Ebook Tự chẩn đoán những bệnh thường gặp: Phần 1

Phần 1 cuốn sách Tự chẩn đoán những bệnh thường gặp giới thiệu tới người đọc một số phương pháp tự chuẩn đoán một số bệnh thường gặp hiện nay như: Béo phì, phù thủng, chóng mặt, đau đầu,... Mời các bạn cùng tham khảo nội dung chi tiết.

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TU SACH BAO VE SLTC KHOE GIA DINH

Chifong I

NHLfNG BfiNH THlTCJNG GAP

1 Ban hay tinh xem minh co beo khong?

C o the con nguoi co tieu chuan trong luong binh thuong la: Doi voi nam thi tinh theo cong thuc: Chieu cao (cm) - 100 = ?kg; doi voi nu th'i tinh theo cong thurc: Chieu cao (cm) - 102 = ?kg Thong thudng nhung nguoi vuot qua tieu chuain ve the trong 10% la da qua trong luong, con nhirng ngiroi virot qua tir 20% tro len thi bi coi la beo phi Bcu phi cilia lam may loai diroi day:

- Churng beo phi don thiuin: Tir luc nho da kha bu bam dieu kien an uong tot, chat m o phan bo deu dan trong co the, co thoi quen thich an do ngot hoac nhurng mon an co chira nhieu chat dau, trong gia dinh co truy6n thong beo cac kiem tra khac deu binh thuong

- C hu ng giam chirc nang cua tuyen giap trang: Co sir tang trong lirong c a the a mire do binh thuong Phan Ion la

do bi phu cac dich long trong co the nhiet lirong tieu hao it gay ra C h u n g nav co bieu hien id la mat beo phi hai ben

long m ay rung den 1/3, da de nhort nhat nhip tim giam

cham bi dai tien, tieu tien Ti Id cua sir thay the c o so (t6ng nang lirong tieu hao cua ngudi hoac do ng vat khi thurc, nhung khong hoat dong); ti le ket hop iot cua albumin o

huyet thanh, ti le tuyen giap trang hap thu iot loai 131

- Chung beo phi co dau don: Beo phi thuong phan bo

co tinh doi xurng, dau nhurc khap co the, va con cam thay suy nhuoc khong co chut sure lire, da so' la o phu nir sau thai

ky man kinh Benh nay ngoai bid’u hien m an kinh qua som, ngoai giam churc nang cua bo phan sinh due tirong doi sdm

ra thi khong co bieu hien nao dac biet tren toan c o the

- Beo phi mang duoc tinh cua thuoc: Vi du n g chat insulin trong thdi gian lau dai hoac thuc day sir ket hop chat albumin che thanh thuoc, da gay ra sir them an ma d i n den

beo phi Nhirng neu ngirng dung thuoc mot thdi gian se dan

dan bi sut can va gay di

- Benh da nang bu6ng trurng tong hop Trieu chumg: Kinh nguyet khong ddu, hoac xuat hien hidn tuong tac kinh khong sinh de duoc, khong rung trung trong thoi gian dai, nhiet do co the giam Ki6m tra co thd’ tha'y budng trirng lorn dan len

- Chung vo sinh do beo phi: Co the beo phi, th em an

su trao d6i chat beo va churc nang cua tuyen sinh d ue khac thuong, co tuyen sinh due khong phat due Benh nay c o the

co lien quan den yeu to di truyen hoac yeu to bam sinh

2 Vi sao lai gay di?

Gay di tiirc la trong luong co the minh bi giam can

Th on g thuong nguoi ta cho rang, khi trong luong co the’ giam 10% tro len so voi tieu chuain the trong binh thirong

thi goi la bj gay di Trieu chung gay di co th£ chia lam mS'y loai sau:

- C hun g giam chric nang tuyen yen o nao: Chung gay

di thirdng phat benh cham, truoc tien la tuyen sinh due kho heo, bi6u hien la phu nu sau khi sinh khong co sira, rung 16ng, rung toe, ro nhat la rung long nach va long d vung km; ham m u o n tinh due giam hoac mat di, co quan sinh due kh ong con cam giac Tid'p do, sinh ra hien tucrng giam churc nang cu a tuyen giap trang va tuyen thuong than, bieu hien la k ho n g m uo n an, g£y di, thieu sinh lire, so lanh, huyet ap tut, m ach dap giam cham, da de mong, nhSn bong

va nhot nhat, tam trang phien muon, lanh nhat, doi khi co trieu churng ve tinh than rat ro Nhung nguoi mdc benh 6 mure do n g h i em trong co the sinh ra cac trieu churng giam luong d u d n g trong mau, d5n den hon me, ch oan g vang

- Dinh duong khong du: Thudng la vi dinh duong khong duoc hap thu day du, dac biet la nhung do an co chua nhieu protein, hoac vi mac benh ia chay, thieu cac loai vitamin

- Churc nang tuyen giap trang: Churng g£y di do tuyen giap trang bi sung to, dot nhien mat va tuyen giap trang tiet

ra djch qua mire lam cho tam huyet quan, he thong than kinh va su trao doi chat khong binh thuong xuat hien Cac trieu chu ng thuon g thay la sot nhe, tim dap nhanh, ra mo hoi, c o bap moi nhir va khong co sinh lire

- Churng x o gan va viem gan man tinh: Co the gay di, dong thdi co cac trieu chung vang da, vang mat, bien d6i tinh chat cua gan, than sung to, bi truong bung va bi phu thung chan Ket qua thu nghiem chuc nang cua gan khong binh thuong Ch up gan co thd chan doan duoc ch m h xac

- U ac tinh: Tir trircrc den nay, co the van lu6n khoe manh, gan day lai co trieu chirng gay di ma k h ong ro nguyen nhan, tinh than met moi va thieu sinh luc nhir vay nen xem xet co phai mac benh u ac tinh hay khong can tien hanh kiem tra ky hon

- Cac chirng viem nhidm man tinh: Co the gay di, con thirong kem theo cac trieu chirng: Len con sot ra mo hoi trom, khong muon an tinh than met moi, khong co sure song, thieu mau Churng viem nhidm man tinh co nhieu dang nhu benh ket hach, viem nhidm mung mu man tinh hoac cac churng ky sinh trung khac

3 Met moi, thieu sinh lire co phai la mot loai benh khong?

Met moi thieu sinh lire la chi cam giac met moi ra rdi, khong co sinh lire xuat hien trong nhung hoat d6ng hang ngay

- Viem gan sieu vi trung: Co the met moi dong thoi co cac trieu chung vang da vang mat, kem an, day bung, trudng bung, gan than sung to, churc nang cua gan khong binh thuong

- Benh lao ph6i: Co the met moi, dong thdi xuat hien cac trieu churng gay di, phat sot, go ma do, ho khan, ho co ddm, trong ddm co mau dau dau ra mo hoi trom phu nu kinh nguyet khong dt*u chup X-quang vung nao co the chan doan duoc chfnh xac

- Sir suy giam churc nang cua tuyen giap trang: C o the met moi kem theo cac trieu churng tinh than khong tot so lanh, thich su yen tinh, khong co hung thu it hoat d ong , kem an long toe kho xo thua thdt va dd rung, sac mat nhot

nhat Lay mau de lam cac xet nghiem albumin trong huyet thanh ket hop vdri xac dinh chat cholesterol, hap thu iot 131 se rat de dang chan doan benh

- Chirng co nang sinh ly qua muc binh thuong cua tuyen giap trang: Co the met moi kem theo cac trieu churng chan iin, trong luong co the giam, lim dap nhanh Ti le trao doi chat va ti le tuyen giap trang hap thu iot tang cao

4 Bi phu thung thudng co nhung bieu hien nhu the nao?

Phu thu ng la chi hien tuong benh Iv tfch nude qua nhieu d cac khe hd cua mo trong co the Benh nay co the

bi khap nguoi, cu ng co the chi bi d mot so bo phan tren

c o the

- Phu thung d ngudi gia: Benh thudng xuat hien d ngudi cao tudi vi the chat ciia ngudi gia co sir thay d6i, cac churc nang tim phoi, gan, than, bi lao hoa theo sir tang len cua tudi tac kha nang luu thong cua huyet quan cung thay doi theo tudi tac, cac he thong tifi't dieh va su trao doi chat cua c o the cung khac vdi ngudi tre tudi do la: Ti le cua cac loai dudng trong chat djch co tinh acid dudi da tang len, no ket hop vdi nude mo, se dd dan den churng phu thung cac chat dich

- Phu th u ng trudc thdi ky kinh nguvet: Benh nay thu d n g tha y d phu n u dan g do tudi sinh de, trong vdng tir

10 d en 14 ngay trudc khi co kinh va xuat hien cac trieu churng toa n than kho chiu tam trang cang thang, lo au so hai, cam thay co quanh, d6 cau ban, dau dau met moi hoac toan than sung len khi co kinh thi luo ng nude tieu

10 Cl WEN FANG - CHEN CHU CHUN

nhidu len, benh phu thung va cac trieu churng Khac dan

dan mat di

- Phu thung phat sinh co tm h chu k>': Bdnh nay thudng thay nhidu 6 phu n u dang 6 dd tudi sinh de (2 0 -

49 tudi) sir xuat hien cua benh khong co lidn quan den chu

ky kinh nguyet nhung co the benh se nang them trong thdi ky co kinh Benh nay thudng do sir bien doi ve trang thai tinh cam gay ndn co cac trieu churng v<* tinh than va than kinh nhu cac churng sau muon, lo nghi tim dap nhanh va loan nhip, met moi, dau dau budn n o n sang sdm mat bi sung len chieu toi hai c ha n co cam giac can g

ra, hoac chan bi phu thung, khi an vao co han lom xuo ng; thdi gian giua buoi sang va buoi toi trong luong c o the co the chenh lech toi tir 2 - 3kg trd len; d o n g thdi co n kem theo cam giac khat nude va uong nhidu nude Ngoai ra

c o n c o cac trieu chung he than kinh thuc vat kh on g on dinh nhu tinh than bat an ngu khong ngon giac mat nong birng, dd toat mo hoi, huyet ap cao Nh u ng ngudi mac benh nay nen nghi ngoi tinh d u on g co the k hon g lam tieu tan het cac trieu churng nhung neu hoat d on g qua mure thi benh se nang them Vao mua he benh thu dn g phat nang hon, ngoai ra khi co the beo len va kinh nguyet bi roi loan, huyet ap thap luc dung hay luc hoat d ong , cha n se

bi sung len rat ro khi duoc nghi ngoi yen tinh thi trieu churng cua benh se giam

- Phil thung do tinh nang cua thuoc: Nguyen nhan la

do dung thuoc loi tieu trong thdi gian dai gay ra sau khi ngirng dung thuoc thi benh nay se tir mat di

TL/C h A n D O AN

5 Chong mat thifdng co nhumg bieu hien nhir the nao?

Chong mat chfnh la cam giac dinh hudng hoac cam

giac khong can bang cua nguoi bi mac benh nay doi voi cac

quan he khong gian bi gap can trd, la mot kieu cam giac

van dong gia Don g thdi co kem theo cac trieu chung nhu

ghe co buon non, sac mat nhot nhat, toat mo hoi thay doi

nhip dap va huyet ap

- Chong mat co lien quan den tai trong: Chong mat

dot nhien phat sinh vao bat cir luc nao cung co the xay ra

Chong mat la cam giac co tinh xoay tron, luc m o mat thi

cam thay moi trudng xung quanh hoac cac su vat hien

tuong xung q uan h dang chuyen dong hdn loan, luc nham

mat thi lai ca m thay ban than minh dang chuyen dong

Nhung ngudi bi mac chirng nay kho m a dung va di lai duoc

luc di se bj ngh ieng ngudi va nga, trong khi dang chong mat

ma quay dau hay dao mat ddu lam cho benh nang them Co cac trieu chu ng ke m theo nhu u tai, cam giac tai bi bit km

va bien d6i benh ly nhu tai diec, ghe co, buon non, sac mat nhot nhat, toat m o hoi, dau bung, ia c h ay

- Chong mat do trung doc cua thuoc: La benh chong mat do thuoc gay ra nhu streptomixin, chung trung doc cap tmh streptomixin hay xay ra sau khi dung thuoc trong vai ngay sinh ra cho ng mat ghe co, buon non Nhung ngudi dieu tri trung doc man tinh thong thudng vao tuan thu tu cua dot tri lieu se xuat hien trieu chung chong mat, khoang trong mot tuan thi benh len toi dinh diem Noi chung la neu ngirng dung thuoc thi benh chong mat se het di

12 Cl WEN FANG - CHEN CHU CHUN

- Chong mat do bj anh hudng bdi dong c o m ay moc: Chong mat la do khi ngoi xe, ngoi tau thuyen may bay mang nhT trong tai phai chju sir kich thich cua do n g c o may

moc dan den roi loan churc nang tien dinh gay ra; thuong kem theo cac trieu chung nhu ghe co bu6n non sac mat nhot nhat, ra mo hoi lanh toan than ra rdi kh ong co sinh luc The chat bj suy nhuoc thieu ngu lo au buon ba va nhung mui vi kho chiu kich thich vao thudng la nhan to lam phat sinh ra benh

- Chung xo cung phat sinh nhieu liin: Chong mat bo phan quan trong la nao phat sinh ra cac trieu churng la mot kieu chong mat co tinh xoay tron xay ra dot ngdt va rat nghiem trong, kem theo cac trieu churng ghe c6 buon non u tai, diec tai, nhan cau mat bi sung

- Chong mat do cam nhidm: Chong mat co thd la do cam nhidm sieu vi trung than kinh 6 mure do nhe bieu hien chu yeu la benh chong mat don thuftn dot nhien xay ra nhan cau co the rung hoac khong, khong anh hu dng den thfnh giac, benh duy tri trong khoang thdi gian tu 2 den 10 ngay sau do hoan toan hoi phuc

- Churng dong kinh co chong mat: Chong mat c o the

la trieu chung bao trudc cua benh dong kinh thdi gian phat benh rat ngzin thong thudng chi vai phut, giong n h u phong dien truyen khap co the co kem theo cac trieu chu ng nh u budn non dau dau kicim tra bang dien nao d6 se phat hien thay dieu khac thudng

- Chong mat co lien quan den bo phan c6: C ho ng mat chu yeu la vi dot song c6 thit d co bien ddi benh ly viem day than kinh bap tay hoac viem than kinh Chong ma t co

t u c h A n d o A n 13

nhidu kidu nhirng da s6 la dot nhidn quay dau hoac de yen d mot vi tri nhat dinh thi sinh ra churng chong mat co tinh bat 6n hoac lac lu trong mdt vai giay den mot vai phut, cung co luc sinh ra churng chong mat tren, co the kem theo trieu churng ghe co, bu6n non luc dang di khong dam quay dau nh;n hoac nhin trai nhin phai Chup X-quang co the giup chan doan benh

- Churng roi loan churc nang he than kinh thuc vat: Chong mat, thirong gap d phu nir tre tudi co cac trieu chirng, nhu Ddt nhien phat benh, dau oc quay cudng manh, non mira, sac mat tai nhot, thudng keo dai mot vai gid dong ho den mot vai ngay, va co cac trieu chung khac la ve chuc nang cua c o q u an than kinh Benh nay khi phat tac khong gay ra ii tai hay nhan cau bj rung, thudng la do lao dong qua sure hoac do cac yeu than kinh gay ra Khoang cach giira mdi 15n phat khong theo thdi gian nhat djnh, thud ng la vai t u l n hoac vai ngay lai xay ra mdt lan

- Chong mat do ton thuong ben ngoai so nao: Chung nay do sau khi bj tdn thuong ben ngoai co the gay ra Ngudi mac benh thudng cam tha'y ban than minh hoac sir vat xung quanh minli eu su chuyen dong, ddng thdi cam thay bat dn Cac ctr dong n h u quay d5u hoac nhin len tien co the lam cho benh nang them Chung chong mat dau dau xuat hien d ngudi bj chan thuong so nao thi thdi gian phat benh se dai hon so vdi cac trieu chung khac khi bj t6n thuong ben ngoai

r • < • • • * j

6 Phi/dng phap tir quan sat va phan biet dau dau

Dau dau la chi cac churng dau nhiirc d nira tren cua nao, benh nay rat hay gap, co khoang 10% den 20 % so ngudi

14 Cl WEN FANG - CHEN CHU CHUN

mdc benh dirge chan doan bdnh la do dau dau co th£ la dau hidu cua churng met moi, cang thang thong thudng cun g c o the la da'u hieu cua mot s6 can benh nghiem trong nao do nhu benh u nao, benh tang ap lire ndi so xuat huyet nao khoang mang nhen

- Dau nhurc khap dau: Dau dau co thd co cac trieu churng bao trudc va cac trieu churng kem theo, con dau thinh thoang ngung giong nh u 6 nhirng ngudi binh thudng Benh nay co tmh di truydn, phu n u hay bi mac nhieu bdnh thudng phat sinh d nhung ngudi tre tudi, nhung ngudi tir 10

- 30 tu6i chiem ti le la 80% Benh nay thudng la d o met moi, lo nghi, dau oc cang thang gay ra; uong ruou hut thuoc cung co the lam cho benh nang hon, tridu chirng cua b£nh hay bien ddi, mdi ian phat benh, thdi gian co the tir trong ngay den may ngay va benh phat tac co ti'nh chu ky

- Dau dau co tinh tap trung: La chung dau d3u c o tinh lien tiep, m6i ngay m6t ian hoac m6t vai lan, keo dai den hang chuc phut, thudng tap trung phat benh lien tuc trong vong mot tuan Thdi gian ngat quang ciia benh co the tir hang tuan den hang nam, th6ng thudng benh hay phat tac d

do tuoi 20 - 40, tudi cang tang cao thi kha nang phat tac cua benh cang giam, nam gidi mac benh nhieu hon nu gidi D ay

la chirng benh co trieu churng nong, thudng la khi ngu vao ban dem hay bi tinh gia'c, co kem theo cac tridu churng chay nuoc mat, ket mac, nh6i mau, ngat mui, chay nude mui Uong ruou va dung cac chat kich thich co th^ lam benh phat tac nang them

- Dau dau hoac ddt nhien phat sinh ra chirng cha'n dong ma nh giong n h u bdnh dau d i u , ke m theo tridu chumg

TU’CHAN DOAN 15

non mua Co luc no can trd nhan thuc cua con nguoi trong thdi gian rat ngan hoac trong mot khoang thdi gian, co bieu hien kich thich ma ng nao rat ro, chat dich nao luc dau co mau do, va co chua mot luong hong cau Ion, ve sau thi lai

co mau vang Benh nay thudng gap d nhung ngudi tre tuoi von co the chat tot

- Dau dau co tmh chat cao huyet ap: La chung benh dau dau do cao huyet ap gay nen, thudng thay nhieu d nhung ngudi bj ma c benh cao huyet ap nghiem trong Benh nay co the dau kh ap dau hoac chi dau d phan tran, thudng thay la chung dau te dai Ngoai nguy c o phat sinh la hien tuong cao huyet ap ra, thi dau dau thudng khong d u doi, dau dau khong co qu an he vdi nhieu sir len xuong cua huyet

ap Sau khi tien hanh cac l?i?n phap de giam huyet ap thi co the giam bdt benh

- Dau dau co tmh chat huyet ap trong nao tang cao: Dai| diiu do u nao, sung tay co mu trong nao, sung tay do chay mau trong n ao gay nen, 85% den 9 0 % ngudi m ac ben h

u nao co hien tuon g dau dau, nhung nhung ngudi co hien tuong dau dau la trieu chirng cua ben h u nao thi chi co 20% den 49% D au dau la churng dau ngam ngam, k hon g co dac trung ro rang, ho manh; hoat dong tay chan, hoac dot nhien

c u ddng phan d au cung co the lam cho churng dau dau m a n h th£m, khi thurc da y vao buoi sang c am tha'y dau hoi nang; thudng k e m theo trieu churng non thoc non thao Cho uong nude hoac tiem chat thuoc can quan de chup X-q uan g song sieu am nao bo va huyet qu an nao bd co the giup cho viec chdn doan

16 Cl WEN FANG - CHEN CHU CHUN

- Dau dau co tinh chat viem mang nao: Dau dau do churng viem mang nao gay ra: thudng 6 giai do an ca'p tinh

se gay ra dau dau, dau d ben trong rat manh va lien tuc thudng kem theo cac tridu chirng: Len con sdt, non mira luc gap c6 thi tha'y c6 bj cung va kem theo chung kich thich mang nao Kiem tra djch nao tha'y co hien tuong viem hoa

- Dau dau sau khi bj ton thuong ben ngoai: D au dau

do bj va dap, co the dau trong vai gid ddng ho den may ngay liln, khoang 1/3 - 1/2 bo phan dau bj tdn t h uo n g ben ngoai co the gay ra dau dau, thudng gap d churng cha'n thuong so nao, dau dau co the bieu hien la chirng dau nhiirc

co tmh lien tuc, kem theo cac trieu chirng dau dau, mat ngii, hay quen Neu nhtfng ngudi bj dau detu ngay ca n g nang them va con xuat hien hien tuong non mira, thay ddi nhan thuc thi nen canh giac vdi kha nang sung tay do c h a y mau trong nao

- Dau dau co tinh chat don g kinh: C am giac d au dau thud ng tap trung d phan tran, benh co tinh chat phat tac trong thdi gian ngan, luc ben h phat tac co the k em theo cac trieu chu ng roi loan he than kinh thuc vat n h u s i c mat nhot nhat, toat m o hoi, dau dau, non mua K ho an g ca ch thdi gian giua cac ian phat benh hoan toan binh t hu dng Benh n a y thu d n g gap d tre em va dd tuoi thieu nien c o tdi 1/3 so ngudi mac benh la do tm h di truydn Co the' dung cac loai thuoc chua chung ngat ljm de chua benh n av cun g

co hieu qua

- Dau dau do mac benh ve mat: La chirng dau dau han che q ua nh viing mat tran hoac thai duong Benh mu mat

tit c h a n d o A n 17

xanh ca'p tinh khi phat tac co the bieu hien la churng dau

d i u dtr doi, dau mat, ghe cd, bu6n non, toat mo hoi, thi lire can trd, va’n due giac mac, ket mac, chay mau, dong tir mat gian to N£u nhan ap co hien tuong tang cao thi co the chan doan chinh xac Benh dau dau do viem hdng mac (man g mong hinh vong tron co chira sac to d phan trirdc nhan cau)

va viem tiep trang the (bo phan tao ra djch the trong mat) gay ra

- Dau dau co tinh co co: La chung dau dau m a n tmh thudng gap nhat, benh nay hay thay d nhung ngudi tre, khoe

va phu nu, thudng la do cang thang, met mdi va bi anh sang kich thich vao mat hoac bi anh hudng bdi sir on ao gay ra Nao bo neu bj bat cur mot su kich thich nao nghiem trong keo dai thi deu co the dan den co co didn ra lien tuc, tiep do

la huyet q u a n bj thu nho, gay ra thieu m au va phat sinh ra chirng dau dau Ti nh chat cua benh dau dau la luon phai chju ap lire nang va co cam giac cang thang, hoac cung co the la churng dau ho ac chung sung ta'y co lien quan Mac du b6nh dau dau thu d ng bi d thai duong vung tran hoac ca dau, nhung chirng dau d tran, dinh dau va thai du ong cun g co the di6n ra cung m o t luc dau dai va dien ra lien tuc trong vai ngay, vai tuan, vai thang ho3c m6t nam Chirng benh dau dau thudng phat nang hqri vao buoi sang va luc ch ap toi; suy nghi nhieu, lo au, cang thar^f^cTfS^W^ftig’ thuc day cho

b e n h phat tac va co nguy co nang them, chai dau hay doi

m u cung co the lam benh nang them Benh nay thudn g kem theo cac tridu c h u n g dau dau, mat ngu, hay quen, non nong, sdt ruot

18 Cl WEN FANG - CHEN CHU CHUN

- Benh ddt song cd: Dau d i u , d vung cd, co luc lan ldn vung tran va thai duong la churng dau nhurc can g thang co tmh hai ben (didn ra d hai ben tran, hai ben thai du o n g) hoac co tmh mdt ben; co the mdt moi, cang t h i n g , ngoi doc sach hoac quay cd ddu co thd lam benh nang them; c an h tay

va ba vai dau nhurc, te liet, cac hoat dong bi han che, chup X-quang p h i n xuong cd cd the giup cho viec c h i n doan

- Benh t h i n kinh (benh tam th in ): Dau d i u co tm h phat tac va han che d cac vung co p h i n bo t h i n kinh, mdi ngay benh cd the phat sinh den vai lin Benh dau t h i n kinh chi phat tac d vung xuong cham va p h i n tren cd Doi thu’ nam t h i n kinh nao bi dau tuy theo su khac nhau cua cac nhanh co lien quan, co the phat sinh d mot ben dudi c i m , d

ma, vung thai du ong hoac trudc tran Benh thudn g x u i t hien

d d6 tuoi tir 40 - 60 Benh dau d i u cd tm h tidp tuc phat sinh

co the keo dai, phan mat co the co cam giac bi can trd

Ng u ye n nhan thudng thay nhat la ung thu vom hong

7 The nao goi la giac ngu bi can trd?

Giac ngu bi can trd la chi thdi gian ngu va c h i t luong giac ngu khong binh thudng, c h i n g han n h u ngu ft hoac ngu qua nhieu, trong luc ngu co thd sinh ra mot so trieu churng lam sang nao do

Tron g cud c ddi m6i ngudi, khoan g 1/3 thdi gi an la

da n h cho viec ngu M ot ngudi binh thudng cur c a c h 24 gid

do ng ho la cd m ot ch u ky thurc va ngu, qu y luat thong thu d n g la ban ngay thuc, ban de m ngu Tre e m mdi sinh

c i n ngu tir 18 - 24 g id do ng ho, d do tu6i nhi d d n g thi c i n ngu 1 2 - 1 4 tieng, thanli nien thi m6i ngay ngu 7 - 9 tieng

- Mat ngu do ca c yeu to sinh ly: Mat ngu thudng la do

su thay doi cu a ho an canh song va cong viec, chang han nhu lan dau tien rdi xa nha den mdt noi khac sinh song, chua thich nghi du oc vdi hoan canh mdi, hoac trong phong ngu cd nhieu tieng dn ao choi tai, qua nhieu an h sang, sir thay doi cu a nhiet do, do dm, cac mui vi, giudng d em kh ong thoai mai hay uo n g che dac hoac ca phe cung gay ra mat ngu, da so la trong mot thdi gian ngan la co the thich ung duoc Nhiing ngay mat ngu thudng khong keo dai

- M at ngu do cac yeu to ve thuoc: Reserpine co the lam cho 5 - H T va N E trong he thong trung khu than kinh

bi tieu hao m a gay ra mat ngu hoac trong luc ngu thud ng xuat hien n h u ng g ia c m o ky la; chat alinine co the rut ngan thdi gian ngu, lam cho t6ng sd thdi gian ngu giam xuong Cac vj thuo c k ha c nhu alinine, caphein, ephederin, atein

20 Cl WEN FANG - CHEN CHU CHUN

cung deu co the gay ra mat ngu Nhirng ngudi m ac bdnh mat ngu ma thuong xuyen dung thudc ngu neu sau khi dot nhien ngimg dung thudc thi co the phat sinh ra churng mat ngu cd tmh ngimg thuoc hoac sau khi ngimg du ng ihudc mac du van ngu duoc nhung khi ngu thudng de bi tinh giac

va hay nam mo

- Benh buon ngu cd tmh phat tac: Dae diem cua benh nay la khong the chong c u ndi con buon ngu tu nhien phat sinh va thudng kem theo chirng dot nhidn ngu gat khi ngu

bi te liet va ao giac Da so benh nay thudng phat sinh d do tu6i 1 0 - 2 0 , nguyen nhan sinh ra benh nav van c h u a duoc xac minh ro rang

Benh nay phat tac da so la k h o n g the kiem c h e du oc , trong bat cur trudng hop nao c h a n g han nh u t ron g luc an com , noi ch u y en , lam viec di lai deu cd the tu nh ie n phat sinh Co n g viec don dieu, bu 6n te, k h on g gian lam viec yen tinh vang lang va sau khi an co m cang dd lam c h o benh nhan phat benh C h u n g buon ngu nay c u n g g io n g nhu churng buon ngu th on g th ud ng D o sau cu a giac ngu

cu n g kh ac nhau, tuv d mdi ngu di, th on g t h u d n g ngu

kh on g sau giac dd tinh n h un g sau khi tinh lai ngu tiep duoc; co ngudi thi tham chi na m mo sau khi tinh d a y thi het T r o n g mot ngav benh co the phat sinh vai ian d en vai c hu c lan Thdi gian m6i lan phat sinh be n h t h o n g

th ud n g la hon mudi phut, cu n g cd luc ngan thi k h o a n g vai phut n h un g cung cd luc dai thi den kho ang mot g i d d o n s

ho hoac hon

Churng buon ngu tuc thdi la trieu chung phat sinh kem theo thudng gap nhat cua can benh nay chiem kh oa n g 50%

TU CHAN DOAN 21

- 70%; thudng phat sinh vao luc su kich thich tinh than manh, hoac luc phan urng tinh cam, chang han nhu luc giat minh so hai, khoc thut thit, dac biet la vao luc cudi to Su co gian co d than ngudi va tur chi dot nhien giam va dan den buon ngu Luc phat sinh churng nay, dau oc con ngudi van tinh tao, he thong than kinh van binh thudng Churng benh nay thudng keo dai mot den hai phut

Kh o an g 2 0 % - 30% ngudi ma c b en h bu o n ngu co hien tuong khi ngu k h o ng cir do n g duo c, cd bieu hien la:

Te liet lan dan ra toan than, m ac du van nh an thuc duoc

ro rang n hu ng k h o n g the cir dong du o c c o the, tay chan Neu bi te liet khi ngu ma benh phat sinh vao luc trud c khi ngu thi ngudi b e n h cur m6i lan sau khi b e n h phat tac la lai

co the nha nh c h o n g ngu lai duoc; ben h te liet phat tac luc thurc thong t h u d n g k eo dai co the len d e n m o t h o ac hai tieng don g ho N g u d i mac churng nay khi cd n gu d i lay dong vao m i n h c d the se tinh va het bi te liet, c u n g cd ngudi phai lay that m a n h mdi co the tinh duoc

Ngu ao giac chie m khoang 25% can ben h nay, thudng hay gap la ao giac nhin va nghe nhung thur m a d a gap hang ngay Ngudi be nh cd nhan biet ve nhung dieu nay nhung lai

co cam giac giong n h u canh trong mo

- Ngu qua nhieu: Ngu qua nhieu la chi thdi gian ngu qua dai, so vdi thdi gian ngu binh thudng thi nhieu hon vai tieng ddng ho hoa c dai hon den vai ngay Churng ben h nay

kh ong giong vdi ben h bu on ngu co tm h phat tac va churng bdnh ngu q u a nhi eu nay kh ong phai la k ho ng kh an g cu duoc, cung k h o n g k em theo trieu churng bu dn ngu tire thdi

va ngu bi td liet ngudi

22 Cl WEN FANG - CHEN CHU CHUN

N gu qua nhidu co the phat sinh d ra't nhidu c a c benh

v i nao, ch an g han nhu phan day nao that thur ba, u nao, viem nao, benh huyet quan nao, ton t h u o n g ngoai na o

cu ng co th£ phat sinh 6 cac churng ben h suy giam churc nang cu a tuyen giap trang va tu y en yen, b e n h dai d u o n g ,

ch un g nhidm doc nude tieu tru ng d d c t d c u a th u o c an

t ha n Tro ng cac nguy en nhan lam phat sinh ra c h u n g ngu qua nhieu, thi da so n hu ng ngudi m ac b e n h nay la cd

tm h di truyen

- Chung mong du: Chung m o n g du la chi cac dang hoat dong duoc thuc hien trong giac m o khi dang ngu Chang han nhu dung len di lai, m o cua chfnh, m d cua so, cam cac d d vat, thuc hien lai cac do n g tac quen thuoc, hoac lam bam nhung cau rat ky cuc Luc chu ng m o n g du phat tac, co the mure do nhe hon luc tinh binh th udng, hai mat

m d hoac nua khep nua md ve mat khong bieu lo tinh cam, hoi nhung kh ong dap, thudng tranh gay ra can trd doi khi cung co the gay ra nhung hanh dong co anh hu dng den sir

an toan cua ban than hoac nhung hanh dong cd hai cho ngudi khac Thong thudng hay thay la ngudi bi m o n g du ngoi tren giudng hoac ngoi quanh m ep giudng Mdi lan benh nay phat tac, chi keo dai khoang ma'y phut, sau dd ngudi benh lai tu treo len giudng, ngu tid'p, cd luc di khap phong hoac ngoai nha Cac sir vat la cd the lam ngudi m on g

du tinh mong, nhung sau khi tinh thi khong the n h d lai duoc

nh ung thu mi nh da lam, da gap trong giac mo Benh nay thudng k em theo chung dai son va thudng cd tinh di truvan, hay gap d nam gidi, d tre em thi benh nay phat sinh nhidu hon d ngudi ldn va theo nam thang thi benh cun g d an dan

ti/ c hAn d oAn 23

mat di Di£u nay cho tha'y bdnh m6ng du la do trung khu than kinh truong thanh cham gay ra, d nguoi Ion khi benh nay phat sinh thudng la do cac benh ve tinh than, chang han

nh u suy nhuoc thSn kinh hoac benh tam than

- Ac mong: Ac mong la chi cac canh tuong ghe gdm dang so gap trong giac mo, chang han nh u manh thu, yeu

ma quy quai ruot dudi hoac vat Ion danh nhau vdi chung; ngudi gap ac m on g thudng keu gao, ren ri sau do dot nhien giat minh tinh giac Sau khi tinh day van con m o ho trong phut choc, tam trang cang thang, lo so va co the’ nhd lai duoc nhung canh trong m o hoac van co the ngu tiep duoc Benh nay thudng la do ban ngay hay bi giat minh, hung phan qua muc hoac tieu hoa kh6ng tot, duong ho hap khong thong, nao va tu chi phai chiu nhieu ap luc gay ra Nhung ngudi thudng xuyen dung thudc an than, thuoc ngu, neu sau khi ngirng du n g thudc cung cd the sinh ra hien tuong nay

- Giat m i n h vao ban dem: Giat minh vao ban dem la chi trong khi ngu tu nhien giat mi nh tinh day, hai mat nhin thang, ve mat bieu Id su cang thang, gao thet to hoac khoc

ni non, tam tran g bat dn, co cam giac ra't lo lang, c a m thay ngat t h d hoa c sap chet, tim dap nh anh den 150 - 170 l^n/phut, tan s d va bien do ho hap tang len thay ro Benh nay mdi Mn phat tac khoang 1 - 2 phut, neu dai thi cd the tir 15 - 20 phut, sau do lai co the ngu tiep Sang h o m sau tinh day thi qu en het, neu co the n h d lai du oc thi chi la nhung c an h tu o n g kinh khung Chirng giat m in h vao ban dem th ud ng bat dau sau khi ngu duoc 1 5 - 3 0 phut 6 tre

em, churng b e n h nay la do he thong trung khu than kinh truong than h c h a m gay ra Ion dSn theo tudi tac thi benh

cung dan dan mat di CJ ngudi ldn da so la do benh hay lo

l i n g gay ra

8 The nao la trd ngai ngon ngur?

Trd ngai ngon ngu la chi churc nang van dung va ly giai ngon ngu sinh ra kho khan hoac mat di T h u d n g la do sir thay ddi benh ly cua mang nao hoac c o quan phat am va cac yeu td v6 tinh t h in gay ra

- Chung mat ngon ngu: Churng mat ngon ngur la chi ngudi bi m ! c benh co the nghe duoc ngon ngur va nhin thay

c hu viet nhung co luc khong the ly giai duoc y nghla dac trung cua no Bo may phat am khong bi can trd, tay kh ong

bj te liet nhung khong the noi ra ldi, khong the viet duoc Ngudi benh cung khong bj suy nhuorc tinh than, n hu n g v l n khong the noi duoc Benh nay la do sir bien ddi ben h ly cua

bo may phat am co tinh han che bdi ban cau dai nao gay ra

- Kho khan trong viec phat am: Kho khan trong viec phat am turc la: Do luc cua co phat am bj suy yeu, hoac bj te liet, lire cang cua co phat am bj thay doi hoac k hd ng hai hoa

d i n den phat am khong chuan, am van khong d£u, noi nang cham chap khong liru loat va roi loan nhip dieu

+ Phat am kho khan co tinh chat cham chap: Do co phat am bj benh hoac day t h i n kinh van dong dudi chi phoi

C o phat am bi ton thuong da d i n den co phat am cham, khdng cd sinh lire

+ Churng phat am kho khan co tinh cham c h ap cap tinh: D a so nguyen nhan la do huyet quan nao bj nhiem benh (dong mach xuong song bien doi benh ly) hoac mac cac chu ng viem (viem chat xam cap tmh d dien tuy viem

+ Churng phat am kho khan co tinh a cap tinh, thudng

te liet dien tuy: Phat am kho khan cd tinh chap chon khong cm dinh khi co the met moi se lam churng benh nay nang them; sau khi nghi ngoi benh se giam hon va benh nay co hien tuong sang sdm benh nhe va sau buc>i trua thi benh nang hon

+ Phat am kho khan co tinh cham chap man tinh: Da

so gap d cac churng x o curng kho heo co, va thudng gap d nhung ngudi trung tudi, co thit co bieu hien kho heo, run run, khong co cam giac; hay cac chung r6ng dien tuy, va thudng bieu hien d nhung ngudi tre tuoi, xuat hien chung dau nhurc d cac vung bj chi phoi, ngoai ra benh nay con thay

d cac benh u budu dien tuy; cac benh ve co mat, co hong.+ Phat am kho khan co tmh co giat: Vi day than kinh van dong tren chi phoi co phat am bj ton hai, da lam cho luc cang c o cua mieng, co ludi, co moi tang cao, con luc cua c o thi lai suy yeu da gay ra churng benh nay Th on g thudng la d o hai ben dien tuy nao bi tdn thuo ng dSn den churng benh nay, con mot ben dien tuy nao bj tdn thuong thi churng phat am kho khan khong bieu hien ro nhung noi

ng on g lai c h a m chap, bj rit giong va ton sure, am giong nhe thap va nang am mui Nhung ngudi mac churng phat am kho khan cd t m h co that khong bj kho heo nhung lai kem theo cac trieu churng non mua kho khan, te liet hai ben

mi nh va chi co quap, thudng gap nhat d churng bien d6i

26 Cl WEN FANG - CHEN CHU CHUN

benh ly hai ben tui huy£t quan cung c6 the phai sinh ct cac

di chung sau khi bj viem nao, nao thieu dxy hoac trung doc ruou metylic man tmh

+ Phat am kho khan co tinh van ddng mat dieu hoa:: Benh nay thudng do bien doi tam ly ti£u nao gay ra

+ Bien d6i benh ly tie’u nao co thd lam c ho cac do n g tac hai hoa cua co phat am gap trd ngai va xuat hien hien tuong phat am khong ro rang, am dieu hoac la c a o h o ac la thap, vi khong the khdng che su ngirng ngat durt q u a n g khi noi, am ch u thudng tir nhien phat ra tao thanh ki£u noi cd tmh bung phat, hoac xuat hien kieu noi gi on g n h u ngat nhjp khi ngam tho (nhip 2/4, 3/4, 4/4 .), thud ng k em theo cac trieu chung nhan cau mat rung, tu the ngudi ng hi en g lech, trang thai bat 6n, tay chan long ngong, ca c d o n g tac khong binh thudng, lire cang co giam hoac cac trieu c h u n g

ve tieu nao

+ Bien d6i do co phat am te curng, noi nang cham chap, am dieu thap, cau tu don dieu, thudng cd am rung hoac lap lai am dau tien.

- Noi lap: Noi lap la chi luc noi lap lai am ch u mot hay nhieu lan, dac biet la am chu dau tien, khi phat am thudng keo dai trong am khong ro rang, noi nang khdng liru loat, hay bj ngac ngur thudng kem theo cac bie’u hien tam trang cang thang Khi phat am dong tac ho hap khong hai hoa cd the’ xuat hien cac bieu hien tren mat va cac dong tac cua c o the’ cung nhu vung vay theo ldi noi Benh noi lap thudng xuat hien d tre em noi chung la ldn len thi benh se dan d o hon hoac mat di, nhung co ngudi thi trieu churng cua benh con keo dai den khi truong thanh Nguyen nhan co the do nhu to'

d tre cm co hanh vi khong binh thudng co nhung ngudi trong mot hoan canh nao do im lang khong noi nhung trong hoan canh khac thi lai noi rat nhieu Day la mot bieu hien

co tinh khang cu 0 nhung ngudi mac benh tam than cung

co the’ xuat hien chung im lang khong noi, nhung thong thudng hay thay d nhung ngudi bi mat am trong nhung luc than kinh bi te curng cang thang, ngon ngu bi trd ngai ho cho rang lay im lang la tot nhat

9 Phi/dng phap tif chan doan cac benh ve than kinh

Benh than kinh la chi bien doi benh ly he thong than kinh va gay ra dau nhurc trong pham vi chi phoi than kinh

do Bp phan bien doi benh ly cua no co the la d day than kinh chu m day than kinh hoac nhanh than kinh Lam sang thudng lay bien dcii benh ly co lien quan den cac khu vuc than kinh de’ dat ten cho cac benh than kinh, thudng thay la chung dau day thur 5 than kinh so nao, dau than kinh ludi, yet hau (doi than kinh so nao thur 9), dau than kinh canh tay, dau than kinh sudn dau than kinh toa; cung co nhung chung ben h than kinh dupe dat ten tir tinh chat dau cua no chang han n h u dau than kinh giong nhu lira ddt dau xuong

co tinh chat khac thudng

28 v i w ti\ r ainvj - v nr.in v ri w - nv>'

- Churng dau day thu 5 than kinh so nao cd tinh chat khdi dau: La mot kieiu dau co tinh phat sinh tung dot trong thdi gian ngan rat manh d trong vung cd phan bo doi thur 5 than kinh nao Nguyen nhan cua chung benh nav c h u a xac dinh dupe ro rang Benh thudng phat sinh d do tudi khoang tir 40 - 50 va d nu gidi nhieu hon nam gidi Churng dau thudng phat ra d trong pham vi co phan bo nhanh cam giac day thur 5 than kinh so nao thudng hay thay la nhanh thu hai va nhanh thur 3 Cac hoat dong binh thud ng n h u noi chuyen, an com, nhai rua mat, danh ran g deu cd the gay

ra churng dau M6i lan churpg dau nay phat tac, thdi gian chi vai giay hoac mot phut, roi tu nhien het dau Ngudi bi dau

cd cam giac giong nhu dao cat, kim cham thdi gian ngat quang giua hai lan phat benh thi hoan toan binh thudng Thdi gian dau co the la vai ngay mot lan sau dd dan tang len den m6i ngay mot lan

- Churng dau day thur 5 than kinh so nao cd ti'nh chat phat sinh lien tuc: La cac kieu bien doi benh ly tac dong den day thur 5 than kinh so nao, tiet than kinh can than kinh

ma dan den chung dau d cac vung bi no chi phoi Diem khac nhau giura chung dau nay vdi chung dau day thur 5 than kinh so nao co tinh khdi dau la cam giac dau thud ng cd tinh lien tuc, dong thdi kem theo cac trieu churng te liet van dong va cam giac cua day thur 5 than kinh so nao hoac cd cac bieu hien bi ton thuong cac day than kinh khac cu a nao Nguyen nhan thudng thay cua benh nay la do bi u budu cd tmh di truyen trong do dac biet thudng gap la ung thu vom hong, ngoai ra con co u cau nao, u day than kinh ch ua trong nao u mang nao u gan u dong mach va viem m a n g na o

TIT CHAN DOAN 29

- Churng dau th^n kinh ludi - yet hau (cap day than kinh so nao thtf 9): Chirng dau than kinh ludi - yet hau co

t m h chat khdi dau la churng dau th£n kinh co tm h phat tac

m an h d cac vung co phan bo than kinh cam giac ludi - yet hau, nguyen nhan cua benh con chua hoan toan xac dinh duoc Chirng dau nay thudng phat hien ra d mot ben cuong ludi hong, ami dan hoac khoang mieng va co the lan rong len ong tai ngoai cung ben va phan c6 Churng dau than kinh ludi - yet hau cung phat tac, ngudi bi dau co cam giac giong

nh u bi dao cat hoac kim cham Cac dong tac nh u non mua noi chuyen ho khac cung co the gay ra chung dau, nhung khong co trieu chu ng duong tmh he thong than kinh

- Chirng dau dau than kinh tram: Than kinh tram dai, than kinh tram tieu va than kinh nhi dai lan luot xuat hien d day than kinh cd so 2 - 3, phan bo d sau phan tram, chung dau than kinh m a nam trong pham vi phan bo cac than kinh

ke tren goi la churng dau than kinh tram Chung dau nay cd the la phat benh d mdt ben hoac hai ben sau phan tram, cung co the lan sang phan dinh dau, bo phan vu hoac tai ngoai C hu ng dau nay co the la chung dau cd tinh lien tuc

va manh hon chu ng dau co tmh ngat quang Hoat dong phan dau, tran, ho khac hat hoi cung cd the lam dau man h hon Con ve c o thit toan than thi cd the phat sinh trieu chung co giat

- Churng dau than kinh bap canh tay: Bap canh tay chu yeu phan bo d vai va tay, khi bap canh tay bi t6n thuong lam phat sinh ra churng dau trong pham vi vai va tay nay thi goi la dau than kinh bap tay Benh chu yeu phat sinh do su

ep buoc bien ddi benh ly cua cac md gan dd hoac day than

30 Cl WEN FANG - CHEN CHU CHUN

kinh hay can th£n kinh kich thich bap tay N gu y en nhan cua chung dau than kinh bap can h tay do anh h ud ng cu a day than kinh, thudng la do dau x u ong cd, ket hach x uo n g cd, u budu, gay xuong, sai khdp, u tuy cd, viem man g n a o Con nguyen nhan cua churng dau than kinh bap can h tay d o can than kinh, thudng la phan cd bi sung thanh cuc, s u ng tuye'n hach d horn nach, bap canh tay bi ton thuong, x u o n g quai xanh bi g5y, viem than kinh bap can h tay, viem th an kinh vai Trong dd, benh v£ xuong co la thud ng gap nhat

- Vie m than kinh bap tay: Churng ben h nay t h u d n g gap d ngudi ldn, cd the la viem th£n kinh bap tay c a p tm h, hoac a ca'p tinh Lam sang c h o biet, da y la churng d a u d phan vai sau dd lan x u dn g c a n h tay va ban tay C h u n g dau luc dau la cd t m h chat ngat qu an g , k h d n g lau sau c h u y e n sang t m h chat duy tri lau dai Vi bj dau nen k h d p x u o n g d khuyu tay thud ng hay gap lai, khi ngu k h d n g the’ nam nghi eng ve ben tay bj dau, loi keo hoac ch a m vao b ap tay

se gay dau Bap canh tay va can than kinh bap c a n h tay cd hien tuong de an thay dau, vao buoi sang co the’ c d bieu hien c o luc cua ban tay va bap tay bj suy yeu, ph an x a cu a

co gan giam hoac mat di, n h un g c o thjt kh o h e o va d a de

co cam giac cang kho chju thi ng o n tay se bi s u n g va da cang len nhan bong Churng viem than kinh bap c a n h tay nay co the thay d cac ch u n g viem cua cac vung bj n h i i m benh hoac cac bo phan gan cac vung n h i i m ben h dd, c u n g

cd the thay d benh cam cu m hoac cac benh c a m n h i i m sieu vi trung khac

- Vie m than kinh vai: Churng benh nay da so la phat sinh cd t m h chat mot ben cun g cd thd’ la hai ben va bat dau

TIT CHAN DOAN 31

tir benh ve vai va canh tay tren Chirng dau co the nhe hoac nang, bi nang thi co cam giac dau nh u bi dao dam sau vao hoac dau n h u bi lira dot, keo dai may ngay den may tuan

Co thjt co trieu chung te liet va kho heo, phan thuong xuyen

bj dau la nhung ch6 han va dudi co, tiep do la co nam nghieng, co dai vien co nguc, co dai nao, phan ft bi dau la canh tay, co dau, co co tay Cam giac bi chudng ngai kha nang, thudng la 6 ba vai, ben ngoai canh tay tren Nguyen nhan cua benh con chua duoc xac dinh ro rang hoac la co lien quan den cac chung cam n h i i m sieu vi trung hay cac chung dj ung

- Churng dau than kinh sudn: La chung dau tong hop trong nhung vung co than kinh suon chi phoi Bi dau 6 mot hoac mot vai gie xuong suon, thudng phat sinh co tfnh duy tri lau dai, cd luc thi phat ra con dau manh tung dot; cac hoat dong n h u thd manh, ho khac, hat xi hoi cung co the lam dau nang hon Khi bj dau rat nang co the lan sang phan vai vung ben hoac la lan sang lung, co luc co trieu chung giong n h u bj troi buoc; co the co cam giac dj ung doi vdi nhung vung da tuong ung vdi ch6 suon bj dau va nhung ch6 gan xuong sudn de, an thay dau

+ Chung dau than kinh sudn co tfnh chat khdi phat thudng ft gap, da so chung dau nay phat ra d su bien doi benh ly cua cac c o quan hoac bo phan lan can, chang han

nh u benh d I6ng nguc (viem man g phPi, viem ph6i man tfnh, u do ng m a c h chu ), ton thuong ben ngoai cot song, xuong sudn (lien tuc hinh thanh vay xuong va viem ma ng xuong), u xu ong nguc, u cot song nguc (gom 12 ddt), churng r6ng tuy song, viem tuy song

32 Cl WEN FANG - CHEN CHU CHUN

- Chirng dau than kinh toa: La churng dau tdng hop d nhung duong than kinh toa hoac nhung vung co phan bo than kinh toa Churng dau bat dau phat d phan lung, canh tay

va lan ra ben ngoai sau dui va sau chan, ben ngoai ban chan; di lai hoat dong va co keo than kinh toa cun g co the lam cho chung dau nguy kich hon Khi dudi thang ch an gio cao len, an vao than kinh toa se thay dau Co ngudi cd the xuat hien trieu chirng ton thuong bo phan day th an kinh td thanh nen than kinh toa hoac can than kinh toa ch an g han

nh u suy giam cam giac va co luc, phan xa cua mat ca chan giam hoac mat di

+ Churng dau co tinh chat cam giac k h dn g binh thudng: Bieu hien chu yeu cua churng dau nay la cam giac khong binh thudng giong nh u kien bo, gai da m d khoang 2/3 dui ve phfa dudi ben ngoai dang trudc, cun g cd the la chirng dau nhurc khi di lai va dung co the lam cho dau nang hon Kiem tra co the thay nhung bo phan ke tren xuat hien cam giac suy giam hoac nhung vung bi di ung k h dn g deu nhau co luc co nhung ch6 de, a'n thay dau Chirng nay thudng gap nhieu d nam gidi do tudi trung nien cung thudng thay d phu nu dang mang thai

- Churng dau than kinh giong nhu lira ddt: Sau khi bi

tdn thuong nhe d nhung ch6 xung quanh than kinh, dac biet

la trung khu than kinh co chua nhieu day than kinh giao cam; hoac d than kinh bap chan, than kinh toa, mdt so ngudi cd the phat sinh ra chung dau than kinh giong n h u lira ddt Dac diem ciia churng dau nay la tay hoac cha n bj dau

d u doi giong nhu cd lira thieu ddt, nhat la dau cac ngon tav ban tay con da de thi mong, cang bong, ra nhidu m d hoi

i u C h a n duaim 33

huyet quan thu nho va co cam giac bi chudng ngai rat ro phat nong khSp huyet quan, sung do tay hoac phat lanh, tfm den Nhung tac dong nhe vao chan, tham chi' la gio nhe ludt qua, tieng 6n ao, am I ben ngoai, anh sang qua nhe cung

co the kich thich lam phat ra churng dau hoac lam cho dau nang hon

10 Te liet thirdng co nhung bieu hien nhu the nao?

Te liet la sir suy giam hoac mat di cu a c o luc van dong; suy gi am c o luc van don g la te liet nhe hoac te liet

kh ong hoan toan con mat di co luc van d o ng la te liet hoan toan

- Te liet phan mat: Te liet phan mat la chi su te liet

co thit 6 phan mat do chirng te liet than kinh gay ra Dua theo cac bo ph an bi bien doi benh ly va nhung bieu hien lam sang, co the phan thanh hai loai la: Te liet co tm h chu

vi va te liet co tinh trung khu Te liet co tfnh chu vi nSm o hach than kinh ma t hoac than kinh mat, con te liet co tfnh trung khu thi phat sinh 6 dien tuy vo nao tren hach than kinh mat

Chung te liet phan mat co tm h chu vi la churng te liet than kinh thu on g gap nhat, nguyen nhan chu yeu cua benh nay la do viem than kinh mat, con ngu y en nhan chfnh xac thi chua xac d i n h duoc ro rang Co mot so nguoi vi bi lanh hoac trung gio m a phat benh, dac di£m cua no la phat benh cap tinh va tdn thuo ng mot ben than kinh mat Do than kinh mat, o n g tai trong va vung nguc co lien he mat thiet voi nhau vi vay m a cac chung viem tai trong co sinh mil cap tfnh, m a n tfnh, viem tuyen vu va viem phan xuong thai

34 Cl WEN FANG - CHEN CHU CHUN

duong deu co th£ phat benh cung voi chirng te list phan mat co tinh chu vi, goi la churng te liet than kinh mat c d nguon gdc tir tai Churng viem thfin kinh phat tac n h i i u lan

co tinh cam n h i i m cap tinh co t h i lam phat sinh chirng te liet phan mat co tinh chu vi, dac di em cua no la co the xuat hien chirng cam n h i i m than trudc Te liet phan mat thudng phat sinh cd tfnh hai b£n va cd tri£u ch u ng tfe liet than kinh van dong dudi cua tur chi cd tinh ddi xurng va cd c a m giac

bi trd ngai

Dac diem cua churng te liet phan mat cd tinh trung khu

la chi te liet co thjt d phan dudi mat Churng benh nay cd bieu hien la ranh giua mui va mdi bang phang, hai ben m ep triu xuong, h o rang; khi thuc hien cac dong tac n h u thoi hoi, thoi sao, thay bj te liet, con cac dong tac n h u nhan tran, nham mat van binh thudng Benh nay thudng thay d nhung ngudi mac cac benh ve huyet qu an nao

Bieu hien dien hinh nhat cua ben h viem nao la: N g o n

ng u bj chudn g ngai, noi c h uy en d i gay ra met md i, dac biet la luc m u o n cao giong va nh an m an h ng u dieu neu

m u o n noi cham rai thi giong lai k ho n g ro rang, va d o bj te liet vdm hong m a lam phat sinh ra am mui giong n h u day thanh qu an khdng co luc Sau khi ngon ngur bj c h u d n g ngai, k hon g lau sau se phat sinh ra chirng non m u a kho khan, dau tien la phat sinh d churng an nhanh uong nhanh; sau do dan dan bj nang hon, luc an com bj sac ho ac c ha y nude mui, khi co nhai bi nhurc mdi thi ngay ca d o n g tac nuot nude bot cung lam phat sinh ra ch ung dau; cuoi cung

la m ien g ha ra, chay nhieu nude bot, kh ong t h i noi c h uy en

va non mua

ti / c h A n d o A n 35

Benh nay thudng tha'y cac hi£n tuong hinh thanh lie

dong mach, viem than kinh phat sinh nhieu lan co tmh cam nhiem cap tmh, vi£m chat xa m tuy sd'ng cap tmh, viem than kinh nao co tmh phat sinh nhieu ian, viem nao, xo cung phat sinh nhieu

- Bai liet nua ngudi: Bai liet nua nguoi la chi churng bai liet mot ben tay va chan, co khi con kem theo churng bai liet phSn c o ludi d dudi mat cung ben d do va benh nay la mot loai benh thudng gap nhat trong churng bai liet, ngoai mot sd' ft truong hop ngoai le thi hau het deu do ton thuong chum hinh non gay ra

Bai liet nua ngudi thud ng thay n g u y en nhan do huyet quan nao, tiep den la cac benh u nao, viem nao, ap xe nao, viem m a n g nao, tdn thuong ngoai nao Neu churng xuat huyet nao gap nhieu d ngudi gia bi cao huyet ap, dot nhien gay ra bai liet, nhan thurc bi trd ngai, thi churng tac m ac h

m au nao thu d n g tha'y d nhtfng ngudi tre tudi va thud ng co cac trieu c h u n g tim bi phong thap: Hai ngan tim hep va day tam nhl bi rung; hoac viem m an g tim, doi khi co n thay hien tuon g gay x u o n g ong (tac md), ur khi nao trudng bung day hoi (tac khi), dot nhien gay ra bai liet nua ngudi, co

nh un g churng co n co bieu hien co giat va than tri kh dn g tinh tao Churng bai liet nua ngudi do bi en doi benh ly trong so nao (u nao, m u ng m u nao, sung tay do ch ay mau dudi m a n g curng va ngoai m a n g curng) thi da so phat benh

c h a m n h un g lai co tfnh phat trien, va cd trieu churng huyet

ap nao tang cao

- Liet n u a ngu di: Bi bai liet hai ch an , ph an Ion la do

t on t h u o n g tuy sd'ng, p h^ n du di cd p h i n h to gay ra

ra thoi rua hoai tir.

Nguyen nhan chu yeu cua churng bai liet nua ngudi man tinh la viem mang cd tinh chat dinh lien man tinh ket hach cot song va u budu tiiy song cd tinh di t ru y e n Churng bai liet nay phat benh cham nhung lai cd tinh tang tien

- Liet tu chi: Liet tur chi la chi churng bai liet ca hai chan va hai tav nao trudng thanh k hdn g hoan loan do bam sinh gay ra; chung bai liet tir chi cd tinh co quap Neu hai chan bi liet nang han hai tay thi goi la bai liet hai ben cd tinh co quap baim sinh neu hai tay bi liet nang hon hai chan thi goi la chung liet nira ngudi hai ben cd tinh bam sinh

- Te liet trong thdi gian ngan: La chirng te liet do co thit than kinh truyen chudng ngai gay ra Dac di em chunn ciia loai benh liet nav la cd tinh tam thdi

+ Co khdng cd luc bieu hien la co thit rat de met mdi khi co thit bat dau co lai thi van con cd lire, nhung khi bi co lai lien tuc thi co luc dan dan suy giam sau khi n^hi n '’oi

cd the se hoi phuc duoc va thudng vao buoi sang bi nhe chieu bi nang Dac diem cua churng co khong cd luc la sir thay ddi mure do te liet va su thay doi co bi ton thuong

TU CHAN DOAN 37

+ Te liet co tinh chu ky: La mot nhom benh dac trirng

tu chi bi te liet nhi£u I An lap di lap lai Chung benh nay thudng gap d ngudi tre tudi d nam gidi nhi£u hon nir gidi

va te liet thudng phat sinh vao budi toi hai chan bi nang hon hai tav giam hoac mat phan xa co gan giam luong kali trong man Khi benh phat tac thudng la sau mot den hai tieng ddng ho thi dat tdi dinh diem, sail khi phat benh lien tuc trong vai g id ddng ho den vai ngav thi dan dan hoi phuc, thdi gian ngat quang ciia benh hoan toan binh thudng.+ Cac chirng khac nhu: Khi benh dai thao dudng dung nhieu chat insulin, khi bi ia chay man tinh churc nang cua tuyen giap trang giam dung thudng xuyen va lau dai cac loai thudc lpi tieu hoac chat adrenaline cung cd the! lam phat sinh churng te liet tur chi

+ Chirng te liet sau khi bi dong kinh: Sau khi churng dong kinh cd tfnh han che phat tac, cd the’ xuat hien trieu chirng te liet tam thdi, tir chi co giat thudng keo dai may tieng ddng ho hoac may ngay roi mdi hoi phuc, neu chung dong kinh lai phat tac thi sau dd cd the lai xuat hien te liet.+ Chirng thieu mau nao cd tinh tam thdi phat tac: Te liet cd bieu hien la churng liet mot ben hoac liet nira ngudi

cd tfnh phat tac thdi gian mdi lan bi te liet thudng keo dai khdng qua 24 gid ddng ho

11 The nao la trang thai hirng phan?

Trang thai hung phan hay con goi la hung phan cd tfnh hoat do n g tinh than, dac trirng lam sang chii yeu la

do n g tac hanh vi va ldi noi cua ngudi benh tang len ro ret Neu chi cd d d n g tac, hanh vi tang len con ldi noi khdng

38 CI WEN FANG - CHEN CHU CHUN

tang thi goi la hung phan co tinh van ddng: nguoc lai chi co noi nhieu con hanh dong la mot kieu trieu churng thudng gap cua benh tinh than, khi benh a muc cap tinh thi trieu churng cang bieu hien ro hon khong chi ton hai den ban than nguoi benh ma con quay nhieu nghiem trong den nguoi khac

- Churng buc boi phien muon: Benh nay co dac diem la phat tac co tmh chu ky va bao g6m hai trang thai tam ly la buc boi va phien muon, d mot so nguoi hai trang thai nay

co the thay nhau xuat hien, lap di lap lai co tinh chu ky Thoi gian ngat quang cua cac trieu churng benh tinh than hoan toan binh thuong Benh nay co xu hudng di truyen Benh nay thudng phat tac ian dau tien phat benh thud ng la d ngudi tre tudi, nhung ngudi giao tiep nhieu thich hoat dong, lac quan va tinh luc ddi dao Trieu ch un g ndi bat khi benh phat tac la hung thu tang cao, cd sir kich d o n g vui sudng manh va lau, td ra duong duong tu dac, ch i khi hien ngang ndi cudi lung tung, lam cho moi ngudi xung quanh vui ve, thoai mai nhung lai khdng chiu dupe su phe binh de

bi kich dong, tuy nhien chi trong phut choc lai n h u khdng

cd chuyen gi xay ra Ngudi bj benh thudng lien tudng rat nhanh y nghi khdng chac chan, nghi den dau ndi den day, noi dung phong phu da dang va con cd the lien he vdi thuc

te tham chi con cd cac bieu hien nhu thich khoe k h o a n s cd thai do ngao man the Idn ap ngudi kha nang chu y thav ddi theo hoan canh thich dua ra y kien ndi lien tuc khong biet met mdi doi vdi cac cong viec deu cd hung thu nhuno

thudng la lam khdng de'n noi den chon, dau voi duoi chupt

cd dau ma khdng cd cudi; cd luc an mac Ijch su khoe

t u c hAn d o An 39

khoang, phong tinh, doi hoi v6 tinh due Ngoai thai gian phat benh, hanh vi va suy nghi cua ngudi benh van cd su hai hoa thong nhat va con duy tri duoc mdi quan he tot dep vdi moi ngudi xun g quanh

- Benh tam than phan liet: C hun g ben h nay thudng gap d nh ung ngudi tre tuoi khoe manh Trud c khi mdc benh, ngudi d d thudng cd tfnh cach thich cd quan h, nhut nhat, m an cam va d i ao tudng Benh nay da so phat sinh cham va cd bieu hien la giua tam tir, hanh vi va suy nghi

kh ong hai hoa thong nhat, lien tudng tan man, suy nghi lung tung, k hd n g cd logic, tinh cam lanh lung, ldi ndi va viec lam ky di khac thudng, hanh vi co lai va rdi xa thuc ti£n; ngoai mot so it trudng hap cd the benh tu khdi ra, con lai neu k h d n g q u a tri lieu hap ly, de lau cd the dan den sa sut tinh than

N h u n g n gu d i m ac benh d do tudi thanh x u a n da so benh phat sinh vao thdi ky phat due day du, cd the’ bieu hien ndi bat nhat la hung phan n h un g suy ng h i lai bj trd ngai, ngoai ra c o n cd cac bieu hien n h u ndi nang Ion xon, suy ng h i lung tung, dieu bo kec h c a m ; cac bieu hien nhu tam tran g that t h u d n g hay thay doi, kh oe cudi k h d n g binh

th udng, cud i n h u me dai la mot kieu bieu hien tinh cam

th ud n g thay Dd i vdi cac sir vat be n ngoai, ngudi b en h tuy

cd cam giac ve thinh giac va thj giac n hu n g h anh vi va tinh c a m c u a ho lai hay thay ddi, chju su chi phoi cua ao giac va sir ti nh to an ngong cuon g, t h ud n g lam n h u n g hanh

d o n g lam ngu di k hac cam thay kh o hieu, cd khi co n dai

tieu tien ba y ba, kh o a than trudc mo i ngudi hoac hanh

d o n g q u a khich

4 0 Cl WEN FANG - CHEN CHU CHUN

Tro ng trang thai ca ng thang da sd la benh d mure c a p tfnh ho p a cap tfnh trang thai tam ly chu y e u la k h o curng

va hung phan hai trang thai tam ly nay cun g co the thay nhau xuat hien nhung thudng thay la trang thai curng nhac va thdi gian mac benh keo dai Ngudi bi ben h thud ng dot nhien kfch dd ng hung phan, nhay m u a lan Ion

kh dn g cd m uc dfch, thu d ng cd hanh vi qua khfch va pha

ph ac h dd vat, cung chiu s u chi phoi cua ao giac Khi benh

d mure d o ngh iem trong, ngudi benh cd the h u n g phan trong thdi gian dai, k hd n g an k h dn g ngu, ch o nen ca the d6 bj suy kiet

- Benh tam than cd tfnh phan liet tinh cam: Benh nay thudng gap d nhung ngudi tre tuoi khoe m an h va n u gidi mac benh nhieu hon Benh phat sinh da so la nhanh bieu hien chu yeu la benh tam than phan liet va cac trang thai birc boi hoac phien muon ke't hop cung tdn tai hoac lan luot xuat hien trong nhung hoan canh phat benh khac nhau

- Benh tam than cd tfnh phan ung: Benh nay d o cac yeu td tinh than nhanh va manh lam can trd churc nang cua nao gay ra Cac ye'u td tinh than anh hudng den benh nay thudng la dot nhien phat sinh ra churng so hai va thu dn g cd lien quan den cac kieu tai hoa va cac sir cd ngoai y m u o n uy hiep sinh mang con ngudi nhu dong dat, hoa hoan va lu lut Bieu hien cua churng benh nay thudng la y thuc m o hd c am nhan ve cac sir vat xung qua nh khdng ro rang, mat kha nang djnh hudng, bieu hien tinh cam, tam trang s o hai canu thang; khi bj hung phan man h thudng hanh dong k h o n g co muc dfch nhung thdi gian mac benh thudng la ngan va sau

dd quen het moi viec

va trd ngai churc nang ngu quan (tai, mat, m d m , mui va than ngudi).

Chirng co q u a p cd tinh chat cua benh tam than thudng dot nhien phat tac va cd bieu hien toan than cung,

tu chi co giat, th d ga'p, dau luc lac, tir chi vung vaiy, dam nguc dirt toe, xe ao can tay, hoac trong hong phat ra nh ung tieng cuc cuc, trong m ie ng k hd ng ngimg thdi hoi; phai qua

h a n mudi phut hoac nua tieng m a mang, tinh c am phat tac gao khoe om s o m roi ket thuc benh Hoan canh, mdi trudng, tieng d o n g xung qu an h cd nhieu ngudi cun g cd the thuc d«fy ch o ben h phat tac va nang them, thdi gian cung kha dai; tinh trang nay cd the xuat hien nhieu lan, lap di lap lai, nhat la neu cd ngudi nhac den yeu td tinh than hoac trong tinh trang am thi tam ly k h dng tot cun g cd the lam benh phat tac

Trang thai m a hd cd tfnh chat cua benh tam than:

T h ud n g phat benh nhanh chong sau nhan to tinh than Hoat

dd n g cua y thurc chi han che d noi dung cd lien quan den the

ng hie m tm h cam, sac thai tu tudng nong hau, dong tac gid ng nh u d d n g kich giau tfnh am thi; cd ngudi mac benh