{"id":21403,"date":"2023-04-15T11:38:46","date_gmt":"2023-04-15T04:38:46","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21403"},"modified":"2023-04-17T16:11:15","modified_gmt":"2023-04-17T09:11:15","slug":"co-nen-dung-thuoc-corticoid-cho-benh-nhan-covid-19","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/co-nen-dung-thuoc-corticoid-cho-benh-nhan-covid-19\/","title":{"rendered":"C\u00f3 n\u00ean d\u00f9ng thu\u1ed1c corticoid cho b\u1ec7nh nh\u00e2n COVID-19?"},"content":{"rendered":"

COVID-19 l\u00e0 b\u1ec7nh truy\u1ec1n nhi\u1ec5m do virus SARS-CoV-2<\/a> g\u00e2y ra. Hi\u1ec7n nay c\u00f3 nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n COVID- 19. C\u00f3 nhi\u1ec1u th\u1eafc m\u1eafc v\u1ec1 v\u1ea5n \u0111\u1ec1 c\u00f3 \u0111\u01b0\u1ee3c d<\/strong>\u00f9ng thu\u1ed1c corticoid (corticosteroid) cho b\u1ec7nh nh\u00e2n COVID-19 kh\u00f4ng? D\u01b0\u1edbi \u0111\u00e2y l\u00e0 m\u1ed9t s\u1ed1 ch\u1ec9 \u0111\u1ecbnh d\u00f9ng thu\u1ed1c corticoid cho b\u1ec7nh nh\u00e2n COVID-19 \u0111\u01b0\u1ee3c B\u1ed9 Y t\u1ebf khuy\u1ebfn c\u00e1o.<\/strong><\/p>\n

\"Theo
Corticoid kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e9p d\u00f9ng cho b\u1ec7nh nh\u00e2n COVID-19 kh\u00f4ng tri\u1ec7u ch\u1ee9ng ho\u1eb7c tri\u1ec7u ch\u1ee9ng m\u1edbi ch\u1ec9 \u1edf m\u1ee9c \u0111\u1ed9 nh\u1eb9.<\/figcaption><\/figure>\n

1. T\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c corticoid \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n COVID-19<\/h2>\n

Thu\u1ed1c corticoid to\u00e0n th\u00e2n l\u00e0 m\u1ed9t lo\u1ea1i thu\u1ed1c ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 gi\u1ea3m vi\u00eam v\u00e0 \u1ee9c ch\u1ebf h\u1ec7 mi\u1ec5n d\u1ecbch trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh l\u00fd v\u1ec1 vi\u00eam. Trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh COVID-19, corticoid to\u00e0n th\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 gi\u1ea3m t\u00ecnh tr\u1ea1ng vi\u00eam ph\u1ed5i v\u00e0 gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong.<\/p>\n

C\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng s\u1eed d\u1ee5ng corticoid to\u00e0n th\u00e2n c\u00f3 hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb COVID-19 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u1eb7ng. Theo h\u01b0\u1edbng d\u1eabn c\u1ee7a T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi (WHO), vi\u1ec7c s\u1eed d\u1ee5ng corticoid to\u00e0n th\u00e2n \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n COVID-19 n\u1eb7ng \u0111\u00e3 gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong v\u00e0 t\u0103ng t\u1ef7 l\u1ec7 ph\u1ee5c h\u1ed3i so v\u1edbi nh\u00f3m kh\u00f4ng s\u1eed d\u1ee5ng corticoid.<\/p>\n

Tuy nhi\u00ean, vi\u1ec7c s\u1eed d\u1ee5ng corticoid to\u00e0n th\u00e2n c\u0169ng c\u00f3 nh\u1eefng t\u00e1c d\u1ee5ng ph\u1ee5 nh\u01b0 t\u0103ng nguy c\u01a1 nhi\u1ec5m khu\u1ea9n, \u0111\u01b0\u1eddng huy\u1ebft t\u0103ng v\u00e0 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch. Do \u0111\u00f3, quy\u1ebft \u0111\u1ecbnh s\u1eed d\u1ee5ng corticoid to\u00e0n th\u00e2n cho b\u1ec7nh nh\u00e2n COVID-19 n\u00ean \u0111\u01b0\u1ee3c \u0111\u01b0a ra d\u1ef1a tr\u00ean t\u00ecnh tr\u1ea1ng b\u1ec7nh v\u00e0 theo ch\u1ec9 \u0111\u1ecbnh c\u1ee7a b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb.<\/p>\n

2. Ch\u1ec9 \u0111\u1ecbnh<\/h2>\n

* Kh\u00f4ng s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c corticosteroids to\u00e0n th\u00e2n th\u01b0\u1eddng quy cho vi\u00eam \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean, tr\u1eeb khi c\u00f3 nh\u1eefng ch\u1ec9 \u0111\u1ecbnh kh\u00e1c.<\/p>\n

* Khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng corticosteroid to\u00e0n th\u00e2n (\u0111\u01b0\u1eddng ti\u00eam, u\u1ed1ng) trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p sau:<\/p>\n

a) B\u1ec7nh nh\u00e2n m\u1eafc COVID-19\u00a0m\u1ee9c \u0111\u1ed9 v\u1eeba, n\u1eb7ng\u00a0<\/b>ho\u1eb7c\u00a0nguy k\u1ecbch\u00a0<\/b>theo m\u1ee5c 3, 4, 5 ph\u1ea7n IV m\u1ee5c ph\u00e2n lo\u1ea1i c\u00e1c m\u1ee9c \u0111\u1ed9 l\u00e2m s\u00e0ng<\/p>\n

b) H\u1ed9i ch\u1ee9ng vi\u00eam h\u1ec7 th\u1ed1ng \u1edf tr\u1ebb em li\u00ean quan t\u1edbi COVID-19 (Multisytem Inflammatory Syndrome in Children- MIS-C)<\/p>\n

c) Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p covid-19 c\u00f3 b\u1ec7nh n\u1ec1n c\u1ea7n\u00a0\u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng corticosteroid ph\u1ea3i ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh n\u1ec1n b\u1eb1ng corticosteroid<\/p>\n

3. Thu\u1ed1c v\u00e0 li\u1ec1u l\u01b0\u1ee3ng<\/h2>\n

3.1. B\u1ec7nh nh\u00e2n m\u1eafc COVID-19 m\u1ee9c \u0111\u1ed9 v\u1eeba, n\u1eb7ng ho\u1eb7c nguy k\u1ecbch:<\/h3>\n

– \u01afu ti\u00ean s\u1eed d\u1ee5ng\u00a0DEXAMETHASONE<\/b><\/p>\n

– Th\u1eddi gian s\u1eed d\u1ee5ng: t\u1ed1i thi\u1ec3u t\u1edbi 7-10 ng\u00e0y<\/p>\n

– C\u1ea7n theo d\u00f5i s\u00e1t glucose m\u00e1u v\u00e0 c\u00e1c t\u00e1c d\u1ee5ng b\u1ea5t l\u1ee3i kh\u00e1c c\u1ee7a thu\u1ed1c trong th\u1eddi gian s\u1eed d\u1ee5ng corticosteroid v\u00e0 c\u00f3 c\u00e1c bi\u1ec7n ph\u00e1p x\u1eed l\u00fd ph\u00f9 h\u1ee3p.<\/p>\n

* Dexamethasone<\/b><\/p>\n

– Li\u1ec1u l\u01b0\u1ee3ng:<\/p>\n

+ Ng\u01b0\u1eddi l\u1edbn:\u00a0t\u1ed1i thi\u1ec3u\u00a06 mg, 1 l\u1ea7n\/ng\u00e0y c\u00f3 th\u1ec3 t\u0103ng li\u1ec1u l\u00ean 10-12mg\/ng\u00e0y t\u00f9y theo m\u1ee9c \u0111\u1ed9 n\u1eb7ng tr\u00ean l\u00e2m s\u00e0ng.<\/p>\n

+ Tr\u1ebb em: 0.15 mg\/kg\/l\u1ea7n (t\u1ed1i \u0111a 6 mg), 1 l\u1ea7n\/ng\u00e0y<\/p>\n

– \u0110\u01b0\u1eddng d\u00f9ng: ti\u00eam t\u0129nh m\u1ea1ch ho\u1eb7c \u0111\u01b0\u1eddng u\u1ed1ng<\/p>\n

N\u1ebfu kh\u00f4ng c\u00f3 s\u1eb5n Dexamethasone, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i steroid thay th\u1ebf v\u1edbi li\u1ec1u l\u01b0\u1ee3ng t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nh\u01b0 sau:<\/p>\n

* Hydrocortisone\u00a0<\/b>(d\u1ea1ng ti\u00eam b\u1eafp\/ti\u00eam t\u0129nh m\u1ea1ch; vi\u00ean)<\/p>\n

– Li\u1ec1u l\u01b0\u1ee3ng:<\/p>\n

+ Ng\u01b0\u1eddi l\u1edbn: 50 mg\/l\u1ea7n, 3 l\u1ea7n\/ng\u00e0y c\u00e1ch 8 gi\u1edd, ho\u1eb7c 100 mg\/l\u1ea7n, 2 l\u1ea7n\/ng\u00e0y, c\u00e1ch 12 gi\u1edd, ti\u00eam t\u0129nh m\u1ea1ch<\/p>\n

+ Tr\u1ebb em: 0.5 mg\/kg\/l\u1ea7n, 2 l\u1ea7n\/ng\u00e0y c\u00e1ch 12 gi\u1edd (t\u1ed1i \u0111a 150 mg\/ng\u00e0y)<\/p>\n

– \u0110\u01b0\u1eddng d\u00f9ng: ti\u00eam t\u0129nh m\u1ea1ch\u00a0ho\u1eb7c u\u1ed1ng<\/p>\n

* Methylprednisolone<\/b><\/p>\n

– Li\u1ec1u l\u01b0\u1ee3ng:<\/p>\n

+ Ng\u01b0\u1eddi l\u1edbn: 16 mg\/l\u1ea7n, 2 l\u1ea7n\/ng\u00e0y c\u00e1ch 12 gi\u1edd<\/p>\n

+ Tr\u1ebb em: 0.8 mg\/kg\/l\u1ea7n, 2 l\u1ea7n\/ng\u00e0y c\u00e1ch 12 gi\u1edd (t\u1ed1i \u0111a 32 mg\/ng\u00e0y)<\/p>\n

– \u0110\u01b0\u1eddng d\u00f9ng: ti\u00eam t\u0129nh m\u1ea1ch\u00a0ho\u1eb7c u\u1ed1ng<\/p>\n

* Prednisolone<\/b><\/p>\n

– Li\u1ec1u l\u01b0\u1ee3ng:<\/p>\n

+ Ng\u01b0\u1eddi l\u1edbn: 40 mg\/l\u1ea7n, 1 l\u1ea7n\/ng\u00e0y,<\/p>\n

+ Tr\u1ebb em: 1 mg\/kg\/l\u1ea7n (t\u1ed1i \u0111a 40 mg), 1 l\u1ea7n\/ng\u00e0y<\/p>\n

– \u0110\u01b0\u1eddng d\u00f9ng: u\u1ed1ng<\/p>\n

3.2.\u00a0 H\u1ed9i ch\u1ee9ng vi\u00eam h\u1ec7 th\u1ed1ng li\u00ean quan t\u1edbi COVID-19 \u1edf tr\u1ebb em (Multisytem Inflammatory Syndrome in Children- MIS-C)<\/h3>\n

– Steroid \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh c\u00f9ng v\u1edbi IVIG v\u00e0 c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 kh\u00e1c<\/p>\n

– Thu\u1ed1c s\u1eed d\u1ee5ng: methylprednisolone, prednisolone, prednisone<\/p>\n

– \u0110\u01b0\u1eddng d\u00f9ng: ti\u00eam t\u0129nh m\u1ea1ch, u\u1ed1ng<\/p>\n

* Li\u1ec1u l\u01b0\u1ee3ng v\u00e0 c\u00e1ch s\u1eed d\u1ee5ng:<\/p>\n

– Th\u1ec3 nh\u1eb9-v\u1eeba:\u00a0(kh\u00f4ng c\u00f3 suy h\u00f4 h\u1ea5p, suy tu\u1ea7n ho\u00e0n): Methylprednisolone ho\u1eb7c prednisolone 2 mg\/kg\/ng\u00e0y (t\u1ed1i \u0111a 40-60 mg\/ng\u00e0y), chia th\u00e0nh 2-3 l\u1ea7n, c\u00e1ch 8-12h, gi\u1ea3m d\u1ea7n li\u1ec1u v\u00e0 ng\u1eebng thu\u1ed1c trong 2-3 tu\u1ea7n<\/p>\n

– Th\u1ec3 n\u1eb7ng- nguy k\u1ecbch:\u00a0(c\u00f3 suy h\u00f4 h\u1ea5p, suy tu\u1ea7n ho\u00e0n)<\/p>\n

– Li\u1ec1u t\u1ea5n c\u00f4ng: Methylprednisolone 10-30 mg\/ng\u00e0y, t\u1eeb 1-3 ng\u00e0y. Sau \u0111\u00f3 d\u00f9ng prednisolone li\u1ec1u 2 mg\/kg\/ng\u00e0y (t\u1ed1i \u0111a 40-60 mg\/ng\u00e0y).<\/p>\n

+ Gi\u1ea3m d\u1ea7n li\u1ec1u v\u00e0 ng\u1eebng trong th\u1eddi gian 2-3 tu\u1ea7n (th\u1ec3 n\u1eb7ng), v\u00e0 6-8 tu\u1ea7n (v\u1edbi th\u1ec3 nguy k\u1ecbch).<\/p>\n

+ Gi\u1ea3m li\u1ec1u v\u00e0 ng\u1eebng thu\u1ed1c theo di\u1ec5n bi\u1ebfn l\u00e2m s\u00e0ng c\u1ee7a t\u1eebng b\u1ec7nh nh\u00e2n<\/p>\n

3.3. Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p COVID-19 c\u00f3 b\u1ec7nh n\u1ec1n\u00a0\u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng corticosteroid c\u1ea7n ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh n\u1ec1n b\u1eb1ng corticosteroid to\u00e0n th\u00e2n<\/strong><\/h3>\n

Lo\u1ea1i corticosteroid, li\u1ec1u l\u01b0\u1ee3ng, v\u00e0 c\u00e1ch s\u1eed d\u1ee5ng duy tr\u00ec theo t\u00ecnh tr\u1ea1ng b\u1ec7nh n\u1ec1n \u0111\u00e3 c\u00f3.<\/p>\n

4. T\u00e1c d\u1ee5ng ph\u1ee5 th\u01b0\u1eddng g\u1eb7p c\u1ee7a corticoid to\u00e0n th\u00e2n<\/h2>\n

Corticoid to\u00e0n th\u00e2n l\u00e0 m\u1ed9t lo\u1ea1i thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 gi\u1ea3m vi\u00eam v\u00e0 gi\u1ea3m \u0111au trong nhi\u1ec1u b\u1ec7nh l\u00fd kh\u00e1c nhau, nh\u01b0ng n\u00f3 c\u0169ng c\u00f3 th\u1ec3 g\u00e2y ra m\u1ed9t s\u1ed1 t\u00e1c d\u1ee5ng ph\u1ee5 th\u01b0\u1eddng g\u1eb7p, bao g\u1ed3m:<\/p>\n

    \n
  • T\u0103ng c\u00e2n v\u00e0 t\u00edch n\u01b0\u1edbc: Corticoid to\u00e0n th\u00e2n c\u00f3 th\u1ec3 l\u00e0m t\u0103ng l\u01b0\u1ee3ng m\u1ee1 v\u00e0 n\u01b0\u1edbc t\u00edch t\u1ee5 trong c\u01a1 th\u1ec3, g\u00e2y ra t\u0103ng c\u00e2n.<\/li>\n
  • T\u0103ng huy\u1ebft \u00e1p: Corticoid to\u00e0n th\u00e2n c\u00f3 th\u1ec3 l\u00e0m t\u0103ng huy\u1ebft \u00e1p, l\u00e0m t\u0103ng nguy c\u01a1 m\u1eafc c\u00e1c b\u1ec7nh tim m\u1ea1ch v\u00e0 \u0111\u1ed9t qu\u1ef5.<\/li>\n
  • T\u0103ng nguy c\u01a1 m\u1eafc b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng: Corticoid to\u00e0n th\u00e2n c\u00f3 th\u1ec3 l\u00e0m t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 t\u0103ng nguy c\u01a1 m\u1eafc b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng.<\/li>\n
  • Suy gi\u1ea3m mi\u1ec5n d\u1ecbch: Corticoid to\u00e0n th\u00e2n c\u00f3 th\u1ec3 \u1ee9c ch\u1ebf h\u1ec7 mi\u1ec5n d\u1ecbch c\u1ee7a c\u01a1 th\u1ec3, l\u00e0m t\u0103ng nguy c\u01a1 m\u1eafc c\u00e1c b\u1ec7nh nhi\u1ec5m tr\u00f9ng v\u00e0 b\u1ec7nh l\u00fd kh\u00e1c.<\/li>\n
  • R\u1ed1i lo\u1ea1n gi\u1ea5c ng\u1ee7: Corticoid to\u00e0n th\u00e2n c\u00f3 th\u1ec3 g\u00e2y ra r\u1ed1i lo\u1ea1n gi\u1ea5c ng\u1ee7, nh\u01b0 kh\u00f3 ng\u1ee7, m\u1ea5t ng\u1ee7.<\/li>\n
  • N\u1ed5i m\u1ec1 \u0111ay v\u00e0 ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng: M\u1ed9t s\u1ed1 ng\u01b0\u1eddi c\u00f3 th\u1ec3 ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng v\u1edbi corticoid to\u00e0n th\u00e2n, g\u00e2y ra c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 n\u1ed5i m\u1ec1 \u0111ay, ng\u1ee9a v\u00e0 kh\u00f3 th\u1edf.<\/li>\n<\/ul>\n

    T\u00f3m l\u1ea1i, quy\u1ebft \u0111\u1ecbnh s\u1eed d\u1ee5ng corticoid cho b\u1ec7nh nh\u00e2n COVID-19 n\u00ean \u0111\u01b0\u1ee3c \u0111\u01b0a ra d\u1ef1a tr\u00ean t\u00ecnh tr\u1ea1ng m\u1eafc COVID-19. B\u1ec7nh nh\u00e2n kh\u00f4ng n\u00ean t\u1ef1 \u00fd s\u1eed d\u1ee5ng corticoid m\u00e0 ph\u1ea3i \u0111i\u1ec1u tr\u1ecb theo s\u1ef1 h\u01b0\u1edbng d\u1eabn c\u1ee7a b\u00e1c s\u0129.<\/p>\n

    Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n