{"id":24362,"date":"2023-04-19T21:42:20","date_gmt":"2023-04-19T14:42:20","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24362"},"modified":"2023-04-20T17:21:43","modified_gmt":"2023-04-20T10:21:43","slug":"tai-thong-mach-vanh-hoi-chung-mach-vanh-cap-st-khong-chenh","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/tai-thong-mach-vanh-hoi-chung-mach-vanh-cap-st-khong-chenh\/","title":{"rendered":"T\u00e1i th\u00f4ng m\u1ea1ch v\u00e0nh h\u1ed9i ch\u1ee9ng m\u1ea1ch v\u00e0nh c\u1ea5p st kh\u00f4ng ch\u00eanh"},"content":{"rendered":"

Chi\u1ebfn l\u01b0\u1ee3c t\u00e1i th\u00f4ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 c\u1ea3i thi\u1ec7n d\u00f2ng ch\u1ea3y m\u00e1u trong \u0111\u1ed9ng m\u1ea1ch v\u00e0nh b\u1ecb t\u1eafc ngh\u1ebdn ho\u1eb7c h\u1eb9p l\u1ea1i. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y bao g\u1ed3m s\u1eed d\u1ee5ng c\u00e1c c\u00f4ng c\u1ee5 nh\u01b0 c\u00e1c \u1ed1ng m\u1ecfng v\u00e0 linh ho\u1ea1t \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 \u1ed1ng th\u00f4ng (stent) ho\u1eb7c th\u1ef1c hi\u1ec7n ph\u1eabu thu\u1eadt t\u00e1i th\u00f4ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh (bypass \u0111\u1ed9ng m\u1ea1ch).<\/strong><\/p>\n

1.Gi\u1edbi thi\u1ec7u<\/h2>\n

C\u00e1c \u1ed1ng th\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 gi\u00e3n r\u1ed9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh b\u1ecb h\u1eb9p ho\u1eb7c t\u1eafc ngh\u1ebdn b\u1eb1ng c\u00e1ch \u0111\u1eb7t ch\u00fang v\u00e0o trong \u0111\u1ed9ng m\u1ea1ch v\u00e0nh v\u00e0 b\u01a1m kh\u00ed \u0111\u1ec3 n\u00f3 m\u1edf r\u1ed9ng. Sau \u0111\u00f3, c\u00e1c \u1ed1ng th\u00f4ng n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c gi\u1eef l\u1ea1i trong \u0111\u1ed9ng m\u1ea1ch v\u00e0nh \u0111\u1ec3 gi\u1eef cho n\u00f3 gi\u00e3n r\u1ed9ng v\u00e0 c\u1ea3i thi\u1ec7n d\u00f2ng ch\u1ea3y m\u00e1u. Th\u1ee7 t\u1ee5c n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n d\u01b0\u1edbi s\u1ef1 h\u01b0\u1edbng d\u1eabn c\u1ee7a m\u1ed9t chuy\u00ean gia tim m\u1ea1ch v\u00e0 y t\u1ebf \u0111ang \u0111\u01b0\u1ee3c t\u1eadp hu\u1ea5n.<\/p>\n

N\u1ebfu t\u1eafc ngh\u1ebdn \u0111\u1ed9ng m\u1ea1ch v\u00e0nh qu\u00e1 nghi\u00eam tr\u1ecdng, ph\u1eabu thu\u1eadt t\u00e1i th\u00f4ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh (bypass \u0111\u1ed9ng m\u1ea1ch) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng. Trong ph\u01b0\u01a1ng ph\u00e1p n\u00e0y, m\u1ed9t ph\u1ea7n c\u1ee7a t\u0129nh m\u1ea1ch ho\u1eb7c \u0111\u1ed9ng m\u1ea1ch \u0111\u01b0\u1ee3c l\u1ea5y t\u1eeb c\u01a1 th\u1ec3 c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 t\u1ea1o m\u1ed9t \u0111\u01b0\u1eddng d\u1eabn m\u1edbi cho m\u00e1u ch\u1ea3y qua \u0111\u1ed9ng m\u1ea1ch v\u00e0nh b\u1ecb t\u1eafc ngh\u1ebdn.<\/p>\n

Chi\u1ebfn l\u01b0\u1ee3c t\u00e1i th\u00f4ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 cho c\u00e1c v\u1ea5n \u0111\u1ec1 li\u00ean quan \u0111\u1ebfn \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, gi\u00fap c\u1ea3i thi\u1ec7n d\u00f2ng ch\u1ea3y m\u00e1u v\u00e0 gi\u1ea3m nguy c\u01a1 c\u00e1c bi\u1ebfn ch\u1ee9ng li\u00ean quan \u0111\u1ebfn tim m\u1ea1ch. Tuy nhi\u00ean, nh\u01b0 b\u1ea5t k\u1ef3 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u00e0o kh\u00e1c, n\u00f3 c\u0169ng c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n d\u01b0\u1edbi s\u1ef1 gi\u00e1m s\u00e1t c\u1ee7a c\u00e1c chuy\u00ean gia y t\u1ebf c\u00f3 kinh nghi\u1ec7m.<\/p>\n

2.Chi\u1ebfn l\u01b0\u1ee3c t\u00e1i th\u00f4ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh<\/h2>\n

Khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng m\u1ea1ch quay <\/strong>l\u00e0m \u0111\u01b0\u1eddng v\u00e0o \u0111\u1ec3 ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh v\u00e0 t\u00e1i t\u01b0\u1edbi m\u00e1u, n\u1ebfu c\u1ea7n. Th\u1eddi gian ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch (t\u00ednh t\u1eeb khi v\u1eeba \u0111\u1ebfn vi\u1ec7n) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i d\u1ef1a tr\u00ean nguy c\u01a1 c\u1ee7a t\u1eebng b\u1ec7nh nh\u00e2n.<\/p>\n

Chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb x\u00e2m l\u1ea5n ngay l\u1eadp t\u1ee9c (< 2 gi\u1edd)<\/strong>: Khi nguy c\u01a1 r\u1ea5t cao bao g\u1ed3m:<\/p>\n

    \n
  • Huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh<\/li>\n
  • S\u1ed1c tim<\/li>\n
  • \u0110au ng\u1ef1c t\u00e1i ph\u00e1t ho\u1eb7c dai d\u1eb3ng m\u1eb7c d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa t\u1ed1i \u01b0u<\/li>\n
  • R\u1ed1i lo\u1ea1n nh\u1ecbp nguy hi\u1ec3m t\u00ednh m\u1ea1ng<\/li>\n
  • Bi\u1ebfn ch\u1ee9ng c\u01a1 h\u1ecdc do nh\u1ed3i m\u00e1u c\u01a1 tim<\/li>\n
  • Suy tim c\u1ea5p do h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p\u00a0 kh\u00f4ng st ch\u00eanh<\/li>\n
  • ST ch\u00eanh xu\u1ed1ng >1mm\/6 chuy\u1ec3n \u0111\u1ea1o k\u00e8m theo ST ch\u00eanh l\u00ean avR v\u00e0\/ho\u1eb7c V1<\/li>\n<\/ul>\n

    Chi\u1ebfn l\u01b0\u1ee3c can thi\u1ec7p x\u00e2m l\u1ea5n s\u1edbm (<24 gi\u1edd)<\/strong><\/p>\n

      \n
    • Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh nh\u1ed3i m\u00e1u c\u01a1 tim kh\u00f4ng ST ch\u00eanh<\/li>\n
    • \u0110o\u1ea1n ST thay \u0111\u1ed5i li\u00ean t\u1ee5c\/b\u1eaft \u0111\u1ea7u thay \u0111\u1ed5i \u1edf c\u00e1c chuy\u1ec3n \u0111\u1ea1o li\u1ec1n k\u1ec1<\/li>\n
    • Ph\u1ee5c h\u1ed3i sau c\u1ea5p c\u1ee9u ng\u1eebng tu\u1ea7n ho\u00e0n \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ST ch\u00eanh ho\u1eb7c shock tim<\/li>\n
    • \u0110i\u1ec3m GRACE > 140<\/li>\n<\/ul>\n

       <\/p>\n

      3.L\u1ef1a ch\u1ecdn bi\u1ec7n ph\u00e1p ph\u00e1p t\u00e1i t\u01b0\u1edbi m\u00e1u (can thi\u1ec7p-pci ho\u1eb7c ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u n\u1ed1i – cabg)<\/h2>\n

      N\u00f3i chung, trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 ch\u1ec9 \u0111\u1ecbnh ti\u1ebfp c\u1eadn x\u00e2m l\u1ea5n, b\u1ec7nh nh\u00e2n h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p kh\u00f4ng ST ch\u00eanh c\u1ea7n \u0111\u01b0\u1ee3c \u01b0u ti\u00ean ch\u1ee5p <\/em>\u0111\u1ed9ng m\u1ea1ch v\u00e0nh<\/em> qua da <\/em>v\u00e0 can thi\u1ec7p n\u1ebfu c\u00f3 th\u1ec3.<\/p>\n

      V\u1edbi b\u1ec7nh nh\u00e2n huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh<\/strong>: C\u1ea7n c\u00f3 s\u1ef1 h\u1ed7 tr\u1ee3 tu\u1ea7n ho\u00e0n b\u1eb1ng thu\u1ed1c v\u00e0 c\u00e1c thi\u1ebft b\u1ecb c\u01a1 h\u1ecdc (n\u1ebfu c\u1ea7n), l\u1ef1a ch\u1ecdn can thi\u1ec7p v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh<\/em> th\u1ee7 ph\u1ea1m n\u1ebfu \u0111\u1eb7c \u0111i\u1ec3m t\u1ed5n th\u01b0\u01a1ng gi\u1ea3i ph\u1eabu v\u00e0 k\u1ef9 thu\u1eadt cho ph\u00e9p (k\u1ec3 c\u1ea3 t\u1ed5n th\u01b0\u01a1ng th\u00e2n chung \u0111\u1ed9ng m\u1ea1ch v\u00e0nh<\/em>).<\/p>\n

      V\u1edbi b\u1ec7nh nh\u00e2n l\u00e2m s\u00e0ng \u1ed5n \u0111\u1ecbnh<\/strong>: L\u1ef1a ch\u1ecdn can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh qua da-PCI ho\u1eb7c ph\u1ea9u thu\u1eadt b\u1eafc c\u1ea7u m\u1ea1ch v\u00e0nh-CABG d\u1ef1a tr\u00ean t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng c\u1ee5 th\u1ec3 c\u1ee7a b\u1ec7nh nh\u00e2n, \u0111\u1eb7c \u0111i\u1ec3m t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, kh\u1ea3 n\u0103ng chuy\u00ean m\u00f4n c\u1ee7a c\u01a1 s\u1edf v\u00e0 s\u1ef1 l\u1ef1a ch\u1ecdn c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh. V\u00ec kh\u00f4ng nhi\u1ec1u b\u1eb1ng ch\u1ee9ng th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng, do v\u1eady, khuy\u1ebfn c\u00e1o cho can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh qua da-PCI ho\u1eb7c ph\u1ea9u thu\u1eadt b\u1eafc c\u1ea7u m\u1ea1ch v\u00e0nh-CABG trong h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p kh\u00f4ng st ch\u00eanh\u00a0 trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y g\u1ea7n t\u01b0\u01a1ng t\u1ef1 nh\u01b0 \u0111\u1ed1i v\u1edbi b\u1ec7nh m\u1ea1ch v\u00e0nh m\u1ea1n.<\/p>\n

        \n
      • \u01afu ti\u00ean <\/strong>can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh qua da<\/strong>–PCI: <\/strong>\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ec7nh m\u1ea1ch v\u00e0nh \u0111\u01a1n nh\u00e1nh, v\u1edbi c\u00e1c t\u1ed5n th\u01b0\u01a1ng kh\u00f4ng ph\u1ee9c t\u1ea1p, nhi\u1ec1u nh\u00e1nh ho\u1eb7c th\u00e2n chung \u0111\u1ed9ng m\u1ea1ch v\u00e0nh<\/em> tr\u00e1i: c\u1ea7n t\u00ednh to\u00e1n \u0111i\u1ec3m SYNTAX, SYNTAX II, kh\u1ea3 n\u0103ng k\u1ef9 thu\u1eadt v\u00e0 th\u1ef1c t\u1ebf l\u00e2m s\u00e0ng \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh ph\u00f9 h\u1ee3p. V\u1edbi SYNTAX th\u1ea5p (d\u01b0\u1edbi 23) n\u00ean \u01b0u ti\u00ean can thi\u1ec7p; SYNTAX t\u1eeb 23 \u0111\u1ebfn 32 c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc l\u1ef1a ch\u1ecdn<\/li>\n
      • \u01afu ti\u00ean <\/strong>ph\u1ea9u thu\u1eadt b\u1eafc c\u1ea7u m\u1ea1ch v\u00e0nh-CABG: <\/strong>Khi t\u1ed5n th\u01b0\u01a1ng ph\u1ee9c t\u1ea1p (v\u00f4i h\u00f3a, xo\u1eafn v\u1eb7n, ch\u1ed7 chia nh\u00e1nh, t\u1eafc m\u1ea1n t\u00ednh\u2026) SYNTAX > 32 \u0111i\u1ec3m \u0111\u1eb7c bi\u1ec7t \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i gi\u1ea3m; t\u1ed5n th\u01b0\u01a1ng th\u00e2n chung m\u00e0 h\u00ecnh th\u00e1i gi\u1ea3i ph\u1eabu kh\u00f4ng ph\u00f9 h\u1ee3p can thi\u1ec7p; ho\u1eb7c khi can thi\u1ec7p th\u1ea5t b\u1ea1i ho\u1eb7c c\u00f3 bi\u1ebfn ch\u1ee9ng.<\/li>\n
      • C\u00f3 th\u1ec3 t\u00ednh \u0111\u1ebfn ph\u01b0\u01a1ng ph\u00e1p hybrid: <\/strong>\u0110i\u1ec1u tr\u1ecb t\u1ed5n th\u01b0\u01a1ng th\u1ee7 ph\u1ea1m v\u1edbi can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh qua da-PCI trong giai \u0111o\u1ea1n c\u1ea5p, sau \u0111\u00f3 l\u00e0 ph\u1ea9u thu\u1eadt b\u1eafc c\u1ea7u m\u1ea1ch v\u00e0nh-CABG c\u00f3 k\u1ebf ho\u1ea1ch khi c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 v\u00e0\/ho\u1eb7c ph\u00e2n su\u1ea5t d\u1ef1 tr\u1eef l\u01b0u l\u01b0\u1ee3ng v\u00e0nh c\u1ee7a c\u00e1c t\u1ed5n th\u01b0\u01a1ng kh\u00f4ng ph\u1ea3i l\u00e0 th\u1ee7 ph\u1ea1m, c\u00f3 th\u1ec3 c\u00f3 l\u1ee3i \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n nh\u1ea5t \u0111\u1ecbnh.<\/li>\n<\/ul>\n

        \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n \u0111ang s\u1eed d\u1ee5ng ch\u1ed1ng ng\u01b0ng t\u1eadp ti\u1ec3u c\u1ea7u \u0111\u01a1n tr\u1ecb (Aspirin) m\u00e0 c\u1ea7n can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh qua da-PCI, khuy\u1ebfn c\u00e1o b\u1ed5 sung thu\u1ed1c \u1ee9c ch\u1ebf P2Y12 (Prasugrel ho\u1eb7c Ticagrelor \u0111\u01b0\u1ee3c \u01b0u ti\u00ean h\u01a1n Clopidogrel).<\/p>\n

        L\u1ef1a ch\u1ecdn thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng c\u1ea7n d\u1ef1a tr\u00ean c\u1ea3 nguy c\u01a1 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 v\u00e0 ch\u1ea3y m\u00e1u v\u00e0 kh\u00f4ng n\u00ean chuy\u1ec3n \u0111\u1ed5i (b\u1eaft ch\u00e9o) trong can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh qua da-PCI. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng fondaparinux, ph\u1ea3i th\u00eam Heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n-UFH tr\u01b0\u1edbc can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh qua da-PCI. Tr\u01b0\u1eddng h\u1ee3p ch\u01b0a d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u, xem x\u00e9t s\u1eed d\u1ee5ng bivalirudin.<\/p>\n

        N\u1ebfu c\u00f3 k\u1ebf ho\u1ea1ch ph\u1ea9u thu\u1eadt b\u1eafc c\u1ea7u m\u1ea1ch v\u00e0nh-CABG v\u00e0 \u0111ang \u0111i\u1ec1u tr\u1ecb thu\u1ed1c \u1ee9c ch\u1ebf P2Y12, n\u00ean d\u1eebng thu\u1ed1c n\u00e0y v\u00e0 ho\u00e3n l\u1ea1i ph\u1eabu thu\u1eadt n\u1ebfu t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng v\u00e0 t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch v\u00e0nh cho ph\u00e9p.<\/p>\n

        N\u1ebfu ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh cho th\u1ea5y kh\u00f4ng th\u1ec3 t\u00e1i t\u01b0\u1edbi m\u00e1u do t\u1ed5n th\u01b0\u01a1ng lan t\u1ecfa v\u00e0\/ho\u1eb7c d\u00f2ng ch\u1ea3y \u0111o\u1ea1n xa k\u00e9m, n\u00ean \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa t\u00edch c\u1ef1c v\u1edbi m\u1ee5c ti\u00eau gi\u1ea3m \u0111au ng\u1ef1c.<\/p>\n

         <\/p>\n","protected":false},"excerpt":{"rendered":"

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