sv. đhqg xa hinh phoi bs.phamvantrieu 72016 new
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X HNH PHI
BS Phm Vn Triu
Khoa Y hc ht nhn Bnh vin Ch Ry
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Gii phu v sinh l bnh
- Phi c cp huyt bi M ph qun thuyn
tc M phi (PE) nhi mu phi (PI)
- Thng kh (V) v ti mu (Q) phi bnh
thng lun tng thch nhau.
- Bt tng hp V v Q (V/Q mismatched): c s
sinh l bnh cho x hnh phi.
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Gii phu cc phn thy phi trn x hnh
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Dc cht phng x
X hnh thng kh:
- Xenon-133, Xenon-127, Krypton-81m
(kh phng x, Radioactive gases)
- Tc-99m DTPA (phun kh dung)
X hnh ti mu:
Tc-99m MAA
(Macro Aggregated Albumin)
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Phn liu 99mTc MAA
- Chit 50mCi 99mTc t my pht = (a) ml.
- Rt thm (5-a ml) dung dch NS cho 5 ml.
- Bm vo l kit MAA v .
c tnh ca dung dch trong l kit sau :
- Hot : 50mCi/5ml # 10mCi/1ml.
- S ht: 5,000K ht/5ml # 1,000K ht/1ml.
0,5ml = 5mCi= 500K ht (10-90m)
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X hnh thng kh
- Chun b BN: ho, ht hi, ht su nhiu ln
- Thit b:
- Camera: Large FOV.
- Collimator: LEAP, parallel hole.
- Photo peak: 140-keV (20% window)
- Counts: 200-250K/ hnh
- T th:
- u tin ngi
- 8 t th thng quy
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X hnh ti mu
* Dc cht phng x:
+ Tc-99m MAA
+ Liu ngi ln: 2- 5 mCi, 200-500K ht
Tr s sinh: 10K ht.
Tr
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* Chun b BN
- BN nm nga, TTM chm 3-5 chu k h hp
- Ghi hnh sau tim 10 pht, u tin t th ngi, 8
v tr thng quy: anterior, posterior, RLAT, LLAT,
RAO, LAO, RPO, LPO
Lu :
- Lc u trc khi tim, khng rt ngc mu vo
ng tim
- C th pha long vi dd NS
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Cch tip cn hnh nh x hnh phi:
- XQ ngc (CxR) (trong vng 24 h): m t cc bt
thng, giai on.
-Hnh nh ti mu phi (Q): Xc nh cc khuyt
x (v tr, kch thc, theo phn thy)
-X hnh thng kh phi (V): kim tra c bt
thng theo nhng v tr ca Q. Tt c u c so
snh vi hnh nh CxR.
Nu tn thng trn Q khng tng ng vi V v
CxR (V/Q mismatch) PE. S lng mismatch t
l thun vi kh nng cao ca PE.
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PIOPED (Prospective Investigation of
Pulmonary Embolism Diagnosis )
- Nguy c cao (High probability):
>80% kh nng thuyn tc phi
- Nguy c trung bnh (Intermediate probability):
20-80% kh nng thuyn tc phi
- Nguy c thp (Low probability):
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Tiu chun PIOPED ci bin
trong thc hnh lm sng
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Ch nh
Ch nh:
- nh gi ti mu phi
- Thuyn tc phi
- Huyt khi tnh mch su.
- Cng vi x hnh h tnh mch.
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Chng ch nh
Tuyt i:
- Suy tun hon phi nng, vim phi g cp
- Tng p ng mch phi nng
- Nhy cm vi protein
Tng i:
- C thai, cho con b
- Shunt P-T
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Hnh nh CxR, Q, V trn cng BN 1
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Hnh nh CxR, Q, V trn cng BN 1
Triple match low probability for PE
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Hnh nh CxR, Q, V trn cng BN 2
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Hnh nh CxR, Q, V trn cng BN 2
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Hnh nh CxR, Q, V trn cng BN 2
Single segmental mismatch inter probability for PE
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Hnh nh CxR, Q, V trn cng BN 3
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Hnh nh CxR, Q, V trn cng BN 3
Large segmental mismatch high probability for PE
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SPECT/CT
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