{"id":31860,"date":"2023-05-04T21:55:03","date_gmt":"2023-05-04T14:55:03","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31860"},"modified":"2023-05-04T21:55:03","modified_gmt":"2023-05-04T14:55:03","slug":"ho-van-dong-mach-chu-sinh-benh-hoc-va-cac-giai-doan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/ho-van-dong-mach-chu-sinh-benh-hoc-va-cac-giai-doan\/","title":{"rendered":"H\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7: Sinh b\u1ec7nh h\u1ecdc v\u00e0 c\u00e1c giai \u0111o\u1ea1n"},"content":{"rendered":"

H\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 (hay h\u1edf ch\u1ee7 – aortic valve regurgitation – AR), l\u00e0 b\u1ec7nh l\u00fd van tim \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u00ecnh tr\u1ea1ng van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u0111\u00f3ng kh\u00f4ng ho\u00e0n to\u00e0n, d\u1eabn \u0111\u1ebfn th\u1ee5t ng\u01b0\u1ee3c d\u00f2ng m\u00e1u t\u1eeb \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 (\u0110MC) v\u1ec1 l\u1ea1i th\u1ea5t tr\u00e1i trong th\u1eddi k\u1ef3 t\u00e2m tr\u01b0\u01a1ng. C\u00f3 th\u1ec3 di\u1ec5n ra c\u1ea5p, d\u1eabn \u0111\u1ebfn suy ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i m\u1ea5t b\u00f9 c\u1ea5p nh\u01b0 trong tr\u01b0\u1eddng h\u1ee3p b\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, ho\u1eb7c m\u1ea1n t\u00ednh, c\u00f3 th\u1ec3 kh\u00f4ng bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng trong m\u1ed9t th\u1eddi gian d\u00e0i.<\/strong><\/p>\n

\"ho-van-dong-mach-chu\"
\n1. \u0110\u1ea1i c\u01b0\u01a1ng<\/h2>\n

1.1 D\u1ecbch t\u1ec3 c\u1ee7a h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/strong>
\nT\u1ef7 l\u1ec7 c\u1ee7a h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 t\u0103ng theo tu\u1ed5i, th\u00f4ng th\u01b0\u1eddng cao nh\u1ea5t \u1edf \u0111\u1ed9 tu\u1ed5i t\u1eeb 30 \u0111\u1ebfn 50 tu\u1ed5i.
\nTh\u01b0\u1eddng g\u1eb7p \u1edf nam h\u01a1n l\u00e0 n\u1eef.<\/p>\n

1.2 Nguy\u00ean nh\u00e2n c\u1ee7a h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/strong>
\n1.<\/strong>2.<\/strong>1. T\u1ed5n th\u01b0\u01a1ng t\u1ea1i l\u00e1 van
\n<\/strong>– H\u1eadu th\u1ea5p: m\u00e9p van co r\u00fat l\u1ea1i, d\u1ea7y l\u00ean g\u00e2y h\u1edf ( diastasis )
\n– Tho\u00e1i h\u00f3a van \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i
\n– B\u1ec7nh m\u00f4 li\u00ean k\u1ebft: vi\u00eam \u0111a kh\u1edbp d\u1ea1ng th\u1ea5p, vi\u00eam c\u1ee9ng kh\u1edbp c\u1ed9t s\u1ed1ng
\n– Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m tr\u00f9ng: r\u00e1ch l\u00e1 van do b\u1ecb s\u00f9i ng\u1eb7m nh\u1ea5m, c\u00f3 s\u00f9i \u0111\u00f3ng tr\u00ean m\u00e9p van.
\n– B\u1ea9m sinh:
\no Do van \u0110MC 2 m\u1ea3nh ( Bicuspid Aorta )
\no H\u1edf van \u0110MC : h\u1ed9i ch\u1ee9ng LAUBRY PEZZI (Th\u00f4ng li\u00ean th\u1ea5t + h\u1edf van \u0110MC).
\n– Giang mai th\u1eddi k\u1ef3 3: c\u00f3 s\u00f9i \u0111\u00f3ng tr\u00ean van \u0110MC, g\u00f3c van v\u00e0 th\u00e0nh \u0110M y\u1ebfu l\u00e0m van sa xu\u1ed1ng g\u00e2y h\u1edf.
\n1.2.<\/strong>2 <\/strong>T\u1ed5n th\u01b0\u01a1ng t\u1ea1i g\u1ed1c van
\n<\/strong>– G\u1ed1c van gi\u00e3n, van \u0111\u00f3ng kh\u00f4ng kh\u00edt\u00a0 h\u1edf (T\u0103ng huy\u1ebft \u00e1p l\u00e2u ng\u00e0y).
\n– Gi\u00e3n nguy\u00ean ph\u00e1t trong m\u1ed9t s\u1ed1 b\u1ec7nh.
\n– H\u1ed9i ch\u1ee9ng Marfan<\/a>: h\u00ecnh d\u00e1ng d\u00e0i, tay ch\u00e2n d\u00e0i nh\u01b0 nh\u1ec7n, m\u1ed1ng m\u1eaft co gi\u1eadt li\u00ean t\u1ee5c, \u0110\u1ed9ng ch\u1ee7 ng\u1ef1c ph\u00ecnh, th\u00e0nh \u0110MC y\u1ebfu, sa van v\u00e0 h\u1edf van \u0110MC.
\n1<\/strong>.2<\/strong>.3. Nguy\u00ean nh\u00e2n H\u1edf van \u0110MC c\u1ea5p t\u00ednh
\n<\/strong>– Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m tr\u00f9ng
\n– B\u00f3c t\u00e1ch \u0110\u1ed9ng m\u1ea1ch ch\u1ee7 ng\u1ef1c
\n– Ch\u1ea5n th\u01b0\u01a1ng ng\u1ef1c xuy\u00ean th\u1ea5u<\/p>\n

1.3 Ph\u00e2n lo\u1ea1i h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/strong>
\nH\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ch\u1ee7 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i th\u00e0nh c\u1ea5p ho\u1eb7c m\u1ea1n.
\nH\u1edf van \u0110MC c\u1ea5p<\/strong>
\n\u2022 B\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u00ean
\n\u2022 Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n
\n\u2022 Ch\u1ea5n th\u01b0\u01a1ng ng\u1ef1c
\nH\u1edf van \u0110MC m\u1ea1n<\/strong>
\n\u2022 B\u1ec7nh th\u1ea5p tim
\n\u2022 Van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 hai l\u00e1 b\u1ea9m sinh
\n\u2022 C\u00e1c r\u1ed1i lo\u1ea1n m\u00f4 li\u00ean k\u1ebft (h\u1ed9i ch\u1ee9ng Marfan, H\u1ed9i ch\u1ee9ng Ehler-Danlos)
\n\u2022 Giang mai
\n1.3 C\u00e1c giai \u0111o\u1ea1n c\u1ee7a h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/strong>
\nPh\u00e2n lo\u1ea1i theo Hi\u1ec7p H\u1ed9i Tim M\u1ea1ch Hoa K\u1ef3 ph\u00e2n h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 th\u00e0nh 4 giai \u0111o\u1ea1n:
\nGiai \u0111o\u1ea1n A (c\u00f3 nguy c\u01a1)<\/strong> \u2013 b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 c\u1ee7a h\u1edf ch\u1ee7 nh\u01b0 b\u1ec7nh th\u1ea5p tim ho\u1eb7c van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 hai l\u00e1, nh\u01b0ng kh\u00f4ng c\u00f3 h\u1edf ch\u1ee7 \u0111\u00e1ng k\u1ec3.
\nGiai \u0111o\u1ea1n B (h\u1edf ch\u1ee7 ti\u1ebfn tri\u1ec3n)<\/strong> \u2013 b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a h\u1edf ch\u1ee7, \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i th\u00e0nh:
\nLo\u1ea1i 1. H\u1edf ch\u1ee7 nh\u1eb9.
\nLo\u1ea1i 2. H\u1edf ch\u1ee7 trung b\u00ecnh, v\u1edbi c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m tr\u00ean si\u00eau \u00e2m tim:
\n\u2022 \u0110\u01b0\u1eddng k\u00ednh d\u00f2ng h\u1edf ch\u1ee7 – jet width < 25% d\u00f2ng m\u00e1u \u0111i qua \u0111\u01b0\u1eddng t\u1ed1ng m\u00e1u ra c\u1ee7a th\u1ea5t tr\u00e1i \u2013 left ventricular outflow tract (LVOT).
\n\u2022 \u0110\u1ed9 r\u1ed9ng c\u1ee7a d\u00f2ng h\u1edf khi \u0111i qua ch\u1ed7 h\u1edf van ch\u1ee7 – vena contracta 0.3\u20130.6 cm
\n\u2022 Th\u1ec3 t\u00edch d\u00f2ng ph\u1ee5t < 30 mL\/beat
\n\u2022 Ph\u00e2n su\u1ea5t d\u00f2ng ph\u1ee5t < 30 %<\/p>\n

Giai \u0111o\u1ea1n C\u2013D (h\u1edf ch\u1ee7 n\u1eb7ng bi\u1ec3u hi\u1ec7n ho\u1eb7c kh\u00f4ng bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng)<\/strong><\/p>\n

B\u1ec7nh nh\u00e2n h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, c\u00f3 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m tr\u00ean si\u00eau \u00e2m tim nh\u01b0 sau:
\n\u0110\u1ed9 1: d\u00f2ng h\u1edf d\u01b0\u1edbi m\u00fat van 2 l\u00e1
\n\u0110\u1ed9 2: h\u1edf t\u1edbi m\u00fat van
\n\u0110\u1ed9 3: h\u1edf t\u1edbi nh\u00fa c\u01a1<\/p>\n

\u0110\u1ed9 4: h\u1edf t\u1edbi m\u1ecfm tim<\/p>\n

2. Sinh b\u1ec7nh h\u1ecdc h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/h2>\n

H\u1edf van \u0110MC, m\u00e1u ph\u1ee5t ng\u01b0\u1ee3c t\u1eeb \u0110MC v\u1ec1 c\u1ed9ng v\u1edbi l\u01b0\u1ee3ng m\u00e1u t\u1eeb nh\u0129 tr\u00e1i v\u1ec1 l\u00e0m t\u0103ng th\u1ec3 t\u00edch t\u00e2m tr\u01b0\u01a1ng th\u1ea5t tr\u00e1i, t\u0103ng g\u00e1nh t\u00e2m tr\u01b0\u01a1ng th\u1ea5t, th\u1ea5t tr\u00e1i s\u1ebd gi\u00e3n n\u1edf v\u00e0 t\u0103ng co b\u00f3p, t\u1ed1ng 1 l\u01b0\u1ee3ng m\u00e1u l\u1edbn h\u01a1n b\u00ecnh th\u01b0\u1eddng ra ngo\u00e0i , b\u00f9 tr\u1eeb cho l\u01b0\u1ee3ng m\u00e1u ph\u1ee5t ng\u01b0\u1ee3c v\u1ec1, l\u00fac n\u00e0y \u00e1p l\u1ef1c t\u00e2m tr\u01b0\u01a1ng th\u1ea5t tr\u00e1i ch\u01b0a t\u0103ng cao, tr\u00ean l\u00e2m s\u00e0ng b\u1ec7nh nh\u00e2n ch\u01b0a c\u00f3 tri\u1ec7u ch\u1ee9ng hay ch\u1ec9 h\u1ed3i h\u1ed9p, \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c do tim t\u0103ng co b\u00f3p.<\/p>\n

Ban \u0111\u1ea7u, cung l\u01b0\u1ee3ng tim c\u00f3 th\u1ec3 v\u1eabn \u0111\u01b0\u1ee3c duy tr\u00ec v\u00e0 b\u1ec7nh nh\u00e2n v\u1eabn ch\u01b0a bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng. V\u1edbi t\u00ecnh tr\u1ea1ng h\u1edf van hai l\u00e1 k\u00e9o d\u00e0i, t\u00ednh \u0111\u00e0n h\u1ed3i c\u1ee7a t\u00e2m th\u1ea5t gi\u1ea3m <\/strong>do v\u1eady m\u00e0 th\u1ec3 t\u00edch nh\u00e1t b\u00f3p b\u00ecnh th\u01b0\u1eddng kh\u00f4ng th\u1ec3 duy tr\u00ec l\u00e2u d\u00e0i. T\u00ecnh tr\u1ea1ng t\u01b0\u1edbi m\u00e1u \u0111\u1ebfn t\u00e2m th\u1ea5t kh\u00f4ng th\u1ec3 duy tr\u00ec \u0111\u01b0\u1ee3c, kh\u00e1ng tr\u1edf ngo\u1ea1i vi t\u0103ng v\u00e0 th\u1eddi gian t\u00e2m tr\u01b0\u01a1ng k\u00e9o d\u00e0i. -> H\u1edf van ch\u1ee7 m\u1ea1n t\u00ednh do v\u1eady g\u00e2y ra t\u00ecnh tr\u1ea1ng ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i \u0111\u01a1n thu\u1ea7n.<\/p>\n

L\u00e2u ng\u00e0y, khi th\u1ea5t tr\u00e1i gi\u00e3n qu\u00e1 m\u1ee9c, b\u1eaft \u0111\u1ea7u c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng co b\u00f3p, kh\u00f4ng c\u00f2n t\u1ed1ng 1 l\u01b0\u1ee3ng m\u00e1u l\u1edbn h\u01a1n b\u00ecnh th\u01b0\u1eddng ra ngo\u00e0i \u0111\u01b0\u1ee3c, m\u00e1u \u1ee9 l\u1ea1i \u1edf th\u1ea5t tr\u00e1i nhi\u1ec1u, \u00e1p l\u1ef1c th\u1ea5t tr\u00e1i cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng t\u0103ng cao, xu\u1ea5t hi\u1ec7n tri\u1ec7u ch\u1ee9ng suy tim: kh\u00f3 th\u1edf v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng cung l\u01b0\u1ee3ng tim gi\u1ea3m.
\nDo c\u00f3 s\u1ef1 t\u0103ng co b\u00f3p c\u1ee7a th\u1ea5t tr\u00e1i, s\u1ef1 gia t\u0103ng cung l\u01b0\u1ee3ng t\u00e2m thu, HA t\u00e2m thu t\u0103ng, HA t\u00e2m tr\u01b0\u01a1ng h\u1ea1 do h\u1edf van \u0110MC, t\u1ea1o \u0111\u1ed9 c\u00e1ch bi\u1ec7t r\u1ed9ng c\u1ee7a HA g\u00e2y n\u00ean d\u1ea5u hi\u1ec7u ngo\u1ea1i bi\u00ean c\u1ee7a h\u1edf van \u0110MC: m\u1ea1ch Corrigan, d\u1ea5u s\u00fang l\u1ee5c b\u1eafn, \u00e2m \u0111i\u1ec7u Duroziez\u2026.
\nDo HA t\u00e2m tr\u01b0\u01a1ng h\u1ea1 th\u1ea5p, s\u1ef1 t\u01b0\u1edbi m\u00e1u \u0111\u1ebfn m\u1ea1ch v\u00e0nh v\u00e0 m\u1ea1c treo gi\u1ea3m l\u00e0m xu\u1ea5t hi\u1ec7n nh\u1eefng c\u01a1n \u0111au th\u1eaft ng\u1ef1c, c\u01a1n \u0111au b\u1ee5ng c\u1ea5p.
\n\u0110\u1ed1i v\u1edbi h\u1edf van \u0110MC c\u1ea5p, th\u1ea5t tr\u00e1i ch\u01b0a \u0111\u1ee7 th\u1eddi gian gi\u00e3n n\u1edf \u0111\u1ec3 th\u00edch \u1ee9ng v\u1edbi l\u01b0\u1ee3ng m\u00e1u nh\u1eadn v\u1ec1, h\u1ea1n ch\u1ebf s\u1ef1 b\u00f9 tr\u1eeb c\u1ee7a cung l\u01b0\u1ee3ng tim v\u00e0 \u00e1p l\u1ef1c cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng th\u1ea5t tr\u00e1i cao , l\u00fac n\u00e0y b\u1ec7nh nh\u00e2n kh\u00f3 th\u1edf nhi\u1ec1u. N\u1eb7ng: ph\u00f9 ph\u1ed5i c\u1ea5p, cho\u00e1ng tim, nh\u01b0ng c\u00e1c d\u1ea5u hi\u1ec7u ngo\u1ea1i bi\u00ean kh\u00f4ng r\u00f5 do kh\u00f4ng c\u00f3 \u0111\u1ed9 c\u00e1ch bi\u1ec7t HA.<\/p>\n

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

B\u1ec7nh H\u1ecdc Tim M\u1ea1ch Lecturio<\/p>\n

B\u00e0i gi\u1ea3ng N\u1ed9i Tim m\u1ea1ch \u2013 \u0110\u1ea1i h\u1ecdc Y khoa Ph\u1ea1m Ng\u1ecdc Th\u1ea1ch – 2016<\/p>\n

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

H\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 (hay h\u1edf ch\u1ee7 – aortic valve regurgitation – AR), l\u00e0 b\u1ec7nh l\u00fd van tim \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u00ecnh tr\u1ea1ng van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u0111\u00f3ng kh\u00f4ng ho\u00e0n to\u00e0n, d\u1eabn \u0111\u1ebfn th\u1ee5t ng\u01b0\u1ee3c d\u00f2ng m\u00e1u t\u1eeb \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 (\u0110MC) v\u1ec1 l\u1ea1i th\u1ea5t tr\u00e1i trong th\u1eddi k\u1ef3 t\u00e2m tr\u01b0\u01a1ng. C\u00f3 th\u1ec3 […]<\/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\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7: Sinh b\u1ec7nh h\u1ecdc v\u00e0 c\u00e1c giai \u0111o\u1ea1n - Vinmec<\/title>\n<meta name=\"description\" content=\"H\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 (hay h\u1edf ch\u1ee7), l\u00e0 b\u1ec7nh l\u00fd van tim \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u00ecnh tr\u1ea1ng van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u0111\u00f3ng kh\u00f4ng ho\u00e0n to\u00e0n\" \/>\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\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7: Sinh b\u1ec7nh h\u1ecdc v\u00e0 c\u00e1c giai \u0111o\u1ea1n - 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