{"id":9291,"date":"2022-08-05T18:46:26","date_gmt":"2022-08-05T11:46:26","guid":{"rendered":"https:\/\/easymed.vn\/?p=9291"},"modified":"2022-08-05T18:46:26","modified_gmt":"2022-08-05T11:46:26","slug":"benh-thuyen-tac-huyet-khoi-tinh-mach-o-nguoi-cao-tuoi","status":"publish","type":"post","link":"https:\/\/easymed.vn\/en\/benh-thuyen-tac-huyet-khoi-tinh-mach-o-nguoi-cao-tuoi\/","title":{"rendered":"B\u1ec6NH THUY\u00caN T\u1eaeC HUY\u1ebeT KH\u1ed0I T\u0128NH M\u1ea0CH \u1ede NG\u01af\u1edcI CAO TU\u1ed4I"},"content":{"rendered":"

T\u1ea6N SU\u1ea4T THUY\u00caN T\u1eaeC HUY\u1ebeT KH\u1ed0I T\u0128NH M\u1ea0CH<\/span><\/h3>\n

T\u1ea7n su\u1ea5t thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch (TTHKTM) chi\u1ebfm t\u1ec9 l\u1ec7 cao \u1edf ng\u01b0\u1eddi cao tu\u1ed5i, \u0111\u1eb7c bi\u1ec7t th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n cao tu\u1ed5i \u0111ang n\u1eb1m vi\u1ec7n, \u1edf Anh Qu\u1ed1c kho\u1ea3ng 10% t\u1eed vong trong b\u1ec7nh vi\u1ec7n do b\u1ec7nh TTHKTM. Kho\u1ea3ng 25% b\u1ec7nh nh\u00e2n b\u1ecb huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u (HKTMS) c\u00f3 tri\u1ec7u ch\u1ee9ng \u0111\u1ec3 l\u1ea1i di ch\u1ee9ng lo\u00e9t ch\u00e2n (h\u1ed9i ch\u1ee9ng h\u1eadu huy\u1ebft kh\u1ed1i). Bi\u1ebfn ch\u1ee9ng n\u1eb7ng nh\u1ea5t c\u1ee7a TTHKTM l\u00e0 thuy\u00ean t\u1eafc ph\u1ed5i (TTP). T\u1eed vong do thuy\u00ean t\u1eafc ph\u1ed5i kho\u1ea3ng 30% n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb. N\u1ebfu \u0111i\u1ec1u tr\u1ecb TTP th\u00edch h\u1ee3p, t\u1ec9 l\u1ec7 t\u1eed vong c\u00f2n kho\u1ea3ng 2%. Ch\u1ea9n \u0111o\u00e1n TTHKTM th\u01b0\u1eddng ch\u1eadm tr\u1ec5 do tri\u1ec7u ch\u1ee9ng kh\u00f4ng r\u00f5 r\u00e0ng v\u00e0 th\u1ea7y<\/span> thu\u1ed1c <\/span>\u00edt ngh\u0129 \u0111\u1ebfn.<\/span><\/p>\n

TTHKTM th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi cao tu\u1ed5i, t\u1ea7n su\u1ea5t m\u1edbi m\u1eafc TTHKTM (bao g\u1ed3m HKTMS v\u00e0 TTP) gia t\u0103ng tuy\u1ebfn t\u00ednh theo tu\u1ed5i trong nh\u00f3m tu\u1ed5i 65 – 69, \u1edf Anh Qu\u1ed1c kho\u1ea3ng 1,3% \u0111\u1ebfn 1,8% v\u00e0 t\u0103ng l\u00ean kho\u1ea3ng 2,8% \u0111\u1ebfn 3,1% \u1edf nh\u00f3m tu\u1ed5i 85 – 89. \u1ede b\u1ec7nh nh\u00e2n cao tu\u1ed5i c\u00f3 ti\u1ec1n c\u0103n b\u1ec7nh TTHKTM, t\u1ea7n su\u1ea5t TTP 2% \u0111\u1ebfn 8% trong m\u1ed9t n\u0103m. Ch\u1ea9n \u0111o\u00e1n th\u01b0\u1eddng b\u1ecb b\u1ecf s\u00f3t \u1edf ng\u01b0\u1eddi cao tu\u1ed5i v\u00e0 c\u00f3 khi ch\u1ec9 ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c<\/span> sau <\/span>khi b\u1ec7nh nh\u00e2n \u0111\u00e3 t\u1eed vong.<\/span><\/p>\n

Y\u1ebfu t\u1ed1 nguy c\u01a1 thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch<\/strong><\/p>\n

Y\u1ebfu t\u1ed1 nguy c\u01a1 TTHKTM \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n t\u1eeb l\u00e2u (b\u1ea3ng 1). Nhi\u1ec1u y\u1ebfu t\u1ed1 nguy c\u01a1 r\u1ea5t th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi cao tu\u1ed5i, nh\u1ea5t l\u00e0 b\u1ec7nh nh\u00e2n cao tu\u1ed5i \u0111ang n\u1eb1m vi\u1ec7n v\u00e0 c\u00f3 ph\u1eabu thu\u1eadt ch\u1ec9nh h\u00ecnh (v\u00ed d\u1ee5 nh\u01b0 b\u1ea5t \u0111\u1ed9ng, g\u00e3y x\u01b0\u01a1ng \u0111\u00f9i, \u0111\u1ed9t qu\u1ef5, ung th\u01b0). \u0110ang n\u1eb1m vi\u1ec7n l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 cao TTHKTM (g\u1ea5p 135 l\u1ea7n so v\u1edbi \u1edf c\u1ed9ng \u0111\u1ed3ng). Nguy c\u01a1 TTHKTM l\u1edbn nh\u1ea5t l\u00e0 \u1edf b\u1ec7nh nh\u00e2n b\u1ec7nh n\u1ed9i khoa \u0111ang n\u1eb1m vi\u1ec7n, t\u1ec9 l\u1ec7 kho\u1ea3ng 70% – 80%. \u1ede ch\u00e2u \u00c2u, kho\u1ea3ng m\u1ed9t ph\u1ea7n ba b\u1ec7nh nh\u00e2n<\/span> sau <\/span>ph\u1eabu thu\u1eadt c\u00f3 TTHKTM n\u1ebfu kh\u00f4ng \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng.<\/span><\/p>\n

Y\u1ebfu t\u1ed1 nguy c\u01a1 b\u1ec7nh thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch<\/strong><\/p>\n

Nguy c\u01a1 th\u1ea5p<\/span><\/i><\/span><\/p>\n

Ti\u1ec3u ph\u1eabu ( <30 ph\u00fat ) v\u00e0 kh\u00f4ng c\u00f3 nguy c\u01a1 kh\u00e1c ngo\u00e0i cao tu\u1ed5i.<\/span><\/p>\n

Ch\u1ea5n th\u01b0\u01a1ng nh\u1eb9 ho\u1eb7c b\u1ec7nh n\u1ed9i khoa nh\u1eb9.<\/span><\/p>\n

Nguy c\u01a1 trung b\u00ecnh<\/span><\/i><\/span><\/p>\n

Ph\u1eabu thu\u1eadt l\u1edbn nh\u01b0 t\u1ed5ng qu\u00e1t, ti\u1ebft ni\u1ec7u, tim m\u1ea1ch, l\u1ed3ng ng\u1ef1c, m\u1ea1ch m\u00e1u, th\u1ea7n kinh, tu\u1ed5i l\u1edbn h\u01a1n 40 ho\u1eb7c c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c.<\/span><\/p>\n

B\u1ec7nh n\u1ed9i khoa n\u1eb7ng ho\u1eb7c \u00e1c t\u00ednh.<\/span><\/p>\n

Ch\u1ea5n th\u01b0\u01a1ng n\u1eb7ng ho\u1eb7c b\u1ecfng n\u1eb7ng.<\/span><\/p>\n

Ph\u1eabu thu\u1eadt, ch\u1ea5n th\u01b0\u01a1ng nh\u1ecf ho\u1eb7c b\u1ec7nh n\u1ed9i khoa nh\u1eb9 \u1edf b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n c\u0103n TTHKTM ho\u1eb7c t\u00ecnh tr\u1ea1ng t\u0103ng \u0111\u00f4ng.<\/span><\/p>\n

Nguy c\u01a1 cao<\/span><\/em><\/span><\/p>\n

B\u1ea5t \u0111\u1ed9ng k\u00e9o d\u00e0i.<\/span><\/p>\n

L\u1edbn h\u01a1n 60 tu\u1ed5i.<\/span><\/p>\n

Ti\u1ec1n c\u0103n TTHKTM ho\u1eb7c TTP.<\/span><\/p>\n

Ung th\u01b0 ti\u1ebfn tri\u1ec3n.<\/span><\/p>\n

Suy tim m\u1ea1n.<\/span><\/p>\n

Nhi\u1ec5m tr\u00f9ng c\u1ea5p (v\u00ed d\u1ee5<\/span> vi\u00eam <\/span>ph\u1ed5i)<\/span><\/p>\n

B\u1ec7nh ph\u1ed5i m\u1ea1n.<\/span><\/p>\n

Li\u1ec7t chi d\u01b0\u1edbi (k\u1ec3 c\u1ea3 \u0111\u1ed9t qu\u1ef5)<\/span><\/p>\n

BMI > 30kg\/m2<\/span><\/p>\n

Ph\u1eabu thu\u1eadt g\u00e3y x\u01b0\u01a1ng ho\u1eb7c ph\u1eabu thu\u1eadt ch\u1ec9nh h\u00ecnh l\u1edbn ch\u1eadu, h\u00e1ng ho\u1eb7c chi d\u01b0\u1edbi.<\/span><\/p>\n

Ph\u1eabu thu\u1eadt l\u1edbn ung th\u01b0 ch\u1eadu, b\u1ee5ng.<\/span><\/p>\n

Ch\u1ea5n th\u01b0\u01a1ng l\u1edbn.<\/span><\/p>\n

\u0110o\u1ea1n chi d\u01b0\u1edbi.<\/span><\/p>\n

Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng v\u00e0 ch\u1ea9n \u0111o\u00e1n huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u \u1edf b\u1ec7nh nh\u00e2n cao tu\u1ed5i.<\/strong><\/p>\n

S\u01b0ng m\u1ed9t ch\u00e2n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf ng\u01b0\u1eddi cao tu\u1ed5i; \u0111au b\u1eafp ch\u00e2n th\u1ec9nh tho\u1ea3ng c\u0169ng g\u1eb7p. Th\u00f4ng th\u01b0\u1eddng b\u1ec7nh nh\u00e2n c\u00f3 ph\u1eabu thu\u1eadt ch\u1ec9nh h\u00ecnh, \u0111\u1ed9t qu\u1ef5, ho\u1eb7c m\u1eafc m\u1ed9t s\u1ed1 b\u1ec7nh kh\u00e1c. Th\u1ec9nh tho\u1ea3ng c\u0169ng g\u1eb7p tri\u1ec7u ch\u1ee9ng bi\u1ebfng \u0103n, s\u1ee5t c\u00e2n ho\u1eb7c tri\u1ec7u ch\u1ee9ng kh\u00e1c nghi ng\u1edd ung th\u01b0; tuy nhi\u00ean th\u01b0\u1eddng nh\u1ea5t l\u00e0 kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng.<\/span><\/p>\n

Ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng th\u01b0\u1eddng kh\u00f3 do tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3 m\u01a1 h\u1ed3 \u1edf ng\u01b0\u1eddi cao tu\u1ed5i. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 kh\u00f4ng than phi\u1ec1n v\u1ec1 tri\u1ec7u ch\u1ee9ng s\u01b0ng ch\u00e2n do sa s\u00fat tr\u00ed tu\u1ec7 ho\u1eb7c r\u1ed1i lo\u1ea1n ng\u00f4n ng\u1eef. Ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng d\u1ef1a v\u00e0o s\u01b0ng m\u1ed9t b\u00ean ch\u00e2n, da \u1ea5m, c\u00f3 th\u1ec3 k\u00e8m t\u0129nh m\u1ea1ch n\u00f4ng ph\u1ed3ng ngay d\u01b0\u1edbi da. C\u00f3 th\u1ec3 c\u00f3 \u1ea5n \u0111au v\u00f9ng b\u1eafp ch\u00e2n. Chi d\u01b0\u1edbi s\u01b0ng to h\u01a1n b\u00ean chi l\u00e0nh 2cm c\u1ea7n ngh\u0129 \u0111\u1ebfn HKTMS tr\u1eeb khi c\u00f3 ch\u1ea9n \u0111o\u00e1n kh\u00e1c.<\/span><\/p>\n

Si\u00eau \u00e2m Doppler \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng<\/span> tr\u01b0\u1edbc <\/span>ti\u00ean \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u1edbi \u0111\u1ed9 nh\u1ea1y 96% v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 98% \u1edf HKTMS \u0111o\u1ea1n g\u1ea7n (t\u1eeb t\u0129nh m\u1ea1ch v\u00f9ng khoeo tr\u1edf l\u00ean v\u00f9ng ch\u1eadu). Ch\u1ee5p t\u0129nh m\u1ea1ch c\u1ea3n quang l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng ch\u1ea9n \u0111o\u00e1n HKTMS, ch\u1ec9 s\u1eed d\u1ee5ng khi l\u00e2m s\u00e0ng nghi ng\u1edd cao m\u00e0 si\u00eau \u00e2m Doppler \u00e2m t\u00ednh. D-dimer (ch\u1ea5t gi\u00e1ng ho\u00e1 fibrin) c\u00f3 gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n \u00e2m t\u1ed1t, ch\u1ec9 s\u1eed d\u1ee5ng ch\u1ea9n \u0111o\u00e1n lo\u1ea1i tr\u1eeb \u1edf b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 th\u1ea5p HKTMS. C\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1c nh\u01b0 c\u1ed9ng h\u01b0\u1edfng t\u1eeb c\u00f2n \u0111ang ti\u1ebfp t\u1ee5c nghi\u00ean c\u1ee9u.<\/span><\/p>\n

Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng v\u00e0 ch\u1ea9n \u0111o\u00e1n thuy\u00ean t\u1eafc ph\u1ed5i \u1edf b\u1ec7nh nh\u00e2n cao tu\u1ed5i.<\/strong><\/p>\n

Kh\u00f3 th\u1edf \u0111\u1ed9t ng\u1ed9t l\u00e0 tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf b\u1ec7nh nh\u00e2n cao tu\u1ed5i b\u1ecb TTP. Ngo\u00e0i ra c\u0169ng th\u01b0\u1eddng g\u1eb7p c\u00e1c tri\u1ec7u ch\u1ee9ng \u0111\u1ed9t ng\u1ed9t \u0111au ng\u1ef1c ki\u1ec3u m\u00e0ng ph\u1ed5i, ho, ng\u1ea5t, ho kh\u1ea1c ra m\u00e1u. \u1ede ng\u01b0\u1eddi cao tu\u1ed5i v\u1eeba b\u1ecb \u0111\u1ed9t qu\u1ef5, ch\u1ea5n th\u01b0\u01a1ng ch\u1ec9nh h\u00ecnh xu\u1ea5t hi\u1ec7n m\u1ed9t trong nh\u1eefng tri\u1ec7u ch\u1ee9ng tr\u00ean c\u1ea7n ngh\u0129 t\u1edbi TTP. TTP trung b\u00ecnh hay n\u1eb7ng \u1edf ng\u01b0\u1eddi cao tu\u1ed5i th\u01b0\u1eddng c\u00f3 ng\u1ea5t v\u00ec suy y\u1ebfu kh\u1ea3 n\u0103ng b\u00f9 tr\u1eeb tim m\u1ea1ch do b\u1ec7nh tim m\u1ea1ch s\u1eb5n c\u00f3 ho\u1eb7c do suy gi\u1ea3m ch\u1ee9c n\u0103ng tim m\u1ea1ch l\u00e3o ho\u00e1. TTP nh\u1eb9 h\u01a1n th\u01b0\u1eddng kh\u00f4ng tri\u1ec7u ch\u1ee9ng \u0111\u1eb7c hi\u1ec7u n\u00ean d\u1ec5 b\u1ecf s\u00f3t ch\u1ea9n \u0111o\u00e1n.<\/span><\/p>\n

Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3 ph\u1ee5 thu\u1ed9c v\u00e0o \u0111\u1ed9 n\u1eb7ng c\u1ee7a TTP. \u1ede b\u1ec7nh nh\u00e2n TTP trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng th\u01b0\u1eddng g\u1eb7p nh\u1ecbp tim nhanh, huy\u1ebft \u00e1p th\u1ea5p, t\u00edm t\u00e1i, t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i, d\u1ea5u n\u1ea3y c\u1ea1nh \u1ee9c ph\u1ea3i, ti\u1ebfng T2 t\u00e1ch \u0111\u1ed9i do van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u0111\u00f3ng ch\u1eadm, \u00e2m th\u1ed5i h\u1edf 3 l\u00e1 v\u00e0 ti\u1ebfng co m\u00e0ng ph\u1ed5i. Tuy nhi\u00ean \u1edf b\u1ec7nh nh\u00e2n TTP nh\u1eb9 c\u00f3 th\u1ec3 ch\u1ec9 c\u00f3 nh\u1ecbp tim nhanh. Do \u0111\u00f3, \u1edf b\u1ec7nh nh\u00e2n c\u00f3 x\u00e1c su\u1ea5t l\u00e2m s\u00e0ng cao TTP k\u00e8m nh\u1ecbp tim nhanh c\u1ea7n ngh\u0129 t\u1edbi TTP.<\/span><\/p>\n

Ph\u00e2n t\u00edch kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch ngay khi nghi ng\u1edd TTP. Gi\u1ea3m oxy m\u00e1u ho\u1eb7c oxy m\u00e1u di\u1ec5n ti\u1ebfn x\u1ea5u h\u01a1n gi\u00fap ch\u1ea9n \u0111o\u00e1n TTP tr\u1eeb khi c\u00f3 b\u1ec7nh \u0111i k\u00e8m kh\u00e1c c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c. \u0110i\u1ec7n t\u00e2m \u0111\u1ed3 c\u00f3 th\u1ec3 g\u1eb7p d\u1ea1ng nh\u1ecbp nhanh xoang, s\u00f3ng S \u1edf \u0111\u1ea1o tr\u00ecnh DI, s\u00f3ng Q v\u00e0 T \u0111\u1ea3o ng\u01b0\u1ee3c \u1edf \u0111\u1ea1o tr\u00ecnh DIII, bl\u1ed1c nh\u00e1nh ph\u1ea3i ho\u1eb7c t\u0103ng g\u00e1nh th\u1ea5t ph\u1ea3i. \u1ede b\u1ec7nh nh\u00e2n TTP n\u1eb7ng c\u00f3 th\u1ec3 g\u1eb7p d\u1ea1ng P “ph\u1ebf”. Rung nh\u0129 m\u1edbi c\u0169ng c\u00f3 th\u1ec3 g\u1eb7p trong TTP.<\/span><\/p>\n

X-quang ng\u1ef1c c\u00f3 th\u1ec3 g\u1eb7p c\u01a1 ho\u00e0nh m\u1ed9t b\u00ean n\u00e2ng cao, x\u1eb9p ph\u1ed5i, gi\u1ea3m tu\u1ea7n ho\u00e0n ph\u1ed5i khu tr\u00fa, \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i nh\u00e1nh xu\u1ed1ng d\u00e3n r\u1ed9ng. B\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh ph\u1ed5i m\u1ea1n ho\u1eb7c suy tim k\u00e8m l\u00e0m kh\u00f3 kh\u0103n khi \u0111\u1ecdc phim.<\/span><\/p>\n

X\u1ea1 h\u00ecnh th\u00f4ng kh\u00ed t\u01b0\u1edbi m\u00e1u (V\/Q scan) c\u0169ng gi\u00fap cho ch\u1ea9n \u0111o\u00e1n. X\u1ea1 h\u00ecnh th\u00f4ng kh\u00ed t\u01b0\u1edbi m\u00e1u d\u01b0\u01a1ng t\u00ednh gi\u00fap ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh, x\u1ea1 h\u00ecnh \u00e2m t\u00ednh gi\u00fap lo\u1ea1i tr\u1eeb ch\u1ea9n \u0111o\u00e1n<\/span><\/p>\n

Ch\u1ee5p c\u1eaft l\u1edbp \u0111i\u1ec7n to\u00e1n ph\u1ed5i gi\u00fap ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh TTP. Ch\u1ee5p c\u1eaft l\u1edbp \u00e2m t\u00ednh c\u00f3 gi\u00e1 tr\u1ecb lo\u1ea1i tr\u1eeb ch\u1ea9n \u0111o\u00e1n t\u01b0\u01a1ng t\u1ef1 x\u1ea1 h\u00ecnh th\u00f4ng kh\u00ed t\u01b0\u1edbi m\u00e1u. Ch\u1ee5p c\u1eaft l\u1edbp l\u00e0 ph\u01b0\u01a1ng<\/span> ph\u00e1p <\/span>h\u00e0ng \u0111\u1ea7u \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n TTP \u1edf ng\u01b0\u1eddi cao tu\u1ed5i do d\u1ec5 th\u1ef1c hi\u1ec7n c\u1ea3 khi b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh tim v\u00e0 b\u1ec7nh ph\u1ed5i \u0111i k\u00e8m.<\/span><\/p>\n

D-dimer kh\u00f4ng c\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh do \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u th\u1ea5p nh\u01b0ng c\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n lo\u1ea1i tr\u1eeb.<\/span><\/p>\n

C\u1ed9ng h\u01b0\u1edfng t\u1eeb c\u00f3 c\u1ea3n t\u1eeb l\u00e0 k\u1ef9 thu\u1eadt ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh TTP \u0111ang \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 cao.<\/span><\/p>\n

Si\u00eau \u00e2m tim c\u00f3 \u00edch \u0111\u00e1nh gi\u00e1 \u0111\u1ed9 n\u1eb7ng c\u1ee7a TTP.<\/span><\/p>\n

Ch\u1ee5p m\u1ea1ch m\u00e1u c\u1ea3n quang r\u1ea5t \u00edt \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng \u1edf b\u1ec7nh nh\u00e2n cao tu\u1ed5i.<\/span><\/p>\n

\u0110i\u1ec1u tr\u1ecb thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u \u1edf b\u1ec7nh nh\u00e2n cao tu\u1ed5i.<\/strong><\/p>\n

Thu\u1ed1c<\/span> kh\u00e1ng \u0111\u00f4ng l\u00e0 \u0111i\u1ec1u tr\u1ecb h\u00e0ng \u0111\u1ea7u. C\u00e1c bi\u1ec7n<\/span> ph\u00e1p <\/span>\u00edt \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng h\u01a1n bao g\u1ed3m<\/span> thu\u1ed1c <\/span>ti\u00eau s\u1ee3i huy\u1ebft, ph\u1eabu thu\u1eadt l\u1ea5y huy\u1ebft kh\u1ed1i v\u00e0 \u0111\u1eb7t l\u01b0\u1edbi l\u1ecdc t\u0129nh m\u1ea1ch ch\u1ee7.<\/span><\/p>\n

Heparin tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p hi\u1ec7n t\u1ea1i v\u1eabn l\u00e0<\/span> thu\u1ed1c <\/span>h\u00e0ng \u0111\u1ea7u (low molecular weight heparin – LMWH) do li\u1ec1u l\u01b0\u1ee3ng t\u00f9y theo c\u00e2n n\u1eb7ng, ti\u00eam d\u01b0\u1edbi da v\u00e0 kh\u00f4ng c\u1ea7n x\u00e9t nghi\u1ec7m theo d\u00f5i (ngo\u1ea1i tr\u1eeb b\u1ec7nh nh\u00e2n qu\u00e1 c\u00e2n, qu\u00e1 nh\u1eb9 c\u00e2n hay suy th\u1eadn n\u1eb7ng). Heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n ch\u1ec9 s\u1eed d\u1ee5ng trong tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t nh\u01b0 \u0111ang ph\u1eabu thu\u1eadt hay h\u1eadu ph\u1eabu.<\/span><\/p>\n

N\u00ean b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb khi x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n HKTMS v\u00e0 TTP b\u1eb1ng warfarin v\u00e0 LMWH \u00edt nh\u1ea5t 5 ng\u00e0y cho \u0111\u1ebfn khi INR (international normalized ratios) \u0111\u1ea1t m\u1ee9c 2,5 (2-3). INR \u1edf m\u1ee9c cao h\u01a1n 3,5 (3-4) n\u1ebfu HKTMS t\u00e1i ph\u00e1t trong khi \u0111ang duy tr\u00ec \u1edf m\u1ee9c 2-3. \u1ede b\u1ec7nh nh\u00e2n cao tu\u1ed5i nh\u1ea1y h\u01a1n v\u1edbi t\u00e1c d\u1ee5ng c\u1ee7a warfarin n\u00ean d\u1ec5 b\u1ecb ch\u1ed1ng \u0111\u00f4ng qu\u00e1 m\u1ee9c khi kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb. Cho n\u00ean c\u1ea7n kh\u1edfi \u0111\u1ea7u li\u1ec1u th\u1ea5p v\u00e0 t\u0103ng d\u1ea7n qua theo d\u00f5i INR m\u1ed7i ng\u00e0y trong 4-5 ng\u00e0y \u0111\u1ea7u.<\/span><\/p>\n

Th\u1eddi gian s\u1eed d\u1ee5ng warfarin v\u1eabn ch\u01b0a th\u1ed1ng nh\u1ea5t. C\u00f3 khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng 6 th\u00e1ng. C\u00f3 nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean s\u1eed d\u1ee5ng 3 th\u00e1ng \u1edf TTHKTM l\u1ea7n \u0111\u1ea7u (kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n) v\u00e0 c\u00f3 th\u1ec3 ng\u1eafn h\u01a1n n\u1ebfu c\u00f3 ch\u1ea3y m\u00e1u n\u1eb7ng. Tuy nhi\u00ean th\u1eddi gian s\u1eed d\u1ee5ng warfarin ph\u1ee5 thu\u1ed9c v\u00e0o nguy c\u01a1 t\u00e1i ph\u00e1t TTHKTM \u1edf t\u1eebng c\u00e1 nh\u00e2n. N\u1ebfu TTHKTM x\u1ea3y ra<\/span> sau <\/span>ph\u1eabu thu\u1eadt, nguy c\u01a1 t\u00e1i ph\u00e1t<\/span> sau <\/span>1 n\u0103m khi ng\u01b0ng<\/span> thu\u1ed1c <\/span>l\u00e0 3% cho n\u00ean c\u00f3 th\u1ec3 ng\u01b0ng warfarin<\/span> sau <\/span>6 tu\u1ea7n n\u1ebfu kh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 t\u1ed3n t\u1ea1i kh\u00e1c. M\u1eb7t kh\u00e1c n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f2n y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c nh\u01b0ng nh\u1eb9 c\u00f3 th\u1ec3 h\u1ed3i ph\u1ee5c (nh\u01b0 t\u1ed5n th\u01b0\u01a1ng m\u00f4 m\u1ec1m) c\u00f3 th\u1ec3 ng\u01b0ng warfarin<\/span> sau <\/span>3 th\u00e1ng. B\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao kh\u00f4ng h\u1ed3i ph\u1ee5c nh\u01b0 ung th\u01b0 c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb l\u00e2u d\u00e0i.<\/span><\/p>\n

\u0110i\u1ec1u tr\u1ecb kh\u00e1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng \u1edf ng\u01b0\u1eddi cao tu\u1ed5i c\u1ea7n l\u01b0u \u00fd trong th\u1ef1c h\u00e0nh<\/strong><\/p>\n

Ng\u01b0\u1eddi cao tu\u1ed5i nh\u1ea1y h\u01a1n v\u1edbi t\u00e1c d\u1ee5ng ch\u1ed1ng \u0111\u00f4ng m\u00e1u c\u1ee7a warfarin, c\u00f3 l\u1ebd s\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a c\u00e1c y\u1ebfu t\u1ed1 d\u01b0\u1ee3c l\u1ef1c v\u00e0 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc. Li\u1ec1u warfarin \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng gi\u1ea3m d\u1ea7n theo t\u00edch tu\u1ed5i. C\u00f3 nghi\u00ean c\u1ee9u cho th\u1ea5y b\u1ec7nh nh\u00e2n d\u01b0\u1edbi 35 tu\u1ed5i d\u00f9ng li\u1ec1u g\u1ea5p \u0111\u00f4i warfarin \u0111\u1ec3 duy tr\u00ec INR t\u01b0\u01a1ng \u0111\u01b0\u01a1ng b\u1ec7nh nh\u00e2n h\u01a1n 70 tu\u1ed5i. Thanh th\u1ea3i warfarin gi\u1ea3m d\u1ea7n theo tu\u1ed5i (to\u00e0n b\u1ed9 warfarin ph\u1ea3i qua chuy\u1ec3n ho\u00e1, kh\u00f4ng c\u00f3 warfarin nguy\u00ean th\u1ee7y th\u1ea3i tr\u1eeb qua n\u01b0\u1edbc ti\u1ec3u).<\/span><\/p>\n

Nguy c\u01a1 ch\u1ea3y m\u00e1u do warfarin gia t\u0103ng theo tu\u1ed5i ch\u01b0a r\u00f5, ngo\u1ea1i tr\u1eeb b\u1ec7nh nh\u00e2n l\u1edbn h\u01a1n 80 tu\u1ed5i. Bi\u1ebfn ch\u1ee9ng ch\u1ea3y m\u00e1u th\u01b0\u1eddng x\u1ea3y ra 3 th\u00e1ng \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u1edbi warfarin (\u0111\u1eb7c bi\u1ec7t trong 1 th\u00e1ng \u0111\u1ea7u), ho\u1eb7c do k\u00e9m ki\u1ec3m so\u00e1t<\/span> thu\u1ed1c <\/span>ch\u1ed1ng \u0111\u00f4ng ho\u1eb7c c\u00f3 b\u1ec7nh \u0111i k\u00e8m ch\u01b0a ph\u00e1t hi\u1ec7n nh\u01b0 lo\u00e9t d\u1ea1 d\u00e0y, b\u1ec7nh \u00e1c t\u00ednh. INR cao (>4,5) do ki\u1ec3m so\u00e1t<\/span> thu\u1ed1c <\/span>ch\u1ed1ng \u0111\u00f4ng k\u00e9m ho\u1eb7c do h\u01b0\u1edbng d\u1eabn b\u1ec7nh nh\u00e2n ch\u01b0a t\u1ed1t d\u1ec5 g\u00e2y ch\u1ea3y m\u00e1u.<\/span><\/p>\n

Ng\u01b0\u1eddi cao tu\u1ed5i th\u01b0\u1eddng s\u1eed d\u1ee5ng nhi\u1ec1u lo\u1ea1i <\/span>thu\u1ed1c<\/span>, cho n\u00ean d\u1ec5 c\u00f3 t\u01b0\u01a1ng t\u00e1c<\/span> thu\u1ed1c <\/span>g\u00e2y t\u00e1c d\u1ee5ng ch\u1ed1ng \u0111\u00f4ng qu\u00e1 m\u1ee9c. C\u1ea7n bi\u1ebft<\/span> thu\u1ed1c <\/span>\u0111ang s\u1eed d\u1ee5ng k\u00e8m c\u00f3 l\u00e0m t\u0103ng t\u00e1c d\u1ee5ng ch\u1ed1ng \u0111\u00f4ng hay kh\u00f4ng (v\u00ed d\u1ee5 kh\u00e1ng sinh nh\u00f3m macrolid, amiodarone) \u0111\u1ec3 gi\u1ea3m li\u1ec1u warfarin th\u00edch h\u1ee3p.<\/span><\/p>\n

Xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd th\u01b0\u1eddng g\u00e2y t\u1eed vong v\u00e0 th\u01b0\u1eddng g\u1eb7p h\u01a1n \u1edf ng\u01b0\u1eddi cao tu\u1ed5i do b\u1ec7nh n\u00e3o hay m\u1ea1ch m\u00e1u n\u00e3o. B\u00ean c\u1ea1nh \u0111\u00f3 ng\u01b0\u1eddi cao tu\u1ed5i d\u1ec5 t\u00e9 ng\u00e3 g\u00e2y xu\u1ea5t huy\u1ebft d\u01b0\u1edbi nh\u1ec7n. B\u1ed1n y\u1ebfu t\u1ed1 d\u1ec5 g\u00e2y ch\u1ea3y m\u00e1u \u1edf b\u1ec7nh nh\u00e2n ngo\u1ea1i tr\u00fa g\u1ed3m tu\u1ed5i tr\u00ean 65, ti\u1ec1n c\u0103n xu\u1ea5t huy\u1ebft d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng, ti\u1ec1n c\u0103n \u0111\u1ed9t qu\u1ef5 v\u00e0 c\u00f3 m\u1ed9t ho\u1eb7c nhi\u1ec1u b\u1ec7nh \u0111\u1eb7c bi\u1ec7t \u0111i k\u00e8m (nh\u1ed3i m\u00e1u c\u01a1 tim m\u1edbi, hematocrit d\u01b0\u1edbi 30% , \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, creatinine l\u1edbn h\u01a1n 1,5mg\/dl) c\u1ea7n lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c g\u00e2y xu\u1ea5t huy\u1ebft ngay c\u1ea3 khi INR cao (nh\u01b0 xu\u1ea5t huy\u1ebft n\u1ed9i).<\/span><\/p>\n

X\u1eec L\u00dd TR\u01af\u1edcNG H\u1ee2P CH\u1ed0NG \u0110\u00d4NG QU\u00c1 LI\u1ec0U V\u00c0 CH\u1ea2Y M\u00c1U.<\/span><\/h3>\n

N\u1ebfu 58, kh\u00f4ng c\u00f3 ch\u1ea3y m\u00e1u ho\u1eb7c ch\u1ea3y m\u00e1u \u00edt t\u1ea1m ng\u01b0ng warfarin v\u00e0 cho vitamin K li\u1ec1u th\u1ea5p u\u1ed1ng (0,5-3mg) ho\u1eb7c ch\u00edch t\u0129nh m\u1ea1ch (0,5mg). Tr\u01b0\u1eddng h\u1ee3p xu\u1ea5t huy\u1ebft n\u1eb7ng ng\u01b0ng warfarin v\u00e0 s\u1eed d\u1ee5ng ngay ph\u1ee9c h\u1ee3p prothrombin (y\u1ebfu t\u1ed1 II,VII, IX, X) ho\u1eb7c huy\u1ebft thanh t\u01b0\u01a1i \u0111\u00f4ng l\u1ea1nh, \u0111\u1ed3ng th\u1eddi vitamin K 5mg \u0111\u1ebfn 10mg ti\u00eam t\u0129nh m\u1ea1ch ch\u1eadm.<\/span><\/p>\n

THEO D\u00d5I KHI \u0110I\u1ec0U TR\u1eca WARFARIN.<\/span><\/h3>\n

Theo d\u00f5i s\u00e1t gi\u00fap ph\u00f2ng ng\u1eeba qu\u00e1 li\u1ec1u hay thi\u1ebfu li\u1ec1u l\u01b0\u1ee3ng<\/span> thu\u1ed1c <\/span>warfarin. T\u1ed1t nh\u1ea5t b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i \u0111\u1ecbnh k\u1ef3. H\u01b0\u1edbng d\u1eabn b\u1ec7nh nh\u00e2n tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb theo toa, t\u00e1i kh\u00e1m \u0111\u00fang h\u1ea1n v\u00e0 theo d\u00f5i c\u00e1c d\u1ea5u xu\u1ea5t huy\u1ebft nh\u01b0 d\u1ec5 b\u1ea7m m\u00e1u, ch\u1ea3y m\u00e1u r\u0103ng \u0111\u1ec3 k\u1ecbp th\u1eddi t\u00e1i kh\u00e1m.<\/span><\/p>\n

\u0110\u1eb6T L\u01af\u1edaI L\u1eccC T\u0128NH M\u1ea0CH CH\u1ee6 D\u01af\u1edaI.<\/span><\/h3>\n

S\u1eed d\u1ee5ng trong tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh d\u00f9ng<\/span> thu\u1ed1c <\/span>ch\u1ed1ng \u0111\u00f4ng, ho\u1eb7c b\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng m\u00e0 c\u00f3 xu\u1ea5t huy\u1ebft ho\u1eb7c ti\u1ebfp t\u1ee5c c\u00f3 TTHKTM. Nghi\u00ean c\u1ee9u PREPIC g\u1ed3m 400 b\u1ec7nh nh\u00e2n HKTMS chi d\u01b0\u1edbi \u0111o\u1ea1n g\u1ea7n c\u00f3 ho\u1eb7c kh\u00f4ng TTP, theo d\u00f5i 8 n\u0103m \u0111\u1eb7t l\u01b0\u1edbi l\u1ecdc t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi l\u00e0m gi\u1ea3m \u0111\u01b0\u1ee3c TTP nh\u01b0ng l\u00e0m t\u0103ng HKTMS so v\u1edbi b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng. Bi\u1ebfn ch\u1ee9ng c\u1ee7a \u0111\u1eb7t l\u01b0\u1edbi l\u1ecdc bao g\u1ed3m l\u01b0\u1edbi l\u1ecdc l\u1ea1c ch\u1ed7, t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u ho\u1eb7c huy\u1ebft kh\u1ed1i, tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i ho\u1eb7c thuy\u00ean t\u1eafc kh\u00ed.<\/span><\/p>\n

\u0110I\u1ec0U TR\u1eca THUY\u00caN T\u1eaeC PH\u1ed4I KHI HUY\u1ebeT \u0110\u1ed8NG KH\u00d4NG \u1ed4N \u0110\u1ecaNH.<\/span><\/h3>\n

TTP l\u1edbn c\u00f3 th\u1ec3 k\u00e8m cho\u00e1ng tim. Ng\u01b0\u1eddi cao tu\u1ed5i th\u01b0\u1eddng suy tim ph\u1ea3i v\u00e0 cho\u00e1ng tim khi TTP l\u1edbn. B\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb trong \u0111\u01a1n v\u1ecb ch\u0103m s\u00f3c \u0111\u1eb7c bi\u1ec7t. Ngo\u00e0i vi\u1ec7c h\u1ed3i s\u1ee9c tim m\u1ea1ch v\u00e0 h\u00f4 h\u1ea5p, c\u1ea7n c\u00e2n nh\u1eafc \u0111\u1ebfn \u0111i\u1ec1u tr\u1ecb ti\u00eau s\u1ee3i huy\u1ebft ho\u1eb7c ph\u1eabu thu\u1eadt l\u1ea5y huy\u1ebft kh\u1ed1i thuy\u00ean t\u1eafc. Xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd x\u1ea3y ra 3% khi d\u00f9ng<\/span> thu\u1ed1c <\/span>ti\u00eau s\u1ee3i huy\u1ebft. B\u1ec7nh nh\u00e2n c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh ti\u00eau s\u1ee3i huy\u1ebft ho\u1eb7c ti\u00eau s\u1ee3i huy\u1ebft th\u1ea5t b\u1ea1i \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt l\u1ea5y huy\u1ebft kh\u1ed1i \u1edf \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i. M\u1eb7c d\u00f9 c\u00f3 \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c, t\u1ec9 l\u1ec7 t\u1eed vong v\u1eabn cao.<\/span><\/p>\n

PH\u00d2NG NG\u1eeaA.<\/span><\/h3>\n

R\u1ea5t nhi\u1ec1u b\u1ec7nh nh\u00e2n cao tu\u1ed5i n\u1eb1m vi\u1ec7n c\u00f3 nguy c\u01a1 TTHKTM. B\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5, g\u00e3y x\u01b0\u01a1ng ch\u1eadu ho\u1eb7c ph\u1eabu thu\u1eadt ch\u1ec9nh h\u00ecnh c\u00f3 nguy c\u01a1 cao. Tuy nhi\u00ean t\u1ec9 l\u1ec7 \u0111\u01b0\u1ee3c ph\u00f2ng ng\u1eeba th\u1ea5p ngay c\u1ea3 \u1edf c\u00e1c n\u01b0\u1edbc ph\u01b0\u01a1ng t\u00e2y t\u1eeb 13% \u0111\u1ebfn 64%. \u0110i\u1ec1u tr\u1ecb ph\u00f2ng ng\u1eeba \u0111\u1eb7c bi\u1ec7t th\u1ea5p h\u01a1n \u1edf b\u1ec7nh nh\u00e2n n\u1ed9i khoa. \u0110i\u1ec1u tr\u1ecb ph\u00f2ng ng\u1eeba gi\u1ea3m \u0111\u01b0\u1ee3c nguy c\u01a1 TTHK \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh \u1edf nhi\u1ec1u nghi\u00ean c\u1ee9u.<\/span><\/p>\n

Theo khuy\u1ebfn c\u00e1o c\u1ee7a hi\u1ec7p h\u1ed9i th\u1ea7y<\/span> thu\u1ed1c <\/span>L\u1ed3ng Ng\u1ef1c<\/span> Hoa K\u1ef3 <\/span>(ACCP American College of Chest Physicians) c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng LMWH hay heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n, fondaparinux \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb ph\u00f2ng ng\u1eeba b\u1ec7nh nh\u00e2n n\u1ed9i khoa c\u1ea5p t\u00ednh \u0111ang n\u1eb1m vi\u1ec7n. Nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u00f3 th\u1ec3 d\u00f9ng v\u1edb \u00e1p l\u1ef1c ho\u1eb7c \u00e9p h\u01a1i gi\u00e1n \u0111o\u1ea1n.<\/span><\/p>\n

Nhi\u1ec1u nghi\u00ean c\u1ee9u cho th\u1ea5y \u0111i\u1ec1u tr\u1ecb ph\u00f2ng ng\u1eeba b\u1eb1ng<\/span> thu\u1ed1c <\/span>ch\u1ed1ng \u0111\u00f4ng gi\u1ea3m \u0111\u01b0\u1ee3c TTHKTM c\u00f3 tri\u1ec7u ch\u1ee9ng kh\u00f4ng l\u00e0m t\u0103ng xu\u1ea5t huy\u1ebft n\u1eb7ng so v\u1edbi nh\u00f3m kh\u00f4ng \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng.<\/span><\/p>\n

THU\u1ed0C<\/span> CH\u1ed0NG \u0110\u00d4NG M\u1edaI B\u1eb0NG \u0110\u01af\u1edcNG U\u1ed0NG TRONG \u0110I\u1ec0U TR\u1eca V\u00c0 D\u1ef0 PH\u00d2NG TTHK.<\/span><\/h3>\n

Nh\u00f3m<\/span> thu\u1ed1c <\/span>ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng \u1ee9c ch\u1ebf y\u1ebfu t\u1ed1 X ho\u1ea1t ho\u00e1 v\u00e0 nh\u00f3m<\/span> thu\u1ed1c <\/span>\u1ee9c ch\u1ebf tr\u1ef1c ti\u1ebfp thrombin \u0111\u00e3 v\u00e0 \u0111ang ti\u1ebfp t\u1ee5c nghi\u00ean c\u1ee9u \u1ee9ng d\u1ee5ng. M\u1ed9t s\u1ed1 qu\u1ed1c gia \u0111ang s\u1eed d\u1ee5ng tuy nhi\u00ean hi\u1ec7n t\u1ea1i ch\u01b0a c\u00f3 khuy\u1ebfn c\u00e1o ch\u00ednh th\u1ee9c. M\u1eb7c d\u00f9 v\u1eady LMWH v\u1eabn l\u00e0<\/span> thu\u1ed1c <\/span>\u0111ang s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i nh\u1ea5t trong \u0111i\u1ec1u tr\u1ecb v\u00e0 ph\u00f2ng ng\u1eeba TTHKTM \u1edf b\u1ec7nh nh\u00e2n cao tu\u1ed5i.<\/span><\/p>\n

V\u1edb \u00e1p l\u1ef1c.<\/strong><\/p>\n

V\u1edb \u00e1p l\u1ef1c gi\u00fap gi\u1ea3m nguy c\u01a1 TTHKTM \u1edf b\u1ec7nh nh\u00e2n<\/span> sau <\/span>ph\u1eabu thu\u1eadt nh\u01b0ng kh\u00f4ng t\u1ed1t h\u01a1n LMWH. L\u00fd t\u01b0\u1edfng l\u00e0 s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p c\u1ea3 hai. B\u1ec7nh nh\u00e2n cao tu\u1ed5i c\u00f3 b\u1ec7nh m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean c\u1ea7n c\u1ea9n th\u1eadn v\u1edb \u00e1p l\u1ef1c v\u00ec c\u00f3 th\u1ec3 g\u00e2y bi\u1ebfn ch\u1ee9ng thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 chi d\u01b0\u1edbi. B\u1ec7nh nh\u00e2n \u0111\u00e3 ch\u1ea9n \u0111o\u00e1n HKTMS n\u00ean mang v\u1edb \u00e1p l\u1ef1c ngay<\/span> sau <\/span>khi ch\u1ea9n \u0111o\u00e1n v\u00e0 ti\u1ebfp t\u1ee5c \u00edt nh\u1ea5t 2 n\u0103m.<\/span><\/p>\n

TI\u00caN L\u01af\u1ee2NG.<\/span><\/h3>\n

M\u1ed9t nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 \u1edf b\u1ec7nh nh\u00e2n TTHKTM th\u1ea5y t\u1ec9 l\u1ec7 t\u00e1i ph\u00e1t TTHKTM v\u00e0o ng\u00e0y th\u1ee9 7, th\u1ee9 30, th\u1ee9 180 v\u00e0 n\u0103m \u0111\u1ea7u v\u00e0 10 n\u0103m<\/span> sau <\/span>l\u1ea7n l\u01b0\u1ee3t l\u00e0 1,6%; 5,2%; 10,1%; 12,9% v\u00e0 30,4% nguy c\u01a1 t\u00e1i ph\u00e1t l\u1edbn nh\u1ea5t v\u00e0o 6 th\u00e1ng v\u00e0 12 th\u00e1ng \u0111\u1ea7u<\/span> sau <\/span>TTHKTM. Y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u1ed9c l\u1eadp cho TTHKTM t\u00e1i ph\u00e1t bao g\u1ed3m tu\u1ed5i, c\u00e2n n\u1eb7ng, b\u1ec7nh th\u1ea7n kinh g\u00e2y li\u1ec7t, b\u1ec7nh \u00e1c t\u00ednh v\u00e0 ph\u1eabu thu\u1eadt th\u1ea7n kinh.<\/span><\/p>\n

M\u1ed9t nghi\u00ean c\u1ee9u s\u01a1 b\u1ed9 \u0111a qu\u1ed1c gia d\u1ef1 \u0111o\u00e1n TTP g\u00e2y t\u1eed vong \u1edf b\u1ec7nh nh\u00e2n TTHKTM , k\u1ebft qu\u1ea3 t\u1eed vong trong 3 th\u00e1ng \u0111\u1ea7u l\u00e0 8,65% v\u00e0 t\u1eed vong do TTP l\u00e0 1,68%. B\u1ec7nh nh\u00e2n TTP nh\u1ecf c\u00f3 tri\u1ec7u ch\u1ee9ng nguy c\u01a1 TTP g\u00e2y t\u1eed vong g\u1ea5p 5,42 l\u1ea7n so v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 HKTM s\u00e2u kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng TTP (p<0,001). Nguy c\u01a1 TTP g\u00e2y t\u1eed vong g\u1ea5p 17,5 l\u1ea7n n\u1ebfu b\u1ec7nh nh\u00e2n \u0111\u00e3 c\u00f3 TTP l\u1edbn c\u00f3 tri\u1ec7u ch\u1ee9ng. Y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u1ed9c l\u1eadp kh\u00e1c g\u00e2y TTP t\u1eed vong bao g\u1ed3m b\u1ea5t \u0111\u1ed9ng do b\u1ec7nh th\u1ea7n kinh, tu\u1ed5i l\u1edbn h\u01a1n 75 v\u00e0 ung th\u01b0.<\/span><\/p>\n

Bi\u1ebfn ch\u1ee9ng l\u00e2u d\u00e0i c\u1ee7a TTHKTM g\u1ed3m h\u1ed9i ch\u1ee9ng<\/span> sau <\/span>huy\u1ebft kh\u1ed1i v\u00e0 t\u0103ng \u00e1p ph\u1ed5i m\u1ea1n t\u00ednh.<\/span><\/p>\n

M\u1ed8T S\u1ed0 \u0110I\u1ec2M C\u1ea6N L\u01afU \u00dd \u1ede NG\u01af\u1edcI CAO TU\u1ed4I TRONG TTHKTM<\/span><\/h3>\n

TTHKTM l\u00e0 nguy\u00ean nh\u00e2n quan tr\u1ecdng g\u00e2y t\u1eed vong v\u00e0 di ch\u1ee9ng b\u1ec7nh \u1edf ng\u01b0\u1eddi cao tu\u1ed5i. \u0110\u00e3 c\u00f3 nhi\u1ec1u ti\u1ebfn b\u1ed9 trong ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb. M\u1ed9t s\u1ed1<\/span> thu\u1ed1c <\/span>m\u1edbi \u0111\u01b0\u1eddng u\u1ed1ng \u1ee9c ch\u1ebf tr\u1ef1c ti\u1ebfp thrombin ho\u1eb7c \u1ee9c ch\u1ebf y\u1ebfu t\u1ed1 X ho\u1ea1t ho\u00e1 \u0111ang nghi\u00ean c\u1ee9u v\u00e0 c\u00f3 th\u1ec3 thay th\u1ebf warfarin. D\u00f9 ti\u1ebfn b\u1ed9 trong \u0111i\u1ec1u tr\u1ecb nh\u01b0 th\u1ebf n\u00e0o \u0111i n\u1eefa th\u00ec vi\u1ec7c ch\u1ea9n \u0111o\u00e1n s\u1edbm v\u00e0 theo d\u00f5i k\u1ef9 gi\u00fap gi\u1ea3m t\u1eed vong v\u00e0 di ch\u1ee9ng cho ng\u01b0\u1eddi cao tu\u1ed5i.<\/span><\/p>\n

M\u1ed9t s\u1ed1 \u0111i\u1ec3m t\u00f3m t\u1eaft c\u1ea7n l\u01b0u \u00fd:<\/strong><\/p>\n

TTHKTM l\u00e0 nguy\u00ean nh\u00e2n quan tr\u1ecdng g\u00e2y t\u1eed vong \u1edf b\u1ec7nh nh\u00e2n n\u1eb1m vi\u1ec7n v\u00e0 th\u01b0\u1eddng g\u1eb7p h\u01a1n \u1edf ng\u01b0\u1eddi cao tu\u1ed5i.<\/span><\/p>\n

Y\u1ebfu t\u1ed1 nguy c\u01a1 TTHKTM th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi cao tu\u1ed5i nh\u01b0 b\u1ea5t \u0111\u1ed9ng, g\u00e3y x\u01b0\u01a1ng, \u0111\u1ed9t qu\u1ef5.<\/span><\/p>\n

Ng\u01b0\u1eddi cao tu\u1ed5i b\u1ecb \u0111\u1ed9t qu\u1ef5 ho\u1eb7c v\u1eeba ph\u1eabu thu\u1eadt ch\u1ec9nh h\u00ecnh m\u00e0 \u0111\u1ed9t ng\u1ed9t kh\u00f3 th\u1edf, \u0111au ng\u1ef1c, ng\u1ea5t c\u1ea7n ngh\u0129 t\u1edbi TTP.<\/span><\/p>\n

Ch\u1ee5p c\u1eaft l\u1edbp \u0111i\u1ec7n to\u00e1n \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i l\u00e0 k\u1ef9 thu\u1eadt h\u00ecnh \u1ea3nh ngh\u0129 \u0111\u1ebfn<\/span> tr\u01b0\u1edbc <\/span>ti\u00ean khi nghi ng\u1edd TTP.<\/span><\/p>\n

\u0110i\u1ec1u tr\u1ecb ph\u00f2ng ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb kh\u1edfi \u0111\u1ea7u HKTMS v\u00e0 TTP<\/span> thu\u1ed1c <\/span>\u0111\u01b0\u1ee3c ch\u1ecdn \u0111\u1ea7u ti\u00ean l\u00e0 heparin tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p (th\u01b0\u1eddng s\u1eed d\u1ee5ng hi\u1ec7n nay l\u00e0 enoxaparin).<\/span><\/p>\n

Ng\u01b0\u1eddi cao tu\u1ed5i nh\u1ea1y h\u01a1n v\u1edbi t\u00e1c d\u1ee5ng ch\u1ed1ng \u0111\u00f4ng c\u1ee7a warfarin.<\/span><\/p>\n

Nhi\u1ec1u nghi\u00ean c\u1ee9u x\u00e1c nh\u1eadn c\u00f3 m\u1ed1i li\u00ean quan gi\u1eefa m\u1ee9c \u0111\u1ed9 t\u00e1c d\u1ee5ng kh\u00e1ng \u0111\u00f4ng v\u00e0 nguy c\u01a1 ch\u1ea3y m\u00e1u.<\/span><\/p>\n

B\u1ec7nh nh\u00e2n c\u00f3 thuy\u00ean t\u1eafc ph\u1ed5i l\u1edbn, \u0111i\u1ec1u tr\u1ecb bao g\u1ed3m<\/span> thu\u1ed1c <\/span>ti\u00eau s\u1ee3i huy\u1ebft v\u00e0 ph\u1eabu th\u1eadt l\u1ea5y huy\u1ebft kh\u1ed1i thuy\u00ean t\u1eafc.<\/span><\/p>\n

Thu\u1ed1c<\/span> \u1ee9c ch\u1ebf y\u1ebfu t\u1ed1 X ho\u1ea1t ho\u00e1 v\u00e0<\/span> thu\u1ed1c <\/span>\u1ee9c ch\u1ebf thrombin tr\u1ef1c ti\u1ebfp b\u1eb1ng \u0111\u01b0\u1eddng u\u1ed1ng \u0111ang \u0111\u01b0\u1ee3c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean cho \u0111i\u1ec1u tr\u1ecb TTHKTM.<\/span><\/p>\n

Ch\u1ea9n \u0111o\u00e1n s\u1edbm v\u00e0 theo d\u00f5i c\u1ea9n th\u1eadn khi \u0111i\u1ec1u tr\u1ecb s\u1ebd l\u00e0m gi\u1ea3m t\u1eed vong v\u00e0 di ch\u1ee9ng b\u1ec7nh t\u1eadt do TTHKTM \u1edf ng\u01b0\u1eddi cao tu\u1ed5i.<\/span><\/p>","protected":false},"excerpt":{"rendered":"

T\u1ea6N SU\u1ea4T THUY\u00caN T\u1eaeC HUY\u1ebeT KH\u1ed0I T\u0128NH M\u1ea0CH T\u1ea7n su\u1ea5t thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch (TTHKTM) chi\u1ebfm<\/p>","protected":false},"author":21,"featured_media":9292,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[66],"tags":[],"class_list":["post-9291","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-lao-khoa"],"_links":{"self":[{"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/posts\/9291","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/users\/21"}],"replies":[{"embeddable":true,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/comments?post=9291"}],"version-history":[{"count":2,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/posts\/9291\/revisions"}],"predecessor-version":[{"id":9294,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/posts\/9291\/revisions\/9294"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/media\/9292"}],"wp:attachment":[{"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/media?parent=9291"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/categories?post=9291"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/tags?post=9291"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}