{"id":13172,"date":"2023-12-28T19:02:27","date_gmt":"2023-12-28T11:02:27","guid":{"rendered":"https:\/\/docquity.com\/?post_type=articles&#038;p=13172"},"modified":"2025-02-11T13:38:43","modified_gmt":"2025-02-11T05:38:43","slug":"esc-2022-huong-dan-kiem-soat-roi-loan-nhip-that-va-phong-ngua-dot-tu-do-tim","status":"publish","type":"articles","link":"https:\/\/docquity.com\/vi\/articles\/esc-2022-huong-dan-kiem-soat-roi-loan-nhip-that-va-phong-ngua-dot-tu-do-tim\/","title":{"rendered":"ESC 2022: H\u01b0\u1edbng d\u1eabn ki\u1ec3m so\u00e1t r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t v\u00e0 ph\u00f2ng ng\u1eeba \u0111\u1ed9t t\u1eed do tim"},"content":{"rendered":"\n<p>Hi\u1ec7p h\u1ed9i tim m\u1ea1ch Ch\u00e2u \u00c2u (European Society of Cardiology \u2013 ESC) \u0111\u00e3 \u0111\u01b0a ra h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb n\u0103m 2022 v\u1ec1 v\u1ea5n \u0111\u1ec1 ki\u1ec3m so\u00e1t b\u1ec7nh nh\u00e2n lo\u1ea1n nh\u1ecbp th\u1ea5t v\u00e0 ph\u00f2ng ng\u1eeba \u0111\u1ed9t t\u1eed do tim. H\u01b0\u1edbng d\u1eabn t\u00f3m t\u1eaft v\u00e0 \u0111\u00e1nh gi\u00e1 nh\u1eefng b\u1eb1ng ch\u1ee9ng hi\u1ec7n c\u00f3 nh\u1eb1m h\u1ed7 tr\u1ee3 c\u00e1c nh\u00e2n vi\u00ean y t\u1ebf \u0111\u01b0a ra chi\u1ebfn l\u01b0\u1ee3c ki\u1ec3m so\u00e1t t\u1ed1t nh\u1ea5t cho t\u1eebng b\u1ec7nh nh\u00e2n lo\u1ea1n nh\u1ecbp th\u1ea5t. H\u01b0\u1edbng d\u1eabn ki\u1ec3m so\u00e1t lo\u1ea1n nh\u1ecbp th\u1ea5t v\u00e0 ph\u00f2ng ng\u1eeba \u0111\u1ed9t t\u1eed do tim n\u0103m 2022 l\u00e0 phi\u00ean b\u1ea3n c\u1eadp nh\u1eadt c\u1ee7a h\u01b0\u1edbng d\u1eabn n\u0103m 2015. Nh\u1eb1m h\u1ed7 tr\u1ee3 c\u00e1c nh\u00e2n vi\u00ean y t\u1ebf tr\u00ean n\u1ec1n t\u1ea3ng Docquity c\u1eadp nh\u1eadt c\u00e1c khuy\u1ebfn c\u00e1o quan tr\u1ecdng nhanh v\u00e0 hi\u1ec7u qu\u1ea3, \u0111\u1ed9i ng\u0169 Docquity h\u00e2n h\u1ea1nh gi\u1edbi thi\u1ec7u b\u1ea3n l\u01b0\u1ee3c d\u1ecbch m\u1ed9t ph\u1ea7n c\u1ee7a khuy\u1ebfn c\u00e1o \u2013 \u201cLi\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb lo\u1ea1n nh\u1ecbp th\u1ea5t \u2013 kh\u00eda c\u1ea1nh chung\u201d. So v\u1edbi c\u00e1c khuy\u1ebfn c\u00e1o trong h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb n\u0103m 2015, phi\u00ean b\u1ea3n c\u1eadp nh\u1eadt n\u0103m 2022 \u0111\u00e3 c\u00f3 m\u1ed9t s\u1ed1 c\u1eadp nh\u1eadt m\u1edbi v\u1ec1 v\u1ea5n \u0111\u1ec1 \u0111i\u1ec1u tr\u1ecb lo\u1ea1n nh\u1ecbp th\u1ea5t. B\u1ea3n l\u01b0\u1ee3c d\u1ecbch ch\u1ec9 bao g\u1ed3m c\u00e1c khuy\u1ebfn c\u00e1o li\u00ean quan \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c trong ki\u1ec3m so\u00e1t lo\u1ea1n nh\u1ecbp th\u1ea5t v\u00e0 ph\u00f2ng ng\u1eeba \u0111\u1ed9t t\u1eed do tim.<\/p>\n\n\n\n<p><strong>LI\u1ec6U PH\u00c1P \u0110I\u1ec0U TR\u1eca LO\u1ea0N NH\u1ecaP TH\u1ea4T \u2013 KH\u00cdA C\u1ea0NH CHUNG<\/strong><\/p>\n\n\n\n<p><strong>KI\u1ec2M SO\u00c1T C\u1ea4P<\/strong><\/p>\n\n\n\n<p><strong>\u0110i\u1ec1u tr\u1ecb nh\u1eefng nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 \u0111\u1ea3o ngh\u1ecbch<\/strong><\/p>\n\n\n\n<p>Nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 \u0111\u1ea3o ngh\u1ecbch c\u00f3 th\u1ec3 chi\u1ebfm \u0111\u1ebfn 50% c\u00e1c tr\u01b0\u1eddng h\u1ee3p ng\u01b0ng tim \u0111\u1ed9t ng\u1ed9t (sudden cardiac arrest \u2013 SCA). Tuy nhi\u00ean, vi\u1ec7c ph\u00e1t hi\u1ec7n nguy\u00ean nh\u00e2n c\u01a1 b\u1ea3n d\u1eabn \u0111\u1ebfn ng\u01b0ng tim \u0111\u1ed9t ng\u1ed9t v\u00e0 li\u1ec7u r\u1eb1ng nguy\u00ean nh\u00e2n n\u00e0y c\u00f3 th\u1ec3 \u0111\u1ea3o ngh\u1ecbch hay kh\u00f4ng l\u1ea1i th\u01b0\u1eddng g\u1eb7p nhi\u1ec1u kh\u00f3 kh\u0103n. Ti\u1ebfn h\u00e0nh \u0111\u00e1nh gi\u00e1 to\u00e0n di\u1ec7n b\u1ec7nh nh\u00e2n ng\u01b0ng tim \u0111\u1ed9t ng\u1ed9t l\u00e0 b\u1eaft bu\u1ed9c n\u1ebfu ch\u01b0a x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c b\u1ec7nh l\u00fd tim m\u1ea1ch d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng ng\u01b0ng tim \u0111\u1ed9t ng\u1ed9t ho\u1eb7c nghi ng\u1edd v\u1ec1 di\u1ec5n ti\u1ebfn b\u1ec7nh. M\u1ea5t c\u00e2n b\u1eb1ng \u0111i\u1ec7n gi\u1ea3i ch\u1eb3ng h\u1ea1n nh\u01b0 h\u1ea1 kali m\u00e1u c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn nh\u1ecbp nhanh th\u1ea5t, vi\u1ec7c t\u0103ng nhanh ch\u00f3ng n\u1ed3ng \u0111\u1ed9n kali ngo\u1ea1i b\u00e0o c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng v\u00f4 t\u00e2m thu (asystole). M\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 kh\u00e1c nh\u01b0 nh\u1ecbp ch\u1eadm, thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9, co th\u1eaft m\u1ea1ch v\u00e0nh, huy\u1ebft kh\u1ed1i, s\u1ed1t v\u00e0 ch\u1ebf \u0111\u1ed9 \u0103n c\u00f3 th\u1ec3 c\u0169ng l\u00e0 nh\u1eefng nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng nh\u1ecbp nhanh th\u1ea5t.<\/p>\n\n\n\n<p>Vi\u1ec7c nhanh ch\u00f3ng ki\u1ec3m so\u00e1t nh\u1eefng nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 \u0111\u1ea3o ngh\u1ecbch trong \u0111i\u1ec1u tr\u1ecb lo\u1ea1n nh\u1ecbp th\u1ea5t \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o. N\u1ebfu b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng m\u1ed9t s\u1ed1 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb c\u00f3 kh\u1ea3 n\u0103ng l\u00e0m bi\u1ebfn \u0111\u1ed5i ho\u1ea1t \u0111\u1ed9ng \u0111i\u1ec7n tim (ch\u1eb3ng h\u1ea1n k\u00e9o d\u00e0i kho\u1ea3ng QRS v\u00e0\/ho\u1eb7c QT) ho\u1eb7c g\u00e2y b\u1ea5t th\u01b0\u1eddng \u0111i\u1ec7n gi\u1ea3i (ch\u1eb3ng h\u1ea1n nh\u01b0 l\u1ee3i ti\u1ec3u thiazide v\u00e0 l\u1ee3i ti\u1ec3u quai) th\u00ec n\u00ean nghi ng\u1edd nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 l\u00e0 do c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb n\u00e0y. B\u1ea3ng 1 cung c\u1ea5p c\u00e1c khuy\u1ebfn c\u00e1o t\u00f3m t\u1eaft trong vi\u1ec7c \u0111i\u1ec1u tr\u1ecb c\u00e1c nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 \u0111\u1ea3o ngh\u1ecbch.<\/p>\n\n\n\n<p><strong>B\u1ea3ng 1.&nbsp;<\/strong>Khuy\u1ebfn c\u00e1o trong \u0111i\u1ec1u tr\u1ecb c\u00e1c nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 \u0111\u1ea3o ngh\u1ecbch<\/p>\n\n\n\n<p><img decoding=\"async\" alt=\"\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-9f6f95e30c9945f7e435274782eade04.png\"><strong>Ki\u1ec3m so\u00e1t c\u1ea5p nh\u1ecbp nhanh th\u1ea5t \u0111\u01a1n h\u00ecnh dai d\u1eb3ng (sustained monomorphic ventricular tachycardia \u2013 SMVT)<\/strong><\/p>\n\n\n\n<p>B\u1ec7nh nh\u00e2n nh\u1ecbp nhanh th\u1ea5t \u0111\u01a1n h\u00ecnh dai d\u1eb3ng n\u00ean d\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb d\u1ef1a theo tri\u1ec7u ch\u1ee9ng v\u00e0 b\u1ec7nh nguy\u00ean (h\u00ecnh 1). B\u1ec7nh nh\u00e2n c\u00f3 t\u00ecnh tr\u1ea1ng huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh c\u1ea7n \u0111\u01b0\u1ee3c s\u1ed1c \u0111i\u1ec7n chuy\u1ec3n nh\u1ecbp \u0111\u1ed3ng b\u1ed9 (synchronized cardioversion). N\u1ebfu kh\u00f4ng th\u1ec3 ti\u1ebfn h\u00e0nh vi\u1ec7c \u0111\u1ed3ng b\u1ed9 h\u00f3a, n\u00ean s\u1eed d\u1ee5ng bi\u1ec7n ph\u00e1p s\u1ed1c \u0111i\u1ec7n kh\u00f4ng \u0111\u1ed3ng b\u1ed9 (unsynchronized shock). Chuy\u1ec3n nh\u1ecbp kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u1edf b\u1ec7nh nh\u00e2n nh\u1ecbp nhanh th\u1ea5t t\u1ea1m th\u1eddi l\u1eb7p l\u1ea1i (Non-sustained ventricular tachycardia \u2013 NSVT). Adenosine ho\u1eb7c thao t\u00e1c ph\u1ebf v\u1ecb (vagal manoeuvres) \u0111\u1ed3ng th\u1eddi ghi nh\u1eadn li\u00ean t\u1ee5c ECG 12 chuy\u1ec3n \u0111\u1ecda n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc n\u1ebfu nghi ng\u1edd nh\u1ecbp nhanh tr\u00ean th\u1ea5t.<\/p>\n\n\n\n<p>\u0110\u1ed1i v\u1edbi bi\u1ec7n ph\u00e1p d\u01b0\u1ee3c l\u00fd \u0111\u1ec3 ki\u1ec3m so\u00e1t b\u1ec7nh nh\u00e2n nh\u1ecbp nhanh th\u1ea5t dung n\u1ea1p v\u1ec1 m\u1eb7t huy\u1ebft \u0111\u1ed9ng nh\u01b0ng ch\u01b0a r\u00f5 b\u1ec7nh nguy\u00ean, procainamide ho\u1eb7c amiodarone c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc. Tuy nhi\u00ean, procainamide thu\u1ed1c ch\u1ed1ng lo\u1ea1n nh\u1ecbp kh\u00e1c nh\u01b0 ajmaline, sotalol v\u00e0 flecainide c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 b\u1ec7nh tim m\u1ea1ch. Tuy nhi\u00ean c\u1ea7n t\u00ednh to\u00e1n \u0111\u1ebfn nh\u1eefng bi\u1ebfn c\u1ed1 c\u00f3 h\u1ea1i c\u00f3 th\u1ec3 g\u1eb7p c\u1ee7a c\u00e1c thu\u1ed1c n\u00e0y. Tr\u01b0\u1eddng h\u1ee3p nh\u1ecbp nhanh th\u1ea5t t\u1ef1 ph\u00e1t \u0111\u00e3 bi\u1ebft, ch\u1eb9n beta (cho tr\u01b0\u1eddng h\u1ee3p nh\u1ecbp nhanh \u0111\u01b0\u1eddng ra th\u1ea5t ph\u1ea3i) ho\u1eb7c verapamil (cho nh\u1ecbp nhanh th\u1ea5t t\u1eeb b\u00f3 d\u1eabn truy\u1ec1n) \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o.<\/p>\n\n\n\n<p><img decoding=\"async\" alt=\"\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-5c9947ed9c83b4d8f79378ec68da0403.png\"><strong>H\u00ecnh 1.<\/strong>&nbsp;Ph\u00e1c \u0111\u1ed3 ki\u1ec3m so\u00e1t c\u1ea5p nh\u1ecbp nhanh ph\u1ee9c b\u1ed9 QRS r\u1ed9ng (regular wide QRS complex tachycardia)<\/p>\n\n\n\n<p><sup><em>a. Ngo\u00e0i nh\u1ecbp nhanh tr\u00ean th\u1ea5t, adenosine c\u00f3 th\u1ec3 k\u1ebft th\u00fac nh\u1ecbp nhanh th\u1ea5t tr\u00e1i t\u1ef1 ph\u00e1t; b. L\u1ee3i \u00edch c\u1ee7a chuy\u1ec3n nh\u1ecbp n\u00ean \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 so v\u1edbi nguy c\u01a1 li\u00ean quan \u0111\u1ebfn an th\u1ea7n\/g\u00e2y m\u00ea; c. C\u00e2n nh\u1eafc s\u1ef1 h\u1ea1n ch\u1ebf c\u1ee7a c\u00e1c thu\u1ed1c ch\u1ed1ng lo\u1ea1n nh\u1ecbp kh\u00e1c<\/em><\/sup><\/p>\n\n\n\n<p><strong>Ki\u1ec3m so\u00e1t b\u00e3o \u0111i\u1ec7n v\u00e0 nh\u1ecbp nhanh th\u1ea5t li\u00ean t\u1ee5c<\/strong><\/p>\n\n\n\n<p>B\u00e3o \u0111i\u1ec7n (electrical storm) l\u00e0 t\u00ecnh tr\u1ea1ng th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u1eb7t ICD v\u00e0 \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 \u2265 3 \u0111\u1ee3t lo\u1ea1n nh\u1ecbp th\u1ea5t x\u1ea3y ra trong v\u00f2ng 24 gi\u1edd, m\u1ed7i \u0111\u1ee3t c\u00e1ch nhau t\u1ed1i thi\u1ec3u 5 ph\u00fat v\u00e0 c\u1ea7n ph\u1ea3i can thi\u1ec7p b\u1eb1ng t\u1ea1o nh\u1ecbp v\u01b0\u1ee3t t\u1ea7n s\u1ed1 c\u1eaft nh\u1ecbp nhanh (antitachycardia pacing \u2013 ATP) ho\u1eb7c chuy\u1ec3n nh\u1ecbp\/kh\u1eed rung. B\u1ec7nh nh\u00e2n g\u1eb7p ph\u1ea3i t\u00ecnh tr\u1ea1ng b\u00e3o \u0111i\u1ec7n th\u01b0\u1eddng b\u1ecb r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n, suy tim m\u1ea5t b\u00f9 v\u00e0 t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong.<\/p>\n\n\n\n<p>Tr\u01b0\u1eddng h\u1ee3p ICD shock kh\u00f4ng ph\u00f9 h\u1ee3p ho\u1eb7c \u0111\u1eb7t ICD kh\u00f4ng c\u1ea7n thi\u1ebft, vi\u1ec7c ng\u01b0ng ICD \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o. Tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n kh\u00f4ng \u1ed5n \u0111\u1ecbnh v\u1ec1 m\u1eb7t huy\u1ebft \u0111\u1ed9ng trong \u0111\u1ee3t \u0111\u00e1nh gi\u00e1 ban \u0111\u1ea7u, h\u1ed3i s\u1ee9c n\u00e2ng cao \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o. C\u00e1c b\u01b0\u1edbc ki\u1ec3m so\u00e1t xa h\u01a1n ph\u1ee5 thu\u1ed9c v\u00e0o ki\u1ec3u lo\u1ea1n nh\u1ecbp th\u1ea5t v\u00e0 b\u1ec7nh nguy\u00ean. B\u1ea3ng 2 v\u00e0 h\u00ecnh 2 tr\u00ecnh b\u00e0y c\u00e1c khuy\u1ebfn c\u00e1o c\u1ee5 th\u1ec3 trong ki\u1ec3m so\u00e1t b\u00e3o \u0111i\u1ec7n v\u00e0 nh\u1ecbp nhanh th\u1ea5t li\u00ean t\u1ee5c. Vi\u1ec7c qu\u1ea3n l\u00fd th\u01b0\u1eddng c\u1ea7n \u0111\u01b0\u1ee3c ti\u1ebfp c\u1eadn \u0111a ph\u01b0\u01a1ng di\u1ec7n, \u0111\u1ed3ng th\u1eddi ph\u1ea3i tham v\u1ea5n chuy\u00ean gia ICD n\u1ebfu c\u00f3 th\u1ec3. Thu\u1ed1c ch\u1ed1ng lo\u1ea1n nh\u1ecbp, thu\u1ed1c an th\u1ea7n, tri\u1ec7t \u0111\u1ed1t b\u1eb1ng catheter, \u0111i\u1ec1u bi\u1ebfn t\u1ef1 \u0111\u1ed9ng v\u00e0 h\u1ed7 tr\u1ee3 tu\u1ea7n ho\u00e0n c\u01a1 h\u1ecdc.<\/p>\n\n\n\n<p>\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n shock ICD t\u00e1i l\u1eb7p, c\u00e1c bi\u1ec7n ph\u00e1p an th\u1ea7n \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 l\u00e0m d\u1ecbu t\u00e2m th\u1ea7n v\u00e0 gi\u1ea3m nh\u1ecbp giao c\u1ea3m k\u00edch th\u00edch lo\u1ea1n nh\u1ecbp tim. \u0110i\u1ec1u tr\u1ecb ban \u0111\u1ea7u v\u1edbi ch\u1eb9n beta (\u01b0u ti\u00ean ch\u1eb9n beta kh\u00f4ng ch\u1ecdn l\u1ecdc nh\u01b0 propanolol) ph\u1ed1i h\u1ee3p v\u1edbi amiodarone l\u00e0 bi\u1ec7n ph\u00e1p th\u01b0\u1eddng \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn. \u1ede b\u1ec7nh nh\u00e2n nh\u1ecbp nhanh th\u1ea5t kh\u00f4ng dung n\u1ea1p v\u1ec1 m\u1eb7t huy\u1ebft \u0111\u1ed9ng h\u1ecdc t\u00e1i l\u1eb7p kh\u00e1ng tr\u1ecb v\u1edbi amiodarone th\u00ec landiolol (ch\u1eb9n beta1 th\u1eddi gian t\u00e1c \u0111\u1ed9ng r\u1ea5t ng\u1eafn) \u0111\u01b0\u1ee3c cho r\u1eb1ng c\u00f3 hi\u1ec7u qu\u1ea3 \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb t\u00ecnh tr\u1ea1ng lo\u1ea1n nh\u1ecbp. C\u00e1c thu\u1ed1c ch\u1ed1ng lo\u1ea1n nh\u1ecbp kh\u00e1c nh\u01b0 procainamide, lidocaine ho\u1eb7c quinidine \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc t\u00f9y v\u00e0o t\u00ecnh hu\u1ed1ng, ki\u1ec3u lo\u1ea1n nh\u1ecbp th\u1ea5t v\u00e0 b\u1ec7nh nguy\u00ean. N\u1ebfu t\u00ecnh tr\u1ea1ng b\u00e3o \u0111i\u1ec7n kh\u00f3 tr\u1ecb v\u1edbi nhi\u1ec1u c\u01a1n s\u1ed1c trong v\u00f2ng v\u00e0i gi\u1edd m\u1eb7c d\u00f9 b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c ch\u1ed1ng lo\u1ea1n nh\u1ecbp th\u00ec an th\u1ea7n s\u00e2u\/\u0111\u1eb7t kh\u00ed qu\u1ea3n n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc c\u00f9ng v\u1edbi th\u1edf m\u00e1y. N\u1ebfu ch\u1eb9n beta v\u1eabn ch\u01b0a \u0111\u1ee7 \u0111\u1ec3 ki\u1ec3m so\u00e1t t\u00ecnh h\u00ecnh ho\u1eb7c b\u1ec7nh nh\u00e2n kh\u00f4ng dung n\u1ea1p th\u00ec b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc b\u1eb1ng \u0111i\u1ec1u bi\u1ebfn t\u1ef1 \u0111\u1ed9ng.<\/p>\n\n\n\n<p>B\u00e3o \u0111i\u1ec7n tr\u00ean n\u1ec1n lo\u1ea1n nh\u1ecbp th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 nh\u1ecbp nhanh th\u1ea5t \u0111\u01a1n h\u00ecnh dai d\u1eb3ng li\u00ean quan \u0111\u1ebfn b\u1ec7nh tim c\u1ea5u tr\u00fac. Bi\u1ec7n ph\u00e1p tri\u1ec7t \u0111\u1ed1t li\u00ean quan \u0111\u1ebfn vi\u1ec7c gi\u1ea3m c\u00f3 \u00fd ngh\u0129a t\u00ecnh tr\u1ea1ng nh\u1ecbp nhanh th\u1ea5t v\u00e0 b\u00e3o \u0111i\u1ec7n t\u00e1i l\u1eb7p v\u00e0 c\u1ea3i thi\u1ec7n th\u1eddi gian s\u1ed1ng c\u00f2n. \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 nh\u1ecbp nhanh th\u1ea5t \u0111\u01a1n h\u00ecnh ch\u1eadm dai d\u1eb3ng, tri\u1ec7t \u0111\u1ed1t b\u1eb1ng catheter \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn h\u01a1n c\u00e1c thu\u1ed1c ch\u1ed1ng lo\u1ea1n nh\u1ecbp.<\/p>\n\n\n\n<p><strong>B\u1ea3ng 2.<\/strong>&nbsp;Khuy\u1ebfn c\u00e1o ki\u1ec3m so\u00e1t c\u1ea5p nh\u1ecbp nhanh th\u1ea5t dai d\u1eb3ng v\u00e0 b\u00e3o \u0111i\u1ec7n<\/p>\n\n\n\n<p><img decoding=\"async\" alt=\"\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-275038304bbe7a208e78e880643fd6c7.png\"><img decoding=\"async\" alt=\"\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-087898f691184eab71891545c35b2039.png\"><strong>H\u00ecnh 2.1.<\/strong>&nbsp;Khuy\u1ebfn c\u00e1o c\u1ee5 th\u1ec3 trong ki\u1ec3m so\u00e1t b\u00e3o \u0111i\u1ec7n<\/p>\n\n\n\n<p><sup><em>a. Kh\u00eda c\u1ea1nh \u0111\u1eb7c bi\u1ec7t c\u1ee7a li\u1ec7u ph\u00e1p s\u1eed d\u1ee5ng thi\u1ebft b\u1ecb; b. Ch\u01b0a c\u00f3 d\u1eef li\u1ec7u v\u1ec1 hi\u1ec7u qu\u1ea3 c\u1ee7a quinidine v\u1ec1 ngo\u1ea1i t\u00e2m thu th\u1ea5t d\u1eabn \u0111\u1ebfn lo\u1ea1n nh\u1ecbp th\u1ea5t \u0111a h\u00ecnh \u1edf b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh l\u00fd c\u01a1 tim; c. B\u1ec7nh nh\u00e2n c\u00f3 nhi\u1ec1u g\u00e1nh n\u1eb7ng b\u1ec7nh t\u1eadt lo\u1ea1n nh\u1ecbp th\u1ea5t cho th\u1ea5y c\u00f3 th\u1ec3 c\u00e1c \u0111\u1ee3t shock ICD x\u1ea3y ra th\u01b0\u1eddng xuy\u00ean v\u00e0 nh\u1ecbp ch\u1ec9 \u1ed5n \u0111\u1ecbnh trong kho\u1ea3ng th\u1eddi gian ng\u1eafn. \u00cdt g\u00e1nh n\u1eb7ng lo\u1ea1n nh\u1ecbp cho th\u1ea5y shock ICD v\u00e0 t\u1ea1o nh\u1ecbp v\u01b0\u1ee3t t\u1ea7n s\u1ed1 c\u1eaft nh\u1ecbp nhanh x\u1ea3y ra sau khi nh\u1ecbp \u1ed5n \u0111\u1ecbnh; d. N\u1ebfu nh\u1ecbp ch\u1eadm ho\u1eb7c nh\u1eefng kho\u1ea3ng d\u1eebng ngo\u1ea1i t\u00e2m thu t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho ngo\u1ea1i t\u00e2m thu th\u1ea5t\/rung th\u1ea5t; e. Overdrive pacing c\u00f3 th\u1ec3 c\u00f3 l\u1ee3i trong vi\u1ec7c l\u00e0m gi\u1ea3m t\u1ea1m th\u1eddi nh\u1ecbp nhanh th\u1ea5p t\u00e1i l\u1eb7p\/li\u00ean t\u1ee5c<\/em><\/sup><\/p>\n\n\n\n<p><img decoding=\"async\" alt=\"\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-056305779a4fb9a479db8651792e0bbb.png\"><br><strong>H\u00ecnh 2.2.<\/strong>&nbsp;Khuy\u1ebfn c\u00e1o c\u1ee5 th\u1ec3 trong ki\u1ec3m so\u00e1t b\u00e3o \u0111i\u1ec7n<\/p>\n\n\n\n<p><sup><em>a. Kh\u00eda c\u1ea1nh \u0111\u1eb7c bi\u1ec7t c\u1ee7a li\u1ec7u ph\u00e1p s\u1eed d\u1ee5ng thi\u1ebft b\u1ecb; b. Ch\u01b0a c\u00f3 d\u1eef li\u1ec7u v\u1ec1 hi\u1ec7u qu\u1ea3 c\u1ee7a quinidine v\u1ec1 ngo\u1ea1i t\u00e2m thu th\u1ea5t d\u1eabn \u0111\u1ebfn lo\u1ea1n nh\u1ecbp th\u1ea5t \u0111a h\u00ecnh \u1edf b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh l\u00fd c\u01a1 tim; c. B\u1ec7nh nh\u00e2n c\u00f3 nhi\u1ec1u g\u00e1nh n\u1eb7ng b\u1ec7nh t\u1eadt lo\u1ea1n nh\u1ecbp th\u1ea5t cho th\u1ea5y c\u00f3 th\u1ec3 c\u00e1c \u0111\u1ee3t shock ICD x\u1ea3y ra th\u01b0\u1eddng xuy\u00ean v\u00e0 nh\u1ecbp ch\u1ec9 \u1ed5n \u0111\u1ecbnh trong kho\u1ea3ng th\u1eddi gian ng\u1eafn. \u00cdt g\u00e1nh n\u1eb7ng lo\u1ea1n nh\u1ecbp cho th\u1ea5y shock ICD v\u00e0 t\u1ea1o nh\u1ecbp v\u01b0\u1ee3t t\u1ea7n s\u1ed1 c\u1eaft nh\u1ecbp nhanh x\u1ea3y ra sau khi nh\u1ecbp \u1ed5n \u0111\u1ecbnh; d. N\u1ebfu nh\u1ecbp ch\u1eadm ho\u1eb7c nh\u1eefng kho\u1ea3ng d\u1eebng ngo\u1ea1i t\u00e2m thu t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho ngo\u1ea1i t\u00e2m thu th\u1ea5t\/rung th\u1ea5t; e. Overdrive pacing c\u00f3 th\u1ec3 c\u00f3 l\u1ee3i trong vi\u1ec7c l\u00e0m gi\u1ea3m t\u1ea1m th\u1eddi nh\u1ecbp nhanh th\u1ea5p t\u00e1i l\u1eb7p\/li\u00ean t\u1ee5c<\/em><\/sup><\/p>\n\n\n\n<p><em><\/em><strong>H\u00ecnh 2.3.<\/strong>&nbsp;Khuy\u1ebfn c\u00e1o c\u1ee5 th\u1ec3 trong ki\u1ec3m so\u00e1t b\u00e3o \u0111i\u1ec7n<\/p>\n\n\n\n<p><sup><em>a. Kh\u00eda c\u1ea1nh \u0111\u1eb7c bi\u1ec7t c\u1ee7a li\u1ec7u ph\u00e1p s\u1eed d\u1ee5ng thi\u1ebft b\u1ecb; b. Ch\u01b0a c\u00f3 d\u1eef li\u1ec7u v\u1ec1 hi\u1ec7u qu\u1ea3 c\u1ee7a quinidine v\u1ec1 ngo\u1ea1i t\u00e2m thu th\u1ea5t d\u1eabn \u0111\u1ebfn lo\u1ea1n nh\u1ecbp th\u1ea5t \u0111a h\u00ecnh \u1edf b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh l\u00fd c\u01a1 tim; c. B\u1ec7nh nh\u00e2n c\u00f3 nhi\u1ec1u g\u00e1nh n\u1eb7ng b\u1ec7nh t\u1eadt lo\u1ea1n nh\u1ecbp th\u1ea5t cho th\u1ea5y c\u00f3 th\u1ec3 c\u00e1c \u0111\u1ee3t shock ICD x\u1ea3y ra th\u01b0\u1eddng xuy\u00ean v\u00e0 nh\u1ecbp ch\u1ec9 \u1ed5n \u0111\u1ecbnh trong kho\u1ea3ng th\u1eddi gian ng\u1eafn. \u00cdt g\u00e1nh n\u1eb7ng lo\u1ea1n nh\u1ecbp cho th\u1ea5y shock ICD v\u00e0 t\u1ea1o nh\u1ecbp v\u01b0\u1ee3t t\u1ea7n s\u1ed1 c\u1eaft nh\u1ecbp nhanh x\u1ea3y ra sau khi nh\u1ecbp \u1ed5n \u0111\u1ecbnh; d. N\u1ebfu nh\u1ecbp ch\u1eadm ho\u1eb7c nh\u1eefng kho\u1ea3ng d\u1eebng ngo\u1ea1i t\u00e2m thu t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho ngo\u1ea1i t\u00e2m thu th\u1ea5t\/rung th\u1ea5t; e. Overdrive pacing c\u00f3 th\u1ec3 c\u00f3 l\u1ee3i trong vi\u1ec7c l\u00e0m gi\u1ea3m t\u1ea1m th\u1eddi nh\u1ecbp nhanh th\u1ea5p t\u00e1i l\u1eb7p\/li\u00ean t\u1ee5c<\/em><\/sup><\/p>\n\n\n\n<p><strong>KI\u1ec2M SO\u00c1T L\u00c2U D\u00c0I<\/strong><\/p>\n\n\n\n<p><strong>Bi\u1ec7n ph\u00e1p d\u00f9ng thu\u1ed1c<\/strong><\/p>\n\n\n\n<p>T\u1ed1i \u01b0u h\u00f3a c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tim m\u1ea1ch n\u1ec1n, bao g\u1ed3m t\u1ed1i \u0111a h\u00f3a li\u1ec1u thu\u1ed1c \u0111i\u1ec1u tr\u1ecb suy tim l\u00e0 b\u1eaft bu\u1ed9c.<\/p>\n\n\n\n<p>\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n suy tim c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m (heart failure with reduced ejection fraction \u2013 HFrEF), h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb n\u0103m 2021 c\u1ee7a ESC v\u1ec1 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb suy tim c\u1ea5p v\u00e0 m\u1ea1n t\u00ednh \u0111\u00e3 khuy\u1ebfn c\u00e1o ch\u1ea5t \u1ee9c ch\u1ebf men chuy\u1ec3n angiotensin (angiotensinconverting enzyme inhibitor \u2013 ACEI)\/ch\u1ea5t ch\u1eb9n th\u1ee5 th\u1ec3 angiotensin (angiotensin receptor blocker \u2013 ARB)\/ch\u1ea5t \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 angiotensin\/neprilysin (angiotensin receptor neprilysin inhibitors \u2013 ARNI), ch\u1ea5t \u0111\u1ed1i v\u1eadn th\u1ee5 th\u1ec3 mineralocorticoid (mineralocorticoid receptor antagonists \u2013 MRA), ch\u1eb9n beta v\u00e0 ch\u1ea5t \u1ee9c ch\u1ebf k\u00eanh \u0111\u1ed3ng v\u1eadn chuy\u1ec3n natri \u2013 glucose 2 (sodium\u2013 glucose co-transporter 2 inhibitors \u2013 SGLT2i) \u0111\u1ec3 l\u00e0m gi\u1ea3m t\u1ef7 t\u1eed vong do suy tim v\u00e0 \u0111\u1ed9t t\u1eed do tim.<\/p>\n\n\n\n<p><strong>B\u1ea3ng 3.<\/strong>&nbsp;Khuy\u1ebfn c\u00e1o v\u1ec1 c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb suy tim<\/p>\n\n\n\n<p><img decoding=\"async\" alt=\"\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-5acc474423ccd73d30649f8dd0d7507a.png\">Thu\u1ed1c ch\u1ed1ng lo\u1ea1n nh\u1ecbp c\u00f3 vai tr\u00f2 quan tr\u1ecdng nh\u01b0 m\u1ed9t li\u1ec7u ph\u00e1p ph\u1ee5 tr\u1ee3 \u0111\u1ec3 ki\u1ec3m so\u00e1t lo\u1ea1n nh\u1ecbp th\u1ea5t, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng. Cho \u0111\u1ebfn nay, kh\u00f4ng c\u00f3 thu\u1ed1c ch\u1ed1ng lo\u1ea1n nh\u1ecbp n\u00e0o ngo\u1ea1i tr\u1eeb ch\u1eb9n beta ch\u1ee9ng minh \u0111\u01b0\u1ee3c kh\u1ea3 n\u0103ng l\u00e0m nguy c\u01a1 t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n. M\u1ed7i thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u1ec1u c\u00f3 th\u1ec3 g\u00e2y ra bi\u1ebfn c\u1ed1 c\u00f3 h\u1ea1i, bao g\u1ed3m c\u1ea3 th\u00fac \u0111\u1ea9y lo\u1ea1n nh\u1ecbp (pro-arrhythmia). Ch\u1eb3ng h\u1ea1n nh\u01b0 c\u00e1c thu\u1ed1c ch\u1ed1ng lo\u1ea1n nh\u1ecbp c\u00f3 th\u1ec3 k\u00e9o d\u00e0i kho\u1ea3ng QT, g\u00e2y xo\u1eafn \u0111\u1ec9nh, d\u1eabn truy\u1ec1n \u00e2m t\u00ednh, l\u00e0m tr\u1ea7m tr\u1ecdng th\u00eam suy tim v\u00e0 g\u00e2y ch\u1eadm nh\u1ecbp. B\u1ea3ng 5 t\u00f3m t\u1eaft \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a m\u1ed9t s\u1ed1 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng lo\u1ea1n nh\u1ecbp (c\u1ea5p v\u00e0 m\u1ea1n t\u00ednh). H\u00ecnh 3 t\u00f3m t\u1eaft quy tr\u00ecnh \u0111\u00e1nh gi\u00e1 \u0111\u1ec3 b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u00e0 theo d\u00f5i \u0111i\u1ec1u tr\u1ecb khi b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng thu\u1ed1c ch\u1eb9n k\u00eanh natri. H\u00ecnh 4 th\u1ec3 hi\u1ec7n quy tr\u00ecnh \u0111\u00e1nh gi\u00e1 kh\u1edfi \u0111\u1ea7u v\u00e0 theo d\u00f5i \u0111i\u1ec1u tr\u1ecb khi b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c thu\u1ed1c c\u00f3 kh\u1ea3 n\u0103ng k\u00e9o d\u00e0i kho\u1ea3ng QT.<\/p>\n\n\n\n<p><strong>B\u1ea3ng 4.<\/strong>&nbsp;Th\u00f4ng tin thu\u1ed1c ch\u1ed1ng lo\u1ea1n nh\u1ecbp<\/p>\n\n\n\n<p><img decoding=\"async\" alt=\"\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-f6ff2ede9236dafa92d85e0962752e0a.png\">\u0110i\u1ec1u ch\u1ec9nh y\u1ebfu t\u1ed1 nguy c\u01a1 l\u00e0 quan tr\u1ecdng \u0111\u1ec3 ph\u00f2ng ng\u1eeba vi\u1ec7c th\u00fac \u0111\u1ea9y lo\u1ea1n nh\u1ecbp c\u1ee7a c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb. \u1ede b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c thu\u1ed1c c\u00f3 th\u1ec3 th\u00fac \u0111\u1ea9y lo\u1ea1n nh\u1ecbp, vi\u1ec7c gi\u00e1m s\u00e1t ECG th\u01b0\u1eddng xuy\u00ean v\u00e0 c\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1c t\u00f9y thu\u1ed9c v\u00e0o \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a c\u00e1c thu\u1ed1c ch\u1ed1ng lo\u1ea1n nh\u1ecbp \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o.<\/p>\n\n\n\n<p><img decoding=\"async\" alt=\"\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-d2051639c6a8787d6908dc89f5296962.png\"><br><strong>H\u00ecnh 3.<\/strong>&nbsp;Ph\u00e1c \u0111\u1ed3 \u0111\u00e1nh gi\u00e1 tr\u01b0\u1edbc khi kh\u1edfi \u0111\u1ea7u v\u00e0 theo d\u00f5i b\u1ec7nh nh\u00e2n c\u1ea7n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c ch\u1eb9n k\u00eanh natri<\/p>\n\n\n\n<p><img decoding=\"async\" alt=\"\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-bc75fc5f9108cd766575ec51f1f49641.png\"><br><strong>H\u00ecnh 4.<\/strong>&nbsp;Ph\u00e1c \u0111\u1ed3 \u0111\u00e1nh gi\u00e1 tr\u01b0\u1edbc khi kh\u1edfi \u0111\u1ea7u v\u00e0 theo d\u00f5i b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c c\u00f3 kh\u1ea3 n\u0103ng k\u00e9o d\u00e0i kho\u1ea3ng QT<\/p>\n\n\n\n<p><strong>LI\u1ec6U PH\u00c1P S\u1eec D\u1ee4NG THI\u1ebeT B\u1eca &#8211; KH\u00cdA C\u1ea0NH CHUNG<\/strong><\/p>\n\n\n\n<p><strong>Thi\u1ebft b\u1ecb kh\u1eed rung tim c\u00f3 th\u1ec3 c\u1ea5y \u0111\u01b0\u1ee3c \u2013 ICD<\/strong><\/p>\n\n\n\n<p>ICD l\u00e0 thi\u1ebft b\u1ecb \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n s\u1ed1ng s\u00f3t sau ng\u01b0ng tim do lo\u1ea1n nh\u1ecbp ho\u1eb7c cho b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao. ICD l\u00e0 bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb c\u00f3 chi ph\u00ed cao v\u00e0 c\u00f3 nhi\u1ec1u bi\u1ebfn ch\u1ee9ng li\u00ean quan.<\/p>\n\n\n\n<p>Khi c\u00e2n nh\u1eafc ICD cho b\u1ec7nh nh\u00e2n, c\u1ea7n ph\u1ea3i t\u00ednh to\u00e1n \u0111\u1ebfn nhi\u1ec1u v\u1ea5n \u0111\u1ec1 quan tr\u1ecdng nh\u01b0 ti\u00ean l\u01b0\u1ee3ng s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n, ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 b\u1ec7nh m\u1eafc k\u00e8m. C\u00f3 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh th\u1eadn giai \u0111o\u1ea1n cu\u1ed1i, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 b\u1ec7nh nh\u00e2n cao tu\u1ed5i kh\u00f4ng h\u01b0\u1edfng \u0111\u01b0\u1ee3c nhi\u1ec1u l\u1ee3i \u00edch t\u1eeb ICD trong ph\u00f2ng ng\u1eeba th\u1ee9 ph\u00e1t.<\/p>\n\n\n\n<p><strong>B\u1ea3ng 5.<\/strong>&nbsp;Khuy\u1ebfn c\u00e1o v\u1ec1 ICD \u2013 kh\u00eda c\u1ea1nh chung<\/p>\n\n\n\n<p><img decoding=\"async\" alt=\"\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-0799c09417ac4309f88906b77bdf55ad.png\"><strong>B\u1ea3ng 6.<\/strong>&nbsp;Khuy\u1ebfn c\u00f3 ph\u00f2ng ng\u1eeba th\u1ee9 c\u1ea5p \u0111\u1ed9t t\u1eed do tim<\/p>\n\n\n\n<p><img decoding=\"async\" alt=\"\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-a07b8b03e606c811bf88af6ce38145c3.png\"><strong>B\u1ea3ng 7.<\/strong>&nbsp;Khuy\u1ebfn c\u00e1o cho thi\u1ebft b\u1ecb kh\u1eed rung tim d\u01b0\u1edbi da<\/p>\n\n\n\n<p><img decoding=\"async\" alt=\"\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-9568a27e23bad54af875b2b582397a35.png\"><strong>B\u1ed5 sung li\u1ec7u ph\u00e1p t\u00e1i \u0111\u1ed3ng b\u1ed9 tim<\/strong><\/p>\n\n\n\n<p>Li\u1ec7u ph\u00e1p t\u00e1i \u0111\u1ed3ng b\u1ed9 tim c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong \u1edf b\u1ec7nh nh\u00e2n suy tim. Vi\u1ec7c \u0111\u00e1nh gi\u00e1 k\u1ef9 l\u01b0\u1ee1ng l\u1ee3i \u00edch c\u00f3 th\u1ec3 c\u00f3 c\u1ee7a li\u1ec7u ph\u00e1p t\u00e1i \u0111\u1ed3ng b\u1ed9 tim tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ec9 \u0111\u1ecbnh ICD tr\u01b0\u1edbc khi ti\u1ebfn h\u00e0nh l\u00e0 b\u1eaft bu\u1ed9c. Vai tr\u00f2 c\u1ee7a vi\u1ec7c b\u1ed5 sung thi\u1ebft b\u1ecb kh\u1eed rung v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c c\u1ee7ng c\u1ed1 ch\u1eafc ch\u1eafn.<\/p>\n\n\n\n<p><strong>B\u1ea3ng 8.<\/strong>&nbsp;Khuy\u1ebfn c\u00e1o b\u1ed5 sung li\u1ec7u ph\u00e1p t\u00e1i \u0111\u1ed3ng b\u1ed9 tim \u1edf b\u1ec7nh nh\u00e2n c\u1ea5y ICD<\/p>\n\n\n\n<p><img decoding=\"async\" alt=\"\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-8d1fe4849a2a894f88e185bbc76c5930.png\"><strong>Thi\u1ebft b\u1ecb kh\u1eed rung tim mang \u0111\u01b0\u1ee3c<\/strong><\/p>\n\n\n\n<p>Thi\u1ebft b\u1ecb kh\u1eed rung tim mang \u0111\u01b0\u1ee3c l\u00e0 thi\u1ebft b\u1ecb kh\u1eed rung \u0111\u1eb7t \u1edf b\u00ean ngo\u00e0i \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh kh\u1ea3 n\u0103ng ph\u00e1t hi\u1ec7n t\u1ed1t v\u00e0 \u0111i\u1ec1u tr\u1ecb nh\u1ecbp nhanh th\u1ea5t v\u00e0 rung th\u1ea5t. Do v\u1eady, thi\u1ebft b\u1ecb kh\u1eed rung tim mang \u0111\u01b0\u1ee3c ph\u00f9 h\u1ee3p v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 nh\u01b0ng t\u1ea1m th\u1eddi kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh ICD, ch\u1eb3ng h\u1ea1n b\u1ec7nh nh\u00e2n \u0111ang d\u00f2 t\u00ecm thi\u1ebft b\u1ecb nhi\u1ec5m khu\u1ea9n \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh. Tuy nhi\u00ean m\u1ed9t v\u1ea5n \u0111\u1ec1 ch\u01b0a \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft l\u00e0 vi\u1ec7c b\u1ea3o v\u1ec7 b\u1ec7nh nh\u00e2n \u1edf pha s\u01a1m (40 ng\u00e0y) sau c\u01a1n nh\u1ed3i m\u00e1u c\u01a1 tim.<\/p>\n\n\n\n<p>D\u1eef li\u1ec7u v\u1ec1 l\u1ee3i \u00edch c\u1ee7a thi\u1ebft b\u1ecb kh\u1eed rung tim mang \u0111\u01b0\u1ee3c trong ph\u00f2ng ng\u1eeba th\u1ee9 ph\u00e1t \u0111\u1ed9t t\u1eed do tim \u1edf b\u1ed1i c\u1ea3nh l\u00e2m s\u00e0ng kh\u00e1c (ch\u1eb3ng h\u1ea1n nh\u01b0 vi\u00eam c\u01a1 tim c\u1ea5p, ph\u00f2ng ng\u1eeba th\u1ee9 ph\u00e1t \u1edf ph\u1ee5 n\u1eef mang thai) v\u1eabn ch\u01b0a \u0111\u1ea7y \u0111\u1ee7, do \u0111\u00f3 ch\u01b0a c\u00f3 khuy\u1ebfn c\u00e1o \u0111\u01b0\u1ee3c \u0111\u01b0a ra cho nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y.<\/p>\n\n\n\n<p><strong>B\u1ea3ng 9.&nbsp;<\/strong>Khuy\u1ebfn c\u00e1o cho thi\u1ebft b\u1ecb kh\u1eed rung mang \u0111\u01b0\u1ee3c<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-572e7e787029fbe6a3f61c3739ab68a1.png\" alt=\"\" \/><\/figure>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\" \/>\n\n\n\n<p><strong>T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Katja Zeppenfeld, Jacob Tfelt-Hansen, Marta de Rivaet al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Developed by the task force for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC).&nbsp;<em>European Heart Journal<\/em>. 2022;43(40): 3997\u20134126. https:\/\/doi.org\/10.1093\/eurheartj\/ehac262<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Hi\u1ec7p h\u1ed9i tim m\u1ea1ch Ch\u00e2u \u00c2u (European Society of Cardiology \u2013 ESC) \u0111\u00e3 \u0111\u01b0a ra h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb n\u0103m 2022 v\u1ec1 v\u1ea5n \u0111\u1ec1 ki\u1ec3m so\u00e1t b\u1ec7nh nh\u00e2n lo\u1ea1n nh\u1ecbp th\u1ea5t v\u00e0 ph\u00f2ng ng\u1eeba \u0111\u1ed9t t\u1eed do tim. H\u01b0\u1edbng d\u1eabn t\u00f3m t\u1eaft v\u00e0 \u0111\u00e1nh gi\u00e1 nh\u1eefng b\u1eb1ng ch\u1ee9ng hi\u1ec7n c\u00f3 nh\u1eb1m h\u1ed7 tr\u1ee3 c\u00e1c nh\u00e2n &hellip;<\/p>\n<p class=\"read-more\"> <a class=\"\" href=\"https:\/\/docquity.com\/vi\/articles\/esc-2022-huong-dan-kiem-soat-roi-loan-nhip-that-va-phong-ngua-dot-tu-do-tim\/\"> <span class=\"screen-reader-text\">ESC 2022: H\u01b0\u1edbng d\u1eabn ki\u1ec3m so\u00e1t r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t v\u00e0 ph\u00f2ng ng\u1eeba \u0111\u1ed9t t\u1eed do tim<\/span> Read More &raquo;<\/a><\/p>\n","protected":false},"author":123,"featured_media":13173,"comment_status":"closed","ping_status":"closed","template":"","meta":{"content-type":"","inline_featured_image":false,"site-sidebar-layout":"default","site-content-layout":"default","ast-global-header-display":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","footnotes":""},"articles_categories":[1370],"articles_tags":[],"articles_topics":[1436],"articles_languages":[1375],"articles_filters":[],"class_list":["post-13172","articles","type-articles","status-publish","has-post-thumbnail","hentry","articles_categories-medical-content-vi","articles_languages-vietnamese-vi"],"_links":{"self":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles\/13172","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles"}],"about":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/types\/articles"}],"author":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/users\/123"}],"replies":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/comments?post=13172"}],"version-history":[{"count":0,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles\/13172\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media\/13173"}],"wp:attachment":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media?parent=13172"}],"wp:term":[{"taxonomy":"articles_categories","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_categories?post=13172"},{"taxonomy":"articles_tags","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_tags?post=13172"},{"taxonomy":"articles_topics","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_topics?post=13172"},{"taxonomy":"articles_languages","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_languages?post=13172"},{"taxonomy":"articles_filters","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_filters?post=13172"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}