{"id":31873,"date":"2023-05-05T22:30:30","date_gmt":"2023-05-05T15:30:30","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31873"},"modified":"2023-05-05T22:30:30","modified_gmt":"2023-05-05T15:30:30","slug":"dieu-tri-benh-nhan-nhoi-mau-co-tim-co-st-chenh","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/05\/dieu-tri-benh-nhan-nhoi-mau-co-tim-co-st-chenh\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u c\u01a1 tim c\u00f3 ST ch\u00eanh"},"content":{"rendered":"

Nh\u1ed3i m\u00e1u c\u01a1 tim l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh tim m\u1ea1ch nguy hi\u1ec3m nh\u1ea5t hi\u1ec7n nay v\u00e0 \u0111\u01b0\u1ee3c coi l\u00e0 m\u1ed9t trong nh\u1eefng nguy\u00ean nh\u00e2n ch\u00ednh g\u00e2y t\u1eed vong \u1edf nhi\u1ec1u qu\u1ed1c gia tr\u00ean th\u1ebf gi\u1edbi. N\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 b\u1ecb \u0111au th\u1eaft ng\u1ef1c, suy tim, ho\u1eb7c th\u1eadm ch\u00ed l\u00e0 \u0111\u1ed9t qu\u1ef5. Trong b\u00e0i vi\u1ebft n\u00e0y, ch\u00fang ta s\u1ebd t\u00ecm hi\u1ec3u k\u1ef9 h\u01a1n v\u1ec1 nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb hi\u1ec7n \u0111\u1ea1i cho b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u c\u01a1 tim c\u00f3 ST ch\u00eanh. Ch\u00fang ta s\u1ebd c\u00f9ng nhau t\u00ecm hi\u1ec3u nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p m\u1edbi nh\u1ea5t v\u00e0 \u0111\u00e1nh gi\u00e1 t\u00ednh hi\u1ec7u qu\u1ea3 c\u1ee7a ch\u00fang, gi\u00fap b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 ph\u1ee5c h\u1ed3i s\u1ee9c kh\u1ecfe nhanh ch\u00f3ng v\u00e0 gi\u1ea3m thi\u1ec3u nguy c\u01a1 tai bi\u1ebfn.<\/strong><\/p>\n

1. Nguy\u00ean t\u1eafc chung<\/strong><\/h2>\n

\u2666\u00a0T\u0103ng kh\u1ed1i l\u01b0\u1ee3ng c\u01a1 tim \u0111\u01b0\u1ee3c c\u1ee9u s\u1ed1ng:
\n\u2022 Kh\u1ea9n tr\u01b0\u01a1ng \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng b\u1ec7nh nh\u00e2n\/ Ph\u00e1t hi\u1ec7n s\u1edbm, \u0111i\u1ec1u tr\u1ecb s\u1edbm NMCT v\u00e0 kh\u1ed1ng ch\u1ebf bi\u1ebfn ch\u1ee9ng.
\n\u2022 Gi\u1ea3m h\u1eadu qu\u1ea3, gi\u1ea3m bi\u1ebfn ch\u1ee9ng, gi\u1ea3m t\u1eed vong.<\/p>\n

\u2666\u00a0\u00a0\u1ed4n \u0111\u1ecbnh t\u1ea1i ch\u1ed7 c\u00e1c bi\u1ec7n ph\u00e1p chung, thu\u1ed1c ban \u0111\u1ea7u
\n\u2666\u00a0 Chi\u1ebfn l\u01b0\u1ee3c t\u00e1i t\u01b0\u1edbi m\u00e1u s\u1edbm: can thi\u1ec7p ngay th\u00ec \u0111\u1ea7u n\u1ebfu c\u00f3 th\u1ec3
\n\u2666\u00a0 \u0110i\u1ec1u tr\u1ecb c\u00e1c v\u1ea5n \u0111\u1ec1 kh\u00e1c \u0111i k\u00e8m.<\/p>\n

2. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p c\u1ee5 th\u1ec3 \u0111i\u1ec1u tr\u1ecb nh\u1ed3i m\u00e1u c\u01a1 tim ST ch\u00eanh<\/strong><\/h2>\n

2.1 Ph\u01b0\u01a1ng ph\u00e1p t\u00e1i t\u01b0\u1edbi m\u00e1u<\/strong><\/h3>\n

\u2022 Can thi\u1ec7p m\u1ea1ch v\u00e0nh qua da (PCI)
\n\u2022 Li\u1ec7u ph\u00e1p ti\u00eau s\u1ee3i huy\u1ebft<\/p>\n

2.1.1 Can thi\u1ec7p m\u1ea1ch v\u00e0nh qua da (PCI)<\/strong><\/p>\n

Can thi\u1ec7p m\u1ea1ch v\u00e0nh c\u1ea5p c\u1ee9u l\u00e0 chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c \u01b0u ti\u00ean trong nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p c\u00f3 ST ch\u00eanh l\u00ean, v\u1edbi \u01b0u th\u1ebf v\u01b0\u1ee3t tr\u1ed9i so v\u1edbi ti\u00eau s\u1ee3i huy\u1ebft do gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong, xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd, t\u00e1i nh\u1ed3i m\u00e1u\u2026<\/p>\n

Th\u1ee7 thu\u1eadt can thi\u1ec7p qua \u1ed1ng th\u00f4ng, lu\u1ed3n d\u00e2y d\u1eabn qua t\u1ed5n th\u01b0\u01a1ng (h\u1eb9p, t\u1eafc), r\u1ed3i \u0111\u01b0a b\u00f3ng v\u00e0\/ho\u1eb7c stent l\u00ean \u0111\u1ec3 nong r\u1ed9ng ch\u1ed7 h\u1eb9p\/t\u1eafc v\u00e0 \u0111\u1eb7t stent \u0111\u1ec3 l\u01b0u th\u00f4ng l\u00f2ng m\u1ea1ch.<\/p>\n

\"Endopr\u00f3tesis
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Endopr\u00f3tesis coronaria – Ngu\u1ed3n: Cigna Healthcare<\/strong><\/figcaption><\/figure>\n
\"Ngu\u1ed3n:
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Ngu\u1ed3n: Khuy\u1ebfn c\u00e1o AHA\/ACC 2013<\/strong>\u2003<\/span><\/figcaption><\/figure>\n

C\u00e1c lo\u1ea1i stent<\/strong>
\n\u2022 Stent kh\u00f4ng ph\u1ee7 thu\u1ed1c (BMS)
\n\u2022 Stent ph\u1ee7 thu\u1ed1c (DES): \u0111\u01b0\u1ee3c ph\u1ee7 c\u00e1c lo\u1ea1i thu\u1ed1c l\u00ean tr\u00ean b\u1ec1 m\u1eb7t c\u1ee7a khung kim lo\u1ea1i \u0111\u1ec3 ng\u0103n ch\u1eb7n s\u1ef1 t\u0103ng sinh qu\u00e1 m\u1ee9c l\u1edbp n\u1ed9i m\u1ea1c m\u1ea1ch m\u00e1u nh\u1eb1m gi\u1ea3m nguy c\u01a1 t\u00e1i h\u1eb9p trong stent.
\n\u2022 Stent ho\u1ea1t h\u00f3a ph\u00f3ng x\u1ea1 ho\u1eb7c li\u1ec7u ph\u00e1p \u0111\u01b0a ch\u1ea5t ph\u00f3ng x\u1ea1 v\u00e0o l\u00f2ng m\u1ea1ch v\u00e0nh tr\u01b0\u1edbc khi \u0111\u1eb7t stent ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh hi\u1ec7u qu\u1ea3 trong vi\u1ec7c gi\u1ea3m t\u1ef7 l\u1ec7 t\u00e1i h\u1eb9p trong stent.
\n\u2022 Stents t\u1ef1 ti\u00eau sinh h\u1ecdc: \u0111ang \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n, nh\u01b0ng vi\u1ec7c s\u1eed d\u1ee5ng hi\u1ec7n ch\u1ec9 gi\u1edbi h\u1ea1n trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng.<\/p>\n

\"Ngu\u1ed3n:
Ngu\u1ed3n: Timmachhoc. vn<\/figcaption><\/figure>\n

2.2 Li\u1ec7u ph\u00e1p ti\u00eau s\u1ee3i huy\u1ebft<\/strong><\/p>\n

\u2022 L\u00e0m v\u1ee1 c\u1ee5c m\u00e1u \u0111\u00f4ng gi\u00fap t\u00e1i th\u00f4ng m\u1ea1ch tr\u1edf l\u1ea1i
\n\u2022 L\u00e0 li\u1ec7u ph\u00e1p t\u00e1i t\u01b0\u1edbi m\u00e1u quan tr\u1ecdng trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng th\u1ec3 th\u1ef1c hi\u1ec7n PCI trong th\u1eddi gian h\u1ea1n \u0111\u1ecbnh
\n\u2022 \u0110em l\u1ea1i hi\u1ec7u qu\u1ea3 cho 50 – 70% c\u00e1c b\u1ec7nh nh\u00e2n STEMI trong v\u00f2ng 4 – 6 gi\u1edd \u0111\u1ea7u t\u1eeb khi xu\u1ea5t hi\u1ec7n tri\u1ec7u ch\u1ee9ng \u0111au ng\u1ef1c; gi\u00fap l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i, suy tim sau nh\u1ed3i m\u00e1u, s\u1ed1c tim, v\u00e0 r\u1ed1i lo\u1ea1n nh\u1ecbp tim.
\n\u2022 Trong v\u00f2ng 2 – 24 gi\u1edd sau khi ti\u00eau s\u1ee3i huy\u1ebft th\u00e0nh c\u00f4ng, ng\u01b0\u1eddi b\u1ec7nh v\u1eabn c\u1ea7n \u0111\u01b0\u1ee3c ch\u1ee5p l\u1ea1i \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, \u0111\u00e1nh gi\u00e1 l\u1ea1i t\u1ed5n th\u01b0\u01a1ng th\u1ee7 ph\u1ea1m v\u00e0 \u0111\u1eb7t stent gi\u1ea3i quy\u1ebft t\u00ecnh tr\u1ea1ng h\u1eb9p m\u1ea1ch v\u00e0nh n\u1ebfu c\u1ea7n thi\u1ebft
\n\u2022 L\u1ee3i \u00edch c\u1ee7a \u0111i\u1ec1u tr\u1ecb \u0111\u1ea1t t\u1ed1i \u0111a khi s\u1eed d\u1ee5ng s\u1edbm.
\n\u2022 C\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ee9ng minh thu\u1ed1c ch\u1ec9 c\u00f3 \u00edch khi s\u1eed d\u1ee5ng tr\u01b0\u1edbc 12h, v\u00e0 t\u1ed1t nh\u1ea5t d\u01b0\u1edbi 3h \u0111\u1ea7u.<\/p>\n

\"Ngu\u1ed3n:
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Ngu\u1ed3n: Timmachhoc. vn<\/strong><\/figcaption><\/figure>\n

\u2022 Ch\u1ea3y m\u00e1u: T\u1ef7 l\u1ec7 g\u1eb7p kho\u1ea3ng 10%, h\u1ea7u h\u1ebft l\u00e0 ch\u1ea3y m\u00e1u nh\u1eb9, t\u1ea1i v\u1ecb tr\u00ed ch\u1ecdc m\u1ea1ch
\n\u2022 T\u1ee5t huy\u1ebft \u00e1p trong khi truy\u1ec1n streptokinase kh\u00e1 th\u01b0\u1eddng g\u1eb7p
\n\u2022 Ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng: Ch\u1ee7 y\u1ebfu g\u1eb7p v\u1edbi thu\u1ed1c streptokinase
\n\u2022 Xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd g\u1eb7p \u1edf 0,3% b\u1ec7nh \u0111i\u1ec1u tr\u1ecb v\u1edbi Streptokinase v\u00e0 0,6% \u1edf b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb v\u1edbi rt-PA.
\n\u2022 R\u1ed1i lo\u1ea1n nh\u1ecbp sau t\u00e1i t\u01b0\u1edbi m\u00e1u: H\u1ea7u h\u1ebft l\u00e0 t\u1ea1m th\u1eddi, t\u1ef1 h\u1ebft, do t\u00e1i t\u01b0\u1edbi m\u00e1u.
\n\u2022 T\u1eafc m\u1ea1ch h\u1ec7 th\u1ed1ng do ly gi\u1ea3i huy\u1ebft kh\u1ed1i t\u1eeb nh\u0129 tr\u00e1i, th\u1ea5t tr\u00e1i ho\u1eb7c ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.<\/p>\n

3. \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa<\/h2>\n

3.1 N\u1ed9i khoa c\u1ea5p c\u1ee9u.<\/strong><\/p>\n

\u2022 Li\u1ec7u ph\u00e1p ch\u1ed1ng ng\u01b0ng t\u1eadp ti\u1ec3u c\u1ea7u
\n\u2022 Li\u1ec7u ph\u00e1p ch\u1ed1ng \u0111\u00f4ng
\n\u2022 Oxy
\n\u2022 Gi\u1ea3m \u0111au: Nitroglycerin, Morphine\u2026
\n\u2022 \u0110i\u1ec1u tr\u1ecb kh\u00e1c: ch\u1eb9n beta, ACEIs\/ARBs, MRA, Statin c\u01b0\u1eddng \u0111\u1ed9 cao\u2026<\/p>\n

3.2 Li\u1ec7u ph\u00e1p ch\u1ed1ng ng\u01b0ng t\u1eadp ti\u1ec3u c\u1ea7u<\/strong><\/p>\n

3.2.1 B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c PCI<\/strong><\/p>\n

DAPT_Kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p (aspirin + ch\u1ea5t \u1ee9c ch\u1ebf P2Y12)
\n\u2022 D\u00f9ng tr\u01b0\u1edbc ho\u1eb7c ngay l\u00fac can thi\u1ec7p
\n\u2022 Duy tr\u00ec tr\u00ean 12 th\u00e1ng t\u00f9y thu\u1ed9c v\u00e0o t\u1eebng c\u00e1 th\u1ec3<\/p>\n\n\n\n\n\n\n\n
Li\u1ec1u kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u trong can thi\u1ec7p th\u00ec \u0111\u1ea7u<\/strong><\/td>\n<\/tr>\n
Aspirin<\/td>\nLi\u1ec1u n\u1ea1p 150 – 300 mg \u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c 75 – 250 mg \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch<\/p>\n

n\u1ebfu ko c\u00f3 kh\u1ea3 n\u0103ng nu\u1ed1t, sau \u0111\u00f3 duy tr\u00ec li\u1ec1u 75 – 100 mg\/24h<\/td>\n<\/tr>\n

Clopidogrel<\/td>\nLi\u1ec1u n\u1ea1p 600 mg \u0111\u01b0\u1eddng u\u1ed1ng, sau \u0111\u00f3 duy tr\u00ec 75 mg\/24h<\/td>\n<\/tr>\n
Prasugrel<\/td>\nLi\u1ec1u n\u1ea1p 60 mg \u0111\u01b0\u1eddng u\u1ed1ng, sau \u0111\u00f3 duy tr\u00ec li\u1ec1u 10 mg\/24h.<\/p>\n

Bn c\u00e2n n\u1eb7ng \u2264 60 kg, li\u1ec1u duy tr\u00ec l\u00e0 5 mg\/24h.<\/p>\n

Prasugrel ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u1edf b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed \u0111\u1ed9t qu\u1ef5. \u1ede b\u1ec7nh nh\u00e2n\u2265 75 tu\u1ed5i, Prasugrel nh\u00ecn chung kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o, nh\u01b0ng v\u1edbi li\u1ec1u5 mg\/24h duy tr\u00ec c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng n\u1ebfu c\u1ea7n thi\u1ebft.<\/td>\n<\/tr>\n

Ticagrelor<\/td>\nLi\u1ec1u n\u1ea1p 180 mg \u0111\u01b0\u1eddng u\u1ed1ng, li\u1ec1u duy tr\u00ec 90 mg x 2 l\u1ea7n\/24h<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
\"Ngu\u1ed3n:
Ngu\u1ed3n: Timmachhoc. vn<\/strong><\/figcaption><\/figure>\n

\u2022 S\u1eed d\u1ee5ng Heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng th\u01b0\u1eddng quy
\n\u2022 C\u00e2n nh\u1eafc s\u1eed d\u1ee5ng enoxaparin th\u01b0\u1eddng quy<\/p>\n

3.2.2 BN kh\u00f4ng \u0111\u01b0\u1ee3c PCI<\/strong><\/p>\n\n\n\n\n\n\n
Li\u1ec1u ch\u1ed1ng \u0111\u00f4ng \u1edf bn kh\u00f4ng \u0111\u01b0\u1ee3c PCI<\/strong><\/td>\n<\/tr>\n
Enoxaparin<\/td>\n–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 < 75 tu\u1ed5i: N\u1ea1p 30mg t\u0129nh m\u1ea1ch sau 15 ph\u00fat s\u1eed d\u1ee5ng li\u1ec1u 1mg\/kg TDD\u00a0 m\u1ed7i 12h \u0111\u1ebfn khi t\u00e1i th\u00f4ng ho\u1eb7c \u0111\u1ebfn khi ra vi\u1ec7n cho t\u1ed1i \u0111a 8 ng\u00e0y. 2 li\u1ec1u\u00a0 TDD \u0111\u1ea7u ti\u00ean kh\u00f4ng n\u00ean v\u01b0\u1ee3t qu\u00e1 100 mg m\u1ed7i l\u1ea7n ti\u00eam.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u226575 tu\u1ed5i : Kh\u00f4ng d\u00f9ng li\u1ec1u bolus t\u0129nh m\u1ea1ch, b\u1eaft \u0111\u1ea7u v\u1edbi li\u1ec1u TDD \u0111\u1ea7u<\/p>\n

ti\u00ean 0,75 mg\/kg v\u1edbi li\u1ec1u t\u1ed1i \u0111a kh\u00f4ng qu\u00e1 75 mg cho 2 l\u1ea7n TDD \u0111\u1ea7u ti\u00ean.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Khi v\u1edbi eGFR < 30 mL\/min\/1,73m2, b\u1ea5t k\u1ec3 tu\u1ed5i, li\u1ec1u TDD da 1 l\u1ea7n\/24h.<\/td>\n<\/tr>\n

UFH<\/td>\nLi\u1ec1u n\u1ea1p 60 UI\/kg t\u0129nh m\u1ea1ch (li\u1ec1u t\u1ed1i \u0111a 4000 IU) sau \u0111\u00f3 truy\u1ec1n t\u0129nh m\u1ea1ch\u00a0 v\u1edbi li\u1ec1u 12 UI\/kg (t\u1ed1i \u0111a 1000 IU\/h) cho 24 – 48h. M\u1ee5c ti\u00eau aPTT: 50 – 70s\u00a0 ho\u1eb7c 1,5 – 2 l\u1ea7n theo d\u00f5i t\u1ea1i th\u1eddi \u0111i\u1ec3m 3, 6, 12 v\u00e0 24h.<\/td>\n<\/tr>\n
Fondaparinux<\/td>\nLi\u1ec1u 2,5 mg t\u0129nh m\u1ea1ch sau \u0111\u00f3 li\u1ec1u TDD 2,5 mg x 1 l\u1ea7n\/24h cho \u0111\u1ebfn 8<\/p>\n

ng\u00e0y ho\u1eb7c \u0111\u1ebfn khi ra vi\u1ec7n.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Li\u1ec7u ph\u00e1p Oxy<\/strong>
\n\u2022 Th\u1edf oxy n\u1ebfu c\u00f3 t\u00ecnh tr\u1ea1ng gi\u1ea3m \u0111\u1ed9 b\u00e3o h\u00f2a oxy m\u00e1u (SaO2 < 90% ho\u1eb7cPaO2 < 60 mmHg)
\n\u2022 Kh\u00f4ng ch\u1ec9 \u0111\u1ecbnh th\u1edf oxy th\u01b0\u1eddng quy khi SpO2 > 90%.<\/p>\n

Gi\u1ea3m \u0111au<\/strong>
\n\u2666 Nitroglycerin: 0,4 mg ng\u1eadm d\u01b0\u1edbi l\u01b0\u1ee1i ho\u1eb7c 5 \u2013 10 \u00b5g\/ph\u00fat IV. C\u00f3 th\u1ec3 l\u1eb7p l\u1ea1i li\u1ec1u tr\u00ean sau 5 ph\u00fat n\u1ebfu v\u1eabn ch\u01b0a ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c \u0111au ng\u1ef1c.<\/p>\n

\u2666 Morphin \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch n\u1ebfu c\u00f2n \u0111au ng\u1ef1c nhi\u1ec1u. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi nitrate:
\n\u2022 Huy\u1ebft \u00e1p t\u00e2m thu < 90 mmHg
\n\u2022 Nh\u1ed3i m\u00e1u th\u1ea5t ph\u1ea3i
\n\u2022 C\u00f3 s\u1eed d\u1ee5ng nh\u00f3m \u1ee9c ch\u1ebf phosphodiesterase trong v\u00f2ng 24 gi\u1edd qua.<\/p>\n

4. \u0110i\u1ec1u tr\u1ecb kh\u00e1c<\/strong><\/h2>\n

4.1 Ch\u1eb9n beta<\/strong><\/p>\n

S\u1eed d\u1ee5ng s\u1edbm ch\u1eb9n beta:<\/strong>
\n\u2022 Ch\u1eb9n beta s\u1eed d\u1ee5ng s\u1edbm trong 24h \u0111\u1ea7u b\u1eb1ng \u0111\u01b0\u1eddng u\u1ed1ng cho t\u1ea5t c\u1ea3 b\u00eanh nh\u00e2n NMCT n\u1ebfu kh\u00f4ng c\u00f3 m\u1ed9t trong c\u00e1c d\u1ea5u hi\u1ec7u sau:
\n(1) Suy tim b\u1eb1ng ch\u1ee9ng c\u1ee7a gi\u1ea3m cung l\u01b0\u1ee3ng tim
\n(2) T\u0103ng nguy c\u01a1 b\u1ecb cho\u00e1ng tim
\n(3) Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh t\u01b0\u01a1ng \u0111\u1ed1i kh\u00e1c c\u1ee7a ch\u1eb9n beta giao c\u1ea3m<\/p>\n

4.2 Statin c\u01b0\u1eddng \u0111\u1ed9 cao<\/strong><\/p>\n