{"id":3427,"date":"2023-04-10T11:54:20","date_gmt":"2023-04-10T04:54:20","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=3427"},"modified":"2023-04-10T14:07:40","modified_gmt":"2023-04-10T07:07:40","slug":"chan-doan-sieu-am-va-hoi-chung-ong-co-tay-hcoct","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/10\/chan-doan-sieu-am-va-hoi-chung-ong-co-tay-hcoct\/","title":{"rendered":"Si\u00eau \u00e2m trong ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay (HCOCT)"},"content":{"rendered":"<p>H\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay (HCOCT) l\u00e0 b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p \u1edf c\u1ed5 tay g\u00e2y ra \u0111au, t\u00ea v\u00e0 bu\u1ed3n tay do g\u00e2y \u1ee9c ch\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a d\u00e2y th\u1ea7n kinh c\u1ed5 tay. Si\u00eau \u00e2m c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n\u00a0 v\u00e0 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 v\u00e0 v\u1ecb tr\u00ed c\u1ee7a b\u1ec7nh l\u00fd, c\u00e1c d\u1ea5u hi\u1ec7u si\u00eau \u00e2m c\u00f3 th\u1ec3 gi\u00fap \u0111\u00e1nh gi\u00e1 b\u1ec7nh v\u1edbi \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u v\u00e0 \u0111\u1ed9 nh\u1ea1y kh\u00e1c nhau khi so s\u00e1nh v\u1edbi nhau<\/p>\n<h2><span style=\"font-weight: 400;\">1) Hi\u1ec7u s\u1ed1 ch\u00eanh l\u1ec7ch di\u1ec7n t\u00edch, ph\u1ea7n tr\u0103m ch\u00eanh l\u1ec7ch di\u1ec7n t\u00edch v\u00e0 t\u1ec9 s\u1ed1 di\u1ec7n t\u00edch th\u1ea7n kinh gi\u1eefa \u0111\u1ea7u v\u00e0o \u1ed1ng c\u1ed5 tay v\u00e0 ngang c\u01a1 s\u1ea5p<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Khi so s\u00e1nh di\u1ec7n t\u00edch d\u00e2y th\u1ea7n kinh gi\u1eefa \u1edf \u0111\u1ea7u g\u1ea7n \u1ed1ng c\u1ed5 tay v\u1edbi c\u1eb3ng tay Klauser v\u00e0 c\u1ed9ng s\u1ef1 (2008) cho k\u1ebft qu\u1ea3 v\u1edbi hi\u1ec7u s\u1ed1 ch\u00eanh l\u1ec7ch di\u1ec7n t\u00edch Delta CSA = 2mm2 \u0111\u1ed9 nh\u1ea1y 99% \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 100% [32]. V\u1edbi gi\u00e1 tr\u1ecb Delta S = 4mm2 \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 d\u1ea5u hi\u1ec7u th\u1ea7n kinh gi\u1eefa t\u00e1ch \u0111\u00f4i, \u0111\u1ed9 nh\u1ea1y 92.5% v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 96,4% Klauser v\u00e0 c\u1ed9ng s\u1ef1 (2011) [33]. Theo Navbahor Akbar nghi\u00ean c\u1ee9u 62 \u1ed1ng c\u1ed5 tay b\u1ec7nh (42 b\u1ec7nh nh\u00e2n), v\u1edbi Delta s = 3,65, \u0111\u1ed9 nh\u1ea1y 83% v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 82%.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Ph\u1ea7n tr\u0103m ch\u00eanh l\u1ec7ch di\u1ec7n t\u00edch c\u0169ng c\u00f3 gi\u00e1 tr\u1ecb cao trong ch\u1ea9n \u0111o\u00e1n HCOCT. Theo Navbahor Akbar, v\u1edbi ph\u1ea7n tr\u0103m ch\u00eanh l\u1ec7ch di\u1ec7n t\u00edch l\u00e0 83%, \u0111\u1ed9 nh\u1ea1y l\u00e0 55% v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u l\u00e0 97%, c\u00f2n v\u1edbi ph\u1ea7n tr\u0103m ch\u00eanh l\u1ec7ch di\u1ec7n t\u00edch l\u00e0 50%, \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u \u0111\u1ec1u l\u00e0 85%. T\u1ec9 s\u1ed1 ch\u00eanh l\u1ec7ch di\u1ec7n t\u00edch WFR = 1,4 c\u00f3 \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u l\u00e0: 97% v\u00e0 99% theo Hobson &#8211; Webb 2008 v\u00e0 Mhoon 2012 [45]. Trong Nghi\u00ean c\u1ee9u c\u1ee7a t\u00e1c gi\u1ea3 Ahmad v\u00e0 c\u1ed9ng s\u1ef1 t\u1ec9 s\u1ed1 n\u00e0y l\u00e0 2,2 \u00b1 0,16. Theo Altinok (2004) ti s\u1ed1 d\u1eb9t l\u00e0 1,2. Theo Keberle 2000, t\u1ec9 s\u1ed1 d\u1eb9t l\u00e0 1,3 c\u00f3 \u0111\u1ed9 nh\u1ea1y 100% v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 74%.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">2) T\u1ec9 s\u1ed1 d\u1eb9t d\u00e2y th\u1ea7n kinh khi ch\u1ea9n \u0111o\u00e1n HCOCT<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Theo nghi\u00ean c\u1ee9u c\u1ee7a Buchberger, t\u1ec9 s\u1ed1 d\u1eb9t c\u1ee7a d\u00e2y th\u1ea7n kinh trong ch\u1ea9n \u0111o\u00e1n HCOCT c\u00f3 \u0111\u1ed9 nh\u1ea1y dao \u0111\u1ed9ng t\u1eeb 38 &#8211; 65%. Gi\u00e1 tr\u1ecb t\u1ec9 s\u1ed1 d\u1eb9t \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o ch\u1ea9n \u0111o\u00e1n trong nghi\u00ean c\u1ee9u c\u1ee7a Buchberger l\u00e0 3, c\u1ee7a Nevbahar Akbar l\u00e0 2,7. Theo Nevbahar Akbar, t\u1ec9 s\u1ed1 d\u1eb9t l\u00e0 2,7 c\u00f3 \u0111\u1ed9 nh\u1ea1y l\u00e0 52% v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u l\u00e0 70%. Theo t\u00e1c gi\u1ea3 Ducan ch\u1ec9 s\u1ed1 d\u1eb9t trung b\u00ecnh l\u00e0 3,09\u00b10,7. C\u0169ng theo t\u00e1c gi\u1ea3 n\u00e0y th\u00ec ch\u1ec9 s\u1ed1 d\u1eb9t c\u1ee7a d\u00e2y th\u1ea7n kinh &gt; 3,3 c\u00f3 \u0111\u1ed9 nh\u1ea1y l\u00e0 38%, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u l\u00e0 75%. T\u00e1c gi\u1ea3 Keles v\u00e0 c\u1ed9ng s\u1ef1, ch\u1ec9 s\u1ed1 d\u1eb9t 3,7 c\u00f3 \u0111\u1ed9 nh\u1ea1y l\u00e0 71% v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u l\u00e0 55%. Ch\u1ec9 s\u1ed1 n\u00e0y s\u1edf d\u0129 \u0111\u1ed9 nh\u1ea1y th\u1ea5p b\u1edfi v\u00ec h\u00ecnh th\u00e1i d\u00e2y th\u1ea7n kinh gi\u1eefa \u0111o\u1ea1n qua OCX thay \u0111\u1ed5i khi thay \u0111\u1ed5i t\u01b0 th\u1ebf b\u00e0n tay (c\u00f3 th\u1ec3 do du\u1ed7i ho\u1eb7c g\u1ea5p c\u00e1c ng\u00f3n tay qu\u00e1 m\u1ee9c.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">3) \u0110\u1ed9 khum c\u1ee7a m\u1ea1c ch\u1eb1ng trong ch\u1ea9n \u0111o\u00e1n HCOCT<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Theo nghi\u00ean c\u1ee9u c\u1ee7a Maha K v\u00e0 c\u1ed9ng s\u1ef1 (2012) \u0111\u1ed9 khum c\u1ee7a <a href=\"http:\/\/vinmec.com\">m\u1ea1c ch\u1eb1ng<\/a> &gt; 2mm c\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n. Theo t\u00e1c gi\u1ea3 Uchiyama v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u1ed9 khum m\u1ea1c ch\u1eb1ng l\u00e0 2,26 \u00b1 0,84. Theo Burberger (1992) \u0111\u1ed9 khum c\u00f3 \u0111\u1ed9 nh\u1ea1y 45% trong ch\u1ea9n \u0111o\u00e1n HCOCT. Nghi\u00ean c\u1ee9u c\u1ee7a Satria v\u00e0 c\u1ed9ng s\u1ef1 n\u0103m 2000 cho k\u1ebft qu\u1ea3 v\u1edbi \u0111\u1ed9 khum = 2,5 mm, \u0111\u1ed9 nh\u1ea1y 81% v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 64% trong ch\u1ea9n \u0111o\u00e1n HCOCT.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">4) \u0110\u1ed9 d\u00e0y m\u1ea1c ch\u1eb1ng<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Theo Jafari v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u1ed9 d\u00e0y m\u1ea1c gi\u1eef c\u00e1c g\u00e2n g\u1ea5p trung b\u00ecnh l\u00e0 9mm. Trong nghi\u00ean c\u1ee9u c\u1ee7a Sernik v\u00e0 c\u1ed9ng s\u1ef1 cho th\u1ea5y s\u1ef1 kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea \u0111\u1ed9 d\u00e0y m\u1ea1c gi\u1eef c\u00e1c g\u00e2n g\u1ea5p gi\u1eefa nh\u00f3m b\u1ecb HCOCT (0,88 \u00b1 0,23 mm) v\u00e0 nh\u00f3m ch\u1ee9ng (0,75 \u00b1 0,1 mm) v\u1edbi p=0,0018. Theo Nuri Karabay v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u1ed9 d\u00e0y m\u1ea1c gi\u1eef c\u00e1c g\u00e2n g\u1ea5p l\u00e0 0,75 mm \u1edf nh\u00f3m c\u00f3 tri\u1ec7u ch\u1ee9ng.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">5) Si\u00eau \u00e2m Doppler m\u00e0u v\u00e0 Doppler n\u0103ng l\u01b0\u1ee3ng<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Trong m\u1ed9t v\u00e0i n\u0103m g\u1ea7n \u0111\u00e2y, <a href=\"https:\/\/www.vinmec.com\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/ung-dung-cua-sieu-am-doppler-mau\/\">si\u00eau \u00e2m Doppler m\u00e0u<\/a>, \u0111\u1eb7c bi\u1ec7t si\u00eau \u00e2m Doppler n\u0103ng l\u01b0\u1ee3ng c\u0169ng m\u1edbi \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n HCOCT. Si\u00eau \u00e2m Doppler ph\u00e1t hi\u1ec7n t\u0103ng sinh m\u1ea1ch trong d\u00e2y th\u1ea7n kinh gi\u1eefa \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 qu\u00e1 tr\u00ecnh vi\u00eam d\u00e2y th\u1ea7n kinh gi\u1eefa tr\u01b0\u1edbc khi tho\u00e1i h\u00f3a myelin.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">N\u0103m 2006 Mallouhi v\u00e0 c\u1ed9ng s\u1ef1 s\u1eed d\u1ee5ng si\u00eau \u00e2m Doppler kh\u1ea3o s\u00e1t 172 \u1ed1ng c\u1ed5 tay b\u1ec7nh (\u0111\u01b0\u1ee3c kh\u1eb3ng \u0111\u1ecbnh b\u1edfi \u0111i\u1ec7n c\u01a1) v\u00e0 so s\u00e1nh v\u1edbi di\u1ec7n t\u00edch c\u1eaft ngang d\u00e2y th\u1ea7n kinh gi\u1eefa (gi\u00e1 tr\u1ecb t\u1edbi h\u1ea1n 11mm2). Si\u00eau \u00e2m Doppler c\u00f3 \u0111\u1ed9 nh\u1ea1y cao h\u01a1n di\u1ec7n t\u00edch c\u1eaft ngang d\u00e2y th\u1ea7n kinh gi\u1eefa trong ch\u1ea9n \u0111o\u00e1n HCOCT (95% v\u00e0 91%).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">N\u0103m 2011 Ahmad Reza Ghasemi- Este v\u00e0 c\u1ed9ng s\u1ef1 nghi\u00ean c\u1ee9u si\u00eau \u00e2m Doppler n\u0103ng l\u01b0\u1ee3ng tr\u00ean 101 HCOCT v\u00e0 55 ng\u01b0\u1eddi t\u00ecnh nguy\u1ec7n c\u00f3 so s\u00e1nh v\u1edbi \u0111i\u1ec7n th\u1ea7n kinh cho k\u1ebft qu\u1ea3 \u0111\u1ed9 nh\u1ea1y l\u00e0 83%, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 89% trong khi \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u c\u1ee7a \u0111i\u1ec7n th\u1ea7n kinh l\u00e0 81% v\u00e0 84% [46]. \u1ede nh\u00f3m HCOCT m\u1ee9c \u0111\u1ed9 nh\u1eb9 (theo ph\u00e2n lo\u1ea1i tr\u00ean \u0111i\u1ec7n c\u01a1 c\u1ee7a Padual-L), c\u00f3 91,4% b\u1ec7nh nh\u00e2n c\u00f3 t\u0103ng sinh m\u1ea1ch tr\u00ean Doppler n\u0103ng l\u01b0\u1ee3ng v\u00e0 100% \u1edf nh\u00f3m HCOCT m\u1ee9c \u0111\u1ed9 trung b\u00ecnh v\u00e0 n\u1eb7ng [46],<\/span><\/p>\n<p><span style=\"font-weight: 400;\">N\u0103m 2012, nghi\u00ean c\u1ee9u v\u1ec1 si\u00eau \u00e2m Doppler m\u00e0u c\u1ee7a Maha K v\u00e0 c\u1ed9ng s\u1ef1 tr\u00ean 53 c\u1ed5 tay c\u00f3 HCOCT c\u0169ng cho k\u1ebft qu\u1ea3 94% b\u1ec7nh nh\u00e2n c\u00f3 t\u0103ng sinh m\u1ea1ch tr\u00ean Doppler m\u00e0u [35], Evans v\u00e0 c\u1ed9ng s\u1ef1 n\u0103m 2012 nghi\u00ean c\u1ee9u \u0111i\u1ec7n c\u01a1 v\u00e0 si\u00eau \u00e2m Doppler n\u0103ng l\u01b0\u1ee3ng tr\u00ean 47 b\u1ec7nh nh\u00e2n c\u00f3 HCOCT v\u00e0 44 nh\u00f3m ch\u1ee9ng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng. K\u1ebft qu\u1ea3 cho th\u1ea5y c\u00f3 m\u1ed1i li\u00ean quan gi\u1eefa s\u1ed1 \u0111\u1ebfm m\u1ea1ch v\u00e0 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a HCOCT.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">N\u0103m 2014, Vanderschueren v\u00e0 c\u1ed9ng s\u1ef1 \u0111a t\u1ed5ng h\u1ee3p c\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 si\u00eau \u00e2m Doppler trong HCOCT v\u00e0 \u0111\u01b0a ra k\u1ebft lu\u1eadn: si\u00eau \u00e2m Doppler n\u0103ng l\u01b0\u1ee3ng c\u00f3 \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao trong ch\u1ea9n \u0111o\u00e1n HCOCT. T\u00e1c gi\u1ea3 c\u0169ng \u0111\u01b0a ra khuy\u1ebfn c\u00e1o v\u1ec1 protocol chu\u1ea9n v\u00e0 thang \u0111i\u1ec3m \u0111\u00e1nh gi\u00e1 si\u00eau \u00e2m Doppler n\u0103ng l\u01b0\u1ee3ng.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">6) Ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n HCOCT v\u00e0 c\u00e1c b\u1ea5t th\u01b0\u1eddng gi\u1ea3i ph\u1eabu<\/span><\/h2>\n<figure id=\"attachment_3432\" aria-describedby=\"caption-attachment-3432\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-medium wp-image-3432\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Capture-2-300x139.png\" alt=\"B\u1ea3ng 4.2: Si\u00eau \u00e2m ph\u00e1t hi\u1ec7n c\u00e1c c\u1ea5u tr\u00fac b\u1ea5t th\u01b0\u1eddng trong \u1ed1ng c\u1ed5 tay\" width=\"300\" height=\"139\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Capture-2-300x139.png 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Capture-2.png 602w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-3432\" class=\"wp-caption-text\">B\u1ea3ng 4.2: Si\u00eau \u00e2m ph\u00e1t hi\u1ec7n c\u00e1c c\u1ea5u tr\u00fac b\u1ea5t th\u01b0\u1eddng trong \u1ed1ng c\u1ed5 tay<\/figcaption><\/figure>\n<p><span style=\"font-weight: 400;\">Nghi\u00ean c\u1ee9u c\u1ee7a Carvewright v\u00e0 c\u1ed9ng s\u1ef1 (2012) t\u1ed5ng h\u1ee3p nghi\u00ean c\u1ee9u nh\u00f3m 3: nghi\u00ean c\u1ee9u b\u1ec7nh &#8211; ch\u1ee9ng ph\u00e1t hi\u1ec7n c\u00e1c b\u1ea5t th\u01b0\u1eddng th\u1ea7n kinh gi\u1eefa trong h\u1ed9i ch\u1ee9ng \u1ed0ng c\u1ed5 tay. K\u1ebft qu\u1ea3: si\u00eau \u00e2m ph\u00e1t hi\u1ec7n nh\u1eefng c\u1ea5u tr\u00fac b\u1ea5t th\u01b0\u1eddng \u1edf \u1ed1ng c\u1ed5 tay m\u00e0 \u0111i\u1ec7n c\u01a1 kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c (B\u1ea5t th\u01b0\u1eddng th\u1ea7n kinh gi\u1eefa t\u00e1ch \u0111\u00f4i 2-13% [47-49]; Hai nghi\u00ean c\u1ee9u trong nh\u00f3m 3 I11\u00d4 t\u00e1 c\u00f2n \u0111\u1ed9ng m\u1ea1ch gi\u1eefa v\u1edbi t\u1ec9 l\u1ec7 6% v\u00e0 9% [47, 49], Nghi\u00ean c\u1ee9u c\u1ee7a Padual &#8211; L ph\u00e1t hi\u1ec7n vi\u00eam bao g\u00e2n chi\u1ebfm t\u1ec9 l\u1ec7 6%, c\u01a1 ph\u1ee5 \u1edf c\u1ed5 tay chi\u1ebfm 3%. Nghi\u00ean c\u1ee9u c\u1ee7a Nakamichi v\u00e0 Tachibana cho th\u1ea5y 25% b\u1ec7nh nh\u00e2n c\u00f3 HCOCT m\u1ed9t b\u00ean c\u00f3 nguy\u00ean nh\u00e2n do k\u00e9n ho\u1ea1t d\u1ecbch c\u1ed5 tay [48].<\/span><\/p>\n<p><span style=\"font-weight: 400;\">K\u1ebft qu\u1ea3 t\u1ed5ng h\u1ee3p nghi\u00ean c\u1ee9u nh\u00f3m 4 (19 b\u00e0i b\u00e1o) c\u1ee7a Cartwright v\u00e0 c\u1ed9ng s\u1ef1 cho th\u1ea5y vai tr\u00f2 si\u00eau \u00e2m ph\u00e1t hi\u1ec7n nh\u1eefng b\u1ea5t th\u01b0\u1eddng th\u1ea7n kinh gi\u1eefa trong h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay m\u1ed9t b\u00ean do c\u00e1c nguy\u00ean nh\u00e2n: ch\u1ea5n th\u01b0\u01a1ng th\u1ea7n kinh, u bao d\u00e2y th\u1ea7n kinh, u x\u01a1 m\u1ee1, k\u00e9n ho\u1ea1t d\u1ecbch, huy\u1ebft kh\u1ed1i \u0111\u1ed9ng m\u1ea1ch gi\u1eefa, \u00e1p xe, ch\u00e8n \u00e9p c\u1ee7a h\u1ea1t Tophi trong b\u1ec7nh G\u00fat [50, 51],<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">7) So s\u00e1nh gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n c\u1ee7a si\u00eau \u00e2m v\u00e0 \u0111i\u1ec7n c\u01a1<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Viser v\u00e0 c\u1ed9ng s\u1ef1 (2008) nghi\u00ean c\u1ee9u 168 OCT b\u1ec7nh v\u00e0 137 OCT ch\u1ee9ng. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n HCOCT l\u00e0 th\u1eddi gian ti\u1ec1m c\u1ea3m gi\u00e1c &gt; 3,2ms; hi\u1ec7u s\u1ed1 ti\u1ec1m c\u1ea3m gi\u00e1c gi\u1eefa-tr\u1ee5 0,4ms; th\u1eddi gian ti\u1ec1m v\u1eadn \u0111\u1ed9ng &gt; 3,8ms. Si\u00eau \u00e2m \u0111o di\u1ec7n t\u00edch d\u00e2y th\u1ea7n kinh gi\u1eefa \u1edf \u0111\u1ea7u g\u00e2n \u1ed1ng c\u1ed5 tay v\u00e0 ngang c\u01a1 s\u1ea5p. K\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u si\u00eau \u00e2m c\u00f3 \u0111\u1ed9 nh\u1ea1y 78%, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 91%. \u0110i\u1ec7n c\u01a1 c\u00f3 \u0111\u1ed9 nh\u1ea1y 82%, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 88%. C\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t r\u00f5 r\u1ec7t v\u1ec1 di\u1ec7n t\u00edch c\u1eaft ngang d\u00e2y th\u1ea7n kinh gi\u1eefa \u1edf nh\u00f3m b\u1ec7nh v\u00e0 nh\u00f3m ch\u1ee9ng [52].<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Mondelli v\u00e0 c\u1ed9ng s\u1ef1 (2008) nghi\u00ean c\u1ee9u si\u00eau \u00e2m v\u00e0 \u0111i\u1ec7n c\u01a1 \u1edf 85 b\u1ec7nh nh\u00e2n c\u00f3 HCOCT, si\u00eau \u00e2m \u0111o di\u1ec7n t\u00edch \u0111\u1ea7u g\u1ea7n, \u0111\u1ea7u xa, trong OCT. K\u1ebft qu\u1ea3 \u0111i\u1ec7n c\u01a1 c\u00f3 \u0111\u1ed9 nh\u1ea1y 67%; si\u00eau \u00e2m c\u00f3 \u0111\u1ed9 nh\u1ea1y 64,7%. K\u1ebft h\u1ee3p c\u1ea3 si\u00eau \u00e2m v\u00e0 \u0111i\u1ec7n c\u01a1 c\u00f3 \u0111\u1ed9 nh\u1ea1y 76,5%. V\u00ec v\u1eady k\u1ebft h\u1ee3p si\u00eau \u1ea9m v\u00e0 \u0111i\u1ec7n c\u01a1 cho gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n cao h\u01a1n khi s\u1eed d\u1ee5ng m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111\u01a1n l\u1ebb [6]<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">8) Nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">\u0110\u00e1nh gi\u00e1 vai tr\u00f2 c\u1ee7a si\u00eau \u00e2m Doppler n\u0103ng l\u01b0\u1ee3ng (PD) trong ch\u1ea9n \u0111o\u00e1n v\u00e0 ph\u00e2n lo\u1ea1i m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay (HCOCT) tr\u00ean 170 b\u1ec7nh nh\u00e2n g\u1ed3m 205 \u1ed1ng c\u1ed5 tay (OCT) c\u00f3 HCOCT tr\u00ean l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c l\u00e0m \u0111i\u1ec7n c\u01a1 \u0111\u1ec3 kh\u1eb3ng \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n, 170 nh\u00f3m ch\u1ee9ng (340 OCT) l\u00e0 ng\u01b0\u1eddi t\u00ecnh nguy\u1ec7n, kh\u1ecfe m\u1ea1nh. T\u1ea5t c\u1ea3 nh\u00f3m b\u1ec7nh v\u00e0 nh\u00f3m ch\u1ee9ng \u0111\u01b0\u1ee3c si\u00eau \u00e2m \u0111o di\u1ec7n t\u00edch d\u00e2y th\u1ea7n kinh gi\u1eefa \u1edf 4 v\u1ecb tr\u00ed: ngang c\u01a1 s\u1ea5p (CSAa), \u0111\u1ea7u g\u1ea7n OCT (CSAb), trong \u1ed1ng c\u1ed5 tay (CSAi) v\u00e0 \u0111\u1ea7u xa \u1ed1ng c\u1ed5 tay (CSAo). T\u00ednh Delta S (CSAb &#8211; CSAa) v\u00e0 % ch\u00eanh l\u1ec7ch S (CSAb &#8211; CSAa).100\/CSAb. Si\u00eau \u00e2m PD t\u00ednh s\u1ed1 \u0111i\u1ec3m m\u1ea1ch. S\u1eed d\u1ee5ng test T- Student so s\u00e1nh nh\u00f3m b\u1ec7nh v\u00e0 nh\u00f3m ch\u1ee9ng. T\u00ednh gi\u00e1 tr\u1ecb cut-off \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n HCOCT d\u1ef1a v\u00e0o \u0111\u01b0\u1eddng cong ROC. S\u1eed d\u1ee5ng l\u00e2m s\u00e0ng v\u00e0 \u0111i\u1ec7n c\u01a1 \u0111\u1ec3 ph\u00e2n lo\u1ea1i m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a HCOCT v\u00e0 kh\u1ea3o s\u00e1t m\u1ed1i li\u00ean quan v\u1edbi si\u00eau \u00e2m v\u00e0 si\u00eau PD.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">C\u00e1c k\u1ebft qu\u1ea3 thu \u0111\u01b0\u1ee3c cho th\u1ea5y: C\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa nh\u00f3m b\u1ec7nh v\u00e0 nh\u00f3m ch\u1ee9ng v\u1ec1 CSAb, CSAi, CSAo c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea v\u1edbi p &lt; 0,01. T\u1eeb \u0111\u01b0\u1eddng cong ROC t\u00ednh \u0111\u01b0\u1ee3c gi\u00e1 tr\u1ecb cut\u00ad-off CSAb: 9,5mm2 v\u1edbi \u0111\u1ed9 nh\u1ea1y 82%, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 60%. CSAi: 9,2mm2, \u0111\u1ed9 nh\u1ea1y 80%, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 60%. S\u1ed1 \u0111i\u1ec3m m\u1ea1ch trung b\u00ecnh tr\u00ean PD: 0,87. C\u00f3 m\u1ed1i li\u00ean quan gi\u1eefa di\u1ec7n t\u00edch d\u00e2y th\u1ea7n kinh (CSAb, CSAi, CSAo) v\u1edbi m\u1ee9c \u0111\u1ed9 n\u1eb7ng tr\u00ean \u0111i\u1ec7n c\u01a1 v\u00e0 l\u00e2m s\u00e0ng. Tuy nhi\u00ean kh\u00f4ng c\u00f3 m\u1ed1i li\u00ean quan gi\u1eefa t\u1ef7 l\u1ec7 t\u0103ng sinh m\u1ea1ch v\u00e0 m\u1ee9c \u0111\u1ed9 n\u1eb7ng tr\u00ean \u0111i\u1ec7n c\u01a1.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">K\u1ebft lu\u1eadn: Si\u00eau \u00e2m \u0111o di\u1ec7n t\u00edch c\u1eaft ngang d\u00e2y th\u1ea7n kinh gi\u1eefa c\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n v\u00e0 ph\u00e2n lo\u1ea1i m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a HCOCT. Si\u00eau \u00e2m PW c\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n nh\u01b0ng kh\u00f4ng c\u00f3 gi\u00e1 tr\u1ecb ph\u00e2n lo\u1ea1i m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh.<\/span><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>H\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay (HCOCT) l\u00e0 b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p \u1edf c\u1ed5 tay g\u00e2y ra \u0111au, t\u00ea v\u00e0 bu\u1ed3n tay do g\u00e2y \u1ee9c ch\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a d\u00e2y th\u1ea7n kinh c\u1ed5 tay. Si\u00eau \u00e2m c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n\u00a0 v\u00e0 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 v\u00e0 v\u1ecb tr\u00ed c\u1ee7a b\u1ec7nh l\u00fd, c\u00e1c [&hellip;]<\/p>\n","protected":false},"author":54,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[40],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Si\u00eau \u00e2m trong ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay (HCOCT)<\/title>\n<meta name=\"description\" content=\"C\u00e1c gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n si\u00eau \u00e2m \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o trong c\u00e1c nghi\u00ean c\u1ee9u \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 v\u00e0 so s\u00e1nh \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u trong 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