TAP CHl TIM MACH HOC VIET NAM - SO 56 - 2010
CHUYEN DE CHO NGIfSl BENH
Tim Hieu Benh Dpng Mach Ngoai Bien
Ths. Phan Dinh Phong; Ths. Nguyen Ngpc Quang (Vien Tim Mgch Viet Nam)
BENH DQNG MACH NGOAI BIEN LA GJ?
B?nh ddng mgch ngoai bien la benh ly tSc nghen mgch mau ngogi bien bdi cac mang xa viia va huyet khd'i. Cac dpng mach do khdng bao gom mgeh mau nudi tim va nao.
Benh dpng mgeh ngoai bien thudng gap nhat la eae tdn thuang dpng mgch vung tieu khung, chi dudi va ehi tien. Ve sinh benh hoc, tinh tiang tae nghen d eae mach nay ding tuong ty nhu tae ddng mgch vanh hay dpng mgch canh. Diein khac biet la vimg cap mau eiia eae dpng maeh: dpng maeh vanh ea'p mau cho ca tim, dpng maeh eanh cap mau cho nao edn cac ddng mach ngogi bien cap mau eho cac ehi.
Nguyen nhan ehinh gay benh ly dpng mgeh ngogi bien la hep tae do mang xo viia. Long mach bj hep lgi do lang dgng md - va eae chat khae tren thanh maeh. Nhiing chat lang dpng nay tao nen mang bam vao ldp npi mge thanh mach tgo thanh mang xo viia, cac mang nay phat trien dan ga)' hep va cd the gay tac nghen hoan toan ddng ehay trong Idng mgeh. Bang each kiem soat tdt eac ye'u td'nguy co eita benh ddng maeh ngoai bien, ban ciing cd the lam giam nguy cd cho nhoi mau co tim va dot quy.
BENH DONG MACH NGOAI BIEN THU'CXNG GAP Cf D6\ TUp-NG NAG?
Co khoang gan 75% trudng hgp khdng ed trieu chung. Benh dpng mgeh ngogi bien hi^n ed xu hudng tang len eimg vdi sy tang ciia tudi thp.
ldi sdhg thay doi va dge bi§t la cae yeli td'nguy ca tim mgeh gja tang. Sau tudi 70, khoang 20%
dan sd'bi benh dpng mach ngogi bien.
Nhiing nguy co eao bj berth dpng mgeh ngogi bien la:
• Hiit thude la
• Benh tieu dudng
• Tang huyet ap
• Rdi loan md mau...
Trong so' dd, hiit thud'e la va dai thao dudng la 2 nguy ca bj benh dac biet cao. Neu bgn cd dii ehi mgt nhiing nguy eo tien ciia benh dpng mgch ngoai bien, hay tim hieu ve berth. Ciing nhu eae benh ly khae, bgn cang hieu biet ve benh bao nhieu thi ban ed the giiip phat hien benh sdm bay iJiieu.
T A M Q U A N TRONG QUA VIEC PHAT HIEN SQM BENH DONG MACH NGOAI BIEN.
Viee phat hien berth mgch mau ngoai bien cd vai tid rat quan tipng. Ngoai viee giiip dieu trj sdm finh tiang thieii mau chi trudc khi cd nhung bieh chung nang ne nhu hogi tii chi, phai cat cut chi, ngudi bi berth dpng maeh ngoai bien thudng cd tinh tiang xa viia d eac dgng mach khac bao gom ea dpng maeh cap mau cho tim va nao. Thye te^ benh nhan bi berth ddng maeh ngogi bien ed nguy CO nhdi mau ea tim hay dot cpay cao ga'p 6 dCTi 7 IEUI so vdi ngudi khdng eo benh.
Nhieu benh nhan hi benh ddng mach ngogi bien khdng c6 bat cii mpt tri?u ehiing nao nhat la tiong giai doan sdm eiia benh. Dd la ly do ma
benh de bj bd sdt ehan doan. Mpt so'chi ed bieu hien dau b5p ehan hoae chupt nit khi di lai xa.
Ben eanh do, nhieu trudng hgp bj ehan doan nheun do nguyen nhan viem khdp, berth ly eiia CO hay ehi la bieu hien cua tudi gia. Phan Idn cac trudng hpp bi b?nh ehi dugc phat hien khi da ed bieii hien mudn hay bieh chiing ciia berth nhu ed nhiing vet loet tren da ehan khd lanh, dau nhieu va tim dau chi hay hogi tii ehi.
Nhiing ngudi hiit thud'e la va bi tieii dudng ed nguy co mac benh rat cao. Neu ban bj benh ddng mgch ngoai bien, dieu tri hi|u qua se lam giam trieu chting va giam eae nguy ca bj cat eyt ehan, nhdi mau co tim hay nguy ca bi dpt tii trong tuong lai.
TINH HINH CHUNG COA BENH DONG MACH NGOAI BIEN
• Gan 75% b?nh nhan bj benh dpng mgeh ngoai bien khong bieu hien trieu chiing.
• Nhieu berth nhan bj cham doan nham tri|u ehiing ciia benh ddng mach ngogi bien vdi eac benh ly khae.
• Trieu chiing thudng gap nhat la dau nhu chupt nit hay cam giac mdi d viing co ehan va hdng khi di lgi hoae treo eau thang, dd dau khi nghi va dau lai xuat hien tid lgi khi tie'p tyc di bg vdi khoang each nhu vgy.
Khoang each di dugc trude khi xuat hi?n dau eho phep ude doan miie dp nang eiia b?nh.
• Viec thdng bao eho bae si ve cae yeu td'nguy eo eiia ban la rat quan trpng de bae sy ed the ehi djnh mdt sd'xet nghiem sang Ipc de phat hi?n benh sdm.
• Nhiing nguoi bi boih dpng mach ngogi bien eo nguy co cao bj nhoi mau eo tim va dpt quy.
• Ne'u khdng duge dieu tn, benh dgng mgeh ngoai bien eo the dan deh hogi tii va eat cut chan.
• B^nh ddng mgeh ngoai bien eo the
duge phat hien sdm bSng eac phuong phap don gian va khdng gay ehay mau.
• Bgn ed the phdng bpnh bSng each duy tri mpt ldi sd'ng lanh manh va thye hien theo ldi khuyen ciia bae si.
• Phan Idn cac trudng hpp can duge dieu trj bang che' dp luy^n tap, ehe' dp an giam ehlesterol, giam chat beo bao hoa va diing thude vdi eae trudng hgp nang.
TRIEU CHLTNG DONG MACH NGOAI BIEN LAGi?
Trieu duing thudng gap nhat eiia berth ddng mgeh ngogi bien la cam giae chupt nit d vung diii, hdng va bap chan xuat hien khi di bp, treo cau thang hoac khi gSng siic. Tri^u chung nay da hoae het khi dugc nghi ngoi dii ehi vai phiit
Ca die'gay dau la khi co hogt dgng, duing can duoc cap mau nhieu hon, nhung do long mgeh bi hep tie bdi mang xa viia, ea bj thieii mau nen gay ra trieu ehiing dau. Khi nghi ngai, nhu cau dxi giam xuong nen tri?u ehiing dau ciing gjam va hei Hien tugng dd gpi la dau each hoi.
Nhieu ngudi eho rang dau chan la mpt trieu ehiing tiiudng gap d ngudi gia. Ngudi benh Ihudng eho rang dd la tri^u ehiing ctia viem khdp hay dau day th&i kinh tog hay hien tugng Cling khdp d ngudi gia.
Dau chan do benh dpng mgch ngoai bien thudng xuat hien d ea (nhu ea bap chan) ehii khdng phai d khdp. Vdi nhiing benh nhan bi tieii duong till tiieu ehiing nay cd tiie bi ehe lap bdi trieu chting dau, te bi d ban ehan hoae diii do biei ehiing than kinh, mpt bieh chiing Ihudng gap ciia berth.
Trieu ehiing nang ciia benh dpng mgch ngoai bien bao gom;
• Dau chan khdng dd khi nghi ngoi.
• Vet tiiuong d ngdn chan hay ban chan khd lanh.
TAP CHI TIM MACH HQC VIET NAM - S6 56 - 2010
• Hoai tii ban chan, ngdn chan.
• Chan ben bj benh Ignh hon ehan lanh hogc Ignh han so vdi cae phan ehi phia tren.
Ne'u ban cd nhirng con dau lap lai nhieu lan, hay di kham va md ta chi tiet con dau de bae sy co the djnh hudng va cd the cho ban lam nhiing tham dd can ihie't.
Neil ban cd cac ye'u td' nguy ca ciia benh dpng mgch ngoai bien, mac dit khdng cd trieu chiing, bien?e tieh hanh cae tham dd thudng quy theo dinh ky ed the giiip ban phat hien duge b^nh ngay tu giai doan sdm nhat.
CAC Y £ U T 6 NGUY CCf CUA BENH DONG MACH NGOAI BIEN
Cae ye'u to' nguy co khdng the kiem soat dupe nhu:
• Tudi
• Tien sti gia dinh bj benh ddng mach ngoai bien, berth tim madi hay dot quy.
Nhihig ye'u to nguy co cd the khd'ng ehe' dupe nhu;
• Hut thuoc Id: Day la nguy eo ehinh ctia berth ddng maeh ngogi bien. Nhiing ngudi hiit thud'e la ed nguy co bj benh dpng mgeh ngoai bien sdm hon khoang 10 nam nhiing ngudi khdng hiit thuoe.
• Beo phi lam tang nguy co lang dpng md du thua vao thanh mach (benh xa vua mach mau).
' Mo mdu cao: Lam tang nguy co xo viia mgeh (do tang lang dpng chat beo d thanh dpng maeh).
• Benh tieu duang: ldp npi mac mgch ding de bi tdn thuong lam tang nguy ea lang dgng md du thua vao thanh mgch.
• Benh tdng huyei dp: Ap lye trong thanh mgch tang len ed the gay ton thuang thanh mgch va gay lang dpng eae chat md vao thanh maeh.
' It van dong. Hoat the lye tiiudng xuyen lam giam nguy eo nhdi mau ca tim va dot quy, nd ciing lam tang do dai quang dudng ma ngudi bi benh ddng mach ngoai bien ed the di ma khdng bj dau ehan. Chuong trinh tap luyen the lue cd giam sat la mpt trong nhiing phuong phap dieu tri hieu qua cho benh nhan bi benh ddng mach ngoai bien.
Cac yeii td' nguy ea eiia benh dgng mgch ngoai bien ciing gj&ig nhu cae benh ly tim mgch khac Phan Idn cac ye'u to' nay deu eo the dupc Idem soat Hay nhd, de phdng tianh va dieu tri benh hieu qua, can ki&n soat day dti cac yeu to' nguyeo.
Ban khdng the tha)' doi tuoi hay bgn cd tien sii gia dinh bj b?nh ly tim maeh. Nhung ban CO the bd thuoc la neu ban dang hilt an nhihig thtic an cd lgi eho siie khoe va tang cudng hoat dpng the lye.
C H A N DOAN BENH DONG MACH NGOAI BIEN NHU" THE NAO?
Trong chain doan benh dpng mach ngoai bien, trieu ehiing dau caeh hoi vdi nhiing rinh chat ke tren va tham kham lam sang (nhu bat maeh ehan tim da'u hieu mgeh dap ye'u hay mat mgch) la rat quan trpng.
Tham do kiem tra ehi so'mgch eo ehan - ed tay (ankle-bra chial index) eCing thudng dupc lam. Day la mpt tham do don gian, khdng gay dau va bae si cd the thye hien de dang chi trong vai phiit. Bang each so sanh ap lye mau d cd ehan vdi ap lyc mau d ed tay etia ban, bae sy ed the danh gia td'c dp ddng mau chay d ehan cd tot khdng. Binh thudng ap lue dong mau d mat ea ehan td'i thieu bang 90% ap lyc dong mau d tay, nhung vdi cac trudng hgp hep nang nd cd the nhd hon 50% ap lye ddng mau d tay.
Ne'u ket qua do bat thudng, bgn ed the bi benh ddng mach eanh phdi hgp.
Ngoai ra, bae si ed the cho ban lam them mpt so tham dd khae nhu:
• Sieu dm Doppler mach mdu: Day la mdt phuang phap chan doan khdng xam nhap su dyng cae sdng am de gtup khao sat mgch mau va danh gja toe dp ddng ehay eua mgch de qua dd xac djnh tinh trang tSc nghen.
• Chup cdt lap vi tuih da day (MS CT) mach mdu: Day eiing la mdt phuang phap fham dd khdng xam nhap. Ket qua dio phep danh gja rgng rai eac ddng mgch nghi ngd ton thuong, tir dgng mgdi ehii bimg, dpng madi chau tdi ddng mach ehi. Phuong phap nay dae biet ed ieh vdi nhung benh nhan ed tien su dgt may tao nhip tim hay dgt stent Hi?n nay, vdi phuang phap chup cat Idp bien tinh da day, hinh anh tdn thuong maeh mau dugc dung lai rat rd rang vdi dp ehinh xae kha eao.
• <Jtup cong hiKmg td hat rdidn: Day la mpt phuong phap khdng xam nhap cimg cap tiidng tin tuong tu nhu diup eat ldp bioi tinh mgch mau, nhung khdng diing tia X. Tuy nhien, nhiing benh nhan cd tien sii dat may tao nhjp khdng the ap dung duge phuang phap nay.
• Chup dong mach cdn quang. Trong phuong phap nay, chat can quang dupe tiem vao mgch mau va hinh anh mach mau dupc quan sat dudi man huynh quang de phat hien ra ehd tae nghen, miic dp ton thuong va sy cd mgt hay khdng cua cae mach mau di tat qua chd hep (tuan hoan bang he). Ngoai gia tri chain doan, phuang phap nay con cho phep cd the ket hgp dieu tri bang npng hoae dat stent tai \-i tri ton thuang.
DI^U TRj BENH DONG MACH NGOAI BIEN NHU'THeNAO?
Nguyen tac dieu trj benh dpng mgeh ngoai bien la gjam trieu ehiing dau va phdng nhiing tieh trien xau ctia benh nhir eat cut chan, con
dau that ngyc hay dot quy. Bae si se quyet dinh phuang phap dieu trj nao la tiiich hpp vdi ban dya tren tinh tiang toan than va mtic dp tiam trpng cua benh.
Trong phan Idn cac trudng hgp, thay ddi ldi sdhg, tap the dye va dimg tiiudc deu cd the lam diam su tieh trien hay day liii trieu chiing eita berth. Vdi nhiing trudng hpp ton ttiuang thieii mau nang, hian hoan bang he kem, ngudi b?nh ed the dirpc xem xet dieu tri bang phuong phap ean thiep dgt stent hoac phau ihuat hie eau ndi de tianh bioi chiing cat eyt chi.
Luyen tap
Phucmg phap dieu tri hieu qua nhat eho berth ddng mgeh ngogi bien la thudng xuyen luyen tap. Bae si se gjiipbgn ed mpt chuang trinh luyen tap phii hgp. Ban cd tiie bat dau mdt each til tir nhu di bp, tap cac bid tap danh eho ehan va cac bai tap khae tir 3 dot 4 lan/tuan. Bien phap nay cd the lam giam trieu ehiing ciia benh sau vai tiiang. Tuy hieu qua xuat hien cham nhung day la bien phap dieu tri eo ban eho tat ea cac benh nhan bi berth ddng mach ngoai bien.
Tap luyen trong tnrdng hop cd trieu chiing dau each hoi nhu di bd ed the gay dau. Vi vay, chuong trinh l u y ^ tap bao gom xen ke nhiing doan dudng di bp vdi n^ii ngoi; sau do, quang dudng nay dupc keo dai dan va thdi gjan nghi giiia nhiing lan dd ciing dan dupc nit ngan nhim tang khoang fhdi gian bgn cd the di dupc trudc khi xuat hien dau ehan. viee luyen tap va theo ddi tai eac trung tam phue hm ditie nang la rat ed idi dio bgn. Neu bgn khraig cd dieu k i ^ dot eac trung tam phyc hoi chiic nang, hay de nghi bae a giiip ban lap mdt ke'hogeh tap luyen phii hgp.
Che^dodn
Nhieu b^nh nhan bj berth dgng mgeh ngogi bien ed md mau tang cao. Ben cgnh viee dimg thudc, mgt ehe dp an it cholesterol va md bao hoa la rat can tiiiet de ghip lam giam md mau.
TAP CHi TIM MACH HQC VIET NAM - S6 56 - 2010
hgn ehe'tinh trang xo viia maeh.
Bo thuoc Id
Hiit thudc la lam tang nguy eo bi benh ddng maeh ngoai bien, nhoi mau eo tim va dot quy.
Do do, hay bd fhud'c la ne'u ban dang hiit Nd se giiip lam cham tieh trieh bf nh dpng mgeh ngogi bien va eae b?nh lien quan d m tim mgch khae.
Dieu tri bdng thuoc
Bae si cd the dugc ke eho ban thuoc ha huyet ap va/hoge thuoc dieu chinh md mau. Viee dung thuoc theo diing ehi djnh ciia bae sT la rat quan tipng, Dimg thudc khdng dung chi dinh eua bae sT se lam tang nguy ca eho benh ddng mach ngoai bien edng nhu nhdi mau eo tim va dot tii. Cac thudc nhom dlostazol, pentoinfylin se giiip bgn cai thien dupc quang dudng di bp neu bgn bi dau each hoi. Nhiing thuoc nay lam giam dp nhdt ctia mau va giam hinh fhanh cue mau dong, cai thien toe dp ddng ehay. Cac thud'e ehdhg ngung tap tieu cau (aspirin, clopidogrel) eCing giiip phdng ngira huyet khdi gay nghen mgch.
Can thiep dieii tri qua duong ong tiidng Vdi mpt so' berth nhan, ben canh eae phuong phap dieu tri tren, hp can dugc tie'n hanh can thiep hay phau thuat.
Phuong phap ean thilp bao gdm nong hay dgt stent dpng mgch, tuang b^ nhu dat stent dpng maeh vanh. Day la phuang phap khdng phau thuat. Bae sy lam thii thuat ehi can dua mpt d'ng Ihdng nhd qua da vao ddng mach de la'y eye mau ddng, sau dd dimg mdt qua bdng nhd bam len trong Idng mgeh de nong rpng chd tSc. Mdt stent (gia dd kim logi dac biet) dupe dat vao vi tri tac nghen han ehe'tai hep.
Ngudi benh can nhd day khdng phai la bien phap cd the giai quyet toan bd finh trang benh cua minh ma ehi giiip eai thi^n mtic do tiam tigng etia benh. Sau ean fhiep dat stent ngirdi benh can phai kien tri dimg thud'e deu dgn theo dting ehi dinh va thye hien eac bi|n phap luyen tap, dieu
ehinh che'dp an nhu chi dan ciia bae sy.
Phau thudt
Phau thuat ed the ean tiiiet trong mdt so' trudng hgp nhu: tie hoan toan mdt doan mach mau dai va ban ed trieu chiing thie'u mau chi nang. Trong phiu thuat bae sy se lay mdt doan maeh (thudng la tinh maeh) tir mpt phan khac ciia eo the de bae cau not qua ehd tae tdi cae mgeh mau nudi phan chi phia dudi ehd tac. Tirang ty nhu sau can thiep dgt stent ddng mgeh, ngudi b#nh sau dd van can tuan thii tdt ehe dp dimg thuPc va thay ddi ldi sd'ng.
Viee lya chpn bi^n phap dieu tri nao, dimg thude, dat stent ddng maeh hay phau thugt se can eii vao miic dp va tinh chat tdn thuong eiia bgn. Bae si se hpi chlin va quyet djnh xem phuong phap nao la thich hgp nhat vdi ban.
Tdm lai, ne'u ban dugc ehan doan la bi benh dpng mach ngoai bien, hay ty tiang bj eho minh bang rihiing hieii biet ve cac yeii to' nguy co eiia benh va lam the' nao de giarh bdt eac yeu to' nguy CO dd, nguyen tac dieu tri de giam bdt trieu chiing va tie'p tyc duy tri mpt cupe sd'ng khoe mgnh.
Luu y sau cdng
Benh dpng maeh ngogi bien khong chi ban than nguy hiem ma nd con la mdt ehi bao ban ed the dang bj cae benh tim maeh khae di kem.
Mpt khi ban bi benh dpng maeh ngoai vi, nguy ea bgn bi nhoi mau co tim va tai bieh mgch nao eao hon nhieu. Do vgy, hay fim hieu va biet rd them ve:
- Cac ye'u to'nguy co tim mgch - Benh dpng mgeh vanh va nhdi mau eo tim - Cac da'u hieu eanh bao biai ed' tim mgeh..
Ciing nhieu thdng tin bd ieh khae trong cud'n saeh nay.
Hieu biet la siie manh de bgn sdhg khde va hanh phuc hon.
