{"id":21366,"date":"2023-04-16T08:43:54","date_gmt":"2023-04-16T01:43:54","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21366"},"modified":"2023-04-17T14:16:25","modified_gmt":"2023-04-17T07:16:25","slug":"covid-2","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/16\/covid-2\/","title":{"rendered":"COVID 19: Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 c\u00e1c c\u1eadn l\u00e2m s\u00e0ng"},"content":{"rendered":"

COVID-19 l\u00e0 m\u1ed9t b\u1ec7nh truy\u1ec1n nhi\u1ec5m do virus SARS-CoV-2 g\u00e2y ra. C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a COVID-19 c\u00f3 th\u1ec3 kh\u00e1c nhau t\u1eeb ng\u01b0\u1eddi n\u00e0y sang ng\u01b0\u1eddi kh\u00e1c, t\u1eeb nh\u1eb9 \u0111\u1ebfn n\u1eb7ng l\u00e0m cho vi\u1ec7c ch\u1ea9n \u0111o\u00e1n \u0111\u00f4i khi\u00a0 g\u1eb7p kh\u00f3 kh\u0103n. Do \u0111\u00f3, vi\u1ec7c nh\u1eadn bi\u1ebft \u0111\u01b0\u1ee3c c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng ph\u1ed5 bi\u1ebfn v\u00e0 \u1ee9ng d\u1ee5ng c\u00e1c c\u1eadn l\u00e2m s\u00e0ng ph\u00f9 h\u1ee3p s\u1ebd gi\u00fap ch\u1ea9n \u0111o\u00e1n nhanh ch\u00f3ng COVID 19 tr\u00ean l\u00e2m s\u00e0ng c\u0169ng nh\u01b0 trong c\u1ed9ng \u0111\u1ed3ng.<\/strong><\/p>\n

1. C\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a COVID 19<\/strong><\/h1>\n

Kh\u1ea3 n\u0103ng m\u1eafc COVID-19 n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t \u1edf b\u1ea5t k\u1ef3 ai b\u1ecb s\u1ed1t v\u00e0\/ho\u1eb7c c\u00e1c tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p m\u1edbi kh\u1edfi ph\u00e1t. M\u1eb7c d\u00f9 ho v\u00e0 kh\u00f3 th\u1edf \u0111\u01b0\u1ee3c coi l\u00e0 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m h\u00f4 h\u1ea5p c\u1ed5 \u0111i\u1ec3n c\u1ee7a COVID-19, nh\u01b0ng c\u00e1c tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p kh\u00e1c nh\u01b0 \u0111au h\u1ecdng, ch\u1ea3y n\u01b0\u1edbc m\u0169i v\u00e0 ngh\u1eb9t m\u0169i th\u01b0\u1eddng \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o v\u00e0 th\u01b0\u1eddng l\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng duy nh\u1ea5t c\u1ee7a COVID-19.<\/p>\n

C\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng ph\u1ed5 bi\u1ebfn kh\u00e1c bao g\u1ed3m r\u1ed1i lo\u1ea1n m\u00f9i ho\u1eb7c v\u1ecb, \u0111au c\u01a1 v\u00e0 ti\u00eau ch\u1ea3y. COVID-19 c\u0169ng n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p d\u01b0\u1edbi nghi\u00eam tr\u1ecdng m\u00e0 kh\u00f4ng c\u00f3 nguy\u00ean nh\u00e2n r\u00f5 r\u00e0ng kh\u00e1c.<\/p>\n

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C\u00e1c tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n COVID 19. Ngu\u1ed3n<\/strong>: WHO 2021<\/em><\/figcaption><\/figure>\n

Kh\u00f4ng c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng c\u1ee5 th\u1ec3 n\u00e0o c\u00f3 th\u1ec3 ph\u00e2n bi\u1ec7t COVID-19 v\u1edbi c\u00e1c b\u1ec7nh nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p do vi-r\u00fat kh\u00e1c. Tuy nhi\u00ean, m\u1ed9t s\u1ed1 t\u00ednh n\u0103ng c\u00f3 th\u1ec3 \u0111\u1ea3m b\u1ea3o m\u1ee9c \u0111\u1ed9 nghi ng\u1edd l\u00e2m s\u00e0ng cao h\u01a1n. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u \u0111\u00e3 g\u1ee3i \u00fd r\u1eb1ng m\u1ea5t v\u1ecb gi\u00e1c v\u00e0 m\u1ea5t kh\u1ee9u gi\u00e1c l\u00e0 nh\u1eefng tri\u1ec7u ch\u1ee9ng li\u00ean quan r\u00f5 r\u1ec7t nh\u1ea5t v\u1edbi x\u00e9t nghi\u1ec7m SARS-CoV-2 d\u01b0\u01a1ng t\u00ednh. Kh\u00f3 th\u1edf ph\u00e1t tri\u1ec3n v\u00e0i ng\u00e0y sau khi xu\u1ea5t hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng ban \u0111\u1ea7u c\u0169ng g\u1ee3i \u00fd \u0111\u1ebfn COVID-19. Tuy nhi\u00ean, kh\u00f4ng c\u00f3 ph\u00e1t hi\u1ec7n n\u00e0o trong s\u1ed1 n\u00e0y x\u00e1c l\u1eadp ch\u1eafc ch\u1eafn ch\u1ea9n \u0111o\u00e1n COVID-19 m\u00e0 kh\u00f4ng c\u1ea7n x\u00e9t nghi\u1ec7m vi sinh.<\/p>\n

COVID-19 c\u0169ng n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ebfn ch\u1ee9ng ngo\u00e0i ph\u1ed5i li\u00ean quan \u0111\u1ebfn nhi\u1ec5m SARS-CoV-2, bao g\u1ed3m t\u1ed5n th\u01b0\u01a1ng tim, \u0111\u1ed9t qu\u1ef5 do thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 v\u00e0 c\u00e1c bi\u1ebfn c\u1ed1 huy\u1ebft kh\u1ed1i t\u1eafc m\u1ea1ch kh\u00e1c c\u0169ng nh\u01b0 c\u00e1c bi\u1ebfn ch\u1ee9ng vi\u00eam (v\u00ed d\u1ee5: vi\u00eam \u0111a h\u1ec7 th\u1ed1ng \u1edf tr\u1ebb em).<\/p>\n

2. C\u1eadn l\u00e2m s\u00e0ng th\u01b0\u1eddng d\u00f9ng trong COVID 19<\/strong><\/h2>\n

2.1. Huy\u1ebft h\u1ecdc<\/strong><\/p>\n

– T\u1ebf b\u00e0o m\u00e1u ngo\u1ea1i vi: s\u1ed1 l\u01b0\u1ee3ng H\u1ed3ng c\u1ea7u b\u00ecnh th\u01b0\u1eddng ho\u1eb7c t\u0103ng (do m\u1ea5t n\u01b0\u1edbc) b\u1ea1ch c\u1ea7u b\u00ecnh th\u01b0\u1eddng ho\u1eb7c gi\u1ea3m, B\u1ea1ch c\u1ea7u Lympho gi\u1ea3m nhi\u1ec1u, s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u b\u00ecnh th\u01b0\u1eddng sau \u0111\u00f3 gi\u1ea3m.<\/p>\n

– T\u0103ng \u0111\u00f4ng v\u00e0 t\u1eafc m\u1ea1ch: c\u00e1c x\u00e9t nghi\u1ec7m bi\u1ec3u hi\u1ec7n t\u0103ng \u0111\u00f4ng, D-dimer th\u01b0\u1eddng t\u0103ng cao tr\u00ean 4-5 l\u1ea7n, Ti\u1ec3u c\u1ea7u < 150.000, DIC ho\u1eb7c SIC (sepsis induced coagulopathy).<\/p>\n

2.2. C\u00e1c x\u00e9t nghi\u1ec7m bilan vi\u00eam<\/strong><\/p>\n

– B\u1ea1ch c\u1ea7u gi\u1ea3m, \u0111\u1eb7c bi\u1ec7t B\u1ea1ch c\u1ea7u Lympho (< 800). Gi\u1ea3m CD4, CD8, Th17, Ti\u1ec3u c\u1ea7u.<\/p>\n

– Cytokin t\u0103ng cao: TNF \u03b1 t\u0103ng, IL-1\u03b2, IL6, IFNs, GCSF, IP-10.<\/p>\n

– Ferritin, CRP, LDH t\u0103ng.<\/p>\n

2.3. Kh\u00ed m\u00e1u<\/strong><\/p>\n

Ban \u0111\u1ea7u PaO2\u00a0<\/sub>gi\u1ea3m, CO2\u00a0<\/sub>b\u00ecnh th\u01b0\u1eddng, n\u1eb7ng h\u01a1n PaO2\u00a0<\/sub>gi\u1ea3m n\u1eb7ng, PaCO2\u00a0<\/sub>t\u0103ng, pH gi\u1ea3m, gi\u1ea3m HCO3<\/sub>. Shunt ph\u1ed5i D(A-a)O2\u00a0<\/sub>t\u0103ng.<\/p>\n

2.4. C\u00e1c r\u1ed1i lo\u1ea1n th\u01b0\u1eddng g\u1eb7p kh\u00e1c<\/strong><\/p>\n

– \u0110i\u1ec7n gi\u1ea3i: r\u1ed1i lo\u1ea1n natri m\u00e1u v\u00e0 kali m\u00e1u.<\/p>\n

– Th\u1eadn: Ti\u1ec3u \u0111\u1ea1m, ti\u1ec3u m\u00e1u, t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p (\u0111a ni\u1ec7u, thi\u1ec3u ni\u1ec7u, t\u0103ng Ure, creatinin), g\u1eb7p m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p \u0111\u00e1i th\u00e1o nh\u1ea1t.<\/p>\n

– Gan: T\u0103ng SGPT, Bilirubin t\u0103ng.<\/p>\n

– T\u1ed5n th\u01b0\u01a1ng tim: T\u0103ng troponin T v\u00e0 Pro-BNP t\u0103ng.<\/p>\n

– Suy \u0111a t\u1ea1ng (MOF).<\/p>\n

– B\u1ed9i nhi\u1ec5m th\u1ee9 ph\u00e1t: T\u0103ng Procalcitonin, B\u1ea1ch c\u1ea7u v\u00e0 CRP.<\/p>\n

2.5. X-quang ph\u1ed5i<\/strong><\/p>\n

– \u1ede giai \u0111o\u1ea1n s\u1edbm ho\u1eb7c ch\u1ec9 vi\u00eam \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean, h\u00ecnh \u1ea3nh X-quang b\u00ecnh th\u01b0\u1eddng.<\/p>\n

– Giai \u0111o\u1ea1n sau c\u00e1c t\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng g\u1eb7p: T\u1ed5n th\u01b0\u01a1ng d\u1ea1ng k\u00ednh m\u1edd, nhi\u1ec1u \u0111\u1ed1m m\u1edd. D\u00e0y c\u00e1c t\u1ed5 ch\u1ee9c k\u1ebd. T\u1ed5n th\u01b0\u01a1ng \u0111\u00f4ng \u0111\u1eb7c.<\/p>\n

– G\u1eb7p ch\u1ee7 y\u1ebfu \u1edf hai b\u00ean ph\u1ed5i, ngo\u1ea1i vi v\u00e0 v\u00f9ng th\u1ea5p c\u1ee7a ph\u1ed5i \u1edf giai \u0111o\u1ea1n \u0111\u1ea7u c\u1ee7a COVID-19.<\/p>\n

– T\u1ed5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n nhanh trong ARDS. I\u0301t khi g\u1eb7p d\u1ea5u hi\u1ec7u t\u1ea1o hang hay tr\u00e0n d\u1ecbch, tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i.<\/p>\n

– C\u00f3 nhi\u1ec1u thang \u0111i\u1ec3m \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng b\u1ea3ng \u0111i\u1ec3m Brixia, CXR, TSS trong \u0111\u00f3 TSS (Total severity score) d\u1ec5 \u0111\u00e1nh gi\u00e1 v\u00e0 ti\u00ean l\u01b0\u1ee3ng m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh: nh\u1eb9 (1-2), trung b\u00ecnh (3-6), 7-8 (n\u1eb7ng).<\/p>\n

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H\u00ecnh \u1ea3nh k\u00ednh m\u1edd<\/strong>. C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m bao g\u1ed3m \u0111\u1ed9 m\u1edd \u1edf c\u1ea3 v\u00f9ng gi\u1eefa v\u00e0 v\u00f9ng d\u01b0\u1edbi c\u1ee7a ph\u1ed5i, ch\u1ee7 y\u1ebfu l\u00e0 v\u00f9ng ngo\u1ea1i vi (m\u0169i t\u00ean tr\u1eafng) . \u0110\u1ed9 m\u1edd thay \u0111\u1ed5i c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c nh\u00ecn th\u1ea5y \u1edf ngo\u1ea1i vi c\u1ee7a v\u00f9ng gi\u1eefa b\u00ean tr\u00e1i (m\u0169i t\u00ean \u0111en)<\/strong>. Ngu\u1ed3n<\/strong>: The role of chest radiography in confirming covid-19 pneumonia<\/em><\/figcaption><\/figure>\n

2.6. Ch\u1ee5p CT-Scan<\/strong><\/p>\n

– T\u1ed5n th\u01b0\u01a1ng k\u00ednh m\u1edd \u0111a \u1ed5 \u1edf v\u00f9ng \u0111\u00e1y v\u00e0 ngo\u1ea1i vi hai b\u00ean ph\u1ed5i. T\u1ed5n th\u01b0\u01a1ng l\u00e1t \u0111\u00e1.<\/p>\n

– T\u1ed5n th\u01b0\u01a1ng k\u00ednh m\u1edd v\u00e0 \u0111\u00f4ng \u0111\u1eb7c \u1edf v\u00f9ng \u0111\u00e1y v\u00e0 ngo\u1ea1i vi hai b\u00ean ph\u1ed5i.<\/p>\n

– Ph\u00e1t hi\u1ec7n c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u1eafc m\u1ea1ch ph\u1ed5i.<\/p>\n

– Ph\u00e2n lo\u1ea1i CO-RADS<\/p>\n

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H\u00ecnh \u1ea3nh k\u00ednh m\u1edd \u1edf v\u00f9ng ngo\u1ea1i bi\u00ean. Ngu\u1ed3n<\/strong>: Chest CT in COVID-19: What the Radiologist Needs to Know<\/em><\/figcaption><\/figure>\n

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

2.7.1. Si\u00eau \u00e2m ph\u1ed5i<\/strong><\/p>\n

– C\u00e1c d\u1ea5u hi\u1ec7u h\u00ecnh \u1ea3nh:<\/p>\n

+ Nhi\u1ec5u \u1ea3nh B-line: do d\u00e0y v\u00e1ch li\u00ean ti\u1ec3u thu\u1ef3 v\u00e0 tr\u00ean ng\u01b0\u1eddi b\u1ec7nh c\u00f3 h\u1ed9i ch\u1ee9ng k\u1ebd-ph\u1ebf nang c\u00f3 t\u1ee5 d\u1ecbch kho\u1ea3ng k\u1ebd, h\u01b0\u1edbng th\u1eb3ng \u0111\u1ee9ng, t\u0103ng \u00e2m, xu\u1ea5t ph\u00e1t t\u1eeb m\u00e0ng ph\u1ed5i ho\u1eb7c t\u1eeb v\u00f9ng \u0111\u00f4ng \u0111\u1eb7c. \u0110\u01b0\u1eddng B-line c\u00f3 th\u1ec3 \u0111\u01a1n \u0111\u1ed9c hay r\u1ea3i r\u00e1c ho\u1eb7c giao nhau.<\/p>\n

+ I\u0301t d\u1ecbch khoang m\u00e0ng ph\u1ed5i, m\u00e0ng ph\u1ed5i d\u00e0y kh\u00f4ng \u0111\u1ec1u, \u0111\u00f4ng \u0111\u1eb7c d\u01b0\u1edbi m\u00e0ng ph\u1ed5i.<\/p>\n

+ C\u00f3 th\u1ec3 c\u00f3 tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i.<\/p>\n

– \u0110\u00e1nh gi\u00e1 ph\u00e2n lo\u1ea1i type L v\u00e0 type H qua \u0111\u00f3 ti\u00ean l\u01b0\u1ee3ng nh\u1eefng tr\u01b0\u1eddng h\u1ee3p chuy\u1ec3n n\u1eb7ng \u1edf ng\u01b0\u1eddi b\u1ec7nh COVID-19.<\/p>\n

– Di\u1ec5n bi\u1ebfn t\u1ed1t l\u00ean: s\u1ed1 \u0111\u01b0\u1eddng B gi\u1ea3m d\u1ea7n, b\u1eaft \u0111\u1ea7u xu\u1ea5t hi\u1ec7n \u0111\u01b0\u1eddng A tr\u1edf l\u1ea1i v\u00e0 \u0111\u01b0\u1eddng m\u00e0ng ph\u1ed5i b\u00ecnh th\u01b0\u1eddng.<\/p>\n

– Di\u1ec5n bi\u1ebfn x\u1ea5u \u0111i: nhi\u1ec1u \u0111\u01b0\u1eddng B xu\u1ea5t hi\u1ec7n h\u01a1n v\u00e0 t\u1eadp trung th\u00e0nh m\u1ea3ng t\u1ea1o n\u00ean v\u00f9ng \u201cph\u1ed5i tr\u1eafng\u201d (tr\u00ean CLVT t\u01b0\u01a1ng \u1ee9ng v\u1edbi h\u00ecnh \u0111\u00e1m k\u00ednh m\u1edd gia t\u0103ng k\u00edch th\u01b0\u1edbc, d\u00e0y v\u00e1ch li\u00ean ti\u1ec3u thu\u1ef3 hay \u0111\u00f4ng \u0111\u1eb7c ph\u1ed5i) \u2192 c\u1ea7n xem x\u00e9t ch\u1ec9 \u0111\u1ecbnh can thi\u1ec7p th\u1edf m\u00e1y.<\/p>\n

– M\u1ee9c \u0111\u1ed9 n\u1eb7ng nh\u1ea5t l\u00e0 t\u1ed5n th\u01b0\u01a1ng \u0111\u00f4ng \u0111\u1eb7c xu\u1ea5t hi\u1ec7n v\u00e0 lan r\u1ed9ng c\u1ea7n ch\u1ec9 \u0111\u1ecbnh h\u1ec7 th\u1ed1ng trao \u0111\u1ed5i kh\u00ed oxy ngo\u00e0i c\u01a1 th\u1ec3 (ECMO).<\/p>\n

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\u00a0 \u00a0 \u00a0 \u00a0 Thang \u0111i\u1ec3m LUS Score tr\u00ean si\u00eau \u00e2m. Ngu\u1ed3n<\/strong>: AI for Health 2023<\/em><\/figcaption><\/figure>\n

 <\/p>\n

B\u1ea3ng \u0111i\u1ec3m d\u00f9ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1, ph\u00e2n lo\u1ea1i d\u00f9ng cho khoa c\u1ea5p c\u1ee9u v\u00e0 \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c bao g\u1ed3m:<\/p>\n

+ LUSS (lung ultrasound score): \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i v\u00e0 v\u1edbi LUSS > 18 cho th\u1ea5y t\u1ec9 l\u1ec7 t\u1eed vong t\u0103ng cao v\u00e0 \u0111\u00f2i h\u1ecfi c\u1ea7n xem x\u00e9t th\u1edf m\u00e1y x\u00e2m nh\u1eadp.<\/p>\n

+ LUS re-aeration score v\u00e0 LUS loss of aeration score: \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 t\u00e1i th\u00f4ng kh\u00ed v\u00e0 m\u1ea5t th\u00f4ng kh\u00ed \u1edf ng\u01b0\u1eddi b\u1ec7nh th\u1edf m\u00e1y x\u00e2m nh\u1eadp v\u00e0 ECMO.<\/p>\n

2.7.2. Si\u00eau \u00e2m tim<\/strong><\/p>\n

– \u0110\u00e1nh gi\u00e1 b\u1ec7nh n\u1ec1n tim m\u1ea1ch.<\/p>\n

– B\u1ec7nh c\u01a1 tim li\u00ean quan \u0111\u1ebfn nhi\u1ec5m tr\u00f9ng.<\/p>\n

– Vi\u00eam c\u01a1 tim.<\/p>\n

– Nh\u1ed3i m\u00e1u c\u01a1 tim, t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, huy\u1ebft kh\u1ed1i bu\u1ed3ng tim.<\/p>\n

– Suy th\u1ea5t tr\u00e1i v\u00e0 th\u1ea5t ph\u1ea3i (ACP).<\/p>\n

– Tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim.<\/p>\n

– H\u01b0\u1edbng d\u1eabn \u0111\u00e1nh gi\u00e1 huy\u1ebft \u0111\u1ed9ng (t\u00ecnh tr\u1ea1ng d\u1ecbch, thi\u1ebfu d\u1ecbch, qu\u00e1 t\u1ea3i d\u1ecbch): si\u00eau \u00e2m t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi, bi\u1ec7n ph\u00e1p n\u00e2ng ch\u00e2n\u2026<\/p>\n

– T\u0103ng \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, c\u1ea7n theo d\u00f5i nhi\u1ec1u l\u1ea7n.<\/p>\n

2.7.3. Si\u00eau \u00e2m m\u1ea1ch m\u00e1u<\/strong><\/p>\n

\u0110\u00e1nh gi\u00e1 bi\u1ebfn ch\u1ee9ng \u0111\u00f4ng m\u00e1u c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh COVID-19: Thi\u1ebfu m\u00e1u chi c\u1ea5p t\u00ednh, huy\u1ebft kh\u1ed1i \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, thi\u1ebfu m\u00e1u m\u1ea1c treo, nh\u1ed3i m\u00e1u c\u01a1 tim, tai bi\u1ebfn m\u1ea1ch n\u00e3o, huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch, DIC.<\/p>\n

2.8. X\u00e9t nghi\u1ec7m Vi sinh<\/strong><\/p>\n

2.8.1. Ch\u1ec9 \u0111\u1ecbnh x\u00e9t nghi\u1ec7m<\/strong><\/p>\n

– C\u00e1c tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd, c\u1ea7n l\u00e0m x\u00e9t nghi\u1ec7m kh\u1eb3ng \u0111\u1ecbnh nhi\u1ec5m SARS- CoV-2.<\/p>\n

– L\u1ea5y b\u1ec7nh ph\u1ea9m (d\u1ecbch h\u1ea7u h\u1ecdng, d\u1ecbch m\u0169i h\u1ecdng) x\u00e9t nghi\u1ec7m.<\/p>\n

– Khi \u00e2m t\u00ednh nh\u01b0ng v\u1eabn nghi ng\u1edd v\u1ec1 l\u00e2m s\u00e0ng, c\u1ea7n l\u1ea5y m\u1eabu b\u1ec7nh ph\u1ea9m d\u1ecbch h\u00fat ph\u1ebf qu\u1ea3n, ho\u1eb7c d\u1ecbch r\u1eeda ph\u1ebf qu\u1ea3n, r\u1eeda ph\u1ebf nang. N\u1ebfu \u0111ang th\u1edf m\u00e1y th\u00ec l\u1ea5y b\u1ec7nh ph\u1ea9m d\u1ecbch \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p d\u01b0\u1edbi.<\/p>\n

– Kh\u00f4ng d\u00f9ng x\u00e9t nghi\u1ec7m ph\u00e1t hi\u1ec7n kh\u00e1ng th\u1ec3 kh\u00e1ng SARS-CoV-2 \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n \u0111ang m\u1eafc COVID-19.<\/p>\n

– X\u00e9t nghi\u1ec7m kh\u00e1ng nguy\u00ean SARS-CoV-2 s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00e1t hi\u1ec7n kh\u00e1ng nguy\u00ean c\u1ee7a vi r\u00fat.<\/p>\n

– X\u00e9t nghi\u1ec7m SARS-CoV-2 trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh theo y\u00eau c\u1ea7u c\u1ee5 th\u1ec3 c\u1ee7a B\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb tr\u00ean t\u1eebng ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n

– C\u1ea5y m\u00e1u n\u1ebfu nghi ng\u1edd ho\u1eb7c c\u00f3 nhi\u1ec5m tr\u00f9ng huy\u1ebft, c\u1ea5y m\u00e1u c\u1ea7n x\u00e1c \u0111\u1ecbnh c\u00e1c c\u0103n nguy\u00ean vi khu\u1ea9n, n\u1ea5m n\u1ebfu c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng nghi ng\u1edd nhi\u1ec5m tr\u00f9ng, nhi\u1ec5m n\u1ea5m huy\u1ebft.<\/p>\n

– B\u1ec7nh ph\u1ea9m \u0111\u01b0\u1ee3c l\u1ea5y theo quy \u0111\u1ecbnh chuy\u00ean m\u00f4n, n\u00ean l\u1ea5y 2 m\u1eabu \u1edf 2 v\u1ecb tr\u00ed, c\u00f9ng th\u1eddi \u0111i\u1ec3m.<\/p>\n

– C\u1ea5y b\u1ec7nh ph\u1ea9m \u0111\u01b0\u1eddng h\u00f4 d\u01b0\u1edbi n\u1ebfu nghi ng\u1edd ho\u1eb7c c\u00f3 nhi\u1ec5m khu\u1ea9n b\u1ed9i nhi\u1ec5m. C\u1ea7n x\u00e9t nghi\u1ec7m x\u00e1c \u0111\u1ecbnh c\u0103n nguy\u00ean vi khu\u1ea9n, n\u1ea5m n\u1ebfu c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng nghi ng\u1edd.<\/p>\n

– C\u00e1c b\u1ec7nh ph\u1ea9m \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p d\u01b0\u1edbi bao g\u1ed3m: \u0111\u1eddm, d\u1ecbch h\u00fat n\u1ed9i kh\u00ed qu\u1ea3n, d\u1ecbch r\u1eeda ph\u1ebf qu\u1ea3n, d\u1ecbch r\u1eeda ph\u1ebf nang. Ngo\u00e0i ra c\u00e1c b\u1ec7nh ph\u1ea9m kh\u00e1c (n\u01b0\u1edbc ti\u1ec3u, m\u1ee7, ph\u00e2n, d\u1ecbch c\u00e1c khoang v\u00f4 tr\u00f9ng, d\u1ecbch d\u1eabn l\u01b0u\u2026) c\u0169ng c\u1ea7n \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh c\u0103n nguy\u00ean vi khu\u1ea9n, n\u1ea5m n\u1ebfu c\u00f3 d\u1ea5u hi\u1ec7n g\u1ee3i \u00fd nhi\u1ec5m khu\u1ea9n k\u00e8m theo.<\/p>\n

– B\u1ec7nh ph\u1ea9m \u0111\u01b0\u1ee3c l\u1ea5y theo quy \u0111\u1ecbnh chuy\u00ean m\u00f4n \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh c\u0103n nguy\u00ean g\u00e2y nhi\u1ec5m tr\u00f9ng.<\/p>\n

– C\u00e1c b\u1ec7nh ph\u1ea9m nu\u00f4i c\u1ea5y m\u00e1u, h\u00f4 h\u1ea5p v\u00e0 c\u00e1c b\u1ec7nh ph\u1ea9m vi sinh kh\u00e1c c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh l\u1eadp l\u1ea1i sau 2-3 ng\u00e0y \u1edf c\u00e1c ng\u01b0\u1eddi b\u1ec7nh c\u00f3 d\u1ea5u hi\u1ec7u nhi\u1ec5m khu\u1ea9n, nhi\u1ec5m n\u1ea5m n\u1eb7ng \u0111\u1ec3 theo d\u00f5i s\u1ef1 xu\u1ea5t hi\u1ec7n c\u00e1c t\u00e1c nh\u00e2n m\u1edbi, t\u00e1c nh\u00e2n kh\u00e1ng thu\u1ed1c trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<\/p>\n

– C\u00e1c x\u00e9t nghi\u1ec7m sinh h\u1ecdc ph\u00e2n t\u1eed x\u00e1c \u0111\u1ecbnh t\u00e1c nh\u00e2n g\u00e2y nhi\u1ec5m tr\u00f9ng, nhi\u1ec5m n\u1ea5m v\u00e0 gene kh\u00e1ng kh\u00e1ng sinh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00e1t hi\u1ec7n nhanh c\u0103n nguy\u00ean, \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi \u1edf c\u00e1c c\u01a1 s\u1edf y t\u1ebf c\u00f3 \u0111i\u1ec1u ki\u1ec7n.<\/p>\n

– Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p d\u01b0\u01a1ng t\u00ednh v\u1edbi SARS-CoV-2 c\u1ea7n b\u00e1o c\u00e1o B\u1ed9 Y t\u1ebf ho\u1eb7c CDC \u0111\u1ecba ph\u01b0\u01a1ng theo quy \u0111\u1ecbnh hi\u1ec7n h\u00e0nh.<\/p>\n

– X\u00e1c \u0111\u1ecbnh v\u1ec1 m\u1eb7t d\u1ecbch t\u1ec5 h\u1ecdc: n\u01a1i sinh s\u1ed1ng, n\u01a1i l\u00e0m vi\u1ec7c, \u0111i l\u1ea1i, l\u1eadp danh s\u00e1ch nh\u1eefng ng\u01b0\u1eddi \u0111\u00e3 ti\u1ebfp x\u00fac tr\u1ef1c ti\u1ebfp, tu\u00e2n th\u1ee7 theo h\u01b0\u1edbng d\u1eabn gi\u00e1m s\u00e1t v\u00e0 ph\u00f2ng, ch\u1ed1ng COVID-19 c\u1ee7a B\u1ed9 Y t\u1ebf.<\/p>\n

2.8.2. X\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n c\u0103n nguy\u00ean<\/strong><\/p>\n

2.8.2.1<\/strong>. X\u00e9t nghi\u1ec7m Realtime RT-PCR<\/em><\/strong><\/p>\n

X\u00e9t nghi\u1ec7m n\u00e0y \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n tr\u00ean c\u00e1c m\u1eabu b\u1ec7nh ph\u1ea9m h\u00f4 h\u1ea5p nh\u01b0 m\u1eabu ngo\u00e1y d\u1ecbch t\u1ef5 h\u1ea7u, m\u1eabu ph\u1ebft h\u1ecdng, m\u1eabu d\u1ecbch h\u00fat kh\u00ed qu\u1ea3n\u2026 k\u1ef9 thu\u1eadt Realtime RT- PCR l\u00e0 x\u00e9t nghi\u1ec7m c\u00f3 \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao<\/p>\n

2.8.2.2. X\u00e9t nghi\u1ec7m nhanh ph\u00e1t hi\u1ec7n kh\u00e1ng nguy\u00ean<\/em><\/strong><\/p>\n

– X\u00e9t nghi\u1ec7m nhanh ph\u00e1t hi\u1ec7n kh\u00e1ng nguy\u00ean vi r\u00fat SARS-CoV-2 nh\u1eb1m ph\u00e1t hi\u1ec7n c\u00e1c protein b\u1ec1 m\u1eb7t c\u1ee7a vi r\u00fat (hay c\u00e1c th\u00e0nh ph\u1ea7n c\u1ea5u tr\u00fac kh\u00e1ng nguy\u00ean kh\u00e1c) trong m\u1eabu b\u1ec7nh ph\u1ea9m. \u01afu \u0111i\u1ec3m cho k\u1ebft qu\u1ea3 nhanh, nh\u01b0\u1ee3c \u0111i\u1ec3m \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u th\u1ea5p h\u01a1n k\u1ef9 thu\u1eadt PCR.<\/p>\n

– M\u1eabu b\u1ec7nh ph\u1ea9m bao g\u1ed3m m\u1eabu ngo\u00e1y d\u1ecbch t\u1ef5 h\u1ea7u, m\u1eabu ngo\u00e1y d\u1ecbch h\u1ecdng, m\u1eabu n\u01b0\u1edbc b\u1ecdt v\u00e0 c\u00e1c m\u1eabu kh\u00e1c theo h\u01b0\u1edbng d\u1eabn c\u1ee7a nh\u00e0 s\u1ea3n xu\u1ea5t.<\/p>\n

Ngu\u1ed3n: <\/strong><\/p>\n

H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb COVID 19 c\u1ee7a B\u1ed9 Y t\u1ebf 2022<\/p>\n

Uptodate: COVID-19: Diagnosis<\/p>\n","protected":false},"excerpt":{"rendered":"

COVID-19 l\u00e0 m\u1ed9t b\u1ec7nh truy\u1ec1n nhi\u1ec5m do virus SARS-CoV-2 g\u00e2y ra. C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a COVID-19 c\u00f3 th\u1ec3 kh\u00e1c nhau t\u1eeb ng\u01b0\u1eddi n\u00e0y sang ng\u01b0\u1eddi kh\u00e1c, t\u1eeb nh\u1eb9 \u0111\u1ebfn n\u1eb7ng l\u00e0m cho vi\u1ec7c ch\u1ea9n \u0111o\u00e1n \u0111\u00f4i khi\u00a0 g\u1eb7p kh\u00f3 kh\u0103n. Do \u0111\u00f3, vi\u1ec7c nh\u1eadn bi\u1ebft \u0111\u01b0\u1ee3c c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng ph\u1ed5 bi\u1ebfn v\u00e0 \u1ee9ng […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[20,33],"tags":[3],"yoast_head":"\nCOVID 19: Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 c\u00e1c c\u1eadn l\u00e2m s\u00e0ng - Vinmec<\/title>\n<meta name=\"description\" content=\"C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a COVID-19 c\u00f3 th\u1ec3 kh\u00e1c nhau t\u1eeb ng\u01b0\u1eddi n\u00e0y sang ng\u01b0\u1eddi kh\u00e1c, t\u1eeb nh\u1eb9 \u0111\u1ebfn n\u1eb7ng l\u00e0m cho vi\u1ec7c ch\u1ea9n \u0111o\u00e1n \u0111\u00f4i khi\u00a0 g\u1eb7p kh\u00f3 kh\u0103n\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"COVID 19: Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 c\u00e1c c\u1eadn l\u00e2m s\u00e0ng - 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