NGHIEN CLfU LAM SANG
Nghien ciiU, danh gia tmh hmh roi loan nhip that tai Benh vien Da khoa tinh Quang Ninh
trong 2 nam (2012-2013)
TS.BS.CKILNguygn Hdng H^nh*, BS.Phan Thanh Nghia**
*Tnjdng cao dang y te Qudng Ninh
" B e n h vien Da khoa tinh QuSng Ninh
TOMTAT
Nghien cufu 199 benh nhan (BN) roi loan nhip thjit ( R L N / T ) tai BW)K tinh Quang Ninh trong 2 nam 2012-2013, phtidng phap nghien ci5fu m o ta lam sang co can thi^p di^u tri, khong doi chiJng, ti|fn a i u . K a qua nghien Cliu: Ty le R L N / T l i 4,2%, tu6i mSc 66,25± 13,81nam (17- 94 tuoi), nam nhieu hcfn niJ. Cac b^nh tim m^ch gay R L N / T hay gap la THA, suy tim, b^nh mach vanh ( N M C T cap, thi^u nang vanh m ^ tinh), benh cd tim dan. Cac R L N / T thifcfng gap la N T T T (95,97%), chu y^u la dp 1 va dp II, hay gap d thit phai, cac chi s6 khoang ghep, phiic bp QRS Clia N I I T cua 2 that khong co sU khac b i ^ Cac cOn T N T tyle it hdn N T T T (5,52%) hay gap la cdn T N T ddn dang, da dang, that phai gap nhilu hdn that trai (64,71%), kh6ng c6 sd khac biet ve tan so, thcri gian chu ky cd ban, QRS cua cdn T N T phai va cdn T N T that tr^.
Ty le xuat vi$n 93,47%, ty 16 dieu tn tot (h^t N T T T va cdn T N T ) la 78,89%, ty le dieu tri khi va trung binh (con N T T T thiia, cat cdn T N T ) la 14,57%. Ty le tii vong ehung la 6,53%. Cic R L N / T gay tii vong la rung that, cac cdn T N T da dang, kich phat, k ^ h^p v6i suy tim nging dO III-IV Cac thuoc dieu tri R L N / T co hieu qua: Lidocain, Cordarone, Betaloc. S6c dien d p ciiu CO hi$u qua t6t v6i rung that, cdn T N T da dajig, kich phat.
OAT VAN DE (XD), cuong tiilt (CT), rung tiilt (RT). Nghi^
Roi loan nhip tiilt (RLN/T) la bien chiing ciiu aia Vien tim m,eh VietNam eho tiilytyl^ tfl
• L. . . u . i - l - ' L- u • r > - voncdoRLN/Ttirone2nanil999-2000la39,2%
va hau qua thtiong gap cua benh tim mach va cac ,. ., ° ° 1 . , , , , I T . J ^ . T>TXT/'T-i- 5 [3i.Hientaid\letNameiinechvfac6mptnghien benh khac khong do tun gay ra, RLN/T la nguydn , , j
1.- I.- J ' • ^-^ r. T>vT .^i_ J ' 1* Cliu thong; ke toan quoc vl tyle mac va tii vong do nhanhangdaugaytitvongchoBN,tiieotiiongke ° ^ ' ' * A.TL^-U' - ' u * L L- ._•. " t . - T- RLN/T. Vl tinh chat thiicfng cap va nguy hiem oia d My hang nam so benh nhan tii vong ngoai benh o o • r o /
•'• J DixT/T I' innnnr, ..-irtnnn T>XT/ - RLN/TvataitiuhQuangNiiihchodeuhi^Huay vien do RLN/T la 300.000-420.000 BN/nam ' . *<. 6 v / [1], Cac RLN/T bao gom: ngoai tam thu that chtia co-ghi^n oiu nao v« RLN/T nen ehung t6i (NTTT), thoat thit (Ventricular Escape), song « " h a n h nghite oiu de tai:
tim thu that (Ventricular Parasystol), nhip tU that " N ^ e n c*i, danh gia tinh hinh r6i loan ccfn am nhanh that (TNT) bao g6m: TNT khong ""HP * « tai Benh vite Da khoa linh Quing bfa bi, TNT ben bi, TNT dtfn dang, TNT da N ' " * t™"? ^ " * " 2012-2013"
dang, TNT hai chieu (bidirectionVT), xoan dinh Nham muc tieu:
170TAP CHi TIM MACH HOC VIET NAM-SO 58.2014
NGHIEN CLfU LAM SANG t^
Ddnh gid ddc ^im ldm sdng, can ldm sdng vd kit qua dieu tri r6i loan nhip titdt tm Binh viin Da khoa tinh Quang Ninh trong 2 ndm 2012-2013.
BOI TUDNG VA PHl/DNG PHAP NGHIEN CUU D d i ttitfng n ^ ^ e n cuTu
-199 BN dti^e chan doan, dilu tri RLN/T tai khoa tim mach cua BVDK tinh Chiang Ninh tii thing 1/2012-12/2013. Cac BN dddc kham lam sang tim mach, lam cac xet nghiern sinh hoa mau, huyet hoc, ntidc tieu thticJng quy, ^ dien tam do thticftig quy 12 chuyen dao nhieu lan de chan doan va theo doi dien bien cua cac RLN/T, sieu am tim doppler mau 2D, difdc ghi Holter dien tim neu CO cac RLN/T dioang cjua. Tieu ehuan loai trif:
Nhui^ BN khong co RLN/T, khong tii nguyen tiiam gia vao nghien e i ^
P h i i f f t ^ p h ^ n g ^ e n cda
- Phiftftig tien ng^en ciiu: may dien tam do 12 chuyen dao cua Nhat ban hai^ Nihokondent, may sieu am doppler mau 2D ehuyen tim mach hangCE (My), may Holter ghi dien tim 24 gicf, 12 kenh ciia hang Rozine-Electries (My).
- PhiitJng phap n ^ e n ciiu: N ^ e n ctiu mo ta lam sang co can thiep khor^ doi chtiig, tien ctiu 100%. Cac thdng so ket qua nghien cthi dtitfc xfi ly bang eae thuat toan thong ke tren phan mem SPSS phien ban 16.0. Dia diem nghien cAi: Khoa tim maeh B \ ^ K tinh Quang Ninh.
K f r QUA NGHIlN COU VA BAN LUAN Dac diem ehung cda n h o m n ^ i i e n CDCU -199 BN CO RLN/T dtide kham, chan doan, dieu tri tai BVDK tinh Quai^ Ninh trong 2 nam 2012-2013 (diangl/2012-12/2013). Tyle BN CO RLN/T SO vcfi tong s6 BN noi khoa la 4,2 %, ty le nay eiing phii h^p vdS n ^ e n Cliu khac[5]. So ngay nam vien: 9,54 ±5,85 ngay, dai nhat 30 ngay, ngan nhit 1 t ^ y
Tuoi vd gi&i
• Ty le BN nam 102/199BN (51,26%), ty le BN nd 97/199BN (48,74%), nhii vay ty le BN nam nhieu hcJn BN nii (p> 0,05). Tuoi trung binh la 66,25±13,81 nam, tuoi oia BN ni?65,74±14,98 nam, BN nam 66,76+12,64 nam, so sanh tuoi nam va nii khong eo sii khac biet (p>0,05).
Dqc diem binh ly Idti vdo viin Binh kem theo
- Cacbeiih kem theo gom nhieu Ioai: Roi loan chuyen hoa Lipid mau (19,59%), tieu difcftig typ 2 (18,66%), tai bien m^eh nao, benh tilt nieu: soi than, suy than man, benh gan mat, Hoi chdng da day ta trang, benh ho hap: viem phe quan, viem phdi, basedow, viem khc^ dang thlp.v:v. So liftfng va tifr le BN eo RLN/T co cae benh kem theo la 134/199BN (67,34%). Benh kem tiieo la nhting benh n&i, khong la benh tim mach, co tnidc khi RLN/T xay ra, hoac la bien chuiig ciia benh tim mach, eo die la benh ehinh khi vao vien. Mpt BN bi RLN/T CO the ed nhilu benh (tren 2 b|nh), nhat la nhiiiig BN cao tuoi.
Cdc chisd tim mqdi vd xetn^iem khi nhqp vi$n - Chi s6 huylt ap tam thu vi huyet ap tam tnicftig
+ Huyet ap tam thu (HATT) khi nhap vien:
139,80±26,41 mmHg, HATT trong gicft han binh thiidng, nhuiig ti^ng so nay eo 101BN(50,75%) HArTcaol4O-220mmHg.Huyet ap tam trticfng (HATTr) khi nhap vien: 81,91±11,77 mmHg, HATTr trong gidi han binh tiiifdng, tuy nhien trong d6 CO 73/199BN (36,68%) HATTr tif 90- 11 OmniI%. Kit qua nghien ciiu tren eho tiily ty le BN tang HA3T eao htfn tang HATTr
- Chi so nhip tim va dien sinh ly tim khi nhip xoang:
+ Cd 168/199BN (ty le 83,42%) khi nhap vien la nhip xoang, tan so that la 86,25±I9,45 ek/p, trong s6 nhip xoang nay ed 59/168BN (35,12%) nhip xoang nhanh tin s6 90-150ek/p va 8/168BN (4,76%) nhjp xoang cham tin sd 46- TAPCHiTIMMACH HOCVIETNAM-SO68.20141171
NGHIEN CUU LAM SANG
60ck/p, cac BN nhip xoang chim nay co chi so HATT va HATTr binh thUc(ng.Thc!i gian chu ky cd ban (TGCKCB) nhip xoang 730,88±168,02ms, dai nhit 1304 ms, ngan nhit 385ms
+ Khoang QT khi nhip xoang:
378,68±29,49ins, khoang QT trong gidi han binh thuftng. BN so 102, co QT dai nhit 490ms, nhip xoang cham tin so 50ck/p, nhiihg BN nay khong CO cdn xoin dinh.
- Cic chi so huyet hoc: Cac chi so huyet hpc trong gidi ban binh thudng.
- Cac chi s6 sinh hda
+ Creatinin mau 105,92±93,95mmol/l, chl so nay trong gidi han binh thifdng; Tuy nhien co 5BN (2,51%) bi suy thin cip va suy than man chi s6 Creatinine mau tang cao 145-1288MmoI/l.
+ Glucose mau luc ddi 7,12±3,02mmol/l, trong gidi han binh thiidng, tuy nhien cd 63BN(31,66%) Glucose ting cao 7,2-19,lmmol/I.
Nhii v^y ty 1? tieu dudng type 2 d nhom nghien aiu nay cao hdn so vdi ty le mac trong cpng d6ng[l].
+ Triglycerid m4ul,83+l,32mmol/l, c6 6/199BN (3,02%)Triglyceridtang4.9-5.6mmol/l.
Cholesterol miu toan phin 5,04±l,38mmol/l, cd 72/199BN (36,18%) Cholesterol toan phan tang 5,2-14,5mmpl/l. HDL-Chplesterol 1,25±0,44 mmol/1, co 26/199BN (13,07%) HDL-Cholesterol giam 0,3-0,8mmol/l. LDL- Cholesterol 3,03±0,83mmpl/l, co 14/199BN (7,06%) LDL-Cholesterol tang 4.1-5.2mmol/l.
+ MenCK204,91±635,73UI/l,c649/I99BN Bdng 1, Cdc loai roi loan nhip thdt thudnggap
(24,62%) men CK tang cao 143-7680UI/1.
Men CK-MB 27,19+37,39 UI/1, cd 38/199BN (19,10%)men CK-MB tang cao 26-341 UI/l.Axit Uric miu 368,44+111,00 mmol/1, cd 5/199BN (2,51%) Axit uric tang cao 437-603 mmol/1.
- Cac chi s6 Sieu im-doppler tim:
-h Khoi lUdng cd that trai (KLCTT):
186,18±47,96g, KLCTT trong gidi h^n binh thddng. Tuy nhien cd 65BN(32,66%) KLCTT tang 200-25 Ig, nhiing BN nay bi THA cd suy tim dp II-III, benh cd tim, benh van tim
+ Phin so tong mau (EF%) la 55,03±13,22%, trong gidi ban binh thiidng, nhiing trong sd nay cd 42BN (21,11%) cd EF% thap 22-45%, nhflng BN nay cd suy tim dp III-IV do THA, benh cd tim dan, thieu nang vinh va b^nh van hai li vi van DMC.
Dac di^m roi loan nhip that Benh tim mach
+ Sd Ilidng va ty IS THA la cao nhit 120/199BN (60,3%), ti«p sau la cic bSnh suy tim do cac nguyen nhan 77BN (38,69%), thilu nang vinh man tinh 38BN (19,10%), bfnh cd tim danlSBN (9,04%), NhSi miu cd tim cSp (NMCTC) 15BN(7,54%), benh van tim (van hai li, van DMC) MBN (7,03%), Suy tinh mjch chi dudi 2BN (1%), Phinh tich d^ng mach chu IBN (0,5%), Hpi chiing suy ndt xoang benh 1^
1BN(0,5%)
- Benh tim mach thiidng gap li nhiing benh nen, man tinh hoac cap va la nguydn nhin giy ra
STT 1 2 3 4 S 6
Cac loai r6i loan nh|p that Ngoai tam thu cac loai Con TNT ddn dang Cdn TNT da dang va xoan dinh Rung that
Nhip tu thit Thoat that
S6 Ilidng v i t ^ l £ % 191/199(95,97%) 11/199(5,52%)
3/199(1,5%) 2/199(1%) 3/199(1,5%) 1/199(0,5%)
172ITAP CHi TIM MACH HOC VIET NAM-SO 68.2014
NGHIEN CUU LAM SANG .
nhiingRLN/T.Sohitfngvatylel BNcdtren2benhtimniaehla55/199BN (27,64%), nhifBNsd 123, 127,146 TW. Hep hd van hai la, tang huylt ap.w.
Cdc rdi logn nhip thdt
Cac RLN/T xuat hien ngay khi nhap viem 159/199BN (79,90%), cac RLN/T xuat hien sau vao vien la 40/199BN (20,1%). Thdi gian xnat hien RLN/T sau vao vien: 23,8 ±67,02 gid, lau nhat la 568 gid, nhanh nhit la 1 gid.
Cdc loqi rdi loqn nhip thdt
- Ket qua bang 1 cho thiy: NTTT ehiem tyle cao nhat 191BN (95,97%), edn TNT dtfn dang 5,52%
tiioat that gap IBN (0,5%). IBN co the xuit hien nhilu Ioai RLN/T (BN s6 87 dau tien xuat hien NTTT, sau do Hiat hien ecfti TNT dtfn dang, roi rung tiiat va tnidc khi td vong xuat hien nhip td thit) (Bai^ 1 trang 172).
Ngoqi tdm diu thdt
- Dae diem ehung cua ngoai tam thu t h a t ( N ' i n ) Bdng 2. Phdn loqi Ngoqi tdm thu thdt theo Lown.B
STT 1 2 3 4 5 6
Mdc do ngo^i tam thv that Ngoai tam thu that dd 1 Ngoai tam thu that dp 11 Ngoai tam thu that do III Ngoai tam thu that dp IVa Ngoai tam thu thit dp IVb Ngoai tam thu that dp V Tdng
SaIiiiyngTat^l$%
150/195(67,36%) 45/195(22,95%)
1/195(0,51%) 11/195(5,61%) 6/195 (3,06%) 1/195 (0,51%) 195(100%)
So lieu d bang 2: Phan loai miic dp i^uy hiem cua NTTT theo Lown B ciia BN[4] thi so BN cd NTTT la 195BN, tdng sd 6 NTTT la 199 6, so BN cd 2 d NTTT la 4/199BN (2%). Khoang ghep cua 199 6 NTTT la 461,71±74,37ms (24O-760ms). NTTT dp I phd bien nhit 150/19SBN (67,36%), sau din la NTTT dp a (22,95%), cd 1 BN (0,51%) xuat hien NTTT dp V (hien hidng R/T). Kit qua nghien oiu cua ehung tdi phu hdp vdi mpt sp nghien ciiu trpi^ nUdc[6].
- Die diem dien sinh Iy cua ngoai tam thu thit phai vi thit trai:
+ Ty le va sd hidng S i^oai tam thu that phii (NTTT?) la 137/199 6 (68,5%), ty le va so Iddng 6 i^oai tim thu thit tiii (NTTT/T) la 62/199 d (31,5%). Khoang ghep trung binh cua NTTTP:
463,07±73,44 ms. Phiic bp QRS cua NTTTP la 133,06 ±21,32 ms (100-200ms). Khoang ghep trung binh cua NTTT/T: 4«l,63±80,S2ms. Phiic bd QRS cua NTTT/T li 128,47±22,13 ms (105-200ms).
Bdng 3. So sdnh ddc diem ngoai tdm thu thdt phdi vd ngoai tdm thu thdt trdi
Dac diem di^n sinh Iy Khoang ghep (ms)
QRS (ms)
NTTTP (n=137) 463,0"=-3,44 133,06 ±2132
NTTT/T (n=62) 461,63 ±80,52
128,47*22,13 P
>0,05
>0,05 TAP CHi TIM MACH HOC VIET NAM-SO 68.20141173
s. NGHIEN CUU LAM SANG
Kit qua nghien ctJu bang 3 la so sanh NTTTP va NTTT/T ve khoang g^ep va phdc bp QRS eho thay khong co sti khac biet (p > 0,05). Nghiin cdu cua Pham Qu6c Khanh va eong sii eung cho kit qua tiftfngtif[4],[5].
Cdc cdn tim nhanh thdt
- Dac diem ehung cua cac ctfn tim nhanh that (TNT)
+14 BN ed 17 TNT, CO 2BN CO 2 loai etfn T N T xuat hien tiieo thdi gian (BN so 36 luc diu la TNTP khong bin bi, mot d?ng, sau dd xuat hien xoan dinh). Cac ctfn T N T diu xuit hi^n tren BN eo benh tim thtic t6n[5], [6]: NMCTC, benh ctf tim dan co suy tim dp III, THA cd suy tim dp III-IV .w. chi ed IBN khong co benh tim thiic t6n, hi Viem niem mac da day (BN so 198). Thdi gian xuat hien TNT sau NTTT trung binh la 27,39±49,50 gid (xuit hien sdm nhit ngay sau NTTT trong gid dau tien, ctfn TNT xuat hien mugn nhit la sau 168 gid). Tan so that trung binh cua edn T N T la 191,59+73,40 ek/p(lOO- 375ek/p). TGCKCB eua cdn TNT la 358,35±119,32ms (l60-600ms). Phdc bp QRS cua ctfn TNT la 154,71±42,74ms (ll0-240ms).Ty le edn tim nhanh tiiat phai (TNTP) la 11/17 (64,71%), tyle cdn tim nhanh tiilt ti-li (TNT/T) la 6/17 (35,29%)
- Dac diem dien sinh ly cda ctfn TNT phai va ctfn T N T trai Bdng 4. So sdnh dqc diem di$n sinh ly cua TNTP vdi TNT/T
Dac di^m dien sinh ly Tan s6 that (ck/p)
TGCKCB QRS (ms)
T N T P ( n = l l ) I99,09±77,01 344,73± 106,23
152,73+43,15
T N T / T (n=6) 177,83±70,91 383,33±147,74
158,33±45,79
P
>0,05
>0,05
>0,05 Ket qua bang 4 cho thiy: cic cap thdng sd tan
sd that, TGCKCB, thdi gian QRS cua cdn TNTP va cdn T N T / T khdng thay cd sii khic bi^t cd y nghia thdngke(p>0,0S)[l],[2],[5]
- Die diem dien sinh ly tim cua cdn TNT da dang va cdn TNT ddn dang
+ Cdn TP*T da dang: sd lUdng 3 TNT, Tan s6 that 26433±lll,59ck/p (nhanh nhit 375ck/p, chim nhat 176ck/p). TGCKCB: 273,33+98,66 ms (160-340ms). Phiic bp QRS cua TNT da dang 200,00±4O,00ms (160-240ms).
+ Cdn TNT ddn dang: S P Ilidng 11 cdn TNT, tan sd that 16S,27±35,77ck/p (nhanh nhit 250ck/p, cham nhit 115ck/p). TGCKCB:
388,36±82,57 ms (240-520ms). Thdi gian QRS Clia cdn TNT da dang 137,27±37,97ms ( 110- 240ms).
Dac diem dien sinh ly cua nhip t^ that
Cd 2BN hi nhip tti that gia tdc: Tan sd thit 62,50 +17,68ck/p(50-70ck/p). TGCKCB 1000,00±282,84ms(800-1200ms). Phiic bO QRS: 180,00±28,28ms(160-200ms). 2BN nay hi NMCTC tnidc rpng, xuit hien NTTT/T sdm chum ddi, tiep thep la xuit hien rung that, cudi cung xuit hien nhip tii thit va tii vpng.
Cac rdi loan nhip tim khac kem theo Rung nhi
-Sdliidngvatyle33/199BN (16,58%), tin sd nhi 366,64+40,24 ck/p. Tan so thit 106,48122,44 ck/p (62-133ck/p). BN s6 162 cd tan sd that 62ck/p, cd nhit thoat that, hi H / C suy niit xoang benhly
BlSc nhi-thit (BIocAV)
Ty Ie 4/199BN (2,01%) Bloc AV: Bloc AV capIcd3BN,BlpcAVcapmcp IBN (BNsd 162 tan SP nhi lOOck/p, tin sd thit la 26ck/p, khoing 174ITAP CHiTIM MACH HOC VlfT NAM-SO 68.2014
NGHIEN CUU LAM SANG ^.
ngifng tim 2,32s, TGCKCB la 2307,69ms, chi dinh dat Pacemaker CRT).
Ctfn tim nhanh Iddt phdt trin that BNs67, Tan so that 150ek/p, xuat hien sau NTTT 12 gid, TGCKCB cua ctfn tim nhanh tren thit la 400ms.
Nhip h^ ndi gida gia tdc
Cd 2 BN so 81, xuat hien sau NTTT 384 gid, tan so 95ck/p, TGCKCB 630ms, thdi gian ton tai la 3,2s.
BN sd 126 tan so tiilt 83ek/p, TGCKCB 720ms.
Dieu tri rdi loan nhip that
- Thdi gian dilu tn trung binh la 9,01 ±5,67 ngay. Dieu tri NTTT thiia: Cordarone uong lieu 200-400mg/24 gid, nlu cd nhip xoang nhanh kit h ^ vcft chen p giao elm Betaloc lilu 25-50mg/24 gid. VtA NTTT nhip ddi chum, R/X ed dia thieu nang vanh, thu6e Ida ehpn dau tien la Lidocain/
TM 80mg/lan, sau do cdng co duy tri bang Cordarone uong 200-4O0mg/24gid[l].
- Cae edn TNT khdi dau la Lidoeain/TM 80mg/lan hoac Cordarone/TM lieu 300mg/24 gid, nlu eat dtitfc ctfn TNT tiii duy tri va cung co bang Cordarone uong 200-400mg/24 gid, neu nhip xoang nhanh, chi s6 EF% binh thifdng co thieu nang vanh ket hdp thim Betaloc uong lilu 25-50mg/24 gid[6]. Soc dien cap edu khi ed rung that, ccJn TNT da dang eo tut huylt ap lilu soc: 2 nhat soc 200w/s vdi IBN.
- Dieu tri nen suy tim dif III-IV: Digoxin lilu 0,25mg/24 gid vdi nhiing BN cd EF <40%, bu dien giai Kali, Magne, chong dong mau Sintrom, Aspirine 80-100 mg/24 gid, Idi tilu trofurit 40mg/24 gid. Dilu tri rung nhi nhanh: Nlu cd suy tim EF% diidi 50% dimg Digoxine lieu 0,25- 0,5mg/24 gid, duy tri each nhat 0,25mg/24 gid. Neu rung nhi nhanh vdi EF% binh thtidng dimg Cordarone 400mg/24 gid sau dd duy tri lilu 200mg/24 gid, kit htfp vdi Betaloc lilu 25- SOmg/24 gid neu dap ting cham vdi Cordarone.
-Tyllxuatvienl86/199BN (93,47%), Tyle dieu tri tot (hit NTTT) la 157/199BN (78,89%), ty 1? dilu tri kha(c6n NTTT thtfa, eat diidc ecJn TNT) la 29/199BN (14,57%).
Tdvong
Ty le hi vong ehung la 13/I99BN (6,53%), Nguyen nhan tfl vong la NMCTC hay gap nhit la 8/13 BN (61,54%), THA bien chdng suy tim dp UI-IV, IBN bi Basedow bien chting suy tim IV, TBMN cd 2 BN, 1 BN bi HHoHL va Osier, suy tim dp I\^ IBN hi thieu nang vanh man tinh va viem phtic mac.
KETLUAN
Nghien cdu ti-en 199BN cd RLN/T td Benh vien Da khoa tinh Quar^ Ninh trong 2 nam 2012- 2013 ehiing toi nit ra mdt s6 kit luan sau
Dac diem Iim sing vi can Iam sang cua benh nhan roi loan nhip that
- Dp tuoi mac RLN/T la 66,25±13,81nam (17-94), nam nhilu hdn nii, tyle RLN/T la 4,2%, ty 11 NTTT la 95,97%, ty ll ctfn TNT la 5,52%.
- Nguyen nhan thifdng do cac benh tim maeh: THA, suy tim, benh maeh vanh, benh ctf tim dan.w. Cac benh kem theo hay gap la tieu diidng type 2, rdi loan chuyin hoa lipid miu, tai biln maeh nao w . Cae RLN/T thtfcftig gap nhat:
NTTT (95,97%), chu ylu la dp I va dp II, hay gap d that phai, eae ehi so khoang ghep, phiJc bp QRS eua NTTT cua 2 tiiat khong cd sii khac biet. Cac edn TNT hay gap la ccfn TNT ddn dang, da dgmg, thltphai(64,71%) gap nhilu htfn thit trai, khong ed sii khac biet vl tan so, TG CKCB, QRS cua cda TNTP va ctfn T N T / T
Ket qua dien tri cac rdi loan nhip that - Ty le xuat vien (93,47%), trong do ty 11 dieu tri tot (hit NTTT va etfn TNT) la 78,89%, ty le dieu til kha (eon NTTT thiia, cat ctfn TNT) la 14,57%.
Cae thudc dieu tri RLN/T ed hi|u qua: Lidocain, Cordarone, Betaloc Sdc dien d p eilu cd hieu qua tot vcfi rung tiilt, ccfti TNT da dang,kieh phat
- Ty le td vong ehung la 6,53%, cae benh tim maeh thiidng gly tfl vong la NMCTC (61,54%), THA biln chting suy tim dp III-IV, benh mach vanh, benh ed tim dan, benh van tim, Cac RLN/T gay tfl vong la nmg thit, cac edn TNT da dang, kich phat.
TAPCHiTIMMACH HOC VIET NAM-SO 68.20141175
NGHIEN CLft LAM SANG
ABSTRACT
Objective: Evaluate the clinical characteristics, preclinical and clinical outcomes of 199 patients were suffer from ventricular arrhythmias in Quang Ninh Provincial General Hospital during two years 2012-2013. StndyingMetiiod: research methodology is describing dinical treatment interventions, uncontrolled, prospective. Results: The rate of ventricular arrhythmias (VA) is 4.2%, median Aged 66.25 ±13,8Iyears (17-94 years), men more than womerL Cardiovascular diseases caused VA is hypertension, heart failure, coronary heart disease, dilated cardiomyopatiiy. The Common VA is Ventricular Extrasystoles (VE) (95.97%), mainly level I and level II, often seen in the right ventricle, tiie researching indexs is about couplarge. Interval of QRS of the right VE and left VE comparation no differenee(P>0,05). Conclusions: The rate of ventricular tachycardia (VT) is 5,52% less than VE. Common form of VT is monomorphic VT, polymorphic VT, but right VT more than left VT (64.71%), there was no difference in the frequency, basic cycle length, QRS interval of right VT and left VT(P>0,05). The rate of discharge from Hospital is 93.47%, rate of good tireatment (no VE and no VT) is 78.89%, and the proportion treated fairly average (VE also remained, cutting ofVT) is 14.57%. Overall mortality rate was 6.53%. The VA caused dead is ventricular fibrillation(VF), paroxysmal polymorphic VT, assodated with grade III-IV of severe heart failure. The antiarrhythmic drugs for treatment of VA has good effective is Lidocaine, Cordarone, Betaloc. Emergency Cardiodefibrillator is effective for VF, paroxysmal polymorphic VT. Keyword: ventricular arrhythmias, ventricular tachycardia, Ventricular Extrasystoles, monomorphic VT, polymorphic VT.
TAI LlfiU THAM K H A O
1. 1. AHA/ACC/NASPE (2006). "Guideline for Management of Patients witii Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of tiie American College of Cardiology/
American Heart Assodation Task Force and the European Sodety of Cardiology Committee for Practice Guidelines for Management of Patients With Ventricular Arrhytiunias and the Prevention of Sudden Cardiac Death..." Circulation Chapter, 114, pp.385-484.
2. 2. GAndreng (2006). "TreatingPatients With Ventricular EctopicBeats",Heart, 92, pp.1707-1712.
3. 3.NgayinTiinH^ (2001). Mgt so nhan xet ve tinh htnh tiivong tqi vien tim mqch VtetNam trong hai ndm 1999-2000. Luan van tot nghiep bac sy y khoa khda 1995-2001, tnidng dai hpc y Ha Npi. Ha Npi 4. 4. Leonard N.Horowitz and John Parkinson (2000). "Polymorphic Ventricular Tachycardia Induding
Torsades de Pointes, Long QT Syndrome, and Bidirectional Tachycardia in Arrhytiimias", Edited by John A.Kastor 2"''Edition, Chapter 13, Pp.415-445, WB Saunders Company, USA.
^. 5.J Thomas Bigger Jr (2000). "Ventricular Premature Beats in Arriiythmias" Edited by John A.Kastor MD, Second Edition, Chapter 11, PP.294-341 W.B Saunder Company, USA.
6. 6. Thomas Bump, Pham Quoc Khanh, Ph^m Nbif Hi^g, Ta H ^ Phiidc, Viitfng Du Ihinh (2007).
"Tim nhanh thit" mgt so vdn decqp nhqt trongchdn dodn vd dieu tri henh tim mqch ndm 2007, tr.358-402, sach dieh Tieng Viet, Nha xuat ban Y hpe. Ha Ndi.
178TAP CHI TIM MACH HOC VIET NAM - SO 68.2014
