{"id":32331,"date":"2022-04-25T10:56:06","date_gmt":"2022-04-25T03:56:06","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=32331"},"modified":"2022-04-26T08:09:54","modified_gmt":"2022-04-26T01:09:54","slug":"can-thiep-thu-thuat-y-khoa-tren-benh-nhan-co-thiet-bi-dien-cay-ghep-tim","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/can-thiep-thu-thuat-y-khoa-tren-benh-nhan-co-thiet-bi-dien-cay-ghep-tim\/","title":{"rendered":"Can thi\u1ec7p th\u1ee7 thu\u1eadt y khoa tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 thi\u1ebft b\u1ecb \u0111i\u1ec7n c\u1ea5y gh\u00e9p tim"},"content":{"rendered":"

vnras.com\/drug<\/a> – B\u00e0i vi\u1ebft Can thi\u1ec7p th\u1ee7 thu\u1eadt y khoa tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 thi\u1ebft b\u1ecb \u0111i\u1ec7n c\u1ea5y gh\u00e9p tim<\/a>.<\/strong><\/p>\n

\u0110\u1ecaNH NGH\u0128A<\/h2>\n
\n
Thi\u1ebft b\u1ecb \u0111i\u1ec7n c\u1ea5y gh\u00e9p tim (CIEDs, cardiac implantable electronic devices) bao g\u1ed3m: m\u00e1y t\u1ea1o nh\u1ecbp tim (PM), c\u1ea5y ph\u00e1 rung (ICD), t\u00e1i \u0111\u1ed3ng b\u1ed9 tim (CRT) v\u00e0 theo d\u00f5i nh\u1ecbp tim (ILR).<\/li>\n
M\u1ed9t s\u1ed1 can thi\u1ec7p y khoa b\u00ean ngo\u00e0i, c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 nhi\u1ec5u, c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u00e1c thi\u1ebft b\u1ecb \u0111i\u1ec7n c\u1ea5y gh\u00e9p tim n\u00e0y.<\/li>\n
C\u00e1c d\u1ea1ng n\u0103ng l\u01b0\u1ee3ng nh\u01b0 tia x\u1ea1, c\u1ed9ng h\u01b0\u1edfng t\u1eeb ho\u1eb7c \u0111i\u1ec7n t\u1eeb tr\u01b0\u1eddng (EMF), c\u0169ng nh\u01b0 c\u00e1c t\u00edn hi\u1ec7u \u00e2m thanh \u0111\u1eb7c bi\u1ec7t c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng th\u00f4ng qua vi\u1ec7c g\u00e2y qu\u00e1 nh\u1eadn c\u1ea3m (oversensing) (t\u00edn hi\u1ec7u \u0111\u01b0\u1ee3c m\u00e1y c\u1ea3m nh\u1eadn m\u00e0 kh\u00f4ng ph\u1ea3i do kh\u1eed c\u1ef1c c\u1ee7a c\u01a1 tim) g\u00e2y \u1ee9c ch\u1ebf t\u1ea1m th\u1eddi ho\u1eb7c \u0111i\u1ec1u tr\u1ecb kh\u00f4ng th\u00edch h\u1ee3p t\u1eeb thi\u1ebft b\u1ecb, l\u1ed7i l\u1eadp tr\u00ecnh (kh\u1edfi \u0111\u1ed9ng l\u1ea1i thi\u1ebft b\u1ecb), ho\u1eb7c th\u1eadm ch\u00ed g\u00e2y m\u1ea5t ch\u1ee9c n\u0103ng v\u0129nh vi\u1ec5n.<\/li>\n<\/ul>\n\n\n\n\n\n\n\n\n\n
Lo\u1ea1i t\u00edn hi\u1ec7u<\/td>\n Ngu\u1ed3n t\u00edn hi\u1ec7u<\/td>\n \u1ea2nh h\u01b0\u1edfng<\/td>\n T\u1ea7n su\u1ea5t<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
\u0110i\u1ec7n t\u1eeb<\/td>\n \u0110\u1ed1t \u0111i\u1ec7n<\/td>\n D, 0, R,l<\/td>\n H<\/td>\n T\u00e1c \u0111\u1ed9ng ph\u1ee5 thu\u1ed9c v\u00e0o c\u01b0\u1eddng \u0111\u1ed9 tr\u01b0\u1eddng c\u0169ng nh\u01b0 kho\u1ea3ng c\u00e1ch \u0111\u1ebfn m\u00e1y v\u00e0 d\u00e2y d\u1eabn<\/td>\n<\/tr>\n
Tri\u1ec7t \u0111\u1ed1t v\u1edbi s\u00f3ng cao t\u1ea7n<\/td>\n D, 0,1<\/td>\n H<\/td>\n<\/tr>\n
\u0110\u1ed1t s\u00f3ng cao t\u1ea7n kh\u00f4ng t\u1ea1i tim<\/td>\n 0,1<\/td>\n M<\/td>\n<\/tr>\n
Thi\u1ebft b\u1ecb nh\u1eadn d\u1ea1ng s\u00f3ng cao t\u1ea7n<\/td>\n 0,1<\/td>\n L<\/td>\n<\/tr>\n
Li\u1ec7u ph\u00e1p k\u00edch th\u00edch \u0111i\u00ean (TENS, EMS,<\/p>\n
SCS)<\/td>\n
0,1<\/td>\n H<\/td>\n<\/tr>\n
Li\u1ec7u ph\u00e1p th\u1ea5u nhi\u1ec7t<\/td>\n 0,1<\/td>\n L<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
D: ph\u00e1 h\u1ee7y tr\u1ef1c ti\u1ebfp thi\u1ebft b\u1ecb ho\u1eb7c d\u00e2y d\u1eabn; O: qu\u00e1 nh\u1eadn c\u1ea3m, R: t\u00e1i kh\u1edfi \u0111\u1ed9ng l\u1ea1i thi\u1ebft b\u1ecb; I: ch\u1ed1ng nh\u1ecbp nhanh ho\u1eb7c t\u1ea1o nh\u1ecbp kh\u00f4ng th\u00edch h\u1ee3p t\u1eeb ICD; H: cao (>1\/10); M: trung b\u00ecnh (1\/100); L: th\u1ea5p (<l\/1000).<\/p>\n
<\/p>\n\n\n\n\n\n\n\n\n
Lo\u1ea1i t\u00edn hi\u1ec7u<\/td>\n Ngu\u1ed3n t\u00edn hi\u1ec7u<\/td>\n \u1ea2nh h\u01b0\u1edfng<\/td>\n “lan su\u1ea5t<\/td>\n M\u1ee9c \u0111\u1ed9<\/td>\n<\/tr>\n
Tr\u1ecb li\u1ec7u b\u1ee9c x\u1ea1 ion h\u00f3a<\/td>\n Tia gamma<\/td>\n D, 0, R, I, h\u01b0 pin
\n\u0111\u1ed9t ng\u1ed9t<\/td>\n L<\/td>\n<\/tr>\n
Photon<\/td>\n M<\/td>\n<\/tr>\n
Proton<\/td>\n H<\/td>\n<\/tr>\n
Carbon<\/td>\n L<\/td>\n T\u00e1c \u0111\u1ed9ng ph\u1ee5 thu\u1ed9c v\u00e0o li\u1ec1u b\u1ee9c x\u1ea1 t\u00edch l\u0169y tr\u00ean m\u00e1y v\u00e0 s\u1ef1 ph\u01a1i nhi\u1ec5m neutron<\/td>\n<\/tr>\n
S\u00f3ng \u00e2m<\/td>\n T\u00e1n s\u1ecfi<\/td>\n D, 0,1<\/td>\n L<\/td>\n S\u00f3ng xung k\u00edch c\u00f3 th\u1ec3 g\u00e2y bi\u1ebfn d\u1ea1ng c\u01a1 h\u1ecdc<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
D: ph\u00e1 h\u1ee7y tr\u1ef1c ti\u1ebfp thi\u1ebft b\u1ecb ho\u1eb7c d\u00e2y d\u1eabn; O: qu\u00e1 nh\u1eadn c\u1ea3m, R: t\u00e1i kh\u1edfi \u0111\u1ed9ng l\u1ea1i thi\u1ebft b\u1ecb; I: ch\u1ed1ng nh\u1ecbp nhanh ho\u1eb7c t\u1ea1o nh\u1ecbp kh\u00f4ng th\u00edch h\u1ee3p t\u1eeb ICD; H: cao (>1\/10); M: trung b\u00ecnh (1\/100); L: th\u1ea5p (<1\/1000).<\/p>\n\n\n\n\n\n\n\n\n
Lo\u1ea1i t\u00edn hi\u1ec7u<\/td>\n Ngu\u1ed3n t\u00edn hi\u1ec7u<\/td>\n \u1ea2nh h\u01b0\u1edfng<\/td>\n T\u1ea7n su\u1ea5t<\/td>\n M\u1ee9c \u0111\u1ed9<\/td>\n<\/tr>\n
H\u1ed7n h\u1ee3p<\/td>\n S\u1ed1c \u0111i\u1ec7n kh\u1eed rung ho\u1eb7c chuy\u1ec3n nh\u1ecbp<\/td>\n R,D<\/td>\n M<\/td>\n T\u00e1c \u0111\u1ed9ng ph\u1ee5 thu\u1ed9c v\u00e0o 1 v\u1ecb tr\u00ed \u0111\u1eb7t so v\u1edbi CIED<\/td>\n<\/tr>\n
Li\u1ec7u ph\u00e1p s\u1ed1c \u0111i\u1ec7n<\/td>\n I<\/td>\n M<\/td>\n<\/tr>\n
T\u1eeb tr\u01b0\u1eddng m\u1edf r\u1ed9ng m\u00f4<\/td>\n I<\/td>\n L<\/td>\n<\/tr>\n
\u0110i\u1ec7n c\u01a1<\/td>\n 0<\/td>\n L<\/td>\n<\/tr>\n
\u0110a t\u00edn hi\u1ec7u<\/td>\n C\u1ed9ng h\u01b0\u1edfng t\u1eeb<\/td>\n D, 0, R, I, h\u01b0 pin \u0111\u1ed9t ng\u1ed9t<\/td>\n H<\/td>\n T\u00e1c \u0111\u1ed9ng ph\u1ee5 thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd ch\u1ee5p MRI v\u00e0 l\u1eadp tr\u00ecnh m\u00e1y<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
D: ph\u00e1 h\u1ee7y tr\u1ef1c ti\u1ebfp thi\u1ebft b\u1ecb ho\u1eb7c d\u00e2y d\u1eabn; O: qu\u00e1 nh\u1eadn c\u1ea3m, R: t\u00e1i kh\u1edfi \u0111\u1ed9ng l\u1ea1i thi\u1ebft b\u1ecb; I: ch\u1ed1ng nh\u1ecbp nhanh ho\u1eb7c t\u1ea1o nh\u1ecbp kh\u00f4ng th\u00edch h\u1ee3p t\u1eeb ICD; H: cao (>1\/10); M: trung b\u00ecnh (1\/100); L: th\u1ea5p (<1\/1000).<\/p>\n
T\u1ea6N SU\u1ea4T<\/h2>\n
\n
Ph\u1ea7n l\u1edbn c\u00e1c ngu\u1ed3n g\u00e2y nhi\u1ec5u c\u00f3 ngu\u1ed3n g\u1ed1c phi sinh h\u1ecdc v\u00e0 x\u1ea3y ra v\u00e0 h\u1ea7u h\u1ebft \u0111\u1ec1u c\u00f3 th\u1ec3 tr\u00e1nh \u0111\u01b0\u1ee3c.<\/li>\n
Nhi\u1ec5u \u0111i\u1ec7n t\u1eeb (EMI, Electromagnetic interference) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n b\u1eb1ng c\u00e1ch ki\u1ec3m tra thi\u1ebft b\u1ecb v\u00e0 ph\u00e2n t\u00edch \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 trong tim v\u00e0 kh\u00f4ng ph\u1ea3i hi\u1ebfm g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n CIED: trong c\u00e1c nghi\u00ean c\u1ee9u \u0111\u01a1n trung t\u00e2m, t\u1ef7 l\u1ec7 EMI \u1edf CIED \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 1,87% b\u1ec7nh nh\u00e2n-n\u0103m, trong \u0111\u00f3 t\u00e1c \u0111\u1ed9ng g\u00e2y bi\u1ec3u hi\u1ec7n tr\u00ean l\u00e2m s\u00e0ng l\u00e0 0,27%.<\/li>\n
Do \u0111\u00f3, th\u00f4ng tin v\u1ec1 ngu\u1ed3n t\u00edn hi\u1ec7u, c\u01a1 ch\u1ebf, t\u00e1c \u0111\u1ed9ng c\u1ee7a thi\u1ebft b\u1ecb v\u00e0 vi\u1ec7c ph\u00f2ng ng\u1eeba EMI l\u00e0 r\u1ea5t quan tr\u1ecdng.<\/li>\n<\/ul>\n
PH\u1ea2N \u1ee8NG C\u1ee6A CIED V\u1edaI T\u00cdN HI\u1ec6U NHI\u1ec4U<\/h2>\n
Qu\u00e1 nh\u1eadn c\u1ea3m g\u00e2y ra b\u1edfi EMI c\u00f3 nhi\u1ec1u bi\u1ec3u hi\u1ec7n kh\u00e1c nhau:<\/p>\n
Tr\u00ean h\u1ec7 th\u1ed1ng t\u1ea1o nh\u1ecbp:<\/p>\n
\n
Qu\u00e1 nh\u1eadn c\u1ea3m \u1edf nh\u0129 g\u00e2y th\u00fac \u0111\u1ea9y t\u1ea1o nh\u1ecbp th\u1ea5t kh\u00f4ng th\u00edch h\u1ee3p ho\u1eb7c l\u00e0m m\u00e1y xem nh\u01b0 m\u1ed9t bi\u1ebfn c\u1ed1 v\u1edbi t\u1ea7n s\u1ed1 nh\u0129 cao v\u00e0 c\u00f3 th\u1ec3 l\u00e0m thay \u0111\u1ed5i ch\u1ebf \u0111\u1ed9 c\u00e0i c\u1ee7a m\u00e1y.<\/li>\n
Qu\u00e1 nh\u1eadn c\u1ea3m \u1edf th\u1ea5t khi\u1ebfn m\u00e1y xem c\u00e1c t\u00edn hi\u1ec7u nhi\u1ec5u l\u00e0 s\u00f3ng R n\u1ed9i t\u1ea1i t\u1eeb \u0111\u00f3 s\u1ebd \u1ee9c ch\u1ebf t\u1ea1o nh\u1ecbp th\u1ea5t, \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn v\u00f4 t\u00e2m thu v\u00e0 ng\u1ea5t tr\u00ean b\u1ec7nh nh\u00e2n ph\u1ee5 thu\u1ed9c m\u00e1y t\u1ea1o nh\u1ecbp.<\/li>\n<\/ul>\n
Tr\u00ean h\u1ec7 th\u1ed1ng ICD:<\/p>\n
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Qu\u00e1 nh\u1eadn c\u1ea3m \u1edf th\u1ea5t kh\u00f4ng ch\u1ec9 \u1ee9c ch\u1ebf t\u1ea1o nh\u1ecbp th\u1ea5t m\u00e0 c\u00f3 th\u1ec3 khi\u1ebfn m\u00e1y t\u1ef1 \u0111\u1ed9ng ph\u00f3ng th\u00edch c\u01a1n s\u1ed1c \u0111i\u1ec7n v\u00ec rung th\u1ea5t, n\u1ebfu n\u00f3 k\u00e9o d\u00e0i \u0111\u1ee7 l\u00e2u.<\/li>\n
T\u00edn hi\u1ec7u EMI tho\u00e1ng qua c\u00f3 th\u1ec3 ch\u1ec9 thay \u0111\u1ed5i ch\u1ee9c n\u0103ng CIED t\u1ea1m th\u1eddi, ng\u01b0\u1ee3c l\u1ea1i t\u00edn hi\u1ec7u k\u00e9o d\u00e0i v\u00e0 l\u1eb7p l\u1ea1i nhi\u1ec1u l\u1ea7n c\u00f3 th\u1ec3 thay \u0111\u1ed5i c\u00e0i \u0111\u1eb7t c\u1ee7a thi\u1ebft b\u1ecb, khi\u1ebfn thi\u1ebft b\u1ecb kh\u00f4ng th\u1ec3 t\u1ef1 h\u1ed3i ph\u1ee5c sau khi ng\u01b0ng EMI.<\/li>\n
Thi\u1ebft b\u1ecb CIED sau \u0111\u00f3 c\u00f3 th\u1ec3 tr\u1edf v\u1ec1 ch\u1ebf \u0111\u1ed9 “back-up”, th\u1eadm ch\u00ed v\u1ec1 ch\u1ebf \u0111\u1ed9 “reset mode”, d\u1eabn \u0111\u1ebfn vi\u1ec7c c\u1ea7n ph\u1ea3i l\u1eadp tr\u00ecnh l\u1ea1i thi\u1ebft b\u1ecb.<\/li>\n<\/ul>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
T\u1ea1o nh\u1ecbp<\/td>\n T\u00e1c \u0111\u1ed9ng<\/td>\n<\/tr>\n
\u1ee9c ch\u1ebf t\u1ea1o nh\u1ecbp trong bu\u1ed3ng tim c\u00f9ng b\u00ean (qu\u00e1 nh\u1eadn c\u1ea3m th\u1ea5t)<\/td>\n T<\/td>\n<\/tr>\n
T\u1ea1o nh\u1ecbp bu\u1ed3ng tim \u0111\u1ed1i b\u00ean (t\u1ea1o nh\u1ecbp th\u1ea5t do qu\u00e1 nh\u1eadn c\u1ea3m nh\u0129)<\/td>\n T<\/td>\n<\/tr>\n
Thay \u0111\u1ed5i \u0111\u00e1p \u1ee9ng nh\u1ecbp tim<\/td>\n T<\/td>\n<\/tr>\n
T\u1ea1o nh\u1ecbp kh\u00f4ng \u0111\u1ed3ng b\u1ed9, m\u1ea5t \u0111\u1ed3ng b\u1ed9 nh\u0129 th\u1ea5t tr\u00ean thi\u1ebft b\u1ecb 2 bu\u1ed3ng<\/td>\n T<\/td>\n<\/tr>\n
Chuy\u1ec3n ch\u1ebf \u0111\u1ed9 kh\u00f4ng th\u00edch h\u1ee3p ho\u1eb7c t\u1ea1o nh\u1ecbp v\u01b0\u1ee3t t\u1ea7n s\u1ed1 nh\u0129 do qu\u00e1 nh\u1eadn c\u1ea3m nh\u0129<\/td>\n T<\/td>\n<\/tr>\n
Thay \u0111\u1ed5i ng\u01b0\u1ee1ng t\u1ea1o nh\u1ecbp\/nh\u1eadn c\u1ea3m<\/td>\n T<\/td>\n<\/tr>\n
M\u1ea5t t\u1ea1o nh\u1ecbp (nh\u1ecbp nhanh do m\u00e1y t\u1ea1o nh\u1ecbp)<\/td>\n p<\/td>\n<\/tr>\n
Chuy\u1ec3n ch\u1ebf \u0111\u1ed9 reset ho\u1eb7c backup<\/td>\n p<\/td>\n<\/tr>\n
\u2022 T: tho\u00e1ng qua; P: k\u00e9o d\u00e0i<\/td>\n<\/tr>\n
ICD<\/td>\n T\u00e1c \u0111\u1ed9ng<\/td>\n<\/tr>\n
Thay \u0111\u1ed5i ch\u1ee9c n\u0103ng ch\u1ed1ng nh\u1ecbp ch\u1eadm<\/td>\n T<\/td>\n<\/tr>\n
S\u1ed1c \u0111i\u1ec7n ho\u1eb7c t\u1ea1o nh\u1ecbp v\u01b0\u1ee3t t\u1ea7n s\u1ed1 kh\u00f4ng th\u00edch h\u1ee3p<\/td>\n T<\/td>\n<\/tr>\n
T\u1ea1o nh\u1ecbp xen k\u1ebd ho\u1eb7c t\u1ea1o nh\u1ecbp kh\u00f4ng th\u00edch h\u1ee3p<\/td>\n T<\/td>\n<\/tr>\n
H\u01b0 pin \u0111\u1ed9t ng\u1ed9t<\/td>\n P<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
T: tho\u00e1ng qua; P: k\u00e9o d\u00e0i<\/p>\n
CHU\u1ea8N B\u1eca TR\u01af\u1edaC TH\u1ee6 THU\u1eacT<\/h2>\n
C\u1ea7n x\u00e1c \u0111\u1ecbnh chi ti\u1ebft v\u1ec1 lo\u1ea1i thi\u1ebft b\u1ecb, nh\u00e0 s\u1ea3n xu\u1ea5t, t\u00ecnh tr\u1ea1ng pin v\u00e0 c\u00e0i tr\u01b0\u1edbc khi th\u1ef1c hi\u1ec7n can thi\u1ec7p:<\/p>\n
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T\u00ecm hi\u1ebfu v\u1ec1 th\u1ee7 thu\u1eadt (v\u00f9ng x\u1ea1 tr\u1ecb, ch\u1ec9 \u0111\u1ecbnh, v\u1ecb tr\u00ed ph\u1eabu thu\u1eadt v\u00e0 gi\u1ea3i ph\u1eabu, t\u01b0 th\u1ee7 thu\u1eadt…)<\/li>\n
X\u00e1c \u0111\u1ecbnh lo\u1ea1i thi\u1ebft b\u1ecb CIED<\/li>\n
\u0110\u00e1nh gi\u00e1 s\u1ef1 ph\u1ee5 thu\u1ed9c m\u00e1y t\u1ea1o nh\u1ecbp c\u1ee7a b\u1ec7nh nh\u00e2n<\/li>\n
Ph\u00e2n t\u1ea7ng nguy c\u01a1 r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t chu ph\u1eabu<\/li>\n
\u01af\u1edbc l\u01b0\u1ee3ng m\u1ee9c \u0111\u1ed9 nhi\u1ec5u \u0111i\u1ec7n t\u1eeb<\/li>\n
X\u00e1c \u0111\u1ecbnh s\u1ef1 c\u1ea7n thi\u1ebft v\u00e0 \u0111\u1ed9 quan tr\u1ecdng c\u1ee7a CIED<\/li>\n<\/ul>\n
N\u1ebfu h\u1ed3 s\u01a1 v\u1ec1 thi\u1ebft b\u1ecb kh\u00f4ng c\u00f3 s\u1eb5n, ch\u1ee5p X-quang ng\u1ef1c r\u1ea5t h\u1eefu \u00edch v\u00e0 c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh lo\u1ea1i thi\u1ebft b\u1ecb.<\/p>\n
$\"Ch\u1ee5p$ <\/p>\n
PH\u1ee4 THU\u1ed8C M\u00c1Y T\u1ea0O NH\u1ecaP<\/h2>\n
\n
\u0110\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a khi m\u1ea5t nh\u1ecbp tho\u00e1t n\u1ed9i t\u1ea1i ho\u1eb7c t\u1ea7n s\u1ed1 tim th\u1ea5p (< 50 l\/p) g\u00e2y ra c\u00e1c tri\u1ec7u ch\u1ee9ng do nh\u1ecbp ch\u1eadm, \u0111\u00e2y c\u00f3 th\u1ec3 l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a ng\u01b0ng xoang ho\u1eb7c bl\u1ed1c nh\u0129 th\u1ea5t.<\/li>\n
Ch\u1ea9n \u0111o\u00e1n d\u1ef1a v\u00e0o ti\u1ec1n s\u1eed b\u1ec7nh nh\u01b0 t\u1eebng tr\u1ea3i qua th\u1ee7 thu\u1eadt \u0111\u1ed1t n\u00fat nh\u0129 th\u1ea5t tr\u01b0\u1edbc \u0111\u00f3, ho\u1eb7c nh\u1ecbp m\u00e1y h\u1ea7u nh\u01b0 g\u1ea7n 100% khi ph\u00e2n t\u00edch t\u1eeb CIED.<\/li>\n
B\u1ec7nh nh\u00e2n c\u00f3 nh\u1ecbp nh\u0129 th\u1ea5t \u0111\u1ed3ng nh\u1ea5t tr\u00ean ECG v\u1edbi t\u1ea7n s\u1ed1 > 50 l\/p th\u01b0\u1eddng kh\u00f4ng ph\u1ee5 thu\u1ed9c m\u00e1y t\u1ea1o nh\u1ecbp.<\/li>\n
Tuy nhi\u00ean s\u1ef1 c\u00f3 m\u1eb7t c\u1ee7a nh\u1ecbp n\u1ed9i t\u1ea1i kh\u00f4ng ch\u1ee9ng minh ho\u1eb7c b\u1ea3o \u0111\u1ea3m tuy\u1ec7t \u0111\u1ed1i, \u0111\u1eb7c bi\u1ec7t khi b\u1ec7nh nh\u00e2n g\u00e2y m\u00ea. c\u1ea7n theo d\u00f5i li\u00ean t\u1ee5c nh\u1ecbp tim tr\u00ean nh\u1eefng th\u1ee7 thu\u1eadt c\u00f3 nguy c\u01a1 EMI cao.<\/li>\n<\/ul>\n
PH\u00c2N T\u1ea6NG NGUY C\u01a0 R\u1ed0I LO\u1ea0N NH\u1ecaP TH\u1ea4T CHU PH\u1eaaU<\/h2>\n
\n
D\u1ef1a tr\u00ean b\u1ec7nh s\u1eed, b\u1ec7nh l\u00fd tim m\u1ea1ch k\u00e8m theo, ch\u1ec9 \u0111\u1ecbnh c\u1ea5y CIED v\u00e0 ti\u1ec1n s\u1eed r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t ho\u1eb7c c\u1ea7n tr\u1ecb li\u1ec7u t\u1eeb ICD trong 6 th\u00e1ng g\u1ea7n \u0111\u00e2y.<\/li>\n
Ph\u1eabu thu\u1eadt t\u1ea1o ra stress v\u1edbi s\u1ef1 m\u1ea5t c\u00e2n b\u1eb1ng t\u1ef1 ch\u1ee7 v\u00e0 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i, thay \u0111\u1ed5i c\u00e2n b\u1eb1ng d\u1ecbch v\u00e0 t\u0103ng nhu c\u1ea7u oxy c\u1ee7a c\u01a1 tim. Nh\u1eefng y\u1ebfu t\u1ed1 n\u00e0y l\u00e0m p th\u1ea5t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh tim c\u1ea5u tr\u00fac v\u00e0 b\u1ec7nh l\u00fd k\u00eanh.<\/li>\n
Ng\u01b0\u1ee3c l\u1ea1i, k\u1ef9 thu\u1eadt g\u00e2y m\u00ea th\u1ea7n kinh, qu\u1ea3n l\u00fd ch\u1ed1ng lo\u1ea1n nh\u1ecbp v\u00e0 \u0111au sau ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m g\u00e1nh n\u1eb7ng r\u1ed1i lo\u1ea1n nh\u1ecbp tim.<\/li>\n<\/ul>\n
\u0110\u00c1NH GI\u00c1 SAU TH\u1ee6 THU\u1eacT<\/h2>\n
\n
Ki\u1ec3m tra c\u00e1c bi\u1ebfn c\u1ed1 r\u1ed1i lo\u1ea1n nh\u1ecbp c\u00f3 li\u00ean quan trong th\u1ee7 thu\u1eadt.<\/li>\n
Ki\u1ec3m tra thi\u1ebft b\u1ecb (l\u1eadp tr\u00ecnh m\u00e1y, ng\u01b0\u1ee1ng, t\u00ecnh tr\u1ea1ng pin, c\u1ea3nh b\u00e1o…)<\/li>\n
L\u1eadp tr\u00ecnh l\u1ea1i c\u00e0i \u0111\u1eb7t khi khi ti\u1ebfn h\u00e0nh th\u1ee7 thu\u1eadt n\u1ebfu c\u1ea7n thi\u1ebft<\/li>\n
K\u00edch ho\u1ea1t l\u1ea1i ch\u1ee9c n\u1eb7ng ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n nh\u1ecbp nhanh tr\u00ean ICD c\u00e0ng nhanh c\u00e0ng t\u1ed1t<\/li>\n<\/ul>\n
TH\u1ee6 THU\u1eacT LI\u00caN QUAN PH\u1eaaU THU\u1eacT<\/h2>\n
\n
Vi\u1ec7c s\u1eed d\u1ee5ng nam ch\u00e2m trong ph\u1eabu thu\u1eadt cho b\u1ec7nh nh\u00e2n c\u00f3 m\u00e1y t\u1ea1o nh\u1ecbp n\u00ean \u0111\u01b0\u1ee3c \u01b0u ti\u00ean n\u1ebfu c\u00f3 th\u1ec3 (gi\u00fap thi\u1ebft b\u1ecb c\u00f3 th\u1ec3 truy c\u1eadp \u0111\u01b0\u1ee3c trong qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt, \u0111\u00e1p \u1ee9ng t\u1eeb tr\u01b0\u1eddng \u0111\u1ee7 trong qu\u00e1 tr\u00ecnh theo d\u00f5i nh\u1ecbp tim tr\u01b0\u1edbc khi ph\u1eabu thu\u1eadt) v\u00e0 \u0111\u00f4i khi c\u1ea7n thi\u1ebft \u0111\u1ec3 tr\u00e1nh EMI, \u0111\u1ec3 \u0111\u01a1n gi\u1ea3n h\u00f3a quy tr\u00ecnh l\u00e0m vi\u1ec7c v\u00e0 r\u00fat ng\u1eafn th\u1eddi gian t\u1ea1o nh\u1ecbp kh\u00f4ng \u0111\u1ed3ng b\u1ed9.<\/li>\n
L\u1eadp tr\u00ecnh l\u1ea1i ICD l\u00e0 c\u1ea7n thi\u1ebft \u1edf b\u1ec7nh nh\u00e2n ph\u1ee5 thu\u1ed9c m\u00e1y t\u1ea1o nh\u1ecbp n\u1ebfu kho\u1ea3ng c\u00e1ch tr\u01b0\u1eddng ph\u1eabu thu\u1eadt t\u1edbi thi\u1ebft b\u1ecb <15 cm ho\u1eb7c n\u1ebfu thi\u1ebft b\u1ecb kh\u00f4ng th\u1ec3 truy c\u1eadp \u0111\u01b0\u1ee3c trong su\u1ed1t qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt.<\/li>\n
N\u00ean s\u1eed d\u1ee5ng nam ch\u00e2m \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o cho m\u1ecdi b\u1ec7nh nh\u00e2n c\u00f3 ICD m\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c l\u1eadp tr\u00ecnh l\u1ea1i, trong qu\u00e1 tr\u00ecnh d\u00f9ng dao \u0111\u1ed1t \u0111i\u1ec7n, n\u1ebfu c\u00f3 nguy c\u01a1 EMI.<\/li>\n
N\u00ean l\u1eadp tr\u00ecnh l\u1ea1i t\u1ea5t c\u1ea3 thi\u1ebft b\u1ecb ICD tr\u00ean b\u1ec7nh nh\u00e2n ph\u1ee5 thu\u1ed9c v\u00e0o m\u00e1y t\u1ea1o nh\u1ecbp v\u00e0 tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng ph\u00e1t ra d\u1ea5u hi\u1ec7u \u0111\u00e1p \u1ee9ng v\u1edbi nam ch\u00e2m.<\/li>\n<\/ul>\n
EMI DO DAO \u0110\u1ed0T \u0110I\u1ec6N TRONG PH\u1eaaU THU\u1eacT<\/h2>\n
\n
Theo d\u00f5i \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 l\u00e0 b\u1eaft bu\u1ed9c \u1edf b\u1ea5t k\u1ef3 b\u1ec7nh nh\u00e2n CIED n\u00e0o tr\u1ea3i qua thu\u1eadt c\u00f3 d\u00f9ng dao \u0111\u1ed1t \u0111i\u1ec7n.<\/li>\n
Theo d\u00f5i m\u1ea1ch ngo\u1ea1i bi\u00ean v\u1edbi \u0111o \u0111\u1ed9 b\u00e3o h\u00f2a oxy ho\u1eb7c s\u00f3ng \u0111\u1ed9ng m\u1ea1ch n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n k\u00e8m v\u1edbi theo d\u00f5i \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 \u1edf b\u1ea5t k\u1ef3 b\u1ec7nh nh\u00e2n CIED n\u00e0o tr\u1ea3i qua cu\u1ed9c ph\u1eabu thu\u1eadt c\u00f3 d\u00f9ng dao \u0111\u1ed1t \u0111i\u1ec7n.<\/li>\n
Pad \u0111i\u1ec7n c\u1ef1c kh\u1eed rung n\u00ean \u0111\u1eb7t c\u00e1ch xa thi\u1ebft b\u1ecb >15cm nh\u1eb1m tr\u00e1nh g\u00e2y h\u1ecfng CIED. Pad \u0111i\u1ec7n c\u1ef1c n\u1ed1i \u0111\u1ea5t c\u0169ng n\u00ean \u0111\u1eb7t xa CIED >15cm.<\/li>\n
M\u1ed9t nam ch\u00e2m c\u00f3 t\u1eeb tr\u01b0\u1eddng >10 G n\u00ean \u0111\u01b0\u1ee3c chu\u1ea9n b\u1ecb s\u1eb5n c\u00f3 trong su\u1ed1t qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt tr\u00ean m\u1ecdi b\u1ec7nh nh\u00e2n c\u00f3 CIED.<\/li>\n
Nguy c\u01a1 ch\u00ednh c\u1ee7a b\u1ec7nh nh\u00e2n CIED tr\u1ea3i qua ph\u1eabu thu\u1eadt l\u00e0 EMI do dao \u0111\u1ed1t \u0111i\u1ec7n, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn vi\u1ec7c \u1ee9c ch\u1ebf t\u1ea1o nh\u1ecbp, ch\u1ebf \u0111\u1ed9 \u0111\u1ea3o ng\u01b0\u1ee3c nhi\u1ec5u (v\u1edbi t\u1ea1o nh\u1ecbp kh\u00f4ng \u0111\u1ed3ng b\u1ed9) v\u00e0 li\u1ec7u ph\u00e1p ICD kh\u00f4ng th\u00edch h\u1ee3p do qu\u00e1 nh\u1eadn c\u1ea3m.<\/li>\n
N\u1ebfu cu\u1ed9c ph\u1eabu thu\u1eadt th\u1ef1c hi\u1ec7n v\u1edbi dao \u0111\u1ed1t \u0111i\u1ec7n \u0111\u01a1n c\u1ef1c t\u1eeb v\u00f9ng r\u1ed1n tr\u1edf xu\u1ed1ng th\u00ec vi\u1ec7c t\u1eaft k\u00edch ho\u1ea1t li\u1ec7u ph\u00e1p t\u1eeb ICD l\u00e0 kh\u00f4ng c\u1ea7n thi\u1ebft.<\/li>\n
Tuy nhi\u00ean, n\u1ebfu \u0111i\u1ec7n c\u1ef1c tr\u1edf v\u1ec1 \u0111\u1eb7t g\u1ea7n thi\u1ebft b\u1ecb ho\u1eb7c s\u1eed d\u1ee5ng \u0111i\u1ec7n c\u1ef1c tr\u1edf v\u1ec1 to\u00e0n th\u00e2n, s\u1ed1c \u0111i\u1ec7n kh\u00f4ng th\u00edch h\u1ee3p t\u1eeb ICD \u0111\u01b0\u1ee3c ghi nh\u1eadn trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p.<\/li>\n
Nhi\u1ec1u nghi\u00ean c\u1ee9u cho th\u1ea5y ph\u1eabu thu\u1eadt d\u01b0\u1edbi v\u00f9ng m\u00e0o ch\u1eadu tr\u1edf xu\u1ed1ng v\u1edbi \u0111i\u1ec7n c\u1ef1c tr\u1edf v\u1ec1 \u0111\u1eb7t \u1edf v\u00f9ng \u0111\u00f9i c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n m\u1ed9t c\u00e1ch an to\u00e0n m\u00e0 kh\u00f4ng c\u1ea7n s\u1eed d\u1ee5ng nam ch\u00e2m ho\u1eb7c ph\u1ea3i t\u00e1i l\u1eadp tr\u00ecnh l\u1ea1i m\u00e1y.<\/li>\n
Dao \u0111\u1ed1t \u0111i\u1ec7n l\u01b0\u1ee1ng c\u1ef1c ho\u1eb7c dao m\u1ed5 si\u00eau \u00e2m n\u00ean \u0111\u01b0\u1ee3c \u01b0u ti\u00ean s\u1eed d\u1ee5ng h\u01a1n dao \u0111\u1ed1t \u0111i\u1ec7n \u0111\u01a1n c\u1ef1c n\u1ebfu c\u00f3 th\u1ec3, t\u1ea5m \u00e2m c\u1ef1c (\u0111i\u1ec7n c\u1ef1c tr\u1edf l\u1ea1i) n\u00ean \u0111\u1eb7t c\u00e0ng xa CIED c\u00e0ng t\u1ed1t v\u00e0 dao \u0111\u1ed1t \u0111i\u1ec7n n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ed1t ng\u1eaft qu\u00e3ng \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 c\u1ee7a EMI.<\/li>\n
Nh\u00e2n vi\u00ean v\u00e0 l\u1eadp tr\u00ecnh vi\u00ean \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o qua CIED n\u00ean khuy\u1ebfn kh\u00edch c\u00f3 m\u1eb7t t\u1ea1i b\u1ec7nh vi\u1ec7n\/c\u01a1 s\u1edf ph\u00f2ng kh\u00e1m l\u1eadp tr\u00ecnh l\u1ea1i ICD n\u1ebfu s\u1eed d\u1ee5ng nam ch\u00e2m, c\u0169ng nh\u01b0 nh\u1eefng thay \u0111\u1ed5i v\u1ec1 t\u00ecnh tr\u1ea1ng c\u1ee7a b\u1ec7nh nh\u00e2n trong l\u00fac ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 y\u00eau c\u1ea7u l\u1eadp tr\u00ecnh l\u1ea1i c\u00e1c th\u00f4ng s\u1ed1 t\u1ea1o nh\u1ecbp.<\/li>\n
Dao \u0111\u1ed1t \u0111i\u1ec7n l\u01b0\u1ee1ng c\u1ef1c \u0111\u01b0\u1ee3c \u01b0u ti\u00ean s\u1eed d\u1ee5ng h\u01a1n do hi\u1ebfm khi g\u00e2y EMI.<\/li>\n
N\u1ebfu dao \u0111i\u1ec7n \u0111\u01a1n c\u1ef1c \u0111\u01b0\u1ee3c d\u00f9ng, \u0111i\u1ec7n c\u1ef1c n\u1ed1i \u0111\u1ea5t c\u1ea7n \u0111\u1eb7t \u0111\u1ed1i b\u00ean v\u1edbi kho\u1ea3ng c\u00e1ch xa CIED nh\u1ea5t c\u00f3 th\u1ec3 \u0111\u1ec3 tr\u00e1nh EMI.<\/li>\n
\u0110i\u1ec7n c\u1ef1c tr\u1edf l\u1ea1i to\u00e0n th\u00e2n kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn kh\u00edch s\u1eed d\u1ee5ng (tr\u1eeb khi thi\u1ebft b\u1ecb \u0111\u01b0\u1ee3c l\u1eadp tr\u00ecnh th\u00edch h\u1ee3p tr\u01b0\u1edbc khi l\u00e0m ph\u1eabu thu\u1eadt).<\/li>\n<\/ul>\n
S\u1eec D\u1ee4NG NAM CH\u00c2M TRONG QU\u00c1 TR\u00ccNH PH\u1eaaU THU\u1eacT<\/h2>\n
\n
Tr\u00ean m\u00e1y t\u1ea1o nh\u1ecbp, s\u1eed d\u1ee5ng nam ch\u00e2m d\u1eabn \u0111\u1ebfn ch\u1ebf \u0111\u1ed9 tao nh\u1ecbp kh\u00f4ng \u0111\u1ed3ng b\u1ed9 (AOO, VOO, DOO) theo t\u1ea7n s\u1ed1 c\u1ee7a nam ch\u00e2m. T\u1ea1o nh\u1ecbp kh\u00f4ng \u0111\u1ed3ng b\u1ed9 c\u00f3 th\u1ec3 k\u00edch th\u00edch nh\u1eefng pha d\u1ec5 t\u1ed5n th\u01b0\u01a1ng v\u00e0 d\u1eabn \u0111\u1ebfn nguy c\u01a1 r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t.<\/li>\n
Do \u0111\u00f3, b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i trong qu\u00e1 tr\u00ecnh s\u1eed d\u1ee5ng nam ch\u00e2m ho\u1eb7c ph\u1eabu thu\u1eadt \u1edf ch\u1ebf \u0111\u1ed9 kh\u00f4ng \u0111\u1ed3ng b\u1ed9 v\u1edbi trang b\u1ecb c\u1ea5p c\u1ee9u bao g\u1ed3m m\u00e1y kh\u1eed rung ngo\u00e0i c\u01a1 th\u1ec3 v\u1edbi kh\u1ea3 n\u0103ng t\u1ea1o nh\u1ecbp qua da c\u1ea7n ph\u1ea3i lu\u00f4n s\u1eb5n s\u00e0ng.<\/li>\n
Tr\u00ean m\u00e1y ICD, s\u1eed d\u1ee5ng nam ch\u00e2m ch\u1ec9 t\u1eaft ch\u1ebf \u0111\u1ed9 ph\u00e1t hi\u1ec7n r\u1ed1i lo\u1ea1n nh\u1ecbp nhanh m\u00e0 kh\u00f4ng t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn ch\u1ebf \u0111\u1ed9 t\u1ea1o nh\u1ecbp. Do \u0111\u00f3, t\u00e1i l\u1eadp tr\u00ecnh thi\u1ebft b\u1ecb l\u00e0 c\u1ea7n thi\u1ebft tr\u00ean b\u1ec7nh nh\u00e2n ICD ph\u1ee5 thu\u1ed9c m\u00e1y t\u1ea1o nh\u1ecbp.<\/li>\n
Ngo\u00e0i ra, n\u00ean t\u00e1i l\u1eadp tr\u00ecnh thi\u1ebft b\u1ecb n\u1ebfu kh\u00f4ng ph\u00e1t ra d\u1ea5u hi\u1ec7u \u0111\u00e1p \u1ee9ng v\u1edbi nam ch\u00e2m.<\/li>\n
S\u1eed d\u1ee5ng nam ch\u00e2m tr\u00ean b\u1ec7nh nh\u00e2n ICD d\u00f9ng dao \u0111\u1ed1t \u0111i\u1ec7n c\u00f3 kho\u1ea3ng c\u00e1ch >15cm so v\u1edbi thi\u1ebft b\u1ecb gi\u00fap \u0111\u01a1n gi\u1ea3n h\u00f3a qu\u00e1 tr\u00ecnh th\u1ee7 thu\u1eadt v\u00e0 \u0111\u01b0\u1ee3c ch\u1ee9ng minh an to\u00e0n h\u01a1n v\u1edbi vi\u1ec7c r\u00fat ng\u1eafn c\u00f3 \u00fd ngh\u0129a th\u1eddi gian b\u1ea5t ho\u1ea1t li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u1eeb ICD.<\/li>\n
T\u00e1i l\u1eadp tr\u00ecnh CIED n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n khi tr\u01b0\u1eddng ph\u1eabu thu\u1eadt c\u00e1ch thi\u1ebft b\u1ecb <15cM do vi\u1ec7c s\u1eed d\u1ee5ng nam ch\u00e2m trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y kh\u00e1 kh\u00f3 v\u00ec g\u1ea7n ph\u1eabu tr\u01b0\u1eddng ho\u1eb7c khi nam ch\u00e2m kh\u00f4ng \u0111\u01b0\u1ee3c \u0111\u1ea3m b\u1ea3o c\u1ed1 \u0111\u1ecbnh t\u1ea1i v\u1ecb tr\u00ed thu\u1eadn l\u1ee3i (khi b\u1ec7nh nh\u00e2n c\u1ea7n n\u1eb1m s\u1ea5p ho\u1eb7c n\u1eb1m nghi\u00eang \u0111\u1ec3 ph\u1eabu thu\u1eadt)<\/li>\n<\/ul>\n
C\u00c1C Y\u1ebeU T\u1ed0 KH\u00c1C G\u00c2Y EMI<\/h2>\n
\n
Thi\u1ebft b\u1ecb theo d\u00f5i t\u1ea7n s\u1ed1 h\u00f4 h\u1ea5p, di chuy\u1ec3n b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 khi\u1ebfn t\u1ea1o nh\u1ecbp nhanh h\u01a1n, \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 b\u1ecb xem nh\u01b0 nhanh th\u1ea5t, do \u0111\u00f3 n\u00ean b\u1ea5t ho\u1ea1t ch\u1ebf \u0111\u1ed9 \u0111\u00e1p \u1ee9ng t\u1ea7n s\u1ed1 tim trong v\u00e0 sau ph\u1eabu thu\u1eadt n\u1ebfu c\u00f3 \u0111\u00e1p \u1ee9ng t\u1ea7n s\u1ed1 kh\u00f4ng th\u00edch h\u1ee3p.<\/li>\n
Ngo\u00e0i ra, guidewire hay catheter c\u00f3 th\u1ec3 g\u00e2y \u1ee9c ch\u1ebf t\u1ea1o nh\u1ecbp, s\u1ed1c kh\u00f4ng th\u00edch h\u1ee3p ho\u1eb7c bung \u0111i\u1ec7n c\u1ef1c.<\/li>\n
Ph\u1eabu thu\u1eadt l\u1ed3ng ng\u1ef1c do tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i hay l\u1ea5y b\u1ecf x\u01b0\u01a1ng \u1ee9c c\u0169ng g\u00e2y t\u0103ng ng\u01b0\u1ee1ng kh\u1eed rung ho\u1eb7c h\u01b0 m\u00e1y ICD d\u01b0\u1edbi da.<\/li>\n<\/ul>\n
$\"\"$ $\"\"$ <\/p>\n
C\u1ed8NG H\u01af\u1edeNG T\u1eea<\/h2>\n
\u01af\u1edbc t\u00ednh kho\u1ea3ng 50 – 75% b\u1ec7nh nh\u00e2n c\u00f3 CIED s\u1ebd c\u1ea7n ph\u1ea3i ch\u1ee5p MRI trong su\u1ed1t th\u1eddi gian mang thi\u1ebft b\u1ecb.<\/p>\n
MRI c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn thi\u1ebft b\u1ecb:<\/p>\n
\n
Thay \u0111\u1ed5i ch\u1ebf \u0111\u1ed9 k\u00edch th\u00edch t\u1ea1o ra k\u00edch th\u00edch kh\u00f4ng \u0111\u1ed3ng b\u1ed9<\/li>\n
G\u00e2y r\u1ed1i lo\u1ea1n nh\u1ecbp nh\u0129 ho\u1eb7c th\u1ea5t b\u1eb1ng c\u00e1ch cung c\u1ea5p c\u00e1c k\u00edch th\u00edch trong giai \u0111o\u1ea1n d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng c\u1ee7a t\u00e2m nh\u0129 ho\u1eb7c t\u00e2m th\u1ea5t<\/li>\n
T\u1ea1o m\u00f4-men xo\u1eafn b\u00ean trong t\u00fai c\u1ee7a thi\u1ebft b\u1ecb; c\u1ea3m gi\u00e1c rung (hi\u1ebfm)<\/li>\n
L\u00e0m n\u00f3ng v\u00f9ng m\u00f4 tim ti\u1ebfp gi\u00e1p v\u1edbi c\u00e1c \u0111i\u1ec7n c\u1ef1c, thay \u0111\u1ed5i ng\u01b0\u1ee1ng t\u1ea1o nh\u1ecbp\/nh\u1eadn c\u1ea3m’<\/li>\n
L\u1eadp tr\u00ecnh l\u1ea1i PM, d\u1ea5u hi\u1ec7u h\u01b0 pin (tho\u00e1ng qua)<\/li>\n
Qu\u00e1 nh\u1eadn c\u1ea3m ho\u1eb7c gi\u1ea3m nh\u1eadn c\u1ea3m<\/li>\n
K\u00edch ho\u1ea1t l\u1ea1i li\u1ec7u ph\u00e1p ch\u1ed1ng nh\u1ecbp tim nhanh<\/li>\n<\/ul>\n
MRI tr\u00ean b\u1ec7nh nh\u00e2n CIED ch\u1ec9 n\u00ean th\u1ef1c hi\u1ec7n t\u1ea1i trung t\u00e2m c\u00f3 \u0111\u1ed9i ng\u0169, h\u01b0\u1edbng d\u1eabn v\u00e0 trang thi\u1ebft b\u1ecb th\u00edch h\u1ee3p. C\u00f3 s\u1ef1 ph\u1ed1i h\u1ee3p gi\u1eefa b\u00e1c s\u0129 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh, k\u1ef9 thu\u1eadt vi\u00ean, b\u00e1c s\u0129 tim m\u1ea1ch c\u00f9ng c\u00e1c ngu\u1ed3n nh\u00e2n l\u1ef1c s\u1ee9c kh\u1ecfe kh\u00e1c \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o s\u1ef1 an to\u00e0n.<\/p>\n
N\u00ean th\u1ef1c hi\u1ec7n theo checklist bao g\u1ed3m:<\/p>\n
Tr\u01b0\u1edbc ch\u1ee5p:<\/em><\/p>\n
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>6 tu\u1ea7n sau c\u1ea5y thi\u1ebft b\u1ecb<\/li>\n
CIED c\u00f3 ch\u1ebf \u0111\u1ed9 ch\u1ee5p \u0111\u01b0\u1ee3c MRI hay kh\u00f4ng<\/li>\n
C\u00f3 d\u00e2y \u0111i\u1ec7n c\u1ef1c kh\u00f4ng ch\u1ee5p \u0111\u01b0\u1ee3c MRI kh\u00f4ng<\/li>\n
C\u00f3 d\u00e2y \u0111i\u1ec7n c\u1ef1c b\u1ecf r\u01a1i, \u0111\u1ea7u n\u1ed1i \u0111i\u1ec7n c\u1ef1c ho\u1eb7c \u0111i\u1ec7n c\u1ef1c th\u01b0\u1ee3ng m\u1ea1c kh\u00f4ng<\/li>\n
B\u1ec7nh nh\u00e2n c\u00f3 ph\u1ee5 thu\u1ed9c m\u00e1y t\u1ea1o nh\u1ecbp kh\u00f4ng<\/li>\n
C\u00f3 \u0111\u1ed9i ng\u0169 c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n CPR trong khi ch\u1ee5p MRI kh\u00f4ng<\/li>\n
C\u00f3 m\u00e1y kh\u1eed rung b\u00ean ngo\u00e0i v\u1edbi kh\u1ea3 n\u0103ng t\u1ea1o nh\u1ecbp qua da trong khi ch\u1ee5p MRI kh\u00f4ng<\/li>\n
C\u00f3 k\u1ef9 thu\u1eadt vi\u00ean \u0111\u01b0\u1ee3c hu\u1ea5n luy\u1ec7n qua CIED ki\u1ec3m tra to\u00e0n b\u1ed9 thi\u1ebft b\u1ecb tr\u01b0\u1edbc v\u00e0 sau ch\u1ee5p MRI kh\u00f4ng<\/li>\n
Li\u1ec7t k\u00ea t\u00ecnh tr\u1ea1ng thi\u1ebft b\u1ecb, th\u00f4ng s\u1ed1 v\u1ec1 pin, ng\u01b0\u1ee1ng t\u1ea1o nh\u1ecbp, nh\u1eadn c\u1ea3m v\u00e0 tr\u1edf kh\u00e1ng d\u00e2y d\u1eabn tr\u01b0\u1edbc ch\u1ee5p<\/li>\n
Thi\u1ebft b\u1ecb \u0111\u00e3 \u0111\u01b0\u1ee3c chuy\u1ebfn qua ch\u1ebf \u0111\u1ed9 ch\u1ee5p MRI ch\u01b0a:\n
\n
Ch\u1ebf \u0111\u1ed9 kh\u00f4ng \u0111\u1ed3ng b\u1ed9 (DOO\/VOO\/AOO)<\/li>\n
Ch\u1ebf \u0111\u1ed9 \u1ee9c ch\u1ebf (DDI\/WI\/AAI)<\/li>\n
Ch\u1ebf \u0111\u1ed9 b\u1ea5t ho\u1ea1t (ODO\/OVO\/OAO\/OOO)<\/li>\n
T\u1ea1o nh\u1ecbp v\u00e0 nh\u1eadn c\u1ea3m l\u01b0\u1ee1ng c\u1ef1c<\/li>\n
B\u1ea5t ho\u1ea1t \u0111\u00e1p \u1ee9ng t\u1eeb tr\u01b0\u1eddng<\/li>\n
B\u1ea5t ho\u1ea1t li\u1ec7u ph\u00e1p ch\u1ed1ng nh\u1ecbp nhanh<\/li>\n
B\u1ea5t ho\u1ea1t n\u00e2ng cao (\u0111\u00e1p \u1ee9ng nh\u1eadn c\u1ea3m th\u1ea5t tr\u00ean CRT)<\/li>\n<\/ul>\n<\/li>\n
Trong khi ch\u1ee5p: theo d\u00f5i ECG, huy\u1ebft \u00e1p, \u0111\u1ed9 b\u00e3o h\u00f2a oxy<\/li>\n<\/ul>\n
Sau ch\u1ee5p:<\/em><\/p>\n
\n
T\u00e1i ki\u1ec3m tra thi\u1ebft b\u1ecb v\u00e0 th\u00f4ng s\u1ed1 d\u00e2y d\u1eabn<\/li>\n
T\u1eaft ch\u1ebf \u0111\u1ed9 ch\u1ee5p MRI<\/li>\n
T\u00e1i l\u1eadp tr\u00ecnh v\u1ec1 c\u00e0i \u0111\u1eb7t ban \u0111\u1ea7u ch\u01b0a<\/li>\n
Theo d\u00f5i t\u1eeb xa n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1eb7c bi\u1ec7t trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng ch\u1ee5p \u0111\u01b0\u1ee3c MRI ho\u1eb7c c\u00f3 nguy c\u01a1 cao<\/li>\n<\/ul>\n
THI\u1ebeT B\u1eca KH\u00d4NG TH\u1ec2 CH\u1ee4P MRI<\/h2>\n
\n
CIED kh\u00f4ng ch\u1ee5p MRI th\u01b0\u1eddng l\u00e0 c\u00e1c th\u1ebf h\u1ec7 c\u0169 ho\u1eb7c l\u00e0 s\u1ef1 k\u1ebft h\u1ee3p gi\u1eefa m\u00e1y ch\u1ee5p \u0111\u01b0\u1ee3c MRI v\u1edbi d\u00e2y \u0111i\u1ec7n c\u1ef1c ch\u1ee5p \u0111\u01b0\u1ee3c MRI nh\u01b0ng t\u1eeb 2 nh\u00e0 s\u1ea3n xu\u1ea5t kh\u00e1c nhau ho\u1eb7c v\u1edbi d\u00e2y \u0111i\u1ec7n c\u1ef1c kh\u00f4ng ch\u1ee5p \u0111\u01b0\u1ee3c MRI; s\u1ef1 c\u00f3 m\u1eb7t c\u1ee7a d\u00e2y \u0111i\u1ec7n c\u1ef1c b\u1ecb b\u1ecf, \u0111\u1ee9t, ho\u1eb7c \u0111i\u1ec7n c\u1ef1c th\u01b0\u1ee3ng t\u00e2m m\u1ea1c, hay d\u00e2n d\u1eabn m\u1edf r\u1ed9ng\/k\u1ebft n\u1ed1i.<\/li>\n
Khuy\u1ebfn c\u00e1o ESC hi\u1ec7n h\u00e0nh tr\u00ean thi\u1ebft b\u1ecb CRT ho\u1eb7c t\u1ea1o nh\u1ecbp kh\u00f4ng ch\u1ee5p \u0111\u01b0\u1ee3c MRI cho ph\u00e9p c\u00e2n nh\u1eafc ch\u1ee5p khi kh\u00f4ng th\u1ec3 thay \u0111\u1ed5i ch\u1ebf \u0111\u1ed9 ch\u1ee5p v\u00e0 ngay c\u1ea3 khi c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a \u0111i\u1ec7n c\u1ef1c th\u01b0\u1ee3ng t\u00e2m m\u1ea1c, ho\u1eb7c \u0111i\u1ec7n c\u1ef1c h\u01b0 hay b\u1ecb b\u1ecf l\u1ea1i, \u0111i\u1ec7n c\u1ef1c m\u1edf r\u1ed9ng\/k\u1ebft n\u1ed1i v\u00ec l\u1ee3i \u00edch nhi\u1ec1u h\u01a1n nguy c\u01a1.<\/li>\n
B\u1ec7nh nh\u00e2n c\u1ea5y ICD ho\u1eb7c ph\u1ee5 thu\u1ed9c m\u00e1y t\u1ea1o nh\u1ecbp gia t\u0103ng nguy c\u01a1 khi ch\u1ee5p, do \u0111\u00f3 c\u1ea7n t\u00ednh to\u00e1n c\u1ea9n tr\u1ecdng v\u00e0 th\u1ea3o lu\u1eadn v\u1edbi b\u1ec7nh nh\u00e2n.<\/li>\n
D\u1ef1a tr\u00ean c\u00e1c b\u1eb1ng ch\u1ee9ng hi\u1ec7n t\u1ea1i, kh\u00f4ng khuy\u1ebfn c\u00e1o lo\u1ea1i b\u1ecf c\u00e1c d\u00e2y \u0111i\u1ec7n c\u1ef1c b\u1ecb b\u1ecf ch\u1ec9 \u0111\u1ec3 ch\u1ee5p MRI v\u00ec nguy c\u01a1 l\u1ea5y \u0111i\u1ec7n c\u1ef1c cao h\u01a1n so v\u1edbi vi\u1ec7c ch\u1ee5p MRI.<\/li>\n<\/ul>\n
KI\u1ec0M TRA V\u00c0 L\u1eacP TR\u00ccNH THI\u1ebeT B\u1eca<\/h2>\n
\n
Nh\u00ecn chung, ch\u1ee9c n\u0103ng ph\u00e1t hi\u1ec7n nh\u1ecbp nhanh ho\u1eb7c\/v\u00e0 ch\u1ed1ng nh\u1ecbp nhanh n\u00ean \u0111\u01b0\u1ee3c t\u1eaft tr\u00ean m\u00e1y ICD (c\u0169ng nh\u01b0 tr\u00ean m\u00e1y t\u1ea1o nh\u1ecbp v\u1edbi ch\u1ebf \u0111\u1ed9 t\u1ea1o nh\u1ecbp v\u01b0\u1ee3t t\u1ea7n s\u1ed1 nh\u0129) v\u00e0 c\u00e1c ch\u1ee9c n\u0103ng n\u00e2ng cao (nh\u01b0 ch\u1ebf \u0111\u1ed9 VVT tr\u00ean CRT) n\u00ean \u0111\u01b0\u1ee3c t\u1eaft.<\/li>\n
Tr\u00ean b\u1ec7nh nh\u00e2n ph\u1ee5 thu\u1ed9c t\u1ea1o nh\u1ecbp, thi\u1ebft b\u1ecb n\u00ean \u0111\u01b0\u1ee3c l\u1eadp tr\u00ecnh sang ch\u1ebf \u0111\u1ed9 kh\u00f4ng \u0111\u1ed3ng b\u1ed9 (AOO, voo, DOO) v\u00e0 ng\u01b0\u1ee1ng t\u1ea7n s\u1ed1 d\u01b0\u1edbi n\u00ean \u0111\u01b0\u1ee3c c\u00e0i \u0111\u1eb7t \u0111\u1ee7 cao \u0111\u1ec3 tr\u00e1nh s\u1ef1 xung \u0111\u1ed9t t\u1ea1o nh\u1ecbp (>20 l\/p so v\u1edbi nh\u1ecbp n\u1ed9i t\u1ea1i).<\/li>\n
Tr\u00ean b\u1ec7nh nh\u00e2n kh\u00f4ng l\u1ec7 thu\u1ed9c t\u1ea1o nh\u1ecbp, thi\u1ec7t b\u1ecb n\u00ean \u0111\u01b0\u1ee3c l\u1eadp tr\u00ecnh sang ch\u1ebf \u0111\u1ed9 \u1ee9c ch\u1ebf (DDI, VVI, AAI) ho\u1eb7c \u01b0u ti\u00ean kh\u00f4ng t\u1ea1o nh\u1ecbp (OAO, ovo, ODO).<\/li>\n<\/ul>\n
<\/p>\n
<\/p>\n
$\"Ki\u1ec3m$ <\/p>\n
$\"Ki\u1ec3m$
Ki\u1ec3m tra v\u00e0 l\u1eadp trinh thi\u1ebft b\u1ecb<\/figcaption><\/figure>\n
Khuy\u1ebfn c\u00e1o th\u00f4ng s\u1ed1 MRI tr\u00ean b\u1ec7nh nh\u00e2n CIED kh\u00f4ng ch\u1ee5p \u0111\u01b0\u1ee3c MRI:<\/p>\n
\n
\u01afu ti\u00ean 1.5 T h\u01a1n 3 T<\/li>\n
M\u1ee9c h\u1ea5p th\u1ee5 s\u00f3ng SAR < 2W\/kg<\/li>\n
T\u1ec9 l\u1ec7 ch\u00eanh \u00e1p quay t\u1eeb tr\u01b0\u1eddng < 200 T\/m\/s<\/li>\n
Gi\u1ea3m thi\u1ec3u s\u1ed1 l\u01b0\u1ee3ng v\u00e0 \u0111\u1ed9 d\u00e0i chu\u1ed7i (Bl + RMS < 2.8 p.T)<\/li>\n<\/ul>\n
\u0110\u1ed3ng thu\u1eadn<\/p>\n
\n
Quy tr\u00ecnh v\u00e0 checklist tr\u00ean b\u1ec7nh nh\u00e2n CIED ch\u1ee5p MRI n\u00ean \u0111\u01b0\u1ee3c ph\u00e1c th\u1ea3o<\/li>\n
T\u00ecm c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1: \u0111i\u1ec7n c\u1ef1c b\u1ecb b\u1ecf ho\u1eb7c \u0111\u1ee9t, \u0111i\u1ec7n c\u1ef1c th\u01b0\u1ee3ng t\u00e2m m\u1ea1c, \u0111i\u1ec7n c\u1ef1c k\u1ebft n\u1ed1i\/m\u1edf r\u1ed9ng, m\u00e1y ICD ho\u1eb7c b\u1ec7nh nh\u00e2n l\u1ec7 thu\u1ed9c m\u00e1y t\u1ea1o nh\u1ecbp<\/li>\n
N\u00ean theo d\u00f5i ECG v\u00e0 \u0111\u1ed9 b\u00e3o h\u00f2a oxy trong khi ch\u1ee5p MRI<\/li>\n
Ch\u1ebf \u0111\u1ed9 t\u1ea1o nh\u1ecbp kh\u00f4ng \u0111\u1ed3ng b\u1ed9 (DOO\/VOO\/AOO) n\u00ean \u0111\u01b0\u1ee3c c\u00e0i tr\u00ean b\u1ec7nh nh\u00e2n l\u1ec7 thu\u1ed9c m\u00e1y<\/li>\n
Ch\u1ebf \u0111\u1ed9 t\u1ea1o nh\u1ecbp \u1ee9c ch\u1ebf (WI\/DDI\/AAI)v\u1edbi b\u1ea5t ho\u1ea1t t\u1eeb tr\u01b0\u1eddng v\u00e0 ch\u1ee9c n\u0103ng n\u00e2ng cao (\u0111\u1ea3o ng\u01b0\u1ee3c nhi\u1ec5u, \u0111\u00e1p \u1ee9ng nh\u1eadn c\u1ea3m th\u1ea5t, t\u1ea1o nh\u1ecbp v\u01b0\u1ee3t t\u1ea7n s\u1ed1) n\u00ean \u0111\u01b0\u1ee3c c\u00e0i tr\u00ean b\u1ec7nh nh\u00e2n kh\u00f4ng l\u1ec7 thu\u1ed9c m\u00e1y nh\u01b0ng c\u00f3 nguy c\u01a1 v\u00f4 t\u00e2m thu ho\u1eb7c nh\u1ecbp ch\u1eadm nguy hi\u1ec3m; ng\u01b0\u1ee3c l\u1ea1i, ch\u1ebf \u0111\u1ed9 kh\u00f4ng t\u1ea1o nh\u1ecbp n\u00ean \u0111\u01b0\u1ee3c c\u00e0i.<\/li>\n
Ch\u1ee9c n\u0103ng t\u1ea1o nh\u1ecbp kh\u00e1c (\u0111\u00e1p \u1ee9ng t\u1ea7n s\u1ed1, \u0111\u1ea3o ng\u01b0\u1ee3c nhi\u1ec5u, \u0111\u00e1p \u1ee9ng nh\u1eadn c\u1ea3m th\u1ea5t, \u0111\u00e1p \u1ee9ng rung nh\u0129) n\u00ean \u0111\u01b0\u1ee3c t\u1eaft \u1edf ch\u1ebf \u0111\u1ed9 t\u1ea1o nh\u1ecbp kh\u00f4ng \u0111\u1ed3ng b\u1ed9 ho\u1eb7c \u1ee9c ch\u1ebf \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o EMI kh\u00f4ng d\u1eabn \u0111\u1ebfn t\u1ea1o nh\u1ecbp kh\u00f4ng mong mu\u1ed1n<\/li>\n
Ch\u1ebf \u0111\u1ed9 ph\u00e1t hi\u1ec7n r\u1ed1i lo\u1ea1n nh\u1ecbp nhanh (ATP\/s\u1ed1c) n\u00ean t\u1eaft tr\u00ean b\u1ec7nh nh\u00e2n ICD tr\u00e1nh s\u1ed1c kh\u00f4ng th\u00edch h\u1ee3p<\/li>\n
Tr\u00ean b\u1ec7nh nh\u00e2n CIED kh\u00f4ng th\u1ec3 ch\u1ee5p MRI, MRI c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t (ICD, l\u1ec7 thu\u1ed9c m\u00e1y, m\u1edbi c\u1ea5y CIED, \u0111i\u1ec7n c\u1ef1c th\u01b0\u1ee3ng t\u00e2m m\u1ea1c)<\/li>\n
K\u1ef9 thu\u1eadt vi\u00ean \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o kh\u00f4ng c\u1ea7n \u0111\u1ee9ng c\u1ea1nh gi\u01b0\u1eddng trong khi ch\u1ee5p MRI \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c b\u1eadt ch\u1ebf \u0111\u1ed9 ch\u1ee5p MRI<\/li>\n
K\u1ef9 thu\u1eadt vi\u00ean \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o c\u1ea7n \u0111\u1ee9ng c\u1ea1nh gi\u01b0\u1eddng v\u1edbi c\u00e1c thi\u1ebft b\u1ecb \u0111\u01b0\u1ee3c l\u1eadp tr\u00ecnh th\u00edch h\u1ee3p trong khi ch\u1ee5p MRI \u1edf tr\u01b0\u1eddng h\u1ee3p nguy c\u01a1 cao (b\u1ec7nh nh\u00e2n ICD l\u1ec7 thu\u1ed9c m\u00e1y, \u0111i\u1ec7n c\u1ef1c th\u01b0\u1ee3ng t\u00e2m m\u1ea1c, \u0111i\u1ec7n c\u1ef1c b\u1ecb b\u1ecf, \u0111i\u1ec7n c\u1ef1c k\u1ebft n\u1ed1i\/m\u1edf r\u1ed9ng) tr\u00ean b\u1ec7nh nh\u00e2n CIED kh\u00f4ng th\u1ec3 ch\u1ee5p MRI<\/li>\n
N\u00ean ti\u1ebfn h\u00e0nh l\u1eadp tr\u00ecnh CIED t\u1ea1i ph\u00f2ng MRI g\u1ea7n nh\u1ea5t c\u00f3 th\u1ec3 v\u00e0 theo d\u00f5i \u0111\u1ee7 \u0111\u1ea3m b\u1ea3o \u0111ang trong ch\u1ebf \u0111\u1ed9 ch\u1ee5p MRI, \u0111\u1eb7c bi\u1ec7t tr\u00ean b\u1ec7nh nh\u00e2n ICD<\/li>\n
Theo d\u00f5i t\u1eeb xa \u0111\u01b0\u1ee3c khuy\u1ebfn kh\u00edch sau ch\u1ee5p MRI, \u0111\u1eb7c bi\u1ec7t \u1edf b\u1ec7nh nh\u00e2n CIED kh\u00f4ng th\u1ec3 ch\u1ee5p MRI v\u00e0 b\u1ec7nh nh\u00e2n nguy c\u01a1 (ICD, l\u1ec7 thu\u1ed9c m\u00e1y, \u0111i\u1ec7n c\u1ef1c th\u01b0\u1ee3ng t\u00e2m m\u1ea1c th\u1ea5t tr\u00e1i)<\/li>\n
\u0110\u1ed9i ng\u0169 c\u1ea5p c\u1ee9u trong l\u00fac ch\u1ee5p MRI n\u00ean \u0111\u01b0\u1ee3c s\u1eb5n s\u00e0ng t\u1ea1i khu v\u1ef1c 3 (Zone 3) (ngo\u00e0i ph\u00f2ng MRI)<\/li>\n
\u0110i\u1ec7n c\u1ef1c b\u1ecb b\u1ecf kh\u00f4ng khuy\u1ebfn c\u00e1o l\u1ea5y ra v\u1edbi m\u1ee5c \u0111\u00edch \u0111\u1ec3 ch\u1ee5p MRI<\/li>\n<\/ul>\n
S\u1ed0C \u0110I\u1ec6N CHUY\u1ec0N NH\u1ecaP HAY KH\u1eec RUNG<\/h2>\n
Tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 CIED \u0111\u01b0\u1ee3c s\u1ed1c \u0111i\u1ec7n tr\u1ef1c ti\u1ebfp chuy\u1ec3n nh\u1ecbp ho\u1eb7c kh\u1eed rung b\u00ean ngo\u00e0i c\u01a1 th\u1ec3, c\u00e1c b\u1ea3n \u0111i\u1ec7n c\u1ef1c qua da l\u00fd t\u01b0\u1edfng n\u00ean \u0111\u01b0\u1ee3c \u0111\u1eb7t \u1edf v\u1ecb tr\u00ed tr\u01b0\u1edbc-sau v\u1edbi b\u1ea3n \u0111i\u1ec7n c\u1ef1c tr\u01b0\u1edbc c\u00e0ng xa CIED c\u00e0ng t\u1ed1t.<\/p>\n
Vi\u1ec7c ki\u1ec3m tra CIED n\u00ean \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh sau khi s\u1ed1c \u0111i\u1ec7n chuy\u1ec3n nh\u1ecbp v\u00e0 tr\u01b0\u1edbc khi b\u1ec7nh nh\u00e2n xu\u1ea5t vi\u1ec7n trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p nguy c\u01a1 cao (h\u1ec7 th\u1ed1ng CIED c\u0169, kho\u1ea3ng c\u00e1ch gi\u1eefa b\u1ea3n \u0111i\u1ec7n c\u1ef1c v\u00e0 thi\u1ebft b\u1ecb ng\u1eafn, v\u1ecb tr\u00ed b\u1ea3n \u0111i\u1ec7n c\u1ef1c kh\u00f4ng ph\u1ea3i t\u01b0 th\u1ebf tr\u01b0\u1edbc-sau).<\/p>\n
C\u1eaeT \u0110\u1ed0T \u0110I\u1ec6N SINH L\u00dd<\/h2>\n
\n
T\u00e1c \u0111\u1ed9ng: g\u00e2y qu\u00e1 nh\u1eadn c\u1ea3m \u1ee9c ch\u1ebf t\u1ea1o nh\u1ecbp kh\u00f4ng th\u00edch h\u1ee3p, chuy\u1ec3n \u0111\u1ed5i mode, s\u1ed1c ch\u1ed1ng r\u1ed1i lo\u1ea1n nh\u1ecbp nhanh kh\u00f4ng th\u00edch h\u1ee3p, h\u01b0 b\u1ec1 m\u1eb7t ti\u1ebfp x\u00fac gi\u1eefa \u0111i\u1ec7n c\u1ef1c v\u00e0 m\u00f4, reset l\u1ea1i thi\u1ebft b\u1ecb.<\/li>\n
Li\u1ec7u ph\u00e1p ICD n\u00ean \u0111\u01b0\u1ee3c t\u1eaft trong khi c\u1eaft \u0111\u1ed1t \u0111i\u1ec7n v\u1edbi s\u00f3ng cao t\u1ea7n.<\/li>\n
Trong c\u1eaft \u0111\u1ed1t \u0111i\u1ec7n b\u1eb1ng \u00e1p \u0111\u00f4ng, kh\u00f4ng ghi nh\u1eadn c\u00f3 EMI tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 CIED<\/li>\n<\/ul>\n
\u0110\u1ed3ng thu\u1eadn<\/p>\n
Tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 CIED \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh c\u1eaft \u0111\u1ed1t \u0111i\u1ec7n sinh l\u00fd b\u1eb1ng s\u00f3ng cao 1 t\u1ea7n \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n nh\u1ecbp tim, l\u1eadp tr\u00ecnh m\u1ed9t c\u00e1ch c\u1ea9n th\u1eadn CIED \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh nh\u1eb1m tr\u00e1nh qu\u00e1 nh\u1eadn c\u1ea3m do EMI v\u00e0 \u0111\u1ea3m b\u1ea3o t\u1ea1o nh\u1ecbp th\u00edch h\u1ee3p c\u0169ng nh\u01b0 tr\u00e1nh s\u1ed1c \u0111i\u1ec7n kh\u00f4ng th\u00edch h\u1ee3p t\u1eeb ICD trong qu\u00e1 tr\u00ecnh l\u00e0m th\u1ee7 thu\u1eadt.<\/p>\n
C\u1eaft \u0111\u1ed1t \u0111i\u1ec7n sinh l\u00fd v\u1edbi kho\u1ea3ng c\u00e1ch so v\u1edbi d\u00e2y \u0111i\u1ec7n c\u1ef1c trong v\u00f2ng 1 cm n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n h\u1ebft s\u1ee9c th\u1eadn tr\u1ecdng v\u00e0 ch\u1ec9 n\u00ean ti\u1ebfn h\u00e0nh trong m\u1ed9t v\u00e0i t\u00ecnh hu\u1ed1ng \u0111\u1eb7c bi\u1ec7t<\/p>\n
T\u00c1I TH\u00d4NG M\u1ea0CH V\u00c0NH QUA DA<\/h2>\n
\u0110i\u1ec7n t\u00e2m \u0111\u1ed3 12 chuy\u1ec3n \u0111\u1ea1o n\u00ean \u0111\u01b0\u1ee3c ki\u1ec3m tra sau PCI, v\u00e0 theo d\u00f5i CIED n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 d\u1ea5u hi\u1ec7u ho\u1eb7c tri\u1ec7u ch\u1ee9ng g\u1ee3i \u00fd b\u1ea5t th\u01b0\u1eddng ch\u1ee9c n\u0103ng thi\u1ebft b\u1ecb.<\/p>\n
PH\u1eaaU THU\u1eacT TIM V\u00c0 THAY M\u00c1Y<\/h2>\n
Dao \u0111\u1ed1t \u0111i\u1ec7n l\u01b0\u1ee1ng c\u1ef1c s\u1eed d\u1ee5ng n\u0103ng l\u01b0\u1ee3ng th\u1ea5p \u0111\u01b0\u1ee3c \u01b0u ti\u00ean s\u1eed d\u1ee5ng, v\u00e0 t\u00e1i l\u1eadp tr\u00ecnh CIED n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n nh\u1eb1m gi\u1ea3m nguy c\u01a1 EMI.<\/p>\n
Tr\u00ean b\u1ec7nh nh\u00e2n c\u1ea5y thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3 th\u1ea5t tr\u00e1i, theo d\u00f5i CIED t\u1eeb xa c\u00f3 \u0111em l\u1ea1i l\u1ee3i \u00edch.<\/p>\n
TR\u1eca LI\u1ec6U B\u1ee8CX\u1ea0<\/h2>\n
\n
CIED n\u00ean \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u x\u1ea1 tr\u1ecb v\u00e0 k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u (bao g\u1ed3m \u01b0\u1edbc t\u00ednh li\u1ec1u x\u1ea1 tr\u1ecb) n\u00ean \u0111\u01b0\u1ee3c ph\u00e1c th\u1ea3o b\u1edfi chuy\u00ean gia v\u1ec1 CIED v\u00e0 b\u00e1c s\u0129 x\u1ea1 tr\u1ecb ung th\u01b0 h\u1ecdc tr\u01b0\u1edbc khi kh\u1edfi tr\u1ecb<\/li>\n
Ki\u1ec3m tra CIED v\u00e0 theo d\u00f5i ECG n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n t\u00f9y thu\u1ed9c v\u00e0o ph\u00e2n t\u1ea7ng nguy c\u01a1 trong th\u1eddi gian x\u1ea1 tr\u1ecb v\u00e0 sau khi ho\u00e0n th\u00e0nh \u0111\u1ee3t cu\u1ed1i c\u00f9ng c\u1ee7a \u0111i\u1ec1u tr\u1ecb<\/li>\n
K\u1ef9 thu\u1eadt vi\u00ean \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o CIED lu\u00f4n c\u00f3 m\u1eb7t s\u1eb5n ho\u1eb7c th\u00f4ng qua t\u1ed5ng \u0111\u00e0i “on call” trong c\u00e1c \u0111\u1ee3t x\u1ea1 tr\u1ecb tr\u00ean t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n CIED<\/li>\n
Kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh di chuy\u1ebfn v\u1ecb tr\u00ed CIED nh\u1eb1m m\u1ee5c \u0111\u00edch x\u1ea1 tr\u1ecb, tr\u1eeb khi thi\u1ebft b\u1ecb \u1ea3nh h\u01b0\u1edfng \u0111\u1ee7 nhi\u1ec1u \u0111\u1ebfn vi\u1ec7c \u0111i\u1ec1u tr\u1ecb kh\u1ed1i u<\/li>\n<\/ul>\n
$\"Tr\u1ecb$
Tr\u1ecb li\u1ec7u b\u1ee9c x\u1ea1<\/figcaption><\/figure>\n
LI\u1ec6U PH\u00c1P K\u00cdCH TH\u00cdCH \u0110I\u1ec6N<\/h2>\n
\n
TENS v\u00e0 c\u00e1c li\u1ec7u ph\u00e1p EST tr\u00ean b\u1ec7nh nh\u00e2n CIED ch\u1ec9 n\u00ean \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng sau khi tham v\u1ea5n v\u1edbi chuy\u00ean gia v\u1ec1 CIED<\/li>\n
EST n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n xa CIED nh\u1ea5t c\u00f3 th\u1ec3 v\u00e0 \u01b0u ti\u00ean th\u1ef1c hi\u1ec7n 1 b\u00ean<\/li>\n
Chy k\u1ef3 EST \u0111\u1ea7u ti\u00ean tr\u00ean b\u1ec7nh nh\u00e2n l\u1ec7 thu\u1ed9c m\u00e1y n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n d\u01b0\u1edbi s\u1ef1 theo d\u00f5i EGM v\u00e0 c\u00e1c k\u00eanh \u0111\u00e1nh d\u1ea5u b\u1edfi k\u1ef9 thu\u1eadt vi\u00ean \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o CIED nh\u1eb1m lo\u1ea1i tr\u1eeb nhi\u1ec5u<\/li>\n
Chu k\u1ef3 EST \u0111\u1ea7u ti\u00ean tr\u00ean b\u1ec7nh nh\u00e2n ICD n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n v\u1edbi s\u1ef1 gi\u00e1m s\u00e1t c\u1ee7a k\u1ef9 thu\u1eadt vi\u00ean \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o CIED b\u1eb1ng theo d\u00f5i ECG li\u00ean t\u1ee5c k\u00e8m m\u00e1y kh\u1eed rung k\u1ebf c\u1eadn<\/li>\n
Trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 s\u1ef1 t\u01b0\u01a1ng t\u00e1c sau khi \u0111\u00e3 ki\u1ec3m tra \u0111\u1ee7, EST c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n khi kh\u00f4ng c\u00f3 k\u1ef9 thu\u1eadt vi\u00ean \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o CIED<\/li>\n
Theo d\u00f5i t\u1eeb xa \u0111\u01b0\u1ee3c khuy\u1ebfn kh\u00edch trong khi \u0111i\u1ec1u tr\u1ecb EST \u1edf b\u1ec7nh nh\u00e2n ICD l\u1ec7 thu\u1ed9c m\u00e1y.<\/li>\n<\/ul>\n
M\u1ed8T S\u1ed0 TH\u1ee6 THU\u1eacT KH\u00c1C<\/h2>\n
N\u1ed9i soi: Theo d\u00f5i ECG trong qu\u00e1 tr\u00ecnh l\u00e0m th\u1ee7 thu\u1eadt \u0111\u01b0\u1ee3c khuy\u1ebfn kh\u00edch khi n\u1ed9i soi trong tr\u01b0\u1eddng h\u1ee3p s\u1eed d\u1ee5ng n\u0103ng l\u01b0\u1ee3ng s\u00f3ng cao t\u1ea7n \u0111\u01a1n c\u1ef1c.<\/p>\n
N\u1ed9i soi: S\u1eed d\u1ee5ng nam ch\u00e2m c\u00f3 th\u1ec3 \u0111\u1ea3m b\u1ea3o cho b\u1ec7nh nh\u00e2n c\u00f3 ICD trong qu\u00e1 tr\u00ecnh n\u1ed9i soi can thi\u1ec7p bao g\u1ed3m c\u1ea3 s\u1eed d\u1ee5ng n\u0103ng l\u01b0\u1ee3ng s\u00f3ng cao t\u1ea7n \u0111\u01a1n c\u1ef1c.<\/p>\n
T\u00e1n s\u1ecfi: B\u1ec7nh nh\u00e2n CIED c\u00f3 th\u1ec3 an to\u00e0n th\u1ef1c hi\u1ec7n t\u00e1n s\u1ecfi m\u00e0 kh\u00f4ng c\u1ea7n t\u00e1i l\u1eadp tr\u00ecnh l\u1ea1i thi\u1ebft b\u1ecb ho\u1eb7c s\u1eed d\u1ee5ng nam ch\u00e2m.<\/p>\n
Th\u1ee7 thu\u1eadt nha khoa: T\u00e1i l\u1eadp tr\u00ecnh CIED t\u1ed5ng qu\u00e1t ho\u1eb7c s\u1eed d\u1ee5ng nam ch\u00e2m l\u00e0 kh\u00f4ng c\u1ea7n thi\u1ebft.<\/p>\n","protected":false},"excerpt":{"rendered":"
vnras.com\/drug – B\u00e0i vi\u1ebft Can thi\u1ec7p th\u1ee7 thu\u1eadt y khoa tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 thi\u1ebft b\u1ecb \u0111i\u1ec7n c\u1ea5y gh\u00e9p tim. \u0110\u1ecaNH NGH\u0128A Thi\u1ebft b\u1ecb \u0111i\u1ec7n c\u1ea5y gh\u00e9p tim (CIEDs, cardiac implantable electronic devices) bao g\u1ed3m: m\u00e1y t\u1ea1o nh\u1ecbp tim (PM), c\u1ea5y ph\u00e1 rung (ICD), t\u00e1i \u0111\u1ed3ng b\u1ed9 tim (CRT) v\u00e0 theo d\u00f5i nh\u1ecbp tim (ILR). […]\n","protected":false},"author":1,"featured_media":32333,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-32331","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/32331","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=32331"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/32331\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/32333"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=32331"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=32331"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=32331"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}