{"id":29464,"date":"2023-05-02T09:10:07","date_gmt":"2023-05-02T02:10:07","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29464"},"modified":"2023-05-02T09:10:10","modified_gmt":"2023-05-02T02:10:10","slug":"benh-crohn-nguyen-tac-quan-ly-benh-crohn","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/02\/benh-crohn-nguyen-tac-quan-ly-benh-crohn\/","title":{"rendered":"B\u1ec7nh Crohn: Nguy\u00ean t\u1eafc qu\u1ea3n l\u00fd b\u1ec7nh Crohn"},"content":{"rendered":"

B\u1ec7nh Crohn c\u00f3 kh\u1edfi ph\u00e1t l\u00e2m s\u00e0ng r\u1ea5t \u0111a d\u1ea1ng, c\u00f3 th\u1ec3 g\u00e2y tri\u1ec7u ch\u1ee9ng \u1edf \u0111\u01b0\u1eddng ti\u00eau h\u00f3a v\u00e0 \u1edf c\u00e1c c\u01a1 quan n\u1eb1m ngo\u00e0i \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. T\u00f9y theo \u0111\u00e1nh gi\u00e1 c\u1ee7a nh\u00e0 l\u00e2m s\u00e0ng v\u1ec1 m\u1ee9c \u0111\u1ed9 v\u00e0 d\u1ea1ng kh\u1edfi ph\u00e1t c\u1ee7a b\u1ec7nh, c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn nhi\u1ec1u lo\u1ea1i thu\u1ed1c kh\u00e1c nhau \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh Crohn. D\u1ef1a tr\u00ean h\u01b0\u1edbng d\u1eabn c\u1ee7a Hi\u1ec7p h\u1ed9i Ti\u00eau H\u00f3a Hoa K\u1ef3, nguy\u00ean t\u1eafc qu\u1ea3n l\u00fd b\u1ec7nh Crohn nh\u1eb9 s\u1ebd \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u v\u00e0 b\u00e0n lu\u1eadn b\u00ean d\u01b0\u1edbi.<\/strong><\/p>\n

1. Tri\u1ec7u ch\u1ee9ng, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111\u00e1nh gi\u00e1 b\u1ec7nh Crohn<\/h2>\n

B\u1ec7nh Crohn (Crohn’s Disease – CD), c\u00f9ng v\u1edbi vi\u00eam lo\u00e9t \u0111\u1ea1i tr\u00e0ng (ulcerative colitis), l\u00e0 hai lo\u1ea1i ch\u00ednh c\u1ee7a nh\u00f3m b\u1ec7nh ru\u1ed9t vi\u00eam (inflammatory bowel disease \u2013 IBD). \u00a0IBD l\u00e0 nh\u00f3m b\u1ec7nh l\u00fd vi\u00eam m\u1ea1n t\u00ednh c\u1ee7a \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, c\u00f3 c\u01a1 ch\u1ebf b\u1ec7nh sinh r\u1ea5t ph\u1ee9c t\u1ea1p, nguy\u00ean nh\u00e2n v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh r\u00f5 r\u00e0ng. B\u1ec7nh Crohn l\u00e0 b\u1ec7nh l\u00fd th\u1ef1c th\u1ec3, m\u1ea1n t\u00ednh v\u00e0 ti\u1ebfn tri\u1ec3n trong h\u1ea7u h\u1ebft tr\u01b0\u1eddng h\u1ee3p.\u00a0<\/span><\/p>\n

B\u1ec7nh Crohn c\u00f3 kh\u1edfi ph\u00e1t r\u1ea5t \u0111a d\u1ea1ng v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng ch\u1ee7 \u0111\u1ea1o th\u1ec3 hi\u1ec7n t\u00ecnh tr\u1ea1ng vi\u00eam v\u00e0 t\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1eddng ti\u00eau h\u00f3a nh\u01b0: ti\u00eau ph\u00e2n l\u1ecfng, ch\u00e1n \u0103n, s\u1ee5t c\u00e2n, s\u1ed1t nh\u1eb9, h\u00ecnh th\u00e0nh l\u1ed7 r\u00f2, vi\u00eam lo\u00e9t d\u1ea1 d\u00e0y, \u00e1p t\u01a1 mi\u1ec7ng, ch\u00edt h\u1eb9p th\u1ef1c qu\u1ea3n. Tri\u1ec7u ch\u1ee9ng ngo\u00e0i h\u1ec7 ti\u00eau h\u00f3a c\u1ee7a CD c\u00f3 th\u1ec3 g\u1eb7p nh\u01b0: vi\u00eam kh\u1edbp\/\u0111au kh\u1edbp, vi\u00eam m\u00e0ng b\u1ed3 \u0111\u00e0o, thi\u1ebfu m\u00e1u, s\u1ecfi th\u1eadn, h\u1ed3ng ban da d\u1ea1ng n\u1ed1t, vi\u00eam da m\u1ee7 ho\u1ea1i t\u1eed. V\u1ecb tr\u00ed c\u1ee7a b\u1ec7nh c\u00f3 xu h\u01b0\u1edbng \u1ed5n \u0111\u1ecbnh nh\u01b0ng \u0111\u00f4i khi c\u00f3 th\u1ec3 lan r\u1ed9ng.<\/p>\n

Ch\u1ea9n \u0111o\u00e1n CD ch\u1ee7 y\u1ebfu d\u1ef1a v\u00e0o l\u00e2m s\u00e0ng, \u0111\u01b0\u1ee3c g\u1ee3i \u00fd t\u1eeb nh\u1eefng tri\u1ec7u ch\u1ee9ng nh\u01b0 tr\u00ean. Ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh v\u1edbi c\u00e1c b\u1eb1ng ch\u1ee9ng h\u00ecnh \u1ea3nh h\u1ecdc, quan s\u00e1t \u0111\u1ea1i th\u1ec3 qua n\u1ed9i soi v\u00e0 gi\u1ea3i ph\u1eabu b\u1ec7nh h\u1ecdc. C\u00e1c d\u1ea5u hi\u1ec7u h\u00f3a sinh th\u01b0\u1eddng kh\u00f4ng d\u00f9ng \u0111\u01a1n \u0111\u1ed9c \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n m\u00e0 c\u00f3 gi\u00e1 tr\u1ecb trong theo d\u00f5i \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd CD.<\/p>\n

\u0110\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 b\u1ec7nh, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng c\u00f4ng c\u1ee5 Ch\u1ec9 s\u1ed1 ho\u1ea1t \u0111\u1ed9ng c\u1ee7a b\u1ec7nh Crohn (Crohn’s Disease Activity Index – CDAI). \u0110\u00e2y c\u0169ng l\u00e0 c\u00f4ng c\u1ee5 \u0111\u01b0\u1ee3c d\u00f9ng ph\u1ed5 bi\u1ebfn tr\u00ean to\u00e0n th\u1ebf gi\u1edbi v\u00e0 \u0111\u01b0\u1ee3c Hi\u1ec7p h\u1ed9i Ti\u00eau H\u00f3a Hoa K\u1ef3 (ACG) s\u1eed d\u1ee5ng trong khuy\u1ebfn c\u00e1o v\u1ec1 \u0111i\u1ec1u tr\u1ecb CD. V\u1ec1 \u0111\u00e1nh gi\u00e1 h\u00ecnh th\u00e1i c\u1ee7a b\u1ec7nh, th\u01b0\u1eddng d\u00f9ng thang ph\u00e2n lo\u1ea1i Montreal cho CD \u0111\u1ec3 \u0111\u00e1nh gi\u00e1. Thang ph\u00e2n lo\u1ea1i n\u00e0y c\u0169ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o trong khuy\u1ebfn c\u00e1o c\u1ee7a ACG trong \u0111i\u1ec1u tr\u1ecb CD. C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a CD kh\u00f4ng nh\u1ea5t thi\u1ebft ph\u1ea3i t\u01b0\u01a1ng x\u1ee9ng v\u1edbi t\u1ed5n th\u01b0\u01a1ng th\u1ef1c th\u1ec3 c\u1ee7a b\u1ec7nh. Do v\u1eady, kh\u00f4ng th\u1ec3 s\u1eed d\u1ee5ng tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng l\u00e0 c\u00f4ng c\u1ee5 theo d\u00f5i duy nh\u1ea5t trong \u0111i\u1ec1u tr\u1ecb CD. B\u00e0i vi\u1ebft chi ti\u1ebft v\u1ec1 c\u00e1ch \u0111\u00e1nh gi\u00e1 CD theo CDAI v\u00e0 ph\u00e2n lo\u1ea1i Montreal \u0111\u00e3 c\u00f3 tr\u00ean chuy\u00ean trang VinmecDr<\/a>.<\/p>\n

2. Nguy\u00ean t\u1eafc qu\u1ea3n l\u00fd b\u1ec7nh Crohn<\/h2>\n

2.1 Nguy\u00ean t\u1eafc qu\u1ea3n l\u00fd b\u1ec7nh Crohn<\/h3>\n

Ch\u1ebf \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb cho m\u1ed7i b\u1ec7nh nh\u00e2n m\u1eafc CD \u0111\u01b0\u1ee3c x\u00e2y d\u1ef1ng d\u1ef1a tr\u00ean v\u1ecb tr\u00ed ph\u00e2n b\u1ed1 ch\u1ee7 y\u1ebfu c\u1ee7a t\u1ed5n th\u01b0\u01a1ng, m\u1ee9c \u0111\u1ed9 c\u1ee7a b\u1ec7nh, c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a b\u1ec7nh v\u00e0 ti\u00ean l\u01b0\u1ee3ng v\u1ec1 di\u1ec5n ti\u1ebfn c\u1ee7a b\u1ec7nh trong t\u01b0\u01a1ng lai. \u0110\u1ed3ng th\u1eddi, ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb c\u0169ng c\u1ea7n c\u00e1 th\u1ec3 h\u00f3a d\u1ef1a tr\u00ean \u0111\u00e1p \u1ee9ng, dung n\u1ea1p v\u1edbi \u0111i\u1ec1u tr\u1ecb v\u00e0 s\u1ef1 s\u1eb5n c\u00f3 c\u1ee7a c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u1edf m\u1ed7i c\u01a1 s\u1edf y t\u1ebf.<\/p>\n

Nh\u00ecn chung, c\u00e1c m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb CD bao g\u1ed3m: \u0111\u1ea1t \u0111\u01b0\u1ee3c lui b\u1ec7nh, duy tr\u00ec lui b\u1ec7nh v\u00e0 qu\u1ea3n l\u00fd c\u00e1c \u0111\u1ee3t t\u00e1i ph\u00e1t. M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb c\u00f3 nhi\u1ec1u ti\u00eau ch\u00ed, bao g\u1ed3m c\u1ea3 c\u1ea3i thi\u1ec7n m\u1ee9c \u0111\u1ed9 b\u1ec7nh d\u1ef1a tr\u00ean c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng, \u00a0s\u1ef1 h\u1ed3i ph\u1ee5c c\u1ee7a ni\u00eam m\u1ea1c \u0111\u1ea1i tr\u00e0ng – \u0111\u00e1nh gi\u00e1 qua n\u1ed9i soi sau \u0111i\u1ec1u tr\u1ecb hay s\u1ef1 c\u1ea3i thi\u1ec7n b\u1ec7nh d\u1ef1a tr\u00ean c\u00e1c th\u00f4ng s\u1ed1 sinh h\u00f3a (CRP m\u00e1u hay calprotectin trong ph\u00e2n). \u0110\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n v\u1edbi \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u, c\u00e1c b\u1eb1ng ch\u1ee9ng kh\u00e1c quan nh\u01b0 h\u00ecnh n\u1ed9i soi, CT hay MRI n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n tr\u01b0\u1edbc khi x\u00e2y d\u1ef1ng chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ti\u1ebfp t\u1ee5c. Trong giai \u0111o\u1ea1n \u0111\u1ea7u c\u1ee7a \u0111i\u1ec1u tr\u1ecb, khi c\u1ea7n \u0111\u1ea1t \u0111\u01b0\u1ee3c lui b\u1ec7nh, c\u00e1c gi\u00e1 tr\u1ecb sinh h\u00f3a n\u00eau tr\u00ean c\u00f3 th\u1ec3 h\u1ed3i ph\u1ee5c s\u1edbm h\u01a1n c\u00e1c t\u1ed5n th\u01b0\u01a1ng th\u1ef1c th\u1ec3 \u1edf ru\u1ed9t, \u0111\u1eb7c bi\u1ec7t khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c thu\u1ed1c sinh h\u1ecdc (nh\u01b0 anti-TNF).<\/p>\n

Ch\u00fa \u00fd c\u00e1c t\u00ecnh tr\u1ea1ng c\u00f3 th\u1ec3 g\u00e2y ra nh\u1eefng tri\u1ec7u ch\u1ee9ng t\u01b0\u01a1ng t\u1ef1 CD, c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb nh\u01b0: nhi\u1ec5m Clostridium difficile, cytomegalovirus (CMV)….C\u00e1c t\u00ecnh tr\u1ea1ng n\u00e0y c\u00f3 th\u1ec3 l\u00e0m sai l\u1ec7ch \u0111\u00e1nh gi\u00e1 c\u1ee7a nh\u00e0 l\u00e2m s\u00e0ng v\u1ec1 \u0111\u00e1p \u1ee9ng c\u1ee7a b\u1ec7nh.<\/p>\n

\u0110i\u1ec1u tr\u1ecb b\u1ec7nh Crohn c\u1ea7n \u0111i\u1ec1u tr\u1ecb to\u00e0n di\u1ec7n. C\u00e1c y\u1ebfu t\u1ed1 \u0111\u1ed3ng m\u1eafc, c\u00e1c bi\u1ebfn ch\u1ee9ng \u1edf h\u1ec7 ti\u00eau h\u00f3a hay ngo\u00e0i ti\u00eau h\u00f3a c\u1ee7a CD c\u0169ng c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb, t\u1eeb \u0111\u00f3 thi\u1ebft l\u1eadp chi\u1ebfn l\u01b0\u1ee3c ph\u00f9 h\u1ee3p, ph\u1ed1i h\u1ee3p c\u00e1c lo\u1ea1i thu\u1ed1c hay can thi\u1ec7p ngo\u1ea1i khoa khi c\u1ea7n thi\u1ebft<\/p>\n

\"Nhieu-loai-thuoc-duoc-dung-trong-viem-loet-dai-trang\"<\/p>\n

2.2 Nh\u1eefng khuy\u1ebfn c\u00e1o chung<\/h3>\n
    \n
  • C\u00e1c thu\u1ed1c kh\u00e1ng vi\u00eam kh\u00f4ng ph\u1ea3i steroid (NSAID) c\u00f3 th\u1ec3 l\u00e0m t\u0103ng n\u1eb7ng m\u1ee9c \u0111\u1ed9 b\u1ec7nh v\u00e0 n\u00ean tr\u00e1nh khi c\u00f3 th\u1ec3 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n CD (khuy\u1ebfn c\u00e1o m\u1ea1nh, b\u1eb1ng ch\u1ee9ng th\u1ea5p). S\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i NSAID, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c lo\u1ea1i NSAID kh\u00f4ng ch\u1ecdn l\u1ecdc c\u00f3 nguy c\u01a1 cao g\u00e2y t\u00e1i ph\u00e1t hay l\u00e0m n\u1eb7ng CD. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u cho th\u1ea5y s\u1eed d\u1ee5ng NSAID ch\u1ecdn l\u1ecdc COX-2 ng\u1eafn ng\u00e0y kh\u00f4ng l\u00e0m n\u1eb7ng th\u00eam b\u1ec7nh l\u00fd vi\u00eam lo\u00e9t \u0111\u1ea1i tr\u00e0ng, nh\u01b0ng ch\u01b0a c\u00f3 b\u1eb1ng ch\u1ee9ng t\u01b0\u01a1ng t\u1ef1 tr\u00ean b\u1ec7nh nh\u00e2n CD<\/li>\n
  • H\u00fat thu\u1ed1c l\u00e1 c\u00f3 th\u1ec3 l\u00e0m l\u00e0m t\u0103ng n\u1eb7ng v\u00e0 th\u00fac \u0111\u1ea9y t\u00e1i ph\u1ea3i b\u1ec7nh, v\u00ec th\u1ebf n\u00ean tr\u00e1nh \u1edf b\u1ec7nh nh\u00e2n CD. (khuy\u1ebfn c\u00e1o m\u1ea1nh, b\u1eb1ng ch\u1ee9ng th\u1ea5p). Nhi\u1ec1u b\u1eb1ng ch\u1ee9ng ch\u1ec9 ra vi\u1ec7c ng\u1eebng thu\u1ed1c l\u00e0 c\u00f3 l\u1ee3i \u1edf b\u1ec7nh nh\u00e2n CD.<\/li>\n
  • Kh\u00f4ng n\u00ean tr\u00e1nh s\u1eed d\u1ee5ng kh\u00e1ng sinh ch\u1ec9 \u0111\u1ec3 ng\u0103n ch\u1eb7n CD b\u00f9ng ph\u00e1t (khuy\u1ebfn c\u00e1o c\u00f3 \u0111i\u1ec1u ki\u1ec7n, m\u1ee9c \u0111\u1ed9 b\u1eb1ng ch\u1ee9ng r\u1ea5t th\u1ea5p)<\/li>\n
  • \u0110\u00e1nh gi\u00e1 v\u00e0 qu\u1ea3n l\u00fd stress, tr\u1ea7m c\u1ea3m v\u00e0 lo l\u1eafng c\u0169ng n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n CD (khuy\u1ebfn c\u00e1o m\u1ea1nh, b\u1eb1ng ch\u1ee9ng r\u1ea5t th\u1ea5p). \u0110\u00e2y l\u00e0 c\u00e1c t\u00ecnh tr\u1ea1ng th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n m\u1eafc CD, c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n c\u0169ng, tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb v\u00e0 k\u1ebft c\u1ee5c chung c\u1ee7a b\u1ec7nh.<\/li>\n<\/ul>\n

     <\/p>\n

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

    B\u1ec7nh Crohn c\u00f3 kh\u1edfi ph\u00e1t l\u00e2m s\u00e0ng r\u1ea5t \u0111a d\u1ea1ng, c\u00f3 th\u1ec3 g\u00e2y tri\u1ec7u ch\u1ee9ng \u1edf \u0111\u01b0\u1eddng ti\u00eau h\u00f3a v\u00e0 \u1edf c\u00e1c c\u01a1 quan n\u1eb1m ngo\u00e0i \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. T\u00f9y theo \u0111\u00e1nh gi\u00e1 c\u1ee7a nh\u00e0 l\u00e2m s\u00e0ng v\u1ec1 m\u1ee9c \u0111\u1ed9 v\u00e0 d\u1ea1ng kh\u1edfi ph\u00e1t c\u1ee7a b\u1ec7nh, c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn nhi\u1ec1u lo\u1ea1i thu\u1ed1c kh\u00e1c nhau […]<\/p>\n","protected":false},"author":37,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[5,33],"tags":[],"yoast_head":"\nB\u1ec7nh Crohn: Nguy\u00ean t\u1eafc qu\u1ea3n l\u00fd b\u1ec7nh Crohn - Vinmec<\/title>\n<meta name=\"description\" content=\"D\u1ef1a tr\u00ean h\u01b0\u1edbng d\u1eabn c\u1ee7a Hi\u1ec7p h\u1ed9i Ti\u00eau H\u00f3a Hoa K\u1ef3, nguy\u00ean t\u1eafc qu\u1ea3n l\u00fd b\u1ec7nh Crohn nh\u1eb9 s\u1ebd \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u v\u00e0 b\u00e0n lu\u1eadn\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"B\u1ec7nh Crohn: Nguy\u00ean t\u1eafc qu\u1ea3n l\u00fd b\u1ec7nh Crohn - 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