{"id":155674,"date":"2026-03-18T17:11:37","date_gmt":"2026-03-18T10:11:37","guid":{"rendered":"https:\/\/hmm88i.com\/drug\/?p=155674"},"modified":"2026-03-18T17:12:08","modified_gmt":"2026-03-18T10:12:08","slug":"phau-thuat-bac-cau-chu-vanh","status":"publish","type":"post","link":"https:\/\/hmm88i.com\/drug\/phau-thuat-bac-cau-chu-vanh\/","title":{"rendered":"PH\u00c1C \u0110\u1ed2 39: PH\u1eaaU THU\u1eacT B\u1eaeC C\u1ea6U CH\u1ee6-V\u00c0NH"},"content":{"rendered":"

Xem v\u00e0 t\u1ea3i file PDF t\u1ea1i \u0111\u00e2y<\/a>.<\/p>\n

\u0110\u1ecaNH NGH\u0128A<\/h2>\n

Ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u ch\u1ee7-v\u00e0nh<\/strong> (PTBCCV) l\u00e0 m\u1ed9t ph\u01b0\u01a1ng th\u1ee9c t\u00e1i t\u01b0\u1edbi m\u00e1u d\u00f9ng m\u1ea1ch gh\u00e9p t\u1ef1 th\u00e2n \u0111\u1ec3 b\u1eafc c\u1ea7u<\/strong> qua c\u00e1c \u0111\u1ed9ng m\u1ea1ch v\u00e0nh (\u0110MV) ch\u00ednh b\u1ecb h\u1eb9p ho\u1eb7c t\u1eafc.<\/p>\n

S\u01a0 L\u01af\u1ee2C L\u1ecaCH S\u1eec PH\u1eaaU THU\u1eacT B\u1eaeC C\u1ea6U CH\u1ee6-V\u00c0NH<\/h2>\n

Alexis Carrel l\u00e0 ng\u01b0\u1eddi \u0111\u1ea7u ti\u00ean l\u00e0m ph\u1eabu thu\u1eadt th\u1ef1c nghi\u1ec7m BCCV v\u1edbi vi\u1ec7c gh\u00e9p m\u1ed9t \u0111o\u1ea1n \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh v\u00e0o \u0110MV c\u1ee7a ch\u00f3 n\u0103m 1910. N\u0103m 1940, Gordon Murray gh\u00e9p m\u1ed9t \u0111o\u1ea1n t\u0129nh m\u1ea1ch \u0111\u1ed3ng lo\u1ea1i t\u1eeb \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0o \u0110MV \u0111\u1ed3ng th\u1eddi v\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng heparin \u0111\u1ec3 ng\u1eeba huy\u1ebft kh\u1ed1i. 6 n\u0103m sau Vineberg th\u1ef1c nghi\u1ec7m th\u00e0nh c\u00f4ng ph\u1eabu thu\u1eadt n\u1ed1i \u0111\u1ed9ng m\u1ea1ch ng\u1ef1c trong tr\u1ef1c ti\u1ebfp v\u00e0o m\u00f4 c\u01a1 tim tr\u00ean ch\u00f3. N\u0103m 1950, ph\u1eabu thu\u1eadt Vineberg \u0111\u00e3 th\u00e0nh c\u00f4ng tr\u00ean ng\u01b0\u1eddi v\u00e0 ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n cho \u0111\u1ebfn \u0111\u1ea7u th\u1eadp ni\u00ean 70. N\u0103m 1953, John Gibbon ch\u1ebf t\u1ea1o v\u00e0 ho\u00e0n thi\u1ec7n m\u00e1y tim ph\u1ed5i nh\u00e2n t\u1ea1o \u0111\u1ea7u ti\u00ean v\u00e0 \u0111\u1ebfn th\u00e1ng 3\/1955 John Kirklin v\u00e0 Brian Barratt-Boyes s\u1eed d\u1ee5ng th\u00e0nh c\u00f4ng h\u1ec7 th\u1ed1ng tu\u1ea7n ho\u00e0n ngo\u00e0i c\u01a1 th\u1ec3 (THNCT) tr\u00ean ng\u01b0\u1eddi. N\u0103m 1959, Dubost s\u1eed d\u1ee5ng THNCT \u0111\u1ec3 t\u00e1i t\u1ea1o l\u1ed7 \u0110MV tr\u00e1i cho m\u1ed9t b\u1ec7nh nh\u00e2n b\u1ecb vi\u00eam t\u1eafc l\u1ed7 \u0110MV do giang mai. V\u00e0i n\u0103m sau, Sones v\u00e0 Shirey \u0111\u00e3 ph\u00e1t tri\u1ec3n k\u1ef9 thu\u1eadt ch\u1ee5p \u0110MV ch\u1ecdn l\u1ecdc \u0111\u1eb7t n\u1ec1n m\u00f3ng cho PT BCCV. N\u0103m 1964, Kolesov l\u00e0 ng\u01b0\u1eddi \u0111\u1ea7u ti\u00ean th\u1ef1c hi\u1ec7n PTBCCV v\u1edbi \u0111\u1ed9ng m\u1ea1ch ng\u1ef1c trong tr\u00e1i n\u1ed1i xu\u1ed1ng \u0110MV xu\u1ed1ng tr\u01b0\u1edbc tr\u00e1i cho m\u1ed9t b\u1ec7nh nh\u00e2n nam 44 tu\u1ed5i. N\u0103m 1967, Favarolo v\u00e0 Effler \u1edf Cleveland l\u1ea7n \u0111\u1ea7u ti\u00ean th\u1ef1c hi\u1ec7n th\u00e0nh c\u00f4ng PTBCCV c\u00f3 THNCT v\u1edbi c\u00e1c m\u1ea1ch gh\u00e9p l\u00e0 t\u0129nh m\u1ea1ch hi\u1ec3n l\u1edbn. M\u1ed9t n\u0103m sau, Green \u1edf NewYork v\u00e0 Edward \u1edf Alabama b\u00e1o c\u00e1o k\u1ebft qu\u1ea3 d\u00f9ng \u0111\u1ed9ng m\u1ea1ch ng\u1ef1c trong tr\u00e1i \u0111\u1ec3 b\u1eafc c\u1ea7u. N\u0103m 1971, Flemma v\u00e0 Johnson b\u00e1o c\u00e1o k\u1ef9 thu\u1eadt th\u1ef1c hi\u1ec7n mi\u1ec7ng n\u1ed1i li\u00ean ti\u1ebfp d\u00f9ng t\u0129nh m\u1ea1ch hi\u1ec3n. \u0110\u1ebfn giai \u0111o\u1ea1n 1970-1980 PTBCCV tr\u1edf th\u00e0nh th\u01b0\u1eddng quy \u1edf nhi\u1ec1u trung t\u00e2m tim m\u1ea1ch tr\u00ean th\u1ebf gi\u1edbi.<\/p>\n

T\u1eeb 1990 PTBCCV \u0111\u00e3 ti\u1ebfn th\u00eam m\u1ed9t b\u01b0\u1edbc m\u1edbi nh\u1edd \u00e1p d\u1ee5ng c\u00e1c k\u1ef9 thu\u1eadt m\u1edbi v\u00e0 d\u1ee5ng c\u1ee5 m\u1edbi nh\u01b0: PTBCCV kh\u00f4ng d\u00f9ng THNCT (OPCAB), PTBCCV x\u00e2m l\u1ea5n t\u1ed1i thi\u1ec3u (MID CAB v\u00e0 MICS CAB), PTBCCV k\u1ebft h\u1ee3p th\u00f4ng tim can thi\u1ec7p (hybrid CABG) ho\u1eb7c PTBCCV b\u1eb1ng r\u00f4-b\u1ed1t (robotic CABG) gi\u00fap r\u00fat ng\u1eafn th\u1eddi gian n\u1eb1m vi\u1ec7n c\u0169ng nh\u01b0 chi ph\u00ed \u0111i\u1ec1u tr\u1ecb. Th\u1ed1ng k\u00ea c\u1ee7a Idata Research 2018 \u01b0\u1edbc t\u00ednh c\u00f3 340.000 tr\u01b0\u1eddng h\u1ee3p PTBCCV \u1edf Hoa K\u1ef3, trong \u0111\u00f3 17,6% l\u00e0 OPCAB.<\/p>\n

CH\u1ea8N \u0110O\u00c1N TR\u01af\u1edaC M\u1ed4<\/h2>\n

L\u00e2m s\u00e0ng<\/h3>\n

\u0110au th\u1eaft ng\u1ef1c \u1ed5n \u0111\u1ecbnh ho\u1eb7c kh\u00f4ng \u1ed5n \u0111\u1ecbnh.<\/p>\n

Nh\u1ed3i m\u00e1u c\u01a1 tim (NMCT) m\u1edbi xu\u1ea5t hi\u1ec7n ho\u1eb7c \u0111\u00e3 c\u00f3 t\u1eeb tr\u01b0\u1edbc.<\/p>\n

C\u1eadn l\u00e2m s\u00e0ng<\/h3>\n
    \n
  • ECG: \u0111a d\u1ea1ng v\u00e0 thay \u0111\u1ed5i theo giai \u0111o\u1ea1n: thay \u0111\u1ed5i \u0111o\u1ea1n ST, hi\u1ec7n di\u1ec7n s\u00f3ng Q. Si\u00eau \u00e2m tim: ph\u00e1t hi\u1ec7n v\u00f9ng gi\u1ea3m \u0111\u1ed9ng, v\u00f4 \u0111\u1ed9ng ho\u1eb7c lo\u1ea1n \u0111\u1ed9ng, c\u00f3 th\u1ec3 k\u00e8m gi\u1ea3m ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i. Si\u00eau \u00e2m tim qua th\u00e0nh ng\u1ef1c v\u00e0 qua th\u1ef1c qu\u1ea3n c\u00f2n c\u00f3 vai tr\u00f2 ch\u1ea9n \u0111o\u00e1n b\u1ec7nh van tim v\u00e0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng kh\u00e1c k\u1ebft h\u1ee3p.<\/li>\n
  • ECG v\u00e0 si\u00eau \u00e2m tim g\u1eafng s\u1ee9c: gi\u00fap ph\u00e1t hi\u1ec7n thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 tim. \u1ede b\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i, si\u00eau \u00e2m tim v\u1edbi dobutamin gi\u00fap ph\u00e1t hi\u1ec7n v\u00f9ng c\u01a1 tim c\u00f2n s\u1ed1ng.<\/li>\n
  • MSCT (t\u1eeb 64 l\u00e1t c\u1eaft tr\u1edf l\u00ean): c\u00f3 vai tr\u00f2 t\u1ea7m so\u00e1t th\u01b0\u01a1ng t\u1ed5n c\u0169ng nh\u01b0 ch\u1ea9n \u0111o\u00e1n h\u1eb9p m\u1ea1ch v\u00e0nh v\u1edbi \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u > 95%. MSCT c\u0169ng cho ph\u00e9p ch\u1ea9n \u0111o\u00e1n t\u00ecnh tr\u1ea1ng t\u1eafc ho\u1eb7c h\u1eb9p n\u1eb7ng c\u1ea7u n\u1ed1i \u0110MV sau m\u1ed5.<\/li>\n
  • SPECT: cho ph\u00e9p \u0111\u00e1nh gi\u00e1 ch\u00ednh x\u00e1c c\u00e1c v\u00f9ng c\u01a1 tim c\u00f2n s\u1ed1ng, ng\u1ee7 \u0111\u00f4ng hay \u0111\u00e3 ch\u1ebft.<\/li>\n
  • Stress Perfusion MRI: l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p m\u1edbi cho ph\u00e9p \u0111\u00e1nh gi\u00e1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p thi\u1ebfu m\u00e1u c\u01a1 tim kh\u00f4ng do t\u1ed5n th\u01b0\u01a1ng th\u1ef1c th\u1ec3.<\/li>\n
  • Ch\u1ee5p \u0110MV ch\u1ecdn l\u1ecdc c\u1ea3n quang: l\u00e0 kh\u1ea3o s\u00e1t kh\u00f4ng th\u1ec3 thi\u1ebfu \u0111\u1ec3 ch\u1ec9 \u0111\u1ecbnh PTBCCV ho\u1eb7c can thi\u1ec7p m\u1ea1ch v\u00e0nh qua da (CTMVQD). Ch\u1ee5p \u0110MV cho bi\u1ebft s\u1ed1 l\u01b0\u1ee3ng v\u00e0 t\u00ednh ch\u1ea5t th\u01b0\u01a1ng t\u1ed5n, m\u1ee9c \u0111\u1ed9 h\u1eb9p, m\u1ea1ch m\u00e1u c\u00f2n c\u00f3 th\u1ec3 b\u1eafc c\u1ea7u c\u0169ng nh\u01b0 \u0111\u00e1nh gi\u00e1 \u0111\u1ed9 th\u00f4ng c\u1ee7a c\u1ea7u n\u1ed1i sau ph\u1eabu thu\u1eadt.<\/li>\n
  • Si\u00eau \u00e2m n\u1ed9i m\u1ea1ch v\u00e0nh (IVUS): \u0111\u00e1nh gi\u00e1 b\u1ed5 sung m\u1ee9c \u0111\u1ed9 h\u1eb9p l\u00f2ng m\u1ea1ch \u1edf nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u00f3 h\u00ecnh \u1ea3nh h\u1eb9p kh\u00f4ng r\u00f5 r\u00e0ng khi ch\u1ee5p m\u1ea1ch v\u00e0nh.<\/li>\n
  • FFR (fractional flow reserve – ph\u00e2n su\u1ea5t l\u01b0u l\u01b0\u1ee3ng d\u1ef1 tr\u1eef \u0110MV): FFR < 0,8 l\u00e0 c\u00f3 ch\u1ec9 \u0111\u1ecbnh can thi\u1ec7p. Hi\u1ec7n t\u1ea1i vai tr\u00f2 c\u1ee7a FFR \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 cao trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng ch\u01b0a x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c m\u1ee9c \u0111\u1ed9 h\u1eb9p d\u1ef1a v\u00e0o ch\u1ee5p \u0110MV c\u1ea3n quang[1]<\/li>\n
  • OCT (ch\u1ee5p c\u1eaft l\u1edbp quang h\u1ecdc): gi\u00fap \u0111\u00e1nh gi\u00e1 di\u1ec5n ti\u1ebfn t\u1ef1 nhi\u00ean c\u1ee7a m\u1ea3ng x\u01a1 v\u1eefa, gi\u1ea3i th\u00edch c\u01a1 ch\u1ebf c\u1ee7a h\u1ed9i ch\u1ee9ng m\u1ea1ch v\u00e0nh c\u1ea5p v\u00e0 t\u1ed1i \u01b0u h\u00f3a CTMVQD.<\/li>\n<\/ul>\n

    CH\u1ec8 \u0110\u1ecaNH PH\u1eaaU THU\u1eacT<\/h2>\n

    M\u1ee5c ti\u00eau v\u00e0 ch\u1ec9 \u0111\u1ecbnh PTBCCV<\/h3>\n

    M\u1ee5c ti\u00eau c\u1ee7a PTBCCV l\u00e0 c\u1ea3i thi\u1ec7n t\u1ec9 l\u1ec7 s\u1ed1ng c\u00f2n v\u00e0 gi\u1ea3m tri\u1ec7u ch\u1ee9ng. PTBCCV \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong c\u00e1c t\u00ecnh hu\u1ed1ng sau:<\/p>\n

      \n
    • H\u1eb9p th\u00e2n chung \u0110MV tr\u00e1i \u2265 50% kh\u00f4ng \u0111\u01b0\u1ee3c b\u1ea3o v\u1ec7 (I).<\/li>\n
    • H\u1eb9p c\u1ea3 3 th\u00e2n ch\u00ednh \u0110MV \u2265 70% (ho\u1eb7c FFR \u2264 0,8) \u0111i k\u00e8m ho\u1eb7c kh\u00f4ng \u0111i k\u00e8m h\u1eb9p th\u00e2n chung (I).<\/li>\n
    • H\u1eb9p 2 th\u00e2n ch\u00ednh \u0110MV trong \u0111\u00f3 c\u00f3 h\u1eb9p n\u1eb7ng \u0111o\u1ea1n g\u1ea7n \u0110MV xu\u1ed1ng tr\u01b0\u1edbc tr\u00e1i v\u00e0 k\u00e8m ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u < 50% ho\u1eb7c c\u00f3 bi\u1ec3u hi\u1ec7n thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 r\u00f5 r\u1ec7t khi kh\u1ea3o s\u00e1t kh\u00f4ng x\u00e2m nh\u1eadp (I).<\/li>\n
    • H\u1eb9p 2 th\u00e2n \u0110MV trong \u0111\u00f3 kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng \u0111o\u1ea1n g\u1ea7n \u0110MV xu\u1ed1ng tr\u01b0\u1edbc tr\u00e1i nh\u01b0ng c\u00f3 b\u1eb1ng ch\u1ee9ng thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 lan r\u1ed9ng (lla).<\/li>\n
    • H\u1eb9p \u2265 70% \u0111o\u1ea1n g\u1ea7n \u0110MV xu\u1ed1ng tr\u01b0\u1edbc tr\u00e1i v\u00e0 c\u00f3 l\u1ee3i \u00edch l\u00e2u d\u00e0i khi t\u00e1i t\u01b0\u1edbi m\u00e1u b\u1eb1ng \u0111\u1ed9ng m\u1ea1ch ng\u1ef1c trong tr\u00e1i (Ila).<\/li>\n
    • H\u1eb9p \u2265 1 nh\u00e1nh ch\u00ednh k\u00e8m \u0111au th\u1eaft ng\u1ef1c kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa v\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 ph\u1eabu thu\u1eadt th\u1ea5p (Ila).<\/li>\n
    • H\u1ed9i ch\u1ee9ng m\u1ea1ch v\u00e0nh c\u1ea5p c\u00f3 r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng n\u1eb7ng\/s\u1ed1c tim n\u1ebfu CTMVQD tr\u00ean \u0110MV th\u1ee7 ph\u1ea1m kh\u00f4ng th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c ho\u1eb7c th\u1ea5t b\u1ea1i (I).<\/li>\n<\/ul>\n

      L\u1ef1a ch\u1ecdn gi\u1eefa PTBCCV v\u00e0 CTMVQD<\/h3>\n

      C\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ph\u00e2n nh\u00f3m ng\u1eabu nhi\u00ean cho th\u1ea5y \u1edf b\u1ec7nh nh\u00e2n c\u00f3 h\u1eb9p th\u00e2n chung, h\u1eb9p n\u1eb7ng ho\u1eb7c t\u1eafc c\u1ea3 3 nh\u00e1nh ch\u00ednh, PTBCCV c\u00f3 l\u1ee3i h\u01a1n CTMVQD. Tuy nhi\u00ean ch\u1ec9 \u0111\u1ecbnh PTBCCV hay CTMVQD hay c\u00e1c bi\u1ec7n ph\u00e1p ph\u1ed1i h\u1ee3p kh\u00e1c cho b\u1ec7nh nh\u00e2n b\u1ecb h\u1eb9p\/t\u1eafc \u0110MV m\u1ea1n n\u00ean l\u00e0 quy\u1ebft \u0111\u1ecbnh chung c\u1ee7a \u00ea k\u00edp Heart Team nh\u1eb1m t\u1ed1i \u01b0u k\u1ebft c\u1ee5c cho ng\u01b0\u1eddi b\u1ec7nh. Tr\u00ean B\u1ea3ng 1 l\u00e0 c\u00e1c khuy\u1ebfn c\u00e1o v\u1ec1 l\u1ef1a ch\u1ecdn bi\u1ec7n ph\u00e1p t\u00e1i t\u01b0\u1edbi m\u00e1u trong b\u1ec7nh m\u1ea1ch v\u00e0nh m\u1ea1n theo h\u01b0\u1edbng d\u1eabn c\u1ee7a AHA\/ACC.<\/p>\n

      B\u1ea3ng 1. L\u1ef1a ch\u1ecdn bi\u1ec7n ph\u00e1p t\u00e1i t\u01b0\u1edbi m\u00e1u (theo AHA\/ACC 2023)<\/p>\n\n\n\n\n\n\n\n\n\n\n\n
      Khuy\u1ebfn c\u00e1o<\/td>\nClass<\/td>\n<\/tr>\n
      Ng\u01b0\u1eddi b\u1ec7nh m\u1ea1ch v\u00e0nh m\u1ea1n<\/td>\n<\/tr>\n
      \u1ede ng\u01b0\u1eddi b\u1ec7nh m\u1ea1ch v\u00e0nh m\u1ea1n c\u1ea7n \u0111\u01b0\u1ee3c t\u00e1i t\u01b0\u1edbi m\u00e1u v\u00ec c\u00f3 h\u1eb9p c\u00f3 \u00fd ngh\u0129a c\u1ee7a th\u00e2n chung tr\u00e1i ph\u1ed1i h\u1ee3p v\u1edbi t\u1ed5n th\u01b0\u01a1ng \u0110MV r\u1ea5t ph\u1ee9c t\u1ea1p (SYNTAX score > 33), PTBCCV \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u01b0u ti\u00ean h\u01a1n CTMVQD \u0111\u1ec3 c\u1ea3i thi\u1ec7n s\u1ed1ng c\u00f2n.<\/td>\n1<\/td>\n<\/tr>\n
      \u1ede ng\u01b0\u1eddi b\u1ec7nh m\u1ea1ch v\u00e0nh m\u1ea1n c\u1ea7n \u0111\u01b0\u1ee3c t\u00e1i t\u01b0\u1edbi m\u00e1u v\u00ec c\u00f3 h\u1eb9p t\u1eafc nhi\u1ec1u \u0110MV v\u1edbi t\u1ed5n th\u01b0\u01a1ng \u0110MV ph\u1ee9c t\u1ea1p v\u00e0 lan t\u1ecfa (SYNTAX score > 33), PTBCCV n\u00ean \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn h\u01a1n l\u00e0 CTMVQD nh\u1eb1m c\u1ea3i thi\u1ec7n s\u1ed1ng c\u00f2n.<\/td>\n2a<\/td>\n<\/tr>\n
      Ng\u01b0\u1eddi b\u1ec7nh m\u1ea1ch v\u00e0nh m\u1ea1n c\u00f3 nguy c\u01a1 ph\u1eabu thu\u1eadt cao<\/td>\n<\/tr>\n
      \u1ede ng\u01b0\u1eddi b\u1ec7nh m\u1ea1ch v\u00e0nh m\u1ea1n c\u00f3 ch\u1ec9 \u0111\u1ecbnh t\u00e1i t\u01b0\u1edbi m\u00e1u nh\u01b0ng kh\u00f4ng ph\u1ea3i l\u00e0 \u1ee9ng vi\u00ean ph\u00f9 h\u1ee3p cho ph\u1eabu thu\u1eadt, vi\u1ec7c ch\u1ecdn CTMVQD thay v\u00ec PTBCCV l\u00e0 h\u1ee3p l\u00fd nh\u1eb1m c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng v\u00e0 gi\u1ea3m nguy c\u01a1 bi\u1ebfn c\u1ed1 tim m\u1ea1ch.<\/td>\n2a<\/td>\n<\/tr>\n
      Ng\u01b0\u1eddi b\u1ec7nh m\u1ea1ch v\u00e0nh m\u1ea1n c\u00f3 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/td>\n<\/tr>\n
      \u1ede ng\u01b0\u1eddi b\u1ec7nh m\u1ea1ch v\u00e0nh m\u1ea1n c\u00f3 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 h\u1eb9p\/t\u1eafc nhi\u1ec1u \u0110MV (trong \u0111\u00f3 c\u00f3 \u0110MV xu\u1ed1ng tr\u01b0\u1edbc tr\u00e1i) l\u00e0 \u1ee9ng vi\u00ean ph\u00f9 h\u1ee3p cho PTBCCV. PTBCCV (v\u1edbi \u0111\u1ed9ng m\u1ea1ch ng\u1ef1c trong tr\u00e1i n\u1ed1i v\u00e0o \u0110MV xu\u1ed1ng tr\u01b0\u1edbc tr\u00e1i) \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u01b0u ti\u00ean h\u01a1n CTMVQD nh\u1eb1m gi\u1ea3m t\u1eed vong v\u00e0 t\u00e1i t\u01b0\u1edbi m\u00e1u l\u1eb7p l\u1ea1i.<\/td>\n1<\/td>\n<\/tr>\n
      \u1ede ng\u01b0\u1eddi b\u1ec7nh m\u1ea1ch v\u00e0nh m\u1ea1n c\u00f3 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 h\u1eb9p th\u00e2n chung tr\u00e1i k\u00e8m t\u1ed5n th\u01b0\u01a1ng \u0110MV m\u1ee9c \u0111\u1ed9 ph\u1ee9c t\u1ea1p th\u1ea5p ho\u1eb7c trung gian (SYNTAX score \u2264 33), CTMVQD c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc nh\u01b0 l\u00e0 m\u1ed9t bi\u1ec7n ph\u00e1p thay th\u1ebf cho PTBCCV nh\u1eb1m gi\u1ea3m nguy c\u01a1 bi\u1ebfn c\u1ed1 tim m\u1ea1ch.<\/td>\n2b<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

      K\u1ef8 THU\u1eacT B\u1eaeC C\u1ea6U CH\u1ee6-V\u00c0NH<\/h2>\n

      L\u01b0\u1ee3ng gi\u00e1 nguy c\u01a1 ph\u1eabu thu\u1eadt b\u1eb1ng ch\u1ec9 s\u1ed1 EuroSCORE II ho\u1eb7c STS<\/h3>\n

      Ti\u1ebfn tr\u00ecnh c\u1ee7a PTBCCV quy \u01b0\u1edbc (conventional CABG – ONCAB)<\/h3>\n
        \n
      • M\u1edf ng\u1ef1c \u0111\u01b0\u1eddng gi\u1eefa \u0111\u1ed3ng th\u1eddi l\u1ea5y c\u00e1c m\u1ea1ch gh\u00e9p.<\/li>\n
      • Thi\u1ebft l\u1eadp THNCT.<\/li>\n
      • K\u1eb9p ngang \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, truy\u1ec1n dung d\u1ecbch l\u00e0m li\u1ec7t tim (Custodiol) v\u00e0 n\u1ed1i c\u00e1c \u0111\u1ea7u xa.<\/li>\n
      • M\u1edf k\u1eb9p \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, cho tim \u0111\u1eadp l\u1ea1i v\u00e0 n\u1ed1i \u0111\u1ea7u g\u1ea7n (n\u1ebfu c\u00f3).<\/li>\n
      • Ng\u01b0ng d\u1ea7n THNCT, ki\u1ec3m tra \u0111\u1ed9 th\u00f4ng c\u1ee7a c\u00e1c c\u1ea7u n\u1ed1i (b\u1eb1ng m\u00e1y \u0111o TTFM), c\u1ea7m m\u00e1u, \u0111\u1eb7t \u0111i\u1ec7n c\u1ef1c t\u1ea1m th\u1eddi v\u00e0 \u0111\u00f3ng ng\u1ef1c.<\/li>\n<\/ul>\n

        Ch\u1ecdn lo\u1ea1i m\u1ea1ch gh\u00e9p s\u1eed d\u1ee5ng<\/h3>\n

        M\u1ea1ch gh\u00e9p s\u1eed d\u1ee5ng bao g\u1ed3m:<\/p>\n

        M\u1ea1ch gh\u00e9p \u0111\u1ed9ng m\u1ea1ch:<\/p>\n

          \n
        • \u0110\u1ed9ng m\u1ea1ch ng\u1ef1c trong tr\u00e1i v\u00e0 ph\u1ea3i.<\/li>\n
        • \u0110\u1ed9ng m\u1ea1ch quay.<\/li>\n
        • \u0110\u1ed9ng m\u1ea1ch v\u1ecb m\u1ea1c n\u1ed1i ph\u1ea3i.<\/li>\n<\/ul>\n

          M\u1ea1ch gh\u00e9p t\u0129nh m\u1ea1ch: T\u0129nh m\u1ea1ch hi\u1ec3n l\u1edbn<\/p>\n

          C\u00e1c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng m\u1ea1ch gh\u00e9p theo ACC\/AHA 2021 v\u00e0 STS 2016:<\/p>\n

            \n
          • \u0110\u1ed9ng m\u1ea1ch ng\u1ef1c trong b\u00ean tr\u00e1i ph\u1ea3i \u0111\u01b0\u1ee3c n\u1ed1i v\u1edbi \u0110MV xu\u1ed1ng tr\u01b0\u1edbc tr\u00e1i khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh b\u1eafc c\u1ea7u tr\u00ean \u0110MV xu\u1ed1ng tr\u01b0\u1edbc tr\u00e1i nh\u1eb1m c\u1ea3i thi\u1ec7n s\u1ed1ng c\u00f2n v\u00e0 l\u00e0m gi\u1ea3m bi\u1ebfn c\u1ed1 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 t\u00e1i ph\u00e1t (lo\u1ea1i 1, m\u1ee9c ch\u1ee9ng c\u1ee9 B-NR).<\/li>\n
          • \u0110\u1ed9ng m\u1ea1ch ng\u1ef1c trong b\u00ean ph\u1ea3i \u0111\u01b0\u1ee3c n\u1ed1i v\u1edbi \u0110MV xu\u1ed1ng tr\u01b0\u1edbc tr\u00e1i khi \u0111\u1ed9ng m\u1ea1ch ng\u1ef1c trong tr\u00e1i kh\u00f4ng s\u1eed d\u1ee5ng \u0111\u01b0\u1ee3c (lo\u1ea1i Ila, m\u1ee9c ch\u1ee9ng c\u1ee9 C).<\/li>\n
          • S\u1eed d\u1ee5ng c\u1ea3 hai \u0111\u1ed9ng m\u1ea1ch ng\u1ef1c trong ph\u1ea3i \u0111\u01b0\u1ee3c xem x\u00e9t nh\u1eb1m l\u00e0m t\u0103ng s\u1ed1ng c\u00f2n v\u00e0 gi\u1ea3m m\u1ed5 l\u1ea1i n\u1ebfu PTV c\u00f3 kinh nghi\u1ec7m v\u00e0 nguy c\u01a1 vi\u00eam x\u01b0\u01a1ng \u1ee9c th\u1ea5p (lo\u1ea1i Ila, m\u1ee9c ch\u1ee9ng c\u1ee9 B-NR). Khi s\u1eed d\u1ee5ng c\u1ea3 2 \u0111\u1ed9ng m\u1ea1ch ng\u1ef1c trong th\u00ec ph\u1ea3i d\u00f9ng k\u1ef9 thu\u1eadt l\u1ea5y tr\u1ea7n (skeletonization technique).<\/li>\n
          • T\u00e1i t\u01b0\u1edbi m\u00e1u to\u00e0n b\u1ed9 n\u00ean th\u1ef1c hi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n \u2264 60 tu\u1ed5i v\u1edbi \u00edt b\u1ec7nh n\u1ec1n k\u1ebft h\u1ee3p (lo\u1ea1i IIb, m\u1ee9c ch\u1ee9ng c\u1ee9 C).<\/li>\n
          • M\u1ea1ch gh\u00e9p \u0111\u1ed9ng m\u1ea1ch cho \u0110MV ph\u1ea3i c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n khi \u0110MV ph\u1ea3i h\u1eb9p \u2265 90% (lo\u1ea1i llb, m\u1ee9c ch\u1ee9ng c\u1ee9 B).<\/li>\n
          • \u0110\u1ed9ng m\u1ea1ch quay c\u1ea7n \u0111\u01b0\u1ee3c \u01b0u ti\u00ean ch\u1ecdn l\u1ef1a h\u01a1n l\u00e0 t\u0129nh m\u1ea1ch hi\u1ec3n (nh\u01b0 l\u00e0 c\u1ea7u n\u1ed1i quan tr\u1ecdng th\u1ee9 hai) khi h\u1eb9p n\u1eb7ng nh\u00e1nh m\u0169 (> 70%) v\u00e0 h\u1eb9p r\u1ea5t kh\u00edt \u0110MV ph\u1ea3i (\u2265 90%) (lo\u1ea1i 1, m\u1ee9c ch\u1ee9ng c\u1ee9 B-R theo ACC\/AHA 2021 v\u00e0 lo\u1ea1i Ila, m\u1ee9c ch\u1ee9ng c\u1ee9 B theo STS 2016). C\u1ea7n l\u01b0u \u00fd s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng co th\u1eaft trong v\u00e0 sau m\u1ed5 khi s\u1eed d\u1ee5ng \u0111\u1ed9ng m\u1ea1ch quay.<\/li>\n
          • S\u1eed d\u1ee5ng \u0111\u1ed9ng m\u1ea1ch v\u1ecb m\u1ea1c n\u1ed1i ph\u1ea3i (RGEA) cho \u0110MV ph\u1ea3i trong tr\u01b0\u1eddng h\u1ee3p thi\u1ebfu m\u1ea1ch gh\u00e9p \u0111\u1ed9ng m\u1ea1ch ho\u1eb7c nh\u01b0 l\u00e0 m\u1ed9t ch\u1ecdn l\u1ef1a b\u1ed5 sung khi c\u1ea7n t\u00e1i t\u01b0\u1edbi m\u00e1u to\u00e0n b\u1ed9 b\u1eb1ng \u0111\u1ed9ng m\u1ea1ch (lo\u1ea1i IIb, m\u1ee9c ch\u1ee9ng c\u1ee9 B).<\/li>\n<\/ul>\n

            Tr\u00ean c\u01a1 s\u1edf khuy\u1ebfn c\u00e1o n\u00e0y, c\u00f3 th\u1ec3 ch\u1ecdn l\u1ef1a ph\u1ed1i h\u1ee3p c\u00e1c m\u1ea1ch gh\u00e9p sau (d\u1ef1a v\u00e0o c\u00e1c y\u1ebfu t\u1ed1 l\u00e2m s\u00e0ng nh\u01b0 tu\u1ed5i, gi\u1edbi t\u00ednh, b\u1ec7nh n\u1ec1n, m\u1ee9c \u0111\u1ed9 h\u1eb9p v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng m\u1ea1ch v\u00e0nh<\/em>):<\/p>\n

              \n
            • \u0110\u1ed9ng m\u1ea1ch ng\u1ef1c trong tr\u00e1i: c\u1ea7u n\u1ed1i \u0111\u1ed9ng m\u1ea1ch ng\u1ef1c trong tr\u00e1i n\u1ed1i v\u00e0o \u0110MV xu\u1ed1ng tr\u01b0\u1edbc tr\u00e1i v\u1eabn l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng.<\/li>\n
            • \u0110\u1ed9ng m\u1ea1ch ng\u1ef1c trong ph\u1ea3i: kh\u00f4ng s\u1eed d\u1ee5ng n\u1ebfu b\u1ec7nh nh\u00e2n b\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng kh\u00f3 ki\u1ec3m so\u00e1t \u0111i k\u00e8m v\u1edbi BMI \u2265 30.<\/li>\n
            • \u0110\u1ed9ng m\u1ea1ch quay: tu\u1ed5i \u2264 60-65, kh\u00f4ng \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng ho\u1eb7c \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng ki\u1ec3m so\u00e1t t\u1ed1t.<\/li>\n
            • \u0110\u1ed9ng m\u1ea1ch v\u1ecb m\u1ea1c n\u1ed1i: s\u1eed d\u1ee5ng h\u1ea1n ch\u1ebf nh\u01b0 l\u00e0 m\u1ed9t \u0111\u1ed9ng m\u1ea1ch c\u00f3 cu\u1ed1ng, t\u01b0\u1edbi m\u00e1u ch\u1ee7 y\u1ebfu cho h\u1ec7 \u0110MV ph\u1ea3i v\u00e0 nh\u00e1nh b\u1edd t\u00f9 th\u1ea5p.<\/li>\n
            • T\u0129nh m\u1ea1ch hi\u1ec3n l\u1edbn: kh\u00f4ng s\u1eed d\u1ee5ng n\u1ebfu c\u00f3 gi\u00e3n t\u0129nh m\u1ea1ch, ti\u1ec1n s\u1eed vi\u00eam t\u1eafc t\u0129nh m\u1ea1ch.<\/li>\n<\/ul>\n

              Khuynh h\u01b0\u1edbng m\u1edbi l\u00e0 s\u1eed d\u1ee5ng c\u1ea3 hai \u0111\u1ed9ng m\u1ea1ch ng\u1ef1c trong \u0111\u1ec3 th\u1ef1c hi\u1ec7n t\u1ea5t c\u1ea3 c\u00e1c mi\u1ec7ng n\u1ed1i ho\u1eb7c s\u1eed d\u1ee5ng to\u00e0n b\u1ed9 c\u00e1c c\u1ea7u n\u1ed1i \u0111\u1ec1u l\u00e0 \u0111\u1ed9ng m\u1ea1ch. \u0110\u1ec3 b\u1ea3o \u0111\u1ea3m k\u1ebft qu\u1ea3 l\u00e2u d\u00e0i c\u1ea7n ti\u1ebfn h\u00e0nh t\u00e1i t\u01b0\u1edbi m\u00e1u to\u00e0n b\u1ed9 khi \u0111i\u1ec1u ki\u1ec7n cho ph\u00e9p. Theo \u0111\u1ecbnh ngh\u0129a t\u00e1i t\u01b0\u1edbi m\u00e1u to\u00e0n b\u1ed9 l\u00e0 khi t\u1ec9 l\u1ec7 t\u1ed5ng s\u1ed1 c\u1ea7u n\u1ed1i l\u00e0m \u0111\u01b0\u1ee3c chia cho s\u1ed1 th\u00e2n ch\u00ednh b\u1ecb h\u1eb9p ho\u1eb7c t\u1eafc l\u1edbn h\u01a1n ho\u1eb7c b\u1eb1ng 1.<\/p>\n

              \u0110\u01b0\u1eddng m\u1ed5: t\u00f9y theo ph\u01b0\u01a1ng th\u1ee9c ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 ch\u1ecdn l\u1ef1a<\/h3>\n
                \n
              • \u0110\u01b0\u1eddng gi\u1eefa x\u01b0\u01a1ng \u1ee9c to\u00e0n b\u1ed9: th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u1ea5t.<\/li>\n
              • \u0110\u01b0\u1eddng m\u1edf ng\u1ef1c tr\u01b0\u1edbc b\u00ean tr\u00e1i: d\u00f9ng cho ph\u1eabu thu\u1eadt \u00edt x\u00e2m l\u1ea5n MIDCAB v\u00e0 MICSCAB.<\/li>\n<\/ul>\n

                C\u00e1c ph\u01b0\u01a1ng th\u1ee9c ph\u1eabu thu\u1eadt<\/h3>\n
                  \n
                • PT BCCV quy \u01b0\u1edbc (m\u1edf ng\u1ef1c \u0111\u01b0\u1eddng gi\u1eefa to\u00e0n b\u1ed9 + THNCT h\u1ed7 tr\u1ee3).<\/li>\n
                • PT BCCV kh\u00f4ng s\u1eed d\u1ee5ng tu\u1ea7n ho\u00e0n ngo\u00e0i c\u01a1 th\u1ec3 (OPCAB).<\/li>\n
                • PT BCCV \u00edt x\u00e2m l\u1ea5n v\u00e0 nh\u00ecn tr\u1ef1c ti\u1ebfp (MIDCAB v\u00e0 MICS CAB).<\/li>\n
                • PT BCCV v\u1edbi tr\u1ee3 gi\u00fap c\u1ee7a VATS (TECAB).<\/li>\n
                • PT BCCV qua c\u1ed5ng (port-access CABG).<\/li>\n
                • PT BCCV v\u1edbi tr\u1ee3 gi\u00fap c\u1ee7a r\u00f4 b\u1ed1t (Robotic CABG).<\/li>\n
                • PT BCCV lai (b\u1eafc c\u1ea7u b\u1eb1ng \u0111\u1ed9ng m\u1ea1ch cho \u0110MV tr\u00e1i ph\u1ed1i h\u1ee3p CTMVQD cho \u0110MV ph\u1ea3i v\u00e0 nh\u00e1nh \u0110M m\u0169).<\/li>\n<\/ul>\n

                  C\u00e1c lo\u1ea1i c\u1ea7u n\u1ed1i<\/h3>\n

                  C\u1ea7u n\u1ed1i \u0111\u01a1n: m\u1ed9t m\u1ea1ch gh\u00e9p-m\u1ed9t mi\u1ec7ng n\u1ed1i.<\/h4>\n

                  Th\u01b0\u1eddng l\u00e0m: \u0111\u1ed9ng m\u1ea1ch ng\u1ef1c trong tr\u00e1i \u2192 \u0110MV xu\u1ed1ng tr\u01b0\u1edbc tr\u00e1i; \u0111\u1ed9ng m\u1ea1ch ng\u1ef1c trong ph\u1ea3i \u2192 \u0110MV b\u1edd t\u00f9; T\u0129nh m\u1ea1ch hi\u1ec3n\/\u0111\u1ed9ng m\u1ea1ch quay \u2192 \u0110MV b\u1edd t\u00f9\/\u0110MV ph\u1ea3i\/\u0110MV li\u00ean th\u1ea5t sau.<\/p>\n

                  C\u1ea7u n\u1ed1i li\u00ean ti\u1ebfp (sequential anastomosis)<\/h4>\n
                    \n
                  • C\u1ea7u n\u1ed1i li\u00ean ti\u1ebfp d\u00f9ng m\u1ed9t m\u1ea1ch gh\u00e9p<\/li>\n<\/ul>\n

                    Th\u01b0\u1eddng l\u00e0m: \u0111\u1ed9ng m\u1ea1ch ng\u1ef1c trong tr\u00e1i \u2192 \u0110MV ch\u00e9o \u2192 \u0110MV xu\u1ed1ng tr\u01b0\u1edbc tr\u00e1i.<\/p>\n

                      \n
                    • C\u1ea7u n\u1ed1i li\u00ean ti\u1ebfp d\u00f9ng 2 m\u1ea1ch gh\u00e9p hay ph\u1ee9c h\u1ee3p m\u1ea1ch gh\u00e9p (composite graft).<\/li>\n<\/ul>\n

                      Th\u01b0\u1eddng l\u00e0m Y\/T graft: \u0110\u1ed9ng m\u1ea1ch ng\u1ef1c trong tr\u00e1i \u2192 \u0110MV ch\u00e9o \u2192 \u0110MV xu\u1ed1ng tr\u01b0\u1edbc tr\u00e1i \u2192 \u0111\u1ed9ng m\u1ea1ch ng\u1ef1c trong ph\u1ea3i \u2192 \u0110MV b\u1edd t\u00f9 \u2192 \u0110MV qu\u1eb7t ng\u01b0\u1ee3c th\u1ea5t sau.<\/p>\n

                      Bi\u1ebfn ch\u1ee9ng c\u1ee7a ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u ch\u1ee7 v\u00e0nh<\/h3>\n
                        \n
                      • Ch\u1ea3y m\u00e1u: 5-15%.<\/li>\n
                      • Chuy\u1ec3n t\u1eeb OPCAB sang ONCAB < 3% nh\u01b0ng t\u1eed vong cao.<\/li>\n
                      • Vi\u00eam x\u01b0\u01a1ng \u1ee9c-trung th\u1ea5t: t\u1ea7n su\u1ea5t 0,5-3% nh\u01b0ng t\u1eed vong l\u00ean \u0111\u1ebfn 20-25%.<\/li>\n
                      • Rung nh\u0129: 11-20%. X\u1ea3y ra t\u1ea1m th\u1eddi v\u00e0 ng\u1eafn h\u1ea1n sau m\u1ed5.<\/li>\n
                      • NMCT chu ph\u1eabu: \u00edt g\u1eb7p nh\u01b0ng ti\u00ean l\u01b0\u1ee3ng r\u1ea5t n\u1eb7ng. Nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p: (i) kh\u00f4ng th\u1ec3 t\u00e1i t\u01b0\u1edbi m\u00e1u ho\u00e0n to\u00e0n; (ii) co th\u1eaft m\u1ea1ch gh\u00e9p \u0111\u1eb7c bi\u1ec7t l\u00e0 \u0111\u1ed9ng m\u1ea1ch quay; (iii) h\u1eb9p ho\u1eb7c t\u1eafc mi\u1ec7ng n\u1ed1i s\u1edbm.<\/li>\n
                      • Tai bi\u1ebfn th\u1ea7n kinh: g\u1ed3m s\u1ea3ng, c\u01a1n thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 n\u00e3o tho\u00e1ng qua, \u0111\u1ed9t qu\u1ef5. T\u1ea7n su\u1ea5t 3-11%.<\/li>\n
                      • T\u1eed vong:<\/li>\n<\/ul>\n

                        + V\u1edbi PT BCCV \u0111\u01a1n thu\u1ea7n v\u00e0 m\u1ed5 ch\u01b0\u01a1ng tr\u00ecnh: 0,5-3%; m\u1ed5 c\u1ea5p c\u1ee9u: 10-30%.<\/p>\n

                        + V\u1edbi PT BCCV k\u1ebft h\u1ee3p ph\u1eabu thu\u1eadt van tim, m\u1ed5 ch\u01b0\u01a1ng tr\u00ecnh: 3-5%.<\/p>\n

                        PH\u1eaaU THU\u1eacT B\u1eaeC C\u1ea6U CH\u1ee6 V\u00c0NH KH\u00d4NG D\u00d9NG TU\u1ea6N HO\u00c0N NGO\u00c0I C\u01a0 TH\u1ec2 (OPCAB)<\/h2>\n

                        \u0110\u1ecbnh ngh\u0129a: OPCAB l\u00e0 PTBCCV quy \u01b0\u1edbc ho\u1eb7c x\u00e2m l\u1ea5n t\u1ed1i thi\u1ec3u nh\u01b0ng kh\u00f4ng s\u1eed d\u1ee5ng THNCT. \u0110\u1ec3 th\u1ef1c hi\u1ec7n mi\u1ec7ng n\u1ed1i, c\u1ea7n s\u1eed d\u1ee5ng d\u1ee5ng c\u1ee5 c\u1ed1 \u0111\u1ecbnh v\u00f9ng tim (v\u00ed d\u1ee5 Octopus), ch\u1ec9 cao su ch\u1eadn d\u00f2ng, shunt n\u1ed9i m\u1ea1ch v\u00e0nh (intra-coronary shunt), b\u1ed9 th\u1ed5i ph\u1eabu tr\u01b0\u1eddng v\u00e0 d\u1ee5ng c\u1ee5 n\u1ed1i \u0111\u1ea7u g\u1ea7n (v\u00ed d\u1ee5 Enclose II) n\u1ebfu c\u00f3.<\/p>\n

                        Ch\u1ec9 \u0111\u1ecbnh:<\/p>\n

                          \n
                        • B\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i > 65-70, c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh s\u1eed d\u1ee5ng THNCT.<\/li>\n
                        • Nhi\u1ec1u b\u1ec7nh n\u1ec1n: suy th\u1eadn n\u1eb7ng, suy gan, c\u00f3 t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh ho\u1eb7c nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 cao, COPD, b\u1ec7nh m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean ti\u1ebfn tri\u1ec3n, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i (LVEF < 35%).<\/li>\n
                        • Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh:<\/li>\n
                        • C\u00f3 h\u1edf van hai l\u00e1 ho\u1eb7c \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 m\u1ee9c \u0111\u1ed9 trung b\u00ecnh-n\u1eb7ng tr\u1edf l\u00ean ho\u1eb7c c\u00f3 ph\u1eabu thu\u1eadt van tim k\u00e8m theo.<\/li>\n
                        • PTBCCV c\u1ea5p c\u1ee9u, s\u1ed1c tim.<\/li>\n
                        • Ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i suy gi\u1ea3m n\u1eb7ng LVEF \u2264 20%.<\/li>\n<\/ul>\n
                          \"phau-thuat-bac-cau-chu-vanh\"
                          H\u00ecnh 1. Ph\u1ee9c h\u1ee3p c\u1ea7u n\u1ed1i ch\u1eef Y s\u1eed d\u1ee5ng 2 \u0111\u1ed9ng m\u1ea1ch ng\u1ef1c trong tr\u00e1i v\u00e0 ph\u1ea3i.<\/figcaption><\/figure>\n
                          \"phau-thuat-bac-cau-chu-vanh-1\"
                          H\u00ecnh 2. Nguy\u00ean l\u00fd PTBCCV kh\u00f4ng d\u00f9ng THNCT.<\/figcaption><\/figure>\n

                          PH\u1eaaU THU\u1eacT B\u1eaeC C\u1ea6U CH\u1ee6 V\u00c0NH \u00cdT X\u00c2M L\u1ea4N<\/h2>\n

                          Tr\u00ean c\u01a1 s\u1edf m\u1ed9t s\u1ed1 \u00edt b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng nhi\u1ec1u nh\u00e1nh \u0110MV nh\u01b0ng kh\u00f4ng th\u1ec3 t\u00e1i t\u01b0\u1edbi m\u00e1u ho\u00e0n to\u00e0n ho\u1eb7c \u0111\u00e3 c\u00f3 can thi\u1ec7p nh\u00e1nh kh\u00e1c ngo\u00e0i \u0110MV li\u00ean th\u1ea5t tr\u01b0\u1edbc, PTBCCV \u00edt x\u00e2m l\u1ea5n ra \u0111\u1eddi. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y c\u00f3 kh\u00e1c bi\u1ec7t l\u00e0 m\u1edf ng\u1ef1c tr\u00e1i tr\u01b0\u1edbc b\u00ean thay v\u00ec m\u1edf x\u01b0\u01a1ng \u1ee9c, v\u00ec v\u1eady nh\u1eb9 nh\u00e0ng h\u01a1n do tr\u00e1nh \u0111\u01b0\u1ee3c c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a m\u1edf x\u01b0\u01a1ng \u1ee9c. Ban \u0111\u1ea7u, ch\u1ec9 m\u1ed9t c\u1ea7u n\u1ed1i t\u1eeb \u0111\u1ed9ng m\u1ea1ch ng\u1ef1c trong tr\u00e1i xu\u1ed1ng \u0110MV xu\u1ed1ng tr\u01b0\u1edbc tr\u00e1i \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n (MIDCAB). Hi\u1ec7n t\u1ea1i, v\u1edbi c\u00e1c d\u1ee5ng c\u1ee5 \u0111\u1eb7c bi\u1ec7t, c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n nhi\u1ec1u c\u1ea7u n\u1ed1i t\u1edbi t\u1ea5t c\u1ea3 c\u00e1c nh\u00e1nh ch\u00ednh \u0110MV (PTBCCV \u00edt x\u00e2m l\u1ea5n \u0111\u00fang ngh\u0129a: MICSCAB). M\u1ea1ch gh\u00e9p \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng t\u01b0\u01a1ng t\u1ef1 nh\u01b0 PTBCCV truy\u1ec1n th\u1ed1ng.<\/p>\n

                          Ch\u1ec9 \u0111\u1ecbnh cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u2265 70-80 tu\u1ed5i, ch\u1ec9 c\u1ea7n 1-2 c\u1ea7u n\u1ed1i (ch\u1ee7 y\u1ebfu b\u00ean tr\u00e1i), th\u1ec3 tr\u1ea1ng k\u00e9m, c\u00f3 nhi\u1ec1u b\u1ec7nh n\u1ec1n k\u1ebft h\u1ee3p.<\/p>\n

                          Th\u00f4ng th\u01b0\u1eddng s\u1eed d\u1ee5ng 1 \u0111\u1ed9ng m\u1ea1ch ng\u1ef1c trong tr\u00e1i v\u00e0 1-2 t\u0129nh m\u1ea1ch hi\u1ec3n. Tuy nhi\u00ean c\u1ea7n c\u00e1c d\u1ee5ng c\u1ee5 t\u01b0\u01a1ng \u0111\u1ed1i \u0111\u1eb7c bi\u1ec7t m\u1edbi c\u00f3 th\u1ec3 l\u1ea5y \u0111\u1ed9ng m\u1ea1ch ng\u1ef1c trong tr\u00e1i, ph\u1ea3i.<\/p>\n

                          \"phau-thuat-bac-cau-chu-vanh-2\"
                          H\u00ecnh 3. PTBCCV \u00edt x\u00e2m l\u1ea5n qua \u0111\u01b0\u1eddng m\u1edf ng\u1ef1c tr\u00e1i t\u1ea1i Vi\u1ec7n Tim.<\/figcaption><\/figure>\n

                          PH\u1eaaU THU\u1eacT B\u1eaeC C\u1ea6U CH\u1ee6 V\u00c0NH K\u1ebeT H\u1ee2P V\u1edaI C\u00c1C PH\u1eaaU THU\u1eacT TIM KH\u00c1C<\/h2>\n

                          Khuy\u1ebfn c\u00e1o<\/h3>\n
                            \n
                          • PT BCCV \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u1edf b\u1ec7nh nh\u00e2n c\u1ea7n ph\u1eabu thu\u1eadt tim n\u1ebfu c\u00f3 h\u1eb9p > 50% th\u00e2n ch\u00ednh \u0110MV tr\u00e1i ho\u1eb7c > 70% c\u00e1c nh\u00e1nh ch\u00ednh kh\u00e1c (lo\u1ea1i 1, m\u1ee9c ch\u1ee9ng c\u1ee9 C).<\/li>\n
                          • S\u1eed d\u1ee5ng \u0111\u1ed9ng m\u1ea1ch ng\u1ef1c trong tr\u00e1i \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o b\u1eafc c\u1ea7u v\u00e0o \u0110MV xu\u1ed1ng tr\u01b0\u1edbc tr\u00e1i (lo\u1ea1i lla, m\u1ee9c ch\u1ee9ng c\u1ee9 C).<\/li>\n
                          • N\u00ean PTBCCV cho b\u1ec7nh nh\u00e2n h\u1eb9p > 50% c\u00e1c nh\u00e1nh ch\u00ednh \u1edf b\u1ec7nh nh\u00e2n c\u1ea7n ph\u1eabu thu\u1eadt ngo\u00e0i tim (lo\u1ea1i lla, m\u1ee9c ch\u1ee9ng c\u1ee9 C).<\/li>\n<\/ul>\n

                            Ph\u1eabu thu\u1eadt k\u1ebft h\u1ee3p<\/h3>\n
                              \n
                            • PT BCCV k\u1ebft h\u1ee3p ph\u1eabu thu\u1eadt t\u1ea1o h\u00ecnh ho\u1eb7c thay van hai l\u00e1.<\/li>\n
                            • PT BCCV k\u1ebft h\u1ee3p ph\u1eabu thu\u1eadt thay van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.<\/li>\n
                            • PTBCCV k\u1ebft h\u1ee3p c\u1eaft kh\u1ed1i ph\u1ed3ng th\u1ea5t tr\u00e1i ho\u1eb7c \u0111\u00f3ng th\u00f4ng li\u00ean th\u1ea5t sau nh\u1ed3i m\u00e1u (PT Dor, Daggett).<\/li>\n
                            • PT BCCV k\u1ebft h\u1ee3p ph\u1eabu thu\u1eadt tim kh\u00e1c nh\u01b0 Bentall, l\u1ea5y u nh\u0129 tr\u00e1i…<\/li>\n<\/ul>\n

                              \u0110I\u1ec0U TR\u1eca N\u1ed8I KHOA SAU PH\u1eaaU THU\u1eacT<\/h2>\n

                              Thu\u1ed1c kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u<\/h3>\n
                                \n
                              • Aspirin d\u00f9ng s\u1edbm (b\u1eaft \u0111\u1ea7u 6 gi\u1edd sau ph\u1eabu thu\u1eadt) \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 t\u1eafc s\u1edbm c\u1ea7u n\u1ed1i t\u0129nh m\u1ea1ch v\u00e0 gi\u1ea3m c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch kh\u00e1c. Li\u1ec1u \u0111\u1ea7u 240-320 mg, duy tr\u00ec 81 mg\/ng\u00e0y.<\/li>\n
                              • Clopidogrel 75 mg\/ng\u00e0y \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n d\u1ecb \u1ee9ng ho\u1eb7c kh\u00f4ng dung n\u1ea1p aspirin ho\u1eb7c \u0111\u01b0\u1ee3c d\u00f9ng ph\u1ed1i h\u1ee3p v\u1edbi aspirin sau h\u1ed9i ch\u1ee9ng m\u1ea1ch v\u00e0nh c\u1ea5p.<\/li>\n<\/ul>\n

                                Thu\u1ed1c kh\u00e1ng vitamin K<\/h3>\n

                                \u0110\u01b0\u1ee3c d\u00f9ng khi b\u1ec7nh nh\u00e2n c\u00f3 thay van tim c\u01a1 h\u1ecdc \u0111i k\u00e8m ho\u1eb7c rung nh\u0129. M\u1ee9c INR c\u1ea7n \u0111\u1ea1t: xem Ph\u00e1c \u0111\u1ed3 33.<\/p>\n

                                Thu\u1ed1c nh\u00f3m statin<\/h3>\n

                                \u0110\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n sau PTBCCV v\u1edbi m\u1ee5c ti\u00eau h\u1ea1 LDL-C < 55 mg\/dL.<\/p>\n

                                C\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh n\u1ec1n kh\u00e1c nh\u01b0:<\/h3>\n

                                T\u0103ng huy\u1ebft \u00e1p, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, b\u1ec7nh th\u1eadn m\u1ea1n, b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i vi.<\/p>\n

                                T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/h2>\n
                                  \n
                                1. Virani SS, Newby K, Arnold SV, et al. 2023 AHA\/ACC\/ACCP\/ASCP\/NLA\/PCNA Guideline for the management of patients with chronic coronary disease: A report of the American Heart Association\/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148.DOI:10.1161\/CIR0000000000001168.<\/li>\n
                                2. Hillis D, Smith PK, Anderson JL et al. 2011 ACCF\/AHA Guideline for Coronary Artery Bypass Graft Surgery. J Am Coll Cardiol 2011;58.<\/li>\n
                                3. Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC\/EACTS Guidelines on myocardial revascularization. Euro Heart J 2019; doi:10.1093\/eurheartj\/ehy394.<\/li>\n
                                4. Kirklin JW, Barrat-Boyes B. Cardiac Surgery, 4th edition, 2013. Chapter 7, p.354-428.<\/li>\n
                                5. LH Cohn. Cardiac Surgery in Adult, 3rd edition. Mc Graw Hill 2008. Chapter 22.<\/li>\n
                                6. Gaudino M, Angelini GD, Antoniades C, et al. Off-pump coronary artery bypass grafting: 30 years of debate. JAHA 2018;7(26), DOI: 10.1161\/JAHA.118.009934.<\/li>\n
                                7. V\u0103n H\u00f9ng D\u0169ng. Ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u \u0110MV cho ng\u01b0\u1eddi gi\u00e0 tr\u00ean 70 tu\u1ed5i. T\u1ea1p ch\u00ed Ph\u1eabu thu\u1eadt Tim m\u1ea1ch v\u00e0 L\u1ed3ng ng\u1ef1c Vi\u1ec7t Nam, s\u1ed1 20, th\u00e1ng 5 n\u0103m 2018, pp 129-13.<\/li>\n
                                8. V\u0103n H\u00f9ng D\u0169ng. B\u1eafc c\u1ea7u ch\u1ee7 v\u00e0nh s\u1eed d\u1ee5ng to\u00e0n b\u1ed9 c\u1ea7u n\u1ed1i l\u00e0 \u0111\u1ed9ng m\u1ea1ch: k\u1ebft qu\u1ea3 b\u01b0\u1edbc \u0111\u1ea7u. Y h\u1ecdc Vi\u1ec7t Nam s\u1ed1 \u0111\u1eb7c bi\u1ec7t th\u00e1ng 11\/2010, t\u1eadp 375, trang 161-167.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

                                  Xem v\u00e0 t\u1ea3i file PDF t\u1ea1i \u0111\u00e2y. \u0110\u1ecaNH NGH\u0128A Ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u ch\u1ee7-v\u00e0nh (PTBCCV) l\u00e0 m\u1ed9t ph\u01b0\u01a1ng th\u1ee9c t\u00e1i t\u01b0\u1edbi m\u00e1u d\u00f9ng m\u1ea1ch gh\u00e9p t\u1ef1 th\u00e2n \u0111\u1ec3 b\u1eafc c\u1ea7u qua c\u00e1c \u0111\u1ed9ng m\u1ea1ch v\u00e0nh (\u0110MV) ch\u00ednh b\u1ecb h\u1eb9p ho\u1eb7c t\u1eafc. S\u01a0 L\u01af\u1ee2C L\u1ecaCH S\u1eec PH\u1eaaU THU\u1eacT B\u1eaeC C\u1ea6U CH\u1ee6-V\u00c0NH Alexis Carrel l\u00e0 ng\u01b0\u1eddi \u0111\u1ea7u […]\n","protected":false},"author":1,"featured_media":155675,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-155674","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/posts\/155674","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/comments?post=155674"}],"version-history":[{"count":1,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/posts\/155674\/revisions"}],"predecessor-version":[{"id":155680,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/posts\/155674\/revisions\/155680"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/media\/155675"}],"wp:attachment":[{"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/media?parent=155674"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/categories?post=155674"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/tags?post=155674"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}