{"id":163,"date":"2023-04-08T12:56:31","date_gmt":"2023-04-08T05:56:31","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=163"},"modified":"2023-04-17T10:52:48","modified_gmt":"2023-04-17T03:52:48","slug":"phan-biet-dich-tiet-va-dich-tham","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/08\/phan-biet-dich-tiet-va-dich-tham\/","title":{"rendered":"Ph\u00e2n bi\u1ec7t d\u1ecbch th\u1ea5m v\u00e0 d\u1ecbch ti\u1ebft"},"content":{"rendered":"

D\u1ecbch ti\u1ebft v\u00e0 d\u1ecbch th\u1ea5m l\u00e0 hai kh\u00e1i ni\u1ec7m li\u00ean quan \u0111\u1ebfn ch\u1ea5t l\u1ecfng trong c\u01a1 th\u1ec3. D\u1ecbch ti\u1ebft l\u00e0 ch\u1ea5t l\u1ecfng \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t b\u1edfi c\u00e1c t\u1ebf b\u00e0o ho\u1eb7c tuy\u1ebfn ti\u1ebft trong c\u01a1 th\u1ec3, c\u00f3 ch\u1ee9c n\u0103ng b\u00f4i tr\u01a1n ho\u1eb7c b\u1ea3o v\u1ec7 c\u00e1c c\u01a1 quan trong c\u01a1 th\u1ec3. Trong khi \u0111\u00f3, d\u1ecbch th\u1ea5m l\u00e0 ch\u1ea5t l\u1ecfng \u0111\u01b0\u1ee3c th\u1ea5m v\u00e0o c\u01a1 th\u1ec3 t\u1eeb b\u00ean ngo\u00e0i th\u00f4ng qua c\u00e1c mao m\u1ea1ch v\u00e0 c\u00e1c m\u00f4 m\u1ecfng trong c\u01a1 th\u1ec3.<\/strong><\/p>\n

1. Th\u1ebf n\u00e0o l\u00e0 d\u1ecbch th\u1ea5m?<\/strong><\/h2>\n

D\u1ecbch th\u1ea5m (Pleural transudates) l\u00e0 m\u1ed9t d\u1ea1ng d\u1ecbch trong m\u00e0ng ph\u1ed5i \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t b\u1edfi c\u00e1c mao m\u1ea1ch trong m\u00e0ng ph\u1ed5i. D\u1ecbch n\u00e0y th\u01b0\u1eddng c\u00f3 th\u00e0nh ph\u1ea7n t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi ch\u1ea5t l\u01b0\u1ee3ng c\u1ee7a ch\u1ea5t l\u1ecfng b\u1ecb tr\u00e0n v\u00e0o t\u1eeb mao m\u1ea1ch, bao g\u1ed3m n\u01b0\u1edbc, ion v\u00e0 m\u1ed9t s\u1ed1 l\u01b0\u1ee3ng nh\u1ecf protein. D\u1ecbch th\u1ea5m th\u01b0\u1eddng kh\u00f4ng g\u00e2y ra vi\u00eam nhi\u1ec5m v\u00e0 l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a c\u00e1c t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn s\u1ef1 r\u1ed1i lo\u1ea1n c\u1ee7a c\u00e1c c\u01a1 ch\u1ebf \u0111i\u1ec1u h\u00f2a \u00e1p su\u1ea5t trong c\u01a1 th\u1ec3, ch\u1eb3ng h\u1ea1n nh\u01b0 suy tim, x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch, suy th\u1eadn ho\u1eb7c d\u1ecbch b\u1ee5ng. Tri\u1ec7u ch\u1ee9ng c\u1ee7a d\u1ecbch th\u1ea5m th\u01b0\u1eddng bao g\u1ed3m kh\u00f3 th\u1edf, \u0111au ng\u1ef1c v\u00e0 ho.<\/p>\n

2. Th\u1ebf n\u00e0o l\u00e0 d\u1ecbch ti\u1ebft?<\/h2>\n

D\u1ecbch ti\u1ebft (Pleural exudate) l\u00e0 m\u1ed9t lo\u1ea1i d\u1ecbch trong b\u1ec7nh l\u00fd ph\u1ed5i, \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t b\u1edfi c\u00e1c t\u1ebf b\u00e0o ho\u1eb7c mao m\u1ea1ch trong m\u00e0ng ph\u1ed5i v\u00e0 th\u01b0\u1eddng c\u00f3 trong vi\u00eam nhi\u1ec5m. Khi c\u00f3 vi\u00eam nhi\u1ec5m trong m\u00e0ng ph\u1ed5i, c\u00e1c t\u1ebf b\u00e0o ho\u1eb7c c\u00e1c mao m\u1ea1ch trong m\u00e0ng ph\u1ed5i s\u1ebd s\u1ea3n xu\u1ea5t d\u1ecbch \u0111\u1ec3 b\u1ea3o v\u1ec7 v\u00e0 gi\u1ea3m vi\u00eam.<\/p>\n

D\u1ecbch ti\u1ebft th\u01b0\u1eddng l\u00e0 m\u1ed9t bi\u1ec3u hi\u1ec7n c\u1ee7a nhi\u1ec1u b\u1ec7nh l\u00fd ph\u1ed5i, ch\u1eb3ng h\u1ea1n nh\u01b0 vi\u00eam ph\u1ed5i, lao, ung th\u01b0 ph\u1ed5i, vi\u00eam m\u00e0ng ph\u1ed5i, ho\u1eb7c c\u00e1c b\u1ec7nh t\u0103ng sinh kh\u00e1c. Tri\u1ec7u ch\u1ee9ng c\u1ee7a d\u1ecbch ti\u1ebft th\u01b0\u1eddng bao g\u1ed3m kh\u00f3 th\u1edf, \u0111au ng\u1ef1c v\u00e0 ho.<\/p>\n

3. S\u1ef1 kh\u00e1c nhau gi\u1eef d\u1ecbch ti\u1ebft v\u00e0 d\u1ecbch th\u1ea5m<\/h2>\n

D\u1ecbch th\u1ea5m v\u00e0 d\u1ecbch ti\u1ebft l\u00e0 hai d\u1ea1ng d\u1ecbch trong m\u00e0ng ph\u1ed5i v\u00e0 ch\u00fang c\u00f3 nh\u1eefng \u0111i\u1ec3m kh\u00e1c bi\u1ec7t sau \u0111\u00e2y:<\/p>\n

3.1. Nguy\u00ean nh\u00e2n<\/strong>: d\u1ecbch th\u1ea5m th\u01b0\u1eddng l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a c\u00e1c t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn s\u1ef1 r\u1ed1i lo\u1ea1n c\u1ee7a c\u00e1c c\u01a1 ch\u1ebf \u0111i\u1ec1u h\u00f2a \u00e1p su\u1ea5t trong c\u01a1 th\u1ec3, ch\u1eb3ng h\u1ea1n nh\u01b0 suy tim, x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch, suy th\u1eadn ho\u1eb7c d\u1ecbch b\u1ee5ng. Trong khi \u0111\u00f3, d\u1ecbch ti\u1ebft th\u01b0\u1eddng l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a vi\u00eam nhi\u1ec5m trong m\u00e0ng ph\u1ed5i, do s\u1ea3n xu\u1ea5t d\u1ecbch b\u1edfi c\u00e1c t\u1ebf b\u00e0o ho\u1eb7c mao m\u1ea1ch trong m\u00e0ng ph\u1ed5i.<\/p>\n

3.2. Th\u00e0nh ph\u1ea7n<\/strong>: d\u1ecbch th\u1ea5m th\u01b0\u1eddng c\u00f3 th\u00e0nh ph\u1ea7n t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi ch\u1ea5t l\u01b0\u1ee3ng c\u1ee7a ch\u1ea5t l\u1ecfng b\u1ecb tr\u00e0n v\u00e0o t\u1eeb mao m\u1ea1ch, bao g\u1ed3m n\u01b0\u1edbc, ion v\u00e0 m\u1ed9t s\u1ed1 l\u01b0\u1ee3ng nh\u1ecf protein. Trong khi \u0111\u00f3, d\u1ecbch ti\u1ebft c\u00f3 th\u00e0nh ph\u1ea7n ch\u1ea5t l\u01b0\u1ee3ng cao h\u01a1n so v\u1edbi d\u1ecbch transudate, ch\u1ee9a nhi\u1ec1u protein, t\u1ebf b\u00e0o v\u00e0 m\u1ee7.<\/p>\n

3.3. T\u00ednh vi\u00eam<\/strong>: d\u1ecbch th\u1ea5m th\u01b0\u1eddng kh\u00f4ng g\u00e2y ra vi\u00eam nhi\u1ec5m. Trong khi \u0111\u00f3, d\u1ecbch ti\u1ebft g\u00e2y ra vi\u00eam nhi\u1ec5m.<\/p>\n

3.4. Tri\u1ec7u ch\u1ee9ng<\/strong>: d\u1ecbch th\u1ea5m v\u00e0 d\u1ecbch ti\u1ebft \u0111\u1ec1u c\u00f3 tri\u1ec7u ch\u1ee9ng chung nh\u01b0 kh\u00f3 th\u1edf, \u0111au ng\u1ef1c v\u00e0 ho. Tuy nhi\u00ean, tri\u1ec7u ch\u1ee9ng c\u1ee7a d\u1ecbch ti\u1ebft th\u01b0\u1eddng n\u1eb7ng h\u01a1n so v\u1edbi d\u1ecbch th\u1ea5m.<\/p>\n

\"\"
Minh h\u1ecda d\u1ecbch th\u1ea5m v\u00e0 d\u1ecbch ti\u1ebft. Ngu\u1ed3n<\/strong>: FIRST AID FOR THE USMLE STEP 1 2022<\/em><\/figcaption><\/figure>\n

 <\/p>\n

4. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/h2>\n

4.1. Ph\u1ea3n \u1ee9ng Rivalta<\/strong>: D\u00f9ng pipet h\u00fat d\u1ecbch ch\u1ea5t acid cetic \u0111\u1eb7c v\u00e0 nh\u1ecf v\u00e0i gi\u1ecdt v\u00e0o dung d\u1ecbch v\u1eeba pha v\u00e0 quan s\u00e1t:<\/p>\n

N\u1ebfu th\u1ea5y hi\u1ec7n t\u01b0\u1ee3ng t\u1ee7a kh\u00f3i tr\u1eafng khi gi\u1ecdt d\u1ecbch r\u01a1i xu\u1ed1ng \u0111\u00e1y c\u1ed1c th\u00ec ph\u1ea3n \u1ee9ng Rivalta(+), t\u1ee9c l\u00e0 d\u1ecbch \u0111\u00f3 l\u00e0 d\u1ecbch ti\u1ebft v\u00e0 k\u1ebft qu\u1ea3 \u0111\u1ecbnh l\u01b0\u1ee3ng protein d\u1ecbch ch\u1ecdc d\u00f2 th\u01b0\u1eddng tr\u00ean 30g\/L. D\u1ecbch n\u00e0y g\u1eb7p trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p do vi\u00eam.<\/p>\n

N\u1ebfu kh\u00f4ng c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng tr\u00ean th\u00ec ph\u1ea3n \u1ee9ng Rivalta (-) v\u00e0 d\u1ecbch \u0111\u00f3 th\u01b0\u1eddng l\u00e0 d\u1ecbch th\u1ea5m v\u00e0 l\u01b0\u1ee3ng protein th\u01b0\u1eddng d\u01b0\u1edbi 30 g\/L, g\u1eb7p trong c\u00e1c b\u1ec7nh x\u01a1 gan, h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0.<\/p>\n

4.2. Ti\u00eau chu\u1ea9n Light<\/strong><\/p>\n

    \n
  • Protein DMP \/ Protein huy\u1ebft t\u01b0\u01a1ng > 0.5<\/li>\n
  • LDH d\u1ecbch m\u00e0ng ph\u1ed5i \/ LDH huy\u1ebft t\u01b0\u01a1ng > 0.6<\/li>\n
  • LDH d\u1ecbch m\u00e0ng ph\u1ed5i > 2\/3 ULN<\/li>\n<\/ul>\n

    Th\u1ecfa 1\/3 ti\u00eau chu\u1ea9n l\u00e0 d\u1ecbch ti\u1ebft, c\u00f2n n\u1ebfu kh\u00f4ng th\u1ecfa b\u1ea5t c\u1ee9 c\u00e1i n\u00e0o l\u00e0 d\u1ecbch th\u1ea5m.<\/p>\n

    L\u01b0u \u00fd<\/strong>: Ti\u00eau chu\u1ea9n Light \u0111\u1ed9 nh\u1ea1y 98-99%, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 74%. Ngh\u0129a l\u00e0 c\u00f3 t\u1eeb 15-20% tr\u01b0\u1eddng h\u1ee3p l\u00e0 d\u1ecbch th\u1ea5m nh\u01b0ng ch\u1ea9n \u0111o\u00e1n l\u1ea7m l\u00e0 d\u1ecbch ti\u1ebft, th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n suy tim sung huy\u1ebft \u0111\u00e3 c\u00f3 \u0111i\u1ec1u tr\u1ecb l\u1ee3i ti\u1ec3u tr\u01b0\u1edbc khi ti\u1ebfn h\u00e0nh ch\u1ecdc d\u1ecbch.<\/p>\n

    4.3. Si\u00eau \u00e2m<\/strong><\/p>\n

    Ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng d\u1ecbch th\u1ea5m v\u00e0 d\u1ecbch ti\u1ebft d\u1ef1a v\u00e0o ki\u1ec3m tra sinh h\u00f3a d\u1ecbch m\u00e0ng ph\u1ed5i thu \u0111\u01b0\u1ee3c b\u1eb1ng ch\u1ecdc d\u00f2 l\u1ed3ng ng\u1ef1c. Tuy nhi\u00ean, ki\u1ec3m tra n\u00e0y kh\u00f4ng th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n cao tu\u1ed5i c\u00f3 th\u1ec3 tr\u1ea1ng y\u1ebfu ho\u1eb7c n\u1eb1m li\u1ec7t gi\u01b0\u1eddng v\u00ec t\u00ednh x\u00e2m l\u1ea5n c\u1ee7a n\u00f3.<\/p>\n

    Khi s\u1eed d\u1ee5ng si\u00eau \u00e2m \u0111\u1ec3 ph\u00e2n bi\u1ec7t gi\u1eefa hai lo\u1ea1i d\u1ecbch n\u00e0y, ch\u00fang ta th\u01b0\u1eddng ch\u00fa \u00fd \u0111\u1ebfn c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m sau:<\/p>\n

      \n
    • \u0110\u1ed9 d\u00e0y<\/strong>: d\u1ecbch ti\u1ebft th\u01b0\u1eddng c\u00f3 \u0111\u1ed9 d\u00e0y cao h\u01a1n so v\u1edbi d\u1ecbch th\u1ea5m.<\/li>\n
    • T\u00ednh \u0111\u1ed3ng nh\u1ea5t c\u1ee7a d\u1ecbch<\/strong>: N\u1ebfu d\u1ecbch trong m\u00e0ng ph\u1ed5i c\u00f3 t\u00ednh \u0111\u1ed3ng nh\u1ea5t, t\u1ee9c l\u00e0 kh\u00f4ng c\u00f3 c\u00e1c b\u1ecdt kh\u00ed ho\u1eb7c c\u1eb7n b\u1ea9n, th\u00ec \u0111\u00f3 th\u01b0\u1eddng l\u00e0 d\u1ecbch th\u1ea5m. Trong khi \u0111\u00f3, n\u1ebfu d\u1ecbch c\u00f3 c\u00e1c b\u1ecdt kh\u00ed ho\u1eb7c c\u1eb7n b\u1ea9n, th\u00ec \u0111\u00f3 th\u01b0\u1eddng l\u00e0 d\u1ecbch ti\u1ebft.<\/li>\n
    • V\u1ecb tr\u00ed c\u1ee7a d\u1ecbch<\/strong>: d\u1ecbch ti\u1ebft th\u01b0\u1eddng \u1edf v\u1ecb tr\u00ed kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t ho\u1eb7c kh\u00f4ng th\u01b0\u1eddng xuy\u00ean, trong khi d\u1ecbch th\u1ea5m th\u01b0\u1eddng \u1edf v\u1ecb tr\u00ed \u0111\u1ed3ng nh\u1ea5t v\u00e0 c\u00f3 th\u1ec3 ph\u00e2n b\u1ed1 \u0111\u1ed3ng \u0111\u1ec1u trong m\u00e0ng ph\u1ed5i.<\/li>\n<\/ul>\n

      Tuy nhi\u00ean, vi\u1ec7c ph\u00e2n bi\u1ec7t gi\u1eefa d\u1ecbch th\u1ea5m v\u00e0 d\u1ecbch ti\u1ebft b\u1eb1ng si\u00eau \u00e2m ch\u1ec9 cung c\u1ea5p th\u00f4ng tin kh\u00f4ng \u0111\u1ee7 ch\u00ednh x\u00e1c \u0111\u1ec3 \u0111\u01b0a ra ch\u1ea9n \u0111o\u00e1n cu\u1ed1i c\u00f9ng. Do \u0111\u00f3, c\u1ea7n s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n kh\u00e1c nhau \u0111\u1ec3 \u0111\u01b0a ra ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c v\u00e0 \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p.<\/p>\n

      T\u1ed5ng h\u1ee3p c\u00e1c th\u00f4ng tin tr\u00ean, c\u00f3 th\u1ec3 k\u1ebft lu\u1eadn r\u1eb1ng d\u1ecbch th\u1ea5m v\u00e0 d\u1ecbch ti\u1ebft l\u00e0 hai d\u1ea1ng d\u1ecbch trong m\u00e0ng ph\u1ed5i c\u00f3 nh\u1eefng \u0111i\u1ec3m kh\u00e1c bi\u1ec7t \u0111\u00e1ng k\u1ec3 v\u1ec1 nguy\u00ean nh\u00e2n, th\u00e0nh ph\u1ea7n, t\u00ednh vi\u00eam v\u00e0 tri\u1ec7u ch\u1ee9ng. Vi\u1ec7c ph\u00e2n bi\u1ec7t ch\u00ednh x\u00e1c gi\u1eefa hai lo\u1ea1i d\u1ecbch n\u00e0y l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 \u0111\u01b0a ra ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c v\u00e0 quy\u1ebft \u0111\u1ecbnh li\u1ec7u tr\u1ecb ph\u00f9 h\u1ee3p. Si\u00eau \u00e2m l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p h\u1eefu \u00edch \u0111\u1ec3 ph\u00e2n bi\u1ec7t gi\u1eefa d\u1ecbch th\u1ea5m d\u1ecbch ti\u1ebft. Tuy nhi\u00ean c\u1ea7n s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n kh\u00e1c nhau \u0111\u1ec3 \u0111\u01b0a ra k\u1ebft lu\u1eadn cu\u1ed1i c\u00f9ng.<\/p>\n","protected":false},"excerpt":{"rendered":"

      D\u1ecbch ti\u1ebft v\u00e0 d\u1ecbch th\u1ea5m l\u00e0 hai kh\u00e1i ni\u1ec7m li\u00ean quan \u0111\u1ebfn ch\u1ea5t l\u1ecfng trong c\u01a1 th\u1ec3. D\u1ecbch ti\u1ebft l\u00e0 ch\u1ea5t l\u1ecfng \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t b\u1edfi c\u00e1c t\u1ebf b\u00e0o ho\u1eb7c tuy\u1ebfn ti\u1ebft trong c\u01a1 th\u1ec3, c\u00f3 ch\u1ee9c n\u0103ng b\u00f4i tr\u01a1n ho\u1eb7c b\u1ea3o v\u1ec7 c\u00e1c c\u01a1 quan trong c\u01a1 th\u1ec3. Trong khi \u0111\u00f3, d\u1ecbch th\u1ea5m l\u00e0 […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[5,33],"tags":[3],"yoast_head":"\nPh\u00e2n bi\u1ec7t d\u1ecbch th\u1ea5m v\u00e0 d\u1ecbch ti\u1ebft - Ti\u00eau h\u00f3a Vinmec<\/title>\n<meta name=\"description\" content=\"D\u1ecbch ti\u1ebft v\u00e0 d\u1ecbch th\u1ea5m l\u00e0 hai kh\u00e1i ni\u1ec7m li\u00ean quan \u0111\u1ebfn ch\u1ea5t l\u1ecfng trong c\u01a1 th\u1ec3. 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