{"id":1313,"date":"2026-05-04T21:48:33","date_gmt":"2026-05-04T14:48:33","guid":{"rendered":"https:\/\/cdha.edu.vn\/cdha\/?p=1313"},"modified":"2026-05-04T21:58:43","modified_gmt":"2026-05-04T14:58:43","slug":"1313-2","status":"publish","type":"post","link":"https:\/\/cdha.edu.vn\/cdha\/1313-2\/","title":{"rendered":"C\u1eadp nh\u1eadt si\u00eau \u00e2m xuy\u00ean s\u1ecd ng\u01b0\u1eddi l\u1edbn"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"\/\/www.youtube.com\/embed\/uHq70gev4Qs\" width=\"100%\" height=\"314\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><span style=\"font-size: 18pt;\"><strong>Si\u00eau \u00e2m xuy\u00ean s\u1ecd ng\u01b0\u1eddi l\u1edbn<\/strong><\/span><\/p>\n<h3 data-path-to-node=\"1\">T\u00f3m t\u1eaft<\/h3>\n<p style=\"text-align: justify;\" data-path-to-node=\"2\">Si\u00eau \u00e2m (US) xuy\u00ean s\u1ecd l\u00e0 m\u1ed9t k\u1ef9 thu\u1eadt ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh th\u1eddi gian th\u1ef1c, di \u0111\u1ed9ng v\u00e0 kh\u00f4ng x\u00e2m l\u1ea5n, cho ph\u00e9p \u0111\u00e1nh gi\u00e1 m\u1ee5c ti\u00eau h\u1ec7 tu\u1ea7n ho\u00e0n n\u1ed9i s\u1ecd v\u00e0 c\u00e1c c\u1ea5u tr\u00fac nhu m\u00f4 n\u00e3o ch\u1ecdn l\u1ecdc th\u00f4ng qua c\u00e1c c\u1eeda s\u1ed5 x\u01b0\u01a1ng s\u1ecd. Theo truy\u1ec1n th\u1ed1ng, si\u00eau \u00e2m Doppler xuy\u00ean s\u1ecd (TCD) \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong c\u00e1c k\u1ecbch b\u1ea3n l\u00e2m s\u00e0ng \u0111\u00e3 \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp r\u00f5 r\u00e0ng, bao g\u1ed3m theo d\u00f5i co th\u1eaft m\u1ea1ch, \u0111\u00e1nh gi\u00e1 nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 v\u00e0 l\u00e0 x\u00e9t nghi\u1ec7m h\u1ed7 tr\u1ee3 ch\u1ea9n \u0111o\u00e1n ch\u1ebft n\u00e3o. TCD bao g\u1ed3m hai k\u1ef9 thu\u1eadt ch\u00ednh: TCD kh\u00f4ng h\u00ecnh \u1ea3nh (niTCD) v\u00e0 TCD c\u00f3 h\u00ecnh \u1ea3nh (TCDi). niTCD l\u00e0 m\u1ed9t k\u1ef9 thu\u1eadt si\u00eau \u00e2m &#8220;m\u00f9&#8221;, d\u1ef1a v\u00e0o c\u00e1c \u0111\u1ed9 s\u00e2u ti\u00eau chu\u1ea9n \u0111\u1ec3 \u0111\u1ecbnh v\u1ecb m\u1ea1ch m\u00e1u, d\u01b0\u1edbi s\u1ef1 h\u01b0\u1edbng d\u1eabn c\u1ee7a c\u00e1c d\u1ea1ng s\u00f3ng d\u00f2ng ch\u1ea3y \u0111\u1eb7c tr\u01b0ng. Ng\u01b0\u1ee3c l\u1ea1i, TCDi l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p ti\u1ebfp c\u1eadn triplex (ba ch\u1ebf \u0111\u1ed9), t\u00edch h\u1ee3p si\u00eau \u00e2m thang x\u00e1m (B-mode), si\u00eau \u00e2m Doppler m\u00e0u v\u00e0 si\u00eau \u00e2m Doppler ph\u1ed5 v\u00e0o m\u1ed9t quy tr\u00ecnh th\u0103m kh\u00e1m c\u00f3 h\u01b0\u1edbng d\u1eabn b\u1eb1ng h\u00ecnh \u1ea3nh, cho ph\u00e9p quan s\u00e1t tr\u1ef1c ti\u1ebfp gi\u1ea3i ph\u1eabu n\u1ed9i s\u1ecd, \u0111\u1ed3ng th\u1eddi c\u1ea3i thi\u1ec7n s\u1ef1 tin c\u1eady v\u00e0 kh\u1ea3 n\u0103ng l\u1eb7p l\u1ea1i c\u1ee7a ch\u1ea9n \u0111o\u00e1n. Song song \u0111\u00f3, si\u00eau \u00e2m B-mode xuy\u00ean s\u1ecd (TCS), \u0111\u01b0\u1ee3c t\u00edch h\u1ee3p trong TCDi hi\u1ec7n \u0111\u1ea1i, \u0111\u00e3 cho th\u1ea5y nh\u1eefng \u1ee9ng d\u1ee5ng \u0111\u1ea7y h\u1ee9a h\u1eb9n \u1edf b\u1ec7nh nh\u00e2n ng\u01b0\u1eddi l\u1edbn, c\u1ea3 trong \u0111\u01a1n v\u1ecb h\u1ed3i s\u1ee9c th\u1ea7n kinh v\u00e0 th\u1ef1c h\u00e0nh ngo\u1ea1i tr\u00fa. Ngo\u00e0i ra, si\u00eau \u00e2m c\u00f3 ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n (CEUS) \u0111\u00e3 n\u1ed5i l\u00ean nh\u01b0 m\u1ed9t c\u00f4ng c\u1ee5 h\u1ed7 tr\u1ee3 m\u1ea1nh m\u1ebd, gi\u00fap t\u0103ng c\u01b0\u1eddng \u0111\u00e1ng k\u1ec3 t\u00edn hi\u1ec7u Doppler \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 c\u1eeda s\u1ed5 x\u01b0\u01a1ng k\u00e9m, v\u00e0 \u0111\u00e3 m\u1edf r\u1ed9ng ph\u1ea1m vi c\u1ee7a si\u00eau \u00e2m xuy\u00ean s\u1ecd h\u01b0\u1edbng t\u1edbi c\u00e1c \u1ee9ng d\u1ee5ng th\u0103m d\u00f2 m\u1edbi v\u1ec1 m\u1ea1ch m\u00e1u v\u00e0 t\u01b0\u1edbi m\u00e1u n\u00e3o. B\u00e0i vi\u1ebft n\u00e0y cung c\u1ea5p nh\u1eefng c\u1eadp nh\u1eadt to\u00e0n di\u1ec7n v\u1ec1 si\u00eau \u00e2m xuy\u00ean s\u1ecd \u1edf ng\u01b0\u1eddi l\u1edbn, bao g\u1ed3m h\u00ecnh \u1ea3nh thang x\u00e1m, c\u00e1c k\u1ef9 thu\u1eadt Doppler v\u00e0 \u1ee9ng d\u1ee5ng CEUS. V\u1edbi tr\u1ecdng t\u00e2m l\u00e0 c\u00e1c ch\u1ec9 \u0111\u1ecbnh d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng v\u00e0 k\u1ef9 thu\u1eadt th\u1ef1c h\u00e0nh, b\u00e0i vi\u1ebft nh\u1eb1m h\u1ed7 tr\u1ee3 n\u00e2ng cao nh\u1eadn th\u1ee9c v\u00e0 \u00e1p d\u1ee5ng l\u00e2m s\u00e0ng r\u1ed9ng r\u00e3i h\u01a1n c\u1ee7a si\u00eau \u00e2m xuy\u00ean s\u1ecd trong ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh th\u1ea7n kinh ng\u01b0\u1eddi l\u1edbn hi\u1ec7n \u0111\u1ea1i, \u0111\u1eb7c bi\u1ec7t nh\u1ea5n m\u1ea1nh v\u00e0o TCDi\u2014k\u1ef9 thu\u1eadt v\u1ed1n v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c nh\u1eadn di\u1ec7n \u0111\u00fang m\u1ee9c v\u00e0 ch\u01b0a \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u00fang ti\u1ec1m n\u0103ng m\u1eb7c d\u00f9 \u0111\u00e3 ch\u1ee9ng minh \u0111\u01b0\u1ee3c gi\u00e1 tr\u1ecb l\u00e2m s\u00e0ng trong c\u00e1c ch\u1ec9 \u0111\u1ecbnh ch\u1ecdn l\u1ecdc.<\/p>\n<p data-path-to-node=\"2\"><img decoding=\"async\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/1yIwi6SepFjjPtOEilbIx3O6ZTCMJZjAC=s0\" \/><\/p>\n<h3 data-path-to-node=\"1\">Gi\u1edbi thi\u1ec7u<\/h3>\n<p style=\"text-align: justify;\" data-path-to-node=\"2\">Si\u00eau \u00e2m xuy\u00ean s\u1ecd \u0111\u1ec1 c\u1eadp \u0111\u1ebfn m\u1ed9t nh\u00f3m c\u00e1c k\u1ef9 thu\u1eadt si\u00eau \u00e2m kh\u00f4ng x\u00e2m l\u1ea5n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 huy\u1ebft \u0111\u1ed9ng h\u1ecdc n\u00e3o v\u00e0 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m m\u00f4 n\u00e3o th\u00f4ng qua x\u01b0\u01a1ng s\u1ecd. C\u00e1c k\u1ef9 thu\u1eadt n\u00e0y bao g\u1ed3m si\u00eau \u00e2m Doppler xuy\u00ean s\u1ecd (TCD), c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c chia nh\u1ecf th\u00e0nh Doppler xuy\u00ean s\u1ecd kh\u00f4ng h\u00ecnh \u1ea3nh (niTCD) v\u00e0 Doppler xuy\u00ean s\u1ecd c\u00f3 h\u00ecnh \u1ea3nh (TCDi), trong \u0111\u00f3 TCDi l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p triplex c\u00f3 m\u00e3 h\u00f3a m\u00e0u (1). niTCD, th\u01b0\u1eddng \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 k\u1ef9 thu\u1eadt &#8220;m\u00f9&#8221;, li\u00ean quan \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng si\u00eau \u00e2m Doppler xung \u0111\u1ec3 \u0111o v\u1eadn t\u1ed1c d\u00f2ng ch\u1ea3y trong c\u00e1c \u0111\u1ed9ng m\u1ea1ch l\u1edbn n\u1ed9i s\u1ecd m\u00e0 kh\u00f4ng c\u1ea7n quan s\u00e1t tr\u1ef1c ti\u1ebfp gi\u1ea3i ph\u1eabu m\u1ea1ch m\u00e1u. Vi\u1ec7c \u0111\u1ecbnh danh m\u1ea1ch m\u00e1u d\u1ef1a tr\u00ean \u0111\u1ed9 s\u00e2u t\u00ednh t\u1eeb x\u01b0\u01a1ng s\u1ecd, h\u01b0\u1edbng d\u00f2ng ch\u1ea3y v\u00e0 h\u01b0\u1edbng c\u1ee7a \u0111\u1ea7u d\u00f2. S\u1ef1 b\u1ed5 sung c\u1ee7a h\u00ecnh \u1ea3nh B-mode v\u00e0 Doppler m\u00e3 h\u00f3a m\u00e0u trong TCDi cho ph\u00e9p h\u01b0\u1edbng d\u1eabn gi\u1ea3i ph\u1eabu theo th\u1eddi gian th\u1ef1c \u0111\u1ec3 \u0111\u1ecbnh v\u1ecb m\u1ea1ch m\u00e1u v\u00e0 l\u1ea5y m\u1eabu d\u00f2ng ch\u1ea3y c\u00f3 hi\u1ec7u ch\u1ec9nh g\u00f3c. G\u1ea7n \u0111\u00e2y h\u01a1n, si\u00eau \u00e2m c\u00f3 ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n (CEUS) \u0111\u00e3 \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u nh\u01b0 m\u1ed9t k\u1ef9 thu\u1eadt b\u1ed5 tr\u1ee3, ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 c\u1ea3i thi\u1ec7n vi\u1ec7c ph\u00e1t hi\u1ec7n t\u00edn hi\u1ec7u Doppler. H\u00ecnh 1 minh h\u1ecda s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa niTCD v\u00e0 TCDi.<\/p>\n<p style=\"text-align: center;\" data-path-to-node=\"2\"><img decoding=\"async\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/1gPkr_jO98Z42NfKRjP8HxCuEALczVCzh=s0\" \/><em>H\u00ecnh 1: So s\u00e1nh si\u00eau \u00e2m xuy\u00ean s\u1ecd c\u00f3 h\u00ecnh \u1ea3nh (TCDi) v\u00e0 kh\u00f4ng c\u00f3 h\u00ecnh \u1ea3nh (nTCD)<\/em><\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"2\">Theo truy\u1ec1n th\u1ed1ng, TCD \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho m\u1ed9t nh\u00f3m c\u00e1c \u1ee9ng d\u1ee5ng l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh r\u00f5 r\u00e0ng, bao g\u1ed3m theo d\u00f5i co th\u1eaft m\u1ea1ch sau xu\u1ea5t huy\u1ebft d\u01b0\u1edbi nh\u1ec7n, \u0111\u00e1nh gi\u00e1 nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 \u1edf tr\u1ebb em m\u1eafc b\u1ec7nh h\u1ed3ng c\u1ea7u h\u00ecnh li\u1ec1m (SCD), ph\u00e1t hi\u1ec7n lu\u1ed3ng th\u00f4ng tim t\u1eeb ph\u1ea3i sang tr\u00e1i v\u00e0 l\u00e0 x\u00e9t nghi\u1ec7m h\u1ed7 tr\u1ee3 \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n ch\u1ebft n\u00e3o. Nh\u1eefng \u1ee9ng d\u1ee5ng \u0111\u00e3 \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp n\u00e0y \u2014 ch\u1ee7 y\u1ebfu d\u1ef1a tr\u00ean niTCD \u2014 \u0111\u00e3 ch\u1ee9ng minh gi\u00e1 tr\u1ecb l\u00e2m s\u00e0ng c\u1ee7a TCD trong vi\u1ec7c \u0111\u00e1nh gi\u00e1 huy\u1ebft \u0111\u1ed9ng h\u1ecdc n\u00e3o ngay t\u1ea1i gi\u01b0\u1eddng b\u1ec7nh (2).<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"3\">Tuy nhi\u00ean, ph\u1ea1m vi c\u1ee7a si\u00eau \u00e2m xuy\u00ean s\u1ecd \u0111\u00e3 m\u1edf r\u1ed9ng \u0111\u00e1ng k\u1ec3 trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y. Nh\u1eefng ti\u1ebfn b\u1ed9 trong c\u00f4ng ngh\u1ec7 si\u00eau \u00e2m, bao g\u1ed3m nh\u1eefng c\u1ea3i ti\u1ebfn trong TCDi v\u00e0 s\u1ef1 ra \u0111\u1eddi c\u1ee7a CEUS, \u0111\u00e3 cho ph\u00e9p quan s\u00e1t th\u1eddi gian th\u1ef1c h\u1ec7 m\u1ea1ch m\u00e1u n\u1ed9i s\u1ecd, c\u1ea3i thi\u1ec7n \u0111\u1ed9 nh\u1ea1y \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 c\u1eeda s\u1ed5 \u00e2m k\u00e9m v\u00e0 m\u1edf r\u1ed9ng c\u00e1c \u1ee9ng d\u1ee5ng ngo\u00e0i c\u00e1c ch\u1ec9 \u0111\u1ecbnh c\u1ed5 \u0111i\u1ec3n. Song song \u0111\u00f3, si\u00eau \u00e2m nhu m\u00f4 n\u00e3o xuy\u00ean s\u1ecd (ch\u1ebf \u0111\u1ed9 B-mode &#8211; TCS), v\u1ed1n tr\u01b0\u1edbc \u0111\u00e2y ch\u1ec9 gi\u1edbi h\u1ea1n trong ch\u0103m s\u00f3c s\u01a1 sinh, ng\u00e0y c\u00e0ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u00e0 nghi\u00ean c\u1ee9u cho c\u00e1c \u1ee9ng d\u1ee5ng trong h\u1ed3i s\u1ee9c th\u1ea7n kinh v\u00e0 \u0111\u00e1nh gi\u00e1 c\u00e1c b\u1ea5t th\u01b0\u1eddng nhu m\u00f4 \u1edf b\u1ec7nh nh\u00e2n ng\u01b0\u1eddi l\u1edbn (3).<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"3\">M\u1eb7c d\u00f9 ti\u1ec1m n\u0103ng ch\u1ea9n \u0111o\u00e1n ng\u00e0y c\u00e0ng t\u0103ng, si\u00eau \u00e2m xuy\u00ean s\u1ecd \u1edf ng\u01b0\u1eddi l\u1edbn v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c c\u00e1c b\u00e1c s\u0129 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh s\u1eed d\u1ee5ng \u0111\u00fang m\u1ee9c, ph\u1ea7n l\u1edbn l\u00e0 do nh\u1eefng h\u1ea1n ch\u1ebf v\u1ec1 nh\u1eadn th\u1ee9c v\u00e0 \u0111\u00e0o t\u1ea1o. Trong l\u1ecbch s\u1eed, niTCD l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u00e0 nghi\u00ean c\u1ee9u r\u1ed9ng r\u00e3i nh\u1ea5t. Tuy nhi\u00ean, v\u00ec thi\u1ebfu th\u00e0nh ph\u1ea7n h\u00ecnh \u1ea3nh, n\u00f3 \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n v\u00e0 \u00e1p d\u1ee5ng ch\u1ee7 y\u1ebfu b\u1edfi c\u00e1c b\u00e1c s\u0129 n\u1ed9i th\u1ea7n kinh, ph\u1eabu thu\u1eadt th\u1ea7n kinh v\u00e0 c\u00e1c b\u00e1c s\u0129 trong m\u00f4i tr\u01b0\u1eddng h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c v\u00e0 c\u1ea5p c\u1ee9u h\u01a1n l\u00e0 b\u1edfi c\u00e1c b\u00e1c s\u0129 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh (3). C\u00e1c r\u00e0o c\u1ea3n b\u1ed5 sung bao g\u1ed3m vi\u1ec7c thi\u1ebfu c\u00e1c quy tr\u00ecnh chu\u1ea9n h\u00f3a v\u00e0 th\u1ef1c t\u1ebf l\u00e0 h\u1ea7u h\u1ebft c\u00e1c b\u00e1c s\u0129 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh quen thu\u1ed9c v\u1edbi CT v\u00e0 MRI h\u01a1n l\u00e0 si\u00eau \u00e2m.<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"3\">Kinh nghi\u1ec7m t\u1ea1i c\u01a1 s\u1edf c\u1ee7a c\u00e1c t\u00e1c gi\u1ea3 cho th\u1ea5y r\u1eb1ng, v\u1edbi vi\u1ec7c \u0111\u00e0o t\u1ea1o t\u1eadp trung, c\u00e1c b\u00e1c s\u0129 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh c\u00f3 th\u1ec3 tr\u1edf n\u00ean th\u00e0nh th\u1ea1o si\u00eau \u00e2m xuy\u00ean s\u1ecd trong m\u1ed9t th\u1eddi gian t\u01b0\u01a1ng \u0111\u1ed1i ng\u1eafn. S\u1ef1 quen thu\u1ed9c s\u1eb5n c\u00f3 c\u1ee7a h\u1ecd v\u1edbi c\u00e1c k\u1ef9 thu\u1eadt Doppler v\u00e0 thi\u1ebft b\u1ecb si\u00eau \u00e2m, k\u1ebft h\u1ee3p v\u1edbi kinh nghi\u1ec7m v\u1ec1 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh \u0111a ph\u01b0\u01a1ng th\u1ee9c, gi\u00fap h\u1ecd c\u00f3 v\u1ecb th\u1ebf t\u1ed1t \u0111\u1ec3 ch\u1ec9 \u0111\u1ecbnh ph\u01b0\u01a1ng ph\u00e1p n\u00e0y m\u1ed9t c\u00e1ch ph\u00f9 h\u1ee3p.<\/p>\n<h3 style=\"text-align: justify;\" data-path-to-node=\"7\">K\u1ef9 thu\u1eadt si\u00eau \u00e2m xuy\u00ean s\u1ecd<\/h3>\n<h4 style=\"text-align: justify;\" data-path-to-node=\"8\">\u0110\u1ea7u d\u00f2 v\u00e0 Thi\u1ebft b\u1ecb<\/h4>\n<p style=\"text-align: justify;\" data-path-to-node=\"9\">Si\u00eau \u00e2m xuy\u00ean s\u1ecd \u1edf ng\u01b0\u1eddi l\u1edbn th\u01b0\u1eddng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng \u0111\u1ea7u d\u00f2 t\u1ea7n s\u1ed1 th\u1ea5p (<strong data-path-to-node=\"9\" data-index-in-node=\"89\">1\u20132 MHz<\/strong>). TCDi s\u1eed d\u1ee5ng \u0111\u1ea7u d\u00f2 sector m\u1ea3ng pha (phased-array), cung c\u1ea5p kh\u1ea3 n\u0103ng \u0111\u00e2m xuy\u00ean \u00e2m t\u1ed1t qua x\u01b0\u01a1ng s\u1ecd v\u00e0 tr\u01b0\u1eddng quan s\u00e1t r\u1ed9ng (1,5).<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"10\">T\u1eeb g\u00f3c \u0111\u1ed9 v\u1eadt l\u00fd, vi\u1ec7c l\u1ef1a ch\u1ecdn t\u1ea7n s\u1ed1 ph\u1ea3n \u00e1nh s\u1ef1 \u0111\u00e1nh \u0111\u1ed5i c\u01a1 b\u1ea3n gi\u1eefa kh\u1ea3 n\u0103ng \u0111\u00e2m xuy\u00ean v\u00e0 \u0111\u1ed9 ph\u00e2n gi\u1ea3i. C\u00e1c \u0111\u1ea7u d\u00f2 t\u1ea7n s\u1ed1 th\u1ea5p (1\u20132 MHz) d\u00f9ng cho ng\u01b0\u1eddi l\u1edbn l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u1ed9 xuy\u00ean th\u1ea5u \u0111\u1ee7, \u0111\u1eb7c bi\u1ec7t l\u00e0 qua x\u01b0\u01a1ng th\u00e1i d\u01b0\u01a1ng; tuy nhi\u00ean, \u0111i\u1ec1u n\u00e0y ph\u1ea3i \u0111\u00e1nh \u0111\u1ed5i b\u1eb1ng \u0111\u1ed9 ph\u00e2n gi\u1ea3i kh\u00f4ng gian th\u1ea5p h\u01a1n. \u1ede tr\u1ebb s\u01a1 sinh, s\u1ef1 k\u1ebft h\u1ee3p gi\u1eefa x\u01b0\u01a1ng v\u00f2m s\u1ecd m\u1ecfng v\u00e0 c\u00e1c th\u00f3p ch\u01b0a \u0111\u00f3ng cho ph\u00e9p \u0111\u00e2m xuy\u00ean \u00e2m thu\u1eadn l\u1ee3i ngay c\u1ea3 v\u1edbi \u0111\u1ea7u d\u00f2 t\u1ea7n s\u1ed1 cao h\u01a1n, gi\u00fap mang l\u1ea1i ch\u1ea5t l\u01b0\u1ee3ng h\u00ecnh \u1ea3nh v\u01b0\u1ee3t tr\u1ed9i (5).<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"11\">N\u00ean duy tr\u00ec c\u00e1c h\u01b0\u1edbng Doppler m\u00e0u v\u00e0 ph\u1ed5 ti\u00eau chu\u1ea9n (m\u00e0u \u0111\u1ecf cho d\u00f2ng ch\u1ea3y h\u01b0\u1edbng v\u1ec1 \u0111\u1ea7u d\u00f2, m\u00e0u xanh cho d\u00f2ng ch\u1ea3y \u0111i xa \u0111\u1ea7u d\u00f2), v\u00ec h\u01b0\u1edbng d\u00f2ng ch\u1ea3y ch\u00ednh x\u00e1c l\u00e0 thi\u1ebft y\u1ebfu \u0111\u1ec3 \u0111\u1ecbnh danh m\u1ea1ch m\u00e1u v\u00e0 \u0111\u00e1nh gi\u00e1 c\u00e1c m\u00f4 h\u00ecnh ph\u00e2n ph\u1ed1i l\u1ea1i d\u00f2ng ch\u1ea3y b\u00f9 tr\u1eeb ho\u1eb7c li\u00ean quan \u0111\u1ebfn b\u1ec7nh l\u00fd, nh\u01b0 \u0111\u01b0\u1ee3c minh h\u1ecda trong \u0111a gi\u00e1c Willis b\u00ecnh th\u01b0\u1eddng (H\u00ecnh 2).<\/p>\n<div class=\"attachment-container search-images\" style=\"text-align: justify;\">\n<div class=\"image-container ng-star-inserted\" data-full-size-image-uri=\"https:\/\/encrypted-tbn2.gstatic.com\/licensed-image?q=tbn:ANd9GcSmovdfme6tBFkSq-BFC9QIfBihkgCvU4ozITP4TEk3Faiz8nwPdrOJLpQMnqH7HgvVxWWcOhHGtziAs4g3IuguLFoe2L0VsBL0tsO9FE95pLIr-oE\">\n<div class=\"overlay-container ng-star-inserted\"><em><img decoding=\"async\" style=\"display: block; margin-left: auto; margin-right: auto;\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/1yzoS3GqD7HUZVSyOzgw2Seu-iKL0VcOv=s0\" \/><strong data-path-to-node=\"1\" data-index-in-node=\"0\">H\u00ecnh 2.<\/strong> Si\u00eau \u00e2m TCDi kh\u1ea3o s\u00e1t \u0111a gi\u00e1c Willis qua c\u1eeda s\u1ed5 \u00e2m th\u00e1i d\u01b0\u01a1ng \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n 48 tu\u1ed5i. H\u00ecnh v\u1ebd \u1edf gi\u1eefa ph\u00eda tr\u00ean minh h\u1ecda v\u1ecb tr\u00ed \u0111\u1eb7t \u0111\u1ea7u d\u00f2 \u0111i\u1ec3n h\u00ecnh ngay ph\u00eda tr\u00ean cung g\u00f2 m\u00e1 v\u00e0 ph\u00eda tr\u01b0\u1edbc b\u00ecnh tai. H\u00ecnh v\u1ebd \u1edf g\u00f3c d\u01b0\u1edbi b\u00ean tr\u00e1i minh h\u1ecda gi\u1ea3i ph\u1eabu m\u1ea1ch m\u00e1u khi quan s\u00e1t qua c\u1eeda s\u1ed5 xuy\u00ean th\u00e1i d\u01b0\u01a1ng, v\u1edbi <span style=\"background-color: #fbeeb8;\">n\u00e3o gi\u1eefa<\/span> \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng l\u00e0m m\u1ed1c \u0111\u1ec3 \u0111\u1ecbnh v\u1ecb \u0111a gi\u00e1c Willis. H\u00ecnh qu\u00e9t TCDi \u1edf g\u00f3c d\u01b0\u1edbi b\u00ean ph\u1ea3i cho th\u1ea5y t\u00edn hi\u1ec7u d\u00f2ng ch\u1ea3y trong c\u00e1c m\u1ea1ch m\u00e1u n\u1ed9i s\u1ecd t\u01b0\u01a1ng \u1ee9ng. L\u01b0u \u00fd h\u01b0\u1edbng d\u00f2ng ch\u1ea3y b\u00ecnh th\u01b0\u1eddng \u1edf m\u1ed7i \u0111\u1ed9ng m\u1ea1ch.<br \/>\n<\/em><em>(\u0110\u01b0\u1ee3c t\u1ea1o b\u1eb1ng BioRender. Esmeraldo M [2025], <a class=\"ng-star-inserted\" href=\"https:\/\/BioRender.com\/x0bcrxy\" target=\"_blank\" rel=\"noopener\" data-hveid=\"0\" data-ved=\"0CAAQ_4QMahgKEwjJhPX7mpKUAxUAAAAAHQAAAAAQ5gU\">https:\/\/BioRender.com\/x0bcrxy<\/a>.)<\/em><\/div>\n<\/div>\n<\/div>\n<h3 style=\"text-align: justify;\" data-path-to-node=\"13\">Si\u00eau \u00e2m xuy\u00ean s\u1ecd: C\u00e1c c\u1eeda s\u1ed5<\/h3>\n<p style=\"text-align: justify;\" data-path-to-node=\"14\">Nhi\u1ec1u c\u1eeda s\u1ed5 \u00e2m \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong si\u00eau \u00e2m xuy\u00ean s\u1ecd, m\u1ed7i c\u1eeda s\u1ed5 cho ph\u00e9p ti\u1ebfp c\u1eadn c\u00e1c v\u00f9ng m\u1ea1ch m\u00e1u v\u00e0 c\u00e1c m\u1ed1c nhu m\u00f4 kh\u00e1c nhau.<\/p>\n<h4 style=\"text-align: justify;\" data-path-to-node=\"15\">C\u1eeda s\u1ed5 th\u00e1i d\u01b0\u01a1ng (Transtemporal Window)<\/h4>\n<p style=\"text-align: justify;\" data-path-to-node=\"16\">C\u1eeda s\u1ed5 th\u00e1i d\u01b0\u01a1ng l\u00e0 c\u1eeda s\u1ed5 \u00e2m \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng th\u01b0\u1eddng xuy\u00ean nh\u1ea5t v\u00e0 l\u00e0 t\u1ed1i \u01b0u nh\u1ea5t \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 tu\u1ea7n ho\u00e0n tr\u01b0\u1edbc. \u0110\u1ea7u d\u00f2 th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111\u1eb7t ph\u00eda tr\u00ean cung g\u00f2 m\u00e1 v\u00e0 ph\u00eda tr\u01b0\u1edbc b\u00ecnh tai (tragus), ho\u1eb7c h\u01a1i ph\u00eda tr\u00ean tai ngo\u00e0i nh\u01b0 m\u1ed9t v\u1ecb tr\u00ed thay th\u1ebf (1).<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"17\"><strong data-path-to-node=\"17\" data-index-in-node=\"0\">\u0110\u00e1nh gi\u00e1 m\u1ea1ch m\u00e1u:<\/strong> C\u00e1c m\u1ea1ch m\u00e1u sau \u0111\u00e2y \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 qua c\u1eeda s\u1ed5 th\u00e1i d\u01b0\u01a1ng: \u0111\u1ed9ng m\u1ea1ch n\u00e3o gi\u1eefa (MCA), c\u00e1c \u0111o\u1ea1n A1 v\u00e0 A2 c\u1ee7a \u0111\u1ed9ng m\u1ea1ch n\u00e3o tr\u01b0\u1edbc (ACA), c\u00e1c \u0111o\u1ea1n P1 v\u00e0 P2 c\u1ee7a \u0111\u1ed9ng m\u1ea1ch n\u00e3o sau (PCA), \u0111o\u1ea1n t\u1eadn \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh trong (ICA), \u0111\u1ed9ng m\u1ea1ch th\u00f4ng tr\u01b0\u1edbc v\u00e0 \u0111\u1ed9ng m\u1ea1ch th\u00f4ng sau. <strong data-path-to-node=\"17\" data-index-in-node=\"288\">B\u1ea3ng 1<\/strong> cung c\u1ea5p c\u00e1c th\u00f4ng s\u1ed1 tham chi\u1ebfu v\u00e0 gi\u00e1 tr\u1ecb \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ea1ch m\u00e1u (1,6).<\/p>\n<table style=\"border-collapse: collapse; border-width: 1px;\" border=\"1\" data-path-to-node=\"2\">\n<thead>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><strong>\u0110\u1ed9ng m\u1ea1ch ho\u1eb7c \u0110o\u1ea1n*<\/strong><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><strong>C\u1eeda s\u1ed5<\/strong><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><strong>\u0110\u1ed9 s\u00e2u (cm)<\/strong><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><strong>H\u01b0\u1edbng \u0111\u1ea7u d\u00f2<\/strong><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><strong>H\u01b0\u1edbng d\u00f2ng ch\u1ea3y \u2020<\/strong><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><strong>MFV (cm\/sec) \u2021<\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,1,0,0\">\u0110o\u1ea1n M1 c\u1ee7a MCA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,1,1,0\">Th\u00e1i d\u01b0\u01a1ng<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; text-align: center;\"><span data-path-to-node=\"2,1,2,0\">3.5\u20136.0<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,1,3,0\">Tr\u1ef1c di\u1ec7n\u00a0<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,1,4,0\">H\u01b0\u1edbng v\u1ec1 \u0111\u1ea7u d\u00f2<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; text-align: center;\"><span data-path-to-node=\"2,1,5,0\">46\u201386<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,2,0,0\">\u0110o\u1ea1n A1 c\u1ee7a ACA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,2,1,0\">Th\u00e1i d\u01b0\u01a1ng<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; text-align: center;\"><span data-path-to-node=\"2,2,2,0\">6.0\u20137.5<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,2,3,0\">Ph\u00eda tr\u01b0\u1edbc<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,2,4,0\">Xa \u0111\u1ea7u d\u00f2<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; text-align: center;\"><span data-path-to-node=\"2,2,5,0\">41\u201376<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,3,0,0\">\u0110o\u1ea1n P1 c\u1ee7a PCA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,3,1,0\">Th\u00e1i d\u01b0\u01a1ng<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; text-align: center;\"><span data-path-to-node=\"2,3,2,0\">6.0\u20137.5<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,3,3,0\">Ph\u00eda sau<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,3,4,0\">H\u01b0\u1edbng v\u1ec1 \u0111\u1ea7u d\u00f2<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; text-align: center;\"><span data-path-to-node=\"2,3,5,0\">33\u201364<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,4,0,0\">BA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,4,1,0\">Xuy\u00ean l\u1ed7 ch\u1ea9m<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; text-align: center;\"><span data-path-to-node=\"2,4,2,0\">7.0\u201312.0<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,4,3,0\">Ph\u00eda tr\u00ean<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,4,4,0\">Xa \u0111\u1ea7u d\u00f2<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; text-align: center;\"><span data-path-to-node=\"2,4,5,0\">30\u201357<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,5,0,0\">VA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,5,1,0\">Xuy\u00ean l\u1ed7 ch\u1ea9m<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; text-align: center;\"><span data-path-to-node=\"2,5,2,0\">4.5\u20137.5<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,5,3,0\">Ph\u00eda tr\u00ean v\u00e0 ch\u1ebfch<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,5,4,0\">Xa \u0111\u1ea7u d\u00f2<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; text-align: center;\"><span data-path-to-node=\"2,5,5,0\">27\u201355<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,6,0,0\">\u0110\u1ed9ng m\u1ea1ch m\u1eaft<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,6,1,0\">H\u1ed1c m\u1eaft<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; text-align: center;\"><span data-path-to-node=\"2,6,2,0\">4.0\u20135.0<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,6,3,0\">H\u01a1i l\u1ec7ch v\u00e0o trong<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,6,4,0\">H\u01b0\u1edbng v\u1ec1 \u0111\u1ea7u d\u00f2<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; text-align: center;\"><span data-path-to-node=\"2,6,5,0\">16\u201326<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify;\" data-path-to-node=\"2\"><em>* <strong data-path-to-node=\"2\" data-index-in-node=\"2\">ACA<\/strong> = \u0111\u1ed9ng m\u1ea1ch n\u00e3o tr\u01b0\u1edbc, <strong data-path-to-node=\"2\" data-index-in-node=\"29\">BA<\/strong> = \u0111\u1ed9ng m\u1ea1ch th\u00e2n n\u1ec1n, <strong data-path-to-node=\"2\" data-index-in-node=\"49\">PCA<\/strong> = \u0111\u1ed9ng m\u1ea1ch n\u00e3o sau, <strong data-path-to-node=\"2\" data-index-in-node=\"74\">VA<\/strong> = \u0111\u1ed9ng m\u1ea1ch \u0111\u1ed1t s\u1ed1ng.<\/em><\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"3\"><em>\u2020 H\u01b0\u1edbng d\u00f2ng ch\u1ea3y \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh t\u01b0\u01a1ng \u0111\u1ed1i so v\u1edbi \u0111\u1ea7u d\u00f2 (h\u01b0\u1edbng v\u1ec1 = d\u00f2ng ch\u1ea3y ti\u1ebfn l\u1ea1i g\u1ea7n [m\u00e3 h\u00f3a m\u00e0u \u0111\u1ecf tr\u00ean TCDi]; xa = d\u00f2ng ch\u1ea3y l\u00f9i ra xa [m\u00e3 h\u00f3a m\u00e0u xanh tr\u00ean TCDi]).<\/em><\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"4\"><em>\u2021 Khi s\u1eed d\u1ee5ng TCDi v\u00e0 c\u00f3 hi\u1ec7u ch\u1ec9nh g\u00f3c, v\u1eadn t\u1ed1c d\u00f2ng ch\u1ea3y c\u00f3 th\u1ec3 cao h\u01a1n so v\u1edbi c\u00e1c gi\u00e1 tr\u1ecb \u0111o \u0111\u01b0\u1ee3c b\u1eb1ng niTCD (6,25). \u0110i\u1ec1u n\u00e0y \u0111\u1eb7c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a \u0111\u1ed1i v\u1edbi \u0111\u1ed9ng m\u1ea1ch n\u00e3o gi\u1eefa v\u00e0 \u0111\u1ed9ng m\u1ea1ch n\u00e3o sau, n\u01a1i m\u00e0 \u0111\u1ed9 cong c\u1ee7a m\u1ea1ch m\u00e1u c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u00e1ng k\u1ec3 \u0111\u1ebfn c\u00e1c ph\u00e9p \u0111o. Do \u0111\u00f3, c\u00e1c v\u1eadn t\u1ed1c d\u00f2ng ch\u1ea3y ph\u1ea3i lu\u00f4n \u0111\u01b0\u1ee3c di\u1ec5n gi\u1ea3i d\u1ef1a tr\u00ean s\u1ef1 c\u00e2n nh\u1eafc c\u00e1c khuy\u1ebfn c\u00e1o c\u1ee5 th\u1ec3 cho t\u1eebng b\u1ec7nh l\u00fd. <strong data-path-to-node=\"4\" data-index-in-node=\"383\">MFV<\/strong> = v\u1eadn t\u1ed1c d\u00f2ng ch\u1ea3y trung b\u00ecnh.<\/em><\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"17\"><strong>\u0110\u00e1nh gi\u00e1 nhu m\u00f4:<\/strong> C\u00e1c c\u1ea5u tr\u00fac nhu m\u00f4 n\u00e3o sau \u0111\u00e2y \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 qua c\u1eeda s\u1ed5 th\u00e1i d\u01b0\u01a1ng ch\u1ec9 b\u1eb1ng k\u1ef9 thu\u1eadt TCDi thang x\u00e1m: h\u00ecnh th\u00e1i v\u00e0 \u0111\u1ed9 h\u1ed3i \u00e2m c\u1ee7a n\u00e3o gi\u1eefa (cu\u1ed1ng n\u00e3o), n\u00e3o th\u1ea5t ba, c\u00e1c ph\u1ea7n c\u1ee7a n\u00e3o th\u1ea5t b\u00ean, tuy\u1ebfn t\u00f9ng, v\u00e0 c\u00e1c ph\u1ea7n c\u1ee7a th\u00f9y th\u00e1i d\u01b0\u01a1ng, th\u00f9y \u0111\u1ec9nh (7).<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"3\">H\u00ecnh 2 t\u1eadp trung v\u00e0o gi\u1ea3i ph\u1eabu m\u1ea1ch m\u00e1u \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 qua c\u1eeda s\u1ed5 xuy\u00ean th\u00e1i d\u01b0\u01a1ng; c\u00e1c c\u1ea5u tr\u00fac nhu m\u00f4 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 b\u1eb1ng TCS s\u1ebd \u0111\u01b0\u1ee3c minh h\u1ecda \u1edf ph\u1ea7n sau (trong ph\u1ea7n &#8220;TCS thang x\u00e1m [B-mode]: C\u00e1c \u1ee9ng d\u1ee5ng nhu m\u00f4&#8221;). Trong H\u00ecnh 2, l\u01b0u \u00fd r\u1eb1ng m\u1ed9t h\u00ecnh elip m\u00e0u tr\u1eafng tr\u00ean v\u00f9ng th\u00e1i d\u01b0\u01a1ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 minh h\u1ecda c\u00e1c v\u1ecb tr\u00ed \u0111\u1eb7t \u0111\u1ea7u d\u00f2 c\u00f3 th\u1ec3 c\u00f3 trong c\u1eeda s\u1ed5 th\u00e1i d\u01b0\u01a1ng. M\u1eb7c d\u00f9 m\u1ed9t s\u1ed1 t\u00e1c gi\u1ea3 m\u00f4 t\u1ea3 c\u00e1c v\u1ecb tr\u00ed n\u00e0y l\u00e0 c\u1eeda s\u1ed5 th\u00e1i d\u01b0\u01a1ng tr\u01b0\u1edbc, gi\u1eefa v\u00e0 sau, nh\u01b0ng trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng, ch\u00fang ch\u1ec9 \u0111\u1ea1i di\u1ec7n cho nh\u1eefng thay \u0111\u1ed5i nh\u1ecf v\u1ec1 v\u1ecb tr\u00ed \u0111\u1eb7t \u0111\u1ea7u d\u00f2 trong v\u00f9ng ph\u00e1t s\u00f3ng si\u00eau \u00e2m (insonation area) (8). Vi\u1ec7c qu\u00e9t qua to\u00e0n b\u1ed9 v\u00f9ng n\u00e0y l\u00e0 m\u1ed9t ph\u1ea7n c\u1ee7a k\u1ef9 thu\u1eadt th\u0103m kh\u00e1m ti\u00eau chu\u1ea9n v\u00e0 gi\u00fap t\u0103ng kh\u1ea3 n\u0103ng t\u00ecm th\u1ea5y c\u1eeda s\u1ed5 \u00e2m t\u1ed1i \u01b0u \u1edf m\u1ed7i b\u1ec7nh nh\u00e2n.<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"4\">C\u00e1c nghi\u00ean c\u1ee9u qu\u1ea7n th\u1ec3 ch\u1ec9 ra r\u1eb1ng <strong data-path-to-node=\"4\" data-index-in-node=\"36\">8%\u201320%<\/strong> ng\u01b0\u1eddi l\u1edbn c\u00f3 c\u1eeda s\u1ed5 th\u00e1i d\u01b0\u01a1ng k\u00e9m, l\u00e0m h\u1ea1n ch\u1ebf s\u1ef1 th\u00e0nh c\u00f4ng c\u1ee7a vi\u1ec7c ph\u00e1t s\u00f3ng si\u00eau \u00e2m. C\u00e1c d\u1ea5u hi\u1ec7u h\u00ecnh \u1ea3nh nh\u01b0 \u0111\u1ed9 d\u00e0y x\u01b0\u01a1ng th\u00e1i d\u01b0\u01a1ng \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 tr\u00ean CT \u0111\u1ea7u c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 d\u1ef1 \u0111o\u00e1n h\u1ea1n ch\u1ebf n\u00e0y, v\u00ec nhi\u1ec1u b\u1ec7nh nh\u00e2n th\u1ef1c hi\u1ec7n si\u00eau \u00e2m xuy\u00ean s\u1ecd \u0111\u00e3 t\u1eebng ch\u1ee5p CT tr\u01b0\u1edbc \u0111\u00f3 (9). M\u1ed9t l\u01b0u \u00fd quan tr\u1ecdng l\u00e0 vi\u1ec7c s\u1eed d\u1ee5ng ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch h\u1ea7u nh\u01b0 c\u00f3 th\u1ec3 kh\u1eafc ph\u1ee5c ho\u00e0n to\u00e0n c\u00e1c h\u1ea1n ch\u1ebf li\u00ean quan \u0111\u1ebfn c\u1eeda s\u1ed5 \u00e2m th\u00e1i d\u01b0\u01a1ng k\u00e9m (\u0111\u01b0\u1ee3c th\u1ea3o lu\u1eadn trong ph\u1ea7n &#8220;CEUS xuy\u00ean s\u1ecd&#8221;), cho ph\u00e9p th\u1ef1c hi\u1ec7n th\u0103m kh\u00e1m ch\u1ea9n \u0111o\u00e1n trong g\u1ea7n <strong data-path-to-node=\"4\" data-index-in-node=\"578\">100%<\/strong> c\u00e1c tr\u01b0\u1eddng h\u1ee3p (10).<\/p>\n<h4 style=\"text-align: justify;\" data-path-to-node=\"5\">C\u1eeda s\u1ed5 l\u1ed7 ch\u1ea9m (D\u01b0\u1edbi ch\u1ea9m)<\/h4>\n<p style=\"text-align: justify;\" data-path-to-node=\"6\">Khi s\u1eed d\u1ee5ng c\u1eeda s\u1ed5 l\u1ed7 ch\u1ea9m (d\u01b0\u1edbi ch\u1ea9m), c\u1ed5 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c g\u1ea5p l\u1ea1i v\u00e0 \u0111\u1ea7u d\u00f2 \u0111\u01b0\u1ee3c \u0111\u1eb7t \u1edf \u0111\u01b0\u1eddng gi\u1eefa, ph\u00eda d\u01b0\u1edbi x\u01b0\u01a1ng ch\u1ea9m v\u00e0 h\u01b0\u1edbng v\u1ec1 ph\u00eda s\u1ecd (1). C\u00e1ch ti\u1ebfp c\u1eadn n\u00e0y cho ph\u00e9p ti\u1ebfp c\u1eadn h\u1ec7 tu\u1ea7n ho\u00e0n sau, ch\u1ee7 y\u1ebfu l\u00e0 \u0111\u1ed9ng m\u1ea1ch n\u1ec1n (BA) v\u00e0 c\u00e1c \u0111o\u1ea1n V4 c\u1ee7a \u0111\u1ed9ng m\u1ea1ch \u0111\u1ed1t s\u1ed1ng (VAs) (H\u00ecnh 3).<\/p>\n<p data-path-to-node=\"6\"><img decoding=\"async\" style=\"display: block; margin-left: auto; margin-right: auto;\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/14XRHxyFW_ICqtStRoit7PkbuHYfUUG5W=s0\" \/><\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\"><em><strong data-path-to-node=\"1\" data-index-in-node=\"0\">H\u00ecnh 3.<\/strong> TCDi c\u1ee7a h\u1ec7 tu\u1ea7n ho\u00e0n sau qua c\u1eeda s\u1ed5 l\u1ed7 ch\u1ea9m (d\u01b0\u1edbi ch\u1ea9m). H\u00ecnh v\u1ebd b\u00ean tr\u00e1i minh h\u1ecda m\u1eb7t ph\u1eb3ng ph\u00e1t s\u00f3ng si\u00eau \u00e2m qua l\u1ed7 l\u1edbn. H\u00ecnh v\u1ebd d\u1ecdc gi\u1eefa minh h\u1ecda v\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 v\u00e0 \u0111\u01b0\u1eddng \u0111i c\u1ee7a s\u00f3ng si\u00eau \u00e2m. H\u00ecnh qu\u00e9t TCDi m\u00e3 h\u00f3a m\u00e0u b\u00ean ph\u1ea3i cho th\u1ea5y d\u00f2ng ch\u1ea3y c\u1ee7a \u0111\u1ed9ng m\u1ea1ch \u0111\u1ed1t s\u1ed1ng (VA) v\u00e0 \u0111\u1ed9ng m\u1ea1ch n\u1ec1n (BA), b\u00ecnh th\u01b0\u1eddng h\u01b0\u1edbng ra xa \u0111\u1ea7u d\u00f2 (v\u00f9ng m\u00e0u xanh d\u01b0\u01a1ng). (\u0110\u01b0\u1ee3c t\u1ea1o b\u1eb1ng BioRender. Esmeraldo M [2025], <a class=\"ng-star-inserted\" href=\"https:\/\/BioRender.com\/x0bcrxy\" target=\"_blank\" rel=\"noopener\" data-hveid=\"0\" data-ved=\"0CAAQ_4QMahgKEwifncuLpZOUAxUAAAAAHQAAAAAQmgQ\">https:\/\/BioRender.com\/x0bcrxy<\/a>.)<\/em><\/p>\n<h4><span style=\"font-size: 12pt;\">C\u1eeda s\u1ed5 h\u1ed1c m\u1eaft (Transorbital Window)<\/span><\/h4>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\">Vi\u1ec7c s\u1eed d\u1ee5ng c\u1eeda s\u1ed5 h\u1ed1c m\u1eaft li\u00ean quan \u0111\u1ebfn vi\u1ec7c \u0111\u1eb7t nh\u1eb9 nh\u00e0ng \u0111\u1ea7u d\u00f2 l\u00ean m\u00ed m\u1eaft \u0111\u00e3 nh\u1eafm, \u0111\u1ed3ng th\u1eddi <span style=\"background-color: #fbeeb8;\">tu\u00e2n th\u1ee7 nghi\u00eam ng\u1eb7t c\u00e1c gi\u1edbi h\u1ea1n an to\u00e0n v\u1ec1 m\u1eaft <\/span>\u0111\u00e3 \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp \u0111\u1ed1i v\u1edbi h\u00ecnh \u1ea3nh Doppler. C\u1eeda s\u1ed5 \u00e2m n\u00e0y cho ph\u00e9p \u0111\u00e1nh gi\u00e1 Doppler \u0111\u1ed9ng m\u1ea1ch m\u1eaft v\u00e0 siphon \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh (H\u00ecnh 4).<\/p>\n<p data-path-to-node=\"1\"><img decoding=\"async\" style=\"display: block; margin-left: auto; margin-right: auto;\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/1dRk2q2lnifpNHuL7Dks7-7WS08tVT8ow=s0\" \/><\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\"><em><strong data-path-to-node=\"1\" data-index-in-node=\"0\">H\u00ecnh 4.<\/strong> C\u1eeda s\u1ed5 h\u1ed1c m\u1eaft trong si\u00eau \u00e2m xuy\u00ean s\u1ecd. H\u00ecnh v\u1ebd b\u00ean tr\u00e1i cho th\u1ea5y v\u1ecb tr\u00ed \u0111\u1eb7t \u0111\u1ea7u d\u00f2 tr\u00ean m\u00ed m\u1eaft nh\u1eafm, ch\u1ebfch nh\u1eb9 v\u00e0o trong. C\u00e1c h\u00ecnh v\u1ebd v\u00e0 h\u00ecnh si\u00eau \u00e2m \u1edf gi\u1eefa v\u00e0 b\u00ean ph\u1ea3i m\u00f4 t\u1ea3 \u0111\u1ed9ng m\u1ea1ch m\u1eaft v\u00e0 siphon \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh trong (ICA). L\u01b0u \u00fd: Vi\u1ec7c hi\u1ec7u ch\u1ec9nh g\u00f3c khi kh\u1ea3o s\u00e1t b\u1eb1ng s\u00f3ng si\u00eau \u00e2m \u0111\u1ed1i v\u1edbi ICA qua c\u1eeda s\u1ed5 n\u00e0y th\u01b0\u1eddng kh\u00f4ng kh\u1ea3 thi; c\u00e1c gi\u00e1 tr\u1ecb tham chi\u1ebfu d\u1ef1a tr\u00ean c\u00e1c g\u00f3c kh\u00f4ng \u0111\u01b0\u1ee3c hi\u1ec7u ch\u1ec9nh (g\u00f3c c\u1ed1 \u0111\u1ecbnh \u1edf 0\u00b0).<br \/>\n(\u0110\u01b0\u1ee3c t\u1ea1o b\u1eb1ng BioRender. Esmeraldo M [2025],\u00a0<a class=\"ng-star-inserted\" href=\"https:\/\/BioRender.com\/56cncvv\" target=\"_blank\" rel=\"noopener\" data-hveid=\"0\" data-ved=\"0CAAQ_4QMahgKEwifncuLpZOUAxUAAAAAHQAAAAAQ6x0\">https:\/\/BioRender.com\/56cncvv<\/a>.)<\/em><\/p>\n<h4 data-path-to-node=\"1\">C\u1eeda s\u1ed5 d\u01b0\u1edbi h\u00e0m<\/h4>\n<p data-path-to-node=\"1\">\u0110\u1ed1i v\u1edbi c\u00e1c \u0111\u00e1nh gi\u00e1 qua c\u1eeda s\u1ed5 d\u01b0\u1edbi h\u00e0m, \u0111\u1ea7u d\u00f2 \u0111\u01b0\u1ee3c \u0111\u1eb7t d\u01b0\u1edbi x\u01b0\u01a1ng h\u00e0m d\u01b0\u1edbi v\u00e0 ch\u1ebfch v\u1ec1 ph\u00eda \u0111\u1ea7u \u0111\u1ec3 kh\u1ea3o s\u00e1t b\u1eb1ng s\u00f3ng si\u00eau \u00e2m \u0111o\u1ea1n xa c\u1ee7a \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh trong \u0111o\u1ea1n c\u1ed5 (H\u00ecnh 5). C\u00e1ch ti\u1ebfp c\u1eadn n\u00e0y ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 t\u00ednh to\u00e1n c\u00e1c t\u1ef7 s\u1ed1 Lindegaard ho\u1eb7c Sloan trong \u0111\u00e1nh gi\u00e1 co th\u1eaft m\u1ea1ch v\u00e0 h\u1eb9p m\u1ea1ch b\u1eb1ng c\u00e1ch cung c\u1ea5p c\u00e1c v\u1eadn t\u1ed1c tham chi\u1ebfu ngo\u00e0i s\u1ecd, nh\u01b0 \u0111\u01b0\u1ee3c th\u1ea3o lu\u1eadn trong c\u00e1c ph\u1ea7n t\u01b0\u01a1ng \u1ee9ng c\u1ee7a b\u00e0i vi\u1ebft n\u00e0y.<\/p>\n<p data-path-to-node=\"1\"><img decoding=\"async\" style=\"display: block; margin-left: auto; margin-right: auto;\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/1ddG7n0w8ulLAuOg9OvPuFpqn8w_fIfpl=s0\" \/><\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\"><em><strong data-path-to-node=\"1\" data-index-in-node=\"0\">H\u00ecnh 5.<\/strong> B\u00ean tr\u00e1i: C\u00e1c h\u00ecnh v\u1ebd ph\u00eda tr\u00ean v\u00e0 ph\u00eda d\u01b0\u1edbi minh h\u1ecda v\u1ecb tr\u00ed \u0111\u1eb7t \u0111\u1ea7u d\u00f2 b\u00ean d\u01b0\u1edbi x\u01b0\u01a1ng h\u00e0m d\u01b0\u1edbi, v\u1edbi ch\u00f9m tia si\u00eau \u00e2m h\u01b0\u1edbng v\u1ec1 ph\u00eda \u0111\u1ea7u \u0111\u1ec3 kh\u1ea3o s\u00e1t b\u1eb1ng s\u00f3ng si\u00eau \u00e2m \u0111o\u1ea1n xa v\u00f9ng c\u1ed5 c\u1ee7a ICA (\u0111\u1ed9ng m\u1ea1ch c\u1ea3nh trong). B\u00ean ph\u1ea3i: H\u00ecnh v\u1ebd (ph\u00eda tr\u00ean) v\u00e0 h\u00ecnh \u1ea3nh Doppler n\u0103ng l\u01b0\u1ee3ng (power Doppler) t\u01b0\u01a1ng \u1ee9ng (ph\u00eda d\u01b0\u1edbi) m\u00f4 t\u1ea3 \u0111o\u1ea1n m\u1ea1ch m\u00e1u \u0111\u01b0\u1ee3c kh\u1ea3o s\u00e1t b\u1eb1ng s\u00f3ng si\u00eau \u00e2m.<br \/>\n(\u0110\u01b0\u1ee3c t\u1ea1o b\u1eb1ng BioRender. Esmeraldo M [2025], <a class=\"ng-star-inserted\" href=\"https:\/\/BioRender.com\/80ibgmi\" target=\"_blank\" rel=\"noopener\" data-hveid=\"0\" data-ved=\"0CAAQ_4QMahgKEwifncuLpZOUAxUAAAAAHQAAAAAQoR4\">https:\/\/BioRender.com\/80ibgmi<\/a>.)<\/em><\/p>\n<h4 data-path-to-node=\"1\">C\u00e1c c\u1eeda s\u1ed5 b\u1ed5 sung<\/h4>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\">C\u1eeda s\u1ed5 xuy\u00ean tr\u00e1n hi\u1ebfm khi \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u1edf ng\u01b0\u1eddi l\u1edbn, nh\u01b0ng n\u00f3 c\u00f3 th\u1ec3 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n ti\u1ebfp c\u1eadn t\u1ed1t h\u01a1n \u0111\u1ed1i v\u1edbi \u0111\u1ed9ng m\u1ea1ch n\u00e3o tr\u01b0\u1edbc (ACA) &#8211; \u0111\u1eb7c bi\u1ec7t l\u00e0 \u0111o\u1ea1n A2 &#8211; v\u1edbi s\u1ef1 hi\u1ec7u ch\u1ec9nh g\u00f3c t\u1ed1i thi\u1ec3u (7). C\u1eeda s\u1ed5 ch\u1ea9m cho ph\u00e9p \u0111\u00e1nh gi\u00e1 gi\u1ea3i ph\u1eabu t\u0129nh m\u1ea1ch \u0111\u01b0\u1eddng gi\u1eefa (c\u00e1c <span style=\"background-color: #fbeeb8;\">t\u0129nh m\u1ea1ch n\u00e3o trong, t\u0129nh m\u1ea1ch n\u00e3o l\u1edbn<\/span> v\u00e0 xoang th\u1eb3ng); tuy nhi\u00ean, c\u00e1c c\u1eeda s\u1ed5 b\u1ed5 sung n\u00e0y hi\u1ec7n nay ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho c\u00e1c \u1ee9ng d\u1ee5ng nghi\u00ean c\u1ee9u (5).<\/p>\n<blockquote data-path-to-node=\"2\">\n<p style=\"text-align: justify;\" data-path-to-node=\"2,0\"><strong data-path-to-node=\"2,0\" data-index-in-node=\"0\">Teaching Point:<\/strong> TCDi t\u00edch h\u1ee3p h\u00ecnh \u1ea3nh si\u00eau \u00e2m thang x\u00e1m, Doppler m\u00e0u v\u00e0 Doppler ph\u1ed5 \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 theo th\u1eddi gian th\u1ef1c, cung c\u1ea5p h\u00ecnh \u1ea3nh gi\u1ea3i ph\u1eabu v\u00e0 \u0111\u1ed9 ch\u00ednh x\u00e1c v\u1eadn t\u1ed1c \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n khi s\u1eed d\u1ee5ng hi\u1ec7u ch\u1ec9nh g\u00f3c, \u0111i\u1ec1u kh\u00f4ng th\u1ec3 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c khi s\u1eed d\u1ee5ng niTCD. Vi\u1ec7c s\u1eed d\u1ee5ng TCDi l\u00e0m t\u0103ng \u0111\u1ed9 tin c\u1eady ch\u1ea9n \u0111o\u00e1n v\u00e0 m\u1edf r\u1ed9ng c\u00e1c \u1ee9ng d\u1ee5ng l\u00e2m s\u00e0ng\u2014ngo\u1ea1i tr\u1eeb khi c\u1ea7n theo d\u00f5i k\u00e9o d\u00e0i v\u00e0 c\u1ed1 \u0111\u1ecbnh \u0111\u1ea7u d\u00f2, ch\u1eb3ng h\u1ea1n nh\u01b0 trong theo d\u00f5i vi huy\u1ebft kh\u1ed1i (microemboli), khi \u0111\u00f3 niTCD v\u1eabn \u0111\u01b0\u1ee3c \u01b0a chu\u1ed9ng h\u01a1n.<\/p>\n<\/blockquote>\n<h3 style=\"text-align: justify;\" data-path-to-node=\"3\">TCD: C\u00e1c \u1ee9ng d\u1ee5ng m\u1ea1ch m\u00e1u<\/h3>\n<h4 style=\"text-align: justify;\" data-path-to-node=\"4\">Co th\u1eaft m\u1ea1ch<\/h4>\n<p style=\"text-align: justify;\" data-path-to-node=\"4\">Co th\u1eaft m\u1ea1ch l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng ph\u1ed5 bi\u1ebfn c\u1ee7a xu\u1ea5t huy\u1ebft d\u01b0\u1edbi nh\u1ec7n do v\u1ee1 ph\u00ecnh m\u1ea1ch, x\u1ea3y ra \u1edf kho\u1ea3ng 30% s\u1ed1 ca b\u1ec7nh. \u0110\u00e2y l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u g\u00e2y thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 n\u00e3o <span style=\"background-color: #fbeeb8;\">tr\u00ec ho\u00e3n<\/span>, th\u01b0\u1eddng ti\u1ebfn tri\u1ec3n t\u1eeb ng\u00e0y th\u1ee9 4 \u0111\u1ebfn ng\u00e0y th\u1ee9 14 sau khi v\u1ee1 ph\u00ecnh m\u1ea1ch, v\u1edbi \u0111\u1ec9nh \u0111i\u1ec3m v\u00e0o kho\u1ea3ng ng\u00e0y th\u1ee9 7\u20138. TCD l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng \u0111\u00e3 \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp t\u1ed1t \u0111\u1ec3 ph\u00e1t hi\u1ec7n v\u00e0 theo d\u00f5i s\u1ef1 co th\u1eaft m\u1ea1ch trong b\u1ec7nh c\u1ea3nh n\u00e0y. T\u00ednh di \u0111\u1ed9ng v\u00e0 kh\u1ea3 n\u0103ng l\u1eb7p l\u1ea1i c\u1ee7a n\u00f3 cho ph\u00e9p th\u1ef1c hi\u1ec7n c\u00e1c \u0111\u00e1nh gi\u00e1 h\u00e0ng lo\u1ea1t, th\u01b0\u1eddng l\u00e0 m\u1ed9t ho\u1eb7c hai l\u1ea7n m\u1ed7i ng\u00e0y t\u1eeb ng\u00e0y th\u1ee9 3 \u0111\u1ebfn ng\u00e0y th\u1ee9 10, th\u1eddi \u0111i\u1ec3m c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng x\u1ea3y ra co th\u1eaft m\u1ea1ch nh\u1ea5t (11). TCD cho ph\u00e9p ph\u00e1t hi\u1ec7n s\u1edbm t\u00ecnh tr\u1ea1ng t\u0103ng v\u1eadn t\u1ed1c d\u00f2ng ch\u1ea3y trung b\u00ecnh (MFVs), bi\u1ec3u th\u1ecb s\u1ef1 h\u1eb9p m\u1ea1ch m\u00e1u (H\u00ecnh 6). C\u00e1c ng\u01b0\u1ee1ng v\u1eadn t\u1ed1c c\u1ee5 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00e2n \u0111\u1ed9 m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a co th\u1eaft m\u1ea1ch (B\u1ea3ng 2) (1,12).<\/p>\n<p data-path-to-node=\"4\"><img decoding=\"async\" style=\"display: block; margin-left: auto; margin-right: auto;\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/1eWYQhWCVnYr87hHDCMZbO5k0WzFIHbP5=s0\" \/><\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\"><em><strong data-path-to-node=\"1\" data-index-in-node=\"0\">H\u00ecnh 6.<\/strong> \u0110\u00e1nh gi\u00e1 co th\u1eaft m\u1ea1ch n\u00e3o \u1edf m\u1ed9t ng\u01b0\u1eddi ph\u1ee5 n\u1eef 46 tu\u1ed5i. B\u00ean tr\u00e1i: \u0110\u00e1nh gi\u00e1 TCD \u0111o\u1ea1n M1 c\u1ee7a \u0111\u1ed9ng m\u1ea1ch n\u00e3o gi\u1eefa (MCA) ph\u1ea3i cho th\u1ea5y v\u1eadn t\u1ed1c \u0111\u1ec9nh t\u00e2m thu (PS) t\u0103ng cao (205 cm\/s), g\u1ee3i \u00fd t\u00ecnh tr\u1ea1ng co th\u1eaft m\u1ea1ch m\u1ee9c \u0111\u1ed9 nh\u1eb9. \u1ede gi\u1eefa: Ph\u00e2n t\u00edch Doppler m\u00e0u v\u00e0 Doppler ph\u1ed5 si\u00eau \u00e2m \u0111o\u1ea1n xa c\u1ee7a \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh trong (ICA) \u0111o\u1ea1n c\u1ed5 t\u01b0\u01a1ng \u1ee9ng qua c\u1eeda s\u1ed5 d\u01b0\u1edbi h\u00e0m cho th\u1ea5y v\u1eadn t\u1ed1c \u0111\u1ec9nh t\u00e2m thu th\u1ea5p h\u01a1n (52 cm\/s), cho ph\u00e9p t\u00ednh to\u00e1n ch\u1ec9 s\u1ed1 Lindegaard &#8211; trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y l\u00e0 3,9 &#8211; c\u0169ng ph\u00f9 h\u1ee3p v\u1edbi t\u00ecnh tr\u1ea1ng co th\u1eaft m\u1ea1ch nh\u1eb9. B\u00ean ph\u1ea3i: H\u00ecnh \u1ea3nh ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh m\u1ea1ch m\u00e1u (CTA) cho th\u1ea5y t\u00ecnh tr\u1ea1ng h\u1eb9p nh\u1eb9 v\u00e0 c\u00e1c \u0111i\u1ec3m kh\u00f4ng \u0111\u1ec1u c\u1ee7a MCA ph\u1ea3i (m\u0169i t\u00ean tr\u1eafng n\u00e9t li\u1ec1n) v\u00e0 \u0111\u1ed9ng m\u1ea1ch n\u00e3o tr\u01b0\u1edbc (m\u0169i t\u00ean \u0111\u1ee9t n\u00e9t), c\u00e1c ph\u00e1t hi\u1ec7n n\u00e0y sau \u0111\u00f3 \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn b\u1eb1ng ch\u1ee5p m\u1ea1ch qua \u1ed1ng th\u00f4ng (kh\u00f4ng hi\u1ec3n th\u1ecb). M\u1ed9t t\u00fai ph\u00ecnh \u0111\u00e3 v\u1ee1 (m\u0169i t\u00ean v\u00e0ng) c\u0169ng \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y. ED = v\u1eadn t\u1ed1c cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng.<\/em><\/p>\n<table style=\"border-collapse: collapse; border-width: 1px;\" border=\"1\" data-path-to-node=\"2\">\n<thead>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><strong>\u0110\u1ed9ng m\u1ea1ch<\/strong><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><strong>PSV (cm\/s)<\/strong><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><strong>MFV (cm\/s)<\/strong><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><strong>Ratio <sup>(*)<\/sup><\/strong><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><strong>Di\u1ec5n gi\u1ea3i<\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,1,0,0\"><strong data-path-to-node=\"2,1,0,0\" data-index-in-node=\"0\">MCA<\/strong> (N\u00e3o gi\u1eefa)<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,1,1,0\">200\u2013250<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,1,2,0\">120\u2013150<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,1,3,0\">3.0\u20134.5<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,1,4,0\">Co th\u1eaft m\u1ea1ch nh\u1eb9<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,2,1,0\">&gt;250\u2013300<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,2,2,0\">&gt;150\u2013200<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,2,3,0\">&gt;4.5\u20136.0<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,2,4,0\">Co th\u1eaft m\u1ea1ch trung b\u00ecnh<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,3,1,0\">&gt;300<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,3,2,0\">&gt;200<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,3,3,0\">&gt;6.0<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,3,4,0\">Co th\u1eaft m\u1ea1ch n\u1eb7ng<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,4,0,0\"><strong data-path-to-node=\"2,4,0,0\" data-index-in-node=\"0\">BA<\/strong> (\u0110\u1ed9ng m\u1ea1ch n\u1ec1n)<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,4,1,0\">NA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,4,2,0\">&gt;70<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,4,3,0\">&gt;2.0<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,4,4,0\">Co th\u1eaft m\u1ea1ch<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,5,1,0\">NA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,5,2,0\">&gt;85<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,5,3,0\">&gt;2.5<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,5,4,0\">Co th\u1eaft m\u1ea1ch trung b\u00ecnh ho\u1eb7c n\u1eb7ng<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,6,1,0\">NA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,6,2,0\">&gt;85<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,6,3,0\">&gt;3.0<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,6,4,0\">Co th\u1eaft m\u1ea1ch n\u1eb7ng<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,7,0,0\"><strong data-path-to-node=\"2,7,0,0\" data-index-in-node=\"0\">ICA<\/strong> (C\u1ea3nh trong)<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,7,1,0\">NA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,7,2,0\">&gt;80<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,7,3,0\">NA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,7,4,0\">C\u00f3 kh\u1ea3 n\u0103ng co th\u1eaft m\u1ea1ch<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,8,1,0\">NA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,8,2,0\">&gt;110<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,8,3,0\">NA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,8,4,0\">Nhi\u1ec1u kh\u1ea3 n\u0103ng co th\u1eaft m\u1ea1ch<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,9,1,0\">NA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,9,2,0\">&gt;130<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,9,3,0\">NA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,9,4,0\">Ch\u1eafc ch\u1eafn co th\u1eaft m\u1ea1ch<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,10,0,0\"><strong data-path-to-node=\"2,10,0,0\" data-index-in-node=\"0\">ACA<\/strong> (N\u00e3o tr\u01b0\u1edbc)<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,10,1,0\">&gt;120<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,10,2,0\">&gt;90<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,10,3,0\">&gt;4.0<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,10,4,0\">C\u00f3 kh\u1ea3 n\u0103ng co th\u1eaft m\u1ea1ch<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,11,1,0\">NA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,11,2,0\">&gt;110<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,11,3,0\">NA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,11,4,0\">Nhi\u1ec1u kh\u1ea3 n\u0103ng co th\u1eaft m\u1ea1ch<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,12,1,0\">NA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,12,2,0\">&gt;120<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,12,3,0\">NA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,12,4,0\">Ch\u1eafc ch\u1eafn co th\u1eaft m\u1ea1ch<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,13,0,0\"><strong data-path-to-node=\"2,13,0,0\" data-index-in-node=\"0\">PCA<\/strong> (N\u00e3o sau)<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,13,1,0\">&gt;120<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,13,2,0\">&gt;60<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,13,3,0\">NA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,13,4,0\">C\u00f3 kh\u1ea3 n\u0103ng co th\u1eaft m\u1ea1ch<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,14,1,0\">NA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,14,2,0\">&gt;80<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,14,3,0\">NA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,14,4,0\">Nhi\u1ec1u kh\u1ea3 n\u0103ng co th\u1eaft m\u1ea1ch<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,15,1,0\">NA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,15,2,0\">&gt;90<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,15,3,0\">NA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,15,4,0\">Ch\u1eafc ch\u1eafn co th\u1eaft m\u1ea1ch<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,16,0,0\"><strong data-path-to-node=\"2,16,0,0\" data-index-in-node=\"0\">VA<\/strong> (\u0110\u1ed1t s\u1ed1ng)<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,16,1,0\">NA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,16,2,0\">&gt;60<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,16,3,0\">NA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,16,4,0\">C\u00f3 kh\u1ea3 n\u0103ng co th\u1eaft m\u1ea1ch<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,17,1,0\">NA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,17,2,0\">&gt;80<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,17,3,0\">NA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,17,4,0\">Nhi\u1ec1u kh\u1ea3 n\u0103ng co th\u1eaft m\u1ea1ch<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,18,1,0\">NA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,18,2,0\">&gt;90<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,18,3,0\">NA<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,18,4,0\">Ch\u1eafc ch\u1eafn co th\u1eaft m\u1ea1ch<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\"><em><strong data-path-to-node=\"1\" data-index-in-node=\"0\">Ghi ch\u00fa: <\/strong>B\u1ea3ng tr\u00ecnh b\u00e0y c\u00e1c v\u1eadn t\u1ed1c \u0111\u1ec9nh t\u00e2m thu (PSVs), v\u1eadn t\u1ed1c d\u00f2ng ch\u1ea3y trung b\u00ecnh (MFVs) v\u00e0 c\u00e1c ch\u1ec9 s\u1ed1 ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u1ef1 hi\u1ec7n di\u1ec7n v\u00e0 m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a co th\u1eaft m\u1ea1ch \u1edf c\u00e1c \u0111\u1ed9ng m\u1ea1ch n\u1ed9i s\u1ecd ch\u00ednh. C\u00e1c ng\u01b0\u1ee1ng gi\u00e1 tr\u1ecb \u0111\u01b0\u1ee3c chu\u1ea9n h\u00f3a ch\u1ee7 y\u1ebfu cho MCA v\u00e0 BA; gi\u00e1 tr\u1ecb c\u1ee7a c\u00e1c m\u1ea1ch m\u00e1u kh\u00e1c d\u1ef1a tr\u00ean d\u1eef li\u1ec7u h\u1ea1n ch\u1ebf v\u00e0 s\u1ef1 \u0111\u1ed3ng thu\u1eadn c\u1ee7a chuy\u00ean gia. <strong data-path-to-node=\"1\" data-index-in-node=\"370\">ACA<\/strong> = \u0111\u1ed9ng m\u1ea1ch n\u00e3o tr\u01b0\u1edbc, <strong data-path-to-node=\"1\" data-index-in-node=\"397\">PCA<\/strong> = \u0111\u1ed9ng m\u1ea1ch n\u00e3o sau.<\/em><\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"2\"><em>* Ratio \u0111\u01b0\u1ee3c t\u00ednh to\u00e1n d\u1ef1a tr\u00ean MFV &#8211; c\u1ee5 th\u1ec3 l\u00e0 ch\u1ec9 s\u1ed1 Lindegaard (MFV trung b\u00ecnh c\u1ee7a MCA\/MFV trung b\u00ecnh c\u1ee7a ICA), ch\u1ec9 s\u1ed1 Sviri (MFV trung b\u00ecnh c\u1ee7a BA\/MFV trung b\u00ecnh c\u1ee7a VA) v\u00e0 ch\u1ec9 s\u1ed1 Sloan (MFV trung b\u00ecnh c\u1ee7a ACA\/MFV trung b\u00ecnh c\u1ee7a ICA)\u2014\u0111\u1ec3 gi\u00fap ph\u00e2n bi\u1ec7t co th\u1eaft m\u1ea1ch v\u1edbi t\u0103ng l\u01b0u l\u01b0\u1ee3ng tu\u1ea7n ho\u00e0n (hyperemia).\u00a0<strong data-path-to-node=\"2\" data-index-in-node=\"314\">NA<\/strong> = kh\u00f4ng \u00e1p d\u1ee5ng ho\u1eb7c kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng th\u01b0\u1eddng quy do thi\u1ebfu b\u1eb1ng ch\u1ee9ng ch\u1ea5t l\u01b0\u1ee3ng cao (1,12).<\/em><\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\"><strong data-path-to-node=\"1\" data-index-in-node=\"0\">Hi\u1ec7u su\u1ea5t ch\u1ea9n \u0111o\u00e1n v\u00e0 Gi\u00e1 tr\u1ecb ng\u01b0\u1ee1ng.<\/strong> <span style=\"font-size: 12pt;\">Vi\u1ec7c s\u1eed d\u1ee5ng TCD \u0111\u01b0\u1ee3c Hi\u1ec7p h\u1ed9i Tim m\u1ea1ch Hoa K\u1ef3 v\u00e0 Ti\u00eau chu\u1ea9n Ph\u00f9 h\u1ee3p c\u1ee7a Tr\u01b0\u1eddng Cao \u0111\u1eb3ng \u0110i\u1ec7n quang Hoa K\u1ef3 \u1ee7ng h\u1ed9 trong vi\u1ec7c ph\u00e1t hi\u1ec7n co th\u1eaft m\u1ea1ch v\u00e0 d\u1ef1 b\u00e1o thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 n\u00e3o tr\u00ec ho\u00e3n, h\u1ed7 tr\u1ee3 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb (11,13). TCD c\u00f3 \u0111\u1ed9 nh\u1ea1y cao (90%) v\u00e0 gi\u00e1 tr\u1ecb d\u1ef1 b\u00e1o \u00e2m t\u00ednh cao (92%), c\u00f9ng v\u1edbi \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u trung b\u00ecnh (71%) v\u00e0 gi\u00e1 tr\u1ecb d\u1ef1 b\u00e1o d\u01b0\u01a1ng t\u00ednh trung b\u00ecnh (57%), gi\u00fap n\u00f3 \u0111\u1eb7c bi\u1ec7t h\u1eefu \u00edch nh\u01b0 m\u1ed9t c\u00f4ng c\u1ee5 t\u1ea7m so\u00e1t (11). Hi\u1ec7u su\u1ea5t c\u1ee7a TCDi t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi niTCD, nh\u01b0ng n\u00f3 l\u00e0m t\u0103ng \u0111\u1ed9 tin c\u1eady ch\u1ea9n \u0111o\u00e1n b\u1eb1ng c\u00e1ch cho ph\u00e9p quan s\u00e1t tr\u1ef1c ti\u1ebfp m\u1ea1ch m\u00e1u (14).<\/span><\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"2\">H\u1ea7u h\u1ebft c\u00e1c ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n t\u1eadp trung v\u00e0o MCA, trong \u0111\u00f3 co th\u1eaft m\u1ea1ch \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 MFV l\u1edbn h\u01a1n ho\u1eb7c b\u1eb1ng 120 cm\/s v\u00e0 ch\u1ec9 s\u1ed1 Lindegaard (MFV c\u1ee7a MCA chia cho MFV c\u1ee7a ICA ngo\u00e0i s\u1ecd c\u00f9ng b\u00ean) l\u1edbn h\u01a1n ho\u1eb7c b\u1eb1ng 3 (11). \u0110\u1ed1i v\u1edbi BA, ch\u1ec9 s\u1ed1 Sviri\u2014so s\u00e1nh MFV c\u1ee7a BA v\u1edbi MFV trung b\u00ecnh c\u1ee7a c\u1ea3 hai VA ngo\u00e0i s\u1ecd\u2014c\u00f3 vai tr\u00f2 t\u01b0\u01a1ng t\u1ef1. C\u00e1c ch\u1ec9 s\u1ed1 n\u00e0y gi\u00fap ph\u00e2n bi\u1ec7t co th\u1eaft m\u1ea1ch th\u1ef1c s\u1ef1 v\u1edbi t\u00ecnh tr\u1ea1ng t\u0103ng l\u01b0u l\u01b0\u1ee3ng tu\u1ea7n ho\u00e0n do c\u00e1c y\u1ebfu t\u1ed1 h\u1ec7 th\u1ed1ng nh\u01b0 thi\u1ebfu m\u00e1u, s\u1ed1t ho\u1eb7c t\u0103ng cung l\u01b0\u1ee3ng tim (12). M\u1eb7c d\u00f9 c\u00e1c gi\u00e1 tr\u1ecb tham chi\u1ebfu cho c\u00e1c \u0111\u1ed9ng m\u1ea1ch kh\u00e1c (nh\u01b0 \u0111\u1ed9ng m\u1ea1ch n\u00e3o tr\u01b0\u1edbc [ACA], \u0111\u1ed9ng m\u1ea1ch n\u00e3o sau v\u00e0 VA) d\u1ef1a tr\u00ean k\u1ebft qu\u1ea3 t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u nh\u1ecf h\u01a1n v\u00e0 \u00fd ki\u1ebfn chuy\u00ean gia, ch\u00fang v\u1eabn c\u00f3 gi\u00e1 tr\u1ecb l\u00e2m s\u00e0ng v\u00e0 \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft trong B\u1ea3ng 2 (1,12). Trong th\u1ef1c h\u00e0nh, c\u00e1c ph\u00e1t hi\u1ec7n TCD b\u1ea5t th\u01b0\u1eddng th\u01b0\u1eddng d\u1eabn \u0111\u1ebfn vi\u1ec7c th\u1ef1c hi\u1ec7n ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh x\u00e1c nh\u1eadn b\u1eb1ng ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh m\u1ea1ch m\u00e1u (CTA) ho\u1eb7c c\u1ed9ng h\u01b0\u1edfng t\u1eeb m\u1ea1ch m\u00e1u (MRA) \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng h\u1eb9p \u0111\u1ed9ng m\u1ea1ch. C\u00e1c h\u01b0\u1edbng d\u1eabn hi\u1ec7n h\u00e0nh khuy\u1ebfn c\u00e1o CTA v\u00e0 ch\u1ee5p m\u1ea1ch s\u1ed1 h\u00f3a x\u00f3a n\u1ec1n (DSA) l\u00e0 c\u00e1c ph\u01b0\u01a1ng ti\u1ec7n ch\u1ea9n \u0111o\u00e1n ch\u00ednh, v\u1edbi MRA l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn thay th\u1ebf v\u00e0 TCD \u0111\u00f3ng vai tr\u00f2 l\u00e0 c\u00f4ng c\u1ee5 h\u1ed7 tr\u1ee3 v\u00e0 theo d\u00f5i (13).<\/p>\n<h4 style=\"text-align: justify;\" data-path-to-node=\"3\">Ng\u1eebng tu\u1ea7n ho\u00e0n n\u00e3o trong Ch\u1ebft n\u00e3o<\/h4>\n<p style=\"text-align: justify;\" data-path-to-node=\"3\">Ch\u1ebft n\u00e3o \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi h\u00f4n m\u00ea v\u0129nh vi\u1ec5n, m\u1ea5t t\u1ea5t c\u1ea3 ch\u1ee9c n\u0103ng th\u00e2n n\u00e3o v\u00e0 m\u1ea5t kh\u1ea3 n\u0103ng t\u1ef1 th\u1edf d\u00f9 c\u00f3 k\u00edch th\u00edch \u0111\u1ea7y \u0111\u1ee7. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n d\u1ef1a ch\u1ee7 y\u1ebfu v\u00e0o k\u1ebft qu\u1ea3 \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng, c\u00e1c x\u00e9t nghi\u1ec7m b\u1ed5 tr\u1ee3 \u0111\u01b0\u1ee3c d\u00e0nh ri\u00eang cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng th\u1ec3 ho\u00e0n th\u00e0nh \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng. TCD l\u00e0 m\u1ed9t x\u00e9t nghi\u1ec7m b\u1ed5 tr\u1ee3 \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t v\u00e0 \u0111\u01b0a v\u00e0o h\u01b0\u1edbng d\u1eabn cho t\u00ecnh tr\u1ea1ng ch\u1ebft n\u00e3o \u1edf ng\u01b0\u1eddi l\u1edbn nh\u1eb1m ph\u00e1t hi\u1ec7n ng\u1eebng tu\u1ea7n ho\u00e0n n\u00e3o (15). Trong khi <span style=\"background-color: #fbeeb8;\">ch\u1ee5p m\u1ea1ch qua \u1ed1n<\/span>g th\u00f4ng b\u1ed1n m\u1ea1ch m\u00e1u v\u00e0 c\u00e1c nghi\u00ean c\u1ee9u y h\u1ecdc h\u1ea1t nh\u00e2n c\u1ee5 th\u1ec3\u2014nh\u01b0 ch\u1ee5p m\u1ea1ch ph\u00f3ng x\u1ea1 ph\u1eb3ng v\u00e0 x\u1ea1 h\u00ecnh t\u01b0\u1edbi m\u00e1u SPECT\u2014c\u0169ng l\u00e0 c\u00e1c x\u00e9t nghi\u1ec7m b\u1ed5 tr\u1ee3 \u0111\u01b0\u1ee3c ch\u1ea5p nh\u1eadn, c\u1ea7n l\u01b0u \u00fd r\u1eb1ng CTA, MRA v\u00e0 c\u00e1c x\u00e9t nghi\u1ec7m \u0111i\u1ec7n sinh l\u00fd kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o do \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u h\u1ea1n ch\u1ebf v\u00e0 thi\u1ebfu s\u1ef1 chu\u1ea9n h\u00f3a (15). Trong b\u1ed1i c\u1ea3nh ch\u1ebft n\u00e3o, TCDi d\u1ec5 th\u1ef1c hi\u1ec7n h\u01a1n \u0111\u1ed1i v\u1edbi nh\u1eefng ng\u01b0\u1eddi kh\u00f4ng ph\u1ea3i chuy\u00ean gia, th\u1ef1c t\u1ebf h\u01a1n trong m\u00f4i tr\u01b0\u1eddng ch\u0103m s\u00f3c t\u00edch c\u1ef1c v\u00e0 cho ph\u00e9p nh\u1eadn di\u1ec7n m\u1ea1ch m\u00e1u t\u1ed1t h\u01a1n v\u1edbi s\u1ef1 h\u01b0\u1edbng d\u1eabn b\u1eb1ng h\u00ecnh \u1ea3nh, m\u1eb7c d\u00f9 c\u1ea3 niTCD v\u00e0 TCDi \u0111\u1ec1u c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng (16).<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"4\">C\u00e1c d\u1ea1ng ph\u1ed5 d\u00f2ng ch\u1ea3y si\u00eau \u00e2m \u0111\u1eb7c tr\u01b0ng li\u00ean quan \u0111\u1ebfn ng\u1eebng tu\u1ea7n ho\u00e0n n\u00e3o \u0111\u01b0\u1ee3c minh h\u1ecda trong H\u00ecnh 7, v\u00e0 m\u1ed9t v\u00ed d\u1ee5 tr\u01b0\u1eddng h\u1ee3p \u0111i\u1ec3n h\u00ecnh \u0111\u01b0\u1ee3c cung c\u1ea5p trong H\u00ecnh 8. M\u1ed9t quy tr\u00ecnh thu nh\u1eadn chi ti\u1ebft h\u01a1n \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n ch\u1ebft n\u00e3o b\u1eb1ng si\u00eau \u00e2m \u0111\u00e3 \u0111\u01b0\u1ee3c Walter v\u00e0 c\u1ed9ng s\u1ef1 m\u00f4 t\u1ea3 (17).<\/p>\n<p data-path-to-node=\"4\"><img decoding=\"async\" style=\"display: block; margin-left: auto; margin-right: auto;\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/1kb_VlmJPMgZpzUpRIxbPgmvCfcxbjbRx=s0\" \/><\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\"><em><strong data-path-to-node=\"1\" data-index-in-node=\"0\">H\u00ecnh 7.<\/strong> S\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a ng\u1eebng tu\u1ea7n ho\u00e0n n\u00e3o \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 qua c\u00e1c d\u1ea1ng ph\u1ed5 TCD. C\u00e1c d\u1ea1ng ph\u1ed5 d\u00f2ng ch\u1ea3y b\u00ecnh th\u01b0\u1eddng (b\u00ean tr\u00e1i) chuy\u1ec3n d\u1ea7n sang c\u00e1c d\u1ea1ng ph\u1ed5 kh\u00e1ng l\u1ef1c cao v\u1edbi d\u00f2ng ch\u1ea3y dao \u0111\u1ed9ng ho\u1eb7c c\u00e1c \u0111\u1ec9nh t\u00e2m thu \u0111\u01a1n \u0111\u1ed9c, cu\u1ed1i c\u00f9ng d\u1eabn \u0111\u1ebfn m\u1ea5t t\u00edn hi\u1ec7u ho\u00e0n to\u00e0n (b\u00ean ph\u1ea3i) li\u00ean quan \u0111\u1ebfn s\u1ef1 gia t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd (ICP) v\u00e0 ng\u1eebng t\u01b0\u1edbi m\u00e1u n\u00e3o. (\u0110\u01b0\u1ee3c t\u1ea1o b\u1eb1ng BioRender. Esmeraldo M [2025], <a class=\"ng-star-inserted\" href=\"https:\/\/BioRender.com\/xnfjl22\" target=\"_blank\" rel=\"noopener\" data-hveid=\"0\" data-ved=\"0CAAQ_4QMahgKEwj_08qI0ZOUAxUAAAAAHQAAAAAQxwE\">https:\/\/BioRender.com\/xnfjl22<\/a>.)<\/em><\/p>\n<p data-path-to-node=\"1\"><em><img decoding=\"async\" style=\"display: block; margin-left: auto; margin-right: auto;\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/1OhNmEYjLZ-YtNEjsMP1qCXHymhlC-Gal=s0\" \/><\/em><\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\"><em><strong data-path-to-node=\"1\" data-index-in-node=\"0\">H\u00ecnh 8.<\/strong> C\u00e1c v\u00ed d\u1ee5 TCDi \u0111i\u1ec3n h\u00ecnh t\u1eeb nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 d\u1ea1ng ph\u1ed5 d\u00f2ng ch\u1ea3y ph\u00f9 h\u1ee3p v\u1edbi ng\u1eebng tu\u1ea7n ho\u00e0n n\u00e3o. T\u1eeb tr\u00e1i sang ph\u1ea3i: d\u00f2ng ch\u1ea3y dao \u0111\u1ed9ng (hai v\u00ed d\u1ee5 v\u1edbi c\u00e1c v\u1eadn t\u1ed1c d\u00f2ng ch\u1ea3y kh\u00e1c nhau), c\u00e1c \u0111\u1ec9nh t\u00e2m thu \u0111\u01a1n \u0111\u1ed9c v\u00e0 s\u1ef1 m\u1ea5t d\u00f2ng ch\u1ea3y c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c.<\/em><\/p>\n<h4 style=\"text-align: justify;\" data-path-to-node=\"1\">Ph\u00e1t hi\u1ec7n vi huy\u1ebft kh\u1ed1i<\/h4>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\">TCD c\u00f3 th\u1ec3 cho ph\u00e9p ph\u00e1t hi\u1ec7n c\u00e1c t\u00edn hi\u1ec7u vi huy\u1ebft kh\u1ed1i (MES) trong nhi\u1ec1u b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng kh\u00e1c nhau, v\u1ed1n c\u00f3 th\u1ec3 \u0111\u1ea1i di\u1ec7n cho c\u00e1c huy\u1ebft kh\u1ed1i d\u1ea1ng r\u1eafn ho\u1eb7c d\u1ea1ng kh\u00ed. \u0110\u1ed1i v\u1edbi m\u1ee5c \u0111\u00edch n\u00e0y, niTCD th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng thay v\u00ec TCDi nh\u1edd v\u00e0o t\u00ednh \u1ed5n \u0111\u1ecbnh v\u00e0 s\u1ef1 ph\u00f9 h\u1ee3p \u0111\u1ec3 theo d\u00f5i trong th\u1eddi gian d\u00e0i nh\u1eb1m ph\u00e1t hi\u1ec7n huy\u1ebft kh\u1ed1i. TCDi c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng khi c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u1ecbnh v\u1ecb m\u1ea1ch m\u00e1u v\u00e0 x\u00e1c \u0111\u1ecbnh c\u1eeda s\u1ed5 x\u01b0\u01a1ng t\u1ed1i \u01b0u (2).<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"2\">C\u00e1c MES \u0111\u01b0\u1ee3c quan s\u00e1t d\u01b0\u1edbi d\u1ea1ng c\u00e1c t\u00edn hi\u1ec7u tho\u00e1ng qua c\u01b0\u1eddng \u0111\u1ed9 cao v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e2n bi\u1ec7t m\u1ed9t c\u00e1ch \u0111\u00e1ng tin c\u1eady l\u00e0 nhi\u1ec5u \u1ea3nh (artifacts) hay huy\u1ebft kh\u1ed1i b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng qu\u00e9t \u0111a c\u1ed5ng (multigate scanning) v\u00e0 thu\u1eadt to\u00e1n ph\u00e2n lo\u1ea1i t\u1ef1 \u0111\u1ed9ng. Vi\u1ec7c ph\u00e2n bi\u1ec7t gi\u1eefa huy\u1ebft kh\u1ed1i d\u1ea1ng kh\u00ed v\u00e0 d\u1ea1ng r\u1eafn c\u0169ng c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c, m\u1eb7c d\u00f9 \u0111\u1ed9 ch\u00ednh x\u00e1c th\u1ea5p h\u01a1n m\u1ed9t ch\u00fat (\u0111\u1ed9 nh\u1ea1y 89%, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 86%) (18).<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"3\">C\u00e1c MES \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n b\u1eb1ng niTCD th\u01b0\u1eddng li\u00ean quan nh\u1ea5t \u0111\u1ebfn b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch l\u1edbn v\u00e0 \u0111\u00f3ng vai tr\u00f2 l\u00e0 c\u00e1c d\u1ea5u \u1ea5n nguy c\u01a1 gi\u00e1 tr\u1ecb trong nhi\u1ec1u b\u1ec7nh c\u1ea3nh m\u1ea1ch m\u00e1u n\u00e3o kh\u00e1c nhau. MES gi\u00fap d\u1ef1 b\u00e1o \u0111\u1ed9t qu\u1ef5 trong t\u01b0\u01a1ng lai v\u1edbi t\u1ef7 s\u1ed1 ch\u00eanh (odds ratios) l\u00e0 2,4 trong b\u1ec7nh c\u1ea3nh \u0111\u1ed9t qu\u1ef5 c\u1ea5p, 9,6 trong h\u1eb9p \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh c\u00f3 tri\u1ec7u ch\u1ee9ng, 7,5 trong h\u1eb9p \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh kh\u00f4ng tri\u1ec7u ch\u1ee9ng v\u00e0 24,5 sau ph\u1eabu thu\u1eadt b\u00f3c t\u00e1ch n\u1ed9i m\u1ea1c \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh (19). Trong h\u1eb9p \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh n\u1eb7ng kh\u00f4ng tri\u1ec7u ch\u1ee9ng, s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a MES gi\u00fap ph\u00e2n bi\u1ec7t m\u1ed9t nh\u00f3m nh\u1ecf c\u00f3 nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 c\u00f9ng b\u00ean t\u0103ng \u0111\u00e1ng k\u1ec3, v\u1edbi t\u1ef7 s\u1ed1 nguy c\u01a1 (hazard ratio) l\u00e0 5,6 v\u00e0 nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 h\u00e0ng n\u0103m l\u00e0 3,62%, so v\u1edbi 0,70% \u1edf nh\u1eefng ng\u01b0\u1eddi kh\u00f4ng c\u00f3 MES. MES \u00edt g\u1eb7p h\u01a1n v\u00e0 \u00edt c\u00f3 gi\u00e1 tr\u1ecb d\u1ef1 b\u00e1o h\u01a1n \u0111\u1ed1i v\u1edbi c\u00e1c ngu\u1ed3n g\u00e2y thuy\u00ean t\u1eafc t\u1eeb tim, \u0111i\u1ec1u n\u00e0y l\u00e0m n\u1ed5i b\u1eadt m\u1ed1i li\u00ean quan ch\u1eb7t ch\u1ebd h\u01a1n c\u1ee7a ch\u00fang v\u1edbi b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch l\u1edbn (2).<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"4\">Giao th\u1ee9c niTCD ti\u00eau chu\u1ea9n \u0111\u1ec3 ph\u00e1t hi\u1ec7n MES th\u01b0\u1eddng bao g\u1ed3m 60 ph\u00fat theo d\u00f5i li\u00ean t\u1ee5c (20). Theo d\u00f5i trong ph\u1eabu thu\u1eadt\u2014\u0111\u1eb7c bi\u1ec7t l\u00e0 trong ph\u1eabu thu\u1eadt tim, b\u00f3c t\u00e1ch n\u1ed9i m\u1ea1c \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh ho\u1eb7c c\u00e1c th\u1ee7 thu\u1eadt can thi\u1ec7p n\u1ed9i m\u1ea1ch\u2014th\u01b0\u1eddng \u0111\u00f2i h\u1ecfi ghi h\u00ecnh k\u00e9o d\u00e0i \u0111\u1ec3 h\u01b0\u1edbng d\u1eabn c\u00e1c quy\u1ebft \u0111\u1ecbnh l\u00e2m s\u00e0ng theo th\u1eddi gian th\u1ef1c nh\u1eb1m gi\u1ea3m g\u00e1nh n\u1eb7ng thuy\u00ean t\u1eafc (2). C\u00e1c h\u1ec7 th\u1ed1ng TCD l\u01b0u \u0111\u1ed9ng l\u00e0 nh\u1eefng c\u00f4ng c\u1ee5 m\u1edbi n\u1ed5i \u0111\u1ec3 ph\u00e1t hi\u1ec7n thuy\u00ean t\u1eafc d\u01b0\u1edbi l\u00e2m s\u00e0ng, ch\u1eb3ng h\u1ea1n nh\u01b0 trong rung nh\u0129 k\u1ecbch ph\u00e1t ho\u1eb7c c\u00e1c bi\u1ebfn c\u1ed1 thuy\u00ean t\u1eafc tho\u00e1ng qua kh\u00e1c (20). M\u1ed9t c\u00e1i nh\u00ecn t\u1ed5ng quan \u0111\u01b0\u1ee3c cung c\u1ea5p trong H\u00ecnh 9.<\/p>\n<p data-path-to-node=\"4\"><img decoding=\"async\" style=\"display: block; margin-left: auto; margin-right: auto;\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/1o5vykegjxQammLQJD6hShbQhGwwDHKLo=s0\" \/><\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\"><em><strong data-path-to-node=\"1\" data-index-in-node=\"0\">H\u00ecnh 9.<\/strong> S\u01a1 \u0111\u1ed3 ph\u00e1c th\u1ea3o vi\u1ec7c s\u1eed d\u1ee5ng niTCD \u0111\u1ec3 theo d\u00f5i, ph\u00e2n lo\u1ea1i v\u00e0 \u0111\u1ebfm c\u00e1c t\u00edn hi\u1ec7u vi huy\u1ebft kh\u1ed1i (MES). (\u0110\u01b0\u1ee3c t\u1ea1o b\u1eb1ng BioRender. Esmeraldo M [2025], <a class=\"ng-star-inserted\" href=\"https:\/\/BioRender.com\/s6yf5l0\" target=\"_blank\" rel=\"noopener\" data-hveid=\"0\" data-ved=\"0CAAQ_4QMahgKEwj_08qI0ZOUAxUAAAAAHQAAAAAQgAI\">https:\/\/BioRender.com\/s6yf5l0<\/a>.)<\/em><\/p>\n<h4 style=\"text-align: justify;\" data-path-to-node=\"1\">Shunt Ph\u1ea3i &#8211; Tr\u00e1i<\/h4>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\">TCD c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c <span style=\"background-color: #fbeeb8;\">vi thuy\u00ean t\u1eafc<\/span> n\u00e3o, ch\u1eb3ng h\u1ea1n nh\u01b0 c\u00e1c b\u1ecdt kh\u00ed, \u0111i t\u1eeb h\u1ec7 tu\u1ea7n ho\u00e0n b\u00ean ph\u1ea3i sang b\u00ean tr\u00e1i th\u00f4ng qua l\u1ed7 b\u1ea7u d\u1ee5c th\u00f4ng li\u00ean nh\u0129 (PFO) ho\u1eb7c c\u00e1c lu\u1ed3ng th\u00f4ng kh\u00e1c trong tim ho\u1eb7c trong ph\u1ed5i. \u0110\u1ed9 nh\u1ea1y c\u1ee7a TCD trong vi\u1ec7c ph\u00e1t hi\u1ec7n lu\u1ed3ng th\u00f4ng ph\u1ea3i &#8211; tr\u00e1i t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n, v\u1edbi c\u00e1c \u01b0u \u0111i\u1ec3m b\u1ed5 sung l\u00e0 kh\u00f4ng x\u00e2m l\u1ea5n, d\u1ec5 d\u00e0ng l\u1eb7p l\u1ea1i, c\u00f3 kh\u1ea3 n\u0103ng ph\u00e2n \u0111\u1ed9 lu\u1ed3ng th\u00f4ng v\u00e0 \u0111i k\u00e8m v\u1edbi nguy c\u01a1 bi\u1ebfn ch\u1ee9ng t\u1ed1i thi\u1ec3u (21). \u0110\u1ed1i v\u1edbi ch\u1ec9 \u0111\u1ecbnh n\u00e0y, TCD \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1eb1ng c\u00e1ch ti\u00eam dung d\u1ecbch n\u01b0\u1edbc mu\u1ed1i sinh l\u00fd t\u1ea1o b\u1ecdt v\u00e0o t\u0129nh m\u1ea1ch ngo\u1ea1i vi v\u00e0 theo d\u00f5i c\u00e1c t\u00edn hi\u1ec7u vi b\u1ecdt t\u1ea1i MCA (H\u00ecnh 10). M\u1ed9t quy tr\u00ecnh t\u1eebng b\u01b0\u1edbc \u0111\u1ec3 \u00e1p d\u1ee5ng TCD trong ph\u00e1t hi\u1ec7n lu\u1ed3ng th\u00f4ng ph\u1ea3i &#8211; tr\u00e1i \u0111\u01b0\u1ee3c ph\u00e1c th\u1ea3o trong B\u1ea3ng 3 (21).<\/p>\n<p data-path-to-node=\"1\"><img decoding=\"async\" style=\"display: block; margin-left: auto; margin-right: auto;\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/1SO-XkPyfH_93waiIjcrVIniIsqHnY_XC=s0\" \/><\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\"><em><strong data-path-to-node=\"1\" data-index-in-node=\"0\">H\u00ecnh 10.<\/strong> C\u00e1c h\u00ecnh v\u1ebd minh h\u1ecda quy tr\u00ecnh ph\u00e1t hi\u1ec7n c\u00e1c <strong data-path-to-node=\"1\" data-index-in-node=\"54\">shunt<\/strong> ph\u1ea3i &#8211; tr\u00e1i b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng TCD. <strong data-path-to-node=\"1\" data-index-in-node=\"93\">(A)<\/strong> Dung d\u1ecbch n\u01b0\u1edbc mu\u1ed1i sinh l\u00fd t\u1ea1o b\u1ecdt tr\u1ed9n v\u1edbi kh\u00ed \u0111\u01b0\u1ee3c chu\u1ea9n b\u1ecb v\u00e0 ti\u00eam v\u00e0o t\u0129nh m\u1ea1ch ngo\u1ea1i vi. <strong data-path-to-node=\"1\" data-index-in-node=\"192\">(B)<\/strong> C\u00e1c vi b\u1ecdt di chuy\u1ec3n \u0111\u1ebfn tim v\u00e0 c\u00f3 th\u1ec3 \u0111i qua m\u1ed9t <strong data-path-to-node=\"1\" data-index-in-node=\"246\">shunt<\/strong> ph\u1ea3i-tr\u00e1i ch\u1eb3ng h\u1ea1n nh\u01b0 l\u1ed7 b\u1ea7u d\u1ee5c th\u00f4ng li\u00ean nh\u0129, m\u1ed9t khi\u1ebfm khuy\u1ebft kh\u00e1c trong tim, ho\u1eb7c r\u00f2 \u0111\u1ed9ng t\u0129nh m\u1ea1ch ph\u1ed5i. <strong data-path-to-node=\"1\" data-index-in-node=\"365\">(C)<\/strong> N\u1ebfu c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a m\u1ed9t <strong data-path-to-node=\"1\" data-index-in-node=\"397\">shunt<\/strong>, c\u00e1c vi b\u1ecdt s\u1ebd \u0111i t\u1eaft qua tu\u1ea7n ho\u00e0n ph\u1ed5i v\u00e0 \u0111i v\u00e0o h\u1ec7 th\u1ed1ng \u0111\u1ed9ng m\u1ea1ch to\u00e0n th\u00e2n, cu\u1ed1i c\u00f9ng \u0111\u1ebfn n\u00e3o th\u00f4ng qua \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh trong (ICA). <strong data-path-to-node=\"1\" data-index-in-node=\"540\">(D)<\/strong> Vi\u1ec7c theo d\u00f5i TCD \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n qua c\u1eeda s\u1ed5 xuy\u00ean th\u00e1i d\u01b0\u01a1ng \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c vi b\u1ecdt n\u00e0y trong tu\u1ea7n ho\u00e0n n\u00e3o, v\u1ed1n \u0111\u01b0\u1ee3c quan s\u00e1t d\u01b0\u1edbi d\u1ea1ng c\u00e1c t\u00edn hi\u1ec7u c\u01b0\u1eddng \u0111\u1ed9 cao\u00a0tho\u00e1ng qua. <strong data-path-to-node=\"1\" data-index-in-node=\"720\">(E)<\/strong> S\u1ed1 l\u01b0\u1ee3ng vi b\u1ecdt \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n cho ph\u00e9p ph\u00e2n \u0111\u1ed9 m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a <strong data-path-to-node=\"1\" data-index-in-node=\"796\">shunt<\/strong>, gi\u00fap h\u01b0\u1edbng d\u1eabn c\u00e1c quy\u1ebft \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb ti\u1ebfp theo. <strong data-path-to-node=\"1\" data-index-in-node=\"866\">HITS<\/strong> = t\u00edn hi\u1ec7u tho\u00e1ng qua c\u01b0\u1eddng \u0111\u1ed9 cao. (\u0110\u01b0\u1ee3c t\u1ea1o b\u1eb1ng BioRender. Esmeraldo M [2025], <a class=\"ng-star-inserted\" href=\"https:\/\/BioRender.com\/4fvrk7s\" target=\"_blank\" rel=\"noopener\" data-hveid=\"0\" data-ved=\"0CAAQ_4QMahgKEwj_08qI0ZOUAxUAAAAAHQAAAAAQ3wI\">https:\/\/BioRender.com\/4fvrk7s<\/a>.)<\/em><\/p>\n<p data-path-to-node=\"1\"><strong><span style=\"font-size: 12pt;\">B\u1ea3ng 3: Quy tr\u00ecnh t\u1eebng b\u01b0\u1edbc chu\u1ea9n h\u00f3a \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c shunt ph\u1ea3i- tr\u00e1i b\u1eb1ng TCD<\/span><\/strong><\/p>\n<table style=\"width: 100%; border-collapse: collapse; border-width: 1px; height: 847.2px;\" border=\"1\" data-path-to-node=\"2\">\n<thead>\n<tr style=\"height: 34.8px;\">\n<td style=\"width: 8.8634%; border-width: 1px; padding: 5px;\"><strong>B\u01b0\u1edbc<\/strong><\/td>\n<td style=\"width: 27.8893%; border-width: 1px; padding: 5px;\"><strong>Th\u00e0nh ph\u1ea7n quy tr\u00ecnh<\/strong><\/td>\n<td style=\"width: 63.2212%; border-width: 1px; padding: 5px;\"><strong>Chi ti\u1ebft ch\u00ednh<\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"height: 58.8px;\">\n<td style=\"width: 8.8634%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,1,0,0\">1<\/span><\/td>\n<td style=\"width: 27.8893%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,1,1,0\">Chu\u1ea9n b\u1ecb b\u1ec7nh nh\u00e2n<\/span><\/td>\n<td style=\"width: 63.2212%; border-width: 1px; padding: 5px; text-align: justify;\"><span data-path-to-node=\"2,1,2,0\">N\u1eb1m ng\u1eeda ho\u1eb7c ng\u1ed3i th\u1eb3ng (ng\u1ed3i th\u1eb3ng \u0111\u01b0\u1ee3c \u01b0u ti\u00ean h\u01a1n); \u0111\u1eb7t kim 18-gauge v\u00e0o t\u0129nh m\u1ea1ch khu\u1ef7u tay ph\u1ea3i<\/span><\/td>\n<\/tr>\n<tr style=\"height: 58.8px;\">\n<td style=\"width: 8.8634%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,2,0,0\">2<\/span><\/td>\n<td style=\"width: 27.8893%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,2,1,0\">Chu\u1ea9n b\u1ecb ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n<\/span><\/td>\n<td style=\"width: 63.2212%; border-width: 1px; padding: 5px; text-align: justify;\"><span data-path-to-node=\"2,2,2,0\">9 mL n\u01b0\u1edbc mu\u1ed1i sinh l\u00fd + 1 mL kh\u00ed, t\u1ea1o b\u1ecdt b\u1eb1ng ch\u1ea1c ba v\u00e0 ti\u00eam nhanh (bolus); c\u00f3 th\u1ec3 th\u00eam 0,5 mL m\u00e1u \u0111\u1ec3 t\u0103ng \u0111\u1ed9 nh\u1ea1y<\/span><\/td>\n<\/tr>\n<tr style=\"height: 82.8px;\">\n<td style=\"width: 8.8634%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,3,0,0\">3<\/span><\/td>\n<td style=\"width: 27.8893%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,3,1,0\">Theo d\u00f5i \u0111\u1ed9ng m\u1ea1ch<\/span><\/td>\n<td style=\"width: 63.2212%; border-width: 1px; padding: 5px; text-align: justify;\"><span data-path-to-node=\"2,3,2,0\">Kh\u1ea3o s\u00e1t MCA \u1edf \u0111\u1ed9 s\u00e2u 50\u201360 mm b\u1eb1ng niTCD hai b\u00ean ho\u1eb7c TCDi m\u1ed9t b\u00ean; c\u00f3 th\u1ec3 kh\u1ea3o s\u00e1t h\u1ec7 \u0111\u1ed1t s\u1ed1ng-n\u1ec1n ho\u1eb7c xuy\u00ean h\u1ed1c m\u1eaft n\u1ebfu c\u1eeda s\u1ed5 th\u00e1i d\u01b0\u01a1ng k\u00e9m, v\u1edbi hi\u1ec7u su\u1ea5t t\u01b0\u01a1ng \u0111\u01b0\u01a1ng<\/span><\/td>\n<\/tr>\n<tr style=\"height: 58.8px;\">\n<td style=\"width: 8.8634%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,4,0,0\">4<\/span><\/td>\n<td style=\"width: 27.8893%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,4,1,0\">Ph\u00e1t hi\u1ec7n MES<\/span><\/td>\n<td style=\"width: 63.2212%; border-width: 1px; padding: 5px; text-align: justify;\"><span data-path-to-node=\"2,4,2,0\">MES l\u00e0 c\u00e1c t\u00edn hi\u1ec7u c\u01b0\u1eddng \u0111\u1ed9 cao tho\u00e1ng qua ng\u1eafn h\u01a1n 300 ms, cao h\u01a1n 3 dB so v\u1edbi n\u1ec1n, v\u1edbi \u00e2m thanh s\u1eafc n\u00e9t<\/span><\/td>\n<\/tr>\n<tr style=\"height: 58.8px;\">\n<td style=\"width: 8.8634%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,5,0,0\">5<\/span><\/td>\n<td style=\"width: 27.8893%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,5,1,0\">K\u1ef9 thu\u1eadt c\u1ed5ng \u0111\u00f4i (n\u1ebfu c\u00f3)<\/span><\/td>\n<td style=\"width: 63.2212%; border-width: 1px; padding: 5px; text-align: justify;\"><span data-path-to-node=\"2,5,2,0\">S\u1eed d\u1ee5ng hai th\u1ec3 t\u00edch l\u1ea5y m\u1eabu, c\u00e1ch nhau 1 cm trong MCA \u0111\u1ec3 ph\u00e2n bi\u1ec7t MES v\u1edbi nhi\u1ec5u \u1ea3nh; k\u1ef9 thu\u1eadt n\u00e0y c\u00f3 th\u1ec3 c\u00f3 tr\u00ean niTCD<\/span><\/td>\n<\/tr>\n<tr style=\"height: 58.8px;\">\n<td style=\"width: 8.8634%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,6,0,0\">6<\/span><\/td>\n<td style=\"width: 27.8893%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,6,1,0\">TCD M-mode n\u0103ng l\u01b0\u1ee3ng<\/span><\/td>\n<td style=\"width: 63.2212%; border-width: 1px; padding: 5px; text-align: justify;\"><span data-path-to-node=\"2,6,2,0\">T\u0103ng c\u01b0\u1eddng kh\u1ea3 n\u0103ng ph\u00e1t hi\u1ec7n MES; k\u1ef9 thu\u1eadt n\u00e0y c\u00f3 th\u1ec3 c\u00f3 tr\u00ean niTCD<\/span><\/td>\n<\/tr>\n<tr style=\"height: 58.8px;\">\n<td style=\"width: 8.8634%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,7,0,0\">7<\/span><\/td>\n<td style=\"width: 27.8893%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,7,1,0\">C\u1eeda s\u1ed5 \u0111\u1ebfm MES<\/span><\/td>\n<td style=\"width: 63.2212%; border-width: 1px; padding: 5px; text-align: justify;\"><span data-path-to-node=\"2,7,2,0\">\u0110\u1ebfm trong 40 gi\u00e2y sau khi ti\u00eam; c\u00f3 th\u1ec3 gi\u1ea3m xu\u1ed1ng 30 gi\u00e2y \u0111\u1ec3 t\u0103ng \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u<\/span><\/td>\n<\/tr>\n<tr style=\"height: 58.8px;\">\n<td style=\"width: 8.8634%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,8,0,0\">8<\/span><\/td>\n<td style=\"width: 27.8893%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,8,1,0\">Ti\u00eam th\u0103m d\u00f2 (Baseline)<\/span><\/td>\n<td style=\"width: 63.2212%; border-width: 1px; padding: 5px; text-align: justify;\"><span data-path-to-node=\"2,8,2,0\">Ti\u00eam ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n n\u01b0\u1edbc mu\u1ed1i sinh l\u00fd t\u1ea1o b\u1ecdt l\u1ea7n \u0111\u1ea7u khi b\u1ec7nh nh\u00e2n \u0111ang th\u1edf b\u00ecnh th\u01b0\u1eddng<\/span><\/td>\n<\/tr>\n<tr style=\"height: 58.8px;\">\n<td style=\"width: 8.8634%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,9,0,0\">9<\/span><\/td>\n<td style=\"width: 27.8893%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,9,1,0\">Chu\u1ea9n b\u1ecb nghi\u1ec7m ph\u00e1p VM<\/span><\/td>\n<td style=\"width: 63.2212%; border-width: 1px; padding: 5px; text-align: justify;\"><span data-path-to-node=\"2,9,2,0\">Chu\u1ea9n b\u1ecb ti\u00eam nh\u1eafc l\u1ea1i k\u1ebft h\u1ee3p v\u1edbi nghi\u1ec7m ph\u00e1p Valsalva (VM); n\u1ebfu kh\u00f4ng c\u00f3 MES, \u0111\u1ee3i \u2265 2 ph\u00fat gi\u1eefa c\u00e1c l\u1ea7n ti\u00eam<\/span><\/td>\n<\/tr>\n<tr style=\"height: 58.8px;\">\n<td style=\"width: 8.8634%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,10,0,0\">10<\/span><\/td>\n<td style=\"width: 27.8893%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,10,1,0\">Th\u1ef1c hi\u1ec7n VM<\/span><\/td>\n<td style=\"width: 63.2212%; border-width: 1px; padding: 5px; text-align: justify;\"><span data-path-to-node=\"2,10,2,0\">B\u1eaft \u0111\u1ea7u VM 5 gi\u00e2y sau khi ti\u00eam; duy tr\u00ec trong 10 gi\u00e2y; c\u1ea7n t\u1eadp d\u01b0\u1ee3t tr\u01b0\u1edbc cho b\u1ec7nh nh\u00e2n<\/span><\/td>\n<\/tr>\n<tr style=\"height: 58.8px;\">\n<td style=\"width: 8.8634%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,11,0,0\">11<\/span><\/td>\n<td style=\"width: 27.8893%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,11,1,0\">Ki\u1ec3m tra hi\u1ec7u qu\u1ea3 VM<\/span><\/td>\n<td style=\"width: 63.2212%; border-width: 1px; padding: 5px; text-align: justify;\"><span data-path-to-node=\"2,11,2,0\">M\u1ee5c ti\u00eau &gt; 40 mm Hg (th\u1ed5i v\u00e0o \u00e1p k\u1ebf) ho\u1eb7c gi\u1ea3m MFV c\u1ee7a MCA \u2265 35%; l\u1eb7p l\u1ea1i x\u00e9t nghi\u1ec7m m\u1ed9t l\u1ea7n sau 2 ph\u00fat n\u1ebfu kh\u00f4ng c\u00f3 MES<\/span><\/td>\n<\/tr>\n<tr style=\"height: 58.8px;\">\n<td style=\"width: 8.8634%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,12,0,0\">12<\/span><\/td>\n<td style=\"width: 27.8893%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,12,1,0\">\u0110i\u1ec1u ch\u1ec9nh t\u01b0 th\u1ebf<\/span><\/td>\n<td style=\"width: 63.2212%; border-width: 1px; padding: 5px; text-align: justify;\"><span data-path-to-node=\"2,12,2,0\">N\u1ebfu v\u1eabn kh\u00f4ng c\u00f3 MES, l\u1eb7p l\u1ea1i th\u0103m kh\u00e1m \u1edf t\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n ng\u1ed3i th\u1eb3ng, c\u00f3 v\u00e0 kh\u00f4ng c\u00f3 VM<\/span><\/td>\n<\/tr>\n<tr style=\"height: 82.8px;\">\n<td style=\"width: 8.8634%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,13,0,0\">13<\/span><\/td>\n<td style=\"width: 27.8893%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,13,1,0\">Ph\u00e2n t\u00edch t\u00edn hi\u1ec7u<\/span><\/td>\n<td style=\"width: 63.2212%; border-width: 1px; padding: 5px; text-align: justify;\"><span data-path-to-node=\"2,13,2,0\">Ng\u01b0\u1eddi th\u1ef1c hi\u1ec7n xem v\u00e0 \u0111\u1ebfm MES c\u1ea3 tr\u1ef1c ti\u1ebfp v\u00e0 xem l\u1ea1i sau \u0111\u00f3 trong t\u1ea5t c\u1ea3 c\u00e1c giai \u0111o\u1ea1n; th\u0103m kh\u00e1m TCDi m\u1ed9t b\u00ean y\u00eau c\u1ea7u \u0111\u1ebfm huy\u1ebft kh\u1ed1i th\u1ee7 c\u00f4ng r\u1ed3i nh\u00e2n 2 \u0111\u1ec3 theo ti\u00eau chu\u1ea9n Spencer<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify;\" data-path-to-node=\"4\"><strong data-path-to-node=\"1\" data-index-in-node=\"0\">Ghi ch\u00fa.<\/strong>\u2014VM = nghi\u1ec7m ph\u00e1p Valsalva.<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\"><strong data-path-to-node=\"1\" data-index-in-node=\"0\">Shunt<\/strong> ph\u1ea3i-tr\u00e1i th\u01b0\u1eddng \u0111\u01b0\u1ee3c ph\u00e2n \u0111\u1ed9 b\u1eb1ng m\u1ed9t thang \u0111o, ch\u1eb3ng h\u1ea1n nh\u01b0 thang logarit Spencer, t\u01b0\u01a1ng \u1ee9ng v\u1edbi k\u00edch th\u01b0\u1edbc c\u1ee7a <strong data-path-to-node=\"1\" data-index-in-node=\"121\">shunt<\/strong> (B\u1ea3ng 4) (22). Vi\u1ec7c ph\u00e2n \u0111\u1ed9 n\u00e0y l\u00e0 thi\u1ebft y\u1ebfu \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng g\u00e2y b\u1ec7nh c\u1ee7a l\u1ed7 b\u1ea7u d\u1ee5c th\u00f4ng li\u00ean nh\u0129 v\u00e0 h\u01b0\u1edbng d\u1eabn x\u1eed tr\u00ed, v\u00ec l\u1ed7 b\u1ea7u d\u1ee5c th\u00f4ng li\u00ean nh\u0129 r\u1ea5t ph\u1ed5 bi\u1ebfn (g\u1eb7p \u1edf kho\u1ea3ng 25% d\u00e2n s\u1ed1 chung) nh\u01b0ng ch\u1ec9 chi\u1ebfm kho\u1ea3ng 5% c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 (21).<\/p>\n<p data-path-to-node=\"1\"><strong><span style=\"font-size: 12pt;\">B\u1ea3ng 4: Ph\u00e2n \u0111\u1ed9 shunt theo thang logarit Spencer<\/span><\/strong><\/p>\n<table style=\"border-collapse: collapse; border-width: 1px; width: 63.2812%;\" border=\"1\" data-path-to-node=\"2\">\n<thead>\n<tr>\n<td style=\"border-width: 1px; padding: 5px; width: 17.0185%;\"><strong>\u0110\u1ed9<\/strong><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 54.5024%;\"><strong>M\u00f4 t\u1ea3<\/strong><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 28.436%;\"><strong>S\u1ed1 l\u01b0\u1ee3ng HITS<\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td style=\"border-width: 1px; padding: 5px; width: 17.0185%;\"><span data-path-to-node=\"2,1,0,0\">0<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 54.5024%;\"><span data-path-to-node=\"2,1,1,0\">Kh\u00f4ng c\u00f3 HITS<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 28.436%;\"><span data-path-to-node=\"2,1,2,0\">0<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px; width: 17.0185%;\"><span data-path-to-node=\"2,2,0,0\">1<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 54.5024%;\"><span data-path-to-node=\"2,2,1,0\">T\u1ed1i thi\u1ec3u<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 28.436%;\"><span data-path-to-node=\"2,2,2,0\">1\u201310<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px; width: 17.0185%;\"><span data-path-to-node=\"2,3,0,0\">2<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 54.5024%;\"><span data-path-to-node=\"2,3,1,0\">Nh\u1eb9<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 28.436%;\"><span data-path-to-node=\"2,3,2,0\">11\u201330<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px; width: 17.0185%;\"><span data-path-to-node=\"2,4,0,0\">3<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 54.5024%;\"><span data-path-to-node=\"2,4,1,0\">Trung b\u00ecnh<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 28.436%;\"><span data-path-to-node=\"2,4,2,0\">31\u2013100<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px; width: 17.0185%;\"><span data-path-to-node=\"2,5,0,0\">4<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 54.5024%;\"><span data-path-to-node=\"2,5,1,0\">\u0110\u00e1ng k\u1ec3<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 28.436%;\"><span data-path-to-node=\"2,5,2,0\">101\u2013300<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px; width: 17.0185%;\"><span data-path-to-node=\"2,6,0,0\">5<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 54.5024%;\"><span data-path-to-node=\"2,6,1,0\">N\u1eb7ng (hi\u1ec7u \u1ee9ng r\u00e8m che)<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 28.436%;\"><span data-path-to-node=\"2,6,2,0\">&gt;300<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify;\" data-path-to-node=\"3\"><em><strong data-path-to-node=\"3\" data-index-in-node=\"0\">Ghi ch\u00fa.<\/strong>\u2014 HITS = t\u00edn hi\u1ec7u c\u01b0\u1eddng \u0111\u1ed9 cao tho\u00e1ng qua. D\u1eef li\u1ec7u d\u1ef1a tr\u00ean thang logarit Spencer \u0111\u1ec3 ph\u00e2n \u0111\u1ed9\u00a0<strong data-path-to-node=\"3\" data-index-in-node=\"101\">shunt<\/strong> ph\u1ea3i &#8211; tr\u00e1i. Th\u1eddi gian \u0111\u1ebfm n\u00ean l\u00e0 40 gi\u00e2y, nh\u01b0ng c\u00f3 th\u1ec3 gi\u1ea3m xu\u1ed1ng 30 gi\u00e2y m\u1ed9t c\u00e1ch t\u00f9y ch\u1ecdn nh\u1eb1m c\u1ed1 g\u1eafng tr\u00e1nh <strong data-path-to-node=\"3\" data-index-in-node=\"217\">shunt<\/strong> t\u1ea1i ph\u1ed5i, m\u1eb7c d\u00f9 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y ph\u01b0\u01a1ng ph\u00e1p n\u00e0y c\u00f3 th\u1ec3 kh\u00f4ng hi\u1ec7u qu\u1ea3 cho m\u1ee5c \u0111\u00edch \u0111\u00f3 (22).<\/em><\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\">M\u1eb7c d\u00f9 TCD c\u00f3 \u0111\u1ed9 nh\u1ea1y r\u1ea5t cao trong vi\u1ec7c ph\u00e1t hi\u1ec7n c\u00e1c <strong data-path-to-node=\"1\" data-index-in-node=\"55\">shunt<\/strong> ph\u1ea3i-tr\u00e1i (theo m\u1ed9t s\u1ed1 d\u1eef li\u1ec7u, n\u00f3 th\u1eadm ch\u00ed c\u00f2n nh\u1ea1y h\u01a1n si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n v\u00ec cho ph\u00e9p th\u1ef1c hi\u1ec7n nghi\u1ec7m ph\u00e1p Valsalva hi\u1ec7u qu\u1ea3 h\u01a1n m\u00e0 kh\u00f4ng c\u1ea7n g\u00e2y m\u00ea hay d\u00f9ng \u0111\u1ea7u d\u00f2 th\u1ef1c qu\u1ea3n), nh\u01b0ng n\u00f3 kh\u00f4ng cung c\u1ea5p c\u00e1c chi ti\u1ebft gi\u1ea3i ph\u1eabu v\u1ec1 <strong data-path-to-node=\"1\" data-index-in-node=\"298\">shunt<\/strong>. Tuy nhi\u00ean, x\u00e9t th\u1ea5y si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n t\u01b0\u01a1ng \u0111\u1ed1i x\u00e2m l\u1ea5n v\u00e0 c\u00f3 th\u1ec3 kh\u00f4ng d\u1ec5 d\u00e0ng th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c trong b\u1ec7nh c\u1ea3nh \u0111\u1ed9t qu\u1ef5 b\u00e1n c\u1ea5p, vi\u1ec7c b\u1eaft \u0111\u1ea7u \u0111\u00e1nh gi\u00e1 b\u1eb1ng TCD \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o. N\u1ebfu k\u1ebft qu\u1ea3 d\u01b0\u01a1ng t\u00ednh v\u00e0 vi\u1ec7c can thi\u1ec7p ngo\u1ea1i khoa \u0111ang \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc, khi \u0111\u00f3 c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n \u0111\u1ec3 x\u00e1c nh\u1eadn v\u1ecb tr\u00ed v\u00e0 h\u00ecnh th\u00e1i c\u1ee7a <strong data-path-to-node=\"1\" data-index-in-node=\"647\">shunt<\/strong> (21).<\/p>\n<blockquote data-path-to-node=\"2\">\n<p style=\"text-align: justify;\" data-path-to-node=\"2,0\"><span style=\"background-color: #ba372a; color: #ecf0f1;\"><strong data-path-to-node=\"2,0\" data-index-in-node=\"0\">Teaching point:<\/strong>\u00a0<\/span>TCD c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00e1t hi\u1ec7n kh\u00f4ng x\u00e2m l\u1ea5n c\u00e1c <strong data-path-to-node=\"2,0\" data-index-in-node=\"71\">shunt<\/strong> tim ph\u1ea3i-tr\u00e1i m\u00e0 kh\u00f4ng c\u1ea7n g\u00e2y m\u00ea hay s\u1eed d\u1ee5ng d\u1ee5ng c\u1ee5 qua th\u1ef1c qu\u1ea3n. N\u00f3 c\u00f3 \u0111\u1ed9 nh\u1ea1y t\u01b0\u01a1ng \u0111\u01b0\u01a1ng ho\u1eb7c cao h\u01a1n si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n, gi\u00fap n\u00f3 tr\u1edf th\u00e0nh m\u1ed9t c\u00f4ng c\u1ee5 t\u1ea7m so\u00e1t ban \u0111\u1ea7u \u0111\u01b0\u1ee3c \u01b0u ti\u00ean, trong khi c\u00e1c kh\u1ea3o s\u00e1t qua th\u1ef1c qu\u1ea3n \u0111\u01b0\u1ee3c d\u00e0nh ri\u00eang cho vi\u1ec7c l\u1eadp k\u1ebf ho\u1ea1ch ph\u1eabu thu\u1eadt ho\u1eb7c \u0111\u1eb7c t\u00ednh h\u00f3a gi\u1ea3i ph\u1eabu.<\/p>\n<\/blockquote>\n<h4 style=\"text-align: justify;\" data-path-to-node=\"3\">B\u1ec7nh h\u1ed3ng c\u1ea7u h\u00ecnh li\u1ec1m (SCD)<\/h4>\n<p style=\"text-align: justify;\" data-path-to-node=\"3\">Nh\u1ed3i m\u00e1u n\u00e3o th\u1ea7m l\u1eb7ng l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t g\u00e2y t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh v\u0129nh vi\u1ec5n \u1edf tr\u1ebb em v\u00e0 ng\u01b0\u1eddi l\u1edbn m\u1eafc b\u1ec7nh SCD, x\u1ea3y ra \u1edf kho\u1ea3ng 39% tr\u1ebb em tr\u01b0\u1edbc 18 tu\u1ed5i v\u00e0 h\u01a1n 50% ng\u01b0\u1eddi l\u1edbn tr\u01b0\u1edbc 30 tu\u1ed5i (23).<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"4\">N\u0103m 1998, nghi\u00ean c\u1ee9u D\u1ef1 ph\u00f2ng \u0110\u1ed9t qu\u1ef5 trong B\u1ec7nh Thi\u1ebfu m\u00e1u H\u1ed3ng c\u1ea7u h\u00ecnh li\u1ec1m (STOP) \u0111\u00e3 ch\u1ee9ng minh vi\u1ec7c truy\u1ec1n h\u1ed3ng c\u1ea7u m\u00e3n t\u00ednh c\u00f3 gi\u00e1 tr\u1ecb \u0111\u00e1ng k\u1ec3 trong vi\u1ec7c gi\u1ea3m 92% nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 l\u1ea7n \u0111\u1ea7u \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh c\u00f3 nguy c\u01a1 cao b\u1eb1ng niTCD (24). D\u1ef1a tr\u00ean nh\u1eefng ph\u00e1t hi\u1ec7n n\u00e0y, nhi\u1ec1u h\u01b0\u1edbng d\u1eabn, bao g\u1ed3m H\u01b0\u1edbng d\u1eabn c\u1ee7a Hi\u1ec7p h\u1ed9i Huy\u1ebft h\u1ecdc Hoa K\u1ef3 (n\u0103m 2020), khuy\u1ebfn c\u00e1o t\u1ea7m so\u00e1t TCD h\u00e0ng n\u0103m \u1edf b\u1ec7nh nh\u00e2n t\u1eeb 2\u201316 tu\u1ed5i m\u1eafc b\u1ec7nh SCD, c\u1ee5 th\u1ec3 l\u00e0 nh\u1eefng ng\u01b0\u1eddi c\u00f3 huy\u1ebft s\u1eafc t\u1ed1 S \u0111\u1ed3ng h\u1ee3p t\u1eed ho\u1eb7c thi\u1ebfu m\u00e1u v\u00f9ng bi\u1ec3n h\u00ecnh li\u1ec1m \u03b2-0 (HbS\u03b2\u00b0) (23).<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"5\">Th\u0103m kh\u00e1m t\u1ea7m so\u00e1t TCD \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng c\u00e1c gi\u00e1 tr\u1ecb v\u1eadn t\u1ed1c trung b\u00ecnh t\u1ed1i \u0111a trung b\u00ecnh theo th\u1eddi gian trong niTCD v\u00e0 s\u1eed d\u1ee5ng c\u00e1c gi\u00e1 tr\u1ecb t\u1ed1i \u0111a trung b\u00ecnh theo th\u1eddi gian, c\u00f2n g\u1ecdi l\u00e0 TAMAX ho\u1eb7c c\u00e1c gi\u00e1 tr\u1ecb v\u1eadn t\u1ed1c \u0111\u1ec9nh trung b\u00ecnh theo th\u1eddi gian trong TCDi, l\u00e0m c\u00e1c th\u00f4ng s\u1ed1 ch\u00ednh \u0111\u1ec3 ph\u00e2n t\u1ea7ng nguy c\u01a1; th\u1ef1c hi\u1ec7n khi b\u1ec7nh nh\u00e2n t\u1ec9nh t\u00e1o v\u00e0 kh\u00f4ng s\u1ed1t, \u00edt nh\u1ea5t 4 tu\u1ea7n sau c\u00e1c bi\u1ebfn c\u1ed1 c\u1ea5p t\u00ednh ho\u1eb7c truy\u1ec1n m\u00e1u (24).<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"6\">niTCD, nh\u01b0 \u0111\u00e3 s\u1eed d\u1ee5ng trong nghi\u00ean c\u1ee9u STOP, kh\u00f4ng c\u00f3 s\u1eb5n t\u1ea1i t\u1ea5t c\u1ea3 c\u00e1c trung t\u00e2m, \u0111i\u1ec1u n\u00e0y th\u00fac \u0111\u1ea9y m\u1ed9t s\u1ed1 c\u01a1 s\u1edf \u00e1p d\u1ee5ng TCDi \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ea1ch m\u00e1u n\u1ed9i s\u1ecd. V\u1eadn t\u1ed1c TCDi kh\u00f4ng hi\u1ec7u ch\u1ec9nh g\u00f3c th\u1ea5p h\u01a1n kho\u1ea3ng 10% so v\u1edbi v\u1eadn t\u1ed1c niTCD\u2014m\u1ed9t ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c h\u1ed7 tr\u1ee3 b\u1edfi m\u1ed9t s\u1ed1 nh\u01b0ng kh\u00f4ng ph\u1ea3i t\u1ea5t c\u1ea3 c\u00e1c nghi\u00ean c\u1ee9u\u2014v\u00e0 do \u0111\u00f3 y\u00eau c\u1ea7u c\u00e1c ng\u01b0\u1ee1ng c\u1eaft \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh (23). Ng\u01b0\u1ee3c l\u1ea1i, v\u1eadn t\u1ed1c TCDi c\u00f3 hi\u1ec7u ch\u1ec9nh g\u00f3c c\u00f3 th\u1ec3 cao h\u01a1n 25%\u201330% (25). Do \u0111\u00f3, \u0111\u1eb7c bi\u1ec7t trong b\u1ed1i c\u1ea3nh ph\u00e2n t\u1ea7ng nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 li\u00ean quan \u0111\u1ebfn thi\u1ebfu m\u00e1u h\u1ed3ng c\u1ea7u h\u00ecnh li\u1ec1m, vi\u1ec7c hi\u1ec7u ch\u1ec9nh g\u00f3c kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o do thi\u1ebfu s\u1ef1 chu\u1ea9n h\u00f3a v\u00e0 \u0111\u1ec3 duy tr\u00ec t\u00ednh nh\u1ea5t qu\u00e1n v\u1edbi k\u1ef9 thu\u1eadt c\u1ee7a giao th\u1ee9c STOP (26). C\u00e1c ng\u01b0\u1ee1ng c\u1eaft v\u1eadn t\u1ed1c theo h\u01b0\u1edbng d\u1eabn v\u00e0 khuy\u1ebfn c\u00e1o theo d\u00f5i \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft trong B\u1ea3ng 5 (23,27).<\/p>\n<p><strong><span style=\"font-size: 12pt;\">B\u1ea3ng 5: Ng\u01b0\u1ee1ng v\u1eadn t\u1ed1c v\u00e0 khuy\u1ebfn c\u00e1o theo d\u00f5i d\u1ef1a tr\u00ean TCD trong b\u1ec7nh h\u1ed3ng c\u1ea7u h\u00ecnh li\u1ec1m<\/span><\/strong><\/p>\n<table style=\"width: 100%; border-collapse: collapse; border-width: 1px;\" border=\"1\" data-path-to-node=\"2\">\n<thead>\n<tr>\n<td style=\"width: 13.5333%; border-width: 1px; padding: 5px;\"><strong>Ph\u01b0\u01a1ng th\u1ee9c<\/strong><\/td>\n<td style=\"width: 18.7441%; border-width: 1px; padding: 5px;\"><strong>\u0110\u1ed9ng m\u1ea1ch<\/strong><\/td>\n<td style=\"width: 29.4707%; border-width: 1px; padding: 5px;\"><strong>Ng\u01b0\u1ee1ng can thi\u1ec7p<\/strong><\/td>\n<td style=\"width: 38.1917%; border-width: 1px; padding: 5px;\"><strong>Kho\u1ea3ng v\u1eadn t\u1ed1c c\u1ea7n theo d\u00f5i<\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td style=\"width: 13.5333%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,1,0,0\"><strong data-path-to-node=\"2,1,0,0\" data-index-in-node=\"0\">niTCD<\/strong><\/span><\/td>\n<td style=\"width: 18.7441%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,1,1,0\">ICA \u0111o\u1ea1n xa ho\u1eb7c MCA \u0111o\u1ea1n g\u1ea7n<\/span><\/td>\n<td style=\"width: 29.4707%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,1,2,0\">Hai l\u1ea7n \u0111o TAMMV \u2265\u00a0 200 cm\/s ho\u1eb7c m\u1ed9t l\u1ea7n \u0111o TAMMV &gt; 220 cm\/s<\/span><\/td>\n<td style=\"width: 38.1917%; border-width: 1px; padding: 5px;\">\n<p data-path-to-node=\"2,1,3,0\">Theo d\u00f5i d\u1ef1a tr\u00ean TAMMV:<\/p>\n<p data-path-to-node=\"2,1,3,2\">\u2022 &lt; 170 cm\/s: l\u1eb7p l\u1ea1i h\u00e0ng n\u0103m<\/p>\n<p data-path-to-node=\"2,1,3,4\">\u2022 170\u2013184 cm\/s: l\u1eb7p l\u1ea1i sau 3\u20136 th\u00e1ng<\/p>\n<p data-path-to-node=\"2,1,3,6\">\u2022 185\u2013199 cm\/s: l\u1eb7p l\u1ea1i sau 1\u20133 th\u00e1ng<\/p>\n<p data-path-to-node=\"2,1,3,8\">\u2022 \u2265 200 cm\/s: l\u1eb7p l\u1ea1i sau 1\u20132 tu\u1ea7n<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 13.5333%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,2,0,0\"><strong data-path-to-node=\"2,2,0,0\" data-index-in-node=\"0\">TCDi<\/strong><\/span><\/td>\n<td style=\"width: 18.7441%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,2,1,0\">ICA \u0111o\u1ea1n xa ho\u1eb7c MCA \u0111o\u1ea1n g\u1ea7n<\/span><\/td>\n<td style=\"width: 29.4707%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,2,2,0\">Hai l\u1ea7n \u0111o TAMX \u2265 185 cm\/s ho\u1eb7c m\u1ed9t l\u1ea7n \u0111o &gt; 205 cm\/s; khuy\u1ebfn c\u00e1o kh\u00f4ng \u0111i\u1ec1u ch\u1ec9nh g\u00f3c (gi\u1eef g\u00f3c c\u1ed1 \u0111\u1ecbnh \u1edf 0\u00b0)<\/span><\/td>\n<td style=\"width: 38.1917%; border-width: 1px; padding: 5px;\"><span data-path-to-node=\"2,2,3,0\">Ch\u01b0a c\u00f3 khuy\u1ebfn c\u00e1o d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng ch\u1ea5t l\u01b0\u1ee3ng cao<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong data-path-to-node=\"1\" data-index-in-node=\"0\">Ghi ch\u00fa.<\/strong>\u2014<strong data-path-to-node=\"1\" data-index-in-node=\"9\">TAMMV<\/strong> = v\u1eadn t\u1ed1c trung b\u00ecnh t\u1ed1i \u0111a trung b\u00ecnh theo th\u1eddi gian, <strong data-path-to-node=\"1\" data-index-in-node=\"70\">TAMX<\/strong> = v\u1eadn t\u1ed1c t\u1ed1i \u0111a trung b\u00ecnh theo th\u1eddi gian.<\/p>\n<blockquote data-path-to-node=\"1\">\n<p style=\"text-align: justify;\" data-path-to-node=\"1,0\"><span style=\"background-color: #ba372a; color: #ecf0f1;\"><strong data-path-to-node=\"2,0\" data-index-in-node=\"0\">Teaching point:<\/strong>\u00a0<\/span> Ph\u00e2n t\u1ea7ng nguy c\u01a1 b\u1eb1ng TCD trong b\u1ec7nh h\u1ed3ng c\u1ea7u h\u00ecnh li\u1ec1m (SCD) \u0111\u00e3 l\u00e0m thay \u0111\u1ed5i vi\u1ec7c ch\u0103m s\u00f3c b\u1ec7nh nh\u00e2n nh\u1edd x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c nh\u1eefng tr\u1ebb em c\u00f3 nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 cao. Trong c\u1ed9ng \u0111\u1ed3ng b\u1ec7nh nh\u00e2n SCD, nh\u1ed3i m\u00e1u n\u00e3o th\u1ea7m l\u1eb7ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn h\u01a1n 50% ng\u01b0\u1eddi l\u1edbn v\u00e0 g\u1ea7n 40% tr\u1ebb em. Vi\u1ec7c truy\u1ec1n m\u00e1u d\u1ef1 ph\u00f2ng c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 \u0111\u1ed9t qu\u1ef5 l\u00ean \u0111\u1ebfn 92%.<\/p>\n<\/blockquote>\n<h4 data-path-to-node=\"2\">\u0110\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng \u0111\u00e1p \u1ee9ng m\u1ea1ch m\u00e1u n\u00e3o<\/h4>\n<p style=\"text-align: justify;\" data-path-to-node=\"2\">Kh\u1ea3 n\u0103ng \u0111\u00e1p \u1ee9ng m\u1ea1ch m\u00e1u n\u00e3o (CVR) ph\u1ea3n \u00e1nh kh\u1ea3 n\u0103ng \u0111i\u1ec1u ch\u1ec9nh d\u00f2ng m\u00e1u c\u1ee7a c\u00e1c m\u1ea1ch m\u00e1u n\u00e3o \u0111\u1ec3 \u0111\u00e1p \u1ee9ng v\u1edbi c\u00e1c k\u00edch th\u00edch chuy\u1ec3n h\u00f3a ho\u1eb7c m\u00f4i tr\u01b0\u1eddng, \u0111i\u1ec3n h\u00ecnh l\u00e0 nh\u1eefng thay \u0111\u1ed5i v\u1ec1\u00a0<span class=\"math-inline\" data-math=\"PaCO_2\" data-index-in-node=\"223\">PaCO<sub>2<\/sub><\/span>. S\u1ef1 gi\u1ea3m \u0111\u00e1p \u1ee9ng v\u1eadn m\u1ea1ch tr\u00ean TCD cho th\u1ea5y kh\u1ea3 n\u0103ng d\u1ef1 tr\u1eef m\u1ea1ch m\u00e1u n\u00e3o b\u1ecb suy gi\u1ea3m v\u00e0 l\u00e0m t\u0103ng nguy c\u01a1 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 (28). \u1ee8ng d\u1ee5ng l\u00e2m s\u00e0ng ch\u00ednh c\u1ee7a CVR l\u00e0 \u0111\u00e1nh gi\u00e1 nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 trong b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh, v\u1ed1n l\u00e0 n\u01a1i c\u00f3 b\u1eb1ng ch\u1ee9ng m\u1ea1nh m\u1ebd nh\u1ea5t. CVR c\u0169ng c\u00f3 li\u00ean quan \u0111\u1ebfn suy gi\u1ea3m nh\u1eadn th\u1ee9c, sa s\u00fat tr\u00ed tu\u1ec7, t\u0103ng huy\u1ebft \u00e1p v\u00e0 h\u1ed9i ch\u1ee9ng co m\u1ea1ch n\u00e3o c\u00f3 h\u1ed3i ph\u1ee5c, m\u1eb7c d\u00f9 vai tr\u00f2 c\u1ee7a n\u00f3 trong qu\u1ea3n l\u00fd l\u00e2m s\u00e0ng c\u00e1c t\u00ecnh tr\u1ea1ng n\u00e0y v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh r\u00f5 r\u00e0ng (2,28).<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"3\">Suy gi\u1ea3m CVR l\u00e0m t\u0103ng \u0111\u00e1ng k\u1ec3 nguy c\u01a1 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 \u1edf b\u1ec7nh nh\u00e2n t\u1eafc \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh kh\u00f4ng tri\u1ec7u ch\u1ee9ng, v\u00e0 l\u00e0m t\u0103ng nguy c\u01a1 n\u00e0y t\u1eeb 10% l\u00ean 13.9% \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n h\u1eb9p kh\u00f4ng tri\u1ec7u ch\u1ee9ng tr\u00ean 70% (29). \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n t\u1eafc \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh v\u00e0 thi\u1ebfu c\u00e1c \u0111\u01b0\u1eddng tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7, suy gi\u1ea3m CVR c\u00f3 li\u00ean quan \u0111\u1ebfn nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 c\u00f9ng b\u00ean h\u00e0ng n\u0103m l\u00e0 32.7%, so v\u1edbi 0% \u1edf nh\u1eefng ng\u01b0\u1eddi c\u00f2n duy tr\u00ec \u0111\u01b0\u1ee3c kh\u1ea3 n\u0103ng \u0111\u00e1p \u1ee9ng v\u00e0 c\u00f3 tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7. Do \u0111\u00f3, \u0111\u00e1nh gi\u00e1 CVR cung c\u1ea5p th\u00f4ng tin ti\u00ean l\u01b0\u1ee3ng v\u01b0\u1ee3t tr\u1ed9i h\u01a1n so v\u1edbi si\u00eau \u00e2m \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh ti\u00eau chu\u1ea9n v\u00e0 c\u00f3 th\u1ec3 gi\u00fap h\u01b0\u1edbng d\u1eabn c\u00e1c quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb, ch\u1eb3ng h\u1ea1n nh\u01b0 c\u00e2n nh\u1eafc c\u00e1c th\u1ee7 thu\u1eadt t\u00e1i th\u00f4ng m\u1ea1ch m\u00e1u \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m huy\u1ebft \u0111\u1ed9ng nguy c\u01a1 cao (2).<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"4\">TCD \u0111\u00f3ng vai tr\u00f2 l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p t\u1ea1i gi\u01b0\u1eddng an to\u00e0n, c\u00f3 th\u1ec3 l\u1eb7p l\u1ea1i \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 CVR v\u1edbi \u0111\u1ed9 ph\u00e2n gi\u1ea3i th\u1eddi gian cao (H\u00ecnh 11). \u0110\u1ed9 ch\u00ednh x\u00e1c c\u1ee7a TCD \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn so v\u1edbi \u0111\u1ed9 ch\u00ednh x\u00e1c c\u1ee7a SPECT, PET v\u00e0 MRI trong b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh (2).<\/p>\n<p data-path-to-node=\"4\"><img decoding=\"async\" style=\"display: block; margin-left: auto; margin-right: auto;\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/1iby5GFsCDv8SW7t2jCABO1HB8hM6uLtH=s0\" \/><\/p>\n<p data-path-to-node=\"1\"><em><strong data-path-to-node=\"1\" data-index-in-node=\"0\">H\u00ecnh 11.<\/strong> \u0110\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng \u0111\u00e1p \u1ee9ng m\u1ea1ch m\u00e1u n\u00e3o (CVR) b\u1eb1ng TCD \u1edf m\u1ed9t ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh 28 tu\u1ed5i kh\u1ecfe m\u1ea1nh. <strong data-path-to-node=\"1\" data-index-in-node=\"107\">(A)<\/strong> Trong qu\u00e1 tr\u00ecnh n\u00edn th\u1edf 30 gi\u00e2y, n\u1ed3ng \u0111\u1ed9\u00a0<span class=\"math-inline\" data-math=\"PaCO_2\" data-index-in-node=\"152\">PaCO<sub>2<\/sub><\/span>\u00a0t\u0103ng d\u1eabn \u0111\u1ebfn gi\u00e3n m\u1ea1ch v\u00e0 v\u1eadn t\u1ed1c d\u00f2ng m\u00e1u n\u00e3o t\u0103ng d\u1ea7n, \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n qua ph\u1ed5 Doppler li\u00ean t\u1ee5c. <strong data-path-to-node=\"1\" data-index-in-node=\"256\">(B)<\/strong> Trong qu\u00e1 tr\u00ecnh t\u0103ng th\u00f4ng kh\u00ed k\u00e9o d\u00e0i 120 gi\u00e2y, n\u1ed3ng \u0111\u1ed9\u00a0<span class=\"math-inline\" data-math=\"PaCO_2\" data-index-in-node=\"317\">PaCO<sub>2<\/sub><\/span>\u00a0gi\u1ea3m d\u1eabn \u0111\u1ebfn co m\u1ea1ch v\u00e0 v\u1eadn t\u1ed1c d\u00f2ng ch\u1ea3y gi\u1ea3m t\u01b0\u01a1ng \u1ee9ng. <strong data-path-to-node=\"1\" data-index-in-node=\"382\">ED<\/strong> = v\u1eadn t\u1ed1c cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng, <strong data-path-to-node=\"1\" data-index-in-node=\"412\">PI<\/strong> = ch\u1ec9 s\u1ed1 xung, <strong data-path-to-node=\"1\" data-index-in-node=\"430\">RI<\/strong> = ch\u1ec9 s\u1ed1 kh\u00e1ng, <strong data-path-to-node=\"1\" data-index-in-node=\"449\">PS<\/strong> = v\u1eadn t\u1ed1c \u0111\u1ec9nh t\u00e2m thu, <strong data-path-to-node=\"1\" data-index-in-node=\"476\">TAMAX<\/strong> = v\u1eadn t\u1ed1c t\u1ed1i \u0111a trung b\u00ecnh theo th\u1eddi gian, <strong data-path-to-node=\"1\" data-index-in-node=\"526\">TAMEAN<\/strong> = v\u1eadn t\u1ed1c trung b\u00ecnh theo th\u1eddi gian. (\u0110\u01b0\u1ee3c t\u1ea1o b\u1eb1ng BioRender. Esmeraldo M [2025], <a class=\"ng-star-inserted\" href=\"https:\/\/biorender.com\/ya6bt5z\" target=\"_blank\" rel=\"noopener\" data-hveid=\"0\" data-ved=\"0CAAQ_4QMahgKEwj_08qI0ZOUAxUAAAAAHQAAAAAQhAQ\">https:\/\/BioRender.com\/ya6bt5z<\/a>.)<\/em><\/p>\n<p data-path-to-node=\"1\"><strong>B\u1ea3ng 6: Quy tr\u00ecnh chu\u1ea9n h\u00f3a th\u1eed nghi\u1ec7m BHI b\u1eb1ng TCD<\/strong><\/p>\n<table style=\"width: 100%; border-collapse: collapse; border-width: 1px;\" border=\"1\" data-path-to-node=\"2\">\n<thead>\n<tr style=\"height: 61.6px;\">\n<td style=\"width: 20.6753%; padding: 5px;\"><strong>B\u01b0\u1edbc quy tr\u00ecnh<\/strong><\/td>\n<td style=\"width: 28.4039%; padding: 5px;\"><strong>M\u00f4 t\u1ea3<\/strong><\/td>\n<td style=\"width: 50.9034%; padding: 5px;\"><strong>Chi ti\u1ebft v\u00e0 Th\u1ef1c h\u00e0nh t\u1ed1t nh\u1ea5t<\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"height: 109.6px;\">\n<td style=\"width: 20.6753%; padding: 5px;\"><span data-path-to-node=\"2,1,0,0\"><strong data-path-to-node=\"2,1,0,0\" data-index-in-node=\"0\">1. Chu\u1ea9n b\u1ecb b\u1ec7nh nh\u00e2n<\/strong><\/span><\/td>\n<td style=\"width: 28.4039%; padding: 5px;\"><span data-path-to-node=\"2,1,1,0\">\u0110\u1ea3m b\u1ea3o s\u1ef1 tho\u1ea3i m\u00e1i v\u00e0 c\u00e1c ch\u1ec9 s\u1ed1 sinh l\u00fd c\u01a1 b\u1ea3n c\u1ee7a b\u1ec7nh nh\u00e2n<\/span><\/td>\n<td style=\"width: 50.9034%; padding: 5px;\"><span data-path-to-node=\"2,1,2,0\">N\u1eb1m ng\u1eeda ho\u1eb7c n\u1eb1m nghi\u00eang trong ph\u00f2ng y\u00ean t\u0129nh; ngh\u1ec9 ng\u01a1i <span class=\"math-inline\" data-math=\"\\ge\" data-index-in-node=\"58\">$\\ge$<\/span> 5 ph\u00fat tr\u01b0\u1edbc khi \u0111o; tr\u00e1nh s\u1eed d\u1ee5ng caffeine, nicotine, thu\u1ed1c v\u1eadn m\u1ea1ch; gi\u1ea3i th\u00edch c\u00e1ch n\u00edn th\u1edf: h\u00edt v\u00e0o b\u00ecnh th\u01b0\u1eddng (kh\u00f4ng h\u00edt s\u00e2u) sau \u0111\u00f3 ng\u1eebng th\u1edf.<\/span><\/td>\n<\/tr>\n<tr style=\"height: 109.6px;\">\n<td style=\"width: 20.6753%; padding: 5px;\"><span data-path-to-node=\"2,2,0,0\"><strong data-path-to-node=\"2,2,0,0\" data-index-in-node=\"0\">2. Theo d\u00f5i ban \u0111\u1ea7u<\/strong><\/span><\/td>\n<td style=\"width: 28.4039%; padding: 5px;\"><span data-path-to-node=\"2,2,1,0\">Thi\u1ebft l\u1eadp MFV khi ngh\u1ec9 ng\u01a1i<\/span><\/td>\n<td style=\"width: 50.9034%; padding: 5px;\"><span data-path-to-node=\"2,2,2,0\">Kh\u1ea3o s\u00e1t MCA qua c\u1eeda s\u1ed5 th\u00e1i d\u01b0\u01a1ng (50\u201355 mm); s\u1eed d\u1ee5ng \u0111\u1ea7u d\u00f2 2-MHz; c\u1ed1 \u0111\u1ecbnh g\u00f3c v\u00e0 \u0111\u1ed9 s\u00e2u \u0111\u1ea7u d\u00f2; ghi l\u1ea1i MFV \u1ed5n \u0111\u1ecbnh trong \u2265 30 gi\u00e2y; t\u00f9y ch\u1ecdn: theo d\u00f5i huy\u1ebft \u00e1p (BP) v\u00e0 nh\u1ecbp tim (HR) xuy\u00ean su\u1ed1t.<\/span><\/td>\n<\/tr>\n<tr style=\"height: 112.8px;\">\n<td style=\"width: 20.6753%; padding: 5px;\"><span data-path-to-node=\"2,3,0,0\"><strong data-path-to-node=\"2,3,0,0\" data-index-in-node=\"0\">3. Nghi\u1ec7m ph\u00e1p n\u00edn th\u1edf<\/strong><\/span><\/td>\n<td style=\"width: 28.4039%; padding: 5px;\"><span data-path-to-node=\"2,3,1,0\">G\u00e2y ra t\u00ecnh tr\u1ea1ng t\u0103ng\u00a0<span class=\"math-inline\" data-math=\"CO_2\" data-index-in-node=\"23\">CO<sub>2<\/sub><\/span>\u00a0m\u00e1u b\u1eb1ng c\u00e1ch ng\u1eebng th\u1edf ch\u1ee7 \u0111\u1ed9ng<\/span><\/td>\n<td style=\"width: 50.9034%; padding: 5px;\"><span data-path-to-node=\"2,3,2,0\">H\u01b0\u1edbng d\u1eabn b\u1ec7nh nh\u00e2n h\u00edt th\u1edf b\u00ecnh th\u01b0\u1eddng v\u00e0 sau \u0111\u00f3 n\u00edn th\u1edf t\u1ed1i \u0111a 30 gi\u00e2y; ghi l\u1ea1i MFV li\u00ean t\u1ee5c; ghi ch\u00fa th\u1eddi gian n\u00edn th\u1edf th\u1ef1c t\u1ebf.<\/span><\/td>\n<\/tr>\n<tr style=\"height: 85.6px;\">\n<td style=\"width: 20.6753%; padding: 5px;\"><span data-path-to-node=\"2,4,0,0\"><strong data-path-to-node=\"2,4,0,0\" data-index-in-node=\"0\">4. Theo d\u00f5i sau ng\u1eebng th\u1edf<\/strong><\/span><\/td>\n<td style=\"width: 28.4039%; padding: 5px;\"><span data-path-to-node=\"2,4,1,0\">Ghi nh\u1eadn s\u1ef1 tr\u1edf l\u1ea1i tr\u1ea1ng th\u00e1i ban \u0111\u1ea7u<\/span><\/td>\n<td style=\"width: 50.9034%; padding: 5px;\"><span data-path-to-node=\"2,4,2,0\">B\u1ec7nh nh\u00e2n ti\u1ebfp t\u1ee5c h\u00edt th\u1edf b\u00ecnh th\u01b0\u1eddng; ti\u1ebfp t\u1ee5c ghi MFV trong <span class=\"math-inline\" data-math=\"\\ge\" data-index-in-node=\"63\">$\\ge$<\/span> 30 gi\u00e2y.<\/span><\/td>\n<\/tr>\n<tr style=\"height: 85.6px;\">\n<td style=\"width: 20.6753%; padding: 5px;\"><span data-path-to-node=\"2,5,0,0\"><strong data-path-to-node=\"2,5,0,0\" data-index-in-node=\"0\">5. L\u1eb7p l\u1ea1i<\/strong><\/span><\/td>\n<td style=\"width: 28.4039%; padding: 5px;\"><span data-path-to-node=\"2,5,1,0\">C\u1ea3i thi\u1ec7n \u0111\u1ed9 tin c\u1eady<\/span><\/td>\n<td style=\"width: 50.9034%; padding: 5px;\"><span data-path-to-node=\"2,5,2,0\">L\u1eb7p l\u1ea1i c\u00e1c b\u01b0\u1edbc 2\u20134 t\u1eeb hai \u0111\u1ebfn ba l\u1ea7n; cho ph\u00e9p ngh\u1ec9 <span class=\"math-inline\" data-math=\"\\ge\" data-index-in-node=\"54\">$\\ge$<\/span> 4 ph\u00fat gi\u1eefa c\u00e1c l\u1ea7n th\u1ef1c hi\u1ec7n; s\u1eed d\u1ee5ng BHI trung b\u00ecnh \u0111\u1ec3 gi\u1ea3i th\u00edch k\u1ebft qu\u1ea3.<\/span><\/td>\n<\/tr>\n<tr style=\"height: 81px;\">\n<td style=\"width: 20.6753%; padding: 5px;\"><span data-path-to-node=\"2,6,0,0\"><strong data-path-to-node=\"2,6,0,0\" data-index-in-node=\"0\">6. T\u00ednh to\u00e1n BHI<\/strong><\/span><\/td>\n<td style=\"width: 28.4039%; padding: 5px;\"><span data-path-to-node=\"2,6,1,0\">\u0110\u1ecbnh l\u01b0\u1ee3ng kh\u1ea3 n\u0103ng \u0111\u00e1p \u1ee9ng m\u1ea1ch m\u00e1u n\u00e3o<\/span><\/td>\n<td style=\"width: 50.9034%; padding: 5px;\">\n<div data-path-to-node=\"2,6,2,0\">\n<div class=\"math-block\" data-math=\"BHI = \\frac{MFV_{cu\u1ed1i} - MFV_{\u0111\u1ea7u}}{MFV_{\u0111\u1ea7u} \\times \\text{th\u1eddi gian n\u00edn th\u1edf (gi\u00e2y)}} \\times 100\"><img decoding=\"async\" style=\"display: block; margin-left: auto; margin-right: auto;\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/1ERiOh41UwN80lCxIKy1W2Rw0mN64tJg_=s0\" \/><\/div>\n<\/div>\n<\/td>\n<\/tr>\n<tr style=\"height: 61.6px;\">\n<td style=\"width: 20.6753%; padding: 5px;\"><span data-path-to-node=\"2,7,0,0\"><strong data-path-to-node=\"2,7,0,0\" data-index-in-node=\"0\">7. Gi\u1ea3i th\u00edch k\u1ebft qu\u1ea3<\/strong><\/span><\/td>\n<td style=\"width: 28.4039%; padding: 5px;\"><span data-path-to-node=\"2,7,1,0\">X\u00e1c \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng CVR<\/span><\/td>\n<td style=\"width: 50.9034%; padding: 5px;\"><span data-path-to-node=\"2,7,2,0\">Suy gi\u1ea3m CVR: &lt; 0,70%\/gi\u00e2y; gi\u00e1 tr\u1ecb cao h\u01a1n cho th\u1ea5y kh\u1ea3 n\u0103ng \u0111\u00e1p \u1ee9ng v\u1eadn m\u1ea1ch c\u00f2n duy tr\u00ec.<\/span><\/td>\n<\/tr>\n<tr style=\"height: 181.6px;\">\n<td style=\"width: 20.6753%; padding: 5px;\"><span data-path-to-node=\"2,8,0,0\"><strong data-path-to-node=\"2,8,0,0\" data-index-in-node=\"0\">8. C\u00e1c l\u01b0u \u00fd ch\u00ednh<\/strong><\/span><\/td>\n<td style=\"width: 28.4039%; padding: 5px;\"><span data-path-to-node=\"2,8,1,0\">\u0110\u1ea3m b\u1ea3o gi\u00e1 tr\u1ecb c\u1ee7a x\u00e9t nghi\u1ec7m<\/span><\/td>\n<td style=\"width: 50.9034%; padding: 5px;\"><span data-path-to-node=\"2,8,2,0\">Ng\u1eebng th\u1edf ph\u1ea3i th\u1ef1c hi\u1ec7n sau khi h\u00edt v\u00e0o b\u00ecnh th\u01b0\u1eddng (tr\u00e1nh nghi\u1ec7m ph\u00e1p Valsalva); MFV th\u01b0\u1eddng t\u0103ng sau 8\u201314 gi\u00e2y; n\u00edn th\u1edf ng\u1eafn h\u01a1n 20 gi\u00e2y c\u00f3 th\u1ec3 kh\u00f4ng \u0111\u00e1ng tin c\u1eady; nghi\u1ec7m ph\u00e1p BHI kh\u00f4ng \u0111\u00e1ng tin c\u1eady \u1edf b\u1ec7nh nh\u00e2n kh\u00f3 th\u1edf ho\u1eb7c kh\u00f4ng h\u1ee3p t\u00e1c; \u0111\u1ea3m b\u1ea3o t\u00edn hi\u1ec7u Doppler ch\u1ea5t l\u01b0\u1ee3ng cao v\u00e0 h\u1ea1n ch\u1ebf c\u1eed \u0111\u1ed9ng; \u0111\u1ea3m b\u1ea3o bao vi\u1ec1n ph\u1ed5 Doppler t\u1ed1i \u01b0u \u0111\u1ec3 \u0111o MFV ch\u00ednh x\u00e1c.<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p data-path-to-node=\"3\"><em><strong data-path-to-node=\"3\" data-index-in-node=\"0\">Ghi ch\u00fa.<\/strong>\u2014B\u1ea3ng tr\u00ecnh b\u00e0y c\u00e1c b\u01b0\u1edbc ch\u00ednh, khuy\u1ebfn ngh\u1ecb k\u1ef9 thu\u1eadt v\u00e0 ti\u00eau ch\u00ed gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o \u0111\u00e1nh gi\u00e1 CVR \u0111\u00e1ng tin c\u1eady. <strong data-path-to-node=\"3\" data-index-in-node=\"135\">BP<\/strong> = huy\u1ebft \u00e1p, <strong data-path-to-node=\"3\" data-index-in-node=\"150\">HR<\/strong> = nh\u1ecbp tim.<\/em><\/p>\n<p data-path-to-node=\"3\"><em><img decoding=\"async\" style=\"display: block; margin-left: auto; margin-right: auto;\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/1P0MxuU6WtLYY9myr4iCWaOnv9KuJDLdz=s0\" \/><\/em><\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\"><em><strong data-path-to-node=\"1\" data-index-in-node=\"0\">H\u00ecnh 12.<\/strong> Nghi\u1ec7m ph\u00e1p \u0111o ch\u1ec9 s\u1ed1 n\u00edn th\u1edf (BHI) \u1edf hai b\u1ec7nh nh\u00e2n b\u1ecb h\u1eb9p \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh trong (ICA) tr\u00ean 70%. \u1ede b\u1ec7nh nh\u00e2n 1, m\u1ed9t nam gi\u1edbi 72 tu\u1ed5i, BHI gi\u1ea3m r\u00f5 r\u1ec7t (0,19), v\u1edbi v\u1eadn t\u1ed1c d\u00f2ng ch\u1ea3y trung b\u00ecnh (MFV) ch\u1ec9 t\u0103ng 5,7%, ph\u00f9 h\u1ee3p v\u1edbi t\u00ecnh tr\u1ea1ng suy gi\u1ea3m kh\u1ea3 n\u0103ng \u0111\u00e1p \u1ee9ng m\u1ea1ch m\u00e1u n\u00e3o (CVR) v\u00e0 nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 cao h\u01a1n. Ng\u01b0\u1ee3c l\u1ea1i, b\u1ec7nh nh\u00e2n 2, m\u1ed9t nam gi\u1edbi 70 tu\u1ed5i, cho th\u1ea5y BHI b\u00ecnh th\u01b0\u1eddng (1,72) v\u00e0 MFV t\u0103ng 51,6%, cho bi\u1ebft CVR v\u1eabn \u0111\u01b0\u1ee3c b\u1ea3o t\u1ed3n. (<a href=\"https:\/\/BioRender.com\/36hymy5\" target=\"_blank\" rel=\"noopener\">\u0110\u01b0\u1ee3c t\u1ea1o b\u1eb1ng BioRender. Esmeraldo M [2025]<\/a>.)<\/em><\/p>\n<blockquote data-path-to-node=\"1\">\n<p data-path-to-node=\"1,0\"><span style=\"background-color: #ba372a; color: #ecf0f1;\"><strong data-path-to-node=\"2,0\" data-index-in-node=\"0\">Teaching point:<\/strong><\/span> \u0110\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng \u0111\u00e1p \u1ee9ng m\u1ea1ch m\u00e1u n\u00e3o (CVR) b\u1eb1ng TCD c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 cao; s\u1ef1 suy gi\u1ea3m kh\u1ea3 n\u0103ng \u0111\u00e1p \u1ee9ng l\u00e0m t\u0103ng \u0111\u00e1ng k\u1ec3 nguy c\u01a1 n\u00e0y khi c\u00f3 t\u00ecnh tr\u1ea1ng h\u1eb9p ho\u1eb7c t\u1eafc \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh. BHI l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p t\u1ea1i gi\u01b0\u1eddng an to\u00e0n, \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 CVR v\u00e0 ph\u00e2n t\u1ea7ng nguy c\u01a1, \u0111\u1ed3ng th\u1eddi \u0111\u00f3ng vai tr\u00f2 l\u00e0 x\u00e9t nghi\u1ec7m \u0111\u1ea7u tay th\u1ef1c t\u1ebf \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n h\u1ee3p t\u00e1c.<\/p>\n<\/blockquote>\n<h4 style=\"text-align: justify;\" data-path-to-node=\"2\">H\u1eb9p \u0111\u1ed9ng m\u1ea1ch n\u1ed9i s\u1ecd<\/h4>\n<p style=\"text-align: justify;\" data-path-to-node=\"2\">TCD \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p kh\u00f4ng x\u00e2m l\u1ea5n \u0111\u1ec3 ph\u00e1t hi\u1ec7n h\u1eb9p m\u1ea1ch m\u00e1u n\u1ed9i s\u1ecd, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf MCA, \u0111o\u1ea1n t\u1eadn \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh trong n\u1ed9i s\u1ecd, VA v\u00e0 BA. C\u00e1c ph\u00e2n t\u00edch g\u1ed9p ch\u1ea5t l\u01b0\u1ee3ng cao cho th\u1ea5y TCD c\u00f3 \u0111\u1ed9 nh\u1ea1y t\u1ed5ng h\u1ee3p cao (90%\u201395%), \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u (87%\u201395%) v\u00e0 gi\u00e1 tr\u1ecb d\u1ef1 b\u00e1o \u00e2m t\u00ednh (l\u00ean \u0111\u1ebfn 86%\u201394%) trong vi\u1ec7c ph\u00e1t hi\u1ec7n h\u1eb9p n\u1ed9i s\u1ecd. Tuy nhi\u00ean, gi\u00e1 tr\u1ecb d\u1ef1 b\u00e1o d\u01b0\u01a1ng t\u00ednh c\u00f3 th\u1ec3 th\u1ea5p \u1edf m\u1ee9c 36%, v\u00ec v\u1eady c\u00e1c k\u1ebft qu\u1ea3 b\u1ea5t th\u01b0\u1eddng lu\u00f4n y\u00eau c\u1ea7u x\u00e1c nh\u1eadn l\u1ea1i b\u1eb1ng ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh m\u1ea1ch m\u00e1u (CTA), c\u1ed9ng h\u01b0\u1edfng t\u1eeb m\u1ea1ch m\u00e1u (MRA) ho\u1eb7c ch\u1ee5p m\u1ea1ch s\u1ed1 h\u00f3a x\u00f3a n\u1ec1n (DSA).<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"3\">Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n h\u1eb9p \u0111\u1ed9ng m\u1ea1ch n\u1ed9i s\u1ecd d\u1ef1a tr\u00ean c\u00e1c ng\u01b0\u1ee1ng v\u1eadn t\u1ed1c v\u00e0 t\u1ef7 l\u1ec7; c\u00e1c th\u00f4ng s\u1ed1 Doppler v\u00e0 ng\u01b0\u1ee1ng kh\u00e1c nhau \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t cho c\u00e1c ph\u00e9p \u0111o niTCD v\u00e0 TCDi (B\u1ea3ng 7). Ngo\u00e0i ra, ch\u1ec9 s\u1ed1 xung (PI) r\u1ea5t h\u1eefu \u00edch \u0111\u1ec3 ph\u00e2n bi\u1ec7t b\u1ec7nh l\u00fd khu tr\u00fa so v\u1edbi lan t\u1ecfa, v\u00ec ki\u1ec3u h\u00ecnh MFV th\u1ea5p k\u00e8m theo PI cao (\u2265 1,2) \u1edf hai ho\u1eb7c nhi\u1ec1u \u0111\u1ed9ng m\u1ea1ch g\u1ee3i \u00fd b\u1ec7nh l\u00fd n\u1ed9i s\u1ecd lan t\u1ecfa v\u1edbi \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao (\u0111\u1ed9 nh\u1ea1y 58%, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 95%). M\u1ed9t tr\u01b0\u1eddng h\u1ee3p minh h\u1ecda v\u1ec1 h\u1eb9p MCA \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n b\u1eb1ng TCDi v\u00e0 x\u00e1c nh\u1eadn b\u1eb1ng CTA \u0111\u01b0\u1ee3c cung c\u1ea5p trong H\u00ecnh 13.<\/p>\n<div class=\"container\">\n<div id=\"model-response-message-contentr_755a3b6b5ea1c426\" class=\"markdown markdown-main-panel stronger enable-updated-hr-color\" dir=\"ltr\" aria-live=\"polite\" aria-busy=\"false\">\n<p data-path-to-node=\"1\"><strong>B\u1ea3ng 7: Ng\u01b0\u1ee1ng v\u1eadn t\u1ed1c ch\u1ea9n \u0111o\u00e1n h\u1eb9p \u0111\u1ed9ng m\u1ea1ch n\u1ed9i s\u1ecd \u0111o b\u1eb1ng niTCD v\u00e0 TCDi<\/strong><\/p>\n<div class=\"horizontal-scroll-wrapper\">\n<div class=\"table-block-component\">\n<div class=\"table-block has-export-button new-table-style has-scrollbar is-at-scroll-start\">\n<div class=\"table-content\" data-hveid=\"0\" data-ved=\"0CAAQ3ecQahcKEwiBs_mvmZWUAxUAAAAAHQAAAAAQbw\">\n<table style=\"width: 100%; border-collapse: collapse; border-width: 1px;\" border=\"1\" cellpadding=\"5px\" data-path-to-node=\"2\">\n<thead>\n<tr style=\"height: 58.8px;\">\n<th style=\"border-width: 1px; padding: 5px; text-align: left; width: 117.2px;\"><span data-path-to-node=\"2,0,0,0\">\u0110\u1ed9ng m\u1ea1ch n\u1ed9i s\u1ecd<\/span><\/th>\n<th style=\"border-width: 1px; padding: 5px; text-align: left; width: 279.1px;\"><span data-path-to-node=\"2,0,1,0\">Ti\u00eau chu\u1ea9n niTCD<\/span><\/th>\n<th style=\"border-width: 1px; padding: 5px; text-align: left; width: 332.712px;\"><span data-path-to-node=\"2,0,2,0\">Ti\u00eau chu\u1ea9n TCDi*<\/span><\/th>\n<th style=\"border-width: 1px; padding: 5px; text-align: left; width: 162.038px;\"><span data-path-to-node=\"2,0,3,0\">Hi\u1ec7u ch\u1ec9nh g\u00f3c (Ch\u1ec9 TCDi)<\/span><\/th>\n<th style=\"border-width: 1px; padding: 5px; text-align: left; width: 314.15px;\"><span data-path-to-node=\"2,0,4,0\">C\u1eeda s\u1ed5 v\u00e0 M\u1eb7t c\u1eaft<\/span><\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"height: 116.8px;\">\n<td style=\"border-width: 1px; padding: 5px; width: 117.2px;\"><span data-path-to-node=\"2,1,0,0\"><strong data-path-to-node=\"2,1,0,0\" data-index-in-node=\"0\">MCA<\/strong><\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 279.1px;\">\n<p data-path-to-node=\"2,1,1,0\">H\u1eb9p <span class=\"mrel\">\u2265<\/span> 50%: MFV <span class=\"mrel\">\u2265<\/span> 100 cm\/s, SPR <span class=\"mrel\">\u2265<\/span> 2<\/p>\n<p data-path-to-node=\"2,1,1,2\">H\u1eb9p <span class=\"mrel\">\u2265<\/span> 70%: MFV <span class=\"mrel\">\u2265<\/span> 120 cm\/s, SPR <span class=\"mrel\">\u2265<\/span> 3<\/p>\n<p data-path-to-node=\"2,1,1,4\">G\u1ea7n t\u1eafc\/b\u1ec7nh l\u00fd lan t\u1ecfa: MFV &lt; 30 cm\/s, SPR &lt; 1<\/p>\n<\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 332.712px;\">\n<p data-path-to-node=\"2,1,2,0\">H\u1eb9p nh\u1eb9: PSV <span class=\"mrel\">\u2265<\/span> 155 cm\/s<\/p>\n<p data-path-to-node=\"2,1,2,2\">H\u1eb9p v\u1eeba: PSV 180\u2013220 cm\/s, EDV <span class=\"mrel\">\u2265<\/span> 75 cm\/s, MFV <span class=\"mrel\">\u2265<\/span> 110 cm\/s, SDR <span class=\"mrel\">\u2265<\/span> 2.5<\/p>\n<p data-path-to-node=\"2,1,2,4\">H\u1eb9p n\u1eb7ng: PSV <span class=\"mrel\">\u2265<\/span> 240 cm\/s, EDV <span class=\"mrel\">\u2265<\/span> 100 cm\/s, MFV <span class=\"mrel\">\u2265<\/span> 160 cm\/s, SDR <span class=\"mrel\">\u2265<\/span> 4.0<\/p>\n<\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 162.038px;\"><span data-path-to-node=\"2,1,3,0\">C\u00f3, \u01b0u ti\u00ean n\u1ebfu \u0111o\u1ea1n m\u1ea1ch th\u1eb3ng <span class=\"mrel\">\u2265<\/span> 20 mm; n\u00ean tr\u00e1nh hi\u1ec7u ch\u1ec9nh &gt; 30\u00b0<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 314.15px;\"><span data-path-to-node=\"2,1,4,0\">Xuy\u00ean th\u00e1i d\u01b0\u01a1ng, m\u1eb7t c\u1eaft tr\u1ee5c (axial)<\/span><\/td>\n<\/tr>\n<tr style=\"height: 114.8px;\">\n<td style=\"border-width: 1px; padding: 5px; width: 117.2px;\"><span data-path-to-node=\"2,2,0,0\"><strong data-path-to-node=\"2,2,0,0\" data-index-in-node=\"0\">\u0110o\u1ea1n t\u1eadn ICA<\/strong> (ch\u1ec9 TCDi)<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 279.1px;\"><span data-path-to-node=\"2,2,1,0\">Kh\u00f4ng c\u00f3 d\u1eef li\u1ec7u<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 332.712px;\">\n<p data-path-to-node=\"2,2,2,0\">H\u1eb9p v\u1eeba: PSV 150\u2013200 cm\/s, ch\u1ec9 s\u1ed1 (PSV \u0111o\u1ea1n t\u1eadn ICA \u00f7 PSV ICA \u0111o\u1ea1n xa ngo\u00e0i s\u1ecd) <span class=\"mrel\">\u2248<\/span> 2.0\u20133.0<\/p>\n<p data-path-to-node=\"2,2,2,2\">H\u1eb9p n\u1eb7ng: PSV &gt; 200 cm\/s, ch\u1ec9 s\u1ed1 &gt; 3.0<\/p>\n<\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 162.038px;\"><span data-path-to-node=\"2,2,3,0\">Kh\u00f4ng (c\u1ed1 \u0111\u1ecbnh 0\u00b0)<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 314.15px;\"><span data-path-to-node=\"2,2,4,0\">Xuy\u00ean th\u00e1i d\u01b0\u01a1ng, m\u1eb7t c\u1eaft \u0111\u1ee9ng ngang (coronal), xoay 90\u00b0 t\u1eeb m\u1eb7t c\u1eaft tr\u1ee5c th\u00f4ng th\u01b0\u1eddng<\/span><\/td>\n<\/tr>\n<tr style=\"height: 166.8px;\">\n<td style=\"border-width: 1px; padding: 5px; width: 117.2px;\"><span data-path-to-node=\"2,3,0,0\"><strong data-path-to-node=\"2,3,0,0\" data-index-in-node=\"0\">ACA<\/strong><\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 279.1px;\">\n<p data-path-to-node=\"2,3,1,0\">H\u1eb9p <span class=\"mrel\">\u2265<\/span> 50%: MFV <span class=\"mrel\">\u2265<\/span> 80 cm\/s, SPR <span class=\"mrel\">\u2265<\/span> 2<\/p>\n<p data-path-to-node=\"2,3,1,2\">H\u1eb9p <span class=\"mrel\">\u2265<\/span> 70%: Kh\u00f4ng c\u00f3 ti\u00eau chu\u1ea9n MFV, SPR <span class=\"mrel\">\u2265<\/span> 3<\/p>\n<p data-path-to-node=\"2,3,1,4\">G\u1ea7n t\u1eafc ho\u1eb7c b\u1ec7nh l\u00fd lan t\u1ecfa: MFV &lt; 30 cm\/s, SPR &lt; 1<\/p>\n<\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 332.712px;\">\n<p data-path-to-node=\"2,3,2,0\">H\u1eb9p nh\u1eb9: PSV <span class=\"mrel\">\u2265<\/span> 120 cm\/s<\/p>\n<p data-path-to-node=\"2,3,2,2\">H\u1eb9p v\u1eeba: PSV <span class=\"mrel\">\u2265<\/span> 155 cm\/s<\/p>\n<p data-path-to-node=\"2,3,2,4\">H\u1eb9p n\u1eb7ng: PSV <span class=\"mrel\">\u2265<\/span> 155 cm\/s k\u00e8m c\u00e1c d\u1ea5u hi\u1ec7u gi\u00e1n ti\u1ebfp\u2020<\/p>\n<\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 162.038px;\"><span data-path-to-node=\"2,3,3,0\">Kh\u00f4ng (c\u1ed1 \u0111\u1ecbnh 0\u00b0)<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 314.15px;\"><span data-path-to-node=\"2,3,4,0\">Xuy\u00ean th\u00e1i d\u01b0\u01a1ng, m\u1eb7t c\u1eaft tr\u1ee5c<\/span><\/td>\n<\/tr>\n<tr style=\"height: 166.8px;\">\n<td style=\"border-width: 1px; padding: 5px; width: 117.2px;\"><span data-path-to-node=\"2,4,0,0\"><strong data-path-to-node=\"2,4,0,0\" data-index-in-node=\"0\">PCA<\/strong><\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 279.1px;\">\n<p data-path-to-node=\"2,4,1,0\">H\u1eb9p <span class=\"mrel\">\u2265<\/span> 50%: MFV <span class=\"mrel\">\u2265<\/span> 80 cm\/s, SPR <span class=\"mrel\">\u2265<\/span> 2<\/p>\n<p data-path-to-node=\"2,4,1,2\">H\u1eb9p <span class=\"mrel\">\u2265<\/span> 70%: Kh\u00f4ng c\u00f3 ti\u00eau chu\u1ea9n MFV, SPR <span class=\"mrel\">\u2265<\/span> 3<\/p>\n<p data-path-to-node=\"2,4,1,4\">G\u1ea7n t\u1eafc ho\u1eb7c b\u1ec7nh l\u00fd lan t\u1ecfa: MFV &lt; 30 cm\/s, SPR &lt; 1<\/p>\n<\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 332.712px;\">\n<p data-path-to-node=\"2,4,2,0\">H\u1eb9p nh\u1eb9: PSV <span class=\"mrel\">\u2265<\/span> 100 cm\/s<\/p>\n<p data-path-to-node=\"2,4,2,2\">H\u1eb9p v\u1eeba: PSV <span class=\"mrel\">\u2265<\/span> 145 cm\/s<\/p>\n<p data-path-to-node=\"2,4,2,4\">H\u1eb9p n\u1eb7ng: PSV <span class=\"mrel\">\u2265<\/span> 145 cm\/s k\u00e8m c\u00e1c d\u1ea5u hi\u1ec7u gi\u00e1n ti\u1ebfp\u2020<\/p>\n<\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 162.038px;\"><span data-path-to-node=\"2,4,3,0\">Kh\u00f4ng (c\u1ed1 \u0111\u1ecbnh 0\u00b0)<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 314.15px;\"><span data-path-to-node=\"2,4,4,0\">Xuy\u00ean th\u00e1i d\u01b0\u01a1ng, m\u1eb7t c\u1eaft tr\u1ee5c<\/span><\/td>\n<\/tr>\n<tr style=\"height: 166.8px;\">\n<td style=\"border-width: 1px; padding: 5px; width: 117.2px;\"><span data-path-to-node=\"2,5,0,0\"><strong data-path-to-node=\"2,5,0,0\" data-index-in-node=\"0\">BA<\/strong><\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 279.1px;\">\n<p data-path-to-node=\"2,5,1,0\">H\u1eb9p <span class=\"mrel\">\u2265<\/span> 50%: MFV <span class=\"mrel\">\u2265<\/span> 90 cm\/s, SPR <span class=\"mrel\">\u2265<\/span> 2<\/p>\n<p data-path-to-node=\"2,5,1,2\">H\u1eb9p <span class=\"mrel\">\u2265<\/span> 70%: MFV <span class=\"mrel\">\u2265<\/span> 110 cm\/s, SPR <span class=\"mrel\">\u2265<\/span> 3<\/p>\n<p data-path-to-node=\"2,5,1,4\">G\u1ea7n t\u1eafc ho\u1eb7c b\u1ec7nh l\u00fd lan t\u1ecfa: MFV &lt; 20 cm\/s, SPR &lt; 1<\/p>\n<\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 332.712px;\">\n<p data-path-to-node=\"2,5,2,0\">H\u1eb9p nh\u1eb9: PSV <span class=\"mrel\">\u2265<\/span> 110 cm\/s<\/p>\n<p data-path-to-node=\"2,5,2,2\">H\u1eb9p v\u1eeba: PSV <span class=\"mrel\">\u2265<\/span> 150 cm\/s, MFV <span class=\"mrel\">\u2265<\/span> 90 cm\/s, PSV BA\/PSV VA <span class=\"mrel\">\u2265<\/span> 2.0<\/p>\n<p data-path-to-node=\"2,5,2,4\">H\u1eb9p n\u1eb7ng: PSV <span class=\"mrel\">\u2265<\/span> 210 cm\/s, MFV <span class=\"mrel\">\u2265<\/span> 120 cm\/s, PSV BA\/PSV VA <span class=\"mrel\">\u2265<\/span> 3.0<\/p>\n<\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 162.038px;\"><span data-path-to-node=\"2,5,3,0\">C\u00f3, \u01b0u ti\u00ean n\u1ebfu \u0111o\u1ea1n m\u1ea1ch th\u1eb3ng <span class=\"mrel\">\u2265<\/span> 20 mm; n\u00ean tr\u00e1nh hi\u1ec7u ch\u1ec9nh &gt; 30\u00b0<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 314.15px;\"><span data-path-to-node=\"2,5,4,0\">D\u01b0\u1edbi ch\u1ea9m (xuy\u00ean l\u1ed7 ch\u1ea9m), b\u1ec7nh nh\u00e2n \u1edf t\u01b0 th\u1ebf ng\u1ed3i<\/span><\/td>\n<\/tr>\n<tr style=\"height: 166.8px;\">\n<td style=\"border-width: 1px; padding: 5px; width: 117.2px;\"><span data-path-to-node=\"2,6,0,0\"><strong data-path-to-node=\"2,6,0,0\" data-index-in-node=\"0\">VA<\/strong> (\u0111o\u1ea1n n\u1ed9i m\u1ea1c t\u1ee7y [V4])<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 279.1px;\">\n<p data-path-to-node=\"2,6,1,0\">H\u1eb9p <span class=\"mrel\">\u2265<\/span> 50%: MFV <span class=\"mrel\">\u2265<\/span> 90 cm\/s, SPR <span class=\"mrel\">\u2265<\/span> 2<\/p>\n<p data-path-to-node=\"2,6,1,2\">H\u1eb9p <span class=\"mrel\">\u2265<\/span> 70%: MFV <span class=\"mrel\">\u2265<\/span> 110 cm\/s, SPR <span class=\"mrel\">\u2265<\/span> 3<\/p>\n<p data-path-to-node=\"2,6,1,4\">G\u1ea7n t\u1eafc ho\u1eb7c b\u1ec7nh l\u00fd lan t\u1ecfa: MFV &lt; 20 cm\/s, SPR &lt; 1<\/p>\n<\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 332.712px;\">\n<p data-path-to-node=\"2,6,2,0\">H\u1eb9p nh\u1eb9: PSV <span class=\"mrel\">\u2265<\/span> 90 cm\/s<\/p>\n<p data-path-to-node=\"2,6,2,2\">H\u1eb9p v\u1eeba: PSV <span class=\"mrel\">\u2265<\/span> 120 cm\/s<\/p>\n<p data-path-to-node=\"2,6,2,4\">H\u1eb9p n\u1eb7ng: PSV <span class=\"mrel\">\u2265<\/span> 120 cm\/s k\u00e8m c\u00e1c d\u1ea5u hi\u1ec7u gi\u00e1n ti\u1ebfp\u2020<\/p>\n<\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 162.038px;\"><span data-path-to-node=\"2,6,3,0\">C\u00f3, \u01b0u ti\u00ean n\u1ebfu \u0111o\u1ea1n m\u1ea1ch th\u1eb3ng <span class=\"mrel\">\u2265<\/span> 20 mm; n\u00ean tr\u00e1nh hi\u1ec7u ch\u1ec9nh &gt; 30\u00b0<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px; width: 314.15px;\"><span data-path-to-node=\"2,6,4,0\">D\u01b0\u1edbi ch\u1ea9m (xuy\u00ean l\u1ed7 ch\u1ea9m), b\u1ec7nh nh\u00e2n \u1edf t\u01b0 th\u1ebf ng\u1ed3i<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<div class=\"table-footer hide-from-message-actions\"><em><strong data-path-to-node=\"3\" data-index-in-node=\"0\">Ghi ch\u00fa.<\/strong>\u2014B\u1ea3ng tr\u00ecnh b\u00e0y c\u00e1c ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n h\u1eb9p \u0111\u1ed9ng m\u1ea1ch n\u1ed9i s\u1ecd b\u1eb1ng niTCD v\u00e0 TCDi (2,31\u201336).<\/em><\/div>\n<\/div>\n<\/div>\n<\/div>\n<p data-path-to-node=\"4\"><em>* H\u1eb9p <span class=\"mrel\">\u2264<\/span> 50% \u0111\u01b0\u1ee3c coi l\u00e0 nh\u1eb9; h\u1eb9p 50%\u201369% l\u00e0 v\u1eeba; v\u00e0 h\u1eb9p <span class=\"mrel\">\u2265<\/span> 70% l\u00e0 n\u1eb7ng. \u2020 C\u00e1c d\u1ea5u hi\u1ec7u gi\u00e1n ti\u1ebfp g\u1ee3i \u00fd h\u1eb9p c\u00f3 \u1ea3nh h\u01b0\u1edfng huy\u1ebft \u0111\u1ed9ng \u0111\u00e1ng k\u1ec3 bao g\u1ed3m: gi\u1ea3m v\u1eadn t\u1ed1c t\u00e2m tr\u01b0\u01a1ng v\u00e0 ph\u1ed5 kh\u00e1ng l\u1ef1c cao \u1edf \u0111o\u1ea1n g\u1ea7n, d\u1ea1ng ph\u1ed5 tardus-parvus \u1edf \u0111o\u1ea1n xa, ho\u1eb7c s\u1ef1 t\u00e1i ph\u00e2n ph\u1ed1i d\u00f2ng m\u00e1u ph\u00f9 h\u1ee3p v\u1edbi v\u1ecb tr\u00ed h\u1eb9p. <strong data-path-to-node=\"4\" data-index-in-node=\"297\">ACA<\/strong> = \u0111\u1ed9ng m\u1ea1ch n\u00e3o tr\u01b0\u1edbc, <strong data-path-to-node=\"4\" data-index-in-node=\"324\">EDV<\/strong> = v\u1eadn t\u1ed1c cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng, <strong data-path-to-node=\"4\" data-index-in-node=\"355\">PCA<\/strong> = \u0111\u1ed9ng m\u1ea1ch n\u00e3o sau, <strong data-path-to-node=\"4\" data-index-in-node=\"380\">PSV<\/strong> = v\u1eadn t\u1ed1c \u0111\u1ec9nh t\u00e2m thu, <strong data-path-to-node=\"4\" data-index-in-node=\"408\">SDR<\/strong> = t\u1ef7 l\u1ec7 t\u00e2m thu\/t\u00e2m tr\u01b0\u01a1ng, <strong data-path-to-node=\"4\" data-index-in-node=\"440\">SPR<\/strong> = t\u1ef7 l\u1ec7 v\u1eadn t\u1ed1c t\u1ea1i \u0111i\u1ec3m h\u1eb9p\/tr\u01b0\u1edbc \u0111i\u1ec3m h\u1eb9p.<\/em><\/p>\n<p data-path-to-node=\"4\"><em><img decoding=\"async\" style=\"display: block; margin-left: auto; margin-right: auto;\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/1icjE6hO0Z_sBSp9cuqSTBc97ms1mH_Xd=s0\" \/><\/em><\/p>\n<p data-path-to-node=\"1\"><em><strong data-path-to-node=\"1\" data-index-in-node=\"0\">H\u00ecnh 13.<\/strong> TCDi \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n 62 tu\u1ed5i. <strong data-path-to-node=\"1\" data-index-in-node=\"39\">(A)<\/strong> H\u00ecnh \u1ea3nh si\u00eau \u00e2m Doppler m\u00e0u cho th\u1ea5y hi\u1ec7n t\u01b0\u1ee3ng v\u01b0\u1ee3t ng\u01b0\u1ee1ng (aliasing) v\u00e0 t\u0103ng v\u1eadn t\u1ed1c \u1edf MCA ph\u1ea3i (\u0111o\u1ea1n M1), v\u1edbi v\u1eadn t\u1ed1c \u0111\u1ec9nh t\u00e2m thu (<strong data-path-to-node=\"1\" data-index-in-node=\"179\">PSV<\/strong>) l\u00e0 165 cm\/s, ph\u00f9 h\u1ee3p v\u1edbi t\u00ecnh tr\u1ea1ng h\u1eb9p nh\u1eb9. <strong data-path-to-node=\"1\" data-index-in-node=\"229\">(B)<\/strong> T\u00ecnh tr\u1ea1ng h\u1eb9p khu tr\u00fa sau \u0111\u00f3 \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn b\u1eb1ng ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh m\u1ea1ch m\u00e1u (CTA), cho th\u1ea5y h\u00ecnh \u1ea3nh h\u1eb9p \u0111o\u1ea1n M1 b\u00ean ph\u1ea3i t\u01b0\u01a1ng \u1ee9ng (m\u0169i t\u00ean).<\/em><\/p>\n<h4 data-path-to-node=\"1\">\u0110\u00e1nh gi\u00e1 m\u1ea1ch m\u00e1u b\u00e0ng h\u1ec7<\/h4>\n<p data-path-to-node=\"1\">TCD, \u0111\u1eb7c bi\u1ec7t l\u00e0 TCDi, r\u1ea5t h\u1eefu \u00edch trong vi\u1ec7c \u0111\u00e1nh gi\u00e1 c\u00e1c \u0111\u01b0\u1eddng tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 v\u00e0 h\u1ec7 qu\u1ea3 huy\u1ebft \u0111\u1ed9ng \u1edf h\u1ea1 l\u01b0u c\u1ee7a h\u1eb9p \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh, bao g\u1ed3m c\u1ea3 vi\u1ec7c \u0111\u00e1nh gi\u00e1 \u0111a gi\u00e1c Willis v\u00e0 \u0111\u1ed9ng m\u1ea1ch m\u1eaft th\u00f4ng qua c\u1eeda s\u1ed5 xuy\u00ean \u1ed5 m\u1eaft. \u0110\u1ed9ng m\u1ea1ch m\u1eaft c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n d\u00f2ng ch\u1ea3y \u0111\u1ea3o ng\u01b0\u1ee3c trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh trong (ICA) n\u1eb7ng ho\u1eb7c t\u1eafc ngh\u1ebdn, \u0111\u00f3ng vai tr\u00f2 nh\u01b0 m\u1ed9t d\u1ea5u hi\u1ec7u b\u1ed5 sung c\u1ee7a s\u1ef1 b\u00f9 tr\u1eeb b\u00e0ng h\u1ec7. M\u1ed9t tr\u01b0\u1eddng h\u1ee3p minh h\u1ecda \u0111\u01b0\u1ee3c cung c\u1ea5p trong H\u00ecnh 14.<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\"><strong data-path-to-node=\"1\" data-index-in-node=\"0\"><img decoding=\"async\" style=\"display: block; margin-left: auto; margin-right: auto;\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/1iEqJInyf0doEa3_k-bqSvVPsMGE1OMJo=s0\" \/><em>H\u00ecnh 14.<\/em><\/strong><em> T\u00e1i ph\u00e2n ph\u1ed1i d\u00f2ng ch\u1ea3y b\u00e0ng h\u1ec7 \u1edf m\u1ed9t nam gi\u1edbi 71 tu\u1ed5i b\u1ecb h\u1eb9p nhi\u1ec1u v\u1ecb tr\u00ed \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh. H\u00ecnh \u1ea3nh ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh m\u1ea1ch m\u00e1u (CTA) m\u1eb7t c\u1eaft \u0111\u1ee9ng d\u1ecdc (h\u00ecnh ngo\u00e0i c\u00f9ng b\u00ean ph\u1ea3i) cho th\u1ea5y t\u1ed5n th\u01b0\u01a1ng h\u1eb9p n\u1eb7ng \u1edf 1\/3 tr\u00ean \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh chung v\u00e0 t\u1ea1i g\u1ed1c c\u1ee7a \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh trong (ICA) (m\u0169i t\u00ean v\u00e0ng). C\u00e1c h\u00ecnh \u1ea3nh TCDi (h\u00ecnh th\u1ee9 hai v\u00e0 th\u1ee9 ba t\u1eeb tr\u00e1i sang) v\u00e0 s\u01a1 \u0111\u1ed3 t\u01b0\u01a1ng \u1ee9ng minh h\u1ecda s\u1ef1 thay \u0111\u1ed5i huy\u1ebft \u0111\u1ed9ng n\u1ed9i s\u1ecd, v\u1edbi d\u00f2ng ch\u1ea3y b\u00f9 tr\u1eeb qua \u0111a gi\u00e1c Willis. B\u1ec7nh nh\u00e2n c\u00f3 d\u00f2ng ch\u1ea3y xu\u00f4i d\u00f2ng \u0111\u01b0\u1ee3c b\u1ea3o t\u1ed3n trong \u0111\u1ed9ng m\u1ea1ch m\u1eaft (kh\u00f4ng hi\u1ec3n th\u1ecb), g\u1ee3i \u00fd s\u1ef1 huy \u0111\u1ed9ng tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 qua \u0111a gi\u00e1c Willis thay v\u00ec qua con \u0111\u01b0\u1eddng \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh ngo\u00e0i. M\u1ed9t h\u00ecnh \u1ea3nh TCDi (h\u00ecnh ngo\u00e0i c\u00f9ng b\u00ean tr\u00e1i) v\u00e0 s\u01a1 \u0111\u1ed3 t\u01b0\u01a1ng \u1ee9ng v\u1ec1 c\u1ea5u tr\u00fac \u0111a gi\u00e1c Willis b\u00ecnh th\u01b0\u1eddng \u0111\u01b0\u1ee3c cung c\u1ea5p \u0111\u1ec3 so s\u00e1nh. (\u0110\u01b0\u1ee3c t\u1ea1o b\u1eb1ng BioRender. Esmeraldo M [2025], <a class=\"ng-star-inserted\" href=\"https:\/\/BioRender.com\/dsjzjk4\" target=\"_blank\" rel=\"noopener\" data-hveid=\"0\" data-ved=\"0CAAQ_4QMahgKEwiBs_mvmZWUAxUAAAAAHQAAAAAQowI\">https:\/\/BioRender.com\/dsjzjk4<\/a>.)<\/em><\/p>\n<h4 style=\"text-align: justify;\" data-path-to-node=\"1\">Thi\u1ebfu n\u0103ng tu\u1ea7n ho\u00e0n h\u1ec7 \u0111\u1ed1t s\u1ed1ng &#8211; th\u00e2n n\u1ec1n v\u00e0 b\u1ec7nh l\u00fd t\u1eafc h\u1eb9p tu\u1ea7n ho\u00e0n sau n\u1ed9i s\u1ecd<\/h4>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\">Thi\u1ebfu n\u0103ng tu\u1ea7n ho\u00e0n h\u1ec7 \u0111\u1ed1t s\u1ed1ng &#8211; th\u00e2n n\u1ec1n (VBI) l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 gi\u1ea3m d\u00f2ng m\u00e1u trong h\u1ec7 tu\u1ea7n ho\u00e0n sau c\u1ee7a n\u00e3o, v\u1ed1n \u0111\u01b0\u1ee3c cung c\u1ea5p b\u1edfi \u0111\u1ed9ng m\u1ea1ch \u0111\u1ed1t s\u1ed1ng (VA) v\u00e0 \u0111\u1ed9ng m\u1ea1ch th\u00e2n n\u1ec1n (BA). M\u1eb7c d\u00f9 VBI th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n \u0111\u00fang m\u1ee9c, \u0111\u00e2y l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn g\u00e2y ch\u00f3ng m\u1eb7t, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf ng\u01b0\u1eddi cao tu\u1ed5i. \u01af\u1edbc t\u00ednh c\u00f3 t\u1edbi 5% c\u00e1 nh\u00e2n tr\u00ean 60 tu\u1ed5i g\u1eb7p t\u00ecnh tr\u1ea1ng ch\u00f3ng m\u1eb7t c\u00f3 nguy\u00ean nh\u00e2n b\u1ec7nh l\u00fd VBI ti\u1ec1m \u1ea9n. C\u00e1c tri\u1ec7u ch\u1ee9ng ch\u00ednh c\u1ee7a VBI bao g\u1ed3m ch\u00f3ng m\u1eb7t quay, nh\u00ecn \u0111\u00f4i, lo\u1ea1n ng\u00f4n, ch\u00f3ng m\u1eb7t v\u00e0 r\u1ed1i lo\u1ea1n th\u1ecb gi\u00e1c. Nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u c\u1ee7a VBI l\u00e0 x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch. C\u00e1c nguy\u00ean nh\u00e2n kh\u1ea3 thi kh\u00e1c bao g\u1ed3m thuy\u00ean t\u1eafc m\u1ea1ch, b\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch \u0111\u1ed1t s\u1ed1ng v\u00e0 c\u00e1c b\u1ec7nh l\u00fd \u0111\u00f4ng m\u00e1u, c\u00f9ng m\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n kh\u00e1c.<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"2\">Trong Ti\u00eau chu\u1ea9n Ph\u00f9 h\u1ee3p c\u1ee7a Tr\u01b0\u1eddng Cao \u0111\u1eb3ng \u0110i\u1ec7n quang Hoa K\u1ef3, TCD \u0111\u01b0\u1ee3c d\u1eabn ch\u1ee9ng l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 ti\u1ec1m n\u0103ng h\u1eefu \u00edch trong vi\u1ec7c \u0111\u00e1nh gi\u00e1 ch\u00f3ng m\u1eb7t quay, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi nghi ng\u1edd c\u00f3 VBI. TCD \u0111\u00e3 ch\u1ee9ng minh c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m d\u00f2ng m\u00e1u kh\u00e1c bi\u1ec7t gi\u1eefa nh\u1eefng c\u00e1 nh\u00e2n b\u1ecb ch\u00f3ng m\u1eb7t do VBI, nh\u1eefng ng\u01b0\u1eddi ch\u00f3ng m\u1eb7t do c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c v\u00e0 c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng ki\u1ec3m ch\u1ee9ng kh\u1ecfe m\u1ea1nh (H\u00ecnh 15).<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"2\"><img decoding=\"async\" style=\"display: block; margin-left: auto; margin-right: auto;\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/1KF-kQkVHwcCejXHF9K5qGmGDavQ_8Fcg=s0\" \/><em><strong data-path-to-node=\"1\" data-index-in-node=\"0\">H\u00ecnh 15.<\/strong> Hi\u1ec7n t\u01b0\u1ee3ng c\u01b0\u1edbp m\u00e1u \u0111\u1ed9ng m\u1ea1ch d\u01b0\u1edbi \u0111\u00f2n \u1edf m\u1ed9t ph\u1ee5 n\u1eef 69 tu\u1ed5i b\u1ecb ch\u00f3ng m\u1eb7t ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c k\u00edch ho\u1ea1t khi s\u1eed d\u1ee5ng tay tr\u00e1i. <strong data-path-to-node=\"1\" data-index-in-node=\"127\">B\u00ean tr\u00e1i:<\/strong> H\u00ecnh \u1ea3nh ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh m\u1ea1ch m\u00e1u (CTA) cho th\u1ea5y t\u1eafc \u0111o\u1ea1n g\u1ea7n \u0111\u1ed9ng m\u1ea1ch d\u01b0\u1edbi \u0111\u00f2n tr\u00e1i. <strong data-path-to-node=\"1\" data-index-in-node=\"229\">B\u00ean ph\u1ea3i:<\/strong> H\u00ecnh \u1ea3nh si\u00eau \u00e2m xuy\u00ean s\u1ecd cho th\u1ea5y d\u00f2ng ch\u1ea3y \u0111\u1ea3o ng\u01b0\u1ee3c \u1edf \u0111o\u1ea1n V4 \u0111\u1ed9ng m\u1ea1ch \u0111\u1ed1t s\u1ed1ng tr\u00e1i v\u00e0 \u0111\u1ed9ng m\u1ea1ch th\u00e2n n\u1ec1n; \u1edf c\u1ea3 hai m\u1ea1ch m\u00e1u, d\u00f2ng ch\u1ea3y h\u01b0\u1edbng v\u1ec1 ph\u00eda \u0111\u1ea7u d\u00f2 m\u1ed9t c\u00e1ch b\u1ea5t th\u01b0\u1eddng (\u0111\u01b0\u1ee3c m\u00e3 h\u00f3a m\u00e0u \u0111\u1ecf). D\u1ea1ng ph\u1ed5 Doppler \u0111\u1ed9ng m\u1ea1ch th\u00e2n n\u1ec1n cho th\u1ea5y d\u00f2ng ch\u1ea3y v\u1eadn t\u1ed1c cao lu\u00e2n phi\u00ean nh\u01b0ng ch\u1ee7 y\u1ebfu l\u00e0 ng\u01b0\u1ee3c chi\u1ec1u, ph\u00f9 h\u1ee3p v\u1edbi hi\u1ec7n t\u01b0\u1ee3ng c\u01b0\u1edbp m\u00e1u \u0111\u1ed9ng m\u1ea1ch d\u01b0\u1edbi \u0111\u00f2n k\u00e8m \u0111\u1ea3o ng\u01b0\u1ee3c d\u00f2ng ch\u1ea3y \u0111\u1ed9ng m\u1ea1ch th\u00e2n n\u1ec1n.<\/em><\/p>\n<\/div>\n<\/div>\n<p style=\"text-align: justify;\" data-path-to-node=\"0\">C\u00e1c th\u00f4ng s\u1ed1 ti\u00eau chu\u1ea9n kh\u00e1ch quan \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n VBI khi s\u1eed d\u1ee5ng TCD c\u00f2n thi\u1ebfu s\u1ef1 chu\u1ea9n h\u00f3a v\u00e0 c\u00e1c khuy\u1ebfn ngh\u1ecb h\u01b0\u1edbng d\u1eabn ch\u00ednh th\u1ee9c, v\u1edbi b\u1eb1ng ch\u1ee9ng hi\u1ec7n t\u1ea1i ch\u1ee7 y\u1ebfu d\u1ef1a tr\u00ean m\u1ed9t v\u00e0i nghi\u00ean c\u1ee9u v\u00e0 b\u00e1o c\u00e1o ca b\u1ec7nh (41\u201343). \u1ede nh\u1eefng c\u00e1 nh\u00e2n kh\u1ecfe m\u1ea1nh, MFV c\u1ee7a BA thay \u0111\u1ed5i kh\u00f4ng qu\u00e1 5% trong qu\u00e1 tr\u00ecnh xoay \u0111\u1ea7u, trong khi \u1edf nh\u1eefng ng\u01b0\u1eddi c\u00f3 c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed1t s\u1ed1ng c\u00f3 tri\u1ec7u ch\u1ee9ng, c\u00f3 th\u1ec3 quan s\u00e1t th\u1ea5y s\u1ef1 s\u1ee5t gi\u1ea3m t\u1eeb 30% tr\u1edf l\u00ean \u0111\u1ed1i v\u1edbi MFV c\u1ee7a BA trong khi quay \u0111\u1ea7u t\u1eeb 60\u00b0 tr\u1edf l\u00ean, c\u00f9ng v\u1edbi t\u00ecnh tr\u1ea1ng xung huy\u1ebft tho\u00e1ng qua sau khi \u0111\u1ea7u \u0111\u01b0\u1ee3c \u0111\u01b0a v\u1ec1 v\u1ecb tr\u00ed trung gian. D\u1ef1a tr\u00ean nh\u1eefng ph\u00e1t hi\u1ec7n n\u00e0y, s\u1ef1 s\u1ee5t gi\u1ea3m 20% MFV \u1edf t\u01b0 th\u1ebf c\u00f3 tri\u1ec7u ch\u1ee9ng \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t l\u00e0m ng\u01b0\u1ee1ng ch\u1ea9n \u0111o\u00e1n (43). Thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 c\u00e1nh tay tho\u00e1ng qua do b\u01a1m v\u00e0 x\u1ea3 b\u0103ng qu\u1ea5n c\u00e1nh tay tr\u00ean m\u1ee9c huy\u1ebft \u00e1p t\u00e2m thu \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u00e0 m\u1ed9t nghi\u1ec7m ph\u00e1p k\u00edch th\u00edch \u0111\u1ed1i v\u1edbi VBI trong b\u1ec7nh c\u1ea3nh c\u01b0\u1edbp m\u00e1u \u0111\u1ed9ng m\u1ea1ch d\u01b0\u1edbi \u0111\u00f2n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng \u0111\u1ea3o ng\u01b0\u1ee3c d\u00f2ng ch\u1ea3y \u0111\u1ed9ng m\u1ea1ch th\u00e2n n\u1ec1n; tuy nhi\u00ean, b\u1eb1ng ch\u1ee9ng h\u1ed7 tr\u1ee3 c\u00f2n h\u1ea1n ch\u1ebf v\u00e0 ti\u1ec7n \u00edch l\u00e2m s\u00e0ng c\u1ee7a n\u00f3 v\u1eabn ch\u01b0a r\u00f5 r\u00e0ng (44).<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\">Trong b\u1ec7nh c\u1ea3nh VBI, TCD kh\u00f4ng ch\u1ec9 \u0111\u00f3ng vai tr\u00f2 l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 ch\u1ea9n \u0111o\u00e1n m\u00e0 c\u00f2n l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ti\u1ec7n ph\u00e2n t\u1ea7ng nguy c\u01a1. V\u1eadn t\u1ed1c trung b\u00ecnh h\u1ec7 \u0111\u1ed1t s\u1ed1ng &#8211; th\u00e2n n\u1ec1n ch\u1eadm h\u01a1n 15 cm\/s c\u00f3 li\u00ean quan \u0111\u1ebfn nguy c\u01a1 nh\u1ed3i m\u00e1u tu\u1ea7n ho\u00e0n sau (t\u1ef7 s\u1ed1 s\u1ed1 ch\u00eanh: 2,55) v\u00e0 t\u1ed5ng s\u1ed1 ca \u0111\u1ed9t qu\u1ef5 do thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 (t\u1ef7 s\u1ed1 s\u1ed1 ch\u00eanh: 1,75) cao h\u01a1n, v\u1edbi v\u1eadn t\u1ed1c gi\u1ea3m \u0111\u00e1ng k\u1ec3 theo tu\u1ed5i t\u00e1c (45).<\/p>\n<h4 style=\"text-align: justify;\" data-path-to-node=\"2\">\u0110\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 c\u1ea5p t\u00ednh<\/h4>\n<p style=\"text-align: justify;\" data-path-to-node=\"3\">TCD c\u00f3 kh\u1ea3 n\u0103ng ph\u00e1t hi\u1ec7n t\u1eafc ngh\u1ebdn m\u1ea1ch m\u00e1u l\u1edbn trong b\u1ec7nh c\u1ea3nh \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 c\u1ea5p t\u00ednh. Trong c\u00e1c ph\u00e2n t\u00edch g\u1ed9p, \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u t\u1ed5ng h\u1ee3p kho\u1ea3ng 90%\u201395% \u0111\u1ed1i v\u1edbi vi\u1ec7c ph\u00e1t hi\u1ec7n c\u00e1c t\u1eafc ngh\u1ebdn m\u1ea1ch m\u00e1u l\u1edbn \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf MCA (H\u00ecnh 16) (32). Tuy nhi\u00ean, vi\u1ec7c \u0111\u00e1nh gi\u00e1 b\u1eb1ng TCD kh\u00f4ng \u0111\u01b0\u1ee3c l\u00e0m ch\u1eadm tr\u1ec5 li\u1ec7u ph\u00e1p t\u00e1i t\u01b0\u1edbi m\u00e1u; n\u1ebfu s\u1eed d\u1ee5ng TCD, t\u1ed1t h\u01a1n l\u00e0 n\u00ean th\u1ef1c hi\u1ec7n n\u00f3 trong khi \u0111ang ti\u1ebfn h\u00e0nh h\u01a1n l\u00e0 tr\u01b0\u1edbc khi ti\u00eau huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch, v\u00ec TCD tr\u01b0\u1edbc ti\u00eau huy\u1ebft kh\u1ed1i c\u00f3 th\u1ec3 l\u00e0m t\u0103ng th\u1eddi gian &#8220;t\u1eeb c\u1eeda \u0111\u1ebfn khi ti\u00eam thu\u1ed1c&#8221; trong b\u1ed1i c\u1ea3nh qu\u1ea3n l\u00fd \u0111\u1ed9t qu\u1ef5 c\u1ea5p t\u00ednh. M\u1eb7c d\u00f9 TCD c\u00f3 th\u1ec3 cho ph\u00e9p \u0111\u00e1nh gi\u00e1 t\u00e1i t\u01b0\u1edbi m\u00e1u theo th\u1eddi gian th\u1ef1c \u0111\u1ec3 \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb, nh\u01b0ng m\u1ed1i quan h\u1ec7 nh\u00e2n qu\u1ea3 r\u00f5 r\u00e0ng gi\u1eefa vi\u1ec7c s\u1eed d\u1ee5ng TCD v\u00e0 k\u1ebft qu\u1ea3 \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh (46).<\/p>\n<p data-path-to-node=\"3\"><img decoding=\"async\" style=\"display: block; margin-left: auto; margin-right: auto;\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/1_5pOsRDIwDiSXgivw5HHxyqDl7uLRgm0=s0\" \/><\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\"><em><strong data-path-to-node=\"1\" data-index-in-node=\"0\">H\u00ecnh 16.<\/strong> T\u1eafc MCA ph\u1ea3i g\u1ea7n \u0111\u00e2y \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n 48 tu\u1ed5i b\u1ecb y\u1ebfu n\u1eeda ng\u01b0\u1eddi b\u00ean tr\u00e1i. <strong data-path-to-node=\"1\" data-index-in-node=\"81\">(A)<\/strong> H\u00ecnh \u1ea3nh ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh m\u1ea1ch m\u00e1u m\u1eb7t c\u1eaft tr\u1ee5c (tr\u00ean c\u00f9ng \u1edf gi\u1eefa) cho th\u1ea5y t\u1eafc \u0111o\u1ea1n g\u1ea7n M1 b\u00ean ph\u1ea3i. H\u00ecnh \u1ea3nh \u0111\u01b0\u1ee3c xoay 90\u00b0 theo chi\u1ec1u kim \u0111\u1ed3ng h\u1ed3 (d\u01b0\u1edbi c\u00f9ng b\u00ean ph\u1ea3i) \u0111\u1ec3 so s\u00e1nh v\u1edbi h\u00ecnh \u1ea3nh TCDi (d\u01b0\u1edbi c\u00f9ng b\u00ean tr\u00e1i), v\u1ed1n cho th\u1ea5y s\u1ef1 v\u1eafng m\u1eb7t c\u1ee7a d\u00f2ng ch\u1ea3y trong MCA ph\u1ea3i. M\u0169i t\u00ean v\u00e0ng ch\u1ec9 \u0111o\u1ea1n b\u1ecb t\u1eafc. <strong data-path-to-node=\"1\" data-index-in-node=\"394\">(B)<\/strong> C\u00e1c k\u1ebft qu\u1ea3 h\u00ecnh \u1ea3nh Doppler ph\u1ed5 x\u00e1c nh\u1eadn s\u1ef1 v\u1eafng m\u1eb7t c\u1ee7a d\u00f2ng ch\u1ea3y trong MCA ph\u1ea3i, ng\u01b0\u1ee3c l\u1ea1i v\u1edbi d\u00f2ng ch\u1ea3y b\u00ecnh th\u01b0\u1eddng \u1edf MCA tr\u00e1i.<\/em><\/p>\n<h4 data-path-to-node=\"0\">Ph\u00e1t hi\u1ec7n ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch n\u1ed9i s\u1ecd<\/h4>\n<p data-path-to-node=\"0\">TCDi \u0111\u00f4i khi c\u00f3 th\u1ec3 m\u00f4 t\u1ea3 c\u00e1c t\u00fai ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch n\u1ed9i s\u1ecd l\u1edbn\u2014\u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng t\u00fai ph\u00ecnh l\u1edbn h\u01a1n 5 mm (H\u00ecnh 17). \u0110\u1ed9 nh\u1ea1y tr\u00ean m\u1ed7i b\u1ec7nh nh\u00e2n dao \u0111\u1ed9ng t\u1eeb 40% \u0111\u1ebfn 78%, v\u1edbi \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u kho\u1ea3ng 90%\u201391% (47). Tuy nhi\u00ean, TCDi kh\u00f4ng \u0111\u00e1ng tin c\u1eady \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c t\u00fai ph\u00ecnh nh\u1ecf (\u22645 mm) ho\u1eb7c nh\u1eefng t\u00fai ph\u00ecnh n\u1eb1m \u1edf \u0111o\u1ea1n xoang hang ho\u1eb7c \u0111o\u1ea1n t\u1eadn \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh trong (ICA) (48). Do \u0111\u00f3, kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng n\u00f3 \u0111\u01a1n \u0111\u1ed9c \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00fai ph\u00ecnh do \u0111\u1ed9 nh\u1ea1y h\u1ea1n ch\u1ebf v\u00e0 kh\u00f4ng \u0111\u1ee7 b\u1eb1ng ch\u1ee9ng v\u1ec1 hi\u1ec7u qu\u1ea3; c\u00e1c k\u1ef9 thu\u1eadt h\u00ecnh \u1ea3nh ti\u00eau chu\u1ea9n v\u1eabn c\u1ea7n thi\u1ebft \u0111\u1ec3 ph\u00e1t hi\u1ec7n \u0111\u00e1ng tin c\u1eady.<\/p>\n<p data-path-to-node=\"0\"><img decoding=\"async\" style=\"display: block; margin-left: auto; margin-right: auto;\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/1G7oqYIAkRwsE3WriW7CAW4ZK99VeGV5f=s0\" \/><\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\"><em><strong data-path-to-node=\"1\" data-index-in-node=\"0\">H\u00ecnh 17.<\/strong> H\u00ecnh \u1ea3nh ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh m\u1ea1ch m\u00e1u (<strong data-path-to-node=\"1\" data-index-in-node=\"49\">CTA<\/strong>) m\u1eb7t c\u1eaft tr\u1ee5c (tr\u00e1i), Doppler m\u00e0u TCDi (gi\u1eefa) v\u00e0 Doppler n\u0103ng l\u01b0\u1ee3ng TCDi (ph\u1ea3i) \u1edf m\u1ed9t ph\u1ee5 n\u1eef 52 tu\u1ed5i b\u1ecb \u0111au \u0111\u1ea7u. H\u00ecnh ph\u00f3ng to c\u1ee7a \u1ea3nh CTA, \u0111\u01b0\u1ee3c xoay 90\u00b0 theo chi\u1ec1u kim \u0111\u1ed3ng h\u1ed3 \u0111\u1ec3 kh\u1edbp v\u1edbi h\u01b0\u1edbng c\u1ee7a TCDi, cho th\u1ea5y hai t\u00fai ph\u00ecnh: m\u1ed9t t\u00fai ph\u00ecnh 15 mm (m\u0169i t\u00ean \u0111en) \u1edf \u0111o\u1ea1n m\u1eaft c\u1ee7a \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh trong (ICA) ph\u1ea3i v\u00e0 m\u1ed9t t\u00fai ph\u00ecnh 4 mm (m\u0169i t\u00ean tr\u1eafng) t\u1ea1i ch\u1ed7 chia nh\u00e1nh M1\u2013M2. Tr\u00ean c\u00e1c h\u00ecnh \u1ea3nh Doppler m\u00e0u (gi\u1eefa) v\u00e0 Doppler n\u0103ng l\u01b0\u1ee3ng TCDi (ph\u1ea3i), t\u00fai ph\u00ecnh l\u1edbn h\u01a1n (m\u0169i t\u00ean \u0111en) c\u00f3 th\u1ec3 d\u1ec5 d\u00e0ng nh\u00ecn th\u1ea5y, trong khi t\u00fai ph\u00ecnh nh\u1ecf h\u01a1n (m\u0169i t\u00ean tr\u1eafng) kh\u00f3 ph\u00e2n bi\u1ec7t v\u1edbi d\u00f2ng ch\u1ea3y xo\u1eafn v\u1eb7n b\u00ecnh th\u01b0\u1eddng.<\/em><\/p>\n<h4 data-path-to-node=\"1\">\u01af\u1edbc t\u00ednh \u00e1p l\u1ef1c n\u1ed9i s\u1ecd kh\u00f4ng x\u00e2m l\u1ea5n<\/h4>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\">T\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd (ICP), th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 ICP l\u1edbn h\u01a1n 20 mm Hg \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh, c\u00f3 th\u1ec3 l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a nhi\u1ec1u lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng n\u00e3o kh\u00e1c nhau v\u00e0 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn tho\u00e1t v\u1ecb n\u00e3o, thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 ho\u1eb7c t\u1eed vong. M\u1eb7c d\u00f9 \u0111o ICP tr\u1ef1c ti\u1ebfp b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p \u0111\u1eb7t catheter v\u1eabn l\u00e0 ti\u00eau chu\u1ea9n tham chi\u1ebfu, nh\u01b0ng t\u00ednh ch\u1ea5t x\u00e2m l\u1ea5n, nhu c\u1ea7u th\u1ef1c hi\u1ec7n ph\u1eabu thu\u1eadt v\u00e0 c\u00e1c r\u1ee7i ro li\u00ean quan \u0111\u00e3 h\u1ea1n ch\u1ebf kh\u1ea3 n\u0103ng \u1ee9ng d\u1ee5ng c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p n\u00e0y. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p thay th\u1ebf kh\u00f4ng x\u00e2m l\u1ea5n, bao g\u1ed3m c\u00e1c k\u1ef9 thu\u1eadt d\u1ef1a tr\u00ean si\u00eau \u00e2m, \u0111\u00e3 tr\u1edf th\u00e0nh nh\u1eefng c\u00f4ng c\u1ee5 c\u00f3 gi\u00e1 tr\u1ecb.<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"2\"><strong data-path-to-node=\"2\" data-index-in-node=\"0\">\u0110\u01b0\u1eddng k\u00ednh bao d\u00e2y th\u1ea7n kinh th\u1ecb gi\u00e1c.<\/strong> \u2014 \u0110\u00e1nh gi\u00e1 \u0111\u01b0\u1eddng k\u00ednh bao d\u00e2y th\u1ea7n kinh th\u1ecb gi\u00e1c b\u1eb1ng si\u00eau \u00e2m xuy\u00ean \u1ed5 m\u1eaft l\u00e0 m\u1ed9t d\u1ea5u hi\u1ec7u gi\u00e1n ti\u1ebfp \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn t\u1ed1t c\u1ee7a t\u00ecnh tr\u1ea1ng t\u0103ng ICP. V\u00ec bao d\u00e2y th\u1ea7n kinh th\u1ecb gi\u00e1c li\u00ean t\u1ee5c v\u1edbi khoang d\u01b0\u1edbi nh\u1ec7n n\u00ean n\u00f3 s\u1ebd gi\u00e3n ra khi ICP t\u0103ng. Trong c\u00e1c ph\u00e2n t\u00edch g\u1ed9p, \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u l\u1ea7n l\u01b0\u1ee3t kho\u1ea3ng 90% v\u00e0 87% \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o, v\u1edbi c\u00e1c gi\u00e1 tr\u1ecb ng\u01b0\u1ee1ng t\u1ed1i \u01b0u n\u1eb1m trong kho\u1ea3ng t\u1eeb 5,6 mm \u0111\u1ebfn 6,3 mm. Quy tr\u00ecnh \u0111o \u0111\u01b0\u1eddng k\u00ednh bao d\u00e2y th\u1ea7n kinh th\u1ecb gi\u00e1c \u0111\u01b0\u1ee3c minh h\u1ecda trong H\u00ecnh 18.<\/p>\n<p data-path-to-node=\"2\"><img decoding=\"async\" style=\"display: block; margin-left: auto; margin-right: auto;\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/15n_Q2vVX4g5SGGBUDV9d5nm0_yyw4rMd=s0\" \/><\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\"><em><strong data-path-to-node=\"1\" data-index-in-node=\"0\">H\u00ecnh 18.<\/strong> \u0110o \u0111\u01b0\u1eddng k\u00ednh bao d\u00e2y th\u1ea7n kinh th\u1ecb gi\u00e1c b\u1eb1ng si\u00eau \u00e2m xuy\u00ean \u1ed5 m\u1eaft \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n v\u1edbi m\u1ed9t \u0111\u1ea7u d\u00f2 tuy\u1ebfn t\u00ednh (t\u1ea7n s\u1ed1 cao) \u0111\u1eb7t tr\u00ean m\u00ed m\u1eaft tr\u00ean \u0111\u00e3 nh\u1eafm c\u1ee7a b\u1ec7nh nh\u00e2n \u1edf t\u01b0 th\u1ebf n\u1eb1m ng\u1eeda. Ph\u00e9p \u0111o \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n t\u1ea1i v\u1ecb tr\u00ed c\u00e1ch nh\u00e3n c\u1ea7u 3 mm v\u1ec1 ph\u00eda sau. Bao d\u00e2y th\u1ea7n kinh th\u1ecb gi\u00e1c xu\u1ea5t hi\u1ec7n d\u01b0\u1edbi d\u1ea1ng c\u1ea5u tr\u00fac gi\u1ea3m \u00e2m hai l\u1edbp bao quanh d\u00e2y th\u1ea7n kinh th\u1ecb gi\u00e1c c\u0169ng gi\u1ea3m \u00e2m. M\u1ed7i c\u1ea5u tr\u00fac \u0111\u1ec1u \u0111\u01b0\u1ee3c ch\u1ec9 d\u1eabn t\u01b0\u01a1ng \u1ee9ng b\u1eb1ng c\u00e1c m\u0169i t\u00ean trong h\u00ecnh b\u00ean ph\u1ea3i.<\/em><\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\"><strong data-path-to-node=\"1\" data-index-in-node=\"0\">C\u00e1c th\u00f4ng s\u1ed1 ngu\u1ed3n g\u1ed1c t\u1eeb Doppler.<\/strong> \u2014 Vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c ch\u1ec9 s\u1ed1 TCD nh\u01b0 ch\u1ec9 s\u1ed1 xung v\u00e0 ICP \u01b0\u1edbc t\u00ednh mang l\u1ea1i \u0111\u1ed9 ch\u00ednh x\u00e1c ch\u1ea9n \u0111o\u00e1n l\u00ean \u0111\u1ebfn 85%\u201386% c\u00e1c tr\u01b0\u1eddng h\u1ee3p. Vi\u1ec7c k\u1ebft h\u1ee3p c\u00e1c ph\u00e9p \u0111o n\u00e0y v\u1edbi \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1eddng k\u00ednh bao d\u00e2y th\u1ea7n kinh th\u1ecb gi\u00e1c gi\u00fap c\u1ea3i thi\u1ec7n h\u01a1n n\u1eefa \u0111\u1ed9 ch\u00ednh x\u00e1c l\u00ean tr\u00ean 90%. ICP \u01b0\u1edbc t\u00ednh c\u00f3 gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n \u00e2m t\u00ednh cao (96%), trong khi ch\u1ec9 s\u1ed1 xung \u00edt nh\u1ea5t qu\u00e1n h\u01a1n v\u00e0 n\u00ean \u0111\u01b0\u1ee3c di\u1ec5n gi\u1ea3i m\u1ed9t c\u00e1ch th\u1eadn tr\u1ecdng trong b\u1ed1i c\u1ea3nh c\u1ee5 th\u1ec3. C\u00e1c th\u00f4ng s\u1ed1 ch\u00ednh \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00e1t hi\u1ec7n t\u0103ng ICP kh\u00f4ng x\u00e2m l\u1ea5n, c\u0169ng nh\u01b0 c\u00e1c kho\u1ea3ng b\u00ecnh th\u01b0\u1eddng v\u00e0 gi\u00e1 tr\u1ecb ng\u01b0\u1ee1ng g\u1ee3i \u00fd c\u1ee7a ch\u00fang, \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft trong B\u1ea3ng 8.<\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"2\"><strong data-path-to-node=\"2\" data-index-in-node=\"0\">B\u1ea3ng 8: C\u00e1c th\u00f4ng s\u1ed1 si\u00eau \u00e2m ch\u00ednh v\u00e0 gi\u00e1 tr\u1ecb ng\u01b0\u1ee1ng g\u1ee3i \u00fd \u0111\u1ec3 \u01b0\u1edbc t\u00ednh t\u0103ng ICP kh\u00f4ng x\u00e2m l\u1ea5n<\/strong><\/p>\n<table style=\"border-collapse: collapse; border-width: 1px;\" border=\"1\" data-path-to-node=\"3\">\n<thead>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><strong>Th\u00f4ng s\u1ed1 si\u00eau \u00e2m<\/strong><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><strong>Ng\u01b0\u1ee1ng g\u1ee3i \u00fd cho t\u0103ng ICP<\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"3,1,0,0\">\u0110\u01b0\u1eddng k\u00ednh bao d\u00e2y th\u1ea7n kinh th\u1ecb gi\u00e1c<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"3,1,1,0\">&gt;5 mm cho \u0111\u1ed9 nh\u1ea1y cao h\u01a1n; &gt;6 mm cho \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao h\u01a1n<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"3,2,0,0\">eICP<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"3,2,1,0\">&gt;20,5 mm Hg<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"3,3,0,0\">MCA PI<\/span><\/td>\n<td style=\"border-width: 1px; padding: 5px;\"><span data-path-to-node=\"3,3,1,0\">&gt;1,2<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"horizontal-scroll-wrapper\">\n<div class=\"table-block-component\" style=\"text-align: justify;\">\n<div class=\"table-block has-export-button new-table-style is-at-scroll-start is-at-scroll-end\">\n<div class=\"table-content\" data-hveid=\"0\" data-ved=\"0CAAQ3ecQahgKEwiBs_mvmZWUAxUAAAAAHQAAAAAQiAQ\">\n<p style=\"text-align: justify;\" data-path-to-node=\"4\"><em data-path-to-node=\"4\" data-index-in-node=\"0\">L\u01b0u \u00fd.\u2014\u00c1p l\u1ef1c n\u1ed9i s\u1ecd \u01b0\u1edbc t\u00ednh (eICP) = huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch trung b\u00ecnh \u00d7 (1 &#8211; EDV\/TAMEAN) &#8211; 14, trong \u0111\u00f3 EDV = v\u1eadn t\u1ed1c cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng v\u00e0 TAMEAN = v\u1eadn t\u1ed1c trung b\u00ecnh theo th\u1eddi gian. PI = ch\u1ec9 s\u1ed1 xung.<\/em><\/p>\n<h3 style=\"text-align: justify;\" data-path-to-node=\"5\">Si\u00eau \u00e2m xuy\u00ean s\u1ecd (TCS) thang x\u00e1m (B-Mode): \u1ee8ng d\u1ee5ng nhu m\u00f4<\/h3>\n<h4 style=\"text-align: justify;\" data-path-to-node=\"6\">B\u1ec7nh Parkinson v\u00e0 c\u00e1c r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng<\/h4>\n<p style=\"text-align: justify;\" data-path-to-node=\"6\">TCS \u0111\u00e3 n\u1ed5i l\u00ean nh\u01b0 m\u1ed9t k\u1ef9 thu\u1eadt ti\u1ec1m n\u0103ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 b\u1ec7nh Parkinson (PD), ch\u1ee7 y\u1ebfu b\u1eb1ng c\u00e1ch hi\u1ec3n th\u1ecb v\u00f9ng t\u0103ng h\u1ed3i \u00e2m c\u1ee7a ch\u1ea5t \u0111en (substantia nigra). Ph\u00e1t hi\u1ec7n si\u00eau \u00e2m n\u00e0y \u0111\u01b0\u1ee3c th\u1ea5y \u1edf kho\u1ea3ng 90% b\u1ec7nh nh\u00e2n PD v\u00f4 c\u0103n v\u00e0 \u00edt ph\u1ed5 bi\u1ebfn h\u01a1n nhi\u1ec1u (th\u1ea5y trong kho\u1ea3ng 10% tr\u01b0\u1eddng h\u1ee3p) \u1edf c\u00e1c h\u1ed9i ch\u1ee9ng Parkinson kh\u00e1c nh\u01b0 teo \u0111a h\u1ec7 th\u1ed1ng v\u00e0 li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n (H\u00ecnh 19, 20).<\/p>\n<p data-path-to-node=\"6\"><img decoding=\"async\" style=\"display: block; margin-left: auto; margin-right: auto;\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/1oFXQCCEhAXUNxsK9llu41VcR0YCblZ1g=s0\" \/><\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\"><em><strong data-path-to-node=\"1\" data-index-in-node=\"0\">H\u00ecnh 19.<\/strong> \u0110\u00e1nh gi\u00e1 n\u00e3o gi\u1eefa qua c\u1eeda s\u1ed5 xuy\u00ean th\u00e1i d\u01b0\u01a1ng. <strong data-path-to-node=\"1\" data-index-in-node=\"56\">B\u00ean tr\u00e1i:<\/strong> S\u01a1 \u0111\u1ed3 n\u00e3o gi\u1eefa (m\u0169i t\u00ean r\u1ed7ng) v\u00e0 v\u1ecb tr\u00ed gi\u1ea3i ph\u1eabu c\u1ee7a ch\u1ea5t \u0111en (m\u0169i t\u00ean \u0111\u1eb7c). <strong data-path-to-node=\"1\" data-index-in-node=\"144\">B\u00ean ph\u1ea3i:<\/strong> H\u00ecnh \u1ea3nh si\u00eau \u00e2m t\u01b0\u01a1ng \u1ee9ng \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n m\u1eafc PD cho th\u1ea5y n\u00e3o gi\u1eefa (m\u0169i t\u00ean r\u1ed7ng) v\u00e0 ch\u1ea5t \u0111en (substantia nigra) (m\u0169i t\u00ean \u0111\u1eb7c) bi\u1ec3u hi\u1ec7n t\u00ecnh tr\u1ea1ng t\u0103ng h\u1ed3i \u00e2m.\u00a0<\/em><\/p>\n<p data-path-to-node=\"1\"><em><img decoding=\"async\" style=\"display: block; margin-left: auto; margin-right: auto;\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/1jDIrV2x-XanshdgUJ5xeL7-qwy9g9-p_=s0\" \/><\/em><\/p>\n<p style=\"text-align: justify;\" data-path-to-node=\"1\"><em><strong data-path-to-node=\"1\" data-index-in-node=\"0\">H\u00ecnh 20.<\/strong> <strong data-path-to-node=\"1\" data-index-in-node=\"9\">(A)<\/strong> Minh h\u1ecda s\u01a1 \u0111\u1ed3 v\u1ec1 c\u1eeda s\u1ed5 xuy\u00ean th\u00e1i d\u01b0\u01a1ng cho th\u1ea5y m\u1eb7t ph\u1eb3ng qu\u00e9t si\u00eau \u00e2m n\u00e3o gi\u1eefa. <strong data-path-to-node=\"1\" data-index-in-node=\"175\">(B\u2013E)<\/strong> H\u00ecnh \u1ea3nh ch\u1ea5t \u0111en (m\u0169i t\u00ean) \u1edf c\u00e1c b\u1ec7nh nh\u00e2n kh\u00e1c nhau tr\u00ean h\u00ecnh \u1ea3nh TCS thu \u0111\u01b0\u1ee3c qua c\u1eeda s\u1ed5 xuy\u00ean th\u00e1i d\u01b0\u01a1ng: h\u1ed3i \u00e2m b\u00ecnh th\u01b0\u1eddng <strong data-path-to-node=\"1\" data-index-in-node=\"310\">(B)<\/strong>; c\u00e1c \u0111\u1ed1m h\u1ed3i \u00e2m d\u1ea1ng ch\u1ea5m, c\u00f3 th\u1ec3 th\u1ea5y \u1edf nh\u1eefng c\u00e1 nh\u00e2n kh\u1ecfe m\u1ea1nh <strong data-path-to-node=\"1\" data-index-in-node=\"379\">(C)<\/strong>; t\u0103ng h\u1ed3i \u00e2m <strong data-path-to-node=\"1\" data-index-in-node=\"396\">(D)<\/strong>; v\u00e0 t\u0103ng h\u1ed3i \u00e2m r\u00f5 r\u1ec7t \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n \u0111\u00e3 x\u00e1c \u0111\u1ecbnh m\u1eafc PD <strong data-path-to-node=\"1\" data-index-in-node=\"458\">(E)<\/strong>.<\/em><\/p>\n<p data-path-to-node=\"1\">Nhi\u1ec1u ph\u00e2n t\u00edch g\u1ed9p \u0111\u00e3 x\u00e1c nh\u1eadn gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n c\u1ee7a t\u00ecnh tr\u1ea1ng t\u0103ng h\u1ed3i \u00e2m ch\u1ea5t \u0111en \u1edf b\u1ec7nh nh\u00e2n m\u1eafc PD\u2014v\u1edbi \u0111\u1ed9 nh\u1ea1y t\u1ed5ng h\u1ee3p dao \u0111\u1ed9ng t\u1eeb 83% \u0111\u1ebfn 85%, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u t\u1eeb 71% \u0111\u1ebfn 87% v\u00e0 gi\u00e1 tr\u1ecb \u0111\u1ed9 ch\u00ednh x\u00e1c l\u00ean \u0111\u1ebfn 94% \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh PD\u2014khi so s\u00e1nh v\u1edbi nh\u1eefng c\u00e1 nh\u00e2n kh\u1ecfe m\u1ea1nh, v\u00e0 trong vi\u1ec7c ph\u00e2n bi\u1ec7t PD v\u1edbi c\u00e1c h\u1ed9i ch\u1ee9ng Parkinson kh\u00e1c v\u00e0 run v\u00f4 c\u0103n.<\/p>\n<p data-path-to-node=\"2\">Ngo\u00e0i gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n, t\u0103ng h\u1ed3i \u00e2m ch\u1ea5t \u0111en c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 m\u1ed9t d\u1ea5u hi\u1ec7u ti\u1ec1n l\u00e2m s\u00e0ng \u0111\u1ea7y tri\u1ec3n v\u1ecdng c\u1ee7a PD. C\u00e1c nh\u00e0 nghi\u00ean c\u1ee9u trong m\u1ed9t nghi\u00ean c\u1ee9u \u0111a trung t\u00e2m theo d\u00f5i d\u1ecdc quy m\u00f4 l\u1edbn tr\u00ean 1271 ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh tr\u00ean 50 tu\u1ed5i kh\u1ecfe m\u1ea1nh v\u1ec1 m\u1eb7t th\u1ea7n kinh \u0111\u00e3 ph\u00e1t hi\u1ec7n ra r\u1eb1ng t\u00ecnh tr\u1ea1ng t\u0103ng h\u1ed3i \u00e2m ch\u1ea5t \u0111en \u1edf th\u1eddi \u0111i\u1ec3m b\u1eaft \u0111\u1ea7u nghi\u00ean c\u1ee9u c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c t\u0103ng nguy c\u01a1 m\u1eafc b\u1ec7nh PD trong v\u00f2ng 5 n\u0103m l\u00ean g\u1ea5p 17\u201320 l\u1ea7n.<\/p>\n<p data-path-to-node=\"3\">Trong c\u00e1c h\u1ed9i ch\u1ee9ng Parkinson kh\u00f4ng \u0111i\u1ec3n h\u00ecnh, c\u00f3 th\u1ec3 th\u1ea5y th\u00eam c\u00e1c ph\u00e1t hi\u1ec7n kh\u00e1c: li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn gi\u00e3n n\u00e3o th\u1ea5t ba, t\u0103ng h\u1ed3i \u00e2m nh\u00e2n b\u00e8o r\u00f5 r\u1ec7t v\u00e0 gi\u1ea3m di\u1ec7n t\u00edch trung n\u00e3o. Teo \u0111a h\u1ec7 th\u1ed1ng \u0111i\u1ec3n h\u00ecnh bao g\u1ed3m c\u00e1c thay \u0111\u1ed5i nh\u00e2n b\u00e8o n\u1ed5i b\u1eadt v\u00e0 ch\u1ec9 \u1ea3nh h\u01b0\u1edfng nh\u1eb9 \u0111\u1ebfn ch\u1ea5t \u0111en. Tho\u00e1i h\u00f3a v\u1ecf n\u00e3o &#8211; n\u1ec1n v\u00e0 sa s\u00fat tr\u00ed tu\u1ec7 th\u1ec3 Lewy c\u00f3 th\u1ec3 bao g\u1ed3m s\u1ef1 k\u1ebft h\u1ee3p t\u0103ng h\u1ed3i \u00e2m c\u1ee7a ch\u1ea5t \u0111en v\u00e0 nh\u00e2n b\u00e8o, nh\u01b0ng t\u00ecnh tr\u1ea1ng gi\u00e3n n\u00e3o th\u1ea5t ba thay \u0111\u1ed5i nhi\u1ec1u h\u01a1n. Tuy nhi\u00ean, b\u1eb1ng ch\u1ee9ng cho c\u00e1c t\u00ecnh tr\u1ea1ng n\u00e0y c\u00f2n h\u1ea1n ch\u1ebf h\u01a1n so v\u1edbi PD. Ngo\u00e0i ra, vi\u1ec7c qu\u00e9t si\u00eau \u00e2m c\u00e1c c\u1ea5u tr\u00fac nh\u01b0 h\u1ea1ch n\u1ec1n v\u00e0 \u0111o di\u1ec7n t\u00edch trung n\u00e3o \u0111\u00f2i h\u1ecfi chuy\u00ean m\u00f4n cao h\u01a1n, do \u0111\u00f3 vi\u1ec7c th\u0103m kh\u00e1m n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi m\u1ed9t ng\u01b0\u1eddi v\u1eadn h\u00e0nh \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o b\u00e0i b\u1ea3n.<\/p>\n<h4 data-path-to-node=\"4\">\u0110\u00e1nh gi\u00e1 n\u00e3o th\u1ea5t<\/h4>\n<p data-path-to-node=\"5\">TCS cho ph\u00e9p \u0111\u00e1nh gi\u00e1 k\u00edch th\u01b0\u1edbc n\u00e3o th\u1ea5t t\u1ea1i gi\u01b0\u1eddng, v\u1edbi c\u00e1c b\u1eb1ng ch\u1ee9ng h\u1ed7 tr\u1ee3 vi\u1ec7c \u0111o l\u01b0\u1eddng \u0111\u00e1ng tin c\u1eady n\u00e3o th\u1ea5t ba, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u0111\u1ec3 ph\u00e1t hi\u1ec7n gi\u00e3n n\u00e3o th\u1ea5t. C\u00e1c h\u1ec7 s\u1ed1 t\u01b0\u01a1ng quan v\u1edbi CT th\u01b0\u1eddng v\u01b0\u1ee3t qu\u00e1 0,9 v\u00e0 hi\u1ec7u qu\u1ea3 ch\u1ea9n \u0111o\u00e1n cao, v\u1edbi \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u1edbn h\u01a1n 90% trong vi\u1ec7c ph\u00e1t hi\u1ec7n gi\u00e3n n\u00e3o th\u1ea5t. Tuy nhi\u00ean, tu\u1ed5i c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 c\u00e1c ph\u00e1t hi\u1ec7n tr\u00ean CT \u0111\u1ea7u ban \u0111\u1ea7u n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t khi di\u1ec5n gi\u1ea3i k\u1ebft qu\u1ea3. Ng\u01b0\u1ee3c l\u1ea1i, m\u1eb7c d\u00f9 c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 c\u00e1c n\u00e3o th\u1ea5t b\u00ean, nh\u01b0ng ph\u01b0\u01a1ng ph\u00e1p n\u00e0y d\u01b0\u1eddng nh\u01b0 \u00edt c\u00f3 kh\u1ea3 n\u0103ng l\u1eb7p l\u1ea1i v\u00e0 thi\u1ebfu c\u00e1c d\u1eef li\u1ec7u h\u1ed7 tr\u1ee3 ch\u1ea5t l\u01b0\u1ee3ng cao (H\u00ecnh 21).<\/p>\n<p data-path-to-node=\"5\"><img decoding=\"async\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/1w9ti2IiHfaOkk6kmXzz8n-6ycaY-QhBE=s0\" \/><\/p>\n<p data-path-to-node=\"1\"><em><strong data-path-to-node=\"1\" data-index-in-node=\"0\">H\u00ecnh 21.<\/strong> \u0110\u00e1nh gi\u00e1 n\u00e3o th\u1ea5t b\u1eb1ng TCS v\u1edbi s\u1ef1 t\u01b0\u01a1ng quan tr\u00ean CT. <strong data-path-to-node=\"1\" data-index-in-node=\"63\">(A)<\/strong> \u0110\u00e1nh gi\u00e1 n\u00e3o th\u1ea5t ba b\u1eb1ng si\u00eau \u00e2m qua c\u1eeda s\u1ed5 xuy\u00ean th\u00e1i d\u01b0\u01a1ng, v\u1edbi ph\u00e9p \u0111o \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n gi\u1eefa hai \u0111\u01b0\u1eddng h\u1ed3i \u00e2m \u0111\u1ea1i di\u1ec7n cho c\u00e1c th\u00e0nh n\u00e3o th\u1ea5t. <strong data-path-to-node=\"1\" data-index-in-node=\"212\">(B)<\/strong> C\u00e1c ph\u00e1t hi\u1ec7n tr\u00ean h\u00ecnh \u1ea3nh CT t\u01b0\u01a1ng \u1ee9ng \u1edf c\u00f9ng m\u1ed9t b\u1ec7nh nh\u00e2n x\u00e1c nh\u1eadn k\u00edch th\u01b0\u1edbc c\u1ee7a n\u00e3o th\u1ea5t ba. <strong data-path-to-node=\"1\" data-index-in-node=\"315\">(C)<\/strong> \u0110\u00e1nh gi\u00e1 c\u00e1c n\u00e3o th\u1ea5t b\u00ean b\u1eb1ng si\u00eau \u00e2m. <strong data-path-to-node=\"1\" data-index-in-node=\"359\">(D)<\/strong> H\u00ecnh \u1ea3nh CT t\u01b0\u01a1ng \u1ee9ng \u1edf b\u1ec7nh nh\u00e2n trong h\u00ecnh <strong data-path-to-node=\"1\" data-index-in-node=\"408\">C<\/strong>. Trong h\u00ecnh <strong data-path-to-node=\"1\" data-index-in-node=\"422\">C<\/strong> v\u00e0 <strong data-path-to-node=\"1\" data-index-in-node=\"427\">D<\/strong>, d\u1ea5u * bi\u1ec3u th\u1ecb th\u00e2n n\u00e3o th\u1ea5t b\u00ean tr\u00e1i. L\u01b0u \u00fd r\u1eb1ng c\u00e1c ph\u00e9p \u0111o n\u00e3o th\u1ea5t ba (nh\u01b0 trong <strong data-path-to-node=\"1\" data-index-in-node=\"515\">A<\/strong>) th\u01b0\u1eddng c\u00f3 kh\u1ea3 n\u0103ng l\u1eb7p l\u1ea1i cao h\u01a1n do h\u01b0\u1edbng nh\u1ea5t qu\u00e1n c\u1ee7a c\u00e1c r\u00eca h\u1ed3i \u00e2m, so v\u1edbi m\u1eb7t ph\u1eb3ng qu\u00e9t xi\u00ean c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 c\u00e1c n\u00e3o th\u1ea5t b\u00ean (nh\u01b0 trong <strong data-path-to-node=\"1\" data-index-in-node=\"669\">C<\/strong>).<\/em><\/p>\n<h4 data-path-to-node=\"3\">\u0110\u00e1nh gi\u00e1 di l\u1ec7ch \u0111\u01b0\u1eddng gi\u1eefa<\/h4>\n<p data-path-to-node=\"3\">TCS c\u00f3 th\u1ec3 m\u00f4 t\u1ea3 v\u00e0 \u0111\u1ecbnh l\u01b0\u1ee3ng t\u00ecnh tr\u1ea1ng di l\u1ec7ch \u0111\u01b0\u1eddng gi\u1eefa c\u1ee7a n\u00e3o v\u1edbi \u0111\u1ed9 ph\u00f9 h\u1ee3p cao so v\u1edbi c\u00e1c ph\u00e1t hi\u1ec7n tr\u00ean CT, cho th\u1ea5y h\u1ec7 s\u1ed1 t\u01b0\u01a1ng quan ph\u00f9 h\u1ee3p t\u1ed5ng h\u1ee3p l\u00e0 0,91 v\u00e0 sai s\u1ed1 trung b\u00ecnh d\u01b0\u1edbi 1 mm trong m\u1ed9t ph\u00e2n t\u00edch g\u1ed9p g\u1ea7n \u0111\u00e2y (63). Nh\u1eefng ph\u00e1t hi\u1ec7n n\u00e0y h\u1ed7 tr\u1ee3 TCS nh\u01b0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p thay th\u1ebf t\u00ecnh hu\u1ed1ng cho CT khi ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh th\u00f4ng th\u01b0\u1eddng kh\u00f4ng kh\u1ea3 thi \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u1ea1i gi\u01b0\u1eddng hi\u1ec7u \u1ee9ng kh\u1ed1i v\u00e0 s\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a c\u00e1c t\u1ed5n th\u01b0\u01a1ng cho\u00e1n ch\u1ed7 trong h\u1ed3i s\u1ee9c th\u1ea7n kinh, bao g\u1ed3m c\u1ea3 theo d\u00f5i sau ph\u1eabu thu\u1eadt m\u1edf h\u1ed9p s\u1ecd gi\u1ea3m \u00e1p (63).<\/p>\n<h4 data-path-to-node=\"4\">U n\u1ed9i s\u1ecd<\/h4>\n<p data-path-to-node=\"4\">TCS c\u00f3 th\u1ec3 c\u00f3 \u00edch trong c\u00e1c k\u1ecbch b\u1ea3n l\u00e2m s\u00e0ng c\u1ee5 th\u1ec3 li\u00ean quan \u0111\u1ebfn u n\u00e3o, m\u1eb7c d\u00f9 n\u00f3 kh\u00f4ng \u0111\u01b0\u1ee3c coi l\u00e0 ph\u01b0\u01a1ng ti\u1ec7n ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh ch\u00ednh trong b\u1ec7nh c\u1ea3nh n\u00e0y. M\u1ed9t ph\u00e2n t\u00edch g\u1ed9p g\u1ea7n \u0111\u00e2y (3) \u0111\u00e3 b\u00e1o c\u00e1o r\u1eb1ng TCS c\u00f3 \u0111\u1ed9 nh\u1ea1y cao trong vi\u1ec7c ph\u00e1t hi\u1ec7n c\u00e1c kh\u1ed1i n\u1ed9i s\u1ecd l\u1edbn ho\u1eb7c n\u1eb1m \u1edf \u0111\u01b0\u1eddng gi\u1eefa; tuy gi\u1edd, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u th\u1ea5p \u0111\u00e3 h\u1ea1n ch\u1ebf gi\u00e1 tr\u1ecb c\u1ee7a n\u00f3 nh\u01b0 m\u1ed9t c\u00f4ng c\u1ee5 ch\u1ea9n \u0111o\u00e1n \u0111\u1ed9c l\u1eadp. Ngo\u00e0i ra, n\u00f3 c\u00f3 th\u1ec3 h\u1eefu \u00edch \u0111\u1ec3 theo d\u00f5i \u0111\u1ecbnh k\u1ef3 c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u0111\u00e3 bi\u1ebft \u1edf nh\u1eefng v\u1ecb tr\u00ed thu\u1eadn l\u1ee3i v\u1ec1 m\u1eb7t \u00e2m h\u1ecdc, ch\u1eb3ng h\u1ea1n nh\u01b0 v\u00f9ng tuy\u1ebfn t\u00f9ng ho\u1eb7c h\u1ed1 y\u00ean, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi MRI kh\u00f4ng s\u1eb5n c\u00f3 \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh theo d\u00f5i (H\u00ecnh 22) (64,65).<\/p>\n<p data-path-to-node=\"4\"><img decoding=\"async\" style=\"display: block; margin-left: auto; margin-right: auto;\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/186b5A6JKBHU9Kg3kN3I5ud9BwqmNbu0q=s0\" \/><\/p>\n<p data-path-to-node=\"1\"><em><strong data-path-to-node=\"1\" data-index-in-node=\"0\">H\u00ecnh 22.<\/strong> Ph\u00e1t hi\u1ec7n v\u00e0 \u0111o l\u01b0\u1eddng u n\u1ed9i s\u1ecd b\u1eb1ng TCS \u1edf hai b\u1ec7nh nh\u00e2n. <strong data-path-to-node=\"1\" data-index-in-node=\"66\">(A)<\/strong> B\u00ean tr\u00e1i: H\u00ecnh \u1ea3nh c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI) chu\u1ed7i xung FIESTA m\u1eb7t c\u1eaft xi\u00ean \u1edf m\u1ed9t ng\u01b0\u1eddi \u0111\u00e0n \u00f4ng 40 tu\u1ed5i, \u0111\u01b0\u1ee3c t\u00e1i t\u1ea1o \u0111\u1ec3 kh\u1edbp v\u1edbi h\u01b0\u1edbng si\u00eau \u00e2m xuy\u00ean th\u00e1i d\u01b0\u01a1ng (b\u00ean ph\u1ea3i), cho th\u1ea5y m\u1ed9t u tuy\u1ebfn y\u00ean (m\u0169i t\u00ean). B\u00ean ph\u1ea3i: H\u00ecnh \u1ea3nh si\u00eau \u00e2m xuy\u00ean s\u1ecd t\u01b0\u01a1ng \u1ee9ng thu \u0111\u01b0\u1ee3c b\u1eb1ng \u0111\u1ea7u d\u00f2 convex 2,5-MHz cho th\u1ea5y tr\u1ee5c ngang c\u1ee7a t\u1ed5n th\u01b0\u01a1ng (m\u0169i t\u00ean) c\u00f3 th\u1ec3 \u0111o l\u01b0\u1eddng r\u00f5 r\u00e0ng v\u00e0 cung c\u1ea5p m\u1ed9t k\u00edch th\u01b0\u1edbc c\u00f3 kh\u1ea3 n\u0103ng l\u1eb7p l\u1ea1i. <strong data-path-to-node=\"1\" data-index-in-node=\"472\">(B)<\/strong> B\u00ean tr\u00e1i: H\u00ecnh \u1ea3nh MRI T1 sau ti\u00eam thu\u1ed1c t\u01b0\u01a1ng ph\u1ea3n \u1edf m\u1ed9t ph\u1ee5 n\u1eef 50 tu\u1ed5i cho th\u1ea5y m\u1ed9t u m\u00e0ng n\u00e3o v\u00f9ng l\u1ed3i (m\u0169i t\u00ean) \u1edf v\u00f9ng tr\u00e1n &#8211; th\u00e1i d\u01b0\u01a1ng &#8211; \u0111\u1ec9nh b\u00ean ph\u1ea3i. B\u00ean ph\u1ea3i: H\u00ecnh \u1ea3nh si\u00eau \u00e2m xuy\u00ean s\u1ecd t\u01b0\u01a1ng \u1ee9ng. M\u1eb7c d\u00f9 c\u00e1c t\u1ed5n th\u01b0\u01a1ng v\u00f9ng l\u1ed3i \u00edt \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y m\u1ed9t c\u00e1ch nh\u1ea5t qu\u00e1n h\u01a1n so v\u1edbi c\u00e1c kh\u1ed1i \u1edf \u0111\u01b0\u1eddng gi\u1eefa, v\u00f9ng y\u00ean v\u00e0 v\u00f9ng tuy\u1ebfn t\u00f9ng, nh\u01b0ng t\u1ed5n th\u01b0\u01a1ng n\u00e0y v\u1eabn c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c v\u00e0 \u0111\u01b0\u1eddng k\u00ednh l\u1edbn nh\u1ea5t c\u1ee7a n\u00f3 c\u00f3 th\u1ec3 \u0111o l\u01b0\u1eddng l\u1eb7p l\u1ea1i \u0111\u01b0\u1ee3c. H\u00ecnh <strong data-path-to-node=\"1\" data-index-in-node=\"928\">A<\/strong> v\u00e0 <strong data-path-to-node=\"1\" data-index-in-node=\"933\">B<\/strong> c\u0169ng bao g\u1ed3m minh h\u1ecda s\u01a1 \u0111\u1ed3 v\u1ec1 c\u1eeda s\u1ed5 xuy\u00ean th\u00e1i d\u01b0\u01a1ng (ngo\u00e0i c\u00f9ng b\u00ean ph\u1ea3i). (\u0110\u01b0\u1ee3c t\u1ea1o b\u1eb1ng BioRender. Esmeraldo M [2025], <a class=\"ng-star-inserted\" href=\"https:\/\/BioRender.com\/x0bcrxy\" target=\"_blank\" rel=\"noopener\" data-hveid=\"0\" data-ved=\"0CAAQ_4QMahgKEwjw1LOe5ZWUAxUAAAAAHQAAAAAQ0gE\">https:\/\/BioRender.com\/x0bcrxy<\/a>.)<\/em><\/p>\n<h4 data-path-to-node=\"1\">\u0110\u00e1nh gi\u00e1 xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd<\/h4>\n<p data-path-to-node=\"1\">Trong m\u1ed9t ph\u00e2n t\u00edch g\u1ed9p t\u1eeb 18 nghi\u00ean c\u1ee9u bao g\u1ed3m 803 b\u1ec7nh nh\u00e2n ng\u01b0\u1eddi l\u1edbn, TCS \u0111\u00e3 cho th\u1ea5y hi\u1ec7u qu\u1ea3 ch\u1ea9n \u0111o\u00e1n \u0111\u1ea7y tri\u1ec3n v\u1ecdng trong vi\u1ec7c \u0111\u00e1nh gi\u00e1 xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd, v\u1edbi \u0111\u1ed9 nh\u1ea1y t\u1ed5ng h\u1ee3p l\u00e0 88%, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u t\u1ed5ng h\u1ee3p l\u00e0 81% v\u00e0 \u0111\u1ed9 ch\u00ednh x\u00e1c t\u1ed5ng h\u1ee3p l\u00e0 94%. Vi\u1ec7c ph\u00e1t hi\u1ec7n \u0111\u1ea1t \u0111\u1ed9 ch\u00ednh x\u00e1c cao nh\u1ea5t \u0111\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p xu\u1ea5t huy\u1ebft th\u00f9y n\u00e3o, \u0111\u1ed3i th\u1ecb v\u00e0 c\u00e1c xu\u1ea5t huy\u1ebft tr\u00ean l\u1ec1u kh\u00e1c trong v\u00f2ng 1\u20134 tu\u1ea7n k\u1ec3 t\u1eeb khi kh\u1edfi ph\u00e1t, trong khi c\u00e1c kh\u1ed1i xu\u1ea5t huy\u1ebft nh\u1ecf (&lt;1 cm), xu\u1ea5t huy\u1ebft d\u01b0\u1edbi l\u1ec1u v\u00e0 xu\u1ea5t huy\u1ebft v\u00f9ng l\u1ed3i cao th\u01b0\u1eddng b\u1ecb b\u1ecf s\u00f3t. Xu\u1ea5t huy\u1ebft d\u01b0\u1edbi nh\u1ec7n kh\u00f4ng th\u1ec3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh m\u1ed9t c\u00e1ch \u0111\u00e1ng tin c\u1eady. Kh\u1ed1i m\u00e1u t\u1ee5 d\u01b0\u1edbi m\u00e0ng c\u1ee9ng c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c trong m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u, trong khi b\u1eb1ng ch\u1ee9ng v\u1ec1 kh\u1ed1i m\u00e1u t\u1ee5 ngo\u00e0i m\u00e0ng c\u1ee9ng ch\u1ec9 gi\u1edbi h\u1ea1n \u1edf c\u00e1c b\u00e1o c\u00e1o ca b\u1ec7nh ri\u00eang l\u1ebb.<\/p>\n<p data-path-to-node=\"2\">Tuy nhi\u00ean, c\u01a1 s\u1edf b\u1eb1ng ch\u1ee9ng c\u00f2n nh\u1eefng h\u1ea1n ch\u1ebf \u0111\u00e1ng ch\u00fa \u00fd: Nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u00e3 \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 c\u00e1ch \u0111\u00e2y h\u01a1n 2 th\u1eadp k\u1ef7, thi\u1ebfu thi\u1ebft k\u1ebf m\u00f9 ho\u1eb7c ng\u1eabu nhi\u00ean, v\u00e0 th\u01b0\u1eddng b\u1eaft ngu\u1ed3n t\u1eeb c\u00e1c nh\u00f3m nghi\u00ean c\u1ee9u tr\u00f9ng l\u1eb7p, g\u00e2y ra lo ng\u1ea1i v\u1ec1 sai l\u1ec7ch l\u1ef1a ch\u1ecdn v\u00e0 sai l\u1ec7ch c\u00f4ng b\u1ed1. Ngo\u00e0i ra c\u00f2n c\u00f3 s\u1ef1 kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t \u0111\u00e1ng k\u1ec3 trong c\u00e1c thi\u1ebft l\u1eadp si\u00eau \u00e2m v\u00e0 vi\u1ec7c l\u01b0u h\u1ed3 s\u01a1 v\u1ec1 \u0111\u00e0o t\u1ea1o k\u1ef9 thu\u1eadt vi\u00ean si\u00eau \u00e2m c\u00f2n ngh\u00e8o n\u00e0n. M\u1eb7c d\u00f9 vi\u1ec7c \u0111\u00e1nh gi\u00e1 xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd b\u1eb1ng TCS hi\u1ec7n ch\u01b0a \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng th\u01b0\u1eddng quy c\u1ee5 th\u1ec3, nh\u01b0ng vi\u1ec7c s\u1eed d\u1ee5ng l\u00e2m s\u00e0ng trong t\u01b0\u01a1ng lai c\u00f3 th\u1ec3 kh\u1ea3 thi v\u1edbi nh\u1eefng ti\u1ebfn b\u1ed9 v\u1ec1 thi\u1ebft b\u1ecb, c\u00e1c quy tr\u00ecnh chu\u1ea9n h\u00f3a v\u00e0 \u0111\u00e0o t\u1ea1o ng\u01b0\u1eddi v\u1eadn h\u00e0nh. M\u1ed9t v\u00ed d\u1ee5 \u0111i\u1ec3n h\u00ecnh \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y trong H\u00ecnh 23.<\/p>\n<p data-path-to-node=\"2\"><img decoding=\"async\" style=\"display: block; margin-left: auto; margin-right: auto;\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/1PJYpJAjll7B1E8pRLaf8n1__1uFNg7yA=s0\" \/><\/p>\n<p data-path-to-node=\"1\"><em><strong data-path-to-node=\"1\" data-index-in-node=\"0\">H\u00ecnh 23.<\/strong> Xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd trong s\u1eebng th\u00e1i d\u01b0\u01a1ng c\u1ee7a n\u00e3o th\u1ea5t b\u00ean \u1edf giai \u0111o\u1ea1n t\u00e1i h\u1ea5p thu. <strong data-path-to-node=\"1\" data-index-in-node=\"91\">(A)<\/strong> H\u00ecnh \u1ea3nh CT m\u1eb7t c\u1eaft tr\u1ee5c xoay 90\u00b0 ng\u01b0\u1ee3c chi\u1ec1u kim \u0111\u1ed3ng h\u1ed3 cho th\u1ea5y m\u1ed9t v\u00f9ng t\u0103ng t\u1ef7 tr\u1ecdng (m\u0169i t\u00ean), ph\u00f9 h\u1ee3p v\u1edbi m\u00e1u giai \u0111o\u1ea1n b\u00e1n c\u1ea5p. <strong data-path-to-node=\"1\" data-index-in-node=\"231\">(B)<\/strong> H\u00ecnh \u1ea3nh TCS t\u01b0\u01a1ng \u1ee9ng cho th\u1ea5y m\u1ed9t ti\u00eau \u0111i\u1ec3m t\u0103ng h\u1ed3i \u00e2m (m\u0169i t\u00ean) \u0111\u1ea1i di\u1ec7n cho kh\u1ed1i xu\u1ea5t huy\u1ebft \u1edf c\u00f9ng khu v\u1ef1c.<\/em><\/p>\n<h4 data-path-to-node=\"1\">C\u1eeda s\u1ed5 t\u1ea1o h\u00ecnh h\u1ed9p s\u1ecd xuy\u00ean \u00e2m (Sonolucent)<\/h4>\n<p data-path-to-node=\"1\">C\u00e1c m\u1ea3nh gh\u00e9p t\u1ea1o h\u00ecnh h\u1ed9p s\u1ecd xuy\u00ean \u00e2m cung c\u1ea5p m\u1ed9t ph\u01b0\u01a1ng ti\u1ec7n an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 \u0111\u1ec3 th\u1ef1c hi\u1ec7n TCS \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n tr\u1ea3i qua c\u00e1c th\u1ee7 thu\u1eadt ngo\u1ea1i th\u1ea7n kinh b\u1eb1ng c\u00e1ch t\u1ea1o ra c\u00e1c c\u1eeda s\u1ed5 \u00e2m h\u1ecdc nh\u00e2n t\u1ea1o, t\u01b0\u01a1ng t\u1ef1 nh\u01b0 \u0111\u01b0\u1eddng ti\u1ebfp c\u1eadn m\u1edf h\u1ed9p s\u1ecd (66). C\u00e1c m\u1ea3nh gh\u00e9p b\u1eb1ng poly-ether-ether-ketone (PEEK) v\u00e0 polymethylmethacrylate (PMMA) \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 trong su\u1ed1t v\u1edbi si\u00eau \u00e2m, t\u1ea1o ra h\u00ecnh \u1ea3nh c\u00f3 \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao h\u01a1n so v\u1edbi h\u00ecnh \u1ea3nh xuy\u00ean qua x\u01b0\u01a1ng th\u00e1i d\u01b0\u01a1ng nguy\u00ean v\u1eb9n (67,68). Ng\u01b0\u1ee3c l\u1ea1i, c\u00e1c v\u1eadt li\u1ec7u nh\u01b0 hydroxyapatite, titan v\u00e0 polyethylene kh\u00f4ng c\u00f3 t\u00ednh ch\u1ea5t xuy\u00ean \u00e2m (69).<\/p>\n<p data-path-to-node=\"2\">C\u00e1c m\u1ea3nh gh\u00e9p n\u00e0y m\u1edf r\u1ed9ng \u1ee9ng d\u1ee5ng c\u1ee7a si\u00eau \u00e2m bao g\u1ed3m \u0111\u00e1nh gi\u00e1 c\u1ea7u n\u1ed1i m\u1ea1ch m\u00e1u ngo\u1ea1i s\u1ecd &#8211; n\u1ed9i s\u1ecd, \u0111\u00e1nh gi\u00e1 to\u00e0n di\u1ec7n m\u1ea1ch m\u00e1u n\u1ed9i s\u1ecd b\u1ea5t k\u1ec3 ch\u1ea5t l\u01b0\u1ee3ng c\u1eeda s\u1ed5 t\u1ef1 nhi\u00ean v\u00e0 ph\u00e1t hi\u1ec7n xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd (70). Trong ung b\u01b0\u1edbu th\u1ea7n kinh, ch\u00fang c\u00f3 th\u1ec3 h\u1ed7 tr\u1ee3 theo d\u00f5i t\u00e1i ph\u00e1t u (71). Ngay c\u1ea3 c\u00e1c n\u1eafp l\u1ed7 khoan xuy\u00ean \u00e2m nh\u1ecf 2 cm c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 k\u00edch th\u01b0\u1edbc n\u00e3o th\u1ea5t \u1edf b\u1ec7nh nh\u00e2n c\u00f3 d\u1eabn l\u01b0u ho\u1eb7c gi\u00e3n n\u00e3o th\u1ea5t (72).<\/p>\n<h3 data-path-to-node=\"3\">CEUS xuy\u00ean s\u1ecd<\/h3>\n<h4 data-path-to-node=\"4\">Nguy\u00ean l\u00fd c\u1ee7a CEUS<\/h4>\n<p data-path-to-node=\"4\">CEUS li\u00ean quan \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c vi bong b\u00f3ng c\u00f3 v\u1ecf lipid k\u00edch th\u01b0\u1edbc 1\u20135-\u03bcm \u0111\u00f3ng vai tr\u00f2 l\u00e0 c\u00e1c ch\u1ea5t thu\u1ea7n t\u00fay trong m\u1ea1ch m\u00e1u \u0111\u1ec3 h\u00ecnh \u1ea3nh h\u00f3a d\u00f2ng m\u00e1u \u0111\u1ea1i m\u1ea1ch, vi m\u1ea1ch v\u00e0 t\u01b0\u1edbi m\u00e1u n\u00e3o trong th\u1eddi gian th\u1ef1c. K\u00edch th\u01b0\u1edbc c\u1ee7a c\u00e1c vi bong b\u00f3ng ng\u0103n c\u1ea3n s\u1ef1 khu\u1ebfch t\u00e1n v\u00e0o m\u00f4, cho ph\u00e9p \u0111\u00e1nh gi\u00e1 ch\u00ednh x\u00e1c \u0111\u1ed9ng h\u1ecdc vi m\u1ea1ch v\u00e0 c\u00e1c b\u1ea5t th\u01b0\u1eddng m\u1ea1ch m\u00e1u (73). Kh\u00f4ng gi\u1ed1ng nh\u01b0 c\u00e1c ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n d\u1ef1a tr\u00ean iod ho\u1eb7c gadolinium, vi bong b\u00f3ng CEUS \u0111\u01b0\u1ee3c \u0111\u00e0o th\u1ea3i qua ph\u1ed5i v\u00e0 kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o \u0111\u1ed9 thanh th\u1ea3i c\u1ee7a th\u1eadn, gi\u00fap ch\u00fang an to\u00e0n h\u01a1n cho b\u1ec7nh nh\u00e2n suy ch\u1ee9c n\u0103ng th\u1eadn. So v\u1edbi thu\u1ed1c t\u01b0\u01a1ng ph\u1ea3n CT, ch\u00fang cho ph\u00e9p h\u00ecnh \u1ea3nh h\u00f3a th\u1eddi gian th\u1ef1c, kh\u00f4ng g\u00e2y b\u1ee9c x\u1ea1 ion h\u00f3a v\u00e0 c\u00f3 nguy c\u01a1 d\u1ecb \u1ee9ng th\u1ea5p h\u01a1n. H\u01a1n n\u1eefa, c\u00e1c ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n vi bong b\u00f3ng kh\u00f4ng g\u00e2y lo ng\u1ea1i v\u1ec1 vi\u1ec7c l\u1eafng \u0111\u1ecdng m\u00f4 v\u00e0 nguy c\u01a1 x\u01a1 h\u00f3a h\u1ec7 th\u1ed1ng do th\u1eadn li\u00ean quan \u0111\u1ebfn c\u00e1c ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n d\u1ef1a tr\u00ean gadolinium (73,74). Kh\u00e1c v\u1edbi CT v\u00e0 MRI, CEUS cung c\u1ea5p kh\u1ea3 n\u0103ng ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh thu\u1eadn ti\u1ec7n t\u1ea1i gi\u01b0\u1eddng v\u00e0 do s\u1ef1 \u0111\u00e0o th\u1ea3i nhanh ch\u00f3ng c\u1ee7a c\u00e1c vi bong b\u00f3ng, n\u00f3 cho ph\u00e9p ti\u00eam l\u1eb7p l\u1ea1i \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 d\u00f2ng ch\u1ea3y v\u00e0 t\u01b0\u1edbi m\u00e1u (75).<\/p>\n<p data-path-to-node=\"5\">\u1ede ng\u01b0\u1eddi l\u1edbn, c\u00e1c \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch c\u1ee1 18\u201320 gauge \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ti\u00eam nh\u1eb1m gi\u1ea3m thi\u1ec3u s\u1ef1 ph\u00e1 h\u1ee7y c\u00e1c vi bong b\u00f3ng. CEUS n\u00e3o l\u00e0 m\u1ed9t \u1ee9ng d\u1ee5ng ngo\u00e0i nh\u00e3n (off-label) c\u1ee7a c\u00e1c thu\u1ed1c t\u01b0\u01a1ng ph\u1ea3n si\u00eau \u00e2m m\u00e0 kh\u00f4ng c\u00f3 h\u01b0\u1edbng d\u1eabn c\u1ee7a nh\u00e0 s\u1ea3n xu\u1ea5t v\u1ec1 li\u1ec1u l\u01b0\u1ee3ng. Tuy nhi\u00ean, theo kinh nghi\u1ec7m c\u1ee7a ch\u00fang t\u00f4i, vi c\u1ea7u lipid sulfur hexafluoride l\u00e0 ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho m\u1ee5c \u0111\u00edch n\u00e0y, v\u1edbi li\u1ec1u \u1edf ng\u01b0\u1eddi l\u1edbn l\u00e0 2,0\u20132,4 mL \u0111\u01b0\u1ee3c ti\u00eam b\u1eb1ng tay v\u1edbi t\u1ed1c \u0111\u1ed9 1\u20132 mL\/s, sau \u0111\u00f3 l\u00e0 \u0111\u1ea9y n\u01b0\u1edbc mu\u1ed1i sinh l\u00fd 5\u201310 mL v\u1edbi t\u1ed1c \u0111\u1ed9 2 mL\/s. Quy tr\u00ecnh n\u00e0y \u0111\u01b0\u1ee3c t\u1ea1o \u0111i\u1ec1u ki\u1ec7n thu\u1eadn l\u1ee3i b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng kh\u00f3a ba ng\u1ea3, cho ph\u00e9p ti\u00eam thu\u1ed1c t\u01b0\u01a1ng ph\u1ea3n v\u00e0 dung d\u1ecbch n\u01b0\u1edbc mu\u1ed1i hi\u1ec7u qu\u1ea3. Ch\u1ec9 s\u1ed1 c\u01a1 h\u1ecdc (MI) th\u1ea5p (&lt;0,4) \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 tr\u00e1nh ph\u00e1 h\u1ee7y vi bong b\u00f3ng (73,75,76).<\/p>\n<h4 data-path-to-node=\"6\">T\u0103ng c\u01b0\u1eddng t\u00edn hi\u1ec7u Doppler<\/h4>\n<p data-path-to-node=\"6\">Trong si\u00eau \u00e2m xuy\u00ean s\u1ecd, CEUS c\u1ea3i thi\u1ec7n vi\u1ec7c quan s\u00e1t c\u00e1c m\u1ea1ch m\u00e1u n\u00e3o b\u1eb1ng c\u00e1ch kh\u1eafc ph\u1ee5c t\u00ecnh tr\u1ea1ng suy gi\u1ea3m t\u00edn hi\u1ec7u v\u00e0 kh\u1ea3 n\u0103ng xuy\u00ean th\u1ea5u h\u1ed9p s\u1ecd k\u00e9m th\u01b0\u1eddng th\u1ea5y \u1edf TCD th\u00f4ng th\u01b0\u1eddng. Vi\u1ec7c s\u1eed d\u1ee5ng CEUS l\u00e0m t\u0103ng t\u1ef7 l\u1ec7 ph\u00e1t hi\u1ec7n m\u1ea1ch m\u00e1u n\u1ed9i s\u1ecd t\u1eeb kho\u1ea3ng 85%\u201387% l\u00ean 94%\u2013100%, gi\u1ea3i quy\u1ebft hi\u1ec7u qu\u1ea3 c\u00e1c h\u1ea1n ch\u1ebf \u1edf 8%\u201320% b\u1ec7nh nh\u00e2n c\u00f3 c\u1eeda s\u1ed5 th\u00e1i d\u01b0\u01a1ng k\u00e9m (H\u00ecnh 24) (9,10).<\/p>\n<p data-path-to-node=\"6\"><img decoding=\"async\" style=\"display: block; margin-left: auto; margin-right: auto;\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/19Z73xonaEQBhwnA80_iiZp0ZwG66z4AS=s0\" \/><\/p>\n<p data-path-to-node=\"1\"><em><strong data-path-to-node=\"1\" data-index-in-node=\"0\">H\u00ecnh 24.<\/strong> CEUS k\u1ebft h\u1ee3p v\u1edbi TCDi \u1edf hai b\u1ec7nh nh\u00e2n. <strong data-path-to-node=\"1\" data-index-in-node=\"48\">(A, B)<\/strong> H\u00ecnh \u1ea3nh Doppler ph\u1ed5 kh\u00f4ng t\u0103ng c\u01b0\u1eddng <strong data-path-to-node=\"1\" data-index-in-node=\"93\">(A)<\/strong> \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 c\u1eeda s\u1ed5 \u00e2m h\u1ecdc xuy\u00ean th\u00e1i d\u01b0\u01a1ng kh\u1ea3 d\u1ee5ng cho th\u1ea5y kh\u00f4ng c\u00f3 d\u00f2ng ch\u1ea3y n\u00e0o \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n \u1edf MCA ph\u1ea3i. H\u00ecnh \u1ea3nh Doppler ph\u1ed5 t\u0103ng c\u01b0\u1eddng t\u01b0\u01a1ng \u1ee9ng <strong data-path-to-node=\"1\" data-index-in-node=\"263\">(B)<\/strong> cho th\u1ea5y t\u00edn hi\u1ec7u d\u00f2ng ch\u1ea3y MCA r\u00f5 r\u00e0ng sau khi ti\u00eam ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n. (H\u00ecnh minh h\u1ecda c\u1eeda s\u1ed5 xuy\u00ean th\u00e1i d\u01b0\u01a1ng \u0111\u01b0\u1ee3c t\u1ea1o b\u1eb1ng BioRender. Esmeraldo M [2025], <a class=\"ng-star-inserted\" href=\"https:\/\/BioRender.com\/x0bcrxy\" target=\"_blank\" rel=\"noopener\" data-hveid=\"0\" data-ved=\"0CAAQ_4QMahgKEwjw1LOe5ZWUAxUAAAAAHQAAAAAQ2gI\">https:\/\/BioRender.com\/x0bcrxy<\/a>.) <strong data-path-to-node=\"1\" data-index-in-node=\"453\">(C, D)<\/strong> H\u00ecnh \u1ea3nh Doppler m\u00e0u <strong data-path-to-node=\"1\" data-index-in-node=\"481\">(C)<\/strong> \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n kh\u00e1c c\u00f3 c\u1eeda s\u1ed5 th\u00e1i d\u01b0\u01a1ng h\u01a1i k\u00e9m t\u1ed1i \u01b0u tr\u01b0\u1edbc khi ti\u00eam ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n. H\u00ecnh \u1ea3nh Doppler m\u00e0u <strong data-path-to-node=\"1\" data-index-in-node=\"595\">(D)<\/strong> sau khi ti\u00eam ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n cho th\u1ea5y t\u00edn hi\u1ec7u m\u1ea1nh v\u00e0 kh\u1ea3 n\u0103ng quan s\u00e1t c\u00e1c m\u1ea1ch m\u00e1u c\u1ee7a \u0111a gi\u00e1c Willis \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n.<\/em><\/p>\n<p data-path-to-node=\"1\">CEUS xuy\u00ean s\u1ecd gi\u00fap gi\u1ea3m c\u00e1c k\u1ebft qu\u1ea3 Doppler kh\u00f4ng thuy\u1ebft ph\u1ee5c trong \u0111\u00e1nh gi\u00e1 ch\u1ebft n\u00e3o t\u1eeb m\u1ee9c l\u00ean \u0111\u1ebfn 20% xu\u1ed1ng ch\u1ec9 c\u00f2n 3% \u0111\u1ed1i v\u1edbi c\u1ea3 niTCD v\u00e0 TCDi. Trong TCDi, vi\u1ec7c b\u1ed5 sung t\u0103ng c\u01b0\u1eddng ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n khi\u00eam t\u1ed1n kh\u1ea3 n\u0103ng ph\u00e1t hi\u1ec7n d\u00f2ng ch\u1ea3y t\u00e1i l\u1eadp (refilling) trong c\u00e1c t\u00fai ph\u00ecnh n\u1ed9i s\u1ecd k\u00edch th\u01b0\u1edbc t\u1eeb 5 mm tr\u1edf l\u00ean \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng v\u00f2ng xo\u1eafn kim lo\u1ea1i (coils) qua \u0111\u01b0\u1eddng n\u1ed9i m\u1ea1ch, nh\u01b0ng c\u00e1c b\u1eb1ng ch\u1ee9ng hi\u1ec7n t\u1ea1i ch\u01b0a h\u1ed7 tr\u1ee3 vi\u1ec7c \u1ee9ng d\u1ee5ng l\u00e2m s\u00e0ng th\u01b0\u1eddng quy cho m\u1ee5c \u0111\u00edch n\u00e0y.<\/p>\n<blockquote>\n<p data-path-to-node=\"2\"><span style=\"background-color: #ba372a; color: #ffffff;\"><strong data-path-to-node=\"2\" data-index-in-node=\"0\">Teaching Point:<\/strong><\/span> CEUS gi\u00fap c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng ph\u00e1t hi\u1ec7n m\u1ea1ch m\u00e1u n\u1ed9i s\u1ecd \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 c\u1eeda s\u1ed5 \u00e2m h\u1ecdc k\u00e9m, t\u0103ng t\u1ef7 l\u1ec7 ph\u00e1t hi\u1ec7n t\u1eeb 85%\u201387% l\u00ean g\u1ea7n 100%, v\u00e0 gi\u1ea3m c\u00e1c k\u1ebft qu\u1ea3 kh\u00f4ng thuy\u1ebft ph\u1ee5c trong \u0111\u00e1nh gi\u00e1 ch\u1ebft n\u00e3o xu\u1ed1ng ch\u1ec9 c\u00f2n 3%.<\/p>\n<\/blockquote>\n<\/div>\n<h3 class=\"table-content\" data-hveid=\"0\" data-ved=\"0CAAQ3ecQahgKEwiBs_mvmZWUAxUAAAAAHQAAAAAQiAQ\">Tri\u1ec3n v\u1ecdng t\u01b0\u01a1ng lai<\/h3>\n<div class=\"table-content\" data-hveid=\"0\" data-ved=\"0CAAQ3ecQahgKEwiBs_mvmZWUAxUAAAAAHQAAAAAQiAQ\">\n<p data-path-to-node=\"4\">Si\u00eau \u00e2m xuy\u00ean s\u1ecd \u0111ang ti\u1ebfn h\u00f3a nhanh ch\u00f3ng, v\u1edbi nhi\u1ec1u k\u1ef9 thu\u1eadt ti\u00ean ti\u1ebfn \u0111ang chuy\u1ec3n d\u1ea7n t\u1eeb nghi\u00ean c\u1ee9u ti\u1ec1n l\u00e2m s\u00e0ng v\u00e0 s\u01a1 sinh sang c\u00e1c ph\u01b0\u01a1ng ph\u00e1p nghi\u00ean c\u1ee9u \u1ee9ng d\u1ee5ng trong ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh th\u1ea7n kinh \u1edf ng\u01b0\u1eddi l\u1edbn.<\/p>\n<h3 data-path-to-node=\"5\">C\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng giai \u0111o\u1ea1n \u0111\u1ea7u<\/h3>\n<p data-path-to-node=\"5\">Nh\u1eefng ti\u1ebfn b\u1ed9 g\u1ea7n \u0111\u00e2y trong h\u00ecnh \u1ea3nh vi m\u1ea1ch, v\u1ed1n \u0111\u00e3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng trong ch\u0103m s\u00f3c b\u1ec7nh nhi, cho ph\u00e9p quan s\u00e1t d\u00f2ng ch\u1ea3y v\u1eadn t\u1ed1c th\u1ea5p m\u00e0 kh\u00f4ng c\u1ea7n ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n v\u00e0 cho th\u1ea5y ti\u1ec1m n\u0103ng trong \u0111\u00e1nh gi\u00e1 m\u1ea1ch m\u00e1u n\u00e3o \u1edf ng\u01b0\u1eddi l\u1edbn khi c\u00f4ng ngh\u1ec7 n\u00e0y ho\u00e0n thi\u1ec7n. Si\u00eau \u00e2m \u0111\u00e0n h\u1ed3i, m\u1eb7c d\u00f9 ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u \u1edf tr\u1ebb s\u01a1 sinh, nh\u01b0ng c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c qua c\u1eeda s\u1ed5 xuy\u00ean th\u00e1i d\u01b0\u01a1ng \u1edf ng\u01b0\u1eddi l\u1edbn v\u00e0 h\u1ee9a h\u1eb9n trong vi\u1ec7c \u0111\u00e1nh gi\u00e1 \u0111\u1ed9 c\u1ee9ng c\u1ee7a n\u00e3o trong c\u00e1c b\u1ec7nh l\u00fd nh\u01b0 gi\u00e3n n\u00e3o th\u1ea5t, ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o v\u00e0 \u0111\u1ed9t quy. Ngo\u00e0i ra, CEUS xuy\u00ean s\u1ecd \u1edf ng\u01b0\u1eddi l\u1edbn c\u00f3 th\u1ec3 cung c\u1ea5p c\u00e1c th\u00f4ng s\u1ed1 t\u01b0\u1edbi m\u00e1u theo th\u1eddi gian th\u1ef1c nh\u01b0 th\u1eddi gian \u0111\u1ea1t \u0111\u1ec9nh (time to peak) v\u00e0 th\u1eddi gian trung chuy\u1ec3n trung b\u00ecnh (mean transit time), v\u1ec1 m\u1eb7t kh\u00e1i ni\u1ec7m c\u00f3 th\u1ec3 so s\u00e1nh v\u1edbi c\u00e1c th\u00f4ng s\u1ed1 thu \u0111\u01b0\u1ee3c t\u1eeb \u0111\u00e1nh gi\u00e1 t\u01b0\u1edbi m\u00e1u tr\u00ean MRI v\u00e0 CT. Kh\u1ea3 n\u0103ng n\u00e0y cho ph\u00e9p \u0111\u00e1nh gi\u00e1 l\u01b0u l\u01b0\u1ee3ng m\u00e1u n\u00e3o t\u1ea1i gi\u01b0\u1eddng trong c\u00e1c b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng nh\u01b0 \u0111\u1ed9t qu\u1ef5, b\u1ec7nh n\u00e3o thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 &#8211; thi\u1ebfu oxy v\u00e0 ch\u1ebft n\u00e3o \u1edf c\u1ea3 ng\u01b0\u1eddi l\u1edbn v\u00e0 tr\u1ebb em. Tuy nhi\u00ean, hi\u1ec7u qu\u1ea3 l\u00e2m s\u00e0ng c\u1ee7a quy tr\u00ecnh n\u00e0y v\u1eabn \u0111ang \u0111\u01b0\u1ee3c ti\u1ebfp t\u1ee5c nghi\u00ean c\u1ee9u (H\u00ecnh 25).<\/p>\n<p data-path-to-node=\"5\"><img decoding=\"async\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/1esphl_NVhR5Ya7a7Zl6nsxuumgUygB3o=s0\" \/><\/p>\n<p data-path-to-node=\"1\"><em><strong data-path-to-node=\"1\" data-index-in-node=\"0\">H\u00ecnh 25.<\/strong> Quy tr\u00ecnh \u0111\u00e1nh gi\u00e1 t\u01b0\u1edbi m\u00e1u b\u1eb1ng si\u00eau \u00e2m xuy\u00ean s\u1ecd c\u00f3 t\u0103ng c\u01b0\u1eddng ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n. M\u1ed9t v\u00f9ng quan t\u00e2m \u0111\u01b0\u1ee3c \u0111\u1eb7t \u1edf th\u00f9y th\u00e1i d\u01b0\u01a1ng (s\u01a1 \u0111\u1ed3 b\u00ean tr\u00e1i v\u00e0 h\u00ecnh \u1ea3nh si\u00eau \u00e2m ph\u00eda tr\u00ean b\u00ean ph\u1ea3i), v\u00e0 m\u1ed9t \u0111\u01b0\u1eddng cong th\u1eddi gian &#8211; c\u01b0\u1eddng \u0111\u1ed9 (ph\u00eda d\u01b0\u1edbi b\u00ean ph\u1ea3i) \u0111\u01b0\u1ee3c t\u1ea1o ra \u0111\u1ec3 \u0111\u1ecbnh l\u01b0\u1ee3ng m\u1ee9c \u0111\u1ed9 t\u01b0\u1edbi m\u00e1u nhu m\u00f4. Sau khi truy\u1ec1n m\u1ed9t li\u1ec1u thu\u1ed1c t\u01b0\u01a1ng ph\u1ea3n (bolus), m\u1ed9t tia nh\u00e1y n\u0103ng l\u01b0\u1ee3ng cao \u1edf th\u1eddi \u0111i\u1ec3m 30 gi\u00e2y s\u1ebd ph\u00e1 h\u1ee7y c\u00e1c vi bong b\u00f3ng, v\u00e0 \u0111\u1ed9ng h\u1ecdc t\u00e1i l\u1ea5p \u0111\u1ea7y sau \u0111\u00f3 \u0111\u01b0\u1ee3c ph\u00e2n t\u00edch. C\u00e1c th\u00f4ng s\u1ed1 t\u01b0\u1edbi m\u00e1u ch\u00ednh nh\u01b0 th\u1eddi gian \u0111\u1ea1t \u0111\u1ec9nh v\u00e0 th\u1eddi gian trung chuy\u1ec3n trung b\u00ecnh sau \u0111\u00f3 \u0111\u01b0\u1ee3c r\u00fat ra, t\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u00e1c th\u00f4ng s\u1ed1 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong c\u00e1c nghi\u00ean c\u1ee9u t\u01b0\u1edbi m\u00e1u b\u1eb1ng MRI. <\/em><\/p>\n<h3 data-path-to-node=\"1\">C\u00e1c c\u00f4ng ngh\u1ec7 th\u1ef1c nghi\u1ec7m<\/h3>\n<p data-path-to-node=\"1\">Si\u00eau \u00e2m ch\u1ee9c n\u0103ng (fUS) cung c\u1ea5p \u0111\u1ed9 ph\u00e2n gi\u1ea3i kh\u00f4ng gian v\u00e0 th\u1eddi gian cao (~100 \u03bcm) \u0111\u1ec3 l\u1eadp b\u1ea3n \u0111\u1ed3 nh\u1eefng thay \u0111\u1ed5i v\u1ec1 th\u1ec3 t\u00edch m\u00e1u n\u00e3o, cho ph\u00e9p theo d\u00f5i th\u1eddi gian th\u1ef1c c\u00e1c ph\u1ea3n \u1ee9ng th\u1ea7n kinh m\u1ea1ch m\u00e1u \u0111\u1ed1i v\u1edbi ho\u1ea1t \u0111\u1ed9ng c\u1ee7a t\u1ebf b\u00e0o th\u1ea7n kinh, ch\u1eb3ng h\u1ea1n nh\u01b0 nh\u1eefng ph\u1ea3n \u1ee9ng \u0111\u01b0\u1ee3c k\u00edch g\u1ee3i b\u1edfi k\u00edch th\u00edch c\u1ea3m gi\u00e1c. \u0110\u1ed9 ph\u00e2n gi\u1ea3i kh\u00f4ng gian v\u00e0 \u0111\u1ed9 ph\u00e2n gi\u1ea3i th\u1eddi gian c\u1ee7a si\u00eau \u00e2m ch\u1ee9c n\u0103ng v\u01b0\u1ee3t tr\u1ed9i h\u01a1n so v\u1edbi MRI ch\u1ee9c n\u0103ng (fMRI). Khi si\u00eau \u00e2m ch\u1ee9c n\u0103ng \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p v\u1edbi si\u00eau \u00e2m vi khu tr\u00fa (US localization microscopy) \u2014 k\u1ef9 thu\u1eadt cung c\u1ea5p \u0111\u1ed9 ph\u00e2n gi\u1ea3i kh\u00f4ng gian xu\u1ed1ng t\u1edbi 13 \u03bcm v\u1edbi \u0111\u1ed9 nh\u1ea1y th\u1eddi gian cao \u2014 ng\u01b0\u1eddi ta c\u00f3 th\u1ec3 quan s\u00e1t \u0111\u01b0\u1ee3c c\u00e1c c\u1ea5u tr\u00fac vi m\u1ea1ch v\u00e0 d\u00f2ng ch\u1ea3y \u1edf c\u1ea5p \u0111\u1ed9 mao m\u1ea1ch (H\u00ecnh 26).<\/p>\n<p data-path-to-node=\"1\">\u00a0<img decoding=\"async\" src=\"https:\/\/lh3.googleusercontent.com\/u\/0\/d\/1j6nF_4yyFttSkmS_6-s_Nz9_WYRP7OMm=s0\" \/><\/p>\n<div class=\"container\">\n<div id=\"model-response-message-contentr_ef909a1bf6ad1d19\" class=\"markdown markdown-main-panel stronger enable-updated-hr-color\" dir=\"ltr\" aria-live=\"polite\" aria-busy=\"false\">\n<p data-path-to-node=\"1\"><em><strong data-path-to-node=\"1\" data-index-in-node=\"0\">H\u00ecnh 26.<\/strong> B\u1ea3n \u0111\u1ed3 hi\u1ec3n vi khu tr\u00fa si\u00eau \u00e2m ch\u1ee9c n\u0103ng v\u1ec1 nh\u1eefng thay \u0111\u1ed5i d\u00f2ng ch\u1ea3y vi m\u1ea1ch n\u00e3o \u1edf chu\u1ed9t trong qu\u00e1 tr\u00ecnh k\u00edch th\u00edch x\u00fac gi\u00e1c c\u1ee7a r\u00e2u m\u1eb7t. K\u00edch th\u00edch r\u00e2u l\u00e0 m\u1ed9t m\u00f4 h\u00ecnh ti\u1ec1n l\u00e2m s\u00e0ng ti\u00eau chu\u1ea9n \u0111\u1ec3 k\u00edch g\u1ee3i s\u1ef1 ho\u1ea1t h\u00f3a n\u00e3o khu tr\u00fa th\u00f4ng qua con \u0111\u01b0\u1eddng c\u1ea3m gi\u00e1c th\u00e2n th\u1ec3. (H\u00ecnh minh h\u1ecda b\u00ean tr\u00e1i \u0111\u01b0\u1ee3c t\u1ea1o b\u1eb1ng BioRender. Esmeraldo M [2025], <a class=\"ng-star-inserted\" href=\"https:\/\/BioRender.com\/qgy4ggn\" target=\"_blank\" rel=\"noopener\" data-hveid=\"0\" data-ved=\"0CAAQ_4QMahgKEwjw1LOe5ZWUAxUAAAAAHQAAAAAQ-wM\">https:\/\/BioRender.com\/qgy4ggn<\/a>.) Thang m\u00e0u bi\u1ec3u th\u1ecb s\u1ed1 l\u01b0\u1ee3ng vi bong b\u00f3ng (MB) tr\u00ean m\u1ed7i pixel (pix), v\u1edbi c\u00e1c MB \u0111\u00f3ng vai tr\u00f2 l\u00e0 ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n trong m\u1ea1ch m\u00e1u \u0111\u1ec3 l\u1eadp b\u1ea3n \u0111\u1ed3 d\u00f2ng m\u00e1u \u1edf \u0111\u1ed9 ph\u00e2n gi\u1ea3i vi m\u00f4. T\u00edn hi\u1ec7u MB t\u0103ng ph\u1ea3n \u00e1nh t\u00ecnh tr\u1ea1ng t\u0103ng t\u01b0\u1edbi m\u00e1u do k\u00edch th\u00edch, ch\u1ee7 y\u1ebfu \u1edf v\u1ecf n\u00e3o c\u1ea3m gi\u00e1c th\u00e2n th\u1ec3 \u0111\u1ed1i b\u00ean. (\u0110\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh v\u00e0 in l\u1ea1i, v\u1edbi s\u1ef1 cho ph\u00e9p, t\u1eeb t\u00e0i li\u1ec7u tham kh\u1ea3o 78, theo gi\u1ea5y ph\u00e9p CC BY 4.0.)<\/em><\/p>\n<p data-path-to-node=\"3\">M\u1eb7c d\u00f9 ban \u0111\u1ea7u \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n tr\u00ean c\u00e1c m\u00f4 h\u00ecnh lo\u00e0i g\u1eb7m nh\u1ea5m, si\u00eau \u00e2m ch\u1ee9c n\u0103ng v\u00e0 hi\u1ec3n vi khu tr\u00fa si\u00eau \u00e2m g\u1ea7n \u0111\u00e2y \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1eed nghi\u1ec7m tr\u00ean m\u1ed9t \u0111\u1ed1i t\u01b0\u1ee3ng ng\u01b0\u1eddi t\u1ec9nh t\u00e1o b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng m\u1ea3nh gh\u00e9p s\u1ecd trong su\u1ed1t v\u1edbi si\u00eau \u00e2m (79). Ngo\u00e0i ra, hi\u1ec3n vi khu tr\u00fa si\u00eau \u00e2m si\u00eau nhanh \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n th\u00e0nh c\u00f4ng th\u00f4ng qua c\u1eeda s\u1ed5 xuy\u00ean th\u00e1i d\u01b0\u01a1ng \u1edf m\u1ed9t ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh, cung c\u1ea5p \u0111\u1ed9 ph\u00e2n gi\u1ea3i m\u1ea1ch m\u00e1u ch\u01b0a t\u1eebng c\u00f3 v\u00e0 do \u0111\u00f3 \u0111\u1ea1i di\u1ec7n cho m\u1ed9t b\u01b0\u1edbc quan tr\u1ecdng h\u01b0\u1edbng t\u1edbi vi\u1ec7c chuy\u1ec3n \u0111\u1ed5i l\u00e2m s\u00e0ng r\u1ed9ng r\u00e3i h\u01a1n (80).<\/p>\n<p data-path-to-node=\"4\">C\u00e1c c\u00f4ng c\u1ee5 m\u1edbi n\u1ed5i n\u00e0y v\u1ec1 t\u1ed5ng th\u1ec3 n\u1eafm gi\u1eef ti\u1ec1m n\u0103ng m\u1ea1nh m\u1ebd trong vi\u1ec7c m\u1edf r\u1ed9ng vai tr\u00f2 c\u1ee7a si\u00eau \u00e2m trong ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh th\u1ea7n kinh \u1edf ng\u01b0\u1eddi l\u1edbn, k\u1ebft n\u1ed1i c\u00e1c hi\u1ec3u bi\u1ebft v\u1ec1 c\u1ea5u tr\u00fac, t\u01b0\u1edbi m\u00e1u v\u00e0 ch\u1ee9c n\u0103ng \u1edf \u0111\u1ecbnh d\u1ea1ng di \u0111\u1ed9ng v\u00e0 th\u1eddi gian th\u1ef1c.<\/p>\n<h3 data-path-to-node=\"5\">K\u1ebft lu\u1eadn<\/h3>\n<p data-path-to-node=\"6\">Si\u00eau \u00e2m xuy\u00ean s\u1ecd l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 t\u1ea1i gi\u01b0\u1eddng kh\u00f4ng x\u00e2m l\u1ea5n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 huy\u1ebft \u0111\u1ed9ng h\u1ecdc n\u00e3o v\u00e0 c\u00e1c c\u1ea5u tr\u00fac nhu m\u00f4 n\u00e3o ch\u1ecdn l\u1ecdc. TCDi cung c\u1ea5p nh\u1eefng \u01b0u \u0111i\u1ec3m so v\u1edbi niTCD b\u1eb1ng c\u00e1ch cho ph\u00e9p h\u01b0\u1edbng d\u1eabn gi\u1ea3i ph\u1eabu theo th\u1eddi gian th\u1ef1c v\u00e0 c\u1ea3i thi\u1ec7n \u0111\u1ed9 tin c\u1eady ch\u1ea9n \u0111o\u00e1n. Khi TCDi \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p v\u1edbi c\u00e1c k\u1ef9 thu\u1eadt si\u00eau \u00e2m thang x\u00e1m v\u00e0 t\u0103ng c\u01b0\u1eddng ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n, n\u00f3 m\u1edf r\u1ed9ng ti\u1ec7n \u00edch l\u00e2m s\u00e0ng c\u1ee7a si\u00eau \u00e2m xuy\u00ean s\u1ecd tr\u00ean m\u1ed9t lo\u1ea1t c\u00e1c \u1ee9ng d\u1ee5ng ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh th\u1ea7n kinh d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng \u0111\u00e3 \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp r\u00f5 r\u00e0ng v\u00e0 nhi\u1ec1u \u1ee9ng d\u1ee5ng kh\u00e1c v\u1eabn \u0111ang \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u, t\u1ea1o \u0111i\u1ec1u ki\u1ec7n \u0111\u1ec3 n\u00f3 \u0111\u00f3ng vai tr\u00f2 ng\u00e0y c\u00e0ng t\u0103ng trong ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh th\u1ea7n kinh hi\u1ec7n \u0111\u1ea1i.<\/p>\n<h3 data-path-to-node=\"7\">Ch\u00fa th\u00edch<\/h3>\n<p data-path-to-node=\"8\">\u0110\u01b0\u1ee3c tr\u00ecnh b\u00e0y d\u01b0\u1edbi d\u1ea1ng tri\u1ec3n l\u00e3m gi\u00e1o d\u1ee5c t\u1ea1i H\u1ed9i ngh\u1ecb th\u01b0\u1eddng ni\u00ean RSNA n\u0103m 2024<\/p>\n<blockquote>\n<p data-path-to-node=\"8\">https:\/\/doi.org\/10.1148\/rg.250182.<\/p>\n<\/blockquote>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>ph\u1ea1m vi c\u1ee7a si\u00eau \u00e2m xuy\u00ean s\u1ecd \u0111\u00e3 m\u1edf r\u1ed9ng \u0111\u00e1ng k\u1ec3 trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y. Nh\u1eefng ti\u1ebfn b\u1ed9 trong c\u00f4ng ngh\u1ec7 si\u00eau \u00e2m, bao g\u1ed3m nh\u1eefng c\u1ea3i ti\u1ebfn trong TCDi v\u00e0 s\u1ef1 ra \u0111\u1eddi c\u1ee7a CEUS, \u0111\u00e3 cho ph\u00e9p quan s\u00e1t th\u1eddi gian th\u1ef1c h\u1ec7 m\u1ea1ch m\u00e1u n\u1ed9i s\u1ecd, c\u1ea3i thi\u1ec7n \u0111\u1ed9 nh\u1ea1y \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 c\u1eeda s\u1ed5 \u00e2m k\u00e9m v\u00e0 m\u1edf r\u1ed9ng c\u00e1c \u1ee9ng d\u1ee5ng ngo\u00e0i c\u00e1c ch\u1ec9 \u0111\u1ecbnh c\u1ed5 \u0111i\u1ec3n. Song song \u0111\u00f3, si\u00eau \u00e2m nhu m\u00f4 n\u00e3o xuy\u00ean s\u1ecd (ch\u1ebf \u0111\u1ed9 B-mode &#8211; TCS), v\u1ed1n tr\u01b0\u1edbc \u0111\u00e2y ch\u1ec9 gi\u1edbi h\u1ea1n trong ch\u0103m s\u00f3c s\u01a1 sinh, ng\u00e0y c\u00e0ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u00e0 nghi\u00ean c\u1ee9u cho c\u00e1c \u1ee9ng d\u1ee5ng trong h\u1ed3i s\u1ee9c th\u1ea7n kinh v\u00e0 \u0111\u00e1nh gi\u00e1 c\u00e1c b\u1ea5t th\u01b0\u1eddng nhu m\u00f4 \u1edf b\u1ec7nh nh\u00e2n ng\u01b0\u1eddi l\u1edbn<\/p>\n","protected":false},"author":1,"featured_media":1320,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,2,41],"tags":[],"class_list":["post-1313","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-khong-phan-loai","category-doc-sach-cho-vui","category-english-corner"],"_links":{"self":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/1313","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/comments?post=1313"}],"version-history":[{"count":6,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/1313\/revisions"}],"predecessor-version":[{"id":1321,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/1313\/revisions\/1321"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/media\/1320"}],"wp:attachment":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/media?parent=1313"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/categories?post=1313"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/tags?post=1313"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}