{"id":27218,"date":"2023-04-23T22:55:38","date_gmt":"2023-04-23T15:55:38","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=27218"},"modified":"2023-04-23T22:55:38","modified_gmt":"2023-04-23T15:55:38","slug":"hoi-chung-guillain-barre-xu-tri-tien-luong-va-bien-chung","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/hoi-chung-guillain-barre-xu-tri-tien-luong-va-bien-chung\/","title":{"rendered":"H\u1ed9i ch\u1ee9ng Guillain-Barre: X\u1eed tr\u00ed, ti\u00ean l\u01b0\u1ee3ng v\u00e0 bi\u1ebfn ch\u1ee9ng"},"content":{"rendered":"

H\u1ed9i ch\u1ee9ng Guillain-Barre (GBS)<\/a> l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd t\u1ea5n c\u00f4ng h\u1ec7 th\u1ea7n kinh v\u1eadn \u0111\u1ed9ng v\u00e0 c\u1ea3m gi\u00e1c. B\u1ec7nh n\u00e0y th\u01b0\u1eddng b\u1eaft \u0111\u1ea7u b\u1eb1ng nh\u1eefng tri\u1ec7u ch\u1ee9ng nh\u01b0 c\u1ea3m gi\u00e1c t\u00ea, kh\u00f3 kh\u0103n trong vi\u1ec7c di chuy\u1ec3n, v\u00e0 \u0111au nh\u1ee9c c\u01a1 b\u1eafp. Sau \u0111\u00f3, b\u1ec7nh ti\u1ebfn tri\u1ec3n v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra t\u00ea li\u1ec7t v\u00e0 kh\u00f3 th\u1edf. GBS l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd hi\u1ebfm g\u1eb7p nh\u01b0ng r\u1ea5t nguy hi\u1ec3m \u0111\u1ebfn t\u00ednh m\u1ea1ng. Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb GBS th\u01b0\u1eddng bao g\u1ed3m s\u1ef1 h\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p v\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c \u0111\u1ec3 gi\u1ea3m tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh.<\/strong><\/p>\n

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H\u1ed9i ch\u1ee9ng Guillain-Barre<\/figcaption><\/figure>\n

1. X\u1eed tr\u00ed h\u1ed9i ch\u1ee9ng Guillain-Barre<\/strong><\/span><\/b><\/h2>\n

1.1. Nguy\u00ean t\u1eafc x\u1eed tr\u00ed<\/span><\/b><\/h3>\n

– \u0110\u1ea3m b\u1ea3o duy tr\u00ec ch\u1ee9c n\u0103ng s\u1ed1ng, \u0111\u1eb7c bi\u1ec7t khi c\u00f3 li\u1ec7t c\u01a1 h\u00f4 h\u1ea5p.<\/span><\/p>\n

– \u0110i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n n\u01b0\u1edbc v\u00e0 \u0111i\u1ec7n gi\u1ea3i.<\/span><\/p>\n

– T\u1eadp v\u1eadn \u0111\u1ed9ng \u0111\u1ec3 h\u1ea1n ch\u1ebf bi\u1ebfn ch\u1ee9ng do li\u1ec7t v\u1eadn \u0111\u1ed9ng g\u00e2y ra.<\/span><\/p>\n

– Lo\u1ea1i b\u1ecf nhanh c\u00e1c kh\u00e1ng th\u1ec3 t\u1ef1 mi\u1ec5n g\u00e2y ra t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh ngo\u1ea1i vi.<\/span><\/p>\n

1.2. X\u1eed tr\u00ed ban \u0111\u1ea7u v\u00e0 v\u1eadn chuy\u1ec3n c\u1ea5p c\u1ee9u<\/span><\/b><\/h3>\n

– N\u1eb1m \u0111\u1ea7u cao 30o\u00a0<\/sup>– 45o<\/sup><\/span><\/p>\n

– Th\u1edf oxy k\u00ednh ho\u1eb7c qua m\u1eb7t n\u1ea1. \u0110\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n v\u00e0 b\u00f3p b\u00f3ng qua \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n khi c\u00f3 li\u1ec7t c\u01a1 h\u00f4 h\u1ea5p.<\/span><\/p>\n

– \u0110\u1eb7t \u1ed1ng th\u00f4ng d\u1ea1 d\u00e0y, \u0103n qua \u1ed1ng th\u00f4ng khi c\u00f3 r\u1ed1i lo\u1ea1n nu\u1ed1t. Vitamin nh\u00f3m B.<\/span><\/p>\n

– Glucocorticoid: methylprednisolon 500mg\/ng\u00e0y x 5 ng\u00e0y, sau \u0111\u00f3 gi\u1ea3m li\u1ec1u d\u1ea7n.<\/span><\/p>\n

1.3. X\u1eed tr\u00ed t\u1ea1i b\u1ec7nh vi\u1ec7n<\/span><\/b><\/h3>\n

a) C\u00e1c x\u1eed tr\u00ed h\u1ed7 tr\u1ee3<\/span><\/p>\n

– H\u00f4 h\u1ea5p:<\/span><\/p>\n

+ Khi c\u00f3 d\u1ea5u hi\u1ec7u suy h\u00f4 h\u1ea5p c\u1ea7n th\u1edf m\u00e1y h\u1ed7 tr\u1ee3 ngay.<\/span><\/p>\n

+ Th\u1edf oxy, n\u1ebfu kh\u00f4ng k\u1ebft qu\u1ea3 chuy\u1ec3n sang th\u1edf m\u00e1y x\u00e2m nh\u1eadp v\u1edbi Vt cao (12ml\/kg) k\u1ebft h\u1ee3p PEEP 5 cmH2<\/sub>O \u0111\u1ec3 tr\u00e1nh x\u1eb9p ph\u1ed5i.<\/span><\/p>\n

+ C\u00e1c y\u1ebfu t\u1ed1 n\u1eb7ng nh\u01b0: ti\u1ebfn tri\u1ec3n nhanh <7 ng\u00e0y, m\u1ea5t kh\u1ea3 n\u0103ng ho, kh\u00f4ng n\u00e2ng \u0111\u01b0\u1ee3c khu\u1ef7u tay ho\u1eb7c \u0111\u1ea7u, m\u1ea5t kh\u1ea3 n\u0103ng \u0111\u1ee9ng, ph\u1ea3i nh\u1eadp Khoa h\u1ed3i s\u1ee9c \u0111\u1ec3 theo d\u00f5i, c\u1ea7n \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n v\u00e0 th\u1edf m\u00e1y s\u1edbm.<\/span><\/p>\n

– Tu\u1ea7n ho\u00e0n: theo d\u00f5i li\u00ean t\u1ee5c m\u1ea1ch, \u0111i\u1ec7n tim, huy\u1ebft \u00e1p \u0111\u1ec3 ph\u00e1t hi\u1ec7n v\u00e0 x\u1eed tr\u00ed k\u1ecbp th\u1eddi r\u1ed1i lo\u1ea1n nh\u1ecbp, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1ecbp ch\u1eadm khi h\u00fat \u0111\u1eddm, t\u1ee5t huy\u1ebft \u00e1p.<\/span><\/p>\n

– D\u1ef1 ph\u00f2ng thuy\u00ean t\u1eafc t\u0129nh m\u1ea1nh s\u00e2u v\u00e0 t\u1eafc m\u1ea1ch ph\u1ed5i: v\u1eadn \u0111\u1ed9ng tr\u1ecb li\u1ec7u, d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng heparin ho\u1eb7c heparin tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p.<\/span><\/p>\n

– D\u1ef1 ph\u00f2ng lo\u00e9t d\u1ea1 d\u00e0y v\u00e0 \u0111\u01b0\u1eddng ti\u00eau h\u00f3a: gi\u1ea3m ti\u1ebft d\u1ecbch d\u1ea1 d\u00e0y (thu\u1ed1c kh\u00e1ng th\u1ee5 th\u1ec3 H2<\/sub>, thu\u1ed1c \u1ee9c ch\u1ebf b\u01a1m proton) \u0103n qua \u1ed1ng th\u00f4ng s\u1edbm.<\/span><\/p>\n

– \u0110i\u1ec1u chinh r\u1ed1i lo\u1ea1n n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i, \u0110\u1ea3m b\u1ea3o dinh d\u01b0\u1ee1ng: 40 Kcalo\/kg\/ng\u00e0y v\u00e0 c\u00e1c kho\u00e1ng ch\u1ea5t.<\/span><\/p>\n

b) X\u1eed tr\u00ed \u0111\u1eb7c hi\u1ec7u<\/span><\/p>\n

M\u1ee5c \u0111\u00edch:\u00a0<\/span><\/i>l\u00e0m gi\u1ea3m l\u01b0\u1ee3ng kh\u00e1ng th\u1ec3 kh\u00e1ng myelin trong m\u00e1u<\/span><\/p>\n

– Corticoid:<\/span><\/p>\n

+ T\u00e1c d\u1ee5ng l\u00e0m gi\u1ea3m \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch. Tuy nhi\u00ean hi\u1ec7u qu\u1ea3 kh\u00f4ng nhi\u1ec1u.<\/span><\/p>\n

+ Li\u1ec1u methylprednisolon 500mg\/ng\u00e0y x 5 ng\u00e0y. Sau \u0111\u00f3 gi\u1ea3m li\u1ec1u d\u1ea7n.<\/span><\/p>\n

– L\u1ecdc huy\u1ebft t\u01b0\u01a1ng:<\/span><\/p>\n

+ Thay huy\u1ebft t\u01b0\u01a1ng: (xin xem quy tr\u00ecnh k\u1ef9 thu\u1eadt thay huy\u1ebft t\u01b0\u01a1ng).<\/span><\/p>\n

+ L\u1ecdc k\u00e9p (double filter): (xin xem quy tr\u00ecnh k\u1ef9 thu\u1eadt l\u1ecdc)<\/span><\/p>\n

+ L\u1ecdc h\u1ea5p ph\u1ee5 (hemoadsorption): (xin xem quy tr\u00ecnh k\u1ef9 thu\u1eadt l\u1ecdc h\u1ea5p ph\u1ee5)<\/span><\/p>\n

* Ch\u00fa \u00fd<\/span><\/i>:<\/span><\/p>\n

Th\u1eddi gian l\u1ecdc c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t: kh\u1ea3 n\u0103ng h\u1ed3i ph\u1ee5c t\u1ed1t.<\/span><\/p>\n

S\u1ed1 l\u1ea7n l\u1ecdc v\u00e0 kho\u1ea3ng c\u00e1ch: h\u00e0ng ng\u00e0y ho\u1eb7c c\u00e1ch ng\u00e0y, 3-6 l\u1ea7n t\u00f9y theo \u0111\u00e1p \u1ee9ng, c\u00f3 th\u1ec3 t\u1edbi 15-16 l\u1ea7n. N\u1ebfu sau 6 l\u1ea7n kh\u00f4ng ti\u1ebfn tri\u1ec3n th\u00ec ng\u1eebng.<\/span><\/p>\n

C\u00f3 nguy c\u01a1 d\u1ecb \u1ee9ng ho\u1eb7c s\u1ed1c ph\u1ea3n v\u1ec7, r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u, r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i, nhi\u1ec5m khu\u1ea9n t\u1ea1i ch\u1ed7 ho\u1eb7c nhi\u1ec5m khu\u1ea9n m\u00e1u\u2026<\/span><\/p>\n

– Truy\u1ec1n globulin mi\u1ec5n d\u1ecbch: gi\u00e1 th\u00e0nh \u0111i\u1ec1u tr\u1ecb cao.<\/span><\/p>\n

+ Li\u1ec1u d\u00f9ng: 0,4 g\/kg\/ng\u00e0y x 5 ng\u00e0y.<\/span><\/p>\n

+ Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh: suy th\u00e2n, d\u1ecb \u1ee9ng thu\u1ed1c.<\/span><\/p>\n

c) Theo d\u00f5i<\/span><\/p>\n

– \u0110\u00e1nh gi\u00e1 h\u00e0ng ng\u00e0y c\u01a1 l\u1ef1c t\u1ee9 chi,c\u00e1c d\u00e2y th\u1ea7n kinh s\u1ecd nh\u01b0: r\u1ed1i lo\u1ea1n nu\u1ed1t \u2026<\/span><\/p>\n

– Theo d\u00f5i s\u00e1t: h\u00f4 h\u1ea5p (SpO2<\/sub>, PaO2<\/sub>, PaCO2<\/sub>, m\u1ea1ch, nh\u1ecbp tim, huy\u1ebft \u00e1p.<\/span><\/p>\n

– \u0110\u00e1nh gi\u00e1 th\u1ec3 t\u00edch kh\u00ed l\u01b0u th\u00f4ng (Vt), \u00e1p l\u1ef1c \u00e2m h\u00edt v\u00e0o t\u1ed1i \u0111a (NIP) h\u00e0ng ng\u00e0y.<\/span><\/p>\n

2. Ti\u00ean l\u01b0\u1ee3ng v\u00e0 bi\u1ebfn ch\u1ee9ng c\u1ee7a <\/span><\/b>h\u1ed9i ch\u1ee9ng Guillain-Barre<\/strong><\/span><\/b><\/h2>\n

2.1. Ti\u00ean l\u01b0\u1ee3ng<\/span><\/b><\/h3>\n

Kho\u1ea3ng 70% h\u1ed3i ph\u1ee5c ho\u00e0n to\u00e0n, k\u1ec3 c\u1ea3 li\u1ec7t c\u01a1 h\u00f4 h\u1ea5p c\u1ea7n ph\u1ea3i th\u1edf m\u00e1y h\u1ed7 tr\u1ee3.<\/span><\/p>\n

T\u1ef7 l\u1ec7 h\u1ed3i ph\u1ee5c ho\u00e0n to\u00e0n t\u1eeb 48 – 90% trong n\u0103m \u0111\u1ea7u, 60 – 88% trong n\u0103m th\u1ee9 hai.<\/span><\/p>\n

H\u1ed3i ph\u1ee5c k\u00e9m n\u1ebfu> 60 tu\u1ed5i, ti\u1ebfn tri\u1ec3n nhanh, \u0111i\u1ec7n c\u01a1 t\u1ed5n th\u01b0\u01a1ng s\u1ee3i tr\u1ee5c, th\u1edf m\u00e1y h\u1ed7 tr\u1ee3 d\u00e0i ng\u00e0y.<\/span><\/p>\n

2.2. Bi\u1ebfn ch\u1ee9ng<\/span><\/b><\/h3>\n

Quan tr\u1ecdng nh\u1ea5t l\u00e0 suy h\u00f4 h\u1ea5p c\u1ea5p do li\u1ec7t c\u01a1 h\u00f4 h\u1ea5p, vi\u00eam ph\u1ed5i do h\u00edt ph\u1ea3i, x\u1eb9p ph\u1ed5i, thuy\u00ean t\u1eafc m\u1ea1ch ph\u1ed5i.<\/span><\/p>\n

C\u00e1c r\u1ed1i lo\u1ea1n th\u1ea7n kinh t\u1ef1 \u0111\u1ed9ng: r\u1ed1i lo\u1ea1n nhip tim, t\u0103ng ti\u1ebft d\u1ecbch ph\u1ebf qu\u1ea3n ph\u1ed5i, li\u1ec7t ru\u1ed9t c\u01a1 n\u0103ng, b\u00ed ti\u1ec3u ti\u1ec7n, vi\u00eam \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u, lo\u00e9t t\u1ef3 \u0111\u00e8\u2026<\/span><\/p>\n

Di ch\u1ee9ng li\u1ec7t kh\u00f4ng h\u1ed3i ph\u1ee5c.<\/span><\/p>\n

3. Ph\u00f2ng b\u1ec7nh<\/span><\/b><\/h2>\n

Hi\u1ec7n ch\u01b0a c\u00f3 c\u00e1ch ph\u00f2ng ng\u1eeba ch\u00ednh x\u00e1c cho H\u1ed9i ch\u1ee9ng Guillain-Barre (GBS). Tuy nhi\u00ean, vi\u1ec7c gi\u1eef g\u00ecn s\u1ee9c kh\u1ecfe t\u1ed1t v\u00e0 ki\u1ec3m tra s\u1ee9c kh\u1ecfe \u0111\u1ecbnh k\u1ef3 c\u00f3 th\u1ec3 gi\u00fap gi\u1ea3m nguy c\u01a1 m\u1eafc b\u1ec7nh.<\/p>\n

    \n
  • Ph\u00f2ng tr\u00e1nh c\u00e1c nhi\u1ec5m khu\u1ea9n, vi r\u00fat.<\/span><\/li>\n
  • Gi\u1eef g\u00ecn s\u1ee9c kh\u1ecfe t\u1ed1t: B\u1ea1n n\u00ean \u0103n u\u1ed1ng \u0111\u1ea7y \u0111\u1ee7, bao g\u1ed3m rau xanh, tr\u00e1i c\u00e2y, th\u1ef1c ph\u1ea9m gi\u00e0u ch\u1ea5t x\u01a1 v\u00e0 th\u1ef1c ph\u1ea9m gi\u00e0u \u0111\u1ea1m. H\u1ea1n ch\u1ebf \u0103n th\u1ef1c ph\u1ea9m gi\u00e0u ch\u1ea5t b\u00e9o v\u00e0 \u0111\u01b0\u1eddng. B\u1ea1n c\u0169ng n\u00ean t\u1eadp th\u1ec3 d\u1ee5c \u0111\u1ec1u \u0111\u1eb7n \u0111\u1ec3 gi\u1eef g\u00ecn s\u1ee9c kh\u1ecfe t\u1ed1t v\u00e0 gi\u1ea3m nguy c\u01a1 m\u1eafc b\u1ec7nh.<\/li>\n
  • Ki\u1ec3m tra s\u1ee9c kh\u1ecfe \u0111\u1ecbnh k\u1ef3: B\u1ea1n n\u00ean \u0111i kh\u00e1m s\u1ee9c kh\u1ecfe \u0111\u1ecbnh k\u1ef3 \u0111\u1ec3 ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1edbm c\u00e1c b\u1ec7nh l\u00fd ti\u1ec1m \u1ea9n, bao g\u1ed3m c\u00e1c b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch, b\u1ec7nh l\u00fd vi\u00eam kh\u1edbp v\u00e0 b\u1ec7nh nhi\u1ec5m tr\u00f9ng.<\/li>\n
  • Th\u1ef1c hi\u1ec7n c\u00e1c bi\u1ec7n ph\u00e1p v\u1ec7 sinh c\u00e1 nh\u00e2n: B\u1ea1n n\u00ean th\u1ef1c hi\u1ec7n c\u00e1c bi\u1ec7n ph\u00e1p v\u1ec7 sinh c\u00e1 nh\u00e2n nh\u01b0 r\u1eeda tay th\u01b0\u1eddng xuy\u00ean, tr\u00e1nh ti\u1ebfp x\u00fac v\u1edbi c\u00e1c ch\u1ea5t g\u00e2y k\u00edch \u1ee9ng v\u00e0 \u0111\u1ed9c h\u1ea1i, v\u00e0 \u0111eo kh\u1ea9u trang khi c\u1ea7n thi\u1ebft.<\/li>\n<\/ul>\n

    Khi c\u00f3 bi\u1ec3u hi\u1ec7n t\u00ea b\u00ec tay, ch\u00e2n, c\u01a1 l\u1ef1c y\u1ebfu th\u00ec b\u1ec7nh nh\u00e2n c\u1ea7n ph\u1ea3i \u0111i kh\u00e1m \u0111\u1ec3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi \u0111\u1ec3 h\u1ea1n ch\u1ebf li\u1ec7t c\u01a1 ti\u1ebfn tri\u1ec3n v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng do li\u1ec7t c\u01a1 g\u00e2y ra.<\/span><\/p>\n

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

    H\u1ed9i ch\u1ee9ng Guillain-Barre (GBS) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd t\u1ea5n c\u00f4ng h\u1ec7 th\u1ea7n kinh v\u1eadn \u0111\u1ed9ng v\u00e0 c\u1ea3m gi\u00e1c. B\u1ec7nh n\u00e0y th\u01b0\u1eddng b\u1eaft \u0111\u1ea7u b\u1eb1ng nh\u1eefng tri\u1ec7u ch\u1ee9ng nh\u01b0 c\u1ea3m gi\u00e1c t\u00ea, kh\u00f3 kh\u0103n trong vi\u1ec7c di chuy\u1ec3n, v\u00e0 \u0111au nh\u1ee9c c\u01a1 b\u1eafp. Sau \u0111\u00f3, b\u1ec7nh ti\u1ebfn tri\u1ec3n v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra t\u00ea li\u1ec7t v\u00e0 […]<\/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":"\nH\u1ed9i ch\u1ee9ng Guillain-Barre: X\u1eed tr\u00ed, ti\u00ean l\u01b0\u1ee3ng v\u00e0 bi\u1ebfn ch\u1ee9ng - Vinmec<\/title>\n<meta name=\"description\" content=\"H\u1ed9i ch\u1ee9ng Guillain-Barre (GBS) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd t\u1ea5n c\u00f4ng h\u1ec7 th\u1ea7n kinh v\u1eadn \u0111\u1ed9ng v\u00e0 c\u1ea3m gi\u00e1c. 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