Các biện pháp điều trị trong suy tim tiến triển
Tóm tắt
rong những thập kỷ qua, mặc dù có những tiến bộ lớn về các thuốc điều trị suy tim với chức năng tâm thu thất trái giảm, suy tim vẫn là nguyên nhân hàng đầu dẫn đến tái nhập viện và tử vong ở các bệnh nhân tim mạch. Suy tim là một bệnh mạn tính, tiến triển và cuối cùng gây tình trạng suy yếu, ở giai đoạn nặng có tỷ lệ tử vong hàng năm trên 50%. Thêm nữa, có sự gia tăng tỷ lệ hiện mắc ở các nước phát triển [1, 2]. Một nhóm nhỏ các bệnh nhân suy tim sẽ tiến triển với các triệu chứng của suy tim nặng hoặc “giai đoạn cuối”, có thể được phân loại là giai đoạn D theo khuyến cáo của ACC/AHA. Ước tính khoảng 5% tất cả các bệnh nhân suy tim có thể phân loại vào nhóm suy tim độ cao [3]. Bệnh nhân suy tim giai đoạn D thường có các triệu chứng nặng tiến triển và dai dẳng, tái phát các đợt cấp mất bù mặc dù đã được điều trị thuốc tối ưu theo khu-yến cáo, điều trị phẫu thuật và/hoặc thiết bị hỗ trợ. Tuổi, tình trạng già yếu và các vấn đề tâm lý thường ảnh hưởng tiêu cực đến cả kết cục và việc lựa chọn biện pháp điều trị ở các bệnh nhân này [4].
Nhìn chung, việc điều trị bệnh nhân suy tim giai đoạn cuối (giai đoạn D) nên được quản lý bởi các cơ sở chuyên khoa tim mạch và phối hợp chăm sóc liên ngành, lấy bệnh nhân làm trung tâm. Lựa chọn điều trị bao gồm các thuốc vận mạch ngắn hạn hoặc dài hạn, ghép tim, các thiết bị hỗ trợ tuần hoàn hoặc chăm sóc giảm nhẹ. Mặc dù ghép tim là lựa chọn tốt nhất nhưng việc số người hiến tạng giới hạn làm hạn chế tác động tổng thể của nó. Cơ quan liên ngành về hỗ trợ tuần hoàn cơ học (The Interagency Registry for mechanically Assisted Circulation Support –INTERMACS) đã đề xuất bảy mô hình cho phép phân tầng hơn nữa nhóm bệnh nhân suy tim tiến triển khi lựa chọn biện pháp điều trị tối ưu [5].
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