Natri bicarbonat ti\u00eam t\u0129nh m\u1ea1ch v\u00e0 acetylcystein \u0111\u01b0\u1eddng u\u1ed1ng \u0111\u1ec1u \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i sau ch\u1ee5p m\u1ea1ch nh\u1eb1m d\u1ef1 ph\u00f2ng t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p v\u00e0 c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n k\u00e8m theo, m\u00e0 kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng ch\u1eafc ch\u1eafn cho hi\u1ec7u qu\u1ea3 c\u1ee7a c\u00e1c bi\u1ec7n ph\u00e1p n\u00e0y.<\/p>\n
Ch\u00ednh v\u00ec v\u1eady c\u00e1c t\u00e1c gi\u1ea3 \u0111\u00e3 s\u1eed d\u1ee5ng thi\u1ebft k\u1ebf nghi\u00ean c\u1ee9u \u1ea3nh h\u01b0\u1edfng nh\u00e2n t\u1ed1 2×2 v\u00e0 ph\u00e2n b\u1ed1 ng\u1eabu nhi\u00ean 5177 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ee5p m\u1ea1ch theo l\u1ecbch c\u00f3 nguy c\u01a1 cao bi\u1ebfn ch\u1ee9ng tr\u00ean th\u1eadn v\u00e0o c\u00e1c nh\u00f3m d\u00f9ng natri bicarbonate 1,26% \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch, ho\u1eb7c natri chloride 0,9% \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch v\u00e0 5 ng\u00e0y d\u00f9ng acetylcystein \u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c gi\u1ea3 d\u01b0\u1ee3c \u0111\u01b0\u1eddng u\u1ed1ng; trong s\u1ed1 n\u00e0y, 4993 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o ph\u00e2n t\u00edch theo qu\u1ea7n th\u1ec3 d\u1ef1 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb c\u00f3 \u0111i\u1ec1u ch\u1ec9nh. Ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 cu\u1ed1i k\u00ec ch\u00ednh l\u00e0 ph\u1ee9c h\u1ee3p t\u1eed vong, \u0111\u00f2i h\u1ecfi th\u1ea9m ph\u00e2n ho\u1eb7c t\u0103ng dai d\u1eb3ng \u00edt nh\u1ea5t 50% n\u1ed3ng \u0111\u1ed9 creatinine huy\u1ebft thanh so v\u1edbi tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb sau 90 ng\u00e0y. T\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p do thu\u1ed1c c\u1ea3n quang l\u00e0 ti\u00eau ch\u00ed cu\u1ed1i k\u00ec ph\u1ee5.<\/p>\n
Nh\u00e0 t\u00e0i tr\u1ee3 nghi\u00ean c\u1ee9u \u0111\u00e3 k\u1ebft th\u00fac th\u1eed nghi\u1ec7m sau l\u1ea7n ti\u1ebfn h\u00e0nh ph\u00e2n t\u00edch gi\u1eefa k\u00ec theo k\u1ebf ho\u1ea1ch. Khi xem x\u00e9t ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 ch\u00ednh, kh\u00f4ng nh\u1eadn th\u1ea5y t\u01b0\u01a1ng t\u00e1c gi\u1eefa natri bicarbonate v\u00e0 acetylcysteine (P=0,33). Ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 ch\u00ednh xu\u1ea5t hi\u1ec7n \u1edf 110 tr\u00ean t\u1ed5ng s\u1ed1 2511 b\u1ec7nh nh\u00e2n (4,4%) \u1edf nh\u00f3m d\u00f9ng natri bicarbonate, so v\u1edbi 116 tr\u00ean t\u1ed5ng s\u1ed1 2482 b\u1ec7nh nh\u00e2n (4,7%) \u1edf nh\u00f3m d\u00f9ng natri chloride (t\u1ec9 su\u1ea5t ch\u00eanh 0,93; kho\u1ea3ng tin c\u1eady 95% [95% CI] 0,72-1,22; P=0,62) v\u00e0 \u1edf 114 tr\u00ean t\u1ed5ng s\u1ed1 2495 b\u1ec7nh nh\u00e2n (4,6%) \u1edf nh\u00f3m d\u00f9ng acetylcysteine so v\u1edbi 112 tr\u00ean t\u1ed5ng s\u1ed1 2498 (4,5%) b\u1ec7nh nh\u00e2n \u1edf nh\u00f3m d\u00f9ng gi\u1ea3 d\u01b0\u1ee3c (t\u1ec9 su\u1ea5t ch\u00eanh 1,02; 95% CI 0,78-1,33; P=0,08). Kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa c\u00e1c nh\u00f3m v\u1ec1 t\u1ec9 l\u1ec7 t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p do thu\u1ed1c c\u1ea3n quang.<\/p>\n
C\u00e1c t\u00e1c gi\u1ea3 \u0111i \u0111\u1ebfn k\u1ebft lu\u1eadn, trong s\u1ed1 c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao bi\u1ebfn ch\u1ee9ng tr\u00ean th\u1eadn khi ch\u1ee5p m\u1ea1ch, kh\u00f4ng ghi nh\u1eadn th\u1ea5y l\u1ee3i \u00edch c\u1ee7a vi\u1ec7c s\u1eed d\u1ee5ng natri bicarbonate \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch so v\u1edbi natri chloride, hay s\u1eed d\u1ee5ng acetylcysteine \u0111\u01b0\u1eddng u\u1ed1ng so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c trong d\u1ef1 ph\u00f2ng t\u1eed vong, \u0111\u00f2i h\u1ecfi th\u1ea9m ph\u00e2n hay suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn k\u00e9o d\u00e0i sau 90 ng\u00e0y hay \u0111\u1ec3 d\u1ef1 ph\u00f2ng t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p do thu\u1ed1c c\u1ea3n quang.<\/p>\n