TAP CHf Y DUpc LAM SANG 108 ^ T i p 11-565/2016
Danh gia ket qua digu tri benh thi§u mau co* tim cue bo man tinh bang song xung kich
Result treatment of ischemic heart disease by extracorporeal shock wave therapy
Le Duy Th^nh, Ph^m Nguygn Sffn Benh vien Tmng uang Qudn dpi 108
Bdnh thieu m i u co tim cue bd man tinh la benh thudng gap, ed nhieu bien chUng nguy hiem va t y id t f l vong con cao. Tuy nhidn van cd mdt ty- Id Idn bdnh nhan van cdn trieu chflng dau ngUe sau khi tai thong ddng maeh vanh hoae khdng the phau thuat (CABG) va can thidp (PCI). Sdng xung kfch ed t h e Iam tang sinh mach mau, g i i m tridu chflng dau ngUc va chflc nang that trai. Muc tieu: Danh gia hidu q u i va dp an toan cfla dieu tri benh thieu mau co t i m cue bd b i n g sdng xung kich. Doi tugng vd phuang phdp:
Gdm 38 bdnh nhan hep da than ed dau ngUc ^ e u t n npi tru tai Benh vien Trung uong Quan dpi 108.
Dupe dieu trj bang sdng xung kfch vdi phac dd chuan: Phat xung vao vung can dieu tri vdi lieu 100 xung/diem vdi mflc n i n g lucmg 0,09mJ/mm^ t f l 3 - 6 diem/mol lan ban. Quy trinh dieu tri dupe nhac lai 3 lan/tuin vao t u i n dau tien eua moi t h i n g tai tuan t h f l 1, tuan t h f l 5 va tuan t h f l 9. Theo ddi dau ngUe, kha nang gang sdc, tinh trang khd t h d , sidu i m tim, xa hlnh tUdi m i u ed tim sau 3 t h i n g dieu tri. Kit qud:
C i c tridu chflng dau ngUe c i i thien rd ret (sd lUpng con 8,7 ± 4,9 so vdi 2,6 ± 1,7, thdi gian con dau 381,2 + 152,8s so vdi 85,4 ± 59,8s, sd lupng vien Nitrat sfl dung 6,1 ± 2,2 vien/tuan so vdi 1,9 ± 1,1 vidn/tuan, phan dp dau ngue CCS t f l 2,63 ± 0,9 so vdi 1,95 ± 0,8 so vdi trudc dieu t n . Cac mflc dp gang sflc n h u t e s t di bp 6 phut t f l 340 ± 80,3m len den 440,2 ± 79,7m, NYHA 111 cai thien nhieu (50% so vdi 23%), NYHAIV tU 7,7% xudng 0% d nhdm cd dieu tri b i n g sdng xung kich vdi p<0,05, Pro-BNP giam rd ret (tfl 2721,0 ± 3507,4pg/ml so vdi 927,5 + 1265pg/ml). Chi sd WMSI t f l 2,53 ± 0,28 xudng 1,48 ± 0,17. Tren xa hlnh tUdi mau CO tim diem trung binh ei!ia SRS sau dieu tri c i i thien r 6 r e t ( 1 7 , 6 ± 10,9 so vdi 21,2 + 12,0), SSS (11,7 + 10,5 so vdi 14,7 ± 12,1). Sd vung mat van ddng d n h d m sau dieu tri giam di ed ^ nghTa (6,5 + 3,7 so vdi 8,4 ± 4,3). Dieu trj t h i l u mau eo tim b i n g sdng xung kich trong bdnh thieu mau co tim cue bp man tinh an t o i n , khdng thay tang men tim, chUa thay c i c tac dung khdng mong mudn trong thdi gian nghien cflu. Kef/udn: D i l u tri thieu mau cd tim bang sdng xung kfch cd hieu q u i rd ret va dp an toan cao.
Ti/khod: Bdnh dong mach vanh, sdng xung kich.
Summary
Ischemic heart disease Is frequently disease with risky complications and highly mortality. However there are a large rate of patients who are unsuitable for PCI or CABG and patients after revascularization also have refractory angina. Extracoporeal shock wave therapy (ESWT) can contribute t o angiogenesis and improve symptoms of angia and left ventricular function. Objective: To evaluate the effectiveness and safety of shock wave therapy in treatment of ischemic heart disease. Subject and method: 38
Ngdy nhg,n 1/8/2016. ngdy chdp nlign 19/10/2016
Ngudi phdn hoi: Le Duy Thdnh. Email: [email protected] - Benh vi^n TlfQB 108
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY VoLl1-N"5/20l6 multilesions patiens with refractory angina were treated at the 108 Military Central Hospital, treated by ESWT with the application of 100 shocks/spot at a 0 9 m J / m m ' energy flux density for 3 - 6 spots each time, with three times per week at each series for three series at 1,5,9 weeks. The following parameters will be evaluated including symptoms of angina and the exercise tolerance, breathlessness, echocardiography and myocardial perfusion imaging after 3 months. Result The symptoms of angina decreased statistically significant (amount of chest pain from 8.7 ± 4.9 to 2.6 ± 1.7, t i m e of chest pain from 381.2 ± 152.85 t o 85.4 ± 59.8s, using of nitroglycerin reduced from 6.1 ± 2.2p/w t o 1,9 ± 1.1 p/w, CCS angina class from 2.63 ± 0.9 t o 1.95 ± 0.8. The exercise tolerance tests as six-minute walk test improved from 340.2 ± 80.3m to 440.2 ± 79.7 and NYHA class III reduced from 50% to 23%, NYHA class IV score reduced from 7.7% to 0% in group after ESWT. Pro-BNP reduced from 2721.0 ± 3507.4pg/ml t o 927.5 ± 1265pg/ml. Wall motion septal index (WSMI) decreased from 2.53 ± 0.28 to 1.48 ± 0.17. In myocardial perfusion imaging SRS improved remarkably after ESWT (17.6 ± 10.9 t o 21.2 + 12.0), SSS (11.7 ± 10.5 compare to 14.7 ± 12.1). In group after ESWT hypokinetic segments decreased statistically significant (8.4
± 4.3 to 6.5 + 3.7). ESWT is safe. No side effects and no rise of cardiac enzymes were observed with this therapy. Conclusion: Extracoporeal shock wave therapy (ESWT) in ischemic heart disease is effective and hightly safe.
Keywords: Coronary artery disease (CAD), extrcoporeal shock wave therapy (ESWT).
1 . D a t van d e
BSnh thieu mau co t i m cue bo man tlnh (BTMCTCBMT) hay benh d o n g mach vanh man t i n h va ca nhQng tCr n h u suy vanh, thieu nang vanh la nhOng cum ttr khac nhau de chi t i n h trang d p n g mach vanh bj hep d o nhieu nguyen nhan khac nhau ma ehu yeu ia do x a viJa d o n g mach. Khi long d o n g mach vanh bj tac nghen co t h e gay b&nh c5nh nhoi mau CO t i m va dan d i n tut vong. Benh mach vanh gay t i l vong cao nhat trong cac benh ly t i m mach 6 cac nude phat trien. Trong nam 2004, benh d o n g mach vanh (DMV) la nguyen nhan cua 1,6 trieu ca t i l vong hang nam d chau Au. IVloi nam co khoang 5,8 trieu trifcmg hop benh mcri mac [1]. Hien nay c6 3 p h u o n g phap dieu tri benh OIVIV g o m : Dieu tri npi khoa (dieu t n bSng thuoc t h o n g t h u d n g va dCing thudc tieu soi t o huyet), mo bac cau ehu vanh (CABG) va can thiep BUN qua da (PCI). Muc dich cCia cac p h u o n g phap nay la khoi phuc lai tuan hoan mach vanh bj t o n t h u o n g hep hoac tac, tU do duy t n va bao t o n chile nang t i m va giam t y le t d v o n g . Tuy nhien van co m o t t y le Idn benh nhan van con trieu chUng dau ngUc sau khi tai t h o n g DMV hoac khong t h e phau thuat. VI vay dieu trj thieu mau eo t i m bang song x u n g kich la m o t phuong phap dieu tri m d i ho t r d eho cac p h u a n g phap trudc do.
C d ehe b e n h sinh cCia d i e u t r i t h i l u m a u ca t i m bang sdng x u n g kich; D i l u trj t h i e u m a u c d tim bang sdng x u n g kfch la m o t can t h i e p k h d n g xam lan. Sdng x u n g kfch (Shockwave) la m o t d a n g sdng am t h a n h t u a n g t u n h u s d n g sieu a m cd nang lUdng. Chung ed bien d p ap luc cao, d p r d n g xung n h d va t a n g t h d i gian x u n g n g a n . Khi ban eae sdng x u n g kfch vao v i i n g t h i e u m a u ngay lap tile gay gian mach va gicim dau t h o n g qua vi§e khuyen khfch te bao npi m o giai p h d n g NO t i r L-arginin bdi enzyme NO synthases. NO cd tac d u n g g i a m bam dfnh bach cau vao t h a n h maeh, g i a m t a n g sinh cac te bao c d t r o n va tai eau true t h a n h maeh, Uc che n g u n g ket t i e u eau va h l n h t h a n h huyet khoi thanh mach. Sau d d NO di t U t e bao npi m d den t e bao cfl t r o n cCia t h a n h mach m a u gSy g i a n mach d d n g thdi giai p h d n g lam t a n g sinh cae y e u t d phat trien npi maeh eCia mach m a u (VEGF) t i r cac t e bao npi md, Ue che su eo thSt mach m a u t h d n g qua lam giSm thieu t u o n g tae b e n h ly giufa c i e sol co aetin va myosin, thiie day qua t r i n h tai tao collagen d npi m d mach m a u [4]. C h u n g t d i t i l n hanh d l tai nay ; nham mue dfch Bdnh gia hieu qua va an toan cia aieu tri thieu mau ca tim bang song xung kich d binh thieu mau ca tim cue bd man tinh.
IP CHl Y Dl/OC LAM SANG 1 Ol
Tap11-S65/2016
2. Ddi tiTcmg va phUomg phap
2.1.B6itUcngk Gdm 38 bdnh nhan (BN) dupe chin doan xie I bdnh tim thi^u mau cue bd man tinh ed dau ngiic, dieu tri npi trfl tai Khoa A2 - Benh vien Trung Udng Quan dpi lOBtrong thdi gian tflthing 12/2012 -3/2016.
77du chudn chgn binh nhdn
Cic benh nhan cd BTMCTCBMT khdng phfl hpp vdi can thidp hoae phau thuat bic cau vanh mac dfl da dUde cReu tn ndi khoa tdi uu nhung van cdn dau ngUc.
Benh nhan cdn dau ngUc sau khi da tai thong DMV bang can thiep hoac phau thuat bic cau va
dugc dxiu trj ndi khoa tdi uu.Tieu chuan logi trU
BN khdng ddng tham gia vao nghien cflu.
BN cd huyet khdi trong budng tim.
2.2. Phuang phdp
Nghidn cflu md ta tien cflu ngau nhien khdng ddi chflng trong 06 thang.
Phac dd dieu tn; Ll^u ehuin: Phit xung vao vflng can dieu tri vdi lieu (khdng qua 300 xung cho mot vflng thieu mau vcn" mflc ning lupng 0,09mJ/mm^).
Quy trinh dieu trj dupc nh^e lai 3 lan/tuan vao tuan diu tidn cfla moi thing, trong vdng 3 thing [10].
Theo ddi lam sang: Dau nguc (sd lupng eon, tan suat, cudng dp); sd lupng Nitrat sfl dung trong tuan; khi nang gang sflc test di bp; tinh trang khd thd.
Theo ddi can lam sing eae xet nghidm edng thfle miu, sinh hda mau, sidu am tim (sd vflng giim hoac mit van ddng); xa hinh tUdi miu cd tim (dien v i mfle dp khuyet xa cd hdi phuc). Dinh gii rdi loan vin dpng thanh theo Hdi tim mach Hoa Ky nam 1987. Ket qua phan tich xa hinh tudi mau cd tim theo hudng dan thue hanh tim maeh hat nhan cfla ASNC nam 2007 [7].
Theo ddi tie dung ngoai •^.
Xfl ly sd lieu: Cac sd lidu nghien CUM dupe xfl ly bang phan mem SPSS 16.0.
3. Ket qud
3.1. IVIptsd ddc diim chung
Bdng 1. Mdt sd dac di^m cCia cAc dot tUtfng nghien cihi
cdc dac diem Gidi Nam
NO Tuoi trung bfnh
Cacky thuat
Khdng can t h i ^ p
Cdean thiep
PCI CABG PCI +CABG
T y l § ( n , % ) 35 (92,1%) 3 (7,9%) 72,8 ± 8,8 26 (68,4%) 9 (23,7%) 2 (5,3%) 1 (2,6%)
Tudi trung binh cfla cac ddi tUpng nghien cflU la 72,8 ± 8,8 (tfl 47 den 85 tudi). Da so la nam gidi (92,1%). Benh nhan khdng can thiep chiem tdi 68,4%, benh nhan can thidp v i phau thuat bSc cau chiem 32,6%.
Bdng 2. Oac diem lam sang va cac yeu to nguy ctf
f>ac ^ I m lam sang vacac yeu to nguy ca Bau ngiic
Roi loan e h u y i n hda lipid Tang h u y l t ap Hut thudc la Dai thao dudng Nhdi mau c o t i m Beo ph)
So liforng (n) 38 38 35 30 13 19 25
Tile
%
100 100 92,1 78,9 34,2 50 65
Trieu chiing dau nguc chiem 100% so BN.
Cac YTNC thudng gapdnhdm nghien cilu ia tang
huyet ap (92,1%), rdi loan chuyen hda lipid la 100%,
dai thao dudng (34,2%), nhoi mau cotim (50%).
JOURNAL OF 108 - CUNICAL MEDICINE AND PHARMACY Vol.11-N-s/aois
Bang 3. Mile 66 tdn thuong lan tda flong mach vanh
Mule do ton thuong DMV Tdn thuong 1 than
Ton thuong 2 than Ton thuang 3 than Hep than ehung
Sd benh nhan (n = 20) T^le%
15,8 23,7
Benh nhan cd tdn thuang da than DMV chiem 84,2%, sd benh nhan hep than ehung DMV ehilm ty thap (13,2%).
B^ng 4. Sac diem lihuydt xa tren xa hinh tudi miu co tim
le
Dac diem {(huyet xa
Kha nang phuc hoi
MUc do k h u y i t x a '
Do rdng k h u y i t xa
K h u y l t x a cd hdi phuc K h u y l t x a c d d i n h K i t hop Nhe VUa Nang Hep Trung binh Rpng
Sdbenh nhan 13
0 25 01 18 19 03 12 23
TJIe(%)
34,20 65,8
2,6 47,4 50,0 7,9 31,6 60,5
MUc dp khuyet xa dinh gii theo tdn thuong cd mflc dp nang nhat tren BN.
Khuyet xa ed hdi phuc chiem (34,2%), khuyet xa ket hpp ehidm (65,8%).
Khuyet xa mflc dd ning ehi^m (50%) va khuyet xa dien rpng (60,5%).
BSng 5. Thay ddi cac trieu chuTng lam sang sau dieu tri
Trieu chUng Sd luong can/tuin Thdi gian can dau/tuan (s) So luong vien Nitrat/tuan MUc dp dau CCS Test di bp 6 phut (m) NYHA dp II, III
TrUOc dieu trj ( X ± S D ) 8,7 ±4,9 381,2 ±152,8
6,1 ± 2,2 2,63 ± 0,9 340,0 ± 80,3
23 (88,5%)
Sau dieu trj ( X ± S D ) 2,6 ± 1 , 7 85,5 ± 5 9 , 8
1,9±1,1 1,95 ± 0,8 440,2 ± 79,7 15(66,6%)
P
<o.'" .,«
<0,01
<0,01 i
•I <0,01 ' ;
S <o,oi '•'
<0,05
Tan suat eon dau ngUc, thdi gian con dau, sd lupng con dau giam d nhdm sau dieu tri vdi Op NYHA dIu giam va eai thien ed y nghTa so vdi trude dilu tri.
TJ le CCS III xudng CCS II 6 (15,8%) va 31 (81,6%) tUCCS II xudng CCS I.
(p<0,05).
TAP CHI Y Dl/OC L A M SANG 108 T a p l l - S 6 5/2016
B i n g 6. So sanh cac thdng sd s i i u a m trUdc va sau di^u trj Cac thdng sd
Dd (mm) Ds (mm) FS(%) EF(%) EF sympson's (%)
WMSI
TrUOc d i l u tri 51,2 ± 7 , 9 37,4 ±10,7 29,0 ±12,3 52,8 ±17,1 39,3 ±12,6 2,53 ± 0 , 2 8
Sau d i l u tri 48,4 ± 8 , 4 34,9 ± 9 , 5 30,0 ± 9 , 4 55,2 ±14,1 44,3 ±10,5 1,48 ± 0 , 1 7
P p>0,05 p>0,05 p>0,05 p>0,05 p<0,OS p<0,05
Cac thdng sd (Dd, Ds, FS, EF) ddu thay ddi nhung chUa cd su khae bidt cd y nghTa thdng ke vdi p>0,05.
Chi sd EF sympson's (%) sau dieu trj ed cai thien so vdi trUdc dieu tri.
Chi sd van dpng thinh tim cii thien nhieu so vdi trUde dieu tn.
BSng 7. So sanh Icet qua xa hinh tutfi mau ctf tim triTtfc va sau dieu tri
Cac thong so Tdng sd diem tudi m^ukhigangsUe (SSS) Tdng sd d i l m tudi m^u khi nghi (SRS) Tdng sd d i l m chenh Igeh giUa hai pha (SDS) Sd vung mat van ddng
TrUdc dieu trj ( X ± S D ) 21,2±12,0 14,7±12,1 5,8 ± 6 , 2 8,4 ± 4 , 3 '
Sau dieu trj ( X ± S D ) 17,6 ± 1 0 , 9 11,7±10,5 4,8 ± 5,5 6,5 ± 3,7
P p<0,001 p<0,001 p>0,05 p>0,05 Theo doi tde dung phu
Trong qua trinh dieu tri ed 2 BN xuat hien ngoai tam thu that va 2 BN xuat hien ngoai tam thu tren thSt, sau dd tu hit sau khi kit thue phat xung. Khdng ghi nhan eae rdi loan nhjp phUe tap.
Khdngtacdung NTTtr phu
Cae xet nghiem cdng thUc miu, men tim, chUe nang gan va ehUe nang than khdng thay ed su khac biet giO trudc va sau dilu tri.
4. Ban luin
Trong 50 38 trUdng hop dupe chi dinh dilu trj thilu mau CO tim bang sdng xung kich, eae benh
nhan cd BMV dlu cd trieu chung dau ngue diln hinh dai ding mac dCi da dilu tri tdi Uu bang thude eung nhu eae bien phap can thilp hoae bac eau vanh.
Tudi trung binh eiia eae benh nhan 72,8 ± 8,8, phan
Idn la nam gidi (92,1%), ed 68,4% benh nhan khdng
can thiep hoac tU chdi phau thuSt. T^ le ed suy tim
chilm 68,4%, nhdi mau co tim eu 50%. Cac yeu td
JOURNALOF 108- CLINICAL MEDICINE AND PHARMACY
nguy co t i m mach hay gap la tang huyet ap, RLCH lipid, dai t h ^ o d u d n g va h u t thudc, beo phi. N h i l u nghien eUu t r o n g vh ngoai nude cung nh$n thay m d i lien quan chat ehe giite h u t t h u d e la, RLCH lipid va tang h u y l t ap, dai thao d u d n g vdi BMV. Dae d i l m nay cung ehl eho eae thay thuoc lam sang, ngoai dieu tri benh chinh edn c I n cae bien phap d i l u tri ho t r p han c h i eac yeu t d nguy co.
He t h d n g DMV dSm n h i l m chiJc nang eung cap mau cho t i m . Hau h i t cac t d n t h u o n g DMV la t d n t h u a n g phijc tap. Tdn t h u o n g da t h a n DMV chiem t d i 84,2% b i n h nhan. Trong d d t ^ le khuyet xa ed hdi phuc chiem 34,2%, t y le khuyet xa k i t h o p 65,8%.
Phan Idn k h u y i t xa ia mUe d p nang va d i l n rpng.
NhUng t ^ le nay hoan toan phu hdp vdi k i t qua hep d a t h a n D M V e O a e i c B N .
Qua dieu trj 38 benh nhan sau ba t h a n g ehung tdi nhan thay sd lupng eon dau ngUc, t h d i gian cdn dau, mUe d d con dau (CCS) t h e o phan loai cua Hiep hdi Tim mach Canada, miJc do sis d u n g vien Nitrat t r o n g tuan d l u g i ^ m hdn so vdi trUde dieu trj vdi p<0,05. NgoJi ra eae trieu chUng n h u k h d t h d , mUc dp NYHA, t h d i gian gang sUe eung duoc cai t h i l n rd ret so vdi trude d i l u trj. Dieu nay ed duoc la do eo e h l gian maeh va t a n g sinh tan tao mach mau cua d i l u tri bang sdng xung kich. K i t qua eCia ehOng t d i eung hoan toan phCi h p p vdi eac nghien eUu tren t h e gidi. Leon IVIB nghlSn cUu trdn 28 benh nhan cd benh DMV khdng thich h o p cho tai t h d n g DMV bang can thiep hoae phau t h u ^ t dupc dieu tri bang ky thuat Shockwave. K i t qua cho thay t a n g Suae t h d i gian gSng sUc, eJi thien dupe trieu chiJng dau ngue so vdi n h d m chUng (45 ± 23% so vdi 6 + 20%, p=0,04), khdng cd tac dung phu nao ghi nhan t r o n g sudt va sau d i l u tri [5J. Nghien eilu eCia Yury A tren 24 BN dieu tri bang SWT eho k i t quS test di b d 6 phut eSi thien tU 416 ± 141 len 509 ± 131m, giam dupc phan dp dau nguc CCS 2,6 ± 0,7 xudng 1,9 ± 0,6 [9]. M d t nghien cUu khac eua McGillion M tren 15 benh nhan cd benh d d n g mach vanh nhung dau ngue dai r i n g , dupc d i l u tri bang ky t h u a t sdng xung kich (3 lan/tuSn, c i c h nhau 1 thang keo dai trong 03 thang) so sanh vdi n h d m chUng. K i t qu§
cho t h I y cai thien dupc mUc dp dau ngue theo phan
d d cua Hiep hdi t i m m?ch Canada t r u n g b i n h til 2,8 - 1,7 sau 6 t h a n g (p<0,001) so v d i n h d m c h i i n g vJ giSm duoc sil d u n g nitrat va tai nhap vien cOa benh nhan [7]. K i t q u i eCia c h u n g t d i c u n g phCl h o p vdi k i t qua n g h i l n cUu cOa Kazml W.H cai t h i e n duOc miJc d p dau ngUe CCS tO 1,95 ± 0,8 l l n 2,63 ± 0,69 va dp NYHA t u 1,95 ± 0,8 len 2,48 ± 0,59 [4].
Cac t h d n g sd tren sieu a m t i m ve D d , Ds, EF % khdng t h a y sU khac biet ed ^ nghia cd t h e d o thdi gian t h e d ddi cda e h u n g t d i edn n g a n , s d lupng benh nhan cdn chua n h i e u . Tuy nhien EF theo phUdng phap Sympson's t a n g ed y nghia d nhdm sau d i l u trj. D i l m rdi Idan van d d n g t h a n h t i m eai t h i e n n h i l u so vdi trude d i l u t r j . PhCi h o p vdi n g h i l n cUu McGillion M so vOng giSm van d p n g tren s i l u am giam d i n g k l tir 11,5% x u d n g 6 % (p=0,03) [7].
K i t qua xa hlnh t u d i m a u c d t i m c h o t h a y t d n g sd d i l m t u d i mau khi g a n g sUc va t d n g sd d i l m tudi m a u khi nghi d n h d m dieu t r i t h i e u m a u cO t i m b i n g sdng x u n g ki'eh deu cai t h i e n rd ret so vdi trude d i l u trj. Dieu nay eung p h i i h p p vdi ket qua nghien eUu cCia M o r g a n Mao-Young Fu [8].
T r o n g qua t r i n h dieu trj sdng x u n g kfch cd khoang 2 BN ed ngoai t a m t h u t h a t va 2 BN ed ngoai t a m t h u tren thSt thUa. Sau d d tU het khi k i t thijc qua trtnh bSn x u n g . Chdng t d i khdng t h a y eae tae d u n g p h u khae, khdng anh h u d n g d i n t l bao mau va CO quan tao m a u , c u n g n h u m e n tirri, chCre nang gan va t h a n t r o n g sudt dcrt d i l u t r j . Khdng cd b i n h nhan nao phai tai nhap vien v) trieu chUng t i m maeh t r o n g sudt qua t r i n h d i l u t r j .
5. K i t l u i n
Qua khao sat tren 38 BN BTMCTCBMT cd dau ngUe dai dang duoc dilu tri bang sdng xung kfch, nghien eiJu eho thay hieu qua va tfnh an toan ciia ailu trj bSng sdng xung kfch nhu sau:
1. Cac trieu chUng dau ngue eai thien rd ret (sd
lupng eon 8,7 ± 4,9 so vdi 2,6 ± 1,7, thdi gian con
dau 381,2 ± 152,8s so vdi 85,4 ± S9,8s, so luong vien
Nitrat sil dung/tuan 6,1 ± 2,2 so vdi 1,9 ± 1,1, phan
dp dau ngue CCS 2,63 ± 0,9 so vdi 1,95 ± 0,8. Test di
bp 6 phut, dp NYHA, Pro-BNP, phan sd tdng mau
theo phuong phap Sympson's cai thien nhilu d
TAP CHf Y D\JpC LAM SANG 108 T i p l l - S 6 5 / 2 0 1 6
n h d m c d dieu t r i b i n g sdng x u n g kich vdi p<0,05. Sd v u n g g i i m van d d n g va chi sd WMSI tren sieu am ciling cai t h i e n nhieu so vdi trude dieu t r i . Tinh trang t u d i mau ed t i m trdn xa h i n h t u d i m i u ed t i m c i i t h i e n rd ret so vdi t r u d c d i i u trj.
2. Dieu t r i t h i e u m i u c d t i m b i n g sdng x u n g loch t r o n g BMV an t o a n , khdng thay cd tac d u n g t o n t h u o n g m e n t i m , chUc n i n g gan va than, ed quan tad mau va chua t h a y c i e tac d u n g khdng m o n g m u d n t r o n g t h d i gian nghien cUu.
Tai lieu t h a m khdo
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