{"id":30635,"date":"2023-05-04T18:41:08","date_gmt":"2023-05-04T11:41:08","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30635"},"modified":"2023-05-04T18:41:08","modified_gmt":"2023-05-04T11:41:08","slug":"bien-chung-cap-duong-vao-mach-mau-benh-nhan-suy-than-man","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/bien-chung-cap-duong-vao-mach-mau-benh-nhan-suy-than-man\/","title":{"rendered":"\u0110\u01b0\u1eddng v\u00e0o m\u1ea1ch m\u00e1u b\u1ec7nh nh\u00e2n suy th\u1eadn m\u1ea1n v\u00e0 bi\u1ebfn ch\u1ee9ng c\u1ea5p"},"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. 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.T\u1ed5ng quan<\/h2>\n

B\u1ec7nh th\u1eadn m\u1ea1n t\u00ednh \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn kho\u1ea3ng 13% d\u00e2n s\u1ed1 th\u1ebf gi\u1edbi. T\u1ea1i Vi\u1ec7t Nam, n\u0103m 2013 c\u00f3 h\u01a1n 10.000 b\u1ec7nh nh\u00e2n giai \u0111o\u1ea1n cu\u1ed1i \u0111ang ch\u1ea1y th\u1eadn trong c\u1ea3 n\u01b0\u1edbc. T\u1ef7 l\u1ec7 t\u1eed vong c\u1ee7a nh\u1eefng b\u1ec7nh nh\u00e2n c\u1ea7n l\u1ecdc m\u00e1u r\u1ea5t cao, kho\u1ea3ng 40% trong 3 th\u00e1ng \u0111\u1ea7u v\u00e0 trung b\u00ecnh 20%\/n\u0103m. \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. 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.<\/p>\n

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

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

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

2.1 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

    2.2 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

    2.3 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

    3. Sinh l\u00fd b\u1ec7nh h\u1ecdc c\u1ee7a \u0111\u01b0\u1eddng v\u00e0o l\u1ecdc m\u00e1u<\/h2>\n

    Ph\u0201u thu\u1eadt t\u1ea1o c\u1ea7u n\u1ed1i \u0111\u1ed9ng t\u0129nh m\u1ea1ch l\u00e0 ph\u0201u thu\u1eadt n\u1ed1i gi\u1eefa \u0111\u1ed9ng m\u1ea1ch (n\u01a1i c\u00f3 \u00e1p l\u1ef1c cao) sang t\u0129nh m\u1ea1ch (n\u01a1i c\u00f3 \u00e1p l\u1ef1c th\u1ea5p) g\u00e2y t\u0103ng l\u1ef1c x\u00e9 v\u00e0 s\u1ee9c c\u0103ng l\u00ean th\u00e0nh t\u0129nh m\u1ea1ch, l\u00e0m d\u00e0y v\u00e0 gi\u00e3n th\u00e0nh t\u0129nh m\u1ea1ch (\u0111\u1ed9ng m\u1ea1ch ho\u00e1 t\u0129nh m\u1ea1ch). L\u01b0u l\u01b0\u1ee3ng t\u1ea1i \u0111\u1ed9ng m\u1ea1ch b\u00ecnh th\u01b0\u1eddng t\u1eeb 20 – 30 mL\/min, t\u0103ng l\u00ean ngay l\u1eadp t\u1ee9c 200 – 300 mL\/min sau ph\u0201u thu\u1eadt, \u0111\u1ea1t \u0111\u1ebfn 600 – 1200 mL\/min khi c\u1ea7u n\u1ed1i tr\u01b0\u1edfng th\u00e0nh. L\u01b0u l\u01b0\u1ee3ng d\u00f2ng ch\u1ea3y l\u1edbn khu\u1ebfch \u0111\u1ea1i hi\u1ec7u \u1ee9ng huy\u1ebft \u0111\u1ed9ng l\u00ean th\u00e0nh t\u0129nh m\u1ea1ch. Do \u0111\u00f3, n\u1ebfu l\u01b0u l\u01b0\u1ee3ng d\u00f2ng ch\u1ea3y th\u1ea5p, l\u00e0m gi\u1ea3m l\u1ef1c x\u00e9 l\u00ean th\u00e0nh t\u0129nh m\u1ea1ch g\u00e2y t\u0103ng sinh n\u1ed9i m\u1ea1c t\u0129nh m\u1ea1ch, d\u0201n \u0111\u1ebfn h\u1eb9p v\u00e0 huy\u1ebft kh\u1ed1i.<\/p>\n

    Ngo\u00e0i ra c\u00f2n c\u00e1c y\u1ebfu t\u1ed1 g\u00f3p ph\u1ea7n v\u00e0o ti\u1ebfn tri\u1ec3n c\u1ee7a t\u0103ng sinh n\u1ed9i m\u1ea1c nh\u01b0 suy gi\u1ea3m ch\u1ee9c n\u0103ng t\u1ebf b\u00e0o n\u1ed9i m\u00f4 do t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch, c\u1ea5u tr\u00fac gi\u1ea3i ph\u0201u c\u1ee7a mi\u1ec7ng n\u1ed1i v\u00e0 g\u00f3c t\u1ea1o b\u1edfi \u0111\u1ed9ng m\u1ea1ch v\u00e0 t\u0129nh m\u1ea1ch, t\u00e1i c\u1ea5u tr\u00fac m\u1ea1ch, \u0111\u1ed9 nh\u1edbt m\u00e1u…<\/p>\n

    4. \u0110\u00e1nh gi\u00e1 m\u1ed9t \u0111\u01b0\u1eddng v\u00e0o l\u1ecdc m\u00e1u tr\u01b0\u1edfng th\u00e0nh \u0111\u1ea3m b\u1ea3o ch\u1ee9c n\u0103ng<\/h3>\n

    C\u1ea7u n\u1ed1i tr\u01b0\u1edfng th\u00e0nh \u0111\u01b0\u1ee3c l\u00e0 m\u1ed9t \u1ed1ng d\u0201n m\u00e1u d\u01b0\u1edbi da \u0111\u1ea3m b\u1ea3o cung c\u1ea5p \u0111\u1ee7 l\u01b0u l\u01b0\u1ee3ng m\u00e1u cho qu\u00e1 tr\u00ecnh l\u1ecdc. T\u1ea1i Vi\u1ec7t Nam, l\u01b0u l\u01b0\u1ee3ng l\u1ecdc cho b\u1ec7nh nh\u00e2n 3 l\u1ea7n\/tu\u1ea7n ph\u1ed5 bi\u1ebfn t\u1eeb 250 – 300 mL\/ph. C\u1ea7u n\u1ed1i tr\u01b0\u1edfng th\u00e0nh l\u00e0 c\u1ea7u n\u1ed1i \u0111\u1ea3m b\u1ea3o cung c\u1ea5p \u0111\u01b0\u1ee3c \u0111\u1ee7 l\u01b0u l\u01b0\u1ee3ng tr\u00ean.<\/p>\n

    \u0110\u1ec3 tr\u00e1nh x\u1eb9p t\u0129nh m\u1ea1ch trong qu\u00e1 tr\u00ecnh l\u1ecdc m\u00e1u, l\u01b0u l\u01b0\u1ee3ng c\u1ea7u n\u1ed1i c\u1ea7n cao h\u01a1n l\u01b0u l\u01b0\u1ee3ng l\u1ecdc \u00edt nh\u1ea5t 250 – 300 mL \/ min , do \u0111\u00f3 l\u01b0u l\u01b0\u1ee3ng c\u1ea7u n\u1ed1i t\u1ed1t nh\u1ea5t t\u1eeb 600 – 800 mL \/min .<\/p>\n

    C\u00e1c ti\u00eau chu\u1ea9n c\u1ea7u n\u1ed1i tr\u01b0\u1edfng th\u00e0nh ( Quy lu\u1eadt 6): <\/em><\/strong><\/p>\n

      \n
    • \u0110\u01b0\u1eddng k\u00ednh t\u0129nh m\u1ea1ch hi\u1ec7u d\u1ee5ng \u2265 6 mm. L\u01b0u l\u01b0\u1ee3ng c\u1ea7u n\u1ed1i \u2265 600 mL \/min.<\/li>\n
    • Kho\u1ea3ng c\u00e1ch \u0111\u1ebfn m\u1eb7t da \u2264 6 mm.<\/li>\n
    • Chi\u1ec1u d\u00e0i t\u0129nh m\u1ea1ch t\u1ed1i thi\u1ec3u \u0111\u1ec3 ch\u1ecdc m\u1ea1ch \u2265 6 cm.<\/li>\n<\/ul>\n

      AVF v\u00e0 AVG c\u1ea7n th\u1eddi gian \u0111\u1ec3 tr\u01b0\u1edfng th\u00e0nh. AVF c\u1ea7n trung b\u00ecnh 6 – 8 tu\u1ea7n \u0111\u1ec3 t\u0129nh m\u1ea1ch d\u00e0y l\u00ean v\u00e0 gi\u00e3n ra. AVG c\u1ea7n \u00edt nh\u1ea5t 2 tu\u1ea7n \u0111\u1ec3 v\u1eadt li\u1ec7u graft li\u00ean k\u1ebft v\u1edbi t\u1ed5 ch\u1ee9c d\u01b0\u1edbi da trong \u0111\u01b0\u1eddng h\u1ea7m. Ch\u1ecdc m\u1ea1ch qu\u00e1 s\u1edbm c\u00f3 th\u1ec3 d\u0201n \u0111\u1ebfn t\u1ee5 m\u00e1u, ch\u1ea3y m\u00e1u, gi\u1ea3 ph\u00ecnh hay huy\u1ebft kh\u1ed1i s\u1edbm.<\/p>\n

      5. C\u00e1c bi\u1ebfn ch\u1ee9ng s\u1edbm th\u01b0\u1eddng g\u1eb7p c\u1ee7a \u0111\u01b0\u1eddng v\u00e0o l\u1ecdc m\u00e1u v\u00e0 x\u1eed tr\u00ed<\/h2>\n

      5.1 C\u1ea7u n\u1ed1i kh\u00f4ng tr\u01b0\u1edfng th\u00e0nh<\/strong><\/h3>\n

      \u0110\u1ecbnh ngh\u0129a: <\/strong>C\u1ea7u n\u1ed1i kh\u00f4ng tr\u01b0\u1edfng th\u00e0nh l\u00e0 c\u1ea7u n\u1ed1i v\u0129nh vi\u1ec5n kh\u00f4ng th\u1ec3 l\u1ecdc m\u00e1u ho\u1eb7c kh\u00f4ng th\u1ec3 l\u1ecdc m\u00e1u sau 3 th\u00e1ng k\u1ec3 t\u1eeb ng\u00e0y ph\u0201u thu\u1eadt.<\/p>\n

      Nguy\u00ean nh\u00e2n:<\/strong><\/p>\n

        \n
      • H\u1eb9p t\u0129nh m\u1ea1ch sau mi\u1ec7ng n\u1ed1i l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u.<\/li>\n
      • Xu\u1ea5t hi\u1ec7n tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 g\u00e2y gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng t\u0129nh m\u1ea1ch ch\u00ednh. Kh\u00f4ng \u0111\u1ee7 l\u01b0u l\u01b0\u1ee3ng t\u1eeb \u0111\u1ed9ng m\u1ea1ch.<\/li>\n
      • H\u1eb9p mi\u1ec7ng n\u1ed1i do sang ch\u1ea5n trong qu\u00e1 tr\u00ecnh ph\u0201u thu\u1eadt ho\u1eb7c do k\u0129 thu\u1eadt. T\u0129nh m\u1ea1ch hi\u1ec7u d\u1ee5ng c\u00f3 huy\u1ebft kh\u1ed1i ho\u1eb7c x\u01a1 ho\u00e1 t\u1eeb tr\u01b0\u1edbc.<\/li>\n
      • T\u0129nh m\u1ea1ch c\u00f3 k\u00edch th\u01b0\u1edbc nh\u1ecf tr\u01b0\u1edbc ph\u0201u thu\u1eadt ( < 2 mm).<\/li>\n
      • H\u1eb9p t\u0129nh m\u1ea1ch ngay sau mi\u1ec7ng n\u1ed1i, th\u01b0\u1eddng do t\u0129nh m\u1ea1ch b\u1ecb di chuy\u1ec3n, k\u00e9o c\u0103ng, g\u1eadp g\u00f3c trong qu\u00e1 tr\u00ecnh ph\u0201u thu\u1eadt.<\/li>\n<\/ul>\n

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

        Rung miu v\u00e0 th\u1ed5i ch\u1ec9 th\u1ea5y \u1edf th\u00ec t\u00e2m thu, ho\u1eb7c m\u1ea5t rung miu n\u1ebfu h\u1eb9p r\u1ea5t kh\u00edt, thay b\u1eb1ng ti\u1ebfng m\u1ea1ch \u0111\u1eadp m\u1ea1nh v\u00e0 th\u00f4.<\/p>\n

        T\u0129nh m\u1ea1ch c\u1ee7a c\u1ea7u n\u1ed1i b\u00ecnh th\u01b0\u1eddng c\u00f3 th\u1ec3 s\u1edd th\u1ea5y m\u1ea1ch \u0111\u1eadp, nh\u01b0ng n\u1ebfu h\u1eb9p kh\u00edt sau mi\u1ec7ng n\u1ed1i th\u00ec m\u1ea1ch \u0111\u1eadp y\u1ebfu ho\u1eb7c kh\u00f4ng s\u1edd th\u1ea5y.<\/p>\n

        Si\u00eau \u00e2m: <\/strong>T\u0103ng t\u1ed1c \u0111\u1ed9 d\u00f2ng ch\u1ea3y qua v\u1ecb tr\u00ed h\u1eb9p.<\/p>\n

        X\u1eed tr\u00ed: <\/strong>Ph\u0201u thu\u1eadt (n\u1ebfu li\u00ean quan \u0111\u1ebfn k\u1ef9 thu\u1eadt m\u1ed5) ho\u1eb7c nong v\u1ecb tr\u00ed h\u1eb9p b\u1eb1ng b\u00f3ng qua da.<\/p>\n

         <\/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. 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