{"id":19699,"date":"2023-04-16T15:28:01","date_gmt":"2023-04-16T08:28:01","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=19699"},"modified":"2023-04-17T14:13:58","modified_gmt":"2023-04-17T07:13:58","slug":"chan-doan-benh-phoi-tang-bach-cau-ai-toan-vo-can-cap-tinhaep","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/16\/chan-doan-benh-phoi-tang-bach-cau-ai-toan-vo-can-cap-tinhaep\/","title":{"rendered":"Ch\u1ea9n \u0111o\u00e1n b\u1ec7nh ph\u1ed5i t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan v\u00f4 c\u0103n c\u1ea5p t\u00ednh(AEP)"},"content":{"rendered":"

B\u1ec7nh ph\u1ed5i t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan v\u00f4 c\u0103n c\u1ea5p t\u00ednh(AEP) l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh ph\u1ed5i li\u00ean quan \u0111\u1ebfn t\u0103ng b\u1ea1ch c\u1ea7u<\/a> \u00e1i toan m\u00e1u ngo\u1ea1i vi ho\u1eb7c nhu m\u00f4 ph\u1ed5i. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n b\u1ec7nh \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp \u0111\u1ebfn sau khi \u0111\u00e3 lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y vi\u00eam ph\u1ed5i t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan nh\u01b0: n\u1ea5m ph\u1ebf qu\u1ea3n ph\u1ed5i d\u1ecb \u1ee9ng, nhi\u1ec5m k\u00fd sinh tr\u00f9ng, do thu\u1ed1c, vi\u00eam m\u1ea1ch t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan\u2026<\/strong><\/p>\n

1. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/b><\/h2>\n

1.1. L\u00e2m s\u00e0ng<\/b><\/h3>\n

\u0110\u00e1nh gi\u00e1 ban \u0111\u1ea7u \u1edf c\u00e1c b\u1ec7nh nh\u00e2n nghi ng\u1edd l\u00e0 vi\u1ec7c d\u00f9ng thu\u1ed1c, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c thu\u1ed1c li\u00ean quan \u0111\u1ebfn t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan trong ph\u1ed5i (cocain, daptomycin, gemcitabine, infliximab, ranitidine, sulfasalazine\/mesalamine, venlafaxine), x\u1ea1 tr\u1ecb v\u00f9ng ng\u1ef1c tr\u01b0\u1edbc \u0111\u00f3, s\u1ed1ng \u1edf v\u00f9ng c\u00f3 d\u1ecbch t\u1ec5 c\u1ee7a k\u00fd sinh tr\u00f9ng ho\u1eb7c n\u1ea5m.<\/p>\n

    \n
  • B\u1ec7nh c\u00f3 th\u1ec3 g\u1eb7p \u1edf c\u00e1c l\u1ee9a tu\u1ed5i, ch\u1ee7 y\u1ebfu t\u1eeb 20-40 tu\u1ed5i, t\u1ef7 l\u1ec7 ng\u01b0\u1eddi b\u1ec7nh nam g\u1ea7n g\u1ea5p \u0111\u00f4i so v\u1edbi n\u1eef.<\/li>\n
  • Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 th\u1ec3 c\u00f3 ti\u1ec1n s\u1eed d\u1ecb \u1ee9ng.<\/li>\n
  • Kh\u1edfi ph\u00e1t b\u1ec7nh c\u1ea5p t\u00ednh t\u1eeb v\u00e0i ng\u00e0y \u0111\u1ebfn v\u00e0i tu\u1ea7n (th\u01b0\u1eddng < 4 tu\u1ea7n).<\/li>\n
  • C\u00e1c tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p nh\u01b0ng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u bao g\u1ed3m: ho khan, kh\u00f3 th\u1edf, s\u1ed1t v\u00e0 tri\u1ec7u ch\u1ee9ng \u00edt g\u1eb7p h\u01a1n nh\u01b0 m\u1ec7t m\u1ecfi, \u0111au c\u01a1, ra m\u1ed3 h\u00f4i \u0111\u00eam, \u1edbn l\u1ea1nh, \u0111au ng\u1ef1c ki\u1ec3u m\u00e0ng ph\u1ed5i.<\/li>\n
  • Th\u0103m kh\u00e1m th\u1ea5y ng\u01b0\u1eddi b\u1ec7nh th\u01b0\u1eddng s\u1ed1t cao v\u00e0 th\u1edf nhanh, ran n\u1ed5 \u1edf \u0111\u00e1y ph\u1ed5i 2 b\u00ean, c\u00f3 th\u1ec3 c\u00f3 ran co th\u1eaft. M\u1ed9t s\u1ed1 ng\u01b0\u1eddi b\u1ec7nh c\u00f3 bi\u1ec3u hi\u1ec7n suy h\u00f4 h\u1ea5p gi\u1ea3m oxy m\u00e1u c\u1ea7n th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o.<\/li>\n<\/ul>\n

    1.2. C\u1eadn l\u00e2m s\u00e0ng<\/b><\/p>\n

    Kh\u00f4ng c\u00f3 x\u00e9t nghi\u1ec7m \u0111\u1eb7c hi\u1ec7u. C\u00e1c x\u00e9t nghi\u1ec7m chung bao g\u1ed3m t\u1ebf b\u00e0o m\u00e1u ngo\u1ea1i vi, ch\u1ee9c n\u0103ng gan th\u1eadn, ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u, c\u1ea5y m\u00e1u.<\/p>\n

    X\u00e9t nghi\u1ec7m m\u00e1u: ban \u0111\u1ea7u c\u00f3 th\u1ec3 t\u0103ng b\u1ea1ch c\u1ea7u trung t\u00ednh, ph\u1ea7n l\u1edbn c\u00f3 t\u1ef7 l\u1ec7 b\u1ea1ch c\u1ea7u \u00e1i toan ban \u0111\u1ea7u kh\u00f4ng t\u0103ng, nh\u01b0ng t\u0103ng r\u00f5 trong di\u1ec5n bi\u1ebfn ti\u1ebfp theo. M\u00e1u l\u1eafng, CRP t\u0103ng, n\u1ed3ng \u0111\u1ed9 IgE t\u0103ng \u1edf ph\u1ea7n l\u1edbn ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n

    C\u00e1c XN c\u00f3 th\u1ec3 gi\u00fap ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t:<\/b><\/p>\n

    \u2012 Test antineutrophil cytoplasmic antibody (ANCA): \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi u h\u1ea1t c\u00f3 vi\u00eam \u0111a tuy\u1ebfn (granulomatosis with polyangiitis – GPA) ho\u1eb7c u h\u1ea1t c\u00f3 vi\u00eam \u0111a tuy\u1ebfn t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan (granulomatosis with polyangiitis – EGPA, Churg Strauss) (40-60% d\u01b0\u01a1ng t\u00ednh).<\/p>\n

    \u2012 X\u00e9t nghi\u1ec7m mi\u1ec5n d\u1ecbch li\u00ean k\u1ebft enzym IgM v\u00e0 IgG \u0111\u1eb7c hi\u1ec7u cho Coccidioides.<\/p>\n

    \u2012 X\u00e9t nghi\u1ec7m ELISA ho\u1eb7c test huy\u1ebft thanh kh\u00e1c \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n giun l\u01b0\u01a1n ho\u1eb7c s\u00e1n l\u00e1 ph\u1ed5i t\u00f9y theo nguy c\u01a1 ph\u01a1i nhi\u1ec5m.<\/p>\n

    X\u00e9t nghi\u1ec7m \u0111\u1eddm g\u00e2y kh\u1ea1c c\u00f3 m\u1ed9t s\u1ed1 ng\u01b0\u1eddi b\u1ec7nh t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan nh\u01b0ng \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u kh\u00f4ng \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1.<\/p>\n

    Tr\u01b0\u1eddng h\u1ee3p ng\u01b0\u1eddi b\u1ec7nh c\u00f3 tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, ph\u00e2n t\u00edch t\u1ebf b\u00e0o d\u1ecbch c\u00f3 th\u1ec3 th\u1ea5y t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan (10-50%)<\/p>\n

    Xquang ng\u1ef1c<\/b>: t\u1ed5n th\u01b0\u01a1ng ch\u1ee7 y\u1ebfu l\u00e0 m\u1edd d\u1ea1ng l\u01b0\u1edbi 2 b\u00ean (c\u00f3 ho\u1eb7c kh\u00f4ng k\u00e8m theo h\u00ecnh \u1ea3nh \u0111\u00f4ng \u0111\u1eb7c r\u1ea3i r\u00e1c). Th\u01b0\u1eddng g\u1eb7p h\u00ecnh \u1ea3nh tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i 2 b\u00ean, s\u1ed1 l\u01b0\u1ee3ng \u00edt.<\/p>\n

    HRCT<\/b>: th\u01b0\u1eddng g\u1eb7p h\u00ecnh k\u00ednh m\u1edd r\u1ea3i r\u00e1c 2 b\u00ean, th\u01b0\u1eddng k\u00e8m theo d\u00e0y v\u00e1ch li\u00ean ti\u1ec3u th\u00f9y v\u00e0 c\u00f3 th\u1ec3 c\u00f3 h\u00ecnh \u1ea3nh \u0111\u00f4ng \u0111\u1eb7c ph\u1ed5i ho\u1eb7c n\u1ed1t m\u1edd<\/p>\n

    \"T\u1ed5n
    X-Q b\u1ec7nh ph\u1ed5i t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan: H\u00ecnh \u1ea3nh k\u00ednh m\u1edd t\u1eebng \u0111\u00e1m lan t\u1ecfa 2 b\u00ean, d\u00e0y v\u00e1ch ng\u0103n ti\u1ec3u th\u00f9y v\u00e0 tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i 2 b\u00ean<\/figcaption><\/figure>\n

    D\u1ecbch ph\u1ebf qu\u1ea3n<\/b>: t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan trong d\u1ecbch r\u1eeda ph\u1ebf qu\u1ea3n, th\u01b0\u1eddng > 25%.<\/p>\n

    M\u00f4 b\u1ec7nh h\u1ecdc<\/b><\/p>\n

    \u2012 C\u00e1c d\u1ea5u hi\u1ec7u ch\u1ea9n \u0111o\u00e1n bao g\u1ed3m t\u1ed5n th\u01b0\u01a1ng ph\u1ebf nang lan t\u1ecfa v\u1edbi c\u00e1c m\u00e0ng hyalin v\u00e0 ph\u00f9 m\u00f4 k\u1ebd, k\u00e8m th\u1ea5m nh\u1eadp b\u1ea1ch c\u1ea7u \u00e1i toan trong l\u00f2ng ph\u1ebf nang, ti\u1ec3u ph\u1ebf qu\u1ea3n v\u00e0 m\u00f4 k\u1ebd. Tuy nhi\u00ean, nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p giai \u0111o\u1ea1n \u0111\u1ea7u c\u1ee7a b\u1ec7nh ph\u1ed5i t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan v\u00f4 c\u0103n c\u1ea5p t\u00ednh kh\u00f4ng c\u00f3 th\u1ea5m nh\u1eadp nhi\u1ec1u b\u1ea1ch c\u1ea7u \u00e1i toan.<\/p>\n

    \u2012 M\u1ed9t \u0111\u00f4i ch\u1ed7 hay m\u1ed9t v\u00e0i tr\u01b0\u1eddng h\u1ee3p m\u1eabu m\u00f4 sinh thi\u1ebft c\u00f3 h\u00ecnh \u1ea3nh m\u00f4 h\u1ecdc c\u1ee7a b\u1ec7nh ph\u1ed5i t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan v\u00f4 c\u0103n m\u1ea1n t\u00ednh.<\/p>\n

    \"M\u00f4
    M\u00f4 b\u1ec7nh h\u1ecdc b\u1ec7nh ph\u1ed5i t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan v\u00f4 c\u0103n c\u1ea5p t\u00ednh (AIEP)<\/figcaption><\/figure>\n

    T\u1ed5n th\u01b0\u01a1ng ph\u1ebf nang lan t\u1ecfa v\u1edbi c\u00e1c m\u00e0ng hyalin, ph\u00f9 m\u00f4 k\u1ebd v\u00e0 th\u1ea5m nh\u1eadp b\u1ea1ch c\u1ea7u \u00e1i toan<\/p>\n

    2. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n<\/b><\/h2>\n

    Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh b\u1ec7nh \u0111i\u1ec3n h\u00ecnh d\u1ef1a v\u00e0o c\u00e1c ti\u00eau chu\u1ea9n sau:<\/p>\n

    \u2012 S\u1ed1t trong th\u1eddi gian ng\u1eafn (th\u01b0\u1eddng kh\u00f4ng qu\u00e1 1 th\u00e1ng).<\/p>\n

    \u2012 Suy h\u00f4 h\u1ea5p gi\u1ea3m oxy m\u00e1u (SpO2 <90% khi th\u1edf kh\u00ed ph\u00f2ng ho\u1eb7c PaO2 <60 mmHg).<\/p>\n

    \u2012 T\u1ed5n th\u01b0\u01a1ng m\u1edd d\u1ea1ng l\u01b0\u1edbi lan t\u1ecfa tr\u00ean phim ch\u1ee5p X quang ph\u1ed5i.<\/p>\n

    \u2012 Ph\u00e2n t\u00edch t\u1ebf b\u00e0o d\u1ecbch r\u1eeda ph\u1ebf qu\u1ea3n ph\u1ebf nang c\u00f3 t\u1ef7 l\u1ec7 b\u1ea1ch c\u1ea7u \u00e1i toan > 25%.<\/p>\n

    \u2012 Kh\u00f4ng c\u00f3 c\u00e1c b\u1ec7nh l\u00fd g\u00e2y vi\u00eam ph\u1ed5i t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan kh\u00e1c bao g\u1ed3m thu\u1ed1c, nhi\u1ec5m tr\u00f9ng, hen suy\u1ec5n ho\u1eb7c b\u1ec7nh d\u1ecb \u1ee9ng.<\/p>\n

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

    \u2012 B\u1ec7nh u h\u1ea1t t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan k\u00e8m theo vi\u00eam \u0111a tuy\u1ebfn (EGPA, Churg Strauss): c\u00f3 bi\u1ec3u hi\u1ec7n nh\u01b0 b\u1ec7nh ph\u1ed5i t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan v\u00f4 c\u0103n c\u1ea5p t\u00ednh v\u1edbi suy h\u00f4 h\u1ea5p ti\u1ebfn tri\u1ec3n, s\u1ed1t, t\u1ed5n th\u01b0\u01a1ng m\u1edd tr\u00ean Xquang ng\u1ef1c v\u00e0 t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan trong BAL. EGPA th\u01b0\u1eddng c\u00f3 b\u1ea1ch c\u1ea7u \u00e1i toan m\u00e1u ngo\u1ea1i vi > 10% v\u00e0 c\u00f3 t\u1ed5n th\u01b0\u01a1ng nhi\u1ec1u c\u01a1 quan kh\u00e1c. B\u1ec7nh ph\u1ed5i t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan v\u00f4 c\u0103n c\u1ea5p t\u00ednh \u00edt g\u1eb7p t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan m\u00e1u ngo\u1ea1i vi.<\/p>\n

    \u2012 Nhi\u1ec5m n\u1ea5m Coccidioides immitis v\u00e0 c\u00e1c lo\u00e0i n\u1ea5m k\u00fd sinh c\u00f3 th\u1ec3 g\u00e2y vi\u00eam ph\u1ed5i c\u1ea5p t\u00ednh t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan . Nhi\u1ec5m n\u1ea5m aspergillus x\u00e2m l\u1ea5n c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n nh\u01b0 AEP. C\u1ea7n ch\u00fa \u00fd ti\u1ec1n s\u1eed d\u1ecbch t\u1ec5 \u1edf c\u00e1c ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n

    \u2012 Nhi\u1ec5m k\u00fd sinh tr\u00f9ng do giun \u0111\u0169a, s\u00e1n l\u00e1 ph\u1ed5i, giun l\u01b0\u01a1n, v\u00e0 giun \u0111\u0169a ch\u00f3 m\u00e8o c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i lan t\u1ecfa, t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan m\u00e1u ngo\u1ea1i vi v\u00e0 d\u1ecbch ph\u1ebf qu\u1ea3n.<\/p>\n

    \u2012 Vi\u00eam ph\u1ed5i t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan do thu\u1ed1c, ch\u1ea5t \u0111\u1ed9c v\u00e0 x\u1ea1 tr\u1ecb ph\u1ed5i.<\/p>\n

    \u2012 C\u00e1c b\u1ec7nh l\u00fd c\u00f3 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng t\u01b0\u01a1ng t\u1ef1 nh\u01b0ng kh\u00f4ng c\u00f3 t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan d\u1ecbch ph\u1ebf qu\u1ea3n bao g\u1ed3m h\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p ti\u1ebfn tri\u1ec3n (ARDS), vi\u00eam ph\u1ed5i k\u1ebd c\u1ea5p t\u00ednh, vi\u00eam ph\u1ed5i t\u1ed5 ch\u1ee9c h\u00f3a (COP), xu\u1ea5t huy\u1ebft ph\u1ebf nang lan t\u1ecfa (DAH), u h\u1ea1t v\u1edbi vi\u00eam \u0111a tuy\u1ebfn (GPA).<\/p>\n","protected":false},"excerpt":{"rendered":"

    B\u1ec7nh ph\u1ed5i t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan v\u00f4 c\u0103n c\u1ea5p t\u00ednh(AEP) l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh ph\u1ed5i li\u00ean quan \u0111\u1ebfn t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan m\u00e1u ngo\u1ea1i vi ho\u1eb7c nhu m\u00f4 ph\u1ed5i. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n b\u1ec7nh \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp \u0111\u1ebfn sau khi \u0111\u00e3 lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y vi\u00eam ph\u1ed5i t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i […]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[20,33],"tags":[3],"yoast_head":"\nCh\u1ea9n \u0111o\u00e1n b\u1ec7nh ph\u1ed5i t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan v\u00f4 c\u0103n c\u1ea5p t\u00ednh(AEP)<\/title>\n<meta name=\"description\" content=\"B\u1ec7nh ph\u1ed5i t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh ph\u1ed5i li\u00ean quan \u0111\u1ebfn t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan m\u00e1u ngo\u1ea1i vi ho\u1eb7c ...\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, 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