Nhoi mau co tim.

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Nhoi mau co tim

Nhoi mau co tim la mot thuat ngu y hoc de chi tinh trang hoai tu mot phan co tim do giam sut dang ke luong mau cung cap den mot vung co tim..

Nhoi mau co tim - Ban co dau.
Nhoi mau co tim - Ban khong dau.
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Nhoi mau co tim.

Dai da so cac truong hop, nguyen nhan  gay ra nhoi mau co tim la do su tac mot trong so cac dong mach vanh nuoi qua tim, do cuc mau dong hinh thanh tai cho khi mang xo vua bi nut, vo ra, von thuong xay ra tren nen cua benh canh dong mach vanh bi hep do xo vua tu truoc. Mot so it cac truong hop khac, nhoi mau co tim co the la hau qua cua tinh trang co that mach vanh dang ke lam ngung tre qua muc dong mau dan den nuoi co tim.

Ty le bi nhoi mau co tim cao nhat o nam gioi tuoi tren 40 (trung nien va cao tuoi). Ty le nay o nu gioi theo do tuoi thap hon o nam song  cung tang len gan tuong duong tu 5 den 10 nam sau man kinh. Gan mot nua cac truong hop gap o do tuoi duoi nguong 60 - 65. Nhoi mau co tim gap voi ty le cao hon dang ke o nhung nguoi hut thuoc la, beo phi, roi loan mo mau, tang huyet ap, tieu duong hoac gia dinh  co nguoi mac benh tim mach som truoc tuoi 60. Khong it cac truong hop nhoi mau co tim xay ra ngay ca o nguoi tre hoac nguoi khong he co bat ky yeu to nguy co nao.

Trieu chung nhu the nao?

Trieu chung dien hinh va thuong gap nhat cua nhoi mau co tim la con dau that nguc voi cam giac dau nhu bi de ep, bop chat o giua nguc, dien ra trong khoang 5 - 15 phut (keo dai hon han so voi con dau that nguc on dinh thong thuong), thuong khong qua 1 gio. Con dau co the lan  len vai, co, ham hoac lan  doc theo canh tay, dac biet la tay trai. Co the co kem theo cac trieu chung nhu va mo hoi, buon non, chong mat hoac kho tho. Nhieu truong hop nhoi mau co tim lai bieu hien nhu mot tinh trang roi loan tieu hoa, hoac chang he co trieu chung (nhoi mau co tim tham lang), hoac het suc dot ngot, bieu hien bang bien chung roi loan nhip, ngung tim hay dot tu...

Chan doan benh

Do tinh chat thuong gap, nguy hiem den tinh mang va dien bien nhanh chong cua benh, nen phuong cham chu dao la tranh toi da bo sot. Can nghi toi nhoi mau co tim truoc bieu hien dau hoac tuc nang o nguc trai ma khong biet do nguyen nhan  nao khac gay ra o mot nguoi lon tuoi, nhat la khi co cac yeu to nguy co cua benh tim mach. Khi nghi ngo, can vao benh vien hoac co so chuyen khoa de theo doi it nhat 12 - 24 gio nham loai tru hoac xac dinh chan doan. Chan doan nhoi mau co tim dua vao dac diem con dau that nguc, cac bien doi tren dien tam do, cac thay doi ve nong do men tim trong mau dien ra trong qua trinh theo doi (phai lam dien tam do hoac dinh luong men tim trong mau nhieu lan de phat hien ra cac thay doi nay, khoang cach giua cac lan toi da la 6 gio). Chup dong mach vanh bang thuoc can quang co hinh anh  tac mot doan dong mach vanh do huyet khoi la bien phap chan doan chac chan. Doi voi mot so benh nhan co trieu chung dien hinh, nguy co bien chung cao (soc tim, suy tim nang, roi loan nhip. ..), nen chup dong mach vanh ngay de co chan doan xac dinh va ap dung cac bien phap dieu tri kip thoi. Nhung benh nhan con nghi ngo co the su dung mot so bien phap chan doan khac nhu sieu am tim, nghiem phap gang suc, xa hinh tuoi mau co tim... tuy tung truong hop truoc khi chup dong mach vanh.

Bien chung nguy hiem

Nang ne nhat va khong hiem xay ra, do la tu vong. Nhung bien chung tiem tang, de doa tinh mang, co the xay ra bat ky luc nao khi nhoi mau co tim bao gom roi loan nhip tram trong, suy tim tien trien, soc tim va ngung tim... Mot vai truong hop, vung co tim bi hoai tu lon, gay thung buong tim (vo tim) co the gay tu vong hoac phai phau thuat cap cuu. Nhung bien phap dieu tri hien dai nhu thuoc tieu cuc mau dong, can thiep dong mach vanh qua da, ket hop voi dieu tri noi khoa tich cuc tu som cho phep ngan ngua, han che tien trien va muc do anh huong cua cac bien chung voi tien luong song cua benh nhan trong giai doan som cung nhu lau dai.

Dieu tri nhu the nao?

Nhoi mau co tim la mot tinh trang can cap cuu. Nguyen tac chung la tai lap dong mau chay trong doan dong mach vanh bi tac cang som cang tot, de cuu van toi da phan co tim thoi thop do thieu mau nuoi duong nam xen lan voi nhung vung co tim da chet vi hoai tu do thieu mau. Dong chay dong mach vanh chi duoc khoi phuc khi loai bo duoc cuc mau dong bang thuoc tieu mau dong, hoac su dung cac bien phap can thiep qua da nhu nong bang bong va hoac dat gia do trong long dong mach vanh ket hop voi viec hut bo cuc mau dong... Chi co mot ty le rat nho cuc mau dong tu tan con da so phai duoc can thiep. Tuy nhien hieu qua cua cac bien phap nay phu thuoc rat nhieu vao thoi gian  ap dung dieu tri, thuoc tieu cuc mau dong chi co loi thuc su khi duoc dung ngay trong vong tu 2 den 4 gio ke tu luc khoi phat. Can thiep dong mach vanh qua da cung chi co loi ro ret khi duoc tien hanh trong vong 12 - 18 gio ke tu luc khoi phat, tru mot so truong hop can thiep muon (trong vong 36 gio) van co loi nhu dau nguc tai phat sau nhoi mau, soc tim, suy tim hoac roi loan nhip tien trien. Mot ty le nhat dinh cac truong hop muon khong dung duoc thuoc tieu soi huyet, thuong ton khong phu hop de can thiep bang bong hoac dat gia do thi mo bac cau noi chu vanh cap cuu la bien phap cuoi cung de mo thong long mach va cuu song benh nhan, du ty le thanh cong o giai doan cap khong cao. Nhu vay khi da nhoi mau co tim, benh nhan can duoc dieu tri tich cuc cang som cang tot, nhat la viec mo thong doan mach bi tac.

Viec dieu tri cac thuoc phoi hop nhu thuoc uc che ngung tap tieu cau, thuoc chen beta giao cam, nitrat, thuoc uc che men chuyen, thuoc gian mach, thuoc giam dau, thuoc chong loan nhip, chua suy tim... la vo cung can thiet, giup co tim nghi ngoi, tang cuong hieu qua cua viec tai luu thong dong chay trong dong mach vanh, ngan ngua su lan  rong va han che anh huong cua vung co tim da chet doi voi chuc nang co bop that trai va su song con cua benh nhan, ke ca trong giai doan truoc mat cung nhu lau dai. Doi voi nhung benh nhan khong duoc can thiep thi dieu tri noi khoa khong he vo tac dung, ma nguoc lai, khong it benh nhan van duy tri duoc chat luong va thoi gian  song. Sau khi song sot va phuc hoi mot phan qua giai doan cap, benh nhan se co chuong trinh  phuc hoi chuc nang phu hop, dieu chinh loi song va che do du phong cung nhu dieu tri va theo doi lau dai.

Nhoi mau co tim chi la mot bien co, bieu hien cap tinh cua ca mot qua trinh benh ly xo vua tien trien am y tiem tang. Cac bien phap dieu tri trong giai doan cap cung chi giai quyet duoc hau qua cua doan dong mach thu pham tuc thoi ngay luc do ma thoi. Thuoc tieu cuc mau dong khong lam giam muc do hep cua dong mach vanh thu pham. Can thiep dong mach vanh qua da hoac mo bac cau noi trong giai doan cap cuu cung khong phai la dieu tri triet de, khong the giai quyet duoc moi cho hep va hoan toan khong ngan ngua duoc tien trinh xo vua dang dien ra am tham. Ve lau dai, dieu tri noi khoa bang thuoc ket hop voi nhung bien phap du phong khac van la nen tang co ban trong dieu tri. Viec can thiep dong mach vanh qua da, mo bac cau chu vanh co the duoc tien hanh nhieu lan ve sau de tiep tuc giai quyet nhung cho hep khac con ton dong hoac xuat hien moi theo thoi gian.

Du phong nhu the nao?

Dieu chinh loi song thich hop lam giam nguy co xo vua dong mach noi chung va nguy co nhoi mau co tim noi rieng (ke ca nhoi mau moi hoac nhoi mau lai) bao gom viec bo hoan toan hut thuoc la, tranh ngui khoi thuoc, an it chat beo, an them rau qua, giam can nang neu thua can, kiem soat chat che huyet ap va duong mau trong gioi han cho phep. Nhieu thu nghiem co quy mo rat lon o nhieu nuoc tren the gioi  da cho thay viec dung cac thuoc chong ngung tap tieu cau (aspirin...) va cac thuoc ha mo mau nhom statin co hieu qua tuong doi ro doi voi phong ngua xuat hien cac bien co tim mach (khong nhung nhoi mau co tim ma ca tai bien mach mau nao...). Ngoai ra, theo doi sat, dieu chinh kip thoi, phat hien tu som va xu tri triet de con dau that nguc cung co vai tro het suc quan trong de han che va phong ngua xuat hien nhoi mau co tim.

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Updated: 26/07/2008 | Views: 753 | Comments: 0

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