{"id":30656,"date":"2023-05-03T15:03:10","date_gmt":"2023-05-03T08:03:10","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30656"},"modified":"2023-05-03T15:03:10","modified_gmt":"2023-05-03T08:03:10","slug":"hep-dong-mach-than","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/hep-dong-mach-than\/","title":{"rendered":"H\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn t\u1eeb ch\u1ea9n \u0111o\u00e1n \u0111\u1ebfn \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

H\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn<\/a> l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y t\u0103ng huy\u1ebft \u00e1p th\u1ee9 ph\u00e1t th\u01b0\u1eddng g\u1eb7p, chi\u1ebfm 90% do x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch v\u00e0 kho\u1ea3ng 10% do c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c nh\u01b0 lo\u1ea1n s\u1ea3n x\u01a1 c\u01a1, vi\u00eam \u0111\u1ed9ng m\u1ea1ch, ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch th\u1eadn hay ch\u00e8n \u00e9p t\u1eeb b\u00ean ngoai…<\/strong><\/p>\n

1. D\u1ecbch t\u1ec5 h\u1ecdc<\/h2>\n

T\u0103ng huy\u1ebft \u00e1p do h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn chi\u1ebfm 1 – 5% s\u1ed1 b\u1ec7nh nh\u00e2n THA; trong \u0111\u00f3, tr\u00ean 90% tr\u01b0\u1eddng h\u1ee3p do x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch (th\u01b0\u1eddng \u1edf l\u1ed7 v\u00e0o), kho\u1ea3ng 10% do lo\u1ea1n s\u1ea3n x\u01a1 c\u01a1 (b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch kh\u00f4ng do x\u01a1 v\u1eefa, kh\u00f4ng do vi\u00eam, t\u1ed5n th\u01b0\u01a1ng l\u1edbp c\u01a1 c\u1ee7a \u0111o\u1ea1n gi\u1eefa v\u00e0 \u0111o\u1ea1n xa th\u00e0nh c\u00e1c \u0111\u1ed9ng m\u1ea1ch c\u1ee1 v\u1eeba – nh\u1ecf, th\u01b0\u1eddng g\u1eb7p \u1edf n\u1eef gi\u1edbi tr\u1ebb tu\u1ed5i v\u00e0 trung ni\u00ean) ho\u1eb7c b\u1ec7nh l\u00fd hi\u1ebfm g\u1eb7p kh\u00e1c.<\/p>\n

Ph\u1ea7n l\u1edbn nh\u1eefng nghi\u00ean c\u1ee9u v\u1ec1 ti\u1ebfn tri\u1ec3n t\u1ef1 nhi\u00ean (t\u0103ng m\u1ee9c \u0111\u1ed9 h\u1eb9p, teo th\u1eadn.) do x\u01a1 v\u1eefa l\u00e0 h\u1ed3i c\u1ee9u, cho th\u1ea5y t\u1ef7 l\u1ec7 ti\u1ebfn tri\u1ec3n t\u1eeb 36 – 71%. H\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn c\u00f3 ti\u00ean l\u01b0\u1ee3ng x\u1ea5u, d\u00f9 ch\u01b0a ti\u1ebfn tri\u1ec3n \u0111\u1ebfn b\u1ec7nh th\u1eadn giai \u0111o\u1ea1n cu\u1ed1i. T\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t sau 2 n\u0103m l\u00e0 96% \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n h\u1eb9p 1 b\u00ean, 74% n\u1ebfu h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn 2 b\u00ean v\u00e0 47% n\u1ebfu h\u1eb9p ho\u1eb7c t\u1eafc tr\u00ean 1 th\u1eadn duy nh\u1ea5t c\u00f2n ch\u1ee9c n\u0103ng.<\/p>\n

\"H\u1eb9p<\/p>\n

H\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn<\/strong><\/p>\n

2. L\u00e2m s\u00e0ng<\/h2>\n

Bi\u1ec3u hi\u1ec7n th\u01b0\u1eddng g\u1eb7p l\u00e0 THA, 1\/3 s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 THA \u00e1c t\u00ednh ho\u1eb7c kh\u00f4ng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t d\u00f9 \u0111\u00e3 d\u00f9ng nhi\u1ec1u lo\u1ea1i thu\u1ed1c. C\u00f3 th\u1ec3 g\u1eb7p h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n suy th\u1eadn m\u1ea1n ho\u1eb7c suy th\u1eadn giai \u0111o\u1ea1n cu\u1ed1i c\u00f3 ho\u1eb7c kh\u00f4ng k\u00e8m theo t\u0103ng huy\u1ebft \u00e1p.<\/p>\n

C\u00e1c t\u00ecnh hu\u1ed1ng l\u00e2m s\u00e0ng g\u1ee3i \u00fd\u00a0 bao g\u1ed3m:<\/p>\n

    \n
  • Kh\u1edfi ph\u00e1t THA \u1edf ng\u01b0\u1eddi tr\u1ebb (d\u01b0\u1edbi 4 0 tu\u1ed5i).<\/li>\n
  • Kh\u1edfi ph\u00e1t THA n\u1eb7ng \u1edf tu\u1ed5i tr\u00ean 55, k\u00e8m theo suy tim, suy th\u1eadn m\u1ea1n.<\/li>\n
  • THA k\u00e8m theo th\u1ed5i \u1edf \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng.<\/li>\n
  • THA ti\u1ebfn tri\u1ec3n nhanh, kh\u00f3 ki\u1ec3m so\u00e1t \u1edf b\u1ec7nh nh\u00e2n THA tr\u01b0\u1edbc \u0111\u00f3 v\u0201n ki\u1ec3m so\u00e1t t\u1ed1t v\u00e0 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb.<\/li>\n
  • THA kh\u00e1ng tr\u1ecb (lo\u1ea1i tr\u1eeb nguy\u00ean nh\u00e2n THA kh\u00e1c, kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c huy\u1ebft \u00e1p m\u1eb7c d\u00f9 \u0111\u00e3 d\u00f9ng 3 nh\u00f3m thu\u1ed1c huy\u1ebft \u00e1p \u0111\u1ee7 li\u1ec1u, trong \u0111\u00f3 c\u00f3 1 thu\u1ed1c l\u1ee3i ti\u1ec3u).<\/li>\n
  • C\u01a1n THA c\u1ea5p c\u1ee9u (suy th\u1eadn c\u1ea5p, suy tim c\u1ea5p, b\u1ec7nh n\u00e3o THA, b\u1ec7nh v\u00f5ng m\u1ea1c \u0111\u1ed9 3 – 4).<\/li>\n
  • Suy th\u1eadn c\u1ea5p ho\u1eb7c t\u0103ng creatinin huy\u1ebft thanh khi d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n ho\u1eb7c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3.<\/li>\n<\/ul>\n
      \n
    • Teo th\u1eadn kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n, ho\u1eb7c ch\u00eanh l\u1ec7ch k\u00edch th\u01b0\u1edbc th\u1eadn, ho\u1eb7c suy th\u1eadn kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n.<\/li>\n<\/ul>\n
        \n
      • Ph\u00f9 ph\u1ed5i tho\u00e1ng qua t\u00e1i ph\u00e1t.<\/li>\n<\/ul>\n

        3.C\u1eadn l\u00e2m s\u00e0ng<\/h2>\n

        3.1 Si\u00eau \u00e2m Doppler \u0111\u1ed9ng m\u1ea1ch th\u1eadn<\/strong><\/h3>\n

        \u0110\u01b0\u1ee3c khuy\u1ebfn c\u00e1o l\u00e0 ph\u01b0\u01a1ng ti\u1ec7n ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh \u0111\u1ea7u ti\u00ean \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9, theo d\u00f5i sau can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch th\u1eadn.<\/p>\n

        Ch\u1ea9n \u0111o\u00e1n h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn tr\u00ean si\u00eau \u00e2m:<\/p>\n

        H\u1eb9p d\u01b0\u1edbi 60%:<\/em><\/strong><\/p>\n

        PSVs > 180 cm\/s.<\/p>\n

        RAR: 1,5 – 2,5.<\/p>\n

        Kh\u00f4ng c\u00f3 d\u00f2ng lo\u1ea1n s\u1eafc sau v\u1ecb tr\u00ed h\u1eb9p.<\/p>\n

        H\u1eb9p tr\u00ean 60%: <\/em><\/strong><\/p>\n

        PSVs > 18 cm\/s. RAR > 3,5.<\/p>\n

        C\u00f3 d\u00f2ng lo\u1ea1n s\u1eafc sau v\u1ecb tr\u00ed h\u1eb9p.<\/p>\n

        Hi\u1ec7n t\u01b0\u1ee3ng \u201cch\u1ea3y ch\u1eadm – \u0111\u1ebfn mu\u1ed9n” (tardus parvus) \u1edf m\u1ea1ch ph\u00eda xa sau v\u1ecb tr\u00ed h\u1eb9p: AT > 100 ms.<\/p>\n

        Ch\u1ea9n \u0111o\u00e1n t\u1eafc ho\u00e0n to\u00e0n \u0111\u1ed9ng m\u1ea1ch th\u1eadn tr\u00ean si\u00eau \u00e2m:<\/strong><\/p>\n

        Nh\u00ecn th\u1ea5y r\u00f5 h\u00ecnh \u1ea3nh \u0111\u1ed9ng m\u1ea1ch th\u1eadn tr\u00ean si\u00eau \u00e2m 2D, nh\u01b0ng kh\u00f4ng ghi \u0111\u01b0\u1ee3c t\u00edn hi\u1ec7u d\u00f2ng ch\u1ea3y.<\/p>\n

        T\u1ed1c \u0111\u1ed9 d\u00f2ng ch\u1ea3y t\u1ea1i nhu m\u00f4 th\u1eadn < 10 cm\/s.<\/p>\n

        Ch\u1ec9 s\u1ed1 s\u1ee9c c\u1ea3n t\u1eeb \u0111\u1ed9ng m\u1ea1ch nhu m\u00f4 th\u1eadn > 0,8 gi\u00fap x\u00e1c \u0111\u1ecbnh b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd th\u1eadn c\u00f3 th\u1ec3 kh\u00f4ng \u0111\u01b0\u1ee3c h\u01b0\u1edfng l\u1ee3i t\u1eeb \u0111i\u1ec1u tr\u1ecb t\u00e1i t\u01b0\u1edbi m\u00e1u qua da.<\/p>\n

        3.2 Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh m\u1ea1ch m\u00e1u<\/h3>\n

        \u0110\u00e1nh gi\u00e1 h\u00ecnh \u1ea3nh gi\u1ea3i ph\u0201u \u0111\u1ed9ng m\u1ea1ch th\u1eadn r\u1ea5t t\u1ed1t nh\u01b0ng kh\u00f4ng c\u00f3 c\u00e1c th\u00f4ng s\u1ed1 v\u1ec1 huy\u1ebft \u0111\u1ed9ng nh\u01b0 v\u1eadn t\u1ed1c d\u00f2ng ch\u1ea3y. L\u01b0u \u00fd ch\u1ee9c n\u0103ng th\u1eadn v\u00e0 d\u1ecb \u1ee9ng thu\u1ed1c c\u1ea3n quang tr\u01b0\u1edbc khi ch\u1ee5p.<\/p>\n

        3.3 Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb m\u1ea1ch m\u00e1u<\/h3>\n

        C\u00f3 \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch m\u00e3 ho\u00e1 xo\u00e1 n\u1ec1n, c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c c\u00e1c \u0111\u1ed9ng m\u1ea1ch th\u1eadn ph\u1ee5, \u0111\u00e1nh gi\u00e1 t\u01b0\u1edbi m\u00e1u th\u1eadn v\u00e0 k\u00edch th\u01b0\u1edbc th\u1eadn, th\u1eadm ch\u00ed c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn. L\u01b0u \u00fd ch\u1ee9c n\u0103ng th\u1eadn tr\u01b0\u1edbc khi ch\u1ee5p.<\/p>\n

        \"H\u1eb9p<\/p>\n

        H\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn<\/strong><\/p>\n

        3.4 Ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch th\u1eadn qua da<\/h3>\n

        L\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n, \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong \u0111i\u1ec1u tr\u1ecb can thi\u1ec7p t\u00e1i t\u01b0\u1edbi m\u00e1u \u0111\u1ed9ng m\u1ea1ch th\u1eadn, ho\u1eb7c \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n khi nghi ng\u1edd c\u00f3 b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch th\u1eadn nh\u01b0ng c\u00e1c k\u1ef9 thu\u1eadt ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh kh\u00e1c kh\u00f4ng k\u1ebft lu\u1eadn \u0111\u01b0\u1ee3c.<\/p>\n

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

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

        D\u1ef1 ph\u00f2ng th\u1ee9 ph\u00e1t bi\u1ebfn c\u1ed1 tim m\u1ea1ch v\u00e0 c\u1ea3i thi\u1ec7n ti\u00ean l\u01b0\u1ee3ng, bao g\u1ed3m:<\/p>\n

          \n
        • Ki\u1ec3m so\u00e1t t\u1ed1t huy\u1ebft \u00e1p : M\u1ee5c ti\u00eau huy\u1ebft \u00e1p c\u1ea7n \u0111\u1ea1t: N\u1ebfu b\u1ec7nh nh\u00e2n ch\u01b0a c\u00f3 suy th\u1eadn: < 140\/90 mmHg. N\u1ebfu b\u1ec7nh nh\u00e2n \u0111\u00e3 c\u00f3 suy th\u1eadn: < 130\/90 mmHg.<\/li>\n
        • Ng\u1eebng h\u00fat thu\u1ed1c l\u00e1.<\/li>\n
        • Ki\u1ec3m so\u00e1t c\u00e2n n\u1eb7ng.<\/li>\n
        • Ki\u1ec3m so\u00e1t ch\u1eb7t ch\u1ebd \u0111 \u01b0\u1eddng huy\u1ebft n\u1ebfu c\u00f3 ti\u1ec3u \u0111\u01b0\u1eddng.<\/li>\n
        • Kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u: Aspirin 75 – 100 mg\/24h ho\u1eb7c clopidogrel 75 mg\/24h<\/li>\n
        • Statin : M\u1ee9c LDL-C c\u1ea7n \u0111\u1ea1t d\u1ef1a v\u00e0o ph\u00e2n t\u1ea7ng nguy c\u01a1 tim m\u1ea1ch c\u1ee7a b\u1ec7nh nh\u00e2n.<\/li>\n<\/ul>\n

          Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p do h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn:<\/p>\n

            \n
          • Thu\u1ed1c \u01afCMC\/\u01afCTT \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p li\u00ean quan \u0111\u1ebfn h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn ch\u1ec9 m\u1ed9t b\u00ean.<\/li>\n
          • Thu\u1ed1c ch\u1eb9n k\u00eanh canxi, ch\u1eb9n beta giao c\u1ea3m v\u00e0 l\u1ee3i ti\u1ec3u \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p li\u00ean quan \u0111\u1ebfn b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch th\u1eadn.<\/li>\n
          • C\u00e2 n nh\u1eafc khi c\u1ea7n s\u1eed d\u1ee5ng thu\u1ed1c \u01afCMC\/\u01afCTT trong tr\u01b0\u1eddng h\u1ee3p h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn 2 b\u00ean ho\u1eb7c h\u1eb9p tr\u00ean 1 th\u1eadn duy nh\u1ea5t c\u00f2n ch\u1ee9c n\u0103ng, n\u1ebfu dung n\u1ea1p t\u1ed1t v\u00e0 ph\u1ea3i theo d\u00f5i ch\u1eb7t ch\u1ebd.<\/li>\n<\/ul>\n

            4.2 \u0110i\u1ec1u tr\u1ecb t\u00e1i t\u01b0\u1edbi m\u00e1u<\/h3>\n

            Kh\u00f4ng khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb t\u00e1i t\u01b0\u1edbi m\u00e1u th\u01b0\u1eddng quy v\u1edbi h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn do x\u01a1 v\u1eefa.<\/p>\n

            Hi\u1ec7n nay, v\u1edbi m\u1ee9c \u0111\u1ed9 b\u1eb1ng ch\u1ee9ng th\u1ea5p v\u1ec1 l\u1ee3i \u00edch khi so v\u1edbi \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa, \u0111i\u1ec1u tr\u1ecb t\u00e1i t\u01b0\u1edbi m\u00e1u ch\u1ec9 n\u00ean c\u00e2n nh\u1eafc \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn c\u00f3 \u00fd ngh\u0129a v\u1ec1 m\u1eb7t gi\u1ea3i ph\u0201u v\u00e0 ch\u1ee9c n\u0103ng v\u1edbi b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng \u0111\u1eb7c bi\u1ec7t, nh\u01b0:<\/p>\n

            H\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn c\u00f3 \u00fd ngh\u0129a v\u1ec1 huy\u1ebft \u0111\u1ed9ng k\u00e8m theo suy tim sung huy\u1ebft t\u00e1i ph\u00e1t, kh\u00f4ng l\u00fd gi\u1ea3i \u0111\u01b0\u1ee3c.<\/p>\n

            Ho\u1eb7c ph\u00f9 ph\u1ed5i c\u1ea5p \u0111\u1ed9t ng\u1ed9t.<\/p>\n

            T\u0103ng huy\u1ebft \u00e1p v\u00e0\/ho\u1eb7c suy th\u1eadn k\u00e8m theo h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn do lo\u1ea1n s\u1ea3n x\u01a1 c\u01a1.<\/p>\n

            4.2.1 Can thi\u1ec7p m\u1ea1ch th\u1eadn qua da <\/strong>(nong t\u1ea1o h\u00ecnh b\u1eb1ng b\u00f3ng v\u00e0\/ho\u1eb7c \u0111\u1eb7t stent)<\/h4>\n

            L\u00e0 ph\u01b0\u01a1ng ph\u00e1p t\u00e1i t\u01b0\u1edbi m\u00e1u h\u00e0ng \u0111\u1ea7u hi\u1ec7n nay khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh.<\/p>\n

            V\u1edbi h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn do x\u01a1 v\u1eefa: Th\u01b0\u1eddng k\u1ebft h\u1ee3p nong t\u1ea1o h\u00ecnh v\u00e0 \u0111\u1eb7t stent.<\/p>\n

            V\u1edbi h\u1eb9p do lo\u1ea1n s\u1ea3n x\u01a1 c\u01a1: Th\u01b0\u1eddng ch\u1ec9 c\u1ea7n nong t\u1ea1o h\u00ecnh, c\u00f3 th\u1ec3 \u0111\u1eb7t stent c\u1ee9u v\u00e3n khi c\u00f3 t\u00e1ch th\u00e0nh \u0111\u1ed9ng m\u1ea1ch ho\u1eb7c nong t\u1ea1o h\u00ecnh th\u1ea5t b\u1ea1i.<\/p>\n

            Bi\u1ebfn ch\u1ee9ng <\/em>: T\u1eafc \u0111\u1ed9ng m\u1ea1ch th\u1eadn do x\u01a1 v\u1eefa, t\u00e1ch th\u00e0nh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, h\u1ed9i ch\u1ee9ng ng\u00f3n ch\u00e2n xanh do t\u1eafc m\u1ea1ch ngo\u1ea1i bi\u00ean, t\u1ee5 m\u00e1u bao th\u1eadn do th\u1ee7ng nh\u00e1nh \u0111\u1ed9ng m\u1ea1ch th\u1eadn, t\u00e1i h\u1eb9p ( < 20%).<\/p>\n

            4.3 Ph\u1eabu thu\u1eadt<\/h3>\n

            Ch\u1ec9 \u0111\u1ecbnh gi\u1edbi h\u1ea1n: \u0110\u01b0\u1ee3c \u0111\u1eb7t ra khi c\u00f3 b\u1ec7nh l\u00fd c\u1ee7a nh\u00e1nh \u0111\u1ed9ng m\u1ea1ch th\u1eadn do lo\u1ea1n s\u1ea3n x\u01a1 c\u01a1 kh\u00f4ng th\u1ec3 \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c b\u1eb1ng nong b\u00f3ng t\u1ea1o h\u00ecnh, t\u00e1i h\u1eb9p sau \u0111\u1eb7t stent, ho\u1eb7c ph\u0201u thu\u1eadt \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng \u0111\u1ed3ng th\u1eddi.<\/p>\n

            Ph\u0201u thu\u1eadt c\u00f3 t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng v\u1ec1 k\u1ef9 thu\u1eadt cao v\u1edbi t\u1ef7 l\u1ec7 huy\u1ebft kh\u1ed1i ho\u1eb7c h\u1eb9p sau ph\u0201u thu\u1eadt < 10%. \u0110\u00e1p \u1ee9ng huy\u1ebft \u00e1p sau ph\u0201u thu\u1eadt t\u01b0\u01a1ng t\u1ef1 nh\u01b0 sau can thi\u1ec7p.<\/p>\n","protected":false},"excerpt":{"rendered":"

            H\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y t\u0103ng huy\u1ebft \u00e1p th\u1ee9 ph\u00e1t th\u01b0\u1eddng g\u1eb7p, chi\u1ebfm 90% do x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch v\u00e0 kho\u1ea3ng 10% do c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c nh\u01b0 lo\u1ea1n s\u1ea3n x\u01a1 c\u01a1, vi\u00eam \u0111\u1ed9ng m\u1ea1ch, ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch th\u1eadn hay ch\u00e8n \u00e9p t\u1eeb b\u00ean ngoai… 1. D\u1ecbch t\u1ec5 h\u1ecdc T\u0103ng huy\u1ebft \u00e1p […]<\/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":"\nH\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn t\u1eeb ch\u1ea9n \u0111o\u00e1n \u0111\u1ebfn \u0111i\u1ec1u tr\u1ecb - Vinmec<\/title>\n<meta name=\"description\" content=\"H\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y t\u0103ng huy\u1ebft \u00e1p th\u1ee9 ph\u00e1t th\u01b0\u1eddng g\u1eb7p, chi\u1ebfm 90% do x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch v\u00e0 kho\u1ea3ng 10% do c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c\" \/>\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=\"H\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn t\u1eeb ch\u1ea9n \u0111o\u00e1n \u0111\u1ebfn \u0111i\u1ec1u tr\u1ecb - 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