{"id":32732,"date":"2023-05-13T18:34:27","date_gmt":"2023-05-13T11:34:27","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=32732"},"modified":"2023-05-13T18:34:27","modified_gmt":"2023-05-13T11:34:27","slug":"chan-doan-va-dieu-tri-guillain-barre","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/13\/chan-doan-va-dieu-tri-guillain-barre\/","title":{"rendered":"H\u1ed9i ch\u1ee9ng Guillain &#8211; Barr\u00e9: Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"<p><b>H\u1ed9i ch\u1ee9ng Guillain &#8211; Barre l\u00e0 m\u1ed9t r\u1ed1i lo\u1ea1n hi\u1ebfm g\u1eb7p, ti\u1ebfn tri\u1ec3n r\u1ea5t nhanh ch\u00f3ng, c\u00f3 th\u1ec3 \u0111\u1ec3 l\u1ea1i nh\u1eefng h\u1eadu qu\u1ea3 nghi\u00eam tr\u1ecdng cho b\u1ec7nh nh\u00e2n. \u0110a s\u1ed1 b\u1ec7nh nh\u00e2n s\u1ebd h\u1ed3i ph\u1ee5c sau khi m\u1eafc h\u1ed9i ch\u1ee9ng Guillain &#8211; Barre, tuy nhi\u00ean m\u1ed9t s\u1ed1 ng\u01b0\u1eddi s\u1ebd b\u1ecb di ch\u1ee9ng, ch\u1eb3ng h\u1ea1n nh\u01b0 y\u1ebfu c\u01a1, t\u00ea b\u00ec, m\u1ec7t m\u1ecfi. Qua b\u00e0i vi\u1ebft n\u00e0y ch\u00fang ta h\u00e3y c\u00f9ng t\u00ecm hi\u1ec3u ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u1ee7a b\u1ec7nh l\u00fd n\u00e0y.<\/b><\/p>\n<h2>1. \u0110\u1ea1i c\u01b0\u01a1ng<\/h2>\n<ul>\n<li><span class=\"Y2IQFc\" lang=\"vi\">H\u1ed9i ch\u1ee9ng Guillain-Barr\u00e9 (GBS) l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t g\u00e2y li\u1ec7t m\u1ec1m\u00a0 th\u1ea7n kinh c\u01a1, c\u1ea5p t\u00ednh. H\u1ed9i ch\u1ee9ng Guillain-Barr\u00e9 l\u1ea7n \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn c\u00e1ch \u0111\u00e2y h\u01a1n m\u1ed9t th\u1ebf k\u1ef7. <\/span><\/li>\n<li><span class=\"Y2IQFc\" lang=\"vi\">Nh\u1eefng ti\u1ebfn b\u1ed9 trong th\u1ebf k\u1ef7 qua bao g\u1ed3m nghi\u00ean c\u1ee9u sinh l\u00fd b\u1ec7nh qua trung gian mi\u1ec5n d\u1ecbch c\u1ee7a b\u1ec7nh, nh\u1eadn bi\u1ebft bi\u1ec3u hi\u1ec7n, n\u00e2ng cao ph\u01b0\u01a1ng th\u1ee9c ch\u1ea9n \u0111o\u00e1n, m\u00f4 h\u00ecnh ti\u00ean l\u01b0\u1ee3ng v\u00e0 th\u1ef1c hi\u1ec7n c\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean v\u1ec1 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 c\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3.\u00a0<\/span><\/li>\n<\/ul>\n<h2>2. C\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a h\u1ed9i ch\u1ee9ng Gullain &#8211; Barr\u00e9<\/h2>\n<ul>\n<li><span class=\"Y2IQFc\" lang=\"vi\">H\u1ed9i ch\u1ee9ng Guillain-Barr\u00e9 (GBS) v\u00e0 c\u00e1c bi\u1ebfn th\u1ec3 c\u1ee7a n\u00f3 \u0111\u01b0\u1ee3c coi l\u00e0 b\u1ec7nh th\u1ea7n kinh qua trung gian mi\u1ec5n d\u1ecbch x\u1ea3y ra sau nhi\u1ec5m tr\u00f9ng. Trong nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u00eau h\u00f3a do Campylobacter jejuni, m\u1ed9t lipooligosacarit c\u00f3 trong m\u00e0ng ngo\u00e0i c\u1ee7a vi khu\u1ea9n t\u01b0\u01a1ng t\u1ef1 nh\u01b0 ganglioside l\u00e0 th\u00e0nh ph\u1ea7n c\u1ee7a c\u00e1c d\u00e2y th\u1ea7n kinh ngo\u1ea1i bi\u00ean. Do \u0111\u00f3, m\u1ed9t ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch \u0111\u01b0\u1ee3c k\u00edch ho\u1ea1t \u0111\u1ec3 ch\u1ed1ng nhi\u1ec5m tr\u00f9ng c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn ph\u1ea3n \u1ee9ng ch\u00e9o tr\u00ean d\u00e2y th\u1ea7n kinh c\u1ee7a v\u1eadt ch\u1ee7<\/span><\/li>\n<li>Nhi\u1ec1u b\u1ec7nh nhi\u1ec5m tr\u00f9ng c\u00f3 li\u00ean quan v\u1edbi GBS. Ph\u1ed5 bi\u1ebfn nh\u1ea5t l\u00e0 c\u00e1c b\u1ec7nh v\u1ec1 \u0111\u01b0\u1eddng ti\u00eau h\u00f3a ho\u1eb7c h\u00f4 h\u1ea5p. C\u00f3 t\u1edbi 70% b\u1ec7nh nh\u00e2n \u0111\u00e3 b\u00e1o c\u00e1o c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh trong v\u00f2ng 1 \u0111\u1ebfn 6 tu\u1ea7n tr\u01b0\u1edbc khi xu\u1ea5t hi\u1ec7n GBS. Trong \u0111\u1ee3t b\u00f9ng ph\u00e1t vi r\u00fat Zika, nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p GBS \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n. C\u00e1c b\u00e1o c\u00e1o ca b\u1ec7nh n\u00eau l\u00ean nhi\u1ec1u nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 kh\u00e1c li\u00ean quan \u0111\u1ebfn GBS, bao g\u1ed3m c\u1ea3 thu\u1ed1c men v\u00e0 ph\u1eabu thu\u1eadt.<\/li>\n<\/ul>\n<h2>3. Tri\u1ec7u ch\u1ee9ng c\u1ee7a h\u1ed9i ch\u1ee9ng Guillain &#8211; Barr\u00e9<\/h2>\n<p><strong>3.1. L\u00e2m s\u00e0ng<\/strong><\/p>\n<p>&#8211; Kho\u1ea3ng 1-3 tu\u1ea7n tr\u01b0\u1edbc khi kh\u1edfi ph\u00e1t co\u0301 th\u00ea\u0309 co\u0301 bi\u00ea\u0309u hi\u00ea\u0323n cu\u0309a nhi\u00ea\u0303m vi r\u00fat nh\u01b0 h\u0103\u0301t h\u01a1i, s\u00f4\u0309 m\u0169i, ch\u1ea3y n\u01b0\u1edbc m\u1eaft, \u0111au ho\u0323ng, \u0111au mo\u0309i b\u0103\u0301p c\u01a1.<\/p>\n<p><em>a) Giai \u0111oa\u0323n kh\u01a1\u0309i pha\u0301t:<\/em><\/p>\n<p>&#8211; R\u00f4\u0301i loa\u0323n ca\u0309m gia\u0301c nh\u01b0 ki\u00ea\u0301n bo\u0300 \u01a1\u0309 ngo\u0323n chi hay quanh m\u00f4i.<\/p>\n<p>&#8211; \u0110au mo\u0309i nhi\u00ea\u0300u n\u01a1i t\u0103ng d\u1ea7n.<\/p>\n<p><em>b) Giai \u0111oa\u0323n toa\u0300n pha\u0301t:<\/em><\/p>\n<p>&#8211; Y\u1ebfu c\u01a1 th\u01b0\u1eddng b\u1eaft \u0111\u1ea7u \u1edf ch\u00e2n, c\u00f3 th\u1ec3 b\u1eaft \u0111\u1ea7u \u1edf c\u00e1nh tay ho\u1eb7c c\u01a1 v\u00f9ng m\u1eb7t. C\u00f3 d\u1ecb c\u1ea3m \u1edf tay v\u00e0 ch\u00e2n b\u1ecb y\u1ebfu c\u01a1.<\/p>\n<p>&#8211; Y\u1ebfu c\u01a1 m\u1eb7t, li\u1ec7t c\u01a1 h\u1ea7u h\u1ecdng. Y\u1ebfu c\u01a1 v\u1eadn nh\u00e3n.<\/p>\n<p>&#8211; Y\u1ebfu c\u01a1 h\u00f4 h\u1ea5p c\u1ea7n ph\u1ea3i th\u1edf m\u00e1y h\u1ed7 tr\u1ee3.<\/p>\n<p>&#8211; R\u1ed1i lo\u1ea1n th\u1ea7n kinh t\u1ef1 \u0111\u1ed9ng: nh\u1ecbp tim nhanh (hay g\u1eb7p nh\u1ea5t), ho\u1eb7c nh\u1ecbp ch\u1eadm, b\u00ed ti\u1ec3u, huy\u1ebft \u00e1p thay \u0111\u1ed5i, t\u1eafc ru\u1ed9t, ra nhi\u1ec1u m\u1ed3 h\u00f4i.<\/p>\n<p>&#8211; C\u00f3 90% b\u1ec7nh ti\u1ebfn tri\u1ec3n trong 2-4 tu\u1ea7n t\u1eeb khi xu\u1ea5t hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng ban \u0111\u1ea7u.<\/p>\n<p><strong>3.2. C\u1eadn l\u00e2m s\u00e0ng<\/strong><\/p>\n<p><em>a) D\u1ecbch n\u00e3o t\u1ee7y:<\/em><\/p>\n<p>+ C\u00f3 s\u1ef1 ph\u00e2n ly \u0111\u1ea1m- t\u1ebf b\u00e0o: protein &gt; 0,5g\/l\u00edt, t\u1ebf b\u00e0o &lt; 10\/mm<sup>3<\/sup>.<\/p>\n<p>+ C\u00f3 80 &#8211; 90% ng\u01b0\u1eddi b\u1ec7nh t\u0103ng protein d\u1ecbch n\u00e3o t\u1ee7y trong tu\u1ea7n \u0111\u1ea7u c\u1ee7a b\u1ec7nh.<\/p>\n<p><em>b) \u0110i\u1ec7n c\u01a1 v\u00e0 d\u1eabn truy\u1ec1n th\u1ea7n kinh:<\/em><\/p>\n<p>T\u1ed5n th\u01b0\u01a1ng Myelin: k\u00e9o d\u00e0i th\u1eddi gian ti\u1ec1m t\u00e0ng ng\u1ecdn chi v\u00e0 s\u00f3ng F, gi\u1ea3m t\u1ed1c \u0111\u00f4\u0323 d\u00e2\u0303n truy\u00ea\u0300n cu\u0309a ca\u0301c d\u00e2y th\u1ea7n kinh, ngh\u1ebdn d\u1eabn truy\u1ec1n do m\u1ea5t Myelin t\u1eebng \u0111 o\u1ea1n.<\/p>\n<p>&#8211; T\u1ed5n th\u01b0\u01a1ng s\u1ee3i tr\u1ee5c: s\u00f3ng F c\u00f3 th\u1ec3 m\u1ea5t, \u0111\u00e1p \u1ee9ng v\u1eadn \u0111\u1ed9ng v\u00e0 c\u1ea3m gi\u00e1c gi\u1ea3m ho\u1eb7c m\u1ea5t.<\/p>\n<p><em>c). C\u00e1c x\u00e9t nghi\u1ec7m v\u1ec1 mi\u1ec5n d\u1ecbch<\/em>: kh\u00e1ng th\u1ec3 Glycolipid nh\u01b0: GQ1b. GM1, GD1a, GalNac-GD1a, GD1b . GT1a. GD1b \u2026<\/p>\n<figure id=\"attachment_32736\" aria-describedby=\"caption-attachment-32736\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-medium wp-image-32736\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Hoi-chung-Guillain-Barre-300x170.png\" alt=\"hoi-chung-Guillain-Barre\" width=\"300\" height=\"170\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Hoi-chung-Guillain-Barre-300x170.png 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Hoi-chung-Guillain-Barre-768x436.png 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Hoi-chung-Guillain-Barre.png 900w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-32736\" class=\"wp-caption-text\">H\u1ed9i ch\u1ee9ng Guillain &#8211; Barr\u00e9<\/figcaption><\/figure>\n<h2>4. Ch\u1ea9n \u0111o\u00e1n H\u1ed9i ch\u1ee9ng Guillain &#8211; Barr\u00e9<\/h2>\n<p><strong>4.1. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/strong>: (Theo ti\u00eau chu\u1ea9n c\u1ee7a Ashbury v\u00e0 comblath n\u0103m 1990)<\/p>\n<p><em>a) L\u00e2m s\u00e0ng:<\/em><\/p>\n<p>&#8211; C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u1ea7n ngh\u0129 \u0111\u1ebfn h\u1ed9i ch\u1ee9ng Guilain-Barr\u00e9.<\/p>\n<p>+ C\u00f3 s\u1ef1 y\u1ebfu c\u01a1 ti\u1ebfn tri\u1ec3n d\u1ea7n d\u1ea7n c\u1ee7a c\u1ea3 ch\u00e2n v\u00e0 tay.<\/p>\n<p>+ C\u00f3 gi\u1ea3m ho\u1eb7c m\u1ea5t ph\u1ea3n x\u1ea1.<\/p>\n<p>&#8211; C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng c\u1ee7ng c\u1ed1 th\u00eam cho ch\u1ea9n \u0111o\u00e1n:<\/p>\n<p>+ Ti\u1ebfn tri\u1ec3n nhi\u1ec1u ng\u00e0y \u0111\u1ebfn 4 tu\u1ea7n.<\/p>\n<p>+ C\u00f3 t\u00ednh ch\u1ea5t \u0111\u1ed1i x\u1ee9ng c\u1ee7a c\u00e1c d\u1ea5u hi\u1ec7u.<\/p>\n<p>+ C\u00e1c tri\u1ec7u ch\u1ee9ng hay d\u1ea5u hi\u1ec7u c\u1ea3m gi\u00e1c th\u01b0\u1eddng l\u00e0 nh\u1eb9.<\/p>\n<p>+ T\u1ed5n th\u01b0\u01a1ng d\u00e2y th\u1ea7n kinh s\u1ecd (t\u00ednh ch\u1ea5t hai b\u00ean).<\/p>\n<p>+ B\u1eaft \u0111\u1ea7u ph\u1ee5c h\u1ed3i sau 2-4 tu\u1ea7n sau khi ng\u1eebng ti\u1ebfn tri\u1ec3n.<\/p>\n<p>+ R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea7n kinh t\u1ef1 \u0111\u1ed9ng.<\/p>\n<p>+ Kh\u00f4ng c\u00f3 s\u1ed1t l\u00fac kh\u1edfi b\u1ec7nh.<\/p>\n<p><em>b) C\u1eadn l\u00e2m s\u00e0ng:<\/em><\/p>\n<p>&#8211; D\u1ecbch n\u00e3o t\u1ee7y: Protein t\u0103ng, t\u1ebf b\u00e0o &lt;10\/mm<sup>3<\/sup><\/p>\n<p>&#8211; \u0110i\u1ec7n c\u01a1: d\u1eabn truy\u1ec1n th\u1ea7n kinh ch\u1eadm ho\u1eb7c m\u1ea5t, t\u1ed5n th\u01b0\u01a1ng myelin v\u00e0\/ho\u1eb7c s\u1ee3i tr\u1ee5c<\/p>\n<p><em>c) C\u00e1c d\u1ea5u hi\u1ec7u n\u1eb7ng:<\/em><\/p>\n<p>&#8211; Li\u1ec7t t\u1ee9 chi c\u00f3 k\u00e8m theo li\u1ec7t h\u1ea7u h\u1ecdng: nu\u1ed1t ngh\u1eb9n, s\u1eb7c.<\/p>\n<p>&#8211; C\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea7n kinh t\u1ef1 \u0111\u1ed9ng.<\/p>\n<p>&#8211; C\u00f3 t\u00ecnh tr\u1ea1ng suy h\u00f4 h\u1ea5p:<\/p>\n<p>+ Li\u1ec7t c\u01a1 h\u00f4 h\u1ea5p: th\u1edf nhanh ho\u1eb7c ch\u1eadm ( &gt; 30 ho\u1eb7c &lt; 10 l\u1ea7n\/ph\u00fat), n\u00f4ng.<\/p>\n<p>+ T\u00edm m\u00f4i, \u0111\u1ea7u chi: t\u0103ng PaCO<sub>2<\/sub>, gi\u1ea3m PaO<sub>2<\/sub>.<\/p>\n<p>+ Xquang ph\u1ed5i: h\u00ecnh \u1ea3nh vi\u00eam ph\u1ed5i do s\u1eb7c, x\u1eb9p ph\u1ed5i.<\/p>\n<p><strong>4.2. Ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n<\/strong><\/p>\n<p>&#8211; Th\u01b0\u01a1\u0300ng g\u0103\u0323p nh\u00e2\u0301t la\u0300\u00a0 <em>Campylobacter jeuni. <\/em>\u00a0T\u00ecm vi khu\u00e2\u0309n na\u0300y trong d\u1ecbch da\u0323 da\u0300y.<\/p>\n<p>&#8211; C\u00e1c nguy\u00ean nh\u00e2n \u00edt g\u1eb7p:\u00a0<em>Cytomegalovirus<\/em>,\u00a0<em>Epstein-barr virus<\/em>\u00a0v\u00e0\u00a0<em>Mycoplasma<\/em>\u00a0<em>pneumoniae<\/em>.<\/p>\n<p>&#8211; Ho\u1eb7c ng\u01b0\u1eddi b\u1ec7nh tr\u01b0\u1edbc \u0111\u00f3 c\u00f3 s\u1eedd\u1ee5ng m\u1ed9t s\u1ed1vacxin.<\/p>\n<p><strong>4.3. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/strong><\/p>\n<p>&#8211; C\u00e1c b\u1ec7nh c\u1ee7a kh\u1edbp th\u1ea7n kinh-c\u01a1.<\/p>\n<p>&#8211; Vi\u00eam m\u1ea1ch th\u1ea7n kinh ngo\u1ea1i vi<\/p>\n<p>&#8211; H\u1ed9i ch\u1ee9ng Miller-Fisher: c\u01a1n \u0111\u1ed9t qu\u1ef5 n\u00e3o, b\u1ec7nh n\u00e3o Wernicke v\u00e0 vi\u00eam n\u00e3o v\u00f9ng th\u00e2n n\u00e3o, nh\u01b0ng th\u01b0\u1eddng c\u00f3 thay \u0111\u1ed5i \u00fd th\u1ee9c.<\/p>\n<p>&#8211; B\u1ec7nh l\u00fd t\u1ee7y s\u1ed1ng c\u1ea5p: l\u00fan c\u1ed9t s\u1ed1ng, vi\u00eam t\u1ee7y c\u1eaft ngang c\u1ea5p t\u00ednh.<\/p>\n<p>&#8211; B\u1ec7nh vi\u00eam \u0111a c\u01a1, b\u1ec7nh l\u00fd c\u01a1 n\u1eb7ng, b\u1ec7nh l\u00fd th\u1ea7n kinh n\u1eb7ng \u0111\u00f4i khi gi\u1ed1ng Guillain-Barr\u00e9.<\/p>\n<p>&#8211; B\u1ea1i li\u1ec7t<\/p>\n<p>&#8211; R\u1eafn c\u1ea1p nia c\u1eafn.<\/p>\n<p>&#8211; H\u1ea1 kali m\u00e1u: n\u1ed3ng \u0111\u1ed9 kali m\u00e1u gi\u1ea3m &lt; 3,5 mEq\/l.<\/p>\n<p>&#8211; \u0110\u00e1i ra porphyrin: x\u00e9t nghi\u1ec7m n\u01b0\u1edbc ti\u1ec3u c\u00f3 porphobilinogen.<\/p>\n<p>&#8211; Vi\u00eam tu\u1ef7 lan l\u00ean: t\u1ed5n th\u01b0\u01a1ng t\u1ee7y ki\u1ec3u khoanh (m\u1ea5t v\u1eadn \u0111\u1ed9ng v\u00e0 c\u1ea3m gi\u00e1c).<\/p>\n<p>&#8211; T\u1ed5n th\u01b0\u01a1ng tu\u1ef7 do: vi\u00eam m\u00e0ng nh\u1ec7n tu\u1ef7, ch\u00e8n \u00e9p tu\u1ef7 (lao, ung th\u01b0, tho\u00e1t<\/p>\n<p>v\u1ecb&#8230;).<\/p>\n<p>&#8211; H\u1ed9i ch\u1ee9ng ch\u00f9m \u0111u\u00f4i ng\u1ef1a.<\/p>\n<p>&#8211; B\u1ec7nh l\u00fd th\u1ea7n kinh ngo\u1ea1i vi do r\u1ef1\u01a1u, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng&#8230;<\/p>\n<p><strong>4.4. Ch\u1ea9n \u0111o\u00e1n th\u1ec3 l\u00e2m s\u00e0ng<\/strong><\/p>\n<p>&#8211; <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/benh-viem-da-day-kinh-huy-myelin-cidp-la-benh-gi\/\">B\u00ea\u0323nh \u0111a d\u00e2y th\u00e2\u0300n kinh h\u1ee7y Myelin c\u00e2\u0301p<\/a>:<\/p>\n<p>+ M\u1ea5t ph\u1ea3n x\u1ea1 g\u00e2n x\u01b0\u01a1ng.<\/p>\n<p>+ S\u1ef1 h\u1ed3i ph\u1ee5c Myelin th\u1ea7n kinh ngo\u1ea1i vi x\u1ea3y ra t\u01b0\u01a1ng \u0111\u1ed1i nhanh.<\/p>\n<p>&#8211; B\u00ea\u0323nh th\u00e2\u0300n kinh s\u01a1\u0323i tru\u0323c v\u00e2\u0323n \u0111\u00f4\u0323ng c\u00e2\u0301p:<\/p>\n<p>+ Ph\u1ea3n x\u1ea1 g\u00e2n x\u01b0\u01a1ng \u0111\u00f4i khi c\u00f2n,d\u1eabn truy\u1ec1n th\u1ea7n kinh c\u1ea3m gi\u00e1c b\u00ecnh th\u01b0\u1eddng<\/p>\n<p>+ L\u00e2m s\u00e0ng v\u00e0 s\u1ef1 ph\u1ee5c h\u1ed3i kh\u00f4ng gi\u1ed1ng nh\u01b0 th\u1ec3 h\u1ee7y Myelin c\u1ea5p.<\/p>\n<p>&#8211; B\u00ea\u0323nh th\u00e2\u0300n kinh s\u01a1\u0323i tru\u0323c v\u00e2\u0323n \u0111\u00f4\u0323ng va\u0300 ca\u0309m gia\u0301c c\u00e2\u0301p:<\/p>\n<p>+ S\u1ee3i c\u1ea3m gi\u00e1c v\u00e0 v\u1eadn \u0111\u1ed9ng b\u1ecb t\u1ed5n th\u01b0\u01a1ng, h\u1ed3i ph\u1ee5c ch\u1eadm v\u00e0 kh\u00f4ng ho\u00e0n to\u00e0n.<\/p>\n<p>+ C\u00f3 tri\u1ec7u ch\u1ee9ng c\u1ea3m gi\u00e1c \u0111i k\u00e8m nhi\u1ec1u h\u01a1n, li\u00ea\u0323t xu\u00e2\u0301t hi\u00ea\u0323n nhanh va\u0300 n\u0103\u0323ng.<\/p>\n<p>&#8211; H\u00f4\u0323i ch\u01b0\u0301ng Miller Fisher:<\/p>\n<p>+ G\u0103\u0323p khoa\u0309ng 5% c\u00e1c tr\u01b0\u1eddng h\u1ee3p GBS.<\/p>\n<p>+ Th\u01b0\u01a1\u0300ng do nhi\u00ea\u0303m\u00a0<em>Campylobacter jejuni<\/em>\u00a0tr\u01b0\u01a1\u0301c \u0111o\u0301.<\/p>\n<p>+ L\u00e2m s\u00e0ng \u0111i\u1ec3n h\u00ecnh: li\u1ec7t v\u1eadn nh\u00e3n, m\u1ea5t \u0111i\u1ec1u h\u00f2a v\u00e0 m\u1ea5t ph\u1ea3n x\u1ea1<\/p>\n<h2>5. \u0110I\u1ec0U TR\u1eca<\/h2>\n<p><strong>5.1. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb<\/strong><\/p>\n<p>&#8211; \u0110\u1ea3m b\u1ea3o duy tr\u00ec ch\u1ee9c n\u0103ng s\u1ed1ng, \u0111\u1eb7c bi\u1ec7t khi c\u00f3 li\u1ec7t c\u01a1 h\u00f4 h\u1ea5p.<\/p>\n<p>&#8211; \u0110i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n n\u01b0\u1edbc v\u00e0 \u0111i\u1ec7n gi\u1ea3i.<\/p>\n<p>&#8211; T\u1eadp v\u1eadn \u0111\u1ed9ng \u0111\u1ec3 h\u1ea1n ch\u1ebf bi\u1ebfn ch\u1ee9ng do li\u1ec7t v\u1eadn \u0111\u1ed9ng g\u00e2y ra.<\/p>\n<p>&#8211; Lo\u1ea1i b\u1ecf nhanh c\u00e1c kh\u00e1ng th\u1ec3 t\u1ef1 mi\u1ec5n g\u00e2y ra t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh ngo\u1ea1i vi.<\/p>\n<p><strong>5.2. X\u1eed tr\u00ed ban \u0111\u1ea7u v\u00e0 v\u1eadn chuy\u1ec3n c\u1ea5p c\u1ee9u<\/strong><\/p>\n<p>&#8211; N\u1eb1m \u0111\u1ea7u cao 30<sup>o<\/sup>\u00a0&#8211; 45<sup>o.<\/sup><\/p>\n<p>&#8211; Th\u1edf oxy k\u00ednh ho\u1eb7c qua m\u1eb7t n\u1ea1. \u0110\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n v\u00e0 b\u00f3p b\u00f3ng qua \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n khi c\u00f3 li\u1ec7t c\u01a1 h\u00f4 h\u1ea5p.<\/p>\n<p>&#8211; \u0110\u1eb7t \u1ed1ng th\u00f4ng d\u1ea1 d\u00e0y, \u0103n qua \u1ed1ng th\u00f4ng khi c\u00f3 r\u1ed1i lo\u1ea1n nu\u1ed1t.<\/p>\n<p>&#8211; Vitamin nh\u00f3m B.<\/p>\n<p>&#8211; Glucocorticoid: Methylprednisolon 500mg\/ng\u00e0y x\u00a0 5 ng\u00e0y, sau \u0111\u00f3 gi\u1ea3m li\u1ec1u d\u1ea7n.<\/p>\n<p><strong>5.3. \u0110i\u1ec1u tr\u1ecb t\u1ea1i b\u1ec7nh vi\u1ec7n<\/strong><\/p>\n<p><strong><em>a) C\u00e1c \u0111i\u1ec1u tr\u1ecb h\u00f4\u0303 tr\u01a1\u0323<\/em><\/strong><\/p>\n<p>&#8211; H\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p h\u00f4 h\u00e2\u0301p:<\/p>\n<p>+ Khi c\u00f3 d\u1ea5u hi\u1ec7u suy h\u00f4 h\u1ea5p c\u1ea7n th\u1edf m\u00e1y h\u1ed7 tr\u1ee3 ngay.<\/p>\n<p>+ Th\u1edf oxy, n\u1ebfu kh\u00f4ng k\u1ebft qu\u1ea3 chuy\u1ec3n sang th\u1edf m\u00e1y x\u00e2m nh\u1eadp v\u1edbi Vt cao (12ml\/kg) k\u1ebft h\u1ee3p PEEP 5 cmH<sub>2<\/sub>O \u0111\u1ec3 tr\u00e1nh x\u1eb9p ph\u1ed5i .<\/p>\n<p>+ C\u00e1c y\u1ebfu t\u1ed1 n\u1eb7ng nh\u01b0: ti\u1ebfn tri\u1ec3n nhanh &lt; 7 ng\u00e0y, m\u1ea5t kh\u1ea3 n\u0103ng ho, kh\u00f4ng n\u00e2ng \u0111\u01b0\u1ee3c khu\u1ef7u tay ho\u1eb7c \u0111\u1ea7u, m\u1ea5t kh\u1ea3 n\u0103ng \u0111\u1ee9ng, ph\u1ea3i nh\u1eadp Khoa h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c \u0111\u1ec3 theo d\u00f5i, c\u1ea7n \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n v\u00e0 th\u1edf m\u00e1y s\u1edbm.<\/p>\n<p>&#8211; Tu\u1ea7n ho\u00e0n: theo do\u0303i li\u00ean t\u1ee5c m\u1ea1ch , \u0111i\u1ec7n tim, huy\u00ea\u0301t a\u0301p \u0111\u00ea\u0309 pha\u0301t hi\u00ea\u0323n va\u0300 x\u01b0\u0309 tri\u0301 k\u1ecbp th\u1eddi r\u1ed1i lo\u1ea1n nh\u1ecbp, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1ecbp ch\u1eadm khi h\u00fat \u0111\u1eddm, t\u1ee5t huy\u00ea\u0301t a\u0301p.<\/p>\n<p>&#8211; D\u01b0\u0323 pho\u0300ng thuy\u00ean \u00a0t\u1eafc ti\u0303nh ma\u0323ch s\u00e2u v\u00e0 t\u1eafc m\u1ea1ch ph\u00f4\u0309i: v\u1eadn \u0111\u1ed9ng tr\u1ecb li\u1ec7u, d\u00f9ng thu\u00f4\u0301c ch\u00f4\u0301ng \u0111\u00f4ng Heparin ho\u1eb7c Heparin tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p.<\/p>\n<p>&#8211; D\u01b0\u0323 pho\u0300ng loe\u0301t da\u0323 d\u00e0y v\u00e0 \u0111\u01b0\u1eddng ti\u00eau h\u00f3a: gi\u1ea3m ti\u1ebft d\u1ecbch d\u1ea1 d\u00e0y (thu\u1ed1c kh\u00e1ng th\u1ee5 th\u1ec3 H<sub>2<\/sub>, thu\u1ed1c \u1ee9c ch\u1ebf b\u01a1m Proton) \u0103n qua \u1ed1ng th\u00f4ng s\u1edbm.<\/p>\n<p>&#8211; \u0110i\u1ec1u chi\u0309nh r\u00f4\u0301i loa\u0323n n\u01b0\u01a1\u0301c \u0111i\u00ea\u0323n gia\u0309i. \u0110a\u0309m ba\u0309o dinh d\u01b0\u01a1\u0303ng: 40 Kcalo\/kg\/ng\u00e0y va\u0300 c\u00e1c kho\u00e1ng ch\u1ea5t.<\/p>\n<p><strong><em>b) \u0110i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u<\/em><\/strong><\/p>\n<p>&#8211; <em>M\u1ee5c ti\u00eau:<\/em> l\u00e0m gi\u1ea3m l\u01b0\u1ee3ng kh\u00e1ng th\u1ec3 kh\u00e1ng Myelin trong m\u00e1u<em>.<\/em><\/p>\n<p>&#8211; Corticoid:<\/p>\n<p>+ T\u00e1c d\u1ee5ng l\u00e0m gi\u1ea3m \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch. Tuy nhi\u00ean hi\u00ea\u0323u qua\u0309 kh\u00f4ng nhi\u1ec1u.<\/p>\n<p>+ Li\u00ea\u0300u Methylprednisolon 500mg\/ng\u00e0y x 5 ng\u00e0y. Sau \u0111\u00f3 gi\u1ea3m li\u1ec1u d\u1ea7n.<\/p>\n<p>&#8211; L\u1ecdc huy\u00ea\u0301t t\u01b0\u01a1ng:<\/p>\n<p>+ Thay huy\u1ebft t\u01b0\u01a1ng<\/p>\n<p>+ L\u1ecdc k\u00e9p (Double Filter)<\/p>\n<p>+ L\u1ecdc h\u1ea5p ph\u1ee5 (Hemoadsorption)<\/p>\n<p>&#8211;<em> Ch\u00fa \u00fd:<\/em><\/p>\n<p>+Th\u1eddi gian l\u1ecdc c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t: kh\u1ea3 n\u0103ng h\u1ed3i ph\u1ee5c t\u1ed1t.<\/p>\n<p>+S\u1ed1 l\u1ea7n l\u1ecdc v\u00e0 kho\u1ea3ng c\u00e1ch: h\u00e0ng ng\u00e0y ho\u1eb7c c\u00e1ch ng\u00e0y, 3-6 l\u1ea7n t\u00f9y theo \u0111\u00e1p \u1ee9ng, c\u00f3 th\u1ec3 t\u1edbi 15-16 l\u1ea7n. N\u1ebfu sau 6 l\u1ea7n kh\u00f4ng ti\u1ebfn tri\u1ec3n th\u00ec ng\u1eebng.<\/p>\n<p>+C\u00f3 nguy c\u01a1 d\u1ecb \u1ee9ng ho\u1eb7c s\u1ed1c ph\u1ea3n v\u1ec7, r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u, r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i, nhi\u1ec5m khu\u1ea9n t\u1ea1i ch\u1ed7 ho\u1eb7c nhi\u1ec5m khu\u1ea9n m\u00e1u\u2026<\/p>\n<p>&#8211; Truy\u1ec1n Globulin mi\u00ea\u0303n di\u0323ch: gi\u00e1 th\u00e0nh \u0111i\u1ec1u tr\u1ecb cao.<\/p>\n<p>+ Li\u00ea\u0300u du\u0300ng: 0,4 g\/kg\/ng\u00e0y x 5 ng\u00e0y.<\/p>\n<p>+ Ch\u00f4\u0301ng chi\u0309 \u0111i\u0323nh: suy th\u00e2\u0323n, d\u1ecb \u1ee9ng thu\u1ed1c.<\/p>\n<p>&#8211;<em> Theo d\u00f5i:<\/em><\/p>\n<p>+ \u0110\u00e1nh gi\u00e1 h\u00e0ng ng\u00e0y c\u01a1 l\u1ef1c t\u1ee9 chi ,c\u00e1c d\u00e2y th\u1ea7n kinh s\u1ecd nh\u01b0: r\u1ed1i lo\u1ea1n nu\u1ed1t<\/p>\n<p>+ Theo d\u00f5i s\u00e1t: h\u00f4 h\u1ea5p ( SpO<sub>2<\/sub>,PaO<sub>2<\/sub>, PaCO<sub>2<\/sub>, m\u1ea1ch, nh\u1ecbp tim, huy\u1ebft \u00e1p).<\/p>\n<p>+ \u0110\u00e1nh gi\u00e1 th\u1ec3 t\u00edch kh\u00ed l\u01b0u th\u00f4ng (Vt), \u00e1p l\u1ef1c \u00e2m h\u00edt v\u00e0o t\u1ed1i \u0111a (NIP) h\u00e0ng ng\u00e0y.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>H\u1ed9i ch\u1ee9ng Guillain &#8211; 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