{"id":2602,"date":"2023-04-09T14:29:45","date_gmt":"2023-04-09T07:29:45","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=2602"},"modified":"2023-04-10T14:28:26","modified_gmt":"2023-04-10T07:28:26","slug":"dien-sinh-ly-than-kinh-trong-chan-doan-hoi-chung-ong-co-tay","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/09\/dien-sinh-ly-than-kinh-trong-chan-doan-hoi-chung-ong-co-tay\/","title":{"rendered":"\u0110i\u1ec7n sinh l\u00fd th\u1ea7n kinh trong ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay"},"content":{"rendered":"<p><strong>\u0110i\u1ec7n sinh l\u00fd th\u1ea7n kinh (nerve conduction study) l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng c\u1ee7a c\u00e1c d\u00e2y th\u1ea7n kinh v\u00e0 c\u00e1c s\u1ee3i th\u1ea7n kinh. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y c\u0169ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay. H\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi lao \u0111\u1ed9ng v\u0103n ph\u00f2ng, c\u00f3 tri\u1ec7u ch\u1ee9ng \u0111au v\u00e0 t\u00ea \u1edf v\u00f9ng c\u1ed5 tay v\u00e0 ng\u00f3n tay c\u00e1i. B\u1ec7nh n\u00e0y th\u01b0\u1eddng do vi\u1ec7c s\u1eed d\u1ee5ng qu\u00e1 nhi\u1ec1u tay khi l\u00e0m vi\u1ec7c tr\u00ean m\u00e1y t\u00ednh ho\u1eb7c s\u1eed d\u1ee5ng c\u00e1c c\u00f4ng c\u1ee5 kh\u00e1c. Vi\u1ec7c \u0111o d\u1eabn truy\u1ec1n th\u1ea7n kinh l\u00e0 th\u0103m d\u00f2 nh\u1eb1m \u0111\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng d\u1eabn truy\u1ec1n c\u1ea3 v\u1ec1 c\u1ea3m gi\u00e1c l\u1eabn v\u1eadn \u0111\u1ed9ng \u1edf v\u00f9ng da v\u00e0 c\u01a1 m\u00e0 th\u1ea7n kinh chi ph\u1ed1i.<\/strong><\/p>\n<p><strong>Nh\u00f3m t\u00e1c gi\u1ea3:<\/strong> PGS.TS \u0110inh Ng\u1ecdc S\u01a1n, BSCKII. V\u0169 Tr\u01b0\u1eddng Th\u1ecbnh<\/p>\n<p><strong>Ng\u00e0y ph\u00e1t h\u00e0nh:<\/strong> 30\/03\/2022<\/p>\n<h2><b>1. C\u01a1 s\u1edf sinh l\u00fd c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p \u0111o d\u1eabn truy\u1ec1n th\u1ea7n kinh<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Khi k\u00edch th\u00edch m\u1ed9t d\u00e2y th\u1ea7n kinh v\u1eadn \u0111\u1ed9ng b\u1eb1ng m\u1ed9t xung \u0111i\u1ec7n, d\u00e2y th\u1ea7n kinh s\u1ebd b\u1ecb kh\u1eed c\u1ef1c t\u1ea1i \u0111i\u1ec3m k\u00edch th\u00edch, t\u1ea1o th\u00e0nh m\u1ed9t xung th\u1ea7n kinh. Xung n\u00e0y di chuy\u1ec3n d\u1ecdc theo d\u00e2y th\u1ea7n kinh, v\u01b0\u1ee3t qua synap, th\u00f4ng qua ch\u1ea5t trung gian h\u00f3a h\u1ecdc g\u00e2y kh\u1eed c\u1ef1c m\u00e0ng sau synap. Kh\u1eed c\u1ef1c s\u1ebd t\u1eeb m\u00e0ng sau synap lan t\u1ecfa d\u1ecdc s\u1ee3i c\u01a1 v\u00e0 g\u00e2y co c\u01a1. \u0110i\u1ec7n c\u1ef1c ghi (\u0111\u01b0\u1ee3c \u0111\u1eb7t \u1edf da ngay tr\u00ean b\u1eafp c\u01a1 \u0111\u00f3) s\u1ebd ghi \u0111\u01b0\u1ee3c m\u1ed9t s\u00f3ng \u0111i\u1ec7n th\u1ec3 do co c\u01a1 g\u00e2y ra. \u0110i\u1ec7n th\u1ebf n\u00e0y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng to\u00e0n ph\u1ea7n c\u1ee7a m\u1ed9t b\u1eafp c\u01a1 CMAP (Compound muscle action potential).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Khi k\u00edch th\u00edch m\u1ed9t d\u00e2y th\u1ea7n kinh c\u1ea3m gi\u00e1c b\u1eb1ng m\u1ed9t xung \u0111i\u1ec7n, d\u00e2y th\u1ea7n kinh s\u1ebd b\u1ecb kh\u1eed c\u1ef1c t\u1ea1i \u0111i\u1ec3m k\u00edch th\u00edch, t\u1ea1o th\u00e0nh m\u1ed9t xung th\u1ea7n kinh. Xung n\u00e0y di chuy\u1ec3n d\u1ecdc theo d\u00e2y th\u1ea7n kinh \u0111\u1ebfn v\u00f9ng da m\u00e0 n\u00f3 chi ph\u1ed1i. \u0110i\u1ec7n c\u1ef1c ghi \u0111\u01b0\u1ee3c \u0111\u1eb7t \u1edf v\u00f9ng da \u0111\u00f3 s\u1ebd ghi \u0111\u01b0\u1ee3c s\u00f3ng \u0111i\u1ec7n th\u1ebf \u0111\u00e1p \u1ee9ng c\u1ea3m gi\u00e1c. \u0110i\u1ec7n th\u1ebf n\u00e0y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a d\u00e2y th\u1ea7n kinh c\u1ea3m gi\u00e1c SNAP (Sensory Nerve Action Potential). C\u00f3 th\u1ec3 k\u00edch th\u00edch v\u00e0 ghi \u0111\u01b0\u1ee3c s\u00f3ng \u0111\u00e1p \u1ee9ng c\u1ea3m gi\u00e1c tr\u00ean c\u00e1c d\u00e2y th\u1ea7n kinh thu\u1ea7n t\u00fay c\u1ea3m gi\u00e1c ho\u1eb7c c\u00e1c d\u00e2y th\u1ea7n kinh h\u1ed7n h\u1ee3p (bao g\u1ed3m c\u1ea3 c\u00e1c s\u1ee3i c\u1ea3m gi\u00e1c v\u00e0 c\u00e1c s\u1ee3i v\u1eadn \u0111\u1ed9ng).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">C\u00f3 hai ph\u01b0\u01a1ng ph\u00e1p \u0111o d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c: (1) ph\u01b0\u01a1ng ph\u00e1p thu\u1eadn chi\u1ec1u: k\u00edch th\u00edch \u0111i\u1ec7n v\u00e0o th\u1ee5 th\u1ec3 c\u1ea3m gi\u00e1c ngo\u00e0i da v\u00e0 ghi \u0111\u00e1p \u1ee9ng tr\u00ean th\u00e2n d\u00e2y th\u1ea7n kinh, xung \u0111\u1ed9ng s\u1ebd \u0111i xu\u00f4i chi\u1ec1u sinh l\u00fd c\u1ee7a d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c v\u00e0 (2) ph\u01b0\u01a1ng ph\u00e1p ng\u01b0\u1ee3c chi\u1ec1u: k\u00edch th\u00edch \u0111i\u1ec7n v\u00e0o th\u00e2n d\u00e2y th\u1ea7n kinh v\u00e0 ghi \u0111\u00e1p \u1ee9ng t\u1ea1i v\u00f9ng chi ph\u1ed1i c\u1ea3m gi\u00e1c da c\u1ee7a n\u1ecf, xung \u0111\u1ed9ng s\u1ebd \u0111i ng\u01b0\u1ee3c chi\u1ec1u sinh l\u00fd c\u1ee7a d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c. Kho\u1ea3ng c\u00e1ch gi\u1eefa \u0111i\u1ec7n c\u1ef1c ghi v\u00e0 \u0111i\u1ec7n c\u1ef1c k\u00edch th\u00edch l\u00e0 14 cm. Th\u00f4ng th\u01b0\u1eddng k\u1ef9 thu\u1eadt \u0111o ng\u01b0\u1ee3c chi\u1ec1u \u0111\u01b0\u1ee3c nhi\u1ec1u t\u00e1c gi\u1ea3 s\u1eed d\u1ee5ng h\u01a1n.<\/span><\/p>\n<figure id=\"attachment_2605\" aria-describedby=\"caption-attachment-2605\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-2605 size-medium\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/1-7-300x161.jpg\" alt=\"\u0110i\u1ec7n sinh l\u00fd th\u1ea7n kinh trong ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay\" width=\"300\" height=\"161\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/1-7-300x161.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/1-7.jpg 731w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-2605\" class=\"wp-caption-text\">\u0110i\u1ec7n sinh l\u00fd th\u1ea7n kinh trong ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay<\/figcaption><\/figure>\n<h2><b>2. C\u00e1ch \u0111\u1eb7t \u0111i\u1ec7n c\u1ef1c khi kh\u1ea3o s\u00e1t v\u1eadn \u0111\u1ed9ng d\u00e2y th\u1ea7n kinh gi\u1eefa:<\/b><\/h2>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u0110i\u1ec7n c\u1ef1c ghi \u0111\u1eb7t \u1edf \u00f4 m\u00f4 c\u00e1i, g\u1ea7n g\u1ed1c chi.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u0110i\u1ec7n c\u1ef1c \u0111\u1ed1i chi\u1ebfu \u0111\u1eb7t \u1edf \u00f4 I11\u00d4 c\u00e1i, xa g\u1ed1c chi.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u0110i\u1ec7n c\u1ef1c k\u00edch th\u00edch d\u00e2y th\u1ea7n kinh v\u1eadn \u0111\u1ed9ng \u1edf hai v\u1ecb tr\u00ed tr\u00ean \u0111\u01b0\u1eddng \u0111i c\u1ee7a d\u00e2y th\u1ea7n kinh: t\u1ea1i c\u00f4 tay k\u00edch th\u00edch t\u1ea1i v\u1ecb tr\u00ed \u0111i\u1ec7n c\u1ef1c ghi \u0111o l\u00ean 7cm, t\u1ea1i khu\u1ef7u tay tr\u00ean \u0111\u01b0\u1eddng \u0111i c\u1ee7a d\u00e2y th\u1ea7n kinh, c\u00e1ch v\u1ecb tr\u00ed k\u00edch th\u00edch t\u1ea1i c\u1ed5 tay 20 &#8211; 27 cm t\u00f9y theo chi\u1ec1u d\u00e0i tay c\u1ee7a b\u1ec7nh nh\u00e2n.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u0110\u1ec3 ghi \u0111\u01b0\u1ee3c s\u00f3ng \u0111\u00e1p \u1ee9ng v\u1eadn \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh, c\u01b0\u1eddng \u0111\u1ed9 k\u00edch th\u00edch \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cao h\u01a1n ng\u01b0\u1ee1ng c\u01b0\u1eddng \u0111\u1ed9 k\u00edch t\u1ed1i t\u1ed1i \u0111a 20 &#8211; 30% (15-30 \u00ecnA).<\/span><\/li>\n<\/ul>\n<h2><b>3. C\u00e1c ch\u1ec9 s\u1ed1 d\u1eabn truy\u1ec1n v\u1eadn \u0111\u1ed9ng:<\/b><\/h2>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Th\u1eddi gian ti\u1ec1m v\u1eadn \u0111\u1ed9ng (Distal Motor Latency &#8211; DML): L\u00e0 th\u1eddi gian t\u00ednh t\u1eeb khi k\u00edch th\u00edch \u0111i\u1ec7n v\u00e0o d\u00e2y th\u1ea7n kitili \u0111\u1ebfn khi b\u1eaft \u0111\u1ea7u xu\u1ea5t hi\u1ec7n kh\u1edfi \u0111i\u1ec3m c\u1ee7a \u0111i\u1ec7n th\u1ebf \u0111\u00e1p \u1ee9ng CMAP, \u0111\u01a1n v\u1ecb t\u00ednh l\u00e0 ms.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">T\u1ed1c \u0111\u1ed9 d\u1eabn truy\u1ec1n v\u1eadn \u0111\u1ed9ng (Motor Conduction Velocity &#8211; MCV ): Mu\u1ed1n \u0111o t\u1ed1c \u0111\u1ed9 d\u1eabn truy\u1ec1n v\u1eadn \u0111\u1ed9ng c\u1ee7a ri\u00eang d\u00e2y th\u1ea7n kinh, ta ph\u1ea3i k\u00edch th\u00edch t\u1ea1i hai \u0111i\u1ec3m kh\u00e1c nhau.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Bi\u00ean \u0111\u1ed9 d\u1eabn truy\u1ec1n v\u1eadn \u0111\u1ed9ng (Amplitude): Bi\u00ean \u0111\u1ed9 l\u00e0 \u0111\u1ed9 cao c\u1ee7a \u0111i\u1ec7n th\u1ebf (CMAP) theo tr\u1ee5c th\u1eb3ng \u0111\u1ee9ng, vu\u00f4ng g\u00f3c v\u1edbi \u0111\u01b0\u1eddng \u0111\u1eb3ng \u0111i\u1ec7n, \u0111\u01a1n v\u1ecb t\u00ednh b\u1eb1ng mV. C\u00f3 hai c\u00e1ch t\u00ednh bi\u00ean \u0111\u1ed9, m\u1ed9t l\u00e0 t\u00ednh t\u1eeb \u0111\u01b0\u1eddng \u0111\u00e1ng \u0111i\u1ec7n t\u1edbi \u0111\u1ec9nh \u00e2m (baseline to negative peak amplitude). \u0110\u1ec9nh cao nh\u1ea5t ph\u00eda tr\u00ean \u0111\u01b0\u1eddng \u0111\u1eb3ng \u0111i\u1ec7n, hai l\u00e0 t\u00ednh t\u1eeb \u0111\u1ec9nh \u00e2m t\u1edbi \u0111\u1ec9nh d\u01b0\u01a1ng (peak to peak amplitude). Tr\u00ean l\u00e2m s\u00e0ng th\u01b0\u1eddng d\u00f9ng c\u00e1ch t\u00ednh \u0111\u1ea7u ti\u00ean.<\/span><\/li>\n<\/ul>\n<h2><b>4. \u0110o d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Kh\u00e1c v\u1edbi c\u00e1c s\u1ee3i v\u1eadn \u0111\u1ed9ng, kh\u00f4ng c\u00f3 c\u00e1c kh\u1edbp th\u1ea7n kinh ng\u0103n c\u00e1ch gi\u1eefa c\u00e1c c\u01a1 quan th\u1ee5 c\u1ea3m v\u00e0 s\u1ee3i c\u1ea3m gi\u00e1c n\u00ean th\u1eddi gian ti\u1ec1m c\u1ea3m gi\u00e1c ch\u00ednh l\u00e0 th\u1eddi gian d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c c\u1ee7a ch\u00ednh d\u00e2y th\u1ea7n kinh \u0111\u00f3. Khi \u0111o t\u1ed1c \u0111\u1ed9 d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c ch\u1ec9 c\u1ea7n k\u00edch th\u00edch t\u1ea1i m\u1ed9t v\u1ecb tr\u00ed m\u00e0 kh\u00f4ng c\u1ea7n ph\u1ea3i k\u00edch th\u00edch hai v\u1ecb tr\u00ed, Bi\u00ean \u0111\u1ed9 \u0111\u01b0\u1ee3c t\u00ednh t\u1eeb \u0111i\u1ec3m th\u1ea5p nh\u1ea5t cho \u0111\u1ebfn \u0111i\u1ec3m cao nh\u1ea5t c\u1ee7a \u0111i\u1ec7n th\u1ebf c\u1ea3m gi\u00e1c.<\/span><\/p>\n<h3><b>4.1. C\u00e1ch \u0111\u1eb7t \u0111i\u1ec7n c\u1ef1c:<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">C\u00e1ch \u0111\u1eb7t \u0111i\u1ec7n c\u1ef1c khi kh\u1ea3o s\u00e1t d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c d\u00e2y th\u1ea7n kinh gi\u1eefa:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u0110i\u1ec7n c\u1ef1c ghi \u0111\u1eb7t \u1edf ng\u00f3n tay II, g\u1ea7n g\u1ed1c chi.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u0110i\u1ec7n c\u1ef1c \u0111\u1ed1i chi\u1ebfu \u0111\u1eb7t \u1edf ng\u00f3n tay II, xa g\u1ed1c chi.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u0110i\u1ec7n c\u1ef1c k\u00edch th\u00edch d\u00e2y th\u1ea7n kinh c\u1ea3m gi\u00e1c \u0111\u01b0\u1ee3c \u0111\u1eb7t tr\u00ean \u0111\u01b0\u1eddng \u0111i c\u1ee7a d\u00e2y th\u1ea7n kinh gi\u1eefa \u1edf c\u1ed5 tay (c\u00e1ch v\u1ecb tr\u00ed \u0111\u1eb7t \u0111i\u1ec7n c\u1ef1c ghi 14 cm).<\/span><\/li>\n<\/ul>\n<h3><b>4.2. C\u00e1c ch\u1ec9 s\u1ed1 d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c:<\/b><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Th\u1eddi gian ti\u1ec1m c\u1ea3m gi\u00e1c (Distal Sensory Latency &#8211; DSL) L\u00e0 th\u1eddi gian t\u00ednh t\u1eeb khi k\u00edch th\u00edch \u0111i\u1ec7n v\u00e0o d\u00e2y th\u1ea7n kinh \u0111\u1ebfn khi b\u1eaft \u0111\u1ea7u xu\u1ea5t hi\u1ec7n kh\u1edfi \u0111i\u1ec3m c\u1ee7a \u0111i\u1ec7n th\u1ebf \u0111\u00e1p \u1ee9ng SNAP, \u0111\u01a1n v\u1ecb t\u00ednh l\u00e0 ms.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">T\u1ed1c \u0111\u1ed9 d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c (Sensory Conduction Velocity &#8211; SCV): Kh\u00e1c v\u1edbi d\u00e2y th\u1ea7n kinh v\u1eadn \u0111\u1ed9ng, gi\u1eefa c\u00e1c th\u1ee5 th\u1ec3 c\u1ea3m gi\u00e1c v\u00e0 d\u00e2y th\u1ea7n kinh c\u1ea3m gi\u00e1c kh\u00f4ng c\u00f3 m\u1ed9t synap n\u00e0o ng\u0103n c\u00e1ch. Do v\u1eady, d\u00f9 k\u00edch th\u00edch thu\u1eadn chi\u1ec1u hay ng\u01b0\u1ee3c chi\u1ec1u, th\u1eddi gian ti\u1ec1m c\u1ea3m gi\u00e1c c\u00f9ng \u0111\u1ec1u ch\u1ec9 g\u1ed3m th\u1eddi gian d\u1eabn truy\u1ec1n tr\u00ean ch\u00ednh d\u00e2y th\u1ea7n kinh \u0111\u00f3, kh\u00f4ng m\u1ea5t th\u1eddi gian \u0111\u1ebf v\u01b0\u1ee3t qua synap v\u00e0 lan t\u1ecfa d\u1ecdc c\u01a1 quan th\u1ef1c hi\u1ec7n. V\u00ec v\u1eady, \u0111\u1ec3 \u0111o \u0111\u01b0\u1ee3c t\u1ed1c \u0111\u1ed9 d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c (SCV) ch\u00fang ta ch\u1ec9 c\u1ea7n k\u00edch th\u00edch \u0111i\u1ec7n t\u1ea1i m\u1ed9t v\u1ecb tr\u00ed, m\u00e0 kh\u00f4ng c\u1ea7n ph\u1ea3i k\u00edch th\u00edch hai v\u1ecb tr\u00ed nh\u01b0 trong nghi\u00ean c\u1ee9u MCV. Bi\u00ean \u0111\u1ed9 c\u1ea3m gi\u00e1c (SNAP): T\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u00e1ch t\u00ednh bi\u00ean \u0111\u1ed9 CMAP.<\/span><\/li>\n<\/ul>\n<figure id=\"attachment_2608\" aria-describedby=\"caption-attachment-2608\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-2608 size-medium\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/3-5-300x125.jpg\" alt=\"\u0110i\u1ec7n sinh l\u00fd: S\u01a1 \u0111\u1ed3 ghi \u0111i\u1ec7n th\u1ebf c\u1ea3m gi\u00e1c d\u00e2y th\u1ea7n kinh gi\u1eefa ng\u01b0\u1ee3c chi\u1ec1u\" width=\"300\" height=\"125\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/3-5-300x125.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/3-5.jpg 726w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-2608\" class=\"wp-caption-text\">\u0110i\u1ec7n sinh l\u00fd: S\u01a1 \u0111\u1ed3 ghi \u0111i\u1ec7n th\u1ebf c\u1ea3m gi\u00e1c d\u00e2y th\u1ea7n kinh gi\u1eefa ng\u01b0\u1ee3c chi\u1ec1u<\/figcaption><\/figure>\n<h3><b>4.3. C\u00e1c thay \u0111\u1ed5i b\u1ea5t th\u01b0\u1eddng v\u1ec1 \u0111i\u1ec7n sinh l\u00fd th\u1ea7n kinh gi\u1eefa trong h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay<\/b><\/h3>\n<h4><b>4.3.1. C\u00e1c thay \u0111\u1ed5i trong nh\u1eefng d\u1ea5u hi\u1ec7u nh\u1ea1y nh\u1ea5t v\u1ec1 h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay<\/b><\/h4>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Gi\u1ea3m t\u1ed1c \u0111\u1ed9 d\u1eabn truy\u1ec1n th\u1ea7n kinh c\u1ea3m gi\u00e1c c\u1ee7a d\u00e2y gi\u1eefa \u0111o\u1ea1n qua \u1ed1ng c\u1ed5 tay r\u1ea5t hay g\u1eb7p.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">K\u00e9o d\u00e0i th\u1eddi gian ti\u1ec1m t\u00e0ng ngo\u1ea1i bi\u00ean c\u1ee7a d\u00e2y th\u1ea7n kinh gi\u1eefa c\u1ea3m gi\u00e1c (DSL) c\u0169ng l\u00e0 bi\u1ec3u hi\u1ec7n r\u1ea5t th\u01b0\u1eddng g\u1eb7p trong h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay, ch\u1ec9 s\u1ed1 b\u1ea5t th\u01b0\u1eddng khi {DSL t\u0103ng &gt;3,5 ms).<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">B\u1ea5t th\u01b0\u1eddng v\u1ec1 hi\u1ec7u s\u1ed1 gi\u1eefa th\u1eddi gian ti\u1ec1m t\u00e0ng ngo\u1ea1i bi\u00ean c\u1ee7a d\u00e2y th\u1ea7n kinh gi\u1eefa c\u1ea3m gi\u00e1c v\u00e0 d\u00e2y th\u1ea7n kinh tr\u1ee5 c\u1ea3m gi\u00e1c (DSLD) l\u00e0 th\u00f4ng s\u1ed1 quan tr\u1ecdng trong th\u0103m d\u00f2 \u0111i\u1ec7n sinh l\u00fd v\u00ec trong h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay th\u00ec d\u00e2y th\u1ea7n kinh gi\u1eefa b\u1ecb t\u1ed5n th\u01b0\u01a1ng trong khi \u0111\u00f3 d\u00e2y th\u1ea7n kinh tr\u1ee5 v\u1eabn b\u00ecnh th\u01b0\u1eddng, ch\u1ec9 s\u1ed1 b\u1ea5t th\u01b0\u1eddng khi (DSLD t\u0103ng &gt; 0,79 ms).<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Gi\u1ea3m t\u1ed1c \u0111\u1ed9 d\u1eabn truy\u1ec1n th\u1ea7n kinh gi\u1eefa v\u1eadn \u0111\u1ed9ng: \u00edt g\u1eb7p h\u01a1n, ch\u1ec9 s\u1ed1 b\u1ea5t th\u01b0\u1eddng khi (MCV gi\u1ea3m &lt; 49).<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">K\u00e9o d\u00e0i th\u1eddi gian ti\u1ec1m t\u00e0ng ngo\u1ea1i bi\u00ean c\u1ee7a d\u00e2y th\u1ea7n kinh gi\u1eefa v\u1eadn \u0111\u1ed9ng (DML) c\u00f3 \u0111\u1ed9 nh\u1ea1y cao h\u01a1n t\u1ed1c \u0111\u1ed9 d\u1eabn truy\u1ec1n th\u1ea7n kinh v\u1eadn \u0111\u1ed9ng, ch\u1ec9 s\u1ed1 b\u1ea5t th\u01b0\u1eddng khi (DML t\u0103ng &gt;4,4 ms).<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">B\u1ea5t th\u01b0\u1eddng v\u1ec1 hi\u1ec7u s\u1ed1 gi\u1eefa th\u1eddi gian ti\u1ec1m t\u00e0ng ngo\u1ea1i bi\u00ean c\u1ee7a d\u00e2y th\u1ea7n kinh gi\u1eefa v\u1eadn \u0111\u1ed9ng v\u00e0 d\u00e2y th\u1ea7n kinh tr\u1ee5 v\u1eadn \u0111\u1ed9ng (DMLD) c\u0169ng g\u1eb7p nhi\u1ec1u h\u01a1n t\u1ef7 l\u1ec7 b\u1ea5t th\u01b0\u1eddng v\u1ec1 t\u1ed1c \u0111\u1ed9 truy\u1ec1n th\u1ea7n kinh v\u1eadn \u0111\u1ed9ng, ch\u1ec9 s\u1ed1 b\u1ea5t th\u01b0\u1eddng khi (DMLD tang 1,25 ms)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ph\u00e2n \u0111\u1ed9 h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay d\u1ef1a tr\u00ean hi\u1ec7u ti\u1ec1m v\u1eadn \u0111\u1ed9ng v\u00e0 c\u1ea3m gi\u00e1c th\u1ea7n kinh gi\u1eefa v\u1edbi th\u1ea7n kinh tr\u1ee5:<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<table>\n<tbody>\n<tr>\n<td colspan=\"2\"><span style=\"font-weight: 400;\">DMLD<\/span><\/td>\n<td><span style=\"font-weight: 400;\">DSLD<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">B\u00ecnh th\u01b0\u1eddng<\/span><\/td>\n<td><span style=\"font-weight: 400;\">&lt; 1,25<\/span><\/td>\n<td><span style=\"font-weight: 400;\">&lt;0,79<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">\u0110\u1ed9 1<\/span><\/td>\n<td><span style=\"font-weight: 400;\">1,25-2,35<\/span><\/td>\n<td><span style=\"font-weight: 400;\">0,79- 1,58<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">\u0110\u1ed9 2<\/span><\/td>\n<td><span style=\"font-weight: 400;\">2,35-4,13<\/span><\/td>\n<td><span style=\"font-weight: 400;\">1,58-2,66<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">\u0110\u1ed9 3<\/span><\/td>\n<td><span style=\"font-weight: 400;\">&gt;4,13<\/span><\/td>\n<td><span style=\"font-weight: 400;\">&gt;2,66<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">\u0110\u1ed9 4<\/span><\/td>\n<td><span style=\"font-weight: 400;\">M\u1ea5t \u0111\u00e1p \u1ee9ng<\/span><\/td>\n<td><span style=\"font-weight: 400;\">M\u1ea5t \u0111\u00e1p \u1ee9ng<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<h4><b>4.3.2. Ph\u00e2n \u0111\u1ed9 HCOCT tr\u00ean \u0111i\u1ec7n c\u01a1: \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng ph\u1ed5 bi\u1ebfn tr\u00ean l\u00e2m s\u00e0ng<\/b><\/h4>\n<p><span style=\"font-weight: 400;\">C\u00f3 nhi\u1ec1u lo\u1ea1i ph\u00e2n \u0111\u1ed9 HCOCT, trong \u0111\u00f3 ph\u00e2n \u0111\u1ed9 theo t\u00e1c gi\u1ea3 Padua c\u00f3 6 m\u1ee9c \u0111\u1ed9:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">R\u1ea5t n\u1eb7ng: Kh\u00f4ng ghi \u0111\u01b0\u1ee3c s\u00f3ng \u0111\u00e1p \u1ee9ng c\u1ea3m gi\u00e1c l\u1eabn v\u1eadn \u0111\u1ed9ng c\u1ee7a th\u1ea7n kinh gi\u1eefa.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">N\u1eb7ng: Kh\u00f4ng ghi \u0111\u01b0\u1ee3c s\u00f3ng \u0111\u00e1p \u1ee9ng c\u1ea3m gi\u00e1c nh\u01b0ng v\u1eabn c\u00f2n s\u00f3ng \u0111\u00e1p \u1ee9ng v\u1eadn \u0111\u1ed9ng, gi\u1ea3m d\u1eabn truy\u1ec1n v\u1eadn \u0111\u1ed9ng c\u1ee7a th\u1ea7n kinh gi\u1eefa \u0111o\u1ea1n qua \u1ed1ng c\u1ed5 tay.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Trung b\u00ecnh: Gi\u1ea3m d\u1eabn truy\u1ec1n c\u1ea3 v\u1ec1 c\u1ea3m gi\u00e1c l\u1eabn v\u1eadn \u0111\u1ed9ng c\u1ee7a th\u1ea7n kinh gi\u1eefa \u0111o\u1ea1n qua \u1ed1ng c\u1ed5 tay.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Nh\u1eb9: Gi\u1ea3m d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c th\u1ea7n kinh gi\u1eefa \u0111o\u1ea1n qua \u1ed1ng c\u1ed5 tay ho\u1eb7c t\u0103ng hi\u1ec7u th\u1eddi gian ti\u1ec1m c\u1ee7a th\u1ea7n kinh gi\u1eefa v\u00e0 th\u1ea7n kinh tr\u1ee5 c\u00f9ng b\u00ean. D\u1eabn truy\u1ec1n v\u1eadn \u0111\u1ed9ng b\u00ecnh th\u01b0\u1eddng.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">R\u1ea5t nh\u1eb9: T\u0103ng hi\u1ec7u th\u1eddi gian ti\u1ec1m c\u1ee7a th\u1ea7n kinh gi\u1eefa v\u1edbi th\u1ea7n kinh tr\u1ee5 khi ghi \u0111\u00e1p \u1ee9ng t\u1ea1i ng\u00f3n IV ho\u1eb7c th\u1ea7n kinh gi\u1eefa v\u1edbi th\u1ea7n kinh quay khi ghi \u0111\u00e1p \u1ee9ng t\u1ea1i ng\u00f3n I.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">B\u00ecnh th\u01b0\u1eddng: T\u1ea5t c\u1ea3 c\u00e1c ch\u1ec9 s\u1ed1 v\u1ec1 \u0111i\u1ec7n sinh l\u00fd th\u1ea7n kinh \u0111\u1ec1u trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">\u0110\u1ec3 \u0111\u1eb7t l\u1ecbch kh\u00e1m t\u1ea1i vi\u1ec7n, Qu\u00fd kh\u00e1ch vui l\u00f2ng b\u1ea5m s\u1ed1 <\/span><a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/dich-2019-ncov\/thong-tin-suc-khoe\/co-nen-tri-hoan-viec-tiem-chung-trong-dot-dich-covid-19\/\"><b>HOTLINE<\/b><\/a><span style=\"font-weight: 400;\"> ho\u1eb7c \u0111\u1eb7t l\u1ecbch tr\u1ef1c ti\u1ebfp <\/span><a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/dich-2019-ncov\/thong-tin-suc-khoe\/co-nen-tri-hoan-viec-tiem-chung-trong-dot-dich-covid-19\/\"><b>T\u1ea0I \u0110\u00c2Y<\/b><\/a><span style=\"font-weight: 400;\">. T\u1ea3i v\u00e0 \u0111\u1eb7t l\u1ecbch kh\u00e1m t\u1ef1 \u0111\u1ed9ng tr\u00ean <\/span><a href=\"https:\/\/www.vinmec.com\/myvinmec\/\"><span style=\"font-weight: 400;\">\u1ee9ng d\u1ee5ng MyVinmec<\/span><\/a><span style=\"font-weight: 400;\"> \u0111\u1ec3 qu\u1ea3n l\u00fd, theo d\u00f5i l\u1ecbch v\u00e0 \u0111\u1eb7t h\u1eb9n m\u1ecdi l\u00fac m\u1ecdi n\u01a1i ngay tr\u00ean \u1ee9ng d\u1ee5ng.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u0110i\u1ec7n sinh l\u00fd th\u1ea7n kinh (nerve conduction study) l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng c\u1ee7a c\u00e1c d\u00e2y th\u1ea7n kinh v\u00e0 c\u00e1c s\u1ee3i th\u1ea7n kinh. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y c\u0169ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay. H\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay l\u00e0 m\u1ed9t b\u1ec7nh [&hellip;]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[40],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>\u0110i\u1ec7n sinh l\u00fd th\u1ea7n kinh trong ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay<\/title>\n<meta name=\"description\" content=\"\u0110i\u1ec7n sinh l\u00fd \u0111o d\u1eabn truy\u1ec1n th\u1ea7n kinh l\u00e0 th\u0103m d\u00f2 nh\u1eb1m \u0111\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng d\u1eabn truy\u1ec1n c\u1ea3 v\u1ec1 c\u1ea3m gi\u00e1c l\u1eabn v\u1eadn \u0111\u1ed9ng \u1edf v\u00f9ng da v\u00e0 c\u01a1 m\u00e0 th\u1ea7n kinh ...\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta 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