{"id":22837,"date":"2023-04-20T10:58:29","date_gmt":"2023-04-20T03:58:29","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22837"},"modified":"2023-04-20T16:06:50","modified_gmt":"2023-04-20T09:06:50","slug":"huong-dan-chan-doan-ngo-doc-botulinum","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/20\/huong-dan-chan-doan-ngo-doc-botulinum\/","title":{"rendered":"H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n ng\u1ed9 \u0111\u1ed9c Botulinum"},"content":{"rendered":"

Ch\u1ea9n \u0111o\u00e1n<\/a> ng\u1ed9 \u0111\u1ed9c Botulinum l\u00e0 r\u1ea5t quan tr\u1ecdng v\u00ec \u0111\u1ed9c t\u1ed1 Botulinum l\u00e0 m\u1ed9t lo\u1ea1i \u0111\u1ed9c t\u1ed1 r\u1ea5t nguy hi\u1ec3m v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra t\u00ecnh tr\u1ea1ng li\u1ec7t c\u01a1 v\u00e0 kh\u00f3 th\u1edf. T\u00ecnh tr\u1ea1ng n\u00e0y c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng nh\u01b0 suy h\u00f4 h\u1ea5p, suy tim v\u00e0 t\u1eed vong. N\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi, ng\u1ed9 \u0111\u1ed9c Botulinum c\u00f3 th\u1ec3 g\u00e2y ra nh\u1eefng h\u1eadu qu\u1ea3 nghi\u00eam tr\u1ecdng cho b\u1ec7nh nh\u00e2n. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb ng\u1ed9 \u0111\u1ed9c Botulinum \u0111\u00fang c\u00e1ch l\u00e0 \u0111i\u1ec1u c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o s\u1ef1 an to\u00e0n v\u00e0 ph\u1ee5c h\u1ed3i s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n.<\/strong><\/p>\n

\"Ng\u1ed9
Ng\u1ed9 \u0111\u1ed9c Botulinum do \u0103n th\u1ef1c ph\u1ea9m kh\u00f4ng \u0111\u01b0\u1ee3c n\u1ea5u ch\u00edn tr\u01b0\u1edbc \u0103n ho\u1eb7c \u0111\u00e3 n\u1ea5u ch\u00edn nh\u01b0ng \u0111\u1ec3 l\u00e2u.<\/figcaption><\/figure>\n

1. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/span><\/b><\/h2>\n

1.1. Lo\u1ea1i th\u1ef1c ph\u1ea9m nghi ng\u1edd:<\/span><\/b>\u00a0th\u1ef1c ph\u1ea9m kh\u00f4ng \u0111\u01b0\u1ee3c n\u1ea5u ch\u00edn tr\u01b0\u1edbc \u0103n ho\u1eb7c \u0111\u00e3 n\u1ea5u ch\u00edn nh\u01b0ng \u0111\u1ec3 l\u00e2u.<\/span><\/p>\n

1.2. Y\u1ebfu t\u1ed1 d\u1ecbch t\u1ec5: <\/span><\/b>c\u00f3 2 ng\u01b0\u1eddi tr\u1edf l\u00ean c\u00f9ng bi\u1ec3u hi\u1ec7n t\u01b0\u01a1ng t\u1ef1 sau khi \u0103n, u\u1ed1ng c\u00f9ng m\u1ed9t lo\u1ea1i th\u1ef1c ph\u1ea9m. C\u00f3 th\u1ec3 g\u1eb7p c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u01a1n \u0111\u1ed9c ho\u1eb7c ri\u00eang r\u1ebd \u1edf c\u00e1c n\u01a1i kh\u00e1c nhau.<\/span><\/p>\n

1.3. Th\u1eddi gian kh\u1ecfi ph\u00e1t b\u1ec7nh: <\/span><\/b>ph\u1ed5 bi\u1ebfn 12-36 gi\u1edd sau \u0103n, ph\u1ea7n l\u1edbn trong ng\u00e0y \u0111\u1ea7u ti\u00ean, c\u00f3 th\u1ec3 trong kho\u1ea3ng 6 gi\u1edd \u0111\u1ebfn 8 ng\u00e0y sau \u0103n.<\/span><\/p>\n

1.4. L\u00e2m s\u00e0ng<\/span><\/b><\/p>\n

*\u00a0D\u1ea5u hi\u1ec7u sinh t\u1ed3n:\u00a0<\/span><\/b>kh\u00f4ng s\u1ed1t (n\u1ebfu kh\u00f4ng c\u00f3 nguy\u00ean nh\u00e2n kh\u00e1c), huy\u1ebft \u00e1p c\u00f3 th\u1ec3 t\u1ee5t trong khi m\u1ea1ch\/nh\u1ecbp tim c\u00f3 xu h\u01b0\u1edbng kh\u00f4ng nhanh.<\/span><\/p>\n

*\u00a0Ti\u00eau h\u00f3a:\u00a0<\/span><\/b>xu\u1ea5t hi\u1ec7n s\u1edbm, bu\u1ed3n n\u00f4n, n\u00f4n, ch\u01b0\u1edbng b\u1ee5ng, \u0111au b\u1ee5ng, sau \u0111\u00f3 li\u1ec7t ru\u1ed9t c\u01a1 n\u0103ng, t\u00e1o b\u00f3n.<\/span><\/p>\n

*\u00a0Th\u1ea7n kinh:<\/span><\/b><\/p>\n

–\u00a0Li\u1ec7t \u0111\u1ed1i x\u1ee9ng hai b\u00ean, xu\u1ea5t ph\u00e1t t\u1eeb v\u00f9ng \u0111\u1ea7u m\u1eb7t, c\u1ed5 lan xu\u1ed1ng ch\u00e2n: t\u1eeb d\u00e2y th\u1ea7n kinh s\u1ecd (s\u1ee5p mi, nh\u00ecn \u0111\u00f4i, nh\u00ecn m\u1edd, \u0111au h\u1ecdng, kh\u00f3 n\u00f3i, kh\u00f3 nu\u1ed1t, kh\u00e0n ti\u1ebfng, kh\u00f4 mi\u1ec7ng). Sau \u0111\u00f3 li\u1ec7t tay, li\u1ec7t c\u00e1c c\u01a1 v\u00f9ng ng\u1ef1c, b\u1ee5ng v\u00e0 li\u1ec7t hai ch\u00e2n.<\/span><\/p>\n

–\u00a0Ph\u1ea3n x\u1ea1 g\u00e2n x\u01b0\u01a1ng th\u01b0\u1eddng gi\u1ea3m ho\u1eb7c m\u1ea5t.<\/span><\/p>\n

–\u00a0T\u1ec9nh t\u00e1o.<\/span><\/p>\n

–\u00a0\u0110\u1ed3ng t\u1eed c\u00f3 th\u1ec3 gi\u00e3n hai b\u00ean.<\/span><\/p>\n

–\u00a0Kh\u00f4ng c\u00f3 r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c.<\/span><\/p>\n

–\u00a0M\u1ee9c \u0111\u1ed9 li\u1ec7t: t\u1eeb nh\u1eb9 (m\u1ec7t m\u1ecfi, m\u1ecfi c\u01a1 t\u01b0\u01a1ng t\u1ef1 suy nh\u01b0\u1ee3c c\u01a1 th\u1ec3, kh\u00f4ng l\u00e0m \u0111\u01b0\u1ee3c c\u00e1c \u0111\u1ed9ng t\u00e1c g\u1eafng s\u1ee9c b\u00ecnh th\u01b0\u1eddng) \u0111\u1ebfn li\u1ec7t n\u1eb7ng (\u1ee9 \u0111\u1ecdng \u0111\u1eddm r\u00e3i, ho kh\u1ea1c k\u00e9m, d\u1ec5 s\u1eb7c, suy h\u00f4 h\u1ea5p). Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 th\u1ec3 li\u1ec7t ho\u00e0n to\u00e0n t\u1ea5t c\u1ea3 c\u00e1c c\u01a1, k\u1ebft h\u1ee3p \u0111\u1ed3ng t\u1eed gi\u00e3n hai b\u00ean, \u0111ang th\u1edf m\u00e1y d\u1ec5 nh\u1ea7m v\u1edbi h\u00f4n m\u00ea ho\u1eb7c m\u1ea5t n\u00e3o (th\u1ef1c t\u1ebf \u0111ang t\u1ec9nh n\u1ebfu kh\u00f4ng thi\u1ebfu \u00f4 xy n\u00e3o).<\/span><\/p>\n

–\u00a0Th\u1eddi gian th\u1edf m\u00e1y \u0111\u1ec3 chuy\u1ec3n sang cai m\u00e1y trung b\u00ecnh 2 th\u00e1ng v\u1edbi \u0111\u1ed9c t\u1ed1\u00a0type\u00a0A v\u00e0 1 th\u00e1ng v\u1edbi \u0111\u1ed9c t\u1ed1\u00a0type\u00a0B. Tuy nhi\u00ean b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3\u00a0c\u1ea7n t\u1edbi 100 ng\u00e0y \u0111\u1ec3 b\u1eaft \u0111\u1ea7u h\u1ed3i ph\u1ee5c.<\/span><\/p>\n

–\u00a0B\u1ec7nh c\u1ea3nh kh\u00f4ng \u0111i\u1ec3n h\u00ecnh (chi\u1ebfm t\u1edbi 7%): li\u1ec7t m\u1ed9t b\u00ean ho\u1eb7c li\u1ec7t ki\u1ec3u lan l\u00ean.<\/span><\/p>\n

*\u00a0H\u00f4 h\u1ea5p:\u00a0<\/span><\/b>c\u00f3 th\u1ec3 suy h\u00f4 h\u1ea5p, bi\u1ec3u hi\u1ec7n \u1ee9 \u0111\u1ecdng \u0111\u1eddm r\u00e3i, ho kh\u1ea1c k\u00e9m, th\u1edf y\u1ebfu, th\u1edf nhanh, n\u00f4ng do li\u1ec7t c\u01a1 li\u00ean s\u01b0\u1eddn, c\u01a1 ho\u00e0nh.<\/span><\/p>\n

*\u00a0Ti\u1ebft ni\u1ec7u:\u00a0<\/span><\/b>c\u00f3 th\u1ec3 b\u00ed \u0111\u00e1i, c\u1ea7u b\u00e0ng quang<\/span><\/p>\n

1.5. C\u1eadn l\u00e2m s\u00e0ng<\/span><\/b><\/p>\n

*\u00a0C\u00e1c x\u00e9t nghi\u1ec7m, th\u0103m d\u00f2 th\u00f4ng th\u01b0\u1eddng:<\/span><\/b><\/p>\n

–\u00a0X\u00e9t nghi\u1ec7m m\u00e1u: c\u00f4ng th\u1ee9c m\u00e1u, ur\u00ea, \u0111\u01b0\u1eddng, creatinin,\u00a0bilirubin,\u00a0\u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3 (Na, K,\u00a0Cl,\u00a0Ca),\u00a0GOT,\u00a0GPT, CPK.<\/span><\/p>\n

–\u00a0Kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch: \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng suy h\u00f4 h\u1ea5p<\/span><\/p>\n

–\u00a0N\u01b0\u1edbc ti\u1ec3u:\u00a0protein, h\u1ed3ng\u00a0c\u1ea7u, b\u1ea1ch c\u1ea7u.<\/span><\/p>\n

–\u00a0\u0110i\u1ec7n tim.<\/span><\/p>\n

–\u00a0Xquang ph\u1ed5i.<\/span><\/p>\n

–\u00a0C\u00e1c x\u00e9t nghi\u1ec7m, th\u0103m d\u00f2 gi\u00fap ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi c\u00e1c b\u1ec7nh kh\u00e1c: ch\u1ee5p c\u1eaft l\u1edbp n\u00e3o, c\u1ed9ng h\u01b0\u1edfng t\u1eeb s\u1ecd n\u00e3o, ch\u1ecdc d\u1ecbch n\u00e3o t\u1ee7y,…<\/span><\/p>\n

*\u00a0Th\u0103m d\u00f2 \u0111i\u1ec7n sinh l\u00fd (\u0111i\u1ec7n\u00a0c\u01a1):\u00a0<\/span><\/b>khi c\u00f3 y\u1ebfu c\u01a1 ho\u1eb7c li\u1ec7t, gi\u00fap ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh tr\u00ean l\u00e2m s\u00e0ng, k\u1ec3 c\u1ea3 khi \u0111\u1ebfn mu\u1ed9n.<\/span><\/p>\n

–\u00a0\u0110i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u00e1c d\u00e2y th\u1ea7n kinh c\u1ea3m gi\u00e1c b\u00ecnh th\u01b0\u1eddng.<\/span><\/p>\n

–\u00a0\u0110i\u1ec7n th\u1ebf v\u1eadn \u0111\u1ed9ng gi\u1ea3m r\u00f5 khi c\u00f3 li\u1ec7t nh\u01b0ng t\u1ed1c \u0111\u1ed9 d\u1eabn truy\u1ec1n kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng.<\/span><\/p>\n

–\u00a0K\u00edch th\u00edch l\u1eb7p l\u1ea1i v\u1edbi t\u1ea7n s\u1ed1 cao d\u1eabn t\u1edbi bi\u00ean \u0111\u1ed9 \u0111i\u1ec7n th\u1ebf v\u1eadn \u0111\u1ed9ng c\u00f3 \u0111\u00e1p \u1ee9ng t\u0103ng \u1edf m\u1ee9c \u0111\u1ed9 h\u1ea1n ch\u1ebf (m\u1ee9c \u0111\u1ed9 t\u0103ng nhi\u1ec1u g\u1eb7p trong h\u1ed9i ch\u1ee9ng nh\u01b0\u1ee3c c\u01a1 Lambert-Eaton, trong nh\u01b0\u1ee3c c\u01a1 khi k\u00edch th\u00edch l\u1eb7p l\u1ea1i v\u1edbi t\u1ea7n s\u1ed1 th\u1ea5p th\u00ec bi\u00ean \u0111\u1ed9 gi\u1ea3m d\u1ea7n).<\/span><\/p>\n

–\u00a0\u0110\u00e1nh gi\u00e1 b\u1eb1ng \u0111i\u1ec7n c\u01a1 c\u00f3 c\u1eafm kim: d\u1ea5u hi\u1ec7u \u0111\u1eb7c tr\u01b0ng l\u00e0 gi\u1ea3m bi\u00ean \u0111\u1ed9 v\u00e0 r\u00fat ng\u1eafn th\u1eddi gian \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u00e1c \u0111\u01a1n v\u1ecb v\u1eadn \u0111\u1ed9ng, do hi\u1ec7n t\u01b0\u1ee3ng phong t\u1ecfa d\u1eabn truy\u1ec1n th\u1ea7n kinh c\u01a1 \u1edf nhi\u1ec1u s\u1ee3i c\u01a1. C\u0169ng c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng nhi\u1ec1u pha \u1edf \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u00e1c \u0111\u01a1n v\u1ecb v\u1eadn \u0111\u1ed9ng.<\/span><\/p>\n

–\u00a0Th\u01b0\u1eddng th\u1ea5y c\u00e1c ho\u1ea1t \u0111\u1ed9ng t\u1ef1 ph\u00e1t, c\u00e1c s\u00f3ng nh\u1ecdn d\u01b0\u01a1ng t\u00ednh ho\u1eb7c \u0111i\u1ec7n th\u1ebf rung.<\/span><\/p>\n

–\u00a0Khi nhi\u1ec5m \u0111\u1ed9c t\u1ed1\u00a0botulinum\u00a0kh\u00f4ng g\u1eb7p hi\u1ec7n t\u01b0\u1ee3ng k\u00edch th\u00edch l\u1eb7p l\u1ea1i c\u00e1c nh\u00f3m c\u01a1 nh\u1ecf v\u1edbi t\u1ea7n s\u1ed1 t\u0103ng d\u1ea7n d\u1eabn t\u1edbi \u0111\u00e1p \u1ee9ng bi\u00ean \u0111\u1ed9 \u0111i\u1ec7n th\u1ebf t\u0103ng d\u1ea7n.<\/span><\/p>\n

*\u00a0X\u00e9t nghi\u1ec7m vi khu\u1ea9n v\u00e0 \u0111\u1ed9c t\u1ed1<\/span><\/b><\/p>\n

+ C\u00f3 gi\u00e1 tr\u1ecb h\u1ed7 tr\u1ee3 ch\u1ea9n \u0111o\u00e1n, gi\u00fap x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n trong v\u1ee5 ng\u1ed9 \u0111\u1ed9c. N\u1ebfu ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng \u0111\u00e3 r\u00f5 th\u00ec kh\u00f4ng ch\u1edd \u0111\u1ee3i c\u00f3 k\u1ebft qu\u1ea3 d\u01b0\u01a1ng t\u00ednh m\u1edbi d\u00f9ng thu\u1ed1c gi\u1ea3i \u0111\u1ed9c. Th\u01b0\u1eddng th\u1ef1c hi\u1ec7n \u1edf c\u00e1c ph\u00f2ng x\u00e9t nghi\u1ec7m chuy\u00ean s\u00e2u nh\u01b0 \u1edf c\u00e1c vi\u1ec7n v\u1ec7 sinh d\u1ecbch t\u1ec5, vi\u1ec7n ki\u1ec3m nghi\u1ec7m.<\/span><\/p>\n

+ Tr\u01b0\u1eddng h\u1ee3p ch\u01b0a g\u1eedi \u0111\u01b0\u1ee3c m\u1eabu x\u00e9t nghi\u1ec7m, c\u1ea7n thu gom m\u1eabu, l\u01b0u l\u1ea1i v\u00e0 g\u1eedi t\u1edbi ph\u00f2ng x\u00e9t nghi\u1ec7m th\u00edch h\u1ee3p.<\/span><\/p>\n

+ B\u1ec7nh ph\u1ea9m: m\u1eabu th\u1ef1c ph\u1ea9m nghi ng\u1edd, ch\u1ea5t n\u00f4n, d\u1ecbch h\u00fat d\u1ea1 d\u00e0y, d\u1ecbch ru\u1ed9t (n\u1ebfu m\u1edbi \u0103n, u\u1ed1ng, v\u1edbi d\u1ecbch ru\u1ed9t l\u1ea5y qua gi\u1ea3i ph\u1eabu t\u1eed thi), ph\u00e2n c\u1ee7a b\u1ec7nh nh\u00e2n (c\u00f2n th\u1ea5y vi khu\u1ea9n khi b\u1ec7nh nh\u00e2n \u0111\u1ebfn mu\u1ed9n), m\u1eabu khu\u1ea9n l\u1ea1c c\u1ee7a c\u00e1c ch\u1ee7ng\u00a0Clostridium<\/i>\u00a0\u0111\u00e3 m\u1ecdc khi nu\u00f4i c\u1ea5y. B\u1ec7nh nh\u00e2n th\u01b0\u1eddng c\u00f3 t\u00e1o b\u00f3n n\u00ean c\u00f3 th\u1ec3 c\u1ea7n ph\u1ea3i d\u00f9ng thu\u1ed1c nhu\u1eadn tr\u00e0ng ho\u1eb7c th\u1ee5t th\u00e1o \u0111\u1ec3 l\u1ea5y ph\u00e2n.<\/span><\/p>\n

+ \u0110\u1ea3m b\u1ea3o an to\u00e0n khi ti\u1ebfp x\u00fac v\u1edbi m\u1eabu x\u00e9t nghi\u1ec7m: do \u0111\u1ed9c t\u1ed1\u00a0botulinum\u00a0c\u00f3 \u0111\u1ed9c t\u00ednh r\u1ea5t cao, c\u1ea7n ch\u00fa \u00fd \u0111\u1ea3m b\u1ea3o an to\u00e0n khi thu gom, l\u01b0u, v\u1eadn chuy\u1ec3n v\u00e0 x\u1eed l\u00fd c\u00e1c lo\u1ea1i m\u1eabu. C\u00e1c m\u1eabu c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u1ec3 \u1edf ng\u0103n m\u00e1t t\u1ee7 l\u1ea1nh.<\/span><\/p>\n

–\u00a0Nu\u00f4i c\u1ea5y t\u00ecm c\u00e1c ch\u1ee7ng vi khu\u1ea9n\u00a0Clostridium<\/i>\u00a0g\u00e2y ng\u1ed9 \u0111\u1ed9c: nu\u00f4i c\u1ea5y k\u1ef5 kh\u00ed.<\/span><\/p>\n

–\u00a0Ph\u00e1t hi\u1ec7n \u0111\u1ed9c t\u1ed1\u00a0botulinum:<\/span><\/p>\n

+\u00a0Ch\u00fa \u00fd v\u1edbi m\u1eabu m\u00e1u:<\/span><\/p>\n

\u221a<\/span>\u00a0N\u1ed3ng \u0111\u1ed9 \u0111\u1ed9c t\u1ed1 th\u1ea5p, c\u1ea7n l\u00e0m s\u1edbm, kh\u1ea3 n\u0103ng d\u01b0\u01a1ng t\u00ednh cao nh\u1ea5t trong v\u00f2ng 1-2 ng\u00e0y sau \u0103n u\u1ed1ng. Th\u1eddi gian \u0111\u1ed9c t\u1ed1 t\u1ed3n t\u1ea1i: \u0111\u1ed9c t\u1ed1 botilinum\u00a0type\u00a0A sau khi h\u1ea5p thu v\u00e0o m\u00e1u, nhanh ch\u00f3ng t\u1edbi c\u00e1c v\u1ecb tr\u00ed \u0111\u00edch, k\u1ebft qu\u1ea3 ph\u00e1t hi\u1ec7n c\u00f3 th\u1ec3 \u00e2m t\u00ednh, v\u1edbi \u0111\u1ed9c t\u1ed1 B v\u00e0 E n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng gi\u1ea3i \u0111\u1ed9c t\u1ed1, c\u00e1c \u0111\u1ed9c t\u1ed1 n\u00e0y c\u00f2n t\u1ed3n t\u1ea1i trong m\u00e1u 10-20 ng\u00e0y sau \u0103n, u\u1ed1ng.<\/span><\/p>\n

\u221a<\/span>\u00a0<\/span>Ch\u00fa \u00fd l\u1ea5y\u00a010ml\u00a0m\u00e1u l\u01b0u s\u1eb5n tr\u01b0\u1edbc khi d\u00f9ng thu\u1ed1c gi\u1ea3i \u0111\u1ed9c (thu\u1ed1c gi\u1ea3i \u0111\u1ed9c s\u1ebd trung h\u00f2a h\u1ebft \u0111\u1ed9c t\u1ed1 t\u1ef1 do) v\u00e0 tr\u01b0\u1edbc khi ti\u00eam\u00a0edrophonium\u00a0(n\u1ebfu d\u1ef1 \u0111\u1ecbnh l\u00e0m\u00a0test Tensilon, do edrophonium\u00a0ho\u1eb7c c\u00e1c thu\u1ed1c c\u00f9ng nh\u00f3m c\u00f3 th\u1ec3 \u0111\u1ed9c v\u1edbi chu\u1ed9t khi l\u00e0m th\u1eed nghi\u1ec7m \u0111\u1ed9c t\u1ed1 tr\u00ean chu\u1ed9t).<\/span><\/p>\n

+ Ph\u01b0\u01a1ng ph\u00e1p ph\u00e1t hi\u1ec7n \u0111\u1ed9c t\u1ed1: s\u1eed d\u1ee5ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p theo \u0111i\u1ec1u ki\u1ec7n hi\u1ec7n c\u00f3 s\u1eb5n c\u1ee7a ph\u00f2ng x\u00e9t nghi\u1ec7m<\/span><\/p>\n

\u221a<\/span>\u00a0Quang ph\u1ed5 kh\u1ed1i (cho k\u1ebft qu\u1ea3 trong ng\u00e0y).<\/span><\/p>\n

\u221a<\/span>\u00a0Th\u1eed nghi\u1ec7m sinh h\u1ecdc tr\u00ean chu\u1ed9t (m\u1eabu huy\u1ebft thanh, nh\u1ea1y, c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n \u0111\u1ed9c t\u1ed1 v\u1edbi n\u1ed3ng \u0111\u1ed9 5-10 pg\/ml, cho k\u1ebft qu\u1ea3 sau 3-5 ng\u00e0y).<\/span><\/p>\n

\u221a<\/span>\u00a0Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec7n di tr\u01b0\u1eddng xung tr\u00ean th\u1ea1ch\u00a0(Pulsed-field\u00a0gel\u00a0electrophoresis)\u00a0k\u1ebft h\u1ee3p ph\u00e2n t\u00edch DNA \u0111a h\u00ecnh khu\u1ebfch \u0111\u1ea1i ng\u1eabu nhi\u00ean\u00a0(randomly amplified polymorphic\u00a0DNA\u00a0analysis).<\/span><\/p>\n

\u221a<\/span>\u00a0X\u00e9t nghi\u1ec7m mi\u1ec5n d\u1ecbch g\u1eafn\u00a0enzyme (ELISA).<\/span><\/p>\n

* Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh d\u1ef1a v\u00e0o:<\/span><\/i><\/b><\/p>\n

–\u00a0B\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng \u0111i\u1ec3n h\u00ecnh, \u0111\u00e3 lo\u1ea1i tr\u1eeb c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c (xem ph\u1ea7n ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t), ho\u1eb7c:<\/span><\/i><\/p>\n

–\u00a0B\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng k\u1ebft h\u1ee3p x\u00e9t nghi\u1ec7m th\u1ea5y \u0111\u1ed9c t\u1ed1\u00a0botulinum\u00a0ho\u1eb7c vi khu\u1ea9n C.\u00a0botulinum,\u00a0C. baratii, C. butyricum, ho\u1eb7c C. argentinense trong m\u00e1u b\u1ec7nh ph\u1ea9m (th\u1ef1c ph\u1ea9m nghi ng\u1edd, ch\u1ea5t n\u00f4n, d\u1ecbch d\u1ea1 d\u00e0y, d\u1ecbch ru\u1ed9t, ph\u00e2n, m\u00e1u), ho\u1eb7c:<\/span><\/i><\/p>\n

–\u00a0B\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng \u0111i\u1ec3n h\u00ecnh v\u00e0 c\u00f3 li\u00ean quan v\u1ec1 m\u1eb7t d\u1ecbch t\u1ec5 v\u1edbi ca b\u1ec7nh \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n x\u00e9t nghi\u1ec7m ng\u1ed9 \u0111\u1ed9c th\u1ef1c ph\u1ea9m do \u0111\u1ed9c t\u1ed1\u00a0botulinum.<\/span><\/i><\/p>\n

2. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t:<\/span><\/b><\/h2>\n

B\u1ea3ng ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t ng\u1ed9 \u0111\u1ed9c th\u1ef1c ph\u1ea9m do \u0111\u1ed9c t\u1ed1\u00a0botulinum\u00a0v\u1edbi c\u00e1c b\u1ec7nh kh\u00e1c.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

B\u1ea3ng: Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t ng\u1ed9 \u0111\u1ed9c th\u1ef1c ph\u1ea9m do \u0111\u1ed9c t\u1ed1 botulinum v\u1edbi c\u00e1c b\u1ec7nh kh\u00e1c<\/span><\/b><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

STT<\/b><\/p>\n<\/td>\n

\n

Lo\u1ea1i ng\u1ed9 \u0111\u1ed9c\/nhi\u1ec5m \u0111\u1ed9c<\/b><\/p>\n<\/td>\n

\n

\u0110\u1eb7c \u0111i\u1ec3m ph\u00e2n bi\u1ec7t<\/b><\/p>\n<\/td>\n<\/tr>\n

\n

1<\/p>\n<\/td>\n

Ng\u1ed9 \u0111\u1ed9c tetrodotoxin (c\u00e1 n\u00f3c, b\u1ea1ch tu\u1ed9c v\u00f2ng xanh, m\u1ed9t s\u1ed1 lo\u00e0i \u1ed1c bi\u1ec3n, so bi\u1ec3n)<\/td>\n–\u00a0Lo\u1ea1i th\u1ee9c \u0103n \u0111\u1eb7c tr\u01b0ng \u0111\u00e3 bi\u1ebft c\u00f3 \u0111\u1ed9c t\u1ed1.<\/p>\n

–\u00a0Kh\u1edfi \u0111\u1ea7u th\u01b0\u1eddng nhanh, trong v\u00f2ng v\u00e0i gi\u1edd sau \u0103n, c\u00f3 th\u1ec3 h\u00e0ng ch\u1ee5c ph\u00fat sau \u0103n.<\/p>\n

–\u00a0Ng\u1ed9 \u0111\u1ed9c x\u1ea3y ra c\u1ea3 v\u1edbi th\u1ee9c \u0103n m\u1edbi n\u1ea5u ch\u00edn<\/p>\n

–\u00a0Th\u01b0\u1eddng c\u00f3 r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c: t\u00ea b\u00ec<\/p>\n

–\u00a0Li\u1ec7t ki\u1ec3u lan l\u00ean (b\u1eaft \u0111\u1ea7u t\u1eeb ch\u00e2n)<\/p>\n

– C\u00f3 th\u1ec3 c\u00f3 co gi\u1eadt, lo\u1ea1n nh\u1ecbp tim<\/p>\n

–\u00a0Li\u1ec7t c\u1ea3i thi\u1ec7n nhanh, h\u1ebft li\u1ec7t trong v\u00f2ng v\u00e0i ng\u00e0y.<\/td>\n<\/tr>\n

\n

2<\/p>\n<\/td>\n

R\u1eafn c\u1ea1p nia c\u1eafn<\/td>\n–\u00a0\u00cdt li\u00ean quan t\u1edbi \u0103n, u\u1ed1ng<\/p>\n

–\u00a0Ho\u00e0n c\u1ea3nh b\u1ecb r\u1eafn c\u1eafn: \u0111i l\u1ea1i \u1edf v\u1ecb tr\u00ed g\u1ea7n n\u01b0\u1edbc ng\u1ecdt (v\u00ed d\u1ee5 ru\u1ed9ng, ao, h\u1ed3, k\u00eanh, m\u01b0\u01a1ng, trong ho\u1eb7c sau c\u01a1n m\u01b0a), ng\u1ee7 tr\u00ean n\u1ec1n \u0111\u1ea5t.<\/p>\n

–\u00a0Th\u01b0\u1eddng t\u0103ng c\u1ea3m gi\u00e1c \u0111au tr\u00ean da (va ch\u1ea1m nh\u1eb9 g\u00e2y \u0111au), c\u00f3 th\u1ec3 t\u00ea b\u00ec v\u00f9ng b\u1ecb c\u1eafn.<\/p>\n

–\u00a0Th\u01b0\u1eddng c\u00f3 h\u1ea1 natri m\u00e1u, t\u0103ng natri ni\u1ec7u.<\/p>\n

–\u00a0M\u1ea1ch xu h\u01b0\u1edbng nhanh, huy\u1ebft \u00e1p xu h\u01b0\u1edbng t\u0103ng.<\/p>\n

–\u00a0D\u00f9ng huy\u1ebft thanh kh\u00e1ng n\u1ecdc r\u1eafn c\u1ea1p nia b\u1ec7nh nh\u00e2n h\u1ebft li\u1ec7t nhanh.<\/p>\n

–\u00a0Li\u1ec7t ban \u0111\u1ea7u c\u00f3 th\u1ec3 ho\u00e0n to\u00e0n nh\u01b0ng t\u1ef1 c\u1ea3i thi\u1ec7n d\u1ea7n, v\u1eadn \u0111\u1ed9ng t\u1ed1t sau 2 tu\u1ea7n \u0111\u1ebfn 1 th\u00e1ng.<\/td>\n<\/tr>\n

\n

3<\/p>\n<\/td>\n

B\u1ea1ch h\u1ea7u<\/td>\n– Vi\u00eam h\u1ecdng xu\u1ea5t ti\u1ebft, li\u1ec7t c\u00e1c d\u00e2y th\u1ea7n kinh s\u1ecd, c\u00e1c bi\u1ec3u hi\u1ec7n tim, t\u1ee5t huy\u1ebft \u00e1p<\/td>\n<\/tr>\n
<\/td>\nC\u00e1c b\u1ec7nh kh\u00e1c<\/b><\/td>\n<\/td>\n<\/tr>\n
\n

4<\/p>\n<\/td>\n

H\u1ed9i ch\u1ee9ng nh\u01b0\u1ee3c c\u01a1 Lambert- Eaton<\/td>\n–\u00a0B\u1ec7nh nh\u00e2n c\u00f3 ung th\u01b0 ph\u1ed5i, th\u01b0\u1eddng th\u1ec3 t\u1ebf b\u00e0o nh\u1ecf<\/p>\n

–\u00a0Li\u1ec7t chi nhi\u1ec1u h\u01a1n so v\u1edbi li\u1ec7t v\u1eadn nh\u00e3n<\/p>\n

–\u00a0C\u01a1 l\u1ef1c t\u0103ng l\u00ean khi g\u1eafng s\u1ee9c li\u00ean t\u1ee5c<\/p>\n

–\u00a0Ph\u00e2n bi\u1ec7t tr\u00ean \u0111i\u1ec7n c\u01a1<\/td>\n<\/tr>\n

\n

5<\/p>\n<\/td>\n

H\u1ed9i ch\u1ee9ng\u00a0Guillain-\u00a0Barre\/B\u1ec7nh l\u00fd \u0111a d\u00e2y th\u1ea7n kinh m\u1ea5t\u00a0myelin\u00a0do vi\u00eam c\u1ea5p t\u00ednh<\/td>\n–\u00a0M\u1ea5t ph\u1ea3n x\u1ea1 g\u00e2n x\u01b0\u01a1ng, c\u00f3 t\u00ea b\u00ec, m\u1ea5t \u0111i\u1ec1u h\u00f2a.<\/p>\n

–\u00a0D\u1ecbch n\u00e3o t\u1ee7y c\u00f3 ph\u00e2n ly \u0111\u1ea1m t\u1ebf b\u00e0o<\/p>\n

–\u00a0\u0110i\u1ec7n c\u01a1 gi\u1ea3m t\u1ed1c \u0111\u1ed9 d\u1eabn truy\u1ec1n d\u00e2y th\u1ea7n kinh<\/td>\n<\/tr>\n

\n

6<\/p>\n<\/td>\n

Nh\u01b0\u1ee3c c\u01a1<\/td>\n–\u00a0M\u1ec7t t\u0103ng l\u00ean khi g\u1eafng s\u1ee9c<\/p>\n

–\u00a0T\u00ecnh tr\u1ea1ng y\u1ebfu c\u01a1 dao \u0111\u1ed9ng<\/p>\n

– Test edrophonium\u00a0c\u00f3 \u0111\u00e1p \u1ee9ng r\u00f5<\/p>\n

–\u00a0\u0110i\u1ec7n c\u01a1 k\u00edch th\u00edch nhanh l\u1eb7p l\u1ea1i th\u1ea5y gi\u1ea3m d\u1ea7n bi\u00ean \u0111\u1ed9 \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng<\/td>\n<\/tr>\n

\n

7<\/p>\n<\/td>\n

\u0110\u1ee3t c\u1ea5p\u00a0porphyria<\/td>\n–\u00a0Li\u1ec7t c\u01a1 nh\u01b0ng th\u01b0\u1eddng c\u00f3 r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c (t\u00ea b\u00ec, c\u1ea3m gi\u00e1c \u0111au \u1edf chi)<\/p>\n

–\u00a0C\u00f3 th\u1ec3 c\u00f3 tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh trung \u01b0\u01a1ng: k\u00edch th\u00edch, lo l\u1eafng, \u1ea3o gi\u00e1c, co gi\u1eadt, r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c.<\/p>\n

–\u00a0Th\u01b0\u1eddng m\u1ea1ch nhanh, huy\u1ebft \u00e1p t\u0103ng<\/p>\n

–\u00a0\u0110\u1ecbnh l\u01b0\u1ee3ng\u00a0delta-aminolevulinic acid,\u00a0\u0111\u1eb7c bi\u1ec7t\u00a0porphobilinogen\u00a0t\u0103ng\u00a0(porphobilinogen\u00a0n\u01b0\u1edbc ti\u1ec3u tr\u00ean 20 mg\/ng\u00e0y).<\/td>\n<\/tr>\n

\n

8<\/p>\n<\/td>\n

Tai bi\u1ebfn m\u1ea1ch n\u00e3o<\/td>\n–\u00a0B\u1ec7nh xu\u1ea5t hi\u1ec7n \u0111\u1ed9t ng\u1ed9t<\/p>\n

–\u00a0Th\u01b0\u1eddng li\u1ec7t m\u1ed9t b\u00ean<\/p>\n

–\u00a0Ch\u1ee5p c\u1eaft l\u1edbp ho\u1eb7c c\u1ed9ng h\u01b0\u1edfng t\u1eeb n\u00e3o: c\u00f3 xu\u1ea5t huy\u1ebft ho\u1eb7c nh\u1ed3i m\u00e1u<\/td>\n<\/tr>\n

\n

9<\/p>\n<\/td>\n

Vi\u00eam n\u00e3o<\/td>\n– S\u1ed1t, r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c, co gi\u1eadt<\/p>\n

– D\u1ecbch n\u00e3o t\u1ee7y: t\u0103ng\u00a0protein<\/p>\n

–\u00a0Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb s\u1ecd n\u00e3o c\u00f3 t\u1ed5n th\u01b0\u01a1ng<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

T\u00f3m l\u1ea1i, vi\u1ec7c ch\u1ea9n \u0111o\u00e1n ng\u1ed9 \u0111\u1ed9c Botulinum l\u00e0 m\u1ed9t c\u00f4ng vi\u1ec7c y t\u1ebf r\u1ea5t quan tr\u1ecdng v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n k\u1ef9 l\u01b0\u1ee1ng \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o s\u1ef1 an to\u00e0n cho b\u1ec7nh nh\u00e2n v\u00e0 c\u1ed9ng \u0111\u1ed3ng.<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n","protected":false},"excerpt":{"rendered":"

Ch\u1ea9n \u0111o\u00e1n ng\u1ed9 \u0111\u1ed9c Botulinum l\u00e0 r\u1ea5t quan tr\u1ecdng v\u00ec \u0111\u1ed9c t\u1ed1 Botulinum l\u00e0 m\u1ed9t lo\u1ea1i \u0111\u1ed9c t\u1ed1 r\u1ea5t nguy hi\u1ec3m v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra t\u00ecnh tr\u1ea1ng li\u1ec7t c\u01a1 v\u00e0 kh\u00f3 th\u1edf. T\u00ecnh tr\u1ea1ng n\u00e0y c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng nh\u01b0 suy h\u00f4 h\u1ea5p, suy tim v\u00e0 t\u1eed vong. N\u1ebfu […]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[5,33],"tags":[3],"yoast_head":"\nH\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n ng\u1ed9 \u0111\u1ed9c Botulinum - Vinmec<\/title>\n<meta name=\"description\" content=\"Ch\u1ea9n \u0111o\u00e1n ng\u1ed9 \u0111\u1ed9c Botulinum l\u00e0 r\u1ea5t quan tr\u1ecdng v\u00ec \u0111\u1ed9c t\u1ed1 Botulinum l\u00e0 m\u1ed9t lo\u1ea1i \u0111\u1ed9c t\u1ed1 r\u1ea5t nguy hi\u1ec3m v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra t\u00ecnh tr\u1ea1ng li\u1ec7t c\u01a1 ...\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n ng\u1ed9 \u0111\u1ed9c Botulinum - Vinmec\" \/>\n<meta property=\"og:description\" content=\"Ch\u1ea9n \u0111o\u00e1n ng\u1ed9 \u0111\u1ed9c Botulinum l\u00e0 r\u1ea5t quan tr\u1ecdng v\u00ec \u0111\u1ed9c t\u1ed1 Botulinum l\u00e0 m\u1ed9t lo\u1ea1i \u0111\u1ed9c t\u1ed1 r\u1ea5t nguy hi\u1ec3m v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra t\u00ecnh tr\u1ea1ng li\u1ec7t c\u01a1 ...\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/20\/huong-dan-chan-doan-ngo-doc-botulinum\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-20T03:58:29+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-04-20T09:06:50+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/istockphoto-1410182132-612x612-1-300x205.jpg\" \/>\n<meta name=\"author\" content=\"mitkaka mitkaka\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"mitkaka mitkaka\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"9 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/20\/huong-dan-chan-doan-ngo-doc-botulinum\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/20\/huong-dan-chan-doan-ngo-doc-botulinum\/\",\"name\":\"H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n ng\u1ed9 \u0111\u1ed9c Botulinum - 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