Hội chứng CRPS trên bệnh nhân đột quỵ

Hoi churng CRPS

tren b^nh nhan d6t quy

Phu mu ban tay d benh nhan cb

hoi chdng CRPS

tJmm H^^ *1"^ (thudng duge ggi I W^d tai bien mach mau

J^^ ^ nao) la mdt trong nhCfng

nguyen nhan gay tfl vong vd tdn

tdt hdng dau tren toan the gidi.

Theo WHO (2011), mdi nam th i

gidi cd khoang 16 trieu ngudi bi dot

quy, va 6,2 trieu ngUdi tfl vong vi

dot quy, dflng thfl hai chi sau nhoi

mdu cd tim. U nUdc ta, theo "Hiep

hpi phdng chd'ng tai bien mach

mdu nao Viet Nam" hien co khoang

486.000 ngUdi bi dot quy, moi nam

cd khoang 200.000 ngUdi mdi mdc,

trong sd' dd khoang 25% tfl vong,

25% song va lam viec trd lai binh

thfldng va 50% de lai di chflng tfl

nhe den nang. Do dd, viec phong

ngfla dot quy va dieu tri giflp ngudi

benh sdng sdt va han che tdn tat,

hda nhdp cpng dong la vd cimg

quan trgng va cap thilt,

Cd ra't nhieu yeu to anh hudng

den sU phuc hoi tren benh nhdn

dot quy nhU tudi tac, mflc dp ton

thuang nao, sd lan dot quy, thdi

gian bdt dau dieu tri, benh ly

kem theo,.,, va "Hoi chflng dau

vung phflc tap" tam dich tfl cum

tfl tieng Anh: Complex Regional

Pain Syndrome (CRPS) cd thi Id

mgt trong nhflng nhan td ay, Niu

dugc phat hien sdm va dieu tri kip

thdi se giai quye't td't hon nhflng

va'n de khd chiu do benh gay nen,

dong thdi tilt kiem thdi gian qui

bau trong qua trinh dieu tri phuc

hdi. Niu phdt hien vd dieu tri trd

thi kha nang tan tat la rat ldn.

Hiep hpi quoc te nghien cflli ve

dau (lASP) nam 1993 chia CRPS

lam 2 typ, theo dd CRPS typ I thay

cho loan dUdng giao cam do phan

xa, typ ndy khdng cd ton thUdng

than kinh ngoai bien, va CRPS typ

II thay cho thudt ngfl dau hoa thdng,

typ nay cd ton thudng than kinh

ngoai bien. Bdnh dac tnfng bdng

cac trieu chflng chinh cua CRPS:

- Dau: gom dau tU phat, tang

cam gide dau, ddp flng dau qua mflc

vdi mpt kich thich dau nhe, hodc

dau khdi phdt do kich thich binh

thudng khdng gay dau.

- Rd'i loan van mach (thay doi

mau sde vd nhiet do da d viJng bi

anh hudng) va rd'i loan tiet mo hdi.

- Phu d da va md dUdi da.

- Thay doi dinh dudng da vd

long, tdc (da khd, tang hoac giam

sac to' da, ldng tde rung).

- Rd'i loan van dgng (ylu cd, gidi

han van dpng khdp).

Nguyen nhdn cua CRPS hidn

chua dugc biet rd, CRPS thudng xay

ra sau cac yeu td thuan lgi la: chan

Phu chan d benh nhkn bt

hgi chdng CRPS

-»BS.LY MINH DAO

thuong, phau thuat hoac nhdi mdu

CO tim, dot quy, nhiem trimgHerpes

zoster, benh md lidn kit.

CRPS cd lidn quan den rd'i loan

dilu hda cua he than kinh trung

uong va he than kinh tU tri ddn

de'n tdn thdt nhilu chflc ndng va

tan tdt. Chflc ndng mien dich cd

the dieu chinh boat ddng sinh l^

cua thdn kinh trung UOng, nd cung

da dugc dua ra ldm gia thuylt

rang mdt loat cac qud trinh miln

dich cd the ddng gdp vdo sU khdi

phdt ban dau cua CRPS vd duy tri

sU nhay cam cua than kinh ngoai

bidn vd trung Udng ldm cdc tri§u

chflng cua CRPS ludn dflgc duy

tri khdng thuyen gidm ne'u khdng

cd nhflng bien phdp tri lidu tich

cUc. Sinh ly benh cua hpi chflng

dau vung phflc tap chfla dUdc bilt

chinh xae, cd gia thuyet cho rang

CRPS, vdi nhflng bieu hien cua

nd, cd the la ke't qud cua nhilu

cd che' benh sinh cdng gdp. Hdn

nfla, ton thuong nao trong dot quy

cd lien quan din viec phdng thich

cytokin, lam tram trgng hdn sd

viem than kinh, ket hgp vdi ludng

giao cam hudng tam, thu the giao

cam bdnh ly, boat hda te bdo thdn

kinh dem, td chflc lai vd nao, vd

tdn thUdng do oxy hda (bdi cdc

gd'c tu do) deu cd lien quan hodc

tham gia vdo cd chi sinh Iy b@nh

cua CRPS.

Khong cd mot xdt nghidm cu

the ndo de chan dodn cho CRPS,

hpi chifng nay chi dUdc ch&i dodn

chu ylu thdng qua quan sdt cdc

tridu chflng ma nd bilu hidn. Tuy

nhien, vide do nhiet dd, kiem tra

mo hdi, do dien cd, vd phUdng phdp

flc che giao cam cd the dfldc sfl

dung de chan dodn vd phdn loai

hgi chflng nay. Su chdm tr§ trong

chan dodn vd/hodc dieu tri cho

THUOC & sCrc KH6 E sd504 (15.7.2014)