{"id":20477,"date":"2023-04-14T20:21:56","date_gmt":"2023-04-14T13:21:56","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=20477"},"modified":"2023-04-17T15:47:06","modified_gmt":"2023-04-17T08:47:06","slug":"viem-cot-song-dinh-khop-huong-dan-dieu-tri-theo-bo-y-te","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/viem-cot-song-dinh-khop-huong-dan-dieu-tri-theo-bo-y-te\/","title":{"rendered":"Vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp: h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb theo B\u1ed9 Y t\u1ebf"},"content":{"rendered":"
\n

Vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd h\u1ec7 th\u1ed1ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn kh\u1edbp v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n, c\u00e1c tri\u1ec7u ch\u1ee9ng tim v\u00e0 vi\u00eam m\u00e0ng b\u1ed3 \u0111\u00e0o. Bi\u1ec3u hi\u1ec7n ban \u0111\u1ea7u th\u01b0\u1eddng l\u00e0 \u0111au l\u01b0ng ki\u1ec3u vi\u00eam v\u00e0 c\u1ee9ng l\u01b0ng \u0111\u00f4i khi c\u00f9ng v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u1edbp ngo\u1ea1i vi v\u00e0\/ho\u1eb7c vi\u00eam m\u00e0ng b\u1ed3 \u0111\u00e0o tr\u01b0\u1edbc. D\u01b0\u1edbi \u0111\u00e2y l\u00e0 h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp theo khuy\u1ebfn c\u00e1o c\u1ee7a ASAS\/EULAR 2011 (H\u1ed9i \u0111\u00e1nh gi\u00e1 vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp qu\u1ed1c t\u1ebf\/H\u1ed9i kh\u1edbp h\u1ecdc ch\u00e2u \u00c2u)<\/strong><\/p>\n

Ch\u1ea9n \u0111o\u00e1n vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp d\u1ef1a tr\u00ean c\u00e1c k\u1ebft qu\u1ea3 ch\u1ee5p phim c\u1ed9t s\u1ed1ng th\u1eaft l\u01b0ng, ch\u1ee5p kh\u1edbp c\u00f9ng ch\u1eadu, MRI kh\u1edbp c\u00f9ng ch\u1eadu, x\u00e9t nghi\u1ec7m m\u00e1u (t\u1ed1c \u0111\u1ed9 m\u00e1u l\u1eafng, CRP, kh\u00e1ng nguy\u00ean b\u1ea1ch c\u1ea7u ng\u01b0\u1eddi B27 [HLA-B27], v\u00e0 c\u00f4ng th\u1ee9c m\u00e1u) v\u00e0\/ho\u1eb7c c\u00e1c ti\u00eau chu\u1ea9n l\u00e2m s\u00e0ng r\u00f5 r\u00e0ng.<\/p>\n<\/div>\n

1. Nguy\u00ean t\u1eafc chung:<\/h2>\n

Bao g\u1ed3m \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa, v\u1eadt l\u00fd tr\u1ecb li\u1ec7u v\u00e0 ngo\u1ea1i khoa.<\/p>\n

M\u1ee5c \u0111\u00edch \u0111i\u1ec1u tr\u1ecb: ch\u1ed1ng vi\u00eam, ch\u1ed1ng \u0111au; ph\u00f2ng ch\u1ed1ng c\u1ee9ng kh\u1edbp, \u0111\u1eb7c bi\u1ec7t l\u00e0 ph\u00f2ng ch\u1ed1ng c\u1ee9ng kh\u1edbp \u1edf t\u01b0 th\u1ebf x\u1ea5u v\u00e0 kh\u1eafc ph\u1ee5c d\u00ednh kh\u1edbp (n\u1ebfu c\u00f3).<\/p>\n

4.2. L\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb<\/h3>\n

Tr\u00ean m\u1ed7i b\u1ec7nh nh\u00e2n c\u1ee5 th\u1ec3, quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb d\u1ef1a v\u00e0o c\u00e1c th\u00f4ng s\u1ed1 sau:<\/p>\n

\u2212 T\u00ecnh tr\u1ea1ng b\u1ec7nh, m\u1ee9c \u0111\u1ed9 ho\u1ea1t \u0111\u1ed9ng b\u1ec7nh, tri\u1ec7u ch\u1ee9ng ti\u00ean l\u01b0\u1ee3ng.<\/p>\n

\u2212 Bi\u1ec3u hi\u1ec7n hi\u1ec7n t\u1ea1i c\u1ee7a b\u1ec7nh (c\u1ed9t s\u1ed1ng, kh\u1edbp ngo\u1ea1i bi\u00ean, \u0111i\u1ec3m b\u00e1m g\u00e2n…).<\/p>\n

\u2212 Bi\u1ec3u hi\u1ec7n ngo\u00e0i kh\u1edbp v\u00e0 b\u1ec7nh k\u00e8m theo: c\u00f3 th\u1ec3 c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n ngo\u00e0i kh\u1edbp nh\u01b0 v\u1ea9y n\u1ebfn, vi\u00eam m\u00e0ng b\u1ed3 \u0111\u00e0o v\u00e0 vi\u00eam ru\u1ed9t m\u1ea1n t\u00ednh. \u0110\u1eb7c bi\u1ec7t v\u1edbi vi\u00eam m\u00e0ng b\u1ed3 \u0111\u00e0o c\u1ea7n kh\u00e1m chuy\u00ean khoa m\u1eaft nh\u1eb1m \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng k\u1ebft h\u1ee3p.<\/p>\n

\u2212 Tr\u1ea1ng th\u00e1i l\u00e2m s\u00e0ng chung (tu\u1ed5i, gi\u1edbi, b\u1ec7nh k\u00e8m theo, thu\u1ed1c k\u00e8m theo, y\u1ebfu t\u1ed1 t\u00e2m l\u00fd). C\u0169ng c\u1ea7n l\u01b0u \u00fd \u0111\u1ebfn c\u00e1c nguy c\u01a1 b\u1ec7nh lo\u00e3ng x\u01b0\u01a1ng, b\u1ec7nh tim m\u1ea1ch \u1edf b\u1ec7nh nh\u00e2n vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp nh\u1eb1m ph\u00e1t hi\u1ec7n, theo d\u00f5i v\u00e0 d\u1ef1 ph\u00f2ng.<\/p>\n

4.3. \u0110i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3 vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp<\/h3>\n

Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb theo khuy\u1ebfn c\u00e1o c\u1ee7a ASAS\/EULAR 2011 (ASAS\/EULAR- Assessment in Ankylosing Spondylitis International Society\/European League against Rheumatism – H\u1ed9i \u0111\u00e1nh gi\u00e1 vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp qu\u1ed1c t\u1ebf\/H\u1ed9i kh\u1edbp h\u1ecdc ch\u00e2u \u00c2u), \u00e1p d\u1ee5ng v\u00e0o \u0111i\u1ec1u ki\u1ec7n Vi\u1ec7t Nam, \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft b\u1edfi s\u01a1 \u0111\u1ed3 v\u00e0 m\u1ed9t s\u1ed1 l\u01b0u \u00fd d\u01b0\u1edbi \u0111\u00e2y.<\/p>\n

\"viem-cot-song-dinh-khop\"
Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb theo khuy\u1ebfn c\u00e1o c\u1ee7a ASAS\/EULAR 2011<\/figcaption><\/figure>\n

\u2212 \u0110i\u1ec1u tr\u1ecb kh\u00f4ng d\u00f9ng thu\u1ed1c:<\/strong><\/em> \u0110i\u1ec1u r\u1ea5t quan tr\u1ecdng l\u00e0 b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c gi\u00e1o d\u1ee5c nh\u1eb1m hi\u1ec3u bi\u1ebft v\u1ec1 b\u1ec7nh v\u00e0 th\u1ef1c hi\u1ec7n ch\u1ebf \u0111\u1ed9 luy\u1ec7n t\u1eadp ph\u00f9 h\u1ee3p v\u00e0 \u0111\u1ec1u \u0111\u1eb7n. C\u00f3 th\u1ec3 luy\u1ec7n t\u1eadp c\u00f3 hi\u1ec7u qu\u1ea3 t\u1ea1i nh\u00e0 ho\u1eb7c \u0111i\u1ec1u tr\u1ecb v\u1eadt l\u00fd, c\u00f3 s\u1ef1 gi\u00e1m s\u00e1t v\u1ec1 m\u1ee9c \u0111\u1ed9 luy\u1ec7n t\u1eadp. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 t\u1ef1 t\u1eadp m\u1ed9t m\u00ecnh ho\u1eb7c t\u1eadp h\u1ee3p theo nh\u00f3m.<\/p>\n

\u2212 Thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid:<\/strong> <\/em>Thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid l\u00e0 l\u1ef1a ch\u1ecdn \u0111\u1ea7u ti\u00ean ch\u1ec9 \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp c\u00f3 \u0111au v\u00e0\/ho\u1eb7c c\u1ee9ng kh\u1edbp. C\u00f3 th\u1ec3 s\u1eed d\u1ee5ng trong th\u1eddi gian d\u00e0i n\u1ebfu t\u00ecnh tr\u1ea1ng vi\u00eam k\u00e9o d\u00e0i. C\u1ea7n ch\u00fa \u00fd \u0111\u1ebfn c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n tr\u00ean tim m\u1ea1ch, d\u1ea1 d\u00e0y, th\u1eadn \u1edf b\u1ec7nh nh\u00e2n khi \u0111i\u1ec1u tr\u1ecb thu\u1ed1c b\u1eb1ng ch\u1ed1ng vi\u00eam kh\u00f4ng steroide.<\/p>\n

C\u00f3 th\u1ec3 s\u1eed d\u1ee5ng m\u1ed9t trong c\u00e1c lo\u1ea1i sau: celecoxib 200 – 400mg \/ ng\u00e0y- duy tr\u00ec li\u1ec1u 200 mg h\u00e0ng ng\u00e0y; meloxicam 7,5- 15 mg \/ ng\u00e0y; diclofenac 75 mg \/ ng\u00e0y; etoricoxib 60 -90 mg \/ ng\u00e0y.<\/p>\n

\u2212 Thu\u1ed1c gi\u1ea3m \u0111au:<\/strong><\/em> N\u00ean ph\u1ed1i h\u1ee3p thu\u1ed1c gi\u1ea3m \u0111au (paracetamol, c\u00e1c d\u1ea1ng k\u1ebft h\u1ee3p) theo s\u01a1 \u0111\u1ed3 s\u1eed d\u1ee5ng thu\u1ed1c gi\u1ea3m \u0111au c\u1ee7a WHO.<\/p>\n

\u2212 Thu\u1ed1c gi\u00e3n c\u01a1:<\/em> <\/strong>eperisone (50mg x 3 l\u1ea7n\/ ng\u00e0y), thiocolchicoside (4mg x 3 l\u1ea7n\/ ng\u00e0y)<\/p>\n

\u2212 Glucocorticoids:<\/strong> <\/em>Ti\u00eam corticosteroids t\u1ea1i ch\u1ed7: ch\u1ec9 \u0111\u1ecbnh v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam c\u00e1c \u0111i\u1ec3m b\u00e1m g\u00e2n ho\u1eb7c c\u00e1c kh\u1edbp ngo\u1ea1i bi\u00ean c\u00f3 t\u00ecnh tr\u1ea1ng vi\u00eam k\u00e9o d\u00e0i. N\u1ebfu l\u00e0 kh\u1edbp h\u00e1ng, n\u00ean ti\u00eam d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a si\u00eau \u00e2m. Kh\u00f4ng khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb corticosteroid to\u00e0n th\u00e2n.<\/strong><\/p>\n

\u2212 Thu\u1ed1c th\u1ea5p kh\u1edbp l\u00e0m bi\u1ebfn \u0111\u1ed5i b\u1ec7nh-DMARD:<\/strong> <\/em>Thu\u1ed1c DMARD nh\u01b0 sulfasalazine, methotrexat kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n th\u1ec3 c\u1ed9t s\u1ed1ng \u0111\u01a1n thu\u1ea7n.<\/p>\n

Sulfasalazine: <\/strong>ch\u1ec9 \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n vi\u00eam kh\u1edbp ngo\u1ea1i bi\u00ean. Li\u1ec1u kh\u1edfi \u0111\u1ea7u 500 mg x 2 vi\u00ean m\u1ed7i ng\u00e0y, t\u0103ng d\u1ea7n li\u1ec1u d\u1ef1a v\u00e0o \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh, th\u01b0\u1eddng duy tr\u00ec 2.000 mg chia 2 l\u1ea7n, h\u00e0ng ng\u00e0y, u\u1ed1ng sau b\u1eefa \u0103n.<\/p>\n

\u2212 \u0110i\u1ec1u tr\u1ecb b\u1eb1ng ch\u1ebf ph\u1ea9m sinh h\u1ecdc:<\/strong> kh\u00e1ng TNF\u03b1<\/p>\n

+ \u0110i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng TNF: theo khuy\u1ebfn c\u00e1o c\u1ee7a ASAS – H\u1ed9i \u0111\u00e1nh gi\u00e1 vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp qu\u1ed1c t\u1ebf, ch\u1ec9 \u0111\u1ecbnh thu\u1ed1c kh\u00e1ng TNF cho c\u00e1c th\u1ec3 b\u1ec7nh ho\u1ea1t \u0111\u1ed9ng dai d\u1eb3ng, m\u1eb7c d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng quy. C\u1ea7n tu\u00e2n theo quy tr\u00ecnh ch\u1ec9 \u0111\u1ecbnh c\u00e1c thu\u1ed1c sinh h\u1ecdc.<\/p>\n

+ B\u1ec7nh nh\u00e2n vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp th\u1ec3 c\u1ed9t s\u1ed1ng: \u0110i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng TNF k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid, kh\u00f4ng k\u1ebft h\u1ee3p v\u1edbi nh\u00f3m DMARD kinh \u0111i\u1ec3n (Sulfasalazine, Methotrexate). C\u00f3 th\u1ec3 chuy\u1ec3n sang kh\u00e1ng TNF th\u1ee9 hai n\u1ebfu b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi kh\u00e1ng TNF ban \u0111\u1ea7u. Etanercept 50mg ti\u00eam d\u01b0\u1edbi da tu\u1ea7n m\u1ed9t l\u1ea7n ho\u1eb7c 25mg x2 l\u1ea7n \/tu\u1ea7n (ti\u00eam d\u01b0\u1edbi da). Ho\u1eb7c Infliximab 3-5mg\/kg truy\u1ec1n t\u0129nh m\u1ea1ch m\u1ed7i 4-8 tu\u1ea7n. Adalimumab 40mg ti\u00eam d\u01b0\u1edbi da m\u1ed7i 2 tu\u1ea7n. \u2212 \u0110i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt<\/p>\n

\"thuoc-sinh-hoc-dieu-tri-viem-cot-song-dinh-khop\"
Thu\u1ed1c sinh h\u1ecdc \u0111i\u1ec1u tr\u1ecb vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp<\/figcaption><\/figure>\n

+ Thay kh\u1edbp h\u00e1ng: ch\u1ec9 \u0111\u1ecbnh trong tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n \u0111au k\u00e9o d\u00e0i, h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng v\u00e0 c\u00f3 ph\u00e1 h\u1ee7y c\u1ea5u tr\u00fac r\u00f5 tr\u00ean h\u00ecnh \u1ea3nh X quang. Tr\u01b0\u1edbc kia th\u01b0\u1eddng c\u1ed1 g\u1eafng ch\u1ec9 \u0111\u1ecbnh \u1edf b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i (\u00edt nh\u1ea5t tr\u00ean 50 tu\u1ed5i). G\u1ea7n \u0111\u00e2y tu\u1ed5i kh\u00f4ng c\u00f2n l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 c\u1ea7n quan t\u00e2m khi ch\u1ec9 \u0111\u1ecbnh thay kh\u1edbp h\u00e1ng.<\/p>\n

+ Ph\u1eabu thu\u1eadt ch\u1ec9nh h\u00ecnh \u0111\u1ed1i v\u1edbi c\u1ed9t s\u1ed1ng: ch\u1ec9 \u0111\u1ecbnh khi c\u1ed9t s\u1ed1ng bi\u1ebfn d\u1ea1ng.<\/p>\n

+ \u1ede b\u1ec7nh nh\u00e2n vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp c\u00f3 g\u00e3y \u0111\u1ed1t s\u1ed1ng c\u1ea5p t\u00ednh: x\u00e9t ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt<\/p>\n

Ngu\u1ed3n: B\u1ed9 Y t\u1ebf<\/em><\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd h\u1ec7 th\u1ed1ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn kh\u1edbp v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n, c\u00e1c tri\u1ec7u ch\u1ee9ng tim v\u00e0 vi\u00eam m\u00e0ng b\u1ed3 \u0111\u00e0o. Bi\u1ec3u hi\u1ec7n ban \u0111\u1ea7u th\u01b0\u1eddng l\u00e0 \u0111au l\u01b0ng ki\u1ec3u vi\u00eam v\u00e0 c\u1ee9ng l\u01b0ng \u0111\u00f4i khi c\u00f9ng v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u1edbp […]<\/p>\n","protected":false},"author":10,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[29,33],"tags":[3],"yoast_head":"\nVi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp: h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb theo B\u1ed9 Y t\u1ebf - Vinmec<\/title>\n<meta name=\"description\" content=\"Vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd h\u1ec7 th\u1ed1ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn kh\u1edbp v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n. 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