{"id":35940,"date":"2023-07-01T19:29:45","date_gmt":"2023-07-01T12:29:45","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=35940"},"modified":"2023-07-01T19:29:45","modified_gmt":"2023-07-01T12:29:45","slug":"dieu-tri-viem-mui-di-ung","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/07\/01\/dieu-tri-viem-mui-di-ung\/","title":{"rendered":"C\u00e1ch \u0111i\u1ec1u tr\u1ecb vi\u00eam m\u0169i d\u1ecb \u1ee9ng: Ph\u01b0\u01a1ng ph\u00e1p v\u00e0 thu\u1ed1c h\u1eefu \u00edch"},"content":{"rendered":"

\u00a0 \u00a0\u0110i\u1ec1u tr\u1ecb vi\u00eam m\u0169i d\u1ecb \u1ee9ng hi\u1ec7n nay d\u1ef1a tr\u00ean c\u01a1 ch\u1ebf c\u1ee7a b\u1ec7nh. V\u1edbi hai nh\u00f3m ch\u00ednh l\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u v\u00e0 kh\u00f4ng \u0111\u1eb7c hi\u1ec7u. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00f4ng \u0111\u1eb7c hi\u1ec7u nh\u1eb1m m\u1ee5c \u0111\u00edch v\u00f4 hi\u1ec7u ho\u00e1 c\u00e1c ho\u1ea1t ch\u1ea5t trung gian. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u bao g\u1ed3m c\u00e1c bi\u1ec7n ph\u00e1p nh\u01b0 tr\u00e1nh xa d\u1ecb nguy\u00ean, mi\u1ec5n d\u1ecbch li\u1ec7u ph\u00e1p, gen li\u1ec7u ph\u00e1p th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp \u0111\u1ebfn.<\/strong><\/span><\/p>\n

\"dieu-tri-viem-mui-di-ung\"<\/p>\n

1. Ph\u01b0\u01a1ng h\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb b\u1ec7nh vi\u00eam m\u0169i d\u1ecb \u1ee9ng<\/strong><\/h2>\n

C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c chia l\u00e0m hai nh\u00f3m: C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111\u1eb7c hi\u1ec7u (giai \u0111o\u1ea1n I,II) v\u00e0 kh\u00f4ng \u0111\u1eb7c hi\u1ec7u (giai \u0111o\u1ea1n III,IV)<\/span><\/p>\n

–<\/span> \u00a0 \u00a0 \u00a0 <\/span>C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00f4ng \u0111\u1eb7c hi\u1ec7u nh\u1eb1m m\u1ee5c \u0111\u00edch v\u00f4 hi\u1ec7u ho\u00e1 c\u00e1c ho\u1ea1t ch\u1ea5t trung gian (giai \u0111o\u1ea1n III), x\u1eed l\u00fd nh\u1eefng r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng, t\u1ed5n th\u01b0\u01a1ng t\u1ed5 ch\u1ee9c, c\u00e1c tri\u1ec7u ch\u1ee9ng d\u1ecb \u1ee9ng (giai \u0111o\u1ea1n IV) b\u1eb1ng nhi\u1ec1u lo\u1ea1i thu\u1ed1c kh\u00e1c nhau. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y ch\u1ee7 y\u1ebfu l\u00e0 d\u00f9ng :<\/span><\/p>\n

–<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>C\u00e1c thu\u1ed1c kh\u00e1ng histamin th\u1ebf h\u1ec7 I v\u00e0 2<\/span><\/p>\n

–<\/span> \u00a0 \u00a0 \u00a0 <\/span>C\u00e1c thu\u1ed1c c\u00f3 ch\u1ee9a corticoid<\/span><\/p>\n

–<\/span>\u00a0 <\/span>C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch<\/span><\/p>\n

–<\/span> \u00a0 \u00a0 \u00a0 <\/span>C\u00e1c bi\u1ec7n ph\u00e1p v\u1eadt l\u00fd tr\u1ecb li\u1ec7u, kh\u00ed h\u1eadu li\u1ec7u ph\u00e1p, th\u1ec3 d\u1ee5c li\u1ec7u ph\u00e1p…<\/span><\/p>\n

Tuy nhi\u00ean, ph\u01b0\u01a1ng ph\u00e1p kh\u00f4ng \u0111\u1eb7c hi\u1ec7u n\u00e0y \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 l\u00e0 t\u1ed1n c\u00f4ng s\u1ee9c, t\u1ed1n th\u1eddi gian, t\u1ed1n thu\u1ed1c men, hi\u1ec7u qu\u1ea3 ng\u1eafn ng\u1ee7i.<\/span><\/p>\n

–<\/span> \u00a0 \u00a0 \u00a0 <\/span>C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u bao g\u1ed3m c\u00e1c bi\u1ec7n ph\u00e1p nh\u01b0 tr\u00e1nh xa d\u1ecb nguy\u00ean, mi\u1ec5n d\u1ecbch li\u1ec7u ph\u00e1p, gen li\u1ec7u ph\u00e1p th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp \u0111\u1ebfn. Nh\u01b0ng tr\u00e1nh xa d\u1ecb nguy\u00ean b\u1eb1ng c\u00e1ch thay \u0111\u1ed5i ch\u1ed7 \u1edf, \u0111\u1ed5i ngh\u1ec1, \u0111\u1ed5i t\u1eadp qu\u00e1n s\u00f4ng v.v…l\u00e0 \u0111i\u1ec1u kh\u00f4ng ph\u1ea3i d\u1ec5 th\u1ef1c hi\u1ec7n. Ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c nhi\u1ec1u t\u00e1c gi\u1ea3 cho l\u00e0 t\u1ed1t nh\u1ea5t hi\u1ec7n nay l\u00e0 \u00e1p d\u1ee5ng mi\u1ec5n d\u1ecbch li\u1ec7u ph\u00e1p (MDLP), m\u00e0 m\u1ed9t trong c\u00e1c bi\u1ec7n ph\u00e1p th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng l\u00e0 ph\u01b0\u01a1ng ph\u00e1p gi\u1ea3m m\u1eabn c\u1ea3m \u0111\u1eb7c hi\u1ec7u(GMC\u0110H).<\/span><\/p>\n

\u00a0 2. Gi\u1edbi thi\u1ec7u ph\u01b0\u01a1ng ph\u00e1p gi\u1ea3m m\u1eabn c\u1ea3m \u0111\u1eb7c hi\u1ec7u<\/strong><\/h2>\n

Gi\u1ea3m m\u1eabn c\u1ea3m \u0111\u1eb7c hi\u1ec7u (GMC\u0110H), m\u1ed9t trong nh\u1eefng bi\u1ec7n ph\u00e1p h\u1eefu d\u1ee5ng nh\u1ea5t c\u1ee7a mi\u1ec5n d\u1ecbch li\u1ec7u ph\u00e1p (MDLP) \u0111\u00e3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng tr\u00ean l\u00e2m s\u00e0ng t\u1eeb r\u1ea5t s\u1edbm. Theo c\u00f4ng b\u1ed1 t\u1eeb n\u0103m 1911, hai b\u00e1c s\u0129 ng\u01b0\u1eddi Anh l\u00e0 Noon v\u00e0 Freeman \u0111\u00e3 d\u00f9ng d\u1ecbch chi\u1ebft xu\u1ea5t t\u1eeb ph\u1ea5n hoa \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb cho nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb “s\u1ed1t c\u1ecf” (Hayfever) v\u1edbi li\u1ec1u l\u01b0\u1ee3ng t\u0103ng d\u1ea7n. K\u1ebft qu\u1ea3 thu \u0111\u01b0\u1ee3c r\u1ea5t t\u1ed1t, t\u00ecnh tr\u1ea1ng b\u1ec7nh \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n r\u00f5 r\u1ec7t. Do v\u1eady t\u00e1c gi\u1ea3 gi\u1ea3i th\u00edch c\u01a1 ch\u1ebf l\u00e0 do xu\u1ea5t hi\u1ec7n “kh\u00e1ng \u0111\u1ed9c t\u1ed1'” ch\u1ed1ng l\u1ea1i m\u1ed9t c\u00e1ch \u0111\u1eb7c hi\u1ec7u c\u00e1c \u0111\u1ed9c t\u1ed1 c\u1ee7a ph\u1ea5n hoa c\u1ecf. \u0110\u1eb7c bi\u1ec7t t\u1eeb n\u0103m 1918, c\u00f4ng tr\u00ecnh c\u1ee7a Cooke c\u0169ng \u0111\u00e3 \u0111\u1ec1 x\u01b0\u1edbng c\u00e1c k\u1ef9 thu\u1eadt v\u00e0 c\u01a1 ch\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p gi\u1ea3m m\u1eabn c\u1ea3m \u0111\u1eb7c hi\u1ec7u.<\/span><\/p>\n

C\u00e1c ch\u1ec9 \u0111\u1ecbnh chung c\u1ee7a gi\u1ea3m m\u1eabn c\u1ea3m \u0111\u1eb7c hi\u1ec7u<\/strong><\/p>\n

–<\/span> \u00a0 \u00a0 \u00a0 <\/span>C\u00e1c b\u00e1o c\u00e1o \u1edf h\u1ed9i ngh\u1ecb h\u00e0ng n\u0103m v\u1ec1 mi\u1ec5n d\u1ecbch d\u1ecb \u1ee9ng l\u00e2m s\u00e0ng <\/span>\u1edf<\/span><\/i> ch\u00e2u \u00c2u (EAACI) th\u00e1ng 6 -1997 \u0111\u00e3 \u0111\u00e1nh gi\u00e1 MDLP l\u00e0 c\u00e1ch \u0111i\u1ec1u tr\u1ecb t\u1ed1t nh\u1ea5t \u0111\u1ec3 \u0111i\u1ec1u bi\u1ebfn h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch c\u00f3 l\u1ee3i cho b\u1ec7nh nh\u00e2n. Tuy nhi\u00ean, \u0111\u00e2y l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb k\u00e9o d\u00e0i v\u00e0 g\u00f2 b\u00f3 n\u00ean kh\u00f4ng th\u1ec3 \u00e1p d\u1ee5ng \u0111\u01b0\u1ee3c cho m\u1ecdi b\u1ec7nh nh\u00e2n.<\/span><\/p>\n

Nhi\u1ec1u t\u00e1c gi\u1ea3 nh\u01b0 Garabedian, F.Meynadier cho r\u1eb1ng ch\u1ec9 n\u00ean \u0111\u1eb7t v\u1ea5n \u0111\u1ec1 \u0111i\u1ec1u tr\u1ecb gi\u1ea3m m\u1eabn c\u1ea3m \u0111\u1eb7c hi\u1ec7u khi c\u00e1c bi\u1ec7n ph\u00e1p kh\u00e1c \u0111\u1ec1u \u0111\u00e3 th\u1ea5t b\u1ea1i, ho\u1eb7c ph\u1ea3i x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c \u0111\u00fang m\u1ed9t d\u1ecb nguy\u00ean duy nh\u1ea5t m\u1eabn c\u1ea3m, kh\u00f4ng n\u00ean ch\u1ec9 \u0111\u1ecbnh v\u1edbi tr\u01b0\u1eddng h\u1ee3p m\u1eabn c\u1ea3m \u0111a d\u1ecb nguy\u00ean (polisensibilisation).<\/span><\/p>\n

–<\/span> \u00a0 \u00a0 \u00a0 <\/span>Ngo\u00e0i ra, <\/span>gi\u1ea3m m\u1eabn c\u1ea3m \u0111\u1eb7c hi\u1ec7u ch\u1ec9 n\u00ean \u0111\u01b0\u1ee3c coi l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng c\u1ee7a d\u1ecb \u1ee9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p<\/span><\/i> nh\u01b0 vi\u00eam m\u0169i d\u1ecb \u1ee9ng, hen ph\u1ebf qu\u1ea3n. Kh\u00f4ng khi n\u00e0o n\u00f3 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng cho m\u1ed9t b\u1ec7nh c\u1ea5p t\u00ednh.<\/span><\/p>\n

* C\u00e1c ch\u1ec9 \u0111\u1ecbnh \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng l\u00e0:<\/span><\/p>\n

–<\/span> \u00a0 \u00a0 \u00a0 <\/span>B\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh qua trung gian IgE.<\/span><\/p>\n

–<\/span> \u00a0 \u00a0 \u00a0 <\/span>B\u1ec7nh c\u0103n nguy\u00ean d\u1ecb \u1ee9ng \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh.<\/span><\/p>\n

–<\/span> \u00a0 \u00a0 \u00a0 <\/span>D\u1ecb nguy\u00ean kh\u00f4ng d\u1ec5 d\u00e0ng lo\u1ea1i b\u1ecf \u0111\u01b0\u1ee3c.<\/span><\/p>\n

–<\/span> \u00a0 \u00a0 \u00a0 <\/span>B\u1ec7nh nh\u00e2n ph\u1ea3i c\u00f3 \u0111i\u1ec1u ki\u1ec7n ch\u1ea5p nh\u1eadn m\u1ed9t kho\u1ea3ng th\u1eddi gian d\u00e0i \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng MDLP (gi\u1ea3m m\u1eabn c\u1ea3m \u0111\u1eb7c hi\u1ec7u).<\/span><\/p>\n

–<\/span> \u00a0 \u00a0 \u00a0 <\/span>\u0110i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c th\u00f4ng th\u01b0\u1eddng kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3.<\/span><\/p>\n

–<\/span> \u00a0 \u00a0 \u00a0 <\/span>Ph\u1ea3i c\u00f3 d\u1ecb nguy\u00ean \u0111\u01b0\u1ee3c chi\u1ebft xu\u1ea5t v\u1edbi ch\u1ea5t l\u01b0\u1ee3ng \u0111\u1ea1t ti\u00eau chu\u1ea9n cao.<\/span><\/p>\n

Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee7a gi\u1ea3m m\u1eabn c\u1ea3m \u0111\u1eb7c hi\u1ec7u<\/strong><\/p>\n

Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p sau kh\u00f4ng \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng GMC\u0110H:<\/span><\/p>\n

–<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>B\u1ec7nh d\u1ecb \u1ee9ng \u0111ang <\/span>\u1edf<\/span><\/i> giai \u0111o\u1ea1n c\u1ea5p t\u00ednh<\/span><\/p>\n

–<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>C\u00e1c b\u1ec7nh nhi\u1ec5m tr\u00f9ng c\u1ea5p t\u00ednh, lao ph\u1ed5i.<\/span><\/p>\n

–<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>B\u1ec7nh tim m\u1ea1ch gan th\u1eadn m\u1ea5t b\u00f9;<\/span><\/p>\n

–<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>B\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh t\u1ef1 mi\u1ec5n. B\u1ec7nh t\u00e2m th\u1ea7n<\/span><\/p>\n

–<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>B\u1ec7nh nh\u00e2n \u0111ang c\u00f3 thai, ho\u1eb7c kh\u00f4ng \u0111\u1ed3ng \u00fd theo c\u00e1ch \u0111i\u1ec1u tr\u1ecb n\u00e0y.<\/span><\/p>\n

–<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>B\u1ec7nh nh\u00e2n hen kh\u00f4ng th\u1ec3 ki\u1ec3m so\u00e1t, polyp m\u0169i, b\u1ea5t dung n\u1ea1p aspirin v\u00e0 m\u1eabn c\u1ea3m v\u1edbi nhi\u1ec1u lo\u1ea1i d\u1ecb nguy\u00ean.<\/span><\/p>\n

2. \u0110i\u1ec1u tr\u1ecb vi\u00eam m\u0169i d\u1ecb \u1ee9ng b\u1eb1ng thu\u1ed1c<\/strong><\/h2>\n

Thu\u1ed1c ch\u1ed1ng vi\u00eam m\u0169i v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng c\u00f3 li\u00ean quan c\u00f3 th\u1ec3 ho\u1ea1t \u0111\u1ed9ng ch\u1ee9c n\u0103ng theo m\u1ed9t trong ba h\u01b0\u1edbng:<\/span><\/p>\n

–<\/span> \u00a0 \u00a0 \u00a0 <\/span>\u1ee8c ch\u1ebf gi\u1ea3i ph\u00f3ng ch\u1ea5t trung gian h\u00f3a h\u1ecdc t\u1eeb c\u00e1c t\u1ebf b\u00e0o mastocyte v\u00e0 c\u00e1c t\u1ebf b\u00e0o vi\u00eam kh\u00e1c (c\u00e1c d\u1ea1ng corticosteroid, natri cromoglycate)*<\/span><\/p>\n

–<\/span> \u00a0 \u00a0 \u00a0 <\/span>\u0110\u1ed1i l\u1eadp, kh\u00e1ng l\u1ea1i ho\u1ea1t \u0111\u1ed9ng ch\u1ee9c n\u0103ng c\u1ee7a c\u00e1c ch\u1ea5t trung gian ho\u00e1 h\u1ecdc \u0111\u01b0\u1ee3c gi\u1ea3i ph\u00f3ng (c\u00e1c th\u1ee5 th\u1ec3\u00a0 adrenergic).<\/span><\/p>\n

–<\/span> \u00a0 \u00a0 \u00a0 <\/span>Tranh ch\u1ea5p v\u1edbi c\u00e1c ch\u1ea5t trung gian c\u00e1 th\u1ec3 (th\u1ee5 th\u1ec3 H<\/span>1 <\/span>kh\u00e1ng histamin, th\u1ee5 th\u1ec3 kh\u00e1ng cholinergic).<\/span><\/p>\n

2.1 \u00a0 \u00a0Thu\u1ed1c kh\u00e1ng histamin<\/strong><\/p>\n

Hai lo\u1ea1i th\u1ee5 th\u1ec3 histamin v\u1edbi nh\u1eefng ch\u1ee9c n\u0103ng sinh l\u00fd kh\u00e1c nhau \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 th\u00e0nh hai ph\u00e2n nh\u00f3m H1 v\u00e0 H<\/span>2<\/span>. Th\u1ee5 th\u1ec3 H1 c\u00f3 li\u00ean quan ch\u1ee7 y\u1ebfu \u0111\u1ebfn c\u00e1c k\u1ebft qu\u1ea3 d\u1ecb \u1ee9ng ho\u1eb7c ph\u1ea3n v\u1ec7 c\u1ee7a histamin \u0111\u01b0\u1ee3c gi\u1ea3i ph\u00f3ng. C\u00f2n th\u1ee5 th\u1ec3 H<\/span>2<\/span> \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong \u0111i\u1ec1u khi\u1ec3n sinh l\u00fd ti\u1ebft acid d\u1ea1 d\u00e0y.<\/span><\/p>\n

C\u00e1c b\u1ec7nh d\u1ecb \u1ee9ng \u1edf c\u1ea3 m\u0169i v\u00e0 m\u1eaft \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh ch\u1ee7 y\u1ebfu d\u00f9ng kh\u00e1ng ch\u1ee7 v\u1eadn histamin H<\/span>b<\/span> lo\u1ea1i ch\u1ebf ph\u1ea9m n\u00e0y c\u00f3 b\u00e1n r\u1ed9ng r\u00e3i. C\u00e1c thu\u1ed1c quen thu\u1ed9c nh\u01b0 clorpheniramin, ankylamin, promethazin, cyproheptadin.<\/span><\/p>\n

Vi\u1ec7c ph\u1ed1i h\u1ee3p kh\u00e1ng histamin H1 v\u00e0 H<\/span>2<\/span> \u0111\u00e3 \u0111\u01b0\u1ee3c nhi\u1ec1u \u00fd ki\u1ebfn n\u00eau ra \u0111\u1ec3 t\u0103ng ph\u1ea7n hi\u1ec7u qu\u1ea3 l\u00e0m gi\u1ea3m histamin g\u00e2y b\u1ec7nh m\u0169i h\u01a1n l\u00e0 d\u00f9ng ho\u1eb7c H<\/span>2<\/span> \u0111\u01a1n thu\u1ea7n.<\/span><\/p>\n

2.2 Corticosteroid t\u1ea1i ch\u1ed7 trong \u0111i\u1ec1u tr\u1ecb vi\u00eam m\u0169i<\/strong><\/p>\n

Vi\u1ec7c d\u00f9ng glucocorticoid t\u1ea1i ch\u1ed7 trong \u0111i\u1ec1u tr\u1ecb vi\u00eam m\u0169i \u0111\u00e3 nhanh ch\u00f3ng ph\u00e1t tri\u1ec3n trong v\u00f2ng g\u1ea7n n\u1eeda th\u1ebf k\u1ef7 qua, n\u00f3 \u0111\u01b0\u1ee3c th\u1eed nghi\u1ec7m s\u1edbm sau khi c\u00f3 s\u1ef1 tr\u00ecnh b\u00e0y v\u1ec1 hi\u1ec7u qu\u1ea3 c\u1ee7a glucocorticoid to\u00e0n th\u00e2n, s\u1eed d\u1ee5ng hydrocortison v\u00e0 prednisolon d\u1ea1ng b\u1ed9t h\u00edt \u0111\u00e3 cho th\u1ea5y m\u1ed9t <\/span>s\u1ed1<\/span><\/i> k\u1ebft qu\u1ea3 kh\u1ea3 quan trong \u0111i\u1ec1u tr\u1ecb vi\u00eam m\u0169i d\u1ecb \u1ee9ng. Song ch\u1ec9 c\u00f3 r\u1ea5t \u00edt ho\u1eb7c kh\u00f4ng c\u00f3 \u0111i\u1ec3m l\u1ee3i n\u00e0o h\u01a1n trong c\u00e1ch d\u00f9ng t\u1ea1i ch\u1ed7 khi so s\u00e1nh v\u1edbi c\u00e1ch d\u00f9ng to\u00e0n th\u00e2n do h\u1eadu qu\u1ea3 \u1ee9c ch\u1ebf c\u1ee7a tr\u1ee5c hypothalamus- tuy\u1ebfn y\u00ean- th\u01b0\u1ee3ng th\u1eadn, c\u00e1c tri\u1ec7u ch\u1ee9ng \u1edf m\u1eaft c\u0169ng suy gi\u1ea3m n\u1ebfu c\u00f3 t\u00e1c d\u1ee5ng to\u00e0n th\u00e2n c\u1ee7a thu\u1ed1c. Nh\u01b0 v\u1eady, kh\u00f4ng c\u00f3 ch\u1ebf ph\u1ea9m n\u00e0o \u0111\u01b0\u1ee3c d\u00f9ng r\u1ed9ng r\u00e3i. \u0110\u1ea7u nh\u1eefng n\u0103m 1960, dexamethason t\u00e1c d\u1ee5ng m\u1ea1nh hdn \u0111\u00e3 \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u. Nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u00e3 tr\u00ecnh b\u00e0y \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 c\u1ee7a thu\u1ed1c n\u00e0y trong \u0111i\u1ec1u tr\u1ecb vi\u00eam m\u0169i theo m\u00f9a v\u00e0 vi\u00eam m\u0169i quanh n\u0103m, song v\u1eabn c\u00f2n h\u1eadu qu\u1ea3 \u0111\u00e1ng k\u1ec3 tr\u00ean tr\u1ee5c hypothalamus – y\u00ean – th\u01b0\u1ee3ng th\u1eadn, v\u00ec m\u1ed9t ph\u1ea7n \u0111\u01b0\u1ee3c h\u1ea5p thu l\u1ea1i kh\u00f4ng qua b\u01b0\u1edbc kh\u1eed ho\u1ea1t t\u00ednh tr\u01b0\u1edbc ti\u00ean \u1edf gan. Nh\u01b0 v\u1eady vi\u1ec7c nghi\u00ean c\u1ee9u nh\u1eefng thu\u1ed1c kh\u00e1c v\u1edbi kh\u00eda c\u1ea1nh d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc kh\u00e1c nhau v\u1eabn \u0111ang \u0111\u01b0\u1ee3c khuy\u1ebfn kh\u00edch. Dexamethason hi\u1ec7n v\u1eabn \u0111ang \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ebf l\u1ea1i theo d\u1ea1ng m\u1edbi.<\/span><\/p>\n

2.3 Corticosteroid to\u00e0n th\u00e2n trong \u0111i\u1ec1u tr\u1ecb vi\u00eam m\u0169i<\/strong><\/p>\n

\u00a0Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb<\/span><\/i><\/p>\n

Corticosteroid l\u00e0 thu\u1ed1c c\u00f3 c\u00f4ng hi\u1ec7u cao trong \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh d\u1ecb \u1ee9ng v\u00e0 ph\u1ea7n l\u1edbn c\u00e1c ca vi\u00eam m\u0169i kh\u00f4ng d\u1ecb \u1ee9ng. Th\u1eadm ch\u00ed ng\u01b0\u1eddi ta c\u00f3 th\u1ec3 coi \u0111\u00e2y l\u00e0 d\u1ea1ng duy nh\u1ea5t \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh n\u00e0y n\u1ebfu nh\u01b0 n\u00f3 kh\u00f4ng g\u00e2y t\u00e1c d\u1ee5ng ph\u1ee5, \u0111i\u1ec1u n\u00e0y ng\u0103n tr\u1edf vi\u1ec7c \u0111i\u1ec1u tr\u1ecb l\u00e2u d\u00e0i b\u1ec7nh vi\u00eam m\u0169i. Song li\u1ec7u ph\u00e1p ng\u1eafn h\u1ea1n \u0111\u00f4i khi l\u00e0 c\u1ea7n thi\u1ebft n\u1ebfu c\u00e1c d\u1ea1ng thu\u1ed1c kh\u00e1c kh\u00f4ng hi\u1ec7u qu\u1ea3. Tr\u01b0\u1edbc h\u1ebft, ch\u00fang ta ph\u1ea3i n\u1eafm \u0111\u01b0\u1ee3c ba nguy\u00ean t\u1eafc d\u00f9ng corticoid to\u00e0n th\u00e2n trong vi\u1ec7c \u0111i\u1ec1u tr\u1ecb vi\u00eam m\u0169i d\u1ecb \u1ee9ng l\u00e0:<\/span><\/p>\n

Ch\u1ec9 d\u00f9ng \u0111\u1ee3t ng\u1eafn h\u1ea1n (trong v\u00f2ng 2 tu\u1ea7n)<\/span><\/p>\n

D\u00f9ng corticoid to\u00e0n th\u00e2n v\u1edbi vai tr\u00f2 thu\u1ed1c th\u00eam v\u00e0o ch\u1ee9 kh\u00f4ng ph\u1ea3i l\u00e0 thu\u1ed1c thay th\u1ebf cho thu\u1ed1c kh\u00e1c.<\/span><\/p>\n

Xem th\u00eam: T\u00ecm hi\u1ec3u v\u1ec1 ph\u01b0\u01a1ng ph\u00e1p gi\u1ea3m m\u1eabn c\u1ea3m trong \u0111i\u1ec1u tr\u1ecb d\u1ecb \u1ee9ng<\/a><\/p>\n

Tags: #D\u1ecb \u1ee9ng mi\u1ec5n d\u1ecbch,#Vi\u00eam m\u0169i d\u1ecb \u1ee9ng,#Gi\u1ea3i m\u1eabn c\u1ea3m \u0111\u1eb7c hi\u1ec7u,#Thu\u1ed1c \u0111i\u1ec1u<\/p>\n","protected":false},"excerpt":{"rendered":"

\u00a0 \u00a0\u0110i\u1ec1u tr\u1ecb vi\u00eam m\u0169i d\u1ecb \u1ee9ng hi\u1ec7n nay d\u1ef1a tr\u00ean c\u01a1 ch\u1ebf c\u1ee7a b\u1ec7nh. V\u1edbi hai nh\u00f3m ch\u00ednh l\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u v\u00e0 kh\u00f4ng \u0111\u1eb7c hi\u1ec7u. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00f4ng \u0111\u1eb7c hi\u1ec7u nh\u1eb1m m\u1ee5c \u0111\u00edch v\u00f4 hi\u1ec7u ho\u00e1 c\u00e1c ho\u1ea1t ch\u1ea5t trung gian. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u bao […]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[73,33],"tags":[],"yoast_head":"\nC\u00e1ch \u0111i\u1ec1u tr\u1ecb vi\u00eam m\u0169i d\u1ecb \u1ee9ng: Ph\u01b0\u01a1ng ph\u00e1p v\u00e0 thu\u1ed1c h\u1eefu \u00edch - Vinmec<\/title>\n<meta name=\"description\" content=\"\u0110i\u1ec1u tr\u1ecb vi\u00eam m\u0169i d\u1ecb \u1ee9ng hi\u1ec7n nay d\u1ef1a tr\u00ean c\u01a1 ch\u1ebf c\u1ee7a b\u1ec7nh. 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