Nghiệm pháp hô hấp tim mạch gắng sức trong chẩn đoán khó thở mạn tính

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Tác giả: Ngọc Phương Thư Nguyễn

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2023

Mô tả vật lý: tr.15

Bộ sưu tập: Báo, Tạp chí

ID: 339306

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Khó thở khi gắng sức là một vấn đề thường gặp trong thực hành lâm sàng. Trên thực tế, tiếp cận chẩn đoán bệnh nhân khó thở thường bắt đầu bằng hỏi bệnh sử chi tiết và khám thực thể toàn diện. Từ đó, người thầy thuốc sẽ chỉ định cho bệnh nhân làm các thăm dò cận lâm sàng phù hợp để có được chẩn đoán xác định và điều trị phù hợp. Tuy nhiên, trong một số trường hợp, dù bệnh nhân đã được chỉ định làm các xét nghiệm đánh giá hình ảnh và hoặc chức năng hô hấp và tim mạch chuyên sâu như chụp CT ngực có cản quang, chụp động mạch vành… nhưng vẫn không tìm được nguyên nhân gây khó thở. Đây thật sự là một thách thức cho người thầy thuốc. Nghiệm pháp hô hấp tim mạch gắng sức hay CPET là một thăm dò động học, trong điều kiện gắng sức và tương đối an toàn, giúp xác định các bất thường sinh lý của hệ hô hấp, tim mạch và thần kinh cơ trong việc gây khó thở khi gắng sức mà không được phát hiện bằng các xét nghiệm thường quy khác. Mặc dù CPET đã tồn tại trong nhiều thập kỷ và cung cấp thông tin có giá trị và thích hợp về đáp ứng của hệ hô hấp, tim mạch, thần kinh cơ đối với gắng sức, nhưng vẫn chưa được sử dụng rộng rãi do việc diễn giải không đơn giản và cần có kiến thức về đáp ứng sinh lý đối với gắng sức. Mục tiêu của bài viết này nhằm cung cấp thông tin về ý nghĩa lâm sàng của các thông số CPET và ứng dụng CPET trong chẩn đoán khó thở mạn tính. Abstract Dyspnea on exertion is a common problem in clinical practice. In reality, a diagnostic approach to dyspnea often begins with a detailed history and a complete physical examination. Then, a physician will indicate paraclinical tests to the patient to get a definite diagnosis and appropriate treatment. However, in some cases, even though apatient has been indicated to have intensive respiratory and cardiovascular imaging and/or function tests such as contrast chest CT scan, coronary angiography, we don’t know causes of shortness of breath. This is a real challenge for aphysician. CardioPulmonaryExercise Testing or CPET is a safetydynamic and stress test. It can help to identify physiological abnormalities of the respiratory, cardiovascular, and neuromuscular systems that contribute to exertional dyspnea andare not uncovered by routine tests. Although CPET has been for decades and providedvaluable and relevant information on the respiratory, cardiovascular, and neuromuscular responses to exercise, it has not been widely used because of its interpretation which is not straightforward and requires knowledge of physiological response to exercise. The objective of this article is to provide information on the clinical significance of CPET parameters and the application of CPET in the diagnosis of chronic dyspnea. DOI: 10.59715/pntjmp.1.2.2

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