{"id":29313,"date":"2023-04-29T22:05:41","date_gmt":"2023-04-29T15:05:41","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29313"},"modified":"2023-04-29T22:05:41","modified_gmt":"2023-04-29T15:05:41","slug":"co-che-roi-loan-nhip-tim","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/co-che-roi-loan-nhip-tim\/","title":{"rendered":"C\u01a1 ch\u1ebf r\u1ed1i lo\u1ea1n nh\u1ecbp tim"},"content":{"rendered":"

R\u1ed1i lo\u1ea1n nh\u1ecbp tim – arrhythmia hay dysrhythmia \u2013 b\u1ea5t th\u01b0\u1eddng v\u1ec1 t\u1ea7n s\u1ed1 (rate) hay v\u1ec1 nh\u1ecbp (rhythm) c\u1ee7a tim.<\/strong><\/p>\n

\u2013 Tim qu\u00e1 nh\u00e1nh: nh\u1ecbp nhanh (tachycardia)<\/strong><\/p>\n

\u2013 Tim qu\u00e1 ch\u1eadm: nh\u1ecbp ch\u1eadm (bradycardia)<\/strong><\/p>\n

\u2013 Nh\u1ecbp tim kh\u00f4ng \u0111\u1ec1u (irregular rhythm)<\/strong><\/p>\n

H\u1ea7u h\u1ebft lo\u1ea1n nh\u1ecbp tim l\u00e0 v\u00f4 h\u1ea1i. Trong l\u00fac b\u1ecb lo\u1ea1n nh\u1ecbp tim, m\u00e1u c\u00f3 th\u1ec3 kh\u00f4ng cung c\u1ea5p \u0111\u1ee7 \u0111\u1ebfn c\u00e1c c\u01a1 quan\u00a0 g\u00e2y t\u1ed5n th\u01b0\u01a1ng n\u00e3o, tim, v\u00e0 c\u01a1 quan kh\u00e1c.<\/strong><\/p>\n

1. C\u00e1c c\u01a1 ch\u1ebf<\/h2>\n

C\u01a1 ch\u1ebf g\u00e2y r\u1ed1i lo\u1ea1n nh\u1ecbp tim \u0111\u01b0\u1ee3c chia l\u00e0m 3 lo\u1ea1i:<\/p>\n

+ R\u1ed1i lo\u1ea1n h\u00ecnh th\u00e0nh xung \u0111\u1ed9ng<\/p>\n

+ R\u1ed1i lo\u1ea1n d\u1eabn truy\u1ec1n xung \u0111\u1ed9ng<\/p>\n

+ Lo\u1ea1i k\u1ebft h\u1ee3p c\u1ea3 r\u1ed1i lo\u1ea1n h\u00ecnh th\u00e0nh xung \u0111\u1ed9ng v\u00e0 r\u1ed1i lo\u1ea1n d\u1eabn truy\u1ec1n xung \u0111\u1ed9ng.<\/p>\n

2. R\u1ed1i lo\u1ea1n nh\u1ecbp do r\u1ed1i lo\u1ea1n h\u00ecnh th\u00e0nh xung \u0111\u1ed9ng<\/h2>\n

– L\u00e0 r\u1ed1i lo\u1ea1n ph\u00e1t nh\u1ecbp c\u1ee7a trung t\u00e2m ch\u1ee7 nh\u1ecbp c\u1ee7a tim (n\u00fat xoang)<\/p>\n

– Ho\u1eb7c do nh\u1ecbp \u0111\u01b0\u1ee3c ph\u00e1t t\u1eeb nh\u1eefng \u1ed5 ngo\u1ea1i v\u1ecb. Nh\u1eefng v\u1ecb tr\u00ed c\u1ee7a \u1ed5 ngo\u1ea1i v\u1ecb th\u01b0\u1eddng \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 ch\u1ee7 nh\u1ecbp ph\u1ee5 (subsidiary), c\u00f3 th\u1ec3 xu\u1ea5t ph\u00e1t t\u1eeb m\u1ed9t s\u1ed1 v\u00f9ng c\u1ee7a nh\u0129, xoang v\u00e0nh, van nh\u0129 th\u1ea5t, b\u1ed9 n\u1ed1i nh\u0129 th\u1ea5t, v\u00e0 h\u1ec7 th\u1ed1ng His- Purkinje.<\/p>\n

B\u00ecnh th\u01b0\u1eddng: c\u00e1c \u1ed5 ngo\u1ea1i v\u1ecb n\u00e0y kh\u00f4ng \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u1ebfn m\u1ee9c \u0111i\u1ec7n th\u1ebf ng\u01b0\u1ee1ng, do:<\/p>\n

+ \u1ee8c ch\u1ebf v\u01b0\u1ee3t t\u1ea7n s\u1ed1 c\u1ee7a n\u00fat xoang<\/p>\n

+ \u1ee8c ch\u1ebf v\u1ec1 m\u1eb7t \u0111i\u1ec7n h\u1ecdc c\u1ee7a c\u00e1c t\u1ed5 ch\u1ee9c k\u1ec1 s\u00e1t.<\/p>\n

Ho\u1ea1t \u0111\u1ed9ng ch\u1ee7 nh\u1ecbp c\u1ee7a \u1ed5 ngo\u1ea1i v\u1ecb c\u00f3 th\u1ec3 tr\u1edf n\u00ean tr\u1ed9i h\u01a1n khi:<\/p>\n

+ Trung t\u00e2m ph\u00e1t nh\u1ecbp n\u00fat xoang b\u1ecb suy y\u1ebfu<\/p>\n

+ Ho\u1eb7c t\u1eafc ngh\u1ebdn x\u1ea3y ra gi\u1eefa v\u1ecb tr\u00ed ph\u00e1t nh\u1ecbp c\u1ee7a n\u00fat xoang v\u00e0 v\u1ecb tr\u00ed ph\u00e1t nh\u1ecbp c\u1ee7a \u1ed5 ngo\u1ea1i v\u1ecb v\u00e0 cho ph\u00e9p \u1ed5 ngo\u1ea1i v\u1ecb \u0111\u1ee9ng ra gi\u1eef vai tr\u00f2 ch\u1ee7 nh\u1ecbp.<\/p>\n

V\u00ed d\u1ee5: nh\u1ecbp ch\u1eadm xoang v\u1edbi t\u1ea7n s\u1ed1 45 l\u1ea7n\/ph\u00fat\u00a0 cho ph\u00e9p nh\u1ecbp tho\u00e1t b\u1ed9 n\u1ed1i x\u1ea3y ra \u1edf t\u1ea7n s\u1ed1 50 chu k\u1ef3\/ph\u00fat.<\/p>\n

+ Ho\u1eb7c t\u1ea7n s\u1ed1 ph\u00e1t c\u1ee7a trung t\u00e2m ch\u1ee7 nh\u1ecbp ph\u1ee5 c\u00f3 th\u1ec3 \u0111\u1ea1t \u0111\u1ebfn m\u1ed9t t\u1ea7n s\u1ed1 kh\u00f4ng th\u00edch h\u1ee3p v\u00e0 gi\u1eef vai tr\u00f2 ch\u1ee7 nh\u1ecbp \u1ee9c ch\u1ebf n\u00fat xoang v\u1edbi t\u1ea7n s\u1ed1 b\u00ecnh th\u01b0\u1eddng.<\/p>\n

V\u00ed d\u1ee5: m\u1ed9t ngo\u1ea1i t\u00e2m thu th\u1ea5t ho\u1eb7c m\u1ed9t c\u01a1n tim nhanh th\u1ea5t c\u00f3 th\u1ec3 \u1ee9c ch\u1ebf nh\u1ecbp xoang b\u00ecnh th\u01b0\u1eddng.<\/p>\n

2.1. T\u00ednh t\u1ef1 \u0111\u1ed9ng b\u1ea5t th\u01b0\u1eddng:<\/strong> l\u00e0 kh\u1ea3 n\u0103ng t\u1ef1 kh\u1eed c\u1ef1c c\u1ee7a m\u1ed9t s\u1ed1 t\u1ebf b\u00e0o c\u01a1 tim bi\u1ec7t ho\u00e1 \u0111\u1ec3 \u0111\u1ea1t \u0111\u1ebfn \u0111i\u1ec7n th\u1ebf ng\u01b0\u1ee1ng kh\u1edfi \u0111\u1ea7u m\u1ed9t \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng.<\/p>\n

T\u1ef1 \u0111\u1ed9ng t\u00ednh gia t\u0103ng ch\u1ee9ng t\u1ecf c\u00f3 m\u1ed9t \u1ed5 ngo\u1ea1i v\u1ecb c\u1ee7a c\u00e1c TB ph\u00e1t nh\u1ecbp t\u1ed3n t\u1ea1i trong c\u01a1 tim \u0111\u00e3 \u0111ang trong t\u00ecnh tr\u1ea1ng gi\u1ea3m \u0111i\u1ec7n th\u1ebf ng\u01b0\u1ee1ng. Nh\u1ecbp c\u01a1 b\u1ea3n c\u1ee7a tim \u0111\u00e3 n\u00e2ng c\u00e1c TB n\u00e0y t\u1edbi ng\u01b0\u1ee1ng v\u00e0 kh\u1edfi ph\u00e1t nh\u1ecbp \u0111\u1eadp t\u1eeb \u1ed5 ngo\u1ea1i v\u1ecb.<\/p>\n

T\u1ef1 \u0111\u1ed9ng t\u00ednh gia t\u0103ng c\u00f3 th\u1ec3 do c\u00e1c r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i ho\u1eb7c do thi\u1ebfu m\u00e1u c\u01a1 tim.<\/p>\n

2.2. Ho\u1ea1t \u0111\u1ed9ng kh\u1edfi k\u00edch (Triggered activity):<\/strong><\/p>\n

Do qu\u00e1 tr\u00ecnh sau kh\u1eed c\u1ef1c \u0111\u01b0\u1ee3c kh\u1edfi k\u00edch b\u1edfi c\u00e1c \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng \u0111i tr\u01b0\u1edbc. Hi\u1ec7n t\u01b0\u1ee3ng sau kh\u1eed c\u1ef1c \u0111\u01b0\u1ee3c kh\u1edfi k\u00edch b\u1edfi xung \u0111\u1ed9ng \u0111i tr\u01b0\u1edbc c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn s\u1ef1 ho\u1ea1t ho\u00e1 s\u1edbm c\u00e1c \u1ed5 ngo\u1ea1i v\u1ecb, n\u1ebfu nh\u01b0 k\u00edch th\u00edch \u0111\u1ea1t t\u1edbi ng\u01b0\u1ee1ng s\u1ebd g\u00e2y ho\u1ea1t \u0111\u1ed9ng l\u1eaby c\u00f2 \u2192 h\u00ecnh th\u00e0nh xung ph\u00e1t nh\u1ecbp.<\/p>\n

Hi\u1ec7n t\u01b0\u1ee3ng sau kh\u1eed c\u1ef1c c\u00f3 th\u1ec3 x\u1ea3y ra:<\/p>\n

+ Ngay trong giai \u0111o\u1ea1n t\u00e1i c\u1ef1c (h\u1eadu kh\u1eed c\u1ef1c s\u1edbm): x\u1ea3y ra \u1edf pha 2 \u2013 3, th\u01b0\u1eddng g\u00e2y n\u00ean ngo\u1ea1i t\u00e2m thu li\u00ean quan \u0111\u1ebfn nh\u1ecbp tim ch\u1eadm. Tuy nhi\u00ean t\u00ecnh tr\u1ea1ng n\u00e0y c\u0169ng c\u00f3 th\u1ec3 x\u1ea3y ra trong b\u1ec7nh l\u00fd thi\u1ebfu m\u00e1u c\u01a1 tim v\u00e0 r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i. Ho\u1eb7c nh\u01b0 lo\u1ea1n nh\u1ecbp th\u1ea5t trong h\u1ed9i ch\u1ee9ng QT d\u00e0i (xo\u1eafn \u0111\u1ec9nh).<\/p>\n

+ Ho\u1eb7c sau khi t\u00e1i c\u1ef1c xong (h\u1eadu kh\u1eed c\u1ef1c mu\u1ed9n): x\u1ea3y ra \u1edf pha 4, nh\u01b0 lo\u1ea1n nh\u1ecbp do Digitalis hay g\u1eb7p l\u00e0 nh\u1ecbp b\u1ed9 n\u1ed1i gia t\u1ed1c, nh\u1ecbp nhanh th\u1ea5t.<\/p>\n

2.3. C\u01a1 ch\u1ebf v\u00f2ng v\u00e0o l\u1ea1i<\/strong><\/p>\n

Ba \u0111i\u1ec1u ki\u1ec7n t\u1ea1o ra v\u00f2ng v\u00e0o l\u1ea1i:<\/p>\n

+ C\u00f3 hai \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n \u0111\u1ed9c l\u1eadp \u0111\u1ee9ng c\u1ea1nh nhau, nh\u01b0ng t\u00e1ch bi\u1ec7t v\u1ec1 m\u1eb7t sinh l\u00fd, kh\u00e1c nhau v\u1ec1 v\u1eadn t\u1ed1c d\u1eabn truy\u1ec1n v\u00e0 th\u1eddi k\u1ef3 tr\u01a1.<\/p>\n

+ C\u00f3 1 \u0111\u01b0\u1eddng b\u1ecb block m\u1ed9t chi\u1ec1u.<\/p>\n

+ D\u1eabn truy\u1ec1n theo \u0111\u01b0\u1eddng c\u00f2n l\u1ea1i \u0111\u1ee7 ch\u1eadm \u0111\u1ec3 \u0111\u01b0\u1eddng b\u1ecb block c\u00f3 th\u1eddi gian ph\u1ee5c h\u1ed3i.<\/p>\n

->\u00a0 S\u1ef1 ch\u1eadm tr\u1ec5 ho\u1eb7c block d\u1eabn truy\u1ec1n c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn r\u1ed1i lo\u1ea1n nh\u1ecbp tim nhanh ho\u1eb7c ch\u1eadm:<\/p>\n

+ V\u1edbi c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp ch\u1eadm: khi lan truy\u1ec1n c\u00e1c xung b\u1ecb t\u1eafc ngh\u1ebdn, ti\u1ebfp theo l\u00e0 v\u00f4 t\u00e2m thu ho\u1eb7c nh\u1ecbp tho\u00e1t ch\u1eadm.<\/p>\n

+ V\u1edbi c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp tim nhanh: khi ch\u1eadm tr\u1ec5 v\u00e0 block t\u1ea1o ra v\u00f2ng v\u00e0o l\u1ea1i.<\/p>\n

3. R\u1ed1i lo\u1ea1n nh\u1ecbp do r\u1ed1i lo\u1ea1n d\u1eabn truy\u1ec1n xung \u0111\u1ed9ng.<\/h2>\n

B\u00ecnh th\u01b0\u1eddng xung \u0111i\u1ec7n \u0111\u01b0\u1ee3c ph\u00e1t ra t\u1eeb n\u00fat xoang (kh\u1eed c\u1ef1c nh\u0129) \u2192 xu\u1ed1ng n\u00fat nh\u0129 th\u1ea5t (A-V node) \u2192 b\u00f3 His\u00a0 \u2192 nh\u00e1nh (P) v\u00e0 nh\u00e1nh (T) \u2192 m\u1ea1ng l\u01b0\u1edbi Purkinje (kh\u1eed c\u1ef1c th\u1ea5t).<\/p>\n

\"roi-loan-nhip-tim\"
H\u1ec7 th\u1ed1ng d\u1eabn truy\u1ec1n c\u1ee7a tim\u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0<\/span><\/figcaption><\/figure>\n

M\u1ed9t s\u1ed1 r\u1ed1i lo\u1ea1n nh\u1ecbp tim c\u00f3 th\u1ec3 kh\u1edfi ph\u00e1t b\u1edfi m\u1ed9t c\u01a1 ch\u1ebf v\u00e0 \u0111\u01b0\u1ee3c duy tr\u00ec b\u1edfi m\u1ed9t c\u01a1 ch\u1ebf kh\u00e1c.<\/p>\n

V\u00ed d\u1ee5:<\/p>\n

– Ngo\u1ea1i t\u00e2m thu th\u1ea5t do t\u00ednh t\u1ef1 \u0111\u1ed9ng b\u1ea5t th\u01b0\u1eddng c\u00f3 th\u1ec3 ti\u1ebfp theo b\u1edfi m\u1ed9t c\u01a1n nh\u1ecbp nhanh th\u1ea5t do v\u00f2ng v\u00e0o l\u1ea1i.<\/p>\n

– M\u1ed9t giai \u0111o\u1ea1n tim nhanh do m\u1ed9t c\u01a1 ch\u1ebf c\u00f3 th\u1ec3 ti\u1ebfp theo m\u1ed9t giai \u0111o\u1ea1n kh\u00e1c do m\u1ed9t c\u01a1 ch\u1ebf kh\u00e1c.<\/p>\n

T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/strong><\/p>\n

    \n
  • B\u00e0i gi\u1ea3ng “R\u1ed0I LO\u1ea0N NH\u1ecaP TIM<\/em>“, TS <\/b>L\u00ca C\u00d4NG T\u1ea4N, B\u1ed9 m\u00f4n N\u1ed9i \u2013 \u0110HYK PH\u1ea0M NG\u1eccC TH\u1ea0CH<\/li>\n
  • 2018 ACC\/AHA – Advanced Cardiovascular Life Support<\/li>\n
  • General Comprehensive Life Support for Practitioners 2016<\/li>\n
  • 2017 AHA\/ACC\/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death<\/li>\n
  • 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS<\/li>\n
  • 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death<\/li>\n
  • 2015 ACC\/AHA\/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia<\/li>\n
  • \u0110i\u1ec1u tr\u1ecb tim m\u1ea1ch \u2013 Vi\u1ec7n Tim 2017<\/li>\n
  • Ch\u1ea9n \u0111o\u00e1n tim nhanh v\u1edbi QRS h\u1eb9p \u2013 BS. Ph\u1ea1m Nh\u01b0 H\u00f9ng<\/li>\n
  • Ch\u1ea9n \u0111o\u00e1n lo\u1ea1n nh\u1ecbp th\u1ea5t \u2013 TS. T\u00f4n Th\u1ea5t Minh<\/li>\n
  • X\u1eed tr\u00ed c\u1ea5p c\u1ee9u c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp tim \u2013 PGS. T\u1ea1 M\u1ea1nh C\u01b0\u1eddng<\/li>\n
  • Ch\u1ea9n \u0111o\u00e1n tim nhanh v\u1edbi QRS r\u1ed9ng \u2013 TS. Phan \u0110\u00ecnh Phong<\/li>\n
  • X\u1eed tr\u00ed c\u1ea5p c\u1ee9u c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp nhanh \u2013 TS. Tr\u1ea7n V\u0103n \u0110\u00f4ng<\/li>\n<\/ul>\n

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

    R\u1ed1i lo\u1ea1n nh\u1ecbp tim – arrhythmia hay dysrhythmia \u2013 b\u1ea5t th\u01b0\u1eddng v\u1ec1 t\u1ea7n s\u1ed1 (rate) hay v\u1ec1 nh\u1ecbp (rhythm) c\u1ee7a tim. \u2013 Tim qu\u00e1 nh\u00e1nh: nh\u1ecbp nhanh (tachycardia) \u2013 Tim qu\u00e1 ch\u1eadm: nh\u1ecbp ch\u1eadm (bradycardia) \u2013 Nh\u1ecbp tim kh\u00f4ng \u0111\u1ec1u (irregular rhythm) H\u1ea7u h\u1ebft lo\u1ea1n nh\u1ecbp tim l\u00e0 v\u00f4 h\u1ea1i. Trong l\u00fac b\u1ecb lo\u1ea1n nh\u1ecbp […]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[],"yoast_head":"\nC\u01a1 ch\u1ebf r\u1ed1i lo\u1ea1n nh\u1ecbp tim - Vinmec<\/title>\n<meta name=\"description\" content=\"R\u1ed1i lo\u1ea1n nh\u1ecbp tim - arrhythmia hay dysrhythmia \u2013 l\u00e0 t\u00ecnh tr\u1ea1ng b\u1ea5t th\u01b0\u1eddng v\u1ec1 t\u1ea7n s\u1ed1 (rate) hay v\u1ec1 nh\u1ecbp (rhythm) tim.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"C\u01a1 ch\u1ebf r\u1ed1i lo\u1ea1n nh\u1ecbp tim - Vinmec\" \/>\n<meta property=\"og:description\" content=\"R\u1ed1i lo\u1ea1n nh\u1ecbp tim - arrhythmia hay dysrhythmia \u2013 l\u00e0 t\u00ecnh tr\u1ea1ng b\u1ea5t th\u01b0\u1eddng v\u1ec1 t\u1ea7n s\u1ed1 (rate) hay v\u1ec1 nh\u1ecbp (rhythm) tim.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/co-che-roi-loan-nhip-tim\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-29T15:05:41+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/heart-diagram-labelled-300x150.png\" \/>\n<meta name=\"author\" content=\"Dai Tran Van\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Dai Tran Van\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/co-che-roi-loan-nhip-tim\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/co-che-roi-loan-nhip-tim\/\",\"name\":\"C\u01a1 ch\u1ebf r\u1ed1i lo\u1ea1n nh\u1ecbp tim - 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