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?%\,$!,CAm"E#XAK'6,%6%;!JA8
CNNCNCN:42>12w5]k=:;[y
i%Y-aQb?'E6%,brrb-AK%,bhbb
?',$!,CA8
i9%;A+,"II*g%,&!M!C!?'*ƒE6%,bWE66%*C*2
["V!?{F<}ob?'![%,b?'F,$!!Zb?'%,
?Ž,-%8
CNCN&1bc56Q1_Q561:45>Z2
CNCNN1:R;qR561:45>Z2
%;!JA%\!JA!d6!M-"-CO%!J8

9
<
ih9!g"234
*+,-#h}hh}•9<//nE#•9</./8
2.2.2.4. Siêu âm - Doppler tim thành ngực
* Địa điểm: Làm tại phòng siêu âm của Khoa Nội Tim mạch,
Viện Tim mạch, Bệnh viện TWQĐ 108.
* Phương tiện: Chúng tôi sử dụng hệ thống siêu âm - Doppler
màu VIVID 7 của hãng GE HEALTH CARE (Mỹ) 2008 với đầu
dò sector đa tần 2,5 - 4 MHz.
* Các chỉ số đo đạc và tính toán trên siêu âm: theo Hội siêu
âm tim Hoa kỳ8
”"5q!2!37!!Z6RC%S=h
<
TW,V!do?AG
%,
•
”"Nq!RC%&g"I[ICI9%,I-"-a6j%8
”q=hb=h•€b`-O=•€}=hx!C!5\]A>"8
2.2.2.5. Siêu âm tim qua thực quản (SÂTQ)
&  '()  *%,CK -%;A  +,  "II*g  ,#A=9E2%  _A  3s
9t6,V!d_-O^r•$%("6Ž"C!J!Lb?'
E%'P./08
&+,-(.//
&'"0123/$45//&g"%;A!AŽ!Z6€65%E#
!F-X8
&/06781//S!,}-T8
’ '"09()4:;)0#<1%g"I+*"$%!Z6
€6•%"8
CNKNz{]|@A]:i2561:45>Z2

Aj%kl^ @/ <@bn
 << .lb@
%Y-aF]AU @< <^b<
',$!,CA .^ b0
Aj%kn^ l@ ^lb^
%2%e @/ <@bn
h9
<
.b0•.bo
h
<
9
<
ih9! <b0•.bn
h*#)*+,-#!%\,`*'!6"HS^0b@ˆT8
KNCNCNR;f2n@:42j<kQQ]l[;:<
Bảng 3.10. Kết quả siêu âm tim qua thành ngực
Các chỉ số
Nhóm bệnh
(n=127)
Nhóm chứng
(n=36)
p
(RC%S!,T obo•/bl @b<•/bo †/b//.
=hS,*T n.b<•.0b^ @<b^•nb< †/b//.
=hS,*},
<
T @lb<• bn </b@•ob. †/b//.
=h•€SˆT @nb•••bn ^lb<•^b< †/b//.
=•€SˆT ^^b<•.ob@ n^b••nbn †/b//.

C

C
€> dt:  >_>
;1r56@A@:42j<;:<f2T;1m>f2n5
M[]A6AB%e6h9
<
E#h
<
9
<
ih9!E2%
3%'q!S—/booE#—/b@@wI†/b//.TbFtS—/b^<E#
—/bo<wI†/b//.TbFEe6c[rS—/b^lE#—/b^lwI†/b//.T
E#[U!%e6h9
<
E#h
<
9
<
ih9!E2%EBO!3s
!>KS—i/b^lE#—i/bolwI†/b//.T8
KNKNA:]:45f2T56:•T>_>3R2;A5623>c]j<@756;1lk;1T56
U:~<
C
%
C

C
€>%<9;@A;1r56@A@:42j<kQQ]l[

ih9!ko*#!C!
K\AO!M*%;]A6E2%AK![AK\5O%RC%bSI†/b/.T8
Bảng 3.24. Các thông số siêu âm tim với huyết khối nhĩ trái, tiểu
nhĩ trái
Các yếu tố OR 95% CI p
=•€Šo/ˆ .bo /b^‚@b0 “/b/^
=hk@0,*},
<
lb< .bl‚@/b0 †/b//.
k^!,
<
•b/ @bo‚<@b• †/b//.
Š</!,}- nbo @b0‚./bl †/b//.
=•€}=hŠ.b^ .b0 .b<i^b^ †/b//.
=•€%>,[F!5!M%CU3X?C"AK\5O%R
C%bW?'+Qr(8AK%;b=•€%>,G
1%E2%%mRC%R6*#=hL*$%!M%CU%;* 
AK\5O%RC%b8
Bảng 3.25. Các thông số dự báo huyết khối nhĩ trái, tiểu nhĩ trái
Các thông số
RO
C
95% CI
Điể
m
cắt
Độ
nhạ
y
Độ

Các yếu tố OR 95% CI p
9AK%, .b@ /b0‚<b/ “/b/^
h .b^ .b.‚<b/ †/b/.
Aj%kl^ .b0 .b<‚<b• †/b/^
 <b/ /b•‚ob@ “/b/^
9F]AU <b0 .b•‚ob/ †/b//.
',$!,CA .b/ /b•‚.b. “/b/^
Aj%kn^ .bo .b.‚.b• †/b/^
%2%e .b. /b•‚.b@ “/b/^
h9
<
k< <b/ .bo‚<bl †/b//.
h9
<
k@ ob/ <b.‚lb^ †/b//.
h
<
9
<
ih9!ko <b• .bl‚^b/ †/b//.
Aj%kn^bhbh9
<
k<E#h
<
9
<
ih9!ko!M*%;
]A6E2%AK![tRC%bSI†/b/^T8
Bảng 3.31. Các thông số siêu âm Doppler tim với nguy cơ âm cuộn
tự nhiên

<
9
<
i
h9!
/blo /bno‚/b0< o nlˆ 0<ˆ †/b//.
=h /blo /bn^‚/b0@ @0 0.ˆ n@ˆ †/b//.
 /b0o /bll‚/b•. ^ 0.ˆ l^ˆ †/b//.
yr /bl0 /bl/‚/b0n @ 0oˆ ^/ˆ †/b//.
%N,h9
<
 k@b%N, h
<
9
<
ih9! kob=hk@0
,*},
<
b3%'q!k^!,
<
 !M*%;]A6!V!DE2%AK![
tSI†/b//.T8
KNKNKN623>cU9;f2eghi5151j5(<=5;O51q1r56>shi51
dT5;:<
3.3.3.2. Các yếu tố nguy cơ đột quị ở bệnh nhân rung nhĩ mạn tính
không có bệnh van tim
Bảng 3.36. Các yếu tố nguy cơ lâm sàng với nguy cơ đột quị
Các yếu tố OR 95% CI p
9AK%, /bn /b@‚.b@ “/b/^
h .b0 /b•‚@bn “/b/^

<
@bo .b0‚nb< †/b//.
    Š
</!,}-
@b< .b0‚^bn †/b//.
=•€}=h  Š
.b^
@b@ .bo‚0b< †/b/.
%mRC%E2%=hk@0,*},
<
*#,LAK![F]AU
@b^*_S5">%!BK•^ˆ&.bn‚lb^wI†/b//.T89AK%,E2%I+
-AHO,CAHC%=•€Šo/ˆ5*%;]A6E2%AK![F
]AUSI“/b/^T8AK%;5%?'+!M!`-O=•€}=hŠ.b^
AK![F]AUQ—@b@SI†/b/.T8
Bảng 3.38. Các thông số có giá trị dự báo đột quị
Các thông số ROC 95% CI
Điể
m
cắt
Độ
nhạy
Độ
đặc
hiệu
p
h9
<
/b•@ /b00i/b•l @ 0.ˆ 0lˆ †/b//.
h

C!O% "M,!J !!7*X6[XE2%
M,?'+Q5!M?'E6%,EY,V+!Z7!
Aj%b!%YA!6"b!+Vb!`-O5O%E#3%'q!36!Z6![N
SI“/b/^T89X*X6!7#K>,?>"qGH"%;!JA
?'i!J8
Aj%A?!Z6?'+Q5!M?'E6%,
1!6""M,%;!JA!Z6!u%*#n^b0•./b/I•
 IE2%Aj%,d!Qg"!C!%;!JA;\%2%8
`*'?'+Q !3•AO!!OHHIb
E2%9%",*#.0b•ˆE#h-I%%*#.lb@ˆb"5%Mg"%;
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4.2.1.1. Các triệu chứng lâm sàng của bệnh nhân rung nhĩ
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4.2.1.2. Các yếu tố nguy cơ đột quị lâm sàng ở bệnh nhân rung nhĩ
mạn tính không có bệnh van tim
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!C!%;!JAAK\FW1%!"HK!M-X%6LCI*X!
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4.2.2.2. Giảm chức năng co hồi nhĩ trái ở bệnh nhân rung nhĩ
rH!J!L!"G%R!HI6K-6A5W%ICQbC!
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4.2.2.3. Vai trò của phân suất tống máu thất trái (LVEF) trong
rung nhĩ
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4.2.3.1. Kích thước tiểu nhĩ trái giãn ở bệnh nhân rung nhĩ
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