Trong chuỗi những căn bệnh nguy hiểm thì nhồi máu não được xếp hàng đầu. Bởi đây là bệnh nặng nhưng có khả năng điều trị để giảm bớt tỷ lệ tử vong và di chứng, đặc biệt trong giai đoạn cấp tính. Vậy làm thế nào để chẩn đoán và xử trí nhồi máu não giai đoạn cấp tính? Nếu bạn đang quan tâm về căn bệnh này có thể theo chân iSofHcare để được các bác sĩ chuyên khoa tư vấn qua bài viết dưới đây.
Chẩn đoán nhồi máu não giai đoạn cấp
Nhồi máu não xảy ra khi các tế bào não không được cấp máu, dẫn tới thiếu oxy và hoại tử. Nguyên nhân có thể do tắc nghẽn hoặc lấp mạch máu não với bất kỳ yếu tố nguy cơ nào.
Thông thường, khi chẩn đoán nhồi máu não giai đoạn cấp thì triệu chứng lâm sàng rất quan trọng. Tiếp theo là tìm kiếm sự ủng hộ của cận lâm sàng và các yếu tố nguy cơ. Tuy nhiên, để chẩn đoán xác định thì cận lâm sàng là tiêu chuẩn vàng. Thông thường, khi chẩn đoán nhồi máu não giai đoạn cấp thì triệu chứng lâm sàng rất quan trọng. Tiếp theo là tìm kiếm sự ủng hộ của cận lâm sàng và các yếu tố nguy cơ. Tuy nhiên, để chẩn đoán xác định thì cận lâm sàng là tiêu chuẩn vàng.
1.Tiền sử
Nhồi máu não khi tới bệnh viện đều đang ở trong trạng thái hôn mê hoặc các triệu chứng đã xuất hiện một thời gian trước đó. Điều này quan trọng vì nó quyết định 99% chỉ định sử dụng thuốc tiêu sợi huyết hay không?
Đối với những bệnh nhân hôn mê, không có khả năng khai thác tiền sử thì xác định thời điểm cuối cùng bệnh nhân còn tỉnh táo, bình thường trước đó. Mặc dù chỉ là con số ước chừng nhưng cũng đủ để các bác sĩ có những quyết định chính xác hơn.
Đặc biệt, khi khai thác tiền sử của bệnh nhân cần lưu tâm tới những yếu tố nguy cơ có khả năng gây nhồi máu não như bệnh lý về tim mạch, tăng huyết áp, xơ vữa động mạch, đái tháo đường, chấn thương não trước đó...
2. Khám lâm sàng
Lâm sàng quyết định phần lớn chẩn đoán và là tiền đề cho các đề nghị xét nghiệm cần làm. Khi khám lâm sàng, cần khám tổng quát, toàn thân sau đó mới khu trú tại vùng bị tổn thương để tránh bỏ sót.
Đối với bệnh lý nhồi máu não biểu hiện đa dạng, chủ yếu liên quan tới các tổn thương thần kinh khu trú. Ngoài ra, khi vào viện kiểm tra dấu hiệu sống như mạch, nhiệt, huyết áp, tần số thở... là điều kiện bắt buộc hàng đầu.
Một số các dấu hiệu lâm sàng mà bạn có thể gặp ở một bệnh nhân nhồi máu não giai đoạn cấp:
- Thường bệnh nhân hôn mê, thang điểm glasgow thấp
- Bệnh nhân có các tổn thương thần kinh trung ương khu trú như liệt tay chân, liệt mặt, cảm giác tê bì hoặc mất cảm giác tay chân, khó nói, méo miệng....
Bên cạnh đó còn có các triệu chứng đi kèm của bệnh lý nên như rối loạn nhịp tim, huyết áp thấp... Đây là yếu tố thuận lợi ủng hộ cho chẩn đoán nhồi máu não trên bệnh nhân. Điều này rất quan trọng vì nó giúp bạn định hướng nguyên nhân hoặc có thể dùng để phân biệt một bệnh nhân xuất huyết não hay nhồi máu não.
![Chụp cộng hưởng từ nhồi máu 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)
3. Cận lâm sàng
Chỉ định cận lâm sàng cần thiết giúp đánh giá nhanh tình trạng bệnh nhân, chẩn đoán và tìm hướng điều trị hợp lý. Trong nhồi máu não giai đoạn cấp, các xét nghiệm chẩn đoán chính xác thường hiếm. Bởi hầu như các tổn thương não chưa thể thấy được trên CT Scan hay MRI.
Một số xét nghiệm thường làm ở bệnh nhân nhồi máu não như:
- Các xét nghiệm thường quy bao gồm công thức máu, chức năng đông máu toàn phần, nhóm máu, điện giải đồ, glucose mao mạch...
- Các xét nghiệm chuyên biệt như chụp CT sọ não không cản quang, CT so đa lớp cắt, MRI. Trong đó MRI có độ đặc hiệu và độ nhạy cao nhất. Trên chụp não cắt lớp vi tính, giai đoạn tối cập được tính từ 0-6 giờ sau phát bệnh.
Xét nghiệm hình ảnh là tiêu chuẩn vàng để chẩn đoán nhồi máu não trên bệnh nhân. Tuy nhiên ở nhồi máu não giai đoạn cấp thì rất khó phát hiện. Chủ yếu chúng có ý nghĩa chẩn đoán loại trừ xuất huyết não.
Hướng điều trị của bệnh nhân nhồi máu não giai đoạn cấp
Điều trị giai đoạn cấp tính là mấu chốt cho sự sống còn cũng như di chứng sau giai đoạn hồi phục. Điều trị càng sớm, càng chuẩn xác thì tiên lượng sống tiếp của bệnh nhân được gia tăng.
Điều trị nội khoa
![Điều trị bằng 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)
Đối với các tuyến cơ sở chỉ giữ lại điều trị đối với nhồi máu não thoáng qua. Còn khi đã xuất hiện nhồi máu não hình thành cấp tính nên chuyển bệnh nhân lên tuyến huyện, tỉnh hay trung ương.
Đầu tiên, xác định dấu hiệu sinh tồn của bệnh nhân nếu không ổn định thì cần phải hồi sức tích cực. Với các bước như đường thở - thông khí - tuần hoàn - toàn thân – thần kinh. Sau đã ổn định và xác định thời gian xuất hiện nhồi máu não giai đoạn cấp thì chỉ định tiêu sợi huyết được cân nhắc hàng đầu. Với mục tiêu di trì đời sống, giới hạn tổn thương não, hạn chế di chứng và biến chứng. Sau đó, một số loại thuốc kháng được sử dụng đi kèm tùy thuộc vào mức độ bệnh và các triệu chứng như thuốc chẹn Ca, thuốc chống đông, thuốc giãn mạch não...
Điều trị dự phòng
Có rất nhiều yếu tố nguy cơ đáng chú ý đối với nhồi máu não. Do đó cần áp dụng rộng rãi các biện pháp dự phòng tùy theo từng đối tượng khác nhau để giảm bớt nguy cơ mắc nhồi máu não.
Phòng bệnh có nhiều cấp bậc khác nhau. Từ cấp 0 là dự phòng cho người chưa mắc, có yếu tố nguy cơ cho tới dự phòng cấp 3 đối với những bệnh nhân có di chứng sau nhồi máu. Chính vì vậy việc tìm kiếm các bác sĩ chuyên khoa để được tư vấn là rất cần thiết. Không có một bác sĩ google nào có thể giúp bạn điều trị căn bệnh nhồi máu não.
Thường xuyên quan tâm đến vấn đề sức khỏe của bản thân để nhận biết những thay đổi bất thường. Đồng thời thăm khám và tầm soát thường xuyên để ngăn ngừa và điều trị các nguy cơ gây nhồi máu não. Hy vọng bài viết cung cấp cho bạn đọc nhiều thông tin bổ ích.