X HNH PHI

BS Phm Vn Triu

Khoa Y hc ht nhn Bnh vin Ch Ry

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.

Gii phu cc phn thy phi trn x hnh

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)

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)

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

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

* 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

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.

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):

Tiu chun PIOPED ci bin

trong thc hnh lm sng

Ch nh

Ch nh:

- nh gi ti mu phi

- Thuyn tc phi

- Huyt khi tnh mch su.

- Cng vi x hnh h tnh mch.

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

Hnh nh CxR, Q, V trn cng BN 1

Hnh nh CxR, Q, V trn cng BN 1

Triple match low probability for PE

Hnh nh CxR, Q, V trn cng BN 2

Hnh nh CxR, Q, V trn cng BN 2

Hnh nh CxR, Q, V trn cng BN 2

Single segmental mismatch inter probability for PE

Hnh nh CxR, Q, V trn cng BN 3

Hnh nh CxR, Q, V trn cng BN 3

Large segmental mismatch high probability for PE

SPECT/CT