{"id":2625,"date":"2022-09-23T21:26:27","date_gmt":"2022-09-23T14:26:27","guid":{"rendered":"https:\/\/ykhoataynguyen.com\/site\/?p=2625"},"modified":"2024-09-14T18:07:05","modified_gmt":"2024-09-14T11:07:05","slug":"tran-dich-mang-ngoai-tim-sieu-am-benh-tran-dich-tim","status":"publish","type":"post","link":"https:\/\/ykhoataynguyen.com\/site\/tran-dich-mang-ngoai-tim-sieu-am-benh-tran-dich-tim\/","title":{"rendered":"Tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim – Si\u00eau \u00e2m b\u1ec7nh tr\u00e0n d\u1ecbch tim"},"content":{"rendered":"

Vi\u00eam m\u00e0ng ngo\u00e0i tim th\u01b0\u1eddng c\u00f3 tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim k\u00e8m theo, v\u00ec th\u1ebf trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p ng\u01b0\u1eddi ta th\u01b0\u1eddng \u0111\u1ed3ng nh\u1ea5t hai kh\u00e1i ni\u1ec7m n\u00e0y l\u00e0 m\u1ed9t. B\u1ec7nh c\u00f3 th\u1ec3 c\u1ea5p t\u00ednh, b\u00e1n c\u1ea5p v\u00e0 m\u1ea1n t\u00ednh. Ch\u1ea9n \u0111o\u00e1n tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim kh\u00f4ng kh\u00f3 v\u1edbi si\u00eau \u00e2m, tuy nhi\u00ean \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n l\u1ea1i l\u00e0 v\u1ea5n \u0111\u1ec1 kh\u00e1 ph\u1ee9c t\u1ea1p v\u00e0 th\u1eadm ch\u00ed nhi\u1ec1u khi kh\u00f4ng th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c. C\u00f3 r\u1ea5t nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau g\u00e2y ra tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim, sau \u0111\u00e2y l\u00e0 m\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n ch\u00ednh:
\n– Do lao
\n– Do vir\u00fat, vi khu\u1ea9n, n\u1ea5m, k\u00fd sinh tr\u00f9ng
\n– Do c\u00e1c b\u1ec7nh \u00e1c t\u00ednh c\u1ee7a tim ho\u1eb7c t\u1eeb n\u01a1i kh\u00e1c di c\u0103n v\u00e0o tim
\n– \u0110i\u1ec1u tr\u1ecb b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p x\u1ea1 tr\u1ecb
\n– T\u0103ng u r\u00ea m\u00e1u
\n– D\u1ecb \u1ee9ng
\n– H\u1ed9i ch\u1ee9ng suy gi\u1ea3m mi\u1ec5n d\u1ecbch ( AIDS )
\n– M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh kh\u1edbp
\n– Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p
\n– \u0110\u1ed9t qu\u1ecb
\n– Sau ph\u1eabu thu\u1eadt v\u00e0 can thi\u1ec7p tim m\u1ea1ch
\n– B\u1ec7nh ch\u1ea5t t\u1ea1o keo ( lupus ban \u0111\u1ecf )
\n– T\u00e1ch th\u00e0nh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7
\n– Kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n
\nB\u00ecnh th\u01b0\u1eddng gi\u1eefa hai l\u00e1 m\u00e0ng ngo\u00e0i tim c\u00f3 m\u1ed9t l\u1edbp d\u1ecbch m\u1ecfng, l\u01b0\u1ee3ng d\u1ecbch n\u00e0y cho ph\u00e9p c\u00e1c l\u00e1 m\u00e0ng ngo\u00e0i tim tr\u1ee3t l\u00ean nhau d\u1ec5 d\u00e0ng trong khi tim co b\u00f3p. B\u1eb1ng si\u00eau \u00e2m tim ch\u00fang ta c\u00f3 th\u1ec3 quan s\u00e1t \u0111\u01b0\u1ee3c l\u1edbp d\u1ecbch n\u00e0y, m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ee9ng minh ch\u1ec9 t\u0103ng s\u1ed1 l\u01b0\u1ee3ng d\u1ecbch l\u00ean t\u1eeb 5- 10ml \u0111\u00e3 c\u00f3 th\u1ec3 th\u1ea5y tr\u00ean si\u00eau \u00e2m, v\u00ec th\u1ebf c\u00f3 th\u1ec3 coi si\u00eau \u00e2m tim l\u00e0 ph\u01b0\u01a1ng ti\u1ec7n t\u1ed1t nh\u1ea5t, l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng trong ch\u1ea9n \u0111o\u00e1n tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim. Ngo\u00e0i ra si\u00eau \u00e2m tim c\u00f2n cho bi\u1ebft tr\u00e0n d\u1ecbch khu tr\u00fa hay to\u00e0n b\u1ed9 m\u00e0ng ngo\u00e0i tim, gi\u00fap \u1edbc t\u00ednh s\u1ed1 l\u01b0\u1ee3ng d\u1ecbch v\u00e0 trong m\u1ed9t ch\u1eebng m\u1ef1c n\u00e0o \u0111o n\u00f3 c\u00f2n c\u00f3 \u00fd ngh\u0129a g\u1ee3i \u00fd ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n v\u00e0 h\u1edbng d\u1eabn ch\u1ecdc h\u00fat d\u1ecbch \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb. Ch\u00ednh v\u00ec v\u1eady \u0111\u1ee9ng tr\u01b0\u1edbc m\u1ed9t b\u1ec7nh nh\u00e2n nghi c\u00f3 tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim si\u00eau \u00e2m tim c\u1ea7n x\u00e1c \u0111\u1ecbnh:
\n– C\u00f3 tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim hay kh\u00f4ng.
\n– \u01af\u1edbc t\u00ednh s\u1ed1 l\u01b0\u1ee3ng d\u1ecbch.
\n– Ph\u00e1t hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u \u0111\u1ec3 h\u1edbng t\u1edbi ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n.
\n– \u0110\u00e1nh gi\u00e1 nh\u1eefng h\u1eadu qu\u1ea3 c\u1ee7a tr\u00e0n d\u1ecbch nh\u01b0: c\u00e1c d\u1ea5u hi\u1ec7u \u00e9p tim, vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft…
\n1. Si\u00eau \u00e2m trong ch\u1ea9n \u0111o\u00e1n tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim.<\/b>
\n1.1 Ch\u1ea9n \u0111o\u00e1n quy\u1ebft \u0111\u1ecbnh.<\/b>
\n1.1.1 Si\u00eau \u00e2m 2D<\/b>
\n– Tr\u00ean h\u00ecnh \u1ea3nh si\u00eau \u00e2m 2D qua th\u00e0nh ng\u1ef1c ch\u00fang ta c\u00f3 th\u1ec3 nh\u00ecn th\u1ea5y m\u1ed9t l\u1edbp r\u1ed7ng \u00e2m ( kh\u00f4ng c\u00f3 h\u00ecnh \u1ea3nh ph\u1ea3n h\u1ed3i \u00e2m ) gi\u1eefa 2 l\u00e1 th\u00e0nh v\u00e0 l\u00e1 t\u1ea1ng c\u1ee7a m\u00e0ng ngo\u00e0i tim qua c\u00e1c m\u1eb7t c\u1eaft tr\u1ee5c d\u00e0i, tr\u1ee5c ng\u1eafn c\u1ea1nh \u1ee9c tr\u00e1i, m\u1eb7t c\u1eaft 4 bu\u1ed3ng tim, \u0111\u00f3 ch\u00ednh l\u00e0 l\u1edbp d\u1ecbch m\u00e0ng ngo\u00e0i tim, chi\u1ec1u d\u00e0y c\u1ee7a l\u1edbp d\u1ecbch n\u00e0y thay \u0111\u1ed5i theo s\u1ef1 co b\u00f3p c\u1ee7a tim, n\u00f3 d\u00e0y l\u00ean trong k\u1ef3 t\u00e2m thu v\u00e0 m\u1ecfng \u0111i khi t\u00e2m tr\u01b0\u01a1ng. Th\u00f4ng th\u01b0\u1eddng l\u1edbp d\u1ecbch ch\u1ec9 th\u1ea5y \u1edf th\u00e0nh tr\u01b0\u1edbc th\u1ea5t ph\u1ea3i, nh\u0129 ph\u1ea3i v\u00e0 th\u00e0nh sau th\u1ea5t tr\u00e1i, r\u1ea5t \u00edt khi th\u1ea5y ph\u00eda sau nh\u0129 tr\u00e1i, tr\u1eeb tr\u01b0\u1eddng h\u1ee3p l\u01b0\u1ee3ng d\u1ecbch qu\u00e1 nhi\u1ec1u.
\n– H\u00ecnh \u1ea3nh tim chuy\u1ec3n \u0111\u1ed9ng nh\u01b0 \u201cm\u1ec1n m\u1ea1i\u201d h\u01a1n, th\u1eadm ch\u00ed khi tr\u00e0n d\u1ecbch m\u1ee9c \u0111\u1ed9 nhi\u1ec1u tim nh\u01b0 \u201c b\u01a1i \u201d trong n\u1edbc. M\u1ecfn tim l\u00e0 ph\u1ea7n chuy\u1ec3n \u0111\u1ed9ng nhi\u1ec1u nh\u1ea5t, c\u00f2n n\u1ec1n tim h\u1ea7u nh\u01b0 c\u1ed1 \u0111\u1ecbnh.<\/p>\n

\"[\u200bIMG]\"H\u00ecnh \u1ea3nh si\u00eau \u00e2m 2D c\u1ee7a tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim<\/i><\/b><\/p>\n

– Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p th\u1ea5y s\u1ee3i t\u01a1 huy\u1ebft trong khoang m\u00e0ng ngo\u00e0i tim, c\u00f3 th\u1ec3 th\u1ea5y d\u1ecbch trong \u0111\u1ed3ng nh\u1ea5t, th\u01b0\u1eddng g\u1eb7p trong tr\u00e0n d\u1ecbch do lao, do vi rut, do c\u00e1c b\u1ec7nh ch\u1ea5t t\u1ea1o keo…D\u1ecbch c\u00f3 ch\u1ee9a c\u00e1c ph\u1ea7n t\u1eed nh\u1ecf l\u01a1 l\u1eedng, di \u0111\u1ed9ng theo chuy\u1ec3n \u0111\u1ed9ng c\u1ee7a tim, hay g\u1eb7p trong tr\u00e0n d\u1ecbch do b\u1ec7nh l\u00fd \u00e1c t\u00ednh, do nhi\u1ec5m khu\u1ea9n.
\n– C\u0169ng tr\u00ean si\u00eau \u00e2m 2D ch\u00fang ta ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c tr\u00e0n d\u1ecbch to\u00e0n b\u1ed9 khoang m\u00e0ng ngo\u00e0i tim hay ch\u1ec9 khu tr\u00fa \u1edf m\u1ed9t v\u1ecb tr\u00ed nh\u1ea5t \u0111\u1ecbnh
\n– \u0110\u00e1nh gi\u00e1 v\u1eadn \u0111\u1ed9ng c\u1ee7a c\u00e1c v\u00f9ng c\u01a1 tim, c\u1ee7a th\u1ea5t ph\u1ea3i, nh\u0129 ph\u1ea3i \u0111\u1ec3 t\u00ecm ki\u1ebfm d\u1ea5u hi\u1ec7u \u00e9p tim.
\n– Ki\u1ec3m tra t\u0129nh m\u1ea1ch ch\u1ee7 d\u1edbi, t\u0129nh m\u1ea1ch tr\u00ean gan \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng t\u0103ng \u00e1p l\u1ef1c c\u1ee7a h\u1ec7 th\u1ed1ng n\u00e0y trong suy tim ph\u1ea3i.
\n1.1.2 Si\u00eau \u00e2m TM<\/b>
\n– Khi c\u1eaft qua tr\u1ee5c d\u00e0i c\u1ea1nh \u1ee9c tr\u00e1i qua, th\u1ea5y l\u1edbp d\u1ecbch \u1edf ph\u00eda th\u00e0nh tr\u01b0\u1edbc th\u1ea5t ph\u1ea3i v\u00e0 th\u00e0nh sau th\u1ea5t tr\u00e1i, chi\u1ec1u d\u00e0y l\u1edbp d\u1ecbch t\u0103ng l\u00ean trong k\u1ef3 t\u00e2m thu v\u00e0 gi\u1ea3m \u0111i trong k\u1ef3 t\u00e2m tr\u01b0\u01a1ng.
\n– \u0110o chi\u1ec1u d\u00e0y c\u1ee7a m\u00e0ng ngo\u00e0i tim \u1edf c\u00e1c v\u1ecb tr\u00ed kh\u00e1c nhau \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft.
\n– \u0110\u00e1nh gi\u00e1 v\u1eadn \u0111\u1ed9ng c\u1ee7a v\u00e1ch li\u00ean th\u1ea5t v\u00e0 c\u00e1c v\u00f9ng th\u1ea5t tr\u00e1i, th\u1ea5t ph\u1ea3i.<\/p>\n

\"[\u200bIMG]\"
\nH\u00ecnh \u1ea3nh si\u00eau \u00e2m TM c\u1ee7a tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim<\/i><\/b><\/p>\n

1.1.3 Si\u00eau \u00e2m Doppler<\/b>.
\n– Trong ch\u1ea9n \u0111o\u00e1n tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim si\u00eau \u00e2m Doppler ch\u1ec9 c\u00f3 vai tr\u00f2 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng \u00e9p tim v\u00e0 vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft.
\n– Th\u00f4ng th\u01b0\u1eddng Doppler xung \u0111o d\u00f2ng ch\u1ea3y qua van 2 l\u00e1, 3 l\u00e1, t\u0129nh m\u1ea1ch ph\u1ed5i v\u00e0 t\u0129nh m\u1ea1ch tr\u00ean gan, ch\u1ee7 d\u1edbi \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh c\u00e1c t\u00ecnh tr\u1ea1ng n\u00e0y.
\n1.2 \u01af\u1edbc t\u00ednh s\u1ed1 l\u01b0\u1ee3ng d\u1ecbch<\/b>
\nTr\u00ean si\u00eau \u00e2m 2D v\u00e0 TM ch\u00fang ta c\u00f3 th\u1ec3 \u1edbc t\u00ednh \u0111\u01b0\u1ee3c s\u1ed1 l\u01b0\u1ee3ng d\u1ecbch m\u00e0ng ngo\u00e0i tim, tuy nhi\u00ean cho \u0111\u1ebfn nay \u0111\u00e3 c\u00f3 nhi\u1ec1u c\u00f4ng th\u1ee9c \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 ra cho m\u1ee5c \u0111\u00edch n\u00e0y, Nh\u01b0ng v\u1eabn kh\u00f4ng c\u00f3 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p n\u00e0o ho\u00e0n h\u1ea3o v\u00e0 \u0111\u1ea1t \u0111\u1ed9 ch\u00ednh x\u00e1c tuy\u1ec7t \u0111\u1ed1i. Ch\u00ednh v\u00ec v\u1eady \u1edbc t\u00ednh s\u1ed1 l\u01b0\u1ee3ng d\u1ecbch m\u00e0ng ngo\u00e0i tim ch\u1ec9 c\u00f3 \u00fd ngh\u0129a t\u01b0\u01a1ng \u0111\u1ed1i, m\u00e0 \u0111\u00f4i khi ph\u1ee5 thu\u1ed9c kh\u00e1 nhi\u1ec1u v\u00e0o kinh nghi\u00eam c\u1ee7a ng\u01b0\u1eddi l\u00e0m si\u00eau \u00e2m, b\u1edfi v\u00ec k\u00edch th\u1edbc tim m\u1ed7i b\u1ec7nh nh\u00e2n kh\u00e1c nhau, m\u1eb7t kh\u00e1c t th\u1ebf tim v\u00e0 l\u01b0\u1ee3ng d\u1ecbch \u1edf c\u00e1c v\u1ecb tr\u00ed kh\u00e1c nhau trong khoang m\u00e0ng tim c\u0169ng kh\u00f4ng ho\u00e0n to\u00e0n gi\u1ed1ng nhau, ngo\u00e0i ra c\u00f2n ph\u1ee5 thu\u1ed9c v\u00e0o c\u00e1c m\u1eb7t c\u1eaft c\u1ee7a ng\u01b0\u1eddi l\u00e0m si\u00eau \u00e2m n\u00ean \u0111\u00f4i khi kinh nghi\u1ec7m l\u1ea1i c\u00f3 \u00fd ngh\u0129a t\u1ed1t. Tuy nhi\u00ean c\u1ea7n kh\u1eb3ng \u0111\u1ecbnh s\u1ed1 l\u01b0\u1ee3ng d\u1ecbch kh\u00f4ng ph\u1ea3i l\u00e0 y\u1ebfu t\u1ed1 quy\u1ebft \u0111\u1ecbnh \u0111\u1ebfn ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh. Nhi\u1ec1u b\u1ec7nh nh\u00e2n th\u01b0\u1eddng c\u00f3 t\u00e2m l\u00fd r\u1ea5t coi tr\u1ecdng y\u1ebfu t\u1ed1 n\u00e0y, Nh\u01b0ng th\u1ef1c t\u1ebf nguy\u00ean nh\u00e2n g\u00e2y tr\u00e0n d\u1ecbch v\u00e0 t\u1ed1c \u0111\u1ed9 h\u00ecnh th\u00e0nh d\u1ecbch m\u1edbi l\u00e0 v\u1ea5n \u0111\u1ec1 c\u1ea7n quan t\u00e2m h\u01a1n. \u0110\u1ed3ng th\u1eddi c\u0169ng kh\u00f4ng n\u00ean \u0111\u1ed3ng ngh\u0129a s\u1ed1 l\u01b0\u1ee3ng d\u1ecbch m\u00e0 si\u00eau \u00e2m \u1edbc l\u01b0\u1ee3ng v\u1edbi l\u01b0\u1ee3ng d\u1ecbch \u0111\u01b0\u1ee3c h\u00fat ra d\u1edbi h\u1edbng d\u1eabn c\u1ee7a si\u00eau \u00e2m, b\u1edfi v\u00ec trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng kh\u00f4ng bao gi\u1edd h\u00fat h\u1ebft \u0111\u01b0\u1ee3c d\u1ecbch m\u00e0ng ngo\u00e0i tim. Ch\u00ednh v\u00ec t\u00ednh ch\u1ea5t t\u01b0\u01a1ng \u0111\u1ed1i c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p n\u00ean ch\u00fang t\u00f4i gi\u1edbi thi\u1ec7u m\u1ed9t s\u1ed1 c\u00e1ch t\u00ednh th\u00f4ng th\u01b0\u1eddng c\u1ee7a c\u00e1c t\u00e1c gi\u1ea3 \u0111\u1ec3 tham kh\u1ea3o.
\n1.2.1 \u01af\u1edbc l\u01b0\u1ee3ng c\u00f3 t\u00ednh ch\u1ea5t t\u01b0\u01a1ng \u0111\u1ed1i.<\/b>
\n– B\u00ecnh th\u01b0\u1eddng ch\u1ec9 c\u00f3 th\u1ec3 nh\u00ecn th\u1ea5y m\u1ed9t l\u1edbp d\u1ecbch r\u1ea5t m\u1ecfng \u1edf th\u00e0nh sau th\u1ea5t tr\u00e1i trong k\u1ef3 t\u00e2m thu.
\n– Khi chi\u1ec1u d\u00e0y l\u1edbp d\u1ecbch \u0111o trong k\u1ef3 t\u00e2m thu ph\u00eda th\u00e0nh sau th\u1ea5t tr\u00e1i < 1cm, t\u01b0\u01a1ng \u1ee9ng v\u1edbi l\u01b0\u1ee3ng d\u1ecbch < 100ml.
\n– Khi chi\u1ec1u d\u00e0y l\u1edbp d\u1ecbch t\u1eeb 1-2 cm t\u01b0\u01a1ng \u1ee9ng l\u01b0\u1ee3ng d\u1ecbch < 500ml.
\n– Khi chi\u1ec1u d\u00e0y l\u1edbp d\u1ecbch > 2cm , l\u01b0\u1ee3ng d\u1ecbch >500ml
\nHo\u1eb7c c\u0103n c\u1ee9 v\u00e0o chi\u1ec1u d\u00e0y l\u1edbp d\u1ecbch ph\u00eda th\u00e0nh sau th\u1ea5t tr\u00e1i trong k\u1ef3 t\u00e2m tr\u01b0\u01a1ng
\n– Khi < 1cm t\u01b0\u01a1ng \u1ee9ng v\u1edbi l\u01b0\u1ee3ng d\u1ecbch < 300ml
\n– Khi 1- 2cm t\u01b0\u01a1ng \u1ee9ng v\u1edbi l\u01b0\u1ee3ng d\u1ecbch 300- 700ml
\n– Khi > 2cm t\u01b0\u01a1ng \u1ee9ng v\u1edbi > 700ml
\n1.2.3 \u01af\u1edbc t\u00ednh c\u1ee5 th\u1ec3 s\u1ed1 l\u01b0\u1ee3ng d\u1ecbch.<\/b>
\n– Ch\u00fang ta c\u00f3 th\u1ec3 t\u00ednh l\u01b0\u1ee3ng d\u1ecbch tr\u00ean si\u00eau \u00e2m 2D qua m\u1eb7t c\u1eaft 4 bu\u1ed3ng tim v\u00e0 tr\u1ee5c ng\u1eafn li\u00ean s\u1eddn IV-V c\u1ea1nh \u1ee9c tr\u00e1i qua v\u00f9ng n\u1ec1n tim. B\u1eb1ng c\u00e1ch t\u00ednh th\u1ec3 t\u00edch theo ph\u01b0\u01a1ng ph\u00e1p Simpson, hay ph\u01b0\u01a1ng ph\u00e1p t\u00ednh th\u1ec3 t\u00edch c\u1ee7a h\u00ecnh E-lip \u0111\u1ed1i v\u1edbi m\u1eb7t c\u1eaft 4 bu\u1ed3ng v\u00e0 h\u00ecnh c\u1ea7u \u0111\u1ed1i v\u1edbi m\u1eb7t c\u1eaft tr\u1ee5c ng\u1eafn c\u1ea1nh \u1ee9c tr\u00e1i. T\u00ednh th\u1ec3 t\u00edch c\u1ee7a h\u00ecnh kh\u1ed1i l\u1edbn ( bao g\u1ed3m c\u1ea3 l\u1edbp d\u1ecbch v\u00e0 tim ) r\u1ed3i tr\u1eeb \u0111i th\u1ec3 t\u00edch c\u1ee7a tim.
\nVPF = V \u2013 v ( ml )<\/i>
\nTuy nhi\u00ean c\u1ea7n ph\u1ea3i nh\u1eafc l\u1ea1i r\u1eb1ng d\u00f9 t\u00ednh b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p n\u00e0o th\u00ec vi\u1ec7c \u1edbc l\u01b0\u1ee3ng c\u0169ng ch\u1ec9 l\u00e0 b\u00e1n \u0111\u1ecbnh l\u01b0\u1ee3ng, hay n\u00f3i c\u00e1ch kh\u00e1c n\u00f3 ch\u1ec9 c\u00f3 \u00fd ngh\u0129a t\u01b0\u01a1ng \u0111\u1ed1i v\u00e0 ng\u01b0\u1eddi ki\u1ec3m tra c\u00e0ng c\u00f3 kinh nghi\u1ec7m th\u00ec vi\u1ec7c \u1edbc l\u01b0\u1ee3ng c\u00e0ng ch\u00ednh x\u00e1c h\u01a1n, m\u1eb7c d\u00f9 \u0111i\u1ec1u n\u00e0y c\u0169ng kh\u00f4ng quan tr\u1ecdng l\u1eafm.
\n1.2 Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/b>
\n– L\u1edbp m\u1ee1 m\u00e0ng ngo\u00e0i tim hay g\u1eb7p n\u1eb1m \u1edf th\u00e0nh tr\u01b0\u1edbc th\u1ea5t ph\u1ea3i c\u0169ng d\u1ec5 nh\u1ea7m l\u00e0 tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim, Nh\u01b0ng n\u1ebfu \u0111i\u1ec1u ch\u1ec9nh \u201cGain\u201d m\u1ed9t c\u00e1ch c\u00f3 kinh nghi\u1ec7m ch\u00fang ta c\u00f3 th\u1ec3 ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c d\u1ec5 d\u00e0ng. M\u1eb7t kh\u00e1c trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y chuy\u1ec3n \u0111\u1ed9ng c\u1ee7a tim v\u1eabn b\u00ecnh th\u01b0\u1eddng, kh\u00f4ng \u201c m\u1ec1n m\u1ea1i \u201d nh\u01b0 b\u01a1i trong n\u1edbc.
\n– M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh l\u00fd kh\u00e1c tuy \u00edt g\u1eb7p, Nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 g\u00e2y nh\u1ea7m l\u1eabn trong ch\u1ea9n \u0111o\u00e1n v\u1edbi tr\u00e0n d\u1ecbch khu tr\u00fa m\u00e0ng ngo\u00e0i tim nh\u01b0: C\u00e1c kh\u1ed1i u gi\u1ea3m \u00e2m, u tuy\u1ebfn \u1ee9c, l\u1ed7 b\u1ea7u d\u1ee5c Morgagni.
\n– Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i tr\u00e1i, nh\u1ea5t l\u00e0 khi tr\u00e0n d\u1ecbch m\u1ee9c \u0111\u1ed9 nhi\u1ec1u, n\u00f3 s\u1ebd \u00e1p s\u00e1t m\u00e0ng tim n\u00ean d\u1ec5 nh\u1ea7m l\u1eabn, \u0111\u1ec3 ph\u00e2n bi\u1ec7t ch\u00fang ta c\u1ea7n quan s\u00e1t v\u1eadn \u0111\u1ed9ng c\u1ee7a tim, v\u00ec n\u1ebfu tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim m\u1ee9c \u0111\u1ed9 l\u1edbn nh\u01b0 th\u1ebf tim \u0111\u00e3 v\u1eadn \u0111\u1ed9ng ki\u1ec3u l\u1eafc l. H\u01a1n n\u1eefa tr\u00ean si\u00eau \u00e2m TM ch\u00fang ta v\u1eabn nh\u00ecn th\u1ea5y m\u00e0ng ngo\u00e0i tim b\u00ecnh th\u01b0\u1eddng \u1edf ph\u00eda th\u00e0nh sau th\u1ea5t tr\u00e1i. Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i tr\u00e1i th\u01b0\u1eddng n\u1eb1m sau th\u1ea5t tr\u00e1i, nh\u0129 tr\u00e1i. Trong tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim, l\u01b0\u1ee3ng d\u1ecbch kh\u00f4ng thay \u0111\u1ed5i theo h\u00f4 h\u1ea5p, trong khi \u0111\u00f3 tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i tr\u00e1i l\u01b0\u1ee3ng d\u1ecbch thay \u0111\u1ed5i theo nh\u1ecbp th\u1edf.
\nCh\u00fa \u00fd:<\/i><\/b>
\n– Si\u00eau \u00e2m Doppler ch\u1ec9 c\u00f3 \u00fd ngh\u0129a trong \u0111\u00e1nh gi\u00e1 d\u00f2ng ch\u1ea3y qua van \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng \u00e9p tim.
\n– Si\u00eau \u00e2m v\u1edbi d\u00f2 th\u1ef1c qu\u1ea3n c\u00f3 th\u1ec3 c\u00f3 \u00edch trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, x\u00e1c \u0111\u1ecbnh tr\u00e0n d\u1ecbch khu tr\u00fa, ho\u1eb7c m\u00e1u t\u1ee5 sau can thi\u1ec7p m\u1ea1ch, nh\u1eefng k\u00e9n m\u00e0ng ngo\u00e0i tim, nh\u1ea5t l\u00e0 \u1edf ph\u00eda tim ph\u1ea3i.
\n– Kh\u00f4ng ph\u1ea3i nh\u1ea5t thi\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam m\u00e0ng ngo\u00e0i tim \u0111\u1ec1u c\u00f3 tr\u00e0n d\u1ecbch, m\u00e0 c\u00f3 nh\u1eefng th\u1ec3 \u201cvi\u00eam m\u00e0ng ngo\u00e0i tim kh\u00f4\u201d ( dry pericarditis )
\n– Khi tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim m\u1ee9c \u0111\u1ed9 nhi\u1ec1u nh\u1eefng ch\u1ea9n \u0111o\u00e1n sa van tim ( bao g\u1ed3m van 2 l\u00e1, 3 l\u00e1, \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i ), c\u00e1c v\u1eadn \u0111\u1ed9ng ngh\u1ecbch th\u01b0\u1eddng c\u1ee7a th\u00e0nh th\u1ea5t tr\u00e1i, c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u00f3 th\u1ec3 kh\u00f4ng ch\u00ednh x\u00e1c, do \u0111\u00f3 nh\u1eefng ch\u1ea9n \u0111o\u00e1n n\u00e0y n\u00ean x\u00e1c \u0111\u1ecbnh l\u1ea1i sau khi \u0111\u00e3 ch\u1ecdc h\u00fat d\u1ecbch m\u00e0ng ngo\u00e0i tim.
\n– Khi tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim m\u1ee9c \u0111\u1ed9 \u00edt c\u00f3 th\u1ec3 ch\u1ec9 khu tr\u00fa \u1edf th\u00e0nh tr\u01b0\u1edbc nh\u0129 ph\u1ea3i, v\u00ec \u00e1p l\u1ef1c nh\u0129 ph\u1ea3i nh\u1ecf nh\u1ea5t n\u00ean d\u1ec5 nh\u00ecn th\u1ea5y d\u1ecbch, c\u00e1c m\u1eb7t c\u1eaft 4 bu\u1ed3ng tim d\u1edbc m\u0169i \u1ee9c, tr\u1ee5c d\u00e0i c\u1ea1nh \u1ee9c tr\u00e1i li\u00ean s\u1eddn IV-V c\u0169ng l\u00e0 nh\u1eefng m\u1eb7t c\u1eaft c\u00f3 th\u1ec3 quan s\u00e1t d\u1ecbch m\u00e0ng ngo\u00e0i tim m\u1ee9c \u0111\u1ed9 \u00edt t\u01b0\u01a1ng \u0111\u1ed1i d\u1ec5 d\u00e0ng.
\n2. \u00e9p tim.<\/b>
\n\u00e9p tim l\u00e0 t\u00ecnh tr\u1ea1ng t\u0103ng \u00e1p l\u1ef1c trong khoang m\u00e0ng ngo\u00e0i tim, do tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim g\u00e2y ra, l\u00e0m t\u0103ng \u00e1p l\u1ef1c trong bu\u1ed3ng tim, g\u00e2y h\u1ea1n ch\u1ebf \u0111\u1ed5 \u0111\u1ea7y t\u00e2m th\u1ea5t trong k\u1ef3 t\u00e2m tr\u01b0\u01a1ng v\u00e0 gi\u1ea3m cung l\u01b0\u1ee3ng tim. Trong h\u1ed9i ch\u1ee9ng \u00e9p tim, s\u1ed1 l\u01b0\u1ee3ng d\u1ecbch nhi\u1ec1u khi kh\u00f4ng ph\u1ea3i l\u00e0 v\u1ea5n \u0111\u1ec1 quy\u1ebft \u0111\u1ecbnh, m\u00e0 t\u1ed1c \u0111\u1ed9 h\u00ecnh th\u00e0nh d\u1ecbch quan tr\u1ecdng h\u01a1n. Ch\u00ednh v\u00ec v\u1eady nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n ch\u1ec9 c\u00f3 l\u01b0\u1ee3ng d\u1ecbch 300- 400ml \u0111\u00e3 b\u1ecb \u00e9p tim, Nh\u01b0ng c\u00f3 ng\u01b0\u1eddi 700-800ml v\u1eabn kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u \u00e9p tim.
\nNh\u1eefng nguy\u00ean nh\u00e2n g\u00e2y \u00e9p tim th\u01b0\u1eddng g\u1eb7p theo Terry Raynolds:
\n– B\u1ec7nh l\u00fd \u00e1c t\u00ednh ( 32% )
\n– Kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n ( 14% )
\n– Ur\u00ea m\u00e1u cao ( 9% )
\n– Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p c\u00f3 d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng ( 7,5% )
\n– Do nhi\u1ec5m khu\u1ea9n ( 7,5% )
\n– Do lao ( 5% )
\n– Do chi\u1ebfu x\u1ea1 ( 4% )
\n– Do t\u00e1ch th\u00e0nh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ( 4% )…
\n\u00e9p tim l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng c\u1ea5p c\u1ee9u kh\u1ea9n c\u1ea5p v\u00ec n\u1ebfu kh\u00f4ng \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi c\u00f3 th\u1ec3 g\u00e2y h\u1eadu qu\u1ea3 n\u1eb7ng n\u1ec1 do r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng g\u00e2y ra. \u00e9p tim trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng ph\u1ea3i do s\u1ed1 l\u01b0\u1ee3ng d\u1ecbch m\u00e0 do t\u1ed1c \u0111\u1ed9 h\u00ecnh th\u00e0nh d\u1ecbch quy\u1ebft \u0111\u1ecbnh. Ch\u1ea9n \u0111o\u00e1n \u00e9p tim c\u00f3 th\u1ec3 d\u1ef1a v\u00e0o l\u00e2m s\u00e0ng, \u0111i\u1ec7n tim, si\u00eau \u00e2m, X quang, th\u00f4ng tim, trong \u0111\u00f3 si\u00eau \u00e2m \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng v\u00ec cho ch\u1ea9n \u0111o\u00e1n nhanh ch\u00f3ng, ch\u00ednh x\u00e1c. M\u1ed9t s\u1ed1 d\u1ea5u hi\u1ec7u ch\u00ednh c\u1ee7a si\u00eau \u00e2m trong \u00e9p tim nh\u01b0 sau:
\n2.1 Si\u00eau \u00e2m TM<\/b>
\n– X\u00e1c \u0111\u1ecbnh c\u00f3 tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim
\n– D\u1ea5u hi\u1ec7u \u00e9p tim ph\u1ea3i ( RVIDd <= 7mm )
\n– D\u1ea5u \u1ea5n s\u1edbm t\u00e2m thu c\u1ee7a m\u00e0ng ngo\u00e0i tim l\u00ean th\u00e0nh tr\u01b0\u1edbc th\u1ea5t ph\u1ea3i
\n– RVIDd t\u0103ng l\u00ean khi h\u00edt v\u00e0o, th\u01b0\u1eddng kho\u1ea3ng 10mm .Trong khi \u0111\u00f3 LVIDd gi\u1ea3m \u0111i, trung b\u00ecnh c\u0169ng kho\u1ea3n 10mm. Hay n\u00f3i c\u00e1ch kh\u00e1c \u0111\u01b0\u1eddng k\u00ednh th\u1ea5t tr\u00e1i, th\u1ea5t ph\u1ea3i thay \u0111\u1ed5i theo nh\u1ecbp h\u00f4 h\u1ea5p, n\u1ebfu ch\u00fang ta ghi m\u1ed9t \u0111o\u1ea1n d\u00e0i \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 nh\u1eadn th\u1ea5y m\u1ed9t c\u00e1ch d\u1ec5 d\u00e0ng.
\n– D\u1ed1c EF van 2 l\u00e1 gi\u1ea3m ( th\u01b0\u1eddng < 50mm\/s )
\n– Gi\u1ea3m D-E c\u1ee7a van 2 l\u00e1 ( trung b\u00ecnh 6mm )
\n– Van 2 l\u00e1 m\u1edf ch\u1eadm khi h\u00edt v\u00e0o
\n– Van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 c\u0169ng gi\u1ea3m bi\u00ean \u0111\u1ed9 m\u1edf v\u00e0 th\u1eddi gian t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i c\u0169ng gi\u1ea3m trong th\u00ec th\u1edf v\u00e0o.
\n– V\u1eadn \u0111\u1ed9ng t\u00e2m tr\u01b0\u01a1ng th\u00e0nh sau th\u1ea5t tr\u00e1i t\u0103ng l\u00ean ( b\u00ecnh th\u01b0\u1eddng 1-7mm ).
\n2.2 Si\u00eau \u00e2m 2D<\/b>
\n– Tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim, th\u01b0\u1eddng l\u00e0 v\u1edbi s\u1ed1 l\u01b0\u1ee3ng nhi\u1ec1u
\n– H\u00ecnh \u1ea3nh tim b\u01a1i trong n\u1edbc
\n– Trong giai \u0111o\u1ea1n ti\u1ec1n t\u00e2m thu nh\u0129 ph\u1ea3i x\u1eb9p l\u1ea1i ( > 30% )
\n– Th\u1ea5t ph\u1ea3i x\u1eb9p trong \u0111\u1ea7u t\u00e2m tr\u01b0\u01a1ng ( th\u00e0nh t\u1ef1 do th\u1ea5t ph\u1ea3i v\u1eabn b\u1ecb v\u1eadn \u0111\u1ed9ng v\u00e0o trong bu\u1ed3ng th\u1ea5t \u00edt nh\u1ea5t 0,05 gi\u00e2y sau khi b\u1eaft \u0111\u1ea7u m\u1edf van 2 l\u00e1 )
\n– Nh\u0129 tr\u00e1i c\u0169ng b\u1ecb x\u1eb9p cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng, ho\u1eb7c \u0111\u1ea7u t\u00e2m thu.
\n– V\u00e1ch li\u00ean th\u1ea5t v\u1eadn \u0111\u1ed9ng v\u1ec1 ph\u00eda th\u1ea5t tr\u00e1i trong k\u1ef3 h\u00edt v\u00e0o, v\u00e1ch li\u00ean nh\u0129 c\u0169ng v\u1eadn \u0111\u1ed9ng v\u1ec1 ph\u00eda nh\u0129 tr\u00e1i
\n– T\u0129nh m\u1ea1ch ch\u1ee7 d\u1edbi gi\u00e3n v\u00e0 \u00edt thay \u0111\u1ed5i k\u00edch th\u1edbc theo nh\u1ecbp h\u00f4 h\u1ea5p ( b\u00ecnh th\u01b0\u1eddng s\u1ef1 thay \u0111\u1ed5i n\u00e0y > 50% )
\n– T\u0129nh m\u1ea1ch ch\u1ee7 tr\u00ean c\u0169ng gi\u00e3n
\n2.3 Si\u00eau \u00e2m Doppler<\/b>
\n– H\u00ecnh \u1ea3nh \u0111\u1eb7c hi\u1ec7u c\u1ee7a h\u1ed9i ch\u1ee9ng \u00e9p tim l\u00e0 v\u1eadn t\u1ed1c \u0111\u1ec9nh s\u00f3ng E (VE ) v\u00e0 t\u00edch ph\u00e2n th\u1eddi gian, t\u1ed1c \u0111\u1ed9 s\u00f3ng E ( VTIE ) qua c\u1ea3 van 2 l\u00e1 v\u00e0 3 l\u00e1 \u0111\u1ec1u thay \u0111\u1ed5i theo chu k\u1ef3 h\u00f4 h\u1ea5p. Khi h\u00edt v\u00e0o VE qua van 2 l\u00e1 gi\u1ea3m, VE qua van 3 l\u00e1 t\u0103ng, Ng\u01b0\u1ee3c l\u1ea1i khi th\u1edf ra VE qua van 2 l\u00e1 t\u0103ng, qua van 3 l\u00e1 l\u1ea1i gi\u1ea3m. S\u1ef1 thay \u0111\u1ed5i n\u00e0y th\u01b0\u1eddng > 25% gi\u00e1 tr\u1ecb c\u1ee7a ch\u00fang.
\n– VA v\u00e0 VTIA qua van 2 l\u00e1 gi\u1ea3m khi h\u00edt v\u00e0o v\u00e0 t\u0103ng khi th\u1edf ra. Nh\u01b0ng t\u00ednh chung l\u1ea1i t\u1ef7 l\u1ec7 VE\/ VA v\u00e0 VTIE\/VTIA gi\u1ea3m khi h\u00edt v\u00e0o v\u00e0 t\u0103ng khi th\u1edf ra.
\n– T\u01b0\u01a1ng t\u1ef1 nh\u01b0 v\u1eady Vmax qua van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i v\u00e0 van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 c\u0169ng b\u1ecb thay \u0111\u1ed5i theo nh\u1ecbp h\u00f4 h\u1ea5p. Khi h\u00edt v\u00e0o Vmax qua van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i t\u0103ng, khi th\u1edf ra gi\u1ea3m , Ng\u01b0\u1ee3c l\u1ea1i Vmax qua van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 t\u0103ng khi th\u1edf ra v\u00e0 gi\u1ea3m khi h\u00edt v\u00e0o.
\n– T\u0129nh m\u1ea1ch ph\u1ed5i gi\u1ea3m t\u1ed1c \u0111\u1ed9 khi h\u00edt v\u00e0o v\u00e0 t\u0103ng khi th\u1edf ra ( c\u1ea3 v\u1eadn t\u1ed1c \u0111\u1ec9nh v\u00e0 t\u00edch ph\u00e2n th\u1eddi gian, t\u1ed1c \u0111\u1ed9 s\u00f3ng )
\n– D\u00f2ng ch\u1ea3y t\u00e2m thu chi\u1ebfm ch\u1ee7 y\u1ebfu trong t\u0129nh m\u1ea1ch ch\u1ee7 tr\u00ean.
\n– M\u1edf th\u00f4ng l\u1ed7 b\u1ea7u d\u1ee5c v\u1edbi shunt ph\u1ea3i – tr\u00e1i.
\n– IVRT t\u0103ng khi h\u00edt v\u00e0o, trong khi \u0111\u00f3 ET l\u1ea1i gi\u1ea3m khi h\u00edt v\u00e0o.
\n– Th\u1ec3 t\u00edch nh\u00e1t b\u00f3p ( Strock Volume- SV ) th\u1ea5t tr\u00e1i c\u0169ng t\u0103ng khi th\u1edf ra v\u00e0 gi\u1ea3m khi h\u00edt v\u00e0o.
\n– C\u00e1c d\u00f2ng ch\u1ea3y t\u0129nh m\u1ea1ch tr\u00ean gan v\u00e0 t\u0129nh m\u1ea1ch ch\u1ee7 d\u1edbi c\u0169ng thay \u0111\u1ed5i theo chu k\u1ef3 h\u00f4 h\u1ea5p.
\n– Nh\u1eefng d\u1ea5u hi\u1ec7u tr\u00ean s\u1ebd thay \u0111\u1ed5i nhanh ch\u00f3ng sau khi ch\u1ecdc h\u00fat d\u1ecbch m\u00e0ng ngo\u00e0i tim, n\u1ebfu kh\u00f4ng thay \u0111\u1ed5i nhi\u1ec1u c\u00f3 th\u1ec3 l\u00e0 vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft.
\n2.4 Si\u00eau \u00e2m th\u1ef1c qu\u1ea3n<\/b>
\n– S\u1eed d\u1ee5ng trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p si\u00eau \u00e2m qua th\u00e0nh ng\u1ef1c kh\u00f4ng nh\u00ecn r\u00f5.
\n– C\u00f3 th\u1ec3 d\u1eabn \u0111\u01b0\u1eddng cho ch\u1ecdc h\u00fat d\u1ecbch m\u00e0ng ngo\u00e0i tim trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u1ea7n thi\u1ebft.
\n– \u0110\u1eb7c bi\u1ec7t c\u1ea7n thi\u1ebft \u0111\u1ed1i v\u1edbi tr\u01b0\u1eddng h\u1ee3p tr\u00e0n d\u1ecbch khu tr\u00fa ho\u1eb7c m\u00e1u t\u1ee5 m\u00e0ng ngo\u00e0i tim sau c\u00e1c can thi\u1ec7p tim m\u1ea1ch.
\nCh\u00fa \u00fd :\u00a0<\/i><\/b>B\u00ecnh th\u01b0\u1eddng \u00e1p l\u1ef1c trong m\u00e0ng ngo\u00e0i tim th\u1ea5p h\u01a1n trong t\u0129nh m\u1ea1ch trung \u01b0\u01a1ng v\u00e0 nh\u0129 ph\u1ea3i 3 \u2013 5 mmHg, khi tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim nhi\u1ec1u ho\u1eb7c t\u1ed1c \u0111\u1ed9 nhanh l\u00e0m \u00e1p l\u1ef1c n\u00e0y t\u0103ng l\u00ean, c\u00f3 khi v\u1ee3t c\u1ea3 \u00e1p l\u1ef1c trong nh\u0129 ph\u1ea3i v\u00e0 g\u00e2y l\u00ean \u00e9p tim. C\u0103n c\u1ee9 v\u00e0o \u00e1p l\u1ef1c trong m\u00e0ng ngo\u00e0i tim ng\u01b0\u1eddi ta chia th\u00e0nh 3 m\u1ee9c \u0111\u1ed9 c\u1ee7a tr\u1ea1ng th\u00e1i \u00e9p tim.
\n– \u0110\u1ed9 1. Khi \u00e1p l\u1ef1c trong m\u00e0ng ngo\u00e0i tim cha v\u1ee3t qu\u00e1 \u00e1p l\u1ef1c trong nh\u0129 ph\u1ea3i.
\n– \u0110\u1ed9 2. Khi \u00e1p l\u1ef1c n\u00e0y \u0111\u00e3 l\u1edbn h\u01a1n \u00e1p l\u1ef1c trong nh\u0129 ph\u1ea3i, Nh\u01b0ng cha v\u1ee3t qu\u00e1 \u00e1p l\u1ef1c r\u00eca mao m\u1ea1ch ph\u1ed5i.
\n– \u0110\u1ed9 3. khi \u00e1p l\u1ef1c trong m\u00e0ng ngo\u00e0i tim \u0111\u00e3 v\u1ee3t qu\u00e1 \u00e1p l\u1ef1c r\u00eca mao m\u1ea1ch ph\u1ed5i.
\nTrong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p \u00e1p l\u1ef1c m\u00e0ng ngo\u00e0i tim ch\u1ec9 t\u0103ng \u1edf m\u1ee9c \u0111\u1ed9 v\u1eeba ph\u1ea3i Nh\u01b0ng v\u1eabn x\u1ea3y ra d\u1ea5u hi\u1ec7u \u00e9p tim, nh\u01b0 khi b\u1ec7nh nh\u00e2n c\u00f3 m\u1ea5t m\u00e1u, m\u1ea5t n\u1edbc nhi\u1ec1u k\u00e8m theo.
\n3. Vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft<\/b>
\nL\u00e0 t\u00ecnh tr\u1ea1ng d\u00e0y l\u00ean v\u00e0 x\u01a1 ho\u00e1 m\u00e0ng ngo\u00e0i tim, g\u00e2y c\u1ea3n tr\u1edf \u0111\u1ed5 \u0111\u1ea7y t\u00e2m tr\u01b0\u01a1ng th\u1ea5t tr\u00e1i. Th\u01b0\u1eddng l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim k\u00e9o d\u00e0i v\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb \u0111\u00fang \u0111\u1eafn, do \u0111\u00f3 nguy\u00ean nh\u00e2n c\u1ee7a vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft c\u0169ng gi\u1ed1ng nh\u01b0 trong tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim n\u00f3i chung. Trong th\u1ef1c t\u1ebf nhi\u1ec1u b\u1ec7nh nh\u00e2n kh\u00f4ng bi\u1ebft ti\u1ec1n s\u1eed tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim tr\u01b0\u1edbc \u0111\u00f3, n\u00ean ph\u1ea7n nhi\u1ec1u vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft \u0111\u01b0\u1ee3c cho l\u00e0 kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n.
\nCh\u1ea9n \u0111o\u00e1n vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft c\u00f3 th\u1ec3 d\u1ef1a v\u00e0o c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng, X quang, si\u00eau \u00e2m, \u0111i\u1ec7n tim, th\u00f4ng tim…trong \u0111\u00f3 si\u00eau \u00e2m c\u00f3 vai tr\u00f2 r\u1ea5t quan tr\u1ecdng. Tuy v\u1eady trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p vi\u1ec7c ch\u1ea9n \u0111o\u00e1n kh\u00f4ng ph\u1ea3i lu\u00f4n lu\u00f4n d\u1ec5 d\u00e0ng, nhi\u1ec1u khi ph\u1ea3i s\u1eed d\u1ee5ng nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p, k\u1ec3 c\u1ea3 th\u00f4ng tim, c\u1ed9ng h\u01b0\u1edfng t\u1eeb m\u1edbi c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c.
\n3.1 Si\u00eau \u00e2m TM<\/b>
\n– M\u00e0ng ngo\u00e0i tim d\u00e0y, trong khi k\u00edch th\u1edbc v\u00e0 chi\u1ec1u d\u00e0y th\u00e0nh th\u1ea5t tr\u00e1i v\u1eabn trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng. Ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i c\u00f3 th\u1ec3 b\u1ecb \u1ea3nh h\u01b0\u1edfng nh\u1eb9.
\n– D\u1ea5u hi\u1ec7u \u201c\u0111\u01b0\u1eddng ray\u201d c\u1ee7a m\u00e0ng ngo\u00e0i tim th\u01b0\u1eddng nh\u00ecn th\u1ea5y \u1edf th\u00e0nh sau th\u1ea5t tr\u00e1i, v\u00f9ng m\u1ecfn tim. \u0110\u00f3 l\u00e0 nh\u1eefng \u0111\u01b0\u1eddng th\u1eb3ng song song do m\u00e0ng ngo\u00e0i tim d\u00e0y l\u00ean t\u1ea1o th\u00e0nh.
\n– V\u00e1ch li\u00ean th\u1ea5t c\u00f3 th\u1ec3 v\u1eadn \u0111\u1ed9ng kh\u00f4ng b\u00ecnh th\u01b0\u1eddng ( \u0111\u1ea3o ngh\u1ecbch v\u1eadn \u0111\u1ed9ng, gi\u1ea3m hay kh\u00f4ng v\u1eadn \u0111\u1ed9ng ), ho\u1eb7c trong \u0111\u1ea7u t\u00e2m tr\u01b0\u01a1ng v\u1eadn \u0111\u1ed9ng v\u1ec1 ph\u00eda bu\u1ed3ng th\u1ea5t tr\u00e1i, sau \u0111\u00f3 m\u1edbi v\u1eadn \u0111\u1ed9ng v\u1ec1 ph\u00eda th\u1ea5t ph\u1ea3i nh\u01b0 b\u00ecnh th\u01b0\u1eddng.
\n– Th\u00e0nh sau th\u1ea5t tr\u00e1i gi\u00e3n nhanh \u1edf giai \u0111o\u1ea1n \u0111\u1ea7u t\u00e2m tr\u01b0\u01a1ng, sau \u0111\u00f3 di \u0111\u1ed9ng h\u1ea7u nh\u01b0 n\u1eb1m ngang t\u1eeb gi\u1eefa t\u00e2m tr\u01b0\u01a1ng \u0111\u1ebfn cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng.
\n– D\u1ed1c EF l\u00e1 tr\u01b0\u1edbc van 2 l\u00e1 gi\u1ea3m.
\n– Van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i m\u1edf s\u1edbm trong k\u1ef3 t\u00e2m tr\u01b0\u01a1ng. S\u00f3ng a c\u1ee7a van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i t\u0103ng bi\u00ean \u0111\u1ed9 khi h\u00edt v\u00e0o.
\n3.2 Si\u00eau \u00e2m 2D<\/b>
\n– M\u00e0ng ngo\u00e0i tim t\u0103ng s\u00e1ng v\u00e0 d\u00e0y h\u01a1n b\u00ecnh th\u01b0\u1eddng.Th\u00f4ng th\u01b0\u1eddng nh\u1eefng d\u1ea5u hi\u1ec7u n\u00e0y \u0111\u01b0\u1ee3c quan s\u00e1t tr\u00ean m\u1eb7t c\u1eaft tr\u1ee5c d\u00e0i c\u1ea1nh \u1ee9c tr\u00e1i, 4 bu\u1ed3ng tim, d\u1edbi m\u0169i \u1ee9c…m\u00e0ng ngo\u00e0i tim th\u01b0\u1eddng ch\u1ec9 d\u00e0y l\u00ean \u1edf ph\u00eda t\u00e2m th\u1ea5t, r\u1ea5t \u00edt khi lan t\u1edbi ph\u00eda t\u00e2m nh\u0129. Si\u00eau \u00e2m 2D c\u1ea7n m\u00f4 t\u1ea3 chi ti\u1ebft v\u1ecb tr\u00ed, \u0111\u1ed9 d\u00e0y c\u1ee7a t\u1eebng v\u00f9ng quan s\u00e1t \u0111\u01b0\u1ee3c \u0111\u1ec3 gi\u00fap cho ch\u1ec9 \u0111\u1ecbnh ngo\u1ea1i khoa ch\u00ednh x\u00e1c h\u01a1n.Tuy nhi\u00ean c\u1ea7n lu \u00fd \u0111o \u0111\u1ed9 d\u00e0y m\u00e0ng ngo\u00e0i tim kh\u00f4ng ph\u1ea3i l\u00fac n\u00e0o c\u0169ng \u0111\u1ea1t \u0111\u1ed9 ch\u00ednh x\u00e1c so v\u1edbi th\u1ef1c t\u1ebf.
\n– V\u1ec1 k\u00edch th\u1edbc c\u00e1c bu\u1ed3ng tim, th\u1ea5t tr\u00e1i th\u01b0\u1eddng \u00edt thay \u0111\u1ed5i, Nh\u01b0ng nh\u0129 tr\u00e1i hay b\u1ecb gi\u00e3n do c\u1ea3n tr\u1edf \u0111\u1ed5 \u0111\u1ea7y th\u1ea5t tr\u00e1i trong k\u1ef3 t\u00e2m tr\u01b0\u01a1ng.
\n– D\u1ea5u hi\u1ec7u v\u00e1ch li\u00ean th\u1ea5t b\u1ecb ph\u00ecnh l\u00ean trong khi h\u00edt v\u00e0o. V\u00e1ch li\u00ean nh\u0129 v\u1eadn \u0111\u1ed9ng v\u1ec1 ph\u00eda nh\u0129 tr\u00e1i trong khi h\u00edt v\u00e0o.
\n– Gi\u1ea3m v\u1eadn \u0111\u1ed9ng c\u1ee7a m\u1ed9t s\u1ed1 v\u00f9ng th\u1ea5t tr\u00e1i, nh\u1ea5t l\u00e0 v\u00f9ng m\u1ecfn tim, th\u00e0nh b\u00ean.
\n– Gi\u00e3n t\u0129nh m\u1ea1ch ch\u1ee7 d\u1edbi, t\u0129nh m\u1ea1ch tr\u00ean gan v\u00e0 c\u00e1c t\u0129nh m\u1ea1ch n\u00e0y \u00edt thay \u0111\u1ed5i k\u00edch th\u1edbc trong chu k\u1ef3 h\u00f4 h\u1ea5p. N\u1ebfu d\u00f9ng dung d\u1ecbch c\u1ea3n \u00e2m s\u1ebd th\u1ea5y d\u1ea5u hi\u1ec7u ch\u1ea3y Ng\u01b0\u1ee3c ch\u1ea5t c\u1ea3n \u00e2m v\u00e0o t\u0129nh m\u1ea1ch ch\u1ee7 d\u1edbi, t\u0129nh m\u1ea1ch tr\u00ean gan trong k\u1ef3 t\u00e2m tr\u01b0\u01a1ng.
\n– Ch\u1ee9c n\u0103ng t\u00e2m thu c\u1ee7a th\u1ea5t tr\u00e1i, th\u1ea5t ph\u1ea3i th\u01b0\u1eddng v\u1eabn duy tr\u00ec.
\n– Gi\u1ea3m g\u00f3c gi\u1eefa th\u00e0nh sau th\u1ea5t tr\u00e1i v\u1edbi th\u00e0nh sau nh\u0129 tr\u00e1i, do m\u00e0ng ngo\u00e0i tim d\u00e0y v\u00e0 c\u1ee9ng.
\n– Gan to, l\u00e1ch to v\u00e0 nhi\u1ec1u khi c\u00f3 d\u1ecbch c\u1ed5 tr\u1edbng trong \u1ed5 b\u1ee5ng.
\n3.3 Si\u00eau \u00e2m Doppler<\/b>
\n– Thay \u0111\u1ed5i ( > 25% ) S\u00f3ng E qua van 2 l\u00e1 v\u00e0 3 l\u00e1 theo chu k\u1ef3 h\u00f4 h\u1ea5p t\u01b0\u01a1ng t\u1ef1 nh\u01b0 trong \u00e9p tim k\u1ec3 c\u1ea3 t\u1ed1c \u0111\u1ed9 \u0111\u1ec9nh s\u00f3ng E v\u00e0 t\u00edch ph\u00e2n th\u1eddi gian t\u1ed1c \u0111\u1ed9 s\u00f3ng E, Nh\u01b0ng t\u1ed1c \u0111\u1ed9 s\u00f3ng A th\u01b0\u1eddng \u00edt thay \u0111\u1ed5i v\u00e0 t\u1ef7 l\u1ec7 VE\/VA b\u00ecnh th\u01b0\u1eddng.
\n– IVRT t\u0103ng l\u00ean kho\u1ea3ng 20% trong khi h\u00edt v\u00e0o so v\u1edbi khi th\u1edf ra, trong khi \u0111\u00f3 DT gi\u1ea3m trong th\u00ec h\u00edt v\u00e0o.
\n– T\u0103ng t\u1ed1c \u0111\u1ed9 \u0111\u1ec9nh, t\u00edch ph\u00e2n th\u1eddi gian, t\u1ed1c \u0111\u1ed9 s\u00f3ng ph\u1ee5t Ng\u01b0\u1ee3c c\u1ee7a h\u1edf van 3 l\u00e1 trong khi h\u00edt v\u00e0o.
\n– \u0110\u1ed1i v\u1edbi d\u00f2ng ch\u1ea3y t\u0129nh m\u1ea1ch ph\u1ed5i c\u0169ng c\u00f3 nh\u1eefng thay \u0111\u1ed5i li\u00ean quan \u0111\u1ebfn h\u00f4 h\u1ea5p. T\u1ef7 l\u1ec7 S \/ D t\u0103ng t\u1eeb 65% tr\u1edf l\u00ean khi h\u00edt v\u00e0o so v\u1edbi khi th\u1edf ra, do t\u1ed1c \u0111\u1ed9 s\u00f3ng D gi\u1ea3m khi h\u00edt v\u00e0o v\u00e0 t\u0103ng khi th\u1edf ra ( th\u01b0\u1eddng > 40% ). T\u1ed1c \u0111\u1ed9 v\u00e0 th\u1eddi gian s\u00f3ng a c\u1ee7a t\u0129nh m\u1ea1ch ph\u1ed5i c\u0169ng gi\u1ea3m khi h\u00edt v\u00e0o v\u00e0 t\u0103ng khi th\u1edf ra.
\n– D\u00f2ng ch\u1ea3y t\u0129nh m\u1ea1ch tr\u00ean gan c\u0169ng thay \u0111\u1ed5i theo chu k\u1ef3 h\u00f4 h\u1ea5p.
\nCh\u00fa \u00fd:<\/i><\/b>
\n– Vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft l\u00e0 l\u00e0 v\u00ed d\u1ee5 \u0111i\u1ec3n h\u00ecnh c\u1ee7a suy tim do r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng g\u00e2y n\u00ean.
\n– Vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft c\u00f3 th\u1ec3 c\u00f9ng m\u1ed9t l\u00fac c\u00f3 tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim k\u00e8m theo, si\u00eau \u00e2m tim c\u00f3 th\u1ec3 ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c t\u00ecnh tr\u1ea1ng n\u00e0y.
\n– Si\u00eau \u00e2m th\u1ef1c qu\u1ea3n c\u00f3 th\u1ec3 c\u00f3 \u00edch trong vi\u1ec7c \u0111o \u0111\u1ea1c chi\u1ec1u d\u00e0y m\u00e0ng ngo\u00e0i tim v\u00e0 x\u00e1c \u0111\u1ecbnh d\u00f2ng ch\u1ea3y c\u1ee7a t\u0129nh m\u1ea1ch ph\u1ed5i trong ch\u1ea9n \u0111o\u00e1n vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft.
\n– \u0110i\u1ec1u tr\u1ecb vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft b\u1eb1ng ph\u1eabu thu\u1eadt l\u00e0 m\u1ed9t kh\u00f3 kh\u0103n v\u1edbi t\u1ef7 l\u1ec7 t\u1eed vong v\u00e0o kho\u1ea3ng 5- 15%.<\/p>\n","protected":false},"excerpt":{"rendered":"

Vi\u00eam m\u00e0ng ngo\u00e0i tim th\u01b0\u1eddng c\u00f3 tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim k\u00e8m theo, v\u00ec th\u1ebf trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p ng\u01b0\u1eddi ta th\u01b0\u1eddng \u0111\u1ed3ng nh\u1ea5t hai kh\u00e1i ni\u1ec7m n\u00e0y l\u00e0 m\u1ed9t. B\u1ec7nh c\u00f3 th\u1ec3 c\u1ea5p t\u00ednh, b\u00e1n c\u1ea5p v\u00e0 m\u1ea1n t\u00ednh. Ch\u1ea9n \u0111o\u00e1n tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim kh\u00f4ng kh\u00f3 v\u1edbi si\u00eau \u00e2m, tuy nhi\u00ean \u0111\u1ec3 …<\/p>\n","protected":false},"author":11,"featured_media":4513,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[74],"tags":[],"class_list":["post-2625","post","type-post","status-publish","format-standard","has-post-thumbnail","","category-chan-doan-hinh-anh"],"_links":{"self":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2625","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/comments?post=2625"}],"version-history":[{"count":1,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2625\/revisions"}],"predecessor-version":[{"id":2626,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2625\/revisions\/2626"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media\/4513"}],"wp:attachment":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media?parent=2625"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/categories?post=2625"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/tags?post=2625"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}