{"id":26037,"date":"2023-04-21T14:07:43","date_gmt":"2023-04-21T07:07:43","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=26037"},"modified":"2023-04-21T18:02:16","modified_gmt":"2023-04-21T11:02:16","slug":"dieu-tri-bang-tu-truong-xuyen-so-tms-cho-benh-nhan-dot-quy-nao","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/dieu-tri-bang-tu-truong-xuyen-so-tms-cho-benh-nhan-dot-quy-nao\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb b\u1eb1ng t\u1eeb tr\u01b0\u1eddng xuy\u00ean s\u1ecd (TMS) cho b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 n\u00e3o"},"content":{"rendered":"

K\u00edch th\u00edch t\u1eeb tr\u01b0\u1eddng xuy\u00ean s\u1ecd (Transcranial Magnetic Stimulation – TMS) l\u00e0 k\u1ef9 thu\u1eadt s\u1eed d\u1ee5ng t\u00e1c d\u1ee5ng c\u1ee7a \u0111i\u1ec7n t\u1eeb xuy\u00ean qua x\u01b0\u01a1ng s\u1ecd, t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn c\u00e1c t\u1ebf b\u00e0o th\u1ea7n kinh \u1edf v\u1ecf n\u00e3o v\u1edbi m\u1ee5c \u0111\u00edch t\u0103ng c\u01b0\u1eddng ho\u1ea1t \u0111\u1ed9ng \u0111i\u1ec7n sinh l\u00fd c\u1ee7a t\u1ebf b\u00e0o th\u1ea7n kinh, t\u00e1i t\u1ea1o \u0111\u01b0\u1eddng li\u00ean h\u1ec7 gi\u1eefa c\u00e1c v\u00f9ng ch\u1ee9c n\u0103ng c\u1ee7a v\u1ecf n\u00e3o, c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3i \u1ee9c ch\u1ebf v\u00e0 ch\u1ed1ng tr\u1ea7m c\u1ea3m. \u0110\u00e2y l\u00e0 k\u00edch th\u00edch kh\u00f4ng x\u00e2m l\u1ea5n, kh\u00f4ng b\u1ecb tr\u1edf ng\u1ea1i b\u1edfi t\u1ed5 ch\u1ee9c m\u1ee1 hay x\u01b0\u01a1ng v\u00e0 kh\u00f4ng g\u00e2y kh\u00f3 ch\u1ecbu, \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn trong ch\u1ea9n \u0111o\u00e1n<\/a> v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n sau \u0111\u1ed9t qu\u1ef5 n\u00e3o.<\/strong><\/p>\n

\"\u0110i\u1ec1u
\u0110i\u1ec1u tr\u1ecb b\u1eb1ng t\u1eeb tr\u01b0\u1eddng xuy\u00ean s\u1ecd (TMS) c\u00f3 hi\u1ec7u qu\u1ea3 kh\u1ea3 quan v\u1edbi b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 n\u00e3o<\/figcaption><\/figure>\n

1. Ch\u1ec9 \u0111\u1ecbnh<\/b><\/h2>\n

–<\/span> \u00a0 <\/span>\u0110i\u1ec1u tr\u1ecb c\u00e1c r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n: tr\u1ea7m c\u1ea3m, lo \u00e2u, r\u1ed1i lo\u1ea1n li\u00ean quan stress\u2026<\/span><\/p>\n

–<\/span> \u00a0 <\/span>\u0110i\u1ec1u tr\u1ecb b\u1ec7nh c\u1ee7a h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng, nh\u01b0 sau \u0111\u1ed9t qu\u1ef5 n\u00e3o.<\/span><\/p>\n

–<\/span> \u00a0 <\/span>\u0110i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh v\u1ec1 m\u1ea1ch m\u00e1u.<\/span><\/p>\n

–<\/span> \u00a0 <\/span>\u0110i\u1ec1u tr\u1ecb c\u00e1c t\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng, c\u1ed9t s\u1ed1ng, c\u01a1, kh\u1edbp v\u00e0 c\u00e1c b\u1ec7nh l\u00fd ph\u1ee9c t\u1ea1p.<\/span><\/p>\n

–<\/span> \u00a0 <\/span>X\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed ch\u1ee9c n\u0103ng c\u1ee7a c\u00e1c trung t\u00e2m n o c\u00f3 nguy c\u01a1 b\u1ecb t\u1ed5n th\u01b0\u01a1ng.<\/span><\/p>\n

–<\/span> \u00a0 <\/span>\u0110i\u1ec1u tr\u1ecb gi\u1ea3m \u0111au trong b\u1ec7nh th\u1ea7n kinh ngo\u1ea1i vi.<\/span><\/p>\n

–<\/span> \u00a0 <\/span>K\u00edch th\u00edch th\u1ea7n kinh ph\u1ebf v\u1ecb.<\/span><\/p>\n

2. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/b><\/h2>\n

2.1.<\/b>\u00a0 <\/span>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh li\u00ean quan \u0111\u1ebfn t\u00e1c \u0111\u1ed9ng tr\u1ef1c ti\u1ebfp c\u1ee7a t\u1eeb tr\u01b0\u1eddng <\/b><\/h3>\n
    \n
  • C\u1ea5y gh\u00e9p n\u1ed9i s\u1ecd b\u1eb1ng kim lo\u1ea1i.<\/span><\/li>\n
  • Mang m\u00e1y t\u1ea1o nh\u1ecbp tim (theo l\u00fd thuy\u1ebft t\u1eeb tr\u01b0\u1eddng kh\u00f4ng t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn v\u00f9ng tr\u01b0\u1edbc tim).<\/span><\/li>\n
  • \u0110\u1eb7t m\u00e1y b\u01a1m thu\u1ed1c.<\/span><\/li>\n
  • \u0110\u1eb7t \u0111i\u1ec7n c\u1ef1c \u1ed1c tai.<\/span><\/li>\n
  • DBS (c\u1ea3m \u1ee9ng c\u1ee7a d\u00e2y c\u00e1p t\u00e1c \u0111\u1ed9ng l\u00ean n\u00e3o khi s\u1eed d\u1ee5ng t\u1ea7n s\u1ed1 v\u00e0 c\u01b0\u1eddng \u0111\u1ed9 l\u1edbn).<\/span><\/li>\n<\/ul>\n

    2.2.<\/b>\u00a0 <\/span>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh li\u00ean quan \u0111\u1ebfn t\u0103ng nguy c\u01a1 co gi\u1eadt <\/b><\/h3>\n
      \n
    • Nhi\u1ec5m \u0111\u1ed9c tuy\u1ebfn gi\u00e1p giai \u0111o\u1ea1n 3.<\/span><\/li>\n
    • T\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng<\/span><\/li>\n
    • Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 b\u1ec7nh \u1edf n\u00e3o b\u1ed9 (kh\u1ed1i u, ch\u1ea3y m\u00e1u n\u00e3o, thi\u1ebfu m\u00e1u n\u00e3o,, vi\u00eam n\u00e3o, vi\u00eam m\u00e0ng n\u00e3o. Ch\u00fa \u00fd \u0111\u1ebfn c\u01a1n \u0111\u1ed9ng kinh.<\/span><\/li>\n
    • Ti\u1ec1n s\u1eed ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o g\u00e2y m\u1ea5t \u00fd th\u1ee9c \u2265 15 gi\u00e2y.<\/span><\/li>\n
    • Ti\u1ec1n s\u1eed ph\u1eabu thu\u1eadt s\u1ecd n\u00e3o.<\/span><\/li>\n
    • Ti\u1ec1n s\u1eed c\u01a1n \u0111\u1ed9ng kinh ho\u1eb7c co gi\u1eadt.<\/span><\/li>\n
    • Ti\u1ec1n s\u1eed nghi\u1ec7n ch\u1ea5t ho\u1eb7c m\u1edbi cai nghi\u1ec7n.<\/span><\/li>\n
    • Gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi \u0111\u1ed9ng kinh.<\/span><\/li>\n
    • T\u00ecnh hu\u1ed1ng co gi\u1eadt c\u00f3 th\u1ec3 tr\u1edf l\u00ean nguy hi\u1ec3m khi \u0111\u1ed3ng th\u1eddi c\u00f3 b\u1ec7nh l\u00fd ti\u1ec1m t\u00e0ng (suy tim m\u1ea5t b\u00f9, t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd). T\u00ecnh tr\u1ea1ng h\u1ea1 huy\u1ebft \u00e1p c\u1ea5p.<\/span><\/li>\n
    • B\u1ec7nh m\u00e1u ph\u1ee9c t\u1ea1p.<\/span><\/li>\n
    • T\u1ea1ng d\u1ec5 ch\u1ea3y m\u00e1u.<\/span><\/li>\n
    • Vi\u00eam t\u1eafc m\u1ea1ch.<\/span><\/li>\n
    • X\u01b0\u01a1ng g\u00e3y ch\u01b0a c\u1ed1 \u0111\u1ecbnh.<\/span><\/li>\n
    • T\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng c\u1ea5p t\u00ednh.<\/span><\/li>\n
    • C\u00e1c kh\u1ed1i \u00e1p xe, \u1ed5 vi\u00eam c\u1ea5p.<\/span><\/li>\n
    • T\u00ecnh tr\u1ea1ng s\u1ed1t.<\/span><\/li>\n
    • Ph\u1ee5 n\u1eef mang thai (kh\u00f4ng k\u00edch th\u00edch t\u1ea1i v\u00f9ng \u0111\u1ea7u, c\u1ed5 v\u00e0 \u1ed5 b\u1ee5ng \u1edf ph\u1ee5 n\u1eef mang thai).<\/span><\/li>\n<\/ul>\n

      3. Chu\u1ea9n b\u1ecb<\/b><\/h2>\n

      3,1.<\/b>\u00a0 <\/span>Ng\u01b0\u1eddi th\u1ef1c hi\u1ec7n\u00a0<\/b><\/h3>\n

      – B\u00e1c s\u0129 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng.\u00a0 K\u1ef9 thu\u1eadt vi\u00ean v\u1eadt l\u00fd tr\u1ecb li\u1ec7u.<\/span><\/p>\n

      3.2.<\/b>\u00a0 <\/span>Ng\u01b0\u1eddi b\u1ec7nh\u00a0 <\/b><\/h3>\n

      S\u00e0ng l\u1ecdc l\u1ef1a ch\u1ecdn ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ea3m b\u1ea3o an to\u00e0n khi s\u1eed d\u1ee5ng k\u1ef9 thu\u1eadt TMS qua b\u1ea3ng c\u00e2u h\u1ecfi h\u01b0\u1edbng d\u1eabn t\u1ef1 \u0111\u00e1nh gi\u00e1 (Rossi, Hallett et al 2009) cho ng\u01b0\u1eddi b\u1ec7nh.<\/span><\/p>\n

      – K\u1ef9 thu\u1eadt vi\u00ean gi\u1ea3i th\u00edch h\u1ee3p l\u00fd v\u1ec1 c\u00e1ch ti\u1ebfn h\u00e0nh k\u1ef9 thu\u1eadt v\u00e0 t\u00ednh an to\u00e0n, \u00edch l\u1ee3i c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p.<\/span><\/p>\n

      –\u00a0 <\/span>Y\u00eau c\u1ea7u ng\u01b0\u1eddi b\u1ec7nh th\u00e1o b\u1ecf t\u1ea5t c\u1ea3 c\u00e1c \u0111\u1ed3 v\u1eadt b\u1eb1ng kim lo\u1ea1i ra kh\u1ecfi c\u01a1 th\u1ec3. Ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c ki\u1ec3m tra c\u00e1c th\u00f4ng s\u1ed1 sinh h\u1ecdc tr\u01b0\u1edbc v\u00e0 sau khi ti\u1ebfn h\u00e0nh k\u1ef9 thu\u1eadt (m\u1ea1ch, huy\u1ebft \u00e1p, nh\u1ecbp th\u1edf, th\u00e2n nhi\u1ec7t).<\/span><\/p>\n

      – Ng\u01b0\u1eddi b\u1ec7nh ng\u1ed3i tr\u00ean gh\u1ebf chuy\u00ean d\u1ee5ng, kh\u00f4ng ch\u1ea1m v\u00e0o t\u01b0\u1eddng, ch\u00e2n c\u00e1ch \u0111\u1ea5t, t\u01b0 th\u1ebf tho\u1ea3i m\u00e1i c\u00f3 th\u1ec3 n\u00f3i chuy\u1ec7n ho\u1eb7c \u0111\u1ecdc b\u00e1o l\u00fac \u0111i\u1ec1u tr\u1ecb.<\/span><\/p>\n

      3.3.<\/b>\u00a0 <\/span>Ph\u01b0\u01a1ng ti\u1ec7n\u00a0<\/b><\/h3>\n

      – M\u00e1y k\u00edch th\u00edch t\u1eeb c\u00f9ng c\u00e1c ph\u1ee5 ki\u1ec7n \u0111i k\u00e8m.<\/span><\/p>\n

      Ki\u1ec3m tra c\u00e1c th\u00f4ng s\u1ed1 c\u1ee7a m\u00e1y \u0111\u1ea3m b\u1ea3o m\u00e1y ho\u1ea1t \u0111\u1ed9ng t\u1ed1t, an to\u00e0n v\u1ec1 h\u1ec7 th\u1ed1ng \u0111i\u1ec7n, d\u00e2y d\u1eabn, nhi\u1ec7t c\u1ee7a cu\u1ed9n coil, d\u00e2y ti\u1ebfp \u0111\u1ea5t.<\/span><\/p>\n

      – <\/span>Chu\u1ea9n b\u1ecb gh\u1ebf \u0111\u1ec3 v\u1ecb tr\u00ed ph\u00f9 h\u1ee3p cho ng\u01b0\u1eddi b\u1ec7nh.<\/span><\/p>\n

      3.4.<\/b>\u00a0 <\/span>H\u1ed3 s\u01a1 b\u1ec7nh \u00e1n\u00a0 <\/b><\/h3>\n

      Phi\u1ebfu ch\u1ec9 \u0111\u1ecbnh c\u1ee7a b\u00e1c s\u0129 chuy\u00ean khoa ghi li\u1ec1u \u0111i\u1ec1u tr\u1ecb; (t\u1ea7n s\u1ed1 Hz, c\u01b0\u1eddng \u0111\u1ed9 % MT, lo\u1ea1i k\u00edch th\u00edch li\u00ean t\u1ee5c, hay chu\u1ed7i l\u1eb7p… v\u1ecb tr\u00ed k\u00edch th\u00edch, th\u1eddi gian k\u00edch th\u00edch trong m\u1ed9t bu\u1ed5i, th\u1eddi gian k\u00edch th\u00edch trong m\u1ed9t \u0111\u1ee3t…).<\/span><\/p>\n

      4. C\u00e1c b\u01b0\u1edbc ti\u1ebfn h\u00e0nh<\/b><\/h2>\n

      B\u01b0\u1edbc 1. X\u00e1c \u0111\u1ecbnh ng\u01b0\u1ee1ng v\u1eadn \u0111\u1ed9ng <\/b><\/p>\n

        \n
      • Ng\u01b0\u1eddi b\u1ec7nh ng\u1ed3i tr\u00ean gh\u1ebf<\/span><\/li>\n
      • Ng\u01b0\u1eddi b\u1ec7nh v\u00e0 nh\u00e2n vi\u00ean c\u00f3 th\u1ec3 n\u00fat tai.<\/span><\/li>\n
      • X\u00e1c \u0111\u1ecbnh v\u00f9ng v\u1ecf n\u00e3o v\u1eadn \u0111\u1ed9ng c\u00f3 \u0111\u00e1p \u1ee9ng t\u1edbi c\u01a1 d\u1ea1ng ng\u1eafn ng\u00f3n tay c\u00e1i (\u00b1 5cm t\u1eeb h\u01b0\u1edbng \u1ed1ng tai ngo\u00e0i).<\/span><\/li>\n
      • X\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed, t\u1ea7n s\u1ed1 k\u00edch th\u00edch ph\u00f9 h\u1ee3p cho c\u00e1ch \u0111i\u1ec1u tr\u1ecb.<\/span><\/li>\n
      • \u0110\u1ec3 m\u00e1y \u1edf ch\u1ebf \u0111\u1ed9 k\u00edch th\u00edch xung \u0111\u01a1n<\/span><\/li>\n
      • B\u1eaft \u0111\u1ea7u k\u00edch th\u00edch v\u1edbi t\u1ea7n s\u1ed1 trung b\u00ecnh (th\u01b0\u1eddng \u2248 60% c\u00f4ng su\u1ea5t t\u1ed1i \u0111a \u0111\u1ea7u ra c\u1ee7a thi\u1ebft b\u1ecb). Tr\u01b0\u1eddng h\u1ee3p c\u00f3 c\u1ea3m gi\u00e1c kh\u00f3 ch\u1ecbu ho\u1eb7c \u0111au v\u00f9ng da \u0111\u1ea7u k\u00edch th\u00edch th\u00ec c\u00f3 th\u1ec3 kh\u1edfi \u0111\u1ea7u v\u1edbi t\u1ea7n s\u1ed1 th\u1ea5p h\u01a1n (\u2248 30%);<\/span><\/li>\n
      • \u1ea4n n\u00fat start \u1edf cu\u1ed9n coil ho\u1eb7c \u1edf ph\u00eda tr\u01b0\u1edbc b\u1ea3ng \u0111i\u1ec1u khi\u1ec3n c\u1ee7a m\u00e1y.<\/span><\/li>\n
      • \u0110\u1eb7t cu\u1ed9n coil 45\u00ba theo h\u01b0\u1edbng m\u0169i t\u00ean song song v\u1edbi v\u00f9ng tr\u01b0\u1edbc tr\u00e1n tay c\u1ea7m xu\u00f4i xu\u1ed1ng ph\u00eda d\u01b0\u1edbi.<\/span><\/li>\n
      • Y\u00eau c\u1ea7u ng\u01b0\u1eddi b\u1ec7nh gi\u00e3n m\u1ec1m c\u01a1 tay (c\u00f3 th\u1ec3 l\u00e0 gi\u1ea3m s\u1ef1 c\u0103ng th\u1eb3ng b\u1eb1ng m\u1ed9t s\u1ed1 ho\u1ea1t \u0111\u1ed9ng kh\u00e1c, nh\u01b0 l\u00e0 c\u0103ng c\u01a1 tay kh\u00e1c).<\/span><\/li>\n
      • N\u1ebfu kh\u00f4ng quan s\u00e1t th\u1ea5y hi\u1ec7n t\u01b0\u1ee3ng co c\u01a1 (n\u1ea9y nh\u1eb9 ng\u00f3n tay ho\u1eb7c ng\u00f3n c\u00e1i), t\u0103ng d\u1ea7n c\u01b0\u1eddng \u0111\u1ed9 5% m\u1ed7i n\u1ea5c, t\u00ecm ki\u1ebfm v\u00f9ng xung quanh v\u1ecb tr\u00ed v\u1ecf n\u00e3o v\u1eadn \u0111\u1ed9ng \u00b1 2cm. \u1ede c\u01b0\u1eddng \u0111\u1ed9 ban \u0111\u1ea7u g\u00e2y co c\u01a1 d\u1ea1ng ng\u1eafn ng\u00f3n tay c\u00e1i c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng co v\u00e0 n\u1ea9y \u0111\u1ea7u ng\u00f3n tay c\u00e1i. X\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed nh\u1ea1y c\u1ea3m c\u1ee7a v\u00f9ng v\u1ecf n\u00e3o v\u1eadn \u0111\u1ed9ng (k\u00edch th\u00edch co c\u01a1 m\u1ee9c cao h\u01a1n). C\u00f3 v\u1ea5n \u0111\u1ec1 quan tr\u1ecdng c\u1ea7n bi\u1ebft r\u1eb1ng \u0111i\u1ec3m n\u00e0y kh\u00f4ng ph\u1ea3i lu\u00f4n lu\u00f4n \u0111\u01b0\u1ee3c \u0111\u00e1p \u1ee9ng.\u00a0<\/span><\/li>\n
      • Gi\u1ea3m d\u1ea7n c\u01b0\u1eddng \u0111\u1ed9 (5%) m\u1ed7i n\u1ea5c cho \u0111\u1ebfn khi kh\u00f4ng quan s\u00e1t th\u1ea5y c\u1eed \u0111\u1ed9ng c\u1ee7a ng\u00f3n tay ho\u1eb7c ng\u00f3n tay c\u00e1i.<\/span><\/li>\n
      • T\u0103ng d\u1ea7n c\u01b0\u1eddng \u0111\u1ed9 2% m\u1ed7i n\u1ea5c cho \u0111\u1ebfn khi nh\u00ecn th\u1ea5y ng\u00f3n tay ho\u1eb7c ng\u00f3n c\u00e1i v\u1eadn \u0111\u1ed9ng.<\/span><\/li>\n
      • Gi\u1ea3m m\u1ed7i n\u1ea5c 1% cho \u0111\u1ebfn khi t\u00ecm \u0111\u01b0\u1ee3c ng\u01b0\u1ee1ng v\u1eadn \u0111\u1ed9ng (th\u1ea5y 5 l\u1ea7n co c\u01a1 trong 10 k\u00edch th\u00edch).<\/span><\/li>\n<\/ul>\n

        B\u01b0\u1edbc 2. T\u00ecm v\u00f9ng DLPFC, thi\u1ebft l\u1eadp c\u00e1c th\u00f4ng s\u1ed1 cho m\u00e1y\u00a0<\/b><\/p>\n

          \n
        • Dorsolateral prefrontal cortex (DLPFC or DL-PFC) l\u00e0 v\u00f9ng n o tr\u00e1n tr\u01b0\u1edbc. T\u00ecm v\u00e0 \u0111\u00e1nh d\u1ea5u v\u00f9ng DLPFC (F3 \u1edf b\u00ean tr\u00e1i v\u00e0 F4 \u1edf b\u00ean ph\u1ea3i ho\u1eb7c c\u00e1ch 5 cm t\u1eeb \u0111i\u1ec3m x\u00e1c \u0111\u1ecbnh MT song song v\u1edbi m\u1eb7t ph\u1eb3ng d\u1ecdc h\u01b0\u1edbng v\u1ec1 ph\u00eda tr\u01b0\u1edbc).<\/span><\/li>\n
        • \u0110i\u1ec1u ch\u1ec9nh th\u00f4ng s\u1ed1 k\u00edch th\u00edch theo t\u1eebng ng\u01b0\u1eddi b\u1ec7nh ri\u00eang bi\u1ec7t v\u1ec1 t\u1ea7n s\u1ed1, th\u1eddi gian chu\u1ed7i, th\u1eddi gian ngh\u1ec9 gi\u1eefa c\u00e1c chu\u1ed7i, th\u1eddi gian c\u1ee7a phi\u00ean \u0111i\u1ec1u tr\u1ecb, \u1ea5n n\u00fat c\u1ed1 \u0111\u1ecbnh MT v\u00e0 \u0111\u1eb7t c\u01b0\u1eddng \u0111\u1ed9 k\u00edch th\u00edch (bi\u00ean \u0111\u1ed9 c\u00f4ng xu\u1ea5t m\u00e1y) trong % c\u1ee7a MT.<\/span><\/li>\n
        • \u0110\u1eb7t cu\u1ed9n coil 45\u00ba tr\u00ean v\u00f9ng DLPFC.<\/span><\/li>\n<\/ul>\n

          B\u01b0\u1edbc 3. B\u1eaft \u0111\u1ea7u phi\u00ean \u0111i\u1ec1u tr\u1ecb v\u00e0 theo d\u00f5i trong su\u1ed1t phi\u00ean \u0111i\u1ec1u tr\u1ecb<\/b><\/p>\n

            \n
          • Quan s\u00e1t \u0111\u00e1p \u1ee9ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh, th\u1eddi gian c\u00f2n l\u1ea1i t\u1edbi khi k\u1ebft th\u00fac phi\u00ean \u0111i\u1ec1u tr\u1ecb (khi s\u1eed d\u1ee5ng Neuro – MS\/D, th\u1eddi gian hi\u1ec3n th\u1ecb nh\u1ea5p nh\u00e1y tr\u00ean b\u1ea3ng \u0111i\u1ec1u khi\u1ec3n).<\/span><\/li>\n
          • Kh\u00f4ng \u0111\u1ec3 cu\u1ed9n coil qu\u00e1 n\u00f3ng (n\u1ebfu s\u1eed d\u1ee5ng cu\u1ed9n coil kh\u00f4ng c\u00f3 b\u1ed9 ph\u1eadn l\u00e0m m\u00e1t). Thi\u1ebft b\u1ecb Neuro – MS\/D s\u1ebd t\u1ef1 \u0111\u1ed9ng d\u1eebng khi cu\u1ed9n coil n\u00f3ng qu\u00e1, v\u00e0 th\u1eddi gian c\u00f2n l\u1ea1i s\u1ebd kh\u00f4ng \u0111\u01b0\u1ee3c t\u00ednh l\u00e0 th\u1eddi gian \u0111i\u1ec1u tr\u1ecb.<\/span><\/li>\n
          • N\u1ebfu cu\u1ed9n coil c\u00f3 s\u1eed d\u1ee5ng b\u1ed9 ph\u1eadn l\u00e0m m\u00e1t, th\u1ea5y n\u00f3 d\u1ec5 d\u00e0ng nhanh ch\u00f3ng (c\u00f3 th\u1ec3 thay trong th\u1eddi gian ngh\u1ec9 c\u1ee7a m\u00e1y).<\/span><\/li>\n
          • Kh\u00f4ng bao gi\u1edd thay \u0111\u1ed5i cu\u1ed9n coil khi m\u00e1y \u0111ang l\u00e0m vi\u1ec7c. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 g\u00e2y n\u1ed5 thi\u1ebft b\u1ecb.<\/span><\/li>\n
          • Quan s\u00e1t s\u1ef1 t\u1ea1o thu\u1eadn co c\u01a1 ho\u1eb7c \u1edf b\u00ean chi \u0111\u1ed1i di\u1ec7n ho\u1eb7c th\u1ea5y b\u1ea5t c\u1ee9 hi\u1ec7n t\u01b0\u1ee3ng b\u1ea5t th\u01b0\u1eddng n\u00e0o x\u1ea3y ra.<\/span><\/li>\n
          • V\u00e0o b\u1ea5t k\u1ef3 th\u1eddi gian n\u00e0o, n\u1ebfu c\u1ea7n thi\u1ebft d\u1eebng ngay phi\u00ean \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1ch \u1ea5n n\u00fat Start tr\u00ean cu\u1ed9n coil ho\u1eb7c tr\u00ean b\u1ea3ng \u0111i\u1ec1u khi\u1ec3n ph\u00eda tr\u01b0\u1edbc c\u1ee7a m\u00e1y.<\/span><\/li>\n<\/ul>\n

            B\u01b0\u1edbc 4. K\u1ebft th\u00fac<\/b><\/p>\n

            Ki\u1ec3m tra l\u1ea1i c\u00e1c ch\u1ec9 s\u1ed1 sinh t\u1ed3n c\u01a1 b\u1ea3n, h\u1eb9n th\u1eddi gian cho bu\u1ed5i \u0111i\u1ec1u tr\u1ecb ti\u1ebfp theo.<\/span><\/p>\n

            * Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb m\u1ed7i l\u1ea7n 10-15 ph\u00fat, m\u1ed7i tu\u1ea7n \u0111i\u1ec1u tr\u1ecb 2 l\u1ea7n, t\u1ed5ng li\u1ec1u kh\u00f4ng qu\u00e1 15 l\u1ea7n.<\/span><\/p>\n

            5. Theo d\u00f5i<\/b><\/h2>\n
              \n
            • Theo d\u00f5i ph\u1ea3n \u1ee9ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh, ch\u00fa \u00fd t\u00ecnh tr\u1ea1ng co gi\u1eadt.\u00a0<\/span><\/li>\n
            • Theo d\u00f5i t\u00ecnh tr\u1ea1ng ho\u1ea1t \u0111\u1ed9ng c\u1ee7a m\u00e1y.<\/span><\/li>\n
            • Theo d\u00f5i nhi\u1ec7t c\u1ee7a cu\u1ed9n coil khi k\u00edch th\u00edch.<\/span><\/li>\n<\/ul>\n

              6. Tai bi\u1ebfn<\/b><\/h2>\n

              – N\u1ebfu c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u co gi\u1eadt (rung ph\u1ea7n chi tr\u00ean, lo\u1ea1n ng\u00f4n ng\u1eef, l\u1eafp b\u1eafp..) n\u00f3 c\u00f3 th\u1ec3 l\u00e0 c\u01a1n c\u1ee5c b\u1ed9 ho\u1eb7c to\u00e0n th\u1ec3. C\u1ea7n ph\u1ea3i th\u1ef1c hi\u1ec7n:<\/span><\/p>\n

                \n
              • B\u1ea3o v\u1ec7 ph\u1ea7n \u0111\u1ea7u ng\u01b0\u1eddi b\u1ec7nh.<\/span><\/li>\n
              • Nghi\u00eang \u0111\u1ea7u sang m\u1ed9t b\u00ean tr\u00e1nh xa c\u00e1c v\u1eadt s\u1eafc nh\u1ecdn.<\/span><\/li>\n
              • Th\u00f4ng tho\u00e1ng \u0111\u01b0\u1eddng th\u1edf.<\/span><\/li>\n
              • Cung c\u1ea5p \u0111\u1ee7 oxy.<\/span><\/li>\n<\/ul>\n

                – N\u1ebfu c\u01a1n gi\u1eadt k\u00e9o d\u00e0i h\u01a1n 3 ph\u00fat (ch\u01b0a x\u1ea3y ra v\u1edbi k\u1ef9 thu\u1eadt TMS), b\u01b0\u1edbc ti\u1ebfp theo ph\u1ea3i th\u1ef1c hi\u1ec7n l\u00e0:<\/span><\/p>\n

                  \n
                • Ti\u1ebfp t\u1ee5c cung c\u1ea5p \u0111\u1ee7 oxy.<\/span><\/li>\n
                • Thi\u1ebft l\u1eadp \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch.<\/span><\/li>\n
                • D\u00f9ng thu\u1ed1c ch\u1ed1ng co gi\u1eadt (Midazolam 5-15mg \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch, ho\u1eb7c Diazepam 10 mg ti\u00eam t\u0129nh m\u1ea1ch).<\/span><\/li>\n
                • Y\u00eau c\u1ea7u tr\u1ee3 gi\u00fap th\u00eam.<\/span><\/li>\n<\/ul>\n

                  – <\/span>Sau c\u01a1n co gi\u1eadt b\u01b0\u1edbc ti\u1ebfp theo ph\u1ea3i l\u00e0m l\u00e0:<\/span><\/p>\n

                    \n
                  • \u0110\u00e1nh gi\u00e1 th\u1ea7n kinh.<\/span><\/li>\n
                  • L\u00e0m x\u00e9t nghi\u1ec7m c\u01a1 b\u1ea3n.<\/span><\/li>\n
                  • \u0110i\u1ec1u tra v\u1ec1 nghi\u1ec7n ch\u1ea5t.<\/span><\/li>\n
                  • Th\u0103m d\u00f2 ch\u1ee9c n\u0103ng (mRI,ho\u1eb7c CT scans).<\/span><\/li>\n
                  • \u0110i\u1ec7n n\u00e3o \u0111\u1ed3.<\/span><\/li>\n
                  • Th\u00f4ng b\u00e1o cho ng\u01b0\u1eddi b\u1ec7nh v\u1ec1 kh\u1ea3 n\u0103ng xu\u1ea5t hi\u1ec7n c\u01a1n co gi\u1eadt kh\u00f4ng t\u0103ng h\u01a1n.<\/span><\/li>\n<\/ul>\n

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

                    K\u00edch th\u00edch t\u1eeb tr\u01b0\u1eddng xuy\u00ean s\u1ecd (Transcranial Magnetic Stimulation – TMS) l\u00e0 k\u1ef9 thu\u1eadt s\u1eed d\u1ee5ng t\u00e1c d\u1ee5ng c\u1ee7a \u0111i\u1ec7n t\u1eeb xuy\u00ean qua x\u01b0\u01a1ng s\u1ecd, t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn c\u00e1c t\u1ebf b\u00e0o th\u1ea7n kinh \u1edf v\u1ecf n\u00e3o v\u1edbi m\u1ee5c \u0111\u00edch t\u0103ng c\u01b0\u1eddng ho\u1ea1t \u0111\u1ed9ng \u0111i\u1ec7n sinh l\u00fd c\u1ee7a t\u1ebf b\u00e0o th\u1ea7n kinh, t\u00e1i t\u1ea1o \u0111\u01b0\u1eddng li\u00ean […]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[10,33],"tags":[3],"yoast_head":"\n\u0110i\u1ec1u tr\u1ecb b\u1eb1ng t\u1eeb tr\u01b0\u1eddng xuy\u00ean s\u1ecd (TMS) cho b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 n\u00e3o<\/title>\n<meta name=\"description\" content=\"K\u00edch th\u00edch t\u1eeb 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