{"id":30311,"date":"2023-05-02T07:46:30","date_gmt":"2023-05-02T00:46:30","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30311"},"modified":"2023-05-04T21:31:10","modified_gmt":"2023-05-04T14:31:10","slug":"dieu-tri-benh-dong-mach-chi-duoi-man-tinh","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/02\/dieu-tri-benh-dong-mach-chi-duoi-man-tinh\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi m\u1ea1n t\u00ednh- Ph\u1ea7n 1"},"content":{"rendered":"

B\u1ec7nh \u0111\u1ed9ng <\/span><\/span>m\u1ea1ch chi d\u01b0\u1edbi<\/span><\/span><\/a> m\u1ea1n t\u00ednh c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng v\u00e0 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n. <\/span>Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi m\u1ea1n t\u00ednh \u0111\u00fang c\u00e1ch v\u00e0 theo d\u00f5i th\u01b0\u1eddng xuy\u00ean c\u00f3 th\u1ec3 gi\u00fap ng\u0103n ch\u1eb7n c\u00e1c bi\u1ebfn ch\u1ee9ng v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/span><\/span><\/strong><\/p>\n

\"B\u1ec7nh
B\u1ec7nh \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi<\/figcaption><\/figure>\n

1. M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb<\/span><\/span><\/strong><\/h2>\n


\n<\/strong>\u0110i\u1ec1u tr\u1ecb b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi m\u1ea1n t\u00ednh g\u1ed3m 3 m\u1ee5c ti\u00eau ch\u00ednh: <\/span><\/span>
\nGi\u1ea3m bi\u1ebfn c\u1ed1 tim m\u1ea1ch ch\u00ednh (MACE): gi\u1ea3m t\u1eed vong, Nh\u1ed3i m\u00e1u c\u01a1 tim (NMCT), Tai bi\u1ebfn \u0111\u1ed9t qu\u1ef5 n\u00e3o (TBMN). <\/span>C\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh hi\u1ec7u qu\u1ea3 bao g\u1ed3m: thu\u1ed1c ch\u1ed1ng huy\u1ebft kh\u1ed1i (thu\u1ed1c ch\u1ed1ng ti\u1ec3u c\u1ea7u v\u00e0 ch\u1ed1ng \u0111\u00f4ng), statin, thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n, ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 huy\u1ebft \u00e1p. <\/span><\/span>
\nGi\u1ea3m t\u1ef7 l\u1ec7 c\u1eaft c\u1ee5t chi v\u00e0 c\u00e1c bi\u1ebfn c\u1ed1 \u0111\u1ecbnh l\u1edbn \u1edf chi (MALE). <\/span>C\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb bao g\u1ed3m: T\u00e1i th\u00f4ng m\u1ea1ch m\u00e1u t\u1ed1i \u01b0u, ch\u0103m s\u00f3c b\u00e0n ch\u00e2n, li\u1ec7u ph\u00e1p ch\u1ed1ng huy\u1ebft kh\u1ed1i. <\/span><\/span>
\nC\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng cho ng\u01b0\u1eddi b\u1ec7nh: t\u1eadp \u0111i b\u1ed9, t\u1eadp ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng, thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng, b\u1ecf thu\u1ed1c l\u00e1, ch\u0103m s\u00f3c v\u1ebft r\u1ea1ch b\u00e0n ch\u00e2n.<\/span><\/span><\/p>\n

2. \u0110i\u1ec1u ch\u1ec9nh c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 tim m\u1ea1ch do x\u01a1 v\u1eefa<\/span><\/span><\/h2>\n


\n<\/strong>\u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa b\u1ea3o t\u1ed3n l\u00e0 ph\u01b0\u01a1ng ph\u00e1p n\u1ec1n t\u1ea3ng v\u00e0 \u00e1p d\u1ee5ng cho m\u1ecdi b\u1ec7nh nh\u00e2n B\u0110MCD d\u00f9 c\u00f3 hay kh\u00f4ng s\u1eed d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p t\u00e1i sinh th\u00f4ng m\u1ea1ch (c\u00f3 th\u1ec3 m\u1ed5 ho\u1eb7c ph\u1eabu thu\u1eadt). <\/span>\u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa c\u01a1 b\u1ea3n bao g\u1ed3m theo d\u00f5i v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 tim m\u1ea1ch d\u1eabn \u0111\u1ebfn bi\u1ebfn c\u1ed1 huy\u1ebft kh\u1ed1i x\u01a1 v\u1eefa nh\u1eb9 \u0111\u1ed9ng m\u1ea1ch. <\/span>Nguy\u00ean l\u00fd c\u01a1 b\u1ea3n bao g\u1ed3m: ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t th\u01b0\u1eddng xuy\u00ean, gi\u1ea3m c\u00e2n \u1edf b\u1ec7nh nh\u00e2n th\u1eeba c\u00e2n, b\u1ecf h\u00fat thu\u1ed1c (v\u00e0 c\u00e1c h\u00ecnh th\u00e1i t\u01b0\u01a1ng t\u1ef1), thu\u1ed1c ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u, c\u0169ng nh\u01b0 \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p t\u1ed1i \u01b0u , r\u1ed1i lo\u1ea1n lipid m\u00e1u v\u00e0 kh\u00f3 ch\u1ecbu \u0111\u01b0\u1eddng\u2026<\/span><\/span><\/p>\n

2.1. <\/span>h\u00fat thu\u1ed1c l\u00e1<\/span><\/span><\/h3>\n

Cai thu\u1ed1c l\u00e1 (v\u00e0 c\u00e1c h\u00ecnh th\u00e1i t\u01b0\u01a1ng t\u1ef1 nh\u01b0 thu\u1ed1c l\u00e0o, nhai thu\u1ed1c\u2026) l\u00e0 thu\u1ed1c duy nh\u1ea5t tuy\u1ec7t \u0111\u1ed1i \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n B\u0110MCD \u1edf m\u1ecdi giai \u0111o\u1ea1n b\u1ec7nh v\u00ec t\u00e1c h\u1ea1i c\u1ee7a thu\u1ed1c l\u00e1 v\u1edbi b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u ch\u1ee9ng minh R\u00f5 r\u00e0ng nh\u01b0 l\u1ee3i \u00edch <\/span><\/span>
\nlo\u1ea1i b\u1ecf thu\u1ed1c l\u00e1 gi\u00fap c\u1ea3i thi\u1ec7n thi\u1ec7n ti\u00ean l\u01b0\u1ee3ng v\u00e0 tri\u1ec7u ch\u1ee9ng cho ng\u01b0\u1eddi b\u1ec7nh. <\/span><\/span>
\nH\u01b0\u1edbng d\u1eabn th\u1ef1c hi\u1ec7n ch\u01b0\u01a1ng tr\u00ecnh thu\u1ed1c gi\u1ea3m \u0111au cho nh\u1eefng ng\u01b0\u1eddi h\u00fat thu\u1ed1c b\u1eb1ng c\u00e1c gi\u00e1m \u0111\u1ed1c quan s\u00e1t y t\u1ebf, nh\u00f3m tr\u1ecb li\u1ec7u v\u00e0 c\u00e1c bi\u1ec7n ph\u00e1p s\u1eed d\u1ee5ng nicotin thay th\u1ebf n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t (tham kh\u1ea3o \u00fd ki\u1ebfn \u200b\u200bch\u01b0\u01a1ng tr\u00ecnh Ph\u00f2ng ch\u1ed1ng t\u00e1c h\u1ea1i thu\u1ed1c l\u00e1).<\/span><\/span><\/p>\n

2.2. <\/span>\u0110i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n m\u1ee1 m\u00e1u<\/span><\/span><\/h3>\n

Nh\u00f3m thu\u1ed1c statin ch\u1ec9 \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n B\u0110MCD, gi\u00fap ph\u00f2ng ng\u1eeba bi\u1ebfn ch\u1ee9ng tim m\u1ea1ch. <\/span><\/span>
\n\u00a0B\u1ec7nh nh\u00e2n B\u0110MCD \u0111\u01b0\u1ee3c coi l\u00e0 nguy c\u01a1 cao \u0111\u1ebfn r\u1ea5t cao, do \u0111\u00f3 c\u1ea7n s\u1eed d\u1ee5ng statin c\u00f3 c\u01b0\u1eddng \u0111\u1ed9 cao nh\u01b0 rosuvastatin (20 \u2013 40 mg); <\/span>artovastatin (40 \u2013 80 mg) ho\u1eb7c thu\u1ed1c ph\u1ed1i h\u1ee3p statin v\u1edbi ezetimide. <\/span><\/span>
\nVi\u1ec7c cho statin v\u1edbi nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y b\u1ea5t k\u1ec3 x\u00e9t nghi\u1ec7m th\u1eed nghi\u1ec7m c\u1ea5m cholesterol LDL-C ban \u0111\u1ea7u l\u00e0 bao nhi\u00eau v\u00e0 h\u01b0\u1edbng t\u1edbi m\u1ee5c ti\u00eau gi\u1ea3m cholesterol LDL-C xu\u1ed1ng d\u01b0\u1edbi 1,4 mmol\/l ho\u1eb7c gi\u1ea3m \u00edt nh\u1ea5t l\u00e0 m\u1ed9t n\u1eeda m\u1ee9c c\u1ea5m \u0111\u1ea7u. <\/span><\/span>
\n\u00a0Kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng \u1ee9c ch\u1ebf PCSK9 c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc cho b\u1ec7nh nh\u00e2n B\u0110MCD \u0111ang s\u1eed d\u1ee5ng d\u1eabn d\u1ee5 statin t\u1ed1i \u0111a c\u00f3 th\u1ec3 dung n\u1ea1p v\u00e0 ezetimibe m\u00e0 v\u1eabn ch\u01b0a \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee5c ti\u00eau LDL<\/span><\/span><\/p>\n

2.3. \u0110i\u1ec1u tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/span><\/span><\/h3>\n

H\u01b0\u1edbng d\u1eabn c\u00e1c b\u1ec7nh nh\u00e2n kh\u00f3 ch\u1ecbu lo\u1ea1i b\u1ecf \u0111\u01b0\u1eddng n\u00ean \u0111\u01b0\u1ee3c s\u00e0ng l\u1ecdc ph\u00e1t hi\u1ec7n b\u1ec7nh l\u00fd B\u00d0MCD. <\/span><\/span>
\nNg\u01b0\u1ee3c l\u1ea1i, h\u01b0\u1edbng d\u1eabn m\u1ecdi b\u1ec7nh nh\u00e2n B\u00d0MCD n\u00ean s\u1eb5n s\u00e0ng l\u1ecdc c\u00f3 t\u00ednh n\u0103ng s\u00e0ng l\u1ecdc \u0111\u01b0\u1eddng, ti\u1ec1n thu\u1eadt di\u1ec7t tr\u1eeb \u0111\u01b0\u1eddng hay kh\u00f4ng v\u00e0 kh\u1edfi \u0111\u1ed9ng ngay \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 n\u1ebfu \u0111\u01b0\u1ee3c Ch\u1ed1ng t\u00ednh n\u0103ng \u0111i\u1ec1u khi\u1ec3n \u0111\u01b0\u1eddng. <\/span><\/span>
\n\u1ede b\u1ec7nh nh\u00e2n B\u0110MCD c\u00f3 lo\u1ea1i tr\u1eeb \u0111\u01b0\u1eddng lo\u1ea1i 2, th\u1ef1c hi\u1ec7n ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng, t\u1eadp luy\u1ec7n theo khuy\u1ebfn c\u00e1o, thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 SGLT2 (nh\u01b0 empagliflozin, dapagliflozin) v\u00e0\/ho\u1eb7c thu\u1ed1c \u0111\u1ed3ng v\u1eadn GLP1 (liraglutid) ho\u1eb7c thu\u1ed1c \u1ee9c ch\u1ebf ch\u1ebf \u0111\u1ed9 DPP- <\/span><\/span>
\n4 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh s\u1eed d\u1ee5ng \u0111\u1ea7u tay b\u00ean c\u1ea1nh metformin.<\/span><\/span><\/p>\n

2.4. <\/span>\u0110i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p<\/span><\/span><\/h3>\n

C\u1ea7n ki\u1ec3m tra huy\u1ebft \u00e1p t\u00edch c\u1ef1c \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n B\u0110MCD \u0111\u1ec3 gi\u1ea3m c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch. <\/span><\/span>
\nHuy\u1ebft \u00e1p m\u1ee5c ti\u00eau: \u0111\u1ea1t huy\u1ebft \u00e1p t\u00e2m thu d\u01b0\u1edbi 140 mmHg; <\/span>t\u1ed1i \u01b0u t\u1eeb 120 \u2013 129 mmHg \u1edf b\u1ec7nh nh\u00e2n < 65 tu\u1ed5i v\u00e0 130 \u2013 139 mm Hg \u1edf b\u1ec7nh nh\u00e2n \u2265 65 tu\u1ed5i, c\u00f3 ho\u1eb7c kh\u00f4ng m\u1eafc b\u1ec7nh tim m\u1ea1ch. <\/span><\/span>
\nTrong s\u1ed1 c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb THA, thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n ho\u1eb7c thu\u1ed1c ch\u1eb9n th\u1ee5 th\u1ec3 angiotensin \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn (n\u1ebfu kh\u00f4ng c\u00f3 thu\u1ed1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh).<\/span><\/span><\/p>\n

3. Thu\u1ed1c ch\u1ed1ng huy\u1ebft kh\u1ed1i<\/span><\/span><\/h2>\n


\n<\/strong>Kh\u00f4ng ch\u1ec9 \u0111\u1ecbnh m\u1ed9t c\u00e1ch th\u00f4ng th\u01b0\u1eddng quy thu\u1ed1c ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u ho\u1eb7c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u1edf b\u1ec7nh nh\u00e2n B\u00d0MCD \u0111\u01a1n thu\u1ea7n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng m\u00e0 kh\u00f4ng c\u00f3 c\u00e1c ch\u1ec9 \u0111\u1ecbnh kh\u00e1c.<\/span><\/span><\/p>\n

Thu\u1ed1c ch\u1ed1ng k\u1ebft t\u1eadp \u0111\u01a1n tr\u1ecb li\u1ec7u nh\u1ecf (SAPT), th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng l\u00e0 aspirin ho\u1eb7c clopidogrel, ch\u1ec9 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh s\u1eed d\u1ee5ng th\u1eddi h\u1ea1n d\u00e0i ngay t\u1eeb \u0111\u1ea7u ho\u1eb7c sau giai \u0111o\u1ea1n s\u1eed d\u1ee5ng kh\u00e1ng huy\u1ebft kh\u1ed1i k\u00e9p, cho c\u00e1c b\u1ec7nh nh\u00e2n: + B\u1ec7nh nh\u00e2n sau c\u00e1c <\/span><\/span>
\nb\u1ec7nh bi\u1ec7n ph\u00e1p t\u00e1i sinh th\u00f4ng \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi v\u00e0 sau giai \u0111o\u1ea1n s\u1eed d\u1ee5ng kh\u00e1ng huy\u1ebft kh\u1ed1i k\u00e9p. <\/span><\/span>
\n+ B\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u n\u1ed1i b\u1eb1ng \u0111o\u1ea1n m\u1ea1ch nh\u00e2n t\u1ea1o d\u01b0\u1edbi c\u00f9ng \u0111\u00f9i. <\/span><\/span>
\n+ B\u1ec7nh nh\u00e2n kh\u00e1ng \u0111\u01b0\u1eddng c\u1ea7n \u0111i\u1ec1u tr\u1ecb SAPT, n\u00ean \u01b0u ti\u00ean clopidogrel h\u01a1n aspirin. <\/span><\/span>
\n+ C\u00f3 th\u1ec3 c\u00e2n nh\u1eafc kh\u00e1ng thu\u1ed1c kh\u00e1ng vitamin K sau ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u b\u1eb1ng \u0111o\u1ea1n m\u1ea1ch nh\u00e2n t\u1ea1o.<\/span><\/span><\/p>\n

Li\u1ec7u ph\u00e1p 2 thu\u1ed1c ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u (kh\u00e1ng ti\u1ec3u c\u1ea7u k\u00e9p \u2013 DAPT), n\u00ean ph\u1ed1i h\u1ee3p gi\u1eefa aspirin (75 \u2013 100mg) v\u1edbi clopidogrel (75mg), th\u1eddi gian k\u00e9o d\u00e0i t\u1ed1i thi\u1ec3u l\u00e0 1 th\u00e1ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n sau can th\u1ef1c v\u1eadt. t\u00e1i sinh th\u00f4ng \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi ho\u1eb7c theo ch\u1ec9 \u0111\u1ecbnh c\u1ee7a c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c (\u0111\u1ed9ng m\u1ea1ch v\u00e0nh, \u0111\u1ed9ng m\u1ea1ch n\u00e3o). <\/span><\/span>
\nN\u00ean d\u00f9ng ph\u00e1c \u0111\u1ed3 k\u1ebft h\u1ee3p aspirin (85 -100 mg\/ng\u00e0y) v\u1edbi thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng rivaroxaban \u0111\u1ea1m th\u1ea5p (2,5 mg x 2 l\u1ea7n\/ng\u00e0y) sau can sinh t\u00e1i th\u00f4ng m\u1ea1ch chi, c\u00f3 th\u1ec3 gi\u00fap gi\u1ea3m bi\u1ebfn c\u1ed1 tim m\u1ea1ch , bi\u1ebfn c\u1ed1 l\u1edbn tr\u00ean chi c\u1ee5 th\u1ec3 l\u00e0 gi\u1ea3m t\u1ef7 l\u1ec7 c\u1eaft c\u1ee5t \u0111\u1ed1i v\u1edbi ng\u01b0\u1eddi b\u1ec7nh, n\u1ebfu nguy c\u01a1 xu\u1ea5t huy\u1ebft kh\u00f4ng cao (kh\u00f4ng c\u00f3: ti\u1ec1n s\u1eed xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd\/qu\u1ef5 s\u00e1t thi\u1ebfu m\u00e1u n\u00e3o, xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a g\u1ea7n \u0111\u00e2y ho\u1eb7c thi\u1ebfu m\u00e1u do suy gan, suy th\u1eadn; b\u1ec7nh l\u00fd t\u0103ng nguy c\u01a1 ch\u1ea3y m\u00e1u, tu\u1ed5i cao) ho\u1eb7c kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh kh\u00e1c.<\/span><\/span>
\nN\u00ean s\u1eed d\u1ee5ng ph\u00e1c \u0111\u1ed3 k\u1ebft h\u1ee3p aspirin (85 -100 mg\/ng\u00e0y) v\u1edbi thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng rivaroxaban \u0111\u1ea1m th\u1ea5p (2,5 mg x 2 l\u1ea7n\/ng\u00e0y) cho b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh B\u00d0MCD m\u1ea1n t\u00ednh c\u00f3 tri\u1ec7u ch\u1ee9ng, c\u00f3 nguy c\u01a1 tim m\u1ea1ch cao nh\u01b0 suy tim, b\u1ec7nh l\u00fd \u0111a m\u1ea1ch s\u01a1 s\u00e0i, s\u00e0ng l\u1ecdc \u0111\u01b0\u1eddng, suy th\u1eadn v\u00e0\/ho\u1eb7c b\u1ec7nh nh\u00e2n B\u0110MCD sau th\u1ec3 nh\u00e0n, b\u1ec7nh nh\u00e2n nguy c\u01a1 cao ph\u1ea3i c\u1eaft c\u1ee5t chi (xem thang \u0111i\u1ec3m WIFI), \u0111au khi ngh\u1ec9, khe v\u00e0 nguy c\u01a1 ch\u1ea3y m\u00e1u kh\u00f4ng cao.<\/span><\/span><\/p>\n

V\u1edbi b\u1ec7nh nh\u00e2n ch\u1ec9 \u0111\u1ecbnh ph\u1ea3i u\u1ed1ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng (rung nh\u0129, van tim c\u01a1 h\u1ecdc\u2026): <\/span><\/span>
\n+ C\u00f3 th\u1ec3 c\u00e2n nh\u1eafc ch\u1ec9 d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng \u0111\u01a1n \u0111\u1ed9c (thu\u1ed1c kh\u00e1ng vitamin K ho\u1eb7c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng h\u1ec7 th\u1ebf h\u1ec7 m\u1edbi) – NOAC). <\/span><\/span>
\n+ Sau can sinh t\u00e1i th\u00f4ng m\u1ea1ch m\u00e1u, aspirin ho\u1eb7c clopidogrel n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc c\u00f9ng v\u1edbi thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng \u00edt nh\u1ea5t 1 th\u00e1ng. <\/span><\/span>
\n+ B\u1ec7nh nh\u00e2n nguy c\u01a1 xu\u1ea5t huy\u1ebft cao, sau can t\u00e1i sinh th\u00f4ng m\u1ea1ch m\u00e1u, n\u00ean d\u00f9ng lo\u1ea1i thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng.<\/span><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

B\u1ec7nh \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi m\u1ea1n t\u00ednh c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng v\u00e0 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n. Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi m\u1ea1n t\u00ednh \u0111\u00fang c\u00e1ch v\u00e0 theo d\u00f5i th\u01b0\u1eddng xuy\u00ean c\u00f3 th\u1ec3 gi\u00fap ng\u0103n ch\u1eb7n c\u00e1c bi\u1ebfn ch\u1ee9ng v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng […]<\/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":[],"yoast_head":"\n\u0110i\u1ec1u tr\u1ecb b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi m\u1ea1n t\u00ednh- Ph\u1ea7n 1 - Vinmec<\/title>\n<meta name=\"description\" content=\"\u0111i\u1ec1u tr\u1ecb b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi m\u1ea1n t\u00ednh gi\u00fap ng\u0103n ng\u1eeba c\u00e1c bi\u1ebfn ch\u1ee9ng v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n.\" \/>\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=\"\u0110i\u1ec1u tr\u1ecb b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi m\u1ea1n t\u00ednh- Ph\u1ea7n 1 - 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