{"id":28175,"date":"2023-04-26T16:58:42","date_gmt":"2023-04-26T09:58:42","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28175"},"modified":"2023-04-26T16:58:42","modified_gmt":"2023-04-26T09:58:42","slug":"dieu-tri-dot-quy-nao-bang-phuong-phap-tieu-soi-huyet","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/26\/dieu-tri-dot-quy-nao-bang-phuong-phap-tieu-soi-huyet\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb \u0111\u1ed9t quy n\u00e3o b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p ti\u00eau s\u1ee3i huy\u1ebft (rt-PA)"},"content":{"rendered":"<p><strong>Thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft l\u00e0 m\u1ed9t h\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o c\u1ea5p t\u00ednh \u0111\u00f3ng vai tr\u00f2 quang tr\u1ecdng t\u1ea1i c\u00e1c trung t\u00e2m \u0111\u1ed9t qu\u1ef5 trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y \u0111\u00e3 m\u1edf ra ti\u00ean l\u01b0\u1ee3ng t\u1ed1t h\u01a1n cho nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o, gi\u00fap c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng, t\u1ef7 l\u00ea t\u1eed vong v\u00e0 di ch\u1ee9ng. Trong b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y, ch\u00fang ta h\u00e3y c\u00f9ng t\u00ecm hi\u1ec3u v\u1ec1 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u00e0y.<\/strong><\/p>\n<h2>1. Thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft l\u00e0 g\u00ec?<\/h2>\n<p><span lang=\"VI\">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).<\/span><\/p>\n<p><span lang=\"VI\">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.<\/span><\/p>\n<h2><b><span lang=\"VI\">2. Ti\u00eau chu\u1ea9n l\u1ef1a ch\u1ecdn b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb ti\u00eau s\u1ee3i huy\u1ebft<\/span><\/b><\/h2>\n<p><span lang=\"VI\">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:<\/span><\/p>\n<p><span lang=\"VI\">&#8211; 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<\/span><\/p>\n<p><span lang=\"VI\">&#8211; Kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng &lt; 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.<\/span><\/p>\n<p><span lang=\"VI\">&#8211; D\u1ea5u hi\u1ec7u th\u1ea7n kinh r\u00f5 r\u00e0ng<\/span><\/p>\n<p><span lang=\"VI\">&#8211; D\u1ea5u hi\u1ec7u th\u1ea7n kinh kh\u00f4ng k\u00edn \u0111\u00e1o v\u00e0 \u0111\u01a1n \u0111\u1ed9c<\/span><\/p>\n<p><span lang=\"VI\">&#8211; C\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00f4ng g\u1ee3i \u00fd xu\u1ea5t huy\u1ebft d\u01b0\u1edbi nh\u1ec7n<\/span><\/p>\n<p><span lang=\"VI\">&#8211; Kh\u00f4ng c\u00f3 ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ea7u ho\u1eb7c \u0111\u1ed9t qu\u1ef5 trong 3 th\u00e1ng v\u1eeba qua<\/span><\/p>\n<p><span lang=\"VI\">&#8211; Kh\u00f4ng b\u1ecb nh\u1ed3i m\u00e1u c\u01a1 tim trong 3 th\u00e1ng v\u1eeba qua<\/span><\/p>\n<p><span lang=\"VI\">&#8211; Kh\u00f4ng xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a, sinh d\u1ee5c trong 21 ng\u00e0y v\u1eeba qua<\/span><\/p>\n<p><span lang=\"VI\">&#8211; 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<\/span><\/p>\n<p><span lang=\"VI\">&#8211; Kh\u00f4ng tr\u1ea3i qua \u0111\u1ea1i ph\u1eabu thu\u1eadt trong 14 ng\u00e0y v\u1eeba qua<\/span><\/p>\n<p><span lang=\"VI\">&#8211; Kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed ch\u1ea3y m\u00e1u n\u1ed9i s\u1ecd<\/span><\/p>\n<p><span lang=\"VI\">&#8211; 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<\/span><\/p>\n<p><span lang=\"VI\">&#8211; 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<\/span><\/p>\n<p><span lang=\"VI\">&#8211; 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<\/span><\/p>\n<p><span lang=\"VI\">&#8211; 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<\/span><\/p>\n<p><span lang=\"VI\">&#8211; S\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u tr\u00ean 100.000 \/ L<\/span><\/p>\n<p><span lang=\"VI\">&#8211; \u0110\u01b0\u1eddng huy\u1ebft tr\u00ean 2,7 mmol\/L (&gt; 50 mg\/dL)<\/span><\/p>\n<p><span lang=\"VI\">&#8211; 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<\/span><\/p>\n<p><span lang=\"VI\">&#8211; 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.<\/span><\/p>\n<figure id=\"attachment_28177\" aria-describedby=\"caption-attachment-28177\" style=\"width: 270px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-full wp-image-28177\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Tieu-soi-huyet.jpg\" alt=\"Minh-hoa-thuoc-tieu-soi-huyet\" width=\"270\" height=\"187\" \/><figcaption id=\"caption-attachment-28177\" class=\"wp-caption-text\">Minh h\u1ecda thu\u00f4c ti\u00eau s\u1ee3i huy\u1ebft<\/figcaption><\/figure>\n<h2><b><span lang=\"VI\">3. Ti\u00eau chu\u1ea9n lo\u1ea1i tr\u1eeb<\/span><\/b><\/h2>\n<p><span lang=\"VI\">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.<\/span><\/p>\n<h2><b><span lang=\"VI\">4. Nguy c\u01a1 xu\u1ea5t huy\u1ebft<\/span><\/b><\/h2>\n<p><span lang=\"VI\">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.<\/span><\/p>\n<h2><b><span lang=\"VI\">5. Ph\u1ed1i h\u1ee3p si\u00eau \u00e2m tr\u1ecb li\u1ec7u<\/span><\/b><\/h2>\n<p><span lang=\"VI\">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. 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.<\/span><\/p>\n<h2>6. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u hi\u1ec7n t\u1ea1i v\u1ec1 hi\u1ec7u qu\u1ea3 rt-PA<\/h2>\n<ul>\n<li><span class=\"Y2IQFc\" lang=\"vi\">K\u1ec3 t\u1eeb khi xu\u1ea5t b\u1ea3n c\u00e1c h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o g\u1ea7n \u0111\u00e2y nh\u1ea5t v\u00e0o n\u0103m 2008, m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u \u0111\u00e3 \u0111\u01b0a ra ng\u00e0y c\u00e0ng nhi\u1ec1u t\u00e0i li\u1ec7u \u1ee7ng h\u1ed9 vi\u1ec7c s\u1eed d\u1ee5ng rtPA. <\/span><\/li>\n<li><span class=\"Y2IQFc\" lang=\"vi\">K\u1ebft qu\u1ea3 c\u1ee7a ECASS III v\u00e0 SITS-ISTR \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 v\u00e0o n\u0103m 2008, cung c\u1ea5p kh\u1ea3 n\u0103ng \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n m\u1edf r\u1ed9ng \u0111\u1ec3 s\u1eed d\u1ee5ng rtPA. Tuy nhi\u00ean, \u0111\u1ed1i v\u1edbi m\u1ed9t s\u1ed1 qu\u1ea7n th\u1ec3 b\u1ec7nh nh\u00e2n, vi\u1ec7c s\u1eed d\u1ee5ng rtPA t\u1eeb 3 \u0111\u1ebfn 4,5 gi\u1edd k\u1ec3 t\u1eeb khi kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng \u0111\u1ed9t qu\u1ef5 ch\u01b0a \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u v\u00e0 do \u0111\u00f3 hi\u1ec7n ch\u01b0a \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o. <\/span><\/li>\n<li><span class=\"Y2IQFc\" lang=\"vi\">C\u1ea3 t\u00e0i li\u1ec7u t\u1eeb tr\u01b0\u1edbc \u0111\u00f3 v\u00e0 hi\u1ec7n t\u1ea1i l\u00e0 k\u1ebft qu\u1ea3 d\u1eef li\u1ec7u \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 b\u1edfi Fonarow v\u00e0 c\u00e1c \u0111\u1ed3ng nghi\u1ec7p \u0111\u1ec1u x\u00e1c nh\u1eadn r\u1eb1ng k\u1ebft qu\u1ea3 v\u00e0 gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong t\u1ed1t h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n d\u00f9ng rtPA c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t sau khi kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng \u0111\u1ed9t qu\u1ef5. M\u1ed1c th\u1eddi gian \u226460 ph\u00fat \u1edf b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n \u0111\u1ed9t qu\u1ef5 \u0111\u00e3 t\u0103ng t\u1eeb 19,5% n\u0103m 2003 l\u00ean 29,1% n\u0103m 2009, t\u0103ng kho\u1ea3ng 1,6% m\u1ed7i n\u0103m. V\u1edbi nhi\u1ec1u trung t\u00e2m \u0111\u1ed9t qu\u1ef5 \u0111\u01b0\u1ee3c th\u00e0nh l\u1eadp v\u00e0 t\u1ea5t c\u1ea3 c\u00e1c trung t\u00e2m \u0111\u1ed9t qu\u1ef5 ti\u1ebfp t\u1ee5c t\u1eadp trung \u0111\u1ec3 \u0111\u00e1p \u1ee9ng m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb rtPA k\u1ecbp th\u1eddi, c\u00f3 kh\u1ea3 n\u0103ng hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9t qu\u1ef5 nh\u1ed3i m\u00e1u n\u00e3o s\u1ebd ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n trong nh\u1eefng n\u0103m t\u1edbi.<\/span><\/li>\n<\/ul>\n<p><strong>Ngu\u1ed3n t\u00e0i li\u1ec7u<\/strong>:<\/p>\n<p><span lang=\"VI\">1. H\u01af\u1edaNG D\u1eaaN CH\u1ea8N \u0110O\u00c1N V\u00c0 X\u1eec TR\u00cd \u0110\u1ed8T QU\u1ef4 N\u00c3O &#8211; B\u1ed9 Y t\u1ebf<\/span><\/p>\n<p>2. Pubmed: Recombinant tissue plasminogen activator for the treatment of acute ischemic stroke.<\/p>\n<p>Xem th\u00eam: <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/dieu-tri-nhoi-mau-nao-bang-thuoc-tieu-soi-huyet\/\">\u0110i\u1ec1u tr\u1ecb nh\u1ed3i m\u00e1u n\u00e3o b\u1eb1ng thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft l\u00e0 m\u1ed9t h\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o c\u1ea5p t\u00ednh \u0111\u00f3ng vai tr\u00f2 quang tr\u1ecdng t\u1ea1i c\u00e1c trung t\u00e2m \u0111\u1ed9t qu\u1ef5 trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y. 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