Cập nhật về chẩn đoán và điều trị rung nhĩ

DIEN DAN Y HOC

Chuyen de trong thang

CAP NHAT VE CHAN DOAN VA DIEU TRI RUNG NHI • •

Updating on Management of Atrial Fibrillation

Pham Qudc Khanh'*

Rung nhl la mdt tiong nhiing rdi loan nhjp tim

thudng gap nhat trong cdng ddng va thudng gay ra

nhiing bien chimg nang ne lam benh nhan (BN) cd

the tu vong hoac tan phe sudt ddi. Rung nh! cd the la

nguyen nhan gay ra khoang 5% eac trudng hgp dot

quy mdi nam. BN suy rim ed kem theo rung nbi ri le

tir vong tang bon den 34%. Ti le rung nhi tang dan

theo tudi, tmng binh ti le mdi mac rung nhi khoang

0,1% mdi nam d ngudi dudi 40 mdi nhung tang len

tdi 1,5 - 2% d ngudi tren 80 tudi.

I. CHA N DOAN XAC DINH RUNG NHI

Dua vao dien tam do thudng quy 12 chuyen

dao.

- Sdng P bien mat dupe thay the bdi nhimg sdng

lan tan gpi la sdng f (fibrillation)

- Sdng fed dac diem:

+ Tan sd nhanh cham khdng deu tir 350 -

dOOek/phut.

+ Cae sdng f rat khac nhau ve hinh dang, bien

dp, thdi gian.

+ Thay rd sdng f d cae chuyen dao trude tim

phai (VI, V3R) va eac chuyen dao dudi (D2, D3,

aVF), cdn cae chuyen dao trude tim trai (Dl, aVL,

V5, V6) thudng khd thdy.

- Nhip that rat khdng deu: bieu hien bang cac

khoang RR dai ngan khac nhau, khdng theo quy luat

nao ea. Dd la binh anh loan nhip hoan toan.

- Tan sd that nhanh hay cham phu thupc vao

dan truyen cua mil nhi that.

- Hinh dang QRS ndi chung thudng hep, nhung

* lien Tim nuuh Vici .\cim

tren ciing 1 chuyen dao ed the cd khac nhau ehiit it

ve bien dp, thai gian, ...

- Phan biet rung nhi vdi cudng nh! dien hinh,

tan sd sdng F tir 240 den 320ek/pbiit. Ngoai ra, cdn

can phan biet vdi nhip nhanh nh! da d ludn ed sdng

P' di trude QRS.

II. PHAN LOAI RUNG NH I

Dua vao lam sang tien trien cua rung nhi chia

eac the lam sang:

- Con rung nh! kich phat: rung nhT keo dai < 7

ngay, tu het con rung nhi.

- Rung nhl ben bi: rung nbi keo dai >7 ngay,

phai dimg eac bien phap chuyen nhip can thiep mdi

ed the cat dupe rung nhl.

- Rung nhl man tinh: keo dai ban 1 nam va

khdng the cd gang chuyen nhip dugc bang cac bien

phap can thiep.

III. LAM SANG RUNG NHI

- Thdi diem xuat hien trieu chimg dau tien (cd

the la ngay khdi phat rung nbi) nhu: hdi hop danh

trdng nguc, choang vang, dau nguc, ...

- Nhip tim khdng deu liic nhanh liic cham, tieng

tim liic manh, liic yeu khoang each khac nhau giQa

cac chu ki (loan nhip hoan toan).

- Phat hien eac trieu chimg ciia benh rim thuc

tdn nhu: benh van tim, benh maeh vanh, benh tim

bam sinh,...

IV. CHIEN LLTQC DIE U TRI RUNG NH I

1. Nguyen tac dieu trj

- Kiem soat tan sd that,chuyen rung nhi ve nhip

xoang, du phdng huyet khdi.

S6 59 (Thang 12/2010) Y HOC LAM SANG I 11