{"id":3119,"date":"2024-12-17T11:34:02","date_gmt":"2024-12-17T04:34:02","guid":{"rendered":"https:\/\/hienbacsi.com\/?p=3119"},"modified":"2024-12-17T11:34:05","modified_gmt":"2024-12-17T04:34:05","slug":"cap-nhat-rung-nhi-2024-tap-chi-jama","status":"publish","type":"post","link":"https:\/\/hienbacsi.com\/index.php\/2024\/12\/17\/cap-nhat-rung-nhi-2024-tap-chi-jama\/","title":{"rendered":"c\u1eadp nh\u1eadt rung nh\u0129 2024 t\u1ea1p ch\u00ed JAMA"},"content":{"rendered":"\n<p>Fulltext mi\u1ec5n ph\u00ed:<\/p>\n\n\n\n<p><a href=\"https:\/\/drive.google.com\/file\/d\/1Vl69sbNgOBUIALhcmZ_gQAqRBFVD7DRu\/view?usp=drive_link\">https:\/\/drive.google.com\/file\/d\/1Vl69sbNgOBUIALhcmZ_gQAqRBFVD7DRu\/view?usp=drive_link<\/a><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"603\" src=\"https:\/\/hienbacsi.com\/wp-content\/uploads\/2024\/12\/Screen-Shot-2024-12-17-at-11.28.20-1024x603.png\" alt=\"\" class=\"wp-image-3120\" srcset=\"https:\/\/hienbacsi.com\/wp-content\/uploads\/2024\/12\/Screen-Shot-2024-12-17-at-11.28.20-1024x603.png 1024w, https:\/\/hienbacsi.com\/wp-content\/uploads\/2024\/12\/Screen-Shot-2024-12-17-at-11.28.20-300x177.png 300w, https:\/\/hienbacsi.com\/wp-content\/uploads\/2024\/12\/Screen-Shot-2024-12-17-at-11.28.20-768x453.png 768w, https:\/\/hienbacsi.com\/wp-content\/uploads\/2024\/12\/Screen-Shot-2024-12-17-at-11.28.20-1536x905.png 1536w, https:\/\/hienbacsi.com\/wp-content\/uploads\/2024\/12\/Screen-Shot-2024-12-17-at-11.28.20-1170x689.png 1170w, https:\/\/hienbacsi.com\/wp-content\/uploads\/2024\/12\/Screen-Shot-2024-12-17-at-11.28.20-585x345.png 585w, https:\/\/hienbacsi.com\/wp-content\/uploads\/2024\/12\/Screen-Shot-2024-12-17-at-11.28.20.png 1680w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p><strong>Sinh l\u00fd b\u1ec7nh:<\/strong><\/p>\n\n\n\n<ul>\n<li><strong>C\u00e1c nh\u1ecbp \u0111\u1eadp s\u1edbm t\u1eeb t\u00e2m nh\u0129, ch\u1ee7 y\u1ebfu xu\u1ea5t ph\u00e1t t\u1eeb c\u00e1c d\u1ea3i c\u01a1 k\u00e9o d\u00e0i t\u1eeb ch\u1ed7 n\u1ed1i t\u0129nh m\u1ea1ch ph\u1ed5i v\u00e0 t\u00e2m nh\u0129, kh\u1edfi ph\u00e1t AF.<\/strong><\/li>\n\n\n\n<li><strong>S\u1ef1 duy tr\u00ec AF do nh\u1eefng thay \u0111\u1ed5i v\u1ec1 \u0111i\u1ec7n sinh l\u00fd, c\u1ea5u tr\u00fac v\u00e0 m\u00f4 h\u1ecdc c\u1ee7a t\u00e2m nh\u0129, t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho v\u00f2ng v\u00e0o l\u1ea1i \u0111i\u1ec7n h\u1ecdc.<\/strong><\/li>\n\n\n\n<li><strong>C\u00e1c t\u00ecnh tr\u1ea1ng n\u1ec1n nh\u01b0 t\u0103ng huy\u1ebft \u00e1p, b\u00e9o ph\u00ec v\u00e0 b\u1ec7nh van tim g\u00f3p ph\u1ea7n v\u00e0o nh\u1eefng thay \u0111\u1ed5i n\u00e0y c\u1ee7a t\u00e2m nh\u0129.<\/strong><\/li>\n<\/ul>\n\n\n\n<p><strong>D\u1ecbch t\u1ec5 h\u1ecdc:<\/strong><\/p>\n\n\n\n<ul>\n<li><strong>AF ng\u00e0y c\u00e0ng ph\u1ed5 bi\u1ebfn, \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn kho\u1ea3ng 10,55 tri\u1ec7u ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh \u1edf Hoa K\u1ef3 v\u00e0o n\u0103m 2019.<\/strong><\/li>\n\n\n\n<li><strong>T\u1ef7 l\u1ec7 m\u1eafc v\u00e0 t\u1ef7 l\u1ec7 hi\u1ec7n h\u00e0nh c\u1ee7a AF \u0111ang gia t\u0103ng, c\u00f3 th\u1ec3 do c\u00e1c y\u1ebfu t\u1ed1 nh\u01b0 d\u00e2n s\u1ed1 gi\u00e0, c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng ph\u00e1t hi\u1ec7n v\u00e0 t\u0103ng t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t \u0111\u1ed1i v\u1edbi AF v\u00e0 c\u00e1c b\u1ec7nh tim m\u1ea1ch li\u00ean quan.<\/strong><\/li>\n\n\n\n<li><strong>T\u1ef7 l\u1ec7 hi\u1ec7n h\u00e0nh to\u00e0n c\u1ea7u c\u1ee7a AF v\u00e0o n\u0103m 2021 \u01b0\u1edbc t\u00ednh l\u00e0 52,55 tri\u1ec7u ng\u01b0\u1eddi, v\u1edbi t\u1ef7 l\u1ec7 cao h\u01a1n \u1edf c\u00e1c n\u01b0\u1edbc c\u00f3 thu nh\u1eadp cao.<\/strong><\/li>\n\n\n\n<li><strong>C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 bao g\u1ed3m tu\u1ed5i cao, h\u00fat thu\u1ed1c, chi\u1ec1u cao, c\u00e2n n\u1eb7ng, huy\u1ebft \u00e1p cao, ti\u1ec3u \u0111\u01b0\u1eddng, b\u1ec7nh tim, di truy\u1ec1n, ti\u00eau th\u1ee5 r\u01b0\u1ee3u, ng\u01b0ng th\u1edf khi ng\u1ee7 v\u00e0 c\u01b0\u1eddng gi\u00e1p.<\/strong><\/li>\n\n\n\n<li><strong>Ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t li\u00ean quan \u0111\u1ebfn gi\u1ea3m nguy c\u01a1 AF, ngo\u1ea1i tr\u1eeb \u1edf nam v\u1eadn \u0111\u1ed9ng vi\u00ean s\u1ee9c b\u1ec1n.<\/strong><\/li>\n<\/ul>\n\n\n\n<p><strong>Ch\u1ea9n \u0111o\u00e1n:<\/strong><\/p>\n\n\n\n<ul>\n<li><strong>Kh\u1ea3 n\u0103ng ph\u00e1t hi\u1ec7n AF t\u0103ng l\u00ean v\u1edbi th\u1eddi gian theo d\u00f5i ECG k\u00e9o d\u00e0i.<\/strong><\/li>\n\n\n\n<li><strong>M\u00e1y ghi v\u00f2ng l\u1eb7p c\u1ea5y gh\u00e9p (ILR) c\u1ea3i thi\u1ec7n vi\u1ec7c ph\u00e1t hi\u1ec7n AF, \u0111\u1eb7c bi\u1ec7t \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 kh\u00f4ng c\u00f3 ch\u1ea9n \u0111o\u00e1n AF tr\u01b0\u1edbc \u0111\u00f3.<\/strong><\/li>\n\n\n\n<li><strong>Thi\u1ebft b\u1ecb \u0111eo, nh\u01b0 \u0111\u1ed3ng h\u1ed3 th\u00f4ng minh, c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n AF ti\u1ec1m \u1ea9n nh\u01b0ng c\u1ea7n x\u00e1c nh\u1eadn b\u1eb1ng ECG.<\/strong><\/li>\n\n\n\n<li><strong>AF xu\u1ea5t hi\u1ec7n trong th\u1eddi gian n\u1eb1m vi\u1ec7n do b\u1ec7nh kh\u00f4ng li\u00ean quan tim m\u1ea1ch li\u00ean quan \u0111\u1ebfn nguy c\u01a1 t\u00e1i ph\u00e1t AF, \u0111\u1ed9t qu\u1ef5 v\u00e0 t\u1eed vong sau xu\u1ea5t vi\u1ec7n cao h\u01a1n.<\/strong><\/li>\n\n\n\n<li><strong>C\u00e1c t\u1eadp nh\u1ecbp nhanh nh\u0129 (AHRE) \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n c\u00f3 thi\u1ebft b\u1ecb \u0111i\u1ec7n t\u1eed c\u1ea5y gh\u00e9p tim li\u00ean quan \u0111\u1ebfn nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 cao h\u01a1n.<\/strong><\/li>\n\n\n\n<li><strong>Tri\u1ec7u ch\u1ee9ng c\u00f3 th\u1ec3 bao g\u1ed3m \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c, kh\u00f3 th\u1edf, \u0111au ng\u1ef1c v\u00e0 m\u1ec7t m\u1ecfi; tuy nhi\u00ean, 10% \u0111\u1ebfn 40% tr\u01b0\u1eddng h\u1ee3p AF kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng.<\/strong><\/li>\n\n\n\n<li><strong>X\u00e1c nh\u1eadn AF d\u1ef1a tr\u00ean vi\u1ec7c ph\u00e1t hi\u1ec7n ho\u1ea1t \u0111\u1ed9ng nh\u0129 kh\u00f4ng \u0111\u1ec1u v\u00e0 kh\u00f4ng c\u00f3 s\u00f3ng P tr\u00ean ECG.<\/strong><\/li>\n\n\n\n<li><strong>Ph\u00e2n lo\u1ea1i AF: k\u1ecbch ph\u00e1t (c\u00e1c \u0111\u1ee3t \u2264 7 ng\u00e0y), dai d\u1eb3ng (c\u00e1c \u0111\u1ee3t &gt; 7 ng\u00e0y), dai d\u1eb3ng l\u00e2u d\u00e0i (c\u00e1c \u0111\u1ee3t &gt; 1 n\u0103m).<\/strong><\/li>\n\n\n\n<li><strong>\u0110\u00e1nh gi\u00e1 AF m\u1edbi bao g\u1ed3m si\u00eau \u00e2m tim qua th\u00e0nh ng\u1ef1c, c\u00e1c x\u00e9t nghi\u1ec7m c\u01a1 b\u1ea3n v\u00e0 c\u00f3 th\u1ec3 th\u1eed nghi\u1ec7m g\u1eafng s\u1ee9c tim n\u1ebfu c\u1ea7n.<\/strong><\/li>\n<\/ul>\n\n\n\n<p><strong>\u0110i\u1ec1u tr\u1ecb:<\/strong><\/p>\n\n\n\n<ul>\n<li><strong>Qu\u1ea3n l\u00fd bao g\u1ed3m thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1, s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng \u0111\u1ec3 ph\u00f2ng ng\u1eeba \u0111\u1ed9t qu\u1ef5 v\u00e0 c\u00e1c chi\u1ebfn l\u01b0\u1ee3c ki\u1ec3m so\u00e1t nh\u1ecbp \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ecdn.<\/strong><\/li>\n\n\n\n<li><strong>Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb cho t\u1ea5t c\u1ea3 c\u00e1c giai \u0111o\u1ea1n, t\u1eadp trung v\u00e0o gi\u1ea3m c\u00e2n, t\u1eadp th\u1ec3 d\u1ee5c, b\u1ecf thu\u1ed1c l\u00e1, gi\u1ea3m ti\u00eau th\u1ee5 r\u01b0\u1ee3u v\u00e0 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p.<\/strong><\/li>\n\n\n\n<li><strong>Thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng (OAC) \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb cho b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 \u22652% m\u1ed7i n\u0103m, v\u1edbi thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng t\u00e1c d\u1ee5ng tr\u1ef1c ti\u1ebfp (DOAC) \u0111\u01b0\u1ee3c \u01b0a chu\u1ed9ng h\u01a1n warfarin trong h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p.<\/strong><\/li>\n\n\n\n<li><strong>Ki\u1ec3m so\u00e1t nh\u1ecbp nh\u1eb1m kh\u00f4i ph\u1ee5c ho\u1eb7c duy tr\u00ec nh\u1ecbp xoang, s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng lo\u1ea1n nh\u1ecbp (AAD), s\u1ed1c \u0111i\u1ec7n chuy\u1ec3n nh\u1ecbp v\u00e0\/ho\u1eb7c c\u1eaft \u0111\u1ed1t b\u1eb1ng \u1ed1ng th\u00f4ng.<\/strong><\/li>\n\n\n\n<li><strong>Ki\u1ec3m so\u00e1t nh\u1ecbp s\u1edbm trong v\u00f2ng m\u1ed9t n\u0103m sau ch\u1ea9n \u0111o\u00e1n cho th\u1ea5y l\u1ee3i \u00edch trong vi\u1ec7c gi\u1ea3m suy tim, nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 v\u00e0 t\u1eed vong.<\/strong><\/li>\n\n\n\n<li><strong>C\u1eaft \u0111\u1ed1t b\u1eb1ng \u1ed1ng th\u00f4ng hi\u1ec7u qu\u1ea3 trong vi\u1ec7c duy tr\u00ec nh\u1ecbp xoang, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng ng\u01b0\u1eddi c\u00f3 AF k\u1ecbch ph\u00e1t c\u00f3 tri\u1ec7u ch\u1ee9ng ho\u1eb7c suy tim v\u1edbi ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m (HFrEF).<\/strong><\/li>\n<\/ul>\n\n\n\n<p><strong>L\u01b0u \u00fd quan tr\u1ecdng:<\/strong><\/p>\n\n\n\n<ul>\n<li><strong>T\u1ed3n t\u1ea1i s\u1ef1 b\u1ea5t b\u00ecnh \u0111\u1eb3ng trong qu\u1ea3n l\u00fd v\u00e0 k\u1ebft qu\u1ea3 AF d\u1ef1a tr\u00ean c\u00e1c y\u1ebfu t\u1ed1 nh\u01b0 gi\u1edbi t\u00ednh, ch\u1ee7ng t\u1ed9c, d\u00e2n t\u1ed9c v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 x\u00e3 h\u1ed9i kinh t\u1ebf.<\/strong><\/li>\n\n\n\n<li><strong>C\u1ea7n nghi\u00ean c\u1ee9u th\u00eam \u0111\u1ec3 gi\u1ea3i quy\u1ebft nh\u1eefng ch\u00eanh l\u1ec7ch n\u00e0y v\u00e0 t\u1ed1i \u01b0u h\u00f3a ch\u0103m s\u00f3c AF cho t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n.<\/strong><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Fulltext mi\u1ec5n ph\u00ed: https:\/\/drive.google.com\/file\/d\/1Vl69sbNgOBUIALhcmZ_gQAqRBFVD7DRu\/view?usp=drive_link Sinh l\u00fd b\u1ec7nh: D\u1ecbch t\u1ec5 h\u1ecdc: Ch\u1ea9n \u0111o\u00e1n: \u0110i\u1ec1u tr\u1ecb: L\u01b0u \u00fd quan tr\u1ecdng:<\/p>\n","protected":false},"author":1,"featured_media":3120,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[131],"tags":[133,132],"jetpack_featured_media_url":"https:\/\/hienbacsi.com\/wp-content\/uploads\/2024\/12\/Screen-Shot-2024-12-17-at-11.28.20.png","_links":{"self":[{"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/posts\/3119"}],"collection":[{"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/comments?post=3119"}],"version-history":[{"count":1,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/posts\/3119\/revisions"}],"predecessor-version":[{"id":3121,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/posts\/3119\/revisions\/3121"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/media\/3120"}],"wp:attachment":[{"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/media?parent=3119"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/categories?post=3119"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/tags?post=3119"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}