{"id":280,"date":"2021-01-08T08:30:47","date_gmt":"2021-01-08T01:30:47","guid":{"rendered":"https:\/\/cdha.edu.vn\/cdha\/?p=280"},"modified":"2021-01-09T22:59:42","modified_gmt":"2021-01-09T15:59:42","slug":"cap-nhat-chan-doan-va-dieu-tri-benh-ly-dong-mach-canh-2021","status":"publish","type":"post","link":"https:\/\/cdha.edu.vn\/cdha\/cap-nhat-chan-doan-va-dieu-tri-benh-ly-dong-mach-canh-2021\/","title":{"rendered":"C\u1eadp nh\u1eadt ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh 2021"},"content":{"rendered":"\n<p style=\"text-align: justify;\"><iframe loading=\"lazy\" src=\"\/\/www.youtube.com\/embed\/nY8FLDdaR-E\" width=\"560\" height=\"314\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p style=\"text-align: justify;\">N\u1ed9i dung ch\u00ednh trong b\u00e0i:<\/p>\n<ol>\n<li style=\"text-align: justify;\">H\u1eb9p \u0110M c\u1ea3nh trong l\u00e0 c\u0103n nguy\u00ean c\u1ee7a 10-15% tai bi\u1ebfn m\u1ea1ch m\u00e1u n\u00e3o.<\/li>\n<li style=\"text-align: justify;\">10% b\u1ec7nh \u0110MV c\u00f3 k\u00e8m theo b\u1ec7nh l\u00fd \u0110MC, 20% h\u1eb9p \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi c\u00f3 k\u00e8m theo h\u1eb9p \u0110MC.<\/li>\n<li style=\"text-align: justify;\">C\u00f3 n\u00ean s\u00e0ng l\u1ecdc th\u01b0\u1eddng quy h\u1eb9p \u0110MC?\n<ol>\n<li>Kh\u00f4ng s\u00e0ng l\u1ecdc th\u01b0\u1eddng quy \u1edf t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n<\/li>\n<li>N\u00ean s\u00e0ng l\u1ecdc nh\u00f3m c\u00f3 nguy c\u01a1 cao, t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u ph\u1ed1i h\u1ee3p.<\/li>\n<\/ol>\n<\/li>\n<li style=\"text-align: justify;\">H\u1eb9p \u0110MC kh\u00f4ng tri\u1ec7u ch\u1ee9ng:\n<ol>\n<li>H\u1eb9p &gt; 50% \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh<\/li>\n<li>Kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng c\u1ee7a TBMMN\/ TBMMN tho\u00e1ng qua (TIA) c\u00f9ng b\u00ean<\/li>\n<li>H\u1eb9p \u0110MC kh\u00f4ng g\u00e2y ch\u00f3ng m\u1eb7t, v\u00e1ng \u0111\u1ea7u, th\u1ec9u (?) &#8211;&gt; kh\u00f4ng d\u1ef1a v\u00e0o c\u00e1c tri\u1ec7u ch\u1ee9ng n\u00e0y \u0111\u1ec3 n\u00f3i b\u1ec7nh nh\u00e2n c\u00f3 h\u1eb9p \u0110MC<\/li>\n<\/ol>\n<\/li>\n<li style=\"text-align: justify;\">H\u1eb9p \u0110MC kh\u00f4ng tri\u1ec7u ch\u1ee9ng c\u00f3 nguy c\u01a1 cao:\n<ol>\n<li>M\u1ea3ng x\u01a1 v\u1eefa k\u00edch th\u01b0\u1edbc l\u1edbn<\/li>\n<li>H\u1eb9p ti\u1ebfn tri\u1ec3n &gt; 20%\/ n\u0103m.<\/li>\n<li>Lo\u00e9t \u0110MC (N\u1ebfu c\u00f3 t\u1eeb 3 m\u1ea3ng x\u01a1 v\u1eefa lo\u00e9t th\u00ec t\u1ef7 l\u1ec7 TBMMN 18% so v\u1edbi 2% n\u1ebfu kh\u00f4ng c\u00f3 lo\u00e9t)<\/li>\n<li>Kh\u1ed1i echo tr\u1ed1ng tr\u00ean si\u00eau \u00e2m<\/li>\n<li>Gi\u1ea3m d\u1ef1 tr\u1eef t\u01b0\u1edbi m\u00e1u n\u00e3o (MRI)<\/li>\n<li>MRI \u0110MC: xu\u1ea5t huy\u1ebft trong l\u00f5i x\u01a1 v\u1eefa<\/li>\n<\/ol>\n<\/li>\n<li style=\"text-align: justify;\">Si\u00eau \u00e2m n\u1ed9i m\u1ea1ch (IVUS) c\u00f3 t\u01b0\u01a1ng quan v\u1edbi GPB nh\u01b0ng ch\u01b0a c\u00f3 \u0111\u1ed3ng thu\u1eadn \u0111\u1ec3 \u1ee9ng d\u1ee5ng.<\/li>\n<li style=\"text-align: justify;\">Ch\u1ec9 \u0111\u1ecbnh t\u00e1i t\u01b0\u1edbi m\u00e1u \u1edf h\u1eb9p \u0110MC kh\u00f4ng tri\u1ec7u ch\u1ee9ng:\n<ol>\n<li>H\u1eb9p &gt; 60% \u0110MC<\/li>\n<li>Gi\u1ea3i ph\u1eabu ph\u00f9 h\u1ee3p<\/li>\n<li>Nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 cao (xem \u1edf tr\u00ean)<\/li>\n<li>K\u1ef3 v\u1ecdng s\u1ed1ng &gt; 5 n\u0103m.<\/li>\n<\/ol>\n<\/li>\n<li style=\"text-align: justify;\">Kh\u00f4ng qu\u00ean \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa:\n<ol>\n<li>Ki\u1ec3m so\u00e1t lipid m\u00e1u LDL-C &lt; 1.8 mmol\/ L<\/li>\n<li>Kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u: aspirin li\u1ec1u th\u1ea5p 75-100mg\/ ng\u00e0y.<\/li>\n<li>Ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p, \u0111\u01b0\u1eddng m\u00e1u, b\u1ecf thu\u1ed1c l\u00e1, thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng, gi\u1ea3m c\u00e2n&#8230;<\/li>\n<\/ol>\n<\/li>\n<li style=\"text-align: justify;\">KH\u00d4NG t\u00e1i th\u00f4ng d\u1ef1 ph\u00f2ng \u1edf bn h\u1eb9p \u0110MC kh\u00f4ng tri\u1ec7u ch\u1ee9ng \u1edf c\u00e1c bn c\u00f3 ph\u1eabu thu\u1eadt c\u1ea7u n\u1ed1i \u0110MV.<\/li>\n<li style=\"text-align: justify;\">\u0110\u1ed1i v\u1edbi h\u1eb9p \u0110MC c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng (\u0111\u1ed9t qu\u1ef5\/ TIA trong 6 th\u00e1ng g\u1ea7n \u0111\u00e2y):\n<ol>\n<li>H\u1eb9p &lt; 50%: \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa<\/li>\n<li>H\u1eb9p 50 &#8211; 69%:\n<ul>\n<li>Ph\u1eabu thu\u1eadt b\u00f3c t\u00e1ch n\u1ed9i m\u1ea1ch + \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa ho\u1eb7c<\/li>\n<li>Can thi\u1ec7p n\u1ed9i m\u1ea1ch + \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa.<\/li>\n<\/ul>\n<\/li>\n<li>H\u1eb9p 70-99%:\n<ul>\n<li>Ph\u1eabu thu\u1eadt b\u00f3c t\u00e1ch n\u1ed9i m\u1ea1ch + \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa<\/li>\n<li>Can thi\u1ec7p n\u1ed9i m\u1ea1ch + \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<\/li>\n<li style=\"text-align: justify;\">Kh\u00f4ng c\u00f2n ch\u1ec9 \u0111\u1ecbnh t\u00e1i t\u01b0\u1edbi m\u00e1u:\n<ol>\n<li>Nh\u00ecn th\u1ea5y huy\u1ebft kh\u1ed1i \u0110MC, cho d\u00f9 c\u00f3 b\u00edt ho\u00e0n to\u00e0n l\u00f2ng m\u1ea1ch hay kh\u00f4ng.<\/li>\n<li>T\u1eafc ho\u00e0n to\u00e0n \u0110MC<\/li>\n<li>H\u1eb9p g\u1ea7n t\u1eafc \u0110MC khi ch\u1ee5p DSA n\u1ebfu c\u00f3 1 trong 4 tr\u01b0\u1eddng h\u1ee3p:\n<ul>\n<li>\u0110MC ng\u1ea5m thu\u1ed1c mu\u1ed9n (sau 4-6s m\u1edbi ng\u1ea5m thu\u1ed1c \u0111o\u1ea1n xa)<\/li>\n<li>Ch\u1ee5p \u0110MC b\u00ean \u0111\u1ed1i di\u1ec7n ph\u00e1t hi\u1ec7n tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 n\u1ed9i s\u1ecd<\/li>\n<li>\u0110MC trong \u0111o\u1ea1n xa teo nh\u1ecf so v\u1edbi b\u00ean \u0111\u1ed1i di\u1ec7n<\/li>\n<li>\u0110MC trong \u0111o\u1ea1n xa teo nh\u1ecf so v\u1edbi \u0110MC ngo\u00e0i c\u00f9ng b\u00ean.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<\/li>\n<li style=\"text-align: justify;\">Th\u1eddi \u0111i\u1ec3m t\u00e1i th\u00f4ng \u0110MC:\n<ol>\n<li>Sau TIA\/ TBMMN nh\u1eb9: hi\u1ec7u qu\u1ea3 cao nh\u1ea5t trong v\u00f2ng 2 tu\u1ea7n sau bi\u1ebfn c\u1ed1 nh\u01b0ng kh\u00f4ng n\u00ean s\u1edbm h\u01a1n 48h \u0111\u1ea7u ti\u00ean sau bi\u1ebfn c\u1ed1.<\/li>\n<li>Sau TBMMN n\u1eb7ng: t\u1ed1t nh\u1ea5t t\u00e1i th\u00f4ng trong v\u00f2ng 6 tu\u1ea7n.<\/li>\n<li>Sau d\u00f9ng thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft: c\u00f3 th\u1ec3 t\u00e1i th\u00f4ng m\u1ed9t c\u00e1ch an to\u00e0n, nh\u01b0ng KH\u00d4NG t\u00e1i th\u00f4ng qu\u00e1 s\u1edbm trong v\u00f2ng 1 tu\u1ea7n -&gt; t\u0103ng nguy c\u01a1 t\u1eed cung<\/li>\n<\/ol>\n<\/li>\n<li style=\"text-align: justify;\">H\u00fat huy\u1ebft kh\u1ed1i \u0111\u01a1n thu\u1ea7n hi\u1ec7u qu\u1ea3 l\u00e2m s\u00e0ng kh\u00f4ng kh\u00e1c nhi\u1ec1u h\u00fat huy\u1ebft kh\u1ed1i \u0111\u01a1n thu\u1ea7n k\u00e8m \u0111\u1eb7t stent \u0110MC.<\/li>\n<li style=\"text-align: justify;\">N\u00ean th\u1ef1c hi\u1ec7n t\u00e1i th\u00f4ng \u0110MC \u1edf b\u1ec7nh nh\u00e2n h\u1eb9p 50-99% c\u00f3 tri\u1ec7u ch\u1ee9ng c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t, t\u1ed1t nh\u1ea5t l\u00e0 trong v\u00f2ng 14 ng\u00e0y k\u1ec3 t\u1eeb khi c\u00f3 tri\u1ec7u ch\u1ee9ng kh\u1edfi ph\u00e1t.<\/li>\n<li style=\"text-align: justify;\">Ph\u1eabu thu\u1eadt b\u00f3c t\u00e1ch n\u1ed9i m\u1ea1c \u0110MC (CEA) v\u00e0 \u0111\u1eb7t stent \u0110MC (CAS) hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng. Nh\u01b0ng CAS: t\u1ef7 l\u1ec7 tai bi\u1ebfn quanh th\u1ee7 thu\u1eadt cao h\u01a1n (do c\u00f3 th\u1ec3 l\u00e0m bong tr\u00f3c m\u1ea3ng x\u01a1 v\u1eefa), CEA: t\u1ef7 l\u1ec7 NMCT, li\u1ec7t th\u1ea7n kinh s\u1ecd cao h\u01a1n.<\/li>\n<li style=\"text-align: justify;\">Kh\u00f4ng n\u00ean ph\u1eabu thu\u1eadt\n<ol>\n<li>H\u1eb9p \u0110MC sau ph\u1eabu thu\u1eadt v\u00f9ng c\u1ed5<\/li>\n<li>H\u1eb9p \u0110MC sau x\u1ea1 tr\u1ecb<\/li>\n<li>T\u00e1i h\u1eb9p sau ph\u1eabu thu\u1eadt<\/li>\n<li>T\u1eafc ho\u00e0n to\u00e0n \u0110MC \u0111\u1ed1i b\u00ean<\/li>\n<li>TS NMCT\/ b\u1ec7nh \u0110MV<\/li>\n<li>Suy tim, b\u1ec7nh n\u1ed9i khoa n\u1eb7ng<\/li>\n<\/ol>\n<\/li>\n<li style=\"text-align: justify;\">Kh\u00f4ng n\u00ean can thi\u1ec7p:<br \/>\n<ol>\n<li>\u0110MC xo\u1eafn v\u1eb7n<\/li>\n<li>\u0110MC v\u00f4i h\u00f3a nhi\u1ec1u<\/li>\n<li>\u0110\u01b0\u1eddng v\u00e0o kh\u00f4ng thu\u1eadn l\u1ee3i<\/li>\n<li>D\u1ecb \u1ee9ng thu\u1ed1c c\u1ea3n quang.<\/li>\n<\/ol>\n<\/li>\n<li style=\"text-align: justify;\">Bi\u1ebfn ch\u1ee9ng:\n<ol>\n<li>T\u1eafc m\u1ea1ch n\u00e3o, TBMMN<\/li>\n<li>H\u1ed9i ch\u1ee9ng t\u0103ng t\u01b0\u1edbi m\u00e1u.<\/li>\n<li>NMCT, ph\u1ea3n \u1ee9ng ph\u1ebf v\u1ecb d\u1eabn \u0111\u1ebfn t\u1ee5t huy\u1ebft \u00e1p, nh\u1ecbp ch\u1eadm.<\/li>\n<li>T\u1eafc stent.<\/li>\n<\/ol>\n<\/li>\n<li style=\"text-align: justify;\">B\u1ec7nh nh\u00e2n h\u1eb9p \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh hai b\u00ean: Kh\u00f4ng can thi\u1ec7p m\u1ed9t th\u00ec.\n<ol>\n<li>T\u0103ng nguy c\u01a1 h\u1ed9i ch\u1ee9ng t\u00e1i t\u01b0\u1edbi m\u00e1u<\/li>\n<li>T\u0103ng nguy c\u01a1 c\u01b0\u1eddng ph\u1ebf v\u1ecb<\/li>\n<li>B\u1ec7nh th\u1eadn do thu\u1ed1c c\u1ea3n quang.<\/li>\n<\/ol>\n<\/li>\n<li style=\"text-align: justify;\">T\u00e1i t\u01b0\u1edbi m\u00e1u d\u1ef1 ph\u00f2ng: kh\u00f4ng ch\u1ec9 \u0111\u1ecbnh\n<ul>\n<li>C\u00e2n nh\u1eafc nguy c\u01a1 TBMMN v\u1edbi nguy c\u01a1 ch\u1ea3y m\u00e1u.<\/li>\n<\/ul>\n<\/li>\n<li style=\"text-align: justify;\">\u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa tr\u01b0\u1edbc th\u1ee7 thu\u1eadt:\n<ol>\n<li>Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng<\/li>\n<li>Kh\u00e1ng ti\u1ec3u c\u1ea7u k\u00e9p (kh\u00e1ng ti\u1ec3u c\u1ea7u k\u00e9p trong 1 th\u00e1ng sau \u0111\u00f3 kh\u00e1ng ti\u1ec3u c\u1ea7u \u0111\u01a1n)<\/li>\n<li>Ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p &lt; 140\/ 90 mmHg<\/li>\n<li>Statin.<\/li>\n<\/ol>\n<\/li>\n<li style=\"text-align: justify;\">Kh\u00e1ng ti\u1ec3u c\u1ea7u sau th\u1ee7 thu\u1eadt.<\/li>\n<li style=\"text-align: justify;\">Si\u00eau \u00e2m \u0111\u1ecbnh k\u1ef3 6-24 th\u00e1ng.<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>N\u1ed9i dung ch\u00ednh trong b\u00e0i: H\u1eb9p \u0110M c\u1ea3nh trong l\u00e0 c\u0103n nguy\u00ean c\u1ee7a 10-15% tai bi\u1ebfn m\u1ea1ch m\u00e1u n\u00e3o. 10% b\u1ec7nh \u0110MV c\u00f3 k\u00e8m theo<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[50,5],"tags":[44,51,52,43],"class_list":["post-280","post","type-post","status-publish","format-standard","hentry","category-mach-mau","category-sieu-am","tag-dong-mach-canh","tag-mach-mau","tag-mach-mau-ngoai-bien","tag-tam-diem-2020"],"_links":{"self":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/280","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/comments?post=280"}],"version-history":[{"count":13,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/280\/revisions"}],"predecessor-version":[{"id":296,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/280\/revisions\/296"}],"wp:attachment":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/media?parent=280"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/categories?post=280"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/tags?post=280"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}