{"id":27202,"date":"2023-04-23T22:56:03","date_gmt":"2023-04-23T15:56:03","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=27202"},"modified":"2023-04-23T22:56:03","modified_gmt":"2023-04-23T15:56:03","slug":"ngo-doc-chi-dieu-tri-tien-luong-va-phong-benh","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/ngo-doc-chi-dieu-tri-tien-luong-va-phong-benh\/","title":{"rendered":"Ng\u1ed9 \u0111\u1ed9c ch\u00ec: \u0110i\u1ec1u tr\u1ecb, ti\u00ean l\u01b0\u1ee3ng v\u00e0 ph\u00f2ng b\u1ec7nh"},"content":{"rendered":"

Ng\u1ed9 \u0111\u1ed9c ch\u00ec l\u00e0 t\u00ecnh tr\u1ea1ng b\u1ecb t\u1ed5n th\u01b0\u01a1ng s\u1ee9c kh\u1ecfe do ti\u1ebfp x\u00fac v\u1edbi ch\u00ec ho\u1eb7c h\u00edt ph\u1ea3i h\u01a1i ch\u00ec trong m\u00f4i tr\u01b0\u1eddng s\u1ed1ng v\u00e0 l\u00e0m vi\u1ec7c. Ng\u1ed9 \u0111\u1ed9c ch\u00ec c\u00f3 th\u1ec3 x\u1ea3y ra khi ch\u00ec \u0111\u01b0\u1ee3c ti\u1ebfp x\u00fac tr\u1ef1c ti\u1ebfp v\u1edbi da, h\u00edt ph\u1ea3i h\u01a1i ch\u00ec trong kh\u00f4ng kh\u00ed ho\u1eb7c \u0103n u\u1ed1ng c\u00e1c th\u1ef1c ph\u1ea9m ch\u1ee9a ch\u00ec. Ch\u00ec l\u00e0 m\u1ed9t kim lo\u1ea1i n\u1eb7ng \u0111\u1ed9c h\u1ea1i<\/a> cho c\u01a1 th\u1ec3 con ng\u01b0\u1eddi, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u0111\u1ed1i v\u1edbi tr\u1ebb em v\u00e0 ph\u1ee5 n\u1eef mang thai. V\u00ec v\u1eady vi\u1ec7c ph\u00e1t hi\u1ec7n s\u1edbm v\u00e0 \u0111i\u1ec1u tr\u1ecb ng\u1ed9 \u0111\u1ed9c ch\u00ec l\u00e0 r\u1ea5t quan tr\u1ecdng.<\/strong><\/p>\n

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Ch\u00ec l\u00e0 m\u1ed9t kim lo\u1ea1i n\u1eb7ng \u0111\u1ed9c h\u1ea1i<\/a> cho c\u01a1 th\u1ec3 con ng\u01b0\u1eddi<\/figcaption><\/figure>\n

1. \u0110i\u1ec1u tr\u1ecb ng\u1ed9 \u0111\u1ed9c ch\u00ec<\/h2>\n

1.1. Ti\u00eau chu\u1ea9n nh\u1eadp vi\u1ec7n<\/b><\/h3>\n

a) Ng\u1ed9 \u0111\u1ed9c trung b\u00ecnh v\u00e0 n\u1eb7ng.<\/p>\n

b) Ho\u1eb7c di\u1ec5n bi\u1ebfn ph\u1ee9c t\u1ea1p c\u1ea7n theo d\u00f5i s\u00e1t v\u00e0 th\u0103m d\u00f2 k\u1ef9 h\u01a1n.<\/p>\n

1.2. \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng, \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3<\/b><\/h3>\n

a) X\u1eed tr\u00ed c\u1ea5p c\u1ee9u \u0111i\u1ec1u tr\u1ecb c\u00e1c tri\u1ec7u ch\u1ee9ng: suy h\u00f4 h\u1ea5p, co gi\u1eadt, h\u00f4n m\u00ea, t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd,…theo ph\u00e1c \u0111\u1ed3 c\u1ea5p c\u1ee9u.<\/p>\n

b) D\u00f9ng thu\u1ed1c ch\u1ed1ng co gi\u1eadt \u0111\u01b0\u1eddng u\u1ed1ng n\u1ebfu c\u00f3 s\u00f3ng \u0111\u1ed9ng kinh tr\u00ean \u0111i\u1ec7n n\u00e3o.<\/p>\n

c) Truy\u1ec1n m\u00e1u n\u1ebfu thi\u1ebfu m\u00e1u n\u1eb7ng.<\/p>\n

d) D\u00f9ng thu\u1ed1c ch\u1ed1ng co th\u1eaft n\u1ebfu \u0111au b\u1ee5ng.<\/p>\n

1.3. \u0110i\u1ec1u tr\u1ecb \u0111\u1ec3 h\u1ea1n ch\u1ebf h\u1ea5p thu ch\u00ec<\/b><\/h3>\n

a) X\u00e1c \u0111\u1ecbnh ngu\u1ed3n ch\u00ec v\u00e0 ng\u1eebng ph\u01a1i nhi\u1ec5m.<\/p>\n

b) R\u1eeda d\u1ea1 d\u00e0y: n\u1ebfu m\u1edbi u\u1ed1ng, nu\u1ed1t ch\u00ec d\u1ea1ng vi\u00ean thu\u1ed1c, b\u1ed9t trong v\u00f2ng 6 gi\u1edd.<\/p>\n

c) R\u1eeda ru\u1ed9t to\u00e0n b\u1ed9<\/p>\n

1.4. N\u1ed9i soi l\u1ea5y d\u1ecb v\u1eadt c\u00f3 ch\u00ec<\/b><\/h3>\n

1.5. S\u1eed d\u1ee5ng thu\u1ed1c gi\u1ea3i \u0111\u1ed9c ch\u00ec (g\u1eafp ch\u00ec)<\/b><\/h3>\n

a) Ch\u1ec9 \u0111\u1ecbnh thu\u1ed1c g\u1eafp ch\u00ec d\u1ef1a tr\u00ean n\u1ed3ng \u0111\u1ed9 ch\u00ec m\u00e1u, tu\u1ed5i v\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

– Ng\u1ed9 \u0111\u1ed9c ch\u00ec n\u1eb7ng: d\u00f9ng dimercaprol (British anti-Lewisite, BAL), calcium disodium edetate (CaNa2<\/sub>EDTA).<\/p>\n

– Ng\u1ed9 \u0111\u1ed9c ch\u00ec trung b\u00ecnh, nh\u1eb9:<\/p>\n

+ \u01afu ti\u00ean d\u00f9ng succimer (2,3-dimercaptosuccinic acid, DMSA):<\/p>\n

+ Khi kh\u00f4ng c\u00f3 ho\u1eb7c kh\u00f4ng d\u00f9ng \u0111\u01b0\u1ee3c c\u00e1c thu\u1ed1c tr\u00ean: d\u00f9ng D-penicillamin<\/p>\n

b) C\u00e1ch d\u00f9ng thu\u1ed1c g\u1eafp ch\u00ec:<\/p>\n

– M\u1ee5c ti\u00eau: ch\u00ec m\u00e1u < 20 \u00b5g\/dL v\u00e0 \u1ed5n \u0111\u1ecbnh (hai l\u1ea7n x\u00e9t nghi\u1ec7m cu\u1ed1i c\u00f9ng c\u00e1ch nhau 3 th\u00e1ng)<\/p>\n

– C\u00e1ch d\u00f9ng:<\/p>\n

+ D\u00f9ng theo \u0111\u1ee3t:<\/p>\n

\u2022 BAL, EDTA: 3-5 ng\u00e0y\/\u0111\u1ee3t.<\/p>\n

\u2022 Succimer: 19 ng\u00e0y\/\u0111\u1ee3t.<\/p>\n

\u2022 D-penicillamin: 7 \u2013 30 ng\u00e0y\/\u0111\u1ee3t, theo d\u00f5i n\u1ebfu kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng ph\u1ee5 th\u00ec d\u00f9ng t\u1ed1i \u0111a 30 ng\u00e0y\/\u0111\u1ee3t, t\u1ea1m ng\u1eebng ho\u1eb7c gi\u1ea3m li\u1ec1u ngay khi c\u00f3 t\u00e1c d\u1ee5ng ph\u1ee5.<\/p>\n

+ Kho\u1ea3ng th\u1eddi gian ngh\u1ec9:<\/p>\n

\u2022 D\u00f9ng BAL, EDTA: sau \u0111\u1ee3t 1 ngh\u1ec9 2 ng\u00e0y, sau \u0111\u1ee3t 2 ngh\u1ec9 5-7 ng\u00e0y, c\u00e1c \u0111\u1ee3t sau c\u00f3 th\u1ec3 d\u00e0i h\u01a1n t\u00f9y theo n\u1ed3ng \u0111\u1ed9 ch\u00ec m\u00e1u.<\/p>\n

\u2022 Succimer: th\u01b0\u1eddng ngh\u1ec9 \u00edt nh\u1ea5t 2 tu\u1ea7n tr\u01b0\u1edbc khi d\u00f9ng thu\u1ed1c \u0111\u1ee3t ti\u1ebfp theo.<\/p>\n

\u2022 D-penicillamin: B\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng nh\u1eb9, ngh\u1ec9 10-14 ng\u00e0y tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111\u1ee3t g\u1eafp ti\u1ebfp theo, c\u00e1c \u0111\u1ee3t ngh\u1ec9 14 ng\u00e0y.<\/p>\n

Ch\u1ec9 \u0111\u1ecbnh, li\u1ec1u thu\u1ed1c \u0111i\u1ec1u tr\u1ecb (g\u1eafp ch\u00ec) c\u1ee5 th\u1ec3 theo b\u1ea3ng sau:<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Tri\u1ec7u ch\u1ee9ng, n\u1ed3ng \u0111\u1ed9 ch\u00ec m\u00e1u (\u03bcg\/dL)<\/p>\n<\/td>\n

\n

T\u00ean thu\u1ed1c, li\u1ec1u d\u00f9ng<\/p>\n<\/td>\n

\n

C\u00e1ch d\u00f9ng 1 \u0111\u1ee3t<\/p>\n<\/td>\n<\/tr>\n

\n

Ng\u01b0\u1eddi l\u1edbn<\/b><\/p>\n<\/td>\n<\/tr>\n

B\u1ec7nh n\u00e3o do ch\u00ec<\/td>\nD\u00f9ng k\u1ebft h\u1ee3p:<\/p>\n

BAL: 450mg\/m2<\/sup>\/24h<\/p>\n

(24 mg\/kg\/24h)<\/td>\n

– Chia l\u00e0m 6 l\u1ea7n, 75mg\/m2<\/sup>\/l\u1ea7n<\/p>\n

(4mg\/kg\/l\u1ea7n) , 4 gi\u1edd\/l\u1ea7n, ti\u00eam b\u1eafp s\u00e2u, \u0111\u1ed5i v\u1ecb tr\u00ed ti\u00eam m\u1ed7i l\u1ea7n.<\/p>\n

– D\u00f9ng 5 ng\u00e0y\/\u0111\u1ee3t<\/td>\n<\/tr>\n

B\u1ec7nh n\u00e3o do ch\u00ec<\/td>\nV\u00e0:<\/p>\n

CaNa2EDTA 1500mg\/m2<\/sup>\/24h (50-75mg\/kg\/24h), t\u1ed1i \u0111a 2-3 gam\/24h<\/td>\n

– B\u1eaft \u0111\u1ea7u sau khi \u0111\u00e3 d\u00f9ng BAL \u0111\u01b0\u1ee3c 4 gi\u1edd.<\/p>\n

– Truy\u1ec1n t\u0129nh m\u1ea1ch li\u00ean t\u1ee5c trong 24 gi\u1edd ho\u1eb7c chia l\u00e0m 2-4 l\u1ea7n \u0111\u1ec3 truy\u1ec1n ng\u1eaft qu\u00e3ng.<\/p>\n

– D\u00f9ng 5 ng\u00e0y\/\u0111\u1ee3t, ngh\u1ec9 \u00edt nh\u1ea5t 2 ng\u00e0y tr\u01b0\u1edbc khi d\u00f9ng thu\u1ed1c \u0111\u1ee3t ti\u1ebfp theo.<\/td>\n<\/tr>\n

C\u00f3 tri\u1ec7u ch\u1ee9ng g\u1ee3i \u00fd b\u1ec7nh n\u00e3o, ho\u1eb7c ch\u00ec m\u00e1u >100<\/td>\nD\u00f9ng k\u1ebft h\u1ee3p:<\/p>\n

BAL: 300 – 450mg\/m2<\/sup>\/24h<\/p>\n

(18-24mg\/kg\/24h)<\/td>\n

– Chia l\u00e0m 6 l\u1ea7n, 50-75mg\/m2<\/sup>\/l\u1ea7n (3 – 4mg\/kg\/l\u1ea7n) , 4 gi\u1edd\/l\u1ea7n, ti\u00eam b\u1eafp s\u00e2u, \u0111\u1ed5i v\u1ecb tr\u00ed ti\u00eam m\u1ed7i l\u1ea7n.<\/p>\n

– D\u00f9ng 3-5 ng\u00e0y\/\u0111\u1ee3t<\/p>\n

– Li\u1ec1u c\u1ee5 th\u1ec3, th\u1eddi gian d\u00f9ng c\u0103n c\u1ee9 v\u00e0o ch\u00ec m\u00e1u, m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a tri\u1ec7u ch\u1ee9ng<\/td>\n<\/tr>\n

C\u00f3 tri\u1ec7u ch\u1ee9ng g\u1ee3i \u00fd b\u1ec7nh n\u00e3o, ho\u1eb7c ch\u00ec m\u00e1u >100<\/td>\nV\u00e0:<\/p>\n

CaNa2EDTA 1000 \u2013 1500 mg\/m2<\/sup>\/24h<\/p>\n

(25-75mg\/kg\/24h)<\/td>\n

– B\u1eaft \u0111\u1ea7u sau khi \u0111\u00e3 d\u00f9ng BAL \u0111\u01b0\u1ee3c 4 gi\u1edd<\/p>\n

– Truy\u1ec1n t\u0129nh m\u1ea1ch li\u00ean t\u1ee5c trong 24 gi\u1edd ho\u1eb7c chia l\u00e0m 2-4 l\u1ea7n \u0111\u1ec3 truy\u1ec1n ng\u1eaft qu\u00e3ng.<\/p>\n

– D\u00f9ng 5 ng\u00e0y\/\u0111\u1ee3t<\/p>\n

– Li\u1ec1u c\u1ee5 th\u1ec3, th\u1eddi gian d\u00f9ng c\u0103n c\u1ee9 v\u00e0o ch\u00ec m\u00e1u, m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a tri\u1ec7u ch\u1ee9ng<\/td>\n<\/tr>\n

Tri\u1ec7u ch\u1ee9ng nh\u1eb9 ho\u1eb7c ch\u00ec m\u00e1u 70 \u2013 100<\/td>\nSuccimer 700- 1.050mg\/m2<\/sup>\/24h<\/p>\n

(20-30mg\/kg\/24h)<\/td>\n

– U\u1ed1ng 350mg\/ m2<\/sup>\/l\u1ea7n (10mg\/kg\/l\u1ea7n), 3 l\u1ea7n\/ng\u00e0y, trong 5 ng\u00e0y, sau \u0111\u00f3 2 l\u1ea7n\/ng\u00e0y trong 14 ng\u00e0y. N\u1ebfu kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh g\u1eafp nhanh ch\u00f3ng th\u00ec c\u1ea7n t\u1ea1m ngh\u1ec9 \u00edt nh\u1ea5t 2 tu\u1ea7n tr\u01b0\u1edbc khi d\u00f9ng thu\u1ed1c \u0111\u1ee3t ti\u1ebfp theo.<\/td>\n<\/tr>\n
Tri\u1ec7u ch\u1ee9ng nh\u1eb9 ho\u1eb7c ch\u00ec m\u00e1u 70 \u2013 100<\/td>\nD-penicillamin:<\/p>\n

25-35mg\/kg\/ng\u00e0y, b\u1eaft \u0111\u1ea7u li\u1ec1u nh\u1ecf h\u01a1n 25% li\u1ec1u n\u00e0y, sau 2 tu\u1ea7n t\u0103ng v\u1ec1 li\u1ec1u trung b\u00ecnh.<\/p>\n

V\u00ec nhi\u1ec1u t\u00e1c d\u1ee5ng ph\u1ee5 ch\u1ec9 n\u00ean d\u00f9ng li\u1ec1u th\u1ea5p nh\u1ea5t c\u00f3 hi\u1ec7u qu\u1ea3.<\/td>\n

– Li\u1ec1u trong ng\u00e0y chia th\u00e0nh c\u00e1c li\u1ec1u nh\u1ecf, u\u1ed1ng xa b\u1eefa \u0103n.<\/p>\n

– N\u1ebfu kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh g\u1eafp nhanh ch\u00f3ng th\u00ec ch\u1ec9 n\u00ean d\u00f9ng trong 1 th\u00e1ng, sau \u0111\u00f3 t\u1ea1m ngh\u1ec9 \u00edt nh\u1ea5t 2 tu\u1ea7n tr\u01b0\u1edbc khi d\u00f9ng thu\u1ed1c \u0111\u1ee3t ti\u1ebfp theo. C\u00e1c \u0111\u1ee3t ngh\u1ec9 sau c\u00f3 th\u1ec3 2 tu\u1ea7n ho\u1eb7c k\u00e9o d\u00e0i h\u01a1n.<\/td>\n<\/tr>\n

Kh\u00f4ng tri\u1ec7u ch\u1ee9ng v\u00e0 ch\u00ec m\u00e1u <70<\/td>\nTh\u01b0\u1eddng kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh<\/p>\n

C\u00e2n nh\u1eafc n\u1ebfu ph\u1ee5 n\u1eef c\u00f3 k\u1ebf ho\u1ea1ch mu\u1ed1n c\u00f3 thai, ng\u01b0\u1eddi b\u1ecb m\u1ed9t s\u1ed1 b\u1ec7nh m\u00e0 ch\u00ec m\u00e1u c\u00f3 th\u1ec3 l\u00e0m b\u1ec7nh n\u1eb7ng h\u01a1n (VD \u0111\u1ed9ng kinh, t\u0103ng huy\u1ebft \u00e1p,…)<\/td>\n

– N\u1ebfu d\u00f9ng thu\u1ed1c g\u1eafp ch\u00ec th\u00ec d\u00f9ng succimer ho\u1eb7c D-penicillamin nh\u01b0 tr\u00ean<\/td>\n<\/tr>\n
\n

Tr\u1ebb em<\/b><\/p>\n<\/td>\n<\/tr>\n

B\u1ec7nh n\u00e3o do ch\u00ec<\/td>\nD\u00f9ng k\u1ebft h\u1ee3p:<\/p>\n

BAL: 450mg\/m2<\/sup>\/24h<\/p>\n

(24 mg\/kg\/24h)<\/td>\n

– Chia l\u00e0m 6 l\u1ea7n, 75mg\/m \/l\u1ea7n (4mg\/kg\/l\u1ea7n), 4 gi\u1edd\/l\u1ea7n, ti\u00eam b\u1eafp s\u00e2u, \u0111\u1ed5i v\u1ecb tr\u00ed ti\u00eam m\u1ed7i l\u1ea7n.<\/p>\n

– D\u00f9ng 5 ng\u00e0y\/\u0111\u1ee3t.<\/td>\n<\/tr>\n

B\u1ec7nh n\u00e3o do ch\u00ec<\/td>\nV\u00e0:<\/p>\n

CaNa2EDTA 1500 mg\/m2<\/sup>\/24h<\/p>\n

(50-75mg\/kg\/24h)<\/td>\n

– B\u1eaft \u0111\u1ea7u sau khi \u0111\u00e3 d\u00f9ng BAL \u0111\u01b0\u1ee3c 4 gi\u1edd.<\/p>\n

– Truy\u1ec1n t\u0129nh m\u1ea1ch li\u00ean t\u1ee5c trong 24 gi\u1edd ho\u1eb7c chia l\u00e0m 2-4 l\u1ea7n \u0111\u1ec3 truy\u1ec1n ng\u1eaft qu\u00e3ng.<\/p>\n

– D\u00f9ng 5 ng\u00e0y\/\u0111\u1ee3t<\/td>\n<\/tr>\n

Ch\u00ec m\u00e1u > 70 ho\u1eb7c c\u00f3 tri\u1ec7u ch\u1ee9ng<\/td>\nD\u00f9ng k\u1ebft h\u1ee3p:<\/p>\n

BAL: 300 – 450mg\/m2<\/sup>\/24h<\/p>\n

(18-24mg\/kg\/24h)<\/td>\n

– Chia l\u00e0m 6 l\u1ea7n, 50-75mg\/m \/l\u1ea7n (3-4mg\/kg\/l\u1ea7n) , 4 gi\u1edd\/l\u1ea7n, ti\u00eam b\u1eafp s\u00e2u, \u0111\u1ed5i v\u1ecb tr\u00ed ti\u00eam m\u1ed7i l\u1ea7n.<\/p>\n

– D\u00f9ng 3-5 ng\u00e0y\/\u0111\u1ee3t<\/p>\n

– Li\u1ec1u c\u1ee5 th\u1ec3, th\u1eddi gian d\u00f9ng c\u0103n c\u1ee9 v\u00e0o ch\u00ec m\u00e1u, m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a tri\u1ec7u ch\u1ee9ng<\/td>\n<\/tr>\n

Ch\u00ec m\u00e1u > 70 ho\u1eb7c c\u00f3 tri\u1ec7u ch\u1ee9ng<\/td>\nV\u00e0:<\/p>\n

CaNa2EDTA 1000 \u2013 1500 mg\/m2<\/sup>\/24h<\/p>\n

(25-75mg\/kg\/24h)<\/td>\n

– B\u1eaft \u0111\u1ea7u sau khi \u0111\u00e3 d\u00f9ng BAL \u0111\u01b0\u1ee3c 4 gi\u1edd<\/p>\n

– Truy\u1ec1n t\u0129nh m\u1ea1ch li\u00ean t\u1ee5c trong 24 gi\u1edd ho\u1eb7c chia l\u00e0m 2-4 l\u1ea7n \u0111\u1ec3 truy\u1ec1n ng\u1eaft qu\u00e3ng.<\/p>\n

– D\u00f9ng 5 ng\u00e0y\/\u0111\u1ee3t<\/p>\n

– Li\u1ec1u c\u1ee5 th\u1ec3, th\u1eddi gian d\u00f9ng c\u0103n c\u1ee9 v\u00e0o ch\u00ec m\u00e1u, m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a tri\u1ec7u ch\u1ee9ng<\/td>\n<\/tr>\n

Ch\u00ec m\u00e1u 45 \u2013 70<\/td>\nSuccimer 700- 1050mg\/m2<\/sup>\/24h<\/p>\n

(20-30mg\/kg\/24h)<\/td>\n

– U\u1ed1ng 350mg\/ m2<\/sup>\/l\u1ea7n (10mg\/kg\/l\u1ea7n), 3l\u1ea7n\/ng\u00e0y, trong 5 ng\u00e0y, sau \u0111\u00f3 2 l\u1ea7n\/ng\u00e0y trong 14 ng\u00e0y.<\/td>\n<\/tr>\n
Ch\u00ec m\u00e1u 45 \u2013 70<\/td>\nHo\u1eb7c:<\/p>\n

CaNa2<\/sub>\u00a0EDTA, 1000 mg\/m2<\/sup>\/24h<\/p>\n

(25-50mg\/kg\/24h)<\/td>\n

– Truy\u1ec1n t\u0129nh m\u1ea1ch li\u00ean t\u1ee5c trong 24 gi\u1edd, ho\u1eb7c chia 2-4 \u0111\u1ec3 truy\u1ec1n ng\u1eaft qu\u00e3ng trong ng\u00e0y, \u0111\u1ee3t 5 ng\u00e0y<\/td>\n<\/tr>\n
Ch\u00ec m\u00e1u 45 \u2013 70<\/td>\nHo\u1eb7c (hi\u1ebfm khi):<\/p>\n

D-penicillamin:<\/p>\n

25-35mg\/kg\/ng\u00e0y, b\u1eaft \u0111\u1ea7u li\u1ec1u nh\u1ecf h\u01a1n 25% li\u1ec1u n\u00e0y, sau 2 tu\u1ea7n t\u0103ng v\u1ec1 li\u1ec1u trung b\u00ecnh.<\/td>\n

– Li\u1ec1u trong ng\u00e0y chia th\u00e0nh c\u00e1c li\u1ec1u nh\u1ecf, u\u1ed1ng xa b\u1eefa \u0103n.<\/p>\n

– N\u1ebfu kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh g\u1eafp nhanh ch\u00f3ng th\u00ec ch\u1ec9 n\u00ean d\u00f9ng trong 1 th\u00e1ng, sau \u0111\u00f3 t\u1ea1m ngh\u1ec9 \u00edt nh\u1ea5t 2 tu\u1ea7n tr\u01b0\u1edbc khi d\u00f9ng thu\u1ed1c \u0111\u1ee3t ti\u1ebfp theo. C\u00e1c \u0111\u1ee3t ngh\u1ec9 sau c\u00f3 th\u1ec3 2 tu\u1ea7n ho\u1eb7c k\u00e9o d\u00e0i h\u01a1n.<\/p>\n

– V\u00ec nhi\u1ec1u t\u00e1c d\u1ee5ng ph\u1ee5 ch\u1ec9 n\u00ean d\u00f9ng li\u1ec1u th\u1ea5p nh\u1ea5t c\u00f3 hi\u1ec7u qu\u1ea3.<\/td>\n<\/tr>\n

Ch\u00ec m\u00e1u 20 \u2013 44<\/td>\nKh\u00f4ng ch\u1ec9 \u0111\u1ecbnh g\u1eafp th\u01b0\u1eddng quy.<\/p>\n

D\u00f9ng thu\u1ed1c g\u1eafp n\u1ebfu: tr\u1ebb <2 tu\u1ed5i, g\u1ee3i \u00fd c\u00f3 tri\u1ec7u ch\u1ee9ng k\u00edn \u0111\u00e1o, ch\u00ec m\u00e1u 35-44 \u00b5g\/dL, ch\u00ec m\u00e1u v\u1eabn kh\u00f4ng gi\u1ea3m sau ng\u1eebng ph\u01a1i nhi\u1ec5m 2 th\u00e1ng<\/td>\n

– D\u00f9ng succimer ho\u1eb7c D-penicillamin nh\u01b0 tr\u00ean.<\/td>\n<\/tr>\n
Ch\u00ec m\u00e1u < 20<\/td>\nKh\u00f4ng ch\u1ec9 \u0111\u1ecbnh g\u1eafp, Ng\u1eebng ph\u01a1i nhi\u1ec5m Theo d\u00f5i s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a tr\u1ebb v\u00e0 n\u1ed3ng \u0111\u1ed9 ch\u00ec m\u00e1u m\u1ed7i 6 th\u00e1ng<\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

c. T\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c g\u1eafp ch\u00ec, th\u01b0\u1eddng g\u1eb7p l\u00e0:<\/p>\n

– \u0110\u1ed1i v\u1edbi BAL:<\/p>\n

+ Ng\u1ee9a, t\u0103ng th\u00e2n nhi\u1ec7t, t\u0103ng huy\u1ebft \u00e1p, nh\u1ecbp tim nhanh, \u0111au, \u00e1p xe v\u1ecb tr\u00ed ti\u00eam, d\u00f9ng c\u00f9ng s\u1eaft c\u00f3 th\u1ec3 g\u00e2y \u0111\u1ed9c v\u1edbi th\u1eadn.<\/p>\n

+ X\u1eed tr\u00ed: t\u1ea1m ng\u1eebng thu\u1ed1c, d\u00f9ng thu\u1ed1c ch\u1ed1ng d\u1ecb \u1ee9ng, kh\u00f4ng d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi s\u1eaft.<\/p>\n

– \u0110\u1ed1i v\u1edbi CaNa2<\/sub>\u00a0EDTA:<\/p>\n

+ S\u00f3ng T \u0111\u1ea3o ng\u01b0\u1ee3c, nh\u1ecbp tim kh\u00f4ng \u0111\u1ec1u, gi\u1ea3m huy\u1ebft \u00e1p tho\u00e1ng qua, ho\u1ea1i t\u1eed \u1ed1ng l\u01b0\u1ee3n g\u1ea7n, \u0111\u00e1i m\u00e1u, protein ni\u1ec7u, \u0111\u01b0\u1eddng ni\u1ec7u, suy th\u1eadn c\u1ea5p (\u0111\u1ed9c t\u00ednh v\u1edbi th\u1eadn ph\u1ee5 thu\u1ed9c li\u1ec1u), vi\u00eam da, huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch n\u1ebfu truy\u1ec1n nhanh v\u00e0 pha thu\u1ed1c n\u1ed3ng \u0111\u1ed9 cao, bu\u1ed3n n\u00f4n, n\u00f4n, \u0111au b\u1ee5ng, \u1ec9a ch\u1ea3y, t\u0103ng nh\u1eb9 AST, ALT, thi\u1ebfu m\u00e1u, \u1ee9c ch\u1ebf t\u1ee7y, m\u1ec7t m\u1ecfi, \u0111au c\u01a1, gi\u1ea3m k\u1ebdm, \u0111au \u0111\u1ea7u, run, t\u00ea b\u00ec. C\u00f3 th\u1ec3 l\u00e0m n\u1eb7ng th\u00eam b\u1ec7nh l\u00fd n\u00e3o n\u1ebfu kh\u00f4ng k\u1ebft h\u1ee3p v\u1edbi BAL.<\/p>\n

+ X\u1eed tr\u00ed: theo d\u00f5i \u0111i\u1ec7n tim, huy\u1ebft \u00e1p khi \u0111ang truy\u1ec1n thu\u1ed1c, l\u01b0u l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u, t\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u, ch\u1ee9c n\u0103ng th\u1eadn. \u0110\u1ea3m b\u1ea3o t\u0103ng l\u01b0u l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u khi d\u00f9ng thu\u1ed1c. D\u00f9ng li\u1ec1u th\u1ea5p nh\u1ea5t c\u00f3 hi\u1ec7u qu\u1ea3. Lu\u00f4n b\u00f9 k\u1ebdm, b\u00f9 s\u1eaft n\u1ebfu thi\u1ebfu. Khi c\u00f3 b\u1ec7nh l\u00fd n\u00e3o, ch\u00ec m\u00e1u >70 BAL.\uf020\uf06dg\/dL c\u1ea7n d\u00f9ng k\u1ebft h\u1ee3p v\u1edbi<\/p>\n

– \u0110\u1ed1i v\u1edbi succimer:<\/p>\n

+ Bu\u1ed3n n\u00f4n, n\u00f4n, \u1ec9a ch\u1ea3y, m\u00e0y \u0111ay, bu\u1ed3n ng\u1ee7, t\u00ea, t\u0103ng tho\u00e1ng qua AST, ALT, gi\u1ea3m nh\u1eb9 \u0111\u1ebfn v\u1eeba b\u1ea1ch c\u1ea7u trung t\u00ednh.<\/p>\n

+ X\u1eed tr\u00ed: theo d\u00f5i c\u00f4ng th\u1ee9c m\u00e1u, AST, ALT. T\u1ea1m d\u1eebng n\u1ebfu gi\u1ea3m b\u1ea1ch c\u1ea7u, AST, ALT ti\u1ebfp t\u1ee5c t\u0103ng.<\/p>\n

– \u0110\u1ed1i v\u1edbi D-penicillamin:<\/p>\n

+ T\u0103ng b\u1ea1ch c\u1ea7u \u01b0a axit, gi\u1ea3m b\u1ea1ch c\u1ea7u trung t\u00ednh (n\u1ebfu ti\u1ebfp t\u1ee5c d\u00f9ng thu\u1ed1c khi c\u00f3 gi\u1ea3m b\u1ea1ch c\u1ea7u trung t\u00ednh c\u00f3 th\u1ec3 d\u1eabn t\u1edbi thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n), gi\u1ea3m ti\u1ec3u c\u1ea7u, t\u0103ng ure m\u00e1u, protein ni\u1ec7u, \u0111\u00e1i m\u00e1u vi th\u1ec3, \u0111\u1ea1i ti\u1ec3u ti\u1ec7n kh\u00f4ng t\u1ef1 ch\u1ee7, \u0111au b\u1ee5ng, m\u00e0y \u0111ay, ban, ph\u1ed5ng n\u01b0\u1edbc ng\u1ee9a, \u0111\u1ecf da \u0111a h\u00ecnh th\u00e1i, ho\u1ea1i t\u1eed th\u01b0\u1ee3ng b\u00ec nhi\u1ec5m \u0111\u1ed9c, gi\u1ea3m v\u1ecb gi\u00e1c. D\u00f9ng D-penicillamin k\u00e9o d\u00e0i (nhi\u1ec1u tu\u1ea7n tr\u1edf l\u00ean) t\u0103ng t\u1ef7 l\u1ec7 t\u00e1c d\u1ee5ng ph\u1ee5. Ng\u01b0\u1eddi d\u1ecb \u1ee9ng v\u1edbi penicillin c\u00f3 th\u1ec3 b\u1ecb d\u1ecb \u1ee9ng ch\u00e9o.<\/p>\n

+ X\u1eed tr\u00ed: theo d\u00f5i da, n\u01b0\u1edbc ti\u1ec3u, c\u00f4ng th\u1ee9c m\u00e1u, ch\u1ee9c n\u0103ng th\u1eadn, t\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u. Ng\u1eebng thu\u1ed1c n\u1ebfu gi\u1ea3m b\u1ea1ch c\u1ea7u, s\u1ed1c, bi\u1ec3u hi\u1ec7n da n\u1eb7ng.<\/p>\n

Ch\u1ec9 n\u00ean d\u00f9ng n\u1ebfu kh\u00f4ng c\u00f3 thu\u1ed1c kh\u00e1c thay th\u1ebf.<\/p>\n

1.6. Ph\u1ee5 n\u1eef c\u00f3 thai, cho con b\u00fa, tr\u1ebb s\u01a1 sinh<\/b><\/h3>\n

a) Ph\u1ee5 n\u1eef c\u00f3 thai: l\u1ef1a ch\u1ecdn thu\u1ed1c c\u0103n c\u1ee9 v\u00e0o c\u00e1c y\u1ebfu t\u1ed1:<\/p>\n

– Theo ph\u00e2n lo\u1ea1i \u0111\u1ed9 an to\u00e0n khi d\u00f9ng cho ph\u1ee5 n\u1eef c\u00f3 thai: EDTA thu\u1ed9c nh\u00f3m B, succimer thu\u1ed9c nh\u00f3m C, BAL thu\u1ed9c nh\u00f3m C, D-penicillamin thu\u1ed9c nh\u00f3m D.<\/p>\n

– Th\u1ef1c t\u1ebf v\u1eabn c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh d\u00f9ng thu\u1ed1c g\u1eafp ch\u00ec n\u1ebfu l\u1ee3i \u00edch nhi\u1ec1u h\u01a1n nguy c\u01a1.<\/p>\n

b) M\u1eb9 b\u1ecb nhi\u1ec5m \u0111\u1ed9c ch\u00ec t\u1ed1t nh\u1ea5t kh\u00f4ng n\u00ean cho con b\u00fa; c\u1ea7n x\u00e9t nghi\u1ec7m ch\u00ec trong s\u1eefa, n\u1ebfu ch\u00ec s\u1eefa kh\u00f4ng \u0111\u00e1ng k\u1ec3 m\u1edbi cho tr\u1ebb b\u00fa.<\/p>\n

c) Tr\u1ebb s\u01a1 sinh nhi\u1ec5m \u0111\u1ed9c ch\u00ec t\u1eeb m\u1eb9 th\u00ec \u00e1p d\u1ee5ng li\u1ec7u ph\u00e1p g\u1eafp theo khuy\u1ebfn c\u00e1o tr\u00ean.<\/p>\n

d) Ph\u1ee5 n\u1eef \u0111ang b\u1ecb nhi\u1ec5m \u0111\u1ed9c ch\u00ec kh\u00f4ng n\u00ean c\u00f3 thai, ch\u1ec9 n\u00ean c\u00f3 thai khi ch\u00ec m\u00e1u < 10 \u00b5g\/dL.<\/p>\n

2. Ti\u00ean l\u01b0\u1ee3ng<\/h2>\n
    \n
  • N\u1ed3ng \u0111\u1ed9 ch\u00ec m\u00e1u > 70 \u00b5g\/dL th\u01b0\u1eddng g\u00e2y h\u1ed9i ch\u1ee9ng n\u00e3o c\u1ea5p \u1edf tr\u1ebb nh\u1ecf.<\/li>\n
  • H\u1ed9i ch\u1ee9ng n\u00e3o c\u1ea5p d\u1ec5 g\u00e2y t\u1eed vong ho\u1eb7c di ch\u1ee9ng th\u1ea7n kinh, t\u00e2m th\u1ea7n n\u1eb7ng n\u1ec1: t\u1ef7 l\u1ec7 t\u1eed vong l\u00e0 65% khi ch\u01b0a c\u00f3 thu\u1ed1c g\u1eafp ch\u00ec v\u00e0 gi\u1ea3m xu\u1ed1ng <5% khi c\u00f3 c\u00e1c thu\u1ed1c g\u1eafp ch\u00ec c\u00f3 hi\u1ec7u qu\u1ea3, 25-30% tr\u1ebb s\u1ebd b\u1ecb di ch\u1ee9ng v\u0129nh vi\u1ec5n bao g\u1ed3m ch\u1eadm ph\u00e1t tri\u1ec3n tr\u00ed tu\u1ec7 (m\u1ea5t kh\u1ea3 n\u0103ng h\u1ecdc t\u1eadp v\u00e0 t\u1ef1 ph\u1ee5c v\u1ee5), co gi\u1eadt, m\u00f9, li\u1ec7t.<\/li>\n
  • Ph\u1ea7n l\u1edbn c\u00e1c tr\u1ebb c\u00f3 ch\u00ec m\u00e1u t\u0103ng nh\u01b0ng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng r\u00f5 v\u00e0 v\u1eabn c\u00f3 nguy c\u01a1 ch\u1eadm ph\u00e1t tri\u1ec3n tr\u00ed tu\u1ec7 v\u00e0 th\u1ec3 ch\u1ea5t, c\u1ea7n ph\u1ea3i \u0111i\u1ec1u tr\u1ecb.<\/li>\n
  • C\u00f3 m\u1ed1i li\u00ean quan t\u1ef7 l\u1ec7 ngh\u1ecbch gi\u1eefa ch\u1ec9 s\u1ed1 IQ c\u1ee7a tr\u1ebb em v\u00e0 n\u1ed3ng \u0111\u1ed9 ch\u00ec m\u00e1u, ngay c\u1ea3 khi n\u1ed3ng \u0111\u1ed9 ch\u00ec m\u00e1u th\u1ea5p.<\/li>\n<\/ul>\n

    3. Ph\u00f2ng b\u1ec7nh<\/h2>\n
      \n
    • T\u0103ng c\u01b0\u1eddng tuy\u00ean truy\u1ec1n, gi\u00e1o d\u1ee5c s\u1ee9c kh\u1ecfe, n\u00e2ng cao nh\u1eadn th\u1ee9c c\u1ee7a ng\u01b0\u1eddi d\u00e2n, khi b\u1ecb b\u1ec7nh ch\u1ec9 kh\u00e1m \u1edf c\u00e1c c\u01a1 s\u1edf c\u00f3 \u0111\u0103ng k\u00fd v\u00e0 d\u00f9ng c\u00e1c thu\u1ed1c l\u01b0u h\u00e0nh h\u1ee3p ph\u00e1p.<\/li>\n
    • Lo\u1ea1i b\u1ecf c\u00e1c s\u1ea3n ph\u1ea9m c\u00f3 nguy c\u01a1 g\u00e2y nhi\u1ec5m \u0111\u1ed9c ch\u00ec trong cu\u1ed9c s\u1ed1ng h\u00e0ng ng\u00e0y nh\u01b0 s\u01a1n c\u00f3 ch\u00ec, \u0111\u1ed3 ch\u01a1i c\u00f3 ch\u00ec,\u2026<\/li>\n
    • Gi\u1eef v\u1ec7 sinh m\u00f4i tr\u01b0\u1eddng, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u00e0 v\u00e0 tr\u01b0\u1eddng h\u1ecdc, th\u1ef1c hi\u1ec7n t\u1ed1t v\u1ec7 sinh c\u00e1 nh\u00e2n cho tr\u1ebb (\u0111\u1eb7c bi\u1ec7t r\u1eeda tay, c\u1eaft m\u00f3ng tay, kh\u00f4ng \u0111\u01b0a tay v\u00e0 m\u1ecdi v\u1eadt l\u00ean mi\u1ec7ng). Tr\u1ebb em \u1edf n\u01a1i c\u00f3 \u00f4 nhi\u1ec5m ch\u00ec b\u00ean c\u1ea1nh vi\u1ec7c x\u1eed l\u00fd m\u00f4i tr\u01b0\u1eddng c\u1ea7n ch\u00fa \u00fd th\u01b0\u1eddng xuy\u00ean cung c\u1ea5p \u0111\u1ee7 c\u00e1c ch\u1ea5t kho\u00e1ng c\u1ea7n thi\u1ebft nh\u01b0 canxi, s\u1eaft, k\u1ebdm, ma gi\u00ea,\u2026<\/li>\n
    • \u0110\u1ea3m b\u1ea3o v\u1ec7 sinh, an to\u00e0n lao \u0111\u1ed9ng, \u0111\u1eb7c bi\u1ec7t v\u1edbi c\u00e1c ngh\u1ec1 nghi\u1ec7p c\u00f3 nguy c\u01a1 nhi\u1ec5m \u0111\u1ed9c ch\u00ec c\u1ea7n \u0111\u1ea3m b\u1ea3o m\u00f4i tr\u01b0\u1eddng v\u00e0 an to\u00e0n lao \u0111\u1ed9ng, tr\u00e1nh g\u00e2y \u00f4 nhi\u1ec5m, ki\u1ec3m tra s\u1ee9c kh\u1ecfe (g\u1ed3m x\u00e9t nghi\u1ec7m ch\u00ec m\u00e1u) \u0111\u1ecbnh k\u1ef3.<\/li>\n<\/ul>\n

      Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n","protected":false},"excerpt":{"rendered":"

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