{"id":18700,"date":"2023-04-22T15:45:07","date_gmt":"2023-04-22T08:45:07","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=18700"},"modified":"2023-04-22T15:45:07","modified_gmt":"2023-04-22T08:45:07","slug":"huong-dan-quy-trinh-test-chan-doan-nhuoc-co-bang-ghi-dien-co-sinh-ly","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/huong-dan-quy-trinh-test-chan-doan-nhuoc-co-bang-ghi-dien-co-sinh-ly\/","title":{"rendered":"H\u01b0\u1edbng d\u1eabn quy tr\u00ecnh test ch\u1ea9n \u0111o\u00e1n nh\u01b0\u1ee3c c\u01a1 b\u1eb1ng ghi \u0111i\u1ec7n c\u01a1 sinh l\u00fd"},"content":{"rendered":"

Ghi \u0111i\u1ec7n c\u01a1<\/a> l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n b\u1ec7nh nh\u01b0\u1ee3c c\u01a1 b\u1eb1ng c\u00e1ch ghi l\u1ea1i ho\u1ea1t \u0111\u1ed9ng \u0111i\u1ec7n c\u1ee7a c\u01a1 b\u1eafp. Ghi \u0111i\u1ec7n c\u01a1 l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111\u01a1n gi\u1ea3n, kh\u00f4ng \u0111au v\u00e0 an to\u00e0n \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n b\u1ec7nh nh\u01b0\u1ee3c c\u01a1.<\/strong><\/p>\n

\"ghi-dien-co\"
Ghi \u0111i\u1ec7n c\u01a1 trong l\u00e2m s\u00e0ng th\u1ea7n kinh<\/figcaption><\/figure>\n

1. \u0110\u1ea1i c\u01b0\u01a1ng v\u1ec1 ghi \u0111i\u1ec7n c\u01a1<\/h2>\n

Ghi \u0111i\u1ec7n c\u01a1<\/strong><\/a> (electromyography-EMG) l\u00e0 ph\u01b0\u01a1ng ph\u00e1p th\u0103m d\u00f2 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 nghi\u00ean c\u1ee9u ph\u1ea3n \u1ee9ng \u0111i\u1ec7n c\u1ee7a th\u1ea7n kinh v\u00e0 c\u01a1, \u0111\u00e1nh gi\u00e1 s\u1ef1 m\u1ea5t ph\u00e2n b\u1ed1 th\u1ea7n kinh c\u1ee7a c\u01a1. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y s\u1eed d\u1ee5ng c\u00e1c \u0111i\u1ec7n c\u1ef1c \u0111\u1ec3 ghi l\u1ea1i t\u00edn hi\u1ec7u \u0111i\u1ec7n t\u1eeb c\u01a1 b\u1eafp khi ch\u00fang ho\u1ea1t \u0111\u1ed9ng v\u00e0 ph\u00e1t ra s\u00f3ng \u0111i\u1ec7n. Th\u00f4ng qua ph\u00e2n t\u00edch c\u00e1c d\u1ea5u hi\u1ec7u \u0111i\u1ec7n n\u00e0y, b\u00e1c s\u0129 c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng c\u1ee7a c\u01a1 b\u1eafp v\u00e0 x\u00e1c \u0111\u1ecbnh c\u00e1c v\u1ea5n \u0111\u1ec1 s\u1ee9c kh\u1ecfe nh\u01b0 b\u1ec7nh nh\u01b0\u1ee3c c\u01a1, b\u1ea1i li\u1ec7t, b\u1ec7nh th\u1ea7n kinh v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 li\u00ean quan \u0111\u1ebfn c\u01a1 b\u1eafp kh\u00e1c.<\/p>\n

Nh\u01b0\u1ee3c c\u01a1 l\u00e0 m\u1ed9t b\u1ec7nh th\u1ea7n kinh – c\u01a1 c\u00f3 \u0111\u1eb7c t\u00ednh l\u00e0 m\u1ecfi v\u00e0 y\u1ebfu c\u00e1c c\u01a1 v\u00e2n xu\u1ea5t hi\u1ec7n t\u0103ng khi g\u1eafng s\u1ee9c v\u00e0 gi\u1ea3m khi ngh\u1ec9 ng\u01a1i, do c\u00f3 s\u1ef1 gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng c\u00e1c th\u1ee5 th\u1ec3 acetylcholine \u1edf m\u00e0ng c\u01a1 sau synap. S\u1ef1 thay \u0111\u1ed5i n\u00e0y l\u00e0m gi\u1ea3m hi\u1ec7u l\u1ef1c d\u1eabn truy\u1ec1n th\u1ea7n kinh c\u01a1. S\u1eed d\u1ee5ng k\u00edch th\u00edch l\u1eb7p l\u1ea1i, k\u00edch th\u00edch li\u00ean t\u1ee5c t\u00e1c \u0111\u1ed9ng tr\u00ean th\u00e2n c\u1ee7a d\u00e2y th\u1ea7n kinh v\u00e0 ghi \u0111i\u1ec7n th\u1ebf \u0111\u00e1p \u1ee9ng \u1edf c\u01a1 \u0111\u00edch. Trong b\u1ec7nh nh\u01b0\u1ee3c c\u01a1 s\u1ebd c\u00f3 s\u1ef1 suy gi\u1ea3m bi\u00ean \u0111\u1ed9 v\u00e0 di\u1ec7n t\u00edch \u0111i\u1ec7n th\u1ebf \u0111\u00e1p \u1ee9ng c\u1ee7a c\u01a1 do k\u00edch th\u00edch l\u1eb7p l\u1ea1i.<\/p>\n

2. Ch\u1ec9 \u0111\u1ecbnh ghi \u0111i\u1ec7n c\u01a1<\/h2>\n

Ph\u01b0\u01a1ng ph\u00e1p \u0111o \u0111i\u1ec7n c\u01a1 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00e0 theo d\u00f5i nh\u1eefng r\u1ed1i lo\u1ea1n ch\u1ed7 n\u1ed1i th\u1ea7n kinh c\u01a1 (b\u1ec7nh nh\u01b0\u1ee3c c\u01a1, h\u1ed9i ch\u1ee9ng nh\u01b0\u1ee3c c\u01a1).<\/p>\n

3. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh ghi \u0111i\u1ec7n c\u01a1<\/h2>\n

Kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi ph\u01b0\u01a1ng ph\u00e1p \u0111o \u0111i\u1ec7n c\u01a1.<\/p>\n

4. Chu\u1ea9n b\u1ecb tr\u01b0\u1edbc ghi \u0111i\u1ec7n c\u01a1<\/h2>\n

4.1. Ng\u01b0\u1eddi th\u1ef1c hi\u1ec7n<\/h3>\n

Ng\u01b0\u1eddi th\u1ef1c hi\u1ec7n ghi \u0111i\u1ec7n c\u01a1 g\u1ed3m 01 b\u00e1c s\u0129, 01 k\u1ef9 thu\u1eadt vi\u00ean (KTV).<\/p>\n

4.2. Ph\u01b0\u01a1ng ti\u1ec7n, d\u1ee5ng c\u1ee5, thu\u1ed1c<\/h3>\n

V\u1eadt t\u01b0 s\u1eed d\u1ee5ng trong \u0111o \u0111i\u1ec7n c\u01a1 g\u1ed3m c\u00f3:<\/p>\n

    \n
  • \u0110i\u1ec7n c\u1ef1c ghi b\u1ec1 m\u1eb7t b\u1ed9<\/li>\n
  • \u0110i\u1ec7n c\u1ef1c k\u00edch th\u00edch l\u01b0\u1ee1ng c\u1ef1c c\u00e1i<\/li>\n
  • \u0110i\u1ec7n c\u1ef1c ti\u1ebfp \u0111\u1ea5t c\u00e1i<\/li>\n
  • Gel t\u1ea9y s\u1ea1ch da tu\u00fdp<\/li>\n
  • Paste d\u1eabn \u0111i\u1ec7n l\u1ecd<\/li>\n
  • N\u01b0\u1edbc mu\u1ed1i sinh l\u00fd l\u00edt<\/li>\n
  • Gi\u1ea5y in A4<\/li>\n<\/ul>\n

    4.3. Ng\u01b0\u1eddi b\u1ec7nh<\/h3>\n

    Chu\u1ea9n b\u1ecb ng\u01b0\u1eddi b\u1ec7nh tr\u01b0\u1edbc khi \u0111o \u0111i\u1ec7n c\u01a1:<\/p>\n

      \n
    • Ng\u01b0\u1eddi b\u1ec7nh c\u1ea7n \u0103n u\u1ed1ng tr\u01b0\u1edbc khi \u0111o.<\/li>\n
    • B\u1ec7nh nhi c\u1ea7n ph\u1ea3i c\u00f3 kh\u0103n, t\u00e3 l\u00f3t \u0111\u1ea7y \u0111\u1ee7.<\/li>\n
    • Ng\u01b0\u1eddi b\u1ec7nh nh\u01b0\u1ee3c c\u01a1 ph\u1ea3i ng\u01b0ng thu\u1ed1c kh\u00e1ng men tr\u01b0\u1edbc \u0111o EMG 24 gi\u1edd: Mestinon, Prostigmin.<\/li>\n
    • Ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c th\u0103m kh\u00e1m l\u00e2m s\u00e0ng, l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m th\u01b0\u1eddng quy, chu\u1ea9n b\u1ecb t\u01b0 t\u01b0\u1edfng, \u0111\u01b0\u1ee3c th\u00f4ng b\u00e1o v\u00e0 gi\u1ea3i th\u00edch v\u1ec1 c\u00e1ch ti\u1ebfn h\u00e0nh th\u1ee7 thu\u1eadt.<\/li>\n
    • H\u01b0\u1edbng d\u1eabn ng\u01b0\u1eddi b\u1ec7nh ph\u1ed1i h\u1ee3p trong khi ghi \u0111i\u1ec7n c\u01a1.<\/li>\n<\/ul>\n

      4.4. H\u1ed3 s\u01a1 b\u1ec7nh \u00e1n<\/h3>\n

      Trong h\u1ed3 s\u01a1 b\u1ec7nh \u00e1n c\u1ea7n ghi r\u00f5 t\u00ean tu\u1ed5i \u0111\u1ecba ch\u1ec9, gi\u1edbi t\u00ednh, ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng, ng\u00e0y gi\u1edd \u0111o \u0111i\u1ec7n c\u01a1.<\/p>\n

      5. C\u00e1c b\u01b0\u1edbc ti\u1ebfn h\u00e0nh \u0111\u00e1nh gi\u00e1, ghi h\u1ed3 s\u01a1 v\u00e0 b\u00e1o c\u00e1o<\/h2>\n

      5.1. Ki\u1ec3m tra h\u1ed3 s\u01a1<\/h3>\n

      Tr\u01b0\u1edbc khi th\u1ef1c hi\u1ec7n quy tr\u00ecnh, c\u1ea7n \u0111\u1ed1i chi\u1ebfu h\u1ed3 s\u01a1 b\u1ec7nh \u00e1n v\u00e0 ng\u01b0\u1eddi b\u1ec7nh, tr\u00e1nh x\u1ea3y ra sai s\u00f3t.<\/p>\n

      5.2. Ki\u1ec3m tra ng\u01b0\u1eddi b\u1ec7nh<\/h3>\n

      Ng\u01b0\u1eddi b\u1ec7nh ghi \u0111i\u1ec7n c\u01a1 c\u1ea7n \u1edf t\u01b0 th\u1ebf th\u01b0 gi\u00e3n c\u01a1 v\u00e0 chu\u1ea9n b\u1ecb m\u00e1y (\u0111\u00e3 \u0111\u01b0\u1ee3c c\u00e0i \u0111\u1eb7t s\u1eb5n c\u00e1c th\u00f4ng s\u1ed1 nh\u01b0 t\u1ed1c \u0111\u1ed9 qu\u00e9t, \u0111\u1ed9 ph\u00f3ng \u0111\u1ea1i, gi\u1edbi h\u1ea1n t\u1ea7n s\u1ed1 cao v\u00e0 th\u1ea5p).<\/p>\n

      5.3. Quy tr\u00ecnh th\u1ef1c hi\u1ec7n k\u1ef9 thu\u1eadt<\/h3>\n

      Ghi \u0111i\u1ec7n c\u01a1 l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p th\u0103m d\u00f2 kh\u00f4ng x\u00e2m l\u1ea5n, \u0111\u01a1n gi\u1ea3n v\u00e0 d\u1ec5 th\u1ef1c hi\u1ec7n:<\/p>\n

        \n
      • C\u00e1ch \u0111\u1eb7t \u0111i\u1ec7n c\u1ef1c k\u00edch th\u00edch v\u00e0 ghi k\u1ebft qu\u1ea3 gi\u1ed1ng nh\u01b0 khi ghi \u0111i\u1ec7n c\u01a1 nh\u1eb1m \u0111o t\u1ed1c \u0111\u1ed9 d\u1eabn truy\u1ec1n v\u1eadn \u0111\u1ed9ng. C\u01b0\u1eddng \u0111\u1ed9 k\u00edch th\u00edch tr\u00ean m\u1ee9c t\u1ed1i \u0111a (120%).<\/li>\n
      • T\u00ecm v\u1ecb tr\u00ed \u0111i\u1ec7n c\u1ef1c \u0111\u1ec3 h\u00ecnh d\u1ea1ng s\u00f3ng r\u00f5 r\u00e0ng nh\u1ea5t. Ch\u1edd v\u00e0i gi\u00e2y sau khi k\u00edch th\u00edch th\u1eed \u0111\u1ec3 cho c\u01a1 ph\u1ee5c h\u1ed3i l\u1ea1i tr\u1ea1ng th\u00e1i b\u00ecnh th\u01b0\u1eddng.<\/li>\n
      • K\u00edch th\u00edch chu\u1ed7i xung (10 xung) v\u00e0 ghi s\u00f3ng. Th\u00f4ng th\u01b0\u1eddng ng\u01b0\u1eddi ta ch\u1ecdn 3 c\u01a1 sau \u0111\u1ec3 l\u00e0m test th\u1eed: m\u1ed9t c\u01a1 nh\u1ecf \u1edf b\u00e0n tay (\u00f4 m\u00f4 c\u00e1i ho\u1eb7c \u00f4 m\u00f4 \u00fat), c\u01a1 thang ho\u1eb7c m\u1ed9t c\u01a1 kh\u00e1c \u1edf vai (v\u00ed d\u1ee5 c\u01a1 delta), sau \u0111\u00f3 l\u00e0 m\u1ed9t c\u01a1 \u1edf m\u1eb7t.<\/li>\n
      • K\u1ef9 thu\u1eadt: k\u00edch th\u00edch l\u1eb7p l\u1ea1i li\u00ean ti\u1ebfp\u00a0 chu\u1ed7i 10 k\u00edch th\u00edch b\u1eb1ng xung \u0111i\u1ec7n li\u00ean ti\u1ebfp \u1edf t\u1ea7n s\u1ed1 3 Hz (3 k\u00edch th\u00edch\/gi\u00e2y).<\/li>\n<\/ul>\n

        N\u1ebfu bi\u00ean \u0111\u1ed9 co c\u01a1 th\u1ee9 4 ho\u1eb7c 5 so v\u1edbi bi\u00ean \u0111\u1ed9 co c\u01a1 \u0111\u1ea7u ti\u00ean gi\u1ea3m kho\u1ea3ng 5% th\u00ec nghi ng\u1edd b\u1ec7nh nh\u01b0\u1ee3c c\u01a1. N\u1ebfu suy gi\u1ea3m tr\u00ean 10% v\u00e0 \u0111\u01b0\u1ee3c th\u1ea5y \u1edf \u00edt nh\u1ea5t 2 c\u01a1 b\u1eafp th\u00ec coi nh\u01b0 ch\u1eafc ch\u1eafn b\u1ecb b\u1ec7nh nh\u01b0\u1ee3c c\u01a1. N\u1ebfu nghi ng\u1edd c\u00f3 h\u1ed9i ch\u1ee9ng nh\u01b0\u1ee3c c\u01a1 c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n th\u00eam chu\u1ed7i 30-50 k\u00edch th\u00edch li\u00ean ti\u1ebfp, t\u1ea7n s\u1ed1 50Hz c\u0169ng th\u1ea5y c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng suy gi\u1ea3m ch\u00fat \u00edt nh\u01b0ng sau \u0111\u00f3 c\u00e1c bi\u00ean \u0111\u1ed9 co c\u01a1 t\u0103ng l\u00ean (g\u1ecdi l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng t\u0103ng c\u01b0\u1eddng), v\u1edbi \u0111\u1eb7c \u0111i\u1ec3m c\u00e0ng v\u1ec1 sau c\u00e0ng <\/strong>cao h\u01a1n tr\u01b0\u1edbc v\u00e0 s\u1ebd cao h\u01a1n c\u1ea3 co c\u01a1 \u0111\u1ea7u ti\u00ean trong chu\u1ed7i \u0111\u00f3. N\u1ebfu bi\u00ean \u0111\u1ed9 co c\u01a1 v\u1ec1 sau cao h\u01a1n bi\u00ean \u0111\u1ed9 co c\u01a1 ban \u0111\u1ea7u c\u1ee7a chu\u1ed7i t\u1eeb 200% tr\u1edf l\u00ean th\u00ec ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng Eaton – Lambert.<\/strong><\/p>\n

        Sau khi d\u00f9ng kh\u00e1ng cholinesterase: gi\u1ea3m nh\u1eb9 \u0111i ho\u1eb7c bi\u1ebfn m\u1ea5t, c\u00e0ng kh\u1eb3ng \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n nh\u01b0\u1ee3c c\u01a1. D\u01b0\u01a1ng t\u00ednh r\u00f5 r\u1ec7t \u1edf c\u01a1 y\u1ebfu nh\u1ea5t.<\/p>\n

        Test \u0111i\u1ec7n c\u01a1 l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 h\u1eefu \u00edch gi\u00fap b\u00e1c s\u0129 ch\u1ea9n \u0111o\u00e1n b\u1ec7nh nh\u01b0\u1ee3c c\u01a1 v\u00e0 x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n c\u1ee7a n\u00f3. Th\u00f4ng qua ph\u00e2n t\u00edch c\u00e1c d\u1ea5u hi\u1ec7u \u0111i\u1ec7n n\u00e0y, b\u00e1c s\u0129 c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng c\u1ee7a c\u01a1 b\u1eafp v\u00e0 x\u00e1c \u0111\u1ecbnh c\u00e1c v\u1ea5n \u0111\u1ec1 s\u1ee9c kh\u1ecfe nh\u01b0 b\u1ec7nh nh\u01b0\u1ee3c c\u01a1, b\u1ea1i li\u1ec7t, b\u1ec7nh th\u1ea7n kinh v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 li\u00ean quan \u0111\u1ebfn c\u01a1 b\u1eafp kh\u00e1c. V\u00ec v\u1eady th\u1ef1c hi\u1ec7n \u0111\u00fang quy tr\u00ecnh k\u1ef9 thu\u1eadt ghi \u0111i\u1ec7n c\u01a1 l\u00e0 v\u00f4 c\u00f9ng quan tr\u1ecdng \u0111\u1ec3 c\u00f3 \u0111\u01b0\u1ee3c nh\u1eefng k\u1ebft qu\u1ea3 th\u0103m d\u00f2 ch\u00ednh x\u00e1c nh\u1ea5t h\u1ed7 tr\u1ee3 ch\u1ea9n \u0111o\u00e1n.<\/p>\n","protected":false},"excerpt":{"rendered":"

        Ghi \u0111i\u1ec7n c\u01a1 l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n b\u1ec7nh nh\u01b0\u1ee3c c\u01a1 b\u1eb1ng c\u00e1ch ghi l\u1ea1i ho\u1ea1t \u0111\u1ed9ng \u0111i\u1ec7n c\u1ee7a c\u01a1 b\u1eafp. Ghi \u0111i\u1ec7n c\u01a1 l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111\u01a1n gi\u1ea3n, kh\u00f4ng \u0111au v\u00e0 an to\u00e0n \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n b\u1ec7nh nh\u01b0\u1ee3c c\u01a1. 1. \u0110\u1ea1i c\u01b0\u01a1ng v\u1ec1 ghi \u0111i\u1ec7n c\u01a1 Ghi \u0111i\u1ec7n c\u01a1 (electromyography-EMG) l\u00e0 ph\u01b0\u01a1ng […]<\/p>\n","protected":false},"author":24,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[10,33],"tags":[],"yoast_head":"\nH\u01b0\u1edbng d\u1eabn quy tr\u00ecnh test ch\u1ea9n \u0111o\u00e1n nh\u01b0\u1ee3c c\u01a1 b\u1eb1ng ghi \u0111i\u1ec7n c\u01a1 sinh l\u00fd<\/title>\n<meta name=\"description\" content=\"Ghi \u0111i\u1ec7n c\u01a1 l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111\u01a1n gi\u1ea3n v\u00e0 an to\u00e0n nh\u1eb1m ch\u1ea9n \u0111o\u00e1n b\u1ec7nh nh\u01b0\u1ee3c c\u01a1 b\u1eb1ng c\u00e1ch ghi l\u1ea1i ho\u1ea1t \u0111\u1ed9ng 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