{"id":30624,"date":"2023-05-02T15:08:43","date_gmt":"2023-05-02T08:08:43","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30624"},"modified":"2023-05-02T15:08:43","modified_gmt":"2023-05-02T08:08:43","slug":"kiem-soat-bien-chung-man-tinh-o-benh-nhan-dtd-bo-y-te","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/02\/kiem-soat-bien-chung-man-tinh-o-benh-nhan-dtd-bo-y-te\/","title":{"rendered":"Ki\u1ec3m so\u00e1t bi\u1ebfn ch\u1ee9ng m\u00e3n t\u00ednh \u1edf b\u1ec7nh nh\u00e2n \u0110T\u0110 \u2013 B\u1ed9 Y t\u1ebf"},"content":{"rendered":"

Bi\u1ebfn ch\u1ee9ng m\u00e3n t\u00ednh c\u1ee7a b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (\u0110T\u0110) g\u1ed3m hai nh\u00f3m ch\u00ednh:\u00a0bi\u1ebfn ch\u1ee9ng m\u1ea1ch m\u00e1u l\u1edbn (b\u1ec7nh tim m\u1ea1ch, b\u1ec7nh m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean, m\u1ea1ch m\u00e1u n\u00e3o) v\u00e0 bi\u1ebfn ch\u1ee9ng m\u1ea1ch m\u00e1u nh\u1ecf c\u1ee7a b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng (bi\u1ebfn ch\u1ee9ng m\u1eaft, th\u1eadn, th\u1ea7n kinh), ho\u1eb7c c\u1ea3 hai. L\u00e0m t\u0103ng nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch, \u0111\u1ed9t qu\u1ef5 v\u00e0 b\u1ec7nh th\u1eadn tr\u00ean b\u1ec7nh nh\u00e2n (BN) \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/strong>\u00a0<\/strong><\/p>\n

1. Bi\u1ebfn ch\u1ee9ng m\u00e3n t\u00ednh vi m\u1ea1ch.<\/strong><\/h2>\n

1.1.\u00a0Bi\u1ebfn ch\u1ee9ng m\u1eaft \u0110T\u0110:<\/em><\/strong><\/p>\n

a)\u00a0Bi\u1ebfn ch\u1ee9ng n\u1eb7ng l\u00e0 b\u1ec7nh v\u00f5ng m\u1ea1c t\u0103ng sinh do \u0110T\u0110. C\u00f3 2 th\u1ec3 b\u1ec7nh v\u00f5ng m\u1ea1c ch\u00ednh:<\/p>\n

–\u00a0B\u1ec7nh v\u00f5ng m\u1ea1c kh\u00f4ng t\u0103ng sinh\u00a0<\/em><\/strong>(vi\u00eam v\u00f5ng m\u1ea1c t\u1ed5n th\u01b0\u01a1ng n\u1ec1n): giai \u0111o\u1ea1n s\u1edbm : Vi ph\u00ecnh m\u1ea1ch, xu\u1ea5t huy\u1ebft h\u00ecnh ch\u1ea5m, xu\u1ea5t huy\u1ebft – ph\u00f9 v\u00f5ng m\u1ea1c c\u00f3 th\u1ec3 g\u00e2y t\u1ed5n th\u01b0\u01a1ng t\u1ea1i ho\u00e0ng \u0111i\u1ec3m v\u00e0 g\u00e2y m\u00f9.<\/p>\n

B\u1ec7nh v\u00f5ng m\u1ea1c t\u0103ng sinh do \u0110T\u0110:\u00a0<\/em><\/strong>T\u0103ng sinh mao m\u1ea1ch, t\u1ed5 ch\u1ee9c x\u01a1 t\u1ea1i v\u00f5ng m\u1ea1c\u00a0\u00ae\u00a0t\u1eafc m\u1ea1ch m\u00e1u nh\u1ecf\u00a0\u00ae\u00a0thi\u1ebfu \u00f4xy t\u1ea1i v\u00f5ng m\u1ea1c k\u00edch th\u00edch s\u1ef1 ph\u00e1t tri\u1ec3n m\u1ea1ch m\u00e1u m\u1edbi. N\u1eb7ng xu\u1ea5t huy\u1ebft d\u1ecbch k\u00ednh, bong v\u00f5ng m\u1ea1c\u00a0\u00ae\u00a0m\u00f9.<\/p>\n

b)\u00a0\u0110\u1ee5c th\u1ee7y tinh th\u1ec3<\/em><\/strong>: Bi\u1ec3u hi\u1ec7n 2 th\u1ec3:<\/p>\n

–\u00a0Th\u1ec3 d\u01b0\u1edbi v\u1ecf: ti\u1ebfn tri\u1ec3n nhanh c\u1ea3 2 m\u1eaft\u00a0\u00ae\u00a0h\u00ecnh \u1ea3nh b\u00f4ng tuy\u1ebft d\u01b0\u1edbi v\u1ecf th\u1ee7y tinh th\u1ec3<\/p>\n

–\u00a0Th\u1ec3 l\u00e3o h\u00f3a: th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi l\u1edbn, \u1edf nh\u00e2n th\u1ee7y tinh th\u1ec3.<\/p>\n

c)\u00a0Glaucoma:\u00a0<\/em><\/strong>X\u1ea3y ra \u1edf 6 % BN \u0110T\u0110, th\u01b0\u1eddng l\u00e0 Glaucoma g\u00f3c m\u1edf. Glaucoma g\u00f3c \u0111\u00f3ng \u00edt g\u1eb7p, g\u1eb7p trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 t\u00e2n m\u1ea1ch \u1edf m\u1ed1ng m\u1eaft.<\/p>\n

d)\u00a0BN \u0110T\u0110 t\u00edp 2 c\u1ea7n \u0111\u01b0\u1ee3c kh\u00e1m m\u1eaft to\u00e0n di\u1ec7n, \u0111o th\u1ecb l\u1ef1c t\u1ea1i th\u1eddi \u0111i\u1ec3m \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n b\u1ec7nh \u0110T\u0110.<\/p>\n

e)\u00a0N\u1ebfu kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 b\u1ec7nh v\u00f5ng m\u1ea1c \u1edf m\u1ed9t ho\u1eb7c nhi\u1ec1u l\u1ea7n kh\u00e1m m\u1eaft h\u00e0ng n\u0103m v\u00e0 \u0111\u01b0\u1eddng huy\u1ebft \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t t\u1ed1t, c\u00f3 th\u1ec3 xem x\u00e9t kh\u00e1m m\u1eaft 2 n\u0103m m\u1ed9t l\u1ea7n. N\u1ebfu b\u1ec7nh v\u00f5ng m\u1ea1c \u0111ang ti\u1ebfn tri\u1ec3n ho\u1eb7c \u0111e d\u1ecda \u0111\u1ebfn th\u1ecb l\u1ef1c, ph\u1ea3i kh\u00e1m m\u1eaft th\u01b0\u1eddng xuy\u00ean h\u01a1n.<\/p>\n\n\n\n\n\n\n\n
KHUY\u1ebeN C\u00c1O V\u1ec0 BI\u1ebeN CH\u1ee8NG V\u00d5NG M\u1ea0C DO \u0110\u00c1I TH\u00c1O \u0110\u01af\u1edcNG<\/strong><\/td>\n<\/tr>\n
1. C\u1ea7n t\u1ea7m so\u00e1t bi\u1ebfn ch\u1ee9ng v\u00f5ng m\u1ea1c cho ng\u01b0\u1eddi b\u1ec7nh \u0110T\u0110 t\u00edp 1 n\u0103m n\u0103m sau khi ch\u1ea9n \u0111o\u00e1n; c\u1ea7n t\u1ea7m\u00a0so\u00e1t\u00a0bi\u1ebfn ch\u1ee9ng v\u00f5ng m\u1ea1c cho ng\u01b0\u1eddi b\u1ec7nh \u0110T\u0110 t\u00edp 2 ngay th\u1eddi \u0111i\u1ec3m ch\u1ea9n \u0111o\u00e1n. Ph\u1ee5 n\u1eef \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n \u0110T\u0110 t\u00edp 1 v\u00e0 t\u00edp 2 c\u1ea7n \u0111\u01b0\u1ee3c t\u1ea7m so\u00e1t bi\u1ebfn ch\u1ee9ng v\u00f5ng m\u1ea1c tr\u01b0\u1edbc khi c\u00f3 thai hay chu\u1ea9n b\u1ecb mang thai. Kh\u00f4ng c\u1ea7n t\u1ea7m so\u00e1t bi\u1ebfn ch\u1ee9ng v\u00f5ng m\u1ea1c cho ph\u1ee5 n\u1eef \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n \u0110T\u0110 thai k\u1ef3.<\/td>\n<\/tr>\n
2. N\u1ebfu l\u1ea7n t\u1ea7m so\u00e1t \u0111\u1ea7u ti\u00ean cho k\u1ebft qu\u1ea3 b\u00ecnh th\u01b0\u1eddng (kh\u00f4ng c\u00f3 bi\u1ebfn ch\u1ee9ng v\u00f5ng m\u1ea1c do \u0110T\u0110), ng\u01b0\u1eddi b\u1ec7nh s\u1ebd \u0111\u01b0\u1ee3c t\u1ea7m so\u00e1t m\u1ed7i 1-2 n\u0103m m\u1ed9t l\u1ea7n. Theo d\u00f5i s\u00e1t h\u01a1n s\u1ebd do b\u00e1c s\u0129 chuy\u00ean khoa m\u1eaft quy\u1ebft \u0111\u1ecbnh.<\/td>\n<\/tr>\n
3. K\u1ef9 thu\u1eadt vi\u00ean hay b\u00e1c s\u0129 chuy\u00ean khoa \u0110T\u0110 \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o v\u00e0 hu\u1ea5n luy\u1ec7n c\u00f3 th\u1ec3 t\u1ea7m so\u00e1t b\u1ec7nh l\u00fd v\u00f5ng m\u1ea1c \u0111\u1ecbnh k\u1ef3. B\u00e1c s\u0129 chuy\u00ean khoa m\u1eaft s\u1ebd h\u1ed9i \u00fd v\u00e0 cho \u00fd ki\u1ebfn trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u00f3 hay c\u00f3 bi\u1ebfn ch\u1ee9ng v\u00f5ng m\u1ea1c n\u1eb7ng.<\/td>\n<\/tr>\n
4. Ki\u1ec3m so\u00e1t t\u1ed1t \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 huy\u1ebft \u00e1p gi\u00fap ng\u0103n ng\u1eeba v\u00e0 l\u00e0m ch\u1eadm di\u1ec5n ti\u1ebfn c\u1ee7a bi\u1ebfn ch\u1ee9ng v\u00f5ng m\u1ea1c. N\u1ebfu c\u00f3 b\u1eb1ng ch\u1ee9ng bi\u1ebfn ch\u1ee9ng v\u00f5ng m\u1ea1c kh\u00f4ng t\u0103ng sinh m\u1ee9c \u0111\u1ed9 nh\u1eb9, fenofibrate 145-200 mg\/ng\u00e0y \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh m\u00e0 kh\u00f4ng c\u1ea7n c\u00f3 t\u0103ng triglycerides. Laser quang \u0111\u00f4ng v\u00e0 anti- VEGF \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh v\u00e0 th\u1ef1c hi\u1ec7n b\u1edfi b\u00e1c s\u0129 chuy\u00ean khoa m\u1eaft.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

1.2.\u00a0Bi\u1ebfn ch\u1ee9ng th\u1eadn:<\/em><\/strong><\/p>\n

a)\u00a0\u00cdt nh\u1ea5t m\u1ed7i n\u0103m m\u1ed9t l\u1ea7n \u0111\u00e1nh gi\u00e1 albumin ni\u1ec7u v\u00e0 m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn \u1edf t\u1ea5t c\u1ea3 c\u00e1c BN \u0110T\u0110 t\u00edp 2, kh\u00f4ng k\u1ec3 \u0111ang \u0111i\u1ec1u tr\u1ecb nh\u01b0 th\u1ebf n\u00e0o<\/p>\n

b)\u00a0BN c\u00f3 albumin ni\u1ec7u > 30 mg\/g creatinine v\u00e0\/ ho\u1eb7c m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn eGFR< 60 mL\/ph\u00fat\/1,73m2 c\u1ea7n \u0111\u00e1nh gi\u00e1 hai l\u1ea7n m\u1ed9t n\u0103m nh\u1eb1m \u0111\u1ecbnh h\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb<\/p>\n

c)\u00a0C\u1ea7n t\u1ed1i \u01b0u ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 ho\u1eb7c l\u00e0m ch\u1eadm qu\u00e1 tr\u00ecnh ti\u1ebfn tri\u1ec3n b\u1ec7nh th\u1eadn m\u1ea1n<\/p>\n

d)\u00a0B\u1ec7nh nh\u00e2n \u0110T\u0110 t\u00edp 2 m\u1eafc k\u00e8m b\u1ec7nh th\u1eadn do \u0110T\u0110, c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng \u1ee8c ch\u1ebf SGLT2 \u1edf BN c\u00f3 \u0111\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn \u226530 mL\/ph\u00fat\/1,73m2 v\u00e0 albumin ni\u1ec7u >30 mg\/g creatinine, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng BN c\u00f3 albumin ni\u1ec7u \u2265300 mg\/g creatinine, \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 ti\u1ebfn tri\u1ec3n b\u1ec7nh th\u1eadn m\u1ea1n v\u00e0 bi\u1ebfn c\u1ed1 tim m\u1ea1ch ho\u1eb7c c\u1ea3 hai.<\/p>\n

e)\u00a0BN c\u00f3 b\u1ec7nh th\u1eadn m\u1ea1n c\u00f3 gia t\u0103ng nguy c\u01a1 g\u1eb7p bi\u1ebfn c\u1ed1 tim m\u1ea1ch, s\u1eed d\u1ee5ng GLP-1 RA c\u00f3 th\u1ec3 gi\u1ea3m nguy c\u01a1 ti\u1ebfn tri\u1ec3n almumin ni\u1ec7u v\u00e0 bi\u1ebfn c\u1ed1 tim m\u1ea1ch ho\u1eb7c c\u1ea3 hai.<\/p>\n

B\u1ea3ng . C\u00e1c x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 v\u00e0 theo d\u00f5i bi\u1ec3u hi\u1ec7n c\u1ee7a bi\u1ebfn ch\u1ee9ng th\u1eadn do \u0110T\u0110 (ngo\u00e0i ACR v\u00e0 \u0111\u1ed9 thanh l\u1ecdc c\u1ea7u th\u1eadn \u01b0\u1edbc t\u00ednh)<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Bi\u1ebfn ch\u1ee9ng c\u1ee7a b\u1ec7nh th\u1eadn m\u1ea1n<\/strong><\/td>\n\u0110\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng<\/strong><\/td>\n<\/tr>\n
T\u0103ng huy\u1ebft \u00e1p<\/td>\nHuy\u1ebft \u00e1p v\u00e0 c\u00e2n n\u1eb7ng<\/td>\n<\/tr>\n
Qu\u00e1 t\u1ea3i d\u1ecbch<\/td>\nB\u1ec7nh s\u1eed, kh\u00e1m l\u00e2m s\u00e0ng, c\u00e2n n\u1eb7ng<\/td>\n<\/tr>\n
R\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i<\/td>\nKh\u00e1m l\u00e2m s\u00e0ng, \u0111i\u1ec7n t\u00e2m \u0111\u1ed3, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3<\/td>\n<\/tr>\n
Toan chuy\u1ec3n h\u00f3a<\/td>\nKh\u00e1m l\u00e2m s\u00e0ng, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3, kh\u00ed m\u00e1u<\/td>\n<\/tr>\n
Thi\u1ebfu m\u00e1u<\/td>\nS\u1eaft, hemoglobin<\/td>\n<\/tr>\n
B\u1ec7nh x\u01b0\u01a1ng do chuy\u1ec3n h\u00f3a<\/td>\nCalci, Phosphor, vitamin D, PTH m\u00e1u<\/td>\n<\/tr>\n
KHUY\u1ebeN C\u00c1O V\u1ec0 BI\u1ebeN CH\u1ee8NG TH\u1eacN DO \u0110\u00c1I TH\u00c1O \u0110\u01af\u1edcNG<\/strong><\/td>\n<\/tr>\n
1. C\u1ea7n t\u1ea7m so\u00e1t bi\u1ebfn ch\u1ee9ng th\u1eadn cho ng\u01b0\u1eddi b\u1ec7nh \u0110T\u0110 t\u00edp 1 sau 5 n\u0103m v\u00e0 ng\u01b0\u1eddi b\u1ec7nh \u0110T\u0110 t\u00edp 2 ngay khi ch\u1ea9n \u0111o\u00e1n. T\u1ef7 s\u1ed1 A\/C ni\u1ec7u l\u00e0 x\u00e9t nghi\u1ec7m t\u1ea7m so\u00e1t hi\u1ec7u qu\u1ea3 nh\u1ea5t. T\u1ea7m so\u00e1t v\u00e0 \u0111\u00e1nh gi\u00e1 l\u1ea1i t\u1ed1i thi\u1ec3u 6-12 th\u00e1ng m\u1ed9t l\u1ea7n. BN c\u00f3 t\u1ef7 s\u1ed1 A\/C > 30mg\/g v\u00e0\/ho\u1eb7c eGFR < 60mL\/ph\/1,73m2<\/sup>\u00a0da \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 b\u1ec7nh th\u1eadn do \u0110T\u0110 v\u00e0 theo d\u00f5i s\u00e1t h\u01a1n (m\u1ed7i 6 th\u00e1ng)<\/td>\n<\/tr>\n
2. Ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft ch\u1eb7t ch\u1ebd l\u00e0 n\u1ec1n t\u1ea3ng \u0111\u1ec3 ph\u00f2ng ng\u1eeba v\u00e0 l\u00e0m ch\u1eadm bi\u1ebfn ch\u1ee9ng th\u1eadn do \u0110T\u0110. Metformin l\u00e0 thu\u1ed1c l\u1ef1a ch\u1ecdn \u0111\u1ea7u tay tr\u1eeb khi c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh (eGFR < 30mL\/ph\/1,73m2 da). \u1ee8c ch\u1ebf SGLT-2 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh l\u00e0 thu\u1ed1c h\u00e0ng th\u1ee9 nh\u00ec khi c\u00f3 t\u1ef7 s\u1ed1 A\/C > 30 mg\/g. N\u1ebfu c\u00f3 nguy c\u01a1 cao tim m\u1ea1ch k\u00e8m theo, \u0111\u1ed3ng v\u1eadn th\u1ee5 th\u1ec3 GLP-1 \u0111\u01b0\u1ee3c xem x\u00e9t ch\u1ec9 \u0111\u1ecbnh.<\/td>\n<\/tr>\n
3. Thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n hay \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 angiotensin II \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh tr\u00ean ng\u01b0\u1eddi b\u1ec7nh c\u00f3 t\u0103ng huy\u1ebft \u00e1p c\u00f3\/kh\u00f4ng c\u00f3 albumin ni\u1ec7u. Kh\u00f4ng k\u1ebft h\u1ee3p hai thu\u1ed1c v\u00e0 kh\u00f4ng khuy\u1ebfn c\u00e1o tr\u00ean ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng t\u0103ng huy\u1ebft \u00e1p \u0111\u1ec3 ph\u00f2ng ng\u1eeba nguy\u00ean ph\u00e1t b\u1ec7nh th\u1eadn do \u0110T\u0110. Ki\u1ec3m tra \u0111\u1ecbnh k\u1ef3 creatinine huy\u1ebft thanh v\u00e0 kali \u1edf ng\u01b0\u1eddi b\u1ec7nh c\u00f3 d\u00f9ng \u1ee9c ch\u1ebf men chuy\u1ec3n hay \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 angiotensin II.<\/td>\n<\/tr>\n
4. Ch\u1ebf \u0111\u1ed9 \u0103n v\u1edbi kh\u1ea9u ph\u1ea7n \u0111\u1ea1m x\u1ea5p x\u1ec9 0,8 g\/kg c\u00e2n n\u1eb7ng\/ng\u00e0y \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho ng\u01b0\u1eddi b\u1ec7nh th\u1eadn do \u0110T\u0110 kh\u00f4ng l\u1ecdc th\u1eadn. H\u1ea1n ch\u1ebf natri < 2.300 mg\/ng\u00e0y v\u00e0 h\u1ea1n ch\u1ebf kali.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

2. Bi\u1ebfn ch\u1ee9ng m\u00e3n t\u00ednh m\u1ea1ch m\u00e1u l\u1edbn:<\/strong><\/h2>\n

X\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch s\u1edbm lan r\u1ed9ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u00e1c m\u1ea1ch m\u00e1u xa<\/p>\n

2.1.\u00a0B\u1ec7nh l\u00fd m\u1ea1ch v\u00e0nh:<\/strong><\/p>\n

Ng\u01b0\u1eddi \u0110T\u0110 t\u0103ng g\u1ea5p 2-3 l\u1ea7n ng\u01b0\u1eddi kh\u00f4ng \u0110T\u0110<\/p>\n

–\u00a0Tri\u1ec7u ch\u1ee9ng: C\u01a1n \u0111au th\u1eaft ng\u1ef1c \u0111i\u1ec3n h\u00ecnh ho\u1eb7c ch\u1ec9 bi\u1ec3u hi\u1ec7n tr\u00ean \u0110T\u0110 Nh\u1ed3i m\u00e1u c\u01a1 tim: \u0110i\u1ec3n h\u00ecnh ho\u1eb7c t\u00ecnh c\u1edd khi th\u1ea5y NMCT c\u0169 tr\u00ean ECG.<\/p>\n

2.2. B\u1ec7nh m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean:<\/strong><\/p>\n

Tri\u1ec7u ch\u1ee9ng: \u0110au c\u00e1ch h\u1ed3i, \u0111au ch\u00e2n \u1edf t\u01b0 th\u1ebf n\u1eb1m, ch\u00e2n l\u1ea1nh, t\u00edm \u1edf ph\u1ea7n chi d\u01b0\u1edbi v\u00e0 ng\u00f3n ch\u00e2n, teo c\u01a1 li\u00ean \u0111\u1ed1t, ho\u1ea1i th\u01b0. Ho\u1ea1i th\u01b0 g\u1ed3m 2 lo\u1ea1i: ho\u1ea1i th\u01b0 kh\u00f4 ng\u1ecdn chi: ho\u1ea1i t\u1eed kh\u00f4ng nhi\u1ec5m khu\u1ea9n ti\u00ean l\u01b0\u1ee3ng t\u1ed1t. Ho\u1ea1i th\u01b0 \u01b0\u1edbt: c\u00f3 vi\u00eam nhi\u1ec5m k\u00e8m theo (ti\u00ean l\u01b0\u1ee3ng x\u1ea5u). Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh d\u1ef1a v\u00e0o: doppler m\u1ea1ch chi, ch\u1ee5p m\u1ea1ch<\/p>\n

3 Bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh:<\/strong><\/h2>\n

T\u1ea5t c\u1ea3 BN c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 v\u1ec1 b\u1ec7nh th\u1ea7n kinh ngo\u1ea1i bi\u00ean t\u1ea1i th\u1eddi \u0111i\u1ec3m b\u1eaft \u0111\u1ea7u \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n \u0111o\u00e1n \u0110T\u0110 t\u00edp 2 v\u00e0 5 n\u0103m sau khi ch\u1ea9n \u0111o\u00e1n b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng t\u00edp 1, sau \u0111\u00f3 \u00edt nh\u1ea5t m\u1ed7i n\u0103m m\u1ed9t l\u1ea7n.<\/p>\n\n\n\n\n\n\n\n
KHUY\u1ebeN C\u00c1O V\u1ec0 BI\u1ebeN CH\u1ee8NG TH\u1ea6N KINH DO \u0110\u00c1I TH\u00c1O \u0110\u01af\u1edcNG<\/strong><\/td>\n<\/tr>\n
1. Ng\u01b0\u1eddi b\u1ec7nh \u0110T\u0110 t\u00edp 1 sau ch\u1ea9n \u0111o\u00e1n 5 n\u0103m v\u00e0 ng\u01b0\u1eddi b\u1ec7nh \u0110TD t\u00edp 2 ngay th\u1eddi \u0111i\u1ec3m ch\u1ea9n \u0111o\u00e1n c\u1ea7n \u0111\u01b0\u1ee3c t\u1ea7m so\u00e1t bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh t\u1ed1i thi\u1ec3u m\u1ed9t n\u0103m m\u1ed9t l\u1ea7n.<\/td>\n<\/tr>\n
2. H\u1ecfi b\u1ec7nh s\u1eed, kh\u00e1m l\u00e2m s\u00e0ng v\u00e0 c\u00e1c test \u0111\u01a1n gi\u1ea3n d\u00f9ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh do \u0110T\u0110. Kh\u00e1m c\u1ea3m gi\u00e1c \u0111au v\u00e0 c\u1ea3m gi\u00e1c nhi\u1ec7t \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh s\u1ee3i tr\u1ee5c nh\u1ecf. Monofilament 10g v\u00e0 rung \u00e2m thoa 128 Hz \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh s\u1ee3i tr\u1ee5c l\u1edbn v\u00e0 c\u1ea3m gi\u00e1c b\u1ea3o v\u1ec7. C\u1ea7n kh\u00e1m c\u00e1c bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh t\u1ef1 ch\u1ee7 do \u0110T\u0110.<\/td>\n<\/tr>\n
3. Ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft ch\u1eb7t ch\u1ebd \u0111\u01b0\u1ee3c xem l\u00e0 n\u1ec1n t\u1ea3ng c\u1ee7a vi\u1ec7c ph\u00f2ng ng\u1eeba v\u00e0 l\u00e0m ch\u1eadm di\u1ec5n ti\u1ebfn c\u1ee7a bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh do \u0110T\u0110.<\/td>\n<\/tr>\n
4. C\u00e1c thu\u1ed1c gi\u1ea3m \u0111au th\u1ea7n kinh nh\u01b0 pregabalin, gabapentin, duloxetine \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ec3 kh\u1edfi tr\u1ecb c\u00e1c tri\u1ec7u ch\u1ee9ng \u0111au do bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh \u0110T\u0110.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

4. B\u00e0n ch\u00e2n ng\u01b0\u1eddi \u0110T\u0110:<\/strong><\/h2>\n

a) T\u1ed5n th\u01b0\u01a1ng b\u00e0n ch\u00e2n<\/a> l\u00e0 bi\u1ebfn ch\u1ee9ng m\u00e3n t\u00ednh th\u01b0\u1eddng g\u1eb7p b\u1eaft \u0111\u1ea7u \u1edf nh\u1eefng ng\u00f3n ch\u00e2n, \u00f4 m\u00f4 ng\u00f3n b\u1ecb m\u1ea5t c\u1ea3m gi\u00e1c, \u0111\u1eb7c bi\u1ec7t nh\u1eefng n\u01a1i ng\u00f3n \u0111\u00e3 b\u1ecb bi\u1ebfn d\u1ea1ng v\u00e0\/ ho\u1eb7c thi\u1ebfu m\u00e1u. Nh\u1eefng ng\u00f3n ch\u00e2n d\u1ec5 b\u1ecb ch\u1ea5n th\u01b0\u01a1ng, d\u1ec5 h\u00ecnh th\u00e0nh nh\u1eefng c\u1ee5c chai, \u1ed5 lo\u00e9t, nhi\u1ec5m tr\u00f9ng v\u00e0 ho\u1ea1i th\u01b0. T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh g\u00e2y gi\u1ea3m ti\u1ebft m\u1ed3 h\u00f4i v\u00e0 kh\u00f4 da, l\u00e0m da ng\u01b0\u1eddi b\u1ec7nh d\u1ec5 n\u1ee9t n\u1ebb, lo\u00e9t v\u00e0 ho\u1ea1i t\u1eed.<\/p>\n

\"Bien-chung-man-tinh\"
B\u00e0n ch\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/figcaption><\/figure>\n

b)\u00a0Tri\u1ec7u ch\u1ee9ng b\u00e0n ch\u00e2n th\u01b0\u1eddng g\u1eb7p:<\/p>\n

–\u00a0\u0110au v\u1ec1 \u0111\u00eam, th\u1eadm ch\u00ed \u0111au c\u00e1ch h\u1ed3i, l\u1ea1nh chi, ch\u1eadm \u0111\u1ed5 \u0111\u1ea7y m\u00e1u t\u0129nh m\u1ea1ch sau khi gi\u01a1 ch\u00e2n l\u00ean cao, c\u00f3 th\u1ec3 m\u1ea5t m\u1ea1ch khi kh\u00e1m<\/p>\n

–\u00a0Da v\u00f9ng ch\u00e2n t\u00e1i khi gi\u01a1 ch\u00e2n cao, teo l\u1edbp m d\u01b0\u1edbi da, m\u1ea5t l\u00f4ng b\u00e0n ng\u00f3n ch\u00e2n, m\u00f3ng d\u00e0y l\u00ean, nhi\u1ec5m n\u1ea5m m\u00f3ng, ho\u1ea1i t\u1eed<\/p>\n

–\u00a0Teo c\u01a1 do t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh v\u1eadn \u0111\u1ed9ng, d\u1eabn \u0111\u1ebfn bi\u1ebfn d\u1ea1ng b\u00e0n ch\u00e2n do m\u1ea5t c\u00e2n b\u1eb1ng gi\u1eefa hai h\u1ec7 th\u1ed1ng c\u01a1 g\u1ea5p v\u00e0 c\u01a1 du\u00f5i. Do bi\u1ebfn d\u1ea1ng b\u00e0n ch\u00e2n n\u00ean s\u1ebd t\u1ea1o ra nh\u1eefng v\u00f9ng ch\u1ecbu tr\u1ecdng l\u1ef1c \u0111\u1eb7c bi\u1ec7t, t\u1ea1o thu\u1eadn l\u1ee3i xu\u1ea5t hi\u1ec7n lo\u00e9t v\u00e0 ho\u1ea1i t\u1eed ch\u00e2n<\/p>\n

c)\u00a0Ph\u00e2n \u0111\u1ed9 b\u00e0n ch\u00e2n theo Wagner v\u00e0 Meggit<\/p>\n

–\u00a0\u0110\u1ed9 0: Kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng nh\u01b0ng c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 nh\u01b0 c\u00e1c chai ch\u00e2n.<\/p>\n

–\u00a0\u0110\u1ed9 1: Lo\u00e9t n\u00f4ng \u1edf nh\u1eefng n\u01a1i ch\u1ecbu s\u1ef1 t\u1ef3 \u0111\u00e8 l\u1edbn (m\u00f4 \u00fat, m\u00f4 c\u00e1i, g\u00f3t ch\u00e2n)<\/p>\n

–\u00a0\u0110\u1ed9 2: Lo\u00e9t s\u00e2u c\u00f3 nhi\u1ec5m tr\u00f9ng t\u1ea1i ch\u1ed7, c\u00f3 t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh, nh\u01b0ng ch\u01b0a c\u00f3 t\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng.<\/p>\n

–\u00a0\u0110\u1ed9 3: C\u00f3 vi\u00eam m\u00f4 t\u1ebf b\u00e0o, \u0111\u00f4i khi h\u00ecnh th\u00e0nh \u1ed5 \u00e1p xe. C\u00f3 th\u1ec3 c\u00f3 vi\u00eam x\u01b0\u01a1ng.<\/p>\n

–\u00a0\u0110\u1ed9 4: Ho\u1ea1i t\u1eed ng\u00f3n, ph\u1ea7n tr\u01b0\u1edbc c\u1ee7a b\u00e0n ch\u00e2n ho\u1eb7c g\u00f3t ch\u00e2n.<\/p>\n

–\u00a0\u0110\u1ed9 5: Ho\u1ea1i t\u1eed n\u1eb7ng r\u1ed9ng v\u00e0 s\u00e2u c\u1ee7a b\u00e0n ch\u00e2n.<\/p>\n

d)\u00a0Th\u1ef1c hi\u1ec7n \u0111\u00e1nh gi\u00e1 b\u00e0n ch\u00e2n to\u00e0n di\u1ec7n \u00edt nh\u1ea5t m\u1ed7i n\u0103m m\u1ed9t l\u1ea7n \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a lo\u00e9t v\u00e0 c\u1eaft c\u1ee5t chi.<\/p>\n

e)\u00a0T\u1ea5t c\u1ea3 c\u00e1c BN \u0110T\u0110 ph\u1ea3i \u0111\u01b0\u1ee3c ki\u1ec3m tra b\u00e0n ch\u00e2n v\u00e0o m\u1ed7i l\u1ea7n kh\u00e1m b\u1ec7nh.<\/p>\n

T\u00c0I LI\u1ec6U THAM KH\u1ea2O:<\/strong><\/p>\n

“Ki\u1ec3m so\u00e1t v\u00e0 ph\u00f2ng ng\u1eeba bi\u1ebfn ch\u1ee9ng m\u00e3n t\u00ednh ” S\u1ed1 5481\/Q\u0110-BYT ‘V\u1ec0 VI\u1ec6C BAN H\u00c0NH T\u00c0I LI\u1ec6U CHUY\u00caN M\u00d4N \u201cH\u01af\u1edaNG D\u1eaaN CH\u1ea8N \u0110O\u00c1N V\u00c0 \u0110I\u1ec0U TR\u1eca \u0110\u00c1I TH\u00c1O \u0110\u01af\u1edcNG T\u00cdP 2\u201d, 30\/12\/2020<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Bi\u1ebfn ch\u1ee9ng m\u00e3n t\u00ednh c\u1ee7a b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (\u0110T\u0110) g\u1ed3m hai nh\u00f3m ch\u00ednh:\u00a0bi\u1ebfn ch\u1ee9ng m\u1ea1ch m\u00e1u l\u1edbn (b\u1ec7nh tim m\u1ea1ch, b\u1ec7nh m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean, m\u1ea1ch m\u00e1u n\u00e3o) v\u00e0 bi\u1ebfn ch\u1ee9ng m\u1ea1ch m\u00e1u nh\u1ecf c\u1ee7a b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng (bi\u1ebfn ch\u1ee9ng m\u1eaft, th\u1eadn, th\u1ea7n kinh), ho\u1eb7c c\u1ea3 hai. L\u00e0m t\u0103ng nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch, […]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[80,33],"tags":[],"yoast_head":"\nKi\u1ec3m so\u00e1t bi\u1ebfn ch\u1ee9ng m\u00e3n t\u00ednh \u1edf b\u1ec7nh nh\u00e2n \u0110T\u0110 \u2013 B\u1ed9 Y t\u1ebf - Vinmec<\/title>\n<meta name=\"description\" content=\"Bi\u1ebfn ch\u1ee9ng m\u00e3n t\u00ednh c\u1ee7a b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (\u0110T\u0110) g\u1ed3m hai nh\u00f3m ch\u00ednh:\u00a0bi\u1ebfn ch\u1ee9ng m\u1ea1ch m\u00e1u l\u1edbn, m\u1ea1ch m\u00e1u nh\u1ecf ho\u1eb7c c\u1ea3 hai.\" \/>\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=\"Ki\u1ec3m so\u00e1t bi\u1ebfn ch\u1ee9ng m\u00e3n t\u00ednh \u1edf b\u1ec7nh nh\u00e2n \u0110T\u0110 \u2013 B\u1ed9 Y t\u1ebf - 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