{"id":28460,"date":"2023-04-26T18:53:58","date_gmt":"2023-04-26T11:53:58","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28460"},"modified":"2023-04-26T18:53:58","modified_gmt":"2023-04-26T11:53:58","slug":"cach-tham-kham-than-kinh-o-benh-nhan-hon-me","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/26\/cach-tham-kham-than-kinh-o-benh-nhan-hon-me\/","title":{"rendered":"C\u00e1ch th\u0103m kh\u00e1m th\u1ea7n kinh \u1edf b\u1ec7nh nh\u00e2n h\u00f4n m\u00ea"},"content":{"rendered":"

B\u1ec7nh nh\u00e2n h\u00f4n m\u00ea khi nh\u1eadp vi\u1ec7n c\u1ea7n th\u0103m kh\u00e1m t\u1ed5ng qu\u00e1t \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 nguy\u00ean nh\u00e2n g\u00e2y ra t\u00ecnh tr\u1ea1ng h\u00f4n m\u00ea. Song song v\u1edbi ph\u1ea7n th\u0103m kh\u00e1m t\u1ed5ng qu\u00e1t, v\u1ed1n c\u1ea7n \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh g\u1ecdn v\u00e0 nhanh, vi\u1ec7c th\u0103m kh\u00e1m th\u1ea7n kinh<\/a> h\u1ecdc \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng nh\u1eb9 c\u1ee7a t\u1ed5n th\u01b0\u01a1ng \u0111\u00e3 g\u00e2y ra h\u00f4n m\u00ea. Nh\u1eefng l\u0129nh v\u1ef1c c\u1ea7n l\u01b0u \u00fd trong th\u0103m kh\u00e1m th\u1ea7n kinh bao g\u1ed3m ch\u1ee9c n\u0103ng v\u1ecf n\u00e3o v\u00e0 \u0111\u1eb7c bi\u1ec7t l\u00e0 ch\u1ee9c n\u0103ng th\u00e2n n\u00e3o.<\/strong><\/p>\n

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B\u1ec7nh nh\u00e2n h\u00f4n m\u00ea c\u1ea7n kh\u00e1m th\u1ea7n kinh \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 n\u1eb7ng nh\u1eb9 t\u1ed5n th\u01b0\u01a1ng g\u00e2y h\u00f4n m\u00ea<\/figcaption><\/figure>\n

1. Vai tr\u00f2 c\u1ee7a\u00a0th\u0103m kh\u00e1m th\u1ea7n kinh \u1edf b\u1ec7nh nh\u00e2n h\u00f4n m\u00ea<\/h2>\n

S\u1ef1 th\u0103m kh\u00e1m l\u00e2m s\u00e0ng \u0111\u1ec3 th\u0103m d\u00f2 ch\u1ee9c n\u0103ng th\u00e2n n\u00e3o s\u1ebd gi\u00fap \u00edch nhi\u1ec1u nh\u1ea5t cho vi\u1ec7c nh\u1eadn \u0111\u1ecbnh v\u1ec1 nguy\u00ean nh\u00e2n v\u00e0 c\u01a1 ch\u1ebf sinh l\u00fd b\u1ec7nh h\u1ecdc c\u1ee5 th\u1ec3 c\u1ee7a t\u1eebng tr\u01b0\u1eddng h\u1ee3p h\u00f4n m\u00ea. <\/span><\/p>\n

Th\u00f4ng th\u01b0\u1eddng l\u00e0 c\u00e1c qu\u00e1 tr\u00ecnh t\u1ed5n th\u01b0\u01a1ng c\u1ea5u tr\u00fac c\u00f3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ee9c n\u0103ng c\u1ee7a t\u1ed5 ch\u1ee9c l\u01b0\u1edbi c\u1ea7u n\u00e3o v\u00e0 trung n\u00e3o (ho\u1eb7c l\u00e0 t\u1ed5n th\u01b0\u01a1ng c\u1ea5u tr\u00fac n\u1ed9i t\u1ea1i c\u1ee7a th\u00e2n n\u00e3o, ho\u1eb7c l\u00e0 t\u1ed5n th\u01b0\u01a1ng th\u00e2n n\u00e3o th\u1ee9 ph\u00e1t sau ch\u00e8n \u00e9p b\u1edfi b\u00e1n c\u1ea7u n\u00e3o) \u0111\u1ec1u c\u00f3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u00e1c c\u1ea5u tr\u00fac th\u00e2n n\u00e3o li\u00ean quan \u0111\u1ebfn ch\u1ee9c n\u0103ng v\u1eadn nh\u00e3n v\u00e0 ch\u1ee9c n\u0103ng \u0111\u1ed3ng t\u1eed. N\u1ebfu h\u00f4n m\u00ea s\u00e2u nh\u01b0ng ch\u1ee9c n\u0103ng th\u00e2n n\u00e3o \u00edt b\u1ecb \u1ea3nh h\u01b0\u1edfng, v\u1eabn t\u01b0\u01a1ng \u0111\u1ed1i c\u00f2n nguy\u00ean v\u1eb9n, th\u00ec \u0111\u1eb7c \u0111i\u1ec3m n\u00e0y g\u1ee3i \u00fd r\u1eb1ng kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng c\u1ea5u tr\u00fac c\u1ee7a trung n\u00e3o hay c\u1ea7u n\u00e3o. <\/span><\/p>\n

Tuy nhi\u00ean c\u0169ng c\u1ea7n ghi nh\u1edb r\u1eb1ng s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c d\u1ea5u hi\u1ec7u b\u1ea5t th\u01b0\u1eddng v\u1ec1 ch\u1ee9c n\u0103ng th\u00e2n n\u00e3o kh\u00f4ng lu\u00f4n lu\u00f4n \u0111\u1ed3ng ngh\u0129a v\u1edbi s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a t\u1ed5n th\u01b0\u01a1ng c\u1ea5u tr\u00fac th\u00e2n n\u00e3o. Ng\u1ed9 \u0111\u1ed9c c\u00e1c thu\u1ed1c nh\u01b0 thu\u1ed1c ch\u1ed1ng b\u1ea7m c\u1ea3m ba v\u00f2ng, phenytoin, barbiturat c\u00f3 th\u1ec3 l\u00e0m li\u1ec7t ch\u1ee9c n\u0103ng ki\u1ec3m so\u00e1t v\u1eadn nh\u00e3n (c\u1ed1 khi g\u00e2y li\u1ec7t v\u1eadn nh\u00e3n to\u00e0n b\u1ed9) nh\u01b0ng l\u1ea1i kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ee9c n\u0103ng \u0111\u1ed3ng t\u1eed. M\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n kh\u00e1c c\u1ee7a h\u00f4n m\u00ea s\u00e2u do r\u1ed1i lo\u1ea1n chuy\u1ec3n ho\u00e1 c\u0169ng g\u00e2y ra r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng v\u1eadn nh\u00e3n nh\u01b0ng kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn \u0111\u00e1p \u1ee9ng c\u1ee7a \u0111\u1ed3ng t\u1eed. Trong ph\u1ea7n ti\u1ebfp theo sau \u0111\u00e2y s\u1ebd m\u00f4 t\u1ea3 c\u00e1c n\u1ed9i dung th\u0103m kh\u00e1m v\u1ec1 th\u1ea7n kinh g\u1ed3m c\u1ed5 t\u01b0 th\u1ebf v\u00e0 ph\u1ea3n x\u1ea1 t\u1ee9 chi, t\u01b0 th\u1ebf c\u1ee7a \u0111\u1ea7u v\u00e0 m\u1eaft, c\u1eed \u0111\u1ed9ng m\u1eaft, \u0111\u1ed3ng t\u1eed v\u00e0 ki\u1ec3u c\u00e1ch th\u1edf.<\/span><\/p>\n

2. C\u00e1ch th\u0103m kh\u00e1m th\u1ea7n kinh \u1edf b\u1ec7nh nh\u00e2n h\u00f4n m\u00ea<\/strong><\/h2>\n

2.1. T\u01b0 th\u1ebf v\u00e0 ph\u1ea3n x\u1ea1 c\u1ee7a t\u1ee9 chi<\/strong><\/h3>\n

T\u01b0 th\u1ebf v\u00e0 s\u1ef1 c\u1eed \u0111\u1ed9ng c\u1ee7a ch\u00e2n tay b\u1ec7nh nh\u00e2n h\u00f4n m\u00ea ch\u1ee7 y\u1ebfu ch\u1ec9 g\u1ee3i \u00fd m\u1ed9t c\u00e1ch s\u01a1 b\u1ed9 v\u1ec1 ph\u00eda b\u00ean n\u00e0o c\u1ee7a \u0111\u1ea1i n\u00e3o hay th\u00e2n n\u00e3o b\u1ecb t\u1ed5n th\u01b0\u01a1ng v\u00e0 kh\u00f4ng c\u00f3 gi\u00e1 tr\u1ecb ch\u1ec9 \u0111i\u1ec3m cao v\u1ec1 v\u1ecb tr\u00ed \u0111\u00edch x\u00e1c c\u1ee7a t\u1ed5n th\u01b0\u01a1ng.<\/span>\u00a0<\/span><\/p>\n

T\u01b0 th\u1ebf m\u1ea5t v\u1ecf <\/span>\u00a0g\u1eb7p \u1edf trong tr\u01b0\u1eddng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng c\u00e1c t\u1ea7ng cao c\u1ee7a tr\u1ee5c th\u1ea7n kinh nh\u01b0 ph\u1ea7n s\u00e2u c\u1ee7a b\u00e1n c\u1ea7u \u0111\u1ea1i n\u00e3o, ho\u1eb7c \u1edf ngay ph\u00eda b\u00ean trung n\u00e3o. \u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a t\u01b0 th\u1ebf n\u00e0y l\u00e0 chi tr\u00ean c\u01a1 g\u1ea5p \u00e1p v\u00e0o th\u00e2n m\u00ecnh, chi d\u01b0\u1edbi th\u00ec du\u1ed7i c\u1ee9ng. Trong tr\u01b0\u1eddng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng \u1edf th\u1ea5p h\u01a1n n\u1eefa, trong kho\u1ea3ng gi\u1eefa nh\u00e2n \u0111\u1ecf v\u00e0 nh\u00e2n ti\u1ec1n \u0111\u00ecnh, b\u1ec7nh nh\u00e2n c\u00f3 chi tr\u00ean du\u1ed7i c\u1ee9ng xoay trong v\u00e0 \u00e1p v\u00e0o th\u00e2n m\u00ecnh c\u00f2n chi d\u01b0\u1edbi th\u00ec du\u1ed7i c\u1ee9ng, t\u01b0 th\u1ebf n\u00e0y c\u00f3 t\u00ean g\u1ecdi l\u00e0 <\/span>t\u01b0 th\u1ebf m\u1ea5t n\u00e3o.<\/span><\/p>\n

Trong tr\u01b0\u1eddng h\u1ee3p trung n\u00e3o hay c\u1ea7u n\u00e3o b\u1ecb t\u1ed5n th\u01b0\u01a1ng quan tr\u1ecdng, b\u1ec7nh nh\u00e2n h\u00f4n m\u00ea c\u00f3 li\u1ec7t m\u1ec1m t\u1ee9 chi k\u00e8m theo.<\/span><\/p>\n

2.2. T\u01b0 th\u1ebf \u0111\u1ea7u v\u00e0 m\u1eaft<\/strong><\/h3>\n

Th\u0103m kh\u00e1m th\u1ea7n kinh nh\u00e3n khoa c\u00f3 vai tr\u00f2 quan tr\u1ecdng v\u00ec r\u1ea5t h\u1eefu \u00edch cho vi\u1ec7c \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u00e2n n\u00e3o trong tr\u01b0\u1eddng h\u1ee3p h\u00f4n m\u00ea. T\u01b0 th\u1ebf c\u1ee7a m\u1eaft v\u00e0 c\u00e1c c\u1eed \u0111\u1ed9ng c\u1ee7a m\u1eaft \u1edf b\u1ec7nh nh\u00e2n h\u00f4n m\u00ea cung c\u1ea5p nh\u1eefng th\u00f4ng tin quan tr\u1ecdng sau \u0111\u00e2y: <\/span><\/p>\n

(1) nh\u1eadn \u0111\u1ecbnh \u0111\u01b0\u1ee3c v\u1ec1 t\u00ecnh tr\u1ea1ng c\u1ee7a c\u00e1c c\u1ea5u tr\u00fac th\u00e2n n\u00e3o c\u00f3 ch\u1ee9c n\u0103ng v\u1eadn nh\u00e3n; <\/span><\/p>\n

(2) suy di\u1ec5n \u0111\u01b0\u1ee3c v\u1ec1 v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng d\u1ef1a tr\u00ean m\u1ed1i t\u01b0\u01a1ng quan gi\u1eefa t\u01b0 th\u1ebf m\u1eaft v\u1edbi b\u00ean b\u1ecb li\u1ec7t n\u1eeda ng\u01b0\u1eddi; <\/span><\/p>\n

(3) m\u1ed9t s\u1ed1 ki\u1ec3u c\u1eed \u0111\u1ed9ng m\u1eaft trong h\u00f4n m\u00ea c\u00f3 th\u1ec3 gi\u00fap \u00edch cho vi\u1ec7c \u0111\u1ecbnh v\u1ecb t\u1ed5n th\u01b0\u01a1ng v\u00e0 suy di\u1ec5n v\u1ec1 nguy\u00ean nh\u00e2n c\u1ee7a h\u00f4n m\u00ea.<\/span><\/p>\n

Trong h\u00f4n m\u00ea do t\u1ed5n th\u01b0\u01a1ng b\u00e1n c\u1ea7u (g\u00e2y t\u1ed5n th\u01b0\u01a1ng c\u1ea3 v\u00f9ng xoay m\u1eaft th\u00f9y tr\u00e1n), <\/span>hai m\u1eaft <\/span>r\u00e0 <\/span>\u0111\u1ea7u b\u1ec7nh nh\u00e2n xoay nh\u00ecn v\u1ec1 ph\u1ee7i b\u00ean c\u00f3 t\u1ed5n th\u01b0\u01a1ng<\/span>, ngh\u0129a l\u00e0 v\u1ec1 ph\u00eda b\u00ean kh\u00f4ng b\u1ecb y\u1ebfu li\u1ec7t n\u1eeda ng\u01b0\u1eddi. Trong h\u00f4n m\u00ea do t\u1ed5n th\u01b0\u01a1ng c\u1ea7u n\u00e3o (g\u00e2y t\u1ed5n th\u01b0\u01a1ng PPRF hay nh\u00e2n d\u00e2y VI), <\/span>hai m\u1eaft v\u00e0 \u0111\u1ea7u l\u1ea1i xoay nh\u00ecn v\u1ec1 ph\u00eda kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng, <\/span>ngh\u0129a l\u00e0 ph\u00eda b\u00ean c\u00f3 y\u1ebfu li\u1ec7t n\u1eeda ng\u01b0\u1eddi.<\/span><\/p>\n

2.3. C\u1eed \u0111\u1ed9ng m\u1eaft<\/strong><\/h3>\n

B\u00ean c\u1ea1nh c\u00e1c b\u1ea5t th\u01b0\u1eddng c\u1ee7a t\u01b0 th\u1ebf hai m\u1eaft \u1edf tr\u1ea1ng th\u00e1i ngh\u1ec9 v\u1eeba n\u00eau, b\u1ec7nh nh\u00e2n h\u00f4n m\u00ea c\u00f2n c\u00f3 th\u1ec3 bi\u1ec3u l\u1ed9 nh\u1eefng c\u1eed \u0111\u1ed9ng t\u1ef1 ph\u00e1t c\u1ee7a m\u1eaft nh\u01b0 c\u1eed \u0111\u1ed9ng ngang l\u00e1o li\u00eang qua l\u1ea1i c\u1ee7a m\u1eaft, c\u1eed \u0111\u1ed9ng m\u1eaft nh\u1ea5p nh\u00f4, c\u1eed \u0111\u1ed9ng m\u1eaft d\u00ecm xu\u1ed1ng, v\u00e0 c\u1eed \u0111\u1ed9ng m\u1eaft nh\u1ea5p nh\u00f4 tr\u1edf lui.<\/span><\/p>\n

C\u1eed \u0111\u1ed9ng m\u1eaft ngang l\u00e1o li\u00eang qua l\u1ea1i (roving eyes) <\/span>l\u00e0 nh\u1eefng c\u1eed \u0111\u1ed9ng ch\u1ea1y qua ch\u1ea1y l\u1ea1i t\u1ef1 ph\u00e1t \u0111i chu k\u1ef3 1-2 gi\u00e2y cho m\u1ed9t l\u1ea7n tr\u00f4i ngang qua h\u1ebft m\u1ed9t ph\u00eda – ng\u1eebng l\u1ea1i ch\u1ea7n ch\u1edd m\u1ed9t ch\u00fat – sau \u0111\u00f3 l\u1ea1i tr\u00f4i ngang theo chi\u1ec1u ng\u01b0\u1ee3c tr\u1edf l\u1ea1i. Lo\u1ea1i c\u1eed \u0111\u1ed9ng n\u00e0y \u0111\u01b0\u1ee3c th\u1ea5y trong h\u00f4n m\u00ea do t\u1ed5n th\u01b0\u01a1ng quan tr\u1ecdng c\u1ee7a hai b\u00e1n c\u1ea7u \u0111\u1ea1i n\u00e3o nh\u01b0ng th\u00e2n n\u00e3o v\u1eabn t\u01b0\u01a1ng \u0111\u1ed1i c\u00f2n nguy\u00ean v\u1eb9n. Hi\u1ec7n t\u01b0\u1ee3ng n\u00e0y \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch nh\u01b0 l\u00e0 s\u1ef1 ph\u00f3ng th\u00edch c\u1ee7a ch\u1ee9c n\u0103ng th\u00e2n n\u00e3o khi ch\u1ee9c n\u0103ng c\u1ee7a v\u1ecf n\u00e3o hai b\u00ean b\u1ecb tri\u1ec7t ti\u00eau. \u0110\u00f4i khi c\u1eed \u0111\u1ed9ng ngang l\u00e1o li\u00eang n\u00e0y tr\u1edf n\u00ean n\u1ed5i b\u1eadt, c<5 nh\u1ecbp dao \u0111\u1ed9ng qua l\u1ea1i, l\u00fac <\/span>\u0111\u00f3 <\/span>thu\u1eadt ng\u1eef ti\u1ebfng Anh g\u1ecdi l\u00e0 \u201cping-pong gaze\u201d, \u201cocular agitation\u201d, \u201crestless eyes\u201d hay \u201cperiodic alternating gaze\u201d.<\/span><\/p>\n

C\u1eed \u0111\u1ed9ng m\u1eaft nh\u1ea5p nh\u00f4 (ocular bobbing) <\/span>l\u00e0 thu\u1eadt ng\u1eef m\u00f4 t\u1ea3 nh\u1eefng c\u1eed \u0111\u1ed9ng x\u1ea3y \u0111\u1ebfn t\u1eebng h\u1ed3i c\u1ee7a hai m\u1eaft trong \u0111\u00f3 c\u00f3 nh\u1eefng c\u1eed \u0111\u1ed9ng gi\u1eadt nhanh xu\u1ed1ng d\u01b0\u1edbi v\u00e0 ti\u1ebfp theo sau l\u00e0 hai m\u1eaft t\u1eeb t\u1eeb tr\u00f4i l\u00ean v\u1ec1 v\u1ecb tr\u00ed trung gian ban \u0111\u1ea7u. Trong tr\u01b0\u1eddng h\u1ee3p c\u1eed \u0111\u1ed9ng m\u1eaft nh\u1ea5p nh\u00f4 \u0111i\u1ec3n h\u00ecnh, c\u00e1c c\u1eed \u0111\u1ed9ng ngang c\u1ee7a m\u1eaft (ph\u1ea3n x\u1ea1 c\u0169ng nh\u01b0 t\u1ef1 ph\u00e1t) \u0111\u1ec1u b\u1ecb m\u1ea5t. C\u1eed \u0111\u1ed9ng m\u1eaft nh\u1ea5p nh\u00f4 \u0111\u01b0\u1ee3c g\u1eb7p trong t\u1ed5n th\u01b0\u01a1ng n\u1eb7ng n\u1ec1 c\u1ee7a c\u1ea7u n\u00e3o, th\u01b0\u1eddng l\u00e0 xu\u1ea5t huy\u1ebft hay nh\u1ed3i m\u00e1u c\u1ea7u n\u00e3o. <\/span>C\u1eed \u0111\u1ed9ng m\u1eaft nh\u1ea5p nh\u00f4 kh\u00f4ng \u0111i\u1ec3n h\u00ecnh <\/span>l\u00e0 tr\u01b0\u1eddng h\u1ee3p hai m\u1eaft nh\u1ea5p nh\u00f4 nh\u01b0ng v\u1eabn c\u00f2n s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c c\u1eed \u0111\u1ed9ng m\u1eaft ngang; tri\u1ec7u ch\u1ee9ng kh\u00f4ng \u0111i\u1ec3n h\u00ecnh n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p xu\u1ea5t huy\u1ebft ti\u1ec3u n\u00e3o g\u00e2y ch\u00e8n \u00e9p l\u00ean c<\/span>\u1ea7u n\u00e3o, v\u00e0 c\u1ea3 trong b\u1ec7nh n\u00e3o chuy\u1ec3n ho\u00e1. Hi\u1ec7n t\u01b0\u1ee3ng m\u1eaft nh\u1ea5p nh\u00f4 \u0111i\u1ec3n h\u00ecnh th\u01b0\u1eddng \u0111\u01b0\u1ee3c g\u1eb7p trong b\u1ec7nh n\u1ed9i t\u1ea1i c\u1ee7a c\u1ea7u n\u00e3o.<\/span><\/p>\n

C\u1eed \u0111\u1ed9ng m\u1eaft nh\u00ecn xu\u1ed1ng (ocular dipping), <\/span>c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 c\u1eed \u0111\u1ed9ng m\u1eaft nh\u1ea5p nh\u00f4 ng\u01b0\u1ee3c (inverse ocular bobbing), l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng hai m\u1eaft c\u00f3 c\u1eed \u0111\u1ed9ng li\u1ebfc nh\u00ecn ch\u1eadm xu\u1ed1ng d\u01b0\u1edbi (1 \u0111\u1ebfn 2 gi\u00e2y) sau \u0111\u00f3 l\u00e0 c\u1eed \u0111\u1ed9ng tr\u00f4i nhanh ng\u01b0\u1ee3c l\u00ean tr\u00ean. Trong c\u1eed \u0111\u1ed9ng m\u1eaft d\u00ecm xu\u1ed1ng, hai m\u1eaft c\u00f3 th\u1ec3 li\u1ebfc nh\u00ecn xu\u1ed1ng d\u01b0\u1edbi v\u1edbi bi\u00ean \u0111\u1ed9 t\u1ed1i \u0111a (\u0111\u1ed3ng t\u1eed b\u1ecb che l\u1ea5p ph\u1ea7n l\u1edbn b\u1edfi mi d\u01b0\u1edbi) v\u00e0 duy tr\u00ec t\u01b0 th\u1ebf n\u00e0y k\u00e9o d\u00e0i \u0111\u1ebfn c\u1ea3 10 gi\u00e2y, tr\u01b0\u1edbc khi tr\u1eddi tr\u1edf ng\u01b0\u1ee3c l\u00ean tr\u00ean. Trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 c\u1eed \u0111\u1ed9ng m\u1eaft d\u00ecm xu\u1ed1ng, c\u00e1c c\u1eed \u0111\u1ed9ng m\u1eaft l\u00e1o li\u00eang ngang v\u1eabn c\u00f2n. C\u1eed \u0111\u1ed9ng m\u1eaft d\u00ecm xu\u1ed1ng \u0111\u01b0\u1ee3c g\u1eb7p trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh n\u00e3o do thi\u1ebfu oxy.<\/span><\/p>\n

C\u1eed \u0111\u1ed9ng m\u1eaft nh\u1ea5p nh\u00f4 tr\u1edf l\u1ea1i (reverse ocular bobbing) <\/span>l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng hai m\u1eaft c\u1eed \u0111\u1ed9ng nhanh l\u00ean tr\u00ean sau \u0111\u00f3 l\u1ea1i tr\u00f4i t\u1eeb t\u1eeb tr\u1edf xu\u1ed1ng v\u1ec1 v\u1ecb tr\u00ed trung gian ban \u0111\u1ea7u. Hi\u1ec7n t\u01b0\u1ee3ng n\u00e0y \u0111\u01b0\u1ee3c ghi nh\u1eadn trong c\u00e1c b\u1ec7nh n\u00e3o chuy\u1ec3n ho\u00e1 v\u00e0 b\u1ec7nh n\u00e3o do thi\u1ebfu oxy.<\/span><\/p>\n

2.4. \u0110\u1ed3ng t\u1eed<\/strong><\/h3>\n

Khi kh\u00e1m \u0111\u1ed3ng t\u1eed b\u1ec7nh nh\u00e2n h\u00f4n m\u00ea c\u1ea7n ch\u00fa \u00fd \u0111\u1ebfn k\u00edch th\u01b0\u1edbc, \u0111\u1ed9 tr\u00f2n m\u00e9o, \u0111\u00e1p \u1ee9ng tr\u1ef1c ti\u1ebfp v\u00e0 \u0111\u1ed3ng c\u1ea3m c\u1ee7a \u0111\u1ed3ng t\u1eed \u0111\u1ed1i k\u00edch th\u00edch \u00e1nh s\u00e1ng (ph\u1ea3n x\u1ea1 quang v\u1eadn \u0111\u1ed9ng). Trong tr\u01b0\u1eddng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng trung n\u00e3o \u0111\u1ed3ng t\u1eed kh\u00f4ng co v\u00e0 kh\u00f4ng gi\u00e3n, c\u00f3 \u0111\u01b0\u1eddng k\u00ednh 3-5 cm v\u00e0 kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi k\u00edch th\u00edch \u00e1nh s\u00e1ng. \u0110\u1ed3ng t\u1eed c\u00f2n ph\u1ea3n x\u1ea1 v\u1edbi k\u00edch th\u00edch \u00e1nh s\u00e1ng th\u00ec ch\u1ee9ng t\u1ecf trung n\u00e3o c\u00f2n to\u00e0n v\u1eb9n. Trong tr\u01b0\u1eddng h\u1ee3p h\u00f4n m\u00ea do r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a ho\u1eb7c do ng\u1ed9 \u0111\u1ed9c c\u00e1c c\u1eed \u0111\u1ed9ng m\u1eaft v\u00e0 ph\u1ea3n x\u1ea1 gi\u00e1c m\u1ea1c b\u1ecb m\u1ea5t nh\u0169ng ph\u1ea3n x\u1ea1 \u00e1nh s\u00e1ng v\u1eabn c\u00f2n. Trong tr\u01b0\u1eddng h\u1ee3p d\u00e2y s\u1ecd in b\u1ecb ch\u00e8n \u00e9p, th\u00ed d\u1ee5 nh\u01b0 trong t\u1ee5t n\u00e3o th\u00f9y th\u00e1i d\u01b0\u01a1ng, \u0111\u1ed3ng t\u1eed b\u00ean b\u1ecb ch\u00e8n \u00e9p gi\u00e3n to v\u00e0 kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi k\u00edch th\u00edch \u00e1nh s\u00e1ng. Hai \u0111\u1ed3ng t\u1eed co nh\u1ecf, c\u00f2n \u0111\u00e1p \u00fat v\u1edbi k\u00edch th\u00edch \u00e1nh s\u00e1ng th\u00ec g\u1ee3i \u00fd \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng c\u1ee7a c\u1ea7u n\u00e3o. Hi\u1ec7n t\u01b0\u1ee3ng t\u01b0\u01a1ng t\u1ef1 c\u0169ng \u0111\u01b0\u1ee3c th\u1ea5y trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p ng\u1ed9 \u0111\u1ed9c thu\u1ed1c phi\u1ec7n. Ph\u1ea3n x\u1ea1 mi gai l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng \u0111\u1ed3ng t\u1eed gi\u00e3n ra khi c\u00f3 k\u00edch th\u00edch \u0111au \u1edf c\u1ed5: s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a ph\u1ea3n x\u1ea1 n\u00e0y ch\u1ee9ng t\u1ecf th\u00e2n n\u00e3o c\u00f2n to\u00e0n v\u1eb9n, s\u1ef1 m\u1ea5t \u0111i c\u1ee7a ph\u1ea3n x\u1ea1 n\u00e0y ch\u1ee9ng t\u1ecf l\u00e0 trung n\u00e3o b\u1ecb t\u1ed5n th\u01b0\u01a1ng n\u1eb7ng n\u1ec1.<\/span><\/p>\n

2.5. Ki\u1ec3u c\u00e1ch th\u1edf<\/strong><\/h3>\n

Trong \u0111\u00e1nh gi\u00e1 h\u00f4n m\u00ea, ng\u01b0\u1eddi ta \u0111\u00e3 ch\u00fa \u00fd t\u1eeb l\u00e2u \u0111\u1ebfn \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a ki\u1ec3u th\u1edf nh\u01b0ng th\u1eadt ra c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a chu k\u1ef3 th\u1edf \u00edt c\u00f3 gi\u00e1 tr\u1ecb.<\/span><\/p>\n

Ki\u1ec3u th\u1edf Cheyne-Stokes <\/span>g\u1ed3m c\u00e1c giai \u0111o\u1ea1n th\u1edf nhanh d\u1ea7n v\u00e0 th\u1edf ch\u1eadm d\u1ea7n lu\u00e2n phi\u00ean xen k\u1ebd nhau, \u0111\u01b0\u1ee3c ghi nh\u1eadn trong t\u1ed5n th\u01b0\u01a1ng ph\u1ea7n s\u00e2u c\u1ee7a b\u00e1n c\u1ea7u \u0111\u1ea1i n\u00e3o hai b\u00ean ho\u1eb7c ph\u1ea7n ng\u1ecdn c\u1ee7a th\u00e2n n\u00e3o. Nh\u1ecbp th\u1edf Cheyne-Stokes c\u00f2n \u0111\u01b0\u1ee3c ghi nh\u1eadn trong nh\u1eefng b\u1ec7nh ngo\u00e0i h\u1ec7 th\u1ea7n kinh, v\u00ed d\u1ee5 nh\u01b0 trong suy tim.<\/span><\/p>\n

Ki\u1ec3u th\u1edf t\u0103ng th\u00f4ng kh\u00ed th\u1ea7n kinh trung \u01b0\u01a1ng <\/span>c\u00f3 nh\u1ecbp nhanh \u0111\u1ec1u v\u00e0 s\u00e2u d\u1ea7n v\u1edbi t\u1ea7n s\u1ed1 l\u00e0 25 nh\u1ecbp\/ph\u00fat. Ki\u1ec3u th\u1edf n\u00e0y \u00edt c\u00f3 gi\u00e1 tr\u1ecb \u0111\u1ecbnh v\u1ecb t\u1ed5n th\u01b0\u01a1ng nh\u01b0ng th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn nh\u1eefng t\u1ed5n th\u01b0\u01a1ng lan r\u1ed9ng c\u1ee7a th\u00e2n n\u00e3o. T\u00ednh ch\u1ea5t \u0111\u1ec1u \u0111\u1eb7n c\u1ee7a nh\u1ecbp th\u1edf \u1edf \u0111\u00e2y l\u00e0 m\u1ed9t d\u1ea5u hi\u1ec7u ti\u00ean l\u01b0\u1ee3ng x\u1ea5u, nh\u1ecbp th\u1edf c\u00e0ng \u0111\u1ec1u \u0111\u1eb7n bao nhi\u00eau th\u00ec h\u00f4n m\u00ea c\u00e0ng s\u00e2u b\u1ea5y nhi\u00eau, c\u1ea7n l\u01b0u \u00fd lo\u1ea1i tr\u1eeb c\u00e1c tr\u1ea1ng th\u00e1i nhi\u1ec5m acid v\u00e0 thi\u1ebfu oxy m\u00e1u tr\u01b0\u1edbc khi k\u1ebft lu\u1eadn l\u00e0 b\u1ec7nh nh\u00e2n h\u00f4n m\u00ea c\u00f3 nh\u1ecbp th\u1edf t\u0103ng th\u00f4ng kh\u00ed th\u1ea7n kinh trung \u01b0\u01a1ng.<\/span><\/p>\n

Trong tr\u01b0\u1eddng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng c\u1ea7u n\u00e3o, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u00f3 th\u00ec h\u00edt v\u00e0o k\u00e9o d\u00e0i sau \u0111\u00f3 ng\u1eebng th\u1edf trong m\u1ed9t th\u1eddi gian ng\u1eafn tr\u01b0\u1edbc khi th\u1edf ra, ho\u1eb7c c\u00f3 nh\u1ecbp h\u00f4 h\u1ea5p g\u1ed3m nhi\u1ec1u c\u1ee5m h\u00edt v\u00e0o th\u1edf ra xen k\u1ebd b\u1edfi c\u00e1c giai \u0111o\u1ea1n ng\u1eebng th\u1edf ho\u00e0n to\u00e0n.<\/span><\/p>\n

Nh\u1ecbp th\u1edf th\u1ea5t \u0111i\u1ec1u <\/span>v\u00e0 th\u1edf ng\u00e1p c\u00e1 \u0111\u01b0\u1ee3c g\u1eb7p <\/span>\u1edf <\/span>nh\u1eefng b\u1ec7nh nh\u00e2n h\u1ea5p h\u1ed1i, v\u00e0 ch\u1ee9ng t\u1ecf l\u00e0 h\u00e0nh n\u00e3o \u0111\u00e3 b\u1ecb t\u1ed5n th\u01b0\u01a1ng. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p suy ch\u1ee9c n\u0103ng h\u00e0nh n\u00e3o do thu\u1ed1c th\u00ec nh\u1ecbp th\u1edf tr\u1edf n\u00ean ch\u1eadm v\u00e0 s\u00e2u.<\/span><\/p>\n

Ngu\u1ed3n tham kh\u1ea3o: Th\u1ea7n kinh h\u1ecdc- \u0110H Y TP H\u1ed3 Ch\u00ed Minh<\/em><\/p>\n

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

B\u1ec7nh nh\u00e2n h\u00f4n m\u00ea khi nh\u1eadp vi\u1ec7n c\u1ea7n th\u0103m kh\u00e1m t\u1ed5ng qu\u00e1t \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 nguy\u00ean nh\u00e2n g\u00e2y ra t\u00ecnh tr\u1ea1ng h\u00f4n m\u00ea. Song song v\u1edbi ph\u1ea7n th\u0103m kh\u00e1m t\u1ed5ng qu\u00e1t, v\u1ed1n c\u1ea7n \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh g\u1ecdn v\u00e0 nhanh, vi\u1ec7c th\u0103m kh\u00e1m th\u1ea7n kinh h\u1ecdc \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 […]<\/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\u00e1ch th\u0103m kh\u00e1m th\u1ea7n kinh \u1edf b\u1ec7nh nh\u00e2n h\u00f4n m\u00ea - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u1ec7nh nh\u00e2n h\u00f4n m\u00ea khi nh\u1eadp vi\u1ec7n c\u1ea7n th\u0103m kh\u00e1m t\u1ed5ng qu\u00e1t \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 nguy\u00ean nh\u00e2n g\u00e2y ra t\u00ecnh tr\u1ea1ng h\u00f4n m\u00ea. 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