{"id":28004,"date":"2023-04-26T16:28:18","date_gmt":"2023-04-26T09:28:18","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28004"},"modified":"2023-04-26T16:28:18","modified_gmt":"2023-04-26T09:28:18","slug":"nhoi-mau-nao-quy-trinh-chan-doan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/26\/nhoi-mau-nao-quy-trinh-chan-doan\/","title":{"rendered":"Nh\u1ed3i m\u00e1u n\u00e3o: Quy tr\u00ecnh ch\u1ea9n \u0111o\u00e1n"},"content":{"rendered":"

Nh\u1ed3i m\u00e1u n\u00e3o l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p \u1edf con ng\u01b0\u1eddi, g\u00e2y ra do t\u1eafc ngh\u1ebdn ho\u1eb7c r\u1ed1i lo\u1ea1n tu\u1ea7n ho\u00e0n m\u00e1u \u0111\u1ebfn n\u00e3o. \u0110\u00e2y l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 nghi\u00eam tr\u1ecdng v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra nh\u1eefng h\u1eadu qu\u1ea3 kh\u00f3 l\u01b0\u1eddng \u0111\u1ebfn s\u1ee9c kh\u1ecfe c\u1ee7a con ng\u01b0\u1eddi. Trong b\u00e0i vi\u1ebft n\u00e0y, ch\u00fang ta s\u1ebd t\u00ecm hi\u1ec3u quy tr\u00ecnh ch\u1ea9n \u0111o\u00e1n b\u1ec7nh l\u00fd n\u00e0y.<\/strong><\/p>\n

1. L\u00e2m s\u00e0ng<\/span><\/b><\/h2>\n

1.1. Khai th\u00e1c ti\u1ec1n s\u1eed v\u00e0 h\u1ecfi b\u1ec7nh<\/span><\/b><\/p>\n

C\u1ea7n khai th\u00e1c c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch v\u00e0 b\u1ec7nh l\u00fd tim m\u1ea1ch, bao g\u1ed3m:<\/span><\/p>\n

– T\u0103ng huy\u1ebft \u00e1p<\/span><\/p>\n

– \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/span><\/p>\n

– H\u00fat thu\u1ed1c l\u00e1, thu\u1ed1c l\u00e0o<\/span><\/p>\n

– R\u1ed1i lo\u1ea1n lipid m\u00e1u<\/span><\/p>\n

– Ti\u1ec1n s\u1eed b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, b\u1eafc c\u1ea7u ch\u1ee7 v\u00e0nh, rung nh\u0129…<\/span><\/p>\n

Nh\u1eefng b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i h\u01a1n c\u1ea7n khai th\u00e1c th\u00eam:<\/span><\/p>\n

– Ti\u1ec1n s\u1eed ch\u1ea5n th\u01b0\u01a1ng<\/span><\/p>\n

– C\u00e1c b\u1ec7nh v\u1ec1 \u0111\u00f4ng m\u00e1u<\/span><\/p>\n

– D\u00f9ng ch\u1ea5t k\u00edch th\u00edch (\u0111\u1eb7c bi\u1ec7t l\u00e0 cocaine)<\/span><\/p>\n

– \u0110au \u0111\u1ea7u migraine<\/span><\/p>\n

– U\u1ed1ng thu\u1ed1c tr\u00e1nh thai<\/span><\/p>\n

C\u1ea7n ngh\u0129 t\u1edbi \u0111\u1ed9t qu\u1ef5 khi b\u1ec7nh nh\u00e2n c\u00f3 d\u1ea5u hi\u1ec7u th\u1ea7n kinh (khu tr\u00fa ho\u1eb7c lan t\u1ecfa) ho\u1eb7c r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c \u0111\u1ed9t ng\u1ed9t. Kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t r\u00f5 r\u00e0ng gi\u1eefa \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o (nh\u1ed3i m\u00e1u n\u00e3o) v\u00e0 \u0111\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft n\u00e3o (xu\u1ea5t huy\u1ebft n\u00e3o) m\u1eb7c d\u00f9 c\u00e1c tri\u1ec7u ch\u1ee9ng bu\u1ed3n n\u00f4n, n\u00f4n, \u0111au \u0111\u1ea7u, \u0111\u1ed9t ng\u1ed9t thay \u0111\u1ed5i \u00fd th\u1ee9c g\u1eb7p nhi\u1ec1u h\u01a1n trong xu\u1ea5t huy\u1ebft n\u00e3o.<\/span><\/p>\n

C\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a nh\u1ed3i m\u00e1u n\u00e3o th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n \u0111\u1ed9t ng\u1ed9t:<\/span><\/p>\n

– Li\u1ec7t n\u1eeda ng\u01b0\u1eddi ho\u1eb7c li\u1ec7t 1 ph\u1ea7n c\u01a1 th\u1ec3<\/span><\/p>\n

– M\u1ea5t ho\u1eb7c gi\u1ea3m c\u1ea3m gi\u00e1c m\u1ed9t b\u00ean c\u01a1 th\u1ec3<\/span><\/p>\n

– M\u1ea5t th\u1ecb l\u1ef1c m\u1ed9t ho\u1eb7c hai m\u1eaft<\/span><\/p>\n

– M\u1ea5t ho\u1eb7c gi\u1ea3m th\u1ecb tr\u01b0\u1eddng<\/span><\/p>\n

– Nh\u00ecn \u0111\u00f4i (song th\u1ecb).<\/span><\/p>\n

– Gi\u1ea3m ho\u1eb7c kh\u00f4ng v\u1eadn \u0111\u1ed9ng \u0111\u01b0\u1ee3c kh\u1edbp x\u01b0\u01a1ng<\/span><\/p>\n

– Li\u1ec7t m\u1eb7t<\/span><\/p>\n

– Th\u1ea5t \u0111i\u1ec1u<\/span><\/p>\n

– Ch\u00f3ng m\u1eb7t (hi\u1ebfm khi xu\u1ea5t hi\u1ec7n \u0111\u01a1n l\u1ebb).<\/span><\/p>\n

– Th\u1ea5t ng\u00f4n<\/span><\/p>\n

– R\u1ed1i lo\u1ea1n \u00fd th\u1ee9c \u0111\u1ed9t ng\u1ed9t<\/span><\/p>\n

C\u00e1c tri\u1ec7u ch\u1ee9ng tr\u00ean c\u00f3 th\u1ec3 \u0111\u01a1n \u0111\u1ed9c ho\u1eb7c ph\u1ed1i h\u1ee3p. Ng\u01b0\u1eddi th\u1ea7y thu\u1ed1c c\u1ea7n x\u00e1c \u0111\u1ecbnh th\u1eddi \u0111i\u1ec3m cu\u1ed1i c\u00f9ng b\u1ec7nh nh\u00e2n c\u00f2n b\u00ecnh th\u01b0\u1eddng \u0111\u1ec3 xem x\u00e9t ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch. C\u00f3 th\u1ec3 c\u00f3 nhi\u1ec1u y\u1ebfu t\u1ed1 tr\u00ec ho\u00e3n th\u1eddi gian ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ebfn c\u01a1 s\u1edf y t\u1ebf nh\u01b0 \u0111\u1ed9t qu\u1ef5 trong khi ng\u1ee7, kh\u00f4ng ph\u00e1t hi\u1ec7n ra cho \u0111\u1ebfn khi t\u1ec9nh d\u1eady; \u0111\u1ed9t qu\u1ef5 nh\u01b0ng b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 g\u1ecdi s\u1ef1 gi\u00fap \u0111\u1ee1 v\u00e0 \u0111\u00f4i khi, b\u1ec7nh nh\u00e2n ho\u1eb7c ng\u01b0\u1eddi ch\u0103m s\u00f3c kh\u00f4ng nh\u1eadn bi\u1ebft \u0111\u01b0\u1ee3c d\u1ea5u hi\u1ec7u \u0111\u1ed9t qu\u1ef5…<\/span><\/p>\n

1.2. Kh\u00e1m l\u00e2m s\u00e0ng<\/span><\/b><\/p>\n

1.2.1. Kh\u00e1m to\u00e0n th\u00e2n v\u00e0 tim m\u1ea1ch<\/span><\/i><\/b><\/p>\n

M\u1ee5c ti\u00eau:<\/span><\/i><\/b><\/p>\n

– X\u00e1c nh\u1eadn c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 d\u1ea5u hi\u1ec7u \u0111\u1ed9t qu\u1ef5 (suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1ea7n kinh) tr\u00ean ng\u01b0\u1eddi b\u1ec7nh.<\/span><\/p>\n

– Ph\u00e2n bi\u1ec7t \u0111\u1ed9t qu\u1ef5 n\u00e3o v\u1edbi nh\u1eefng b\u1ec7nh c\u00f3 tri\u1ec7u ch\u1ee9ng gi\u1ed1ng \u0111\u1ed9t qu\u1ef5.<\/span><\/p>\n

– \u0110\u00e1nh gi\u00e1 ti\u1ebfn tri\u1ec3n c\u1ee7a \u0111\u1ed9t qu\u1ef5 v\u00e0 t\u00ecnh tr\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh.<\/span><\/p>\n

Kh\u00e1m l\u00e2m s\u00e0ng c\u1ea7n ch\u00fa \u00fd \u0111\u1eb7c bi\u1ec7t \u0111\u1ebfn c\u00e1c d\u1ea5u hi\u1ec7u ch\u1ea5n th\u01b0\u01a1ng, t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng v\u00f9ng \u0111\u1ea7u – c\u1ed5, d\u1ea5u hi\u1ec7u k\u00edch th\u00edch m\u00e0ng n\u00e3o. C\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng sau g\u1ee3i \u00fd nguy\u00ean nh\u00e2n tim m\u1ea1ch:<\/span><\/p>\n

– B\u1ec7nh l\u00fd \u0111\u00e1y m\u1eaft: b\u1ec7nh v\u00f5ng m\u1ea1c, t\u1eafc m\u1ea1ch, xu\u1ea5t huy\u1ebft.<\/span><\/p>\n

– Tim: lo\u1ea1n nh\u1ecbp ho\u00e0n to\u00e0n, ti\u1ebfng th\u1ed5i b\u1ea5t th\u01b0\u1eddng, ti\u1ebfng ng\u1ef1a phi.<\/span><\/p>\n

– M\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean: ti\u1ebfng th\u1ed5i ho\u1eb7c rung miu \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh, m\u1ea1ch quay ho\u1eb7c m\u1ea1ch \u0111\u00f9i b\u1eaft y\u1ebfu.<\/span><\/p>\n

– Kh\u00e1m to\u00e0n th\u00e2n:<\/span><\/p>\n

\u25cb Ki\u1ec3m tra \u0111\u01b0\u1eddng th\u1edf, nh\u1ecbp th\u1edf v\u00e0 tu\u1ea7n ho\u00e0n, c\u00e1c d\u1ea5u hi\u1ec7u sinh t\u1ed3n. Ch\u00fa \u00fd b\u1ea3o v\u1ec7 \u0111\u01b0\u1eddng th\u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb r\u1ed1i lo\u1ea1n \u00fd v\u00e0 ph\u1ea3n x\u1ea1 ho, nu\u1ed1t.<\/span><\/p>\n

\u25cb Huy\u1ebft \u00e1p: huy\u1ebft \u00e1p c\u00f3 th\u1ec3 t\u0103ng cao sau \u0111\u1ed9t qu\u1ef5 v\u00e0 ph\u1ea7n l\u1edbn huy\u1ebft \u00e1p s\u1ebd gi\u1ea3m d\u1ea7n v\u1ec1 m\u1ee9c n\u1ec1n.<\/span><\/p>\n

\u25cb \u0110\u1ea7u, m\u1eb7t, c\u1ed5: ki\u1ec3m tra \u0111\u1ec3 ph\u00e1t hi\u1ec7n ch\u1ea5n th\u01b0\u01a1ng.<\/span><\/p>\n

1.2.2. Kh\u00e1m th\u1ea7n kinh<\/span><\/i><\/b><\/p>\n

Th\u1ea7y thu\u1ed1c ph\u1ea3i \u0111\u00e1nh gi\u00e1 nhanh nh\u01b0ng c\u1ea7n ch\u00ednh x\u00e1c b\u1ec7nh nh\u00e2n nghi ng\u1edd \u0111\u1ed9t qu\u1ef5 \u0111\u1ec3 xem x\u00e9t \u0111i\u1ec1u tr\u1ecb ti\u00eau s\u1ee3i huy\u1ebft ho\u1eb7c h\u00fat huy\u1ebft kh\u1ed1i. M\u1ee5c \u0111\u00edch kh\u00e1m th\u1ea7n kinh nh\u1eb1m:<\/span><\/p>\n

– M\u1ed9t l\u1ea7n n\u1eefa x\u00e1c \u0111\u1ecbnh tri\u1ec7u ch\u1ee9ng \u0111\u1ed9t qu\u1ef5.<\/span><\/p>\n

– \u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 thi\u1ebfu h\u1ee5t th\u1ea7n kinh v\u00e0 theo d\u00f5i ti\u1ebfn tri\u1ec3n theo thang \u0111i\u1ec3m NIHSS [2].<\/span><\/p>\n

– Ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n v\u00e0 l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u1ed1i \u01b0u nh\u1ea5t<\/span><\/p>\n

C\u00e1c d\u1ea5u hi\u1ec7u c\u1ea7n \u0111\u00e1nh gi\u00e1 g\u1ed3m:<\/span><\/p>\n

– C\u00e1c d\u00e2y th\u1ea7n kinh s\u1ecd.<\/span><\/p>\n

– Ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng, c\u1ea3m gi\u00e1c.<\/span><\/p>\n

– Ch\u1ee9c n\u0103ng ti\u1ec3u n\u00e3o.<\/span><\/p>\n

– D\u00e1ng \u0111i.<\/span><\/p>\n

– Ng\u00f4n ng\u1eef: kh\u1ea3 n\u0103ng \u0111\u00e1p \u1ee9ng v\u00e0 nh\u1eadn th\u1ee9c.<\/span><\/p>\n

– \u00dd th\u1ee9c.<\/span><\/p>\n

Ngo\u00e0i ra c\u1ea7n \u0111\u00e1nh gi\u00e1 s\u1ecd n\u00e3o v\u00e0 c\u1ed9t s\u1ed1ng, t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng.<\/span><\/p>\n

Thang \u0111i\u1ec3m NIHSS (National Institutes of Health Stroke Scale) l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 h\u1eefu \u00edch l\u01b0\u1ee3ng gi\u00e1 m\u1ee9c \u0111\u1ed9 suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1ea7n kinh, g\u1ed3m 6 y\u1ebfu t\u1ed1 ch\u00ednh sau \u0111\u00e2y:<\/span><\/p>\n

– M\u1ee9c \u0111\u1ed9 \u00fd th\u1ee9c.<\/span><\/p>\n

– Th\u1ecb l\u1ef1c, th\u1ecb tr\u01b0\u1eddng.<\/span><\/p>\n

– Ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng.<\/span><\/p>\n

– C\u1ea3m gi\u00e1c v\u00e0 m\u1ee9c \u0111\u1ed9 ch\u00fa \u00fd.<\/span><\/p>\n

– Ch\u1ee9c n\u0103ng ti\u1ec3u n\u00e3o.<\/span><\/p>\n

– Ng\u00f4n ng\u1eef.<\/span><\/p>\n

T\u1ed5ng \u0111i\u1ec3m NIHSS l\u00e0 42 \u0111i\u1ec3m. B\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 nh\u1eb9 c\u00f3 \u0111i\u1ec3m NIHSS < 5 \u0111i\u1ec3m v\u00e0 n\u1eb7ng l\u00e0 tr\u00ean 24 \u0111i\u1ec3m.<\/span><\/p>\n

1.3. M\u1ed9t s\u1ed1 th\u1ec3 l\u00e2m s\u00e0ng \u0111\u1ecbnh khu<\/span><\/b><\/p>\n

\u00a0 – <\/span><\/i>Nh\u1ed3i m\u00e1u n\u00e3o \u0111\u1ed9ng m\u1ea1ch n\u00e3o gi\u1eefa<\/span><\/i><\/p>\n

\u00a0 – Nh\u1ed3i m\u00e1u n\u00e3o \u0111\u1ed9ng m\u1ea1ch n\u00e3o tr\u01b0\u1edbc<\/span><\/i><\/p>\n

\u00a0 – Nh\u1ed3i m\u00e1u n\u00e3o \u0111\u1ed9ng m\u1ea1ch n\u00e3o sau<\/span><\/i><\/p>\n

\u00a0 – Nh\u1ed3i m\u00e1u \u1ed5 khuy\u1ebft<\/span><\/i><\/p>\n

1.4. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd to\u00e0n th\u00e2n<\/span><\/b><\/p>\n

C\u00e1c tri\u1ec7u ch\u1ee9ng \u0111\u1ed9t qu\u1ef5 d\u1ec5 b\u1ecb nh\u1ea7m l\u1eabn tr\u00ean l\u00e2m s\u00e0ng v\u1edbi m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd to\u00e0n th\u00e2n.<\/span><\/p>\n

C\u00e1c tri\u1ec7u ch\u1ee9ng d\u1ec5 nh\u1ea7m l\u1eabn nh\u1ea5t v\u1edbi \u0111\u1ed9t qu\u1ef5 l\u00e0:<\/span><\/p>\n

– Co gi\u1eadt,<\/span><\/p>\n

– Nhi\u1ec5m khu\u1ea9n to\u00e0n th\u00e2n,<\/span><\/p>\n

– U n\u00e3o,<\/span><\/p>\n

– R\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a, r\u1ed1i lo\u1ea1n n\u01b0\u1edbc, \u0111i\u1ec7n gi\u1ea3i nh\u01b0 h\u1ea1 natri m\u00e1u, h\u1ea1 \u0111\u01b0\u1eddng m\u00e1u,<\/span><\/p>\n

– H\u1ed9i ch\u1ee9ng h\u1ed1 sau.<\/span><\/p>\n

1.5. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi xu\u1ea5t huy\u1ebft n\u00e3o<\/span><\/b><\/p>\n

M\u1eb7c d\u00f9 \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh c\u1ea7n ph\u1ea3i ch\u1ee5p c\u1eaft l\u1edbp s\u1ecd n\u00e3o, tuy nhi\u00ean tr\u00ean l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 ngh\u0129 \u0111\u1ebfn xu\u1ea5t huy\u1ebft n\u00e3o n\u1ebfu b\u1ec7nh nh\u00e2n:<\/span><\/p>\n

– H\u00f4n m\u00ea s\u00e2u,<\/span><\/p>\n

– G\u00e1y c\u1ee9ng,<\/span><\/p>\n

– Co gi\u1eadt,<\/span><\/p>\n

– Huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng > 110 mmHg,<\/span><\/p>\n

– N\u00f4n,<\/span><\/p>\n

– \u0110au \u0111\u1ea7u nhi\u1ec1u.<\/span><\/p>\n

1.6. \u0110\u1ed9t qu\u1ef5 tho\u00e1ng qua<\/span><\/b><\/p>\n

– C\u00f2n g\u1ecdi l\u00e0 c\u01a1n thi\u1ebfu m\u00e1u n\u00e3o tho\u00e1ng qua (TIA): suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1ea7n kinh c\u1ea5p t\u00ednh, t\u1ea1m th\u1eddi trong v\u00f2ng 24h m\u00e0 nguy\u00ean nh\u00e2n do thi\u1ebfu m\u00e1u m\u1ed9t v\u00f9ng n\u00e3o, t\u1ee7y s\u1ed1ng ho\u1eb7c h\u1ec7 th\u1ed1ng l\u01b0\u1edbi.<\/span><\/p>\n

– Kho\u1ea3ng 80% b\u1ec7nh nh\u00e2n TIA t\u1ef1 h\u1ed3i ph\u1ee5c trong 60 ph\u00fat, c\u01a1 ch\u1ebf g\u00e2y TIA t\u01b0\u01a1ng t\u1ef1 nh\u01b0 \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o.<\/span><\/p>\n

– Kho\u1ea3ng 10% b\u1ec7nh nh\u00e2n TIA s\u1ebd b\u1ecb \u0111\u1ed9t qu\u1ef5 n\u00e3o th\u1eadt s\u1ef1 trong th\u1eddi gian 90 ng\u00e0y, 50% trong s\u1ed1 \u0111\u00f3 \u0111\u1ed9t qu\u1ef5 n\u00e3o trong v\u00f2ng 2 ng\u00e0y.<\/span><\/p>\n

– Hi\u1ec7n nay, v\u1edbi s\u1ef1 ti\u1ebfn b\u1ed9 c\u1ee7a ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh v\u00e0 chuy\u00ean khoa th\u1ea7n kinh, nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p ch\u1ea9n \u0111o\u00e1n TIA nh\u01b0ng l\u1ea1i l\u00e0 \u0111\u1ed9t qu\u1ef5 n\u00e3o th\u1ef1c s\u1ef1 v\u1edbi c\u00e1c v\u00f9ng thi\u1ebfu m\u00e1u n\u00e3o tr\u00ean phim ch\u1ee5p. Do \u0111\u00f3, \u0111\u1ecbnh ngh\u0129a TIA d\u1ef1a tr\u00ean sinh l\u00fd b\u1ec7nh h\u01a1n l\u00e0 d\u1ef1a v\u00e0o th\u1eddi gian xu\u1ea5t hi\u1ec7n v\u00e0 ph\u1ee5c h\u1ed3i tri\u1ec7u ch\u1ee9ng.<\/span><\/a><\/p>\n

\"Minh-hoa-nhoi-mau-nao\"
Minh h\u1ecda Nh\u1ed3i m\u00e1u n\u00e3o<\/figcaption><\/figure>\n

2. C\u1eadn l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n nh\u1ed3i m\u00e1u n\u00e3o\u00a0<\/span><\/b><\/h2>\n

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

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

\u01afu \u0111i\u1ec3m:<\/span><\/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><\/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. 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

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

2.4. X\u00e9t nghi\u1ec7m m\u00e1u<\/span><\/b><\/p>\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

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

Xem th\u00eam: Nh\u1ed3i m\u00e1u n\u00e3o: Nh\u1eefng \u0111i\u1ec1u c\u1ea7n bi\u1ebft<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Nh\u1ed3i m\u00e1u n\u00e3o l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p \u1edf con ng\u01b0\u1eddi, g\u00e2y ra do t\u1eafc ngh\u1ebdn ho\u1eb7c r\u1ed1i lo\u1ea1n tu\u1ea7n ho\u00e0n m\u00e1u \u0111\u1ebfn n\u00e3o. \u0110\u00e2y l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 nghi\u00eam tr\u1ecdng v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra nh\u1eefng h\u1eadu qu\u1ea3 kh\u00f3 l\u01b0\u1eddng \u0111\u1ebfn s\u1ee9c kh\u1ecfe c\u1ee7a con ng\u01b0\u1eddi. Trong b\u00e0i vi\u1ebft n\u00e0y, ch\u00fang ta s\u1ebd […]<\/p>\n","protected":false},"author":26,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[10],"tags":[],"yoast_head":"\nNh\u1ed3i m\u00e1u n\u00e3o: Quy tr\u00ecnh ch\u1ea9n \u0111o\u00e1n - Vinmec<\/title>\n<meta name=\"description\" content=\"Nh\u1ed3i m\u00e1u n\u00e3o l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p \u1edf con ng\u01b0\u1eddi, g\u00e2y ra do t\u1eafc ngh\u1ebdn ho\u1eb7c r\u1ed1i lo\u1ea1n tu\u1ea7n ho\u00e0n m\u00e1u \u0111\u1ebfn n\u00e3o.\" \/>\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=\"Nh\u1ed3i m\u00e1u n\u00e3o: Quy tr\u00ecnh ch\u1ea9n \u0111o\u00e1n - Vinmec\" \/>\n<meta property=\"og:description\" content=\"Nh\u1ed3i m\u00e1u n\u00e3o l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p \u1edf con ng\u01b0\u1eddi, g\u00e2y ra do t\u1eafc ngh\u1ebdn ho\u1eb7c r\u1ed1i lo\u1ea1n tu\u1ea7n ho\u00e0n m\u00e1u \u0111\u1ebfn n\u00e3o.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/26\/nhoi-mau-nao-quy-trinh-chan-doan\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-26T09:28:18+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Nhoi-mau-nao-3-300x201.jpg\" \/>\n<meta name=\"author\" content=\"Duyet Vu Hong\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Duyet Vu Hong\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"10 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/26\/nhoi-mau-nao-quy-trinh-chan-doan\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/26\/nhoi-mau-nao-quy-trinh-chan-doan\/\",\"name\":\"Nh\u1ed3i m\u00e1u n\u00e3o: Quy tr\u00ecnh ch\u1ea9n \u0111o\u00e1n - 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