{"id":21692,"date":"2023-04-16T11:28:51","date_gmt":"2023-04-16T04:28:51","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21692"},"modified":"2023-04-18T15:38:27","modified_gmt":"2023-04-18T08:38:27","slug":"thang-diem-dapt-trong-dieu-tri-khang-tieu-cau-kep","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/16\/thang-diem-dapt-trong-dieu-tri-khang-tieu-cau-kep\/","title":{"rendered":"Thang \u0111i\u1ec3m DAPT v\u00e0 \u0111i\u1ec1u tr\u1ecb kh\u00e1ng ti\u1ec3u c\u1ea7u k\u00e9p"},"content":{"rendered":"

Li\u1ec7u ph\u00e1p kh\u00e1ng ti\u1ec3u c\u1ea7u k\u00e9p v\u1edbi aspirin v\u00e0 m\u1ed9t thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 P2Y12 \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c gi\u1ea3m c\u00e1c bi\u1ebfn c\u1ed1 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9, c\u1ea3i thi\u1ec7n ti\u00ean l\u01b0\u1ee3ng, gi\u1ea3m t\u1ec9 l\u1ec7 t\u1eed vong \u1edf b\u1ec7nh nh\u00e2n b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.Thang \u0111i\u1ec3m DAPT l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 h\u1eefu \u00edch trong quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb li\u1ec7u ph\u00e1p kh\u00e1ng ti\u1ec3u c\u1ea7u k\u00e9p. Vi\u1ec7c s\u1eed d\u1ee5ng thang \u0111i\u1ec3m DAPT c\u1ea7n \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p v\u1edbi \u0111\u00e1nh gi\u00e1 to\u00e0n di\u1ec7n v\u1ec1 b\u1ec7nh nh\u00e2n \u0111\u1ec3 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p nh\u1ea5t.<\/strong><\/p>\n

1.Gi\u1edbi thi\u1ec7u v\u1ec1 \u0111i\u1ec1u tr\u1ecb kh\u00e1ng ti\u1ec3u c\u1ea7u k\u00e9p<\/h2>\n

DAPT l\u00e0 vi\u1ebft t\u1eaft c\u1ee7a thu\u1eadt ng\u1eef ti\u1ebfng Anh “Dual Antiplatelet Therapy”, c\u00f3 ngh\u0129a l\u00e0 “\u0111i\u1ec1u tr\u1ecb kh\u00e1ng ti\u1ec3u c\u1ea7u k\u00e9p”. DAPT l\u00e0 m\u1ed9t li\u1ec7u ph\u00e1p \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ng\u0103n ng\u1eeba c\u00e1c bi\u1ebfn ch\u1ee9ng sau khi ph\u1eabu thu\u1eadt tim m\u1ea1ch ho\u1eb7c khi \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd tim m\u1ea1ch.C\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng \u0111\u01b0\u1ee3c xem x\u00e9t s\u1eed d\u1ee5ng DAPT bao g\u1ed3m b\u1ec7nh nh\u00e2n v\u1edbi h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p (\u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa \u0111\u01a1n thu\u1ea7n, s\u1eed d\u1ee5ng thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft, can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh qua da, ho\u1eb7c ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u \u0111\u1ed9ng m\u1ea1ch v\u00e0nh) v\u00e0 b\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 \u1ed5n \u0111\u1ecbnh \u0111\u01b0\u1ee3c can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh qua da ho\u1eb7c ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.<\/p>\n

DAPT bao g\u1ed3m s\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a hai lo\u1ea1i thu\u1ed1c kh\u00e1ng ti\u1ec3u c\u1ea7u, th\u01b0\u1eddng l\u00e0 clopidogrel v\u00e0 aspirin. C\u00e1c thu\u1ed1c n\u00e0y ho\u1ea1t \u0111\u1ed9ng b\u1eb1ng c\u00e1ch ng\u0103n ch\u1eb7n s\u1ef1 g\u1eafn k\u1ebft c\u1ee7a ti\u1ec3u c\u1ea7u trong m\u00e1u, t\u1eeb \u0111\u00f3 gi\u1ea3m nguy c\u01a1 h\u00ecnh th\u00e0nh c\u1ee5c m\u00e1u v\u00e0 t\u1eafc \u0111\u1ed9ng m\u1ea1ch.<\/p>\n

Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb DAPT th\u01b0\u1eddng k\u00e9o d\u00e0i t\u1eeb 6 \u0111\u1ebfn 12 th\u00e1ng sau ph\u1eabu thu\u1eadt tim m\u1ea1ch ho\u1eb7c khi b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n m\u1eafc b\u1ec7nh l\u00fd tim m\u1ea1ch. Tuy nhi\u00ean, th\u1eddi gian \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 thay \u0111\u1ed5i t\u00f9y thu\u1ed9c v\u00e0o tr\u1ea1ng th\u00e1i s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 \u0111\u00e1nh gi\u00e1 nguy c\u01a1 bi\u1ebfn ch\u1ee9ng.<\/p>\n

DAPT c\u0169ng c\u00f3 th\u1ec3 g\u00e2y ra m\u1ed9t s\u1ed1 t\u00e1c d\u1ee5ng ph\u1ee5 nh\u01b0 ch\u1ea3y m\u00e1u d\u01b0\u1edbi da, ti\u00eau ch\u1ea3y, bu\u1ed3n n\u00f4n, \u0111au \u0111\u1ea7u v\u00e0 d\u1ec5 b\u1ea7m t\u00edm. Do \u0111\u00f3, quy\u1ebft \u0111\u1ecbnh s\u1eed d\u1ee5ng DAPT ph\u1ea3i \u0111\u01b0\u1ee3c \u0111\u01b0a ra d\u1ef1a tr\u00ean \u0111\u00e1nh gi\u00e1 c\u1ea9n th\u1eadn c\u1ee7a c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 v\u00e0 l\u1ee3i \u00edch c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

Vi\u1ec7c t\u0103ng c\u01b0\u1eddng \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng ng\u01b0ng t\u1eadp ti\u1ec3u c\u1ea7u b\u1eb1ng c\u00e1ch ph\u1ed1i h\u1ee3p m\u1ed9t thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 P2Y12 v\u1edbi aspirin c\u0169ng nh\u01b0 k\u00e9o d\u00e0i th\u1eddi gian \u0111i\u1ec1u tr\u1ecb KTCK c\u1ea7n c\u00e2n b\u1eb1ng gi\u1eefa gi\u1ea3m nguy c\u01a1 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 v\u00e0 t\u0103ng nguy c\u01a1 xu\u1ea5t huy\u1ebft.<\/p>\n

2.Thang \u0111i\u1ec3m DAPT<\/h2>\n

Thang \u0111i\u1ec3m nguy c\u01a1 m\u1edbi (thang \u0111i\u1ec3m DAPT), b\u1eaft ngu\u1ed3n t\u1eeb nghi\u00ean c\u1ee9u Dual Antiplatelet Therapy , c\u00f3 th\u1ec3 h\u1eefu \u00edch \u0111\u1ec3 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh ti\u1ebfp t\u1ee5c k\u00e9o d\u00e0i DAPT \u1edf b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u1eb7t stent \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.<\/p>\n

Thang \u0111i\u1ec3m DAPT (DAPT score) l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 nguy c\u01a1 bi\u1ebfn ch\u1ee9ng v\u00e0 quy\u1ebft \u0111\u1ecbnh th\u1eddi gian \u0111i\u1ec1u tr\u1ecb DAPT sau ph\u1eabu thu\u1eadt tim m\u1ea1ch ho\u1eb7c khi \u0111i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd tim m\u1ea1ch. Thang \u0111i\u1ec3m n\u00e0y c\u00f3 th\u1ec3 gi\u00fap b\u00e1c s\u0129 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh l\u1ef1a ch\u1ecdn th\u1eddi gian \u0111i\u1ec1u tr\u1ecb v\u00e0 gi\u1ea3m nguy c\u01a1 bi\u1ebfn ch\u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

C\u00e1c y\u1ebfu t\u1ed1 g\u00f3p ph\u1ea7n v\u00e0o \u0111i\u1ec3m s\u1ed1 DAPT cao bao g\u1ed3m \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, hi\u1ec7n t\u1ea1i h\u00fat thu\u1ed1c l\u00e1, ti\u1ec1n s\u1eed can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh qua da ho\u1eb7c ti\u1ec1n s\u1eed nh\u1ed3i m\u00e1u c\u01a1 tim, suy tim sung huy\u1ebft ho\u1eb7c ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i < 30%, nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p, can thi\u1ec7p m\u1ea1ch v\u00e0nh qua da c\u1ea7u t\u0129nh m\u1ea1ch hi\u1ec3n v\u00e0 \u0111\u01b0\u1eddng k\u00ednh stent < 3 mm; l\u1edbn tu\u1ed5i g\u00f3p ph\u1ea7n v\u00e0o \u0111i\u1ec3m s\u1ed1 DAPT th\u1ea5p<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Bi\u1ebfn s\u1ed1<\/td>\n\u0110i\u1ec3m<\/td>\n<\/tr>\n
Tu\u1ed5i >=65<\/td>\n-2<\/td>\n<\/tr>\n
Tu\u1ed5i 65 \u0111\u1ebfn < 75<\/td>\n-1<\/td>\n<\/tr>\n
Tu\u1ed5i < 65<\/td>\n0<\/td>\n<\/tr>\n
\u0110ang h\u00fat thu\u1ed1c<\/td>\n1<\/td>\n<\/tr>\n
Ti\u1ec3u \u0111\u01b0\u1eddng<\/td>\n1<\/td>\n<\/tr>\n
Nh\u1ed3i m\u00e1u \u0111ang ti\u1ebfn tri\u1ec3n<\/td>\n1<\/td>\n<\/tr>\n
Ti\u1ec1n s\u1eed c\u00f3 PCI ho\u1eb7c NMCT tr\u01b0\u1edbc \u0111\u00f3<\/td>\n1<\/td>\n<\/tr>\n
\u0110\u01b0\u1eddng k\u00ednh stent < 3 mm<\/td>\n1<\/td>\n<\/tr>\n
Sten ph\u1ee7 thu\u1ed1c ph\u00f3ng th\u00edch ch\u1eadm<\/td>\n1<\/td>\n<\/tr>\n
Suy tim m\u1ea1n ho\u1eb7c ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u < 30%<\/td>\n2<\/td>\n<\/tr>\n
PCI t\u0129nh m\u1ea1ch hi\u1ec3n gh\u00e9p<\/td>\n2<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

N\u1ebfu \u0111i\u1ec3m \u2265 2: li\u00ean quan v\u1edbi t\u1ec9 s\u1ed1 l\u1ee3i \u00edch \/ nguy c\u01a1 thu\u1eadn l\u1ee3i cho vi\u1ec7c d\u00f9ng DAPT k\u00e9o d\u00e0i<\/p>\n

\u0110i\u1ec3m <2 : li\u00ean quan v\u1edbi t\u1ec9 s\u1ed1 l\u1ee3i \u00edch \/ nguy c\u01a1 kh\u00f4ng thu\u1eadn l\u1ee3i cho vi\u1ec7c d\u00f9ng DAPT k\u00e9o d\u00e0i<\/p>\n

3. \u01afu \u0111i\u1ec3m , h\u1ea1n ch\u1ebf thang \u0111i\u1ec3m DAPT<\/h2>\n

3.1 \u01afu \u0111i\u1ec3m<\/h3>\n

Thang \u0111i\u1ec3m DAPT c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c quy\u1ebft \u0111\u1ecbnh th\u1eddi gian \u0111i\u1ec1u tr\u1ecb DAPT \u0111\u1ec3 ng\u0103n ng\u1eeba s\u1ef1 t\u00e1i ph\u00e1t c\u01a1n \u0111au tim ho\u1eb7c nh\u1ed3i m\u00e1u c\u01a1 tim. Vi\u1ec7c s\u1eed d\u1ee5ng thang \u0111i\u1ec3m DAPT gi\u00fap cho vi\u1ec7c quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb DAPT \u0111\u01b0\u1ee3c \u0111\u01b0a ra m\u1ed9t c\u00e1ch ch\u00ednh x\u00e1c h\u01a1n, \u0111\u1ea3m b\u1ea3o t\u00ednh an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb.<\/p>\n

L\u1ee3i \u00edch c\u1ee7a thang \u0111i\u1ec3m DAPT l\u00e0 gi\u00fap cho c\u00e1c chuy\u00ean gia y t\u1ebf c\u00f3 th\u1ec3 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb DAPT d\u1ef1a tr\u00ean nguy c\u01a1 bi\u1ebfn ch\u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n, t\u1eeb \u0111\u00f3 gi\u1ea3m thi\u1ec3u nguy c\u01a1 ch\u1ea3y m\u00e1u v\u00e0 t\u0103ng t\u00ednh hi\u1ec7u qu\u1ea3 c\u1ee7a \u0111i\u1ec1u tr\u1ecb.<\/p>\n

3.2 H\u1ea1n ch\u1ebf<\/h3>\n

Tuy nhi\u00ean, h\u1ea1n ch\u1ebf c\u1ee7a thang \u0111i\u1ec3m DAPT l\u00e0 n\u00f3 ch\u1ec9 l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 h\u1ed7 tr\u1ee3 quy\u1ebft \u0111\u1ecbnh v\u00e0 kh\u00f4ng th\u1ec3 thay th\u1ebf cho s\u1ef1 \u0111\u00e1nh gi\u00e1 to\u00e0n di\u1ec7n c\u1ee7a b\u1ec7nh nh\u00e2n. Ngo\u00e0i ra, c\u00e1c y\u1ebfu t\u1ed1 kh\u00e1c nh\u01b0 t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe t\u1ed5ng th\u1ec3 c\u1ee7a b\u1ec7nh nh\u00e2n c\u0169ng c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb DAPT.<\/span><\/p>\n

4. K\u1ebft lu\u1eadn<\/h2>\n

T\u00f3m l\u1ea1i, li\u1ec7u ph\u00e1p kh\u00e1ng ti\u1ec3u c\u1ea7u k\u00e9p \u0111\u00f3ng vai tr\u00f2 thi\u1ebft y\u1ebfu trong c\u1ea3i thi\u1ec7n ti\u00ean l\u01b0\u1ee3ng c\u1ee7a b\u1ec7nh nh\u00e2n b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh. Quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb v\u00e0 th\u1eddi gian li\u1ec7u ph\u00e1p DAPT c\u1ea7n \u0111\u00e1nh gi\u00e1 c\u1ea9n th\u1eadn t\u1ec9 s\u1ed1 l\u1ee3i \u00edch \u2013 nguy c\u01a1, ph\u1ed1i h\u1ee3p d\u1eef li\u1ec7u nghi\u00ean c\u1ee9u v\u00e0 xem x\u00e9t s\u1ef1 \u01b0a th\u00edch c\u1ee7a b\u1ec7nh nh\u00e2n. Nh\u00ecn chung, th\u1eddi gian DAPT ng\u1eafn h\u01a1n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem x\u00e9t \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 th\u1ea5p thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 v\u00e0 nguy c\u01a1 cao xu\u1ea5t huy\u1ebft, trong khi th\u1eddi gianDAPTk\u00e9o d\u00e0i c\u00f3 th\u1ec3 h\u1ee3p l\u00fd \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 v\u00e0 nguy c\u01a1 th\u1ea5p xu\u1ea5t huy\u1ebft.Thang \u0111i\u1ec3m nguy c\u01a1 m\u1edbi (thang \u0111i\u1ec3m DAPT), b\u1eaft ngu\u1ed3n t\u1eeb nghi\u00ean c\u1ee9u Dual Antiplatelet Therapy , c\u00f3 th\u1ec3 h\u1eefu \u00edch \u0111\u1ec3 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh ti\u1ebfp t\u1ee5c k\u00e9o d\u00e0i DAPT ho\u1eb7c r\u00fat ng\u1eafn DAPT.<\/p>\n","protected":false},"excerpt":{"rendered":"

Li\u1ec7u ph\u00e1p kh\u00e1ng ti\u1ec3u c\u1ea7u k\u00e9p v\u1edbi aspirin v\u00e0 m\u1ed9t thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 P2Y12 \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c gi\u1ea3m c\u00e1c bi\u1ebfn c\u1ed1 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9, c\u1ea3i thi\u1ec7n ti\u00ean l\u01b0\u1ee3ng, gi\u1ea3m t\u1ec9 l\u1ec7 t\u1eed vong \u1edf b\u1ec7nh nh\u00e2n b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.Thang \u0111i\u1ec3m DAPT l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 h\u1eefu \u00edch […]<\/p>\n","protected":false},"author":25,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[3],"yoast_head":"\nThang \u0111i\u1ec3m DAPT v\u00e0 \u0111i\u1ec1u tr\u1ecb kh\u00e1ng ti\u1ec3u c\u1ea7u k\u00e9p - Vinmec<\/title>\n<meta name=\"description\" content=\"Thang \u0111i\u1ec3m DAPT l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 h\u1eefu \u00edch trong quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb li\u1ec7u ph\u00e1p kh\u00e1ng ti\u1ec3u c\u1ea7u k\u00e9p. 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