{"id":134129,"date":"2025-08-21T23:23:50","date_gmt":"2025-08-21T16:23:50","guid":{"rendered":"https:\/\/vnras.com\/drug\/?p=134129"},"modified":"2025-08-23T08:49:18","modified_gmt":"2025-08-23T01:49:18","slug":"vsh-vnha-2024-chien-luoc-thuc-hanh-lam-sang-quan-ly-tang-huyet-ap","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/vsh-vnha-2024-chien-luoc-thuc-hanh-lam-sang-quan-ly-tang-huyet-ap\/","title":{"rendered":"Chi\u1ebfn L\u01b0\u1ee3c Th\u1ef1c H\u00e0nh L\u00e2m S\u00e0ng Qu\u1ea3n L\u00fd T\u0103ng Huy\u1ebft \u00c1p t\u1ea1i Vi\u1ec7t Nam C\u1ee7a Ph\u00e2n H\u1ed9i T\u0103ng Huy\u1ebft \u00c1p VSH\/ VNHA 2024"},"content":{"rendered":"

Xem v\u00e0 t\u1ea3i file PDF t\u1ea1i \u0111\u00e2y<\/a>.<\/p>\n

PH\u1ea6N M\u1ede \u0110\u1ea6U<\/h2>\n
T\u0103ng huy\u1ebft \u00e1p (THA) hi\u1ec7n v\u1eabn l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c y t\u1ebf h\u00e0ng \u0111\u1ea7u, l\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh d\u1eabn \u0111\u1ebfn c\u00e1c b\u1ec7nh l\u00fd tim m\u1ea1ch v\u00e0 t\u1eed vong tr\u00ean to\u00e0n c\u1ea7u. T\u1ef7 l\u1ec7 ki\u1ec3m so\u00e1t THA tr\u00ean th\u1ebf gi\u1edbi v\u1eabn c\u00f2n h\u1ea1n ch\u1ebf, v\u1edbi ch\u1ec9 kho\u1ea3ng 20% b\u1ec7nh nh\u00e2n \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee9c ki\u1ec3m so\u00e1t (1). Trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y, c\u00e1c ti\u1ebfn b\u1ed9 nh\u01b0 s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a c\u00e1c nh\u00f3m thu\u1ed1c m\u1edbi \u0111\u1ea7y h\u1ee9a h\u1eb9n, c\u00e1c ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p t\u1ed1i \u01b0u ho\u00e1 vi\u1ec7c ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p nh\u1eb1m ng\u0103n ch\u1eb7n di\u1ec5n ti\u1ebfn c\u1ee7a THA v\u00e0 nh\u1eefng h\u1ec7 qu\u1ea3 nghi\u00eam tr\u1ecdng c\u1ee7a n\u00f3. T\u1ea1i ch\u00e2u \u00c2u, Hi\u1ec7p h\u1ed9i T\u0103ng Huy\u1ebft \u00c1p Ch\u00e2u \u00c2u (ESH) 2023-2024, Hi\u1ec7p h\u1ed9i Tim M\u1ea1ch Ch\u00e2u \u00c2u (ESC) 2024 \u0111\u00e3 c\u00f4ng b\u1ed1 c\u00e1c khuy\u1ebfn c\u00e1o m\u1edbi, v\u1eeba c\u00f3 t\u00ednh h\u00e0n l\u00e2m cao v\u1eeba s\u00e1t th\u1ef1c ti\u1ec5n nh\u01b0ng l\u1ea1i c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t l\u00e0m b\u1ed1i r\u1ed1i kh\u00f4ng \u00edt c\u00e1c th\u1ea7y thu\u1ed1c l\u00e2m s\u00e0ng (1-3). T\u1ea1i c\u00e1c n\u01b0\u1edbc Ch\u00e2u \u00c1 nh\u01b0 H\u00e0n Qu\u1ed1c, Nh\u1eadt B\u1ea3n, \u0110\u00e0i Loan, Trung Qu\u1ed1c v\u00e0 Vi\u1ec7t Nam trong nh\u1eefng n\u0103m v\u1eeba qua c\u0169ng \u0111\u00e3 c\u00f3 nh\u1eefng c\u1eadp nh\u1eadt khuy\u1ebfn c\u00e1o ri\u00eang, ph\u00f9 h\u1ee3p v\u1edbi th\u1ef1c ti\u1ec5n y t\u1ebf v\u00e0 \u0111\u1eb7c th\u00f9 khu v\u1ef1c (4-8).<\/p>\n
T\u1ea1i Vi\u1ec7t Nam theo b\u00e1o c\u00e1o c\u1ee7a WHO 2023, t\u1ef7 l\u1ec7 THA tu\u1ed5i t\u1eeb 30-79 l\u00e0 30% trong \u0111\u00f3 47% \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n, 30% \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb nh\u01b0ng ch\u1ec9 c\u00f3 13% \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t, t\u01b0\u01a1ng \u1ee9ng 14,3 tri\u1ec7u ng\u01b0\u1eddi THA (9). N\u0103m 2019, c\u00f3 287.000 ng\u01b0\u1eddi ch\u1ebft do b\u1ec7nh tim m\u1ea1ch trong \u0111\u00f3 60% c\u00f3 li\u00ean quan THA. N\u1ebfu ch\u00fang ta c\u1ed1 g\u1eafng c\u1ea3i thi\u1ec7n t\u1ef7 l\u1ec7 ki\u1ec3m so\u00e1t THA<140\/90mmHg l\u00ean 50% th\u00ec ph\u1ea3i c\u1ea7n th\u00eam 5,4 tri\u1ec7u ng\u01b0\u1eddi THA \u0111i\u1ec1u tr\u1ecb ki\u1ec3m s\u00f3at v\u00e0 s\u1ebd c\u1ee9u s\u1ed1ng 671.000 ng\u01b0\u1eddi v\u00e0o n\u0103m 2040 (1). M\u1ed9t th\u00e1ch th\u1ee9c v\u00f4 c\u00f9ng l\u1edbn lao, do \u0111\u00f3 VSH\/VNHA nh\u1eadn th\u1ea5y s\u1ef1 c\u1ea7n thi\u1ebft v\u1ec1 \u0111\u1ed3ng thu\u1eadn m\u1ed9t chi\u1ebfn l\u01b0\u1ee3c th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng trong qu\u1ea3n l\u00fd THA, c\u1eadp nh\u1eadt m\u1edbi ng\u1eafn g\u1ecdn nh\u1eb1m t\u1ed1i \u01b0u h\u00f3a vi\u1ec7c ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p \u0111\u1ea1t nhi\u1ec1u h\u01a1n v\u00e0 h\u00f2a nh\u1ecbp v\u1edbi nh\u1eefng ti\u1ebfn b\u1ed9 y h\u1ecdc v\u00e0 c\u00e1c khuy\u1ebfn c\u00e1o qu\u1ed1c t\u1ebf, th\u1ec3 hi\u1ec7n qua nguy\u00ean t\u1eafc c\u01a1 b\u1ea3n l\u1ea5y b\u1ec7nh nh\u00e2n l\u00e0m trung t\u00e2m v\u00e0 tri\u1ec3n khai “L\u1ed9 tr\u00ecnh chi\u1ebfn l\u01b0\u1ee3c 5\u0110” trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng v\u1edbi 5 b\u01b0\u1edbc c\u01a1 b\u1ea3n l\u1ea5y b\u1ec7nh nh\u00e2n l\u00e0m trung t\u00e2m \u0111\u1ec3 \u0111i \u0111\u1ebfn ki\u1ec3m so\u00e1t THA c\u00f3 hi\u1ec7u qu\u1ea3.<\/p>\n
PH\u00c2N LO\u1ea0I KHUY\u1ebeN C\u00c1O V\u00c0 M\u1ee8C CH\u1ee8NG C\u1ee8<\/h2>\n\n\n\n\n\n\n\n\n
Lo\u1ea1i khuy\u1ebfn c\u00e1o<\/th>\n \u0110\u1ecbnh ngh\u0129a<\/th>\n G\u1ee3i \u00fd s\u1eed d\u1ee5ng<\/th>\n<\/tr>\n
Lo\u1ea1i I<\/td>\n Ch\u1ee9ng c\u1ee9 v\u00e0\/ ho\u1eb7c s\u1ef1 \u0111\u1ed3ng thu\u1eadn cho th\u1ea5y vi\u1ec7c \u0111i\u1ec1u tr\u1ecb mang l\u1ea1i l\u1ee3i \u00edch v\u00e0 hi\u1ec7u qu\u1ea3.<\/td>\n \u0110\u01b0\u1ee3c khuy\u1ebfn c\u00e1o\/ ch\u1ec9 \u0111\u1ecbnh<\/td>\n<\/tr>\n
Lo\u1ea1i II<\/td>\n Ch\u1ee9ng c\u1ee9 \u0111ang c\u00f2n b\u00e0n v\u00e0\/ ho\u1eb7c \u00fd ki\u1ebfn kh\u00e1c nhau v\u1ec1 s\u1ef1 h\u1eefu \u00edch\/ hi\u1ec7u qu\u1ea3 c\u1ee7a vi\u1ec7c \u0111i\u1ec1u tr\u1ecb.<\/td>\n <\/td>\n<\/tr>\n
Nh\u00f3m IIa<\/td>\n Ph\u1ea7n l\u1edbn ch\u1ee9ng c\u1ee9\/ \u00fd ki\u1ebfn \u1ee7ng h\u1ed9 v\u1ec1 t\u00ednh hi\u1ec7u qu\u1ea3 c\u1ee7a vi\u1ec7c \u0111i\u1ec1u tr\u1ecb.<\/td>\n N\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t<\/td>\n<\/tr>\n
Nh\u00f3m IIb<\/td>\n Ch\u1ee9ng c\u1ee9\/ \u00fd ki\u1ebfn ch\u01b0a cho th\u1ea5y hi\u1ec7u qu\u1ea3\/ h\u1eefu \u00edch<\/td>\n C\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem x\u00e9t<\/td>\n<\/tr>\n
Lo\u1ea1i III<\/td>\n Ch\u1ee9ng c\u1ee9 v\u00e0\/ ho\u1eb7c s\u1ef1 \u0111\u1ed3ng thu\u1eadn cho th\u1ea5y vi\u1ec7c \u0111i\u1ec1u tr\u1ecb kh\u00f4ng mang l\u1ea1i l\u1ee3i \u00edch v\u00e0 hi\u1ec7u qu\u1ea3 trong v\u00e0i tr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 g\u00e2y nguy h\u1ea1i.<\/td>\n C\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem x\u00e9t<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
<\/p>\n\n\n\n\n\n\n\n
M\u1ee9c ch\u1ee9ng c\u1ee9<\/th>\n \u0110\u1ecbnh ngh\u0129a<\/th>\n<\/tr>\n<\/thead>\n
A<\/td>\n D\u1eef li\u1ec7u c\u00f3 t\u1eeb nhi\u1ec1u nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean ho\u1eb7c c\u00e1c ph\u00e2n t\u00edch g\u1ed9p<\/td>\n<\/tr>\n
B<\/td>\n D\u1eef li\u1ec7u c\u00f3 t\u1eeb nhi\u1ec1u nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean ho\u1eb7c c\u00e1c nghi\u00ean c\u1ee9u l\u1edbn kh\u00f4ng ng\u1eabu nhi\u00ean<\/td>\n<\/tr>\n
C<\/td>\n S\u1ef1 \u0111\u1ed3ng thu\u1eadn c\u1ee7a c\u00e1c chuy\u00ean gia v\u00e0\/ho\u1eb7c c\u00e1c nghi\u00ean c\u1ee9u nh\u1ecf, c\u00e1c nghi\u00ean c\u1ee9u h\u1ed3i c\u1ee9u<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Ph\u1ea7n 1: \u0110I\u1ec0U CH\u1ec8NH KHUY\u1ebeN C\u00c1O 2022<\/h2>\n
1\/\u0110i\u1ec1u ch\u1ec9nh ph\u00e2n lo\u1ea1i huy\u1ebft \u00e1p v\u00e0 t\u0103ng huy\u1ebft \u00e1p<\/h3>\n
Th\u1ed1ng nh\u1ea5t thu\u1eadt ng\u1eef “huy\u1ebft \u00e1p kh\u00f4ng t\u0103ng” c\u00f3 k\u00e8m (b\u00ecnh th\u01b0\u1eddng):<\/p>\n
a. Thang \u0111o li\u00ean t\u1ee5c c\u1ee7a nguy c\u01a1:<\/strong> Nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch kh\u00f4ng ch\u1ec9 b\u1eaft \u0111\u1ea7u t\u1eeb ng\u01b0\u1ee1ng “t\u0103ng huy\u1ebft \u00e1p” (\u2265 130\/80mmHg hay(\u2265 140\/90mmHg), m\u00e0 c\u00f3 th\u1ec3 t\u0103ng d\u1ea7n v\u1edbi b\u1ea5t k\u1ef3 m\u1ee9c huy\u1ebft \u00e1p n\u00e0o cao h\u01a1n l\u00fd t\u01b0\u1edfng (1).<\/p>\n
b. Gi\u1ea3m b\u1edbt s\u1ef1 hi\u1ec3u nh\u1ea7m:<\/strong> Thu\u1eadt ng\u1eef “huy\u1ebft \u00e1p b\u00ecnh th\u01b0\u1eddng” c\u00f3 th\u1ec3 khi\u1ebfn m\u1ed9t s\u1ed1 ng\u01b0\u1eddi l\u1ea7m t\u01b0\u1edfng r\u1eb1ng ch\u1ec9 c\u1ea7n huy\u1ebft \u00e1p d\u01b0\u1edbi ng\u01b0\u1ee1ng “t\u0103ng huy\u1ebft \u00e1p” th\u00ec kh\u00f4ng c\u00f3 nguy c\u01a1. Trong th\u1ef1c t\u1ebf, nguy c\u01a1 t\u0103ng d\u1ea7n v\u00e0 kh\u00f4ng ch\u1ec9 b\u1eaft \u0111\u1ea7u \u1edf m\u1ee9c huy\u1ebft \u00e1p cao (1).<\/p>\n
c. Nh\u1eefng ch\u1ee9ng c\u1ee9 t\u1eeb 2002 \u0111\u1ebfn nay:<\/strong> Lewingston ghi nh\u1eadn \u1edf \u0111\u1ed1i t\u01b0\u1ee3ng tr\u00ean 40 tu\u1ed5i, HA th\u01b0\u1eddng c\u00f3 m\u1ed1i quan h\u1ec7 m\u1ea1nh m\u1ebd v\u00e0 tr\u1ef1c ti\u1ebfp v\u1edbi t\u1ef7 l\u1ec7 t\u1eed vong do m\u1ea1ch m\u00e1u (v\u00e0 t\u1eed vong chung), m\u00e0 kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng n\u00e0o v\u1ec1 m\u1ed9t ng\u01b0\u1ee1ng c\u1ed1 \u0111\u1ecbnh, \u00edt nh\u1ea5t l\u00e0 \u0111\u1ebfn m\u1ee9c huy\u1ebft \u00e1p 115\/75 mmHg. N\u0103m 2020, Whelton qua nghi\u00ean c\u1ee9u MESA ghi nh\u1eadn c\u1ee9 t\u0103ng m\u1ed7i 10mmHg th\u00ec t\u0103ng 53% nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch do x\u01a1 v\u1eefa (BTMDXV) \u1edf ng\u01b0\u1eddi c\u00f3 HATT t\u1eeb 90-130mmHg (11). Trong BLTTC 2021 cho th\u1ea5y gi\u1ea3m m\u1ed7i 5mmHg HATT v\u00e0 m\u1ed7i 3mmHg HATTr \u0111\u1ec1u gi\u1ea3m 10% c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch b\u1ea5t k\u1ec3 c\u00f3 ti\u1ec1n s\u1eed c\u00f3 b\u1ec7nh tim m\u1ea1ch hay kh\u00f4ng v\u00e0 k\u1ebft qu\u1ea3 SPRINT c\u1ee7a Smith v\u00e0 c\u00f4ng s\u1ef1 th\u00e1ng 3,2024 v\u1ec1 HATTr cho th\u1ea5y gi\u1ea3m HATTr < 70mmHg kh\u00f4ng l\u00e0 r\u00e0o c\u1ea3n \u0111i\u1ec1u tr\u1ecb (12, 13).<\/p>\n
d. Khuy\u1ebfn kh\u00edch qu\u1ea3n l\u00fd huy\u1ebft \u00e1p t\u00edch c\u1ef1c h\u01a1n:<\/strong> Vi\u1ec7c s\u1eed d\u1ee5ng thu\u1eadt ng\u1eef \u201chuy\u1ebft \u00e1p kh\u00f4ng t\u0103ng” gi\u00fap nh\u1ea5n m\u1ea1nh r\u1eb1ng m\u1ee9c huy\u1ebft \u00e1p c\u00e0ng th\u1ea5p trong ph\u1ea1m vi h\u1ee3p l\u00fd th\u00ec c\u00e0ng c\u00f3 l\u1ee3i, thay v\u00ec ch\u1ec9 duy tr\u00ec d\u01b0\u1edbi ng\u01b0\u1ee1ng “b\u00ecnh th\u01b0\u1eddng”. Nh\u01b0ng \u0111\u1ec3 ph\u00f9 h\u1ee3p theo thu\u1eadt ng\u1eef ch\u00fang ta \u0111\u00e3 quen d\u00f9ng n\u00ean th\u1ed1ng nh\u1ea5t thu\u1eadt ng\u1eef \u201c huy\u1ebft \u00e1p kh\u00f4ng t\u0103ng (b\u00ecnh th\u01b0\u1eddng)”<\/p>\n
e. V\u1ec1 m\u1ee9c HA t\u0103ng “elevated BP” theo AHA\/ACC \u0111\u00e3 d\u00f9ng t\u1eeb 2017<\/strong>, Nh\u1eadt B\u1ea3n v\u00e0 H\u00e0n qu\u1ed1c c\u0169ng \u0111\u00e3 d\u00f9ng, nay v\u1edbi nh\u1eefng ch\u1ee9ng c\u1ee9 t\u1eeb nhi\u1ec1u th\u1eed nghi\u1ec7m g\u1ea7n \u0111\u00e2y (14-18) \u0111\u00e3 cho th\u1ea5y HATT 120-139 mmHg v\u00e0\/ho\u1eb7c HATTr 70-79mmHg l\u00e0 \u1edf m\u1ee9c nguy c\u01a1 gia t\u0103ng b\u1ec7nh tim m\u1ea1ch, v\u00e0 VSH\/VNHA th\u1ed1ng nh\u1ea5t d\u00f9ng t\u1eeb “ti\u1ec1n t\u0103ng huy\u1ebft \u00e1p” nh\u01b0 JNC VII \u0111\u00e3 d\u00f9ng tr\u01b0\u1edbc \u0111\u00e2y.<\/p>\n
T\u1eeb \u0111\u00f3 \u0111\u00e3 th\u1ed1ng nh\u1ea5t ph\u00e2n lo\u1ea1i THA nh\u01b0 sau:<\/p>\n
B\u1ea3ng 1.<\/strong> Ph\u00e2n lo\u1ea1i huy\u1ebft \u00e1p v\u00e0 THA c\u1ee7a VSH\/VNHA 2024<\/p>\n\n\n\n\n\n\n\n\n\n
Ph\u00e2n lo\u1ea1i<\/th>\n HATT (mmHg)<\/th>\n <\/th>\n HATTr (mmHg)<\/th>\n<\/tr>\n<\/thead>\n
Huy\u1ebft \u00e1p kh\u00f4ng t\u0103ng<\/td>\n <120<\/td>\n v\u00e0<\/td>\n <70<\/td>\n<\/tr>\n
Ti\u1ec1n t\u0103ng huy\u1ebft \u00e1p<\/td>\n 120-139<\/td>\n v\u00e0\/ho\u1eb7c<\/td>\n \u00a070-89<\/td>\n<\/tr>\n
T\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9 1<\/td>\n 140-159<\/td>\n v\u00e0\/ho\u1eb7c<\/td>\n 90-99<\/td>\n<\/tr>\n
T\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9 2<\/td>\n \u2265160<\/td>\n v\u00e0\/ho\u1eb7c<\/td>\n \u2265100<\/td>\n<\/tr>\n
T\u0103ng huy\u1ebft \u00e1p c\u1ea5p c\u1ee9u<\/td>\n \u2265180<\/td>\n v\u00e0\/ho\u1eb7c<\/td>\n \u2265110<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Ghi ch\u00fa: Huy\u1ebft \u00e1p kh\u00f4ng t\u0103ng: \u0110\u01b0\u1ee3c xem HA b\u00ecnh th\u01b0\u1eddng.<\/em><\/span>
\n T\u0103ng huy\u1ebft \u00e1p c\u1ea5p c\u1ee9u: Th\u01b0\u1eddng k\u00e8m t\u1ed5n th\u01b0\u01a1ng c\u01a1 trung gian (HMOD) v\u00e0 tri\u1ec7u ch\u1ee9ng nghi\u00eam tr\u1ecdng, c\u1ea7n x\u1eed tr\u00ed c\u1ea5p c\u1ee9u.<\/em><\/span><\/p>\n
2\/ Ph\u00e2n t\u1ea7ng nguy c\u01a1 \u1edf b\u1ec7nh nh\u00e2n THA<\/h3>\n
Theo s\u1ed1 li\u1ec7u th\u1ed1ng k\u00ea g\u1ea7n \u0111\u00e2y c\u1ee7a WHO, t\u1eed vong do tim m\u1ea1ch \u1edf Vi\u1ec7t Nam l\u00e0 178 tr\u00ean 100.000 ng\u01b0\u1eddi, thu\u1ed9c qu\u1ed1c gia c\u00f3 nguy c\u01a1 cao (7). Ch\u00fang t\u00f4i khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng thang \u0111i\u1ec3m nguy c\u01a1 tim m\u1ea1ch, nh\u01b0 thang \u0111i\u1ec3m nguy c\u01a1 ISH 2020 c\u00f3 b\u1ed5 sung m\u1ed9t s\u1ed1 YTNC m\u1edbi c\u1ee7a ESH 2023, ESC 2024, c\u00e1c t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u00edch v\u00e0 b\u1ec7nh \u0111\u1ed3ng m\u1eafc (1, 3, 19). Ch\u00fang ta c\u00f3 th\u1ec3 d\u1ef1a tr\u00ean b\u1ea5t k\u1ef3 thang \u0111i\u1ec3m n\u00e0o c\u00f3 s\u1eb5n nh\u01b0 thang \u0111i\u1ec3m c\u1ee7a WHO cho ng\u01b0\u1eddi \u0110\u00f4ng Nam \u00c1 ti\u00eau chu\u1ea9n thi\u1ebft y\u1ebfu (20), ho\u1eb7c SCORE 2, SCORE 2 \u2013 OP ho\u1eb7c s\u1eed d\u1ee5ng thang \u0111i\u1ec3m nguy c\u01a1 PCE (21) hay \u01b0u ti\u00ean s\u1eed d\u1ee5ng thang \u0111i\u1ec3m PREVENT c\u1ee7a Hoa K\u1ef3 cho ng\u01b0\u1eddi t\u1eeb 30 tu\u1ed5i tr\u1edf l\u00ean (22).<\/p>\n
B\u1ea3ng 2.<\/strong> Ph\u00e2n t\u1ea7ng nguy c\u01a1 t\u01b0\u01a1ng \u0111\u1ed1i d\u1ef1a v\u00e0o c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 VSH, 2024<\/p>\n\n\n\n\n\n\n\n\n
YTNC<\/th>\n TI\u1ec0N THA<\/th>\n THA \u0110\u1ed8 I<\/th>\n THA \u0110\u1ed8 II<\/th>\n<\/tr>\n
(120-129\/70-79)<\/th>\n (130-139\/80-89)<\/th>\n (140-159\/90-99)<\/th>\n (\u2265160\/100)<\/th>\n<\/tr>\n<\/thead>\n
1-2 (tr\u1eeb \u0110T\u0110, FH)<\/td>\n TH\u1ea4P<\/td>\n TH\u1ea4P<\/td>\n CAO<\/td>\n CAO<\/td>\n<\/tr>\n
\u22653 YTNC, HMOD, \u0110T\u0110, FH, CKD III<\/td>\n TH\u1ea4P<\/td>\n TRUNG B\u00ccNH<\/td>\n CAO<\/td>\n CAO<\/td>\n<\/tr>\n
B\u1ec7nh Tim M\u1ea1ch-N\u00e3o, CKD IV,V<\/td>\n TRUNG B\u00ccNH<\/td>\n CAO<\/td>\n CAO<\/td>\n CAO<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
TH\u1ea4P <5%, TRUNG B\u00ccNH 5-10%, <\/em>CAO > 10%,<\/em>T<\/em>h\u1ea5p \u0111\u1ebfn Cao: T\u0110LS. Cao: thu\u1ed1c, <\/em>Trung B\u00ecnh: sau 6 th\u00e1ng \u1edf nh\u00f3m ti\u00ean THA T\u0110LS kh\u00f4ng \u0111\u1ea1t \u0111\u00edch \u0111\u1ec1u tr\u1ecb thu\u1ed1c<\/em><\/span><\/p>\n
Y\u1ebfu t\u1ed1 nguy c\u01a1:<\/strong> <\/em>Tu\u1ed5i > 65, gi\u1edbi t\u00ednh nam, t\u1ea7n s\u1ed1 tim >80 l\u1ea7n\/ph\u00fat, th\u1eeba c\u00e2n, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, t\u0103ng LDL-C ho\u1eb7c triglyceride, FH, ti\u1ec1n s\u1eed gia \u0111\u00ecnh m\u1eafc THA, m\u00e1n kinh s\u1edbm, h\u00fat thu\u1ed1c l\u00e1, c\u00e1c y\u1ebfu t\u1ed1 m\u00f4i tr\u01b0\u1eddng – x\u00e1 h\u1ed9i, m\u00e1n kinh, sinh con s\u1ed1ng t\u0129nh t\u1ea1i.<\/p>\n
T\u1ed5n th\u01b0\u01a1ng c\u01a1 quan trung gian (HMOD):<\/strong><\/em> D\u00e0y th\u1ea5t tr\u00e1i ho\u1eb7c c\u00e1c b\u1eb1ng ch\u1ee9ng cho th\u1ea5y t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan n\u00e1o, tim, th\u1eadn, m\u1ea1ch m\u00e1u, CKD III, Hi\u1ec7u \u00e1p > 60 mmHg.<\/p>\n
B\u1ec7nh tim m\u1ea1ch:<\/strong> <\/em>B\u1ec7nh m\u1ea1ch v\u00e0nh, suy tim, \u0111\u1ed9t qu\u1ef5, b\u1ec7nh m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean, rung nh\u0129, b\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n IV V.<\/p>\n
3\/ M\u1ee5c \u0111\u00edch \u0111i\u1ec1u tr\u1ecb THA<\/h3>\n
M\u1ee5c \u0111\u00edch ch\u00ednh c\u1ee7a \u0111i\u1ec1u tr\u1ecb THA l\u00e0 ng\u0103n ng\u1eeba c\u00e1c b\u1ec7nh tim m\u1ea1ch th\u1eadn do t\u0103ng HA v\u00e0 gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong b\u1eb1ng c\u00e1ch ki\u1ec3m so\u00e1t HA \u0111\u1ea1t m\u1ee5c ti\u00eau t\u1ed1i \u01b0u. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 c\u00f3 b\u1ec7nh tim m\u1ea1ch, \u0111i\u1ec1u tr\u1ecb nh\u1eb1m m\u1ee5c \u0111\u00edch ki\u1ec3m so\u00e1t HA \u0111\u1ec3 ng\u0103n ng\u1eeba s\u1ef1 ti\u1ebfn tri\u1ec3n ho\u1eb7c t\u00e1i ph\u00e1t c\u1ee7a b\u1ec7nh nh\u1eb1m gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng theo khuy\u1ebfn c\u00e1o 2022 (7) (H\u00ecnh 1).<\/p>\n
$\"Hi\u0300nh$
Hi\u0300nh 1.<\/strong> Khuye\u0302\u0301n ca\u0301o ve\u0302\u0300 ngu\u031bo\u031b\u0303ng huye\u0302\u0301t a\u0301p ban \u0111a\u0302\u0300u ca\u0302\u0300n \u0111ie\u0302\u0300u tri\u0323<\/figcaption><\/figure>\n
a. M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb huy\u1ebft \u00e1p ph\u1ea3i ph\u00f9 h\u1ee3p v\u1edbi t\u1eebng b\u1ec7nh nh\u00e2n b\u1ea3o \u0111\u1ea3m c\u00f3 l\u1ee3i \u00edch hi\u1ec7u qu\u1ea3 tim m\u1ea1ch\/ nguy c\u01a1 t\u00e1c d\u1ee5ng ph\u1ee5-gi\u00e1 th\u00e0nh \u0111i\u1ec1u tr\u1ecb, d\u1ef1a tr\u00ean nguy\u00ean t\u1eafc c\u00e1 nh\u00e2n h\u00f3a. M\u1ee5c ti\u00eau n\u00e0y gi\u00fap \u0111\u1ecbnh h\u01b0\u1edbng cho c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb v\u00e0 \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch chia s\u1ebd v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1i nh\u00ecn r\u00f5 r\u00e0ng v\u1ec1 qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 c\u00f9ng tham gia \u0111\u1ea1t v\u00e0 duy tr\u00ec \u0111\u00edch: Do hi\u1ec7n nay \u0111\u00e3 c\u00f3 nhi\u1ec1u ch\u1ee9ng c\u1ee9 m\u1edbi t\u1eeb STEP (23), ESPRIT (18), SPRINT (13), CRHCP (24), ph\u00e2n t\u00edch g\u1ed9p c\u1ee7a Whelton v\u00e0 c\u1ed9ng s\u1ef1 (10) v\u00e0 m\u1edbi nh\u1ea5t th\u1eed nghi\u1ec7m BPROAD (25), ch\u00fang t\u00f4i c\u1eadp nh\u1eadt theo b\u1ea3ng 3 v\u00e0 h\u00ecnh 2:<\/p>\n
B\u1ea3ng 3.<\/strong> M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb h\u1ea1 HA theo c\u00e1 th\u1ec3 h\u00f3a<\/p>\n\n\n\n\n\n\n\n
M\u1ee4C TI\u00caU C\u00c1 TH\u1ec2 H\u00d3A<\/th>\n LO\u1ea0I<\/th>\n LOE<\/th>\n<\/tr>\n
M\u1ee5c ti\u00eau chung: T\u00edch c\u1ef1c T\u0110LS v\u00e0 d\u00f9ng thu\u1ed1c \u0111\u1ec3 \u0111\u1ea1t HA <130\/80 mmHg cho \u0111a s\u1ed1 tr\u01b0\u1eddng h\u1ee3p<\/td>\n I<\/td>\n A<\/td>\n<\/tr>\n
M\u1ee5c ti\u00eau t\u1ed1i \u01b0u: C\u00f3 th\u1ec3 h\u1ea1 <120\/70 mmHg n\u1ebfu dung n\u1ea1p t\u1ed1t \u1edf b\u1ec7nh nh\u00e2n THA nguy c\u01a1 cao, theo d\u00f5i s\u00e1t t\u00e1c d\u1ee5ng ph\u1ee5<\/td>\n IIa<\/td>\n A<\/td>\n<\/tr>\n
M\u1ee5c ti\u00eau HATT: \u00cdt nh\u1ea5t <140 mmHg. N\u1ebfu kh\u00f4ng dung n\u1ea1p v\u1edbi <130 mmHg, \u00e1p d\u1ee5ng nguy\u00ean t\u1eafc ALARA (“As low as reasonably achievable”)<\/td>\n IIb<\/td>\n B<\/td>\n<\/tr>\n
\u00c1p d\u1ee5ng nguy\u00ean t\u1eafc ALARA cho ng\u01b0\u1eddi THA c\u00f3 h\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb v\u00e0\/ho\u1eb7c tu\u1ed5i \u226585<\/td>\n IIa<\/td>\n B<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
<\/p>\n
$\"M\u1ee4C$
M\u1ee4C TI\u00caU CHUNG \u0110I\u1ec0U TR\u1eca THEO H\u1ea0PK \u1ede B\u1ec6NH NH\u00c2N THA-VSH\/VNHA 2024 \u0110I\u1ec0U CH\u1ec8NH<\/strong><\/figcaption><\/figure>\n
Ph\u1ea7n II: \u0110\u1ed3ng Thu\u1eadn v\u1ec1 Chi\u1ebfn L\u01b0\u1ee3c Th\u1ef1c H\u00e0nh L\u00e2m S\u00e0ng Qu\u1ea3n L\u00fd T\u0103ng Huy\u1ebft \u00c1p T\u1ea1i Vi\u1ec7t Nam<\/h2>\n
$\"Hi\u0300nh$
Hi\u0300nh 3.<\/strong> Lo\u0323\u0302 tri\u0300nh chie\u0302\u0301n lu\u031bo\u031b\u0323c 5\u0110 Thu\u031b\u0323c Ha\u0300nh La\u0302m Sa\u0300ng Qua\u0309n Ly\u0301 Ta\u0306ng Huye\u0302\u0301t A\u0301p ta\u0323i Vie\u0323\u0302t Nam<\/figcaption><\/figure>\n
T\u1ea1i Vi\u1ec7t Nam, t\u1ef7 l\u1ec7 ki\u1ec3m so\u00e1t THA c\u00f2n r\u1ea5t th\u1ea5p, ch\u1ec9 \u0111\u1ea1t 11% \u1edf nam gi\u1edbi v\u00e0 15% \u1edf n\u1eef gi\u1edbi. Trong th\u1ef1c t\u1ebf, c\u1ea3 \u0111\u1ed9i ng\u0169 y t\u1ebf l\u1eabn b\u1ec7nh nh\u00e2n \u0111\u1ec1u ph\u1ea3i \u0111\u1ed1i m\u1eb7t v\u1edbi nhi\u1ec1u r\u00e0o c\u1ea3n, g\u00f3p ph\u1ea7n l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p. V\u00ec v\u1eady, c\u1ea7n nh\u1ea5n m\u1ea1nh s\u1ef1 c\u1ea7n thi\u1ebft c\u1ee7a c\u00e1ch ti\u1ebfp c\u1eadn c\u00e1 th\u1ec3 h\u00f3a v\u00e0 h\u1ed7 tr\u1ee3 \u0111\u1ec3 gi\u1ea3i quy\u1ebft c\u00e1c r\u00e0o c\u1ea3n n\u00e0y. VSH\/VNHA \u0111\u01b0a ra m\u1ed9t chi\u1ebfn l\u01b0\u1ee3c th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng qu\u1ea3n l\u00fd t\u0103ng huy\u1ebft \u00e1p, l\u00e0 l\u1ed9 tr\u00ecnh 5\u0110 th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng \u0111\u1eb7t b\u1ec7nh nh\u00e2n l\u00e0m trung t\u00e2m trong vi\u1ec7c qu\u1ea3n l\u00fd THA. M\u1ed7i ch\u1eef c\u00e1i \u0111\u1ea1i di\u1ec7n cho m\u1ed9t b\u01b0\u1edbc quan tr\u1ecdng trong quy tr\u00ecnh v\u00e0 phi\u00ean ra Vi\u1ec7t ng\u1eef th\u00e0nh 5\u0110 nh\u01b0 h\u00ecnh 3.<\/p>\n
\u01101. \u0110o huy\u1ebft \u00e1p. (Track Blood Pressure)<\/h3>\n
\u01101.1. \u0110o huy\u1ebft \u00e1p v\u00e0 x\u00e1c \u0111\u1ecbnh c\u00e1c ph\u00e2n lo\u1ea1i THA<\/h4>\n
\u0110\u1ec3 c\u00f3 m\u1ed9t ch\u1ea9n \u0111o\u00e1n THA ch\u00ednh x\u00e1c, vi\u1ec7c \u0111o huy\u1ebft \u00e1p c\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u00fang quy tr\u00ecnh g\u1ed3m \u1edf c\u1ea3 m\u00f4i tr\u01b0\u1eddng l\u00e2m s\u00e0ng (ph\u00f2ng kh\u00e1m) (HAPK), HA c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111o b\u1eb1ng thi\u1ebft b\u1ecb c\u01a1 ho\u1eb7c thi\u1ebft b\u1ecb t\u1ef1 \u0111\u1ed9ng, c\u00f3 th\u1ec3 c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a nh\u00e2n vi\u00ean y t\u1ebf (T\u0110HAPK), v\u00e0 \u0111o HA ngo\u00e0i ph\u00f2ng kh\u00e1m (HANPK) g\u1ed3m: \u0110o huy\u1ebft \u00e1p t\u1ea1i nh\u00e0 (HATN), \u0111o huy\u1ebft \u00e1p l\u01b0u \u0111\u1ed9ng (HAL\u0110) (h\u00ecnh 4):<\/p>\n
\n
THAPK c\u1ea3 t\u00e2m thu v\u00e0 t\u00e2m tr\u01b0\u01a1ng<\/strong> (THA th\u1eadt s\u1ef1) \u2265 140\/90mmHg, THATN:<\/strong> HATT \u2265 135mmHg v\u00e0 ho\u1eb7c HATTr<\/strong> \u2265 85mmHg, THALD: 24 gi\u1edd \u2265 130\/80mmHg, THALD ban ng\u00e0y (th\u1ee9c)<\/strong> \u2265 135\/85mmHg, THALD ban \u0111\u00eam (ng\u1ee7)<\/strong> \u2265 120\/70mmHg<\/li>\n
THA \u00e1o cho\u00e0ng tr\u1eafng:<\/strong> khi \u0111o HAPK \u2265 140\/90 mmHg nh\u01b0ng \u0111o HATN <135\/80 mmHg ho\u1eb7c HAL\u0110 24 gi\u1edd <135\/85mmHg<\/li>\n
THA \u1ea9n gi\u1ea5u<\/strong> khi \u0111o HARK <140\/90mmHg nh\u01b0ng \u0111o HATN HA \u2265 135\/85mmHg ho\u1eb7c HALD 24 gi\u1edd \u2265 130\/80mmHg ho\u1eb7c HAL\u0110 ban ng\u00e0y \u2265 135\/85mmHg ho\u1eb7c HALD ban \u0111\u00eam \u2265 120\/70mmHg.<\/li>\n
HA kh\u00f4ng t\u0103ng (b\u00ecnh th\u01b0\u1eddng)<\/strong> theo ESC 2024 khi \u0111o HAPK <120\/70mmHg ho\u1ea1c HATN <120\/70mmHg ho\u1eb7c, HAL\u0110 24 gi\u1edd <115\/65mmHg (1). \u2022<\/li>\n
H\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf:<\/strong> trong l\u1ea7n kh\u00e1m \u0111o huy\u1ebft \u00e1p \u0111\u1ea7u ti\u00ean ho\u1eb7c m\u1ed7i l\u1ea7n t\u0103ng li\u1ec1u hay khi nghi ng\u1edd h\u1ea1 HA c\u1ea7n ph\u1ea3i \u0111o huy\u1ebft \u00e1p t\u01b0 th\u1ebf \u0111\u1ee9ng sau khi n\u1eb1m ngh\u1ec9 5 ph\u00fat \u0111o HA t\u01b0 th\u1ebf \u0111\u1ee9ng v\u00e0o 1′, 3′ v\u00e0 ph\u00fat th\u1ee9 5. N\u1ebfu huy\u1ebft \u00e1p t\u00e2m thu gi\u1ea3m t\u1eeb 20 mmHg tr\u1edf l\u00ean, ho\u1eb7c huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng gi\u1ea3m t\u1eeb 10 mmHg tr\u1edf l\u00ean so v\u1edbi t\u01b0 th\u1ebf n\u1eb1m\/ng\u1ed3i, c\u00f3 th\u1ec3 l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a h\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf. L\u1eb7p l\u1ea1i n\u1ebfu c\u1ea7n, trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, b\u00e1c s\u0129 c\u00f3 th\u1ec3 y\u00eau c\u1ea7u \u0111o l\u1ea1i sau v\u00e0i ph\u00fat \u0111\u1ee9ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u1ef1 thay \u0111\u1ed5i huy\u1ebft \u00e1p theo th\u1eddi gian. \u0110o huy\u1ebft \u00e1p t\u01b0 th\u1ebf \u0111\u1ee9ng gi\u00fap ph\u00e1t hi\u1ec7n v\u00e0 \u0111\u00e1nh gi\u00e1 nguy c\u01a1 h\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 li\u00ean quan, gi\u00fap cung c\u1ea5p th\u00f4ng tin h\u1eefu \u00edch cho vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb.<\/li>\n<\/ol>\n
$\"H\u00ecnh$
H\u00ecnh 4. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111o huy\u1ebft \u00e1p<\/figcaption><\/figure>\n
\u01101.2. Quy tr\u00ecnh \u0111o huy\u1ebft \u00e1p ti\u00eau chu\u1ea9n t\u1ea1i ph\u00f2ng kh\u00e1m HAPK hay HATN theo t\u01b0 th\u1ebf ng\u1ed3i (xem them \u1edf \u0111\u1ed3ng thu\u1eadn VSHA\/NHA v\u1ec1 HATN) (h\u00ecnh 3)<\/h4>\n
\u01101.3. Theo d\u00f5i li\u00ean t\u1ee5c v\u00e0 t\u0103ng c\u01b0\u1eddng h\u1ee3p t\u00e1c b\u1ec7nh nh\u00e2n v\u00e0 b\u00e1c s\u0129<\/h4>\n
Sau khi \u0111\u00e3 c\u00f3 ch\u1ea9n \u0111o\u00e1n, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c khuy\u1ebfn kh\u00edch ti\u1ebfp t\u1ee5c t\u1ef1 \u0111o HATN h\u00e0ng ng\u00e0y \u0111\u1ec3 gi\u00e1m s\u00e1t v\u00e0 duy tr\u00ec tu\u00e2n th\u1ee7 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p\u30fb \u0110i\u1ec1u n\u00e0y gi\u00fap ph\u00e1t hi\u1ec7n s\u1edbm c\u00e1c xu h\u01b0\u1edbng b\u1ea5t th\u01b0\u1eddng trong tr\u1ecb s\u1ed1 huy\u1ebft \u00e1p v\u00e0 theo d\u00f5i hi\u1ec7u qu\u1ea3 c\u1ee7a c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb.<\/p>\n
B\u1ec7nh nh\u00e2n n\u00ean c\u00f3 m\u00e1y \u0111o HATN \u0111\u1ec3 c\u00f3 th\u1ec3 theo d\u00f5i t\u1eeb xa v\u1edbi t\u1ef1 \u0111o HATN lo\u1ea1i m\u1edbi c\u00f3 th\u1ec3 cung c\u1ea5p c\u00e1c th\u00f4ng s\u1ed1 c\u1ea7n thi\u1ebft \u0111\u1ec3 qu\u1ea3n l\u00fd t\u1ed1t HA, \u0111\u01b0\u1ee3c xem l\u00e0 ph\u01b0\u01a1ng ph\u00e1p theo d\u00f5i trung t\u00e2m c\u00e1 th\u1ec3 h\u00f3a.<\/p>\n
Theo d\u00f5i li\u00ean t\u1ee5c kh\u00f4ng ch\u1ec9 gi\u00fap b\u00e1c s\u0129 c\u00f3 d\u1eef li\u1ec7u th\u1ef1c t\u1ebf v\u1ec1 s\u1ef1 thay \u0111\u1ed5i huy\u1ebft \u00e1p trong th\u1eddi gian d\u00e0i, m\u00e0 c\u00f2n gi\u00fap b\u1ec7nh nh\u00e2n c\u00f3 \u00fd th\u1ee9c t\u1ed1t h\u01a1n v\u1ec1 t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe c\u1ee7a m\u00ecnh. B\u1ec7nh nh\u00e2n c\u0169ng c\u00f3 th\u1ec3 ghi ch\u00e9p ho\u1eb7c s\u1eed d\u1ee5ng c\u00e1c \u1ee9ng d\u1ee5ng theo d\u00f5i \u0111\u1ec3 l\u01b0u tr\u1eef s\u1ed1 li\u1ec7u huy\u1ebft \u00e1p, gi\u00fap b\u00e1c s\u0129 \u0111\u00e1nh gi\u00e1 v\u00e0 \u0111i\u1ec1u ch\u1ec9nh \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi.<\/p>\n
Khi b\u1ec7nh nh\u00e2n th\u1ef1c hi\u1ec7n vi\u1ec7c t\u1ef1 \u0111o v\u00e0 ghi ch\u00e9p huy\u1ebft \u00e1p, h\u1ecd s\u1ebd c\u1ea3m th\u1ea5y c\u00f3 tr\u00e1ch nhi\u1ec7m v\u00e0 tham gia t\u00edch c\u1ef1c h\u01a1n v\u00e0o qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb. Th\u00f4ng qua c\u00e1c bu\u1ed5i t\u00e1i kh\u00e1m \u0111\u1ecbnh k\u1ef3, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 th\u1ea3o lu\u1eadn v\u1ec1 k\u1ebft qu\u1ea3 theo d\u00f5i v\u1edbi b\u00e1c s\u0129, t\u1eeb \u0111\u00f3 c\u1ea3i thi\u1ec7n s\u1ef1 h\u1ee3p t\u00e1c gi\u1eefa hai b\u00ean v\u00e0 gi\u00fap b\u00e1c s\u0129 c\u00f3 \u0111\u1ee7 th\u00f4ng tin \u0111\u1ec1 x\u00e2y d\u1ef1ng k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p nh\u1ea5t.<\/p>\n
B\u1ea3ng 4. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n t\u0103ng huy\u1ebft \u00e1p d\u1ef1a v\u00e0o huy\u1ebft \u00e1p ph\u00f2ng kh\u00e1m v\u00e0 huy\u1ebft \u00e1p ngo\u00e0i ph\u00f2ng kh\u00e1m c\u1ee7a VSH\/VNHA 2024<\/p>\n\n\n\n\n\n\n
Lo\u1ea1i THA mmHg<\/td>\n HAPK<\/td>\n HATN<\/td>\n HALD BAN NG\u00c0Y<\/td>\n HALD BAN \u0110\u00caM<\/td>\n HALD 24 GI\u1edc<\/td>\n<\/tr>\n
HA KH\u00d4NG T\u0102NG (b\u00ecnh th\u01b0\u1eddng)<\/td>\n HATT < 120<\/p>\n
V\u00e0<\/p>\n
HATTr < 70<\/td>\n
HATT < 120<\/p>\n
V\u00e0<\/p>\n
HATTr < 70<\/td>\n
HATT < 120<\/p>\n
V\u00e0<\/p>\n
HATTr < 70<\/td>\n
HATT < 120<\/p>\n
V\u00e0<\/p>\n
HATTr < 60<\/td>\n
HATT < 120<\/p>\n
V\u00e0<\/p>\n
HATTr < 65<\/td>\n<\/tr>\n
TI\u1ec0N T\u0102NG HUY\u1ebeT \u00c1P<\/td>\n HATT 120 – 139<\/p>\n
Ho\u1eb7c<\/p>\n
HATTr 70 – 89<\/td>\n
HATT 120 – 134<\/p>\n
Ho\u1eb7c<\/p>\n
HATTr 70 – 84<\/td>\n
HATT 120 – 134<\/p>\n
Ho\u1eb7c<\/p>\n
HATTr 70 – 84<\/td>\n
HATT 110 – 120<\/p>\n
Ho\u1eb7c<\/p>\n
HATTr 60 – 69<\/td>\n
HATT 115 – 129<\/p>\n
Ho\u1eb7c<\/p>\n
HATTr 65 – 79<\/td>\n<\/tr>\n
T\u0102NG HUY\u1ebeT \u00c1P<\/td>\n HATT >= 140<\/p>\n
Ho\u1eb7c<\/p>\n
HATTr >= 70<\/td>\n
HATT >= 135<\/p>\n
Ho\u1eb7c<\/p>\n
HATTr >= 85<\/td>\n
HATT >= 135<\/p>\n
Ho\u1eb7c<\/p>\n
HATTr >= 85<\/td>\n
HATT >= 120<\/p>\n
Ho\u1eb7c<\/p>\n
HATTr >= 70<\/td>\n
HATT >= 130<\/p>\n
Ho\u1eb7c<\/p>\n
HATTr >= 80<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
*Ch\u1ea9n \u0111o\u00e1n THA, ti\u1ec1n THA c\u1ea7n x\u00e1c \u0111\u1ecbnh b\u1eb1ng HA ngo\u00e0i ph\u00f2ng kh\u00e1m (HATN ho\u1eb7c HAL\u0110) ho\u1eb7c \u00edt nh\u1ea5t \u0111o th\u00eam 1 l\u1ea7n HAPK<\/em><\/p>\n
$\"H\u00ecnh$
H\u00ecnh 5. S\u01a1 \u0111\u1ed3 c\u00e1 b\u01b0\u1edbc kh\u00e1m \u0111o v\u00e0 ch\u1ea9n \u0111o\u00e1n THA v\u00e0 c\u00e1c sai l\u1ea7m th\u01b0\u1eddng m\u1eafc<\/figcaption><\/figure>\n
T\u00f3m l\u1ea1i: \u01101. \u0110O HUY\u1ebeT \u00c1P – (Track BP)<\/strong> trong l\u1ed9 tr\u00ecnh 5\u0110 th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng gi\u00fap t\u1ea1o n\u1ec1n t\u1ea3ng cho vi\u1ec7c ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c v\u00e0 theo d\u00f5i s\u00e1t sao t\u00ecnh tr\u1ea1ng huy\u1ebft \u00e1p c\u1ee7a b\u1ec7nh nh\u00e2n. \u0110\u00e2y l\u00e0 b\u01b0\u1edbc \u0111\u1ea7u ti\u00ean, nh\u01b0ng r\u1ea5t quan tr\u1ecdng, \u0111\u1ec3 b\u00e1c s\u0129 c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb v\u00e0 \u0111\u01b0a ra c\u00e1c quy\u1ebft \u0111\u1ecbnh ch\u00ednh x\u00e1c nh\u1eb1m c\u1ea3i thi\u1ec7n s\u1ee9c kh\u1ecfe tim m\u1ea1ch c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 b\u1ec7nh nh\u00e2n t\u1ef1 theo d\u00f5i qu\u1ea3n l\u00fd huy\u1ebft \u00e1p c\u1ee7a m\u00ecnh.<\/p>\n
\u01102. \u0110\u00e1nh gi\u00e1 to\u00e0n di\u1ec7n b\u1ec7nh nh\u00e2n \u4e00 (Review Patient)<\/h3>\n
$\"H\u00ecnh$
H\u00ecnh 6. \u0110\u00e1nh gi\u00e1 to\u00e0n di\u1ec7n b\u1ec7nh nh\u00e2n THA<\/figcaption><\/figure>\n
Nh\u1eb1m thi\u1ebft l\u1eadp ch\u1ea9n \u0111o\u00e1n \u0111\u1ea7y \u0111\u1ee7 to\u00e0n di\u1ec7n \u1edf ng\u01b0\u1eddi b\u1ec7nh c\u00f3 THA v\u1edbi c\u00e1c m\u1ee9c \u0111\u1ed9, giai \u0111o\u1ea1n THA qua ti\u1ec1n s\u1eed c\u00e1 nh\u00e2n v\u00e0 gia \u0111\u00ecnh, th\u0103m kh\u00e1m l\u00e2m s\u00e0ng, c\u00e1c x\u00e9t nghi\u1ec7m, s\u00e0ng l\u1ecdc nguy\u00ean nh\u00e2n THA th\u1ee9 ph\u00e1t, c\u00e1c y\u1ebfu t\u1ed1 tham gia ph\u00e1t tri\u1ec3n THA, c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 tim m\u1ea1ch \u0111i k\u00e8m, t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan trung gian do THA (HMOD), c\u00e1c b\u1ec7nh c\u1ea3nh \u0111\u1ed3ng m\u1eafc tim m\u1ea1ch, th\u1eadn v\u00e0 n\u00e3o (h\u00ecnh 6).<\/p>\n
Th\u1ef1c hi\u1ec7n qua c\u00e1c b\u01b0\u1edbc: Kh\u00e1m s\u00e0ng l\u1ecdc \u0111o huy\u1ebft \u00e1p hay \u0111i kh\u00e1m b\u1ec7nh b\u1ea5t k\u1ef3 b\u1ec7nh n\u00e0o th\u00f4ng qua ki\u1ec3m tra HA, ph\u00e1t hi\u1ec7n c\u00f3 Ti\u1ec1n THA ho\u1eb7c THA. Ti\u1ebfn h\u00e0nh kh\u1ea3o s\u00e1t th\u0103m kh\u00e1m to\u00e0n di\u1ec7n v\u1edbi h\u1ecfi k\u1ef9 ti\u1ec1n s\u1eed y khoa, ti\u1ec1n s\u1eed d\u00f9ng thu\u1ed1c, kh\u00e1m l\u00e2m s\u00e0ng to\u00e0n di\u1ec7n, x\u00e9t nghi\u1ec7m, t\u1ed3ng h\u1ee3p ph\u00e2n t\u1ea7ng nguy c\u01a1\u30fb M\u1ee5c \u0111\u00edch c\u1ee7a \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng l\u00e0 ch\u1ea9n \u0111o\u00e1n THA, x\u00e1c \u0111\u1ecbnh \u0111\u00e1nh gi\u00e1 c\u00e1c y\u1ebfu t\u1ed1 c\u00f3 kh\u1ea3 n\u0103ng g\u00f3p ph\u1ea7n g\u00e2y THA, x\u00e1c \u0111\u1ecbnh c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch kh\u00e1c, x\u00e1c \u0111\u1ecbnh c\u00e1c b\u1ec7nh \u0111i k\u00e8m c\u00f3 li\u00ean quan, s\u00e0ng l\u1ecdc c\u00e1c nguy\u00ean nh\u00e2n th\u1ee9 ph\u00e1t ti\u1ec1m \u1ea9n g\u00e2y THA (n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh) (b\u1ea3ng 5, 6, 7 v\u00e0 h\u00ecnh 6, h\u00ecnh 7).<\/p>\n
T\u1eeb \u0111\u00f3 thi\u1ebft l\u1eadp m\u1ed9t ch\u1ea9n \u0111o\u00e1n c\u1ee5 th\u1ec3 \u0111\u1ea7y \u0111\u1ee7 v\u00e0 th\u1ea3o lu\u1eadn th\u00f4ng b\u00e1o cho b\u1ec7nh nh\u00e2n c\u00f9ng quy\u1ebft \u0111\u1ecbnh ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb theo \u0111\u00fang chi\u1ebfn l\u01b0\u1ee3c ho\u1eb7c c\u1ea7n tham v\u1ea5n th\u00eam chuy\u00ean gia h\u1ed9i ch\u1ea9n chuy\u1ec3n vi\u1ec7n.<\/p>\n
T\u00f3m l\u01b0\u1ee3c \u01102 \u0110\u00e1nh gi\u00e1 to\u00e0n di\u1ec7n (Review Patient)<\/strong> trong chi\u1ebfn l\u01b0\u1ee3c 5\u0110 th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng gi\u00fap c\u00e1c b\u00e1c s\u0129 c\u00f3 c\u00e1i nh\u00ecn ch\u1ea9n \u0111o\u00e1n to\u00e0n di\u1ec7n v\u1ec1 t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n, gi\u00fap c\u00e1 th\u1ec3 h\u00f3a v\u00e0 t\u1ed1i \u01b0u h\u00f3a k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb. B\u1eb1ng c\u00e1ch th\u1ef1c hi\u1ec7n \u0111\u00e1nh gi\u00e1 chi ti\u1ebft v\u00e0 \u0111a chi\u1ec1u, b\u00e1c s\u0129 c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh c\u00e1c y\u1ebfu t\u1ed1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn huy\u1ebft \u00e1p, gi\u00fap \u0111i\u1ec1u ch\u1ec9nh \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 t\u1ed1t nh\u1ea5t v\u00e0 gi\u1ea3m nguy c\u01a1 bi\u1ebfn ch\u1ee9ng.<\/p>\n
\u01103. \u0110i\u1ec1u tr\u1ecb c\u00e1 th\u1ec3 h\u00f3a- \u0110i\u1ec1u tr\u1ecb ban \u0111\u1ea7u-(Assign individualized therapy \u4e00 Initial management of HTN)<\/h3>\n
\u01103-1. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ph\u00e2n t\u1ea7ng nguy c\u01a1 \u0111\u1ec1 x\u00e1c \u0111\u1ecbnh ng\u01b0\u1ee1ng ban \u0111\u1ea7u c\u1ea7n \u0111i\u1ec1u tr\u1ecb v\u00e0 m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb<\/strong><\/p>\n
C\u00f3 th\u1ec3 d\u1ef1a tr\u00ean b\u00e1t k\u1ef3 thang \u0111i\u1ec3m n\u00e0o c\u00f3 s\u1eb5n nh\u01b0 thang \u0111i\u1ec3m c\u1ee7a WHO cho ng\u01b0\u1eddi \u0110\u00f4ng Nam \u00c1 ti\u00eau chu\u1ea9n thi\u1ebft y\u1ebfu (20), ho\u1eb7c SCORE 2, SCORE 2 – OP ho\u1eb7c s\u1eed d\u1ee5ng thang \u0111i\u1ec3m nguy c\u01a1 PCE (21) hay \u01b0u ti\u00ean s\u1eed d\u1ee5ng thang \u0111i\u1ec3m PREVENT c\u1ee7a Hoa K\u1ef3 cho ng\u01b0\u1eddi t\u1eeb 30 tu\u1ed5i tr\u1edf l\u00ean (22) (bang 2).<\/p>\n
\u01103.2. \u0110\u1eb7t m\u1ee5c ti\u00eau huy\u1ebft \u00e1p ph\u00f9 h\u1ee3p v\u1edbi t\u1eebng b\u1ec7nh nh\u00e2n d\u1ef1a tr\u00ean c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 c\u00e1 nh\u00e2n, bao g\u1ed3m m\u1ee9c \u0111\u1ed9 suy y\u1ebfu, l\u00e3o h\u00f3a, t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe, c\u00e1c b\u1ec7nh \u0111\u1ed3ng m\u1eafc v\u00e0 b\u1ec7nh k\u00e8m theo<\/strong> (1,7, 10, 25, 26). M\u1ee5c ti\u00eau n\u00e0y gi\u00fap \u0111\u1ecbnh h\u01b0\u1edbng cho c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb v\u00e0 gi\u00fap b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1i nh\u00ecn r\u00f5 r\u00e0ng v\u1ec1 qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb: Do hi\u1ec7n nay \u0111\u00e3 c\u00f3 nhi\u1ec1u ch\u1ee9ng c\u1ee9 t\u1eeb STEP (23), ESPRIT (18), SPRINT (13, 15, 27), CRHCP (24), ph\u00e2n t\u00edch g\u1ed9p c\u1ee7a Whelton (10) v\u00e0 m\u1edbi nh\u1ea5t BPROAD (25). Tr\u00ean c\u01a1 s\u1edf m\u1ee5c ti\u00eau khuy\u1ebfn c\u00e1o c\u1ee7a VSHA\/NHA n\u0103m 2022 (7), nay c\u1ee5 th\u1ec3 r\u00f5 r\u00e0ng h\u01a1n nh\u01b0 sau:<\/p>\n
\u01103.3. M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb c\u00e1 th\u1ec3 h\u00f3a: <\/strong>HATT\/HATTr: <130\/80 mmHg, c\u00f3 th\u1ec3 th\u1ea5p h\u01a1n n\u1eefa <120\/70mmHg n\u1ebfu b\u1ec7nh nh\u00e2n dung n\u1ea1p t\u1ed1t (t\u1ed1i \u01b0u) ho\u1eb7c dung n\u1ea1p k\u00e9m \u00e1p d\u1ee5ng nguy\u00ean t\u1eafc ALARA (As Low As Reason\u00adably Achievable) v\u1edbi \u00edt nh\u1ea5t HATT <140mmHg, \u0111\u1eb7c bi\u1ec7t \u1edf b\u1ec7nh nh\u00e2n > 85 tu\u1ed5i, suy y\u1ebfu, h\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf, tu\u1ed5i th\u1ecd h\u1ea1n ch\u1ebf ho\u1eb7c kh\u00f4ng dung n\u1ea1p. (h\u00ecnh 2, b\u1ea3ng 3).<\/p>\n
$\"H\u00ecnh$
H\u00ecnh 7. C\u00e1c nguy\u00ean nh\u00e2n t\u0103ng huy\u1ebft \u00e1p th\u1ee9 ph\u00e1t \u1edf ng\u01b0\u1eddi d\u01b0\u1edbi 40 tu\u1ed5i<\/figcaption><\/figure>\n
\u01103.4. Nh\u1eadn th\u1ee9c v\u1ec1 b\u1ec7nh l\u00fd c\u00f9ng quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb \u0111\u1ea1t m\u1ee5c ti\u00eau<\/strong><\/p>\n
Trao \u0111\u1ed5i th\u1ea3o lu\u1eadn v\u1edbi b\u1ec7nh nh\u00e2n \u0111i \u0111\u1ebfn th\u1ed1ng nh\u1ea5t c\u00f9ng quy\u1ebft \u0111\u1ecbnh chung v\u1ec1 \u0111i\u1ec1u tr\u1ecb. \u0110\u00e2y l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 r\u1ea5t quan tr\u1ecdng, c\u1ea7n d\u00e0nh th\u1eddi gian th\u1ef1c hi\u1ec7n m\u00f4 t\u1ea3 b\u1ec7nh l\u00fd ch\u00ednh v\u00e0 t\u1ea1o ni\u1ec1m tin v\u1ec1 \u0111i\u1ec1u tr\u1ecb: \u1ee9ng d\u1ee5ng trong vi\u1ec7c truy\u1ec1n \u0111\u1ea1t ch\u1ea9n \u0111o\u00e1n THA cho b\u1ec7nh nh\u00e2n. C\u00e1ch b\u1ec7nh nh\u00e2n hi\u1ec3u v\u1ec1 b\u1ec7nh l\u00fd THA, m\u1ee9c \u0111\u1ed9 nguy hi\u1ec3m c\u1ee7a n\u00f3, v\u00e0 ni\u1ec1m tin c\u1ee7a h\u1ecd v\u1ec1 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb s\u1ebd \u1ea3nh h\u01b0\u1edfng l\u1edbn \u0111\u1ebfn vi\u1ec7c tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb v\u00e0 qu\u1ea3n l\u00fd b\u1ec7nh.<\/p>\n
Nguy\u00ean nh\u00e2n:<\/strong> B\u1ec7nh nh\u00e2n th\u01b0\u1eddng mu\u1ed1n bi\u1ebft l\u00fd do g\u00e2y THA. \u0110\u1ed1i v\u1edbi m\u1ed9t s\u1ed1 ng\u01b0\u1eddi, \u0111\u1eb7c bi\u1ec7t l\u00e0 nam gi\u1edbi, nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u00fd gi\u1ea3i qua c\u00e1c y\u1ebfu t\u1ed1 nh\u01b0 c\u0103ng th\u1eb3ng, th\u00f3i quen kh\u00f4ng l\u00e0nh m\u1ea1nh ho\u1eb7c di truy\u1ec1n. Ph\u1ee5 n\u1eef c\u00f3 th\u1ec3 li\u00ean h\u1ec7 THA v\u1edbi c\u00e1c y\u1ebfu t\u1ed1 nh\u01b0 n\u1ed9i ti\u1ebft, c\u1ea3m x\u00fac, ho\u1eb7c lo l\u1eafng trong gia \u0111\u00ecnh.<\/p>\n
Tri\u1ec7u ch\u1ee9ng:<\/strong> M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 cho r\u1eb1ng THA lu\u00f4n c\u00f3 tri\u1ec7u ch\u1ee9ng r\u00f5 r\u1ec7t nh\u01b0 \u0111au \u0111\u1ea7u, ch\u00f3ng m\u1eb7t L\u00e0m r\u00f5 r\u1eb1ng THA th\u01b0\u1eddng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng c\u1ee5 th\u1ec3 v\u00e0 nh\u1ea5n m\u1ea1nh r\u1eb1ng vi\u1ec7c \u0111o huy\u1ebft \u00e1p \u0111\u1ecbnh k\u1ef3 l\u00e0 quan tr\u1ecdng, ngay c\u1ea3 khi kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n n\u00e0o.<\/p>\n
T\u00ednh nghi\u00eam tr\u1ecdng:<\/strong> B\u1ec7nh nh\u00e2n c\u1ea7n hi\u1ec3u r\u1eb1ng THA c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng n\u1ebfu kh\u00f4ng ki\u1ec3m so\u00e1t. Tuy nhi\u00ean, c\u00e1ch ti\u1ebfp c\u1eadn c\u1ea7n m\u1ec1m m\u1ecfng, tr\u00e1nh g\u00e2y lo l\u1eafng th\u00e1i qu\u00e1.<\/p>\n
Kh\u1ea3 n\u0103ng ki\u1ec3m so\u00e1t:<\/strong> \u0110\u1ea3m b\u1ea3o b\u1ec7nh nh\u00e2n hi\u1ec3u r\u1eb1ng THA c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t t\u1ed1t qua tha\u1ef5 \u0111\u1ed5i l\u1ed1i s\u1ed1ng v\u00e0 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb. Nam gi\u1edbi c\u00f3 th\u1ec3 C\u00d3 xu h\u01b0\u1edbng ngh\u0129 r\u1eb1ng THA l\u00e0 kh\u00f4ng tr\u00e1nh kh\u1ecfi, trong khi ph\u1ee5 n\u1eef th\u01b0\u1eddng xem vi\u1ec7c \u0111i\u1ec1u tr\u1ecb l\u00e0 kh\u1ea3 thi h\u01a1n.<\/p>\n
\u01103.5. T\u1ea1o ni\u1ec1m tin v\u1ec1 \u0111i\u1ec1u tr\u1ecb<\/strong><\/p>\n
Hi\u1ec7u qu\u1ea3 c\u1ee7a \u0111i\u1ec1u tr\u1ecb:<\/strong> M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 nghi ng\u1edd hi\u1ec7u qu\u1ea3 c\u1ee7a thu\u1ed1c, \u0111\u1eb7c bi\u1ec7t l\u00e0 n\u1ebfu h\u1ecd kh\u00f4ng c\u1ea3m th\u1ea5y tri\u1ec7u ch\u1ee9ng, c\u1ea7n truy\u1ec1n t\u1ea3i r\u1eb1ng thu\u1ed1c gi\u00fap ng\u0103n ng\u1eeba bi\u1ebfn ch\u1ee9ng l\u00e2u d\u00e0i, kh\u00f4ng ch\u1ec9 l\u00e0 gi\u1ea3m tri\u1ec7u ch\u1ee9ng t\u1ee9c th\u1eddi.<\/p>\n
Lo ng\u1ea1i v\u1ec1 t\u00e1c d\u1ee5ng ph\u1ee5:<\/strong> Ph\u1ee5 n\u1eef c\u00f3 th\u1ec3 lo l\u1eafng v\u1ec1 t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c h\u01a1n so v\u1edbi nam gi\u1edbi. \u0110i\u1ec1u n\u00e0y c\u1ea7n \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch r\u00f5 r\u00e0ng v\u00e0 th\u1ea3o lu\u1eadn \u0111\u1ec3 tr\u1ea5n an b\u1ec7nh nh\u00e2n v\u1ec1 hi\u1ec7u qu\u1ea3 v\u00e0 t\u00ednh an to\u00e0n c\u1ee7a thu\u1ed1c khi s\u1eed d\u1ee5ng \u0111\u00fang li\u1ec1u.<\/p>\n
Ni\u1ec1m tin v\u1ec1 thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng:<\/strong> Nam gi\u1edbi th\u01b0\u1eddng \u0111\u00e1nh gi\u00e1 cao c\u00e1c bi\u1ec7n ph\u00e1p thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng (nh\u01b0 t\u1eadp th\u1ec3 d\u1ee5c) h\u01a1n l\u00e0 d\u00f9ng thu\u1ed1c. Cung c\u1ea5p c\u00e1c l\u1ef1a ch\u1ecdn thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng ph\u00f9 h\u1ee3p v\u00e0 khuy\u1ebfn kh\u00edch ph\u1ed1i h\u1ee3p gi\u1eefa l\u1ed1i s\u1ed1ng l\u00e0nh m\u1ea1nh v\u00e0 \u0111i\u1ec1u tr\u1ecb d\u01b0\u1ee3c l\u00fd.<\/p>\n
\u01103.6. \u1ee8ng d\u1ee5ng trong giao ti\u1ebfp<\/strong><\/p>\n
C\u00e1 th\u1ec3 h\u00f3a th\u00f4ng \u0111i\u1ec7p:<\/strong> S\u1eed d\u1ee5ng ng\u00f4n ng\u1eef d\u1ec5 hi\u1ec3u v\u00e0 ph\u00f9 h\u1ee3p v\u1edbi ni\u1ec1m tin v\u00e0 tr\u1ea3i nghi\u1ec7m c\u1ee7a t\u1eebng gi\u1edbi t\u00ednh. V\u00ed d\u1ee5, nh\u1ea5n m\u1ea1nh l\u1ee3i \u00edch c\u1ee7a vi\u1ec7c duy tr\u00ec s\u1ee9c kh\u1ecfe \u0111\u1ec3 ch\u0103m s\u00f3c gia \u0111\u00ecnh khi n\u00f3i chuy\u1ec7n v\u1edbi ph\u1ee5 n\u1eef, ho\u1eb7c khuy\u1ebfn kh\u00edch tr\u00e1ch nhi\u1ec7m t\u1ef1 ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe khi n\u00f3i chuy\u1ec7n v\u1edbi nam gi\u1edbi.<\/p>\n
T\u0103ng c\u01b0\u1eddng gi\u00e1o d\u1ee5c:<\/strong> Gi\u1ea3i th\u00edch r\u00f5 r\u00e0ng v\u1ec1 s\u1ef1 nguy hi\u1ec3m c\u1ee7a k\u1ebb gi\u1ebft ng\u01b0\u1eddi th\u1ea7m l\u1eb7ng n\u00e0y v\u00e0 vai tr\u00f2 c\u1ee7a b\u1ec7nh nh\u00e2n trong vi\u1ec7c qu\u1ea3n l\u00fd b\u1ec7nh.<\/p>\n
H\u1ed7 tr\u1ee3 c\u1ea3m x\u00fac:<\/strong> M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n, \u0111\u1eb7c bi\u1ec7t l\u00e0 ph\u1ee5 n\u1eef, c\u00f3 th\u1ec3 c\u1ea7n th\u00eam h\u1ed7 tr\u1ee3 v\u1ec1 m\u1eb7t c\u1ea3m x\u00fac khi nh\u1eadn ch\u1ea9n \u0111o\u00e1n. Khuy\u1ebfn kh\u00edch h\u1ecd chia s\u1ebb c\u1ea3m x\u00fac v\u00e0 gi\u1ea3i t\u00f4a nh\u1eefng lo ng\u1ea1i v\u1ec1 b\u1ec7nh l\u00fd c\u0169ng nh\u01b0 \u0111i\u1ec1u tr\u1ecb.<\/p>\n
Nh\u01b0 v\u1eady, vi\u1ec7c truy\u1ec1n \u0111\u1ea1t ch\u1ea9n \u0111o\u00e1n THA n\u00ean d\u1ef1a tr\u00ean s\u1ef1 hi\u1ec3u bi\u1ebft s\u00e2u s\u1eafc v\u1ec1 c\u00e1c m\u00f4 t\u1ea3 b\u1ec7nh l\u00fd v\u00e0 ni\u1ec1m tin v\u1ec1 \u0111i\u1ec1u tr\u1ecb c\u1ee7a b\u1ec7nh nh\u00e2n, \u0111\u1ed3ng th\u1eddi nh\u1ea1y c\u1ea3m v\u1edbi y\u1ebfu t\u1ed1 gi\u1edbi t\u00ednh \u0111\u1ec3 t\u1ed1i \u01b0u h\u00f3a qu\u00e1 tr\u00ecnh giao ti\u1ebfp v\u00e0 th\u00fac \u0111\u1ea9y tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb.<\/p>\n
\u01103.7. \u0110i\u1ec1u tr\u1ecb kh\u00f4ng d\u00f9ng thu\u1ed1c: Can thi\u1ec7p thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng<\/strong><\/p>\n
K\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb lu\u00f4n b\u1eaft \u0111\u1ea7u n\u1ec1n t\u1ea3ng thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh h\u1ea1 HA (H\u00ecnh 8).<\/p>\n
Ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng:<\/strong> Khuy\u1ebfn c\u00e1o b\u1ec7nh nh\u00e2n \u0103n gi\u1ea3m mu\u1ed1i, ti\u00eau th\u1ee5 \u00edt th\u1ef1c ph\u1ea9m ch\u1ebf bi\u1ebfn s\u1eb5n v\u00e0 \u0103n nhi\u1ec1u rau qu\u1ea3, c\u00e1c lo\u1ea1i h\u1ea1t, th\u1ef1c ph\u1ea9m gi\u00e0u kali v\u00e0 ch\u1ea5t x\u01a1 ch\u1ebf \u0111\u1ed9 DASH.<\/p>\n
Gi\u1ea3m ti\u00eau th\u1ee5 \u0111\u01b0\u1eddng t\u1ef1 do<\/strong> c\u00f3 trong c\u00e1c lo\u1ea1i \u0111\u1ed3 u\u1ed1ng c\u00f3 \u0111\u01b0\u1eddng, ch\u1eb3ng h\u1ea1n nh\u01b0 n\u01b0\u1edbc ng\u1ecdt v\u00e0 n\u01b0\u1edbc \u00e9p tr\u00e1i c\u00e2y c\u00f3 th\u00eam \u0111\u01b0\u1eddng., t\u1ed1i \u0111a kh\u00f4ng qu\u00e1 10% t\u1ed5ng n\u0103ng l\u01b0\u1ee3ng v\u00e0 n\u00ean gi\u1ea3m ti\u00eau th\u1ee5 ngay t\u1eeb l\u00fac tr\u1ebb. Gi\u1ea3m l\u01b0\u1ee3ng mu\u1ed1i ti\u00eau th\u1ee5: Natri ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c ti\u00eau th\u1ee5 d\u01b0\u1edbi d\u1ea1ng mu\u1ed1i t\u1eeb th\u1ef1c ph\u1ea9m ch\u1ebf bi\u1ebfn s\u1eb5n ho\u1eb7c th\u00eam v\u00e0o khi n\u1ea5u \u0103n. H\u1ea1n ch\u1ebf mu\u1ed1i < 5 g (kho\u1ea3ng 2 g natri) ho\u1eb7c 1 mu\u1ed7ng c\u00e0 ph\u00ea m\u1ed7i ng\u00e0y.<\/p>\n
T\u0103ng c\u01b0\u1eddng l\u01b0\u1ee3ng kali ti\u00eau th\u1ee5:<\/strong> T\u0103ng ti\u00eau th\u1ee5 kali, t\u1ed1t nh\u1ea5t l\u00e0 qua ch\u1ebf \u0111\u1ed9 \u0103n, ngo\u1ea1i tr\u1eeb b\u1ec7nh nh\u00e2n THA c\u00f3 b\u1ec7nh th\u1eadn m\u1ea1n ti\u1ebfn tri\u1ec3n. Th\u1ef1c ph\u1ea9m gi\u00e0u kali bao g\u1ed3m \u0111\u1eadu tr\u0103ng, b\u01a1 v\u00e0 chu\u1ed1i.<\/p>\n
$\"H\u00ecnh$
H\u00ecnh 8. \u0110i\u1ec1u tr\u1ecb kh\u00f4ng d\u00f9ng thu\u1ed1c: Can thi\u1ec7p thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng<\/figcaption><\/figure>\n
S\u1eed d\u1ee5ng c\u00e1c ch\u1ea5t thay th\u1ebf g\u1ed3m mu\u1ed1i NaCI 75% v\u00e0 25% KCL cho nh\u1eefng ng\u01b0\u1eddi ti\u00eau th\u1ee5 ch\u1ebf \u0111\u1ed9 \u0103n nhi\u1ec1u mu\u1ed1i.<\/p>\n
T\u0103ng c\u01b0\u1eddng t\u1eadp th\u1ec3 d\u1ee5c:<\/strong> T\u1eadp th\u1ec3 d\u1ee5c aerobic c\u01b0\u1eddng \u0111\u1ed9 v\u1eeba \/th\u1ea5p: ch\u1eb3ng h\u1ea1n nh\u01b0 \u0111i b\u1ed9, \u0111\u1ea1p xe, ho\u1eb7c b\u01a1i l\u1ed9i v\u1eeba ph\u1ea3i \u00edt nh\u1ea5t 150 ph\u00fat m\u1ed7i tu\u1ea7n (\u00edt nh\u1ea5t 30 ph\u00fat, 5-7 ng\u00e0y\/tu\u1ea7n) ho\u1eb7c thay th\u1ebf b\u1eb1ng 75 ph\u00fat t\u1eadp th\u1ec3 d\u1ee5c aerobic c\u01b0\u1eddng \u0111\u1ed9 m\u1ea1nh m\u1ed7i tu\u1ea7n, chia ra 3 ng\u00e0y, \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb, ho\u1ea1t \u0111\u1ed9ng n\u00e0y n\u00ean \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p v\u1edbi c\u00e1c b\u00e0i t\u1eadp kh\u00e1ng l\u1ef1c \u0111\u1ed9ng ho\u1eb7c t\u0129nh c\u01b0\u1eddng \u0111\u1ed9 th\u1ea5p ho\u1eb7c v\u1eeba (2-3 l\u1ea7n\/tu\u1ea7n) \u0111\u1ec3 gi\u00fap gi\u1ea3m huy\u1ebft \u00e1p v\u00e0 nguy c\u01a1 m\u1eafc b\u1ec7nh tim m\u1ea1ch nh\u01b0ng ph\u1ea3i b\u1ea3o \u0111\u1ea3m an to\u00e0n.<\/p>\n
Ki\u1ec3m so\u00e1t c\u00e2n n\u1eb7ng:<\/strong> Gi\u1ea3m c\u00e2n \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n th\u1eeba c\u00e2n gi\u00fap gi\u1ea3m huy\u1ebft \u00e1p BMI 20-25, v\u00f2ng eo \u1edf nam <94cm v\u00e0 n\u1eef <80cm.<\/p>\n
Gi\u1ea3m stress v\u00e0 tr\u00e1nh l\u1ed1i s\u1ed1ng t\u0129nh t\u1ea1i:<\/strong> Khuy\u1ebfn kh\u00edch c\u00e1c ho\u1ea1t \u0111\u1ed9ng th\u01b0 gi\u00e3n nh\u01b0 thi\u1ec1n, yoga ho\u1eb7c c\u00e1c b\u00e0i t\u1eadp th\u1edf \u0111\u1ec3 gi\u1ea3m c\u0103ng th\u1eb3ng.<\/p>\n
H\u1ea1n ch\u1ebf r\u01b0\u1ee3u v\u00e0 tr\u00e1nh thu\u1ed1c l\u00e1:<\/strong> Khuy\u1ebfn kh\u00edch b\u1ec7nh nh\u00e2n h\u1ea1n ch\u1ebf u\u1ed1ng r\u01b0\u1ee3u <200g\/ tu\u1ea7n \u0111\u1ebfn 0. B\u1ecf thu\u1ed1c l\u00e1 v\u00ec ch\u00fang \u0111\u1ec1u c\u00f3 th\u1ec3 l\u00e0m THA.<\/p>\n
S\u1ed1ng trong m\u00f4i tr\u01b0\u1eddng t\u1ed1t kh\u00f4ng \u00f4 nhi\u1ec5m kh\u00f4ng kh\u00ed, ti\u1ebfng \u1ed3n<\/strong><\/p>\n
\u01103.8. \u0110i\u1ec1u tr\u1ecb d\u00f9ng thu\u1ed1c v\u00e0 can thi\u1ec7p<\/strong><\/p>\n
\u0110i\u1ec1u tr\u1ecb THA l\u00e0 m\u1ed9t qu\u00e1 tr\u00ecnh l\u00e2u d\u00e0i li\u00ean t\u1ee5c, v\u00ec v\u1eady, c\u1ea7n c\u00f3 c\u00e1c l\u1ecbch t\u00e1i kh\u00e1m \u0111\u1ec3 b\u00e1c s\u0129 c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 \/ t\u00e1c d\u1ee5ng ph\u1ee5\/ gi\u00e1 c\u1ee7a ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb v\u00e0 \u0111i\u1ec1u ch\u1ec9nh khi c\u1ea7n thi\u1ebft. N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 b\u1ea5t k\u1ef3 t\u00e1c d\u1ee5ng ph\u1ee5 n\u00e0o ho\u1eb7c kh\u00f4ng \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb, b\u00e1c s\u0129 s\u1ebd th\u1ef1c hi\u1ec7n c\u00e1c thay \u0111\u1ed5i ph\u00f9 h\u1ee3p theo nguy\u00ean t\u1eafc ALARA. Th\u1eddi gian chu\u1ea9n li\u1ec1u t\u1eeb 1 – 3 th\u00e1ng, t\u1ed1i \u01b0u c\u00f3 th\u1ec3 1 th\u00e1ng.<\/p>\n
T\u00f3m l\u01b0\u1ee3c: \u01103:-\u0110i\u1ec1u tr\u1ecb to\u00e0n di\u1ec7n (Assign Therapy)<\/strong> theo ph\u00e1c \u0111\u1ed3 c\u00e1 th\u1ec3 h\u00f3a trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng THA t\u1ea1o n\u00ean m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb to\u00e0n di\u1ec7n , k\u1ebft h\u1ee3p thu\u1ed1c v\u00e0 thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng. B\u1eb1ng c\u00e1ch h\u1ed7 tr\u1ee3 b\u1ec7nh nh\u00e2n trong su\u1ed1t qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb v\u00e0 th\u1ef1c hi\u1ec7n c\u00e1c \u0111i\u1ec1u ch\u1ec9nh c\u1ea7n thi\u1ebft, b\u00e1c s\u0129 c\u00f9ng b\u1ec7nh nh\u00e2n cam k\u1ebft th\u1ef1c hi\u1ec7n c\u00e1c ch\u1ec9 \u0111\u1ecbnh, tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p hi\u1ec7u qu\u1ea3 h\u01a1n, gi\u1ea3m nguy c\u01a1 bi\u1ebfn ch\u1ee9ng v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng.<\/p>\n
$\"H\u00ecnh$
H\u00ecnh 9. Chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb thu\u1ed1c v\u00e0 can thi\u1ec7p<\/figcaption><\/figure>\n
$\"\"$ <\/p>\n
\u01104. \u0110\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb – (check response)<\/h3>\n
\u0110\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n v\u1edbi \u0111i\u1ec1u tr\u1ecb gi\u00fap t\u1ed1i \u01b0u h\u00f3a k\u1ebf ho\u1ea1ch v\u00e0 \u0111\u1ea3m b\u1ea3o b\u1ec7nh nh\u00e2n lu\u00f4n trong t\u00ecnh tr\u1ea1ng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t t\u1ed1t nh\u1ea5t.<\/p>\n
\u01104.1. Theo d\u00f5i c\u00e1c ch\u1ec9 s\u1ed1 huy\u1ebft \u00e1p \u0111\u1ecbnh k\u1ef3:<\/strong> Th\u1eddi gian ban \u0111\u1ea7u, ng\u1eafn h\u1ea1n v\u00e0 d\u00e0i h\u1ea1n<\/p>\n
Sau khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng T\u0110LS v\u00e0 thu\u1ed1c h\u1ea1 \u00e1p t\u1ea1i tuy\u1ebfn c\u01a1 s\u1edf \/ph\u00f2ng kh\u00e1m c\u00f3 b\u1ea3o hi\u1ec3m y t\u1ebf ho\u1eb7c ph\u00f2ng kh\u00e1m gia \u0111\u00ecnh, t\u01b0 nh\u00e2n, \u0111i\u1ec1u tr\u1ecb v\u00e0 t\u00e1i kh\u00e1m \u0111\u1ecbnh k\u1ef3 m\u1ed7i 2-4 tu\u1ea7n\/l\u1ea7n trong 2-3 th\u00e1ng \u0111\u1ea7u \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00e1c d\u1ee5ng tr\u00ean HA v\u00e0 \u0111\u00e1nh gi\u00e1 c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 c\u00f3 th\u1ec3 x\u1ea3y ra cho \u0111\u1ebfn khi \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee5c ti\u00eau HA. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb \u0111\u1ea1t \u0111\u00edch t\u1eeb m\u1ed9t \u0111\u1ebfn 3 th\u00e1ng, gi\u1eefa c\u00e1c b\u01b0\u1edbc t\u1eeb 1-3 th\u00e1ng, t\u1ed1i \u01b0u 1 th\u00e1ng, sau khi \u0111\u1ea1t \u0111\u00edch t\u00e1i kh\u00e1m theo l\u1ecbch h\u1eb9n v\u00e0 khi c\u00f3 b\u1ea5t th\u01b0\u1eddng.<\/p>\n
B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c khuy\u1ebfn kh\u00edch \u0111o huy\u1ebft \u00e1p th\u01b0\u1eddng xuy\u00ean t\u1ea1i nh\u00e0 v\u00e0 ghi ch\u00e9p l\u1ea1i c\u00e1c k\u1ebft qu\u1ea3 \u0111\u1ec3 so s\u00e1nh v\u1edbi m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb, tr\u01b0\u1edbc khi t\u00e1i kh\u00e1m. Vi\u1ec7c theo d\u00f5i li\u00ean t\u1ee5c gi\u00fap ph\u00e1t hi\u1ec7n s\u1edbm nh\u1eefng bi\u1ebfn \u0111\u1ed9ng b\u1ea5t th\u01b0\u1eddng v\u00e0 gi\u00fap b\u00e1c s\u0129 \u0111i\u1ec1u ch\u1ec9nh ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb khi c\u1ea7n thi\u1ebft.<\/p>\n
T\u1ea1i c\u00e1c bu\u1ed5i t\u00e1i kh\u00e1m, b\u00e1c s\u0129 s\u1ebd ki\u1ec3m tra c\u00e1c ch\u1ec9 s\u1ed1 huy\u1ebft \u00e1p do b\u1ec7nh nh\u00e2n ghi l\u1ea1i \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 xem huy\u1ebft \u00e1p c\u00f3 \u0111ang \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t \u1ed5n \u0111\u1ecbnh kh\u00f4ng. N\u1ebfu huy\u1ebft \u00e1p kh\u00f4ng \u0111\u1ea1t m\u1ee5c ti\u00eau, xem x\u00e9t c\u00e1c y\u1ebfu t\u1ed1 \u1ea3nh h\u01b0\u1edfng v\u00e0 \u0111\u01b0a ra \u0111i\u1ec1u ch\u1ec9nh ph\u00f9 h\u1ee3p v\u00e0 chu\u1ea9n li\u1ec1u.<\/p>\n
\u01104.2. \u0110\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb\/ t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c:<\/strong><\/p>\n
– B\u00e1c s\u0129 s\u1ebd h\u1ecfi b\u1ec7nh nh\u00e2n v\u1ec1 c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 m\u00e0 h\u1ecd c\u00f3 th\u1ec3 g\u1eb7p ph\u1ea3i khi s\u1eed d\u1ee5ng thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p, ch\u1eb3ng h\u1ea1n nh\u01b0 ho khan, ch\u00f3ng m\u1eb7t, m\u1ec7t m\u1ecfi, bu\u1ed3n n\u00f4n, ho\u1eb7c ph\u00f9 ch\u00e2n. Ph\u1ea3n \u1ee9ng c\u1ee7a c\u01a1 th\u1ec3 v\u1edbi thu\u1ed1c l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 b\u00e1c s\u0129 c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh xem c\u00f3 c\u1ea7n thay \u0111\u1ed5i lo\u1ea1i thu\u1ed1c ho\u1eb7c li\u1ec1u l\u01b0\u1ee3ng kh\u00f4ng.<\/p>\n
– Khi ph\u00e1t hi\u1ec7n t\u00e1c d\u1ee5ng ph\u1ee5 kh\u00f4ng dung n\u1ea1p, b\u00e1c s\u0129 c\u00f3 th\u1ec3 thay \u0111\u1ed5i thu\u1ed1c ho\u1eb7c \u0111\u01b0a ra c\u00e1c bi\u1ec7n ph\u00e1p h\u1ed7 tr\u1ee3 gi\u00fap b\u1ec7nh nh\u00e2n gi\u1ea3m b\u1edbt c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00f4ng mong mu\u1ed1n.<\/p>\n
\u01104.3. \u0110\u00e1nh gi\u00e1 s\u1ef1 thay \u0111\u1ed5i trong l\u1ed1i s\u1ed1ng<\/strong><\/p>\n
– Vi\u1ec7c thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong d\u1ef1 ph\u00f2ng v\u00e0 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p, n\u00ean b\u00e1c s\u0129 c\u0169ng s\u1ebd h\u1ecfi b\u1ec7nh nh\u00e2n v\u1ec1 c\u00e1c bi\u1ec7n ph\u00e1p c\u1ea3i thi\u1ec7n l\u1ed1i s\u1ed1ng \u0111\u00e3 th\u1ef1c hi\u1ec7n (ch\u1ebf \u0111\u1ed9 \u0103n, t\u1eadp th\u1ec3 d\u1ee5c, b\u1ecf thu\u1ed1c l\u00e1, h\u1ea1n ch\u1ebf r\u01b0\u1ee3u bia). Theo d\u00f5i qu\u00e1 tr\u00ecnh n\u00e0y gi\u00fap \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 tu\u00e2n th\u1ee7 v\u00e0 hi\u1ec7u qu\u1ea3 c\u1ee7a c\u00e1c bi\u1ec7n ph\u00e1p kh\u00f4ng d\u00f9ng thu\u1ed1c. \u0110\u1eb7c bi\u1ec7t trong luy\u1ec7n t\u1eadp g\u1eafng s\u1ee9c c\u01b0\u1eddng \u0111\u1ed9 cao (b\u1ea3ng )<\/p>\n
– N\u1ebfu b\u1ec7nh nh\u00e2n g\u1eb7p kh\u00f3 kh\u0103n trong vi\u1ec7c duy tr\u00ec nh\u1eefng thay \u0111\u1ed5i n\u00e0y, b\u00e1c s\u0129 c\u00f3 th\u1ec3 cung c\u1ea5p th\u00eam c\u00e1c h\u1ed7 tr\u1ee3 ho\u1eb7c g\u1ee3i \u00fd c\u00e1c ph\u01b0\u01a1ng ph\u00e1p d\u1ec5 th\u1ef1c hi\u1ec7n h\u01a1n<\/p>\n
\u01104.4. Ki\u1ec3m tra ti\u1ebfn tr\u00ecnh \u0111\u00e1p \u1ee9ng v\u00e0 \u0111\u1ed9ng vi\u00ean<\/strong><\/p>\n
– C\u00e1c bu\u1ed5i t\u00e1i kh\u00e1m \u0111\u1ecbnh k\u1ef3 c\u0169ng l\u00e0 c\u01a1 h\u1ed9i \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 l\u1ea1i v\u1ec1 s\u1ef1 \u0111\u00e1p \u1ee9ng c\u1ea3i thi\u1ec7n m\u1ee9c \u0111\u1ed9 THA, HMOD, b\u1ec7nh \u0111\u1ed3ng m\u1eafc, \u0111\u1ed9ng vi\u00ean b\u1ec7nh nh\u00e2n, gi\u00fap h\u1ecd duy tr\u00ec \u0111\u1ed9ng l\u1ef1c trong vi\u1ec7c tu\u00e2n th\u1ee7 k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb. B\u00e1c s\u0129 c\u00f3 th\u1ec3 ghi nh\u1eadn nh\u1eefng c\u1ea3i thi\u1ec7n trong ch\u1ec9 s\u1ed1 huy\u1ebft \u00e1p v\u00e0 s\u1ee9c kh\u1ecfe t\u1ed5ng th\u1ec3 \u0111\u1ec3 b\u1ec7nh nh\u00e2n th\u1ea5y \u0111\u01b0\u1ee3c k\u1ebft qu\u1ea3 t\u00edch c\u1ef1c t\u1eeb n\u1ed7 l\u1ef1c c\u1ee7a h\u1ecd.<\/p>\n
– Khi b\u1ec7nh nh\u00e2n \u0111\u1ea1t \u0111\u01b0\u1ee3c c\u00e1c m\u1ee5c ti\u00eau ng\u1eafn h\u1ea1n, b\u00e1c s\u0129 c\u00f3 th\u1ec3 thi\u1ebft l\u1eadp th\u00eam nh\u1eefng m\u1ee5c ti\u00eau m\u1edbi \u0111\u1ec3 duy tr\u00ec ti\u1ebfn \u0111\u1ed9 c\u1ea3i thi\u1ec7n s\u1ee9c kh\u1ecfe.<\/p>\n
\u01104.5. \u0110i\u1ec1u ch\u1ec9nh v\u00e0 t\u1ed1i \u01b0u h\u00f3a ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb khi c\u1ea7n thi\u1ebft<\/strong><\/p>\n
– D\u1ef1a tr\u00ean c\u00e1c d\u1eef li\u1ec7u thu th\u1eadp t\u1eeb vi\u1ec7c theo d\u00f5i huy\u1ebft \u00e1p, c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n, v\u00e0 s\u1ef1 thay \u0111\u1ed5i trong l\u1ed1i s\u1ed1ng, b\u00e1c s\u0129 s\u1ebd \u0111i\u1ec1u ch\u1ec9nh ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 ph\u00f9 h\u1ee3p h\u01a1n v\u1edbi t\u00ecnh tr\u1ea1ng hi\u1ec7n t\u1ea1i.<\/p>\n
– Vi\u1ec7c \u0111i\u1ec1u ch\u1ec9nh ph\u00e1c \u0111\u1ed3 gi\u00fap \u0111\u1ea3m b\u1ea3o r\u1eb1ng k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb lu\u00f4n \u0111\u00e1p \u1ee9ng nhu c\u1ea7u c\u1ee7a b\u1ec7nh nh\u00e2n, gi\u00fap ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p hi\u1ec7u qu\u1ea3 v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng.<\/p>\n
\u01104.6. Theo d\u00f5i t\u1eeb xa<\/strong><\/p>\n
V\u1edbi t\u1ef1 \u0111o HATN b\u1eb1ng c\u00e1c lo\u1ea1i m\u00e1y m\u1edbi c\u00f3 th\u1ec3 cung c\u1ea5p c\u00e1c th\u00f4ng s\u1ed1 c\u1ea7n thi\u1ebft t\u1eeb xa \u0111\u1ec3 qu\u1ea3n l\u00fd t\u1ed1t HA, \u0111\u01b0\u1ee3c xem l\u00e0 ph\u01b0\u01a1ng ph\u00e1p theo d\u00f5i trung t\u00e2m c\u00e1 nh\u00e2n h\u00f3a<\/p>\n\n\n\n\n\n\n\n\n\n\n\n
4. \u0110\u00c1P \u1ee8NG \u0110I\u1ec0U TR\u1eca – CHECK RESPONSE<\/strong><\/td>\n<\/tr>\n
Kh\u1edfi \u0111\u1ea7u (3 th\u00e1ng)<\/td>\n Theo d\u00f5i ng\u1eafn h\u1ea1n (3 th\u00e1ng – 1 n\u0103m)<\/td>\n Theo d\u00f5i ng\u1eafn h\u1ea1n (3 th\u00e1ng – 1 n\u0103m)<\/td>\n<\/tr>\n
M\u1ee5c \u0111\u00edch ki\u1ec3m so\u00e1t HA<\/td>\n Thi\u1ebft l\u1eadp ki\u1ec3m so\u00e1t HA \u1ed5n \u0111\u1ecbnh<\/td>\n Duy tr\u00ecnh ki\u1ec3m so\u00e1t HA \u1ed5n \u0111\u1ecbnh<\/td>\n<\/tr>\n
Th\u0103m kh\u00e1m m\u00f4i 2-4 tu\u1ea7n\/ l\u1ea7n trong 1-3 th\u00e1ng \u0111\u1ea7u \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00e1c d\u1ee5ng ki\u1ec3m so\u00e1t HA ban \u0111\u1ea7u\/ c\u00e1c t\u00e1c d\u1ee5ng c\u00f3 th\u1ec3 x\u1ea3y ra cho \u0111\u1ebfn khi \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee5c ti\u00eau HA<\/td>\n T\u00e1i kh\u00e1m m\u00f4i th\u00e1ng\/1-2 l\u1ea7n \u0111\u00e1nh gi\u00e1 ki\u1ec3m so\u00e1t HA\/ t\u00e1c d\u1ee5ng ph\u1ee5 c\u00f3 th\u1ec3 x\u1ea3y ra, duy tr\u00ec \u0111\u00edch ho\u1eb7c \u0111i\u1ec1u ch\u1ec9nh thu\u1ed1c cho \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u00edch HA (ALARA). Th\u01b0\u1eddng xuy\u00ean h\u01a1n \u0111\u1ed1i v\u1edbi nh\u00f3m nguy c\u01a1 cao, gi\u00e0, suy y\u1ebfu, kh\u00f3 ki\u1ec3m so\u00e1t. Theo d\u00f5i t\u1eeb xa<\/td>\n T\u00e1i kh\u00e1m m\u1ed7i 6 th\u00e1ng\/l\u1ea7n trong n\u0103m ho\u1eb7c 1 l\u1ea7n\/n\u0103m \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u1ef1 tu\u00e2n th\u1ee7, duy tr\u00ecnh \u0111\u00edch\/ t\u00e1c d\u1ee5ng ph\u1ee5. Th\u01b0\u1eddng xuy\u00ean h\u01a1n \u0111\u1ed1i v\u1edbi nh\u00f3m nguy c\u01a1 cao gi\u00e0 suy y\u1ebfu, kh\u00f3 ki\u1ec3m so\u00e1t. Theo d\u00f5i t\u1eeb xa<\/td>\n<\/tr>\n
Ki\u1ec3m tra ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh c\u00e1c lo\u1ea1i THA qua HBPM & ABPM, t\u00ecnh tr\u1ea1ng thay \u0111\u1ed5i s\u1ed1ng, h\u1ea1 HA\/t\u00e1c d\u1ee5ng ph\u1ee5. Ch\u00fa \u00fd \u0111\u00e1nh gi\u00e1 THA bu\u1ed5i, THA ban \u0111\u00eam<\/td>\n T\u1ef1 theo d\u00f5i HBPM \u0111\u00e1nh gi\u00e1 bi\u1ebfn thi\u00ean HA ng\u00e0y, m\u00f9a, t\u00ecnh tr\u1ea1ng \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb. N\u1ebfu THA Kh\u00e1ng tr\u1ecb \u0111o HA ngo\u00e0i PK\u00a0 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh, xem x\u00e9t tham v\u1ea5n chuy\u00ean gia, h\u1ed9i ch\u1ea9n \u0111a ng\u00e0nh, chuy\u1ec3n vi\u1ec7n khi c\u1ea7n thi\u1ebft<\/td>\n<\/tr>\n
X\u00e9t nghi\u1ec7m ch\u1ecdn l\u1ecdc \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o s\u1ef1 an to\u00e0n khi d\u00f9ng thu\u1ed1c ho\u1eb7c ph\u00e1t hi\u1ec7n c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1<\/td>\n T\u00f9y theo c\u00e1c th\u1ec3 c\u00f3 c\u00e1c b\u1ec7nh n\u1ec1n YTNCTM \u0111i k\u00e8m, c\u00e1c th\u00f4ng s\u1ed1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 an to\u00e0n v\u00e0 l\u1ef1a ch\u1ecdn thu\u1ed1c m\u00e0 ki\u1ec3m tra l\u1ea1i nh\u01b0 glucose, HbA1c, LDL-C<\/td>\n<\/tr>\n
\u0110\u00e1nh gi\u00e1 l\u1ea1i c\u00e1c y\u1ebfu t\u1ed1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn nguy c\u01a1 tim m\u1ea1ch \u1edf b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p, YTNC, TT CQTG, B\u1ec7nh \u0111\u1ed3ng m\u1eafc<\/td>\n \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 TTCQTG t\u1eeb tr\u01b0\u1edbc x\u00e1c minh do THA g\u00e2y ra (t\u00f9y thu\u1ed9c \u0111\u1ed9 nh\u1ea1y c\u1ea3m v\u1edbi s\u1ef1 thay \u0111\u1ed5i) v\u00ed d\u1ee5 eGFR, albumin ni\u1ec7u, ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i…<\/td>\n \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 TTCQTG t\u1eeb tr\u01b0\u1edbc, \u0111\u00e1nh gi\u00e1 l\u1ea1i trong kho\u1ea3ng th\u1eddi gian d\u00e0i h\u1ea1n sau 3 n\u0103m. \u1ede b\u1ec7nhnh\u00e2n c\u00f3 TTCQTG t\u1eeb tr\u01b0\u1edbc \u0111\u00e1nh gi\u00e1 l\u1ea1i th\u01b0\u1eddng xuy\u00ean h\u01a1n v\u1ec1 nh\u1eefng thay \u0111\u1ed5i do HA g\u00e2y ra<\/td>\n<\/tr>\n
Th\u1ea3o lu\u1eadn b\u1ec7nh nh\u00e2n v\u1ec1 \u0111\u00edch HA, M\u1ee9c nguy c\u01a1, L\u1ee3i \u00edch \u0111i\u1ec1u tr\u1ecb\/ t\u00e1c d\u1ee5ng ph\u1ee5. Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb c\u00e1 th\u1ec3 h\u00f3a. Cam k\u1ebft h\u01b0\u1edbng \u0111\u1ebfn \u0111\u00edch c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 th\u1ea7y thu\u1ed1c<\/td>\n H\u1ed7 tr\u1ee3 th\u1ef1c hi\u1ec7n c\u00e1c can thi\u1ec7p TDLS. C\u00e2n nh\u1eafc \u0111i\u1ec1u ch\u1ec9nh thu\u1ed1c t\u00f9y thu\u1ed9c v\u00e0o ki\u1ec3m so\u00e1t HA, kh\u1ea3 n\u0103ng dung n\u1ea1p v\u00e0 thay \u0111\u1ed5i b\u1ec7nh \u0111\u1ed3ng m\u1eafc, tr\u00e1nh qu\u00e1n t\u00ednh<\/p>\n
C\u00e2n nh\u1eafc k\u00ea \u0111\u01a1n \u1edf b\u1ec7nh nh\u00e2n gi\u00e0 y\u1ebfu, c\u00f3 huy\u1ebft \u00e1p th\u1ea5p c\u00f3 tri\u1ec7u ch\u1ee9ng<\/p>\n
Theo d\u00f5i vi\u1ec7c tu\u00e2n th\u1ee7 (m\u1ee5c sau)<\/td>\n<\/tr>\n
T\u00ecm s\u1ef1 h\u1ee3p t\u00e1c h\u1ed7 tr\u1ee3 \u0111a ng\u00e0nh gi\u1eefa nhu c\u1ea7u c\u00e1 nh\u00e2n v\u00e0 c\u1ed9ng \u0111\u1ed3ng<\/td>\n T\u1ed5 ch\u1ee9c v\u00e0 th\u1ef1c hi\u1ec7n h\u1ed3 s\u01a1 xem x\u00e9t c\u00e1c lo\u1ea1i d\u1ecbch v\u1ee5 ch\u0103m s\u00f3c to\u00e0n di\u1ec7n t\u1eeb xa, gi\u00e1m s\u00e1t v\u00e0 trackplan b\u1ec7nh nh\u00e2n THA<\/td>\n Duy tr\u00ec s\u1ef1 h\u1ed7 tr\u1ee3 cho b\u1ec7nh nh\u00e2n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
H\u00ecnh 10. Ki\u1ec3m tra \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb<\/p>\n
T\u00f3m l\u01b0\u1ee3c \u01104 – \u0110\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb:<\/strong> Ki\u1ec3m tra theo d\u00f5i (Check respone) trong chi\u1ebfn l\u01b0\u1ee3c th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng gi\u00fap duy tr\u00ec ki\u1ec3m so\u00e1t t\u1ed1t huy\u1ebft \u00e1p c\u1ee7a b\u1ec7nh nh\u00e2n th\u00f4ng qua vi\u1ec7c \u0111\u00e1nh gi\u00e1 li\u00ean t\u1ee5c v\u00e0 \u0111i\u1ec1u ch\u1ec9nh ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb. Theo d\u00f5i ph\u1ea3n \u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n kh\u00f4ng ch\u1ec9 h\u1ed7 tr\u1ee3 qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb m\u00e0 c\u00f2n t\u0103ng c\u01b0\u1eddng s\u1ef1 h\u1ee3p t\u00e1c gi\u1eefa b\u00e1c s\u0129 v\u00e0 b\u1ec7nh nh\u00e2n, g\u00f3p ph\u1ea7n \u0111\u1ea1t \u0111\u01b0\u1ee3c c\u00e1c m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb v\u00e0 gi\u1ea3m nguy c\u01a1 bi\u1ebfn ch\u1ee9ng.<\/p>\n
\u01105. \u0110\u1ea7y \u0111\u1ee7 tu\u00e2n th\u1ee7: (Keep Adherence)<\/h3>\n
Duy tr\u00ec v\u00e0 H\u1ed7 tr\u1ee3 Tu\u00e2n th\u1ee7 \u0110i\u1ec1u tr\u1ecb. Tu\u00e2n th\u1ee7 (adherence) l\u00e0 m\u1ee9c \u0111\u1ed9 v\u00e0 h\u00e0nh vi c\u1ee7a b\u1ec7nh nh\u00e2n, v\u00ed d\u1ee5 nh\u01b0 vi\u1ec7c d\u00f9ng thu\u1ed1c, ph\u00f9 h\u1ee3p v\u1edbi c\u00e1c khuy\u1ebfn c\u00e1o \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ed1ng nh\u1ea5t t\u1eeb nh\u00e0 cung c\u1ea5p d\u1ecbch v\u1ee5 y t\u1ebf. Duy tr\u00ec (persistence) \u0111\u1ec1 c\u1eadp \u0111\u1ebfn kho\u1ea3ng th\u1eddi gian t\u1eeb khi b\u1eaft \u0111\u1ea7u \u0111\u1ebfn khi ng\u1eebng li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb. Hi\u1ec7n nay t\u1ef7 l\u1ec7 kh\u00f4ng tu\u00e2n th\u1ee7 c\u00f2n r\u1ea5t cao, \u0111\u1eb7t bi\u1ec7t THA \u1edf ng\u01b0\u1eddi tr\u1ebb tu\u1ed5i. Vi\u1ec7c kh\u00f4ng tu\u00e2n th\u1ee7 li\u1ec7u ph\u00e1p h\u1ea1 huy\u1ebft \u00e1p c\u00f3 li\u00ean quan \u0111\u1ebfn nguy c\u01a1 m\u1eafc c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch cao h\u01a1n. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00e1ch quan \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 tu\u00e2n th\u1ee7, nh\u01b0 ph\u00e1t hi\u1ec7n thu\u1ed1c k\u00ea \u0111\u01a1n trong m\u1eabu m\u00e1u ho\u1eb7c n\u01b0\u1edbc ti\u1ec3u, ho\u1eb7c quan s\u00e1t tr\u1ef1c ti\u1ebfp vi\u1ec7c u\u1ed1ng thu\u1ed1c (nh\u01b0 trong theo d\u00f5i HA 24 gi\u1edd), \u0111\u00e3 ch\u1ee9ng minh t\u00ednh h\u1eefu \u00edch, \u0111\u1eb7c bi\u1ec7t trong tr\u01b0\u1eddng h\u1ee3p t\u0103ng huy\u1ebft \u00e1p kh\u00e1ng tr\u1ecb. Tuy nhi\u00ean, t\u1ea5t c\u1ea3 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ki\u1ec3m tra vi\u1ec7c tu\u00e2n th\u1ee7 \u0111\u1ec1u c\u00f3 nh\u1eefng h\u1ea1n ch\u1ebf. Vi\u1ec7c kh\u00f4ng tu\u00e2n th\u1ee7 li\u1ec7u ph\u00e1p h\u1ea1 huy\u1ebft \u00e1p ph\u1ee5 thu\u1ed9c v\u00e0o nhi\u1ec1u y\u1ebfu t\u1ed1 kh\u00e1c nhau.<\/p>\n
\u01105.1. Gi\u00e1o d\u1ee5c v\u00e0 n\u00e2ng cao nh\u1eadn th\u1ee9c c\u1ee7a b\u1ec7nh nh\u00e2n:<\/strong><\/p>\n
– B\u1ec7nh nh\u00e2n ph\u1ea3i hi\u1ec3u r\u00f5 v\u1ec1 t\u1ea7m quan tr\u1ecdng c\u1ee7a vi\u1ec7c tu\u00e2n th\u1ee7 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb, gi\u00fap h\u1ecd hi\u1ec3u t\u1ea1i sao vi\u1ec7c d\u00f9ng thu\u1ed1c \u0111\u1ec1u \u0111\u1eb7n v\u00e0 thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p. Khi b\u1ec7nh nh\u00e2n nh\u1eadn th\u1ee9c \u0111\u01b0\u1ee3c t\u00e1c \u0111\u1ed9ng t\u00edch c\u1ef1c c\u1ee7a vi\u1ec7c tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb, h\u1ecd s\u1ebd c\u00f3 \u0111\u1ed9ng l\u1ef1c duy tr\u00ec.<\/p>\n
– Cung c\u1ea5p t\u00e0i li\u1ec7u gi\u00e1o d\u1ee5c, video, ho\u1eb7c h\u01b0\u1edbng d\u1eabn \u0111\u1ec3 gi\u00fap b\u1ec7nh nh\u00e2n hi\u1ec3u v\u1ec1 c\u00e1c bi\u1ebfn ch\u1ee9ng c\u00f3 th\u1ec3 x\u1ea3y ra n\u1ebfu h\u1ecd kh\u00f4ng tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb, nh\u01b0 \u0111\u1ed9t qu\u1ef5, suy tim v\u00e0 b\u1ec7nh th\u1eadn.<\/p>\n
\u01105.2. \u0110\u01a1n gi\u1ea3n h\u00f3a <\/strong><\/p>\n
B\u00e1c s\u0129 s\u1ebd c\u1ed1 g\u1eafng \u0111\u01a1n gi\u1ea3n h\u00f3a ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 b\u1ec7nh nh\u00e2n d\u1ec5 d\u00e0ng th\u1ef1c hi\u1ec7n h\u01a1n, ch\u1eb3ng h\u1ea1n nh\u01b0 gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng li\u1ec1u thu\u1ed1c ph\u1ea3i u\u1ed1ng m\u00f4i ng\u00e0y b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng thu\u1ed1c ph\u1ed1i h\u1ee3p li\u1ec1u c\u1ed1 \u0111\u1ecbnh. C\u00e1c bi\u1ec7n ph\u00e1p n\u00e0y gi\u00fap b\u1ec7nh nh\u00e2n kh\u00f4ng b\u1ecb nh\u1ea7m l\u1eabn ho\u1eb7c qu\u00ean u\u1ed1ng thu\u1ed1c.<\/p>\n
\u01105.3. H\u1ed7 tr\u1ee3 s\u1eed d\u1ee5ng c\u00f4ng ngh\u1ec7 \u0111\u1ec3 nh\u1eafc nh\u1edf<\/strong><\/p>\n
– Khuy\u1ebfn kh\u00edch b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng \u1ee9ng d\u1ee5ng nh\u1eafc nh\u1edf tr\u00ean \u0111i\u1ec7n tho\u1ea1i ho\u1eb7c c\u00e1c thi\u1ebft b\u1ecb \u0111eo tay \u0111\u1ec3 nh\u1eafc nh\u1edf v\u1ec1 th\u1eddi gian u\u1ed1ng thu\u1ed1c, \u0111o huy\u1ebft \u00e1p v\u00e0 ghi l\u1ea1i c\u00e1c ch\u1ec9 s\u1ed1 li\u00ean quan. C\u00f4ng ngh\u1ec7 gi\u00fap b\u1ec7nh nh\u00e2n ki\u1ec3m so\u00e1t l\u1ecbch tr\u00ecnh \u0111i\u1ec1u tr\u1ecb d\u1ec5 d\u00e0ng v\u00e0 c\u00f3 t\u00ednh t\u1ef1 gi\u00e1c h\u01a1n.<\/p>\n
– M\u1ed9t s\u1ed1 \u1ee9ng d\u1ee5ng s\u1ee9c kh\u1ecfe c\u00f2n c\u00f3 t\u00ednh n\u0103ng theo d\u00f5i ti\u1ebfn tr\u00ecnh, cung c\u1ea5p b\u00e1o c\u00e1o v\u1ec1 huy\u1ebft \u00e1p v\u00e0 t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u1ec3 h\u1ecd c\u00f3 th\u1ec3 nh\u00ecn th\u1ea5y nh\u1eefng c\u1ea3i thi\u1ec7n v\u00e0 th\u00e0nh qu\u1ea3 trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<\/p>\n
\u01105.4. Thi\u1ebft l\u1eadp v\u00e0 duy tr\u00ec m\u1ed1i quan h\u1ec7 h\u1ed7 tr\u1ee3<\/strong><\/p>\n
– B\u00e1c s\u0129 v\u00e0 \u0111\u1ed9i ng\u0169 y t\u1ebf n\u00ean x\u00e2y d\u1ef1ng m\u1ed9t m\u1ed1i quan h\u1ec7 h\u1ed7 tr\u1ee3 v\u1edbi b\u1ec7nh nh\u00e2n, gi\u00fap b\u1ec7nh nh\u00e2n c\u1ea3m th\u1ea5y \u0111\u01b0\u1ee3c quan t\u00e2m v\u00e0 khuy\u1ebfn kh\u00edch. Vi\u1ec7c n\u00e0y c\u00f3 th\u1ec3 bao g\u1ed3m c\u00e1c bu\u1ed5i t\u00e1i kh\u00e1m \u0111\u1ecbnh k\u1ef3 ho\u1eb7c giao ti\u1ebfp qua \u0111i\u1ec7n tho\u1ea1i\/email \u0111\u1ec3 ki\u1ec3m tra t\u00ecnh tr\u1ea1ng v\u00e0 nh\u1eafc nh\u1edf b\u1ec7nh nh\u00e2n v\u1ec1 t\u1ea7m quan tr\u1ecdng c\u1ee7a vi\u1ec7c tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb.<\/p>\n
– \u0110\u1ed3ng th\u1eddi, gia \u0111\u00ecnh c\u0169ng c\u00f3 th\u1ec3 \u0111\u00f3ng vai tr\u00f2 h\u1ed7 tr\u1ee3 trong vi\u1ec7c nh\u1eafc nh\u1edf b\u1ec7nh nh\u00e2n v\u1ec1 l\u1ecbch tr\u00ecnh u\u1ed1ng thu\u1ed1c v\u00e0 khuy\u1ebfn kh\u00edch h\u1ecd duy tr\u00ec l\u1ed1i s\u1ed1ng l\u00e0nh m\u1ea1nh.<\/p>\n
\u01105.5. T\u1ea1o \u0111\u1ed9ng l\u1ef1c v\u00e0 khuy\u1ebfn kh\u00edch b\u1ec7nh nh\u00e2n<\/strong><\/p>\n
– Ghi nh\u1eadn nh\u1eefng c\u1ea3i thi\u1ec7n m\u00e0 b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u1ea1t \u0111\u01b0\u1ee3c v\u00e0 \u0111\u1ed9ng vi\u00ean h\u1ecd ti\u1ebfp t\u1ee5c tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb. Nh\u1eefng ti\u1ebfn b\u1ed9 d\u00f9 nh\u1ecf c\u0169ng l\u00e0 \u0111\u1ed9ng l\u1ef1c gi\u00fap b\u1ec7nh nh\u00e2n c\u1ea3m th\u1ea5y h\u00e0i l\u00f2ng v\u00e0 ki\u00ean tr\u00ec trong vi\u1ec7c \u0111i\u1ec1u tr\u1ecb.<\/p>\n
– \u0110\u1eb7t ra c\u00e1c m\u1ee5c ti\u00eau ng\u1eafn h\u1ea1n v\u00e0 d\u00e0i h\u1ea1n cho b\u1ec7nh nh\u00e2n, gi\u00fap h\u1ecd th\u1ea5y r\u00f5 nh\u1eefng l\u1ee3i \u00edch t\u00edch c\u1ef1c t\u1eeb vi\u1ec7c tu\u00e2n th\u1ee7 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb. M\u1ed7i l\u1ea7n \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ed9t m\u1ee5c ti\u00eau, b\u1ec7nh nh\u00e2n s\u1ebd c\u00f3 th\u00eam \u0111\u1ed9ng l\u1ef1c \u0111\u1ec3 ti\u1ebfp t\u1ee5c ti\u1ebfn tr\u00ecnh.<\/p>\n
Theo T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi, c\u00f3 n\u0103m kh\u00eda c\u1ea1nh kh\u00e1c nhau \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn vi\u1ec7c tu\u00e2n th\u1ee7 thu\u1ed1c, bao g\u1ed3m c\u00e1c y\u1ebfu t\u1ed1 x\u00e3 h\u1ed9i\/kinh t\u1ebf, li\u00ean quan \u0111\u1ebfn li\u1ec7u ph\u00e1p, b\u1ec7nh nh\u00e2n, t\u00ecnh tr\u1ea1ng b\u1ec7nh, v\u00e0 h\u1ec7 th\u1ed1ng y t\u1ebf. Do \u0111\u00f3, l\u00fd do kh\u00f4ng tu\u00e2n th\u1ee7 thu\u1ed1c th\u01b0\u1eddng ph\u1ee5 thu\u1ed9c v\u00e0o b\u1ed1i c\u1ea3nh v\u00e0 kh\u00f3 c\u00f3 th\u1ec3 c\u00f3 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p chung cho t\u1ea5t c\u1ea3 (h\u00ecnh 14).<\/p>\n
C\u00e1c h\u1ec7 th\u1ed1ng y t\u1ebf c\u00f3 th\u1ec3 c\u1ea7n suy ngh\u0129 l\u1ea1i v\u1ec1 c\u00e1ch h\u1ed7 tr\u1ee3 b\u1ec7nh nh\u00e2n THA. Vi\u1ec7c t\u00edch h\u1ee3p c\u00e1c chi\u1ebfn l\u01b0\u1ee3c s\u1ee9c kh\u1ecfe h\u00e0nh vi, h\u1ec7 th\u1ed1ng h\u1ed7 tr\u1ee3 t\u1eeb c\u1ed9ng \u0111\u1ed3ng, v\u00e0 c\u00e1c can thi\u1ec7p c\u00f4ng ngh\u1ec7 nh\u01b0 nh\u1eafc nh\u1edf ho\u1eb7c thi\u1ebft b\u1ecb theo d\u00f5i tu\u00e2n th\u1ee7 k\u1ef9 thu\u1eadt s\u1ed1 c\u00f3 th\u1ec3 cung c\u1ea5p th\u00eam c\u00f4ng c\u1ee5 gi\u00fap b\u1ec7nh nh\u00e2n v\u01b0\u1ee3t qua th\u00e1ch th\u1ee9c tu\u00e2n th\u1ee7. Quan tr\u1ecdng h\u01a1n, c\u00e1c b\u00e1c s\u0129 c\u00f3 th\u1ec3 h\u01b0\u1edfng l\u1ee3i t\u1eeb vi\u1ec7c \u0111\u00e0o t\u1ea1o \u0111\u1ec3 hi\u1ec3u r\u00f5 h\u01a1n c\u00e1c s\u1eafc th\u00e1i c\u1ee7a vi\u1ec7c tu\u00e2n th\u1ee7 v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 \u0111a d\u1ea1ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn n\u00f3.<\/p>\n
T\u00f3m l\u01b0\u1ee3c 5\u0110 – \u0110\u1ea7y \u0111\u1ee7 tu\u00e2n th\u1ee7 (Keep Adherence)<\/strong> – Gi\u1eef V\u1eefng Duy Tr\u00ec Tu\u00e2n Th\u1ee7 \u0110i\u1ec1u Tr\u1ecb trong chi\u1ebfn l\u01b0\u1ee3c 5\u0110 th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng qu\u1ea3n l\u00fd THA gi\u00fap \u0111\u1ea3m b\u1ea3o b\u1ec7nh nh\u00e2n ki\u00ean tr\u00ec tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb, t\u1eeb \u0111\u00f3 \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 ki\u1ec3m so\u00e1t huy\u1ebft t\u1ed1t nh\u1ea5t v\u00e0 gi\u1ea3m nguy c\u01a1 bi\u1ebfn ch\u1ee9ng. Vi\u1ec7c h\u1ed7 tr\u1ee3 b\u1ec7nh nh\u00e2n trong su\u1ed1t qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb, \u0111\u01a1n gi\u1ea3n h\u00f3a ph\u00e1c \u0111\u1ed3 v\u00e0 t\u1ea1o \u0111\u1ed9ng l\u1ef1c s\u1ebd gi\u00fap h\u1ecd x\u00e2y d\u1ef1ng th\u00f3i quen t\u00edch c\u1ef1c v\u00e0 \u00fd th\u1ee9c v\u1ec1 t\u1ea7m quan tr\u1ecdng c\u1ee7a vi\u1ec7c b\u1ea3o v\u1ec7 s\u1ee9c kh\u1ecfe tim m\u1ea1ch c\u1ee7a ch\u00ednh m\u00ecnh v\u00e0 gia \u0111\u00ecnh x\u00e3 h\u1ed9i.<\/p>\n
$\"T\u1ed5$
H\u00ecnh 11: T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi nh\u1ea5n m\u1ea1nh n\u0103m kh\u00eda c\u1ea1nh kh\u00e1c nhau \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn vi\u1ec7c tu\u00e2n th\u1ee7 thu\u1ed1c<\/figcaption><\/figure>\n
B\u1ec7nh nh\u00e2n l\u00e0 trung t\u00e2m<\/h2>\n
L\u1ea5y b\u1ec7nh nh\u00e2n l\u00e0m trung t\u00e2m trong chi\u1ebfn l\u01b0\u1ee3c th\u1ef1c h\u00e0nh qu\u1ea3n l\u00fd t\u0103ng huy\u1ebft \u00e1p ngh\u0129a l\u00e0 t\u1eadp trung v\u00e0o nhu c\u1ea7u, m\u1ee5c ti\u00eau v\u00e0 s\u1ef1 tham gia c\u1ee7a b\u1ec7nh nh\u00e2n trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb. \u0110\u00e2y l\u00e0 c\u00e1ch ti\u1ebfp c\u1eadn gi\u00fap t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho b\u1ec7nh nh\u00e2n tham gia ch\u1ee7 \u0111\u1ed9ng v\u00e0 hi\u1ec3u r\u00f5 vai tr\u00f2 c\u1ee7a h\u1ecd trong vi\u1ec7c qu\u1ea3n l\u00fd b\u1ec7nh. B\u1ec7nh nh\u00e2n t\u1ef1 \u0111o theo d\u00f5i c\u00f9ng \u0111\u1ed9i ng\u0169 y t\u1ebf x\u00e1c \u0111\u1ecbnh v\u00e0 \u0111i\u1ec1u ch\u1ec9nh m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb d\u1ef1a tr\u00ean c\u00e1 th\u1ec3 h\u00f3a \u0111\u1ec3 \u0111\u1ea1t v\u00e0 duy tr\u00ec m\u1ee5c ti\u00eau. H\u1ecd c\u1ea7n \u0111\u00e1p \u1ee9ng ngu\u1ed3n l\u1ef1c v\u1edbi s\u1ef1 h\u1ed7 tr\u1ee3 \u0111a ng\u00e0nh, gia \u0111\u00ecnh, x\u00e3 h\u1ed9i, b\u1ea3o hi\u1ec3m y t\u1ebf, l\u1eafng nghe v\u00e0 th\u1ea5u hi\u1ec3u v\u01b0\u1ee3t qua c\u00e1c r\u00e0o c\u1ea3n \u0111\u1ec3 c\u00f9ng \u0111\u1ea1t \u0111\u00edch. \u0110\u1ea3m b\u1ea3o c\u00f9ng b\u1ec7nh nh\u00e2n x\u00e2y d\u1ef1ng bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u01b0u t\u1ed1i \u01b0u hi\u1ec7u qu\u1ea3 an to\u00e0n kinh t\u1ebf v\u1edbi nh\u1eadn th\u1ee9c h\u00e0nh \u0111\u1ed9ng tu\u00e2n th\u1ee7 . Li\u00ean t\u1ee5c theo d\u00f5i huy\u1ebft \u00e1p v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c, \u0111\u1ed3ng th\u1eddi \u0111i\u1ec1u ch\u1ec9nh \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi d\u1ef1a tr\u00ean ph\u1ea3n h\u1ed3i v\u00e0 t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n. \u0110\u1ea3m b\u1ea3o r\u1eb1ng b\u1ec7nh nh\u00e2n lu\u00f4n \u0111\u01b0\u1ee3c tham gia v\u00e0o quy\u1ebft \u0111\u1ecbnh li\u00ean quan \u0111\u1ebfn s\u1ee9c kh\u1ecfe c\u1ee7a h\u1ecd. Thi\u1ebft l\u1eadp k\u00eanh giao ti\u1ebfp hai chi\u1ec1u v\u1edbi b\u00e1c s\u0129, cho ph\u00e9p b\u1ec7nh nh\u00e2n d\u1ec5 d\u00e0ng h\u1ecfi \u0111\u00e1p, nh\u1eadn l\u1eddi khuy\u00ean v\u00e0 \u0111\u1ed9ng vi\u00ean. S\u1ef1 k\u1ebft n\u1ed1i n\u00e0y, qua c\u00e1c ph\u01b0\u01a1ng th\u1ee9c nh\u01b0 telemedicine, gi\u00fap b\u1ec7nh nh\u00e2n c\u1ea3m th\u1ea5y an t\u00e2m v\u00e0 duy tr\u00ec \u0111\u1ed9ng l\u1ef1c trong \u0111i\u1ec1u tr\u1ecb, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111\u1eb7t c\u00e2u h\u1ecfi, gi\u1ea3i quy\u1ebft th\u1eafc m\u1eafc v\u00e0 nh\u1eadn ph\u1ea3n h\u1ed3i nhanh ch\u00f3ng v\u1ec1 qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb c\u1ee7a h\u1ecd, t\u1eeb \u0111\u00f3 x\u00e2y d\u1ef1ng ni\u1ec1m tin v\u1edbi b\u00e1c s\u0129 v\u00e0 h\u1ed7 tr\u1ee3 vi\u1ec7c \u0111i\u1ec1u tr\u1ecb li\u00ean t\u1ee5c. B\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c trang b\u1ecb ki\u1ebfn th\u1ee9c v\u1ec1 t\u0103ng huy\u1ebft \u00e1p v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng, gi\u00fap h\u1ecd hi\u1ec3u r\u00f5 \u00fd ngh\u0129a c\u1ee7a vi\u1ec7c \u0110i\u1ec1u n\u00e0y kh\u00f4ng ch\u1ec9 c\u1ea3i thi\u1ec7n hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb c\u00e1 nh\u00e2n m\u00e0 c\u00f2n g\u00f3p ph\u1ea7n n\u00e2ng cao nh\u1eadn th\u1ee9c c\u1ed9ng \u0111\u1ed3ng c\u1ee7a b\u1ec7nh nh\u00e2n v\u1ec1 t\u0103ng huy\u1ebft \u00e1p v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng li\u00ean quan. T\u1eeb \u0111\u00f3 c\u00f9ng tham gia c\u1ea3i thi\u1ec7n tr\u00ecnh \u0111\u1ed9 d\u00e2n tr\u00ed \u0111\u01b0\u1ee3c n\u00e2ng cao, th\u1ec3 hi\u1ec7n qua vai tr\u00f2 \u0111\u1ea9y m\u1ea1nh ph\u00e1t tri\u1ec3n kinh t\u1ebf x\u00e3 h\u1ed9i quy\u1ebft \u0111\u1ecbnh s\u1ee9c kh\u1ecfe (SODH)<\/p>\n
T\u00f3m l\u1ea1i, l\u1ea5y b\u1ec7nh nh\u00e2n l\u00e0m trung t\u00e2m l\u00e0 chi\u1ebfn l\u01b0\u1ee3c gi\u00fap t\u1ea1o ra m\u1ed9t m\u00f4i tr\u01b0\u1eddng ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe t\u00edch c\u1ef1c, trong \u0111\u00f3 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c trao quy\u1ec1n t\u1ef1 \u0111o v\u00e0 theo d\u00f5i, v\u00e0 cam k\u1ebft v\u1edbi m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb, g\u00f3p ph\u1ea7n n\u00e2ng cao hi\u1ec7u qu\u1ea3 qu\u1ea3n l\u00fd t\u0103ng huy\u1ebft \u00e1p.<\/p>\n
$\"B\u1ea3ng$
B\u1ea3ng ch\u1ec9 s\u1ed1 huy\u1ebft \u00e1p<\/figcaption><\/figure>\n
T\u1ed5ng th\u1ec3 th\u1ea7y thu\u1ed1c c\u1ea7n c\u1eadp nh\u1eadt nh\u1eefng ti\u1ebfn b\u1ed9 \u0111\u1ec3 c\u00f3 m\u1ed9t chi\u1ebfn l\u01b0\u1ee3c th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng THA to\u00e0n di\u1ec7n hi\u1ec7u qu\u1ea3<\/h2>\n
– Ph\u00e2n lo\u1ea1i huy\u1ebft \u00e1p g\u1ed3m: huy\u1ebft \u00e1p kh\u00f4ng t\u0103ng, ti\u1ec1n t\u0103ng huy\u1ebft \u00e1p v\u00e0 t\u0103ng huy\u1ebft \u00e1p<\/p>\n
– \u00c1p d\u1ee5ng \u201cL\u1ed9 tr\u00ecnh chi\u1ebfn l\u01b0\u1ee3c 5\u0110 qu\u1ea3n l\u00fd to\u00e0n di\u1ec7n THA c\u1ee7a VSH\/VNHA 2024\u201d.<\/p>\n
– B\u1ec7nh nh\u00e2n l\u00e0 trung t\u00e2m, \u0111\u01b0\u1ee3c trao quy\u1ec1n t\u1ef1 \u0111o, theo d\u00f5i v\u00e0 gi\u00e1o d\u1ee5c nh\u1eadn th\u1ee9c h\u00e0nh \u0111\u1ed9ng tu\u00e2n th\u1ee7 \u0111\u1ec3 \u0111\u1ea1t m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb<\/p>\n
– \u0110o ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c THA. \u0110\u00e1nh gi\u00e1 b\u1ec7nh nh\u00e2n to\u00e0n di\u1ec7n. C\u00e1 th\u1ec3 h\u00f3a ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb. Theo d\u00f5i \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb. Duy tr\u00ec s\u1ef1 tu\u00e2n th\u1ee7<\/p>\n
– M\u1ee5c ti\u00eau theo c\u00e1 th\u1ec3 h\u00f3a: M\u1ee5c ti\u00eau theo c\u00e1 th\u1ec3 h\u00f3a: HATT\/HATTr <130\/80mmHg, c\u00f3 th\u1ec3 h\u1ea1 th\u1ea5p h\u01a1n n\u1eefa \u0111\u1ebfn <120\/70mmHg n\u1ebfu dung n\u1ea1p t\u1ed1t ho\u1eb7c k\u00e9m dung n\u1ea1p theo nguy\u00ean t\u1eafc ALARA nh\u01b0ng \u00edt nh\u1ea5t HATT <140mmHg, \u0111\u1eb7c bi\u1ec7t \u1edf ng\u01b0\u1eddi > 85 tu\u1ed5i, c\u00f3 t\u00ecnh tr\u1ea1ng suy y\u1ebfu, h\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf tri\u1ec7u ch\u1ee9ng, tu\u1ed5i th\u1ecd h\u1ea1n ch\u1ebf.<\/p>\n
– T\u00edch c\u1ef1c thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng: H\u1ea1n ch\u1ebf natri v\u00e0 t\u0103ng kali, h\u1ea1n ch\u1ebf \u0111\u1ed3 ng\u1ecdt t\u1ef1 do, gi\u1ea3m r\u01b0\u1ee3u bia, ti\u1ebft th\u1ef1c DASH, t\u1eadp luy\u1ec7n g\u1eafng s\u1ee9c b\u1ed5 sung v\u1edbi s\u1ee9c \u0111\u1ec1 kh\u00e1ng trong an to\u00e0n, ng\u1eebng h\u00fat thu\u1ed1c…<\/p>\n
– \u0110i\u1ec1u tr\u1ecb thu\u1ed1c ngay cho b\u1ec7nh nh\u00e2n ch\u1ea9n \u0111o\u00e1n THA ho\u1eb7c s\u1edbm \u1edf Ti\u1ec1n THA c\u00f3 nguy c\u01a1 cao<\/p>\n
– \u0110i\u1ec1u tr\u1ecb d\u1ef1a tr\u00ean A, C, D v\u00e0 spironolactone khi kh\u00f3 ki\u1ec3m so\u00e1t, s\u1eed d\u1ee5ng B ch\u1ec9 khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh c\u1ee5 th\u1ec3.<\/p>\n
– Th\u00eam ARNI, SGLT2i, GLP1-RA, nsMRA trong m\u1ed9t s\u1ed1 b\u1ec7nh \u0111\u1ed3ng m\u1eafc.<\/p>\n
– Kh\u1edfi tr\u1ecb ph\u1ed1i h\u1ee3p \u0111\u00f4i li\u1ec1u th\u1ea5p, n\u1ebfu kh\u00f4ng \u0111\u1ea1t chuy\u1ec3n sang ph\u1ed1i h\u1ee3p ba li\u1ec1u th\u1ea5p cho \u0111a s\u1ed1 THA<\/p>\n
– \u0110\u00e1nh gi\u00e1 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u00fang m\u1ee9c THA kh\u00e1ng tr\u1ecb c\u0169ng nh\u01b0 THA c\u00f3 c\u00e1c b\u1ec7nh \u0111\u1ed3ng m\u1eafc<\/p>\n
– Tri\u1ec7t \u0111\u1ed1t th\u1ea7n kinh th\u1eadn giao c\u1ea3m qua \u0111\u1ed9ng m\u1ea1ch th\u1eadn c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem x\u00e9t cho b\u1ec7nh nh\u00e2n THA kh\u00e1ng tr\u1ecb ho\u1eb7c kh\u00f4ng ki\u1ec3m so\u00e1t v\u1edbi \u0111\u1ed9i ng\u0169 c\u01a1 s\u1edf \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o \u0111\u1ea7y \u0111\u1ee7 v\u1edbi l\u01b0\u1ee3ng th\u1ee7 thu\u1eadt trung b\u00ecnh cao v\u00e0 c\u00f3 s\u1ef1 \u0111\u1ed3ng \u00fd c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n
K\u1ebft lu\u1eadn<\/h2>\n
Chi\u1ebfn l\u01b0\u1ee3c 5\u0110 trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng qu\u1ea3n l\u00fd THA c\u1ee7a VSH-VNHA v\u1edbi s\u1ef1 ph\u1ed1i h\u1ee3p ch\u1eb7t ch\u1ebd gi\u1eefa b\u00e1c s\u0129, c\u00e1c t\u1ed5 ch\u1ee9c \u0111a ng\u00e0nh v\u00e0 b\u1ec7nh nh\u00e2n. V\u1edbi \u0111o HA ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c THA. \u0110\u00e1nh gi\u00e1 b\u1ec7nh nh\u00e2n to\u00e0n di\u1ec7n. \u0110i\u1ec1u tr\u1ecb c\u00e1 th\u1ec3 h\u00f3a linh ho\u1ea1t. T\u1ef1 theo d\u00f5i \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb v\u00e0 ki\u00ean \u0111\u1ecbnh tu\u00e2n th\u1ee7. \u0110\u1eb7t b\u1ec7nh nh\u00e2n l\u00e0m trung t\u00e2m, c\u00f9ng tham gia quy\u1ebft \u0111\u1ecbnh trong vi\u1ec7c qu\u1ea3n l\u00fd s\u1ee9c kh\u1ecfe c\u1ee7a h\u1ecd. B\u1eb1ng c\u00e1ch cung c\u1ea5p c\u00e1c m\u1ee5c ti\u00eau r\u00f5 r\u00e0ng, gi\u1eefa l\u1ee3i \u00edch v\u00e0 kh\u1ea3 n\u0103ng dung n\u1ea1p, b\u1ea3o \u0111\u1ea3m ngu\u1ed3n l\u1ef1c, h\u1ed7 tr\u1ee3 thu\u1ed1c men tinh th\u1ea7n v\u00e0 th\u1ec3 ch\u1ea5t, n\u00e2ng cao nh\u1eadn th\u1ee9c v\u00e0 \u00fd th\u1ee9c c\u00f9ng c\u00f9ng c\u1ed9ng \u0111\u1ed3ng x\u00e3 h\u1ed9i, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 tr\u1edf th\u00e0nh nh\u1eefng ng\u01b0\u1eddi qu\u1ea3n l\u00fd ki\u1ec3m so\u00e1t hi\u1ec7u qu\u1ea3 h\u01a1n t\u00ecnh tr\u1ea1ng THA c\u1ee7a m\u00ecnh m\u1ed9t c\u00e1ch l\u00e2u d\u00e0i v\u00e0 t\u1ed1i \u01b0u h\u00f3a ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng, g\u00f3p ph\u1ea7n ph\u00e1t kinh t\u1ebf x\u00e3 h\u1ed9i.<\/p>\n
T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n
1.McEvoy JW, McCarthy CP, Bruno RM, Brouwers S, Canavan MD, Ceconi C, et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J. 2024;45(38):3912-4018.<\/p>\n
2.Kreutz R, Brunstrom M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, et al. 2024 European Society of Hypertension clinical practice guidelines for the management of arterial hypertension. Eur J Intern Med. 2024;126:1-15.<\/p>\n
3.Mancia G, Kreutz R, Brunstrom M, Burnier M, Grassi G, Januszewicz A, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023;41(12):1874-2071.<\/p>\n
4. Hypertension Branch of Chinese Geriatrics Society BHANCRCotGD, Hua Q, Fan L, Wang ZW, Li J. 2023 Guideline for the management of hypertension in the elderly population in China. J Geriatr Cardiol. 2024;21(6):589-630.<\/p>\n
5.Kim HL, Lee EM, Ahn SY, Kim KI, Kim HC, Kim JH, et al. The 2022 focused update of the 2018 Korean Hypertension Society Guidelines for the management of hypertension. Clin Hypertens. 2023;29(1):11.<\/p>\n
6. Wang TD, Chiang CE, Chao TH, Cheng HM, Wu YW, Wu YJ, et al. 2022 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the Management of Hypertension. Acta Cardiol Sin. 2022;38(3):225-325.<\/p>\n
7.Van Minh H, Van Huy T, Long DPP, Tien HA. Highlights of the 2022 Vietnamese Society of Hypertension guidelines for the diagnosis and treatment of arterial hypertension: The collabora-tion of the Vietnamese Society of Hypertension (VSH) task force with the contribution of the Vietnam National Heart Association (VNHA): The collaboration of the Vietnamese Society of Hypertension (VSH) task force with the contribution of the Vietnam National Heart Association (VNHA). J Clin Hypertens (Greenwich). 2022;24(9):1121-38.<\/p>\n
8. Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, et al. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res. 2019;42(9):1235-481.<\/p>\n
9.Rahman ARA, Magno JDA, Cai J, Han M, Lee HY, Nair T, et al. Management of Hypertension in the Asia-Pacific Region: A Structured Review. Am J Cardiovasc Drugs. 2024;24(2):141-70.<\/p>\n
10.Whelton PK, O’Connell S, Mills KT, He J. Optimal Antihypertensive Systolic Blood Pressure: A Systematic Review and Meta-Analysis. Hypertension. 2024;81(11):2329-39.<\/p>\n
11.Whelton SP, McEvoy JW, Shaw L, Psaty BM, Lima JAC, Budoff M, et al. Association of Normal Systolic Blood Pressure Level With Cardiovascular Disease in the Absence of Risk Factors. JAMA Cardiol. 2020;5(9):1011-8.<\/p>\n
12.Nazarzadeh M, Bidel Z, Canoy D, Copland E. Bennett DA, Dehghan A, et al. Blood pressure-lowering treatment for prevention of major cardiovascular diseases in people with and without type 2 diabetes: an individual participant-level data meta-analysis. Lancet Diabetes Endocrinol. 2022:10(9):645-54.<\/p>\n
13.Smith C, Berry JD, Scherzer R, de Lemos JA, Nambi V, Ballantyne CM, et al. Intensive Blood Pressure Lowering in Individuals With Low Diastolic Blood Pressure and Elevated Troponin Levels in SPRINT. J Am Heart Assoc. 2024;13(6):e032493.<\/p>\n
14. Group AS, Cushmn WC, Evans GW, Byington RP, Goff DC, Jr., Grimm RH, Jr., et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010:362(17):1575-85.<\/p>\n
15.Ambrosius WT, Sink KM, Foy CG, Berlowitz DR, Cheung AK, Cushman WC, et al. The design and rationale of a multicenter clinical trial comparing two strategies for control of systolic blood pressure: the Systolic Blood Pressure Intervention Trial (SPRINT). Clin Trials. 2014;11(5):532-46.<\/p>\n
16.Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, et al. Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1990-2015. JAMA. 2017:317(2):165-82.<\/p>\n
17.Kitagawa K, Yamamoto Y, Arima H, Maeda T, Sunami N, Kanzawa T, et al. Effect of Standard vs Intensive Blood Pressure Control on the Risk of Recurrent Stroke: A Randomized Clinical Trial and Meta-analysis. JAMA Neurol. 2019;76(11):1309-18.<\/p>\n
18.Liu J, Li Y, Ge J, Yan X, Zhang H, Zheng X, et al. Lowering systolic blood pressure to less than 120 mm Hg versus less than 140 mm Hg in patients with high cardiovascular risk with and without diabetes or previous stroke: an open-label, blinded-outcome, randomised trial. Lancet. 2024:404(10449):245-55.<\/p>\n
19. Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020;75(6):1334-57.<\/p>\n
20.Group WCRCW. World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions. Lancet Glob Health. 2019;7(10):e1332-e45.<\/p>\n
21.Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC\/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596-e646.<\/p>\n
22.Khan SS, Matsushita K, Sang Y, Ballew SH, Grams ME, Surapaneni A, et al. Development and Validation of the American Heart Association’s PREVENT Equations. Circulation. 2024;149(6):430-49.<\/p>\n
23.Zhang W, Zhang S, Deng Y, Wu S, Ren J, Sun G, et al. Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension. N Engl J Med. 2021;385(14):1268-79.<\/p>\n
24.He J, Ouyang N, Guo X, Sun G, Li Z, Mu J, et al. Effectiveness of a non-physician community health-care provider-led intensive blood pressure intervention versus usual care on cardiovascu-lar disease (CRHCP): an open-label, blinded-endpoint, cluster-randomised trial. Lancet. 2023:401(10380):928-38.<\/p>\n
25.Bi Y, Li M, Liu Y, Li T, Lu J, Duan P, et al. Intensive Blood-Pressure Control in Patients with Type 2 Diabetes. N Engl J Med. 2024.<\/p>\n
26. Verdecchia P, Angeli F, Reboldi G. The lowest well tolerated blood pressure: A personalized target for all? Eur J Intern Med. 2024;123:42-8.<\/p>\n
27.Krishnaswami A, Peterson ED, Goyal P, Kim DH, Rich MW, Lee SJ. Time to benefit and harm of intensive blood pressure treatment: insights from SPRINT. Eur Heart J Qual Care Clin Outcomes. 2021;7(4):e1-e2.<\/p>\n
28.Charchar FJ, Prestes PR, Mills C, Ching SM, Neupane D, Marques FZ, et al. Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension. J Hypertens. 2024;42(1):23-49.<\/p>\n","protected":false},"excerpt":{"rendered":"
Xem v\u00e0 t\u1ea3i file PDF t\u1ea1i \u0111\u00e2y. PH\u1ea6N M\u1ede \u0110\u1ea6U T\u0103ng huy\u1ebft \u00e1p (THA) hi\u1ec7n v\u1eabn l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c y t\u1ebf h\u00e0ng \u0111\u1ea7u, l\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh d\u1eabn \u0111\u1ebfn c\u00e1c b\u1ec7nh l\u00fd tim m\u1ea1ch v\u00e0 t\u1eed vong tr\u00ean to\u00e0n c\u1ea7u. T\u1ef7 l\u1ec7 ki\u1ec3m so\u00e1t THA tr\u00ean th\u1ebf gi\u1edbi v\u1eabn c\u00f2n h\u1ea1n ch\u1ebf, v\u1edbi ch\u1ec9 […]\n","protected":false},"author":1,"featured_media":134125,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-134129","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/134129","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=134129"}],"version-history":[{"count":7,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/134129\/revisions"}],"predecessor-version":[{"id":134601,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/134129\/revisions\/134601"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/134125"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=134129"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=134129"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=134129"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}