{"id":31657,"date":"2023-05-07T13:33:35","date_gmt":"2023-05-07T06:33:35","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31657"},"modified":"2023-05-18T10:41:58","modified_gmt":"2023-05-18T03:41:58","slug":"esc-2019-ve-chan-doan-va-quan-ly-thuyen-tac-phoi-cap-phan-2","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/esc-2019-ve-chan-doan-va-quan-ly-thuyen-tac-phoi-cap-phan-2\/","title":{"rendered":"ESC 2019 Khuy\u1ebfn c\u00e1o v\u1ec1 ch\u1ea9n \u0111o\u00e1n thuy\u00ean t\u1eafc ph\u1ed5i &#8211; Ph\u1ea7n 2"},"content":{"rendered":"<div id=\"wpadminbar\" class=\"nojq\">\n<div id=\"wp-toolbar\" class=\"quicklinks\" role=\"navigation\" aria-label=\"Toolbar\"><\/div>\n<\/div>\n<div class=\"wp-site-blocks\">\n<div class=\"entry-content wp-block-post-content has-global-padding is-layout-constrained\">\n<p><strong>\u00a0Ch\u00fang ta \u0111ang \u1edf k\u1ef7 nguy\u00ean c\u00e1 th\u1ec3 h\u00f3a \u0111i\u1ec1u tr\u1ecb, v\u00ec v\u1eady vi\u1ec7c hi\u1ec3u s\u00e2u s\u1eafc c\u00e1c khuy\u1ebfn c\u00e1o s\u1ebd g\u00f3p ph\u1ea7n r\u1ea5t l\u1edbn \u0111\u1ea1t \u0111\u01b0\u1ee3c nh\u1eefng m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3 cho t\u1eebng b\u1ec7nh nh\u00e2n. Ch\u00fang t\u00f4i chuy\u1ec3n th\u1ec3\u00a0 c\u00e1c b\u00e0i to\u00e0n v\u0103n H\u01b0\u1edbng d\u1eabn c\u1ee7a ESC sang Ti\u1ebfng Vi\u1ec7t \u0111\u1ec3 qu\u00fd\u00a0 \u0111\u1ed3ng nghi\u1ec7p thu\u1eadn ti\u1ec7n h\u01a1n khi tham kh\u1ea3o, c\u1eadp nh\u1eadt trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p.<\/strong><\/p>\n<figure id=\"attachment_32175\" aria-describedby=\"caption-attachment-32175\" style=\"width: 474px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-full wp-image-32175\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/OIP.jpg\" alt=\"thuyen-tac-phoi\" width=\"474\" height=\"412\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/OIP.jpg 474w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/OIP-300x261.jpg 300w\" sizes=\"(max-width: 474px) 100vw, 474px\" \/><figcaption id=\"caption-attachment-32175\" class=\"wp-caption-text\">\u1ea2nh m\u00f4 t\u1ea3 thuy\u00ean t\u1eafc ph\u1ed5i<\/figcaption><\/figure>\n<h2><strong>1. T\u1ed5ng quan\u00a0\u00a0<\/strong><\/h2>\n<p>Xem th\u00eam: <em>ESC 2019 v\u1ec1 ch\u1ea9n \u0111o\u00e1n v\u00e0 qu\u1ea3n l\u00fd thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p &#8211; Ph\u1ea7n 1<\/em><\/p>\n<h2><strong>2. <\/strong>Ch\u1ea9n \u0111o\u00e1n thuy\u00ean t\u1eafc ph\u1ed5i<\/h2>\n<p>Vi\u1ec7c n\u00e2ng cao nh\u1eadn th\u1ee9c v\u1ec1 b\u1ec7nh thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch v\u00e0 ti\u1ebfp c\u1eadn ng\u00e0y c\u00e0ng d\u1ec5 c\u00e1c ph\u01b0\u01a1ng ti\u1ec7n ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh kh\u00f4ng x\u00e2m l\u1ea5n, ch\u1ee7 y\u1ebfu l\u00e0 <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/chup-cat-lop-vi-tinh-phoi-nhung-dieu-can-biet\/\"><strong>ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh (CT) m\u1ea1ch m\u00e1u ph\u1ed5i (CTPA)<\/strong><\/a>, \u0111\u00e3 t\u1ea1o ra m\u1ed9t xu h\u01b0\u1edbng cho c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng b\u1eaft \u0111\u1ea7u nghi ng\u1edd v\u00e0 ti\u1ebfn h\u00e0nh ch\u1ea9n \u0111o\u00e1n PE th\u01b0\u1eddng xuy\u00ean h\u01a1n trong qu\u00e1 kh\u1ee9. Th\u00e1i \u0111\u1ed9 thay \u0111\u1ed5i n\u00e0y \u0111\u01b0\u1ee3c minh h\u1ecda b\u1eb1ng t\u1ef7 l\u1ec7 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh PE tr\u00ean b\u1ec7nh nh\u00e2n tr\u1ea3i qua qu\u00e1 tr\u00ecnh ch\u1ea9n \u0111o\u00e1n: t\u1ef7 l\u1ec7 n\u00e0y th\u1ea5p t\u1edbi 5% trong c\u00e1c nghi\u00ean c\u1ee9u ch\u1ea9n \u0111o\u00e1n \u1edf B\u1eafc M\u1ef9 th\u1eddi gian g\u1ea7n \u0111\u00e2y, tr\u00e1i ng\u01b0\u1ee3c ho\u00e0n to\u00e0n v\u1edbi t\u1ef7 l\u1ec7 hi\u1ec7n m\u1eafc kho\u1ea3ng 50% \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o v\u00e0o \u0111\u1ea7u nh\u1eefng n\u0103m 1980. Do \u0111\u00f3, \u0111i\u1ec1u quan tr\u1ecdng l\u00e0 khi \u0111\u00e1nh gi\u00e1 chi\u1ebfn l\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n PE kh\u00f4ng x\u00e2m l\u1ea5n trong k\u1ef7 nguy\u00ean hi\u1ec7n \u0111\u1ea1i, c\u1ea7n \u0111\u1ea3m b\u1ea3o kh\u1ea3 n\u0103ng lo\u1ea1i tr\u1eeb PE m\u1ed9t c\u00e1ch an to\u00e0n trong d\u00e2n s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u01b0\u01a1ng th\u1eddi v\u1edbi m\u1ed9t x\u00e1c su\u1ea5t b\u1ec7nh tr\u01b0\u1edbc khi c\u00f3 c\u1eadn l\u00e2m s\u00e0ng kh\u00e1 th\u1ea5p. Ng\u01b0\u1ee3c l\u1ea1i, x\u00e9t nghi\u1ec7m d\u01b0\u01a1ng t\u00ednh c\u1ea7n c\u00f3 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u th\u00edch h\u1ee3p \u0111\u1ec3 \u0111\u01b0a ra ch\u1ec9 \u0111\u1ecbnh cho \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng m\u00e1u.<\/p>\n<h3><strong>2.1. Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng\u00a0<\/strong><\/h3>\n<p>C\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng v\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a PE c\u1ea5p t\u00ednh th\u01b0\u1eddng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u. \u1ede h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p, nghi ng\u1edd PE khi b\u1ec7nh nh\u00e2n kh\u00f3 th\u1edf, \u0111au ng\u1ef1c, ti\u1ec1n ng\u1ea5t ho\u1eb7c ng\u1ea5t, ho\u1eb7c <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/ho-ra-mau-co-canh-bao-benh-gi\/\">ho ra m\u00e1u<\/a>. <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/cac-roi-loan-huyet-dong-dac-trung-trong-soc-tim\/\">R\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng<\/a> l\u00e0 m\u1ed9t d\u1ea1ng bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng hi\u1ebfm g\u1eb7p nh\u01b0ng quan tr\u1ecdng, v\u00ec n\u00f3 ch\u1ec9 ra PE trung t\u00e2m ho\u1eb7c PE di\u1ec7n r\u1ed9ng v\u1edbi huy\u1ebft \u0111\u1ed9ng d\u1ef1 tr\u1eef gi\u1ea3m nghi\u00eam tr\u1ecdng. Ng\u1ea5t c\u00f3 th\u1ec3 x\u1ea3y ra, v\u00e0 c\u00f3 li\u00ean quan khi t\u1ef7 l\u1ec7 hi\u1ec7n h\u00e0nh r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV cao.<\/p>\n<p>Ng\u01b0\u1ee3c l\u1ea1i, theo k\u1ebft qu\u1ea3 c\u1ee7a m\u1ed9t nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y, PE c\u1ea5p t\u00ednh c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t ph\u00e1t hi\u1ec7n th\u01b0\u1eddng g\u1eb7p \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n ng\u1ea5t (17%), ngay c\u1ea3 khi \u0111\u00e3 c\u00f3 m\u1ed9t gi\u1ea3i th\u00edch kh\u00e1c cho t\u00ecnh tr\u1ea1ng ng\u1ea5t. Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, PE c\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng ho\u1eb7c \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n t\u00ecnh c\u1edd trong qu\u00e1 tr\u00ecnh ch\u1ea9n \u0111o\u00e1n b\u1ec7nh m\u1ed9t b\u1ec7nh kh\u00e1c. Kh\u00f3 th\u1edf c\u00f3 th\u1ec3 l\u00e0 c\u1ea5p t\u00ednh v\u00e0 nghi\u00eam tr\u1ecdng \u0111\u1ed1i v\u1edbi PE trung t\u00e2m; c\u00f2n PE ngo\u1ea1i vi nh\u1ecf, n\u00f3 th\u01b0\u1eddng nh\u1eb9 v\u00e0 c\u00f3 th\u1ec3 tho\u00e1ng qua. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb suy tim ho\u1eb7c c\u00f3 b\u1ec7nh ph\u1ed5i t\u1eeb tr\u01b0\u1edbc, kh\u00f3 th\u1edf ng\u00e0y c\u00e0ng n\u1eb7ng c\u00f3 th\u1ec3 l\u00e0 tri\u1ec7u ch\u1ee9ng duy nh\u1ea5t c\u1ee7a PE.<\/p>\n<p><a href=\"https:\/\/www.vinmec.com\/vi\/bai-viet\/dau-nguc-va-cac-nguyen-nhan-thuong-gap\/\">\u0110au ng\u1ef1c<\/a> l\u00e0 tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p c\u1ee7a PE v\u00e0 th\u01b0\u1eddng l\u00e0 do k\u00edch th\u00edch m\u00e0ng ph\u1ed5i do thuy\u00ean t\u1eafc \u0111o\u1ea1n xa g\u00e2y nh\u1ed3i m\u00e1u ph\u1ed5i. \u0110\u1ed1i v\u1edbi PE trung t\u00e2m, \u0111au ng\u1ef1c c\u00f3 th\u1ec3 c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m \u0111au th\u1eaft ng\u1ef1c \u0111i\u1ec3n h\u00ecnh, kh\u1ea3 n\u0103ng l\u00e0 ph\u1ea3n \u00e1nh thi\u1ebfu m\u00e1u RV v\u00e0 c\u1ea7n ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi h\u1ed9i ch\u1ee9ng m\u1ea1ch v\u00e0nh c\u1ea5p t\u00ednh ho\u1eb7c b\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.<\/p>\n<p>Ngo\u00e0i c\u00e1c tri\u1ec7u ch\u1ee9ng, ki\u1ebfn th\u1ee9c v\u1ec1 c\u00e1c y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y VTE r\u1ea5t quan tr\u1ecdng trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh x\u00e1c su\u1ea5t l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh, t\u0103ng theo s\u1ed1 l\u01b0\u1ee3ng c\u00e1c y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y xu\u1ea5t hi\u1ec7n; tuy nhi\u00ean, kho\u1ea3ng 40% b\u1ec7nh nh\u00e2n PE kh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y n\u00e0o \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y. Thi\u1ebfu oxy m\u00e1u l\u00e0 th\u01b0\u1eddng g\u1eb7p, nh\u01b0ng \u226440% b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1ed9 b\u00e3o h\u00f2a oxy \u0111\u1ed9ng m\u1ea1ch b\u00ecnh th\u01b0\u1eddng (SaO2) v\u00e0 20% c\u00f3 \u0111\u1ed9 ch\u00eanh oxy ph\u1ebf nang \u2013 \u0111\u1ed9ng m\u1ea1ch b\u00ecnh th\u01b0\u1eddng. Gi\u1ea3m th\u00e1n kh\u00ed c\u0169ng th\u01b0\u1eddng g\u1eb7p. X-quang ng\u1ef1c th\u01b0\u1eddng b\u1ea5t th\u01b0\u1eddng v\u00e0 m\u1eb7c d\u00f9 h\u00ecnh \u1ea3nh c\u1ee7a n\u00f3 th\u01b0\u1eddng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u trong PE, n\u00f3 c\u00f3 th\u1ec3 h\u1eefu \u00edch trong vi\u1ec7c lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y kh\u00f3 th\u1edf ho\u1eb7c \u0111au ng\u1ef1c kh\u00e1c. Thay \u0111\u1ed5i \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 cho th\u1ea5y c\u0103ng RV \u2013 nh\u01b0 s\u00f3ng T \u0111\u1ea3o ng\u01b0\u1ee3c \u1edf chuy\u1ec3n \u0111\u1ea1o V1 \u2013 V4, h\u00ecnh d\u1ea1ng QR \u1edf V1, h\u00ecnh d\u1ea1ng S1Q3T3 v\u00e0 block nh\u00e1nh ph\u1ea3i kh\u00f4ng ho\u00e0n to\u00e0n ho\u1eb7c ho\u00e0n to\u00e0n \u2013 th\u01b0\u1eddng \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p PE n\u1eb7ng, \u1edf tr\u01b0\u1eddng h\u1ee3p nh\u1eb9 h\u01a1n, s\u1ef1 b\u1ea5t th\u01b0\u1eddng duy nh\u1ea5t c\u00f3 th\u1ec3 ch\u1ec9 l\u00e0 nh\u1ecbp nhanh xoang, hi\u1ec7n di\u1ec7n trong 40% b\u1ec7nh nh\u00e2n. Cu\u1ed1i c\u00f9ng, r\u1ed1i lo\u1ea1n nh\u1ecbp nh\u0129, th\u01b0\u1eddng xuy\u00ean nh\u1ea5t l\u00e0 <a href=\"https:\/\/www.vinmec.com\/vi\/tim-mach\/thong-tin-suc-khoe\/rung-nhi-roi-loan-nhip-tim-thuong-gap-nhat\/\">rung nh\u0129<\/a>, c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn PE c\u1ea5p t\u00ednh.<\/p>\n<h3><strong>2.2. \u0110\u00e1nh gi\u00e1 x\u00e1c su\u1ea5t l\u00e2m s\u00e0ng ( ti\u1ec1n c\u1eadn l\u00e2m s\u00e0ng )<\/strong><\/h3>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"aligncenter size-full wp-image-31266\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-588.png\" sizes=\"(max-width: 664px) 100vw, 664px\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-588.png 664w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-588-300x261.png 300w\" alt=\"Geneva-sua-doi\" width=\"664\" height=\"578\" \/><\/p>\n<p>S\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a c\u00e1c tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng v\u00e0 th\u1ef1c th\u1ec3 v\u1edbi s\u1ef1 hi\u1ec7n di\u1ec7n c\u00e1c y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y VTE cho ph\u00e9p ph\u00e2n lo\u1ea1i b\u1ec7nh nh\u00e2n nghi ng\u1edd PE th\u00e0nh c\u00e1c ph\u00e2n lo\u1ea1i kh\u00e1c nhau v\u1ec1 x\u00e1c su\u1ea5t l\u00e2m s\u00e0ng ho\u1eb7c x\u00e1c su\u1ea5t ti\u1ec1n x\u00e9t nghi\u1ec7m, t\u01b0\u01a1ng \u1ee9ng v\u1edbi t\u1ef7 su\u1ea5t hi\u1ec7n h\u00e0nh th\u1ef1c t\u1ebf c\u1ee7a PE \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh. \u0110\u00e1nh gi\u00e1 ti\u1ec1n c\u1eadn l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1eb1ng c\u00e1ch t\u1ef1 ph\u00e1n \u0111o\u00e1n l\u00e2m s\u00e0ng (theo kinh nghi\u1ec7m) ho\u1eb7c b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng c\u00e1c thang \u0111i\u1ec3m d\u1ef1 \u0111o\u00e1n. V\u00ec x\u00e1c su\u1ea5t sau c\u1eadn l\u00e2m s\u00e0ng (t\u1ee9c l\u00e0 sau khi c\u00f3 k\u1ebft qu\u1ea3 h\u00ecnh \u1ea3nh h\u1ecdc) c\u1ee7a PE kh\u00f4ng ch\u1ec9 ph\u1ee5 thu\u1ed9c v\u00e0o c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a ch\u00ednh c\u1eadn l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n m\u00e0 c\u00f2n v\u1ec1 x\u00e1c su\u1ea5t ti\u1ec1n c\u1eadn l\u00e2m s\u00e0ng cho n\u00ean \u0111\u00e2y l\u00e0 b\u01b0\u1edbc quan tr\u1ecdng trong t\u1ea5t c\u1ea3 c\u00e1c l\u01b0\u1ee3c \u0111\u1ed3 ch\u1ea9n \u0111o\u00e1n cho PE. Gi\u00e1 tr\u1ecb c\u1ee7a <strong>\u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng theo kinh nghi\u1ec7m<\/strong> \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn trong nhi\u1ec1u nghi\u00ean c\u1ee9u h\u00e0ng lo\u1ea1t l\u1edbn.<\/p>\n<p>\u0110\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng th\u01b0\u1eddng bao g\u1ed3m c\u00e1c c\u1eadn l\u00e2m s\u00e0ng ph\u1ed5 bi\u1ebfn nh\u01b0 X-quang ng\u1ef1c v\u00e0 \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t. Tuy nhi\u00ean, v\u00ec ph\u00e1n \u0111o\u00e1n l\u00e2m s\u00e0ng thi\u1ebfu chu\u1ea9n h\u00f3a, m\u1ed9t s\u1ed1 thang \u0111i\u1ec3m l\u00e2m s\u00e0ng d\u1ef1 \u0111o\u00e1n r\u00f5 r\u00e0ng, chi ti\u1ebft \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n. Trong s\u1ed1 n\u00e0y, c\u00e1c thang \u0111i\u1ec3m d\u1ef1 \u0111o\u00e1n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng th\u01b0\u1eddng xuy\u00ean nh\u1ea5t l\u00e0 thang \u0111i\u1ec3m Geneva c\u1ea3i ti\u1ebfn (B\u1ea3ng 5) v\u00e0 <a href=\"https:\/\/www.vinmec.com\/vi\/tim-mach\/thong-tin-suc-khoe\/chan-doan-va-dieu-tri-huyet-khoi-tinh-mach-sau-chi-duoi\/\">thang \u0111i\u1ec3m Wells<\/a> (xem D\u1eef li\u1ec7u b\u1ed5 sung B\u1ea3ng 1). C\u1ea3 hai thang \u0111i\u1ec3m d\u1ef1 \u0111o\u00e1n \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u01a1n gi\u1ea3n h\u00f3a \u0111\u1ec3 n\u1ed7 l\u1ef1c s\u1eed d\u1ee5ng ch\u00fang trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng, phi\u00ean b\u1ea3n \u0111\u01a1n gi\u1ea3n h\u00f3a c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c th\u1ef1c. B\u1ea5t k\u1ec3 b\u1ea3ng \u0111i\u1ec3m n\u00e0o \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh PE c\u00f3 th\u1ec3 d\u1ef1 ki\u1ebfn kho\u1ea3ng 10% trong ph\u00e2n lo\u1ea1i x\u00e1c su\u1ea5t th\u1ea5p, 30% trong ph\u00e2n lo\u1ea1i x\u00e1c su\u1ea5t trung b\u00ecnh v\u00e0 65% trong ph\u00e2n lo\u1ea1i x\u00e1c su\u1ea5t cao. Khi s\u1eed d\u1ee5ng c\u00e1ch ph\u00e2n lo\u1ea1i hai m\u1ee9c \u0111\u1ed9, t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh PE l\u00e0 12% \u1edf nh\u00f3m kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng PE v\u00e0 30% \u1edf nh\u00f3m c\u00f3 kh\u1ea3 n\u0103ng PE. M\u1ed9t nghi\u00ean c\u1ee9u ti\u1ebfn c\u1ee9u so s\u00e1nh tr\u1ef1c ti\u1ebfp gi\u1eefa c\u00e1c thang \u0111i\u1ec3m n\u00e0y \u0111\u00e3 x\u00e1c nh\u1eadn kh\u1ea3 n\u0103ng ch\u1ea9n \u0111o\u00e1n t\u01b0\u01a1ng t\u1ef1 nhau<\/p>\n<h3><strong>2.3. Tr\u00e1nh l\u1ea1m d\u1ee5ng c\u00e1c c\u1eadn l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n thuy\u00ean t\u1eafc ph\u1ed5i<\/strong><\/h3>\n<p>T\u00ecm ki\u1ebfm PE \u1edf m\u1ecdi b\u1ec7nh nh\u00e2n b\u1ecb kh\u00f3 th\u1edf ho\u1eb7c \u0111au ng\u1ef1c c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn chi ph\u00ed cao v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a c\u00e1c c\u1eadn l\u00e2m s\u00e0ng kh\u00f4ng c\u1ea7n thi\u1ebft.<\/p>\n<p>Ti\u00eau ch\u00ed lo\u1ea1i tr\u1eeb thuy\u00ean t\u1eafc ph\u1ed5i (PERC) \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n cho b\u1ec7nh nh\u00e2n khoa c\u1ea5p c\u1ee9u v\u1edbi m\u1ee5c \u0111\u00edch l\u1ef1a ch\u1ecdn nh\u1eefng b\u1ec7nh nh\u00e2n, tr\u00ean c\u0103n c\u1ee9 l\u00e2m s\u00e0ng , c\u00f3 kh\u1ea3 n\u0103ng m\u1eafc PE th\u1ea5p \u0111\u1ebfn m\u1ee9c th\u1eadm ch\u00ed kh\u00f4ng n\u00ean b\u1eaft \u0111\u1ea7u c\u00f4ng vi\u1ec7c ti\u1ebfn h\u00e0nh ch\u1ea9n \u0111o\u00e1n. Ch\u00fang bao g\u1ed3m t\u00e1m bi\u1ebfn l\u00e2m s\u00e0ng li\u00ean quan c\u00f3 \u00fd ngh\u0129a \u0111\u1ebfn vi\u1ec7c lo\u1ea1i tr\u1eeb PE: (1) tu\u1ed5i &lt;50 tu\u1ed5i; (2) m\u1ea1ch &lt;100 nh\u1ecbp m\u1ed7i ph\u00fat; (3) SaO2 &gt;94%; (4) kh\u00f4ng s\u01b0ng m\u1ed9t ch\u00e2n; (5) kh\u00f4ng ho ra m\u00e1u; (6) kh\u00f4ng c\u00f3 ch\u1ea5n th\u01b0\u01a1ng ho\u1eb7c ph\u1eabu thu\u1eadt g\u1ea7n \u0111\u00e2y; (7) kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed VTE; v\u00e0 (8) kh\u00f4ng s\u1eed d\u1ee5ng hormone u\u1ed1ng.<\/p>\n<p>K\u1ebft qu\u1ea3 c\u1ee7a m\u1ed9t nghi\u00ean c\u1ee9u ti\u1ebfn c\u1ee9u v\u1ec1 t\u00ednh x\u00e1c th\u1ef1c, v\u00e0 nh\u1eefng nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean v\u1ec1 qu\u1ea3n l\u00fd kh\u00f4ng thua k\u00e9m, \u0111\u1ec1 xu\u1ea5t lo\u1ea1i tr\u1eeb PE an to\u00e0n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n v\u1edbi x\u00e1c su\u1ea5t l\u00e2m s\u00e0ng th\u1ea5p, k\u00e8m theo, \u0111\u00e1p \u1ee9ng t\u1ea5t c\u1ea3 c\u00e1c ti\u00eau ch\u00ed c\u1ee7a PERC quy \u0111\u1ecbnh. Tuy nhi\u00ean, t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh PE chung th\u1ea5p trong c\u00e1c nghi\u00ean c\u1ee9u n\u00e0y kh\u00f4ng h\u1ed7 tr\u1ee3 t\u00ednh t\u1ed5ng qu\u00e1t c\u1ee7a k\u1ebft qu\u1ea3.<\/p>\n<h3><strong>2.4. <a href=\"https:\/\/www.vinmec.com\/en\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/xet-nghiem-d-dimer-chan-doan-huyet-khoi-trong-mau\/\">X\u00e9t nghi\u1ec7m D-dimer<\/a><\/strong><\/h3>\n<p>N\u1ed3ng \u0111\u1ed9 D-dimer t\u0103ng l\u00ean trong huy\u1ebft t\u01b0\u01a1ng khi c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a huy\u1ebft kh\u1ed1i c\u1ea5p t\u00ednh do k\u00edch ho\u1ea1t \u0111\u1ed3ng th\u1eddi \u0111\u00f4ng m\u00e1u v\u00e0 ti\u00eau s\u1ee3i huy\u1ebft. Gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n \u00e2m c\u1ee7a x\u00e9t nghi\u1ec7m D-dimer th\u00ec cao v\u00e0 m\u1ee9c D-dimer b\u00ecnh th\u01b0\u1eddng th\u00ec \u00edt c\u00f3 kh\u1ea3 n\u0103ng PE ho\u1eb7c DVT c\u1ea5p t\u00ednh. M\u1eb7t kh\u00e1c, gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n d\u01b0\u01a1ng c\u1ee7a n\u1ed3ng \u0111\u1ed9 D-dimer t\u0103ng l\u00e0 th\u1ea5p v\u00e0 v\u00ec th\u1ebf x\u00e9t nghi\u1ec7m D-dimer kh\u00f4ng h\u1eefu \u00edch \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh PE. D-dimer c\u0169ng th\u01b0\u1eddng t\u0103ng cao \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0, \u1edf b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n, \u1edf b\u1ec7nh nhi\u1ec5m tr\u00f9ng n\u1eb7ng ho\u1eb7c b\u1ec7nh l\u00fd vi\u00eam v\u00e0 khi mang thai. Do \u0111\u00f3, s\u1ed1 b\u1ec7nh nh\u00e2n m\u00e0 D-dimer ph\u1ea3i \u0111\u01b0\u1ee3c \u0111o \u0111\u1ec3 lo\u1ea1i tr\u1eeb PE (s\u1ed1 BN c\u1ea7n \u0111\u01b0\u1ee3c x\u00e9t nghi\u1ec7m) t\u0103ng t\u1eeb 3 trong m\u1eabu chung c\u1ee7a khoa c\u1ea5p c\u1ee9u l\u00ean \u226510 \u1edf c\u00e1c t\u00ecnh hu\u1ed1ng c\u1ee5 th\u1ec3 \u0111\u01b0\u1ee3c li\u1ec7t k\u00ea ph\u00eda tr\u00ean. V\u00ec nhi\u1ec1u n\u01a1i c\u00f3 x\u00e9t nghi\u1ec7m D-dimer, c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng n\u00ean nh\u1eadn th\u1ee9c v\u1ec1 hi\u1ec7u su\u1ea5t ch\u1ea9n \u0111o\u00e1n c\u1ee7a x\u00e9t nghi\u1ec7m \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong b\u1ec7nh vi\u1ec7n m\u00ecnh. X\u00e9t nghi\u1ec7m \u0111\u1ecbnh l\u01b0\u1ee3ng mi\u1ec5n d\u1ecbch li\u00ean k\u1ebft enzyme (ELISA) ho\u1eb7c c\u00e1c x\u00e9t nghi\u1ec7m c\u00f3 ngu\u1ed3n g\u1ed1c ELISA c\u00f3 \u0111\u1ed9 nh\u1ea1y ch\u1ea9n \u0111o\u00e1n \u226595%, v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 lo\u1ea1i tr\u1eeb PE \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 x\u00e1c su\u1ea5t ti\u1ec1n c\u1eadn l\u00e2m s\u00e0ng th\u1ea5p ho\u1eb7c trung b\u00ecnh. Trong khoa c\u1ea5p c\u1ee9u, ELISA D-dimer \u00e2m t\u00ednh k\u1ebft h\u1ee3p v\u1edbi x\u00e1c su\u1ea5t l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 lo\u1ea1i tr\u1eeb b\u1ec7nh m\u00e0 kh\u00f4ng c\u1ea7n l\u00e0m th\u00eam c\u1eadn l\u00e2m s\u00e0ng kh\u00e1c \u1edf kho\u1ea3ng 30% b\u1ec7nh nh\u00e2n nghi ng\u1edd PE. C\u00e1c k\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng nguy c\u01a1 thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i trong 3 th\u00e1ng l\u00e0 &lt;1% \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 x\u00e1c su\u1ea5t l\u00e2m s\u00e0ng th\u1ea5p ho\u1eb7c trung b\u00ecnh kh\u00f4ng \u0111i\u1ec1u tr\u1ecb d\u1ef1a tr\u00ean k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m \u00e2m t\u00ednh.<\/p>\n<ul>\n<li><strong>Ng\u01b0\u1ee1ng D-dimer \u0111i\u1ec1u ch\u1ec9nh theo \u0111\u1ed9 tu\u1ed5i<\/strong><\/li>\n<\/ul>\n<p>\u0110\u1ed9 \u0111\u1eb7c hi\u1ec7u c\u1ee7a D-dimer trong tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd PE gi\u1ea3m d\u1ea7n theo tu\u1ed5i \u0111\u1ebfn ~10% \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n &gt;80 tu\u1ed5i. Vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c ng\u01b0\u1ee1ng c\u1eaft theo \u0111\u1ed9 tu\u1ed5i c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n hi\u1ec7u su\u1ea5t x\u00e9t nghi\u1ec7m D-dimer \u1edf ng\u01b0\u1eddi cao tu\u1ed5i. M\u1ed9t nghi\u00ean c\u1ee9u ti\u1ebfn c\u1ee9u v\u1ec1 \u0111i\u1ec1u tr\u1ecb \u0111a qu\u1ed1c gia \u0111\u00e3 \u0111\u00e1nh gi\u00e1 m\u1ed9t ng\u01b0\u1ee1ng c\u1eaft \u0111i\u1ec1u ch\u1ec9nh theo tu\u1ed5i \u0111\u01b0\u1ee3c x\u00e1c th\u1ef1c tr\u01b0\u1edbc \u0111\u00e2y (tu\u1ed5i x 10 mg\/L, cho b\u1ec7nh nh\u00e2n \u1edf \u0111\u1ed9 tu\u1ed5i &gt;50) trong m\u1ed9t nh\u00f3m nghi\u00ean c\u1ee9u g\u1ed3m 3346 b\u1ec7nh nh\u00e2n. B\u1ec7nh nh\u00e2n c\u00f3 gi\u00e1 tr\u1ecb D-dimer \u0111i\u1ec1u ch\u1ec9nh theo tu\u1ed5i b\u00ecnh th\u01b0\u1eddng th\u00ec kh\u00f4ng l\u00e0m CTPA; h\u1ecd kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u00e0 theo d\u00f5i trong th\u1eddi gian 3 th\u00e1ng. Trong s\u1ed1 766 b\u1ec7nh nh\u00e2n \u226575 tu\u1ed5i, 673 c\u00f3 x\u00e1c su\u1ea5t l\u00e2m s\u00e0ng kh\u00f4ng cao. S\u1eed d\u1ee5ng ng\u01b0\u1ee1ng c\u1eaft D-dimer \u0111i\u1ec1u ch\u1ec9nh theo tu\u1ed5i (thay v\u00ec \u201cti\u00eau chu\u1ea9n\u201d 500 mg\/L) t\u0103ng s\u1ed1 l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 lo\u1ea1i tr\u1eeb PE t\u1eeb 6.4 l\u00ean \u0111\u1ebfn 30%, m\u00e0 kh\u00f4ng c\u00f3 k\u1ebft qu\u1ea3 \u00e2m t\u00ednh gi\u1ea3.<\/p>\n<ul>\n<li><strong><em>\u00a0<\/em>Ng\u01b0\u1ee1ng gi\u1edbi h\u1ea1n D-dimer t\u01b0\u01a1ng \u1ee9ng v\u1edbi x\u00e1c su\u1ea5t l\u00e2m s\u00e0ng\u00a0<\/strong><\/li>\n<\/ul>\n<p>M\u1ed9t th\u1eed nghi\u1ec7m ti\u1ebfn c\u1ee9u v\u1ec1 qu\u1ea3n l\u00fd \u0111\u00e3 s\u1eed d\u1ee5ng quy t\u1eafc quy\u1ebft \u0111\u1ecbnh l\u00e2m s\u00e0ng \u2018YEARS\u2019, bao g\u1ed3m ba y\u1ebfu t\u1ed1 l\u00e2m s\u00e0ng c\u1ee7a thang \u0111i\u1ec3m Wells (xem ph\u1ea7n d\u1eef li\u1ec7u b\u1ed5 sung B\u1ea3ng 1) \u2013 tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng \u0111\u1eb7c tr\u01b0ng c\u1ee7a DVT, ho ra m\u00e1u, v\u00e0 \u00edt c\u00f3 kh\u1ea3 n\u0103ng b\u1ecb b\u1ec7nh l\u00fd kh\u00e1c ngo\u00e0i PE \u2013 c\u1ed9ng v\u1edbi n\u1ed3ng \u0111\u1ed9 D-dimer. PE \u0111\u01b0\u1ee3c coi l\u00e0 lo\u1ea1i tr\u1eeb \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 l\u00e2m s\u00e0ng n\u00e0o k\u00e8m m\u1ee9c \u0111\u1ed9 D-dimer &lt;1000 ng\/mL, ho\u1eb7c \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 m\u1ed9t ho\u1eb7c nhi\u1ec1u h\u01a1n m\u1ed9t y\u1ebfu t\u1ed1 l\u00e2m s\u00e0ng k\u00e8m m\u1ee9c \u0111\u1ed9 D-dimer &lt;500 ng\/mL. T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n kh\u00e1c \u0111\u01b0\u1ee3c cho l\u00e0m CTPA. Trong s\u1ed1 2946 b\u1ec7nh nh\u00e2n (85%) m\u00e0 PE \u0111\u00e3 \u0111\u01b0\u1ee3c lo\u1ea1i tr\u1eeb v\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb, 18 [0.61%, kho\u1ea3ng tin c\u1eady 95% (CI) 0.36-0.96%] \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n VTE c\u00f3 tri\u1ec7u ch\u1ee9ng trong 3 th\u00e1ng theo d\u00f5i. Tr\u00e1nh ch\u1ec9 \u0111\u1ecbnh CTPA trong 48% b\u1ec7nh nh\u00e2n khi s\u1eed d\u1ee5ng l\u01b0\u1ee3c \u0111\u1ed3 n\u00e0y, so v\u1edbi 34% n\u1ebfu s\u1eed d\u1ee5ng thang \u0111i\u1ec3m Wells v\u00e0 ng\u01b0\u1ee1ng D-dimer c\u1ed1 \u0111\u1ecbnh l\u00e0 500 ng\/mL.<\/p>\n<ul>\n<li><em><strong>X\u00e9t nghi\u1ec7m D-dimer t\u1ea1i gi\u01b0\u1eddng<\/strong>\u00a0<\/em><\/li>\n<\/ul>\n<p>Trong m\u1ed9t s\u1ed1 t\u00ecnh hu\u1ed1ng, \u0111\u00e1ng ch\u00fa \u00fd l\u00e0 trong c\u1ed9ng \u0111\u1ed3ng ho\u1eb7c ch\u0103m s\u00f3c ban \u0111\u1ea7u, x\u00e9t nghi\u1ec7m D-dimer t\u1ea1i ch\u1ed7 c\u00f3 th\u1ec3 c\u00f3 l\u1ee3i th\u1ebf h\u01a1n so v\u1edbi vi\u1ec7c gi\u1edbi thi\u1ec7u b\u1ec7nh nh\u00e2n \u0111\u1ebfn m\u1ed9t ph\u00f2ng th\u00ed nghi\u1ec7m trung t\u00e2m \u0111\u1ec3 x\u00e9t nghi\u1ec7m D-dimer. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 \u0111\u1eb7c bi\u1ec7t \u00e1p d\u1ee5ng cho c\u00e1c v\u00f9ng s\u00e2u v\u00f9ng xa n\u01a1i vi\u1ec7c ti\u1ebfp c\u1eadn ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe b\u1ecb h\u1ea1n ch\u1ebf. Tuy nhi\u00ean, c\u00e1c x\u00e9t nghi\u1ec7m t\u1ea1i gi\u01b0\u1eddng c\u00f3 \u0111\u1ed9 nh\u1ea1y v\u00e0 gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n \u00e2m th\u1ea5p h\u01a1n so v\u1edbi D-dimer \u0111\u01b0\u1ee3c l\u00e0m trong ph\u00f2ng th\u00ed nghi\u1ec7m. Trong m\u1ed9t t\u1ed5ng quan h\u1ec7 th\u1ed1ng v\u00e0 ph\u00e2n t\u00edch g\u1ed9p, \u0111\u1ed9 nh\u1ea1y c\u1ee7a c\u00e1c x\u00e9t nghi\u1ec7m D-dimer t\u1ea1i gi\u01b0\u1eddng l\u00e0 88% (95% CI 83-92%) trong khi x\u00e9t nghi\u1ec7m D-dimer truy\u1ec1n th\u1ed1ng l\u00e0m t\u1ea1i ph\u00f2ng th\u00ed nghi\u1ec7m c\u00f3 \u0111\u1ed9 nh\u1ea1y \u00edt nh\u1ea5t 95%. Do \u0111\u00f3, ch\u1ec9 n\u00ean x\u00e9t nghi\u1ec7m D-dimer t\u1ea1i gi\u01b0\u1eddng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 x\u00e1c su\u1ea5t ti\u1ec1n c\u1eadn l\u00e2m s\u00e0ng th\u1ea5p. Trong nh\u1eefng t\u00ecnh hu\u1ed1ng n\u00e0y, PE c\u00f3 th\u1ec3 lo\u1ea1i tr\u1eeb \u1edf 46% b\u1ec7nh nh\u00e2n nghi ng\u1edd PE m\u00e0 kh\u00f4ng ti\u1ebfn h\u00e0nh l\u00e0m ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh (v\u1edbi t\u1ef7 l\u1ec7 th\u1ea5t b\u1ea1i 1.5%), nh\u01b0 \u0111\u1ec1 xu\u1ea5t c\u1ee7a m\u1ed9t nghi\u00ean c\u1ee9u ti\u1ebfn c\u1ee9u v\u1ec1 ch\u0103m s\u00f3c ban \u0111\u1ea7u t\u1ea1i H\u00e0 Lan.<\/p>\n<h3><strong>2.5. Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh m\u1ea1ch m\u00e1u ph\u1ed5i (CTPA)<\/strong><\/h3>\n<p>CTPA \u0111a \u0111\u1ea7u d\u00f2 l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u0111\u1ec3 ch\u1ee5p \u1ea3nh m\u1ea1ch m\u00e1u ph\u1ed5i \u1edf b\u1ec7nh nh\u00e2n nghi ng\u1edd c\u00f3 PE. N\u00f3 cho ph\u00e9p h\u00ecnh dung \u0111\u1ea7y \u0111\u1ee7 c\u00e1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i xu\u1ed1ng \u0111\u1ebfn m\u1ee9c \u0111\u1ed9 h\u1ea1 ph\u00e2n th\u00f9y. Nghi\u00ean c\u1ee9u ti\u1ebfn c\u1ee9u \u0111i\u1ec1u tra v\u1ec1 ch\u1ea9n \u0111o\u00e1n thuy\u00ean t\u1eafc ph\u1ed5i (PIOPED) II quan s\u00e1t \u0111\u1ed9 nh\u1ea1y 83% v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 96% \u0111\u1ed1i v\u1edbi CTPA (\u0111a ph\u1ea7n l\u00e0 b\u1ed1n \u0111\u1ea7u d\u00f2) trong ch\u1ea9n \u0111o\u00e1n PE. PIOPED II c\u0169ng nh\u1ea5n m\u1ea1nh t\u1ea7m \u1ea3nh h\u01b0\u1edfng c\u1ee7a x\u00e1c su\u1ea5t l\u00e2m s\u00e0ng tr\u01b0\u1edbc khi c\u00f3 c\u1eadn l\u00e2m s\u00e0ng v\u1ec1 gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n c\u1ee7a CTPA \u0111a \u0111\u1ea7u d\u00f2. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 x\u00e1c su\u1ea5t l\u00e2m s\u00e0ng PE th\u1ea5p ho\u1eb7c trung b\u00ecnh, CTPA \u00e2m t\u00ednh c\u00f3 gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n \u00e2m cho PE cao (t\u01b0\u01a1ng \u1ee9ng 96 v\u00e0 89%), nh\u01b0ng gi\u00e1 tr\u1ecb d\u1ef1 \u0111o\u00e1n \u00e2m c\u1ee7a n\u00f3 ch\u1ec9 l\u00e0 60% n\u1ebfu x\u00e1c su\u1ea5t ti\u1ec1n c\u1eadn l\u00e2m s\u00e0ng cao. Ng\u01b0\u1ee3c l\u1ea1i, gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n d\u01b0\u01a1ng c\u1ee7a CTPA d\u01b0\u01a1ng t\u00ednh l\u00e0 cao (92-96%) \u1edf b\u1ec7nh nh\u00e2n c\u00f3 x\u00e1c su\u1ea5t l\u00e2m s\u00e0ng trung b\u00ecnh ho\u1eb7c cao, nh\u01b0ng th\u1ea5p h\u01a1n nhi\u1ec1u (58%) \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 kh\u1ea3 n\u0103ng PE ti\u1ec1n c\u1eadn l\u00e2m s\u00e0ng th\u1ea5p. Do \u0111\u00f3, c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng n\u00ean xem x\u00e9t th\u00eam nh\u1eefng c\u1eadn l\u00e2m s\u00e0ng kh\u00e1c trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng t\u01b0\u01a1ng \u0111\u1ed3ng gi\u1eefa \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng v\u00e0 k\u1ebft qu\u1ea3 CTPA. Nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u00e3 cung c\u1ea5p b\u1eb1ng ch\u1ee9ng \u1ee7ng h\u1ed9 CTPA nh\u01b0 l\u00e0 m\u1ed9t c\u1eadn l\u00e2m s\u00e0ng h\u00ecnh \u1ea3nh \u0111\u01a1n \u0111\u1ed9c \u0111\u1ec3 lo\u1ea1i tr\u1eeb PE. K\u1ebft h\u1ee3p l\u1ea1i v\u1edbi nhau, d\u1eef li\u1ec7u hi\u1ec7n c\u00f3 cho th\u1ea5y k\u1ebft qu\u1ea3 CTPA \u00e2m t\u00ednh l\u00e0 m\u1ed9t ti\u00eau ch\u00ed \u0111\u1ea7y \u0111\u1ee7 \u0111\u1ec3 lo\u1ea1i tr\u1eeb PE \u1edf b\u1ec7nh nh\u00e2n x\u00e1c su\u1ea5t PE l\u00e2m s\u00e0ng th\u1ea5p ho\u1eb7c trung b\u00ecnh.<\/p>\n<p>M\u1eb7t kh\u00e1c, n\u00f3 v\u1eabn c\u00f2n g\u00e2y tranh c\u00e3i r\u1eb1ng li\u1ec7u b\u1ec7nh nh\u00e2n c\u00f3 CTPA \u00e2m t\u00ednh v\u00e0 x\u00e1c su\u1ea5t l\u00e2m s\u00e0ng cao c\u00f3 c\u1ea7n th\u00eam c\u1eadn l\u00e2m s\u00e0ng hay kh\u00f4ng. T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i do thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i m\u1ea1n t\u00ednh (CTEPH) l\u00e0 m\u1ed9t di ch\u1ee9ng mu\u1ed9n c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y t\u1eed vong c\u1ee7a PE, nh\u01b0ng kh\u00f4ng n\u00ean b\u1ecf s\u00f3t CTEPH \u0111\u00e3 t\u1ed3n t\u1ea1i t\u1eeb tr\u01b0\u1edbc \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nghi ng\u1edd PE c\u1ea5p t\u00ednh. C\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a CTEPH\u00a0 hi\u1ec7n c\u00f3 tr\u00ean CTPA \u0111\u01b0\u1ee3c li\u1ec7t k\u00ea trong d\u1eef li\u1ec7u b\u1ed5 sung B\u1ea3ng 2; ch\u1ea9n \u0111o\u00e1n v\u00e0 qu\u1ea3n l\u00fd CTEPH \u0111\u01b0\u1ee3c th\u1ea3o lu\u1eadn trong ph\u1ea7n 10. Nh\u1eefng \u0111i\u1ec3m m\u1ea1nh, \u0111i\u1ec3m y\u1ebfu\/h\u1ea1n ch\u1ebf v\u00e0 v\u1ea5n \u0111\u1ec1 b\u1ee9c x\u1ea1 li\u00ean quan \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng CTPA trong ch\u1ea9n \u0111o\u00e1n PE \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft trong B\u1ea3ng 6<\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"aligncenter size-full wp-image-31268\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-589.png\" sizes=\"(max-width: 550px) 100vw, 550px\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-589.png 550w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-589-238x300.png 238w\" alt=\"chan-doan-hinh-anh-thuyen-tac-phoi\" width=\"550\" height=\"694\" \/><\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"aligncenter size-full wp-image-31269\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-590.png\" sizes=\"(max-width: 551px) 100vw, 551px\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-590.png 551w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-590-300x213.png 300w\" alt=\"\" width=\"551\" height=\"391\" \/><\/p>\n<h3><strong>2.6. X\u1ea1 h\u00ecnh ph\u1ed5i<\/strong><\/h3>\n<p>X\u1ea1 h\u00ecnh th\u00f4ng kh\u00ed\/t\u01b0\u1edbi m\u00e1u [V\/Q (x\u1ea1 h\u00ecnh ph\u1ed5i)] l\u00e0 m\u1ed9t c\u1eadn l\u00e2m s\u00e0ng th\u00f4ng d\u1ee5ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n khi nghi ng\u1edd PE. X\u1ea1 h\u00ecnh t\u01b0\u1edbi m\u00e1u \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p v\u1edbi c\u00e1c nghi\u00ean c\u1ee9u th\u00f4ng kh\u00ed, trong \u0111\u00f3 c\u00f3 nhi\u1ec1u ch\u1ea5t theo d\u00f5i nh\u01b0 kh\u00ed xenon-133, kh\u00ed krypton-81, kh\u00ed dung \u0111\u00e1nh d\u1ea5u technetium-99m, ho\u1eb7c c\u00e1c vi h\u1ea1t carbon \u0111\u01b0\u1ee3c \u0111\u00e1nh d\u1ea5u Technetium-99m (Technegas) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng. M\u1ee5c \u0111\u00edch c\u1ee7a x\u1ea1 h\u00ecnh th\u00f4ng kh\u00ed l\u00e0 \u0111\u1ec3 t\u0103ng \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u: trong PE c\u1ea5p t\u00ednh, th\u00f4ng kh\u00ed \u0111\u01b0\u1ee3c d\u1ef1 ki\u1ebfn l\u00e0 b\u00ecnh th\u01b0\u1eddng \u1edf c\u00e1c th\u00f9y gi\u1ea3m t\u01b0\u1edbi m\u00e1u (b\u1ea5t t\u01b0\u01a1ng h\u1ee3p). V\u00ec l\u00e0 th\u1ee7 thu\u1eadt c\u00f3 b\u1ee9c x\u1ea1 th\u1ea5p h\u01a1n v\u00e0 ti\u1ebft ki\u1ec7m ch\u1ea5t c\u1ea3n quang, x\u1ea1 h\u00ecnh V\/Q c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng t\u1ed1t h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n ngo\u1ea1i tr\u00fa c\u00f3 x\u00e1c su\u1ea5t l\u00e2m s\u00e0ng th\u1ea5p v\u00e0 X-quang ng\u1ef1c b\u00ecnh th\u01b0\u1eddng, \u1edf b\u1ec7nh nh\u00e2n tr\u1ebb (\u0111\u1eb7c bi\u1ec7t l\u00e0 n\u1eef), \u1edf ph\u1ee5 n\u1eef c\u00f3 thai, \u1edf b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed ph\u1ea3n v\u1ec7 v\u1edbi ch\u1ea5t c\u1ea3n quang v\u00e0 b\u1ec7nh nh\u00e2n suy th\u1eadn n\u1eb7ng.<\/p>\n<p>K\u1ebft qu\u1ea3 x\u1ea1 h\u00ecnh ph\u1ed5i th\u01b0\u1eddng \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i theo c\u00e1c ti\u00eau ch\u00ed \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp trong nghi\u00ean c\u1ee9u PIOPED. Nh\u1eefng ti\u00eau ch\u00ed n\u00e0y l\u00e0 ch\u1ee7 \u0111\u1ec1 g\u00e2y tranh c\u00e3i v\u00e0 \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eeda \u0111\u1ed5i. \u0110\u1ec3 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n trao \u0111\u1ed5i v\u1edbi b\u00e1c s\u0129 l\u00e2m s\u00e0ng, n\u00ean \u01b0u ti\u00ean s\u1eed d\u1ee5ng ba nh\u00f3m ph\u00e2n lo\u1ea1i: x\u1ea1 h\u00ecnh b\u00ecnh th\u01b0\u1eddng (lo\u1ea1i tr\u1eeb PE), x\u1ea1 h\u00ecnh x\u00e1c su\u1ea5t cao (\u0111\u01b0\u1ee3c coi l\u00e0 ch\u1ea9n \u0111o\u00e1n PE \u1edf h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n) v\u00e0 x\u1ea1 h\u00ecnh kh\u00f4ng ch\u1ea9n \u0111o\u00e1n. Nghi\u00ean c\u1ee9u ti\u1ebfn c\u1ee9u k\u1ebft c\u1ee5c l\u00e2m s\u00e0ng cho th\u1ea5y an to\u00e0n khi kh\u00f4ng \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng m\u00e1u \u1edf b\u1ec7nh nh\u00e2n x\u1ea1 h\u00ecnh t\u01b0\u1edbi m\u00e1u b\u00ecnh th\u01b0\u1eddng. \u0110i\u1ec1u n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn b\u1edfi m\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean so s\u00e1nh x\u1ea1 h\u00ecnh V\/Q v\u1edbi CTPA. M\u1ed9t ph\u00e2n t\u00edch t\u1eeb nghi\u00ean c\u1ee9u PIOPED II cho th\u1ea5y r\u1eb1ng x\u1ea1 h\u00ecnh V\/Q x\u00e1c su\u1ea5t cao c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh PE, m\u1eb7c d\u00f9 c\u00e1c ngu\u1ed3n kh\u00e1c cho th\u1ea5y gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n d\u01b0\u01a1ng c\u1ee7a x\u1ea1 h\u00ecnh ph\u1ed5i x\u00e1c su\u1ea5t cao l\u00e0 kh\u00f4ng \u0111\u1ee7 \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh PE \u1edf b\u1ec7nh nh\u00e2n x\u00e1c su\u1ea5t l\u00e2m s\u00e0ng th\u1ea5p. C\u00f3 th\u1ec3 ch\u1ea5p nh\u1eadn ch\u1ec9 th\u1ef1c hi\u1ec7n x\u1ea1 h\u00ecnh t\u01b0\u1edbi m\u00e1u \u1edf b\u1ec7nh nh\u00e2n c\u00f3 X-quang ng\u1ef1c b\u00ecnh th\u01b0\u1eddng; b\u1ea5t k\u1ef3 khi\u1ebfm khuy\u1ebft t\u01b0\u1edbi m\u00e1u n\u00e0o trong tr\u01b0\u1eddng h\u1ee3p \u0111\u00f3 \u0111\u1ec1u \u0111\u01b0\u1ee3c coi l\u00e0 b\u1ea5t t\u01b0\u01a1ng h\u1ee3p. Nh\u01b0ng x\u1ea1 h\u00ecnh kh\u00f4ng ch\u1ea9n \u0111o\u00e1n l\u1ea1i th\u01b0\u1eddng g\u1eb7p v\u00e0 l\u00e0 m\u1ed9t \u0111i\u1ec3m y\u1ebfu v\u00ec \u0111i\u1ec1u \u0111\u00f3 cho th\u1ea5y c\u1ea7n ph\u1ea3i l\u00e0m th\u00eam c\u1eadn l\u00e2m s\u00e0ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n.<\/p>\n<p>Nhi\u1ec1u chi\u1ebfn l\u01b0\u1ee3c kh\u00e1c nhau \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t \u0111\u1ec3 kh\u1eafc ph\u1ee5c v\u1ea5n \u0111\u1ec1 n\u00e0y, \u0111\u00e1ng ch\u00fa \u00fd l\u00e0 vi\u1ec7c k\u1ebft h\u1ee3p x\u00e1c su\u1ea5t l\u00e2m s\u00e0ng. M\u1eb7c d\u00f9 vi\u1ec7c s\u1eed d\u1ee5ng x\u1ea1 h\u00ecnh t\u01b0\u1edbi m\u00e1u v\u00e0 ch\u1ee5p X-quang ng\u1ef1c v\u1edbi ti\u00eau chu\u1ea9n c\u1ee7a Nghi\u00ean c\u1ee9u ti\u1ebfn c\u1ee9u v\u1ec1 ch\u1ea9n \u0111o\u00e1n Thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p t\u00ednh (PISAPED) c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn t\u1ef7 su\u1ea5t k\u1ebft qu\u1ea3 kh\u00f4ng k\u1ebft lu\u1eadn th\u1ea5p, nh\u01b0ng \u0111\u1ed9 nh\u1ea1y l\u1ea1i qu\u00e1 th\u1ea5p \u0111\u1ec3 lo\u1ea1i tr\u1eeb PE v\u00e0 do \u0111\u00f3 ph\u01b0\u01a1ng ph\u00e1p n\u00e0y c\u00f3 th\u1ec3 k\u00e9m an to\u00e0n h\u01a1n CTPA. Nhi\u1ec1u nghi\u00ean c\u1ee9u cho th\u1ea5y vi\u1ec7c thu th\u1eadp d\u1eef li\u1ec7u trong h\u00ecnh \u1ea3nh<a href=\"https:\/\/vinmec.com\/vi\/ung-buou-xa-tri\/thong-tin-suc-khoe\/ky-thuat-xa-hinh-danh-gia-chuc-nang-voi-spectct-tai-benh-vien-da-khoa-quoc-te-vinmec-times-city\/?link_type=related_posts\"> CT ph\u00e1t x\u1ea1 \u0111\u01a1n photon (SPECT)<\/a>, c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 CT li\u1ec1u th\u1ea5p, c\u00f3 th\u1ec3 gi\u1ea3m t\u1ef7 l\u1ec7 x\u1ea1 h\u00ecnh kh\u00f4ng ch\u1ea9n \u0111o\u00e1n xu\u1ed1ng m\u1ee9c th\u1ea5p \u0111\u1ebfn 0-5%. Tuy nhi\u00ean, h\u1ea7u h\u1ebft c\u00e1c nghi\u00ean c\u1ee9u b\u00e1o c\u00e1o v\u1ec1 \u0111\u1ed9 ch\u00ednh x\u00e1c SPECT b\u1ecb gi\u1edbi h\u1ea1n b\u1edfi thi\u1ebft k\u1ebf h\u1ed3i c\u1ee9u c\u1ee7a ch\u00fang ho\u1eb7c do bao g\u1ed3m ch\u00ednh SPECT trong ti\u00eau chu\u1ea9n tham chi\u1ebfu, v\u00e0 ch\u1ec9 c\u00f3 m\u1ed9t nghi\u00ean c\u1ee9u \u0111\u00e3 s\u1eed d\u1ee5ng l\u01b0u \u0111\u1ed3 ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c x\u00e1c th\u1ef1c. C\u00e1c ti\u00eau ch\u00ed ch\u1ea9n \u0111o\u00e1n b\u1eb1ng SPECT c\u0169ng \u0111a d\u1ea1ng; h\u1ea7u h\u1ebft c\u00e1c nghi\u00ean c\u1ee9u \u0111\u1ecbnh ngh\u0129a PE l\u00e0 m\u1ed9t ho\u1eb7c hai khi\u1ebfm khuy\u1ebft t\u01b0\u1edbi m\u00e1u h\u1ea1 ph\u00e2n th\u00f9y m\u00e0 kh\u00f4ng c\u00f3 gi\u1ea3m th\u00f4ng kh\u00ed, nh\u01b0ng c\u00e1c ti\u00eau ch\u00ed n\u00e0y \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng kh\u00f4ng th\u01b0\u1eddng xuy\u00ean trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng.<\/p>\n<p>Ngo\u00e0i ra, v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c k\u1ef9 thu\u1eadt qu\u00e9t n\u00e0o l\u00e0 t\u1ed1i \u01b0u (t\u01b0\u1edbi m\u00e1u SPECT, SPECT V\/Q, t\u01b0\u1edbi m\u00e1u SPECT v\u1edbi CT kh\u00f4ng t\u0103ng c\u01b0\u1eddng ho\u1eb7c V\/Q SPECT v\u1edbi CT kh\u00f4ng t\u0103ng c\u01b0\u1eddng). Cu\u1ed1i c\u00f9ng, hi\u1ec7n c\u00f3 r\u1ea5t \u00edt k\u1ebft c\u1ee5c nghi\u00ean c\u1ee9u \u0111\u00e3 c\u00f3, v\u00e0 v\u1edbi s\u1ef1 theo d\u00f5i kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7. C\u00e1c nghi\u00ean c\u1ee9u tri\u1ec3n v\u1ecdng quy m\u00f4 l\u1edbn l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 x\u00e1c th\u1ef1c c\u00e1c k\u1ef9 thu\u1eadt SPECT. Nh\u1eefng \u0111i\u1ec3m m\u1ea1nh, \u0111i\u1ec3m y\u1ebfu\/h\u1ea1n ch\u1ebf v\u00e0 v\u1ea5n \u0111\u1ec1 b\u1ee9c x\u1ea1 li\u00ean quan \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng x\u1ea1 h\u00ecnh V\/Q v\u00e0 V\/Q SPECT trong ch\u1ea9n \u0111o\u00e1n PE \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft trong B\u1ea3ng 6.<\/p>\n<h3><strong>2.7. <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/cac-phuong-phap-chup-x-quang-phoi-va-nhung-dieu-ban-can-biet\/\">Ch\u1ee5p X quang \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i<\/a><\/strong><\/h3>\n<p>Trong nhi\u1ec1u th\u1eadp k\u1ef7, ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i l\u00e0 \u2018ti\u00eau chu\u1ea9n v\u00e0ng\u2019 \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n ho\u1eb7c lo\u1ea1i tr\u1eeb PE c\u1ea5p t\u00ednh, nh\u01b0ng hi\u1ec7n nay hi\u1ebfm khi \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n v\u00ec CTPA \u00edt x\u00e2m l\u1ea5n cung c\u1ea5p ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c t\u01b0\u01a1ng t\u1ef1. Ch\u1ea9n \u0111o\u00e1n PE c\u1ea5p t\u00ednh d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng tr\u1ef1c ti\u1ebfp c\u1ee7a huy\u1ebft kh\u1ed1i trong hai t\u00ecnh hu\u1ed1ng, ho\u1eb7c l\u00e0 c\u00f3 kh\u1ed1i cho\u00e1n ch\u1ed7 m\u1ed9t ph\u1ea7n trong l\u00f2ng m\u1ea1ch m\u00e1u, ho\u1eb7c nh\u00e1nh \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u1eaft c\u1ee5t. Huy\u1ebft kh\u1ed1i nh\u1ecf kho\u1ea3ng 1-2 mm trong c\u00e1c \u0111\u1ed9ng m\u1ea1ch h\u1ea1 ph\u00e2n th\u00f9y c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c b\u1eb1ng ch\u1ee5p m\u1ea1ch s\u1ed1 h\u00f3a x\u00f3a n\u1ec1n (DSA), nh\u01b0ng c\u00f3 s\u1ef1 kh\u00e1c nhau \u0111\u00e1ng k\u1ec3 gi\u1eefa nh\u1eefng ng\u01b0\u1eddi \u0111\u1ecdc k\u1ebft qu\u1ea3 n\u00e0y.<\/p>\n<p>Ch\u1ee5p X-quang m\u1ea1ch ph\u1ed5i kh\u00f4ng ph\u1ea3i l\u00e0 kh\u00f4ng c\u00f3 r\u1ee7i ro. Trong m\u1ed9t nghi\u00ean c\u1ee9u v\u1edbi 1111 b\u1ec7nh nh\u00e2n, t\u1ef7 l\u1ec7 t\u1eed vong li\u00ean quan \u0111\u1ebfn ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i l\u00e0 0.5%, bi\u1ebfn ch\u1ee9ng l\u1edbn kh\u00f4ng g\u00e2y t\u1eed vong l\u00e0 1% v\u00e0 bi\u1ebfn ch\u1ee9ng nh\u1ecf l\u00e0 5%. Ph\u1ea7n l\u1edbn c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u1eed vong x\u1ea3y ra \u1edf b\u1ec7nh nh\u00e2n c\u00f3 huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh ho\u1eb7c suy h\u00f4 h\u1ea5p. L\u01b0\u1ee3ng ch\u1ea5t c\u1ea3n quang n\u00ean gi\u1ea3m v\u00e0 tr\u00e1nh ti\u00eam kh\u00f4ng ch\u1ecdn l\u1ecdc \u1edf b\u1ec7nh nh\u00e2n c\u00f3 huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh. Nh\u1eefng \u0111i\u1ec3m m\u1ea1nh, \u0111i\u1ec3m y\u1ebfu\/h\u1ea1n ch\u1ebf v\u00e0 v\u1ea5n \u0111\u1ec1 b\u1ee9c x\u1ea1 li\u00ean quan \u0111\u1ebfn vi\u1ec7c ch\u1ee5p m\u1ea1ch ph\u1ed5i trong ch\u1ea9n \u0111o\u00e1n PE \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft trong B\u1ea3ng 6<\/p>\n<h3><strong>2.8. <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/chup-cong-huong-tu-giup-danh-gia-chi-tiet-ton-thuong-mach-mau\/\">Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb m\u1ea1ch m\u00e1u\u00a0<\/a><\/strong><\/h3>\n<p>Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb m\u1ea1ch m\u00e1u (MRA) \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 trong nhi\u1ec1u n\u0103m li\u00ean quan \u0111\u1ebfn nghi ng\u1edd PE. Tuy nhi\u00ean, k\u1ebft qu\u1ea3 c\u1ee7a c\u00e1c nghi\u00ean c\u1ee9u quy m\u00f4 l\u1edbn cho th\u1ea5y k\u1ef9 thu\u1eadt n\u00e0y, m\u1eb7c d\u00f9 \u0111\u1ea7y h\u1ee9a h\u1eb9n, v\u1eabn ch\u01b0a s\u1eb5n s\u00e0ng cho th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng do \u0111\u1ed9 nh\u1ea1y th\u1ea5p, t\u1ef7 l\u1ec7 MRA kh\u00f4ng k\u1ebft lu\u1eadn cao v\u00e0 kh\u00f4ng c\u00f3 s\u1eb5n \u1edf nhi\u1ec1u n\u01a1i c\u1ea5p c\u1ee9u. Gi\u1ea3 thuy\u1ebft r\u1eb1ng MRA \u00e2m t\u00ednh, k\u1ebft h\u1ee3p v\u1edbi DVT \u0111o\u1ea1n g\u1ea7n \u00e2m t\u00ednh tr\u00ean si\u00eau \u00e2m t\u0129nh m\u1ea1ch v\u1edbi nghi\u1ec7m ph\u00e1p \u1ea5n (CUS) c\u00f3 th\u1ec3 lo\u1ea1i tr\u1eeb PE c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng m\u1ed9t c\u00e1ch an to\u00e0n hi\u1ec7n v\u1eabn c\u00f2n \u0111ang ti\u1ebfp t\u1ee5c nghi\u00ean c\u1ee9u trong m\u1ed9t nghi\u00ean c\u1ee9u k\u1ebft c\u1ee5c \u0111a trung t\u00e2m \u0111ang th\u1ef1c hi\u1ec7n [Clinicaltrials.gov Th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng qu\u1ed1c gia (NCT) s\u1ed1 02059551].<\/p>\n<h3><a href=\"https:\/\/www.vinmec.com\/vi\/tim-mach\/thong-tin-suc-khoe\/nhung-dieu-can-biet-ve-sieu-am-tim\/\"><strong>2.9. Si\u00eau \u00e2m tim<\/strong><\/a><\/h3>\n<p>PE c\u1ea5p t\u00ednh c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn qu\u00e1 t\u1ea3i \u00e1p l\u1ef1c v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV, m\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n b\u1eb1ng si\u00eau \u00e2m tim. Do h\u00ecnh h\u1ecdc \u0111\u1eb7c th\u00f9 c\u1ee7a RV, kh\u00f4ng c\u00f3 th\u00f4ng s\u1ed1 si\u00eau \u00e2m tim ri\u00eang l\u1ebb n\u00e0o c\u00f3 th\u1ec3 cung c\u1ea5p th\u00f4ng tin nhanh ch\u00f3ng v\u00e0 \u0111\u00e1ng tin c\u1eady v\u1ec1 k\u00edch th\u01b0\u1edbc ho\u1eb7c ch\u1ee9c n\u0103ng RV. \u0110\u00e2y l\u00e0 l\u00fd do t\u1ea1i sao ti\u00eau chu\u1ea9n si\u00eau \u00e2m tim \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n PE l\u1ea1i kh\u00e1c nhau gi\u1eefa c\u00e1c nghi\u00ean c\u1ee9u. V\u00ec gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n \u00e2m l\u00e0 40-50%, n\u00ean k\u1ebft qu\u1ea3 \u00e2m t\u00ednh kh\u00f4ng th\u1ec3 lo\u1ea1i tr\u1eeb PE. M\u1eb7t kh\u00e1c, c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a qu\u00e1 t\u1ea3i ho\u1eb7c r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y khi kh\u00f4ng c\u00f3 PE c\u1ea5p t\u00ednh, m\u00e0 c\u00f3 th\u1ec3 l\u00e0 do b\u1ec7nh tim ho\u1eb7c b\u1ec7nh h\u00f4 h\u1ea5p \u0111i k\u00e8m. K\u1ebft qu\u1ea3 si\u00eau \u00e2m tim c\u1ee7a qu\u00e1 t\u1ea3i v\u00e0\/ho\u1eb7c r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y b\u1eb1ng h\u00ecnh \u1ea3nh trong H\u00ecnh 3. Th\u1ea5t ph\u1ea3i gi\u00e3n \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y trong \u226525% b\u1ec7nh nh\u00e2n c\u00f3 PE tr\u00ean si\u00eau \u00e2m tim qua th\u00e0nh ng\u1ef1c (TTE) v\u00e0 r\u1ea5t h\u1eefu \u00edch trong ph\u00e2n t\u1ea7ng nguy c\u01a1 c\u1ee7a b\u1ec7nh.<\/p>\n<p>K\u1ebft qu\u1ea3 si\u00eau \u00e2m tim chi ti\u1ebft h\u01a1n \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u0111\u1ec3 gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n d\u01b0\u01a1ng cao cho PE ngay c\u1ea3 khi c\u00f3 b\u1ec7nh h\u00f4 h\u1ea5p, tim m\u1ea1ch tr\u01b0\u1edbc \u0111\u00f3. Do \u0111\u00f3, s\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a th\u1eddi gian gia t\u1ed1c t\u1ed1ng m\u00e1u ph\u1ed5i (\u0111\u01b0\u1ee3c \u0111o \u1edf bu\u1ed3ng t\u1ed1ng th\u1ea5t ph\u1ea3i) &lt;60 ms v\u1edbi \u0111\u1ed9 ch\u00eanh \u00e1p t\u00e2m thu t\u1ed1i \u0111a qua van ba l\u00e1 &lt;60 mmHg (d\u1ea5u hi\u1ec7u \u201860\/60\u2019), ho\u1eb7c gi\u1ea3m v\u1eadn \u0111\u1ed9ng th\u00e0nh t\u1ef1 do th\u1ea5t ph\u1ea3i, trong khi m\u1ecfm th\u1ea5t ph\u1ea3i v\u1eabn v\u1eadn \u0111\u1ed9ng b\u00ecnh th\u01b0\u1eddng (d\u1ea5u hi\u1ec7u McConnell), l\u00e0 g\u1ee3i \u00fd c\u1ee7a PE. Tuy nhi\u00ean, nh\u1eefng h\u00ecnh \u1ea3nh n\u00e0y ch\u1ec9 xu\u1ea5t hi\u1ec7n l\u1ea7n l\u01b0\u1ee3t \u1edf ~12 v\u00e0 20% b\u1ec7nh nh\u00e2n PE kh\u00f4ng ch\u1ecdn l\u1ecdc. Ph\u00e1t hi\u1ec7n c\u00e1c h\u00ecnh \u1ea3nh si\u00eau \u00e2m tim c\u1ee7a\u00a0 qu\u00e1 t\u1ea3i \u00e1p l\u1ef1c RV gi\u00fap ph\u00e2n bi\u1ec7t PE c\u1ea5p t\u00ednh v\u1edbi gi\u1ea3m \u0111\u1ed9ng ho\u1eb7c v\u00f4 \u0111\u1ed9ng th\u00e0nh t\u1ef1 do RV do nh\u1ed3i m\u00e1u RV, d\u1ea5u hi\u1ec7u b\u1eaft ch\u01b0\u1edbc McConnell. C\u1ea7n l\u01b0u \u00fd r\u1eb1ng trong ~10% b\u1ec7nh nh\u00e2n PE, si\u00eau \u00e2m tim c\u00f3 th\u1ec3 cho th\u1ea5y c\u00e1c ph\u00e1t hi\u1ec7n ng\u1eabu nhi\u00ean c\u00f3 th\u1ec3 g\u00e2y hi\u1ec3u l\u1ea7m nh\u01b0 r\u1ed1i lo\u1ea1n \u0111\u00e1ng k\u1ec3 ch\u1ee9c n\u0103ng t\u00e2m thu LV ho\u1eb7c b\u1ec7nh van tim. Gi\u1ea3m s\u1ef1 d\u1ecbch chuy\u1ec3n v\u00f2ng van ba l\u00e1 trong th\u00ec t\u00e2m thu (TAPSE) c\u0169ng c\u00f3 th\u1ec3 th\u1ea5y \u1edf b\u1ec7nh nh\u00e2n thuy\u00ean t\u1eafc ph\u1ed5i. Th\u00f4ng s\u1ed1 si\u00eau \u00e2m tim v\u1ec1 ch\u1ee9c n\u0103ng RV c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb h\u00ecnh \u1ea3nh Doppler m\u00f4 v\u00e0 \u0111\u00e1nh gi\u00e1 s\u1ef1 c\u0103ng th\u00e0nh c\u0169ng c\u00f3 th\u1ec3 b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a PE c\u1ea5p t\u00ednh (H\u00ecnh 3). Tuy nhi\u00ean, si\u00eau \u00e2m tim v\u1ec1 ch\u1ee9c n\u0103ng RV c\u00f3 th\u1ec3 c\u00f3 \u0111\u1ed9 nh\u1ea1y th\u1ea5p n\u1ebfu s\u1eed d\u1ee5ng ri\u00eang l\u1ebd, v\u00ec ch\u00fang \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u00e0 b\u00ecnh th\u01b0\u1eddng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n PE c\u00f3 huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh.<\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"aligncenter size-full wp-image-31271\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-591.png\" sizes=\"(max-width: 537px) 100vw, 537px\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-591.png 537w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-591-300x275.png 300w\" alt=\"sieu-am-tim-qua-thanh-nguc-danh-gia-qua-tai-ap-luc\" width=\"537\" height=\"492\" \/><\/p>\n<p>Ki\u1ec3m tra b\u1eb1ng si\u00eau \u00e2m tim l\u00e0 kh\u00f4ng b\u1eaft bu\u1ed9c nh\u01b0 l\u00e0 m\u1ed9t ph\u1ea7n c\u1ee7a ch\u1ea9n \u0111o\u00e1n th\u01b0\u1eddng quy \u1edf b\u1ec7nh nh\u00e2n nghi ng\u1edd PE c\u00f3 huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh, m\u1eb7c d\u00f9 c\u00f3 th\u1ec3 h\u1eefu \u00edch \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t trong kh\u00f3 th\u1edf c\u1ea5p. Ng\u01b0\u1ee3c l\u1ea1i th\u00ec v\u1edbi nghi ng\u1edd PE nguy c\u01a1 cao, khi kh\u00f4ng c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u qu\u00e1 t\u1ea3i ho\u1eb7c r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t ph\u1ea3i tr\u00ean si\u00eau \u00e2m tim th\u00ec g\u1ea7n nh\u01b0 c\u00f3 th\u1ec3 lo\u1ea1i tr\u1eeb PE l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng. Trong tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd PE nguy c\u01a1 cao, si\u00eau \u00e2m tim c\u00f3 th\u1ec3 gi\u00fap \u00edch th\u00eam trong ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t nguy\u00ean nh\u00e2n g\u00e2y ra s\u1ed1c, b\u1eb1ng c\u00e1ch ph\u00e1t hi\u1ec7n ch\u00e8n \u00e9p tim c\u1ea5p, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng van tim c\u1ea5p t\u00ednh, r\u1ed1i lo\u1ea1n nghi\u00eam tr\u1ecdng ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i to\u00e0n b\u1ed9 ho\u1eb7c c\u1ee5c b\u1ed9, b\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ho\u1eb7c gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n. C\u00f2n \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng v\u1edbi nghi ng\u1edd PE, khi c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u r\u00f5 r\u00e0ng c\u1ee7a t\u00ecnh tr\u1ea1ng qu\u00e1 t\u1ea3i \u00e1p l\u1ef1c th\u1ea5t ph\u1ea3i, \u0111\u1eb7c bi\u1ec7t l\u00e0 v\u1edbi c\u00e1c k\u1ebft qu\u1ea3 si\u00eau \u00e2m tim c\u1ee5 th\u1ec3 (d\u1ea5u hi\u1ec7u 60\/60, d\u1ea5u hi\u1ec7u McConnell ho\u1eb7c huy\u1ebft kh\u1ed1i tim ph\u1ea3i), l\u00e0 \u0111\u1ee7 \u1ee7ng h\u1ed9 cho \u0111i\u1ec1u tr\u1ecb PE t\u00e1i t\u01b0\u1edbi m\u00e1u c\u1ea5p c\u1ee9u n\u1ebfu ch\u1ee5p CT m\u1ea1ch m\u00e1u ngay t\u1ee9c th\u00ec l\u00e0 kh\u00f4ng kh\u1ea3 thi \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n c\u00f3 x\u00e1c su\u1ea5t l\u00e2m s\u00e0ng cao v\u00e0 kh\u00f4ng c\u00f3 nguy\u00ean nh\u00e2n r\u00f5 r\u00e0ng kh\u00e1c cho qu\u00e1 t\u1ea3i \u00e1p l\u1ef1c RV. Huy\u1ebft kh\u1ed1i di \u0111\u1ed9ng trong bu\u1ed3ng tim Ph\u1ea3i \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n b\u1eb1ng TTE ho\u1eb7c si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n (TOE) ho\u1eb7c b\u1eb1ng ch\u1ee5p CT m\u1ea1ch m\u00e1u trong &lt;4% b\u1ec7nh nh\u00e2n PE kh\u00f4ng ch\u1ecdn l\u1ecdc. T\u1ef7 su\u1ea5t l\u01b0u h\u00e0nh c\u1ee7a ch\u00fang c\u00f3 th\u1ec3 \u0111\u1ebfn 18% s\u1ed1 b\u1ec7nh nh\u00e2n PE trong ph\u00f2ng ch\u0103m s\u00f3c t\u00edch c\u1ef1c. Huy\u1ebft kh\u1ed1i di \u0111\u1ed9ng trong bu\u1ed3ng tim ph\u1ea3i v\u1ec1 c\u01a1 b\u1ea3n x\u00e1c nh\u1eadn ch\u1ea9n \u0111o\u00e1n PE v\u00e0 c\u00f3 li\u00ean quan cao \u0111\u1ebfn t\u1ef7 l\u1ec7 t\u1eed vong s\u1edbm, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV. \u1ede m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n nghi ng\u1edd PE c\u1ea5p t\u00ednh, si\u00eau \u00e2m tim c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n t\u0103ng \u0111\u1ed9 d\u00e0y th\u00e0nh RV ho\u1eb7c t\u1ed1c \u0111\u1ed9 d\u00f2ng h\u1edf kh\u00f4ng hi\u1ec7u qu\u1ea3 qua van 3 l\u00e1 v\u01b0\u1ee3t qu\u00e1 c\u00e1c gi\u00e1 tr\u1ecb t\u01b0\u01a1ng th\u00edch v\u1edbi qu\u00e1 t\u1ea3i \u00e1p l\u1ef1c RV c\u1ea5p t\u00ednh (3.8 m\/s ho\u1eb7c \u0111\u1ed9 ch\u00eanh \u00e1p t\u00e2m thu t\u1ed1i \u0111a qua van ba l\u00e1 &gt;60 mmHg). Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y, t\u0103ng \u00e1p ph\u1ed5i (PH) m\u1ea1n t\u00ednh do huy\u1ebft kh\u1ed1i (ho\u1eb7c do nguy\u00ean nh\u00e2n kh\u00e1c) n\u00ean \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t.<\/p>\n<h3><a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/thuc-hien-sieu-am-mach-chi-duoi-nhu-nao\/\"><strong>2.10. Si\u00eau \u00e2m t\u0129nh m\u1ea1ch chi d\u01b0\u1edbi v\u1edbi nghi\u1ec7m ph\u00e1p \u1ea5n (CUS)\u00a0<\/strong><\/a><\/h3>\n<p>Trong ph\u1ea7n l\u1edbn c\u00e1c tr\u01b0\u1eddng h\u1ee3p, thuy\u00ean t\u1eafc ph\u1ed5i b\u1eaft ngu\u1ed3n t\u1eeb huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u (DVT) \u1edf chi d\u01b0\u1edbi v\u00e0 r\u1ea5t hi\u1ebfm khi t\u1eeb DVT chi tr\u00ean (ch\u1ee7 y\u1ebfu l\u00e0 do \u0111\u1eb7t catheter t\u0129nh m\u1ea1ch). Trong m\u1ed9t nghi\u00ean c\u1ee9u s\u1eed d\u1ee5ng ch\u1ee5p t\u0129nh m\u1ea1ch, DVT \u0111\u00e3 \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y \u1edf 70% b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh PE. Ng\u00e0y nay, CUS chi d\u01b0\u1edbi \u0111\u00e3 thay th\u1ebf ph\u1ea7n l\u1edbn ch\u1ee5p t\u0129nh m\u1ea1ch \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n DVT. CUS c\u00f3 \u0111\u1ed9 nh\u1ea1y &gt;90% v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u ~95% cho DVT \u0111o\u1ea1n g\u1ea7n c\u00f3 tri\u1ec7u ch\u1ee9ng. CUS cho th\u1ea5y DVT trong 30-50% b\u1ec7nh nh\u00e2n m\u1eafc PE, v\u00e0 t\u00ecm th\u1ea5y DVT \u0111o\u1ea1n g\u1ea7n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nghi ng\u1edd c\u00f3 thuy\u00ean t\u1eafc ph\u1ed5i \u0111\u01b0\u1ee3c coi l\u00e0 \u0111\u1ee7 \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng m\u00e0 kh\u00f4ng c\u1ea7n l\u00e0m th\u00eam c\u1eadn l\u00e2m s\u00e0ng.<\/p>\n<p>Tuy nhi\u00ean, nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n PE gi\u00e1n ti\u1ebfp qua s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a DVT \u0111o\u1ea1n g\u1ea7n n\u00ean \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 th\u00eam nguy c\u01a1 \u0111\u1ed9 n\u1eb7ng c\u1ee7a PE v\u00e0 nguy c\u01a1 t\u1eed vong s\u1edbm. \u0110\u1ed1i v\u1edbi ti\u1ebfp c\u1eadn tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd thuy\u00ean t\u1eafc ph\u1ed5i, CUS c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c gi\u1edbi h\u1ea1n si\u00eau \u00e2m ki\u1ec3m tra b\u1ed1n \u0111i\u1ec3m \u0111\u01a1n gi\u1ea3n (h\u00e1ng hai b\u00ean v\u00e0 h\u1ed1 khoeo hai b\u00ean). Ti\u00eau ch\u00ed ch\u1ea9n \u0111o\u00e1n x\u00e1c th\u1ef1c duy nh\u1ea5t cho DVT l\u00e0 t\u0129nh m\u1ea1ch kh\u00f4ng x\u1eb9p \u0111\u01b0\u1ee3c ho\u00e0n to\u00e0n, ngh\u0129a l\u00e0 c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a huy\u1ebft kh\u1ed1i, trong khi c\u00e1c ph\u00e9p \u0111o d\u00f2ng ch\u1ea3y l\u1ea1i kh\u00f4ng \u0111\u00e1ng tin c\u1eady. K\u1ebft qu\u1ea3 CUS \u0111o\u1ea1n g\u1ea7n d\u01b0\u01a1ng t\u00ednh c\u00f3 gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n d\u01b0\u01a1ng cao cho PE. \u0110\u1ed9 \u0111\u1eb7c hi\u1ec7u ch\u1ea9n \u0111o\u00e1n cao (96%) c\u00f9ng v\u1edbi \u0111\u1ed9 nh\u1ea1y th\u1ea5p (41%) c\u1ee7a CUS trong c\u00e1ch ti\u1ebfp c\u1eadn n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c cho th\u1ea5y trong ph\u00e2n t\u00edch g\u1ed9p g\u1ea7n \u0111\u00e2y. CUS l\u00e0 m\u1ed9t th\u1ee7 thu\u1eadt h\u1eefu \u00edch trong chi\u1ebfn l\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh CT. X\u00e1c su\u1ea5t CUS \u0111o\u1ea1n g\u1ea7n d\u01b0\u01a1ng t\u00ednh th\u00ec cao h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng li\u00ean quan \u0111\u1ebfn t\u0129nh m\u1ea1ch ch\u00e2n so v\u1edbi b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng trong tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd PE. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o khoa c\u1ea5p c\u1ee9u m\u00e0 huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh v\u00e0 nghi ng\u1edd PE, s\u1ef1 k\u1ebft h\u1ee3p gi\u1eefa si\u00eau \u00e2m t\u0129nh m\u1ea1ch v\u1edbi si\u00eau \u00e2m tim c\u00f3 th\u1ec3 l\u00e0m t\u0103ng th\u00eam \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u.<\/p>\n<p>Ng\u01b0\u1ee3c l\u1ea1i, si\u00eau \u00e2m tim kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV v\u00e0 si\u00eau \u00e2m t\u0129nh m\u1ea1ch b\u00ecnh th\u01b0\u1eddng lo\u1ea1i tr\u1eeb PE c\u00f3 gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n \u00e2m cao (96%) trong m\u1ed9t nghi\u00ean c\u1ee9u. \u0110\u1ec3 bi\u1ebft th\u00eam chi ti\u1ebft v\u1ec1 ch\u1ea9n \u0111o\u00e1n v\u00e0 qu\u1ea3n l\u00fd DVT, b\u1ea1n \u0111\u1ecdc s\u1ebd tham kh\u1ea3o t\u00e0i li\u1ec7u \u0111\u1ed3ng thu\u1eadn chung c\u1ee7a ESC C\u00e1c nh\u00f3m l\u00e0m vi\u1ec7c v\u1ec1 b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean, v\u00e0 tu\u1ea7n ho\u00e0n ph\u1ed5i v\u00e0 ch\u1ee9c n\u0103ng t\u00e2m th\u1ea5t ph\u1ea3i<\/p>\n<h3><strong>2.11. Khuy\u1ebfn c\u00e1o v\u1ec1 ch\u1ea9n \u0111o\u00e1n PE<\/strong><img decoding=\"async\" loading=\"lazy\" class=\"aligncenter size-full wp-image-31272\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-592.png\" sizes=\"(max-width: 806px) 100vw, 806px\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-592.png 806w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-592-300x260.png 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-592-768x665.png 768w\" alt=\"\" width=\"806\" height=\"698\" \/><img decoding=\"async\" loading=\"lazy\" class=\"aligncenter size-full wp-image-31273\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-593.png\" sizes=\"(max-width: 454px) 100vw, 454px\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-593.png 454w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-593-195x300.png 195w\" alt=\"\" width=\"454\" height=\"699\" \/><img decoding=\"async\" loading=\"lazy\" class=\"aligncenter size-full wp-image-31274\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-594.png\" sizes=\"(max-width: 472px) 100vw, 472px\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-594.png 472w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-594-300x152.png 300w\" alt=\"\" width=\"472\" height=\"239\" \/><\/h3>\n<h3><strong>2.12. Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh t\u0129nh m\u1ea1ch<\/strong><\/h3>\n<p>Khi s\u1eed d\u1ee5ng CTPA, c\u00f3 th\u1ec3 cho th\u1ea5y h\u00ecnh \u1ea3nh c\u00e1c t\u0129nh m\u1ea1ch s\u00e2u c\u1ee7a ch\u00e2n c\u00f9ng l\u00fac v\u1edbi kh\u1ea3o s\u00e1t m\u1ea1ch m\u00e1u ph\u1ed5i. Tuy nhi\u00ean, c\u00e1ch ti\u1ebfp c\u1eadn n\u00e0y ch\u01b0a \u0111\u01b0\u1ee3c x\u00e1c th\u1ef1c r\u1ed9ng r\u00e3i v\u00e0 gi\u00e1 tr\u1ecb c\u1ee7a h\u00ecnh \u1ea3nh t\u0129nh m\u1ea1ch th\u00ec \u00edt. H\u01a1n n\u1eefa, s\u1eed d\u1ee5ng CT t\u0129nh m\u1ea1ch c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng li\u1ec1u ph\u00f3ng x\u1ea1.<\/p>\n<p>Xem th\u00eam:\u00a0<a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/cac-dau-hieu-som-cua-thuyen-tac-mach-phoi\/\">C\u00e1c d\u1ea5u hi\u1ec7u s\u1edbm c\u1ee7a thuy\u00ean t\u1eafc m\u1ea1ch ph\u1ed5i<\/a><\/p>\n<p>Video \u0111\u1ec1 xu\u1ea5t:<\/p>\n<p><iframe loading=\"lazy\" title=\"Khi n\u00e0o c\u1ea7n ch\u1ee5p PET\/CT, quy tr\u00ecnh ch\u1ee5p th\u1ebf n\u00e0o?\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/RAkaMK3Mfto?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" allowfullscreen><\/iframe><\/p>\n<p>Khi n\u00e0o c\u1ea7n ch\u1ee5p PET\/CT, quy tr\u00ecnh ch\u1ee5p nh\u01b0 th\u1ebf n\u00e0o?<\/p>\n<p>&nbsp;<\/p>\n<\/div>\n<p>&nbsp;<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>\u00a0Ch\u00fang ta \u0111ang \u1edf k\u1ef7 nguy\u00ean c\u00e1 th\u1ec3 h\u00f3a \u0111i\u1ec1u tr\u1ecb, v\u00ec v\u1eady vi\u1ec7c hi\u1ec3u s\u00e2u s\u1eafc c\u00e1c khuy\u1ebfn c\u00e1o s\u1ebd g\u00f3p ph\u1ea7n r\u1ea5t l\u1edbn \u0111\u1ea1t \u0111\u01b0\u1ee3c nh\u1eefng m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3 cho t\u1eebng b\u1ec7nh nh\u00e2n. Ch\u00fang t\u00f4i chuy\u1ec3n th\u1ec3\u00a0 c\u00e1c b\u00e0i to\u00e0n v\u0103n H\u01b0\u1edbng d\u1eabn c\u1ee7a ESC sang Ti\u1ebfng Vi\u1ec7t \u0111\u1ec3 qu\u00fd\u00a0 [&hellip;]<\/p>\n","protected":false},"author":17,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[20,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>ESC 2019 Khuy\u1ebfn c\u00e1o v\u1ec1 ch\u1ea9n \u0111o\u00e1n thuy\u00ean t\u1eafc ph\u1ed5i - Ph\u1ea7n 2<\/title>\n<meta name=\"description\" content=\"\u0110\u1ec3 qu\u00fd\u00a0 \u0111\u1ed3ng nghi\u1ec7p thu\u1eadn ti\u1ec7n h\u01a1n khi tham kh\u1ea3o, c\u1eadp nh\u1eadt trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p.\" \/>\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=\"ESC 2019 Khuy\u1ebfn c\u00e1o v\u1ec1 ch\u1ea9n \u0111o\u00e1n thuy\u00ean t\u1eafc ph\u1ed5i - Ph\u1ea7n 2\" \/>\n<meta property=\"og:description\" content=\"\u0110\u1ec3 qu\u00fd\u00a0 \u0111\u1ed3ng nghi\u1ec7p thu\u1eadn ti\u1ec7n h\u01a1n khi tham kh\u1ea3o, c\u1eadp nh\u1eadt trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/esc-2019-ve-chan-doan-va-quan-ly-thuyen-tac-phoi-cap-phan-2\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-05-07T06:33:35+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-05-18T03:41:58+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/OIP.jpg\" \/>\n<meta name=\"author\" content=\"An Huynh Phan Ngoc\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"An Huynh Phan Ngoc\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"26 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\/05\/07\/esc-2019-ve-chan-doan-va-quan-ly-thuyen-tac-phoi-cap-phan-2\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/esc-2019-ve-chan-doan-va-quan-ly-thuyen-tac-phoi-cap-phan-2\/\",\"name\":\"ESC 2019 Khuy\u1ebfn c\u00e1o v\u1ec1 ch\u1ea9n \u0111o\u00e1n thuy\u00ean t\u1eafc ph\u1ed5i - Ph\u1ea7n 2\",\"isPartOf\":{\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-05-07T06:33:35+00:00\",\"dateModified\":\"2023-05-18T03:41:58+00:00\",\"author\":{\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/106da77d14bd9697d17d477cee4fe3b8\"},\"description\":\"\u0110\u1ec3 qu\u00fd\u00a0 \u0111\u1ed3ng nghi\u1ec7p thu\u1eadn ti\u1ec7n h\u01a1n khi tham kh\u1ea3o, c\u1eadp nh\u1eadt trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p.\",\"breadcrumb\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/esc-2019-ve-chan-doan-va-quan-ly-thuyen-tac-phoi-cap-phan-2\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/esc-2019-ve-chan-doan-va-quan-ly-thuyen-tac-phoi-cap-phan-2\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/esc-2019-ve-chan-doan-va-quan-ly-thuyen-tac-phoi-cap-phan-2\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/noithathoaphat.in\/ctv\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"ESC 2019 Khuy\u1ebfn c\u00e1o v\u1ec1 ch\u1ea9n \u0111o\u00e1n thuy\u00ean t\u1eafc ph\u1ed5i &#8211; 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