{"id":19687,"date":"2023-04-16T18:19:51","date_gmt":"2023-04-16T11:19:51","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=19687"},"modified":"2023-04-17T14:09:37","modified_gmt":"2023-04-17T07:09:37","slug":"tiep-can-chan-doan-benh-phoi-ke","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/16\/tiep-can-chan-doan-benh-phoi-ke\/","title":{"rendered":"Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n b\u1ec7nh ph\u1ed5i k\u1ebd"},"content":{"rendered":"

B\u1ec7nh ph\u1ed5i k\u1ebd (interstitial lung disease – ILD<\/a>) l\u00e0 m\u1ed9t nh\u00f3m b\u1ec7nh g\u1ed3m nhi\u1ec1u r\u1ed1i lo\u1ea1n \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u1ed5n th\u01b0\u01a1ng nhu m\u00f4 ph\u1ed5i lan t\u1ecfa v\u1edbi \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng, h\u00ecnh \u1ea3nh h\u1ecdc, gi\u1ea3i ph\u1eabu b\u1ec7nh c\u0169ng nh\u01b0 ti\u00ean l\u01b0\u1ee3ng kh\u00e1c nhau. Tuy nhi\u00ean, trong h\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh ph\u1ed5i k\u1ebd, th\u00e0nh ph\u1ebf nang b\u1ecb th\u00e2m nhi\u1ec5m b\u1edfi c\u00e1c t\u1ebf b\u00e0o vi\u00eam, t\u1ebf b\u00e0o x\u01a1 v\u00e0 c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng t\u0103ng sinh c\u1ee7a c\u00e1c t\u1ebf b\u00e0o th\u00e0nh ph\u1ebf nang.<\/strong><\/p>\n

1. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh b\u1ec7nh ph\u1ed5i k\u1ebd<\/strong><\/h2>\n

1.1. Kh\u1ea3o s\u00e1t l\u00e2m s\u00e0ng<\/strong>:<\/h3>\n
    \n
  • Ho khan ch\u1ee7 y\u1ebfu, k\u00e9o d\u00e0i t\u1eeb 1 \u0111\u1ebfn 2 n\u0103m, k\u00e9m \u0111\u00e1p \u1ee9ng v\u1edbi c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb gi\u1ea3m ho th\u00f4ng th\u01b0\u1eddng; kh\u00f3 th\u1edf g\u1eafng s\u1ee9c n\u1eb7ng d\u1ea7n k\u00e9o d\u00e0i h\u01a1n 6 th\u00e1ng l\u00e0 hai tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng th\u01b0\u1eddng g\u1eb7p. Tri\u1ec7u ch\u1ee9ng th\u0103m kh\u00e1m ch\u1ee7 y\u1ebfu l\u00e0 ran n\u1ed5 cu\u1ed1i th\u00ec h\u00edt v\u00e0o \u00e2m s\u1eafc kh\u00f4, nghe c\u1ea3 hai b\u00ean ph\u1ed5i (g\u1ecdi l\u00e0 ran Velcro). V\u00e0o giai \u0111o\u1ea1n mu\u1ed9n h\u01a1n c\u1ee7a ILD, tri\u1ec7u ch\u1ee9ng ng\u00f3n tay d\u00f9i tr\u1ed1ng c\u00f3 th\u1ec3 g\u1eb7p.<\/li>\n
  • Do nhi\u1ec1u b\u1ec7nh h\u00f4 h\u1ea5p v\u00e0 ngo\u00e0i h\u00f4 h\u1ea5p c\u0169ng c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng k\u1ec3 tr\u00ean, tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a ILD th\u01b0\u1eddng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u v\u00e0 c\u1ea7n d\u1ef1a v\u00e0o nh\u1eefng th\u0103m d\u00f2 c\u1eadn l\u00e2m s\u00e0ng ti\u1ebfp theo \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n.<\/li>\n<\/ul>\n

    1.2. Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh<\/strong>:<\/h3>\n

    H\u00ecnh \u1ea3nh XQ ph\u1ed5i kh\u00f4ng \u0111\u1eb7c hi\u1ec7u ch\u1ea9n \u0111o\u00e1n ILD. H\u00ecnh \u1ea3nh XQ c\u00f3 th\u1ec3 l\u00e0 h\u00ecnh \u1ea3nh m\u1edd d\u1ea1ng l\u01b0\u1edbi, n\u1ed1t m\u1edd, gi\u1ea3m th\u1ec3 t\u00edch ph\u1ed5i, d\u00e0y r\u00e3nh li\u00ean th\u00f9y, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, t\u1ed5n th\u01b0\u01a1ng m\u1edd v\u00f9ng ngo\u1ea1i vi, \u0111\u01b0\u1eddng Kerley B, \u0111\u00f4i khi c\u00f3 h\u00ecnh \u1ea3nh k\u00ednh m\u1edd, \u0111\u1eb7c bi\u1ec7t l\u00e0 trong \u0111\u1ee3t c\u1ea5p ILD. N\u1ebfu nghi ng\u1edd b\u1ec7nh ph\u1ed5i k\u1ebd, b\u00e1c s\u1ef9 c\u1ea7n ch\u1ec9 \u0111\u1ecbnh ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao HRCT. H\u00ecnh \u1ea3nh HRCT cho ph\u00e9p ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng m\u00f4 k\u1ebd ph\u1ed5i ph\u00f9 h\u1ee3p ILD: h\u00ecnh \u1ea3nh t\u1ed5 ong, gi\u00e3n ph\u1ebf qu\u1ea3n\/ ti\u1ec3u ph\u1ebf qu\u1ea3n co k\u00e9o, l\u01b0\u1edbi ngo\u1ea1i bi\u00ean v\u1edbi c\u00e1c h\u00ecnh th\u00e1i t\u1ed5n th\u01b0\u01a1ng kh\u00e1c nhau.<\/p>\n

    \"H\u00ecnh
    H\u00ecnh \u1ea3nh X-Quang b\u1ec7nh ph\u1ed5i k\u1ebd<\/figcaption><\/figure>\n

    1.3. Th\u0103m d\u00f2 ch\u1ee9c n\u0103ng<\/strong>:<\/h3>\n

    \u0110o h\u00f4 h\u1ea5p k\u00fd g\u1ee3i \u00fd r\u1ed1i lo\u1ea1n th\u00f4ng kh\u00ed h\u1ea1n ch\u1ebf v\u1edbi bi\u1ec3u \u0111\u1ed3 l\u01b0u l\u01b0\u1ee3ng th\u1ec3 t\u00edch h\u00ecnh \u1ea3nh \u201cm\u0169 ph\u00f9 th\u1ee7y\u201d v\u00e0 ch\u1ec9 s\u1ed1 dung t\u00edch s\u1ed1ng g\u1eafng s\u1ee9c FVC (Forced Vital Capacity) gi\u1ea3m < 80% tr\u1ecb s\u1ed1 d\u1ef1 \u0111o\u00e1n. M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p COPD c\u00f3 t\u1eafc ngh\u1ebdn n\u1eb7ng \u0111\u01b0\u1eddng th\u1edf nh\u1ecf, FVC c\u0169ng c\u00f3 th\u1ec3 gi\u1ea3m th\u1ee9 ph\u00e1t sau b\u1eaby kh\u00ed trong ph\u1ed5i. B\u00e1c s\u1ef9 c\u1ea7n ch\u1ec9 \u0111\u1ecbnh th\u0103m d\u00f2 ph\u1ebf th\u00e2n k\u00fd \u0111\u1ec3 kh\u1eb3ng \u0111\u1ecbnh. Ch\u1ec9 s\u1ed1 t\u1ed5ng dung l\u01b0\u1ee3ng ph\u1ed5i TLC (Total Lung Capacity) gi\u1ea3m < 80% tr\u1ecb s\u1ed1 d\u1ef1 \u0111o\u00e1n cho ph\u00e9p x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n r\u1ed1i lo\u1ea1n th\u00f4ng kh\u00ed h\u1ea1n ch\u1ebf. Cu\u1ed1i c\u00f9ng, r\u1ed1i lo\u1ea1n th\u00f4ng kh\u00ed h\u1ea1n ch\u1ebf c\u0169ng c\u00f3 th\u1ec3 do c\u00e1c b\u1ec7nh khung x\u01b0\u01a1ng v\u00e0 c\u01a1 th\u00e0nh ng\u1ef1c g\u00e2y ra b\u00ean c\u1ea1nh b\u1ec7nh ph\u1ed5i k\u1ebd. B\u00e1c s\u1ef9 c\u1ea7n ch\u1ec9 \u0111\u1ecbnh \u0111o kh\u1ea3 n\u0103ng khu\u1ebfch t\u00e1n qua m\u00e0ng ph\u1ebf nang mao m\u1ea1ch DL<\/sub>CO<\/p>\n

    M\u1eb7c d\u00f9 trong \u0111a s\u1ed1 tr\u01b0\u1eddng h\u1ee3p ILD, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p ch\u1ee7 y\u1ebfu l\u00e0 h\u1ed9i ch\u1ee9ng h\u1ea1n ch\u1ebf v\u00e0 gi\u1ea3m khu\u1ebfch t\u00e1n qua m\u00e0ng ph\u1ebf nang mao m\u1ea1ch, trong m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd nh\u01b0 lymphagioleiomyomatosis, b\u1ec7nh m\u00f4 b\u00e0o Langerhans, sarcoidosis, vi\u00eam ph\u1ed5i t\u0103ng c\u1ea3m, c\u00f3 th\u1ec3 c\u00f3 t\u00ecnh tr\u1ea1ng t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng th\u1edf k\u1ebft h\u1ee3p \u1ee9 kh\u00ed.<\/p>\n

    2. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n lo\u1ea1i\/ nguy\u00ean nh\u00e2n b\u1ec7nh ph\u1ed5i k\u1ebd:<\/strong><\/h2>\n

    2.1. Kh\u1ea3o s\u00e1t l\u00e2m s\u00e0ng<\/strong>:<\/h3>\n
      \n
    • Gi\u1eef vai tr\u00f2 quan tr\u1ecdng trong ch\u1ea9n \u0111o\u00e1n ph\u00e2n lo\u1ea1i\/ nguy\u00ean nh\u00e2n ILD nh\u01b0 vi\u00eam ph\u1ed5i t\u0103ng c\u1ea3m, b\u1ec7nh ph\u1ed5i k\u1ebd do thu\u1ed1c, b\u1ec7nh ph\u1ed5i ngh\u1ec1 nghi\u1ec7p, b\u1ec7nh b\u1ee5i ph\u1ed5i.<\/li>\n
    • Ti\u1ec1n s\u1eed b\u1ec7nh l\u00fd g\u00f3p ph\u1ea7n ch\u1ea9n \u0111o\u00e1n ph\u00e2n lo\u1ea1i v\u00e0 nguy\u00ean nh\u00e2n ILD: b\u1ec7nh l\u00fd m\u00f4 li\u00ean k\u1ebft: vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p, vi\u00eam da c\u01a1, vi\u00eam \u0111a c\u01a1, x\u01a1 c\u1ee9ng b\u00ec, lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng, b\u1ec7nh l\u00fd nhi\u1ec5m tr\u00f9ng: lao ph\u1ed5i, HIV, nhi\u1ec5m k\u00fd sinh tr\u00f9ng, c\u00e1c b\u1ec7nh l\u00fd ung th\u01b0 v\u00e0 ti\u1ec1n s\u1eed x\u1ea1 tr\u1ecb v\u00e0o ph\u1ed5i.<\/li>\n
    • Ti\u1ec1n s\u1eed ti\u1ebfp x\u00fac trong m\u00f4i tr\u01b0\u1eddng ngh\u1ec1 nghi\u1ec7p g\u00f3p ph\u1ea7n ch\u1ea9n \u0111o\u00e1n ILD do ngh\u1ec1 nghi\u1ec7p: b\u1ec7nh b\u1ee5i ph\u1ed5i amiang, b\u1ee5i ph\u1ed5i silic, ILD do ti\u1ebfp x\u00fac h\u00f3a ch\u1ea5t, kim lo\u1ea1i kh\u00e1c nh\u01b0: Cobalt, Zirconium (c\u00f4ng nh\u00e2n g\u1ed1m s\u1ee9); Sulfate \u0111\u1ed3ng v\u00e0 pyrethrum trong thu\u1ed1c tr\u1eeb s\u00e2u; Methacrylates (trong l\u0129nh v\u1ef1c nha khoa). Ti\u1ec1n s\u1eed h\u00fat thu\u1ed1c l\u00e1, thu\u1ed1c l\u00e0o trong c\u00e1c ILD li\u00ean quan thu\u1ed1c l\u00e1 nh\u01b0 x\u01a1 ph\u1ed5i v\u00f4 c\u0103n IPF. Ti\u1ec1n s\u1eed d\u00f9ng thu\u1ed1c: ch\u1ea9n \u0111o\u00e1n ILD do thu\u1ed1c: c\u00e1c thu\u1ed1c kh\u00e1ng sinh, kh\u00e1ng n\u1ea5m: isoniazid. nitrofurantoin, amphotericin; c\u00e1c thu\u1ed1c kh\u00e1ng vi\u00eam: aspirin, etanercept, methotrexate, NSAIDS; c\u00e1c thu\u1ed1c sinh h\u1ecdc: adalimumab, rituximab, TNF-alpha blockers; h\u00f3a ch\u1ea5t tr\u1ecb li\u1ec7u: bcnu, bleomycin, busulfan, hydroxurea, MTX.<\/li>\n
    • Ti\u1ec1n s\u1eed ph\u01a1i nhi\u1ec5m v\u1edbi c\u00e1c d\u1ecb nguy\u00ean \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p trong \u0111\u1eddi s\u1ed1ng h\u00e0ng ng\u00e0y ho\u1eb7c ngh\u1ec1 nghi\u1ec7p g\u00f3p ph\u1ea7n ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u1ed5i t\u0103ng c\u1ea3m: ti\u1ebfp x\u00fac chim, gia c\u1ea7m, s\u1eed d\u1ee5ng g\u1ed1i l\u00f4ng v\u0169, ch\u0103n l\u00f4ng th\u00fa. Ph\u01a1i nhi\u1ec5m v\u1edbi c\u00e1c lo\u1ea1i kh\u00f3i b\u1ee5i trong c\u00f4ng nghi\u1ec7p v\u00e0 m\u00f4i tr\u01b0\u1eddng c\u0169ng c\u00f3 th\u1ec3 g\u00e2y vi\u00eam ph\u1ed5i t\u0103ng c\u1ea3m.<\/li>\n
    • Di\u1ec5n bi\u1ebfn b\u1ec7nh s\u1eed v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng c\u00f3 vai tr\u00f2 \u0111\u1ecbnh h\u01b0\u1edbng trong ch\u1ea9n \u0111o\u00e1n ph\u00e2n lo\u1ea1i ILD. Di\u1ec5n bi\u1ebfn c\u1ea5p t\u00ednh: t\u1eeb v\u00e0i ng\u00e0y \u0111\u1ebfn 4 tu\u1ea7n, th\u01b0\u1eddng g\u1eb7p trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh ph\u1ed5i k\u1ebd do nguy\u00ean nh\u00e2n nhi\u1ec5m tr\u00f9ng, vi\u00eam ph\u1ed5i t\u0103ng c\u1ea3m c\u1ea5p t\u00ednh, \u0111\u1ee3t c\u1ea5p c\u1ee7a b\u1ec7nh ph\u1ed5i k\u1ebd (AIP). Di\u1ec5n bi\u1ebfn m\u1ea1n t\u00ednh tr\u00ean 12 tu\u1ea7n, \u0111\u1ed1i v\u1edbi c\u00e1c b\u1ec7nh ph\u1ed5i k\u1ebd li\u00ean quan \u0111\u1ebfn ngh\u1ec1 nghi\u1ec7p hay IPF. Tri\u1ec7u ch\u1ee9ng ho ra m\u00e1u c\u00f3 th\u1ec3 g\u1eb7p \u1edf ILD li\u00ean quan \u0111\u1ebfn SLE (ch\u1ea3y m\u00e1u ph\u1ebf nang) hay h\u1ed9i ch\u1ee9ng Goodpasture. Tri\u1ec7u ch\u1ee9ng \u0111au c\u01a1, \u0111au kh\u1edbp, h\u1ed9i ch\u1ee9ng Raynaud c\u0169ng th\u01b0\u1eddng c\u00f3 tr\u00ean ILD trong b\u1ec7nh m\u00f4 li\u00ean k\u1ebft.<\/li>\n
    • Kh\u00e1m th\u1ef1c th\u1ec3 l\u00e2m s\u00e0ng c\u0169ng g\u00f3p ph\u1ea7n ch\u1ea9n \u0111o\u00e1n ph\u00e2n lo\u1ea1i v\u00e0 nguy\u00ean nh\u00e2n ILD: tr\u00ean NB ILD trong b\u1ec7nh m\u00f4 li\u00ean k\u1ebft t\u1ef1 mi\u1ec5n c\u00f3 th\u1ec3 th\u1ea5y tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, c\u00e1c t\u1ed5n th\u01b0\u01a1ng ban tr\u00ean da, t\u1ed5n th\u01b0\u01a1ng kh\u1edbp, c\u01a1.<\/li>\n<\/ul>\n

      2.2. Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh<\/strong>:<\/h3>\n

      Ch\u1ee5p CT ph\u1ed5i \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao(HRCT) c\u00f3 vai tr\u00f2 \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng trong ch\u1ea9n \u0111o\u00e1n ph\u00e2n lo\u1ea1i c\u00e1c h\u00ecnh th\u00e1i t\u1ed5n th\u01b0\u01a1ng trong ILD. M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, HRCT cho ph\u00e9p \u0111\u1ecbnh h\u01b0\u1edbng nguy\u00ean nh\u00e2n ILD m\u00e0 kh\u00f4ng c\u1ea7n ph\u1ea3i sinh thi\u1ebft ph\u1ed5i. Xem th\u00eam m\u00f4 t\u1ea3 h\u00ecnh th\u00e1i t\u1ed5n th\u01b0\u01a1ng HRCT t\u1ea1i c\u00e1c ph\u1ea7n m\u00f4 t\u1ea3 t\u1eebng b\u1ec7nh ILD c\u1ee5 th\u1ec3 v\u00e0 ch\u1ec9 \u0111\u1ecbnh sinh thi\u1ebft ph\u1ed5i d\u1ef1a tr\u00ean h\u00ecnh \u1ea3nh HRCT trong c\u00e1c ch\u01b0\u01a1ng sau c\u1ee7a h\u01b0\u1edbng d\u1eabn n\u00e0y.<\/p>\n

      2.3. X\u00e9t nghi\u1ec7m t\u1ef1 kh\u00e1ng th\u1ec3<\/strong>:<\/h3>\n

      Cho \u0111\u1ebfn nay kh\u00f4ng c\u00f3 m\u1ed9t x\u00e9t nghi\u1ec7m t\u1ef1 kh\u00e1ng th\u1ec3 n\u00e0o cho ph\u00e9p ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh ch\u1eafc ch\u1eafn c\u0103n nguy\u00ean ILD. Tuy nhi\u00ean, khi k\u1ebft h\u1ee3p v\u1edbi c\u00e1c \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng c\u00f9ng v\u1edbi h\u00ecnh \u1ea3nh HRCT, m\u1ed9t s\u1ed1 x\u00e9t nghi\u1ec7m t\u1ef1 kh\u00e1ng th\u1ec3 cho ph\u00e9p x\u00e1c l\u1eadp ch\u1ea9n \u0111o\u00e1n m\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n g\u00e2y ILD trong b\u1ec7nh l\u00fd m\u00f4 li\u00ean k\u1ebft. \u00dd ngh\u0129a v\u00e0 gi\u00e1 tr\u1ecb c\u1ee7a c\u00e1c x\u00e9t nghi\u1ec7m t\u1ef1 kh\u00e1ng th\u1ec3 trong ch\u1ea9n \u0111o\u00e1n ILD s\u1ebd \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp \u0111\u1ebfn trong ch\u01b0\u01a1ng \u201cB\u1ec7nh ph\u1ed5i k\u1ebd li\u00ean quan \u0111\u1ebfn b\u1ec7nh l\u00fd m\u00f4 li\u00ean k\u1ebft\u201d.<\/p>\n

      2.4. N\u1ed9i soi ph\u1ebf qu\u1ea3n r\u1eeda ph\u1ebf qu\u1ea3n ph\u1ebf nang: <\/strong><\/h3>\n

      C\u00f3 th\u1ec3 gi\u00fap g\u1ee3i \u00fd nguy\u00ean nh\u00e2n ILD trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, n\u00ean \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh n\u1ebfu l\u00e2m s\u00e0ng nghi ng\u1edd m\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n \u0111\u1eb7c bi\u1ec7t. N\u1ed9i soi ph\u1ebf qu\u1ea3n c\u00f3 th\u1ec3 gi\u00fap l\u1ea5y b\u1ec7nh ph\u1ea9m l\u00e0 d\u1ecbch r\u1eeda ph\u1ebf qu\u1ea3n l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m vi sinh, \u0111\u1ebfm s\u1ed1 l\u01b0\u1ee3ng th\u00e0nh ph\u1ea7n c\u00e1c t\u1ebf b\u00e0o trong d\u1ecbch r\u1eeda ph\u1ebf qu\u1ea3n. Nh\u1edd \u0111\u00f3, x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c c\u00e1c \u0111\u01b0\u1ee3c m\u1ed9t s\u1ed1 c\u0103n nguy\u00ean li\u00ean quan \u0111\u1ebfn nhi\u1ec5m tr\u00f9ng (lao ph\u1ed5i, n\u1ea5m x\u00e2m l\u1ea5n ph\u1ed5i), vi\u00eam ph\u1ed5i t\u0103ng c\u1ea3m, xu\u1ea5t huy\u1ebft ph\u1ebf nang, b\u1ec7nh t\u00edch protein ph\u1ebf nang, b\u1ec7nh m\u00f4 b\u00e0o Langerhans. N\u1ed9i soi ph\u1ebf qu\u1ea3n k\u1ebft h\u1ee3p sinh thi\u1ebft ph\u1ed5i xuy\u00ean th\u00e0nh ph\u1ebf qu\u1ea3n l\u00e0m x\u00e9t nghi\u1ec7m m\u00f4 b\u1ec7nh h\u1ecdc trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p. Sinh thi\u1ebft h\u1ea1ch trung th\u1ea5t qua si\u00eau \u00e2m n\u1ed9i soi (EBUS-TBNA): ch\u1ea9n \u0111o\u00e1n c\u00e1c b\u1ec7nh l\u00fd nh\u01b0: sarcoidosis, ung th\u01b0 bi\u1ec3u m\u00f4 di c\u0103n. Tuy nhi\u00ean sinh thi\u1ebft qua n\u1ed9i soi ph\u1ebf qu\u1ea3n m\u1ea3nh sinh thi\u1ebft nh\u1ecf, hi\u1ec7u qu\u1ea3 ch\u1ea9n \u0111o\u00e1n kh\u00f4ng cao.<\/p>\n

      2.5. Gi\u1ea3i ph\u1eabu b\u1ec7nh: <\/strong><\/p>\n

      \u0110\u00f2i h\u1ecfi ph\u1ea3i c\u00f3 m\u1eabu m\u00f4 \u0111\u1ee7 l\u1edbn, th\u01b0\u1eddng l\u1ea5y qua sinh thi\u1ebft ph\u1ed5i ngo\u1ea1i khoa (ph\u1eabu thu\u1eadt n\u1ed9i soi l\u1ed3ng ng\u1ef1c (VATS)). \u0110\u00e2y \u0111\u1ec1u l\u00e0 nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p th\u0103m d\u00f2 x\u00e2m l\u1ea5n, c\u00f3 nguy c\u01a1 g\u00e2y ra c\u00e1c bi\u1ebfn ch\u1ee9ng n\u1eb7ng n\u1ec1 sau can thi\u1ec7p. Vi\u1ec7c ch\u1ec9 \u0111\u1ecbnh sinh thi\u1ebft ph\u1ed5i ngo\u1ea1i khoa ph\u1ea3i \u0111\u01b0\u1ee3c \u0111\u01b0a ra b\u1edfi h\u1ed9i \u0111\u1ed3ng h\u1ed9i ch\u1ea9n \u0111a chuy\u00ean khoa trong ch\u1ea9n \u0111o\u00e1n ILD.<\/p>\n

      3. Ch\u1ea9n \u0111o\u00e1n m\u1ee9c \u0111\u1ed9 n\u1eb7ng b\u1ec7nh ph\u1ed5i k\u1ebd<\/strong><\/h2>\n

      3.1. Kh\u1ea3o s\u00e1t l\u00e2m s\u00e0ng<\/strong>:<\/h3>\n

      \u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng kh\u00f3 th\u1edf v\u1edbi thang \u0111i\u1ec3m mMRC, kh\u1ea3 n\u0103ng g\u1eafng s\u1ee9c c\u1ee7a NB ILD v\u1edbi test \u0111i b\u1ed9 6 ph\u00fat c\u00f3 th\u1ec3 gi\u00fap \u0111\u00e1nh gi\u00e1 s\u01a1 b\u1ed9 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh. Kh\u00e1m l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n nh\u1eefng d\u1ea5u hi\u1ec7u n\u1eb7ng c\u1ee7a b\u1ec7nh nh\u01b0 ng\u00f3n tay d\u00f9i tr\u1ed1ng, c\u00e1c d\u1ea5u hi\u1ec7u t\u00e2m ph\u1ebf m\u1ea1n, suy h\u00f4 h\u1ea5p m\u1ea1n.<\/p>\n

      3.2. Th\u0103m d\u00f2 ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p<\/strong>:<\/h3>\n

      FVC \u0111\u01b0\u1ee3c xem l\u00e0 ch\u1ec9 s\u1ed1 ti\u00ean l\u01b0\u1ee3ng trong ILD, trong \u0111\u00f3 gi\u00e1 tr\u1ecb FVC c\u00e0ng th\u1ea5p, t\u1ed1c \u0111\u1ed9 suy gi\u1ea3m FVC c\u00e0ng nhanh th\u00ec ILD c\u00e0ng n\u1eb7ng.<\/p>\n

      3.3. X\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 \u1ea3nh h\u01b0\u1edfng tim ph\u1ed5i c\u1ee7a ILD<\/strong>:<\/h3>\n

      Si\u00eau \u00e2m tim c\u00f3 th\u1ec3 gi\u00fap \u0111\u00e1nh gi\u00e1 gi\u00e1n ti\u1ebfp \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1ea5t ph\u1ea3i; kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch, \u0111o \u0111\u1ed9 b\u00e3o h\u00f2a oxy theo m\u1ea1ch \u0111\u1eadp SpO2<\/sub>\u00a0cho th\u00f4ng s\u1ed1 kh\u00e1ch quan v\u1ec1 s\u1ef1 hi\u1ec7n di\u1ec7n v\u00e0 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a suy h\u00f4 h\u1ea5p; c\u00f4ng th\u1ee9c m\u00e1u cho ph\u00e9p \u0111\u00e1nh gi\u00e1 s\u1ef1 hi\u1ec7n di\u1ec7n v\u00e0 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a \u0111a h\u1ed3ng c\u1ea7u n\u1ebfu c\u00f3.<\/p>\n

      T\u00f3m l\u1ea1i, qua ba b\u01b0\u1edbc kinh \u0111i\u1ec3n ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n ILD v\u1eeba tr\u00ecnh b\u00e0y \u1edf tr\u00ean, b\u00e1c s\u1ef9 l\u00e2m s\u00e0ng t\u1ea1i Vi\u1ec7t Nam th\u01b0\u1eddng ph\u1ea3i gi\u1ea3i \u0111\u00e1p ba c\u00e2u h\u1ecfi c\u1ee5 th\u1ec3 tr\u01b0\u1edbc m\u1ed9t tr\u01b0\u1eddng h\u1ee3p ILD l\u00e0:<\/p>\n

      1) ILD n\u00e0y c\u00f3 nguy\u00ean nh\u00e2n \u0111\u00e3 r\u00f5 ho\u1eb7c c\u00f3 li\u00ean quan m\u1ed9t b\u1ec7nh l\u00fd nguy\u00ean ph\u00e1t kh\u00f4ng?<\/p>\n

      C\u0103n nguy\u00ean nhi\u1ec5m tr\u00f9ng: vi\u00eam ph\u1ed5i do virus, lao ph\u1ed5i, n\u1ea5m ph\u1ed5i.<\/p>\n

      B\u1ec7nh t\u1ef1 mi\u1ec5n: vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p, x\u01a1 c\u1ee9ng b\u00ec, vi\u00eam da c\u01a1, vi\u00eam \u0111a c\u01a1, SLE, MCTD.<\/p>\n

      B\u1ec7nh ph\u1ed5i k\u1ebd do thu\u1ed1c, b\u1ec7nh ph\u1ed5i ngh\u1ec1 nghi\u1ec7p<\/p>\n

      B\u1ec7nh ph\u1ed5i k\u1ebd do h\u00edt ph\u1ea3i c\u00e1c d\u1ecb nguy\u00ean \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p: vi\u00eam ph\u1ed5i t\u0103ng c\u1ea3m<\/p>\n

      B\u1ec7nh \u0111\u1ed3ng m\u1eafc kh\u00e1c: suy tim, ung th\u01b0 di c\u0103n ph\u1ed5i.<\/p>\n

      2) ILD n\u00e0y c\u00f3 thu\u1ed9c nh\u00f3m ch\u01b0a r\u00f5 nguy\u00ean nh\u00e2n (b\u1ec7nh x\u01a1 ph\u1ed5i v\u00f4 c\u0103n IPF) nh\u01b0ng kh\u00f4ng c\u1ea7n sinh thi\u1ebft ph\u1ed5i kh\u00f4ng?<\/p>\n

      3) ILD n\u00e0y c\u00f3 thu\u1ed9c nh\u00f3m ch\u01b0a r\u00f5 nguy\u00ean nh\u00e2n (bao g\u1ed3m c\u1ea3 x\u01a1 ph\u1ed5i v\u00f4 c\u0103n) nh\u01b0ng c\u1ea7n ph\u1ea3i sinh thi\u1ebft ph\u1ed5i kh\u00f4ng?<\/p>\n

      B\u1ec7nh ph\u1ed5i k\u1ebd l\u00e0 m\u1ed9t b\u1ec7nh ph\u1ed5i\u00a0 c\u00f3 ti\u1ec1m \u1ea9n nguy c\u01a1 g\u00e2y ra t\u1eed vong v\u00e0 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n. B\u1ec7nh n\u00e0y th\u01b0\u1eddng x\u1ea3y ra do t\u00e1c \u0111\u1ed9ng c\u1ee7a c\u00e1c ch\u1ea5t \u0111\u1ed9c h\u1ea1i nh\u01b0 kh\u00f3i thu\u1ed1c l\u00e1, b\u1ee5i m\u1ecbn v\u00e0 h\u00f3a ch\u1ea5t trong kh\u00f4ng kh\u00ed. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n b\u1ec7nh ph\u1ed5i k\u1ebd c\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi c\u00e1c chuy\u00ean gia y t\u1ebf c\u00f3 kinh nghi\u1ec7m v\u00e0 s\u1eed d\u1ee5ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00e1c nhau \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p v\u00e0 t\u1ed5n th\u01b0\u01a1ng c\u1ee7a ph\u1ed5i.<\/p>\n

      Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n