nghiên cứu một số đặc điểm của suy tim mạn tính tại khoa nội tim mạch tại bệnh viện đa khoa tỉnh đắk la81k từ tháng 10 2010 04 2011

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NGHIÊN CU MT S M CA SUY TIM MN TÍNH TI KHOA NI
TIM MCH BNH VIK LK T THÁNG 10/2010  04/2011

Nguyn Th 
Khoa Tim mch, Bnh vik Lk

  



 
.
  
k Lk
- 04/2011.
 



 







SUMMARY
STUDY OF SOME FEATURES CHRONIC HEART FAILURE
IN DEPARTMENT CARDIOVASCULAR INTERNAL - DAK LAK GENERAL HOSPITAL

FROM 10/2010 - 04/2011

Introduction: Chronic heart failure is the ultimate consequence of cardiovascular disease,
but this disease can be prevented, and if diagnosed, early treatment will increase your chances of
living, improved quality of life for patients, reducing the cost of treatment.
Objectives: Clinical features, and clinical stage of heart failure in patients with chronic heart
failure is treated. Identify some characteristics of the causes of chronic heart failure are common.
Subjects and methods: cross-sectional study described in all patients diagnosed with chronic
heart failure treatment in Department cardiovascular internal - Dak Lak general hospital in the
study period from 10/2010 - 04/2011.
Results: The incidence of chronic heart failure increases with age. The common clinical
symptoms of chronic heart failure are prominent, breathing difficulties which occur in 100% of
cases, fatigue is 93.10%. Most patients had grade III heart failure, according to NYHA
percentage of 59.48% and 43.96% under the Vietnam Association of Internal Medicine. 69.97%
of patients in the study group is looking to shadow images's large heart, 70% of our patients with
the phenomenon of expansion chambers of the heart, EF falls below 40% share of 10.04%,
76.72% of patients have increased pulmonary artery pressure. Topping causes of chronic heart
failure is heart valve disease accounted for 37.37% rate, followed by hypertension accounted for
22.42% rate, the rate of coronary heart disease accounted for 17.24%, disorders heart rate
percentage 13.79% and 9.48% is due to other causes. Although the cause of chronic heart failure
but can vary, but you have chronic heart failure, symptoms of the common clinical
manifestations were almost equally dominant. Patients with chronic heart failure due to coronary
artery disease and hypertension is often preserved EF.
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
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7, theo nghiên
 -     
, trong
13- 2%
  15.
- 
9.
 ính, song
 


7.



     
 


h - 


II. 



- - 04/2011.

1113





Tim to





Phù chi


Gan to

Dun
Tim nhanh > 120 l/ph

 


486

- 

- 






- 
- 
- 
- 





Nam

n
%
n
%
< 30
0
0,00
2
1,73

5
4,31
4
3,45

9
7,76
5
4,31


16
13,79
10
8,62

19
16,38
11
9,48
> 70
20
17,24
15
12,93

69
59,48
47
40,52


 


n
%
Khó th
116
100


57
49,14

108
93,10

52
44,83

42
36,21
Phù
72
62,09
Gan to
93
80,17
 
91
78,45

53
45,69

61
52,59

cao 93,1%.





1
2
3
4
n
%
n
%
n
%
n
%


18
15,52
28
24,14
41
35,34
29
25,00
2,70 ± 1,01
Gan
23
19,83
53

45,69
28
24,14
12
10,34
2,25 ± 0,89
Phù
44
37,93
45
38,79
19
16,38
8
6,90
1,91 ± 0,90

55
47,41
48
41,38
11
9,48
2
1,73
1,66 ± 0,72
487

- Khó t


-  



I
II
III
IV
n
%
n
%
n
%
n
%
NYHA
0
0,00
18
15,52
69
59,48
29
25,00

18
15,52
28
24,14

51
43,96
19
16,38




n
%
X Quang
ngc thng
Bóng tim to
80
69,97

63
54,31
ECG

70
60,34

31
26,72

62
53,45
Siêu âm
Doppler tim


82
70,69

65
56,03

89
76,72


tim trong siêu âm.




n
%
Min
Max
Trung
bình
EF (%)
>55
ng
51
43,97
21
81
56,25 ±

14,16
50 

26
22,41
40 

27
23,28


12
10,34

(mmHg)
<30

36
31,04
22
101
47,60 ±
20,71


55
47,41
>60

25

21,55




- t là 21%.
- 


Nguyên nhân
n
%
BLVT
43
37,07
THA
26
22,42
BMV
20
17,24
RLNT
16
13,79
NNK
11
9,48

116
100



488
 
 

hân suy tim
 

IV. 
 



 

 
         








 59
  13.





 

13
Nguyên nhân

< 30





50 



>70




n
%
n
%
n
%
n
%

n
%
n
%
BLVT
1
2,33
4
9,30
7
16,28
11
25,58
13
30,23
7
16,28
43
THA
0
0
2
7,69
2
7,69
7
26,92
6
23,08
9

34,62
26
BMV
0
0
2
10,00
3
15,00
4
20,00
6
30,00
5
25,00
20
RLNT
0
0
0
0
2
12,50
2
12,50
3
18,75
9
56,25
16

NNK
1
9,09
1
9,09
0
0
2
18,18
2
18,18
5
45,46
11

2

9

14

26

30

35

116
Nguyên nhân
Nam



n
%
n
%
Bnh lý van tim
16
37,21
27
62,79
43

17
65,38
9
34,62
26

12
60,00
8
40,00
20

14
87,50
2
12,50
16

Nguyên nhân khác
10
90,91
1
09,09
11

69

47

116
489
nh Kim Gàn, Nguyn Phú
Quí, Phm Ngc 2.

                
  -   






 10], [11]. Theo

khác [9 ProBNP cho phép ta

71011
Theo NY



 


   




- Trên X Quang: 


suy tim là 62% , 67%, 32% [15]. 

5.
- Siêu âm doppler tim:

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[15], [17]
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 
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
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915.

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
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                 
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490
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

13.


1.

15.
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- 
 
50  
 
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
- 


 
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- 
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
-                  

-  
  

5.2. Nguyên nhân suy tim
- 

491


- Cho dù nguyên nhân gây ra suy tim 

- 






- 

- 
tính.


1.  
1999: 6  11.
2. Hunh Kim Gàn, Nguyn Phú Quí, Phm Ngc ng và CS (2008),   NT-
ProBNP  bnh nhân suy tim mn tính, Hà Ni 2008.
3.  Minh (2006), Suy tim,  
 30.
4.  - Khoa Y
-  65.
5. ), Suy tim, 
2007: 393  427.
6.   Hà
 63.
7. 
.

8. V ình Hi, Nguyn Th Trúc, Tr Trinh, Phm Nguyn Vinh (1998),  suy
tim, K yu toàn v tài khoa hi hi Tim mch hc Quc gia ln th VII ,
t 1998: 26 - 32.
9. American Heart Association (2009), Heart disease and Stroke statistics, Journal of The
American Heart Association: 81  82.
10. Barbara G.Wells, Joseph T.Dipiro, Terry L.Schwinghammer, Cecily V.Dipiro (2009), Heart
Failure, Pharmacotherapy handbook ,The McGraw-Hill Companies, Inc, USA: 82  97.
11. Eugene Braunwald (2005), Heart Failure and Cor Pulmonale,   
Internal Medicine, The McGraw-Hill Companies, Inc, USA: 1367  1378.
12. John D.Bisognano, Mark L.Baker, Mary Beth Earley (2009), Systolic Heart Failure,
Manual of Heart Failure Management, Department of Medicine, Cardiology Division,
University of Rochester, Rochester, NY, USA: 49  57.
13. Kalon K. L.Ho, Joan L.Pinsky, William B.Kannel, Daniel Levy (1993), The
Epidemiology of Heart Failure, The Framingham Study, J Am Coll Cardiol: 6A  13A.
14. Mario J. GARCIA, Diastolic heart failure, A clinical quandary, Patient Care 200: 13-24.
15. M. R. Cowie, A. Mosterdft, D. A. Wood, J. W. Deckers, P. A. Poole-Wilson, G. C. Sutton and
D. E. Grobbeef (1997), The epidemiology of heart failure, European Heart Journal: 208-225.
16. Marjorie Funk, Kerry A.Milner, Harlan M.Krumholz (2001), Epidemiology of Heart
Failure, Improving Outcomes in Heart Failure, Aspen Publishers, Inc, USA: 3  15.
17.       Specific Disease - Related Problems in
Diastolic Heart Failure, Diastolic Heart Failure, Springer  Verlag London: 243 - 271
18. Russell J Greene, Norman D Harris (2007), Heart Failure, Pathology and Therapeutics for
Pharmacists, 186  208.
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