Tổn thương phối hợp Block nhĩ thất van hai lá ở bệnh nhi Lupus ban đỏ hệ thống

Sianesi M, Mario FD. "The race from chronic

pancreatitis to pancretic cancer". JOP.J pancreas

(oneline) 2003; 4(5): 165-168.

5. Lin Y, Tamakoshi A, Matsuno S, et

al: Nationwide epidemiological survey of chronic

pancreatitis in Japan. J Gastroenterol 2000; 35:136.

6. Malka D, Hammel P, Sauvanet A, et al: Risk

factors for diabetes mellitus in chronic pancreatitis.

Gastroenterology 2000; 119:1324.

7. Lin Y, Tamakoshi A, IVlatsuno S, et

al: Nationwide epidemiologicai survey of chronic

pancreatitis in Japan. J Gastroenterol 2000; 35:136.

8. Niederau C, Grendell JH: Diagnosis of

chronic pancreatitis. Gastroenterology 1985; 88:1973

9. Songur Y, et al: Endoscopy ultrasould and

endoscopic retrograde pancreatography in the

diagnosis d chronic pancratitis. Digestive endoscopy

2000: 12:37-43.

TON THimNG PHOI HOP BLOCK NHl THAT VAN HAI LA

or BENH NHI LUPUS BAN DO HE THONG

Mpt tre gai 10 tudi dUde ehan doan lupus ban dd

he thdng bj suy tim nang cd tdn thUdng block nhT tha't

cap 1 xen ke cS'p 11 (mobitz 2:1) ket hdp tdn thUdng

van hai la nang. Sau cS'y mSy tao nhjp vTnh viln

VDDR benh nhan het suy tim.

DAT VAN DE

Lupus ban dd he thdng (LBDHT) IS tinh trang rdi

loan tu miln man tfnh gay tdn thUdng da phii tang.

Ton ttiudng tim la mot trong nhung tdn thUdng tang

thudng gap nha't > 56%[1] bao gdm eSc thUdng tdn:

mSng ngoai tim, cd tim, van tim, dpng mach vanh vS

he thdng din truyen. Cac rdi loan nhjp vS tdn thUdng

dSn truyen vao khoang tren 10% vdi cac miire dp bieu

hien khSc nhau nhu la: block nhT that cae mife dp,

block nhSnh, nhjp nhanh xoang, ngoai tam thu nhTvS

rung nhT Tuy nhien, cho den nay eae bSo.cSo ve tdn

thUdng tim trong LBOHT d tre em rat han che'[2-4].

Hau chUa cd bao cao nSo ve trUdng hdp tJtock nhT

that kem theo tdn thUdng van tim d tre Idn.

BAO CAO TRl/ONG HOP BENH

Tre gSi, 12 tudi, benh dien bien khoang 3 nSm.

Bleu hien ban dau sUng dau cae khdp chi, dUde dieu

trj phdng thS'p tai benh vien tinh trong 2 nam. Trude

vao vien 1 thang tre sung dau khdp tang, sdt cao 39-

40°C keo dai 3 tuan, ban dd 2 ben ma, ho nhieu kem

theo khd thd khi di lai vS khi nam, thinh thoang ed edn

dSnh trdng ngUc. CSe trieu chimg va dS'u hieu lam

sang va can ISm sang dSp img day du tieu chuan

chan doan LBDHT cua ACR.

CSc bleu hien d he tim mach. Lam sang cd suy

tim dp 111 theo I^YHA; dai ft; phii 2 chi dudi; nhjp tim

cham khdng deu khoang 40 lan/phiit; huye't ap

115/75 mmHg; thdi tam thu 3/6; gan to; nghiem phSp

phan hdi gan tTnh mach ed dUdng tfnh. Phim XQ tim

phdi cd bdng tim to vdi eSc nhSnh huyet quan dam

(hinh 4). Sieu am tim cd nhTtrSi vS tha't trSi gian to, hd

van hai la nang va hd van ba IS nhe. Tuy nhien phan

xua't tdng mau vin trong gidi ban binh thudng

(EF~65%).

NGUYI N THANH HAI,

NGUY§N L'}'THINH TRUONG, NGUYI N VAN LINH

Benh vien Nhl Trung l/ong

Hinlil Phim XQ trifdc cay

may tao nhip

Hinh 2 Ptiim XQ sau cay may

tao nhip

Oien tam dd 12 chuyen dao vdi nhjp xoang deu 51

lan/phiit, block nhT that cap 1 vdi PQ khoang 260ms

(hinh 3). Holier dien tam do 24 gid: block nhT tha't ca'p

I xen ke block nhT that cap II kieu mobitz 2 (hinh 4),

nhjp that cham nhat 34 lan/phiit (nhT/tha't=2/1), nhjp

trung binh 58 Ian/phut nhanh nha't 147 lan/phiit

(nhT/tha't=1/1), rai rac ngoai tam thu tha't ddn le vS

nhjp ddi, cd vai edn nhanh tha't tan sd khoang 145

Ian/phut keo dSi 2-5 giay (hinh 5).

Hinh 3: Block nhi that cap I vdi PQ khoang 260ms

Oieu trj benh ehfnh bang corticosteroid. Oieu trj

suy tim bang cae thudc laxis, aldacton, loprin. Benh

nhan dap img dieu trj tdt vdi bieu hien: het sdt, het

SLfng dau khdp, suy tim thuyen giam dan tif NYHA 111

xudng dp NYiHA II. Tuy nhien cac trieu chimg rdi loan

ve nhjp tim khong cd dau hieu tien then.

Y HOC THl/C HANH (729) - SO 8/2010 37