{"id":32774,"date":"2023-05-09T03:02:19","date_gmt":"2023-05-08T20:02:19","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=32774"},"modified":"2023-05-09T04:48:36","modified_gmt":"2023-05-08T21:48:36","slug":"dieu-tri-noi-khoa-u-than-kinh-dem","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/09\/dieu-tri-noi-khoa-u-than-kinh-dem\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa u th\u1ea7n kinh \u0111\u1ec7m"},"content":{"rendered":"

\u0110i\u1ec1u tr\u1ecb u th\u1ea7n kinh \u0111\u1ec7m<\/a> ph\u1ee5 thu\u1ed9c v\u00e0o nhi\u1ec1u y\u1ebfu t\u1ed1, bao g\u1ed3m k\u00edch th\u01b0\u1edbc v\u00e0 v\u1ecb tr\u00ed c\u1ee7a u, t\u00ednh ch\u1ea5t c\u1ee7a u (u l\u00e0nh t\u00ednh hay \u00e1c t\u00ednh), t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe chung c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng m\u00e0 b\u1ec7nh nh\u00e2n \u0111ang g\u1eb7p ph\u1ea3i. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ch\u00ednh bao g\u1ed3m ph\u1eabu thu\u1eadt, x\u1ea1 tr\u1ecb, h\u00f3a tr\u1ecb v\u00e0 x\u1ea1 ph\u1eabu. B\u00ean c\u1ea1nh \u0111\u00f3, \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa \u0111\u01b0\u1ee3c xem nh\u01b0 \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 cho b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc v\u00e0 sau khi s\u1eed d\u1ee5ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ch\u00ednh. H\u00e3y c\u00f9ng t\u00ecm hi\u1ec3u c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa u th\u1ea7n kinh \u0111\u1ec7m th\u00f4ng qua b\u00e0i vi\u1ebft n\u00e0y<\/p>\n

\"Hinh-anh-minh-hoa-u-than-kinh-dem\"
H\u00ecnh \u1ea3nh minh h\u1ecda u th\u1ea7n kinh \u0111\u1ec7m<\/figcaption><\/figure>\n

1. S\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c ch\u1ed1ng ph\u00f9 n\u00e3o, gi\u1ea3m \u00e1p l\u1ef1c n\u1ed9i s\u1ecd<\/strong><\/h2>\n

Ph\u00f9 n\u00e3o l\u00e0 s\u1ef1 t\u00edch t\u1ee5 b\u1ea5t th\u01b0\u1eddng n\u01b0\u1edbc v\u00e0 d\u1ecbch trong khu v\u1ef1c t\u1ebf b\u00e0o ho\u1eb7c khu v\u1ef1c ngo\u00e0i t\u1ebf b\u00e0o n\u00e3o, d\u1eabn \u0111\u1ebfn t\u0103ng th\u1ec3 t\u00edch to\u00e0n b\u1ed9 c\u1ee7a n\u00e3o. Ph\u00f9 n\u00e3o d\u1eabn \u0111\u1ebfn t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd khi \u00e1p l\u1ef1c trong h\u1ed9p s\u1ecd t\u0103ng k\u00e9o d\u00e0i tr\u00ean 20mmHg. T\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd g\u00e2y ra nh\u1eefng h\u1eadu qu\u1ea3 \u0111e d\u1ecda t\u00ednh m\u1ea1ng nh\u01b0 l\u00e0m gi\u1ea3m \u00e1p l\u1ef1c t\u01b0\u1edbi m\u00e1u n\u00e3o v\u00e0 gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng m\u00e1u n\u00e3o d\u1eabn \u0111\u1ebfn thi\u1ebfu m\u00e1u n\u00e3o c\u1ee5c b\u1ed9 v\u00e0 t\u1ed5n th\u01b0\u01a1ng kh\u00f4ng h\u1ed3i ph\u1ee5c; m\u1eb7c kh\u00e1c t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd c\u00f2n d\u1eabn \u0111\u1ebfn tho\u00e1t v\u1ecb n\u00e3o v\u00e0 t\u1ee5t n\u00e3o g\u00e2y m\u1ea5t n\u00e3o v\u00e0 t\u1eed vong nhanh ch\u00f3ng.<\/p>\n

Ph\u00f9 n\u00e3o trong u n\u00e3o l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a kh\u1ed1i cho\u00e1ng ch\u1ed7 n\u1ed9i s\u1ecd, l\u00e0 nguy\u00ean nh\u00e2n g\u00f3p ph\u1ea7n l\u00e0m b\u1ec7nh th\u00eam tr\u1ea7m tr\u1ecdng. Do \u0111\u00f3, \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa ch\u1ed1ng ph\u00f9 n\u00e3o l\u00e0 r\u1ea5t c\u1ea7n thi\u1ebft, gi\u00fap c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng.<\/p>\n

1.1. Manitol 20%<\/strong><\/h3>\n

Manitol l\u00e0 thu\u1ed1c l\u00e0m t\u0103ng \u00e1p l\u1ef1c th\u1ea9m th\u1ea5u, c\u00f3 t\u00e1c d\u1ee5ng g\u00e2y l\u1ee3i ti\u1ec3u th\u1ea9m th\u1ea5u, k\u00e9o n\u01b0\u1edbc ra kh\u1ecfi nhu m\u00f4 n\u00e3o l\u00e0m gi\u1ea3m ph\u00f9 n\u00e3o.<\/p>\n

C\u00e1ch s\u1eed d\u1ee5ng:<\/p>\n

    \n
  • Truy\u1ec1n t\u0129nh m\u1ea1ch nhanh 1-1,5g\/kg\/6 gi\u1edd (200-300ml),<\/li>\n
  • Ho\u1eb7c ti\u00eam t\u0129nh m\u1ea1ch nhanh 0,25g\/kg, 3-4 gi\u1edd\/l\u1ea7n.<\/li>\n<\/ul>\n

    Ch\u00fa \u00fd: Manitol c\u00f3 t\u00e1c d\u1ee5ng sau 45 ph\u00fat v\u00e0 k\u00e9o d\u00e0i 4-6 gi\u1edd. Kh\u00f4ng d\u00f9ng manitol k\u00e9o d\u00e0i qu\u00e1 72 gi\u1edd, ho\u1eb7c khi hematocrit <30% v\u00e0 c\u1ea7n truy\u1ec1n d\u1ecbch thay th\u1ebf k\u00e8m theo tr\u00e1nh gi\u1ea3m th\u1ec3 t\u00edch d\u1ecbch l\u01b0u h\u00e0nh. C\u00f3 th\u1ec3 thay th\u1ebf manitol b\u1eb1ng dung d\u1ecbch mu\u1ed1i \u01b0u tr\u01b0\u01a1ng 1,25-3%.<\/p>\n

    1.2. Corticoid<\/strong><\/h3>\n

    C\u00e1c lo\u1ea1i corticoid \u0111\u01b0\u1ee3c d\u00f9ng trong \u0111i\u1ec1u tr\u1ecb ph\u00f9 n\u00e3o c\u00f3 th\u1ec3 k\u1ec3 \u0111\u1ebfn:<\/p>\n

      \n
    • Dexamethason 4mg, li\u1ec1u 4-8 l\u1ecd\/ng\u00e0y, ti\u00eam t\u0129nh m\u1ea1ch.<\/li>\n
    • Ho\u1eb7c Methylprednisolone 4-16mg, u\u1ed1ng ng\u00e0y 2-4 vi\u00ean, u\u1ed1ng v\u00e0o 8 gi\u1edd s\u00e1ng sau \u0103n no.<\/li>\n
    • Trong m\u1ed9t s\u1ed1 tr\u01b0\u1edfng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng ph\u00f9 n\u00e3o nhi\u1ec1u c\u00f3 th\u1ec3 d\u00f9ng methylprednisolone 40mg, 1-2 l\u1ecd\/ng\u00e0y, ti\u00eam t\u0129nh m\u1ea1ch ho\u1eb7c pha truy\u1ec1n v\u1edbi 250ml dung d\u1ecbch NaCl 0,9% truy\u1ec1n t\u0129nh m\u1ea1ch.<\/li>\n
    • C\u00f3 th\u1ec3 s\u1eed d\u1ee5ng synacthene 1mg ti\u00eam b\u1eafp, m\u1ed7i l\u1ea7n 1 l\u1ecd, tu\u1ea7n 1-2 l\u1ecd.<\/li>\n<\/ul>\n

      C\u1ea7n gi\u1ea3m li\u1ec1u corticoid d\u1ea7n d\u1ea7n tr\u01b0\u1edbc khi ng\u01b0ng thu\u1ed1c.<\/p>\n

      1.3. Furosemide<\/strong><\/h3>\n

      N\u1ebfu c\u00f3 t\u0103ng g\u00e1nh th\u1ec3 t\u00edch, d\u00f9ng Furosemide vi\u00ean 40mg u\u1ed1ng, ho\u1eb7c \u1ed1ng 20mg ti\u00eam t\u0129nh m\u1ea1ch. C\u1ea7n h\u1ea1n ch\u1ebf l\u01b0\u1ee3ng n\u01b0\u1edbc v\u00e0o c\u01a1 th\u1ec3 (10-15ml\/kg\/24 gi\u1edd), v\u00e0 \u0111\u1ea3m b\u1ea3o b\u1ec7nh nh\u00e2n kh\u00f4ng b\u1ecb h\u1ea1 natri m\u00e1u.<\/p>\n

      2. S\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh<\/strong><\/h2>\n
        \n
      • \u0110\u01b0\u1eddng ti\u00eam: Diazepam 10mg ti\u00eam t\u0129nh m\u1ea1ch ho\u1eb7c ti\u00eam b\u1eafp.<\/li>\n
      • \u0110\u01b0\u1eddng u\u1ed1ng: Depakine 500mg u\u1ed1ng ng\u00e0y 1- 3 vi\u00ean ho\u1eb7c tegretol 200mg ng\u00e0y 1-2 vi\u00ean t\u00f9y theo \u0111\u00e1p \u1ee9ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh m\u00e0 l\u1ef1a ch\u1ecdn li\u1ec1u duy tr\u00ec ph\u00f9 h\u1ee3p.<\/li>\n<\/ul>\n

        3. S\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c gi\u1ea3m \u0111au th\u1ea7n kinh<\/strong><\/h2>\n

        Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb \u0111au t\u1eebng b\u01b0\u1edbc theo m\u1ee9c \u0111\u1ed9 \u0111au c\u1ee7a WHO:<\/p>\n

          \n
        • B\u1eadc 1:<\/strong> Thu\u1ed1c gi\u1ea3m \u0111au kh\u00f4ng c\u00f3 opioid, c\u00f3 ho\u1eb7c kh\u00f4ng k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c kh\u00e1ng vi\u00eam kh\u00f4ng \u0111\u1eb7c hi\u1ec7u, c\u00f3 ho\u1eb7c kh\u00f4ng k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c h\u1ed7 tr\u1ee3 \u0111\u1ed3ng gi\u1ea3m \u0111au.<\/li>\n<\/ul>\n
            \n
          • B\u1eadc 2:<\/strong> Thu\u1ed1c c\u00f3 opioid d\u1ea1ng y\u1ebfu, opioid y\u1ebfu d\u1ea1ng ph\u1ed1i h\u1ee3p, c\u00f3 ho\u1eb7c kh\u00f4ng k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c kh\u00e1ng vi\u00eam kh\u00f4ng \u0111\u1eb7c hi\u1ec7u, c\u00f3 ho\u1eb7c kh\u00f4ng k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c h\u1ed7 tr\u1ee3 \u0111\u1ed3ng gi\u1ea3m \u0111au.<\/li>\n<\/ul>\n
              \n
            • B\u1eadc 3:<\/strong> Thu\u1ed1c gi\u1ea3m \u0111au opioid \u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c ti\u00eam, c\u00f3 ho\u1eb7c kh\u00f4ng k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c kh\u00e1ng vi\u00eam kh\u00f4ng \u0111\u1eb7c hi\u1ec7u, c\u00f3 ho\u1eb7c kh\u00f4ng k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c h\u1ed7 tr\u1ee3 \u0111\u1ed3ng gi\u1ea3m \u0111au<\/li>\n<\/ul>\n

              4. Ch\u1ebf \u0111\u1ed9 dinh d\u01b0\u1ee1ng<\/strong><\/h2>\n

              Ch\u1ebf \u0111\u1ed9 \u0103n dinh d\u01b0\u1ee1ng r\u1ea5t quan tr\u1ecdng \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n ung th\u01b0, gi\u00fap c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng, t\u0103ng c\u01b0\u1eddng s\u1ee9c kh\u1ecfe v\u00e0 t\u0103ng kh\u1ea3 n\u0103ng ch\u1ed1ng l\u1ea1i b\u1ec7nh t\u1eadt.<\/p>\n

              Khi b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 t\u1ef1 \u0103n \u0111\u01b0\u1ee3c c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng dinh d\u01b0\u1ee1ng t\u0129nh m\u1ea1ch ho\u1eb7c nu\u00f4i \u0103n qua sonde d\u1ea1 d\u00e0y t\u00f9y thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

              4.1. M\u1ee5c ti\u00eau dinh d\u01b0\u1ee1ng trong \u0111i\u1ec1u tr\u1ecb ung th\u01b0<\/strong><\/h3>\n
                \n
              • Ng\u0103n ng\u1eeba ho\u1eb7c \u0111i\u1ec1u ch\u1ec9nh thi\u1ebfu h\u1ee5t dinh d\u01b0\u1ee1ng, s\u1ee5t c\u00e2n hay m\u1ea5t kh\u1ed1i n\u1ea1c c\u1ee7a c\u01a1 th\u1ec3.<\/li>\n
              • \u0110\u1ea1t v\u00e0 duy tr\u00ec \u0111\u01b0\u1ee3c c\u00e2n n\u1eb7ng c\u01a1 th\u1ec3 \u1edf m\u1ee9c t\u1ed1i \u01b0u.<\/li>\n
              • T\u0103ng kh\u1ea3 n\u0103ng dung n\u1ea1p v\u1edbi c\u00e1c \u0111i\u1ec1u tr\u1ecb ung th\u01b0.<\/li>\n
              • Gi\u1ea3m ho\u1eb7c ng\u0103n ng\u1eeba \u0111\u01b0\u1ee3c c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<\/li>\n
              • C\u1ea3i thi\u1ec7n h\u1ec7 mi\u1ec5n d\u1ecbch, n\u0103ng cao s\u1ee9c \u0111\u1ec1 kh\u00e1ng c\u1ee7a c\u01a1 th\u1ec3.<\/li>\n
              • Gi\u00fap c\u01a1 th\u1ec3 h\u1ed3i ph\u1ee5c nhanh v\u00e0 ch\u00f3ng l\u00e0nh v\u1ebft th\u01b0\u01a1ng.<\/li>\n
              • C\u1ea3i thi\u1ec7n ti\u00ean l\u01b0\u1ee3ng v\u00e0 t\u0103ng kh\u1ea3 n\u0103ng ph\u1ee5c h\u1ed3i c\u1ee7a c\u01a1 th\u1ec3.<\/li>\n
              • ng cao ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed1c s\u1ed1ng cho b\u1ec7nh nh\u00e2n ung th\u01b0.<\/li>\n<\/ul>\n

                4.2. Nhu c\u1ea7u dinh d\u01b0\u1ee1ng trong \u0111i\u1ec1u tr\u1ecb ung th\u01b0<\/strong><\/h3>\n
                  \n
                • N\u0103ng l\u01b0\u1ee3ng: Ti\u00eau th\u1ee5 n\u0103ng l\u01b0\u1ee3ng \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0 r\u1ea5t l\u1edbn, trung b\u00ecnh kho\u1ea3ng 30-35 Kcal\/kg\/ng\u00e0y. M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t c\u00f3 th\u1ec3 c\u1ea7n t\u1edbi 40-50 Kcal\/kg\/ng\u00e0y.<\/li>\n
                • Protein: 15-20% t\u1ed5ng n\u0103ng l\u01b0\u1ee3ng. Protein \u0111\u1ed9ng v\u1eadt chi\u1ebfm 30%-50% t\u1ed5ng s\u1ed1 protein, \u0111\u1eb7c bi\u1ec7t c\u00e1c acid amin leucine, glutamine, arginine, HMB.<\/li>\n
                • Lipid: 18-25% t\u1ed5ng n\u0103ng l\u01b0\u1ee3ng trong \u0111\u00f3: 1\/3 acid b\u00e9o no, 1\/3 acid b\u00e9o kh\u00f4ng no m\u1ed9t n\u1ed1i \u0111\u00f4i, 1\/3 acid b\u00e9o kh\u00f4ng no nhi\u1ec1u n\u1ed1i \u0111\u00f4i.<\/li>\n
                • Glucid: 60-70% t\u1ed5ng n\u0103ng l\u01b0\u1ee3ng.<\/li>\n
                • Vitamin, kho\u00e1ng ch\u1ea5t v\u00e0 ch\u1ea5t x\u01a1: theo nhu c\u1ea7u c\u1ee7a ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng kh\u1ecfe m\u1ea1nh.<\/li>\n
                • N\u01b0\u1edbc: 40ml\/kg c\u00e2n n\u1eb7ng\/ng\u00e0y (35ml\/kg c\u00e2n n\u1eb7ng \u1edf ng\u01b0\u1eddi cao tu\u1ed5i).<\/li>\n
                • Mu\u1ed1i: kh\u00f4ng qu\u00e1 6g\/ng\u00e0y.<\/li>\n<\/ul>\n

                  Ngo\u00e0i nh\u1eefng \u0111i\u1ec1u tr\u1ecb k\u1ec3 tr\u00ean, b\u1ec7nh nh\u00e2n c\u1ea7n n\u1eb1m ngh\u1ec9 ng\u01a1 t\u1ea1i ch\u1ed7, h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng, c\u1ed1 g\u1eafng ng\u1ee7 \u0111\u1ee7 gi\u1ea5c. B\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb c\u1ea7n theo d\u00f5i ch\u1eb7t ch\u1ebd s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a kh\u1ed1i u \u0111\u1ec3 c\u00f3 k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb th\u00edch h\u1ee3p.<\/p>\n

                  Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n","protected":false},"excerpt":{"rendered":"

                  \u0110i\u1ec1u tr\u1ecb u th\u1ea7n kinh \u0111\u1ec7m ph\u1ee5 thu\u1ed9c v\u00e0o nhi\u1ec1u y\u1ebfu t\u1ed1, bao g\u1ed3m k\u00edch th\u01b0\u1edbc v\u00e0 v\u1ecb tr\u00ed c\u1ee7a u, t\u00ednh ch\u1ea5t c\u1ee7a u (u l\u00e0nh t\u00ednh hay \u00e1c t\u00ednh), t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe chung c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng m\u00e0 b\u1ec7nh nh\u00e2n \u0111ang g\u1eb7p ph\u1ea3i. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ch\u00ednh […]<\/p>\n","protected":false},"author":61,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[6,33],"tags":[],"yoast_head":"\n\u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa u th\u1ea7n kinh \u0111\u1ec7m - Vinmec<\/title>\n<meta name=\"description\" content=\"\u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa u th\u1ea7n kinh \u0111\u1ec7m \u0111\u01b0\u1ee3c xem nh\u01b0 \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 cho b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc v\u00e0 sau khi s\u1eed d\u1ee5ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ch\u00ednh.\" \/>\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=\"\u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa u th\u1ea7n kinh \u0111\u1ec7m - 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