{"id":29719,"date":"2023-05-06T22:09:28","date_gmt":"2023-05-06T15:09:28","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29719"},"modified":"2023-05-06T22:09:28","modified_gmt":"2023-05-06T15:09:28","slug":"cat-lop-vi-tinh-tuoi-mau-nao-ap-dung-phan-mem-rapid-o-benh-nhan-nhoi-mau-nao","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/cat-lop-vi-tinh-tuoi-mau-nao-ap-dung-phan-mem-rapid-o-benh-nhan-nhoi-mau-nao\/","title":{"rendered":"\u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng, h\u00ecnh \u1ea3nh c\u1eaft l\u1edbp vi t\u00ednh t\u01b0\u1edbi m\u00e1u n\u00e3o \u00e1p d\u1ee5ng ph\u1ea7n m\u1ec1m Rapid \u1edf b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u n\u00e3o h\u1ec7 tu\u1ea7n ho\u00e0n n\u00e3o tr\u01b0\u1edbc"},"content":{"rendered":"

C\u1eaft l\u1edbp vi t\u00ednh t\u01b0\u1edbi m\u00e1u n\u00e3o \u00e1p d\u1ee5ng ph\u1ea7n m\u1ec1m Rapid<\/strong> l\u00e0 m\u1ed9t c\u00f4ng ngh\u1ec7 h\u00ecnh \u1ea3nh ti\u00ean ti\u1ebfn \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111\u00e1nh gi\u00e1 c\u00e1c b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn n\u00e3o. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y s\u1eed d\u1ee5ng m\u00e1y t\u00ednh \u0111\u1ec3 x\u1eed l\u00fd th\u00f4ng tin t\u1eeb c\u00e1c h\u00ecnh \u1ea3nh c\u1eaft l\u1edbp c\u1ee7a n\u00e3o, t\u1ea1o th\u00e0nh m\u1ed9t h\u00ecnh \u1ea3nh to\u00e0n di\u1ec7n v\u00e0 chi ti\u1ebft v\u1ec1 c\u1ea5u tr\u00fac v\u00e0 ch\u1ee9c n\u0103ng c\u1ee7a n\u00e3o. N\u00f3 cung c\u1ea5p cho c\u00e1c chuy\u00ean gia y t\u1ebf m\u1ed9t c\u00e1i nh\u00ecn to\u00e0n di\u1ec7n v\u1ec1 c\u00e1c t\u1ebf b\u00e0o, m\u1ea1ch m\u00e1u, v\u00e0 c\u00e1c b\u1ed9 ph\u1eadn kh\u00e1c trong n\u00e3o, gi\u00fap h\u1ecd c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn n\u00e3o m\u1ed9t c\u00e1ch ch\u00ednh x\u00e1c v\u00e0 hi\u1ec7u qu\u1ea3. Vi\u1ec7c s\u1eed d\u1ee5ng ph\u1ea7n m\u1ec1m Rapid c\u0169ng gi\u00fap cho qu\u00e1 tr\u00ecnh \u0111\u00e1nh gi\u00e1 v\u00e0 ch\u1ea9n \u0111o\u00e1n nhanh h\u01a1n, \u0111\u1ed3ng th\u1eddi cung c\u1ea5p \u0111\u1ed9 ch\u00ednh x\u00e1c cao h\u01a1n. T\u1eeb \u0111\u00f3, c\u00e1c b\u00e1c s\u0129 c\u00f3 th\u1ec3 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p v\u00e0 nhanh ch\u00f3ng h\u01a1n, gi\u00fap b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u n\u00e3o<\/a> h\u1ec7 tu\u1ea7n ho\u00e0n n\u00e3o tr\u01b0\u1edbc \u0111\u01b0\u1ee3c ch\u0103m s\u00f3c v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi \u0111\u1ec3 gi\u1ea3m thi\u1ec3u c\u00e1c bi\u1ebfn ch\u1ee9ng v\u00e0 t\u0103ng c\u01b0\u1eddng kh\u1ea3 n\u0103ng ph\u1ee5c h\u1ed3i.<\/p>\n

\"\u0110\u1eb7c
\u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng, h\u00ecnh \u1ea3nh c\u1eaft l\u1edbp vi t\u00ednh t\u01b0\u1edbi m\u00e1u n\u00e3o \u00e1p d\u1ee5ng ph\u1ea7n m\u1ec1m Rapid \u1edf b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u n\u00e3o h\u1ec7 tu\u1ea7n ho\u00e0n n\u00e3o tr\u01b0\u1edbc<\/figcaption><\/figure>\n

Ba\u0300i vi\u00ea\u0301t tri\u0301ch ngu\u00f4\u0300n t\u01b0\u0300 H\u00f4\u0323i th\u00e2\u0300n kinh ho\u0323c Vi\u00ea\u0323t Nam<\/em><\/p>\n

Ta\u0301c gia\u0309:<\/b><\/em><\/p>\n

Nguy\u1ec5n Huy Ng\u1ecdc 1, Nguy\u1ec5n Quang \u00c2n 2, \u0110\u1ed7 \u0110\u1ee9c Thu\u1ea7n 3<\/em>
\nS\u1edf Y t\u1ebf Ph\u00fa Th\u1ecd1<\/sup><\/em>
\nTr\u01b0\u1eddng Cao \u0111\u1eb3ng Y t\u1ebf Ph\u00fa Th\u1ecd2<\/sup><\/em>
\nB\u1ec7nh vi\u1ec7n Qu\u00e2n y 103\u00a03<\/sup><\/em><\/p>\n

T\u00d3M T\u1eaeT<\/strong><\/h2>\n

M\u1ee5c ti\u00eau: M\u00f4 t\u1ea3 \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng, h\u00ecnh \u1ea3nh c\u1eaft l\u1edbp vi t\u00ednh t\u01b0\u1edbi m\u00e1u n\u00e3o \u00e1p d\u1ee5ng ph\u1ea7n m\u1ec1m Rapid \u1edf b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u n\u00e3o h\u1ec7 tu\u1ea7n ho\u00e0n n\u00e3o tr\u01b0\u1edbc.
\n\u0110\u1ed1i t\u01b0\u1ee3ng v\u00e0 ph\u01b0\u01a1ng ph\u00e1p nghi\u00ean c\u1ee9u: G\u1ed3m 61 b\u1ec7nh nh\u00e2n Nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p \u0111\u1ebfn vi\u1ec7n trong c\u1eeda s\u1ed5 th\u1eddi gian 24 gi\u1edd k\u1ec3 t\u1eeb th\u1eddi \u0111i\u1ec3m kh\u1edfi ph\u00e1t t\u1ea1i Trung t\u00e2m \u0111\u1ed9t qu\u1ef5 \u2013 B\u1ec7nh vi\u1ec7n \u0110a khoa t\u1ec9nh Ph\u00fa Th\u1ecd, t\u1eeb th\u00e1ng 6 n\u0103m 2021 \u0111\u1ebfn th\u00e1ng 6 n\u0103m 2022. K\u1ebft qu\u1ea3: Ti\u1ec1n s\u1eed t\u0103ng huy\u1ebft \u00e1p 67,2%, \u0111\u1ed9t qu\u1ef5 n\u00e3o c\u0169 chi\u1ebfm 26,2%. \u0110i\u1ec3m Glasgow trung b\u00ecnh: 12,8 \u00b1 2,3 ml. Trung b\u00ecnh NIHSS: 14,1 \u00b1 5,8. Trung b\u00ecnh th\u1ec3 t\u00edch v\u00f9ng t\u1ed5n th\u01b0\u01a1ng cao nh\u1ea5t \u1edf nh\u00f3m kh\u00f4ng r\u00f5 th\u1eddi \u0111i\u1ec3m kh\u1edfi ph\u00e1t 73,8 \u00b1 9,2, trung b\u00ecnh th\u1ec3 t\u00edch v\u00f9ng tranh t\u1ed1i tranh s\u00e1ng l\u1edbn nh\u1ea5t \u1edf nh\u00f3m t\u1eafc \u0110M c\u1ea3nh: 65,3 \u00b1 19,9 ml.
\nK\u1ebft lu\u1eadn: Th\u1ec3 t\u00edch v\u00f9ng tranh t\u1ed1i tranh s\u00e1ng ph\u00e2n b\u1ed5 t\u01b0\u01a1ng \u0111\u1ed1i \u0111\u1ed3ng \u0111\u1ec1u \u1edf c\u00e1c nh\u00f3m tu\u1ed5i v\u00e0 \u1edf c\u00e1c nh\u00f3m th\u1eddi gian t\u1eeb l\u00fac kh\u1edfi ph\u00e1t \u0111\u1ebfn l\u00fac nh\u1eadp vi\u1ec7n kh\u00e1c nhau trong v\u00f2ng 24 gi\u1edd k\u1ec3 t\u1eeb khi kh\u1edfi ph\u00e1t. V\u1ecb tr\u00ed t\u1eafc m\u1ea1ch ngo\u00e0i s\u1ecd c\u00f3 th\u1ec3 t\u00edch v\u00f9ng t\u1ed5n th\u01b0\u01a1ng v\u00e0 th\u1ec3 t\u00edch v\u00f9ng tranh t\u1ed1i tranh s\u00e1ng l\u1edbn h\u01a1n so v\u1edbi t\u1eafc m\u1ea1ch n\u1ed9i s\u1ecd.
\nT\u1eeb kh\u00f3a: Nh\u1ed3i m\u00e1u n\u00e3o, c\u1eaft l\u1edbp vi t\u00ednh t\u01b0\u1edbi m\u00e1u n\u00e3o, ph\u1ea7n m\u1ec1m tr\u00ed tu\u1ec7 nh\u00e2n t\u1ea1o Rapid.<\/p>\n

1. \u0110\u1eb6T V\u1ea4N \u0110\u1ec0<\/strong><\/h2>\n

\u0110\u1ed9t qu\u1ef5 n\u00e3o l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y t\u1eed vong \u0111\u1ee9ng th\u1ee9 ba sau b\u1ec7nh tim m\u1ea1ch, ung th\u01b0; v\u00e0 l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u g\u00e2y t\u00e0n ph\u1ebf \u1edf Vi\u1ec7t Nam v\u00e0 tr\u00ean th\u1ebf gi\u1edbi, trong \u0111\u00f3 \u0111\u1ed9t qu\u1ef5 nh\u1ed3i m\u00e1u n\u00e3o (NMN) chi\u1ebfm ph\u1ea7n l\u1edbn v\u1edbi t\u1ef7 l\u1ec7 80% \u2013 85% [3]. Theo c\u00e1c nghi\u00ean c\u1ee9u \u01b0\u1edbc t\u00ednh t\u1ea1i Ch\u00e2u \u00c2u, t\u1ef7 l\u1ec7 n\u00e0y c\u00f3 xu h\u01b0\u1edbng s\u1ebd ti\u1ebfp t\u1ee5c t\u0103ng 3,718,785 ng\u01b0\u1eddi v\u00e0o n\u0103m 2015 l\u00ean 4,631,050 ng\u01b0\u1eddi v\u00e0o 2035, t\u0103ng g\u1ea7n 1 tri\u1ec7u ng\u01b0\u1eddi, t\u01b0\u01a1ng \u0111\u01b0\u01a1ng 25%, song song v\u1edbi \u0111\u00f3 d\u1ef1 ki\u1ebfn s\u1ed1 ca t\u1eed vong do \u0111\u1ed9t qu\u1ef5 s\u1ebd t\u0103ng 45% t\u1eeb 532,321 ng\u01b0\u1eddi n\u0103m 2015 l\u00ean 770,038 ng\u01b0\u1eddi n\u0103m 2035 [7]. Tr\u1ef1c ti\u1ebfp \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn gia \u0111\u00ecnh v\u00e0 x\u00e3 h\u1ed9i, l\u00e0 g\u00e1nh n\u1eb7ng v\u1ec1 s\u1ee9c kh\u1ecfe, kinh t\u1ebf v\u00e0 gi\u1ea3m \u0111\u00e1ng k\u1ec3 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng.
\nPhim CLVT t\u01b0\u1edbi m\u00e1u n\u00e3o \u00e1p d\u1ee5ng ph\u1ea7n m\u1ec1m Rapid cung c\u1ea5p th\u00eam nh\u1eefng ch\u1ec9 s\u1ed1 h\u00ecnh \u1ea3nh m\u1edbi \u0111\u00e1ng tin c\u1eady ph\u1ee5c v\u1ee5 ti\u00ean l\u01b0\u1ee3ng, \u0111i\u1ec1u tr\u1ecb v\u00e0 m\u1edf r\u1ed9ng c\u1eeda s\u1ed5 th\u1eddi gian can thi\u1ec7p \u0111\u1eb7c hi\u1ec7u \u0111\u1ed1i v\u1edbi \u0111\u1ed9t qu\u1ef5 nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p. T\u1eeb \u0111\u00f3 ch\u00fang t\u00f4i l\u00e0m nghi\u00ean c\u1ee9u n\u00e0y nh\u1eb1m m\u1ee5c ti\u00eau: \u201cM\u00f4 t\u1ea3 \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng, h\u00ecnh \u1ea3nh c\u1eaft l\u1edbp vi t\u00ednh t\u01b0\u1edbi m\u00e1u n\u00e3o \u00e1p d\u1ee5ng ph\u1ea7n m\u1ec1m Rapid \u1edf b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u n\u00e3o h\u1ec7 tu\u1ea7n ho\u00e0n n\u00e3o tr\u01b0\u1edbc\u201d.<\/p>\n

2. \u0110\u1ed0I T\u01af\u1ee2NG V\u00c0 PH\u01af\u01a0NG PH\u00c1P NGHI\u00caN C\u1ee8U<\/strong><\/h2>\n

2.1. \u0110\u1ed1i t\u01b0\u1ee3ng<\/strong><\/h3>\n

G\u1ed3m 61 b\u1ec7nh nh\u00e2n Nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p \u0111\u1ebfn vi\u1ec7n trong c\u1eeda s\u1ed5 th\u1eddi gian 24 gi\u1edd k\u1ec3 t\u1eeb th\u1eddi \u0111i\u1ec3m kh\u1edfi ph\u00e1t t\u1ea1i B\u1ec7nh vi\u1ec7n \u0110a khoa t\u1ec9nh Ph\u00fa Th\u1ecd, t\u1eeb th\u00e1ng 6 n\u0103m 2021 \u0111\u1ebfn th\u00e1ng 6 n\u0103m 2022, \u0111\u00e1p \u1ee9ng cao \u0111i\u1ec1u ki\u1ec7n ti\u00eau chu\u1ea9n ch\u1ecdn b\u1ec7nh nh\u00e2n:
\n+ Tu\u1ed5i \u2265 18.
\n+ \u0110i\u1ec3m mRS: 0-1 \u0111i\u1ec3m.
\n+ \u0110\u01b0\u1ee3c kh\u1ea3o s\u00e1t h\u00ecnh \u1ea3nh n\u00e3o, m\u1ea1ch n\u00e3o phim: CLVT s\u1ecd n\u00e3o; CTA; MRI m\u1ea1ch m\u00e1u n\u00e3o.
\n+ \u0110\u01b0\u1ee3c kh\u1ea3o s\u00e1t m\u1ed9t s\u1ed1 th\u00f4ng s\u1ed1 \u00e1p d\u1ee5ng ph\u1ea7n m\u1ec1m RAPID: Th\u1ec3 t\u00edch l\u00f5i nh\u1ed3i m\u00e1u; Th\u1ec3 t\u00edch v\u00f9ng t\u1ed5n th\u01b0\u01a1ng; Th\u1ec3 t\u00edch v\u00f9ng tranh t\u1ed1i tranh s\u00e1ng tr\u00ean phim c\u1eaft l\u1edbp vi t\u00ednh t\u01b0\u1edbi m\u00e1u n\u00e3o.
\n+ \u0110\u01b0\u1ee3c s\u1ef1 ch\u1ea5p thu\u1eadn c\u1ee7a BN ho\u1eb7c ng\u01b0\u1eddi \u0111\u1ea1i di\u1ec7n h\u1ee3p ph\u00e1p \u0111\u1ed3ng \u00fd tham gia nghi\u00ean c\u1ee9u.
\nLo\u1ea1i kh\u1ecfi nghi\u00ean c\u1ee9u khi c\u00f3 1 trong c\u00e1c ti\u00eau ch\u00ed
\n+ Suy gan, suy th\u1eadn n\u1eb7ng: Creatinine > 264 \u03bcmol\/L
\n+ Nh\u1ed3i m\u00e1u n\u00e3o do t\u1ed5n th\u01b0\u01a1ng h\u1ec7 m\u1ea1ch thu\u1ed9c tu\u1ea7n ho\u00e0n n\u00e3o sau.<\/p>\n

2.2. Ph\u01b0\u01a1ng ph\u00e1p nghi\u00ean c\u1ee9u<\/strong><\/h3>\n

2.2.1. Thi\u1ebft k\u1ebf nghi\u00ean c\u1ee9u<\/strong><\/h4>\n

Nghi\u00ean c\u1ee9u m\u00f4 t\u1ea3 c\u1eaft ngang.<\/p>\n

2.2.2. N\u1ed9i dung nghi\u00ean c\u1ee9u<\/strong><\/h4>\n

\u0110\u00e1nh gi\u00e1 c\u00e1c s\u1ed1 li\u1ec7u thu \u0111\u01b0\u1ee3c d\u1ef1a v\u00e0o c\u00e1c ti\u00eau chu\u1ea9n sau:
\n\u2013 \u0110\u00e1nh gi\u00e1 c\u00e1c ti\u00eau chu\u1ea9n l\u00e2m s\u00e0ng:
\n+ C\u00e1c tri\u1ec7u ch\u1ee9ng \u0111\u1ed9t qu\u1ef5 n\u00e3o.
\n+ \u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a \u0111\u1ed9t qu\u1ef5 n\u00e3o theo thang \u0111i\u1ec3m NIHSS.
\n+ \u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 li\u1ec7t theo thang \u0111i\u1ec3m s\u1ee9c c\u01a1 MRC.
\n+ \u0110\u00e1nh gi\u00e1 r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c theo thang \u0111i\u1ec3m Glasgow.
\n\u2013 \u0110\u00e1nh gi\u00e1 c\u00e1c ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh CLVT t\u01b0\u1edbi m\u00e1u n\u00e3o \u00e1p d\u1ee5ng ph\u1ea7n m\u1ec1m RAPID.
\n+ \u0110\u00e1nh gi\u00e1 th\u1ec3 t\u00edch v\u00f9ng l\u00f5i nh\u1ed3i m\u00e1u:
\nV (CBF < 30%) (ml)
\n+ Th\u1ec3 t\u00edch v\u00f9ng t\u1ed5n th\u01b0\u01a1ng: V (Tmax>6s) (ml).
\n+ Th\u1ec3 t\u00edch v\u00f9ng Mismatch = V (CBF < 30%) \u2013 V (Tmax > 6s) (ml).<\/p>\n

2.3. X\u1eed l\u00fd s\u1ed1 li\u1ec7u<\/strong><\/h3>\n

X\u1eed l\u00fd s\u1ed1 li\u1ec7u tr\u00ean ph\u1ea7n m\u1ec1m SPSS 22.0 bao g\u1ed3m: Th\u1ed1ng k\u00ea m\u00f4 t\u1ea3 chung c\u00e1c bi\u1ebfn s\u1ed1 nghi\u00ean c\u1ee9u. C\u00e1c bi\u1ebfn \u0111\u1ecbnh t\u00ednh \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 b\u1eb1ng t\u1ea7n su\u1ea5t v\u00e0 t\u1ef7 l\u1ec7 ph\u1ea7n tr\u0103m (%).<\/p>\n

3. K\u1ebft qu\u1ea3 v\u1ec1 c\u1eaft l\u1edbp vi t\u00ednh t\u01b0\u1edbi m\u00e1u n\u00e3o \u00e1p d\u1ee5ng ph\u1ea7n m\u1ec1m Rapid \u1edf b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u n\u00e3o h\u1ec7 tu\u1ea7n ho\u00e0n tr\u01b0\u1edbc<\/strong><\/h2>\n

3.1. \u0110\u1eb7c \u0111i\u1ec3m chung c\u1ee7a nh\u00f3m NC<\/strong><\/h3>\n

\"\"<\/a><\/p>\n

Bi\u1ec3u \u0111\u1ed3 1. Gi\u1edbi t\u00ednh<\/p>\n

S\u1ed1 b\u1ec7nh nh\u00e2n nam nhi\u1ec1u h\u01a1n n\u1eef, t\u1ef7 l\u1ec7 nam\/n\u1eef = 1,3\/1. Trong \u0111\u00f3 nam gi\u1edbi chi\u1ebfm 57,4%, n\u1eef gi\u1edbi chi\u1ebfm 42,6%.<\/p>\n

\"\"<\/a><\/p>\n

Bi\u1ec3u \u0111\u1ed3 2. \u0110\u1eb7c \u0111i\u1ec3m c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1<\/p>\n

Ti\u1ec1n s\u1eed THA (67,2%), rung nh\u0129 (14,8%), ti\u1ec1n s\u1eed NMN c\u0169 chi\u1ebfm 26,2%.<\/p>\n

3.2. \u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng<\/strong><\/h3>\n

B\u1ea3ng 1. \u0110i\u1ec3m Glasgow khi nh\u1eadp vi\u1ec7n<\/em><\/p>\n\n\n\n\n\n\n\n\n
Nh\u00f3m<\/strong><\/p>\n

\u0110i\u1ec3m Glasgow<\/strong><\/td>\n

S\u1ed1 b\u1ec7nh nh\u00e2n<\/strong><\/p>\n

(n=61)<\/strong><\/td>\n

T\u1ef7 l\u1ec7<\/strong><\/p>\n

(%)<\/strong><\/td>\n<\/tr>\n

13 \u2013 15<\/td>\n33<\/td>\n54,1<\/td>\n<\/tr>\n
9 \u2013 12<\/td>\n25<\/td>\n41<\/td>\n<\/tr>\n
6 \u2013 8<\/td>\n3<\/td>\n4,9<\/td>\n<\/tr>\n
3 \u2013 5<\/td>\n0<\/td>\n0<\/td>\n<\/tr>\n
\u0110i\u1ec3m Glasgow trung b\u00ecnh: 12,8 \u00b1 2,3<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

S\u1ed1 l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec3m Glasgow 13-15 c\u00f3 t\u1ef7 l\u1ec7 cao nh\u1ea5t chi\u1ebfm 51,1%.<\/p>\n

B\u1ea3ng 2. \u0110i\u1ec3m NIHSS khi nh\u1eadp vi\u1ec7n<\/em><\/p>\n\n\n\n\n\n\n\n\n
Nh\u00f3m \u0110i\u1ec3m NIHSS<\/strong><\/td>\nS\u1ed1 b\u1ec7nh nh\u00e2n<\/strong><\/p>\n

(n=61)<\/strong><\/td>\n

T\u1ef7 l\u1ec7<\/strong><\/p>\n

(%)<\/strong><\/td>\n<\/tr>\n

Nh\u00f3m NIHSS<\/td>\n\u2264 5<\/td>\n7<\/td>\n11,5<\/td>\n<\/tr>\n
6 \u2013 15<\/td>\n27<\/td>\n44,3<\/td>\n<\/tr>\n
16 \u2013 20<\/td>\n18<\/td>\n29,5<\/td>\n<\/tr>\n
21 \u2013 42<\/td>\n9<\/td>\n14,8<\/td>\n<\/tr>\n
Trung b\u00ecnh<\/td>\n14,1 \u00b1 5,8<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

C\u00f3 27 b\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec3m NIHSS t\u1eeb 6 \u2013 15 chi\u1ebfm 44,3%, nh\u00f3m \u0111i\u1ec3m NIHSS t\u1eeb 16 \u2013 20 chi\u1ebfm 29,5%.<\/p>\n

B\u1ea3ng 3. Ph\u00e2n lo\u1ea1i s\u1ee9c c\u01a1 khi nh\u1eadp vi\u1ec7n<\/em><\/p>\n\n\n\n\n\n\n\n\n\n
Nh\u00f3m<\/strong><\/p>\n

S\u01b0\u0301c c\u01a1 \u2013 MRC<\/strong><\/td>\n

S\u1ee9c c\u01a1 tay<\/strong><\/p>\n

n (%)<\/strong><\/td>\n

S\u1ee9c c\u01a1 ch\u00e2n<\/strong><\/p>\n

n (%)<\/strong><\/td>\n<\/tr>\n

0<\/td>\n24 (39,3)<\/td>\n19 (31,1)<\/td>\n<\/tr>\n
1<\/td>\n19 (31,1)<\/td>\n17 (27,9)<\/td>\n<\/tr>\n
2<\/td>\n4 (6,6)<\/td>\n4 (6,6)<\/td>\n<\/tr>\n
3<\/td>\n8 (13,1)<\/td>\n13 (21,3)<\/td>\n<\/tr>\n
4<\/td>\n5 (8,2)<\/td>\n7 (11,5)<\/td>\n<\/tr>\n
5<\/td>\n1 (1,6)<\/td>\n1 (1,6)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\u0110\u1ed1i v\u1edbi s\u1ee9c c\u01a1 tay, MRC = 0 chi\u1ebfm 39,3%, MRC = 1 chi\u1ebfm 31,1. \u0110\u1ed1i v\u1edbi s\u1ee9c c\u01a1 ch\u00e2n, MRC = 0 chi\u1ebfm 31,1%.<\/p>\n

3.3. \u0110\u1eb7c \u0111i\u1ec3m h\u00ecnh \u1ea3nh c\u1eaft l\u1edbp vi t\u00ednh t\u01b0\u1edbi m\u00e1u n\u00e3o \u00e1p d\u1ee5ng ph\u1ea7n m\u1ec1m RAPID<\/strong><\/h3>\n

Bi\u1ec3u \u0111\u1ed3 3. \u0110\u1eb7c \u0111i\u1ec3m th\u1ec3 t\u00edch v\u00f9ng tranh t\u1ed1i\u00a0<\/em>tranh s\u00e1ng theo tu\u1ed5i<\/em><\/p>\n

\"\"<\/a><\/p>\n\n\n\n
Nh\u00f3m tu\u1ed5i<\/td>\n< 40<\/td>\n40 \u2013 59<\/td>\n60 \u2013 79<\/td>\n\u2265 80<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Th\u1ec3 t\u00edch v\u00f9ng tranh t\u1ed1i tranh s\u00e1ng ph\u00e2n b\u1ed5 t\u01b0\u01a1ng \u0111\u1ed1i \u0111\u1ed3ng \u0111\u1ec1u \u1edf c\u00e1c nh\u00f3m tu\u1ed5i kh\u00e1c nhau.<\/p>\n

B\u1ea3ng 4. Th\u1ec3 t\u00edch v\u00f9ng l\u00f5i nh\u1ed3i m\u00e1u \u1edf c\u00e1c nh\u00f3m c\u1eeda s\u1ed5 th\u1eddi gian nh\u1eadp vi\u1ec7n<\/em><\/p>\n\n\n\n\n\n\n\n\n
Nh\u00f3m th\u1eddi gian t\u1eeb l\u00fac kh\u1edfi ph\u00e1t \u0111\u1ebfn l\u00fac nh\u1eadp vi\u1ec7n<\/strong><\/td>\nTrung b\u00ecnh th\u1ec3 t\u00edch\u00a0<\/strong>v\u00f9ng l\u00f5i nh\u1ed3i m\u00e1u (ml)<\/strong><\/p>\n

(CBF < 30%)<\/strong><\/td>\n<\/tr>\n

< 6 gi\u1edd (n = 17)<\/td>\n27,3 \u00b1 6,9<\/td>\n<\/tr>\n
6 \u2013 11 gi\u1edd (n = 13)<\/td>\n33 \u00b1 11,7<\/td>\n<\/tr>\n
12 -17 gi\u1edd (n = 3)<\/td>\n16 \u00b1 9,2<\/td>\n<\/tr>\n
18- 24 gi\u1edd (n = 3)<\/td>\n1,3 \u00b1 1,3<\/td>\n<\/tr>\n
Kh\u00f4ng r\u00f5 th\u1eddi gian kh\u1edfi ph\u00e1t (n=25)<\/td>\n28,6 \u00b1 7,3<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Trung b\u00ecnh th\u1ec3 t\u00edch v\u00f9ng l\u00f5i nh\u1ed3i m\u00e1u \u1edf nh\u00f3m khung 6-24 gi\u1edd v\u00e0 nh\u00f3m kh\u00f4ng r\u00f5 th\u1eddi \u0111i\u1ec3m kh\u1edfi ph\u00e1t t\u01b0\u01a1ng \u0111\u1ed3ng so v\u1edbi nh\u00f3m \u0111\u1ebfn trong c\u1ee7a s\u1ed5 th\u1eddi gian < 6 gi\u1edd.<\/p>\n

B\u1ea3ng 5. Th\u1ec3 t\u00edch\u00a0<\/em>V\u00f9ng t\u1ed5n th\u01b0\u01a1ng<\/em>\u00a0\u1edf c\u00e1c nh\u00f3m c\u1eeda s\u1ed5 th\u1eddi gian nh\u1eadp vi\u1ec7n<\/em><\/p>\n\n\n\n\n\n\n\n\n\n
Nh\u00f3m th\u1eddi gian t\u1eeb l\u00fac kh\u1edfi ph\u00e1t \u0111\u1ebfn l\u00fac nh\u1eadp vi\u1ec7n<\/strong><\/td>\nTrung b\u00ecnh th\u1ec3 t\u00edch\u00a0<\/strong>v\u00f9ng t\u1ed5n th\u01b0\u01a1ng (ml)<\/strong><\/p>\n

(Tmax > 6s)<\/strong><\/td>\n<\/tr>\n<\/thead>\n

< 6 gi\u1edd (n = 17)<\/td>\n67 \u00b1 8<\/td>\n<\/tr>\n
6 \u2013 11 gi\u1edd (n = 13)<\/td>\n53,6 \u00b1 13,1<\/td>\n<\/tr>\n
12 -17 gi\u1edd (n = 3)<\/td>\n65,3 \u00b1 28,2<\/td>\n<\/tr>\n
18- 24 gi\u1edd (n = 3)<\/td>\n35,6 \u00b1 19,7<\/td>\n<\/tr>\n
Kh\u00f4ng r\u00f5 th\u1eddi gian kh\u1edfi ph\u00e1t (n=25)<\/td>\n73,8 \u00b1 9,2<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Trung b\u00ecnh th\u1ec3 t\u00edch v\u00f9ng t\u1ed5n th\u01b0\u01a1ng cao nh\u1ea5t \u1edf nh\u00f3m kh\u00f4ng r\u00f5 th\u1eddi \u0111i\u1ec3m kh\u1edfi ph\u00e1t 73,8 \u00b1 9,2.<\/p>\n

B\u1ea3ng 6. Th\u1ec3 t\u00edch V\u00f9ng t\u1ed5n th\u01b0\u01a1ng \u1edf c\u00e1c nh\u00f3m c\u1eeda s\u1ed5 th\u1eddi gian nh\u1eadp vi\u1ec7n<\/em><\/p>\n\n\n\n\n\n\n\n\n
Nh\u00f3m th\u1eddi gian t\u1eeb l\u00fac kh\u1edfi ph\u00e1t \u0111\u1ebfn l\u00fac nh\u1eadp vi\u1ec7n<\/strong><\/td>\nTrung b\u00ecnh th\u1ec3 t\u00edch\u00a0<\/strong>v\u00f9ng tranh t\u1ed1i tranh s\u00e1ng (ml) (Mismacth)<\/strong><\/td>\n<\/tr>\n
< 6 gi\u1edd (n = 17)<\/td>\n39,6 \u00b1 8,3<\/td>\n<\/tr>\n
6 \u2013 11 gi\u1edd (n = 13)<\/td>\n20,6 \u00b1 4,7<\/td>\n<\/tr>\n
12 -17 gi\u1edd (n = 3)<\/td>\n49,3 \u00b1 19,3<\/td>\n<\/tr>\n
18- 24 gi\u1edd (n = 3)<\/td>\n34,3 \u00b1 18,6<\/td>\n<\/tr>\n
Kh\u00f4ng r\u00f5 th\u1eddi gian kh\u1edfi ph\u00e1t<\/p>\n

(n=25)<\/td>\n

44,9 \u00b1 8,6<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Th\u1ec3 t\u00edch v\u00f9ng tranh t\u1ed1i tranh s\u00e1ng t\u1ed3n t\u1ea1i \u1edf t\u1ea5t c\u1ea3 c\u00e1c nh\u00f3m th\u1eddi gian, v\u00e0 ph\u00e2n b\u1ed5 t\u01b0\u01a1ng \u0111\u1ed1i \u0111\u1ed3ng \u0111\u1ec1u \u1edf c\u00e1c nh\u00f3m.<\/p>\n

B\u1ea3ng 7. Th\u1ec3 t\u00edch v\u00f9ng tranh t\u1ed1i tranh s\u00e1ng v\u00e0 th\u1ec3 t\u00edch v\u00f9ng t\u1ed5n th\u01b0\u01a1ng theo v\u1ecb tr\u00ed t\u1eafc m\u1ea1ch<\/em><\/p>\n\n\n\n\n\n\n\n\n
V\u1ecb tr\u00ed t\u1eafc m\u1ea1ch<\/strong><\/td>\nTrung b\u00ecnh th\u1ec3 t\u00edch<\/strong><\/p>\n

v\u00f9ng tranh t\u1ed1i tranh s\u00e1ng (ml)<\/strong><\/p>\n

(mismacth)<\/strong><\/td>\n

Trung b\u00ecnh th\u1ec3 t\u00edch<\/strong><\/p>\n

v\u00f9ng t\u1ed5n th\u01b0\u01a1ng (ml)<\/strong><\/p>\n

(Tmax > 6s)<\/strong><\/td>\n

T\u1ef7 l\u1ec7 V<\/strong><\/p>\n

(mismacth)\/V<\/strong><\/p>\n

(Tmax > 6s) (%)<\/strong><\/td>\n<\/tr>\n

\u0110\u1ed9ng m\u1ea1ch c\u1ea3nh (n = 9)<\/td>\n65,3 \u00b1 19,9<\/td>\n80 \u00b1 16<\/td>\n81,6<\/td>\n<\/tr>\n
\u0110M c\u1ea3nh trong \u0111o\u1ea1n n\u1ed9i s\u1ecd<\/p>\n

(n = 8)<\/td>\n

26,8 \u00b1 5,5<\/td>\n58,6 \u00b1 14,1<\/td>\n45,7<\/td>\n<\/tr>\n
\u0110M c\u1ea3nh trong \u0111o\u1ea1n ngo\u00e0i s\u1ecd (n = 10)<\/td>\n63,4 \u00b1 19,4<\/td>\n100,7 \u00b1 17,7<\/td>\n63,4<\/td>\n<\/tr>\n
M1 \u0110M n\u00e3o gi\u1eefa (n = 25)<\/td>\n34,4 \u00b1 4,8<\/td>\n62,2 \u00b1 6,2<\/td>\n55,3<\/td>\n<\/tr>\n
M2 \u0110M n\u00e3o gi\u1eefa (n = 9)<\/td>\n15,6 \u00b1 4,05<\/td>\n19,6 \u00b1 2,4<\/td>\n79,5<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

V\u1ecb tr\u00ed t\u1eafc m\u1ea1ch ngo\u00e0i s\u1ecd c\u00f3 th\u1ec3 t\u00edch v\u00f9ng t\u1ed5n th\u01b0\u01a1ng v\u00e0 th\u1ec3 t\u00edch v\u00f9ng tranh t\u1ed1i tranh s\u00e1ng l\u1edbn h\u01a1n so v\u1edbi t\u1eafc m\u1ea1ch n\u1ed9i s\u1ecd, trung b\u00ecnh th\u1ec3 t\u00edch v\u00f9ng tranh t\u1ed1i tranh s\u00e1ng nh\u1ecf nh\u1ea5t khi t\u1eafc \u1edf v\u1ecb tr\u00ed M2 \u0110M n\u00e3o gi\u1eefa 15,6 \u00b1 4,05.<\/p>\n

4. B\u00e0n lu\u1eadn v\u1ec1 \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng khi s\u1eed d\u1ee5ng c\u1eaft l\u1edbp vi t\u00ednh t\u01b0\u1edbi m\u00e1u n\u00e3o \u00e1p d\u1ee5ng ph\u1ea7n m\u1ec1m Rapid \u1edf b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u n\u00e3o h\u1ec7 tu\u1ea7n ho\u00e0n tr\u01b0\u1edbc<\/strong><\/h2>\n

4.1. \u0110\u1eb7c \u0111i\u1ec3m chung c\u1ee7a nghi\u00ean c\u1ee9u<\/strong><\/h3>\n

\u0110\u1eb7c \u0111i\u1ec3m v\u1ec1 gi\u1edbi trong nghi\u00ean c\u1ee9u c\u1ee7a t\u00f4i c\u0169ng t\u01b0\u01a1ng \u0111\u1ed3ng v\u1edbi c\u00e1c nghi\u00ean c\u1ee9u kh\u00e1c t\u1ea1i Vi\u1ec7t Nam. t\u1ef7 l\u1ec7 nam\/n\u1eef = 1,3\/1. Trong \u0111\u00f3 nam gi\u1edbi chi\u1ebfm 57,4%, n\u1eef gi\u1edbi chi\u1ebfm 42,6%.
\n\u0110\u1eb7c \u0111i\u1ec3m v\u1ec1 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1, V\u1ec1 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 g\u00e2y \u0111\u1ed9t qu\u1ef5 nh\u1ed3i m\u00e1u n\u00e3o hay ti\u1ec1n s\u1eed b\u1ec7nh cho th\u1ea5y, ti\u1ec1n s\u1eed b\u1ec7nh l\u00fd g\u1eb7p nhi\u1ec1u nh\u1ea5t l\u00e0 t\u0103ng huy\u1ebft \u00e1p (67,2%) v\u00e0 rung nh\u0129 (14,8). Trong nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i s\u1ed1 b\u1ec7nh nh\u00e2n ti\u1ec1n s\u1eed nh\u1ed3i m\u00e1u n\u00e3o c\u0169 chi\u1ebfm t\u1ef7 l\u1ec7 cao th\u1ee9 2 v\u1edbi 26,2%. T\u1ef7 l\u1ec7 n\u00e0y cao h\u01a1n so v\u1edbi NC kh\u00e1c nh\u01b0 c\u1ee7a \u0110\u00e0o Vi\u1ec7t Ph\u01b0\u01a1ng l\u00e0 4,7%; C\u0169ng c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch do trong nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i c\u00f3 nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p s\u1eed d\u1ee5ng phim ch\u1ee5p CTP v\u00e0 ph\u1ea7n m\u1ec1m RAPID v\u1edbi m\u1ee5c \u0111\u00edch \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng t\u1eafc m\u1ea1ch m\u1ea1n t\u00ednh hay c\u1ea5p t\u00ednh, v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u1eafc m\u1ea1ch n\u00e3o m\u1ea1n t\u00ednh v\u1edbi v\u00f9ng Mismacth nh\u1ecf s\u1ebd kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh can thi\u1ec7p l\u1ea5y huy\u1ebft kh\u1ed1i b\u1eb1ng d\u1ee5ng c\u1ee5 c\u01a1 h\u1ecdc [5].<\/p>\n

4.2. \u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng<\/strong><\/h3>\n

\u0110i\u1ec3m Glasgow: R\u1ed1i lo\u1ea1n \u00fd th\u1ee9c l\u00e0 bi\u1ec3u hi\u1ec7n th\u01b0\u1eddng g\u1eb7p trong \u0111\u1ed9t qu\u1ef5 n\u00e3o c\u1ea5p, \u0111\u1eb7c bi\u1ec7t \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 t\u1eafc m\u1ea1ch l\u1edbn v\u00e0 t\u1ed5n th\u01b0\u01a1ng di\u1ec7n r\u1ed9ng ho\u1eb7c c\u00f3 t\u1ed5n th\u01b0\u01a1ng h\u1ec7 tu\u1ea7n ho\u00e0n n\u00e3o sau. Trong nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i t\u1eadp trung v\u00e0o nghi\u00ean c\u1ee9u b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 c\u00f3 t\u1ed5n th\u01b0\u01a1ng h\u1ec7 tu\u1ea7n ho\u00e0n n\u00e3o tr\u01b0\u1edbc. K\u1ebft qu\u1ea3 cho th\u1ea5y c\u00f3 54,1% b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c ho\u1eb7c r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c nh\u1eb9, 41% b\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c m\u1ee9c \u0111\u1ed9 trung b\u00ecnh v\u1edbi \u0111i\u1ec3m Glasgow 9-12.
\nTrong nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i c\u00f3 27 b\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec3m NIHSS t\u1eeb 6 \u2013 15 chi\u1ebfm 44,3%, nh\u00f3m \u0111i\u1ec3m NIHSS t\u1eeb 16 \u2013 20 chi\u1ebfm 29,5%. B\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec3m l\u00e2m s\u00e0ng nh\u1eb9 v\u1edbi NIHSS \u2264 5 chi\u1ebfm 11,5%. Trong c\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 can thi\u1ec7p m\u1ea1ch n\u00e3o nh\u01b0 EXTEND-IA hay MR CLEAN ti\u00eau chu\u1ea9n \u0111i\u1ec3m NIHSS \u0111\u01b0\u1ee3c m\u1edf r\u1ed9ng h\u01a1n \u1edf c\u1ea3 nh\u00f3m c\u00f3 NIHSS < 6 \u0111i\u1ec3m [6], [2]. V\u1ea5n \u0111\u1ec1 n\u00e0y hi\u1ec7n nay c\u00f2n nhi\u1ec1u tranh c\u00e3i, tuy nhi\u00ean tr\u00ean l\u00e2m s\u00e0ng c\u0169ng c\u00f3 nhi\u1ec1u b\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec3m NIHSS t\u0103ng d\u1ea7n theo th\u1eddi gian, v\u00e0 vi\u1ec7c l\u1ef1a ch\u1ecdn th\u1eddi \u0111i\u1ec3m can thi\u1ec7p \u1edf c\u1eeda s\u1ed5 m\u1edf r\u1ed9ng 6-24 gi\u1edd s\u1ebd c\u0103n c\u1ee9 v\u00e0o \u0111i\u1ec3m NIHSS t\u1ea1i th\u1eddi \u0111i\u1ec3m \u0111\u00e1nh gi\u00e1 can thi\u1ec7p v\u00e0 ch\u1ee5p phim CTP \u0111\u00e1nh gi\u00e1 v\u0169ng l\u00f5i v\u00e0 v\u00f9ng tranh t\u1ed1i tranh s\u00e1ng ch\u1ee9 kh\u00f4ng ch\u1ec9 c\u0103n c\u1ee9 v\u00e0o \u0111i\u1ec3m NIHSS t\u1ea1i th\u1eddi \u0111i\u1ec3m v\u00e0o vi\u1ec7n.
\n\u0110a ph\u1ea7n b\u1ec7nh nh\u00e2n \u1edf nh\u00f3m nghi\u00ean c\u1ee9u c\u00f3 li\u1ec7t n\u1eb7ng v\u1edbi s\u1ee9c c\u01a1 tay v\u00e0 ch\u00e2n 0, 1 chi\u1ebfm t\u1ef7 l\u1ec7 nhi\u1ec1u nh\u1ea5t. \u0110\u1ed1i v\u1edbi s\u1ee9c c\u01a1 tay, MRC = 0 chi\u1ebfm 39,3%, MRC = 1 chi\u1ebfm 31,1%; c\u00e1c thang \u0111i\u1ec3m c\u00f2n l\u1ea1i chi\u1ebfm t\u1ef7 l\u1ec7 \u00edt h\u01a1n. \u0110\u1ed1i v\u1edbi s\u1ee9c c\u01a1 ch\u00e2n, MRC = 0 chi\u1ebfm 31,1%, MRC = 1 chi\u1ebfm 27,9%. \u0110\u00e2y l\u00e0 thang \u0111i\u1ec3m quan tr\u1ecdng \u0111\u1ec3 t\u1eadp trung \u0111i\u1ec1u tr\u1ecb c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng c\u0169ng nh\u01b0 theo d\u00f5i v\u00e0 \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n

4.3. \u0110\u1eb7c \u0111i\u1ec3m h\u00ecnh \u1ea3nh c\u1eaft l\u1edbp vi t\u00ednh t\u01b0\u1edbi m\u00e1u n\u00e3o \u00e1p d\u1ee5ng ph\u1ea7n m\u1ec1m Rapid<\/strong><\/h3>\n

Trong nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i, tu\u1ed5i kh\u00f4ng ph\u1ea3i l\u00e0 y\u1ebfu t\u1ed1 t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn s\u1ef1 t\u1ed3n t\u1ea1i th\u1ec3 t\u00edch v\u00f9ng tranh t\u1ed1i tranh s\u00e1ng, th\u1ec3 t\u00edch n\u00e0y ph\u00e2n b\u1ed1 t\u01b0\u01a1ng \u0111\u1ed1i \u0111\u1ed3ng \u0111\u1ec1u \u1edf c\u00e1c nh\u00f3m tu\u1ed5i. Ri\u00eang \u1edf nh\u00f3m \u2265 80 tu\u1ed5i th\u00f4ng s\u1ed1 v\u1ec1 th\u1ec3 t\u00edch v\u00f9ng tranh t\u1ed1i tranh s\u00e1ng c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong \u0111\u00e1nh gi\u00e1 l\u1ee3i \u00edch\/nguy c\u01a1 c\u00f3 c\u00e1c ch\u1ec9 \u0111\u1ecbnh can thi\u1ec7p \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u. C\u00f3 1 s\u1ed1 b\u1ec7nh nh\u00e2n trong c\u1eeda s\u1ed5 6 gi\u1edd nh\u01b0ng tu\u1ed5i cao, th\u1ec3 tr\u1ea1ng gi\u00e0 y\u1ebfu vi\u1ec7c c\u00f3 th\u00eam nh\u1eefng th\u00f4ng tin \u0111\u00e1ng tin c\u1eady \u0111\u1ec3 l\u00e0m c\u0103n c\u1ee9 t\u1eeb phim CLVT t\u01b0\u1edbi m\u00e1u n\u00e3o l\u00e0 c\u1ea7n thi\u1ebft. Trong nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i, v\u00f9ng t\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1ee3c quy \u0111\u1ecbnh b\u1edfi th\u1ec3 t\u00edch Tmax > 6s c\u00f3 di\u1ec5n ti\u1ebfn theo th\u1eddi gian: < 6 gi\u1edd; 6 \u2013 11 gi\u1edd; 12 -17 gi\u1edd; 18- 24 gi\u1edd l\u1ea7n l\u01b0\u1ee3t l\u00e0: 67 \u00b1 8; 53,6 \u00b1 13,1; 65,3 \u00b1 28,2; 35,6 \u00b1 19,7 (ml) trong \u0111\u00f3 nh\u00f3m kh\u00f4ng r\u00f5 th\u1eddi \u0111i\u1ec3m kh\u1edfi ph\u00e1t l\u00e0 73,8 \u00b1 9,2 ml. C\u00f3 th\u1ec3 th\u1ea5y s\u1ef1 ph\u00e2n b\u1ed1 c\u1ee7a v\u00f9ng t\u1ed5n th\u01b0\u01a1ng l\u00e0 t\u01b0\u01a1ng \u0111\u1ed1i \u0111\u1ed3ng \u0111\u1ec1u \u1edf c\u00e1c nh\u00f3m th\u1eddi gian. V\u00f9ng n\u00e0y \u0111\u01b0\u1ee3c t\u00ednh l\u00e0 v\u00f9ng t\u1ed5n th\u01b0\u01a1ng to\u00e0n b\u1ed9 c\u1ee7a nh\u1ed3i m\u00e1u n\u00e3o bao g\u1ed3m c\u1ea3 v\u00f9ng l\u00f5i nh\u1ed3i m\u00e1u v\u00e0 v\u00f9ng tranh t\u1ed1i tranh s\u00e1ng. V\u1ec1 c\u00e1c ch\u1ec9 s\u1ed1 Tmax ch\u00fang ta c\u00f3 Tmax > 4s; Tmax > 6s; Tmax > 8s; Tmax > 10s; Trong \u0111\u00f3 c\u00f3 v\u00f9ng t\u1ed5n th\u01b0\u01a1ng n\u1eb7ng nh\u1ea5t l\u00e0 Tmax > 10s l\u00e0 v\u00f9ng n\u00e3o c\u00f3 th\u1eddi gian t\u01b0\u1edbi m\u00e1u b\u1ecb tr\u1ec5 l\u00e2u nh\u1ea5t. Tuy nhi\u00ean Tmax > 10s l\u1ea1i kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u01b0\u1edbc t\u00ednh l\u00f5i c\u1ee7a nh\u1ed3i m\u00e1u, m\u00e0 s\u1eed d\u1ee5ng ch\u1ec9 s\u1ed1 kh\u00e1c \u0111\u1ec3 t\u00ednh v\u00f9ng t\u1ed5n th\u01b0\u01a1ng n\u00e0y l\u00e0 CBF < 30%.
\nTh\u1ec3 t\u00edch v\u00f9ng l\u00f5i nh\u1ed3i m\u00e1u di\u1ec5n ti\u1ebfn theo th\u1eddi gian < 6 gi\u1edd; 6 \u2013 11 gi\u1edd; 12 -17 gi\u1edd; 18- 24 gi\u1edd l\u1ea7n l\u01b0\u1ee3t l\u00e0: 27,3 \u00b1 6,9; 33 \u00b1 11,7; 16 \u00b1 9,2; 1,3 \u00b1 1,3 (ml). \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n kh\u00f4ng r\u00f5 th\u1eddi gian kh\u1edfi ph\u00e1t t\u1ef7 l\u1ec7 n\u00e0y l\u00e0 28,6 \u00b1 7,3. Khi so s\u00e1nh v\u1edbi c\u00e1c nghi\u00ean c\u1ee9u EXTEND-IA t\u1ef7 l\u1ec7 n\u00e0y l\u00e0 19.6 \u00b1 17.4, NC DEFUSE 3 c\u00f3 trung v\u1ecb l\u00e0 9.4 (th\u1ea5p nh\u1ea5t l\u00e0 2.3 v\u00e0 cao nh\u1ea5t l\u00e0 25.6), trong NC DAWN trung v\u1ecb l\u00f5i nh\u1ed3i m\u00e1u l\u00e0: 7,6. Nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i c\u00f3 th\u1ec3 t\u00edch v\u00f9ng l\u00f5i cao h\u01a1n c\u00e1c nghi\u00ean c\u1ee9u tr\u00ean do trong t\u1eadp \u0111\u1ed1i t\u01b0\u1ee3ng NC c\u00f3 c\u1ea3 nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n can thi\u1ec7p v\u00e0 kh\u00f4ng \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n can thi\u1ec7p [4], [1], [2]. Trong NC c\u1ee7a Zaidi S V(Core) \u1edf c\u1ee7a s\u1ed5 sau 8 gi\u1edd c\u00f2n nh\u1ecf h\u01a1n so v\u1edbi c\u1ee7a s\u1ed5 trong v\u00f2ng 8 gi\u1edd.
\nKhi l\u1ea5y th\u1ec3 t\u00edch Tmax > 6s tr\u1eeb \u0111i th\u1ec3 t\u00edch CBF < 30% s\u1ebd cho ra k\u1ebft qu\u1ea3 th\u1ec3 t\u00edch v\u00f9ng Mismatch, \u0111\u01b0\u1ee3c \u01b0\u1edbc t\u00ednh nh\u01b0 v\u00f9ng tranh t\u1ed1i tranh s\u00e1ng \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p. V\u00e0 \u0111\u00e2y l\u00e0 c\u0103n c\u1ee9 quan tr\u1ecdng trong NC DEFUSE 3 \u0111\u1ec3 l\u1ef1a ch\u1ecdn b\u1ec7nh nh\u00e2n \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n can thi\u1ec7p huy\u1ebft kh\u1ed1i b\u1eb1ng d\u1ee5ng c\u1ee5 c\u01a1 h\u1ecdc. Trong nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i, th\u1ec3 t\u00edch v\u00f9ng Mismatch c\u00f3 trung b\u00ecnh \u0111\u01b0\u1ee3c ph\u00e2n b\u1ed5 \u0111\u1ed3ng \u0111\u1ec1u theo th\u1eddi gian v\u00e0 ngay c\u1ea3 \u1edf nh\u00f3m \u0111\u1ed9t qu\u1ef5 kh\u00f4ng r\u00f5 th\u1eddi \u0111i\u1ec3m. V\u1edbi th\u1ea5p nh\u1ea5t l\u00e0 kho\u1ea3ng th\u1eddi gian 6-11 gi\u1edd v\u1edbi gi\u00e1 tr\u1ecb trung b\u00ecnh 20,6 \u00b1 4,7 ml v\u00e0 cao nh\u1ea5t \u1edf nh\u00f3m kh\u00f4ng r\u00f5 th\u1eddi \u0111i\u1ec3m l\u00e0 44,9 \u00b1 8,6 ml v\u00e0 nh\u00f3m t\u1eeb 12 \u2013 17 gi\u1edd l\u00e0 49,3 \u00b1 19,3. \u0110i\u1ec1u n\u00e0y cho th\u1ea5y v\u1eabn c\u00f2n t\u1ed3n t\u1ea1i v\u00f9ng tranh t\u1ed1i tranh s\u00e1ng \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 \u0111\u1ebfn vi\u1ec7n trong kho\u1ea3ng th\u1eddi gian t\u1eeb 6-24 gi\u1edd hay \u1edf c\u00e1c b\u1ec7nh nh\u00e2n kh\u00f4ng r\u00f5 th\u1eddi \u0111i\u1ec3m kh\u1edfi ph\u00e1t.
\nTh\u1ec3 t\u00edch v\u00f9ng tranh t\u1ed1i tranh s\u00e1ng v\u00e0 th\u1ec3 t\u00edch v\u00f9ng t\u1ed5n th\u01b0\u01a1ng c\u00f3 li\u00ean quan \u0111\u1ebfn v\u1ecb tr\u00ed t\u1eafc m\u1ea1ch. T\u1eafc m\u1ea1ch v\u1ecb tr\u00ed ngo\u00e0i s\u1ecd c\u00f3 th\u1ec3 t\u00edch v\u00f9ng tranh t\u1ed1i tranh s\u00e1ng v\u00e0 th\u1ec3 t\u00edch v\u00f9ng t\u1ed5n th\u01b0\u01a1ng l\u1edbn h\u01a1n so v\u1edbi t\u1eafc m\u1ea1ch n\u1ed9i s\u1ecd. T\u1ef7 l\u1ec7 th\u1ec3 t\u00edch v\u00f9ng tranh t\u1ed1i tranh s\u00e1ng\/th\u1ec3 t\u00edch v\u00f9ng t\u1ed5n th\u01b0\u01a1ng gi\u1ea3m d\u1ea7n \u1edf c\u00e1c nh\u00f3m theo th\u1ee9 t\u1ef1 l\u1ea7n l\u01b0\u1ee3t l\u00e0: \u0110M c\u1ea3nh; \u0110MC trong \u0111o\u1ea1n ngo\u00e0i s\u1ecd; M1 \u0110M n\u00e3o gi\u1eefa; \u0110MC trong \u0111o\u1ea1n trong s\u1ecd. T\u1eafc M2 \u0110M n\u00e3o gi\u1eefa ch\u1ec9 c\u00f3 th\u1ec3 t\u00edch v\u00f9ng t\u1ed5n th\u01b0\u01a1ng nh\u1ecf d\u01b0\u1edbi 20ml. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch l\u00e0 nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 t\u1eafc m\u1ea1ch ngo\u00e0i s\u1ecd c\u00f3 t\u01b0\u1edbi m\u00e1u b\u00e0ng h\u1ec7 t\u1ed1t h\u01a1n \u1edf \u0111o\u1ea1n trong s\u1ecd, \u0111\u1eb7c bi\u1ec7t l\u00e0 t\u1eeb \u0111a gi\u00e1c Willis.<\/p>\n

5. K\u1ebft lu\u1eadn v\u1ec1 \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng, h\u00ecnh \u1ea3nh khi s\u1eed d\u1ee5ng c\u1eaft l\u1edbp vi t\u00ednh t\u01b0\u1edbi m\u00e1u n\u00e3o \u00e1p d\u1ee5ng ph\u1ea7n m\u1ec1m RAPID \u1edf b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u n\u00e3o h\u1ec7 tu\u1ea7n ho\u00e0n tr\u01b0\u1edbc<\/strong><\/h2>\n

Th\u1ec3 t\u00edch v\u00f9ng tranh t\u1ed1i tranh s\u00e1ng ph\u00e2n b\u1ed5 t\u01b0\u01a1ng \u0111\u1ed1i \u0111\u1ed3ng \u0111\u1ec1u \u1edf c\u00e1c nh\u00f3m tu\u1ed5i v\u00e0 \u1edf c\u00e1c nh\u00f3m th\u1eddi gian t\u1eeb l\u00fac kh\u1edfi ph\u00e1t \u0111\u1ebfn l\u00fac nh\u1eadp vi\u1ec7n kh\u00e1c nhau trong v\u00f2ng 24 gi\u1edd k\u1ec3 t\u1eeb khi kh\u1edfi ph\u00e1t. V\u1ecb tr\u00ed t\u1eafc m\u1ea1ch ngo\u00e0i s\u1ecd c\u00f3 th\u1ec3 t\u00edch v\u00f9ng t\u1ed5n th\u01b0\u01a1ng v\u00e0 th\u1ec3 t\u00edch v\u00f9ng tranh t\u1ed1i tranh s\u00e1ng l\u1edbn h\u01a1n so v\u1edbi t\u1eafc m\u1ea1ch n\u1ed9i s\u1ecd. Nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i cho th\u1ea5y phim c\u1eaft l\u1edbp vi t\u00ednh t\u01b0\u1edbi m\u00e1u n\u00e3o c\u00f3 \u00e1p d\u1ee5ng ph\u1ea7n m\u1ec1m Rapid \u0111\u01b0a ra th\u00eam \u0111\u01b0\u1ee3c nh\u01b0ng th\u00f4ng s\u1ed1 m\u1edbi quan tr\u1ecdng \u0111\u1ec3 ph\u1ee5c v\u1ee5 \u0111i\u1ec1u tr\u1ecb khi k\u1ebft h\u1ee3p v\u1edbi l\u00e2m s\u00e0ng.<\/p>\n

T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/strong><\/h2>\n

1. G.W. Albers v\u00e0 c\u00e1c c\u1ed9ng s\u1ef1. (2018), \u201cThrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging\u201d, N Engl J Med. 378, tr. 708-18.
\n2. Campbell B. C, Mitchell P. J v\u00e0 Kleinig T. J (2015), \u201cEndovascular therapy for ischemic stroke with perfusion-imaging selection, EXTEND IA\u201d, N Engl J Med. 372(11), tr. 1009-1018.
\n3. Caplan L (2009), \u201cCaplan\u2019s stroke: a clinical approach\u201d, Fourth Edition. Saunders Elsevier.
\n4. R.G. Nogueira v\u00e0 c\u00e1c c\u1ed9ng s\u1ef1. (2018), \u201cThrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct\u201d, N Engl J Med 2018. 378, tr. 11-21.
\n5. \u0110\u00e0o Vi\u1ec7t Ph\u01b0\u01a1ng (2019), \u201cNghi\u00ean c\u1ee9u \u0111i\u1ec1u tr\u1ecb t\u1eafc \u0111\u1ed9ng m\u1ea1ch l\u1edbn h\u1ec7 tu\u1ea7n ho\u00e0n n\u00e3o tr\u01b0\u1edbc trong v\u00f2ng 6 gi\u1edd \u0111\u1ea7u b\u1eb1ng thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft t\u0129nh m\u1ea1ch k\u1ebft h\u1ee3p v\u1edbi l\u1ea5y huy\u1ebft kh\u1ed1i c\u01a1 h\u1ecdc\u201d, Lu\u1eadn \u00e1n ti\u1ebfn s\u0129 y h\u1ecdc, Tr\u01b0\u1eddng \u0110\u1ea1i h\u1ecdc Y H\u00e0 N\u1ed9i.
\n6. Fransen P. S, Beumer D v\u00e0 Berkhemer O. A (2014), \u201cMR CLEAN, a multicenter randomized clinical trial of endovascular treatment for acute ischemic stroke in the Netherlands: study protocol for a randomized controlled trial\u201d. 15(343).
\n7. Hatem A. Wafa v\u00e0 c\u00e1c c\u1ed9ng s\u1ef1. (2020), \u201cThirty-Year Projections of Incidence, Prevalence, Deaths, and Disability-Adjusted Life Years\u201d, Stroke.<\/p>\n","protected":false},"excerpt":{"rendered":"

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