{"id":19654,"date":"2023-04-13T12:32:12","date_gmt":"2023-04-13T05:32:12","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=19654"},"modified":"2023-04-22T00:13:56","modified_gmt":"2023-04-21T17:13:56","slug":"dieu-tri-loet-da-day-ta-trang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/dieu-tri-loet-da-day-ta-trang\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb lo\u00e9t d\u1ea1 d\u00e0y – t\u00e1 tr\u00e0ng"},"content":{"rendered":"

Lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng l\u00e0 m\u1ed9t c\u0103n b\u1ec7nh th\u01b0\u1eddng g\u1eb7p v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi. Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng l\u00e0 m\u1ed9t qu\u00e1 tr\u00ecnh d\u00e0i v\u00e0 \u0111\u00f2i h\u1ecfi s\u1ef1 ki\u00ean tr\u00ec c\u1ee7a b\u1ec7nh nh\u00e2n. Tuy nhi\u00ean, n\u1ebfu \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u00fang c\u00e1ch, h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng \u0111\u1ec1u c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t v\u00e0 \u0111i\u1ec1u tr\u1ecb th\u00e0nh c\u00f4ng.<\/strong><\/p>\n

<\/p>\n

1. \u0110i\u1ec1u tr\u1ecb lo\u00e9t d\u1ea1 d\u00e0y – t\u00e1 tr\u00e0ng<\/strong><\/h2>\n

1.1. X\u1eed tr\u00ed ban \u0111\u1ea7u<\/strong><\/h3>\n

– Ti\u1ec7t tr\u1eeb H. Pylori n\u1ebfu c\u00f3
\n– \u0110i\u1ec1u ch\u1ec9nh c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 th\u00fac \u0111\u1ea9y: ng\u01b0ng s\u1eed d\u1ee5ng NSAID n\u1ebfu \u0111\u01b0\u1ee3c, \u0111i\u1ec1u ch\u1ec9nh t\u00ecnh tr\u1ea1ng dinh d\u01b0\u1ee1ng, thi\u1ebfu m\u00e1u, b\u1ec7nh l\u00fd k\u1ebft h\u1ee3p.
\n– Ng\u01b0ng h\u00fat thu\u1ed1c l\u00e1, h\u1ea1n ch\u1ebf u\u1ed1ng r\u01b0\u1ee3u bia < 1 \u0111\u01a1n v\u1ecb c\u1ed3n\/ ng\u00e0y.
\n– Tr\u00e1nh \u0103n th\u1ee9c \u0103n g\u00e2y kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng, kh\u00f4ng b\u1eaft bu\u1ed9t ch\u1ebf \u0111\u1ed9 \u0103n ki\u00eang khem nh\u1ea5t \u0111\u1ecbnh.
\n– \u0102n nhi\u1ec1u b\u1eefa, \u0103n \u00edt l\u1ea1i trong ng\u00e0y, \u0103n th\u1ee9c \u0103n m\u1ec1m, d\u1ec5 ti\u00eau. Kh\u00f4ng n\u00ean \u0111\u1ec3 qu\u00e1 \u0111\u00f3i ho\u1eb7c qu\u00e1 no, kh\u00f4ng \u0103n b\u1eefa \u0103n cu\u1ed1i ng\u00e0y g\u1ea7n gi\u1ea5c ng\u1ee7.
\n– Ngh\u1ec9 ng\u01a1i khi c\u00f3 c\u01a1n \u0111au nhi\u1ec1u.<\/p>\n

1.2. Nh\u00f3m thu\u1ed1c \u0111i\u1ec1u tr\u1ecb lo\u00e9t d\u1ea1 d\u00e0y – t\u00e1 tr\u00e0ng<\/strong><\/h3>\n

1.2.1. Trung h\u00f2a toan:\u00a0<\/strong><\/h4>\n

– Maalox, Gelox, Alusi, Mylanta.
\n– C\u00e1ch d\u00f9ng:<\/strong>
\no U\u1ed1ng sau \u0103n 1-2 gi\u1edd, ho\u1eb7c tr\u01b0\u1edbc \u0103n 15-30 ph\u00fat.
\no Li\u1ec1u trung b\u00ecnh 3-4 l\u1ea7n\/ ng\u00e0y v\u00e0o 3 b\u1eefa \u0103n ch\u00ednh v\u00e0 tr\u01b0\u1edbc khi ng\u1ee7.
\no Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb k\u00e9o d\u00e0i t\u1eeb 6 -8 tu\u1ea7n.
\n– Th\u01b0\u1eddng d\u00f9ng k\u1ebft h\u1ee3p hydro xyde nh\u00f4m v\u00e0 magn\u00e9 \u0111\u1ec3 gi\u1ea3m t\u00e1c d\u1ee5ng g\u00e2y b\u00f3n c\u1ee7a nh\u00f4m v\u00e0 g\u00e2y \u0111i ch\u1ea3y c\u1ee7a magne; tuy nhi\u00ean, ch\u00fang c\u0169ng t\u1ea1o c\u00e1c mu\u1ed1i phosphate kh\u00f4ng h\u00f2a tan l\u00e2u ng\u00e0y g\u00e2y m\u1ea5t phospho (t\u00ednh ch\u1ea5t n\u1ea7y \u0111\u01b0\u1ee3c khai th\u00e1c \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb t\u0103ng phospho m\u00e1u trong suy th\u1eadn).
\n– C\u00e1c bi\u1ec7t d\u01b0\u1ee3c th\u01b0\u1eddng l\u00e0 Maalox, Gelox, Alusi, Mylanta c\u00f3 th\u00eam Sim\u00e9ticon l\u00e0 ch\u1ea5t ch\u1ed1ng s\u00f9i b\u1ecdt l\u00e0m gi\u1ea3m h\u01a1i trong d\u1ea1 d\u00e0y, Trigel c\u00f3 ph\u1ed1i h\u1ee3p th\u00eam ch\u1ea5t l\u00e0m gi\u1ea3m \u0111au, Phosphalugel \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y d\u01b0\u1edbi d\u1ea1ng gel n\u00ean c\u00f3 t\u00ednh ch\u1ea5t b\u0103ng ni\u00eam m\u1ea1c v\u00e0 gi\u1eef l\u1ea1i trong d\u1ea1 d\u00e0y l\u00e2u h\u01a1n. Hi\u1ec7n nay tr\u00ean l\u00e2m s\u00e0ng c\u00f3 3 d\u1ea1ng thu\u1ed1c :d\u1ea1ng gel t\u1ed1t nh\u1ea5t, sau \u0111\u1ebfn d\u1ea1ng b\u1ed9t, d\u1ea1ng vi\u00ean n\u00e9n.<\/p>\n

1.2.2. Nh\u00f3m \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 H2<\/strong><\/h3>\n

– C\u00e1c d\u1ea1ng:<\/strong>
\no Cimetidin (Tagamet): 800-1200mg\/24h. Chia 2 l\u1ea7n (u\u1ed1ng v\u00e0o s\u00e1ng s\u1edbm v\u00e0 bu\u1ed5i t\u1ed1i tr\u01b0\u1edbc khi \u0111i ng\u1ee7 \u0111\u1ec3 t\u0103ng h\u1ea5p thu)
\no Ranitidin: Vi\u00ean 150mg: 150mg – 300mg\/24h.
\no Famotidine: 20mg x 2 l\u1ea7n \/ng\u00e0y, t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf HCl m\u1ea1nh h\u01a1n cimetidin 20 l\u1ea7n.
\no Nizatidin: M\u1ea1nh h\u01a1n Cimetidin 5 – 10 l\u1ea7n. Vi\u00ean 150mg: 150mg – 300mg\/24h.
\n+ Th\u1eddi gian t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c k\u00e9o d\u00e0i t\u1eeb 5-7 gi\u1edd.
\n+ Khi s\u1eed d\u1ee5ng b\u1eb1ng \u0111\u01b0\u1eddng u\u1ed1ng, thu\u1ed1c c\u1ea7n \u0111\u1ebfn H+ \u0111\u1ec3 ho\u1ea1t h\u00f3a v\u00ec v\u1eady n\u00ean u\u1ed1ng c\u00e1ch xa nh\u00f3m antacid t\u1eeb 2-3 gi\u1edd.
\nT\u00e1c d\u1ee5ng ph\u1ee5:<\/strong> Gi\u1ea3m tinh tr\u00f9ng, b\u1ea5t l\u1ef1c, n\u1eef h\u00f3a tuy\u1ebfn v\u00fa t\u1ea1m th\u1eddi.<\/p>\n

1.2.3. PPI<\/strong><\/h3>\n

– C\u00e1c d\u1ea1ng:<\/strong><\/h4>\n

o Omeprazole 40mg\/ ng\u00e0y.
\no Dexlansoprazole 30mg\/ ng\u00e0y.
\no Rapeprazole 20mg\/ ng\u00e0y.
\no Pantoprazole 40mg\/ ng\u00e0y.
\no Esomeprazol 40mg\/ ng\u00e0y.
\n– T\u1ea5t c\u1ea3 c\u00e1c thu\u1ed1c d\u00f9ng 1 l\u1ea7n\/ng\u00e0y, tr\u01b0\u1edbc b\u1eefa \u0103n \u0111\u1ea7u ti\u00ean trong ng\u00e0y, b\u1eefa \u0103n n\u00ean c\u00f3 \u0111\u1ea1m \u0111\u1ec3 k\u00edch th\u00edch s\u1ef1 b\u00e0i ti\u1ebft c\u1ee7a t\u1ebf b\u00e0o th\u00e0nh.<\/p>\n

– T\u01b0\u01a1ng t\u00e1c thu\u1ed1c:<\/strong>
\no PPI l\u00e0m gi\u1ea3m kh\u1ea3 n\u0103ng h\u1ea5p thu c\u1ee7a m\u1ed9t s\u1ed1 thu\u1ed1c: B12, S\u1eaft, Canxi, Tyrosin.
\no C\u00e1c thu\u1ed1c kh\u00e1ng \u0111\u00f4ng, Clopidogrel n\u00ean d\u00f9ng c\u00e1c thu\u1ed1c n\u00e0y c\u00e1ch kho\u1ea3ng 12 gi\u1edd.
\no C\u00e1c Sucrafate v\u00e0 Antacid n\u00ean d\u00f9ng PPI c\u00e1ch c\u00e1c thu\u1ed1c k\u1ec3 tr\u00ean kho\u1ea3ng 1 gi\u1edd.<\/p>\n

1.2.4. B\u1ea3o v\u1ec7 ni\u00eam m\u1ea1c:<\/strong><\/h3>\n

– Misoprostol 200-400mcg x 4 l\u1ea7n\/ ng\u00e0y
\no T\u0103ng t\u01b0\u1edbi m\u00e1u ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y, t\u0103ng ti\u1ebft h\u1ec7 Mucin, t\u0103ng k\u00edch th\u00edch m\u00f4 h\u1ea1t v\u00e0 m\u00f4 s\u1ee3i do \u0111\u00f3 mau l\u00e0nh \u1ed5 lo\u00e9t.
\n– Nh\u00f3m Sucralfate: 1g x 4 l\u1ea7n\/ ng\u00e0y, u\u1ed1ng l\u00fac b\u1ee5ng \u0111\u00f3i, k\u00e9o d\u00e0i trong 6-8 tu\u1ea7n.
\n– Bismuth: vi\u00ean 120mg, 2vi\u00ean x 2 l\u1ea7n \/ng\u00e0y. Thu\u1ed1c c\u1ea7n H+ \u0111\u1ec3 t\u00e1c d\u1ee5ng n\u00ean ph\u1ea3i u\u1ed1ng l\u00fac \u0111\u00f3i.<\/p>\n

1.2.5. Di\u1ec7t HP:<\/strong><\/h3>\n

– Ch\u1ec9 \u0111\u1ecbnh:<\/strong><\/h4>\n

o Lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng.
\no U MALT lymphoma.
\no Vi\u00eam d\u1ea1 d\u00e0y m\u1ea1n teo.
\no Sau ph\u1eabu thu\u1eadt ung th\u01b0 d\u1ea1 d\u00e0y giai \u0111o\u1ea1n s\u1edbm.
\no C\u00f3 quan h\u1ec7 huy\u1ebft th\u1ed1ng v\u1edbi b\u1ec7nh nh\u00e2n ung th\u01b0 d\u1ea1 d\u00e0y (cha, m\u1eb9, con c\u00e1i, anh, ch\u1ecb em ru\u1ed9t c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh).
\no Kh\u00f3 ti\u00eau ch\u1ee9c n\u0103ng.
\no Theo y\u00eau c\u1ea7u b\u1ec7nh nh\u00e2n (sau khi \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ea7y thu\u1ed1c th\u1ea3o lu\u1eadn v\u00e0 t\u01b0 v\u1ea5n k\u1ef9).
\no B\u1ec7nh tr\u00e0o ng\u01b0\u1ee3c d\u1ea1 d\u00e0y \u2013 th\u1ef1c qu\u1ea3n c\u1ea7n \u0111i\u1ec1u tr\u1ecb v\u1edbi PPI l\u00e2u d\u00e0i.
\no Nguy c\u01a1 lo\u00e9t v\u00e0 ch\u1ea3y m\u00e1u do lo\u00e9t \u1edf b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb v\u1edbi ASA v\u00e0 NSAID.
\no Thi\u1ebfu m\u00e1u thi\u1ebfu s\u1eaft kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n.
\no Ban xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u v\u00f4 c\u0103n.<\/p>\n

\u2666 \u0110i\u1ec1u tr\u1ecb l\u1ea7n \u0111\u1ea7u ti\u00ean:<\/h3>\n

Ph\u00e1c \u0111\u1ed3 3 thu\u1ed1c d\u1ef1a tr\u00ean PPI chu\u1ea9n trong 14 ng\u00e0y<\/strong>
\n– PPI + Amoxicilline + Clarithromycine.
\n– PPI + Metronidazole + Clarithromycine.
\n– PPI + Amoxicilline + Metronidazole.<\/p>\n

\u2666 C\u00f3 th\u1ec3 d\u00f9ng l\u1ea7n \u0111\u1ea7u ti\u00ean :<\/h3>\n

– Ph\u00e1c \u0111\u1ed3 4 thu\u1ed1c c\u00f3 Bismuth (PPI-BTM):<\/strong> 14 ng\u00e0y. Th\u01b0\u1eddng d\u00f9ng cho b\u1ec7nh nh\u00e2n d\u1ecb \u1ee9ng v\u1edbi peniciclline.
\nPPI + Bismuth + Tetracycline + Metronidazole (ho\u1eb7c Tinidazole).<\/p>\n

– Ho\u1eb7c ph\u00e1c \u0111\u1ed3 4 thu\u1ed1c kh\u00f4ng c\u00f3 Bismuth (PPI – ACM\/T): 10 ng\u00e0y
\nPPI + Amoxicilline + Clarithromycine + Metronidazole\/ Tinidazole.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb theo th\u1ee9 t\u1ef1 g\u1ed3m 2 pha:<\/strong>
\no Pha d\u1eabn nh\u1eadp (5 ng\u00e0y): PPI + Amoxicilline.
\no Pha di\u1ec7t khu\u1ea9n (5 ng\u00e0y): PPI + clarithromycine + tinidazole.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb n\u1ed1i ti\u1ebfp g\u1ed3m 2 pha:<\/strong>
\no PPI + Amoxicilline (7 ng\u00e0y).
\no PPI + Clarithromycine + Metronidazole (7 ng\u00e0y).<\/p>\n

\u2666 N\u1ebfu ph\u00e1c \u0111\u1ed3 l\u1ea7n \u0111\u1ea7u th\u1ea5t b\u1ea1i: c\u00f3 th\u1ec3 d\u00f9ng ph\u00e1c \u0111\u1ed3 l\u1ea7n th\u1ee9 2 nh\u01b0 sau:<\/strong><\/h3>\n

– D\u00f9ng ph\u00e1c \u0111\u1ed3 4 thu\u1ed1c c\u00f3 Bismuth, n\u1ebfu tr\u01b0\u1edbc \u0111\u00f3 ch\u01b0a d\u00f9ng ph\u00e1c \u0111\u1ed3 n\u00e0y
\n– D\u00f9ng ph\u00e1c \u0111\u1ed3 3 thu\u1ed1c ho\u1eb7c 4 thu\u1ed1c c\u00f3 Fluoroquinolone 14 ng\u00e0y (n\u1ebfu tr\u01b0\u1edbc \u0111\u00f3 d\u00f9ng ph\u00e1c \u0111\u1ed3 4 thu\u1ed1c c\u00f3 Bismuth th\u1ea5t b\u1ea1i):
\no PPI + Amoxicillin + levofloxacin.
\no PPI + Levofloxacin + Bismuth + Amoxicillin ( ho\u1eb7c Tetracycline ).
\nLi\u1ec1u Levofloxacin: 250-500mg x 2 l\u1ea7n\/ng\u00e0y.<\/p>\n

– Hi\u1ec7n \u1edf Vi\u1ec7t Nam t\u00ecnh h\u00ecnh lao kh\u00e1ng thu\u1ed1c c\u00f2n ph\u1ee9c t\u1ea1p, n\u00ean ch\u01b0a khuy\u1ebfn c\u00e1o d\u00f9ng ph\u00e1c \u0111\u1ed3 c\u00f3 Rifabutin.<\/p>\n

\u2666 Ph\u00e1c \u0111\u1ed3 c\u1ee9u v\u00e3n \u0111\u1ec3 di\u1ec7t Hp:<\/h3>\n

– Khi di\u1ec7t tr\u1eeb HP v\u1eabn th\u1ea5t b\u1ea1i sau 2 l\u1ea7n \u0111i\u1ec1u tr\u1ecb:<\/strong> N\u00ean nu\u00f4i c\u1ea5y v\u00e0 l\u00e0m kh\u00e1ng sinh \u0111\u1ed3 \u0111\u1ec3 ch\u1ecdn kh\u00e1ng sinh ph\u00f9 h\u1ee3p. Kh\u00f4ng ung l\u1ea1i kh\u00e1ng sinh \u0111\u00e3 ung trong ph\u00e1c \u0111\u1ed3 tr\u01b0\u1edbc \u0111\u00f3 b\u1ecb th\u1ea5t b\u1ea1i \u0111\u1eb7c bi\u1ec7t l\u00e0 Clarithromycin (tr\u1eeb Amoxicilline c\u00f3 th\u1ec3 ung l\u1ea1i), v\u00ec t\u1ef7 l\u1ec7 kh\u00e1ng thu\u1ed1c r\u1ea5t cao.<\/p>\n

– Li\u1ec1u PPI s\u1eed d\u1ee5ng trong c\u00e1c ph\u00e1c \u0111\u1ed3 ti\u1ec7t tr\u1eeb :<\/strong>
\no Omeprazole 40 mg
\no Lansoprazole 30 mg
\no Pantoprazole 40 mg
\no Rabeprazole 20 mg
\no Esomeprazole 40 mg
\nT\u1ea5t c\u1ea3 \u0111\u1ec1u d\u00f9ng 2 l\u1ea7n\/ng\u00e0y<\/p>\n\n\n\n\n\n\n\n\n
THU\u1ed0C<\/strong><\/td>\nNG\u01af\u1edcI L\u1edaN<\/strong><\/td>\nTR\u1eba EM<\/strong><\/td>\n<\/tr>\n
Amoxicillin <\/strong><\/td>\n1000 mg x 2 l\u1ea7n \/ ng\u00e0y<\/p>\n

 <\/td>\n

50 mg \/ kg \/ ng\u00e0y<\/p>\n

 <\/td>\n<\/tr>\n

Clarithromycine <\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

500 mg x 2 l\u1ea7n \/ ng\u00e0y<\/p>\n

 <\/td>\n

15 mg \/ kg \/ ng\u00e0y<\/p>\n

 <\/td>\n<\/tr>\n

Metronidazole <\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

500 mg x 2 l\u1ea7n \/ ng\u00e0y<\/p>\n

 <\/td>\n

15 mg \/ kg \/ ng\u00e0y<\/p>\n

 <\/td>\n<\/tr>\n

Tinidazole <\/strong><\/p>\n

Tetracycline <\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

500 mg x 2 l\u1ea7n \/ ng\u00e0y<\/p>\n

500 mg x 4 l\u1ea7n \/ ng\u00e0y<\/p>\n

 <\/td>\n

15 mg \/ kg \/ ng\u00e0y<\/p>\n

Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/p>\n

 <\/td>\n<\/tr>\n

Colloidal Bismuth subcitrate <\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

120 mg x 4 l\u1ea7n \/ ng\u00e0y<\/p>\n

 <\/td>\n

0.1 -0.2g\/ tu\u1ed5i\/ ng\u00e0y.<\/p>\n

Chia l\u00e0m 4 l\u1ea7n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

2. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb<\/strong><\/h2>\n

2.1. Lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng do H. Pylori :<\/strong><\/h3>\n

– Lo\u00e9t t\u00e1 tr\u00e0ng do H.Pylori kh\u00f4ng bi\u1ebfn ch\u1ee9ng: \u0111i\u1ec1u tr\u1ecb ph\u00e1c \u0111\u1ed3 PPI k\u1ebft h\u1ee3p kh\u00e1ng sinh, \u0111i\u1ec1u tr\u1ecb trong 4 tu\u1ea7n v\u00e0 kh\u00f4ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb th\u00eam n\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f2n tri\u1ec7u ch\u1ee9ng.
\n– Lo\u00e9t t\u00e1 tr\u00e0ng c\u00f3 bi\u1ebfn ch\u1ee9ng: t\u1ed5ng th\u1eddi gian \u0111i\u1ec1u tr\u1ecb t\u1eeb 4-8 tu\u1ea7n.
\n– Lo\u00e9t d\u1ea1 d\u00e0y: t\u1ed5ng th\u1eddi gian \u0111i\u1ec1u tr\u1ecb t\u1eeb 8 \u2013 12 tu\u1ea7n.<\/p>\n

2.2. Lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng do NSAID :<\/strong><\/h3>\n

– \u0110i\u1ec1u tr\u1ecb PPI \u00edt nh\u1ea5t 8 tu\u1ea7n.
\n– N\u1ebfu b\u1ec7nh nh\u00e2n sau \u0111\u00f3 v\u1eabn c\u1ea7n ti\u1ebfp t\u1ee5c d\u00f9ng NSAID ho\u1eb7c Aspirin: c\u1ea7n duy tr\u00ec ti\u1ebfp t\u1ee5c PPI.<\/p>\n

2.3. Lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng kh\u00f4ng do NSAID v\u00e0 H. Pylori :<\/strong><\/h3>\n

– \u0110i\u1ec1u tr\u1ecb PPI 4-8 tu\u1ea7n t\u00f9y thu\u1ed9c v\u00e0o v\u1ecb tr\u00ed lo\u00e9t \u1edf d\u1ea1 d\u00e0y hay t\u00e1 tr\u00e0ng v\u00e0 c\u00f3 bi\u1ebfn ch\u1ee9ng hay kh\u00f4ng.
\n– C\u1ea7n ti\u1ebfp t\u1ee5c xem x\u00e9t k\u0129 l\u01b0\u1ee1ng l\u1ea1i ch\u1ea9n \u0111o\u00e1n H.Pylori v\u00e0 t\u00ecnh tr\u1ea1ng s\u1eed d\u1ee5ng NSAID.
\n– Trong tr\u01b0\u1eddng h\u1ee3p \u0111\u00e3 lo\u1ea1i tr\u1eeb ch\u1eafc ch\u1eafn 2 nguy\u00ean nh\u00e2n n\u00e0y, c\u1ea7n \u0111i\u1ec1u tr\u1ecb duy tr\u00ec PPI v\u00ec lo\u00e9t kh\u00f3 l\u00e0nh v\u00e0 nguy c\u01a1 t\u00e1i ph\u00e1t cao h\u01a1n lo\u00e9t do 2 nguy\u00ean nh\u00e2n n\u00eau tr\u00ean.<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o:\u00a0<\/strong><\/p>\n

    \n
  • Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb lo\u00e9t d\u1ea1 d\u00e0y – t\u00e1 tr\u00e0ng c\u1ee7a B\u1ed9 Y T\u1ebf<\/li>\n
  • B\u00e0i gi\u1ea3ng Lo\u00e9t d\u1ea1 d\u00e0y – t\u00e1 tr\u00e0ng n\u1ed9i ti\u00eau ho\u00e1 tr\u01b0\u1eddng \u0110\u1ea1i h\u1ecdc T\u00e2y Nguy\u00ean 2020<\/li>\n
  • S\u00e1ch l\u00e2m s\u00e0ng n\u1ed9i ti\u00eau ho\u00e1 \u0110H Y khoa Ph\u1ea1m Ng\u1ecdc Th\u1ea1ch<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"

    Lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng l\u00e0 m\u1ed9t c\u0103n b\u1ec7nh th\u01b0\u1eddng g\u1eb7p v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi. Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng l\u00e0 m\u1ed9t qu\u00e1 tr\u00ecnh d\u00e0i v\u00e0 \u0111\u00f2i h\u1ecfi s\u1ef1 ki\u00ean tr\u00ec c\u1ee7a b\u1ec7nh nh\u00e2n. Tuy nhi\u00ean, n\u1ebfu \u0111\u01b0\u1ee3c […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[5,33],"tags":[],"yoast_head":"\n\u0110i\u1ec1u tr\u1ecb lo\u00e9t d\u1ea1 d\u00e0y - t\u00e1 tr\u00e0ng - Vinmec<\/title>\n<meta name=\"description\" content=\"Lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng l\u00e0 m\u1ed9t c\u0103n b\u1ec7nh th\u01b0\u1eddng g\u1eb7p v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"\u0110i\u1ec1u tr\u1ecb lo\u00e9t d\u1ea1 d\u00e0y - t\u00e1 tr\u00e0ng - Vinmec\" \/>\n<meta property=\"og:description\" content=\"Lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng l\u00e0 m\u1ed9t c\u0103n b\u1ec7nh th\u01b0\u1eddng g\u1eb7p v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/dieu-tri-loet-da-day-ta-trang\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-13T05:32:12+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-04-21T17:13:56+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/i.imgur.com\/UqiAoHt.png\" \/>\n<meta name=\"author\" content=\"Nguy\u1ec5n H\u00f9ng Nh\u1eadt Duy\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Nguy\u1ec5n H\u00f9ng Nh\u1eadt Duy\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"7 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/dieu-tri-loet-da-day-ta-trang\/\",\"url\":\"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/dieu-tri-loet-da-day-ta-trang\/\",\"name\":\"\u0110i\u1ec1u tr\u1ecb lo\u00e9t d\u1ea1 d\u00e0y - t\u00e1 tr\u00e0ng - Vinmec\",\"isPartOf\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-04-13T05:32:12+00:00\",\"dateModified\":\"2023-04-21T17:13:56+00:00\",\"author\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/93244bcbae85b37711d0dde67f41b5f6\"},\"description\":\"Lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng l\u00e0 m\u1ed9t c\u0103n b\u1ec7nh th\u01b0\u1eddng g\u1eb7p v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi.\",\"breadcrumb\":{\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/dieu-tri-loet-da-day-ta-trang\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/dieu-tri-loet-da-day-ta-trang\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/dieu-tri-loet-da-day-ta-trang\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"http:\/\/noithathoaphat.in\/ctv\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"\u0110i\u1ec1u tr\u1ecb lo\u00e9t d\u1ea1 d\u00e0y – t\u00e1 tr\u00e0ng\"}]},{\"@type\":\"WebSite\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/\",\"name\":\"Vinmec\",\"description\":\"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"http:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/93244bcbae85b37711d0dde67f41b5f6\",\"name\":\"Nguy\u1ec5n H\u00f9ng Nh\u1eadt Duy\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/\",\"url\":\"http:\/\/1.gravatar.com\/avatar\/1b748902abde9a821c917fe33912a06a?s=96&d=mm&r=g\",\"contentUrl\":\"http:\/\/1.gravatar.com\/avatar\/1b748902abde9a821c917fe33912a06a?s=96&d=mm&r=g\",\"caption\":\"Nguy\u1ec5n H\u00f9ng Nh\u1eadt Duy\"},\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/phamvanhoa1612gmail-com\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"\u0110i\u1ec1u tr\u1ecb lo\u00e9t d\u1ea1 d\u00e0y - t\u00e1 tr\u00e0ng - Vinmec","description":"Lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng l\u00e0 m\u1ed9t c\u0103n b\u1ec7nh th\u01b0\u1eddng g\u1eb7p v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi.","robots":{"index":"noindex","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"og_locale":"en_US","og_type":"article","og_title":"\u0110i\u1ec1u tr\u1ecb lo\u00e9t d\u1ea1 d\u00e0y - t\u00e1 tr\u00e0ng - Vinmec","og_description":"Lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng l\u00e0 m\u1ed9t c\u0103n b\u1ec7nh th\u01b0\u1eddng g\u1eb7p v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi.","og_url":"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/dieu-tri-loet-da-day-ta-trang\/","og_site_name":"Vinmec","article_published_time":"2023-04-13T05:32:12+00:00","article_modified_time":"2023-04-21T17:13:56+00:00","og_image":[{"url":"https:\/\/i.imgur.com\/UqiAoHt.png"}],"author":"Nguy\u1ec5n H\u00f9ng Nh\u1eadt Duy","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Nguy\u1ec5n H\u00f9ng Nh\u1eadt Duy","Est. reading time":"7 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/dieu-tri-loet-da-day-ta-trang\/","url":"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/dieu-tri-loet-da-day-ta-trang\/","name":"\u0110i\u1ec1u tr\u1ecb lo\u00e9t d\u1ea1 d\u00e0y - t\u00e1 tr\u00e0ng - Vinmec","isPartOf":{"@id":"http:\/\/noithathoaphat.in\/ctv\/#website"},"datePublished":"2023-04-13T05:32:12+00:00","dateModified":"2023-04-21T17:13:56+00:00","author":{"@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/93244bcbae85b37711d0dde67f41b5f6"},"description":"Lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng l\u00e0 m\u1ed9t c\u0103n b\u1ec7nh th\u01b0\u1eddng g\u1eb7p v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi.","breadcrumb":{"@id":"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/dieu-tri-loet-da-day-ta-trang\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/dieu-tri-loet-da-day-ta-trang\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/dieu-tri-loet-da-day-ta-trang\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"http:\/\/noithathoaphat.in\/ctv\/"},{"@type":"ListItem","position":2,"name":"\u0110i\u1ec1u tr\u1ecb lo\u00e9t d\u1ea1 d\u00e0y – t\u00e1 tr\u00e0ng"}]},{"@type":"WebSite","@id":"http:\/\/noithathoaphat.in\/ctv\/#website","url":"http:\/\/noithathoaphat.in\/ctv\/","name":"Vinmec","description":"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"http:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/93244bcbae85b37711d0dde67f41b5f6","name":"Nguy\u1ec5n H\u00f9ng Nh\u1eadt Duy","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/","url":"http:\/\/1.gravatar.com\/avatar\/1b748902abde9a821c917fe33912a06a?s=96&d=mm&r=g","contentUrl":"http:\/\/1.gravatar.com\/avatar\/1b748902abde9a821c917fe33912a06a?s=96&d=mm&r=g","caption":"Nguy\u1ec5n H\u00f9ng Nh\u1eadt Duy"},"url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/phamvanhoa1612gmail-com\/"}]}},"_links":{"self":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/19654"}],"collection":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/comments?post=19654"}],"version-history":[{"count":6,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/19654\/revisions"}],"predecessor-version":[{"id":26328,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/19654\/revisions\/26328"}],"wp:attachment":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/media?parent=19654"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/categories?post=19654"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/tags?post=19654"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}