{"id":20849,"date":"2023-04-14T20:20:24","date_gmt":"2023-04-14T13:20:24","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=20849"},"modified":"2023-04-17T15:49:20","modified_gmt":"2023-04-17T08:49:20","slug":"viem-cot-song-dinh-khop-huong-dan-phuc-hoi-chuc-nang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/viem-cot-song-dinh-khop-huong-dan-phuc-hoi-chuc-nang\/","title":{"rendered":"Vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp: H\u01b0\u1edbng d\u1eabn ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng"},"content":{"rendered":"
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Vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp (VCSDK) la\u0300 m\u1ecd\u0302t b\u1ec7nh vie\u0302m kh\u01a1\u0301p ma\u0323n ti\u0301nh, \u0111\u1ea1\u0306c tr\u01b0ng b\u01a1\u0309i t\u00f4\u0309n th\u01b0o\u031bng ta\u0323i c\u1ecd\u0302t s\u00f4\u0301ng va\u0300 kh\u01a1\u0301p cu\u0300ng ch\u1ea1\u0302u. B\u1eb9\u0302nh ti\u00ea\u0301n tri\u00ea\u0309n ch\u1ea1\u0302m, co\u0301 xu h\u01b0\u01a1\u0301ng di\u0301nh kh\u01a1\u0301p, th\u01b0\u01a1\u0300ng ph\u00f4\u0301i h\u01a1\u0323p v\u01a1\u0301i vie\u0302m ca\u0301c \u0111i\u00ea\u0309m ba\u0301m ga\u0302n. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb chung bao g\u1ed3m \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa, v\u1eadt l\u00fd tr\u1ecb li\u1ec7u v\u00e0 ngo\u1ea1i khoa. D\u01b0\u1edbi \u0111\u00e2y l\u00e0 h\u01b0\u1edbng d\u1eabn kh\u00e1m, l\u01b0\u1ee3ng gi\u00e1 ch\u1ee9c n\u0103ng v\u00e0 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng can thi\u1ec7p v\u00e0o \u0111i\u1ec1u tr\u1ecb.<\/b><\/p>\n

\"Cot-song-binh-thuong-va-cot-song-bi-VCSDK\"
Co\u0323\u0302t so\u0302\u0301ng bi\u0300nh thu\u031bo\u031b\u0300ng va\u0300 co\u0323\u0302t so\u0302\u0301ng bi\u0323 VCSDK<\/figcaption><\/figure>\n
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1.Kha\u0301m va\u0300 l\u01b0\u01a1\u0323ng gia\u0301 ch\u01b0\u0301c na\u0306ng b\u1ec7nh nh\u00e2n vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp<\/h2>\n

– Quan sa\u0301t hi\u0300nh da\u0301ng, \u0111\u1ecd\u0302 ca\u0302n x\u01b0\u0301ng cu\u0309a co\u031b th\u00ea\u0309, da\u0301ng \u0111i \u0111\u00ea\u0309 pha\u0301t hi\u1eb9\u0302n \u0111a\u0301nh gia\u0301 ca\u0301c bi\u00ea\u0301n da\u0323ng gu\u0300, ve\u0323o c\u1ecd\u0302t s\u00f4\u0301ng, ca\u0301c bi\u00ea\u0301n da\u0323ng kh\u01a1\u0301p ha\u0301ng, g\u00f4\u0301i, c\u00f4\u0309 cha\u0302n.<\/p>\n

– \u0110a\u0301nh gia\u0301 \u0111\u1ecd\u0302 da\u0303n c\u1ecd\u0302t s\u00f4\u0301ng th\u0103\u0301t l\u01b0ng (nghi\u1ec7m pha\u0301p Schober) va\u0300 toa\u0300n b\u1ecd\u0302 c\u1ed9t s\u00f4\u0301ng (nghi\u1eb9\u0302m pha\u0301p Stibor), v\u1ea1\u0302n \u0111\u1ed9ng nghie\u0302ng, xoay c\u1ecd\u0302t s\u00f4\u0301ng.<\/p>\n

– Nghi\u1eb9\u0302m pha\u0301p e\u0301p, da\u0303n ca\u0301nh ch\u1ea1\u0302u nh\u0103\u0300m xa\u0301c \u0111i\u0323nh co\u0301 vie\u0302m kh\u01a1\u0301p cu\u0300ng ch\u1ea1\u0302u hay kho\u0302ng.<\/p>\n

– \u0110o \u0111\u1ecd\u0302 gia\u0303n n\u01a1\u0309 l\u00f4\u0300ng ng\u01b0\u0323c, t\u00e2\u0300m v\u1ea1\u0302n \u0111\u1ecd\u0302ng kh\u01a1\u0301p vai, giu\u0301p d\u01b0\u0323 ba\u0301o ch\u01b0\u0301c na\u0306ng ho\u0302 h\u00e2\u0301p<\/p>\n

– \u0110o t\u00e2\u0300m v\u1ea1\u0302n \u0111\u1ecd\u0302ng ca\u0301c kh\u01a1\u0301p ha\u0301ng, g\u00f4\u0301i, c\u00f4\u0309 cha\u0302n n\u00ea\u0301u co\u0301 \u0111au, vie\u0302m.<\/p>\n

– L\u01b0\u01a1\u0323ng gia\u0301 co\u031b l\u01b0\u0323c cu\u0309a ca\u0301c nho\u0301m co\u031b chi d\u01b0\u01a1\u0301i, co\u031b mo\u0302ng.<\/p>\n

– Ca\u0301c tha\u0306m kha\u0301m v\u00ea\u0300 th\u00e2\u0300n kinh: giu\u0301p xa\u0301c \u0111i\u0323nh co\u0301 bi\u00ea\u0309u hi\u1eb9\u0302n che\u0300n e\u0301p tu\u0309y ho\u1ea1\u0306c r\u00ea\u0303, da\u0302y th\u00e2\u0300n kinh hay kho\u0302ng<\/p>\n

+ Pha\u0309n xa\u0323 ga\u0302n g\u00f4\u0301i, go\u0301t cha\u0302n hai be\u0302n<\/p>\n

+ Tha\u0306m kha\u0301m v\u00ea\u0300 ca\u0309m gia\u0301c: pha\u0301t hi\u1eb9\u0302n ca\u0301c r\u00f4\u0301i loa\u0323n m\u00e2\u0301t ho\u1ea1\u0306c gia\u0309m ca\u0309m gia\u0301c, ho\u1ea1\u0306c ca\u0301c di\u0323 ca\u0309m, te\u0302 bi\u0300…<\/p>\n

+ Ch\u01b0\u0301c na\u0306ng v\u1ea1\u0302n \u0111\u1ecd\u0302ng<\/p>\n

+ Ch\u01b0\u0301c na\u0306ng ru\u1ecd\u0302t \/ ba\u0300ng quang.<\/p>\n

– \u0110a\u0301nh gia\u0301 m\u01b0\u0301c \u0111\u1ecd\u0302 \u0111au theo thang \u0111i\u00ea\u0309m NRC, VAS.<\/p>\n

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2. Nguye\u0302n t\u0103\u0301c phu\u0323c h\u00f4\u0300i ch\u01b0\u0301c na\u0306ng va\u0300 \u0111i\u00ea\u0300u tri\u0323 vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp<\/h2>\n

– Ki\u00ea\u0309m soa\u0301t \u0111au va\u0300 vie\u0302m.<\/p>\n

– Duy tri\u0300 t\u00e2\u0300m v\u1ea1\u0302n \u0111\u1ecd\u0302ng kh\u01a1\u0301p va\u0300 c\u1ecd\u0302t s\u00f4\u0301ng, \u0111\u00ea\u0300 pho\u0300ng ca\u0301c th\u01b0o\u031bng t\u1ea1\u0302t th\u01b0\u0301 pha\u0301t nh\u01b0 teo co\u031b, c\u01b0\u0301ng kh\u01a1\u0301p, bi\u00ea\u0301n da\u0323ng kh\u01a1\u0301p, c\u1ecd\u0302t s\u00f4\u0301ng.<\/p>\n

– \u0110a\u0309m ba\u0309o ch\u01b0\u0301c na\u0306ng ho\u0302 h\u00e2\u0301p, tim ma\u0323ch.<\/p>\n

– Duy tri\u0300 va\u0300 ca\u0309i thi\u1eb9\u0302n ca\u0301c ch\u01b0\u0301c na\u0306ng v\u1ea1\u0302n \u0111\u1ecd\u0302ng, di chuy\u00ea\u0309n va\u0300 ca\u0301c hoa\u0323t \u0111\u1ecd\u0302ng sinh hoa\u0323t ha\u0300ng nga\u0300y.<\/p>\n

– Na\u0302ng cao ch\u00e2\u0301t l\u01b0\u01a1\u0323ng cu\u1ecd\u0302c s\u00f4\u0301ng, vui cho\u031bi gia\u0309i tri\u0301, lao \u0111\u1ecd\u0302ng va\u0300 h\u01b0\u01a1\u0301ng nghi\u1eb9\u0302p, ho\u0300a nh\u1ea1\u0302p xa\u0303 h\u1ecd\u0302i cho b\u1eb9\u0302nh nha\u0302n<\/p>\n

2.1 Ca\u0301c ph\u01b0o\u031bng pha\u0301p va\u0300 ky\u0303 thu\u1ea1\u0302t phu\u0323c h\u00f4\u0300i ch\u01b0\u0301c na\u0306ng<\/h3>\n

V\u1ea1\u0302n \u0111\u1ecd\u0302ng gi\u01b0\u0303 m\u1ecd\u0302t vai tro\u0300 r\u00e2\u0301t quan tro\u0323ng trong qua\u0301 tri\u0300nh \u0111i\u00ea\u0300u tri\u0323 nh\u0103\u0300m ha\u0323n ch\u00ea\u0301 teo co\u031b, di\u0301nh kh\u01a1\u0301p, ba\u0309o toa\u0300n va\u0300 duy tri\u0300 ch\u01b0\u0301c na\u0306ng v\u1ea1\u0302n \u0111\u1ecd\u0302ng c\u1ecd\u0302t s\u00f4\u0301ng, ca\u0301c kh\u01a1\u0301p. T\u01b0 v\u00e2\u0301n, gia\u0301o du\u0323c cung c\u00e2\u0301p \u0111\u00e2\u0300y \u0111u\u0309 ca\u0301c tho\u0302ng tin v\u00ea\u0300 b\u1eb9\u0302nh t\u1ea1\u0302t va\u0300 h\u01b0\u01a1\u0301ng d\u00e2\u0303n cho ng\u01b0\u01a1\u0300i b\u1eb9\u0302nh ca\u0301c ba\u0300i t\u1ea1\u0302p v\u1ea1\u0302n \u0111\u1ecd\u0302ng c\u00e2\u0300n thi\u00ea\u0301t cu\u0303ng nh\u01b0 ca\u0301c t\u01b0 th\u00ea\u0301 \u0111u\u0301ng: n\u0103\u0300m ngu\u0309 tre\u0302n n\u00ea\u0300n c\u01b0\u0301ng v\u01a1\u0301i g\u00f4\u0301i mo\u0309ng ho\u1ea1\u0306c kho\u0302ng co\u0301 g\u00f4\u0301i, kho\u0302ng ng\u00f4\u0300i x\u00f4\u0309m, kho\u0302ng mang va\u0301c n\u1ea1\u0306ng. M\u00f4\u0303i giai \u0111oa\u0323n b\u1eb9\u0302nh co\u0301 ca\u0301c bi\u1eb9\u0302n pha\u0301p \u0111i\u00ea\u0300u tri\u0323 va\u0300 t\u1ea1\u0302p luy\u1eb9\u0302n kha\u0301c nhau.<\/p>\n

2.1.1 Giai \u0111oa\u0323n c\u00e2\u0301p ti\u0301nh<\/h4>\n

– Trong giai \u0111oa\u0323n b\u1eb9\u0302nh ti\u00ea\u0301n tri\u00ea\u0309n c\u00e2\u0301p ti\u0301nh: \u0111au, ha\u0323n ch\u00ea\u0301 v\u1ea1\u0302n \u0111\u1ecd\u0302ng c\u1ecd\u0302t s\u00f4\u0301ng nhi\u00ea\u0300u, vie\u0302m ca\u0301c kh\u01a1\u0301p ngoa\u0323i bie\u0302n, ng\u01b0\u01a1\u0300i b\u1eb9\u0302nh pha\u0309i \u0111\u01b0\u01a1\u0323c nghi\u0309 ngo\u031bi, v\u1ea1\u0302n \u0111\u1ecd\u0302ng nhe\u0323 nha\u0300ng, tra\u0301nh ca\u0301c ba\u0300i t\u1ea1\u0302p kh\u01a1\u0301p qua\u0301 n\u1ea1\u0306ng. \u0110\u1ea1\u0306t t\u01b0 th\u00ea\u0301 \u0111u\u0301ng, tra\u0301nh ca\u0301c t\u01b0 th\u00ea\u0301 g\u1ea1\u0302p c\u1ecd\u0302t s\u00f4\u0301ng ho\u1ea1\u0306c ga\u0302y co ru\u0301t ca\u0301c kh\u01a1\u0301p sau na\u0300y. Co\u0301 th\u00ea\u0309 s\u01b0\u0309 du\u0323ng ca\u0301c ne\u0323p chi\u0309nh hi\u0300nh, h\u00f4\u0303 tr\u01a1\u0323 duy tri\u0300 t\u01b0 th\u00ea\u0301 \u0111u\u0301ng cho ca\u0301c kh\u01a1\u0301p.<\/p>\n

\"Viem-cot-song-dinh-khop-anh-huong-den-tu-the-benh-nhan\"
Vie\u0302m co\u0323\u0302t so\u0302\u0301ng di\u0301nh kho\u031b\u0301p a\u0309nh hu\u031bo\u031b\u0309ng \u0111e\u0302\u0301n tu\u031b the\u0302\u0301 be\u0323\u0302nh nha\u0302n<\/figcaption><\/figure>\n

– S\u01b0\u0309 du\u0323ng ca\u0301c ph\u01b0o\u031bng pha\u0301p v\u1ea1\u0302t ly\u0301 tri\u0323 li\u1eb9\u0302u nh\u01b0 nhi\u1eb9\u0302t no\u0301ng nhe\u0323, nhi\u1eb9\u0302t la\u0323nh, \u0111i\u1eb9\u0302n xung gia\u0309m \u0111au, sie\u0302u a\u0302m, thi\u0301ch h\u01a1\u0323p v\u01a1\u0301i vi\u0323 tri\u0301 kh\u01a1\u0301p t\u00f4\u0309n th\u01b0o\u031bng, k\u00ea\u0301t h\u01a1\u0323p thu\u0309y tri\u0323 li\u1eb9\u0302u co\u0301 ta\u0301c du\u0323ng ch\u00f4\u0301ng vie\u0302m, gia\u0309m phu\u0300 n\u00ea\u0300, gia\u0309m \u0111au ta\u0323i ch\u00f4\u0303.<\/p>\n

– V\u1ea1\u0302n \u0111\u1ecd\u0302ng tri\u0323 li\u1eb9\u0302u: Ca\u0301c ky\u0303 thu\u1ea1\u0302t xoa bo\u0301p, di \u0111\u1ecd\u0302ng kh\u01a1\u0301p, di \u0111\u1ecd\u0302ng mo\u0302 m\u00ea\u0300m, ca\u0301c ba\u0300i t\u1ea1\u0302p thu\u0323 \u0111\u1ecd\u0302ng, chu\u0309 \u0111\u1ecd\u0302ng giu\u0301p duy tri\u0300 t\u00e2\u0300m v\u1ea1\u0302n \u0111\u1ecd\u0302ng va\u0300 \u0111\u1ecd\u0302 \u0111a\u0300n h\u00f4\u0300i cu\u0309a ga\u0302n, co\u031b, kh\u01a1\u0301p, ca\u0309i thi\u1eb9\u0302n ti\u0301nh linh hoa\u0323t cu\u0309a ca\u0301c c\u00e2\u0301u tru\u0301c mo\u0302 m\u00ea\u0300m, \u0111\u00f4\u0300ng th\u01a1\u0300i cu\u0303ng co\u0301 ta\u0301c du\u0323ng gia\u0309m \u0111au, gia\u0309m vie\u0302m, ta\u0323o s\u01b0\u0323 th\u01b0 gia\u0303n co\u031b.<\/p>\n

\"Bai-tap-cho-benh-nhan-viem-cot-song-dinh-khop\"
Ba\u0300i ta\u0323\u0302p cho be\u0323\u0302nh nha\u0302n vie\u0302m co\u0323\u0302t so\u0302\u0301ng di\u0301nh kho\u031b\u0301p<\/figcaption><\/figure>\n
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– Ca\u0301c ky\u0303 thu\u1ea1\u0302t t\u1ea1\u0302p th\u01a1\u0309 sa\u0302u, nh\u00e2\u0301t la\u0300 th\u01a1\u0309 ng\u01b0\u0323c (th\u01a1\u0309 lie\u0302n s\u01b0\u01a1\u0300n), ca\u0301c ba\u0300i t\u1ea1\u0302p \u0111ai vai \u0111\u00ea\u0309 duy tri\u0300 \u0111\u1ecd\u0302 gia\u0303n n\u01a1\u0309 l\u00f4\u0300ng ng\u01b0\u0323c.<\/p>\n

2.1.2. Giai \u0111oa\u0323n ba\u0301n c\u00e2\u0301p va\u0300 ma\u0323n ti\u0301nh<\/h4>\n

– Ca\u0301c ba\u0300i t\u1ea1\u0302p chu\u0309 \u0111\u1ecd\u0302ng, co\u0301 kha\u0301ng tr\u01a1\u0309 ta\u0306ng ti\u00ea\u0301n \u0111\u00ea\u0309 ta\u0306ng c\u01b0\u01a1\u0300ng s\u01b0\u0301c ma\u0323nh co\u031b, ba\u0300i t\u1ea1\u0302p di \u0111\u1ecd\u0302ng kh\u01a1\u0301p va\u0300 ke\u0301o gia\u0303n giu\u0301p gia ta\u0306ng t\u00e2\u0300m v\u1ea1\u0302n \u0111\u1ecd\u0302ng ca\u0301c kh\u01a1\u0301p.<\/p>\n

– Ba\u0300i t\u1ea1\u0302p v\u1ea1\u0302n \u0111\u1ecd\u0302ng c\u1ecd\u0302t s\u00f4\u0301ng c\u00f4\u0309, ng\u01b0\u0323c va\u0300 th\u0103\u0301t l\u01b0ng: duy tri\u0300 va\u0300 ca\u0309i thi\u1eb9\u0302n ca\u0301c hoa\u0323t \u0111\u1ecd\u0302ng g\u1ea1\u0302p, du\u00f4\u0303i, nghie\u0302ng va\u0300 xoay tha\u0302n, ta\u0306ng c\u01b0\u01a1\u0300ng s\u01b0\u0301c ma\u0323nh nho\u0301m co\u031b du\u00f4\u0303i l\u01b0ng.<\/p>\n

– Luy\u1eb9\u0302n t\u1ea1\u0302p chi\u0309nh s\u01b0\u0309a t\u01b0 th\u00ea\u0301 va\u0300 da\u0301ng \u0111i, ki\u00ea\u0309m soa\u0301t v\u1ea1\u0302n \u0111\u1ecd\u0302ng cu\u0309a khung ch\u1ea1\u0302u.<\/p>\n

– Hoa\u0323t \u0111\u1ecd\u0302ng tri\u0323 li\u1eb9\u0302u giu\u0301p ng\u01b0\u01a1\u0300i b\u1eb9\u0302nh \u0111\u1ecd\u0302c l\u1ea1\u0302p t\u00f4\u0301i \u0111a trong ca\u0301c sinh hoa\u0323t ha\u0300ng nga\u0300y va\u0300 di chuy\u00ea\u0309n, co\u0301 th\u00ea\u0309 chi\u0309 \u0111i\u0323nh ca\u0301c du\u0323ng cu\u0323 tr\u01a1\u0323 giu\u0301p, thi\u0301ch nghi nh\u01b0 ne\u0323p chi\u0309nh hi\u0300nh, khung t\u1ea1\u0302p \u0111i…<\/p>\n

– Ca\u0301c ba\u0300i t\u1ea1\u0302p s\u01b0\u0301c b\u00ea\u0300n, ta\u0306ng c\u01b0\u01a1\u0300ng ch\u01b0\u0301c na\u0306ng tim ma\u0323ch ho\u0302 h\u00e2\u0301p, ca\u0301c hoa\u0323t \u0111\u1ecd\u0302ng th\u00ea\u0309 thao nh\u01b0 bo\u031bi l\u1ecd\u0302i, \u0111i b\u1ecd\u0302, \u0111a\u0323p xe…<\/p>\n

– Ch\u01b0o\u031bng tri\u0300nh t\u1ea1\u0302p v\u1ea1\u0302n \u0111\u1ecd\u0302ng co\u0301 th\u00ea\u0309 \u0111\u01b0\u01a1\u0323c thi\u00ea\u0301t k\u00ea\u0301 theo ca\u0301 nha\u0302n ho\u1ea1\u0306c theo nho\u0301m.<\/p>\n

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2.2 \u0110i\u00ea\u0300u tri\u0323 thu\u00f4\u0301c<\/h3>\n

– Thu\u00f4\u0301c ch\u00f4\u0301ng vie\u0302m kho\u0302ng steroide la\u0300 l\u01b0\u0323a cho\u0323n \u0111\u00e2\u0300u tie\u0302n, ne\u0302n l\u01b0\u0323a cho\u0323n thu\u00f4\u0301c \u01b0\u0301c ch\u00ea\u0301 cho\u0323n lo\u0323c COX2 k\u00ea\u0301t h\u01a1\u0323p v\u01a1\u0301i thu\u00f4\u0301c gia\u0309m \u0111au va\u0300 gia\u0303n co\u031b va\u0302n.<\/p>\n

– Thu\u00f4\u0301c gia\u0309m \u0111au: ph\u00f4\u0301i h\u01a1\u0323p thu\u00f4\u0301c gia\u0309m \u0111au b\u1ea1\u0302c 1-2 theo so\u031b \u0111\u00f4\u0300 s\u01b0\u0309 du\u0323ng thu\u00f4\u0301c gia\u0309m \u0111au cu\u0309a WHO.<\/p>\n

– Glucocorticoids<\/p>\n

+ Tie\u0302m corticosteroids ta\u0323i ch\u00f4\u0303: chi\u0309 \u0111i\u0323nh v\u01a1\u0301i ca\u0301c tr\u01b0\u01a1\u0300ng h\u01a1\u0323p vie\u0302m ca\u0301c \u0111i\u00ea\u0309m ba\u0301m ga\u0302n ho\u1ea1\u0306c ca\u0301c kh\u01a1\u0301p ngoa\u0323i bie\u0302n co\u0301 ti\u0300nh tra\u0323ng vie\u0302m ke\u0301o da\u0300i. N\u00ea\u0301u la\u0300 kh\u01a1\u0301p ha\u0301ng, ne\u0302n tie\u0302m d\u01b0\u01a1\u0301i h\u01b0\u01a1\u0301ng d\u00e2\u0303n cu\u0309a sie\u0302u a\u0302m.<\/p>\n

+ S\u01b0\u0309 du\u0323ng corticosteroids toa\u0300n tha\u0302n: kho\u0302ng co\u0301 chi\u0309 \u0111i\u0323nh. Tr\u01b0\u0300 tr\u01b0\u01a1\u0300ng h\u01a1\u0323p kho\u0302ng \u0111a\u0301p \u01b0\u0301ng v\u01a1\u0301i thu\u00f4\u0301c CVKS co\u0301 th\u00ea\u0309 du\u0300ng corticosteroids toa\u0300n tha\u0302n ng\u0103\u0301n nga\u0300y.<\/p>\n

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\n
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– Thu\u00f4\u0301c ch\u00f4\u0301ng th\u00e2\u0301p kh\u01a1\u0301p la\u0300m thay \u0111\u00f4\u0309i b\u1eb9\u0302nh (DMARD): Sulfasalazin: chi\u0309 \u0111i\u0323nh cho th\u00ea\u0309 co\u0301 vie\u0302m kh\u01a1\u0301p ngoa\u0323i bie\u0302n. Li\u00ea\u0300u 2-4g\/nga\u0300y, ke\u0301o da\u0300i nhi\u00ea\u0300u na\u0306m<\/p>\n

– \u0110i\u00ea\u0300u tri\u0323 thu\u00f4\u0301c kha\u0301ng TNF (DMARD sinh ho\u0323c)<\/p>\n

+ Chi\u0309 \u0111i\u0323nh thu\u00f4\u0301c kha\u0301ng TNF cho ca\u0301c th\u00ea\u0309 b\u1eb9\u0302nh hoa\u0323t \u0111\u1ecd\u0302ng dai d\u0103\u0309ng, kho\u0302ng \u0111a\u0301p \u01b0\u0301ng v\u01a1\u0301i pha\u0301c \u0111\u00f4\u0300 \u0111i\u00ea\u0300u tri\u0323 tho\u0302ng th\u01b0\u01a1\u0300ng.<\/p>\n

\n
\n
\n
\n

+ B\u1eb9\u0302nh nha\u0302n VCSDK th\u00ea\u0309 c\u1ecd\u0302t s\u00f4\u0301ng: \u0111i\u00ea\u0300u tri\u0323 thu\u00f4\u0301c kha\u0301ng TNF k\u00ea\u0301t h\u01a1\u0323p v\u01a1\u0301i thu\u00f4\u0301c ch\u00f4\u0301ng vie\u0302m gia\u0309m \u0111au, kho\u0302ng k\u00ea\u0301t h\u01a1\u0323p v\u01a1\u0301i nho\u0301m DMARD kinh \u0111i\u00ea\u0309n (Sulfasalazine, Methotrexate)<\/p>\n

+ Ca\u0301c thu\u00f4\u0301c kha\u0301ng TNF\u03b1: Infliximab (RemicadeR), Etanercept (EnbrelR), Adalimumab. C\u00e2\u0300n loa\u0323i tr\u01b0\u0300 ca\u0301c ch\u00f4\u0301ng chi\u0309 \u0111i\u0323nh tr\u01b0\u01a1\u0301c khi quy\u00ea\u0301t \u0111i\u0323nh \u0111i\u00ea\u0300u tri\u0323: nguy co\u031b nhi\u00ea\u0303m tru\u0300ng, b\u1eb9\u0302nh lao, suy tim, kh\u00f4\u0301i u a\u0301c ti\u0301nh, b\u1eb9\u0302nh ma\u0301u va\u0300 nhi\u00ea\u0303m virus…<\/p>\n

2.3 Ca\u0301c \u0111i\u00ea\u0300u tri\u0323 kha\u0301c b\u1ec7nh l\u00fd vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp<\/h3>\n

– Thay kh\u01a1\u0301p nha\u0302n ta\u0323o (kh\u01a1\u0301p ha\u0301ng, g\u00f4\u0301i)<\/p>\n

– Ph\u00e2\u0303u thu\u1ea1\u0302t chi\u0309nh hi\u0300nh \u0111\u00f4\u0301i v\u01a1\u0301i c\u1ecd\u0302t s\u00f4\u0301ng: khi co\u0301 gu\u0300 ve\u0323o, lu\u0301n xe\u0323p, ga\u0303y c\u1ecd\u0302t s\u00f4\u0301ng<\/p>\n

– Can thi\u1eb9\u0302p thay \u0111\u00f4\u0309i nh\u1ea1\u0302n th\u01b0\u0301c \u2013 ha\u0300nh vi, ta\u0302m ly\u0301 tri\u0323 li\u1eb9\u0302u giu\u0301p b\u1eb9\u0302nh nha\u0302n ki\u00ea\u0309m soa\u0301t t\u00f4\u0301t ho\u031bn ti\u0300nh tra\u0323ng \u0111au ma\u0323n ti\u0301nh, ho\u0300a nh\u1ea1\u0302p xa\u0303 h\u1ecd\u0302i.<\/p>\n

3. Theo d\u00f5i v\u00e0 t\u00e1i kh\u00e1m<\/h2>\n

– B\u1eb9\u0302nh nha\u0302n vie\u0302m c\u1ecd\u0302t s\u00f4\u0301ng di\u0301nh kh\u01a1\u0301p c\u00e2\u0300n ta\u0301i kha\u0301m ha\u0300ng tha\u0301ng<\/strong>. Tu\u0300y theo ti\u0300nh tra\u0323ng b\u1eb9\u0302nh nha\u0302n (v\u00ea\u0300 la\u0302m sa\u0300ng va\u0300 xe\u0301t nghi\u1eb9\u0302m), c\u00e2\u0300n \u0111i\u00ea\u0300u chi\u0309nh li\u00ea\u0300u thu\u00f4\u0301c ch\u00f4\u0301ng vie\u0302m, thu\u00f4\u0301c gia\u0309m \u0111au, \u0111i\u00ea\u0300u tri\u0323 co\u031b ba\u0309n, thu\u00f4\u0301c h\u00f4\u0303 tr\u01a1\u0323 \u0111i\u00ea\u0300u tri\u0323 (thu\u00f4\u0301c ch\u00f4\u0301ng loa\u0303ng x\u01b0o\u031bng, thu\u00f4\u0301c ba\u0309o v\u1eb9\u0302 nie\u0302m ma\u0323c da\u0323 da\u0300y…)<\/p>\n

– Tr\u01b0\u01a1\u0300ng h\u01a1\u0323p n\u00ea\u0301u m\u1ecd\u0302t thay \u0111\u00f4\u0309i \u0111a\u0301ng k\u00ea\u0309 trong qua\u0301 tri\u0300nh cu\u0309a b\u1eb9\u0302nh xa\u0309y ra, ngoa\u0300i nguye\u0302n nha\u0302n do vie\u0302m, co\u0301 th\u00ea\u0309 co\u0301 ca\u0301c ti\u0300nh tra\u0323ng b\u00e2\u0301t th\u01b0\u01a1\u0300ng (vi\u0301 du\u0323 ga\u0303y x\u01b0o\u031bng c\u1ecd\u0302t s\u00f4\u0301ng), c\u00e2\u0300n chi\u0309 \u0111i\u0323nh ca\u0301c xe\u0301t nghi\u1eb9\u0302m ch\u00e2\u0309n \u0111oa\u0301n hi\u0300nh a\u0309nh thi\u0301ch h\u01a1\u0323p.<\/p>\n

– Ch\u01b0o\u031bng tri\u0300nh phu\u0323c h\u00f4\u0300i ch\u01b0\u0301c na\u0306ng, ch\u00ea\u0301 \u0111\u1ecd\u0302 t\u1ea1\u0302p luy\u1eb9\u0302n c\u00e2\u0300n<\/a> \u0111\u01b0\u01a1\u0323c l\u01b0\u01a1\u0323ng gia\u0301 la\u0323i \u0111i\u0323nh ky\u0300 3-6 tha\u0301ng \u0111\u00ea\u0309 \u0111a\u0301nh gia\u0301 m\u01b0\u0301c \u0111\u1ecd\u0302 ca\u0309i thi\u1eb9\u0302n ho\u1ea1\u0306c ha\u0323n ch\u00ea\u0301 ch\u01b0\u0301c na\u0306ng, \u0111\u01b0a ra mu\u0323c tie\u0302u phu\u0300 h\u01a1\u0323p va\u0300 h\u01b0\u01a1\u0301ng d\u00e2\u0303n b\u1eb9\u0302nh nha\u0302n ca\u0301c ky\u0303 thu\u1ea1\u0302t ch\u01b0o\u031bng tri\u0300nh t\u1ea1\u0302p t\u00f4\u0301t nh\u00e2\u0301t.<\/p>\n

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

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

Vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp (VCSDK) la\u0300 m\u1ecd\u0302t b\u1ec7nh vie\u0302m kh\u01a1\u0301p ma\u0323n ti\u0301nh, \u0111\u1ea1\u0306c tr\u01b0ng b\u01a1\u0309i t\u00f4\u0309n th\u01b0o\u031bng ta\u0323i c\u1ecd\u0302t s\u00f4\u0301ng va\u0300 kh\u01a1\u0301p cu\u0300ng ch\u1ea1\u0302u. B\u1eb9\u0302nh ti\u00ea\u0301n tri\u00ea\u0309n ch\u1ea1\u0302m, co\u0301 xu h\u01b0\u01a1\u0301ng di\u0301nh kh\u01a1\u0301p, th\u01b0\u01a1\u0300ng ph\u00f4\u0301i h\u01a1\u0323p v\u01a1\u0301i vie\u0302m ca\u0301c \u0111i\u00ea\u0309m ba\u0301m ga\u0302n. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb chung bao g\u1ed3m \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa, v\u1eadt […]<\/p>\n","protected":false},"author":10,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[24,33],"tags":[3],"yoast_head":"\nVi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp: H\u01b0\u1edbng d\u1eabn ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng<\/title>\n<meta name=\"description\" content=\"Vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd m\u1ea1n t\u00ednh. 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