{"id":29949,"date":"2023-05-06T22:02:38","date_gmt":"2023-05-06T15:02:38","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29949"},"modified":"2023-05-06T22:02:38","modified_gmt":"2023-05-06T15:02:38","slug":"hoi-chung-guillain-barre-o-tre-em","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/hoi-chung-guillain-barre-o-tre-em\/","title":{"rendered":"H\u1ed9i ch\u1ee9ng Guillain – Barre \u1edf tre\u0309 em"},"content":{"rendered":"
\n

H\u1ed9i ch\u1ee9ng Guillain – Barre \u1edf tr\u1ebb em<\/strong> l\u00e0 b\u1ec7nh l\u00fd hi\u1ebfm g\u1eb7p, l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y li\u1ec7t m\u1ec1m c\u1ea5p. N\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi, b\u1ec7nh nh\u00e2n Guillain – Barre c\u00f3 nguy c\u01a1 t\u1eed vong cao do suy h\u00f4 h\u1ea5p ho\u1eb7c s\u1eb7c ph\u1ed5i do r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng nu\u1ed1t, ho\u1eb7c ng\u1eebng tim do t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh chi ph\u1ed1i tim. H\u1ed9i ch\u1ee9ng Guillain – Barre\u00a0l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u1ea7n kinh ngo\u1ea1i bi\u00ean m\u1eafc ph\u1ea3i \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 b\u1ec7nh\u00a0vi\u00eam \u0111a r\u1ec5 d\u00e2y th\u1ea7n kinh<\/a>\u00a0m\u1ea5t myelin c\u1ea5p t\u00ednh (Acute Demyelinating Polyradiculoneuropathy) ho\u1eb7c li\u1ec7t Landry. \u0110\u00e2y l\u00e0 ch\u1ee9ng r\u1ed1i lo\u1ea1n do h\u1ec7 mi\u1ec5n d\u1ecbch t\u1ea5n c\u00f4ng v\u00e0o m\u1ed9t ph\u1ea7n h\u1ec7 th\u1ea7n kinh ngo\u1ea1i bi\u00ean. T\u00ecnh tr\u1ea1ng n\u00e0y g\u00e2y\u00a0t\u1ed5n th\u01b0\u01a1ng d\u00e2y th\u1ea7n kinh, g\u00e2y vi\u00eam, d\u1eabn \u0111\u1ebfn li\u1ec7t ho\u1eb7c y\u1ebfu c\u01a1 n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1eefa tr\u1ecb k\u1ecbp th\u1eddi.<\/p>\n<\/div>\n

Ba\u0300i vi\u00ea\u0301t H\u1ed9i ch\u1ee9ng Guillain \u2013 Barre\u0301 \u1edf tre\u0309 em tri\u0301ch ngu\u00f4\u0300n t\u01b0\u0300 H\u00f4\u0323i Th\u00e2\u0300n kinh ho\u0323c Vi\u00ea\u0323t Nam. <\/strong><\/em><\/p>\n

Ta\u0301c gia\u0309:<\/strong><\/em><\/p>\n

\u0110\u0103\u0323ng Hoa\u0300ng H\u01b0ng1<\/sup>, Nguy\u00ea\u0303n L\u00ea Trung Hi\u00ea\u0301u\u00a01,2<\/sup><\/strong><\/em>
\nB\u00f4\u0323 m\u00f4n Th\u00e2\u0300n kinh, \u0110a\u0323i ho\u0323c Y D\u01b0\u01a1\u0323c TP. H\u00f4\u0300 Chi\u0301 Minh1<\/sup><\/strong><\/em>
\nKhoa Th\u00e2\u0300n kinh, B\u00ea\u0323nh vi\u00ea\u0323n Nhi \u0110\u00f4\u0300ng 22<\/sup><\/em><\/p>\n

To\u0301m t\u0103\u0301t<\/strong>
\nH\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 l\u00e0 nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p g\u00e2y li\u1ec7t m\u1ec1m c\u1ea5p t\u00ednh, \u0111\u1eb7c tr\u01b0ng b\u1edfi y\u1ebfu chi \u0111\u1ed1i x\u1ee9ng k\u00e8m gi\u1ea3m ho\u1eb7c m\u1ea5t ph\u1ea3n x\u1ea1 g\u00e2n c\u01a1, \u0111\u1ea1t m\u1ee9c \u0111\u1ed9 n\u1eb7ng t\u1ed1i \u0111a trong v\u00f2ng 4 tu\u1ea7n.
\nCh\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 \u1edf tr\u1ebb em l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c v\u00ec nhi\u1ec1u l\u00fd do nh\u01b0 gi\u1edbi h\u1ea1n trong giao ti\u1ebfp, th\u0103m kh\u00e1m v\u00e0 s\u1ef1 \u0111a d\u1ea1ng trong bi\u1ec3u hi\u1ec7n[11]. Ch\u1ec9 kho\u1ea3ng m\u1ed9t ph\u1ea7n ba tr\u1ebb tr\u01b0\u1edbc tu\u1ed5i \u0111\u1ebfn tr\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 t\u1ea1i th\u1eddi \u0111i\u1ec3m nh\u1eadp vi\u1ec7n [26]. Vi\u1ec7c \u0111o \u0111i\u1ec7n c\u01a1 \u1edf tr\u1ebb em c\u0169ng kh\u00f3 h\u01a1n so v\u1edbi ng\u01b0\u1eddi l\u1edbn. K\u00edch th\u00edch g\u00e2y \u0111au l\u00e0m n\u1eb7ng th\u00eam t\u00ecnh tr\u1ea1ng \u0111au th\u1ea7n kinh s\u1eb5n c\u00f3 c\u1ee7a tr\u1ebb, v\u00ec v\u1eady kh\u00f4ng ph\u1ea3i l\u00fac n\u00e0o c\u0169ng c\u00f3 th\u1ec3 \u0111o \u0111\u1ea7y \u0111\u1ee7 c\u00e1c d\u00e2y th\u1ea7n kinh v\u00e0 th\u1ef1c hi\u1ec7n \u0111i\u1ec7n c\u01a1 kim, v\u00e0 g\u1ea7n nh\u01b0 kh\u00f4ng th\u1ec3 \u0111o l\u1eb7p l\u1ea1i [16].
\n\u0110i\u00ea\u0300u tri\u0323 h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 \u01a1\u0309 tre\u0309 em cho \u0111\u00ea\u0301n nay ch\u01b0a co\u0301 b\u0103\u0300ng ch\u01b0\u0301ng ma\u0323nh va\u0300 v\u00e2\u0303n s\u01b0\u0309 du\u0323ng theo pha\u0301c \u0111\u00f4\u0300 t\u01b0\u01a1ng t\u01b0\u0323 cu\u0309a ng\u01b0\u01a1\u0300i l\u01a1\u0301n. H\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 \u1edf tr\u1ebb em nh\u00ecn chung c\u00f3 ti\u00ean l\u01b0\u1ee3ng t\u1ed1t, nh\u01b0ng \u0111\u00e3 c\u00f3 b\u00e1o c\u00e1o t\u1eed vong do r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea7n kinh t\u1ef1 \u0111\u1ed9ng hay do \u0111i\u1ec1u tr\u1ecb [28]. Nhi\u1ec1u y\u1ebfu t\u1ed1 ti\u00ean l\u01b0\u1ee3ng \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u \u1edf ng\u01b0\u1eddi l\u1edbn, tuy nhi\u00ean kh\u00f4ng nhi\u1ec1u trong s\u1ed1 \u0111\u00f3 c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng \u0111\u01b0\u1ee3c \u1edf tr\u1ebb em.
\nT\u1eeb kh\u00f3a: H\u1ed9i ch\u1ee9ng Guilain Barr\u00e9 \u1edf tr\u1ebb em.<\/p>\n

1. T\u00f4\u0309ng quan<\/strong><\/h2>\n

H\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 l\u00e0 nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t g\u00e2y li\u1ec7t m\u1ec1m c\u1ea5p t\u00ednh, th\u01b0\u1eddng x\u1ea3y ra sau nhi\u1ec5m tr\u00f9ng, g\u00e2y \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch t\u1ea1o n\u00ean c\u00e1c kh\u00e1ng th\u1ec3 l\u00e0m t\u1ed5n th\u01b0\u01a1ng d\u00e2y th\u1ea7n kinh ho\u1eb7c gi\u00e1n \u0111o\u1ea1n ch\u1ee9c n\u0103ng d\u1eabn truy\u1ec1n c\u1ee7a d\u00e2y th\u1ea7n kinh [29].
\nH\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 \u1edf tr\u1ebb em c\u00f3 c\u00f9ng \u0111\u1eb7c \u0111i\u1ec3m chung l\u00e0 kh\u1edfi \u0111\u1ea7u l\u00e0 t\u00ecnh tr\u1ea1ng y\u1ebfu chi \u0111\u1ed1i x\u1ee9ng, ti\u1ebfn tri\u1ec3n nhanh, \u0111\u1ea1t \u0111\u1ec9nh tri\u1ec7u ch\u1ee9ng trong v\u00f2ng 4 tu\u1ea7n \u0111\u1ea7u, sau \u0111\u00f3 l\u00e0 giai \u0111o\u1ea1n b\u00ecnh nguy\u00ean k\u00e9o d\u00e0i 2 ng\u00e0y \u0111\u1ebfn 6 th\u00e1ng, tr\u01b0\u1edbc khi b\u01b0\u1edbc v\u00e0o giai \u0111o\u1ea1n h\u1ed3i ph\u1ee5c [8].
\nT\u1ef7 l\u1ec7 m\u0103\u0301c m\u01a1\u0301i ha\u0300ng n\u0103m cu\u0309a H\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 \u1edf tr\u1ebb em kha\u0301 dao \u0111\u00f4\u0323ng tu\u0300y theo nghi\u00ean c\u01b0\u0301u, t\u01b0\u0300 0,4 \u2013 1,4 ca trong 100.000 tre\u0309 d\u01b0\u01a1\u0301i 18 tu\u00f4\u0309i, th\u00e2\u0301p h\u01a1n so v\u01a1\u0301i ng\u01b0\u01a1\u0300i l\u01a1\u0301n [20]. Hi\u00ea\u0301m khi chu\u0301ng ta th\u00e2\u0301y h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 \u01a1\u0309 tre\u0309 d\u01b0\u01a1\u0301i 2 tu\u00f4\u0309i. T\u1ef7 l\u1ec7 tre\u0309 nam\/tre\u0309 n\u01b0\u0303 = 1,5\/1.
\n76% b\u1ec7nh nh\u00e2n h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 n\u00f3i chung c\u00f3 li\u00ean quan \u0111\u1ebfn m\u1ed9t s\u1ef1 ki\u1ec7n trong 4 tu\u1ea7n tr\u01b0\u1edbc khi kh\u1edfi b\u1ec7nh, ch\u1ee7 y\u1ebfu l\u00e0 nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean (36%) v\u00e0 vi\u00eam d\u1ea1 d\u00e0y ru\u1ed9t (27%) [7]. Ch\u00ednh s\u1ef1 li\u00ean quan m\u1eadt thi\u1ebft v\u1edbi nhi\u1ec5m tr\u00f9ng n\u00ean c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t t\u1ef7 l\u1ec7 m\u1edbi m\u1eafc gi\u1eefa c\u00e1c m\u00f9a trong n\u0103m. Nhi\u1ec1u nghi\u00ean c\u1ee9u \u1edf c\u00e1c n\u01b0\u1edbc ph\u01b0\u01a1ng T\u00e2y g\u1ee3i \u00fd r\u1eb1ng \u0111\u1ec9nh b\u1ec7nh th\u01b0\u1eddng g\u1eb7p v\u00e0o m\u00f9a \u0111\u00f4ng, trong khi \u1edf m\u1ed9t s\u1ed1 n\u01b0\u1edbc ch\u00e2u \u00c1 th\u00ec l\u1ea1i \u0111\u1ea1t \u0111\u1ec9nh v\u00e0o c\u00e1c th\u00e1ng m\u00f9a h\u00e8.
\nC\u0169ng nh\u01b0 \u1edf ng\u01b0\u1eddi l\u1edbn, c\u00e1c b\u00e1o c\u00e1o \u0111\u00e3 cho th\u1ea5y m\u1ed1i li\u00ean quan gi\u1eefa nhi\u1ec5m tr\u00f9ng Campylobacter jejuni v\u00e0 H\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 th\u1ec3 AMAN[28]. Trong \u0111\u1ea1i d\u1ecbch COVID \u2013 19, \u0111\u00e3 c\u00f3 c\u00e1c b\u00e1o c\u00e1o v\u1ec1 H\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 v\u00e0 h\u1ed9i ch\u1ee9ng Miller Fisher li\u00ean quan v\u1edbi nhi\u1ec5m virus SARS-CoV-2, m\u1eb7c d\u00f9 m\u1ed1i quan h\u1ec7 nh\u00e2n qu\u1ea3 ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh [12].<\/p>\n

2. C\u01a1 ch\u00ea\u0301 b\u00ea\u0323nh sinh<\/strong><\/h2>\n

T\u1eeb th\u1eddi \u0111i\u1ec3m \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 l\u1ea7n \u0111\u1ea7u, 1916 \u0111\u1ebfn cu\u1ed1i nh\u1eefng n\u0103m 1980, h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 \u0111\u01b0\u1ee3c xem l\u00e0 b\u1ec7nh l\u00fd th\u1ef1c th\u1ec3 \u0111\u01a1n thu\u1ea7n do t\u00ecnh tr\u1ea1ng t\u1ed5n th\u01b0\u01a1ng ph\u1ee9c h\u1ee3p myelin nguy\u00ean ph\u00e1t qua trung gian mi\u1ec5n d\u1ecbch v\u00e0 t\u1ed5n th\u01b0\u01a1ng s\u1ee3i tr\u1ee5c th\u1ee9 ph\u00e1t. Sau \u0111\u00f3 h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u r\u00f5 h\u01a1n v\u00e0 \u0111\u01b0\u1ee3c chia l\u00e0m hai th\u1ec3: AIDP (Acute Inlfammatory Demyelinating Polyradiculoneuropathy) v\u00e0 AMAN (Acute Motor Axonal Neuropathy), d\u1ef1a v\u00e0o v\u1ecb tr\u00ed c\u1ee7a kh\u00e1ng nguy\u00ean t\u00f4\u0309n th\u01b0\u01a1ng th\u00e2\u0300n kinh.
\nC\u00e1c nghi\u00ean c\u1ee9u t\u1eed thi\u1ebft cho th\u1ea5y AIDP \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a th\u00e2m nhi\u1ec5m vi\u00eam c\u1ee7a t\u1ebf b\u00e0o T v\u00e0 \u0111\u1ea1i th\u1ef1c b\u00e0o bao g\u1ed3m c\u00e1c \u0111\u1ea1i th\u1ef1c b\u00e0o t\u1ea1o myelin [2] (H\u00ecnh 1.1A). Ng\u01b0\u1ee3c l\u1ea1i v\u1edbi AIDP, b\u1ec7nh nh\u00e2n th\u1ec3 AMAN c\u00f3 t\u00ecnh tr\u1ea1ng t\u1ed5n th\u01b0\u01a1ng s\u1ee3i tr\u1ee5c nguy\u00ean ph\u00e1t m\u00e0 kh\u00f4ng k\u00e8m theo th\u00e2m nhi\u1ec5m t\u1ebf b\u00e0o T hay h\u1ee7y myelin ma\u0300 thay va\u0300o \u0111o\u0301 la\u0300 \u0111\u1ea1i th\u1ef1c b\u00e0o, b\u1ed5 th\u1ec3 ho\u1ea1t h\u00f3a v\u00e0 IgG l\u1eafng \u0111\u1ecdng \u1edf m\u00e0ng s\u1ee3i tr\u1ee5c [10]. \u0110\u1ea1i th\u1ef1c b\u00e0o x\u00e2m l\u1ea5n v\u00e0o khoang quanh s\u1ee3i tr\u1ee5c, l\u00e0m r\u1ed9ng n\u1ed1t, theo sau b\u01a1\u0309i bong myelin c\u1eadn n\u1ed1t, d\u1eabn \u0111\u1ebfn l\u00e0m ch\u1eadm t\u1ed1c \u0111\u1ed9 d\u1eabn truy\u1ec1n (H\u00ecnh 1.1B).
\nS\u1ef1 kh\u00e1c bi\u1ec7t c\u01a1 ch\u1ebf b\u1ec7nh sinh gi\u1eefa AMAN v\u00e0 AIDP d\u1eabn \u0111\u1ebfn s\u1ef1 kh\u00e1c nhau khi h\u1ed3i ph\u1ee5c v\u1ec1 l\u00e2m s\u00e0ng v\u00e0 \u0111i\u1ec7n sinh l\u00fd. \u1ede AIDP, s\u1ef1 h\u1ed3i ph\u1ee5c ph\u1ee5 thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng t\u00e1i t\u1ea1o myelin v\u00e0 m\u1ee9c \u0111\u1ed9 c\u1ee7a tho\u00e1i h\u00f3a s\u1ee3i tr\u1ee5c th\u1ee9 ph\u00e1t. C\u00f2n \u1edf AMAN, s\u1ef1 h\u1ed3i ph\u1ee5c ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng do l\u1eafng \u0111\u1ecdng kh\u00e1ng th\u1ec3. Qu\u00e1 tr\u00ecnh n\u00e0y kh\u00e1 ph\u1ee9c t\u1ea1p v\u00ec c\u00e1c kh\u00e1ng th\u1ec3 g\u1eafn v\u00e0o m\u1ea7m c\u1ee7a s\u1ee3i tr\u1ee5c v\u00e0 ng\u0103n ch\u1eb7n s\u1ef1 t\u00e1i t\u1ea1o s\u1ee3i tr\u1ee5c [18]. M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n th\u1ec3 AMAN h\u1ed3i ph\u1ee5c nhanh khi t\u00ecnh tr\u1ea1ng block d\u1eabn truy\u1ec1n do trung gian kh\u00e1ng th\u1ec3 \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft.<\/p>\n

\"\"<\/a><\/p>\n

H\u00ecnh 1.1. B\u1ec7nh sinh mi\u1ec5n d\u1ecbch c\u1ee7a h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9. Ngu\u1ed3n: Yuki v\u00e0 c\u1ed9ng s\u1ef1, 2012 [34].<\/p>\n

Ganglioside l\u00e0 glycolipid ch\u1ee9a acid sialic xu\u1ea5t hi\u1ec7n nhi\u1ec1u \u1edf h\u1ec7 th\u1ea7n kinh c\u1ee7a \u0111\u1ed9ng v\u1eadt c\u00f3 v\u00fa, \u0111\u1eb7c bi\u1ec7t \u1edf n\u1ed1t Ranvier v\u00e0 \u0111\u1ea7u t\u1eadn th\u1ea7n kinh v\u1eadn \u0111\u1ed9ng (H\u00ecnh 1.2). C\u00e1c th\u1ec3 c\u1ee7a h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 li\u00ean quan v\u1edbi c\u00e1c kh\u00e1ng th\u1ec3 kh\u00e1ng ganglioside \u0111\u1eb7c hi\u1ec7u g\u1ee3i \u00fd s\u1ef1 ph\u00e2n b\u1ed1 kh\u00f4ng \u0111\u1ed3ng \u0111\u1ec1u c\u1ee7a c\u00e1c glycolipid \u0111\u00edch \u1edf c\u00e1c d\u00e2y th\u1ea7n kinh kh\u00e1c nhau. Ch\u1eb3ng h\u1ea1n nh\u01b0 h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 th\u1ec3 AMAN th\u01b0\u1eddng c\u00f3 c\u00e1c kh\u00e1ng th\u1ec3 IgG kh\u00e1ng GM1, GD1a v\u00e0 GalNAc \u2013 GD1a, h\u1ed9i ch\u1ee9ng Miller \u2013 Fisher c\u00f3 kh\u00e1ng th\u1ec3 kh\u00e1ng GQ1b, bi\u1ec3u hi\u1ec7n \u1edf v\u00f9ng c\u1eadn n\u1ed1t c\u1ee7a ca\u0301c th\u1ea7n kinh v\u1eadn nh\u00e3n [5].
\nKh\u00e1ng nguy\u00ean \u0111\u00edch trong AIDP cho \u0111\u1ebfn nay v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft. Nhi\u1ec1u nghi\u00ean c\u1ee9u th\u1ef1c nghi\u1ec7m v\u1ec1 vi\u00eam th\u1ea7n kinh t\u1ef1 mi\u1ec5n cho th\u1ea5y protein myelin nh\u01b0 PMP22, P0 v\u00e0 P2 v\u00e0 protein \u1edf n\u1ed1t nh\u01b0 neurofascin c\u00f3 th\u1ec3 l\u00e0 kh\u00e1ng nguy\u00ean \u0111\u00edch. Tuy nhi\u00ean c\u00e1c t\u1ef1 kh\u00e1ng th\u1ec3 kh\u00e1ng protein myelin ch\u01b0a \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n v\u00e0 kh\u00e1ng th\u1ec3 kh\u00e1ng neurofascin hi\u1ebfm g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n AIDP [21].<\/p>\n

\"\"<\/a><\/p>\n

H\u00ecnh 1.2. C\u1ea5u tr\u00fac c\u00e1c kh\u00e1ng th\u1ec3 kh\u00e1ng ganglioside trong h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9. Ngu\u1ed3n: Yuki v\u00e0 c\u1ed9ng s\u1ef1, 2012 [34].<\/p>\n

Trong h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 th\u1ec3 AMAN li\u00ean quan v\u1edbi Campylobacter jejuni, nhi\u1ec1u b\u1eb1ng ch\u1ee9ng cho th\u1ea5y vai tr\u00f2 c\u1ee7a s\u1ef1 t\u01b0\u01a1ng \u0111\u1ed3ng c\u1ea5u tr\u00fac ph\u00e2n t\u1eed c\u00f3 li\u00ean quan \u0111\u1ebfn c\u01a1 ch\u1ebf b\u1ec7nh sinh [23]; b\u1ec7nh nh\u00e2n b\u1ecb h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 th\u1ec3 AMAN li\u00ean quan C.jejuni c\u0169ng c\u00f3 kh\u00e1ng th\u1ec3 kh\u00e1ng GM1 v\u00e0 GD1a; c\u1ea5u tr\u00fac t\u01b0\u01a1ng t\u1ef1 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n gi\u1eefa th\u00e0nh ph\u1ea7n \u0111\u01b0\u1eddng c\u1ee7a lipo-oligosaccharide c\u1ee7a Campylobacter jejuni li\u00ean quan AMAN v\u00e0 ganglioside c\u1ee7a th\u1ea7n kinh ngo\u1ea1i bi\u00ean [34].
\nC\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a H\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 \u1edf tr\u1ebb em c\u0169ng \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 trong H\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 chung.<\/p>\n

3. Bi\u00ea\u0309u hi\u00ea\u0323n l\u00e2m sa\u0300ng<\/strong><\/h2>\n

Bi\u00ea\u0309u hi\u00ea\u0323n l\u00e2m sa\u0300ng \u0111i\u00ea\u0309n hi\u0300nh cu\u0309a h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 la\u0300 di\u0323 ca\u0309m \u0111\u00e2\u0300u ngo\u0301n ch\u00e2n va\u0300 \u0111\u00e2\u0300u ngo\u0301n tay, sau \u0111o\u0301 xu\u00e2\u0301t hi\u00ea\u0323n y\u00ea\u0301u t\u01b0\u0301 chi d\u01b0\u01a1\u0301i \u0111\u00f4\u0301i x\u01b0\u0301ng t\u0103ng d\u00e2\u0300n, hai chi d\u01b0\u01a1\u0301i n\u0103\u0323ng h\u01a1n hai chi tr\u00ean, va\u0300 trong tr\u01b0\u01a1\u0300ng h\u01a1\u0323p n\u0103\u0323ng co\u0301 th\u00ea\u0309 a\u0309nh h\u01b0\u01a1\u0309ng \u0111\u00ea\u0301n c\u01a1 h\u00f4 h\u00e2\u0301p. Khoa\u0309ng 9,6% tre\u0309 c\u00e2\u0300n th\u00f4ng khi\u0301 c\u01a1 ho\u0323c [3].
\nCa\u0301c tri\u00ea\u0323u ch\u01b0\u0301ng th\u01b0\u01a1\u0300ng g\u0103\u0323p nh\u00e2\u0301t cu\u0309a tre\u0309 lu\u0301c nh\u00e2\u0323p vi\u00ea\u0323n theo th\u01b0\u0301 t\u01b0\u0323 [24]:
\n\u2013 Y\u00ea\u0301u t\u01b0\u0301 chi (93%)
\n\u2013 \u0110au th\u00e2\u0300n kinh (73%)
\n\u2013 Y\u00ea\u0301u hai chi d\u01b0\u01a1\u0301i (82%)
\n\u2013 T\u00f4\u0309n th\u01b0\u01a1ng th\u00e2\u0300n kinh so\u0323 (53%)
\n38% tre\u0309 bi\u0323 r\u00f4\u0301i loa\u0323n th\u00e2\u0300n kinh th\u01b0\u0323c v\u00e2\u0323t v\u01a1\u0301i m\u00f4\u0323t trong s\u00f4\u0301 ca\u0301c bi\u00ea\u0309u hi\u00ea\u0323n: r\u00f4\u0301i loa\u0323n nhi\u0323p tim, huy\u00ea\u0301t a\u0301p, r\u00f4\u0301i loa\u0323n c\u01a1 vo\u0300ng (bi\u0301 ti\u00ea\u0309u, ta\u0301o bo\u0301n, li\u00ea\u0323t ru\u00f4\u0323t), r\u00f4\u0301i loa\u0323n th\u00e2n nhi\u00ea\u0323t, r\u00f4\u0301i loa\u0323n ti\u00ea\u0301t m\u00f4\u0300 h\u00f4i [4].
\nM\u00f4\u0323t s\u00f4\u0301 hi\u00ea\u0301m tre\u0309 se\u0303 co\u0301 bi\u00ea\u0309u hi\u00ea\u0323n cu\u0309a h\u00ea\u0323 th\u00e2\u0300n kinh trung \u01b0\u01a1ng b\u01a1\u0309i ti\u0300nh tra\u0323ng vi\u00eam th\u00e2n na\u0303o Bickerstaff.
\nH\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 di\u1ec5n ti\u1ebfn m\u1ed9t pha, th\u01b0\u1eddng \u0111\u1ea1t m\u1ee9c \u0111\u1ed9 n\u1eb7ng t\u1ed1i \u0111a trong v\u00f2ng 4 tu\u1ea7n. 80% b\u1ec7nh nh\u00e2n \u0111\u1ea1t \u0111\u1ec9nh tri\u1ec7u ch\u1ee9ng trong 2 tu\u1ea7n v\u00e0 97% \u0111\u1ea1t \u0111\u1ec9nh trong 4 tu\u1ea7n, m\u1ed9t b\u1ed9 ph\u1eadn nh\u1ecf b\u1ec7nh nh\u00e2n \u0111\u1ea1t \u0111\u1ec9nh tri\u1ec7u ch\u1ee9ng trong 4-6 tu\u1ea7n sau khi kh\u1edfi ph\u00e1t [8]. Sau \u0111\u00f3 l\u00e0 giai \u0111o\u1ea1n b\u00ecnh nguy\u00ean k\u00e9o d\u00e0i t\u1eeb 2 ng\u00e0y \u0111\u1ebfn 6 th\u00e1ng (trung b\u00ecnh l\u00e0 7 ng\u00e0y) tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u h\u1ed3i ph\u1ee5c [8].<\/p>\n

B\u1ea3ng 1. C\u00e1c th\u1ec3 c\u1ee7a h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9. (Ngu\u1ed3n : Sonja E. Leonhard v\u00e0 c\u1ed9ng s\u1ef1, 2019\u00a0[19]<\/sup>)<\/p>\n\n\n\n\n\n\n\n\n\n\n\n
Th\u1ec3 l\u00e2m sa\u0300ng<\/strong><\/td>\nT\u1ea7n su\u1ea5t<\/strong><\/td>\nBi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng<\/strong><\/td>\n<\/tr>\n
H\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 v\u1eadn \u0111\u1ed9ng c\u1ea3m gi\u00e1c \u0111i\u1ec3n h\u00ecnh<\/td>\n30 \u2013 85%<\/td>\nY\u1ebfu v\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ea3m gi\u00e1c \u0111\u1ed1i x\u1ee9ng ti\u1ebfn tri\u1ec3n nhanh, k\u00e8m gi\u1ea3m ho\u1eb7c m\u1ea5t ph\u1ea3n x\u1ea1 g\u00e2n c\u01a1, th\u01b0\u1eddng \u0111\u1ea1t \u0111\u1ec9nh trong v\u00f2ng 2 tu\u1ea7n<\/td>\n<\/tr>\n
V\u1eadn \u0111\u1ed9ng \u0111\u01a1n thu\u1ea7n<\/td>\n5 \u2013 70%<\/td>\nY\u1ebfu kh\u00f4ng k\u00e8m v\u1edbi tri\u1ec7u ch\u1ee9ng c\u1ea3m gi\u00e1c<\/td>\n<\/tr>\n
Li\u1ec7t hai chi d\u01b0\u1edbi<\/td>\n5 \u2013 10%<\/td>\nY\u1ebfu khu tr\u00fa hai chi d\u01b0\u1edbi<\/td>\n<\/tr>\n
H\u1ea7u h\u1ecdng \u2013 c\u1ed5 \u2013 c\u00e1nh tay<\/td>\n<5%<\/td>\nY\u1ebfu c\u01a1 h\u1ea7u h\u1ecdng, c\u1ed5 v\u00e0 c\u00e1nh tay kh\u00f4ng k\u00e8m y\u1ebfu chi<\/td>\n<\/tr>\n
Li\u1ec7t m\u1eb7t hai b\u00ean k\u00e8m d\u1ecb c\u1ea3m<\/td>\n<5%<\/td>\nLi\u1ec7t m\u1eb7t hai b\u00ean, d\u1ecb c\u1ea3m v\u00e0 gi\u1ea3m ph\u1ea3n x\u1ea1 g\u00e2n c\u01a1<\/td>\n<\/tr>\n
C\u1ea3m gi\u00e1c \u0111\u01a1n thu\u1ea7n<\/td>\n<1%<\/td>\nB\u1ec7nh th\u1ea7n kinh c\u1ea3m gi\u00e1c c\u1ea5p ho\u1eb7c b\u00e1n c\u1ea5p kh\u00f4ng k\u00e8m y\u1ebfu li\u1ec7t<\/td>\n<\/tr>\n
H\u1ed9i ch\u1ee9ng Miller Fisher<\/td>\n5 \u2013 25%<\/td>\nLi\u1ec7t v\u1eadn nh\u00e3n, th\u1ea5t \u0111i\u1ec1u v\u00e0 m\u1ea5t ph\u1ea3n x\u1ea1 g\u00e2n c\u01a1. Th\u1ec3 kh\u00f4ng ho\u00e0n to\u00e0n v\u1edbi th\u1ea5t \u0111i\u1ec1u \u0111\u01a1n thu\u1ea7n (b\u1ec7nh th\u1ea7n kinh th\u1ea5t \u0111i\u1ec1u c\u1ea5p t\u00ednh) c\u00f3 th\u1ec3 x\u1ea3y ra. Kho\u1ea3ng 15% b\u1ec7nh nh\u00e2n ch\u1ed3ng l\u1ea5p v\u1edbi h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 v\u1eadn \u0111\u1ed9ng c\u1ea3m gi\u00e1c \u0111i\u1ec3n h\u00ecnh<\/td>\n<\/tr>\n
Vi\u00eam th\u00e2n n\u00e3o Bickerstaff<\/td>\n<5%<\/td>\nLi\u1ec7t v\u1eadn nh\u00e3n, th\u1ea5t \u0111i\u1ec1u, m\u1ea5t ph\u1ea3n x\u1ea1 g\u00e2n c\u01a1, d\u1ea5u th\u00e1p v\u00e0 suy gi\u1ea3m \u00fd th\u1ee9c, th\u01b0\u1eddng ch\u1ed3ng l\u1ea5p v\u1edbi h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 v\u1eadn \u0111\u1ed9ng c\u1ea3m gi\u00e1c<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

4. C\u00e2\u0323n l\u00e2m sa\u0300ng<\/strong><\/h2>\n

Di\u0323ch na\u0303o tu\u0309y<\/strong>
\nC\u0169ng nh\u01b0 \u1edf ng\u01b0\u1eddi l\u1edbn, khi nghi ng\u1edd h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9, b\u1ec7nh nh\u00e2n s\u1ebd \u0111\u01b0\u1ee3c ch\u1ecdc d\u1ecbch n\u00e3o t\u1ee7y, m\u1ee5c \u0111\u00edch ch\u00ednh l\u00e0 \u0111\u1ec3 lo\u1ea1i tr\u1eeb c\u00e1c ch\u1ea9n \u0111o\u00e1n kh\u00e1c h\u01a1n l\u00e0 \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9. T\u0103ng protein d\u1ecbch n\u00e3o t\u1ee7y v\u00e0 t\u1ebf b\u00e0o d\u1ecbch n\u00e3o t\u1ee7y b\u00ecnh th\u01b0\u1eddng (\u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 ph\u00e2n ly \u0111\u1ea1m t\u1ebf b\u00e0o) \u0111\u01b0\u1ee3c xem l\u00e0 ch\u1ec9 \u0111i\u1ec3m c\u1ee7a h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9. Tuy nhi\u00ean, ng\u01b0\u1eddi ta th\u01b0\u1eddng nh\u1ea7m l\u1eabn r\u1eb1ng ph\u00e2n ly \u0111\u1ea1m t\u1ebf b\u00e0o l\u00e0 ti\u00eau chu\u1ea9n c\u1ea7n c\u00f3 \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh, ch\u1ec9 kho\u1ea3ng 64% b\u1ec7nh nh\u00e2n c\u00f3 ph\u00e2n ly \u0111\u1ea1m t\u1ebf b\u00e0o [8]. 50% b\u1ec7nh nh\u00e2n h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 c\u00f3 t\u0103ng protein d\u1ecbch n\u00e3o t\u1ee7y trong 3 ng\u00e0y \u0111\u1ea7u v\u00e0 80% sau tu\u1ea7n \u0111\u1ea7u ti\u00ean [8].
\nKhi t\u1ebf b\u00e0o d\u1ecbch n\u00e3o t\u1ee7y > 50\/\u03bcL c\u1ea7n xem x\u00e9t l\u1ea1i ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9, v\u00e0 ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c nh\u01b0 ung th\u01b0 di c\u0103n m\u00e0ng n\u00e3o t\u1ee7y, u lympho, vi\u00eam r\u1ec5 th\u1ea7n kinh do CMV, b\u1ec7nh \u0111a d\u00e2y th\u1ea7n kinh do HIV v\u00e0 b\u1ea1i li\u1ec7t [8],[30]. N\u1ebfu n\u1ed3ng \u0111\u1ed9 protein d\u1ecbch n\u00e3o t\u1ee7y b\u00ecnh th\u01b0\u1eddng, kh\u00f4ng c\u1ea7n thi\u1ebft ph\u1ea3i l\u1eb7p l\u1ea1i ch\u1ecdc d\u1ecbch n\u00e3o t\u1ee7y \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9. Ngo\u00e0i ra, \u0111i\u1ec1u tr\u1ecb v\u1edbi IVIg li\u1ec1u cao c\u00f3 th\u1ec3 l\u00e0m t\u0103ng c\u1ea3 n\u1ed3ng \u0111\u1ed9 protein l\u1eabn t\u1ebf b\u00e0o d\u1ecbch n\u00e3o t\u1ee7y, c\u00f3 th\u1ec3 do d\u1ecbch th\u1ea5m l\u1eabn vi\u00eam m\u00e0ng n\u00e3o v\u00f4 tr\u00f9ng, g\u00e2y b\u1ed1i r\u1ed1i trong vi\u1ec7c ch\u1ea9n \u0111o\u00e1n n\u1ebfu ta ch\u1ecdc d\u1ecbch n\u00e3o t\u1ee7y l\u1eb7p l\u1ea1i.
\n\u0110o d\u1eabn truy\u1ec1n th\u1ea7n kinh<\/strong>
\n\u0110i\u00ea\u0323n c\u01a1 la\u0300 xe\u0301t nghi\u00ea\u0323m nha\u0323y va\u0300 \u0111\u0103\u0323c hi\u00ea\u0323u nh\u00e2\u0301t trong ch\u00e2\u0309n \u0111oa\u0301n h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9, \u0111\u00f4\u0300ng th\u01a1\u0300i xa\u0301c \u0111i\u0323nh da\u0323ng t\u00f4\u0309n th\u01b0\u01a1ng la\u0300 myelin hay s\u01a1\u0323i tru\u0323c. Tuy nhi\u00ean, \u0111o \u0111i\u1ec7n c\u01a1 \u1edf tr\u1ebb em c\u0169ng kh\u00f3 h\u01a1n so v\u1edbi ng\u01b0\u1eddi l\u1edbn. Vi\u1ec7c k\u00edch th\u00edch g\u00e2y \u0111au l\u00e0m n\u1eb7ng th\u00eam t\u00ecnh tr\u1ea1ng \u0111au th\u1ea7n kinh s\u1eb5n c\u00f3 c\u1ee7a tr\u1ebb, v\u00ec v\u1eady kh\u00f4ng ph\u1ea3i l\u00fac n\u00e0o c\u0169ng c\u00f3 th\u1ec3 \u0111o \u0111\u1ea7y \u0111\u1ee7 c\u00e1c d\u00e2y th\u1ea7n kinh v\u00e0 th\u1ef1c hi\u1ec7n \u0111i\u1ec7n c\u01a1 kim, v\u00e0 g\u1ea7n nh\u01b0 kh\u00f4ng th\u1ec3 \u0111o l\u1eb7p l\u1ea1i [16]. Khi tr\u1ebb kh\u00f4ng dung n\u1ea1p \u0111o \u0111i\u1ec7n c\u01a1, c\u00e1c x\u00e9t nghi\u1ec7m h\u00ecnh \u1ea3nh h\u1ecdc nh\u01b0 MRI hay si\u00eau \u00e2m c\u00f3 th\u1ec3 l\u00e0m sai l\u1ec7ch ch\u1ea9n \u0111o\u00e1n [28].
\nTh\u00ea\u0309 hu\u0309y myelin
\nM\u1ed9t s\u1ed1 \u0111\u1eb7c \u0111i\u1ec3m tr\u00ean \u0111i\u1ec7n c\u01a1 giai \u0111o\u1ea1n s\u1edbm c\u1ee7a h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 th\u1ec3 AIDP l\u00e0 ti\u1ec1m th\u1eddi k\u00e9o d\u00e0i ho\u1eb7c m\u1ea5t ph\u1ea3n x\u1ea1 Hoffmann v\u00e0 s\u00f3ng F [9],[32]. Qu\u1ea3 th\u1ef1c v\u1eady, v\u1ec1 m\u1eb7t b\u1ec7nh h\u1ecdc, AIDP th\u01b0\u1eddng kh\u1edfi ph\u00e1t \u1edf r\u1ec5 th\u1ea7n kinh. Sau \u0111\u00f3, \u0111i\u1ec7n c\u01a1 d\u1eabn truy\u1ec1n th\u01b0\u1eddng quy s\u1ebd c\u00f3 h\u00ecnh \u1ea3nh ti\u1ec1m th\u1eddi k\u00e9o d\u00e0i c\u00f9ng c\u00e1c b\u1eb1ng ch\u1ee9ng c\u1ee7a h\u1ee7y myelin t\u1eebng \u0111o\u1ea1n, \u0111\u1eb7c bi\u1ec7t l\u00e0 block d\u1eabn truy\u1ec1n v\u00e0 ph\u00e1t t\u00e1n theo th\u1eddi gian. Kho\u1ea3ng 50% b\u1ec7nh nh\u00e2n \u1edf tu\u1ea7n th\u1ee9 hai v\u00e0 85% b\u1ec7nh nh\u00e2n \u1edf tu\u1ea7n th\u1ee9 ba s\u1ebd xu\u1ea5t hi\u1ec7n nh\u1eefng thay \u0111\u1ed5i n\u00e0y.
\nH\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n s\u1ebd c\u00f3 b\u1ea5t th\u01b0\u1eddng d\u1eabn truy\u1ec1n v\u1eadn \u0111\u1ed9ng trong v\u00e0i tu\u1ea7n \u0111\u1ea7u, nh\u01b0ng b\u1ea5t th\u01b0\u1eddng \u0111i\u1ec7n c\u01a1 d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c l\u1ea1i \u00edt h\u01a1n nhi\u1ec1u. Giai \u0111o\u1ea1n s\u1edbm, \u0111i\u1ec7n c\u01a1 d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c s\u1ebd c\u00f3 k\u1ebft qu\u1ea3 b\u00ecnh th\u01b0\u1eddng. Sau m\u1ed9t \u0111\u1ebfn hai tu\u1ea7n \u0111\u1ea7u ti\u00ean, \u0111i\u1ec7n c\u01a1 d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c s\u1ebd c\u00f3 h\u00ecnh \u1ea3nh b\u1ea3o t\u1ed3n th\u1ea7n kinh bi\u0300 b\u1eafp ch\u00e2n (sural sparing, ngh\u0129a l\u00e0 \u0111\u00e1p \u1ee9ng c\u1ea3m gi\u00e1c d\u00e2y th\u1ea7n kinh bi\u0300 b\u0103\u0301p ch\u00e2n b\u00ecnh th\u01b0\u1eddng trong khi \u1edf d\u00e2y th\u1ea7n kinh gi\u1eefa v\u00e0 tr\u1ee5 gi\u1ea3m ho\u1eb7c bi\u1ebfn m\u1ea5t). \u0110\u1eb7c \u0111i\u1ec3m n\u00e0y r\u1ea5t \u00edt g\u1eb7p trong b\u1ec7nh \u0111a d\u00e2y th\u1ea7n kinh th\u1ec3 s\u1ee3i tr\u1ee5c.
\nTh\u00ea\u0309 s\u01a1\u0323i tru\u0323c
\n\u0110\u1eb7c tr\u01b0ng c\u1ee7a \u0111i\u1ec7n c\u01a1 trong h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 th\u1ec3 AMAN l\u00e0 gi\u1ea3m ho\u1eb7c m\u1ea5t CMAP (compound muscle action potentials) v\u00e0 kh\u00f4ng c\u00f3 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a h\u1ee7y myelin. \u0110\u1ed1i v\u1edbi th\u1ec3 AMAN, SNAP v\u00e0 \u0111i\u1ec7n c\u01a1 d\u1eabn truy\u1ec1n th\u1ea7n kinh c\u1ea3m gi\u00e1c b\u00ecnh th\u01b0\u1eddng. Ngay nh\u01b0 t\u00ean g\u1ecdi, \u0111\u1ed1i v\u1edbi th\u1ec3 AMSAN (Acute Motor Sensory Axonal Neuropathy), b\u1ea5t th\u01b0\u1eddng v\u1eadn \u0111\u1ed9ng v\u00e0 c\u1ea3m gi\u00e1c tr\u00ean \u0111i\u1ec7n c\u01a1 \u0111\u1ed3ng th\u1eddi xu\u1ea5t hi\u1ec7n.
\nTrong giai \u0111o\u1ea1n s\u1edbm c\u1ee7a h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 r\u1ea5t kh\u00f3 ph\u00e2n bi\u1ec7t gi\u1eefa hai th\u1ec3 AIDP v\u00e0 AMAN, AMSAN v\u00ec m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p AMAN, AMSAN c\u00f3 k\u00e9o d\u00e0i ti\u1ec1m th\u1eddi trong giai \u0111o\u1ea1n s\u1edbm, sau \u0111\u00f3 nhanh ch\u00f3ng h\u1ed3i ph\u1ee5c, trong khi \u0111\u1ed1i v\u1edbi th\u1ec3 AIDP, t\u00ecnh tr\u1ea1ng n\u00e0y ng\u00e0y c\u00e0ng n\u1eb7ng [17].
\nTi\u00eau chu\u00e2\u0309n \u0111i\u00ea\u0323n c\u01a1 trong ch\u00e2\u0309n \u0111oa\u0301n h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 \u0111a\u0303 \u0111\u01b0\u01a1\u0323c \u0111\u00ea\u0300 c\u00e2\u0323p va\u0300 chi\u0309nh s\u01b0\u0309a nhi\u00ea\u0300u l\u00e2\u0300n, g\u00e2\u0300n \u0111\u00e2y nh\u00e2\u0301t la\u0300 ti\u00eau chu\u00e2\u0309n \u0111\u01b0\u01a1\u0323c \u0111\u00ea\u0300 xu\u00e2\u0301t cu\u0309a ta\u0301c gia\u0309 Rajabally va\u0300 c\u00f4\u0323ng s\u01b0\u0323 n\u0103m 2014.<\/p>\n

Ba\u0309ng 2. Ti\u00eau chu\u00e2\u0309n ph\u00e2n loa\u0323i tr\u00ean \u0111i\u00ea\u0323n c\u01a1 (Ngu\u00f4\u0300n: Rajabally va\u0300 c\u00f4\u0323ng s\u01b0\u0323, 2014\u00a0[22]<\/sup>)<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Bi\u0300nh th\u01b0\u01a1\u0300ng (t\u00e2\u0301t ca\u0309 ca\u0301c d\u00e2y th\u00e2\u0300n kinh \u0111\u01b0\u01a1\u0323c \u0111o \u0111\u00ea\u0300u cho k\u00ea\u0301t qua\u0309 d\u01b0\u01a1\u0301i \u0111\u00e2y)<\/strong><\/td>\n<\/tr>\n
DML \u2264 100% gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng tr\u00eanHi\u00ea\u0323n di\u00ea\u0323n so\u0301ng F v\u01a1\u0301i ti\u00ea\u0300m th\u01a1\u0300i \u2264 100% gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng tr\u00ean<\/p>\n

MCV \u2265 100% gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng d\u01b0\u01a1\u0301i<\/p>\n

dCMAP \u2265 100% gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng d\u01b0\u01a1\u0301i<\/p>\n

pCMAP \u2265 100% GHBT d\u01b0\u01a1\u0301i<\/p>\n

T\u1ef7 l\u00ea\u0323 pCMAP\/dCMAP > 0,7 (tr\u01b0\u0300 th\u00e2\u0300n kinh cha\u0300y)<\/td>\n<\/tr>\n

H\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 th\u1ec3 AIDP<\/strong><\/td>\n<\/tr>\n
\u00cdt nh\u1ea5t m\u1ed9t trong c\u00e1c ti\u00eau chu\u1ea9n d\u01b0\u1edbi \u0111\u00e2y xu\u1ea5t hi\u1ec7n t\u1eeb hai d\u00e2y th\u1ea7n kinh tr\u1edf l\u00ean:<\/p>\n

MCV < 70% gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng d\u01b0\u01a1\u0301i<\/p>\n

DML > 150% gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng tr\u00ean<\/p>\n

Ti\u1ec1m th\u1eddi s\u00f3ng F > 120% gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng tr\u00ean, ho\u1eb7c > 150% gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng tr\u00ean (n\u1ebfu CMAP ng\u1ecdn chi < 50% gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng d\u01b0\u01a1\u0301i)<\/td>\n<\/tr>\n

H\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 th\u1ec3 AIDP<\/strong><\/td>\n<\/tr>\n
Ho\u1eb7c\u2013 Kh\u00f4ng xu\u1ea5t hi\u1ec7n s\u00f3ng F \u1edf hai d\u00e2y th\u1ea7n kinh c\u00f3 dCMAP \u2265 20% gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng d\u01b0\u1edbi, k\u00e8m m\u1ed9t trong c\u00e1c ti\u00eau chu\u1ea9n tr\u00ean xu\u1ea5t hi\u1ec7n \u1edf m\u1ed9t d\u00e2y th\u1ea7n kinh kh\u00e1c<\/p>\n

Ho\u1eb7c<\/p>\n

\u2013 T\u1ef7 s\u1ed1 pCMAP\/dCMAP < 0,7 (tr\u1eeb th\u1ea7n kinh ch\u00e0y) \u1edf hai d\u00e2y th\u1ea7n kinh k\u00e8m m\u1ed9t trong c\u00e1c ti\u00eau chu\u1ea9n tr\u00ean xu\u1ea5t hi\u1ec7n \u1edf m\u1ed9t d\u00e2y th\u1ea7n kinh kh\u00e1c<\/td>\n<\/tr>\n

H\u00f4\u0323i ch\u1ee9ng Guillain \u2013 Barr\u00e9 th\u1ec3 AMAN bao g\u00f4\u0300m th\u00ea\u0309 kh\u00f4ng ki\u0301ch thi\u0301ch \u0111\u01b0\u01a1\u0323c<\/strong><\/td>\n<\/tr>\n
Kh\u00f4ng c\u00f3 d\u00e2y th\u1ea7n kinh n\u00e0o th\u1ecfa ti\u00eau chu\u1ea9n h\u1ee7y myelin (tr\u1eeb tr\u01b0\u1eddng h\u1ee3p m\u1ed9t d\u00e2y th\u1ea7n kinh c\u00f3 dCMAP < 10% gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng d\u01b0\u01a1\u0301i thi\u0300 c\u00f3 th\u1ec3 cho phe\u0301p c\u00f3 m\u1ed9t \u0111\u1eb7c \u0111i\u1ec3m h\u1ee7y myelin), v\u00e0 \u00edt nh\u1ea5t m\u1ed9t trong c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m sau:dCMAP < 80% GHBT d\u01b0\u01a1\u0301i \u1edf hai d\u00e2y th\u1ea7n kinh<\/p>\n

Kh\u00f4ng xu\u1ea5t hi\u1ec7n s\u00f3ng F \u1edf 2 d\u00e2y th\u1ea7n kinh c\u00f3 dCMAP \u2265 20% gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng d\u01b0\u01a1\u0301i v\u00e0 kh\u00f4ng k\u00e8m b\u1ea5t k\u1ef3 ti\u00eau chu\u1ea9n h\u1ee7y myelin \u1edf b\u1ea5t k\u1ef3 d\u00e2y th\u1ea7n kinh n\u00e0o<\/p>\n

T\u1ef7 s\u1ed1 pCMAP\/dCMAP < 0,7 \u1edf hai d\u00e2y th\u1ea7n kinh (tr\u1eeb d\u00e2y th\u1ea7n kinh ch\u00e0y)<\/p>\n

Kh\u00f4ng xu\u1ea5t hi\u1ec7n s\u00f3ng F \u1edf m\u1ed9t d\u00e2y th\u1ea7n kinh c\u00f3 dCMAP \u2265 20% gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng d\u01b0\u01a1\u0301i HO\u1eb6C t\u1ef7 s\u1ed1 pCMAP\/dCMAP < 0,7 (tr\u1eeb d\u00e2y th\u1ea7n kinh ch\u00e0y) \u1edf m\u1ed9t d\u00e2y th\u1ea7n kinh; k\u00e8m dCMAP < 80% gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng d\u01b0\u1edbi \u1edf m\u1ed9t d\u00e2y th\u1ea7n kinh kh\u00e1c.<\/p>\n

Kh\u00f4ng k\u00edch th\u00edch \u0111\u01b0\u1ee3c:<\/p>\n

\u2013 dCMAP ng\u1ecdn chi kh\u00f4ng xu\u1ea5t hi\u1ec7n \u01a1\u0309 t\u00e2\u0301t ca\u0309 d\u00e2y th\u00e2\u0300n kinh (ho\u1eb7c xu\u1ea5t hi\u1ec7n ch\u1ec9 \u1edf m\u1ed9t d\u00e2y th\u1ea7n kinh v\u01a1\u0301i dCMAP ng\u1ecdn chi < 10% gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng d\u01b0\u1edbi)<\/td>\n<\/tr>\n

H\u00f4\u0323i ch\u1ee9ng Guillain \u2013 Barr\u00e9 th\u1ec3 AMSAN<\/strong><\/td>\n<\/tr>\n
Th\u1ecfa ti\u00eau chu\u1ea9n \u0111i\u1ec7n c\u01a1 h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 th\u1ec3 AMAN k\u00e8m v\u1edbi:\u2013 SNAP \u2264 50% gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng d\u01b0\u1edbi \u1edf hai d\u00e2y th\u1ea7n kinh<\/td>\n<\/tr>\n
Kh\u00f4ng ro\u0303<\/strong><\/td>\n<\/tr>\n
\u2013 Kh\u00f4ng phu\u0300 h\u01a1\u0323p v\u01a1\u0301i b\u00e2\u0301t k\u1ef3 ti\u00eau chu\u00e2\u0309n na\u0300o trong ca\u0301c nho\u0301m tr\u00ean<\/td>\n<\/tr>\n
Ch\u1eef vi\u1ebft t\u1eaft: dCMAP: distal Compound Muscle Action Potentials, DML: Distal Motor Latency, MCV: Motor conduction Velocity, SNAP: Sensory Never Action Potentials.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\u0110i\u00ea\u0323n c\u01a1 kim:<\/strong>
\nVi\u1ec7c kh\u1ea3o s\u00e1t \u0111i\u1ec7n c\u01a1 kim \u1edf tr\u1ebb em r\u1ea5t h\u1ea1n ch\u1ebf, do \u0111au. Trong H\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 vi\u1ec7c kh\u1ea3o s\u00e1t th\u01b0\u1eddng \u1edf m\u1ed9t, hai ho\u1eb7c ba c\u01a1, ch\u1eb3ng h\u1ea1n c\u01a1 ch\u00e0y tr\u01b0\u1edbc, c\u01a1 b\u1ee5ng ch\u00e2n trong, c\u01a1 gian c\u1ed1t m\u1ed9t mu tay, nh\u1eb1m t\u00ecm ki\u1ebfm hi\u1ec7n t\u01b0\u1ee3ng m\u1ea5t ph\u00e2n b\u1ed1 th\u1ea7n kinh \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 c\u00f3 hay kh\u00f4ng t\u1ed5n th\u01b0\u01a1ng s\u1ee3i tr\u1ee5c th\u1ee9 ph\u00e1t.<\/p>\n

5. Ch\u00e2\u0309n \u0111oa\u0301n<\/strong><\/h2>\n

Ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 \u1edf tr\u1ebb em l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c v\u00ec nhi\u1ec1u l\u00fd do nh\u01b0 gi\u1edbi h\u1ea1n trong giao ti\u1ebfp, th\u0103m kh\u00e1m v\u00e0 s\u1ef1 \u0111a d\u1ea1ng trong bi\u1ec3u hi\u1ec7n [11]. Trong giai \u0111o\u1ea1n \u0111\u1ea7u, vi\u1ec7c ch\u1ea9n \u0111o\u00e1n ch\u1ee7 y\u1ebfu d\u1ef1a v\u00e0o tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng, khi m\u00e0 c\u00e1c b\u1ea5t th\u01b0\u1eddng tr\u00ean \u0111i\u1ec7n c\u01a1 hay d\u1ecbch n\u00e3o t\u1ee7y th\u01b0\u1eddng ch\u01b0a xu\u1ea5t hi\u1ec7n, ch\u1eb3ng h\u1ea1n \u1edf tr\u1ebb em, bi\u1ec3u hi\u1ec7n \u0111au chi\u1ebfm \u01b0u th\u1ebf c\u00f3 th\u1ec3 che d\u1ea5u t\u00ecnh tr\u1ea1ng y\u1ebfu chi v\u00e0 l\u00e0m tr\u00ec ho\u00e3n ch\u1ea9n \u0111o\u00e1n [26]. Ch\u1ec9 kho\u1ea3ng m\u1ed9t ph\u1ea7n ba tr\u1ebb tr\u01b0\u1edbc tu\u1ed5i \u0111\u1ebfn tr\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 t\u1ea1i th\u1eddi \u0111i\u1ec3m nh\u1eadp vi\u1ec7n [26].
\nN\u0103m 1978, NINDS \u0111\u00e3 cho ra \u0111\u1eddi ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 \u0111\u1ea7u ti\u00ean khi \u0111ang nghi\u00ean c\u1ee9u m\u1ed1i li\u00ean quan gi\u1eefa h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 v\u00e0 chi\u1ebfn d\u1ecbch ch\u1ee7ng ng\u1eeba c\u00fam l\u1ee3n n\u0103m 1976 \u2013 1977. Sau \u0111\u00f3 ti\u00eau chu\u1ea9n n\u00e0y \u0111\u00e3 ch\u00ednh th\u1ee9c c\u00f4ng b\u1ed1 n\u0103m 1981 v\u00e0 \u0111i\u1ec1u ch\u1ec9nh b\u01a1\u0309i ta\u0301c gia\u0309 Asbury n\u0103m 1990 [1]. Ban \u0111\u1ea7u ti\u00eau chu\u1ea9n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong nghi\u00ean c\u1ee9u, sau \u0111\u00f3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i tr\u00ean l\u00e2m s\u00e0ng cho \u0111\u1ebfn nay. Ti\u00eau chu\u00e2\u0309n na\u0300y \u0111\u01b0\u01a1\u0323c nghi\u00ean c\u01b0\u0301u tr\u00ean ng\u01b0\u01a1\u0300i l\u01a1\u0301n va\u0300 sau \u0111o\u0301 cu\u0303ng \u0111\u01b0\u01a1\u0323c a\u0301p du\u0323ng r\u00f4\u0323ng ra\u0303i \u01a1\u0309 tre\u0309 em.
\nC\u00e2\u0300n l\u01b0u y\u0301 ti\u00eau chu\u00e2\u0309n na\u0300y kh\u00f4ng a\u0301p du\u0323ng cho m\u00f4\u0323t s\u00f4\u0301 bi\u00ea\u0301n th\u00ea\u0309 \u0111\u0103\u0323c bi\u00ea\u0323t co\u0301 trong Ba\u0309ng 1.<\/p>\n

Ba\u0309ng 3. Ti\u00eau chu\u00e2\u0309n ch\u00e2\u0309n \u0111oa\u0301n h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9<\/p>\n

Ngu\u00f4\u0300n: Asbury va\u0300 c\u00f4\u0323ng s\u01b0\u0323\u00a0[1]<\/sup><\/p>\n\n\n\n\n\n\n\n\n
\u0110\u0103\u0323<\/strong>c<\/strong>\u00a0\u0111<\/strong>i\u00ea\u0309m c\u00e2\u0300n cho ch\u00e2\u0309n \u0111oa\u0301n<\/strong><\/td>\n<\/tr>\n
Y\u00ea\u0301u 2 ch\u00e2n va\u0300 2 tay t\u0103ng d\u00e2\u0300n (co\u0301 th\u00ea\u0309 kh\u01a1\u0309i pha\u0301t chi\u0309 \u01a1\u0309 ch\u00e2n trong giai \u0111oa\u0323n \u0111\u00e2\u0300u)Gia\u0309m ho\u0103\u0323c m\u00e2\u0301t pha\u0309n xa\u0323 g\u00e2n c\u01a1 \u01a1\u0309 chi bi\u00ea\u0309u hi\u00ea\u0323n (ta\u0323i va\u0300i th\u01a1\u0300i \u0111i\u00ea\u0309m trong di\u00ea\u0303n ti\u00ea\u0301n b\u00ea\u0323nh)<\/td>\n<\/tr>\n
\u0110\u0103\u0323c \u0111i\u00ea\u0309m h\u00f4\u0303 tr\u01a1\u0323 ma\u0323nh ch\u00e2\u0309n \u0111oa\u0301n<\/strong><\/td>\n<\/tr>\n
Pha di\u00ea\u0303n ti\u00ea\u0301n t\u01b0\u0300 va\u0300i nga\u0300y \u0111\u00ea\u0301n 4 tu\u00e2\u0300n (th\u01b0\u01a1\u0300ng < 2 tu\u00e2\u0300n)T\u01b0\u01a1ng \u0111\u00f4\u0301i \u0111\u00f4\u0301i x\u01b0\u0301ng v\u00ea\u0300 bi\u00ea\u0309u hi\u00ea\u0323n l\u00e2m sa\u0300ng va\u0300 th\u0103m kha\u0301m<\/p>\n

Tri\u00ea\u0323u ch\u01b0\u0301ng ca\u0309m gia\u0301c t\u01b0\u01a1ng \u0111\u00f4\u0301i nhe\u0323<\/p>\n

T\u00f4\u0309n th\u01b0\u01a1ng ca\u0301c d\u00e2y th\u00e2\u0300n kinh so\u0323, \u0111\u0103\u0323c bi\u00ea\u0323t li\u00ea\u0323t th\u00e2\u0300n kinh m\u0103\u0323t hai b\u00ean<\/p>\n

R\u00f4\u0301i loa\u0323n th\u00e2\u0300n kinh th\u01b0\u0323c v\u00e2\u0323t<\/p>\n

\u0110au chi ho\u0103\u0323c \u0111au c\u01a1 ho\u0103\u0323c \u0111au l\u01b0ng lan ki\u00ea\u0309u r\u00ea\u0303<\/p>\n

T\u0103ng protein trong di\u0323ch na\u0303o tu\u0309y; protein di\u0323ch na\u0303o tu\u0309y bi\u0300nh th\u01b0\u01a1\u0300ng kh\u00f4ng loa\u0323i tr\u01b0\u0300 ch\u00e2\u0309n \u0111oa\u0301n<\/p>\n

\u0110\u0103\u0323c \u0111i\u00ea\u0309m cu\u0309a b\u00ea\u0323nh th\u00e2\u0300n kinh v\u00e2\u0323n \u0111\u00f4\u0323ng ho\u0103\u0323c v\u00e2\u0323n \u0111\u00f4\u0323ng ca\u0309m gia\u0301c tr\u00ean \u0111i\u00ea\u0323n c\u01a1 (\u0111i\u00ea\u0323n c\u01a1 bi\u0300nh th\u01b0\u01a1\u0300ng trong giai \u0111oa\u0323n s\u01a1\u0301m kh\u00f4ng loa\u0323i tr\u01b0\u0300 ch\u00e2\u0309n \u0111oa\u0301n)<\/td>\n<\/tr>\n

\u0110\u0103\u0323c \u0111i\u00ea\u0309m la\u0300m nghi ng\u01a1\u0300 ch\u00e2\u0309n \u0111oa\u0301n<\/strong><\/td>\n<\/tr>\n
T\u0103ng s\u00f4\u0301 l\u01b0\u01a1\u0323ng ba\u0323ch c\u00e2\u0300u \u0111\u01a1n nh\u00e2n va\u0300 \u0111a nh\u00e2n trong di\u0323ch na\u0303o tu\u0309y (> 50\/mm3<\/sup>)Y\u00ea\u0301u chi kh\u00f4ng \u0111\u00f4\u0301i x\u01b0\u0301ng ro\u0303, ke\u0301o da\u0300i<\/p>\n

R\u00f4\u0301i loa\u0323n c\u01a1 vo\u0300ng ba\u0300ng quang, ru\u00f4\u0323t ta\u0323i th\u01a1\u0300i \u0111i\u00ea\u0309m kh\u01a1\u0309i pha\u0301t va\u0300 ke\u0301o da\u0300i trong su\u00f4\u0301t qua\u0301 tri\u0300nh b\u00ea\u0323nh<\/p>\n

Y\u00ea\u0301u c\u01a1 h\u00f4 h\u00e2\u0301p n\u0103\u0323ng ke\u0300m y\u00ea\u0301u chi nhe\u0323 ta\u0323i th\u01a1\u0300i \u0111i\u00ea\u0309m kh\u01a1\u0309i pha\u0301t<\/p>\n

Tri\u00ea\u0323u ch\u01b0\u0301ng ca\u0309m gia\u0301c ke\u0300m y\u00ea\u0301u chi nhe\u0323 ta\u0323i th\u01a1\u0300i \u0111i\u00ea\u0309m kh\u01a1\u0309i pha\u0301t<\/p>\n

S\u00f4\u0301t ta\u0323i th\u01a1\u0300i \u0111i\u00ea\u0309m kh\u01a1\u0309i pha\u0301t<\/p>\n

\u0110a\u0323t \u0111i\u0309nh trong < 24h<\/p>\n

Khoanh ca\u0309m gia\u0301c ro\u0303 g\u01a1\u0323i y\u0301 t\u00f4\u0309n th\u01b0\u01a1ng tu\u0309y s\u00f4\u0301ng<\/p>\n

T\u0103ng pha\u0309n xa\u0323 g\u00e2n c\u01a1 ho\u0103\u0323c clonus<\/p>\n

Pha\u0309n xa\u0323 da lo\u0300ng ba\u0300n ch\u00e2n \u0111a\u0301p \u01b0\u0301ng du\u00f4\u0303i<\/p>\n

\u0110au bu\u0323ng<\/p>\n

Di\u00ea\u0303n ti\u00ea\u0301n ch\u00e2\u0323m ke\u0300m y\u00ea\u0301u chi nhe\u0323 va\u0300 kh\u00f4ng a\u0309nh h\u01b0\u01a1\u0309ng c\u01a1 h\u00f4 h\u00e2\u0301p<\/p>\n

Ti\u00ea\u0301p tu\u0323c di\u00ea\u0303n ti\u00ea\u0301n > 4 tu\u00e2\u0300n k\u00ea\u0309 t\u01b0\u0300 khi xu\u00e2\u0301t hi\u00ea\u0323n tri\u00ea\u0323u ch\u01b0\u0301ng<\/p>\n

Thay \u0111\u00f4\u0309i y\u0301 th\u01b0\u0301c (tr\u01b0\u0300 vi\u00eam th\u00e2n na\u0303o Bickerstaff)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

6. \u0110i\u00ea\u0300u tri\u0323<\/h2>\n

\u0110i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 c\u1ea7n ph\u1ea3i ph\u1ed1i h\u1ee3p \u0111a m\u00f4 th\u1ee9c v\u00e0 li\u1ec7u ph\u00e1p mi\u1ec5n d\u1ecbch.
\nLi\u00ea\u0323u pha\u0301p mi\u00ea\u0303n di\u0323ch
\nTrong \u0111i\u1ec1u tr\u1ecb pha c\u1ea5p, IVIg v\u00e0 thay huy\u1ebft t\u01b0\u01a1ng \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh c\u00f3 hi\u1ec7u qu\u1ea3. Li\u1ec7u ph\u00e1p \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch th\u01b0\u1eddng \u0111\u01b0\u1ee3c kh\u1edfi \u0111\u1ed9ng khi b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 \u0111i \u0111\u01b0\u1ee3c 10m m\u00e0 kh\u00f4ng c\u1ea7n h\u1ed3 tr\u1ee3 (GDS \u2265 3) (H\u00ecnh 1.3). Kha\u0301c v\u01a1\u0301i ng\u01b0\u01a1\u0300i l\u01a1\u0301n, b\u0103\u0300ng ch\u01b0\u0301ng v\u00ea\u0300 hi\u00ea\u0323u qua\u0309 cu\u0309a ca\u0301c li\u00ea\u0323u pha\u0301p mi\u00ea\u0303n di\u0323ch \u01a1\u0309 tre\u0309 em co\u0300n ha\u0323n ch\u00ea\u0301. Cho \u0111\u00ea\u0301n nay v\u00e2\u0303n ch\u01b0a co\u0301 th\u01b0\u0309 nghi\u00ea\u0323m l\u00e2m sa\u0300ng ng\u00e2\u0303u nhi\u00ean co\u0301 \u0111\u00f4\u0301i ch\u01b0\u0301ng na\u0300o \u0111\u01b0\u01a1\u0323c th\u01b0\u0323c hi\u00ea\u0323n.<\/p>\n

\"\"<\/a><\/p>\n

H\u00ecnh 1.3. Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9. Ngu\u1ed3n: Van den Berg v\u00e0 c\u1ed9ng s\u1ef1, 2014 [43].<\/p>\n

Ba\u0309ng 4. Thang \u0111i\u00ea\u0309m GDS (GBS Disability Score). Ngu\u00f4\u0300n: Hughes va\u0300 c\u00f4\u0323ng s\u01b0\u0323, 1978\u00a0[15]<\/sup><\/p>\n\n\n\n\n\n\n\n\n\n\n
\u0110<\/strong>i\u00ea\u0309m<\/strong><\/td>\nM\u00f4 ta\u0309<\/strong><\/td>\n<\/tr>\n
0<\/td>\nKho\u0309e ma\u0323nh<\/td>\n<\/tr>\n
1<\/td>\nTri\u00ea\u0323u ch\u01b0\u0301ng nhe\u0323 va\u0300 co\u0301 th\u00ea\u0309 cha\u0323y<\/td>\n<\/tr>\n
2<\/td>\nCo\u0301 th\u00ea\u0309 \u0111i \u2265 10 m va\u0300 kh\u00f4ng c\u00e2\u0300n tr\u01a1\u0323 giu\u0301p nh\u01b0ng kh\u00f4ng cha\u0323y \u0111\u01b0\u01a1\u0323c<\/td>\n<\/tr>\n
3<\/td>\nCo\u0301 th\u00ea\u0309 \u0111i 10 m trong kh\u00f4ng gian m\u01a1\u0309 va\u0300 c\u00e2\u0300n s\u01b0\u0323 tr\u01a1\u0323 giu\u0301p<\/td>\n<\/tr>\n
4<\/td>\nN\u0103\u0300m li\u00ea\u0323t gi\u01b0\u01a1\u0300ng ho\u0103\u0323c gh\u00ea\u0301<\/td>\n<\/tr>\n
5<\/td>\nC\u00e2\u0300n h\u00f4\u0303 tr\u01a1\u0323 th\u00f4ng khi\u0301 trong nga\u0300y<\/td>\n<\/tr>\n
6<\/td>\nT\u01b0\u0309 vong<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Nhi\u1ec1u th\u1eed nghi\u1ec7m \u0111\u00e3 cho th\u1ea5y kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t trong hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb c\u1ee7a IVIg v\u00e0 thay huy\u1ebft t\u01b0\u01a1ng [13].
\nL\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb d\u1ef1a tr\u00ean b\u1ec7nh nh\u00e2n v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 kinh t\u1ebf, x\u00e3 h\u1ed9i. V\u00ed d\u1ee5, thay huy\u1ebft t\u01b0\u01a1ng c\u1ea7n c\u00e1c thi\u1ebft b\u1ecb \u0111\u1eb7c bi\u1ec7t v\u00e0 kh\u00f4ng ph\u1ea3i b\u1ec7nh vi\u1ec7n n\u00e0o c\u0169ng c\u00f3. Ngo\u00e0i ra, thay huy\u1ebft t\u01b0\u01a1ng kh\u00f3 ti\u1ebfn h\u00e0nh \u1edf tr\u1ebb nh\u1ecf v\u00e0 c\u1ea7n ph\u1ea3i theo d\u00f5i s\u00e1t \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n th\u1ea7n kinh th\u1ef1c v\u1eadt tim m\u1ea1ch. Tuy nhi\u00ean, IVIg t\u1ed1n chi ph\u00ed cao h\u01a1n nhi\u1ec1u so v\u1edbi thay huy\u1ebft t\u01b0\u01a1ng, g\u00e2y kh\u00f3 kh\u0103n trong ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb, \u0111\u1eb7c bi\u1ec7t \u1edf c\u00e1c n\u01b0\u1edbc thu nh\u1eadp th\u1ea5p.
\nCho \u0111\u1ebfn nay, li\u1ec7u c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t trong \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 th\u1ec3 t\u1ed5n th\u01b0\u01a1ng s\u1ee3i tr\u1ee5c v\u00e0 h\u1ee7y myelin v\u1eabn c\u00f2n ch\u01b0a r\u00f5 r\u00e0ng. M\u1ed9t nghi\u00ean c\u1ee9u \u0111\u00e3 cho th\u1ea5y \u1edf h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 th\u1ec3 t\u1ed5n th\u01b0\u01a1ng s\u1ee3i tr\u1ee5c, thay huy\u1ebft t\u01b0\u01a1ng c\u00f3 k\u1ebft c\u1ee5c \u0111i\u1ec1u tr\u1ecb t\u1ed1t h\u01a1n so v\u1edbi IVIg [6].
\n\u0110a\u0301p \u01b0\u0301ng \u0111i\u00ea\u0300u tri\u0323
\nKhoa\u0309ng 40 \u2013 50% b\u00ea\u0323nh nh\u00e2n se\u0303 kh\u00f4ng ca\u0309i thi\u00ea\u0323n v\u01a1\u0301i li\u00ea\u0323u pha\u0301p mi\u00ea\u0303n di\u0323ch ta\u0323i th\u01a1\u0300i \u0111i\u00ea\u0309m 4 tu\u00e2\u0300n sau \u0111i\u00ea\u0300u tri\u0323 [31].
\nPh\u1ed1i h\u1ee3p \u0111i\u1ec1u tr\u1ecb thay huy\u1ebft t\u01b0\u01a1ng va\u0300 theo sau b\u0103\u0300ng IVIg kh\u00f4ng mang l\u1ea1i hi\u1ec7u qu\u1ea3 cao h\u01a1n so v\u1edbi IVIg hay thay huy\u1ebft t\u01b0\u01a1ng m\u1ed9t m\u00ecnh [14]. Vi\u00ea\u0323c l\u0103\u0323p la\u0323i li\u00ea\u0300u IVIg th\u01b0\u0301 2 trong 4 tu\u00e2\u0300n \u0111\u00e2\u0300u khi ch\u01b0a th\u00e2\u0301y \u0111a\u0301p \u01b0\u0301ng v\u01a1\u0301i li\u00ea\u0300u IVIg \u0111\u00e2\u0300u ti\u00ean cu\u0303ng kh\u00f4ng mang la\u0323i hi\u00ea\u0323u qua\u0309 trong ti\u00ean l\u01b0\u01a1\u0323ng ng\u0103\u0301n va\u0300 da\u0300i ha\u0323n [31]. K\u00ea\u0309 ca\u0309 nh\u01b0\u0303ng tr\u01b0\u01a1\u0300ng h\u01a1\u0323p co\u0301 ti\u00ean l\u01b0\u01a1\u0323ng n\u0103\u0323ng thi\u0300 vi\u00ea\u0323c l\u0103\u0323p la\u0323i li\u00ea\u0300u IVIg th\u01b0\u0301 2 kh\u00f4ng giu\u0301p ca\u0309i thi\u00ea\u0323n ti\u00ean l\u01b0\u01a1\u0323ng, th\u00e2\u0323m chi\u0301 co\u0300n co\u0301 nhi\u00ea\u0300u ta\u0301c du\u0323ng phu\u0323 do \u0111i\u00ea\u0300u tri\u0323 g\u00e2y ra [33].
\nDao \u0111\u00f4\u0323ng li\u00ean quan \u0111i\u00ea\u0300u tri\u0323 (TRF \u2013 Treatment \u2013 Related Fluctuation) la\u0300 ti\u0300nh tra\u0323ng x\u00e2\u0301u \u0111i sau khi \u0111a\u0303 ca\u0309i thi\u00ea\u0323n ho\u0103\u0323c \u00f4\u0309n \u0111i\u0323nh v\u00ea\u0300 m\u0103\u0323t l\u00e2m sa\u0300ng. TRF \u0111\u01b0\u01a1\u0323c \u0111i\u0323nh nghi\u0303a la\u0300 GDS t\u0103ng i\u0301t nh\u00e2\u0301t 1 \u0111i\u00ea\u0309m trong vo\u0300ng 8 tu\u00e2\u0300n \u0111\u00e2\u0300u sau kh\u01a1\u0309i pha\u0301t. Khoa\u0309ng 8% tre\u0309 co\u0301 TRF [24] va\u0300 ti\u0300nh tra\u0323ng na\u0300y th\u01b0\u01a1\u0300ng g\u0103\u0323p h\u01a1n khi s\u01b0\u0309 du\u0323ng IVIg li\u1ec1u 1 g\/kg\/ng\u00e0y 2 ng\u00e0y so v\u1edbi li\u1ec1u 0,4 g\/kg\/ng\u00e0y trong 5 ng\u00e0y li\u00ean ti\u1ebfp, d\u00f9 v\u1ec1 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb l\u00e0 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nhau [16].
\nTRF cho th\u00e2\u0301y hi\u00ea\u0323u qua\u0309 cu\u0309a \u0111i\u00ea\u0300u tri\u0323, m\u0103\u0323c du\u0300 kh\u00f4ng ke\u0301o da\u0300i, va\u0300 se\u0303 la\u0323i ca\u0309i thi\u00ea\u0323n n\u00ea\u0301u chu\u0301ng ta l\u0103\u0323p la\u0323i \u0111i\u00ea\u0300u tri\u0323. Hi\u00ea\u0323n ta\u0323i b\u0103\u0300ng ch\u01b0\u0301ng hi\u00ea\u0323u qua\u0309 li\u00ea\u0300u th\u01b0\u0301 2 IVIg la\u0300 ch\u01b0a ro\u0303 ra\u0300ng nh\u01b0ng v\u00e2\u0303n \u0111\u01b0\u01a1\u0323c a\u0301p du\u0323ng tr\u00ean l\u00e2m sa\u0300ng.
\nKhi ti\u0300nh tra\u0323ng TRF xa\u0309y ra sau 8 tu\u00e2\u0300n ho\u0103\u0323c xa\u0309y ra \u2265 3 l\u00e2\u0300n thi\u0300 c\u00e2\u0300n xem xe\u0301t ch\u00e2\u0309n \u0111oa\u0301n A-CIDP.<\/p>\n

7. Ti\u00ean l\u01b0\u01a1\u0323ng<\/strong><\/h2>\n

Nhi\u0300n chung ti\u00ean l\u01b0\u01a1\u0323ng cu\u0309a h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 \u01a1\u0309 tre\u0309 em t\u00f4\u0301t h\u01a1n so v\u01a1\u0301i ng\u01b0\u01a1\u0300i l\u01a1\u0301n. T\u1ef7 l\u00ea\u0323 t\u01b0\u0309 vong \u01a1\u0309 tre\u0309 em va\u0300o khoa\u0309ng 1 \u2013 2% va\u0300 chu\u0309 y\u00ea\u0301u la\u0300 do suy h\u00f4 h\u00e2\u0301p [27]. 11% tre\u0309 bi\u0323 ta\u0300n ph\u00ea\u0301 sau na\u0300y va\u0300 26% tre\u0309 bi\u0323 a\u0309nh h\u01b0\u01a1\u0309ng t\u01a1\u0301i vi\u00ea\u0323c ho\u0323c t\u00e2\u0323p, tre\u0309 ca\u0300ng l\u01a1\u0301n thi\u0300 vi\u00ea\u0323c ho\u0323c ca\u0300ng bi\u0323 a\u0309nh h\u01b0\u01a1\u0309ng nhi\u00ea\u0300u [25].<\/p>\n

8. K\u00ea\u0301t lu\u00e2\u0323n<\/strong><\/h2>\n

H\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 la\u0300 nguy\u00ean nh\u00e2n th\u01b0\u01a1\u0300ng g\u0103\u0323p nh\u00e2\u0301t g\u00e2y li\u00ea\u0323t m\u00ea\u0300m c\u00e2\u0301p \u01a1\u0309 tre\u0309 em. Di\u00ea\u0303n ti\u00ea\u0301n b\u00ea\u0323nh th\u01b0\u01a1\u0300ng la\u0300 1 pha, \u0111a\u0323t \u0111i\u0309nh trong vo\u0300ng 4 tu\u00e2\u0300n. Vi\u00ea\u0323c ch\u00e2\u0309n \u0111oa\u0301n va\u0300 \u0111i\u00ea\u0300u tri\u0323 \u01a1\u0309 tre\u0309 em g\u0103\u0323p nhi\u00ea\u0300u tha\u0301ch th\u01b0\u0301c h\u01a1n so v\u01a1\u0301i ng\u01b0\u01a1\u0300i l\u01a1\u0301n vi\u0300 gi\u1edbi h\u1ea1n trong giao ti\u1ebfp, th\u0103m kh\u00e1m, s\u1ef1 \u0111a d\u1ea1ng trong bi\u1ec3u hi\u1ec7n va\u0300 kho\u0301 kh\u0103n trong \u0111o \u0111i\u00ea\u0323n c\u01a1. Co\u0300n nhi\u00ea\u0300u khoa\u0309ng tr\u00f4\u0301ng trong \u0111i\u00ea\u0300u tri\u0323, \u0111\u0103\u0323c bi\u00ea\u0323t \u01a1\u0309 nho\u0301m \u0111a\u0301p \u01b0\u0301ng ke\u0301m va\u0300 dao \u0111\u00f4\u0323ng v\u01a1\u0301i IVIg va\u0300 thay huy\u00ea\u0301t t\u01b0\u01a1ng. Ti\u00ean l\u01b0\u01a1\u0323ng h\u1ed9i ch\u1ee9ng Guillain \u2013 Barr\u00e9 \u01a1\u0309 tre\u0309 em nhi\u0300n chung la\u0300 t\u00f4\u0301t h\u01a1n so v\u01a1\u0301i ng\u01b0\u01a1\u0300i l\u01a1\u0301n, tuy nhi\u00ean v\u00e2\u0303n co\u0301 m\u00f4\u0323t nho\u0301m tre\u0309 bi\u0323 a\u0309nh h\u01b0\u01a1\u0309ng \u0111\u00ea\u0301n vi\u00ea\u0323c ho\u0323c va\u0300 \u0111\u00ea\u0309 la\u0323i di ch\u01b0\u0301ng l\u00e2u da\u0300i v\u00ea\u0300 sau na\u0300y.<\/p>\n

Phu\u0323 lu\u0323c: Tri\u0323 s\u00f4\u0301 bi\u0300nh th\u01b0\u01a1\u0300ng cu\u0309a \u0111o \u0111i\u00ea\u0323n c\u01a1 d\u00e2\u0303n truy\u00ea\u0300n \u01a1\u0309 tre\u0309 em\u00a0[35]<\/sup><\/p>\n

Ng\u01b0\u1eddi d\u1ecbch: L\u00ea Tr\u1ea7n \u00c1nh Ng\u00e2n2<\/sup>, Nguy\u1ec5n L\u00ea Trung Hi\u1ebfu1.2<\/sup><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Tu\u00f4\u0309i<\/strong><\/td>\nTi\u00ea\u0300m th\u01a1\u0300i ngo\u0323n chi (ms)<\/strong><\/td>\nBi\u00ean \u0111\u00f4\u0323 (mV)<\/strong><\/td>\nV\u00e2\u0323n t\u00f4\u0301c d\u00e2\u0303n truy\u00ea\u0300n (m\/s)<\/strong><\/td>\n<\/tr>\n
Th\u00e2\u0300n kinh gi\u01b0\u0303a<\/em><\/td>\n<\/tr>\n
23-29 tu\u00e2\u0300n<\/td>\n<\/td>\nB\u00e2\u0301t k\u1ef3<\/td>\n\u2265 7<\/td>\n<\/tr>\n
29-33 tu\u00e2\u0300n<\/td>\n<\/td>\nB\u00e2\u0301t k\u1ef3<\/td>\n\u2265 16<\/td>\n<\/tr>\n
33-38 tu\u00e2\u0300n<\/td>\n\u2264 3,8<\/td>\nB\u00e2\u0301t k\u1ef3<\/td>\n\u2265 19<\/td>\n<\/tr>\n
\u0110u\u0309 tha\u0301ng (38-42 tu\u00e2\u0300n)<\/td>\n\u2264 3,5<\/td>\n\u2265 2,5<\/td>\n\u2265 20<\/td>\n<\/tr>\n
2-4 tu\u00e2\u0300n<\/td>\n\u2264 3,0<\/td>\n\u2265 2,5<\/td>\n\u2265 23<\/td>\n<\/tr>\n
1-6 tha\u0301ng<\/td>\n\u2264 3,0<\/td>\n\u2265 3,5<\/td>\n\u2265 30<\/td>\n<\/tr>\n
6-12 tha\u0301ng<\/td>\n\u2264 3,0<\/td>\n\u2265 2,3<\/td>\n\u2265 35<\/td>\n<\/tr>\n
12-18 tha\u0301ng<\/td>\n\u2264 3,0<\/td>\n\u2265 3,7<\/td>\n\u2265 40<\/td>\n<\/tr>\n
18-24 tha\u0301ng<\/td>\n\u2264 3,0<\/td>\n\u2265 3,7<\/td>\n\u2265 45<\/td>\n<\/tr>\n
2-3 tu\u00f4\u0309i<\/td>\n\u2264 3,1<\/td>\n\u2265 2,0<\/td>\n\u2265 47<\/td>\n<\/tr>\n
3-4 tu\u00f4\u0309i<\/td>\n\u2264 3,1<\/td>\n\u2265 2,0<\/td>\n\u2265 48<\/td>\n<\/tr>\n
4-5 tu\u00f4\u0309i<\/td>\n\u2264 3,2<\/td>\n\u2265 3,0<\/td>\n\u2265 49<\/td>\n<\/tr>\n
Ng\u01b0\u01a1\u0300i l\u01a1\u0301n<\/td>\n\u2264 4,5<\/td>\n\u2265 4,1<\/td>\n\u2265 49<\/td>\n<\/tr>\n
Th\u00e2\u0300n kinh tru\u0323<\/em><\/td>\n<\/tr>\n
34-37 tu\u00e2\u0300n<\/td>\n\u2264 3,0<\/td>\n\u2013<\/td>\n\u2265 15<\/td>\n<\/tr>\n
\u0110u\u0309 tha\u0301ng<\/td>\n\u2264 3,5<\/td>\n\u2265 1,0<\/td>\n\u2265 20<\/td>\n<\/tr>\n
0-1 tha\u0301ng<\/td>\n\u2264 3,5<\/td>\n\u2265 2,0<\/td>\n\u2265 20<\/td>\n<\/tr>\n
1-6 tha\u0301ng<\/td>\n\u2264 3,0<\/td>\n\u2265 2,5<\/td>\n\u2265 30<\/td>\n<\/tr>\n
6-12 tha\u0301ng<\/td>\n\u2264 2,5<\/td>\n\u2265 3,0<\/td>\n\u2265 35<\/td>\n<\/tr>\n
1-2 tu\u00f4\u0309i<\/td>\n\u2264 2,5<\/td>\n\u2265 3,0<\/td>\n\u2265 40<\/td>\n<\/tr>\n
2-3 tu\u00f4\u0309i<\/td>\n\u2264 2,5<\/td>\n\u2265 3,0<\/td>\n\u2265 45<\/td>\n<\/tr>\n
3-4 tu\u00f4\u0309i<\/td>\n\u2264 2,5<\/td>\n\u2265 3,0<\/td>\n\u2265 50<\/td>\n<\/tr>\n
4-5 tu\u00f4\u0309i<\/td>\n\u2264 2,7<\/td>\n\u2265 3,0<\/td>\n\u2265 50<\/td>\n<\/tr>\n
Ng\u01b0\u01a1\u0300i l\u01a1\u0301n<\/td>\n\u2264 3,7<\/td>\n\u2265 6,0<\/td>\n\u2265 50<\/td>\n<\/tr>\n
Th\u00e2\u0300n kinh ma\u0301c<\/em><\/td>\n<\/tr>\n
\u0110u\u0309 tha\u0301ng<\/td>\n\u2264 4,5<\/td>\n\u2265 0,5<\/td>\n\u2265 20<\/td>\n<\/tr>\n
Tha\u0301ng<\/td>\n\u2264 4,5<\/td>\n\u2265 0,5<\/td>\n\u2265 20<\/td>\n<\/tr>\n
1-6 tha\u0301ng<\/td>\n\u2264 3,2<\/td>\n\u2265 0,5<\/td>\n\u2265 27<\/td>\n<\/tr>\n
6-12 tha\u0301ng<\/td>\n\u2264 3,2<\/td>\n\u2265 0,7<\/td>\n\u2265 36<\/td>\n<\/tr>\n
1-2 tu\u00f4\u0309i<\/td>\n\u2264 3,2<\/td>\n\u2265 0,7<\/td>\n\u2265 38<\/td>\n<\/tr>\n
2-3 tu\u00f4\u0309i<\/td>\n\u2264 4,1<\/td>\n\u2265 0,9<\/td>\n\u2265 39<\/td>\n<\/tr>\n
3-4 tu\u00f4\u0309i<\/td>\n\u2264 4,1<\/td>\n\u2265 1,0<\/td>\n\u2265 40<\/td>\n<\/tr>\n
4-6 tu\u00f4\u0309i<\/td>\n\u2264 4,1<\/td>\n\u2265 1,3<\/td>\n\u2265 40<\/td>\n<\/tr>\n
Ng\u01b0\u01a1\u0300i l\u01a1\u0301n<\/td>\n\u2264 6,5<\/td>\n\u2265 2,0<\/td>\n\u2265 40<\/td>\n<\/tr>\n
Th\u00e2\u0300n kinh cha\u0300y<\/em><\/td>\n<\/tr>\n
23-29 tu\u00e2\u0300n<\/td>\n\u2013<\/td>\n\u2013<\/td>\n\u2265 6<\/td>\n<\/tr>\n
29-33 tu\u00e2\u0300n<\/td>\n\u2013<\/td>\n\u2013<\/td>\n\u2265 9<\/td>\n<\/tr>\n
33-38 tu\u00e2\u0300n<\/td>\n\u2264 4,7<\/td>\n\u2013<\/td>\n\u2265 13<\/td>\n<\/tr>\n
\u0110u\u0309 tha\u0301ng (38-42 tu\u00e2\u0300n)<\/td>\n\u2264 4,1<\/td>\n\u2265 0,9<\/td>\n\u2265 17<\/td>\n<\/tr>\n
1-3 tha\u0301ng<\/td>\n\u2264 4,0<\/td>\n\u2265 1,2<\/td>\n\u2265 20<\/td>\n<\/tr>\n
3-6 tha\u0301ng<\/td>\n\u2264 3,5<\/td>\n\u2265 1,2<\/td>\n\u2265 25<\/td>\n<\/tr>\n
6-9 tha\u0301ng<\/td>\n\u2264 3,5<\/td>\n\u2265 3,4<\/td>\n\u2265 30<\/td>\n<\/tr>\n
9-12 tha\u0301ng<\/td>\n\u2264 3,5<\/td>\n\u2265 3,4<\/td>\n\u2265 32<\/td>\n<\/tr>\n
1-3 tu\u00f4\u0309i<\/td>\n\u2264 4,0<\/td>\n\u2265 4,8<\/td>\n\u2265 33<\/td>\n<\/tr>\n
3-6 tu\u00f4\u0309i<\/td>\n\u2264 4,7<\/td>\n\u2265 4,8<\/td>\n\u2265 40<\/td>\n<\/tr>\n
Ng\u01b0\u01a1\u0300i l\u01a1\u0301n<\/td>\n\u2264 6,1<\/td>\n\u2265 4,4<\/td>\n\u2265 40<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Tu\u00f4\u0309i<\/strong><\/td>\nBi\u00ean \u0111\u00f4\u0323 (<\/strong>\u03bc<\/strong>V)<\/strong><\/td>\nV\u00e2\u0323n t\u00f4\u0301c d\u00e2\u0303n truy\u00ea\u0300n (m\/s)<\/strong><\/td>\n<\/tr>\n
Th\u00e2\u0300n kinh gi\u01b0\u0303a<\/em><\/td>\n<\/tr>\n
\u0110u\u0309 tha\u0301ng<\/td>\n\u2265 3,5<\/td>\n\u2265 22<\/td>\n<\/tr>\n
0-1 tha\u0301ng<\/td>\n\u2265 3,5<\/td>\n\u2265 24<\/td>\n<\/tr>\n
1-3 tha\u0301ng<\/td>\n\u2265 5<\/td>\n\u2265 25<\/td>\n<\/tr>\n
3-6 tha\u0301ng<\/td>\n\u2265 5<\/td>\n\u2265 32<\/td>\n<\/tr>\n
6-12 tha\u0301ng<\/td>\n\u2265 5<\/td>\n\u2265 33<\/td>\n<\/tr>\n
1-2 tu\u00f4\u0309i<\/td>\n\u2265 9<\/td>\n\u2265 41<\/td>\n<\/tr>\n
2-4 tu\u00f4\u0309i<\/td>\n\u2265 13<\/td>\n\u2265 45<\/td>\n<\/tr>\n
4-6 tu\u00f4\u0309i<\/td>\n\u2265 14<\/td>\n\u2265 48<\/td>\n<\/tr>\n
Th\u00e2\u0300n kinh tru\u0323<\/em><\/td>\n<\/tr>\n
34-36 tu\u00e2\u0300n<\/td>\n\u2013<\/td>\n\u2265 10<\/td>\n<\/tr>\n
\u0110u\u0309 tha\u0301ng<\/td>\n\u2265 4<\/td>\n\u2265 13<\/td>\n<\/tr>\n
2-4 tu\u00e2\u0300n<\/td>\n\u2265 6<\/td>\n\u2265 17<\/td>\n<\/tr>\n
1-3 tha\u0301ng<\/td>\n\u2265 6<\/td>\n\u2265 20<\/td>\n<\/tr>\n
3-6 tha\u0301ng<\/td>\n\u2265 6<\/td>\n\u2265 26<\/td>\n<\/tr>\n
6-12 tha\u0301ng<\/td>\n\u2265 6<\/td>\n\u2265 28<\/td>\n<\/tr>\n
1-3 tu\u00f4\u0309i<\/td>\n\u2265 6<\/td>\n\u2265 29<\/td>\n<\/tr>\n
4-6 tu\u00f4\u0309i<\/td>\n\u2265 6<\/td>\n\u2265 33<\/td>\n<\/tr>\n
Th\u00e2\u0300n kinh sural<\/em><\/td>\n<\/tr>\n
\u0110u\u0309 tha\u0301ng<\/td>\nB\u00e2\u0301t ki\u0300<\/td>\n\u2265 18<\/td>\n<\/tr>\n
0-1 tha\u0301ng<\/td>\nB\u00e2\u0301t ki\u0300<\/td>\n\u2265 21<\/td>\n<\/tr>\n
1-3 tha\u0301ng<\/td>\nB\u00e2\u0301t ki\u0300<\/td>\n\u2265 23<\/td>\n<\/tr>\n
3-6 tha\u0301ng<\/td>\nB\u00e2\u0301t ki\u0300<\/td>\n\u2265 26<\/td>\n<\/tr>\n
6-12 tha\u0301ng<\/td>\nB\u00e2\u0301t ki\u0300<\/td>\n\u2265 30<\/td>\n<\/tr>\n
1-2 tu\u00f4\u0309i<\/td>\n\u2265 6<\/td>\n\u2265 34<\/td>\n<\/tr>\n
2-4 tu\u00f4\u0309i<\/td>\n\u2265 6<\/td>\n\u2265 38<\/td>\n<\/tr>\n
4-6 tu\u00f4\u0309i<\/td>\n\u2265 6<\/td>\n\u2265 41<\/td>\n<\/tr>\n
Th\u00e2\u0300n kinh gan ba\u0300n ch\u00e2n trong<\/em><\/td>\n<\/tr>\n
\u0110u\u0309 tha\u0301ng<\/td>\n\u2265 10<\/td>\n\u2013<\/td>\n<\/tr>\n
1-6 tha\u0301ng<\/td>\n\u2265 15<\/td>\n\u2265 35<\/td>\n<\/tr>\n
6-12 tha\u0301ng<\/td>\n\u2265 15<\/td>\n\u2265 40<\/td>\n<\/tr>\n
1-2 tu\u00f4\u0309i<\/td>\n\u2265 15<\/td>\n\u2265 40<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Ta\u0300i li\u00ea\u0323u tham kha\u0309o<\/strong><\/h2>\n

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\n35. McMillan Hugh J., Kang Peter B. (2017), \u201cPediatric Electromyography: Concepts and Clinical Applications\u201d, Springer, Canada, pp. 373-378.<\/p>\n","protected":false},"excerpt":{"rendered":"

H\u1ed9i ch\u1ee9ng Guillain – Barre \u1edf tr\u1ebb em l\u00e0 b\u1ec7nh l\u00fd hi\u1ebfm g\u1eb7p, l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y li\u1ec7t m\u1ec1m c\u1ea5p. N\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi, b\u1ec7nh nh\u00e2n Guillain – Barre c\u00f3 nguy c\u01a1 t\u1eed vong cao do suy h\u00f4 h\u1ea5p ho\u1eb7c s\u1eb7c ph\u1ed5i do r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng nu\u1ed1t, ho\u1eb7c […]<\/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":"\nH\u1ed9i ch\u1ee9ng Guillain - Barre \u1edf tre\u0309 em - Vinmec<\/title>\n<meta name=\"description\" content=\"H\u1ed9i ch\u1ee9ng Guillain - Barre \u1edf tr\u1ebb em l\u00e0 b\u1ec7nh l\u00fd hi\u1ebfm g\u1eb7p, n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi, c\u00f3 nguy c\u01a1 t\u1eed vong cao.\" \/>\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=\"H\u1ed9i ch\u1ee9ng Guillain - 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