Tải bản đầy đủ (.docx) (57 trang)

nghiên cứu đặc điểm lâm sàng, chẩn đoán, hình ảnh học vỡ túi phình đm cảnh trong đoạn trong sọ

Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (463.39 KB, 57 trang )




NGHIÊN CứU CHẩN ĐOáN Và ĐáNH GIá KếT QUả
ĐIềU TRị VI PHẫU THUậT Vỡ TúI PHìNH ĐộNG MạCH
CảNH TRONG ĐOạN TRONG Sọ
!
"#$%&''()



NGHIÊN CứU CHẩN ĐOáN Và ĐáNH GIá KếT QUả
ĐIềU TRị VI PHẫU THUậT Vỡ TúI PHìNH ĐộNG MạCH
CảNH TRONG ĐOạN TRONG Sọ
Chuyờn ngnh: Ngoi - Thn Kinh s nóo
Mó s:
!

1. PGS.TS Nguyn Th Ho
2.Ts Vừ Hng Khụi
"#$*&''()

  !
 "#$%#&'
(( ')*+, $+/0'1
2( 30+4'
2( 30+4'56
 -7'56#8*
90#: ,;#<:#6:060<:'*='>+4'56 ?'@:A@:B
( '>"#$%#&'3:-5*
 -C*#'DE'


+,
FGHIFJKL(
2MN-6N4''O
-.(/,01 !
!%/#P#'& '
QR,:S0#T1'%1U,0'71#1N)V'W0
',*P0/'-#,*X064N'DE' !56
(5 ?
1.,23456789:;<=>"$?5@;9A68;B9$C;8DEF
Y#O'Z'2(@',0%/%Y#O'Z'2()'#<60364
#<60 !@<P0/+#;1'[\#']#^0/*/0':*0_`1#:+
a0'.#<P#']0$bY#O'Z'2(/0,*P'C'/03D,0C*')*
+, $+/0'1^+#'D;: ?;1''C/*#c%60#<.$E'3]
%1^')*+,#'#/;]'d0#'.e00_%/#f1#c%60#<60 ?
/*']+#$ghibO'Z'2()'#<60#<60 !']+E'6)0jhklhi
#m0 ?#O'Z'2(b;]'d0E''.6#'"#+4'56^<?64
#'n0;o0.$k310)^;]'d0%B'S'\^#,D'6/<\#:6/0/+
'6;1')'#'P+#p#1^'q@E'6)0rhi#<60 ?/*E'S0@;X,
'1 ,*0)+'\#.s0, ?0b
'&'%Z%M*^%1't36 $+^3.:<:'].s3B,#<7's[^
'u,#',M#E7#'e#<603B,E1.$#:'1:*/3B,D#']#b\3B
-'W0*],#?0,*Q/'].s#'v'?#'\#'6+w03p0
%/#x0#'X^'o+'4']#,DA,\#A)*<:;]'d0#x3@'4#'\#q1
#c%60a0'.-'d0b
TX,'18:#O'Z'2()'364#<60 !E'S0@0Z3_#<.0^
0.e;1'3.s'#'1#Z'eR,:#'n+E'+'Z')'56b(# ?@
;X,'18:'yz#'DE''.0)+#'7'6_ >+^#'v6#0)
{,<v '#'Z@j^ji@;B,'18:'p+,56#'60R,:b'#O
'Z'2(%Y#'Z;X,'1C+ /03X'Z'/3:,3D,3#0#^-U-%$
.e03+4'#<60+#'6_%/'O#<p0)+-D#<60%/0e'6_%/

0/*^<\#':0'@0PR,:3];,pS%/S^@#'X;X,'160M#
%/3%/6'S+Pb'n+E'+C+ /0'#'1''d0+/056b|*
#x0+d3+/@-\,'1,#'DE'E',#<O0s[0,*P'C'.1#
%M'5%/ >+-6%Y#O'Z'2(#'S0 :,^0)+'6_+\##'73#
0#-6%Y#O'Z'2(+"#}
$ #];%.s#;M8:E'6:'!S00'1^3_;1#/
'.Q0'#'n+-W'Z')'^%1't36%Y#OV~2(0/*
/0'&'A%/':''@0'Qb|0%$3@^%1'##<X%/'6/
#'1E•#',M#3B,#<7%'u,#',M##<60%Y'Z'+4'563642()'
#<60 !^#'M+'&'u,#',M#\d,35'6E]#R,)30E&'1^/+0)+
30EX#q1#c%60-6#:;]%Y'Z'2(0C*<:b2B,#<n#<`8:
'u,#',M#%P#'DE'/%1't36 $+%/3B,#<7E7#'eW
0_'B,E'@E'n-6'.:@ 0"E]#^'?'s3p0;0U:',*P
0'/'^%1%M',*X;1''C3]#<,0#C+'u,#',M#',*P
E'6:W'M+#<€^+_#E'3B,#<7%Y#O'Z'2(#<60364#<60 !
/'u,#',M#$%/E'@-6'U00,*P'C%B0)'u,^%B '[\
+,56^%BE•#',M#EX+ 6#2(^%B%W0?}2]:*^3B,#<7'u,
#',M##O'Z'/*`.$#:+$'q#M#<,0`#<,0#C+$'./
%/#'/''?p'&('^'&'%Z%M*#q1#c%60%/;]'d0
8:%Y#O'Z'2()'#<60364#<60 !W:6b
$+60+,?0@'D't36 $+%/3B,#<7'u,#',M#@'1,
R,)'O0#S#]'/'3B#/•Nghiên cứu chẩn đoán và đánh giá kết quả
điều trị vi phẫu thuật vỡ túi phình động mạch cảnh trong đoạn trong sọG
2.+H8>$CEA"I4;BIEJ;<K><LM8N9$<O;BN2<$9:8;B9$C;8DEP$;9F
'3n0E[3'!0'Pd, '^+>#P,%/+60+,?34#3.s
8:#S/
Thứ nhất2.s#]ME]#'d+$^<y,*1^C0:6E')n0
#.-,*%/'.Q0'0'Pd,E'6:'!'o+3d03.s'1+%>
8:0.e#'D*#',?b2.s#':+0:/+%1^0'Pd,3B#/#'v6'.$0
35'!3XE''6/#'/'@#'X#<XE':#437:'.Q0'>%>S0#

'n+ @ dE'‚v'C-Cb
Thứ hai2B#/0'Pd,/E')#'-63.s',*P0:3D,
0/''.$0-u^ ' ?0`)V'W0%//+%1#4E'6:'u,
#',M##'DE'k !56;1'%1U,0'71#1N)V'W0^@E'
0'1+#<60'u,#',M#b
0'Pd,'B,E')n03.s5'346;1'%1^',*P
0:3D,0'/''\'MbT1''C#0,*1#':+0:-6PR,:#']#
#'3] dE'‚v8:'!b
2@00@'6',*P0/''u,#',M##'DE''U0'X,;]#^
E'0'1+%/E]#R,)0'Pd,8:3B#//Q `-U1,3X'u,#',M#
%P#'DE':'!'.Q0''u,#',M##?#'\#^+:04'1,R,)
:6'\#'6;1''Cb
3.,23456789:;8QPR<"4>K4F
<.e024'!ƒ/@;B-D*7' c'Q„hhn+^/Q `3/6
#46;*#]C,3e^,*#&'\#8:1#:+b253/6#46%/\;o0'6
'/00'Z0'Pd, 'b
T+S06424'!ƒ/@30a0)0%P'|0'M,
'B,6 .^V'@06 .^] …*'!b@+?0"E]#;1'%1k'/
#<.e0E'n0E'&#b
T1'%11#2dN//Q `#''/'8:;+S064@
,*#&$^.s0;1''C-p-/6b<Z'3^#<:0#']#;7%/;3)+
;)63X'!%P@#'X0'Pd,#'/'S03B#/b
!%P35#x0/'!%P:6'!8:<.e024'!ƒ/^
#?#0'1#'4 •ƒE'6:',*P0'/'064#4#<.e0^'6/#6/#
#.`0E':'!#]24'!ƒ//Q `3/6#460'Pd, '
8:+Z'b
'6: :,34'!8:<.e024'!ƒ//E'6:'dn0 †
'w#<s#6/-1'!%P%B%1'6/#'/'#'8#>'/''&'^#m'd#'
c%/;)6%1\}'6:@;B-/*E'0'1+%/#'/'#&'#?##<60
%13/6#46'Q„hbhhh0'Pd, '*'!b

$#\#)[-6#<P^#S'6/#6/##.`0%/:'!#<.e024
!ƒ/3X#]#>3n0E['!0'Pd, 'b
4. 9S;B36<T;9A"NU94K89<V<K><LM8;9S;BIH8>$CEI4;BIEJ;F
2X34#3.s'U0+>#P,+60+,?^35',t;73B.Q0
0'Pd,'#]#^A[E]3@00@',*P+S8:#'D*S%/3p0
0'1@E'0'1+#<60…'%',*P+S^AC*-0E]'64'^-
E]#'e0:#''1#x00:364#<60R,#<Z'#''13B#/>#'X
LW8(/
k ]'/'E'+%/'u,#',M#^#'v6-‡ :,'u,#',M#b
k Z+3!#/1,#<60^06/.$3X+`<0#'P+E]#'d%/
#':+E')6b
k ',#'M ?1,#'v6+>#P,353B<:b
k ]#;:',*P3B%/;)6%19E'6)0R,[ˆrh„g=
k 'e0:#''1„hˆrh„j3]„rˆrh„‰b
LW8&/
k m0's%/Ac[ ?1,35#',3.sb
k ŠO#<:'M37'b
k T66E]#R,)#',3.s%/%]#;6]#j;/;6S0;?#x0'D
E]#R,)350'Pd,3.sb
k ]#,Mb
k H;)6%1,M9n+rh„‰=b
k @0,*1%!0#'v63,m#]%/#]#>0'Pd,+`<0#<60…'
%/*^d0->0'.Q0'%$;1'[E'':*3.e0+m'‚'s[b
5. X$;9;B9$YIF
ZF(F X$;9;B9$YIA=;B9$C;8DEA"89E[C;;B";9-XF
35S0#P#>„hn+#<600'/''u,#',M##'DE'N
# ?0b<60#'e0:/*^35#':+0:3B,#<7'u,#',M#'6'B,
;1''Cb{,#<Z'3@353.s#]AO%$'B,#'S0#E'6:'!^
0E])#]bT)#'C#':+0:'!'B,E'@:C0:6#4;1'
%11#2d^;1'%1„h‹^;1'%1'sŠu*^;1'%1'\#'.Q0

'q''Z'Vp'&('}
5.2. X$U;>9D8A"P69$VE\$U>A=A]^9_;9+8`;9>a4;B<4K;>a4;BP:F
<60„hn+S0#^35#<#]'u,#',M#'6#<.e0's
')*+,56E'S0-6'\#'.Q0^,56^,#8* ?0%/;1'['\
#'.Q0 !56N# ?0b@'U0#<n#<`%B;1'[%Y'Z'2()'
#<603_;1#/%Y'Z'2()'#<60364#<60 !^/+ :6@#'X't
36 $+%/3B,#<7'u,#',M#E7#'e'6;1''CbTo0%?0640U%/
E'0'1+8:+Z'^@#'X/+%1#?#%$0,p#/1,#]0
'^V'3X@E]#'d'>%>'6%1#]'/'3B#/bW3.s
'!'‚'B,#x'/E'6:'!',*P0/'b'U00s[^ #'?0'\#
%BR,:3X+8:#'D*35#'O3t*R,*]##C+#]'/'3B#//*b
5.3. 689Eb;\T8c7?<d8ad>N$;9;B9$YI>efEg>a_;95"I5Eh;
AO;>9K8PiF
'e ?0"08:;)#'C^ '.$0-u#M#Z'8:#'D*'.$0
-u^35'6/#'/'#?#,M%n:6'!%/#?#0'1#'4 •#4#<.e0
24!ƒ/n+rhhŒ^;.$3D,35#':+0:0'Pd,E'6:'!b
6. 6N$U;A$Y85"IA"8g8;B9$C;8DE>$U^>9j4P7EN9$>J>;B9$Y^
],3.s'\'M@+# ?3O<O#E'0'1+3X'6/#'/'
3B#/+$3.s#?#'Q
k D+Y8:,M#] •<\#E'%$,M%n#'4 •%B#&'E'6:
'!^#D+Y8:%\3B3.:<:^#&'+$+•^#D+#30%/)''.`0#$
0$',*P+S%/03p0}6%M*Dw'B,'Q^/+%1
S0',%/E'6:'!'Q3X@#'X'6/#'/'3B#/#$|0b
k :,E'#?#0'1^ †3v+E]#'d%/E'0'1'!#M3X
0@'D'>%>S0#'n+ @ dE'‚v'C%/#<,*B34#'U0'X,
;]#8:+Z''6#']'1#]#'v6b
7. g88k;B>a_;98c75$C;fE7;<U;<=>"$<l8k;B\JF
7.1. -+mno?p?
q&'(&r? “ Kết quả phẫu thuật sớm máu tụ trong não do vỡ khối di
dạng mạch não”,0'7E'6:'!#'.e0Pk0'7'u,#',M#

#'DE'D„j^ƒ!'/''?p'&('^#<Žb
7.2. -+  mn  o?  p    ?   
q&'(&r?sKết quả điều trị vi phẫu thuật túi phình khổng lồ ĐM
não”, ƒ'!#'/''?p'&('^#M„‰^ ?l^#<r‰lkr‰‹b
7.3. p    ? -+  mn  o?   
q&'(&r?sNhận xét bước đầu về phẫu thuật KEYHOLE trong điều
trị túi phình tuần hoàn trước”, 0'7E'6:'!#'.e0Pk
'u,#',M##'DE'1#:+D#'d„j^ƒ!'/''?p'&
('^#<„„b
7.4. -+  mn  o?     ? p  
q&'(&r? sĐiều trị vi phẫu thuật túi phình ĐM thông trước”, ƒ
'!#''/'^ ?‹ll^#<rŽrkrŽgb
7.5. p    ? -+  mn  o?    
q&'(&r?“ Chẩn đoán và điều trị phẫu thuật chảy máu não do vỡ
khối di dạng mạch não”,ƒ'!#''/'^ ?‹ll^#<jljkjl‰b
8. =tEu>;BLv$9LW;B3w;N9479:8F
k V'@06 .^] …0,*€']/6^E'6:'u,#',M##'DE'T1'%1
1#2d/b
k ] …‡p0'S^E'6:'D';1'%1T4'(:/b
xg8;9h;8c7>9y[9LW;B3w;/
PGS.TS Nguyễn Thế Hào TS Võ Hồng Khôi
12
-.F !
z
Y#O'Z'2()'#<60364#<60 !/+#;1'[\#&'^
0/*/0':*0_`1#:+a0'.#<P#']0$bq1#c%60:6%/3X
4'B,-'d0%B#'DE'^/0'_0'60:3Z'a0'.#6/A5
'b(wn+#4(•@E'6)0rgbhhhkjhbhhh:((E'S0-6'\
#'.Q0b<603@E'6)0„‹bhhh:#c%60'6_3X4-'d0_0Bb•
'M#T)#q1((/lhˆ„hhbhhh-C^#<603@@E'6)0‹hi0,*P

'C-6%Y#O'Z'+4'56b$#&'#q1#O'Z'+4'56#<60-C
?/‹ˆ„hhh-Cb'v6'2#R,•6:E‘#'Z„bgNgi-C ?@#O'Z'
+4'56'6_ †+"#O'Z'+4'56%/'D$'#'1E'35@
;]'d0%Y#O'Z'’j^„j^jŒ“bq1%Y#O'Z'2(E'6)0„i#<60
?0.e+"%/#n0#'v6#'e0:a0'.E&'#'.$#O'Z'b<603@
#O'Z'2()'#<60#<60 !']+E'6)0jhklhi#m0 ?#O'Z'
2(’„^r^‰^„l^„Ž^rg^rŒ“
TX,'18:#O'Z'2()'364#<60 !E'S0@0Z3_#<.0^
0.e;1'3.s'#'1#Z'eR,:#'n+E'+'Z')'56b(# ?@
;X,'18:'yz#'DE''.0)+#'7'6_ >+^':*;X,'1
#<1,'d0'p+,56#'60R,:b'#O'Z'2(%Y#'Z;X,'1C+
/03X'Z'/3:,3D,3#0#^-U-%$.e03+4'#<60+#
'6_%/'O#<p0)+-D#<60%/0e'6_%/0/*^<\#':0'@0P
R,:3];,pS%/S^@#'X;X,'160M#%/3%/6'S+Pb|*#x0
+d3@-\,'1,#'DE'E',#<O0s[0,*P'C'.1#%M'5%/
>+-6%Y#O'Z'2(#'S0 :,^0)+'6_+\##'73#0#-6%Y
#O'Z'2(+"#’j^l^‰^„r^„g^rŽ^jh^lj“}
13
13B,#<7%Y#O'Z'2(/64;‚'6/#6/#O'Z'<:E'‚%W0
#,D'6/;o0:#'1+4'':*'u,#',M#E”m#O'Z';o00
R,:E&'%'u,a0'.3B,#<7;]'d08:%Y#O'Z'2(0C*<:
'.((^6#'"#+4'56^56O0#'8*’„^r^l^g^‰^r„^jg^lh“}
$+60+,?0@'D't36 $+%/3B,#<7'u,#',M#@'1,
R,)'O0#S#]'/'3B#/•B9$C;8DE89b;<4g;A"<g;9B$gNU>fE`
<$=E>aTA$^9wE>9Eh>A]>d$^9_;9+8`;9>a4;B<4K;>a4;BP:G%$r
+>#P,
1. Nghiên cứu đặc điểm lâm sàng, chẩn đoán, hình ảnh học vỡ túi phình
ĐM cảnh trong đoạn trong sọ
2. Kết quả điều trị vi phẫu thuật vỡ túi phình ĐM cảnh trong đoạn trong sọ.
(

{mo
14
(F(F,1| !F
(F(F(FaC;9UB$W$
'6+: • 35'#'1<:3:0• n+„‰Ž‰^+`3D,'6
'U00'Pd,%B#:;]+4'+,56b
n+„Ž„‹^6 +S#)D3D,#P;1')'C+ /08:A,\#
',*]# $+/0'1b
:v< 9„Žlh=^<:%v'v<9„‹„‰=^ :,3@  / Šv< 9„Œj‰=^ :–6<#'v<
9„Œ‰„=^,<:,-9„ŒŽl=350'Pd,%B0)'u,^ '[8:#,D'6/56b
n+„ŽgŽ^,#v<+S#)'d0'Z'2(^'Z'30k#…'+4'
56%/+53]n+„‹Žg#v'v#+$'t36'&'A3.s#<.e0's
3D,#Pb(6<0:0%/T,'#'1<:'d0'Z'+4'56#'S0R,:
+m#c#'8:;1''C#c%60E'S0<‡0,*P'C%/6#']Ef„‹b
n+„ŒrŽ^—0: (6–'#+'<:'>2(^%\3B't36%/
3B,#<7'u,#',M##<.e0's'Z'+4'56+$3.s6#<!0%/P
#>3.s'##<X%/'6/#'1-Db
n+„Œg„^—Ev<%/Šv+v 'v-v<'#'1<:'1#.s06#'"#
+4'56#<P'+'>2(’g^„g^„Ž^r„^rr^r‹“b;]3m%B.$k
310)3_;1#/ 0)+:#<+, :,((3.s˜6#%/+S#)
n+„Œ‰gb’„g^„Ž^j„^jl“b
$=E>aT^9wE>9Eh>^9_;9+n+„‹hg^66v<->0'.Q0
',#v<9#'"#2(,#v<=E'#'"#2()'0?3X3B,#<7'Z'2(
06/ !b<:%v< 9n+„‹hŒ='u,#',M##'/'S0'Z'2()'#<60
A6:0':0;o0'#'"#2()'06/%/3]n+„‹‹g#0)6< v*
35#'/'S0#<.e0's#O'Z'2()'#<60`#<60 !;o0#'"#2(
)'^ :,3@6###''1'u,#',M#;!Q#O'Z'2(bV'u,#',M#E”
15
m#O'Z'2(3.s:-*#''1D3D,%/6n+„ŒŽj;o0
;4bx3@3]:*35@<\#'B,#']'1<:3e’rh^r„^rr^jj^jg“b

U:#']Efrh^,<–v^-:+ %/V66#]'/'->0'.Q0'
+m%'u,#<603B,#<7#O'Z'2(b2_;1#ƒ: :<0(b3.s6'.
'u,#',M#%P#'DE'3#P'60#<60%'u,#',M#2(#<P#']0$
’lg“b™0 c->0E&'%'u,3X?+4'#x2(#' Q0S0%/6
2(0U:3X3B,#<7#"+4'+,56#xn+„Œ‰Žb:,/*S0%/
`24'!š,<'9',•…=#''1%/@E]#R,)#?#;1''C
'Z'+4'+,56%/--4030k#…'+4'56b
$=E>aT;#$IK89^9_;9+/:,'U0#'c0'1+;:3D,;:6
0p+;Q++u,#@%/#X,#'X0C*3S0%/6#O'Z'2(3X0C*#"
#O'Z'E'S0'6'1,R,):6b2]n+„ŒŽ„bv<;vE635 c->0
?0#'S00";@0:#vA3X\#O'Z'2(’„l^„Ž^lr“b
n+„ŒŽ‹^vT<,^:#v^v<%6%/:E#]#> c->0;@08:
v<;vE6%/35@<\#'B,0'Pd,%B%1 c->0;@0`'B,#<,0
#C+E'':,b:#,<6 c->0W 6E+643XO#2(#'M^#]3]
/:35'##<XE•#',M#/*%$WA6V:#,+9, ':;v6kWA6
3t*='6#O'Z'2('.0E]#R,)W'B,'4']-6E'S0
E'?0']3.sWA6E'353t*E'‚?0#'S090,-0:#'v#v<=b
n+„ŒŒh^64WA6+$k,0v+v#:':;v6-6,0v+
35 0']<:^3C*/WA6:#,+"#;o0319vv#<6*#6=b'q :,
E'3.s3_#%/6#<60W0#O'Z'R,:?0#'S0'‚9+<60,-v›<v
:#'v#v<=^WA6 †3.s"#;o0-W031#<#]%/ †o+'6/#6/
#<60W0#O’„Ž^rj^jl^l„^lr“b
(F(F&Fa4;B;LW8F
n+„Œ‰r^0,*€'.e0H,C%/350'Pd,%B't36%/
3B,#<7'u,#',M#%Y#O'Z'2(b
16
n+„ŒŒŒbV'4+W:TZ'%/35;66'U0'MAz#;.$3D*
#<603B,#<7'u,#',M#'Z'2(#4;1'%1„h‹b
Yn'6^0,*€V'60;66E]#R,)3B,#<7%'u,l„#<.e0
's#O'Z'2(;o0,0#:%/6n+rhh„%/@E]#R,)<\#E')R,:b

:#'1+4'3.sV'4+,*'S0%/;66 :,E'#'
'1n+rhh„#'/'S0r‰ˆr‹#<.e0'sb•#',M#/* :,3@3.s'B,
#<,0#C+$#''1^'8*],/#'/''?p'&('%//b
2wp0)9rhh‹=350'Pd,%'u,#',M##O'Z'2()'k
#'S0 :,35%Y#4#'/''?p'&('’l“b
0,*€']/69rhhŒ=35#<Z';/*œ'u,#',M#j„‹:#O'Z'
2(%Y#4;1'%11#2d•’‰“b
0,*€n,\%/ 9rhhŒ=`;1'%1„„g%$œ6 'E]#R,)
3B,#<7+4'%/%'u,#O'Z'2(%Yœb
n+rh„r^0,*€ ']/6/ 0.e 3D, #P->03.e0+m
Ev*'6v3X3B,#<7#O'Z'`%W0#,D'6/#<.$8:2(#4;1'%1
U,0'71#2d’„„“b
(F&F}-~+}F
(F&F(F$`$^9wE+8`;9>a4;B>a4;BP:F
2()'#<60A,\#'##x%7#<&'C3S8:2()'',0#4+0
)'^0:0;e#<P >0^3P%/',%/6?0)'#<60'D3
A.Q0#' Q0b2(/*3PE'6)0„+^ :,3@R,_#%/6#<.$#<60%/
3#$3q'A.Q03<p',R,:A6:0#…'+4'':0b2642()'
#<60 !@-0'U%/3.s'C/+g364#x $P#'v6#'d#
’„j^rŽ^jr^jŒ“
 g#x'w#'6#<:E'‚3q'A.Q03'6#$0? :,b2('4*-!+_#
06/#'CA.Q0;.$+b
17
 l3640U:'D'.$0P'6#$;"#3D,30:0b2(3;P06/*P
;.$+-!#'v6#'/';PA.Q0;.$+b
 j364o+0:0#<60A6:0':0^#x0?#<.$3]0? :,b2(3 $
'C8:+\,0.e0#<.$b
 r3640?#<.$#x'D0:0'63]']#'DW4o+#<60+/0
d0b2(3 $-C*#'DE'#'7b
 „3642(3#<60E'6:0 $'1bx3C* †#'<:#'/'':''

#M/2(#<.$%/2(0U:bO'Z'2(`%7#<&/*0!/#O'Z'
05;:2()'#<60b
364j^l^g#46#'/''D $+\,0.e0^W364„^
r#46#'/''D#<P+\,0.e0b364r^j^l#46#'/''6
2()'b
264#<60 !;"#3D,#x+‚+*P#<.$#$05;:2()'#<60b
264/*2(-/E'6)0„b‰N„^Œ+^E&'#'.$h^gkh^‰+^'4*']'<:
06/%/<: :,+#0@„h‹k„„h
h
^.,.s0+,R,:/jhh+ˆ’rŽ^jŒ“b
2()'#<60'6'';P
+ 'U02(A,*P'‚\+,'6-C*#'DE'#'70^0:6#'6:#'70^
,?0#,*]*P^8O+%O^-)#'70%/ /56#'\#jb
+ 2(+"#%/2(*P#<P#'<:0:*E'2()'#<60',<:E'‚+/0
d0%/'4*#<60?0#'70^2(/*-/h^Žk„^r+%/3.e0E&'
#<,0;Z'/h^l+’rŽ^jŒ“b#O'Z'`%7#<&/*0!/#O'Z'2(
4'+‚+*P#<.$b<1,'d0@#'X0C*0)+#'7-6'zz-C*
^E',*]##'7#<.e0bm#O'Z'#'.e0;7+‚*P#<.$'vE',\#^3C*%7
#<&E'@E'6n#<60'u,#',M#E”m#O'Z'’r^g^„r^rŽ“b
18
+ 2(#'S0 :,A,\#'##x'&:#<60+\,0.e0'4*<: :,@3.e0E&'
#<,0;Z'h^j+^3#<P-C* ?b?%$2( :,#46#'/'4';P
8:3:0• b'@#O'Z'%7#<&/*@#'X;X,'1#<PC+ /0
;o0#<1,'d0053p0#c%/ >+9-6'yz-C*=’r^l^g^„g^
„Ž^j„^jl“b
+ 2(+4'+4#<.$93SE'2(/*A,\#'##x2(0U:='4*<: :,^
$-)#'70^ :,3@'4*<:06/3],?056%/#'X0?06/b2(
+4'+4#<.$3#<P2(2(#'S0 :,%/#M']#`3+<?+4'+4`
x0#' Q056#'\#;Pb<PC+ /0#'.e0&#0_#O'Z'`%7#<&
/*’r^‰^„r^j„^jl“b

(F&F&F,$C;fE7;B$`$^9wED;B3H;B>aC;5•IP";BA"N9$I€F
k+•I[C;>aLW8?A‚;BI";B8D;BqA‚;Bƒ$;r2()'#<603
%/6#<60+/0d0^4'+‚+*P#<.$#'v6'B,,?60P%/<: :,
#46P364 '68:2()'b4%7#<&/*2()'#<60;7'vE',\#
%/;:6;!;`\,#<O'd#4%/R,:#<!0bW0+/0d0A:;:6
;!\,#<OA.Q0+‚*P#<.$`;P06/^%'#'7'&:#<.$^8
*P`;P#<60'6_#<.$bB'& :,^+‚+*P#<.$3A:-D%W0+/0
19
d0bW0+/0d0A:P#>%$+/0d0;:6;!+‚+*P#<.$
'&:06/^+/0d0?0#'70'&:#<.$^+/0d08*P`;P#<60
%/+/0d0+‚+*P :,'&: :,#<60bW0+/0d0A:0'P0r„
h
%/6#<60#<P+_#'ž0#<.$k :,%/0'P0rh
h
<: :,#<P+_#'ž0;Pb
4'#<608:%W0+/0d0:6'Q8*PE'6)0h^l++^;e06/
8:%W0+/0d0#'\'Q;e#<P+‚+*P#<.$„^r++9hkrbŽ++=’r^
rg^jr^jŒ“b
W0+/0d00D0$'4;e#<PA6:00:0^E'S0')/
+#\,#<O+/0d0#' +/'q/+/006/A.Q0^%/'q#'\*<‡`
;e06/2()'#<600:*364+‚+*P#<.$b''u,#&'"#%/6
+/0d00D/35%/6#<60W0A6:0':0b’jr^jŒ“
*,$C;fE7;AW$3•[>9y;N$;9PJA"J;B>9TB$g8 :,E'<:E'‚
A6:0#…'+4'':0^2()'#<603m'.$00M0@„h‹k„„h
h
<: :,^
%/6#<60%/P#<P4'06/+‚*P#<.$%/3 $06/#'DE'#'7
9364;X-7'56#8*=b•3C*2()'#<60'6'';P/2++"#^-/
E'6)0hbl+^3.e0E&'#<,0;Z'/h^j‰+’jŒ“^#x#'/'#<P3%/6
?0#'70|0%$-C*#'DE' ?%/\+,'6'5D,b2(+"#

%/-C* ?0n'':,;`%'A.Q0'‚/%'#'70bO
'Z'2(#4%7#<&/*@#'X0C*+\##'7'6_#'7#<.e0-6'y0:6
#'6:#'70^':*A,\#',*]##'8*#'#'X’r^g^„j^jŒ“bbb
*5$C;fE7;AW$3•[>9y;N$;9PJ/2()'#<603|0#'DE'
^^„^r`#'/'06/A6:0':0b:,E'<:E'‚A.Q03’„j^jŒ“
V'&:#<608:+‚+*P^2()'#<60':+#''2(#'S0
:,A,\#'##x#'/' :,8:@^2(/*'4*'.$0<: :,0:*4'#'D
E'%M'5',09 ?=^ :,3@?%$2(56 :,bV'Z'+4'#4
%7#<&/*@#'X0C*1#%M'5|0;P-6'yz’r^‰^j„^lj“
20
Ÿk 5$C;fE7;>W$>E[U;[C; |0%7#<&A,\#'#%$2(+"#^'Q
A,?0 $2()'#<60'6'';P/2(*P#<P^3.e0E&'#<,0
;Z'/h^l+^\+,'60:6#'6:#'70%/#'|*#<.$#,*]*P^,?0
#,*]*Pb
*g8A‚;B;J$„()…/
+ $2()'06/#'S0R,:''2(0@+"#8:2(+_#^''
8:2(#' Q0S08:2()'06/%$''2+#<P<W0<!%/
2+#<Dm+"#8:2()'#<60b06/<:W%W0?0U:'''…
#<.$8:2('/+#<P#',2()'06/%/'')'k'…#',2(
)'#<60b
+ W0? !2:0• 3.s'6+: • +S#)n+„‰‰l^3C*/
+#%W0?#'S02('o037'%B0)'u,^o+`+_#B8:56#<60
;X0:6#'6:#'7^;:6R,:'0:6#'6:#'70^8A+%/'?P,?0b2:
03.s'Z'#'/'#x''2(#'S0?8:2()'#<60%/2(
#'CB^|0%$2(#'S0#<.$^2(#'S0 :,%/3640D8:2(
56#<.$^560U:%/56 :,bx3:0• %/2('&'@
''A,*P%/''%‚563<:b2(#<,0#C+92(A,*P=@E&'
#'.$'‚^A,\#'##x3:0• %/3640D8:2(560U:^56
#<.$%/56 :,^3%,S00@A,*P C,R,:B563]\+,'6
'CB^;:6#<60%/0:56’„j“b

(F)F    +  }  -~?    ,†    ‡o  ˆ  -‰
+Š
(F)F(F-9•;\J>d$^9_;9<4K;+8`;9>a4;B;#$P:F
ŒgkŒŽi#O'Z'2(0"%/6#'C2(+:0`B !^Q':
''2(bO'Z'2(#',364)'#<60 !']+l„i^
21
#<603@QA,\#'#2(#'S0 :,']+rgi^E'O#<P2()'#<60
']+„li%/#<60A6:0':0/ri’r^‰^„l^„Ž^rj^j„^j‹“b
(F)F&FuE>ad8>d$^9_;9+
@'B,'Z'#'X#O'Z'2('.'Z'#O^'Z'#'6%/'Z';@
#'^:*0_'\#/'Z''Z'#O']+‹gib’‰^„l^„‰^rr^j„“
'/'#O'Z'+‚0'Q#'/'2(-6#'],$;Z'#'.e08:
2(/$60U:%/$ s3/'pb'/'#O'Z''q/$+/0AQ
+‚0^P#]%$$606/8:2(%/'&:#<603.s@#;`$6
+4'+4'+,b
O'Z'0p+j'D0p+m^#'C%/3*bm#O'Z'/Q#]0
%$2(,S92(+:0#O'Z'=/Q3_#E'E”m#O'Z'b2*#O
/+$*],'\#8:#O^#'.e0+‚0-63@-€0C*%Y`3*^<\#']+E'%Y`
m#Ob'v6<:› 6<-#'\*<o0‰li#O%Y`3*^„Ži%Y`#'C%/'q@
ri%Y#4m#O'Z'b'&'%Z%M*E'+mP;@#'#O'Z'#xm#<'
;@#'#x3*#O'Z'3X'4']0,*Q%Y#O'Z'E''u,#',M#b2_
;1#D.,['q ?Š9#q13*ˆm#O'Z'=3X-360,*Q%Y#O
'Z'bq1/*/0$#'Z0,*Q%Y#O'Z'/0:6^/0-€At*<:
;]'d0%YEX)3B,#<7^064E'6:a0'.:#'1+4'b
22
(#'D'‚9„kji='Z'2(@'Z'#'6^3_3X+8:64
'Z'2(/*/E'S0@m^#'.e00_'12(A,*P3<:#x'w
'p0^%Z%M*%13B,#<7;o0'u,#',M#<\#E'@E'nbQU:^3C*/64
'Z'2(<\#&#0_^%Z%M*0'Pd,/*'q#M#<,00)R,*]#'U0
'Z'2('Z'#Ob

'v6T<*v•v<%/: #v˜bV#'Z#O'Z'@j64E&'#'.$#O
'Z''‚9 $„h++=^%x:9„hkrg++=%/#O'Z'2(E'm0p9#<P
rg++=’j„“bO'Z'@+4';P^:A'@:`#'/'#O'Z'^AQ%U:`m
#O'Z'/*],#?E'@E'nE'#]'/'E”m#Ob>+,3S0#<60
W0#O'Z'@#'X0C*#"+4'56%//+#O'Z'#<P'+'>2(
@ E&'  #'.$ '‚  'Q #'  #]^ #'.e0  / E'?  'Z' E'm0  p 9  0:#
:v,<* +=^64/*&#@;]'d0%Y’‰^„„^r‰^jh“b
(F)F)FJ5LM;B>d$^9_;9F
'B,#O'Z'2(/@#x':#O'Z'#<`P^']+h^Œkjj^gib
'v6v' #'\*<o0'B,#O'Z'#'.e0A)*<:`U^&#0_`#<•v+%/
Žri;1''C#<Pgh#,mb\3B3_#<:/#O'Z'2(/6%Y%/D
#'1'u,#',M#;P/6#<.$b'&'%Z%M*^ '?'s8:'u,#',M#E”
m#O'Z'%/:#'1+4'/ :'!'s[#<60#<.e0's
'B,#O'Z'b<.$']#/'u,#',M#^E'S0'U064;‚#O'Z'^+/
W'6#'\*;o0'd03X't363@/#O'Z'%Y^#<''M,R,)30
#]At*<:b'v6v E:v#'Z:#'1'u,#',M#;o0':#'Z#'Z+#E”
m#O'Z';P%Y^ :,rkj#'0E';1''Cm37'#'Z#]'/'E”m
#O'Z''.:%Y^W#'v6#0) '<6^0,*]']/6#'Z'M#'\*
#'1+##'Z#\#)#O'Z'|0;P;D,'6E]#R,)<\#E')R,:
%$3.e0+m#<k#'k Q0B’‰“b
(F)F‹Fd$^9_;9+^9J$9M^AW$\Y;952IK89IgE;l4N9g8F
23
'.e0'?'s%$E'?#'S030k#…'+4'56^#'X/*']+r^Žk
rjib'?'s/*/0,*'X-6/+#n00,*Q')*+,%/0,*P
'C')*+,#'.e0-6%Y#O'Z'2(b0)T<6›'M#'\*0,*
Q')*+,'?'s/Ži+wn+^W`E'?#'S030k#…'+4'/
„^Ži’jl^jŽ^lj“b
(F)FZFBE[C;;9•;\Y;9P$;98c7>d$^9_;9+8`;9>a4;BF
'63]:*^0,*P'C;1' ''&'A8:#O'Z'2(%u'.:
'6/#6/ 0#‚^@0)#']#'6<o0#O'Z'2(/#m#'.Q0+"

')^0)#']#E'4'6<o0#O'Z'2(/#m#'.Q0;t+ 'b'6
-|/#m#'.Q0;t+ '':*+"')^'D,']##0)3B,#'?0'\#
#O'Z'2('Z'#'/'^'##<X%/%Y/-6':*],#?'&'#&'*],
8:#'/'2(%/#308:-W0+,56b
1.3.5.1 Tính yếu của thành ĐMN.
/'M,R,)8: 0364$60U:8:#'/'2(9#m#'.Q0
/*#n0P#'v6#,m%/#'.e0#'\*`05;:2(=b+4'+,56
@'U0E';1#%B\,#46%/ '[ 6%$+4'+,E'#<60Q
#'Xb|.s0+,#x#+@#'X#':*3m%/'eQ']#3B,'W:#,D'6/^
+w'O#%u3B,3_@‹hh++,3.s,0\'6+S56b'U0<?
64-#<,*B#m'dPE]#/+0)+#q1 s6:0v8:#'/'2(
9''d0—'v<k:6 ^#'M3::0^''d0(:< :bbb=^'U0#m
#'.Q0AQ%U:2(^'6_'€+#<|0^'\#'.Q0/+0)+ d;B#'/'
+4'bZ%M*^@#'X#'\*'Z'2('?'s%$AQ%U:2(^'p0
2( :,'€+#<|0^':* :,'\#'.Q0’‰^„g^jh“b
1.3.5.2. Tác động của dòng máu não.
24
¡8:-W0+,#30P#'/'+4'#<60+w#'Z#C+#',^'1
#.s0A6*8:-W0+,')*#<60W02(905;:2(/%7#<&
'7,#30$'\#=b2B,/*0)#'&'#O'Z'2(#'.e0A,\#'1
#4%7#<&/*’l^‰^Ž^j„“b
(F)FŒF$;952\Y;98c7>d$^9_;9+8`;9>a4;B<4K;>a4;BP:F
• TX,'1#<1,'d08:#O'Z'2()'#<60364#<60 !E'':,
#|*#'v6%7#<&^E&'#'.$#O'Z'%/#Z'#<40%Y':*'.:%Y8:#O'Z'b
'v6%7#<&^],#O'Z'`''2(+4'+"#@#'X0C*+\##'7b'v6
E&'Y^'U0#O'Z''‚#'.e0E'S0;X,'1#<1,'d0b0.s4^
'U0#O'Z'$@#'X'yz%/6-C*%/#m'd56bO'Z'
2('.:%Y@#'X;X,'1#<1,'d0'.'Z3S^0)+'6_+\##'7
^3:,+"#'6_'U0Q3:,3D,;6#<.$’‰^Ž^„g^„Ž^j„^jj“b
• Y#O'Z'2(#'.e0A)*<:3#0#^@#'X#'\**],#?#',Ms

'.0"0 d90:6's^<_q:bbb=^#C+[n0#'ž0^AO)++4'':*/+
%1 $"0^Q:6',*]#’‰^„g^„Ž^j„“b
• |*#'v6%7#<&0)'u,^-,0#&'#O^E&'#'.$'w%Y^.s0+,')*
'B,':*&#+/0C*<:((3Q#',D':*E'?+,#>#<60 !'6_
')*+,56#'\#^ ']+'Q/+#E'?+,#> $+/0d0b Y#O
'Z'2()'#<60&#@3_3X+<P0;1#1#c:0.e^E',*]##'7
#<.e0^30E'^1#+_#^#':*3m#<0^Q+Qb'.e0@'?'s%$
E'?+,#>#<6056jŒkggi’‰^j„“b
• (('B,@#']-6%Y#O'Z'E&'#'.$'‚b'+,')*'B,^
 !9=#n0:6%/':'^56;7'',f'B,;1''C $+
3%/6'S+P C,%/#c%60b(# ?E'^ :,E'#O'Z'2(%Y^+,
')*<: †;70n#<60E'6:0 $'10$'44%/#<60 !@
',0 †#n0P':''@0^#30'.+# dz3XD++,b¡
#<60 !#n0P3X0n'_')*+,^'.0E'S0380C*#'],+,56
>;`56b¡#<60 ! †#<`%B;Z'#'.e0„#]0 :,E'@')*
25
+,^'.0a0@E'C,'Qb.s0+,')*<:#'.e0'>#',%/6
*],#?'..,.s0+,^-,0#&'#O%/E')n0#46>+,3S0b
s',*]# †"03!0%/.,.s0+, †0)+3X s',*]#@#'XE]#4b
'e%M*+,@#'XD+^0O;1''CR,:3.s0:3643D,’‰^jŽ^j‹“b
0.e#:E'S0#'1#.s06#'"#+4'+, $+@#->0D++,
E'#O'Z'%YbD++,/*'q@#&''\##4+#'e-6 s',*]##46
P+##'/'+$'6#O'Z'2(%/a03p0#'e/+#O'Z'2(
#6Pb<P$ s',*]#3@ †'Z'#'/'P$+4'#C 'b'$
+4'#C '/*')*+,^;1''C †@#<1,'d0'd3D,b(_#E'
#'/'#O'Z'2(3.s\,#46;` s',*]#3@ †*],@#'X%Y#'P+
+#DU:^0C*;]'d0#4 !%/;]'d0#6/#'Cb
(F)F•F9S;B\$U;89D;B>a4;BP:F
1.3.7.1. Tăng áp lực nội sọ.
')*+,;:3D,0C*P#n0b(d3#n0'>#',%/6

E'?.s0%/%7#<&')*+,b'+,')*&#^'q#n0'”%/#'6)0
R,:^<p':''@0#<`40$'4;Z'#'.e0-63.s;|#<x;`'U0
Q']#3B,'6/8:56b<.e0's+,')*'B,^#n030EX^
%.s#R,'U0Q'];|#<x '[0C*<:'1#.s0#n0_0b
0)#',*]#'6<o0#n0/'M,R,)8:
+ 1#.s0#n0#'X#&'+,569-6<?64%M+4'=b
+ 1#.s0'|56\#&'-6 #':*3m#&'#'\+8:'/0</6+,k56
%/0)+#.$+,56b
+ 1#.s0)#<`.,#'S0%/'\#',-7'56#8*9=0C*P0556
#'\#\#&'9A)*<:`„hkjhi;1''C’rŒ“=b
+ „hkjhi#O'Z'2(%Y'Z'#'/'P+#E'?+,#>#<6056^':*
$+/0d0^/+_0#'P+'1#.s0#n0’jŒ“b
1.3.7.2. Giảm áp lực tưới máu não.

×