{"id":25668,"date":"2023-04-21T11:30:17","date_gmt":"2023-04-21T04:30:17","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=25668"},"modified":"2023-04-21T11:35:17","modified_gmt":"2023-04-21T04:35:17","slug":"dot-quy-thieu-mau-nao-xu-tri-dieu-tri-va-tien-luong","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/dot-quy-thieu-mau-nao-xu-tri-dieu-tri-va-tien-luong\/","title":{"rendered":"\u0110\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o: X\u1eed tr\u00ed, \u0111i\u1ec1u tr\u1ecb v\u00e0 ti\u00ean l\u01b0\u1ee3ng"},"content":{"rendered":"

\u0110\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o(nh\u1ed3i m\u00e1u n\u00e3o<\/a>) l\u00e0 m\u1ed9t lo\u1ea1i \u0111\u1ed9t qu\u1ef5 x\u1ea3y ra khi m\u1ed9t \u0111\u1ed9ng m\u1ea1ch trong n\u00e3o b\u1ecb t\u1eafc ngh\u1ebdn, d\u1eabn \u0111\u1ebfn thi\u1ebfu m\u00e1u v\u00e0 oxy trong khu v\u1ef1c \u0111\u00f3. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 t\u00ea ho\u1eb7c y\u1ebfu c\u01a1 th\u1ec3, kh\u00f3 n\u00f3i ho\u1eb7c hi\u1ec3u ng\u00f4n ng\u1eef, kh\u00f3 th\u1edf, ho\u1eb7c bu\u1ed3n n\u00f4n. \u0110i\u1ec1u tr\u1ecb cho \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o t\u00f9y thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a b\u1ec7nh v\u00e0 th\u1eddi gian t\u1eeb khi tri\u1ec7u ch\u1ee9ng b\u1eaft \u0111\u1ea7u<\/strong>.<\/p>\n

\"Th\u1eddi
Th\u1eddi gian x\u1eed tr\u00ed \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o th\u01b0\u1eddng kh\u00f4ng qu\u00e1 60 ph\u00fat k\u1ec3 t\u1eeb khi ti\u1ebfp c\u1eadn ng\u01b0\u1eddi b\u1ec7nh<\/figcaption><\/figure>\n

1. Nguy\u00ean t\u1eafc<\/h2>\n

Khi ph\u00e1t hi\u1ec7n b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5, c\u1ea5p c\u1ee9u 115 n\u00ean nhanh ch\u00f3ng v\u1eadn chuy\u1ec3n b\u1ec7nh nh\u00e2n an to\u00e0n \u0111\u1ebfn c\u01a1 s\u1edf y t\u1ebf \u0111\u01b0\u1ee3c trang b\u1ecb m\u00e1y ch\u1ee5p CT s\u1ecd n\u00e3o v\u00e0 c\u00f3 kh\u1ea3 n\u0103ng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft \u0111\u1ec3 \u0111em l\u1ea1i cho b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 c\u01a1 h\u1ed9i t\u1ed1t nh\u1ea5t.<\/span><\/p>\n

\u0110\u1ed9t qu\u1ef5 l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng c\u1ea5p c\u1ee9u \u01b0u ti\u00ean, \u0111\u00f2i h\u1ecfi nh\u00e2n vi\u00ean y t\u1ebf ph\u1ea3i ph\u1ea3n \u1ee9ng m\u1ed9t c\u00e1ch nhanh ch\u00f3ng. Ng\u01b0\u1eddi tr\u1ea3 l\u1eddi cu\u1ed9c g\u1ecdi c\u1ea5p c\u1ee9u ph\u1ea3i h\u1ecfi b\u1ec7nh ng\u1eafn g\u1ecdn, thu th\u1eadp nhanh c\u00e1c th\u00f4ng tin quan tr\u1ecdng nh\u01b0 th\u1eddi gian kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng, th\u1eddi gian g\u1ea7n nh\u1ea5t nh\u00ecn th\u1ea5y b\u1ec7nh nh\u00e2n b\u00ecnh th\u01b0\u1eddng, ti\u1ec1n s\u1eed b\u1ec7nh, m\u1ee9c \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 th\u00f4ng b\u00e1o cho ng\u01b0\u1eddi c\u00f3 tr\u00e1ch nhi\u1ec7m \u0111\u1ec3 k\u1ecbp th\u1eddi chu\u1ea9n b\u1ecb c\u00e1c ph\u01b0\u01a1ng \u00e1n ph\u00f9 h\u1ee3p.<\/span><\/p>\n

M\u1ee5c ti\u00eau tr\u1ecdng t\u00e2m trong x\u1eed tr\u00ed, \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o c\u1ea5p l\u00e0 b\u1ea3o t\u1ed3n nhu m\u00f4 n\u00e3o \u1edf v\u00f9ng gi\u1ea3m t\u01b0\u1edbi m\u00e1u nh\u01b0ng b\u1ecb ho\u1ea1i t\u1eed. T\u1ebf b\u00e0o n\u00e3o trong khu v\u1ef1c n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c b\u1ea3o t\u1ed3n b\u1eb1ng c\u00e1ch kh\u00f4i ph\u1ee5c l\u01b0u l\u01b0\u1ee3ng m\u00e1u \u0111\u1ebfn v\u00e0 t\u1ed1i \u01b0u h\u00f3a tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 khu v\u1ef1c b\u1ecb t\u1ed5n th\u01b0\u01a1ng. Chi\u1ebfn l\u01b0\u1ee3c t\u00e1i t\u01b0\u1edbi m\u00e1u c\u1ea7n nhanh ch\u00f3ng \u0111\u01b0\u1ee3c tri\u1ec3n khai, bao g\u1ed3m c\u1ea3 vi\u1ec7c s\u1eed d\u1ee5ng ch\u1ea5t k\u00edch ho\u1ea1t plasminogen m\u00f4 \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch (rt-PA) v\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ti\u1ebfp c\u1eadn trong \u0111\u1ed9ng m\u1ea1ch nh\u1eb1m m\u1ee5c ti\u00eau t\u00e1i th\u00f4ng m\u1ea1ch m\u00e1u \u0111\u1ec3 c\u00f3 th\u1ec3 c\u1ee9u s\u1ed1ng \u0111\u01b0\u1ee3c c\u00e1c t\u1ebf b\u00e0o trong v\u00f9ng tranh t\u1ed1i tranh s\u00e1ng tr\u01b0\u1edbc khi ch\u00fang t\u1ed5n th\u01b0\u01a1ng kh\u00f4ng h\u1ed3i ph\u1ee5c.<\/span><\/p>\n

2. \u0110i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3<\/h2>\n

2.1. \u0110\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng h\u00f4 h\u1ea5p, tu\u1ea7n ho\u00e0n<\/span><\/b><\/h3>\n

– M\u1ee5c ti\u00eau trong vi\u1ec7c x\u1eed tr\u00ed \u0111\u1ed9t qu\u1ef5 l\u00e0 \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1eddng th\u1edf, h\u00f4 h\u1ea5p v\u00e0 tu\u1ea7n ho\u00e0n theo c\u00e1c b\u01b0\u1edbc ABC (A<\/b>: airway,\u00a0B<\/b>: breathing,\u00a0C<\/b>: circulation)<\/span><\/p>\n

– \u1ed4n \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh<\/span><\/p>\n

– Ho\u00e0n th\u00e0nh ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111\u00e1nh gi\u00e1 ban \u0111\u1ea7u, bao g\u1ed3m ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh v\u00e0 x\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng c\u00e0ng nhanh c\u00e0ng t\u1ed1t (th\u01b0\u1eddng kh\u00f4ng qu\u00e1 60 ph\u00fat) sau khi ti\u1ebfp nh\u1eadn b\u1ec7nh nh\u00e2n.<\/span><\/p>\n

2.2. B\u1ed5 sung oxy<\/span><\/b><\/h3>\n

Ch\u1ec9 \u0111\u1ecbnh th\u1edf oxy qua sonde m\u0169i v\u1edbi cung l\u01b0\u1ee3ng th\u1ea5p kho\u1ea3ng 2l\/ph\u00fat khi b\u1ec7nh nh\u00e2n kh\u00f3 th\u1edf, da ni\u00eam m\u1ea1c xanh t\u00e1i, t\u00edm ho\u1eb7c \u0111\u1ed9 b\u00e3o h\u00f2a oxy SaO2 <95.<\/span><\/p>\n

2.3. Ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng m\u00e1u<\/span><\/b><\/h3>\n

C\u1ea7n x\u00e9t nghi\u1ec7m \u0111\u01b0\u1eddng m\u00e1u mao m\u1ea1ch t\u1ea1i gi\u01b0\u1eddng ngay cho b\u1ec7nh nh\u00e2n khi ti\u1ebfp nh\u1eadn c\u1ea5p c\u1ee9u.<\/span><\/p>\n

N\u1ebfu nghi ng\u1edd b\u1ec7nh nh\u00e2n h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft m\u00e0 ch\u01b0a c\u00f3 k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m c\u00f3 th\u1ec3 ti\u00eam truy\u1ec1n t\u0129nh m\u1ea1ch 50ml glucoza \u01b0u tr\u01b0\u01a1ng<\/span><\/p>\n

2.4. Ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p<\/span><\/b><\/h3>\n

2.4.1. N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 t\u0103ng huy\u1ebft \u00e1p (<72h t\u1eeb khi ph\u00e1t hi\u1ec7n \u0111\u1ed9t qu\u1ef5)\u00a0<\/span><\/i><\/b><\/h4>\n

– N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch:<\/span><\/p>\n

\u25cf H\u1ea1 HA t\u00e2m thu < 185 mmHg v\u00e0 HA t\u00e2m tr\u01b0\u01a1ng < 110 mmHg tr\u01b0\u1edbc khi d\u00f9ng thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft<\/span><\/p>\n

\u25cf Duy tr\u00ec HA <180\/105 mmHg trong 24h \u0111\u1ea7u ti\u00ean sau khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c ti\u00eau huy\u1ebft kh\u1ed1i \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch<\/span><\/p>\n

– N\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh d\u00f9ng thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft:<\/span><\/p>\n

\u25cf N\u1ebfu HA <= 220\/110 mmHg: B\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb ho\u1eb7c \u0111i\u1ec1u tr\u1ecb l\u1ea1i trong th\u1eddi gian 48-72h ho\u1eb7c sau khi \u1ed5n \u0111\u1ecbnh nh\u1eefng tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh<\/span><\/p>\n

\u25cf N\u1ebfu HA > 220\/110 mmHg: gi\u1ea3m 15% s\u1ed1 \u0111o HA trong 24h \u0111\u1ea7u ti\u00ean.<\/span><\/p>\n

2.4.2. N\u1ebfu b\u1ec7nh nh\u00e2n b\u1ecb t\u1ee5t huy\u1ebft \u00e1p (HATT < 90 mmHg ho\u1eb7c th\u1ea5p h\u01a1n 30 mmHg so v\u1edbi huy\u1ebft \u00e1p n\u1ec1n)<\/span><\/i><\/b><\/h4>\n

– Truy\u1ec1n dung d\u1ecbch \u0111\u1eb3ng tr\u01b0\u01a1ng theo \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch trung t\u00e2m n\u1ebfu b\u1ec7nh nh\u00e2n m\u1ea5t n\u01b0\u1edbc, thi\u1ebfu d\u1ecbch.<\/span><\/p>\n

– Khi \u0111\u00e3 \u0111\u1ee7 kh\u1ed1i l\u01b0\u1ee3ng tu\u1ea7n ho\u00e0n m\u00e0 huy\u1ebft \u00e1p v\u1eabn kh\u00f4ng n\u00e2ng l\u00ean \u0111\u01b0\u1ee3c th\u00ec d\u00f9ng c\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch nh\u01b0 Dubutamin v\u00e0\/ho\u1eb7c Noradrenalin.<\/span><\/p>\n

2.5. T\u00e1i t\u01b0\u1edbi m\u00e1u b\u1eb1ng thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft v\u00e0\/ho\u1eb7c b\u1eb1ng d\u1ee5ng c\u1ee5 trong l\u00f2ng m\u1ea1ch<\/span><\/b><\/h3>\n

2.6. \u0110i\u1ec1u tr\u1ecb v\u1edbi thu\u1ed1c kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u<\/span><\/b><\/h3>\n

C\u00e1c h\u01b0\u1edbng d\u1eabn c\u1ee7a AHA\/ASA khuy\u1ebfn c\u00e1o u\u1ed1ng aspirin 81 – 325 mg trong v\u00f2ng 24 – 48h k\u1ec3 t\u1eeb khi b\u1eaft \u0111\u1ea7u \u0111\u1ed9t qu\u1ef5 do thi\u1ebfu m\u00e1u n\u00e3o. L\u1ee3i \u00edch c\u1ee7a aspirin r\u1ea5t khi\u00eam t\u1ed1n nh\u01b0ng c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea v\u00e0 ch\u1ee7 y\u1ebfu li\u00ean quan \u0111\u1ebfn vi\u1ec7c gi\u1ea3m \u0111\u1ed9t qu\u1ef5 t\u00e1i ph\u00e1t.<\/span><\/p>\n

2.7. Ki\u1ec3m so\u00e1t th\u00e2n nhi\u1ec7t<\/span><\/b><\/h3>\n

T\u0103ng th\u00e2n nhi\u1ec7t kh\u00f4ng th\u01b0\u1eddng xuy\u00ean li\u00ean quan \u0111\u1ebfn \u0111\u1ed9t qu\u1ef5 nh\u01b0ng c\u00f3 th\u1ec3 l\u00e0m t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5.<\/span><\/p>\n

N\u1ebfu b\u1ec7nh nh\u00e2n s\u1ed1t > 38\u00b0 C th\u00ec d\u00f9ng acetaminophen (\u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c vi\u00ean \u0111\u1eb7t h\u1eadu m\u00f4n). N\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng u\u1ed1ng \u0111\u01b0\u1ee3c ho\u1eb7c kh\u00f4ng c\u00f3 acetaminophen \u0111\u1eb7t tr\u1ef1c tr\u00e0ng th\u00ec d\u00f9ng Paracetamol truy\u1ec1n t\u0129nh m\u1ea1ch.<\/span><\/p>\n

C\u00e1c nghi\u00ean c\u1ee9u th\u1ef1c nghi\u1ec7m cho th\u1ea5y r\u1eb1ng h\u1ea1 th\u00e2n nhi\u1ec7t nh\u1eb9 c\u00f3 t\u00e1c d\u1ee5ng b\u1ea3o v\u1ec7 th\u1ea7n kinh. Vi\u1ec7c s\u1eed d\u1ee5ng h\u1ea1 th\u00e2n nhi\u1ec7t hi\u1ec7n \u0111ang \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 trong giai \u0111o\u1ea1n II c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng.<\/span><\/p>\n

2.8. Ch\u1ed1ng ph\u00f9 n\u00e3o<\/span><\/b><\/h3>\n

Ph\u00f9 n\u00e3o \u0111\u00e1ng k\u1ec3 sau \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o kh\u00e1 hi\u1ebfm (10 – 20%) v\u00e0 th\u01b0\u1eddng x\u1ea3y ra v\u00e0o kho\u1ea3ng 72 – 96 gi\u1edd sau khi kh\u1edfi ph\u00e1t \u0111\u1ed9t qu\u1ef5.<\/span><\/p>\n

C\u00e1c ph\u01b0\u01a1ng ph\u00e1p l\u00e0m gi\u1ea3m ph\u00f9 n\u00e3o:<\/span><\/p>\n

– Truy\u1ec1n dung d\u1ecbch Manitol ng\u1eaft qu\u00e3ng<\/span><\/p>\n

– Ph\u1eabu thu\u1eadt m\u1edf s\u1ecd gi\u1ea3m \u00e1p v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb nh\u1ed3i m\u00e1u l\u1edbn c\u00f3 ph\u00f9 n\u00e3o \u0111e d\u1ecda t\u00ednh m\u1ea1ng.<\/span><\/p>\n

Hi\u1ec7p h\u1ed9i Tim m\u1ea1ch Hoa K\u1ef3 v\u00e0 Hi\u1ec7p h\u1ed9i \u0110\u1ed9t qu\u1ef5 Hoa K\u1ef3 \u0111\u00e3 \u0111\u01b0a ra m\u1ed9t h\u01b0\u1edbng d\u1eabn \u0111\u1ec3 x\u1eed tr\u00ed ph\u00f9 n\u00e3o trong nh\u1ed3i m\u00e1u n\u00e3o v\u00e0 ti\u1ec3u n\u00e3o; c\u00e1c khuy\u1ebfn ngh\u1ecb bao g\u1ed3m:<\/span><\/p>\n

– V\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 ph\u00f9 h\u1ee3p, m\u1edf s\u1ecd gi\u1ea3i \u00e1p c\u00f3 th\u1ec3 c\u00f3 l\u1ee3i, nh\u1ea5t l\u00e0 v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i v\u00e0 c\u00e2n nh\u1eafc th\u1eadt k\u0129 v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n tr\u00ean 60 tu\u1ed5i,<\/span><\/p>\n

– Xu\u1ea5t hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a ph\u00f9 n\u00e3o nh\u01b0 suy gi\u1ea3m \u00fd th\u1ee9c ho\u1eb7c n\u1eb7ng h\u01a1n nh\u01b0 t\u1ee5t k\u1eb9t n\u00e3o, thay \u0111\u1ed5i k\u00edch th\u01b0\u1edbc \u0111\u1ed3ng t\u1eed,<\/span><\/p>\n

– B\u1ec7nh nh\u00e2n ph\u00f9 n\u00e3o do nh\u1ed3i m\u00e1u n\u00e3o, r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c do ch\u00e8n \u00e9p n\u00e3o: m\u1ea5t ph\u1ea3n x\u1ea1 gi\u00e1c m\u1ea1c, \u0111\u1ed3ng t\u1eed co nh\u1ecf,<\/span><\/p>\n

– \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n ph\u00f9 n\u00e3o do nh\u1ed3i m\u00e1u tr\u00ean l\u1ec1u b\u00e1n c\u1ea7u n\u00e3o (supratentorial hemispheric ischemic strocke): kh\u00f4ng nh\u1ea5t thi\u1ebft ph\u1ea3i theo d\u00f5i \u00e1p l\u1ef1c n\u1ed9i s\u1ecd th\u01b0\u1eddng quy ho\u1eb7c ch\u1ecdc d\u1ecbch n\u00e3o t\u1ee7y kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh, nh\u01b0ng n\u1ebfu ti\u1ebfp t\u1ee5c ti\u1ebfn tri\u1ec3n x\u1ea5u \u0111i v\u1ec1 ch\u1ee9c n\u0103ng th\u1ea7n kinh, n\u00ean m\u1edf s\u1ecd gi\u1ea3i \u00e1p,<\/span><\/p>\n

– \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n ph\u00f9 n\u00e3o do \u0111\u1ed9t qu\u1ef5 ti\u1ec3u n\u00e3o c\u00f3 suy gi\u1ea3m v\u1ec1 ch\u1ee9c n\u0103ng th\u1ea7n kinh, ph\u1eabu thu\u1eadt m\u1edf s\u1ecd v\u00e0 m\u1edf m\u00e0ng c\u1ee9ng n\u00ean \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh,<\/span><\/p>\n

– Sau nh\u1ed3i m\u00e1u ti\u1ec3u n\u00e3o, ph\u1eabu thu\u1eadt d\u1eabn l\u01b0u n\u00e3o th\u1ea5t \u0111\u1ec3 l\u00e0m gi\u1ea3m \u00e1p l\u1ef1c d\u1ecbch n\u00e3o t\u1ee7y do t\u1eafc ngh\u1ebdn ph\u1ea3i \u0111\u01b0\u1ee3c \u0111i k\u00e8m v\u1edbi ph\u1eabu thu\u1eadt m\u1edf s\u1ecd.<\/span><\/p>\n

2.9. Ch\u1ed1ng \u0111\u1ed9ng kinh<\/span><\/b><\/h3>\n

\u0110\u1ed9ng kinh x\u1ea3y ra \u1edf 2 – 23% b\u1ec7nh nh\u00e2n trong nh\u1eefng ng\u00e0y \u0111\u1ea7u ti\u00ean sau \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o, th\u01b0\u1eddng l\u00e0 \u0111\u1ed9ng kinh c\u1ee5c b\u1ed9, nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 l\u00e0 nh\u1eefng c\u01a1n to\u00e0n th\u1ec3.<\/span><\/p>\n

M\u1eb7c d\u00f9 \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng ti\u00ean ph\u00e1t c\u01a1n \u0111\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5 kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh, nh\u01b0ng n\u00ean ng\u0103n ng\u1eeba c\u00e1c c\u01a1n \u0111\u1ed9ng kinh ti\u1ebfp theo b\u1eb1ng thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh.<\/span><\/p>\n

M\u1ed9t ph\u1ea7n nh\u1ecf b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 b\u1ecb \u0111\u1ed9ng kinh m\u1ea1n t\u00ednh. \u0110\u1ed9ng kinh th\u1ee9 ph\u00e1t sau \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o \u0111\u01b0\u1ee3c x\u1eed tr\u00ed theo c\u00e1ch t\u01b0\u01a1ng t\u1ef1 nh\u01b0 do t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh.<\/span><\/p>\n

2.10. Thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u v\u00e0 d\u1ef1 ph\u00f2ng huy\u1ebft kh\u1ed1i<\/span><\/b><\/h3>\n

– N\u1ebfu b\u1ec7nh nh\u00e2n b\u1ecb \u0111\u1ed9t qu\u1ef5 do thuy\u00ean t\u1eafc (v\u00ed d\u1ee5 rung nh\u0129) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng v\u1edbi m\u1ee5c ti\u00eau ng\u0103n ng\u1eeba b\u1ec7nh l\u00fd t\u1eafc m\u1ea1ch; tuy nhi\u00ean, c\u1ea7n c\u00e2n nh\u1eafc tr\u01b0\u1edbc nguy c\u01a1 xu\u1ea5t huy\u1ebft chuy\u1ec3n d\u1ea1ng.<\/span><\/p>\n

– Th\u01b0\u1eddng d\u00f9ng Enoxaparin v\u1edbi li\u1ec1u \u0111i\u1ec1u tr\u1ecb l\u00e0 1mg\/kg\/12h trong tr\u01b0\u1eddng h\u1ee3p ch\u1ee9c n\u0103ng th\u1eadn b\u00ecnh th\u01b0\u1eddng. Li\u1ec1u d\u1ef1 ph\u00f2ng huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch chi d\u01b0\u1edbi c\u1ee7a Enoxaparin l\u00e0 40mg\/24h.<\/span><\/p>\n

– Xoa b\u00f3p chi d\u01b0\u1edbi b\u1eaft \u0111\u1ea7u trong 3 ng\u00e0y \u0111\u1ea7u n\u1eb1m vi\u1ec7n gi\u1ea3m \u0111\u01b0\u1ee3c nguy c\u01a1 b\u1ecb huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u \u1edf b\u1ec7nh nh\u00e2n n\u1eb1m l\u00e2u do \u0111\u1ed9t qu\u1ef5 c\u1ea5p t\u00ednh.<\/span><\/p>\n

2.11. B\u1ea3o v\u1ec7 t\u1ebf b\u00e0o th\u1ea7n kinh<\/span><\/b><\/h3>\n

L\u00fd do c\u0103n b\u1ea3n c\u1ee7a vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c b\u1ea3o v\u1ec7 th\u1ea7n kinh l\u00e0 l\u00e0m gi\u1ea3m gi\u1ea3i ph\u00f3ng c\u00e1c ch\u1ea5t d\u1eabn truy\u1ec1n th\u1ea7n kinh b\u1ecb k\u00edch th\u00edch b\u1edfi c\u00e1c t\u1ebf b\u00e0o th\u1ea7n kinh \u1edf v\u00f9ng n\u00e3o thi\u1ebfu m\u00e1u \u0111\u1ec3 t\u0103ng c\u01b0\u1eddng kh\u1ea3 n\u0103ng s\u1ed1ng s\u00f3t c\u1ee7a c\u00e1c t\u1ebf b\u00e0o th\u1ea7n kinh n\u00e0y. M\u1eb7c d\u00f9 k\u1ebft qu\u1ea3 r\u1ea5t \u0111\u00e1ng kh\u00edch l\u1ec7 trong m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u tr\u00ean \u0111\u1ed9ng v\u1eadt, tuy nhi\u00ean, ch\u01b0a c\u00f3 thu\u1ed1c b\u1ea3o v\u1ec7 th\u1ea7n kinh n\u00e0o \u0111\u01b0\u1ee3c \u1ee7ng h\u1ed9 b\u1edfi c\u00e1c nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean, c\u00f3 \u0111\u1ed1i ch\u1ee9ng gi\u1ea3 d\u01b0\u1ee3c. Tuy nhi\u00ean, m\u1ed9t l\u01b0\u1ee3ng nghi\u00ean c\u1ee9u \u0111\u00e1ng k\u1ec3 \u0111ang \u0111\u01b0\u1ee3c tri\u1ec3n khai \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 c\u00e1c chi\u1ebfn l\u01b0\u1ee3c b\u1ea3o v\u1ec7 th\u1ea7n kinh kh\u00e1c nhau.<\/span><\/p>\n

H\u1ea1 th\u00e2n nhi\u1ec7t r\u1ea5t h\u1ee9a h\u1eb9n cho vi\u1ec7c \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n s\u1ed1ng s\u00f3t sau ng\u1eebng tim do nh\u1ecbp nhanh th\u1ea5t ho\u1eb7c rung th\u1ea5t. Tuy nhi\u00ean, ch\u01b0a c\u00f3 nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng l\u1edbn n\u00e0o ch\u1ee9ng minh vai tr\u00f2 c\u1ee7a h\u1ea1 th\u00e2n nhi\u1ec7t trong \u0111i\u1ec1u tr\u1ecb s\u1edbm \u0111\u1ed9t qu\u1ef5 n\u00e3o do thi\u1ebfu m\u00e1u.<\/span><\/p>\n

3. Theo d\u00f5i<\/h2>\n

Ch\u00fa \u00fd trong qu\u00e1 tr\u00ecnh theo d\u00f5i v\u00e0 \u0111i\u1ec1u tr\u1ecb, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111\u1ed9t ng\u1ed9t n\u1eb7ng l\u00ean v\u1edbi nh\u1eefng bi\u1ec3u hi\u1ec7n suy gi\u1ea3m nhanh ch\u00f3ng ch\u1ee9c n\u0103ng th\u1ea7n kinh ho\u1eb7c t\u00ecnh tr\u1ea1ng tu\u1ea7n ho\u00e0n, h\u00f4 h\u1ea5p suy s\u1ee5p \u0111\u1ed9t ng\u1ed9t.<\/span><\/p>\n

Ng\u01b0\u1eddi th\u1ea7y thu\u1ed1c c\u1ea7n \u0111\u00e1nh gi\u00e1 b\u1ec7nh nh\u00e2n t\u1eebng b\u01b0\u1edbc theo quy t\u1eafc ABC, h\u1ed7 tr\u1ee3 tu\u1ea7n ho\u00e0n, h\u00f4 h\u1ea5p v\u00e0 n\u1ebfu c\u00f3 th\u1ec3, n\u00ean ch\u1ec9 \u0111\u1ecbnh ch\u1ee5p c\u1eaft l\u1edbp ho\u1eb7c ch\u1ee5p MRI \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 ti\u1ebfn tri\u1ec3n c\u1ee7a \u1ed5 nh\u1ed3i m\u00e1u c\u0169ng nh\u01b0 ph\u00f9 n\u00e3o c\u00f3 th\u1ec3 x\u1ea3y ra.<\/span><\/p>\n

4. H\u1ed9i ch\u1ea9n<\/h2>\n

N\u00ean c\u00f3 m\u1ed9t nh\u00f3m chuy\u00ean s\u00e2u v\u1ec1 \u0111\u1ed9t qu\u1ef5 ho\u1eb7c m\u1ed9t chuy\u00ean gia c\u00f3 kinh nghi\u1ec7m n\u00ean s\u1eb5n s\u00e0ng c\u00f3 m\u1eb7t trong v\u00f2ng 15 ph\u00fat sau khi b\u1ec7nh nh\u00e2n v\u00e0o vi\u1ec7n. C\u00e1c h\u00ecnh th\u1ee9c tham v\u1ea5n, h\u1ed9i ch\u1ea9n kh\u00e1c c\u0103n c\u1ee9 tr\u00ean t\u1eebng b\u1ec7nh nh\u00e2n c\u1ee5 th\u1ec3. N\u00ean th\u1ef1c hi\u1ec7n s\u1edbm li\u1ec7u ph\u00e1p v\u1eadt l\u00fd tr\u1ecb li\u1ec7u, ng\u00f4n ng\u1eef tr\u1ecb li\u1ec7u v\u00e0 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng t\u01b0 v\u1ea5n trong ng\u00e0y \u0111\u1ea7u ti\u00ean b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n.<\/span><\/p>\n

5. Dinh d\u01b0\u1ee1ng<\/h2>\n

\u0110\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 c\u00f3 li\u00ean quan \u0111\u1ebfn ch\u1ee9ng sa s\u00fat tr\u00ed tu\u1ec7 do nguy\u00ean nh\u00e2n m\u1ea1ch n\u00e3o. Nh\u1eefng ng\u01b0\u1eddi s\u1ed1ng s\u00f3t sau \u0111\u1ed9t qu\u1ef5 c\u00f3 t\u1ef7 l\u1ec7 m\u1eafc ch\u1ee9ng sa s\u00fat tr\u00ed tu\u1ec7 g\u1ea7n g\u1ea5p \u0111\u00f4i so v\u1edbi d\u00e2n s\u1ed1 n\u00f3i chung. <\/span>Theo m\u1ed9t nghi\u00ean c\u1ee9u n\u0103m 2018, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c gi\u00fap \u0111\u1ee1 b\u1eb1ng c\u00e1ch tu\u00e2n theo ch\u1ebf \u0111\u1ed9 \u0103n \u0110\u1ecba Trung H\u1ea3i (DASH). Ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng c\u0169ng c\u00f3 th\u1ec3 gi\u00fap ng\u0103n ng\u1eeba ch\u1ee9ng m\u1ea5t tr\u00ed nh\u1edb \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5.<\/span><\/p>\n

6. Ti\u00ean l\u01b0\u1ee3ng<\/h2>\n

Trong c\u00e1c nghi\u00ean c\u1ee9u \u0111\u1ed9t qu\u1ef5 Framingham v\u00e0 Rochester, t\u1ef7 l\u1ec7 t\u1eed vong chung \u1edf 30 ng\u00e0y sau \u0111\u1ed9t qu\u1ef5 l\u00e0 28%, t\u1ef7 l\u1ec7 t\u1eed vong \u1edf 30 ng\u00e0y sau nh\u1ed3i m\u00e1u n\u00e3o l\u00e0 19% v\u00e0 t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t sau 1 n\u0103m \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u n\u00e3o l\u00e0 77%. Tuy nhi\u00ean, ti\u00ean l\u01b0\u1ee3ng sau nh\u1ed3i m\u00e1u kh\u00e1c nhau gi\u1eefa c\u00e1c b\u1ec7nh nh\u00e2n, t\u00f9y thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 nh\u1ed3i m\u00e1u v\u00e0 nh\u1eefng b\u1ec7nh l\u00fd k\u00e8m theo, tu\u1ed5i c\u0169ng nh\u01b0 c\u00e1c bi\u1ebfn ch\u1ee9ng sau nh\u1ed3i m\u00e1u.<\/span><\/p>\n

C\u00e1c y\u1ebfu t\u1ed1 ch\u00ednh l\u00e0m gia t\u0103ng nguy c\u01a1 li\u00ean quan \u0111\u1ebfn t\u1eed vong s\u1edbm sau nh\u1ed3i m\u00e1u bao g\u1ed3m: tu\u1ed5i, \u0111i\u1ec3m NIHSS cao, \u0111i\u1ec3m Rankin s\u1eeda \u0111\u1ed5i > 0, ti\u1ec1n s\u1eed c\u00f3 b\u1ec7nh tim, ti\u1ec3u \u0111\u01b0\u1eddng.<\/span><\/p>\n

Nh\u1ed3i m\u00e1u n\u00e3o do suy tim c\u1ea5p v\u00e0 r\u1ed1i lo\u1ea1n nh\u1ecbp tim c\u00f3 ti\u00ean l\u01b0\u1ee3ng x\u1ea5u sau 3 th\u00e1ng \u0111i\u1ec1u tr\u1ecb. T\u0103ng \u0111\u01b0\u1eddng huy\u1ebft n\u1eb7ng c\u00f3 li\u00ean quan \u0111\u1ed9c l\u1eadp v\u1edbi ti\u00ean l\u01b0\u1ee3ng x\u1ea5u v\u00e0 gi\u1ea3m k\u1ebft qu\u1ea3 t\u00e1i t\u01b0\u1edbi m\u00e1u b\u1eb1ng thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft, c\u0169ng nh\u01b0 lan r\u1ed9ng khu v\u1ef1c nh\u1ed3i m\u00e1u.<\/span><\/p>\n

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

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