IU TR NMCT CP

1.Gim au : + morphin 2-4mg (IV), lp li sau 5'. c th thay bng

meperidin hoc hydromorphine
Td ph :h huyt p do gin TM ( nm cao chn, truyn dch, k xi
vn mch ), nn ( domperidon, metoclopramide), cng ph v (x tr
bng atropin 0,5mg IV ).
+ nitrat : nitroglycerin 0,4mg ( ngm di li ) >> nitro truyn TM
+chn beta TM
+ khng nn xi corti, NSAID tr aspirin
2.Th oxy : canula hay mask
3.Vn ng
- Trnh vn ng trong nhng gi u trnh lan rng nhi mu
v 6-8 tun lin so nhi mu.
-Trc khi ra vin nn lm nghim php gng sc.Nu thiu mu
xy ra lc ngh hoc thiu mu/h HA khi hot ng gng sc nh th
nn chp mch vnh >> PTCA hoc CABG.
4.Ch n
-t calo chia lm nhiu ba nh, t mui, t cho cholesterol.
-n nhiu cht x trnh to bn do suy tim
- n thc n c cha Kali do xi li tiu mt Kali
-To bn >> i ti ging, n nhiu cht x, dng dioctyl
sulfosuccinat natri 200mg/ngy , nhun trng nh sorbitol.
5.An thn : diazepam 5 mg (seduxen )
6.Chng ng v chng kt tp tiu cu
-Dng aspirin cng sm cng tt : 325 mg ngy u >> duy tr
81mg/ngy
- Heparin 5000 IU ( IV ) , sau duy tr truyn 1000 IU/ gi , chnh
INR =1,5-2
-Khng K nn xi 3-6 thng sau nhi mu , nht l nhi mu trc
rng hoc c suy tim sung huyt
7.Chn beta : Metoprolol IV 5mg mi 5-10', tng liu 15mg , sau
meto ung 50-100mg, 2 ln/ngy hoc Atenolol 50-100mg , 1
ln/ngy
8.Khc : - ACEI (theo nghin cu SAVE ) Captopril 50mg , 3
ln/ngy
- MgSO4 (IV) ; chng lon nhp, gim chuyn ha c tim :
8mmol trong 15'.sau 65mmol /24 gi
- chn canxi : KHNG nn xi
TIU SI HUYT

1.Thi gian : tt nht 1-3 gi u, tuy nhin hiu qu cho php ti

12h.
2. thuc : streptokinase, APSAC ,tPA
- Strepto : 1,5 triu IU TTM trong 1 gi
-APSAC :liu duy nht 30mg
-tPA : khi u 5-10mg (IV), sau 60mg gi u tin, 20 mg gi 2
v 3.Tng liu 100mg
3.Chng ch nh tuyt i
-Tin s stroke
-Mi phu thut < 2 tun hoc th thut gy chy mu
-hypertension nng ( 3 theo JNC VI)
-Lot d dy t trng ang tin trin
4.Bin chng : nng nht l xut huyt no, c bit trn 65 tui.
5. Nu NMCT ti pht : ch c lp li tPA vi liu 50% , KHNG
c lp li Strepto v APSAC do 2 ny l khng nguyn, s gy
phn ng qu mn.
PTCA (percutaneous transluminal coronary angioplasty )
1.Ch nh :
- DTN khng n nh
-DTN n nh , m NPGS dng tnh
- Ti hp sau khi lm CABG
-Khng nn lm BN hp LCA v hp 3 ba DMV.
2. Nguy c cao : n, tui cao, hp LAD, c huyt khi,vi ha, ri
lon chc nng tht tri, hp DM ti mu cho khi lng ln c
tim, hp di lch tm, k c THBH.
3. Hiu qu v theo di
- thnh cng 85-90%
-Hp ti pht : 20-40% trong 6 thng , v 20% trong 12 thng.
-Sau khi lm PTCA, nn dng aspirin v chn calci
CABG ( CORONARY ARTERY BINDING GRATF )
1. ch nh : hp RCA hoc hp 3 dmv
2.i tng : nam gii. di 70 tui, khng c bnh khc , triu
chng nng n, iu tr ni khoa khng gim.
Ngun : harrison