{"id":5245,"date":"2019-03-21T12:06:34","date_gmt":"2019-03-21T05:06:34","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=5245"},"modified":"2019-03-21T12:33:36","modified_gmt":"2019-03-21T05:33:36","slug":"du-phong-chay-mau-vet-loet-do-stress-o-benh-nhan-hoi-suc-tich-cuc-bang-ppis","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/du-phong-chay-mau-vet-loet-do-stress-o-benh-nhan-hoi-suc-tich-cuc-bang-ppis\/","title":{"rendered":"D\u1ef1 ph\u00f2ng ch\u1ea3y m\u00e1u v\u1ebft lo\u00e9t do stress \u1edf b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c b\u1eb1ng PPIs"},"content":{"rendered":"<h2>\u0110i\u1ec3m nghi\u00ean c\u1ee9u m\u1edbi c\u00f4ng b\u1ed1 (NEJM): D\u1ef1 ph\u00f2ng ch\u1ea3y m\u00e1u v\u1ebft lo\u00e9t do stress \u1edf b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c b\u1eb1ng PPIs<\/h2>\n<p>Trong \u1ea5n b\u1ea3n NEJM Journal Watch (General Meidicne) Year in Review 2018, Editor Daniel D. Dressler, MD. \u0111\u00e3 t\u1ed5ng h\u1ee3p k\u1ebft qu\u1ea3 t\u1eeb nh\u1eefng nghi\u00ean c\u1ee9u n\u1ed5i b\u1eadt trong n\u0103m 2018 v\u1ec1 D\u1ef1 ph\u00f2ng ch\u1ea3y m\u00e1u v\u1ebft lo\u00e9t do stress \u1edf b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c b\u1eb1ng PPIs v\u00e0 \u0111\u00e3 \u0111\u01b0a ra nh\u1eefng k\u1ebft lu\u1eadn \u0111\u00e1ng l\u01b0u \u00fd.<\/p>\n<p>K\u1ebft qu\u1ea3 c\u1ee7a m\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean quy m\u00f4 l\u1edbn \u0111\u00e3 cho th\u1ea5y kh\u00f4ng c\u00f3 c\u1ea3i thi\u1ec7n n\u00e0o v\u1ec1 t\u1ec9 l\u1ec7 t\u1eed vong tr\u00ean qu\u1ea7n th\u1ec3 b\u1ec7nh nh\u00e2n tham gia nghi\u00ean c\u1ee9u.<\/p>\n<h2>Hi\u1ec7n nay, t\u1ec9 l\u1ec7 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a do stress \u1edf b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c \u0111ang c\u00f3 chi\u1ec1u h\u01b0\u1edbng gi\u1ea3m xu\u1ed1ng.<\/h2>\n<p>N\u0103m 2018, m\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean quy m\u00f4 l\u1edbn \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ec3 t\u00ecm gi\u1ea3i ph\u00e1p nh\u1eefng lo ng\u1ea1i v\u1ec1 nguy c\u01a1 v\u00e0 l\u1ee3i \u00edch c\u1ee7a vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf b\u01a1m proton (PPIs) trong d\u1ef1 ph\u00f2ng xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a. Kho\u1ea3ng 3300 b\u1ec7nh nh\u00e2n trong t\u00ecnh tr\u1ea1ng nguy k\u1ecbch, c\u00f3 nguy c\u01a1 cao (th\u1edf m\u00e1y &gt; 24 gi\u1edd, shock, r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u ho\u1eb7c s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng, s\u1eed d\u1ee5ng li\u1ec7u ph\u00e1p thay th\u1ebf th\u1eadn m\u1ea1n t\u00ednh ho\u1eb7c b\u1ec7nh gan m\u1ea1n t\u00ednh) \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng b\u1eb1ng pantoprazole ho\u1eb7c gi\u1ea3 d\u01b0\u1ee3c. G\u1ea7n 60% b\u1ec7nh nh\u00e2n nu\u00f4i d\u01b0\u1ee1ng qua \u0111\u01b0\u1eddng ru\u1ed9t ng\u00e0y th\u1ee9 nh\u1ea5t khi v\u00e0o ICU, tr\u00ean 80% b\u1ec7nh nh\u00e2n v\u00e0o ng\u00e0y th\u1ee9 3. T\u1ec9 l\u1ec7 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n d\u00f9ng PPIs l\u00e0 4,2% v\u00e0 nh\u00f3m gi\u1ea3 d\u01b0\u1ee3c l\u00e0 2,5% (n = 59). Kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t n\u00e0o v\u1ec1 t\u1ec9 l\u1ec7 t\u1eed vong c\u0169ng nh\u01b0 c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 gi\u1eefa 2 nh\u00f3m trong th\u1eddi gian theo d\u00f5i 90 ng\u00e0y (nh\u01b0 vi\u00eam ph\u1ed5i, nhi\u1ec5m Clostridium difficile haythi\u1ebfu m\u00e1u c\u01a1 tim c\u1ee5c b\u1ed9; theo NEJM JW Gen Med ng\u00e0y 15\/12and N Engl J Med ng\u00e0y 6\/12; 379:2199).<\/p>\n<p>Tr\u01b0\u1edbc \u0111\u00f3 v\u00e0o n\u0103m 2018, m\u1ed9t ph\u00e2n t\u00edch g\u1ed9p 57 th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 ki\u1ec3m so\u00e1t v\u1ec1 d\u1ef1 ph\u00f2ng lo\u00e9t \u0111\u00e3 \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1. K\u1ebft qu\u1ea3, PPIs c\u00f3 hi\u1ec7u qu\u1ea3 trong ph\u00f2ng ng\u1eeba xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c, thu\u1ed1c ch\u1eb9n th\u1ee5 th\u1ec3 histamine H2 v\u00e0 sucralfate (nguy c\u01a1 tuy\u1ec7t \u0111\u1ed1i gi\u1ea3m 1,6%, n = 63). Tuy nhi\u00ean th\u00ec t\u1ec9 l\u1ec7 vi\u00eam ph\u1ed5i \u1edf nh\u00f3m PPIs c\u0169ng cao h\u01a1n c\u00e1c nh\u00f3m kh\u00e1c (nguy c\u01a1 tuy\u1ec7t \u0111\u1ed1i t\u0103ng 3,1%). Kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 t\u1ec9 l\u1ec7 t\u1eed vong gi\u1eefa c\u00e1c nh\u00f3m (Intensive Care Med th\u00e1ng 1; 44:1).<\/p>\n<h2>V\u1eady nh\u1eefng d\u1eef li\u1ec7u tr\u00ean gi\u00fap \u0111\u01b0a ra k\u1ebft lu\u1eadn g\u00ec?<\/h2>\n<p>&#8211; Th\u1ee9 nh\u1ea5t, lo\u00e9t ti\u00eau h\u00f3a do stress g\u00e2y ch\u1ea3y m\u00e1u kh\u00f4ng ph\u1ed5 bi\u1ebfn \u1edf khoa h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c, \u0111\u1eb7c bi\u1ec7t l\u00e0 v\u1edbi b\u1ec7nh nh\u00e2n nu\u00f4i d\u01b0\u1ee1ng qua \u0111\u01b0\u1eddng ru\u1ed9t v\u00e0 kh\u00f4ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng b\u1eb1ng thu\u1ed1c.<\/p>\n<p>&#8211; Th\u1ee9 hai, b\u1ec7nh nh\u00e2n ICU kh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00f4ng n\u00ean \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng b\u1eb1ng thu\u1ed1c.<\/p>\n<p>&#8211; Th\u1ee9 ba, v\u1edbi b\u1ec7nh nh\u00e2n ICU c\u00f3 nguy c\u01a1 cao, \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng b\u1eb1ng PPIs l\u00e0m gi\u1ea3m nh\u1eb9 nguy c\u01a1 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a nh\u01b0ng kh\u00f4ng l\u00e0m gi\u1ea3m t\u1ec9 l\u1ec7 t\u1eed vong t\u1ea1i b\u1ec7nh vi\u1ec7n.<\/p>\n<p>Ngu\u1ed3n: <a href=\"https:\/\/www.jwatch.org\/na48078\/2018\/12\/27\/nejm-journal-watch-general-medicine-year-review-2018\" rel=\"noopener\">https:\/\/www.jwatch.org\/na48078\/2018\/12\/27\/nejm-journal-watch-general-medicine-year-review-2018<\/a><\/p>\n<p>(Editor Daniel D. Dressler, MD, MSc, SFHM, FACP)<\/p>\n<p>Ng\u01b0\u1eddi t\u1ed5ng h\u1ee3p: Nguy\u1ec5n Th\u1ecb Thu H\u00e0 &#8211; Nguy\u1ec5n Ph\u01b0\u01a1ng Th\u00fay &#8211; Trung T\u00e2m C\u1ea3nh Gi\u00e1c D\u01b0\u1ee3c Qu\u1ed1c Gia.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u0110i\u1ec3m nghi\u00ean c\u1ee9u m\u1edbi c\u00f4ng b\u1ed1 (NEJM): D\u1ef1 ph\u00f2ng ch\u1ea3y m\u00e1u v\u1ebft lo\u00e9t do stress \u1edf b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c b\u1eb1ng PPIs Trong \u1ea5n b\u1ea3n NEJM Journal Watch (General Meidicne) Year in Review 2018, Editor Daniel D. Dressler, MD. \u0111\u00e3 t\u1ed5ng h\u1ee3p k\u1ebft qu\u1ea3 t\u1eeb nh\u1eefng nghi\u00ean c\u1ee9u n\u1ed5i b\u1eadt trong n\u0103m 2018 [&#8230;]\n","protected":false},"author":1,"featured_media":5246,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-5245","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\/5245","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=5245"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/5245\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/5246"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=5245"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=5245"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=5245"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}