KIỂM SOÁT HUYẾT áp ĐÁNH GIÁ QUA THỰC HÀNH điều TRỊ NGOẠI TRÚ tại KHOA nội TIM MẠCH BỆNH VIỆN TRUNG ƯƠNG HUẾ

KIM SOÁT HUYU TR NGOI TRÚ
TI KHOA NI TIM MCH - BNH VI

Nguy
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                -

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
- 

p 




 k


SUMMARY
Objects: To valuate management of hypertension in non-resident clinic of cardiovascular
internal departement - Hue central hospital, and to determine benefit of standard management of
hypertension based on rate of rehospitalization due to cardiovascular events.
Subjects and methods: All of patients with high blood pressure were monitored and treated
in non-resident clinic of cardiovascular internal departement - Hue central hospital. Cohort
study, with following rate of rehospitalization due to cardiovascular events.
Conclusion: Rate of standard management of hypertension in non-resident clinic of
cardiovascular internal departement - Hue central hospital was 90,8%, standard management of

hypertension could reduce rate of rehospitalization due to cardiovascular events.

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






- 
 





- 




Khám lâm sàng: 
               
glucoza), bilan lipide, , siêu âm tim
  HA tâm thu  140
 90 mmHg.

- : HA - HA 90- 99 mmHg

- : HA    HA   109
mmHg ( trung bình)
- : HA tâm thu: HA 



 (HATT 140-

90-99)
-

100-109)


>100)
Không có YTNC




Có 1-2 YTNC





Ng

 

 

                  
 75 mmHg.
Chn c tim mch bao gm: Hi chng vành ct ngc không n
nh, nhp), tai bin mc xut huyt não bng CT -
scan s não)



N= 675
THA




BMV

TBMMN

Suy tim
n
220
24
89
263
176
57
142
%
32,58
3,56
13,19
38,96
26,07
8,44
21,03














Nam
65
197
93
43
237
75

58
167
95
37
214
69
TC
123
364
188
80
451
144




UCMC
UCTTA
UCCa

UC adre

n
347
224
342
262
123
%
51,41
33,19
50,67
38,81
18,22


N = 675




n
%
n
%
n
%
n
%


221
32,74
317
46,96
105
15,56
32
4,74





n
%
n
%

123
100
0
00

337
92,58
27
7,42
 (n= 188)
153
81,38

35
18,62
Tn = 675)
613
90,81
62
09,19






n
%
n
%
n = 80)
79
98,75
1
1,25
n = 451)
413
91,57
38
8,43
n = 144)
120
83,34

14
16,66

613
90,81
62
09,19
 





n
%
n
%

219
99,09
2
0,81

295
93,06
22
6,94

101
78,10

23
21,90

17
53,13
15
46,87

613
90,81
62
09,19
g
 








n
%
n
%
ên (n = 611)
598
97,87
13

2,13
(n = 64)
15
23,44
49
76,56
n = 675)
613
90,81
62
09,19
²
14,34
p
0,0047



UCMC
(247)
UCTTA
( 324 )
UC canxi
( 412 )
 - block
( 365 )

( 123 )

n

%
n
%
n
%
n
%
n
%

/
/
/
/
04
0,97
5
1,43
/
/

/
/
/
/
2
0,48
7
1,92
3

2,44
Ho khan
18
7,29
03
0,93
/
/
/
/
/
/
RL tiêu hóa
/
/
/
/
/
/
11
3,01
/
/
Phù chân
2
0,81
/
/
14
3,40

/
/
/
/

/
/
/
/
3
0,73
/
/
5
4,06





(n = 632)

(n = 43)
n
%
n
%

602
95,25

11
25,57

30
4,75
32
74,42

632
93,63
43
6,37
²
16,78
p
0,0031
 
(74,42%) 






tiêu

%
TBMMN
1
12

13
1,93

3
15
18
2,67
Suy tim
2
08
10
1,48

0
02
02
0,30

6
37
43
6,37
 Các bin c tim m t mc tiêu. Bin c nhiu
nht là bnh mi biên.

IV. BÀN LUN

B Phân tích tng hp 61 nghiên cu cho thy có s liên quan cht ch gia HA
 bin c  mi la tui. Nghiên cu cho thy c
i 20mmHg HA tâm thu và/hoi 10mmHg HA tâm  p 2 ln

nh rõ ràng rng HA là mt trong 3 yu t  yu gây bnh
u t i ta thy bin
chng bng xut hin  các bnh nhân  c 3 yu t 
nghiên cu này, t l BMV kèm theo  bnh nhân THA khong 32,58 %[3,5].
Tai bin mch máu não: THA là nguyên nhân ch yt qy. Khong
ht q t qi b THA có nguy
 t qy cao gp 3-4 ln so vng, ngay c nhi có ch s
HA  gii hn cao c t qp 1,5 ln.
u tr THA lâu dài là bin pháp hiu qu nh phòng ngt qy. T l
bt qu trong nghiên cu này là 26,07 %.
Suy tim: Suy tim hiu gây nhp vin ca các bnh nhân trên
65 tui, và không gin chng khác ca THA, t l b 
trong nh suy tim khong 20% trong nhi ca cuc
i, mt con s c nhiên. HA là yu t ng ch yp 2 ln 
nam gii và gp 3 ln  n gii có THA so vi nhng. 90% s ng
hp mi b suy tim có tin s b t ch vi ch s HA tâm thu
 l bnh nhân THA có suy tim trong nghiên cu này là 21,03 %.
ng: Tình trt áp va là yu t a là hu qu ca bnh
David M Safley, Steven P Marso ( 2003) mt nghiên cnh nhân
y 51 % bt áp[8]. T l b
bnh nhân THy, t l  bn gp 3 l
ng. T l bu này 13,19 %.
Bnh mch máu ngoi biên: THA là yu t  yu ca bnh mch máu ngoi
biên. Mt thông s c chp nhn là ch s áp lc c chân- cánh tay (ABI) < 0,9. Ch s này
liên quan cht ch vi các yu t a bnh vng mc lá,
ng và mt yu t cc k quan tri tác.
Bnh thn mn tính hay suy thn: Có s liên quan gia HA v bnh thn giai
n cu s HA  gii hn cao cng (HA tâm thu t 130-
139mmHg và/ho 85-89mmHg). Bc kim soát tt
 b suy gim chn nhiy rõ ràng là bnh thn mn tính là mt

bin chng quan trng cch.




 


4.3. S dng thuu tr và phi hp thuc
Trong nghiên cu này, chúng tôi ch yu ch dùng 05 loi thuc s
dng ph bin trên lâm sàng. Vic phi hp thu m bt HA mc tiêu sm khi ch cn
có tr s c tiêu là HA tâm thu > 20 mmHg ho
Tùy theo ch u tr bnh kèm theo, chúng tôi d THA,
 ch nh các nhóm thuc phù hp vi tng bnh
nhân. T l phi hp hai loi thuc là ph bin nht trong nghiên cu này.





 càng cao thì càng
 
 
 
  93%. Kaplan  2007, t
 

Lipid-Lowering Treatment to Prevent Heart Attack Tr
 


               
         
  
. 
 
T


        
 2007), Theo Sandra J  

 50% [6]. Ngoài ra





V. KT LUN



TÀI LIU THAM KHO
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