\nT\u1ea3i s\u00e1ch si\u00eau \u00e2m ch\u1ea5n th\u01b0\u01a1ng<\/a><\/p>\n
*. M\u1ee5c ti\u00eau:
\n– Gi\u1edbi thi\u1ec7u kh\u1ea3 n\u0103ng c\u0169ng nh\u01b0 gi\u1edbi h\u1ea1n c\u1ee7a si\u00eau \u00e2m trong ch\u1ea9n \u0111o\u00e1n c\u00e1c t\u1ed5n th\u01b0\u01a1ng do ch\u1ea5n th\u01b0\u01a1ng. Gi\u00fap b\u00e1c s\u0129 l\u00e2m s\u00e0ng s\u1eed d\u1ee5ng m\u1ed9t c\u00e1ch t\u1ed1i \u01b0u si\u00eau \u00e2m trong ch\u1ea9n \u0111o\u00e1n v\u00e0 theo d\u00f5i t\u1ed5n th\u01b0\u01a1ng c\u1ee7a c\u00e1c c\u01a1 quan do ch\u1ea5n th\u01b0\u01a1ng.<\/p>\n
– T\u00f3m l\u01b0\u1ee3c d\u1ea5u hi\u1ec7u ch\u1ea9n \u0111o\u00e1n si\u00eau \u00e2m c\u1ee7a c\u00e1c t\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng g\u1eb7p trong ch\u1ea5n th\u01b0\u01a1ng.
\n*. N\u1ed9i dung:<\/b><\/p>\n
1. Si\u00eau \u00e2m trong ch\u1ea5n th\u01b0\u01a1ng b\u1ee5ng<\/b><\/p>\n
Si\u00eau \u00e2m c\u00f3 \u0111\u1ed9 nh\u1ea1y cao trong vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 ph\u00e2n lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng do ch\u1ea5n th\u01b0\u01a1ng c\u1ee7a c\u00e1c t\u1ea1ng trong \u1ed5 b\u1ee5ng m\u00e0 \u0111\u1eb7c bi\u1ec7t l\u00e0 2 t\u1ea1ng \u0111\u1eb7c l\u00e0 gan v\u00e0 l\u00e1ch. Si\u00eau \u00e2m c\u00f3 kh\u1ea3 n\u0103ng ph\u00e1t hi\u1ec7n d\u1ecbch trong \u1ed5 b\u1ee5ng d\u00f9 v\u1edbi m\u1ed9t l\u01b0\u1ee3ng \u00edt.<\/p>\n
1.1 Ch\u1ea5n th\u01b0\u01a1ng l\u00e1ch<\/b>
\nSi\u00eau \u00e2m r\u1ea5t h\u1eefu \u00edch v\u00e0 c\u00f3 \u0111\u1ed9 ch\u00ednh x\u00e1c cao trong ch\u1ea9n \u0111o\u00e1n c\u1ee7a c\u00e1c kh\u1ed1i m\u00e1u t\u1ee5 d\u01b0\u1edbi bao v\u00e0 quanh l\u00e1ch. M\u1eb7c d\u00f9 \u0111\u00e2y c\u0169ng l\u00e0 l\u0129nh v\u1ef1c ch\u1ee5p CT \u0111\u00e3 t\u1ecf ra \u0111\u1eb7c bi\u1ec7t h\u1eefu d\u1ee5ng. Tuy nhi\u00ean b\u1ec7nh nh\u00e2n trong t\u00ecnh tr\u1ea1ng r\u1ea5t n\u1eb7ng, CT th\u01b0\u1eddng kh\u00f4ng th\u1ec3 s\u1eb5n s\u00e0ng \u0111\u1ec3 th\u1ef1c hi\u1ec7n ngay, si\u00eau \u00e2m l\u00e0 ch\u1ec9 \u0111\u1ecbnh h\u1ee3p l\u00fd. Si\u00eau \u00e2m c\u0169ng th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho vi\u1ec7c theo d\u00f5i ti\u1ebfn tri\u1ec3n c\u00e1c th\u01b0\u01a1ng t\u1ed5n.<\/p>\n
C\u00e1c t\u1ed5n th\u01b0\u01a1ng:<\/b><\/p>\n
– Kh\u1ed1i m\u00e1u t\u1ee5 trong nhu m\u00f4 l\u00e1ch:<\/p>\n
Th\u01b0\u01a1ng t\u1ed5n n\u00e0y h\u00ecnh th\u00e0nh do t\u00e1c \u0111\u1ed9ng c\u1ee7a l\u1ef1c ch\u1ea5n th\u01b0\u01a1ng l\u00e0m x\u00e9 r\u00e1ch nhu m\u00f4 v\u00e0 th\u01b0\u01a1ng t\u1ed5n m\u1ea1ch m\u00e1u m\u00e0 kh\u00f4ng th\u01b0\u01a1ng t\u1ed5n t\u1edbi bao l\u00e1ch.<\/p>\n
H\u00ecnh \u1ea3nh si\u00eau \u00e2m c\u1ee7a kh\u1ed1i m\u00e1u t\u1ee5 trong nhu m\u00f4 c\u0169ng nh\u01b0 c\u00e1c d\u1ea1ng t\u1ed5n th\u01b0\u01a1ng kh\u00e1c c\u1ee7a b\u1ec7nh l\u00fd ch\u1ea5n th\u01b0\u01a1ng thay \u0111\u1ed5i theo th\u1eddi gian. Kh\u1ed1i m\u00e1u t\u1ee5 trong nhu m\u00f4 l\u00e1ch l\u00fac m\u1edbi h\u00ecnh th\u00e0nh cho h\u00ecnh \u1ea3nh kh\u1ed1i cho\u00e1n ch\u1ed7 gi\u1edbi h\u1ea1n \u00edt r\u00f5, \u0111\u1ed9 h\u1ed3i \u00e2m gi\u1ea3m nh\u1eb9 so v\u1edbi \u0111\u1ed9 h\u1ed3i \u00e2m c\u1ee7a nhu m\u00f4 l\u00e1ch, ch\u00ednh h\u00ecnh \u1ea3nh \u0111\u1ed3ng h\u1ed3i \u00e2m n\u00e0y v\u00e0 nh\u1ea5t l\u00e0 k\u00edch th\u01b0\u1edbc \u1ed5 l\u1ea1i nh\u1ecf khi\u1ebfn<\/p>\n
t\u1ed5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 b\u1ecb s\u00f3t tr\u00ean si\u00eau \u00e2m. Theo th\u1eddi gian s\u1ebd x\u1ea3y ra qu\u00e1 tr\u00ecnh \u0111\u00f4ng m\u00e1u v\u00e0 t\u1ed5 ch\u1ee9c h\u00f3a, kh\u1ed1i m\u00e1u t\u1ee5 trong nhu m\u00f4 tr\u1edf n\u00ean gia t\u0103ng \u0111\u1ed9 h\u1ed3i \u00e2m h\u01a1n nhu m\u00f4 l\u00e1ch, sau \u0111\u00f3 do di\u1ec5n ti\u1ebfn h\u1ea5p thu d\u1ea7n v\u00e0 ph\u00e2n h\u1ee7y c\u00e1c th\u00e0nh ph\u1ea7n h\u1eefu h\u00ecnh th\u00ec kh\u1ed1i m\u00e1u t\u1ee5 tr\u1edf n\u00ean d\u1ecbch h\u00f3a, kh\u00f4ng t\u1ea1o h\u1ed3i \u00e2m k\u00e8m xu\u1ea5t hi\u1ec7n nh\u1eefng d\u1ea3i v\u00e1ch h\u00f3a t\u0103ng h\u1ed3i \u00e2m do qu\u00e1 tr\u00ecnh fibrin h\u00f3a \u0111\u1ec3 l\u1ea1i.<\/p>\n
– D\u1eadp nhu m\u00f4 l\u00e1ch : h\u00ecnh \u1ea3nh si\u00eau \u00e2m cho th\u1ea5y v\u00f9ng th\u01b0\u01a1ng t\u1ed5n c\u00f3 gi\u1edbi h\u1ea1n \u00edt r\u00f5 v\u00e0 h\u1ed3i \u00e2m kh\u00f4ng \u0111\u1ed3ng d\u1ea1ng, th\u01b0\u1eddng n\u1ed5i b\u1eadt l\u00e0 h\u00ecnh \u1ea3nh t\u0103ng h\u1ed3i \u00e2m.<\/p>\n
– Kh\u1ed1i m\u00e1u t\u1ee5 d\u01b0\u1edbi bao: kh\u1ed1i m\u00e1u t\u1ee5 c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m hay m\u1ea5t \u0111\u1ed9 l\u1ed3i gi\u1ea3i ph\u1eabu b\u1ec1 m\u1eb7t nhu m\u00f4 l\u00e1ch, th\u1eadm ch\u00ed l\u00e0m l\u00f5m b\u1ec1 m\u1eb7t nhu m\u00f4 l\u00e1ch, \u0111\u1eb7c \u0111i\u1ec3m n\u00e0y d\u00f9ng ph\u00e2n bi\u1ec7t v\u1edbi t\u1ee5 d\u1ecbch b\u00ean ngo\u00e0i l\u00e1ch. Di\u1ec5n ti\u1ebfn \u0111\u1ed9 h\u1ed3i \u00e2m c\u1ee7a kh\u1ed1i m\u00e1u t\u1ee5 d\u01b0\u1edbi bao c\u0169ng t\u01b0\u01a1ng t\u1ef1 nh\u01b0 v\u1edbi kh\u1ed1i m\u00e1u t\u1ee5 trong nhu m\u00f4.<\/p>\n
– R\u00e1ch bao l\u00e1ch v\u00e0 nhu m\u00f4 l\u00e1ch: th\u01b0\u01a1ng t\u1ed5n l\u00e0m gi\u00e1n \u0111o\u1ea1n bao l\u00e1ch v\u00e0 x\u00e9 r\u00e1ch v\u00e0o trong nhu m\u00f4 l\u00e1ch, v\u1ebft r\u00e1ch c\u1ecf th\u1ec3 l\u00e0 d\u1ea1ng \u0111\u01b0\u1eddng th\u1eb3ng hay d\u1ea1ng h\u00ecnh sao. Ngo\u00e0i ra tr\u00ean b\u1ec1 m\u1eb7t l\u00e1ch xung quanh v\u1ebft r\u00e1ch hi\u1ec7n di\u1ec7n m\u00e1u t\u1ef1 do bao quanh l\u00e1ch, \u0111\u1ecdng \u1edf h\u1ed1 l\u00e1ch, khi l\u01b0\u1ee3ng m\u00e1u nhi\u1ec1u th\u00ec lan xu\u1ed1ng t\u1ea7ng d\u01b0\u1edbi \u1ed5 b\u1ee5ng d\u1ecdc theo ng\u00e1ch \u0111\u1ea1i tr\u00e0ng tr\u00e1i.<\/p>\n
– V\u1ee1 l\u00e1ch:<\/p>\n
Th\u01b0\u01a1ng t\u1ed5n v\u1ee1 l\u00e1ch khi \u0111\u01b0\u1eddng r\u00e1ch l\u00e1ch li\u00ean t\u1ee5c t\u1eeb gi\u1edbi h\u1ea1n ngo\u00e0i \u0111\u1ebfn gi\u1edbi h\u1ea1n trong c\u1ee7a l\u00e1ch v\u00e0 ph\u00e2n l\u00e1ch th\u00e0nh hai hay nhi\u1ec1u m\u1ea3nh r\u1eddi nhau, tr\u00ean si\u00eau \u00e2m cho th\u1ea5y \u0111\u01b0\u1eddng v\u1ee1 nham nh\u1edf v\u1edbi \u0111\u1ed9 h\u1ed3i \u00e2m t\u0103ng do s\u1ef1 hi\u1ec7n di\u1ec7n v\u1eeba m\u00e1u c\u1ee5c v\u1edbi m\u00e1u m\u1edbi ch\u1ea3y, t\u1ea1o h\u1ed3i \u00e2m kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t. V\u1ee1 l\u00e1ch th\u01b0\u1eddng \u0111i k\u00e9m v\u1edbi m\u00e1u t\u1ef1 do trong \u1ed5 b\u1ee5ng nhi\u1ec1u.<\/p>\n
– Th\u01b0\u01a1ng t\u1ed5n cu\u1ed1ng l\u00e1ch v\u00e0 xu\u1ea5t huy\u1ebft ho\u1ea1t t\u00ednh: nghi ng\u1edd th\u01b0\u01a1ng t\u1ed5n ki\u1ec3u n\u00e0y khi tr\u00ean si\u00eau \u00e2m th\u1ea5y \u0111\u01b0\u1eddng r\u00e1ch hay \u0111\u01b0\u1eddng v\u1ee1 l\u00e1ch \u0111i ngang qua r\u1ed1n l\u00e1ch, c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y th\u01b0\u01a1ng t\u1ed5n c\u00e1c m\u1ea1ch m\u00e1u l\u1edbn \u1edf r\u1ed1n l\u00e1ch. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh th\u01b0\u1eddng d\u1ef1a v\u00e0o ch\u1ee5p m\u1ea1ch th\u1ea5y ch\u1ea5t c\u1ea3n quang ra ngo\u00e0i l\u00f2ng m\u1ea1ch.<\/p>\n
– Tr\u00e0n m\u00e1u khoang ph\u00fac m\u1ea1c: m\u00e1u t\u1ef1 do trong \u1ed5 b\u1ee5ng l\u00e0 k\u1ebft qu\u1ea3 th\u01b0\u01a1ng t\u1ed5n r\u00e1ch bao l\u00e1ch, r\u00e1ch nhu m\u00f4, v\u1ee1 l\u00e1ch. L\u01b0\u1ee3ng m\u00e1u \u00edt ch\u1ec9 t\u00ecm th\u1ea5y \u1edf t\u1ea7ng tr\u00ean \u1ed5 b\u1ee5ng, khi l\u01b0\u1ee3ng m\u00e1u ch\u1ea3y ra nhi\u1ec1u th\u00ec c\u00f3 th\u1ec3 th\u1ea5y \u1edf ng\u00e1ch gan th\u1eadn ph\u1ea3i, ng\u00e1ch \u0111\u1ea1i tr\u00e0ng hai b\u00ean, t\u00fai c\u00f9ng Douglas, th\u01b0\u1eddng m\u00e1u trong \u1ed5 b\u1ee5ng m\u1edbi ch\u00e0y ra cho h\u00ecnh \u1ea3nh d\u1ecbch l\u1ee3n c\u1ee3n h\u1ed3i \u00e2m, \u0111\u00f4i khi hi\u1ec7n di\u1ec7n nh\u1eefng d\u1ea3i t\u0103ng \u00e2m \u00e2m.<\/p>\n
1.2 Ch\u1ea5n th\u01b0\u01a1ng t\u1ee5y<\/b><\/p>\n
T\u1ee5y l\u00e0 c\u01a1 quan \u0111\u1ecbnh v\u1ecb s\u00e2u trong khoang sau ph\u00fac m\u1ea1c v\u00e0 \u0111\u01b0\u1ee3c n\u00e2ng \u0111\u1ee1 v\u00e0 bao b\u1ecdc b\u1edfi c\u00e1c c\u1ea5u tr\u00fac xung quanh, do \u0111\u00f3 t\u1ecb l\u1ec7 t\u1ed5n th\u01b0\u01a1ng t\u1ee5y trong ch\u1ea5n th\u01b0\u01a1ng b\u1ee5ng k\u00edn th\u1ea5p h\u01a1n r\u1ea5t nhi\u1ec1u so v\u1edbi gan v\u00e0 l\u00e1ch. Ch\u1ea5n th\u01b0\u01a1ng t\u1ee5y th\u01b0\u1eddng k\u1ebft h\u1ee3p v\u1edbi ch\u1ea5n th\u01b0\u01a1ng c\u00e1c t\u1ea1ng kh\u00e1c.<\/p>\n
Th\u01b0\u01a1ng t\u1ed5n th\u01b0\u1eddng l\u00e0 \u1edf th\u00e2n t\u1ee5y, c\u00e1c d\u1ea1ng th\u01b0\u01a1ng t\u1ed5n l\u00e0:<\/p>\n
– D\u1eadp nhu m\u00f4 t\u1ee5y, th\u01b0\u01a1ng t\u1ed5n d\u1eadp m\u00f4 t\u1ebf b\u00e0o k\u00e8m xu\u1ea5t huy\u1ebft vi th\u1ec3.<\/p>\n
– Kh\u1ed1i m\u00e1u t\u1ee5, th\u01b0\u01a1ng t\u1ed5n \u0111\u1ebfn nh\u00e1nh m\u1ea1ch m\u00e1u l\u00e0m xu\u1ea5t hi\u1ec7n \u1ed5 t\u1ee5 m\u00e1u c\u00f3 th\u1ec3 b\u00ean trong nhu m\u00f4 t\u1ee5y hay quanh t\u1ee5y.<\/p>\n
– R\u00e1ch t\u1ee5y t\u1eebng ph\u1ea7n c\u00f3 hay kh\u00f4ng t\u1ed5n th\u01b0\u01a1ng \u0111\u1ebfn \u1ed1ng t\u1ee5y.<\/p>\n
– V\u1ee1 \u0111\u00f4i t\u1ee5y, \u0111\u01b0\u1eddng v\u1ee1 chia t\u1ee5y th\u00e0nh 2 ph\u1ea7n k\u00e8m theo \u0111\u1ee9t \u0111\u00f4i \u1ed1ng t\u1ee5y ch\u00ednh.<\/p>\n
Vi\u1ec7c \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 tr\u1ea7m tr\u1ecdng c\u0169ng nh\u01b0 y\u1ebfu t\u1ed1 \u0111\u1ec3 xem x\u00e9t ti\u00ean l\u01b0\u1ee3ng c\u1ee7a ch\u1ea5n th\u01b0\u01a1ng t\u1ee5y th\u01b0\u1eddng c\u0103n c\u1ee9 tr\u00ean th\u01b0\u01a1ng t\u1ed5n \u1ed1ng t\u1ee5y ch\u00ednh. C\u00f3 th\u01b0\u01a1ng t\u1ed5n \u1ed1ng t\u1ee5y ch\u00ednh l\u00e0m t\u0103ng c\u00e1c bi\u1ebfn ch\u1ee9ng nh\u01b0 vi\u00eam t\u1ee5y, nang gi\u1ea3 t\u1ee5y, \u00e1p-xe t\u1ee5y. Tuy nhi\u00ean si\u00eau \u00e2m h\u1ea7u nh\u01b0 kh\u00f4ng th\u1ec3 \u0111\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng \u1ed1ng t\u1ee5y ch\u00ednh.<\/p>\n
H\u00ecnh \u1ea3nh si\u00eau \u00e2m c\u1ee7a c\u00e1c lo\u1ea1i th\u01b0\u01a1ng t\u1ed5n nh\u01b0 kh\u1ed1i m\u00e1u t\u1ee5, d\u1eadp hay v\u1ee1 nhu m\u00f4 t\u1ee5y v\u00e0 \u0111\u1eb7c t\u00ednh bi\u1ebfn \u0111\u1ed5i \u0111\u1ed9 h\u1ed3i \u00e2m theo th\u1eddi gian c\u1ee7a c\u00e1c lo\u1ea1i th\u01b0\u01a1ng t\u1ed5n n\u00e0y c\u0169ng \u0111\u01b0\u1ee3c ghi nh\u1eadn t\u01b0\u01a1ng t\u1ef1 nh\u01b0 trong ch\u1ea5n th\u01b0\u01a1ng gan, ch\u1ea5n th\u01b0\u01a1ng l\u00e1ch.<\/p>\n
T\u1ee5y l\u00e0 c\u01a1 quan \u0111\u1ecbnh v\u1ecb s\u00e2u ph\u00eda sau ph\u00fac m\u1ea1c, b\u1ecb che ph\u1ee7 ph\u00eda tr\u01b0\u1edbc b\u1edfi d\u1ea1 d\u00e0y v\u00e0 \u0111\u00f4i khi c\u1ea3 quai \u0111\u1ea1i tr\u00e0ng ngang n\u00ean vi\u1ec7c th\u0103m d\u00f2 kh\u00f4ng th\u1ec3 \u0111\u00e1p \u1ee9ng c\u00e1c y\u00eau c\u1ea7u c\u1ee7a l\u00e2m s\u00e0ng.<\/p>\n
1.3 Ch\u1ea5n th\u01b0\u01a1ng gan<\/b><\/p>\n
Th\u01b0\u1eddng trong b\u1ec7nh c\u1ea3nh ch\u1ea5n th\u01b0\u01a1ng b\u1ee5ng k\u00edn, c\u00f3 th\u1ec3 ph\u00e2n chia c\u00e1c th\u01b0\u01a1ng t\u1ed5n nh\u01b0 sau:<\/p>\n
– D\u1eadp nhu m\u00f4 gan:H\u00ecnh \u1ea3nh m\u1ed9t v\u00f9ng nhu m\u00f4 gan t\u0103ng h\u1ed3i \u00e2m so v\u1edbi xung quanh, \u0111\u01b0\u1ee3c l\u00fd gi\u1ea3i do fibrin v\u00e0 m\u00e1u tho\u00e1t ra ngo\u00e0i l\u00f2ng m\u1ea1ch v\u00e0 d\u1eadp m\u00f4 \u1edf m\u1ee9c vi th\u1ec3, v\u00f9ng t\u0103ng \u00e2m n\u00e0y th\u01b0\u1eddng gi\u1edbi h\u1ea1n \u00edt r\u00f5, \u0111\u00f4i khi c\u00f3 th\u1ec3 th\u1ea5y nh\u1eefng \u0111\u01b0\u1eddng r\u00e1ch nhu m\u00f4 t\u1ea1o n\u00ean h\u00ecnh ch\u00e2n chim.<\/p>\n
– R\u00e1ch gan, r\u00e1ch bao gan v\u00e0 r\u00e1ch nhu m\u00f4 gan: R\u00e1ch bao gan th\u01b0\u1eddng k\u1ebft h\u1ee3p v\u1edbi r\u00e1ch nhu m\u00f4 gan b\u00ean d\u01b0\u1edbi, h\u00ecnh si\u00eau \u00e2m c\u1ee7a m\u1eb7t c\u1eaft ngang \u0111\u01b0\u1eddng r\u00e1ch cho th\u1ea5y m\u1ea5t li\u00ean t\u1ee5c c\u1ee7a \u0111\u01b0\u1eddng ph\u1ea3n \u00e2m s\u00e1ng v\u00e0 m\u1ea3nh c\u1ee7a bao gan, t\u01b0\u01a1ng \u1ee9ng v\u1ecb tr\u00ed n\u00e0y l\u00e0 \u0111\u01b0\u1eddng r\u00e1ch nhu m\u00f4 gan d\u1ea1ng h\u00ecnh ch\u00eam b\u1edd nham nh\u1edf, ranh gi\u1edbi h\u00ecnh ch\u00eam c\u1ee7a nhu m\u00f4 gancho th\u1ea5y t\u0103ng h\u1ed3i \u00e2m, k\u00e8m theo h\u00ecnh \u1ea3nh m\u00e1u t\u1ef1 do xu\u1ea5t hi\u1ec7n tr\u00ean b\u1edd m\u1eb7t gan, t\u00f9y theo m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u m\u00e0 l\u01b0\u1ee3ng d\u1ecbch t\u1ef1 do trong \u1ed5 \u00edt hay nhi\u1ec1u m\u00e0 t\u01b0\u01a1ng \u1ee9ng c\u00f3 th\u1ec3 th\u1ea5y \u1edf b\u1ec1 m\u1eb7t gan, g\u1ea7m gan , ng\u00e1ch gan th\u1eadn ph\u1ea3i, ng\u00e1ch \u0111\u1ea1i tr\u00e0ng, t\u00fai c\u00f9ng \u0111\u1ed3. Do v\u1ecb tr\u00ed n\u00f4ng v\u00e0 v\u00e0 s\u00e1t th\u00e0nh b\u1ee5ng c\u1ee7a bao gan n\u00ean \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n d\u1ea1ng t\u1ed5n th\u01b0\u01a1ng n\u00e0y \u0111\u00f2i h\u1ecfi s\u1eed d\u1ee5ng \u0111\u1ea7u d\u00f2 v\u1edbi t\u1ea7n s\u1ed1 cao.<\/p>\n
![\"[\u200bIMG]\"](\"http:\/\/langdidong.0fees.us\/wp-content\/uploads\/2016\/01\/SA2.jpg\" "\\"\\"")
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– Kh\u1ed1i m\u00e1u t\u1ee5 trong nhu m\u00f4: Kh\u1ed1i m\u00e1u t\u1ee5 trong nhu m\u00f4 c\u00f3 c\u1ea5u tr\u00fac h\u1ed3i \u00e2m thay \u0111\u1ed5i theo th\u1eddi gian, l\u00fac m\u1edbi h\u00ecnh th\u00e0nh l\u01b0\u1ee3ng m\u00e1u ch\u1ea3y ra t\u1ea1o h\u00ecnh \u1ea3nh c\u1ea5u tr\u00fac d\u1ecbch v\u1edbi s\u1ef1 hi\u1ec7n di\u1ec7n h\u1ed3i \u00e2m l\u1ee3n c\u1ee3n b\u00ean trong, \u0111\u00f4i khi bi\u1ec3u hi\u1ec7n \u0111\u1ed3ng h\u1ed3i \u00e2m v\u1edbi m\u00f4 gan xung quanh; v\u00e0i gi\u1edd si\u00eau \u00e2mu v\u1edbi s\u1ef1 h\u00ecnh th\u00e0nh c\u1ee5c m\u00e1u \u0111\u00f4ng v\u00e0 t\u1ed5 ch\u1ee9c h\u00f3a t\u1ea1o h\u00ecnh \u1ea3nh m\u1ed9t c\u1ea5u tr\u00fac t\u0103ng h\u1ed3i \u00e2m r\u00f5 \u2013 kh\u00f4ng \u0111\u1ed3ng d\u1ea1ng. Sau \u0111\u00f3 th\u00ec b\u1eaft \u0111\u1ea7u qu\u00e1 tr\u00ecnh h\u00f3a l\u1ecfng t\u1eebng ph\u1ea7n \u0111\u1ec3 l\u1ea1i kh\u1ed1i huy\u1ebft thanh cho h\u00ecnh \u1ea3nh si\u00eau \u00e2m l\u00e0 kh\u1ed1i d\u1ecbch \u00edt nhi\u1ec1u c\u00f3 h\u1ed3i \u00e2m, b\u00ean trong hi\u1ec7n di\u1ec7n v\u00e1ch h\u00f3a, sau \u0111\u00f3 do s\u1ef1 h\u1ea5p th\u1ee5 d\u1ecbch m\u00e0 k\u00edch th\u01b0\u1edbc kh\u1ed1i huy\u1ebft thanh gi\u1ea3m d\u1ea7n ho\u1eb7c bi\u1ebfn m\u1ea5t ho\u00e0n to\u00e0n ho\u1eb7c \u0111\u1ec3 l\u1ea1i di ch\u1ee9ng l\u00e0 c\u1ea5u tr\u00fac nang ho\u1eb7c l\u00e0 v\u1ebft s\u1eb9o x\u01a1 h\u00f3a, \u0111\u00f4i khi l\u00e0 n\u1ed1t v\u00f4i h\u00f3a.<\/p>\n
– Kh\u1ed1i m\u00e1u t\u1ee5 d\u01b0\u1edbi bao gan: \u0110\u00e2y l\u00e0 d\u1ea1ng t\u1ed5n th\u01b0\u01a1ng kh\u00e1 \u0111\u1eb7c bi\u1ec7t c\u1ee7a ch\u1ea5n th\u01b0\u01a1ng gan, bao gan kh\u00f4ng b\u1ecb r\u00e1ch v\u00e0 m\u00e1u ch\u1ea3y ra \u1edf v\u00f9ng d\u01b0\u1edbi bao gan l\u00e0m t\u00e1ch bao gan kh\u1ecfi nhu m\u00f4 gan; t\u1ea1o d\u1ea5u hi\u1ec7u r\u1ea5t \u0111\u1eb7c bi\u1ec7t: kh\u1ed1i m\u00e1u \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh \u0111\u1ea9y nhu m\u00f4 gan l\u00f5m v\u00e0o ph\u00eda trong \u0111\u1ed3ng th\u1eddi \u0111\u1ea9y l\u1ed3i bao gan ra ph\u00eda ngo\u00e0i t\u1ea1o h\u00ecnh th\u1ea5u k\u00ednh hai m\u1eb7t l\u1ed3i; \u0111\u1ed9 h\u1ed3i \u00e2m c\u1ee7a kh\u1ed1i m\u00e1u t\u1ee5 d\u01b0\u1edbi bao c\u0169ng thay \u0111\u1ed5i theo th\u1eddi gian t\u01b0\u01a1ng t\u1ef1 nhu kh\u1ed1i m\u00e1u t\u1ee5 trong nhu m\u00f4. Hi\u1ec7n t\u01b0\u1ee3ng t\u00e1i ch\u1ea3y m\u00e1u \u1edf kh\u1ed1i m\u00e1u t\u1ee5 d\u01b0\u1edbi bao kh\u00e1 th\u01b0\u1eddng g\u1eb7p t\u1ea1o ra h\u00ecnh \u1ea3nh si\u00eau \u00e2m c\u00f3 nhi\u1ec1u l\u1edbp v\u1edbi \u0111\u1ed9 h\u1ed3i \u00e2m kh\u00e1c nhau.<\/p>\n
1.4 Ch\u1ea5n th\u01b0\u01a1ng \u1ed1ng ti\u00eau h\u00f3a<\/b><\/p>\n
Th\u01b0\u01a1ng t\u1ed5n \u1ed1ng ti\u00eau h\u00f3a trong ch\u1ea5n th\u01b0\u01a1ng b\u1ee5ng t\u01b0\u01a1ng \u0111\u1ed1i hi\u1ebfm, v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 g\u1eb7p theo th\u1ee9 t\u1ef1 l\u00e0 : t\u00e1 tr\u00e0ng \u2013 nh\u1ea5t l\u00e0 \u0111o\u1ea1n c\u1ed1 \u0111\u1ecbnh, k\u1ebf \u0111\u1ebfn l\u00e0 ru\u1ed9t non v\u00e0 \u00edt g\u1eb7p h\u01a1n l\u00e0 \u0111\u1ea1i tr\u00e0ng.<\/p>\n
C\u00e1c lo\u1ea1i th\u01b0\u01a1ng t\u1ed5n c\u00f3 th\u1ec3 th\u1ea5y l\u00e0:<\/p>\n
– M\u00e1u t\u1ee5 trong th\u00e0nh \u1ed1ng ti\u00eau h\u00f3a.<\/p>\n
– D\u1eadp ru\u1ed9t.<\/p>\n
– V\u1ee1 ru\u1ed9t; l\u00e0m tho\u00e1t h\u01a1i, d\u1ecbch b\u00ean trong l\u00f2ng ru\u1ed9t v\u00e0o \u1ed5 ph\u00fac m\u1ea1c g\u00e2y vi\u00eam ph\u00fac m\u1ea1c.<\/p>\n
– Th\u01b0\u1eddng c\u00f3 k\u1ebft h\u1ee3p xu\u1ea5t huy\u1ebft m\u1ea1c treo do x\u00e9 r\u00e1ch m\u1ea1c treo l\u00e0m th\u01b0\u01a1ng t\u1ed5n c\u00e1c m\u1ea1ch m\u00e1u trong m\u1ea1c treo.<\/p>\n
– Ngo\u00e0i ra do l\u1ef1c t\u00e1c \u0111\u1ed9ng l\u1edbn n\u00ean gay t\u1ed5n th\u01b0\u01a1ng c\u00e1c t\u1ea1ng kh\u00e1c trong \u1ed5 b\u1ee5ng<\/p>\n
Th\u1ee7ng, v\u1ee1 ru\u1ed9t l\u00e0 lo\u1ea1i th\u01b0\u01a1ng t\u1ed5n tr\u1ea7m tr\u1ecdng nh\u1ea5t n\u00ean c\u1ea7n ph\u00e1t hi\u1ec7n s\u1edbm:<\/p>\n
– D\u1ea5u hi\u1ec7u tr\u1ef1c ti\u1ebfp tr\u00ean si\u00eau \u00e2m : h\u00ecnh \u1ea3nh gi\u00e1n \u0111o\u1ea1n c\u1ee7a th\u00e0nh ru\u1ed9t th\u1ec3 hi\u1ec7n b\u1edfi kh\u00ed \u0111\u1ecdng trong th\u00e0nh ru\u1ed9t v\u00e0 xuy\u00ean th\u00e0nh ru\u1ed9t, c\u00e1c b\u1ecdt kh\u00ed n\u00e0y t\u1ea1o d\u1ea3i b\u00f3ng l\u01b0ng b\u1ea9n ph\u00eda sau.<\/p>\n
– D\u1ea5u hi\u1ec7u gi\u00e1n ti\u1ebfp tr\u00ean si\u00eau \u00e2m : h\u00ecnh \u1ea3nh kh\u00ed tho\u00e1t ra kh\u1ecfi l\u00f2ng ru\u1ed9t v\u00e0o trong \u1ed5 b\u1ee5ng, th\u01b0\u1eddng kh\u00ed t\u1ef1 do n\u00e0y n\u1eb1m k\u1ebf c\u1eadn l\u1ed7 th\u1ee7ng, trong tr\u01b0\u1eddng h\u1ee3p kh\u00ed tho\u00e1t ra nhi\u1ec1u th\u00ec c\u00f3 th\u1ec3 t\u1ee5 t\u1eadp \u1edf c\u00e1c ng\u00e1ch ph\u00fac m\u1ea1c, th\u1eadm ch\u00ed \u1edf d\u01b0\u1edbi v\u00f2m ho\u00e0nh.<\/p>\n
Th\u01b0\u01a1ng t\u1ed5n d\u1eadp v\u00e0 m\u00e1u t\u1ee5 trong th\u00e0nh \u1ed1ng ti\u00eau h\u00f3a th\u1ec3 hi\u1ec7n b\u1edfi h\u00ecnh \u1ea3nh d\u00e0y l\u00ean c\u1ee7a th\u00e0nh \u1ed1ng ti\u00eau h\u00f3a, c\u00f3 th\u1ec3 d\u00e0y \u0111\u1ed3ng t\u00e2m hay l\u1ec7ch t\u00e2m k\u00e8m gi\u1ea3m h\u1ed3i \u00e2m. Xu\u1ea5t huy\u1ebft trong m\u1ea1c treo th\u1ec3 hi\u1ec7n b\u1edfi h\u00ecnh \u1ea3nh d\u00e0y l\u00ean c\u1ee7a m\u1ea1c treo v\u00e0 t\u0103ng h\u1ed3i \u00e2m, c\u00f3 d\u1ecbch m\u00e1u trong \u1ed5 b\u1ee5ng.<\/p>\n
1.5 Ch\u1ea5n th\u01b0\u01a1ng th\u1eadn<\/b><\/p>\n
Th\u01b0\u1eddng trong b\u1ec7nh c\u1ea3nh ch\u1ea5n th\u01b0\u01a1ng b\u1ee5ng k\u00edn, c\u00f3 th\u1ec3 ph\u00e2n chia c\u00e1c th\u01b0\u01a1ng t\u1ed5n nh\u01b0 sau:<\/p>\n
– D\u1eadp nhu m\u00f4 th\u1eadn: h\u00ecnh \u1ea3nh m\u1ed9t v\u00f9ng t\u0103ng h\u1ed3i \u00e2m gi\u1edbi h\u1ea1n \u00edt r\u00f5 n\u1eb1m trong ch\u1ee7 m\u00f4 th\u1eadn, \u00edt khi c\u00f3 bi\u1ec3u hi\u1ec7n \u0111\u00e8 \u0111\u1ea9y tr\u00ean c\u00e1c c\u1ea5u tr\u00fac xung quanh.<\/p>\n
– R\u00e1ch bao th\u1eadn v\u00e0 r\u00e1ch nhu m\u00f4 th\u1eadn: bao th\u1eadn th\u1ec3 hi\u1ec7n nh\u01b0 \u0111\u01b0\u1eddng ph\u1ea3n \u00e2m li\u00ean t\u1ee5c, s\u00e1ng v\u00e0 m\u1ea3nh. Khi xu\u1ea5t hi\u1ec7n s\u1ef1 gi\u00e1n \u0111o\u1ea1n c\u1ee7a \u0111\u01b0\u1eddng n\u00e0y cho ph\u00e9p ch\u1ea9n \u0111o\u00e1n r\u00e1ch bao th\u1eadn. R\u00e1ch bao th\u1eadn th\u01b0\u1eddng k\u1ebft h\u1ee3p v\u1edbi r\u00e1ch nhu m\u00f4 th\u1eadn, \u1edf giai \u0111o\u1ea1n s\u1edbm th\u1ec3 hi\u1ec7n nh\u01b0 d\u1ea3i t\u0103ng h\u1ed3i \u00e2m h\u00ecnh ch\u00eam t\u1eeb bao th\u1eadn \u0111i v\u00e0o trong nhu m\u00f4 th\u1eadn ho\u1eb7c hai b\u1edd h\u00ecnh ch\u00eam l\u00e0 t\u0103ng h\u1ed3i \u00e2m c\u00f2n \u1edf gi\u1eefa h\u00ecnh ch\u00eam l\u00e0 gi\u1ea3m h\u1ed3i \u00e2m.<\/p>\n
– Kh\u1ed1i m\u00e1u t\u1ee5: kh\u1ed1i m\u00e1u t\u1ee5 trong nhu m\u00f4 c\u00f3 \u0111\u1ed9 h\u1ed3i \u00e2m v\u00e0 c\u1ea5u tr\u00fac h\u1ed3i \u00e2m thay \u0111\u1ed5i theo th\u1eddi gian, th\u00f4ng th\u01b0\u1eddng m\u00e1u t\u1ee5 m\u1edbi ch\u1ea3y v\u00e0 t\u1ea1o c\u1ee5c m\u00e1u \u0111\u00f4ng th\u00ec c\u00f3 m\u1ee9c \u0111\u1ed9 h\u1ed3i \u00e2m t\u0103ng, sau \u0111\u00f3 di\u1ec5n bi\u1ebfn h\u1ea5p thu d\u1ea7n v\u00e0 t\u1ed5 ch\u1ee9c h\u00f3a th\u00ec t\u1ea1o m\u1eabu h\u1ed3i \u00e2m h\u1ed7n h\u1ee3p v\u1edbi nh\u1eefng \u0111\u00e1m t\u0103ng h\u1ed3i \u00e2m d\u1ea1ng v\u00e1ch tr\u00ean n\u1ec1n gi\u1ea3m h\u1ed3i \u00e2m. Kh\u1ed1i m\u00e1u t\u1ee5 th\u01b0\u1eddng c\u00f3 bi\u1ec3u hi\u1ec7n kh\u1ed1i g\u00e2y x\u00f4 \u0111\u1ea9y c\u1ea5u tr\u00fac xung quanh.<\/p>\n
C\u00f3 th\u1ec3 th\u1ea5y c\u00e1c d\u1ea1ng t\u1ee5 m\u00e1u:<\/p>\n
o T\u1ee5 m\u00e1u trong nhu m\u00f4, kh\u1ed1i m\u00e1u t\u1ee5 khu tr\u00fa trong v\u1ecf th\u1eadn ho\u1eb7c v\u1ecf t\u1ee7y th\u1eadn.<\/p>\n
o T\u1ee5 m\u00e1u d\u01b0\u1edbi bao th\u1eadn, kh\u1ed1i m\u00e1u t\u1ee5 c\u00f3 xu h\u01b0\u1edbng \u0111\u1ea9y nhu m\u00f4 th\u1eadn v\u1ec1 ph\u00eda r\u1ed1n th\u1eadn l\u00e0m cho b\u1ec1 m\u1eb7t nhu m\u00f4 th\u1eadn m\u1ea5t t\u00ednh ch\u1ea5t l\u1ed3i v\u00e0 tr\u1edf l\u00ean d\u1eb9t hay l\u00f5m.<\/p>\n
– Th\u01b0\u01a1ng t\u1ed5n h\u1ec7 th\u1ed1ng g\u00f3p:<\/p>\n
Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh khi ch\u1ee9ng minh \u0111\u01b0\u1ee3c s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a n\u01b0\u1edbc ti\u1ec3u tr\u00e0n ra ngo\u00e0i h\u1ec7 th\u1ed1ng g\u00f3p.<\/p>\n
Si\u00eau \u00e2m c\u00f3 \u0111\u1ed9 nh\u1ea1y k\u00e9m, tuy nhi\u00ean m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p cho ph\u00e9p g\u1ee3i \u00fd th\u01b0\u01a1ng t\u1ed5n h\u1ec7 th\u1ed1ng g\u00f3p:<\/p>\n
o H\u00ecnh \u1ea3nh \u0111\u00e0i b\u1ec3 th\u1eadn gi\u00e3n v\u00e0 b\u00ean trong ch\u1ee9a m\u00e1u c\u1ee5c c\u00f3 h\u1ed3i \u00e2m.<\/p>\n
o H\u00ecnh \u1ea3nh \u0111\u01b0\u1eddng r\u00e1ch th\u1eadn, d\u1eadp th\u1eadn lan r\u1ed9ng t\u1edbi xoang th\u1eadn.<\/p>\n
o Kh\u1ed1i m\u00e1u t\u1ee5 trong nhu m\u00f4 l\u1edbn, lan \u0111\u1ebfn xoang th\u1eadn g\u00e2y ra s\u1ef1 bi\u1ebfn d\u1ea1ng xoang th\u1eadn.<\/p>\n
o \u0110\u1eb7c bi\u1ec7t h\u00ecnh \u1ea3nh kh\u00e1 \u0111\u1eb7c th\u00f9 l\u00e0 kh\u1ed1i u n\u01b0\u1edbc ti\u1ec3u \u0111\u1ecbnh v\u1ecb \u1edf khoang quanh th\u1eadn hay khoang c\u1ea1nh th\u1eadn.<\/p>\n
– V\u1ee1 th\u1eadn: khi hi\u1ec7n di\u1ec7n m\u1ea5t li\u00ean t\u1ee5c t\u1eeb bao th\u1eadn, nhu m\u00f4 th\u1eadn lan \u0111\u1ebfn r\u1ed1n th\u1eadn. V\u1ee1 th\u1eadn c\u00f3 th\u1ec3 hai hay nhi\u1ec1u m\u1ea3nh. V\u1ee1 th\u1eadn th\u01b0\u1eddng lu\u00f4n k\u00e8m c\u00e1c t\u1ed5n th\u01b0\u01a1ng kh\u00e1c nh\u01b0 d\u1eadp nhu m\u00f4, r\u00e1ch, m\u00e1u t\u1ee5.<\/p>\n
– Th\u01b0\u01a1ng t\u1ed5n cu\u1ed1ng m\u1ea1ch th\u1eadn v\u00e0 m\u1ea1ch m\u00e1u th\u1eadn: khi hi\u1ec7n di\u1ec7n m\u1ed9t kh\u1ed1i m\u00e1u t\u1ee5 \u1edf v\u00f9ng r\u1ed1n th\u1eadn th\u00ec r\u1ea5t g\u1ee3i \u00fd cho th\u01b0\u01a1ng t\u1ed5n m\u1ea1ch m\u00e1u th\u1eadn, l\u00fac n\u00e0y c\u1ea7n s\u1eed d\u1ee5ng si\u00eau \u00e2m doppler \u0111\u1ec3 kh\u1ea3o s\u00e1t t\u1ed5n th\u01b0\u01a1ng.<\/p>\n
C\u00e1c t\u1ed5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 th\u1ea5y :<\/p>\n
o T\u1eafc \u0111\u1ed9ng m\u1ea1ch th\u1eadn<\/p>\n
o T\u1eafc t\u0129nh m\u1ea1ch th\u1eadn<\/p>\n
o Nh\u1ed3i m\u00e1u th\u1eadn<\/p>\n
o Gi\u1ea3 ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch th\u1eadn<\/p>\n
o D\u00f2 \u0111\u1ed9ng m\u1ea1ch \u2013 t\u0129nh m\u1ea1ch th\u1eadn<\/p>\n
1.6 Ch\u1ea5n th\u01b0\u01a1ng b\u00e0ng quang<\/b><\/p>\n
V\u1ee1 b\u00e0ng quang th\u01b0\u1eddng trong ch\u1ea5n th\u01b0\u01a1ng v\u00f9ng b\u1ee5ng d\u01b0\u1edbi v\u00e0 ch\u1eadu, nguy c\u01a1 v\u1ee1 b\u00e0ng quang c\u00e0ng cao khi m\u00e0 b\u00e0ng quang c\u0103ng l\u00fac ch\u1ea5n th\u01b0\u01a1ng. H\u00ecnh \u1ea3nh si\u00eau \u00e2m l\u00e0 th\u01b0\u01a1ng t\u1ed5n gi\u00e1n \u0111o\u1ea1n th\u00e0nh b\u00e0ng quang k\u00e8m h\u00ecnh \u1ea3nh th\u00f4ng th\u01b0\u01a1ng d\u1ecbch trong b\u00e0ng quang v\u00e0 d\u1ecbch t\u1ef1 do ngo\u00e0i \u1ed5 b\u1ee5ng. Trong tr\u01b0\u1eddng h\u1ee3p n\u01b0\u1edbc ti\u1ec3u tho\u00e1t ra ngo\u00e0i \u1ed5 ph\u00fac m\u1ea1c cho h\u00ecnh \u1ea3nh \u1ed5 \u0111\u1ecdng d\u1ecbch \u1edf ng\u00e1ch tr\u01b0\u1edbc b\u00e0ng quang, ng\u00e1ch quanh b\u00e0ng quang, ng\u00e1ch sau tr\u1ef1c tr\u00e0ng.<\/p>\n
1.7 Ch\u1ea5n th\u01b0\u01a1ng ni\u1ec7u \u0111\u1ea1o<\/b><\/p>\n
Th\u01b0\u1eddng x\u1ea3y ra trong ch\u1ea5n th\u01b0\u01a1ng khung ch\u1eadu, c\u00f3 th\u1ec3 kh\u1ea3o s\u00e1t v\u1edbi \u0111\u1ea7u d\u00f2 tr\u1ef1c tr\u00e0ng gi\u00fap th\u1ea5y c\u00e1c t\u1ed5n th\u01b0\u01a1ng r\u00e1ch, d\u1eadp v\u00e0 c\u00e1c kh\u1ed1i t\u1ee5 m\u00e1u.<\/p>\n
2. Si\u00eau \u00e2m trong ch\u1ea5n th\u01b0\u01a1ng ng\u1ef1c<\/b><\/p>\n
Si\u00eau \u00e2m trong ch\u1ea5n th\u01b0\u01a1ng ng\u1ef1c ch\u1ee7 y\u1ebfu gi\u00fap ph\u00e1t hi\u1ec7n c\u00e1c tr\u01b0\u1eddng h\u1ee3p tr\u00e0n d\u1ecbch m\u00e0ng tim, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i do c\u00e1c th\u01b0\u01a1ng t\u1ed5n c\u1ee7a ch\u1ea5n th\u01b0\u01a1ng v\u00f9ng ng\u1ef1c g\u00e2y ra. Si\u00eau \u00e2m trong ch\u1ea5n th\u01b0\u01a1ng ng\u1ef1c th\u01b0\u1eddng k\u1ebft h\u1ee3p v\u00e0 c\u1ea7n l\u01b0u \u00fd ph\u00e1t hi\u1ec7n c\u00e1c t\u1ed5n th\u01b0\u01a1ng do ch\u1ea5n th\u01b0\u01a1ng c\u00e1c c\u01a1 quan v\u00f9ng b\u1ee5ng.<\/p>\n
2.1 Si\u00eau \u00e2m tim<\/b><\/p>\n
Si\u00eau \u00e2m r\u1ea5t h\u1eefu \u00edch v\u00e0 c\u00f3 \u0111\u1ed9 ch\u00ednh x\u00e1c cao trong ch\u1ea9n \u0111o\u00e1n tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim c\u0169ng nh\u01b0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng tim kh\u00e1c do ch\u1ea5n th\u01b0\u01a1ng.<\/p>\n
Si\u00eau \u00e2m tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim: tr\u00ean si\u00eau \u00e2m c\u00f3 kho\u1ea3ng tr\u1ed1ng gi\u1eefa th\u01b0\u1ee3ng t\u00e2m m\u1ea1c v\u00e0 ngo\u1ea1i t\u00e2m m\u1ea1c, g\u1ecdi l\u00e0 kho\u1ea3ng tr\u1ed1ng echo, s\u1ed1 l\u01b0\u1ee3ng th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u01b0\u1edbc t\u00ednh<\/p>\n
– Tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim l\u01b0\u1ee3ng \u00edt: l\u01b0\u1ee3ng d\u1ecbch \u00edt h\u01a1n 300 ml, kho\u1ea3ng tr\u1ed1ng echo < 10 mm.<\/p>\n
– Tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim l\u01b0\u1ee3ng v\u1eeba: l\u01b0\u1ee3ng d\u1ecbch kho\u1ea3ng 300 \u2013 500 ml, kho\u1ea3ng tr\u1ed1ng echo kho\u1ea3ng 10 \u2013 20 mm.<\/p>\n
– Tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim l\u01b0\u1ee3ng nhi\u1ec1u: l\u01b0\u1ee3ng d\u1ecbch tr\u00ean 500 ml, kho\u1ea3ng tr\u1ed1ng echo tr\u00ean 20 mm.<\/p>\n
Bi\u1ec3u hi\u1ec7n ch\u00e8n \u00e9p tim c\u1ea5p tr\u00ean si\u00eau \u00e2m:<\/p>\n
– \u0110\u00e8 s\u1ee5p nh\u0129 ph\u1ea3i th\u00ec t\u00e2m tr\u01b0\u01a1ng, \u0111\u1ed9 nh\u1ea1y cao nh\u01b0ng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u.<\/p>\n
– \u0110\u00e8 s\u1ee5p th\u1ea5t ph\u1ea3i th\u00ec t\u00e2m tr\u01b0\u01a1ng, c\u00f3 t\u00ednh \u0111\u1eb7c hi\u1ec7u cao.<\/p>\n
– Thay \u0111\u1ed5i \u0111\u01b0\u1eddng k\u00ednh th\u1ea5t li\u00ean quan t\u1edbi h\u00f4 h\u1ea5p: khi h\u00edt v\u00e0o th\u1ea5t ph\u1ea3i gi\u00e3n ra v\u00e0 th\u1ea5t tr\u00e1i nh\u1ecf l\u1ea1i; khi th\u1edf ra th\u1ea5t ph\u1ea3i nh\u1ecf l\u1ea1i.<\/p>\n
– T\u0103ng v\u1eadn \u0111\u1ed9ng tim: h\u00ecnh nh\u1ea3y tim nh\u1ea3y m\u00faa trong t\u00fai n\u01b0\u1edbc.<\/p>\n
– Si\u00eau \u00e2m doppler: v\u1eadn t\u1ed1c m\u00e1u qua van nh\u0129 th\u1ea5t thay \u0111\u1ed5i tr\u00ean 40% theo chu k\u1ef3 th\u1edf (b\u00ecnh th\u01b0\u1eddng: \u00edt h\u01a1n 20%). V\u1eadn t\u1ed1c m\u00e1u l\u00e0 t\u0103ng l\u00ean \u1edf tim ph\u1ea3i, gi\u1ea3m \u1edf tim tr\u00e1i.<\/p>\n
Si\u00eau \u00e2m x\u00e1c \u0111\u1ecbnh c\u00e1c t\u1ed5n th\u01b0\u01a1ng kh\u00e1c do ch\u1ea5n th\u01b0\u01a1ng:<\/p>\n
– R\u00e1ch v\u00e1ch li\u00ean th\u1ea5t g\u00e2y th\u00f4ng li\u00ean th\u1ea5t.<\/p>\n
– V\u1ee1 th\u00e0nh t\u1ef1 do c\u1ee7a tim: th\u01b0\u1eddng g\u00e2y ch\u00e8n \u00e9p tim c\u1ea5p nhanh ch\u00f3ng.<\/p>\n
– R\u00e1ch c\u00e1c van tim g\u00e2y h\u1edf van.<\/p>\n
Si\u00eau \u00e2m l\u00e0 r\u1ea5t h\u1eefu \u00edch cho vi\u1ec7c h\u01b0\u1edbng d\u1eabn ch\u1ecdc d\u00f2 m\u00e0ng ngo\u00e0i tim nh\u1eb1m m\u1ee5c \u0111\u00edch ch\u1ea9n \u0111o\u00e1n hay \u0111i\u1ec1u tr\u1ecb.<\/p>\n
2.2 Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i<\/b>
\nSi\u00eau \u00e2m r\u1ea5t h\u1eefu \u00edch trong vi\u1ec7c ph\u00e1t hi\u1ec7n tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, gi\u00fap \u0111\u00e1nh gi\u00e1 l\u01b0\u1ee3ng d\u1ecbch theo \u0111o chi\u1ec1u d\u00e0y l\u1edbp d\u1ecbch hay gi\u1edbi h\u1ea1n tr\u00ean c\u1ee7a tr\u00e0n d\u1ecbch (b\u1ec7nh nh\u00e2n \u1edf t\u01b0 th\u1ebf ng\u1ed3i). Si\u00eau \u00e2m c\u0169ng c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n nhi\u1ec1u l\u1ea7n gi\u00fap theo d\u00f5i ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ecdc d\u00f2 tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a si\u00eau \u00e2m gi\u00fap ch\u1ea9n \u0111o\u00e1n hay \u0111i\u1ec1u tr\u1ecb.<\/p>\n
3. Si\u00eau \u00e2m m\u1ea1ch m\u00e1u chi tr\u00ean, chi d\u01b0\u1edbi trong ch\u1ea5n th\u01b0\u01a1ng.<\/b>
\nM\u1ee5c ti\u00eau l\u00e0 x\u00e1c \u0111\u1ecbnh c\u00e1c th\u01b0\u01a1ng t\u1ed5n m\u1ea1ch m\u00e1u, t\u00ecnh tr\u1ea1ng t\u1eafc \u2013 h\u1eb9p m\u1ea1ch m\u00e1u v\u00e0 t\u00ecnh tr\u1ea1ng t\u01b0\u1edbi m\u00e1u \u1edf \u0111o\u1ea1n sau c\u1ee7a th\u01b0\u01a1ng t\u1ed5n m\u1ea1ch m\u00e1u \u1edf chi tr\u00ean v\u00e0 chi d\u01b0\u1edbi<\/p>\n
C\u00e1c th\u01b0\u01a1ng t\u1ed5n th\u01b0\u1eddng g\u1eb7p:<\/p>\n
– R\u00e1ch m\u1ea1ch m\u00e1u: t\u1ed5n th\u01b0\u01a1ng gi\u00e1n \u0111o\u1ea1n th\u00e0nh m\u1ea1ch m\u00e1u, nh\u01b0ng kh\u00f4ng h\u1ebft \u0111\u01b0\u1eddng k\u00ednh m\u1ea1ch m\u00e1u. \u0110i k\u00e8m c\u00f3 kh\u1ed1i t\u1ee5 m\u00e1u hay t\u00fai ph\u00ecnh gi\u1ea3.<\/p>\n
– \u0110\u1ee9t \u0111o\u1ea1n m\u1ea1ch m\u00e1u: t\u1ed5n th\u01b0\u01a1ng gi\u00e1n \u0111o\u1ea1n m\u1ea1ch m\u00e1u, \u0111i k\u00e8m kh\u1ed1i t\u1ee5 m\u00e1u v\u00e0 t\u00ecnh tr\u1ea1ng gi\u1ea3m t\u01b0\u1edbi m\u00e1u \u0111o\u1ea1n xa<\/p>\n
– Kh\u1ed1i t\u1ee5 m\u00e1u.<\/p>\n
– Huy\u1ebft kh\u1ed1i g\u00e2y t\u1eafc l\u00f2ng m\u1ea1ch. \u0110\u1ed9ng m\u1ea1ch: c\u00f3 h\u00ecnh \u1ea3nh echo d\u00e0y c\u1ee7a kh\u1ed1i huy\u1ebft kh\u1ed1i, si\u00eau \u00e2m doppler kh\u00f4ng c\u00f3 m\u00e0u v\u00e0 ph\u1ed5. T\u0129nh m\u1ea1ch: kh\u00f4ng \u0111\u00e8 x\u1eb9p, si\u00eau \u00e2m doppler kh\u00f4ng c\u00f3 m\u00e0u v\u00e0 ph\u1ed5.<\/p>\n
T\u00ecnh tr\u1ea1ng h\u1eb9p \u0111\u1ed9ng m\u1ea1ch do th\u01b0\u01a1ng t\u1ed5n c\u1ee7a m\u1ea1ch m\u00e1u hay do ch\u00e8n \u00e9p \u0111\u01b0\u1ee3c kh\u1ea3o s\u00e1t b\u1eb1ng si\u00eau \u00e2m doppler. \u0110\u1ec3 x\u00e1c \u0111\u1ecbnh m\u1ed9t v\u1ecb tr\u00ed h\u1eb9p c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng:<\/p>\n
– Tr\u01b0\u1edbc h\u1eb9p : t\u0103ng kh\u00e1ng l\u1ef1c; tuy nhi\u00ean d\u1ea5u hi\u1ec7u n\u00e0y th\u01b0\u1eddng kh\u00f4ng r\u00f5 \u1edf<\/p>\n
m\u1ea1ch m\u00e1u chi.<\/p>\n
– T\u1ea1i ch\u1ed7 h\u1eb9p: t\u0103ng v\u1eadn t\u1ed1c<\/p>\n
– Sau h\u1eb9p: gi\u1ea3m kh\u00e1ng l\u1ef1c v\u00e0 gi\u1ea3m v\u1eadn t\u1ed1c, d\u1ea5u hi\u1ec7u n\u00e0y th\u01b0\u1eddng n\u1ed5i b\u1eadt \u1edf<\/p>\n
m\u1ea1ch m\u00e1u chi.<\/p>\n
T\u00ecnh tr\u1ea1ng t\u01b0\u1edbi m\u00e1u \u1edf \u0111o\u1ea1n sau c\u1ee7a th\u01b0\u01a1ng t\u1ed5n m\u1ea1ch m\u00e1u. C\u0169ng nh\u01b0 theo d\u00f5i s\u1ef1 thay \u0111\u1ed5i t\u00ecnh tr\u1ea1ng t\u01b0\u1edbi m\u00e1u sau c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb.<\/p>\n
– S\u1eed d\u1ee5ng doppler m\u00e0u, doppler n\u0103ng l\u01b0\u1ee3ng kh\u1ea3o s\u00e1t c\u00f3 c\u00f2n s\u1ef1 t\u01b0\u1edbi m\u00e1u.<\/p>\n
– Doppler ph\u1ed5: ph\u1ed5 \u0111\u1ed9ng m\u1ea1ch c\u00f3 v\u1eadn t\u1ed1c v\u00e0 kh\u00e1ng l\u1ef1c c\u00e0ng th\u1ea5p ch\u1ee9ng t\u1ecf s\u1ef1 gi\u1ea3m t\u01b0\u1edbi m\u00e1u n\u1eb7ng.<\/p>\n
T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/p>\n
1. Abigail Thrush, Peripheral vascular ultrasound \u2013 How, why and when, Churchill Livingstone 2005<\/p>\n
2. Carol M.Rumack, Diagnostic ultrasound, Mosby 2005<\/p>\n
3. Harvey Feigenbaum, Echocardiography, Lippincott William & Wilkins 2005<\/p>\n
4. Nguy\u1ec5n Ph\u01b0\u1edbc B\u1ea3o Qu\u00e2n, Si\u00eau \u00e2m b\u1ee5ng t\u1ed5ng qu\u00e1t, Nh\u00e0 xu\u1ea5t b\u1ea3n Thu\u1eadn H\u00f3a, 2008<\/p>\n
5. Ph\u1ea1m Nguy\u1ec5n Vinh, B\u1ec7nh h\u1ecdc tim m\u1ea1ch, Nh\u00e0 xu\u1ea5t b\u1ea3n Y H\u1ecdc, 2003<\/p>\n","protected":false},"excerpt":{"rendered":"
*. Gi\u1edbi thi\u1ec7u: Ch\u1ea5n th\u01b0\u01a1ng l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p t\u1ea1i c\u00e1c \u0111\u01a1n v\u1ecb y t\u1ebf t\u1eeb tuy\u1ebfn c\u01a1 s\u1edf \u0111\u1ebfn c\u00e1c tuy\u1ebfn tr\u00ean. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n s\u1edbm, ch\u00ednh x\u00e1c g\u00f3p ph\u1ea7n quan tr\u1ecdng trong \u0111i\u1ec1u tr\u1ecb c\u0169ng nh\u01b0 c\u1ea3i thi\u1ec7n ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n. Si\u00eau \u00e2m ch\u1ea9n \u0111o\u00e1n l\u00e0 m\u1ed9t k\u1ef9 …<\/p>\n","protected":false},"author":11,"featured_media":4495,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[74],"tags":[],"class_list":["post-2621","post","type-post","status-publish","format-standard","has-post-thumbnail","","category-chan-doan-hinh-anh"],"_links":{"self":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2621","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/comments?post=2621"}],"version-history":[{"count":1,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2621\/revisions"}],"predecessor-version":[{"id":2622,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2621\/revisions\/2622"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media\/4495"}],"wp:attachment":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media?parent=2621"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/categories?post=2621"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/tags?post=2621"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}