{"id":137856,"date":"2025-09-09T21:46:55","date_gmt":"2025-09-09T14:46:55","guid":{"rendered":"https:\/\/vnras.com\/drug\/?p=137856"},"modified":"2025-09-11T10:16:47","modified_gmt":"2025-09-11T03:16:47","slug":"corticosteroids-trong-nhiem-khuan-huyet-nhung-dieu-con-tranh-cai","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/corticosteroids-trong-nhiem-khuan-huyet-nhung-dieu-con-tranh-cai\/","title":{"rendered":"CORTICOSTEROIDS TRONG NHI\u1ec4M KHU\u1ea8N HUY\u1ebeT: NH\u1eeeNG \u0110I\u1ec0U C\u00d2N TRANH C\u00c3I"},"content":{"rendered":"

Ng\u01b0\u1eddi d\u1ecbch: NT HN\u00a0<\/strong><\/p>\n

T\u1ea3i PDF t\u1ea1i \u0111\u00e2y<\/a><\/strong><\/p>\n

Khi Hench v\u00e0 c\u00e1c c\u1ed9ng s\u1ef1 l\u1ea7n \u0111\u1ea7u m\u00f4 t\u1ea3 t\u00e1c d\u1ee5ng c\u1ee7a corticosteroid, h\u1ecd kh\u00f4ng th\u1ec3 ng\u1edd r\u1eb1ng v\u00e0o th\u1eadp ni\u00ean th\u1ee9 ba c\u1ee7a thi\u00ean ni\u00ean k\u1ef7 th\u1ee9 ba, nh\u1eefng thu\u1ed1c n\u00e0y l\u1ea1i tr\u1edf th\u00e0nh thu\u1ed1c kh\u00e1ng vi\u00eam \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n nhi\u1ec1u nh\u1ea5t tr\u00ean to\u00e0n th\u1ebf gi\u1edbi. G\u1ea7n 3% d\u00e2n s\u1ed1 to\u00e0n c\u1ea7u \u0111\u00e3 t\u1eebng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb corticosteroid, v\u00e0 \u0111\u00e2y c\u0169ng l\u00e0 tr\u1ee5 c\u1ed9t trong \u0111i\u1ec1u tr\u1ecb vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p. Th\u1ebf nh\u01b0ng, li\u1ec7u ph\u00e1p corticosteroid trong nhi\u1ec5m tr\u00f9ng huy\u1ebft v\u1eabn l\u00e0 ch\u1ee7 \u0111\u1ec1 g\u00e2y tranh c\u00e3i nhi\u1ec1u nh\u1ea5t, ngay c\u1ea3 sau h\u01a1n 80 th\u1eed nghi\u1ec7m v\u1edbi t\u1ed5ng c\u1ed9ng 22.000 ng\u01b0\u1eddi tham gia.<\/p>\n

Corticosteroid ho\u1ea1t \u0111\u1ed9ng nh\u01b0 th\u1ebf n\u00e0o?<\/h2>\n
C\u01a1 ch\u1ebf t\u00e1c \u0111\u1ed9ng c\u1ee7a corticosteroid \u0111\u00e3 \u0111\u01b0\u1ee3c l\u00e0m s\u00e1ng t\u1ecf h\u01a1n nh\u1edd nh\u1eefng ti\u1ebfn b\u1ed9 trong sinh h\u1ecdc ph\u00e2n t\u1eed. Corticosteroid \u0111i\u1ec1u h\u00f2a s\u1ef1 t\u01b0\u01a1ng t\u00e1c gi\u1eefa t\u1ebf b\u00e0o n\u1ec1n (stroma cells), \u0111\u1ea1i th\u1ef1c b\u00e0o v\u00e0 c\u00e1c t\u1ebf b\u00e0o mi\u1ec5n d\u1ecbch l\u01b0u h\u00e0nh trong m\u00e1u \u1edf m\u1ecdi giai \u0111o\u1ea1n c\u1ee7a ph\u1ea3n \u1ee9ng vi\u00eam. Khi bi\u1ec3u m\u00f4 b\u1ecb t\u1ed5n th\u01b0\u01a1ng do v\u00ec sinh v\u1eadt x\u00e2m nh\u1eadp, trong v\u00f2ng v\u00e0i ph\u00fat, c\u00e1c PAMPS\/DAMPs s\u1ebd k\u00edch ho\u1ea1t \u0111\u1ea1i th\u1ef1c b\u00e0o g\u00e2y ph\u00f3ng th\u00edch c\u00e1c ch\u1ea5t trung gian g\u00e2y vi\u00eam (vd: histamine, chemokine). B\u01b0\u1edbc th\u1ee9 hai di\u1ec5n ra trong v\u00e0i gi\u1edd ti\u1ebfp theo, huy \u0111\u1ed9ng c\u00e1c t\u1ebf b\u00e0o mi\u1ec5n d\u1ecbch t\u1eeb m\u00e1u, \u0111\u1ed3ng th\u1eddi t\u0103ng c\u01b0\u1eddng ho\u1ea1t t\u00ednh ti\u00eau di\u1ec7t m\u1ea7m b\u1ec7nh c\u1ee7a ch\u00fang. Sau v\u00e0i ng\u00e0y, khi m\u00f4 \u0111\u00e3 lo\u1ea1i b\u1ecf m\u1ea7m b\u1ec7nh, corticosteroid t\u00e1i l\u1eadp tr\u00ecnh c\u00e1c \u0111\u1ea1i th\u1ef1c b\u00e0o theo h\u01b0\u1edbng type 2 (ch\u1ed1ng vi\u00eam) nh\u1eb1m t\u1ec9nh ch\u1ec9nh qu\u00e1 tr\u00ecnh d\u1ecdn s\u1ea1ch to\u00e0n b\u1ed9 m\u1ea3nh v\u1ee5n c\u00f2n l\u1ea1i (t\u1eeb c\u1ea3 vi sinh v\u1eadt v\u00e0 t\u1ebf b\u00e0o c\u01a1 th\u1ec3). Ti\u1ebfp theo, giai \u0111o\u1ea1n s\u1eeda ch\u1eefa c\u1ee7a qu\u00e1 tr\u00ecnh vi\u00eam b\u1eaft \u0111\u1ea7u, trong \u0111\u00f3 corticosteroid \u0111i\u1ec1u h\u00f2a s\u1ef1 ph\u00f3ng th\u00edch c\u00e1c y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng, t\u1ed5ng h\u1ee3p collagen v\u00e0 t\u00e1i t\u1ea1o bi\u1ec3u m\u00f4. Vi\u1ec7c \u0111i\u1ec1u h\u00f2a d\u00f2ng chuy\u1ec3n h\u00f3a ty th\u1ec3 c\u0169ng \u0111\u00f3ng vai tr\u00f2 thi\u1ebft y\u1ebfu trong t\u00e1c d\u1ee5ng ch\u1ed1ng vi\u00eam c\u1ee7a corticosteroid. \u1ea2nh h\u01b0\u1edfng c\u1ee7a corticosteroid l\u00ean chuy\u1ec3n h\u00f3a c\u1ee7a t\u1ebf b\u00e0o mi\u1ec5n d\u1ecbch ch\u1ee7 y\u1ebfu trung gian qua c\u00e1c t\u01b0\u01a1ng t\u00e1c phi-genomic gi\u1eefa th\u1ee5 th\u1ec3 glucocorticoid (GR) v\u00e0 pyruvate dehydrogenase r\u1ea5t quan tr\u1ecdng cho \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch t\u1ee9c th\u1eddi c\u1ee7a c\u01a1 th\u1ec3. M\u1eb7c d\u00f9 \u0111\u00e3 c\u00f3 nh\u1eefng hi\u1ec3u bi\u1ebft ti\u1ebfn b\u1ed9, v\u1eabn c\u00f2n nhi\u1ec1u c\u00e2u h\u1ecfi ch\u01b0a \u0111\u01b0\u1ee3c gi\u1ea3i \u0111\u00e1p, nh\u01b0: l\u00e0m th\u1ebf n\u00e0o \u0111\u1ec3 gi\u1ea3i th\u00edch t\u00e1c \u0111\u1ed9ng \u0111\u1eb7c hi\u1ec7u theo t\u1eebng lo\u1ea1i t\u1ebf b\u00e0o c\u1ee7a corticosteroid, v\u00e0 \u00fd ngh\u0129a ch\u1ee9c n\u0103ng c\u1ee7a d\u1ea1ng \u0111\u1ed3ng ph\u00e2n t\u1eed h\u1ee3p (tetrameric isoform) c\u1ee7a glucocorticoid l\u00e0 gi (H\u00ecnh 1).<\/p>\n
\u00dd ngh\u0129a l\u00e2m s\u00e0ng c\u1ee7a corticosteroid \u0111\u1ed1i v\u1edbi r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u01a1 quan<\/h2>\n
Corticosteroid l\u00e0m t\u0103ng tr\u01b0\u01a1ng l\u1ef1c v\u1eadn m\u1ea1ch theo c\u01a1 ch\u1ebf hi\u1ec7p \u0111\u1ed3ng v\u1edbi catecholamine, t\u1eeb \u0111\u00f3 gi\u00fap gi\u1ea3m s\u1ef1 ph\u1ee5 thu\u1ed9c v\u00e0o thu\u1ed1c v\u1eadn m\u1ea1ch \u1edf b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m tr\u00f9ng. M\u1ed9t ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p g\u1ea7n \u0111\u00e2y cho th\u1ea5y, so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c ho\u1eb7c \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng, corticosteroid c\u00f3 kh\u1ea3 n\u0103ng l\u00e0m t\u0103ng t\u1ef7 l\u1ec7 h\u1ed3i ph\u1ee5c s\u1ed1c v\u00e0o ng\u00e0y th\u1ee9 7 (18 th\u1eed nghi\u1ec7m; 6.938 ng\u01b0\u1eddi tham gia; RR 1,22 [KTC 95%: 1,13-1,33; P < 0,00001; m\u00f4 h\u00ecnh hi\u1ec7u \u1ee9ng ng\u1eabu nhi\u00ean]). Trong khi corticosteroid c\u00f3 th\u1ec3 ng\u0103n ng\u1eeba s\u1ef1 kh\u1edfi ph\u00e1t t\u1ec9nh tr\u1ea1ng ph\u1ee5 thu\u1ed9c thu\u1ed1c v\u1eadn m\u1ea1ch \u1edf b\u1ec7nh nh\u00e2n vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i t\u1ea1i c\u1ed9ng \u0111\u1ed3ng (CAP) n\u1eb7ng, th\u00ec l\u1ea1i kh\u00f4ng \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng t\u1ef1 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m tr\u00f9ng huy\u1ebft do c\u00e1c t\u00e1c nh\u00e2n kh\u00e1c. Corticosteroid c\u0169ng nhanh ch\u00f3ng \u1ee9c ch\u1ebf s\u1ef1 bi\u1ec3u hi\u1ec7n c\u1ee7a y\u1ebfu t\u1ed1 nh\u00e2n NF-kB trong s\u1ed1c nhi\u1ec5m tr\u00f9ng, v\u00e0 s\u1ef1 ph\u00f3ng th\u00edch c\u00e1c ch\u1ea5t trung gian ti\u1ec1n vi\u00eam m\u00e0 kh\u00f4ng g\u00e2y \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch. Ph\u00f9 h\u1ee3p v\u1edbi c\u00e1c t\u00e1c \u0111\u1ed9ng mi\u1ec5n d\u1ecbch, so v\u1edbi gi\u00e0 d\u01b0\u1ee3c ho\u1eb7c \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng quy, corticosteroid l\u00e0m gi\u1ea3m m\u1ee9c \u0111\u1ed9 n\u1eb7ng v\u00e0 s\u1ed1 c\u01a1 quan b\u1ecb r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng \u0111\u01b0\u1ee3c \u0111o b\u1eb1ng thang \u0111i\u1ec3m SOFA v\u00e0o ng\u00e0y th\u1ee9 7. Do th\u00fac \u0111\u1ea9y qu\u00e1 tr\u00ecnh ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng t\u1ea1ng, corticosteroid c\u00f3 th\u1ec3 r\u00fat ng\u1eafn th\u1eddi gian n\u1eafm khoa \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c. Trong khi l\u1ee3i \u00edch c\u1ee7a corticosteroid tr\u00ean h\u1ec7 tim m\u1ea1ch v\u00e0 h\u00f4 h\u1ea5p \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u \u0111\u1ea7y \u0111\u1ee7, d\u1eef li\u1ec7u hi\u1ec7n ch\u01b0a \u0111\u1ee7 \u0111\u1ec3 cung c\u1ea5p th\u00f4ng tin cho b\u00e1c s\u0129 v\u1ec1 t\u00e1c \u0111\u1ed9ng c\u1ee7a ch\u00fang \u0111\u1ed1i v\u1edbi r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u01a1 quan kh\u00e1c do nhi\u1ec5m tr\u00f9ng huy\u1ebft, ch\u1eb3ng h\u1ea1n nh\u01b0 th\u1eadn, gan ho\u1eb7c n\u00e3o.<\/p>\n
$\"H\u00ecnh$
H\u00ecnh 1: T\u00f3m t\u1eaft l\u1ee3i \u00edch v\u00e0 t\u00e1c h\u1ea1i c\u1ee7a Corticosteroids<\/em><\/figcaption><\/figure>\n
Glucocorticoid v\u00e0 k\u1ebft c\u1ee5c l\u00e2m s\u00e0ng<\/h2>\n
M\u1ed9t ph\u00e2n t\u00edch g\u1ed9p to\u00e0n di\u1ec7n \u1edf m\u1ee9c \u0111\u1ed9 th\u1eed nghi\u1ec7m g\u1ea7n \u0111\u00e2y cho th\u1ea5y trong nhi\u1ec5m khu\u1ea9n huy\u1ebft so v\u1edbi gi\u00e1 d\u01b0\u1ee3c ho\u1eb7c \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng, corticosteroid c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m t\u1ec9 l\u1ec7 t\u1eed vong 28 ng\u00e0y. T\u00e1c \u0111\u1ed9ng \u0111i\u1ec1u tr\u1ecb l\u00ean t\u1eed vong 28 ng\u00e0y kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi lo\u1ea1i corticosteroid hay c\u00e1ch d\u00f9ng (ti\u00eam bolus so v\u1edbi truy\u1ec1n li\u00ean t\u1ee5c), v\u00e0 hi\u1ec7u qu\u1ea3 m\u1ea1nh h\u01a1n khi corticosteroid \u0111\u01b0\u1ee3c d\u00f9ng v\u1edbi li\u1ec1u kh\u1edfi \u0111\u1ea7u v\u00e0 li\u1ec1u t\u00edch l\u0169y th\u1ea5p h\u01a1n nh\u01b0ng trong giai \u0111o\u1ea1n d\u00e0i h\u01a1n. Tu\u1ed5i v\u00e0 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh kh\u00f4ng ph\u1ea3i l\u00e0 y\u1ebfu t\u1ed1 \u0111i\u1ec1u ch\u1ec9nh hi\u1ec7u qu\u1ea3 c\u1ee7a corticosteroid. Ph\u00e2n t\u00edch g\u1ed9p n\u00e0y cho th\u1ea5y corticosteroid l\u00e0m gi\u1ea3m t\u1eed vong 28 ng\u00e0y khi nhi\u1ec5m tr\u00f9ng huy\u1ebft c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng, ho\u1eb7c c\u00f3 bi\u1ebfn ch\u1ee9ng ARDS ho\u1eb7c s\u1ed1c, nh\u01b0ng kh\u00f4ng c\u00f3 l\u1ee3i \u00edch \u1edf b\u1ec7nh nh\u00e2n nhi\u1ec5m tr\u00f9ng huy\u1ebft kh\u00f4ng bi\u1ebfn ch\u1ee9ng. K\u1ebft qu\u1ea3 n\u00e0y ph\u00f9 h\u1ee3p v\u1edbi c\u00e1c ph\u00e2n t\u00edch g\u1ed9p g\u1ea7n \u0111\u00e2y v\u1ec1 \u0111i\u1ec1u tr\u1ecb corticosteroid cho CAP. Corticosteroid kh\u00f4ng l\u00e0m t\u0103ng nguy c\u01a1 bi\u1ebfn ch\u1ee9ng v\u00e0 di ch\u1ee9ng, nh\u01b0 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a, nhi\u1ec5m tr\u00f9ng th\u1ee9 ph\u00e1t, di ch\u1ee9ng th\u1ea7n kinh; ngo\u1ea1i tr\u1eeb t\u1ec9nh tr\u1ea1ng t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 t\u0103ng natri m\u00e1u tho\u00e1ng qua.<\/p>\n
Nh\u1eefng c\u00e2u h\u1ecfi c\u00f2n b\u1ecf ng\u1ecf v\u1ec1 corticosteroid<\/h2>\n
Hi\u1ec7n t\u1ea1i v\u1eabn c\u00f2n nhi\u1ec1u kho\u1ea3ng tr\u1ed1ng trong b\u1eb1ng ch\u1ee9ng. Th\u1ee9 nh\u1ea5t, ch\u01b0a c\u00f3 \u0111\u1ee7 th\u00f4ng tin \u0111\u1ec3 \u0111\u01b0a ra k\u1ebft lu\u1eadn ch\u1eafc ch\u1eafn v\u1ec1 t\u00e1c \u0111\u1ed9ng c\u1ee7a corticosteroid \u1edf tr\u1ebb em b\u1ecb nhi\u1ec5m tr\u00f9ng huy\u1ebft, c\u0169ng nh\u01b0 v\u1ec1 \u1ea3nh h\u01b0\u1edfng l\u00e2u d\u00e0i \u0111\u1ebfn s\u1ef1 s\u1ed1ng c\u00f2n v\u00e0 di ch\u1ee9ng \u1edf ng\u01b0\u1eddi l\u1edbn. Th\u1ee9 hai, v\u1eabn ch\u01b0a hi\u1ec3u r\u00f5 li\u1ec7u l\u1ee3i \u00edch s\u1ed1ng c\u00f2n t\u1eeb corticosteroid c\u00f3 ph\u1ee5 thu\u1ed9c v\u00e0o \u1ed5 nhi\u1ec5m tr\u00f9ng hay kh\u00f4ng, v\u00ed d\u1ee5 nhi\u1ec5m tr\u00f9ng huy\u1ebft \u0111\u01b0\u1eddng v\u00e0o t\u1eeb h\u00f4 h\u1ea5p so v\u1edbi c\u00e1c \u1ed5 kh\u00e1c. Th\u1ee9 ba, gi\u00e1 tr\u1ecb c\u1ee7a fludrocortisone khi k\u1ebft h\u1ee3p v\u1edbi hydrocortisone v\u1eabn c\u00f2n g\u00e2y tranh c\u00e3i. Th\u1ee9 t\u01b0, t\u1ec9 l\u1ec7 l\u1ee3i \u00edch – nguy c\u01a1 c\u1ee7a corticosteroid trong nhi\u1ec5m tr\u00f9ng huy\u1ebft do virus (ngo\u00e0i COVID-19 n\u1eb7ng) c\u1ea7n \u0111\u01b0\u1ee3c kh\u1ea3o s\u00e1t trong c\u00e1c th\u1eed nghi\u1ec7m v\u1edbi c\u1ee1 m\u1eabu \u0111\u1ee7 l\u1edbn. Th\u1ee9 n\u0103m, c\u00e1c y\u1ebfu t\u1ed1 di truy\u1ec1n, h\u1ec7 gen v\u00e0 ngo\u00e0i gen nhi\u1ec1u kh\u1ea3 n\u0103ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng v\u1edbi corticosteroid, v\u00e0 h\u1ea7u h\u1ebft trong s\u1ed1 \u0111\u00f3 v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c kh\u00e1m ph\u00e1.<\/p>\n
T\u1eeb khuy\u1ebfn c\u00e1o d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng \u0111\u1ebfn th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng<\/h2>\n
C\u00e1c h\u01b0\u1edbng d\u1eabn g\u1ea7n \u0111\u00e2y g\u1ee3i \u00fd s\u1eed d\u1ee5ng corticosteroid cho ng\u01b0\u1eddi l\u1edbn b\u1ecb s\u1ed1c nhi\u1ec5m khu\u1ea9n (m\u1ee9c \u0111\u1ed9 ch\u1eafc ch\u1eafn b\u1eb1ng ch\u1ee9ng th\u1ea5p), v\u00e0 cho nh\u1eefng b\u1ec7nh nh\u00e2n ARDS (m\u1ee9c \u0111\u1ed9 ch\u1eafc ch\u1eafn trung b\u00ecnh), \u0111\u1ed3ng th\u1eddi khuy\u1ebfn c\u00e1o d\u00f9ng corticosteroid cho ng\u01b0\u1eddi l\u1edbn b\u1ecb vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng n\u1eb7ng do vi khu\u1ea9n (CAP n\u1eb7ng) (m\u1ee9c \u0111\u1ed9 ch\u1eafc ch\u1eafn trung b\u00ecnh). M\u1ed9t kh\u1ea3o s\u00e1t tr\u00ean 542 b\u00e1c s\u0129 h\u1ed3i s\u1ee9c c\u1ea5p c\u1ee9u t\u1ea1i M\u1ef9 cho th\u1ea5y 83% kh\u00f4ng s\u1eed d\u1ee5ng corticosteroid th\u01b0\u1eddng quy \u1edf ng\u01b0\u1eddi l\u1edbn b\u1ecb nhi\u1ec5m tr\u00f9ng huy\u1ebft, tr\u00e1i ng\u01b0\u1ee3c v\u1edbi 81% b\u00e1o c\u00e1o th\u01b0\u1eddng s\u1eed d\u1ee5ng corticosteroid trong s\u1ed1c nhi\u1ec5m tr\u00f9ng. Kho\u1ea3ng 1\/3 ng\u01b0\u1eddi tham gia kh\u1ea3o s\u00e1t tin r\u1eb1ng corticosteroid l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong trong s\u1ed1c nhi\u1ec5m tr\u00f9ng, trong khi 27% kh\u00f4ng tin v\u00e0 45% ch\u01b0a ch\u1eafc ch\u1eafn. Hydrocortisone l\u00e0 lo\u1ea1i corticosteroid \u0111\u01b0\u1ee3c k\u00ea nhi\u1ec1u nh\u1ea5t (93%), v\u1edbi li\u1ec1u trung v\u1ecb 200 mg\/ng\u00e0y, th\u01b0\u1eddng d\u00f9ng theo \u0111\u01b0\u1eddng ti\u00eam t\u0129nh m\u1ea1ch bolus. M\u1ed9t nghi\u00ean c\u1ee9u h\u1ed3i c\u1ee9u \u0111a trung t\u00e2m t\u1ea1i \u00dac b\u00e1o c\u00e1o r\u1eb1ng vi\u1ec7c tri\u1ec3n khai \u0111i\u1ec1u tr\u1ecb hydrocortisone th\u01b0\u1eddng quy gi\u00fap gi\u1ea3m t\u1eeb vong li\u00ean quan \u0111\u1ebfn s\u1ed1c nhi\u1ec5m tr\u00f9ng trong 90 ng\u00e0y. M\u1ed9t ph\u00e2n t\u00edch \u0111o\u00e0n h\u1ec7 so s\u00e1nh h\u1ed3i c\u1ee9u kh\u00e1c t\u1ea1i M\u1ef9, s\u1eed d\u1ee5ng d\u1eef li\u1ec7u thu th\u1eadp th\u01b0\u1eddng quy, cho th\u1ea5y th\u00eam fludrocortisone v\u00e0o hydrocortisone gi\u00fap gi\u1ea3m th\u00eam 3.7% nguy c\u01a1 t\u1eed vong trong b\u1ec7nh vi\u1ec7n ho\u1eb7c ra vi\u1ec7n sang hospice.<\/p>\n
T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/h2>\n
1. Annane D, Briegel J, Seymour CW. Corticosteroids in sepsis: certainties and shadows. Intensive Care Med. 2025 Jul 23. doi: 10.1007\/s00134-025-08044-3. Epub ahead of print. PMID: 40699324.<\/p>\n","protected":false},"excerpt":{"rendered":"
Ng\u01b0\u1eddi d\u1ecbch: NT HN\u00a0 T\u1ea3i PDF t\u1ea1i \u0111\u00e2y Khi Hench v\u00e0 c\u00e1c c\u1ed9ng s\u1ef1 l\u1ea7n \u0111\u1ea7u m\u00f4 t\u1ea3 t\u00e1c d\u1ee5ng c\u1ee7a corticosteroid, h\u1ecd kh\u00f4ng th\u1ec3 ng\u1edd r\u1eb1ng v\u00e0o th\u1eadp ni\u00ean th\u1ee9 ba c\u1ee7a thi\u00ean ni\u00ean k\u1ef7 th\u1ee9 ba, nh\u1eefng thu\u1ed1c n\u00e0y l\u1ea1i tr\u1edf th\u00e0nh thu\u1ed1c kh\u00e1ng vi\u00eam \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n nhi\u1ec1u nh\u1ea5t tr\u00ean to\u00e0n th\u1ebf […]\n","protected":false},"author":1,"featured_media":138128,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-137856","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/137856","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=137856"}],"version-history":[{"count":3,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/137856\/revisions"}],"predecessor-version":[{"id":138130,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/137856\/revisions\/138130"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/138128"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=137856"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=137856"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=137856"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}