Tat ca cafc r6i loan co tron tren c6 th€ gi}.ptrong 't6n thuong than kinh trung uong va t6n thuongvung du6i ngua cua than kinh ngoai bien Rei loan chirc nang than kinh SQ - Khi benh nhan t6n thucng nao, thuong kern thee tan thuong mQt sO' day than kinh 89 nhan cac day narn nao, bieu hien bang trieu chung va r6i loan chuc nang cac day d6 " •• T~n thucng d~y I: m1(~ha: gia~ khuu :iac, ~ang ,khUU, ,aDkhuu, \ Ton thucng day II: mu, gram thi luc gram thi truong nhin ) + T6n thucng day III, IV, VI: Ii~t co van nhan, sa mi mat, mat phan xa d6ng ttt vdi anh sang I " I + T6n thucng day V: giam, mat, r6i loan cam giac d mat, phan truce ~ ludi Liet co c~n (kh6ng co phan x~ cAm), mat ph an x~ giac m~c + T6n thtidng day VII: Ii~t m~t, mat vi giac 2/3 trtiac Iuai tt- T6n thtidng day VIII: diec, giam thinh giac, rung gi~t nhan c~u, rii Io~n tien dinh .+ T6n thtidng day IX, X: l~ch mau h~u, li~t quan, an, uing s~c, ,/ nu6t kh6, noi gi9ng mlii , + T6n thtidng day XI: Ii~t cd thang, cd uc don chum + T6n thtidng day XII: li~t ltiai, kh6 noi ' ~ren day la nhung bi€u hi~n lam sang thtidng g~p b~nh ly h~ thftn kinh Ph at hi~n dfty nhung bi€u hi~n d,6, Iti\1ng gia chinh xac r6i lo~n chuc nang ky thu~t vien se co nhung yeu to' c~n thiet d~ d~ ke ho~ch phvc h6i, ch9n phudng phap tri li~u thich h\1p d~t hi~u qua cao dieu tri, d6ng thdi giup tien Iti\1ng va thee d6i tie'n tri€n dieu trio du LUQNG GIA Trinh bay giai phft u cd ban h~ th~n kinh Trinh bay cac thay d6i ve tinh th~n, v~n d9ng, cam giac va dinh dtiang cd e6 t6n thtidng th~n kinh trung tidng va ngo~i bien Trinh bay each kham va phat hi~n mQt 86 phan x~ binh thtidng va b~nh IS co t6n thtidng thftn kinh Trinh bay cae bi€u hi~n r6i lo~n cd tron va cae r6i lo~n chuc nang day thftn kinh 89 b~nh ly thftn kinh 35 VAT LY TRI LIEU, - PHUC Hill CHile NANG TAl BIEN MACH MAu NAo MVC TIEU Nguyen nhan, trieu chung lam sang d.c mach m au nao va vd mach mau nao Tien tri~n cua tai bien mach rnau nao Muc dich, phuong phap PHCN giai dean d9t quy, giai dean Iiet mern, giai doan liet cling cua benh tai bien mach mau nao NQIDUNG D~i cironq Tai bien mach mau nao la t6'n thuong nao, mang nao xay d9t ng9t vd mach, t~c mach cua mach mau nao, Tai bien mach mau nao thuong gay liet nua nguoi doi ben Nguyen nhan 2.1 Tac mech Do xo vua va co cling dong mach Ia nguyen nhan quan nhat thucng g~p d d9ng mach nao giua, d9ng mach canh trong, mang xo vua.boi d~p len dong mach lam dong m~ch h~p l~i gay lien ket ti~u efiu va h6ng efiu t~o e\le mau dong, dfln den uie m~eh ho~e mang xd vila di chuy~n den d9ng m~ch lam eho d9ng m~eh h~p va gay t~e Do e\le huyet khoi ho~e b6ng hoi xu~t hi~n tiem truyen, die e\le huyet khoi g~p cae b~nh ve van tim nhu h~p van la, sui van tim , 2.2 va m{Jch mau: (xuat huyet nao) - M~ch rna tj va ~ rnau tran ngoai - Do cao huyet ap - Do xd vua d9ng m~eh B~nh ua chay mau cung c6 th~ gay xuat huyet nao nhu b~nh b~eh cflu cap, b~nl?-Hemoglobin, xuat huyet giam b~eh eflu b~nh $eholein Henoek 36 Trieu ch((ng lam S~H;g 3.1 Tac mech mtiu nao Giai dean khoi pha t c - 'I'rieu chung xuilt hien tu tu qua nhieu narn - Chu yeu' benh nhan th[y nhirc d~u, hoa mat chong mat, co th~ co cam giac di cam thoang qua - Giarn van dong chan tay, chan tay giclen khokhan ngucng nghiu Roi loan cam giac d tay chan ben liet: ngori tay, ngori chan te te nhu _ _kien bo hoac dau nhu kim cham - Noi kho hoac noi ngong Giai dean liet: day la bi~u hien cua Iiet than kinh trung uong giai dean sdrn - Giai dean d~u li~t mern sau chuyen sang liet cung - Bi~u hien liet nua nguoi, chan tay kh6ng cli d9ng tt;l chu duoc Tinh chat lict: li~t d6ng dgu nhung kh6ng hcan toan, mat va chi tren li~t trQi hdn Chi tren: li~t chu yeu nhom cd du6i: cd ban tay, ngon tay Chi dttoi: li~t chu yeu nhom cd gElp + Roi lo~n y thuc: co th~ h6n me nh~, hoi g9i U d + Roi lo~n cam giac: CElU kh6ng biet dau , + Roi lo:;tn phan x:;t: phan x~ gan xttdng tang, trttdng h;lC cd tang + Roi lo:;tn tinh th~n: tinh tinh thay d6i, cttdi noi va duyen Cd Giai do~n lui b~nh + Tri~u chung lam sang giam d~n + D~ l~i di chung: li~t mla ngttdi, r6i lO ~,_/-c:~ i thang tu6i truong l~c e6 doi xung T_tithekham:=~_B~nh , r'~ nhan quy di6~.t·d~-£~~:~;;;~"m~\ '"'_ ~Il C)W~ X?: nang va du6i dflu tre )'" ==F= 63 ~)- Ket qua: (-) Kh6ng co phan ung cua chi nao vdi kich thich (+)Hai tay tre du6i thang va chan g~p (rnong cham sat got chan) ,.::!)_ Danh gia ket q:ua: , + Binh thlidng.(+) tit -~ thang tu6i + TrEm4>than~ tu6i (+) la dau hieu cham phat tri~n Ph an xa me dao truong luc sap va ngua :_t'l Pha n 'W me dao trucng luc sap: 11~· Tu thekha-m-:+ JJ)- Benhnhan narn sap, dftudvi-tritrung glafit1Cl1~6t -~·~-, ;%~ Kich thich phan xa: nam sap , r'l)- Ket qua: (-) Kh6ng tang trucng luc gap, dliu nang duoi ve phia sau, ~ tay du6i 4')- (+) 'I're khong th~ nang dliu duoi ve phia lung duoc, Danh gia ket qua: Binh thucng (+) tu - thang tuoi Tren thang tu6i (+) la dau hieu cham phat tri~n ~~ ~~,~), (_) 1: -~ Hinh 12 Ph~n x~ nang da h uu hi~u _ Tli the kham: b~nh nhan dung _ Kich thich phan x~: nhun ep nhieu llin long ban chan tre _ Ket qua: (-) Khong tang trlidng l\ic, chan\g~p l~i (+) Tang truong l\ic, duoi m~nh chan _ Danh gia ket qua: binh thlidng " (+) tu - thang tu6i 64 -~ ((~\~ -'_ r- '!j '.' I ," , t.l r IVlv; Hinh 13 Phan xa nang da hiru hi~u Phan xa chinh the' c5 _ Tu the' kharn: benh nhan nam ngua, d:1u d vi trf trung gian, tay chan du6i th&ng _ Rich thich ph an xa: xoay d:1utre sang met ben, _ Ke't qua: (-) than minh khong xoay (+) than minh xoay cling m9t huang vdi d:1usang phia mat - Danh gia ke't qua: + Binh thudng + Treri (3 thang tu6i (+) tu - thang tu6i (+) 13.dau hieu cham ph at tri~n Tu the' kh am 1\ic thi giac ' _:_ T~-thiih~a~~·b~tr~ trongkhong-·gian-d-·tllthe~n(n~g='llu;=a= === 1:5, VLTl 65 - Rich thich phan xa: narn ngua - Ket qua: am tfnh: dau ru, kh6ng nang leri' duoc vi tri binh thuong, DUdng tinh: di'iu nang len cao, mat phang dung, mieng narn ngang - Da nh gia ket qua: binh thudng (+) tu thang tu6i den het doi Tren thang tu6i (-) la dau hieu cham phat tri~n Ph an ling tharig bang d tu the nam ngua - Tu the kham: benh nhan narn ngua tren tam van phang, chan va tay du6i - Rich thich phan xa: nghieng tam van - Ket qua: (-) Di'iu va nguc kh6ng tu chinh the, kh6ng c6 phan ling thang bang hay tu v~ (+) C6 chinh the d:lU va nguc, tay du6i chan dang d phia nang len, ph an ling tu v~ phia thap - Danh gia ket qua: Binh thuong (+) tu thang tu6i den het doi Tren thang tu6i (-) la dau hi~u ch~m phat tri~n Phan ling thang bang d tli the nam sap - Tu the kham: b~nh nhah nAm sap tren tam van ph&ng, chan va tay du6i - Rich thich phan x~: nghieng tam van - Ket qua: Di'iu va ngt;tc kh6ng chinh the, kh6ng c6 phan ling thang bang hay tt;i v~ - Danh gia ket qua: Binh thlidng +) tl:i thang tu6i den het ddi Tren thang tU6i- (-) la dau hi~u ch~m phat tri~n Phan ling thang bang d tu the quy - Tli the kham: b~nh nhart quy di~m = ~ ~_= =_ -c~_~=o=o,~_ 66 = = = ~ ~ = =_ ==-=========~= _", _~ ,"._ - Rich thjchphan xa: nhac nghieng dua tre sang m9t ben - Ke't qua: (-) ~~u va nguc khong chinh the', v~n giu nguyen vi tri (+) C6 chinh the' d~u va nguc, tay va chan phfa nang: du6i dang (phan ung thang bang), Phan ung'tlf I v~phia thap, - Danh gia ke't qua: binh thuong (+) tu thang tu6i de'n he't doi Tren thang tu6i (-) 1a dati hieu cham phat tri€n Ph an ung thang bang d tu the' ~g6i : i ~' ' '" "'," 'I'u the' kharn: benh nhan ngoi - Rich thich ph an xa: keo dua tre sang ~9t ben - Ke't qua: (-) D~u va nguc kh6ng tv chinh the', kh6ng c6 ph an ling thang b~ng, tv v~ (+) C6 chinh the' d~u va nguc, tay va chan phia nang: du6i dang (phan ung thang b~ng) - Danh gia ke't qua: binh thudng (+) tu 10 - 12 thang tu6i de'n he't ddi Tren 12 thang tu6i (-) 1a dftu hi~u ch~m phat tri€n 04(-) Hlnh 14 Phi!m ung thi;ing b~ng , (+) d tLfthe ngoi Ph an 'ung thang b~ng bUGC - Tv the' kham: b~nh nhan dung, giu ph~n tren eanh tay eua b~nh nhan - Rich thich phan x~: dfty dua tre sang m9t ben - Ket qua: (-) D~u va ngvc kh6ng tl,i chinh the', kh6ng· bUGC sang m9t ben d~ tri thang b~ng It'ayutITVe:- 67 (+) C6 chinh the dfiu va ng uc, chan buoc sang mot ben d§ thang bang, - Danh gia ket qua: binh thttdng (+) til 15 - 18 thang tu8i ae'n he't adi 'I'ren 18 thang tu6i (-) la dau hi~u ch arn phat tri§n LUONG GIA Dinh nghia va phan 10?i benh bai nao, 2.' Cac da'u hieu giup chan dean som tre bai n8.0 Neu nguyen b n8.0 t~c va k§ cac kg thuat phuc hoi ch uc nang cho tre TRIEU CHIiNG HOC Dli MAy Hli HAP Ml)C TIEU T'rieu chung lam sang cua b9 may h6 hap Djnh nghia, nguyen nhari va co che gay suy h6 hap NQIDUNG I TRI~U CHUNG co NANG E9 MAy HO HAP - Trieu chirng chu quan: nguoi benh k§ Iai: ho, sot, kh6 thd, dau nguc, - 'I'rie u chtrng khach quan: kham thay: Vi d\l: ho mau: so IU