{"id":22165,"date":"2023-04-19T12:40:16","date_gmt":"2023-04-19T05:40:16","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22165"},"modified":"2023-04-19T14:47:11","modified_gmt":"2023-04-19T07:47:11","slug":"huong-dan-chan-doan-benh-copd-theo-bo-y-te","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/huong-dan-chan-doan-benh-copd-theo-bo-y-te\/","title":{"rendered":"H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n b\u1ec7nh COPD theo B\u1ed9 Y t\u1ebf"},"content":{"rendered":"

B\u1ec7nh ph\u1ed5i<\/a> t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh (COPD) l\u00e0 b\u1ec7nh h\u00f4 h\u1ea5p ph\u1ed5 bi\u1ebfn c\u00f3 th\u1ec3 ph\u00f2ng v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c. B\u1ec7nh \u0111\u1eb7c tr\u01b0ng b\u1edfi c\u00e1c tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p dai d\u1eb3ng v\u00e0 gi\u1edbi h\u1ea1n lu\u1ed3ng kh\u00ed, l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a nh\u1eefng b\u1ea5t th\u01b0\u1eddng c\u1ee7a \u0111\u01b0\u1eddng th\u1edf v\u00e0\/ho\u1eb7c ph\u1ebf nang th\u01b0\u1eddng do ph\u01a1i nhi\u1ec5m v\u1edbi c\u00e1c ph\u00e2n t\u1eed ho\u1eb7c kh\u00ed \u0111\u1ed9c h\u1ea1i. B\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y s\u1ebd cung c\u1ea5p th\u00f4ng tin v\u1ec1\u00a0 h\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n COPD theo B\u1ed9 Y t\u1ebf.<\/strong><\/p>\n

\"B\u1ec7nh
B\u1ec7nh COPD th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi h\u00fat thu\u1ed1c l\u00e1 nhi\u1ec1u n\u0103m<\/figcaption><\/figure>\n

1. Ch\u1ea9n \u0111o\u00e1n \u0111\u1ecbnh h\u01b0\u1edbng \u00e1p d\u1ee5ng t\u1ea1i tuy\u1ebfn ch\u01b0a \u0111\u01b0\u1ee3c trang b\u1ecb m\u00e1y \u0111o ch\u1ee9c n\u0103ng th\u00f4ng kh\u00ed<\/strong><\/h2>\n

Khai th\u00e1c k\u1ef9 ti\u1ec1n s\u1eed ti\u1ebfp x\u00fac v\u1edbi c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 g\u00e2y b\u1ec7nh, th\u0103m kh\u00e1m l\u00e2m s\u00e0ng \u0111\u1ec3 t\u00ecm c\u00e1c d\u1ea5u hi\u1ec7u \u0111\u1ecbnh h\u01b0\u1edbng ch\u1ea9n \u0111o\u00e1n:<\/p>\n

– B\u1ec7nh hay g\u1eb7p \u1edf nam gi\u1edbi tr\u00ean 40 tu\u1ed5i.<\/p>\n

– Ti\u1ec1n s\u1eed: h\u00fat thu\u1ed1c l\u00e1, thu\u1ed1c l\u00e0o (bao g\u1ed3m c\u1ea3 h\u00fat thu\u1ed1c ch\u1ee7 \u0111\u1ed9ng v\u00e0 th\u1ee5 \u0111\u1ed9ng). \u00d4 nhi\u1ec5m m\u00f4i tr\u01b0\u1eddng trong v\u00e0 ngo\u00e0i nh\u00e0: kh\u00f3i b\u1ebfp, kh\u00f3i, ch\u1ea5t \u0111\u1ed1t, b\u1ee5i ngh\u1ec1 nghi\u1ec7p (b\u1ee5i h\u1eefu c\u01a1, v\u00f4 c\u01a1), h\u01a1i, kh\u00ed \u0111\u1ed9c. Nhi\u1ec5m khu\u1ea9n h\u00f4 h\u1ea5p t\u00e1i di\u1ec5n, lao ph\u1ed5i… T\u0103ng t\u00ednh ph\u1ea3n \u1ee9ng \u0111\u01b0\u1eddng th\u1edf (hen ph\u1ebf qu\u1ea3n ho\u1eb7c vi\u00eam ph\u1ebf qu\u1ea3n co th\u1eaft).<\/p>\n

– Ho, kh\u1ea1c \u0111\u1eddm k\u00e9o d\u00e0i kh\u00f4ng do c\u00e1c b\u1ec7nh ph\u1ed5i kh\u00e1c nh\u01b0 lao ph\u1ed5i, gi\u00e3n ph\u1ebf qu\u1ea3n…: l\u00e0 tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p. L\u00fac \u0111\u1ea7u c\u00f3 th\u1ec3 ch\u1ec9 c\u00f3 ho ng\u1eaft qu\u00e3ng, sau \u0111\u00f3 ho dai d\u1eb3ng ho\u1eb7c ho h\u00e0ng ng\u00e0y (ho k\u00e9o d\u00e0i \u00edt nh\u1ea5t 3 th\u00e1ng trong 1 n\u0103m v\u00e0 trong 2 n\u0103m li\u00ean ti\u1ebfp), ho khan ho\u1eb7c ho c\u00f3 \u0111\u1eddm, th\u01b0\u1eddng kh\u1ea1c \u0111\u1eddm v\u1ec1 bu\u1ed5i s\u00e1ng. Ho \u0111\u1eddm m\u1ee7 l\u00e0 m\u1ed9t trong c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a \u0111\u1ee3t c\u1ea5p do b\u1ed9i nhi\u1ec5m.<\/p>\n

– Kh\u00f3 th\u1edf: ti\u1ebfn tri\u1ec3n n\u1eb7ng d\u1ea7n theo th\u1eddi gian, l\u00fac \u0111\u1ea7u ch\u1ec9 c\u00f3 kh\u00f3 th\u1edf khi g\u1eafng s\u1ee9c, sau \u0111\u00f3 kh\u00f3 th\u1edf c\u1ea3 khi ngh\u1ec9 ng\u01a1i v\u00e0 kh\u00f3 th\u1edf li\u00ean t\u1ee5c. B\u1ec7nh nh\u00e2n \u201cph\u1ea3i g\u1eafng s\u1ee9c \u0111\u1ec3 th\u1edf\u201d, \u201ckh\u00f3 th\u1edf, n\u1eb7ng ng\u1ef1c\u201d, \u201cc\u1ea3m gi\u00e1c thi\u1ebfu kh\u00f4ng kh\u00ed, h\u1ee5t h\u01a1i\u201d ho\u1eb7c \u201cth\u1edf h\u1ed5n h\u1ec3n\u201d, th\u1edf kh\u00f2 kh\u00e8. Kh\u00f3 th\u1edf t\u0103ng l\u00ean khi g\u1eafng s\u1ee9c ho\u1eb7c nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p.<\/p>\n

– C\u00e1c tri\u1ec7u ch\u1ee9ng ho kh\u1ea1c \u0111\u1eddm, kh\u00f3 th\u1edf dai d\u1eb3ng v\u00e0 ti\u1ebfn tri\u1ec3n n\u1eb7ng d\u1ea7n theo th\u1eddi gian.<\/p>\n

– Kh\u00e1m l\u00e2m s\u00e0ng:<\/p>\n

+ Giai \u0111o\u1ea1n s\u1edbm c\u1ee7a b\u1ec7nh kh\u00e1m ph\u1ed5i c\u00f3 th\u1ec3 b\u00ecnh th\u01b0\u1eddng. C\u1ea7n \u0111o ch\u1ee9c n\u0103ng th\u00f4ng kh\u00ed \u1edf nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 v\u00e0 c\u00f3 tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng g\u1ee3i \u00fd (ngay c\u1ea3 khi th\u0103m kh\u00e1m b\u00ecnh th\u01b0\u1eddng) \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n s\u1edbm COPD. N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 kh\u00ed ph\u1ebf th\u0169ng c\u00f3 th\u1ec3 th\u1ea5y l\u1ed3ng ng\u1ef1c h\u00ecnh th\u00f9ng, g\u00f5 vang, r\u00ec r\u00e0o ph\u1ebf nang gi\u1ea3m.<\/p>\n

+ Giai \u0111o\u1ea1n n\u1eb7ng h\u01a1n kh\u00e1m ph\u1ed5i th\u1ea5y r\u00ec r\u00e0o ph\u1ebf nang gi\u1ea3m, c\u00f3 th\u1ec3 c\u00f3 ran r\u00edt, ran ng\u00e1y, ran \u1ea9m, ran n\u1ed5.<\/p>\n

+ Giai \u0111o\u1ea1n mu\u1ed9n c\u00f3 th\u1ec3 th\u1ea5y nh\u1eefng bi\u1ec3u hi\u1ec7n c\u1ee7a suy h\u00f4 h\u1ea5p m\u1ea1n t\u00ednh: t\u00edm m\u00f4i, t\u00edm \u0111\u1ea7u chi, th\u1edf nhanh, co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p ph\u1ee5, bi\u1ec3u hi\u1ec7n c\u1ee7a suy tim ph\u1ea3i (t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i, ph\u00f9 2 ch\u00e2n, gan to, ph\u1ea3n h\u1ed3i gan t\u0129nh m\u1ea1ch c\u1ed5 d\u01b0\u01a1ng t\u00ednh).<\/p>\n

Khi ph\u00e1t hi\u1ec7n b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng nghi ng\u1edd COPD nh\u01b0 tr\u00ean c\u1ea7n chuy\u1ec3n b\u1ec7nh nh\u00e2n \u0111\u1ebfn c\u00e1c c\u01a1 s\u1edf y t\u1ebf c\u00f3 \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n (tuy\u1ebfn huy\u1ec7n, tuy\u1ebfn t\u1ec9nh ho\u1eb7c tuy\u1ebfn trung \u01b0\u01a1ng\u2026) \u0111\u1ec3 l\u00e0m th\u00eam c\u00e1c th\u0103m d\u00f2 ch\u1ea9n \u0111o\u00e1n: \u0111o ch\u1ee9c n\u0103ng th\u00f4ng kh\u00ed, ch\u1ee5p X-quang ph\u1ed5i, \u0111i\u1ec7n tim… nh\u1eb1m ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh v\u00e0 lo\u1ea1i tr\u1eeb nh\u1eefng nguy\u00ean nh\u00e2n kh\u00e1c c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng gi\u1ed1ng COPD.<\/p>\n

B\u1ea3ng 1. <\/strong>B\u1ea3ng c\u00e2u h\u1ecfi t\u1ea7m so\u00e1t COPD \u1edf c\u1ed9ng \u0111\u1ed3ng (theo GOLD)<\/p>\n\n\n\n\n\n\n\n\n
<\/td>\nC\u00e2u h\u1ecfi<\/strong><\/td>\nCh\u1ecdn c\u00e2u tr\u1ea3 l\u1eddi<\/strong><\/td>\n<\/tr>\n
1<\/td>\n\u00d4ng\/b\u00e0 c\u00f3 ho v\u00e0i l\u1ea7n trong ng\u00e0y \u1edf h\u1ea7u h\u1ebft c\u00e1c ng\u00e0y.<\/td>\nC\u00f3<\/td>\nKh\u00f4ng<\/td>\n<\/tr>\n
2<\/td>\n\u00d4ng\/b\u00e0 c\u00f3 kh\u1ea1c \u0111\u1eddm \u1edf h\u1ea7u h\u1ebft c\u00e1c ng\u00e0y.<\/td>\nC\u00f3<\/td>\nKh\u00f4ng<\/td>\n<\/tr>\n
3<\/td>\n\u00d4ng\/b\u00e0 c\u00f3 d\u1ec5 b\u1ecb kh\u00f3 th\u1edf h\u01a1n nh\u1eefng ng\u01b0\u1eddi c\u00f9ng tu\u1ed5i.<\/td>\nC\u00f3<\/td>\nKh\u00f4ng<\/td>\n<\/tr>\n
4<\/td>\n\u00d4ng\/b\u00e0 c\u00f3 tr\u00ean 40 tu\u1ed5i.<\/td>\nC\u00f3<\/td>\nKh\u00f4ng<\/td>\n<\/tr>\n
5<\/td>\n\u00d4ng\/b\u00e0 v\u1eabn c\u00f2n h\u00fat thu\u1ed1c l\u00e1 ho\u1eb7c \u0111\u00e3 t\u1eebng h\u00fat thu\u1ed1c l\u00e1.<\/td>\nC\u00f3<\/td>\nKh\u00f4ng<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

N\u1ebfu b\u1ea1n tr\u1ea3 l\u1eddi c\u00f3 t\u1eeb 3 c\u00e2u tr\u1edf l\u00ean. H\u00e3y \u0111\u1ebfn g\u1eb7p b\u00e1c s\u0129 ngay \u0111\u1ec3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi.<\/p>\n

2. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh \u00e1p d\u1ee5ng cho c\u01a1 s\u1edf y t\u1ebf \u0111\u00e3 \u0111\u01b0\u1ee3c trang b\u1ecb m\u00e1y \u0111o <\/strong>ch\u1ee9c n\u0103ng th\u00f4ng kh\u00ed<\/strong><\/h2>\n

Nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed ti\u1ebfp x\u00fac v\u1edbi c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1, c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng nghi ng\u1edd m\u1eafc COPD nh\u01b0 \u0111\u00e3 m\u00f4 t\u1ea3 \u1edf tr\u00ean c\u1ea7n \u0111\u01b0\u1ee3c l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m sau:<\/p>\n

–\u00a0\u0110o ch\u1ee9c n\u0103ng th\u00f4ng kh\u00ed ph\u1ed5i:\u00a0<\/strong>k\u1ebft qu\u1ea3 \u0111o ch\u1ee9c n\u0103ng th\u00f4ng kh\u00ed ph\u1ed5i l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh v\u00e0 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng th\u1edf c\u1ee7a b\u1ec7nh nh\u00e2n COPD.<\/p>\n

– M\u1ed9t s\u1ed1 \u0111i\u1ec3m c\u1ea7n l\u01b0u \u00fd:<\/p>\n

+ C\u1ea7n trang b\u1ecb m\u00e1y \u0111o ch\u1ee9c n\u0103ng th\u00f4ng kh\u00ed \u0111\u1ea3m b\u1ea3o \u0111\u1ee7 ti\u00eau chu\u1ea9n (xem ph\u1ee5 l\u1ee5c v\u1ec1 ti\u00eau chu\u1ea9n ph\u00f2ng qu\u1ea3n l\u00fd) v\u00e0 ph\u1ea3i \u0111\u01b0\u1ee3c \u0111\u1ecbnh chu\u1ea9n h\u1eb1ng ng\u00e0y.<\/p>\n

+ K\u1ef9 thu\u1eadt vi\u00ean c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o v\u1ec1 \u0111o ch\u1ee9c n\u0103ng th\u00f4ng kh\u00ed v\u00e0 bi\u1ebft c\u00e1ch l\u00e0m test h\u1ed3i ph\u1ee5c ph\u1ebf qu\u1ea3n.<\/p>\n

+ B\u1ec7nh nh\u00e2n c\u1ea7n ph\u1ea3i ng\u1eebng thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n tr\u01b0\u1edbc khi \u0111o ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p \u00edt nh\u1ea5t t\u1eeb 4-6 gi\u1edd (\u0111\u1ed1i v\u1edbi SABA, SAMA) ho\u1eb7c 12-24 gi\u1edd \u0111\u1ed1i v\u1edbi LABA, LAMA.<\/p>\n

– Nh\u1eadn \u0111\u1ecbnh k\u1ebft qu\u1ea3:<\/p>\n

+ Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh khi: r\u1ed1i lo\u1ea1n th\u00f4ng kh\u00ed t\u1eafc ngh\u1ebdn kh\u00f4ng h\u1ed3i ph\u1ee5c ho\u00e0n to\u00e0n sau test h\u1ed3i ph\u1ee5c ph\u1ebf qu\u1ea3n: ch\u1ec9 s\u1ed1 FEV1<\/sub>\/FVC < 70% sau test HPPQ.<\/p>\n

+ Th\u00f4ng th\u01b0\u1eddng b\u1ec7nh nh\u00e2n COPD s\u1ebd c\u00f3 k\u1ebft qu\u1ea3 test HPPQ \u00e2m t\u00ednh (ch\u1ec9 s\u1ed1 FEV1\u00a0<\/sub>t\u0103ng < 12% v\u00e0 < 200ml sau test h\u1ed3i ph\u1ee5c ph\u1ebf qu\u1ea3n).<\/p>\n

+ N\u1ebfu b\u1ec7nh nh\u00e2n thu\u1ed9c ki\u1ec3u h\u00ecnh ch\u1ed3ng l\u1ea5p hen v\u00e0 COPD c\u00f3 th\u1ec3 c\u00f3 test HPPQ d\u01b0\u01a1ng t\u00ednh (ch\u1ec9 s\u1ed1 FEV1\u00a0<\/sub>t\u0103ng \u2265 12% v\u00e0 \u2265 200ml sau test HPPQ) ho\u1eb7c d\u01b0\u01a1ng t\u00ednh m\u1ea1nh (FEV1\u00a0<\/sub>t\u0103ng \u2265 15% v\u00e0 \u2265 400ml).<\/p>\n

+ D\u1ef1a v\u00e0o ch\u1ec9 s\u1ed1 FEV1\u00a0<\/sub>gi\u00fap \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng th\u1edf (xem m\u1ee5c 1.3).<\/p>\n

–\u00a0X-quang ph\u1ed5i:<\/strong><\/p>\n

+ COPD \u1edf giai \u0111o\u1ea1n s\u1edbm ho\u1eb7c kh\u00f4ng c\u00f3 kh\u00ed ph\u1ebf th\u0169ng, h\u00ecnh \u1ea3nh X-quang ph\u1ed5i c\u00f3 th\u1ec3 b\u00ecnh th\u01b0\u1eddng.<\/p>\n

+ Giai \u0111o\u1ea1n mu\u1ed9n c\u00f3 h\u1ed9i ch\u1ee9ng ph\u1ebf qu\u1ea3n ho\u1eb7c h\u00ecnh \u1ea3nh kh\u00ed ph\u1ebf th\u0169ng: tr\u01b0\u1eddng ph\u1ed5i 2 b\u00ean qu\u00e1 s\u00e1ng, c\u01a1 ho\u00e0nh h\u1ea1 th\u1ea5p, c\u00f3 th\u1ec3 th\u1ea5y c\u01a1 ho\u00e0nh h\u00ecnh b\u1eadc thang, khoang li\u00ean s\u01b0\u1eddn gi\u00e3n r\u1ed9ng, c\u00e1c b\u00f3ng, k\u00e9n kh\u00ed ho\u1eb7c c\u00f3 th\u1ec3 th\u1ea5y nh\u00e1nh \u0111\u1ed9ng m\u1ea1ch th\u00f9y d\u01b0\u1edbi ph\u1ed5i ph\u1ea3i c\u00f3 \u0111\u01b0\u1eddng k\u00ednh > 16mm.<\/p>\n

+ X-quang ph\u1ed5i gi\u00fap ph\u00e1t hi\u1ec7n m\u1ed9t s\u1ed1 b\u1ec7nh ph\u1ed5i \u0111\u1ed3ng m\u1eafc ho\u1eb7c bi\u1ebfn ch\u1ee9ng c\u1ee7a COPD nh\u01b0: u ph\u1ed5i, gi\u00e3n ph\u1ebf qu\u1ea3n, lao ph\u1ed5i, x\u01a1 ph\u1ed5i… tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i, suy tim, b\u1ea5t th\u01b0\u1eddng khung x\u01b0\u01a1ng l\u1ed3ng ng\u1ef1c, c\u1ed9t s\u1ed1ng…<\/p>\n

–\u00a0CLVT ng\u1ef1c l\u1edbp m\u1ecfng 1mm \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao (HRCT):<\/strong><\/p>\n

+ Gi\u00fap ph\u00e1t hi\u1ec7n t\u00ecnh tr\u1ea1ng gi\u00e3n ph\u1ebf nang, b\u00f3ng k\u00e9n kh\u00ed, ph\u00e1t hi\u1ec7n s\u1edbm ung th\u01b0 ph\u1ed5i, gi\u00e3n ph\u1ebf qu\u1ea3n\u2026 \u0111\u1ed3ng m\u1eafc v\u1edbi COPD.<\/p>\n

+ \u0110\u00e1nh gi\u00e1 b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc khi ch\u1ec9 \u0111\u1ecbnh can thi\u1ec7p gi\u1ea3m th\u1ec3 t\u00edch ph\u1ed5i b\u1eb1ng ph\u1eabu thu\u1eadt ho\u1eb7c \u0111\u1eb7t van ph\u1ebf qu\u1ea3n m\u1ed9t chi\u1ec1u v\u00e0 tr\u01b0\u1edbc khi gh\u00e9p ph\u1ed5i.<\/p>\n

–\u00a0\u0110i\u1ec7n t\u00e2m \u0111\u1ed3:\u00a0<\/strong>\u1edf giai \u0111o\u1ea1n mu\u1ed9n c\u00f3 th\u1ec3 th\u1ea5y c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i v\u00e0 suy tim ph\u1ea3i: s\u00f3ng P cao (> 2,5mm) nh\u1ecdn \u0111\u1ed1i x\u1ee9ng (P ph\u1ebf), tr\u1ee5c ph\u1ea3i (> 1100<\/sup>), d\u00e0y th\u1ea5t ph\u1ea3i (R\/S \u1edf V6 < 1).<\/p>\n

–\u00a0Si\u00eau \u00e2m tim\u00a0<\/strong>\u0111\u1ec3 ph\u00e1t hi\u1ec7n t\u0103ng \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, suy tim ph\u1ea3i gi\u00fap cho ch\u1ea9n \u0111o\u00e1n s\u1edbm t\u00e2m ph\u1ebf m\u1ea1n.<\/p>\n

–\u00a0\u0110o \u0111\u1ed9 b\u00e3o h\u00f2a oxy qua da (SpO2<\/sub>) v\u00e0 kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch:\u00a0<\/strong>\u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 suy h\u00f4 h\u1ea5p, h\u1ed7 tr\u1ee3 cho quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb oxy ho\u1eb7c th\u1edf m\u00e1y. \u0110o SpO2\u00a0<\/sub>v\u00e0 x\u00e9t nghi\u1ec7m kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u1edf t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 d\u1ea5u hi\u1ec7u suy h\u00f4 h\u1ea5p ho\u1eb7c suy tim ph\u1ea3i.<\/p>\n

–\u00a0\u0110o th\u1ec3 t\u00edch kh\u00ed c\u1eb7n, dung t\u00edch to\u00e0n ph\u1ed5i\u00a0<\/strong>(th\u1ec3 t\u00edch k\u00fd th\u00e2n, pha lo\u00e3ng Helium, r\u1eeda Nitrogen\u2026) ch\u1ec9 \u0111\u1ecbnh khi: b\u1ec7nh nh\u00e2n c\u00f3 t\u00ecnh tr\u1ea1ng kh\u00ed ph\u1ebf th\u0169ng n\u1eb7ng gi\u00fap l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb v\u00e0 \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n

–\u00a0\u0110o khu\u1ebfch t\u00e1n kh\u00ed (DLCO)\u00a0<\/strong>b\u1eb1ng \u0111o th\u1ec3 t\u00edch k\u00fd th\u00e2n, pha lo\u00e3ng kh\u00ed Helium\u2026 n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng n\u1eb7ng h\u01a1n m\u1ee9c \u0111\u1ed9 t\u1eafc ngh\u1ebdn khi \u0111o b\u1eb1ng CNTK.<\/p>\n

–\u00a0\u0110o th\u1ec3 t\u00edch k\u00fd th\u00e2n\u00a0<\/strong>c\u1ea7n \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd r\u1ed1i lo\u1ea1n th\u00f4ng kh\u00ed t\u1eafc ngh\u1ebdn nh\u01b0ng kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c b\u1eb1ng \u0111o CNTK ho\u1eb7c khi nghi ng\u1edd r\u1ed1i lo\u1ea1n th\u00f4ng kh\u00ed h\u1ed7n h\u1ee3p.<\/p>\n

T\u00f3m l\u1ea1i, vi\u1ec7c ch\u1ea9n \u0111o\u00e1n b\u1ec7nh COPD l\u00e0 r\u1ea5t quan tr\u1ecdng, v\u00ec n\u00f3 gi\u00fap c\u00e1c b\u00e1c s\u0129 \u0111\u01b0a ra ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p v\u00e0 gi\u00fap ng\u01b0\u1eddi b\u1ec7nh c\u00f3 th\u1ec3 ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh.<\/p>\n

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

 <\/p>\n","protected":false},"excerpt":{"rendered":"

B\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh (COPD) l\u00e0 b\u1ec7nh h\u00f4 h\u1ea5p ph\u1ed5 bi\u1ebfn c\u00f3 th\u1ec3 ph\u00f2ng v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c. 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