{"id":25665,"date":"2023-04-21T11:30:27","date_gmt":"2023-04-21T04:30:27","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=25665"},"modified":"2023-04-21T11:34:43","modified_gmt":"2023-04-21T04:34:43","slug":"xet-nghiem-can-lam-sang-chan-doan-dot-quy-thieu-mau-nao","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/xet-nghiem-can-lam-sang-chan-doan-dot-quy-thieu-mau-nao\/","title":{"rendered":"X\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o"},"content":{"rendered":"

\u0110\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i v\u00e0 l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u g\u00e2y ra t\u00ecnh tr\u1ea1ng li\u1ec7t v\u00e0 t\u1eed vong \u1edf nhi\u1ec1u qu\u1ed1c gia tr\u00ean th\u1ebf gi\u1edbi. B\u1ec7nh x\u1ea3y ra khi c\u00e1c \u0111\u1ed9ng m\u1ea1ch d\u1eabn m\u00e1u \u0111\u1ebfn n\u00e3o b\u1ecb t\u1eafc ngh\u1ebdn ho\u1eb7c h\u1eb9p l\u1ea1i, g\u00e2y gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng m\u00e1u \u0111\u1ebfn n\u00e3o, g\u00e2y t\u1ed5n th\u01b0\u01a1ng c\u00e1c t\u1ebf b\u00e0o n\u00e3o. K\u1ebft qu\u1ea3 l\u00e0, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 b\u1ecb t\u00ea, y\u1ebfu c\u01a1, m\u1ea5t c\u1ea3m gi\u00e1c, kh\u00f3 n\u00f3i v\u00e0 c\u00f3 th\u1ec3 m\u1ea5t kh\u1ea3 n\u0103ng t\u1ef1 ch\u0103m s\u00f3c b\u1ea3n th\u00e2n. X\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng l\u00e0 m\u1ed9t b\u01b0\u1edbc quan tr\u1ecdng trong qu\u00e1 tr\u00ecnh ch\u1ea9n \u0111o\u00e1n<\/a> \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o. C\u00e1c x\u00e9t nghi\u1ec7m n\u00e0y \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 v\u00e0 x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng c\u1ee7a n\u00e3o.\u00a0<\/strong><\/p>\n

\"X\u00e9t
X\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng gi\u00fap ch\u1ea9n \u0111o\u00e1n \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o ch\u00ednh x\u00e1c<\/figcaption><\/figure>\n

1. Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh s\u1ecd n\u00e3o<\/span><\/b><\/h2>\n

– Theo khuy\u1ebfn c\u00e1o n\u0103m 2019 c\u1ee7a H\u1ed9i tim m\u1ea1ch v\u00e0 \u0111\u1ed9t qu\u1ef5 Hoa K\u1ef3 th\u00ec ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh \u0111\u00f3ng vai tr\u00f2 l\u00e0 c\u00f4ng c\u1ee5 h\u00ecnh \u1ea3nh quan tr\u1ecdng nh\u1ea5t trong th\u0103m kh\u00e1m ban \u0111\u1ea7u \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 n\u00e3o nh\u1eb1m ph\u00e2n bi\u1ec7t t\u1ed5n th\u01b0\u01a1ng thi\u1ebfu m\u00e1u v\u00e0 ch\u1ea3y m\u00e1u, \u0111\u1ed3ng th\u1eddi x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng, v\u1ecb tr\u00ed m\u1ea1ch t\u1eafc v\u1edbi k\u1ef9 thu\u1eadt \u0111a d\u1ea1ng. \u0110\u00e2y l\u00e0 ph\u01b0\u01a1ng ph\u00e1p c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh nhanh ch\u00f3ng, thu\u1eadn ti\u1ec7n v\u00e0 c\u00f3 t\u00ednh ph\u1ed5 bi\u1ebfn cao, ph\u00f9 h\u1ee3p v\u1edbi t\u00ednh ch\u1ea5t v\u00e0 y\u00eau c\u1ea7u trong c\u1ea5p c\u1ee9u \u0111\u1ed9t qu\u1ef5 n\u00e3o.<\/span><\/p>\n

– Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh kh\u00f4ng ti\u00eam thu\u1ed1c tr\u01b0\u1edbc h\u1ebft gi\u00fap lo\u1ea1i tr\u1eeb t\u1ed5n th\u01b0\u01a1ng ch\u1ea3y m\u00e1u, sau \u0111\u00f3 l\u00e0 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a t\u1ed5n th\u01b0\u01a1ng thi\u1ebfu m\u00e1u th\u00f4ng qua thang \u0111i\u1ec3m ASPECTS v\u1edbi v\u00f2ng tu\u1ea7n ho\u00e0n tr\u01b0\u1edbc v\u00e0 Pc-ASPECTS v\u1edbi v\u00f2ng tu\u1ea7n ho\u00e0n sau. C\u00e1c d\u1ea5u hi\u1ec7u t\u1ed5n th\u01b0\u01a1ng nhu m\u00f4 th\u01b0\u1eddng g\u1eb7p l\u00e0 gi\u1ea3m t\u1ef7 tr\u1ecdng c\u00e1c nh\u00e2n x\u00e1m, x\u00f3a ranh gi\u1edbi ch\u1ea5t tr\u1eafng-ch\u1ea5t x\u00e1m hay t\u0103ng \u0111\u1eadm c\u1ee7a huy\u1ebft kh\u1ed1i t\u1ea1i v\u1ecb tr\u00ed \u0111\u1ed9ng m\u1ea1ch t\u1eafc.<\/span><\/p>\n

– Ch\u1ee5p MSCT m\u1ea1ch m\u00e1u n\u00e3o gi\u00fap ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c v\u1ecb tr\u00ed \u0111\u1ed9ng m\u1ea1ch t\u1eafc qua \u0111\u00f3 quy\u1ebft \u0111\u1ecbnh ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb l\u1ea5y huy\u1ebft kh\u1ed1i. Ngo\u00e0i ra, nhi\u1ec1u \u1ee9ng d\u1ee5ng hi\u1ec7n \u0111\u1ea1i trong MSCT nh\u01b0 ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh nhi\u1ec1u pha, \u0111\u00e1nh gi\u00e1 t\u00ednh th\u1ea5m th\u00e0nh m\u1ea1ch, ch\u1ee5p t\u01b0\u1edbi m\u00e1u n\u00e3o gi\u00fap b\u1ed5 sung c\u00e1c th\u00f4ng tin c\u1ea7n thi\u1ebft, x\u00e1c \u0111\u1ecbnh m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 nguy c\u01a1, ti\u00ean l\u01b0\u1ee3ng kh\u1ea3 n\u0103ng ch\u1ea3y m\u00e1u c\u0169ng nh\u01b0 t\u00ednh to\u00e1n th\u1ec3 t\u00edch v\u00f9ng l\u00f5i nh\u1ed3i m\u00e1u, th\u1ec3 t\u00edch v\u00f9ng nguy c\u01a1 nh\u1eb1m m\u1edf r\u1ed9ng c\u1eeda s\u1ed5 \u0111i\u1ec1u tr\u1ecb v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u1ebfn vi\u1ec7n sau c\u1eeda s\u1ed5 \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng (6 ti\u1ebfng v\u1edbi t\u1eafc m\u1ea1ch v\u00f2ng tu\u1ea7n ho\u00e0n tr\u01b0\u1edbc v\u00e0 8 ti\u1ebfng v\u1edbi t\u1eafc m\u1ea1ch v\u00f2ng tu\u1ea7n ho\u00e0n sau).<\/span><\/p>\n

2. Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb n\u00e3o<\/span><\/b><\/h2>\n

\u01afu \u0111i\u1ec3m:<\/span><\/strong><\/p>\n

– L\u00e0 k\u1ef9 thu\u1eadt hi\u1ec7n \u0111\u1ea1i, mang l\u1ea1i nhi\u1ec1u th\u00f4ng tin b\u1ed5 sung \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5.<\/span><\/p>\n

– C\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng thi\u1ebfu m\u00e1u hay ch\u1ea3y m\u00e1u n\u00e3o ngay \u1edf giai \u0111o\u1ea1n r\u1ea5t s\u1edbm sau \u0111\u1ed9t qu\u1ef5.<\/span><\/p>\n

– \u0110\u00e1nh gi\u00e1 chi ti\u1ebft c\u00e1c c\u1ea5u tr\u00fac gi\u1ea3i ph\u1eabu c\u1ee7a n\u00e3o nh\u1edd \u0111\u1ed9 ph\u00e2n gi\u1ea3i kh\u00f4ng gian t\u1ed1t.<\/span><\/p>\n

Nh\u01b0\u1ee3c \u0111i\u1ec3m:<\/span><\/strong><\/p>\n

– Kh\u00f4ng \u0111\u01b0\u1ee3c trang b\u1ecb \u1edf m\u1ecdi c\u01a1 s\u1edf y t\u1ebf.<\/span><\/p>\n

– Th\u1eddi gian ch\u1ee5p k\u00e9o d\u00e0i, ch\u1ea5t l\u01b0\u1ee3ng h\u00ecnh \u1ea3nh b\u1ecb \u1ea3nh h\u01b0\u1edfng n\u1ebfu b\u1ec7nh nh\u00e2n k\u00edch th\u00edch trong b\u1ec7nh c\u1ea3nh \u0111\u1ed9t qu\u1ef5 n\u00e3o.<\/span><\/p>\n

– M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n kh\u00f4ng ch\u1ee5p \u0111\u01b0\u1ee3c MRI do c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh (mang m\u00e1y t\u1ea1o nh\u1ecbp v\u0129nh vi\u1ec5n, van c\u01a1 h\u1ecdc ).<\/span><\/p>\n

H\u00ecnh \u1ea3nh khu\u1ebfch t\u00e1n DWI (diffusion weighted imaging) tr\u00ean phim ch\u1ee5p MRI c\u00f3 \u0111\u1ed9 nh\u1ea1y cao trong ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng thi\u1ebfu m\u00e1u n\u00e3o s\u1edbm. [3; 14; 15]. B\u00ean c\u1ea1nh \u0111\u00f3, ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb c\u0169ng gi\u00fap x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed m\u1ea1ch t\u1eafc (xung TOF 3D), \u0111\u00e1nh gi\u00e1 t\u00ecnh t\u01b0\u1edbi m\u00e1u n\u00e3o (perfusion) t\u01b0\u01a1ng t\u1ef1 c\u00e1c ch\u1ee9c n\u0103ng c\u1ee7a ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh. Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb \u0111\u01b0\u1ee3c \u01b0u ti\u00ean s\u1eed d\u1ee5ng trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1ed9t qu\u1ef5 n\u00e3o th\u1ee9c gi\u1ea5c (wake-up stroke) ho\u1eb7c kh\u00f4ng x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c ch\u00ednh x\u00e1c th\u1eddi \u0111i\u1ec3m kh\u1edfi ph\u00e1t. Khi \u0111\u00f3, t\u1ed5n th\u01b0\u01a1ng kh\u00f4ng ph\u00f9 h\u1ee3p (mismatch) tr\u00ean \u1ea3nh c\u1ed9ng h\u01b0\u1edfng t\u1eeb gi\u1eefa xung FLAIR v\u00e0 DWI gi\u00fap b\u1ec7nh nh\u00e2n c\u00f3 c\u01a1 h\u1ed9i \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch \u1edf giai \u0111o\u1ea1n c\u1ea5p.<\/span><\/p>\n

3. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh kh\u00e1c<\/span><\/b><\/h2>\n

– Si\u00eau \u00e2m Doppler xuy\u00ean s\u1ecd l\u00e0 c\u00f4ng c\u1ee5 h\u1eefu \u00edch \u0111\u00e1nh gi\u00e1 c\u00e1c m\u1ea1ch m\u00e1u \u0111o\u1ea1n g\u1ea7n nh\u01b0 \u0111\u1ed9ng m\u1ea1ch n\u00e3o gi\u1eefa, \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh \u0111o\u1ea1n trong s\u1ecd, \u0111\u1ed9ng m\u1ea1ch s\u1ed1ng n\u1ec1n.<\/span><\/p>\n

– Si\u00eau \u00e2m tim: khi nghi ng\u1edd huy\u1ebft kh\u1ed1i t\u1eeb tim g\u00e2y t\u1eafc m\u1ea1ch.<\/span><\/p>\n

– Ch\u1ee5p XQ ng\u1ef1c c\u0169ng c\u00f3 \u00edch trong \u0111\u1ed9t qu\u1ef5 c\u1ea5p, tuy nhi\u00ean kh\u00f4ng \u0111\u01b0\u1ee3c l\u00e0m \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn th\u1eddi gian ch\u1ec9 \u0111\u1ecbnh thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft.<\/span><\/p>\n

– Ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch n\u00e3o qua da: gi\u00fap l\u00e0m r\u00f5 c\u00e1c d\u1ea5u hi\u1ec7u nghi ng\u1edd ho\u1eb7c \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh v\u00e0 \u0111i\u1ec1u tr\u1ecb.<\/span><\/p>\n

4. X\u00e9t nghi\u1ec7m m\u00e1u<\/span><\/b><\/h2>\n

Ch\u1ec9 n\u00ean x\u00e9t nghi\u1ec7m c\u1ea5p c\u00e1c th\u00f4ng s\u1ed1 nh\u01b0 \u0111\u01b0\u1eddng m\u00e1u, \u0111\u00f4ng m\u00e1u c\u01a1 b\u1ea3n (n\u1ebfu b\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng heparin, warfarin, ho\u1eb7c c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng tr\u1ef1c ti\u1ebfp), c\u00f4ng th\u1ee9c m\u00e1u, sinh h\u00f3a m\u00e1u c\u01a1 b\u1ea3n. C\u00e1c ch\u1ec9 \u0111\u1ecbnh x\u00e9t nghi\u1ec7m kh\u00e1c t\u00f9y thu\u1ed9c v\u00e0o l\u00e2m s\u00e0ng c\u1ee7a t\u1eebng ng\u01b0\u1eddi b\u1ec7nh:<\/span><\/p>\n

– Troponin tim: \u0111\u1ec3 ph\u00e1t hi\u1ec7n nh\u1ed3i m\u00e1u c\u01a1 tim kh\u00f4ng ST ch\u00eanh.<\/span><\/p>\n

– X\u00e9t nghi\u1ec7m \u0111\u1ed9c ch\u1ea5t: khi nghi ng\u1edd b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng gi\u1ea3 \u0111\u1ed9t qu\u1ef5 v\u00e0 \u0111\u1ec3 ph\u00e1t hi\u1ec7n ch\u1ea5t g\u00e2y c\u01b0\u1eddng giao c\u1ea3m (cocain) c\u00f3 th\u1ec3 g\u00e2y \u0111\u1ed9t qu\u1ef5.<\/span><\/p>\n

– X\u00e9t nghi\u1ec7m lipid m\u00e1u l\u00fac \u0111\u00f3i<\/span><\/p>\n

– M\u00e1u l\u1eafng<\/span><\/p>\n

– Th\u1eed thai<\/span><\/p>\n

– Kh\u00e1ng th\u1ec3 kh\u00e1ng nh\u00e2n<\/span><\/p>\n

– Y\u1ebfu t\u1ed1 d\u1ea1ng th\u1ea5p<\/span><\/p>\n

– N\u1ed3ng \u0111\u1ed9 homocystein m\u00e1u<\/span><\/p>\n

– X\u00e9t nghi\u1ec7m giang mai (RPR)<\/span><\/p>\n

Kh\u00f4ng n\u00ean tr\u00ec ho\u00e3n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ec9 \u0111\u1ecbnh m\u00e0 kh\u00f4ng d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u v\u00e0 kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u nghi ng\u1edd r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u.<\/span><\/p>\n

N\u1ebfu b\u1ec7nh nh\u00e2n suy h\u00f4 h\u1ea5p, thi\u1ebfu oxy m\u00e1u c\u1ea7n l\u00e0m x\u00e9t nghi\u1ec7m kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch v\u00e0 \u0111\u00e1nh gi\u00e1 r\u1ed1i lo\u1ea1n toan ki\u1ec1m, tuy nhi\u00ean c\u1ea7n h\u1ea1n ch\u1ebf t\u1ed1i \u0111a l\u1ea5y m\u00e1u \u0111\u1ed9ng m\u1ea1ch \u1edf c\u00e1c b\u1ec7nh nh\u00e2n chu\u1ea9n b\u1ecb \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft.<\/span><\/p>\n

T\u00f3m l\u1ea1i, vi\u1ec7c ch\u1ea9n \u0111o\u00e1n \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o s\u1edbm v\u00e0 ph\u00e1t hi\u1ec7n c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 \u0111\u01b0a ra ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 v\u00e0 gi\u1ea3m thi\u1ec3u t\u1ed5n th\u01b0\u01a1ng n\u00e3o. Do \u0111\u00f3, vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c x\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng l\u00e0 m\u1ed9t b\u01b0\u1edbc quan tr\u1ecdng trong qu\u00e1 tr\u00ecnh ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n","protected":false},"excerpt":{"rendered":"

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