{"id":136621,"date":"2025-09-04T12:48:08","date_gmt":"2025-09-04T05:48:08","guid":{"rendered":"https:\/\/vnras.com\/drug\/?p=136621"},"modified":"2025-09-13T09:40:48","modified_gmt":"2025-09-13T02:40:48","slug":"dong-thuan-lam-sang-ve-suc-khoe-tam-than-va-benh-tim-mach-esc-2025","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/dong-thuan-lam-sang-ve-suc-khoe-tam-than-va-benh-tim-mach-esc-2025\/","title":{"rendered":"\u0110\u1ed2NG THU\u1eacN L\u00c2M S\u00c0NG V\u1ec0 S\u1ee8C KH\u1eceE T\u00c2M TH\u1ea6N V\u00c0 B\u1ec6NH TIM M\u1ea0CH ESC 2025"},"content":{"rendered":"

Bi\u00ean d\u1ecbch:<\/p>\n

Khoa n\u1ed9i tim m\u1ea1ch, b\u1ec7nh vi\u1ec7n TWQ\u0110 108<\/p>\n

Ths.BSNT. \u0110inh V\u0103n H\u01b0\u1edbng, Bs. B\u00f9i Th\u1ecb H\u01b0\u01a1ng Lan, BVTWQ\u0110 108<\/p>\n

PGS.TS Ph\u1ea1m Tr\u01b0\u1eddng S\u01a1n, BVTWQ\u0110 108<\/p>\n

T\u1ea3i file PDF t\u1ea1i \u0111\u00e2y.<\/a><\/p>\n

M\u1ed1i li\u00ean h\u1ec7 gi\u1eefa s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n, s\u1ee9c kh\u1ecfe tim m\u1ea1ch v\u00e0 b\u1ec7nh tim m\u1ea1ch<\/h2>\n
\"H\u00ecnh
H\u00ecnh 1: Kh\u00e1i ni\u1ec7m s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n trong \u0111\u1ed3ng thu\u1eadn<\/figcaption><\/figure>\n
\"H\u00ecnh
H\u00ecnh 2: S\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n\/ tim m\u1ea1ch, t\u01b0\u01a1ng t\u00e1c b\u1ec7nh l\u00fd v\u00e0 c\u00e1c \u0111\u1ecbnh h\u01b0\u1edbng trong t\u01b0\u01a1ng lai<\/figcaption><\/figure>\n
\"H\u00ecnh
H\u00ecnh 3: Nh\u00f3m T\u00e2m th\u1ea7n \u2013 Tim m\u1ea1ch<\/figcaption><\/figure>\n
\"H\u00ecnh
H\u00ecnh 4: Nguy\u00ean t\u1eafc ACTIVE \u0111\u1ec3 c\u00e1i thi\u1ec7n s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n trong ch\u0103m s\u00f3c tim m\u1ea1ch<\/figcaption><\/figure>\n

C\u00e1c \u0111i\u1ec3m ch\u00ednh v\u00e0 tuy\u00ean b\u1ed1 \u0111\u1ed3ng thu\u1eadn l\u00e2m s\u00e0ng (1)<\/h3>\n\n\n\n\n\n\n\n\n
NH\u1eeeNG \u0110I\u1ec2M T\u00d3M T\u1eaeT CH\u00cdNH<\/strong><\/td>\n<\/tr>\n
1. S\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n v\u00e0 r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n c\u00f3 m\u1ed1i t\u01b0\u01a1ng t\u00e1c \u0111a chi\u1ec1u v\u1edbi s\u1ee9c kh\u1ecfe v\u00e0 b\u1ec7nh tim m\u1ea1ch.<\/td>\n<\/tr>\n
2. S\u1ef1 t\u1ed3n t\u1ea1i \u0111\u1ed3ng th\u1eddi c\u1ee7a b\u1ec7nh tim m\u1ea1ch v\u00e0 c\u00e1c r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n c\u00f3 th\u1ec3 t\u1ea1o ra s\u1ef1 t\u01b0\u01a1ng t\u00e1c hai chi\u1ec1u, l\u00e0m x\u1ea5u \u0111i c\u1ea3 s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n l\u1eabn s\u1ee9c kh\u1ecfe tim m\u1ea1ch, d\u1eabn \u0111\u1ebfn nh\u1eefng k\u1ebft c\u1ee5c b\u1ea5t l\u1ee3i h\u01a1n.<\/td>\n<\/tr>\n
3. Th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng tim m\u1ea1ch c\u00f2n thi\u1ebfu s\u1ef1 h\u1ec7 th\u1ed1ng, t\u00edch h\u1ee3p trong s\u00e0ng l\u1ecdc, \u0111\u00e1nh gi\u00e1, trao \u0111\u1ed5i v\u00e0 qu\u1ea3n l\u00fd s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n.<\/td>\n<\/tr>\n
4. B\u1eb1ng ch\u1ee9ng c\u00f2n h\u1ea1n ch\u1ebf v\u1ec1 c\u00e1ch t\u1ed1i \u01b0u giao ti\u1ebfp, th\u00fac \u0111\u1ea9y, duy tr\u00ec v\u00e0 c\u1ea3i thi\u1ec7n s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n c\u0169ng nh\u01b0 kh\u1ea3 n\u0103ng ph\u1ee5c h\u1ed3i \u1edf nh\u1eefng ng\u01b0\u1eddi m\u1eafc b\u1ec7nh tim m\u1ea1ch v\u00e0 ng\u01b0\u1eddi th\u00e2n c\u1ee7a h\u1ecd.<\/td>\n<\/tr>\n
5. C\u01a1 s\u1edf b\u1eb1ng ch\u1ee9ng \u0111\u1ec3 h\u01b0\u1edbng d\u1eabn s\u00e0ng l\u1ecdc v\u00e0 qu\u1ea3n l\u00fd c\u00e1c r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n \u1edf b\u1ec7nh nh\u00e2n tim m\u1ea1ch c\u00f2n h\u1ea1n ch\u1ebf.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Nh\u1eefng \u0111i\u1ec3m ch\u00ednh v\u00e0 \u0111\u1ed3ng thu\u1eadn l\u00e2m s\u00e0ng (2)<\/h3>\n\n\n\n\n\n\n\n
NH\u1eeeNG \u0110I\u1ec2M \u0110\u1ed2NG THU\u1eacN V\u1ec0 QU\u1ea2N L\u00dd<\/strong><\/td>\n<\/tr>\n
1. Ch\u0103m s\u00f3c tim m\u1ea1ch \u0111\u01b0\u1ee3c t\u1ed1i \u01b0u n\u1ebfu \u0111\u1ecbnh h\u01b0\u1edbng l\u1ea5y ng\u01b0\u1eddi b\u1ec7nh l\u00e0m trung t\u00e2m v\u00e0 c\u1ea3i thi\u1ec7n s\u1ee9c kh\u1ecfe to\u00e0n di\u1ec7n, kh\u00f4ng ch\u1ec9 tim m\u1ea1ch m\u00e0 c\u00f2n c\u1ea3 s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n nh\u01b0 m\u1ed9t th\u00e0nh ph\u1ea7n kh\u00f4ng th\u1ec3 t\u00e1ch r\u1eddi.<\/td>\n<\/tr>\n
2. M\u1ed9t nh\u00f3m \u0111a chuy\u00ean khoa g\u1ed3m chuy\u00ean gia s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n, nh\u00e0 t\u00e2m l\u00fd h\u1ecdc v\u00e0\/ho\u1eb7c b\u00e1c s\u0129 t\u00e2m th\u1ea7n ( Psycho-Cardio) l\u00e0 c\u1ea7n thi\u1ebft trong ch\u0103m s\u00f3c tim m\u1ea1ch, nh\u1eb1m \u0111\u01b0a ra \u0111\u1ecbnh h\u01b0\u1edbng th\u1ef1c h\u00e0nh v\u00e0 \u0111\u01b0a ra \u0111\u00e1nh gi\u00e1, h\u1ed7 tr\u1ee3 c\u0169ng nh\u01b0 qu\u1ea3n l\u00fd s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n th\u00edch h\u1ee3p cho b\u1ec7nh nh\u00e2n tim m\u1ea1ch v\u00e0 ng\u01b0\u1eddi ch\u0103m s\u00f3c.<\/td>\n<\/tr>\n
3. C\u00e1c d\u1ecbch v\u1ee5 tim m\u1ea1ch n\u00ean h\u01b0\u1edbng t\u1edbi vi\u1ec7c tri\u1ec3n khai m\u00f4 h\u00ecnh nh\u00f3m T\u00e2m th\u1ea7n – Tim m\u1ea1ch (Psycho-Cardio), \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh ph\u00f9 h\u1ee3p v\u1edbi d\u00e2n s\u1ed1, th\u1ef1c t\u1ebf v\u00e0 ngu\u1ed3n l\u1ef1c t\u1ea1i \u0111\u1ecba ph\u01b0\u01a1ng.<\/td>\n<\/tr>\n
4. \u00c1p d\u1ee5ng nguy\u00ean t\u1eafc ACTIVE theo h\u01b0\u1edbng l\u1ea5y ng\u01b0\u1eddi b\u1ec7nh l\u00e0m trung t\u00e2m, \u0111\u1ed3ng th\u1eddi t\u00edch h\u1ee3p ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n v\u00e0o th\u1ef1c h\u00e0nh tim m\u1ea1ch th\u01b0\u1eddng quy nh\u1eb1m n\u00e2ng cao ch\u1ea5t l\u01b0\u1ee3ng \u0111i\u1ec1u tr\u1ecb.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Nguy c\u01a1 tim m\u1ea1ch li\u00ean quan \u0111\u1ebfn s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n \u1edf nh\u1eefng ng\u01b0\u1eddi ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n m\u1eafc b\u1ec7nh tim m\u1ea1ch<\/h2>\n
\"H\u00ecnh
H\u00ecnh 5: Ngu\u1ed3n g\u1ed1c stress t\u00e2m l\u00fd \u2013 y\u1ebfu t\u1ed1 nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch<\/figcaption><\/figure>\n

C\u00e1c \u0111i\u1ec3m ch\u00ednh v\u00e0 \u0111\u1ed3ng thu\u1eadn l\u00e2m s\u00e0ng (1)<\/h3>\n\n\n\n\n\n\n\n
NH\u1eeeNG \u0110I\u1ec2M T\u00d3M T\u1eaeT CH\u00cdNH<\/strong><\/td>\n<\/tr>\n
1. C\u00e1c ch\u1ec9 d\u1ea5u c\u1ee7a s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n t\u00edch c\u1ef1c, nh\u01b0 s\u1ef1 l\u1ea1c quan, h\u1ea1nh ph\u00fac v\u00e0 m\u1ee9c \u0111\u1ed9 h\u00e0i l\u00f2ng cao v\u1edbi cu\u1ed9c s\u1ed1ng, c\u00f3 li\u00ean quan \u0111\u1ebfn nguy c\u01a1 tim m\u1ea1ch th\u1ea5p h\u01a1n.<\/td>\n<\/tr>\n
2. C\u00e1c y\u1ebfu t\u1ed1 t\u00e2m l\u00fd – x\u00e3 h\u1ed9i b\u1ea5t l\u1ee3i (v\u00ed d\u1ee5: c\u00f4 l\u1eadp x\u00e3 h\u1ed9i, \u00e1p l\u1ef1c t\u00e0i ch\u00ednh, \u00e1p l\u1ef1c c\u00f4ng vi\u1ec7c) li\u00ean quan \u0111\u1ebfn vi\u1ec7c t\u0103ng nguy c\u01a1 m\u1eafc b\u1ec7nh tim m\u1ea1ch.<\/td>\n<\/tr>\n
3. C\u00e1c r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n nh\u01b0 tr\u1ea7m c\u1ea3m, lo \u00e2u v\u00e0 r\u1ed1i lo\u1ea1n stress sau sang ch\u1ea5n (PTSD) li\u00ean quan \u0111\u1ebfn vi\u1ec7c gia t\u0103ng nguy c\u01a1 m\u1eafc b\u1ec7nh tim m\u1ea1ch.<\/td>\n<\/tr>\n
4. Nh\u00e2n vi\u00ean y t\u1ebf c\u00f3 tr\u00e1ch nhi\u1ec7m:<\/p>\n
    \n
  • N\u1eafm r\u00f5 c\u00e1c m\u1ed1i li\u00ean quan<\/li>\n
  • C\u1ea3nh gi\u00e1c v\u1edbi c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 trong qu\u00e1 tr\u00ecnh th\u0103m kh\u00e1m<\/li>\n
  • T\u01b0 v\u1ea5n, chuy\u1ec3n tuy\u1ebfn khi c\u1ea7n thi\u1ebft<\/li>\n
  • V\u1eadn \u0111\u1ed9ng thay \u0111\u1ed5i h\u1ec7 th\u1ed1ng m\u1ed9t c\u00e1ch ph\u00f9 h\u1ee3p…<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    C\u00e1c \u0111i\u1ec3m ch\u00ednh v\u00e0 \u0111\u1ed3ng thu\u1eadn l\u00e2m s\u00e0ng (2)<\/h3>\n\n\n\n\n\n
    NH\u1eeeNG \u0110I\u1ec2M \u0110\u1ed2NG THU\u1eacN V\u1ec0 QU\u1ea2N L\u00dd<\/span><\/strong><\/td>\n<\/tr>\n
    1. Qu\u1ea3n l\u00fd stress t\u00e2m l\u00fd \u2013 x\u00e3 h\u1ed9i v\u00e0 th\u00fac \u0111\u1ea9y s\u1ee9c kh\u1ecfe tinh th\u1ea7n l\u00e0 nh\u1eefng th\u00e0nh ph\u1ea7n thi\u1ebft y\u1ebfu c\u1ee7a d\u1ef1 ph\u00f2ng tim m\u1ea1ch to\u00e0n di\u1ec7n.<\/span><\/td>\n<\/tr>\n
    2. K\u1ebft h\u1ee3p vi\u1ec7c s\u00e0ng l\u1ecdc tr\u1ea7m c\u1ea3m, lo \u00e2u v\u00e0 r\u1ed1i lo\u1ea1n stress sau sang ch\u1ea5n v\u00e0o trong \u0111\u00e1nh gi\u00e1 nguy c\u01a1 tim m\u1ea1ch.<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    S\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n v\u00e0 r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh tim m\u1ea1ch<\/h2>\n

    T\u1ef7 l\u1ec7 tr\u1ea7m c\u1ea3m\/ tri\u1ec7u ch\u1ee9ng tr\u1ea7m c\u1ea3m \u1edf ng\u01b0\u1eddi m\u1eafc b\u1ec7nh tim m\u1ea1ch (1)<\/h3>\n\n\n\n\n\n
    B\u1ec7nh<\/strong><\/td>\nD\u1eef li\u1ec7u<\/strong><\/td>\n<\/tr>\n
    H\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p\/ Sau nh\u1ed3i m\u00e1u c\u01a1 tim (ACS\/Post-MI)<\/td>\n31% b\u1ec7nh nh\u00e2n b\u00e1o c\u00e1o c\u00f3 tri\u1ec7u ch\u1ee9ng tr\u1ea7m c\u1ea3m sau nh\u1ed3i m\u00e1u c\u01a1 tim .<\/p>\n

    T\u1ef7 l\u1ec7 tr\u1ea7m c\u1ea3m khi nh\u1eadp vi\u1ec7n l\u00e0 40% \u1edf n\u1eef <60 tu\u1ed5i, so v\u1edbi 22% \u1edf nam c\u00f9ng nh\u00f3m tu\u1ed5i.<\/p>\n

    \u1ede b\u1ec7nh nh\u00e2n >60 tu\u1ed5i, t\u1ef7 l\u1ec7 n\u00e0y l\u00e0 21% \u1edf n\u1eef v\u00e0 15% \u1edf nam<\/p>\n

    Trong nghi\u00ean c\u1ee9u g\u1ed3m 8.580 b\u1ec7nh nh\u00e2n ACS t\u1eeb 22 qu\u1ed1c gia ch\u00e2u \u00c2u, \u22656 th\u00e1ng sau xu\u1ea5t vi\u1ec7n:<\/p>\n

    Tri\u1ec7u ch\u1ee9ng tr\u1ea7m c\u1ea3m g\u1eb7p nhi\u1ec1u h\u01a1n \u1edf n\u1eef (32,3%) so v\u1edbi nam (21,2%).<\/p>\n

    Tr\u1ea7m c\u1ea3m m\u1ee9c \u0111\u1ed9 v\u1eeba\/n\u1eb7ng ghi nh\u1eadn \u1edf 12,7% n\u1eef v\u00e0 7,4% nam.<\/td>\n<\/tr>\n

    Suy tim m\u1ea1n (Chronic HF)<\/td>\nTr\u1ea7m c\u1ea3m \u00e1nh h\u01b0\u1edfng \u0111\u1ebfn 21,5% b\u1ec7nh nh\u00e2n suy tim (HF). Dao \u0111\u1ed9ng: 33,6% khi \u00f0\u00e1nh gi\u00e1 b\u1eb1ng c\u00e2u h\u1ecfi, 19,3% khi ph\u1ecfng v\u1ea5n tr\u1ef1c ti\u1ebfp. T\u1eeb 11% \u1edf NYHA I \u0111\u1ebfn 42% \u1edf NYHA IV.<\/p>\n

    Tr\u1ea7m c\u1ea3m th\u01b0\u1eddng g\u1eb7p h\u01a1n \u1edf n\u1eef gi\u1edbi m\u1eafc suy tim m\u1ea1n (32,7% so v\u1edbi 26,1% \u1edf nam). T\u1ef7 l\u1ec7 dao \u0111\u1ed9ng: 11-67% \u1edf n\u1eef, 7-63% \u1edf nam, v\u00e0 t\u00e3ng d\u1ea7n theo m\u1ee9c \u0111\u1ed9 n\u1eb7ng NYHA.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    T\u1ef7 l\u1ec7 tr\u1ea7m c\u1ea3m\/ tri\u1ec7u ch\u1ee9ng tr\u1ea7m c\u1ea3m \u1edf ng\u01b0\u1eddi m\u1eafc b\u1ec7nh tim m\u1ea1ch (2)<\/h3>\n\n\n\n\n\n\n
    B\u1ec7nh<\/strong><\/td>\nD\u1eef li\u1ec7u<\/strong><\/td>\n<\/tr>\n
    Suy tim giai \u0111o\u1ea1n cu\u1ed1i \u2013 Sau gh\u00e9p tim<\/td>\nTr\u1ea7m c\u1ea3m \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn 25-30% b\u1ec7nh nh\u00e2n sau gh\u00e9p tim.<\/p>\n

    Tr\u1ea7m c\u1ea3m \u0111\u01b0\u1ee3c ghi nh\u1eadn \u1edf 35% b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc gh\u00e9p tim v\u00e0 26,3% sau gh\u00e9p tim.<\/p>\n

    Tr\u1ea7m c\u1ea3m x\u1ea3y ra \u1edf 15%\u201339% b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3 th\u1ea5t, th\u01b0\u1eddng v\u01b0\u1ee3t ng\u01b0\u1ee1ng ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng, \u0111\u1eb7c bi\u1ec7t \u1edf ng\u01b0\u1eddi cao tu\u1ed5i.<\/p>\n

    Ng\u01b0\u1eddi b\u1ec7nh sau gh\u00e9p tim c\u00f3 t\u1ef7 l\u1ec7 tr\u1ea7m c\u1ea3m th\u1ea5p h\u01a1n nh\u00f3m c\u00f3 thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3 c\u01a1 h\u1ecdc<\/td>\n<\/tr>\n

    Rung nh\u0129 (AF)<\/td>\n38% b\u1ec7nh nh\u00e2n rung nh\u0129 c\u00f3 tr\u1ea7m c\u1ea3m (theo thang \u0111i\u1ec3m Beck Depression Inventory (BDI)).<\/td>\n<\/tr>\n
    ICD<\/td>\nPh\u00e2n t\u00edch g\u1ed9p theo m\u00f4 h\u00ecnh hi\u1ec7u \u1ee9ng ng\u1eabu nhi\u00ean cho th\u1ea5y tr\u1ea7m c\u1ea3m c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng \u1edf 15,4% b\u1ec7nh nh\u00e2n c\u00f3 ICD, (KTC 95%: 11,9\u201318,9%) t\u1ea1i t\u1ea5t c\u1ea3 c\u00e1c th\u1eddi \u0111i\u1ec3m sau c\u1ea5y.<\/p>\n

    T\u1ef7 l\u1ec7 m\u1eafc m\u1edbi tr\u1ea7m c\u1ea3m 2 n\u0103m sau c\u1ea5y ICD l\u00e0 11,3% ( t\u1eeb c\u01a1 s\u1edf d\u1eef li\u1ec7u qu\u1ed1c gia v\u1ec1 ICD )<\/p>\n

    Tri\u1ec7u ch\u1ee9ng tr\u1ea7m c\u1ea3m \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn 20% b\u1ec7nh nh\u00e2n c\u00f3 ICD (12% nh\u1eb9, 6% trung
    \nb\u00ecnh,
    \nTri\u1ec7u ch\u1ee9ng tr\u1ea7m c\u1ea3m \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn 20% b\u1ec7nh nh\u00e2n c\u00f3 ICD (12% nh\u1eb9, 6% trung b\u00ecnh, 2% n\u1eb7ng). Tr\u1ea7m c\u1ea3m m\u1ee9c trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng th\u01b0\u1eddng g\u1eb7p h\u01a1n \u1edf b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c c\u1ea5y ICD v\u1edbi ch\u1ec9 \u0111\u1ecbnh d\u1ef1 ph\u00f2ng th\u1ee9 ph\u00e1t v\u00e0 \u1edf nh\u1eefng ng\u01b0\u1eddi t\u1eebng nh\u1eadn \u22655 s\u1ed1c b\u1edfi ICD.<\/p>\n

    B\u1ec7nh nh\u00e2n c\u00f3 ICD v\u00e0 m\u00e1y t\u1ea1o nh\u1ecbp \u0111\u1ec1u c\u00f3 m\u1ee9c \u0111\u1ed9 tr\u1ea7m c\u1ea3m t\u0103ng t\u01b0\u01a1ng t\u1ef1 nhau<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    T\u1ef7 l\u1ec7 tr\u1ea7m c\u1ea3m\/ tri\u1ec7u ch\u1ee9ng tr\u1ea7m c\u1ea3m \u1edf ng\u01b0\u1eddi m\u1eafc b\u1ec7nh tim m\u1ea1ch (3)<\/h3>\n\n\n\n\n\n
    B\u1ec7nh<\/strong><\/td>\nD\u1eef li\u1ec7u<\/strong><\/td>\n<\/tr>\n
    Tim b\u1ea9m sinh ng\u01b0\u1eddi l\u1edbn (ACHD)<\/td>\n\u1ede 2161 b\u1ec7nh nh\u00e2n t\u0103ng \u00e1p ph\u1ed5i, t\u1ef7 l\u1ec7 tr\u1ea7m c\u1ea3m \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u00e0 28% (KTC 95%: 20,5\u201336,8). B\u1ec7nh nh\u00e2n tim b\u1ea9m sinh \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh (ACHD) c\u00f3 nguy c\u01a1 t\u1ef1 t\u1eed th\u1ea5p v\u00e0 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi nh\u00f3m tham chi\u1ebfu<\/td>\n<\/tr>\n
    T\u0103ng \u00e1p ph\u1ed5i\/ T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i (PH\/PAH)<\/td>\nTrong 2.161 b\u1ec7nh nh\u00e2n t\u0103ng \u00e1p ph\u1ed5i (PH), t\u1ef7 l\u1ec7 g\u1ed9p b\u00e1o c\u00e1o c\u1ee7a tr\u1ea7m c\u1ea3m l\u00e0 28% (KTC 95%: 20,5\u201336,8)<\/p>\n

    C\u00e1c nghi\u00ean c\u1ee9u nh\u1ecf h\u01a1n ghi nh\u1eadn t\u1ef7 l\u1ec7 hi\u1ec7n m\u1eafc tr\u1ea7m c\u1ea3m \u1edf b\u1ec7nh nh\u00e2n t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i (PAH) dao \u0111\u1ed9ng t\u1eeb 9% \u0111\u1ebfn 70%, c\u00f3 li\u00ean quan \u0111\u1ebfn m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    T\u1ec9 l\u1ec7 lo \u00e2u\/ tri\u1ec7u ch\u1ee9ng lo \u00e2u \u1edf ng\u01b0\u1eddi m\u1eafc b\u1ec7nh tim m\u1ea1ch (1)<\/h3>\n\n\n\n\n\n
    B\u1ec7nh<\/strong><\/td>\nD\u1eef li\u1ec7u<\/strong><\/td>\n<\/tr>\n
    H\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p\/ Sau nh\u1ed3i m\u00e1u c\u01a1 tim (ACS\/Post-MI)<\/td>\nTrong m\u1ed9t nghi\u00ean c\u1ee9u qu\u1ed1c t\u1ebf, nh\u1eefng b\u1ec7nh nh\u00e2n sau CABG, PCI, NMCT v\u00e0 ACS, \u22656 th\u00e1ng sau xu\u1ea5t vi\u1ec7n, t\u1ef7 l\u1ec7 lo \u00e2u dao \u0111\u1ed9ng t\u1eeb 12\u201342% \u1edf nam v\u00e0 22\u201364% \u1edf n\u1eef; trong \u0111\u00f3 lo \u00e2u m\u1ee9c v\u1eeba \u0111\u1ebfn n\u1eb7ng ghi nh\u1eadn \u1edf 11% nam v\u00e0 23% n\u1eef.<\/p>\n

    Sau 3 th\u00e1ng k\u1ec3 t\u1eeb nh\u1ed3i m\u00e1u c\u01a1 tim, 10% b\u1ec7nh nh\u00e2n b\u00e1o c\u00e1o lo \u00e2u n\u1eb7ng, nh\u01b0ng t\u1ef7 l\u1ec7 n\u00e0y gi\u1ea3m xu\u1ed1ng m\u1ee9c t\u01b0\u01a1ng \u0111\u01b0\u01a1ng d\u00e2n s\u1ed1 chung trong giai \u0111o\u1ea1n 3\u201318 th\u00e1ng ti\u1ebfp theo.<\/p>\n

    \u1ede b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n l\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch v\u00e0nh t\u1ef1 ph\u00e1t, 41% c\u00f3 lo \u00e2u m\u1ee9c \u0111\u1ed9 nh\u1eb9, 16% c\u00f3 lo \u00e2u m\u1ee9c trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng. \u0110i\u1ec3m lo \u00e2u cao th\u01b0\u1eddng g\u1eb7p h\u01a1n \u1edf n\u1eef gi\u1edbi, ng\u01b0\u1eddi tr\u1ebb tu\u1ed5i, nh\u1eefng ng\u01b0\u1eddi c\u00f3 kh\u1ea3 n\u0103ng th\u00edch \u1ee9ng k\u00e9m, v\u00e0 nh\u1eefng ng\u01b0\u1eddi m\u1edbi tr\u1ea3i qua bi\u1ebfn c\u1ed1.<\/td>\n<\/tr>\n

    Suy tim m\u1ea1n ( Chronic HF )<\/td>\nC\u00f3 t\u1edbi 72% b\u1ec7nh nh\u00e2n suy tim xu\u1ea5t hi\u1ec7n lo \u00e2u; \u01b0\u1edbc t\u00ednh g\u1ed9p cho th\u1ea5y 56% c\u00f3 tri\u1ec7u ch\u1ee9ng lo \u00e2u, 29% c\u00f3 lo \u00e2u c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng, v\u00e0 13,1% m\u1eafc r\u1ed1i lo\u1ea1n lo \u00e2u. T\u1ef7 l\u1ec7 n\u00e0y cao h\u01a1n trong c\u00e1c nghi\u00ean c\u1ee9u c\u00f3 nhi\u1ec1u n\u1eef gi\u1edbi.<\/p>\n

    B\u1ec7nh nh\u00e2n suy tim c\u00f3 nguy c\u01a1 lo \u00e2u cao h\u01a1n, v\u1edbi 23% c\u00f3 tri\u1ec7u ch\u1ee9ng lo \u00e2u v\u00e0 32% m\u1eafc \u0111\u1ed3ng th\u1eddi lo \u00e2u v\u00e0 tr\u1ea7m c\u1ea3m.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    T\u1ec9 l\u1ec7 lo \u00e2u\/ tri\u1ec7u ch\u1ee9ng lo \u00e2u \u1edf ng\u01b0\u1eddi m\u1eafc b\u1ec7nh tim m\u1ea1ch (2)<\/h3>\n\n\n\n\n\n\n
    B\u1ec7nh<\/strong><\/td>\nD\u1eef li\u1ec7u<\/strong><\/td>\n<\/tr>\n
    Suy tim giai \u0111o\u1ea1n cu\u1ed1i v\u00e0 sau gh\u00e9p tim<\/td>\nT\u1ef7 l\u1ec7 lo \u00e2u \u1edf b\u1ec7nh nh\u00e2n sau gh\u00e9p tim l\u00e0 11% (KTC 95%: 3,8\u201328,5).<\/td>\n<\/tr>\n
    Rung nh\u0129 (AF)<\/td>\nB\u1ec7nh nh\u00e2n rung nh\u0129 c\u00f3 t\u1ef7 l\u1ec7 lo \u00e2u 28%, t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nh\u00f3m ch\u1ee9ng, v\u00e0 tri\u1ec7u ch\u1ee9ng v\u1eabn t\u1ed3n t\u1ea1i \u1edf 37% sau 6 th\u00e1ng. Trong nh\u00f3m b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c s\u1ed1c \u0111i\u1ec7n chuy\u1ec3n nh\u1ecbp ho\u1eb7c tri\u1ec7t \u0111\u1ed1t, 30% b\u00e1o c\u00e1o lo \u00e2u c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng.<\/td>\n<\/tr>\n
    ICD<\/td>\n\u1ede b\u1ec7nh nh\u00e2n s\u1ed1ng s\u00f3t sau ng\u1eebng tim ngo\u00e0i vi\u1ec7n (OHCA), 36% c\u00f3 lo \u00e2u \u1edf n\u1eef so v\u1edbi 20% nam; t\u1ef7 l\u1ec7 n\u00e0y cao h\u01a1n \u1edf n\u1eef <55 tu\u1ed5i so v\u1edbi n\u1eef \u226555 tu\u1ed5i (43% so v\u1edbi 28%). Sau 18 th\u00e1ng k\u1ec3 t\u1eeb OHCA, 32% b\u1ec7nh nh\u00e2n c\u00f2n c\u00f3 tri\u1ec7u ch\u1ee9ng lo \u00e2u.<\/p>\n

    M\u1ed9t c\u01a1 s\u1edf d\u1eef li\u1ec7u l\u1edbn b\u00e1o c\u00e1o 20% b\u1ec7nh nh\u00e2n c\u00f3 lo \u00e2u \u0111\u1ed1i v\u1edbi nh\u00f3m (OHCA)<\/p>\n

    Ph\u00e2n t\u00edch g\u1ed9p theo m\u00f4 h\u00ecnh hi\u1ec7u \u1ee9ng ng\u1eabu nhi\u00ean cho th\u1ea5y 23% b\u1ec7nh nh\u00e2n c\u1ea5y ICD c\u00f3 lo \u00e2u c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng (KTC 95%: 18,3\u201327,0%) t\u1ea1i t\u1ea5t c\u1ea3 c\u00e1c th\u1eddi \u0111i\u1ec3m sau c\u1ea5y<\/p>\n

    T\u1ef7 l\u1ec7 m\u1eafc m\u1edbi lo \u00e2u sau 24 th\u00e1ng k\u1ec3 t\u1eeb khi c\u1ea5y ICD l\u00e0 15%, v\u1edbi t\u1ef7 l\u1ec7 cao h\u01a1n \u1edf n\u1eef v\u00e0 \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c c\u1ea5y ICD theo ch\u1ec9 \u0111\u1ecbnh d\u1ef1 ph\u00f2ng th\u1ee9 ph\u00e1t<\/p>\n

    B\u1ec7nh nh\u00e2n c\u00f3 ICD v\u00e0 m\u00e1y t\u1ea1o nh\u1ecbp \u0111\u1ec1u bi\u1ec3u hi\u1ec7n m\u1ee9c \u0111\u1ed9 lo \u00e2u t\u0103ng cao t\u01b0\u01a1ng t\u1ef1
    \nnhau.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    T\u1ec9 l\u1ec7 lo \u00e2u\/ tri\u1ec7u ch\u1ee9ng lo \u00e2u \u1edf ng\u01b0\u1eddi m\u1eafc b\u1ec7nh tim m\u1ea1ch (3)<\/h3>\n\n\n\n\n\n
    B\u1ec7nh<\/strong><\/td>\nD\u1eef li\u1ec7u<\/strong><\/td>\n<\/tr>\n
    Tim b\u1ea9m sinh ng\u01b0\u1eddi l\u1edbn (ACHD)<\/td>\nM\u1ed9t ph\u00e2n t\u00edch t\u1ed5ng quan cho th\u1ea5y tri\u1ec7u ch\u1ee9ng lo \u00e2u th\u01b0\u1eddng g\u1eb7p \u0111\u1ed3ng th\u1eddi ngay sau bi\u1ebfn c\u1ed1 tim m\u1ea1ch ho\u1eb7c ph\u1eabu thu\u1eadt, v\u00e0 trong qu\u00e1 tr\u00ecnh theo d\u00f5i sau \u0111\u00f3.<\/p>\n

    T\u1ef7 l\u1ec7 lo \u00e2u \u1edf b\u1ec7nh nh\u00e2n tim b\u1ea9m sinh ng\u01b0\u1eddi l\u1edbn (ACHD) l\u00e0 13%, cao h\u01a1n so v\u1edbi \u0111o\u00e0n h\u1ec7 l\u1ecbch s\u1eed b\u1ec7nh nh\u00e2n lymphoma kh\u00f4ng Hodgkin v\u00e0 so v\u1edbi gi\u00e1 tr\u1ecb tham chi\u1ebfu t\u1ea1i \u0110\u1ee9c (6%).<\/td>\n<\/tr>\n

    T\u0103ng \u00e1p ph\u1ed5i\/ T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i (PH\/PAH)<\/td>\nT\u1ed5ng c\u1ed9ng 24 nghi\u00ean c\u1ee9u tr\u00ean 2161 b\u1ec7nh nh\u00e2n t\u0103ng \u00e1p ph\u1ed5i (PH) b\u00e1o c\u00e1o t\u1ef7 l\u1ec7 c\u00f3 lo \u00e2u l\u00e0 37% (KTC 95%: 28,7\u201346,4).<\/p>\n

    C\u00e1c nghi\u00ean c\u1ee9u nh\u1ecf h\u01a1n cho th\u1ea5y t\u1ef7 l\u1ec7 lo \u00e2u \u1edf b\u1ec7nh nh\u00e2n t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i dao \u0111\u1ed9ng t\u1eeb 9% \u0111\u1ebfn 58%, c\u00f3 li\u00ean quan \u0111\u1ebfn m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh.<\/p>\n

    T\u1ef7 l\u1ec7 lo \u00e2u cao h\u01a1n \u1edf b\u1ec7nh nh\u00e2n t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i s\u1ed1ng t\u1ea1i khu v\u1ef1c th\u00e0nh th\u1ecb v\u00e0 \u1edf nh\u1eefng ng\u01b0\u1eddi kh\u00f4ng h\u00fat thu\u1ed1c ho\u1eb7c kh\u00f4ng u\u1ed1ng r\u01b0\u1ee3u so v\u1edbi nh\u00f3m \u0111\u1ed1i ch\u1ee9ng t\u01b0\u01a1ng \u1ee9ng.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    T\u1ef7 l\u1ec7 r\u1ed1i lo\u1ea1n stress\/ tri\u1ec7u ch\u1ee9ng stress sau sang ch\u1ea5n (PTSS) \u1edf b\u1ec7nh nh\u00e2n tim m\u1ea1ch<\/h3>\n\n\n\n\n\n\n\n
    B\u1ec7nh<\/td>\nD\u1eef li\u1ec7u<\/td>\n<\/tr>\n
    ACS\/Post-MI<\/td>\nPTSD c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng: 12%. T\u1ef7 l\u1ec7 tri\u1ec7u ch\u1ee9ng stress sau sang ch\u1ea5n (PTSS) dao \u0111\u1ed9ng t\u1eeb 0\u201326% t\u00f9y theo ph\u01b0\u01a1ng ph\u00e1p.<\/p>\n

    PTSD g\u1eb7p \u1edf 7\u201320% b\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u ch\u1ee7\u2013v\u00e0nh (CABG).<\/p>\n

    T\u1ef7 l\u1ec7 PTSD \u1edf b\u1ec7nh nh\u00e2n l\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch v\u00e0nh t\u1ef1 ph\u00e1t (SCAD) dao \u0111\u1ed9ng t\u1eeb 28\u201335%.<\/td>\n<\/tr>\n

    Suy tim giai \u0111o\u1ea1n cu\u1ed1i v\u00e0 sau gh\u00e9p tim<\/td>\nPTSD g\u1eb7p \u1edf 11\u201319% b\u1ec7nh nh\u00e2n sau gh\u00e9p tim.<\/td>\n<\/tr>\n
    ICD<\/td>\nT\u1ef7 l\u1ec7 PTSD \u1edf b\u1ec7nh nh\u00e2n s\u1ed1ng s\u00f3t sau ng\u1eebng tim dao \u0111\u1ed9ng 12\u201338%.<\/p>\n

    Tr\u1ea3i qua \u22651 c\u00fa s\u1ed1c ICD th\u00edch h\u1ee3p l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u1ed9c l\u1eadp \u0111\u1ed1i v\u1edbi PTSD (OR 6,0; KTC 95%: 1,45\u201324,63; P<0,013).<\/p>\n

    M\u1ed9t nghi\u00ean c\u1ee9u cho th\u1ea5y t\u1ef7 l\u1ec7 PTSD cao h\u01a1n \u1edf b\u1ec7nh nh\u00e2n ICD t\u1eebng tr\u1ea3i qua c\u01a1n b\u00e3o \u0111i\u1ec7n (electric storm) so v\u1edbi nh\u00f3m kh\u00f4ng tr\u1ea3i qua.<\/td>\n<\/tr>\n

    ACHD<\/td>\nT\u1ef7 l\u1ec7 PTSD \u1edf b\u1ec7nh nh\u00e2n tim b\u1ea9m sinh ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh (ACHD) dao \u0111\u1ed9ng t\u1eeb 1% \u0111\u1ebfn 30%, kh\u00e1c nhau t\u00f9y theo ph\u01b0\u01a1ng ph\u00e1p \u0111o l\u01b0\u1eddng v\u00e0 khu v\u1ef1c \u0111\u1ecba l\u00fd.<\/p>\n

    N\u1eef gi\u1edbi v\u00e0 nh\u1eefng ng\u01b0\u1eddi c\u00f3 nhi\u1ec1u l\u1ea7n ti\u1ebfp x\u00fac y t\u1ebf nh\u01b0ng thi\u1ebfu can thi\u1ec7p t\u00e2m l\u00fd \u2013 x\u00e3 h\u1ed9i c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng b\u1ecb PTSD h\u01a1n.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

     <\/p>\n

    \"H\u00ecnh
    H\u00ecnh 6: H\u1ed7 tr\u1ee3 nh\u1eefng ng\u01b0\u1eddi ch\u0103m s\u00f3c tim m\u1ea1ch kh\u00f4ng chuy\u00ean<\/figcaption><\/figure>\n

    C\u00e1c \u0111i\u1ec3m ch\u00ednh v\u00e0 \u0111\u1ed3ng thu\u1eadn l\u00e2m s\u00e0ng (1)<\/h3>\n\n\n\n\n\n\n\n
    NH\u1eeeNG \u0110I\u1ec2M T\u00d3M T\u1eaeT CH\u00cdNH<\/strong><\/td>\n<\/tr>\n
    1. B\u1ec7nh tim m\u1ea1ch v\u00e0 c\u00e1c r\u1ed1i lo\u1ea1n s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n nh\u01b0 tr\u1ea7m c\u1ea3m, lo \u00e2u v\u00e0 PTSD c\u00f3 m\u1ed1i quan h\u1ec7 \u0111a chi\u1ec1u v\u00e0 ch\u00fang l\u00e0m t\u0103ng nguy c\u01a1 l\u1eabn nhau.<\/td>\n<\/tr>\n
    2. C\u00e1c r\u1ed1i lo\u1ea1n s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n \u1edf b\u1ec7nh nh\u00e2n tim m\u1ea1ch, nh\u01b0 tr\u1ea7m c\u1ea3m, c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng ti\u00eau c\u1ef1c \u0111\u1ebfn vi\u1ec7c t\u1ef1 qu\u1ea3n l\u00fd b\u1ec7nh, bao g\u1ed3m tu\u00e2n th\u1ee7 thu\u1ed1c v\u00e0 thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng, v\u00e0 li\u00ean quan \u0111\u1ebfn ti\u00ean l\u01b0\u1ee3ng k\u00e9m h\u01a1n.<\/td>\n<\/tr>\n
    3. T\u00e1c \u0111\u1ed9ng c\u1ee7a lo \u00e2u v\u00e0 PTSD \u0111\u1ed1i v\u1edbi tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb v\u00e0 k\u1ebft c\u1ee5c tim m\u1ea1ch c\u00f2n ch\u01b0a r\u00f5 r\u00e0ng v\u00e0 c\u00f3 th\u1ec3 ph\u1ee5 thu\u1ed9c v\u00e0o th\u1eddi gian.<\/td>\n<\/tr>\n
    4. Ng\u01b0\u1eddi ch\u0103m s\u00f3c kh\u00f4ng chuy\u00ean ( kh\u00f4ng ph\u1ea3i nh\u00e2n vi\u00ean y t\u1ebf )\u0111\u00f3ng vai tr\u00f2 thi\u1ebft y\u1ebfu trong vi\u1ec7c h\u1ed7 tr\u1ee3 th\u00e0nh vi\u00ean gia \u0111\u00ecnh m\u1eafc b\u1ec7nh tim m\u1ea1ch duy tr\u00ec thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng l\u00e2u d\u00e0i v\u00e0 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb; vi\u1ec7c \u0111\u00e1nh gi\u00e1 v\u00e0 h\u1ed7 tr\u1ee3 s\u1ee9c kh\u1ecfe ng\u01b0\u1eddi ch\u0103m s\u00f3c s\u1ebd mang l\u1ea1i l\u1ee3i \u00edch cho c\u1ea3 hai b\u00ean.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    C\u00e1c \u0111i\u1ec3m ch\u00ednh v\u00e0 \u0111\u1ed3ng thu\u1eadn l\u00e2m s\u00e0ng (2)<\/h3>\n\n\n\n\n\n\n
    NH\u1eeeNG \u0110I\u1ec2M \u0110\u1ed2NG THU\u1eacN V\u1ec0 QU\u1ea2N L\u00dd<\/strong><\/td>\n<\/tr>\n
    1. N\u00ean \u0111\u00e1nh gi\u00e1 tr\u1ea7m c\u1ea3m, lo \u00e2u v\u00e0 r\u1ed1i lo\u1ea1n stress sau sang ch\u1ea5n \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e3 c\u00f3 b\u1ec7nh tim m\u1ea1ch ( T\u1ef7 l\u1ec7 m\u1eafc cao v\u00e0 \u00e1nh h\u01b0\u1edfng \u0111\u1ebfn k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb) \u0111\u1ed3ng th\u1eddi c\u1ea7n chuy\u1ec3n b\u1ec7nh nh\u00e2n \u0111\u1ebfn chuy\u00ean gia khi c\u1ea7n.<\/td>\n<\/tr>\n
    2. Stress l\u00e2u d\u00e0i v\u00e0 c\u00f4 \u0111\u01a1n li\u00ean quan \u0111\u1ebfn k\u1ebft c\u1ee5c b\u1ea5t l\u1ee3i \u1edf b\u1ec7nh nh\u00e2n tim m\u1ea1ch, n\u1ebfu \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n trong qu\u00e1 tr\u00ecnh th\u0103m kh\u00e1m l\u00e2m s\u00e0ng th\u00ec n\u00ean xem x\u00e9t chuy\u1ec3n b\u1ec7nh nh\u00e2n \u0111\u1ebfn chuy\u00ean gia th\u00edch h\u1ee3p.<\/td>\n<\/tr>\n
    3. N\u00ean l\u1ed3ng gh\u00e9p v\u00e0 \u0111\u00e1nh gi\u00e1 h\u1ed7 tr\u1ee3 s\u1ee9c kh\u1ecfe d\u00e0nh cho ng\u01b0\u1eddi ch\u0103m s\u00f3c kh\u00f4ng chuy\u00ean trong c\u00e1ch ti\u1ebfp c\u1eadn to\u00e0n di\u1ec7n \u0111\u1ed1i v\u1edbi s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n v\u00e0 tim m\u1ea1ch.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Nh\u1eadn di\u1ec7n \u2013 D\u1ef1 ph\u00f2ng \u2013 Qu\u1ea3n l\u00fd v\u1ea5n \u0111\u1ec1 s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n trong b\u1ec7nh tim m\u1ea1ch<\/h2>\n
    \"H\u00ecnh
    H\u00ecnh 7: Minh h\u1ecda h\u1ec7 th\u1ed1ng h\u1ed7 tr\u1ee3 \u2018 theo nhu c\u1ea7u\u2019 cho b\u1ec7nh nh\u00e2n tim m\u1ea1ch nh\u1eb1m c\u1ea3i thi\u1ec7n s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n<\/figcaption><\/figure>\n
    \"H\u00ecnh
    H\u00ecnh 8: S\u00e0ng l\u1ecdc r\u1ed1i lo\u1ea1n s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n \u1edf b\u1ec7nh nh\u00e2n tim m\u1ea1ch<\/figcaption><\/figure>\n

    \u0110\u1ed9 nh\u1ea1y\/ \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u c\u1ee7a c\u00e1c c\u00f4ng c\u1ee5 s\u00e0ng l\u1ecdc tri\u1ec7u ch\u1ee9ng lo \u00e2u v\u00e0 tr\u1ea7m c\u1ea3m<\/h3>\n\n\n\n\n\n
    \u0110\u1eb7c \u0111i\u1ec3m \u0111o l\u01b0\u1eddng<\/span><\/td>\nB\u1ed9 c\u00e2u h\u1ecfi Whooley\u00a0<\/span><\/span><\/td>\nGAD-2<\/span><\/td>\nPHQ-2 \u22652 \u0111i\u1ec3m<\/span><\/td>\n<\/tr>\n
    \u0110\u1ed9 nh\u1ea1y<\/span><\/td>\n95% (95% CI 88\u201397)<\/span><\/span><\/td>\n91%<\/span><\/td>\n97%<\/span><\/td>\n<\/tr>\n
    \u0110\u1ed9 \u0111\u1eb7c hi\u1ec7u<\/span><\/td>\n65% (95% CI 56\u201374)<\/td>\n37%<\/span><\/td>\n48%<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Th\u1eddi \u0111i\u1ec3m v\u00e0 c\u00f4ng c\u1ee5 s\u00e0ng l\u1ecdc tri\u1ec7u ch\u1ee9ng lo \u00e2u v\u00e0 tr\u1ea7m c\u1ea3m<\/h3>\n\n\n\n\n\n\n\n
    Th\u1eddi \u0111i\u1ec3m s\u00e0ng l\u1ecdc<\/span><\/strong><\/td>\nC\u00f4ng c\u1ee5 \u0111\u00e1nh gi\u00e1<\/span><\/strong><\/td>\n<\/tr>\n
    Tri\u1ec7u ch\u1ee9ng lo \u00e2u<\/span><\/strong><\/td>\nTri\u1ec7u ch\u1ee9ng tr\u1ea7m c\u1ea3m<\/span><\/strong><\/td>\n<\/tr>\n
    Sau khi \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n m\u1edbi m\u1eafc b\u1ec7nh CVD ho\u1eb7c can thi\u1ec7p tim m\u1ea1ch<\/strong>. C\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n ngay trong th\u1eddi gian n\u1eb1m vi\u1ec7n.<\/span><\/td>\nGAD-2 (N\u1ebfu d\u01b0\u01a1ng t\u00ednh l\u00e0m GAD- 7)<\/strong><\/p>\n

    \u00a0<\/span><\/strong><\/td>\n

    		PHQ-2 (N\u1ebfu d\u01b0\u01a1ng t\u00ednh l\u00e0m PHQ-9)<\/span><\/strong><\/td>\n<\/tr>\n
    T\u1ea1i c\u00e1c l\u1ea7n kh\u00e1m theo d\u00f5i (v\u00ed d\u1ee5: h\u00e0ng n\u0103m)<\/strong> \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh s\u1ef1 thay \u0111\u1ed5i so v\u1edbi l\u1ea7n kh\u00e1m ban \u0111\u1ea7u ho\u1eb7c tr\u01b0\u1edbc \u0111\u00f3.<\/span><\/td>\n<\/tr>\n
    B\u1ea5t c\u1ee9 l\u00fac<\/strong> n\u00e0o d\u1ef1a tr\u00ean \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng c\u1ee7a b\u00e1c s\u0129.<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
    <\/div>\n
    \"H\u00ecnh
    H\u00ecnh 9: Tu\u1ea7n t\u1ef1 c\u00e1c b\u01b0\u1edbc \u0111\u00e1nh gi\u00e1 v\u00e0 qu\u1ea3n l\u00fd c\u00f3 h\u1ec7 th\u1ed1ng s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n c\u1ee7a b\u1ec7nh nh\u00e2n tim m\u1ea1ch<\/figcaption><\/figure>\n
    \"H\u00ecnh
    H\u00ecnh 10: Qu\u1ea3n l\u00fd b\u1eb1ng thu\u1ed1c cho b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh tim m\u1ea1ch c\u00f3 lo \u00e2u tr\u1ea7m c\u1ea3m ho\u1eb7c c\u0103ng th\u1eb3ng sau sang ch\u1ea5n<\/figcaption><\/figure>\n

    T\u00f3m t\u1eaft \u0111i\u1ec3m ch\u00ednh v\u00e0 \u0111\u1ed3ng thu\u1eadn l\u00e2m s\u00e0ng (1)<\/h3>\n\n\n\n\n\n\n\n\n\n
    T\u00f3m t\u1eaft \u0111i\u1ec3m ch\u00ednh<\/strong><\/td>\n<\/tr>\n
    1. L\u00fd t\u01b0\u1edfng nh\u1ea5t, vi\u1ec7c \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n th\u01b0\u1eddng quy trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng b\u1ec7nh tim m\u1ea1ch v\u00e0 \u0111\u01b0\u1ee3c tri\u1ec3n khai khi \u0111i\u1ec1u ki\u1ec7n v\u1ec1 ngu\u1ed3n l\u1ef1c v\u00e0 n\u0103ng l\u1ef1c t\u1ea1i c\u01a1 s\u1edf cho ph\u00e9p.<\/td>\n<\/tr>\n
    2. Tr\u1ea7m c\u1ea3m v\u00e0 lo \u00e2u c\u00f3 th\u1ec3 d\u1ec5 d\u00e0ng b\u1ecb b\u1ecf s\u00f3t trong ch\u0103m s\u00f3c th\u01b0\u1eddng quy cho ng\u01b0\u1eddi b\u1ec7nh tim m\u1ea1ch v\u00e0\/ho\u1eb7c b\u1ecb xem l\u00e0 ph\u1ea3n \u1ee9ng \u2018b\u00ecnh th\u01b0\u1eddng\u2019 tr\u01b0\u1edbc g\u00e1nh n\u1eb7ng l\u00e2m s\u00e0ng\/ti\u00ean l\u01b0\u1ee3ng c\u1ee7a b\u1ec7nh.<\/td>\n<\/tr>\n
    3. Ti\u1ec1n s\u1eed l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 nh\u1eadn di\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n. N\u1ebfu c\u00f3 nghi ng\u1edd l\u00e2m s\u00e0ng, n\u00ean ti\u1ebfn h\u00e0nh s\u00e0ng l\u1ecdc ch\u00ednh th\u1ee9c b\u1eb1ng c\u00e1c c\u00f4ng c\u1ee5 \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ea9m \u0111\u1ecbnh.<\/td>\n<\/tr>\n
    4. C\u00e1c nh\u00f3m Ch\u0103m s\u00f3c t\u00e2m th\u1ea7n – Tim m\u1ea1ch (Psycho-Cardio teams) l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 x\u00e2y d\u1ef1ng c\u00e1c l\u1ed9 tr\u00ecnh cho:<\/p>\n

    S\u00e0ng l\u1ecdc<\/strong> (Screening),<\/p>\n

    Chuy\u1ec3n tuy\u1ebfn<\/strong> (Referral),<\/p>\n

    \u0110i\u1ec1u tr\u1ecb<\/strong> (Treatment) cho nh\u1eefng ng\u01b0\u1eddi m\u1eafc b\u1ec7nh tim m\u1ea1ch (CVD) v\u00e0 c\u00f3 c\u00e1c v\u1ea5n \u0111\u1ec1 s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n nghi ng\u1edd ho\u1eb7c \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh.<\/td>\n<\/tr>\n

    5. Can thi\u1ec7p y khoa, bao g\u1ed3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c, c\u00f3 th\u1ec3 c\u1ea7n thi\u1ebft cho nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh tim m\u1ea1ch \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n r\u1ed1i lo\u1ea1n s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n, \u0111\u1eb7c bi\u1ec7t trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 tri\u1ec7u ch\u1ee9ng n\u1eb7ng c\u1ee7a tr\u1ea7m c\u1ea3m, lo \u00e2u ho\u1eb7c r\u1ed1i lo\u1ea1n stress sau sang ch\u1ea5n (PTSD).<\/td>\n<\/tr>\n
    6. \u1ede m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n tim m\u1ea1ch, li\u1ec7u ph\u00e1p ph\u1ed1i h\u1ee3p gi\u1eefa can thi\u1ec7p t\u00e2m l\u00fd v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c c\u00f3 th\u1ec3 h\u1eefu \u00edch.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    T\u00f3m t\u1eaft \u0111i\u1ec3m ch\u00ednh v\u00e0 \u0111\u1ed3ng thu\u1eadn l\u00e2m s\u00e0ng (2)<\/h3>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    \u0110\u1ed3ng thu\u1eadn \u0111i\u1ec1u tr\u1ecb<\/strong><\/td>\n<\/tr>\n
    1. Khuy\u1ebfn c\u00e1o s\u00e0ng l\u1ecdc s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n b\u1eb1ng c\u00e1c c\u00f4ng c\u1ee5 s\u00e0ng l\u1ecdc \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ea9m \u0111\u1ecbnh sau khi c\u00f3 ch\u1ea9n \u0111o\u00e1n m\u1edbi ho\u1eb7c bi\u1ebfn c\u1ed1 tim m\u1ea1ch, \u00edt nh\u1ea5t m\u1ed9t l\u1ea7n trong qu\u00e1 tr\u00ecnh theo d\u00f5i v\u00e0 b\u1ea5t c\u1ee9 l\u00fac n\u00e0o d\u1ef1a tr\u00ean \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng v\u1ec1 nhu c\u1ea7u.<\/td>\n<\/tr>\n
    2. Vi\u1ec7c s\u00e0ng l\u1ecdc ban \u0111\u1ea7u \u0111\u01a1n gi\u1ea3n b\u1eb1ng c\u00f4ng c\u1ee5 hai c\u00e2u h\u1ecfi (v\u00ed d\u1ee5: b\u1ed9 c\u00e2u h\u1ecfi Whooley, PHQ-2, GAD-2) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c t\u00edch h\u1ee3p v\u00e0o c\u00e1c quy tr\u00ecnh th\u1ef1c h\u00e0nh th\u01b0\u1eddng quy.<\/td>\n<\/tr>\n
    3. N\u00ean \u00e1p d\u1ee5ng ng\u01b0\u1ee1ng th\u1ea5p \u0111\u1ec3 s\u00e0ng l\u1ecdc s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n \u1edf nh\u1eefng ng\u01b0\u1eddi m\u1eafc b\u1ec7nh tim m\u1ea1ch (CVD), do t\u1ec9 l\u1ec7 c\u00e1c b\u1ec7nh l\u00fd t\u00e2m th\u1ea7n \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y cao v\u00e0 \u1ea3nh h\u01b0\u1edfng \u0111\u00e1ng k\u1ec3 \u0111\u1ebfn k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb.<\/td>\n<\/tr>\n
    4. Sau khi c\u00f3 k\u1ebft qu\u1ea3 b\u1ea5t th\u01b0\u1eddng \u1edf s\u00e0ng l\u1ecdc ban \u0111\u1ea7u, n\u00ean s\u1eed d\u1ee5ng m\u1ed9t c\u00f4ng c\u1ee5 s\u00e0ng l\u1ecdc \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ea9m \u0111\u1ecbnh v\u1edbi ph\u1ea1m vi r\u1ed9ng h\u01a1n \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a t\u00ecnh tr\u1ea1ng l\u00e0 nh\u1eb9, trung b\u00ecnh hay n\u1eb7ng.<\/td>\n<\/tr>\n
    5. C\u00e1c nh\u00f3m T\u00e2m l\u00fd \u2013 Tim m\u1ea1ch (Psycho-Cardio teams) c\u1ea7n x\u00e1c \u0111\u1ecbnh r\u00f5 ai l\u00e0 ng\u01b0\u1eddi ch\u1ecbu tr\u00e1ch nhi\u1ec7m trong vi\u1ec7c \u0111\u00e1nh gi\u00e1 c\u00e1c r\u1ed1i lo\u1ea1n s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n, c\u0169ng nh\u01b0 c\u00e1ch th\u1ee9c v\u00e0 th\u1eddi \u0111i\u1ec3m th\u1ef1c hi\u1ec7n, \u0111\u1ed3ng th\u1eddi \u0111i\u1ec1u ch\u1ec9nh ph\u00f9 h\u1ee3p v\u1edbi b\u1ed1i c\u1ea3nh v\u00e0 ngu\u1ed3n l\u1ef1c c\u1ee5 th\u1ec3.<\/td>\n<\/tr>\n
    6. M\u1ed7i nh\u00f3m T\u00e2m l\u00fd \u2013 Tim m\u1ea1ch (Psycho-Cardio team) c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn m\u1ed9t c\u00f4ng c\u1ee5 s\u00e0ng l\u1ecdc c\u1ee5 th\u1ec3 sau khi \u0111\u00e3 \u0111\u00e1nh gi\u00e1 c\u1ea9n th\u1eadn v\u1ec1 t\u00ednh gi\u00e1 tr\u1ecb, \u0111\u1ed9 tin c\u1eady v\u00e0 kh\u1ea3 n\u0103ng \u00e1p d\u1ee5ng cho qu\u1ea7n th\u1ec3 b\u1ec7nh nh\u00e2n c\u1ee7a m\u00ecnh; tuy nhi\u00ean, \u01b0u ti\u00ean s\u1eed d\u1ee5ng c\u00e1c c\u00f4ng c\u1ee5 s\u00e0ng l\u1ecdc chu\u1ea9n h\u00f3a trong \u0111\u00e1nh gi\u00e1 s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n.<\/td>\n<\/tr>\n
    7. Nh\u1eefng ng\u01b0\u1eddi c\u00f3 \u0111i\u1ec3m s\u1ed1 cao trong b\u1ea3ng c\u00e2u h\u1ecfi s\u00e0ng l\u1ecdc c\u1ea7n \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb th\u00edch h\u1ee3p b\u1edfi chuy\u00ean gia s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n.<\/td>\n<\/tr>\n
    8. \u00c1p d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p ch\u0103m s\u00f3c theo t\u1eebng b\u01b0\u1edbc (stepped care) \u0111\u1ec3 qu\u1ea3n l\u00fd c\u00e1c r\u1ed1i lo\u1ea1n s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n \u1edf ng\u01b0\u1eddi b\u1ec7nh tim m\u1ea1ch l\u00e0 h\u1ee3p l\u00fd, d\u1ef1a tr\u00ean s\u1edf th\u00edch c\u1ee7a b\u1ec7nh nh\u00e2n, m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a tri\u1ec7u ch\u1ee9ng v\u00e0 t\u00ecnh tr\u1ea1ng b\u1ec7nh, c\u0169ng nh\u01b0 ngu\u1ed3n l\u1ef1c s\u1eb5n c\u00f3.<\/td>\n<\/tr>\n
    9. Vi\u1ec7c x\u00e2y d\u1ef1ng v\u00e0 \u0111\u00e1nh gi\u00e1 c\u00e1c ch\u01b0\u01a1ng tr\u00ecnh can thi\u1ec7p \u0111\u01b0\u1ee3c c\u00e1 th\u1ec3 h\u00f3a nh\u1eb1m gi\u1ea3m b\u1edbt c\u0103ng th\u1eb3ng cho ng\u01b0\u1eddi b\u1ec7nh tim m\u1ea1ch v\u00e0 ng\u01b0\u1eddi ch\u0103m s\u00f3c c\u00f3 th\u1ec3 h\u1eefu \u00edch.<\/td>\n<\/tr>\n
    10. C\u00e1c bi\u1ec7n ph\u00e1p thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng v\u00e0 gi\u00e1o d\u1ee5c t\u00e2m l\u00fd c\u00f3 \u00edch cho t\u1ea5t c\u1ea3 ng\u01b0\u1eddi b\u1ec7nh tim m\u1ea1ch, trong khi c\u00e1c li\u1ec7u ph\u00e1p t\u00e2m l\u00fd c\u00f3 th\u1ec3 h\u1eefu \u00edch cho nh\u1eefng ng\u01b0\u1eddi \u0111ang tr\u1ea3i qua tr\u1ea7m c\u1ea3m v\u00e0\/ho\u1eb7c lo \u00e2u.<\/td>\n<\/tr>\n
    11. Ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng tim m\u1ea1ch l\u00e0 c\u01a1 h\u1ed9i \u0111\u1ec3 s\u00e0ng l\u1ecdc tr\u1ea7m c\u1ea3m v\u00e0 lo \u00e2u, \u0111\u1ed3ng th\u1eddi c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n c\u1ea3i thi\u1ec7n s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n sau c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch ho\u1eb7c t\u1ea1o \u0111i\u1ec1u ki\u1ec7n nh\u1eadn di\u1ec7n v\u00e0 qu\u1ea3n l\u00fd c\u00e1c r\u1ed1i lo\u1ea1n s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n.<\/td>\n<\/tr>\n
    12. N\u00ean tr\u00e1nh s\u1eed d\u1ee5ng benzodiazepine<\/strong> l\u00e0m li\u1ec7u ph\u00e1p \u0111\u1ea7u tay trong \u0111i\u1ec1u tr\u1ecb lo \u00e2u v\u00e0 tr\u1ea7m c\u1ea3m.<\/td>\n<\/tr>\n
    13. C\u00e1c thu\u1ed1c gi\u1ea3m lo \u00e2u (anxiolytics<\/strong>), thu\u1ed1c an th\u1ea7n (sedatives<\/strong>) v\u00e0 thu\u1ed1c ng\u1ee7 (hypnotics<\/strong>) \u0111ang b\u1ecb l\u1ea1m d\u1ee5ng v\u00e0 k\u00ea \u0111\u01a1n qu\u00e1 m\u1ee9c trong c\u1ed9ng \u0111\u1ed3ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf ng\u01b0\u1eddi cao tu\u1ed5i v\u00e0 nh\u1eefng ng\u01b0\u1eddi c\u00f3 b\u1ec7nh l\u00fd t\u00e2m th\u1ea7n. Do \u0111\u00f3, c\u1ea7n c\u00e2n nh\u1eafc c\u1ea9n th\u1eadn khi l\u1ef1a ch\u1ecdn ch\u1ec9 \u0111\u1ecbnh.<\/td>\n<\/tr>\n
    14. N\u00ean s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m (antidepressant<\/strong>) cho nh\u1eefng ng\u01b0\u1eddi m\u1eafc r\u1ed1i lo\u1ea1n lo \u00e2u v\u00e0 tr\u1ea7m c\u1ea3m t\u1eeb trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng, d\u01b0\u1edbi s\u1ef1 h\u01b0\u1edbng d\u1eabn c\u1ee7a c\u00e1c chuy\u00ean gia s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n c\u00f3 chuy\u00ean m\u00f4n.<\/td>\n<\/tr>\n
    15. N\u00ean s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m (antidepressant<\/strong>) cho nh\u1eefng ng\u01b0\u1eddi m\u1eafc r\u1ed1i lo\u1ea1n lo \u00e2u v\u00e0 tr\u1ea7m c\u1ea3m t\u1eeb trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng, d\u01b0\u1edbi s\u1ef1 h\u01b0\u1edbng d\u1eabn c\u1ee7a c\u00e1c chuy\u00ean gia s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n c\u00f3 chuy\u00ean m\u00f4n.<\/td>\n<\/tr>\n
    16. \u1ede nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh c\u00f3 r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t, c\u00e1c thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m l\u00e0m t\u0103ng nguy c\u01a1 k\u00e9o d\u00e0i QTc (nh\u01b0 thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m 3 v\u00f2ng \u2013 TCA, v\u00e0 c\u00f3 th\u1ec3 l\u00e0 citalopram\/escitalopram v\u1edbi li\u1ec1u tr\u00ean 20 mg) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c chuy\u1ec3n sang c\u00e1c thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m th\u1ebf h\u1ec7 m\u1edbi an to\u00e0n h\u01a1n.<\/td>\n<\/tr>\n
    17. Do thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m (antidepressants<\/strong>) th\u01b0\u1eddng xuy\u00ean t\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c thu\u1ed1c tim m\u1ea1ch (CV drugs<\/strong>), g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn hi\u1ec7u qu\u1ea3 v\u00e0 \u0111\u1ed9 an to\u00e0n, n\u00ean vi\u1ec7c theo d\u00f5i n\u1ed3ng \u0111\u1ed9 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb (therapeutic drug monitoring)<\/strong> l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 t\u1ed1i \u01b0u h\u00f3a li\u1ec7u ph\u00e1p d\u00f9ng thu\u1ed1c v\u00e0 gi\u1ea3m thi\u1ec3u c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 ti\u1ec1m \u1ea9n c\u0169ng nh\u01b0 c\u00e1c t\u01b0\u01a1ng t\u00e1c thu\u1ed1c c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    B\u1ec7nh l\u00fd t\u00e2m th\u1ea7n nghi\u00eam tr\u1ecdng v\u00e0 b\u1ec7nh tim m\u1ea1ch<\/h2>\n
    \"H\u00ecnh
    H\u00ecnh 11: B\u1ec7nh l\u00fd t\u00e2m th\u1ea7n nghi\u00eam tr\u1ecdng<\/figcaption><\/figure>\n
    \"H\u00ecnh
    H\u00ecnh 12: T\u00e1c \u0111\u1ed9ng \u0111a chi\u1ec1u c\u1ee7a b\u1ec7nh l\u00fd t\u00e2m th\u1ea7n v\u1edbi nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch<\/figcaption><\/figure>\n
    \"H\u00ecnh
    H\u00ecnh 14: Qu\u1ea3n l\u00fd \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n t\u00e2m th\u1ea7n nghi\u00eam tr\u1ecdng c\u00f3 r\u1ed1i lo\u1ea1n nh\u1ecbp<\/figcaption><\/figure>\n

    T\u00f3m t\u1eaft c\u00e1c t\u00e1c \u0111\u1ed9ng ti\u00eau c\u1ef1c c\u1ee7a m\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n v\u1edbi c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 tim m\u1ea1ch<\/h3>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    Thu\u1ed1c<\/strong><\/td>\nT\u0103ng c\u00e2n<\/strong><\/td>\nT\u0103ng \u0111\u01b0\u1eddng m\u00e1u<\/strong><\/td>\nLDL cholesterol<\/strong><\/td>\nHDL cholesterol<\/strong><\/td>\nCholesterol tp<\/strong><\/td>\nTriglycerides<\/strong><\/td>\n<\/tr>\n
    Haloperidol<\/td>\n0<\/td>\n++<\/td>\nND<\/td>\nND<\/td>\n++<\/td>\n++<\/td>\n<\/tr>\n
    Ziprasidone<\/td>\n0<\/td>\n+<\/td>\n0<\/td>\n0<\/td>\n+<\/td>\n+<\/td>\n<\/tr>\n
    Aripiprazole<\/td>\n+<\/td>\n++<\/td>\n+<\/td>\n+<\/td>\n++<\/td>\n+<\/td>\n<\/tr>\n
    Lurasidone<\/td>\n+<\/td>\n0<\/td>\n+<\/td>\n+<\/td>\n+<\/td>\n+<\/td>\n<\/tr>\n
    Cariprazine<\/td>\n+<\/td>\n++<\/td>\n0<\/td>\n+<\/td>\n0<\/td>\n+<\/td>\n<\/tr>\n
    Fluphenazine<\/td>\n+<\/td>\nND<\/td>\nND<\/td>\nND<\/td>\nND<\/td>\nND<\/td>\n<\/tr>\n
    Amisulpride<\/td>\n+<\/td>\n0<\/td>\nND<\/td>\n+ + +<\/td>\n++<\/td>\n++<\/td>\n<\/tr>\n
    Brexpiprazole<\/td>\n+<\/td>\n+<\/td>\n++<\/td>\n0<\/td>\n++<\/td>\n0<\/td>\n<\/tr>\n
    Flupentixol<\/td>\n+<\/td>\nND<\/td>\nND<\/td>\nND<\/td>\nND<\/td>\nND<\/td>\n<\/tr>\n
    Asenapine<\/td>\n++<\/td>\n0<\/td>\nND<\/td>\nND<\/td>\nND<\/td>\nND<\/td>\n<\/tr>\n
    Risperidone<\/td>\n++<\/td>\n+<\/td>\n++<\/td>\n++<\/td>\n++<\/td>\n+<\/td>\n<\/tr>\n
    Paliperidone<\/td>\n++<\/td>\n+<\/td>\n++<\/td>\n++<\/td>\n++<\/td>\n+<\/td>\n<\/tr>\n
    Quetiapine<\/td>\n++<\/td>\n+<\/td>\n+++<\/td>\n++<\/td>\n+++<\/td>\n++<\/td>\n<\/tr>\n
    Iloperidone<\/td>\n++<\/td>\n++<\/td>\nND<\/td>\nND<\/td>\n+<\/td>\n++<\/td>\n<\/tr>\n
    Sertindole<\/td>\n+++<\/td>\n+<\/td>\nND<\/td>\nND<\/td>\n++<\/td>\n+<\/td>\n<\/tr>\n
    Zotepine<\/td>\n+++<\/td>\n+++<\/td>\nND<\/td>\nND<\/td>\nND<\/td>\n+++<\/td>\n<\/tr>\n
    Clozapine<\/td>\n+++<\/td>\n+++<\/td>\nND<\/td>\nND<\/td>\n+++<\/td>\n+++<\/td>\n<\/tr>\n
    Olanzapine<\/td>\n+++<\/td>\n++<\/td>\n+++<\/td>\n+++<\/td>\n+++<\/td>\n+++<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

     <\/p>\n\n\n\n\n\n\n\n
    H\u00e0nh \u0111\u1ed9ng<\/strong><\/td>\nN\u1ed9i dung<\/strong><\/td>\n<\/tr>\n
    \u0110i\u1ec1u tr\u1ecb<\/strong><\/td>\nC\u1ea7n th\u1eadn tr\u1ecdng \u0111\u1eb7c bi\u1ec7t v\u1edbi<\/strong>: sertindole, amisulpride, ziprasidone, iloperidone, risperidone, olanzapine v\u00e0 quetiapine.<\/p>\n

    Lu\u00f4n h\u01b0\u1edbng t\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng li\u1ec1u th\u1ea5p nh\u1ea5t c\u00f3 hi\u1ec7u qu\u1ea3<\/strong>.<\/p>\n

    Ki\u1ec3m tra s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c thu\u1ed1c k\u00e9o d\u00e0i QT kh\u00e1c<\/strong>.<\/p>\n

    Ki\u1ec3m tra t\u01b0\u01a1ng t\u00e1c thu\u1ed1c<\/strong>.<\/p>\n

    Lu\u00f4n \u0111\u1eb7c bi\u1ec7t th\u1eadn tr\u1ecdng khi b\u1eaft \u0111\u1ea7u m\u1ed9t lo\u1ea1i thu\u1ed1c m\u1edbi.<\/p>\n

    \u0110i\u1ec1u ch\u1ec9nh r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i.<\/strong><\/p>\n

    X\u1eed tr\u00ed c\u00e1c y\u1ebfu t\u1ed1 k\u00e9o d\u00e0i QT c\u00f3 th\u1ec3 h\u1ed3i ph\u1ee5c kh\u00e1c (v\u00ed d\u1ee5: nh\u1ecbp ch\u1eadm, suy gi\u00e1p, \u0111\u00f3i\/b\u1ec7nh r\u1ed1i lo\u1ea1n \u0103n u\u1ed1ng, l\u1ea1m d\u1ee5ng r\u01b0\u1ee3u v\u00e0 ch\u1ea5t g\u00e2y nghi\u1ec7n, thi\u1ebfu m\u00e1u c\u01a1 tim).<\/p>\n

    L\u01b0u \u00fd c\u00e1c y\u1ebfu t\u1ed1 kh\u00f4ng h\u1ed3i ph\u1ee5c<\/strong> c\u00f3 th\u1ec3 k\u00e9o d\u00e0i QT: suy tim, ph\u00ec \u0111\u1ea1i th\u1ea5t, m\u1edbi chuy\u1ec3n nh\u1ecbp t\u1eeb rung nh\u0129, suy gan\/th\u1eadn, gi\u1edbi n\u1eef, tu\u1ed5i tr\u00ean 65.<\/p>\n

    N\u1ebfu QTc k\u00e9o d\u00e0i (>470 ms) ngay t\u1eeb ban \u0111\u1ea7u, nh\u00ecn chung kh\u00f4ng khuy\u1ebfn c\u00e1o kh\u1edfi tr\u1ecb v\u00e0 c\u1ea7n c\u00e2n nh\u1eafc k\u1ef9 d\u1ef1a tr\u00ean \u0111\u00e1nh gi\u00e1 nguy c\u01a1 \u2013 l\u1ee3i \u00edch c\u00e1 th\u1ec3 h\u00f3a (nh\u00f3m T\u00e2m l\u00fd \u2013 Tim m\u1ea1ch).<\/strong><\/td>\n<\/tr>\n

    Ti\u1ebfp c\u1eadn tri\u1ec7u ch\u1ee9ng<\/strong><\/td>\nTh\u00f4ng th\u01b0\u1eddng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng<\/p>\n

    Trong tr\u01b0\u1eddng h\u1ee3p xo\u1eafn \u0111\u1ec9nh c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c, ch\u00f3ng m\u1eb7t, ng\u1ea5t v\u00e0 ng\u1eebng tim.<\/td>\n<\/tr>\n

    Ch\u1ea9n \u0111o\u00e1n<\/strong><\/td>\n\n
      \n
    • Th\u1ef1c hi\u1ec7n \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 12 \u0111\u1ea1o tr\u00ecnh \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh kho\u1ea3ng QTc \u1edf th\u1eddi \u0111i\u1ec3m ban \u0111\u1ea7u v\u00e0 sau 1, 6 v\u00e0 12 tu\u1ea7n k\u1ec3 t\u1eeb khi b\u1eaft \u0111\u1ea7u d\u00f9ng thu\u1ed1c.<\/li>\n
    • N\u1ebfu kho\u1ea3ng QT k\u00e9o d\u00e0i, c\u1ea7n th\u1ef1c hi\u1ec7n \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 th\u01b0\u1eddng xuy\u00ean h\u01a1n.<\/li>\n
    • S\u1eed d\u1ee5ng c\u00f4ng th\u1ee9c Fridericia \u0111\u1ec3 hi\u1ec7u ch\u1ec9nh nh\u1ecbp tim trong tr\u01b0\u1eddng h\u1ee3p nh\u1ecbp tim nhanh (tachycardia).<\/li>\n
    • Ki\u1ec3m tra n\u1ed3ng \u0111\u1ed9 c\u00e1c ch\u1ea5t \u0111i\u1ec7n gi\u1ea3i: kali, canxi, magie.<\/li>\n
    • Theo d\u00f5i \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 l\u01b0u \u0111\u1ed9ng \u1edf nh\u1eefng ng\u01b0\u1eddi c\u00f3 tri\u1ec7u ch\u1ee9ng.<\/li>\n
    • Lo\u1ea1i tr\u1eeb kh\u1ea3 n\u0103ng m\u1eafc h\u1ed9i ch\u1ee9ng QT d\u00e0i b\u1ea9m sinh.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    C\u1ea9n tr\u1ecdng<\/strong><\/td>\nVi\u1ec7c ng\u1eebng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n v\u00e0 b\u1ea5t k\u1ef3 lo\u1ea1i thu\u1ed1c n\u00e0o kh\u00e1c c\u00f3 kh\u1ea3 n\u0103ng k\u00e9o d\u00e0i kho\u1ea3ng QT \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o n\u1ebfu:<\/p>\n
      \n
    • QTc > 500 ms<\/strong><\/li>\n
    • QTc > 60\u201370 ms so v\u1edbi gi\u00e1 tr\u1ecb ban \u0111\u1ea7u<\/strong><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

      T\u00f3m t\u1eaft \u0111i\u1ec3m ch\u00ednh v\u00e0 \u0111\u1ed3ng thu\u1eadn \u0111i\u1ec1u tr\u1ecb (1)<\/h3>\n\n\n\n\n\n\n\n\n
      T\u00f3m t\u1eaft \u0111i\u1ec3m ch\u00ednh<\/strong><\/td>\n<\/tr>\n
      M\u1eafc b\u1ec7nh l\u00fd t\u00e2m th\u1ea7n nghi\u00eam tr\u1ecdng (SMI) l\u00e0m t\u0103ng nguy c\u01a1 tim m\u1ea1ch , \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng ng\u01b0\u1eddi tr\u1ebb tu\u1ed5i.<\/td>\n<\/tr>\n
      \u0110\u00e1nh gi\u00e1 r\u1ee7i ro tim m\u1ea1ch th\u01b0\u1eddng xuy\u00ean l\u00e0 r\u1ea5t c\u1ea7n thi\u1ebft \u1edf nh\u1eefng ng\u01b0\u1eddi m\u1eafc SMI, b\u1ea5t k\u1ec3 tu\u1ed5i t\u00e1c, nh\u1eb1m ng\u0103n ng\u1eeba s\u1ef1 ph\u00e1t tri\u1ec3n ho\u1eb7c ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh tim m\u1ea1ch (CVD). L\u00fd t\u01b0\u1edfng nh\u1ea5t n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n tr\u01b0\u1edbc khi k\u00ea \u0111\u01a1n thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n v\u00e0 sau \u0111\u00f3, \u0111\u01b0\u1ee3c l\u1eb7p l\u1ea1i \u0111\u1ecbnh k\u1ef3 trong t\u1ea5t c\u1ea3 c\u00e1c giai \u0111o\u1ea1n c\u1ee7a b\u1ec7nh.<\/td>\n<\/tr>\n
      Qu\u1ea3n l\u00fd CVD \u1edf ng\u01b0\u1eddi m\u1eafc SMI nh\u1eb1m m\u1ee5c \u0111\u00edch gi\u1ea3m c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 tim m\u1ea1ch c\u00f3 th\u1ec3 thay \u0111\u1ed5i \u0111\u01b0\u1ee3c, bao g\u1ed3m t\u0103ng c\u00e2n, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, t\u0103ng huy\u1ebft \u00e1p, r\u1ed1i lo\u1ea1n m\u1ee1 m\u00e1u (dyslipidaemia), h\u00fat thu\u1ed1c, ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng kh\u00f4ng l\u00e0nh m\u1ea1nh v\u00e0 th\u00f3i quen s\u1ed1ng \u00edt v\u1eadn \u0111\u1ed9ng.<\/td>\n<\/tr>\n
      Vi\u1ec7c qu\u1ea3n l\u00fd CVD \u1edf ng\u01b0\u1eddi m\u1eafc SMI s\u1ebd c\u00f3 l\u1ee3i h\u01a1n khi t\u1ed1i \u01b0u h\u00f3a li\u1ec7u ph\u00e1p d\u01b0\u1ee3c l\u00fd cho SMI: (i) \u01b0u ti\u00ean li\u1ec7u ph\u00e1p \u0111\u01a1n \u0111\u1ed9c (monotherapy), (ii) s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c \u00edt c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y t\u0103ng c\u00e2n ho\u1eb7c c\u00e1c r\u1ee7i ro tim m\u1ea1ch kh\u00e1c, (iii) theo d\u00f5i c\u00e1c t\u01b0\u01a1ng t\u00e1c thu\u1ed1c v\u00e0 t\u00e1c d\u1ee5ng ph\u1ee5 c\u00f3 th\u1ec3 x\u1ea3y ra, v\u00e0 (iv) \u0111\u1ea3m b\u1ea3o s\u1ef1 tu\u00e2n th\u1ee7 thu\u1ed1c.<\/td>\n<\/tr>\n
      C\u1ea7n n\u1ed7 l\u1ef1c \u0111\u1ec3 gi\u1ea3m thi\u1ec3u t\u00e1c \u0111\u1ed9ng c\u1ee7a c\u00e1c y\u1ebfu t\u1ed1 t\u00e2m l\u00fd x\u00e3 h\u1ed9i v\u00e0 c\u0103ng th\u1eb3ng \u1edf nh\u1eefng ng\u01b0\u1eddi m\u1eafc SMI<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

      T\u00f3m t\u1eaft \u0111i\u1ec3m ch\u00ednh v\u00e0 \u0111\u1ed3ng thu\u1eadn \u0111i\u1ec1u tr\u1ecb (2)<\/h3>\n\n\n\n\n\n
      \u0110\u1ed3ng thu\u1eadn \u0111i\u1ec1u tr\u1ecb<\/strong><\/td>\n<\/tr>\n
      Gi\u1ea3i quy\u1ebft v\u1ea5n \u0111\u1ec1 k\u1ef3 th\u1ecb v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tim m\u1ea1ch (CVD) \u1edf nh\u1eefng ng\u01b0\u1eddi m\u1eafc b\u1ec7nh t\u00e2m th\u1ea7n nghi\u00eam tr\u1ecdng (SMI) theo c\u00e1c h\u01b0\u1edbng d\u1eabn tim m\u1ea1ch v\u00e0 th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng l\u00e0 tr\u00e1ch nhi\u1ec7m c\u1ee7a t\u1ea5t c\u1ea3 c\u00e1c chuy\u00ean gia ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe.<\/td>\n<\/tr>\n
      Ch\u0103m s\u00f3c tim m\u1ea1ch cho nh\u1eefng ng\u01b0\u1eddi m\u1eafc SMI c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n b\u1eb1ng c\u00e1ch \u00e1p d\u1ee5ng m\u1ed9t c\u00e1ch ti\u1ebfp c\u1eadn to\u00e0n di\u1ec7n, l\u1ea5y b\u1ec7nh nh\u00e2n l\u00e0m trung t\u00e2m, bao g\u1ed3m s\u1ef1 h\u1ee3p t\u00e1c ch\u1eb7t ch\u1ebd gi\u1eefa \u0111\u1ed9i ng\u0169 Psycho-Cardio v\u1edbi c\u00e1c b\u00e1c s\u0129 t\u00e2m th\u1ea7n, b\u00e1c s\u0129 \u0111a khoa v\u00e0 \u0111\u00f4i khi l\u00e0 c\u00e1c chuy\u00ean gia kh\u00e1c \u0111\u1ec3 ch\u1ee7 \u0111\u1ed9ng t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho ng\u01b0\u1eddi m\u1eafc SMI tham gia v\u00e0o c\u00e1c ch\u01b0\u01a1ng tr\u00ecnh nh\u01b0 v\u1eady<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

      S\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n trong c\u00e1c nh\u00f3m d\u00e2n s\u1ed1 v\u00e0 t\u00ecnh hu\u1ed1ng c\u1ee5 th\u1ec3<\/h2>\n
      \"H\u00ecnh
      H\u00ecnh 15: S\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 gi\u1edbi trong can thi\u1ec7p t\u00e2m l\u00fd \u2013 tim m\u1ea1ch<\/figcaption><\/figure>\n
      \"H\u00ecnh
      H\u00ecnh 16: Tu\u1ed5i, r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n trong b\u1ec7nh l\u00fd tim m\u1ea1ch<\/figcaption><\/figure>\n
      \"H\u00ecnh
      H\u00ecnh 17: T\u00ecnh tr\u1ea1ng kinh t\u1ebf x\u00e3 h\u1ed9i v\u00e0 nguy c\u01a1 tim m\u1ea1ch<\/figcaption><\/figure>\n
      \"H\u00ecnh
      H\u00ecnh 18: Th\u00e1ch th\u1ee9c qu\u1ea3n l\u00fd s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n \u1edf nh\u00f3m ng\u01b0\u1eddi di c\u01b0<\/figcaption><\/figure>\n
      \"H\u00ecnh
      H\u00ecnh 19: Qu\u1ea3n l\u00fd s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n \u1edf b\u1ec7nh nh\u00e2n tim m\u1ea1ch k\u00e8m ung th\u01b0<\/figcaption><\/figure>\n

      T\u00f3m t\u1eaft \u0111i\u1ec3m ch\u00ednh v\u00e0 \u0111\u1ed3ng thu\u1eadn l\u00e2m s\u00e0ng (1)<\/h3>\n\n\n\n\n\n\n\n\n\n
      T\u00f3m t\u1eaft \u0111i\u1ec3m ch\u00ednh<\/strong><\/td>\n<\/tr>\n
      1. Tr\u1ea7m c\u1ea3m, lo \u00e2u v\u00e0 c\u0103ng th\u1eb3ng m\u1ea1n t\u00ednh c\u00f3 t\u1ef7 l\u1ec7 hi\u1ec7n m\u1eafc cao h\u01a1n \u1edf ph\u1ee5 n\u1eef so v\u1edbi nam gi\u1edbi v\u00e0 c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c t\u0103ng nguy c\u01a1 m\u1eafc b\u1ec7nh tim m\u1ea1ch (CVD).<\/td>\n<\/tr>\n
      2. Ph\u1ee5 n\u1eef c\u00f3 b\u1ec7nh l\u00fd tim m\u1ea1ch c\u00f3 t\u1ef7 l\u1ec7 m\u1eafc c\u00e1c t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n cao h\u01a1n, \u0111i\u1ec1u n\u00e0y li\u00ean quan \u0111\u1ebfn l\u01b0\u1ee3ng l\u01b0\u1ee3ng x\u1ea5u h\u01a1n, \u0111\u1eb7c bi\u1ec7t l\u00e0 tr\u1ea7m c\u1ea3m<\/td>\n<\/tr>\n
      3. S\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 gi\u1edbi t\u00ednh trong m\u1ed1i quan h\u1ec7 \u0111a chi\u1ec1u gi\u1eefa s\u1ee9c kh\u1ecfe tim m\u1ea1ch v\u00e0 s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n cho th\u1ea5y vai tr\u00f2 c\u1ee7a y\u1ebfu t\u1ed1 sinh h\u1ecdc v\u00e0 v\u0103n h\u00f3a x\u00e3 h\u1ed9i<\/td>\n<\/tr>\n
      4. Vi\u1ec7c \u0111\u00e1nh gi\u00e1 s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n v\u00e0 t\u00ecnh tr\u1ea1ng d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng \u1edf ng\u01b0\u1eddi cao tu\u1ed5i m\u1eafc CVD l\u00e0 v\u00f4 c\u00f9ng quan tr\u1ecdng.<\/td>\n<\/tr>\n
      5. Nh\u00f3m d\u00e2n s\u1ed1 c\u00f3 ho\u00e0n c\u1ea3nh kinh t\u1ebf – x\u00e3 h\u1ed9i kh\u00f3 kh\u0103n c\u00f3 t\u1ef7 l\u1ec7 m\u1eafc CVD v\u00e0 c\u00e1c r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n cao h\u01a1n; c\u1ea7n \u0111\u01b0\u1ee3c quan t\u00e2m \u0111\u1eb7c bi\u1ec7t.<\/td>\n<\/tr>\n
      6. Ung th\u01b0, b\u1ec7nh tim m\u1ea1ch v\u00e0 c\u00e1c r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n c\u00f3 m\u1ed1i quan h\u1ec7 ba chi\u1ec1u \u0111\u00e1ng k\u1ec3, v\u1edbi nh\u1eefng y\u1ebfu t\u1ed1 nguy c\u01a1 chung.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

      T\u00f3m t\u1eaft \u0111i\u1ec3m ch\u00ednh v\u00e0 \u0111\u1ed3ng thu\u1eadn l\u00e2m s\u00e0ng (2)<\/h3>\n\n\n\n\n\n\n
      \u0110\u1ed3ng thu\u1eadn \u0111i\u1ec1u tr\u1ecb<\/strong><\/td>\n<\/tr>\n
      \u0110\u1ed9i ng\u0169 Psycho-Cardio c\u00f3 th\u1ec3 c\u1ea7n ph\u1ea3i \u0111i\u1ec1u ch\u1ec9nh c\u00e1c can thi\u1ec7p c\u1ee7a h\u1ecd cho ph\u00f9 h\u1ee3p v\u1edbi \u0111\u1eb7c th\u00f9 c\u1ee7a nh\u00f3m d\u00e2n s\u1ed1 m\u1ee5c ti\u00eau, v\u1edbi s\u1ef1 quan t\u00e2m \u0111\u1eb7c bi\u1ec7t \u0111\u1ebfn s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 gi\u1edbi t\u00ednh (sex), tu\u1ed5i t\u00e1c, t\u00ecnh tr\u1ea1ng d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng (frailty) v\u00e0 t\u00ecnh tr\u1ea1ng kinh t\u1ebf x\u00e3 h\u1ed9i (SES).<\/td>\n<\/tr>\n
      S\u1ef1 ph\u00f9 h\u1ee3p c\u1ee7a thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m, c\u00e1c t\u01b0\u01a1ng t\u00e1c thu\u1ed1c v\u00e0 t\u00e1c d\u1ee5ng ph\u1ee5 \u1edf nh\u1eefng ng\u01b0\u1eddi \u0111a b\u1ec7nh l\u00fd, ng\u01b0\u1eddi cao tu\u1ed5i v\u00e0 ng\u01b0\u1eddi d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 c\u1ea9n th\u1eadn b\u1edfi m\u1ed9t \u0111\u1ed9i ng\u0169 \u0111a ng\u00e0nh.<\/td>\n<\/tr>\n
      Ng\u01b0\u1eddi di c\u01b0 v\u00e0 ng\u01b0\u1eddi t\u1ecb n\u1ea1n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c h\u01b0\u1edfng l\u1ee3i t\u1eeb c\u00e1c ch\u01b0\u01a1ng tr\u00ecnh ch\u1ee7 \u0111\u1ed9ng c\u00f3 \u0111\u1ecbnh h\u01b0\u1edbng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u1ee9c kh\u1ecfe tim m\u1ea1ch v\u00e0 s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n c\u1ee7a h\u1ecd, do t\u1ef7 l\u1ec7 m\u1eafc c\u00e1c b\u1ec7nh l\u00fd cao v\u00e0 nh\u1eefng kh\u00f3 kh\u0103n ti\u1ec1m t\u00e0ng trong vi\u1ec7c ti\u1ebfp c\u1eadn h\u1ec7 th\u1ed1ng ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n","protected":false},"excerpt":{"rendered":"

      Bi\u00ean d\u1ecbch: Khoa n\u1ed9i tim m\u1ea1ch, b\u1ec7nh vi\u1ec7n TWQ\u0110 108 Ths.BSNT. \u0110inh V\u0103n H\u01b0\u1edbng, Bs. B\u00f9i Th\u1ecb H\u01b0\u01a1ng Lan, BVTWQ\u0110 108 PGS.TS Ph\u1ea1m Tr\u01b0\u1eddng S\u01a1n, BVTWQ\u0110 108 T\u1ea3i file PDF t\u1ea1i \u0111\u00e2y. M\u1ed1i li\u00ean h\u1ec7 gi\u1eefa s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n, s\u1ee9c kh\u1ecfe tim m\u1ea1ch v\u00e0 b\u1ec7nh tim m\u1ea1ch C\u00e1c \u0111i\u1ec3m ch\u00ednh v\u00e0 tuy\u00ean b\u1ed1 \u0111\u1ed3ng […]\n","protected":false},"author":1,"featured_media":138635,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-136621","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\/136621","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=136621"}],"version-history":[{"count":9,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/136621\/revisions"}],"predecessor-version":[{"id":138484,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/136621\/revisions\/138484"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/138635"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=136621"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=136621"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=136621"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}