{"id":31895,"date":"2023-05-05T22:06:03","date_gmt":"2023-05-05T15:06:03","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31895"},"modified":"2023-05-05T22:06:03","modified_gmt":"2023-05-05T15:06:03","slug":"loet-ban-chan-do-dai-thao-duong-cap-nhat-chan-doan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/05\/loet-ban-chan-do-dai-thao-duong-cap-nhat-chan-doan\/","title":{"rendered":"Lo\u00e9t b\u00e0n ch\u00e2n do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng: c\u1eadp nh\u1eadt ch\u1ea9n \u0111o\u00e1n"},"content":{"rendered":"

Lo\u00e9t b\u00e0n ch\u00e2n th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (\u0110T\u0110) c\u00f3 \u0111\u1ed3ng th\u1eddi hai ho\u1eb7c nhi\u1ec1u h\u01a1n y\u1ebfu t\u1ed1 nguy c\u01a1<\/a>, trong \u0111\u00f3 b\u1ec7nh l\u00fd th\u1ea7n kinh ngo\u1ea1i bi\u00ean v\u00e0 b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean th\u01b0\u1eddng \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng. Bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh d\u1eabn \u0111\u1ebfn m\u1ea5t c\u1ea3m gi\u00e1c t\u1ea1i b\u00e0n ch\u00e2n v\u00e0 \u0111\u00f4i khi b\u1ecb bi\u1ebfn d\u1ea1ng b\u00e0n ch\u00e2n. B\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean (PAD), c\u00f3 m\u1eb7t \u1edf 50% b\u1ec7nh nh\u00e2n b\u1ecb lo\u00e9t ch\u00e2n do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng. Tuy nhi\u00ean, ph\u1ea7n l\u1edbn c\u00e1c v\u1ebft lo\u00e9t \u1edf ch\u00e2n l\u00e0 do b\u1ec7nh l\u00fd th\u1ea7n kinh ho\u1eb7c b\u1ec7nh th\u1ea7n kinh – thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9.\u00a0<\/strong><\/p>\n

1. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n.<\/h2>\n

Ch\u1ea9n \u0111o\u00e1n ng\u01b0\u1eddi b\u1ec7nh c\u00f3 b\u1ec7nh l\u00fd lo\u00e9t b\u00e0n ch\u00e2n \u0110T\u0110 c\u1ea7n c\u00f3 2 ti\u00eau chu\u1ea9n sau:<\/p>\n

    \n
  • Ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n m\u1eafc \u0110T\u0110.<\/li>\n
  • C\u00f3 t\u00ecnh tr\u1ea1ng lo\u00e9t \u1edf b\u00e0n ch\u00e2n.<\/li>\n<\/ul>\n

    1.1. Ch\u1ea9n \u0111o\u00e1n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/h3>\n

    Theo H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0110T\u0110 t\u00edp 2, Quy\u1ebft \u0111\u1ecbnh s\u1ed1 5481\/Q\u0110-BYT, ng\u00e0y 30 th\u00e1ng 12 n\u0103m 2020. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n \u0110T\u0110 d\u1ef1a v\u00e0o 1 trong 4 ti\u00eau ch\u00ed sau \u0111\u00e2y:<\/p>\n

    a) Glucose huy\u1ebft t\u01b0\u01a1ng l\u00fac \u0111\u00f3i \u2265 126 mg\/dL (hay 7 mmol\/L)<\/p>\n

    b) Glucose huy\u1ebft t\u01b0\u01a1ng \u1edf th\u1eddi \u0111i\u1ec3m sau 2 gi\u1edd l\u00e0m nghi\u1ec7m ph\u00e1p dung n\u1ea1p v\u1edbi 75g glucose b\u1eb1ng \u0111\u01b0\u1eddng u\u1ed1ng \u2265 200 mg\/dL (hay 11,1 mmol\/L).<\/p>\n

    c) HbA1c \u2265 6,5% (48 mmol\/mol). X\u00e9t nghi\u1ec7m HbA1c ph\u1ea3i \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p \u0111\u00e3 chu\u1ea9n h\u00f3a theo ti\u00eau chu\u1ea9n qu\u1ed1c t\u1ebf.<\/p>\n

    d) BN c\u00f3 tri\u1ec7u ch\u1ee9ng kinh \u0111i\u1ec3n c\u1ee7a t\u0103ng glucose huy\u1ebft ho\u1eb7c c\u1ee7a c\u01a1n t\u0103ng glucose huy\u1ebft c\u1ea5p k\u00e8m m\u1ee9c glucose huy\u1ebft t\u01b0\u01a1ng b\u1ea5t k\u1ef3 \u2265 200 mg\/dL (hay 11,1 mmol\/L).<\/p>\n

    Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh n\u1ebfu c\u00f3 2 k\u1ebft qu\u1ea3 tr\u00ean ng\u01b0\u1ee1ng ch\u1ea9n \u0111o\u00e1n trong c\u00f9ng 1 m\u1eabu m\u00e1u x\u00e9t nghi\u1ec7m ho\u1eb7c \u1edf 2 th\u1eddi \u0111i\u1ec3m kh\u00e1c nhau \u0111\u1ed1i v\u1edbi ti\u00eau ch\u00ed a, b, ho\u1eb7c c; ri\u00eang ti\u00eau ch\u00ed d: ch\u1ec9 c\u1ea7n m\u1ed9t l\u1ea7n x\u00e9t nghi\u1ec7m duy nh\u1ea5t.<\/p>\n

    1.2. Ch\u1ea9n \u0111o\u00e1n v\u1ebft lo\u00e9t \u1edf b\u00e0n ch\u00e2n.<\/h3>\n

    Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n lo\u00e9t b\u00e0n ch\u00e2n<\/strong><\/p>\n

    T\u00ecnh tr\u1ea1ng lo\u00e9t \u1edf b\u00e0n ch\u00e2n \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 m\u1ea5t m\u00f4 v\u00e0\/ ho\u1eb7c ho\u1ea1i t\u1eed \u0111\u1ed9 1 tr\u1edf \u0111i theo Ph\u00e2n lo\u1ea1i Wagner \u2013 Meggitt ho\u1eb7c giai \u0111o\u1ea1n 2 tr\u1edf \u0111i theo Ph\u00e2n lo\u1ea1i\u00a0 PEDIS. Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 b\u00e0n ch\u00e2n kh\u00f4ng m\u1ea5t m\u00f4, kh\u00f4ng ho\u1ea1i t\u1eed \u1edf b\u00e0n ch\u00e2n \u0111\u01b0\u1ee3c xem l\u00e0 kh\u00f4ng lo\u00e9t.<\/p>\n

    C\u00f3 th\u1ec3 d\u1ef1a v\u00e0o m\u1ed9t trong hai ph\u00e2n lo\u1ea1i sau \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n lo\u00e9t b\u00e0n ch\u00e2n<\/p>\n

    Ph\u00e2n lo\u1ea1i lo\u00e9t b\u00e0n ch\u00e2n \u0110T\u0110 theo Wagner \u2013 Meggitt<\/h4>\n

    B\u1ea3ng 2. Ph\u00e2n lo\u1ea1i lo\u00e9t b\u00e0n ch\u00e2n \u0110T\u0110 theo Wagner \u2013 Meggitt <\/em><\/p>\n\n\n\n\n\n\n\n\n\n
    \u0110\u1ed9 <\/strong><\/td>\nTri\u1ec7u ch\u1ee9ng <\/strong><\/td>\n<\/tr>\n
    0<\/td>\nKh\u00f4ng c\u00f3 c\u00e1c v\u1ebft th\u01b0\u01a1ng h\u1edf nh\u01b0ng c\u00f3 th\u1ec3 c\u00f3 bi\u1ebfn d\u1ea1ng b\u00e0n ch\u00e2n ho\u1eb7c vi\u00eam m\u00f4 t\u1ebf b\u00e0o<\/td>\n<\/tr>\n
    1<\/td>\nV\u1ebft lo\u00e9t n\u00f4ng (1 ph\u1ea7n ho\u1eb7c to\u00e0n b\u1ed9 l\u1edbp da)<\/td>\n<\/tr>\n
    2<\/td>\nV\u1ebft lo\u00e9t s\u00e2u \u0111\u1ebfn l\u1edbp g\u00e2n ho\u1eb7c bao kh\u1edbp nh\u01b0ng kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng \u00e1p xe ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng<\/td>\n<\/tr>\n
    3<\/td>\nV\u1ebft lo\u00e9t s\u00e2u v\u1edbi \u00e1p xe, vi\u00eam t\u1ee7y x\u01b0\u01a1ng ho\u1eb7c nhi\u1ec5m tr\u00f9ng kh\u1edbp<\/td>\n<\/tr>\n
    4<\/td>\nHo\u1ea1i t\u1eed khu tr\u00fa \u1edf ng\u00f3n ch\u00e2n ho\u1eb7c g\u00f3t ch\u00e2n<\/td>\n<\/tr>\n
    5<\/td>\nHo\u1ea1i t\u1eed lan r\u1ed9ng to\u00e0n b\u1ed9 c\u1eb3ng ch\u00e2n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Ph\u00e2n lo\u1ea1i theo thang \u0111i\u1ec3m PEDIS<\/strong><\/p>\n

    Thang \u0111i\u1ec3m PEDIS d\u1ef1a tr\u00ean H\u01b0\u1edbng d\u1eabn c\u1ee7a Hi\u1ec7p h\u1ed9i b\u00e0n ch\u00e2n \u0110T\u0110 th\u1ebf gi\u1edbi n\u0103m 2019 (IWDGF \u2013 2019).<\/p>\n

    B\u1ea3ng 3. Ph\u00e2n lo\u1ea1i lo\u00e9t b\u00e0n ch\u00e2n \u0110T\u0110 theo thang \u0111i\u1ec3m PEDIS <\/em><\/p>\n\n\n\n\n\n
    Giai \u0111o\u1ea1n <\/strong><\/td>\nT\u01b0\u1edbi m\u00e1u (Perfusion) <\/strong><\/td>\nM\u1ee9c \u0111\u1ed9 (Externt) <\/strong><\/td>\n\u0110\u1ed9 s\u00e2u (Depth) <\/strong><\/td>\nNhi\u1ec5m tr\u00f9ng (Infection) <\/strong><\/td>\nC\u1ea3m gi\u00e1c (Sensation) <\/strong><\/td>\n\u0110i\u1ec3m <\/strong><\/td>\n<\/tr>\n
    1<\/td>\nKh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean, k\u00e8m v\u1edbi 1 trong\u00a0 4 d\u1ea5u hi\u1ec7u: S\u1edd \u0111\u01b0\u1ee3c m\u1ea1ch ch\u00e0y tr\u01b0\u1edbc v\u00e0 ch\u00e0y sau, ABI 0,91,10, TBI > 0,6,<\/p>\n

    TcPO2 > 60 mmHg<\/td>\n

    		Ch\u01b0a t\u1ed5n th\u01b0\u01a1ng<\/td>\nCh\u01b0a<\/p>\n

    t\u1ed5n th\u01b0\u01a1ng<\/td>\n

    		V\u1ebft th\u01b0\u01a1ng kh\u00f4ng c\u00f3 m\u1ee7 ho\u1eb7c kh\u00f4ng c\u00f3 b\u1ea5t k\u1ef3 bi\u1ec3u hi\u1ec7n vi\u00eam n\u00e0o<\/td>\nKh\u00f4ng m\u1ea5t c\u1ea3m gi\u00e1c b\u1ea3o v\u1ec7 \u1edf b\u00e0n ch\u00e2n b\u1ecb lo\u00e9t.<\/td>\n0<\/td>\n<\/tr>\n
    2<\/p>\n

    (nh\u1eb9)<\/td>\n

    		C\u00f3 b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean nh\u01b0ng thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 kh\u00f4ng nghi\u00eam tr\u1ecdng (CLI) k\u00e8m 1 trong 5 d\u1ea5u hi\u1ec7u sau: \u0110i l\u1ea1i c\u00e1ch h\u1ed3i (c\u1ea7n \u0111\u00e1nh gi\u00e1 kh\u00f4ng x\u00e2m nh\u1eadp), ABI < 0,9 nh\u01b0ng HA c\u1ed5 ch\u00e2n > 50 mmHg, TBI < 0,6 nh\u01b0ng HA t\u00e2m thu ng\u00f3n ch\u00e2n > 30 mmHg, TcPO2 30-60 mmHg, B\u1ea5t th\u01b0\u1eddng kh\u00e1c khi th\u0103m d\u00f2 kh\u00f4ng x\u00e2m nh\u1eadp ph\u00f9 h\u1ee3p v\u1edbi b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean<\/p>\n

     <\/td>\n

    		< 1cm2<\/sup><\/td>\nLo\u00e9t n\u00f4ng b\u1ec1 m\u1eb7t v\u00e0<\/p>\n

    kh\u00f4ng lan<\/p>\n

    xu\u1ed1ng l\u1edbp b\u00ec<\/td>\n

    		S\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a \u2265<\/p>\n

    2 bi\u1ec3u hi\u1ec7n vi\u00eam (c\u00f3 m\u1ee7, v\u00f9ng da \u0111\u1ecf, \u0111au, n\u00f3ng ho\u1eb7c s\u01b0ng c\u1ee9ng), nh\u01b0ng b\u1ea5t k\u1ef3 vi\u00eam m\u00f4 t\u1ebf b\u00e0o\/ban da \u0111\u1ecf n\u00e0o k\u00e9o d\u00e0i \u2264 2cm quanh v\u1ebft lo\u00e9t v\u00e0 nhi\u1ec5m tr\u00f9ng ch\u1ec9 gi\u1edbi h\u1ea1n \u1edf da ho\u1eb7c b\u1ec1 m\u1eb7t m\u00f4 d\u01b0\u1edbi da; kh\u00f4ng c\u00f3 bi\u1ebfn ch\u1ee9ng c\u1ee5c b\u1ed9 ho\u1eb7c b\u1ec7nh to\u00e0n th\u00e2n kh\u00e1c<\/td>\n

    		M\u1ea5t c\u1ea3m gi\u00e1c b\u1ea3o v\u1ec7 \u1edf b\u00e0n ch\u00e2n b\u1ecb lo\u00e9t: \u2265 \u00bd d\u1ea5u hi\u1ec7u sau: M\u1ea5t c\u1ea3m gi\u00e1c \u00e1p l\u1ef1c (s\u1ee3i \u0111\u01a1n 10g) \u1edf 2\/3 v\u1ecb tr\u00ed gan b\u00e0n ch\u00e2n.<\/p>\n

    Ho\u1eb7c m\u1ea5t c\u1ea3m gi\u00e1c rung \u00e2m thoa 128 Hz ho\u1eb7c ng\u01b0\u1ee1ng c\u1ea3m gi\u00e1c rung > 25V (k\u1ef9 thu\u1eadt b\u00e1n \u0111\u1ecbnh l\u01b0\u1ee3ng) \u1edf x\u01b0\u01a1ng b\u00e0n ng\u00f3n c\u00e1i<\/td>\n

    		1<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

     <\/p>\n\n\n\n\n\n
    Giai \u0111o\u1ea1n <\/strong><\/td>\nT\u01b0\u1edbi m\u00e1u (Perfusion) <\/strong><\/td>\nM\u1ee9c \u0111\u1ed9 (Externt) <\/strong><\/td>\n\u0110\u1ed9 s\u00e2u (Depth) <\/strong><\/td>\nNhi\u1ec5m tr\u00f9ng (Infection) <\/strong><\/td>\nC\u1ea3m gi\u00e1c (Sensation) <\/strong><\/td>\n\u0110i\u1ec3m <\/strong><\/td>\n<\/tr>\n
    3<\/p>\n

    (v\u1eeba)<\/td>\n

    		<\/td>\n1 \u2013 3 cm2 <\/sup><\/td>\nLo\u00e9t s\u00e2u qua l\u1edbp b\u00ec, lan \u0111\u1ebfn t\u1ed5 ch\u1ee9c d\u01b0\u1edbi da (c\u00e2n, c\u01a1 hay g\u00e2n)<\/td>\nNhi\u1ec5m tr\u00f9ng (nh\u01b0 tr\u00ean) \u1edf m\u1ed9t ng\u01b0\u1eddi b\u1ec7nh \u1ed5n \u0111\u1ecbnh m\u1eb7t chuy\u1ec3n h\u00f3a v\u00e0 to\u00e0n th\u00e2n nh\u01b0ng c\u00f3 \u22651 \u0111\u1eb7c \u0111i\u1ec3m sau: vi\u00eam m\u00f4 t\u1ebf b\u00e0o > 2cm, s\u1ecdc vi\u00eam b\u1ea1ch huy\u1ebft, lan r\u1ed9ng b\u00ean d\u01b0\u1edbi b\u1ec1 m\u1eb7t da, \u00e1p xe m\u00f4 s\u00e2u, ho\u1ea1i th\u01b0 v\u00e0 li\u00ean quan \u0111\u1ebfn c\u01a1, g\u00e2n, kh\u1edbp ho\u1eb7c x\u01b0\u01a1ng<\/td>\n–<\/td>\n2<\/td>\n<\/tr>\n
    4<\/p>\n

    (n\u1eb7ng)<\/td>\n

    		–<\/td>\n> 3 cm2<\/sup><\/td>\nLo\u00e9t \u1ea3nh<\/p>\n

    h\u01b0\u1edfng<\/p>\n

    \u0111\u1ebfn t\u1ea5t c\u1ea3 c\u1ea5u tr\u00fac b\u00e0n ch\u00e2n: x\u01b0\u01a1ng v\u00e0\/ho\u1eb7c kh\u1edbp (l\u1ed9 x\u01b0\u01a1ng ho\u1eb7c ch\u1ea1m x\u01b0\u01a1ng)<\/td>\n

    		Nhi\u1ec5m tr\u00f9ng \u1edf ng\u01b0\u1eddi b\u1ec7nh c\u00f3 nhi\u1ec5m \u0111\u1ed9c to\u00e0n th\u00e2n ho\u1eb7c m\u1ea5t \u1ed5n \u0111\u1ecbnh chuy\u1ec3n h\u00f3a (v\u00ed d\u1ee5 s\u1ed1t, \u1edbn l\u1ea1nh, nh\u1ecbp tim nhanh, h\u1ea1 huy\u1ebft \u00e1p, l\u00fa l\u1eabn, n\u00f4n, t\u0103ng b\u1ea1ch c\u1ea7u, nhi\u1ec5m toan, t\u0103ng glucose m\u00e1u n\u1eb7ng, ho\u1eb7c t\u0103ng ur\u00ea m\u00e1u)<\/td>\n–<\/td>\n3<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    \u0110\u00e1nh gi\u00e1:<\/strong> T\u1ed5ng \u0111i\u1ec3m \u0111\u00e1nh gi\u00e1 sau khi ph\u00e2n lo\u1ea1i c\u00e0ng l\u1edbn th\u00ec nguy c\u01a1 c\u1eaft c\u1ee5t chi c\u00e0ng cao.<\/p>\n

      \n
    • PEDIS < 7: Nguy c\u01a1 c\u1eaft c\u1ee5t chi th\u1ea5p<\/li>\n
    • PEDIS >= 7: Nguy c\u01a1 c\u1eaft c\u1ee5t chi cao<\/li>\n<\/ul>\n

      Lo\u00e9t b\u00e0n ch\u00e2n \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng th\u01b0\u1eddng di\u1ec5n ti\u1ebfn th\u00e0nh b\u1ec7nh l\u00fd m\u1ea1n t\u00ednh, li\u00ean quan \u0111\u1ebfn s\u1ef1 gia t\u0103ng stress c\u01a1 sinh h\u1ecdc, t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 c\u00e1c h\u1eadu qu\u1ea3 chuy\u1ec3n h\u00f3a c\u1ee7a n\u00f3, t\u00ecnh tr\u1ea1ng vi\u00eam k\u00e9o d\u00e0i, s\u1ef1 ch\u1ebft t\u1ebf b\u00e0o theo ch\u01b0\u01a1ng tr\u00ecnh v\u00e0 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9. C\u00e1c y\u1ebfu t\u1ed1 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn nhi\u1ec5m tr\u00f9ng b\u00e0n ch\u00e2n bao g\u1ed3m: lo\u00e9t s\u00e2u, k\u00e9o d\u00e0i ho\u1eb7c t\u00e1i ph\u00e1t ho\u1eb7c do nguy\u00ean nh\u00e2n ch\u1ea5n th\u01b0\u01a1ng; ch\u01b0a r\u00f5 c\u00e1c r\u1ed1i lo\u1ea1n mi\u1ec5n d\u1ecbch li\u00ean quan \u0111\u1ebfn b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, \u0111\u1eb7c bi\u1ec7t l\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng b\u1ea1ch c\u1ea7u trung t\u00ednh; ho\u1eb7c, suy th\u1eadn m\u1ea1n t\u00ednh.<\/p>\n

      2. Ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m tr\u00f9ng b\u00e0n ch\u00e2n \u1edf ng\u01b0\u1eddi b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/h2>\n

      2.1. X\u00e1c \u0111\u1ecbnh c\u00f3 nhi\u1ec5m tr\u00f9ng b\u00e0n ch\u00e2n<\/h3>\n

      Nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh khi c\u00f3 \u00edt nh\u1ea5t hai trong s\u1ed1 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m sau:<\/p>\n

        \n
      • S\u01b0ng ho\u1eb7c chai c\u1ee9ng t\u1ea1i ch\u1ed7<\/li>\n
      • Qu\u1ea7ng \u0111\u1ecf > 0,5 cm xung quanh v\u1ebft th\u01b0\u01a1ng<\/li>\n
      • \u0110au nh\u1ee9c t\u1ea1i ch\u1ed7<\/li>\n
      • N\u00f3ng t\u1ea1i ch\u1ed7<\/li>\n
      • Ch\u1ea3y m\u1ee7<\/li>\n<\/ul>\n

        v\u00e0 kh\u00f4ng c\u00f3 nguy\u00ean nh\u00e2n n\u00e0o kh\u00e1c g\u00e2y ra ph\u1ea3n \u1ee9ng vi\u00eam c\u1ee7a da (v\u00ed d\u1ee5 ch\u1ea5n th\u01b0\u01a1ng, b\u1ec7nh g\u00fat, b\u1ec7nh th\u1ea7n kinh x\u01b0\u01a1ng kh\u1edbp c\u1ea5p t\u00ednh, g\u00e3y x\u01b0\u01a1ng, huy\u1ebft kh\u1ed1i ho\u1eb7c \u1ee9 \u0111\u1ecdng t\u0129nh m\u1ea1ch).<\/p>\n

        2.2. Ph\u00e2n lo\u1ea1i nhi\u1ec5m tr\u00f9ng b\u00e0n ch\u00e2n.<\/h3>\n

        Nhi\u1ec5m tr\u00f9ng nh\u1eb9 (\u0111\u1ed9 2 theo ph\u00e2n lo\u1ea1i IWGDF): kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n to\u00e0n th\u00e2n (xem b\u00ean d\u01b0\u1edbi) li\u00ean quan \u0111\u1ebfn<\/p>\n

          \n
        • ph\u1ea7n da ho\u1eb7c m\u00f4 d\u01b0\u1edbi da (kh\u00f4ng ph\u1ea3i b\u1ea5t k\u1ef3 m\u00f4 s\u00e2u h\u01a1n) v\u00e0<\/li>\n
        • b\u1ea5t k\u1ef3 hi\u1ec7n t\u01b0\u1ee3ng v\u00f9ng da \u0111\u1ecf n\u00e0o kh\u00f4ng qu\u00e1 2 cm xung quanh v\u1ebft th\u01b0\u01a1ng.<\/li>\n<\/ul>\n

          Nhi\u1ec5m tr\u00f9ng trung b\u00ecnh (\u0111\u1ed9 3 theo ph\u00e2n lo\u1ea1i IWGDF): kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n to\u00e0n th\u00e2n (xem b\u00ean d\u01b0\u1edbi) v\u00e0 bao g\u1ed3m:<\/p>\n

            \n
          • Qu\u1ea7ng \u0111\u1ecf k\u00e9o d\u00e0i \u22652 cm t\u1eeb b\u1edd v\u1ebft th\u01b0\u01a1ng v\u00e0 \/ ho\u1eb7c<\/li>\n
          • Nhi\u1ec5m tr\u00f9ng m\u00f4 s\u00e2u h\u01a1n da v\u00e0 m\u00f4 d\u01b0\u1edbi da (v\u00ed d\u1ee5 g\u00e2n, c\u01a1, kh\u1edbp, x\u01b0\u01a1ng)<\/li>\n<\/ul>\n

            Nhi\u1ec5m tr\u00f9ng n\u1eb7ng (\u0111\u1ed9 4 theo ph\u00e2n lo\u1ea1i IWGDF): B\u1ea5t k\u1ef3 nhi\u1ec5m tr\u00f9ng b\u00e0n ch\u00e2n n\u00e0o v\u1edbi c\u00e1c bi\u1ec3u hi\u1ec7n to\u00e0n th\u00e2n (c\u1ee7a h\u1ed9i ch\u1ee9ng \u0111\u00e1p \u1ee9ng vi\u00eam to\u00e0n th\u00e2n [SIRS]), c\u00f3 \u22652 bi\u1ec3u hi\u1ec7n sau \u0111\u00e2y:<\/p>\n

              \n
            • Nhi\u1ec7t \u0111\u1ed9> 38 \u00b0 C ho\u1eb7c <36 \u00b0 C<\/li>\n
            • Nh\u1ecbp tim> 90 nh\u1ecbp \/ ph\u00fat<\/li>\n
            • H\u00f4 h\u1ea5p > 20 nh\u1ecbp th\u1edf \/ ph\u00fat ho\u1eb7c PaCO2 <4,3 kPa (32 mmHg)<\/li>\n
            • S\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u> 12.000\/mm3, ho\u1eb7c <4.000 \/ mm3, ho\u1eb7c> 10% ch\u01b0a tr\u01b0\u1edfng th\u00e0nh (band) t\u1ea1o th\u00e0nh.<\/li>\n<\/ul>\n

              Ho\u1eb7c nhi\u1ec5m tr\u00f9ng \u1edf b\u1ec7nh nh\u00e2n c\u00f3 nhi\u1ec5m \u0111\u1ed9c to\u00e0n th\u00e2n ho\u1eb7c m\u1ea5t \u1ed5n \u0111\u1ecbnh chuy\u1ec3n h\u00f3a (v\u00ed d\u1ee5 s\u1ed1t, \u1edbn l\u1ea1nh, nh\u1ecbp tim nhanh, h\u1ea1 huy\u1ebft \u00e1p, l\u00fa l\u1eabn, n\u00f4n, t\u0103ng b\u1ea1ch c\u1ea7u, nhi\u1ec5m toan, t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft n\u1eb7ng, ho\u1eb7c t\u0103ng ur\u00ea huy\u1ebft).<\/p>\n

              N\u1ebfu vi\u00eam x\u01b0\u01a1ng \u0111\u01b0\u1ee3c ch\u1ee9ng minh, h\u00e3y ph\u00e2n lo\u1ea1i b\u00e0n ch\u00e2n l\u00e0 \u0111\u1ed9 3 th\u00eam ch\u1eef (O) (n\u1ebfu <2 ti\u00eau chu\u1ea9n SIRS) ho\u1eb7c \u0111\u1ed9 4 (O) n\u1ebfu c\u00f3 \u22652 ti\u00eau ch\u00ed SIRS.<\/p>\n

              Ngu\u1ed3n tham kh\u1ea3o:<\/strong><\/p>\n

              B\u1ed9 Y t\u1ebf 2023, H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb Lo\u00e9t b\u00e0n ch\u00e2n do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/p>\n

              IWGDF Guidance 2019.<\/p>\n","protected":false},"excerpt":{"rendered":"

              Lo\u00e9t b\u00e0n ch\u00e2n th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (\u0110T\u0110) c\u00f3 \u0111\u1ed3ng th\u1eddi hai ho\u1eb7c nhi\u1ec1u h\u01a1n y\u1ebfu t\u1ed1 nguy c\u01a1, trong \u0111\u00f3 b\u1ec7nh l\u00fd th\u1ea7n kinh ngo\u1ea1i bi\u00ean v\u00e0 b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean th\u01b0\u1eddng \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng. Bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh d\u1eabn \u0111\u1ebfn m\u1ea5t c\u1ea3m gi\u00e1c t\u1ea1i b\u00e0n […]<\/p>\n","protected":false},"author":69,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[80,33],"tags":[],"yoast_head":"\nLo\u00e9t b\u00e0n ch\u00e2n do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng: c\u1eadp nh\u1eadt ch\u1ea9n \u0111o\u00e1n - Vinmec<\/title>\n<meta name=\"description\" content=\"Lo\u00e9t b\u00e0n ch\u00e2n th\u01b0\u1eddng do b\u1ec7nh l\u00fd th\u1ea7n kinh ho\u1eb7c b\u1ec7nh th\u1ea7n kinh - thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9. Ch\u1ea9n \u0111o\u00e1n d\u1ef1a v\u00e0o ph\u00e2n \u0111\u1ed9 Wagner \u2013 Meggitt v\u00e0 PEDIS.\u00a0\" \/>\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=\"Lo\u00e9t b\u00e0n ch\u00e2n do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng: c\u1eadp nh\u1eadt ch\u1ea9n \u0111o\u00e1n - Vinmec\" \/>\n<meta property=\"og:description\" content=\"Lo\u00e9t b\u00e0n ch\u00e2n th\u01b0\u1eddng do b\u1ec7nh l\u00fd th\u1ea7n kinh ho\u1eb7c b\u1ec7nh th\u1ea7n kinh - thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9. 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