{"id":197,"date":"2024-04-13T11:07:27","date_gmt":"2024-04-13T11:07:27","guid":{"rendered":"https:\/\/oxycaoap.vn\/HBOT\/?p=197"},"modified":"2024-04-13T11:07:36","modified_gmt":"2024-04-13T11:07:36","slug":"cac-xet-nghiem-chan-doan-ngo-doc-khi-co","status":"publish","type":"post","link":"https:\/\/oxycaoap.vn\/HBOT\/cac-xet-nghiem-chan-doan-ngo-doc-khi-co\/","title":{"rendered":"C\u00c1C X\u00c9T NGHI\u1ec6M CH\u1ea8N \u0110O\u00c1N NG\u1ed8 \u0110\u1ed8C KH\u00cd CO"},"content":{"rendered":"<p style=\"text-align: center;\"><strong>C\u00c1C X\u00c9T NGHI\u1ec6M CH\u1ea8N \u0110O\u00c1N NG\u1ed8 \u0110\u1ed8C KH\u00cd CO<\/strong><\/p>\n<p style=\"text-align: right;\"><strong>GS.TS Nguy\u1ec5n Tr\u01b0\u1eddng S\u01a1n<\/strong><\/p>\n<p style=\"text-align: right;\"><strong>G\u0110 TT Y h\u1ecdc d\u01b0\u1edbi n\u01b0\u1edbc v\u00e0 OXCA<\/strong><\/p>\n<p>Ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng v\u1ec1 ng\u1ed9 \u0111\u1ed9c carbon monoxide (CO) c\u1ea5p t\u00ednh c\u1ea7n \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn b\u1eb1ng c\u00e1ch ch\u1ee9ng minh m\u1ee9c \u0111\u1ed9 cao c\u1ee7a carboxyhemoglobin (HbCO).\u00a0C\u00f3 th\u1ec3 d\u00f9ng m\u00e1u \u0111\u1ed9ng m\u1ea1ch ho\u1eb7c m\u00e1u t\u0129nh m\u1ea1ch \u0111\u1ec3 x\u00e9t nghi\u1ec7m.\u00a0<sup>[\u00a0<\/sup><sup>3<\/sup><sup>\u00a0]<\/sup><\/p>\n<p>Ph\u00e2n t\u00edch HbCO y\u00eau c\u1ea7u \u0111o quang ph\u1ed5 tr\u1ef1c ti\u1ebfp trong c\u00e1c m\u00e1y ph\u00e2n t\u00edch kh\u00ed m\u00e1u c\u1ee5 th\u1ec3.\u00a0Ph\u00e9p \u0111o carbon monoxide (CO) xung c\u1ea1nh gi\u01b0\u1eddng hi\u1ec7n \u0111\u00e3 c\u00f3 s\u1eb5n nh\u01b0ng y\u00eau c\u1ea7u m\u1ed9t \u0111\u01a1n v\u1ecb \u0111\u1eb7c bi\u1ec7t v\u00e0 kh\u00f4ng ph\u1ea3i l\u00e0 m\u1ed9t th\u00e0nh ph\u1ea7n c\u1ee7a ph\u00e9p \u0111o oxy xung nh\u1ecbp th\u00f4ng th\u01b0\u1eddng.\u00a0M\u1ed9t nghi\u00ean c\u1ee9u n\u0103m 2012 cho th\u1ea5y ph\u00e9p \u0111o CO-oxi trong m\u1ea1ch kh\u00f4ng x\u00e2m l\u1ea5n t\u01b0\u01a1ng quan v\u1edbi vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb oxy hyperbaric nhanh h\u01a1n so v\u1edbi ph\u00e9p \u0111o CO-oxi trong ph\u00f2ng th\u00ed nghi\u1ec7m.\u00a0Tuy nhi\u00ean, t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn k\u1ebft qu\u1ea3 l\u00e2m s\u00e0ng v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh.\u00a0<sup>[\u00a0<\/sup><sup>24<\/sup><sup>\u00a0]<\/sup>\u00a0\u00a0M\u1ed9t tuy\u00ean b\u1ed1 v\u1ec1 ch\u00ednh s\u00e1ch l\u00e2m s\u00e0ng n\u0103m 2017 c\u1ee7a Tr\u01b0\u1eddng Cao \u0111\u1eb3ng B\u00e1c s\u0129 C\u1ea5p c\u1ee9u Hoa K\u1ef3 (ACEP) khuy\u1ebfn c\u00e1o kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p \u0111o CO-oxy xung \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n ng\u1ed9 \u0111\u1ed9c CO \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nghi ng\u1edd ng\u1ed9 \u0111\u1ed9c CO c\u1ea5p t\u00ednh (khuy\u1ebfn c\u00e1o m\u1ee9c B).\u00a0<sup>[\u00a0<\/sup><sup>25<\/sup><sup>\u00a0]<\/sup><\/p>\n<p>M\u1ee9c CO t\u0103ng \u00edt nh\u1ea5t 3\u20134% \u1edf ng\u01b0\u1eddi kh\u00f4ng h\u00fat thu\u1ed1c v\u00e0 \u00edt nh\u1ea5t 10% \u1edf ng\u01b0\u1eddi h\u00fat thu\u1ed1c l\u00e0 \u0111\u00e1ng k\u1ec3.\u00a0<sup>[\u00a0<\/sup><sup>3<\/sup><sup>\u00a0]<\/sup>\u00a0Tuy nhi\u00ean, n\u1ed3ng \u0111\u1ed9 th\u1ea5p kh\u00f4ng lo\u1ea1i tr\u1eeb kh\u1ea3 n\u0103ng ph\u01a1i nhi\u1ec5m, \u0111\u1eb7c bi\u1ec7t n\u1ebfu b\u1ec7nh nh\u00e2n \u0111\u00e3 nh\u1eadn \u0111\u01b0\u1ee3c 100% oxy ho\u1eb7c n\u1ebfu th\u1eddi gian \u0111\u00e1ng k\u1ec3 \u0111\u00e3 tr\u00f4i qua k\u1ec3 t\u1eeb khi ti\u1ebfp x\u00fac.\u00a0N\u1ed3ng \u0111\u1ed9 HbCO \u1edf nh\u1eefng ng\u01b0\u1eddi h\u00fat thu\u1ed1c l\u00e1 th\u01b0\u1eddng dao \u0111\u1ed9ng t\u1eeb 3-5%, nh\u01b0ng c\u00f3 th\u1ec3 cao t\u1edbi 10% \u1edf m\u1ed9t s\u1ed1 ng\u01b0\u1eddi nghi\u1ec7n thu\u1ed1c l\u00e1 n\u1eb7ng.\u00a0<sup>[\u00a0<\/sup><sup>3<\/sup><sup>\u00a0]<\/sup>\u00a0S\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a hemoglobin thai nhi, cao t\u1edbi 30% \u1edf 3 th\u00e1ng tu\u1ed5i, c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111\u1ecdc l\u00e0 m\u1ee9c HbCO t\u0103ng l\u00ean 7%.\u00a0<sup>[\u00a0<\/sup><sup>26<\/sup><sup>\u00a0]<\/sup>\u00a0C\u00e1c tri\u1ec7u ch\u1ee9ng c\u00f3 th\u1ec3 kh\u00f4ng t\u01b0\u01a1ng quan t\u1ed1t v\u1edbi m\u1ee9c HbCO.<\/p>\n<p><strong>K\u1ebft qu\u1ea3 \u0111o kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch bao g\u1ed3m nh\u1eefng \u0111i\u1ec1u sau<\/strong>:<\/p>\n<ul>\n<li>M\u1ee9c ph\u00e2n \u00e1p oxy m\u00e1u \u0111\u1ed9ng m\u1ea1ch (PaO<sub>2<\/sub>) n\u00ean duy tr\u00ec \u1edf m\u1ee9c b\u00ecnh th\u01b0\u1eddng; \u0110\u1ed9 b\u00e3o h\u00f2a oxy ch\u1ec9 ch\u00ednh x\u00e1c n\u1ebfu \u0111o tr\u1ef1c ti\u1ebfp ch\u1ee9 kh\u00f4ng ch\u00ednh x\u00e1c n\u1ebfu t\u00ednh t\u1eeb PaO<sub>2<\/sub>\u00a0, th\u01b0\u1eddng g\u1eb7p trong nhi\u1ec1u m\u00e1y ph\u00e2n t\u00edch kh\u00ed m\u00e1u.<\/li>\n<li>Nh\u01b0 v\u1edbi ph\u00e9p \u0111o oxy xung, \u01b0\u1edbc t\u00ednh m\u1ee9c PCO<sub>2<\/sub>b\u1eb1ng c\u00e1ch l\u1ea5y m\u1ee9c b\u00e3o h\u00f2a t\u00ednh to\u00e1n tr\u1eeb \u0111i m\u1ee9c carboxyhemoglobin (HbCO). M\u1ee9c PCO<sub>2<\/sub>\u00a0c\u00f3 th\u1ec3 b\u00ecnh th\u01b0\u1eddng ho\u1eb7c gi\u1ea3m nh\u1eb9.\u00a0Nhi\u1ec5m toan chuy\u1ec3n h\u00f3a x\u1ea3y ra th\u1ee9 ph\u00e1t sau nhi\u1ec5m toan lactic do thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9.<\/li>\n<\/ul>\n<p>ACEP khuy\u1ebfn c\u00e1o n\u00ean \u0111o \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 v\u00e0 c\u00e1c m\u1ee9c d\u1ea5u \u1ea5n sinh h\u1ecdc tim \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u1ea5p c\u1ee9u b\u1ecb ng\u1ed9 \u0111\u1ed9c CO t\u1eeb trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng (khuy\u1ebfn ngh\u1ecb m\u1ee9c \u0111\u1ed9 B).\u00a0<sup>[\u00a0<\/sup><sup>25<\/sup><sup>\u00a0]<\/sup>\u00a0K\u1ebft qu\u1ea3 \u0111\u00e1nh d\u1ea5u tim bao g\u1ed3m:<\/p>\n<ul>\n<li>N\u1ed3ng \u0111\u1ed9 troponin I nh\u1ea1y c\u1ea3m cao t\u0103ng cao th\u01b0\u1eddng cho th\u1ea5y b\u1ec7nh c\u01a1 tim, bao g\u1ed3m r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng to\u00e0n th\u1ec3 c\u00f3 th\u1ec3 \u0111\u1ea3o ng\u01b0\u1ee3c v\u00e0 m\u00f4 h\u00ecnh gi\u1ed1ng Takotsubo\u00a0<sup>[\u00a0<\/sup><sup>27<\/sup><sup>]<\/sup><\/li>\n<li>Thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 c\u01a1 tim th\u01b0\u1eddng g\u1eb7p \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n do ph\u01a1i nhi\u1ec5m CO t\u1eeb m\u1ee9c \u0111\u1ed9 trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng v\u00e0 l\u00e0 y\u1ebfu t\u1ed1 d\u1ef1 b\u00e1o t\u1eed vong.\u00a0<sup>[\u00a0<\/sup><sup>28<\/sup><sup>]<\/sup><\/li>\n<li>B\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh tim m\u1ea1ch t\u1eeb tr\u01b0\u1edbc c\u00f3 th\u1ec3 b\u1ecb t\u0103ng \u0111au th\u1eaft ng\u1ef1c khi g\u1eafng s\u1ee9c v\u1edbi n\u1ed3ng \u0111\u1ed9 HbCO ch\u1ec9 t\u1eeb 5-10%;\u00a0\u1edf m\u1ee9c HbCO cao, ngay c\u1ea3 nh\u1eefng b\u1ec7nh nh\u00e2n tr\u1ebb kh\u1ecfe m\u1ea1nh c\u0169ng b\u1ecb suy c\u01a1 tim<\/li>\n<\/ul>\n<p><strong>C\u00e1c k\u1ebft qu\u1ea3 ki\u1ec3m tra kh\u00e1c bao g\u1ed3m:<\/strong><\/p>\n<ul>\n<li>Creatinin kinase, myoglobin trong n\u01b0\u1edbc ti\u1ec3u &#8211; Ti\u00eau c\u01a1 v\u00e2n kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 do nhi\u1ec5m \u0111\u1ed9c CO nghi\u00eam tr\u1ecdng v\u00e0 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn suy th\u1eadn c\u1ea5p.<\/li>\n<li>C\u00f4ng th\u1ee9c m\u00e1u to\u00e0n b\u1ed9 &#8211; C\u00f3 th\u1ec3 c\u00f3 t\u0103ng b\u1ea1ch c\u1ea7u nh\u1eb9;\u00a0<a href=\"http:\/\/emedicine.medscape.com\/article\/779097-overview\">\u0111\u00f4ng m\u00e1u n\u1ed9i m\u1ea1ch lan t\u1ecfa<\/a>(DIC) v\u00e0\u00a0<a href=\"http:\/\/emedicine.medscape.com\/article\/206598-overview\">ban xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u huy\u1ebft kh\u1ed1i<\/a>\u00a0(TTP) \u0111\u00f2i h\u1ecfi c\u00e1c nghi\u00ean c\u1ee9u huy\u1ebft h\u1ecdc th\u00eam.<\/li>\n<li>\u0110i\u1ec7n gi\u1ea3i v\u00e0 m\u1ee9c \u0111\u01b0\u1eddng huy\u1ebft &#8211; H\u1ea1 kali m\u00e1u v\u00e0 t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft x\u1ea3y ra khi nhi\u1ec5m \u0111\u1ed9c n\u1eb7ng.<\/li>\n<li>M\u1ee9c \u0111\u1ed9 lactate trong m\u00e1u &#8211; T\u0103ng l\u00e0 m\u1ed9t d\u1ea5u hi\u1ec7u c\u1ee7a m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng,\u00a0<sup>[\u00a0<\/sup><sup>3<\/sup><sup>,\u00a0<\/sup><sup>29<\/sup><sup>\u00a0,\u00a0<\/sup><sup>30<\/sup><sup>\u00a0]<\/sup>\u00a0\u00a0v\u00e0 c\u00f3 th\u1ec3 t\u01b0\u01a1ng quan v\u1edbi k\u1ebft qu\u1ea3 th\u1ea7n kinh.\u00a0<sup>[\u00a0<\/sup><sup>31<\/sup><sup>\u00a0]<\/sup>\u00a0\u00a0N\u1ebfu ngu\u1ed3n CO l\u00e0 ch\u00e1y nh\u00e0 v\u00e0 m\u1ee9c lactate l\u00e0 10 mmol \/ L ho\u1eb7c cao h\u01a1n, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 b\u1ecb ng\u1ed9 \u0111\u1ed9c xyanua \u0111\u1ed3ng th\u1eddi.\u00a0<sup>[\u00a0<\/sup><sup>3<\/sup><sup>\u00a0]<\/sup><\/li>\n<li>N\u1ed3ng \u0111\u1ed9 nit\u01a1 ur\u00ea trong m\u00e1u (BUN) v\u00e0 creatinine &#8211; Suy th\u1eadn c\u1ea5p t\u00ednh c\u00f3 th\u1ec3 do myoglobin ni\u1ec7u.<\/li>\n<li>X\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gan &#8211; T\u0103ng nh\u1eb9 trong suy gan t\u1ed1i c\u1ea5p<\/li>\n<li>Ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u &#8211; D\u01b0\u01a1ng t\u00ednh v\u1edbi albumin v\u00e0 glucose trong nhi\u1ec5m \u0111\u1ed9c m\u00e3n t\u00ednh<\/li>\n<li>M\u1ee9c methemoglobin &#8211; \u0110\u01b0\u1ee3c \u0111\u01b0a v\u00e0o ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t xanh t\u00edm v\u1edbi \u0111\u1ed9 b\u00e3o h\u00f2a oxy th\u1ea5p nh\u01b0ng PaO\u00a0<sub>2 b\u00ecnh th\u01b0\u1eddng<\/sub><\/li>\n<li>M\u00e0n h\u00ecnh ch\u1ea5t \u0111\u1ed9c &#8211; \u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u1ed1 g\u1eafng t\u1ef1 t\u1eed<\/li>\n<li>M\u1ee9c \u0111\u1ed9 ethanol &#8211; M\u1ed9t y\u1ebfu t\u1ed1 g\u00e2y nhi\u1ec5u c\u1ee7a c\u1ea3 ng\u1ed9 \u0111\u1ed9c c\u00f3 ch\u1ee7 \u00fd v\u00e0 kh\u00f4ng ch\u1ee7 \u00fd<\/li>\n<li>M\u1ee9c \u0111\u1ed9 xyanua &#8211; N\u1ebfu nghi ng\u1edd c\u00f3\u00a0<a href=\"http:\/\/emedicine.medscape.com\/article\/814287-overview\">\u0111\u1ed9c t\u00ednh xyanua<\/a>(v\u00ed d\u1ee5: ch\u00e1y c\u00f4ng nghi\u1ec7p);\u00a0Ph\u01a1i nhi\u1ec5m xyanua l\u00e0 do nhi\u1ec5m toan chuy\u1ec3n h\u00f3a kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c;\u00a0x\u00e1c \u0111\u1ecbnh nhanh hi\u1ebfm khi c\u00f3 s\u1eb5n.\u00a0<a href=\"http:\/\/emedicine.medscape.com\/article\/771194-overview\">H\u00edt kh\u00f3i<\/a>\u00a0l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u1ee7a ng\u1ed9 \u0111\u1ed9c xyanua c\u1ea5p t\u00ednh.<\/li>\n<\/ul>\n<p><strong>Ch\u1ea9n \u0111o\u00e1n<\/strong><strong> h\u00ecnh \u1ea3nh<\/strong><strong> c\u1ee7a ng\u1ed9 \u0111\u1ed9c kh\u00ed CO<\/strong><\/p>\n<p><strong>Ch\u1ee5p X quang ph\u1ed5i<\/strong> \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb nhi\u1ec5m \u0111\u1ed9c n\u1eb7ng, c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng \u1edf ph\u1ed5i, c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 t\u00ecnh tr\u1ea1ng thi\u1ebfu oxy ho\u1eb7c n\u1ebfu ph\u1ea3i s\u1eed d\u1ee5ng oxy t\u0103ng cao.\u00a0C\u00e1c ph\u00e1t hi\u1ec7n th\u01b0\u1eddng l\u00e0 b\u00ecnh th\u01b0\u1eddng.\u00a0Nh\u1eefng thay \u0111\u1ed5i nh\u01b0 sau ng\u1ee5 \u00fd ti\u00ean l\u01b0\u1ee3ng x\u1ea5u h\u01a1n nh\u1eefng ph\u00e1t hi\u1ec7n b\u00ecnh th\u01b0\u1eddng:<\/p>\n<ul>\n<li>K\u00ednh m\u1eb7t \u0111\u1ea5t<\/li>\n<li>S\u01b0\u01a1ng m\u00f9 Perihilar<\/li>\n<li>V\u00f2ng b\u00edt ph\u1ebf qu\u1ea3n<\/li>\n<li>Ph\u00f9 trong ph\u1ebf nang<\/li>\n<\/ul>\n<p><strong>Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh<\/strong><\/p>\n<p>Ch\u1ee5p CT \u0111\u1ea7u khi b\u1ecb nhi\u1ec5m \u0111\u1ed9c n\u1eb7ng ho\u1eb7c thay \u0111\u1ed5i tr\u1ea1ng th\u00e1i t\u00e2m th\u1ea7n kh\u00f4ng gi\u1ea3i quy\u1ebft nhanh ch\u00f3ng.\u00a0\u0110\u00e1nh gi\u00e1 ph\u00f9 n\u00e3o v\u00e0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng khu tr\u00fa;\u00a0h\u1ea7u h\u1ebft l\u00e0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng m\u1eadt \u0111\u1ed9 th\u1ea5p \u0111i\u1ec3n h\u00ecnh c\u1ee7a h\u1ea1ch n\u1ec1n.\u00a0<sup>[\u00a0<\/sup><sup>32<\/sup><sup>\u00a0]<\/sup><\/p>\n<p>K\u1ebft qu\u1ea3 ch\u1ee5p CT d\u01b0\u01a1ng t\u00ednh th\u01b0\u1eddng d\u1ef1 \u0111o\u00e1n c\u00e1c bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh.\u00a0Trong m\u1ed9t nghi\u00ean c\u1ee9u, 53% b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n v\u00ec nhi\u1ec5m \u0111\u1ed9c CO c\u1ea5p t\u00ednh c\u00f3 ph\u00e1t hi\u1ec7n b\u1ea5t th\u01b0\u1eddng tr\u00ean CT scan;\u00a0t\u1ea5t c\u1ea3 nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y \u0111\u1ec1u b\u1ecb di ch\u1ee9ng th\u1ea7n kinh.\u00a0Trong s\u1ed1 nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 k\u1ebft qu\u1ea3 ch\u1ee5p \u00e2m t\u00ednh, ch\u1ec9 c\u00f3 11% c\u00f3 di ch\u1ee9ng th\u1ea7n kinh.\u00a0<sup>[\u00a0<\/sup><sup>32<\/sup><sup>\u00a0]<\/sup><\/p>\n<p>Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh c\u00f3 th\u1ec3 c\u1ea7n thi\u1ebft, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi t\u00ecnh tr\u1ea1ng t\u00e2m th\u1ea7n suy gi\u1ea3m.\u00a0M\u1ed9t b\u00e1o c\u00e1o m\u00f4 t\u1ea3 s\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a n\u00e3o \u00fang th\u1ee7y c\u1ea5p t\u00ednh \u1edf m\u1ed9t \u0111\u1ee9a tr\u1ebb b\u1ecb ng\u1ed9 \u0111\u1ed9c kh\u00ed CO, \u0111\u01b0\u1ee3c ghi l\u1ea1i b\u1eb1ng c\u00e1ch ch\u1ee5p CT n\u1ed1i ti\u1ebfp.\u00a0<sup>[\u00a0<\/sup><sup>33<\/sup><sup>\u00a0]<\/sup><\/p>\n<p><strong>Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb<\/strong><\/p>\n<p>MRI ch\u00ednh x\u00e1c h\u01a1n ch\u1ee5p CT \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c t\u1ed5n th\u01b0\u01a1ng khu tr\u00fa v\u00e0 tho\u00e1i h\u00f3a ch\u1ea5t tr\u1eafng v\u00e0 th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ch\u0103m s\u00f3c theo d\u00f5i.\u00a0<sup>[\u00a0<\/sup><sup>34<\/sup><sup>\u00a0]<\/sup>\u00a0S\u1ef1 ph\u00e1t tri\u1ec3n t\u1eeb MRI th\u00f4ng th\u01b0\u1eddng sang h\u00ecnh \u1ea3nh c\u00f3 tr\u1ecdng s\u1ed1 khu\u1ebfch t\u00e1n (DWI) v\u00e0 sau \u0111\u00f3 l\u00e0 h\u00ecnh \u1ea3nh l\u1ef1c c\u0103ng khu\u1ebfch t\u00e1n (DTI) \u0111\u00e3 cho ph\u00e9p \u0111\u00e1nh gi\u00e1 ng\u00e0y c\u00e0ng s\u00e2u s\u1eafc h\u01a1n v\u1ec1 thi\u1ec7t h\u1ea1i do ng\u1ed9 \u0111\u1ed9c CO.\u00a0DTI c\u00f3 th\u1ec3 h\u00ecnh dung nh\u1eefng thay \u0111\u1ed5i b\u1ec7nh l\u00fd ti\u1ebfn tri\u1ec3n trong giai \u0111o\u1ea1n \u0111\u1ea7u c\u1ee7a nhi\u1ec5m \u0111\u1ed9c CO, cho ph\u00e9p d\u1ef1 \u0111o\u00e1n c\u00e1c t\u00ecnh tr\u1ea1ng m\u00e3n t\u00ednh.\u00a0<sup>[\u00a0<\/sup><sup>8<\/sup><sup>\u00a0]<\/sup><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>C\u00c1C X\u00c9T NGHI\u1ec6M CH\u1ea8N \u0110O\u00c1N NG\u1ed8 \u0110\u1ed8C KH\u00cd CO GS.TS Nguy\u1ec5n Tr\u01b0\u1eddng S\u01a1n G\u0110 TT Y h\u1ecdc d\u01b0\u1edbi n\u01b0\u1edbc v\u00e0 OXCA Ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng v\u1ec1 ng\u1ed9 \u0111\u1ed9c carbon monoxide (CO) c\u1ea5p t\u00ednh c\u1ea7n \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn b\u1eb1ng c\u00e1ch ch\u1ee9ng minh m\u1ee9c \u0111\u1ed9 cao c\u1ee7a carboxyhemoglobin (HbCO).\u00a0C\u00f3 th\u1ec3 d\u00f9ng m\u00e1u \u0111\u1ed9ng m\u1ea1ch ho\u1eb7c m\u00e1u t\u0129nh 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