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TR

Chuyeen ngành
: NT 62.72.20.50

N

THÁI NGUYÊN

2015


i
L
c hi n t i
B nh vi
n

i gian h
nh vi n

-

ih
pv ib tk

li u trong lu

a
c

trong b t k m

Nguy


ii
L IC
Trong su

c t

nhi u s

,t

c

u ki n c

p th

ng nghi p.
l ic

c t i:

ng

o b ph
ih c

i h c

u ki n thu n l
ct

u.
ih cY
yb

su t th i gian h c t

u ki

u.

c bi

c t i:

PGS.TS Nguy n Ti

ih cY
i

ng ngay t

ib

i th

u h c BSNTBV.

-

c B nh vi

ng B
ng d
t

ng

ih
ng d

c

u.
TS .Nguy n Tr ng Hi u

khoa

ng khoa Tim m ch B nh vi
ng B

h

-

r t nhi u th

ct

i th y tr c ti
b

i
ng d
ng d

ct
c t i:


iii
TS .Ph
trong B

ng d y, t

u ki n t t nh t

ct

u.

m
trong h

c

ng ch m lu

p th

hoa N i Tim m ch

B nh vi

p th th
n Tim m ch Vi t Nam, Vi

nhi

,t

ng d y,

u ki

c t p.

Cu

ct ib m

nh

ng nghi
ct

Nguy


iv
DANH M C CH
ACC

VI T T T
ch Hoa k

(American College of cardiology)
ADA

: Hi p h

ng Hoa k

(American Diabetic Association)
AHA

: H i tim m ch Hoa k
(American Heart Association)

ASE

:H

ch Hoa k

(American Society Echocardiography)
BMI

: Ch s kh
(Body mass index)

BN

:B

CABG

: B c c u n i ch
(Coronary Artery Bypass Grafting)

CCS:

: H i tim m ch Canada
(Canadian Cardiology Society)

CCU

c pc
(Coronary care unit)

CVD

: B nh tim m ch
(Cardiovascular disease)

CHD

:B

ng m

(Coronary heart disease)
ESH

:H
(European Society of Hypertension)

ESC

: H i tim m
(European Society of Cardiology)


v
EF

:P

(Ejection fraction)

tt

Dd
Ds
ng m

t ng

nh
ng

HDL-C

: Lipoprotein Cholesterol t tr ng cao
(High density lipoprotein cholesterol)

HCMVC

: H i ch ng m

p

HATT

: Huy

HATTr

: Huy

LDL-C

: Lipoprotein Cholesterol t tr ng th p
(Low density lipoprotein cholesterol)

LAD

ng m

c

(Left anterior descending)
LCX

ng m
(Left circumflex artery)

LV

: Th
(Left ventricle)

LVEF

tt

a th

(Left ventricular ejection fraction)
h th
(Left ventricular end diastolic diameter)

(Left ventricular end systolic diameter)
MSCT

:Ch p c t l

(Multislice computer tomography).


vi
NMCT

: Nh

NMCTSTC : Nh
NMCTKSTC : Nh
PCI

: Can thi

ng m

(Percutaneous coronary intervention)
PAD

:B

ng m ch ngo i vi

(Peripheral arterial disease)
ng m

i

(Right coronary artery)
RLNT

: R i lo n nh p tim

SPECT

:X

tl p

(Single photon emission computed tomography)
THA
TT

: Th

Vd

: Th

Vs

: Th

YTNC

:Y ut

WHO

: T ch c Y t th gi i

WPW

: H i ch ng Wolf- Parkinson- White


vii
M CL C

......................................................................................... 1
................................................................... 3
........................................... 3
1.2.

......... .8
.... 12

1.4.

....... 26

1.5

............................................................ 27
:

.... 30
..................................................................... 30
..................................................................... 31
................................................................ 31

........................................................ 31
......................................................... 33
................................................................. 45
46
.................................................................................. 47
....................................................................... 47
............................................. 50
.................................... 50
.................................... 50

............................................. 59
.................................................................... 64


viii

....................................................................................... 64

.................................................................... 71
........................................................................................... 77
1.
...................................................................................... 78
2.
............................................................................ 79
................................................................................... 80
..................................................................... 81


ix
DANH M

i ............................................... 4
............................................... 6
Vs theo Teicho.

41
41


x
DANH M C BI U

................................................ 50
.......... 54
................................................ 58
.... 60
..................................................... 63


xi
DANH M C B NG
............11
....................................... 16
(
............................................................................ 17
............................................................ 17
..................................... 18
................................. 18
....................................... 19
B ng 1.8. Ch
B

................................................................. 23
i ch s kh

i

............................................................................................................ 33
B
VIII ................................................................................................................. 33
B

nv

t ng c theo h i tim m ch

Canada............................................................................................................ 34
B

nv

B

Killip

b

.................... 34

nh r i lo n chuy

ESC/ESH 2013............................................................................................... 35
B

nv

tc ac

b nh

....................................................................... 35
B ng 2.7.

i t n su t t

ACC/AHA 2013............................................................................................. 36
B

nv

ng c

tim................................................................................................................... 36
B

t

B ng 3.1. T l b
B

ng m

.... 37

u........................................ 48
m v tu i, gi i c

u................................ 48


xii
B

m v ngh nghi p .............................................................. 49

B

m v th tr ng c

B ng 3.5. S

................................................ 49

ut

c can

thi p ................................................................................................................ 50
B

ng c

u..................................... 51

B

m v m t s tri u ch ng th c th

B

m tr s huy
i ch ng m

c can thi p............. 52

ns

nh

p...................................................................... 52

B

killip c a

B ng 3.10. K t qu
B ng 3.11

a

u ........ 53

u .......................... 53

m v nh

B ng 3.12. M

ng

....................................... 54
a th

B ng 3.13. V

n vi

ng m

i lo n nh p tim ........ 55

............................................... 55

B ng 3.14. M c

t

u ......................... 56

B ng 3.15. M

t

u.......................... 56

B ng 3.16. M

t

c

B ng 3.17. S

t

B ng 3.18
b

u ......................... 57
c a

u.................. 57

m r i lo n v
i ch

B ng 3.19

p....................................................................... 58
iv

cc

c

sau can thi p ................................................................................................... 59
B ng 3.20

pc

B ng 3.21. T l b
huy

u ........ 59

i thi n v
p .................................................................................... 60

B ng 3.22
B ng 3.23. K t qu ki
B ng 3.24. S
p sau can thi

p.......................... 61
t s YTNC sau can thi p .......................... 61
ab

i ch ng

................................................. 62

xiii
B ng 3.25. S
c p sau can thi
B ng 3.26. Ch s E
gi

i th

ab

i ch

......................................................... 62
pc

c can thi p....................................................................................... 63


1
TV
B
,

[18],

[15].

(
(

p

N

(NMCTSTC)

(NMCTKSTC
nh (

[30], [67].

a HCMVC

[60].

[49], [65], [71].

(
(CABG),

.
qua da

[27]. K

i
(
tim
[4], [52], [53], [81], [83], [85],

i


2

Hoa K

[7], [31]

[64].
C

iB
(

u:
qua da

1.

2.


3

1.1.

c

[16], [30].
1.1.1.

t
(

-300

.

,
T

2% (

(

,

(

p
[15]. Qua


4
1.1.2.

[15]

(LAD)

(

*

tr

[13].
+
(

(


5

(

-

-

-

45-

(

(

*

(Right coronary artery-RCA)

(
(


6

[13].

+

(

-


7
1.1.3.

-

.

(
(

(

c l i, s

a

ch

a, b o v
cc am

a, ch ng l i s v .

tr m tr ng c a h
b t

am

b t

a. Nhi u m

ad

nh ch p m
c nh

c am
a HCMVC

i,

nh

.
(

.


8

p sau

.

:D

m

ra

ng.

1.2.

h

1.2.1.
-

gi

(THA):
nh nh

i th m l ng,

n c tim m ch

thu

c [32], [48]

cl p
i ta th

ch t ch gi a THA v i NMCT, tai bi n m
th nghi m l n v
l b

n.Nh ng

u tr THA cho th

cc

l t vong do b nh tim m

nh

sinh ch y

, b nh tim thi

b , suy tim, suy th n.
bi

u tr

nt

i th

[36].Vi

c

p h i tim m

ng s

[63]

i th
u tr

c

n ch

m kho

t qu

[9]

ng
ng t i

c c ch men
chuy

c ch th th

c khuy

d


9
u
[30], [36], [84].
:

r

t qu

tt

ng minh

n

[23]. T b thu
c

p5l n

c b nh s gi

it

n gi

c

ng th i m

g

i

(

-1

,

l t vong do m

i ta th y r

p3l n

i 25-79

[51],

t
ng m ch [78], [72]

u thu

in

ng th
nh h

i ta th y r ng nh p tim

m ch
ng x

nc

n huy

ct

i lo n ch

m cm

uc u

at

t m ch d

t kh i [48], [63], [76],thu
[72],

-

i

nd
ca t vong

u thu
nh m (
ch s gi

tn

t n a[86], vi c b thu c s

ms

ng thu c

m t l t vong do m

[39],[50], b thu c s

h i ch ng m ch

p

[73].
- R i lo
m

: R i lo n chuy
ut

b nh tim m ch [39], [48]
tr

ng b c nh t c a
n bao g

n quan

cao (HDLth p (LDL-C). HDLi LDL-C

ng
ov

y m nh m

ng m ch, vi

ch,


10
gi m LDL-C s

n c tim m ch [34], n u gi m HDLng m ch [26]

ut d

n c tim m ch [24]. C
ng m
gi

-C s

p x 1% b nh

[55]. M

khi

c 1 mmol LDL-C s gi m 9% t vong do m

25% bi n c m

b

p [83]

theo t ng quan t

y gi m 1mmol LDL-C s

m 14% t vong do m

m 25% bi n c tim m ch,

gi m 38% t l ph

[79].
:

n

ng m

c bi t

b b

t q y ngay c khi

tk y ut
(

m

i ta th y r

d

ch [86].

m t lo

ut

ng m

i
nh tim m ch bao g m:

i lo n dung n
triglycerid, gi m HDL-

[29], [80].

-

i lo n dung n p glucose: Nh

b

c bi

m

t qu

i m c

l m i m c b nh
ng. B nh c
ng

ng m ch, h u qu
c

[40]

n ch ng
vong do m

[66].

nh


11
B

t h u qu c
a vi c ki

%
HbA1C [25],
[37]
HDL-C [26]

PAD
Triglycerid

14% (nam)

[43]

(

-

LDL-C [55],
[79]

[32]

% CHD

(HATT)

1.2.2.
- Tu i: Nam > 55 tu i, n > 65 tu
t

ch c a b

c tim m ch, y u

ng m

i 10 tu

ng m ch v
huy

ng [55].
- Gi

m

nt

: Nam gi

b
i n gi i

tu i tr [69], t

tq y
c tu

nh tim