{"id":3413,"date":"2023-04-10T12:27:00","date_gmt":"2023-04-10T05:27:00","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=3413"},"modified":"2023-04-10T14:08:00","modified_gmt":"2023-04-10T07:08:00","slug":"dac-diem-hinh-anh-sieu-am-hoi-chung-ong-co-tay","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/10\/dac-diem-hinh-anh-sieu-am-hoi-chung-ong-co-tay\/","title":{"rendered":"\u0110\u1eb7c \u0111i\u1ec3m h\u00ecnh \u1ea3nh si\u00eau \u00e2m h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay"},"content":{"rendered":"

Si\u00eau \u00e2m l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 h\u1eefu hi\u1ec7u \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n b\u1ec7nh l\u00fd n\u00e0y, gi\u00fap x\u00e1c \u0111\u1ecbnh \u0111\u1eb7c \u0111i\u1ec3m h\u00ecnh \u1ea3nh c\u1ee5 th\u1ec3 c\u1ee7a c\u00e1c \u1ed1ng c\u1ed5 tay b\u1ecb \u1ea3nh h\u01b0\u1edfng. H\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd c\u1ee7a c\u1ed5 tay, g\u00e2y ra s\u1ef1 vi\u00eam v\u00e0 s\u01b0ng \u1edf c\u00e1c \u1ed1ng d\u1eabn ch\u1ea5t nh\u1eddn v\u00e0 c\u01a1 b\u1eafp trong khu v\u1ef1c n\u00e0y. <\/strong><\/p>\n

Nh\u00f3m t\u00e1c gi\u1ea3: <\/strong>PGS.TS. Tr\u1ea7n Trung D\u0169ng, BS. Ma Ng\u1ecdc Th\u00e0nh, TS. Nguy\u1ec5n Th\u1ecb Li\u1ec5u, BS. Tr\u1ea7n Quy\u1ebft<\/p>\n

1. C\u00e1c trang thi\u1ebft b\u1ecb v\u00e0 k\u1ef9 thu\u1eadt si\u00eau \u00e2m<\/b><\/h2>\n

M\u00e1y si\u00eau \u00e2m \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao c\u00f3 si\u00eau \u00e2m Doppler n\u0103ng l\u01b0\u1ee3ng, \u0111\u1ea7u d\u00f2 t\u1ea7n s\u1ed1 tr\u00ean 7,5MHz, c\u00f3 \u1ed5 DVD l\u01b0u tr\u1eef h\u00ecnh \u1ea3nh.<\/span><\/p>\n

–<\/span>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 <\/span>K\u1ef9 thu\u1eadt si\u00eau \u00e2m \u1ed1ng c\u1ed5 tay<\/span><\/p>\n

T\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n: N\u1eb1m ng\u1eeda ho\u1eb7c ng\u1ed3i \u0111\u1ed1i di\u1ec7n v\u1edbi b\u00e1c s\u0129 si\u00eau \u00e2m, b\u1ed9c l\u1ed9 v\u00f9ng c\u1eb3ng b\u00e0n tay, th\u00e1o b\u1ecf trang s\u1ee9c n\u1ebfu c\u00f3, tay b\u1ec7nh nh\u00e2n \u0111\u1ec3 \u1edf t\u01b0 th\u1ebf n\u1eeda g\u1ea5p. C\u1ed5 tay \u0111\u01b0\u1ee3c \u0111\u1eb7t tr\u00ean m\u1eb7t ph\u1eb3ng th\u1eb3ng v\u1edbi ng\u00f3n tay \u1edf t\u01b0 th\u1ebf n\u1eeda g\u1ea5p. C\u1ed5 b\u00e0n tay kh\u00f4ng \u0111\u01b0\u1ee3c c\u1eed \u0111\u1ed9ng v\u00ec n\u00f3 c\u00f3 th\u1ec3 l\u00e0m d\u00e0y th\u1ea7n kinh t\u0103ng k\u00edch c\u1ee1. \u0110\u1ecbnh h\u01b0\u1edbng d\u00e2y th\u1ea7n kinh gi\u1eefa tr\u00ean si\u00eau \u00e2m \u1ed1ng c\u1ed5 tay: D\u00e2y th\u1ea7n kinh gi\u1eefa n\u1eb1m song song v\u1edbi khe ng\u00f3n 2-3 khi b\u00e0n tay ng\u1eeda ho\u00e0n to\u00e0n.<\/span><\/p>\n

\"Tu-the-benh-nhan-trong-sieu-am-ong-co-tay\"
T\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n trong si\u00eau \u00e2m \u1ed1ng c\u1ed5 tay<\/figcaption><\/figure>\n

C\u00e1c m\u1eb7t c\u1eaft trong si\u00eau \u00e2m \u1ed1ng c\u1ed5 tay:<\/span><\/p>\n

1.1. <\/i><\/b>M\u1eb7t c\u1eaft ngang d\u00e2y th\u1ea7n kinh gi\u1eefa \u1edf \u0111\u1ea7u xa \u1ed1ng c\u1ed5 tay (ngang c\u01a1 s\u1ea5p)<\/b><\/h3>\n

V\u1ecb tr\u00ed \u0111\u1eb7t \u0111\u1ea7u d\u00f2: c\u00e1ch n\u1ebfp l\u1eb1n c\u1ed5 tay 3cm. \u1ede m\u1eb7t c\u1eaft n\u00e0y \u0111o di\u1ec7n t\u00edch c\u1eaft ngang d\u00e2y th\u1ea7n kinh gi\u1eefa. D\u00e2y th\u1ea7n kinh gi\u1eefa (m\u0169i t\u00ean v\u00e0ng) n\u1eb1m \u1edf gi\u1eefa c\u01a1 g\u1ea5p chung n\u00f4ng v\u00e0 c\u01a1 g\u1ea5p chung s\u00e2u c\u00e1c ng\u00f3n, c\u01a1 s\u1ea5p \u1edf tr\u00ean. \u0110o di\u1ec7n t\u00edch d\u00e2y th\u1ea7n kinh gi\u1eefa \u1edf v\u1ecb tr\u00ed n\u00e0y \u0111\u1ec3 t\u00ednh gi\u00e1 tr\u1ecb Delta <\/span>s <\/span>(hi\u1ec7u s\u1ed5 ch\u00eanh l\u1ec7ch di\u1ec7n t\u00edch th\u1ea7n kinh gi\u1eefa \u1edf \u0111\u1ea7u v\u00e0o c\u1ee7a \u1ed0ng c\u1ed5 tay v\u00e0 ngang c\u01a1 s\u1ea5p), \u0110\u00e2y l\u00e0 m\u1ed9t ch\u1ec9 s\u1ed1 c\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n HCOCT<\/a>.<\/span><\/p>\n

\"Mat-cat-ngang-co-sap\"
M\u1eb7t c\u1eaft ngang c\u01a1 s\u1ea5p<\/figcaption><\/figure>\n

(\u0110\u1ea7u m\u0169i t\u00ean l\u00e0 h\u00ecnh \u1ea3nh d\u00e2y th\u1ea7n kinh gi\u1eefa)<\/em><\/p>\n

1.2. <\/i>M\u1eb7t c\u1eaft ngang \u0111\u1ea7u v\u00e0o \u1ed1ng c\u1ed5 tay<\/b><\/h3>\n

V\u1ecb tr\u00ed: s\u00e1t n\u1ebfp l\u1eb1n c\u1ed5 tay, ngang m\u1ee9c x\u01b0\u01a1ng \u0111\u1eadu. \u1ede m\u1eb7t c\u1eaft n\u00e0y quan s\u00e1t 4 g\u00e2n g\u1ea5p chung n\u00f4ng, 4 g\u00e2n g\u1ea5p chung s\u00e2u, g\u00e2n gan tay d\u00e0i, g\u00e2n g\u1ea5p c\u1ed5 tay quay v\u00e0 g\u00e2n g\u1ea5p c\u1ed5 tay tr\u1ee5. \u0110\u1ed9ng m\u1ea1ch tr\u1ee5 \u1edf r\u1ea5t n\u00f4ng c\u1ea1nh x\u01b0\u01a1ng \u0111\u1eadu, s\u00e1t m\u1ea1c ch\u1eb1ng, ti\u1ebfp theo l\u00e0 d\u00e2y th\u1ea7n kinh tr\u1ee5.<\/span><\/p>\n

Th\u1ea7n kinh gi\u1eefa thay \u0111\u1ed5i k\u00edch th\u01b0\u1edbc t\u1eeb \u0111\u1ea7u xa (ngang c\u01a1 s\u1ea5p) t\u1edbi \u0111\u1ea7u v\u00e0o \u1ed1ng c\u1ed5 tay, n\u00f3 l\u1edbn d\u1ea7n l\u00ean, \u0111\u1ea1t k\u00edch th\u01b0\u1edbc t\u1ed1i \u0111a \u1edf \u0111\u1ea7u g\u1ea7n \u1ed1ng c\u1ed5 tay. Th\u1ea7n kinh gi\u1eefa c\u00f3 c\u1ea5u tr\u00fac b\u00f3, gi\u1ea3m echo, n\u1eb1m gi\u1eefa g\u00e2n g\u1ea5p chung n\u00f4ng v\u00e0 g\u00e2n gan tay d\u00e0i. Di\u1ec7n t\u00edch d\u00e2y th\u1ea7n kinh gi\u1eefa \u0111\u01b0\u1ee3c \u0111o \u1edf \u0111\u1ea7u g\u1ea7n \u1ed1ng c\u1ed5 tay c\u00f3 \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao trong ch\u1ea9n \u0111o\u00e1n HCOCT.<\/span><\/p>\n

T\u00ednh Delta S: l\u00e0 hi\u1ec7u s\u1ed1 gi\u1eefa di\u1ec7n t\u00edch d\u00e2y th\u1ea7n kinh \u1edf \u0111\u1ea7u v\u00e0o c\u1ee7a \u1ed1ng c\u1ed5 tay v\u00e0 \u1edf \u0111o\u1ea1n ngang c\u01a1 s\u1ea5p vu\u00f4ng<\/span><\/p>\n

\"Mat-cat-ngang-dau-vao-ong-co-tay\"
M\u1eb7t c\u1eaft ngang \u0111\u1ea7u v\u00e0o \u1ed1ng c\u1ed5 tay<\/figcaption><\/figure>\n

(\u0110\u1ea7u m\u0169i t\u00ean: m\u1ea1c ch\u1eb1ng c\u1ed5 tay; h\u00ecnh elip l\u00e0 th\u1ea7n kinh gi\u1eefa; c\u00e1c v\u00f2ng tr\u00f2n c\u00f2n l\u1ea1i l\u00e0 bao g\u00e2n g\u1ea5p chung n\u00f4ng v\u00e0 g\u00e2n g\u1ea5p chung s\u00e2u c\u1ed5 tay)<\/span><\/em><\/p>\n

1.3. <\/i>M\u1eb7t c\u1eaft ngang trong \u0111\u01b0\u1eddng h\u1ea7m c\u1ed5 tay v\u00e0 \u0111\u1ea7u ra c\u1ee7a \u1ed5ng c\u1ed5 tay<\/b><\/h3>\n

Ti\u1ebfp t\u1ee5c k\u00e9o \u0111\u1ea7u d\u00f2 t\u1eeb n\u1ebfp l\u1eb1n c\u1ed5 tay xu\u1ed1ng d\u01b0\u1edbi gan tay, \u0111\u1ea7u ra c\u1ee7a \u1ed1ng c\u1ed5 tay ngang m\u1ee9c x\u01b0\u01a1ng m\u00f3c. Th\u1ea7n kinh gi\u1eefa nh\u1ecf d\u1ea7n khi \u0111i ra kh\u1ecfi \u1ed1ng c\u1ed5 tay. \u1ede m\u1eb7t c\u1eaft n\u00e0y quan s\u00e1t c\u00e1c c\u1ea5u tr\u00fac gi\u1ea3i ph\u1eabu trong \u1ed1ng c\u1ed5 tay, t\u00ecm c\u00e1c t\u1ed5n th\u01b0\u01a1ng cho\u00e1n ch\u1ed7 trong \u1ed1ng c\u1ed5 tay, c\u01a1 giun ph\u1ee5, vi\u00eam bao g\u00e2n, k\u00e9n bao g\u00e2n.<\/span><\/p>\n

\u0110o \u0111\u1ed9 d\u1eb9t d\u00e2y th\u1ea7n kinh \u1edf m\u1eb7t c\u1eaft ngang \u0111o\u1ea1n xa. \u0110\u1ed9 d\u1eb9t \u0111\u01b0\u1ee3c t\u00ednh b\u1eb1ng t\u1ec9 s\u1ed1 gi\u1eefa chi\u1ec1u r\u1ed9ng\/chi\u1ec1u cao c\u1ee7a d\u00e2y th\u1ea7n kinh gi\u1eefa.<\/span><\/p>\n

\u0110o \u0111\u1ed9 khum m\u1ea1c ch\u1eb1ng: \u0111o \u1edf \u0111o\u1ea1n xa \u1ed1ng c\u1ed1 tay, v\u1ecb tr\u00ed gi\u1eefa x\u01b0\u01a1ng thang v\u00e0 x\u01b0\u01a1ng m\u00f3c. \u0110\u1ed9 khum b\u00ecnh th\u01b0\u1eddng < <\/span>2mm. \u0110\u1ed9 khum dao \u0111\u1ed9ng t\u1eeb 2,5 – 4mm l\u00e0 b\u1ec7nh l\u00fd t\u00f9y theo t\u00e1c gi\u1ea3.<\/span><\/p>\n

\"Mat-cat-ngang-trong-duong-ham-co-tay-va-dau-ra-cua-ong-co-tay\"
M\u1eb7t c\u1eaft ngang trong \u0111\u01b0\u1eddng h\u1ea7m c\u1ed5 tay v\u00e0 \u0111\u1ea7u ra c\u1ee7a \u1ed1ng c\u1ed5 tay<\/figcaption><\/figure>\n

(\u0110\u1ea7u m\u0169i t\u00ean ch\u1ec9 m\u1ea1c ch\u1eb1ng c\u1ed5 tay \u1edf \u0111\u1ea7u xa OCT)<\/em><\/p>\n

1.4. <\/i>C\u1eaft d\u1ecdc d\u00e2y th\u1ea7n kinh gi\u1eefa<\/b><\/h3>\n

Xoay \u0111\u1ea7u d\u00f2 vu\u00f4ng g\u00f3c v\u1edbi m\u1eb7t c\u1eaft ngang \u0111\u1ec3 quan s\u00e1t d\u00e2y th\u1ea7n kinh gi\u1eefa \u1edf m\u1eb7t c\u1eaft d\u1ecdc. Th\u1ea7n kinh gi\u1eefa \u1edf r\u1ea5t n\u00f4ng, ngay sau t\u1ed5 ch\u1ee9c d\u01b0\u1edbi da v\u00e0 \u1edf tr\u00ean g\u00e2n g\u1ea5p n\u00f4ng. B\u00ecnh th\u01b0\u1eddng d\u00e2y th\u1ea7n kinh l\u00e0 c\u00e1c d\u1ea3i gi\u1ea3m \u00e2m xen k\u1ebd c\u00e1c d\u1ea3i t\u0103ng \u00e2m (v\u1ecf s\u1ee3i th\u1ea7n kinh), c\u1ea7n ph\u00e2n bi\u1ec7t d\u00e2y th\u1ea7n kinh v\u00e0 g\u00e2n, d\u00e2y th\u1ea7n kinh th\u01b0\u1eddng gi\u1ea3m \u00e2m h\u01a1n g\u00e2n.<\/span><\/p>\n

Tr\u00ean l\u00e1t c\u1eaft d\u1ecdc xem thay \u0111\u1ed5i h\u00ecnh th\u00e1i, k\u00edch th\u01b0\u1edbc, t\u00ecm c\u00e1c d\u1ea5u hi\u1ec7u Notch, Notch \u0111\u1ea3o ng\u01b0\u1ee3c. D\u1ea5u hi\u1ec7u <\/span>Notch (encoche), d\u00e2y th\u1ea7n kinh ph\u00ecnh to tr\u00ean ch\u1ed7 h\u1eb9p nh\u01b0 c\u1ee7 h\u00e0nh, gi\u1ea3m \u00e2m v\u00e0 d\u1eb9t trong \u1ed1ng c\u1ed5 tay.<\/span><\/p>\n

D\u1ea5u hi\u1ec7u Notch \u0111\u1ea3o ng\u01b0\u1ee3c: d\u00e2y th\u1ea7n kinh d\u1eb9t trong \u1ed1ng c\u1ed5 tay v\u00e0 ph\u00ecnh to \u1edf \u0111o\u1ea1n sau \u1ed1ng c\u1ed5 tay.<\/span><\/p>\n

Ph\u1ed5 Doppler gi\u1eefa c\u00e1c \u0111o\u1ea1n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 <\/span>m\u1ee9c <\/span>\u0111\u1ed9 t\u0103ng sinh m\u1ea1ch. C\u1eeda <\/span>s\u1ed5 <\/span>Doppler c\u1ea7n chi\u1ebfm to\u00e0n b\u1ed9 d\u00e2y th\u1ea7n kinh c\u1ea7n \u0111\u00e1nh gi\u00e1, ch\u1ec9nh t\u1ea7n s\u1ed1 d\u00f2ng ch\u1ea3y th\u1ea5p t\u1eeb 5-10cm\/s, kh\u00f4ng \u0111\u01b0\u1ee3c \u1ea5n \u0111\u1ea7u d\u00f2 khi ph\u1ed5 Doppler v\u00ec s\u1ebd l\u00e0m m\u1ea5t t\u00edn hi\u1ec7u m\u1ea1ch.<\/span><\/p>\n

\"Mat-cat-doc-than-kinh-giua-ben-trai\"
M\u1eb7t c\u1eaft d\u1ecdc th\u1ea7n kinh gi\u1eefa (b\u00ean tr\u00e1i)<\/figcaption><\/figure>\n

1.5. <\/i>Si\u00eau \u00e2m \u0111\u1ed9ng \u00a0 <\/b>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span> \u1eca<\/span><\/h3>\n

\u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 chuy\u1ec3n \u0111\u1ed9ng c\u1ee7a d\u00e2y th\u1ea7n kinh gi\u1eefa khi v\u1eadn \u0111\u1ed9ng n\u1eafm b\u00e0n tay<\/span><\/p>\n

\"Sieu-am-dong\"
Si\u00eau \u00e2m \u0111\u1ed9ng<\/figcaption><\/figure>\n

2. C\u00e1c t\u1ed5n th\u01b0\u01a1ng tr\u00ean si\u00eau \u00e2m 2D trong H\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay<\/b><\/h2>\n

\u1ede nh\u1eefng th\u1ec3 m\u1edbi b\u1eaft \u0111\u1ea7u, d\u00e2y th\u1ea7n kinh gi\u1eef nguy\u00ean h\u00ecnh d\u1ea1ng b\u00ecnh th\u01b0\u1eddng. D\u00e1ng v\u1ebb b\u00ecnh th\u01b0\u1eddng c\u1ee7a d\u00e2y th\u1ea7n kinh kh\u00f4ng lo\u1ea1i tr\u1eeb \u0111\u01b0\u1ee3c h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay.<\/span><\/p>\n

2.1. <\/i>Nh\u1eefng d\u1ea5u hi\u1ec7u thay \u0111\u1ed5i h\u00ecnh d\u1ea1ng c\u1ee7a d\u00e2y th\u1ea7n kinh bao g\u1ed3m<\/b><\/h3>\n

–<\/span>\u00a0 \u00a0 \u00a0 <\/span>D\u1ea5u hi\u1ec7u kh\u1ea5c (Notch): l\u00e0 d\u1ea5u hi\u1ec7u ph\u00f9 d\u00e2y th\u1ea7n kinh \u1edf tr\u00ean ch\u1ed7 h\u1eb9p s\u00e1t b\u1edd tr\u01b0\u1edbc \u1ed1ng c\u1ed5 tay, v\u00e0 s\u1ef1 d\u1eb9t d\u00e2y th\u1ea7n kinh gi\u1eefa \u1edf trong \u1ed1ng c\u1ed5 tay. D\u00e2y th\u1ea7n kinh gi\u1eefa s\u01b0ng to nh\u01b0 h\u00ecnh c\u1ee7 h\u00e0nh \u1edf s\u00e1t b\u1edd g\u1ea7n \u1ed1ng c\u1ed5 tay. D\u1ea5u hi\u1ec7u n\u00e0y th\u1ea5y r\u00f5 \u1edf m\u1eb7t c\u1eaft d\u1ecdc.<\/span><\/p>\n

\"Dau-hieu-Notch\"
D\u1ea5u hi\u1ec7u Notch<\/figcaption><\/figure>\n

–<\/span> \u00a0 \u00a0 \u00a0 <\/span>Notch \u0111\u1ea3o ng\u01b0\u1ee3c: d\u00e2y th\u1ea7n kinh gi\u1eefa d\u1eb9t trong \u1ed1ng c\u1ed5 tay v\u00e0 ph\u00f9 n\u1ec1 \u1edf \u0111o\u1ea1n sau c\u1ee7a \u1ed1ng c\u1ed5 tay. D\u00e2y th\u1ea7n kinh gi\u1eefa s\u01b0ng to h\u00ecnh c\u1ee7 h\u00e0nh \u1edf \u0111o\u1ea1n chui qua \u1ed1ng c\u1ed5 tay.<\/span><\/p>\n

–<\/span> \u00a0 \u00a0 \u00a0 <\/span>Ph\u00f9 d\u00e2y th\u1ea7n kinh \u1edf tr\u00ean ch\u1ed7 h\u1eb9p: ph\u00eda tr\u00ean \u0111\u01b0\u1eddng h\u1ea7m, d\u00e2y th\u1ea7n kinh r\u1ed9ng, c\u1ea5u tr\u00fac b\u00f3 b\u00ecnh th\u01b0\u1eddng thay th\u1ebf b\u1eb1ng c\u1ea5u tr\u00fac gi\u1ea3m \u00e2m \u0111\u1ed3ng nh\u1ea5t. Ph\u00f9 n\u1ec1 d\u00e2y th\u1ea7n kinh gi\u1eefa \u0111o\u1ea1n qua \u1ed1ng c\u1ed5 tay. D\u00e2y th\u1ea7n kinh b\u1ecb ph\u00f9 n\u1ec1 \u0111o\u1ea1n qua \u1ed1ng c\u1ed5 tay \u0111\u01b0\u1ee3c so s\u00e1nh v\u1edbi \u0111o\u1ea1n ngang c\u01a1 s\u1ea5p vu\u00f4ng ho\u1eb7c v\u1edbi tay b\u00ean \u0111\u1ed1i di\u1ec7n n\u1ebfu tay \u0111\u00f3 kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng.<\/span><\/p>\n

2.2. <\/i>Nh\u1eefng d\u1ea5u hi\u1ec7u \u0111o l\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 s\u1ef1 thay \u0111\u1ed5i v\u1ec1 m\u1eb7t t\u00ednh ch\u1ea5t c\u1ee7a d\u00e2y th\u1ea7n kinh<\/b><\/h3>\n

+ Di\u1ec7n t\u00edch c\u1ee7a d\u00e2y th\u1ea7n kinh: d\u00e2y th\u1ea7n kinh gi\u00e3n tr\u00ean ch\u1ed7 h\u1eb9p. C\u00f3 th\u1ec3 \u0111o di\u1ec7n t\u00edch d\u00e2y th\u1ea7n kinh \u1edf ph\u00eda tr\u00ean, \u0111\u1ea7u g\u1ea7n c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m (ngang m\u1ee9c x\u01b0\u01a1ng thuy\u1ec1n v\u00e0 x\u01b0\u01a1ng \u0111\u1eadu) ho\u1eb7c \u0111o trong \u1ed1ng c\u1ed5 tay, \u0111\u1ea7u xa c\u1ee7a \u1ed1ng c\u1ed5 tay (ngang m\u1ee9c x\u01b0\u01a1ng thang v\u00e0 x\u01b0\u01a1ng m\u00f3c) ho\u1eb7c ngang c\u01a1 s\u1ea5p. \u1ede ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng di\u1ec7n t\u00edch trung b\u00ecnh c\u1ee7a d\u00e2y th\u1ea7n kinh l\u00e0 8mm<\/span>2<\/span>. Gi\u00e1 tr\u1ecb ng\u01b0\u1ee1ng thay \u0111\u1ed5i t\u00f9y theo t\u00e1c gi\u1ea3 (9-15mm<\/span>2<\/span>). Gi\u00e1 tr\u1ecb 10mm<\/span>2<\/span> c\u00f3 \u0111\u1ed9 nh\u1ea1y 85% v\u00e0 \u0111\u1ed9 \u0110\u1eb7c hi\u1ec7u 92%.<\/span><\/p>\n

+ D\u1ea5u hi\u1ec7u Delta S: l\u00e0 hi\u1ec7u s\u1ed1 gi\u1eefa di\u1ec7n t\u00edch d\u00e2y th\u1ea7n kinh gi\u1eefa \u1edf ngang \u0111\u1ea7u v\u00e0o c\u1ee7a \u1ed1ng c\u1ed5 tay v\u00e0 di\u1ec7n t\u00edch d\u00e2y th\u1ea7n kinh gi\u1eefa \u1edf \u0111o\u1ea1n ngang c\u01a1 s\u1ea5p. D\u1ea5u hi\u1ec7u n\u00e0y d\u01b0\u01a1ng t\u00ednh khi hi\u1ec7u s\u1ed1 Delta S<\/span>\u00a0<\/span>> 2mm<\/span>2<\/span> (Klauser v\u00e0 c\u1ed9ng s\u1ef1 2009). Theo Klauser v\u00e0 c\u1ed9ng s\u1ef1 2011 ,tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 th\u1ea7n kinh gi\u1eefa t\u00e1ch \u0111\u00f4i, khi Delta S<\/span>\u00a0<\/span>> 4mm<\/span>2<\/span>, <\/span>\u0111\u1ed9 <\/span>nh\u1ea1y <\/span>92,5%, \u0111\u1ed9 <\/span>\u0111\u1eb7c hi\u1ec7u 94,6%.<\/span>
\n<\/span><\/p>\n

\"Vi-tri-do-dient-ich-day-than-kinh-giua-de-tinh-Delta-S\"
V\u1ecb tr\u00ed \u0111o \u0111i\u1ec7nt \u00edch d\u00e2y th\u1ea7n kinh gi\u1eefa \u0111\u1ec3 t\u00ednh Delta S<\/figcaption><\/figure>\n

+ Ph\u1ea7n tr\u0103m ch\u00eanh l\u1ec7ch di\u1ec7n t\u00edch: l\u00e0 hi\u1ec7u s\u1ed1 gi\u1eefa di\u1ec7n t\u00edch d\u00e2y th\u1ea7n kinh gi\u1eefa \u1edf \u0111\u1ea7u g\u1ea7n \u1ed1ng c\u1ed5 tay v\u00e0 ngang c\u01a1 s\u1ea5p chia cho di\u1ec7n t\u00edch th\u1ea7n kinh gi\u1eefa \u1edf \u0111\u1ea7u g\u1ea7n \u1ed1ng c\u1ed5 tay.<\/span><\/p>\n

+ T\u1ec9 s\u1ed1 di\u1ec7n t\u00edch \u0111\u1ea7u g\u1ea7n \u1ed1ng c\u1ed5 tay v\u00e0 ngang c\u01a1 s\u1ea5p. Theo Hobson 2008 n\u1ebfu t\u1ef7 s\u1ed1 n\u00e0y >1,4 th\u00ec \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 100%.<\/span><\/p>\n

+ \u0110\u1ed9 khum c\u1ee7a m\u1ea1c ch\u1eb1ng: \u0111o \u1edf m\u1eb7t c\u1eaft ngang \u0111\u1ea7u xa \u1ed1ng c\u1ed5 tay (t\u1eeb n\u1ebfp g\u1ea5p c\u1ed5 tay v\u1ec1 ph\u00eda ng\u00f3n tay 1 -2 cm), n\u01a1i m\u1ea1c ch\u1eb1ng th\u1eb3ng. Trong h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay m\u1ea1c ch\u1eb1ng cong v\u1ec1 ph\u00eda tr\u01b0\u1edbc. \u0110\u1ed9 cong b\u00ecnh th\u01b0\u1eddng d\u01b0\u1edbi 2 mm, b\u1ec7nh l\u00fd khi t\u0103ng t\u1eeb 2,5 <\/span>–<\/span>\u00a0 <\/span>4mm t\u00f9y theo t\u00e1c gi\u1ea3.<\/span><\/p>\n

\"Do-do-khum-mac-chang\"
\u0110o \u0111\u1ed9 khum m\u1ea1c ch\u1eb1ng<\/figcaption><\/figure>\n

+ Ch\u1ec9 s\u1ed1 \u0111\u00e1nh gi\u00e1 \u0111\u1ed9 d\u1eb9t c\u1ee7a d\u00e2y th\u1ea7n kinh: <\/span>Ph\u1ea3n \u00e1nh tr\u1ef1c ti\u1ebfp s\u1ef1 ch\u00e8n \u00e9p c\u1ee7a d\u00e2y th\u1ea7n kinh trong \u1ed1ng c\u1ed5 tay, \u0111\u1ed9 d\u1eb9t \u0111\u01b0\u1ee3c \u0111o \u1edf m\u1eb7t c\u1eaft ngang t\u1ea1i \u0111\u1ea7u xa. Ch\u1ec9 s\u1ed1 \u0111\u01b0\u1ee3c t\u00ednh b\u1eb1ng t\u1ec9 s\u1ed1 chi\u1ec1u r\u1ed9ng\/chi\u1ec1u cao d\u00e2y th\u1ea7n kinh. Ch\u1ec9 s\u1ed1 l\u00e0 b\u1ec7nh l\u00fd khi l\u1edbn h\u01a1n 3.<\/p>\n

\"Do-do-det-day-than-kinh\"
\u0110o \u0111\u1ed9 d\u1eb9t d\u00e2y th\u1ea7n kinh<\/figcaption><\/figure>\n

–<\/span> \u00a0 \u00a0 \u00a0 <\/span>Nh\u1eefng b\u1ea5t th\u01b0\u1eddng kh\u00e1c trong h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay: vi\u00eam bao g\u00e2n, vi\u00eam m\u00e0ng ho\u1ea1t d\u1ecbch, k\u00e9n ho\u1ea1t d\u1ecbch, nhi\u1ec5m b\u1ed9t, h\u1ea1t Tophi, chondrocalcinose, b\u1ec7nh l\u00fd c\u00e1c kh\u1ed1i u….<\/span><\/p>\n

+ Vi\u00eam bao g\u00e2n g\u1ea5p chung c\u1ed5 tay l\u00e0 m\u1ed9t trong c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y ch\u00e8n \u00e9p trong h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay. Tr\u00ean si\u00eau \u00e2m quan s\u00e1t th\u1ea5y <\/span>h\u00ecnh \u1ea3nh c\u00e1c bao g\u00e2n d\u00e0y, gi\u1ea3m \u00e2m, t\u0103ng sinh m\u1ea1ch tr\u00ean si\u00eau \u00e2m Doppler. Vi\u00eam bao g\u00e2n g\u1ea5p chung c\u1ed5 tay th\u01b0\u1eddng g\u1eb7p trong c\u00e1c b\u1ec7nh Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p, B\u1ec7nh G\u00fat, B\u1ec7nh Lao, Nhi\u1ec5m khu\u1ea9n bao g\u00e2n. M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p vi\u00eam bao g\u00e2n g\u1ea5p m\u1ea1n t\u00ednh kh\u00f4ng \u0111\u1eb7c hi\u1ec7u.<\/span><\/p>\n

\"Viem-day-than-kinh-giua-do-viem-cac-bao-gan-gap\"
Vi\u00eam d\u00e2y th\u1ea7n kinh gi\u1eefa do vi\u00eam c\u00e1c bao g\u00e2n g\u1ea5p<\/figcaption><\/figure>\n

+ K\u00e9n ho\u1ea1t d\u1ecbch \u1edf v\u1ecb tr\u00ed gan c\u1ed5 tay th\u01b0\u1eddng g\u00e2y ch\u00e8n \u00e9p th\u1ea7n kinh gi\u1eefa. Tr\u00ean si\u00eau \u00e2m k\u00e9n ho\u1ea1t d\u1ecbch l\u00e0 c\u00e1c c\u1ea5u tr\u00fac tr\u1ed1ng \u00e2m, ranh gi\u1edbi r\u00f5.<\/span><\/p>\n

+ B\u1ec7nh G\u00fat c\u00f3 h\u1ea1t tophi trong \u1ed1ng c\u1ed5 tay: h\u1ea1t tophie th\u01b0\u1eddng t\u1eadp trung trong bao g\u00e2n g\u1ea5p chung n\u00f4ng, bao g\u00e2n g\u1ea5p chung s\u00e2u v\u00e0 trong m\u00e0ng ho\u1ea1t d\u1ecbch kh\u1edbp c\u1ed5 tay l\u00e0m t\u0103ng \u00e1p l\u1ef1c trong \u1ed1ng c\u1ed5 tay, g\u00e2y ch\u00e8n \u00e9p <\/span>th\u1ea7n kinh gi\u1eefa. Trong c\u00e1c \u0111\u1ee3t g\u00fat c\u1ea5p c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng vi\u00eam bao g\u00e2n g\u1ea5p chung c\u1ed5 tay l\u00e0m t\u0103ng m\u1ee9c \u0111\u1ed9 ch\u00e8n \u00e9p th\u1ea7n kinh gi\u1eefa. Tr\u00ean si\u00eau \u00e2m th\u1ea5y h\u00ecnh \u1ea3nh c\u00e1c n\u1ed1t t\u0103ng \u00e2m, k\u00e8m b\u00f3ng c\u1ea3n trong bao g\u00e2n ho\u1eb7c trong m\u00e0ng ho\u1ea1t d\u1ecbch kh\u1edbp c\u1ed5 tay. Th\u01b0\u1eddng k\u00e8m theo h\u00ecnh \u1ea3nh d\u00e0y bao g\u00e2n, d\u1ecbch quanh bao g\u00e2n v\u00e0 t\u0103ng t\u00edn hi\u1ec7u m\u1ea1ch quanh v\u00e0 trong g\u00e2n.<\/span><\/p>\n

\"Viem-day-than-kinh-giua-trong-benh-Gut-co-hat-Tophi\"
Vi\u00eam d\u00e2y th\u1ea7n kinh gi\u1eefa trong b\u1ec7nh G\u00fat c\u00f3 h\u1ea1t Tophi<\/figcaption><\/figure>\n

+ C\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c ch\u00e8n \u00e9p th\u1ea7n kinh gi\u1eefa \u00edt g\u1eb7p h\u01a1n: c\u00e1c kh\u1ed1i u, k\u00e9n ho\u1ea1t d\u1ecbch, chondrocalxinose…\u00a0<\/span><\/p>\n

\"U-day-than-kinh\"
U d\u00e2y th\u1ea7n kinh<\/figcaption><\/figure>\n

3. H\u00ecnh \u1ea3nh si\u00eau \u00e2m Doppler<\/strong><\/h2>\n

B\u00ecnh th\u01b0\u1eddng m\u1ea1ch m\u00e1u trong d\u00e2y th\u1ea7n kinh ngh\u00e8o n\u00e0n, kh\u00f4ng th\u1ea5y t\u00edn hi\u1ec7u m\u1ea1ch tr\u00ean Doppler n\u0103ng l\u01b0\u1ee3ng. Khi th\u1ea7n kinh gi\u1eefa b\u1ecb vi\u00eam c\u00f3 t\u0103ng t\u00edn hi\u1ec7u m\u1ea1ch tr\u00ean Doppler n\u0103ng l\u01b0\u1ee3ng.<\/span><\/p>\n

T\u0103ng sinh m\u1ea1ch m\u00e1u trong d\u00e2y th\u1ea7n kinh tr\u00ean Doppler n\u0103ng l\u01b0\u1ee3ng. D\u1ea5u hi\u1ec7u n\u00e0y th\u1ea5y \u1edf \u0111o\u1ea1n tr\u01b0\u1edbc \u1ed1ng c\u1ed5 tay, n\u01a1i th\u1ea7n kinh gi\u1eefa gi\u00e3n r\u1ed9ng ho\u1eb7c b\u00ean trong \u1ed1ng c\u1ed5 tay. C\u00f3 4 m\u1ee9c \u0111\u1ed9 t\u0103ng sinh m\u1ea1ch tr\u00ean Doppler n\u0103ng l\u01b0\u1ee3ng theo Klauser V\u00e0 Shio’:<\/span><\/p>\n

M\u1ee9c \u0111\u1ed9 0: kh\u00f4ng c\u00f3 t\u00edn hi\u1ec7u d\u00f2ng ch\u1ea3y.<\/span><\/p>\n

M\u1ee9c \u0111\u1ed9 1: c\u00f3 01 t\u00edn hi\u1ec7u m\u1ea1ch.<\/span><\/p>\n

M\u1ee9c \u0111\u1ed9 2: c\u00f3 t\u1eeb 2-3 t\u00edn hi\u1ec7u m\u1ea1ch.<\/span><\/p>\n

M\u1ee9c \u0111\u1ed9 3: > 3 t\u00edn hi\u1ec7u m\u1ea1ch<\/span><\/p>\n

\"Hinh-anh-day-than-kinh-giua-phu-ne-tang-sinh-mach-tren-Doppler-nang-luong\"
H\u00ecnh \u1ea3nh d\u00e2y th\u1ea7n kinh gi\u1eefa ph\u00f9 n\u1ec1, t\u0103ng sinh m\u1ea1ch tr\u00ean Doppler n\u0103ng l\u01b0\u1ee3ng<\/figcaption><\/figure>\n

(Ngu\u1ed3n t\u00e1c gi\u1ea3)<\/p>\n","protected":false},"excerpt":{"rendered":"

Si\u00eau \u00e2m l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 h\u1eefu hi\u1ec7u \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n b\u1ec7nh l\u00fd n\u00e0y, gi\u00fap x\u00e1c \u0111\u1ecbnh \u0111\u1eb7c \u0111i\u1ec3m h\u00ecnh \u1ea3nh c\u1ee5 th\u1ec3 c\u1ee7a c\u00e1c \u1ed1ng c\u1ed5 tay b\u1ecb \u1ea3nh h\u01b0\u1edfng. H\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd c\u1ee7a c\u1ed5 tay, g\u00e2y ra s\u1ef1 vi\u00eam v\u00e0 s\u01b0ng \u1edf c\u00e1c \u1ed1ng d\u1eabn ch\u1ea5t nh\u1eddn […]<\/p>\n","protected":false},"author":53,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[40],"tags":[3],"yoast_head":"\n\u0110\u1eb7c \u0111i\u1ec3m h\u00ecnh \u1ea3nh si\u00eau \u00e2m h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay - Vinmec<\/title>\n<meta name=\"description\" content=\"Si\u00eau \u00e2m l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 h\u1eefu hi\u1ec7u \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n b\u1ec7nh l\u00fd n\u00e0y, gi\u00fap x\u00e1c \u0111\u1ecbnh \u0111\u1eb7c \u0111i\u1ec3m h\u00ecnh \u1ea3nh c\u1ee5 th\u1ec3 c\u1ee7a c\u00e1c \u1ed1ng c\u1ed5 tay b\u1ecb \u1ea3nh h\u01b0\u1edfng. 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