NGHIÊN cứu đặc điểm lâm SÀNG và dấu CHỈ điểm SINH học của tổn THƯƠNG TRONG NHỒI máu cơ TIM cấp tại BỆNH VIỆN đa KHOA TP hồ cần THƠ

NGHIÊN CM LÂM SÀNG VÀ DU CH M SINH HC
CA TP
TI BNH VI C

PhanThị Thu Ngân
1
, Nguyễn Thị Nhạn
2
1
Bnh vi
2
ng i hc Hu


Mục tiêu: n

Phương pháp: nghiên cu trên 65 bnh nhân nhp nhp vin 
k
Kết quả: t       ; b   ,31%: t   ,2%.
Troponin I cao rõ  100% bn, 81.0% có t MB và tt
58.73 % bn. 

7.9 %. 


SUMMARY
THE CLINICAL SIGNS, SYMPTOMS AND BIOCHEMICAL MARKERS
OF CARDIAC DAMAGE IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
AT CAN THO HOSPITAL
Objectives: The aim of the study was to present the clinical signs, symptoms and standard

biochemical markers of cardiac damage in patients with acute myocardial infarction (AMI)
Methods: A total of 65 patients of acute myocardial infarction were included in the study at
Cspital.
Results: Overweight and obesity in 53.97%; android obesity: 60,31%: hypertension: 30,2%
pts. Troponin I concentration increase in 100% pts, CK  MB increase in 81.0% and LDH:
82.53%; hsCRP increase in 58.73 % pts. Acute myocardial infarction of anterior wall was
present in 27%, apex anterior wall 23.8 %, anteriolateral AMI in 4.8 %; large anterior AMI in
14,3%; inferior AMI in 19.0 % and AMI with righ ventricular region in 3,2%, non derivation ST
in 7,9% pts. On admission, AMI has been evaluated by Killip classification: 38.1 % pts belonged
to Killip I, 31.7 % to Killip II, 20,6% to Killip III and 9,5% pts to Killip IV class. There was a
fall in ejection fraction as assessed by echocardiography in 73%.


  


 

u, các


 


[11], [13]
 k


II. U
2.1. ng nghiên cu

Tiêu chuẩn chọn bệnh: bnh nhân nhp nhp vin ti Bnh vi
TP. C n tháng 7/2010.
Tiêu chuẩn loại trừ: bc gim lipid máu
i tiu hypothiazide, c ch c nga thai, bnh nhân
b t t c.
u: nghiên cu mô t cu tr.

III. 

Bng 3.1. Phân b bnh nhân nhi



p
Nam
44
69,8
>0,05

19
30,2
29.5%
22.7%
15.9%
15.8%
26.3%
26.3%
25.4%
23.8%
19.0%

31.8%
31.6%
31.7%
0%
5%
10%
15%
20%
25%
30%
35%
≤ 59 60-69 70 - 79 ≥ 80

Tỉ lệ%
Nam

Nhóm NC

Bi 3.1. Phân b bnh nhân nhi
b- 
31,7%. Nam 69,8% so  30,2%, p >0.05
11.4%
10.5%
11.1%
34.1%
36.8%
34.9%
38.6%
26.3%
34.9%

15.9%
26.3%
19.0%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Tỉ lệ %
Gầy BT Thừa cân Béo phì
Thể trọng
Nam
Nữ
Nhóm NC

Bi 3.2.  th trng bnh nhân theo BMI
t
- 
56.82%
43.18%
68.42%
31.57%
60.31%
39.68%
0%
10%

20%
30%
40%
50%
60%
70%

Nam  Chung





Bi 3.3. ng
                
 p >0.05
3.


Chung
p
Nam

Có
14
5
19
> 0.05
31.8%
26.3%

30.2%
Không
30
14
44
68.2%
73.7%
69.8%
t  
 

3.-CRP 


Troponin I (mmol/l)
CK  MB (mmol/l)
LDH (U/L)
p

Nam
X
 SD
28.92  49.62
212  788.3
1119  733.4
> 0.05

317. 4.2
5350
3770


423
2.5
2.18


X
 SD
26.24  28.84
100.58  90.85
1149.79  911.79

114
314
4257

4.05
4
213

Chung
X
 SD
28.11  44.41
178.36  662,61
1128.74  791.559

317.5
5350
4257


4.05
2.5
2.186
-

3.-

hs-CRP (mmol/l)
SGOT (U/L)
p

Nam
X
 SD
5.5305  7.75
355.9  1123


> 0.05

34
7628

0.02
7.2


X
 SD

4.30  6.11
547.57  1369.97

27.3
6289

0.1
17

Chung
X
 SD
5.16  7.32
413.7  1206.31

34
7628

0.02
7.2
p>0.05
 3.
Troponin I
cao

Chung
(n = 63)
p

(n = 16)

60  69
(n = 15)
70  79
(n = 20)

(n = 12)
n
%
n
%
n
%
n
%
n
%
> 0.05
16
100
15
100
20
100
12
100
63
100
ét: t
3.- 
CK - MB


Chung
(N = 63)

(n = 16)
60  69
(n = 15)
70  79
(n = 20)

(n = 12)
n
%
n
%
n
%
n
%
n
%
14
87.5
11
73.33
15
75
11
91.66
51

81
p
> 0.05
t-

3.-
-CRP

Chung
(N = 63)

(n = 16)
60 - 69
(n = 15)
70 - 79
(n = 20)

(n = 12)
n
%
n
%
n
%
n
%
n
%
5
31.25

8
53.33
15
75.0
9
75.0
37
58.73
P
< 0.05
 t-69 và 70 - 79
-
3.


Nam (n=44)

Chung N=63
n
%
n
%
N
%

10
22.7
7
36.8
17

27.0

10
22.7
5
26.3
15
23.8

3
6.8
0
0
3
4.8

6
13.6
3
15.8
9
14.3

11
25
1
5.3
12
19.0


1
2.3
1
5.3
2
3.2
NM ST không chênh
3
6.8
2
10.5
5
7.9
t 27.


3.
Killip

Killip I
Killip II
Killip III
Killip IV
p
n
%
n
%
n
%

n
%

< 0.05

Nam
14
31.8
17
38.6
7
15.9
6
13.6

10
52.6
3
15.8
6
31.6
0
0/0
Chung
24
38.1
20
31.7
13
20.6

6
9.5
t
II ch
3.
EF



Nam
33 (75.0 %)
11 (25 %)

13 (68.4 %)
(31.6 %)
Chung
46 (73 %)
17 (27 %)
p
> 0.05
t



 ,
.  
>0.05
 

 



: 


Quang 

Theo Catalina Liliana Calin, có 50,9%
bnh nhân nhn s t áp. Theo Deepak Somani, RS Gahlot, Manoj
t áp [7], [8], [10].

hs-
-
-
- 
  Trong nhp,
Troponin I b gi th 3  m vào gi th 12  ng tr li
sau 7  c tính va nêu trên, Troponin I  bnh nhân nha chúng
tôi 
- 
- 

-
-69 và 70 - -
Phân 
 
 o
Catalina Liliana CALIN và cng s, có 49,1% bnh nhân nh
c vách ca thi, sau, bên là 46,7%
  


 p < 0.05.
Theo Catalina Liliana CALIN, và cs, nghiên cu trên 10.037 bnh nhân nh
cp, có s liên quan cht ch khá sm git ngc v Killip có suy tim sung
huyt là 67.9% trong Killip I, 17,2% Killip II, 8,7% Killip III và 6,1% Killip IV
Theo MY Nadkar, VI Jain, nghiên cu trên 100 bnh nhân nhp có Killip I
chim 45%, Killip II chim 24%, Killip III là 19% và Killip IV là 12%

Deepak Somani, RS Gahlot, Manoj Lakhotia, n ch rt
cht ch vi EF sau ln nh            m nng thì
Troponin I càng cao; do v t tng máu tht trái
(LVEF)  bnh nhân b nhi máu lu tiên.  mc 6.6ng/ml chng t i 50% và có
th cho th



68.33  

- 
- 
34,9%, béo phì là 19%.
,42%.
,,,3%.
-  

 CK  

60 - 69 và 70 - 
 -69 và 70 - -
- 

  
h 7.9 %


- Siêu âm tim

TÀI LIU THAM KHO
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c Hu
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hóa  bnh nhân mTạp chí y học thực hành số 507 - 508,
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