ecnh, t\u00e1ch th\u00e0nh m\u1ea1ch m\u00e1u . T\u0129nh m\u1ea1ch: D\u00e3n, huy\u1ebft kh\u1ed1i, d\u1ecb d\u1ea1ng.<\/p>\n

    \u0110\u1ed9ng v\u00e0 t\u0129nh m\u1ea1ch:<\/strong> R\u00f2 \u0111\u1ed9ng t\u0129nh m\u1ea1ch th\u1eadn (AVF), d\u1ecb d\u1ea1ng \u0111\u1ed9ng – t\u0129nh m\u1ea1ch th\u1eadn (AVM).<\/p>\n

    B\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u to\u00e0n th\u00e2n:<\/strong><\/p>\n

      \n
    • H\u1eb9p eo \u0111\u1ed9ng m\u1ea1ch ch\u1ee7. Vi\u00eam \u0111\u1ed9ng m\u1ea1ch (Takayasu). X\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch.<\/li>\n
    • M\u1ecdi nguy\u00ean nh\u00e2n l\u00e0m gi\u1ea3m t\u01b0\u1edbi m\u00e1u th\u1eadn \u0111\u1ec1u g\u00e2y \u1ea3nh h\u01b0\u1edfng to\u00e0n th\u00e2n do k\u00edch ho\u1ea1t h\u1ec7 th\u1ed1ng Renin – Angiotensin.<\/li>\n
    • S\u00e0ng l\u1ecdc \u1edf ng\u01b0\u1eddi b\u1ec7nh c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 cao.<\/li>\n
    • Tu\u1ed5i > 70.<\/li>\n
    • \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng, t\u0103ng huy\u1ebft \u00e1p, r\u1ed1i lo\u1ea1n m\u1ee1 m\u00e1u. H\u00fat thu\u1ed1c l\u00e1.<\/li>\n
    • B\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch n\u00e3o, b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean. Kh\u1edfi ph\u00e1t t\u0103ng huy\u1ebft \u00e1p tr\u01b0\u1edbc 30 tu\u1ed5i.<\/li>\n
    • Kh\u1edfi ph\u00e1t t\u0103ng huy\u1ebft \u00e1p n\u1eb7ng sau 55 tu\u1ed5i.<\/li>\n
    • T\u0103ng huy\u1ebft \u00e1p nhanh (x\u1ea5u \u0111i \u0111\u1ed9t ng\u1ed9t v\u00e0 k\u00e9o d\u00e0i tr\u00ean n\u1ec1n b\u1ec7nh t\u0103ng huy\u1ebft \u00e1p \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t t\u1ed1t tr\u01b0\u1edbc \u0111\u00f3).<\/li>\n
    • T\u0103ng huy\u1ebft \u00e1p kh\u00e1ng tr\u1ecb.<\/li>\n
    • T\u0103ng huy\u1ebft \u00e1p \u00e1c t\u00ednh (t\u0103ng huy\u1ebft \u00e1p v\u1edbi t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan k\u00e8m theo: Suy th\u1eadn c\u1ea5p, suy ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i, t\u00e1ch th\u00e0nh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7…).<\/li>\n
    • Suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn sau khi d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n ho\u1eb7c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3.<\/li>\n
    • Teo th\u1eadn kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n ho\u1eb7c ch\u00eanh l\u1ec7ch k\u00edch th\u01b0\u1edbc l\u1edbn h\u01a1n 1,5 cm gi\u1eefa hai th\u1eadn.<\/li>\n
    • Suy th\u1eadn kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c nguy\u00ean nh\u00e2n. Ph\u00f9 ph\u1ed5i c\u1ea5p.<\/li>\n
    • Ki\u1ec3m tra tr\u01b0\u1edbc gh\u00e9p.<\/li>\n<\/ul>\n

      3.3.2 Ch\u1ec9 \u0111\u1ecbnh si\u00eau \u00e2m h\u1ec7 \u0111\u1ed9ng m\u1ea1ch chi tr\u00ean<\/h4>\n
        \n
      • Ch\u00eanh l\u1ec7ch huy\u1ebft \u00e1p chi tr\u00ean hai b\u00ean.<\/li>\n
      • \u0110\u00e1nh gi\u00e1 b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch do x\u01a1 v\u1eefa v\u00e0 b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch kh\u00f4ng do x\u01a1 v\u1eefa (b\u1ec7nh l\u00fd Buerger).<\/li>\n
      • B\u1ec7nh l\u00fd \u0111\u1ea7u chi m\u1ed9t b\u00ean.<\/li>\n
      • H\u1ed9i ch\u1ee9ng ng\u1ef1c – c\u00e1nh tay.<\/li>\n
      • Kh\u00f4ng b\u1eaft \u0111\u01b0\u1ee3c m\u1ea1ch \u1edf chi tr\u00ean m\u1ed9t ho\u1eb7c hai b\u00ean. Tr\u01b0\u1edbc m\u1ed5 c\u1ea7u n\u1ed1i th\u00f4ng \u0111\u1ed9ng – t\u0129nh m\u1ea1ch.<\/li>\n<\/ul>\n

        3.3.3 Ch\u1ec9 \u0111\u1ecbnh si\u00eau \u00e2m h\u1ec7 \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi<\/h4>\n
          \n
        • ABI < 0,9.<\/li>\n
        • \u0110au c\u00e1ch h\u1ed3i chi d\u01b0\u1edbi.<\/li>\n
        • Ch\u1ea9n \u0111o\u00e1n b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi, x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 tr\u1ea7m tr\u1ecdng v\u00e0 g\u00f3p ph\u1ea7n \u0111\u01b0a ra ph\u01b0\u01a1ng \u00e1n \u0111i\u1ec1u tr\u1ecb.<\/li>\n
        • Theo d\u00f5i b\u1ec7nh nh\u00e2n sau can thi\u1ec7p ho\u1eb7c ph\u0201u thu\u1eadt m\u1ea1ch m\u00e1u chi d\u01b0\u1edbi. Ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng h\u1eb9p, t\u1eafc g\u00e2y thay \u0111\u1ed5i huy\u1ebft \u0111\u1ed9ng.<\/li>\n
        • \u0110\u00e1nh gi\u00e1 b\u1ec7nh l\u00fd ph\u00ecnh, gi\u1ea3 ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng v\u00e0 \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi.<\/li>\n
        • Ki\u1ec3m tra tr\u01b0\u1edbc ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, tr\u01b0\u1edbc ph\u0201u thu\u1eadt b\u1eafc c\u1ea7u n\u1ed1i ch\u1ee7 – v\u00e0nh.<\/li>\n
        • Ki\u1ec3m tra tr\u01b0\u1edbc gh\u00e9p th\u1eadn.<\/li>\n<\/ul>\n

          3.3.4 Ch\u1ec9 \u0111\u1ecbnh si\u00eau \u00e2m h\u1ec7 t\u0129nh m\u1ea1ch chi d\u01b0\u1edbi<\/h4>\n
            \n
          • B\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng c\u1ee7a suy t\u0129nh m\u1ea1ch chi d\u01b0\u1edbi (C0-C6): Gi\u00e3n t\u0129nh m\u1ea1ch n\u00f4ng, ph\u00f9, r\u1ed1i lo\u1ea1n s\u1eafc t\u1ed1 da, lo\u00e9t \u0111\u00e3 li\u1ec1n ho\u1eb7c ch\u01b0a li\u1ec1n.<\/li>\n
          • Ph\u00f9 chi d\u01b0\u1edbi m\u1ed9t ho\u1eb7c hai b\u00ean ch\u01b0a r\u00f5 nguy\u00ean nh\u00e2n. Nghi ng\u1edd c\u00f3 huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch.<\/li>\n
          • Theo d\u00f5i \u0111i\u1ec1u tr\u1ecb v\u00e0 \u0111\u00e1nh gi\u00e1 bi\u1ebfn ch\u1ee9ng c\u1ee7a huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch.<\/li>\n
          • Nghi ng\u1edd d\u1ecb d\u1ea1ng m\u1ea1ch m\u00e1u (d\u1ecb d\u1ea1ng t\u0129nh m\u1ea1ch, th\u00f4ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch b\u1ea9m sinh..<\/li>\n<\/ul>\n

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

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