{"id":26182,"date":"2023-04-27T15:50:03","date_gmt":"2023-04-27T08:50:03","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=26182"},"modified":"2023-04-27T15:50:03","modified_gmt":"2023-04-27T08:50:03","slug":"than-hu","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/27\/than-hu\/","title":{"rendered":"H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 \u1edf ng\u01b0\u1eddi l\u1edbn"},"content":{"rendered":"

H\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi l\u1edbn, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf nh\u1eefng ng\u01b0\u1eddi \u0111\u00e3 tr\u1ea3i qua nhi\u1ec1u tu\u1ed5i thanh ni\u00ean v\u00e0 tu\u1ed5i trung ni\u00ean. \u0110i\u1ec1u tr\u1ecb cho h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 t\u00f9y thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 n\u1eb7ng nh\u1eb9 c\u1ee7a b\u1ec7nh, nh\u01b0ng trong h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb s\u1ebd t\u1eadp trung v\u00e0o vi\u1ec7c gi\u1ea3m c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 ng\u0103n ng\u1eeba s\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh.<\/strong><\/p>\n

1. \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng chung trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0<\/strong><\/h1>\n

1.1. Gi\u1ea3m ph\u00f9 trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0<\/strong><\/h3>\n

B\u1ec7nh nh\u00e2n c\u1ea7n \u0103n ch\u1ebf \u0111\u1ed9 gi\u1ea3m mu\u1ed1i v\u00e0 h\u1ea1n ch\u1ebf n\u01b0\u1edbc. Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p nh\u00f3m l\u1ee3i ti\u1ec3u c\u00f3 t\u00e1c d\u1ee5ng \u0111\u1ed1i kh\u00e1ng aldosteron (aldacton, verospiron, spironolacton) c\u00f3 th\u1ec3 r\u1ea5t hi\u1ec7u qu\u1ea3. \u0110\u1ed1i v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 suy th\u1eadn th\u01b0\u1eddng d\u00f9ng furosemid. Li\u1ec1u d\u00f9ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh \u0111\u1ec3 \u0111\u1ea1t s\u1ed1 l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u mong mu\u1ed1n. S\u1eed d\u1ee5ng l\u1ee3i ti\u1ec3u qua\u00a0\u0111\u01b0\u1eddng u\u1ed1ng, li\u1ec1u t\u00f9y thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng ph\u00f9 v\u00e0 \u0111\u00e1p \u1ee9ng v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u (v\u00ed d\u1ee5 20 -60 mg\/ng\u00e0y). Trong tr\u01b0\u1eddng h\u1ee3p kh\u00e1ng l\u1ee3i ti\u1ec3u c\u00f3 th\u1ec3 t\u0103ng li\u1ec1u \u0111\u1ebfn 120mg ho\u1eb7c s\u1eed d\u1ee5ng l\u1ee3i ti\u1ec3u \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch. Th\u00eam metolazone (l\u1ee3i ti\u1ec3u nh\u00f3m thiazide) c\u00f3 th\u1ec3 t\u0103ng t\u00e1c d\u1ee5ng c\u1ee7a furosemid trong tr\u01b0\u1eddng h\u1ee3p kh\u00e1ng l\u1ee3i ti\u1ec3u.<\/p>\n

1.2. B\u00f9 kh\u1ed1i l\u01b0\u1ee3ng tu\u1ea7n ho\u00e0n<\/strong><\/em> trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0<\/h3>\n

Nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n hi\u1ec7u d\u1ee5ng c\u1ea7n \u0111\u01b0\u1ee3c b\u00f9 kh\u1ed1i l\u01b0\u1ee3ng tu\u1ea7n ho\u00e0n. Albumin ng\u01b0\u1eddi l\u00e0 dung d\u1ecbch hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n cho nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 albumin m\u00e1u r\u1ea5t gi\u1ea3m, nh\u01b0ng c\u00f3 th\u1ec3 g\u00e2y ph\u00f9 ph\u1ed5i k\u1ebd v\u00e0 c\u00f3 gi\u00e1 th\u00e0nh cao. Ch\u1ec9 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p ph\u00f9 to \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi l\u1ee3i ti\u1ec3u li\u1ec1u cao, b\u1ec7nh nh\u00e2n chu\u1ea9n b\u1ecb ph\u1eabu thu\u1eadt ho\u1eb7c can thi\u1ec7p (sinh thi\u1ebft th\u1eadn\u2026). Ngo\u00e0i ra c\u00f3 th\u1ec3 d\u00f9ng plasma, c\u00e1c dung d\u1ecbch keo v\u00e0 dung d\u1ecbch mu\u1ed1i sinh l\u00fd \u0111\u1ec3 b\u00f9 l\u1ea1i th\u1ec3 t\u00edch d\u1ecbch trong l\u00f2ng m\u1ea1ch.<\/p>\n

\"\"
Ngu\u1ed3n<\/strong>: Aastha Kidney Hospital<\/em><\/figcaption><\/figure>\n

2. \u0110i\u1ec1u tr\u1ecb b\u1eb1ng li\u1ec7u ph\u00e1p mi\u1ec5n d\u1ecbch \u0111\u1ed1i v\u1edbi h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 nguy\u00ean ph\u00e1t<\/strong><\/h2>\n

Corticoid: Prednison, prednisolon ho\u1eb7c c\u00e1c thu\u1ed1c corticoid kh\u00e1c v\u1edbi li\u1ec1u t\u01b0\u01a1ng \u0111\u01b0\u01a1ng. Th\u01b0\u1eddng d\u00f9ng cho c\u00e1c b\u1ec7nh nh\u00e2n th\u1eadn h\u01b0 c\u00f3 thay \u0111\u1ed5i t\u1ed1i thi\u1ec3u c\u1ea7u th\u1eadn, vi\u00eam c\u1ea7u th\u1eadn t\u0103ng sinh gian m\u1ea1ch v\u00e0 x\u01a1 c\u1ea7u th\u1eadn \u1ed5 c\u1ee5c b\u1ed9.<\/p>\n

2.1. Giai \u0111o\u1ea1n t\u1ea5n c\u00f4ng kh\u1edfi \u0111\u1ea7u<\/strong><\/em><\/h3>\n

1-2mg\/kg\/ng\u00e0y\u00a0(kh\u00f4ng qu\u00e1 80mg\/ng\u00e0y) u\u1ed1ng 1 l\u1ea7n bu\u1ed5i s\u00e1ng ho\u1eb7c c\u00f3 th\u1ec3 chia l\u00e0m 2 l\u1ea7n\/ng\u00e0y trong v\u00f2ng 4-8 tu\u1ea7n. M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 ph\u1ea3i k\u00e9o d\u00e0i th\u00eam th\u1eddi gian d\u00f9ng corticoid li\u1ec1u t\u1ea5n c\u00f4ng. Ngo\u00e0i \u0111\u01b0\u1eddng u\u1ed1ng, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng corticoid t\u0129nh m\u1ea1ch.<\/p>\n

2.2. Giai \u0111o\u1ea1n c\u1ee7ng c\u1ed1<\/strong><\/em><\/h3>\n

K\u00e9o d\u00e0i kho\u1ea3ng 4 th\u00e1ng, li\u1ec1u corticoid \u0111\u01b0\u1ee3c gi\u1ea3m d\u1ea7n .<\/p>\n

2.3. Giai \u0111o\u1ea1n duy tr\u00ec<\/strong><\/em><\/h3>\n

5-10 mg\/ng\u00e0y c\u00f3 th\u1ec3 k\u00e9o d\u00e0i h\u00e0ng n\u0103m.
\nCh\u00fa \u00fd<\/strong>: Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb t\u1ea5n c\u00f4ng duy tr\u00ec c\u1ee7ng c\u1ed1 ph\u1ee5 thu\u1ed9c v\u00e0o t\u1ed5n th\u01b0\u01a1ng m\u00f4 h\u1ecdc c\u1ea7u th\u1eadn: B\u1ec7nh th\u1eadn thay \u0111\u1ed5i t\u1ed1i thi\u1ec3u th\u01b0\u1eddng \u0111\u00e1p \u1ee9ng v\u1edbi corticoid t\u1ed1t nh\u1ea5t trong khi vi\u00eam c\u1ea7u th\u1eadn m\u00e0ng t\u0103ng sinh lu\u00f4n kh\u00e1ng corticoid. C\u00e1c b\u1ec7nh l\u00fd c\u1ea7u th\u1eadn nguy\u00ean ph\u00e1t kh\u00e1c \u0111\u00e1p \u1ee9ng v\u1edbi li\u1ec7u ph\u00e1p corticoid m\u1ee9c trung b\u00ecnh. Li\u1ec1u v\u00e0 th\u1eddi gian \u0111i\u1ec1u tr\u1ecb corticoid t\u00f9y thu\u1ed9c v\u00e0o th\u1ec3 b\u1ec7nh v\u00e0 \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb. Tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh th\u1eadn thay \u0111\u1ed5i t\u1ed1i thi\u1ec3u nguy\u00ean ph\u00e1t: prednisone \u0111\u01b0\u1eddng u\u1ed1ng li\u1ec1u 40-60mg (1-2mg\/kg\/ng\u00e0y \u0111\u1ed1i v\u1edbi tr\u1ebb em) trong 4-6 th\u00e1ng sau \u0111\u00f3 gi\u1ea3m d\u1ea7n li\u1ec1u.<\/p>\n

3. Tr\u00e1nh bi\u1ebfn ch\u1ee9ng khi \u0111i\u1ec1u tr\u1ecb Prednisolone\u00a0<\/strong><\/h2>\n

Prednisolone l\u00e0 thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn nh\u1ea5t \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0. Do c\u00f3 th\u1ec3 g\u00e2y nhi\u1ec1u t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n, thu\u1ed1c ph\u1ea3i \u0111\u01b0\u1ee3c d\u00f9ng d\u01b0\u1edbi s\u1ef1 gi\u00e1m s\u00e1t nghi\u00eam ng\u1eb7t c\u1ee7a b\u00e1c s\u0129.<\/p>\n

C\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n ng\u1eafn h\u1ea1n th\u01b0\u1eddng g\u1eb7p l\u00e0 th\u00e8m \u0103n, t\u0103ng c\u00e2n, ph\u00f9 m\u1eb7t, k\u00edch \u1ee9ng d\u1ea1 d\u00e0y g\u00e2y \u0111au b\u1ee5ng, d\u1ec5 b\u1ecb nhi\u1ec5m tr\u00f9ng. T\u0103ng nguy c\u01a1 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 t\u0103ng huy\u1ebft \u00e1p, d\u1ec5 b\u1ecb k\u00edch th\u00edch, m\u1ecdc m\u1ee5n tr\u1ee9ng c\u00e1 v\u00e0 m\u1ecdc nhi\u1ec1u l\u00f4ng tr\u00ean m\u1eb7t.<\/p>\n

T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n l\u00e2u d\u00e0i nh\u01b0 t\u0103ng c\u00e2n, c\u00f2i c\u1ecdc \u1edf tr\u1ebb em, da m\u1ecfng, r\u1ea1n da v\u00f9ng \u0111\u00f9i, c\u00e1nh tay, v\u00e0 v\u00f9ng b\u1ee5ng, ch\u1eadm l\u00e0nh v\u1ebft th\u01b0\u01a1ng, \u0111\u1ee5c th\u1ee7y tinh th\u1ec3, t\u0103ng lipid m\u00e1u, c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 x\u01b0\u01a1ng (lo\u00e3ng x\u01b0\u01a1ng, ho\u1ea1i t\u1eed v\u00f4 m\u1ea1ch ch\u1ecfm x\u01b0\u01a1ng \u0111\u00f9i) v\u00e0 y\u1ebfu c\u01a1.<\/p>\n

T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n nghi\u00eam tr\u1ecdng c\u1ee7a corticosteroid \u0111\u00e3 \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn nh\u01b0ng n\u1ebfu HCTH kh\u00f4ng \u0111i\u1ec1u tr\u1ecb s\u1ebd c\u00f3 nhi\u1ec1u nguy hi\u1ec3m c\u00f3 th\u1ec3 x\u1ea3y ra. HCTH\u00a0c\u00f3 th\u1ec3 g\u00e2y ph\u00f9 n\u1eb7ng v\u00e0 gi\u1ea3m n\u1ed3ng \u0111\u1ed9 protein trong c\u01a1 th\u1ec3. B\u1ec7nh kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng, nh\u01b0 t\u0103ng nguy c\u01a1 nhi\u1ec5m tr\u00f9ng, gi\u1ea3m th\u1ec3 t\u00edch m\u00e1u, huy\u1ebft kh\u1ed1i t\u1eafc m\u1ea1ch (huy\u1ebft kh\u1ed1i c\u00f3 th\u1ec3 g\u00e2y t\u1eafc m\u1ea1ch m\u00e1u v\u00e0 g\u00e2y \u0111\u1ed9t qu\u1ef5, c\u01a1n \u0111au tim, v\u00e0 b\u1ec7nh l\u00fd ph\u1ed5i), r\u1ed1i lo\u1ea1n lipid, suy dinh d\u01b0\u1ee1ng v\u00e0 thi\u1ebfu m\u00e1u. Li\u1ec1u t\u1ed1i \u01b0u v\u00e0 th\u1eddi gian \u0111i\u1ec1u tr\u1ecb corticosteroid d\u01b0\u1edbi s\u1ef1 gi\u00e1m s\u00e1t y t\u1ebf ph\u00f9 h\u1ee3p mang l\u1ea1i nhi\u1ec1u l\u1ee3i \u00edch nh\u1ea5t v\u00e0 \u00edt g\u00e2y h\u1ea1i nh\u1ea5t.\u00a0\u0110a s\u1ed1 c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a corticosteroid s\u1ebd h\u1ebft theo th\u1eddi gian sau khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb.<\/p>\n

\u0110\u1ec3 tr\u00e1nh c\u00e1c bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m, m\u1ed9t s\u1ed1 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a corticosteroid c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng. C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch kh\u00e1c:
\nKhi corticosteroid kh\u00f4ng hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb HCTH, c\u00e1c thu\u1ed1c \u0111\u1eb7c hi\u1ec7u kh\u00e1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng l\u00e0: cyclophosphamide, cyclosporine, tacrolimus v\u00e0 mycophenolate mofetil (MMF). Th\u01b0\u1eddng s\u1eed d\u1ee5ng cho b\u1ec7nh nh\u00e2n vi\u00eam c\u1ea7u th\u1eadn m\u00e0ng c\u00f3 nguy c\u01a1 cao (\u0111\u01a1n \u0111\u1ed9c ho\u1eb7c ph\u1ed1i h\u1ee3p corticoid) ho\u1eb7c cho nh\u1eefng b\u1ec7nh nh\u00e2n hay t\u00e1i ph\u00e1t, kh\u00e1ng hay ph\u1ee5 thu\u1ed9c corticoid. Cyclophosphamid, azathioprin v\u00e0 cyclosporin \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3.<\/p>\n

T\u00f3m l\u1ea1i, \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 \u1edf ng\u01b0\u1eddi l\u1edbn th\u01b0\u1eddng t\u1eadp trung v\u00e0o gi\u1ea3m c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 ng\u0103n ng\u1eeba s\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh. Vi\u1ec7c \u0111i\u1ec1u ch\u1ec9nh l\u1ed1i s\u1ed1ng v\u00e0 s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c l\u00e0 nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p ch\u00ednh \u0111\u1ec3 gi\u00fap b\u1ec7nh nh\u00e2n v\u01b0\u1ee3t qua t\u00ecnh tr\u1ea1ng n\u00e0y.<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o<\/strong>: H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 theo B\u1ed9 Y t\u1ebf 2019<\/p>\n","protected":false},"excerpt":{"rendered":"

H\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi l\u1edbn, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf nh\u1eefng ng\u01b0\u1eddi \u0111\u00e3 tr\u1ea3i qua nhi\u1ec1u tu\u1ed5i thanh ni\u00ean v\u00e0 tu\u1ed5i trung ni\u00ean. \u0110i\u1ec1u tr\u1ecb cho h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 t\u00f9y thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 n\u1eb7ng nh\u1eb9 c\u1ee7a b\u1ec7nh, nh\u01b0ng trong h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p, vi\u1ec7c \u0111i\u1ec1u […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[29,33],"tags":[],"yoast_head":"\nH\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 \u1edf ng\u01b0\u1eddi l\u1edbn<\/title>\n<meta name=\"description\" content=\"\u0110i\u1ec1u tr\u1ecb cho h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 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