{"id":971,"date":"2021-09-18T23:23:48","date_gmt":"2021-09-18T16:23:48","guid":{"rendered":"http:\/\/phauthuatnhi.vn\/vi\/?p=971"},"modified":"2021-09-18T23:24:00","modified_gmt":"2021-09-18T16:24:00","slug":"thong-lien-that","status":"publish","type":"post","link":"http:\/\/phauthuatnhi.vn\/vi\/cacloaibenh\/thong-lien-that\/","title":{"rendered":"Th\u00f4ng li\u00ean th\u1ea5t"},"content":{"rendered":"\n<p class=\"has-medium-font-size\"><strong>\u0110\u1ea1i c\u01b0\u01a1ng<\/strong><\/p>\n\n\n\n<ul><li>Th\u00f4ng li\u00ean th\u1ea5t (TLT) l\u00e0 t\u1ed5n th\u01b0\u01a1ng b\u1ea9m sinh do khi\u1ebfm khuy\u1ebft m\u1ed9t hay nhi\u1ec1u n\u01a1i tr\u00ean v\u00e1ch li\u00ean th\u1ea5t khi\u1ebfn c\u00f3 s\u1ef1 th\u00f4ng th\u01b0\u01a1ng gi\u1eefa hai t\u00e2m th\u1ea5t (h\u00ecnh 1).<\/li><li>Th\u01b0\u1eddng g\u1eb7p th\u00f4ng li\u00ean th\u1ea5t ph\u1ea7n m\u00e0ng.<\/li><li>B\u1ec7nh th\u01b0\u1eddng g\u1eb7p nh\u1ea5t trong c\u00e1c d\u1ecb t\u1eadt tim b\u1ea9m sinh chi\u1ebfm t\u1ef7 l\u1ec7 25% trong c\u00e1c b\u1ec7nh tim b\u1ea9m sinh.<\/li><\/ul>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img loading=\"lazy\" width=\"430\" height=\"340\" src=\"http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/09\/tlt1.jpg\" alt=\"\" class=\"wp-image-989\" srcset=\"http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/09\/tlt1.jpg 430w, http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/09\/tlt1-300x237.jpg 300w\" sizes=\"(max-width: 430px) 100vw, 430px\" \/><figcaption><strong>H\u00ecnh 1: Th\u00f4ng li\u00ean th\u1ea5t<\/strong><\/figcaption><\/figure><\/div>\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>M\u1ec7t, kh\u00f3 th\u1edf khi g\u1eafng s\u1ee9c.<\/li><li>S\u1ed1t ho t\u00e1i ph\u00e1t nhi\u1ec1u l\u1ea7n do vi\u00eam ph\u1ed5i<\/li><li>Ch\u1eadm l\u1edbn, ch\u1eadm bi\u1ebft \u0111i.<\/li><li>Kh\u00e1m tim: di\u1ec7n tim l\u1edbn hay b\u00ecnh th\u01b0\u1eddng. S\u1edd c\u00f3 th\u1ec3 c\u00f3 rung mi\u00eau t\u00e2m thu. \u00c2m th\u1ed5i t\u00e2m thu c\u01b0\u1eddng \u0111\u1ed9 thay \u0111\u1ed5i, \u00e2m s\u1eafc trung b\u00ecnh hay cao, nghe r\u00f5 \u1edf kho\u1ea3ng li\u00ean s\u01b0\u1eddn IV tr\u00e1i b\u1edd \u1ee9c, c\u00f3 th\u1ec3 lan ra xung quanh. T2 vang m\u1ea1nh n\u1ebfu c\u00f3 t\u0103ng \u00e1p ph\u1ed5i.<\/li><li>Kh\u00e1m t\u00ecm c\u00e1c d\u1ea5u hi\u1ec7u suy tim.<\/li><li>Kh\u00e1m t\u00ecm d\u1ea5u hi\u1ec7u vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 s\u1ed1t k\u00e9o d\u00e0i.<\/li><li>Kh\u00e1m ph\u1ed5i \u0111\u1ec3 ph\u00e1t hi\u1ec7n nhi\u1ec5m tr\u00f9ng ph\u1ed5i \u0111i k\u00e8m<\/li><\/ul>\n\n\n\n<p class=\"has-medium-font-size\"><strong>Ch\u1ea9n \u0111o\u00e1n<\/strong><\/p>\n\n\n\n<ul><li>Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh d\u1ef1a v\u00e0o si\u00eau \u00e2m tim (h\u00ecnh 2). Si\u00eau \u00e2m tim gi\u00fap \u0111\u00e1nh gia ch\u1ee9c n\u0103ng tim, t\u00ecnh tr\u1ea1ng cao \u00e1p ph\u1ed5i v\u00e0 nh\u1eefng d\u1ecb t\u1eadt ph\u1ed1i h\u1ee3p.<\/li><li>ECG, X quang ng\u1ef1c.<\/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\/tlt2.jpg\" alt=\"\" class=\"wp-image-990\" width=\"534\" height=\"228\" srcset=\"http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/09\/tlt2.jpg 712w, http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/09\/tlt2-300x128.jpg 300w\" sizes=\"(max-width: 534px) 100vw, 534px\" \/><figcaption><strong>H\u00ecnh 2: H\u00ecnh \u1ea3nh si\u00eau \u00e2m tim th\u00f4ng li\u00ean th\u1ea5t<\/strong><\/figcaption><\/figure><\/div>\n\n\n\n<p class=\"has-medium-font-size\"><strong>\u0110i\u1ec1u tr\u1ecb<\/strong><\/p>\n\n\n\n<p><strong>Nguy\u00ean t\u1eafc<\/strong><\/p>\n\n\n\n<ul><li>\u0110\u00f3ng l\u1ed7 th\u00f4ng (b\u1eb1ng ph\u1eabu thu\u1eadt ho\u1eb7c th\u00f4ng tim can thi\u1ec7p).<\/li><li>Ph\u00f2ng ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c bi\u1ebfn ch\u1ee9ng n\u1ed9i khoa.<\/li><\/ul>\n\n\n\n<p><strong>N\u1ed9i khoa<\/strong><\/p>\n\n\n\n<ul><li>\u0110i\u1ec1u tr\u1ecb suy tim n\u1ebfu c\u00f3<\/li><li>\u0110i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng h\u00f4 h\u1ea5p n\u1ebfu c\u00f3<\/li><li>\u0110i\u1ec1u tr\u1ecb suy dinh d\u01b0\u1ee1ng<\/li><li>Ph\u00f2ng ng\u1eeba vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m tr\u00f9ng<\/li><li>Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i n\u1eb7ng (h\u1ed9i ch\u1ee9ng Eissenmenger, \u00e1p l\u1ef1c \u0110MP t\u00e2m thu \u2265 \u00e1p l\u1ef1c h\u1ec7 th\u1ed1ng), c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb v\u1edbi Sildenafil u\u1ed1ng 0,3 mg\/kg\/3-6 gi\u1edd (t\u1ed1i \u0111a 1 mg\/kg\/li\u1ec1u). Sau 4 tu\u1ea7n n\u1ebfu kh\u00f4ng \u0111\u00e1p \u1ee9ng s\u1ebd ng\u1eebng s\u1eed d\u1ee5ng.<\/li><\/ul>\n\n\n\n<p><strong>\u0110i\u1ec1u tr\u1ecb th\u00f4ng tim can thi\u1ec7p \u0111\u00f3ng l\u1ed7 th\u00f4ng: (h\u00ecnh 3)<\/strong><\/p>\n\n\n\n<ul><li>Th\u00f4ng li\u00ean th\u1ea5t c\u01a1 b\u00e8 l\u1edbn, c\u00f2n shunt tr\u00e1i-ph\u1ea3i, g\u00e2y l\u1edbn th\u1ea5t tr\u00e1i ho\u1eb7c nh\u0129 tr\u00e1i ho\u1eb7c t\u1ec9 s\u1ed1 Qp\/Qs \u22652:1, r\u00eca \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 >4 mm<\/li><li>Th\u00f4ng li\u00ean th\u1ea5t ph\u1ea7n m\u00e0ng l\u1edbn, c\u00f2n shunt tr\u00e1i-ph\u1ea3i, g\u00e2y l\u1edbn th\u1ea5t tr\u00e1i ho\u1eb7c nh\u0129 tr\u00e1i ho\u1eb7c t\u1ec9 s\u1ed1 Qp\/Qs \u22652:1, c\u00e2n n\u1eb7ng >5kg, r\u00eca \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 >2 mm<\/li><li>Th\u00f4ng li\u00ean th\u1ea5t l\u1ed7 nh\u1ecf, ph\u1ea7n m\u00e0ng (r\u00eca \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 >2 mm) ho\u1eb7c c\u01a1 b\u00e8 (r\u00eca \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 >4 mm), nh\u01b0ng kh\u00f4ng c\u00f2n kh\u1ea3 n\u0103ng t\u1ef1 \u0111\u00f3ng (>8 tu\u1ed5i) ho\u1eb7c t\u1eebng c\u00f3 ti\u1ec1n c\u0103n vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m tr\u00f9ng.<\/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\/tlt3.jpg\" alt=\"\" class=\"wp-image-991\" width=\"438\" height=\"314\" srcset=\"http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/09\/tlt3.jpg 584w, http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/09\/tlt3-300x215.jpg 300w\" sizes=\"(max-width: 438px) 100vw, 438px\" \/><figcaption><strong>H\u00ecnh 3<\/strong>: <strong>Can thi\u1ec7p n\u1ed9i m\u1ea1ch \u0111\u00f3ng l\u1ed7 th\u00f4ng li\u00ean th\u1ea5t<\/strong><\/figcaption><\/figure><\/div>\n\n\n\n<p><strong>Ph\u1eabu thu\u1eadt<\/strong><\/p>\n\n\n\n<ul><li>Ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt:<ul><li>TLT l\u1ed7 nh\u1ecf ph\u1ea7n ti\u1ebfp nh\u1eadn v\u00e0 ph\u1ea7n ph\u1ec5u.<\/li><li>TLT l\u1ed7 l\u1edbn \u1edf v\u1ecb tr\u00ed b\u1ea5t k\u1ef3 c\u00f2n shunt tr\u00e1i-ph\u1ea3i, suy tim, ch\u1eadm ph\u00e1t tri\u1ec3n th\u1ec3 ch\u1ea5t, th\u01b0\u1eddng xuy\u00ean nhi\u1ec5m tr\u00f9ng ph\u1ed5i<\/li><\/ul><\/li><li>\u00a0Ph\u1eabu thu\u1eadt: \u0111\u00f3ng l\u1ed7 th\u00f4ng li\u00ean th\u1ea5t.<\/li><\/ul>\n\n\n\n<p class=\"has-medium-font-size\"><strong>T\u00e1i kh\u00e1m<\/strong><\/p>\n\n\n\n<p><strong>Sau khi \u0111\u00f3ng l\u1ed7 th\u00f4ng b\u1eb1ng d\u1ee5ng c\u1ee5:<\/strong><\/p>\n\n\n\n<ul><li>U\u1ed1ng Aspirin ch\u1ed1ng \u0111\u00f4ng m\u00e1u trong 6 th\u00e1ng.<\/li><li>T\u00e1i kh\u00e1m, theo d\u00f5i l\u00e2m s\u00e0ng v\u00e0 si\u00eau \u00e2m tim \u0111\u1ecbnh k\u1ef3 v\u00e0o c\u00e1c th\u1eddi \u0111i\u1ec3m 1 tu\u1ea7n, 1 th\u00e1ng, 3 th\u00e1ng, 6 th\u00e1ng, 12 th\u00e1ng sau khi \u0111\u00f3ng l\u1ed7 th\u00f4ng b\u1eb1ng d\u1ee5ng c\u1ee5.<\/li><\/ul>\n\n\n\n<p><strong>Sau ph\u1eabu thu\u1eadt:<\/strong><\/p>\n\n\n\n<ul><li>T\u00e1i kh\u00e1m \u0111\u1ecbnh k\u1ef3, kh\u00e1m l\u00e2m s\u00e0ng, ECG, X-quang ng\u1ef1c v\u00e0 si\u00eau \u00e2m tim<\/li><li>Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u00f3 suy tim, cao \u00e1p ph\u1ed5i tr\u01b0\u1edbc ph\u1eabu thu\u1eadt s\u1ebd ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb sau ph\u1eabu thu\u1eadt cho t\u1edbi khi c\u00e1c tri\u1ec7u ch\u1ee9ng bi\u1ebfn m\u1ea5t<\/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>https:\/\/www.heart.org\/en\/health-topics\/congenital-heart-defects\/about-congenital-heart-defects\/ventricular-septal-defect-vsd<\/li><li>Constantine Mavroudis, Carl Backer, Richid F. Idriss. 2012. Pediatric Cardiac Surgery. Blackwell.<\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"<div class=\"mh-excerpt\"><p>\u0110\u1ea1i c\u01b0\u01a1ng Th\u00f4ng li\u00ean th\u1ea5t (TLT) l\u00e0 t\u1ed5n th\u01b0\u01a1ng b\u1ea9m sinh do khi\u1ebfm khuy\u1ebft m\u1ed9t hay nhi\u1ec1u n\u01a1i tr\u00ean v\u00e1ch li\u00ean th\u1ea5t khi\u1ebfn c\u00f3 s\u1ef1 th\u00f4ng th\u01b0\u01a1ng gi\u1eefa hai t\u00e2m th\u1ea5t (h\u00ecnh 1). Th\u01b0\u1eddng g\u1eb7p <a class=\"mh-excerpt-more\" href=\"http:\/\/phauthuatnhi.vn\/vi\/cacloaibenh\/thong-lien-that\/\" title=\"Th\u00f4ng li\u00ean th\u1ea5t\">[&#8230;]<\/a><\/p>\n<\/div>","protected":false},"author":4,"featured_media":989,"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\/971"}],"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=971"}],"version-history":[{"count":6,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/posts\/971\/revisions"}],"predecessor-version":[{"id":996,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/posts\/971\/revisions\/996"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/media\/989"}],"wp:attachment":[{"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/media?parent=971"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/categories?post=971"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/tags?post=971"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}