{"id":25649,"date":"2023-04-21T18:10:36","date_gmt":"2023-04-21T11:10:36","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=25649"},"modified":"2023-04-21T18:10:36","modified_gmt":"2023-04-21T11:10:36","slug":"nguyen-tac-dieu-tri-dong-kinh-nhung-dieu-can-biet","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/nguyen-tac-dieu-tri-dong-kinh-nhung-dieu-can-biet\/","title":{"rendered":"Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9ng kinh: nh\u1eefng \u0111i\u1ec1u c\u1ea7n bi\u1ebft"},"content":{"rendered":"<p><strong>B\u1ec7nh \u0111\u1ed9ng kinh -epilepsy, ti\u1ebfng Hy L\u1ea1p l\u00e0 \u201cto seize upon\u201d hay \u0111\u1ed9ng kinh ngh\u0129a l\u00e0\u00a0 \u201c co gi\u1eadt\u201d , \u201cn\u1eafm l\u1ea5y\u201d \u0111\u1ec3 ch\u1ec9 \u0111\u1ed9ng t\u00e1c khi co gi\u1eadt. B\u1ec7nh \u0111\u1ed9ng kinh l\u00e0 t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng c\u00f3 co gi\u1eadt t\u00e1i di\u1ec5n do s\u1ef1 b\u1ea5t th\u01b0\u1eddng ho\u1ea1t \u0111\u1ed9ng \u0111i\u1ec7n \u1edf 1 khu v\u1ef1c c\u1ee5 th\u1ec3 c\u1ee7a n\u00e3o. \u0110\u00e2y l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng nghi\u00eam tr\u1ecdng \u0111\u00f2i h\u1ecfi ph\u1ea3i \u0111i\u1ec1u tr\u1ecb kh\u1ea9n c\u1ea5p \u0111\u1ec3 tr\u00e1nh h\u1ea1 huy\u1ebft \u00e1p, h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, t\u0103ng th\u00e2n nhi\u1ec7t, nhi\u1ec5m toan chuy\u1ec3n h\u00f3a v\u00e0 t\u1ed5n th\u01b0\u01a1ng n\u00e3o kh\u00f4ng h\u1ed3i ph\u1ee5c.\u00a0<\/strong><\/p>\n<h2><span style=\"font-weight: 400;\">1. \u0110\u1ecbnh ngh\u0129a\u00a0<\/span><\/h2>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">\u00a0B\u1ec7nh <a href=\"https:\/\/www.vinmec.com\/vi\/benh\/dong-kinh-4517\/\">\u0111\u1ed9ng kinh<\/a> l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd m\u00e3n t\u00ednh x\u1ea3y ra do s\u1ef1 b\u1ea5t th\u01b0\u1eddng trong n\u00e3o b\u1ed9 d\u1eabn t\u1edbi s\u1ef1 k\u00edch th\u00edch \u0111\u1ed3ng th\u1eddi m\u1ed9t nh\u00f3m c\u00e1c t\u1ebf b\u00e0o th\u1ea7n kinh c\u1ee7a v\u1ecf n\u00e3o, g\u00e2y ra s\u1ef1 ph\u00f3ng \u0111i\u1ec7n \u0111\u1ed9t ng\u1ed9t v\u00e0 kh\u00f4ng th\u1ec3 ki\u1ec3m so\u00e1t. S\u1ef1 k\u00edch th\u00edch v\u1ecf n\u00e3o \u1edf c\u00e1c v\u00f9ng kh\u00e1c nhau c\u00f3 th\u1ec3 g\u00e2y ra nh\u1eefng bi\u1ec3u hi\u1ec7n kh\u00e1c nhau.<a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/cac-loai-co-giat-thuong-gap-va-nguyen-nhan\/\"> Co gi\u1eadt<\/a> kh\u00f4ng ph\u1ea3i l\u00e0 bi\u1ec3u hi\u1ec7n duy nh\u1ea5t, c\u00e1c c\u01a1n v\u1eafng \u00fd th\u1ee9c \u0111\u1ed9t ng\u1ed9t, co c\u1ee9ng ch\u00e2n tay c\u0169ng l\u00e0 bi\u1ec3u hi\u1ec7n c\u1ee7a b\u1ec7nh \u0111\u1ed9ng kinh.<\/span><\/span>\n<p><figure id=\"attachment_25671\" aria-describedby=\"caption-attachment-25671\" style=\"width: 600px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-full wp-image-25671\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/R.jpg\" alt=\"anh-minh-hoa-bat-thuong-hoat-dong-dien-nao\" width=\"600\" height=\"338\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/R.jpg 600w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/R-300x169.jpg 300w\" sizes=\"(max-width: 600px) 100vw, 600px\" \/><figcaption id=\"caption-attachment-25671\" class=\"wp-caption-text\">\u1ea2nh minh h\u1ecda s\u00f3ng n\u00e3o b\u1ea5t th\u01b0\u1eddng \u1edf ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ed9ng kinh<\/figcaption><\/figure><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u0110\u1ed9ng kinh c\u00f3 t\u1ef7 l\u1ec7 m\u1eafc cao nh\u1ea5t l\u00e0 \u1edf tr\u1ebb d\u01b0\u1edbi 11 tu\u1ed5i v\u00e0 tr\u00ean 60 tu\u1ed5i. Ng\u01b0\u1eddi ta \u01b0\u1edbc t\u00ednh c\u00f3 kho\u1ea3ng 50.000 \u0111\u1ebfn 250.000 b\u1ec7nh nh\u00e2n c\u00f3 c\u01a1n \u0111\u1ed9ng kinh h\u00e0ng n\u0103m. Tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh c\u00f3 t\u1ef7 l\u1ec7 t\u1eed vong 2,7% n\u1ebfu ch\u1ea5m d\u1ee9t tr\u01b0\u1edbc 30 ph\u00fat nh\u01b0ng t\u1ef7 l\u1ec7 t\u1eed vong 32% n\u1ebfu v\u1eabn co gi\u1eadt qu\u00e1 60 ph\u00fat.<\/span><\/li>\n<\/ul>\n<h2><span style=\"font-weight: 400;\">2. \u0110\u1ed1i t\u01b0\u1ee3ng n\u00e0o d\u1ec5 m\u1eafc b\u1ec7nh \u0111\u1ed9ng kinh?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">B\u1ea5t c\u1ee9 ai c\u0169ng c\u00f3 nguy c\u01a1 m\u1eafc b\u1ec7nh \u0111\u1ed9ng kinh, nh\u01b0ng d\u01b0\u1edbi \u0111\u00e2y l\u00e0 nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng c\u00f3 nguy c\u01a1 cao:\u00a0\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u0110\u1ed9 tu\u1ed5i: B\u1ec7nh \u0111\u1ed9ng kinh c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf m\u1ecdi l\u1ee9a tu\u1ed5i nh\u01b0ng ph\u1ed5 bi\u1ebfn h\u01a1n \u1edf ng\u01b0\u1eddi gi\u00e0 v\u00e0 tr\u1ebb em. C\u1ee5 th\u1ec3, b\u1ec7nh \u0111\u1ed9ng kinh xu\u1ea5t hi\u1ec7n \u1edf tr\u1ebb d\u01b0\u1edbi 10 tu\u1ed5i chi\u1ebfm kho\u1ea3ng 40%, \u0111\u1ed9ng kinh xu\u1ea5t hi\u1ec7n d\u01b0\u1edbi 20 tu\u1ed5i chi\u1ebfm kho\u1ea3ng 50% v\u00e0 c\u00f3 xu h\u01b0\u1edbng t\u0103ng l\u00ean sau 60 tu\u1ed5i.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi m\u1eafc b\u1ec7nh \u0111\u1ed9ng kinh.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng c\u00f3 v\u1ea5n \u0111\u1ec1 v\u1ec1 n\u00e3o nh\u01b0 b\u1ecb ch\u1ea5n th\u01b0\u01a1ng n\u00e3o, t\u1ed5n th\u01b0\u01a1ng n\u00e3o v\u00e0 nhi\u1ec5m tr\u00f9ng n\u00e3o nh\u01b0 vi\u00eam n\u00e3o, vi\u00eam t\u1ee7y s\u1ed1ng, \u0111\u1ed9t qu\u1ef5\u2026<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">B\u1ec7nh sa s\u00fat tr\u00ed tu\u1ec7 (<a href=\"https:\/\/www.vinmec.com\/vi\/benh\/benh-sa-sut-tri-tue-dementia-3294\/\">Dementia<\/a>) c\u00f3 th\u1ec3 l\u00e0 nguy\u00ean nh\u00e2n d\u1eabn t\u1edbi b\u1ec7nh \u0111\u1ed9ng kinh \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Nh\u1eefng em b\u00e9 b\u1ecb s\u1ed1t co gi\u1eadt \u0111\u1ec1u ph\u1ea3i \u0111\u01b0\u1ee3c th\u0103m kh\u00e1m v\u00ec khi s\u1ed1t cao \u0111\u1ebfn co gi\u1eadt m\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 m\u1eafc \u0111\u1ed9ng kinh cho tr\u1ebb khi \u0111\u1ebfn tu\u1ed5i tr\u01b0\u1edfng th\u00e0nh.<\/span><\/li>\n<\/ul>\n<h2><span style=\"font-weight: 400;\">3. Ph\u00e2n lo\u1ea1i<\/span><\/h2>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\"><em>Petit Mal \u2013 \u0111\u1ed9ng kinh c\u01a1n nh\u1ecf<\/em> : Th\u00f4ng th\u01b0\u1eddng, c\u01a1n n\u00e0y ng\u1eafn, ch\u1ec9 k\u00e9o d\u00e0i v\u00e0i gi\u00e2y. B\u1ec7nh nh\u00e2n tr\u1edf n\u00ean kh\u00f4ng bi\u1ebft g\u00ec ho\u1eb7c \u0111\u1ed9t nhi\u00ean b\u1ecb m\u1ea5t \u00fd th\u1ee9c. \u0110\u00e2y l\u00e0 lo\u1ea1i \u0111\u1ed9ng kinh c\u00f3 th\u1ec3 bao g\u1ed3m co gi\u1eadt m\u1eaft ho\u1eb7c nh\u00ecn ch\u1eb1m ch\u1eb1m v\u00e0o kh\u00f4ng gian. Kh\u00f4ng c\u00f3 kho\u1ea3ng th\u1eddi gian sau c\u01a1n m\u00e0 b\u1ec7nh nh\u00e2n ho\u1ea1t \u0111\u1ed9ng b\u00ecnh th\u01b0\u1eddng ngay sau c\u01a1n.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\"><em>\u0110\u1ed9ng kinh c\u01a1n l\u1edbn:<\/em> Nh\u1eefng c\u01a1n co gi\u1eadt th\u01b0\u1eddng b\u1eaft \u0111\u1ea7u v\u1edbi s\u1ef1 m\u1ea5t \u00fd th\u1ee9c \u0111\u1ed9t ng\u1ed9t v\u00e0 tr\u01b0\u01a1ng l\u1ef1c c\u01a1. Sau c\u01a1n, b\u1ec7nh nh\u00e2n ng\u00e3 xu\u1ed1ng s\u00e0n v\u00e0 co gi\u1eadt to\u00e0n th\u00e2n. C\u1eafn v\u00e0o l\u01b0\u1ee1i l\u00e0 bi\u1ec3u hi\u1ec7n hay g\u1eb7p v\u00e0 b\u1ec7nh nh\u00e2n m\u1ea5t t\u1ef1 ch\u1ee7. Th\u1eddi gian sau c\u01a1n g\u1ed3m t\u00ecnh tr\u1ea1ng th\u1ea7n kinh v\u1eabn ch\u01b0a ph\u1ee5c h\u1ed3i k\u00e9o d\u00e0i v\u00e0i ph\u00fat t\u1edbi 1 gi\u1edd.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\"><em>\u0110\u1ed9ng kinh c\u1ee5c b\u1ed9:<\/em> Nh\u1eefng c\u01a1n co gi\u1eadt l\u00e0 do ph\u00f3ng \u0111i\u1ec7n \u1edf c\u00e1c khu v\u1ef1c c\u1ee5 th\u1ec3 c\u1ee7a n\u00e3o v\u00e0 th\u01b0\u1eddng t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn khu v\u1ef1c trong n\u00e3o. Th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n co gi\u1eadt 1 b\u00ean, r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c, th\u1ecb gi\u00e1c, kh\u1ee9u gi\u00e1c, v\u1ecb gi\u00e1c ho\u1eb7c \u1ea3o gi\u00e1c v\u00e0 th\u01b0\u1eddng c\u00f3 ti\u1ec1n tri\u1ec7u. c\u00f3 r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c k\u00e8m theo ti\u1ebfn tri\u1ec3n d\u1eabn \u0111\u1ebfn co gi\u1eadt to\u00e0n th\u00e2n.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\"><em>\u0110\u1ed9ng kinh c\u1ee5c b\u1ed9 ph\u1ee9c t\u1ea1p<\/em>: \u0110\u00e2y l\u00e0 nh\u1eefng c\u01a1n co gi\u1eadt th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn th\u00f9y th\u00e1i d\u01b0\u01a1ng. B\u1ec7nh nh\u00e2n th\u01b0\u1eddng c\u00f3 suy ngh\u0129 v\u00e0 h\u00e0nh vi k\u1ef3 l\u1ea1.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\"><em>\u0110\u1ed9ng kinh to\u00e0n th\u00e2n:<\/em> Nh\u1eefng c\u01a1n co gi\u1eadt b\u1eaft \u0111\u1ea7u v\u1edbi s\u1ef1 m\u1ea5t \u0111\u1ed9t ng\u1ed9t \u00fd th\u1ee9c sau \u0111\u00f3 co gi\u1eadt to\u00e0n th\u00e2n, c\u1eafn v\u00e0o l\u01b0\u1ee1i, kh\u00f4ng ki\u1ec3m so\u00e1t h\u00e0nh vi v\u00e0 th\u1eddi gian sau c\u01a1n k\u00e9o d\u00e0i. Nguy\u00ean nh\u00e2n \u0111\u01b0\u1ee3c cho l\u00e0 do k\u00edch th\u00edch \u0111i\u1ec7n c\u1ee7a to\u00e0n b\u1ed9 v\u1ecf n\u00e3o<\/span><\/li>\n<\/ul>\n<h2><span style=\"font-weight: 400;\">4. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb<\/span><\/h2>\n<p><strong>\u0110i\u1ec1u tr\u1ecb theo nh\u1eefng nguy\u00ean t\u1eafc c\u01a1 b\u1ea3n.<\/strong><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0Nguy\u00ean t\u1eafc chung<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n co gi\u1eadt ngay l\u1eadp t\u1ee9c c\u1ea7n th\u1ef1c hi\u1ec7n:<\/span><\/li>\n<\/ul>\n<ol>\n<li><span style=\"font-weight: 400;\"> B\u1ea3o v\u1ec7 \u0111\u01b0\u1eddng th\u1edf v\u00e0 th\u1edf oxy.<\/span><\/li>\n<li><span style=\"font-weight: 400;\"> l\u1eadp \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch \u0111\u1ec3 d\u00f9ng thu\u1ed1c ch\u1ed1ng co gi\u1eadt khi c\u1ea7n\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\"> Bi\u1ec7n ph\u00e1p ph\u00f2ng co gi\u1eadt, lo\u1ea1i b\u1ecf qu\u1ea7n \u00e1o qu\u00e1 ch\u1eb7t ho\u1eb7c r\u0103ng gi\u1ea3. Khi co gi\u1eadt \u0111\u1ec3 b\u1ec7nh nh\u00e2n n\u1eb1m nghi\u00eang tr\u00e1i tr\u00e1nh h\u00edt s\u1eb7c.<\/span><\/li>\n<\/ol>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u00a0Lo\u1ea1i b\u1ecf y\u1ebfu t\u1ed1 c\u00f3 th\u1ec3 d\u1eabn t\u1edbi co gi\u1eadt nh\u01b0 thi\u1ebfu oxy m\u00e1u, r\u1ed1i lo\u1ea1n nh\u1ecbp tim, h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/viem-mang-nao-o-nguoi-lon-nguyen-nhan-trieu-chung-va-cach-dieu-tri\/\">vi\u00eam m\u00e0ng n\u00e3o<\/a>, <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/tong-quan-ve-san-giat-va-tien-san-giat\/\">s\u1ea3n gi\u1eadt<\/a>, h\u1ea1 natri m\u00e1u, xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd v\u00e0 c\u00e1c \u0111\u1ed9c t\u1ed1 c\u1ee5 th\u1ec3. Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3 ph\u1ee5 thu\u1ed9c v\u00e0o nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">D\u00f9ng thu\u1ed1c ch\u1ed1ng co gi\u1eadt:\u00a0 d\u00f9ng khi b\u1ec7nh nh\u00e2n c\u00f3 nhi\u1ec1u h\u01a1n 1 c\u01a1n co gi\u1eadt ho\u1eb7c khi c\u01a1n co gi\u1eadt k\u00e9o d\u00e0i tr\u00ean 5 ph\u00fat. Benzodiazepines l\u00e0 thu\u1ed1c \u0111\u1ea7u tay ch\u1ed1ng co gi\u1eadt.\u00a0<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<table>\n<tbody>\n<tr>\n<td><span style=\"font-weight: 400;\">Th\u1eddi gian (ph\u00fat )<\/span><\/td>\n<td><span style=\"font-weight: 400;\"> Thu\u1ed1c + th\u1ee7 thu\u1eadt<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Ti\u1ebfn h\u00e0nh ABC, sonde d\u1ea1 d\u00e0y. th\u1edf oxy qua canula ho\u1eb7c mask. monitor tim, SpO2, d\u1ea5u hi\u1ec7u sinh t\u1ed3n<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">5<\/span><\/td>\n<td><span style=\"font-weight: 400;\">N\u1ebfu h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft: Thiamin 100mg IV + 50ml Glucose 50 %<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">10<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Lorazepam 0.1mg\/kg IV t\u1eeb 2mg\/min t\u1edbi 4mg t\u1ed5ng li\u1ec1u, ho\u1eb7c Diazepam, 0.2 mg\/kg IV t\u1edbi 5 mg\/min, l\u1eb7p l\u1ea1i m\u1ed7i 6h t\u1ed1i \u0111a 20mg sau d\u00f9ng diazepam c\u00f3 th\u1ec3 d\u00f9ng th\u00eam Fosphenytoin ho\u1eb7c phenytoin\u00a0<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">15<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Fosphenytoin IV, 150 mg\/min t\u1edbi 18 mg\/kg; ho\u1eb7c phenytoin, 50 mg\/min, t\u1edbi 20 mg\/kg Theo d\u00f5i huy\u1ebft \u00e1p v\u00e0 nh\u1ecbp tim<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">30<\/span><\/td>\n<td><span style=\"font-weight: 400;\">N\u1ebfu v\u1eabn ti\u1ebfp t\u1ee5c co gi\u1eadt, cho fosphenytoin ho\u1eb7c phenytoin 5 mg \/ kg \u0111\u1ebfn t\u1ed1i \u0111a l\u00e0 30 mg \/ kg. N\u1ebfu t\u00ecnh tr\u1ea1ng v\u1eabn c\u00f2n, b\u1eaft \u0111\u1ea7u \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n Phenobarbital 100 mg \/ ph\u00fat, \u1edf m\u1ee9c 20 mg \/ kg g\u00e2y m\u00ea to\u00e0n th\u00e2n v\u1edbi pentobarbital, midazolam ho\u1eb7c propofol. Thu\u1ed1c co m\u1ea1ch c\u00f3 th\u1ec3 c\u1ea7n d\u00f9ng.<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><span style=\"font-weight: 400;\">\u00a0B\u1ea3ng 1.\u00a0 Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb co gi\u1eadt<\/span><\/p>\n<p><strong>Benzodiazepines: <\/strong><span style=\"font-weight: 400;\">Lo\u1ea1i thu\u1ed1c n\u00e0y ki\u1ec3m so\u00e1t c\u01a1n \u0111\u1ed9ng kinh \u1edf 80% b\u1ec7nh nh\u00e2n. N\u00f3 k\u00edch th\u00edch t\u0103ng GABA v\u00e0 \u1ee9c ch\u1ebf d\u1eabn truy\u1ec1n th\u1ea7n kinh.<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u00a0Lorazepam l\u00e0 lo\u1ea1i thu\u1ed1c l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u c\u1ee7a c\u01a1n \u0111\u1ed9ng kinh. Li\u1ec1u d\u00f9ng th\u00f4ng th\u01b0\u1eddng l\u00e0 0,1 mg \/ kg. hay d\u00f9ng 2 mg \/ ph\u00fat bolus t\u0129nh m\u1ea1ch, t\u1ed1i \u0111a 4 mg. N\u00f3 c\u00f3 \u00e1i l\u1ef1c cao v\u1edbi th\u1ee5 th\u1ec3 benzodiazepine trong n\u00e3o, \u0111\u1ed9 h\u00f2a tan lipid th\u1ea5p v\u00e0 th\u1eddi gian t\u00e1c d\u1ee5ng d\u00e0i (4-14 gi\u1edd) so v\u1edbi diazepam (20 ph\u00fat). Lorazepam nhanh ch\u00f3ng chuy\u1ec3n h\u00f3a trong gan v\u00e0 kh\u00f4ng c\u00f3 ch\u1ea5t chuy\u1ec3n h\u00f3a ho\u1ea1t \u0111\u1ed9ng. Th\u1eddi gian kh\u1edfi ph\u00e1t trung b\u00ecnh c\u1ee7a lorazepam l\u00e0 3 ph\u00fat. d\u00f9ng lorazepam tr\u1ef1c tr\u00e0ng th\u00e0nh c\u00f4ng trong \u0111i\u1ec1u tr\u1ecb co gi\u1eadt \u1edf tr\u1ebb em.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u00a0Diazepam th\u01b0\u1eddng d\u00f9ng ti\u00eam t\u0129nh m\u1ea1ch ho\u1eb7c h\u1eadu m\u00f4n. Li\u1ec1u ti\u00eam t\u0129nh m\u1ea1ch l\u00e0 2-5 mg \/ ph\u00fat, t\u0103ng \u0111\u1ebfn t\u1ed1i \u0111a l\u00e0 20 mg. Diazepam r\u1ea5t \u01b0a m\u1ee1 n\u00ean n\u00f3 nhanh ch\u00f3ng t\u00edch t\u1ee5 trong n\u00e3o, th\u01b0\u1eddng trong v\u00f2ng 1-2 ph\u00fat. Trong v\u00f2ng 20 ph\u00fat t\u00e1i ph\u00e2n ph\u1ed1i \u0111\u1ebfn c\u00e1c b\u1ed9 ph\u1eadn c\u00f3 m\u1ee1 kh\u00e1c c\u1ee7a c\u01a1 th\u1ec3. Diazepam gi\u00e1ng h\u00f3a trong gan v\u00e0 c\u00f3 ch\u1ea5t chuy\u1ec3n h\u00f3a ho\u1ea1t \u0111\u1ed9ng (N-dismethydiazepam). Th\u1eddi gian lo\u1ea1i b\u1ecf kh\u1ecfi c\u01a1 th\u1ec3 t\u1edbi 24 gi\u1edd. Nhi\u1ec1u t\u00e1c gi\u1ea3 tin r\u1eb1ng diazepam c\u00f3 nhi\u1ec1u thu\u1ed9c t\u00ednh \u1ee9c ch\u1ebf t\u00edch l\u0169y h\u01a1n lorazepam.\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">C\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng kho\u1ea3ng 10% b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng m\u1ed9t trong hai lo\u1ea1i thu\u1ed1c c\u00f3 suy h\u00f4 h\u1ea5p \u0111\u00e1ng k\u1ec3. Midazolam (ti\u00eam t\u0129nh m\u1ea1ch ho\u1eb7c ti\u00eam b\u1eafp) c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb co gi\u1eadt. N\u00f3\u00a0 r\u1ea5t \u01b0a m\u1ee1 v\u00e0 kh\u1edfi ph\u00e1t t\u00e1c d\u1ee5ng c\u1ef1c nhanh. \u0110\u1ed9ng kinh th\u01b0\u1eddng h\u1ebft trong v\u00f2ng 1 ph\u00fat. Midazolam \u0111\u01b0\u1ee3c nhanh ch\u00f3ng chuy\u1ec3n h\u00f3a \u1edf gan v\u00e0 th\u1eddi gian b\u00e1n th\u1ea3i r\u1ea5t ng\u1eafn. \u0110\u1ed9ng kinh kh\u00e1ng thu\u1ed1c \u0111i\u1ec1u tr\u1ecb th\u00e0nh c\u00f4ng v\u1edbi truy\u1ec1n nh\u1ecf gi\u1ecdt.<\/span><\/p>\n<p><span style=\"font-weight: 400;\"><strong>Phenytoin<\/strong>: <\/span><span style=\"font-weight: 400;\">\u00a0Phenytoin (Dilantin) c\u00f3 hi\u1ec7u qu\u1ea3 trong vi\u1ec7c ch\u1ea5m d\u1ee9t t\u1edbi 90% c\u00e1c c\u01a1n \u0111\u1ed9ng kinh. M\u1eb7c d\u00f9 n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh c\u1ee7a thu\u1ed1c \u0111\u1ea1t trong v\u00f2ng 6-10 ph\u00fat, c\u00e1c t\u00ednh ch\u1ea5t v\u1eadt l\u00fd c\u1ee7a thu\u1ed1c \u0111\u00f2i h\u1ecfi ph\u1ea3i truy\u1ec1n t\u01b0\u01a1ng \u0111\u1ed1i ch\u1eadm. Phenytoin kh\u00f4ng h\u00f2a tan trong n\u01b0\u1edbc, do \u0111\u00f3 \u0111\u01b0\u1ee3c h\u00f2a tan trong dung m\u00f4i 40% propylene glycol, 10% ethanol v\u00e0 natri hydroxit (pH 12). K\u1ebft qu\u1ea3 l\u00e0, n\u00f3 c\u00f3 \u0111\u1ed9c t\u00ednh cao v\u1edbi t\u0129nh m\u1ea1ch v\u00e0 g\u00e2y ho\u1ea1i t\u1eed n\u1ebfu n\u00f3 x\u00e2m nh\u1eadp v\u00e0o c\u00e1c m\u00f4 d\u01b0\u1edbi da (khi truy\u1ec1n t\u0129nh m\u1ea1ch). Phenytoin c\u00f3 th\u1ec3 g\u00e2y t\u1ee5t huy\u1ebft \u00e1p v\u00e0 r\u1ed1i lo\u1ea1n nh\u1ecbp tim (QT d\u00e0i) v\u00e0 kh\u00f4ng n\u00ean truy\u1ec1n nhanh h\u01a1n 50mg \/ ph\u00fat. Li\u1ec1u n\u1ea1p theo khuy\u1ebfn c\u00e1o l\u00e0 15-18mg \/ kg.<\/span><\/p>\n<p><span style=\"font-weight: 400;\"><strong>Fosphenytoin<\/strong>: <\/span><span style=\"font-weight: 400;\">\u00a0\u0110\u00e2y l\u00e0 m\u1ed9t ti\u1ec1n ch\u1ea5t h\u00f2a tan trong n\u01b0\u1edbc c\u1ee7a phenytoin. M\u1ed9t khi n\u00f3 x\u00e2m nh\u1eadp v\u00e0o m\u00e1u, n\u00f3 nhanh ch\u00f3ng chuy\u1ec3n \u0111\u1ed5i sang phenytoin. N\u00f3 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ti\u00eam b\u1eafp (\u0111\u1ea1t n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh sau 30 ph\u00fat) ho\u1eb7c ti\u00eam t\u0129nh m\u1ea1ch (\u0111\u1ea1t \u0111\u1ec9nh sau 6 ph\u00fat). Fosphenytoin 1,5 mg, t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi 1 mg phenytoin, v\u00e0 li\u1ec1u l\u00e0 18mg \/ kg. Kh\u00f4ng gi\u1ed1ng nh\u01b0 phenytoin, Fosphenytoin c\u00f3 th\u1ec3 d\u00f9ng v\u1edbi t\u1ed1c \u0111\u1ed9 nhanh h\u01a1n, l\u00ean \u0111\u1ebfn 150 mg \/ ph\u00fat. N\u00f3 kh\u00f4ng g\u00e2y suy h\u00f4 h\u1ea5p v\u00e0 l\u00e0 m\u1ed9t lo\u1ea1i thu\u1ed1c l\u00fd t\u01b0\u1edfng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb co gi\u1eadt trong tr\u01b0\u1eddng h\u1ee3p c\u1ea5p c\u1ee9u. Ng\u1ee9a v\u00e0 d\u1ecb c\u1ea3m l\u00e0 nh\u1eefng t\u00e1c d\u1ee5ng ph\u1ee5 th\u01b0\u1eddng g\u1eb7p nh\u1ea5t, nh\u01b0ng Fosphenytoin c\u00f3 th\u1ec3 g\u00e2y h\u1ea1 huy\u1ebft \u00e1p n\u00ean truy\u1ec1n ph\u1ea3i \u0111\u01b0\u1ee3c theo d\u00f5i ch\u1eb7t ch\u1ebd.<\/span><\/p>\n<p><span style=\"font-weight: 400;\"><strong>Phenobarbital<\/strong>: <\/span><span style=\"font-weight: 400;\">Thu\u1ed1c n\u00e0y kh\u00f4ng \u01b0a m\u1ee1 nh\u01b0 c\u00e1c benzodiazepin. N\u00f3 v\u00e0o n\u00e3o trong v\u00f2ng 3 ph\u00fat v\u00e0 \u1ea3nh h\u01b0\u1edfng c\u1ee7a n\u00f3 k\u00e9o d\u00e0i trong v\u00e0i gi\u1edd. Th\u1eddi gian b\u00e1n th\u1ea3i kho\u1ea3ng 50-150 gi\u1edd. B\u00e0i ti\u1ebft thu\u1ed1c gi\u1ea3m \u1edf b\u1ec7nh nh\u00e2n suy th\u1eadn ho\u1eb7c gan. An th\u1ea7n, suy h\u00f4 h\u1ea5p, v\u00e0 h\u1ea1 huy\u1ebft \u00e1p l\u00e0 t\u00e1c d\u1ee5ng ph\u1ee5 hay g\u1eb7p n\u00ean c\u1ea7n truy\u1ec1n kh\u00f4ng qu\u00e1 100 mg \/ ph\u00fat, v\u1edbi t\u1ed5ng li\u1ec1u 20mg \/ kg, iv.<\/span><\/p>\n<p><span style=\"font-weight: 400;\"><strong>Pentobarbital<\/strong>:\u00a0 P<\/span><span style=\"font-weight: 400;\">entobarbital th\u01b0\u1eddng d\u00f9ng v\u1edbi \u0111\u1ed9ng kinh kh\u00e1ng thu\u1ed1c. \u0110\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n l\u00e0 c\u1ea7n thi\u1ebft v\u00ec n\u00f3 g\u00e2y suy h\u00f4 h\u1ea5p \u0111\u00e1ng k\u1ec3. Ngo\u00e0i ra, t\u1ea5t c\u1ea3 c\u00e1c ho\u1ea1t \u0111\u1ed9ng v\u1eadn \u0111\u1ed9ng b\u1ecb \u1ee9c ch\u1ebf v\u00e0 c\u1ea7n theo d\u00f5i EEG li\u00ean t\u1ee5c. Li\u1ec1u t\u1ea3i l\u00e0 5 mg \/ kg v\u1edbi 50mg \/ ph\u00fat truy\u1ec1n t\u0129nh m\u1ea1ch, ti\u1ebfp theo l\u00e0 truy\u1ec1n li\u00ean t\u1ee5c 0,5-3 mg \/ kg \/ gi\u1edd. T\u1ee5t huy\u1ebft \u00e1p do thu\u1ed1c hay g\u1eb7p n\u00ean c\u00f3 th\u1ec3 ph\u1ea3i d\u00f9ng th\u00eam v\u1eadn m\u1ea1ch.<\/span><\/p>\n<p><span style=\"font-weight: 400;\"><strong>Propofol<\/strong>: <\/span><span style=\"font-weight: 400;\">\u0110\u00e2y l\u00e0 m\u1ed9t thu\u1ed1c g\u00e2y m\u00ea t\u0129nh m\u1ea1ch th\u1eddi gian t\u00e1c d\u1ee5ng r\u1ea5t ng\u1eafn, nhanh ch\u00f3ng b\u1ecb h\u1ee7y \u1edf gan. N\u00f3 \u0111\u01b0\u1ee3c truy\u1ec1n li\u00ean t\u1ee5c, v\u1edbi li\u1ec1u 1,5 mg \/ kg sau \u0111\u00f3 truy\u1ec1n 6-10 mg \/ kg \/ gi\u1edd. Thu\u1ed1c n\u00e0y c\u00f3 th\u1ec3 g\u00e2y \u1ee9c ch\u1ebf h\u00f4 h\u1ea5p v\u00e0 th\u1ea7n kinh trung \u01b0\u01a1ng, c\u00f3 th\u1ec3 c\u1ea7n ph\u1ea3i ch\u00fa \u00fd b\u1ea3o v\u1ec7 \u0111\u01b0\u1eddng th\u1edf. T\u1ee5t huy\u1ebft \u00e1p l\u00e0 t\u00e1c d\u1ee5ng ph\u1ee5 hay g\u1eb7p n\u00ean ch\u00fa \u00fd d\u00f9ng li\u1ec1u v\u1eeba ph\u1ea3i.<\/span><\/p>\n<p><span style=\"font-weight: 400;\"><strong>Etomidate<\/strong>: <\/span><span style=\"font-weight: 400;\">\u00a0Thu\u1ed1c g\u00e2y m\u00ea t\u0129nh m\u1ea1ch n\u00e0y c\u00f3 t\u00e1c d\u1ee5ng trong v\u00f2ng 1 ph\u00fat. Trong khi truy\u1ec1n c\u1ea7n theo d\u00f5i \u0111i\u1ec7n n\u00e3o \u0111\u1ed3 li\u00ean t\u1ee5c. Corticosteroid ph\u1ea3i d\u00f9ng trong v\u00e0 sau khi cho thu\u1ed1c n\u00e0y v\u00ec etomidate g\u00e2y \u1ee9c ch\u1ebf tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn.<\/span><\/p>\n<p><strong>Ch\u00fa \u00fd \u0111\u1ebfn bi\u1ebfn ch\u1ee9ng c\u1ee7a co gi\u1eadt:<\/strong><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Vi\u00eam ph\u1ed5i do h\u00edt nhi\u1ec1u khi kh\u00f4ng r\u00f5 tr\u00ean X quang ban \u0111\u1ea7u nh\u01b0ng kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch s\u1ebd c\u00f3 t\u00ecnh tr\u1ea1ng thi\u1ebfu oxy. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng sinh nh\u01b0 penicillin v\u00e0 kh\u00e1ng sinh vi khu\u1ea9n k\u1ef5 kh\u00ed \u0111\u01b0\u1eddng u\u1ed1ng.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">N\u1ebfu t\u1eafc ngh\u1ebdn ph\u1ebf qu\u1ea3n c\u1ea7n soi l\u1ea5y d\u1ecb v\u1eadt.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u00a0Nhi\u1ec5m toan lactic sau co gi\u1eadt c\u00f3 th\u1ec3 n\u1eb7ng nh\u01b0ng th\u01b0\u1eddng t\u1ef1 h\u1ebft. Th\u01b0\u1eddng kh\u00f4ng ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb Bicarbonate tr\u1eeb khi pH m\u00e1u \u0111\u1ed9ng m\u1ea1ch d\u01b0\u1edbi 7.0.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u00a0B\u1ec7nh nh\u00e2n c\u00f3 c\u01a1n \u0111\u1ed9ng kinh c\u00f3 th\u1ec3 t\u1ed5n th\u01b0\u01a1ng c\u01a1 x\u01b0\u01a1ng nh\u01b0 g\u00e3y x\u01b0\u01a1ng hay r\u00e1ch, tr\u1eadt kh\u1edbp vai ra sau do co c\u01a1 m\u00e3nh li\u1ec7t trong c\u01a1n \u0111\u1ed9ng kinh to\u00e0n th\u1ec3.<\/span><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>B\u1ec7nh \u0111\u1ed9ng kinh -epilepsy, ti\u1ebfng Hy L\u1ea1p l\u00e0 \u201cto seize upon\u201d hay \u0111\u1ed9ng kinh ngh\u0129a l\u00e0\u00a0 \u201c co gi\u1eadt\u201d , \u201cn\u1eafm l\u1ea5y\u201d \u0111\u1ec3 ch\u1ec9 \u0111\u1ed9ng t\u00e1c khi co gi\u1eadt. B\u1ec7nh \u0111\u1ed9ng kinh l\u00e0 t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng c\u00f3 co gi\u1eadt t\u00e1i di\u1ec5n do s\u1ef1 b\u1ea5t th\u01b0\u1eddng ho\u1ea1t \u0111\u1ed9ng \u0111i\u1ec7n \u1edf 1 khu v\u1ef1c c\u1ee5 th\u1ec3 [&hellip;]<\/p>\n","protected":false},"author":17,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[10],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9ng kinh: nh\u1eefng \u0111i\u1ec1u c\u1ea7n bi\u1ebft - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u1ec7nh \u0111\u1ed9ng kinh l\u00e0 t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng c\u00f3 co gi\u1eadt t\u00e1i di\u1ec5n do s\u1ef1 b\u1ea5t th\u01b0\u1eddng ho\u1ea1t \u0111\u1ed9ng \u0111i\u1ec7n \u1edf 1 khu v\u1ef1c c\u1ee5 th\u1ec3 c\u1ee7a n\u00e3o.\" \/>\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=\"Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9ng kinh: nh\u1eefng \u0111i\u1ec1u c\u1ea7n bi\u1ebft - 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