{"id":27535,"date":"2023-04-23T17:26:10","date_gmt":"2023-04-23T10:26:10","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=27535"},"modified":"2023-05-02T09:35:51","modified_gmt":"2023-05-02T02:35:51","slug":"phuong-phap-kiem-soat-nhiem-trung-trong-benh-ly-noi-nha","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/phuong-phap-kiem-soat-nhiem-trung-trong-benh-ly-noi-nha\/","title":{"rendered":"Ph\u01b0\u01a1ng ph\u00e1p ki\u1ec3m so\u00e1t nhi\u1ec5m tr\u00f9ng trong b\u1ec7nh l\u00fd N\u1ed9i nha."},"content":{"rendered":"

Hai ph\u01b0\u01a1ng ph\u00e1p ki\u1ec3m so\u00e1t nhi\u1ec5m tr\u00f9ng trong b\u1ec7nh l\u00fd N\u1ed9i nha c\u00f3 th\u1ec3 k\u1ec3 \u0111\u1ebfn, bao g\u1ed3m s\u1eed d\u1ee5ng kh\u00e1ng sinh, c\u1ee5 th\u1ec3 nh\u01b0 kh\u00e1ng sinh to\u00e0n th\u00e2n \u0111\u01b0\u1ee3c khuy\u00ean d\u00f9ng trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 nhi\u1ec5m tr\u00f9ng lan r\u1ed9ng, \u0111\u1ed3ng th\u1eddi k\u1ebft h\u1ee3p v\u1edbi b\u0103ng thu\u1ed1c n\u1ed9i nha, nh\u01b0 nhi\u1ec1u lo\u1ea1i thu\u1ed1c n\u1ed9i t\u1ee7y \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng \u0111\u1ec3 ho\u00e0n t\u1ea5t vi\u1ec7c kh\u1eed tr\u00f9ng. C\u00f9ng t\u00ecm hi\u1ec3u s\u00e2u v\u00e0o hai n\u1ed9i dung ch\u00ednh n\u00e0y.<\/strong><\/p>\n

1. S\u1eed d\u1ee5ng kh\u00e1ng sinh trong ki\u1ec3m so\u00e1t nhi\u1ec5m tr\u00f9ng n\u1ed9i nha<\/h2>\n

Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u ti\u00ean cho r\u0103ng vi\u00eam quanh ch\u00f3p c\u00f3 tri\u1ec7u ch\u1ee9ng ho\u1eb7c abscess ch\u00f3p c\u1ea5p l\u00e0 lo\u1ea1i b\u1ecf \u1ed5 vi\u00eam ho\u1eb7c \u1ed5 nhi\u1ec5m tr\u00f9ng b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u1ea1i ch\u1ed7, bao g\u1ed3m \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha, nh\u1ed5 r\u0103ng, r\u1ea1ch v\u00e0 d\u1eabn l\u01b0u t\u1ea1i ch\u1ed7 sung. Kh\u00e1ng sinh to\u00e0n th\u00e2n \u0111\u01b0\u1ee3c khuy\u00ean d\u00f9ng trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 nhi\u1ec5m tr\u00f9ng lan r\u1ed9ng (vi\u00eam m\u00f4 t\u1ebf b\u00e0o c\u00f3 li\u00ean quan \u0111\u1ebfn h\u1ea1ch, s\u01b0ng lan t\u1ecfa) ho\u1eb7c c\u00f3 tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n (s\u1ed1t v\u00e0 suy ki\u1ec7t) c\u0169ng nh\u01b0 \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng dai d\u1eb3ng. Vi\u1ec7c l\u1ea1m d\u1ee5ng kh\u00e1ng sinh l\u00e0m t\u0103ng nguy c\u01a1 ph\u00e1t tri\u1ec3n nh\u1eefng ch\u1ee7ng vi khu\u1ea9n kh\u00e1ng thu\u1ed1c, thay \u0111\u1ed5i h\u1ec7 vi khu\u1ea9n c\u1ed9ng sinh, do \u0111\u00f3 l\u00e0m t\u0103ng kh\u1ea3 n\u0103ng x\u1ea3y ra c\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5 nh\u01b0 d\u1ecb \u1ee9ng, ph\u1ea3n \u1ee9ng ph\u1ea3n v\u1ec7, bu\u1ed3n n\u00f4n, n\u00f4n… Thu\u1ed1c do nha s\u0129 k\u00ea \u0111\u01a1n chi\u1ebfm kho\u1ea3ng 8 \u2013 10% l\u01b0\u1ee3ng kh\u00e1ng sinh ph\u00e2n b\u1ed1 \u1edf c\u00e1c n\u01b0\u1edbc ph\u00e1t tri\u1ec3n, v\u00e0 \u0111i\u1ec1u quan tr\u1ecdng l\u00e0 kh\u00f4ng n\u00ean \u0111\u00e1nh gi\u00e1 th\u1ea5p s\u1ef1 \u1ea3nh h\u01b0\u1edfng c\u1ee7a ng\u00e0nh nha \u0111\u1ebfn v\u1ea5n \u0111\u1ec1 gia t\u0103ng nghi\u00eam tr\u1ecdng c\u1ee7a vi khu\u1ea9n kh\u00e1ng kh\u00e1ng sinh.<\/p>\n

S\u1eed d\u1ee5ng kh\u00e1ng sinh to\u00e0n th\u00e2n n\u00ean \u0111\u01b0\u1ee3c coi l\u00e0 bi\u1ec7n ph\u00e1p h\u1ed7 tr\u1ee3 cho \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha v\u00e0 kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam nhi\u1ec5m t\u1ea1i ch\u1ed7 nh\u01b0 vi\u00eam t\u1ee7y hay vi\u00eam quanh ch\u00f3p. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u ch\u1ec9 ra r\u1eb1ng thu\u1ed1c kh\u00e1ng sinh kh\u00f4ng l\u00e0m gi\u1ea3m \u0111au ho\u1eb7c gi\u1ea3m s\u01b0ng tr\u00ean r\u0103ng c\u00f3 b\u1ec7nh l\u00fd quanh ch\u00f3p c\u00f3 tri\u1ec7u ch\u1ee9ng m\u00e0 kh\u00f4ng c\u00f3 li\u00ean quan \u0111\u1ebfn to\u00e0n th\u00e2n. Tuy nhi\u00ean, trong m\u1ed9t cu\u1ed9c kh\u1ea3o s\u00e1t c\u00e1c th\u00e0nh vi\u00ean c\u1ee7a Hi\u1ec7p h\u1ed9i n\u1ed9i nha M\u1ef9 (American Association of Endodontic) th\u00ec 54% ng\u01b0\u1eddi \u0111\u01b0\u1ee3c h\u1ecfi cho bi\u1ebft h\u1ecd s\u1ebd k\u00ea \u0111\u01a1n kh\u00e1ng sinh nh\u01b0 l\u00e0 bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u ti\u00ean cho nh\u1eefng ng\u01b0\u1eddi b\u1ecb \u0111au r\u0103ng. Ngo\u1ea1i tr\u1eeb nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 suy gi\u1ea3m h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch th\u00ec kh\u00e1ng sinh kh\u00f4ng ph\u1ea3i thu\u1ed1c ch\u1eefa b\u1ec7nh nh\u01b0ng thay v\u00e0o \u0111\u00f3 l\u1ea1i c\u00f3 ch\u1ee9c n\u0103ng h\u1ed7 tr\u1ee3 s\u1ef1 t\u00e1i l\u1eadp c\u00e2n b\u1eb1ng gi\u1eefa h\u00e0ng r\u00e0o ph\u00f2ng ng\u1ef1 c\u1ee7a c\u01a1 th\u1ec3 v\u1edbi c\u00e1c t\u00e1c nh\u00e2n x\u00e2m nh\u1eadp.<\/p>\n

\u0110\u1ec3 t\u1eadn d\u1ee5ng t\u1ed1i \u0111a hi\u1ec7u qu\u1ea3 c\u1ee7a kh\u00e1ng sinh v\u00e0 gi\u1ea3m thi\u1ec3u kh\u1ea3 n\u0103ng ph\u00e1t tri\u1ec3n c\u00e1c ch\u1ee7ng vi khu\u1ea9n kh\u00e1ng thu\u1ed1c, b\u1ec7nh nh\u00e2n ph\u1ea3i \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn \u0111\u1ec3 b\u1eaft \u0111\u1ea7u li\u1ec7u tr\u00ecnh \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t. Hi\u1ec7n nay v\u1eabn c\u00f2n nhi\u1ec1u tranh c\u00e3i li\u00ean quan \u0111\u1ebfn v\u1ea5n \u0111\u1ec1 k\u00ea \u0111\u01a1n kh\u00e1ng sinh d\u00e0i ng\u00e0y. Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec3n h\u00ecnh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng n\u1ed9i nha l\u00e0 t\u1eeb 6 \u2013 10 ng\u00e0y.<\/p>\n

2. B\u0103ng thu\u1ed1c trong n\u1ed9i nha<\/h2>\n

S\u1ef1 ph\u1ee9c t\u1ea1p v\u1ec1 gi\u1ea3i ph\u1eabu c\u1ee7a h\u1ec7 th\u1ed1ng \u1ed1ng t\u1ee7y, \u0111\u1eb7c bi\u1ec7t l\u00e0 gi\u1ea3i ph\u1eabu v\u00f9ng ch\u00f3p khi\u1ebfn cho vi\u1ec7c lo\u1ea1i b\u1ecf ho\u00e0n to\u00e0n l\u01b0\u1ee3ng m\u00f4 t\u1ee7y v\u00e0 vi khu\u1ea9n c\u00f2n l\u1ea1i r\u1ea5t kh\u00f3 kh\u0103n, ngay c\u1ea3 khi \u0111\u00e3 \u00e1p d\u1ee5ng c\u00e1c k\u0129 thu\u1eadt cao nh\u1ea5t v\u1ec1 s\u1eeda so\u1ea1n c\u01a1 \u2013 h\u00f3a h\u1ecdc.<\/p>\n

\"kiem-soat-nhiem-trung-555\"
(a) H\u00ecnh \u1ea3nh qu\u00e9t tr\u00ean k\u00ednh hi\u1ec3n vi \u0111i\u1ec7n t\u1eed m\u1ed9t tr\u00e2m tay sau khi \u0111i qua l\u1ed7 ch\u00f3p, mang theo m\u00f9n ng\u00e0 t\u1eeb th\u00e0nh \u1ed1ng t\u1ee7y. \u0110\u1ed9 ph\u00f3ng \u0111\u1ea1i x120. (b) H\u00ecnh \u1ea3nh s\u1eed d\u1ee5ng k\u00ednh hi\u1ec3n vi hu\u1ef3nh quang c\u1ee7a l\u1edbp m\u00f9n v\u1edbi Candida albicans. Nh\u1eefng m\u1ea3nh v\u1ee5n n\u00e0y \u0111\u01b0\u1ee3c nhu\u1ed9m m\u00e0u v\u1edbi thu\u1ed1c nhu\u1ed9m m\u00e0u Live\/Dead, cho th\u1ea5y nh\u1eefng vi khu\u1ea9n s\u1ed1ng th\u00ec b\u1eaft m\u00e0u xanh l\u00e1 v\u00e0 vi khu\u1ea9n ch\u1ebft th\u00ec b\u1eaft m\u00e0u \u0111\u1ecf (c).<\/figcaption><\/figure>\n

Nhi\u1ec5m tr\u00f9ng \u1ed1ng t\u1ee7y l\u00e0 do nhi\u1ec1u ch\u1ee7ng vi khu\u1ea9n, bao g\u1ed3m c\u1ea3 vi khu\u1ea9n hi\u1ebfu kh\u00ed v\u00e0 k\u1ecb kh\u00ed, n\u00ean nhi\u1ec1u lo\u1ea1i thu\u1ed1c n\u1ed9i t\u1ee7y \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng \u0111\u1ec3 ho\u00e0n t\u1ea5t vi\u1ec7c ki\u1ec3m so\u00e1t nhi\u1ec5m tr\u00f9ng – kh\u1eed tr\u00f9ng. S\u1eed d\u1ee5ng kh\u00e1ng sinh t\u1ea1i ch\u1ed7 trong \u1ed1ng t\u1ee7y \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t \u0111\u1ec3 kh\u1eafc ph\u1ee5c nguy c\u01a1 ti\u1ec1m \u1ea9n t\u1eeb t\u00e1c d\u1ee5ng ph\u1ee5 c\u00f3 h\u1ea1i \u0111\u01b0\u1eddng to\u00e0n th\u00e2n v\u00e0 l\u00e0 m\u1ed9t h\u00ecnh th\u1ee9c ch\u1ee7 \u0111\u1ed9ng ph\u00e2n ph\u1ed1i thu\u1ed1c v\u00e0o nh\u1eefng r\u0103ng thi\u1ebfu h\u1ec7 tu\u1ea7n ho\u00e0n do ho\u1ea1i t\u1eed t\u1ee7y ho\u1eb7c kh\u00f4ng c\u00f2n t\u1ee7y.<\/p>\n

M\u1ed9t v\u00e0i b\u00e1o c\u00e1o \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 g\u1ea7n \u0111\u00e2y \u0111\u00e3 m\u00f4 t\u1ea3 s\u1ef1 t\u00e1i t\u1ea1o m\u1ea1ch m\u00e1u ho\u1eb7c t\u00e1i t\u1ea1o s\u1ef1 s\u1ed1ng cho nh\u1eefng r\u0103ng ch\u01b0a tr\u01b0\u1edfng th\u00e0nh b\u1ecb ho\u1ea1i t\u1eed t\u1ee7y. B\u00ean c\u1ea1nh s\u1eed d\u1ee5ng thu\u1ed1c kh\u1eed tr\u00f9ng n\u1ed9i nha kh\u00f4ng \u0111\u1eb7c hi\u1ec7u theo l\u1ed1i truy\u1ec1n th\u1ed1ng, nh\u1eefng b\u00e0i b\u00e1o c\u00e1o n\u00e0y c\u00f2n ghi nh\u1eadn vi\u1ec7c s\u1eed d\u1ee5ng kem kh\u00e1ng sinh h\u1ed7n h\u1ee3p (triple antibiotic paste (ciprofloxacin, metronidazole v\u00e0 minocycline)), calcium hydroxide ho\u1eb7c formocresol nh\u01b0 l\u00e0 thu\u1ed1c b\u0103ng n\u1ed9i t\u1ee7y gi\u1eefa c\u00e1c l\u1ea7n h\u1eb9n. Tr\u1ed9n h\u1ed7n h\u1ee3p kh\u00e1ng sinh v\u1edbi calcium hydroxide \u0111\u00f4i khi cho ph\u00e9p ti\u1ebfp t\u1ee5c l\u00e0m t\u0103ng \u0111\u1ed9 d\u00e0y v\u00e0 chi\u1ec1u d\u00e0i ch\u00e2n r\u0103ng, nh\u01b0ng v\u1edbi formocresol th\u00ec kh\u00f4ng c\u00f3 \u0111\u01b0\u1ee3c t\u00e1c d\u1ee5ng \u0111\u00f3.<\/p>\n

Hi\u1ec7u qu\u1ea3 kh\u00e1ng khu\u1ea9n c\u1ee7a c\u00e1c kh\u00e1ng sinh n\u1ed9i t\u1ee7y so v\u1edbi calcium hydroxide c\u1ea7n \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u th\u00eam, nh\u01b0ng s\u1ef1 ph\u1ed1i h\u1ee3p gi\u1eefa ch\u00fang d\u01b0\u1eddng nh\u01b0 c\u00f3 hi\u1ec7u qu\u1ea3 t\u1ed1t ch\u1ed1ng l\u1ea1i c\u00e1c y\u1ebfu t\u1ed1 g\u00e2y b\u1ec7nh trong n\u1ed9i nha. Calcium hydroxide l\u00e0 m\u1ed9t thu\u1ed1c b\u0103ng n\u1ed9i t\u1ee7y \u0111\u01b0\u1ee3c ch\u1ea5p nh\u1eadn r\u1ed9ng r\u00e3i nh\u1edd \u0111\u1eb7c t\u00ednh kh\u00e1ng khu\u1ea9n c\u1ee7a n\u00f3, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u0111\u1ed1i v\u1edbi vi khu\u1ea9n gram \u00e2m. Nh\u1eefng nghi\u00ean c\u1ee9u in vitro v\u00e0 in vivo cho th\u1ea5y n\u00f3 l\u00e0m gi\u1ea3m qu\u1ea7n th\u1ec3 vi khu\u1ea9n trong \u1ed1ng t\u1ee7y ho\u1eb7c \u00edt nh\u1ea5t th\u00ec c\u0169ng \u1ee9c ch\u1ebf s\u1ef1 gia t\u0103ng vi khu\u1ea9n. C\u00f3 m\u1ed9t v\u00e0i t\u00e1c gi\u1ea3 c\u00f2n \u0111ang tranh c\u00e3i l\u00e0 li\u1ec7u calcium hydroxide c\u00f3 hi\u1ec7u qu\u1ea3 lo\u1ea1i b\u1ecf Enterococcus faecalis hay kh\u00f4ng. C\u00f2n c\u00f3 nh\u1eefng nghi\u00ean c\u1ee9u kh\u00e1c \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 c\u1ee7a calcium hydroxide n\u1ed9i t\u1ee7y \u0111\u1ebfn t\u1ec9 l\u1ec7 \u0111au sau \u0111i\u1ec1u tr\u1ecb v\u00e0 th\u1ea5y r\u1eb1ng calcium hydroxide kh\u00f4ng th\u1ef1c s\u1ef1 hi\u1ec7u qu\u1ea3 trong vi\u1ec7c l\u00e0m gi\u1ea3m \u0111au khi s\u1eed d\u1ee5ng \u0111\u01a1n \u0111\u1ed9c, nh\u01b0ng hi\u1ec7u qu\u1ea3 c\u1ee7a n\u00f3 s\u1ebd t\u0103ng l\u00ean khi s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c nh\u01b0 chlorhexidine gluconate 2% v\u00e0 camphorated monochlorophenol. Ngo\u00e0i ra c\u00f3 m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u kh\u00e1c \u0111\u00e3 k\u1ebft lu\u1eadn r\u1eb1ng c\u00e1c thu\u1ed1c c\u00f3 ch\u1ee9a th\u00e0nh ph\u1ea7n corticosteroid th\u00ec t\u1ed1t h\u01a1n calcium hydroxide trong vi\u1ec7c l\u00e0m gi\u1ea3m \u0111au sau \u0111i\u1ec1u tr\u1ecb, \u0111i\u1ec1u n\u00e0y \u0111\u01b0\u1ee3c cho l\u00e0 nh\u1edd kh\u1ea3 n\u0103ng kh\u00e1ng vi\u00eam c\u1ee7a corticosteroid<\/p>\n

Ngu\u1ed3n: Clinical Guide for Optimal Treatment Outcome – Springer International Publishing Switzerland 2017<\/span><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Hai ph\u01b0\u01a1ng ph\u00e1p ki\u1ec3m so\u00e1t nhi\u1ec5m tr\u00f9ng trong b\u1ec7nh l\u00fd N\u1ed9i nha c\u00f3 th\u1ec3 k\u1ec3 \u0111\u1ebfn, bao g\u1ed3m s\u1eed d\u1ee5ng kh\u00e1ng sinh, c\u1ee5 th\u1ec3 nh\u01b0 kh\u00e1ng sinh to\u00e0n th\u00e2n \u0111\u01b0\u1ee3c khuy\u00ean d\u00f9ng trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 nhi\u1ec5m tr\u00f9ng lan r\u1ed9ng, \u0111\u1ed3ng th\u1eddi k\u1ebft h\u1ee3p v\u1edbi b\u0103ng thu\u1ed1c n\u1ed9i nha, nh\u01b0 nhi\u1ec1u lo\u1ea1i thu\u1ed1c n\u1ed9i t\u1ee7y […]<\/p>\n","protected":false},"author":21,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[28,33],"tags":[],"yoast_head":"\nPh\u01b0\u01a1ng ph\u00e1p ki\u1ec3m so\u00e1t nhi\u1ec5m tr\u00f9ng trong b\u1ec7nh l\u00fd N\u1ed9i nha.<\/title>\n<meta name=\"description\" content=\"Hai ph\u01b0\u01a1ng ph\u00e1p ki\u1ec3m so\u00e1t nhi\u1ec5m tr\u00f9ng N\u1ed9i nha c\u00f3 th\u1ec3 k\u1ec3 \u0111\u1ebfn, bao g\u1ed3m s\u1eed d\u1ee5ng kh\u00e1ng sinh k\u1ebft h\u1ee3p v\u1edbi b\u0103ng thu\u1ed1c n\u1ed9i nha. 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