N g h i e n cmi Y h o c Y Hpc T P . H b C h i M i n h * Tap 15 * So 2 * 2011
thue hien hieu qua cac ehuong trinh cai nghien thuoc la. Da d ^ g hda cac hinh thiic tu van cai nghien thuoc la; Hoat dpng ho trg cai nghien thuoc la phai dugc long ghep trong cac ehuong trinh, ke hoach va chiai luge ve y te va giao due quoc gia vdi su tham gia ciia cac can bg y te, can bg giao due va can bg tai cong dong; Cho phep san xuat, nhap va sii dung cae thuoc dieu tri cai nghien thuoc la vdi chirih sch thue uu di theo quy dinh hien hanh oia Nha nude; Day manh cong tac nghien cuu khoa hoc va ung dung cae phuong phap cai nghien phii hop vdi dieu kien kinh te, xa hoi cua Viet Nam; va tao nguon kinh phi de phat trieh cac dich vu ho trg cai nghien thuoc la tir ngan sach nha nude, ngubn tai trg quoc te va ddng gop eiia nguoi dan dudi hinh thiic vi#n phi va bao hiem y te"^*".
KETLUAN
Nghien cuu cho thay tan suat va mire do sir dung thuoc la trong nhdm hiit thuoc o Viet nam
la dang nghi ngai. Can tang cudng hoat ddng eiia cae phong kham dich vu cai nghien thuoc la thong qua tap huan cho cac y ta, cae nhan vien y te ve ky nang tu van; mo rgng dich vu cai nghien va long ghep djch vu cai nghien trong cac CO sd cham soc sue khde ban dau.
TAI LIEU THAM KHAO
1 Ministry of Health (2003). Vietnam National Health Survey (XTs-'HS), 2001-02. Hanoi: Mmistry of Health.
2 Le\y DT, Bales S, Lam NT, Nikolayev L (2006). The role of public policies in reducing smoking and deaths caused by anoking in Vietnam: Results from the Vietnam tobacco policy simulation model Soc SciMed. 62:1819-1830.
3 World Health Organization (2003). W H O Frameworit Convention on Tobacco Control Geneva: World Health Organization.
4 World Health Organization (2008). W H O Report on the Global T o b a a o Epidemic 2008: The MPOWER Packaged Geneva:
World Health Organization.
5 Vietnam Steering Committee on Smoking and Health (VINACOSH) (2009), Hanoi Medical Umveraty: Pre- intervention assessment Implementation of regulations of Smoke-free environment and legal documents on Tobacco Control Hanoi.
CAC YEU TO D V BAO RUNG NHI SAU PHAU THUAT BAC CAU DONG MACH VANH
Le Thanh Hiing*, Pham Nguyen Vinh**
TOM TAT
Muc dich nghien aht: Nghien dm nay nhdm muc dich nhan biei cac yeii todu bdo lam sang cua rung nhi sau phSu thuat bdc mu dgng mach vanh.
Phuong phdp nghien ahi: Dodn hi hoi ciru vd tien cim. Nghien cieu tien hanh tren 356 benh nhan dmc phau thuat bdc cau dgng mach vdnh tai Vien Tim TP.HCM tir 9/2001 deh 5/2006. Cdc die lieu trirac mo, trong movd sau mo duoc thu tlrnp. Benh nhan duoc chia theo nhom co rung nhi sau mo hay khong.
Kei qua:. Ket qud nhir sau: Rung nhi my ra trong 46 benhnhdn (13%). Thiri diem xay ra rung nh'i la xung quanh ban ngay dau hau phtu vai ti le 80,44%. Ti le tuoi >65 a nhom rung nhi la 56,5% so v&i 36,S% is nhom ididng rung nhi (p=0,011). Ti le tang huyei dp i nhom rung nht Id 89,1%, so voi 75,5% i nhom khong rung nhi (p=0,039). Thoi gum tha may > 24h a nhom rung nhi Id 23% so voi 4,8% b nhom khong rung nhi (p=0,04).
lABP (bom bong noi dong nach chu) nhom rung nlii Id 4,3% so v&i 0,3% i nhom khong rung nhi (p=0,0i5).
Diing thuoc van nmch & nhom rung nhild 52,2% so v&i 32,3% a nhom khong rung nhi (p=0,008). Phan tich hSi quy da bicii dmc sie dung denhan biei cdc yeii to die bdo doc lap ciia rung nhi sau phiu thuat CABG (hie cm dong mqch vdnh) (p<0,05): Tuoi > 65 (OR=l,93: 95% CI: 1,01 - 3,69), tien can NMCT (nhoi mdu ca tim) (0R=a5; 95% CI: 0,25 - 0,99), lABP (OR-12,36: 95% CI: 1 -151), dung thuoc van mach (OR'2,07: 95% CI:
1,07-i).
Ket luan: Rung nlii van la bien chimg thuong gap nhat sau phau thuat CABG. Tuoi, lABP vd dung thuoc
100
Y Hpc TP. H o Chi M i n h * T i p 15 * So 2 * 2011 N g h i e n o i u Y h o c
van nmch Idm tang nguy ca dta rung nhi sau phau thuat CABG. Thuoc iec chebita co tlie'hieu qud nliat vd kinh te nhat trong viec phong ngiea rung nhi sau phau thuat CABG.
Tic khoa: Rung nhi, benh madi vdnh, bac cau.
*BVDK tmh Binh PhuDC » Vi|n Tim TP.HCM
Tdc gia lien lac: Ths.Bs. Le Thanh Hung DT: 0903066646, Email: [email protected]
101
N g h i e n cixu Y hpc Y Hpc TP. Hb Chi M i n h * Tap 15 * So 2 * 2011
ABSTRACT
PREDICTORS OP ATRIAL FIBRILLATION AFTER CABG
Le Thanh Hung, Pham Nguyen Vinh* Y hoc TP. Ho Chi Minh * Vol. 15 - No. 1 - 2011:100 - 105 Objectives: The objective of this study was to identify the clinical predictors of atiial fibrillation (AF) after CABG.
Methodes: Prospective and retrospective Cohort. A total of 356 patients who had undergone CABG from 2001 September to 2006 May at Heart Institute of HCMC wei-e studied. Preoperative, inti-aoperative and postoperative data were collected. Patient were grouped according to whether AF appeared postoperatively
Results: AF occurred in 46 patients (13%). Most cases of AF (80.44%) appeared on or before the fourth postoperative day Rate of age > 65fijr patients with AF was 56.5% compared with 36.8% for patients without AF (p = 0.011). Rate of hypertension for patients with AF was 89.1% compared with 75.5% for patients without AF (p = 0.039). Rate of ventilation time > 24h for patients with AF was 13% compared with 4.8% for patients without AF(p = 0.04). Rate qflABPfbr patients with AF was 4.3% compared with 0.3% for patients without AF (p = 0.045). Rate of vasopressor use for patients ivithAF was 52.2% compared with 32.3% far patients without AF (p = 0.008). Multivariate logistic regression analysis was used to identify the following independent predictois of postoperative AF(p< 0.05): Age > 65 years (OR=1.93; 95% Ch 1.01 - 3.69), prior Ml (OR=0.5; 95% CI: 0.25 -0.99), lABP (OR=12.36: 95% CL 1 -151), vasopressor use (OR=2.07; 95% CL 1.07-4).
Conclusions: AF remains the most common complication after CABG. Age, lABP and vasopressor use can increase the risk of atrial fibrillation after CABG. ^ blocker may be the most economical and e^ctive preventioh for AF early after CABG.
rpass graft
mng nhi trong dan so chung va 6 nhung benh Keywords: Atrial fibrillation, coronary disease, h
D A T VAN DE
Rung nhi dugc nhgn thay la bien chiing som, thuong gap nhat sau phau thuat bac cau dong mach vanh (CABG), chiern ti le khoang 10% - 40%<^*'. Nhimg thay doi ve ti le mng nhi sau phau thuat CABG la dua vao: Dan so dugc nghien cuu, loai phau thuat dugc tien hanh, djnh nghia roi loan nhip, phuong phap dung de phat hi^n roi loan nhip, thoi gian quan sat (lien tuc hay gian doan)"-^^. Rung nhi sau phau thuat CABG, lam gia tang b^nh xuat, tii xuat va nhihig bat loi cho benh nhan voi nguy co dot quy gia tang gap 2-3 Ian, mng nhi co the gay suy tim, thieu mau eo tim, mng nhi lam gia tang ti 10 tyt huyet ap hau phau va roi loan nhip that, lam keo dai thoi gian nam vien, gia tang chi phi dieu tri cho b^nh nhan""'.
Co che benh sinh dan den lam ti le mng nhi tang cao sau phau thuat tim noi ehung va sau phau thuat CABG noi rieng la chua ro rang. Ti le rung nht sau phau thuat CABG vugt xa so voi
nhan xo viia dgng mach vanh (DMV). No cao hon mot each co y nghia so voi phau thuat ngoai tim, bat chap co tmh trang xo vua dgng mach vanh hay khong*^'.
Vi vay, co the eo nhung ca che chua xac dinh dan doi mot h le Ion benh nhan sau phau thuat CABG xay ra mng nhi nhu: Tuoi gia tang, gioi tinh, tang huyet ap truoc mo, diing tuan hoan ngoai co the^ thoi gian kep dgng mach chu keo dai, dung nhieu cau noi, dung thuoc van m^ch sau mo, dung bom bong ngi dgng maeh chu sau mo<'-'*''^.„
Mot giai tiu'ch eo tinh hop ly hon, la eo the CO nhung bat thuong sinh ly dien hgc ton tai tmoc do, dugc khuech dai len trong luc phlu thuat, chung eo the gay anh huong bat Igi trong hau phau va dan den rung nhi xay ra. Tuy nhien viec nhlin ra bat thuong sinh ly di^n hgc tmoc mo va trong mo o nhung benh nhan nay la phiic tap, ton nhieu chi phi va thoi gian. Vi vay viec
Y Hpc TP. Ho Chi M i n h * Tap 15 * So 2 * 2011
n h | n biet eac yeu to du bao lam sang van la van de thiet thuc nhat*^).
O Viet Nam, p h l u thuat bac cau dgng maeh vanh dugc tien hanh trong nhung nam gan day, dae biet la o Vien Tim thanh pho Ho Chi Minh.
Viec xac dinh ti le mng nhi, cae yeu to du bao lam sang cua m n g nhi doi voi nhiing benh nhan diK?c phau thuat CABG, co khac biet voi nuoc ngoai hay khong, hon nua 6 Vi?t Nam hien nay chua CO mot nghien emi nao ve van de nay.
Thiet nghl nghien cuu ve vlui de nay eo y nghia thiet thue trong viec dieu tri va tien lupng benh nhan benh dgng mach vanh dugc phau thuat bac cau.
DOITI/ONG -PHUtSSIG PHAPNGHIEN OL/U Doi higmg nghien cmi
Tieu chuan chon benh
Tat ca benh nhan dugc phau thuat bac cau DMV voi tuan hoan ngoai eo the, tqii Vi?n Tim TPHCM tu thang 9/2001 den thang 5/2006.
Tieu chuan loai trii' - Co rung nhi trude mo.
- Co sua van va/hoae thay van tim truoc day hoac lam phoi hgp trong liic phau thuat CABG.
- Hep van 2 la, hep van DMC (dgng mach chii), hep van DMP (dgng mach phoi).
- Ho van 2 la, h o van 3 la, ho van DMC > 2/4.
- Phau tiiuat CABG cap cuu.
Phuong phap nghien cmi Thiet hen^ien ahi
Nghien cuu doan he hoi o i u va tien cuu.
Camau
Z - . w / 2 i f ( l - P ) _ 1,96-X 0.3(1-0,3) .
" " d- 0,05' - ^ 3 2 3
(P=0,3 la ti le rung nhi sau mo CABG co dxK?c til nghien cuu oia AranW')
Thu thap bien so
Cac bien so truoc mo: Tuoi, gicn, NYHA tien can nhoi mau co tim (NMCT), dai thao
Nghien a h i Y hpc
duong, tang huyet ap, roi loan lipid mau, hut thuoc !a, COPD, tien can mo CABG, tien can nong maeh vanh, tien can dgt quy, BMI, creatinin mau, dung Ihuoe uc che beta, diing thuoc ire che eald, EF that trai, hep dgng maeh (DM), lien that tmoc (LAD) > 70%, hep DM mu (LCx) > 70%, hep DM vanh phai (RCA) > 70%, Ideu hep (1, 2, 3 nhanh). Cac bien so trong mo:
so lugng cau noi, thoi gian kep DMC, thdi gian CBP (tiian hoan ngoai eo the). Cac bien so sau md: lABP, thdi gian thd may, dung thuoc v | n mach, md lai, nhoi mau co tim cap, rdi loan nhip that, ngung tim, viem phoi, nhap lai ICU, viem xuong lie, nhiem trimg benh vien, suy than, tham phan phiic mac, dat may tao nhip, mng nhi (Bien so phu thude). Cac bien so nay dugc thu thap tu cac ho so hgp le.
Phan tich va xu ly sd lieu
- Kiem dinh t-student cho 2 sd trung binh oia 2 mau dgc lap cd phan phoi chuan.
- Kiem dinh chi binh phuong cho 2 ti le. Neii sd d cd fan so ly thuyet < 5 chiem > 20% thi dimg phep kiem chinh xac Fischer.
- Khao sat anh hudng ddng thoi ciia nhieu yeii to len rung nhi sau md, dua tat ca cac yeu to trong phan b'ch don bien lien quan vdi mng nhi sau md ed P < 0,2 vao md hinh hoi quy logistic da bien, diing thu tuc chgn bien b&ig phuong phap dua vao dan va loai trir dan, ket qua cae md hinh dugc so sanh voi nhau chgn ra md hinh phii hgp vdi thuc te nhat.
- Sd lieu dugc xir ly bang phan rhem SPSS 13.0
KET Q U A
356 benh nhan phau thuat CABG dugc dua vao nghien cuu trong do: 248 nam (70%), 108 Txix (30%), hidi thap nhat la 31, cao nhat la 79, tuoi trung binh la 61,26 ± 8,6, 27,8% benh nhan bi dai thao dudng, 77,2% co tang huyet ap trudc mo, 83,7% CO rdi loan lipid mau, 34,8% cd hiit thude la, 44,9% ed tien can NMCT, 6,74% ed tien can PQ(nong mach vanh), 7% cd suy tim III-IV
N g h i e n ctru Y hpc Y Hpc TP. H o Chi M i n h * Tap 15 * So 2 * 2011
trudc md va 93p% b | n h nhan ed dimg thuoc uc che beta trudc mo.
Bang 1: Phan bo idn sova ti le benh nhan theo nhom tuoi.
Tuoi
<50 5 0 - 5 4 5 5 - 5 9 6 0 - 6 4 265
Tan s6 (n) 42 41 55 78 140
Tile%
11,8 11,5 15,4 21,9 39,3 Benh nhan > 65 tuoi ehi&n 140 nguoi (39,3%).
Bang 2: PMn bo tan sova ti lexdy ra rung nhi tren ngdyliauphau.
Ngdy li|u pliiu NgayO Ngayl Ngay 2 Ngay 3 Ngay 4 Ngay 6 Ngay 6 Ngay 6*
Tin s6(n) 5 8 13 6 5 0 1 8
Ti l#%
10,86 17,39 28,26 13,04 10,86 0 2,17 17,39 Rung nhi xay ra trong 46 benh nhan (13%), thdi diem xay ra rung nhi la quanh 4 ngay dau h?u phau vdi ti 1# la 80,44%.
Phan tich don bien
Bang 3: NJii'mg dac diem ciia benh nhan tne&c mo.
Dac diem TUOI 2 65 (nSm)
Gioi nam NYHA (III, IV) Tien can NMCT Dai thao du^ng Tang HA RL lipide mau
HutthuScia COPD Tien can CABG
Tiln can PCI Tien can d$l quy
BMI(Kg;m') Dung Lpc che beta Dijng i>c che oalci Craatinin mau(|jg/L)
EF(%) Hep LAD > 70%
Rung nhT (n=46) 26(56,5%) 27(58,7%) 1(2,2%) 16(34,8%) 13(28,3%) 41(89,1%) 42(91,3%) 14(30,4%) 1(2,2%)
0(0%) 2(4,3%) 4(8,7%) 23,59 ±312
44(95,7%) 24(52,2%) 95,65 ±23,61 62,50+12,71 40(87%)
Ktmng mng nhT(n=310) 114<36,8%) 221(71,3%) 24(7,7%) 144<46,5%) 86(27,7%) 234(75,5%) 256(82,6%) 110(35,5%) 5(1,6%) 1(0,3%) 22(7,1%) 16(6,1%) 23,51 ±2,91 289(93,2%) 128(41,3%) 95,16 ± 29,05 6324 ±11,76 273(88,1%)
P P=0,011 P=0,083 P=0,225 P=0,138 P=0,942 P=0,039 P=0,135 P=0,502 P=0,567 P=1 P=0,753 P=0,518 P=0,855 P=0,752 P=0,164 P=0,913 P=0,693 P=0,S30
Dac diem Hep LCx 2 70%
Hep RCA > 70%
Hep (2, 3 nhanh) Rung nhi
(n=46) 35(76,1%) 38(82.6%) 44(95,7%)
Khong njng nhr(n=310) 219(70,6%) 231(74,5%) 286(92,3%)
' " - « |
P=«M|
p=oi^
"^^Si
Nhiing dae diem ciia benh nhan trudc m ^ cho thay trong bang 3, d moi nhdm m n g nhT hoac khdng rung nhi. Ti le tudi > 65 va tang huyet ap d nhdm rung nhi Idn hon nhdm khong m n g nhi cd y nghia thong ke, gidi tinh d 2 nhdm cd khuynh h u d n g khac nhau nhung khong CO y nghia thdng ke. Sir dung thuoc uc che ealei va lic che beta 6 2 n h d m khdng khac nhau.
Bang 4: Cdc die kien cua phSu thu&t.
Cac do ki^n cua phlu thuat
S o d u ndi Thiri gian i(ep DMC(phut) Thai gian CPB(phut)
Rung nhT (n=46) 3,37 ± 0,645
Khdngmng nhr(n=310) 3,2 ±0,767 96,20 ±21,96 90,18 ±21,83
153,17 ± 28,93
146,18 ± 32,24
P P=0,15
5 P=0,08
2 P=0,16
5 Thdi gian kep DMC d hai nhdm m n g nhi va khdng m n g nhi, cd khuynh hudng khac nhau, nhung khdng co y nghia thong ke. Thdi gian CPB va so cau noi trung binh, d hai nhdm m n g nhi va khdng m n g nhi, khac nhau khdng cd y nghia thdng ke.
Bang 5: Cdc bien chung vd cdc yeu td'sau mS.
Cac bi§n chOng va cac y i u td sau m6 Thoi gian tha may >24ti
lABP Dung thu6c van mach
M6lai Nh6i mau ca tim cap
R6i lo^n nhip th^t Ngif ng tim Viem ptToi Viem xuong |>C
Nhap lai ICU Nhilm trung b ^ h vien
suy than Tham phan phuc mac
Rung nhf (n=46) 6(13%) 2(4,3%) 24(52,2%)
1(22%) 0(0%) 2(4,3%)
0(0%) 3(6.5%) 1(2,2%) 0(0%) 5(10,9%)
4(8,7%) 1(2,2%)
Khdng mng nhT(n=310) 16(4.8%)
1(0,3%) 100(32,3%)
9(2,9%) 2(0,6%) 17(5,5%) 1(0,3%) 32(103%)
12(3.9%) 6(1,9%) 44(14,2%)
16(5.2%) 9(2,9%)
P P=0.04 P=0.045 P=0.008 P=1 P=1 P=1 P=1 P=0.597
P=1 P=1 P=0.541 P=0.308 P=1
10-1
Y H p c T P . H o Chi M i n h * T a p 15 * So 2 * 2011 N g h i e n cthi Y h p c
Cac bidn chi>ng va cac yeu t6 sau mo Dat may tao nhip
Rung nhi (n=46) 1(2,2%)
Khdngmng nht(n=310) 6 ( 1 , « )
P P=1
Bang 7: Ti le rung nhi sau phau thuat CABG.
Cae ti 1| lABP, diing thuoc vgn mach, thdi gian tho may > 24h, d nhdm rang nhi eao hon nhdm khdng rung nhi cd y nghia thong ke.
Phan tich hoi quy da bien
Bang 6: Kei qud ph&n tich Iwi quy logistic ciia nhieu yeu to, dnh huong len rung nhi sau mo
Bidn Tu6i2
65 Tien can
NMCT lABP Diing TVIVI Constant
B 0,660
0,693 2,615 0,728
2,282 S.E.
0.330 0.351 1.279 0.336 0.290
Wald 3.986 3.886 3.867 4.695 51,752 df
1 1 1 1 1
P 0.046 0049 0.049 0.030 0,000
OR 1.934 0,500 12,365 2,072 0.102
95% CI 1,012-
3,695 0,251- 0,996 1,008-151
,65 1,072-
4,004
Phan tich hbi quy logistic da bien cho thay:
Tuoi > 65, dimg thuoc van mach, lABP la cac yeu to dir bao dgc lap ciia nong nhi sau CABG, hen can NMCT la yeu to du bao doc lap giam nguy CO nmg nhi sau CABG,
BAN LUAN Ti le cda rung nhi
Rung nhi vln la bien chiing som thuong gap nhat sau CABG. Ti le lint hanh cua rung nhi trong dan so chung, 6 benh nhan xo viia dgng mach, va sau phlu thuat ngoai long nguc, la hirong d i n can ban, de chiing ta co mot su danh gia diing ve tam quan ttong cua mng nhi sau p h l u thuat CABG.
Theo thong ke cua cac nuoc phuong Tay, cho thay fin suat luu hanh ciia rung nhi trong dan so chung khoang 0,4%, tang theo hioi va >
5% 6 nguoi tren 65 taSi"'.
Ti 1? rang nhi 6 benh nhan xo vira dong mach la 3,6% va sau p h l u thuat ngom long nguc la5%B'.
Rung nhi xay ra sau phlu thuat CABG la 10%-40%l«'.
Tac gia Villareal RP""
Amar D'"
Aranki SF*' Guo yan"
Chung toi
Sd b#nh nhan 6475 1553 570 322 356
Ti le mng nhT 16%
33%
33%
23,3%
13%
Ti le mng nhi sau md trong nghien cuu oia chiing toi la 13% gan bing vdi tac gia Villareal RPO'^, so vdi cac tac gia cdn lai ti le mng nhi sau md ciia chiing tdi thap hon nhieu, su khac biet nay la do: Benh nhan nghien cuu cua chting tdi cd tudi trung binh tre hon cac tac gia khac, hau het benh nhan trong nghien cuu eua chiing tdi trudc mo dupe dimg thuoc uc che beta (93,5%), ma thude lie che beta eo tac dung lam giam ti le mng nhi sau mo, dieu tri phdng ngira vdi thuoc uc che beta, lam giam ti le rung nhi sau phau thuat CABG tir 40% cdn 20%P-»^. Hon nua trong mau nghien cuu cua chiing tdi, chiing tdi da loai nhiing benh nhan cd tien can rung nhi, co b | n h van tim, ed md sua van va/hoac thay van, ma benh nhan ed tien can mng nhi hoac cd benh van tim thi tuong quan vdi mng nhi sau md'c^-^'*, ti le mng nhi d p h l u thuat van tim hoae phau thuat CABG ket hgp vdi phau thuat van tim, cao hon d phau thuat CABG don thuan^^, ngoai ra trong mau nghien eihi eiia chiing tdi l?enh COPD chiem ti le tiiap (1,7%) ma COPD la yeii td du bao dpc lap ciia rung nhi sau md'^*'. Vi vay ma ti le rung nhi sau mo trong mau nghien cuu cua chiing tdi thap hon cac tac gia khac.
Cac yeu td dtr bao doc lap cua rung nhi sau phau thuat CABG
Tudi > 65 la yeii to du bao doc lap eiia rung nhi sau phau tiiuat CABG, tuong tu nhu cac nghien cuu oia Aranki SF*'*(p<0,05)va Guo yanf^(p<0,05). Tudi tuong quan vdi nhiing thay ddi d nhi nhu: Xo hoa nhi, gian nhi, phi dai co nhi, giam dan tmyen va nhiing dieu nay cd the lam cho ti le mng nhi sau md gia tang vdi tudi(*^3) Qia t ^ g truong luc giao cam va pho giao cam lam ngan thdi ky tro ciia nhi, tudi tang lien quan den gia tang nong do Noradrenaline,
N g h i e n c u u Y h p c Y Hpc T P . H o C h i M i n h * T a p 15 * So 2 * 2011
no cd the dan den gia tang tmong luc giao cam va mng nhi cd xu hudng de xay ra""'.
LABP la yeii to du bao doe lap cua rung nhi sau phau thuat CABG. Dieu nay cung phii hgp vdi nghien cuu ciia Aranki SF^^* (p<0,05). Sir dung lABF thudng la can tiiiet trong trudng hgp rdi loan chuc nang ca tim tram trgng do hoai tir CO tim hoac co tim bi choang. dan den suy tim, dieu nay lam gia tang mng nhi do ha oxy mau, giam the ti'ch mau, nhiem trimg huyet, va mat can bang dien giai®.
Dimg thude van mach la yeu td du bao dgc lap ciia mng nht sau phiu thuat CABG. Trong nghien oiu cua chiing tdi tat ca berih nhan diing thude van mach sau mo la do suy tim, ma suy tim cd the lam gia tang rung nhi theo nhiing co che nhu da ndi d tren. Hoat ddng giao cam, cd the ddng vai tro quan trgng trong co che benh sinh ciia rung nhi sau phau thuat CABG''.
Thude van mach la thuoc kich thich hoat dgng giao cam, ma gia tang hoat dgng giao cam se lam ngan thdi ky tro cua nhi dan den gia tang sdng vao lai va mng nhi de xay ra*''^"*.
Ngoai ra trong nghien cuu eiia chiing tdi thay rSng: Tien can nhoi mau co tim la yeu to du bao dgc lap giam nguy co xay ra mng nhi sau md CABG. Dieu nay la do hau het benh nhan cd tien can NMCT trong nghien cuu cua chiing tdi deu dugc diing thuoc uc che beta (95%), ma lic che beta cd tac dyng lam giam nguy eo oia mng nhi sau mof^'^'. Diing tiiuoc lic che beta trude md cd the lam giam ti le mng nhi sau md CABG
\'a chi dinh thuoc lic che beta hau phau co the lam giam ti le cua roi loan nhip nhl'^.
KET LUAN
Rung nhi van la bien chung thudng gap nhat sau phau thuat CABG. Tuoi, lABP va diing thude van mach lam tang nguy co oia rung nhi sau phau thuat CABG. Thuoc uc che beta co the hieu qua nhat va kinh te nhat trong viec phong ngira mng nhi sau phau thuat CABG.
TAI LIEU THAM KHAO
1 Asdone R, Masamo Caputi, C51io!a Calon et al (2000).
"Predictors of Atnal FibrillfJon After Covaidonal and Beating Heart Coronary Surgery", arnilalicm. 102(13): f^.1530 2 Aranki SF, Shaw DP„ Adams DH. (1996), "Predictors of Atnal
Fibrillahcm After Cononar>' Artery Surgery", Cirnilalim, 94:
pp390-397.
3 Amar D, Shi W, Hogue CW, el al (2004), "Clinical predictum rule for atnal filmllation after coronary artery bj'pass grafting". ] Ml Cdl cardiol, 44 p p 1248-1253.
4 Budeus H Hennetsdorf M, Rohkfi et al (2006). "Pred«ctior of atrial fibrillation after CABG: the role of chemoreflexsensitwity and P wave signal averaged EOG", bitemaimtai Jnumal of Cardiology, 106: pp. 67-74.
:, Banadi H Rysz ], Okonski P et al (2006), "Risk factors of Atnal fibillatwr foUoMing CABG", Crrc/, 70: p p 43»441.
6 Edamj M, Mirkhani H, Sanatkar M et al (2O05), "Role of Biatnal P a a n g m Prevention of Atrial Fibrillation after CABG", Mum padns i""' Ekctrophysblogy purmd (ISSN 0972-6292), 5(1): pp5- 11.
7 Fuster V, Ryden LE, Asinger RW et al pOOl), "ACC/AHA/ESC Guidelines for the management of patients with atnal fibrillation". Eiimpain Heart }oumal, 22: pp.1852-1923.
8 G u o Yan, H U Shengshou, Wu Qingyu et al (2002), "Predictors of atnal fibrillation after bypass graft surgery", Ckm Med j , 115(2): pp332-n4
9 H o Hujmh Quang Tri Pham N g u y i n Vmh (2006), "Chan doan va dieu tri mpt so roi loan nhip rieng bi?t", B?«h hoc tm rmdi.
NXB Y Hgc. tap IL-tr.l 97-204
10. fideus L (2001), "Atrial fibnllaticm After CABG, A study of Causes arwi Risk Pastors", Acta Universitatis Upsaliensis.
Comprehensive Summaries cf Uppsala Dissertations from the Faculty ofMedichw 1093.56 pp. Uppsala. ISBB 91-554-515-9.
11. Kalman JM, Munawar H Howes LG et al (1995), "Atrial fibrillation after CABG is Associated with sympathetic activation". Aim Thorac Surg, 60: pp.1709-15.
u. Mathew JP, Fontes M l , Tudor IC (2004), "A Multicenter Risk Index For Atrial Fibrillabcm After Cardiac S u r g e i / ' , jAMA, Vol 291, No.l4, pp 1720-1729.
13. O m m e n SR, OdeU JA, Stanton MS (1997), "Atrial arriiythmias after cardiothoradc surgery", Massachusetts Mediait Smety, Vol 336, N o 20, [^.1429-1434.
14 Prystowdc EN, Katz A (2002), "Atrial Fibrillation", Tcxlfwo* of cardiovascular medicine, Upipinoott Williams & Wilkins, Second edition. Vol 2: pp.1403-1420.
15. Tamis ]E, Homel P, Durani M et al (2000), "Atrial fibnllaUon after nunimalty invasive direct CABG", ] Am OM cardial, 36:
Villareal RF, Hanharan R, Liu BC et al (2004), "Postoperation atnal fibnllahon arjd mortality after CABG", ]Am CoU cardioi, 42r.
pp.742-8.
Maisel W K , Raw p . , Stevenson WG. (2001), "Atrial Fibnllation after Cardiac Surgery", Annals ofMemal Medicine, Vohrai IJS, Issue 12, pp.1061-1073.
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