{"id":27211,"date":"2023-04-23T22:55:10","date_gmt":"2023-04-23T15:55:10","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=27211"},"modified":"2023-04-23T22:55:10","modified_gmt":"2023-04-23T15:55:10","slug":"con-nhuoc-co-nang-nguyen-nhan-trieu-chung-va-chan-doan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/con-nhuoc-co-nang-nguyen-nhan-trieu-chung-va-chan-doan\/","title":{"rendered":"C\u01a1n nh\u01b0\u1ee3c c\u01a1 n\u1eb7ng: Nguy\u00ean nh\u00e2n, tri\u1ec7u ch\u1ee9ng v\u00e0 ch\u1ea9n \u0111o\u00e1n"},"content":{"rendered":"

Nh\u01b0\u1ee3c c\u01a1 l\u00e0 do c\u01a1 th\u1ec3 ng\u01b0\u1eddi b\u1ec7nh sinh ra kh\u00e1ng th\u1ec3 ch\u1ed1ng l\u1ea1i th\u1ee5 th\u1ec3 acetylcholine \u1edf m\u00e0ng sau synap d\u1eabn \u0111\u1ebfn s\u1ef1 v\u1eadn \u0111\u1ed9ng c\u1ee7a c\u01a1 v\u00e2n y\u1ebfu d\u1ea7n, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u01a1 h\u00f4 h\u1ea5p d\u1eabn \u0111\u1ebfn suy h\u00f4 h\u1ea5p n\u1eb7ng c\u1ea7n ph\u1ea3i th\u1edf m\u00e1y, s\u1ef1 y\u1ebfu c\u01a1 c\u00f3 t\u00ednh ch\u1ea5t t\u00e1i ph\u00e1t n\u1ebfu kh\u00f4ng lo\u1ea1i b\u1ecf \u0111\u01b0\u1ee3c c\u0103n nguy\u00ean. C\u01a1n nh\u01b0\u1ee3c c\u01a1 n\u1eb7ng l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng m\u1ea5t kh\u1ea3 n\u0103ng ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u01a1 b\u1eafp, th\u01b0\u1eddng x\u1ea3y ra \u0111\u1ed9t ng\u1ed9t v\u00e0 k\u00e9o d\u00e0i trong m\u1ed9t kho\u1ea3ng th\u1eddi gian ng\u1eafn.\u00a0<\/span><\/strong><\/p>\n

\"\"
Nh\u01b0\u1ee3c c\u01a1 l\u00e0 do c\u01a1 th\u1ec3 ng\u01b0\u1eddi b\u1ec7nh sinh ra kh\u00e1ng th\u1ec3 ch\u1ed1ng l\u1ea1i th\u1ee5 th\u1ec3 acetylcholine<\/span><\/figcaption><\/figure>\n

1. Nguy\u00ean nh\u00e2n c\u1ee7a c\u01a1n nh\u01b0\u1ee3c c\u01a1 n\u1eb7ng<\/span><\/b><\/h2>\n

– Th\u01b0\u1eddng do u ho\u1eb7c ph\u00ec \u0111\u1ea1i tuy\u1ebfn \u1ee9c \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh.<\/span><\/p>\n

– Tuy\u1ebfn \u1ee9c c\u00f3 th\u1ec3 \u1edf sau x\u01b0\u01a1ng \u1ee9c ho\u1eb7c l\u1ea1c ch\u1ed7. M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng t\u00ecm th\u1ea5y u tuy\u1ebfn \u1ee9c.<\/span><\/p>\n

– C\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c nhi\u1ec1u khi kh\u00f4ng t\u00ecm th\u1ea5y.<\/span><\/p>\n

– T\u00ecnh tr\u1ea1ng nh\u01b0\u1ee3c c\u01a1 n\u1eb7ng l\u00ean th\u01b0\u1eddng l\u00e0 do:<\/span><\/p>\n

+ \u0110\u1ee3t nhi\u1ec5m khu\u1ea9n h\u00f4 h\u1ea5p.<\/span><\/p>\n

+ Sau ph\u1eabu thu\u1eadt.<\/span><\/p>\n

+ D\u00f9ng thu\u1ed1c kh\u00f4ng \u0111\u1ee7 li\u1ec1u, b\u1ecf thu\u1ed1c ho\u1eb7c qu\u00e1 li\u1ec1u thu\u1ed1c.<\/span><\/p>\n

+ M\u1ed9t s\u1ed1 thu\u1ed1c l\u00e0m t\u0103ng m\u1ee9c \u0111\u1ed9 y\u1ebfu c\u01a1 nh\u01b0: aminoglycosides<\/a>, erythromycin<\/a>, azithromycin, ch\u1eb9n beta, procainamide, quinidine, magnesium…<\/span><\/p>\n

2. Tri\u1ec7u ch\u1ee9ng c\u1ee7a <\/span><\/b>c\u01a1n nh\u01b0\u1ee3c c\u01a1 n\u1eb7ng<\/span><\/b><\/h2>\n

2.1. L\u00e2m s\u00e0ng<\/span><\/b><\/h3>\n

– Y\u1ebfu c\u01a1 m\u00ed m\u1eaft c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn s\u1ee5p mi, nh\u00ecn \u0111\u00f4i.<\/span><\/p>\n

– C\u01a1 h\u00e0m y\u1ebfu khi nhai l\u00e2u (m\u1ec7t khi nhai).<\/span><\/p>\n

– C\u01a1 h\u1ea7u h\u1ecdng y\u1ebfu t\u1ea1o ra n\u00f3i kh\u00f3, nu\u1ed1t kh\u00f3,nguy c\u01a1 g\u00e2y ra s\u1eb7c.<\/span><\/p>\n

– C\u01a1 n\u00e2ng v\u00e0 c\u01a1 g\u1eadp c\u1ed5 th\u01b0\u1eddng b\u1ecb \u1ea3nh h\u01b0\u1edfng, t\u1ea1o ra \u201ch\u1ed9i ch\u1ee9ng \u0111\u1ea7u g\u1ee5c xu\u1ed1ng\u201d.<\/span><\/p>\n

– Y\u1ebfu c\u00e1c c\u01a1 \u1edf chi, ch\u1ee7 y\u1ebfu l\u00e0 y\u1ebfu c\u00e1c g\u1ed1c chi.<\/span><\/p>\n

– Y\u1ebfu c\u00e1c c\u01a1 h\u00f4 h\u1ea5p l\u00e0 tri\u1ec7u ch\u1ee9ng n\u1eb7ng nh\u1ea5t trong nh\u01b0\u1ee3c c\u01a1 n\u1eb7ng. Y\u1ebfu c\u01a1 h\u00f4 h\u1ea5p d\u1eabn \u0111\u1ebfn suy h\u00f4 h\u1ea5p \u0111e d\u1ecda t\u00ednh m\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 c\u01a1n nh\u01b0\u1ee3c c\u01a1 n\u1eb7ng.<\/span><\/p>\n

2.2. C\u1eadn l\u00e2m s\u00e0ng<\/span><\/b><\/h3>\n

a) Th\u1eed nghi\u1ec7m t\u1ea1i gi\u01b0\u1eddng: neostigmin (prostigmin)<\/span><\/p>\n

– Ti\u00eam neostigmin t\u0129nh m\u1ea1ch ch\u1eadm: 1 mg + atropin 0,5 mg t\u0129nh m\u1ea1ch.<\/span><\/p>\n

– Sau ti\u00eam 5-10 ph\u00fat, th\u1ea5y c\u00e1c c\u01a1 b\u1ecb y\u1ebfu \u0111\u01b0\u1ee3c h\u1ed3i ph\u1ee5c nhanh ch\u00f3ng.<\/span><\/p>\n

b) C\u00e1c x\u00e9t nghi\u1ec7m huy\u1ebft thanh<\/span><\/p>\n

– Kh\u00e1ng th\u1ec3 kh\u00e1ng th\u1ee5 th\u1ec3 acetylcholin: d\u01b0\u01a1ng t\u00ednh kho\u1ea3ng 80 -100% ng\u01b0\u1eddi. N\u1ed3ng \u0111\u1ed9 kh\u00e1ng th\u1ec3 kh\u00f4ng t\u01b0\u01a1ng quan v\u1edbi m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh.<\/span><\/p>\n

– Ngo\u00e0i ra c\u00f2n kh\u00e1ng th\u1ec3 kh\u00e1ng c\u01a1 v\u00e2n: 30-80%,kh\u00e1ng th\u1ec3 kh\u00e1ng titin: 50-95%.<\/span><\/p>\n

c) Sinh l\u00fd \u0111i\u1ec7n c\u01a1<\/span><\/p>\n

– Nghi\u1ec7m ph\u00e1p k\u00edch th\u00edch th\u1ea7n kinh l\u1eb7p \u0111i l\u1eb7p l\u1ea1i: c\u00f3 s\u1ef1 gi\u1ea3m bi\u00ean b\u1ed9 d\u1ea7n trong 4 – 5 k\u00edch th\u00edch \u0111\u1ea7u ti\u00ean (suy gi\u1ea3m \u0111\u00e1p \u1ee9ng). K\u1ebft qu\u1ea3 (+) n\u1ebfu bi\u00ean \u0111\u1ed9 gi\u1ea3m tr\u00ean 10%.<\/span><\/p>\n

– \u0110i\u1ec7n c\u01a1 \u0111\u1ed3 c\u00e1c s\u1ee3i \u0111\u01a1n l\u1ebb: c\u00f3 \u0111\u1ed9 nh\u1eady cao, d\u01b0\u01a1ng t\u00ednh chi\u1ebfm tr\u00ean 95%.<\/span><\/p>\n

d) Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh.<\/span><\/p>\n

– Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh, ho\u1eb7c c\u1ed9ng h\u01b0\u1edfng t\u1eeb l\u1ed3ng ng\u1ef1c: x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c h\u00ecnh th\u00e1i c\u1ee7a tuy\u1ebfn \u1ee9c c\u0169ng nh\u01b0 m\u1ed1i t\u01b0\u01a1ng quan c\u1ee7a n\u00f3 v\u1edbi c\u00e1c c\u01a1 quan kh\u00e1c trong trung th\u1ea5t. Nh\u01b0ng \u0111\u00f4i khi c\u0169ng kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c.<\/span><\/p>\n

3. Ch\u1ea9n \u0111o\u00e1n <\/span><\/b>c\u01a1n nh\u01b0\u1ee3c c\u01a1 n\u1eb7ng<\/span><\/b><\/h2>\n

3.1. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/span><\/b><\/h3>\n

a) L\u00e2m s\u00e0ng<\/span><\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 y\u1ebfu c\u01a1 t\u1eebng l\u00fac, y\u1ebfu t\u0103ng l\u00ean khi v\u1eadn \u0111\u1ed9ng, h\u1ed3i ph\u1ee5c khi ngh\u1ec9.<\/span><\/p>\n

– Th\u01b0\u1eddng c\u00f3 s\u1ee5p mi, c\u00f3 th\u1ec3 c\u00f3 nh\u00ecn \u0111\u00f4i, nu\u1ed1t kh\u00f3, n\u00f3i kh\u00f3.<\/span><\/p>\n

– Y\u1ebfu c\u01a1 h\u00f4 h\u1ea5p: th\u1edf nhanh, n\u00f4ng, t\u00edm m\u00f4i v\u00e0 \u0111\u1ea7u chi.<\/span><\/p>\n

– L\u00e0m c\u00e1c nghi\u1ec7m ph\u00e1p g\u1eafng s\u1ee9c th\u1ea5y c\u01a1 y\u1ebfu \u0111i r\u00f5 r\u1ec7t. b) C\u1eadn l\u00e2m s\u00e0ng<\/span><\/p>\n

– Th\u1eed nghi\u1ec7m prostigmin: (+).<\/span><\/p>\n

– Nghi\u1ec7m ph\u00e1p k\u00edch th\u00edch th\u1ea7n kinh l\u1eb7p \u0111i l\u1eb7p l\u1ea1i: (+).<\/span><\/p>\n

– Kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch: gi\u1ea3m PaO2<\/sub>, t\u0103ng PaCO2<\/sub>\u00a0do gi\u1ea3m th\u00f4ng kh\u00ed ph\u1ebf nang.<\/span><\/p>\n

– Xquang ph\u1ed5i: c\u00f3 th\u1ec3 c\u00f3 h\u00ecnh \u1ea3nh vi\u00eam ph\u1ed5i do s\u1eb7c, ho\u1eb7c x\u1eb9p ph\u1ed5i.<\/span><\/p>\n

– C\u1eaft l\u1edbp vi t\u00ednh ho\u1eb7c c\u1ed9ng h\u01b0\u1edfng t\u1eeb l\u1ed3ng ng\u1ef1c: c\u00f3 th\u1ec3 t\u00ecm th\u1ea5y u tuy\u1ebfn \u1ee9c.<\/span><\/p>\n

c) C\u00e1c d\u1ea5u hi\u1ec7u n\u1eb7ng<\/span><\/p>\n

– Kh\u00f3 nu\u1ed1t, nu\u1ed1t s\u1eb7c.<\/span><\/p>\n

– Li\u1ec7t c\u01a1 h\u00f4 h\u1ea5p g\u00e2y suy h\u00f4 h\u1ea5p: th\u1edf nhanh ho\u1eb7c ch\u1eadm, n\u00f4ng. gi\u1ea3m SpO2<\/sub>, PaO2<\/sub>, t\u0103ng PaCO2<\/sub>.<\/span><\/p>\n

3.2. Ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n<\/span><\/b><\/h3>\n

– Do u ho\u1eb7c ph\u00ec \u0111\u1ea1i tuy\u1ebfn \u1ee9c \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh:<\/span><\/p>\n

+ Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh ho\u1eb7c c\u1ed9ng h\u01b0\u1edfng t\u1eeb \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh.<\/span><\/p>\n

+ \u0110\u1ed3ng v\u1ecb ph\u00f3ng x\u1ea1: khi nghi ng\u1edd tuy\u1ebfn \u1ee9c l\u1ea1c ch\u1ed7.<\/span><\/p>\n

– Nh\u01b0ng \u0111\u00f4i khi kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n.<\/span><\/p>\n

3.3. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/span><\/b><\/h3>\n

a) Nh\u01b0\u1ee3c c\u01a1 m\u1eaft<\/span><\/p>\n

– B\u1ec7nh l\u00fd m\u1eaft c\u1ee7a tuy\u1ebfn gi\u00e1p. H\u1ed9i ch\u1ee9ng Kearns-Sayre.<\/span><\/p>\n

– B\u1ec7nh l\u00fd th\u1ea7n kinh s\u1ecd v\u1eadn \u0111\u1ed9ng v\u00e0 t\u1ed5n th\u01b0\u01a1ng v\u00f9ng th\u00e2n n\u00e3o.<\/span><\/p>\n

b) Nh\u01b0\u1ee3c c\u01a1 to\u00e0n th\u00e2n<\/span><\/p>\n

– M\u1ec7t m\u1ecfi to\u00e0n th\u00e2n: c\u1ea3m gi\u00e1c m\u1ec7t m\u1ecfi qu\u00e1 m\u1ee9c, kh\u00f4ng ph\u1ea3i l\u00e0 bi\u1ec3u hi\u1ec7n duy nh\u1ea5t.<\/span><\/p>\n

– X\u01a1 c\u1ee9ng c\u1ed9t b\u00ean teo c\u01a1 (Amyotrophic lateral sclerosis-ALS): b\u1ec7nh ti\u1ebfn tri\u1ec3n gi\u1ed1ng nh\u01b0 nh\u01b0\u1ee3c c\u01a1. T\u0103ng ph\u1ea3n x\u1ea1 v\u00e0 d\u1ea5u hi\u1ec7u Babinski, teo c\u01a1 v\u00e0 co c\u1ee9ng c\u1ee5c b\u1ed9.<\/span><\/p>\n

– H\u1ed9i ch\u1ee9ng nh\u01b0\u1ee3c c\u01a1 Lambert-Eaton (LEMS): t\u1ed5n th\u01b0\u01a1ng kh\u1edbp n\u1ed1i th\u1ea7n kinh- c\u01a1 th\u01b0\u1eddng li\u00ean quan v\u1edbi b\u1ec7nh \u00e1c t\u00ednh. \u0110i\u1ec7n c\u01a1 c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng t\u0103ng bi\u00ean \u0111\u1ed9 ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u01a1 khi k\u00edch th\u00edch li\u00ean t\u1ee5c (\u0111\u00e1p \u1ee9ng gia t\u0103ng).<\/span><\/p>\n

– Ng\u1ed9 \u0111\u1ed9c botulism (ng\u1ed9 \u0111\u1ed9c th\u1ecbt): \u0103n th\u1ee9c \u0103n b\u1ecb nhi\u1ec5m Clostridium botulinum. C\u00f3 tri\u1ec7u ch\u1ee9ng \u1edf h\u00e0nh t\u1ee7y v\u00e0 c\u01a1 m\u1eaft. Kho\u1ea3ng 50% ng\u01b0\u1eddi b\u1ec7nh c\u00f3 gi\u00e3n \u0111\u1ed3ng t\u1eed. B\u1ec7nh ti\u1ebfn tri\u1ec3n nhanh. \u0110i\u1ec7n c\u01a1 c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng t\u0103ng bi\u00ean \u0111\u1ed9 ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u01a1 khi k\u00edch th\u00edch li\u00ean t\u1ee5c (\u0111\u00e1p \u1ee9ng gia t\u0103ng) t\u01b0\u01a1ng t\u1ef1 nh\u01b0 trong LEMS.<\/span><\/p>\n

– Nh\u01b0\u1ee3c c\u01a1 do penicillamine: penicillamine k\u00edch th\u00edch c\u01a1 th\u1ec3 t\u1ea1o ra kh\u00e1ng th\u1ec3 kh\u00e1ng th\u1ee5 th\u1ec3 acetylcholin. Th\u01b0\u1eddng h\u1ebft trong v\u00f2ng 3 – 12 th\u00e1ng sau ng\u1eebng thu\u1ed1c.<\/span><\/p>\n

– Vi\u00eam \u0111a r\u1ec5 v\u00e0 d\u00e2y th\u1ea7n kinh: li\u1ec7t c\u00f3 t\u00ednh ch\u1ea5t \u0111\u1ed1i x\u1ee9ng, k\u00e9m theo t\u00ea b\u00ec. Trong h\u1ed9i ch\u1ee9ng Guillain-Barre\u2019 D\u1ecbch n\u00e3o t\u1ee7y c\u00f3 protein t\u0103ng > 0,5 g\/l; t\u1ebf b\u00e0o < 10 t\u1ebf b\u00e0o\/mm3<\/sup>. \u0110i\u1ec7n c\u01a1 c\u00f3 t\u1ed5n th\u01b0\u01a1ng myelin ho\u1eb7c s\u1ee3i tr\u1ee5c ho\u1eb7c c\u1ea3 hai.<\/span><\/p>\n

– B\u1ea1i li\u1ec7t: li\u1ec7t kh\u00f4ng \u0111\u1ed1i x\u1ee9ng, kh\u00f4ng c\u00f3 r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c k\u00e8m theo.<\/span><\/p>\n

– R\u1eafn c\u1ea1p nia c\u1eafn: li\u1ec7t v\u1eadn \u0111\u1ed9ng, th\u01b0\u1eddng k\u00e8m theo \u0111\u1ed3ng t\u1eed gi\u00e3n.<\/span><\/p>\n

– H\u1ea1 kali m\u00e1u: khi n\u1ed3ng \u0111\u1ed9 Kali m\u00e1u gi\u1ea3m < 3 mEq\/l. Ho\u1eb7c li\u1ec7t c\u01a1 c\u00f3 t\u00ednh ch\u1ea5t chu k\u1ef3 (b\u1ec7nh Westphal), ho\u1eb7c c\u01b0\u1eddng gi\u00e1p…<\/span><\/p>\n

– \u0110\u00e1i ra porphyrin: x\u00e9t nghi\u1ec7m n\u01b0\u1edbc ti\u1ec3u c\u00f3 porphobilinogen.<\/span><\/p>\n

– Vi\u00eam t\u1ee7y lan l\u00ean: t\u1ed5n th\u01b0\u01a1ng t\u1ee7y ki\u1ec3u khoanh (m\u1ea5t v\u1eadn \u0111\u1ed9ng v\u00e0 c\u1ea3m gi\u00e1c).<\/span><\/p>\n

3.4. Ch\u1ea9n \u0111o\u00e1n m\u1ee9c \u0111\u1ed9:<\/span><\/b>\u00a0<\/span><\/h3>\n

Ch\u1ea9n \u0111o\u00e1n m\u1ee9c \u0111\u1ed9 c\u1ee7a Osserman v\u00e0 Genkin \u1edf ng\u01b0\u1eddi l\u1edbn<\/span><\/p>\n

a) Nh\u01b0\u1ee3c c\u00e1c c\u01a1 m\u1eaft \u0111\u01a1n thu\u1ea7n: ch\u1ec9 c\u00f3 c\u00e1c c\u01a1 nh\u00e3n c\u1ea7u b\u1ecb y\u1ebfu c\u01a1.<\/span><\/p>\n

b) Nh\u01b0\u1ee3c c\u01a1 to\u00e0n th\u00e2n m\u1ee9c \u0111\u1ed9 nh\u1eb9: ngo\u00e0i nh\u01b0\u1ee3c c\u01a1 m\u1eaft, d\u1ea7n d\u1ea7n c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0\u1ee3c c\u01a1 to\u00e0n th\u00e2n. Ch\u01b0a c\u00f3 tri\u1ec7u ch\u1ee9ng nh\u01b0\u1ee3c c\u01a1 h\u00f4 h\u1ea5p.<\/span><\/p>\n

c) Nh\u01b0\u1ee3c c\u01a1 to\u00e0n th\u00e2n m\u1ee9c \u0111\u1ed9 trung b\u00ecnh: nh\u01b0\u1ee3c c\u01a1 to\u00e0n th\u00e2n n\u1eb7ng h\u01a1n. C\u00f3 tri\u1ec7u ch\u1ee9ng h\u00e0nh c\u1ea7u n\u00e3o (kh\u00f3 nu\u1ed1t, nu\u1ed1t ngh\u1eb9n, n\u00f3i ng\u1ecdng\u2026). C\u00f3 th\u1ec3 c\u00f3 y\u1ebfu nh\u1eb9 c\u00e1c c\u01a1 h\u00f4 h\u1ea5p<\/span><\/p>\n

d) Nh\u01b0\u1ee3c c\u01a1 n\u1eb7ng c\u1ea5p t\u00ednh: C\u00f3 li\u1ec7t c\u01a1 h\u00f4 h\u1ea5p. Th\u01b0\u1eddng c\u00f3 u tuy\u1ebfn \u1ee9c. T\u1ec9 l\u1ec7 t\u1eed vong cao.<\/span><\/p>\n

e) Nh\u01b0\u1ee3c c\u01a1 n\u1eb7ng giai \u0111o\u1ea1n mu\u1ed9n: ti\u1ebfn tri\u1ec3n k\u00e9o d\u00e0i tr\u00ean 2 n\u0103m sau c\u00e1c nh\u01b0\u1ee3c c\u01a1 m\u1eaft ho\u1eb7c nh\u01b0\u1ee3c c\u01a1 to\u00e0n th\u00e2n. Th\u01b0\u1eddng k\u00e8m theo u tuy\u1ebfn \u1ee9c. \u0110\u00e1p \u1ee9ng r\u1ea5t k\u00e9m v\u1edbi \u0111i\u1ec1u tr\u1ecb.<\/span><\/p>\n

Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Nh\u01b0\u1ee3c c\u01a1 l\u00e0 do c\u01a1 th\u1ec3 ng\u01b0\u1eddi b\u1ec7nh sinh ra kh\u00e1ng th\u1ec3 ch\u1ed1ng l\u1ea1i th\u1ee5 th\u1ec3 acetylcholine \u1edf m\u00e0ng sau synap d\u1eabn \u0111\u1ebfn s\u1ef1 v\u1eadn \u0111\u1ed9ng c\u1ee7a c\u01a1 v\u00e2n y\u1ebfu d\u1ea7n, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u01a1 h\u00f4 h\u1ea5p d\u1eabn \u0111\u1ebfn suy h\u00f4 h\u1ea5p n\u1eb7ng c\u1ea7n ph\u1ea3i th\u1edf m\u00e1y, s\u1ef1 y\u1ebfu c\u01a1 c\u00f3 t\u00ednh ch\u1ea5t t\u00e1i ph\u00e1t […]<\/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":[],"yoast_head":"\nC\u01a1n nh\u01b0\u1ee3c c\u01a1 n\u1eb7ng: Nguy\u00ean nh\u00e2n, tri\u1ec7u ch\u1ee9ng v\u00e0 ch\u1ea9n \u0111o\u00e1n<\/title>\n<meta name=\"description\" content=\"Nh\u01b0\u1ee3c c\u01a1 l\u00e0 do c\u01a1 th\u1ec3 ng\u01b0\u1eddi b\u1ec7nh sinh ra kh\u00e1ng th\u1ec3 ch\u1ed1ng l\u1ea1i th\u1ee5 th\u1ec3 acetylcholine \u1edf m\u00e0ng sau synap d\u1eabn \u0111\u1ebfn s\u1ef1 v\u1eadn \u0111\u1ed9ng c\u1ee7a c\u01a1 v\u00e2n y\u1ebfu ...\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"C\u01a1n nh\u01b0\u1ee3c c\u01a1 n\u1eb7ng: Nguy\u00ean nh\u00e2n, tri\u1ec7u ch\u1ee9ng v\u00e0 ch\u1ea9n \u0111o\u00e1n\" \/>\n<meta property=\"og:description\" content=\"Nh\u01b0\u1ee3c c\u01a1 l\u00e0 do c\u01a1 th\u1ec3 ng\u01b0\u1eddi b\u1ec7nh sinh ra kh\u00e1ng th\u1ec3 ch\u1ed1ng l\u1ea1i th\u1ee5 th\u1ec3 acetylcholine \u1edf m\u00e0ng sau synap d\u1eabn \u0111\u1ebfn s\u1ef1 v\u1eadn \u0111\u1ed9ng c\u1ee7a c\u01a1 v\u00e2n y\u1ebfu ...\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/con-nhuoc-co-nang-nguyen-nhan-trieu-chung-va-chan-doan\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-23T15:55:10+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/istockphoto-1412729946-612x612-1-300x238.jpg\" \/>\n<meta name=\"author\" content=\"mitkaka mitkaka\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"mitkaka mitkaka\" \/>\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\/23\/con-nhuoc-co-nang-nguyen-nhan-trieu-chung-va-chan-doan\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/con-nhuoc-co-nang-nguyen-nhan-trieu-chung-va-chan-doan\/\",\"name\":\"C\u01a1n nh\u01b0\u1ee3c c\u01a1 n\u1eb7ng: Nguy\u00ean nh\u00e2n, tri\u1ec7u ch\u1ee9ng v\u00e0 ch\u1ea9n \u0111o\u00e1n\",\"isPartOf\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-04-23T15:55:10+00:00\",\"dateModified\":\"2023-04-23T15:55:10+00:00\",\"author\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/afa83c897f17e0b5f69265f912e0572c\"},\"description\":\"Nh\u01b0\u1ee3c c\u01a1 l\u00e0 do c\u01a1 th\u1ec3 ng\u01b0\u1eddi b\u1ec7nh sinh ra kh\u00e1ng th\u1ec3 ch\u1ed1ng l\u1ea1i th\u1ee5 th\u1ec3 acetylcholine \u1edf m\u00e0ng sau synap d\u1eabn \u0111\u1ebfn s\u1ef1 v\u1eadn \u0111\u1ed9ng c\u1ee7a c\u01a1 v\u00e2n y\u1ebfu ...\",\"breadcrumb\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/con-nhuoc-co-nang-nguyen-nhan-trieu-chung-va-chan-doan\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/con-nhuoc-co-nang-nguyen-nhan-trieu-chung-va-chan-doan\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/con-nhuoc-co-nang-nguyen-nhan-trieu-chung-va-chan-doan\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"http:\/\/noithathoaphat.in\/ctv\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"C\u01a1n nh\u01b0\u1ee3c c\u01a1 n\u1eb7ng: Nguy\u00ean nh\u00e2n, tri\u1ec7u ch\u1ee9ng v\u00e0 ch\u1ea9n \u0111o\u00e1n\"}]},{\"@type\":\"WebSite\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/\",\"name\":\"Vinmec\",\"description\":\"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"http:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/afa83c897f17e0b5f69265f912e0572c\",\"name\":\"mitkaka mitkaka\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/\",\"url\":\"http:\/\/0.gravatar.com\/avatar\/f102cd9b17e5dabdddda292eb3a7dd3d?s=96&d=mm&r=g\",\"contentUrl\":\"http:\/\/0.gravatar.com\/avatar\/f102cd9b17e5dabdddda292eb3a7dd3d?s=96&d=mm&r=g\",\"caption\":\"mitkaka mitkaka\"},\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/mitkaka2009mitkaka2009gmail-com\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"C\u01a1n nh\u01b0\u1ee3c c\u01a1 n\u1eb7ng: Nguy\u00ean nh\u00e2n, tri\u1ec7u ch\u1ee9ng v\u00e0 ch\u1ea9n \u0111o\u00e1n","description":"Nh\u01b0\u1ee3c c\u01a1 l\u00e0 do c\u01a1 th\u1ec3 ng\u01b0\u1eddi b\u1ec7nh sinh ra kh\u00e1ng th\u1ec3 ch\u1ed1ng l\u1ea1i th\u1ee5 th\u1ec3 acetylcholine \u1edf m\u00e0ng sau synap d\u1eabn \u0111\u1ebfn s\u1ef1 v\u1eadn \u0111\u1ed9ng c\u1ee7a c\u01a1 v\u00e2n y\u1ebfu ...","robots":{"index":"noindex","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"og_locale":"en_US","og_type":"article","og_title":"C\u01a1n nh\u01b0\u1ee3c c\u01a1 n\u1eb7ng: Nguy\u00ean nh\u00e2n, tri\u1ec7u ch\u1ee9ng v\u00e0 ch\u1ea9n \u0111o\u00e1n","og_description":"Nh\u01b0\u1ee3c c\u01a1 l\u00e0 do c\u01a1 th\u1ec3 ng\u01b0\u1eddi b\u1ec7nh sinh ra kh\u00e1ng th\u1ec3 ch\u1ed1ng l\u1ea1i th\u1ee5 th\u1ec3 acetylcholine \u1edf m\u00e0ng sau synap d\u1eabn \u0111\u1ebfn s\u1ef1 v\u1eadn \u0111\u1ed9ng c\u1ee7a c\u01a1 v\u00e2n y\u1ebfu ...","og_url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/con-nhuoc-co-nang-nguyen-nhan-trieu-chung-va-chan-doan\/","og_site_name":"Vinmec","article_published_time":"2023-04-23T15:55:10+00:00","og_image":[{"url":"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/istockphoto-1412729946-612x612-1-300x238.jpg"}],"author":"mitkaka mitkaka","twitter_card":"summary_large_image","twitter_misc":{"Written by":"mitkaka mitkaka","Est. reading time":"6 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/con-nhuoc-co-nang-nguyen-nhan-trieu-chung-va-chan-doan\/","url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/con-nhuoc-co-nang-nguyen-nhan-trieu-chung-va-chan-doan\/","name":"C\u01a1n nh\u01b0\u1ee3c c\u01a1 n\u1eb7ng: Nguy\u00ean nh\u00e2n, tri\u1ec7u ch\u1ee9ng v\u00e0 ch\u1ea9n \u0111o\u00e1n","isPartOf":{"@id":"http:\/\/noithathoaphat.in\/ctv\/#website"},"datePublished":"2023-04-23T15:55:10+00:00","dateModified":"2023-04-23T15:55:10+00:00","author":{"@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/afa83c897f17e0b5f69265f912e0572c"},"description":"Nh\u01b0\u1ee3c c\u01a1 l\u00e0 do c\u01a1 th\u1ec3 ng\u01b0\u1eddi b\u1ec7nh sinh ra kh\u00e1ng th\u1ec3 ch\u1ed1ng l\u1ea1i th\u1ee5 th\u1ec3 acetylcholine \u1edf m\u00e0ng sau synap d\u1eabn \u0111\u1ebfn s\u1ef1 v\u1eadn \u0111\u1ed9ng c\u1ee7a c\u01a1 v\u00e2n y\u1ebfu ...","breadcrumb":{"@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/con-nhuoc-co-nang-nguyen-nhan-trieu-chung-va-chan-doan\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/con-nhuoc-co-nang-nguyen-nhan-trieu-chung-va-chan-doan\/"]}]},{"@type":"BreadcrumbList","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/con-nhuoc-co-nang-nguyen-nhan-trieu-chung-va-chan-doan\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"http:\/\/noithathoaphat.in\/ctv\/"},{"@type":"ListItem","position":2,"name":"C\u01a1n nh\u01b0\u1ee3c c\u01a1 n\u1eb7ng: Nguy\u00ean nh\u00e2n, tri\u1ec7u ch\u1ee9ng v\u00e0 ch\u1ea9n \u0111o\u00e1n"}]},{"@type":"WebSite","@id":"http:\/\/noithathoaphat.in\/ctv\/#website","url":"http:\/\/noithathoaphat.in\/ctv\/","name":"Vinmec","description":"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"http:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/afa83c897f17e0b5f69265f912e0572c","name":"mitkaka mitkaka","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/","url":"http:\/\/0.gravatar.com\/avatar\/f102cd9b17e5dabdddda292eb3a7dd3d?s=96&d=mm&r=g","contentUrl":"http:\/\/0.gravatar.com\/avatar\/f102cd9b17e5dabdddda292eb3a7dd3d?s=96&d=mm&r=g","caption":"mitkaka mitkaka"},"url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/mitkaka2009mitkaka2009gmail-com\/"}]}},"_links":{"self":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/27211"}],"collection":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/comments?post=27211"}],"version-history":[{"count":4,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/27211\/revisions"}],"predecessor-version":[{"id":27352,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/27211\/revisions\/27352"}],"wp:attachment":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/media?parent=27211"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/categories?post=27211"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/tags?post=27211"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}