G y m cho phut thut tim Nguy n l

39. Nh?ng khuy?n c�o trong THNCT Ph? c?p Site HAS/ s�ch CEC H?i ngh? (CFP, SFAR, chirurgie) �i?u tra th?c h�nh ? c?p d? qu?c gia (2005) Ph? c?p ti?ng ph�p v� ti?ng anh (JECT, AFAR, Journal SFCCTV) �i?u tra t? l? bi?n ch?ng sau khi c� nh?ng khuy?n c�o chung Van b?n g?i cho G� b?nh vi?n, Pr�sidents de CME, ch? nhi?m khoa (PT, GMHS) Ph? c?p c�c k?t qu? nghi�n c?u Li�n l?c v?i HAS 2007 d? c� nh?ng khuy?n c�o sau

40. �i?u tra nh?ng thi?t b? d?m b?o an to�n trong THNCT 

45. M?t nghi�n c?u h?i c?u nh?ng tai bi?n trong CEC 

64. Nh?ng bi?n ch?ng trong PT tim

72. NC ti?n c?u tr�n 11825 BN m? b?c c?u ch? v�nh (1996 � 2001) AVC= t?n thuong TK du?c ch?n do�n v� xu?t hi?n trong hon 24h sau m? T? l? AVC = 1,5 %,

74. T?n thuong �MC ?

78. Xo v?a �MC B?nh l� kh�c nhau g�y canxi h�a �MC Tang theo tu?i Kh�ng th? ph�t hi?n b?ng RX, TDM l?n s? S? d?ng si�u �m d? ph�t hi?n l� c?n thi?t (TO ho?c �pi-aortique)

80. Bi?n ch?ng TK typ II sau PT tim

81. T? l? bi?n ch?ng TK sau PT tim Type I: 1-5 % t�y theo d?nh nghia Borowicz LM et al. J.Cardiothorac.Vasc.Anesth. 1996;10:105-12 Type I: 3,2 % (2100 BN) Newman MF et al. Circulation 1996�; 94:II74-II80 Type II: 10% ��b?nh n�o�� Borowicz LM et al. 1996 L�m thay d?i c�c test do t�m th?n: 70 % Doblar DD. . J Cardiothorac.Vasc.Anesth.1996�; 10:3-14.

83. Tr�n 261 BN m? CABG C�c test TK Kh? nang nh?n th?c 53 % sau m?, 36 % sau 6 tu?n, 24 % sau 6 th�ng, 42 % sau 5 nam. N Engl J Med 2001;344:395-402 Measurement of Neurocognitive Function A brief battery of neurocognitive tests was administered before surgery (at base line), on the day before discharge (approximately seven days after CABG), and six weeks, six months, and five years after CABG (Fig. 1). Assessments were performed individually by experienced psychometricians using a well-validated battery that included five tests. The short-story module of the Randt Memory Test requires subjects to recall the details of a short story immediately after it is read to them and after a 30-minute delay. Scoring is based on both the ability of the subject to recall the story verbatim and the ability to capture its gist on immediate and delayed testing (resulting in four variable scores ranging from 0 to 10 or 0 to 20, with higher scores indicating better function). 11 The Digit Span subtest of the Wechsler Adult Intelligence Scale�Revised requires subjects, first, to repeat in numerical order a series of digits that has been presented to them orally and then, in an independent test, to repeat the digits in reverse order (resulting in two variable scores ranging from 0 to 14, with higher scores indicating better function). 12 The Benton Revised Visual Retention Test requires subjects to reproduce from memory a series of geometric shapes after a 10-second exposure (resulting in one variable score ranging from 0 to 10, with a higher score indicating better function). 13 The Digit Symbol subtest of the Wechsler Adult Intelligence Scale�Revised is a task that requires subjects to reproduce on paper, within 90 seconds, as many coded symbols as possible in blank boxes beneath randomly generated digits, according to a coding scheme for pairing digits with symbols (for one variable score ranging from 0 to 90, with a higher score indicating better function). 12 The Trail Making Test (Part B) requires subjects to connect with a line, as quickly as possible, a series of numbers and letters in sequence (e.g., 1�A�2�B) (for one variable score ranging from 1 to 300, with a lower score indicating better function). 14 Treatment of Patients during Cardiac Surgery Anesthetic management with midazolam, fentanyl, vecuronium, and a perfusion apparatus has been previously described. 2 Nonpulsatile perfusion of 2 to 2.4 liters per minute per square meter of body-surface area was maintained throughout cardiopulmonary bypass. The pump was primed with crystalloid solution designed to achieve a hematocrit of 18 percent or higher during extracorporeal circulation. Packed red cells were added when necessary to achieve the desired hematocrit. Cardiopulmonary bypass was instituted through cannulation of the ascending aorta in all patients. Arterial carbon dioxide tension was maintained at 35 to 40 mm Hg (uncorrected for temperature) throughout the cardiopulmonarybypass procedure, and the partial pressure of oxygen was maintained at 150 to 250 mm Hg. Measurement of Neurocognitive Function A brief battery of neurocognitive tests was administered before surgery (at base line), on the day before discharge (approximately seven days after CABG), and six weeks, six months, and five years after CABG (Fig. 1). Assessments were performed individually by experienced psychometricians using a well-validated battery that included five tests. The short-story module of the Randt Memory Test requires subjects to recall the details of a short story immediately after it is read to them and after a 30-minute delay. Scoring is based on both the ability of the subject to recall the story verbatim and the ability to capture its gist on immediate and delayed testing (resulting in four variable scores ranging from 0 to 10 or 0 to 20, with higher scores indicating better function). 11 The Digit Span subtest of the Wechsler Adult Intelligence Scale�Revised requires subjects, first, to repeat in numerical order a series of digits that has been presented to them orally and then, in an independent test, to repeat the digits in reverse order (resulting in two variable scores ranging from 0 to 14, with higher scores indicating better function). 12 The Benton Revised Visual Retention Test requires subjects to reproduce from memory a series of geometric shapes after a 10-second exposure (resulting in one variable score ranging from 0 to 10, with a higher score indicating better function). 13 The Digit Symbol subtest of the Wechsler Adult Intelligence Scale�Revised is a task that requires subjects to reproduce on paper, within 90 seconds, as many coded symbols as possible in blank boxes beneath randomly generated digits, according to a coding scheme for pairing digits with symbols (for one variable score ranging from 0 to 90, with a higher score indicating better function). 12 The Trail Making Test (Part B) requires subjects to connect with a line, as quickly as possible, a series of numbers and letters in sequence (e.g., 1�A�2�B) (for one variable score ranging from 1 to 300, with a lower score indicating better function). 14 Treatment of Patients during Cardiac Surgery Anesthetic management with midazolam, fentanyl, vecuronium, and a perfusion apparatus has been previously described. 2 Nonpulsatile perfusion of 2 to 2.4 liters per minute per square meter of body-surface area was maintained throughout cardiopulmonary bypass. The pump was primed with crystalloid solution designed to achieve a hematocrit of 18 percent or higher during extracorporeal circulation. Packed red cells were added when necessary to achieve the desired hematocrit. Cardiopulmonary bypass was instituted through cannulation of the ascending aorta in all patients. Arterial carbon dioxide tension was maintained at 35 to 40 mm Hg (uncorrected for temperature) throughout the cardiopulmonarybypass procedure, and the partial pressure of oxygen was maintained at 150 to 250 mm Hg.

85. Probl�mes des �tudes sur les troubles cognitifs apr�s chirurgie cardiaque Groupe(s) contr�le Cognitive outcomes three years after coronary artery bypass surgery: a comparison of on-pump coronary artery bypass graft surgery and nonsurgical controls. Selnes OA, Grega MA, Borowicz LM Jr, Barry S, Zeger S, Baumgartner WA, McKhann GM. Ann Thorac Surg. 2005 Apr;79(4):1201-9. Prospective longitudinal neuropsychological performance of patients with coronary artery bypass grafting did not differ from that of a comparable nonsurgical control group of patients with coronary artery disease at 1 or 3 years after baseline examination. This finding suggests that previously reported late cognitive decline after coronary artery bypass grafting may not be specific to the use of cardiopulmonary bypass, but may also occur in patients with similar risk factors for cardiovascular and cerebrovascular disease.

86. Postcardiac surgical cognitive impairment in the aged using diffusion-weighted magnetic resonance imaging. Cook DJ, Huston J 3rd, Trenerry MR, Brown RD Jr, Zehr KJ, Sundt TM 3rd. Ann Thorac Surg. 2007 Apr;83(4):1389-95 Among 50 patients with a mean age of 73 years, 88% demonstrated cognitive decline in the postoperative testing period while 32% showed evidence of acute perioperative cerebral ischemia by DW-MRI. At postdischarge follow-up, 30% of patients showed cognitive impairment. However, cognitive decline assessed postoperatively, or at a four to six week follow-up, was unrelated to the presence or absence of DW-MRI detected cerebral ischemia

87. Y?u t? nguy co g�y bi?n ch?ng TK typ II Tang HA t�m thu ��Ti?n s? b?nh h� h?p�� Nghi?n ru?u Tu?i Roach GW et al N.Engl.J.Med.1996�; 335:1857-63. T?c m?ch ?

89. Ph�n lo?i y?u t? nguy co bi?n ch?ng TK typ II Nguy co n?m ph�a BN TS b?nh TK, ti?n tri?n l�m s�ng c?a XV�M, c� d?c, m?c gi�o d?c th?p Nguy co ? qui tr�nh cham s�c CEC c� t�c d?ng b?o v? ? Bi?n ch?ng sau m? Bi?n ch?ng d?t ng?t sau m?

94. Y?u t? nguy co hoang tu?ng sau PT tim Nguy co ph�a BN (tru?c m?) Tu?i, �T�, ti?n s? AVC, ACFA, s?c tim, FE VG < 30 % Nguy co trong m? CEC so v?i OPCAB, tg PT > 3 h, truy?n m�u > 2l, s? d?ng l?c m�u NB: Kh�ng CEC v� tu?i < 70 kh�ng ph?i h?p l�m gi?m bi?n ch?ng

95. Theo d�i TK th?c t? ? Ph�p So d? sinh l� b?nh: Nghi�n c?u c�c gi� tr? c?a DSC (DTC) ho?c dung n?p s? gi?m DSC tr�n c�c phuong ti?n d�nh gi� CN n�o (Svj02 / EEG / PEA) Theo d�i EEG (BIS/PEA): ?nh hu?ng c?a c�c thu?c g�y m�

96. V�i nguy�n l� quan tr?ng S? ?n d?nh huy�t d?ng to�n th? ph?n �nh tu?n ho�n b?t thu?ng ? c�c co quan( nh?t l� n�o) H?p �M c?nh RL t? di?u ch?nh �i?u ch?nh t?i ch? (thi?u oxy, toan khu tr�, nhu?c th�n�) C?n thi?t ph?i TD tu?n ho�n v� oxy h�a t? ch?c

97. Theo d�i CN n�o EEG 10/20 KT ph?c t?p B? thay d?i do c�c NN kh�c khi thi?u oxy G�y m�, t?t T� C� th? d? nh?y �t DTC KT kh� Gi? thuy?t tr�n dk d?ng m?ch HITS (charge embolique) SvjO2 X�m l?n �o m?c d? oxy h�a to�n b? n�o SPIR Kh�ng x�m l?n Tuong quan v?i Svj02 ch?p nh?n du?c C� gi� tr? ? ngu?i l?n?

100. Murkin JM et al.

107. Khuy?n c�o g?n d�y

111. http://www.acc.org/clinical/guidelines/cabg/cabg.pdf. 4.1.1.1.1. Xo v?a �MC v� d?t qu? do m?ng xo v?a l?n S? nh?n d?nh c?a PTV d?i v?i xo v?a �MC xu?ng l� y?u t? c� � nghia duy nh?t bi?n ch?ng ? n�o sau PT b?c c?u ch? v�nh(OR 4.5, P <0.05), th? hi?n ?nh hu?ng c?a xo v?a �MC trong d?t qu? do thi?u m�u Khi m� tu?i TB c?a BN m? PT m?ch v�nh c�ng tang, t?c m?ch do m?ng xo v?a �MC cung tang v� g?n nhu chi?m 1/3 d?t qu? sau m?. Nguy co n�y d?c bi?t tang ? nh?ng BN tr�n 75 � 80 tu?i.

112. Phuong ti?n ph�t hi?n XV�M �t / kh�ng nh?y L�m s�ng, s?, TDM, ETO tru?c m? Khuy?n c�o S� �piaortique +++ Tuong quan y?u v?i ETO trong m? (hi?n th? �t/ kh�ng r� �MC xu?ng) T�c d?ng (t?n thuong < ho?c > � 3 mm chi?u d�y) L�m thay d?i ki thu?t m? trong 20 % TH

114. Khuy?n c�o kh�c Th?n tr?ng kho?ng tg 4 tu?n gi?a AVC v� PT tim

117. Khuy?n c�o c?a ACC/AHA l�m gi?m t? l? bi?n ch?ng TK typ II Gi?m g�y ra c?c t?c Kh� v� lo?i kh�c Phin l?c �M 40 �m ? Kh�ng h�t m�u ? v�ng m? v�o b�nh ch?a / nhung c� th? sang cell-saver

121. Khuy?n c�o n�o trong th?c h�nh l�m s�ng ?

133. Guidelines for Reducing the Risk of Brain Dysfunction in Cardiac Surgery According to American Heart Association Task Force Committee Guidelines Preoperatively Chronic atrial fibrillation Anticoagulation Preoperative TEE Recent myocardial infarction Preoperative echocardiography Anticoagulation Recent cardiovascular accident Delay of operation Carotid artery disease Carotid artery screening* Surgical plan* *(not used in previous years)

134. Khuy?n c�o l�m gi?m bi?n ch?ng ? n�o trong PT tim theo AHA Trong m? Epiaortic scanning* V�ng d?t canul c� th? thay d?i* V�ng c?p clamp c� th? thay d?i ho?c c� th? s? d?ng KT kh�ng c?p clamp* Proximal anastomosis site may be changed or in situ IMA to the LAD* S? d?ng phin loc �M* Th�i quen d�ng m�ng trao d?i oxy ?n d?nh d�ng m�u n�o trong CEC* Tr�nh tang th�n nhi?t* Tr�nh tang du?ng m�u* *(kh�ng du?c khuy?n c�o tru?c d�y)

135. Khuy?n c�o l�m gi?m bi?n ch?ng ? n�o trong PT tim theo AHA Tr�nh tang du?ng m�u* Tr�nh tang th�n nhi?t* H?n ch? ph� n�o* *(kh�ng du?c khuy?n c�o tru?c d�y)