{"id":23712,"date":"2023-04-20T20:35:23","date_gmt":"2023-04-20T13:35:23","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=23712"},"modified":"2023-04-21T10:49:06","modified_gmt":"2023-04-21T03:49:06","slug":"phuong-phap-tai-tuoi-mau-trong-dieu-tri-nhoi-mau-nao","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/20\/phuong-phap-tai-tuoi-mau-trong-dieu-tri-nhoi-mau-nao\/","title":{"rendered":"Ph\u01b0\u01a1ng pha\u0301p ta\u0301i t\u01b0\u01a1\u0301i ma\u0301u trong \u0111i\u00ea\u0300u tri\u0323 nh\u00f4\u0300i ma\u0301u na\u0303o"},"content":{"rendered":"

Ph\u01b0\u01a1ng pha\u0301p ta\u0301i t\u01b0\u01a1\u0301i ma\u0301u l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb nh\u1ed3i m\u00e1u n\u00e3o<\/strong> <\/a>b\u1eb1ng c\u00e1ch c\u1ea3i thi\u1ec7n l\u01b0u th\u00f4ng m\u00e1u t\u1edbi n\u00e3o, gi\u1ea3m thi\u1ec3u c\u00e1c c\u1ee5c m\u00e1u \u0111\u00f4ng v\u00e0 ph\u1ee5c h\u1ed3i c\u00e1c t\u1ebf b\u00e0o n\u00e3o b\u1ecb t\u1ed5n th\u01b0\u01a1ng. C\u00f3 hai ph\u01b0\u01a1ng ph\u00e1p ch\u00ednh \u0111\u1ec3 t\u00e1i t\u01b0\u1edbi m\u00e1u trong \u0111i\u1ec1u tr\u1ecb nh\u1ed3i m\u00e1u n\u00e3o: t\u00e1i t\u01b0\u1edbi m\u00e1u b\u1eb1ng thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft va\u0300 t\u00e1i t\u01b0\u1edbi m\u00e1u b\u1eb1ng ph\u1eabu thu\u1eadt \u0111\u1ed9ng m\u1ea1ch n\u00e3o.\u00a0C\u1ea3 hai ph\u01b0\u01a1ng ph\u00e1p t\u00e1i t\u01b0\u1edbi m\u00e1u \u0111\u1ec1u c\u00f3 th\u1ec3 gi\u00fap c\u1ea3i thi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a nh\u1ed3i m\u00e1u n\u00e3o v\u00e0 gi\u1ea3m nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 n\u1ebfu \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u00fang c\u00e1ch v\u00e0 d\u01b0\u1edbi s\u1ef1 gi\u00e1m s\u00e1t c\u1ee7a c\u00e1c chuy\u00ean gia y t\u1ebf. Tuy nhi\u00ean, quy\u1ebft \u0111\u1ecbnh s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p n\u00e0o ph\u00f9 h\u1ee3p nh\u1ea5t v\u1eabn ph\u1ee5 thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe v\u00e0 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd c\u1ee7a t\u1eebng b\u1ec7nh nh\u00e2n.<\/p>\n

1. Ph\u01b0\u01a1ng pha\u0301p ta\u0301i t\u01b0\u01a1\u0301i ma\u0301u b\u0103\u0300ng thu\u00f4\u0301c ti\u00eau s\u01a1\u0323i huy\u00ea\u0301t \u0111\u01b0\u01a1\u0300ng ti\u0303nh ma\u0323ch<\/strong><\/b><\/h2>\n

Thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft duy nh\u1ea5t \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u00f3 l\u1ee3i cho nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o c\u1ea5p t\u00ednh l\u00e0 alteplase (rt-PA).<\/p>\n

Ti\u00eau s\u1ee3i huy\u1ebft (v\u00ed d\u1ee5: rt-PA) ph\u1ee5c h\u1ed3i l\u01b0u l\u01b0\u1ee3ng m\u00e1u n\u00e3o \u1edf c\u00e1c b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p v\u00e0 c\u00f3 th\u1ec3 gi\u00fap c\u1ea3i thi\u1ec7n ho\u1eb7c gi\u1ea3i quy\u1ebft c\u00e1c khi\u1ebfm khuy\u1ebft th\u1ea7n kinh. Tuy nhi\u00ean, ti\u00eau s\u1ee3i huy\u1ebft c\u0169ng c\u00f3 th\u1ec3 g\u00e2y xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd. C\u00e1c bi\u1ebfn ch\u1ee9ng kh\u00e1c bao g\u1ed3m xu\u1ea5t huy\u1ebft ngo\u1ea1i s\u1ecd v\u00e0 ph\u00f9 m\u1ea1ch ho\u1eb7c d\u1ecb \u1ee9ng.<\/p>\n

1.1. Ti\u00eau chu\u1ea9n l\u1ef1a ch\u1ecdn b\u1ec7nh nh\u00e2n<\/strong><\/b><\/h3>\n

Khi l\u1ef1a ch\u1ecdn b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch, ph\u1ea3i \u0111\u00e1nh gi\u00e1 k\u1ef9 c\u00e1c ti\u00eau chu\u1ea9n thu nh\u1eadn v\u00e0 lo\u1ea1i tr\u1eeb b\u1ec7nh nh\u00e2n. H\u01b0\u1edbng d\u1eabn l\u1ef1a ch\u1ecdn b\u1ec7nh nh\u00e2n c\u1ee7a H\u1ed9i Tim m\u1ea1ch Hoa K\u1ef3\/H\u1ed9i \u0110\u1ed9t qu\u1ef5 Hoa K\u1ef3 (AHA\/ASA) \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch rt-PA, c\u1ee5 th\u1ec3 nh\u01b0 sau:<\/p>\n

– Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh nh\u1ed3i m\u00e1u n\u00e3o l\u00e0 nguy\u00ean nh\u00e2n c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 d\u1ea5u hi\u1ec7u th\u1ea7n kinh khu tr\u00fa<\/p>\n

– Kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng < 4.5 gi\u1edd tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb; n\u1ebfu kh\u00f4ng bi\u1ebft ch\u00ednh x\u00e1c th\u00ec \u0111\u00f3 l\u00e0 th\u1eddi gian b\u00ecnh th\u01b0\u1eddng cu\u1ed1i c\u00f9ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh t\u00ednh \u0111\u1ebfn th\u1eddi \u0111i\u1ec3m b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb.<\/p>\n

– D\u1ea5u hi\u1ec7u th\u1ea7n kinh r\u00f5 r\u00e0ng<\/p>\n

– D\u1ea5u hi\u1ec7u th\u1ea7n kinh kh\u00f4ng k\u00edn \u0111\u00e1o v\u00e0 \u0111\u01a1n \u0111\u1ed9c<\/p>\n

– C\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00f4ng g\u1ee3i \u00fd xu\u1ea5t huy\u1ebft d\u01b0\u1edbi nh\u1ec7n<\/p>\n

– Kh\u00f4ng c\u00f3 ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ea7u ho\u1eb7c \u0111\u1ed9t qu\u1ef5 trong 3 th\u00e1ng v\u1eeba qua<\/p>\n

– Kh\u00f4ng b\u1ecb nh\u1ed3i m\u00e1u c\u01a1 tim trong 3 th\u00e1ng v\u1eeba qua<\/p>\n

– Kh\u00f4ng xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a, sinh d\u1ee5c trong 21 ng\u00e0y v\u1eeba qua<\/p>\n

– Kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch t\u1ea1i v\u1ecb tr\u00ed kh\u00f4ng \u00e9p c\u1ea7m m\u00e1u \u0111\u01b0\u1ee3c trong 7 ng\u00e0y v\u1eeba qua<\/p>\n

– Kh\u00f4ng tr\u1ea3i qua \u0111\u1ea1i ph\u1eabu thu\u1eadt trong 14 ng\u00e0y v\u1eeba qua<\/p>\n

– Kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed ch\u1ea3y m\u00e1u n\u1ed9i s\u1ecd<\/p>\n

– Huy\u1ebft \u00e1p t\u00e2m thu d\u01b0\u1edbi 185 mm Hg, huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng d\u01b0\u1edbi 110 mm Hg<\/p>\n

– Kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng ch\u1ea5n th\u01b0\u01a1ng c\u1ea5p t\u00ednh ho\u1eb7c ch\u1ea3y m\u00e1u c\u1ea5p t\u00ednh<\/p>\n

– Kh\u00f4ng d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng, ho\u1eb7c n\u1ebfu u\u1ed1ng, INR ph\u1ea3i d\u01b0\u1edbi 1,7<\/p>\n

– N\u1ebfu d\u00f9ng heparin trong v\u00f2ng 48 gi\u1edd, th\u1eddi gian ho\u1ea1t h\u00f3a prothrombin \u0111\u01b0\u1ee3c (aPT) ph\u1ea3i b\u00ecnh th\u01b0\u1eddng<\/p>\n

– S\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u tr\u00ean 100.000 \/ L<\/p>\n

– \u0110\u01b0\u1eddng huy\u1ebft tr\u00ean 2,7 mmol\/L (> 50 mg\/dL)<\/p>\n

– CT scan kh\u00f4ng th\u1ea5y d\u1ea5u hi\u1ec7u nh\u1ed3i m\u00e1u n\u00e3o di\u1ec7n r\u1ed9ng (gi\u1ea3m t\u1ef7 tr\u1ecdng tr\u00ean 1\/3 b\u00e1n c\u1ea7u) ho\u1eb7c xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd<\/p>\n

– B\u1ec7nh nh\u00e2n v\u00e0 gia \u0111\u00ecnh \u0111\u1ed3ng \u00fd \u0111i\u1ec1u tr\u1ecb sau khi \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch v\u1ec1 l\u1ee3i \u00edch v\u00e0 nh\u1eefng r\u1ee7i ro ti\u1ec1m t\u00e0ng c\u1ee7a thu\u1ed1c khi s\u1eed d\u1ee5ng.<\/p>\n

1.2. Ti\u00eau chu\u1ea9n lo\u1ea1i tr\u1eeb<\/strong><\/b><\/h3>\n

C\u00e1c ti\u00eau chu\u1ea9n lo\u1ea1i tr\u1eeb ch\u1ee7 y\u1ebfu t\u1eadp trung v\u00e0o vi\u1ec7c x\u00e1c \u0111\u1ecbnh nguy c\u01a1 bi\u1ebfn ch\u1ee9ng xu\u1ea5t huy\u1ebft sau khi d\u00f9ng thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft.<\/p>\n

Xem chi ti\u1ebft t\u1ea1i ph\u1ee5 l\u1ee5c IV.<\/p>\n

1.3. Nguy c\u01a1 xu\u1ea5t huy\u1ebft<\/strong><\/b><\/h3>\n

M\u1eb7c d\u00f9 thu\u1ed1c ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd khi d\u00f9ng thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft nh\u01b0ng qua t\u1ed5ng k\u1ebft ng\u01b0\u1eddi ta \u0111i \u0111\u1ebfn k\u1ebft lu\u1eadn r\u1eb1ng kh\u00f4ng n\u00ean coi nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u l\u00e0 b\u1ecb ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft, m\u1eb7c d\u00f9 c\u1ea7n th\u1eadn tr\u1ecdng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p aspirin v\u00e0 clopidogrel [22; 23].<\/p>\n

1.4. Ph\u1ed1i h\u1ee3p si\u00eau \u00e2m tr\u1ecb li\u1ec7u<\/strong><\/b><\/h3>\n

C\u00e1c nh\u00e0 nghi\u00ean c\u1ee9u \u0111\u00e3 nghi\u00ean c\u1ee9u vi\u1ec7c s\u1eed d\u1ee5ng si\u00eau \u00e2m xuy\u00ean s\u1ecd nh\u01b0 m\u1ed9t ph\u01b0\u01a1ng ti\u1ec7n h\u1ed7 tr\u1ee3 rt-PA trong \u0111i\u1ec1u tr\u1ecb ti\u00eau s\u1ee3i huy\u1ebft [24]. B\u1eb1ng c\u00e1ch cung c\u1ea5p s\u00f3ng \u00e1p l\u1ef1c \u0111\u1ebfn huy\u1ebft kh\u1ed1i, si\u00eau \u00e2m v\u1ec1 m\u1eb7t l\u00fd thuy\u1ebft c\u00f3 th\u1ec3 gia t\u0103ng b\u1ec1 m\u1eb7t ti\u1ebfp x\u00fac c\u1ee7a huy\u1ebft kh\u1ed1i v\u1edbi thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft trong m\u00e1u. C\u1ea7n c\u00f3 nhi\u1ec1u nghi\u00ean c\u1ee9u s\u00e2u h\u01a1n \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh vai tr\u00f2 ch\u00ednh x\u00e1c c\u1ee7a si\u00eau \u00e2m Doppler xuy\u00ean s\u1ecd trong vi\u1ec7c h\u1ed7 tr\u1ee3 ti\u00eau s\u1ee3i huy\u1ebft trong \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o c\u1ea5p t\u00ednh.<\/p>\n

2. <\/strong><\/b>Ph\u01b0\u01a1ng pha\u0301p ta\u0301i t\u01b0\u01a1\u0301i ma\u0301u s\u01b0\u0309 du\u0323ng du\u0323ng cu\u0323 l<\/strong><\/b>\u00e2\u0301y huy\u00ea\u0301t kh\u00f4\u0301i\u00a0<\/strong><\/b><\/h2>\n

B\u1eaft \u0111\u1ea7u \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u \u00e1p d\u1ee5ng t\u1eeb 15 n\u0103m tr\u01b0\u1edbc v\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c th\u1ebf h\u1ec7 1 v\u00e0 2, k\u1ef9 thu\u1eadt can thi\u1ec7p l\u1ea5y huy\u1ebft kh\u1ed1i b\u1eb1ng d\u1ee5ng c\u1ee5 qua \u0111\u01b0\u1eddng \u0111\u1ed9ng m\u1ea1ch sau \u0111\u00f3 \u0111\u01b0\u1ee3c c\u1ea3i ti\u1ebfn v\u01b0\u1ee3t b\u1eadc v\u1edbi th\u1ebf h\u1ec7 th\u1ee9 3 t\u1eeb n\u0103m 2012 v\u00e0 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i trong c\u00e1c h\u01b0\u1edbng d\u1eabn c\u1ee7a H\u1ed9i Tim m\u1ea1ch v\u00e0 \u0110\u1ed9t qu\u1ef5 Hoa K\u1ef3 t\u1eeb n\u0103m 2016 sau k\u1ebft qu\u1ea3 t\u00edch c\u1ef1c t\u1ea1i 5 nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean kh\u00f4ng \u0111\u1ed1i ch\u1ee9ng \u1edf c\u00e1c b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p do t\u1eafc \u0111\u1ed9ng m\u1ea1ch l\u1edbn. Cho \u0111\u1ebfn hi\u1ec7n t\u1ea1i, k\u1ef9 thu\u1eadt l\u1ea5y huy\u1ebft kh\u1ed1i c\u01a1 h\u1ecdc l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb c\u01a1 b\u1ea3n, \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p ngay sau khi d\u00f9ng thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft t\u0129nh m\u1ea1ch (v\u1edbi c\u1eeda s\u1ed5 4,5 gi\u1edd v\u00e0 kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh rt-PA) ho\u1eb7c \u0111i\u1ec1u tr\u1ecb \u0111\u01a1n thu\u1ea7n khi b\u1ec7nh nh\u00e2n t\u1edbi c\u01a1 s\u1edf y t\u1ebf ngo\u00e0i c\u1eeda s\u1ed5 4,5 gi\u1edd sau khi \u0111\u1ed9t qu\u1ef5 n\u00e3o do t\u1eafc m\u1ea1ch l\u1edbn.<\/p>\n

V\u1ec1 m\u1eb7t l\u00fd thuy\u1ebft, l\u00e0m tan c\u1ee5c huy\u1ebft kh\u1ed1i b\u1eb1ng k\u1ef9 thu\u1eadt c\u01a1 h\u1ecdc \u00edt g\u00e2y ra c\u00e1c nguy c\u01a1 ch\u1ea3y m\u00e1u h\u01a1n trong v\u00e0 sau t\u00e1i t\u01b0\u1edbi m\u00e1u so v\u1edbi d\u00f9ng thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch. V\u1ec1 c\u01a1 ch\u1ebf t\u00e1c \u0111\u1ed9ng, c\u00e1c d\u1ee5ng c\u1ee5 l\u1ea5y huy\u1ebft kh\u1ed1i c\u01a1 h\u1ecdc c\u0169ng c\u00f3 th\u1ec3 chia th\u00e0nh 2 nh\u00f3m ch\u00ednh, t\u00f9y thu\u1ed9c v\u00e0o v\u1ecb tr\u00ed t\u1ea1o l\u1ef1c l\u00ean \u0111\u1ea7u g\u1ea7n hay \u0111\u1ea7u xa c\u1ee5c huy\u1ebft kh\u1ed1i. Nh\u00f3m t\u1ea1o l\u1ef1c \u0111\u1ea7u g\u1ea7n bao g\u1ed3m c\u00e1c \u1ed1ng th\u00f4ng h\u00fat huy\u1ebft kh\u1ed1i r\u1ea5t m\u1ec1m, ch\u1eafc c\u00f3 kh\u1ea3 n\u0103ng ti\u1ebfp c\u1eadn d\u1ec5 d\u00e0ng \u0111\u1ea7u g\u1ea7n c\u1ee7a c\u1ee5c huy\u1ebft kh\u1ed1i v\u00e0 ti\u1ebfn h\u00e0nh th\u1ee7 thu\u1eadt nhanh v\u1edbi t\u1ef7 l\u1ec7 bi\u1ebfn ch\u1ee9ng th\u1ea5p, \u00edt t\u1ed5n th\u01b0\u01a1ng th\u00e0nh m\u1ea1ch. M\u1ed9t s\u1ed1 \u1ed1ng th\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng th\u01b0\u1eddng xuy\u00ean l\u00e0: Sofia Plus (microvention), Jet7 (Penumbra), React (Medtronic), Catalyst (Stryker). Nh\u00f3m t\u1ea1o l\u1ef1c \u0111\u1ea7u xa, bao g\u1ed3m c\u00e1c d\u1ee5ng c\u1ee5 l\u1ea5y huy\u1ebft kh\u1ed1i, th\u01b0\u1eddng l\u00e0 stent v\u1edbi c\u00e1c h\u00ecnh d\u1ea1ng kh\u00e1c nhau (h\u00ecnh th\u00f2ng l\u1ecdng, h\u00ecnh r\u1ed5 hay h\u00ecnh v\u00f2ng xo\u1eafn) s\u1ebd ti\u1ebfp c\u1eadn \u0111\u1ea7u xa c\u1ee5c huy\u1ebft kh\u1ed1i qua m\u1ed9t vi \u1ed1ng th\u00f4ng \u0111\u01b0\u1ee3c \u0111\u01b0a qua kho\u1ea3ng tr\u1ed1ng gi\u1eefa huy\u1ebft kh\u1ed1i v\u00e0 l\u00f2ng m\u1ea1ch. Nh\u00f3m n\u00e0y c\u00f3 t\u1ef7 l\u1ec7 l\u1ea5y huy\u1ebft kh\u1ed1i th\u00e0nh c\u00f4ng cao h\u01a1n nh\u01b0ng s\u1ebd l\u00e0m t\u0103ng nguy c\u01a1 t\u1eafc m\u1ed9t s\u1ed1 nh\u00e1nh xa do m\u1ea3nh v\u1ee5n c\u1ee7a huy\u1ebft kh\u1ed1i di tr\u00fa. B\u00ean c\u1ea1nh \u0111\u00f3, k\u00e9o huy\u1ebft kh\u1ed1i tr\u1ef1c ti\u1ebfp b\u1eb1ng c\u00e1c d\u1ee5ng c\u1ee5 stent kim lo\u1ea1i tr\u00ean m\u1ed9t \u0111o\u1ea1n d\u00e0i c\u0169ng d\u1ec5 g\u00e2y t\u1ed5n th\u01b0\u01a1ng th\u00e0nh m\u1ea1ch, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn co th\u1eaft, h\u1eb9p t\u1eafc ho\u1eb7c b\u00f3c t\u00e1ch n\u1ed9i m\u1ea1c. M\u1ed9t s\u1ed1 lo\u1ea1i stent l\u1ea5y huy\u1ebft kh\u1ed1i ph\u1ed5 bi\u1ebfn \u0111\u01b0\u1ee3c ch\u1ee9ng nh\u1eadn c\u1ee7a FDA trong can thi\u1ec7p n\u1ed9i m\u1ea1ch: Solitaire (Medtronic), Trevo (Stryker) [35; 36; 37; 38; 39].<\/p>\n

T\u1eeb n\u0103m 2018, th\u00e0nh c\u00f4ng c\u1ee7a nghi\u00ean c\u1ee9u DAWN v\u00e0 DEFUSE 3 \u0111\u00e3 gi\u00fap m\u1edf r\u1ed9ng c\u1eeda s\u1ed5 \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o c\u1ea5p b\u1eb1ng d\u1ee5ng c\u1ee5 c\u01a1 h\u1ecdc t\u1eeb 6 gi\u1edd l\u00ean \u0111\u1ebfn 24 gi\u1edd \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n ph\u00f9 h\u1ee3p c\u00e1c ti\u00eau chu\u1ea9n l\u1ef1a ch\u1ecdn. C\u00e1c h\u01b0\u1edbng d\u1eabn m\u1edbi c\u1ee7a H\u1ed9i tim m\u1ea1ch v\u00e0 \u0111\u1ed9t qu\u1ef5 Hoa K\u1ef3 n\u0103m 2018, 2019 \u0111\u01b0a ra khuy\u1ebfn ngh\u1ecb l\u1ea5y huy\u1ebft kh\u1ed1i \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n trong c\u1eeda s\u1ed5 6 \u0111\u1ebfn 16 gi\u1edd sau \u0111\u1ed9t qu\u1ef5, c\u1ee5 th\u1ec3 l\u00e0 \u0111\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 m\u1ed9t c\u1ee5c m\u00e1u \u0111\u00f4ng l\u1edbn \u1edf m\u1ed9t trong nh\u1eefng m\u1ea1ch l\u1edbn \u1edf n\u1ec1n n\u00e3o v\u00e0 \u0111\u00e1p \u1ee9ng c\u00e1c ti\u00eau ch\u00ed sau:<\/p>\n

    \n
  • \u0110i\u1ec3m s\u1ed1 Rankin s\u1eeda \u0111\u1ed5i (mRS) t\u1eeb 0 – 1;<\/li>\n
  • T\u1eafc \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh trong ho\u1eb7c \u0111\u1ed9ng m\u1ea1ch n\u00e3o gi\u1eefa ph\u00e2n \u0111o\u1ea1n 1 (M1);<\/li>\n
  • Tu\u1ed5i tr\u00ean 18 tu\u1ed5i;<\/li>\n
  • Thang \u0111i\u1ec3m \u0111\u1ed9t qu\u1ef5 NIHSS t\u1eeb 6 tr\u1edf l\u00ean v\u00e0<\/li>\n
  • Ch\u01b0\u01a1ng tr\u00ecnh \u0111\u1ed9t qu\u1ef5 c\u1ee7a Alberta \u0110i\u1ec3m CT s\u1edbm t\u1eeb 6 tr\u1edf l\u00ean.<\/li>\n<\/ul>\n

    H\u1ed9i \u0111\u1ed9t qu\u1ef5 ch\u00e2u \u00c2u c\u00f4ng b\u1ed1 h\u01b0\u1edbng d\u1eabn can thi\u1ec7p l\u1ea5y huy\u1ebft kh\u1ed1i c\u01a1 h\u1ecdc trong \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 c\u1ea5p t\u00ednh [59] nh\u01b0 sau:<\/p>\n

      \n
    • L\u1ea5y huy\u1ebft kh\u1ed1i c\u01a1 h\u1ecdc v\u00e0 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa t\u1ed1i \u01b0u n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 n\u00e3o c\u1ea5p do thi\u1ebfu m\u00e1u trong v\u00f2ng 6h kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng do t\u1eafc m\u1ea1ch l\u1edbn c\u1ee7a tu\u1ea7n ho\u00e0n n\u00e3o tr\u01b0\u1edbc<\/li>\n
    • L\u1ea5y huy\u1ebft kh\u1ed1i c\u01a1 h\u1ecdc v\u00e0 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa t\u1ed1i \u01b0u n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh \u0111\u1ed9t qu\u1ef5 n\u00e3o c\u1ea5p do thi\u1ebfu m\u00e1u li\u00ean quan \u0111\u1ebfn t\u1eafc m\u1ea1ch v\u00f2ng tu\u1ea7n ho\u00e0n n\u00e3o tr\u01b0\u1edbc xu\u1ea5t hi\u1ec7n trong kho\u1ea3ng t\u1eeb 6 \u0111\u1ebfn 24 gi\u1edd.<\/li>\n
    • Ti\u00eau s\u1ee3i huy\u1ebft \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch ph\u1ed1i h\u1ee3p l\u1ea5y huy\u1ebft kh\u1ed1i c\u01a1 h\u1ecdc n\u00ean \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o do t\u1eafc m\u1ea1ch m\u00e1u l\u1edbn. C\u1ea3 hai ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t sau khi b\u1ec7nh nh\u00e2n \u0111\u1ebfn b\u1ec7nh vi\u1ec7n.<\/li>\n
    • L\u1ea5y huy\u1ebft kh\u1ed1i c\u01a1 h\u1ecdc v\u00e0 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa t\u1ed1i \u01b0u (bao g\u1ed3m c\u1ea3 ti\u00eau s\u1ee3i huy\u1ebft khi \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh) n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t v\u1edbi b\u1ec7nh nh\u00e2n t\u1eeb 80 tu\u1ed5i tr\u1edf l\u00ean, \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o c\u1ea5p t\u00ednh do t\u1eafc m\u1ea1ch m\u00e1u l\u1edbn xu\u1ea5t hi\u1ec7n trong v\u00f2ng 6 gi\u1edd k\u1ec3 t\u1eeb khi kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng.<\/li>\n
    • L\u1ea5y huy\u1ebft kh\u1ed1i v\u00e0 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa t\u1ed1i \u01b0u (bao g\u1ed3m c\u1ea3 \u0111i\u1ec1u tr\u1ecb ti\u00eau s\u1ee3i huy\u1ebft khi \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh) \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb trong c\u1eeda s\u1ed5 th\u1eddi gian 0 – 6 gi\u1edd \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n b\u1ecb \u0111\u1ed9t qu\u1ef5 tu\u1ea7n ho\u00e0n n\u00e3o tr\u01b0\u1edbc do t\u1eafc m\u1ea1ch l\u1edbn m\u00e0 kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 nh\u1ed3i m\u00e1u di\u1ec7n r\u1ed9ng.<\/li>\n
    • L\u1ea5y huy\u1ebft kh\u1ed1i c\u01a1 h\u1ecdc v\u00e0 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa t\u1ed1i \u01b0u (bao g\u1ed3m c\u1ea3 \u0111i\u1ec1u tr\u1ecb ti\u00eau s\u1ee3i huy\u1ebft khi \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh) \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb trong c\u1eeda s\u1ed5 th\u1eddi gian 6 – 24 gi\u1edd \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n b\u1ecb \u0111\u1ed9t qu\u1ef5 tu\u1ea7n ho\u00e0n n\u00e3o tr\u01b0\u1edbc do t\u1eafc m\u1ea1ch l\u1edbn, \u0111\u00e1p \u1ee9ng c\u00e1c ti\u00eau ch\u00ed thu nh\u1eadn trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng DEFUSE-3 v\u00e0 DAWN.<\/li>\n
    • C\u00e1c ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh n\u00e2ng cao l\u00e0 kh\u00f4ng c\u1ea7n thi\u1ebft \u0111\u1ec3 l\u1ef1a ch\u1ecdn b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 n\u00e3o do t\u1eafc m\u1ea1ch m\u00e1u l\u1edbn c\u1ee7a tu\u1ea7n ho\u00e0n n\u00e3o tr\u01b0\u1edbc xu\u1ea5t hi\u1ec7n t\u1eeb 0 – 6 gi\u1edd k\u1ec3 t\u1eeb khi kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng.<\/li>\n<\/ul>\n
      \"Ph\u01b0\u01a1ng
      Ph\u01b0\u01a1ng pha\u0301p ta\u0301i t\u01b0\u01a1\u0301i ma\u0301u b\u0103\u0300ng l\u00e2\u0301y huy\u00ea\u0301t kh\u00f4\u0301i.
      B\u00ea\u0323nh nh\u00e2n nam 77 tu\u00f4\u0309i, \u0111\u00f4\u0323t quy\u0323 gi\u01a1\u0300 th\u01b0\u0301 1, no\u0301i ngo\u0323ng, me\u0301o mi\u00ea\u0323ng, NIHSS 14 \u0111i\u00ea\u0309m, li\u00ea\u0323t n\u01b0\u0309a ng\u01b0\u01a1\u0300i tra\u0301i, Glasgow 12 \u0111i\u00ea\u0309m. Huy\u00ea\u0301t a\u0301p 160\/100 mmHg. Hi\u0300nh CLVT t\u0103\u0301c \u0111m na\u0303o gi\u01b0\u0303a va\u0300 ca\u0309nh trong pha\u0309i, ASPECT 6 (A-B). Can thi\u00ea\u0323p l\u00e2\u0301y huy\u00ea\u0301t kh\u00f4\u0301i ta\u0301i th\u00f4ng hoa\u0300n toa\u0300n (C) va\u0300 l\u00e2\u0301y ra huy\u00ea\u0301t kh\u00f4\u0301i \u0111en 1 cm (D). B\u00ea\u0323nh nh\u00e2n sau can thi\u00ea\u0323p h\u00f4\u0300i phu\u0323c hoa\u0300n toa\u0300n.<\/figcaption><\/figure>\n","protected":false},"excerpt":{"rendered":"

      Ph\u01b0\u01a1ng pha\u0301p ta\u0301i t\u01b0\u01a1\u0301i ma\u0301u l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb nh\u1ed3i m\u00e1u n\u00e3o b\u1eb1ng c\u00e1ch c\u1ea3i thi\u1ec7n l\u01b0u th\u00f4ng m\u00e1u t\u1edbi n\u00e3o, gi\u1ea3m thi\u1ec3u c\u00e1c c\u1ee5c m\u00e1u \u0111\u00f4ng v\u00e0 ph\u1ee5c h\u1ed3i c\u00e1c t\u1ebf b\u00e0o n\u00e3o b\u1ecb t\u1ed5n th\u01b0\u01a1ng. C\u00f3 hai ph\u01b0\u01a1ng ph\u00e1p ch\u00ednh \u0111\u1ec3 t\u00e1i t\u01b0\u1edbi m\u00e1u trong \u0111i\u1ec1u tr\u1ecb nh\u1ed3i m\u00e1u n\u00e3o: t\u00e1i […]<\/p>\n","protected":false},"author":42,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[10,33],"tags":[3],"yoast_head":"\nPh\u01b0\u01a1ng pha\u0301p ta\u0301i t\u01b0\u01a1\u0301i ma\u0301u trong \u0111i\u00ea\u0300u tri\u0323 nh\u00f4\u0300i ma\u0301u na\u0303o - Vinmec<\/title>\n<meta name=\"description\" content=\"Ph\u01b0\u01a1ng pha\u0301p ta\u0301i t\u01b0\u01a1\u0301i ma\u0301u c\u1ea3i thi\u1ec7n l\u01b0u th\u00f4ng m\u00e1u t\u1edbi n\u00e3o, gi\u1ea3m thi\u1ec3u c\u00e1c c\u1ee5c m\u00e1u \u0111\u00f4ng v\u00e0 ph\u1ee5c h\u1ed3i c\u00e1c t\u1ebf b\u00e0o n\u00e3o b\u1ecb t\u1ed5n th\u01b0\u01a1ng.\" \/>\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=\"Ph\u01b0\u01a1ng pha\u0301p ta\u0301i t\u01b0\u01a1\u0301i ma\u0301u trong \u0111i\u00ea\u0300u tri\u0323 nh\u00f4\u0300i ma\u0301u na\u0303o - 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