Tac dong mach phoi cap Benh ly nguy hiem

Tags: dong mach phoi, can lam sang, chong chi dinh, Sieu am tim, chan doan, tinh mach, benh nhan, dieu tri, trieu chung, nguy co, thuoc, gap, that, tinh, hien
Tac dong mach phoi cap Benh ly nguy hiem
Tac dong mach phoi.
Tac dong mach phoi ( TDMP) hay con goi la thuyen tac mach phoi, la hien tuong tac cua dong mach phoi chinh hoac mot trong cac nhanh cua no. TDMP cap la tinh trang cap cuu doi hoi duoc chan doan va dieu tri kip thoi vi benh nhan co nguy co tu vong cao neu khong duoc dieu tri. Chan doan con gap nhieu kho khan do cac trieu chung lam sang va can lam sang thuong quy khong dac hieu.

Viem tac tinh mach sau la nguyen nhan hang dau gay benh

TDMP la mot bien chung thuong gap cua viem tac tinh mach sau (VTTMS), hon 50% truong hop TDMP chup tinh mach co VTTMS. Cac yeu to nguy co co the gap la: bat dong keo dai, hau phau trong vong 3 thang, TBMN, liet nua nguoi, liet 2 chan, tien su viem tac tinh mach, ung thu, dat catheter tinh mach trung tam trong vong 3 thang, benh tim man tinh, phu nu beo phi, hut thuoc la nhieu (tren 25 dieu/ngay) va tang huyet ap.

Can su nhay cam cua thay thuoc khi chan doan benh

Voi TDMP neu nguoi thay thuoc khong nghi den thi khong the chan doan duoc. Dung truoc benh nhan cap cuu co bieu hien kho tho, dau nguc kieu mang phoi, ngat, tut huyet ap ma khong ro nguyen nhan. Co the kem theo cac yeu to nguy co cua benh ly huyet khoi - tac mach, nguoi thay thuoc can phai nghi den va thuc hien quy trinh chan doan phu hop tranh bo sot TDMP, mot benh ly co the gay tu vong cho benh nhan.

Mot so bien phap can thiet de chan doan benh

Cung voi nhung bien phap nhu dien tam do, Xquang tim phoi thi cac bien phap sau day giup phat hien benh chinh xac hon nhu:

Sieu am Doppler tinh mach chi duoi: Co the duoc dung de chan doan gian tiep trong cac truong hop nghi ngo TDMP, neu phat hien viem tac tinh mach sau thi dieu tri nhu TDMP cap. Duong tinh gia cua sieu am Doppler tinh mach chi duoi (3%) co the dan den dieu tri chong dong khong can thiet cho benh nhan; 29% benh nhan TDMP co viem tac tinh mach sau tren sieu am Doppler co ep tinh mach.

Chup mach phoi: Duoc xem la tieu chuan vang de chan doan TDMP cap. Chup mach phoi am tinh cho phep loai tru TDMP, nguy am tinh gia rat thap. Ty le tu vong gay do chup mach phoi la 2%, ty le bien chung khoang 5% thuong lien quan den dat catheter, thuoc can quang, roi loan nhip tim hoac suy ho hap. Ky thuat nay doi hoi nguoi lam thanh thuc; thoi gian lam keo dai; nguy co dung thuoc can quang, nguy co nhiem tia X cao hon so voi chup cat lop vi tinh xoan oc.

Chup cat lop vi tinh xoan oc (chup MsCT) phoi: Do dac hieu cao, an toan, nhanh chong, chan doan duoc cac cap cuu khac cua long nguc; trong khi do cung co nhung nhuoc diem nhat dinh nhu can nguoi doc co kinh nghiem, khong di chuyen duoc, can dung thuoc can quang. Ky thuat nay cho do nhay 90% va do dac hieu 95%.

Sieu am tim: Cac bat thuong tren sieu am tim co the gap nhu tang kich thuoc that phai, giam chuc nang that phai, ho van ba la. Neu co roi loan chuc nang that phai va huyet khoi buong that phai tren sieu am tim la yeu to tien luong nang cua TDMP. Ty le TDMP o benh nhan co huyet khoi that phai >35%, nguoc lai trong so cac benh nhan TDMP thi 4% co huyet khoi that phai. Sieu am tim la mot tham do nhanh phai lam truoc khi dung thuoc tieu soi huyet.

Xu tri tac dong mach phoi cap nhu the nao?

Hoi suc: Can on dinh benh nhan, tho oxy nong do cao, co the tho may qua noi khi quan (NKQ), truyen dich. Neu truyen dich ma khong giup cai thien huyet dong thi tien hanh cho thuoc van mach.

Bat dong: Voi TDMP thi benh nhan can bat dong tai cho 24-48 gio. ket hop dung thuoc chong dong, thuoc tieu soi huyet va dung phin loc tinh mach chu duoi, lay bo huyet khoi (qua catheter hoac phau thuat).Lay huyet khoi duoc can nhac khi TDMP nang co chi dinh tieu soi huyet nhung that bai hoac chong chi dinh.

Benh can duoc cap cuu va dieu tri kip thoi

TDMP cap la tinh trang cap cuu doi hoi duoc chan doan va dieu tri kip thoi vi benh nhan co nguy co tu vong cao neu khong duoc dieu tri. Chan doan con gap nhieu kho khan do cac trieu chung lam sang va can lam sang thuong quy khong dac hieu. Can ap dung cac quy trinh chan doan phu hop voi tung co so. Dung thuoc tieu soi huyet can nhac cho tung truong hop, dac biet la neu TDMP co tut huyet ap va neu khong co chong chi dinh. Tieu soi huyet that bai hoac chong chi dinh xem xet kha nang lay bo huyet khoi.

Cac dau hieu can phai nghi den tac dong mach phoi cap

Nguoi benh thuong kho tho la dau hieu hay gap nhat, ngay ca khi nghi ngoi hoac khi gang suc, dau nguc kieu mang phoi, ho, kho tho, dau, sung bap chan va dui… Cac dau hieu khac: nhip tho nhanh, nhip tim nhanh, phoi co ran, rung thanh giam, tinh mach co noi, truy mach it gap. TÐMP nang co dau hieu suy tim phai cap nhu tang ap luc tinh mach co... Nhung noi chung cac trieu chung lam sang khong dac hieu, co the gap o nhung benh nhan cap cuu khong co TÐMP. Co 2 loai TÐMP la cap va man tinh, TÐMP cap tinh dien hinh thuong bieu hien trieu chung ram ro sau khi cac mach phoi bi tac. Nguoc lai TÐMP man co xu huong phat trien trieu chung mot cach tu tu thuong la kho tho tang dan tu 2 tuan cho den vai nam lien quan den muc do tang ap dong mach phoi. Chan doan TÐMP gap nhieu kho khan do trieu chung lam sang thuong thay doi va khong dac hieu, nhieu truong hop chi duoc chan doan khi mo tu thi.

Theo ThS. Hoang Bui Hai (Suc khoe & Doi song)

Tìm hiểu: dong mach phoi, can lam sang, chong chi dinh, Sieu am tim, chan doan, tinh mach, benh nhan, dieu tri, trieu chung, nguy co, thuoc, gap, that, tinh, hien

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Lien he ve tin Tac dong mach phoi cap Benh ly nguy hiem

Nhan xet, hay lien he ve tin Tac dong mach phoi cap Benh ly nguy hiem co the gui bang duong dan o duoi. Ban nen gui kem tieu de bai viet Tac dong mach phoi cap Benh ly nguy hiem de lam tham khao. Bai viet nay thuoc chuyen de Tin suc khoe trong chuyen muc Suc khoe.

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