{"id":33598,"date":"2022-08-12T23:03:11","date_gmt":"2022-08-12T16:03:11","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=33598"},"modified":"2022-08-13T09:06:20","modified_gmt":"2022-08-13T02:06:20","slug":"cap-nhat-ve-xu-tri-dot-quy-cap-2022","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/cap-nhat-ve-xu-tri-dot-quy-cap-2022\/","title":{"rendered":"C\u1eadp nh\u1eadt c\u00e1c h\u01b0\u1edbng d\u1eabn v\u1ec1 x\u1eed tr\u00ed \u0111\u1ed9t qu\u1ef5 c\u1ea5p 2022"},"content":{"rendered":"

T\u00e1c gi\u1ea3: Ph\u00f3 gi\u00e1o s\u01b0 – Ti\u1ebfn s\u0129 Mai Duy T\u00f4n<\/em><\/p>\n

vnras.com\/drug – \u0110\u1ec3 t\u1ea3i file PDF c\u1ee7a b\u00e0i vi\u1ebft C\u1eadp nh\u1eadt v\u1ec1 x\u1eed tr\u00ed \u0111\u1ed9t qu\u1ef5 c\u1ea5p 2022<\/strong><\/a>, xin vui l\u00f2ng click v\u00e0o link \u1edf \u0111\u00e2y<\/a>.<\/p>\n

N\u1ed9i dung 1: \u0110\u01a1n v\u1ecb \u0111\u1ed9t qu\u1ef5 di \u0111\u1ed9ng<\/h2>\n
$\"\u1ea2nh$
\u1ea2nh h\u01b0\u1edfng c\u1ee7a MSU \u0111\u1ebfn t\u1eed vong do t\u1ea5t c\u1ea3 nguy\u00ean nh\u00e2n ng\u00e0y th\u1ee9 7<\/figcaption><\/figure>\n
$\"\u1ea2nh$
\u1ea2nh h\u01b0\u1edfng c\u1ee7a MSU \u0111\u1ebfn t\u1eed vong do t\u1ea5t c\u1ea3 nguy\u00ean nh\u00e2n ng\u00e0y th\u1ee9 90<\/figcaption><\/figure>\n
$\"\u1ea2nh$
\u1ea2nh h\u01b0\u1edfng c\u1ee7a MSU \u0111\u1ebfn mRS 0-1 ng\u00e0y th\u1ee9 90<\/figcaption><\/figure>\n
$\"\u1ea2nh$
\u1ea2nh h\u01b0\u1edfng c\u1ee7a MSU \u0111\u1ebfn mRS 0-2 ng\u00e0y th\u1ee9 90<\/figcaption><\/figure>\n
$\"\u1ea2nh$
\u1ea2nh h\u01b0\u1edfng c\u1ee7a MSU \u0111\u1ebfn rtPA trong 60 ph\u00fat t\u1eeb khi kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng<\/figcaption><\/figure>\n
K\u1ebft lu\u1eadn<\/h3>\n
B\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 c\u1ea5p, MSU gi\u00fap c\u1ea3i thi\u1ec7n k\u1ebft c\u1ee5c ch\u1ee9c n\u0103ng th\u1ea7n kinh, t\u0103ng t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ti\u00eau s\u1ee3i huy\u1ebft rtPA trong gi\u1edd v\u00e0ng (60 ph\u00fat t\u1eeb khi kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng).<\/p>\n
N\u1ed9i dung 2: X\u1eed tr\u00ed \u0111\u1ed9t qu\u1ef5 \u1edf ph\u1ee5 n\u1eef trong chu k\u1ef3 kinh, mang thai v\u00e0 th\u1eddi k\u1ef3 h\u1eadu s\u1ea3n<\/h2>\n
rtPA trong khi mang thai<\/h3>\n
C\u00e2u h\u1ecfi: \u1ede ph\u1ee5 n\u1eef mang thai b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p, rtPA c\u00f3 gi\u00fap c\u1ea3i thi\u1ec7n k\u1ebft c\u1ee5c \u0111i\u1ec1u tr\u1ecb kh\u00f4ng?<\/p>\n
V\u1edbi c\u00e1c d\u1eef li\u1ec7u hi\u1ec7n c\u00f3, ch\u1ee7 y\u1ebfu l\u00e0 c\u00e1c b\u00e1o c\u00e1o ca l\u00e2m s\u00e0ng, kh\u00f4ng cho ph\u00e9p \u0111\u01b0a ra khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng rtPA cho ph\u1ee5 n\u1eef mang thai b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p.<\/p>\n
\u0110\u1ed3ng thu\u1eadn c\u1ee7a chuy\u00ean gia ESO: 12\/13 chuy\u00ean gia \u0111\u1ec1 ngh\u1ecb ph\u1ee5 n\u1eef mang thai b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p g\u00e2y t\u00e0n ph\u1ebf, \u0111\u00e1p \u1ee9ng \u0111\u1ee7 c\u00e1c ti\u00eau chu\u1ea9n, c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb rtPA sau khi \u0111\u00e1nh gi\u00e1 l\u1ee3i \u00edch\/nguy c\u01a1 d\u1ef1a tr\u00ean c\u00e1 th\u1ec3 h\u00f3a ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n
LHK trong khi mang thai<\/h3>\n
C\u00e2u h\u1ecfi: \u1ede ph\u1ee5 n\u1eef mang thai b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p, LHK ho\u1eb7c ti\u00eau s\u1ee3i huy\u1ebft \u0111\u01b0\u1eddng \u0111\u1ed9ng m\u1ea1ch c\u00f3 gi\u00fap c\u1ea3i thi\u1ec7n k\u1ebft c\u1ee5c \u0111i\u1ec1u tr\u1ecb kh\u00f4ng?<\/p>\n
V\u1edbi c\u00e1c d\u1eef li\u1ec7u hi\u1ec7n c\u00f3, ch\u1ec9 l\u00e0 c\u00e1c b\u00e1o c\u00e1o ca l\u00e2m s\u00e0ng, kh\u00f4ng cho ph\u00e9p \u0111\u01b0a ra khuy\u1ebfn c\u00e1o c\u1ee5 th\u1ec3 v\u1ec1 ch\u1ec9 \u0111\u1ecbnh LHK \u1edf ph\u1ee5 n\u1eef mang thai b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p.<\/p>\n
\u0110\u1ed3ng thu\u1eadn c\u1ee7a chuy\u00ean gia ESO: 13\/13 chuy\u00ean gia \u0111\u1ec1 ngh\u1ecb ph\u1ee5 n\u1eef mang thai b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p do t\u1eafc m\u1ea1ch l\u1edbn, \u0111\u00e1p \u1ee9ng \u0111\u1ee7 c\u00e1c ti\u00eau chu\u1ea9n, n\u00ean \u0111\u01b0\u1ee3c LHK sau khi c\u00e2n nh\u1eafc l\u1ee3i \u00edch\/nguy c\u01a1 d\u1ef1a tr\u00ean c\u00e1 th\u1ec3 h\u00f3a ng\u01b0\u1eddi b\u1ec7nh 12\/13 chuy\u00ean gia \u0111\u1ec1 ngh\u1ecb n\u1ebfu ph\u1ee5 n\u1eef mang thai b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o do t\u1eafc m\u1ea1ch l\u1edbn, LHK h\u01a1n l\u00e0 rtPA ho\u1eb7c \u0111i\u1ec1u tr\u1ecb b\u1eafc c\u1ea7u.<\/p>\n
rtPA trong th\u1eddi k\u00ec h\u1eadu s\u1ea3n<\/h3>\n
C\u00e2u h\u1ecfi: \u1ede ph\u1ee5 n\u1eef trong th\u1eddi k\u1ef3 h\u1eadu s\u1ea3n, b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p, rtPA c\u00f3 gi\u00fap c\u1ea3i thi\u1ec7n k\u1ebft c\u1ee5c \u0111i\u1ec1u tr\u1ecb kh\u00f4ng?<\/p>\n
V\u1edbi c\u00e1c d\u1eef li\u1ec7u hi\u1ec7n c\u00f3, ch\u1ec9 l\u00e0 c\u00e1c b\u00e1o c\u00e1o ca l\u00e2m s\u00e0ng, kh\u00f4ng cho ph\u00e9p \u0111\u01b0a ra khuy\u1ebfn c\u00e1o c\u1ee5 th\u1ec3 v\u1ec1 ch\u1ec9 \u0111\u1ecbnh rtPA \u1edf ph\u1ee5 n\u1eef trong th\u1eddi k\u1ef3 h\u1eadu s\u1ea3n b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p (>=10 ng\u00e0y v\u00e0 < 3 th\u00e1ng sau \u0111\u1ebb).<\/p>\n
\u0110\u1ed3ng thu\u1eadn c\u1ee7a chuy\u00ean gia ESO: 13\/13 chuy\u00ean gia \u0111\u1ec1 ngh\u1ecb ph\u1ee5 n\u1eef trong th\u1eddi k\u1ef3 h\u1eadu s\u1ea3n b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p g\u00e2y t\u00e0n ph\u1ebf, v\u00e0 \u0111\u00e3 \u0111\u1ebb \u0111\u01b0\u1ee3c \u00edt nh\u1ea5t 10 ng\u00e0y, \u0111\u00e1p \u1ee9ng \u0111\u1ee7 c\u00e1c ti\u00eau chu\u1ea9n, c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb rtPA sau khi c\u00e2n nh\u1eafc l\u1ee3i \u00edch\/nguy c\u01a1 d\u1ef1a v\u00e0o c\u00e1 th\u1ec3 h\u00f3a ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n
LHK trong th\u1eddi k\u00ec h\u1eadu s\u1ea3n<\/h3>\n
C\u00e2u h\u1ecfi: \u1ede ph\u1ee5 n\u1eef trong th\u1eddi k\u1ef3 h\u1eadu s\u1ea3n b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p, LHK ho\u1eb7c ti\u00eau s\u1ee3i huy\u1ebft \u0111\u01b0\u1eddng \u0111\u1ed9ng m\u1ea1ch c\u00f3 gi\u00fap c\u1ea3i thi\u1ec7n k\u1ebft c\u1ee5c \u0111i\u1ec1u tr\u1ecb kh\u00f4ng?<\/p>\n
V\u1edbi c\u00e1c d\u1eef li\u1ec7u hi\u1ec7n c\u00f3 kh\u00f4ng cho ph\u00e9p \u0111\u01b0a ra khuy\u1ebfn c\u00e1o ch\u1ec9 \u0111\u1ecbnh LHK \u1edf ph\u1ee5 n\u1eef trong th\u1eddi k\u1ef3 h\u1eadu s\u1ea3n b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p (>=10 ng\u00e0y v\u00e0 < 3 th\u00e1ng sau \u0111\u1ebb).<\/p>\n
\u0110\u1ed3ng thu\u1eadn c\u1ee7a chuy\u00ean gia ESO: h\u1ea7u h\u1ebft c\u00e1c chuy\u00ean gia \u0111\u1ec1 ngh\u1ecb ph\u1ee5 n\u1eef trong th\u1eddi k\u1ef3 h\u1eadu s\u1ea3n b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p g\u00e2y t\u00e0n ph\u1ebf, v\u00e0 \u0111\u00e3 \u0111\u1ebb \u0111\u01b0\u1ee3c \u00edt nh\u1ea5t 10 ng\u00e0y, \u0111\u00e1p \u1ee9ng \u0111\u1ee7 c\u00e1c ti\u00eau chu\u1ea9n, n\u00ean \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh LHK sau khi c\u00e2n nh\u1eafc l\u1ee3i \u00edch\/nguy c\u01a1 d\u1ef1a v\u00e0o c\u00e1 th\u1ec3 h\u00f3a ng\u01b0\u1eddi b\u1ec7nh 12\/13 chuy\u00ean gia cho r\u1eb1ng n\u1ebfu c\u00f3 s\u1eb5n LHK th\u00ec l\u1ea5y HK \u0111\u01a1n thu\u1ea7n h\u01a1n l\u00e0 rtPA ho\u1eb7c \u0111i\u1ec1u tr\u1ecb b\u1eafc c\u1ea7u.<\/p>\n
rtPA trong chu k\u00ec kinh nguy\u1ec7t<\/h3>\n
C\u00e2u h\u1ecfi: \u1ede ph\u1ee5 n\u1eef \u0111ang trong chu k\u1ef3 kinh nguy\u1ec7t b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p, rtPA c\u00f3 gi\u00fap c\u1ea3i thi\u1ec7n k\u1ebft c\u1ee5c \u0111i\u1ec1u tr\u1ecb?<\/p>\n
V\u1edbi c\u00e1c d\u1eef li\u1ec7u hi\u1ec7n c\u00f3 kh\u00f4ng cho ph\u00e9p \u0111\u01b0a ra khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng rtPA \u1edf ph\u1ee5 n\u1eef \u0111ang trong chu k\u1ef3 kinh nguy\u1ec7t b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p.<\/p>\n
\u0110\u1ed3ng thu\u1eadn c\u1ee7a chuy\u00ean gia ESO: 12\/13 chuy\u00ean gia \u0111\u1ec1 ngh\u1ecb ph\u1ee5 n\u1eef \u0111ang trong chu k\u1ef3 kinh nguy\u1ec7t b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p, \u0111\u00e1p \u1ee9ng \u0111\u1ee7 c\u00e1c ti\u00eau chu\u1ea9n, n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb rtPA sau khi c\u00e2n nh\u1eafc l\u1ee3i \u00edch\/nguy c\u01a1 d\u1ef1a v\u00e0o c\u00e1 th\u1ec3 h\u00f3a ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n
N\u1ed9i dung 3: Ch\u1ec9 \u0111\u1ecbnh rtPA tr\u01b0\u1edbc LHK \u1edf b\u1ec7nh nh\u00e2n t\u1eafc \u0111\u1ed9ng m\u1ea1ch l\u1edbn h\u1ec7 tu\u1ea7n ho\u00e0n tr\u01b0\u1edbc<\/h2>\n
C\u01a1 s\u1edf khoa h\u1ecdc<\/h3>\n
Ch\u00fang ta c\u00f3 c\u00f2n c\u1ea7n IVT tr\u01b0\u1edbc khi MT \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb t\u1eafc m\u1ea1ch l\u1edbn kh\u00f4ng?<\/strong><\/p>\n
L\u1ee3i \u00edch c\u1ee7a l\u1ea5y HK tr\u1ef1c ti\u1ebfp<\/p>\n
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rtPA c\u00f3 t\u1ef7 l\u1ec7 t\u00e1i th\u00f4ng th\u1ea5p tr\u01b0\u1edbc l\u1ea5y HK<\/li>\n
rtPA l\u00e0m t\u0103ng nguy c\u01a1 ch\u1ea3y m\u00e1u n\u1ed9i s\u1ecd<\/li>\n
rtPA l\u00e0m di chuy\u1ec3n huy\u1ebft kh\u1ed1i<\/li>\n
rtPA c\u00f3 th\u1ec3 l\u00e0m ch\u1eadm tr\u1ec5 l\u1ea5y HK<\/li>\n
rtPA l\u00e0m gia t\u0103ng chi ph\u00ed<\/li>\n<\/ul>\n
L\u1ee3i \u00edch \u0111i\u1ec1u tr\u1ecb b\u1eafc c\u1ea7u (IVT + MT)<\/p>\n
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M\u1ed9t s\u1ed1 \u00edt b\u1ec7nh nh\u00e2n LVO t\u00e1i th\u00f4ng s\u1edbm v\u1edbi rtPA<\/li>\n
rtPA c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n t\u1ef7 l\u1ec7 t\u00e1i t\u01b0\u1edbi m\u00e1u th\u00e0nh c\u00f4ng sau LHK<\/li>\n
\u00cdt n\u1ed7 l\u1ef1c t\u00e1i th\u00f4ng h\u01a1n?<\/li>\n
C\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m huy\u1ebft kh\u1ed1i \u1edf vi m\u1ea1ch<\/li>\n
C\u00f3 l\u1ee3i \u1edf b\u1ec7nh nh\u00e2n LHK kh\u00f4ng th\u00e0nh c\u00f4ng?<\/li>\n<\/ul>\n
T\u00ecnh hu\u1ed1ng 1<\/h2>\n
Mothership, trong c\u1eeda s\u1ed5 \u2264 4.5 gi\u1edd<\/p>\n
V\u1edbi b\u1ec7nh nh\u00e2n b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p do t\u1eafc m\u1ea1ch l\u1edbn trong c\u1eeda s\u1ed5 4.5 gi\u1edd \u0111\u1ea7u nh\u1eadp trung t\u00e2m \u0111\u1ed9t qu\u1ef5 l\u1edbn c\u00f3 kh\u1ea3 n\u0103ng l\u1ea5y huy\u1ebft kh\u1ed1i c\u01a1 h\u1ecdc v\u00e0 \u0111\u00e1p \u1ee9ng \u0111\u1ee7 ti\u00eau chu\u1ea9n hai ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u00e1i t\u01b0\u1edbi m\u00e1u, th\u00ec LHK \u0111\u01a1n thu\u1ea7n so v\u1edbi rtPA k\u1ebft h\u1ee3p LHK c\u00f3 \u0111em l\u1ea1i:<\/p>\n
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t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n c\u00f3 k\u1ebft c\u1ee5c \u0111i\u1ec1u tr\u1ecb t\u1ed1t kh\u00f4ng k\u00e9m h\u01a1n trong 90 ng\u00e0y (mRS 0-2)?<\/li>\n
hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb kh\u00e1c kh\u00f4ng k\u00e9m h\u01a1n ho\u1eb7c t\u1ed1t h\u01a1n (mRS to\u00e0n ph\u1ea7n; mRS 0-1; t\u00e1i t\u01b0\u1edbi m\u00e1u th\u00e0nh c\u00f4ng)?<\/li>\n
gi\u1ea3m c\u00e1c bi\u1ebfn c\u1ed1 nguy hi\u1ec3m (t\u1eed vong trong 90 ng\u00e0y, ch\u1ea3y m\u00e1u n\u1ed9i s\u1ecd)?<\/li>\n<\/ul>\n
C\u00e1c RCT \u0111\u00e3 c\u00f3 k\u1ebft qu\u1ea3<\/h2>\n
Mothership, c\u1eeda s\u1ed5 \u2264 4.5 gi\u1edd<\/p>\n\n\n\n\n\n\n\n\n\n
Th\u1eed nghi\u1ec7m<\/td>\n K\u1ebft qu\u1ea3<\/td>\n N<\/td>\n \u0110\u1ecba \u0111i\u1ec3m<\/td>\n Ti\u00eau ch\u00ed \u2018kh\u00f4ng k\u00e9m h\u01a1n\u2019<\/td>\n K\u1ebft lu\u1eadn \u2018kh\u00f4ng k\u00e9m h\u01a1n\u2019<\/td>\n<\/tr>\n
DIRECT-MT<\/td>\n \u0110\u00e3 c\u00f4ng b\u1ed1<\/td>\n 654<\/td>\n China<\/td>\n Relative, cOR 0.80<\/td>\n Yes<\/td>\n<\/tr>\n
DEVT<\/td>\n \u0110\u00e3 c\u00f4ng b\u1ed1<\/td>\n 234<\/td>\n China<\/td>\n Absolute, 10% mRS 0-2<\/td>\n Yes<\/td>\n<\/tr>\n
SKIP<\/td>\n \u0110\u00e3 c\u00f4ng b\u1ed1<\/td>\n 204<\/td>\n Japan<\/td>\n Relative, OR 0.74 mRS 0-2<\/td>\n No<\/td>\n<\/tr>\n
MR CLEAN No IV<\/td>\n \u0110\u00e3 c\u00f4ng b\u1ed1<\/td>\n 539<\/td>\n Europe<\/td>\n Relative, cOR 0.80<\/td>\n No<\/td>\n<\/tr>\n
SWIFT DIRECT<\/td>\n \u0110\u00e3 b\u00e1o c\u00e1o k\u1ebft<\/p>\n
qu\u1ea3<\/td>\n
404<\/td>\n Europe & North<\/p>\n
America<\/td>\n
Absolute, 12% mRS 0-2<\/td>\n No<\/td>\n<\/tr>\n
DIRECT-SAFE<\/td>\n \u0110\u00e3 b\u00e1o c\u00e1o k\u1ebft qu\u1ea3<\/td>\n 293<\/td>\n Oceania & Asia<\/td>\n Absolute, 10% mRS 0-2<\/td>\n No<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Ph\u00e2n t\u00edch g\u1ed9p c\u00e1c RCT<\/h2>\n
Ti\u00eau ch\u00ed \u2018kh\u00f4ng k\u00e9m h\u01a1n\u201d<\/h3>\n
\n
K\u1ebft c\u1ee5c ch\u00ednh: s\u1ef1 kh\u00e1c bi\u1ec7t t\u1ef7 l\u1ec7 % \u0111\u1ea1t k\u1ebft c\u1ee5c ch\u1ee9c n\u0103ng th\u1ea7n kinh t\u1ed1t mRS 0-2 trong 90 ng\u00e0y.<\/li>\n
Ti\u00eau ch\u00ed \u2018kh\u00f4ng k\u00e9m h\u01a1n\u2019: 1.3% (range: 1.0% to 5.0%)<\/li>\n<\/ul>\n
$\"Ph\u00e2n$
Ph\u00e2n t\u00edch g\u1ed9p c\u00e1c RCT<\/figcaption><\/figure>\n
MT tr\u1ef1c ti\u1ebfp vs. IVT + MT<\/h2>\n
$\"K\u1ebft$
K\u1ebft c\u1ee5c ch\u1ee9c n\u0103ng th\u1ea7n kinh t\u1ed1t (mRS 0-2 trong 90 ng\u00e0y)<\/figcaption><\/figure>\n
$\"K\u1ebft$
K\u1ebft c\u1ee5c ch\u1ee9c n\u0103ng th\u1ea7n kinh t\u1ed1t (mRS 0-2 trong 90 ng\u00e0y)<\/figcaption><\/figure>\n
$\"Gi\u1ea3m$
Gi\u1ea3m m\u1ee9c \u0111\u1ed9 t\u00e0n ph\u1ebf trong 90 ng\u00e0y<\/figcaption><\/figure>\n
$\"T\u1eed$
T\u1eed vong trong 90 ng\u00e0y<\/figcaption><\/figure>\n
$\"T\u00e1i$
T\u00e1i th\u00f4ng m\u1ea1ch th\u00e0nh c\u00f4ng (mTICI \u22652b)<\/figcaption><\/figure>\n
$\"Ch\u1ea3y$
Ch\u1ea3y m\u00e1u n\u1ed9i s\u1ecd c\u00f3 tri\u1ec7u ch\u1ee9ng<\/figcaption><\/figure>\n
$\"Ch\u1ea3y$
Ch\u1ea3y m\u00e1u n\u1ed9i s\u1ecd<\/figcaption><\/figure>\n
Khuy\u1ebfn c\u00e1o<\/h2>\n
Mothership, c\u1eeda s\u1ed5 \u2264 4.5 gi\u1edd<\/p>\n
V\u1edbi b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u n\u00e3o do t\u1eafc m\u1ea1ch l\u1edbn h\u1ec7 tu\u1ea7n ho\u00e0n tr\u01b0\u1edbc nh\u1eadp b\u1ec7nh vi\u1ec7n c\u00f3 kh\u1ea3 n\u0103ng LHK trong c\u1eeda s\u1ed5 4.5 gi\u1edd v\u00e0 \u0111\u00e1p \u1ee9ng \u0111\u1ee7 ti\u00eau chu\u1ea9n c\u1ee7a hai ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u00e1i t\u01b0\u1edbi m\u00e1u, ch\u00fang t\u00f4i khuy\u1ebfn c\u00e1o rtPA k\u1ebft h\u1ee3p LHK h\u01a1n l\u00e0 LHK \u0111\u01a1n thu\u1ea7n.
\nC\u1ea3 hai ph\u01b0\u01a1ng ph\u00e1p t\u00e1i t\u01b0\u1edbi m\u00e1u n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t sau khi nh\u1eadp vi\u1ec7n. LHK kh\u00f4ng n\u00ean ng\u0103n c\u1ea3n rtPA v\u00e0 rtPA kh\u00f4ng n\u00ean l\u00e0m ch\u1eadm tr\u1ec5 LHK.<\/p>\n
\n
M\u1ee9c \u0111\u1ed9 b\u1eb1ng ch\u1ee9ng: Trung b\u00ecnh \u2295\u2295\u2295<\/li>\n
\u0110\u1ed9 m\u1ea1nh c\u1ee7a khuy\u1ebfn c\u00e1o: M\u1ea1nh \u2191\u2191<\/li>\n<\/ul>\n
\u0110\u1ed3ng thu\u1eadn c\u1ee7a chuy\u00ean gia ESO-ESMINT<\/h2>\n
Mothership, \u0111\u1ed9t qu\u1ef5 th\u1ee9c gi\u1ea5c<\/p>\n
V\u1edbi b\u1ec7nh nh\u00e2n b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o th\u1ee9c gi\u1ea5c do t\u1eafc m\u1ea1ch l\u1edbn nh\u1eadp b\u1ec7nh vi\u1ec7n c\u00f3 kh\u1ea3 n\u0103ng LHK trong c\u1eeda s\u1ed5 4.5 gi\u1edd t\u1eeb khi ph\u00e1t hi\u1ec7n tri\u1ec7u ch\u1ee9ng, ch\u00fang t\u00f4i \u0111\u1ec1 ngh\u1ecb rtPA k\u1ebft h\u1ee3p LHK h\u01a1n l\u00e0 LHK \u0111\u01a1n thu\u1ea7n cho nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u1ee7 ti\u00eau chu\u1ea9n.<\/p>\n
Ti\u00eau chu\u1ea9n l\u1ef1a ch\u1ecdn d\u1ef1a v\u00e0o mismatch DWI-FLAIR v\u00e0\/ho\u1eb7c l\u00f5i t\u01b0\u1edbi m\u00e1u\/penumbra .<\/p>\n
\n
L\u00f5i nh\u1ed3i m\u00e1u\/penumbra mismatch:\n
\n
Th\u1ec3 t\u00edch l\u00f5i nh\u1ed3i m\u00e1u < 70 ml<\/li>\n
V\u00e0 t\u1ef7 l\u1ec7 th\u1ec3 t\u00edch penumbra\/th\u1ec3 t\u00edch l\u00f5i nh\u1ed3i m\u00e1u > 1.2<\/li>\n
V\u00e0 Th\u1ec3 t\u00edch Penumbra-th\u1ec3 t\u00edch l\u00f5i nh\u1ed3i m\u00e1u > 10 ml<\/li>\n<\/ul>\n<\/li>\n
rCBF <30% (CT t\u01b0\u1edbi m\u00e1u) ho\u1eb7c ADC < 620 \u00b5m2\/s (Diffusion MRI)\n
\n
Tmax >6s (CT t\u01b0\u1edbi m\u00e1u ho\u1eb7c MRI t\u01b0\u1edbi m\u00e1u)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
T\u00ecnh hu\u1ed1ng 2<\/h2>\n
Drip-and-ship, c\u1eeda s\u1ed5 \u2264 4.5 gi\u1edd<\/p>\n
V\u1edbi b\u1ec7nh nh\u00e2n b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p do t\u1eafc m\u1ea1ch l\u1edbn nh\u1eadp b\u1ec7nh vi\u1ec7n kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng can thi\u1ec7p LHK trong c\u1eeda s\u1ed5 4.5 gi\u1edd v\u00e0 \u0111\u00e1p \u1ee9ng \u0111\u1ee7 ti\u00eau chu\u1ea9n c\u1ee7a hai ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u00e1i t\u01b0\u1edbi m\u00e1u, th\u00ec LHK \u0111\u01a1n thu\u1ea7n so v\u1edbi rtPA k\u1ebft h\u1ee3p LHK c\u00f3 mang l\u1ea1i:<\/p>\n
\n
t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n c\u00f3 k\u1ebft c\u1ee5c \u0111i\u1ec1u tr\u1ecb t\u1ed1t kh\u00f4ng k\u00e9m h\u01a1n trong 90 ng\u00e0y (mRS 0-2)?<\/li>\n
hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb kh\u00e1c kh\u00f4ng k\u00e9m h\u01a1n ho\u1eb7c t\u1ed1t h\u01a1n (mRS to\u00e0n ph\u1ea7n; mRS 0-1; t\u00e1i t\u01b0\u1edbi m\u00e1u th\u00e0nh c\u00f4ng)?<\/li>\n
gi\u1ea3m c\u00e1c bi\u1ebfn c\u1ed1 nguy hi\u1ec3m (t\u1eed vong trong 90 ng\u00e0y, ch\u1ea3y m\u00e1u n\u1ed9i s\u1ecd)?<\/li>\n<\/ul>\n
Khuy\u1ebfn c\u00e1o<\/h2>\n
Drip-and-ship, trong c\u1eeda s\u1ed5 \u2264 4.5 gi\u1edd<\/p>\n
V\u1edbi b\u1ec7nh nh\u00e2n b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p do t\u1eafc m\u1ea1ch l\u1edbn nh\u1eadp b\u1ec7nh vi\u1ec7n kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng can thi\u1ec7p LHK, trong c\u1eeda s\u1ed5 4.5 gi\u1edd v\u00e0 \u0111\u00e1p \u1ee9ng \u0111\u1ee7 ti\u00eau chu\u1ea9n c\u1ee7a hai ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u00e1i t\u01b0\u1edbi m\u00e1u, ch\u00fang t\u00f4i khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng rtPA \u0111\u1ed3ng th\u1eddi chuy\u1ec3n nhanh b\u1ec7nh nh\u00e2n t\u1edbi b\u1ec7nh vi\u1ec7n c\u00f3 kh\u1ea3 n\u0103ng LHK h\u01a1n l\u00e0 kh\u00f4ng rtPA v\u00e0 chuy\u1ec3n th\u1eb3ng t\u1edbi BV c\u00f3 kh\u1ea3 n\u0103ng LHK.<\/p>\n
rtPA kh\u00f4ng \u0111\u01b0\u1ee3c l\u00e0m ch\u1eadm tr\u1ec5 vi\u1ec7c v\u1eadn chuy\u1ec3n b\u1ec7nh nh\u00e2n t\u1edbi b\u1ec7nh vi\u1ec7n c\u00f3 kh\u1ea3 n\u0103ng LHK<\/p>\n
M\u1ee9c \u0111\u1ed9 b\u1eb1ng ch\u1ee9ng: Th\u1ea5p \u2295\u2295<\/p>\n
\u0110\u1ed9 m\u1ea1nh c\u1ee7a khuy\u1ebfn c\u00e1o: M\u1ea1nh \u2191\u2191<\/p>\n
\u0110\u1ed3ng thu\u1eadn c\u1ee7a chuy\u00ean gia ESO-ESMINT<\/h2>\n
Drip-and-ship, \u0111\u1ed9t qu\u1ef5 th\u1ee9c gi\u1ea5c<\/h3>\n
V\u1edbi b\u1ec7nh nh\u00e2n b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o th\u1ee9c gi\u1ea5c do t\u1eafc m\u1ea1ch l\u1edbn nh\u1eadp b\u1ec7nh vi\u1ec7n kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng LHK trong c\u1eeda s\u1ed5 4.5 gi\u1edd t\u1eeb khi ph\u00e1t hi\u1ec7n tri\u1ec7u ch\u1ee9ng, ch\u00fang t\u00f4i \u0111\u1ec1 ngh\u1ecb rtPA k\u1ebft h\u1ee3p LHK h\u01a1n l\u00e0 LHK \u0111\u01a1n thu\u1ea7n cho nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u1ee7 ti\u00eau chu\u1ea9n.<\/p>\n
Ti\u00eau chu\u1ea9n l\u1ef1a ch\u1ecdn d\u1ef1a v\u00e0o mismatch DWI-FLAIR v\u00e0\/ho\u1eb7c l\u00f5i t\u01b0\u1edbi m\u00e1u\/penumbra .<\/p>\n
\n
L\u00f5i nh\u1ed3i m\u00e1u\/penumbra mismatch:\n
\n
Th\u1ec3 t\u00edch l\u00f5i nh\u1ed3i m\u00e1u < 70 ml<\/li>\n
V\u00e0 t\u1ef7 l\u1ec7 th\u1ec3 t\u00edch penumbra\/th\u1ec3 t\u00edch l\u00f5i nh\u1ed3i m\u00e1u > 1.2<\/li>\n
V\u00e0 Th\u1ec3 t\u00edch Penumbra-th\u1ec3 t\u00edch l\u00f5i nh\u1ed3i m\u00e1u > 10 ml<\/li>\n<\/ul>\n<\/li>\n
rCBF <30% (CT t\u01b0\u1edbi m\u00e1u) ho\u1eb7c ADC < 620 \u00b5m2\/s (Diffusion MRI)\n
\n
Tmax >6s (CT t\u01b0\u1edbi m\u00e1u ho\u1eb7c MRI t\u01b0\u1edbi m\u00e1u)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
K\u1ebft lu\u1eadn<\/h2>\n
\n
V\u1edbi BN nh\u1ed3i m\u00e1u n\u00e3o do t\u1eafc m\u1ea1ch l\u1edbn h\u1ec7 tu\u1ea7n ho\u00e0n tr\u01b0\u1edbc, nh\u1eadp vi\u1ec7n c\u00f3 kh\u1ea3 n\u0103ng LHK, trong c\u1eeda s\u1ed5 4.5 gi\u1edd, LHK tr\u1ef1c ti\u1ebfp kh\u00f4ng ch\u1ee9ng minh \u0111\u01b0\u1ee3c t\u00ednh \u2018kh\u00f4ng k\u00e9m h\u01a1n\u2019 (1.3%, ho\u1eb7c th\u1eadm ch\u00ed 5%) so v\u1edbi rtPA k\u1ebft h\u1ee3p LHK.<\/li>\n
Do v\u1eady, trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, ESO-ESMINT khuy\u1ebfn c\u00e1o rtPA tr\u01b0\u1edbc LHK.<\/li>\n
rtPA kh\u00f4ng n\u00ean l\u00e0m ch\u1eadm tr\u1ec5 LHK ho\u1eb7c chuy\u1ec3n t\u1edbi trung t\u00e2m c\u00f3 kh\u1ea3 n\u0103ng LHK<\/li>\n
ESO-ESMINT \u0111\u1ec1 ngh\u1ecb rtPA tr\u01b0\u1edbc LHK \u1edf nh\u1eefng BN \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn theo ti\u00eau chu\u1ea9n b\u1ecb \u0111\u1ed9t qu\u1ef5 th\u1ee9c gi\u1ea5c (\u00fd ki\u1ebfn c\u1ee7a
\nchuy\u00ean gia ESO-ESMINT).<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"
T\u00e1c gi\u1ea3: Ph\u00f3 gi\u00e1o s\u01b0 – Ti\u1ebfn s\u0129 Mai Duy T\u00f4n vnras.com\/drug – \u0110\u1ec3 t\u1ea3i file PDF c\u1ee7a b\u00e0i vi\u1ebft C\u1eadp nh\u1eadt v\u1ec1 x\u1eed tr\u00ed \u0111\u1ed9t qu\u1ef5 c\u1ea5p 2022, xin vui l\u00f2ng click v\u00e0o link \u1edf \u0111\u00e2y. N\u1ed9i dung 1: \u0110\u01a1n v\u1ecb \u0111\u1ed9t qu\u1ef5 di \u0111\u1ed9ng K\u1ebft lu\u1eadn B\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 c\u1ea5p, MSU gi\u00fap […]\n","protected":false},"author":1,"featured_media":33614,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-33598","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/33598","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=33598"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/33598\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/33614"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=33598"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=33598"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=33598"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}

Th\u1eed nghi\u1ec7m<\/td>\n	K\u1ebft qu\u1ea3<\/td>\n	N<\/td>\n	\u0110\u1ecba \u0111i\u1ec3m<\/td>\n	Ti\u00eau ch\u00ed \u2018kh\u00f4ng k\u00e9m h\u01a1n\u2019<\/td>\n	K\u1ebft lu\u1eadn \u2018kh\u00f4ng k\u00e9m h\u01a1n\u2019<\/td>\n<\/tr>\n
DIRECT-MT<\/td>\n	\u0110\u00e3 c\u00f4ng b\u1ed1<\/td>\n	654<\/td>\n	China<\/td>\n	Relative, cOR 0.80<\/td>\n	Yes<\/td>\n<\/tr>\n
DEVT<\/td>\n	\u0110\u00e3 c\u00f4ng b\u1ed1<\/td>\n	234<\/td>\n	China<\/td>\n	Absolute, 10% mRS 0-2<\/td>\n	Yes<\/td>\n<\/tr>\n
SKIP<\/td>\n	\u0110\u00e3 c\u00f4ng b\u1ed1<\/td>\n	204<\/td>\n	Japan<\/td>\n	Relative, OR 0.74 mRS 0-2<\/td>\n	No<\/td>\n<\/tr>\n
MR CLEAN No IV<\/td>\n	\u0110\u00e3 c\u00f4ng b\u1ed1<\/td>\n	539<\/td>\n	Europe<\/td>\n	Relative, cOR 0.80<\/td>\n	No<\/td>\n<\/tr>\n
SWIFT DIRECT<\/td>\n	\u0110\u00e3 b\u00e1o c\u00e1o k\u1ebft<\/p>\n qu\u1ea3<\/td>\n	404<\/td>\n	Europe & North<\/p>\n America<\/td>\n	Absolute, 12% mRS 0-2<\/td>\n	No<\/td>\n<\/tr>\n
DIRECT-SAFE<\/td>\n	\u0110\u00e3 b\u00e1o c\u00e1o k\u1ebft qu\u1ea3<\/td>\n	293<\/td>\n	Oceania & Asia<\/td>\n	Absolute, 10% mRS 0-2<\/td>\n	No<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n Ph\u00e2n t\u00edch g\u1ed9p c\u00e1c RCT<\/h2>\n Ti\u00eau ch\u00ed \u2018kh\u00f4ng k\u00e9m h\u01a1n\u201d<\/h3>\n \n K\u1ebft c\u1ee5c ch\u00ednh: s\u1ef1 kh\u00e1c bi\u1ec7t t\u1ef7 l\u1ec7 % \u0111\u1ea1t k\u1ebft c\u1ee5c ch\u1ee9c n\u0103ng th\u1ea7n kinh t\u1ed1t mRS 0-2 trong 90 ng\u00e0y.<\/li>\n Ti\u00eau ch\u00ed \u2018kh\u00f4ng k\u00e9m h\u01a1n\u2019: 1.3% (range: 1.0% to 5.0%)<\/li>\n<\/ul>\n $\"Ph\u00e2n$ Ph\u00e2n t\u00edch g\u1ed9p c\u00e1c RCT<\/figcaption><\/figure>\n MT tr\u1ef1c ti\u1ebfp vs. IVT + MT<\/h2>\n $\"K\u1ebft$ K\u1ebft c\u1ee5c ch\u1ee9c n\u0103ng th\u1ea7n kinh t\u1ed1t (mRS 0-2 trong 90 ng\u00e0y)<\/figcaption><\/figure>\n $\"K\u1ebft$ K\u1ebft c\u1ee5c ch\u1ee9c n\u0103ng th\u1ea7n kinh t\u1ed1t (mRS 0-2 trong 90 ng\u00e0y)<\/figcaption><\/figure>\n $\"Gi\u1ea3m$ Gi\u1ea3m m\u1ee9c \u0111\u1ed9 t\u00e0n ph\u1ebf trong 90 ng\u00e0y<\/figcaption><\/figure>\n $\"T\u1eed$ T\u1eed vong trong 90 ng\u00e0y<\/figcaption><\/figure>\n $\"T\u00e1i$ T\u00e1i th\u00f4ng m\u1ea1ch th\u00e0nh c\u00f4ng (mTICI \u22652b)<\/figcaption><\/figure>\n $\"Ch\u1ea3y$ Ch\u1ea3y m\u00e1u n\u1ed9i s\u1ecd c\u00f3 tri\u1ec7u ch\u1ee9ng<\/figcaption><\/figure>\n $\"Ch\u1ea3y$ Ch\u1ea3y m\u00e1u n\u1ed9i s\u1ecd<\/figcaption><\/figure>\n Khuy\u1ebfn c\u00e1o<\/h2>\n Mothership, c\u1eeda s\u1ed5 \u2264 4.5 gi\u1edd<\/p>\n V\u1edbi b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u n\u00e3o do t\u1eafc m\u1ea1ch l\u1edbn h\u1ec7 tu\u1ea7n ho\u00e0n tr\u01b0\u1edbc nh\u1eadp b\u1ec7nh vi\u1ec7n c\u00f3 kh\u1ea3 n\u0103ng LHK trong c\u1eeda s\u1ed5 4.5 gi\u1edd v\u00e0 \u0111\u00e1p \u1ee9ng \u0111\u1ee7 ti\u00eau chu\u1ea9n c\u1ee7a hai ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u00e1i t\u01b0\u1edbi m\u00e1u, ch\u00fang t\u00f4i khuy\u1ebfn c\u00e1o rtPA k\u1ebft h\u1ee3p LHK h\u01a1n l\u00e0 LHK \u0111\u01a1n thu\u1ea7n. \nC\u1ea3 hai ph\u01b0\u01a1ng ph\u00e1p t\u00e1i t\u01b0\u1edbi m\u00e1u n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t sau khi nh\u1eadp vi\u1ec7n. LHK kh\u00f4ng n\u00ean ng\u0103n c\u1ea3n rtPA v\u00e0 rtPA kh\u00f4ng n\u00ean l\u00e0m ch\u1eadm tr\u1ec5 LHK.<\/p>\n \n M\u1ee9c \u0111\u1ed9 b\u1eb1ng ch\u1ee9ng: Trung b\u00ecnh \u2295\u2295\u2295<\/li>\n \u0110\u1ed9 m\u1ea1nh c\u1ee7a khuy\u1ebfn c\u00e1o: M\u1ea1nh \u2191\u2191<\/li>\n<\/ul>\n \u0110\u1ed3ng thu\u1eadn c\u1ee7a chuy\u00ean gia ESO-ESMINT<\/h2>\n Mothership, \u0111\u1ed9t qu\u1ef5 th\u1ee9c gi\u1ea5c<\/p>\n V\u1edbi b\u1ec7nh nh\u00e2n b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o th\u1ee9c gi\u1ea5c do t\u1eafc m\u1ea1ch l\u1edbn nh\u1eadp b\u1ec7nh vi\u1ec7n c\u00f3 kh\u1ea3 n\u0103ng LHK trong c\u1eeda s\u1ed5 4.5 gi\u1edd t\u1eeb khi ph\u00e1t hi\u1ec7n tri\u1ec7u ch\u1ee9ng, ch\u00fang t\u00f4i \u0111\u1ec1 ngh\u1ecb rtPA k\u1ebft h\u1ee3p LHK h\u01a1n l\u00e0 LHK \u0111\u01a1n thu\u1ea7n cho nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u1ee7 ti\u00eau chu\u1ea9n.<\/p>\n Ti\u00eau chu\u1ea9n l\u1ef1a ch\u1ecdn d\u1ef1a v\u00e0o mismatch DWI-FLAIR v\u00e0\/ho\u1eb7c l\u00f5i t\u01b0\u1edbi m\u00e1u\/penumbra .<\/p>\n \n L\u00f5i nh\u1ed3i m\u00e1u\/penumbra mismatch:\n \n Th\u1ec3 t\u00edch l\u00f5i nh\u1ed3i m\u00e1u* < 70 ml<\/li>\n V\u00e0 t\u1ef7 l\u1ec7 th\u1ec3 t\u00edch penumbra\/th\u1ec3 t\u00edch l\u00f5i nh\u1ed3i m\u00e1u** > 1.2<\/li>\n V\u00e0 Th\u1ec3 t\u00edch Penumbra-th\u1ec3 t\u00edch l\u00f5i nh\u1ed3i m\u00e1u > 10 ml<\/li>\n<\/ul>\n<\/li>\n rCBF <30% (CT t\u01b0\u1edbi m\u00e1u) ho\u1eb7c ADC < 620 \u00b5m2\/s (Diffusion MRI)\n \n Tmax >6s (CT t\u01b0\u1edbi m\u00e1u ho\u1eb7c MRI t\u01b0\u1edbi m\u00e1u)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n T\u00ecnh hu\u1ed1ng 2<\/h2>\n Drip-and-ship, c\u1eeda s\u1ed5 \u2264 4.5 gi\u1edd<\/p>\n V\u1edbi b\u1ec7nh nh\u00e2n b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p do t\u1eafc m\u1ea1ch l\u1edbn nh\u1eadp b\u1ec7nh vi\u1ec7n kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng can thi\u1ec7p LHK trong c\u1eeda s\u1ed5 4.5 gi\u1edd v\u00e0 \u0111\u00e1p \u1ee9ng \u0111\u1ee7 ti\u00eau chu\u1ea9n c\u1ee7a hai ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u00e1i t\u01b0\u1edbi m\u00e1u, th\u00ec LHK \u0111\u01a1n thu\u1ea7n so v\u1edbi rtPA k\u1ebft h\u1ee3p LHK c\u00f3 mang l\u1ea1i:<\/p>\n \n t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n c\u00f3 k\u1ebft c\u1ee5c \u0111i\u1ec1u tr\u1ecb t\u1ed1t kh\u00f4ng k\u00e9m h\u01a1n trong 90 ng\u00e0y (mRS 0-2)?<\/li>\n hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb kh\u00e1c kh\u00f4ng k\u00e9m h\u01a1n ho\u1eb7c t\u1ed1t h\u01a1n (mRS to\u00e0n ph\u1ea7n; mRS 0-1; t\u00e1i t\u01b0\u1edbi m\u00e1u th\u00e0nh c\u00f4ng)?<\/li>\n gi\u1ea3m c\u00e1c bi\u1ebfn c\u1ed1 nguy hi\u1ec3m (t\u1eed vong trong 90 ng\u00e0y, ch\u1ea3y m\u00e1u n\u1ed9i s\u1ecd)?<\/li>\n<\/ul>\n Khuy\u1ebfn c\u00e1o<\/h2>\n Drip-and-ship, trong c\u1eeda s\u1ed5 \u2264 4.5 gi\u1edd<\/p>\n V\u1edbi b\u1ec7nh nh\u00e2n b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o c\u1ea5p do t\u1eafc m\u1ea1ch l\u1edbn nh\u1eadp b\u1ec7nh vi\u1ec7n kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng can thi\u1ec7p LHK, trong c\u1eeda s\u1ed5 4.5 gi\u1edd v\u00e0 \u0111\u00e1p \u1ee9ng \u0111\u1ee7 ti\u00eau chu\u1ea9n c\u1ee7a hai ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u00e1i t\u01b0\u1edbi m\u00e1u, ch\u00fang t\u00f4i khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng rtPA \u0111\u1ed3ng th\u1eddi chuy\u1ec3n nhanh b\u1ec7nh nh\u00e2n t\u1edbi b\u1ec7nh vi\u1ec7n c\u00f3 kh\u1ea3 n\u0103ng LHK h\u01a1n l\u00e0 kh\u00f4ng rtPA v\u00e0 chuy\u1ec3n th\u1eb3ng t\u1edbi BV c\u00f3 kh\u1ea3 n\u0103ng LHK.<\/p>\n rtPA kh\u00f4ng \u0111\u01b0\u1ee3c l\u00e0m ch\u1eadm tr\u1ec5 vi\u1ec7c v\u1eadn chuy\u1ec3n b\u1ec7nh nh\u00e2n t\u1edbi b\u1ec7nh vi\u1ec7n c\u00f3 kh\u1ea3 n\u0103ng LHK<\/p>\n M\u1ee9c \u0111\u1ed9 b\u1eb1ng ch\u1ee9ng: Th\u1ea5p \u2295\u2295<\/p>\n \u0110\u1ed9 m\u1ea1nh c\u1ee7a khuy\u1ebfn c\u00e1o: M\u1ea1nh \u2191\u2191<\/p>\n \u0110\u1ed3ng thu\u1eadn c\u1ee7a chuy\u00ean gia ESO-ESMINT<\/h2>\n Drip-and-ship, \u0111\u1ed9t qu\u1ef5 th\u1ee9c gi\u1ea5c<\/h3>\n V\u1edbi b\u1ec7nh nh\u00e2n b\u1ecb nh\u1ed3i m\u00e1u n\u00e3o th\u1ee9c gi\u1ea5c do t\u1eafc m\u1ea1ch l\u1edbn nh\u1eadp b\u1ec7nh vi\u1ec7n kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng LHK trong c\u1eeda s\u1ed5 4.5 gi\u1edd t\u1eeb khi ph\u00e1t hi\u1ec7n tri\u1ec7u ch\u1ee9ng, ch\u00fang t\u00f4i \u0111\u1ec1 ngh\u1ecb rtPA k\u1ebft h\u1ee3p LHK h\u01a1n l\u00e0 LHK \u0111\u01a1n thu\u1ea7n cho nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u1ee7 ti\u00eau chu\u1ea9n.<\/p>\n Ti\u00eau chu\u1ea9n l\u1ef1a ch\u1ecdn d\u1ef1a v\u00e0o mismatch DWI-FLAIR v\u00e0\/ho\u1eb7c l\u00f5i t\u01b0\u1edbi m\u00e1u\/penumbra .<\/p>\n \n L\u00f5i nh\u1ed3i m\u00e1u\/penumbra mismatch:\n \n Th\u1ec3 t\u00edch l\u00f5i nh\u1ed3i m\u00e1u* < 70 ml<\/li>\n V\u00e0 t\u1ef7 l\u1ec7 th\u1ec3 t\u00edch penumbra\/th\u1ec3 t\u00edch l\u00f5i nh\u1ed3i m\u00e1u** > 1.2<\/li>\n V\u00e0 Th\u1ec3 t\u00edch Penumbra-th\u1ec3 t\u00edch l\u00f5i nh\u1ed3i m\u00e1u > 10 ml<\/li>\n<\/ul>\n<\/li>\n rCBF <30% (CT t\u01b0\u1edbi m\u00e1u) ho\u1eb7c ADC < 620 \u00b5m2\/s (Diffusion MRI)\n \n Tmax >6s (CT t\u01b0\u1edbi m\u00e1u ho\u1eb7c MRI t\u01b0\u1edbi m\u00e1u)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n K\u1ebft lu\u1eadn<\/h2>\n \n V\u1edbi BN nh\u1ed3i m\u00e1u n\u00e3o do t\u1eafc m\u1ea1ch l\u1edbn h\u1ec7 tu\u1ea7n ho\u00e0n tr\u01b0\u1edbc, nh\u1eadp vi\u1ec7n c\u00f3 kh\u1ea3 n\u0103ng LHK, trong c\u1eeda s\u1ed5 4.5 gi\u1edd, LHK tr\u1ef1c ti\u1ebfp kh\u00f4ng ch\u1ee9ng minh \u0111\u01b0\u1ee3c t\u00ednh \u2018kh\u00f4ng k\u00e9m h\u01a1n\u2019 (1.3%, ho\u1eb7c th\u1eadm ch\u00ed 5%) so v\u1edbi rtPA k\u1ebft h\u1ee3p LHK.<\/li>\n Do v\u1eady, trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, ESO-ESMINT khuy\u1ebfn c\u00e1o rtPA tr\u01b0\u1edbc LHK.<\/li>\n rtPA kh\u00f4ng n\u00ean l\u00e0m ch\u1eadm tr\u1ec5 LHK ho\u1eb7c chuy\u1ec3n t\u1edbi trung t\u00e2m c\u00f3 kh\u1ea3 n\u0103ng LHK<\/li>\n ESO-ESMINT \u0111\u1ec1 ngh\u1ecb rtPA tr\u01b0\u1edbc LHK \u1edf nh\u1eefng BN \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn theo ti\u00eau chu\u1ea9n b\u1ecb \u0111\u1ed9t qu\u1ef5 th\u1ee9c gi\u1ea5c (\u00fd ki\u1ebfn c\u1ee7a \nchuy\u00ean gia ESO-ESMINT).<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":" T\u00e1c gi\u1ea3: Ph\u00f3 gi\u00e1o s\u01b0 – Ti\u1ebfn s\u0129 Mai Duy T\u00f4n vnras.com\/drug – \u0110\u1ec3 t\u1ea3i file PDF c\u1ee7a b\u00e0i vi\u1ebft C\u1eadp nh\u1eadt v\u1ec1 x\u1eed tr\u00ed \u0111\u1ed9t qu\u1ef5 c\u1ea5p 2022, xin vui l\u00f2ng click v\u00e0o link \u1edf \u0111\u00e2y. N\u1ed9i dung 1: \u0110\u01a1n v\u1ecb \u0111\u1ed9t qu\u1ef5 di \u0111\u1ed9ng K\u1ebft lu\u1eadn B\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 c\u1ea5p, MSU gi\u00fap […]\n","protected":false},"author":1,"featured_media":33614,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-33598","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/33598","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=33598"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/33598\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/33614"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=33598"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=33598"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=33598"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}