{"id":32267,"date":"2023-05-07T13:30:44","date_gmt":"2023-05-07T06:30:44","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=32267"},"modified":"2023-05-17T02:10:23","modified_gmt":"2023-05-16T19:10:23","slug":"di-chung-lau-dai-cua-thuyen-tac-phoi-esc-2019","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/di-chung-lau-dai-cua-thuyen-tac-phoi-esc-2019\/","title":{"rendered":"\u00a0Di ch\u1ee9ng l\u00e2u d\u00e0i c\u1ee7a thuy\u00ean t\u1eafc ph\u1ed5i\u00a0– ESC 2019"},"content":{"rendered":"

T\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n th\u1ea5y r\u1eb1ng t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe c\u1ee7a h\u1ecd t\u1ec7 h\u01a1n sau 6 th\u00e1ng theo d\u00f5i so v\u1edbi l\u00fac ch\u1ea9n \u0111o\u00e1n PE r\u1ea5t kh\u00e1c nhau, t\u1eeb 20 \u0111\u1ebfn 75%. Vi\u1ec7c theo d\u00f5i v\u00e0 ph\u00e1t hi\u1ec7n s\u1edbm c\u00e1c di ch\u1ee9ng c\u1ee7a Thuy\u00ean t\u1eafc ph\u1ed5i kh\u00f4ng ch\u1ec9 gi\u00fap nh\u00e2n vi\u00ean y t\u1ebf can thi\u1ec7p s\u1edbm m\u00e0 c\u00f2n c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n s\u1edbm c\u00e1c tri\u1ec7u ch\u1ee9ng g\u00e2y kh\u00f3 ch\u1ecbu cho ng\u01b0\u1eddi b\u1ec7nh.\u00a0<\/strong><\/p>\n

\"thuyen-tac-phoi\"
Thuy\u00ean t\u1eafc ph\u1ed5i<\/figcaption><\/figure>\n

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

S\u1ef1 to\u00e0n v\u1eb9n c\u1ee7a gi\u01b0\u1eddng \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u0111\u01b0\u1ee3c ph\u1ee5c h\u1ed3i trong ph\u1ea7n l\u1edbn c\u1ee7a nh\u1eefng ng\u01b0\u1eddi s\u1ed1ng s\u00f3t sau PE trong v\u00e0i th\u00e1ng \u0111\u1ea7u sau giai \u0111o\u1ea1n c\u1ea5p t\u00ednh; do \u0111\u00f3, kh\u00f4ng c\u1ea7n theo d\u00f5i h\u00ecnh \u1ea3nh CTPA \u0111\u1ecbnh k\u1ef3 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb thuy\u00ean t\u1eafc ph\u1ed5i. Tuy nhi\u00ean, \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00e1c, huy\u1ebft kh\u1ed1i th\u01b0\u1eddng dai d\u1eb3ng v\u00e0 m\u00f4 h\u00f3a, \u0111\u00f4i khi c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn CTEPH (t\u0103ng \u00e1p ph\u1ed5i do huy\u1ebft kh\u1ed1i m\u1ea1n t\u00ednh), m\u1ed9t b\u1ec7nh m\u1ea1ch m\u00e1u t\u1eafc ngh\u1ebdn c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y nguy hi\u1ec3m \u0111\u1ebfn t\u00ednh m\u1ea1ng. CTEPH r\u1ea5t hi\u1ebfm g\u1eb7p tr\u00e1i ng\u01b0\u1ee3c v\u1edbi s\u1ed1 l\u01b0\u1ee3ng t\u01b0\u01a1ng \u0111\u1ed1i l\u1edbn b\u1ec7nh nh\u00e2n b\u00e1o kh\u00f3 th\u1edf k\u00e9o d\u00e0i ho\u1eb7c ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t k\u00e9m v\u00e0i th\u00e1ng sau khi thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p t\u00ednh. V\u00ec v\u1eady, m\u1ee5c ti\u00eau c\u1ee7a m\u1ed9t chi\u1ebfn l\u01b0\u1ee3c theo d\u00f5i hi\u1ec7u qu\u1ea3 sau PE l\u00e0:\u00a0<\/span><\/p>\n

(i)<\/strong> Cung c\u1ea5p ph\u01b0\u01a1ng th\u1ee9c ch\u0103m s\u00f3c ph\u00f9 h\u1ee3p (ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng g\u1eafng s\u1ee9c, \u0111i\u1ec1u tr\u1ecb b\u1ec7nh \u0111i k\u00e8m, gi\u00e1o d\u1ee5c h\u00e0nh vi v\u00e0 s\u1eeda \u0111\u1ed5i c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1) cho b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng k\u00e9o d\u00e0i<\/span><\/p>\n

\u00a0(ii)<\/strong> \u0110\u1ea3m b\u1ea3o ph\u00e1t hi\u1ec7n s\u1edbm CTEPH \u0111\u1ec3 gi\u1edbi thi\u1ec7u b\u1ec7nh nh\u00e2n l\u00e0m c\u00e1c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3 th\u00eam.<\/span><\/p>\n

2. C\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 h\u1ea1n ch\u1ebf ch\u1ee9c n\u0103ng k\u00e9o d\u00e0i sau thuy\u00ean t\u1eafc ph\u1ed5i <\/strong><\/h2>\n

C\u00e1c nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong th\u1eadp k\u1ef7 qua (\u0111\u01b0\u1ee3c t\u00f3m t\u1eaft trong Klok v\u00e0 c\u1ed9ng s\u1ef1) \u0111\u00e3 ti\u1ebft l\u1ed9 r\u1eb1ng ch\u1ee9ng kh\u00f3 th\u1edf k\u00e9o d\u00e0i ho\u1eb7c x\u1ea5u \u0111i, v\u00e0 hi\u1ec7u su\u1ea5t th\u1ec3 ch\u1ea5t k\u00e9m, th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n 6 th\u00e1ng \u0111\u1ebfn 3 n\u0103m sau m\u1ed9t \u0111\u1ee3t thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p t\u00ednh. T\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n th\u1ea5y r\u1eb1ng t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe c\u1ee7a h\u1ecd t\u1ec7 h\u01a1n sau 6 th\u00e1ng theo d\u00f5i so v\u1edbi l\u00fac ch\u1ea9n \u0111o\u00e1n PE r\u1ea5t kh\u00e1c nhau, t\u1eeb 20 \u0111\u1ebfn 75%. C\u00e1c th\u00f4ng s\u1ed1 v\u00e0 y\u1ebfu t\u1ed1 c\u01a1 b\u1ea3n sau \u0111\u00e2y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 y\u1ebfu t\u1ed1 d\u1ef1 b\u00e1o kh\u00f3 th\u1edf l\u00fac g\u1eafng s\u1ee9c khi theo d\u00f5i l\u00e2u d\u00e0i sau thuy\u00ean t\u1eafc ph\u1ed5i: tu\u1ed5i cao, b\u1ec7nh tim ho\u1eb7c ph\u1ed5i \u0111\u1ed3ng m\u1eafc, ch\u1ec9 s\u1ed1 kh\u1ed1i c\u01a1 th\u1ec3 cao v\u00e0 ti\u1ec1n s\u1eed h\u00fat thu\u1ed1c, PAP t\u00e2m thu cao h\u01a1n v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV khi ch\u1ea9n \u0111o\u00e1n; v\u00e0 t\u1eafc ngh\u1ebdn m\u1ea1ch m\u00e1u ph\u1ed5i c\u00f2n l\u1ea1i khi ra vi\u1ec7n.<\/span><\/p>\n

\u00a0G\u1ea7n \u0111\u00e2y, m\u1ed9t nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 ti\u1ebfn c\u1ee9u \u0111\u00e3 thu th\u1eadp 100 b\u1ec7nh nh\u00e2n t\u1ea1i n\u0103m b\u1ec7nh vi\u1ec7n \u1edf Canada t\u1eeb n\u0103m 2010 \u0111\u1ebfn 2013 v\u00e0 theo d\u00f5i h\u1ecd trong 1 n\u0103m. C\u00f3 \u0111\u1ebfn 47% b\u1ec7nh nh\u00e2n \u0111\u00e3 gi\u1ea3m dung t\u00edch hi\u1ebfu kh\u00ed t\u1ed1i \u0111a, \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 m\u1ee9c ti\u00eau th\u1ee5 oxy \u0111\u1ec9nh <80% gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n trong nghi\u1ec7m ph\u00e1p g\u1eafng s\u1ee9c tim ph\u1ed5i (CPET). K\u1ebft qu\u1ea3 ch\u1ee9c n\u0103ng n\u00e0y li\u00ean quan \u0111\u1ebfn gi\u1ea3m \u0111\u00e1ng k\u1ec3 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng li\u00ean quan \u0111\u1ebfn s\u1ee9c kh\u1ecfe v\u00e0 \u0111i\u1ec3m s\u1ed1 kh\u00f3 th\u1edf, c\u0169ng nh\u01b0 gi\u1ea3m \u0111\u00e1ng k\u1ec3 kho\u1ea3ng c\u00e1ch \u0111i b\u1ed9 6 ph\u00fat. Nh\u1eefng y\u1ebfu t\u1ed1 ti\u00ean \u0111o\u00e1n \u0111\u1ed9c l\u1eadp v\u1ec1 gi\u1ea3m dung t\u00edch g\u1eafng s\u1ee9c ch\u1ee9c n\u0103ng v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng theo th\u1eddi gian bao g\u1ed3m gi\u1edbi t\u00ednh n\u1eef, ch\u1ec9 s\u1ed1 kh\u1ed1i c\u01a1 th\u1ec3 cao h\u01a1n, ti\u1ec1n s\u1eed b\u1ec7nh ph\u1ed5i, \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i t\u00e2m thu cao h\u01a1n tr\u00ean si\u00eau \u00e2m tim 10 ng\u00e0y v\u00e0 \u0111\u01b0\u1eddng k\u00ednh \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i ch\u00ednh cao h\u01a1n tr\u00ean CTPA.<\/span><\/p>\n

L\u01b0u \u00fd, k\u1ebft qu\u1ea3 \u0111o ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p v\u00e0 si\u00eau \u00e2m tim khi theo d\u00f5i ph\u1ea7n l\u1edbn trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng, c\u1ea3 \u1edf b\u1ec7nh nh\u00e2n c\u00f3 v\u00e0 kh\u00f4ng gi\u1ea3m dung t\u00edch hi\u1ebfu kh\u00ed t\u1ed1i \u0111a. M\u1ed9t nghi\u00ean c\u1ee9u tr\u00ean 20 ng\u01b0\u1eddi s\u1ed1ng s\u00f3t sau thuy\u00ean t\u1eafc ph\u1ed5i r\u1ea5t l\u1edbn ho\u1eb7c l\u1edbn c\u0169ng cho th\u1ea5y hi\u1ec7n kh\u00f4ng c\u00f3 m\u1ed1i li\u00ean quan gi\u1eefa g\u1eafng s\u1ee9c v\u00e0 gi\u00e3n ho\u1eb7c r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV k\u00e9o d\u00e0i.<\/span><\/p>\n

\u00a0K\u1ebft h\u1ee3p l\u1ea1i v\u1edbi nhau, c\u00e1c nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 c\u0169 v\u00e0 g\u1ea7n \u0111\u00e2y \u0111\u00e3 g\u1ee3i \u00fd r\u1eb1ng vi\u1ec7c gi\u1ea3m kh\u1ed1i c\u01a1, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi th\u1eeba c\u00e2n v\u00e0 b\u1ec7nh tim ph\u1ed5i \u0111\u1ed3ng m\u1eafc, g\u00e2y ra ph\u1ea7n l\u1edbn ch\u1ee9ng kh\u00f3 th\u1edf th\u01b0\u1eddng xuy\u00ean \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o v\u00e0 c\u00e1c d\u1ea5u hi\u1ec7u h\u1ea1n ch\u1ebf g\u1eafng s\u1ee9c sau thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p t\u00ednh. \u0110i\u1ec1u n\u00e0y \u0111\u1ed3ng ngh\u0129a v\u1edbi vi\u1ec7c \u00edt nh\u1ea5t trong ph\u1ea7n l\u1edbn c\u00e1c tr\u01b0\u1eddng h\u1ee3p, hi\u1ec7u su\u1ea5t th\u1ec3 ch\u1ea5t k\u00e9m sau thuy\u00ean t\u1eafc ph\u1ed5i c\u00f3 th\u1ec3 kh\u00f4ng ph\u1ea3i do huy\u1ebft kh\u1ed1i \u2018l\u1edbn\u2019 c\u00f2n s\u00f3t l\u1ea1i, ho\u1eb7c r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng PH v\u00e0 RV v\u1eabn t\u1ed3n t\u1ea1i\/ti\u1ebfn tri\u1ec3n. Nh\u1eefng nghi\u00ean c\u1ee9u ti\u1ebfn c\u1ee9u \u0111ang th\u1ef1c hi\u1ec7n \u1edf s\u1ed1 l\u01b0\u1ee3ng l\u1edbn b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 gi\u00fap x\u00e1c \u0111\u1ecbnh t\u1ed1t h\u01a1n c\u00e1c y\u1ebfu t\u1ed1 ti\u00ean \u0111o\u00e1n suy gi\u1ea3m ch\u1ee9c n\u0103ng v\u00e0\/ho\u1eb7c huy\u1ebft \u0111\u1ed9ng sau thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p t\u00ednh, v\u00e0 \u00fd ngh\u0129a c\u1ee7a ch\u00fang c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng cho vi\u1ec7c \u0111\u1ecbnh h\u00ecnh ch\u01b0\u01a1ng tr\u00ecnh theo d\u00f5i.\u00a0<\/span><\/p>\n

V\u1eabn ch\u01b0a r\u00f5 li\u1ec7u \u0111i\u1ec1u tr\u1ecb t\u00e1i t\u01b0\u1edbi m\u00e1u s\u1edbm, \u0111\u1eb7c bi\u1ec7t l\u00e0 ti\u00eau s\u1ee3i huy\u1ebft, c\u00f3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng, gi\u1edbi h\u1ea1n ch\u1ee9c n\u0103ng ho\u1eb7c PH dai d\u1eb3ng (hay kh\u1edfi ph\u00e1t m\u1edbi) khi theo d\u00f5i l\u00e2u d\u00e0i sau PE hay kh\u00f4ng. Do \u0111\u00f3, hi\u1ec7n nay ph\u00f2ng ng\u1eeba di ch\u1ee9ng PE l\u00e2u d\u00e0i kh\u00f4ng ph\u1ea3i l\u00e0 l\u00fd do \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb ti\u00eau s\u1ee3i huy\u1ebft trong giai \u0111o\u1ea1n thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p t\u00ednh.<\/span><\/p>\n

3. T\u0103ng \u00e1p ph\u1ed5i do huy\u1ebft kh\u1ed1i m\u1ea1n t\u00ednh<\/a> (CTEPH)<\/strong><\/h2>\n

\u00a03.1 D\u1ecbch t\u1ec5 h\u1ecdc, sinh l\u00fd b\u1ec7nh v\u00e0 ti\u1ec1n s\u1eed <\/strong><\/h3>\n

CTEPH l\u00e0 m\u1ed9t b\u1ec7nh g\u00e2y ra b\u1edfi s\u1ef1 t\u1eafc ngh\u1ebdn dai d\u1eb3ng c\u00e1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i do huy\u1ebft kh\u1ed1i m\u00f4 h\u00f3a, d\u1eabn \u0111\u1ebfn t\u00e1i ph\u00e2n b\u1ed1 d\u00f2ng ch\u1ea3y v\u00e0 t\u00e1i c\u1ea5u tr\u00fac th\u1ee9 ph\u00e1t c\u1ee7a gi\u01b0\u1eddng vi m\u1ea1ch ph\u1ed5i. CTEPH \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o v\u1edbi t\u1ef7 l\u1ec7 ph\u00e1t sinh t\u00edch l\u0169y t\u1eeb 0.1 \u0111\u1ebfn 9.1% trong 2 n\u0103m \u0111\u1ea7u sau bi\u1ebfn c\u1ed1 PE c\u00f3 tri\u1ec7u ch\u1ee9ng; bi\u00ean sai s\u1ed1 l\u1edbn l\u00e0 do sai s\u1ed1 ch\u1ecdn m\u1eabu, c\u00e1c tri\u1ec7u ch\u1ee9ng s\u1edbm ngh\u00e8o n\u00e0n v\u00e0 kh\u00f3 kh\u0103n trong vi\u1ec7c ph\u00e2n bi\u1ec7t thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p t\u00ednh v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng CTEPH \u0111\u00e3 c\u00f3 t\u1eeb tr\u01b0\u1edbc. M\u1ed9t kh\u1ea3o s\u00e1t s\u00e0ng l\u1ecdc quan s\u00e1t ti\u1ebfn c\u1ee9u \u0111a trung t\u00e2m v\u1ec1 ph\u00e1t hi\u1ec7n CTEPH bao g\u1ed3m nh\u1eefng b\u1ec7nh nh\u00e2n PE c\u1ea5p t\u00ednh t\u1eeb 11 trung t\u00e2m \u1edf Th\u1ee5y S\u0129, t\u1eeb th\u00e1ng 3 n\u0103m 2009 \u0111\u1ebfn th\u00e1ng 11 n\u0103m 2016. S\u00e0ng l\u1ecdc kh\u1ea3 n\u0103ng m\u1eafc CTEPH \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n v\u00e0o th\u00e1ng th\u1ee9 6, 12 v\u00e0 24, s\u1eed d\u1ee5ng l\u01b0u \u0111\u1ed3 t\u1eebng b\u01b0\u1edbc bao g\u1ed3m kh\u1ea3o s\u00e1t kh\u00f3 th\u1edf theo ng\u1eef \u00e2m, TTE, th\u00f4ng tim ph\u1ea3i v\u00e0 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh CTEPH b\u1eb1ng h\u00ecnh \u1ea3nh. Trong s\u1ed1 508 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 s\u00e0ng l\u1ecdc CTEPH trong 2 n\u0103m, t\u1ef7 l\u1ec7 m\u1eafc CTEPH sau thuy\u00ean t\u1eafc ph\u1ed5i l\u00e0 3.7 m\u1ed7i 1000 b\u1ec7nh nh\u00e2n-n\u0103m, v\u1edbi t\u1ef7 l\u1ec7 ph\u00e1t sinh t\u00edch l\u0169y 2 n\u0103m l\u00e0 0.79%. T\u1ea1i \u0110\u1ee9c, t\u1ef7 l\u1ec7 ph\u00e1t sinh CTEPH n\u0103m 2016 \u01b0\u1edbc t\u00ednh l\u00e0 5.7 m\u1ed7i tri\u1ec7u d\u00e2n s\u1ed1 tr\u01b0\u1edfng th\u00e0nh.<\/span><\/p>\n

\u00a0\u0110\u1eb7c tr\u01b0ng c\u1ee7a CTEPH l\u00e0 bi\u1ebfn \u0111\u1ed5i x\u01a1 h\u00f3a c\u1ee7a huy\u1ebft kh\u1ed1i \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, g\u00e2y t\u1eafc ngh\u1ebdn c\u01a1 h\u1ecdc c\u1ed1 \u0111\u1ecbnh c\u00e1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i v\u00e0 d\u1eabn \u0111\u1ebfn t\u0103ng l\u01b0u l\u01b0\u1ee3ng qu\u00e1 m\u1ee9c gi\u01b0\u1eddng \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i m\u1edf. C\u00f9ng v\u1edbi ngu\u1ed3n c\u1ea5p m\u00e1u b\u00ean t\u1eeb c\u00e1c \u0111\u1ed9ng m\u1ea1ch h\u1ec7 th\u1ed1ng ph\u00eda d\u01b0\u1edbi \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i b\u1ecb t\u1eafc, \u0111\u00e3 g\u00f3p ph\u1ea7n v\u00e0o t\u00e1i c\u1ea5u tr\u00fac vi m\u1ea1ch, v\u00e0 g\u00e2y ra s\u1ef1 gia t\u0103ng qu\u00e1 m\u1ee9c trong PVR (kh\u00e1ng l\u1ef1c m\u1ea1ch m\u00e1u ph\u1ed5i). Do sinh l\u00fd b\u1ec7nh ph\u1ee9c t\u1ea1p n\u00e0y, kh\u00f4ng c\u00f3 m\u1ed1i t\u01b0\u01a1ng quan r\u00f5 r\u00e0ng gi\u1eefa m\u1ee9c \u0111\u1ed9 t\u1eafc ngh\u1ebdn c\u01a1 h\u1ecdc \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y b\u1eb1ng h\u00ecnh \u1ea3nh v\u00e0 huy\u1ebft \u0111\u1ed9ng, huy\u1ebft \u0111\u1ed9ng ho\u00e0n to\u00e0n c\u00f3 th\u1ec3 x\u1ea5u \u0111i k\u1ec3 c\u1ea3 khi kh\u00f4ng ph\u1ea3i PE t\u00e1i ph\u00e1t.<\/span><\/p>\n

\u00a0Hai th\u1eed nghi\u1ec7m l\u1ecbch s\u1eed \u0111\u00e1nh gi\u00e1 t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t \u1edf b\u1ec7nh nh\u00e2n CTEPH tr\u01b0\u1edbc khi c\u00f3 \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt. Trong c\u1ea3 hai nghi\u00ean c\u1ee9u, PAP trung b\u00ecnh >30 mmHg li\u00ean quan \u0111\u1ebfn kh\u1ea3 n\u0103ng s\u1ed1ng s\u00f3t k\u00e9m, t\u01b0\u01a1ng t\u1ef1 nh\u01b0 b\u00e1o c\u00e1o \u0111\u1ed1i v\u1edbi t\u0103ng \u00e1p ph\u1ed5i v\u00f4 c\u0103n.<\/span><\/p>\n

\u00a0C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u01b0\u1ee3c tr\u00edch d\u1eabn th\u01b0\u1eddng xuy\u00ean nh\u1ea5t v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y CTEPH \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n trong B\u1ea3ng 13. Trong m\u1ed9t b\u00e1o c\u00e1o qu\u1ed1c t\u1ebf, ti\u1ec1n s\u1eed PE c\u1ea5p t\u00ednh \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf 75% b\u1ec7nh nh\u00e2n. C\u00e1c t\u00ecnh tr\u1ea1ng li\u00ean quan v\u00e0 b\u1ec7nh l\u00fd \u0111i k\u00e8m bao g\u1ed3m r\u1ed1i lo\u1ea1n huy\u1ebft kh\u1ed1i, \u0111\u1eb7c bi\u1ec7t l\u00e0 h\u1ed9i ch\u1ee9ng kh\u00e1ng th\u1ec3 kh\u00e1ng phospholipid v\u00e0 n\u1ed3ng \u0111\u1ed9 y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u VIII cao, ung th\u01b0, ti\u1ec1n s\u1eed c\u1eaft l\u00e1ch, b\u1ec7nh vi\u00eam \u0111\u01b0\u1eddng ru\u1ed9t, shunt nh\u0129 th\u1ea5t v\u00e0 nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch m\u1ea1n v\u00e0 thi\u1ebft b\u1ecb nh\u01b0 m\u00e1y t\u1ea1o nh\u1ecbp tim c\u1ea5y gh\u00e9p.<\/span><\/p>\n

\"yeu-to-nguy-co-va-yeu-to-thuc-day-trong-thuyen-tac-phoi-man\"<\/p>\n

a<\/strong> : Ti\u00eau ch\u00ed si\u00eau \u00e2m tim c\u1ee7a r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y b\u1eb1ng s\u01a1 \u0111\u1ed3 trong H\u00ecnh 3 v\u00e0 gi\u00e1 tr\u1ecb ti\u00ean l\u01b0\u1ee3ng c\u1ee7a ch\u00fang \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft trong d\u1eef li\u1ec7u b\u1ed5 sung B\u1ea3ng 3.\u00a0<\/span><\/p>\n

Tr\u00ean CTPA (g\u00f3c nh\u00ecn b\u1ed1n bu\u1ed3ng c\u1ee7a tim), r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 t\u1ef7 l\u1ec7 \u0111\u01b0\u1eddng k\u00ednh RV\/LV >1.0.<\/span><\/p>\n

\u00a0b:<\/strong>\u00a0 C\u00e1c d\u1ea5u hi\u1ec7u m\u1ea1ch m\u00e1u tr\u1ef1c ti\u1ebfp v\u00e0 gi\u00e1n ti\u1ebfp, c\u0169ng nh\u01b0 c\u00e1c k\u1ebft qu\u1ea3 nhu m\u00f4 ph\u1ed5i, \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft trong d\u1eef li\u1ec7u b\u1ed5 sung B\u1ea3ng 2.<\/span><\/p>\n

3.2 Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng v\u00e0 ch\u1ea9n \u0111o\u00e1n<\/strong><\/h3>\n

\u00a0Kh\u00f3 \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n CTEPH. C\u00e1c l\u01b0u \u0111\u1ed3 \u0111\u1ec3 d\u1ef1 \u0111o\u00e1n ho\u1eb7c lo\u1ea1i tr\u1eeb CTEPH b\u1ecb h\u1ea1n ch\u1ebf b\u1edfi thi\u1ebfu t\u00ednh \u0111\u1eb7c hi\u1ec7u. C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh nh\u00e2n tham gia v\u00e0o \u0111\u0103ng b\u1ed9 CTEPH qu\u1ed1c t\u1ebf \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng tu\u1ed5i trung b\u00ecnh l\u00fac ch\u1ea9n \u0111o\u00e1n l\u00e0 63 tu\u1ed5i v\u00e0 c\u1ea3 hai gi\u1edbi t\u00ednh \u0111\u1ec1u b\u1ecb \u1ea3nh h\u01b0\u1edfng nh\u01b0 nhau; hi\u1ebfm g\u1eb7p \u1edf nhi. Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng v\u00e0 th\u1ef1c th\u1ec3 l\u00e2m s\u00e0ng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u ho\u1eb7c kh\u00f4ng th\u1ea5y khi CTEPH s\u1edbm, d\u1ea5u hi\u1ec7u suy tim ph\u1ea3i ch\u1ec9 tr\u1edf n\u00ean r\u00f5 r\u00e0ng khi b\u1ec7nh ti\u1ebfn tri\u1ec3n. Do \u0111\u00f3, ch\u1ea9n \u0111o\u00e1n s\u1edbm v\u1eabn l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c trong CTEPH, v\u1edbi th\u1eddi gian trung v\u1ecb 14 th\u00e1ng t\u1eeb khi tri\u1ec7u ch\u1ee9ng kh\u1edfi ph\u00e1t cho \u0111\u1ebfn khi ch\u1ea9n \u0111o\u00e1n \u1edf nh\u1eefng trung t\u00e2m chuy\u00ean khoa. N\u1ebfu c\u00f3, c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a CTEPH c\u00f3 th\u1ec3 gi\u1ed1ng nh\u01b0 c\u1ee7a PE c\u1ea5p t\u00ednh ho\u1eb7c t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i; n\u1ebfu gi\u1ed1ng t\u0103ng \u00e1p ph\u1ed5i th\u00ec ph\u00f9 v\u00e0 ho ra m\u00e1u th\u01b0\u1eddng g\u1eb7p h\u01a1n trong CTEPH, trong khi ng\u1ea5t th\u00ec ph\u1ed5 bi\u1ebfn h\u01a1n trong t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.\u00a0<\/span><\/p>\n

Ch\u1ea9n \u0111o\u00e1n CTEPH ph\u1ea3i d\u1ef1a tr\u00ean nh\u1eefng tri\u1ec7u ch\u1ee9ng c\u00f3 \u0111\u01b0\u1ee3c sau \u00edt nh\u1ea5t 3 th\u00e1ng d\u00f9ng ch\u1ed1ng \u0111\u00f4ng hi\u1ec7u qu\u1ea3, \u0111\u1ec3 ph\u00e2n bi\u1ec7t t\u00ecnh tr\u1ea1ng n\u00e0y t\u1eeb PE c\u1ea5p t\u00ednh. Ch\u1ea9n \u0111o\u00e1n y\u00eau c\u1ea7u PAP trung b\u00ecnh \u226525 mmHg c\u00f9ng v\u1edbi \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i b\u00edt \u226415 mmHg, \u0111\u01b0\u1ee3c ghi nh\u1eadn khi th\u00f4ng tim ph\u1ea3i \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n b\u1ea5t t\u01b0\u01a1ng h\u1ee3p t\u01b0\u1edbi m\u00e1u tr\u00ean x\u1ea1 h\u00ecnh ph\u1ed5i V\/Q. D\u1ea5u hi\u1ec7u ch\u1ea9n \u0111o\u00e1n c\u1ee5 th\u1ec3 CTEPH tr\u00ean CT m\u1ea1ch m\u00e1u \u0111a \u0111\u1ea7u d\u00f2 ho\u1eb7c ch\u1ee5p m\u1ea1ch ph\u1ed5i th\u00f4ng th\u01b0\u1eddng bao g\u1ed3m ch\u1ed7 h\u1eb9p d\u1ea1ng v\u00f2ng nh\u1eabn, d\u1ea1ng l\u01b0\u1edbi, khe, v\u00e0 t\u1eafc ngh\u1ebdn to\u00e0n ph\u1ea7n m\u1ea1n t\u00ednh.\u00a0<\/span><\/p>\n

M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u00f3 huy\u1ebft \u0111\u1ed9ng h\u1ecdc ph\u1ed5i b\u00ecnh th\u01b0\u1eddng khi ngh\u1ec9 m\u1eb7c d\u00f9 b\u1ec7nh c\u00f3 tri\u1ec7u ch\u1ee9ng. N\u1ebfu nguy\u00ean nh\u00e2n kh\u00e1c g\u00e2y h\u1ea1n ch\u1ebf g\u1eafng s\u1ee9c \u0111\u01b0\u1ee3c lo\u1ea1i tr\u1eeb, nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y \u0111\u01b0\u1ee3c coi l\u00e0 c\u00f3 b\u1ec7nh thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i m\u1ea1n t\u00ednh (CTED). \u0110\u1ec3 x\u00e1c \u0111\u1ecbnh b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i m\u1ea1n t\u00ednh kh\u00f4ng c\u00f3 t\u0103ng \u00e1p ph\u1ed5i, \u0111\u1ed1i t\u01b0\u1ee3ng c\u00f3 th\u1ec3 c\u00f3 ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u1eabu thu\u1eadt ho\u1eb7c can thi\u1ec7p, \u0111\u00f2i h\u1ecfi ph\u1ea3i l\u00e0 chuy\u00ean gia trong l\u0129nh v\u1ef1c v\u00e0 n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n t\u1ea1i c\u00e1c trung t\u00e2m chuy\u00ean v\u1ec1 CTEPH. Trong s\u1ed1 1019 b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c g\u1eedi \u0111\u1ebfn c\u1eaft b\u1ecf n\u1ed9i m\u1ea1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i (PEA) t\u1ea1i m\u1ed9t trung t\u00e2m tuy\u1ebfn chuy\u00ean khoa \u1edf Anh, 42 b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 t\u0103ng \u00e1p ph\u1ed5i khi ngh\u1ec9 nh\u01b0ng cho th\u1ea5y s\u1ef1 c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng sau khi ph\u1eabu thu\u1eadt.<\/span><\/p>\n

\u00a0X\u1ea1 h\u00ecnh th\u00f4ng kh\u00ed\/t\u01b0\u1edbi m\u00e1u ph\u1ed5i l\u00e0 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh \u0111\u1ea7u tay ph\u00f9 h\u1ee3p cho CTEPH v\u00ec n\u00f3 c\u00f3 \u0111\u1ed9 nh\u1ea1y 96-97% v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 90-95% cho ch\u1ea9n \u0111o\u00e1n. N\u1ebfu \u0111\u00e1nh gi\u00e1 ri\u00eang \u1edf m\u1ee9c \u0111\u1ed9 \u0111\u1ed9ng m\u1ea1ch ph\u00e2n th\u00f9y th\u00ec SPECT c\u00f3 v\u1ebb \u00edt nh\u1ea1y h\u01a1n x\u1ea1 h\u00ecnh V\/Q, nh\u01b0ng n\u1ebfu \u0111\u00e1nh gi\u00e1 tr\u00ean t\u1eebng b\u1ec7nh nh\u00e2n th\u00ec n\u00f3 kh\u00f4ng d\u1ec5 b\u1ecf s\u00f3t CTEPH li\u00ean quan \u0111\u1ebfn l\u00e2m s\u00e0ng. Tr\u00e1i ng\u01b0\u1ee3c v\u1edbi CTEPH, nh\u1eefng khi\u1ebfm khuy\u1ebft b\u1ea5t t\u01b0\u01a1ng h\u1ee3p t\u01b0\u1edbi m\u00e1u b\u1ea5t th\u01b0\u1eddng \u0111\u00f4i khi \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y trong t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i v\u00e0 b\u1ec7nh t\u1eafc t\u0129nh m\u1ea1ch ph\u1ed5i th\u01b0\u1eddng c\u00f3 ki\u1ec3u h\u00ecnh kh\u00f4ng ph\u00e2n th\u00f9y.\u00a0<\/span><\/p>\n

CTPA<\/strong> \u0111ang \u0111\u1ea1t \u0111\u01b0\u1ee3c v\u1ecb th\u1ebf nh\u01b0 m\u1ed9t ph\u01b0\u01a1ng th\u1ee9c ch\u1ea9n \u0111o\u00e1n trong CTEPH, nh\u01b0ng kh\u00f4ng n\u00ean d\u00f9ng l\u00e0m c\u1eadn l\u00e2m s\u00e0ng \u0111\u1ed9c l\u1eadp \u0111\u1ec3 lo\u1ea1i tr\u1eeb b\u1ec7nh. C\u00e1c c\u1eadn l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n m\u1edbi h\u01a1n bao g\u1ed3m CT n\u0103ng l\u01b0\u1ee3ng k\u00e9p, cho ph\u00e9p \u0111\u1ed3ng th\u1eddi \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 to\u00e0n v\u1eb9n c\u1ee7a c\u00e1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i v\u00e0 t\u01b0\u1edbi m\u00e1u ph\u1ed5i, nh\u01b0ng l\u1ea1i t\u0103ng b\u1ee9c x\u1ea1 cho b\u1ec7nh nh\u00e2n. H\u00ecnh \u1ea3nh c\u1ed9ng h\u01b0\u1edfng t\u1eeb m\u1ea1ch m\u00e1u ph\u1ed5i v\u1eabn \u0111\u01b0\u1ee3c coi l\u00e0 k\u00e9m h\u01a1n CT. Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh v\u1edbi ch\u00f9m tia h\u00ecnh n\u00f3n, n\u1ed9i soi m\u1ea1ch m\u00e1u, si\u00eau \u00e2m n\u1ed9i m\u1ea1ch v\u00e0 ch\u1ee5p c\u1eaft l\u1edbp quang h\u1ecdc ph\u00f9 h\u1ee3p \u0111\u1ec3 quan s\u00e1t \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a t\u1ed5n th\u01b0\u01a1ng trong \u0111i\u1ec1u tr\u1ecb can thi\u1ec7p h\u01a1n l\u00e0 ch\u1ea9n \u0111o\u00e1n. CT ng\u1ef1c \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao c\u00f3 th\u1ec3 gi\u00fap ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t CTEPH, cho th\u1ea5y kh\u00ed ph\u1ebf th\u0169ng, b\u1ec7nh ph\u1ebf qu\u1ea3n ho\u1eb7c b\u1ec7nh ph\u1ed5i k\u1ebd, c\u0169ng nh\u01b0 nh\u1ed3i m\u00e1u, v\u00e0 d\u1ecb t\u1eadt th\u00e0nh m\u1ea1ch v\u00e0 ng\u1ef1c. T\u01b0\u1edbi m\u00e1u kh\u00f4ng \u0111\u1ec1u bi\u1ec3u hi\u1ec7n nh\u01b0 m\u1ed9t ki\u1ec3u h\u00ecnh nhu m\u00f4 kh\u1ea3m th\u01b0\u1eddng \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y trong CTEPH, nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y trong \u226412% b\u1ec7nh nh\u00e2n t\u0103ng \u00e1p ph\u1ed5i do nguy\u00ean nh\u00e2n kh\u00e1c. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t CTEPH c\u0169ng n\u00ean bao g\u1ed3m vi\u00eam \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, u \u00e1c m\u1ea1ch m\u00e1u ph\u1ed5i, thuy\u00ean t\u1eafc do u, k\u00fd sinh tr\u00f9ng (nang hydatid), thuy\u00ean t\u1eafc do d\u1ecb v\u1eadt, v\u00e0 h\u1eb9p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i b\u1ea9m sinh ho\u1eb7c m\u1eafc ph\u1ea3i\u00a0<\/span><\/p>\n

3.3 \u0110i\u1ec1u tr\u1ecb b\u1eb1ng ph\u1eabu thu\u1eadt<\/strong><\/p>\n

\u00a0PEA b\u1eb1ng ph\u1eabu thu\u1eadt l\u00e0 l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb cho CTEPH c\u00f3 th\u1ec3 ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c. Ng\u01b0\u1ee3c l\u1ea1i v\u1edbi ph\u1eabu thu\u1eadt l\u1ea5y huy\u1ebft kh\u1ed1i trong PE c\u1ea5p t\u00ednh, \u0111i\u1ec1u tr\u1ecb CTEPH \u0111\u00f2i h\u1ecfi ph\u1ea3i ph\u1eabu thu\u1eadt l\u1ea5y n\u1ed9i m\u1ea1c hai b\u00ean cho \u0111\u1ebfn l\u1edbp gi\u1eefa c\u1ee7a c\u00e1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i. N\u00f3 \u0111\u00f2i h\u1ecfi h\u1ea1 th\u00e2n nhi\u1ec7t s\u00e2u v\u00e0 ng\u1eebng tu\u1ea7n ho\u00e0n ng\u1eaft qu\u00e3ng, kh\u00f4ng c\u1ea7n t\u01b0\u1edbi m\u00e1u n\u00e3o. <\/span>T\u1ef7 l\u1ec7 t\u1eed vong trong b\u1ec7nh vi\u1ec7n hi\u1ec7n th\u1ea5p \u0111\u1ebfn 4.7% v\u00e0 th\u1eadm ch\u00ed c\u00f2n th\u1ea5p h\u01a1n n\u1eefa trong nh\u1eefng b\u1ec7nh vi\u1ec7n chuy\u00ean khoa tuy\u1ebfn cao. Ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n sau \u0111i\u1ec1u tr\u1ecb gi\u1ea3m \u0111\u00e1ng k\u1ec3 c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 g\u1ea7n nh\u01b0 b\u00ecnh th\u01b0\u1eddng h\u00f3a huy\u1ebft \u0111\u1ed9ng. V\u00ec s\u1ef1 ph\u1ee9c t\u1ea1p c\u1ee7a c\u1ea3 k\u1ef9 thu\u1eadt ph\u1eabu thu\u1eadt v\u00e0 qu\u1ea3n l\u00fd chu ph\u1eabu, PEA n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n t\u1ea1i c\u00e1c trung t\u00e2m chuy\u00ean khoa.<\/span><\/p>\n

\u0110\u1ec3 x\u00e9t \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n ph\u1eabu thu\u1eadt \u0111\u00f2i h\u1ecfi ph\u1ea3i c\u00f3 quy\u1ebft \u0111\u1ecbnh trong m\u1ed9t cu\u1ed9c h\u1ed9i ch\u1ea9n k\u1ef9 l\u01b0\u1ee1ng c\u1ee7a nh\u00f3m CTEPH \u0111a chuy\u00ean khoa bao g\u1ed3m c\u00e1c b\u00e1c s\u0129 ph\u1eabu thu\u1eadt c\u00f3 kinh nghi\u1ec7m v\u1ec1 PEA, b\u00e1c s\u0129 can thi\u1ec7p ho\u1eb7c b\u00e1c s\u0129 tim m\u1ea1ch, b\u00e1c s\u0129 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh c\u00f3 kinh nghi\u1ec7m v\u1ec1 h\u00ecnh \u1ea3nh m\u1ea1ch m\u00e1u ph\u1ed5i, v\u00e0 c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng c\u00f3 chuy\u00ean m\u00f4n v\u1ec1 PH. Nh\u00f3m CTEPH n\u00ean ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh, \u0111\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng ti\u1ebfp c\u1eadn ph\u1eabu thu\u1eadt c\u1ee7a s\u1ef1 t\u1eafc ngh\u1ebdn m\u1ea1n sau huy\u1ebft kh\u1ed1i (ph\u1eabu thu\u1eadt c\u00f3 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c kh\u00f4ng) v\u00e0 xem x\u00e9t c\u00e1c nguy c\u01a1 li\u00ean quan \u0111\u1ebfn b\u1ec7nh \u0111\u1ed3ng m\u1eafc (kh\u1ea3 n\u0103ng ph\u1eabu thu\u1eadt tr\u00ean b\u1ec7nh l\u00fd). <\/span><\/p>\n

Kh\u1ea3 n\u0103ng ph\u1eabu thu\u1eadt c\u1ee7a b\u1ec7nh nh\u00e2n CTEPH \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1edfi nhi\u1ec1u y\u1ebfu t\u1ed1 kh\u00f3 m\u00e0 chu\u1ea9n h\u00f3a \u0111\u01b0\u1ee3c. Nh\u1eefng \u0111i\u1ec1u n\u00e0y c\u00f3 li\u00ean quan \u0111\u1ebfn s\u1ef1 ph\u00f9 h\u1ee3p c\u1ee7a b\u1ec7nh nh\u00e2n, chuy\u00ean m\u00f4n c\u1ee7a nh\u00f3m ph\u1eabu thu\u1eadt v\u00e0 c\u00e1c ngu\u1ed3n l\u1ef1c s\u1eb5n c\u00f3. Ti\u00eau ch\u00ed chung bao g\u1ed3m ph\u00e2n t\u1ea7ng ch\u1ee9c n\u0103ng tr\u01b0\u1edbc m\u1ed5 c\u1ee7a Hi\u1ec7p h\u1ed9i Tim m\u1ea1ch New York (NYHA)<\/strong> v\u00e0 kh\u1ea3 n\u0103ng ti\u1ebfp c\u1eadn ph\u1eabu thu\u1eadt c\u1ee7a huy\u1ebft kh\u1ed1i trong \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i ch\u00ednh, th\u00f9y ho\u1eb7c ph\u00e2n th\u00f9y. Ch\u1ec9 c\u00f3 tu\u1ed5i cao kh\u00f4ng ph\u1ea3i l\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh cho ph\u1eabu thu\u1eadt. Kh\u00f4ng c\u00f3 ng\u01b0\u1ee1ng huy\u1ebft \u0111\u1ed9ng ho\u1eb7c th\u01b0\u1edbc \u0111o r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV n\u00e0o \u0111\u1ec3 lo\u1ea1i tr\u1eeb PEA.\u00a0<\/span><\/p>\n

D\u1eef li\u1ec7u t\u1eeb c\u01a1 quan \u0111\u0103ng b\u1ed9 qu\u1ed1c t\u1ebf CTEPH, \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp t\u1ea1i 27 trung t\u00e2m \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 k\u1ebft c\u1ee5c d\u00e0i h\u1ea1n v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 ti\u00ean \u0111o\u00e1n k\u1ebft c\u1ee5c tr\u00ean 679 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt v\u00e0 kh\u00f4ng ph\u1eabu thu\u1eadt, cho th\u1ea5y t\u1ef7 l\u1ec7 s\u1ed1ng c\u00f2n 3 n\u0103m \u01b0\u1edbc t\u00ednh l\u00e0 89% \u1edf b\u1ec7nh nh\u00e2n ph\u1eabu thu\u1eadt v\u00e0 70% \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng ph\u1eabu thu\u1eadt. T\u1ef7 l\u1ec7 t\u1eed vong li\u00ean quan \u0111\u1ebfn ph\u00e2n lo\u1ea1i ch\u1ee9c n\u0103ng NYHA, \u00e1p l\u1ef1c RA, v\u00e0 ti\u1ec1n s\u1eed ung th\u01b0. Trong \u0111\u0103ng b\u1ed9 ti\u1ebfn c\u1ee9u n\u00e0y, ti\u00ean l\u01b0\u1ee3ng l\u00e2u d\u00e0i c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt t\u1ed1t h\u01a1n so v\u1edbi k\u1ebft c\u1ee5c c\u1ee7a b\u1ec7nh nh\u00e2n kh\u00f4ng ph\u1eabu thu\u1eadt. C\u00e1c t\u01b0\u01a1ng quan kh\u00e1c c\u1ee7a t\u1ef7 l\u1ec7 t\u1eed vong l\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1eafc c\u1ea7u b\u1eb1ng thu\u1ed1c gi\u00e3n m\u1ea1ch ph\u1ed5i, PH sau ph\u1eabu thu\u1eadt, c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a ph\u1eabu thu\u1eadt, v\u00e0 c\u00e1c th\u1ee7 thu\u1eadt tim b\u1ed5 sung \u1edf b\u1ec7nh nh\u00e2n ph\u1eabu thu\u1eadt v\u00e0 c\u00e1c b\u1ec7nh k\u00e8m theo nh\u01b0 b\u1ec7nh m\u1ea1ch v\u00e0nh, suy tim tr\u00e1i v\u00e0 b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng ph\u1eabu thu\u1eadt. M\u1ed9t b\u00e1o c\u00e1o g\u1ea7n \u0111\u00e2y \u0111\u00e3 x\u00e1c \u0111\u1ecbnh PAP trung b\u00ecnh \u226538 mmHg v\u00e0 PVR \u2265425 dyn*s*cm-5 l\u00e0 y\u1ebfu t\u1ed1 quy\u1ebft \u0111\u1ecbnh ti\u00ean l\u01b0\u1ee3ng x\u1ea5u \u1edf nh\u1eefng ng\u01b0\u1eddi s\u1ed1ng s\u00f3t trong nh\u00f3m \u0111i\u1ec1u tr\u1ecb CTEPH b\u1eb1ng ph\u1eabu thu\u1eadt.\u00a0<\/span><\/p>\n

ECMO<\/strong> sau ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o l\u00e0 ti\u00eau chu\u1ea9n ch\u0103m s\u00f3c \u1edf nh\u1eefng trung t\u00e2m PEA. Ph\u00f9 ph\u1ed5i s\u1edbm do t\u00e1i t\u01b0\u1edbi m\u00e1u sau ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 c\u1ea7n ECMO t\u0129nh m\u1ea1ch- \u0111\u1ed9ng m\u1ea1ch, v\u00e0 PH nghi\u00eam tr\u1ecdng dai d\u1eb3ng c\u00f3 th\u1ec3 b\u1eafc c\u1ea7u \u0111\u1ec3 gh\u00e9p ph\u1ed5i c\u1ea5p c\u1ee9u v\u1edbi ECMO. Sau PEA, b\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i t\u1ea1i c\u00e1c trung t\u00e2m CTEPH \u0111\u1ec3 lo\u1ea1i tr\u1eeb PH dai d\u1eb3ng ho\u1eb7c t\u00e1i ph\u00e1t, v\u1edbi xem x\u00e9t \u00edt nh\u1ea5t m\u1ed9t \u0111\u00e1nh gi\u00e1 huy\u1ebft \u0111\u1ed9ng l\u00fac 6-12 th\u00e1ng sau can thi\u1ec7p.<\/span><\/p>\n

3.4 Nong b\u00f3ng \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i\u00a0<\/a><\/strong><\/h3>\n

Trong th\u1eadp k\u1ef7 qua, nong b\u00f3ng \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i (BPA) xu\u1ea5t hi\u1ec7n nh\u01b0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb CTEPH b\u1eb1ng k\u1ef9 thu\u1eadt kh\u00f4ng m\u1ed5. N\u00f3 cho ph\u00e9p l\u00e0m gi\u00e3n n\u1edf ch\u1ed7 t\u1eafc ngh\u1ebdn xu\u1ed1ng \u0111\u1ebfn c\u00e1c m\u1ea1ch m\u00e1u h\u1ea1 ph\u00e2n th\u00f9y, n\u01a1i m\u00e0 kh\u00f4ng th\u1ec3 ti\u1ebfp c\u1eadn ph\u1eabu thu\u1eadt. BPA l\u00e0 m\u1ed9t th\u1ee7 thu\u1eadt t\u1eebng b\u01b0\u1edbc \u0111\u00f2i h\u1ecfi nhi\u1ec1u c\u00f4ng \u0111o\u1ea1n ri\u00eang bi\u1ec7t (th\u01b0\u1eddng l\u00e0 4-10). \u0110i\u1ec1u n\u00e0y l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 t\u1edbi \u0111\u01b0\u1ee3c t\u1ea5t c\u1ea3 c\u00e1c th\u00f9y ph\u1ed5i \u00edt \u0111\u01b0\u1ee3c t\u01b0\u1edbi m\u00e1u, \u0111\u1ed3ng th\u1eddi gi\u1ea3m b\u1edbt l\u01b0\u1ee3ng ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n v\u00e0 b\u1ee9c x\u1ea1 m\u00e0 ng\u01b0\u1eddi b\u1ec7nh ph\u1ea3i nh\u1eadn. \u0110\u1ecbnh v\u1ecb \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u0111o\u1ea1n xa \u0111\u00f2i h\u1ecfi chuy\u00ean m\u00f4n \u0111\u1eb7c bi\u1ec7t, v\u00ec s\u1ef1 ph\u1ee9c t\u1ea1p v\u00e0 \u0111a d\u1ea1ng c\u1ee7a c\u00e2y \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i so v\u1edbi c\u00e1c gi\u01b0\u1eddng m\u1ea1ch m\u00e1u kh\u00e1c \u1edf m\u1ed7i c\u00e1 nh\u00e2n. C\u00e1c bi\u1ebfn ch\u1ee9ng th\u01b0\u1eddng l\u00e0 ch\u1ea5n th\u01b0\u01a1ng do d\u00e2y d\u1eabn v\u00e0 do b\u00f3ng, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn ch\u1ea3y m\u00e1u trong ph\u1ed5i, ho ra m\u00e1u v\u00e0 t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i t\u00e1i t\u01b0\u1edbi m\u00e1u. Th\u00f4ng th\u01b0\u1eddng, ch\u1ea3y m\u00e1u s\u1ebd t\u1ef1 h\u1ebft, nh\u01b0ng \u0111\u00f4i khi n\u00f3 ph\u1ea3i \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t b\u1edfi b\u01a1m b\u00f3ng t\u1ea1m th\u1eddi g\u1ea7n v\u1edbi v\u1ecb tr\u00ed th\u1ee7ng; \u0111\u00f4i khi c\u1ea7n ph\u1ea3i t\u1eafc m\u1ea1ch. Thi\u1ebfu oxy m\u00e1u nh\u1eb9 l\u00e0 th\u01b0\u1eddng g\u1eb7p v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t b\u1eb1ng c\u00e1ch cung c\u1ea5p oxy. Th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc ho\u1eb7c ECMO hi\u1ebfm khi c\u1ea7n thi\u1ebft.\u00a0<\/span><\/p>\n

\u0110\u0103ng b\u1ed9 l\u1edbn nh\u1ea5t \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 cho \u0111\u1ebfn nay bao g\u1ed3m 249 b\u1ec7nh nh\u00e2n v\u1edbi tu\u1ed5i trung b\u00ecnh 61.5 tu\u1ed5i, \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng BPA t\u1eeb n\u0103m 2004 \u0111\u1ebfn 2013 trong b\u1ea3y trung t\u00e2m \u1edf Nh\u1eadt B\u1ea3n. PAP trung b\u00ecnh gi\u1ea3m t\u1eeb 43 \u0111\u1ebfn 24 mmHg sau khi k\u1ebft th\u00fac c\u00e1c c\u00f4ng \u0111o\u1ea1n BPA, v\u00e0 k\u1ebft qu\u1ea3 n\u00e0y duy tr\u00ec \u1edf 196 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c th\u00f4ng tim ph\u1ea3i theo d\u00f5i. Bi\u1ebfn ch\u1ee9ng g\u1eb7p \u1edf 36% b\u1ec7nh nh\u00e2n, bao g\u1ed3m ch\u1ea5n th\u01b0\u01a1ng ph\u1ed5i (18%), ho ra m\u00e1u (14%) v\u00e0\u00a0 th\u1ee7ng \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i (2.9%). Sau BPA, t\u1ef7 l\u1ec7 t\u1eed vong trong 30 ng\u00e0y l\u00e0 2.6% v\u00e0 t\u1ef7 l\u1ec7 s\u1ed1ng c\u00f2n chung 1 n\u0103m l\u00e0 97%.\u00a0<\/span><\/p>\n

H\u1ea7u h\u1ebft c\u00e1c th\u1ee7 thu\u1eadt BPA \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 ph\u1eabu thu\u1eadt v\u1ec1 m\u1eb7t k\u1ef9 thu\u1eadt, nh\u01b0ng ph\u01b0\u01a1ng ph\u00e1p n\u00e0y c\u0169ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb PH k\u00e9o d\u00e0i sau PEA. R\u1ea5t \u00edt can thi\u1ec7p BPA c\u1ee9u m\u1ea1ng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng \u1ed5n \u0111\u1ecbnh v\u1eabn \u0111ang c\u00f2n ECMO sau PEA kh\u00f4ng hi\u1ec7u qu\u1ea3.<\/span><\/p>\n

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

\u00a0\u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa t\u1ed1i \u01b0u cho CTEPH bao g\u1ed3m thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng, c\u0169ng nh\u01b0 thu\u1ed1c l\u1ee3i ti\u1ec3u v\u00e0 oxy trong tr\u01b0\u1eddng h\u1ee3p suy tim ho\u1eb7c thi\u1ebfu oxy m\u00e1u. Khuy\u1ebfn c\u00e1o d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng su\u1ed1t \u0111\u1eddi v\u1edbi VKA ( Vitamin K antagonist), v\u00e0 c\u0169ng d\u00f9ng sau khi PEA ho\u1eb7c BPA th\u00e0nh c\u00f4ng. Kh\u00f4ng c\u00f3 d\u1eef li\u1ec7u v\u1ec1 hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n c\u1ee7a NOAC.<\/span><\/p>\n

\u00a0B\u1ec7nh vi m\u1ea1ch ph\u1ed5i trong CTEPH<\/strong> l\u00e0 l\u00fd do th\u1eed nghi\u1ec7m c\u00e1c lo\u1ea1i thu\u1ed1c \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t cho t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i tr\u00ean b\u1ec7nh n\u00e0y. D\u1ef1a tr\u00ean d\u1eef li\u1ec7u hi\u1ec7n c\u00f3, \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa CTEPH b\u1eb1ng li\u1ec7u ph\u00e1p nh\u1eafm tr\u00fang \u0111\u00edch hi\u1ec7n \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 d\u00f9ng \u0111\u01b0\u1ee3c tr\u00ean b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 ph\u1eabu thu\u1eadt v\u1ec1 m\u1eb7t k\u1ef9 thu\u1eadt, c\u0169ng nh\u01b0 cho b\u1ec7nh nh\u00e2n PH k\u00e9o d\u00e0i sau PEA. Cho \u0111\u1ebfn nay, lo\u1ea1i thu\u1ed1c duy nh\u1ea5t \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t cho CTEPH kh\u00f4ng ph\u1eabu thu\u1eadt ho\u1eb7c PH dai d\u1eb3ng\/t\u00e1i ph\u00e1t sau PEA l\u00e0 riociguat, m\u1ed9t thu\u1ed1c u\u1ed1ng k\u00edch th\u00edch guanylate cyclase h\u00f2a tan. Trong m\u1ed9t th\u1eed nghi\u1ec7m ti\u1ebfn c\u1ee9u ng\u1eabu nhi\u00ean 261 b\u1ec7nh nh\u00e2n CTEPH kh\u00f4ng ph\u1eabu thu\u1eadt ho\u1eb7c PH dai d\u1eb3ng\/t\u00e1i ph\u00e1t sau PEA, \u0111i\u1ec1u tr\u1ecb b\u1eb1ng riociguat t\u0103ng kho\u1ea3ng c\u00e1ch 6 ph\u00fat \u0111i b\u1ed9 v\u00e0 gi\u1ea3m PVR c\u00f3 \u00fd ngh\u0129a. Trong m\u1ed9t m\u1eabu t\u01b0\u01a1ng t\u1ef1 v\u1edbi 157 b\u1ec7nh nh\u00e2n, ch\u1ea5t \u0111\u1ed1i v\u1eadn th\u1ee5 th\u1ec3 endothelin k\u00e9p bosentan cho th\u1ea5y t\u00e1c \u0111\u1ed9ng t\u00edch c\u1ef1c \u0111\u1ebfn huy\u1ebft \u0111\u1ed9ng, nh\u01b0ng kh\u00f4ng quan s\u00e1t th\u1ea5y \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n dung t\u00edch g\u1eafng s\u1ee9c v\u00e0 kh\u00f4ng \u0111\u1ea1t \u0111\u01b0\u1ee3c k\u1ebft c\u1ee5c ch\u00ednh. M\u1ed9t ch\u1ea5t \u0111\u1ed1i v\u1eadn th\u1ee5 th\u1ec3 endothelin k\u00e9p kh\u00e1c, macitentan, \u0111\u00e3 cho th\u1ea5y c\u1ea3i thi\u1ec7n \u0111\u00e1ng k\u1ec3 PVR v\u00e0 kho\u1ea3ng c\u00e1ch 6 ph\u00fat \u0111i b\u1ed9 so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c trong m\u1ed9t th\u1eed nghi\u1ec7m giai \u0111o\u1ea1n II t\u1eadp trung v\u00e0o c\u00e1c b\u1ec7nh nh\u00e2n CTEPH kh\u00f4ng th\u1ec3 ph\u1eabu thu\u1eadt. Hi\u1ec7n t\u1ea1i, riociguat \u0111ang \u0111\u01b0\u1ee3c ki\u1ec3m tra trong c\u00e1c th\u1eed nghi\u1ec7m t\u1eadp trung v\u00e0o t\u00ednh hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n c\u1ee7a n\u00f3:<\/span><\/p>\n

\u00a0(i)<\/strong> L\u00e0 li\u1ec7u ph\u00e1p b\u1eafc c\u1ea7u cho b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c l\u00ean l\u1ecbch l\u00e0m PEA (NCT 03273257)\u00a0<\/span><\/p>\n

\u00a0(ii)<\/strong> So s\u00e1nh v\u1edbi BPA (NCT 02634203).\u00a0<\/span><\/p>\n

Nh\u00ecn chung, c\u00e1c t\u00e1c d\u1ee5ng l\u00e0m x\u1ea5u \u0111i tr\u00ean l\u00e2m s\u00e0ng v\u1edbi c\u00e1c thu\u1ed1c \u0111\u01b0\u1ee3c th\u1eed nghi\u1ec7m trong RCT \u1edf b\u1ec7nh nh\u00e2n CTEPH v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c l\u00e0m r\u00f5. H\u01a1n n\u1eefa, kh\u00f4ng c\u00f3 d\u1eef li\u1ec7u v\u1ec1 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c nh\u1eefng b\u1ec7nh \u0111\u1ed3ng m\u1eafc kh\u00f4ng cho ph\u00e9p ho\u1eb7c \u1edf nh\u1eefng ng\u01b0\u1eddi t\u1eeb ch\u1ed1i ph\u1eabu thu\u1eadt. K\u1ebft h\u1ee3p thu\u1ed1c ngo\u00e0i h\u01b0\u1edbng d\u1eabn (off-label) \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t cho t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t cho b\u1ec7nh nh\u00e2n CTEPH c\u00f3 bi\u1ec3u hi\u1ec7n r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng nghi\u00eam tr\u1ecdng, nh\u01b0ng cho \u0111\u1ebfn nay ch\u1ec9 c\u00f3 d\u1eef li\u1ec7u ti\u1ebfn c\u1ee9u h\u1ea1n ch\u1ebf.\u00a0<\/span><\/p>\n

\u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u1edf nh\u1eefng ng\u01b0\u1eddi s\u1ed1ng s\u00f3t sau PE c\u1ea5p c\u00f3 tri\u1ec7u ch\u1ee9ng k\u00e8m ghi nh\u1eadn t\u1eafc ngh\u1ebdn sau huy\u1ebft kh\u1ed1i nh\u01b0ng kh\u00f4ng c\u00f3 PH khi th\u00f4ng tim ph\u1ea3i l\u00fac ngh\u1ec9 (CTED).<\/span><\/p>\n

4.\u00a0 Chi\u1ebfn l\u01b0\u1ee3c theo d\u00f5i b\u1ec7nh nh\u00e2n sau thuy\u00ean t\u1eafc ph\u1ed5i<\/strong>\u00a0<\/span><\/h2>\n

H\u00ecnh 8 hi\u1ec3n th\u1ecb m\u1ed9t chi\u1ebfn l\u01b0\u1ee3c theo d\u00f5i \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t cho nh\u1eefng ng\u01b0\u1eddi s\u1ed1ng s\u00f3t sau c\u1ea5p t\u00ednh PE sau khi xu\u1ea5t vi\u1ec7n. \u0110\u00e1nh gi\u00e1 b\u1ec7nh nh\u00e2n 3-6 th\u00e1ng sau \u0111\u1ee3t PE c\u1ea5p t\u00ednh \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u1ed9 dai d\u1eb3ng (ho\u1eb7c kh\u1edfi ph\u00e1t m\u1edbi) v\u00e0 m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a ch\u1ee9ng kh\u00f3 th\u1edf ho\u1eb7c h\u1ea1n ch\u1ebf ch\u1ee9c n\u0103ng v\u00e0 ki\u1ec3m tra c\u00e1c d\u1ea5u hi\u1ec7u t\u00e1i ph\u00e1t VTE, ung th\u01b0, ho\u1eb7c bi\u1ebfn ch\u1ee9ng ch\u1ea3y m\u00e1u c\u1ee7a thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u. \u0110\u1ed9 n\u1eb7ng c\u1ee7a kh\u00f3 th\u1edf c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 b\u1eb1ng thang \u0111o c\u1ee7a H\u1ed9i \u0111\u1ed3ng nghi\u00ean c\u1ee9u y t\u1ebf (MRC); ho\u1eb7c c\u00f3 th\u1ec3 d\u00f9ng c\u00e1ch ph\u00e2n lo\u1ea1i ch\u1ee9c n\u0103ng c\u1ee7a T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi (d\u1eef li\u1ec7u b\u1ed5 sung B\u1ea3ng 16).<\/strong><\/span><\/p>\n

\u00a0\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n ph\u00e0n n\u00e0n v\u1ec1 kh\u00f3 th\u1edf dai d\u1eb3ng v\u00e0 hi\u1ec7u qu\u1ea3 th\u1ec3 ch\u1ea5t k\u00e9m, TTE n\u00ean \u0111\u01b0\u1ee3c coi l\u00e0 b\u01b0\u1edbc ti\u1ebfp theo \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 x\u00e1c su\u1ea5t c\u1ee7a PH (m\u00e3n t\u00ednh) v\u00e0 c\u00f3 th\u1ec3 l\u00e0 CTEPH. C\u00e1c ti\u00eau ch\u00ed v\u00e0 ph\u00e2n \u0111\u1ed9 x\u00e1c su\u1ea5t PH \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a b\u1edfi h\u01b0\u1edbng d\u1eabn hi\u1ec7n nay c\u1ee7a ESC, v\u00e0 \u0111\u01b0\u1ee3c li\u1ec7t k\u00ea trong d\u1eef li\u1ec7u b\u1ed5 sung B\u1ea3ng 17 v\u00e0 18. B\u1ec7nh nh\u00e2n c\u00f3 x\u00e1c su\u1ea5t PH cao tr\u00ean si\u00eau \u00e2m tim, ho\u1eb7c nh\u1eefng ng\u01b0\u1eddi c\u00f3 x\u00e1c su\u1ea5t trung b\u00ecnh k\u1ebft h\u1ee3p v\u1edbi m\u1ee9c NT-proBNP t\u0103ng ho\u1eb7c c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1\/th\u00fac \u0111\u1ea9y CTEPH, ch\u1eb3ng h\u1ea1n nh\u01b0 nh\u1eefng th\u1ee9 \u0111\u01b0\u1ee3c li\u1ec7t k\u00ea trong B\u1ea3ng 13, n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t l\u00e0m x\u1ea1 h\u00ecnh V\/Q.\u00a0<\/span><\/p>\n

N\u1ebfu c\u00e1c khi\u1ebfm khuy\u1ebft t\u01b0\u1edbi m\u00e1u kh\u00f4ng t\u01b0\u01a1ng h\u1ee3p \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y tr\u00ean x\u1ea1 h\u00ecnh V\/Q, th\u00ec b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh chuy\u1ec3n \u0111\u1ebfn trung t\u00e2m chuy\u00ean khoa v\u1ec1 PH ho\u1eb7c CTEPH \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n th\u00eam. M\u1eb7t kh\u00e1c, n\u1ebfu x\u1ea1 h\u00ecnh V\/Q l\u00e0 b\u00ecnh th\u01b0\u1eddng v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng b\u1ec7nh nh\u00e2n v\u1eabn kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c, c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n CPET. V\u00ec cung c\u1ea5p \u0111\u01b0\u1ee3c b\u1eb1ng ch\u1ee9ng v\u1ec1 gi\u1ea3m dung t\u00edch hi\u1ebfu kh\u00ed t\u1ed1i \u0111a n\u00ean CPET c\u00f3 th\u1ec3 cho bi\u1ebft c\u00f3 c\u1ea7n t\u00e1i kh\u00e1m ti\u1ebfp theo v\u00e0 gi\u00fap x\u00e1c \u0111\u1ecbnh nh\u1eefng b\u1ec7nh nh\u00e2n c\u1ea7n ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng ph\u1ed5i, ch\u01b0\u01a1ng tr\u00ecnh t\u1eadp th\u1ec3 d\u1ee5c ho\u1eb7c gi\u1ea3m c\u00e2n. CPET c\u0169ng c\u00f3 th\u1ec3 h\u1eefu \u00edch \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nghi ng\u1edd CTEPH v\u00e0 \u0111\u1ed3ng m\u1eafc b\u1ec7nh l\u00fd tim tr\u00e1i v\u00e0\/ho\u1eb7c b\u1ec7nh l\u00fd h\u00f4 h\u1ea5p; trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p nh\u01b0 v\u1eady, n\u00f3 c\u00f3 th\u1ec3 gi\u00fap thi\u1ebft l\u1eadp c\u00e1c y\u1ebfu t\u1ed1 h\u1ea1n ch\u1ebf ch\u00ednh v\u00e0 do \u0111\u00f3 \u0111\u1eb7t \u01b0u ti\u00ean cho chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb.\u00a0<\/span><\/p>\n

\u0110\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ea5y kh\u00f3 th\u1edf ho\u1eb7c kh\u00f4ng b\u1ecb h\u1ea1n ch\u1ebf ch\u1ee9c n\u0103ng khi theo d\u00f5i 3-6 th\u00e1ng sau PE c\u1ea5p t\u00ednh nh\u01b0ng c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1\/th\u00fac \u0111\u1ea9y CTEPH (B\u1ea3ng 13), t\u00e1i kh\u00e1m sau \u0111\u00f3 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u00ean l\u1ecbch v\u00e0 b\u1ec7nh nh\u00e2n ph\u1ea3i \u0111\u01b0\u1ee3c d\u1eb7n d\u00f2 quay tr\u1edf l\u1ea1i n\u1ebfu c\u00e1c tri\u1ec7u ch\u1ee9ng xu\u1ea5t hi\u1ec7n. Ngo\u00e0i ra, TTE c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem x\u00e9t \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 x\u00e1c su\u1ea5t PH (H\u00ecnh 8).<\/span><\/p>\n

\"chan-doan-cac-di-chung-lau-dai-cua-thuyen-tac-phoi\"<\/p>\n

c:\u00a0 Theo \u0111\u1ecbnh ngh\u0129a c\u1ee7a h\u01b0\u1edbng d\u1eabn ESC\/ERS v\u1ec1 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb t\u0103ng \u00e1p ph\u1ed5i (d\u1eef li\u1ec7u b\u1ed5 sung B\u1ea3ng 17 v\u00e0 18).<\/span><\/p>\n

\u00a0d:\u00a0 C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 v\u00e0 y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y CTEPH \u0111\u01b0\u1ee3c li\u1ec7t k\u00ea trong B\u1ea3ng 13.\u00a0<\/span><\/p>\n

e: Test g\u1eafng s\u1ee9c tim ph\u1ed5i, n\u1ebfu b\u1ec7nh vi\u1ec7n c\u00f3 chuy\u00ean m\u00f4n v\u00e0 ngu\u1ed3n l\u1ef1c th\u00edch h\u1ee3p; k\u1ebft qu\u1ea3 b\u1ea5t th\u01b0\u1eddng bao g\u1ed3m, c\u00f9ng v\u1edbi nh\u1eefng c\u00e1i kh\u00e1c, gi\u1ea3m dung t\u00edch hi\u1ebfu kh\u00ed t\u1ed1i \u0111a (\u0111\u1ec9nh ti\u00eau th\u1ee5 oxy), gi\u1ea3m th\u00f4ng kh\u00ed t\u01b0\u01a1ng \u0111\u01b0\u01a1ng cho carbon dioxide v\u00e0 gi\u1ea3m \u00e1p l\u1ef1c carbon dioxide cu\u1ed1i th\u00ec th\u1edf ra.<\/span><\/p>\n

\u00a0f:\u00a0 Xem x\u00e9t CPET trong qu\u00e1 tr\u00ecnh ch\u1ea9n \u0111o\u00e1n.<\/span><\/p>\n

Ngo\u00e0i c\u00e1c ph\u01b0\u01a1ng ph\u00e1p s\u00e0ng l\u1ecdc v\u00e0 ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c \u0111\u1ec1 ngh\u1ecb, m\u1ed9t m\u00f4 h\u00ecnh t\u00edch h\u1ee3p ch\u0103m s\u00f3c b\u1ec7nh nh\u00e2n sau PE n\u00ean \u0111\u01b0\u1ee3c cung c\u1ea5p, c\u00f3 t\u00ednh \u0111\u1ebfn c\u01a1 s\u1edf h\u1ea1 t\u1ea7ng v\u00e0 n\u0103ng l\u1ef1c cung c\u1ea5p \u0111\u01b0\u1ee3c b\u1edfi h\u1ec7 th\u1ed1ng y t\u1ebf c\u1ee7a t\u1eebng qu\u1ed1c gia. M\u00f4 h\u00ecnh n\u00ean bao g\u1ed3m c\u00e1c y t\u00e1 c\u00f3 tr\u00ecnh \u0111\u1ed9 ph\u00f9 h\u1ee3p, l\u00e0m vi\u1ec7c li\u00ean chuy\u00ean khoa v\u1edbi c\u00e1c b\u00e1c s\u0129 trong ch\u0103m s\u00f3c c\u1ea3 b\u1ec7nh nh\u00e2n PE trong b\u1ec7nh vi\u1ec7n v\u00e0 ngo\u00e0i b\u1ec7nh vi\u1ec7n, ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c chu\u1ea9n h\u00f3a ph\u00f9 h\u1ee3p v\u1edbi n\u0103ng l\u1ef1c c\u1ee7a t\u1eebng b\u1ec7nh vi\u1ec7n v\u00e0 c\u00e1c nh\u00e1nh gi\u1edbi thi\u1ec7u hai chi\u1ec1u gi\u1eefa b\u00e1c s\u0129 \u0111a khoa v\u00e0 b\u1ec7nh vi\u1ec7n. Nh\u1eefng m\u00f4 h\u00ecnh nh\u01b0 v\u1eady \u0111\u1ea3m b\u1ea3o chuy\u1ec3n ti\u1ebfp su\u00f4n s\u1ebb gi\u1eefa c\u00e1c chuy\u00ean gia trong b\u1ec7nh vi\u1ec7n v\u00e0 c\u00e1c b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb; cung c\u1ea5p li\u00ean t\u1ee5c v\u00e0 d\u1ec5 d\u00e0ng ti\u1ebfp c\u1eadn ch\u0103m s\u00f3c c\u00f9ng v\u1edbi th\u00f4ng tin v\u00e0 gi\u00e1o d\u1ee5c; t\u00f4n tr\u1ecdng mong mu\u1ed1n c\u1ee7a b\u1ec7nh nh\u00e2n, nh\u1eefng ng\u01b0\u1eddi trong gia \u0111\u00ecnh v\u00e0 m\u00f4i tr\u01b0\u1eddng x\u00e3 h\u1ed9i c\u1ee7a b\u1ec7nh nh\u00e2n. Trong b\u1ed1i c\u1ea3nh n\u00e0y, c\u00e1c m\u00f4 h\u00ecnh ch\u0103m s\u00f3c d\u1ef1a v\u00e0o y t\u00e1 \u0111\u1ec3 theo d\u00f5i ti\u1ebfp \u0111\u00e3 th\u1ea5y c\u00f3 hi\u1ec7u qu\u1ea3 sau h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p, trong qu\u1ea3n l\u00fd c\u00e1c b\u1ec7nh m\u00e3n t\u00ednh d\u1ef1a v\u00e0o ch\u0103m s\u00f3c ban \u0111\u1ea7u, v\u00e0 trong t\u1ef1 qu\u1ea3n l\u00fd d\u1ef1a v\u00e0o c\u1ed9ng \u0111\u1ed3ng. <\/span><\/p>\n

M\u1ed9t nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 v\u1ec1 s\u1ef1 ch\u0103m s\u00f3c c\u1ee7a 42 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c theo d\u00f5i d\u1ef1a v\u00e0o y t\u00e1 t\u1ea1i ph\u00f2ng kh\u00e1m ngo\u1ea1i tr\u00fa v\u1ec1 t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i (PAH)\/CTEPH cho th\u1ea5y k\u1ebft qu\u1ea3 kh\u1ea3 quan. Trong c\u00e1c l\u1ea7n b\u1ec7nh nh\u00e2n t\u00e1i kh\u00e1m, c\u00e1c y t\u00e1 \u0111\u1ee7 tr\u00ecnh \u0111\u1ed9 chuy\u00ean m\u00f4n s\u1ebd s\u00e0ng l\u1ecdc c\u00e1c tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng v\u00e0 th\u1ef1c th\u1ec3 c\u1ee7a VTE t\u00e1i ph\u00e1t ho\u1eb7c bi\u1ebfn ch\u1ee9ng c\u1ee7a \u0111i\u1ec1u tr\u1ecb, v\u00e0 \u0111\u00e1nh gi\u00e1 vi\u1ec7c tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c. \u0110i\u1ec1u d\u01b0\u1ee1ng l\u00e0m vi\u1ec7c ph\u1ed1i h\u1ee3p v\u1edbi b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng n\u1ec1n t\u1ea3ng h\u00e0nh vi v\u00e0 trao \u0111\u1ed5i t\u1ea1o \u0111\u1ed9ng l\u1ef1c, \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh v\u00e0 \u0111i\u1ec1u ch\u1ec9nh c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 li\u00ean quan (cai thu\u1ed1c l\u00e1, ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng, ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t v\u00e0 t\u1eadp th\u1ec3 d\u1ee5c). Ngo\u00e0i ra, h\u1ecd th\u00fac \u0111\u1ea9y c\u00e1c k\u1ef9 n\u0103ng t\u1ef1 qu\u1ea3n l\u00fd nh\u01b0 vi\u1ec7c s\u1eed d\u1ee5ng v\u1edb n\u00e9n, t\u0103ng v\u1eadn \u0111\u1ed9ng m\u1ed9t c\u00e1ch an to\u00e0n, t\u0103ng nh\u1eadn th\u1ee9c v\u1ec1 c\u00e1c d\u1ea5u hi\u1ec7u t\u00e1i ph\u00e1t, ho\u1eb7c bi\u1ebfn ch\u1ee9ng.<\/span><\/p>\n

5. Khuy\u1ebfn c\u00e1o theo d\u00f5i sau thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p<\/strong><\/h2>\n

\"khuyen-cao-theo-doi-sau-thuyen-tac-phoi\"<\/p>\n

Xem th\u00eam: Thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng (vinmecdr.com)<\/a><\/p>\n

T\u00e0i li\u1ec7u tham kh\u1ea3o: 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC) – PubMed (nih.gov)<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

T\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n th\u1ea5y r\u1eb1ng t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe c\u1ee7a h\u1ecd t\u1ec7 h\u01a1n sau 6 th\u00e1ng theo d\u00f5i so v\u1edbi l\u00fac ch\u1ea9n \u0111o\u00e1n PE r\u1ea5t kh\u00e1c nhau, t\u1eeb 20 \u0111\u1ebfn 75%. Vi\u1ec7c theo d\u00f5i v\u00e0 ph\u00e1t hi\u1ec7n s\u1edbm c\u00e1c di ch\u1ee9ng c\u1ee7a Thuy\u00ean t\u1eafc ph\u1ed5i kh\u00f4ng ch\u1ec9 gi\u00fap nh\u00e2n vi\u00ean y t\u1ebf can thi\u1ec7p […]<\/p>\n","protected":false},"author":17,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[20,33],"tags":[],"yoast_head":"\n\u00a0Di ch\u1ee9ng l\u00e2u d\u00e0i c\u1ee7a thuy\u00ean t\u1eafc ph\u1ed5i\u00a0- ESC 2019 - Vinmec<\/title>\n<meta name=\"description\" content=\"Ph\u00e1t hi\u1ec7n s\u1edbm c\u00e1c di ch\u1ee9ng l\u00e2u d\u00e0i c\u1ee7a thuy\u00ean t\u1eafc ph\u1ed5i kh\u00f4ng ch\u1ec9 gi\u00fap c\u1ea3i thi\u1ec7n s\u1edbm c\u00e1c tri\u1ec7u ch\u1ee9ng g\u00e2y kh\u00f3 ch\u1ecbu cho ng\u01b0\u1eddi b\u1ec7nh.\u00a0\" \/>\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=\"\u00a0Di ch\u1ee9ng l\u00e2u d\u00e0i c\u1ee7a thuy\u00ean t\u1eafc ph\u1ed5i\u00a0- ESC 2019 - 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