T VN

Nhc n hi chng tin nh chc ai cng cm nhn c n mt

cm gic kh chu v biu hin chng mt, mt thng bng, bun nn v c
th nn. Ri lon tin nh khng phi l mt bnh m l mt hi chng,
gy nn bi cc tn thng n l hoc phi hp h thn kinh, tai, mt,
tim mch, tm thn Ri lon tin nh mc d khng nguy him n
tnh mng nhng nh hng rt ln n ngi bnh. Nhng kh chu do
hi chng tin nh lm ngi bnh chu nhiu thit thi nh: thiu t tin,
lun trong trng thi lo u, cng thng, nh hng ln n sinh hot, lao
ng v tr thnh gnh nng cho gia nh v x hi [2], [5].
Bnh nhn b ri lon tin nh c th c khm v iu tr ti nhiu
chuyn khoa khc nhau nh cp cu ni, khoa thn kinh, khoa Tai - Mi -
Hng, khoa phc hi chc nng Ri lon chc nng tin nh c th do
nhiu nguyn nhn khc nhau gy ra, trong chuyn khoa Tai - Mi - Hng
cn gp nhng bnh nhn sau phu thut tai xng chm [5].
Vic iu tr bnh trong giai on cp cu ban u i hi phi c
s phi hp tt gia cc thuc iu tr v cng tc iu dng. Ch
chm sc v nhng bi tp t n gin n phc tp gp phn rt ln
trong phc hi chc nng tin nh.
gip cho vic iu tr v chm sc bnh tt hn chng ti tin
hnh nghin cu ti: nh gi chm sc bnh nhn ri lon tin nh
ti khoa Tai - Thn kinh Bnh vin Tai Mi - Hng Trung ng t
thng 6 n thng 12 nm 2011 nhm mc tiu:
1. M t triu chng lm sng v phn bnh nhn ri lon tin
nh.
2. nh gi kt qu can thip nhng bnh nhn c hi chng
tin nh ti khoa Tai - Thn kinh Bnh vin Tai Mi Hng Trung
ng.

1
 Chng I
TNG QUAN TI LIU

1. NHC LI GII PHU C QUAN TIN NH

Tin nh - c tai l mt c quan c cu trc phc tp thc hin
hai chc nng l cm nhn m thanh( nghe) v cm nhn v tr ca u
trong khng gian. Ba phn hp nn c quan ny l tai ngoi, tai gia v
tai trong.
1.1. Tai ngoi
Tai ngoi gm loa tai c vai tr thu nhn m thanh v ng tai ngoi
lm nhim v dn truyn sng m ti mng nh.
1.2. Tai gia
Tai gia l mt tp hp cc hc kh c nim mc ph nm trong
phn xng thi dng, trong hm nh l phn trung tm. Hm nh
nm gia tai ngoi v tai trong , thng vi hang chm pha sau qua ng
thng hang v vi t hu trc qua vi tai. Chui xng con cha trong
hm nh m nhim vic dn truyn rung ng ca mng nh ti tai trong.
Vi tai l ng khng kh t t hu i ln hm nh , m bo s cn
bng p lc khng kh hai mt mng nh , nhung cng l ng lan
truyn nhim khun t hu ln hm nh.
1.3. Tai trong
Tai trong vn bao gm m o xng v m o mng , l ni cha
cc c quan nhn cm thnh gic v thng bng. M o xng l h
thng khoang rng phc tp bn trong phn xng thi dng. M o
mng l mt h thng ng v ti mng nm trong m o xng v c
hnh dng gn ging m o xng. Khong nm gia m o mng v
thnh m o xng cha ngoi dch. Dch cha trong m o mng l
ni dch.
C quan tin nh: nm tai trong, gm c

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 - M o mng: nm trong m o xng tai trong, cha ni dch.
Bao gm: c tai, soan nang, cu nang v cc ng bn khuyn.
- ng bn khuyn: mi tai c 3 ng bn khuyn : bn, trc v sau,
nm thng gc vi nhau, phn phnh ra mi ng vo soan nang gi l
bng (ampulla) cha cc th th kch thch khi xoay u. V d khi xoay
u sang tri th ng bn khuyn bo cho bit u quay theo hng no
v nhanh nh th no.
- Soan nang, cu nang : c cc th th cho cc cm gic v trng lc
v gia tc thng. V d : nu u nghing v mt bn, cc th th s bo
gc nghing, u c nghing ra trc hoc ra sau khng; Khi chy xe gia
tng tc , ngng li en cc th th s cho cm tng gia tng tc .
- C quan nhn cm:
Mo: nm trong bng, c cu to bi cc t bo lng, pha trn
cc t bo ph mt lp gelatin gi l i (cupula), lng ca t bo nm
trong i gm c lng rung (kinocilium) v lng lp th (stereocilia), cn
y t bo tip xc vi nron ca nhnh tin nh.
Vt: trn soang nang v cu nang c cu to bi cc t bo lng,
ph ln trn t bo lng l si tai (otolithis).

Hnh 1: gii phu tai v c quan tin nh tai trong

3
 Hnh 2: tai trong v c quan tin nh

Nhn tin nh:

Cc b phn nhn cm ca tin nh ngoi bin nm m o mng,
thn t bo hch tin nh, nhnh tin nh ca dy tin nh c tai (dy
VIII) i n nhn tin nh nm gia cu no v hnh no.
Chc nng nhn tin nh :
- ng nht cc thng tin n t mi bn ca u
- Nhn cc tn hiu v tip tc truyn ti tiu no
- Nhn cc tn hiu v tip tc truyn ti v no cho nhn thc v
gic quan v tr v vn ng
- Gi mnh lnh n cc nhn vn ng nm thn no v ty sng,
cc lnh c a n dy s (III, IV, VI, XI), b tin nh ty sng chi
phi trng lc c ngoi bin v b sung vn ng u v c.
ng dn truyn:
Thn t bo cha khong 19.000 neuron tin nh ngoi bin xut
pht t mo v vt mi bn tp trung hch tin nh v chm dt nhn
tin nh (ranh gii hnh-cu no) v thy nhung nt ca tiu no. Cc
neuron tin nh trung ng (t nhn tin nh) i xung ty sng theo b
tin nh sng v i ln thn no theo b dc gia n cc nhn dy thn
kinh s iu khin c ng mt.

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 V no thy trn

V no thy
chm

Nhn dy III
Di di sau

Nhn dy VI

Nhn tin
nh

Hnh 3: cc nhn tin nh v ng dn truyn tin nh

2. C IM LM SNG CA RI LON TIN NH

2.1. Triu chng lm sng

2.1.1. Triu chng ch quan

- Chng mt: l triu chng ch yu. BN c cm gic b dch

chuyn, mi vt xung quanh xoay trn, hoc chnh bn thn BN xoay trn
so vi nhng vt xung quanh. Trong nhng trng hp in hnh, cm
gic b dch chuyn rt r, c th xy ra trn mt phng ng dc hoc
mt phng ng ngang. Tuy nhin trong mt vi trng hp chng mt
khng r rng, BN ch c cm gic dch chuyn hoc lc l thn mnh,
hoc cm gic bay ln, rt xung hoc cm gic mt thng bng.

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 Cc du hiu i km thng hng nh: BN c cm gic kh chu,
thng l s hi, mt thng bng. T ng c th xy ra lc chng mt, BN
khng th ng c. Ngoi ra c th c ri lon dng i. Bun nn, nn
ma xut hin khi lm nhng c ng nh nhng v thng i km cc
ri lon vn mch nh da ti xanh, v m hi, gim nhp tim.
Cc c im ca chng mt:
+ Kiu xut hin ca chng mt: c th xut hin t ngt v c tnh
cht xoay trn, hoc c th xut hin t t vi nhng cn chng mt nh
ni tip nhau hoc ch mt thng bng nh lc i li v sau triu chng
ny tr thnh mn tnh.
+ Chng mt xy ra lc thay i t th t nm sang ngi khng,
chng mt c lch v mt bn no khng?
+ Cc du hiu i km: quan trng nht l cc du hiu v thnh lc
(gim thnh lc, tai, cm gic tai b y, ic c), k n l cc du
hiu v thn kinh thc vt (bun nn, nn ma lo lng). Lu l bnh
nhn hon ton khng mt thc.
+ Tin s ca bnh nhn v tai mi hng (vim tai ko di), v thn
kinh, chn thng (chn thng s no), v ng c (ng c thuc, c
bit l cc khng sinh c vi tai), v mch mu, v d ng.
+ c im din tin v tn s cn chng mt.
Chng mt sinh l :
Xy ra khi: No c s mt cn i trong ba h thng gi thng bng
(h tin nh, h th gic, h thng cm gic bn th hay cn gi l h
cm gic su). V d nh chng mt do i xe, chng mt do cao,
chng mt th gic khi nhn mt lot cnh chuyn ng ni tip nhau (do
cm gic th gic ghi nhn nhng c ng ca mi trng bn ngoi
khng c i cng vi nhng bin i k tip ca h tin nh v h
cm gic bn th).

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 H tin nh gp nhng vn ng ca u m n cha thch nghi, v
d nh say sng.
T th bt thng ca u v c. V d nh nga u ra qu mc khi
sn trn nh.
Chng mt khng gian (space sickness) l chng mt thong qua
thng gp, do vn ng ch ng ca u trong mi trng khng c
trng lc l mt v d ca chng mt sinh l.
Chng mt bnh l: do tn thng h th gic, h cm gic bn th
hoc h tin nh.
- Chng mt th gic l do thy nhng hnh nh mi hoc hnh nh
khng thch hp, hoc do xut hin lit t ngt c vn nhn km theo
song th; trong trng hp ny h thn kinh trung ng s nhanh chng
b tr tnh trng chng mt ny.
- Chng mt do ri lon cm gic su him khi l triu chng n
c. Chng mt lc ny thng do bnh l thn kinh ngoi bin (c ri
lon cm gic su) lm gim nhng xung ng cm gic cn thit n h
thng b tr trung ng km vi ri lon chc nng ca h tin nh hoc
h th gic.
- Chng mt do ri lon chc nng h tin nh l nguyn nhn
thng gp nht, chng mt thng km theo bun nn, rung git nhn
cu, tht iu dng i. Do chng mt tng ln khi c ng u nhanh,
bnh nhn thng c khuynh hng gi u nm yn khng nhc nhch.
2.1.2. Triu chng khch quan
- Rung git nhn cu:
- Ri lon thng bng:
* Cc ri lon trng thi tnh:
- Du hiu Romberg
- Nghim php i b
- Nghim php gi thng hai tay

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 *Ri lon trng thi ng:
- Nghim php bc i hnh sao
- Nghim php past pointing:
- Nghim php nhit
- Nghim php gh quay [6]
- Nghim php Nylen-Brny
2.2. Cc hi chng tin nh
2.2.1. Hi chng tin nh ngoi bin: tn thng b phn cm nhn
hoc dy TK tin nh.
- Triu chng ch quan: chng mt d di, xy ra tng cn
- Triu chng khch quan: mang tnh cht ton din v ha hp
Ton din: tt c cc ri lon tin nh u hin din nh rung git
nhn cu (ngang-xoay trn), lch cc ngn tay, ri lon tnh trng, ri
lon dng i.
Ha hp: cc triu chng u cng v mt pha thng l bn bnh
Thng km theo cc ri lon thnh gic nh tai, gim thnh lc [2].
2.2.2. Hi chng tin nh trung ng: tn thng nhn tin nh hoc
cc ng lin h nhn tin nh vi h TK trung ng. Triu chng
khng in hnh nh trong tn thng tin nh ngoi bin, c s khc
bit r rt so vi hi chng tin nh ngoi bin [5].
- Trc ht l do tn thng nm xa ng c tai v dy VII nn
khng c tai, ic tai hay tn thng dy VII i km.
- Cc du hiu khch quan thng l hng nh: rung git nhn cu
- Triu chng khng ton din v khng c cng lc cc du hiu.
- S mt ha hp rt r
- Ngoi ra cn c hin din cc tn thng thn kinh nh du hiu
tiu no, tn thng thn no (du hiu thp: yu lit, tn thng vn
nhn).

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2.3. Chn on phn bit
2.3.1. Ch yu chn on phn bit vi cm gic s t, cm gic mt
thng bng, cm gic chong vng do nguyn nhn tm l.
Danh t chng mt c th c bnh nhn s dng m t mt
s biu hin v tm l m chng ta d dng chn on phn bit vi ri
lon tin nh.
2.3.2. Phn bit chng mt v hoa mt
- Hoa mt gm nhng cm gic bnh nhn thng m t nh u c
quay cung, xu, hay chong vng, khng kt hp o gic vn ng (tri
ngc vi chng mt). Nhng cm gic ny xy ra trong iu kin no b
ri lon cung cp mu, v d: nh kch thch thn kinh X qu mc, h
huyt p t th, ri lon nhp tim, thiu mu c tim, h oxy mu, h
ng mu v c th ln n cc im l mt thc, chong.
Nhng biu hin ny thng xy ra trong tnh trng lo lng, cng
thng thn kinh hoc c th i km vi mt bnh tm thn (lon thn )
- Chng mt ngi bnh cm nhn thy cy ci, nh ca quanh
mnh quay, hay bn thn mnh quay tt nh ng gia mt cn lc. Hoc
cm gic bng bnh nh khng c trng lng, hoc cm gic u a,
nhy ma hoc ch thy thnh thong cm gic xem sch b nha.
2.4. Cc cn nguyn ca hi chng tin nh:
2.4.1. Hi chng tin nh ngoi bin
- Cn chng mt d di xut hin cp tnh
Trng hp ny chn on tn thng tin nh khng c g kh
khn c: chng mt rt r, thng l xoay trn v nng ln khi c ng
u. Chng mt i km vi bun nn, i ma v ri lon thng bng
(chng mt thng gy nn t ng, bnh nhn i chnh chong hoc
khng th i c). Khm lm sng ghi nhn c rung git nhn cu v
ngn tay ch lch.

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 + Hi chng tin nh ngoi bin i km vi ic tai
Bnh Mnire hay hi chng Menire
+ Hi chng tin nh ngoi bin khng c ic tai i km
Khi khng c ic tai i km chng ta cn phn bit gia hi chng
tin nh ngoi bin v hi chng tin nh trung ng xy ra t ngt.
Trong hi chng tin nh ngoi bin s khng c cc du hiu tn
thng thn no hay tiu no i km.
Vim thn kinh tin nh
- Chng mt ngoi bin xut hin mn tnh
Trong trng hp ny chng mt thng khng r, xy ra trong thi
gian ngn hoc thng gp l cm gic chng mt, cm gic mt thng
bng v thng kh phn bit vi cm gic s t, cm gic hoa mt.
+ Chng mt t th
Chng mt t th lnh tnh (Benign Positional Vertigo)
+ Chng mt khng theo t th: do vim tai, do u thn kinh thnh
gic (neurinome).
+ Chng mt ngoi bin xy ra trong cc tnh hung c bit
Chng mt do thuc: thuc gy nn tn thng c tnh ln t bo
nhn cm v tn thng ny mang tnh cht khng hi phc.
2.4.2. Hi chng tin nh trung ng
- Cn chng mt d di cp tnh
Cn chng mt kch pht xy ra m khng c tn thng thnh lc i
km,
Nguyn nhn mch mu: nhi mu thn no (hi chng
Wallenberg), nhi mu tiu no
Bnh x cng ri rc (Multiple sclerosis)
- Chng mt trung ng xut hin mn tnh
+ Chng mt t th c ngun gc trung ng: Thng do thiu mu
no ng mch ct sng thn nn hoc him hn do u h sau.

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 + Chng mt khng theo t th: bnh nhn < 50 tui, thng c
th do u no, hoc him hn do bnh x cng ri rc.
- Chng mt xut hin trong nhng tnh hung c bit
Do s dng thuc lm tn thng cc ng tin nh trung ng
Chng mt v Migraine
3. CC PHNG PHP CHM SC V IU TR HI CHNG RI LON
TIN NH
Hi chng tin nh khng phi l mt bnh v c rt nhiu nguyn
nhn gy ra hi chng ri lon tin nh.Ngoi tr nhng trng hp ri
lon tin nh trong cc hi chng tm thn th ngi ta chia cc nguyn
nhn ri lon tin nh theo ba nhm iu tr:
- Ri lon tin nh do bnh l m o gy ra bi cc nguyn nhn
nh: vim tai do vi khun v virus, ri lon vn mch tai trong,
chn thng tai trong (sau phu thut thay th xng bn p),
bnh Mnire,
- Ri lon tin nh do nguyn nhn sau m o nh u dy thn
kinh s VIII, u gc cu tiu no, vim dy thn kinh tin nh
- Ri lon tin nh do nguyn nhn trung tm tin nh hnh no
v trn hnh no do cc nguyn nhn nh: thoi ha t sng c ,
bnh l
V nhng nguyn nhn ri lon tin nh phc tp nh vy nn
chng ta khng bn n iu tr ri lon tin nh mt khi n ch l triu
chng th yu trong mt hi chng bnh l ln( V d nh trong cn tai
bin mch mu no). Phng php iu tr d l ni khoa hay phu thut
cng ch nhm mc ch ct cn ri lon tin nh [3], [6].
3.1. iu tr ni khoa v chm sc iu dng:
iu tr ni khoa c ch nh cho tt c cc trng hp ri lon
tin nh cp tnh hoc mn tnh do ri lon chc nng ca c quan tin

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 nh m ta khng thy hoc cha pht hin c nguyn nhn thc th
gy ri lon tin nh.
3.1.1. iu tr cn ri lon tin nh cp:
- Ngi bnh c t ngh trong phng yn tnh, trnh cc c ng
, trnh cc kch thch tm l. V l do ny ta khng nn gia nh v
thn nhn n thm hi bnh nhn trong cn cp tnh.
- iu tr bng thuc: Nn hn ch s dng thuc ung m s dng
thuc bng ng tim vi mc ch l pht huy hiu qu ca thuc sm
ng thi trnh cho bnh nhn phi ung thuc trong lc chng mt v
bun nn. Cc thuc iu tr bao gm :
+ Cc loi huyt thanh ( ty theo triu chng i km m s dng cc
loi huyt thanh khc nhau)
+ Thuc chng nn.
+ Thuc chng chng mt.
+ Thuc an thn.
3.1.2. iu tr cn ri lon tin nh ti pht:
- Trnh cc kch thch tm l i vi ngi bnh, trnh di chuyn
bnh nhn, trnh thay i t th t ngt, trnh ni n o, trnh tm lnh.
- Ch n: Trnh ung ru, bia, cht kch thch
- Thuc( ty theo tnh trng thc th ca bnh nhn).
3.1.3. iu tr ri lon tin nh do Mnire:
iu tr trong cn cp: nm ti ging l phng php iu tr tt
nht v bnh nhn c th tm ra mt t th thch hp chng mt t xy
ra nht.
Trong nhng cn ko di c th dng dimenhydrinate, cyclizine,
meclizine.
Ch n gim mui cng nn dng d rng hiu qu ca ch n ny
kh m nh gi c.
C th iu tr bng phu thut.

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3.2. iu tr ngoi khoa: Cn tm c nguyn nhn [3], [5].
- Bt lp ng bn khuyn sau khng cho thch nh ri vo vng ny.
- Trng hp ri lon tin nh do r ngoi dch tai trong do chn
thng: Cn tin hnh phu thut bt lp ng r.
- Trng hp ri lon tin nh do vim tai trong c m: Cn lm
phu thut khot m nh hy dit tin nh, kt hp vi s dng khng
sinh liu cao.
- Cc trng hp ri lon tin nh do vim tai gia: tin hnh phu
thut gii quyt bnh tch vim tai kt hp bt lp r ng bn khuyn.

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 Chng II
I TNG V PHNG PHP NGHIN CU

1. I TNG NGHIN CU
Tt c nhng bnh nhn c ri lon tin nh c chn on v iu
tr ti khoa Tai - Thn kinh Bnh vin Tai - Mi - Hng Trung ng t
thng 6 n thng 12 nm 2011.
1.1. Tiu chun la chn
Bnh nhn c chng mt do cc bnh sau:
- Mnire
- ic t ngt
- Hi chng tin nh cha r nguyn nhn
- Sau m thay th xng bn p
1.2. Tiu chun loi tr
BN ri lon tin nh do tai bin mch mu no.
H s bnh n khng y .
2. PHNG PHP NGHIN CU: Nghin cu m t, c can thip
3. NI DUNG NGHIN CU
3.1. Chm sc bnh nhn ri lon tin nh
Chia lm 4 mc ri lon tin nh vi nhng chm sc iu
dng tng ng:
3.1.1. i vi bnh nhn chng mt d di km theo nn:
- BN c nm trong phng yn tnh, u hi cao trong t th nm
nga trn ging thp, mt nghing sang mt bn.
- Trnh cc kch thch tm l cho ngi bnh .
- Trnh di chuyn bnh nhn .
- Trnh thay i t th t ngt (c bit l thay i t th u).
- Thuc:
o An thn: Seduxen

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 o iu tr triu chng : Tanganin, primperan.
3.1.2. i vi bnh nhn chng mt d di, bun nn nhng khng
nn
- Nm bt ng tng i .
- Tp vn ng mc tng dn.
- Tp sm nht mc c th:
+ Vn ng th ng ( c s gip )
Ngi dy: Nhm mt gi nguyn t th u. Nng BN dy t t,
ngi ta lng. Khi ht chng mt: m mt, tp quay u chm.
Khuyn khch n ung t th ngi.
+ Vn ng ch ng ( BN t thc hin): Cn c ngi h tr ng
cnh BN thm t tin v phng b ng. BN t ngi dy chm, nhng
ln u c th nhm mt gim cn chng mt v gim cm gic s.
Tp quay u, lc u c th nhm mt, sau m mt tp. Tp chm.
Sau tp ng: c ngi hoc bm vo thnh ging, tp chm,
nhm mt cho ti khi ht cn chng mt quay. ng trn gt chn ri tp
king chn, tp bc ti ch.
3.1.3. i vi bnh nhn chng mt quay nhe
- Tp i c ngi bn cnh.
- i chn t.
- i dp xp mm.
3.1.4. i vi BN chnh chong
- Tp t i.
- Tp t chm sc bn thn, lm vic nh nh.
Lu : m bo an ton: c ch da hoc bm khi chng mt tng ln.
Ngoi ra: i vi BN c ri lon tin nh cn mt s lu :
- Trnh tm lnh
- Ch n hn ch cht kch thch: ru bia, thuc l
- Theo di bnh nhn tim truyn kp thi pht hin v x tr cc

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 tai bin, tc dng ph ca thuc. Cc phn ng cp c th xy ra:
+ Tim p nhanh, v m hi.
+ Nn, bun nn.
+ au u, chng mt.
+ Tng nhy cm v sc khi truyn dch.
+ Kch ng d dy.
- Gii thch r v tnh trng bnh, ng vin BN yn tm iu tr.
- T vn tn tnh cho BN v ch sinh hot v lao ng.
- Thng cm v chia s vi bnh nhn bt i phn no lo u mc
cm v bnh tt.
3.2. Chm sc BN ri lon tin nh sau m thay th xng bn p:
Ngoi nhng chm sc nh BN ri lon tin nh thng thng, BN c
ri lon tin nh sau m thay th xng bn p cn cn chm sc vt m.
- Trong nhng ngy u: Nu BN c chng mt d di km theo nn
th thay bng ti ging.
- Nhng ngy sau khi BN ht nn cn cm gic chng mt nhng
khng nn khuyn khch du BN ra thay bng ti phng bng.
- BN c thay bng tai ngy mt ln: Thng thng BN c ct
ch sau 7 ngy ( hoc ty theo ch nh ca bc s).
4. NH GI KT QU P DNG CHM SC BN RI LON TIN NH
4.1. c im BN
Khi BN vo vin iu dng vin ly cc ch s ca BN nh: Tui,
gii, mc chng mt, tnh trng BN, du hiu sinh tn, chn on
nh gi cc c im BN:
- Tui : phn ra cc nhm ( di 15 tui, 16-30 tui, 31-45 tui v
trn 45 tui)
- Gii tnh.
- Nguyn nhn (sau phu thut, Meniere, ic t ngt, hoc nguyn
nhn khc)

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4.2. c im lm sng:
- Bnh cnh xut hin ri lon tin nh
- c im lm sng thi im vo vin chia theo tng nhm bnh
4.3. Kt qu iu tr:
- Kt qu iu tr tng nhm bnh
- Tnh trng bnh nhn khi ra vin.
5. O C TRONG NGHIN CU
Nghin cu c tin hnh vi s ng hon ton ca BN v
ngi nh ngi bnh.
Nghin cu khng nh hng n kt qu iu tr v cn tr tin
trnh iu tr cho BN.
Phn tch v s l s liu : Microsoft Excel

17
 Chng 3
KT QU NGHIN CU

1. C IM BN
1.1. Tui

Bng 3.1: phn b tui ca bnh nhn

Tui T 0 n T 16 n T 31 n Trn 45 Tng s

15 tui 30 tui 45 tui tui

S BN 0 7 14 8 29

T l % 0 24,1 48,3 27,6 100

Tui
Tu

14 48,3%

12

10
27,6%
8
24,1%
2
6

0
16 n 30 tui 31 n 45 tui trn 45 tui

Biu 3.1. Phn b BN theo tui

Nhn xt:
Nhm tui t 31- 45 chim t l cao 48,3%
Khng c bnh nhn no di 15 tui

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1.2 Gii tnh
Nam: 5 trng hp
N : 24 trng hp

Gioi tinh

%, Nam,
17.2%

Nam
Nu

%, Nu,
82.8%

Biu 3.2 Phn b BN theo gii

Nhn xt:
T l nam v n c chnh lch rt ln: 17,2/82,8. S khc bit ny l
khng c ngha thng k do c mu ca nghin cu qu nh.

2. C IM LM SNG

2.1. Bnh cnh xut hin ri lon tin nh

Bng 3.2.: cc bnh cnh xut hin ri lon tin nh

Bnh cnh ic t Bnh cnh Sau phu

Mnire Tng s
xut hin ngt khc thut

S BN 6 4 3 16 29

T l % 20,7 13,8 10,3 55,2 100

Nhn xt: - Bnh cnh xut hin ri lon tin nh gp nhiu

i tng sau phu thut thay th xng bn p 16 trng hp chim
t l 55,2%

19
 Nguyn nhn

Sau phu thut

Meniere
ic t ngt
Khc

Biu 3.3: Phn b theo bnh cnh xut hin ri lon tin nh

Nhn xt:
- Trong nghin cu ny chng ti gp BN c ri lon tin nh t
pht trong 2 nhm bnh cnh ch yu l Mnire, ic t ngt.
- Ri lon tin nh gp nhiu sau phu thut tai, y ch yu l
sau phu thut thay th xng bn p.
2.2. Mc ri lon tin nh bnh nhn c hi chng Mnire khi
nhp vin
Bng 3.3. Mc ri lon tin nh bnh nhn c hi chng Mnire
khi nhp vin

Triu chng lm sng S bnh nhn T l %

Chng mt d di + bun nn + nn
Chng mt d di + bun nn +
khng nn
Chng mt quay nh + khng bun
nn + khng nn
Cm gic chnh chong + khng
bun nn + khng nn
Tng s BN
1 16,7
2 33,3
2 33,3
1 16,7
6 100

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2.3. Mc ri lon tin nh bnh nhn ic t ngt khi nhp vin
Bng 3.4. Mc ri lon tin nh bnh nhn ic t ngt
khi nhp vin

Triu chng lm sng S bnh nhn T l %

Chng mt d di + bun nn + nn 0 0

Chng mt d di + bun nn + khng nn 1 25

Chng mt quay nh + khng bun nn + 3 75

khng nn

Cm gic chnh chong + khng bun nn + 0 0

khng nn

Tng s BN 4 100

2.4. Mc ri lon tin nh nhm bnh nhn khng r cn

nguyn khi nhp vin
Bng 3.5. Mc ri lon tin nh nhm bnh nhn khng r cn
nguyn khi nhp vin

Triu chng lm sng S bnh nhn T l %

Chng mt d di + bun nn + nn 1 33,3

Chng mt d di + bun nn + khng nn 0 0

Chng mt quay nh + khng bun nn + 1 33,3

khng nn

Cm gic chnh chong + khng bun nn 1 33,3

+ khng nn

Tng s BN 3 100

21
 2.5. Mc ri lon tin nh nhm BN sau phu thut thay th
xng bn p ngy u tin
Bng 3.6. Mc ri lon tin nh nhm BN sau phu thut thay th
xng bn p ngy u tin

Triu chng lm sng S bnh T l %

nhn
Chng mt d di + bun nn + nn 4 25
Chng mt d di + bun nn + khng nn 3 18,7
Chng mt quay nh + khng bun nn + 4 25
khng nn
Cm gic chnh chong + khng bun nn + 5 31,3
khng nn
Tng s bnh nhn 16 100

2.6. Tng hp mc ri lon tin nh ca nhm BN trong nghin

cu ngy iu tr u tin:
Bng 3.7.: Tng hp mc ri lon tin nh ca nhm BN trong
nghin cu ngy iu tr u tin

Mnire ic t Bnh Sau phu Tng T l

ngt khc thut s BN %
Chng mt d
di + bun nn 1 0 1 4 6 20,7
+ nn
Chng mt d
di + bun nn 2 1 0 3 6 20,7
+ khng nn
Chng mt quay
nh + khng 2 3 1 4 10 34,5
bun nn +
khng nn
Cm gic chnh
chong + khng 1 0 1 5 7 24,1
bun nn +
khng nn
Tng s bnh 6 4 3 16 29 100
nhn

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3. KT QU IU TR
3.1. Chm sc iu dng nhm ri lon tin nh trong bnh cnh
Mnire, ic t ngt v nhm cha r nguyn nhn
Bng 3.8. ch chm sc iu dng nhm ri lon tin nh trong
bnh cnh Mnire, ic t ngt v nhm cha r nguyn nhn
Nm bt
Tp vn Tp i c
Ngy ng tng Tp t i Tng s
ng ngi
iu tr i BN
BN % BN % BN % BN %
Ngy 01 2 15,4 3 23,1 6 46,2 2 15,4 13
Ngy 02 0 3 23,1 4 30,8 6 46,2 13
Ngy 03 0 1 7,7 3 23,1 9 69,2 13
Ngy 04 0 0 1 7,7 12 92,3 13
Ngy 05 0 0 0 13 100 13

3.2. Chm sc iu dng nhm ri lon tin nh sau phu thut

thay th xng bn p:
Bng 3.9. Ch chm sc iu dng nhm ri lon tin nh sau
phu thut thay th xng bn p.
Nm bt
Tp vn Tp i c
Ngy ng Tp t i Tng s
ng ngi
iu tr tng i BN
BN % BN % BN % BN %
Ngy 01 7 43,8 7 43,8 2 12,5 0 16
Ngy 02 3 18,8 6 37,5 7 43,8 0 16
Ngy 03 0 4 25 5 31,2 7 43,8 16
Ngy 04 0 0 4 25 12 75 16
Ngy 05 0 0 1 6,3 15 93,7 16

Nhn xt: - T l bnh nhn trong ngy u sau phu thut cn nm

bt ng tng i v tp vn ng l 43,8%, tp i c ngi l
12,5%. Sau t l nm bt ng v tp vn ng gim dn ngy th 2
v 3. Trong khi t l tp i c ngi v t i tng dn ngy 4-5

23
 3.3. Tnh trng bnh nhn khi ra vin
Bng 3.10. Tnh trng bnh nhn khi ra vin
ic t Bnh Sau phu Tng T
Mnire
ngt khc thut s BN l %
Chng mt 0 0 0 0 0 0
quay nh
cm gic 0 0 1 0 1 3,4
chnh
chong
Bnh 6 4 2 16 28 96,6
thng
Tng s 6 4 3 16 29 100
BN

Nhn xt: Tnh trng bnh nhn tr li bnh thng khi ra vin l 28
trng hp chim t l 96,6% . Mt trng hp cn cm gic chnh
chong chim t l 3,4%.
3.4. Thi gian dng thuc iu tr chng mt
Bng 3.11. Thi gian dng thuc iu tr chng mt phi hp chm sc
iu dng
ic t Bnh Sau phu
Mnire S BN T l %
ngt khc thut
01 ngy 3 1 2 3 9 31,0
02 ngy 1 0 0 5 6 20,7
03 ngy 1 1 0 6 8 27,6
04 ngy 1 2 0 0 3 10,3
05 ngy 0 0 1 2 3 10,3
Tng s 6 4 3 16 29 100
BN

Nhn xt: - Thi gian dng thuc iu tr chng mt trong cc bnh

cnh Menire, ic t ngt, bnh cnh khc ch yu trong nhng ngy
th nht hoc th 2. Nhng sau phu thut th dng di ngy hn n
ngy th 3 thm ch c ngy th 5.

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 Chng 4
BN LUN

1. C IM BNH NHN
1.1. c im v tui
Biu 3.1 cho thy la tui t 31-45 chim t l cao nht 48,3%
Nhm tui di 15 khng gp trng hp no. Nh vy tui hay gp
thng t 16 tui tr ln v c xu hng gim dn theo tui. BN gp
ch yu tui lao ng, rt him gp tui cn tr <15 .
1.2. c im v gii
Biu 3.2 cho thy t l nam/n rt chnh lch, nam 17%, n
83%. . iu ny phn nh m hnh bnh tt ca ri lon tin nh gp
nhiu n hn l nam gii. Tuy nhin do c mu nghin cu qu nh do
t l ny l khng c ngha thng k.
2. C IM LM SNG
2.1. Yu t cn nguyn
Biu 3.3 cho thy t l phn b cn nguyn gy ri lon tin
nh trong nghin cu ny gp ch yu trn i tng sau phu thut
chim t l 55 %. S d c hin tng ny l do khoa Tai - Thn kinh l
mt khoa c s lng bnh nhn phu thut tai nhiu, c bit c nhiu
trng hp c m thay th xng bn p. y l phu thut c tc
ng trc tip ti vng ca s bu dc, t tc ng vo c quan tin
nh tai trong, do vy sau phu thut nhiu bnh nhn c cm gic
chng mt, bun nn. Hin tng ny l do c quan tin nh b kch
thch v gy ri lon tin nh ngoi vi vi cc biu hin bnh tng i
r rt: chng mt quay d di c bit l khi thay i t th, km theo c
bun nn v nn [1].
Nhm nguyn nhn th hai l hi chng Mnire vi 20,7%. y
l dng bnh l nc tai trong gy ri lon tin nh km tai, nghe

25
 km. Chng mt l mt trong nhng biu hin kinh in ca bnh ny vi
tnh cht c nhng cn bnh lp i lp li nhiu ln. Nhng cn chng
mt thng rt d di trong nhng gi u sau du dn i nhng li
cm gic chnh chong khi thay i t th. i khi bnh lm bnh nhn
c cm gic s vn ng [7].
Nhm bnh th 3 trong nghin cu ny l bnh cnh ic t ngt.
Nhm bnh ny c khm v iu tr ti khoa Tai - Thn kinh, Bnh
vin Tai Mi - Hng Trung ng vi t l tng i cao, khong 500
bnh nhn trong mt nm. Tuy nhin ch c mt t l nht nh c km
ri lon tin nh. Khi c ri lon tin nh km theo th tin lng iu
tr bnh km hn [4].
Ngoi ra c 3 bnh nhn c ri lon tin nh m cha xc nh
c nguyn nhn cng nh cha tm ra bnh cnh phi hp. Nhng
bnh nhn ny vic iu tr tr nn kh khn hn.
Theo y vn th gii th cn nhiu nguyn nhn khc gy ra ri lon
tin nh nh: vim dy thn kinh tin nh, x cng di rc, nhim c
tai trong, vim do virus nhng trong nghin cu ny c th do c mu
cn nh do chng ti mi ch gp mt s bnh cnh nu trn [7].
2.2. Mc ri lon tin nh BN c hi chng Mnire khi
nhp vin
Trong nhm BN nghin cu c 6 bnh nhn Mnire th ngy
u tin nhp vin ch c 1 BN chim 16,7% c chng mt d di, bun
nn v nn, 2 bnh nhn c chng mt d di v bun nn nhng khng
nn. Cn li 3 BN (chim 50%) ch c cm gic chng mt nh hoc
chnh chong. S d c nhng mc chng mt khc nhau ny l do
c tnh ca bnh Mnire l bnh xut hin thnh tng cn, mi cn
thng ko di vi gi, nn khi nhp vin mt s bnh nhn qua cn
cp tnh vi triu chng chng mt rm r. Hn na, tu mc v v tr

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 nc tai trong m mi ngi bnh b chng mt nhng mc
khc nhau.
2.3. Mc ri lon tin nh bnh nhn ic t ngt khi
nhp vin
Trong s 4 bnh nhn thuc nhm ny th ch c 1 ngi b chng
mt nhiu cn li 3 ngi b chng mt nh. Thng thng bnh ic t
ngt thng th hin bng nhng ri lon phn c tai vi biu hin
gim kh nng nghe t ngt, tuy nhin mt s trng hp c ri lon
tin nh km theo. S d c hin tng ny l do c quan tin nh l
mt phn ca tai trong, n c s thng thng ni dch ca phn c tai v
cc ng bn khuyn, nn khi c tai tn thng th c th gy tn thng
c cc cu trc tin nh. Thm vo phn mch nui cho c tai v tin
nh c nhnh chung nhau nn c th cng mt lc tn thng c 2 phn.
Trn thc t lm sang, mt bnh nhn ic t ngt c km theo ri lon
tin nh th tin lng km hn.
2.4. Mc ri lon tin nh nhm bnh nhn khng r cn
nguyn khi nhp vin
Chng ti gp 3 bnh nhn c ri lon tin nh m khng tm
c nguyn nhn cng nh bnh phi hp. Nhm ny ch c 1 bnh
nhn (chim 33,3%) c chng mt d di km bun nn v nn. 2 bnh
nhn cn li khi nhp vin ch cn cm gic chng mt nh hoc chnh
chong. Thng thng nhm bnh ny c nhn vo vin iu tr v b
chng mt ko di, vic iu tr ngoi tr c kh khn. Trc ht lun
phi loi tr nhng nguyn nhn nguy him ti tnh mng (nh tai bin
mch mu no, thiu nng tun hon no, u dy thn kinh thnh gic
loi tr nhng nguyn nhn ny thng thng cc bc s iu tr cho
bnh nhn chp cng hng t s no. C 3 bnh nhn ny trn phim
cha pht hin tn thng.

27
 2.5. Mc ri lon tin nh nhm BN sau phu thut thay th
xng bn p ngy u tin
Phu thut thay th xng bn p c tc ng trc tip n vng
ca s bu dc, ni c xng bn p gn vo v l danh gii ca tai
gia v tai trong. Chnh s tc ng ny lm rung ng ni dch tai trong
gy ra chng mt. Rt nhiu bnh nhn sau phu thut thay th xng bn
p than phin b chng mt cc mc khc nhau. Trong nghin cu
ny c 7 bnh nhn (chim 43,8 %) b chng mt d di, 4 bnh nhn
km theo nn. C 4 bnh nhn (chim 25 %) b chng mt nh v 5 bnh
nhn ( chim 31,5%) c cm gic chnh chong khi thay i t th.
Thng thng cc thuc iu tr chng mt v ch iu dng c bit
c ch nh cho bnh nhn ngay t ngy u tin sau phu thut.
Nhng ngy u sau phu thut do tr gm hoc vt liu thay th
xng bn p c t vo cha thc s chc nn ngi bnh cn c
nhng c ng nh nhng, trnh nhng ng tc mnh t ngt c bit
l vng u. Chnh v vy m nhng ngy ny phi quan tm c bit
n vic iu tr gim nn o.
2.6. Mc ri lon tin nh ca BN trong nghin cu ngy iu
tr u tin
Nh vy trong nghin cu ca chng ti, ngy u tin bt u
iu tr c 6 bnh nhn (chim 20,7%) c chng mt d di km bun
nn v nn. C 6 bnh nhn c chng mt quay nhiu, bun nn nhng
khng nn. 17 bnh nhn cn li (chim 58,6%) ch chng mt nh hoc
chnh chong khi thay i t th. Cho d nguyn nhn gy chng mt l
g th vic chm sc iu dng phi ph hp vi mc chng mt.
Tng ng vi mi mc chng mt ny l mt ch chm sc iu
dng khc nhau.

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3. KT QU IU TR
Trong iu tr ri lon tin nh th thuc v ch chm sc iu
dng u rt quan trng, n h tr cho nhau. Khi 2 phng php ny
c phi hp vi nhau hp l th hiu qu iu tr c nng ln, gip
ngi bnh mau hi phc hn, rt ngn thi gian iu tr ni tr.
Vic theo di v nh gi din bin lm sng ca tng bnh nhn
c iu dng vin thc hin hng ngy t a ra ch chm
sc hp l, ph hp vi mc chng mt.
3.1. Chm sc iu dng nhm ri lon tin nh trong bnh cnh
Mnire, ic t ngt v nhm cha r nguyn nhn
Trong nghin cu ca chng ti nhm ny c tt c 13 bnh nhn.
3.1.1. Bnh nhn c chng mt d di km bun nn v nn:
Ngy u tin nhp vin, 2 bnh nhn trong s ny (chim 15,4 %)
c chng mt d di km bun nn v nn. y l nhng biu hin ca
h thng tin nh ang b kch thch mnh, nn vic iu tr giai on
ny l c gng lm du li h thng tin nh. C 2 bnh nhn ny c
nm bt ng mt cch tng i, ni yn tnh. Bt ng mt cch
tng i l bnh nhn c nm ngh ngi, hn ch thay i t th u
gim cc kch thch tin nh ngoi vi. Nn u bnh nhn nghing
nh sang 1 bn phng khi nn khng b sc vo ng th. Thng
thng giai on ny bnh nhn c phi hp iu tr cc thuc gim
chng mt, gim nn v an thn. Nu bnh nhn nn nhiu nn duy tr
ng truyn tnh mch nui dng tm thi v m bo b nc v
in gii. Sang ngy iu tr th 2 nhng bnh nhn ht nn v c
p dng cc bi tp ph hp.
3.1.2. Bnh nhn chng mt nhiu, bun nn nhng khng nn:
C 3 bnh nhn nhp vin iu tr trong tnh trng ny. Nhng bnh
nhn ny ngay t ngy iu tr u tin c p dng ch tp vn
ng. Thng thng giai on ny ngi bnh cn e ngi v thiu t tin

29
 khi thay i t th nn iu dng vin cn gii thch r vi bnh nhn v
ngi nh bnh nhn v mc ch tp vn ng cng nh nhng ng tc
m bnh nhn nn tp. Khuyn khch bnh nhn tp vi mc kh tng
dn: nhng gi u nn tp vn ng th ng, ngha l thc hin nhng
ng tc c s gip ca iu dng. V d: iu dng nng ngi
bnh ngi dy, c ta lng. Nhng ln tp vn ng u tin nn nhc
ngi bnh nhm mt gim kch thch tin nh do thay i trng
nhn. Khi bnh nhn thch nghi hn th khuyn khch ch ng thc
hin ng tc, iu dng vin ng bn cnh h tr khi cn v
ngi bnh thm vng tin.
mc chng mt ny nn p dng ch dinh dng vi n
mm, lng, d tiu nh cho, sp nhng phi m bo cht dinh
dng. Bnh nhn c hng dn n t th ngi.
3.1.3. Bnh nhn chng mt nh, khng bun nn, khng nn:
mc chng mt nh c 6 bnh nhn nhp vin chim 46 %.
Nhng bnh nhn ny c p dng ch iu dng tp t i li, c
ngi bn cnh. Giai on ny chng ti thng cho bnh nhn i
chn t hoc i dp xp mm vic tp luyn c d dng hn.
Ch dinh dng giai on ny khng c g c bit, bnh nhn
nn n cm, m bo cht dinh dng.
3.1.4. Bnh nhn cn cm gic chnh chong khi i:
Nhm bnh nhn ny c 2 trng hp cn cm gic chnh chong
khi nhp vin. Bn cnh cc thuc iu tr ngi bnh c khuyn khch
t phc v sinh hot c nhn, tuy nhin cn nhc bnh nhn quan st k
khi bc i v lun nhng ch c th bm vo khi thy chnh
chong nhiu ln.
Ch dinh dng cho giai on ny khng c g c bit.
Din bin lm sng ca ton b 13 bnh nhn ny tt ln hng ngy
v n ngy th 5 th 100% bnh nhn thuc nhm ny u c th t

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phc v sinh hot c nhn.
3.2. Chm sc iu dng nhm ri lon tin nh sau phu thut
thay th xng bn p
Vic nh gi mc chng mt nhm ny khng c s khc bit so
vi nhm ri lon tin nh bnh cnh ni khoa nhng vic chm sc iu
dng v ch iu tr trong nhng ngy u th c s khc bit r rt.
i chiu gia bng 3.6. v bng 3.9. ta thy: bng 3.6. ch c 4
bnh nhn b chng mt d di km theo nn v 3 bnh nhn ch chng
mt nhiu nhng khng nn, nhng bng 3.9. li c ti 7 bnh nhn
c p dng ch iu dng nm bt ng tng i, v ch c
2/16 bnh nhn nhm phu thut xng bn p c tp i c ngi
bn cnh trong ngy hu phu u tin. S d c s khc bit nh vy
l v nhng ngy u sau phu thut nhng bnh nhn ny c p dng
ch chm sc hu phu phi hp vi ch iu dng cho nhm
bnh nhn c ri lon tin nh.
Cng vi thuc iu tr ri lon tin nh th nhng bi tp vn ng
tng dn cng gip nhm bnh nhn ny hi phc chc nng tin nh
tng i nhanh. Ti ngy th 5 ch c 1 bnh nhn cn chng mt nh
v 15 bnh nhn cn li phn ln ht chng mt, mt s ch cn cm
gic chnh chong.
Sau phu thut xng bn p nu bnh nhn cn chng mt ko
di cn bo co li vi phu thut vin. Mt trong nhng nguyn nhn
gy chng mt ko di bnh nhn m thay th xng bn p l tr dn
qu di, gy kch thch lin tc vo c quan tin nh. Nn thn trng hn
nu chng mt c km theo tai ting cao lin tc, v vy iu dng
vin cn hi bnh nhn hng ngy nh gi xem h c b tai hay
khng v nh th no.
V ch dinh dng cho nhm bnh nhn sau phu thut xng
bn p, chng ti p dng theo tng mc chng mt ging nh nhm

31
 ri lon tin nh do nhng nguyn nhn ni khoa khc, tuy nhin ch
trng cung cp nhiu cht b hn gip vt m hi phc nhanh.
3.3. Tnh trng bnh nhn khi ra vin
Trong nghin cu ny vo thi im bnh nhn xut vin hu ht
bnh nhn (96,6%) ht chng mt, ch cn 1 trng hp (chim 3,4%)
cn cm gic chnh chong khi i li. Bnh nhn ny c chn on ri
lon tin nh khng r nguyn nhn. Sau khi ra vin bnh nhn c
gii thiu n chuyn khoa phc hi chc nng tip tc cc bi tp
iu tr ri lon tin nh.
3.4. Vai tr ca thuc v ch chm sc iu dng trong iu tr
chng mt
bng 3.11. ta thy phn ln bnh nhn (79,3%) c dng thuc
iu tr chng mt ti a l 3 ngy, ch c 1 trng hp ung thuc ko
di sau khi ra vin. Trong khi ch tp luyn cho ri lon tin nh
th ko di hn.
Cc tn thng ca h thng tin nh c kh nng b tr rt ln,
nhng thi gian hi phc ca n nhanh hay chm li ph thuc vo vic
tp luyn. Thuc khng th thay th c cc bi tp tin nh. Cc bi
tp tin nh c rt nhiu dng v mc khc nhau. Chuyn ngnh Tai -
Mi - Hng l chuyn ngnh mang c tnh cht ni khoa v ngoi khoa,
nhng bi tp vn ng m chng ti hin ang p dng l nhng bi tp
rt n gin, ph hp vi thi gian iu tr ban u ca cc ri lon tin
nh. Vi nhng bnh nhn b ri lon tin nh nng hoc ko di lm
nh hng ti sinh hot th sau khi kt thc vic iu tr ban u ny
ngi bnh cn c tip tc iu tr cc c s phc hi chc nng vi
nhng bi tp chuyn su hn.

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 KT LUN

Do t trc n thi im chng ti nghin cu cha c nh gi

no ca iu dng v chm sc bnh nhn ri lon tin nh nn chng
ti cha tm c kt qu so snh. V vy qua nghin cu 29 trng hp
BN c ri lon tin nh ti khoa Tai - Thn Kinh Bnh vin Tai Mi -
Hng Trung ng t thng 6 n ht thng 12 nm 2011 chng ti rt ra
cc kt lun sau:
1. c im BN:
- Hay gp tui lao ng, him gp tui di 15. Nhm tui
t 131-45 chim t l cao nht ( 48,3%). T l ny c xu hng gim dn
t l nghch vi tui .
- N chim t l cao hn nam gii ( 82,8%). Tuy nhin do c mu
nghin cu cn nh nn con s ny cha thc s c ngha.
- T l BN c ri lon tin nh sau phu thut thay th xng bn
p chim a s(55,2 %). S d c hin tng ny l do khoa Tai - Thn
kinh c s lng bnh nhn phu thut tai nhiu, c bit phu thut thay
th xng bn p v ri lon tin nh l mt trong nhng bin chng
hay gp giai on hu phu.
- T l BN c ri lon tin nh cao th hai gp trong nhm bnh
nhn c hi chng Mnire vi 20,7%, v cao th 3 trong bnh cnh ic
t ngt (13,8%).
2. Chm sc BN ri lon tin nh:
- Cng tc chm sc iu dng ng mt phn rt ln vo kt qu
iu tr, thuc khng th thay th c cc bi tp vn ng.
- Phn ln bnh nhn ch iu tr thuc n ngy th 4 chim t l
89,7%
- BN c ri lon tin nh d do nguyn nhn g th s chm sc

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 cng gn ging nhau khng c s khc bit gia cc nhm nguyn nhn
m ph thuc vo mc ri lon tin nh. Quy trnh chm sc theo 4
mc ph thuc vo c im lm sng: mc chng mt, c km
theo bun nn v nn hay khng?
+ Chng mt d di km theo bun nn v nn: Nm bt ng tng
i .
+ Chng mt nhiu km bun nn nhng khng nn: tp vn ng
th ng tp vn ng ch ng.
+ Chng mt nh, khng bun nn: tp i c ngi tr gip.
+ Cm gic chnh chong: tp t phc v bn thn.
- Phn ln bnh nhn c th t tp i ngy th 4 v 5 ca t iu tr.
- Ring v bnh nhn sau m thay th xng bn p cn cn chm
sc, theo di vt m ti ch.

KIN NGH

1. Cn nhn rng cc bi tp vn ng ti cc khoa phng

2. Chun ha cc bi tp sau khi BN xut vin c th t tp ti nh.

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 MC LC

T VN ..........................................................................................1
Chng 1: TNG QUAN TI LIU.......................................................2
1. NHC LI GII PHU C QUAN TIN NH ................................... 2
1.1. Tai ngoi .......................................................................................... 2
1.2. Tai gia ............................................................................................ 2
1.3. Tai trong........................................................................................... 2
2. C IM LM SNG CA RI LON TIN NH ........................ 5
2.1. Triu chng lm sng ...................................................................... 5
2.2. Cc hi chng tin nh................................................................... 8
2.3. Chn on phn bit ........................................................................ 9
2.4. Cc cn nguyn ca hi chng tin nh:........................................ 9
3. CC PHNG PHP CHM SC V IU TR HI CHNG RI
LON TIN NH........................................................................................... 11
3.1. iu tr ni khoa v chm sc iu dng:................................... 11
3.2. iu tr ngoi khoa: Cn tm c nguyn nhn . ........................ 13
Chng 2: I TNG V PHNG PHP NGHIN CU ............ 14
1. I TNG NGHIN CU ............................................................ 14
1.1. Tiu chun la chn....................................................................... 14
1.2. Tiu chun loi tr......................................................................... 14
2. PHNG PHP NGHIN CU ..................................................... 14
3.1. Chm sc bnh nhn ri lon tin nh ......................................... 14
3.2. Chm sc BN ri lon tin nh sau m thay th xng bn p: 16
4.1. c im BN ................................................................................. 16
4.2. c im lm sng: ....................................................................... 17
4.3. Kt qu iu tr: ............................................................................. 17
Chng 3: KT QU NGHIN CU................................................ 18
1. C IM BN ................................................................................... 18

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 1.1. Tui................................................................................................ 18
1.2 Gii tnh .......................................................................................... 19
2. C IM LM SNG ................................................................... 19
2.1. Bnh cnh xut hin ri lon tin nh.......................................... 19
2.2. Mc ri lon tin nh bnh nhn c hi chng Mnire khi
nhp vin ....................................................................................... 20
2.3. Mc ri lon tin nh bnh nhn ic t ngt khi nhp vin
....................................................................................................... 21
2.4. Mc ri lon tin nh nhm bnh nhn khng r cn nguyn
khi nhp vin ................................................................................. 21
2.5. Mc ri lon tin nh nhm BN sau phu thut thay th
xng bn p ngy u tin ........................................................ 22
2.6. Tng hp mc ri lon tin nh ca nhm BN trong nghin
cu ngy iu tr u tin:.......................................................... 22
3. KT QU IU TR .......................................................................... 23
3.1. Chm sc iu dng nhm ri lon tin nh trong bnh cnh
Mnire, ic t ngt v nhm cha r nguyn nhn................. 23
3.2. Chm sc iu dng nhm ri lon tin nh sau phu thut
thay th xng bn p: ................................................................ 23
3.3. Tnh trng bnh nhn khi ra vin................................................... 24
3.4. Thi gian dng thuc iu tr chng mt ...................................... 24
Chng 4: BN LUN........................................................................ 25
1. C IM BNH NHN ................................................................. 25
1.1. c im v tui............................................................................ 25
1.2. c im v gii............................................................................ 25
2. C IM LM SNG ................................................................... 25
2.1. Yu t cn nguyn ......................................................................... 25
2.2. Mc ri lon tin nh BN c hi chng Mnire khi nhp
vin ................................................................................................ 26

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 2.3. Mc ri lon tin nh bnh nhn ic t ngt khi nhp vin
....................................................................................................... 27
2.4. Mc ri lon tin nh nhm bnh nhn khng r cn nguyn
khi nhp vin ................................................................................. 27
2.5. Mc ri lon tin nh nhm BN sau phu thut thay th
xng bn p ngy u tin ........................................................ 28
2.6. Mc ri lon tin nh ca BN trong nghin cu ngy iu tr
u tin .......................................................................................... 28
3. KT QU IU TR .......................................................................... 29
3.1. Chm sc iu dng nhm ri lon tin nh trong bnh cnh
Mnire, ic t ngt v nhm cha r nguyn nhn................. 29
3.2. Chm sc iu dng nhm ri lon tin nh sau phu thut
thay th xng bn p ................................................................. 31
3.3. Tnh trng bnh nhn khi ra vin................................................... 32
3.4. Vai tr ca thuc v ch chm sc iu dng trong iu tr
chng mt ...................................................................................... 32
KT LUN .......................................................................................... 33
KIN NGH ......................................................................................... 34
TI LIU THAM KHO
PH LC

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 DANH MC BNG

Bng 3.1: Phn b tui ca bnh nhn.................................................. 18

Bng 3.2.: Cc bnh cnh xut hin ri lon tin nh............................ 19
Bng 3.3. Mc ri lon tin nh bnh nhn c hi chng
Mnire khi nhp vin.......................................................... 20
Bng 3.4. Mc ri lon tin nh bnh nhn ic t ngt khi
nhp vin.............................................................................. 21
Bng 3.5. Mc ri lon tin nh nhm bnh nhn khng r
cn nguyn khi nhp vin ..................................................... 21
Bng 3.6. Mc ri lon tin nh nhm BN sau phu thut
thay th xng bn p ngy u tin................................... 22
Bng 3.7.: Tng hp mc ri lon tin nh ca nhm BN trong
nghin cu ngy iu tr u tin....................................... 22
Bng 3.8. Ch chm sc iu dng nhm ri lon tin nh
trong bnh cnh Mnire, ic t ngt v nhm cha r
nguyn nhn ......................................................................... 23
Bng 3.9. Ch chm sc iu dng nhm ri lon tin nh
sau phu thut thay th xng bn p. ................................ 23
Bng 3.10. Tnh trng bnh nhn khi ra vin.......................................... 24
Bng 3.11. Thi gian dng thuc iu tr chng mt phi hp chm
sc iu dng ..................................................................... 24

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 DANH MC BIU

Biu 3.1. Phn b BN theo tui......................................................... 18

Biu 3.2. Phn b BN theo gii......................................................... 19
Biu 3.3. Phn b theo bnh cnh xut hin ri lon tin nh .......... 20

DANH MC HNH

Hnh 1: gii phu tai v c quan tin nh tai trong...............................3

Hnh 2: tai trong v c quan tin nh ......................................................4
Hnh 3: cc nhn tin nh v ng dn truyn tin nh........................5

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