Nghiên cứu đặc điểm lâm sàng, siêu âm doppler tim và siêu âm tim qua thực quản ở bệnh nhân rung nhĩ mạn tính không có bệnh van tim (tóm tắt)

 


 !
"#"$%
&&'(!)!*
+(,-.
/0
123455675189:;:<<=>1
?@A8BCDCE
0FGHI,
79:JCK
 !"##$%&%'() !*+,-#./0
1%2345"67!&
.8 9898:%'%;
<8 9898=;7!#
>?%'.&
>?%'<&
>?%'@&
=ABC-D !?>"E'$%F%G!H,*ABC!HI%'7I$%&
%'%;!JA("67!) !*+,-#./08
#"G%8888888888888%18888888888#K8888888888888C8888888888888888L,</.@
MN,%NA*ABC$%&
.8E%'AO!%6
<8E%'P./0
.
"#L"M
NO51>PQ;1:R;>STUV;7:
QARSQT*#O%*"$UI;HV!?W%-X,H
G?FEY%'7!!Z6![R34\-AK%>,!J!L![7!
!Z6+,R8'+Q!MAK![F]AULHI^*_1%

5?UQ8F]AUW?'+Q!M`*'aE"!6"[E#
N*$%3%!JVY[!C!F]AU5!MQ8"MbE%'!
cC!U!C!K\AOAK![d!,$!AK\5O%+KF]AUW?'
+Q*#EHYX!-X]A67E#*#,O%]A6+, !
%;!JAH%YA"eBI5f]A68
C!K\AOAK![ S)T  *+,-#g"6%N,
h9
< 
E#h
<
9
<
ih9!G,-AK%,JAK\bLAK\CIb
Aj%kl^bC%C"1b%Y-aF]AU"V!6%?%\,$!,CAm"
"C]A6bn^ilob?',$!,CAE#%2%e%'6 !-a
3pIj?%\NI+_AK![F]AUW?'+AR
,$q5!M?'E6%,SQr(T8C!-O-%;A
+,"II*g%,C%C5q!2!E#!J!LRC%!: !
!J,%!ME6%s"%;* F]AUW?'+Q8V!
?%'b-%;A+,%,]A6X!]A>S9tT,6*#I[%']A6
7NIC%'AK\5O%%NARC%ST8AK%;b9t
*#,FZAB?Cc+,BIE#5N !-a3p,F!C!
Fm%-%;A+,%,#X!WH!>!C!![-WK\8BK;b
E%'!cC!U !!C!)d!,$!AK\5O%*+,-#E#!C!
-O-%;A+,%,#X!N%;* AK![d!,$!
AK\5O%W?'+Qr(E#,O%*%;]A6%e6!u
E2%9t*#X!-XeAq!8v%'6,b!6!M!C!%;!JA
#"EY!C!)F]AUW?'+Qr(wEEBKE%'!,
<
%NAEHY#K!Mq1%-Xb5"67!E#%uIq!!"!C!_K

AO!"X!#*+,-#8
CNW561XT>STUV;7:
`*'?'+Qr(#K!#LbE%'!cC!U
AK  ![  F  ]AU  W  !C!  ?'  +  #K    ]A6  6  %N,
h9
<
bh
<
9
<
ih9!E#!C!-O-%;A+,%,]A6#
X!6KW!C!![-W5Z%YA5%'9t]A>%uI!"!C!
_KAO!*+,-#!M![-W-a3pAO!!O!M%'A]A>
NIsx6!C!?%\!Od!,$!AK\5O%Sr(T8
KNY>;:42561:45>Z2
iC%CV!%N,*+,-#b!C!K\AOAK![g"6
%N,h9
<
bh
<
9
<
ih9!E#!C!-O-%;A+,"II*g
%,W?'+AR,$q5!M?'E6%,8
iyC!U,O%*%;]A6%e6!C!K\AOAK![g"6
%N,h9
<
bh
<
9

<
ih9!b,F-O-O-%;A+,"II*g
%,E2%AK\5O%E#+,!AFX%;RC%b%NARC%E#F
]AU8
ENP2;[\>]2^5_5
=ABCG,.<o6S!65NIp*p!E##%*%'A6,
5>"TE2%o![!q&VEHY&/<6b![.ij
]A6&@^6b![<iO% E#I[ICI%;!JA&
.^6b![@i(\]A>%;!JA&@^6b![oi#
*AB&@o6b(\*ABE#5%\U&/@68=ABC!Moo?>b
<n?%NAGb.0EDb.^l#%*%'A6,5>""M!M.0#%*%'A
%\%'b.@n#%*%'A%\hE#/@#%*%'A%\CI8
@
`
a!
NN"=:>bc56dV[25651X
NNN"e51561XT[25651X
Q*#O%*"$UI6;HV!?W%-X"$M6
z*"$b5G?F!Z6![R34\-AK%>,!J!L![
7!!Z6R8;%'+,Gb>-M !6K\?{
!C!-MQS|T_-O6So//in//UI}IuT8C!-M#KH
63$EY3$b?%;FE#1%%6b5~,g"CIJH
5YA8
1.1.4.3. Cơ chế hình thành và duy trì rung nhĩ
9X #Q!_!M  E#
EY%>%I4AE#!J!L%'7!!Z6![RI•
 I!"E%'!#E#3AKQ8M<![!\!q!Z6Q&
AK\EsE#"*$%E#jICUI"$%EU8
NNBN_>3R2;A5623>cU9;f2eghi5151j5[25651X
Bảng 1.2. Thang điểm CHADS

2
và CHA
2
DS
2
-VASc
Yếu tố nguy cơ lâm sàng CHADS
2
CHA
2
DS
2
-VASc
9AK%,JAK\S"g-%Egg6€6%*AgT
LAK\CISKIgg-%"T
Aj%kl^SgT
C%C"1S%6?gg-rg**%A-T
%Y-aF]AUS"5gT
',$!,CAS6-!A*63%-g6-gT
Aj%kn^SgT
%2%eSgcT
.
.
.
.
<
.
.
<
.

<
.
.
.
j!F n •
o
Cơ chế gây đột quị của các yếu tố nguy cơ ở bệnh nhân rung nhĩ
i9AK%,JAK\*#,LCV!"RC%?W%]AC>%
CI*X!b3"M*#,%mRC%E#c["C8
iLAK\CIShT34\%mRC%E#JAK\R
C%A%6]A6O%*"$!J!LHC%+,[8
iAj%%#*#,-X%>,!"G%E#EBO!3s!>K+K
JAK\8
iC%C"1ST!MN*#,c["CRC%[X
E2%+,H8
NNDN":V2;[e[25651X:?6"G,&
i(%N,-"C_-OH8
iAKNQEYUIc"6E#3AKUIc"6
iXIs?%\!Jr(8
 !"##$
NCNCN:42j<kQQ]l[;:<;175156m>U_516:_51X;[_:
i15qRC%2!-6A !"?W%-%;A+,ri,"3g8
i"Nq!RC%?{I[ICI9%,I-"-a6j%8
NCNKN:42j<;:<f2T;1m>f2n5
1.2.3.3. Đánh giá hình thái và chức năng tiểu nhĩ trái
oHình thái%> !%BW!>,V!d6]A6
p!dWCKE#,V!d37!]A6<?AGHC%‚RC%"
qE#"8%'q! !"?{.1?d_Ax`!Z6
!+!C!R,$!Ij%;C%37!g""#?F?1F%+,,$!8
+ Chức năng% !C%C?W%EBO!3s!>K?{-%;A

+,"II*g8
v?'+Qb3s!>K1 !]A6-C
32%3$!C!-ML!63[E#+,b6Kj%EY?%;F
^
E#5YA8BO!3s!>KA?!MƒR6-%*ƒ
7!*2[EBO!`8"EBK;qEBO!A?"
%YA!A5„%,8
NKNp511p51561:45>Z2>_>3R2;A5623>cU9;f2eghi51
51j5[25651Xq1r56>shi51dT5;:<
NKNNp511p51561:45>Z25bt>56k7:
…6?6*"%%6rE#!F-X!"HKtRC%bO!F
3s!>K"E#j[yr!Z;9t*#!C!
)F!*BIEY?%\!Jr(W?'+Qr(89A
)E#!F-Xm!"HK?'+Q?UF]AU!MAj%b!M%Y-a
hE#!6"[!6"[M,!J!MƒR6O5;SI
†/b/.T8%;!JA!Z666(;^.^?'+Qr(
!"HKFV!Z6tRC%bb%>,O!F3s!>K
E#FV!Z6j[F,$!!Z;9t!M[
]A6‡'E2%FL3_!Z66%N,h9
<
 !MƒR6
O5;8hK%6*69E#!F-XmX!%'9t@@o?'+
Qr(mIC%'AK\5O%RC%bW^<?'+
S.^bnˆT8%N,h9
<
!#!6"b!`-ONq!RC%LbI+
-AHO,CAHC%HI*#!C!K\AO%;* !MƒR6!Z6-X
#AK\5O%RC%b8P%**g-E#!F-X!"HKE2%
%N, h9
< 

E# h
<
9
<
ih9! k<  !M  %C  U %;* !C!
)!Z69t8
NKNCNp511p51561:45>Z2;[k565bt>
+Ghm%;!JA; <?'+‰I5q
E66%*C3"HI?{-%;A+,%,#X!E#9t!"HKb
Q+KAK\5O%!6"HI^bn*_-"E2%UIc"6w3%'q!R
C%k@/!,
<
bEBO!3s!>KŠ</!,}-E#tRC%*#
!C!K\AO*#,LAK![AK\5O%W?'+‰I5qE66%
n
*C3"HI8$,AK;9[E#!F-Xm%;!JAyr!Z
X!?{9tE#BHKW1%?U?',$!E#1
5qrLb*2IF%,$!E#,>yr3#K[E#_-AH
!Z6,>yr"#!`VI%YA[8AK‹J!>%m
%;!JA$yr?{9tmBHK!C!,>
yr"#!`W!C!EUq!Z6F,$!!ZX!!M%CU3X
?C"G%,CAm"E#G%,CA![%,!6"8
`C
"u&`&H&
CNN"A:;bv56561:45>Z2
.n@O% G,.<l?'+Qr(E#@n1%
M,!J!MAj%E#%2%[[$%%'%,,$!b'
E%'ŒA+F%./0xC0}</./\Co}</.<8
CNNN1s<hi51
G,.<l?'+S6,•lbe@/TAj%A?n^b0•

./b/ !!Ž"CcC!UQr(bXAK'6,%6
%;!JA8
CNNNN:42>12w5>1x5hi51
iH!>!C!?'+ !!Ž"CQr(8
iQ !C%Cg"%;A!AŽ!Z61,%,,$!
"6  („b  F%  %,  ,$!  "6  („b  F%  %,  ,$!  +A  tA
h}hh}•9<//n?{%'%,GE#1%%6?UQk.L,8
CNNNCN:42>12w5]k=:;[y
iM?'E6%,&‰IbWE66%*CbE6F,$!!ZbE6
6%*C+$"b%,?Ž,-% !cC!U?W%-%;A+,"II*g%,8
iAGRbUI6R8
i%Y-acAHAK\m"8
l
iM?'*ƒ!O!`U9tSAX!]A>b%mrX!
]A>•T8
CNNCN1s<>1Z56
@n1%?1bAj%A?b%2%[cJE2%
M,?'8
CNNCNN:42>12w5]mT>1x5
(!M%Y-a!C!?'%,,$!bF%%\b!AKNM6b6%
?%\,$!,CAm"E#XAK'6,%6%;!JA8
CNNCNCN:42>12w5]k=:;[y
i%Y-aQb?'E6%,brrb-AK%,bhbb
?',$!,CA8
i9%;A+,"II*g%,&!M!C!?'*ƒE6%,bWE66%*C*2
["V!?{F<}ob?'![%,b?'F,$!!Zb?'%,
?Ž,-%8
CNCN&1bc56Q1_Q561:45>Z2
CNCNN1:R;qR561:45>Z2
%;!JA%\!JA!d6!M-"-CO%!J8

CNCNCN_>hbt>;:R51751
2.2.2.1. Khám lâm sàng và cận lâm sàng
H!>!C!O% %;!JA !L,5C,*+,-#b
%%'+,Gbc‘%',,CAb!pIy]A6%,iIj%b*#,-%;A
+,"II*g%, ]A6 #X!b9tE#  !%E#"G -[
%;!JAg",4AOH8
2.2.2.2. Tiêu chuẩn xác định các yếu tố nguy cơ
’LAK\CI&3X6E#"%;A!AŽ!Z6)E#F%
h\%2%L,<//@8
0
’Ž"C-AK%,JAK\&g"%;A!AŽ!Ž"C!Z6
€6,%6,8Ž"C-AK%,JAK\5%!MG1%qH*#<
%;A!AŽ!q"V!.%;A!AŽ!q!•E2%<%;A!AŽIp8
’Ž"CC%C"1&g"%;A!AŽ!Ž"C!Z6
%'IF%C%C"1"65„hh<//n8
’  QO%  *"$  *%I%3  ,CA&  g"  %;A  !AŽ  !Ž  "C  !Z6
P}9L,.•••8
’  %'  AO! *C&  g"  ) .••nb  5%  u; ^
%\A}#K"1%%6*%;p!;<L,8
’‘"I&3X6g"%;A!AŽ!Ž"C!Z6)
 !F%6,<//@!`*ƒ8AC!+5%<@ŠrŠ
@/b?‘"I5%r“@/8
’%Y-aF]AUE#%\A,CAm""C]A6&3X6E#"56%
C!%Y-a8
’',$!,CA&G,%Y-aG%,CA![%,b?'F
,$!"$%E%E#,>Ee6IJ!$IF,$!!Z8
’q%N,h9
<
E#h
<

9
<
ih9!g"234
*+,-#h}hh}•9<//nE#•9</./8
2.2.2.4. Siêu âm - Doppler tim thành ngực
* Địa điểm: Làm tại phòng siêu âm của Khoa Nội Tim mạch,
Viện Tim mạch, Bệnh viện TWQĐ 108.
* Phương tiện: Chúng tôi sử dụng hệ thống siêu âm - Doppler
màu VIVID 7 của hãng GE HEALTH CARE (Mỹ) 2008 với đầu
dò sector đa tần 2,5 - 4 MHz.
* Các chỉ số đo đạc và tính toán trên siêu âm: theo Hội siêu
âm tim Hoa kỳ8
”"5q!2!37!!Z6RC%S=h
<
TW,V!do?AG
%,
•
”"Nq!RC%&g"I[ICI9%,I-"-a6j%8
”q=hb=h•€b`-O=•€}=hx!C!5\]A>"8
2.2.2.5. Siêu âm tim qua thực quản (SÂTQ)
&  '()  *%,CK -%;A  +,  "II*g  ,#A=9E2%  _A  3s
9t6,V!d_-O^r•$%("6Ž"C!J!Lb?'
E%'P./08
&+,-(.//
&'"0123/$45//&g"%;A!AŽ!Z6€65%E#
!F-X8
&/06781//S!,}-T8
’ '"09()4:;)0#<1%g"I+*"$%!Z6
€6•%"8
CNKNz{]|@A]:i2561:45>Z2

C!-O*%'AA !x%;!JA-D !ca*ƒ?{!C!AB
"C5;"K7!E#I_,Y,999.n8/8
`K
I!*
KNN"}>U:~<>1256
"1%%6xC0}</./\Co}</.<b!u%
m%\#%;!JAj-O.n@O% b"M.<l?'
+M,?'E#@n1%?1M,!J8Aj%A
?!Z6?'+AR5C!6"n^b0•./b/bAj%–H*#o@
E#Aj%*2H*#0n8
Tỉ lệ bệnh nhân RN trong nghiên cứu có sử dụng thuốc
dự phòng huyết khối khá thấp, với Aspirin là 17,3% và Sintrom
là 18,9%. Thời gian bị RN trung bình 3,5 ± 2,4 năm.
./
KNCN"}>U:~<]j<@756%@:42j<kQQ]l[;:<d7@:42j<;:<
f2T;1m>f2n5ghi5151j5[25651X<=5;O51q1r56>s
hi51dT5;:<
KNCNN"}>U:~<]j<@756
3.2.1.2. Các yếu tố nguy cơ lâm sàng, điểm CHADS
2
và CHA
2
DS
2
-
VASc
Bảng 3.5. Các yếu tố nguy cơ lâm sàng
Các yếu tố Nhóm bệnh (n= 127) %
9AK%, ol @lb/
h lo ^0b@

Aj%kl^ @/ <@bn
 << .lb@
%Y-aF]AU @< <^b<
',$!,CA .^ b0
Aj%kn^ l@ ^lb^
%2%e @/ <@bn
h9
<
.b0•.bo
h
<
9
<
ih9! <b0•.bn
h*#)*+,-#!%\,`*'!6"HS^0b@ˆT8
KNCNCNR;f2n@:42j<kQQ]l[;:<
Bảng 3.10. Kết quả siêu âm tim qua thành ngực
Các chỉ số
Nhóm bệnh
(n=127)
Nhóm chứng
(n=36)
p
(RC%S!,T obo•/bl @b<•/bo †/b//.
=hS,*T n.b<•.0b^ @<b^•nb< †/b//.
=hS,*},
<
T @lb<• bn </b@•ob. †/b//.
=h•€SˆT @nb•••bn ^lb<•^b< †/b//.
=•€SˆT ^^b<•.ob@ n^b••nbn †/b//.

=•€}=h .bl•/b0 @b@•/bl †/b//.

RC%W?'+Qr(%m"[!J!
L!"G%!Z6M%>,[WM,!J!MƒR6O5;
SI†/b//.T8
Bảng 3.11. Kết quả siêu âm tim qua thực quản ở các đối tượng
nghiên cứu
Các chỉ số
Nhóm bệnh
(n=127)
Nhóm chứng
(n=36)
p
#%S!,T @b<•/bo <bn•/b@ †/b//.
QF  
S!,T
<b.•/b@ .bl•/b< †/b//.
S!,
<
T ob@•.b/ <bn•/b@ †/b//.
S!,}-T <lb••0b• o^b@•^bl †/b//.
AK\5O%SˆT b0ˆS.^T / †/b//.
tSˆT o.blˆS^@T / †/b//.
Ft <b0•/b0 / †/b//.
yr 0nbnˆS /T n.b.ˆS<<T †/b//.
rr noboˆS0<T <ob•ˆS•T †/b//.
M,!J5!MAK\5O%E#hRC%b8
KNCNEN  bc56  f2T5  6:•T  
C 
d7 

C

C
€> dt:  >_>
;1r56@A@:42j<;:<f2T;1m>f2n5
M[]A6AB%e6h9
<
E#h
<
9
<
ih9!E2%
3%'q!S—/booE#—/b@@wI†/b//.TbFtS—/b^<E#
—/bo<wI†/b//.TbFEe6c[rS—/b^lE#—/b^lwI†/b//.T
E#[U!%e6h9
<
E#h
<
9
<
ih9!E2%EBO!3s
!>KS—i/b^lE#—i/bolwI†/b//.T8
KNKNA:]:45f2T56:•T>_>3R2;A5623>c]j<@756;1lk;1T56
U:~<
C
%
C

C
€>%<9;@A;1r56@A@:42j<kQQ]l[

;:<dt:123R;q1A:%j<>295;m51:4551X;[_:%;:~251X;[_:d7U9;
f2e
KNKNN623>c123R;q1A:51X;[_:%;:~251X;[_:ghi5151j5[256
51X<=5;O51q1r56>shi51dT5;:<
.<
Bảng 3.23. Các yếu tố nguy cơ lâm sàng với huyết khối nhĩ trái,
tiểu nhĩ trái
Các yếu tố OR 95% CI p
9AK%, .b/ /bl‚.b^ “/b/^
h .b@ /b•‚.b0 “/b/^
Aj%kl^ .b@ /b•‚.b0 “/b/^
 <b. /b•‚^b0 “/b/^
%Y-aF]AU .• obn‚0/b• †/b//.
',$!,CA .b. /b<‚obn “/b/^
Aj%kn^ .b@ /b•‚.b0 “/b/^
%2%e .b0 /b•‚@b0 “/b/^
h9
<
k@ ob^ .bn‚.<b@ †/b/.
h
<
9
<
ih9!ko @bl .b@‚./b@ †/b/.
Y-aF]AUbh9
<
k@E#h
<
9
<

ih9!ko*#!C!
K\AO!M*%;]A6E2%AK![AK\5O%RC%bSI†/b/.T8
Bảng 3.24. Các thông số siêu âm tim với huyết khối nhĩ trái, tiểu
nhĩ trái
Các yếu tố OR 95% CI p
=•€Šo/ˆ .bo /b^‚@b0 “/b/^
=hk@0,*},
<
lb< .bl‚@/b0 †/b//.
k^!,
<
•b/ @bo‚<@b• †/b//.
Š</!,}- nbo @b0‚./bl †/b//.
=•€}=hŠ.b^ .b0 .b<i^b^ †/b//.
=•€%>,[F!5!M%CU3X?C"AK\5O%R
C%bW?'+Qr(8AK%;b=•€%>,G
1%E2%%mRC%R6*#=hL*$%!M%CU%;* 
AK\5O%RC%b8
Bảng 3.25. Các thông số dự báo huyết khối nhĩ trái, tiểu nhĩ trái
Các thông số
RO
C
95% CI
Điể
m
cắt
Độ
nhạ
y
Độ

đặc
hiệu
p
h9
<
/b0< /bl@‚/b•. @ nlˆ lnˆ †/b//.
h
<
9
<
i
/bl0 /bnl‚/b0• o nlˆ l.ˆ †/b//.
.@
h9!
=hS,*},
<
T
/b0< /bl/‚/b•@ @0 0lˆ n/ˆ †/b//.
S!,
<
T
/b0• /b0/‚/b•l ^b/ loˆ 0•ˆ †/b//.
yr
/b0< /bl/‚/b•@ o nnˆ •/ˆ †/b//.
Ft
/b0/ /bnn‚/b•@ o n/ˆ •/ˆ †/b//.
KNKNCN623>cj<>295;m51:4551X;[_:%;:~251X;[_:g hi51
51j5[25651X<=5;O51q1r56>shi51dT5;:<
Bảng 3.30. Các yếu tố nguy cơ lâm sàng với nguy cơ âm cuộn tự
nhiên

Các yếu tố OR 95% CI p
9AK%, .b@ /b0‚<b/ “/b/^
h .b^ .b.‚<b/ †/b/.
Aj%kl^ .b0 .b<‚<b• †/b/^
 <b/ /b•‚ob@ “/b/^
9F]AU <b0 .b•‚ob/ †/b//.
',$!,CA .b/ /b•‚.b. “/b/^
Aj%kn^ .bo .b.‚.b• †/b/^
%2%e .b. /b•‚.b@ “/b/^
h9
<
k< <b/ .bo‚<bl †/b//.
h9
<
k@ ob/ <b.‚lb^ †/b//.
h
<
9
<
ih9!ko <b• .bl‚^b/ †/b//.
Aj%kn^bhbh9
<
k<E#h
<
9
<
ih9!ko!M*%;
]A6E2%AK![tRC%bSI†/b/^T8
Bảng 3.31. Các thông số siêu âm Doppler tim với nguy cơ âm cuộn
tự nhiên

Các yếu tố OR 95% CI p
=•€Šo/ˆ .bn .b.‚<bo †/b/^
=hk@0,*},
<
<bo .bo‚@bl †/b//.
=•€}=hŠ.b^ <bo .b•‚@bo †/b//.
k^!,
<
<b• <b.‚ob/ †/b//.
Š</!,}- @b^ <b^‚ob• †/b//.
.o
Bảng 3.32. Các thông số dự báo âm cuộn tự nhiên nhĩ trái, tiểu
nhĩ trái
Các thông số
RO
C
95% CI
Điể
m
cắt
Độ
nhạy
Độ
đặc
hiệu
p
h9
<
/bl• /bl.‚/b0n @ n^ˆ 0lˆ †/b//.
h

<
9
<
i
h9!
/blo /bno‚/b0< o nlˆ 0<ˆ †/b//.
=h /blo /bn^‚/b0@ @0 0.ˆ n@ˆ †/b//.
 /b0o /bll‚/b•. ^ 0.ˆ l^ˆ †/b//.
yr /bl0 /bl/‚/b0n @ 0oˆ ^/ˆ †/b//.
%N,h9
<
 k@b%N, h
<
9
<
ih9! kob=hk@0
,*},
<
b3%'q!k^!,
<
 !M*%;]A6!V!DE2%AK![
tSI†/b//.T8
KNKNKN623>cU9;f2eghi5151j5(<=5;O51q1r56>shi51
dT5;:<
3.3.3.2. Các yếu tố nguy cơ đột quị ở bệnh nhân rung nhĩ mạn tính
không có bệnh van tim
Bảng 3.36. Các yếu tố nguy cơ lâm sàng với nguy cơ đột quị
Các yếu tố OR 95% CI p
9AK%, /bn /b@‚.b@ “/b/^
h .b0 /b•‚@bn “/b/^

Aj%kl^ @b< .b0‚nb0 †/b/.
 .b@ /bn‚<bn “/b/^
',$!,CA /bl /b<‚<b< “/b/^
Aj%kn^ <bn .b<‚^bn †/b/.
%2%e .b/ /b0‚.bo “/b/^
h9
<
k@ •bl ob@‚<.b0 †/b//.
h
<
9
<
ih9!ko ^bn <bl‚<nb• †/b//.
.^
C!)*+,-#[*˜q!M*%;]A6E2%AK![F
]AU"$%xAj%kn^ SI†/b/.T8AK%;%N,h9
<
 E#
h
<
9
<
ih9!*$%!M*%;]A6E2%AK![F]AU!6"SI†/b//.T8
Bảng 3.37. Các thông số siêu âm tim với nguy cơ đột quị
Các yếu tố OR 95% CI p
=•€Šo/ˆ .b. /b^‚<b. “/b/^
=hk@0,*},
<
@b^ .bn‚lb^ †/b//.
k^!,

<
@bo .b0‚nb< †/b//.
    Š
</!,}-
@b< .b0‚^bn †/b//.
=•€}=h  Š
.b^
@b@ .bo‚0b< †/b/.
%mRC%E2%=hk@0,*},
<
*#,LAK![F]AU
@b^*_S5">%!BK•^ˆ&.bn‚lb^wI†/b//.T89AK%,E2%I+
-AHO,CAHC%=•€Šo/ˆ5*%;]A6E2%AK![F
]AUSI“/b/^T8AK%;5%?'+!M!`-O=•€}=hŠ.b^
AK![F]AUQ—@b@SI†/b/.T8
Bảng 3.38. Các thông số có giá trị dự báo đột quị
Các thông số ROC 95% CI
Điể
m
cắt
Độ
nhạy
Độ
đặc
hiệu
p
h9
<
/b•@ /b00i/b•l @ 0.ˆ 0lˆ †/b//.
h

<
9
<
i
h9!
/b0l /b0/‚/b•o o l^ˆ l•ˆ †/b//.
=hS,*},
<
T /blo /b^o‚/bln @0 l^ˆ noˆ †/b//.
S!,
<
T /bll /bno‚/b0o ^ 0.ˆ n/ˆ †/b//.
yr /blo /bno‚/b0o @ 0lˆ o^ˆ †/b//.
%N,h9
< 
k@b h
<
9
<
ih9! kob=hk@0,*},
<
b
3%'q!k^!,
<
E#Fyrk@!M*%;]A6‡'E2%AK
![F]AUSI†/b//.T8
.n
`E
G
ENN"}>U:~<>1256>STUA:;bv56561:45>Z2

C!O% "M,!J !!7*X6[XE2%
M,?'+Q5!M?'E6%,EY,V+!Z7!
Aj%b!%YA!6"b!+Vb!`-O5O%E#3%'q!36!Z6![N
SI“/b/^T89X*X6!7#K>,?>"qGH"%;!JA
?'i!J8
Aj%A?!Z6?'+Q5!M?'E6%,
1!6""M,%;!JA!Z6!u%*#n^b0•./b/I•
 IE2%Aj%,d!Qg"!C!%;!JA;\%2%8
`*'?'+Q !3•AO!!OHHIb
E2%9%",*#.0b•ˆE#h-I%%*#.lb@ˆb"5%Mg"%;
!JA!Z6(A,%`*'#K*#n•b.ˆE#^lb/ˆ8%YA#K!"HK+,
*ƒg$%3•AO!!O!Z6!C!?C!-RW?'+QE
- !C!?%\!J!>K,CA3"AO!!O5CE%6,%(
S(hT8X!\!"HKb-a3p(h3XIsF]AU!M%YA
!`*%YA*#,%>,AK![[O%QQnlˆ[JE2%%>,
AK![F]AU#L,<blˆ8
= +>?#@"#5A"#B,@#45"##C
DC8*"$EF*4#
ENCNN"}>U:~<]j<@756
4.2.1.1. Các triệu chứng lâm sàng của bệnh nhân rung nhĩ
%'A!J!Z6QH63$•KAF!E#"!C!K\AO
_-OHb!J!L%,b!C!?'*ƒ%5~,E#-X$K!>,
!Z6x?'+8%'A!J1VIH*#G%FI!%\,
n@b/ˆb!C!%'A!J5C!G,5MW^/boˆb!M,V<nb/ˆ
.l
E#,',–%<.b@ˆ[X5\]A>%;!JA!Z6Ai€6-gE#
!F-X8
4.2.1.2. Các yếu tố nguy cơ đột quị lâm sàng ở bệnh nhân rung nhĩ
mạn tính không có bệnh van tim
C!)*+,-#O%E2%F]AU3"d!,$!AK\5O%

*#!C!K\AO!M*%;]A6\-XJAK\!Z6RC%8C!K\AO#K
?6"G,&-AK%,JAK\bAj%kn^E#V!?%'*#Aj%kl^bL
AK\CIbC%C"1b%Y-aF]AU"V!6%?%\,$!,CAm"
"C]A6b?',$!,CAE#%2%e8H!>!C!K\AO#K!MN
MII_+KJAK\RC%b34\*#,LAK![r(8
4.2.1.3. Điểm CHADS
2
và CHA
2
DS
2
-VASc
%N,h9
<
 E#h
<
9
<
ih9!!"HK!M%CU%;
* AK\5O%E#F]AUW?'+Qr(!6"[™
!C!K\AOAK![*+,-#[*˜8%CU%;* !Z66
%N,#K !C%CW.l@@?'+Qr(Aj%xn^
\•^5 !3•š6|6%$%1%%N,cAHE%'8
ENCNCN"}>U:~<@:42j<kQQ]l[;:<;175156m>
4.2.2.1. Nhĩ trái giãn to ở bệnh nhân rung nhĩ
96›*%II"hœE#!F-Xm!"HK!M-X%6LO%cJ
W!>RI>%E#RC%5%g"3‡%?'+Qr("
1%%6A?</bnCSx.<i<0CT8C!%;!JA_
+K!"HK{5q!2!RC%%>,-6A5%-O!%'!AKN
UI#!b%YA#K!#!"HK‡[E6%s%;IC!Z6

Q"+K%mR8C!%;!JA+KQWFEB!:
!C!%;!JAAK\FW1%!"HK!M-X%6LCI*X!
RC%5%!MQb34\*#,L3_Nq!RC%!"\5%
CI*X!EY?18EBKX+AR*#,%6L5q!
2!RC%815qRC%E#!`-ONq!RC%S=hT
.0
W?'+Qr("%;!JA!Z6!u%*2[
M,!J!MƒR6O5;SI†/b//.T8(\]A>#K[
[E2%5\]A>%;!JA!Z6r•gbh"%g**%•E#QA?%
8
4.2.2.2. Giảm chức năng co hồi nhĩ trái ở bệnh nhân rung nhĩ
rH!J!L!"G%R!HI6K-6A5W%ICQbC!
3p#K‡[W?'+!MF%mH%>,8;,E#"Mb
!C!%;!JA!"HK!C!3>%!"!["C%"Cb-X%;A![E#Z
!Z6,%"!"3%6VIWe?'+Q!:*#AK;
+*#,%>,!"G%RC%8"%;!JA!Z6!u%bI+
-AH!"G%RC%W?'+Qr(S@nb•••bnˆT%>,-"
E2%M,!JS^lb^•^b<ˆT!MƒR6O5;SI†/b//.T8
4.2.2.3. Vai trò của phân suất tống máu thất trái (LVEF) trong
rung nhĩ
J!L+,AHC%%>,MII_+KJ'W?'
+Qr(E#5\]A>*#AK![r(LW?'+!M
=•€%>,8AK%;!`q%;I+-AHO,CA =•€
Šo/ˆ!6HKE6%s!Z6=•€O%E2%AK![AK\5O%R
C%b8IO% I%e6%>,=•€E#L=h!MN!M
%CU"%;* AK![AK\5O%RC%b8
ENCNKN"}>U:~<@:42j<;:<f2T;1m>f2n5
4.2.3.1. Kích thước tiểu nhĩ trái giãn ở bệnh nhân rung nhĩ
%m"W?'+Q*#K\AO+KJ',CAW
b+K*#AK ![$"# hE#AK\ 5O%RC%b

8%'q!W?'+Q*2[?'+5Q
!MƒR6O5;SI†/b//.T8(\]A>#K[[E2%5\
]A>%;!JA!Z6QA?%E#rAg8
4.2.3.2. Vận tốc dòng chảy tiểu nhĩ trái
.•
BO!3s!>K" !cg,%eE6%s]A6
7  "    #  AK\  5O%  R  C%b    W  ?'  +
Qr(8C!%;!JA!"HK!M,O%[]A6%e6O!
F3s!>K"%>,E2%-X%6L#AK\5O%8
AK\5O%RC%bqVIW1%UIc"6[*#Q8
%YA1 I?C"!C"AK\5O%W?'+UIc"6
!MO!F3s!>KRC%%>,3"O%*"$!J!L!"
?MI%NARC%[F!8"M,<•?'+  Q(b
rAgE#!F-Xm!"HKn"-Ol?'+!M%Y-aF
]AU  "V!  r(  "$%  ?%;  !M  EB  O!  3s  !>K    HI
S†<^!,}-T8BO!3s!>K"WM,?'+Q
"%;!JA!Z6!u%HI[M,!J!MƒR6
O5;S<lb••0b•!,}--"E2%o^b@•^bl!,}-wI†/b//.T8
4.2.3.3. Âm cuộn tự nhiên và huyết khối nhĩ trái, tiểu nhĩ trái ở
bệnh nhân rung nhĩ mạn tính không có bệnh van tim
t*#$!AKN%\I2!5%#AK\
5O%EEBK1VIW?'+!MAK\5O%RC%E#b
36"Fx^^ˆ\.//ˆ1 I89X*%;]A6%e6tE#
AK\5O%RC%VIW!>?'+Q3"?'E6%,*4
53"?'E6%,8C!%;!JA!"HK`*',d!AK\
5O%RC%L!•E2%-X%6L!Z6,J!FV!Z6t8
gIIAE#!F-XmI+*"$%+,!AFX%;#@,J!F
S5!Mb‰E#VT3X6E#"B,F-%;A+,HK !W
_-O1E#I+?O!Z6M"RC%8€65%E#!-
*$%I+t#^,J!F5C!6A8(!M?'+#"

5!Mt,#*$%!MAK\5O%RC%8t*#K\AO[
]A6%;*˜,$HO%E2%AK\5O%RC%8"%;
!JA!Z6!u%b`*'tW?'+!MAK\5O%*#.//ˆ
</
!6"[C5N-"E2%?'+5!MAK\5O%*#@@b•ˆSI
†/b//.T8(\]A>%;!JA!Z6PK-"5%-5%P•!"HK`*'#K
*#•<ˆE#o.ˆSI†/b///.T8rJ!FV!Z6tW?'+
!MAK\5O%RC%b!:!6"[8FtW?'+!M
AK\5O%RC%bS@b^•/bnT!6"[%YA-"E2%?'+
5!MAK\5O%RC%bS<b0•/bnT!MƒRO5;SI
†/b//.T8
ENCNENbc56f2T56:•TU:~<
C
 d7
C

C
€>dt:
>_>;1r56@A@:42j<;:<f2T;1m>f2n5
(\]A>%;!JA!"HK!M-X*%;]A65C!V!D
%e6h9
<
E#h
<
9
<
ih9!E2%!C!-O9t8h9
<
[]A6E2%!C!-O9t,$[h
<

9
<
ih9!8(\
]A>#K!:I• IE2%%;!JA!Z6P%**g-E#!F-X8
=G H@C:?#3IJB!

A3IJ

B!

KLJ!A#0
E"#B,@#4.A"#0D
$A?$450C*"#<-
EF*4#
ENKNNA:]:45f2T56:•TU:~<
C
d7
C

C
€>dt:
5623>c123R;q1A:%j<>295;m51:4551X;[_:%;:~251Xd7
U9;f2e
%N,h9
<
E#h
<
9
<
ih9!!:!M%CU%;* 

AK\  5O%  R  C%b    !6"8  hK%6*6  9  m  5™  U  %N,
h9
<
 !cg,*#K\AO]A67*#,L#AK\
5O%RC%b8
(%%N,h9
<
k@E#%N,h
<
9
<
ih9!ko!M%CU
3X?C"AK\5O%E#tRC%bW?'+Qr(
<.
E2%F$K\nlˆE#FV!%'A\0lˆbE#AK![F]AU
!6"SI†/b//.T8
ENKNCNA:]:45f2T56:•T>_>;1r56@A@:42j<;:<;175156m>
dt:5623>c123R;q1A:%j<>295;m51:4551X;[_:%;:~2
51X;[_:d7U9;f2e
C!%;!JA!"HKRC%%m"bI+-AHO,CA
HC%%>,W?'+Q!MAK\5O%RC%b8`-O
Nq!RC% !cg,*#K\AO%;* ,$O%E2%!>Q
E#F]AU8`-ONq!RC%L*#,LAK![QM%
!AbLC%ICQ-6A!AKNUIE#E#LAK![F]AU
*_  _A %;8  `  -O N  q! R  C% =h  k@0,*},
<
 E# `  -O
=•€}=hŠ.b^!M%CU%;* AK![AK\5O%b+,!AF
X%;RC%bE#F]AUW?'+Qr(8
ENKNKNA:]:45f2T56:•T>_>;1r56@A@:42j<;:<f2T;1m>f2n5

dt:5623>c123R;q1A:%j<>295;m51:4551X;[_:%;:~2
51X;[_:d7U9;f2e
9XJAK\RC%b*#Y>N#AK\
5O%W?'+Q8AK\5O%W?'+Q*%;]A6!V
!DE2%%>,EBO!3s!>K"8BO!3s!>K
 !]AK\U?W%-X!"G%%NARC%b-X*#,zpF
"+,[HC%E#CI*X!R8BO!3s!>K*#K\A
O3AKHNC%C-XJAK\E#tRC%b !cg,
*#K\AO!`UOH!Z6-XJAK\RC%8"%;!JA
!Z6!u%b?'+!M3%'q!k^!,
<
E#EBO!
Š</!,}-!MAK![AK\5O%btRC%bE#F]AU!6"8
IG
<<
A6%;!JAV!%N,*+,-#b-%;A+,"II*g%,E#
-%;A+,%,]A6X!]A>W.<l?'+AR,$q5
!M?'E6%,Aj%A?n^b0•./b/E#@nO% M,
!Jb!u%u6,F-O5\*AB-6A&
N"}>U:~<]j<@756%>_>3R2;A5623>c]j<@756;1lk
;1T56  U:~<  
C
 d7  
C

C
€>%  qR;  f2n  @:42  j<
kQQ]l[;:<d7@:42j<;:<f2T;1m>f2n5ghi5151j5[25651X
<=5;O51q1r56>shi51dT5;:<
€  _>  3R2  ;A  5623  >c  ]j<  @756  ;1lk  

C
 d7

C

C
€>8
QAR,$q5!M?'E6%,!ZK\AW1%
!6"Aj%bAj%A?n0b^•./b/8LAK\CI*#K\AOAK![
*+,-#!%\,`*'!6"HS^0b@ˆTb%\I\*#Aj%kn^S^lb^ˆTb
-AK%,JAK\S@lb/ˆTb%Y-aF]AUE#%\A,CAm""C]A6
S<^b<ˆTb%2%eS<@bnˆTbC%C"1S.lb@ˆTE#?',$!
,CAS b0ˆT8
%N,h9
< 
A?*#.b0•.boE#%N,h
<
9
<
i
h9!A?*#<b0•.bn8
€R;f2n@:42j<kQQ]l[;:<d7@:42j<;:<f2T;1m>
f2n58
15qRC%Sobo•/bl!,-"E2%@b<•/bo!,TE#!`
-ONq!RC%=hS@lb<• bn,*},
<
-"E2%</b@•ob.,*},
<
T
L"5%I+-AH!"G%RC%=h•€S@nb•••bnˆ-"E2%

^lb<•^b<ˆTE#`-O=•€}=h%>,S.bl•/b0-"E2%@b@•/blTW
?'+AR-"E2%M,!JSI†/b//.T8
%'q!%NARC%LSob@•.b/!,
<
-"E2%<bn•/b@!,i
<
Tb"5%EBO!3s!>K%NARC%%>,C5NS<lb0•
<@
0b•!,}--"E2%o^b@•^bl!,}-TW?'+AR-"E2%M,
!JSI†/b//.T8
AK\5O%b+,!AFX%;RC%b%NARC%!%\,*_
*  b0b o.blˆW?'+ARE#5!MW?'+
M,!J8
CNA:]:45f2T56:•TU:~<
C
%
C

C
€>%
qR;f2n@:42j<kQQ]l[;:<dt:123R;q1A:%j<>295;m51:45
51X;[_:%;:~251X;[_:d7U9;f2eghi5151j5[25651X<=5;O51
q1r56>shi51dT5;:<
%N, h9
<
 E#h
<
9
<
ih9![]A6ABE2%

3%'q!%NARC%bF+,!AFX%;bFEe6c[F,$!
!ZX!E#[]A6U!E2%EBO!3s!>K%NARC%!M
ƒR6O5;SI†/b//.T8
M,O%*%;]A6‡'%e6%N,h9
<
bh
<
9
<
ih9b
!C!-O-%;A+,%,]A6#X!E#-%;A+,%,]A6X!
]A>E2%AK![AK\5O%b+,!AFX%;RC%b%NARC%
E#F]AUW?'+AR,$q5!M?'E6%,8
i;*+,-#b5%%N,h9
<
k@?'+!MAK![
AK\5O%b+,!AFX%;RC%b%NARC%E#F]AU!6"E2%
Q*_* *#ob^wob/E#•blSI†/b/^T"V!E2%Q*_* *#@blw
<b•E#^bnSI†/b/^T5%%N,h
<
9
<
ih9!ko8
i(\]A>-%;A+,%,]A6#X!E2%=hk@0,*},
<
"V!`-O=•€}=hŠ.b^AK![AK\5O%b+,!AFX
%;RC%b%NARC%E#F]AU*_* E2%Q—lb<wQ—<b@
E#Q—@b^SI†/b//.T"V!E2%Q—.b0wQ—<boE#Q—@b@SI
†/b//.T8
i;-%;A+,%,]A6X!]A>bAK![AK\5O%b+,

!AFX%;RC%b%NARC%E#F]AU*_* *#Q—•b/w