Y HOC VIET NAM THANG 10 - SO DAC BIET/2011
NGHIEN CCrU DAU HIEU LAM SANG, CAN LAM SANG cCiA NMCT CAP DEN S 6 M .
Nguyen Thang Toan* va cong su.
DM TAT
TCr thang 8/2008 den thang 7/2011 chung toi jhien ciTu dUOc 36 benh nhan NMCT cap den sdm j'dc 6h trong do:
• Den trUdc 3h co 28 benh nhan chiem ty le 77%
• Den tCr 3-6h co 8 benh nhan chiem ty le 23%
Dau hieu lam sang dau ngUc dien hinh: 36 h h nhan (100%)
Dau hieu can lam sang:
• Dien tim ST chenh dien hinh 100%
. CK-MB: 28,30 ± 23,62
• Troponin T: 0,28 ± 0,27
• Sieu am tim: EF trung binh 48,35 ± 8,81
UMMARY:
: From 8/2008 to 7/2011 we studied 36 atients was acute myocardial infarction to 6 hours in dvance of it:
• Up to 3 hours before: 28 patients aooount for 77%
• To advance from 3-6 hours: 8 patients ccount for 23%
Clinical sign typical with^ chest pain: 36 atients (100%)
Paraclinical signs:
: • Electrocardogram: ST elevation typical 100%
. CK-MB: 28,30 ±23,62
• Troponin T: 0,28 ± 0,27
• Echocardiography: EF mean 48,35 ± 8,81
OAT V A N DE
Bihu tri tai tuoi mau NMCT cap cang jm cang t6t. Dihu tri tir nhirng gio dau tien r khi bat diu con dau mang lai kit qua kha quan.
vdn dh dat ra la phai chin doan som a chinh xac NMCT chp mai co th6 didu tn jm dugc.
Nghien cim nhOng dau hieu lam sang, an lam sang giiip cho chin doan som, chinh ac la can thiet.
Chinh \ i \ ay chiing t6i nghien cuu de tai
"Nghien cii'u nhij'ng dau hieu lam sang, can lam sang ciia benh nhan NMC'l cap den som truac 6h"
Muc tieu nghien ciiu:
M6 ta dac diem lam sang benh nhan NMCT cap den sam truoc 6h
M6 ta dac diem can lam sang ciia benh nhan NMCT dhn sam truac 6h
II. o 6 l TUONG VA PHUONG PHAP NGHIEN COU
1. Doi tuong nghien cuu:
o Tat ca cac benh nhan chan doan NMCT cap dhn sam truoc 6h
o Tieu chuin chin doan NMCT cap dua vao tieu chuin kinh dien: lam sang, dien tim va men tim.
2. Tieu chuin loai trir: benh nhan dhn mugn sau 6h
3. Phuong phap nghien cuu: Phuang phap m6 ta cat ngang
4. Thu thap so lieu: Tit ca cac benh nhan du tieu chuin nghien cuu dugc ghi vao phieu theo doi nghien ciru rieng
III. KET QUA
- Tir thang 8/2008 dhn thang 7/2011 chiing t6i thu thap dugc 36 benh nhan NMCT cip den som truoc 6h dugc dieu tri bang thu6c tieu sgi huyet, trong do:
• Nam: 29,chilm ty le 80,56%
• Nir: 7,chi6m tyle 19,44%
• Tu6i trung binh trong nhom nghien cim: 60,78 ±10,21
+ Thip nhit: 46 tu6i + Cao nhit: 81 tuoi
Diu hieu lam sang:
Benh vien Hihi Nshi Viet Tiep Hdi Phong 243
HOI NGHI KHOA HOC BENH VI$N HCTU
+ + + + + + +
Dau nguc diC-n hinh:
Dau nang: 28 benh nhan, 77,78%
Dau vira: 8 benh nhan, 22,22%
Vi tri dau:
Sau xuong irc: 20 Ix-nii nhan, 55,60%
Nguc trai: 15 benh nhan, 41,70%
Thugng \ j: 1 b(?nh nhan, 2,70%
Thai gian can dau:
20-30 phut: 3 benh nhan, 8,33%
30-60 phiit: 21 benh nhan, 58,33%
Tren 60 phut: 12 benh nhan, 33,34%
Dau hieu can lam sang:
Xet nghii^m dien tim ST chenh h"ong do:
NGHj VlfeTTlgPHAl PHONG LAN THLf 37 + Tru6c rgng: 9 b?nh nhan, 25%
+ Truoc vdch: 5 benh nhan, 13,89%
+ Sau du6i: 16 benh nhan, 44,44%
+ Truorc mom: 1 benh nhan, 2,78%
+ Thit phai: 4 benli nhan, 11,11%
+ Sau ducVi + that phai: 1 benh nhan, 2,78%
• Men CK: gia tri trung binh 207,97±
145,97
• Men CK-MB: gia tri trung binh 28,30
± 23,62
• 1 ropoin T: gia hi trung binh 0 3 ± 0^7
MenCK Men CK-MB Troponin T
Nhom < 3h ( n = 3 3 ) 207,97 ± 145,97
28,30 ± 23,62 0,28 ± 0,27
Nhom 3-6h ( n = 3 ) 260,22 ± 125,76
31,18 ±20,56 0,3 ± 0,25
P
<0,05
<0,05
<0,05
IV. BAN LUAN
Trong 36 benh nhan dugc chan doan NMCT cap den som truoc 6h, 29 nam va 7 nir. Nam gap nhieu hon nir. Nghien cuu cua chiing t6i ciing nhu cac tac gia khac.
- Do tuoi trung binh: 60,78 ± 10,21.
Nhu vay do tu6i trung binh cua NMCT cip la Ilia tu6i >60, do tu6i co nhieu yeu t6 nguy co voi cac benh tim mach.
- Dau hieu lam sang dac trung la: con dau nguc dien hinh, hay gap dau sau xuong ure chiem 55,60%, tiep den la dau nguc chech sang trai 41,70%o, dau viing thugng vj it gap 2,70%. Con dau thuomg co diu hieu kem theo (da lanh 100%, toat va h6 h6i 100%, kho tho 60%)
- ST chenh len co y nghia, thay doi 6 cac chuyen dao chiem 100%, trong do:
• Truoc rgng: 25%o
• Truoc vach: 13,89%
• Sau duoi: 44,44%
• Thit phai: 11,11%
• Truoc m6m: 2,78%)
• Sau duoi + thit phai: 2,78%
Men tim:
• Nhom benh nhan den truoc 3h: CK, CK-MB, troponin T deu chua tang
• Nhom benh nhan den tir 3-6h: CK, CK-MB, troponin T tang nhe (p<0,05)
Sieu am tim: giam van dgng viing 100%
V. KET LUAN
De chan doan som, chinh xac NMCT cip, chi can dua vao 2 trong 3 tieu chuan kinh dien la co the chan doan nhanh dugc:
1. Con dau nguc dien hinh 2. Thay d6i ECG:
• ST chenh len > 1mm 6 2 chuyen d?o liln kc^ truoc tim va chenh >2mm a chuyen dao ngoai bien
• Xuit hien song Q sau >0,04s hoac
> 1 /3 song R ke tiep
• Xuit hi?n bloc nhanh trai mod
3. Khong cin dgi xet nghiem men tini vi men tim chua kip tang va xet nghiem mat nhieu thoi gian quy gia
4. Sieu am tim co gia tri chin doan tim r6i loan van dgng vimg trong NMCT cap.
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