{"id":31014,"date":"2023-05-06T21:54:44","date_gmt":"2023-05-06T14:54:44","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31014"},"modified":"2023-05-06T21:54:44","modified_gmt":"2023-05-06T14:54:44","slug":"zona-day-than-kinh-tam-thoa","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/zona-day-than-kinh-tam-thoa\/","title":{"rendered":"Zona d\u00e2y th\u1ea7n kinh tam thoa"},"content":{"rendered":"<p><strong>Zona d\u00e2y th\u1ea7n kinh tam thoa l\u00e0 b\u1ec7nh nhi\u1ec5m tr\u00f9ng th\u1ea7n kinh do herpes zoster virus g\u00e2y ra, trong \u0111\u00f3 \u0111au, ng\u1ee9a l\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n s\u1edbm, t\u1ed3n t\u1ea1i l\u00e2u nhi\u1ec1u khi dai d\u1eb3ng v\u00e0 r\u1ea5t kh\u00f3 tr\u1ecb. <a href=\"https:\/\/vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/dau-day-kinh-sinh-ba\/\">\u0110au<\/a> sau herpet \u0111\u00e3 tr\u1edf th\u00e0nh n\u1ed7i lo l\u1eafng, phi\u1ec1n mu\u1ed9n c\u1ee7a nhi\u1ec1u b\u1ec7nh nh\u00e2n v\u00e0 g\u00e2y kh\u00f4ng \u00edt kh\u00f3 kh\u0103n cho b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb. Ch\u1ea9n \u0111o\u00e1n b\u1ec7nh c\u1ea7n tu\u00e2n th\u1ee7 ti\u00eau chu\u1ea9n c\u1ee7a IASP trong B\u1ea3ng ph\u00e2n lo\u1ea1i \u0111au l\u1ea7n th\u1ee9 III-2018. Li\u1ec7u ph\u00e1p phong b\u1ebf th\u1ea7n kinh nhi\u1ec1u l\u1ea7n b\u1eb1ng corticoid \u0111\u00e3 cho th\u1ea5y c\u00f3 hi\u1ec7u qu\u1ea3 trong vi\u1ec7c l\u00e0m gi\u1ea3m \u0111au, ng\u1ee9a v\u00e0 h\u1ea1n ch\u1ebf t\u1ef7 l\u1ec7 \u0111au sau herpet. Ch\u1ec9 \u0111\u1ecbnh li\u1ec7u ph\u00e1p n\u00e0y h\u1ee3p l\u00fd, th\u1ef1c hi\u1ec7n k\u1ef9 thu\u1eadt ch\u00ednh x\u00e1c l\u00e0 ni\u1ec1m hy v\u1ecdng cho c\u00e1c b\u1ec7nh nh\u00e2n \u0111au do v\u00e0 sau herpet.<\/strong><\/p>\n<p><em><strong>Ba\u0300i vi\u00ea\u0301t &#8220;\u0110au d\u00e2y th\u1ea7n kinh tam thoa li\u00ean quan v\u1edbi herpes zoster virus: c\u1eadp nh\u1eadt \u2013 th\u00e1ch th\u1ee9c \u2013 tri\u1ec3n v\u1ecdng&#8221; 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<p><em><strong>Ta\u0301c gia\u0309: Nguy\u1ec5n V\u0103n Ch\u01b0\u01a1ng1, Nguy\u1ec5n Th\u00fay Linh2, Nguy\u1ec5n Vi\u1ec7t Trung3<\/strong><\/em><br \/>\n<em>H\u1ed9i Ch\u1ed1ng \u0111au H\u00e0 N\u1ed9i<sup>1<\/sup><\/em><br \/>\n<em>B\u1ec7nh vi\u1ec7n Trung \u01b0\u01a1ng Qu\u00e2n \u0111\u1ed9i 108<sup>2<\/sup><\/em><br \/>\n<em>B\u1ed9 m\u00f4n Th\u1ea7n kinh \u0110\u1ea1i h\u1ecdc Y H\u00e0 N\u1ed9i<sup>3<\/sup><\/em><\/p>\n<h2><strong>1. \u0110\u1eb7t v\u1ea5n \u0111\u1ec1<\/strong><\/h2>\n<p>B\u1ec7nh vi\u00eam d\u00e2y th\u1ea7n kinh tam thoa (d\u00e2y th\u1ea7n kinh sinh ba hay d\u00e2y th\u1ea7n kinh s\u1ed1 V) do herpes zoster virus (do herpes) b\u00ean c\u1ea1nh c\u00e1c tri\u1ec7u ch\u1ee9ng, d\u1ea5u hi\u1ec7u tr\u00ean da, ni\u00eam m\u1ea1c v\u00e0 tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n th\u00ec ng\u1ee9a v\u00e0 \u0111au v\u1edbi t\u00ednh ch\u1ea5t b\u1ecfng \u2013 r\u00e1t \u2013 \u0111i\u1ec7n gi\u1eadt- nh\u1ee9c nh\u1ed1i- t\u00ea c\u00f3ng\u2026 ngay trong ho\u1eb7c k\u00e9o d\u00e0i nhi\u1ec1u th\u00e1ng, nhi\u1ec1u n\u0103m sau giai \u0111o\u1ea1n c\u1ea5p t\u00ednh l\u00e0m b\u1ec7nh nh\u00e2n r\u1ea5t kh\u00f3 ch\u1ecbu, \u1ea3nh h\u01b0\u1edfng s\u00e2u s\u1eafc t\u1edbi ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng v\u00e0 kh\u1ea3 n\u0103ng lao \u0111\u1ed9ng x\u00e3 h\u1ed9i c\u1ee7a b\u1ec7nh nh\u00e2n. Trong B\u1ea3ng ph\u00e2n lo\u1ea1i \u0111au m\u1edbi nh\u1ea5t c\u1ee7a IASP (IASP III-2018) th\u00ec \u0111au do zona th\u1ea7n kinh tam thoa \u0111\u01b0\u1ee3c m\u00e3 h\u00f3a l\u00e0 13.1.2.1 B\u1ec7nh th\u1ea7n kinh tam thoa do virus herpes zoster g\u00e2y \u0111au v\u00e0 \u0111au th\u1ea7n kinh sau zona \u0111\u01b0\u1ee3c m\u00e3 h\u00f3a l\u00e0 13.1.2.2 \u0110au d\u00e2y th\u1ea7n kinh tam thoa sau herpet; vi\u1ec7c chuy\u1ec3n ng\u1eef c\u00f3 th\u1ec3 ch\u01b0a \u0111\u01b0\u1ee3c ho\u00e0n to\u00e0n ph\u00f9 h\u1ee3p nh\u01b0ng v\u1ec1 h\u00e0m \u00fd, 2 m\u00e3 b\u1ec7nh kh\u00e1c nhau \u1edf ch\u1ed7 \u0111au trong v\u00f2ng d\u01b0\u1edbi 3 th\u00e1ng (m\u00e3 b\u1ec7nh 13.1.2.1) ho\u1eb7c \u0111au k\u00e9o d\u00e0i t\u1eeb 3 th\u00e1ng tr\u1edf l\u00ean (m\u00e3 b\u1ec7nh 13.1.2.2). Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb ch\u1ee9ng \u0111au n\u00e0y g\u1eb7p r\u1ea5t nhi\u1ec1u kh\u00f3 kh\u0103n v\u00e0 h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p k\u1ebft qu\u1ea3 kh\u00f4ng th\u1ecfa \u0111\u00e1ng. Trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng ch\u00fang t\u00f4i \u0111\u00e3 g\u1eb7p v\u00e0 \u0111i\u1ec1u tr\u1ecb th\u00e0nh c\u00f4ng nhi\u1ec1u b\u1ec7nh nh\u00e2n nh\u01b0 v\u1eady v\u00e0 \u0111\u00e3 t\u1ed5ng h\u1ee3p c\u00e1c ca b\u1ec7nh t\u1eeb n\u0103m 2021 trong c\u00e1c b\u00e0i b\u00e1o \u1edf T\u1ea1p ch\u00ed Th\u1ea7n kinh h\u1ecdc Vi\u1ec7t Nam s\u1ed1 29-2020 v\u00e0 s\u1ed1 30-2021 [7],[8].<br \/>\nTrong b\u00e0i b\u00e1o n\u00e0y ch\u00fang t\u00f4i xin th\u00f4ng b\u00e1o l\u1ea1i v\u1edbi c\u00e1c \u0111\u1ed3ng nghi\u1ec7p m\u00e3 b\u1ec7nh v\u00e0 ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n c\u1ee7a \u0111au d\u00e2y th\u1ea7n kinh li\u00ean quan v\u1edbi herpes zoster virus khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb v\u00e0 c\u01a1 h\u1ed9i n\u00e2ng cao k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n<figure id=\"attachment_31016\" aria-describedby=\"caption-attachment-31016\" style=\"width: 600px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-full wp-image-31016\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/dau-than-kinh-sinh-ba.jpg\" alt=\"\u0110au d\u00e2y th\u1ea7n kinh tam thoa li\u00ean quan v\u1edbi herpes zoster virus\" width=\"600\" height=\"297\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/dau-than-kinh-sinh-ba.jpg 600w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/dau-than-kinh-sinh-ba-300x149.jpg 300w\" sizes=\"(max-width: 600px) 100vw, 600px\" \/><figcaption id=\"caption-attachment-31016\" class=\"wp-caption-text\">\u0110au d\u00e2y th\u1ea7n kinh tam thoa li\u00ean quan v\u1edbi herpes zoster virus<\/figcaption><\/figure>\n<h2><strong>2. C\u1eadp nh\u1eadt \u0111au th\u1ea7n kinh do herpes<\/strong><\/h2>\n<p>C\u00e1c ch\u1ee9ng \u0111au do d\u00e2y th\u1ea7n kinh \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i v\u00e0 m\u00e3 h\u00f3a trong m\u1ee5c s\u1ed1 13 c\u1ee7a B\u1ea3ng ph\u00e2n lo\u1ea1i \u0111au IASP-III nh\u01b0 sau:<br \/>\n13. C\u00e1c t\u1ed5n th\u01b0\u01a1ng g\u00e2y \u0111au c\u1ee7a c\u00e1c d\u00e2y th\u1ea7n kinh s\u1ecd v\u00e0 c\u00e1c \u0111au m\u1eb7t kh\u00e1c<br \/>\n13.1 \u0110au do t\u1ed5n th\u01b0\u01a1ng ho\u1eb7c b\u1ec7nh c\u1ee7a d\u00e2y th\u1ea7n kinh tam thoa<br \/>\n13.1.1 \u0110au d\u00e2y th\u1ea7n kinh tam thoa<br \/>\n13.1.1.1 \u0110au d\u00e2y th\u1ea7n kinh tam thoa c\u1ed5 \u0111i\u1ec3n<br \/>\n13.1.1.1.1 \u0110au d\u00e2y th\u1ea7n kinh tam thoa c\u1ed5 \u0111i\u1ec3n, ho\u00e0n to\u00e0n k\u1ecbch ph\u00e1t<br \/>\n13.1.1.1.2 \u0110au d\u00e2y th\u1ea7n kinh tam thoa c\u1ed5 \u0111i\u1ec3n v\u1edbi c\u00e1c c\u01a1n \u0111au li\u00ean t\u1ee5c \u0111\u1ed3ng th\u1eddi<br \/>\n13.1.1.2 \u0110au d\u00e2y th\u1ea7n kinh tam thoa th\u1ee9 ph\u00e1t<br \/>\n13.1.1.2.1 \u0110au d\u00e2y th\u1ea7n kinh tam thoa do b\u1ec7nh \u0111a x\u01a1 c\u1ee9ng<br \/>\n13.1.1.2.2 \u0110au d\u00e2y th\u1ea7n kinh tam thoa do t\u1ed5n th\u01b0\u01a1ng chi\u1ebfm ch\u1ed7<br \/>\n13.1.1.2.3 \u0110au d\u00e2y th\u1ea7n kinh tam thoa do nguy\u00ean nh\u00e2n kh\u00e1c<br \/>\n13.1.1.3 \u0110au d\u00e2y th\u1ea7n kinh tam thoa v\u00f4 c\u0103n<br \/>\n13.1.1.3.1 \u0110au d\u00e2y th\u1ea7n kinh tam thoa v\u00f4 c\u0103n, ho\u00e0n to\u00e0n k\u1ecbch ph\u00e1t<br \/>\n13.1.1.3.2 \u0110au d\u00e2y th\u1ea7n kinh tam thoa v\u00f4 c\u0103n v\u1edbi c\u00e1c c\u01a1n \u0111au li\u00ean t\u1ee5c \u0111\u1ed3ng th\u1eddi<br \/>\n13.1.2 B\u1ec7nh th\u1ea7n kinh tam thoa \u0111au<br \/>\n13.1.2.1 B\u1ec7nh th\u1ea7n kinh tam thoa do herpes zoster g\u00e2y \u0111au<br \/>\n13.1.2.2 \u0110au d\u00e2y th\u1ea7n kinh tam thoa sau herpet<br \/>\n13.1.2.3 B\u1ec7nh th\u1ea7n kinh tam thoa sau ch\u1ea5n th\u01b0\u01a1ng<br \/>\n13.1.2.4 B\u1ec7nh th\u1ea7n kinh tam thoa \u0111au do r\u1ed1i lo\u1ea1n kh\u00e1c<br \/>\n13.1.2.5 B\u1ec7nh th\u1ea7n kinh tam thoa v\u00f4 c\u0103n g\u00e2y \u0111au [9].<br \/>\nB\u1ec7nh th\u1ea7n kinh do herpes zoster virus g\u00e2y \u0111au \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i, m\u00e3 h\u00f3a v\u00e0 ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n nh\u01b0 sau:<br \/>\n13.1.2.1 B\u1ec7nh th\u1ea7n kinh do herpes zoster g\u00e2y \u0111au<br \/>\nM\u00f4 t\u1ea3:<br \/>\n\u0110au m\u1ed9t b\u00ean m\u1eb7t trong th\u1eddi gian d\u01b0\u1edbi 3 th\u00e1ng \u1edf v\u00f9ng ph\u00e2n b\u1ed1 c\u1ee7a m\u1ed9t ho\u1eb7c nhi\u1ec1u nh\u00e1nh c\u1ee7a d\u00e2y th\u1ea7n kinh tam thoa v\u00e0 k\u1ebft h\u1ee3p v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0\/ ho\u1eb7c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng kh\u00e1c c\u1ee7a b\u1ec7nh herpes zoster c\u1ea5p t\u00ednh.<br \/>\nTi\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n:<br \/>\nA. \u0110au m\u1ed9t b\u00ean m\u1eb7t \u1edf v\u00f9ng ph\u00e2n b\u1ed1 c\u1ee7a m\u1ed9t ho\u1eb7c c\u00e1c nh\u00e1nh d\u00e2y th\u1ea7n kinh tam thoa, k\u00e9o d\u00e0i &lt;3 th\u00e1ng<br \/>\nB. C\u00f3 m\u1ed9t ho\u1eb7c nhi\u1ec1u ti\u00eau ch\u00ed sau \u0111\u00e2y:<br \/>\n1. \u0110\u00e3 x\u1ea3y ra b\u00f9ng ph\u00e1t n\u1ed1t ph\u1ecfng herpet trong v\u00f9ng ph\u00e2n b\u1ed1 c\u1ee7a ch\u00ednh nh\u00e1nh th\u1ea7n kinh tam thoa \u0111\u00f3.<br \/>\n2. Virus varicella zoster (VZV) \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n trong d\u1ecbch n\u00e3o t\u1ee7y b\u1eb1ng ph\u1ea3n \u1ee9ng chu\u1ed7i polymerase (PCR).<br \/>\n3. X\u00e9t nghi\u1ec7m mi\u1ec5n d\u1ecbch hu\u1ef3nh quang tr\u1ef1c ti\u1ebfp \u0111\u1ed1i v\u1edbi kh\u00e1ng nguy\u00ean VZV ho\u1eb7c x\u00e9t nghi\u1ec7m PCR \u0111\u1ed1i v\u1edbi VZV DNA d\u01b0\u01a1ng t\u00ednh trong c\u00e1c t\u1ebf b\u00e0o thu \u0111\u01b0\u1ee3c t\u1eeb n\u1ec1n c\u1ee7a t\u1ed5n th\u01b0\u01a1ng.<br \/>\nC. Kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c h\u1ee3p l\u00fd h\u01a1n b\u1edfi m\u1ed9t ch\u1ea9n \u0111o\u00e1n ICHD-3 kh\u00e1c.<br \/>\nB\u00e0n lu\u1eadn:<br \/>\nHerpes zoster \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn h\u1ea1ch tam thoa trong 10-15% tr\u01b0\u1eddng h\u1ee3p, 80% s\u1ed1 b\u1ec7nh nh\u00e2n b\u1ecb nh\u00e1nh m\u1eaft \u0111\u01a1n \u0111\u1ed9c. Hi\u1ebfm khi \u0111au kh\u00f4ng k\u00e8m theo ph\u00e1t ban ho\u1eb7c n\u1ed1t ph\u00f2ng n\u01b0\u1edbc (zoster sine herpete). Ch\u1ea9n \u0111o\u00e1n trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p nh\u01b0 v\u1eady \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn b\u1eb1ng ph\u1ea3n \u1ee9ng chu\u1ed7i polymerase ph\u00e1t hi\u1ec7n DNA c\u1ee7a virus Varicella zoster trong d\u1ecbch n\u00e3o t\u1ee7y.<br \/>\n13.1.2.1 \u0110au d\u00e2y th\u1ea7n kinh tam thoa do herpes zoster g\u00e2y ra th\u01b0\u1eddng l\u00e0 b\u1ecfng r\u00e1t, \u0111\u00e2m\/ xuy\u00ean th\u1ea5u, ng\u1ee9a ran ho\u1eb7c \u0111au nh\u1ee9c, v\u00e0 k\u00e8m theo d\u1ecb c\u1ea3m \u0111au tr\u00ean da.<br \/>\nHerpes nh\u00e1nh m\u1eaft c\u00f3 th\u1ec3 \u0111i k\u00e8m theo li\u1ec7t d\u00e2y th\u1ea7n kinh s\u1ecd th\u1ee9 III, IV v\u00e0 \/ ho\u1eb7c VI.<br \/>\nHerpes zoster th\u01b0\u1eddng g\u1eb7p \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb suy gi\u1ea3m mi\u1ec5n d\u1ecbch, x\u1ea3y ra \u1edf kho\u1ea3ng 10% nh\u1eefng ng\u01b0\u1eddi b\u1ecb ung th\u01b0 h\u1ea1ch v\u00e0 25% nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh Hodgkin [9].<br \/>\n13.1.2.2 \u0110au d\u00e2y th\u1ea7n kinh tam thoa sau herpet<br \/>\nThu\u1eadt ng\u1eef \u0111\u00e3 s\u1eed d\u1ee5ng tr\u01b0\u1edbc \u0111\u00e2y: B\u1ec7nh th\u1ea7n kinh tam thoa sau herpet.<br \/>\nM\u00f4 t\u1ea3:<br \/>\n\u0110au m\u1ed9t b\u00ean m\u1eb7t dai d\u1eb3ng ho\u1eb7c t\u00e1i ph\u00e1t trong th\u1eddi gian \u00edt nh\u1ea5t 3 th\u00e1ng \u1edf v\u00f9ng ph\u00e2n b\u1ed1 c\u1ee7a m\u1ed9t ho\u1eb7c nhi\u1ec1u nh\u00e1nh d\u00e2y th\u1ea7n kinh tam thoa, v\u1edbi nh\u1eefng thay \u0111\u1ed5i c\u1ea3m gi\u00e1c kh\u00e1c nhau, do herpes zoster g\u00e2y ra.<br \/>\nTi\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n:<br \/>\nA. \u0110au m\u1ed9t b\u00ean m\u1eb7t \u1edf v\u00f9ng ph\u00e2n b\u1ed1 c\u1ee7a 1 ho\u1eb7c nhi\u1ec1u nh\u00e1nh d\u00e2y th\u1ea7n kinh tam thoa, dai d\u1eb3ng ho\u1eb7c t\u00e1i di\u1ec5n tr\u00ean 3 th\u00e1ng v\u00e0 \u0111\u00e1p \u1ee9ng ti\u00eau ch\u00ed C<br \/>\nB. Herpes zoster \u0111\u00e3 g\u00e2y t\u1ed5n th\u01b0\u01a1ng ch\u00ednh nh\u00e1nh ho\u1eb7c c\u00e1c nh\u00e1nh th\u1ea7n kinh tam thoa \u0111\u00f3.<br \/>\nC. \u0110au ph\u00e1t tri\u1ec3n theo th\u1eddi gian li\u00ean quan \u0111\u1ebfn nhi\u1ec5m tr\u00f9ng herpes zoster.<br \/>\nD. Kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c h\u1ee3p l\u00fd h\u01a1n b\u1edfi m\u1ed9t ch\u1ea9n \u0111o\u00e1n ICHD-3 kh\u00e1c.<br \/>\nGhi ch\u00fa:<br \/>\nTh\u00f4ng th\u01b0\u1eddng, c\u01a1n \u0111au s\u1ebd ph\u00e1t tri\u1ec3n trong khi ban ph\u1ecfng v\u1eabn c\u00f2n ho\u1ea1t \u0111\u1ed9ng, nh\u01b0ng \u0111\u00f4i khi k\u00e9o d\u00e0i t\u1edbi sau khi ban ph\u1ecfng \u0111\u00e3 l\u00e0nh. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p nh\u01b0 v\u1eady, c\u00e1c v\u1ebft s\u1eb9o nh\u1ee3t nh\u1ea1t ho\u1eb7c m\u00e0u t\u00edm nh\u1ea1t c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n nh\u01b0 l\u00e0 di ch\u1ee9ng c\u1ee7a qu\u00e1 tr\u00ecnh ph\u00e1t ban.<br \/>\nB\u00e0n lu\u1eadn:<br \/>\nM\u1eb7c d\u00f9 c\u00f3 c\u00e1i t\u00ean \u0111\u01b0\u1ee3c quen thu\u1ed9c t\u1eeb l\u00e2u, nh\u01b0ng \u0111au d\u00e2y th\u1ea7n kinh sau herpet th\u1ef1c s\u1ef1 l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u1ea7n kinh ho\u1eb7c b\u1ec7nh l\u00fd neuron th\u1ea7n kinh: nh\u1eefng thay \u0111\u1ed5i gi\u1ea3i ph\u1eabu b\u1ec7nh r\u00f5 r\u1ec7t \u0111\u00e3 \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y \u1edf d\u00e2y th\u1ea7n kinh, h\u1ea1ch v\u00e0 r\u1ec5 th\u1ea7n kinh. Trong 13.1.2.2 \u0110au d\u00e2y th\u1ea7n kinh tam thoa sau herpet, c\u0169ng c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 t\u00ecnh tr\u1ea1ng vi\u00eam lan r\u1ed9ng v\u00e0o ph\u1ee9c h\u1ee3p th\u00e2n n\u00e3o tam thoa.<br \/>\nSau herpes zoster c\u1ea5p t\u00ednh, \u0111au d\u00e2y th\u1ea7n kinh sau herpet d\u1ec5 x\u1ea3y ra h\u01a1n \u1edf ng\u01b0\u1eddi cao tu\u1ed5i.<br \/>\nNh\u00e1nh 1 c\u1ee7a d\u00e2y th\u1ea7n kinh tam thoa th\u01b0\u1eddng b\u1ecb \u1ea3nh h\u01b0\u1edfng nh\u1ea5t trong 13.1.2.2 \u0110au d\u00e2y th\u1ea7n kinh tam thoa sau herpet, nh\u01b0ng nh\u00e1nh th\u1ee9 hai v\u00e0 th\u1ee9 ba c\u0169ng c\u00f3 th\u1ec3 b\u1ecb b\u1ec7nh.<br \/>\nBi\u1ec3u hi\u1ec7n \u0111i\u1ec3n h\u00ecnh c\u1ee7a c\u01a1n \u0111au d\u00e2y th\u1ea7n kinh sau herpet l\u00e0 \u0111au r\u00e1t v\u00e0 ng\u1ee9a, sau n\u00e0y \u0111\u00f4i khi c\u1ea3m gi\u00e1c ng\u1ee9a r\u1ea5t n\u1ed5i b\u1eadt v\u00e0 g\u00e2y kh\u00f3 ch\u1ecbu c\u1ef1c k\u1ef3 cho b\u1ec7nh nh\u00e2n. Bi\u1ec3u hi\u1ec7n \u0111\u1eb7c tr\u01b0ng kh\u00e1c, nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb \u0111au th\u1ea7n kinh sau herpet th\u1ea5y thi\u1ebfu h\u1ee5t c\u1ea3m gi\u00e1c r\u00f5 r\u00e0ng v\u00e0 c\u00f3 lo\u1ea1n c\u1ea3m \u0111au (allodynia) do k\u00edch th\u00edch b\u1eb1ng b\u00e0n ch\u1ea3i trong v\u00f9ng ph\u00e2n b\u1ed1 c\u1ee7a nh\u00e1nh tam thoa li\u00ean quan. Tuy nhi\u00ean, nhi\u1ec1u b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n m\u1ea5t c\u1ea3m gi\u00e1c r\u1ea5t \u00edt, thay v\u00e0o \u0111\u00f3 h\u1ecd c\u00f3 ph\u1ea3n \u1ee9ng cao v\u1edbi c\u00e1c k\u00edch th\u00edch nhi\u1ec7t v\u00e0\/ ho\u1eb7c ch\u00e2m kim [9].<\/p>\n<h2><strong>3. Th\u00e1ch th\u1ee9c trong \u0111i\u1ec1u tr\u1ecb \u0111au d\u00e2y th\u1ea7n kinh tam thoa do herpes<\/strong><\/h2>\n<p>Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb \u0111au trong b\u1ec7nh d\u00e2y th\u1ea7n kinh tam thoa do herpes g\u1ed3m nhi\u1ec1u li\u1ec7u ph\u00e1p kh\u00e1c nhau:<br \/>\n\u2013 D\u1ef1 ph\u00f2ng b\u1ec7nh b\u1eb1ng v\u1eafc xin, ch\u1ed1ng vi\u00eam t\u1ed1t trong giai \u0111o\u1ea1n c\u1ea5p t\u00ednh.<br \/>\n\u2013 \u0110i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng virus [1].<br \/>\n\u2013 Corticoid ti\u00eam c\u1ea1nh s\u1ed1ng, ngo\u00e0i m\u00e0ng c\u1ee9ng, phong b\u1ebf d\u00e2y th\u1ea7n kinh, ti\u00eam t\u0129nh m\u1ea1ch ho\u1eb7c \u0111\u01b0\u1eddng u\u1ed1ng [1],[7],[8].<br \/>\n\u2013 C\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh [1], [7].<br \/>\n\u2013 Thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m 3 v\u00f2ng [1],[3],[7].<br \/>\n\u2013 C\u00e1c thu\u1ed1c gi\u1ea3m \u0111au th\u00f4ng th\u01b0\u1eddng, NSAID v\u00e0 opioid (t\u00f9y t\u1eebng m\u1ee9c \u0111\u1ed9 \u0111au) [1].<br \/>\n\u2013 Thu\u1ed1c g\u00e2y t\u00ea c\u1ee5c b\u1ed9 (mi\u1ebfng d\u00e1n lidocain\u2026) [3].<br \/>\nTuy c\u00e1c li\u1ec7u ph\u00e1p phong ph\u00fa, nh\u01b0ng ch\u1ec9 \u0111\u1ecbnh cho nh\u1eefng b\u1ec7nh nh\u00e2n c\u1ee5 th\u1ec3 nh\u01b0 th\u1ebf n\u00e0o, ch\u1ec9 \u0111\u1ecbnh cho t\u1eebng giai \u0111o\u1ea1n c\u1ee5 th\u1ec3 nh\u1eefng thu\u1ed1c n\u00e0o v\u00e0 k\u1ebft h\u1ee3p c\u00e1c thu\u1ed1c ra sao \u0111\u00f2i h\u1ecfi c\u00e1c b\u00e1c s\u0129 c\u00f3 nhi\u1ec1u kinh nghi\u1ec7m l\u00e2m s\u00e0ng v\u00e0 theo t\u1eebng c\u00e1 th\u1ec3.<br \/>\nCho t\u1edbi nay \u0111\u00e3 c\u00f3 nhi\u1ec1u nghi\u00ean c\u1ee9u v\u1ec1 \u0111i\u1ec1u tr\u1ecb ch\u1ee9ng \u0111au tr\u00ean, nh\u01b0ng k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb \u0111\u1ed1i v\u1edbi c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a \u0111au (c\u01b0\u1eddng \u0111\u1ed9, th\u1eddi gian, t\u00ednh ch\u1ea5t\u2026), kh\u1ea3 n\u0103ng c\u1ea3i thi\u1ec7n gi\u1ea5c ng\u1ee7, n\u00e2ng cao ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng\u2026 c\u1ee7a b\u1ec7nh nh\u00e2n v\u1eabn c\u1ea7n \u0111\u01b0\u1ee3c quan t\u00e2m h\u01a1n n\u1eefa. Ngo\u00e0i ra Francesca Pica v\u00e0 CS. (2014) c\u00f2n cho r\u1eb1ng Chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111au hi\u1ec7n nay c\u00f3 hi\u1ec7u qu\u1ea3 l\u00e0m gi\u1ea3m \u0111au nh\u1ea5t \u0111\u1ecbnh trong \u0111au sau herpet nh\u01b0ng c\u00f3 khi ch\u00fang l\u00e0 g\u00e1nh n\u1eb7ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5. [2],[4],[5],[6].<br \/>\nTuy li\u1ec7u ph\u00e1p phong b\u1ebf th\u1ea7n kinh b\u1eb1ng cortocosteroid cho th\u1ea5y nhi\u1ec1u tri\u1ec3n v\u1ecdng v\u1ec1 gi\u1ea3m \u0111au v\u00e0 gi\u1ea3m t\u1ef7 l\u1ec7 \u0111au sau herpet, c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng gi\u1ea5c ng\u1ee7 v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng \u1edf c\u00e1c b\u1ec7nh nh\u00e2n, nh\u01b0ng trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng, th\u1ee7 thu\u1eadt phong b\u1ebf th\u1ea7n kinh b\u1eb1ng c\u00e1c k\u1ef9 thu\u1eadt l\u00e2m s\u00e0ng kh\u00e1c nhau nh\u01b0 ti\u00eam h\u1ea1ch Gasser; ti\u00eam ngo\u00e0i m\u00e0ng c\u1ee9ng c\u1ed9t s\u1ed1ng c\u1ed5 \u2013 l\u01b0ng \u2013 th\u1eaft l\u01b0ng; phong b\u1ebf c\u1ea1nh s\u1ed1ng hay phong b\u1ebf d\u00e2y th\u1ea7n kinh l\u00e0 nh\u1eefng th\u1ee7 thu\u1eadt kh\u00f3; \u0111\u00f2i h\u1ecfi \u0111\u1ed9 ch\u00ednh x\u00e1c cao, nguy c\u01a1 tai bi\u1ebfn, bi\u1ebfn ch\u1ee9ng v\u00e0 m\u1ee9c \u0111\u1ed9 r\u1ee7i ro l\u1edbn, d\u1ec5 g\u1eb7p ph\u1ea3i c\u00e1c tai bi\u1ebfn, bi\u1ebfn ch\u1ee9ng n\u1eb7ng n\u1ec1 nguy hi\u1ec3m th\u1eadm ch\u00ed \u1ea3nh h\u01b0\u1edfng t\u1edbi t\u00ednh m\u1ea1ng b\u1ec7nh nh\u00e2n. B\u00e1c s\u0129 th\u1ef1c hi\u1ec7n th\u1ee7 thu\u1eadt ph\u1ea3i \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o t\u1ed1t v\u1ec1 k\u1ef9 thu\u1eadt, c\u00f3 \u00fd th\u1ee9c ph\u00f2ng ng\u1eeba tai bi\u1ebfn v\u00e0 bi\u1ebfn ch\u1ee9ng cao, v\u00e0 c\u00f3 kh\u1ea3 n\u0103ng ch\u1ee7 \u0111\u1ed9ng x\u1eed tr\u00ed \u0111\u01b0\u1ee3c c\u00e1c t\u00ecnh tr\u1ea1ng kh\u00f4ng mong mu\u1ed1n trong v\u00e0 sau th\u1ee7 thu\u1eadt.<\/p>\n<h2><strong>4. B\u00e0n lu\u1eadn v\u1ec1 tri\u1ec3n v\u1ecdng \u0111i\u1ec1u tr\u1ecb \u0111au th\u1ea7n kinh tam thoa do herpes<\/strong><\/h2>\n<p>C\u00e1c chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb kh\u00e1ng virus, ch\u1ed1ng tr\u1ea7m c\u1ea3m 3 v\u00f2ng, ch\u1ed1ng \u0111\u1ed9ng kinh, gi\u1ea3m \u0111au\u2026 th\u01b0\u1eddng kh\u00f4ng \u0111\u1ea1t \u0111\u01b0\u1ee3c k\u1ebft qu\u1ea3 \u1ea5n t\u01b0\u1ee3ng. M\u1ed9t s\u1ed1 t\u00e1c gi\u1ea3 \u0111\u00e3 v\u1eadn d\u1ee5ng phong b\u1ebf th\u1ea7n kinh nhi\u1ec1u l\u1ea7n b\u1eb1ng thu\u1ed1c cortocoid v\u00e0 thu\u1ed1c t\u00ea t\u1ea1i ch\u1ed7 v\u00e0 \u0111\u1ea1t k\u1ebft qu\u1ea3 t\u1ed1t, r\u1ea5t kh\u1ea3 quan trong hi\u1ec7u qu\u1ea3 gi\u1ea3m \u0111au v\u00e0 gi\u1ea3m t\u1ef7 l\u1ec7 \u0111au sau herpet.<br \/>\nLi\u1ec7u ph\u00e1p phong b\u1ebf th\u1ea7n kinh b\u1eb1ng corticoid trong \u0111i\u1ec1u tr\u1ecb \u0111au d\u00e2y th\u1ea7n kinh tam thoa do herpes<br \/>\nTheo khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb herpes zoster 2007 c\u1ee7a IASP (Robert H. v\u00e0 Cs.); phong b\u1ebf th\u1ea7n kinh giao c\u1ea3m v\u00e0 ti\u00eam ngo\u00e0i m\u00e0ng c\u1ee9ng \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u01a1n \u0111au d\u1eef d\u1ed9i \u1edf b\u1ec7nh nh\u00e2n herpes zoster trong nhi\u1ec1u n\u0103m, nh\u01b0ng \u00edt nghi\u00ean c\u1ee9u c\u00f3 \u0111\u1ed1i ch\u1ee9ng \u0111\u00e3 ki\u1ec3m tra t\u00e1c \u0111\u1ed9ng c\u1ee7a ch\u00fang \u0111\u1ed1i v\u1edbi c\u01a1n \u0111au c\u1ea5p t\u00ednh ho\u1eb7c \u0111au th\u1ea7n kinh sau herpet. Ti\u00eam nhi\u1ec1u l\u1ea7n thu\u1ed1c t\u00ea t\u1ea1i ch\u1ed7 v\u00e0 methylprednisolone ngo\u00e0i m\u00e0ng c\u1ee9ng l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 \u0111au sau zona nhi\u1ec1u h\u01a1n so v\u1edbi prednisolone ti\u00eam t\u0129nh m\u1ea1ch [1].<br \/>\nFang Liu v\u00e0 CS. (2021) nghi\u00ean c\u1ee9u \u0111i\u1ec1u tr\u1ecb 67 b\u1ec7nh nh\u00e2n \u0111au do zoster b\u1eb1ng phong b\u1ebf c\u1ea1nh s\u1ed1ng nhi\u1ec1u l\u1ea7n k\u1ebft h\u1ee3p thu\u1ed1c u\u1ed1ng \u1edf c\u00e1c giai \u0111o\u1ea1n kh\u00e1c nhau c\u1ee7a b\u1ec7nh \u0111\u00e3 k\u1ebft lu\u1eadn r\u1eb1ng hi\u1ec7u qu\u1ea3 c\u1ee7a li\u1ec7u ph\u00e1p kh\u00e1c nhau t\u00f9y theo giai \u0111o\u1ea1n b\u1ec7nh, th\u1eddi gian sau kh\u1edfi ph\u00e1t c\u00e0ng ng\u1eafn hi\u1ec7u qu\u1ea3 c\u00e0ng cao. C\u00e1c b\u1ec7nh nh\u00e2n \u1edf giai \u0111o\u1ea1n c\u1ea5p v\u00e0 b\u00e1n c\u1ea5p \u0111\u1ea1t hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb \u0111au v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng gi\u1ea5c ng\u1ee7 cao h\u01a1n c\u00e1c b\u1ec7nh nh\u00e2n m\u1ea1n t\u00ednh [4].<br \/>\nShuyue Zheng v\u00e0 CS. (2019) th\u1ef1c hi\u1ec7n 1 nghi\u00ean c\u1ee9u c\u00f3 \u0111\u1ed1i ch\u1ee9ng v\u1ec1 t\u00e1c d\u1ee5ng tr\u00ean \u0111au c\u1ea5p v\u00e0 kh\u1ea3 n\u0103ng d\u1ef1 ph\u00f2ng \u0111au sau herpet c\u1ee7a li\u1ec7u ph\u00e1p phong b\u1ebf r\u1ec5 th\u1ea7n kinh c\u1ed5 \u1edf 140 b\u1ec7nh nh\u00e2n chia th\u00e0nh 2 nh\u00f3m, k\u1ebft qu\u1ea3 cho th\u1ea5y gi\u1ea3m g\u00e1nh n\u1eb7ng b\u1ec7nh (burden of illness) \u1edf d\u1ea3i da v\u00f9ng c\u1ed5 v\u00e0 l\u00e0m gi\u1ea3m nh\u1eb9 t\u1ef7 l\u1ec7 \u0111au sau herpet [5].<br \/>\nP Zhao v\u00e0 L Mei phong b\u1ebf c\u1ea1nh s\u1ed1ng ng\u1ef1c b\u1eb1ng methylenum coeruleum v\u00e0 \u0111\u1ea1t k\u1ebft qu\u1ea3 l\u00e0nh c\u00e1c n\u1ed1t ph\u1ecfng tr\u00ean da t\u1ed1t, gi\u1ea3m \u0111au giai \u0111o\u1ea1n c\u1ea5p v\u00e0 gi\u1ea3m t\u1ef7 l\u1ec7 \u0111au sau herpet \u1edf c\u00e1c m\u1ed1c th\u1eddi gian 1; 3 ng\u00e0y, 1;2 tu\u1ea7n v\u00e0 1 th\u00e1ng sau \u0111i\u1ec1u tr\u1ecb. S\u1ef1 b\u1eb1ng l\u00f2ng c\u1ee7a b\u1ec7nh nh\u00e2n t\u0103ng r\u1ea5t r\u00f5 r\u1ec7t [6].<br \/>\nNguy\u1ec5n V\u0103n Ch\u01b0\u01a1ng v\u00e0 CS. (2021) \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb v\u00e0 th\u00f4ng b\u00e1o c\u00e1c ca b\u1ec7nh \u0111au sau herpet \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng li\u1ec7u ph\u00e1p costicoid t\u1ea1i ch\u1ed7 li\u1ec1u th\u1ea5p, th\u01b0\u1eddng xuy\u00ean k\u1ebft h\u1ee3p c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh v\u00e0 ch\u1ed1ng tr\u1ea7m c\u1ea3m 3 v\u00f2ng \u1edf c\u00e1c giai \u0111o\u1ea1n b\u1ec7nh c\u1ea5p t\u00ednh v\u00e0 m\u1ea1n t\u00ednh. K\u1ebft qu\u1ea3 \u0111\u1ea1t \u0111\u01b0\u1ee3c r\u1ea5t t\u1ed1t. 1 b\u1ec7nh nh\u00e2n h\u1ebft \u0111au \u0111\u00e3 \u0111\u01b0\u1ee3c 6 th\u00e1ng sau 1 l\u1ea7n ti\u00eam duy nh\u1ea5t. 1 b\u1ec7nh nh\u00e2n \u0111au nh\u00e1nh m\u1eaft d\u00e2y th\u1ea7n kinh tam thoa do herpet \u0111\u00e3 h\u1ebft \u0111au sau 23 ng\u00e0y \u0111i\u1ec1u tr\u1ecb v\u00e0 t\u1edbi nay \u0111\u01b0\u1ee3c 2 n\u0103m kh\u00f4ng c\u00f2n u\u1ed1ng thu\u1ed1c. \u0110\u1eb7c bi\u1ec7t g\u1ea7n \u0111\u00e2y b\u1ec7nh nh\u00e2n Nguy\u1ec5n Th\u1ecb P. 66 tu\u1ed5i Zona th\u1ea7n kinh D1-D4 b\u00ean tr\u00e1i \u0111\u00e3 h\u01a1n 1 n\u0103m; \u0111au li\u00ean t\u1ee5c su\u1ed1t ng\u00e0y \u0111\u00eam, VAS 8-9. B\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb \u1edf 2 b\u1ec7nh vi\u1ec7n lo\u1ea1i 1 tuy\u1ebfn trung \u01b0\u01a1ng, \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb \u00e1p \u0111\u00f4ng, chuy\u00ean gia n\u01b0\u1edbc ngo\u00e0i \u0111\u00e3 kh\u00e1m t\u01b0 v\u1ea5n v\u00e0 \u0111i\u1ec1u tr\u1ecb sau \u0111\u00f3 nh\u01b0ng kh\u00f4ng c\u00f3 k\u1ebft qu\u1ea3. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ti\u00eam ngo\u00e0i m\u00e0ng c\u1ee9ng ng\u1ef1c v\u00e0 phong b\u1ebf c\u1ea1nh s\u1ed1ng. Sau 2 \u0111\u1ee3t \u0111i\u1ec1u tr\u1ecb \u0111\u1ee1 80% (VAS c\u00f2n 1-2), ng\u1ee7 t\u1ed1t h\u01a1n, t\u00e2m tr\u1ea1ng b\u1ec7nh nh\u00e2n tho\u1ea3i m\u00e1i h\u01a1n r\u00f5 r\u1ec7t trong sinh ho\u1ea1t h\u00e0ng ng\u00e0y. K\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb \u0111\u00e3 duy tr\u00ec \u0111\u01b0\u1ee3c 8 th\u00e1ng.<br \/>\nC\u00e1c nghi\u00ean c\u1ee9u tr\u00ean cho th\u1ea5y, khuy\u1ebfn c\u00e1o ch\u1ec9 \u0111\u1ecbnh phong b\u1ebf th\u1ea7n kinh b\u1eb1ng corticoid nhi\u1ec1u l\u1ea7n \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb \u0111au trong c\u00e1c b\u1ec7nh th\u1ea7n kinh s\u1ecd n\u00e3o (nh\u1ea5t l\u00e0 d\u00e2y th\u1ea7n kinh tam thoa) v\u00e0 d\u00e2y th\u1ea7n kinh t\u1ee7y s\u1ed1ng do herpes zoster \u0111\u00e3 c\u00f3 t\u1eeb l\u00e2u [1] song song v\u1edbi c\u00e1c li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c v\u00e0 \u0111\u1ea1t \u0111\u01b0\u1ee3c k\u1ebft qu\u1ea3 t\u1ed1t h\u01a1n r\u1ea5t r\u00f5 r\u1ec7t so v\u1edbi nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng d\u00f9ng ho\u1eb7c d\u00f9ng corticoid \u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch. C\u01b0\u1eddng \u0111\u1ed9 \u0111au gi\u1ea3m r\u00f5 r\u1ec7t (th\u1eadm ch\u00ed c\u00f3 nh\u1eefng b\u1ec7nh nh\u00e2n h\u1ebft \u0111au ho\u00e0n to\u00e0n), hi\u1ec7u qu\u1ea3 t\u1ed1t nh\u1ea5t trong giai \u0111o\u1ea1n c\u1ea5p t\u00ednh v\u00e0 b\u00e1n c\u1ea5p, ng\u0103n ng\u1eeba v\u00e0 l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 \u0111au sau herpet, c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng gi\u1ea5c ng\u1ee7 [4],[5],[6],[7],[8]. C\u00e1c t\u00e1c gi\u1ea3 c\u0169ng cho th\u1ea5y m\u1ee9c \u0111\u1ed9 an to\u00e0n c\u1ee7a li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb v\u00e0 kh\u1ea3 n\u0103ng dung n\u1ea1p thu\u1ed1c t\u1ed1t.<br \/>\nM\u1ed9t \u0111i\u1ec1u \u0111\u00e1ng m\u1eebng l\u00e0 \u1edf Vi\u1ec7t Nam, c\u00e1c b\u00e1c s\u0129 c\u1ee7a c\u00e1c \u0111\u01a1n v\u1ecb ch\u1ed1ng \u0111au ho\u1eb7c ho\u1ea1t \u0111\u1ed9ng ch\u1ed1ng \u0111au t\u1ea1i nhi\u1ec1u b\u1ec7nh vi\u1ec7n tuy\u1ebfn t\u1ec9nh, ng\u00e0nh v\u00e0 tuy\u1ebfn huy\u1ec7n \u0111\u00e3 ti\u1ebfp c\u1eadn \u0111\u01b0\u1ee3c v\u1edbi m\u1ed9t s\u1ed1 k\u1ef9 thu\u1eadt phong b\u1ebf th\u1ea7n kinh ngo\u1ea1i vi; c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111i\u1ec1u tr\u1ecb \u0111au d\u00e2y th\u1ea7n kinh tam thoa n\u00f3i ri\u00eang v\u00e0 c\u00e1c d\u00e2y th\u1ea7n kinh s\u1ecd n\u00e3o, d\u00e2y th\u1ea7n kinh t\u1ee7y s\u1ed1ng n\u00f3i chung do herpes. H\u01a1n n\u1eefa v\u1edbi s\u1ef1 ph\u00e1t tri\u1ec3n m\u1ea1nh m\u1ebd c\u1ee7a chuy\u00ean ng\u00e0nh ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh c\u00e1c b\u00e1c s\u0129 l\u00e0m th\u1ee7 thu\u1eadt d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a si\u00eau \u00e2m, h\u00ecnh \u1ea3nh c\u1eaft l\u1edbp vi t\u00ednh\u2026 c\u00f3 th\u1ec3 \u0111\u1ea1t \u0111\u1ed9 ch\u00ednh x\u00e1c cao, gi\u1ea3m l\u01b0\u1ee3ng thu\u1ed1c c\u1ea7n thi\u1ebft cho th\u1ee7 thu\u1eadt. Kh\u1ea3 n\u0103ng th\u00e0nh c\u00f4ng c\u1ee7a th\u1ee7 thu\u1eadt \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n r\u00f5 r\u1ec7t.<\/p>\n<h2><strong>5. Khuy\u1ebfn c\u00e1o<\/strong><\/h2>\n<p>C\u1ea7n c\u00f3 nh\u1eefng nghi\u00ean c\u1ee9u c\u00f3 \u0111\u1ed1i ch\u1ee9ng v\u1edbi c\u1ee1 m\u1eabu l\u1edbn v\u1ec1 t\u00e1c d\u1ee5ng \u0111i\u1ec1u tr\u1ecb \u0111au d\u00e2y th\u1ea7n kinh tam thoa do herpes zoster v\u00e0 zona th\u1ea7n kinh kh\u00e1c c\u1ee7a th\u1ee7 thu\u1eadt phong b\u1ebf th\u1ea7n kinh.<br \/>\nC\u00e1c k\u1ef9 thu\u1eadt phong b\u1ebf th\u1ea7n kinh c\u1ea7n c\u00f3 ch\u1ee7 tr\u01b0\u01a1ng, ch\u00ednh s\u00e1ch nh\u00e2n r\u1ed9ng ph\u00f9 h\u1ee3p v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh nhi\u1ec1u h\u01a1n trong \u0111i\u1ec1u tr\u1ecb \u0111au d\u00e2y th\u1ea7n kinh tam thoa do herpes zoster v\u00e0 \u0111au trong zona th\u1ea7n kinh kh\u00e1c.<\/p>\n<h2>T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/h2>\n<p>1. Robert H. Dworkin, Robert W. Johnson, Judith Breuer, John W. Gnann, Myron J. Levin, Miroslav Backonja, Robert F. Betts, Anne A. Gershon, Maija L. Haanp\u00e4\u00e4, Michael W. McKendrick (2007); Recommendations for the Management of Herpes Zoster; Clinical Infectious Diseases, Volume 44, Issue Supplement_1, January 2007, Pages S1-S26, https:\/\/ doi.org\/10.1086\/510206.<br \/>\n2. Francesca Pica, Antonio Gatti, Marco Divizia, Marzia Lazzari, Marco Ciotti, Alessandro Fabrizio Sabato, and Antonio Volpi (2014); One-year follow-up of patients with long-lasting post-herpetic neuralgia; BMC Infect Dis. 2014; 14: 556. Published online 2014 Nov 1. doi: 10.1186\/s12879-014-0556-6.<br \/>\n3. Florentin Cl\u00e8re 1, Claire Delorme-Morin, Brigitte George, Malou Navez, Bruno Rioult, Florence Tiberghien-Chatelain, Herv\u00e9 Ganry (2011); 5% lidocaine medicated plaster in elderly patients with postherpetic neuralgia: results of a compassionate use programme in France PubMed. 2011 Sep 1;28(9):693-702. doi: 10.2165\/11595600-000000000-00000.<br \/>\n4. Fang Liu, Gui-Jun Lu, Zhi-Yong Bai (2021); Efficacy of repetitive paravertebral block combined with medication in the treatment of zoster-related pain with different courses; Neurosciences (Riyadh).2021 Apr;26(2):192-198. doi: 10.17712\/nsj.2021.2.20200124.<br \/>\n5. Shuyue Zheng, Xiuhua Li, Xiaohui Yang, Liangliang He, Yanyan Xue, Zhanmin Yang (2019); Ultrasound-Guided Cervical Nerve Root Block for the Treatment of Acute Cervical Herpes Zoster: A Randomized Controlled Clinical Study; Pain Pract. 2019 Jun;19(5):500-509. doi: 10.1111\/papr.12770.<br \/>\n6. P Zhao, L Mei (2019); A clinical study of paraspinal nerve block on treatment of herpes zoster under ultrasonic guidance; Neurochirurgie; 2019 Dec;65(6):382-386.doi: 10.1016\/j.neuchi.2019.06.007.<br \/>\n7. Nguy\u1ec5n V\u0103n Ch\u01b0\u01a1ng; Nguy\u1ec5n Th\u00f9y Linh, Nguy\u1ec5n Vi\u1ec7t Trung (2020), \u0110au d\u00e2y V do zona: B\u00e0i h\u1ecdc t\u1eeb ca b\u1ec7nh \u0111i\u1ec1u tr\u1ecb th\u00e0nh c\u00f4ng; Th\u1ea7n kinh h\u1ecdc Vi\u1ec7t Nam 29-2020; 17-21.<br \/>\n8. Nguy\u1ec5n V\u0103n Ch\u01b0\u01a1ng; Nguy\u1ec5n Th\u00f9y Linh, Nguy\u1ec5n Vi\u1ec7t Trung (2021), \u0110au do zona \u0111i\u1ec1u tr\u1ecb th\u00e0nh c\u00f4ng b\u1eb1ng phong b\u1ebf corticoid: ch\u00f9m ca b\u1ec7nh; Th\u1ea7n kinh h\u1ecdc Vi\u1ec7t Nam 9\/2021; 69-74.<br \/>\n9. International headache society (2018), The International Classification of Headache Disorders 3rd edition On behalf of the Classification Committee of The International; https:\/\/ichd-3.org\/.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Zona d\u00e2y th\u1ea7n kinh tam thoa l\u00e0 b\u1ec7nh nhi\u1ec5m tr\u00f9ng th\u1ea7n kinh do herpes zoster virus g\u00e2y ra, trong \u0111\u00f3 \u0111au, ng\u1ee9a l\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n s\u1edbm, t\u1ed3n t\u1ea1i l\u00e2u nhi\u1ec1u khi dai d\u1eb3ng v\u00e0 r\u1ea5t kh\u00f3 tr\u1ecb. \u0110au sau herpet \u0111\u00e3 tr\u1edf th\u00e0nh n\u1ed7i lo l\u1eafng, phi\u1ec1n mu\u1ed9n c\u1ee7a nhi\u1ec1u b\u1ec7nh [&hellip;]<\/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":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - 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