{"id":25681,"date":"2023-04-21T11:28:06","date_gmt":"2023-04-21T04:28:06","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=25681"},"modified":"2023-04-21T11:38:15","modified_gmt":"2023-04-21T04:38:15","slug":"dot-quy-xuat-huyet-nao-dieu-tri-va-tien-luong-benh-nhan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/dot-quy-xuat-huyet-nao-dieu-tri-va-tien-luong-benh-nhan\/","title":{"rendered":"\u0110\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft n\u00e3o: \u0110i\u1ec1u tr\u1ecb v\u00e0 ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n"},"content":{"rendered":"

\u0110\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft n\u00e3o l\u00e0 m\u1ed9t lo\u1ea1i \u0111\u1ed9t qu\u1ef5 x\u1ea3y ra khi m\u1ed9t m\u1ea1ch m\u00e1u trong n\u00e3o b\u1ecb v\u1ee1, d\u1eabn \u0111\u1ebfn ch\u1ea3y m\u00e1u v\u00e0o n\u00e3o v\u00e0 g\u00e2y t\u1ed5n th\u01b0\u01a1ng ho\u1eb7c ch\u1ebft c\u00e1c t\u1ebf b\u00e0o n\u00e3o trong khu v\u1ef1c \u0111\u00f3. \u0110\u00e2y l\u00e0 m\u1ed9t lo\u1ea1i \u0111\u1ed9t qu\u1ef5 kh\u00e1c so v\u1edbi \u0111\u1ed9t qu\u1ef5<\/a> thi\u1ebfu m\u00e1u n\u00e3o, v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c tri\u1ec7u ch\u1ee9ng nghi\u00eam tr\u1ecdng nh\u01b0 \u0111au \u0111\u1ea7u, bu\u1ed3n n\u00f4n, n\u00f4n, t\u00ea ho\u1eb7c y\u1ebfu c\u01a1 th\u1ec3, kh\u00f3 n\u00f3i ho\u1eb7c hi\u1ec3u ng\u00f4n ng\u1eef, v\u00e0 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u1eed vong.<\/strong><\/p>\n

\"\u0110\u1ed9t
\u0110\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft n\u00e3o c\u00f3 th\u1ec3 d\u1eabn t\u1edbi t\u1eed vong n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi<\/figcaption><\/figure>\n

1. \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa<\/h2>\n

1.1. Nguy\u00ean t\u1eafc chung<\/span><\/b><\/h3>\n

\u0110i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n XHN ph\u1ee5 thu\u1ed9c v\u00e0o nguy\u00ean nh\u00e2n v\u00e0 m\u1ee9c \u0111\u1ed9 xu\u1ea5t huy\u1ebft. Ki\u1ec3m so\u00e1t c\u00e1c d\u1ea5u hi\u1ec7u sinh t\u1ed3n, ch\u1ea3y m\u00e1u, co gi\u1eadt, huy\u1ebft \u00e1p v\u00e0 \u00e1p l\u1ef1c n\u1ed9i s\u1ecd. C\u00e1c thu\u1ed1c s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9t qu\u1ef5 c\u1ea5p bao g\u1ed3m:<\/span><\/p>\n

– Thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh: d\u1ef1 ph\u00f2ng co gi\u1eadt.<\/span><\/p>\n

– Thu\u1ed1c h\u1ea1 \u00e1p: ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch.<\/span><\/p>\n

– L\u1ee3i ti\u1ec3u th\u1ea9m th\u1ea5u: gi\u1ea3m \u00e1p l\u1ef1c n\u1ed9i s\u1ecd trong khoang d\u01b0\u1edbi nh\u1ec7n.<\/span><\/p>\n

X\u1eed tr\u00ed b\u1eaft \u0111\u1ea7u b\u1eb1ng \u1ed5n \u0111\u1ecbnh c\u00e1c d\u1ea5u hi\u1ec7u sinh t\u1ed3n: \u0111\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng th\u1edf n\u1ebfu b\u1ec7nh nh\u00e2n suy gi\u1ea3m \u00fd th\u1ee9c, c\u00f3 nguy c\u01a1 suy h\u00f4 h\u1ea5p, th\u1edf m\u00e1y ki\u1ec3u t\u0103ng th\u00f4ng kh\u00ed k\u1ebft h\u1ee3p truy\u1ec1n mannitol t\u0129nh m\u1ea1ch n\u1ebfu c\u00f3 t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd, \u0111\u1ed3ng th\u1eddi ch\u1ee5p CT s\u1ecd n\u00e3o c\u1ea5p c\u1ee9u. Theo d\u00f5i \u0111\u01b0\u1eddng m\u00e1u v\u00e0 d\u1ef1 ph\u00f2ng vi\u00eam lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng.<\/span><\/p>\n

1.2. \u0110i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3<\/span><\/b><\/h3>\n

1.2.1. Ki\u1ec3m so\u00e1t c\u01a1n co gi\u1eadt<\/span><\/i><\/b><\/h4>\n

Tri\u1ec7u ch\u1ee9ng co gi\u1eadt s\u1edbm x\u1ea3y ra \u1edf 4-28% b\u1ec7nh nh\u00e2n xu\u1ea5t huy\u1ebft n\u00e3o, th\u01b0\u1eddng kh\u00f4ng ph\u1ea3i l\u00e0 c\u01a1n \u0111\u1ed9ng kinh.<\/span><\/p>\n

C\u00e1c thu\u1ed1c th\u01b0\u1eddng d\u00f9ng l\u00e0 nh\u00f3m benzodiazepin nh\u01b0 lorazepam ho\u1eb7c diazepam. C\u00f3 th\u1ec3 d\u00f9ng th\u00eam li\u1ec1u n\u1ea1p phenytoin ho\u1eb7c fosphenytoin \u0111\u1ec3 ki\u1ec3m so\u00e1t l\u00e2u d\u00e0i.<\/span><\/p>\n

1.2.2. D\u1ef1 ph\u00f2ng \u0111\u1ed9ng kinh<\/span><\/i><\/b><\/h4>\n

Ch\u1ec9 \u0111\u1ecbnh:<\/span><\/p>\n

– B\u1ec7nh nh\u00e2n xu\u1ea5t huy\u1ebft th\u00f9y n\u00e3o \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 co gi\u1eadt.<\/span><\/p>\n

– B\u1ec7nh nh\u00e2n xu\u1ea5t huy\u1ebft d\u01b0\u1edbi nh\u1ec7n do v\u1ee1 ph\u00ecnh m\u1ea1ch.<\/span><\/p>\n

Kh\u00f4ng khuy\u1ebfn c\u00e1o d\u00f9ng k\u00e9o d\u00e0i thu\u1ed1c d\u1ef1 ph\u00f2ng \u0111\u1ed9ng kinh nh\u01b0ng c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed co gi\u1eadt, t\u1ee5 m\u00e1u trong n\u00e3o, t\u0103ng huy\u1ebft \u00e1p kh\u00f3 ki\u1ec3m so\u00e1t, nh\u1ed3i m\u00e1u ho\u1eb7c ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch n\u00e3o gi\u1eefa.<\/span><\/p>\n

1.2.3. Ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p<\/span><\/i><\/b><\/h4>\n

– N\u1ebfu huy\u1ebft \u00e1p t\u00e2m thu >200 mmHg ho\u1eb7c huy\u1ebft \u00e1p trung b\u00ecnh > 150 mmHg: h\u1ea1 \u00e1p b\u1eb1ng thu\u1ed1c truy\u1ec1n t\u0129nh m\u1ea1ch, theo d\u00f5i huy\u1ebft \u00e1p c\u1ee9 m\u1ed7i 5 ph\u00fat\/l\u1ea7n.<\/span><\/p>\n

– N\u1ebfu huy\u1ebft \u00e1p t\u00e2m thu >180 mmHg ho\u1eb7c huy\u1ebft \u00e1p trung b\u00ecnh > 130 mmHg k\u00e8m theo t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd: theo d\u00f5i \u00e1p l\u1ef1c n\u1ed9i s\u1ecd v\u00e0 h\u1ea1 \u00e1p b\u1eb1ng thu\u1ed1c truy\u1ec1n t\u0129nh m\u1ea1ch, duy tr\u00ec \u00e1p l\u1ef1c t\u01b0\u1edbi m\u00e1u n\u00e3o \u2265 60 mmHg.<\/span><\/p>\n

– N\u1ebfu huy\u1ebft \u00e1p t\u00e2m thu >180 mmHg ho\u1eb7c huy\u1ebft \u00e1p trung b\u00ecnh > 130 mmHg v\u00e0 kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd: h\u1ea1 huy\u1ebft \u00e1p t\u1ed1i thi\u1ec3u (\u0111\u00edch huy\u1ebft \u00e1p 160\/90 mmHg ho\u1eb7c huy\u1ebft \u00e1p trung b\u00ecnh 110 mmHg) b\u1eb1ng thu\u1ed1c truy\u1ec1n t\u0129nh m\u1ea1ch, theo d\u00f5i t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng, huy\u1ebft \u00e1p m\u1ed7i 15 ph\u00fat.<\/span><\/p>\n

– V\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n xu\u1ea5t huy\u1ebft d\u01b0\u1edbi nh\u1ec7n do v\u1ee1 ph\u00ecnh m\u1ea1ch, AHA\/ASA 2012 khuy\u1ebfn c\u00e1o h\u1ea1 huy\u1ebft \u00e1p xu\u1ed1ng d\u01b0\u1edbi 160 mmHg \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t.<\/span><\/p>\n

– Theo ACP (American College of Physicians) v\u00e0 AAFP (American Academy of Family Physicians) 2017: c\u00f3 th\u1ec3 xem x\u00e9t b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb cho c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 huy\u1ebft \u00e1p t\u00e2m thu \u2265 150 mmHg \u0111\u01b0a v\u1ec1 \u0111\u00edch huy\u1ebft \u00e1p < 150 mmHg \u0111\u1ec3 gi\u1ea3m thi\u1ec3u nguy c\u01a1 \u0111\u1ed9t qu\u1ef5, c\u00e1c bi\u1ebfn c\u1ed1 tim v\u00e0 t\u1eed vong.<\/span><\/p>\n

(xem th\u00eam ph\u1ee5 l\u1ee5c III v\u1ec1 c\u00e1c thu\u1ed1c h\u1ea1 \u00e1p d\u00f9ng theo \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch).<\/span><\/p>\n

1.2.4. Ki\u1ec3m so\u00e1t \u00e1p l\u1ef1c n\u1ed9i s\u1ecd<\/span><\/i><\/b><\/h4>\n

– N\u00e2ng \u0111\u1ea7u cao 30 \u0111\u1ed9, kh\u00f4ng n\u1eb1m nghi\u00eang gi\u00fap c\u1ea3i thi\u1ec7n d\u00f2ng tr\u1edf v\u1ec1 t\u0129nh m\u1ea1ch trung t\u00e2m, l\u00e0m gi\u1ea3m \u00e1p l\u1ef1c n\u1ed9i s\u1ecd.<\/span><\/p>\n

– C\u00f3 th\u1ec3 cho an th\u1ea7n, g\u00e2y m\u00ea n\u1ebfu c\u1ea7n thi\u1ebft. S\u1eed d\u1ee5ng thu\u1ed1c b\u1ea3o v\u1ec7 d\u1ea1 d\u00e0y d\u1ef1 ph\u00f2ng lo\u00e9t d\u1ea1 d\u00e0y \u1edf b\u1ec7nh nh\u00e2n XHN. C\u00e1c \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 kh\u00e1c bao g\u1ed3m: truy\u1ec1n mannitol ho\u1eb7c mu\u1ed1i \u01b0u tr\u01b0\u01a1ng, g\u00e2y m\u00ea b\u1eb1ng barbiturat, d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf th\u1ea7n kinh c\u01a1, theo d\u00f5i li\u00ean t\u1ee5c \u00e1p l\u1ef1c n\u1ed9i s\u1ecd v\u00e0 huy\u1ebft \u00e1p \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o \u00e1p l\u1ef1c t\u01b0\u1edbi m\u00e1u n\u00e3o \u2265 70 mmHg.<\/span><\/p>\n

1.2.5. \u0110i\u1ec1u tr\u1ecb xu\u1ea5t huy\u1ebft n\u00e3o li\u00ean quan t\u1edbi thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng<\/span><\/i><\/b><\/h4>\n

B\u1ec7nh nh\u00e2n d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng warfarin b\u1ecb XHN nhi\u1ec1u h\u01a1n v\u00e0 h\u01a1n 50% b\u1ec7nh nh\u00e2n t\u1eed vong trong v\u00f2ng 30 ng\u00e0y. C\u1ea7n b\u00ecnh \u1ed5n t\u1ef7 l\u1ec7 Prothrombin \u0111\u1ec3 ng\u0103n ch\u1eb7n XHN ti\u1ebfn tri\u1ec3n b\u1eb1ng:<\/span><\/p>\n

– Ti\u00eam t\u0129nh m\u1ea1ch thu\u1ed1c vitamin K.<\/span><\/p>\n

– Truy\u1ec1n huy\u1ebft t\u01b0\u01a1ng t\u01b0\u01a1i \u0111\u00f4ng l\u1ea1nh (FFP).<\/span><\/p>\n

– Truy\u1ec1n ph\u1ee9c h\u1ee3p prothombin c\u00f4 \u0111\u1eb7c (PCC).<\/span><\/p>\n

– Truy\u1ec1n t\u0129nh m\u1ea1ch rFVIIa.<\/span><\/p>\n

D\u00f9ng vitamin K c\u1ea7n th\u1eddi gian \u00edt nh\u1ea5t 6 gi\u1edd \u0111\u1ec3 \u0111\u01b0a INR v\u1ec1 b\u00ecnh th\u01b0\u1eddng, do \u0111\u00f3 n\u00ean k\u1ebft h\u1ee3p th\u00eam v\u1edbi FFP ho\u1eb7c PCC.<\/span><\/p>\n

C\u00e1c b\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng heparin (tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p ho\u1eb7c kh\u00f4ng ph\u00e2n \u0111o\u1ea1n) b\u1ecb xu\u1ea5t huy\u1ebft n\u00e3o c\u1ea7n \u0111\u01b0\u1ee3c ti\u00eam protamin trung h\u00f2a. Li\u1ec1u protamin ph\u1ee5 thu\u1ed9c v\u00e0o li\u1ec1u heparin v\u00e0 th\u1eddi \u0111i\u1ec3m cu\u1ed1i d\u00f9ng heparin tr\u01b0\u1edbc \u0111\u00f3. C\u00e1c b\u1ec7nh nh\u00e2n thi\u1ebfu h\u1ee5t n\u1eb7ng y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u c\u00f3 th\u1ec3 b\u1ecb xu\u1ea5t huy\u1ebft n\u00e3o t\u1ef1 ph\u00e1t n\u00ean \u0111\u01b0\u1ee3c truy\u1ec1n b\u1ed5 sung c\u00e1c y\u1ebfu t\u1ed1 thay th\u1ebf.<\/span><\/p>\n

1.2.6. \u0110i\u1ec1u tr\u1ecb xu\u1ea5t huy\u1ebft n\u00e3o li\u00ean quan \u0111\u1ebfn thu\u1ed1c kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u<\/span><\/i><\/b><\/h4>\n

Khuy\u1ebfn c\u00e1o AHA\/ASA 2010 v\u1ec1 x\u1eed tr\u00ed xu\u1ea5t huy\u1ebft n\u00e3o t\u1ef1 ph\u00e1t khuy\u1ebfn c\u00e1o ch\u1ec9 truy\u1ec1n ti\u1ec3u c\u1ea7u khi xu\u1ea5t huy\u1ebft n\u00e3o k\u00e8m gi\u1ea3m ti\u1ec3u c\u1ea7u n\u1eb7ng.<\/span><\/p>\n

1.2.7. Ph\u1ed1i h\u1ee3p thu\u1ed1c Statin<\/span><\/i><\/b><\/h4>\n

Nhi\u1ec1u nghi\u00ean c\u1ee9u ch\u1ee9ng minh b\u1ec7nh nh\u00e2n xu\u1ea5t huy\u1ebft n\u00e3o \u0111\u01b0\u1ee3c d\u00f9ng statin c\u00f3 k\u1ebft qu\u1ea3 t\u1ed1t h\u01a1n v\u1ec1 k\u1ebft c\u1ee5c l\u00e2m s\u00e0ng sau xu\u1ea5t huy\u1ebft n\u00e3o [101]. Tr\u00ean l\u00e2m s\u00e0ng hay ch\u1ec9 \u0111\u1ecbnh:<\/span><\/p>\n

– Atorvastatin 10 – 40 mg\/ng\u00e0y<\/span><\/p>\n

– Rosuvastatin 10 – 20 mg\/ng\u00e0y<\/span><\/p>\n

2. \u0110i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt<\/h2>\n

Vai tr\u00f2 c\u1ee7a ph\u1eabu thu\u1eadt \u0111\u1ed1i v\u1edbi xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd v\u00f9ng tr\u00ean l\u1ec1u v\u1eabn c\u00f2n \u0111ang tranh lu\u1eadn. M\u1ed9t ph\u00e2n t\u00edch g\u1ed9p [103] v\u1ec1 ph\u1eabu thu\u1eadt trong xu\u1ea5t huy\u1ebft n\u00e3o cho th\u1ea5y c\u00f3 b\u1eb1ng ch\u1ee9ng c\u1ea3i thi\u1ec7n l\u00e2m s\u00e0ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n:<\/span><\/p>\n

– Ph\u1eabu thu\u1eadt trong th\u1eddi gian 8h sau kh\u1edfi ph\u00e1t.<\/span><\/p>\n

– Th\u1ec3 t\u00edch kh\u1ed1i m\u00e1u t\u1ee5 20-50 ml.<\/span><\/p>\n

– \u0110i\u1ec3m Glasgow 9-12 \u0111i\u1ec3m.<\/span><\/p>\n

– B\u1ec7nh nh\u00e2n 50-69 tu\u1ed5i.<\/span><\/p>\n

– B\u1ec7nh nh\u00e2n t\u1ee5 m\u00e1u trong nhu m\u00f4 m\u00e0 kh\u00f4ng c\u00f3 ch\u1ea3y m\u00e1u n\u00e3o th\u1ea5t c\u00f3 th\u1ec3 can thi\u1ec7p an to\u00e0n [104].<\/span><\/p>\n

– Ph\u1eabu thu\u1eadt c\u00f3 hi\u1ec7u qu\u1ea3 \u1edf c\u00e1c b\u1ec7nh nh\u00e2n xu\u1ea5t huy\u1ebft nhu m\u00f4 n\u00e3o n\u1ebfu \u0111\u01b0\u1eddng k\u00ednh kh\u1ed1i m\u00e1u t\u1ee5 > 3cm, nh\u1eb1m d\u1ef1 ph\u00f2ng t\u1ee5t k\u1eb9t th\u00e2n n\u00e3o.<\/span><\/p>\n

3. \u0110i\u1ec1u tr\u1ecb can thi\u1ec7p m\u1ea1ch<\/h2>\n

\u0110i\u1ec1u tr\u1ecb can thi\u1ec7p m\u1ea1ch \u0111\u01b0\u1ee3c \u0111\u1eb7t ra \u0111\u1ed1i v\u1edbi xu\u1ea5t huy\u1ebft n\u00e3o c\u00f3 nguy\u00ean nh\u00e2n th\u1ee9 ph\u00e1t do b\u1ea5t th\u01b0\u1eddng m\u1ea1ch m\u00e1u bao g\u1ed3m ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch n\u00e3o, d\u1ecb d\u1ea1ng th\u00f4ng \u0111\u1ed9ng-t\u0129nh m\u1ea1ch n\u00e3o, r\u00f2 \u0111\u1ed9ng t\u0129nh m\u1ea1ch m\u00e0ng c\u1ee9ng n\u00e3o.<\/span><\/p>\n

3.1. Ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch n\u00e3o<\/span><\/h3>\n

Ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch n\u00e3o v\u1ee1 l\u00e0 nguy\u00ean nh\u00e2n c\u1ee7a 85% c\u00e1c ca ch\u1ea3y m\u00e1u d\u01b0\u1edbi nh\u1ec7n kh\u00f4ng do ch\u1ea5n th\u01b0\u01a1ng.<\/span><\/p>\n

Ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch n\u00e3o \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i theo h\u00ecnh d\u1ea1ng bao g\u1ed3m ph\u00ecnh h\u00ecnh t\u00fai (saccular aneurysm), ph\u00ecnh h\u00ecnh thoi (fusiform aneurysm), ph\u00ecnh do l\u00f3c t\u00e1ch m\u1ea1ch (dissecting aneurysm), ph\u00ecnh d\u1ea1ng fusi-sacciform trong b\u1ec7nh l\u00fd gi\u00e3n ph\u00ecnh (dolichoectasia), ph\u00ecnh d\u1ea1ng b\u1ecdng n\u01b0\u1edbc (blister aneurysm).\u00a0<\/span><\/p>\n

Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb g\u00e2y t\u1eafc ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch n\u00e3o v\u1ee1 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n theo c\u00e1c khuy\u1ebfn c\u00e1o c\u1ee7a hi\u1ec7p h\u1ed9i \u0111\u1ed9t qu\u1ef5 Ch\u00e2u \u00c2u v\u00e0 M\u1ef9. Ch\u1ea9n \u0111o\u00e1n ph\u00ecnh m\u1ea1ch n\u00e3o v\u1ee1 d\u1ef1a v\u00e0o ch\u1ee5p CT m\u1ea1ch m\u00e1u, c\u1ed9ng h\u01b0\u1edfng t\u1eeb m\u1ea1ch m\u00e1u ho\u1eb7c ch\u1ee5p m\u1ea1ch s\u1ed1 h\u00f3a x\u00f3a n\u1ec1n (DSA) trong \u0111\u00f3 ch\u1ee5p DSA l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n.<\/span><\/p>\n

Hai ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn bao g\u1ed3m ph\u1eabu thu\u1eadt ho\u1eb7c can thi\u1ec7p n\u1ed9i m\u1ea1ch. Vi\u1ec7c l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u00f9y thu\u1ed9c v\u00e0o h\u00ecnh d\u1ea1ng, v\u1ecb tr\u00ed, k\u00edch th\u01b0\u1edbc t\u00fai ph\u00ecnh c\u0169ng nh\u01b0 tu\u1ed5i, c\u00e1c b\u1ec7nh l\u00fd \u0111i k\u00e8m c\u0169ng nh\u01b0 l\u00e0 l\u1ef1a ch\u1ecdn c\u1ee7a b\u1ec7nh nh\u00e2n.<\/span><\/p>\n

<\/b><\/p>\n

B\u1ec7nh nh\u00e2n nam 67 tu\u1ed5i c\u00f3 xu\u1ea5t huy\u1ebft d\u01b0\u1edbi nh\u1ec7n lan t\u1ecfa (Fisher 4) do v\u1ee1 t\u00fai ph\u00ecnh th\u00f4ng tr\u01b0\u1edbc (ph\u00e1t hi\u1ec7n b\u1eb1ng CT m\u1ea1ch m\u00e1u). T\u00fai ph\u00ecnh sau \u0111\u00f3 \u0111\u01b0\u1ee3c can thi\u1ec7p n\u00fat t\u1eafc ho\u00e0n to\u00e0n b\u1eb1ng coils c\u00f3 b\u00f3ng h\u1ed7 tr\u1ee3.<\/span><\/p>\n

3.2. Th\u00f4ng \u0111\u1ed9ng-t\u0129nh m\u1ea1ch n\u00e3o (AVM)<\/span><\/b><\/h3>\n

Th\u00e1i \u0111\u1ed9 x\u1eed tr\u00ed \u0111\u1ed1i v\u1edbi d\u1ecb d\u1ea1ng th\u00f4ng \u0111\u1ed9ng-t\u0129nh m\u1ea1ch n\u00e3o \u0111\u00e3 \u0111\u01b0\u1ee3c hi\u1ec7p h\u1ed9i Tim m\u1ea1ch v\u00e0 \u0111\u1ed9t qu\u1ef5 Hoa K\u1ef3 \u0111\u01b0a ra v\u00e0o n\u0103m 2017. N\u00fat m\u1ea1ch \u0111\u1ed1i v\u1edbi d\u1ecb d\u1ea1ng AVM c\u00f3 xu\u1ea5t huy\u1ebft n\u00e3o c\u1ea5p th\u01b0\u1eddng \u0111\u1eb7t ra \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb ch\u1ea3y m\u00e1u do ph\u00ecnh m\u1ea1ch c\u1ea1nh \u1ed5 nidus d\u1ecb d\u1ea1ng ho\u1eb7c n\u00fat t\u1eafc ch\u1ecdn l\u1ecdc \u0111i\u1ec3m ch\u1ea3y m\u00e1u gi\u1ea3m nguy c\u01a1 ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t. Sau giai \u0111o\u1ea1n c\u1ea5p khi m\u00e0 kh\u1ed1i m\u00e1u t\u1ee5 \u0111\u00e3 ti\u00eau h\u1ebft (kho\u1ea3ng 4-6 tu\u1ea7n), th\u00ec vi\u1ec7c n\u00fat m\u1ea1ch \u0111i\u1ec1u tr\u1ecb d\u1ecb d\u1ea1ng AVM t\u00f9y thu\u1ed9c v\u00e0o m\u1ee5c ti\u00eau c\u1ee5 th\u1ec3 cho t\u1eebng b\u1ec7nh nh\u00e2n bao g\u1ed3m n\u00fat m\u1ea1ch tri\u1ec7t \u0111\u1ec3 d\u1ecb d\u1ea1ng (qua \u0111\u01b0\u1eddng \u0111\u1ed9ng m\u1ea1ch ho\u1eb7c t\u0129nh m\u1ea1ch), n\u00fat m\u1ea1ch gi\u1ea3m m\u1ed9t ph\u1ea7n th\u1ec3 t\u00edch nidus tr\u01b0\u1edbc m\u1ed5 gi\u00fap gi\u1ea3m nguy c\u01a1 ph\u1eabu thu\u1eadt ho\u1eb7c n\u00fat m\u1ea1ch m\u1ed9t ph\u1ea7n d\u1ecb d\u1ea1ng ph\u1ed1i h\u1ee3p v\u1edbi x\u1ea1 ph\u1eabu.<\/span><\/p>\n

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

B\u1ec7nh nh\u00e2n n\u1eef 67 tu\u1ed5i c\u00f3 xu\u1ea5t huy\u1ebft l\u1edbn trong nhu m\u00f4 th\u00e1i d\u01b0\u01a1ng-ph\u1ea3i do d\u1ecb d\u1ea1ng AVM v\u1ee1. D\u1ecb d\u1ea1ng m\u1ea1ch n\u00e0y \u0111\u01b0\u1ee3c can thi\u1ec7p n\u00fat t\u1eafc ch\u1ecdn l\u1ecdc m\u1ed9t ph\u1ea7n ch\u1ea3y m\u00e1u b\u1eb1ng Onyx.<\/span><\/p>\n

3.3. R\u00f2 \u0111\u1ed9ng-t\u0129nh m\u1ea1ch m\u00e0ng c\u1ee9ng n\u00e3o (dAVF)<\/span><\/b><\/h3>\n

Th\u00e1i \u0111\u1ed9 x\u1eed tr\u00ed \u0111\u1ed1i v\u1edbi r\u00f2 \u0111\u1ed9ng t\u0129nh m\u1ea1ch m\u00e0ng c\u1ee9ng c\u00f3 xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn theo khuy\u1ebfn c\u00e1o c\u1ee7a hi\u1ec7p h\u1ed9i Tim m\u1ea1ch v\u00e0 \u0111\u1ed9t qu\u1ef5 Hoa K\u1ef3 n\u0103m 2015. Can thi\u1ec7p m\u1ea1ch l\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u tay \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb th\u00f4ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch m\u00e0ng c\u1ee9ng n\u00e3o. Tuy nhi\u00ean, th\u1eddi \u0111i\u1ec3m \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c \u0111\u1eb7t ra trong pha c\u1ea5p m\u00e0 th\u01b0\u1eddng \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh sau khi kh\u1ed1i m\u00e1u t\u1ee5 \u0111\u00e3 ti\u00eau \u0111i (kho\u1ea3ng 4 \u0111\u1ebfn 6 tu\u1ea7n).<\/span><\/p>\n

4. D\u1eabn l\u01b0u n\u00e3o th\u1ea5t<\/h2>\n

D\u1eabn l\u01b0u n\u00e3o th\u1ea5t th\u01b0\u1eddng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong tr\u01b0\u1eddng h\u1ee3p n\u00e3o \u00fang th\u1ee7y do bi\u1ebfn ch\u1ee9ng xu\u1ea5t huy\u1ebft g\u00e2y ch\u00e8n \u00e9p n\u00e3o th\u1ea5t ba ho\u1eb7c n\u00e3o th\u1ea5t b\u1ed1n. D\u1eabn l\u01b0u n\u00e3o th\u1ea5t c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 nhi\u1ec5m khu\u1ea9n bao g\u1ed3m c\u1ea3 vi\u00eam m\u00e0ng n\u00e3o do vi khu\u1ea9n.<\/span><\/p>\n

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

Ti\u00ean l\u01b0\u1ee3ng \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft thay \u0111\u1ed5i t\u00f9y theo m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a \u0111\u1ed9t qu\u1ef5, v\u1ecb tr\u00ed v\u00e0 k\u00edch th\u01b0\u1edbc c\u1ee7a xu\u1ea5t huy\u1ebft. Thang \u0111i\u1ec3m Glasgow (GCS) th\u1ea5p c\u00f3 li\u00ean quan \u0111\u1ebfn ti\u00ean l\u01b0\u1ee3ng k\u00e9m h\u01a1n v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong cao h\u01a1n. K\u00edch th\u01b0\u1edbc v\u00f9ng xu\u1ea5t huy\u1ebft l\u1edbn c\u00f3 li\u00ean quan \u0111\u1ebfn ti\u00ean l\u01b0\u1ee3ng k\u00e9m h\u01a1n. T\u0103ng k\u00edch th\u01b0\u1edbc c\u1ee7a kh\u1ed1i l\u01b0\u1ee3ng m\u00e1u t\u1ee5 c\u00f3 li\u00ean quan \u0111\u1ebfn k\u1ebft qu\u1ea3 ch\u1ee9c n\u0103ng k\u00e9m h\u01a1n v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong t\u0103ng.<\/span><\/p>\n

\u0110i\u1ec3m xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd l\u00e0 c\u00f4ng c\u1ee5 ph\u1ed5 bi\u1ebfn nh\u1ea5t \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 d\u1ef1 \u0111o\u00e1n k\u1ebft qu\u1ea3 trong \u0111\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft. \u0110i\u1ec3m s\u1ed1 \u0111\u01b0\u1ee3c t\u00ednh nh\u01b0 sau:<\/span><\/p>\n

– \u0110i\u1ec3m GCS 3 – 4: 2 \u0111i\u1ec3m<\/span><\/p>\n

– \u0110i\u1ec3m GCS 5 – 12: 1 \u0111i\u1ec3m<\/span><\/p>\n

– \u0110i\u1ec3m GCS 13 – 15: 0 \u0111i\u1ec3m<\/span><\/p>\n

– Tu\u1ed5i \u2265 80: 1 \u0111i\u1ec3m<\/span><\/p>\n

– Xu\u1ea5t huy\u1ebft d\u01b0\u1edbi l\u1ec1u: 1 \u0111i\u1ec3m<\/span><\/p>\n

– Th\u1ec3 t\u00edch kh\u1ed1i m\u00e1u t\u1ee5 \u226530 cm3<\/sup>: 1 \u0111i\u1ec3m<\/span><\/p>\n

– Th\u1ec3 t\u00edch kh\u1ed1i m\u00e1u t\u1ee5 <30 cm3<\/sup>: 0 \u0111i\u1ec3m<\/span><\/p>\n

– C\u00f3 xu\u1ea5t huy\u1ebft n\u00e3o th\u1ea5t: 1 \u0111i\u1ec3m.<\/span><\/p>\n

Trong m\u1ed9t nghi\u00ean c\u1ee9u c\u1ee7a Hemphill v\u00e0 c\u1ed9ng s\u1ef1, t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec3m xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd l\u00e0 0 \u0111\u1ec1u s\u1ed1ng s\u00f3t v\u00e0 t\u1ea5t c\u1ea3 nh\u1eefng ng\u01b0\u1eddi c\u00f3 \u0111i\u1ec3m 5 \u0111\u1ec1u \u0111\u00e3 ch\u1ebft; T\u1ef7 l\u1ec7 t\u1eed vong trong 30 ng\u00e0y t\u0103ng theo s\u1ed1 \u0111i\u1ec3m.<\/span><\/p>\n

C\u00e1c y\u1ebfu t\u1ed1 ti\u00ean l\u01b0\u1ee3ng kh\u00e1c bao g\u1ed3m:<\/span><\/p>\n

– \u0110\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft quanh cu\u1ed1ng n\u00e3o c\u00f3 ti\u00ean l\u01b0\u1ee3ng t\u1ed1t h\u01a1n<\/span><\/p>\n

– Xu\u1ea5t hi\u1ec7n c\u1ee7a m\u00e1u trong n\u00e3o th\u1ea5t c\u00f3 li\u00ean quan \u0111\u1ebfn t\u1ef7 l\u1ec7 t\u1eed vong cao h\u01a1n; trong m\u1ed9t nghi\u00ean c\u1ee9u, s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a m\u00e1u trong n\u00e3o th\u1ea5t c\u00f3 li\u00ean quan \u0111\u1ebfn s\u1ef1 gia t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong h\u01a1n 2 l\u1ea7n<\/span><\/p>\n

– B\u1ec7nh nh\u00e2n b\u1ecb xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd li\u00ean quan \u0111\u1ebfn thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng c\u00f3 t\u1ef7 l\u1ec7 t\u1eed vong cao h\u01a1n v\u00e0 k\u1ebft qu\u1ea3 ch\u1ee9c n\u0103ng k\u00e9m h\u01a1n.<\/span><\/p>\n

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

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