{"id":26239,"date":"2023-04-22T09:17:08","date_gmt":"2023-04-22T02:17:08","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=26239"},"modified":"2023-04-22T09:17:08","modified_gmt":"2023-04-22T02:17:08","slug":"trang-thai-dong-kinh-chan-doan-va-xu-tri-hoi-suc-tich-cuc","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/trang-thai-dong-kinh-chan-doan-va-xu-tri-hoi-suc-tich-cuc\/","title":{"rendered":"Tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh: ch\u1ea9n \u0111o\u00e1n v\u00e0 x\u1eed tr\u00ed h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c"},"content":{"rendered":"<p><strong>Tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh l\u00e0 tr\u1ea1ng th\u00e1i trong \u0111\u00f3 c\u00e1c c\u01a1n \u0111\u1ed9ng kinh xu\u1ea5t hi\u1ec7n li\u00ean ti\u1ebfp li\u1ec1n nhau m\u00e0 trong giai \u0111o\u1ea1n gi\u1eefa c\u00e1c c\u01a1n v\u1eabn t\u1ed3n t\u1ea1i c\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh v\u00e0\/ho\u1eb7c r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c;\u00a0 ho\u1eb7c m\u1ed9t c\u01a1n \u0111\u1ed9ng kinh k\u00e9o d\u00e0i qu\u00e1 l\u00e2u g\u00e2y n\u00ean m\u1ed9t b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng n\u1eb7ng n\u1ec1. Th\u1eddi gian m\u1ed9t ho\u1ea1t \u0111\u1ed9ng \u0111\u1ed9ng kinh t\u1eeb 30 ph\u00fat tr\u1edf l\u00ean v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c nhau do c\u00e1c qu\u00e1 tr\u00ecnh gi\u1ea3i ph\u1eabu, sinh l\u00fd b\u1ec7nh v\u00e0 nguy\u00ean nh\u00e2n r\u1ea5t \u0111a d\u1ea1ng.<\/strong><\/p>\n<h2><strong>1. \u0110\u1ecbnh ngh\u0129a l\u00e2m s\u00e0ng tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh.<\/strong><\/h2>\n<p>+ C\u01a1n co gi\u1eadt k\u00e9o d\u00e0i tr\u00ean 5 ph\u00fat, ho\u1eb7c<\/p>\n<p>+ C\u00f3 tr\u00ean ho\u1eb7c b\u1eb1ng 2 c\u01a1n co gi\u1eadt m\u00e0 gi\u1eefa c\u00e1c c\u01a1n kh\u00f4ng c\u00f3 s\u1ef1 ph\u1ee5c h\u1ed3i ho\u00e0n to\u00e0n \u00fd th\u1ee9c.<\/p>\n<h2><strong>2. Ch\u1ea9n \u0111o\u00e1n tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh.<\/strong><\/h2>\n<h3><strong>2.1. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh. <\/strong><\/h3>\n<p><strong><em>T\u00ecnh tr\u1ea1ng \u0111\u1ed9ng kinh to\u00e0n th\u1ec3 co gi\u1eadt \u2013 t\u0103ng tr\u01b0\u01a1ng l\u1ef1c (tonico \u2013 clonique) <\/em><\/strong><\/p>\n<ul>\n<li>C\u00e1c c\u01a1n \u0111\u1ed9ng kinh to\u00e0n th\u1ec3 n\u1ed1i ti\u1ebfp nhau, kh\u00f4ng ph\u1ee5c h\u1ed3i \u00fd th\u1ee9c gi\u1eefa c\u00e1c c\u01a1n.<\/li>\n<li>\u0110\u00f4i khi c\u01a1n \u0111\u1ed9ng kinh ch\u1ec9 bi\u1ec3u hi\u1ec7n k\u00edn \u0111\u00e1o tr\u00ean l\u00e2m s\u00e0ng b\u1eb1ng co gi\u1eadt nh\u1eb9 \u1edf m\u1eb7t.<\/li>\n<li>C\u00f3 th\u1ec3 ch\u1ec9 bi\u1ec3u hi\u1ec7n b\u1eb1ng h\u00f4n m\u00ea.<\/li>\n<\/ul>\n<p><strong><em>C\u01a1n v\u1eafng \u00fd th\u1ee9c k\u00e9o d\u00e0i ho\u1eb7c li\u00ean ti\u1ebfp<\/em><\/strong><\/p>\n<ul>\n<li>Th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n b\u1eb1ng t\u00ecnh tr\u1ea1ng l\u1eabn l\u1ed9n.<\/li>\n<li>C\u00f3 th\u1ec3 c\u00f3 co gi\u1eadt k\u00edn \u0111\u00e1o mi m\u1eaft.<\/li>\n<li>Nguy c\u01a1 di ch\u1ee9ng tr\u00ed tu\u1ec7 v\u0129nh vi\u1ec5n n\u1ebfu c\u01a1n k\u00e9o d\u00e0i.<\/li>\n<\/ul>\n<p><strong><em>T\u00ecnh tr\u1ea1ng \u0111\u1ed9ng kinh m\u1ed9t ph\u1ea7n<\/em><\/strong><\/p>\n<ul>\n<li>Nhi\u1ec1u h\u00ecnh th\u00e1i.<\/li>\n<li>C\u01a1n co gi\u1eadt n\u1ed1i ti\u1ebfp nhau v\u1edbi thi\u1ebfu s\u00f3t v\u1eadn \u0111\u1ed9ng gi\u1eefa c\u00e1c c\u01a1n:<\/li>\n<\/ul>\n<p>+ R\u1ed1i lo\u1ea1n l\u1eddi n\u00f3i k\u00e9o d\u00e0i.<\/p>\n<p>+ T\u00ecnh tr\u1ea1ng l\u1eabn l\u1ed9n.<\/p>\n<ul>\n<li>Nguy c\u01a1 c\u00f3 c\u00e1c t\u1ed5n th\u01b0\u01a1ng n\u00e3o kh\u00f4ng h\u1ed3i ph\u1ee5c.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3><strong>2.2. Tri\u1ec7u ch\u1ee9ng c\u1eadn l\u00e2m s\u00e0ng<\/strong><\/h3>\n<ul>\n<li>\u0110i\u1ec7n n\u00e3o \u0111\u1ed3: x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh v\u00e0 ph\u00e2n lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng tr\u00ean h\u1ec7 th\u1ed1ng th\u1ea7n kinh trung \u01b0\u01a1ng.<\/li>\n<li>C\u00e1c ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh v\u00e0 x\u00e9t nghi\u1ec7m kh\u00e1c: \u0111\u00e1nh gi\u00e1 nguy\u00ean nh\u00e2n v\u00e0 bi\u1ebfn ch\u1ee9ng c\u1ee7a tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh.<\/li>\n<\/ul>\n<h3><strong>2.3. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh <\/strong><\/h3>\n<ul>\n<li>L\u00e2m s\u00e0ng: co gi\u1eadt k\u00e9o d\u00e0i tr\u00ean 30 ph\u00fat ho\u1eb7c co gi\u1eadt k\u00e9o d\u00e0i tr\u00ean 5 ph\u00fat m\u00e0 kh\u00f4ng c\u00f3 h\u1ed3i ph\u1ee5c th\u1ea7n kinh gi\u1eefa c\u00e1c c\u01a1n<\/li>\n<li>C\u1eadn l\u00e2m s\u00e0ng: \u0110i\u1ec7n n\u00e3o x\u00e1c \u0111\u1ecbnh c\u00e1c s\u00f3ng \u0111\u1ed9ng kinh k\u00e9o d\u00e0i.<\/li>\n<\/ul>\n<h3><strong>2.4. Ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n <\/strong><\/h3>\n<p><strong><em>Ch\u1ecdc d\u1ecbch n\u00e3o t\u1ee7y<\/em><\/strong><strong>: <\/strong>Ph\u00e1t hi\u1ec7n c\u00e1c t\u00ecnh tr\u1ea1ng vi\u00eam m\u00e0ng n\u00e3o do vi khu\u1ea9n, virus, n\u1ea5m, lao, k\u00ed sinh tr\u00f9ng<strong>. <\/strong><\/p>\n<p><strong><em>Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb s\u1ecd n\u00e3o<\/em><\/strong><strong>: <\/strong>x\u00e1c \u0111\u1ecbnh huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch, t\u1ed5n th\u01b0\u01a1ng n\u00e3o do thi\u1ebfu oxy, do h\u1ea1 \u0111\u01b0\u1eddng m\u00e1u.<\/p>\n<p><strong><em>Ch\u1ee5p CT s\u1ecd n\u00e3o<\/em><\/strong><strong>: <\/strong>x\u00e1c \u0111\u1ecbnh t\u1ed5n th\u01b0\u01a1ng nh\u1ed3i m\u00e1u n\u00e3o, xu\u1ea5t huy\u1ebft n\u00e3o, xu\u1ea5t huy\u1ebft d\u01b0\u1edbi nh\u1ec7n, c\u00e1c ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o, c\u00e1c t\u1ed5n th\u01b0\u01a1ng u n\u00e3o.<\/p>\n<p><strong><em>\u0110i\u1ec7n n\u00e3o: <\/em><\/strong>R\u1ea5t c\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh m\u00e0 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng kh\u00f4ng r\u00f5 r\u00e0ng.<\/p>\n<p><strong><em>C\u00e1c x\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n <\/em><\/strong><\/p>\n<ul>\n<li>T\u00ecm amphetamin, r\u01b0\u1ee3u, thu\u1ed1c ng\u1ee7,\u2026x\u00e9t nghi\u1ec7m m\u00e1u v\u00e0\/ho\u1eb7c n\u01b0\u1edbc ti\u1ec3u.<\/li>\n<li>C\u00e1c r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i m\u00e1u: h\u1ea1 natri m\u00e1u, h\u1ea1 canxi m\u00e1u<strong>.<\/strong><\/li>\n<\/ul>\n<h2><strong>3. X\u1eed tr\u00ed tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh theo h\u01b0\u1edbng d\u1eabn c\u1ee7a B\u1ed9 Y t\u1ebf 2015.<\/strong><\/h2>\n<h3><strong>3.1. Nguy\u00ean t\u1eafc x\u1eed tr\u00ed <\/strong><\/h3>\n<p>\u0110\u1ea3m b\u1ea3o ch\u1ee9c n\u0103ng s\u1ed1ng c\u01a1 b\u1ea3n: h\u00f4 h\u1ea5p, huy\u1ebft \u0111\u1ed9ng, toan chuy\u1ec3n h\u00f3a, th\u00e2n nhi\u1ec7t, s\u01a1 c\u1ee9u c\u00e1c ch\u1ea5n th\u01b0\u01a1ng.<\/p>\n<p>C\u1eaft ngay c\u00e1c c\u01a1n co gi\u1eadt b\u1eb1ng m\u1ecdi thu\u1ed1c c\u00f3 s\u1eb5n, c\u00e0ng nhanh c\u00e0ng t\u1ed1t.<\/p>\n<h3><strong>3.2. C\u00e1c thu\u1ed1c c\u1eaft c\u01a1n co gi\u1eadt <\/strong><\/h3>\n<p>Benzodiazepines: thu\u1ed1c c\u1eaft c\u01a1n co gi\u1eadt \u0111\u1ea7u tay v\u00ec t\u00e1c d\u1ee5ng c\u1eaft c\u01a1n co gi\u1eadt nhanh<\/p>\n<p>&nbsp;<\/p>\n<table width=\"789\">\n<tbody>\n<tr>\n<td width=\"130\"><\/td>\n<td width=\"154\">Th\u1eddi gian t\u00e1c d\u1ee5ng sau ti\u00eam<\/td>\n<td width=\"142\">Th\u1eddi gian duy tr\u00ec t\u00e1c d\u1ee5ng<\/td>\n<td width=\"236\">\u01afu \u0111i\u1ec3m<\/td>\n<td width=\"127\">Nh\u01b0\u1ee3c \u0111i\u1ec3m<\/td>\n<\/tr>\n<tr>\n<td width=\"130\">Diazepam (Valium)<\/td>\n<td width=\"154\">10-20s<\/td>\n<td width=\"142\">&lt; 20 ph\u00fat<\/td>\n<td width=\"236\">\u1ed4n \u0111\u1ecbnh \u1edf nhi\u1ec7t \u0111\u1ed9 ph\u00f2ng<\/td>\n<td width=\"127\">Ph\u00e2n b\u1ed1 v\u00e0o m\u00f4 m\u1ee1<\/td>\n<\/tr>\n<tr>\n<td width=\"130\">Lorazepam (Temesta)<\/td>\n<td width=\"154\">2 ph\u00fat<\/td>\n<td width=\"142\">4-6h<\/td>\n<td width=\"236\"><\/td>\n<td width=\"127\"><\/td>\n<\/tr>\n<tr>\n<td width=\"130\">Midazolam<\/p>\n<p>(Hypnovel)<\/td>\n<td width=\"154\">&lt; 1 ph\u00fat<\/td>\n<td width=\"142\">Ng\u1eafn<\/td>\n<td width=\"236\">C\u00f3 th\u1ec3 truy\u1ec1n li\u00ean t\u1ee5c trong \u0111i\u1ec1u tr\u1ecb tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh tr\u01a1.<\/p>\n<p>\u00cdt \u1ea3nh h\u01b0\u1edfng tim m\u1ea1ch.<\/td>\n<td width=\"127\"><\/td>\n<\/tr>\n<tr>\n<td width=\"130\">Clonazepam<\/p>\n<p>(Rivotril)<\/td>\n<td width=\"154\">Nhanh<\/td>\n<td width=\"142\">2-4h<\/td>\n<td width=\"236\"><\/td>\n<td width=\"127\"><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<ul>\n<li>Phenytoin (ho\u1eb7c fosphenytoin)<strong> (<\/strong>Dyhydan, Dilantin<strong>) <\/strong><\/li>\n<\/ul>\n<p>+ Hi\u1ec7u qu\u1ea3 (60 -80%) \u0111\u1eb7c bi\u1ec7t v\u1edbi c\u01a1n \u0111\u1ed9ng kinh c\u1ee5c b\u1ed9 v\u00e0 d\u1ef1 ph\u00f2ng t\u00e1i ph\u00e1t c\u01a1n co gi\u1eadt trong th\u1eddi gian d\u00e0i<strong>. <\/strong><\/p>\n<p>+ Li\u1ec1u t\u1ed1i \u0111a: phenytoin \u0111\u1ebfn 50mg\/ph\u00fat, fosfenyltoin \u0111\u1ebfn 150mg\/ph\u00fat.<\/p>\n<p>+ T\u00e1c d\u1ee5ng ph\u1ee5: \u1ee9c ch\u1ebf tu\u1ea7n ho\u00e0n v\u00e0 c\u1ea7n ti\u00eam ch\u1eadm.<\/p>\n<p>+ Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh: b\u1ec7nh tim m\u1ea5t b\u00f9, r\u1ed1i lo\u1ea1n d\u1eabn truy\u1ec1n. Kh\u00f4ng n\u00ean d\u00f9ng \u1edf ng\u01b0\u1eddi gi\u00e0, b\u1ec7nh m\u1ea1ch v\u00e0nh.<\/p>\n<ul>\n<li>Barbiturat<strong>: <\/strong>T\u00e1c \u0111\u1ed9ng th\u00f4ng qua GABA receptor. Hai thu\u1ed1c trong nh\u00f3m n\u00e0y hay \u0111\u01b0\u1ee3c d\u00f9ng nh\u1ea5t l\u00e0 Phenobarbital &amp; Pentobarbital<strong>. <\/strong><\/li>\n<\/ul>\n<p>+ Phenobarbital: R\u1ea5t hi\u1ec7u qu\u1ea3, ti\u00eam t\u0129nh m\u1ea1ch t\u00e1c d\u1ee5ng sau 5 ph\u00fat v\u00e0 t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i. Nguy c\u01a1: \u1ee9c ch\u1ebf th\u1ea7n kinh (t\u0103ng l\u00ean khi ph\u1ed1i h\u1ee3p v\u1edbi benzodiazepam)<\/p>\n<p>+ Thiopental: T\u00e1c d\u1ee5ng nhanh, hi\u1ec7u qu\u1ea3; \u0111\u01b0\u1ee3c d\u00f9ng nhi\u1ec1u t\u1ea1i c\u00e1c khoa HSCC. Nguy c\u01a1: \u1ee9c ch\u1ebf th\u1ea7n kinh, ng\u1eebng th\u1edf, tru\u1ef5 m\u1ea1ch, t\u1ed5n th\u01b0\u01a1ng gan. Li\u1ec1u d\u00f9ng: t\u1ea5n c\u00f4ng 3-5mg\/kg sau \u0111\u00f3 50mg\/ph\u00fat, duy tr\u00ec 1-5mg\/kg\/gi\u1edd.<\/p>\n<p>&#8211; Propofol:<\/p>\n<p>+ Th\u01b0\u1eddng d\u00f9ng khi \u0111i\u1ec1u tr\u1ecb tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh tr\u01a1.<\/p>\n<p>+ T\u00e1c d\u1ee5ng nhanh, th\u1eddi gian t\u00e1c d\u1ee5ng ng\u1eafn. C\u00f3 th\u1ec3 g\u00e2y t\u1ee5t huy\u1ebft \u00e1p ho\u1eb7c \u1ee9c ch\u1ebf h\u00f4 h\u1ea5p, hi\u1ebfm g\u1eb7p nh\u01b0ng nguy hi\u1ec3m l\u00e0 h\u1ed9i ch\u1ee9ng bao g\u1ed3m nhi\u1ec5m toan chuy\u1ec3n h\u00f3a, ti\u00eau c\u01a1 v\u00e2n, suy th\u1eadn v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng tim.<\/p>\n<ul>\n<li>M\u1ed9t s\u1ed1 thu\u1ed1c kh\u00e1c:<\/li>\n<\/ul>\n<p>+ Valproate (depakine): \u00edt kinh nghi\u1ec7m d\u00f9ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch.<\/p>\n<p>+ MgSO<sub>4<\/sub>: ch\u1ee7 y\u1ebfu d\u00f9ng trong s\u1ea3n gi\u1eadt, li\u1ec1u 2-4g\/5 ph\u00fat t\u0129nh m\u1ea1ch sau \u0111\u00f3 truy\u1ec1n 1g\/gi\u1edd trong 24 gi\u1edd.<\/p>\n<p>+ Lidocain t\u0129nh m\u1ea1ch: \u00edt d\u00f9ng (hi\u1ec7u qu\u1ea3 tho\u00e1ng qua, t\u00e1c d\u1ee5ng ph\u1ee5 nhi\u1ec1u).<\/p>\n<p>+ Thu\u1ed1c gi\u00e3n c\u01a1: kh\u00f4ng ph\u1ea3i l\u00e0 thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh ch\u1ee7 y\u1ebfu d\u00f9ng \u0111\u1ec3 kh\u1ed1ng ch\u1ebf c\u00e1c h\u1eadu qu\u1ea3 c\u1ee7a c\u01a1n gi\u1eadt.<\/p>\n<h3><strong>3.3. C\u00e1c bi\u1ec7n ph\u00e1p h\u1ed3i s\u1ee9c chung <\/strong><\/h3>\n<p><strong><em>\u00a0\u0110\u1ea3m b\u1ea3o h\u00f4 h\u1ea5p <\/em><\/strong><\/p>\n<ul>\n<li>\u0110\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n (b\u1ea3o v\u1ec7 \u0111\u01b0\u1eddng th\u1edf, h\u00fat \u0111\u1eddm).<\/li>\n<li>Th\u1edf m\u00e1y ch\u1ebf \u0111\u1ed9 ki\u1ec3m so\u00e1t.th\u1ec3 t\u00edch n\u1ebfu h\u00f4n m\u00ea.<\/li>\n<li>Theo d\u00f5i SpO<sub>2<\/sub> ( &gt; 95% ) v\u00e0 kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch.<\/li>\n<\/ul>\n<p><strong><em>\u0110\u1ea3m b\u1ea3o huy\u1ebft \u0111\u1ed9ng<\/em><\/strong><\/p>\n<ul>\n<li>Theo d\u00f5i nh\u1ecbp tim v\u00e0 huy\u1ebft \u00e1p.<\/li>\n<li>N\u00ean \u0111\u1eb7t catheter t\u0129nh m\u1ea1ch trung t\u00e2m: \u0111\u1ea3m b\u1ea3o truy\u1ec1n d\u1ecbch, truy\u1ec1n thu\u1ed1c + \u0111o \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch trung t\u00e2m.<\/li>\n<li>N\u1ebfu t\u1ee5t huy\u1ebft \u00e1p: b\u1ed3i ph\u1ee5 th\u1ec3 t\u00edch, thu\u1ed1c v\u1eadn m\u1ea1ch, \u0111\u1ea3m b\u1ea3o th\u00f4ng kh\u00ed, \u0111i\u1ec1u ch\u1ec9nh r\u1ed1i lo\u1ea1n toan chuy\u1ec3n ho\u00e1 n\u1eb7ng.<\/li>\n<\/ul>\n<p><strong><em>\u00a0Toan chuy\u1ec3n ho\u00e1 <\/em><\/strong><\/p>\n<ul>\n<li>Theo d\u00f5i kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch.<\/li>\n<li>\u0110a s\u1ed1 toan chuy\u1ec3n ho\u00e1 s\u1ebd t\u1ef1 \u0111i\u1ec1u ch\u1ec9nh sau khi \u0111\u00e3 ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c co gi\u1eadt.<strong><em> &#8211;<\/em><\/strong> NaHCO<sub>3<\/sub> khi toan r\u1ea5t n\u1eb7ng pH &lt; 7,15.<\/li>\n<li>C\u00f3 th\u1ec3 k\u1ebft h\u1ee3p toan h\u00f4 h\u1ea5p, ch\u00fa \u00fd \u0111i\u1ec1u ch\u1ec9nh l\u1ea1i l\u01b0u l\u01b0\u1ee3ng th\u00f4ng kh\u00ed\/ph\u00fat.<\/li>\n<\/ul>\n<p><strong><em>T\u0103ng th\u00e2n nhi\u1ec7t <\/em><\/strong><\/p>\n<ul>\n<li>Th\u01b0\u1eddng g\u1eb7p do b\u1ea3n th\u00e2n co gi\u1eadt g\u00e2y ra, nguy c\u01a1 g\u00e2y n\u1eb7ng h\u01a1n t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh trung \u01b0\u01a1ng.<\/li>\n<li>C\u1ea7n nhanh ch\u00f3ng h\u1ea1 th\u00e2n nhi\u1ec7t &lt; 39<sup>0<\/sup>C: ch\u01b0\u1eddm l\u1ea1nh, tho\u00e1ng gi\u00f3, paracetamol 0,5g\/ m\u1ed7i 4 gi\u1edd.<\/li>\n<\/ul>\n<p><strong><em>Ph\u00f9 n\u00e3o <\/em><\/strong><\/p>\n<ul>\n<li>N\u1eb1m \u0111\u1ea7u cao 45 \u0111\u1ed9.<\/li>\n<li>Manitol truy\u1ec1n t\u0129nh m\u1ea1ch nhanh trong 30 ph\u00fat 0,5- 1 g\/kg c\u00e2n n\u1eb7ng m\u1ed7i 4 \u2013 6 gi\u1edd<\/li>\n<li>Methylprednisolon 40mg ti\u00eam t\u0129nh m\u1ea1ch \/6 -8 gi\u1edd. Ho\u1eb7c Dexamethasone trong vi\u00eam m\u00e0ng n\u00e3o.<\/li>\n<li>Kh\u1ed1ng ch\u1ebf c\u01a1n gi\u1eadt.<\/li>\n<\/ul>\n<p><strong><em>Ph\u00f2ng v\u00e0 \u0111i\u1ec1u tr\u1ecb ti\u00eau c\u01a1 v\u00e2n <\/em><\/strong><\/p>\n<p>Truy\u1ec1n d\u1ecbch v\u00e0 cho \u0111i ti\u1ec3u nhi\u1ec1u (100 ml\/gi\u1edd) v\u00e0 thu\u1ed1c l\u1ee3i ti\u1ec3u t\u0129nh m\u1ea1ch n\u1ebfu th\u1ea5y c\u1ea7n thi\u1ebft.<\/p>\n<p><strong><em>Ch\u00fa \u00fd s\u01a1 c\u1ee9u c\u00e1c ch\u1ea5n th\u01b0\u01a1ng k\u00e8m theo<\/em><\/strong>: ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o, ch\u1ea5n th\u01b0\u01a1ng h\u00e0m m\u1eb7t, g\u00e3y x\u01b0\u01a1ng\u2026<\/p>\n<p>Ngu\u1ed3n: H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 x\u1eed tr\u00ed h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c, B\u1ed9 Y t\u1ebf 2015.<\/p>\n<p><a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/chan-doan-va-dieu-tri-trang-thai-dong-kinh\/\">Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh<\/a><\/p>\n<div class=\"share\"><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh l\u00e0 tr\u1ea1ng th\u00e1i trong \u0111\u00f3 c\u00e1c c\u01a1n \u0111\u1ed9ng kinh xu\u1ea5t hi\u1ec7n li\u00ean ti\u1ebfp li\u1ec1n nhau m\u00e0 trong giai \u0111o\u1ea1n gi\u1eefa c\u00e1c c\u01a1n v\u1eabn t\u1ed3n t\u1ea1i c\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh v\u00e0\/ho\u1eb7c r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c;\u00a0 ho\u1eb7c m\u1ed9t c\u01a1n \u0111\u1ed9ng kinh k\u00e9o d\u00e0i qu\u00e1 l\u00e2u g\u00e2y n\u00ean m\u1ed9t b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng [&hellip;]<\/p>\n","protected":false},"author":69,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[23,10,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh: ch\u1ea9n \u0111o\u00e1n v\u00e0 x\u1eed tr\u00ed h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c - Vinmec<\/title>\n<meta name=\"description\" content=\"Tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh l\u00e0 m\u1ed9t th\u1ec3 \u0111\u1ed9ng kinh n\u1eb7ng, k\u00e9o d\u00e0i, c\u00f3 nhi\u1ec1u bi\u1ebfn ch\u1ee9ng. 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X\u1eed tr\u00ed theo BYT 2015 bao g\u1ed3m c\u1eaft c\u01a1n co gi\u1eadt v\u00e0 h\u1ed3i s\u1ee9c chung.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/trang-thai-dong-kinh-chan-doan-va-xu-tri-hoi-suc-tich-cuc\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-22T02:17:08+00:00\" \/>\n<meta name=\"author\" content=\"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/trang-thai-dong-kinh-chan-doan-va-xu-tri-hoi-suc-tich-cuc\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/trang-thai-dong-kinh-chan-doan-va-xu-tri-hoi-suc-tich-cuc\/\",\"name\":\"Tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh: ch\u1ea9n \u0111o\u00e1n v\u00e0 x\u1eed tr\u00ed h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c - Vinmec\",\"isPartOf\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-04-22T02:17:08+00:00\",\"dateModified\":\"2023-04-22T02:17:08+00:00\",\"author\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/b812b6273d037966dff4008e0eed896e\"},\"description\":\"Tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh l\u00e0 m\u1ed9t th\u1ec3 \u0111\u1ed9ng kinh n\u1eb7ng, k\u00e9o d\u00e0i, c\u00f3 nhi\u1ec1u bi\u1ebfn ch\u1ee9ng. 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