vfli TRO CUR Te e n o G O C TRONG NHFlN KHOR
Hodng Thi Minh Chdu*
T
rong hai thap ky gdn day. vice nghien cuu te bdo goc la van de thdi su ndng hdi trong y sinh hgc va cdc nhd khoa hgc da cd nhfl-ng budc tien dai trong lien trinh tim hieu bdn chat, vai trd vd viec ling dung te bdo gdc vao thuc te ddi sdng. Tai moi md, tgng. noi cd qud trinh lu Idi sinh deu cd nhirng vi tri lap trung te bdo gdc (TBG) de tir dd qud trinh tdi sinh md duac thuc hien.Te bao gdc (Stem Cell- SC) la nhirng te bdo cd tiem nang phdt trien thdnh nhieu iogi te bdo khdc nhau Irong ca the. Mdi khi mdt md nao dd cua ca the bi tdn thuong, te bdo gdc cua ca quan dd se lap tiic thyc hien qud trinh siia chua thdng qua viec san xudt cdc te bao cd the biet hda thay the cdc md Idn thuang. Do vdy, TBG cd vai trd quan trgng trong sy tdi sinh vd siia chira cac md Irong co the (nhan cau cung khdng phdi Id ngoai le). Trong nhdn khoa, ke tir khi b^t dau cd nhirng nghien ciiu ve TBG, vi tri dugc quan tdm nghien ciiu sdm nhat vd nhieu nhdt Id be mat nhan cdu bdi vi day Id vi tri thudn Igi nhdt cho nhung nghien ciiu ve TBG [I]. Tdm quan trgng eiia TBG bi6u md gidc mgc dugc thiia nhan va hien nay dugc su dung trong lam sdng de sua chiia nhung tdn hgi gidc mgc nang Irong bdng hda chat va nhiet, hdi chiing Stevens Johnson vd pemphigoid nhan cau [2].
1. Giai phau be mat nhan cau
Be mat nhan eau (BMNC) Id mgt phire hgp
sinh hpc lien luc cd nhiem vii duy tri sy trong sudt ciia giac mac, hinh thanh va duy tri sy ben vCrng cua film nude mat ciJng nhu bdo ve nhan cau khoi sy tan cdng ciia vi khuan va cdc tdc nhan ca hgc khac. Bieu md BMNC bao gdm bieu md cua gidc mgc, bieu md viing ria giac mac vd bieu md ket mac den sat viing liep ndi vdi bieu bi da mi, ve gidi phdu dugc chia thdnh phan sun mi, phan cung do va phdn nhan cau (hinh 1). Day Id loai bieu md lat tdng, lien liep vd khdng simg hda. Cdc yeu td khac nhu film nude mat Irudc gidc mgc, cdc sgi than
Hinh 1. Luac S gidi phdu BMNC vd cdc vi tri tap irung TBG tren kit mgc mi, nhan cdu vd vung
ria: Noi tap trung day dgc nhdt la ciing S (F) va vung ria (L). E,biiu bi; T, vung tiep noi giira bieu
bi vd kit mgc mi; P,kii mgc mi; F,ciing dd; B,ket mgc nhan cdu; L, viing ria; C, gidc mgc [3 ].
* Benh vien Mdt Trung uang
rmmm»^
kinh trong giac mac hay phan \a chdp mat bao ve deu giiip duy tri mdi trudng thugn Igi nhat cho bieu md BMNC BMNC Id noi ly lirdiig cho nghien citu ve sinh hgc ciia TBG do su sap ddt khdng gian dgc dao cua cac TBG vacac lii'bdo phan chia nhanh [1].
I. Khdi niem c<>' l>aii \t- le bi\n goc ( S t ) v:i ddc tinh doi voi be iiial nhan cau
Te bdo gdc Id nhung ic bao (TB) nguyen thiiy cd nhiem vy thay the te bao chet vd Idi sinh md I ii nhfl-ng TB nguyen thiiy ndy. cac TBG cua cac md dugc tgo thanh \a ifl- dd hinh thdnh nen cdc md, tang khdc nhau. Dac linh ciia TBG Id kich thudc nhd, kieu te bdo non vdi ti le nhan-te bdo chat Idn, kem biet hda hogc khdng biet hda, thdi gian sdng
dai [3]. Dd Id mgl quan ihe cdc te bdo it boat dgng va chiem ti I? rat nlio (tu 0.05% den 10%) so vdi tdng the li} bao eiia mgt mo Binh thudng TBG phdn chia lal it, chi khi to su ddi hdi tai tgo md nhu sau chan thuang hay kich ihich, nd sg bj kich thich de phan chia vd bi?t hda ihanh nhitng TB phdn chia nhanh IA{I.I"AC'2. TAC3 (TAC- transient amplifying cell), DOn lirgt minh nhfl-ng TAC ndy nhanh chdng nhan so lugng de thay the te bdo chet hogc bj bi tdn thuong ben trong md. Sau khi nhan len. chimg sS dirng phdn chia. trd thdnh cdc le bdo sau gidn phdn (PMC- postmitotic cells) va sau do bi^t hda vd bieu hien kieu hinh ciia le bdo mo dich (TDC- terminally dinereniialed cells) (Hinh 2) [4].
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flt SeH-rene
1* A
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1 1 i i
o o o o
1 1 r^
O OO o
1 1 1 1
o
Hinh 2. Soldo vSsuphan dp cua TBG (SC), li bao phan chia nhanh (TACl, TAC2, TAC3), IS bdo sau gidn phan (PMC) va ti bao blfl hda dich (TDC). Khi cd nhu cdu han gin,
TBG phdn chia thdnh TB phan chia nhanh (TACs) di rut ngin chu trinh phan bao.
Dong thai qud trinh tu- lal sinh cung dip Ific di duy tri qu^n Ihi TBG 13].
Khi TBG piioi phan chia, co the se tiep tuc la TBG nhir cu hoac trcr thanh mot loai TB khac co nhung chric nang chuyen biet nhir TBG co, hong ciu, TBG than kinh, TBG viing ria giac m a c . g p i l a T B G m o P ] .
(3 nguoi tmong thanh, TBG viing ria tap trung a
vi tri hang rao Vogt vdi be rpng khoang l,5-2mm, trong do 0,5nim ve phia giac mac va l-l,5mm ve phia ket mac nhan cau va cr ciing do (Hinh 3). Tai viing ria chung dong vai tro rao chdn ngan chan cac te bao bieu mo ket mac xam nhap vao giac mac (ngan \o mach vao gay due giac mac).
DIINPANI
Hinh 3. Vung ria gidc mgc binh thudng vdi hdng rdo Vogt cd sdc to mdu nau (dau miii ten den)
3. Nhihig ton thuong do suy giam t^ bdo goc vijng ria
TBG viing ria cd the bi Idn thuang do nhieu nguyen nhdn bdm sinh hode mac phai. Nguyen nhdn bdm sinh rdt hiem gap, cd the xudt hien d benh nhan viem gidc mgc khdng cd mdng mdt, viem giac mac kem theo cdc thieu ndng ndi tiet trong dd TBG vimg ria khdng cd hoac bdt thudng. Nhiing tdn thuang mac phdi ciia vimg ria nhu suy giam hoac phd hiiy viing ria hay gap
tren lam sdng hon, bao gdm bdng hda chat hoac nhiet, hgi chirng Stevens Johnson, Pemphigoid BMNC, benh giac mac do deo kinh tiep xiic keo ddi, viem loet giac mgc viing ria, b6nh giac mgc do liet thdn kinh, mat hot, phau thuat mdt phirc tgp...TBG viing ria cd the bi ton thuang tirng phdn hogc todn bd vdi nhu'ng dac diem lam sang dac trung, bao gdm "ket mgc hda" gidc mgc vdi tan mach, te bao che nhay vd bieu md gd ghe khdng dn dinh.
Hinh 4. Tdn thwffng ti bdo gdc vung ria: mdt cdu true gidi phdu binh thuong vdng ria, tdn mgch xdm nhap gidc mgc
Diu hieu phan biet suy gidm TBG viing ria qud Id mdt ranh gidi rd rdng giu'a bieu md ket mgc (Limbal Stem cell Deficiency- LSCD) la su k8t vd giac mgc d viing ria [4]. Trieu chdng lam sang mgc hda giac mgc va b i k hien lam sang quan trgng ciia suy gidm TBG vimg ria Id gidm thi lye, chdi, nhdt la khuyet bi6u md gidc mac dai ddng vd hdu chdy nude mdt, co qudp mi, dau thdnh dgt tai phdt
aiflai DIEN DAN
do vd bgng bieu md cung nhu tien sur viem mgn tinh. Tiiy Iheo di?n tich viing ria bj Ion thuang md cd the gdp suy giam TBG mgt phan hay suy gidm TBG todn bg [4]. Trong trudng hgp suy gidm mgt phdn, cd nhQng vung gidc mgc van cdn bieu md lanh nen bieu md kel mgc chi phdt trien hgn ehe de che phii nhfl-ng vung GM khdng cd bieu md. Tuy nhien sy khong on djnh mgn Ifnh cua bi^u md gidc mgc va loet gidc mgc dai ddng si! gay nhuyen vd dan den thiing gidc mgc. B?nh canh dge trung ciia suy gidm TBG viing ria la su xSm Ian ciia bieu md ket mgc mang theo mgch mdu vdo gidc mgc [5,6].
Kiem chfl-ng bdng test dp te bdo cho thay sy cd mfit eiia te bdo che nhdy ket mge tren be mgt GM[7].
Bieu hien 1dm sang ciia suy gidm TBG vung ria cd the tir miic dg nhe den ngng vdi cac tri?u chung nhu: mdt cau true gidi phdu vung ria, bieu md GM mdng vd gd ghe, film nude mdt khdng ben vflng, bong bieu md GM dang sgi vd trgt GM, tan mgch GM ndng vd sdu, khuygt bieu md GM dai dfing dan den loet vd hogi tii nhuyen, thung GM, xa mach vd seo, khd mdt simg hda [4].
Viec chdn dodn suy giam TBG viing ria dua vdo cac ddu hieu 1dm sdng, test dp cd sy hien dien cua te bao ch6 nhay ket mgc tren GM, sinh thik biSu md GM Id dgng BM da tdng, cd mgch mdu vd lympho trong BM...
4. Ghep TBG viing ria GM
Do nguyen nhdn vd ca che gay benh phiic tap nen di6u tri suy giam TBG vung ria la mgt phiic hgp nhieu bi$n phdp trong dd ghep TBG vimg ria Id mdt lieu phap lien tien vd cd hi?u qua nhdt nhdm phyc hoi chire nang cho mdt bj b?nh. Ghep TBG vimg ria dugc phdn loai Iheo nguon goc cua TBG nhu ghep tu than hay dj than. Ve ki thugt ghep TBG viing ria bao gdm ghep ria tu than, gh^p ket mgc tir ngudi than cdn song, ghep gidc mgc- ria di than, ghep bieu md vimg ria nudi cay tren tam mdng 6i.
G/(e/)A//m(7crm^if///an (Conjunctival Limbal Auttograft - CLAU) dugc Kenyon va Tseng md
td dau ti6n ndm 1989 [8] nhdm dieu trj nhQng tdn thuong BMNC do suy gidm TBG d mgt mfit hogc cd hai mdt nhung chi mgt phan vung ria nen van cd the dirng nhQ-ng cho cdn Idnh de gh^p cho vimg Ion thuang dugc lay bd. Ve kT thugt ngudi ta lay 2 mdnh vimg ria vdi kich thudc 3x10mm (bao gom 0,5mm GM ria trong vd 2,5mm ket mgc nhdn cau ria) ghdp I3n viing ria ciia mat tSn thuong dd dugc logi bd sgch cdc to chiic xa mgch tren BMNC. Ghep viing ria cd the ket hgp vdi gh^p gidc mgc xuyen, tdch dinh mi-cau vd tgo hinh ciing do, gh^p kel mgc hode tgo hinh mi... Trong trudng hgp cd hai mit bj ton thuong n$ng khdng cdn vimg ria linh, co th^ lien hdnh ghiip TBG vimg ria dj than tir ngudi thdn ciia b^nh nhdn (Living Related Cojunctival Limbal Allograft- Lr-CLAL) hogc tir mdt hi thi (Conjunctival Limbal Allograft- CLAL).
Ghep ket mgc vung ria di thdn dugc dp dyng cho nhil'ng trudng hgp ton thuong Ian rgng can dien tich ghep Idn, dieu nay cung dong nghia vdi nguy CO Ihdi ghep cao nen thudng phdi kel hgp vdi thuoc lie che mien djch nhu cyclosporin... Mgc dii mgt sd bdo cao ket qud ghep ria ket hgp ghep gidc mgc rat tot nhung trong nhiing nghien ciiu sau nay cho thay khodng 50% manh ghep thai log! sau 3-5 nfim [9,10].
Gdn ddy, nhd nhGng liln bg trong ITnh vyc sinh hgc phdn hi va hda md miln djch, nhieu dgc tinh cua mdng di dugc phat hi?n va ngudi ta dd chimg minh dugc mang 6i giiip cho vi?c lanh vlt thuang thugn tgi nhd cd yeu to phat trien biSu md vd kha ndng chong viem, do dd nd khd nang thdc day qua trinh di cu vd han gfin bidu md trong di^u tri benh ly BMNC. Ghep TBG viing ria ty thdn cd thg trdnh duge nguy co thdi logi manh ghep nhung chi ap dyng dugc cho nhihig b?nh nhdn bj benh mdt mdt, mdt kia cdn viing ria binh thudng. Han nCfa, viec lay di mgt di?n tich Idn vimg ria d mdt lanh se dua den nguy co suy giam TBG viing ria do phau thuat cho chinh mfit Idnh. Sy phat minh kT thugt nuoi cay tam TBG viing ria ddn trai tren mdng 6i da g9
DliN DAN I
bd dugc nguy eo ndy va dem Igi cho ngdnh nhan khoa mgt quy trinh mdi trong dieu tri tdn thuong BMNC ngng. Ddi vdi quy trinh nay chi can cfit mdt mdnh vimg ria rdt nhd (dudng kinh 2mm^) tir mat lanh (hoac tu viing ria Idnh cdn Igi rat it ciia mat benh), sau dd nuoi cdy tren nen ikm mdng 6i hogc chdt nen fibrin tgo nen mgt tam bieu md viing ria GM rgng dii de kien tgo todn bg BMNC bi Ion thuong do mdt loan bg TBG vimg ria (bdng ngng, hgi chiing Stevens Johnson...). Vi?c dp dyng quy trinh ghep tam bieu md viing ria GM nudi cay dd trdnh dugc nhung bien chiing cua gh^p ket mgc ria kinh dien doi vdi cd mat nhgn cung nhu mdt cho mdnh ghep. Nhfl^ng kel qud ban ddu thyc hien tren ngudi cho thdy su hiia hen khdng nhCrng ve hieu qua Idm sang, viec cd thS md rgng chi djnh md cdn gidm thieu tac hai ciia thuoc tie che mien dich diing dudng todn than.
5. SC trong dieu tri benh vong mac TBG vdng mac Id nhifng TBG ciia he than kinh trung uong, hinh thdnh nen vong mac Irong qud hinh phdt trien phdi thai. TBG vdng mgc cd mat d chen thj giac phdi thai ciia cdc ddng vat cd xuong sdng. Nhiing ndm gdn day cdc nhd khoa hgc da tien hanh nhiSu nghien ciiu su dyng TBG vdng mac de dieu tri cac benh vong mge trudc ddy dugc coi Id khdng the di6u In dugc (nhu thodi hda hodng diem tudi gid, benh vong mac sdc to...). Vong mgc than kinh Id mdt phiic hgp cau true trong dd mgch mau vd bilu md sdc to co vai trd quan trgng ddi vdi sy khde manh binh thudng ciia nd. Viec dieu tri TBG tai vong mgc chu yeu nham vao 3 loai te bdo khdc nhau vi mdi logi te bao nay khi tdn thuang se bieu hien trong moi benh khac nhau: 1) Te bao vong mgc thdn kinh (bao gdm tB bdo cam thu anh sang, te bao ludng cue, td bdo bgch); 2) T6 bao bieu md sdc td vd 3) Te bdo ngi md mgch mdu. Tiiy thugc vao
logi bgnh ndo md ngudi ta chgn lya TBG thay thS thich hgp. Vi du b?nh thoai hda hodng di^m tuoi gid d giai dogn mugn dd mat thj lyc dugc dgc trung bdi sy mat te bdo cam thu dnh sdng va roi logn chii-c ndng bieu md sac to vdng mac. Viec dieu tri theo hudng hgn che tdn mgch hfic mgc va trj lieu TBG thay the cac te bdo cdm thy dnh sang bj mat vd te bao bieu md sdc to se Id phuong phdp duy tri thj lyc hflu hi^u cho nhimg benh nhan nay. [11 ]
Cd hai gidi phdp ghdp TBG vong mac Id ghep le bdo cam thy dnh sang vd ghep te bdo bieu md sac to vdng mac. Ngudn te bdo eho cd the tu TBG phdi thai, TBG than kinh, TBG vong mgc, TBG trudng thanh hode TBG vong mgc phdi thai. Ve kT thudt, ghep TBG vdng mac ed th6 cd 2 each: ghep dudi vdng mgc vd Irong dich kinh. Ghep dudi vdng mgc phiic tap hon vd ddi hdi eao han vh kT thuat Irong khi tiem trong djch kinh it bi xam lan vd de thuc hien hon nhung te bao phdi di cu tir dich kinh vao vdng mac. Mdt sd nghien ciiu thdy rang TBG thdn kinh (Neural Stem Cell) ghep dudi vong mge dugc djnh vj vd biet hda thdnh ti bdo cdm thu dnh sang tdt hon ghep vdo dich kinh[I2,13][13,59].
Cac nghien ciiu khac Igi chiing minh rdng TBG vdng mac (Retinal Stem Cell) dugc tiem vao djch kinh lai gdn kk tot hon ghep dudi vdng mac [14].
Xung quanh vdn de ghep TBG vdng mac cdn rdt nhieu cau hdi chua dugc trd Idi nhu logi te bdo ndo la tot nhat cho ghep vdng mac? Phuong phdp nao Id tot nhdt? Giai dogn biet hda ndo cua TBG la ly tudng cho viec hda hgp vdi vdng mgc nhan?... Mac dii cdn nhieu trd ngai va thdch thiic nhung cac tai lieu nghien ciiu cho thay ghep TBG cd dugc nhu^ng thdnh cdng nhdt djnh tren ddng vat cung nhu con ngudi. Cdc nghien ciiu cdn can tiep tuc de tri lieu TBG phyc hdi thj lyc eho benh nhan trd thanh thyc te frong mgt tuong lai gan.
DIEN DAN
TAI LIEU THAM K H A O
1. LPK ANG, DTH TAN, "Ocular Surface Stem Cell and Disease: Current concepts and clinical Applications", Ann Acad IVled Singapore, 2004;33:576-80.
2. BOULTON M AND ALBON J (2004):
"Stem cells in the eye". The International journal of Biochemistry & Ceil Biology 36:643-657.
3. L. P. K. ANG, D. T H. TAN, R. W.
BEUERMAN, AND R. M, LAVKER, Ocular Surface Epithelial Stem Cells: Implications for Ocular Surface Homeostasis, in Dry Eye and Ocular Surface Disorders, 2004, Marcel Dekker Inc., Canada, pp 225-246.
4. DUA HS, Transplantation of Limbal Stem Cells, in Cornea and External Eye Disease, Springer, Germany, 2006, pp. 36-52.
5. DUA HS. Stem cell of the ocular surface:
scientific principles and clinical applications. Br J Ophthalmol 1995;79:968-9.
6. TSENG SC. Regulation and clinical implications of corneal epithelial stem cells. Moi Biol Rep 1996; 23:47-58.
7. SRIDHAR MS, VEMUGANTIGK, BANSAL AK, RAO GN. Impression cytology proven corneal stem cell deficiency in patients after surgeries involving the limbus. Cornea 2001; 20:145-8.
8. KENYON KR, TSENG SC. Limbal autograft transplantation for ocular surface disorders.
Ophthalmology 1989; 96:709-22.
9. ILARI L., DAYA SM. Long-term outcomes of keratolimbal allograft for the treatment of severe ocular surface disorders. Ophthalmology 2002;
109:1278-84.
10. SOLOMON A, ELLIES P, ANDERSON DF, TOUHAMl A, GRUETERICH M, ESPANA EM ET AL. Long-term outcomes of keratolimbal allograft with or without penetrating keratoplasty for total limbal stem cell deficiency. Ophthalmology 2002; 109:1159-66.
11. PAUL S. BAKER AND GARY C. BROWN, Stem-cell therapy in retinal disease. Current Opinion in Ophthalmology 2009, 20:175-181.
12. BANIN E, OBOLENSKY A, IDELSON M, ET AL. Retinal incorporation and differentiation of neural precursors derived from human embryonic stem cells. StemCells 2006; 24:246-257.
13. SAKAGUCHI DS, VAN HOFFELEN SJ, THEUSCH E, ET AL. Transplantation of neural progenitor cells into the developing retina of the Brazilian opossum: an in vivo system for studying stem/progenitor cell plasticity. Dev Neurosci 2004;
26:336-345.
14. COLES BL, ANGE' NIEUX B, INOUE T, ET AL. Facile isolation and the characterization of human retinal stem cells. Proc Natl Acad Sci U S A 2004; 101:15772-15777.
D I I N BANI
NHAN MOT TRUONG HOP VIEM 6IAC MAC DO 0N6 OOT
LeXiian Cung*
iem giac mac do ong dot la mdt lai nan it ggp d mat, ngodi Idn thuong tai gidc mac cdn cd the gap nhieu tdn thuang tai cdc phdn khdc ciia mat do ngdi ong gdy ra mdt vet thuang xuyen, phdn ling mien dich, dgc td ciia ngc ong va nhiem trimg.
Chung tdi xin gidi thieu mdt trudng hgp viem giac mgc do ong ddi dien hinh vdi ngdi ong dugc tim thdy Irong nhu md gidc mac vd cdch dieu tri.
I. GI61 THIEU CA LAM SANG
Benh nhdn nam 18 ludi den khdm vdi ly do mat trdi dau nhirc nhin md. Cdch hdm vdo vien 3 ngdy (17/3/2012) benh nhdn bi ong ddi vdo mdt trai, sau dd thay mat sung ne. khdng md dugc. Benh nhdn den khdm cap ciiu tai benh vien huyen dugc dieu
tri thudc sau 2 ngdy thdy mi mat dd phii, md mdt dugc nhung nhin md nen den khdm tai Benh vien Mai Trung uong. Tgi thdi diem khdm benh: thj lye mdt phai: 20/20, mdt trdi: 20/200. Kham thdy mat Irdi mi phii ne nhe, ket mgc cuong lu, giac mgc vimg gan trung tam cd mdt dam tham Idu, d gitia cd mot ngdi ong cam sdu khodng 2/3 chieu ddy gidc mgc. Benh nhan da dugc phau thuat lay ngdi ong va dieu tri thuoc: tra mat Maxilrol 4 lan/
ngay, Atropin 0,5% 2 lan/ngdy, Sanlein 4 lan/
ngay, udng loratadin 10 mg 1 vien/ngdy. Sau dieu tri benh nhan dd nhiic mat dan, phii ne gidc mac gidm. Sau mot tuan giac mac het phii hoan loan, vet khau giac mgc lien lot, de lai mgt seo nhd.
Benh nhdn dugc ra vien, tiep luc dieu trj ngoai tni vd hen khdm Igi
II. BAN LUAN
Ong ddt vdo mdt la mdt tai ngn it gap, ong cd the ddi vdo mi, ket mgc hoac giac mac. Trong dd, vet dot vdo giac mgc thudng gdy tdn thuang ndng nhat.
Sau khi ddt ngdi ong thudng bj diit ra va luu Igi td
chuc (gdm ngdi ong duac ndi vdi mdt tiii chiia ngc ddc) do dd ngc dgc tiep tuc dugc tiet vao td chiic.
Thanh phdn cua ngc ong gdm cd: melitin (Id mgt peptit gom 70 acid amin) lam tan mdu, dung gidi hdng cau, bien ddi dien the mdng than kinh
* Benh vien Mdt Trung uang
DIEN GAN
cdm giac gay cdm giac dau. Chat 1dm va dudng bdo, hyaluronidase va histamine 1dm gidn mgch, tang thoai djch, phu ne. Dopamin 1dm cho tim dgp nhanh va apainin Idm bat hogt bam canxi d mdng te bao do dd 1dm te li^t hogt dgng than kinh co. Khi bi ong dot, ngc ong se gdy dgc tryc tiep cho to chiic vd gay nen phan ung mien djch cua to chirc vdi ngc ong. Ngodi ra, nd cd the gdy nhiem trimg.
Khi bj ong dot vao viing mdt, tuy mire dg ndng nh? cd the gdy ra cdc tdn thuang: viem ket mgc hogi tii, viem ket mgc not, viem gidc mgc, viem mong mdt the mi, dye the thuy tinh, viem dich kinh, gai thj, viem hdc vong mgc, nhiem triing gay viem lodt gidc mgc, viem mdng bo dao.
Ngay sau khi bi ong dot vdo gidc mgc, dieu quan trgng Id phdi khdm vd phdt hi?n ra ngdi ong trong nhu md gidc mge. Neu cd thi phai phau tich d^ lay ngdi ong ra. Khi phlu tich, luu y khong diing kep kep vao tiii ngc vi cd the lam ngc ong tiep tuc tiet ra gay ton thuong them cho giac mgc.
Sau khi phau tich Idy ngdi ong ra, benh nhan can dugc ti^p tuc diSu tri bdng: tra mdt khang sinh, corticosteroid, atropine, dinh dudng. Todn than cd the cho benh nhdn udng thudc khdng histamine va
giam dau (neu b?nh nhan dau nhieu). Tien lugng bgnh phy Ihugc vdo: so lugng vet dot (cdng nhieu vet dot thi lign lugng cdng ndng), Ihdi gian tir khi bj dot den khi dugc dieu trj va phuong phdp dieu Irj dung hay khdng, Neu b?nh nhan den sdm, dugc dieu trj diing vd kjp thdi thi Ion thucmg tien trien tot, gidc mgc het phii dan, thj lyc b^nh nhan hoi phyc ddng ke. Neu b^nh nhdn den mugn, ngc ong gay nhiem dgc gidc mgc ngng (d$c bi^t Id ton hgi' Idp ngi md) sS Idm cho gidc mgc bj dgc, gdy gidm Ihj lyc tram trgng.
III. K £ T LUAN
Viem gidc mgc do ong ddt Id mgl tai ngn it g$p, vdi nhO'ng ton thuang khdc Igi mdt vd ca todn than 1 neu cd nhieu vet dot. Vdi tdn thuong tren giac mgc dieu quan trgng Id phdi kham va dieu trj sdm, dgc biet Id neu phdt hi^n cd ngdi ong con luu tren gidc mgc can phdi lay ra cdng sdm cdng tot de trdnh ngc dge tiep tyc tiet ra gay ton thuong them, ket hgp vdi dung thudc tgi mat va todn than. Tien lugng phu thugc vdo miic dg tdn thucmg, thai gian tir khi bj dot den khi dugc dieu trj va phuong phap dieu trj.