{"id":26931,"date":"2023-04-23T21:37:24","date_gmt":"2023-04-23T14:37:24","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=26931"},"modified":"2023-04-23T21:37:24","modified_gmt":"2023-04-23T14:37:24","slug":"cap-cuu-trong-hoi-chung-dong-mach-vanh-cap","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/cap-cuu-trong-hoi-chung-dong-mach-vanh-cap\/","title":{"rendered":"C\u1ea5p c\u1ee9u trong h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p"},"content":{"rendered":"

H\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p<\/a> kh\u00f4ng c\u00f3 ST ch\u00eanh l\u00ean bao g\u1ed3m hai b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng: NMCT kh\u00f4ng c\u00f3 ST ch\u00eanh l\u00ean v\u00e0 \u0111au ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh (\u0110NK\u00d4\u0110). <\/em>V\u1ec1 l\u00e2m s\u00e0ng v\u00e0 \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa hai b\u1ec7nh c\u1ea3nh n\u00e0y, s\u1ef1 ph\u00e2n bi\u1ec7t \u1edf ch\u1ed7 NMCT kh\u00f4ng c\u00f3 ST ch\u00eanh l\u00ean l\u00e0 c\u00f3 s\u1ef1 t\u0103ng d\u1ea5u \u1ea5n sinh h\u1ecdc c\u01a1 tim tr\u00ean c\u00e1c x\u00e9t nghi\u1ec7m c\u00f2n \u0110NK\u00d4\u0110 th\u00ec kh\u00f4ng.<\/strong><\/p>\n

1.\u0110\u1ecbnh ngh\u0129a:<\/h2>\n

H\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p kh\u00f4ng c\u00f3 ST ch\u00eanh l\u00ean bao g\u1ed3m hai b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng: NMCT kh\u00f4ng c\u00f3 ST ch\u00eanh l\u00ean v\u00e0 \u0111au ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh (\u0110NK\u00d4\u0110). <\/em><\/strong>V\u1ec1 l\u00e2m s\u00e0ng v\u00e0 \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa hai b\u1ec7nh c\u1ea3nh n\u00e0y, s\u1ef1 ph\u00e2n bi\u1ec7t \u1edf ch\u1ed7 NMCT kh\u00f4ng c\u00f3 ST ch\u00eanh l\u00ean l\u00e0 c\u00f3 s\u1ef1 t\u0103ng d\u1ea5u \u1ea5n sinh h\u1ecdc c\u01a1 tim tr\u00ean c\u00e1c x\u00e9t nghi\u1ec7m c\u00f2n \u0110NK\u00d4\u0110 th\u00ec kh\u00f4ng.<\/p>\n

\"H\u1ed9i<\/p>\n

Di\u1ec5n ti\u1ebfn trong h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p<\/strong><\/p>\n

2.L\u00e2m s\u00e0ng<\/h2>\n

2.1 Ti\u1ec1n s\u1eed: <\/strong><\/h3>\n

Th\u01b0\u1eddng gi\u00e0 h\u01a1n, t\u1ef7 l\u1ec7 b\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, t\u0103ng huy\u1ebft \u00e1p (THA) v\u00e0 r\u1ed1i lo\u1ea1n lipid m\u00e1u cao h\u01a1n STEMI.<\/p>\n

Tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh l\u00e0 \u0111au ng\u1ef1c ki\u1ec3u \u0111\u1ed9ng m\u1ea1ch v\u00e0nh: \u0110au th\u1eaft (b\u00f3p) ngh\u1eb9t sau x\u01b0\u01a1ng \u1ee9c, c\u00f3 th\u1ec3 lan l\u00ean vai tr\u00e1i, l\u00ean c\u1eb1m, l\u00ean c\u1ea3 hai vai, c\u01a1n \u0111au th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n sau m\u1ed9t g\u1eafng s\u1ee9c nh\u01b0ng c\u01a1n \u0111au c\u00f3 th\u1ec3 x\u1ea3y ra c\u1ea3 trong khi ngh\u1ec9, c\u01a1n \u0111au th\u01b0\u1eddng k\u00e9o d\u00e0i tr\u00ean 20 ph\u00fat. C\u01a1n \u0111au trong HCMVC kh\u00f4ng c\u00f3 ST ch\u00eanh l\u00ean c\u00f3 th\u1ec3 c\u00f3 c\u00e1c h\u00ecnh th\u00e1i sau:<\/p>\n

    \n
  • C\u01a1n \u0111au th\u1eaft ng\u1ef1c m\u1edbi xu\u1ea5t hi\u1ec7n.<\/li>\n
  • \u0110au th\u1eaft ng\u1ef1c t\u0103ng l\u00ean (tr\u00ean c\u01a1 s\u1edf b\u1ec7nh nh\u00e2n \u0111\u00e3 c\u00f3 ti\u1ec1n s\u1eed \u0111au th\u1eaft ng\u1ef1c \u1ed5n \u0111\u1ecbnh).<\/li>\n
  • \u0110au th\u1eaft ng\u1ef1c x\u1ea3y ra sau c\u00e1c bi\u1ebfn c\u1ed1 ho\u1eb7c th\u1ee7 thu\u1eadt nh\u01b0: Sau NMCT, can thi\u1ec7p \u0110MV, ph\u0201u thu\u1eadt b\u1eafc c\u1ea7u n\u1ed1i ch\u1ee7 v\u00e0nh, kh\u00f4ng r\u00f5 tri\u1ec7u ch\u1ee9ng \u0111au m\u00e0 ch\u1ec9 l\u00e0 c\u1ea3m gi\u00e1c t\u1ee9c n\u1eb7ng kh\u00f3 th\u1edf (\u0111au th\u1ea7m l\u1eb7ng)…<\/li>\n<\/ul>\n

    2.2 Kh\u00e1m l\u00e2m s\u00e0ng: <\/strong><\/p>\n

    \u00cdt c\u00f3 gi\u00e1 tr\u1ecb \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh, nh\u01b0ng kh\u00e1m l\u00e2m s\u00e0ng gi\u00fap ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u00e0 \u0111\u00e1nh gi\u00e1 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1, bi\u1ebfn ch\u1ee9ng…<\/p>\n

    2.3 C\u1eadn l\u00e2m s\u00e0ng<\/h3>\n

    2.3.1 \u0110i\u1ec7n t\u00e2m \u0111\u1ed3<\/strong><\/h4>\n
      \n
    • Trong c\u01a1n \u0111au c\u00f3 th\u1ec3 th\u1ea5y s\u1ef1 bi\u1ebfn \u0111\u1ed5i c\u1ee7a \u0111o\u1ea1n ST ST ch\u00eanh xu\u1ed1ng ki\u1ec3u d\u1ed1c xu\u1ed1ng ho\u1eb7c \u0111i ngang<\/li>\n
    • T \u00e2m nh\u1ecdn, \u0111\u1ea3o chi\u1ec1u<\/li>\n
    • ST c\u00f3 th\u1ec3 ch\u00eanh l\u00ean tho\u00e1ng qua.<\/li>\n
    • Tr\u00ean 20% b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 thay \u0111\u1ed5i t\u1ee9c th\u1eddi tr\u00ean \u0111i\u1ec7n t\u00e2m \u0111\u1ed3, c\u1ea7n l\u00e0m \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 nhi\u1ec1u l\u1ea7n.<\/li>\n<\/ul>\n

      2.3.2 X\u00e9t nghi\u1ec7m m\u00e1u: <\/strong><\/p>\n

        \n
      • T\u0103ng men tim, \u0111\u1eb7c bi\u1ec7t Troponin tim gi\u00fap ph\u00e2n bi\u1ec7t NSTEMI v\u00e0 \u0111au th\u1eaft ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh.<\/li>\n
      • Si\u00eau \u00e2m tim: Ph\u00e1t hi\u1ec7n r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng v\u00f9ng, \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng tim c\u0169ng nh\u01b0 c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a nh\u1ed3i m\u00e1u c\u01a1 tim (H\u1edf hai l\u00e1 c\u1ea5p, th\u00f4ng li\u00ean th\u1ea5t, .v.v.)<\/li>\n<\/ul>\n

        2.3.3 Ph\u00e2n t\u1ea7ng nguy c\u01a1:<\/h4>\n
          \n
        • Nh\u00f3m nguy c\u01a1 r\u1ea5t cao: <\/strong>Can thi\u1ec7p c\u1ea5p c\u1ee9u trong v\u00f2ng 2 gi\u1edd <\/em><\/strong>t\u1eeb khi x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n.<\/li>\n<\/ul>\n
            \n
          1. R\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng ho\u1eb7c s\u1ed1c tim<\/li>\n
          2. \u0110au ng\u1ef1c t\u00e1i ph\u00e1t ho\u1eb7c ti\u1ebfn tri\u1ec3n kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi thu\u1ed1c. R\u1ed1i lo\u1ea1n nh\u1ecbp \u0111e d\u1ecda t\u00ednh m\u1ea1ng ho\u1eb7c ng\u1eebng tim.<\/li>\n
          3. Bi\u1ebfn ch\u1ee9ng c\u01a1 h\u1ecdc c\u1ee7a NMCT. Suy tim c\u1ea5p.<\/li>\n
          4. Bi\u1ebfn \u0111\u1ed5i \u0111\u1ed9ng h\u1ecdc c\u1ee7a \u0111o\u1ea1n ST v\u00e0 s\u00f3ng T.<\/li>\n<\/ol>\n
              \n
            • Nh\u00f3m nguy c\u01a1 cao: <\/strong>Can thi\u1ec7p s\u1edbm trong v\u00f2ng 24 gi\u1edd<\/em><\/strong>.<\/li>\n<\/ul>\n
                \n
              1. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh NMCT kh\u00f4ng c\u00f3 ST ch\u00eanh l\u00ean d\u1ef1a tr\u00ean Troponin tim. Thay \u0111\u1ed5i \u0111\u1ed9ng h\u1ecdc c\u1ee7a \u0111o\u1ea1n ST ho\u1eb7c s\u00f3ng T (c\u00f3 tri\u1ec7u ch\u1ee9ng ho\u1eb7c im l\u1eb7ng). \u0110i\u1ec3m GRACE > 140.<\/li>\n<\/ol>\n
                  \n
                • Nh\u00f3m nguy c\u01a1 v\u1eeba: <\/strong>Can thi\u1ec7p (c\u00f3 th\u1ec3 tr\u00ec ho\u00e3n) trong v\u00f2ng 72 gi\u1edd.<\/li>\n<\/ul>\n
                    \n
                  1. \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng ho\u1eb7c suy th\u1eadn (MLCT < 60 mL\/min\/1,73m\u00b2). LVEF < 40% ho\u1eb7c suy tim sung huy\u1ebft.<\/li>\n
                  2. \u0110au ng\u1ef1c s\u1edbm sau nh\u1ed3i m\u00e1u ho\u1eb7c ti\u1ec1n s\u1eed PCI\/CABG.<\/li>\n
                  3. \u0110i\u1ec3m GRACE > 109 v\u00e0 < 140 ho\u1eb7c tri\u1ec7u ch\u1ee9ng t\u00e1i ph\u00e1t\/thi\u1ebfu m\u00e1u c\u01a1 tim tr\u00ean th\u0103m d\u00f2 kh\u00f4ng x\u00e2m l\u1ea5n.<\/li>\n<\/ol>\n
                      \n
                    • Nh\u00f3m nguy c\u01a1 th\u1ea5p: <\/strong>c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n ho\u1eb7c c\u00f3 th\u1ec3 xem x\u00e9t can thi\u1ec7p t\u00f9y theo \u0111i\u1ec1u k\u1ec7n v\u00e0 kinh nghi\u1ec7m c\u1ee7a trung t\u00e2m<\/li>\n
                    • \u0110au ng\u1ef1c: C\u00f3 m\u1ed9t c\u01a1n \u0111au ng\u1ef1c ng\u1eafn khi ngh\u1ec9, khi g\u1eafng s\u1ee9c. Kh\u00f4ng c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u nh\u01b0 c\u1ee7a c\u00e1c nh\u00f3m nguy c\u01a1 tr\u00ean.<\/li>\n
                    • V\u1edbi nh\u1eefng tr\u01b0\u1eddng h\u1ee3p \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n, sau m\u1ed9t th\u1eddi gian khi b\u1ec7nh nh\u00e2n \u1ed5n \u0111\u1ecbnh, n\u00ean \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 thi\u1ebfu m\u00e1u c\u01a1 tim c\u1ee7a b\u1ec7nh nh\u00e2n (tr\u00ean c\u00e1c th\u0103m d\u00f2 kh\u00f4ng x\u00e2m l\u1ea5n nh\u01b0 nghi\u1ec7m ph\u00e1p g\u1eafng s\u1ee9c \u0111i\u1ec7n t\u00e2m \u0111\u1ed3, g\u1eafng s\u1ee9c h\u00ecnh \u1ea3nh, x\u1ea1 \u0111\u1ed3 t\u01b0\u1edbi m\u00e1u c\u01a1 tim…) ho\u1eb7c \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 h\u1eb9p \u0110MV v\u1ec1 m\u1eb7t gi\u1ea3i ph\u0201u tr\u00ean ch\u1ee5p MSCT \u0111\u1ec3 c\u00f3 h\u01b0\u1edbng gi\u1ea3i quy\u1ebft ti\u1ebfp (gi\u1ed1ng nh\u01b0 m\u1ed9t tr\u01b0\u1eddng h\u1ee3p h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n t\u00ednh.<\/li>\n<\/ul>\n

                      2.3.4 X\u1eed tr\u00ed ban \u0111\u1ea7u, thu\u1ed1c kh\u00e1ng KTTC v\u00e0 m\u1ed9t s\u1ed1 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb k\u00e8m theo<\/strong>: T\u01b0\u01a1ng t\u1ef1 \u0111\u1ed1i v\u1edbi NMCT c\u1ea5p c\u00f3 ST ch\u00eanh l\u00ean<\/p>\n

                        \n
                      1. Chi\u1ebfn l\u01b0\u1ee3c can thi\u1ec7p ho\u1eb7c \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n \u0111\u1ed1i v\u1edbi NMCT kh\u00f4ng c\u00f3 ST ch\u00eanh l\u00ean<\/li>\n<\/ol>\n

                        Khuy\u1ebfn c\u00e1o can thi\u1ec7p t\u00e1i t\u01b0\u1edbi m\u00e1u ho\u1eb7c \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n \u0111\u1ed1i v\u1edbi NMCT kh\u00f4ng c\u00f3 ST ch\u00eanh l\u00ean<\/p>\n

                         <\/p>\n\n\n\n\n\n\n\n\n\n
                         <\/p>\n

                        Khuy\u1ebfn c\u00e1o<\/strong><\/td>\n

                        		M\u1ee9c khuy\u1ebfn c\u00e1o<\/strong><\/td>\nM\u1ee9c \u0111\u1ed9 b\u1eb1ng ch\u1ee9ng<\/strong><\/td>\n<\/tr>\n
                        Can thi\u1ec7p (trong v\u00f2ng 72h t\u1eeb khi kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng) cho c\u00e1c b\u1ec7nh nh\u00e2n:<\/p>\n

                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00cdt nh\u1ea5t c\u00f3 m\u1ed9t nguy c\u01a1 v\u1eeba.<\/p>\n

                        –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 T\u00e1i ph\u00e1t tri\u1ec7u ch\u1ee9ng ho\u1eb7c bi\u1ec3u hi\u1ec7n thi\u1ebfu m\u00e1u tr\u00ean test kh\u00f4ng x\u00e2m l\u1ea5n.<\/td>\n

                        		I<\/td>\nA<\/td>\n<\/tr>\n
                        Can thi\u1ec7p c\u1ea5p (< 2h) cho b\u1ec7nh nh\u00e2n nguy c\u01a1 r\u1ea5t cao (t\u00e1i ph\u00e1t \u0111au ng\u1ef1c, k\u00e8m theo suy tim, r\u1ed1i lo\u1ea1n nh\u1ecbp \u0111e d\u1ecda t\u00ednh m\u1ea1ng, t\u00ecnh tr\u1ea1ng huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh).<\/td>\nI<\/td>\nC<\/td>\n<\/tr>\n
                        Can thi\u1ec7p s\u1edbm (< 24h) cho nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec3m GRACE<\/p>\n

                        > 140 ho\u1eb7c c\u00f3 \u00edt nh\u1ea5t m\u1ed9t nguy c\u01a1 ban \u0111\u1ea7u cao.<\/td>\n

                        		I<\/td>\nA<\/td>\n<\/tr>\n
                        \u0110i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 th\u1ea5p, kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng thi\u1ebfu m\u00e1u c\u01a1 tim t\u00e1i ph\u00e1t.<\/td>\nI<\/td>\nA<\/td>\n<\/tr>\n
                        Chi\u1ebfn l\u01b0\u1ee3c t\u00e1i th\u00f4ng \u0110MV (can thi\u1ec7p ho\u1eb7c ph\u0201u thu\u1eadt CABG) d\u1ef1a tr\u00ean h\u00ecnh \u1ea3nh gi\u1ea3i ph\u0201u tr\u00ean ch\u1ee5p \u0110MV (theo thang \u0111i\u1ec3m SYNTAX score) v\u00e0 \u00fd ki\u1ebfn chuy\u00ean gia trong trung t\u00e2m.<\/td>\nI<\/td>\nC<\/td>\n<\/tr>\n
                        Stent ph\u1ee7 thu\u1ed1c (DES) \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh d\u1ef1a tr\u00ean c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m t\u1ed5n th\u01b0\u01a1ng c\u1ee5 th\u1ec3, v\u00e0 kh\u1ea3 n\u0103ng d\u00f9ng c\u00e1c thu\u1ed1c kh\u00e1ng KTTC k\u00e9p.<\/td>\nI<\/td>\nA<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

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

                        H\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p kh\u00f4ng c\u00f3 ST ch\u00eanh l\u00ean bao g\u1ed3m hai b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng: NMCT kh\u00f4ng c\u00f3 ST ch\u00eanh l\u00ean v\u00e0 \u0111au ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh (\u0110NK\u00d4\u0110). V\u1ec1 l\u00e2m s\u00e0ng v\u00e0 \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa hai b\u1ec7nh c\u1ea3nh n\u00e0y, s\u1ef1 ph\u00e2n bi\u1ec7t \u1edf ch\u1ed7 NMCT kh\u00f4ng […]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[],"yoast_head":"\nC\u1ea5p c\u1ee9u trong h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p - Vinmec<\/title>\n<meta name=\"description\" content=\"C\u1ea5p c\u1ee9u trong h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p l\u00e0 v\u1ea5n \u0111\u1ec1 quan tr\u1ecdng. 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