{"id":31597,"date":"2023-05-04T18:40:23","date_gmt":"2023-05-04T11:40:23","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31597"},"modified":"2023-05-04T18:40:23","modified_gmt":"2023-05-04T11:40:23","slug":"can-lam-sang-tren-benh-nhan-di-tat-tim-bam-sinh","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/can-lam-sang-tren-benh-nhan-di-tat-tim-bam-sinh\/","title":{"rendered":"C\u1eadn l\u00e2m s\u00e0ng tr\u00ean b\u1ec7nh nh\u00e2n d\u1ecb t\u1eadt tim b\u1ea9m sinh"},"content":{"rendered":"

D\u1ecb t\u1eadt tim b\u1ea9m sinh<\/a> (TBS) n\u1eb1m trong nh\u00f3m nh\u1eefng d\u1ecb t\u1eadt b\u1ea9m sinh ph\u1ed5 bi\u1ebfn nh\u1ea5t, \u01b0\u1edbc t\u00ednh t\u1ef7 l\u1ec7 g\u1eb7p kho\u1ea3ng 0,6 – 0,8% tr\u1ebb s\u01a1 sinh. T\u1ea1i Vi\u1ec7t Nam, c\u00f3 kho\u1ea3ng 10.000 tr\u1ebb s\u01a1 sinh m\u1eafc tim b\u1ea9m sinh m\u1ed7i n\u0103m.H\u1ea7u h\u1ebft nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y \u0111\u01b0\u1ee3c ph\u0201u thu\u1eadt gi\u1ea3m nh\u1eb9 ho\u1eb7c ph\u0201u thu\u1eadt s\u1eeda ch\u1eefa.<\/strong><\/p>\n

\"D\u1ecb<\/p>\n

C\u00e1c v\u1ecb tr\u00ed d\u1ecb t\u1eadt tim b\u1ea9m sinh<\/strong><\/p>\n

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

V\u1edbi nh\u1eefng ti\u1ebfn b\u1ed9 trong \u0111i\u1ec1u tr\u1ecb, hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh tim b\u1ea9m sinh \u0111\u00e3 c\u1ea3i thi\u1ec7n \u0111\u00e1ng k\u1ec3, h\u01a1n 85% tr\u1ebb c\u00f3 b\u1ec7nh tim b\u1ea9m sinh c\u00f3 th\u1ec3 s\u1ed1ng \u0111\u1ebfn tu\u1ed5i v\u1ecb th\u00e0nh ni\u00ean v\u00e0 tr\u01b0\u1edfng th\u00e0nh, trong s\u1ed1 \u0111\u00f3 c\u00f3 c\u1ea3 nh\u1eefng b\u1ec7nh tim b\u1ea9m sinh t\u1ed5n th\u01b0\u01a1ng ph\u1ee9c t\u1ea1p. Nh\u1edd s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a ph\u0201u thu\u1eadt, can thi\u1ec7p v\u00e0 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa tim m\u1ea1ch nhi, s\u1ed1 l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n tim b\u1ea9m sinh \u0111\u1ea1t \u0111\u1ebfn tu\u1ed5i tr\u01b0\u1edfng th\u00e0nh ng\u00e0y c\u00e0ng t\u0103ng l\u00ean. Ngo\u00e0i ra, nhi\u1ec1u b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh tim c\u1ea5u tr\u00fac ho\u1eb7c b\u1ec7nh van tim b\u1ea9m sinh ti\u1ebfn tri\u1ec3n t\u1eeb t\u1eeb, ch\u1ec9 bi\u1ec3u hi\u1ec7n mu\u1ed9n \u1edf tu\u1ed5i tr\u01b0\u1edfng th\u00e0nh.<\/p>\n

H\u1ea7u h\u1ebft nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y \u0111\u01b0\u1ee3c ph\u0201u thu\u1eadt gi\u1ea3m nh\u1eb9 ho\u1eb7c ph\u0201u thu\u1eadt s\u1eeda ch\u1eefa. Nh\u01b0 v\u1eady, m\u1ed9t v\u1ea5n \u0111\u1ec1 \u0111\u00e1ng quan t\u00e2m trong nh\u00f3m b\u1ec7nh tim b\u1ea9m sinh b\u00ean c\u1ea1nh vi\u1ec7c ho\u00e0n thi\u1ec7n ph\u0201u thu\u1eadt, can thi\u1ec7p v\u00e0 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa tim m\u1ea1ch nhi ch\u00ednh l\u00e0 theo d\u00f5i chuy\u00ean khoa v\u00e0 qu\u1ea3n l\u00fd nh\u00f3m b\u1ec7nh nh\u00e2n tim b\u1ea9m sinh ng\u01b0\u1eddi l\u1edbn sau khi \u0111\u01b0\u1ee3c ph\u0201u thu\u1eadt gi\u1ea3m nh\u1eb9\/s\u1eeda ch\u1eefa.<\/p>\n

2. C\u1eadn l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n<\/h2>\n

2.1 \u0110i\u1ec7n t\u00e2m \u0111\u1ed3<\/h3>\n

T \u1ea7 n s\u1ed1 v\u00e0 nh\u1ecbp tim: C\u1ea7n l\u01b0u \u00fd g\u1eb7p cu\u1ed3ng nh\u0129 b\u1ecb block khi nh\u1ecbp tim c\u1ed1 \u0111\u1ecbnh 100 ho\u1eb7c 150 nh\u1ecbp\/ph\u00fat, d\u1ec5 ch\u1ea9n \u0111o\u00e1n nh\u1ea7m v\u1edbi nh\u1ecbp xoang. C\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp nhanh nh\u0129 th\u01b0\u1eddng g\u1eb7p sau ph\u0201u thu\u1eadt t\u00e2m nh\u0129 (ph\u0201u thu\u1eadt s\u1eeda ch\u1eefa \u0111\u1ea3o g\u1ed1c \u0111\u1ed9ng m\u1ea1ch c\u00f3 t\u1ea1o \u0111\u01b0\u1eddng h\u1ea7m trong nh\u0129…).<\/p>\n

T\u00ecm c\u00e1c d\u1ea5u hi\u1ec7u gi\u00e3n bu\u1ed3ng nh\u0129 ho\u1eb7c ph\u00ec \u0111\u1ea1i t\u00e2m th\u1ea5t. \u0110\u00e1nh gi\u00e1 block nh\u00e1nh tr\u00e1i, ph\u1ea3i.<\/p>\n

Kho\u1ea3ng QRS sau ph\u0201u thu\u1eadt s\u1eeda ch\u1eefa Fallot IV: B \u1ec7nh nh\u00e2n c\u00f3 kho\u1ea3ng QRS > 180 ms c\u00f3 nguy c\u01a1 r\u1ed1i lo\u1ea1n nh\u1ecbp tim, gi\u00e3n th\u1ea5t ph\u1ea3i v\u00e0 \u0111\u1ed9t t\u1eed mu\u1ed9n cao h\u01a1n.<\/p>\n

Ghi holter \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 24 n\u1ebfu nghi ng\u1edd c\u01a1n nh\u1ecbp tim nhanh.<\/p>\n

2.2 Vai tr\u00f2 test g\u1eafng s\u1ee9c: xe \u0111\u1ea1p, th\u1ea3m ch\u1ea1y, si\u00eau \u00e2m tim g\u1eafng s\u1ee9c, test \u0111i b\u1ed9 6 ph\u00fat…<\/strong><\/h3>\n

\u0110\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng nh\u1ecbp tim v\u00e0 huy\u1ebft \u00e1p khi g\u1eafng s\u1ee9c (ch\u1ec9 \u0111\u1ecbnh \u1edf b\u1ec7nh nh\u00e2n h\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 m\u1ee9c \u0111\u1ed9 v\u1eeba…).<\/p>\n

So s\u00e1nh huy\u1ebft \u00e1p chi tr\u00ean v\u00e0 chi d\u01b0\u1edbi sau ph\u0201u thu\u1eadt h\u1eb9p eo \u0110M ch\u1ee7 .<\/p>\n

Theo d\u00f5i bi\u1ebfn \u0111\u1ed5i \u0111\u1ed9 b\u00e3o ho\u00e0 oxy trong m\u00e1u ngo\u1ea1i vi (SpO2) \u0111\u1ec3 ph\u00e2n t\u1ea7ng nguy c\u01a1 cho c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 t\u00edm.<\/p>\n

\u0110\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng ch\u1ecbu \u0111\u1ef1ng thai k\u1ef3 \u0111\u1ec3 t\u01b0 v\u1ea5n v\u00e0 l\u1eadp k\u1ebf ho\u1ea1ch thai k\u1ef3.<\/p>\n

Test g\u1eafng s\u1ee9c tim ph\u1ed5i \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh ch\u1ec9 \u0111\u1ecbnh, th\u1eddi \u0111i\u1ec3m ph\u0201u thu\u1eadt ho\u1eb7c can thi\u1ec7p tim.<\/p>\n

\u0110\u00e1nh gi\u00e1 gi\u1edbi h\u1ea1n g\u1eafng s\u1ee9c (xem x\u00e9t l\u1ef1a ch\u1ecdn m\u00f4n th\u1ec3 thao ph\u00f9 h\u1ee3p, kh\u1ea3 n\u0103ng quay l\u1ea1i l\u00e0m vi\u1ec7c, ch\u01a1i th\u1ec3 thao..<\/p>\n

Test \u0111i b\u1ed9 6 ph\u00fat <\/em>\u0111\u00e1nh gi\u00e1 c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng g\u1eafng s\u1ee9c tr\u01b0\u1edbc v\u00e0 sau \u0111i\u1ec1u tr\u1ecb \u1edf b\u1ec7nh nh\u00e2n t\u0103ng \u00e1p \u0111\u1ed9ng m \u1ea1ch ph\u1ed5i.<\/p>\n

2.3 X-quang ng\u1ef1c<\/h3>\n

X-quang ng\u1ef1c l\u00e0 th\u0103m d\u00f2 \u0111\u01a1n gi\u1ea3n nh\u01b0ng r\u1ea5t gi\u00e1 tr\u1ecb \u1edf b\u1ec7nh nh\u00e2n TBS. X\u00e1c \u0111\u1ecbnh tr\u00e1i – ph\u1ea3i \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 v\u1ecb tr\u00ed tim v\u00e0 n\u1ed9i t\u1ea1ng.<\/p>\n

\u0110\u00e1nh gi\u00e1 h\u00ecnh \u1ea3nh nh\u00e1nh ph\u1ebf qu\u1ea3n cho ph\u00e9p ch\u1ea9n \u0111o\u00e1n c\u00e1c b\u1ea5t th\u01b0\u1eddng \u0111\u1ed3ng ph\u00e2n, v\u00ed d\u1ee5: Ph\u1ed5i \u0111\u1ed1i x\u1ee9ng d\u1ea1ng ph\u1ed5i ph\u1ea3i \u1edf b\u1ec7nh l\u00fd \u0111\u1ed3ng ph\u00e2n ph\u1ea3i (th\u01b0\u1eddng ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c TBS ph\u1ee9c t\u1ea1p – tim m\u1ed9t th\u1ea5t, th\u00f4ng s\u00e0n nh\u0129 th\u1ea5t, tim m\u1ed9t th\u1ea5t k\u00e8m th\u00e2n chung \u0111\u1ed9ng m\u1ea1ch v\u00e0 b\u1ea5t th\u01b0\u1eddng tr\u1edf v\u1ec1 t\u0129nh m\u1ea1ch ph\u1ed5i th\u1ec3 to\u00e0n ph\u1ea7n).<\/p>\n

X\u00e1c \u0111\u1ecbnh situs inversus <\/em>(H\u00ecnh \u1ea3nh soi g\u01b0\u01a1ng: G an b\u00ean tr\u00e1i, b\u00f3ng h\u01a1i d\u1ea1 d\u00e0y b\u00ean ph\u1ea3i v\u00e0 m\u1ecfm tim \u1edf b\u00ean ph\u1ea3i), c\u1ea7n ngh\u0129 \u0111\u1ebfn h\u1ed9i ch\u1ee9ng Kartagener (\u0111\u1ea3o ng\u01b0\u1ee3c ph\u1ee7 t\u1ea1ng k\u00e8m gi\u00e3n ph\u1ebf qu\u1ea3n, vi\u00eam m\u0169i xoang). Khi v\u1ecb tr\u00ed m\u1ecfm tim v\u00e0 n\u1ed9i t\u1ea1ng kh\u00f4ng t\u01b0\u01a1ng th\u00edch th\u01b0\u1eddng c\u00f3 tim b\u1ea9m sinh \u0111i k\u00e8m.<\/p>\n

\u0110\u00e1nh gi\u00e1 t\u1ef7 s\u1ed1 tim\/ng\u1ef1c.<\/p>\n

Quan s\u00e1t d\u1ea5u \u1ea5n l\u00f5m x\u01b0\u01a1ng s\u01b0\u1eddn <\/em>(do t\u0103ng l\u01b0u l\u01b0\u1ee3ng m\u00e1u trong tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7) g\u1eb7p trong h\u1eb9p eo \u0110M ch\u1ee7 n\u1eb7ng.<\/p>\n

\u0110\u00e1nh gi\u00e1 t\u01b0\u1edbi m\u00e1u ph\u1ed5i.<\/p>\n

\u0110\u00e1nh gi\u00e1 t\u01b0\u1edbi m\u00e1u ph\u1ed5i tr\u00ean phim X-Quang ng\u1ef1c \u1edf b\u1ec7nh nh\u00e2n TBS<\/p>\n\n\n\n
T\u0103ng t\u01b0\u1edbi m\u00e1u<\/strong><\/p>\n

C\u00e1c nguy\u00ean nh\u00e2n t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i<\/p>\n

Shunt tr\u00e1i – ph\u1ea3i (TLN, TLT)<\/p>\n

Ph\u00f9 ph\u1ed5i<\/p>\n

H\u1eb9p ch\u1ed7 \u0111\u1ed5 v\u1ec1 c\u1ee7a t\u0129nh m\u1ea1ch ph\u1ed5i<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n


\nCh\u00fa th\u00edch:<\/u><\/em> TBS: Tim b\u1ea9m sinh; TLN: Th\u00f4ng li\u00ean nh\u0129; TLT: Th\u00f4ng li\u00ean th\u1ea5t; \u0110RTP: \u0110\u01b0\u1eddng ra th\u1ea5t ph\u1ea3i<\/em><\/p>\n

2.4 Si\u00eau \u00e2m Doppler tim<\/h3>\n

L\u00e0 th\u0103m d\u00f2 gi\u00e1 tr\u1ecb nh\u1ea5t trong TBS <\/strong>, nh\u01b0ng c\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n sau khi h\u1ecfi b\u1ec7nh s\u1eed v\u00e0 th\u0103m kh\u00e1m chi ti\u1ebft b\u1ec7nh nh\u00e2n.<\/p>\n

B\u00e1c s\u0129 th\u1ef1c hi\u1ec7n c\u1ea7n c\u00f3 kinh nghi\u1ec7m th\u0103m kh\u00e1m l\u00e2m s\u00e0ng v\u00e0 ki\u1ebfn th\u1ee9c v\u1ec1 TBS.<\/p>\n

C\u1ea7n th\u1ef1c hi\u1ec7n theo quy tr\u00ecnh c\u00e1c b\u01b0\u1edbc th\u0103m d\u00f2 v\u00e0 ph\u00e2n t\u00edch theo quy chu\u1ea9n \u0111\u1ec3 cung c\u1ea5p th\u00f4ng tin to\u00e0n di\u1ec7n v\u1ec1 b\u1ec7nh.<\/p>\n

H\u00ecnh \u1ea3nh s i\u00eau \u00e2m c\u00f3 th\u1ec3 k\u00e9m \u1edf b\u1ec7nh nh\u00e2n b\u00e9o, l\u1ed3ng ng\u1ef1c gi\u00e3n, sau ph\u0201u thu\u1eadt ; c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n b\u1eb1ng s\u1eed d\u1ee5ng si\u00eau \u00e2m qua th\u1ef1c qu\u1ea3n.<\/p>\n

2.5 Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI)<\/h3>\n

L\u00fd t\u01b0\u1edfng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i v\u00e0 h\u1ec7 th\u1ed1ng t\u0129nh m\u1ea1ch <\/strong>.<\/p>\n

\u0110\u00e1nh gi\u00e1 c\u1ea5u tr\u00fac tim, shunt trong v\u00e0 ngo\u00e0i tim.<\/p>\n

L\u01b0\u1ee3ng gi\u00e1 m\u1ee9c \u0111\u1ed9 h\u1edf van tim (V \u00ed d\u1ee5 : \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 h\u1edf ph\u1ed5i v\u00e0 ch\u1ee9c n\u0103ng th\u1ea5t<\/p>\n

ph\u1ea3i \u1edf b\u1ec7nh nh\u00e2n sau ph\u0201u thu\u1eadt s\u1eeda ch\u1eefa Fallot IV).<\/p>\n

R\u1ea5t c\u00f3 gi\u00e1 tr\u1ecb trong \u0111\u00e1nh gi\u00e1 c\u00e1c t\u1ed5n th\u01b0\u01a1ng ph\u1ee9c t\u1ea1p trong tim v\u00e0 quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb. Tuy nhi\u00ean b\u00e1c s \u0129 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh ph\u00e2n t\u00edch k\u1ebft qu\u1ea3 c\u1ea7n c\u00f3 ki\u1ebfn th\u1ee9c chuy\u00ean khoa s\u00e2u v\u1ec1 TBS.<\/p>\n

2.6 Th\u00f4ng tim<\/h3>\n

\u0110\u00e1nh gi\u00e1 ch\u00ednh x\u00e1c c\u00e1c th\u00f4ng s\u1ed1 huy\u1ebft \u0111\u1ed9ng, l\u01b0\u1ee3ng gi\u00e1 c\u00e1c shunt trong v\u00e0 ngo\u00e0i tim \u0110\u01b0\u1ee3c coi l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng ch\u1ea9n \u0111o\u00e1n t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i<\/strong><\/p>\n

K\u1ebft h\u1ee3p v\u1edbi th\u1ee7 thu\u1eadt can thi\u1ec7p b\u00edt \u1ed1ng \u0110M, TLN, TLT b\u1eb1ng d\u1ee5ng c\u1ee5<\/p>\n

Nhi\u1ec1u b\u1ec7nh nh\u00e2n cao tu\u1ed5i c\u1ea7n ch\u1ee5p \u0110MV \u0111\u1ec3 c\u00e2n nh\u1eafc quy\u1ebft \u0111\u1ecbnh ph\u0201u thu\u1eadt b\u1eafc c\u1ea7u n\u1ed1i ch\u1ee7 – v\u00e0nh b\u1ed5 sung c\u00f9ng v\u1edbi ph\u0201u thu\u1eadt s\u1eeda ch\u1eefa ch\u00ednh.<\/p>\n","protected":false},"excerpt":{"rendered":"

D\u1ecb t\u1eadt tim b\u1ea9m sinh (TBS) n\u1eb1m trong nh\u00f3m nh\u1eefng d\u1ecb t\u1eadt b\u1ea9m sinh ph\u1ed5 bi\u1ebfn nh\u1ea5t, \u01b0\u1edbc t\u00ednh t\u1ef7 l\u1ec7 g\u1eb7p kho\u1ea3ng 0,6 – 0,8% tr\u1ebb s\u01a1 sinh. T\u1ea1i Vi\u1ec7t Nam, c\u00f3 kho\u1ea3ng 10.000 tr\u1ebb s\u01a1 sinh m\u1eafc tim b\u1ea9m sinh m\u1ed7i n\u0103m.H\u1ea7u h\u1ebft nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y \u0111\u01b0\u1ee3c ph\u0201u thu\u1eadt gi\u1ea3m nh\u1eb9 ho\u1eb7c […]<\/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":"\nC\u1eadn l\u00e2m s\u00e0ng tr\u00ean b\u1ec7nh nh\u00e2n d\u1ecb t\u1eadt tim b\u1ea9m sinh - Vinmec<\/title>\n<meta name=\"description\" content=\"D\u1ecb t\u1eadt tim b\u1ea9m sinh n\u1eb1m trong nh\u00f3m nh\u1eefng d\u1ecb t\u1eadt b\u1ea9m sinh ph\u1ed5 bi\u1ebfn nh\u1ea5t.T\u1ea1i Vi\u1ec7t Nam, c\u00f3 kho\u1ea3ng 10.000 tr\u1ebb s\u01a1 sinh m\u1eafc tim b\u1ea9m sinh m\u1ed7i n\u0103m.\" \/>\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=\"C\u1eadn l\u00e2m s\u00e0ng tr\u00ean b\u1ec7nh nh\u00e2n d\u1ecb t\u1eadt tim b\u1ea9m sinh - 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