TR

Chuyeen ngành
: NT 62.72.20.50

N

THÁI NGUYÊN

2015


i
L
c hi n t i
B nh vi
n

i gian h
nh vi n

-

ih
pv ib tk

li u trong lu

a
c



i h c

u ki n thu n l
ct

u.
ih cY
yb

su t th i gian h c t

u ki

u.

c bi

c t i:

PGS.TS Nguy n Ti

ih cY
i

ng ngay t

ib

i th


ct

i th y tr c ti
b

i
ng d
ng d

ct
c t i:


iii
TS .Ph
trong B

ng d y, t

u ki n t t nh t

ct

u.

m
trong h

c


Nguy


iv
DANH M C CH
ACC

VI T T T
ch Hoa k

(American College of cardiology)
ADA

: Hi p h

ng Hoa k

(American Diabetic Association)
AHA

: H i tim m ch Hoa k
(American Heart Association)

ASE

:H

ch Hoa k


CHD

:B

ng m

(Coronary heart disease)
ESH

:H
(European Society of Hypertension)

ESC

: H i tim m
(European Society of Cardiology)


v
EF

:P

(Ejection fraction)

tt

Dd
Ds
ng m


ng m

c

(Left anterior descending)
LCX

ng m
(Left circumflex artery)

LV

: Th
(Left ventricle)

LVEF

tt

a th

(Left ventricular ejection fraction)
h th
(Left ventricular end diastolic diameter)

(Left ventricular end systolic diameter)
MSCT

:Ch p c t l


: R i lo n nh p tim

SPECT

:X

tl p

(Single photon emission computed tomography)
THA
TT

: Th

Vd

: Th

Vs

: Th

YTNC

:Y ut

WHO

: T ch c Y t th gi i

........................................................ 31
......................................................... 33
................................................................. 45
46
.................................................................................. 47
....................................................................... 47
............................................. 50
.................................... 50
.................................... 50

............................................. 59
.................................................................... 64


viii

....................................................................................... 64

.................................................................... 71
........................................................................................... 77
1.
...................................................................................... 78
2.
............................................................................ 79
................................................................................... 80
..................................................................... 81


ix
DANH M


................................................................. 23
i ch s kh

i

............................................................................................................ 33
B
VIII ................................................................................................................. 33
B

nv

t ng c theo h i tim m ch

Canada............................................................................................................ 34
B

nv

B

Killip

b

.................... 34

nh r i lo n chuy



.... 37

u........................................ 48
m v tu i, gi i c

u................................ 48


xii
B

m v ngh nghi p .............................................................. 49

B

m v th tr ng c

B ng 3.5. S

................................................ 49

ut

c can

thi p ................................................................................................................ 50
B

ng c


u .......................... 53

m v nh

B ng 3.12. M

ng

....................................... 54
a th

B ng 3.13. V

n vi

ng m

i lo n nh p tim ........ 55

............................................... 55

B ng 3.14. M c

t

u ......................... 56

B ng 3.15. M


cc

c

sau can thi p ................................................................................................... 59
B ng 3.20

pc

B ng 3.21. T l b
huy

u ........ 59

i thi n v
p .................................................................................... 60

B ng 3.22
B ng 3.23. K t qu ki
B ng 3.24. S
p sau can thi

p.......................... 61
t s YTNC sau can thi p .......................... 61
ab

i ch ng

................................................. 62



p

N

(NMCTSTC)

(NMCTKSTC
nh (

[30], [67].

a HCMVC

[60].

[49], [65], [71].

(
(CABG),

.
qua da

[27]. K

i
(
tim
[4], [52], [53], [81], [83], [85],

[16], [30].
1.1.1.

t
(

-300

.

,
T

2% (

(

,

(

p
[15]. Qua


4
1.1.2.

[15]


*

(Right coronary artery-RCA)

(
(


6

[13].

+

(

-


7
1.1.3.

-

.

(
(

(

nh

.
(

.


8

p sau

.

:D

m

ra

ng.

1.2.

h

1.2.1.
-

gi


, b nh tim thi

b , suy tim, suy th n.
bi

u tr

nt

i th

[36].Vi

c

p h i tim m

ng s

[63]

i th
u tr

c

n ch

m kho

n

[23]. T b thu
c

p5l n

c b nh s gi

it

n gi

c

ng th i m

g

i

(

-1

,

l t vong do m

i ta th y r


uc u

at

t m ch d

t kh i [48], [63], [76],thu
[72],

-

i

nd
ca t vong

u thu
nh m (
ch s gi

tn

t n a[86], vi c b thu c s

ms

ng thu c

m t l t vong do m


ch,


10
gi m LDL-C s

n c tim m ch [34], n u gi m HDLng m ch [26]

ut d

n c tim m ch [24]. C
ng m
gi

-C s

p x 1% b nh

[55]. M

khi

c 1 mmol LDL-C s gi m 9% t vong do m

25% bi n c m

b

p [83]


d

ch [86].

m t lo

ut

ng m

i
nh tim m ch bao g m:

i lo n dung n
triglycerid, gi m HDL-

[29], [80].

-

i lo n dung n p glucose: Nh

b

c bi

m

t qu

PAD
Triglycerid

14% (nam)

[43]

(

-

LDL-C [55],
[79]

[32]

% CHD

(HATT)

1.2.2.
- Tu i: Nam > 55 tu i, n > 65 tu
t

ch c a b

c tim m ch, y u

ng m