KHAO SAT SIT DAN HOI DONG MACH CHU IS BENH NHAN TANG HUYET AP NGUYEN PHAT B&NG SIEU AM TIM

NGUYiN TH! THUY hAnG - Tru&ng Dai hqc Y Duxyc Hue

TOM TATDdt van de:TSng huyet ip anh huong tn/c tiep

len c iu true chuc n ing cua tim v i mach m iu lim giim tinh d in hdi dpng mach chu. Nghien ciru s i/ d in hoi dong m$ch chu b ing sieu im tim gdp ph in dinh g ii nhCrng thay doi tim mach tren doi tuong THA. Muc tieu cua nghien ciru l i kh io s it c ic chi so cua do d in hoi DMC tr6n doi tuxyng THA nguyen p h it v i tim mdi tuong quan c ic chi sd n iy v&i chi so khoi co th it trii. Doi tuxyng v i phuong phip nghiin cuu: Nghiin ciru duxyc tiin h inh trin 30 b inh nhin THA, tuoi trung binh 47,43 ± 5,83, cd so s inh v&i 30 ngu&i nhdm chu’ng. T it c i deu duxyc s iiu im tim do du&ng kinh DMC ky tim thu v i tim truong, khdi co th it trii. Ket qui: chi so dd cirng DMC cao hon, sue cing DMC v i chi s6 gian n& th ip hon & nhdm THA so v&i nhdm chirng cd y nghTa thong k i (p < 0,05 ). Chi s6 gian n& DMC v i sire c ing DMC ty l i nghjch v&i chi sd khdi co th it trii. Chi sd dd cirng DMC ty l i thuin v&i khdi co th it t r ii (p < 0,05). Ket luin: Do d in hdi DMC g iim & binh nhin THA v i g iy h$u qu i lin th it trii, l i y iu td d i/ doin nguy c& tim mach.

Tir khda: D in hdi ddng mach chu, tin g huyit ip nguyin phit, s iiu im tim

SUMMARYEVALU ATIO N O F A O R TIC E L A S TIC ITY ON TH E

PRIMARY H Y P E R TE N S IV E S BY EC H O C A R D IO G R A P H YNguyen Thi Thuy Hang (Hue College of Medicine

and Pharmacy)Background: Hypertension, affecting directly

cardiovascular structure and function, reduces aortic elasticity. Studying on aortic elasticity in the primary hypertensives by echocardiography contributes to evaluate cardiovascular changes. Aims: was to estimate the indexes o f aortic elasticity in the primary hypertensives and the correlation between them and left ventricular mass index. Subjects and Methods: this study was carried on 30 primary hypertensives, mean age: 47.43 ± 5.83 and compared with normotensive control group. They are all under echocardiography to measure systolic aortic diameter and diastolic aortic diameter, left ventricular mass, and left ventricular mass index. Results: Aortic stiffness is significantly higher and aortic strain and aortic distensibility are significantly lower in the hypertensives than the normotensive control group (p< 0.05). There are negative correlation between left ventricular mass index and both aortic strain and aortic distensibility. In contrast, there is positive correlation between aortic stiffness and left ventricular mass index (p < 0.05). Conclusions: Aortic elasticity in the primary hypertensives decreases, which has repercussions on left ventricular mass, so it is a

predictor of cardiovascular nsk factorsKeywords: aortic elasticity. primary

hypertensives, echocardiographyOAT VAN 0£Tfeng huyet cip (THA) <33 v i dang trb th3nh mfet

van de quan trong cua sue khoe cfeng d6ng & c ic nubc tren the gibi. THA anh huang true t iip Ifen ciu true chuc nfeng cua tim v i mach mfeu, 13m gifem tinh dfen h6i dfeng mach chu (OMC) [8] Vbi su phfet triln ng3y c3ng ho3n thien cua c3c phuang phfep thfem db chuc nang tim mach cho phfep chung ta nghifen cuu sfeu han cfec bien chung cua THA, dfec bifet trfen chuc nfeng cua DMC. Trong d6 sifeu 3m tim 13 phuang phfep th3m d6 khfeng chay m3u, an to3n, c6 th i Ifep di Ifep lai. Nhiiu nghifen cuu trfen th i gibi d3nh gi3 dfec tinh d3n h6i OMC bing sifeu 3m tim a bfenh nh3n THA ghi nhfen d3n h6i cua OMC giup du b3o nguy ca bfenh mach v3nh nbi rifeng v3 13 y iu t l du do3n ty Ife ti> vong a bfenh THA [4],[5], [6]

Cf nubc ta chua cb nhiiu nghifen cuu v l su d3n h ii OMC trfen d ii tuang THA. Do db, chung tfei thuc hifen d l t3i n3y nhlm 2 myc tifeu: X ic djnh c ic chi sd d in hdi cua ddng mgeh chu tr in b inh nhin ting huyit ip b ing s iiu im tim; K h io s it mdi tuong quan giCra d ie tinh d in hdi dong mach chu v&i chi sd khdi co th it t r ii

0 6 l TU’QNG VA PHIPONG PHAP NGHIEN Cl>U1. Obi tuang nghifen cu>u30 bfenh nhfen d3 duac ch in doan THA nguyfen

phfet, dua v3o ph3n loai THA theo Ph3n hfei THA Vifet Nam nfem 2010 [1], tu ii tu 18 - 55, d in kh3m tai Bfenh vifen Trubng Oai hoc Y Duac H u l thbi gian tu 5/2012 d in 5/2013. So sfenh vbi 30 ngubi nhbm chung khoe manh, cb HA < 120/80 mmHg, cb phfen bo tuoi v3 gibi tuang duang vbi nhbm nghifen cuu.

-Tieu chu in loai trip: + Bfenh nhfen m ic c3c bfenh ly tim mach khfec I3m anh huang k it qua nghifen cuu; + Ngubi hut thu ic 13, nghifen bia ruau, cb r ii loan lipid mfeu, hbi chung chuyen hoa, d3i th3o dubng.

2. Phipang phfep nghien ct>u2.1. T h iit k i nghiin ciru: nghien cuu mb ta d t

ngang cb so s3nh vbi nhbm chirng2.2. Phuong ph ip thuc h iin : Do cfen nfeng, chilu

cao, tinh difen tich da vfe chi s i kh li ca th i. Do huyit fep a tu th i ngli, theo hubng dfen cua Phfen hfei THA Vifet nam [1], do trubc khi Ifem sifeu fern tim.

- T iin hanh do trfen sifeu fern tim: mfey sifeu fem Phillips vbi d iu 3.5 MHz cb kha nfeng cho hinh anh sifeu fem TM, 2D, Doppler mfeu, Doppler xung, Doppler lifen tuc

Dfet d iu db a lifen subn 2, 3 canh ire trfei, khao sfet tofen bfe tim qua hai binh difen theo mfet c it canh

80 Y HOC THUC HANH (90S) - SO 2/2014

i/c iryc 09c, mu u u u c u u v/ov# u i f in Q s6 n g h id n c l p u ,

sir dyng hai nhat d t qua th it ghi b bb ty do cua van hai 13 va nh3t d t qua DM chu.

Do theo khuydn c3o HOi Sibu am Hoa Ky (American Society of Echocardiography) bing sibu am M-mode c3c thbng sd hinh thai dd tinh khdi co thit tr3i. Oipbng kinh dbng mach chu tbm thu (AODs) va tam truang (AODd) duac do trbn mipc van OMC khoang 3 cm ti> bb tapbc thanh trLPbc ddn bb tru’bc thanh sau cua OMC, do b 3 chu ky tim lidn tidp va liy trj trung binh [2],

2.3. C ic thdng sd thu th ip trong nghiin ciru- Chi s6 danh gia sy dan hbi DMC: dLPOc xac djnh

tip ba chi sd:+ Sipc cang OMC (Aortic strain) (%): S lpc cang

AO % = (AODs-AODd) * 100 /AODs+ Chi s6 db cilpng cua DMC (Aortic stiffness): Ob

cbng AO = log (HATT/HATTr)/[(AODs-AODd)/AODd]+ Chi s6 gian nb OMC (Aortic distensibility)

(cm2/dyn)Chi sd gi3n nb AO = (2*Aortic strain)/(HATT -

HATTr) [6]Sy giim tinh dan hbi khi tang db cipng va giam

sue cang dbng mgch chu.- Chi s6 khbi ca th it trai: Dby th it trai khi: NO- £

95 g/m2; Nam s 115 g/m2 [2].3. XCf ty s6 li$u: theo phirong phip thong k i y

hqc thdng thu&ngkEt q u A1. D$c didm hai nhbm nghien cu>uBing 1: D$c didm chung vd cbc doi tu-yng nghien

CU’U

3. Mbi tu’ang quan giOa db d3n hbi dbng mach chu vbi chi sb khbi ca th i t trai

Thbng s6 Nhbm THA (n = 30)

Nh6m chbng (n = 30) P

Tu6i 47,43 ±5,83 47,03 ± 5,92 > 0,05Gibi Nam 20 (66,7%) 20 (66,7%) >0,05

NCr 10(33,3%) 10(33,3%) >0,05BMI 21,01 ± 1,14 19,7 ±1,05 > 0,05

HATT (mmHg) 151,6 ± 18,2 105,5 ±6,6 <0,01HATTr (mmHq) 74,1 ±5,3 -v . . .

73,2 ±5,1 <0,01------- — — — ------- J ------ — T* - - - - - - — ' T ' ' — — — I

gibi, chidu cao can nSng (p>0,05). Huyet bp tam thu (HATT) va huyet 3p tam truang (HATTr) a nhbm b$nh ddu cao han nhbm chipng cb y nghTa (p<0,01).

2. D3c di&m do dan hbi dong mach chu cua hai nhbm nghien ci>u

Bang 2: D3c didm db dan hbi dbng mach chu b <J6i tiling nghien c lp u

Th6ng s6 Nhbm THA (n = 30)

Nhbm chipng (n = 30) P

AODs (mm) 32,59 ±4,5 28,6 ± 3,07 <0,05AODd (mm) 30,35 ± 4,39 23,21 ±3,57 <0,05

Su-c cSnq DMC (%) 7,88 ±4,84 16,9 ±7,83 <0,01cirnq OMC 14,3 ±6.34 5,42 ± 2,45 <0,01

Chi s6 gian nb OMC _ (cm2/dvnj 0,29 ± 0,09 1,25 ±0,58 <0,01

Nhbm THA cb AODs, AODd, db cipng DMC Ibn hen nhbm chipng cb y nghTa thdng kb (p<0,01, P<0,05). Vd sipc cang OMC, nhbm chipng cao han nhbm THA cb y nghTa th6ng kb (p<0,01).

Thbng s6 Nhbm THA (n = 30)

Nhbm chirng (n = 30) P

Kh6i ca thiit trdi (g) 157,92 ± 65,32 98,74 ±21,21 <0,05

Chi s6 kh6i co1 th£t tr£i (g/m2) 96,54 ±39,14 63,40 ± 16,28 <0,05

Khdi ca th it trai va chi sd kh< benh cao han nhbm chipng c

ji ca th it trbi a nhbm b y nghTa thdng ke

(p<0,05).Bang 4. TLPang quan giua chi so khoi ca th it trai va

chi sb dan hoi dong mach chuThbng s6 r P

Sire Ccing (% ) -0,26 <0,05Chi s6 db cirng 0,30 <0,05

Si/ gian nb (cm‘\dyn'l .10'J) -0,32 <0,05

cang OMC, chi sb gian nb DMC vb chi sb khbi ca th it tr3i vbi r = -0,26, r = -0,32, p < 0,05. Tu’ang quan thuan giua db cbng OMC vb chi s6 khbi ca th it trai vbi r = 0,30, cb y nghTa thbng ke vbi p < 0,05.

b An l u a nTrong nghibn cipu cua chiing tbi, cbc d6i tu’ang

nghibn cipu ddu nim trong db tudi tu’ 18 d in 55 vl theo nhieu nghibn cipu ghi nhbn db dbn hdi OMC tang theo tudi, dac bibt tip tuoi 55 [3] nbn d l tranh anh huang cua tudi tac dbng Ibn db dbn hbi DMC chiing tbi chon lipa tuoi nby. Trong nghibn cipu chiing tbi chQn nhCpng d6i tu’ang cb chi s6 khbi ca the (BMI) trong gibi hgn binh thubng vi thipa cbn vb bbo p h i cung anh h LP b n g Ibn db dbn hbi DMC. Chiing tbi chon vbo nghibn cbu nhbm bbnh vb nhbm chu’ng cb ty le v d gibi tu’ang duang nhau vi sy khbc bibt vb gibi cung anh hu>bng den k it qua nghibn cipu. Cf nhbm THA cb HATT vb HATTr cao han a nhbm chu’ng cb y nghTa thong kb (p<0,01).

Nghibn cipu ghi nhbn, nhbm THA cb AODs, AODd, db cipng OMC Ibn han nhbm chipng cb y nghTa thbng kb (p<0,01, p<0,05). Vd sipc cbng OMC, nhbm chipng cao han nhbm THA cb y nghTa (p<0,01). Do dbn hbi DMC tdt khi do cbng DMC giam vb sipc cbng thbnh OMC, chi sd gian nb OMC tbng, cbn ngu>ac lai lb do dbn hdi OMC giam. Db cipng DMC duac xem nhu- lb d iu hibu cua bbnh tim mach [3], Ket qua nby cua chiing tbi cOng phu hap vbi ket qua cua mbt sd tbc gia nLPbc ngobi khbc nhu1 Erdogan D, Lulzim Kamberi, Meenakshisundaram R. [5], [7], [8], Theo Demellis J., Panaretou M. (2005), db cipng OMC ia yeu td dy dobn dibn tien thbnh THA tu’ang lai b doi tu’ang binh thu’ang [4], Telmo Pereira vb cs (2012) nghien clpu tren 1133 benh nhbn THA, tudi trung binh 51.05 ± 12.64, ghi nhbn db cipng DM lb yeu td nguy ca gby dbt quy a benh nhbn THA [10],

Nghien cipu chiing tbi cho thay cb mdi tu’ang quan thubn gitra chi sd khdi ca th it trbi vb chi sd db cipng DMC, trbi lai cb mdi tu’ang quan nghjch giua chi sd khdi ca th it trbi vb sipc cbng vb sy gibn nb DMC, kdt qua nby phu h<?p vbi kdt qua cua mbt sd tbc gia nhy C D. Gatzka, Meenakshisundaram R. [6], [8], Theo C. D.

Y HOC THUC HANH (905) - S6 2/2014 81

Gatzka (2002), <36 cung DMC dll’ <3oan nguy ca tim mach tuang lai va dac biet la ty le tu vong do benh mach vanh trong dan cu. Su cung OMC lam tang cong co bop that trai, vi vay d in d in phi dai that trai vai nhu cau luu luang mau mach vanh cao han [6]. Phi dai th it trai du doan benh tim mach trong tuang lai a cac doi tuang tang huyet ap. Meenakshisundaram (2009) nghien c lpu a Nam An Do 30 ngudi THA c6 thdi gian bi benh tu 5 nam trd len va 30 ngudi THA c6 thdi gian bi bfenh tu 6 thang d in 1 nam c6 so sanh vdi nhdm chung th iy ring THA kfeo dai tac ddng Ifen su dan h ii DMC, h|u qua ia iam tang khii ca th it trai. Qua dd tac gia khing dinh, vai trd THA nhu ia mdt yeu t6 dan le iam tang dd cung OMC va d in d in hau qua tren th it trai d benh nhan THA [8], [9], Erdogan D. (2007) cung ghi nhan ia chi s6 khoi ca th it trai tuang quan nghich vdi su gian nd OMC va tuang quan thuan vdi chi s i cung OMC [5]. Lulzim Selim Kamberi (2013), nghibn cuu 140 bfenh nhan chia iam hai nhdm, d nhdm THA ghi nhan, sue cang, tinh gian OMC giam va dd cung OMC tang so vdi nhdm chung, sau 2 nam diiu tri ha huyet ap va Statin d nhdm THA cho th iy cai thifen rd chuc nang OMC [7], D iiu nay cho thay su c in th iit d iiu trj va kiem soat trj s i HA cd the iam ngung tinh trang cung OMC, qua dd giam nguy ca tim mach d benh nhan THA.

k £t lua n- 06 cung OMC tang cd y nghla va sue cang, chi

so gian nd DMC giam cd y nghla d nhdm THA han so vdi nhdm chung cd huyit ap binh thudng (P<0,01).

- & nhdm THA, cd moi tuang quan nghjch giO-a sue cang DMC, chi so gian nd DMC vdi chi s i khoi ca th it trai, tuang quan thuan giua do cung DMC va chi s i khii ca that trai (p < 0,05).

tA i lieu th a m k h A o1. Guideline tang huyet ap cua Ph5n hdi Tang h u y e t

ap Viet Nam, 20102. Nguyen Anh Vu (2010). Sieu &m tim a ip nh$t

chan do&n, NXB Oai hoc Hue.3. M.Cecelja, P. Chowienczyk (2012). Role of

arterial stiffness in cardiovascular disease. JRSM Cardiovascular Disease, 4 (1).

4. Dernellis J., Panaretou M (2005) Aortic stiffness is an independent predictor of progression to hypertension in nonhypertensive subjects. Hypertension. 45(3), pp. 426-431.

5. Erdogan D., Caliskan M . Yildinm I., Gullu H., Baycan S., Ciftci O., Yildirir A., Mudemsoglu H. (2007), Effect of normal blood pressure, prehypertension and hypertension on left ventricular diastolic function and aortic elastic properties, Blood Pressure, 16, pp. 114-121.

6 Gatzka C. D., Cameron J D , Kingwell B. A(2002), Relation between coronary artery disease, aortic stiffness, and left ventricular structure in a population sample, Hypertension, 32, pp. 575 - 578

7. Lulzim Selim Kamberi, Daut Rashit Gorani, Teuta Faik Hoxha, and Bedri Faik Zahiti (2013), Aortic Compliance and Stiffness Among Severe Longstanding Hypertensive and Non-hypertensive, Acta Inform Med. 21(1): 12-15.

8 Meenakshisundaram R., Kamaraj K., Murugan S., Thirumalaikolundusubramanian P. (2009), Aortic stiffness and distensibility among hypertensives, Annals of the New York Academy of Sciences, 1173, pp. E68 - E71.

9. Turker Pabuccu, Nezihi Baris, Ebru Ozpelit, Bahri Akdeniz, Sema Guneri (2012), The Relationship between Resistant Hypertension and Arterial Stiffness, Clinical and Experimental Hypertension, 34(1):57-62

10.Telmo Pereira; Joao Maldonado; Liliana Pereira; Jorge Conde (2012), Aortic stiffness is an independent predictor of stroke in hypertensive patients, Arq. Bras. Cardiol. 100 (5)

DANH GIA CHllTC NANG TAM THU THAT TRAI TRltfC VA SAU PHAU THUAT BAC CAU NOI DONG MACH VANH KHONG DUNG TUAN HOAN NGOAI Cfl THE

TRAN VAN PHU*, TRAN VIET HUNG**, NGUYiN LAN VI$T *Hoc vien Y Dupe hqc co truyen Viet Nam, ** Benh vien Bach Mai

DAT VAN 0£Phiu thuat b ic cau noi dong mach vanh su dgng

tu in hoan ngoai ca the thudng cd nhung bien chung b it lai, chu y iu phan ung viem he thong gay ra bdi may tim phii nhan tao[0, 0], va hinh thanh eye mau d6ng do kep dong mach chu.

Nhung lai th i tiim nang cua phiu thuat kh6ng dung tu in hoan ngoai ca the bao gom, giam viem he thing, giam nguy ca hinh thanh cue mau d6ng, giam phu n§o va xung huyit ph ii sau phlu thuat [0, 0], Ngoai ra cdn giam thdi gian hSu phiu, giam su dung thuic van mach, va it nhu c iu su dyng cac san phim v i mau.

Sifeu am - Doppler tim dang m it binh difen va hai

binh difen dem lai cac thdng s i kha chinh xac v l kich thudc va th i tich th it trai [0], Danh gia chuc nang tam thu th it trai b ing cac th6ng s i sau:

Kich thudc buong th it trai (Cavity dimensions). Chuc nang toan b i th it trai (Global function).Chuc nang tryc dai (Long-axis function).B6 l TU-grNG VA PHUOTNG PHAP NGHIBN Cl/U D ii tugng nghifen cuu cua chung tdi g im 32 bfenh

nhfen dupe phiu thu$t b ic c iu n ii chu- vdnh khing su dyng tu in hoan ngoai ca th i tai Vifen Tim mach qu ic gia Vifet Nam, Khoa Phiu thuat Tim mach Bfenh vifen Oai hpc Y Dupe TPHCM trong thdri gian tir thang 4/2008 d in thang 10/2008. Khdng phan bifet tuii, gidi, nghi nghifep...

82 Y HOC THITC HANH (905) - SO 2/2014