{"id":29845,"date":"2023-05-03T21:51:57","date_gmt":"2023-05-03T14:51:57","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29845"},"modified":"2023-05-17T01:05:14","modified_gmt":"2023-05-16T18:05:14","slug":"phac-do-chan-doan-va-dieu-tri-nhuoc-co","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/phac-do-chan-doan-va-dieu-tri-nhuoc-co\/","title":{"rendered":"Ph\u00e1c \u0111\u1ed3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb Nh\u01b0\u1ee3c c\u01a1"},"content":{"rendered":"<p><b>Bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m nh\u1ea5t c\u1ee7a b\u1ec7nh nh\u01b0\u1ee3c c\u01a1 l\u00e0 suy h\u00f4 h\u1ea5p do y\u1ebfu ho\u1eb7c li\u1ec7t c\u00e1c c\u01a1 h\u00f4 h\u1ea5p, d\u1eabn \u0111\u1ebfn t\u1eed vong nhanh ch\u00f3ng n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c c\u1ee9u ch\u1eefa k\u1ecbp th\u1eddi. Ngo\u00e0i ra, nh\u01b0\u1ee3c c\u01a1 c\u0169ng khi\u1ebfn cho ng\u01b0\u1eddi b\u1ec7nh lu\u00f4n c\u1ea3m th\u1ea5y m\u1ec7t m\u1ecfi, suy ki\u1ec7t, \u0103n u\u1ed1ng k\u00e9m, m\u1ea5t t\u1eadp trung, \u1ea3nh h\u01b0\u1edfng cu\u1ed9c s\u1ed1ng h\u00e0ng ng\u00e0y c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh. V\u00ec v\u1eady, c\u1ea7n ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u00fang ph\u01b0\u01a1ng ph\u00e1p.<\/b><\/p>\n<h2><strong>1. \u0110\u1ea1i c\u01b0\u01a1ng<\/strong><\/h2>\n<p><span style=\"font-weight: 400;\">\u00a0B\u1ec7nh nh\u01b0\u1ee3c c\u01a1 (Myasthenia gravis) l\u00e0 r\u1ed1i lo\u1ea1n d\u1eabn truy\u1ec1n th\u1ea7n kinh c\u01a1 nguy\u00ean ph\u00e1t ph\u1ed5 bi\u1ebfn nh\u1ea5t. Nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p l\u00e0 b\u1ea5t th\u01b0\u1eddng mi\u1ec5n d\u1ecbch m\u1eafc ph\u1ea3i. Hi\u1ec7n nay b\u1ec7nh nh\u01b0\u1ee3c c\u01a1 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u01b0\u01a1ng \u0111\u1ed1i hi\u1ec7u qu\u1ea3.\u00a0<\/span><\/p>\n<figure id=\"attachment_29852\" aria-describedby=\"caption-attachment-29852\" style=\"width: 388px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-full wp-image-29852\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/download-7.jpg\" alt=\"nhuoc-co\" width=\"388\" height=\"270\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/download-7.jpg 388w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/download-7-300x209.jpg 300w\" sizes=\"(max-width: 388px) 100vw, 388px\" \/><figcaption id=\"caption-attachment-29852\" class=\"wp-caption-text\">\u1ea2nh m\u00f4 t\u1ea3 v\u1ebb m\u1eb7t b\u1ec7nh nh\u00e2n nh\u01b0\u1ee3c c\u01a1<\/figcaption><\/figure>\n<p><span style=\"font-weight: 400;\">T\u1ef7 l\u1ec7 b\u1ec7nh m\u1eafc b\u1ec7nh nh\u01b0\u1ee3c c\u01a1 t\u1ea1i <strong>Hoa K\u1ef3 kho\u1ea3ng 14\/100.000 d\u00e2n<\/strong>. Tuy nhi\u00ean c\u00f3 nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p nh\u01b0\u1ee3c c\u01a1 ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n, n\u00ean t\u1ec9 l\u1ec7 th\u1ef1c t\u1ebf c\u00f3 l\u1ebd cao h\u01a1n. T\u1ef7 l\u1ec7 b\u1ec7nh n\u1eef cao h\u01a1n nam gi\u1edbi. Tu\u1ed5i kh\u1edfi b\u1ec7nh th\u01b0\u1eddng g\u1eb7p c\u1ee7a n\u1eef l\u00e0 <strong>20-40<\/strong> tu\u1ed5i, c\u00f2n \u1edf nam l\u00e0 <strong>70-80<\/strong> tu\u1ed5i.\u00a0<\/span><\/p>\n<h2><strong>2. Nguy\u00ean nh\u00e2n\u00a0<\/strong><\/h2>\n<p><span style=\"font-weight: 400;\">L\u00e0 b\u1ec7nh l\u00fd t\u1ef1 mi\u1ec5n do kh\u00e1ng th\u1ec3 t\u1ea5n c\u00f4ng tr\u1ef1c ti\u1ebfp v\u00e0o th\u1ee5 th\u1ec3 Acetylcholine \u1edf m\u00e0ng sau synap TK c\u01a1.\u00a0<\/span><\/p>\n<figure id=\"attachment_29853\" aria-describedby=\"caption-attachment-29853\" style=\"width: 800px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-full wp-image-29853\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/uZzY1Dc0AQPPzQGsrvLiaw_b.jpg\" alt=\"co-che-benh-nhuoc-co\" width=\"800\" height=\"507\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/uZzY1Dc0AQPPzQGsrvLiaw_b.jpg 800w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/uZzY1Dc0AQPPzQGsrvLiaw_b-300x190.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/uZzY1Dc0AQPPzQGsrvLiaw_b-768x487.jpg 768w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption id=\"caption-attachment-29853\" class=\"wp-caption-text\">\u1ea2nh m\u00f4 t\u1ea3 c\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a Nh\u01b0\u1ee3c c\u01a1<\/figcaption><\/figure>\n<h2><strong>3. Ch\u1ea9n \u0111o\u00e1n nh\u01b0\u1ee3c c\u01a1<\/strong><\/h2>\n<h3><strong>3.1. Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng<\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">\u00a0B\u1ec7nh nh\u00e2n nh\u01b0\u1ee3c c\u01a1 th\u01b0\u1eddng \u0111\u1ebfn kh\u00e1m b\u1ec7nh v\u00ec <strong>y\u1ebfu nh\u1eefng nh\u00f3m c\u01a1 \u0111\u1eb7c hi\u1ec7u<\/strong>, \u00edt khi than phi\u1ec1n m\u1ec7t m\u1ecfi to\u00e0n th\u00e2n. C\u00e1c r\u1ed1i lo\u1ea1n v\u1eadn nh\u00e3n, s\u1ee5p m\u00ed ho\u1eb7c song th\u1ecb, l\u00e0 tri\u1ec7u ch\u1ee9ng \u0111\u1ea7u ti\u00ean c\u1ee7a 2\/3 b\u1ec7nh nh\u00e2n nh\u01b0\u1ee3c c\u01a1; h\u1ea7u nh\u01b0 t\u1ea5t c\u1ea3 \u0111\u1ec1u c\u00f3 2 tri\u1ec7u ch\u1ee9ng n\u00e0y trong v\u00f2ng 2 n\u0103m. Y\u1ebfu c\u01a1 v\u00f9ng h\u1ea7u h\u1ecdng, kh\u00f3 nhai, kh\u00f3 nu\u1ed1t, ho\u1eb7c kh\u00f3 n\u00f3i, l\u00e0 tri\u1ec7u ch\u1ee9ng \u0111\u1ea7u ti\u00ean \u1edf 1\/6 b\u1ec7nh nh\u00e2n nh\u01b0\u1ee3c c\u01a1, v\u00e0 y\u1ebfu tay ch\u00e2n ch\u1ec9 c\u00f3 \u1edf 10% b\u1ec7nh nh\u00e2n. Hi\u1ebfm khi y\u1ebfu c\u01a1 kh\u1edfi \u0111\u1ea7u \u1edf 1 nh\u00f3m c\u01a1 \u0111\u01a1n \u0111\u1ed9c nh\u01b0 c\u01a1 c\u1ed5 ho\u1eb7c c\u01a1 du\u1ed7i c\u00e1c ng\u00f3n ho\u1eb7c c\u01a1 g\u1eadp h\u00f4ng. M\u1ee9c \u0111\u1ed9 y\u1ebfu c\u01a1 dao \u0111\u1ed9ng trong ng\u00e0y, th\u01b0\u1eddng \u00edt n\u1eb7ng v\u00e0o bu\u1ed5i s\u00e1ng, n\u1eb7ng t\u0103ng d\u1ea7n trong ng\u00e0y, \u0111\u1eb7c bi\u1ec7t khi\u00a0 <\/span><span style=\"font-weight: 400;\">v\u1eadn \u0111\u1ed9ng nhi\u1ec1u \u1edf nh\u00f3m c\u01a1 b\u1ecb \u1ea3nh h\u01b0\u1edfng.\u00a0<\/span><\/p>\n<p><strong>3.2. C\u00e1c k\u1ef9 thu\u1eadt ch\u1ea9n \u0111o\u00e1n<\/strong><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">\u00a0Test thu\u1ed1c kh\u00e1ng men acetylcholinesterase Edrophonium (Tensilon) test: T\u1ed5ng li\u1ec1u 10 mg (1 ml) Tensilon t\u0129nh m\u1ea1ch. Kh\u1edfi \u0111\u1ea7u ch\u00edch 1mg (0,1ml). N\u1ebfu b\u1ec7nh nh\u00e2n dung n\u1ea1p thu\u1ed1c t\u1ed1t v\u00e0 kh\u00f4ng th\u1ea5y c\u1ea3i thi\u1ec7n s\u1ee9c c\u01a1 sau 45 gi\u00e2y, ch\u00edch ti\u1ebfp 3-6 mg. Sau 45 gi\u00e2y, n\u1ebfu v\u1eabn kh\u00f4ng c\u00f3 \u0111\u00e1p \u1ee9ng, c\u00f3 th\u1ec3 d\u00f9ng n\u1ed1t l\u01b0\u1ee3ng c\u00f2n l\u1ea1i trong v\u00f2ng 1 ph\u00fat. \u0110a s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u00e1p \u1ee9ng v\u1edbi 5 mg Tensilon, v\u00e0 t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i 4-5 ph\u00fat. \u0110\u00e1p \u1ee9ng l\u00e0 h\u1ebft nh\u00ecn \u0111\u00f4i ho\u1eb7c h\u1ebft s\u1ee5p m\u00ed. Thu\u1ed1c c\u00f3 th\u1ec3 g\u00e2y kh\u00f3 th\u1edf, rung th\u1ea5t v\u00e0 ng\u1eebng tim, ph\u1ea3i th\u1ef1c hi\u1ec7n test trong b\u1ec7nh vi\u1ec7n, n\u01a1i c\u00f3 \u0111i\u1ec1u ki\u1ec7n c\u1ea5p c\u1ee9u n\u1ebfu c\u1ea7n.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Neostigmine test: ch\u00edch 1,5 mg neostigmine b\u1eafp th\u1ecbt. C\u00e1c bi\u1ec3u hi\u1ec7n nh\u01b0\u1ee3c c\u01a1 thuy\u00ean gi\u1ea3m sau 10-15, t\u00e1c d\u1ee5ng t\u1ed1i \u0111a th\u01b0\u1eddng sau 20 ph\u00fat. T\u00e1c d\u1ee5ng k\u00e9o d\u00e0i 2-3 gi\u1edd. N\u1ebfu test \u00e2m t\u00ednh, c\u0169ng kh\u00f4ng lo\u1ea1i tr\u1eeb h\u1eb3n \u0111\u01b0\u1ee3c b\u1ec7nh nh\u01b0\u1ee3c c\u01a1, nh\u01b0ng l\u00e0 m\u1ed9t b\u1eb1ng ch\u1ee9ng m\u1ea1nh \u0111\u1ec3 nghi ng\u1edd ch\u1ea9n \u0111o\u00e1n.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Kh\u00e1ng th\u1ec3 kh\u00e1ng th\u1ee5 th\u1ec3 Acetylcholine (AChR): <\/span>B\u1ea3y m\u01b0\u01a1i b\u1ed1n ph\u1ea7n tr\u0103m b\u1ec7nh nh\u01b0\u1ee3c c\u01a1 lan to\u1ea3 m\u1eafc ph\u1ea3i v\u00e0 54% nh\u01b0\u1ee3c c\u01a1 th\u1ec3 m\u1eaft c\u00f3 kh\u00e1ng th\u1ec3 trong huy\u1ebft thanh g\u1eafn k\u1ebft v\u1edbi AChR. N\u1ed3ng \u0111\u1ed9 kh\u00e1ng th\u1ec3 c\u00f3 th\u1ec3 th\u1ea5p \u1edf giai \u0111o\u1ea1n kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng v\u00e0 t\u0103ng cao l\u00ean sau \u0111\u00f3. T\u0103ng n\u1ed3ng \u0111\u1ed9 kh\u00e1ng th\u1ec3 kh\u00e1ng AChR \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 l\u00e2m s\u00e0ng ph\u00f9 h\u1ee3p th\u00ec gi\u00fap x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n b\u1ec7nh nh\u01b0\u1ee3c c\u01a1, nh\u01b0ng n\u1ed3ng \u0111\u1ed9 kh\u00e1ng th\u1ec3 b\u00ecnh th\u01b0\u1eddng th\u00ec kh\u00f4ng lo\u1ea1i tr\u1eeb \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n.<\/li>\n<li><span style=\"font-weight: 400;\">\u0110i\u1ec7n c\u01a1\u00a0<\/span><\/li>\n<\/ul>\n<p><em><span style=\"font-weight: 400;\"><strong>K\u00edch th\u00edch d\u00e2y th\u1ea7n kinh l\u1eb7p l\u1ea1i (Repetitive Nerve Stimulation &#8211; RNS):<\/strong>\u00a0<\/span><\/em><span style=\"font-weight: 400;\">Bi\u00ean \u0111\u1ed9 c\u1ee7a c\u00e1c ph\u1ee9c h\u1ee3p \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng s\u1ee3i c\u01a1 (CMAP) \u0111\u01b0\u1ee3c t\u1ea1o ra do k\u00edch th\u00edch d\u00e2y TK l\u1eadp l\u1ea1i th\u00ec b\u00ecnh th\u01b0\u1eddng ho\u1eb7c ch\u1ec9 gi\u1ea3m nh\u1eb9 \u1edf c\u00e1c b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 b\u1ec7nh nh\u01b0\u1ee3c c\u01a1. \u1ede b\u1ec7nh nh\u00e2n nh\u01b0\u1ee3c c\u01a1, bi\u00ean \u0111\u1ed9 c\u1ee7a \u0111\u00e1p \u1ee9ng th\u1ee9 t\u01b0 ho\u1eb7c th\u1ee9 n\u0103m trong chu\u1ed7i k\u00edch th\u00edch d\u00e2y TK t\u1ea7n s\u1ed1 th\u1ea5p b\u1ecb gi\u1ea3m \u00edt nh\u1ea5t l\u00e0 10% so v\u1edbi c\u00e1c \u0111\u00e1p \u1ee9ng \u0111\u1ea7u ti\u00ean. \u0110\u00e1p \u1ee9ng suy gi\u1ea3m n\u00e0y th\u01b0\u1eddng g\u1eb7p nhi\u1ec1u h\u01a1n \u1edf c\u00e1c nh\u00f3m c\u01a1 g\u1ed1c chi, nh\u01b0 c\u01a1 v\u00f9ng m\u1eb7t, nh\u1ecb \u0111\u1ea7u, tam \u0111\u1ea7u, c\u01a1 thang h\u01a1n l\u00e0 c\u00e1c c\u01a1 \u1edf b\u00e0n tay. \u0110\u00e1p \u1ee9ng gi\u1ea3m c\u00f3 \u00fd ngh\u0129a trong RNS g\u1eb7p \u1edf kho\u1ea3ng 60% b\u1ec7nh nh\u00e2n nh\u01b0\u1ee3c c\u01a1.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0<em>\u0110i\u1ec7n c\u01a1 s\u1ee3i \u0111\u01a1n \u0111\u1ed9c (Single fiber EMG):<\/em> ghi ri\u00eang r\u1ebd \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a t\u1eebng s\u1ee3i c\u01a1. \u0110\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh khi ph\u01b0\u01a1ng ph\u00e1p k\u00edch th\u00edch d\u00e2y th\u1ea7n kinh l\u1eb7p l\u1ea1i v\u00e0 \u0111\u1ecbnh l\u01b0\u1ee3ng kh\u00e1ng th\u1ec3 kh\u00e1ng th\u1ee5 th\u1ec3 Ach \u00e2m t\u00ednh.<\/span><\/p>\n<h3><strong>\u00a03.3. X\u00e9t nghi\u1ec7m th\u01b0\u1eddng quy \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n v\u00e0 h\u1ed7 tr\u1ee3 \u0111i\u1ec1u tr\u1ecb<\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">\u00a0&#8211; CT Scan ng\u1ef1c c\u00f3 c\u1ea3n quang \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng tuy\u1ebfn \u1ee9c: b\u00ecnh th\u01b0\u1eddng, t\u0103ng sinh tuy\u1ebfn \u1ee9c ho\u1eb7c u tuy\u1ebfn \u1ee9c.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0&#8211; Ch\u1ee9c n\u0103ng tuy\u1ebfn gi\u00e1p.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">&#8211; \u0110\u01b0\u1eddng huy\u1ebft, ion \u0111\u1ed3, ch\u1ee9c n\u0103ng gan th\u1eadn,\u2026<\/span><\/p>\n<h3><strong>3.4. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/strong><\/h3>\n<ul>\n<li><span style=\"font-weight: 400;\">L\u00e2m s\u00e0ng: b\u1ec7nh b\u00e1n c\u1ea5p ho\u1eb7c m\u1ea1n t\u00ednh, y\u1ebfu c\u01a1 khi g\u1eafng s\u1ee9c, c\u1ea3i thi\u1ec7n m\u1ed9t ph\u1ea7n khi ngh\u1ec9 ng\u01a1i.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">\u00a0Test thu\u1ed1c Tensilon ho\u1eb7c Prostigmin d\u01b0\u01a1ng t\u00ednh.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">\u0110i\u1ec7n c\u01a1: test k\u00edch th\u00edch d\u00e2y th\u1ea7n kinh l\u1eb7p l\u1ea1i d\u01b0\u01a1ng t\u00ednh (trong 60% tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u01b0\u1ee3c c\u01a1)<\/span><\/li>\n<li><span style=\"font-weight: 400;\">\u00a0Kh\u00e1ng th\u1ec3 kh\u00e1ng th\u1ee5 th\u1ec3 Acetylcholine d\u01b0\u01a1ng t\u00ednh (trong 50-75% tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u01b0\u1ee3c c\u01a1).<\/span><\/li>\n<\/ul>\n<h3><span style=\"font-weight: 400;\"><strong>3.5.\u00a0 Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/strong>\u00a0<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">&#8211; Vi\u00eam \u0111a c\u01a1: y\u1ebfu c\u01a1 g\u1ed1c chi li\u00ean t\u1ee5c, c\u00f3 th\u1ec3 \u0111\u00e1p \u1ee9ng v\u1edbi test prostigmin\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">&#8211; B\u1ec7nh c\u01a1 do c\u01b0\u1eddng gi\u00e1p\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">&#8211; Li\u1ec7t v\u1eadn nh\u00e3n l\u1ed3i m\u1eaft (Exophthalmic ophthalmoplegia): x\u00e2m l\u1ea5n v\u00e0o \u1ed5 m\u1eaft<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0&#8211; H\u1ed9i ch\u1ee9ng nh\u01b0\u1ee3c c\u01a1, nh\u01b0\u1ee3c c\u01a1 do thu\u1ed1c, nh\u01b0\u1ee3c c\u01a1 do ng\u1ed9 \u0111\u1ed9c botulinum\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">&#8211; B\u1ec7nh c\u01a1 ti th\u1ec3 (Mitochondrial myopathies): li\u1ec7t v\u1eadn nh\u00e3n ti\u1ebfn tri\u1ec3n k\u00e8m s\u1ee5p mi v\u00e0 y\u1ebfu c\u01a1<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0&#8211; <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/benh-sarcoidosis-la-benh-gi\/\">Sarcoidosis<\/a><\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0&#8211; Nh\u01b0\u1ee3c c\u01a1 + lymphoma<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0&#8211; Bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh c\u01a1 c\u1ee7a nhi\u1ec5m HIV\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">&#8211; Li\u1ec7t chu k\u1ef3<\/span><\/p>\n<h3><strong>3.6. Ph\u00e2n \u0111\u1ed9<\/strong><\/h3>\n<table>\n<tbody>\n<tr>\n<td><strong>Ph\u00e2n \u0111\u1ed9 nh\u01b0\u1ee3c c\u01a1<\/strong><\/td>\n<td><strong>Osermann<\/strong><\/td>\n<td><strong>Ossermann c\u1ea3i ti\u1ebfn<\/strong><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">I<\/span><\/td>\n<td><span style=\"font-weight: 400;\"> Nh\u01b0\u1ee3c c\u01a1 th\u1ec3 m\u1eaft<\/span><\/td>\n<td>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">NV th\u1ec3 m\u1eaft<\/span><\/li>\n<\/ol>\n<\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">IIA<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Nh\u01b0\u1ee3c c\u01a1 to\u00e0n th\u00e2n nh\u1eb9, \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi thu\u1ed1c kh\u00e1ng men cholinesterase<\/span><\/td>\n<td>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">NC to\u00e0n th\u00e2n nh\u1eb9<\/span><\/li>\n<\/ol>\n<\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">IIB<\/span><\/td>\n<td><span style=\"font-weight: 400;\"> Nh\u01b0\u1ee3c c\u01a1 to\u00e0n th\u00e2n m\u1ee9c \u0111\u1ed9 trung b\u00ecnh, \u1ea3nh h\u01b0\u1edfng n\u1eb7ng t\u1edbi h\u1ec7 c\u01a1 x\u01b0\u01a1ng v\u00e0 h\u1ec7 c\u01a1 thu\u1ed9c h\u00e0nh n\u00e3o, c\u00f3 \u0111\u00e1p \u1ee9ng v\u1edbi thu\u1ed1c nh\u01b0ng kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7.<\/span><\/td>\n<td>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">NC to\u00e0n th\u00e2n trung b\u00ecnh<\/span><\/li>\n<\/ol>\n<\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">III<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Nh\u01b0\u1ee3c c\u01a1 n\u1eb7ng, suy h\u00f4 h\u1ea5p<\/span><\/td>\n<td>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">NC to\u00e0n th\u00e2n n\u1eb7ng<\/span><\/li>\n<\/ol>\n<\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">IV<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Nh\u01b0\u1ee3c c\u01a1 n\u1eb7ng giai \u0111o\u1ea1n cu\u1ed1i. H\u00ecnh \u1ea3nh gi\u1ed1ng h\u1ec7t nh\u01b0 III, nh\u01b0ng ti\u1ebfn tri\u1ec3n t\u1eeb I sang II m\u1ea5t h\u01a1n 2 n\u0103m.\u00a0<\/span><\/td>\n<td>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">C\u01a1n suy h\u00f4 h\u1ea5p<\/span><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">*4,5: nh\u1eadp vi\u1ec7n<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2><strong>4. \u0110i\u1ec1u tr\u1ecb nh\u01b0\u1ee3c c\u01a1<\/strong><\/h2>\n<p><span style=\"font-weight: 400;\">M\u1ee5c \u0111\u00edch \u0111i\u1ec1u tr\u1ecb l\u00e0 c\u1ea3i thi\u1ec7n s\u1ee9c c\u01a1, \u01b0u ti\u00ean \u0111\u1ea3m b\u1ea3o h\u00f4 h\u1ea5p \u0111\u1ea7y \u0111\u1ee7 cho b\u1ec7nh nh\u00e2n. \u0110\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng kh\u00f4ng x\u1ea3y ra s\u1edbm, c\u1ea7n ph\u1ea3i theo d\u00f5i l\u00e2u d\u00e0i.\u00a0<\/span><\/p>\n<h3><span style=\"font-weight: 400;\"><strong>4.1. <a href=\"https:\/\/www.vinmec.com\/vi\/thong-tin-duoc\/su-dung-thuoc-toan\/thuoc-uc-che-men-chuyen-ace-co-che-hoat-dong-va-tac-dung-phu\/\">Thu\u1ed1c \u1ee9c ch\u1ebf men cholinesterase (ChE)<\/a><\/strong><\/span><\/h3>\n<p><span style=\"font-weight: 400;\">\u00a0Thu\u1ed1c \u1ee9c ch\u1ebf men ChE l\u00e0m gi\u1ea3m ho\u1ea1t \u0111\u1ed9ng thu\u1ef7 ph\u00e2n AcetylCholine (ACh) c\u1ee7a men ChE t\u1ea1i khe synap, do \u0111\u00f3 ACh t\u00edch t\u1ee5 nhi\u1ec1u t\u1ea1i kh\u1edbp TK c\u01a1 v\u00e0 k\u00e9o d\u00e0i hi\u1ec7u qu\u1ea3 c\u1ee7a ACh. Pyridostigmine bromide (Mestinon) v\u00e0 neostigmin bromid (Prostigmin) l\u00e0 nh\u1eefng thu\u1ed1c \u1ee9c ch\u1ebf men ChE th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u1ea5t. Pyridostigmin bromide \u0111\u01b0\u1ee3c d\u00f9ng v\u1edbi li\u1ec1u 30-60mg\/4-6h, ch\u1ec9nh li\u1ec1u t\u00f9y theo \u0111\u00e1p \u1ee9ng, kh\u00f4ng \u0111\u01b0\u1ee3c qu\u00e1 120mg\/3h. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">Nhu c\u1ea7u \u1ee9c ch\u1ebf men ChE thay \u0111\u1ed5i m\u1ed7i ng\u00e0y, tu\u1ef3 thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng, c\u1ea3m x\u00fac, v\u00e0 kh\u00ed h\u1eadu n\u00f3ng. B\u1ec7nh nh\u00e2n th\u01b0\u1eddng than phi\u1ec1n c\u00e1c r\u1ed1i lo\u1ea1n \u0111\u01b0\u1eddng ti\u00eau ho\u00e1: kh\u00f3 ch\u1ecbu, ti\u00eau ph\u00e2n l\u1ecfng, bu\u1ed3n n\u00f4n, n\u00f4n \u00f3i, \u0111au qu\u1eb7n b\u1ee5ng, v\u00e0 ti\u00eau ch\u1ea3y. T\u0103ng ti\u1ebft trong ph\u1ebf qu\u1ea3n v\u00e0 trong mi\u1ec7ng l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 nghi\u00eam tr\u1ecdng \u1edf b\u1ec7nh nh\u00e2n kh\u00f3 nu\u1ed1t ho\u1eb7c suy h\u00f4 h\u1ea5p. Qu\u00e1 li\u1ec1u t\u1ea1i th\u1ee5 th\u1ec3 nicotinic g\u00e2y ra C\u01a1n Nh\u01b0\u1ee3c C\u01a1, m\u1ed9t t\u00ecnh tr\u1ea1ng y\u1ebfu c\u01a1 to\u00e0n th\u00e2n n\u1eb7ng v\u00e0 suy h\u00f4 h\u1ea5p tr\u00ean b\u1ec7nh nh\u00e2n nh\u01b0\u1ee3c c\u01a1.<\/span><\/p>\n<table>\n<tbody>\n<tr>\n<td><strong>Kh\u00e1ng men cholinesterase<\/strong><\/td>\n<td><span style=\"font-weight: 400;\"><strong>Ch\u1ec9 \u0111\u1ecbnh:<\/strong> d\u00f9ng cho t\u1ea5t c\u1ea3 c\u00e1c th\u1ec3 NC, c\u1ea9n th\u1eadn \u1edf ng\u01b0\u1eddi gi\u00e0 khi dung li\u1ec1u cao v\u00ec nguy c\u01a1 r\u1ed1i lo\u1ea1n nh\u1ecbp tim.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0<strong>Pyridostigmine bromide (Mestinon)<\/strong><\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0&#8211; Li\u1ec1u: 30-60mg\/4-6h, ch\u1ec9nh li\u1ec1u t\u00f9y theo \u0111\u00e1p \u1ee9ng (Tensilon test), kh\u00f4ng \u0111\u01b0\u1ee3c qu\u00e1 120mg\/3h.\u00a0<\/span><\/p>\n<p><strong>Neostigmin bromid (Prostigmin)<\/strong><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0&#8211; Li\u1ec1u: 0,5-2, 5mg IV\/IM\/SC m\u1ed7i 1-3h, kh\u00f4ng \u0111\u01b0\u1ee3c qu\u00e1 10mg\/ng\u00e0y<\/span><\/td>\n<td><span style=\"font-weight: 400;\">&#8211; T\u00e1c d\u1ee5ng: 0,5-6h.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\"> &#8211; Tr\u1ebb em: &lt;7mg\/kg\/ng\u00e0y, chia l\u00e0m 4-6 l\u1ea7n.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0&#8211; Tr\u1ebb em: 0,01 0,04mg\/kg \/IV\/IM\/SC m\u1ed7i 2-4h<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3><strong>4.2. <a href=\"https:\/\/www.vinmec.com\/vi\/chu-de\/phau-thuat-cat-tuyen-uc\/\">C\u1eaft tuy\u1ebfn \u1ee9c<\/a><\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">\u00a0C\u1eaft tuy\u1ebfn \u1ee9c \u0111\u01b0\u1ee3c \u0111\u1ec1 ngh\u1ecb cho h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n nh\u01b0\u1ee3c c\u01a1. \u0110\u00e1p \u1ee9ng nhi\u1ec1u h\u1ee9a h\u1eb9n nh\u1ea5t th\u01b0\u1eddng x\u1ea3y ra sau m\u1ed5 2-5 n\u0103m. Tuy nhi\u00ean \u0111\u00e1p \u1ee9ng n\u00e0y t\u01b0\u01a1ng \u0111\u1ed1i kh\u00f4ng th\u1ec3 d\u1ef1 \u0111o\u00e1n \u0111\u01b0\u1ee3c, v\u00e0 s\u1ef1 suy gi\u1ea3m c\u00f3 th\u1ec3 v\u1eabn ti\u1ebfp t\u1ee5c nhi\u1ec1u th\u00e1ng ho\u1eb7c nhi\u1ec1u n\u0103m sau m\u1ed5. \u0110\u00e1p \u1ee9ng t\u1ed1t nh\u1ea5t c\u1ee7a c\u1eaft tuy\u1ebfn \u1ee9c khi ph\u1eabu thu\u1eadt ti\u1ebfn h\u00e0nh \u1edf ng\u01b0\u1eddi tr\u1ebb v\u00e0 \u1edf giai \u0111o\u1ea1n s\u1edbm c\u1ee7a b\u1ec7nh, nh\u01b0ng s\u1ef1 c\u1ea3i thi\u1ec7n v\u1eabn x\u1ea3y ra khi b\u1ec7nh \u0111\u00e3 x\u1ea3y ra tr\u00ean 30 n\u0103m. C\u00e1c b\u1ec7nh nh\u00e2n kh\u1edfi b\u1ec7nh sau 60 tu\u1ed5i hi\u1ebfm khi c\u1ea3i thi\u1ec7n sau c\u1eaft tuy\u1ebfn \u1ee9c. C\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 u tuy\u1ebfn \u1ee9c kh\u00f4ng \u0111\u00e1p \u1ee9ng t\u1ed1t nh\u01b0 b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 u tuy\u1ebfn \u1ee9c.<\/span><\/p>\n<table>\n<tbody>\n<tr>\n<td><strong>PT c\u1eaft tuy\u1ebfn \u1ee9c: t\u1eeb 5-60 tu\u1ed5i<\/strong><\/td>\n<td><strong>Chu\u1ea9n b\u1ecb tr\u01b0\u1edbc PT:<\/strong><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0&#8211; \u0110i\u1ec1u tr\u1ecb t\u1ed1t y\u1ebfu c\u01a1 h\u1ea7u h\u1ecdng v\u00e0 h\u00f4 h\u1ea5p<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0&#8211; \u0110o VC &gt; 15ml\/kg\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">&#8211; N\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng, c\u00f3 th\u1ec3 l\u1ecdc huy\u1ebft t\u01b0\u01a1ng\/IVIG tr\u01b0\u1edbc v\u00e0 PT trong v\u00f2ng 2 tu\u1ea7n sau.\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">&#8211; N\u1ebfu kh\u00f4ng c\u00f3 u tuy\u1ebfn \u1ee9c v\u00e0 kh\u00f4ng thu\u1ed9c nh\u01b0\u1ee3c c\u01a1 to\u00e0n th\u00e2n: tr\u00ec ho\u00e3n \u0111\u1ebfn 15-20 tu\u1ed5i<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0&#8211; \u0110\u00e1nh gi\u00e1 CT Scan l\u1ea1i sau 1 n\u0103m (6 th\u00e1ng \u0111\u1ed1i v\u1edbi u tuy\u1ebfn \u1ee9c)<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0&#8211; Theo d\u00f5i n\u1ed3ng \u0111\u1ed9 kh\u00e1ng th\u1ec3 tr\u01b0\u1edbc v\u00e0 sau ph\u1eabu thu\u1eadt 1 th\u00e1ng.\u00a0<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3><strong>4.3. <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/corticoid-la-gi-corticoid-co-loi-hay-co-hai\/\">Corticoid <\/a><\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">S\u1ef1\u00a0<\/span><span style=\"font-weight: 400;\">c\u1ea3i thi\u1ec7n \u0111\u00e1ng k\u1ec3 ho\u1eb7c ph\u1ee5c h\u1ed3i ho\u00e0n to\u00e0n tri\u1ec7u ch\u1ee9ng x\u1ea3y ra \u1edf h\u01a1n 75% b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng prednisone, v\u00e0 nh\u00f3m c\u00f2n l\u1ea1i ph\u1ee5c h\u1ed3i \u0111\u01b0\u1ee3c m\u1ed9t ph\u1ea7n. Ph\u1ea7n l\u1edbn s\u1ef1 c\u1ea3i thi\u1ec7n x\u1ea3y ra trong 6 \u0111\u1ebfn 8 tu\u1ea7n \u0111\u1ea7u, nh\u01b0ng s\u1ee9c c\u01a1 c\u00f3 th\u1ec3 ti\u1ebfp t\u1ee5c t\u0103ng \u0111\u1ec3 ph\u1ee5c h\u1ed3i g\u1ea7n ho\u00e0n to\u00e0n \u1edf nh\u1eefng th\u00e1ng sau \u0111\u00f3. \u0110\u00e1p \u1ee9ng t\u1ed1t nh\u1ea5t x\u1ea3y ra \u1edf c\u00e1c b\u1ec7nh nh\u00e2n m\u1edbi kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng, nh\u01b0ng c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng m\u00e3n t\u00ednh v\u1eabn c\u00f3 th\u1ec3 \u0111\u00e1p \u1ee9ng. Kh\u00f4ng th\u1ec3 d\u1ef1 \u0111o\u00e1n \u0111\u01b0\u1ee3c s\u1ef1 c\u1ea3i thi\u1ec7n qua m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh. C\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 u tuy\u1ebfn \u1ee9c c\u00f3 s\u1ef1 \u0111\u00e1p \u1ee9ng tuy\u1ec7t v\u1eddi v\u1edbi corticoid tr\u01b0\u1edbc ho\u1eb7c sau khi ph\u1eabu thu\u1eadt l\u1ea5y u.<\/span><\/p>\n<p><span style=\"font-weight: 400;\"> Ph\u1ea7n l\u1edbn \u0111\u00e1p \u1ee9ng v\u1edbi prednisone x\u1ea3y ra khi li\u1ec1u \u0111i\u1ec1u tr\u1ecb m\u1ed7i ng\u00e0y \u0111\u1ea1t 1 \u2013 1,2mg\/kg\/ng\u00e0y. Kho\u1ea3ng 1\/3 b\u1ec7nh nh\u00e2n b\u1ecb y\u1ebfu c\u01a1 t\u1ea1m th\u1eddi sau khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb prednisone, th\u01b0\u1eddng trong v\u00f2ng 7 \u0111\u1ebfn 10 ng\u00e0y \u0111\u1ea7u, v\u00e0 <strong>k\u00e9o d\u00e0i kho\u1ea3ng 6 ng\u00e0y<\/strong>. \u0110i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 b\u1eaft \u0111\u1ea7u b\u1eb1ng li\u1ec1u th\u1ea5p \u0111\u1ec3 tr\u00e1nh t\u00ecnh tr\u1ea1ng n\u00e0y; sau \u0111\u00f3 t\u0103ng li\u1ec1u l\u00ean d\u1ea7n \u0111\u1ec3 cho \u0111\u1ebfn khi c\u00f3 s\u1ef1 c\u1ea3i thi\u1ec7n. D\u00f9ng c\u00e1ch n\u00e0y b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 v\u1eabn b\u1ecb n\u1eb7ng l\u00ean t\u1ea1m th\u1eddi, v\u00e0 kh\u00f4ng th\u1ec3 d\u1ef1 \u0111o\u00e1n \u0111\u01b0\u1ee3c. B\u1ea5t l\u1ee3i ch\u00ednh c\u1ee7a d\u00f9ng corticoid k\u00e9o d\u00e0i ch\u00ednh l\u00e0 c\u00e1c <strong>t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a corticoid.<\/strong><\/span><\/p>\n<table>\n<tbody>\n<tr>\n<td><strong>Corticosterosis:\u00a0<\/strong><\/td>\n<td><span style=\"font-weight: 400;\"><strong>Prednisone \u0111\u01b0\u1eddng u\u1ed1ng<\/strong> <\/span><\/p>\n<p><span style=\"font-weight: 400;\">Kh\u1edfi \u0111\u1ea7u li\u1ec1u th\u1ea5p 10-25mg\/c\u00e1ch ng\u00e0y, t\u0103ng l\u00ean t\u1eeb t\u1eeb 10mg m\u1ed7i 5 ng\u00e0y cho \u0111\u1ebfn khi \u0111\u1ea1t li\u1ec1u \u0111i\u1ec1u tr\u1ecb (1-1,2mg\/kg\/ng\u00e0y) ho\u1eb7c b\u1eaft \u0111\u1ea7u th\u1ea5y c\u00f3 \u0111\u00e1p \u1ee9ng. Gi\u1eef nguy\u00ean li\u1ec1u n\u00e0y trong 2 th\u00e1ng (on-of alternator-day), sau \u0111\u00f3 gi\u1ea3m li\u1ec1u.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0Gi\u1ea3m li\u1ec1u ch\u1eadm cho \u0111\u1ebfn khi \u0111\u1ea1t li\u1ec1u th\u1ea5p nh\u1ea5t c\u00f3 t\u00e1c d\u1ee5ng th\u00ec d\u1eebng:\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">N\u1ebfu &gt;10vi\u00ean\/ng\u00e0y: gi\u1ea3m 2 vi\u00ean\/2 th\u00e1ng N\u1ebfu &lt;10vi\u00ean\/ng\u00e0y: gi\u1ea3m 1 vi\u00ean\/2 th\u00e1ng (C\u00f3 th\u1ec3 gi\u1ea3m li\u1ec1u nhanh h\u01a1n n\u1ebfu c\u00f3 ph\u1ed1i h\u1ee3p thu\u1ed1c \u01afCMD kh\u00e1c)<\/span><\/td>\n<td><span style=\"font-weight: 400;\">&#8211; 5mg prednisone # 4mg methylprednisolone<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0&#8211; <strong>Ch\u00fa \u00fd<\/strong> t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a corticosteroids (b\u00f9 kali, b\u1ea3o v\u1ec7 d\u1ea1 d\u00e0y, b\u1ed5 sung Canxi, ch\u1ea5t \u0111\u1ea1m, ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng ph\u00f9 h\u1ee3p, theo d\u00f5i \u0111\u01b0\u1eddng huy\u1ebft, c\u00f4ng th\u1ee9c m\u00e1u, ch\u1ee9c n\u0103ng gan) v\u00e0 ch\u00fa \u00fd b\u1ed9i nhi\u1ec5m (lao, n\u1ea5m)<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0&#8211;<strong> H\u01b0\u1edbng x\u1eed tr\u00ed khi b\u1ecb TD ph\u1ee5 kh\u00f4ng th\u1ec3 d\u00f9ng ti\u1ebfp t\u1ee5c corticoid.<\/strong><\/span><\/p>\n<p><span style=\"font-weight: 400;\">+\u00a0 Ng\u01b0ng corticoid\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ T\u0103ng li\u1ec1u kh\u00e1ng men\u00a0 Th\u00eam UCMD kh\u00e1c\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ Xem x\u00e9t l\u1ecdc HT\u00a0<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3><span style=\"font-weight: 400;\"><strong>4.4. C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch<\/strong>\u00a0<\/span><\/h3>\n<p><span style=\"font-weight: 400;\"><a href=\"https:\/\/www.vinmec.com\/vi\/thong-tin-duoc\/su-dung-thuoc-toan\/cong-dung-thuoc-azathioprine-50mg\/\"><strong>Azathioprine<\/strong> <\/a>c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng \u1edf ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n nh\u01b0ng hi\u1ec7u qu\u1ea3 n\u00e0y th\u01b0\u1eddng tr\u1ec5 sau khi \u0111i\u1ec1u tr\u1ecb 4 \u20138 th\u00e1ng. M\u1ed9t khi b\u1eaft \u0111\u1ea7u c\u1ea3i thi\u1ec7n, n\u00f3 s\u1ebd duy tr\u00ec trong su\u1ed1t th\u1eddi gian d\u00f9ng thu\u1ed1c, nh\u01b0ng tri\u1ec7u ch\u1ee9ng s\u1ebd t\u00e1i ph\u00e1t l\u1ea1i n\u1ebfu ng\u1eebng thu\u1ed1c 2 \u0111\u1ebfn 3 th\u00e1ng ho\u1eb7c gi\u1ea3m li\u1ec1u d\u01b0\u1edbi ng\u01b0\u1ee1ng \u0111i\u1ec1u tr\u1ecb. C\u00e1c b\u1ec7nh nh\u00e2n th\u1ea5t b\u1ea1i v\u1edbi \u0111i\u1ec1u tr\u1ecb corticoid c\u00f3 th\u1ec3 \u0111\u00e1p \u1ee9ng v\u1edbi azathioprine ho\u1eb7c ng\u01b0\u1ee3c l\u1ea1i. M\u1ed9t s\u1ed1 \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p 2 thu\u1ed1c h\u01a1n l\u00e0 \u0111\u01a1n tr\u1ecb li\u1ec7u. V\u00ec \u0111\u00e1p \u1ee9ng v\u1edbi azthioprine x\u1ea3y ra tr\u1ec5, n\u00ean c\u1ea3 2 thu\u1ed1c c\u00f3 th\u1ec3 b\u1eaft \u0111\u1ea7u c\u00f9ng l\u00fac v\u00e0 sau \u0111\u00f3 gi\u1ea3m li\u1ec1u corticoid d\u1ea7n khi azathioprine b\u1eaft \u0111\u1ea7u c\u00f3 hi\u1ec7u qu\u1ea3. Kho\u1ea3ng 1\/3 b\u1ec7nh nh\u00e2n b\u1ecb t\u00e1c d\u1ee5ng ph\u1ee5 nh\u1eb9 li\u00ean quan v\u1edbi li\u1ec1u v\u00e0 ch\u1ec9 c\u1ea7n gi\u1ea3m li\u1ec1u ch\u1ee9 kh\u00f4ng ph\u1ea3i ng\u1eebng thu\u1ed1c.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\"><a href=\"https:\/\/www.vinmec.com\/vi\/thong-tin-duoc\/su-dung-thuoc-toan\/thuoc-mycophenolate-mofetil-cong-dung-chi-dinh-va-luu-y-khi-dung\/\"><strong>Mycophenolate mofetil<\/strong><\/a> \u0111\u01b0\u1ee3c d\u00f9ng trong \u0111i\u1ec1u tr\u1ecb nh\u01b0\u1ee3c c\u01a1 kh\u00e1ng tr\u1ecb ho\u1eb7c b\u1ec7nh nh\u00e2n b\u1ecb t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch kh\u00e1c. Li\u1ec1u th\u01b0\u1eddng d\u00f9ng l\u00e0 1g chia l\u00e0m 2 l\u1ea7n trong ng\u00e0y. T\u00e1c d\u1ee5ng ph\u1ee5 c\u00f3 th\u1ec3 g\u1eb7p l\u00e0 gi\u1ea3m b\u1ea1ch c\u1ea7u, ti\u1ec3u c\u1ea7u, thi\u1ebfu m\u00e1u, lo\u00e9t d\u1ea1 d\u00e0y, xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<table>\n<tbody>\n<tr>\n<td><strong>Thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch\u00a0<\/strong><\/td>\n<td><span style=\"font-weight: 400;\"><strong>Azathioprine:<\/strong> 50mg\/ng\u00e0y (tu\u1ea7n \u0111\u1ea7u)\u00a0 t\u0103ng l\u00ean 2mg\/kg\/ng\u00e0y. <\/span><span style=\"font-weight: 400;\"><strong>Khi k\u1ebft h\u1ee3p Corticosteroid + Aza<\/strong> &gt;&gt;&gt;\u00a0 c\u00f3 th\u1ec3 gi\u1ea3m li\u1ec1u Corticoid nhanh h\u01a1n.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\"><strong>Mycophenolate mofetil:<\/strong> 500mg 2 l\u1ea7n\/ng\u00e0y\u00a0<\/span><\/td>\n<td>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">&#8211; <strong>Td ph\u1ee5<\/strong>: m\u1ec7t m\u1ecfi gi\u1ed1ng c\u00fam, gi\u1ea3m BC, TC, thi\u1ebfu m\u00e1u, t\u0103ng men gan\u00a0 theo d\u00f5i CTM, men gan m\u1ed7i 2 tu\u1ea7n\/2 th\u00e1ng \u0111\u1ea7u v\u00e0 m\u1ed7i 4 tu\u1ea7n\/ 4 th\u00e1ng k\u1ebf ti\u1ebfp.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">&#8211;<strong> Td ph\u1ee5:<\/strong> gi\u1ea3m BC, TC, thi\u1ebfu m\u00e1u, lo\u00e9t d\u1ea1 d\u00e0y, XHTH.<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3><strong>4.5. <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/ky-thuat-thay-huyet-tuong-trong-dieu-tri-benh-nhuoc-co\/\">Thay huy\u1ebft t\u01b0\u01a1ng<\/a><\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">\u00a0Thay huy\u1ebft t\u01b0\u01a1ng \u0111\u01b0\u1ee3c d\u00f9ng nh\u01b0 l\u00e0 m\u1ed9t can thi\u1ec7p ng\u1eafn h\u1ea1n cho c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0\u1ee3c c\u01a1 x\u1ea5u \u0111\u1ed9t ng\u1ed9t v\u00ec nhi\u1ec1u l\u00fd do, \u0111\u1ec3 c\u1ea3i thi\u1ec7n nhanh ch\u00f3ng s\u1ee9c c\u01a1 tr\u01b0\u1edbc ph\u1eabu thu\u1eadt, v\u00e0 l\u00e0 c\u00e1ch \u0111i\u1ec1u tr\u1ecb \u0111\u1ecbnh k\u1ef3 m\u00e3n t\u00ednh \u1edf c\u00e1c b\u1ec7nh nh\u00e2n kh\u00e1ng tr\u1ecb v\u1edbi t\u1ea5t c\u00e1c c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb nh\u01b0\u1ee3c c\u01a1 kh\u00e1c.\u00a0<\/span><\/p>\n<h3><span style=\"font-weight: 400;\"><strong>4.6. <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/lieu-phap-ivig-de-dieu-tri-cac-benh-tu-mien\/\">Truy\u1ec1n t\u0129nh m\u1ea1ch Globulin Mi\u1ec5n d\u1ecbch (IVIG)<\/a><\/strong>\u00a0<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Nhi\u1ec1u nh\u00f3m nghi\u00ean c\u1ee9u \u0111\u00e3 ghi nh\u1eadn \u0111\u00e1p \u1ee9ng \u0111\u1ea7y h\u1ee9a h\u1eb9n \u0111\u1ed1i v\u1edbi IVIG li\u1ec1u cao (2grams\/ kg truy\u1ec1n TM trong 2 \u2013 5 ng\u00e0y). C\u01a1 ch\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u00f3 th\u1ec3 bao g\u1ed3m s\u1ef1 \u0111i\u1ec1u ho\u00e0 ng\u01b0\u1ee3c c\u00e1c kh\u00e1ng th\u1ec3 kh\u00e1ng AChR. S\u1ef1 c\u1ea3i thi\u1ec7n x\u1ea3y ra \u1edf 50-100% b\u1ec7nh nh\u00e2n, th\u01b0\u1eddng b\u1eaft \u0111\u1ea7u trong v\u00f2ng m\u1ed9t tu\u1ea7n v\u00e0 k\u00e9o d\u00e0i trong v\u00e0i tu\u1ea7n \u0111\u1ebfn v\u00e0i th\u00e1ng. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 ch\u00ednh c\u1ee7a IVIG li\u00ean quan v\u1edbi t\u1ed1c \u0111\u1ed9 truy\u1ec1n. IVIG \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong \u0111i\u1ec1u tr\u1ecb nh\u01b0\u1ee3c c\u01a1 n\u1eb7ng v\u00e0 trong chu\u1ea9n b\u1ecb b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc ph\u1eabu thu\u1eadt tuy\u1ebfn \u1ee9c.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p>Xem th\u00eam:<\/p>\n<p><a href=\"https:\/\/www.vinmec.com\/vi\/benh\/nhuoc-co-4676\/\">Nh\u01b0\u1ee3c c\u01a1: Nguy\u00ean nh\u00e2n, tri\u1ec7u ch\u1ee9ng, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb | Vinmec<\/a><\/p>\n<p><a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/benh-nhuoc-co-bien-chung-nguy-hiem-va-cach-dieu-tri\/\">B\u1ec7nh nh\u01b0\u1ee3c c\u01a1: Bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m v\u00e0 c\u00e1ch \u0111i\u1ec1u tr\u1ecb | Vinmec<\/a><\/p>\n<p><a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/san-phu-khoa-va-ho-tro-sinh-san\/nhuoc-co-o-phu-nu-co-thai-va-nhuoc-co-tre-em\/\">Nh\u01b0\u1ee3c c\u01a1 \u1edf ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 nh\u01b0\u1ee3c c\u01a1 tr\u1ebb em | Vinmec<\/a><\/p>\n<p><a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/co-xuong-khop\/chan-doan-va-dieu-tri-nhuoc-co\/\">Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb nh\u01b0\u1ee3c c\u01a1 | Vinmec<\/a><\/p>\n<p><span style=\"font-weight: 400;\">T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/span><\/p>\n<ol>\n<li><span style=\"font-weight: 400;\"> Wolfe GI, Gross B. Treatment Review and Update for Myasthenia Gravis. J Clin Neuromusc Dis 2004;6:54\u201368.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\"> Reddel SW. Treatment of myasthenia gravis. Aust Prescr 2007;30:156\u201360.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\"> Gilroy J. Myasthenia gravis. In Basic Neurology 3rd edn. McGrawHill 2000: 641-649.\u00a0\u00a0<\/span><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m nh\u1ea5t c\u1ee7a b\u1ec7nh nh\u01b0\u1ee3c c\u01a1 l\u00e0 suy h\u00f4 h\u1ea5p do y\u1ebfu ho\u1eb7c li\u1ec7t c\u00e1c c\u01a1 h\u00f4 h\u1ea5p, d\u1eabn \u0111\u1ebfn t\u1eed vong nhanh ch\u00f3ng n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c c\u1ee9u ch\u1eefa k\u1ecbp th\u1eddi. Ngo\u00e0i ra, nh\u01b0\u1ee3c c\u01a1 c\u0169ng khi\u1ebfn cho ng\u01b0\u1eddi b\u1ec7nh lu\u00f4n c\u1ea3m th\u1ea5y m\u1ec7t m\u1ecfi, suy ki\u1ec7t, \u0103n u\u1ed1ng k\u00e9m, m\u1ea5t t\u1eadp [&hellip;]<\/p>\n","protected":false},"author":17,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[10,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Ph\u00e1c \u0111\u1ed3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb Nh\u01b0\u1ee3c c\u01a1 - Vinmec<\/title>\n<meta name=\"description\" content=\"Nh\u01b0\u1ee3c c\u01a1 khi\u1ebfn cho ng\u01b0\u1eddi b\u1ec7nh lu\u00f4n c\u1ea3m th\u1ea5y m\u1ec7t m\u1ecfi, suy ki\u1ec7t, \u0103n u\u1ed1ng k\u00e9m. 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