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DIENOA N YHOC

Chuyen dl trong thing

TANG AP Ll/C NOI SO 6 TRE EM

Dau Viet Hung

Tdng dp luc ndi sp la mdt dnh trgng ndng, de doa tinh mang binh nhdn. Nguyen nhdn tdng dp luc ndi

so la do nhieu binh ly khac nhau gdy ra, bao gdm cdc nguyin nhdn do tdn thuang tgi nao hoac cdc nguyen

nhdn khdng do tdn thuang tgi nao. Ty li tie vong cd thi len den 30% a nhdm nhiim khudn thdn kinh Trung

leang. Theo Singhi, ty li tre bi tdng dp lire ndi so chiem tai 20% tdng sd binh nhdn nhap khoa Hdi sire cap

cim nhi.

SINH LY

L Ap lyc noi so

Ap lire ndi sg binh thudng: d tre nhu nhi (in￾fant) la 2 - 4 mmHg, d tre nhd (young children) la 3

- 7 mmHg, tre Idn (older children) la 0 - 10 mmHg.

Tang ap luc ndi sg dugc djnh nghTa khi ap luc

ndi sg ldn hon 20 mmHg trong 5 phiit. Tang ap lire

ngi sg dai dang dugc dinh nghTa khi ap luc ndi sg

tir 21 - 29 mmHg keo dai trong hoac hon 30 phut,

til' 30 - 39 mmHg trong hoac hon 15 phut, ldn hon

40 mmHg trong hoac hon 1 phut.

2. Dong luc ap luc nao (cerebral pressure dynamics)

2.1. Hgc thuyet Monro- Kellie

The tich hop sg gdm 80%) la nhu md nao, 10%o

la djch nao tiiy, cdn lai 10%o la the tich mau. Do hop

sg khdng ddi, nen de giu ap luc ndi sg trong gidi

han binh thudng, cac thanh phan tao nen the tich

hop sg phai cd su dieu chinh. Sir dieu chinh chii yeu

ddi vdi djch nao tuy va the tich mau, day la hai yeu

td quan trgng cho viec duy tri ap luc ngi sg trong

gidi han binh thudng.

- Su dieu chinh ciia djch nao tuy dua tren 3 ca che

sau: luu thdng ciia djch nao tuy, giam kha nang san

xuat djch nao tiiy tii' dam rdi mach mac, tang kha

nang hap thu.

- Dieu chinh the tich mau: mau tTnh mach bii trii'

bdi su dich chuyen thdng qua cac xoang tTnh mach

mang cung (dural venous sinuses).

- Ddi vdi tre dudi 18 thang, khdng the ap dung hgc

thuyet Monro - Kellie do tre cdn tdn tai thdp va

dudng khdp nen cd the bii trir bang each gian khdp

sg, thdp phdng.

2.2. Sir ddn hoi ciia to chirc nao (compliance)

Su dan hdi ciia td chirc nao dugc djnh nghTa la

su thay ddi ve ap lire gay ra bdi sir thay ddi ve the

tich. Phan anh sir chju dung ciia nao ddi vdi viec

tang ap luc ndi sg. Mdi benh nhan cd mirc do dan

hdi ciia td chirc nao khac nhau, ngay ca khi ciing

mdt miic do tdn thuong. Ca che chinh xac ciia tinh

trang nay hien van chua rd. Khi mirc do dan hdi ciia

td chuc nao cua benh nhan suy giam, dan den sir

tang manh dudng cong ap luc/ the tich va Iam tang

ap luc ndi sg nhanh chdng.

2.3. Luu luang mdu nao (cerebral blood flow)

Trong dilu kien nao khdng bj tdn thuong, luu

lugng mau nao dugc dieu hda de cung cap dii nhu

cau dxy va cac chat cho nao. Cac tac nhan nhu tang

CO, mau, toan, thieu dxy gay ra gian mach lam

tang lugng mau nao. Khi luu lugng mau nao vugt

qua nhu cau td chirc nao se lam tang tinh trang xung

huyet va tang ap lire ndi sg.

2.4. Ap luc tudi mau nao (cerebralpetfusionpressure)

Ap luc tudi mau nao (GPP) la mirc ap lire te

bao nao dugc tudi mau va la mdt yeu td quan trgng

cua luu lugng mau nao. Day mdt yeu td gian tiep de

*Khoa Hdi sue cap cieu- Binh vien Nhi Trung uong

U I Y HOC LAM SANG S6 53 (Thang 06 / 2010)