{"id":22173,"date":"2023-04-17T17:28:51","date_gmt":"2023-04-17T10:28:51","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22173"},"modified":"2023-04-18T12:17:27","modified_gmt":"2023-04-18T05:17:27","slug":"benh-phoi-tac-nghen-man-tinh-mot-so-kieu-hinh-thuong-gap","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/benh-phoi-tac-nghen-man-tinh-mot-so-kieu-hinh-thuong-gap\/","title":{"rendered":"B\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh: M\u1ed9t s\u1ed1 ki\u1ec3u h\u00ecnh th\u01b0\u1eddng g\u1eb7p"},"content":{"rendered":"

B\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh (COPD<\/a>) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd m\u00e3n t\u00ednh c\u1ee7a \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p, \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1edfi s\u1ef1 t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng kh\u00ed qu\u1ea3n v\u00e0 c\u00e1c \u0111\u01b0\u1eddng ph\u1ed5i. COPD l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh m\u00e3n t\u00ednh ph\u1ed5 bi\u1ebfn nh\u1ea5t tr\u00ean th\u1ebf gi\u1edbi v\u00e0 c\u00f3 t\u1ea7m quan tr\u1ecdng r\u1ea5t l\u1edbn trong l\u0129nh v\u1ef1c y t\u1ebf v\u00e0 c\u00f4ng khai s\u1ee9c kh\u1ecfe. B\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y s\u1ebd cung c\u1ea5p th\u00f4ng tin v\u1ec1 m\u1ed9t s\u1ed1 ki\u1ec3u h\u00ecnh th\u01b0\u1eddng g\u1eb7p c\u1ee7a COPD.<\/strong><\/p>\n

\"COPD
COPD c\u00f3 m\u1ed9t s\u1ed1 ki\u1ec3u h\u00ecnh th\u01b0\u1eddng g\u1eb7p tr\u00ean b\u1ec7nh nh\u00e2n<\/figcaption><\/figure>\n

1. \u0110\u1ecbnh ngh\u0129a ki\u1ec3u h\u00ecnh<\/b><\/h2>\n

– Ki\u1ec3u h\u00ecnh l\u00e0 m\u1ed9t thu\u1ed9c t\u00ednh \u0111\u01a1n l\u1ebb ho\u1eb7c k\u1ebft h\u1ee3p c\u00e1c thu\u1ed9c t\u00ednh m\u00f4 t\u1ea3 b\u1ec7nh, s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa c\u00e1c b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh m\u00e0 li\u00ean quan \u0111\u1ebfn k\u1ebft qu\u1ea3 c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng (c\u00e1c tri\u1ec7u ch\u1ee9ng, \u0111\u1ee3t c\u1ea5p, \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb, ti\u1ebfn tri\u1ec3n b\u1ec7nh, ho\u1eb7c t\u1eed vong).<\/p>\n

– \u0110\u00e2y l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 hi\u1ec7n \u0111ang \u0111\u01b0\u1ee3c quan t\u00e2m, nh\u1eb1m c\u00e1 th\u1ec3 h\u00f3a h\u01a1n n\u1eefa \u0111i\u1ec1u tr\u1ecb v\u00e0 qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh.<\/p>\n

– Ki\u1ec3u h\u00ecnh \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1edfi c\u00e1c tri\u1ec7u ch\u1ee9ng, ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh, sinh l\u00fd h\u1ecdc, c\u00e1c d\u1ea5u \u1ea5n sinh h\u1ecdc.<\/p>\n

– C\u00e1c ki\u1ec3u h\u00ecnh (phenotype): ch\u1ed3ng l\u1ea5p hen v\u00e0 b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh, vi\u00eam ph\u1ebf qu\u1ea3n m\u1ea1n t\u00ednh, kh\u00ed ph\u1ebf th\u0169ng, ki\u1ec3u h\u00ecnh \u0111\u1ee3t c\u1ea5p th\u01b0\u1eddng xuy\u00ean.<\/p>\n

– C\u00e1c ki\u1ec3u n\u1ed9i h\u00ecnh (endotype): neutrophilic endotype, thi\u1ebfu h\u1ee5t anpha 1 antitrypsine, Th2 endotype, endotype vi\u00eam h\u1ec7 th\u1ed1ng (systemic inflammation endotype).<\/p>\n

2. Ch\u1ea9n \u0111o\u00e1n ki\u1ec3u h\u00ecnh b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh<\/b><\/h2>\n

–\u00a0Ki\u1ec3u h\u00ecnh vi\u00eam ph\u1ebf qu\u1ea3n m\u1ea1n t\u00ednh chi\u1ebfm \u01b0u th\u1ebf<\/b>:\u00a0Th\u1ec3 \u201cph\u00f9 t\u00edm\u201d\u00a0(Blue Bloater): tu\u1ed5i tr\u1ebb h\u01a1n, t\u1eeb 40 \u0111\u1ebfn 50, b\u00e9o. Tri\u1ec7u ch\u1ee9ng n\u1ed5i b\u1eadt l\u00e0 ho, kh\u1ea1c \u0111\u1eddm m\u1ea1n t\u00ednh trong nhi\u1ec1u n\u0103m, t\u00edm t\u00e1i, ho nhi\u1ec1u h\u01a1n kh\u00f3 th\u1edf. Tr\u00ean phim ph\u1ed5i: h\u00ecnh \u1ea3nh v\u00f2m ho\u00e0nh b\u00ecnh th\u01b0\u1eddng, m\u1ea1ch m\u00e1u t\u0103ng \u0111\u1eadm v\u00f9ng th\u1ea5p, b\u00f3ng tim h\u01a1i to ra. Khi c\u00f3 suy tim ph\u1ea3i th\u00ec b\u00f3ng tim to h\u01a1n, c\u00e1c m\u1ea1ch m\u00e1u ph\u1ed5i t\u0103ng \u0111\u1eadm h\u01a1n v\u00e0 c\u00f3 h\u00ecnh \u1ea3nh t\u0103ng ph\u00e2n b\u1ed1 m\u1ea1ch m\u00e1u v\u00f9ng cao c\u1ee7a ph\u1ed5i (hi\u1ec7n t\u01b0\u1ee3ng t\u00e1i ph\u00e2n b\u1ed1 m\u1ea1ch m\u00e1u). Tr\u00ean CLVT \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao (HRCT) th\u01b0\u1eddng g\u1eb7p KPT trung t\u00e2m ti\u1ec3u th\u00f9y. Th\u1ec3 n\u00e0y hay c\u00f3 bi\u1ebfn ch\u1ee9ng t\u00e2m ph\u1ebf m\u1ea1n s\u1edbm.<\/p>\n

–\u00a0Ki\u1ec3u h\u00ecnh kh\u00ed ph\u1ebf th\u0169ng chi\u1ebfm \u01b0u th\u1ebf<\/b>: th\u1ec3 \u201ch\u1ed3ng th\u1ed5i\u201d\u00a0(Pink Puffer) th\u01b0\u1eddng g\u1eb7p \u1edf tu\u1ed5i t\u1eeb 50 \u0111\u1ebfn 75, g\u1ea7y, m\u00f4i h\u1ed3ng. Tri\u1ec7u ch\u1ee9ng n\u1ed5i b\u1eadt c\u1ee7a th\u1ec3 b\u1ec7nh n\u00e0y l\u00e0 kh\u00f3 th\u1edf, ban \u0111\u1ea7u kh\u00f3 th\u1edf khi g\u1eafng s\u1ee9c, sau \u0111\u00f3 kh\u00f3 th\u1edf khi ngh\u1ec9 ng\u01a1i. G\u00f5 vang tr\u1ed1ng, r\u00ec r\u00e0o ph\u1ebf nang gi\u1ea3m c\u1ea3 hai b\u00ean. Phim X-quang ph\u1ed5i: Hai ph\u1ed5i t\u0103ng s\u00e1ng, khe gian s\u01b0\u1eddn gi\u00e3n r\u1ed9ng v\u00e0 n\u1eb1m ngang, c\u01a1 ho\u00e0nh h\u1ea1 th\u1ea5p v\u00e0 d\u1eb9t, gi\u1ea3m m\u1ea1ng l\u01b0\u1edbi m\u1ea1ch m\u00e1u ph\u1ed5i \u1edf ngo\u1ea1i vi, b\u00f3ng tim d\u00e0i v\u00e0 nh\u1ecf h\u00ecnh gi\u1ecdt n\u01b0\u1edbc. Tr\u00ean CLVT (HRCT) th\u01b0\u1eddng g\u1eb7p KPT to\u00e0n b\u1ed9 ti\u1ec3u th\u00f9y. T\u00e2m ph\u1ebf m\u1ea1n l\u00e0 bi\u1ebfn ch\u1ee9ng g\u1eb7p \u1edf giai \u0111o\u1ea1n cu\u1ed1i c\u1ee7a b\u1ec7nh.<\/p>\n

–\u00a0Ki\u1ec3u h\u00ecnh \u0111\u1ee3t c\u1ea5p th\u01b0\u1eddng xuy\u00ean (c\u00f3 t\u1eeb 2 \u0111\u1ee3t c\u1ea5p tr\u1edf l\u00ean)<\/b>: trong nghi\u00ean c\u1ee9u ECLIPSE, m\u1ed9t nghi\u00ean c\u1ee9u quan s\u00e1t trong v\u00f2ng 3 n\u0103m tr\u00ean 2138 b\u1ec7nh nh\u00e2n b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh v\u1eeba \u0111\u1ebfn r\u1ea5t n\u1eb7ng, cho th\u1ea5y y\u1ebfu t\u1ed1 ti\u00ean l\u01b0\u1ee3ng quan tr\u1ecdng nh\u1ea5t cho s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a \u0111\u1ee3t c\u1ea5p \u0111\u00f3 ch\u00ednh l\u00e0 ti\u1ec1n s\u1eed c\u00f3 \u0111\u1ee3t c\u1ea5p th\u01b0\u1eddng xuy\u00ean, xu\u1ea5t hi\u1ec7n trong 1 n\u0103m tr\u01b0\u1edbc, c\u00f3 th\u1ec3 \u1edf trong b\u1ea5t k\u1ef3 giai \u0111o\u1ea1n n\u00e0o c\u1ee7a b\u1ec7nh. Do \u0111\u00f3 \u201c\u0111\u1ee3t c\u1ea5p th\u01b0\u1eddng xuy\u00ean\u201d l\u00e0 m\u1ed9t ki\u1ec3u h\u00ecnh ri\u00eang c\u1ee7a b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh (h\u01a1n 2 \u0111\u1ee3t c\u1ea5p t\u1eeb v\u1eeba t\u1edbi n\u1eb7ng trong 1 n\u0103m), t\u1ef7 l\u1ec7 \u0111\u1ee3t c\u1ea5p t\u0103ng theo \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh.<\/p>\n

–\u00a0Ki\u1ec3u h\u00ecnh gi\u00e3n ph\u1ebf qu\u1ea3n<\/b>: ho kh\u1ea1c nhi\u1ec1u \u0111\u1eddm, c\u00f3 h\u00ecnh \u1ea3nh gi\u00e3n ph\u1ebf qu\u1ea3n, kh\u00ed ph\u1ebf th\u0169ng ph\u1ed1i h\u1ee3p tr\u00ean phim ch\u1ee5p CLVT \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao, th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n thi\u1ebfu h\u1ee5t anpha1 antitrypsine.<\/p>\n

–\u00a0Ki\u1ec3u h\u00ecnh ch\u1ed3ng l\u1ea5p b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh – Hen (ACO)<\/b>:<\/p>\n

+ ACO l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng b\u1ec7nh \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 gi\u1edbi h\u1ea1n lu\u1ed3ng kh\u00ed th\u1edf dai d\u1eb3ng v\u1edbi m\u1ed9t s\u1ed1 \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a hen v\u00e0 m\u1ed9t s\u1ed1 \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh. Do \u0111\u00f3, ACO \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1edfi c\u00e1c \u0111\u1eb7c t\u00ednh c\u1ee7a c\u1ea3 hen v\u00e0 b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh. B\u1ec7nh nh\u00e2n ACO b\u1ecb nhi\u1ec1u \u0111\u1ee3t k\u1ecbch ph\u00e1t, ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng k\u00e9m, suy gi\u1ea3m ch\u1ee9c n\u0103ng ph\u1ed5i nhi\u1ec1u h\u01a1n, t\u1eed vong cao v\u00e0 ph\u00ed \u0111i\u1ec1u tr\u1ecb t\u1ed1n k\u00e9m h\u01a1n hen \u0111\u01a1n thu\u1ea7n.<\/p>\n

+ T\u1ea7n su\u1ea5t c\u1ee7a ACO dao \u0111\u1ed9ng t\u1eeb 15% \u0111\u1ebfn 55% t\u00f9y thu\u1ed9c v\u00e0o c\u00e1c ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng. Nghi\u00ean c\u1ee9u t\u1ea1i B\u1ec7nh vi\u1ec7n B\u1ea1ch Mai v\u00e0 \u0110\u1ea1i h\u1ecdc Y d\u01b0\u1ee3c th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh n\u0103m 2016, trong s\u1ed1 c\u00e1c b\u1ec7nh nh\u00e2n b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh \u0111\u1ebfn kh\u00e1m, t\u1ef7 l\u1ec7 ACO chi\u1ebfm 27,3%.<\/p>\n

+ GOLD v\u00e0 GINA c\u0169ng \u0111\u01b0a ra khuy\u1ebfn c\u00e1o \u0111\u1ed3ng thu\u1eadn v\u1ec1 ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n ki\u1ec3u h\u00ecnh ch\u1ed3ng l\u1ea5p hen v\u00e0 b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh. Tuy nhi\u00ean ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n theo c\u00e1c b\u01b0\u1edbc c\u1ee7a GOLD v\u00e0 GINA kh\u00e1 ph\u1ee9c t\u1ea1p, kh\u00f3 \u00e1p d\u1ee5ng trong th\u1ef1c t\u1ebf l\u00e2m s\u00e0ng trong \u0111i\u1ec1u ki\u1ec7n Vi\u1ec7t Nam.<\/p>\n

+ Sau khi nghi\u00ean c\u1ee9u v\u00e0 t\u1ed5ng h\u1ee3p c\u00e1c ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n ACO l\u01b0u h\u00e0nh hi\u1ec7n nay tr\u00ean th\u1ebf gi\u1edbi, nh\u00f3m chuy\u00ean gia th\u1ea5y r\u1eb1ng ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n ACO d\u1ef1a v\u00e0o c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng \u0111o ch\u1ee9c n\u0103ng th\u00f4ng kh\u00ed ph\u1ed5i v\u00e0 x\u00e9t nghi\u1ec7m b\u1ea1ch c\u1ea7u \u00e1i toan c\u1ee7a T\u00e2y Ban Nha, \u0111\u01a1n gi\u1ea3n, d\u1ec5 \u00e1p d\u1ee5ng trong \u0111i\u1ec1u ki\u1ec7n th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng t\u1ea1i Vi\u1ec7t Nam. (Bi\u1ec3u \u0111\u1ed3 1.3).<\/p>\n

<\/p>\n

S\u01a1 \u0111\u1ed3 ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n ACO (theo khuy\u1ebfn c\u00e1o T\u00e2y Ban Nha)<\/p>\n

+ N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 ki\u1ec3u h\u00ecnh ch\u1ed3ng l\u1ea5p ho\u1eb7c nghi ng\u1edd c\u00f3 ki\u1ec3u h\u00ecnh ch\u1ed3ng l\u1ea5p b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh – Hen th\u00ec trong li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb c\u1ea7n ph\u1ea3i c\u00f3 ICS (li\u1ec1u l\u01b0\u1ee3ng t\u00f9y theo m\u1ee9c \u0111\u1ed9 c\u00e1c tri\u1ec7u ch\u1ee9ng) b\u00ean c\u1ea1nh vi\u1ec7c duy tr\u00ec c\u00e1c thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i.<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n","protected":false},"excerpt":{"rendered":"

B\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh (COPD) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd m\u00e3n t\u00ednh c\u1ee7a \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p, \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1edfi s\u1ef1 t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng kh\u00ed qu\u1ea3n v\u00e0 c\u00e1c \u0111\u01b0\u1eddng ph\u1ed5i. COPD l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh m\u00e3n t\u00ednh ph\u1ed5 bi\u1ebfn nh\u1ea5t tr\u00ean th\u1ebf gi\u1edbi v\u00e0 c\u00f3 t\u1ea7m quan tr\u1ecdng r\u1ea5t l\u1edbn trong l\u0129nh v\u1ef1c […]<\/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":"\nB\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh: M\u1ed9t s\u1ed1 ki\u1ec3u h\u00ecnh th\u01b0\u1eddng g\u1eb7p<\/title>\n<meta name=\"description\" content=\"B\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh (COPD) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd m\u00e3n t\u00ednh c\u1ee7a \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p. 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