{"id":30293,"date":"2023-05-04T08:08:45","date_gmt":"2023-05-04T01:08:45","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30293"},"modified":"2023-05-04T08:08:45","modified_gmt":"2023-05-04T01:08:45","slug":"su-dung-thuoc-dmards-theo-huong-dan-cua-bo-y-te","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/su-dung-thuoc-dmards-theo-huong-dan-cua-bo-y-te\/","title":{"rendered":"S\u1eed d\u1ee5ng thu\u1ed1c DMARDs theo h\u01b0\u1edbng d\u1eabn c\u1ee7a B\u1ed9 Y T\u1ebf"},"content":{"rendered":"<p><strong>C\u00e1c thu\u1ed1c c\u00f3 t\u00ean th\u00f4ng d\u1ee5ng l\u00e0 DMARDs \u0111\u01b0\u1ee3c k\u1ef3 v\u1ecdng l\u00e0 c\u00e1c thu\u1ed1c ch\u1ed1ng th\u1ea5p kh\u1edbp c\u00f3 th\u1ec3 l\u00e0m thay \u0111\u1ed5i ti\u1ebfn tr\u00ecnh b\u1ec7nh v\u00e0 l\u00e0 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb c\u01a1 b\u1ea3n. C\u00f3 hai lo\u1ea1i DMARDs: DMARDs c\u1ed5 \u0111i\u1ec3n v\u00e0 DMARDs sinh h\u1ecdc. C\u00f9ng t\u00ecm hi\u1ec3u c\u00e1ch s\u1eed d\u1ee5ng thu\u1ed1c theo h\u01b0\u1edbng d\u1eabn c\u1ee7a B\u1ed9 Y T\u1ebf.<\/strong><\/p>\n<h2>1. Nh\u00f3m DMARDs c\u1ed5 \u0111i\u1ec3n<\/h2>\n<p>Nh\u00f3m DMARDs c\u1ed5 \u0111i\u1ec3n bao g\u1ed3m c\u00e1c thu\u1ed1c ch\u1ed1ng s\u1ed1t r\u00e9t t\u1ed5ng h\u1ee3p (hydroxychloroquin ho\u1eb7c quinacrin hydrochlorid, <a href=\"https:\/\/www.vinmec.com\/vi\/thong-tin-duoc\/su-dung-thuoc-toan\/methotrexate-va-nhung-chu-y-khi-su-dung\/\">methotrexat<\/a>; sulfasalazin; leflunomid; cyclosporin A). Trong s\u1ed1 c\u00e1c thu\u1ed1c nh\u00f3m DMARDs kinh \u0111i\u1ec3n, methotrexat th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nhi\u1ec1u nh\u1ea5t, do \u0111\u00f3 ch\u00fang t\u00f4i tr\u00ecnh b\u00e0y h\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng thu\u1ed1c n\u00e0y. Quy tr\u00ecnh s\u1eed d\u1ee5ng, theo d\u00f5i c\u00e1c thu\u1ed1c kh\u00e1c (tr\u1eeb thu\u1ed1c ch\u1ed1ng s\u1ed1t r\u00e9t<br \/>\nt\u1ed5ng h\u1ee3p) t\u01b0\u01a1ng t\u1ef1 nh\u01b0 methotrexat.<br \/>\nThu\u1ed1c DMARDs c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111\u01a1n \u0111\u1ed9c ho\u1eb7c k\u1ebft h\u1ee3p hai ho\u1eb7c nhi\u1ec1u thu\u1ed1c trong nh\u00f3m.<\/p>\n<h3>1.1. C\u00e1c thu\u1ed1c ch\u1ed1ng s\u1ed1t r\u00e9t t\u1ed5ng h\u1ee3p<\/h3>\n<p><strong><em>(Hydroxychloroquin ho\u1eb7c quinacrin hydrochlorid)<\/em><\/strong><\/p>\n<p>\u2212 Li\u1ec1u d\u00f9ng: 200-600mg\/ng\u00e0y, \u1edf Vi\u1ec7t Nam th\u01b0\u1eddng d\u00f9ng 200mg\/ng\u00e0y.<br \/>\n\u2212 Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh: Ng\u01b0\u1eddi c\u00f3 suy gi\u1ea3m G6PD (glucose-6 phosphate dehydrogenase) ho\u1eb7c c\u00f3 t\u1ed5n th\u01b0\u01a1ng gan. C\u00e2n nh\u1eafc l\u1ee3i-h\u1ea1i \u1edf b\u1ec7nh nh\u00e2n c\u00f3 thai (m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u cho th\u1ea5y c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng hydroxychloroquin \u1edf b\u1ec7nh nh\u00e2n lupus c\u00f3 thai m\u00e0 kh\u00f4ng g\u00e2y c\u00e1c d\u1ecb t\u1eadt \u1edf tr\u1ebb s\u01a1 sinh).<br \/>\n\u2212 C\u1ea7n ki\u1ec3m tra th\u1ecb l\u1ef1c, th\u1ecb tr\u01b0\u1eddng, soi \u0111\u00e1y m\u1eaft m\u1ed7i 6 th\u00e1ng v\u00e0 kh\u00f4ng d\u00f9ng qu\u00e1 5<br \/>\nn\u0103m nh\u1eb1m tr\u00e1nh t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n \u0111\u1ed1i v\u1edbi m\u1eaft: Thu\u1ed1c g\u00e2y vi\u00eam t\u1ed5 ch\u1ee9c l\u01b0\u1edbi \u1edf v\u00f5ng m\u1ea1c kh\u00f4ng h\u1ed3i ph\u1ee5c, d\u1eabn \u0111\u1ebfn m\u1ea5t th\u1ecb l\u1ef1c kh\u00f4ng h\u1ed3i ph\u1ee5c.<br \/>\n\u2212 C\u1ea7n u\u1ed1ng thu\u1ed1c v\u00e0o bu\u1ed5i t\u1ed1i nh\u1eb1m tr\u00e1nh \u00e1nh n\u1eafng, g\u00e2y x\u1ea1m da.<\/p>\n<h3>1.2. Methotrexat<\/h3>\n<p>C\u00e1c x\u00e9t nghi\u1ec7m c\u1ea7n ti\u1ebfn h\u00e0nh tr\u01b0\u1edbc khi cho thu\u1ed1c v\u00e0 ki\u1ec3m tra h\u00e0ng th\u00e1ng th\u1eddi gian d\u00f9ng thu\u1ed1c:<\/p>\n<ul>\n<li>\u00a0T\u1ebf b\u00e0o m\u00e1u ngo\u1ea1i vi, t\u1ed1c \u0111\u1ed9 m\u00e1u l\u1eafng, CRP.<\/li>\n<li>\u00a0Enzym gan, ch\u1ee9c n\u0103ng gan (T\u1ef7 l\u1ec7 prothrombin v\u00e0 albumin huy\u1ebft thanh).<\/li>\n<li>\u00a0Ch\u1ee9c n\u0103ng th\u1eadn (\u00edt nh\u1ea5t c\u1ea7n x\u00e9t nghi\u1ec7m creatinin huy\u1ebft thanh).<\/li>\n<li>\u00a0Xquang ph\u1ed5i th\u1eb3ng (v\u00e0 \u0111o ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p n\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n).<\/li>\n<\/ul>\n<p>C\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u1ea7n l\u01b0u \u00fd:<\/p>\n<ul>\n<li>Kh\u00f4ng ch\u1ec9 \u0111\u1ecbnh \u0111\u1ed1i v\u1edbi ph\u1ee5 n\u1eef \u1edf tu\u1ed5i sinh \u0111\u1ebb, ho\u1eb7c nam gi\u1edbi c\u00f3 v\u1ee3 \u1edf tu\u1ed5i sinh \u0111\u1ebb m\u00e0 kh\u00f4ng c\u00f3 bi\u1ec7n ph\u00e1p tr\u00e1nh thai h\u1eefu hi\u1ec7u. B\u1ec7nh nh\u00e2n ho\u1eb7c v\u1ee3 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 mang thai n\u1ebfu ng\u1eebng methotrexat \u00edt nh\u1ea5t 2 th\u00e1ng (c\u00e1c thu\u1ed1c kh\u00e1c thu\u1ed9c nh\u00f3m DMARDs c\u1ed5 \u0111i\u1ec3n c\u00f3 th\u1eddi gian ng\u1eebng thu\u1ed1c d\u00e0i h\u01a1n, v\u00ed d\u1ee5 leflunomid ph\u1ea3i ng\u1eebng thu\u1ed1c \u00edt nh\u1ea5t 2 n\u0103m).<\/li>\n<li>N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh ph\u1ed5i m\u1ea1n t\u00ednh th\u00ec kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh methotrexat. N\u00ean \u0111o ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p tr\u01b0\u1edbc khi ch\u1ec9 \u0111\u1ecbnh methotrexat \u0111\u1ec3 kh\u1eb3ng \u0111\u1ecbnh l\u00e0 ch\u1ee9c n\u0103ng ph\u1ed5i b\u00ecnh th\u01b0\u1eddng. C\u1ea7n ch\u1ee5p l\u1ea1i ph\u1ed5i m\u1ed7i khi c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p. N\u1ebfu c\u00f3 tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p m\u1ea1n t\u00ednh c\u1ea7n ng\u1eebng methotrexat, chuy\u1ec3n d\u00f9ng c\u00e1c thu\u1ed1c thu\u1ed9c nh\u00f3m DMARDs c\u1ed5 \u0111i\u1ec3n kh\u00e1c.<\/li>\n<li>T\u1ebf b\u00e0o m\u00e1u ngo\u1ea1i vi: Kh\u00f4ng cho thu\u1ed1c ho\u1eb7c c\u1ea7n ng\u1eebng thu\u1ed1c khi s\u1ed1 l\u01b0\u1ee3ng<br \/>\nb\u1ea1ch c\u1ea7u d\u01b0\u1edbi 4G\/mm3 ho\u1eb7c b\u1ea1ch c\u1ea7u lympho d\u01b0\u1edbi 1,5 G\/mm3.<\/li>\n<li>Ch\u1ee9c n\u0103ng gan (t\u1ef7 l\u1ec7 prothrombin v\u00e0 albumin huy\u1ebft thanh). Kh\u00f4ng ch\u1ec9 \u0111\u1ecbnh khi b\u1ec7nh nh\u00e2n suy t\u1ebf b\u00e0o gan ho\u1eb7c enzym gan cao. C\u1ea7n ng\u1eebng thu\u1ed1c khi enzym gan cao g\u1ea5p \u0111\u00f4i tr\u1ecb s\u1ed1 b\u00ecnh th\u01b0\u1eddng.<\/li>\n<li>Ch\u1ee9c n\u0103ng th\u1eadn: Kh\u00f4ng ch\u1ec9 \u0111\u1ecbnh khi b\u1ec7nh nh\u00e2n suy th\u1eadn.<\/li>\n<li>Do methotrexat c\u00f3 c\u1ea5u tr\u00fac t\u01b0\u01a1ng t\u1ef1 acid folic, c\u01a1 ch\u1ebf ch\u00ednh c\u1ee7a thu\u1ed1c l\u00e0 tranh ch\u1ea5p v\u1edbi v\u1ecb tr\u00ed ho\u1ea1t \u0111\u1ed9ng c\u1ee7a acid folic trong qu\u00e1 tr\u00ecnh t\u1ed5ng h\u1ee3p pyrimidin, d\u1eabn \u0111\u1ebfn gi\u1ea3m t\u1ed5ng h\u1ee3p DNA n\u00ean c\u1ea7n b\u1ed5 sung acid folic v\u1edbi li\u1ec1u t\u01b0\u01a1ng \u0111\u01b0\u01a1ng methotrexat nh\u1eb1m tr\u00e1nh thi\u1ebfu m\u00e1u.<\/li>\n<\/ul>\n<figure id=\"attachment_30312\" aria-describedby=\"caption-attachment-30312\" style=\"width: 255px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-30312 size-full\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/tai-xuong-1-3.jpg\" alt=\"thuoc-DMARDs\" width=\"255\" height=\"198\" \/><figcaption id=\"caption-attachment-30312\" class=\"wp-caption-text\">L\u01b0u \u00fd khi d\u00f9ng nh\u00f3m DMARDs c\u1ed5 \u0111i\u1ec3n<\/figcaption><\/figure>\n<p>Li\u1ec1u methotrexat: Trung b\u00ecnh 10 &#8211; 20mg m\u1ed7i tu\u1ea7n (5-20mg\/tu\u1ea7n) ti\u00eam b\u1eafp ho\u1eb7c u\u1ed1ng. Th\u01b0\u1eddng kh\u1edfi \u0111\u1ea7u b\u1eb1ng li\u1ec1u 10mg m\u1ed7i tu\u1ea7n.<\/p>\n<p>Ch\u1ebf ph\u1ea9m: Methotrexat d\u1ea1ng 2,5mg\/vi\u00ean, \u1ed1ng ti\u00eam b\u1eafp 10mg ho\u1eb7c 15mg.<\/p>\n<p>C\u00e1ch d\u00f9ng: Th\u01b0\u1eddng kh\u1edfi \u0111\u1ea7u b\u1eb1ng \u0111\u01b0\u1eddng u\u1ed1ng v\u1edbi li\u1ec1u 10mg\/tu\u1ea7n. N\u00ean u\u1ed1ng m\u1ed9t l\u1ea7n c\u1ea3 li\u1ec1u v\u00e0o m\u1ed9t ng\u00e0y c\u1ed1 \u0111\u1ecbnh trong tu\u1ea7n. Tr\u01b0\u1eddng h\u1ee3p k\u00e9m hi\u1ec7u qu\u1ea3 ho\u1eb7c k\u00e9m dung n\u1ea1p, c\u00f3 th\u1ec3 d\u00f9ng \u0111\u01b0\u1eddng ti\u00eam b\u1eafp ho\u1eb7c ti\u00eam d\u01b0\u1edbi da, m\u1ed7i tu\u1ea7n ti\u00eam m\u1ed9t m\u0169i duy nh\u1ea5t v\u00e0o m\u1ed9t ng\u00e0y c\u1ed1 \u0111\u1ecbnh trong tu\u1ea7n.<br \/>\nLi\u1ec1u methotrexat c\u00f3 th\u1ec3 t\u0103ng ho\u1eb7c gi\u1ea3m tu\u1ef3 hi\u1ec7u qu\u1ea3 \u0111\u1ea1t \u0111\u01b0\u1ee3c.<br \/>\nD\u00f9ng k\u00e9o d\u00e0i n\u1ebfu c\u00f3 hi\u1ec7u qu\u1ea3 v\u00e0 d\u1ee5ng n\u1ea1p t\u1ed1t. Hi\u1ec7u qu\u1ea3 th\u01b0\u1eddng \u0111\u1ea1t \u0111\u01b0\u1ee3c sau 1-2 th\u00e1ng, do \u0111\u00f3 th\u01b0\u1eddng duy tr\u00ec li\u1ec1u \u0111\u00e3 ch\u1ecdn trong m\u1ed7i 1- 2 th\u00e1ng m\u1edbi ch\u1ec9nh li\u1ec1u. Khi c\u00e1c tri\u1ec7u ch\u1ee9ng \u0111\u00e3 thuy\u00ean gi\u1ea3m, c\u00f3 th\u1ec3 gi\u1ea3m li\u1ec1u c\u00e1c thu\u1ed1c k\u1ebft h\u1ee3p: l\u1ea7n l\u01b0\u1ee3t gi\u1ea3m li\u1ec1u corticoid, thay b\u1eb1ng ch\u1ed1ng vi\u00eam kh\u00f4ng steroid, thu\u1ed1c gi\u1ea3m \u0111au gi\u1ea3m cu\u1ed1i c\u00f9ng. Thu\u1ed1c th\u01b0\u1eddng duy tr\u00ec nhi\u1ec1u n\u0103m, th\u1eadm ch\u00ed su\u1ed1t \u0111\u1eddi. Tuy nhi\u00ean, sau m\u1ed9t giai \u0111o\u1ea1n \u1ed5n \u0111\u1ecbnh k\u00e9o d\u00e0i, th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n t\u00ecnh tr\u1ea1ng \u201ckh\u00e1ng\u201d methotrexat. N\u1ebfu kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3 n\u00ean k\u1ebft h\u1ee3p ho\u1eb7c \u0111\u1ed5i c\u00e1c thu\u1ed1c kh\u00e1c trong nh\u00f3m.<\/p>\n<p>Thu\u1ed1c k\u1ebft h\u1ee3p: Th\u01b0\u1eddng k\u1ebft h\u1ee3p methotrexat v\u1edbi thu\u1ed1c ch\u1ed1ng s\u1ed1t r\u00e9t t\u1ed5ng h\u1ee3p nh\u1eb1m t\u0103ng hi\u1ec7u qu\u1ea3 v\u00e0 gi\u1ea3m t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a methotrexat tr\u00ean gan. C\u1ea7n b\u1ed5 sung acid folic (li\u1ec1u t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi li\u1ec1u methotrexat) nh\u1eb1m gi\u1ea3m thi\u1ec3u t\u00e1c d\u1ee5ng ph\u1ee5 v\u1ec1 m\u00e1u, kh\u00f4ng n\u00ean u\u1ed1ng acid folic v\u00e0o ng\u00e0y u\u1ed1ng methotrexat.<br \/>\nV\u00ed d\u1ee5 c\u1ee5 th\u1ec3:<br \/>\n\u2212 Methotrexat vi\u00ean 2,5mg , 4 vi\u00ean m\u1ed7i tu\u1ea7n, u\u1ed1ng m\u1ed9t l\u1ea7n duy nh\u1ea5t v\u00e0o th\u1ee9 2 h\u00e0ng tu\u1ea7n.<br \/>\n\u2212 Acid folic vi\u00ean 5mg: u\u1ed1ng th\u1ee9 4 v\u00e0 th\u1ee9 6 h\u00e0ng tu\u1ea7n, m\u1ed7i ng\u00e0y u\u1ed1ng 1 vi\u00ean 5mg.<\/p>\n<h2>2. DMARDS Sinh h\u1ecdc<\/h2>\n<p>\u0110i\u1ec1u tr\u1ecb sinh h\u1ecdc (Biological therapy) l\u00e0 tr\u1ecb li\u1ec7u s\u1eed d\u1ee5ng c\u00e1c t\u00e1c nh\u00e2n sinh h\u1ecdc nh\u1eb1m k\u00edch th\u00edch ho\u1eb7c kh\u00f4i ph\u1ee5c l\u1ea1i kh\u1ea3 n\u0103ng c\u1ee7a h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch ho\u1eb7c t\u00e1c \u0111\u1ed9ng tr\u1ef1c ti\u1ebfp tr\u00ean b\u1ec7nh t\u01b0\u01a1ng t\u1ef1 nh\u01b0 \u0111\u00e1p \u1ee9ng c\u1ee7a h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch nh\u1eb1m m\u1ee5c \u0111\u00edch b\u1ea3o v\u1ec7 c\u01a1 th\u1ec3 ch\u1ed1ng l\u1ea1i nhi\u1ec5m tr\u00f9ng, b\u1ec7nh t\u1eadt.<\/p>\n<p>\u2212 C\u00e1c thu\u1ed1c hi\u1ec7n c\u00f3 t\u1ea1i Vi\u1ec7t Nam:<br \/>\n+ Nh\u00f3m kh\u00e1ng TNF-\u03b1: etanercept, infliximab\u2026<br \/>\n+ Nh\u00f3m \u1ee9c ch\u1ebf t\u1ebf b\u00e0o lympho B: rituximab.<br \/>\n+ Nh\u00f3m \u1ee9c ch\u1ebf Interleukin 6: tocilizumab.<\/p>\n<p>\u2212 Ch\u1ec9 \u0111\u1ecbnh trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh t\u1ef1 mi\u1ec5n (<a href=\"https:\/\/vinmecdr.com\/viem-khop-dang-thap-tu-chan-doan-den-dieu-tri\/\">vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p<\/a>, lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng, vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp, th\u1ea5p kh\u1edbp v\u1ea9y n\u1ebfn, &#8230;) kh\u00e1ng v\u1edbi c\u00e1c \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng. \u0110\u1ed1i v\u1edbi b\u1ec7nh vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p, th\u01b0\u1eddng v\u1eabn k\u1ebft h\u1ee3p v\u1edbi methotrexat n\u1ebfu kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh. G\u1ea7n \u0111\u00e2y nh\u00f3m thu\u1ed1c n\u00e0y \u0111\u01b0\u1ee3c nhi\u1ec1u t\u00e1c gi\u1ea3 khuy\u1ebfn kh\u00edch s\u1eed d\u1ee5ng s\u1edbm nh\u1eb1m tr\u00e1nh c\u00e1c t\u1ed5n th\u01b0\u01a1ng ph\u00e1 h\u1ee7y kh\u1edbp.<\/p>\n<p>\u2212 C\u00e1c thu\u1ed1c nh\u00f3m n\u00e0y n\u00f3i chung kh\u00e1 an to\u00e0n n\u1ebfu \u0111\u01b0\u1ee3c theo d\u00f5i, qu\u1ea3n l\u00fd t\u1ed1t. T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n \u0111\u00e1ng ng\u1ea1i nh\u1ea5t c\u1ee7a c\u00e1c thu\u1ed1c n\u00e0y l\u00e0 lao v\u00e0 c\u00e1c nhi\u1ec5m khu\u1ea9n c\u01a1 h\u1ed9i, nhi\u1ec5m virus (\u0111\u1eb7c bi\u1ec7t virus vi\u00eam gan B, C), ung th\u01b0.<\/p>\n<p><strong><em>Quy tr\u00ecnh s\u00e0ng l\u1ecdc b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc khi ch\u1ec9 \u0111\u1ecbnh thu\u1ed1c sinh h\u1ecdc:<\/em><\/strong><br \/>\n1. H\u1ecfi b\u1ec7nh nh\u00e2n v\u1ec1 t\u00ecnh tr\u1ea1ng ti\u00eam ch\u1ee7ng<br \/>\nKh\u00f4ng n\u00ean d\u00f9ng v\u1eafc xin s\u1ed1ng v\u00e0 b\u1ea5t ho\u1ea1t \u0111\u1ed3ng th\u1eddi v\u1edbi c\u00e1c thu\u1ed1c sinh h\u1ecdc.<\/p>\n<p>2. Kh\u1ea3o s\u00e1t c\u00e1c c\u01a1 quan d\u1ec5 nhi\u1ec5m khu\u1ea9n<br \/>\n\u2212\u00a0 Ph\u1ed5i: C\u1ea7n lo\u1ea1i tr\u1eeb vi\u00eam ph\u1ed5i do vi khu\u1ea9n, \u0111\u1eb7c bi\u1ec7t l\u00e0 lao ph\u1ed5i: Kh\u00e1m l\u00e2m s\u00e0ng, ch\u1ee5p phim Xquang quy \u01b0\u1edbc ph\u1ed5i th\u1eb3ng, n\u1ebfu c\u00f3 nghi ng\u1edd, ch\u1ec9 \u0111\u1ecbnh CT ng\u1ef1c l\u1edbp m\u1ecfng, n\u1ebfu c\u00f3 t\u1ed5n th\u01b0\u01a1ng, c\u1ea7n n\u1ed9i soi ph\u1ebf qu\u1ea3n, c\u1ea5y d\u1ecbch ph\u1ebf qu\u1ea3n t\u00ecm vi khu\u1ea9n, BK. K\u1ebft h\u1ee3p v\u1edbi k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m test da Mantoux.<br \/>\n\u2212 Th\u1eadn ti\u1ebft ni\u1ec7u: T\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u, c\u1ea5y t\u00ecm vi khu\u1ea9n.<br \/>\n\u2212 R\u0103ng h\u00e0m m\u1eb7t &#8211; tai m\u0169i h\u1ecdng.<br \/>\n\u2212 Tim: Nghe tim, si\u00eau \u00e2m tim n\u1ebfu nghi ng\u1edd<br \/>\n\u2212 Nhi\u1ec5m virus: HIV; HbsAg; Anti HCV.<\/p>\n<p>3. Kh\u1ea3o s\u00e1t ph\u00e1t hi\u1ec7n ung th\u01b0<br \/>\nC\u1ea7n kh\u1ea3o s\u00e1t c\u00e1c c\u01a1 quan sau, n\u1ebfu c\u00f3 t\u1ed5n th\u01b0\u01a1ng ho\u1eb7c nghi ng\u1edd t\u1ed5n th\u01b0\u01a1ng, tu\u00e2n theo quy tr\u00ecnh ch\u1ea9n \u0111o\u00e1n ung th\u01b0 c\u00e1c t\u1ea1ng.<br \/>\n\u2212 Trung th\u1ea5t: Xquang quy \u01b0\u1edbc ph\u1ed5i th\u1eb3ng, n\u1ebfu c\u00f3 nghi ng\u1edd, ch\u1ec9 \u0111\u1ecbnh CT ng\u1ef1c l\u1edbp m\u1ecfng nh\u01b0 tr\u00ean.<br \/>\n\u2212 \u1ed4 b\u1ee5ng: Si\u00eau \u00e2m \u1ed5 b\u1ee5ng.<br \/>\n\u2212 Kh\u00e1m h\u1ec7 th\u1ed1ng h\u1ea1ch v\u00e0 to\u00e0n tr\u1ea1ng.<\/p>\n<p>4. C\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u1ea7n l\u01b0u \u00fd<br \/>\n\u2212 Nghi ng\u1edd nhi\u1ec5m lao:<br \/>\n+ Tr\u01b0\u1eddng h\u1ee3p Mantoux d\u01b0\u01a1ng t\u00ednh m\u00e0 Xquang v\u00e0 CT ph\u1ed5i b\u00ecnh th\u01b0\u1eddng, n\u00ean n\u1ed9i<br \/>\nsoi ph\u1ebf qu\u1ea3n c\u1ea5y t\u00ecm vi khu\u1ea9n lao, PCR- BK. N\u1ebfu kh\u00f4ng th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c th\u1ee7 thu\u1eadt n\u00e0y,<br \/>\nb\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb nh\u01b0 lao s\u01a1 nhi\u1ec5m tr\u01b0\u1edbc khi ti\u1ebfn h\u00e0nh \u0111i\u1ec1u tr\u1ecb sinh h\u1ecdc v\u00e0<br \/>\nph\u1ea3i \u0111\u01b0\u1ee3c theo d\u00f5i ch\u1eb7t ch\u1ebd v\u1ec1 kh\u1ea3 n\u0103ng kh\u1edfi ph\u00e1t lao trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<br \/>\n+ Tr\u01b0\u1eddng h\u1ee3p c\u00f3 nhi\u1ec5m lao: C\u1ea7n \u0111i\u1ec1u tr\u1ecb lao tr\u01b0\u1edbc. Sau \u0111\u00f3 \u0111\u00e1nh gi\u00e1, xem x\u00e9t l\u1ea1i<br \/>\nch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb sinh h\u1ecdc.<\/p>\n<p>\u2212 Nhi\u1ec5m virus vi\u00eam gan:<br \/>\nTr\u01b0\u1eddng h\u1ee3p kh\u00e1ng th\u1ec3 d\u01b0\u01a1ng t\u00ednh, n\u1ebfu kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng c\u1ee7a t\u0103ng sinh c\u1ee7a<br \/>\nvirus v\u00e0 c\u00e1c enzym gan b\u00ecnh th\u01b0\u1eddng c\u00f3 th\u1ec3 xem x\u00e9t ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb sinh h\u1ecdc. Tr\u01b0\u1eddng<br \/>\nh\u1ee3p vi\u00eam gan ti\u1ebfn tri\u1ec3n, c\u1ea7n \u0111i\u1ec1u tr\u1ecb vi\u00eam gan tr\u01b0\u1edbc khi \u0111\u00e1nh gi\u00e1, xem x\u00e9t l\u1ea1i ch\u1ec9 \u0111\u1ecbnh<br \/>\n\u0111i\u1ec1u tr\u1ecb sinh h\u1ecdc.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>C\u00e1c thu\u1ed1c c\u00f3 t\u00ean th\u00f4ng d\u1ee5ng l\u00e0 DMARDs \u0111\u01b0\u1ee3c k\u1ef3 v\u1ecdng l\u00e0 c\u00e1c thu\u1ed1c ch\u1ed1ng th\u1ea5p kh\u1edbp c\u00f3 th\u1ec3 l\u00e0m thay \u0111\u1ed5i ti\u1ebfn tr\u00ecnh b\u1ec7nh v\u00e0 l\u00e0 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb c\u01a1 b\u1ea3n. C\u00f3 hai lo\u1ea1i DMARDs: DMARDs c\u1ed5 \u0111i\u1ec3n v\u00e0 DMARDs sinh h\u1ecdc. C\u00f9ng t\u00ecm hi\u1ec3u c\u00e1ch s\u1eed d\u1ee5ng thu\u1ed1c theo h\u01b0\u1edbng d\u1eabn c\u1ee7a B\u1ed9 [&hellip;]<\/p>\n","protected":false},"author":14,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[12,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>S\u1eed d\u1ee5ng thu\u1ed1c DMARDs theo h\u01b0\u1edbng d\u1eabn c\u1ee7a B\u1ed9 Y T\u1ebf - Vinmec<\/title>\n<meta name=\"description\" content=\"C\u00e1c thu\u1ed1c c\u00f3 t\u00ean l\u00e0 DMARDs \u0111\u01b0\u1ee3c k\u1ef3 v\u1ecdng l\u00e0 c\u00e1c thu\u1ed1c ch\u1ed1ng th\u1ea5p kh\u1edbp v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u01a1 b\u1ea3n b\u1ec7nh. 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