{"id":30267,"date":"2023-05-03T17:05:28","date_gmt":"2023-05-03T10:05:28","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30267"},"modified":"2023-05-03T17:05:28","modified_gmt":"2023-05-03T10:05:28","slug":"hoi-chung-an-than-kinh-ac-tinh","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/hoi-chung-an-than-kinh-ac-tinh\/","title":{"rendered":"H\u1ed9i ch\u1ee9ng an th\u1ea7n kinh \u00e1c t\u00ednh"},"content":{"rendered":"<p><strong>H\u1ed9i ch\u1ee9ng an th\u1ea7n kinh \u00e1c t\u00ednh (NMS) l\u00e0 m\u1ed9t tr\u01b0\u1eddng h\u1ee3p kh\u1ea9n c\u1ea5p th\u1ea7n kinh \u0111e d\u1ecda t\u00ednh m\u1ea1ng li\u00ean quan \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n (thu\u1ed1c an th\u1ea7n kinh). B\u1ec7nh \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi m\u1ed9t h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng \u0111\u1eb7c bi\u1ec7t v\u1ec1 thay \u0111\u1ed5i tr\u1ea1ng th\u00e1i t\u00e2m th\u1ea7n, s\u1ed1t v\u00e0 r\u1ed1i lo\u1ea1n t\u1ef1 ch\u1ee7.<\/strong><\/p>\n<h2>1. D\u1ecbch t\u1ec5 h\u1ecdc<\/h2>\n<p>T\u1ef7 l\u1ec7 m\u1eafc h\u1ed9i ch\u1ee9ng an th\u1ea7n kinh \u00e1c t\u00ednh (NMS) dao \u0111\u1ed9ng t\u1eeb \u00a00,02 \u0111\u1ebfn 3% \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n d\u00f9ng thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n. Ph\u1ea1m vi r\u1ed9ng n\u00e0y c\u00f3 th\u1ec3 ph\u1ea3n \u00e1nh s\u1ef1 kh\u00e1c bi\u1ec7t trong c\u00e1c qu\u1ea7n th\u1ec3 \u0111\u01b0\u1ee3c l\u1ea5y m\u1eabu. V\u00ed d\u1ee5, qu\u1ea7n th\u1ec3 t\u00e2m th\u1ea7n n\u1ed9i tr\u00fa so v\u1edbi ngo\u1ea1i tr\u00fa, c\u0169ng nh\u01b0 s\u1ef1 kh\u00e1c bi\u1ec7t trong c\u00e1c ph\u01b0\u01a1ng ph\u00e1p gi\u00e1m s\u00e1t v\u00e0 \u0111\u1ecbnh ngh\u0129a v\u1ec1 b\u1ec7nh \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng.<\/p>\n<p>Trong khi h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n m\u1eafc NMS l\u00e0 ng\u01b0\u1eddi tr\u1ebb tu\u1ed5i, h\u1ed9i ch\u1ee9ng n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 \u1edf t\u1ea5t c\u1ea3 c\u00e1c nh\u00f3m tu\u1ed5i t\u1eeb 0,9 \u0111\u1ebfn 78 tu\u1ed5i. Tu\u1ed5i t\u00e1c kh\u00f4ng ph\u1ea3i l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1. \u00a0Trong h\u1ea7u h\u1ebft c\u00e1c nghi\u00ean c\u1ee9u, nam gi\u1edbi \u0111\u00f4ng h\u01a1n n\u1eef gi\u1edbi g\u1ea5p \u0111\u00f4i. C\u1ea3 s\u1ef1 ph\u00e2n b\u1ed1 tu\u1ed5i t\u00e1c v\u00e0 gi\u1edbi t\u00ednh \u0111\u1ec1u t\u01b0\u01a1ng \u1ee9ng v\u1edbi s\u1ef1 ph\u00e2n b\u1ed1 ti\u1ebfp x\u00fac v\u1edbi c\u00e1c thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n.<\/p>\n<h2>2. Thu\u1ed1c li\u00ean quan<\/h2>\n<p id=\"xhash_H4\" class=\"headingAnchor\"><strong>Thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n v\u00e0 ch\u1ed1ng n\u00f4n: <\/strong>NMS th\u01b0\u1eddng th\u1ea5y nh\u1ea5t v\u1edbi c\u00e1c thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n th\u1ebf h\u1ec7 \u0111\u1ea7u ti\u00ean c\u00f3 hi\u1ec7u l\u1ef1c cao, tr\u01b0\u1edbc \u0111\u00e2y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 thu\u1ed1c an th\u1ea7n kinh (v\u00ed d\u1ee5: haloperidol, fluphenazine).<span class=\"headingEndMark\">\u00a0<\/span>Tuy nhi\u00ean, m\u1ecdi nh\u00f3m thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n \u0111\u1ec1u c\u00f3 li\u00ean quan, bao g\u1ed3m hi\u1ec7u l\u1ef1c th\u1ea5p (v\u00ed d\u1ee5: <a href=\"https:\/\/vinmec.com\/vi\/thong-tin-duoc\/su-dung-thuoc-toan\/thuoc-chlorpromazine-hcl-cong-dung-chi-dinh-va-luu-y-khi-dung\/\">chlorpromazine<\/a>) v\u00e0 thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n th\u1ebf h\u1ec7 th\u1ee9 hai (v\u00ed d\u1ee5: <a href=\"https:\/\/www.vinmec.com\/vi\/thong-tin-duoc\/su-dung-thuoc-toan\/thuoc-clozapine-cong-dung-chi-dinh-va-luu-y-khi-dung\/\">clozapine<\/a>, <a href=\"https:\/\/vinmec.com\/vi\/thong-tin-duoc\/su-dung-thuoc-toan\/cong-dung-thuoc-risperidone\/\">risperidone<\/a>,\u00a0<a href=\"https:\/\/www.vinmec.com\/vi\/thong-tin-duoc\/su-dung-thuoc-toan\/cong-dung-cua-thuoc-olanzapine\/\">olanzapine<\/a>) c\u0169ng nh\u01b0 thu\u1ed1c ch\u1ed1ng n\u00f4n (v\u00ed d\u1ee5: <a href=\"https:\/\/vinmec.com\/vi\/thong-tin-duoc\/su-dung-thuoc-toan\/thuoc-metoclopramide-tac-dung-lieu-dung-va-luu-y-su-dung\/\">metoclopramide<\/a>, <a href=\"https:\/\/vinmec.com\/vi\/thong-tin-duoc\/su-dung-thuoc-toan\/thuoc-promethazine-hcl-cong-dung-chi-dinh-va-luu-y-khi-dung\/\">promethazine\u00a0<\/a>v\u00e0 levosulpiride).<\/p>\n<p>Trong khi c\u00e1c tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng ph\u00e1t tri\u1ec3n trong hai tu\u1ea7n \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng lo\u1ea1n th\u1ea7n, m\u1ed1i li\u00ean quan c\u1ee7a h\u1ed9i ch\u1ee9ng v\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng ma t\u00fay l\u00e0 \u0111\u1eb7c tr\u01b0ng. NMS c\u00f3 th\u1ec3 x\u1ea3y ra sau m\u1ed9t li\u1ec1u duy nh\u1ea5t ho\u1eb7c sau khi \u0111i\u1ec1u tr\u1ecb v\u1edbi c\u00f9ng m\u1ed9t t\u00e1c nh\u00e2n v\u1edbi c\u00f9ng m\u1ed9t li\u1ec1u trong nhi\u1ec1u n\u0103m. N\u00f3 kh\u00f4ng ph\u1ea3i l\u00e0 m\u1ed9t hi\u1ec7n t\u01b0\u1ee3ng ph\u1ee5 thu\u1ed9c v\u00e0o li\u1ec1u, nh\u01b0ng li\u1ec1u cao h\u01a1n l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1. C\u00e1c nghi\u00ean c\u1ee9u b\u1ec7nh ch\u1ee9ng cho th\u1ea5y s\u1ef1 l\u00ean thang li\u1ec1u g\u1ea7n \u0111\u00e2y ho\u1eb7c nhanh ch\u00f3ng, chuy\u1ec3n t\u1eeb thu\u1ed1c n\u00e0y sang thu\u1ed1c kh\u00e1c v\u00e0 ti\u00eam t\u0129nh m\u1ea1ch l\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1.<\/p>\n<p><strong>C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c<\/strong>: s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi <a href=\"https:\/\/vinmec.com\/vi\/thong-tin-duoc\/su-dung-thuoc-toan\/thuoc-lithium-cong-dung-chi-dinh-va-luu-y-khi-dung\/\">lithium\u00a0<\/a>ho\u1eb7c c\u00e1c thu\u1ed1c h\u01b0\u1edbng t\u00e2m th\u1ea7n kh\u00e1c, thu\u1ed1c c\u00f3 hi\u1ec7u l\u1ef1c cao h\u01a1n, l\u1ea1m d\u1ee5ng ch\u1ea5t \u0111i k\u00e8m ho\u1eb7c b\u1ec7nh th\u1ea7n kinh v\u00e0 b\u1ec7nh n\u1ed9i khoa c\u1ea5p t\u00ednh (bao g\u1ed3m ch\u1ea5n th\u01b0\u01a1ng, ph\u1eabu thu\u1eadt v\u00e0 nhi\u1ec5m tr\u00f9ng), ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh trong c\u00e1c nghi\u00ean c\u1ee9u b\u1ec7nh ch\u1ee9ng.<\/p>\n<p id=\"xhash_H6\" class=\"headingAnchor\"><span class=\"h2 xhash_H6_scrollTarget\"><strong>Ng\u1eebng thu\u1ed1c kh\u00e1ng parkinson<\/strong>: <\/span>NMS c\u0169ng \u0111\u01b0\u1ee3c nh\u00ecn th\u1ea5y \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh Parkinson trong tr\u01b0\u1eddng h\u1ee3p ng\u1eebng \u0111i\u1ec1u tr\u1ecb ch\u1ee7 v\u1eadn L-Dopa ho\u1eb7c dopamine, c\u0169ng nh\u01b0 gi\u1ea3m li\u1ec1u v\u00e0 chuy\u1ec3n t\u1eeb t\u00e1c nh\u00e2n n\u00e0y sang t\u00e1c nh\u00e2n kh\u00e1c.<\/p>\n<h2>3. Sinh b\u1ec7nh h\u1ecdc<\/h2>\n<p id=\"xhash_H7\" class=\"headingAnchor\">Nguy\u00ean nh\u00e2n c\u1ee7a h\u1ed9i ch\u1ee9ng an th\u1ea7n kinh \u00e1c t\u00ednh (NMS) v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft. C\u00e1c l\u00fd thuy\u1ebft hi\u1ec7n t\u1ea1i b\u1ecb h\u1ea1n ch\u1ebf trong kh\u1ea3 n\u0103ng gi\u1ea3i th\u00edch t\u1ea5t c\u1ea3 c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng v\u00e0 trong d\u1eef li\u1ec7u h\u1ed7 tr\u1ee3. M\u1ed9t m\u00f4 h\u00ecnh \u0111\u1ed9ng v\u1eadt cho NMS \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n, nh\u01b0ng n\u00f3 kh\u00f4ng ho\u00e0n to\u00e0n t\u01b0\u01a1ng \u1ee9ng v\u1edbi h\u1ed9i ch\u1ee9ng \u1edf ng\u01b0\u1eddi.<\/p>\n<p>Trong nh\u00f3m t\u00e1c nh\u00e2n m\u00e0 NMS c\u00f3 li\u00ean quan, phong t\u1ecfa th\u1ee5 th\u1ec3 dopamine l\u00e0 trung t\u00e2m c\u1ee7a h\u1ea7u h\u1ebft c\u00e1c l\u00fd thuy\u1ebft v\u1ec1 sinh b\u1ec7nh h\u1ecdc c\u1ee7a n\u00f3. Phong t\u1ecfa th\u1ee5 th\u1ec3 dopamine trung \u01b0\u01a1ng \u1edf v\u00f9ng d\u01b0\u1edbi \u0111\u1ed3i c\u00f3 th\u1ec3 g\u00e2y t\u0103ng th\u00e2n nhi\u1ec7t v\u00e0 c\u00e1c d\u1ea5u hi\u1ec7u kh\u00e1c c\u1ee7a ch\u1ee9ng m\u1ea5t t\u1ef1 ch\u1ee7. Can thi\u1ec7p v\u00e0o c\u00e1c con \u0111\u01b0\u1eddng dopamine nigrostriatal c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn c\u00e1c tri\u1ec7u ch\u1ee9ng lo\u1ea1i Parkinson nh\u01b0 c\u1ee9ng v\u00e0 run. C\u00e1c h\u1ec7 th\u1ed1ng d\u1eabn truy\u1ec1n th\u1ea7n kinh kh\u00e1c (axit gamma aminobutyric, epinephrine, serotonin v\u00e0 acetylcholine) d\u01b0\u1eddng nh\u01b0 c\u0169ng c\u00f3 li\u00ean quan, tr\u1ef1c ti\u1ebfp ho\u1eb7c gi\u00e1n ti\u1ebfp.<\/p>\n<p>M\u1ed9t l\u00fd thuy\u1ebft kh\u00e1c l\u00e0 \u0111\u1ed9 c\u1ee9ng v\u00e0 t\u1ed5n th\u01b0\u01a1ng c\u01a1 th\u1ec3 \u0111\u1ea1i di\u1ec7n cho \u1ea3nh h\u01b0\u1edfng ch\u00ednh \u0111\u1ebfn h\u1ec7 th\u1ed1ng c\u01a1 ngo\u1ea1i bi\u00ean, c\u00f3 l\u1ebd t\u1eeb nh\u1eefng thay \u0111\u1ed5i tr\u1ef1c ti\u1ebfp trong ch\u1ee9c n\u0103ng ty th\u1ec3 c\u01a1 b\u1eafp. \u0110i\u1ec1u n\u00e0y t\u1ef1 n\u00f3 c\u00f3 th\u1ec3 \u0111\u1ea1i di\u1ec7n cho m\u1ed9t khi\u1ebfm khuy\u1ebft c\u01a1 x\u01b0\u01a1ng ch\u00ednh ho\u1eb7c t\u00e1c d\u1ee5ng \u0111\u1ed9c h\u1ea1i tr\u1ef1c ti\u1ebfp c\u1ee7a c\u00e1c lo\u1ea1i thu\u1ed1c n\u00e0y tr\u00ean c\u01a1 x\u01b0\u01a1ng.<\/p>\n<p>M\u1ed9t vai tr\u00f2 ch\u00ednh c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t do b\u1ecb gi\u00e1n \u0111o\u1ea1n h\u1ec7 th\u1ed1ng th\u1ea7n kinh giao c\u1ea3m, bi\u1ec3u hi\u1ec7n trong t\u0103ng tr\u01b0\u01a1ng l\u1ef1c c\u01a1, s\u1ef1 trao \u0111\u1ed5i ch\u1ea5t v\u00e0 v\u1eadn m\u1ea1ch kh\u00f4ng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t; Nh\u1eefng \u0111i\u1ec1u n\u00e0y l\u1ea7n l\u01b0\u1ee3t d\u1eabn \u0111\u1ebfn t\u1ea3n nhi\u1ec7t kh\u00f4ng hi\u1ec7u qu\u1ea3, huy\u1ebft \u00e1p v\u00e0 nh\u1ecbp tim kh\u00f4ng \u1ed5n \u0111\u1ecbnh.<\/p>\n<p>C\u00e1c c\u1ee5m NMS gia \u0111\u00ecnh cho th\u1ea5y b\u1ec7nh c\u00f3 khuynh h\u01b0\u1edbng di truy\u1ec1n. C\u00e1c nghi\u00ean c\u1ee9u di truy\u1ec1n \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a m\u1ed9t alen c\u1ee5 th\u1ec3 c\u1ee7a gen th\u1ee5 th\u1ec3 dopamine D2 \u0111\u01b0\u1ee3c \u0111\u1ea1i di\u1ec7n qu\u00e1 m\u1ee9c \u1edf b\u1ec7nh nh\u00e2n NMS. Alen n\u00e0y c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c gi\u1ea3m m\u1eadt \u0111\u1ed9 v\u00e0 ch\u1ee9c n\u0103ng c\u1ee7a c\u00e1c th\u1ee5 th\u1ec3 dopamine c\u0169ng nh\u01b0 gi\u1ea3m ho\u1ea1t \u0111\u1ed9ng v\u00e0 trao \u0111\u1ed5i ch\u1ea5t dopaminergic.<\/p>\n<figure id=\"attachment_30286\" aria-describedby=\"caption-attachment-30286\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-medium wp-image-30286\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/hinh-anh-minh-hoa-hoi-chung-an-than-kinh-ac-tinh-300x169.jpg\" alt=\"h\u00ecnh \u1ea3nh minh h\u1ecda h\u1ed9i ch\u1ee9ng an th\u1ea7n kinh \u00e1c t\u00ednh\" width=\"300\" height=\"169\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/hinh-anh-minh-hoa-hoi-chung-an-than-kinh-ac-tinh-300x169.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/hinh-anh-minh-hoa-hoi-chung-an-than-kinh-ac-tinh-1024x576.jpg 1024w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/hinh-anh-minh-hoa-hoi-chung-an-than-kinh-ac-tinh-768x432.jpg 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/hinh-anh-minh-hoa-hoi-chung-an-than-kinh-ac-tinh.jpg 1280w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-30286\" class=\"wp-caption-text\">H\u00ecnh \u1ea3nh minh h\u1ecda h\u1ed9i ch\u1ee9ng an th\u1ea7n kinh \u00e1c t\u00ednh<\/figcaption><\/figure>\n<h2>4. Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng<\/h2>\n<h3>4.1 C\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/h3>\n<p>H\u1ed9i ch\u1ee9ng an th\u1ea7n kinh \u00e1c t\u00ednh (NMS) \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1edfi s\u1ef1 li\u00ean quan c\u1ee7a n\u00f3 v\u1edbi m\u1ed9t nh\u00f3m thu\u1ed1c ng\u0103n ch\u1eb7n s\u1ef1 truy\u1ec1n dopamine v\u00e0 m\u1ed9t b\u1ed9 t\u1ee9 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng \u0111\u1eb7c bi\u1ec7t: s\u1ed1t, c\u1ee9ng nh\u1eafc, thay \u0111\u1ed5i tr\u1ea1ng th\u00e1i t\u00e2m th\u1ea7n v\u00e0 m\u1ea5t \u1ed5n \u0111\u1ecbnh t\u1ef1 ch\u1ee7.<\/p>\n<p>C\u00e1c tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh c\u1ee7a b\u1ec7nh bao g\u1ed3m:<\/p>\n<ul>\n<li><em>Thay \u0111\u1ed5i tr\u1ea1ng th\u00e1i t\u00e2m th\u1ea7n:\u00a0<\/em>l\u00e0 tri\u1ec7u ch\u1ee9ng ban \u0111\u1ea7u \u1edf 82% b\u1ec7nh nh\u00e2n. \u0110i\u1ec1u n\u00e0y th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n \u1edf d\u1ea1ng m\u00ea s\u1ea3ng k\u00edch \u0111\u1ed9ng v\u1edbi s\u1ef1 nh\u1ea7m l\u1eabn h\u01a1n l\u00e0 r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n.<a href=\"https:\/\/www.vinmec.com\/vi\/benh\/hoi-chung-catatonia-4791\/#:~:text=Tri%E1%BB%87u%20ch%E1%BB%A9ng%20b%E1%BB%87nh%20H%E1%BB%99i%20ch%E1%BB%A9ng,n%C3%A0y%20s%E1%BA%BD%20%C4%91%C6%B0%E1%BB%A3c%20duy%20tr%C3%AC.\"> D\u1ea5u hi\u1ec7u catatonia<\/a> v\u00e0 \u0111\u1ed9t bi\u1ebfn c\u00f3 th\u1ec3 n\u1ed5i b\u1eadt.Sau ti\u1ebfn tri\u1ec3n th\u00e0nh b\u1ec7nh n\u00e3o s\u00e2u v\u1edbi cho\u00e1ng v\u00e1ng v\u00e0 cu\u1ed1i c\u00f9ng l\u00e0 h\u00f4n m\u00ea.<\/li>\n<li><em>C\u1ee9ng c\u01a1 &#8211; b\u1eafp: <\/em>\u0111i\u1ec3n h\u00ecnh b\u1edfi s\u1ef1 chuy\u1ec3n \u0111\u1ed9ng c\u1ee9ng nh\u1eafc c\u1ee7a c\u00e1c chi. Ngo\u00e0i ra, c\u00f3 th\u1ec3 g\u1eb7p c\u00e1c v\u1eadn \u0111\u1ed9ng b\u1ea5t th\u01b0\u1eddng kh\u00e1c nh\u01b0 run (xu\u1ea5t hi\u1ec7n \u1edf 45 &#8211; 92% s\u1ed1 tr\u01b0\u1eddng h\u1ee3p). B\u1ec7nh nh\u00e2n c\u0169ng c\u00f3 th\u1ec3 c\u00f3 r\u1ed1i lo\u1ea1n nu\u1ed1t, ch\u1ea3y\u00a0 n\u01b0\u1edbc b\u1ecdt,&#8230;.<\/li>\n<li><em>T\u0103ng th\u00e2n nhi\u1ec7t<\/em>: \u00a0l\u00e0 m\u1ed9t tri\u1ec7u ch\u1ee9ng x\u00e1c \u0111\u1ecbnh theo nhi\u1ec1u ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n. Nhi\u1ec7t \u0111\u1ed9 h\u01a1n 38 \u00b0 C l\u00e0 \u0111i\u1ec3n h\u00ecnh (87 ph\u1ea7n tr\u0103m), nh\u01b0ng nhi\u1ec7t \u0111\u1ed9 th\u1eadm ch\u00ed cao h\u01a1n, l\u1edbn h\u01a1n 40 \u00b0 C, l\u00e0 ph\u1ed5 bi\u1ebfn (40%). S\u1ed1t c\u00f3 th\u1ec3 l\u00e0 tri\u1ec7u ch\u1ee9ng \u00edt nh\u1ea5t qu\u00e1n h\u01a1n \u1edf b\u1ec7nh nh\u00e2n NMS li\u00ean quan \u0111\u1ebfn thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n th\u1ebf h\u1ec7 th\u1ee9 hai.<\/li>\n<li><em>M\u1ea5t \u1ed5n \u0111\u1ecbnh th\u1ea7n kinh t\u1ef1 ch\u1ee7<\/em>: bi\u1ec3u hi\u1ec7n b\u1eb1ng nh\u1ecbp tim nhanh (88%), huy\u1ebft \u00e1p cao (61 &#8211; 77%) v\u00e0 th\u1edf nhanh (73%). R\u1ed1i lo\u1ea1n nh\u1ecbp tim c\u0169ng c\u00f3 th\u1ec3 x\u1ea3y ra.<\/li>\n<\/ul>\n<h3>4.2 C\u00e1c x\u00e9t nghi\u1ec7m<\/h3>\n<p><strong>CK huy\u1ebft thanh t\u0103ng cao<\/strong>: l\u00e0 x\u00e9t nghi\u1ec7m \u0111i\u1ec3n h\u00ecnh trong h\u1ed9i ch\u1ee9ng an th\u1ea7n kinh \u00e1c t\u00ednh. M\u1ee9c \u0111\u1ed9 t\u0103ng CK t\u01b0\u01a1ng quan v\u1edbi m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng v\u00e0 ti\u00ean l\u01b0\u1ee3ng c\u1ee7a b\u1ec7nh.<\/p>\n<p><strong>M\u1ed9t s\u1ed1 x\u00e9t nghi\u1ec7m kh\u00f4ng \u0111i\u1ec3n h\u00ecnh kh\u00e1c:\u00a0<\/strong><\/p>\n<ul>\n<li>T\u0103ng s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u.<\/li>\n<li>T\u0103ng nh\u1eb9 lactate dehydrogenase, phosphatase ki\u1ec1m v\u00e0 transaminase gan.<\/li>\n<li>C\u00e1c b\u1ea5t th\u01b0\u1eddng v\u1ec1 \u0111i\u1ec7n gi\u1ea3i: h\u1ea1 canxi m\u00e1u, h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, h\u1ea1 natri m\u00e1u v\u00e0 t\u0103ng natri m\u00e1u, t\u0103ng kali m\u00e1u v\u00e0 nhi\u1ec5m toan chuy\u1ec3n h\u00f3a.<\/li>\n<li>N\u1ed3ng \u0111\u1ed9 s\u1eaft trong huy\u1ebft thanh th\u1ea5p.<\/li>\n<\/ul>\n<h2>5. \u0110i\u1ec1u tr\u1ecb b\u1ec7nh<\/h2>\n<h3>5.1 Nguy\u00ean t\u1eafc chung<\/h3>\n<p>Vi\u1ec7c qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n NMS n\u00ean d\u1ef1a tr\u00ean h\u1ec7 th\u1ed1ng ph\u00e2n c\u1ea5p m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng l\u00e2m s\u00e0ng v\u00e0 \u0111\u1ed9 ch\u1eafc ch\u1eafn ch\u1ea9n \u0111o\u00e1n. Khi c\u00e1c bi\u1ec3u hi\u1ec7n nghi\u00eam tr\u1ecdng, c\u1ea7n theo d\u00f5i v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u01a1n v\u1ecb ch\u0103m s\u00f3c \u0111\u1eb7c bi\u1ec7t.<\/p>\n<p><strong><span class=\"h2 xhash_H24_scrollTarget\">Ng\u1eebng t\u00e1c<\/span> nh\u00e2n g\u00e2y b\u1ec7nh<\/strong>: lo\u1ea1i b\u1ecf t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb quan tr\u1ecdng nh\u1ea5t trong NMS. C\u00e1c thu\u1ed1c h\u01b0\u1edbng t\u00e2m th\u1ea7n (lithium, li\u1ec7u ph\u00e1p kh\u00e1ng cholinergic, thu\u1ed1c serotonergic) c\u0169ng n\u00ean \u0111\u01b0\u1ee3c d\u1eebng l\u1ea1i n\u1ebfu c\u00f3 th\u1ec3.<\/p>\n<p><strong><span class=\"h2 xhash_H25_scrollTarget\">Ch\u0103m s\u00f3c h\u1ed7<\/span> tr\u1ee3<\/strong>, bao g\u1ed3m:<\/p>\n<ul>\n<li>M\u1ea5t n\u01b0\u1edbc v\u00e0 \u0111i\u1ec7n gi\u1ea3i.<\/li>\n<li>\n<p class=\"bulletIndent1\">Suy th\u1eadn c\u1ea5p li\u00ean quan \u0111\u1ebfn ti\u00eau c\u01a1 v\u00e2n.<\/p>\n<\/li>\n<li>\n<p class=\"bulletIndent1\">R\u1ed1i lo\u1ea1n nh\u1ecbp tim.<\/p>\n<\/li>\n<li>\n<p class=\"bulletIndent1\">Nh\u1ed3i m\u00e1u c\u01a1 tim.<\/p>\n<\/li>\n<li>\n<p class=\"bulletIndent1\">B\u1ec7nh c\u01a1 tim.<\/p>\n<\/li>\n<li>\n<p class=\"bulletIndent1\">Suy h\u00f4 h\u1ea5p do c\u1ee9ng th\u00e0nh ng\u1ef1c, vi\u00eam ph\u1ed5i h\u00edt, thuy\u00ean t\u1eafc ph\u1ed5i.<\/p>\n<\/li>\n<li>\n<p class=\"bulletIndent1\">Huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u.<\/p>\n<\/li>\n<li>\n<p class=\"bulletIndent1\">Gi\u1ea3m ti\u1ec3u c\u1ea7u.<\/p>\n<\/li>\n<li>\n<p class=\"bulletIndent1\">\u0110\u00f4ng m\u00e1u n\u1ed9i m\u1ea1ch lan t\u1ecfa.<\/p>\n<\/li>\n<li>\n<p class=\"bulletIndent1\">Huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u.<\/p>\n<\/li>\n<li>\n<p class=\"bulletIndent1\">Co gi\u1eadt do t\u0103ng th\u00e2n nhi\u1ec7t v\u00e0 r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a.<\/p>\n<\/li>\n<li>\n<p class=\"bulletIndent1\">Suy gan.<\/p>\n<\/li>\n<li>\n<p class=\"bulletIndent1\">Nhi\u1ec5m tr\u00f9ng huy\u1ebft.<\/p>\n<\/li>\n<\/ul>\n<h3>5.2 \u0110i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3<\/h3>\n<p>Ti\u1ebfp c\u1eadn ban \u0111\u1ea7u th\u01b0\u1eddng d\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c benzodiazepin (lorazepam ho\u1eb7c diazepam) c\u00f9ng v\u1edbi dantrolene trong tr\u01b0\u1eddng h\u1ee3p c\u1ee9ng c\u01a1 t\u1eeb trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng v\u1edbi CK t\u0103ng cao; Bromocriptine ho\u1eb7c amantadine c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u00eam v\u00e0o cho b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh t\u1eeb trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng.<\/p>\n<ul>\n<li>Lorazepam, m\u1ed9t lo\u1ea1i thu\u1ed1c benzodiazepine, \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng 1 \u0111\u1ebfn 2 mg ti\u00eam b\u1eafp ho\u1eb7c ti\u00eam t\u0129nh m\u1ea1ch m\u1ed7i b\u1ed1n \u0111\u1ebfn s\u00e1u gi\u1edd.<\/li>\n<\/ul>\n<p>Diazepam \u0111\u01b0\u1ee3c d\u00f9ng 10 mg ti\u00eam t\u0129nh m\u1ea1ch m\u1ed7i t\u00e1m gi\u1edd.<\/p>\n<p>Ngo\u00e0i vi\u1ec7c gi\u1ea3m k\u00edch \u0111\u1ed9ng, c\u00e1c thu\u1ed1c benzodiazepin, \u0111\u1eb7c bi\u1ec7t l\u00e0 diazepam, c\u0169ng c\u00f3 th\u1ec3 c\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n c\u01a1.<\/p>\n<ul>\n<li>Dantrolene l\u00e0 m\u1ed9t thu\u1ed1c gi\u00e3n c\u01a1 x\u01b0\u01a1ng t\u00e1c \u0111\u1ed9ng tr\u1ef1c ti\u1ebfp v\u00e0 c\u00f3 hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb t\u0103ng th\u00e2n nhi\u1ec7t \u00e1c t\u00ednh (MH). Li\u1ec1u 1 \u0111\u1ebfn 2,5 mg \/ kg ti\u00eam t\u0129nh m\u1ea1ch th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u1edf ng\u01b0\u1eddi l\u1edbn v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u1eb7p l\u1ea1i v\u1edbi li\u1ec1u t\u1ed1i \u0111a 10 mg \/ kg \/ ng\u00e0y. Hi\u1ec7u qu\u1ea3 bao g\u1ed3m gi\u1ea3m sinh nhi\u1ec7t c\u0169ng nh\u01b0 \u0111\u1ed9 c\u1ee9ng c\u1ee7a c\u00e1c c\u01a1 trong v\u00f2ng v\u00e0i ph\u00fat sau khi d\u00f9ng. C\u00f3 nguy c\u01a1 li\u00ean quan \u0111\u1ebfn nhi\u1ec5m \u0111\u1ed9c gan, v\u00e0 n\u00ean tr\u00e1nh dantrolene n\u1ebfu x\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gan b\u1ea5t th\u01b0\u1eddng. Trong khi m\u1ed9t s\u1ed1 ng\u01b0\u1eddi khuy\u00ean b\u1ea1n n\u00ean ng\u1eebng d\u00f9ng thu\u1ed1c sau v\u00e0i ng\u00e0y, nh\u1eefng ng\u01b0\u1eddi kh\u00e1c \u0111\u1ec1 ngh\u1ecb ti\u1ebfp t\u1ee5c trong 10 \u0111\u1ebfn 14 ng\u00e0y sau \u0111\u00f3 gi\u1ea3m d\u1ea7n \u0111\u1ec3 gi\u1ea3m thi\u1ec3u nguy c\u01a1 t\u00e1i ph\u00e1t.<\/li>\n<li>Bromocriptine, m\u1ed9t ch\u1ea5t ch\u1ee7 v\u1eadn dopamine. N\u00f3 \u0111\u01b0\u1ee3c dung n\u1ea1p t\u1ed1t \u1edf b\u1ec7nh nh\u00e2n t\u00e2m th\u1ea7n. Li\u1ec1u 2,5 mg (qua \u1ed1ng th\u00f4ng m\u0169i d\u1ea1 d\u00e0y) m\u1ed7i s\u00e1u \u0111\u1ebfn t\u00e1m gi\u1edd \u0111\u01b0\u1ee3c chu\u1ea9n \u0111\u1ed9 l\u00ean \u0111\u1ebfn li\u1ec1u t\u1ed1i \u0111a 40 mg \/ ng\u00e0y. Ng\u01b0\u1eddi ta \u0111\u1ec1 ngh\u1ecb r\u1eb1ng \u0111i\u1ec1u n\u00e0y n\u00ean \u0111\u01b0\u1ee3c ti\u1ebfp t\u1ee5c trong 7 \u0111\u1ebfn 14 ng\u00e0y sau khi NMS \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t v\u00e0 sau \u0111\u00f3 gi\u1ea3m d\u1ea7n.<\/li>\n<li>Amantadine c\u00f3 t\u00e1c d\u1ee5ng dopaminergic v\u00e0 kh\u00e1ng cholinergic v\u00e0 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng thay th\u1ebf cho bromocriptine. Li\u1ec1u kh\u1edfi \u0111\u1ea7u l\u00e0 100 mg u\u1ed1ng ho\u1eb7c qua \u1ed1ng d\u1ea1 d\u00e0y v\u00e0 \u0111\u01b0\u1ee3c chu\u1ea9n \u0111\u1ed9 l\u00ean tr\u00ean khi c\u1ea7n thi\u1ebft \u0111\u1ebfn li\u1ec1u t\u1ed1i \u0111a 200 mg m\u1ed7i 12 gi\u1edd.<\/li>\n<li>Li\u1ec7u ph\u00e1p s\u1ed1c \u0111i\u1ec7n (ECT) th\u01b0\u1eddng \u0111\u01b0\u1ee3c d\u00e0nh ri\u00eang cho nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c ho\u1eb7c trong \u0111\u00f3 c\u1ea7n \u0111i\u1ec1u tr\u1ecb h\u01b0\u1edbng t\u00e2m th\u1ea7n kh\u00f4ng d\u00f9ng thu\u1ed1c. Tuy nhi\u00ean, kh\u00f4ng c\u00f3 d\u1eef li\u1ec7u n\u00e0o cho th\u1ea5y k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb \u01b0u vi\u1ebft c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p n\u00e0y.<\/li>\n<\/ul>\n<div class=\"ddict_btn\" style=\"top: 736px; left: 170.333px;\"><\/div>\n","protected":false},"excerpt":{"rendered":"<p>H\u1ed9i ch\u1ee9ng an th\u1ea7n kinh \u00e1c t\u00ednh (NMS) l\u00e0 m\u1ed9t tr\u01b0\u1eddng h\u1ee3p kh\u1ea9n c\u1ea5p th\u1ea7n kinh \u0111e d\u1ecda t\u00ednh m\u1ea1ng li\u00ean quan \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n (thu\u1ed1c an th\u1ea7n kinh). B\u1ec7nh \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi m\u1ed9t h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng \u0111\u1eb7c bi\u1ec7t v\u1ec1 thay \u0111\u1ed5i tr\u1ea1ng th\u00e1i t\u00e2m th\u1ea7n, s\u1ed1t [&hellip;]<\/p>\n","protected":false},"author":26,"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>H\u1ed9i ch\u1ee9ng an th\u1ea7n kinh \u00e1c t\u00ednh - Vinmec<\/title>\n<meta name=\"description\" content=\"H\u1ed9i ch\u1ee9ng an th\u1ea7n kinh \u00e1c t\u00ednh l\u00e0 m\u1ed9t tr\u01b0\u1eddng h\u1ee3p kh\u1ea9n c\u1ea5p th\u1ea7n kinh \u0111e d\u1ecda t\u00ednh m\u1ea1ng li\u00ean quan \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n.\" \/>\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 an th\u1ea7n kinh \u00e1c t\u00ednh - 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