{"id":31836,"date":"2023-05-04T21:53:50","date_gmt":"2023-05-04T14:53:50","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31836"},"modified":"2023-05-04T21:54:35","modified_gmt":"2023-05-04T14:54:35","slug":"hep-van-dong-mach-chu-hinh-anh-hoc-va-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/hep-van-dong-mach-chu-hinh-anh-hoc-va-dieu-tri\/","title":{"rendered":"H\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7: h\u00ecnh \u1ea3nh h\u1ecdc v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

H\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 (\u0110MC) l\u00e0 b\u1ec7nh van tim ng\u00e0y c\u00e0ng g\u1eb7p nhi\u1ec1u \u1edf b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed1i nh\u1ea5t l\u00e0 \u1edf c\u00e1c n\u01b0\u1edbc ph\u00e1t tri\u1ec3n . Thu\u1eadt ng\u1eef h\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 d\u00f9ng \u0111\u1ec3 ch\u1ec9 t\u00ecnh tr\u1ea1ng h\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, d\u1eabn \u0111\u1ebfn t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra c\u1ee7a m\u00e1u t\u1eeb th\u1ea5t tr\u00e1i v\u00e0o \u0111\u1ed9ng m\u1ea1ch ch\u1ee7. \u0110i\u1ec1u n\u00e0y l\u00e0m t\u0103ng h\u1eadu g\u00e1nh l\u00ean th\u1ea5t tr\u00e1i, v\u00e0 th\u1eadm ch\u00ed l\u00e0 g\u00e2y suy th\u1ea5t tr\u00e1i. Ng\u00e0y nay, bi\u1ec7n ph\u00e1p thay van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 qua da ( Transcatheter aortic valve implantation – TAVI) \u0111ang \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p h\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u1edbn tu\u1ed1i ho\u1eb7c nguy c\u01a1 ph\u1eabu thu\u1eadt cao.<\/strong><\/p>\n

1. H\u00ecnh \u1ea3nh h\u1ecdc trong h\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/h2>\n

1.1. Ch\u1ee5p X quang ng\u1ef1c<\/strong>
\n– Cung d\u01b0\u1edbi tr\u00e1i ph\u1ed3ng, m\u1ecfm tim l\u1ec7ch tr\u00e1i do ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i.
\n– Quai \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 gi\u00e3n, tr\u00ean quai \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 c\u00f3 th\u1ec3 c\u00f3 nh\u1eefng n\u1ed1t v\u00f4i h\u00f3a.
\n1.2. \u0110o \u0111i\u1ec7n tim ( ECG )<\/strong>
\n– D\u1ea5u hi\u1ec7u d\u00e0y th\u1ea5t tr\u00e1i t\u0103ng g\u00e1nh t\u00e2m thu \u1edf c\u00e1c chuy\u1ec3n \u0111\u1ea1o DI, aVl, V5, V6. R cao, ST ch\u00eanh xu\u1ed1ng, T (-) kh\u00f4ng \u0111\u1ed1i x\u1ee9ng.
\nCh\u1ec9 s\u1ed1 Sokolow \u2013 Lyon: SV1\/V2 + RV5\/V6 > 35mm.
\n– R\u1ed1i lo\u1ea1n nh\u1ecbp: ngo\u1ea1i t\u00e2m thu nh\u0129, th\u1ea5t, rung nh\u0129.
\n– R\u1ed1i lo\u1ea1n d\u1eabn truy\u1ec1n: bl\u1ed1c nh\u0129 \u2013 th\u1ea5t, bl\u1ed1c xoang nh\u0129.
\n1.3. Si\u00eau \u00e2m tim ( Echocardiography )<\/strong>
\n– L\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n r\u1ebb ti\u1ec1n, kh\u00f4ng x\u00e2m l\u1ea5n, \u0111\u1ed9 ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c kh\u00e1 cao.<\/p>\n

– Ti\u00eau chu\u1ea9n v\u00e0ng, l\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n kh\u00f4ng x\u00e2m l\u1ea5n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 nguy\u00ean nh\u00e2n h\u1eb9p ch\u1ee7, m\u1ee9c \u0111\u1ed9 n\u1eb7ng nh\u1eb9 v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng
\n\u2022 C\u00e1c bi\u1ec3u hi\u1ec7n c\u00f3 th\u1ec3 ghi nh\u1eadn:
\n\u2022 Ph\u00ec \u0111\u1ea1i \u0111\u1ed3ng t\u00e2m th\u1ea5t tr\u00e1i
\n\u2022 H\u1eb9p l\u1ed7 m\u1edf v\u00f2ng van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7
\n\u2022 Gia t\u0103ng ch\u00eanh \u00e1p trung b\u00ecnh qua van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1eb1ng s\u1eed d\u1ee5ng c\u00e1c t\u00edn hi\u1ec7u Doppler<\/p>\n

B\u1ea3ng : Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 h\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 theo \u0111\u1ed9 ch\u1ec7nh \u00e1p qua van v\u00e0 di\u1ec7n t\u00edch m\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ( American College of Cardiology v\u00e0 American Heart Association). (Ngu\u1ed3n: 2014 AHA\/ACC Valvular Heart Disease Guideline )<\/p>\n\n\n\n\n\n\n\n
<\/td>\nNguy c\u01a1<\/td>\nH\u1eb9p nh\u1eb9<\/td>\nH\u1eb9p trung b\u00ecnh<\/td>\nH\u1eb9p n\u1eb7ng<\/td>\nH\u1eb9p r\u1ea5t n\u1eb7ng<\/td>\n<\/tr>\n
V\u1eadn t\u1ed1c t\u1ed1i \u0111a<\/td>\n<2 m\/gi\u00e2y<\/td>\n2-2,9m\/gi\u00e2y<\/td>\n3- 3,9m\/gi\u00e2y<\/td>\n>4m\/gi\u00e2y<\/td>\n>5m\/s<\/td>\n<\/tr>\n
Ch\u00eanh \u00e1p trung b\u00ecnh<\/td>\n<\/td>\n<20mmHg<\/td>\n20-39 mmHg<\/td>\n>40mmHg<\/td>\n>60mmHg<\/td>\n<\/tr>\n
Di\u1ec7n t\u00edch m\u1edf van<\/td>\n<\/td>\n<\/td>\n<\/td>\n<1cm2<\/td>\n<1cm2<\/td>\n<\/tr>\n
Ch\u1ec9 s\u1ed1 di\u1ec7n t\u00edch theo m2 da c\u01a1 th\u1ec3<\/td>\n<\/td>\n<\/td>\n<\/td>\n<0,6cm2\/m2<\/p>\n

da<\/td>\n

<0,6cm2\/m2 da<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

– M\u00f4 t\u1ea3 sang th\u01b0\u01a1ng, ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n h\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.
\n– \u0110\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng c\u1ee7a c\u00e1c bu\u1ed3ng tim: k\u00edch th\u01b0\u1edbc, d\u00e0y gi\u00e3n, ch\u1ee9c n\u0103ng t\u00e2m thu, t\u00e2m tr\u01b0\u01a1ng c\u1ee7a th\u1ea5t tr\u00e1i.
\n– Ch\u1ea9n \u0111o\u00e1n nh\u1eefng b\u1ec7nh \u0111i k\u00e8m (thi\u1ebfu m\u00e1u c\u01a1 tim, b\u1ec7nh van 2 l\u00e1, h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7).
\n– \u0110o di\u1ec7n t\u00edch m\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1eb1ng si\u00eau \u00e2m tim Doppler qua ph\u01b0\u01a1ng tr\u00ecnh li\u00ean t\u1ee5c.<\/p>\n

Nghi\u1ec7m ph\u00e1p g\u1eafng s\u1ee9c<\/strong>
\nNghi\u1ec7m ph\u00e1p g\u1eafng s\u1ee9c c\u00f3 l\u00fd \u00a0khi \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n h\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 n\u1eb7ng ( Vmax.> 4m\/gi\u00e2y, mean Gradient > 40mmHg ) m\u00e0 kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng nh\u1eb1m kh\u1eb3ng \u0111\u1ecbnh h\u1ecd kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng th\u1eadt s\u1ef1, v\u00e0 \u0111\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng g\u1eafng s\u1ee9c c\u0169ng nh\u01b0 \u0111\u00e1p \u1ee9ng huy\u1ebft \u0111\u1ed9ng v\u1edbi g\u1eafng s\u1ee9c, nh\u1eb1m ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb ch\u00ednh x\u00e1c.<\/p>\n

2. \u0110i\u1ec1u tr\u1ecb h\u1eb9p van \u0110MC<\/h2>\n

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

Theo d\u00f5i
\n\u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa k\u00e8m v\u1edbi theo d\u00f5i 6 th\u00e1ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ed1i v\u1edbi nh\u00f3m:
\n\u2022 B\u1ec7nh nh\u00e2n h\u1eb9p ch\u1ee7 nh\u1eb9 – trung b\u00ecnh kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng
\n\u2022 B\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng, h\u1eb9p ch\u1ee7 n\u1eb7ng, m\u1ea5t kh\u1ea3 n\u0103ng ho\u1ea1t \u0111\u1ed9ng sinh l\u00fd, kh\u00f4ng c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 sau:
\n\u2022 T\u1ed1c \u0111\u1ed9 d\u00f2ng m\u00e1u qua van \u0111o b\u1edfi si\u00eau \u00e2m tim > 5.5
\n\u2022 V\u00f4i h\u00f3a van n\u1eb7ng k\u00e8m v\u1edbi ti\u1ebfn tri\u1ec3n li\u00ean t\u1ee5c h\u1eb1ng n\u0103m
\n\u2022 T\u0103ng \u00e1p ph\u1ed5i n\u1eb7ng > 60 mmHg<\/p>\n

\u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa cho th\u1ea5y c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng, nh\u01b0ng kh\u00f4ng c\u1ea3i thi\u1ec7n \u0111\u01b0\u1ee3c ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh.<\/p>\n

V\u00ed d\u1ee5:
\n\u2022 C\u00e1c thu\u1ed1c ki\u1ec3m so\u00e1t t\u1ea7n s\u1ed1 tim
\n\u2022 C\u00e1c thu\u1ed1c gi\u1ea3m h\u1eadu g\u00e1nh<\/p>\n

2.2 \u0110i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt<\/strong><\/h3>\n

Ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n h\u1eb9p ch\u1ee7 n\u1eb7ng khi:
\n\u2022 B\u1ec7nh nh\u00e2n kh\u00f4ng bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i (EF < 50 %).
\n\u2022 B\u1ec7nh nh\u00e2n kh\u00f4ng bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng c\u00f3 kh\u1ea3 n\u0103ng sinh ho\u1ea1t khi ti\u1ebfn h\u00e0nh test g\u1eafng s\u1ee9c th\u1ec3 bi\u1ec3u hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng h\u1eb9p ch\u1ee7 \u0111i\u1ec3n h\u00ecnh ho\u1eb7c huy\u1ebft \u00e1p gi\u1ea3m d\u01b0\u1edbi m\u1ee9c n\u1ec1n.
\n\u2022 B\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng.
\nPh\u1eabu thu\u1eadt c\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh b\u1eb1ng c\u00e1c ph\u01b0\u01a1ng \u00e1n sau:
\n\u2022 Thay van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1eb1ng van nh\u00e2n t\u1ea1o c\u01a1 h\u1ecdc<\/a> \u2013 mechanical prosthetic valves (MPV)
\n\u2022 Thay van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 qua \u1ed1ng th\u00f4ng – Transcatheter aortic valve implantation (TAVI), \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n kh\u00f4ng ph\u00f9 h\u1ee3p \u0111\u1ec3 ti\u1ebfn h\u00e0nh AVR.<\/p>\n

\"hep-van-dong-mach-chu\"
Transcatheter aortic valve implantation<\/figcaption><\/figure>\n

C\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a h\u1eb9p ch\u1ee7
\nC\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a h\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 g\u1ed3m c\u00f3:
\n– Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m tr\u00f9ng
\n– Suy tim t\u00e2m tr\u01b0\u01a1ng, suy tim \u1ee9 huy\u1ebft
\n– \u0110au th\u1eaft ng\u1ef1c, nh\u1ed3i m\u00e1u c\u01a1 tim
\n– Th\u1ea5p tim t\u00e1i ph\u00e1t
\n– R\u1ed1i lo\u1ea1n nh\u1ecbp
\n– \u0110\u1ed9t t\u1eed<\/p>\n

3. Ti\u00ean l\u01b0\u1ee3ng c\u1ee7a h\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/h2>\n

Quy lu\u1eadt 5,3 v\u00e0 2<\/p>\n

    \n
  • 50 % b\u1ec7nh nh\u00e2n \u0111au th\u1eaft ng\u1ef1c s\u1ebd t\u1eed vong sau 5 n\u0103m n\u1ebfu nh\u01b0 kh\u00f4ng \u0111\u01b0\u1ee3c thay van.<\/li>\n
  • 50% b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng ng\u1ea5t do h\u1eb9p ch\u1ee7 s\u1ebd t\u1eed vong sau 3 n\u0103m n\u1ebfu nh\u01b0 kh\u00f4ng \u0111\u01b0\u1ee3c thay van.<\/li>\n
  • 50% b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng suy tim xung huy\u1ebft do h\u1eb9p ch\u1ee7 s\u1ebd t\u1eed vong sau 2 n\u0103m n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c thay van.<\/li>\n<\/ul>\n

    K\u1ebft lu\u1eadn:<\/p>\n

    H\u1eb9p van \u0110MC l\u00e0 b\u1ec7nh van tim ng\u00e0y c\u00e0ng g\u1eb7p nhi\u1ec1u \u1edf b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed1i nh\u1ea5t l\u00e0 \u1edf c\u00e1c n\u01b0\u1edbc ph\u1ea5t tri\u1ec3n .
    \nH\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 n\u1eb7ng \u0111\u1ec3 l\u1ea1i nhi\u1ec1u bi\u1ebfn ch\u1ee9ng n\u1eb7ng nh\u01b0 \u0111au th\u1eaft ng\u1ef1c, nh\u1ed3i m\u00e1u c\u01a1 tim, ng\u1ea5t, lo\u1ea1n nh\u1ecbp, \u0111\u1ed9t t\u1eed.
    \n\u0110i\u1ec1u tr\u1ecb h\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 n\u1eb7ng c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e0 ph\u1eabu thu\u1eadt thay van
    \nNg\u00e0y nay thay van \u0110MC qua da ( TAVI ) \u0111ang \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p h\u1eb9p van \u0110MC l\u1edbn tu\u1ed1i ho\u1eb7c nguy c\u01a1 ph\u1eabu thu\u1eadt cao.<\/p>\n

    T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/strong><\/p>\n

      \n
    • B\u1ec7nh H\u1ecdc Tim M\u1ea1ch Lecturio<\/li>\n
    • B\u00e0i gi\u1ea3ng N\u1ed9i Tim m\u1ea1ch \u2013 \u0110\u1ea1i h\u1ecdc Y khoa Ph\u1ea1m Ng\u1ecdc Th\u1ea1ch – 2016<\/li>\n<\/ul>\n

       <\/p>\n","protected":false},"excerpt":{"rendered":"

      H\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 (\u0110MC) l\u00e0 b\u1ec7nh van tim ng\u00e0y c\u00e0ng g\u1eb7p nhi\u1ec1u \u1edf b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed1i nh\u1ea5t l\u00e0 \u1edf c\u00e1c n\u01b0\u1edbc ph\u00e1t tri\u1ec3n . Thu\u1eadt ng\u1eef h\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 d\u00f9ng \u0111\u1ec3 ch\u1ec9 t\u00ecnh tr\u1ea1ng h\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, d\u1eabn \u0111\u1ebfn t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra c\u1ee7a m\u00e1u t\u1eeb th\u1ea5t tr\u00e1i […]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[],"yoast_head":"\nH\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7: h\u00ecnh \u1ea3nh h\u1ecdc v\u00e0 \u0111i\u1ec1u tr\u1ecb - Vinmec<\/title>\n<meta name=\"description\" content=\"H\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 (\u0110MC) l\u00e0 b\u1ec7nh van tim ng\u00e0y c\u00e0ng g\u1eb7p nhi\u1ec1u \u1edf b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed1i nh\u1ea5t l\u00e0 \u1edf c\u00e1c n\u01b0\u1edbc ph\u00e1t tri\u1ec3n .\" \/>\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 van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7: h\u00ecnh \u1ea3nh h\u1ecdc v\u00e0 \u0111i\u1ec1u tr\u1ecb - 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