{"id":147407,"date":"2025-11-06T13:23:42","date_gmt":"2025-11-06T06:23:42","guid":{"rendered":"https:\/\/vnras.com\/drug\/?p=147407"},"modified":"2025-11-07T12:05:06","modified_gmt":"2025-11-07T05:05:06","slug":"tim-hieu-ve-con-dong-kinh-va-dong-kinh-dinh-nghia-nguyen-nhan","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/tim-hieu-ve-con-dong-kinh-va-dong-kinh-dinh-nghia-nguyen-nhan\/","title":{"rendered":"T\u00ecm hi\u1ec3u v\u1ec1 c\u01a1n \u0111\u1ed9ng kinh v\u00e0 \u0111\u1ed9ng kinh – \u0110\u1ecbnh ngh\u0129a, nguy\u00ean nh\u00e2n"},"content":{"rendered":"

T\u1ea3i file PDF t\u1ea1i \u0111\u00e2y.<\/a><\/p>\n

\u0110\u1ed8NG KINH<\/h2>\n
\u0110\u1ecbnh ngh\u0129a<\/h3>\n
– C\u01a1n \u0111\u1ed9ng kinh (seizure) l\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0\/hay d\u00e2u hi\u1ec7u xu\u1ea5t hi\u1ec7n tho\u00e1ng qua do s\u1ef1 ho\u1ea1t \u0111\u1ed9ng \u0111\u1ed3ng b\u1ed9 hay qu\u00e1 m\u1ee9c b\u1ea5t th\u01b0\u1eddng c\u1ee7a c\u00e1c t\u1ebf b\u00e0o n\u00e3o.<\/p>\n
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C\u00f3 th\u1ec3 l\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a m\u1ed9t t\u1ed5n th\u01b0\u01a1ng n\u00e3o c\u1ea5p nh\u01b0: s\u1eed d\u1ee5ng\/cai r\u01b0\u1ee3u v\u00e0 ch\u1ea5t c\u1ea5m, t\u1ed5n th\u01b0\u01a1ng\/b\u1ea5t th\u01b0\u1eddng n\u00e3o b\u1ed9 (u, ch\u1ea5n th\u01b0\u01a1ng, do nguy\u00ean nh\u00e2n m\u1ea1ch m\u00e1u), nhi\u1ec5m tr\u00f9ng h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng, s\u1ed1t (tr\u1ebb em), chuy\u1ec1n h\u00f3a (h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i, suy gan\/th\u1eadn), thu\u1ed1c.<\/li>\n
Ho\u1eb7c l\u00e0 bi\u1ec3u hi\u1ec7n c\u1ee7a \u0111\u1ed9ng kinh.<\/li>\n<\/ul>\n
– \u0110\u1ed9ng kinh (epilepsy): t\u00f4i lo\u1ea1n c\u1ee7a n\u00e3o b\u1ed9 \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi khuynh h\u01b0\u1edbng b\u1ec1n v\u1eefng t\u1ea1o ra c\u00e1c c\u01a1n \u0111\u1ed9ng kinh v\u00e0 b\u1edfi nh\u1eefng h\u1eadu qu\u1ea3 v\u1ec1 \u0111\u1eddi s\u1ed1ng x\u00e3 h\u1ed9i, t\u00e2m l\u00fd, nh\u1eadn th\u1ee9c, sinh h\u1ecdc th\u1ea7n kinh do \u0111\u1ed9ng kinh g\u00e2y ra. V\u1ec1 th\u1ef1c h\u00e0nh, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u00e2n \u0111o\u00e1n \u0111\u1ed9ng kinh khi th\u1ecfa m\u1ed9t trong c\u00e1c \u0111i\u1ec1u ki\u1ec7n sau:<\/p>\n
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C\u00f3 \u00edt nh\u1ea5t 2 c\u01a1n \u0111\u1ed9ng kinh kh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 kh\u1edfi ph\u00e1t (unprovoked seizure) (hay ph\u1ea3n x\u1ea1) xu\u1ea5t hi\u1ec7n c\u00e1ch nhau > 24 gi\u1edd.<\/li>\n
C\u00f3 \u00edt nh\u1ea5t 1 c\u01a1n \u0111\u1ed9ng kinh kh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 kh\u1edfi ph\u00e1t (hay ph\u1ea3n x\u1ea1) v\u00e0 kh\u1ea3 n\u0103ng t\u00e1i ph\u00e1t c\u01a1n \u0111\u1ed9ng kinh trong v\u00f2ng 10 n\u0103m ti\u1ebfp theo t\u01b0\u01a1ng t\u1ef1 nh\u01b0 nguy c\u01a1 t\u00e1i ph\u00e1t (\u00edt nh\u1ea5t 60%) sau khi c\u00f3 2 c\u01a1n \u0111\u1ed9ng kinh kh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 kh\u1edfi ph\u00e1t.<\/li>\n
Ch\u1ea9n \u0111o\u00e1n c\u1ee7a m\u1ed9t h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng kinh.<\/li>\n<\/ul>\n
D\u1ecbch t\u1ec5 h\u1ecdc<\/h3>\n
– T\u1ef7 l\u1ec7 l\u01b0u h\u00e0nh (prevalence).<\/p>\n
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C\u01a1n \u0111\u1ed9ng kinh: 5 – 10% d\u00e2n s\u1ed1 s\u1ebd c\u00f3 \u00edt nh\u1ea5t m\u1ed9t c\u01a1n \u0111\u1ed9ng kinh trong su\u1ed1t cu\u1ed9c \u0111\u1eddi.<\/li>\n
\u0110\u1ed9ng kinh: 0,5 – 1% d\u00e2n s\u1ed1, cao h\u01a1n \u1edf m\u1ed9t v\u00e0i v\u00f9ng tr\u00ean th\u1ebf gi\u1edbi nh\u01b0 l\u00e0 ch\u00e2u \u00c1. Nghi\u00ean c\u1ee9u c\u1ee7a t\u00e1c gi\u1ea3 Nguy\u1ec5n V\u0103n Tu\u1ea5n cho th\u1ea5y t\u1ef7 l\u1ec7 n\u00e0y t\u1ea1i Vi\u1ec7t Nam l\u00e0 0,44%, \u01b0u th\u1ebf \u1edf nam so v\u1edbi n\u1eef.<\/li>\n<\/ul>\n
– T\u1ef7 l\u1ec7 m\u1edbi m\u1eafc (incidence) x\u1ea3y ra cao nh\u1ea5t \u1edf l\u1ee9a tu\u1ed5i tr\u1ebb nh\u1ecf v\u00e0 ng\u01b0\u1eddi l\u1edbn tu\u1ed5i. C\u0169ng theo t\u00e1c gi\u1ea3 Nguy\u1ec5n V\u0103n Tu\u1ea5n v\u00e0 c\u1ed9ng s\u1ef1 th\u00ec t\u1ef7 l\u1ec7 m\u1edbi m\u1eafc c\u1ee7a \u0111\u1ed9ng kinh t\u1ea1i Ba V\u00ec, Vi\u1ec7t Nam l\u00e0 44,8\/100.000 d\u00e2n, t\u1ef7 l\u1ec7 n\u00e0y cao h\u01a1n \u1edf tr\u1ebb d\u01b0\u1edbi 16 tu\u00f4i, tr\u00ecnh \u0111\u1ed9 h\u1ecdc v\u1ea5n th\u1ea5p v\u00e0 thu nh\u1eadp th\u1ea5p.<\/p>\n
Nguy\u00ean nh\u00e2n<\/h3>\n
– C\u00f3 nhi\u1ec1u nguy\u00ean nh\u00e2n g\u00e2y ra \u0111\u1ed9ng kinh \u0111\u00e3 \u0111\u01b0\u1ee3c nh\u1eadn di\u1ec7n nh\u01b0ng nh\u00ecn chung th\u00ec c\u00f3 5 nh\u00f3m nguy\u00ean nh\u00e2n, \u0111\u00f3 l\u00e0 do gen, c\u1ea5u tr\u00fac (b\u1ea9m sinh hay m\u1eafc ph\u1ea3i nh\u01b0 \u0111\u1ed9t quy, u n\u00e3o, t\u1ed3n th\u01b0\u01a1ng n\u00e3o chu sinh, d\u1ecb d\u1ea1ng m\u1ea1ch m\u00e1u, d\u1ecb d\u1ea1ng c\u1ee7a s\u1ef1 ph\u00e1t tri\u1ec3n v\u1ecf n\u00e3o, tho\u00e1i h\u00f3a th\u1ea7n kinh), nhi\u1ec5m, chuy\u1ec3n h\u00f3a, t\u1ef1 mi\u1ec5n v\u00e0 nh\u00f3m kh\u00f4ng x\u00e1c \u0111\u1ecbnh.<\/p>\n
Ph\u00e2n lo\u1ea1i c\u01a1n \u0111\u1ed9ng kinh<\/h3>\n
$\"C\u01a1n$
B\u1ea3ng 22.1. Ph\u00e2n lo\u1ea1i c\u01a1n \u0111\u1ed9ng kinh theo Li\u00ean h\u1ed9i Ch\u1ed1ng \u0111\u1ed9ng kinh qu\u1ed1c t\u1ebf ILAE 2017<\/figcaption><\/figure>\n
Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng<\/h3>\n
C\u01a1n \u0111\u1ed9ng kinh kh\u1edfi ph\u00e1t c\u1ee5c b\u1ed9<\/h4>\n
– C\u01a1n \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 \u201ckh\u1edfi ph\u00e1t t\u1eeb m\u1ed9t v\u1ecb tr\u00ed \u1edf m\u1ed9t b\u00ean b\u00e1n c\u1ea7u\u201d. Khi ph\u00e2n lo\u1ea1i c\u01a1n \u0111\u1ed9ng kinh c\u1ee5c b\u1ed9 c\u1ea7n xem x\u00e9t m\u1ee9c \u0111\u1ed9 \u00fd th\u1ee9c c\u1ee7a b\u1ec7nh nh\u00e2n trong c\u01a1n. T\u1ec9nh (c\u00f2n \u00fd th\u1ee9c) \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 nh\u1eadn bi\u1ebft b\u1ea3n th\u00e2n v\u00e0 m\u00f4i tr\u01b0\u1eddng xung quanh v\u00e0 suy gi\u1ea3m \u00fd th\u1ee9c l\u00e0 khi ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng nh\u1eadn bi\u1ebft \u0111\u01b0\u1ee3c b\u1ea3n th\u00e2n v\u00e0 xung quanh. D\u1ef1a v\u00e0o tri\u1ec7u ch\u1ee9ng kh\u1edfi ph\u00e1t s\u1edbm nh\u1ea5t c\u1ee7a c\u01a1n c\u1ee7a m\u00e0 c\u00f3 th\u1ec3 ph\u00e2n lo\u1ea1i th\u00e0nh v\u1eadn \u0111\u1ed9ng hay kh\u00f4ng v\u1eadn \u0111\u1ed9ng. C\u00e1c c\u01a1n n\u00e0y c\u00f3 th\u1ec3 chuy\u1ec3n th\u00e0nh co c\u1ee9ng \u2014 co gi\u1eadt hai b\u00ean.<\/p>\n
a. C\u01a1n c\u1ee5c b\u1ed9 c\u00f2n \u00fd th\u1ee9c<\/em><\/p>\n
– C\u00e1c c\u01a1n c\u1ee5c b\u1ed9 c\u00f2n \u00fd th\u1ee9c b\u1eaft \u0111\u1ea7u v\u1edbi c\u00e1c d\u1ea5u hi\u1ec7u v\u1eadn \u0111\u1ed9ng, c\u1ea3m gi\u00e1c hay th\u1ea7n kinh t\u1ef1 ch\u1ee7, nh\u1eadn th\u1ee9c… ph\u1ee5 thu\u1ed9c v\u00e0o v\u00f9ng v\u1ecf n\u00e3o b\u1ecb \u1ea3nh h\u01b0\u1edfng. V\u00ed d\u1ee5, c\u01a1n c\u00f3 th\u00ea ch\u1ec9 l\u00e0 v\u00e0i c\u1eed \u0111\u1ed9ng co gi\u1eadt (clonic) \u1edf m\u1ed9t nh\u00f3m c\u01a1 v\u00f9ng m\u1eb7t, m\u1ed9t chi hay v\u00f9ng h\u1ea7u h\u1ecdng v\u00e0 t\u1ef1 gi\u1edbi h\u1ea1n. Tuy nhi\u00ean, c\u00e1c c\u01a1n n\u00e0y c\u00f3 th\u1ec3 l\u1eb7p \u0111i l\u1eb7p l\u1ea1i hay x\u1ea3y ra li\u00ean t\u1ee5c hay lan sang c\u00e1c v\u00f9ng v\u1ecf n\u00e3o v\u1eadn \u0111\u1ed9ng l\u00e2n c\u1eadn g\u00e2y co gi\u1eadt \u1edf c\u00e1c v\u00f9ng c\u01a1 th\u1ec3 t\u01b0\u01a1ng \u1ee9ng (\u0111\u1ea1o tr\u00ecnh Jackson).<\/p>\n
– Tri\u1ec7u ch\u1ee9ng v\u1eadn \u0111\u1ed9ng bao g\u1ed3m c\u00e1c ki\u1ec3u sau: m\u1ea5t tr\u01b0\u01a1ng l\u1ef1c, co c\u1ee9ng, co gi\u1eadt, gi\u1eadt c\u01a1 l\u1ef1c c\u1ee5c b\u1ed9, co th\u1eaft (g\u1ea5p ho\u1eb7c du\u1ed7i c\u1ee5c b\u1ed9 chi tr\u00ean v\u00e0 g\u1eadp th\u00e2n). Nh\u1eefng bi\u1ec3u hi\u1ec7n v\u1eadn \u0111\u1ed9ng \u00edt r\u00f5 r\u00e0ng h\u01a1n bao g\u1ed3m c\u00e1c v\u1eadn \u0111\u1ed9ng t\u0103ng \u0111\u1ed9ng v\u00e0 c\u00e1c ho\u1ea1t \u0111\u1ed9ng t\u1ef1 \u0111\u1ed9ng (automatisms). Ho\u1ea1t \u0111\u1ed9ng t\u1ef1 \u0111\u1ed9ng l\u00e0 nh\u1eefng c\u1eed \u0111\u1ed9ng c\u00f3 t\u1ed5 ch\u1ee9c ho\u1eb7c kh\u00f4ng, l\u1eb7p \u0111i l\u1eb7p l\u1ea1i, kh\u00f4ng c\u00f3 m\u1ee5c \u0111\u00edch.<\/p>\n
– C\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh t\u1ef1 ch\u1ee7 bi\u1ec3u hi\u1ec7n b\u1eb1ng c\u1ea3m gi\u00e1c d\u1ea1 d\u00e0y ru\u1ed9t, c\u1ea3m gi\u00e1c n\u00f3ng hay l\u1ea1nh, \u0111\u1ecf b\u1eebng m\u1eb7t, c\u1ea3m gi\u00e1c d\u1ef1ng l\u00f4ng n\u1ed5i da g\u00e0, \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c, c\u1ea3m gi\u00e1c ham mu\u1ed1n t\u00ecnh d\u1ee5c, thay \u0111\u1ed5i h\u00f4 h\u1ea5p ho\u1eb7c nh\u1eefng bi\u1ec3u hi\u1ec7n kh\u00e1c c\u1ee7a th\u1ea7n kinh t\u1ef1 ch\u1ee7.<\/p>\n
– C\u00e1c tri\u1ec7u ch\u1ee9ng v\u1ec1 nh\u1eadn th\u1ee9c c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c nh\u1eadn ra do b\u1ec7nh nh\u00e2n m\u00f4 t\u1ea3 l\u1ea1i c\u01a1n ho\u1eb7c bi\u1ec3u hi\u1ec7n r\u1ed1i lo\u1ea1n ng\u00f4n ng\u1eef, r\u1ed1i lo\u1ea1n tr\u00ed nh\u1edb, c\u1ea3m gi\u00e1c \u0111\u00e3 t\u1eebng nh\u00ecn th\u1ea5y – d\u00e9j\u00e0 vu, ch\u01b0a t\u1eebng g\u1eb7p bao gi\u1edd – jamais vu, hay nh\u1eefng r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng v\u1ecf n\u00e3o cao c\u1ea5p nh\u01b0 m\u1ea5t kh\u1ea3 n\u0103ng l\u00e0m to\u00e1n, \u1ea3o t\u01b0\u1edfng, \u1ea3o gi\u00e1c, gi\u1ea3m ch\u00fa \u00fd, th\u1edd \u01a1.<\/p>\n
– C\u00e1c tri\u1ec7u ch\u1ee9ng v\u1ec1 c\u1ea3m x\u00fac bi\u1ec3u hi\u1ec7n nh\u1eefng thay \u0111\u1ed5i v\u1ec1 c\u1ea3m x\u00fac bao g\u1ed3m s\u1ee3 h\u00e3i, lo l\u1eafng, k\u00edch \u0111\u1ed9ng, gi\u1eadn d\u1eef, c\u01b0\u1eddi ho\u1eb7c kh\u00f3c.<\/p>\n
– C\u00e1c tri\u1ec7u ch\u1ee9ng v\u1ec1 gi\u00e1c quan c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n c\u1ea3m gi\u00e1c th\u00e2n th\u1ec3, kh\u1ee9u gi\u00e1c, th\u1ecb gi\u00e1c, th\u00ednh gi\u00e1c, v\u1ecb gi\u00e1c, c\u1ea3m gi\u00e1c n\u00f3ng-l\u1ea1nh ho\u1eb7c c\u1ea3m gi\u00e1c ti\u1ec1n \u0111\u00ecnh.<\/p>\n
– M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 aura tr\u01b0\u1edbc khi b\u1ec7nh nh\u00e2n m\u1ea5t \u00fd th\u1ee9c v\u00e0 sau khi t\u1ec9nh l\u1ea1i, b\u1ec7nh nh\u00e2n v\u1eabn c\u00f3 th\u1ec3 m\u00f4 t\u1ea3 l\u1ea1i c\u00e1c aura \u0111\u00f3. B\u1ea3n ch\u1ea5t c\u1ee7a aura l\u00e0 m\u1ed9t c\u01a1n \u0111\u1ed9ng kinh c\u1ee5c b\u1ed9 kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u00fd th\u1ee9c v\u00e0 \u0111\u00f4i khi aura l\u00e0 bi\u1ec3u hi\u1ec7n duy nh\u1ea5t c\u1ee7a c\u00e1c ph\u00f3ng l\u1ef1c d\u1ea1ng \u0111\u1ed9ng kinh.<\/p>\n
– Trong giai \u0111o\u1ea1n sau c\u01a1n, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u00f3 khi\u1ebfm khuy\u1ebft th\u1ea7n kinh khu tr\u00fa nh\u01b0 li\u1ec7t \u00bd ng\u01b0\u1eddi (li\u1ec7t Todd) c\u00f3 th\u1ec3 k\u00e9o d\u00e0i t\u1eeb 30 ph\u00fat \u0111\u1ebfn 36 gi\u1edd, g\u1ee3i \u00fd c\u00f3 t\u1ed5n th\u01b0\u01a1ng n\u00e3o khu tr\u00fa.<\/p>\n
b. C\u01a1n \u0111\u1ed9ng kinh c\u1ee5c b\u1ed9 c\u00f3 suy gi\u1ea3m \u00fd th\u1ee9c<\/em><\/p>\n
-C\u00e1c c\u01a1n n\u00e0y th\u01b0\u1eddng xu\u1ea5t ph\u00e1t t\u1eeb th\u00f9y th\u00e1i d\u01b0\u01a1ng hay th\u00f9y tr\u00e1n trong nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 l\u00e0 t\u1eeb n\u01a1i kh\u00e1c. C\u00e1c c\u01a1n n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c bi\u1ec3u hi\u1ec7n b\u1eb1ng nhi\u1ec1u tri\u1ec7u ch\u1ee9ng kh\u00e1c nhau nh\u01b0 c\u1ea3m gi\u00e1c th\u01b0\u1ee3ng v\u1ecb (epigastric sensation) hay ho\u1ea3ng s\u1ee3, d\u00e9j\u00e0 vu, jamais vu, \u1ea3o kh\u1ee9u… nh\u01b0ng ch\u00fang th\u01b0\u1eddng \u0111\u1ecbnh h\u00ecnh (stereotyped) tr\u00ean c\u00f9ng m\u1ed9t b\u1ec7nh nh\u00e2n. C\u00e1c c\u01a1n n\u00e0y c\u00f3 th\u1ec3 kh\u1edfi \u0111\u1ea7u b\u1eb1ng aura v\u00e0 c\u01a1n th\u01b0\u1eddng k\u00e9o d\u00e0i kho\u1ea3ng 1-3 ph\u00fat.<\/p>\n
C\u00e1c bi\u1ec3u hi\u1ec7n v\u1eadn \u0111\u1ed9ng trong c\u01a1n c\u1ee5c b\u1ed9 c\u00f3 suy gi\u1ea3m \u00fd th\u1ee9c l\u00e0 ho\u1ea1t \u0111\u1ed9ng t\u1ef1 \u0111\u1ed9ng. Th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 c\u00e1c ho\u1ea1t \u0111\u1ed9ng t\u1ef1 \u0111\u1ed9ng x\u1ea3y ra \u1edf v\u00f9ng mi\u1ec7ng (chi\u1ebfm 75% tr\u01b0\u1eddng h\u1ee3p) hay \u1edf c\u00e1c v\u00f9ng kh\u00e1c c\u1ee7a m\u1eb7t, c\u00f4 hay tay (50%). It g\u1eb7p h\u01a1n l\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111\u1ee9ng d\u1eady, ng\u1ed3i xu\u1ed1ng hay s\u1edd so\u1ea1ng, l\u1ea7n m\u00f2 c\u00e1c \u0111\u1ed3 v\u1eadt.<\/p>\n
C\u01a1n kh\u1edfi ph\u00e1t to\u00e0n th\u1ec3<\/h4>\n
a. C\u01a1n \u0111\u1ed9ng kinh kh\u1edfi ph\u00e1t to\u00e0n th\u1ec3 v\u1edbi bi\u1ec3u hi\u1ec7n v\u1eadn \u0111\u1ed9ng<\/em><\/p>\n
– C\u01a1n co c\u1ee9ng – co gi\u1eadt: l\u00e0 c\u00e1c c\u01a1n co gi\u1eadt c\u00f3 m\u1ea5t \u00fd th\u1ee9c, th\u01b0\u1eddng kh\u00f4ng c\u00f3 aura hay c\u00e1c d\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o, n\u1ebfu c\u00f3 ch\u1ec9 l\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u. C\u01a1n co c\u1ee9ng – co gi\u1eadt g\u1ed3m 3 pha:<\/p>\n
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Pha co c\u1ee9ng (tonic phase): bi\u1ec3u hi\u1ec7n trong pha n\u00e0y g\u1ed3m m\u1ea5t \u00fd th\u1ee9c, co c\u1ee9ng c\u00e1c c\u01a1 ch\u1ec9 trong 10 – 30 gi\u00e2y g\u00e2y du\u1ed7i t\u1ee9 chi v\u00e0 \u01b0\u1ee1n cong ng\u01b0\u1eddi nh\u01b0 b\u1ec7nh nh\u00e2n u\u1ed1n v\u00e1n, co c\u1ee9ng c\u01a1 h\u00f4 h\u1ea5p t\u1ea1o ti\u1ebfng th\u1edf \u1ed3n \u00e0o, t\u00edm t\u00e1i, co c\u00e1c c\u01a1 nhai c\u00f3 th\u1ec3 l\u00e0m b\u1ec7nh nh\u00e2n c\u1eafn l\u01b0\u1ee1i. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 b\u1ecb ng\u00e3 xu\u1ed1ng \u0111\u1ea5t v\u00e0 ch\u1ea5n th\u01b0\u01a1ng.<\/li>\n
Pha co gi\u1eadt (clonic phase – t\u00ecnh tr\u1ea1ng co c\u01a1 xen k\u1ebd v\u1edbi bi\u1ec3u hi\u1ec7n th\u01b0 gi\u00e3n c\u01a1): xu\u1ea5t hi\u1ec7n sau pha co c\u1ee9ng. B\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c c\u1eed \u0111\u1ed9ng gi\u1eadt chi \u0111\u1ed1i x\u1ee9ng, th\u01b0\u1eddng k\u00e9o d\u00e0i 30-60 gi\u00e2y ho\u1eb7c l\u00e2u h\u01a1n. Ngay sau khi k\u1ebft th\u00fac pha co c\u1ee9ng, h\u00f4 h\u1ea5p c\u1ee7a b\u1ec7nh nh\u00e2n h\u1ed3i ph\u1ee5c v\u00e0 kh\u00f4ng c\u00f2n t\u00ecnh tr\u1ea1ng t\u00edm t\u00e1i, c\u00f3 th\u1ec3 c\u00f3 s\u00f9i b\u1ecdt m\u00e9p. C\u00e1c c\u1eed \u0111\u1ed9ng gi\u1eadt th\u01b0a d\u1ea7n cho \u0111\u1ebfn khi ng\u1eebng h\u1eb3n c\u00e1c c\u1eed \u0111\u1ed9ng v\u00e0 c\u01a1 tr\u1edf n\u00ean m\u1ec1m nh\u0169ng. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 ti\u1ec3u d\u1ea7m do co c\u01a1 detrusor v\u00e0 d\u00e3n c\u01a1 v\u00f2ng. Sau \u0111\u00f3, b\u1ec7nh nh\u00e2n v\u1eabn c\u00f2n m\u1ea5t \u00fd th\u1ee9c m\u1ed9t kho\u1ea3ng th\u1eddi gian nh\u01b0ng hi\u1ebfm khi k\u00e9o d\u00e0i qu\u00e1 30 ph\u00fat.<\/li>\n
H\u1ed3i ph\u1ee5c: sau khi h\u1ed3i ph\u1ee5c \u00fd th\u1ee9c, b\u1ec7nh nh\u00e2n th\u01b0\u1eddng \u0111au \u0111\u1ea7u v\u00e0 c\u00f3 t\u00ecnh tr\u1ea1ng l\u00fa l\u1eabn sau c\u01a1n. Th\u01b0\u1eddng b\u1ec7nh nh\u00e2n h\u1ed3i t\u1ec9nh ho\u00e0n to\u00e0n sau kho\u1ea3ng 10 \u2013 30 ph\u00fat, th\u1eadm ch\u00ed l\u00e2u h\u01a1n n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh ho\u1eb7c c\u00f3 b\u1ea5t th\u01b0\u1eddng chuy\u1ec3n h\u00f3a hay c\u1ea5u tr\u00fac \u1edf n\u00e3o. Th\u0103m kh\u00e1m sau c\u01a1n th\u01b0\u1eddng b\u00ecnh th\u01b0\u1eddng trong \u0111\u1ed9ng kinh v\u00f4 c\u0103n hay c\u00e1c c\u01a1n \u0111\u1ed9ng kinh x\u1ea3y ra do nguy\u00ean nh\u00e2n chuy\u1ec3n h\u00f3a ngo\u1ea1i tr\u1eeb ph\u1ea3n x\u1ea1 da l\u00f2ng b\u00e0n ch\u00e2n c\u00f3 th\u1ec3 \u0111\u00e1p \u1ee9ng du\u1ed7i tho\u00e1ng qua. Ph\u1ea3n x\u1ea1 \u00e1nh s\u00e1ng lu\u00f4n d\u01b0\u01a1ng t\u00ednh ngay c\u1ea3 khi b\u1ec7nh nh\u00e2n m\u1ea5t \u00fd th\u1ee9c. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u00f3 y\u1ebfu n\u1eeda ng\u01b0\u1eddi tho\u00e1ng qua trong giai \u0111o\u1ea1n sau c\u01a1n (li\u1ec7t Todd), d\u1ea5u hi\u1ec7u n\u00e0y ph\u1ea3n \u00e1nh \u0111\u00e2y l\u00e0 c\u01a1n \u0111\u1ed9ng kinh c\u1ee5c b\u1ed9 chuy\u1ec3n th\u00e0nh co c\u1ee9ng – co gi\u1eadt hai b\u00ean v\u00e0 g\u1ee3i \u00fd nguy\u00ean nh\u00e2n co gi\u1eadt l\u00e0 do t\u1ed5n th\u01b0\u01a1ng n\u00e3o khu tr\u00fa.<\/li>\n<\/ul>\n
$\"C\u01a1n$
H\u00ecnh 22.1. \u1ea2nh minh ho\u1ea1 c\u01a1n co c\u1ee9ng \u2014 co gi\u1eadt to\u00e0n th\u1ec3 v\u1edbi 2 pha co c\u1ee9ng (tonic phase) v\u00e0 co gi\u1eadt (clonic phase)<\/figcaption><\/figure>\n
C\u01a1n co c\u1ee9ng (Tonic seizures) \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u00ecnh tr\u1ea1ng co c\u1ee9ng c\u01a1 ch\u1ec9 hay n\u00e2ng chi l\u00ean, th\u01b0\u1eddng k\u00e8m theo c\u1ee9ng c\u1ed5. T\u00ecnh tr\u1ea1ng co c\u01a1 li\u00ean t\u1ee5c khi\u1ebfn t\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n g\u1eadp hay du\u1ed7i b\u1ea5t th\u01b0\u1eddng, th\u1ec9nh tho\u1ea3ng k\u00e8m run \u1edf ng\u1ecdn chi. B\u1ec7nh nh\u00e2n c\u0169ng c\u00f3 t\u00ecnh tr\u1ea1ng m\u1ea5t \u00fd th\u1ee9c nh\u01b0ng kh\u00f4ng c\u00f3 pha co gi\u1eadt (clonic) \u0111i k\u00e8m.<\/p>\n
– C\u01a1n co gi\u1eadt (Clonic seizures) \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi c\u00e1c c\u1eed \u0111\u1ed9ng gi\u1eadt l\u1eb7p \u0111i l\u1eb7p l\u1ea1i, nh\u1ecbp nh\u00e0ng \u1edf t\u1ee9 chi, \u0111\u1ea7u, m\u1eb7t, c\u1ed5 v\u00e0 th\u00e2n m\u00ecnh k\u00e8m m\u1ea5t \u00fd th\u1ee9c nh\u01b0ng kh\u00f4ng c\u00f3 pha t\u0103ng tr\u01b0\u01a1ng l\u1ef1c tr\u01b0\u1edbc \u0111\u00f3. Lo\u1ea1i c\u01a1n n\u00e0y \u00edt g\u1eb7p h\u01a1n c\u01a1n co c\u1ee9ng -co gi\u1eadt v\u00e0 th\u01b0\u1eddng x\u1ea3y ra \u1edf tr\u1ebb nh\u1ecf.<\/p>\n
– C\u01a1n gi\u1eadt c\u01a1 (Myclonic seizures) \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi nh\u1eefng \u0111\u1ee3t co c\u01a1 ng\u1eafn, \u0111\u1ed9t ng\u1ed9t nh\u01b0 shock \u0111i\u1ec7n khu tr\u00fa \u1edf m\u1ed9t v\u00e0i c\u01a1, m\u1ed9t hay v\u00e0i chi hay to\u00e0n th\u1ec3 g\u00e2y t\u00e9 ng\u00e3. Nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 \u0111\u1ed9ng kinh gi\u1eadt c\u01a1 thi\u1ebfu ni\u00ean (Juvenile myoclonic epilepsy), tuy nhi\u00ean, kh\u00f4ng ph\u1ea3i m\u1ecdi gi\u1eadt c\u01a1 \u0111\u1ec1u do c\u0103n nguy\u00ean \u0111\u1ed9ng kinh. So v\u1edbi c\u01a1n co gi\u1eadt th\u00ec c\u01a1n gi\u1eadt c\u01a1 ng\u1eafn h\u01a1n v\u00e0 \u00edt \u0111\u1ec1u \u0111\u1eb7n h\u01a1n.<\/p>\n
– C\u01a1n m\u1ea5t tr\u01b0\u01a1ng l\u1ef1c (Atonic seizures): \u0111\u1eb7c tr\u01b0ng l\u00e0 c\u00e1c \u0111\u1ee3t m\u1ea5t tr\u01b0\u01a1ng l\u1ef1c t\u01b0 th\u1ebf ng\u1eafn x\u1ea3y ra \u0111\u1ed9t ng\u1ed9t. Khi ch\u00e2n m\u1ea5t tr\u01b0\u01a1ng l\u1ef1c trong c\u01a1n m\u1ea5t tr\u01b0\u01a1ng l\u1ef1c to\u00e0n th\u1ec3, b\u1ec7nh nh\u00e2n s\u1ebd t\u00e9 \u0111\u1eadp m\u00f4ng xu\u1ed1ng ho\u1eb7c th\u1ec9nh tho\u1ea3ng t\u00e9 ra tr\u01b0\u1edbc \u0111\u1eadp g\u1ed1i v\u00e0 m\u1eb7t xu\u1ed1ng s\u00e0n. Ng\u01b0\u1ee3c l\u1ea1i, trong c\u00e1c c\u01a1n co c\u1ee9ng hay co c\u1ee9ng \u2013 co gi\u1eadt th\u00ec b\u1ec7nh nh\u00e2n th\u01b0\u1eddng b\u1ecb \u0111\u1ea9y ng\u00e3 v\u1ec1 ph\u00eda sau. C\u00e1c c\u01a1n n\u00e0y th\u01b0\u1eddng g\u1eb7p nh\u1ea5t trong h\u1ed9i ch\u1ee9ng Lennox-Gastaut.<\/p>\n
– C\u01a1n gi\u1eadt c\u01a1 – co c\u1ee9ng – co gi\u1eadt to\u00e0n th\u1ec3 (Generalized myoclonic – tonic – clonic) b\u1eaft \u0111\u1ea7u v\u1edbi nh\u1eefng c\u1eed \u0111\u1ed9ng gi\u1eadt c\u01a1 theo sau l\u00e0 tri\u1ec7u ch\u1ee9ng co c\u1ee9ng co gi\u1eadt. Nh\u1eefng c\u01a1n n\u00e0y hay g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n b\u1ecb h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng kinh gi\u1eadt c\u01a1 thi\u1ebfu ni\u00ean (Juvenile myoclonic epilepsy) v\u00e0 c\u00e1c \u0111\u1ed9ng kinh to\u00e0n th\u1ec3 kh\u00e1c.<\/p>\n
– C\u01a1n gi\u1eadt c\u01a1 – m\u1ea5t tr\u01b0\u01a1ng l\u1ef1c (Myoclonic atonic) bi\u1ec3u hi\u1ec7n nh\u1eefng c\u1eed \u0111\u1ed9ng gi\u1eadt c\u01a1 ng\u1eafn c\u1ee7a chi hay th\u00e2n, theo sau l\u00e0 m\u1ea5t tr\u01b0\u01a1ng l\u1ef1c chi. Nh\u1eefng c\u01a1n ki\u1ec3u n\u00e0y, tr\u01b0\u1edbc \u0111\u00e2y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 gi\u1eadt c\u01a1 m\u1ea5t \u0111\u1ee9ng, th\u01b0\u1eddng g\u1eb7p nh\u1ea5t trong h\u1ed9i ch\u1ee9ng Doose, nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 c\u00f3 trong h\u1ed9i ch\u1ee9ng Lennox Gastaut v\u00e0 c\u00e1c h\u1ed9i ch\u1ee9ng kh\u00e1c.<\/p>\n
– C\u01a1n \u0111\u1ed9ng kinh co th\u1eaft (Epileptic spasms) v\u1edbi bi\u1ec3u hi\u1ec7n \u0111\u1ed9t ng\u1ed9t g\u1eadp, du\u1ed7i ho\u1eb7c g\u1eadp du\u1ed7i k\u1ebft h\u1ee3p ch\u1ee7 y\u1ebfu c\u1ee7a c\u01a1 tr\u1ee5c th\u00e2n v\u00e0 g\u1ed1c chi. C\u00e1c c\u01a1n n\u00e0y th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n th\u00e0nh c\u1ee5m v\u00e0 hay g\u1eb7p nh\u1ea5t \u1edf tr\u1ebb nh\u0169 nhi.<\/p>\n
b. C\u01a1n \u0111\u1ed9ng kinh to\u00e0n th\u1ec3 kh\u00f4ng bi\u1ec3u hi\u1ec7n v\u1eadn \u0111\u1ed9ng<\/em> (C\u01a1n v\u1eafng \u00fd th\u1ee9c)<\/em>: g\u1ed3m c\u00f3 nhi\u1ec1u th\u1ec3. C\u1ea7n ph\u00e2n bi\u1ec7t c\u01a1n v\u1eafng \u00fd th\u1ee9c \u0111i\u1ec3n h\u00ecnh v\u1edbi c\u01a1n v\u1eafng \u00fd th\u1ee9c kh\u00f4ng \u0111i\u1ec3n h\u00ecnh b\u1edfi hai lo\u1ea1i c\u01a1n n\u00e0y c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m \u0111i\u1ec7n n\u00e3o \u0111\u1ed3, h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng kinh, \u0111i\u1ec1u tr\u1ecb v\u00e0 ti\u00ean l\u01b0\u1ee3ng kh\u00e1c nhau.<\/p>\n
– C\u01a1n v\u1eafng \u00fd th\u1ee9c \u0111i\u1ec3n h\u00ecnh: x\u1ea3y ra \u1edf tr\u1ebb nh\u1ecf, bi\u1ec3u hi\u1ec7n \u0111\u1eb7c tr\u01b0ng c\u1ee7a c\u01a1n l\u00e0 c\u00e1c \u0111\u1ee3t m\u1ea5t \u00fd th\u1ee9c ng\u1eafn (5-10 gi\u00e2y) m\u00e0 kh\u00f4ng k\u00e8m m\u1ea5t tr\u01b0\u01a1ng l\u1ef1c t\u01b0 th\u1ebf. C\u00e1c c\u01a1n n\u00e0y \u0111\u01b0\u1ee3c ho\u1ea1t h\u00f3a b\u1edfi nghi\u1ec7m ph\u00e1p t\u0103ng th\u00f4ng kh\u00ed. Trong c\u01a1n, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u00f3 v\u00e0i bi\u1ec3u hi\u1ec7n v\u1eadn \u0111\u1ed9ng tinh t\u1ebf nh\u01b0 ch\u1edbp m\u1eaft, xoay \u0111\u1ea7u nh\u1eb9 kh\u00e1 th\u01b0\u1eddng g\u1eb7p trong khi c\u00e1c ho\u1ea1t \u0111\u1ed9ng t\u1ef1 \u0111\u1ed9ng (automatisms) th\u00ec hi\u1ebfm g\u1eb7p h\u01a1n. Sau khi h\u1ebft c\u01a1n, b\u1ec7nh nh\u00e2n h\u1ed3i ph\u1ee5c \u00fd th\u1ee9c ngay. B\u1ec7nh nh\u00e2n c\u00f3 r\u1ea5t nhi\u1ec1u c\u01a1n, th\u1eadm ch\u00edh\u00e0ng tr\u0103m c\u01a1n m\u1ed7i ng\u00e0y, l\u00e0m gi\u1ea3m kh\u1ea3 n\u0103ng h\u1ecdc t\u1eadp v\u00e0 t\u01b0\u01a1ng t\u00e1c x\u00e3 h\u1ed9i, do \u0111\u00f3 nhi\u1ec1u b\u1ec7nh nhi \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n nh\u1ea7m l\u00e0 ch\u1eadm ph\u00e1t tri\u1ec3n t\u00e2m th\u1ea7n. \u0110i\u1ec7n n\u00e3o \u0111\u1ed3 trong c\u01a1n cho th\u1ea5y h\u00ecnh \u1ea3nh \u0111\u1eb7c tr\u01b0ng l\u00e0 c\u00e1c gai \u2013 s\u00f3ng 3 chu k\u1ef3\/gi\u00e2y v\u00e0 ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n ph\u00e1t tri\u1ec3n t\u00e2m th\u1ea7n b\u00ecnh th\u01b0\u1eddng c\u00f3 ho\u1ea1t \u0111\u1ed9ng \u0111i\u1ec7n n\u00e3o n\u1ec1n b\u00ecnh th\u01b0\u1eddng.<\/p>\n
– C\u01a1n v\u1eafng \u00fd th\u1ee9c kh\u00f4ng \u0111i\u1ec3n h\u00ecnh: so v\u1edbi c\u01a1n v\u1eafng \u00fd th\u1ee9c \u0111i\u1ec3n h\u00ecnh th\u00ec c\u01a1n v\u1eafng \u00fd th\u1ee9c kh\u00f4ng \u0111i\u1ec3n h\u00ecnh c\u00f3 thay \u0111\u1ed5i tr\u01b0\u01a1ng l\u1ef1c c\u01a1 r\u00f5 r\u00e0ng h\u01a1n, kh\u1edfi \u0111\u1ea7u hay k\u1ebft th\u00fac c\u01a1n \u00edt \u0111\u1ed9t ng\u1ed9t h\u01a1n. \u0110i\u1ec7n n\u00e3o \u0111\u1ed3 trong c\u01a1n cho th\u1ea5y c\u00e1c gai \u2013 s\u00f3ng < 2,5 chu k\u1ef3\/gi\u00e2y v\u00e0 ho\u1ea1t \u0111\u1ed9ng n\u1ec1n b\u1ea5t th\u01b0\u1eddng.<\/p>\n
– C\u01a1n v\u1eafng \u00fd th\u1ee9c gi\u1eadt c\u01a1 (Myoclonic absence seizure) l\u00e0 nh\u1eefng c\u01a1n v\u0103ng \u00fd th\u1ee9c k\u00e8m c\u00e1c c\u1eed \u0111\u1ed9ng gi\u1eadt c\u01a1 c\u00f3 nh\u1ecbp v\u1edbi t\u1ea7n s\u1ed1 3 chu k\u1ef3\/gi\u00e2y l\u00e0m hai tay b\u1ec7nh nh\u00e2n d\u1ea1ng ra t\u1eeb t\u1eeb r\u1ed3i n\u00e2ng c\u00e1nh tay l\u00ean t\u01b0\u01a1ng \u1ee9ng tr\u00ean \u0111i\u1ec7n n\u00e3o l\u00e0 c\u00e1c ph\u00f3ng l\u1ef1c gai s\u00f3ng 3 chu k\u1ef3\/gi\u00e2y. C\u01a1n k\u00e9o d\u00e0i kho\u1ea3ng 10 60 gi\u00e2y v\u00e0 t\u00ecnh tr\u1ea1ng gi\u1ea3m \u00fd th\u1ee9c c\u00f3 th\u1ec3 kh\u00f4ng r\u00f5 rang nh\u01b0 trong c\u01a1n \u00fd th\u1ee9c \u0111i\u00ean h\u00ecnh.<\/p>\n
– Gi\u1eadt c\u01a1 m\u00ed m\u1eaft (Eyelid myoclonia) c\u00f3 bi\u1ec3u hi\u1ec7n l\u00e0 c\u00e1c gi\u1eadt c\u01a1 m\u00ed m\u1eaft k\u00e8m hai m\u1eaft nh\u00ecn l\u00ean. C\u00e1c c\u01a1n n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c th\u00fac \u0111\u1ea9y b\u1edfi k\u00edch th\u00edch \u00e1nh s\u00e1ng hay khi nh\u1eafm m\u1eaft. Gi\u1eadt c\u01a1 m\u00ed m\u1eaft c\u00f3 th\u1ec3 \u0111i k\u00e8m v\u1edbi c\u01a1n v\u1eafng \u00fd th\u1ee9c hay c\u00e1c c\u01a1n \u0111\u1ed9ng kinh c\u00f3 bi\u1ec3u hi\u1ec7n v\u1eadn \u0111\u1ed9ng kh\u00e1c. C\u01a1n v\u1eafng \u00fd th\u1ee9c k\u00e8m gi\u1eadt c\u01a1 m\u00ed m\u1eaft, c\u00e1c c\u01a1n \u0111\u1ed9ng kinh, bi\u1ec3u hi\u1ec7n k\u1ecbch ph\u00e1t tr\u00ean \u0111i\u1ec7n n\u00e3o \u0111\u1ed3 khi nh\u1eafm m\u1eaft hay khi k\u00edch th\u00edch \u00e1nh s\u00e1ng l\u00e0 tam ch\u1ee9ng c\u1ee7a h\u1ed9i ch\u1ee9ng Jeavons.<\/p>\n
B\u1ea3ng 22.2. C\u00e1c y\u1ebfu t\u1ed1 kinh \u0111i\u1ec3n ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t c\u01a1n \u0111\u1ed9ng kinh, c\u01a1n ng\u1ea5t v\u00e0 c\u01a1n gi\u1ea3 \u0111\u1ed9ng kinh<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
\u0110\u1eb7c \u0111i\u1ec3m<\/strong><\/td>\n C\u01a1n \u0111\u1ed9ng kinh<\/strong><\/td>\n C\u01a1n ng\u1ea5t<\/strong><\/td>\n **C\u01a1n gi\u1ea3 \u0111\u1ed9ng kinh (c\u01a1n co gi\u1eadt kh\u00f4ng ph\u1ea3i \u0111\u1ed9ng kinh do c\u0103n nguy\u00ean t\u00e2m l\u00fd) *<\/strong><\/td>\n<\/tr>\n**
Th\u1eddi \u0111i\u1ec3m<\/td>\n Ng\u00e0y hay \u0111\u00eam<\/td>\n Ng\u00e0y<\/td>\n Ng\u00e0y, c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a ng\u01b0\u1eddi kh\u00e1c<\/td>\n<\/tr>\n
Kh\u1edfi ph\u00e1t<\/td>\n \u0110\u1ed9t ng\u1ed9t, \u1edf b\u1ea5t k\u1ef3 t\u01b0 th\u1ebf n\u00e0o<\/td>\n T\u1eeb t\u1eeb, t\u01b0 th\u1ebf \u0111\u1ee9ng (kh\u00f4ng x\u1ea3y ra \u1edf t\u01b0 th\u1ebf n\u1eb1m)<\/td>\n \u0110\u01b0\u1ee3c g\u00e2y ra khi c\u00f3 s\u1ef1 g\u1ee3i \u00fd hay x\u00e1o tr\u1ed9n v\u1ec1 c\u1ea3m x\u00fac<\/td>\n<\/tr>\n
Tri\u1ec7u ch\u1ee9ng b\u00e1o tr\u01b0\u1edbc<\/td>\n C\u00f3 th\u1ec3 c\u00f3 aura \u0111\u1eb7c hi\u1ec7u<\/td>\n Cho\u00e1ng v\u00e1ng, t\u00e1i nh\u1ee3t, v\u00e3 m\u1ed3 h\u00f4i<\/td>\n Thay \u0111\u1ed5i<\/td>\n<\/tr>\n
Giai \u0111o\u1ea1n gian c\u01a1n<\/td>\n Ng\u1eafn hay d\u00e0i<\/td>\n Ng\u1eafn<\/td>\n Th\u01b0\u1eddng d\u00e0i<\/td>\n<\/tr>\n
Ti\u00eau – ti\u00eau kh\u00f4ng t\u1ef1 ch\u1ee7<\/td>\n Th\u01b0\u1eddng c\u00f3<\/td>\n C\u00f3 th\u1ec3 c\u00f3 nh\u01b0ng hi\u1ebfm<\/td>\n Hi\u1ebfm<\/td>\n<\/tr>\n
Giai \u0111o\u1ea1n sau con<\/td>\n Xu\u1ea5t hi\u1ec7n trong c\u01a1n co c\u1ee9ng -CO gi\u1eadt, hay c\u1ee5c b\u1ed9 c\u00f3 suy gi\u1ea3m \u00fd th\u1ee9c<\/td>\n Kh\u00f4ng c\u00f3<\/td>\n Thay \u0111\u1ed5i, th\u01b0\u1eddng kh\u00f4ng c\u00f3<\/td>\n<\/tr>\n
Ho\u1ea1t \u0111\u1ed9ng v\u1eadn \u0111\u1ed9ng<\/td>\n \u0110\u1ed3ng th\u00ec (synchronous), c\u00f3 t\u00ednh \u0111\u1ecbnh h\u00ecnh, c\u00e1c ho\u1ea1t \u0111\u1ed9ng t\u1ef1 \u0111\u1ed9ng (th\u01b0\u1eddng c\u00f3 trong c\u01a1n v\u1eafng \u00fd th\u1ee9c v\u00e0 c\u01a1n c\u1ee5c b\u1ed9 c\u00f3 suy gi\u1ea3m \u00fd th\u1ee9c), v\u1ebft c\u1eafn \u1edf m\u1eb7t b\u00ean l\u01b0\u1ee1i, m\u1eaft tr\u1ee3n ng\u01b0\u1ee3c<\/td>\n Th\u1ec9nh tho\u1ea3ng c\u00f3 v\u00e0i c\u1eed \u0111\u1ed9ng gi\u1eadt ng\u1eafn<\/td>\n T\u01b0 th\u1ec3 u\u1ed1n v\u00e1n (opisthotonos), g\u1ed3ng c\u1ee9ng, nh\u1eafm m\u1eaft, l\u1eafc \u0111\u1ea7u, \u0111\u1ea9y khung ch\u1eadu l\u00ean, kh\u00f3c, c\u00e1c c\u1eed \u0111\u1ed9ng m\u1eaft nh\u00ecn xu\u1ed1ng \u0111\u1ea5t, v\u1ebft c\u1eafn \u1edf \u0111\u1ea7u l\u01b0\u1ee1i<\/td>\n<\/tr>\n
Ch\u1ea5n th\u01b0\u01a1ng<\/td>\n Th\u01b0\u1eddng c\u00f3<\/td>\n Hi\u1ebfm, tr\u1eeb khi c\u00f3 t\u00e9 ng\u00e3<\/td>\n Hi\u1ebfm<\/td>\n<\/tr>\n
\u0110i\u1ec7n n\u00e3o \u0111\u1ed3<\/td>\n Th\u01b0\u1eddng c\u00f3 b\u1ea5t th\u01b0\u1eddng \u00b1 ph\u00f3ng \u0111i\u1ec7n ngo\u00e0i c\u01a1n<\/td>\n B\u00ecnh th\u01b0\u1eddng<\/td>\n B\u00ecnh th\u01b0\u1eddng<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
* C\u01a1n gi\u1ea3 \u0111\u1ed9ng kinh kh\u00f4ng cho ph\u00e9p lo\u1ea1i tr\u1eeb \u0111\u1ed9ng kinh (v\u00ec b\u1ec7nh nh\u00e2n \u0111\u1ed9ng kinh c\u00f3 th\u1ec3 c\u00f3 c\u00e1c c\u01a1n \u0111\u1ed9ng kinh v\u00e0 c\u00e1c c\u01a1n gi\u1ea3 \u0111\u1ed9ng kinh, bi\u1ec3u hi\u1ec7n n\u00e0y kh\u00f4ng ph\u1ea3i hi\u1ebfm g\u1eb7p).<\/p>\n
C\u00e1c c\u01a1n \u0111\u1ed9ng kinh do cai r\u01b0\u1ee3u c\u00f3 th\u1ec3 x\u1ea3y ra trong v\u00f2ng 2 ng\u00e0y sau l\u1ea7n u\u1ed1ng r\u01b0\u1ee3u cu\u1ed1i c\u00f9ng.<\/p>\n
C\u1eadn l\u00e2m s\u00e0ng<\/h3>\n
– C\u00f4ng th\u1ee9c m\u00e1u, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3, Ca^{2+<\/sup>, Mg^{2+<\/sup>, \u0111\u01b0\u1eddng huy\u1ebft, t\u1ed1c \u0111\u1ed9 l\u1eafng m\u00e1u, creatinin, men gan, CK, prolactin.<\/p>\n}}
– Xem x\u00e9t t\u1ea7m so\u00e1t \u0111\u1ed9c ch\u1ea5t, n\u1ed3ng \u0111\u1ed9 c\u1ed3n, n\u1ed3ng \u0111\u1ed9 thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh.<\/p>\n
– CT\/MRI n\u00e3o (n\u1ebfu l\u00e0 c\u01a1n \u0111\u1ed9ng kinh m\u1edbi kh\u00f4ng c\u00f3 nguy\u00ean nh\u00e2n n\u00e0o \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh hay ti\u1ec1n s\u1eed \u0111\u00e3 c\u00f3 \u0111\u1ed9ng kinh nh\u01b0ng c\u01a1n l\u1ea7n n\u00e0y l\u1ea1i c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng\/d\u1ea5u hi\u1ec7u th\u1ea7n kinh m\u1edbi).<\/p>\n
– Ch\u1ecdc d\u00f2 t\u1ee7y s\u1ed1ng (n\u1ebfu c\u00f3 s\u1ed1t hay h\u1ed9i ch\u1ee9ng m\u00e0ng n\u00e3o).<\/p>\n
– \u0110i\u1ec7n n\u00e3o \u0111\u1ed3 (EEG).<\/p>\n
\u0110i\u1ec1u tr\u1ecb<\/h3>\n
-Tr\u00e1nh c\u00e1c y\u1ebfu t\u1ed1 t\u1ea1o thu\u1eadn l\u1ee3i x\u1ea3y ra c\u01a1n.<\/p>\n
-Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh: EEG c\u00f3 c\u00e1c ho\u1ea1t \u0111\u1ed9ng d\u1ea1ng \u0111\u1ed9ng kinh, t\u1ed5n th\u01b0\u01a1ng n\u00e3o (b\u1ec7nh n\u00e3o th\u1ef1c th\u1ec3, ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ea7u hay nhi\u1ec5m tr\u00f9ng h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng tr\u01b0\u1edbc \u0111\u00e2y) nh\u01b0ng x\u1ea3y ra sau kho\u1ea3ng th\u1eddi gian g\u00e2y c\u01a1n \u0111\u1ed9ng kinh tri\u1ec7u ch\u1ee9ng c\u1ea5p (d\u01b0\u1edbi 7-10 ng\u00e0y), kh\u00e1m th\u1ea7n kinh b\u1ea5t th\u01b0\u1eddng hay c\u00f3 c\u00e1c b\u1ea5t th\u01b0\u1eddng \u0111\u1eb7c hi\u1ec7u tr\u00ean h\u00ecnh \u1ea3nh h\u1ecdc th\u1ea7n kinh, c\u01a1n \u0111\u1ed9ng kinh x\u1ea3y ra v\u00e0o ban \u0111\u00eam.<\/p>\n
– V\u1ea5n \u0111\u1ec1 v\u1ec1 t\u00e2m l\u00fd x\u00e3 h\u1ed9i: d\u1ea5u hi\u1ec7u c\u1ee7a c\u01a1n \u0111\u1ed9ng kinh, gi\u00e1o d\u1ee5c s\u1ee9c kh\u1ecfe cho b\u1ec7nh nh\u00e2n v\u00e0 th\u00e2n nh\u00e2n, t\u00ecnh tr\u1ea1ng v\u1ec1 b\u1eb1ng l\u00e1i xe, v\u1ea5n \u0111\u1ec1 v\u1ec1 thai k\u1ef3 tr\u00ean b\u1ec7nh nh\u00e2n \u0111\u1ed9ng kinh n\u1eef.<\/p>\n
– T\u01b0 v\u1ea5n v\u1ec1 an to\u00e0n ng\u01b0\u1eddi b\u1ec7nh trong c\u00e1c ho\u1ea1t \u0111\u1ed9ng l\u00e1i xe, v\u1eadn h\u00e0nh m\u00e1y m\u00f3c, t\u1eafm r\u1eeda, b\u01a1i l\u1ed9i m\u1ed9t m\u00ecnh.<\/p>\n
– \u0110\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt \u0111\u1ed1i v\u1edbi c\u00e1c c\u01a1n \u0111\u1ed9ng kinh c\u1ee5c b\u1ed9 kh\u00e1ng thu\u1ed1c.<\/p>\n
TR\u1ea0NG TH\u00c1I \u0110\u1ed8NG KI\u039d\u0397<\/h2>\n
\u0110\u1ecbnh ngh\u0129a<\/h3>\n
– Theo li\u00ean \u0111o\u00e0n Ch\u1ed1ng \u0111\u1ed9ng kinh qu\u1ed1c t\u1ebf, tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh l\u00e0 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd do suy y\u1ebfu c\u01a1 ch\u1ebf l\u00e0m k\u1ebft th\u00fac c\u01a1n \u0111\u1ed9ng kinh ho\u1eb7c l\u00e0 do s\u1ef1 kh\u1edfi \u0111\u1ed9ng c\u00e1c c\u01a1 ch\u1ebf l\u00e0m cho c\u00e1c c\u01a1n \u0111\u1ed9ng kinh k\u00e9o d\u00e0i b\u1ea5t th\u01b0\u1eddng (sau th\u1eddi \u0111i\u1ec3m 11). T\u00ecnh tr\u1ea1ng n\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn nh\u1eefng bi\u1ebfn ch\u1ee9ng d\u00e0i h\u1ea1n (sau th\u1eddi \u0111i\u1ec3m 12) nh\u01b0 t\u1ed5n th\u01b0\u01a1ng, ch\u1ebft t\u1ebf b\u00e0o th\u1ea7n kinh, thay \u0111\u1ed5i m\u1ea1ng l\u01b0\u1edbi th\u1ea7n kinh t\u00f9y thu\u1ed9c v\u00e0o lo\u1ea1i c\u01a1n v\u00e0 \u0111\u1ed9 d\u00e0i c\u1ee7a c\u01a1n \u0111\u1ed9ng kinh. B\u1ea3ng 22.3 cho th\u1ea5y c\u00e1c gi\u1edbi h\u1ea1n th\u1eddi gian v\u1ec1 tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh \u00e1p d\u1ee5ng tr\u00ean l\u00e2m s\u00e0ng.<\/p>\n
B\u1ea3ng 22.3. C\u00e1c m\u1ed1c th\u1eddi gian c\u1ea7n l\u01b0u \u00fd trong th\u1ef1c h\u00e0nh v\u1ec1 TT\u0110K v\u1edbi t1 l\u00e0 th\u1eddi \u0111i\u1ec3m n\u00ean kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb TT\u0110K c\u1ea5p c\u1ee9u v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng d\u00e0i d\u1ea1n c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n sau th\u1eddi \u0111i\u1ec3m t2<\/p>\n\n\n\n\n\n\n
Lo\u1ea1i TT\u0110K<\/strong><\/td>\n Th\u1eddi \u0111i\u1ec3m t1<\/strong><\/td>\n Th\u1eddi \u0111i\u1ec3m t2<\/strong><\/td>\n<\/tr>\n
TT\u0110K co c\u1ee9ng \u2013 co gi\u1eadt<\/td>\n 5 ph\u00fat<\/td>\n 30 ph\u00fat<\/td>\n<\/tr>\n
TT\u0110K c\u1ee5c b\u1ed9 c\u00f3 \u1ea3nh h\u01b0\u1edfng \u00fd th\u1ee9c<\/td>\n 10 ph\u00fat<\/td>\n > 60 ph\u00fat<\/td>\n<\/tr>\n
TT\u0110K v\u1eafng \u00fd th\u1ee9c<\/td>\n 10-15 ph\u00fat<\/td>\n Kh\u00f4ng r\u00f5<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Bi\u1ebfn ch\u1ee9ng<\/h3>\n
– Tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 x\u1eed tr\u00ed k\u1ecbp th\u1eddi s\u1ebd \u0111\u1ec3 l\u1ea1i h\u1eadu qu\u1ea3 n\u1eb7ng n\u1ec1 nh\u01b0: thi\u1ebfu oxy, thi\u1ebfu m\u00e1u n\u00e3o v\u00e0 ph\u00f9 n\u00e3o, nh\u1ed3i m\u00e1u c\u01a1 tim, lo\u1ea1n nh\u1ecbp tim, ng\u01b0ng tim, h\u1ee7y c\u01a1 v\u00e0 suy th\u1eadn, vi\u00eam ph\u1ed5i\/vi\u00eam ph\u1ed5i h\u00edt, th\u1eadm ch\u00ed l\u00e0 t\u1eed vong (20%).<\/p>\n
Bi\u1ec7n ph\u00e1p x\u1eed tr\u00ed ban \u0111\u1ea7u<\/h3>\n
– \u1ed4n \u0111\u1ecbnh b\u1ec7nh nh\u00e2n theo nguy\u00ean t\u1eafc ABC.<\/p>\n
– Nhanh ch\u00f3ng m\u1eafc monitor theo d\u00f5i sinh hi\u1ec7u, x\u00e9t nghi\u1ec7m \u0111\u01b0\u1eddng huy\u1ebft mao m\u1ea1ch, ECG.<\/p>\n
– Th\u1edf oxy\/m\u0169i.<\/p>\n
– Truy\u1ec1n t\u0129nh m\u1ea1ch NaCl 0,9%, glucose, ti\u00eam thiamine.<\/p>\n
– Kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch (n\u1ebfu suy h\u00f4 h\u1ea5p\/t\u00edm t\u00e1i).<\/p>\n
– L\u01b0u \u0111\u1ed3 x\u1eed tr\u00ed tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh co c\u1ee9ng \u2013 co gi\u1eadt c\u1ee5 th\u1ec3 \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y trong l\u01b0u \u0111\u1ed3 22.1.<\/p>\n
X\u00e9t nghi\u1ec7m m\u00e1u<\/h3>\n
– \u0110i\u1ec7n gi\u1ea3i \u0111\u1ed3, Ca^{2+<\/sup>, Mg^{2+<\/sup>, PO_{4<\/sub>^{3-<\/sup>.<\/p>\n}}}}
– C\u00f4ng th\u1ee9c m\u00e1u, \u0111\u01b0\u1eddng huy\u1ebft.<\/p>\n
– \u0110\u1ecbnh l\u01b0\u1ee3ng n\u1ed3ng \u0111\u1ed9 ethanol, thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh.<\/p>\n
-T\u1ea7m so\u00e1t \u0111\u1ed9c ch\u1ea5t.<\/p>\n
B\u1ec7nh s\u1eed<\/h3>\n
C\u1ea7n khai th\u00e1c c\u00e1c y\u1ebfu t\u1ed1 sau:<\/strong><\/p>\n
– Ki\u1ec3u kh\u1edfi ph\u00e1t.<\/p>\n
– Ti\u1ec1n s\u1eed c\u00e1c c\u01a1n \u0111\u1ed9ng kinh, s\u1eed d\u1ee5ng thu\u1ed1c v\u00e0 r\u01b0\u1ee3u, ti\u1ec1n s\u1eed, c\u00e1c tri\u1ec7u ch\u1ee9ng k\u00e8m theo.<\/p>\n
– B\u1ec7nh s\u1eed t\u1eeb nh\u1eefng ng\u01b0\u1eddi ch\u1ee9ng ki\u1ebfn c\u01a1n hay ng\u01b0\u1eddi th\u00e2n.<\/p>\n
Kh\u00e1m th\u1ef1c th\u1ec3 (khi c\u01a1n \u0111\u1ed9ng kinh \u0111\u00e3 \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t)<\/h3>\n
– M\u1ee9c \u0111\u1ed9 \u00fd th\u1ee9c, sinh hi\u1ec7u.<\/p>\n
– Kh\u00e1m v\u00f9ng \u0111\u1ea7u m\u1eb7t c\u1ed5 (c\u1ed5 g\u01b0\u1ee3ng, ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ea7u, v\u1ebft c\u1eafn l\u01b0\u1ee1i, ph\u00f9 gai th\u1ecb).<\/p>\n
– Kh\u00e1m th\u1ea7n kinh to\u00e0n di\u1ec7n, t\u00ecm c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a b\u1ec7nh th\u1ea7n kinh-da.<\/p>\n
– Kh\u00e1m tim: gi\u1ea3m ph\u1ebf \u00e2m, \u00e2m th\u1ed5i \u1edf tim hay lo\u1ea1n nh\u1ecbp tim.<\/p>\n
– Kh\u00e1m c\u01a1-x\u01b0\u01a1ng-kh\u1edbp (lo\u1ea1i tr\u1eeb ch\u1ea5n th\u01b0\u01a1ng).<\/p>\n
Khi t\u00ecnh tr\u1ea1ng b\u1ec7nh nh\u00e2n \u1ed7n sau \u0111i\u1ec1u tr\u1ecb<\/h3>\n
– CT scan s\u1ecd n\u00e3o.<\/p>\n
– EEG.<\/p>\n
–\u00a0 \u0110\u1eb7t th\u00f4ng Foley theo d\u00f5i n\u01b0\u1edbc ti\u1ec3u, t\u1ea7m so\u00e1t \u0111\u1ed9c ch\u1ea5t trong n\u01b0\u1edbc ti\u1ec3u.<\/p>\n
– Theo d\u00f5i t\u00ecnh tr\u1ea1ng h\u1ee7y c\u01a1.<\/p>\n
– Truy\u1ec1n d\u1ecbch nh\u1eb1m duy tr\u00ec \u00e1p l\u1ef1c t\u01b0\u1edbi m\u00e1u n\u00e3o b\u00ecnh th\u01b0\u1eddng.<\/p>\n
\u0110i\u1ec1u tr\u1ecb<\/h3>\n
– C\u01a1n \u0111\u1ed9ng kinh c\u1ee5c b\u1ed9 v\u00e0 h\u1ea7u h\u1ebft c\u00e1c c\u01a1n \u0111\u1ed9ng kinh to\u00e0n th\u1ec3: valproate, lamotrigine, levetiracetam, topiramate, phenobarbital, primidone, zonisamide, rufinamide, felbamate, benzodiazepines.<\/p>\n
– C\u01a1n \u0111\u1ed9ng kinh c\u1ee5c b\u1ed9 (\u00b1 to\u00e0n th\u1ec3 h\u00f3a th\u1ee9 ph\u00e1t): carbamazepine, phenytoin, gabapentin, oxcarbazepine, pregabalin, eslicarbazepine acetate, perampenel. tiagabine, lacosamide, vigabatrin,<\/p>\n
– C\u01a1n v\u1eafng \u00fd th\u1ee9c: ethosuximide, valproate.<\/p>\n
– Vi\u1ec7c l\u1ef1a ch\u1ecdn thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh c\u1ea7n \u0111\u01b0\u1ee3c c\u00e1 th\u1ec3 h\u00f3a t\u00f9y theo lo\u1ea1i c\u01a1n, h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng kinh, c\u00e1c b\u1ec7nh \u0111\u1ed3ng -m\u1eafc v\u00e0 v\u00e0i c\u01a1 \u0111\u1ecba \u0111\u1eb7c bi\u1ec7t nh\u01b0 ph\u1ee5 n\u1eef trong \u0111\u1ed9 tu\u1ed5i sinh s\u1ea3n, ng\u01b0\u1eddi l\u1edbn tu\u1ed5i.<\/p>\n
Lu\u00f4n lu\u00f4n theo d\u00f5i b\u1eb1ng EEG li\u00ean t\u1ee5c n\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng h\u1ed3i t\u1ec9nh nhanh ch\u00f3ng sau khi ng\u1eebng co gi\u1eadt tr\u00ean l\u00e2m s\u00e0ng hay khi s\u1eed d\u1ee5ng b\u1ea5t k\u1ef3 thu\u1ed1c TTM li\u00ean t\u1ee5c n\u00e0o<\/em><\/strong><\/p>\n
$\"C\u01a1n$
L\u01b0u \u0111\u1ed3 22.1. X\u1eed tr\u00ed tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh co c\u1ee9ng \u2014 co gi\u1eadt<\/figcaption><\/figure>\n","protected":false},"excerpt":{"rendered":"
T\u1ea3i file PDF t\u1ea1i \u0111\u00e2y. \u0110\u1ed8NG KINH \u0110\u1ecbnh ngh\u0129a – C\u01a1n \u0111\u1ed9ng kinh (seizure) l\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0\/hay d\u00e2u hi\u1ec7u xu\u1ea5t hi\u1ec7n tho\u00e1ng qua do s\u1ef1 ho\u1ea1t \u0111\u1ed9ng \u0111\u1ed3ng b\u1ed9 hay qu\u00e1 m\u1ee9c b\u1ea5t th\u01b0\u1eddng c\u1ee7a c\u00e1c t\u1ebf b\u00e0o n\u00e3o. C\u00f3 th\u1ec3 l\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a m\u1ed9t t\u1ed5n th\u01b0\u01a1ng n\u00e3o c\u1ea5p nh\u01b0: s\u1eed d\u1ee5ng\/cai […]\n","protected":false},"author":1,"featured_media":147429,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-147407","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/147407","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=147407"}],"version-history":[{"count":4,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/147407\/revisions"}],"predecessor-version":[{"id":147433,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/147407\/revisions\/147433"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/147429"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=147407"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=147407"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=147407"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}