{"id":30621,"date":"2023-05-04T18:41:34","date_gmt":"2023-05-04T11:41:34","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30621"},"modified":"2023-05-04T18:41:34","modified_gmt":"2023-05-04T11:41:34","slug":"duong-vao-mach-mau-benh-nhan-suy-than-manbien-chung-man","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/duong-vao-mach-mau-benh-nhan-suy-than-manbien-chung-man\/","title":{"rendered":"\u0110\u01b0\u1eddng v\u00e0o m\u1ea1ch m\u00e1u b\u1ec7nh nh\u00e2n suy th\u1eadn m\u1ea1n,bi\u1ebfn ch\u1ee9ng m\u1ea1n"},"content":{"rendered":"

\u0110\u01b0\u1eddng v\u00e0o m\u1ea1ch m\u00e1u cho l\u1ecdc m\u00e1u (g\u1ecdi t\u1eaft l\u00e0 \u0111\u01b0\u1eddng v\u00e0o l\u1ecdc m\u00e1u) kh\u00f4ng ch\u1ec9 quan tr\u1ecdng trong vi\u1ec7c quy\u1ebft \u0111\u1ecbnh cu\u1ed9c l\u1ecdc m\u00e1u th\u00e0nh c\u00f4ng, n\u00f3 c\u00f2n \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn kh\u1ea3 n\u0103ng s\u1ed1ng c\u00f2n c\u1ee7a b\u1ec7nh nh\u00e2n suy th\u1eadn m\u1ea1n<\/a>. Bi\u1ebfn ch\u1ee9ng c\u1ee7a \u0111\u01b0\u1eddng v\u00e0o l\u1ecdc m\u00e1u g\u00f3p ph\u1ea7n \u0111\u00e1ng k\u1ec3 v\u00e0o t\u1ef7 l\u1ec7 t\u1eed vong v\u00e0 g\u00e1nh n\u1eb7ng b\u1ec7nh t\u1eadt c\u1ee7a b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh th\u1eadn m\u1ea1n t\u00ednh giai \u0111o\u1ea1n cu\u1ed1i \u0111ang l\u1ecdc m\u00e1u nh\u00e2n t\u1ea1o.<\/strong><\/p>\n

1. C\u00e1c lo\u1ea1i \u0111\u01b0\u1eddng v\u00e0o l\u1ecdc m\u00e1u<\/h2>\n

1.1 C\u1ea7u n\u1ed1i t\u1ef1 th\u00e2n<\/strong><\/h3>\n

C\u1ea7u n\u1ed1i \u0111\u1ed9ng t\u0129nh m\u1ea1ch (AVF: Arteriovenous fistula; FAV: Fistule art\u00e9rio-veineuse) <\/em>l\u00e0 lo\u1ea1i \u0111\u01b0\u1eddng v\u00e0o l\u1ecdc m\u00e1u ph\u1ed5 bi\u1ebfn nh\u1ea5t, \u00edt bi\u1ebfn ch\u1ee9ng, th\u1eddi gian s\u1eed d\u1ee5ng k\u00e9o d\u00e0i h\u01a1n so v\u1edbi nh\u1eefng lo\u1ea1i \u0111\u01b0\u1eddng v\u00e0o l\u1ecdc m\u00e1u kh\u00e1c. AVF l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a ph\u0201u thu\u1eadt n\u1ed1i tr\u1ef1c ti\u1ebfp \u0111\u1ed9ng m\u1ea1ch v\u00e0 t\u0129nh m\u1ea1ch, g\u1ed3m c\u00e1c lo\u1ea1i sau:<\/p>\n

    \n
  • AVF \u1edf chi tr\u00ean<\/em>: T\u1ea1i b\u00e0n tay (t\u1eeb \u0111\u1ed9ng m\u1ea1ch quay t\u1ea1i h\u00f5m l\u00e0o v\u00e0 t\u0129nh m\u1ea1ch \u0111\u1ea7u), c\u1eb3ng tay, ho\u1eb7c v\u00f9ng khu\u1ef7u (t\u1eeb \u0111\u1ed9ng m\u1ea1ch c\u00e1nh tay \u0111\u1ebfn t\u0129nh m\u1ea1ch \u0111\u1ea7u, hay t\u0129nh m\u1ea1ch n\u1ec1n chuy\u1ec3n v\u1ecb tr\u00ed).<\/li>\n
  • AVF \u1edf chi d\u01b0\u1edbi<\/em>: N\u1ed1i gi\u1eefa \u0111\u1ed9ng m\u1ea1ch \u0111\u00f9i chung v\u00e0 t\u0129nh m\u1ea1ch hi\u1ec3n l\u1edbn.<\/li>\n<\/ul>\n

    1.2 C\u1ea7u n\u1ed1i nh\u00e2n t\u1ea1o (AVG: Arteriovenous graft)<\/h3>\n

    AVG s\u1eed d\u1ee5ng v\u1eadt li\u1ec7u nh\u00e2n t\u1ea1o (PTFE: polytetrafluroethylene) <\/em>n\u1ed1i gi\u1eefa \u0111\u1ed9ng m\u1ea1ch v\u00e0 t\u0129nh m\u1ea1ch, \u0111\u01b0\u1ee3c \u0111\u1eb7t trong \u0111\u01b0\u1eddng h\u1ea7m d\u01b0\u1edbi da \u0111\u1ec3 thu\u1eadn ti\u1ec7n cho qu\u00e1 tr\u00ecnh l\u1ecdc m\u00e1u.<\/p>\n

    C\u00f3 hai lo\u1ea1i AVG tu\u1ef3 theo h\u00ecnh d\u1ea1ng c\u1ee7a graft: th\u1eb3ng (straight) v\u00e0 quai (loop).<\/p>\n

    Lo\u1ea1i AVG quai \u0111\u01b0\u1ee3c d\u00f9ng nhi\u1ec1u h\u01a1n AVG th\u1eb3ng do th\u1eddi gian s\u1eed d\u1ee5ng \u0111\u01b0\u1ee3c l\u00e2u d \u00e0i h\u01a1n.<\/p>\n

    1.3 Catheter<\/h3>\n

    Catheter l\u00e0 lo\u1ea1i \u1ed1ng th\u00f4ng \u0111\u1eb7t v\u00e0o t\u0129nh m\u1ea1ch l\u1edbn c\u00f3 th\u1ec3 d\u00f9ng \u0111\u1ec3 l\u1ecdc m\u00e1u ngay sau khi \u0111\u1eb7t.<\/p>\n

    C\u00f3 hai lo\u1ea1i catheter: Catheter kh\u00f4ng c\u00f3 \u0111\u01b0\u1eddng h\u1ea7m (non tunneled hemodialysis catheter: NTHC) <\/em>v\u00e0 catheter c\u00f3 \u0111\u01b0\u1eddng h\u1ea7m (tunneled cuffed catheter).<\/em><\/p>\n

    \"C\u00e1c<\/p>\n

    C\u00e1c th\u00e0nh ph\u1ea7n c\u1ee7a m\u1ed9t c\u1ea7u n\u1ed1i\u00a0 \u0111\u01b0\u1eddng v\u00e0o m\u1ea1ch m\u00e1u (AVF) t\u1ea1i c\u1ed5 tay<\/strong><\/p>\n

    2. Bi\u1ebfn ch\u1ee9ng mu\u1ed9n<\/h2>\n

    \u0110\u1ecbnh ngh\u0129a: <\/strong>L\u00e0 nh\u1eefng bi\u1ebfn ch\u1ee9ng x\u1ea3y ra sau ph\u0201u thu\u1eadt t\u1ea1o c\u1ea7u n\u1ed1i \u0111\u01b0\u1eddng v\u00e0o m\u1ea1ch m\u00e1u t\u1eeb 3 tu\u1ea7n tr\u1edf l\u00ean.<\/p>\n

    2.1 H\u1eb9p t\u0129nh m\u1ea1ch hi\u1ec7u d\u1ee5ng<\/strong><\/h3>\n

    L\u00e2m s\u00e0ng: <\/strong>B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 kh\u00f4ng tri\u1ec7u ch\u1ee9ng, ho\u1eb7c xu\u1ea5t hi\u1ec7n ph\u00f9 n\u1ec1 ph\u1ea7n chi tr\u01b0\u1edbc ch\u1ed7 h\u1eb9p t\u0129nh m\u1ea1ch, \u0111au t\u1ee9c tay khi l\u1ecdc m\u00e1u. Kh\u00e1m l\u00e2m s\u00e0ng: Ph\u1ea7n t\u0129nh m\u1ea1ch ngay tr\u01b0\u1edbc ch\u1ed7 h\u1eb9p gi\u00e3n l\u1edbn, khi gi\u01a1 tay kh\u00f4ng x\u1eb9p ho\u1eb7c ch\u1ec9 x\u1eb9p m\u1ed9t ph\u1ea7n. Rung miu t\u1ea1i mi\u1ec7ng n\u1ed1i m\u1ea5t, trong khi s\u1edd th\u1ea5y rung miu \u1edf v\u1ecb tr\u00ed b\u1ea5t th\u01b0\u1eddng, c\u00f3 th\u1ec3 th\u1ea5y c\u00e1c t\u0129nh m\u1ea1ch b\u00e0ng h\u1ec7 xung quanh v\u1ecb tr\u00ed h\u1eb9p.<\/p>\n

    Si\u00eau \u00e2m:<\/strong><\/p>\n

      \n
    • 2D: H\u00ecnh \u1ea3nh gi\u1ea3m \u0111\u01b0\u1eddng k\u00ednh t\u0129nh m\u1ea1ch, th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n gi\u1eefa c\u00e1c v\u1ecb tr\u00ed gi\u00e3n.<\/li>\n
    • Doppler m\u00e0u ph\u00e1t hi\u1ec7n d\u00f2ng kh\u1ea3m m\u00e0u t\u1ea1i v\u1ecb tr\u00ed h\u1eb9p.<\/li>\n<\/ul>\n

      Doppler xung: T\u1ed1c \u0111\u1ed9 d\u00f2ng ch\u1ea3y t\u00e2m thu t\u1ea1i v\u1ecb tr\u00ed h\u1eb9p t\u0103ng g\u1ea5p 2 l\u1ea7n t\u1ed1c \u0111\u1ed9 t\u1ea1i v\u1ecb tr\u00ed tr\u01b0\u1edbc ch\u1ed7 h\u1eb9p 2 cm \u0111\u01b0\u1ee3c coi l\u00e0 c\u00f3 \u00fd ngh\u0129a (tr\u00ean 50%).<\/p>\n

      X\u1eed tr\u00ed: <\/strong>Khi m\u1ee9c \u0111\u1ed9 h\u1eb9p t\u0129nh m\u1ea1ch \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn l\u01b0u l\u01b0\u1ee3ng l\u1ecdc hay b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n kh\u00f3 ch\u1ecbu do h\u1eb9p tr\u00ean l\u00e2m s\u00e0ng.<\/p>\n

      2.2 H\u1eb9p t\u0129nh m\u1ea1ch trung t\u00e2m<\/strong><\/h3>\n

      T\u1ed5ng quan: <\/strong>T\u0129nh m\u1ea1ch trung t\u00e2m g\u1ed3m c\u00e1c t\u0129nh m\u1ea1ch t\u1eeb t\u0129nh m\u1ea1ch d\u01b0\u1edbi \u0111\u00f2n, t\u0129nh m\u1ea1ch th\u00e2n c\u00e1nh tay \u0111\u1ea7u v\u00e0 t\u0129nh m\u1ea1ch ch\u1ee7 tr\u00ean.<\/p>\n

      H\u1eb9p\/t\u1eafc t\u0129nh m\u1ea1ch trung t\u00e2m l\u00e0 t\u00ecnh tr\u1ea1ng t\u1eafc ho\u00e0n to\u00e0n ho\u1eb7c h\u1eb9p tr\u00ean 50% l\u00f2ng c\u00e1c t\u0129nh m\u1ea1ch tr\u00ean, l\u00e0 nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t g\u00e2y t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch.<\/p>\n

      Nguy\u00ean nh\u00e2n <\/strong>: di ch\u1ee9ng t\u1eeb c\u00e1c th\u1ee7 thu\u1eadt \u0111\u1eb7t catheter, d\u00e2y d\u0201n m\u00e1y t\u1ea1o nh\u1ecbp v\u00e0o t\u0129nh m\u1ea1ch trung t\u00e2m, v\u00e0\/ho\u1eb7c qu\u00e1 tr\u00ecnh x\u01a1 h\u00f3a, t\u0103ng sinh n\u1ed9i m\u1ea1c k\u00e9o d\u00e0i.<\/p>\n

      L\u00e2m s\u00e0ng:<\/strong><\/p>\n

        \n
      • T \u00f9y v\u00e0o v\u1ecb tr\u00ed t\u1eafc\/h\u1eb9p m\u00e0 ph\u00f9 <\/strong>c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n \u1edf to\u00e0n b\u1ed9 c\u00e1nh tay, lan l\u00ean n\u1eeda m\u1eb7t, c\u1ed5 m\u1ed9t b\u00ean (t\u1eafc t\u0129nh m\u1ea1ch d\u01b0\u1edbi \u0111\u00f2n), hai b\u00ean (t\u1eafc t\u0129nh m\u1ea1ch ch\u1ee7 tr\u00ean).<\/li>\n
      • Tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 t\u0129nh m\u1ea1ch ph\u00e1t tri\u1ec3n m\u1ea1nh.<\/li>\n
      • C\u00e1c tri\u1ec7u ch\u1ee9ng k\u00e8m theo: \u0111au, d\u1ecb c\u1ea3m, c\u00f3 th\u1ec3 lo\u00e9t, ho\u1ea1i t\u1eed da.<\/li>\n<\/ul>\n

        Si\u00eau \u00e2m Doppler :<\/strong><\/p>\n

        N\u1ebfu t\u1eafc t\u0129nh m\u1ea1ch d\u01b0\u1edbi \u0111\u00f2n c\u00f3 th\u1ec3 quan s\u00e1t \u0111\u01b0\u1ee3c tr\u1ef1c ti\u1ebfp tr\u00ean si\u00eau \u00e2m.<\/p>\n

        N\u1ebfu t\u1eafc t\u0129nh m\u1ea1ch th\u00e2n c\u00e1nh tay \u0111\u1ea7u ho\u1eb7c t\u0129nh m\u1ea1ch ch\u1ee7 tr\u00ean, si\u00eau \u00e2m ch\u1ec9 cho th\u1ea5y nh\u1eefng d\u1ea5u hi\u1ec7u gi\u00e1n ti\u1ebf p nh\u01b0 t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch tr\u01b0\u1edbc v\u1ecb tr\u00ed t\u1eafc, m\u1ea5t s\u1ef1 thay \u0111\u1ed5i ph\u1ed5 Doppler t\u0129nh m\u1ea1ch tr\u01b0\u1edbc v\u1ecb tr\u00ed t\u1eafc theo nh\u1ecbp tim v\u00e0 h\u00f4 h\u1ea5p.<\/p>\n

        Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh <\/strong>d\u1ef1a v\u00e0o ch\u1ee5p c\u1eaft l\u1edbp d\u1ef1ng h\u00ecnh m\u1ea1ch m\u00e1u ho\u1eb7c ch\u1ee5p DSA.<\/p>\n

        X\u1eed tr\u00ed :<\/strong><\/p>\n

        Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb kh\u00f4ng d\u1ef1a v\u00e0o m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng gi\u1ea3i ph\u0201u, m\u00e0 c\u0103n c\u1ee9 v\u00e0o \u0111\u1eb7c \u0111i\u1ec3m b\u1ec7nh sinh v\u00e0 l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

        N\u1ebfu h\u1eb9p t\u0129nh m\u1ea1ch trung t\u00e2m t\u1eeb 50% tr\u1edf l\u00ean, g\u00e2y ra tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng ho\u1eb7c \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn qu\u00e1 tr\u00ecnh l\u1ecdc m\u00e1u c\u1ee7a b\u1ec7nh nh\u00e2n th\u00ec ph\u1ea3i can thi\u1ec7p.<\/p>\n

        Ph\u0201u thu\u1eadt th\u01b0\u1eddng \u00edt \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh do t\u1ed5n th\u01b0\u01a1ng gi\u1ea3i ph\u0201u trong l\u1ed3ng ng\u1ef1c ph\u1ee9c t\u1ea1p, nhi\u1ec1u m\u1ea1ch m\u00e1u b\u00e0ng h\u1ec7.<\/p>\n

        Can thi\u1ec7p nong b\u00f3ng t\u0129nh m\u1ea1ch trung t\u00e2m l\u00e0 l\u1ef1a ch\u1ecdn \u0111\u01b0\u1ee3c \u01b0u ti\u00ean h\u00e0ng \u0111\u1ea7u. \u0110\u1eb7t stent t\u0129nh m\u1ea1ch trung t\u00e2m \u00edt \u0111\u01b0\u1ee3c \u0111\u1eb7t ra do nguy c\u01a1 cao t\u1eafc l\u1ea1i ho\u00e0n to\u00e0n stent trong 3 – 6 th\u00e1ng. Th\u1ee7 thu\u1eadt n\u00e0y ch\u1ec9 n\u00ean th\u1ef1c hi\u1ec7n khi t\u00e1i ph\u00e1t h\u1eb9p ho\u1eb7c t\u1eafc r\u1ea5t nhanh sau nong b\u00f3ng nhi\u1ec1u l\u1ea7n.<\/p>\n

        2.3 Huy\u1ebft kh\u1ed1i<\/h3>\n

        Bi\u1ebfn ch\u1ee9ng n\u00e0y c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n s\u1edbm, ho\u1eb7c mu\u1ed9n \u1edf b\u1ec7nh nh\u00e2n mang c\u1ea7u n\u1ed1i \u0111\u1ed9ng t\u0129nh m\u1ea1ch, l\u00e0 nguy\u00ean nh\u00e2n quan tr\u1ecdng l\u00e0m h\u1ecfng c\u1ea7u.<\/p>\n

        Huy\u1ebft kh\u1ed1i d\u1ec5 h\u00ecnh th\u00e0nh t\u1ea1i t\u0129nh m\u1ea1ch ho\u1eb7c mi\u1ec7ng n\u1ed1i \u0111\u00e3 h\u1eb9p r\u1ea5t kh\u00edt t\u1eeb tr\u01b0\u1edbc, ph\u00ecnh\/gi\u1ea3 ph\u00ecnh, nhi\u1ec5m tr\u00f9ng sau ch\u1ecdc m\u1ea1ch, k\u1ef9 thu\u1eadt ch\u1ecdc m\u1ea1ch kh\u00f4ng t\u1ed1t…<\/p>\n

        Tr\u00ean l\u00e2m s\u00e0ng, b\u1ec7nh nh\u00e2n \u0111au \u1edf v\u1ecb tr\u00ed c\u00f3 huy\u1ebft kh\u1ed1i, kh\u00f4ng th\u1ec3 ti\u1ebfp t\u1ee5c l\u1ecdc m\u00e1u. Kh\u00e1m t\u1ea1i v\u1ecb tr\u00ed huy\u1ebft kh\u1ed1i c\u1ee9ng, \u1ea5n kh\u00f4ng x\u1eb9p, gi\u01a1 tay cao t\u0129nh m\u1ea1ch kh\u00f4ng x\u1eb9p,<\/p>\n

        Si\u00eau \u00e2m gi\u00fap ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed m\u1ea1ch m\u00e1u c\u00f3 huy\u1ebft kh\u1ed1i v\u00e0 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1eddng v\u00e0o n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh can thi\u1ec7p qua da.<\/p>\n

        N\u1ebfu huy\u1ebft kh\u1ed1i c\u1ea5p t\u00ednh (trong v\u00f2ng 48 gi\u1edd), ch\u1ec9 \u0111\u1ecbnh ph\u0201u thu\u1eadt l\u1ea5y huy\u1ebft kh\u1ed1i b\u1eb1ng sonde Fogarty; ho\u1eb7c m\u1edf m\u1ea1ch l\u1ea5y huy\u1ebft kh\u1ed1i tr\u1ef1c ti\u1ebfp; ho\u1eb7c ti\u00eau s\u1ee3i huy\u1ebft t\u1ea1i ch\u1ed7 qua \u0111\u01b0\u1eddng \u1ed1ng th\u00f4ng.<\/p>\n

        C\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng hay thu\u1ed1c kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ec3 d\u1ef1 ph\u00f2ng huy\u1ebft kh\u1ed1i \u1edf b\u1ec7nh nh\u00e2n l\u00e0m c\u1ea7u n\u1ed1i th\u00f4ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch.<\/p>\n

        2.4 Ph\u00ecnh, gi\u1ea3 ph\u00ecnh m\u1ea1ch<\/h3>\n

        Ph\u00ecnh t\u0129nh m\u1ea1ch th\u1ef1c s\u1ef1 khi \u0111\u01b0\u1eddng k\u00ednh m\u1ea1ch m\u00e1u t\u1ea1i v\u1ecb tr\u00ed gi\u00e3n khu tr\u00fa > 1,5 l\u1ea7n \u0111\u01b0\u1eddng k\u00ednh b\u00ecnh th\u01b0\u1eddng, nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 do s\u1ef1 ph\u1ed1i h\u1ee3p c\u1ee7a nhi\u1ec1u y\u1ebfu t\u1ed1: T\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch l\u00e2u ng\u00e0y, ch\u1ecdc m\u1ea1ch t\u1ea1i m\u1ed9t v\u1ecb tr\u00ed k\u00e9o d\u00e0i, d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch.<\/p>\n

        Gi\u1ea3 ph\u00ecnh th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n \u1edf \u0111\u1ed9ng m\u1ea1ch \u0111\u1ebfn, l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a t\u1ed5n th\u01b0\u01a1ng th\u00e0nh m\u1ea1ch do ch\u1ecdc m\u1ea1ch l\u00e2u ng\u00e0y t\u1ea1i m\u1ed9t v\u1ecb tr\u00ed.<\/p>\n

        Nguy c\u01a1 c\u1ee7a ph\u00ecnh\/gi\u1ea3 ph\u00ecnh l\u00e0 v\u1ee1, ch\u1ea3y m\u00e1u, lo\u00e9t da, kh\u00f3 ch\u1ecdc m\u1ea1ch trong qu\u00e1 tr\u00ecnh l\u1ecdc th\u1eadn, \u0111\u00f2i h\u1ecfi ph\u1ea3i theo d\u00f5i \u0111\u1ecbnh k\u1ef3 b\u1eb1ng l\u00e2m s\u00e0ng v\u00e0 si\u00eau \u00e2m.<\/p>\n

        Ch\u1ec9 \u0111\u1ecbnh ph\u0201u thu\u1eadt s\u1eeda ch\u1eefa khi: (1) t\u1ed5n th\u01b0\u01a1ng da, (2) nguy c\u01a1 v\u1ee1 ph\u00ecnh, (3) v\u1ecb tr\u00ed ch\u1ecdc m\u1ea1ch b\u1ecb h\u1ea1n ch\u1ebf.<\/p>\n

        2.5 H\u1ed9i ch\u1ee9ng tr\u1ed9m m\u00e1u<\/h3>\n

        C\u1ea7u n\u1ed1i \u0111\u1ed9ng t\u0129nh m\u1ea1ch c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m t\u01b0\u1edbi m\u00e1u chi \u1edf h\u1ea1 l\u01b0u do hi\u1ec7n t\u01b0\u1ee3ng \u201ctr\u1ed9m\u201d m\u00e1u t\u1eeb \u0111\u1ed9ng m\u1ea1ch qua mi\u1ec7ng n\u1ed1i.<\/p>\n

        H\u1ed9i ch\u1ee9ng tr\u1ed9m m\u00e1u xu\u1ea5t hi\u1ec7n khi v\u00f2ng n\u1ed1i \u0111\u1ed9ng m\u1ea1ch b\u00e0ng h\u1ec7 kh\u00f4ng \u0111\u1ee7 v\u00e0\/ho\u1eb7c mi\u1ec7ng n\u1ed1i qu\u00e1 r\u1ed9ng .<\/p>\n

        Hay x\u1ea3y ra b\u1ec7nh nh\u00e2n tu\u1ed5i cao, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, c\u1ea7u n\u1ed1i AVG, c\u1ea7u n\u1ed1i \u1edf c\u00e1nh tay hay g\u1eb7p h\u01a1n c\u1ea7u n\u1ed1i c\u1ed5 tay.<\/p>\n

        Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng ti\u1ebfn tri\u1ec3n t\u1eeb \u0111au, d\u1ecb c\u1ea3m khi ch\u1ea1y th\u1eadn ho\u1eb7c g\u1eafng s\u1ee9c; \u0111\u1ebfn \u0111au, chu\u1ed9t r\u00fat khi ngh\u1ec9; ho\u1ea1i t\u1eed b\u00e0n ng\u00f3n tay.<\/p>\n

        Si\u00eau \u00e2m c\u00f3 d\u1ea5u hi\u1ec7u \u0111\u1ea3o chi\u1ec1u d\u00f2ng ch\u1ea3y c\u1ee7a \u0111\u1ed9ng m\u1ea1ch h\u1ea1 l\u01b0u, h\u1eb9p \u0111\u1ed9ng m\u1ea1ch.<\/p>\n

        H\u1ed9i ch\u1ee9ng tr\u1ed9m m\u00e1u x\u1ea3y ra \u1edf kho\u1ea3ng 20% b\u1ec7nh nh\u00e2n c\u00f3 c\u1ea7u n\u1ed1i \u0111\u1ed9ng t\u0129nh m\u1ea1ch chi tr\u00ean, trong \u0111\u00f3 4% c\u00f3 tri\u1ec7u ch\u1ee9ng n\u1eb7ng y\u00eau c\u1ea7u ph\u1ea3i \u0111i\u1ec1u tr\u1ecb.<\/p>\n

        Can thi\u1ec7p n\u1ed9i m\u1ea1ch n\u1ebfu c\u00f3 h\u1eb9p \u0111\u1ed9ng m\u1ea1ch \u0111\u1ebfn ho\u1eb7c h\u1eb9p \u0111\u1ed9ng m\u1ea1ch h\u1ea1 l\u01b0u.<\/p>\n

        C\u00e1c ph\u01b0\u01a1ng ph\u00e1p ph\u0201u thu\u1eadt ph\u1ed5 bi\u1ebfn l\u00e0 th\u1eaft b\u1edbt t\u0129nh m\u1ea1ch hi\u1ec7u d\u1ee5ng (banding), th\u1eaft \u0111\u1ed9ng m\u1ea1ch sau mi\u1ec7ng n\u1ed1i ho\u1eb7c t\u0129nh m\u1ea1ch hi\u1ec7u d\u1ee5ng, v\u00e0 t\u1ea1o c\u1ea7u n\u1ed1i nh\u00e2n t\u1ea1o m\u1edbi (DRIL, RUDI, PAI).<\/p>\n

        2.6 Nhi\u1ec5m tr\u00f9ng c\u1ea7u n\u1ed1i<\/h3>\n

        Nhi\u1ec5m tr\u00f9ng c\u1ea7u n\u1ed1i g\u1eb7p nhi\u1ec1u \u1edf AVG (20%) h\u01a1n AVF (10%).<\/p>\n

        L\u00e2m s\u00e0ng:<\/strong> T\u1ea5y \u0111\u1ecf da v\u00f9ng ch\u1ecdc m\u1ea1ch, kh\u1ed1i \u00e1p xe t\u1ea1i v\u1ecb tr\u00ed ch\u1ecdc m\u1ea1ch hay to\u00e0n b\u1ed9 graft l\u1ecfng l\u1ebbo trong \u0111\u01b0\u1eddng h\u1ea7m. B\u1ec7nh nh\u00e2n s\u1ed1t cao, \u0111au nhi\u1ec1u. Nguy\u00ean nh\u00e2n ch\u00ednh l\u00e0 t\u1ee5 c\u1ea7u (S. aureus <\/em>, S. epidermidis <\/em>).<\/p>\n

        \u0110i\u1ec1u tr\u1ecb:<\/strong> b\u1eb1ng kh\u00e1ng sinh \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch trong 6 tu\u1ea7n. Ph\u0201u thu\u1eadt \u1ed5 \u00e1p xe n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh, \u0111\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng gi\u1eef hay ph\u1ea3i hu\u1ef7 b\u1ecf c\u1ea7u n\u1ed1i.<\/p>\n

        2.7 Bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh<\/h3>\n

        \u0110au, d\u1ecb c\u1ea3m, y\u1ebfu c\u01a1 thu\u1ed9c c\u00e1c nh\u00f3m c\u01a1 do th\u1ea7n kinh gi\u1eefa chi ph\u1ed1i.<\/p>\n

        Nguy\u00ean nh\u00e2n li\u00ean quan \u0111\u1ebfn ch\u00e8n \u00e9p th\u1ea7n kinh ho\u1eb7c ch\u1ea5n th\u01b0\u01a1ng (nh\u1ea5t l\u00e0 khi l\u00e0m \u0111\u01b0\u1eddng v\u00e0o t\u1ea1i \u0111\u1ed9ng m\u1ea1ch c\u00e1nh tay), ho\u1eb7c l\u1eafng \u0111\u1ecdng amyloid c\u1ee5c b\u1ed9 \u1edf ng\u01b0\u1eddi l\u1ecdc th\u1eadn l\u00e2u ng\u00e0y, d\u0201n \u0111\u1ebfn h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay.<\/p>\n

        2.8 Ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i, suy tim<\/h3>\n

        Ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i g\u1eb7p \u1edf 7 4 % b\u1ec7nh nh\u00e2n \u1edf th\u1eddi \u0111i\u1ec3m b\u1eaft \u0111\u1ea7u l\u1ecdc m\u00e1u chu k\u1ef3, l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a nhi\u1ec1u y\u1ebfu t\u1ed1 t\u00e1c \u0111\u1ed9ng nh\u01b0 c\u00e1c y\u1ebfu t\u1ed1 g\u00e2y t\u0103ng g\u00e1nh th\u1ec3 t\u00edch, thi\u1ebfu m\u00e1u, t\u0103ng huy\u1ebft \u00e1p…<\/p>\n

        C\u1ea7u n\u1ed1i th\u00f4ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch (AVF\/AVG) l\u00e0m t\u0103ng cung l\u01b0\u1ee3ng tim kho\u1ea3ng 15%, v\u00e0 \u00e1p l\u1ef1c cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng th\u1ea5t tr\u00e1i 4%, nh\u01b0ng hi\u1ebfm khi l\u00e0 nguy\u00ean nh\u00e2n tr\u1ef1c ti\u1ebfp g\u00e2y ra suy tim.<\/p>\n

        Theo nghi\u00ean c\u1ee9u HEMO, 40% b\u1ec7nh nh\u00e2n l\u1ecdc m\u00e1u c\u00f3 suy tim, v\u00e0 39% c\u00f3 b\u1ec7nh m\u1ea1ch v\u00e0nh tr\u01b0\u1edbc khi \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb l\u1ecdc th\u1eadn chu k\u1ef3.<\/p>\n

        Nh\u1eefng nguy c\u01a1 l\u00e0m suy tim n\u1eb7ng h\u01a1n g\u1ed3m rung nh\u0129, gi\u00e3n th\u1ea5t ph\u1ea3i, gi\u00e3n nh\u0129 tr\u00e1i, ti\u1ec1n s\u1eed l\u00e0m c\u1ea7u n\u1ed1i nhi\u1ec1u l\u1ea7n, v\u1ecb tr\u00ed c\u1ea7u n\u1ed1i g\u1ea7n tim (c\u00e1nh tay).<\/p>\n

        Ch\u1ea9n \u0111o\u00e1n suy tim t\u0103ng cung l\u01b0\u1ee3ng do c\u1ea7u n\u1ed1i \u0111\u1ed9ng – t\u0129nh m\u1ea1ch khi b\u1ec7nh c\u00f3 suy tim v\u00e0 l\u01b0u l\u01b0\u1ee3ng c\u1ea7u n\u1ed1i > 3000 mL\/min .<\/p>\n

        Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa g\u1ed3m ki\u1ec3m so\u00e1t th\u1ec3 t\u00edch (b\u1eb1ng l\u1ecdc th\u1eadn, l\u1ee3i ni\u1ec7u), \u0111i\u1ec1u tr\u1ecb thi\u1ebfu m\u00e1u, t\u0103ng huy\u1ebft \u00e1p.<\/p>\n

        Ch\u1ec9 \u0111\u1ecbnh ph\u0201u thu\u1eadt \u0111\u1ec3 th\u1eaft b\u1edbt l\u00e0m gi\u1ea3m \u0111\u01b0\u1eddng k\u00ednh mi\u1ec7ng n\u1ed1i. N\u1ebfu c\u1ea7u n\u1ed1i kh\u00f4ng th\u1ec3 s\u1eed d\u1ee5ng ph\u1ea3i th\u1eaft l\u1ea1i h\u1ee7y b\u1ecf, tr\u00e1nh l\u00e0m t\u0103ng cung l\u01b0\u1ee3ng tim.<\/p>\n

        2.9 T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i<\/h3>\n

        10 – 50% b\u1ec7nh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o chu k\u1ef3 b\u1ecb t\u0103ng \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i. C\u01a1 ch\u1ebf b\u1ec7nh sinh ch\u01b0a r\u00f5 r\u00e0ng, nh\u01b0ng c\u00f3 s\u1ef1 ph\u1ed1i h\u1ee3p c\u1ee7a nhi\u1ec1u y\u1ebfu t\u1ed1.<\/p>\n

        Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 kh\u00f3 th\u1edf, v\u00e0 suy tim ph\u1ea3i. Ch\u1ea9n \u0111o\u00e1n v\u00e0 theo d\u00f5i d\u1ef1a v\u00e0o si\u00eau \u00e2m Doppler tim.<\/p>\n

        T\u0103ng \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i l\u00e0m t\u0103ng nguy c\u01a1 b\u1ecb bi\u1ebfn c\u1ed1 tim m\u1ea1ch, v\u00e0 t\u1eed vong \u1edf b\u1ec7nh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o chu k\u1ef3 g\u1ea5p 2 – 3 l\u1ea7n.<\/p>\n

        \u0110i\u1ec1u tr\u1ecb ch\u1ee7 y\u1ebfu l\u00e0 t\u0103ng l\u01b0\u1ee3ng n\u01b0\u1edbc r\u00fat ra trong m\u1ed7i l\u1ea7n l\u1ecdc th\u1eadn, si\u00eau l\u1ecdc, ph\u0201u<\/p>\n","protected":false},"excerpt":{"rendered":"

        \u0110\u01b0\u1eddng v\u00e0o m\u1ea1ch m\u00e1u cho l\u1ecdc m\u00e1u (g\u1ecdi t\u1eaft l\u00e0 \u0111\u01b0\u1eddng v\u00e0o l\u1ecdc m\u00e1u) kh\u00f4ng ch\u1ec9 quan tr\u1ecdng trong vi\u1ec7c quy\u1ebft \u0111\u1ecbnh cu\u1ed9c l\u1ecdc m\u00e1u th\u00e0nh c\u00f4ng, n\u00f3 c\u00f2n \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn kh\u1ea3 n\u0103ng s\u1ed1ng c\u00f2n c\u1ee7a b\u1ec7nh nh\u00e2n suy th\u1eadn m\u1ea1n. Bi\u1ebfn ch\u1ee9ng c\u1ee7a \u0111\u01b0\u1eddng v\u00e0o l\u1ecdc m\u00e1u g\u00f3p ph\u1ea7n \u0111\u00e1ng k\u1ec3 v\u00e0o t\u1ef7 […]<\/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":"\n\u0110\u01b0\u1eddng v\u00e0o m\u1ea1ch m\u00e1u b\u1ec7nh nh\u00e2n suy th\u1eadn m\u1ea1n,bi\u1ebfn ch\u1ee9ng m\u1ea1n<\/title>\n<meta name=\"description\" content=\"Bi\u1ebfn ch\u1ee9ng c\u1ee7a \u0111\u01b0\u1eddng v\u00e0o m\u1ea1ch m\u00e1u g\u00f3p ph\u1ea7n v\u00e0o t\u1ef7 l\u1ec7 t\u1eed vong c\u1ee7a b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh th\u1eadn m\u1ea1n t\u00ednh giai \u0111o\u1ea1n cu\u1ed1i \u0111ang l\u1ecdc m\u00e1u nh\u00e2n t\u1ea1o.\" \/>\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 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