{"id":34035,"date":"2022-10-05T18:32:35","date_gmt":"2022-10-05T11:32:35","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=34035"},"modified":"2022-10-05T18:36:55","modified_gmt":"2022-10-05T11:36:55","slug":"tinh-hinh-su-dung-thuoc-trong-benh-vien-va-cap-nhat-huong-dan-dieu-tri-thong-tin-thuoc-moi","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/tinh-hinh-su-dung-thuoc-trong-benh-vien-va-cap-nhat-huong-dan-dieu-tri-thong-tin-thuoc-moi\/","title":{"rendered":"T\u00ecnh h\u00ecnh s\u1eed d\u1ee5ng thu\u1ed1c trong b\u1ec7nh vi\u1ec7n v\u00e0 c\u1eadp nh\u1eadt h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb, th\u00f4ng tin thu\u1ed1c m\u1edbi"},"content":{"rendered":"

B\u1ec6NH VI\u1ec6N H\u1eeeU NGH\u1eca VI\u1ec6T – X\u00d4
\nKHOA D\u01af\u1ee2C<\/p>\n

S\u1ed1 3 – 2022<\/p>\n

T\u00e0i li\u1ec7u l\u01b0u h\u00e0nh n\u1ed9i b\u1ed9<\/p>\n

C\u1eadp nh\u1eadt t\u00ecnh h\u00ecnh s\u1eed d\u1ee5ng thu\u1ed1c trong b\u1ec7nh vi\u1ec7n v\u00e0 h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb, s\u1eed d\u1ee5ng thu\u1ed1c m\u1edbi<\/a>.<\/p>\n

\u0110\u1ec3 t\u1ea3i File PDF, h\u00e3y click t\u1ea1i \u0111\u00e2y<\/a>.<\/p>\n

T\u00ccNH H\u00ccNH S\u1eec D\u1ee4NG THU\u1ed0C TRONG B\u1ec6NH VI\u1ec6N<\/h2>\n
M\u00d4 H\u00ccNH \u0110\u1ec0 KH\u00c1NG KH\u00c1NG SINH 6 TH\u00c1NG \u0110\u1ea6U N\u0102M 2022<\/h3>\n
10 ch\u1ee7ng vi khu\u1ea9n g\u00e2y b\u1ec7nh h\u00e0ng \u0111\u1ea7u<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
TT<\/td>\n Vi khu\u1ea9n<\/td>\n n= 481<\/p>\n
(t\u1ef7 l\u1ec7 d\u01b0\u01a1ng t\u00ednh 13.6%)<\/td>\n
T\u1ef7 l\u1ec7 (%)<\/td>\n<\/tr>\n
1<\/td>\n Escherichia coli<\/td>\n 153<\/td>\n 31.8<\/td>\n<\/tr>\n
2<\/td>\n Klebsiella pneumoniae<\/td>\n 119<\/td>\n 24.7<\/td>\n<\/tr>\n
3<\/td>\n Pseu. aeruginosa<\/td>\n 87<\/td>\n 18.1<\/td>\n<\/tr>\n
4<\/td>\n Acinetobacter baumannii<\/td>\n 30<\/td>\n 6.2<\/td>\n<\/tr>\n
5<\/td>\n Enterococcus feacalis<\/td>\n 29<\/td>\n 6.0<\/td>\n<\/tr>\n
6<\/td>\n Staphylococcus aureus<\/td>\n 21<\/td>\n 4.4<\/td>\n<\/tr>\n
7<\/td>\n Proteus vulgaris<\/td>\n 11<\/td>\n 2.3<\/td>\n<\/tr>\n
8<\/td>\n Sta. hemolyticus<\/td>\n 11<\/td>\n 2.3<\/td>\n<\/tr>\n
9<\/td>\n Sta. epidermidis<\/td>\n 5<\/td>\n 1.0<\/td>\n<\/tr>\n
10<\/td>\n Enterobacter cloacae<\/td>\n 3<\/td>\n 0.6<\/td>\n<\/tr>\n
<\/td>\n Kh\u00e1c<\/td>\n 12<\/td>\n 2.4<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
C\u00e1c c\u0103n nguy\u00ean ph\u00e2n l\u1eadp t\u1eeb m\u00e1u<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n
STT<\/td>\n Vi khu\u1ea9n<\/td>\n n= 52<\/td>\n T\u1ef7 l\u1ec7 (%)<\/td>\n<\/tr>\n
1<\/td>\n Escherichia coli<\/td>\n ^{1<\/sup>7<\/td>\n} 32.7<\/td>\n<\/tr>\n
2<\/td>\n Klebsiella pneumoniae<\/td>\n 8<\/td>\n 15.4<\/td>\n<\/tr>\n
3<\/td>\n Sta. hemolyticus<\/td>\n 6<\/td>\n n.5<\/td>\n<\/tr>\n
4<\/td>\n Acinetobacter baumannii<\/td>\n 5<\/td>\n 9.6<\/td>\n<\/tr>\n
5<\/td>\n Staphylococcus aureus<\/td>\n 5<\/td>\n 9.6<\/td>\n<\/tr>\n
6<\/td>\n Sta. epidermidis<\/td>\n 4<\/td>\n 7.7<\/td>\n<\/tr>\n
7<\/td>\n Strep. viridans<\/td>\n 3<\/td>\n 5.8<\/td>\n<\/tr>\n
<\/td>\n Kh\u00e1c<\/td>\n 4<\/td>\n 7.7<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
C\u0103n nguy\u00ean ph\u00e2n l\u1eadp t\u1eeb \u0111\u1eddm v\u00e0 d\u1ecbch ph\u1ebf qu\u1ea3n<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n
STT<\/td>\n Vi khu\u1ea9n<\/td>\n n=i04<\/td>\n T\u1ef7 l\u1ec7 (%)<\/td>\n<\/tr>\n
1<\/td>\n Klebsiella pneumoniae<\/td>\n 45<\/td>\n 43-3<\/td>\n<\/tr>\n
2<\/td>\n Pseu. aeruginosa<\/td>\n 22<\/td>\n 21.2<\/td>\n<\/tr>\n
3<\/td>\n Acinetobacter baumannii<\/td>\n 16<\/td>\n ^{1<\/sup>5-4<\/td>\n<\/tr>\n}
4<\/td>\n Escherichia coli<\/td>\n 8<\/td>\n 7.7<\/td>\n<\/tr>\n
5<\/td>\n Staphylococcus aureus<\/td>\n 6<\/td>\n 5-7<\/td>\n<\/tr>\n
6<\/td>\n Proteus vulgaris<\/td>\n 3<\/td>\n 2.8<\/td>\n<\/tr>\n
7<\/td>\n Sta. hemolyticus<\/td>\n 2<\/td>\n ^{1<\/sup>-9<\/td>\n<\/tr>\n}
<\/td>\n Kh\u00e1c<\/td>\n 2<\/td>\n 1.9<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
C\u0103n nguy\u00ean ph\u00e2n l\u1eadp t\u1eeb n\u01b0\u1edbc ti\u1ec3u<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n
STT<\/td>\n Vi khu\u1ea9n<\/td>\n ^{n<\/sup>= ^{2<\/sup>45<\/td>\n}} T\u1ef7 l\u1ec7 (%)<\/td>\n<\/tr>\n
1<\/td>\n Escherichia coli<\/td>\n 98<\/td>\n 40.0<\/td>\n<\/tr>\n
2<\/td>\n Pseu. aeruginosa<\/td>\n 54<\/td>\n 22.0<\/td>\n<\/tr>\n
3<\/td>\n Klebsiella pneumoniae<\/td>\n 49<\/td>\n 20.0<\/td>\n<\/tr>\n
4<\/td>\n Enterococcus feacalis<\/td>\n 23<\/td>\n 9.4<\/td>\n<\/tr>\n
5<\/td>\n Acinetobacter baumannii<\/td>\n 5<\/td>\n 2.0<\/td>\n<\/tr>\n
6<\/td>\n Sta. saprophyticus<\/td>\n 3<\/td>\n 1.2<\/td>\n<\/tr>\n
7<\/td>\n Proteus vulgaris<\/td>\n 3<\/td>\n 1.2<\/td>\n<\/tr>\n
<\/td>\n Kh\u00e1c<\/td>\n 10<\/td>\n 4.1<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
M\u1ee9c \u0111\u1ed9 kh\u00e1ng kh\u00e1ng sinh c\u1ee7a E.coli ph\u00e2n l\u1eadp trong m\u00e1u (n= 17)<\/strong><\/p>\n
$\"M\u1ee9c$
M\u1ee9c \u0111\u1ed9 kh\u00e1ng kh\u00e1ng sinh c\u1ee7a E.coli ph\u00e2n l\u1eadp trong m\u00e1u (n= 17)<\/figcaption><\/figure>\n
M\u1ee9c \u0111\u1ed9 kh\u00e1ng kh\u00e1ng sinh c\u1ee7a E.coli ph\u00e2n l\u1eadp trong n\u01b0\u1edbc ti\u1ec3u (n=\u1ecd8)<\/strong><\/p>\n
$\"M\u1ee9c$
M\u1ee9c \u0111\u1ed9 kh\u00e1ng kh\u00e1ng sinh c\u1ee7a E.coli ph\u00e2n l\u1eadp trong n\u01b0\u1edbc ti\u1ec3u (n=\u1ecd8)<\/figcaption><\/figure>\n
M\u1ee9c \u0111\u1ed9 kh\u00e1ng kh\u00e1ng sinh c\u1ee7a K. pneumonia ph\u00e2n l\u1eadp t\u1eeb \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p<\/strong><\/p>\n
$\"M\u1ee9c$
M\u1ee9c \u0111\u1ed9 kh\u00e1ng kh\u00e1ng sinh c\u1ee7a K. pneumonia ph\u00e2n l\u1eadp t\u1eeb \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p<\/figcaption><\/figure>\n
M\u1ee9c \u0111\u1ed9 kh\u00e1ng kh\u00e1ng sinh c\u1ee7a P.aeruginosa (n = 87)<\/strong><\/p>\n
$\"M\u1ee9c$
M\u1ee9c \u0111\u1ed9 kh\u00e1ng kh\u00e1ng sinh c\u1ee7a P.aeruginosa (n = 87)<\/figcaption><\/figure>\n
M\u1ee9c \u0111\u1ed9 kh\u00e1ng kh\u00e1ng sinh c\u1ee7a Acinetobacter baumannii (n = 30)<\/strong><\/p>\n
$\"M\u1ee9c$
M\u1ee9c \u0111\u1ed9 kh\u00e1ng kh\u00e1ng sinh c\u1ee7a Acinetobacter baumannii (n = 30)<\/figcaption><\/figure>\n
M\u1ee9c \u0111\u1ed9 kh\u00e1ng kh\u00e1ng sinh c\u1ee7a Staphylococcus aureus (n = 21)<\/strong><\/p>\n
$\"M\u1ee9c$
M\u1ee9c \u0111\u1ed9 kh\u00e1ng kh\u00e1ng sinh c\u1ee7a Staphylococcus aureus (n = 21)<\/figcaption><\/figure>\n
T\u00ccNH H\u00ccNH S\u1eec D\u1ee4NG KH\u00c1NG SINH 6 TH\u00c1NG \u0110\u1ea6U N\u0102M 2022<\/h3>\n
S\u1ed1 DDD\/100 ng\u00e0y gi\u01b0\u1eddng c\u1ee7a c\u00e1c kh\u00e1ng sinh 6 th\u00e1ng \u0111\u1ea7u n\u0103m 2022 v\u00e0 6 th\u00e1ng \u0111\u1ea7u n\u0103m 2021<\/strong><\/p>\n
$\"S\u1ed1$
S\u1ed1 DDD\/100 ng\u00e0y gi\u01b0\u1eddng c\u1ee7a c\u00e1c kh\u00e1ng sinh 6 th\u00e1ng \u0111\u1ea7u n\u0103m 2022 v\u00e0 6 th\u00e1ng \u0111\u1ea7u n\u0103m 2021<\/figcaption><\/figure>\n
Chi ph\u00ed s\u1eed d\u1ee5ng kh\u00e1ng sinh 6 th\u00e1ng \u0111\u1ea7u n\u0103m 2022 so v\u1edbi 6 th\u00e1ng \u0111\u1ea7u n\u0103m 2021 c\u1ee7a c\u00e1c khoa ph\u00f2ng<\/strong><\/p>\n
$\"Chi$
Chi ph\u00ed s\u1eed d\u1ee5ng kh\u00e1ng sinh 6 th\u00e1ng \u0111\u1ea7u n\u0103m 2022 so v\u1edbi 6 th\u00e1ng \u0111\u1ea7u n\u0103m 2021 c\u1ee7a c\u00e1c khoa ph\u00f2ng<\/figcaption><\/figure>\n
C\u1eacP NH\u1eacT H\u01af\u1edaNG D\u1eaaN \u0110I\u00caU TR\u1eca V\u00c0 TH\u00d4NG TIN THU\u1ed0C M\u1edaI<\/h2>\n
H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 qu\u1ea3n l\u00fd vi\u00eam ph\u1ed5i \u1edf ng\u01b0\u1eddi l\u1edbn c\u1ee7a Anh (Published: December 2014, updated Jul 2022 – NICE)<\/h3>\n
Th\u00e1ng 7 n\u0103m 2022, Vi\u1ec7n Y t\u1ebf v\u00e0 Ch\u1ea5t l\u01b0\u1ee3ng \u0110i\u1ec1u tr\u1ecb Qu\u1ed1c gia Anh (NICE) \u0111\u00e3 kh\u00f4i ph\u1ee5c l\u1ea1i h\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 qu\u1ea3n l\u00fd vi\u00eam ph\u1ed5i \u1edf ng\u01b0\u1eddi l\u1edbn sau khi b\u1ecb r\u00fat l\u1ea1i v\u00e0o th\u00e1ng 5\/2020 do d\u1ecbch COVID-19. M\u1ed9t s\u1ed1 \u0111i\u1ec3m ch\u00ednh v\u1ec1 ch\u1ea9n \u0111o\u00e1n v\u00e0 qu\u1ea3n l\u00fd vi\u00eam ph\u1ed5i trong h\u01b0\u1edbng d\u1eabn g\u1ed3m:<\/p>\n
V\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p d\u01b0\u1edbi<\/strong><\/h4>\n
V\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p d\u01b0\u1edbi t\u1ea1i c\u01a1 s\u1edf ch\u0103m s\u00f3c ban \u0111\u1ea7u, khuy\u1ebfn c\u00e1o l\u00e0m x\u00e9t nghi\u1ec7m CRP n\u1ebfu c\u00e1c \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u1ed5i ch\u01b0a th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c v\u00e0 kh\u00f4ng ch\u1eafc c\u00f3 n\u00ean k\u00ea kh\u00e1ng sinh hay kh\u00f4ng. S\u1eed d\u1ee5ng k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m CRP \u0111\u1ec3 \u0111\u1ecbnh h\u01b0\u1edbng k\u00ea \u0111\u01a1n kh\u00e1ng sinh \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u1ed5i nh\u01b0 sau:<\/p>\n
\n
Kh\u00f4ng k\u00ea \u0111\u01a1n kh\u00e1ng sinh th\u01b0\u1eddng quy n\u1ebfu CRP < 20 mg\/L.<\/li>\n
C\u00e2n nh\u1eafc tr\u00ec ho\u00e3n k\u00ea \u0111\u01a1n kh\u00e1ng sinh (ch\u1ec9 k\u00ea \u0111\u01a1n kh\u00e1ng sinh n\u1ebfu c\u00e1c tri\u1ec7u ch\u1ee9ng x\u1ea5u \u0111i) n\u1ebfu CRP t\u1eeb 20 mg\/L – 100 mg\/L.<\/li>\n
K\u00ea \u0111\u01a1n \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh n\u1ebfu CRP > 100 mg\/L.<\/li>\n<\/ul>\n
Vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i \u1edf c\u1ed9ng \u0111\u1ed3ng<\/strong><\/h4>\n\n\n\n\n\n\n
<\/td>\n CRB6_{5<\/sub><\/td>\n} CRUB6_{5<\/sub><\/td>\n<\/tr>\n}
Ti\u00eau ch\u00ed t\u00ednh \u0111i\u1ec3m<\/td>\n – L\u00fa l\u1eabn (\u0111i\u1ec3m ki\u1ec3m tra t\u00e2m th\u1ea7n \u22648.
\n– T\u0103ng nh\u1ecbp th\u1edf \u2265 30 l\u1ea7n\/ph\u00fat
\n– H\u1ea1 huy\u1ebft \u00e1p (HATTr \u226460 mmHg
\nho\u1eb7c HATT \u226490 mmHg)
\n– Tu\u1ed5i \u2265 65<\/td>\n – L\u00fa l\u1eabn (\u0111i\u1ec3m ki\u1ec3m tra t\u00e2m th\u1ea7n \u22648.
\n– Urea m|u > 7 mmol\/L
\n– T\u0103ng nh\u1ecbp th\u1edf \u2265 30 l\u1ea7n\/ph\u00fat
\n– H\u1ea1 huy\u1ebft \u00e1p (HATTr \u226460 mmHg
\nho\u1eb7c HATT \u226490 mmHg)
\n– Tu\u1ed5i \u2265 65<\/td>\n<\/tr>\n
Ph\u00e2n lo\u1ea1i<\/td>\n 0 \u0111i\u1ec3m: nguy c\u01a1 t\u1eed vong th\u1ea5p
\n1- 2 \u0111i\u1ec3m: nguy c\u01a1 t\u1eed vong trung b\u00ecnh
\n3 – 4 \u0111i\u1ec3m: nguy c\u01a1 t\u1eed vong cao<\/td>\n 0 – 1 \u0111i\u1ec3m: nguy c\u01a1 t\u1eed vong th\u1ea5p
\n2 \u0111i\u1ec3m: nguy c\u01a1 t\u1eed vong trung b\u00ecnh
\n3 – 5 \u0111i\u1ec3m: nguy c\u01a1 t\u1eed vong cao<\/td>\n<\/tr>\n
H\u01b0\u1edbng d\u1eabn qu\u1ea3n l\u00fd<\/td>\n – C\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec3m CRB6_{5<\/sub> l\u00e0 0.
\n– C\u00e2n nh\u1eafc nh\u1eadp vi\u1ec7n v\u1edbi nh\u00f3m b\u1ec7nh nh\u00e2n c\u00f2n l\u1ea1i, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec3m CRB6_{5 <\/sub>t\u1eeb 2 tr\u1edf l\u00ean<\/td>\n}} – C\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec3m CRUB6_{5<\/sub> l\u00e0 0 ho\u1eb7c 1.
\n– C\u00e2n nh\u1eafc nh\u1eadp vi\u1ec7n v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec3m CRUB6_{5<\/sub> \u2265 2.
\n– C\u00e2n nh\u1eafc ch\u0103m s\u00f3c t\u00edch c\u1ef1c cho b\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec3m CRUB6_{5<\/sub> \u2265 3.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng t\u1ea1i c\u01a1 s\u1edf ch\u0103m s\u00f3c ban \u0111\u1ea7u\/t\u1ea1i b\u1ec7nh vi\u1ec7n:<\/h5>\nKhi b\u1ec7nh nh\u00e2n c\u00f3 vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i \u1edf c\u1ed9ng \u0111\u1ed3ng, khuy\u1ebfn c\u00e1o \u0111\u00e1nh gi\u00e1 nguy c\u01a1 t\u1eed vong th\u1ea5p, trung b\u00ecnh hay cao b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng thang \u0111i\u1ec3m CRB65 (n\u1ebfu \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n t\u1ea1i c\u01a1 s\u1edf ch\u0103m s\u00f3c ban \u0111\u1ea7u) ho\u1eb7c CURB65 (n\u1ebfu ch\u1ea9n \u0111o\u00e1n t\u1ea1i b\u1ec7nh vi\u1ec7n).<\/p>\n
X\u00e9t nghi\u1ec7m vi sinh:<\/h5>\n\nKh\u00f4ng khuy\u1ebfn c\u00e1o th\u1ef1c hi\u1ec7n x\u00e9t nghi\u1ec7m vi sinh th\u01b0\u1eddng quy cho b\u1ec7nh nh\u00e2n vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i \u1edf c\u1ed9ng \u0111\u1ed3ng nguy c\u01a1 t\u1eed vong th\u1ea5p.<\/li>\n
\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i \u1edf c\u1ed9ng \u0111\u1ed3ng nguy c\u01a1 t\u1eed vong trung b\u00ecnh ho\u1eb7c cao: c\u1ea5y m\u00e1u v\u00e0 \u0111\u1eddm v\u00e0 c\u00e2n nh\u1eafc l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m t\u00ecm kh\u00e1ng nguy\u00ean legionella v\u00e0 ph\u1ebf c\u1ea7u trong n\u01b0\u1edbc ti\u1ec3u.<\/li>\n<\/ul>\nTh\u1eddi gian ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb:<\/h5>\nTh\u1ef1c hi\u1ec7n ch\u1ea9n \u0111o\u00e1n (bao g\u1ed3m c\u1ea3 ch\u1ee5p X-quang) v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i t\u1ea1i c\u1ed9ng \u0111\u1ed3ng trong v\u00f2ng 4 gi\u1edd sau khi nh\u1eadp vi\u1ec7n.<\/p>\n
Theo d\u00f5i t\u1ea1i b\u1ec7nh vi\u1ec7n:<\/h5>\nC\u00e2n nh\u1eafc \u0111o n\u1ed3ng \u0111\u1ed9 CRP ban \u0111\u1ea7u cho b\u1ec7nh nh\u00e2n vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i t\u1ea1i c\u1ed9ng \u0111\u1ed3ng khi nh\u1eadp vi\u1ec7n, l\u1eb7p l\u1ea1i x\u00e9t nghi\u1ec7m n\u1ebfu ti\u1ebfn tri\u1ec3n l\u00e2m s\u00e0ng kh\u00f4ng r\u00f5 r\u1ec7t sau 48 – 72 gi\u1edd.<\/p>\n
Vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i \u1edf b\u1ec7nh vi\u1ec7n<\/strong><\/h4>\nQu\u00fd \u0111\u1ed3ng nghi\u1ec7p vui l\u00f2ng tham kh\u1ea3o t\u1ea1i link: NICE guideline on pneumonia (hospital-acquired): antimicrobial prescribing for recommendations on antibiotic therapy for hospital-acquired pneumonia.<\/a><\/p>\n
Hi\u1ec7u qu\u1ea3 gi\u1ea3m \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 gi\u1ea3m bi\u1ebfn c\u1ed1 m\u1ea1ch m\u00e1u nh\u1ecf v\u00e0 b\u1ec7nh tim m\u1ea1ch \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2<\/h3>\nGlycemia Reduction in Type 2 Diabetes \u2014 Glycemic Outcomes, The GRADE Study Research Group, N Engl J Med 2022; 387:1063-1074<\/p>\n
Glycemia Reduction in Type 2 Diabetes \u2014 Microvascular and Cardiovascular Outcomes, The GRADE Study Research Group*, N Engl J Med 2022; 387:1075-1088<\/p>\n
Th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi nh\u00f3m nghi\u00ean c\u1ee9u GRADE (Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study) t\u1ea1i M\u1ef9 v\u1edbi 2 m\u1ee5c ti\u00eau ch\u00ednh:<\/p>\n
\nM\u1ee5c ti\u00eau 1: So s\u00e1nh hi\u1ec7u qu\u1ea3 c\u1ee7a c\u00e1c thu\u1ed1c h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft khi k\u1ebft h\u1ee3p v\u1edbi metformin \u0111\u1ec3 duy tr\u00ec m\u1ee9c HbA1C m\u1ee5c ti\u00eau \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0110T\u01102. Ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 ch\u00ednh l\u00e0 t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n c\u00f3 HbAiC (\u0111\u01b0\u1ee3c \u0111o h\u00e0ng qu\u00fd) t\u1eeb 7,0% tr\u1edf l\u00ean v\u00e0 ti\u00eau ch\u00ed ph\u1ee5 l\u00e0 t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n c\u00f3 HbAiC l\u1edbn h\u01a1n 7,5%.<\/li>\n
M\u1ee5c ti\u00eau th\u1ee9 2: So s\u00e1nh hi\u1ec7u qu\u1ea3 c\u1ee7a c\u00e1c thu\u1ed1c h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft khi k\u1ebft h\u1ee3p v\u1edbi metformin trong gi\u1ea3m c\u00e1c bi\u1ebfn c\u1ed1 b\u1ec7nh m\u1ea1ch m\u00e1u ngo\u1ea1i vi v\u00e0 b\u1ec7nh tim m\u1ea1ch \u1edf b\u1ec7nh nh\u00e2n \u0110T\u01102. Ti\u00eau ch\u00ed li\u00ean quan \u0111\u1ebfn b\u1ec7nh m\u1ea1ch m\u00e1u ngo\u1ea1i vi v\u00e0 b\u1ec7nh tim m\u1ea1ch bao g\u1ed3m t\u0103ng huy\u1ebft \u00e1p v\u00e0 r\u1ed1i lo\u1ea1n lipid m\u00e1u, albumin ni\u1ec7u t\u0103ng trung b\u00ecnh ho\u1eb7c n\u1eb7ng ho\u1eb7c m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn \u01b0\u1edbc t\u00ednh (eGFR) d\u01b0\u1edbi 60 ml\/ph\u00fat\/1,73 m2, b\u1ec7nh th\u1ea7n kinh ngo\u1ea1i vi do ti\u1ec3u \u0111\u01b0\u1eddng, c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch (c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch nghi\u00eam tr\u1ecdng [MACE], nh\u1eadp vi\u1ec7n v\u00ec suy tim ho\u1eb7c k\u1ebft qu\u1ea3 t\u1ed5ng h\u1ee3p c\u1ee7a b\u1ea5t k\u1ef3 bi\u1ebfn c\u1ed1 tim m\u1ea1ch n\u00e0o) v\u00e0 t\u1eed vong.<\/li>\n<\/ul>\n\u0110\u1ed1i t\u01b0\u1ee3ng tham gia nghi\u00ean c\u1ee9u l\u00e0 nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc \u0110T\u01102 d\u01b0\u1edbi 10 n\u0103m \u0111ang d\u00f9ng metformin v\u00e0 c\u00f3 m\u1ee9c HbA1C t\u1eeb 6,8 \u0111\u1ebfn 8,5%, \u0111\u01b0\u1ee3c ph\u00e2n nh\u00f3m ng\u1eabu nhi\u00ean v\u00e0o c\u00e1c nh\u00f3m d\u00f9ng insulin glargine U-100, glimepirid (\u0111\u1ea1i di\u1ec7n nh\u00f3m sulfonylurea), liraglutid (\u0111\u1ea1i di\u1ec7n nh\u00f3m thu\u1ed1c ch\u1ee7 v\u1eadn th\u1ee5 th\u1ec3 glucagon like peptide-1), ho\u1eb7c sitagliptin (\u0111\u1ea1i di\u1ec7n nh\u00f3m thu\u1ed1c \u1ee9c ch\u1ebf dipeptidyl peptidase 4).<\/p>\n
K\u1ebft qu\u1ea3 c\u1ee7a nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 trong th\u00e1ng 09\/2022 g\u1ed3m:<\/strong><\/p>\n
T\u1ed5ng c\u1ed9ng c\u00f3 5047 ng\u01b0\u1eddi tham gia, \u0111ang d\u00f9ng metformin cho \u0111i\u1ec1u tr\u1ecb \u0110T\u01102 \u0111\u01b0\u1ee3c theo d\u00f5i trong 5 n\u0103m. T\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n c\u00f3 HbAiC t\u1eeb 7,0% tr\u1edf l\u00ean (ti\u00eau ch\u00ed ch\u00ednh) kh\u00e1c bi\u1ec7t \u0111\u00e1ng k\u1ec3 gi\u1eefa b\u1ed1n nh\u00f3m (P <0,001); t\u1ef7 l\u1ec7 \u1edf nh\u00f3m insulin glargin (26,5 tr\u00ean 100 ng\u01b0\u1eddi tham gia\/n\u0103m) t\u01b0\u01a1ng t\u1ef1 nh\u00f3m d\u00f9ng liraglutid (26,1) v\u00e0 th\u1ea5p h\u01a1n nh\u00f3m d\u00f9ng glimepirid (30,4) v\u00e0 nh\u00f3m d\u00f9ng sitagliptin (38,1). S\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa c\u00e1c nh\u00f3m v\u1ec1 t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n c\u00f3 HbAiC l\u1edbn h\u01a1n 7,5% (ti\u00eau ch\u00ed ph\u1ee5) t\u01b0\u01a1ng t\u1ef1 v\u1edbi ti\u00eau ch\u00ed ch\u00ednh. Kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a n\u00e0o \u0111\u1ed1i v\u1edbi ti\u00eau ch\u00ed ch\u00ednh gi\u1eefa c\u00e1c ph\u00e2n nh\u00f3m theo gi\u1edbi t\u00ednh, tu\u1ed5i t\u00e1c hay ch\u1ee7ng t\u1ed9c; tuy nhi\u00ean, trong s\u1ed1 nh\u1eefng ng\u01b0\u1eddi tham gia c\u00f3 m\u1ee9c HbA1C n\u1ec1n cao h\u01a1n, d\u01b0\u1eddng nh\u01b0 insulin glargin, liraglutid v\u00e0 glimepirid c\u00f3 l\u1ee3i \u00edch l\u1edbn h\u01a1n so v\u1edbi sitagliptin. H\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft nghi\u00eam tr\u1ecdng hi\u1ebfm g\u1eb7p x\u1ea3y ra v\u1edbi glimepirid (2,2% s\u1ed1 ng\u01b0\u1eddi tham gia) nhi\u1ec1u h\u01a1n \u0111\u00e1ng k\u1ec3 so v\u1edbi insulin glargin (1,3%), liraglutid (1,0%), ho\u1eb7c sitagliptin (0,7%). Nh\u00f3m d\u00f9ng liraglutid g\u1eb7p c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 tr\u00ean \u0111\u01b0\u1eddng ti\u00eau h\u00f3a ph\u1ed5 bi\u1ebfn h\u01a1n v\u00e0 gi\u1ea3m c\u00e2n nhi\u1ec1u h\u01a1n so v\u1edbi c\u00e1c nh\u00f3m kh\u00e1c.<\/p>\n
Trong th\u1eddi gian theo d\u00f5i trung b\u00ecnh 5,0 n\u0103m \u1edf 5047 ng\u01b0\u1eddi tham gia, kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t \u0111\u00e1ng k\u1ec3 gi\u1eefa c\u00e1c nh\u00f3m v\u1ec1 t\u1ef7 l\u1ec7 m\u1eafc t\u0103ng huy\u1ebft \u00e1p ho\u1eb7c r\u1ed1i lo\u1ea1n lipid m\u00e1u ho\u1eb7c c\u00e1c bi\u1ebfn ch\u1ee9ng m\u1ea1ch m\u00e1u nh\u1ecf; t\u1ef7 l\u1ec7 m\u1eafc trung b\u00ecnh (s\u1ed1 bi\u1ebfn c\u1ed1 tr\u00ean 100 ng\u01b0\u1eddi tham gia-n\u0103m) c\u1ee7a t\u0103ng albumin ni\u1ec7u trung b\u00ecnh l\u00e0 2,6, t\u0103ng albumin ni\u1ec7u n\u1eb7ng 1,1, suy th\u1eadn 2,9 v\u00e0 b\u1ec7nh th\u1ea7n kinh ngo\u1ea1i vi do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng 16,7. C\u00e1c nh\u00f3m \u0111i\u1ec1u tr\u1ecb kh\u00f4ng kh\u00e1c nhau v\u1ec1 MACE (t\u1ef7 l\u1ec7 g\u1ed9p, 1,0), nh\u1eadp vi\u1ec7n v\u00ec suy tim (0,4), t\u1eed vong do nguy\u00ean nh\u00e2n tim m\u1ea1ch (0,3), ho\u1eb7c t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n (0,6). C\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t nh\u1ecf v\u1ec1 t\u1ef7 l\u1ec7 m\u1eafc b\u1ea5t k\u1ef3 b\u1ec7nh tim m\u1ea1ch n\u00e0o, l\u1ea7n l\u01b0\u1ee3t l\u00e0 1,9, 1,9, 1,4 v\u00e0 2,0 \u1edf c\u00e1c nh\u00f3m insulin glargin, glimepirid, liraglutid v\u00e0 sitagliptin.<\/p>\n
K\u1ebft qu\u1ea3 c\u1ee7a nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 trong th\u00e1ng 09_2022<\/figcaption><\/figure>\nK\u1ebft lu\u1eadn<\/strong><\/p>\n
T\u1ea5t c\u1ea3 b\u1ed1n lo\u1ea1i thu\u1ed1c, khi \u0111\u01b0\u1ee3c th\u00eam v\u00e0o metformin, \u0111\u1ec1u l\u00e0m gi\u1ea3m m\u1ee9c HbAiC. Tuy nhi\u00ean, insulin glargin v\u00e0 liraglutid c\u00f3 hi\u1ec7u qu\u1ea3 \u0111\u00e1ng k\u1ec3 h\u01a1n trong vi\u1ec7c \u0111\u1ea1t \u0111\u01b0\u1ee3c v\u00e0 duy tr\u00ec m\u1ee9c HbAiC m\u1ee5c ti\u00eau.<\/p>\n
T\u1ef7 l\u1ec7 bi\u1ebfn ch\u1ee9ng m\u1ea1ch m\u00e1u nh\u1ecf v\u00e0 t\u1eed vong kh\u00f4ng kh\u00e1c nhau gi\u1eefa b\u1ed1n nh\u00f3m \u0111i\u1ec1u tr\u1ecb. Nghi\u00ean c\u1ee9u cho th\u1ea5y c\u00f3 th\u1ec3 c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa c\u00e1c nh\u00f3m v\u1ec1 t\u1ef7 l\u1ec7 m\u1eafc c\u00e1c b\u1ec7nh l\u00fd tim m\u1ea1ch.<\/p>\n
H\u01b0\u1edbng d\u1eabn D\u1ef1 ph\u00f2ng v\u00e0 \u0110i\u1ec1u tr\u1ecb Lo\u00e3ng X\u01b0\u01a1ng c\u1ee7a Anh (NOGG 2021, published 2022 – NICE)<\/h3>\nV\u00e0o th\u00e1ng 3 n\u0103m 2022, Hi\u1ec7p h\u1ed9i H\u01b0\u1edbng d\u1eabn Lo\u00e3ng x\u01b0\u01a1ng Qu\u1ed1c gia c\u1ee7a Anh (NOGG) \u0111\u00e3 xu\u1ea5t b\u1ea3n h\u01b0\u1edbng d\u1eabn m\u1edbi v\u1ec1 \u0111\u00e1nh gi\u00e1 v\u00e0 qu\u1ea3n l\u00fd lo\u00e3ng x\u01b0\u01a1ng v\u00e0 ng\u0103n ng\u1eeba g\u00e3y x\u01b0\u01a1ng \u1edf ph\u1ee5 n\u1eef sau m\u00e3n kinh v\u00e0 nam gi\u1edbi t\u1eeb 50 tu\u1ed5i tr\u1edf l\u00ean. Nh\u1eefng khuy\u1ebfn c\u00e1o ch\u00ednh c\u1ee7a h\u01b0\u1edbng d\u1eabn bao g\u1ed3m:<\/p>\n
Khuy\u1ebfn c\u00e1o v\u1ec1 \u0111\u00e1nh gi\u00e1 nguy c\u01a1 g\u00e3y x\u01b0\u01a1ng:<\/strong><\/p>\n
\nTi\u1ebfn h\u00e0nh \u0111\u00e1nh gi\u00e1 nguy c\u01a1 g\u00e3y x\u01b0\u01a1ng d\u1ef1a tr\u00ean thang \u0111i\u1ec3m FRAX (Fracture Risk Assessment Tool).<\/li>\n
\u0110o m\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng (BMD) \u1edf nh\u1eefng ng\u01b0\u1eddi c\u00f3 nguy c\u01a1 g\u00e3y x\u01b0\u01a1ng trung b\u00ecnh theo thang FRAX \u0111\u1ec3\u2019 \u01b0\u1edbc t\u00ednh nguy c\u01a1 g\u00e3y x\u01b0\u01a1ng trong 10 n\u0103m.<\/li>\n
\u0110o BMD \u1edf nh\u1eefng ng\u01b0\u1eddi c\u00f3 nguy c\u01a1 g\u00e3y x\u01b0\u01a1ng cao v\u00e0 r\u1ea5t cao theo thang FRAX \u0111\u1ec3\u2019 l\u1ef1a ch\u1ecdn thu\u1ed1c v\u00e0 chi\u1ebfn l\u01b0\u1ee3c theo d\u00f5i BMD.<\/li>\n
S\u1eed d\u1ee5ng c\u00e1c x\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh \u0111\u1ec3\u2019 t\u00ecm g\u00e3y x\u01b0\u01a1ng s\u1ed1ng \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ecb \u0111au l\u01b0ng c\u1ea5p t\u00ednh kh\u1edfi ph\u00e1t c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 g\u00e2y lo\u00e3ng x\u01b0\u01a1ng v\u00e0\/ho\u1eb7c \u1edf nh\u1eefng ng\u01b0\u1eddi c\u00f3 ti\u1ec1n s\u1eed gi\u1ea3m chi\u1ec1u cao > 4cm, g\u00f9 v\u1eb9o c\u1ed9t s\u1ed1ng, \u0111i\u1ec1u tr\u1ecb glucocorticoid \u0111\u01b0\u1eddng u\u1ed1ng k\u00e9o d\u00e0i g\u1ea7n \u0111\u00e2y ho\u1eb7c T-score <-2,5.<\/li>\n
\u0110\u00e1nh gi\u00e1 nguy c\u01a1 t\u00e9 ng\u00e3 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb lo\u00e3ng x\u01b0\u01a1ng v\u00e0\/ho\u1eb7c d\u1ec5 g\u00e3y x\u01b0\u01a1ng v\u00e0 h\u01b0\u1edbng d\u1eabn ch\u1ebf \u0111\u1ed9 luy\u1ec7n t\u1eadp \u0111\u1ec3\u2019 c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng gi\u1eef th\u0103ng b\u1eb1ng v\u00e0 s\u1ee9c m\u1ea1nh c\u01a1 b\u1eafp.<\/li>\n<\/ul>\nKhuy\u1ebfn c\u00e1o v\u1ec1 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c \u0111\u1ec3 ng\u0103n ng\u1eeba g\u00e3y x\u01b0\u01a1ng:<\/strong><\/p>\n
\nKhuy\u1ebfn ngh\u1ecb \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c cho nh\u1eefng ng\u01b0\u1eddi c\u00f3 nguy c\u01a1 g\u00e3y x\u01b0\u01a1ng cao v\u00e0 r\u1ea5t cao.<\/li>\n
N\u1ebfu kh\u00f4ng th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c \u0111o BMD, c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb d\u1ef1a tr\u00ean thang \u0111i\u1ec3\u2019m FRAX.<\/li>\n
B\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c ngay sau khi x\u1ea3y ra g\u00e3y x\u01b0\u01a1ng \u1edf b\u1ec7nh nh\u00e2n lo\u00e3ng x\u01b0\u01a1ng, v\u00ec nguy c\u01a1 t\u00e1i g\u00e3y r\u1ea5t cao.<\/li>\n
C\u00e2n nh\u1eafc chuy\u1ec3n b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 r\u1ea5t cao \u0111\u1ebfn chuy\u00ean khoa lo\u00e3ng x\u01b0\u01a1ng, \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 v\u00e0 xem x\u00e9t \u0111i\u1ec1u tr\u1ecb b\u1eb1ng \u0111\u01b0\u1eddng ti\u00eam (m\u1ed9t s\u1ed1 c\u00f3 th\u1ec3\u2019 c\u1ea7n \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u tay b\u1eb1ng thu\u1ed1c \u0111\u1ed3ng h\u00f3a, \u0111\u1eb7c bi\u1ec7t n\u1ebfu g\u00e3y nhi\u1ec1u \u0111\u1ed1t s\u1ed1ng). Ch\u1ec9 \u0111\u1ecbnh chuy\u1ec3n tuy\u1ebfn chuy\u00ean khoa bao g\u1ed3m c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 quan tr\u1ecdng, nh\u01b0 g\u00e3y \u0111\u1ed1t s\u1ed1ng g\u1ea7n \u0111\u00e2y [trong v\u00f2ng 2 n\u0103m qua], g\u00e3y >2 \u0111\u1ed1t s\u1ed1ng, T-Score <-3,5, \u0111i\u1ec1u tr\u1ecb b\u1eb1ng glucocorticoid li\u1ec1u cao [>7,5 mg\/ng\u00e0y prednisolone ho\u1eb7c t\u01b0\u01a1ng \u0111\u01b0\u01a1ng tr\u00ean 3 th\u00e1ng].<\/li>\n
\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00e1c c\u00f3 ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb, xem x\u00e9t li\u1ec7u ph\u00e1p ch\u1ed1ng ti\u00eau x\u01b0\u01a1ng b\u1eb1ng bisphosphonat \u0111\u01b0\u1eddng u\u1ed1ng (alendronat ho\u1eb7c risedronat) ho\u1eb7c zoledronat ti\u00eam t\u0129nh m\u1ea1ch.<\/li>\n
Xem x\u00e9t c\u00e1c l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb thay th\u1ebf n\u1ebfu c\u00e1c bisphosphonat \u0111\u1ea7u tay kh\u00f4ng ph\u00f9 h\u1ee3p ho\u1eb7c kh\u00f4ng dung n\u1ea1p; denosumab, ibandronat, li\u1ec7u ph\u00e1p thay th\u1ebf hormon, raloxifen ho\u1eb7c strontium ranelat.<\/li>\n<\/ul>\nKhuy\u1ebfn c\u00e1o v\u1ec1 theo d\u00f5i \u0111i\u1ec1u tr\u1ecb:<\/strong><\/p>\n
\nTh\u01b0\u1eddng xuy\u00ean xem x\u00e9t m\u1ee9c \u0111\u1ed9 dung n\u1ea1p v\u00e0 tu\u00e2n th\u1ee7 c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u1ed1i v\u1edbi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c u\u1ed1ng.<\/li>\n
L\u1eadp k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb b\u1eb1ng bisphosphonat u\u1ed1ng trong \u00edt nh\u1ea5t 5 n\u0103m, ho\u1eb7c bisphosphonat ti\u00eam t\u0129nh m\u1ea1ch trong \u00edt nh\u1ea5t 3 n\u0103m, sau \u0111\u00f3 \u0111\u00e1nh gi\u00e1 l\u1ea1i nguy c\u01a1 g\u00e3y x\u01b0\u01a1ng. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb l\u00e2u h\u01a1n s\u1ebd c\u1ea7n thi\u1ebft v\u1edbi nh\u1eefng ng\u01b0\u1eddi l\u1edbn tu\u1ed5i (>70 tu\u1ed5i), b\u1ecb g\u00e3y x\u01b0\u01a1ng h\u00f4ng ho\u1eb7c \u0111\u1ed1t s\u1ed1ng, \u0111ang s\u1eed d\u1ee5ng glucocorticoid \u0111\u01b0\u1eddng u\u1ed1ng li\u1ec1u cao [>7,5 mg\/ng\u00e0y prednisolon ho\u1eb7c t\u01b0\u01a1ng \u0111\u01b0\u01a1ng trong 3 th\u00e1ng], ho\u1eb7c b\u1ecb g\u00e3y x\u01b0\u01a1ng trong th\u1eddi gian \u0111i\u1ec1u tr\u1ecb lo\u00e3ng x\u01b0\u01a1ng. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 th\u1ea5p h\u01a1n, c\u00f3 th\u1ec3\u2019 t\u1ea1m d\u1eebng \u0111i\u1ec1u tr\u1ecb t\u1eeb 18 \u0111\u1ebfn 36 th\u00e1ng sau 5 n\u0103m d\u00f9ng bisphosphonat u\u1ed1ng ho\u1eb7c sau 3 n\u0103m bisphosphonat ti\u00eam t\u0129nh m\u1ea1ch).<\/li>\n
\u0110\u00e1nh gi\u00e1 l\u1ea1i nguy c\u01a1 g\u00e3y x\u01b0\u01a1ng sau b\u1ea5t k\u1ef3 bi\u1ebfn c\u1ed1 g\u00e3y x\u01b0\u01a1ng m\u1edbi n\u00e0o.<\/li>\n
\u0110\u00e1nh gi\u00e1 l\u1ea1i nguy c\u01a1 g\u00e3y x\u01b0\u01a1ng sau 18 th\u00e1ng \u0111\u1ebfn 3 n\u0103m t\u1ea1m d\u1eebng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c.<\/li>\n<\/ul>\nKhuy\u1ebfn c\u00e1o v\u1ec1 l\u1ed1i s\u1ed1ng v\u00e0 ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng:<\/strong><\/p>\n
\nKhuy\u1ebfn ngh\u1ecb m\u1ed9t ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng l\u00e0nh m\u1ea1nh, c\u00e2n b\u1eb1ng, h\u1ea1n ch\u1ebf r\u01b0\u1ee3u v\u00e0 tr\u00e1nh h\u00fat thu\u1ed1c l\u00e1. \u0110\u1ea3m b\u1ea3o m\u1ed9t ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng \u0111\u1ee7 canxi v\u00e0 vitamin D v\u00e0 b\u1ed5 sung khi c\u1ea7n thi\u1ebft.<\/li>\n
Khuy\u1ebfn kh\u00edch k\u1ebft h\u1ee3p c\u00e1c b\u00e0i t\u1eadp th\u1ec3\u2019 d\u1ee5c n\u00e2ng cao s\u1ee9c ch\u1ecbu l\u1ef1c v\u00e0 t\u0103ng c\u01b0\u1eddng c\u01a1 b\u1eafp th\u01b0\u1eddng xuy\u00ean.<\/li>\n<\/ul>\nNgu\u1ed3n: NOGG 2022: Clinical guideline for the prevention and treatment of osteoporosis<\/p>\n","protected":false},"excerpt":{"rendered":"
B\u1ec6NH VI\u1ec6N H\u1eeeU NGH\u1eca VI\u1ec6T – X\u00d4 KHOA D\u01af\u1ee2C S\u1ed1 3 – 2022 T\u00e0i li\u1ec7u l\u01b0u h\u00e0nh n\u1ed9i b\u1ed9 C\u1eadp nh\u1eadt t\u00ecnh h\u00ecnh s\u1eed d\u1ee5ng thu\u1ed1c trong b\u1ec7nh vi\u1ec7n v\u00e0 h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb, s\u1eed d\u1ee5ng thu\u1ed1c m\u1edbi. \u0110\u1ec3 t\u1ea3i File PDF, h\u00e3y click t\u1ea1i \u0111\u00e2y. T\u00ccNH H\u00ccNH S\u1eec D\u1ee4NG THU\u1ed0C TRONG B\u1ec6NH VI\u1ec6N M\u00d4 […]\n","protected":false},"author":1,"featured_media":34045,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-34035","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\/34035","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=34035"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/34035\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/34045"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=34035"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=34035"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=34035"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}}}}