{"id":949,"date":"2021-09-10T22:39:49","date_gmt":"2021-09-10T15:39:49","guid":{"rendered":"http:\/\/phauthuatnhi.vn\/vi\/?p=949"},"modified":"2021-09-10T22:39:57","modified_gmt":"2021-09-10T15:39:57","slug":"tu-chung-fallot","status":"publish","type":"post","link":"http:\/\/phauthuatnhi.vn\/vi\/cacloaibenh\/tu-chung-fallot\/","title":{"rendered":"T\u1ee9 ch\u1ee9ng Fallot"},"content":{"rendered":"\n<p class=\"has-medium-font-size\"><strong>\u0110\u1ea1i c\u01b0\u01a1ng<\/strong><\/p>\n\n\n\n<ul><li>T\u1ee9 ch\u1ee9ng Fallot l\u00e0 d\u1ecb t\u1eadt tim b\u1ea9m sinh (TBS) t\u00edm th\u01b0\u1eddng g\u1eb7p nh\u1ea5t: 5-10% TBS; 3,26\/10.000 tr\u1ebb s\u01a1 sinh s\u1ed1ng, 1.300 ca m\u1edbi\/n\u0103m \u1edf M\u1ef9.<\/li><li>T\u1ee9 ch\u1ee9ng Fallot g\u1ed3m 4 t\u1eadt (H\u00ecnh 1):<ul><li>Th\u00f4ng li\u00ean th\u1ea5t r\u1ed9ng<\/li><li>T\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra th\u1ea5t ph\u1ea3i<\/li><li>Ph\u00ec \u0111\u1ea1i th\u1ea5t ph\u1ea3i<\/li><li>\u0110\u1ed9ng m\u1ea1ch ch\u1ee7 cu\u1ee1i ng\u1ef1a tr\u00ean v\u00e1ch li\u00ean th\u1ea5t<\/li><\/ul><\/li><li>Nam nhi\u1ec1u h\u01a1n n\u1eef.\u00a0<\/li><li>D\u1ecb t\u1eadt ph\u1ed1i h\u1ee3p: b\u1ea5t th\u01b0\u1eddng m\u1ea1ch v\u00e0nh, \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 quay ph\u1ea3i, th\u00f4ng li\u00ean nh\u0129, t\u1ed3n t\u1ea1i \u1ed1ng \u0111\u1ed9ng m\u1ea1ch, k\u00eanh nh\u0129 th\u1ea5t.<\/li><\/ul>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large is-resized\"><img loading=\"lazy\" src=\"http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/09\/Anatomical-drawing-of-Tetralogy-of-Fallot.png\" alt=\"\" class=\"wp-image-953\" width=\"701\" height=\"357\" srcset=\"http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/09\/Anatomical-drawing-of-Tetralogy-of-Fallot.png 934w, http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/09\/Anatomical-drawing-of-Tetralogy-of-Fallot-300x153.png 300w, http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/09\/Anatomical-drawing-of-Tetralogy-of-Fallot-768x391.png 768w\" sizes=\"(max-width: 701px) 100vw, 701px\" \/><figcaption><strong>H\u00ecnh 1: T\u1ee9 ch\u1ee9ng Fallot<\/strong><\/figcaption><\/figure><\/div>\n\n\n\n<p class=\"has-medium-font-size\"><strong>Nguy\u00ean nh\u00e2n<\/strong><\/p>\n\n\n\n<ul><li>M\u1eb9 trong l\u00fac mang thai<ul><li>B\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng (con nguy c\u01a1 TOF g\u1ea5p 3 l\u1ea7n)<\/li><li>\u0102n retionoic acids (vitamin A b\u1ecb oxy ho\u00e1) trong 3 th\u00e1ng \u0111\u1ea7u thai k\u1ef3<\/li><li>B\u1ec7nh phenylketone ni\u1ec7u kh\u00f4ng ki\u00eang \u0103n phenylalanine (c\u00f3 trong th\u1ef1c ph\u1ea9m gi\u00e0u protein, qu\u1ea3 h\u1ea1nh, qu\u1ea3 l\u00ea t\u00e0u, \u0111\u1eadu lima, \u0111\u1eadu ph\u1ed9ng, c\u00e1c lo\u1ea1i h\u1ea1t)<\/li><li>U\u1ed1ng trimethadione, paramethadione<\/li><\/ul><\/li><li>Di truy\u1ec1n<ul><li>10% tr\u1ebb TOF c\u00f3 trisomy 13, 18, 21.<\/li><li>\u0110\u1ed9t bi\u1ebfn gene trong TOF<\/li><li>Khi\u1ebfm khuy\u1ebft gene<\/li><\/ul><\/li><\/ul>\n\n\n\n<p class=\"has-medium-font-size\"><strong>Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/strong><\/p>\n\n\n\n<ul><li>Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng tho\u00e1t th\u1ea5t ph\u1ea3i (gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng m\u00e1u l\u00ean ph\u1ed5i).<\/li><li>C\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng ch\u00ednh bao g\u1ed3m:<ul><li>C\u00e2n n\u1eb7ng l\u00fac sanh th\u1ea5p<\/li><li>Ch\u1eadm t\u0103ng tr\u01b0\u1edfng<\/li><li>T\u00edm: h\u1ea7u h\u1ebft xu\u1ea5t hi\u1ec7n v\u00e0o 3 th\u00e1ng tu\u1ed5i, t\u00edm to\u00e0n di\u1ec7n v\u00e0 \u0111\u1ed3ng \u0111\u1ec1u, t\u0103ng khi g\u1eafng s\u1ee9c, kh\u00f3 th\u1edf khi g\u1eafng s\u1ee9c ph\u1ea3i ng\u1ed3i x\u1ed5m.<\/li><li>C\u01a1n t\u00edm: th\u01b0\u1eddng x\u1ea3y ra khi tr\u1ebb g\u1eafng s\u1ee9c, k\u00e9o d\u00e0i 15 &#8211; 30 ph\u00fat, tr\u1ebb th\u1edf m\u1ea1nh, t\u00edm nhi\u1ec1u h\u01a1n v\u00e0 \u0111\u01b0\u1eddng th\u1edf b\u00ecnh th\u01b0\u1eddng, c\u00f3 th\u1ec3 d\u1eabn t\u1edbi t\u1eed vong.<\/li><li>Ng\u00f3n tay v\u00e0 ng\u00f3n ch\u00e2n d\u00f9i tr\u1ed1ng.<\/li><li>\u00c2m th\u1ed5i t\u00e2m thu li\u00ean s\u01b0\u1eddn 3, li\u00ean s\u01b0\u1eddn 4 tr\u00e1i s\u00e1t x\u01b0\u01a1ng \u1ee9c.<\/li><\/ul><\/li><\/ul>\n\n\n\n<p class=\"has-medium-font-size\"><strong>Ch\u1ea9n \u0111o\u00e1n<\/strong><\/p>\n\n\n\n<p><strong>\u0110i\u1ec7n t\u00e2m \u0111\u1ed3<\/strong><\/p>\n\n\n\n<ul><li>Tr\u1ee5c QRS l\u1ec7ch ph\u1ea3i, c\u00f3 th\u1ec3 b\u00ecnh th\u01b0\u1eddng n\u1ebfu Fallot \u201ch\u1ed3ng\u201d<\/li><li>D\u00e0y th\u1ea5t ph\u1ea3i t\u0103ng g\u00e1nh t\u00e2m thu, chuy\u1ec3n ti\u1ebfp \u0111\u1ed9t ng\u1ed9t t\u1eeb V1-V2<\/li><li>D\u00e0y 2 th\u1ea5t trong Fallot \u201ch\u1ed3ng\u201d<\/li><li>L\u1edbn nh\u0129 ph\u1ea3i \u00edt g\u1eb7p<\/li><\/ul>\n\n\n\n<p><strong>X quang ng\u1ef1c<\/strong><\/p>\n\n\n\n<ul><li>B\u00f3ng tim b\u00ecnh th\u01b0\u1eddng ho\u1eb7c nh\u1ecf, h\u00ecnh chi\u1ebfc gi\u00e0y (h\u00ecnh 2)<\/li><li>Tu\u1ea7n ho\u00e0n ph\u1ed5i<ul><li>Th\u01b0\u1eddng gi\u1ea3m<\/li><\/ul><ul><li>T\u0103ng n\u1ebfu c\u00f3 \u1ed1ng \u0111\u1ed9ng m\u1ea1ch ho\u1eb7c tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 ch\u1ee7-ph\u1ed5i<\/li><\/ul><\/li><li>Cung \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i l\u00f5m<\/li><li>L\u1edbn nh\u0129 ph\u1ea3i (25%)<\/li><li>Cung \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u00ean ph\u1ea3i (25%)<\/li><\/ul>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large is-resized\"><img loading=\"lazy\" src=\"http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/09\/tof2.jpg\" alt=\"\" class=\"wp-image-957\" width=\"480\" height=\"230\" srcset=\"http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/09\/tof2.jpg 960w, http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/09\/tof2-300x144.jpg 300w, http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/09\/tof2-768x368.jpg 768w\" sizes=\"(max-width: 480px) 100vw, 480px\" \/><figcaption><strong>H\u00ecnh 2: B\u00f3ng tim h\u00ecnh chi\u1ebfc gi\u00e0y<\/strong><\/figcaption><\/figure><\/div>\n\n\n\n<p><strong>Si\u00eau \u00e2m tim<\/strong><\/p>\n\n\n\n<ul><li>X\u00e1c \u0111\u1ecbnh 4 t\u1eadt ch\u00ednh v\u1edbi \u0111\u1ea7y \u0111\u1ee7 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m<\/li><li>X\u00e1c \u0111\u1ecbnh t\u1ed5n th\u01b0\u01a1ng tim kh\u00e1c \u0111i k\u00e8m<\/li><li>\u0110\u00e1nh gi\u00e1 tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 ch\u1ee7-ph\u1ed5i<\/li><li>\u0110\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1ea5t ph\u1ea3i v\u00e0 tr\u00e1i<\/li><\/ul>\n\n\n\n<p><strong>X\u00e9t nghi\u1ec7m m\u00e1u<\/strong><\/p>\n\n\n\n<ul><li>\u0110a h\u1ed3ng c\u1ea7u (Hct, hemoglobin, h\u1ed3ng c\u1ea7u t\u0103ng cao)<\/li><li>Kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch: toan m\u00e1u<\/li><li>Ti\u1ec3u c\u1ea7u gi\u1ea3m \u1edf tr\u1ebb l\u1edbn, c\u00f4 \u0111\u1eb7c m\u00e1u n\u1eb7ng<\/li><li>Fibrinogen m\u00e1u gi\u1ea3m<\/li><li>R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng \u0111\u00f4ng m\u00e1u<\/li><li>S\u1eaft, s\u1eaft huy\u1ebft thanh c\u00f3 th\u1ec3 gi\u1ea3m<\/li><\/ul>\n\n\n\n<p class=\"has-medium-font-size\"><strong>\u0110i\u1ec1u tr\u1ecb<\/strong><\/p>\n\n\n\n<p><strong>N\u1ed9i khoa<\/strong><\/p>\n\n\n\n<ul><li>\u0110i\u1ec1u tr\u1ecb t\u1ea1m th\u1eddi:<ul><li>\u0110i\u1ec1u tr\u1ecb thi\u1ebfu m\u00e1u v\u00e0 thi\u1ebfu s\u1eaft.<\/li><\/ul><ul><li>C\u1ea5p c\u1ee9u c\u01a1n t\u00edm.<\/li><\/ul><ul><li>C\u1ea3i thi\u1ec7n \u0111\u1ed9 b\u00e3o h\u00f2a oxy.<\/li><\/ul><\/li><\/ul>\n\n\n\n<p><strong>Ngo\u1ea1i khoa<\/strong><\/p>\n\n\n\n<p>Th\u1eddi \u0111i\u1ec3m ph\u1eabu thu\u1eadt:<\/p>\n\n\n\n<ul><li>Th\u00f4ng th\u01b0\u1eddng \u0111\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng tri\u1ec7u ch\u1ee9ng, ph\u1eabu thu\u1eadt th\u1ef1c hi\u1ec7n 1 th\u00ec s\u1eeda ch\u1eefa ho\u00e0n to\u00e0n khi tr\u1ebb >10kg.<\/li><li>\u00a0\u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 tri\u1ec7u ch\u1ee9ng: 1 ho\u1eb7c 2 th\u00ec (th\u00ec 1: BT shunt v\u00e0 th\u00ec 2: s\u1eeda ch\u1eefa ho\u00e0n to\u00e0n).<\/li><\/ul>\n\n\n\n<p>Ch\u1ec9 \u0111\u1ecbnh \u0111\u1ed1i v\u1edbi BT shunt: nh\u00e1nh \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i nh\u1ecf, 2 th\u1ea5t m\u1ea5t c\u00e2n x\u1ee9ng, nhi\u1ec1u l\u1ed7 th\u00f4ng li\u00ean th\u1ea5t, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tu\u1ea7n ho\u00e0n ngo\u00e0i c\u01a1 th\u1ec3.<\/p>\n\n\n\n<p>Ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt kh\u1ea9n:<\/p>\n\n\n\n<ul><li>T\u00ecnh tr\u1ea1ng thi\u1ebfu oxy tr\u1ea7m tr\u1ecdng, li\u00ean quan \u0111\u1ebfn h\u1eb9p \u0111\u01b0\u1eddng tho\u00e1t th\u1ea5t ph\u1ea3i ti\u1ebfn tri\u1ec3n v\u1edbi m\u1ee9c \u0111\u1ed9 b\u00e3o h\u00f2a oxy d\u01b0\u1edbi 75 &#8211; 80%.<\/li><li>C\u01a1n t\u00edm n\u1eb7ng.<\/li><li>Ph\u1ee5 thu\u1ed9c v\u00e0o prostaglandin t\u1eeb ngay sau sinh (nhi\u1ec1u kh\u1ea3 n\u0103ng t\u1ee9 ch\u1ee9ng Fallot k\u00e8m teo \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i).<\/li><\/ul>\n\n\n\n<p>Ph\u1eabu thu\u1eadt tri\u1ec7t \u0111\u1ec3:<\/p>\n\n\n\n<ul><li>Nguy\u00ean t\u1eafc<ul><li>N\u1edbi r\u1ed9ng \u0111\u01b0\u1eddng tho\u00e1t th\u1ea5t ph\u1ea3i (c\u1ed1 g\u1eafng b\u1ea3o t\u1ed3n v\u00f2ng van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i).<\/li><li>\u0110\u00f3ng th\u00f4ng li\u00ean th\u1ea5t.<\/li><li>\u0110\u01b0\u1eddng ti\u1ebfp c\u1eadn th\u00f4ng qua nh\u0129 &#8211; ph\u1ed5i \u0111\u01b0\u1ee3c xem l\u00e0 \u0111\u01b0\u1eddng ti\u1ebfp c\u1eadn l\u00fd t\u01b0\u1edfng do tr\u00e1nh \u0111\u01b0\u1ee3c x\u1ebb c\u01a1 th\u00e0nh th\u1ea5t ph\u1ea3i.<\/li><li>Trong tr\u01b0\u1eddng h\u1ee3p h\u1eb9p v\u00f2ng van \u0110MP nhi\u1ec1u, c\u1ea7n ph\u1ea3i x\u1ebb v\u00f2ng van v\u00e0 n\u1edbi r\u1ed9ng \u0111\u01b0\u1eddng tho\u00e1t th\u1ea5t ph\u1ea3i b\u1eb1ng mi\u1ebfng pacth xuy\u00ean v\u00f2ng van.<\/li><li>T\u1ec9 l\u1ec7 t\u1eed vong: 2 &#8211; 5%.<\/li><\/ul><\/li><\/ul>\n\n\n\n<p class=\"has-medium-font-size\"><strong>Theo d\u00f5i<\/strong><\/p>\n\n\n\n<p><strong>Theo d\u00f5i h\u1eadu ph\u1eabu<\/strong><\/p>\n\n\n\n<ul><li>H\u1ed9i ch\u1ee9ng gi\u1ea3m cung l\u01b0\u1ee3ng tim (LCOS) do:<ul><li>Suy t\u00e2m tr\u01b0\u01a1ng v\u00e0 t\u00e2m thu th\u1ea5t ph\u1ea3i.<\/li><\/ul><ul><li>Suy th\u1ea5t tr\u00e1i (\u00edt g\u1eb7p).<\/li><\/ul><ul><li>R\u1ed1i lo\u1ea1n nh\u1ecbp kh\u00f4ng ki\u1ec3m so\u00e1t.<\/li><\/ul><ul><li>Th\u00f4ng li\u00ean th\u1ea5t t\u1ed3n l\u01b0u<\/li><\/ul><\/li><li>R\u1ed1i lo\u1ea1n nh\u1ecbp<\/li><\/ul>\n\n\n\n<p><strong>Theo d\u00f5i l\u00e2u d\u00e0i: bi\u1ebfn ch\u1ee9ng c\u00f3 th\u1ec3 g\u1eb7p.<\/strong><\/p>\n\n\n\n<ul><li>Suy ch\u1ee9c n\u0103ng th\u1ea5t ph\u1ea3i.<\/li><li>H\u1eb9p \u0111\u01b0\u1eddng tho\u00e1t th\u1ea5t ph\u1ea3i.<\/li><li>H\u1eb9p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.<\/li><li>H\u1edf van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.<\/li><li>Th\u00f4ng li\u00ean th\u1ea5t t\u1ed3n l\u01a3u.<\/li><li>R\u1ed1i lo\u1ea1n nh\u1ecbp.<\/li><li>\u0110\u1ed9t t\u1eed<\/li><\/ul>\n\n\n\n<p><strong><em>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/em><\/strong><\/p>\n\n\n\n<ul><li>Ph\u00e1c \u0111\u1ed3 ngo\u1ea1i nhi B\u1ec7nh vi\u1ec7n Nhi \u0111\u1ed3ng 2<\/li><li>https:\/\/www.heart.org\/en\/health-topics\/congenital-heart-defects\/about-congenital-heart-defects\/tetralogy-of-fallot<\/li><li>Constantine Mavroudis, Carl Backer, Richid F. Idriss. 2012. Pediatric Cardiac Surgery. Blackwell.<\/li><li>Mark Davenport, James D. Geiger. 2020. Operative Pediatric Surgery. London: CRC Press.<\/li><li>Mavroudis, Constantine, Backer, Carl Lewis (Eds.). 2015. Mavroudis, Constantine, Backer, Carl Lewis (Eds.). Springer.<\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"<div class=\"mh-excerpt\"><p>\u0110\u1ea1i c\u01b0\u01a1ng T\u1ee9 ch\u1ee9ng Fallot l\u00e0 d\u1ecb t\u1eadt tim b\u1ea9m sinh (TBS) t\u00edm th\u01b0\u1eddng g\u1eb7p nh\u1ea5t: 5-10% TBS; 3,26\/10.000 tr\u1ebb s\u01a1 sinh s\u1ed1ng, 1.300 ca m\u1edbi\/n\u0103m \u1edf M\u1ef9. T\u1ee9 ch\u1ee9ng Fallot g\u1ed3m 4 t\u1eadt (H\u00ecnh <a class=\"mh-excerpt-more\" href=\"http:\/\/phauthuatnhi.vn\/vi\/cacloaibenh\/tu-chung-fallot\/\" title=\"T\u1ee9 ch\u1ee9ng Fallot\">[&#8230;]<\/a><\/p>\n<\/div>","protected":false},"author":4,"featured_media":966,"comment_status":"open","ping_status":"open","sticky":false,"template":"template-full.php","format":"standard","meta":[],"categories":[4,11],"tags":[],"_links":{"self":[{"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/posts\/949"}],"collection":[{"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/comments?post=949"}],"version-history":[{"count":16,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/posts\/949\/revisions"}],"predecessor-version":[{"id":968,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/posts\/949\/revisions\/968"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/media\/966"}],"wp:attachment":[{"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/media?parent=949"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/categories?post=949"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/tags?post=949"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}