{"id":2970,"date":"2023-04-22T00:11:02","date_gmt":"2023-04-21T17:11:02","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=2970"},"modified":"2023-04-22T00:11:02","modified_gmt":"2023-04-21T17:11:02","slug":"sang-khong-do-ruou-huong-dan-chan-doan-va-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/sang-khong-do-ruou-huong-dan-chan-doan-va-dieu-tri\/","title":{"rendered":"Sa\u0309ng kh\u00f4ng do r\u01b0\u01a1\u0323u va\u0300 ca\u0301c ch\u00e2\u0301t ta\u0301c \u0111\u00f4\u0323ng t\u00e2m th\u00e2\u0300n – H\u01b0\u01a1\u0301ng d\u00e2\u0303n ch\u00e2\u0309n \u0111oa\u0301n va\u0300 \u0111i\u00ea\u0300u tri\u0323"},"content":{"rendered":"

Sa\u0309ng<\/a> co\u0301 th\u1ec3 x\u1ea3y ra \u1edf m\u1ecdi \u0111\u1ed9 tu\u1ed5i, nh\u01b0ng ph\u1ed5 bi\u1ebfn h\u01a1n \u1edf nh\u1eefng ng\u01b0\u1eddi cao tu\u1ed5i. Theo th\u1ed1ng k\u00ea, \u00edt nh\u1ea5t 10% b\u1ec7nh nh\u00e2n cao tu\u1ed5i \u0111\u01b0\u1ee3c nh\u1eadp vi\u1ec7n b\u1ecb s\u1ea3ng v\u00e0 kho\u1ea3ng 15 \u0111\u1ebfn 50% trong s\u1ed1 h\u1ecd c\u00f3 th\u1ec3 tr\u1ea3i qua t\u00ecnh tr\u1ea1ng s\u1ea3ng trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb. S\u1ea3ng c\u0169ng th\u01b0\u1eddng g\u1eb7p sau ph\u1eabu thu\u1eadt, t\u1ea1i c\u00e1c khu d\u01b0\u1ee1ng l\u00e3o v\u00e0 \u1edf c\u00e1c b\u1ec7nh nh\u00e2n trong \u0111\u01a1n v\u1ecb ch\u0103m s\u00f3c t\u00edch c\u1ef1c (ICU). Ngo\u00e0i ra, s\u1ea3ng c\u00f2n x\u1ea3y ra \u1edf ng\u01b0\u1eddi tr\u1ebb do s\u1eed d\u1ee5ng ma t\u00fay ho\u1eb7c b\u1ec7nh l\u00fd \u0111e d\u1ecda t\u00ednh m\u1ea1ng.<\/strong><\/p>\n

Ba\u0300i vi\u00ea\u0301t tham kha\u0309o va\u0300 tri\u0301ch d\u00e2\u0303n t\u01b0\u0300<\/em> h\u01b0\u01a1\u0301ng d\u00e2\u0303n ch\u00e2\u0309n \u0111oa\u0301n va\u0300 \u0111i\u00ea\u0300u tri\u0323 m\u00f4\u0323t s\u00f4\u0301 r\u00f4\u0301i loa\u0323n t\u00e2m th\u00e2\u0300n th\u01b0\u01a1\u0300ng g\u0103\u0323p (Ban h\u00e0nh k\u00e8m theo Quy\u1ebft \u0111\u1ecbnh s\u1ed1 2058\/Q\u0110-BYT Ng\u00e0y 14 th\u00e1ng 05 n\u0103m 2020 c\u1ee7a B\u1ed9 tr\u01b0\u1edfng B\u1ed9 Y t\u1ebf).\u00a0<\/em><\/p>\n

1. SA\u0309NG LA\u0300 GI\u0300 ?<\/b><\/h2>\n

S\u1ea3ng<\/a> l\u00e0 m\u1ed9t thu\u1eadt ng\u1eef \u0111\u01b0\u1ee3c g\u1ecdi b\u1eb1ng nhi\u1ec1u t\u00ean kh\u00e1c nhau: tr\u1ea1ng th\u00e1i l\u00fa l\u1eabn c\u1ea5p, h\u1ed9i ch\u1ee9ng n\u00e3o c\u1ea5p, b\u1ec7nh n\u00e3o do chuy\u1ec3n h\u00f3a, lo\u1ea1n th\u1ea7n do nhi\u1ec5m \u0111\u1ed9c\u2026v\u00e0 \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ed1ng nh\u1ea5t g\u1ecdi chung l\u00e0 s\u1ea3ng. Theo b\u1ea3ng ph\u00e2n lo\u1ea1i b\u1ec7nh qu\u1ed1c t\u1ebf l\u1ea7n th\u1ee9 10 (ICD 10) v\u00e0 th\u1ed1ng k\u00ea r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n v\u00e0 h\u00e0nh vi c\u1ee7a Hoa k\u1ef3 l\u1ea7n 4 (DSM-4) \u0111\u00e2y l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng \u0111\u1eb7c tr\u01b0ng b\u1edfi r\u1ed1i lo\u1ea1n s\u1ef1 \u00fd th\u1ee9c t\u1ee9c l\u00e0 gi\u1ea3m s\u1ef1 t\u1ec9nh t\u00e1o v\u00e0 nh\u1eadn bi\u1ebft v\u1ec1 m\u00f4i tr\u01b0\u1eddng xung quanh, gi\u1ea3m \u0111\u1ed9 t\u1eadp trung v\u00e0 duy tr\u00ec ho\u1eb7c thay \u0111\u1ed5i ch\u00fa \u00fd.<\/p>\n

\"Sa\u0309ng\"
Sa\u0309ng<\/figcaption><\/figure>\n

2. NGUY\u00caN NH\u00c2N G\u00c2Y RA SA\u0309NG<\/b><\/h2>\n

Ngo\u00e0i r\u01b0\u1ee3u v\u00e0 c\u00e1c ch\u1ea5t t\u00e1c \u0111\u1ed9ng t\u00e2m th\u1ea7n, m\u00f4\u0323t s\u00f4\u0301 nguy\u00ean nh\u00e2n g\u00e2y m\u00ea sa\u0309ng kha\u0301c g\u00f4\u0300m co\u0301:<\/p>\n

–\u00a0Ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o, kh\u1ed1i u n\u00e3o, xu\u1ea5t huy\u1ebft ngo\u00e0i m\u00e0ng c\u1ee9ng, \u00e1p xe, xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd, xu\u1ea5t huy\u1ebft n\u00e3o, \u0111\u1ed9t qu\u1ef5 kh\u00f4ng xu\u1ea5t huy\u1ebft, thi\u1ebfu m\u00e1u t\u1ea1m th\u1eddi\u2026<\/p>\n

–\u00a0R\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a, r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i\u2026<\/p>\n

–\u00a0\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng, h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft, ho\u1eb7c kh\u00e1ng insulin<\/p>\n

–\u00a0Nhi\u1ec5m tr\u00f9ng (nh\u01b0 nhi\u1ec5m khu\u1ea9n huy\u1ebft, s\u1ed1t r\u00e9t, virut, b\u1ec7nh d\u1ecbch h\u1ea1ch, giang mai, \u00e1p xe\u2026)<\/p>\n

–\u00a0C\u00e1c lo\u1ea1i thu\u1ed1c nh\u01b0 gi\u1ea3m \u0111au, kh\u00e1ng sinh, ch\u1ed1ng ung th\u01b0\u2026 c\u00f3 th\u1ec3 g\u00e2y m\u00ea s\u1ea3ng khi s\u1eed d\u1ee5ng.<\/p>\n

–\u00a0H\u1ed9i ch\u1ee9ng an th\u1ea7n kinh \u00e1c t\u00ednh, h\u1ed9i ch\u1ee9ng serotonin\u2026<\/p>\n

–\u00a0C\u00e1c b\u1ec7nh c\u01a1 th\u1ec3 n\u1eb7ng: vi\u00eam gan, suy th\u1eadn, suy tim\u2026<\/p>\n

–\u00a0Thi\u1ebfu dinh d\u01b0\u1ee1ng\u2026<\/p>\n

3. CH\u1ea8N \u0110O\u00c1N SA\u0309NG<\/b><\/h2>\n

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

T\u00ednh ch\u1ea5t s\u1ea3ng x\u1ea3y ra<\/strong><\/p>\n

    \n
  • X\u1ea3y ra \u1edf b\u1ea5t k\u1ef3 l\u1ee9a tu\u1ed5i n\u00e0o, ph\u1ed5 bi\u1ebfn \u1edf l\u1ee9a tu\u1ed5i tr\u00ean 60.<\/li>\n
  • H\u1ed9i ch\u1ee9ng \u0111\u1eb7c tr\u01b0ng b\u1edfi r\u1ed1i lo\u1ea1n \u0111\u1ed3ng th\u1eddi \u00fd th\u1ee9c, ch\u00fa \u00fd, tri gi\u00e1c, t\u01b0 duy, tr\u00ed nh\u1edb, t\u00e2m th\u1ea7n v\u1eadn \u0111\u1ed9ng, c\u1ea3m x\u00fac v\u00e0 chu k\u1ef3 th\u1ee9c ng\u1ee7.<\/li>\n
  • Ph\u1ea7n l\u1edbn c\u00e1c tr\u01b0\u1eddng h\u1ee3p h\u1ed3i ph\u1ee5c trong v\u00f2ng 4 tu\u1ea7n ho\u1eb7c \u00edt h\u01a1n.<\/li>\n<\/ul>\n

    \u0110\u1ec3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh, c\u00e1c tri\u1ec7u ch\u1ee9ng, nh\u1eb9 ho\u1eb7c n\u1eb7ng, ph\u1ea3i c\u00f3 \u1edf m\u1ed7i m\u1ed9t l\u0129nh v\u1ef1c trong c\u00e1c l\u0129nh v\u1ef1c sau:<\/b><\/h4>\n
      \n
    • T\u1eadt ch\u1ee9ng v\u1ec1 \u00fd th\u1ee9c v\u00e0 s\u1ef1 ch\u00fa \u00fd (\u0111i t\u1eeb m\u00f9 m\u1edd \u0111\u1ebfn h\u00f4n m\u00ea; gi\u1ea3m kh\u1ea3 n\u0103ng \u0111\u1ecbnh h\u01b0\u1edbng t\u1eadp trung, duy tr\u00ec v\u00e0 s\u1ef1 thay \u0111\u1ed5i ch\u00fa \u00fd)<\/li>\n
    • R\u1ed1i lo\u1ea1n to\u00e0n b\u1ed9 nh\u1eadn th\u1ee9c (l\u1ec7ch l\u1ea1c tri gi\u00e1c, \u1ea3o t\u01b0\u1edfng v\u00e0 \u1ea3o gi\u00e1c – ph\u1ea7n l\u1edbn l\u00e0 th\u1ecb gi\u00e1c; suy gi\u1ea3m t\u01b0 duy tr\u1eebu t\u01b0\u1ee3ng v\u00e0 th\u00f4ng hi\u1ec3u; c\u00f3 ho\u1eb7c kh\u00f4ng k\u00e8m theo hoang t\u01b0\u1edfng nh\u1ea5t th\u1eddi; nh\u01b0ng \u0111i\u1ec3n h\u00ecnh l\u00e0 t\u01b0 duy kh\u00f4ng li\u00ean quan; suy gi\u1ea3m tr\u00ed nh\u1edb t\u00e1i hi\u1ec7n g\u1ea7n v\u00e0 t\u1ee9c th\u1eddi nh\u01b0ng tr\u00ed nh\u1edb xa v\u1eabn t\u01b0\u01a1ng \u0111\u1ed1i c\u00f2n duy tr\u00ec; r\u1ed1i lo\u1ea1n \u0111\u1ecbnh h\u01b0\u1edbng v\u1ec1 th\u1eddi gian,v\u1ec1 kh\u00f4ng gian v\u00e0 b\u1ea3n th\u00e2n trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p tr\u1ea7m tr\u1ecdng h\u01a1n.<\/li>\n
    • R\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n v\u1eadn \u0111\u1ed9ng (gi\u1ea3m ho\u1eb7c t\u0103ng ho\u1ea1t \u0111\u1ed9ng; th\u1eddi gian ph\u1ea3n \u1ee9ng t\u0103ng; t\u0103ng ho\u1eb7c gi\u1ea3m d\u00f2ng ng\u00f4n ng\u1eef; ph\u1ea3n \u1ee9ng gi\u1eadt m\u00ecnh t\u0103ng l\u00ean).<\/li>\n
    • R\u1ed1i lo\u1ea1n chu k\u1ef3 th\u1ee9c – ng\u1ee7 (ng\u1ee7 k\u00e9m ho\u1eb7c trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p tr\u1ea7m tr\u1ecdng, m\u1ea5t ng\u1ee7 ho\u00e0n to\u00e0n ho\u1eb7c chu k\u1ef3 th\u1ee9c ng\u1ee7 \u0111\u1ea3o ng\u01b0\u1ee3c, ng\u1ee7 nhi\u1ec1u ban ng\u00e0y; tri\u1ec7u ch\u1ee9ng x\u1ea5u h\u01a1n v\u1ec1 ban \u0111\u00eam, c\u00f3 th\u1ec3 c\u00f3 \u00e1c m\u1ed9ng)<\/li>\n
    • R\u1ed1i lo\u1ea1n c\u1ea3m x\u00fac nh\u01b0 tr\u1ea7m c\u1ea3m, lo \u00e2u, lo s\u1ee3, c\u00e1u k\u1ec9nh, kho\u00e1i c\u1ea3m, v\u00f4 c\u1ea3m ho\u1eb7c b\u00e0ng ho\u00e0ng ng\u01a1 ng\u00e1c\u2026<\/li>\n
    • Kh\u1edfi ph\u00e1t th\u01b0\u1eddng nhanh, ti\u1ebfn tri\u1ec3n dao \u0111\u1ed9ng trong ng\u00e0y v\u00e0 to\u00e0n b\u1ed9 th\u1eddi gian m\u1eafc b\u1ec7nh d\u01b0\u1edbi 6 th\u00e1ng. B\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng tr\u00ean \u0111\u1eb7c tr\u01b0ng \u0111\u1ebfn m\u1ee9c c\u00f3 th\u1ec3 l\u00e0m ch\u1ea9n \u0111o\u00e1n v\u1ec1 s\u1ea3ng kh\u00e1 tin c\u1eady m\u1eb7c d\u00f9 nguy\u00ean nh\u00e2n b\u00ean d\u01b0\u1edbi ch\u01b0a \u0111\u01b0\u1ee3c l\u00e0m r\u00f5. Th\u00eam v\u00e0o m\u1ed9t b\u1ec7nh s\u1eed c\u1ee7a b\u1ec7nh n\u00e3o ho\u1eb7c b\u1ec7nh c\u01a1 th\u1ec3 n\u1eb1m b\u00ean d\u01b0\u1edbi, b\u1eb1ng ch\u1ee9ng v\u1ec1 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng n\u00e3o c\u1ea7n ph\u1ea3i c\u00f3 n\u1ebfu ch\u1ea9n \u0111o\u00e1n c\u00f2n nghi ng\u1edd (v\u00ed d\u1ee5, \u0111i\u1ec7n n\u00e3o \u0111\u1ed3 kh\u00f4ng b\u00ecnh th\u01b0\u1eddng, th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n s\u00f3ng ch\u1eadm nh\u01b0ng kh\u00f4ng ph\u1ea3i l\u00fac n\u00e0o c\u0169ng v\u1eady).<\/li>\n<\/ul>\n

      3.2. C\u1eadn l\u00e2m s\u00e0ng<\/b><\/h3>\n
        \n
      • X\u00e9t nghi\u1ec7m m\u00e1u: bao g\u1ed3m t\u1ed5ng ph\u00e2n t\u00edch t\u1ebf b\u00e0o m\u00e1u ngo\u1ea1i vi, sinh h\u00f3a m\u00e1u (\u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3, ch\u1ee9c n\u0103ng th\u1eadn v\u00e0 gan, ch\u1ee9c n\u0103ng tuy\u1ebfn gi\u00e1p, glucose, D-dimer, test k\u00edch th\u00edch ACTH,\u2026)<\/li>\n
      • Kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch: \u0111\u00e1nh gi\u00e1 gi\u1ea3m oxy m\u00e1u, t\u0103ng CO2, lactate m\u00e1u.<\/li>\n
      • X\u00e9t nghi\u1ec7m n\u01b0\u1edbc ti\u1ec3u<\/li>\n
      • Th\u0103m d\u00f2 ch\u1ee9c n\u0103ng: \u0111i\u1ec7n t\u00e2m \u0111\u1ed3, \u0111i\u1ec7n n\u00e3o \u0111\u1ed3, l\u01b0u huy\u1ebft n\u00e3o, si\u00eau \u00e2m doppler xuy\u00ean s\u1ecd\u2026<\/li>\n
      • Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh: CT-Scanner, MRI s\u1ecd n\u00e3o, si\u00eau \u00e2m \u1ed5 b\u1ee5ng, ch\u1ee5p Xquang \u1ed5 b\u1ee5ng, ng\u1ef1c\u2026<\/li>\n
      • X\u00e9t nghi\u1ec7m \u0111\u1ed9c ch\u1ea5t trong m\u00e1u: digoxin, lithium, quinidin, r\u01b0\u1ee3u, ma t\u00fay\u2026<\/li>\n
      • D\u1ecbch n\u00e3o t\u1ee7y (CSF) \u0111\u1ec3 ph\u00e1t hi\u1ec7n vi\u00eam n\u00e3o, m\u00e0ng n\u00e3o<\/li>\n
      • X\u00e9t nghi\u1ec7m giang mai, x\u00e9t nghi\u1ec7m kh\u00e1ng th\u1ec3 suy gi\u1ea3m mi\u1ec5n d\u1ecbch \u1edf ng\u01b0\u1eddi (HIV)<\/li>\n
      • C\u00e1c x\u00e9t nghi\u1ec7m b\u1ed5 sung kh\u00e1c trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u1ea7n thi\u1ebft \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh<\/li>\n<\/ul>\n

        3.3. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n sa\u0309ng theo ICD 10<\/b><\/h3>\n

        A. C\u00f3 \u00fd th\u1ee9c u \u00e1m, gi\u1ea3m \u0111\u1ed9 t\u1ec9nh t\u00e1o v\u1ec1 nh\u1eadn bi\u1ebft m\u00f4i tr\u01b0\u1eddng xung quanh<\/p>\n

        B. R\u1ed1i lo\u1ea1n nh\u1eadn th\u1ee9c \u0111\u01b0\u1ee3c bi\u1ec3u hi\u1ec7n b\u1eb1ng c\u1ea3 2 tri\u1ec7u ch\u1ee9ng sau<\/p>\n

          \n
        1. T\u1ed5n th\u01b0\u01a1ng tr\u00ed nh\u1edb g\u1ea7n v\u00e0 tr\u00ed nh\u1edb t\u1ee9c th\u00ec, tr\u00ed nh\u1edb xa kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng<\/li>\n
        2. R\u1ed1i lo\u1ea1n \u0111\u1ecbnh h\u01b0\u1edbng v\u1ec1 kh\u00f4ng gian, th\u1eddi gian ho\u1eb7c ng\u01b0\u1eddi xung quanh<\/li>\n<\/ol>\n

          C. \u00cdt nh\u1ea5t m\u1ed9t trong c\u00e1c r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n v\u1eadn \u0111\u1ed9ng sau xu\u1ea5t hi\u1ec7n<\/p>\n

            \n
          1. S\u1ef1 dao \u0111\u1ed9ng nhanh v\u00e0 kh\u00f4ng th\u1ec3 \u0111o\u00e1n tr\u01b0\u1edbc v\u1ec1 t\u0103ng v\u00e0 gi\u1ea3m ho\u1ea1t \u0111\u1ed9ng<\/li>\n
          2. T\u0103ng th\u1eddi gian ph\u1ea3n \u1ee9ng<\/li>\n
          3. T\u0103ng ho\u1eb7c gi\u1ea3m th\u1eddi gian ph\u1ea3n \u1ee9ng<\/li>\n
          4. T\u0103ng ph\u1ea3n \u1ee9ng gi\u1eadt m\u00ecnh<\/li>\n<\/ol>\n

            D. R\u1ed1i lo\u1ea1n chu k\u1ef3 th\u1ee9c – ng\u1ee7 bi\u1ec3u hi\u1ec7n b\u1eb1ng \u00edt nh\u1ea5t m\u1ed9t trong c\u00e1c tri\u1ec7u ch\u1ee9ng sau:<\/p>\n

              \n
            1. Ng\u1ee7 k\u00e9m ho\u1eb7c trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p tr\u1ea7m tr\u1ecdng m\u1ea5t to\u00e0n b\u1ed9 gi\u1ea5c ng\u1ee7 ho\u1eb7c chu k\u1ef3 th\u1ee9c ng\u1ee7 \u0111\u1ea3o ng\u01b0\u1ee3c, ng\u1ee7 nhi\u1ec1u ban ng\u00e0y;<\/li>\n
            2. Tri\u1ec7u ch\u1ee9ng x\u1ea5u h\u01a1n v\u1ec1 ban \u0111\u00eam,<\/li>\n
            3. C\u00e1c gi\u1ea5c m\u01a1 ho\u1eb7c \u00e1c m\u1ed9ng<\/li>\n<\/ol>\n

              E. C\u00e1c tri\u1ec7u ch\u1ee9ng kh\u1edfi ph\u00e1t nhanh v\u00e0 dao \u0111\u1ed9ng trong ng\u00e0y<\/p>\n

              F. Th\u00eam v\u00e0o m\u1ed9t b\u1ec7nh s\u1eed c\u1ee7a b\u1ec7nh n\u00e3o ho\u1eb7c b\u1ec7nh c\u01a1 th\u1ec3 n\u1eb1m b\u00ean d\u01b0\u1edbi\u00a0b\u1eb1ng ch\u1ee9ng v\u1ec1 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng n\u00e3o c\u1ea7n ph\u1ea3i c\u00f3 n\u1ebfu ch\u1ea9n \u0111o\u00e1n c\u00f2n nghi ng\u1edd (v\u00ed d\u1ee5, \u0111i\u1ec7n n\u00e3o \u0111\u1ed3 kh\u00f4ng b\u00ecnh th\u01b0\u1eddng, th\u01b0\u1eddng cho th\u1ea5y ho\u1ea1t \u0111\u1ed9ng s\u00f3ng c\u01a1 b\u1ea3n b\u1ecb ch\u1eadm, nh\u01b0ng kh\u00f4ng ph\u1ea3i l\u00fac n\u00e0o c\u0169ng v\u1eady)<\/p>\n

              3.4. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/b><\/h3>\n
                \n
              • Sa s\u00fat tr\u00ed tu\u1ec7: c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng gi\u00fap cho vi\u1ec7c ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t. Trong m\u00ea s\u1ea3ng c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u1edfi ph\u00e1t c\u1ea5p di\u1ec5n, \u0111\u1ed9t ng\u1ed9t, c\u00f2n trong sa s\u00fat tr\u00ed tu\u1ec7 tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng kh\u1edfi ph\u00e1t t\u1eeb t\u1eeb, k\u00edn \u0111\u00e1o. C\u00e1c thay \u0111\u1ed5i v\u1ec1 nh\u1eadn th\u1ee9c trong sa s\u00fat tr\u00ed tu\u1ec7 th\u00ec \u1ed5n \u0111\u1ecbnh, kh\u00f4ng dao \u0111\u1ed9ng theo th\u1eddi gian trong ng\u00e0y. Trong sa s\u00fat tr\u00ed tu\u1ec7 b\u1ec7nh nh\u00e2n v\u1eabn t\u1ec9nh t\u00e1o, c\u00f2n m\u1ed9t b\u1ec7nh nh\u00e2n m\u00ea s\u1ea3ng th\u01b0\u1eddng c\u00f3 nh\u1eefng giai \u0111o\u1ea1n \u00fd th\u1ee9c b\u1ecb suy gi\u1ea3m, r\u1ed1i lo\u1ea1n. C\u1ea7n l\u01b0u \u00fd c\u00e1c tr\u01b0\u1eddng h\u1ee3p m\u00ea s\u1ea3ng ch\u1ed3ng l\u1ea5p tr\u00ean b\u1ec7nh nh\u00e2n sa s\u00fat tr\u00ed tu\u1ec7.<\/li>\n
              • T\u00e2m th\u1ea7n ph\u00e2n li\u1ec7t ho\u1eb7c tr\u1ea7m c\u1ea3m, h\u01b0ng c\u1ea3m: Nh\u00ecn chung c\u00e1c tri\u1ec7u ch\u1ee9ng \u1ea3o gi\u00e1c, hoang t\u01b0\u1edfng \u1edf b\u1ec7nh nh\u00e2n t\u00e2m th\u1ea7n ph\u00e2n li\u1ec7t l\u00e0 b\u1ec1n v\u1eefng h\u01a1n v\u00e0 c\u00f3 t\u00ednh ch\u1ea5t h\u1ec7 th\u1ed1ng. Trong t\u00e2m th\u1ea7n ph\u00e2n li\u1ec7t kh\u00f4ng c\u00f3 r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c v\u00e0 r\u1ed1i lo\u1ea1n \u0111\u1ecbnh h\u01b0\u1edbng. M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n m\u00ea s\u1ea3ng v\u1edbi gi\u1ea3m ho\u1ea1t \u0111\u1ed9ng c\u1ea7n ph\u00e2n bi\u1ec7t v\u1edbi tr\u1ea7m c\u1ea3m d\u1ef1a v\u00e0o l\u00e2m s\u00e0ng v\u00e0 \u0111i\u1ec7n n\u00e3o \u0111\u1ed3. Tuy nhi\u00ean c\u00e1c b\u1ec7nh n\u00e0y c\u0169ng d\u1eabn t\u1edbi s\u1ea3ng ho\u1eb7c do t\u1ef1 b\u1ecf b\u00ea ho\u1eb7c ki\u1ec7t s\u1ee9c ho\u1eb7c do thu\u1ed1c h\u01b0\u1edbng th\u1ea7n m\u1ea1nh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb.<\/li>\n
              • C\u00e1c b\u1ec7nh l\u00fd c\u01a1 th\u1ec3: nh\u1ed3i m\u00e1u n\u00e3o, nh\u1ed3i m\u00e1u c\u01a1 tim, nhi\u1ec5m tr\u00f9ng c\u1ea5p, t\u0103ng\/h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, h\u1ea1 oxy m\u00e1u, t\u0103ng CO2 m\u00e1u, t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u c\u1ea5p t\u00ednh, r\u1ed1i lo\u1ea1n do ch\u1ea5t\/thu\u1ed1c, h\u1ed9i ch\u1ee9ng n\u00e3o gan, suy th\u1eadn, t\u0103ng\/h\u1ea1 Na m\u00e1u, h\u1ea1 Canci m\u00e1u, vi\u00eam n\u00e3o-m\u00e0ng n\u00e3o, u n\u00e3o, tr\u1ea1ng th\u00e1i sau \u0111\u1ed9t qu\u1ef5 n\u00e3o, t\u00e1o b\u00f3n, sau ch\u1ea5n th\u01b0\u01a1ng n\u00e3o, b\u1ec7nh Addison, nhi\u1ec5m \u0111\u1ed9c gi\u00e1p, h\u00f4n m\u00ea do suy gi\u00e1p, \u00e1p-xe n\u00e3o, giang mai n\u00e3o, b\u1ec7nh n\u00e3o Wernick.<\/li>\n<\/ul>\n

                4. \u0110I\u1ec0U TR\u1eca S<\/b>A\u0309NG\u00a0<\/b><\/h2>\n

                4.1. Nguy\u00ean t\u1eafc \u0111i\u00ea\u0300u tri\u0323 sa\u0309ng<\/b><\/h3>\n
                  \n
                • \u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n g\u00e2y m\u00ea s\u1ea3ng, vi\u1ec7c ph\u00e1t hi\u1ec7n nguy\u00ean nh\u00e2n g\u00e2y m\u00ea s\u1ea3ng v\u00e0 x\u1eed tr\u00ed nguy\u00ean nh\u00e2n l\u00e0 \u0111i\u1ec1u c\u1ed1t l\u00f5i.<\/li>\n
                • Ki\u1ec3m so\u00e1t h\u00e0nh vi: gi\u1ea3i quy\u1ebft nguy\u00ean nh\u00e2n b\u00ean d\u01b0\u1edbi n\u1ebfu c\u00f3 th\u1ec3. T\u1ea1o m\u00f4i tr\u01b0\u1eddng th\u00e2n thu\u1ed9c, t\u01b0\u01a1ng t\u00e1c b\u00ecnh t\u0129nh, kh\u00f4ng \u0111\u1ed1i \u0111\u1ea7u.<\/li>\n
                • H\u00f3a d\u01b0\u1ee3c: \u0111i\u1ec1u tr\u1ecb h\u00f3a d\u01b0\u1ee3c x\u1eed l\u00fd c\u00e1c tri\u1ec7u ch\u1ee9ng r\u1ed1i lo\u1ea1n. Li\u1ec1u l\u01b0\u1ee3ng \u0111\u1ed1i v\u1edbi m\u00ea s\u1ea3ng th\u01b0\u1eddng th\u1ea5p h\u01a1n ch\u1ec9 \u0111\u1ecbnh th\u00f4ng th\u01b0\u1eddng, li\u1ec1u th\u1ea5p nh\u1ea5t c\u00f3 hi\u1ec7u qu\u1ea3 trong th\u1eddi gian ng\u1eafn nh\u1ea5t c\u00f3 th\u1ec3.<\/li>\n<\/ul>\n

                  4.2. S\u01a1 \u0111\u1ed3\/ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb sa\u0309ng<\/b><\/h3>\n
                    \n
                  • \u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n<\/li>\n
                  • \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng m\u00ea s\u1ea3ng<\/li>\n
                  • Ch\u0103m s\u00f3c qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n<\/li>\n<\/ul>\n

                    4.3. \u0110i\u1ec1u tr\u1ecb sa\u0309ng c\u1ee5 th\u1ec3<\/b><\/h3>\n

                    4.3.1. Li\u1ec7u ph\u00e1p h\u00f3a d\u01b0\u1ee3c<\/h4>\n

                    An th\u1ea7n kinh<\/strong>: L\u1ef1a ch\u1ecdn m\u1ed9t, hai ho\u1eb7c ba thu\u1ed1c trong c\u00e1c thu\u1ed1c sau:<\/p>\n

                      \n
                    • Haloperidol: 5mg – 20 mg\/ng\u00e0y<\/li>\n
                    • Risperidon: 0,5mg – 10mg\/ng\u00e0y<\/li>\n
                    • Clozapin: 25mg – 300mg\/ng\u00e0y<\/li>\n
                    • Olanzapin: 5mg – 30mg\/ng\u00e0y<\/li>\n
                    • Quetiapin: 50mg – 800mg\/ng\u00e0y<\/li>\n
                    • Aripiprazol: 10 – 30mg\/ng\u00e0y<\/li>\n<\/ul>\n

                      \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh Parkinson ho\u1eb7c SSTT th\u1ec3 Lewy v\u00e0 m\u00ea s\u1ea3ng l\u1ef1a ch\u1ecdn thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n \u00edt nguy c\u01a1 l\u00e0m tr\u1ea7m tr\u1ecdng th\u00eam c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh Parkinson (clozapin ho\u1eb7c quetiapin), kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng haloperidol.<\/p>\n

                      M\u1ea5t ng\u1ee7 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u1ed1t v\u1edbi c\u00e1c thu\u1ed1c nh\u00f3m benzodiazepin c\u00f3 th\u1eddi gian b\u00e1n th\u1ea3i ng\u1eafn ho\u1eb7c trung b\u00ecnh (v\u00ed d\u1ee5 lorazepam, zopiclon). Thu\u1ed1c c\u00f3 th\u1eddi gian b\u00e1n th\u1ea3i d\u00e0i v\u00e0 barbiturate n\u00ean tr\u00e1nh<\/p>\n

                      Ch\u0103m s\u00f3c, h\u1ed7 tr\u1ee3 l\u00e0 c\u1ea7n thi\u1ebft v\u1edbi b\u1ec7nh nh\u00e2n. Nguy\u00ean nh\u00e2n g\u00e2y m\u00ea s\u1ea3ng r\u1ea5t nhi\u1ec1u k\u00e8m theo c\u00e1c r\u1ed1i lo\u1ea1n n\u1eb1m b\u00ean d\u01b0\u1edbi c\u1ea7n \u0111\u01b0\u1ee3c ch\u0103m s\u00f3c gi\u1ea3m thi\u1ec3u c\u00e1c nguy c\u01a1 c\u0169ng nh\u01b0 c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng b\u1ec7nh.<\/p>\n

                      C\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 s\u1ea3ng th\u01b0\u1eddng cao tu\u1ed5i n\u00ean ch\u0103m s\u00f3c l\u00e0 g\u00f3p ph\u1ea7n gi\u1ea3m c\u00e1c bi\u1ebft ch\u1ee9ng g\u00e2y ra: ti\u1ec3u kh\u00f4ng t\u1ef1 ch\u1ee7, b\u1ea5t \u0111\u1ed9ng, ng\u00e3, lo\u00e9t do t\u00ec \u0111\u00e8, m\u1ea5t n\u01b0\u1edbc, suy dinh d\u01b0\u1ee1ng\u2026.<\/p>\n

                      C\u00e1c thu\u1ed1c t\u0103ng c\u01b0\u1eddng ch\u1ee9c n\u0103ng nh\u1eadn th\u1ee9c:\u00a0<\/b>L\u1ef1a ch\u1ecdn thu\u1ed1c trong s\u1ed1 c\u00e1c thu\u1ed1c sau:<\/p>\n

                        \n
                      • Donepezil: 5mg – 23mg\/ng\u00e0y<\/li>\n
                      • Rivastigmin: 1,5mg – 12mg\/ng\u00e0y (\u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c mi\u1ebfng d\u00e1n)<\/li>\n
                      • Galantamin: 8mg – 24mg\/ ng\u00e0y\u2026<\/li>\n<\/ul>\n

                        C\u00e1c thu\u1ed1c nu\u00f4i d\u01b0\u1ee1ng, b\u1ea3o v\u1ec7 t\u1ebf b\u00e0o th\u1ea7n kinh<\/b>: L\u1ef1a ch\u1ecdn m\u1ed9t, hai ho\u1eb7c ba thu\u1ed1c trong c\u00e1c thu\u1ed1c sau:<\/p>\n

                          \n
                        • Cerebrolysin 10ml – 20ml\/ng\u00e0y<\/li>\n
                        • Ginkgo biloba 80mg – 120mg\/ng\u00e0y<\/li>\n
                        • Piracetam 400mg – 1200mg\/ng\u00e0y<\/li>\n
                        • Citicholin 100mg – 1000mg\/ng\u00e0y<\/li>\n
                        • Cholin alfoscerate 200mg – 800mg\/ng\u00e0y<\/li>\n
                        • Vinpocetin 5mg – 100mg\/ng\u00e0y<\/li>\n
                        • Nicergolin 10mg – 30mg\/ng\u00e0y<\/li>\n
                        • Thu\u1ed1c ch\u1ed1ng oxy h\u00f3a: vitamin E, selegiline.<\/li>\n<\/ul>\n

                          Thu\u1ed1c h\u1ed7 tr\u1ee3 ch\u1ee9c n\u0103ng gan:\u00a0<\/b>aminoleban, silymarin, boganic, c\u00e1c amin ph\u00e2n nh\u00e1nh kh\u00e1c \u2026<\/p>\n

                          B\u1ed5 sung dinh d\u01b0\u1ee1ng, vitamin, kho\u00e1ng ch\u1ea5t, ch\u1ebf \u0111\u1ed9 \u0103n, nu\u00f4i d\u01b0\u1ee1ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch\u2026<\/p>\n

                          4.3.2. Li\u1ec7u ph\u00e1p t\u00e2m l\u00fd<\/h4>\n
                            \n
                          • Li\u1ec7u ph\u00e1p t\u00e2m l\u00fd tr\u1ef1c ti\u1ebfp: <\/i>Li\u1ec7u ph\u00e1p gia \u0111\u00ecnh, li\u1ec7u ph\u00e1p t\u00e2m l\u00fd c\u00e1 nh\u00e2n\u2026<\/li>\n
                          • Li\u1ec7u ph\u00e1p t\u00e2m l\u00fd gi\u00e1n ti\u1ebfp:<\/i>\n
                              \n
                            • \u0110\u1ea3m b\u1ea3o m\u00f4i tr\u01b0\u1eddng an to\u00e0n v\u1edbi b\u1ec7nh nh\u00e2n v\u00e0 m\u1ecdi ng\u01b0\u1eddi xung quanh<\/li>\n
                            • M\u00f4i tr\u01b0\u1eddng y\u00ean t\u0129nh, tr\u00e1nh c\u00e1c k\u00edch th\u00edch xung quanh<\/li>\n
                            • V\u1ec7 sinh gi\u1ea5c ng\u1ee7<\/li>\n
                            • Gi\u00e1o d\u1ee5c gia \u0111\u00ecnh v\u1ec1 ch\u0103m s\u00f3c, nu\u00f4i d\u01b0\u1ee1ng b\u1ec7nh nh\u00e2n\u2026<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                              4.3.3. V\u1eadt l\u00fd tr\u1ecb li\u1ec7u v\u00e0 ho\u1ea1t \u0111\u1ed9ng tr\u1ecb li\u1ec7u<\/h4>\n

                              4.3.4. \u0110i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd c\u01a1 th\u1ec3 k\u00e8m theo ho\u1eb7c l\u00e0 nguy\u00ean nh\u00e2n b\u00ean d\u01b0\u1edbi<\/h4>\n
                                \n
                              • Do thu\u1ed1c<\/li>\n
                              • Nhi\u1ec5m tr\u00f9ng, r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a<\/li>\n
                              • T\u00ecnh tr\u1ea1ng g\u00e2y suy gi\u1ea3m oxy n\u00e3o (thi\u1ebfu m\u00e1u, suy tim, COPD\u2026)\u2026<\/li>\n<\/ul>\n

                                4.3.5. Ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng<\/h4>\n

                                \u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 kh\u1ea3 n\u0103ng ho\u1ea1t \u0111\u1ed9ng c\u01a1 b\u1ea3n h\u00e0ng ng\u00e0y m\u1ed9t c\u00e1ch th\u01b0\u1eddng xuy\u00ean<\/p>\n

                                T\u1ea1o m\u00f4i tr\u01b0\u1eddng g\u1ea7n g\u0169i v\u1edbi nh\u1eefng th\u00f3i quen v\u00e0 nh\u1eafc nh\u1edf th\u01b0\u1eddng xuy\u00ean v\u1ec1 ng\u00e0y, gi\u1edd, \u0111\u1ecba \u0111i\u1ec3m<\/p>\n

                                Gia \u0111\u00ecnh c\u1ea7n tham gia trong qu\u00e1 tr\u00ecnh n\u00e0y \u0111\u1ec3 ch\u0103m s\u00f3c, h\u1ed7 tr\u1ee3 b\u1ec7nh nh\u00e2n<\/p>\n

                                Gia \u0111\u00ecnh c\u1ea7n \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n \u0111\u1ec3 c\u1ea3nh gi\u00e1c v\u1edbi c\u00e1c d\u1ea5u hi\u1ec7u s\u1edbm t\u00e1i ph\u00e1t c\u1ee7a b\u1ec7nh<\/p>\n

                                5. TI\u00caN L\u01af\u1ee2NG, BI\u1ebeN CH\u1ee8NG VA\u0300 PHO\u0300NG B\u00ca\u0323NH SA\u0309NG<\/b><\/h2>\n

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

                                C\u00e1c tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng t\u1ed3n t\u1ea1i \u0111\u1ebfn khi c\u0103n nguy\u00ean \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft, m\u00ea s\u1ea3ng th\u01b0\u1eddng t\u1ed3n t\u1ea1i d\u01b0\u1edbi m\u1ed9t tu\u1ea7n<\/p>\n

                                B\u1ec7nh nh\u00e2n c\u00e0ng gi\u00e0 ti\u00ean l\u01b0\u1ee3ng c\u00e0ng n\u1eb7ng n\u1ec1 h\u01a1n<\/p>\n

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

                                C\u00e1c bi\u1ebfn ch\u1ee9ng li\u00ean quan \u0111\u1ebfn b\u1ec7nh l\u00fd n\u1ec1n<\/p>\n

                                Bi\u1ebfn ch\u1ee9ng nhi\u1ec5m khu\u1ea9n, ch\u1ea5n th\u01b0\u01a1ng c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i, ki\u1ec3m so\u00e1t<\/p>\n

                                5.3. Pho\u0300ng b\u00ea\u0323nh<\/b><\/h3>\n

                                Ch\u0103m s\u00f3c t\u1ed1t c\u00e1c b\u1ec7nh c\u01a1 th\u1ec3 n\u1eb7ng tr\u00e1nh bi\u1ebfn ch\u1ee9ng g\u00e2y s\u1ea3ng (\u0111i\u1ec1u ki\u1ec7n m\u00f4i tr\u01b0\u1eddng, t\u1ea1o kh\u00f4ng gian y\u00ean t\u0129nh, \u0111\u1ee7 \u00e1nh s\u00e1ng, an to\u00e0n cho b\u1ec7nh nh\u00e2n).<\/p>\n

                                H\u1ea1n ch\u1ebf s\u1eed d\u1ee5ng nhi\u1ec1u lo\u1ea1i thu\u1ed1c, c\u00e1c thu\u1ed1c c\u00f3 th\u1ec3 g\u00e2y m\u00ea s\u1ea3ng.<\/p>\n","protected":false},"excerpt":{"rendered":"

                                Sa\u0309ng co\u0301 th\u1ec3 x\u1ea3y ra \u1edf m\u1ecdi \u0111\u1ed9 tu\u1ed5i, nh\u01b0ng ph\u1ed5 bi\u1ebfn h\u01a1n \u1edf nh\u1eefng ng\u01b0\u1eddi cao tu\u1ed5i. Theo th\u1ed1ng k\u00ea, \u00edt nh\u1ea5t 10% b\u1ec7nh nh\u00e2n cao tu\u1ed5i \u0111\u01b0\u1ee3c nh\u1eadp vi\u1ec7n b\u1ecb s\u1ea3ng v\u00e0 kho\u1ea3ng 15 \u0111\u1ebfn 50% trong s\u1ed1 h\u1ecd c\u00f3 th\u1ec3 tr\u1ea3i qua t\u00ecnh tr\u1ea1ng s\u1ea3ng trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb. S\u1ea3ng c\u0169ng […]<\/p>\n","protected":false},"author":42,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[10,33],"tags":[],"yoast_head":"\nSa\u0309ng kh\u00f4ng do r\u01b0\u01a1\u0323u va\u0300 ca\u0301c ch\u00e2\u0301t ta\u0301c \u0111\u00f4\u0323ng t\u00e2m th\u00e2\u0300n - H\u01b0\u01a1\u0301ng d\u00e2\u0303n ch\u00e2\u0309n \u0111oa\u0301n va\u0300 \u0111i\u00ea\u0300u tri\u0323<\/title>\n<meta name=\"description\" content=\"Sa\u0309ng la\u0300 m\u1ed9t h\u1ed9i ch\u1ee9ng gi\u1ea3m s\u1ef1 t\u1ec9nh t\u00e1o v\u00e0 nh\u1eadn bi\u1ebft v\u1ec1 m\u00f4i tr\u01b0\u1eddng xung quanh, gi\u1ea3m \u0111\u1ed9 t\u1eadp trung v\u00e0 duy tr\u00ec ho\u1eb7c thay \u0111\u1ed5i ch\u00fa \u00fd.\" \/>\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=\"Sa\u0309ng kh\u00f4ng do r\u01b0\u01a1\u0323u va\u0300 ca\u0301c ch\u00e2\u0301t ta\u0301c \u0111\u00f4\u0323ng t\u00e2m th\u00e2\u0300n - 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