Dau hieu ngo doc nam va cach xu ly
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| Kham cho benh nhan tai Khoa chong doc Benh vien Bach Mai |
Trong khoang 10.000 loai nam tren toan the gioi, hien nay uoc tinh co khoang 50-100 loai gay doc.
Nam la loai thuc pham ngon va bo duoc ban rong rai tren thi truong. Nam duoc phan loai dua theo doc chat co trong nam, cac trieu chung va dau hieu lam sang do ngo doc (ND) nam gay ra. Tuy nhien thuc te thi phan biet giua nam doc va khong doc rat kho (nhieu khi khong the phan biet duoc) dac biet la nam moc hoang o vuon, ruong va nam hai trong rung.
Nam doc co the co mau sac sac so nhung nhieu loai co hinh dang rat giong nam thuong nhat la loai Amanita phalloide. Ty le tu vong do ND nam rat cao, neu an phai loai A. phalloide thi tu vong len den 90%. Theo phan tich so lieu cua cac trung tam chong doc My, xac dinh chinh xac loai nam chi thuc hien duoc o 3,4% cac truong hop. Vi vay viec chan doan chu yeu dua vao cac trieu chung lam sang va dich te hoc.
Bieu hien lam sang: chia lam hai nhom la nhom gay ND som va nhom gay ND cham.
Nhom gay ND som: Benh nhan xuat hien trieu chung sau khi an nam rat som truoc 6 gio. Loai nay gom cac loai nam coprinus, clitocybe, boletus, inocybe, psilocybin va psilicin. Loai ND nay thuong lanh tinh. Tuy thuoc loai nam, co the thay:
- Hoi chung cholinecgic (nam amanita muscaria):
+ Gian mach, va mo hoi, chay nuoc dai, chay nuoc mat, tieu chay.
+ Nhip cham, dong tu co, ha huyet ap.
- Hoi chung atropin (nam amanita panthera) co noi goi la nam say:
+ Giay giua, co giat, me sang.
+ Niem mac mieng va mat kho.
+ Mach nhanh, dong tu gian, do da.
- Hoi chung tieu hoa: tieu chay, non mua.
- Ao giac (ao giac don gian): nhin thay cac cham sang va cham mau, hoac cac vach noi nhau chay truoc mat.
Nhom gay ND cham: Cac trieu chung xuat hien muon sau an nam 6 gio, day la nhom rat nguy hiem, gom cac loai nam thuoc nhom amanita phalloid (dac biet la A.verna va A.virosa), co 6 doc to: phallin (gay tan mau) phalloidin, phalloin, amanitin anpha, beta, gamma: tap trung o gan va gay viem gan nhiem doc; nam gyromitrin (monomethylhydrazine), orellanine cung rat doc.
Benh nhan an nam nay sau 6-12 gio hoac tham chi sau 40 gio moi bi dau bung, non mua, tieu chay nhieu, dai nuoc tieu vang, da va cung mac vang dan, chay mau chan rang, mau cam, non va di ngoai ra mau, dai mau, dai it dan va cuoi cung khong co nuoc tieu (vo nieu). Benh nhan thuong tu vong nhanh chong trong vai ngay do suy gan nang (hoai tu te bao gan), chay mau nhieu noi (do giam yeu to dong mau) va co giat.
Nhieu khi benh dien bien 2 pha: pha 1 la cac roi loan tieu hoa lam cho benh nhan phai di cap cuu. Cac trieu chung hoi phuc va duoc cho ra vien. Pha 2 (muon) mot vai ngay sau benh nhan xuat hien met moi, an kem, vang da va mat (bieu hien viem gan va suy te bao gan). Do vay chung ta can than trong khi benh nhan an nam co cac trieu chung tieu hoa xuat hien muon thi nen lam ngay cac enzym gan va theo doi tien trien cua enzym trong 5 ngay dau.
Xet nghiem dac hieu: Tim amatoxin trong huyet thanh, nuoc tieu hoac dich da day bang phuong phap mien dich phong xa hoac sac ki long cao ap. Voi phuong phap sac ki long cao ap co the phat hien doc chat trong huyet thanh sau 36 gio va trong nuoc tieu 4 ngay sau an nhung phuong phap nay rat dat tien va hien nay chua lam duoc o nuoc ta.
Co the chan doan nhanh co phai nam doc chua amatoxin khong bang test Meixner. Nam nghien thanh dung dich roi cho len giay ban tham kho, sau do nho 1 giot acid chlohydric neu xuat hien mau xanh chung to co amatoxin. Chu y do nhay va dac hieu thap nen khong phai la xet nghiem tin cay, chi cho ta huong chan doan goi y.
Xet nghiem khong dac hieu: ure, creatinin, duong, dien giai do, transaminase, prothrombin, bilirubin, cong thuc mau, dong mau.
Chan doan: Chu yeu dua vao hoi benh va dich te hoc, trieu chung xuat hien nhanh hay cham. Yeu cau benh nhan mang nam tuoi hoac da che bien den, neu nam da an het co the lay chat non hoac nuoc tieu de xet nghiem.
Ve dieu tri: Loai bo chat doc neu benh nhan den vien som. Than hoat 50g, sau do 0,5g/kg moi 4-6 gio. Sorbitol 1-2g/kg can nang chia 6 lan, uong cung voi than hoat, dieu chinh nuoc - dien giai, toan - kiem va dieu tri trieu chung.
Voi loai gay ngo doc cham gay suy te bao gan nang dung them cac thuoc nhu: silymarine (legalon): vien 70mg, uong 6 vien/ngay, N-acetylcystein (mucomyst) goi 200mg, uong 140mg/kg lieu dau, sau do dung 70mg/kg/lan cach moi 4 gio cho toi khi men gan ve binh thuong. Ngoai ra dung khang sinh loai penicillin G 500.000ui/kg/ngay trong 3 ngay. Loc mau ngoai than khi co suy than.
Chong roi loan dong mau: truyen mau, huyet tuong tuoi, heparin neu co dong mau trong long mach lan toa.
Thuoc va dung cu cap cuu ngo doc:
- Dich truyen va cac dung cu truyen dich.
- Bo dung cu rua da day.
- Than hoat: goi 20g.
- Thuoc tay: sorbitol.
- Thuoc: atropin, phenothiazin, N acetylcystein, penicillin, silymarine (legalon) tuy theo loai ngo doc.
Theo Suc khoe & doi song
