{"id":5405,"date":"2019-03-25T11:57:29","date_gmt":"2019-03-25T04:57:29","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=5405"},"modified":"2019-03-25T11:57:29","modified_gmt":"2019-03-25T04:57:29","slug":"so-sanh-cac-phac-do-methotrexate-trong-dieu-tri-thai-ngoai-tu-cung","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/so-sanh-cac-phac-do-methotrexate-trong-dieu-tri-thai-ngoai-tu-cung\/","title":{"rendered":"So s\u00e1nh c\u00e1c ph\u00e1c \u0111\u1ed3 Methotrexate trong \u0111i\u1ec1u tr\u1ecb thai ngo\u00e0i t\u1eed cung"},"content":{"rendered":"<p>B\u00e1c s\u0129 L\u00ea Ti\u1ec3u My l\u00e0m vi\u1ec7c t\u1ea1i B\u1ec7nh vi\u1ec7n M\u1ef9 \u0110\u1ee9c<\/p>\n<p>Thai ngo\u00e0i t\u1eed cung (TNTC) x\u1ea3y ra kho\u1ea3ng 2% trong t\u1ed5ng s\u1ed1 c\u00e1c thai k\u1ef3 v\u00e0 hi\u1ec7n nay v\u1eabn l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u li\u00ean quan \u0111\u1ebfn t\u1eed vong m\u1eb9 trong ba th\u00e1ng \u0111\u1ea7u thai k\u1ef3. V\u1edbi s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a k\u1ef9 thu\u1eadt ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh th\u00ec TNTC \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n s\u1edbm h\u01a1n, \u0111i\u1ec1u tr\u1ecb s\u1edbm h\u01a1n. Trong \u0111i\u1ec1u ki\u1ec7n cho ph\u00e9p, \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa v\u1eabn l\u00e0 ch\u1ecdn l\u1ef1a t\u1ed1t. Hi\u1ec7n nay c\u00e1c ph\u00e1c \u0111\u1ed3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng bao g\u1ed3m Methotrexate (MTX) \u0111\u01a1n \u0111i\u1ec1u, nh\u1ecb li\u1ec1u v\u00e0 \u0111a li\u1ec1u. T\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng c\u1ee7a \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa dao \u0111\u1ed9ng kho\u1ea3ng 70-80% \u1edf ph\u00e1c \u0111\u1ed3 \u0111\u01a1n li\u1ec1u, 80-90% \u1edf ph\u00e1c \u0111\u1ed3 nh\u1ecb li\u1ec1u v\u00e0 89-96% trong ph\u00e1c \u0111\u1ed3 \u0111a li\u1ec1u. T\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng c\u00f3 th\u1ec3 tu\u1ef3 thu\u1ed9c v\u00e0o d\u00e2n s\u1ed1 nghi\u00ean c\u1ee9u, ti\u00eau chu\u1ea9n ch\u1ec9 \u0111\u1ecbnh MTX v\u00e0 \u0111\u1ecbnh ngh\u0129a th\u1ebf n\u00e0o l\u00e0 th\u00e0nh c\u00f4ng trong \u0111i\u1ec1u tr\u1ecb. Gi\u1eefa c\u00e1c ph\u00e1c \u0111\u1ed3 tr\u00ean th\u00ec ph\u00e1c \u0111\u1ed3 nh\u1ecb li\u1ec1u \u0111\u01b0\u1ee3c xem l\u00e0 ph\u01b0\u01a1ng ph\u00e1p c\u00e2n b\u1eb1ng nh\u1eefng khuy\u1ebft \u0111i\u1ec3m c\u1ee7a hai ph\u01b0\u01a1ng ph\u00e1p c\u00f2n l\u1ea1i, nh\u01b0 gi\u1ea3m th\u1eddi gian n\u1eb1m vi\u1ec7n so v\u1edbi \u0111a li\u1ec1u v\u00e0 gi\u1ea3m th\u1eddi gian theo d\u00f5i so v\u1edbi ph\u00e1c \u0111\u1ed3 \u0111\u01a1n li\u1ec1u.<\/p>\n<p>M\u1ed9t t\u1ed5ng quan h\u1ec7 th\u1ed1ng c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng c\u00f3 nh\u00f3m ch\u1ee9ng so s\u00e1nh gi\u1eefa c\u00e1c ph\u00e1c MTX \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa TNTC v\u1eeba \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1. Nghi\u00ean c\u1ee9u n\u00e0y ngo\u00e0i so s\u00e1nh t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng \u2013 th\u1ea5t b\u1ea1i c\u1ee7a ph\u00e1c \u0111\u1ed3 \u0111\u01a1n li\u1ec1u v\u00e0 \u0111a li\u1ec1u c\u00f2n ph\u00e2n t\u00edch th\u00eam t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a c\u00e1c ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb MTX so v\u1edbi \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i khoa.<\/p>\n<p>Ph\u00e2n t\u00edch d\u1eef li\u1ec7u thu th\u1eadp \u0111\u1ebfn th\u00e1ng 7\/2018 c\u1ee7a 7 nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c t\u1ed5ng h\u1ee3p cho th\u1ea5y:<\/p>\n<ul>\n<li>Ph\u00e1c \u0111\u1ed3 nh\u1ecb li\u1ec1u c\u00f3 t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng cao h\u01a1n ph\u00e1c \u0111\u1ed3 \u0111\u01a1n li\u1ec1u (OR: 1.84, 95% CI: 1,13 \u2013 3.00).<\/li>\n<li>Ph\u00e1c \u0111\u1ed3 nh\u1ecb li\u1ec1u c\u00f3 t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng cao h\u01a1n ph\u00e1c \u0111\u1ed3 \u0111\u01a1n li\u1ec1u \u1edf tr\u01b0\u1eddng h\u1ee3p n\u1ed3ng \u0111\u1ed9 hCG cao (OR: 3.23, 95% CI: 1.53, 6.84) v\u00e0 kh\u1ed1i thai c\u00f3 k\u00edch th\u01b0\u1edbc l\u1edbn (OR: 2.93, 95% CI: 1.23 &#8211; 6.9)<\/li>\n<li>T\u1ef7 l\u1ec7 v\u1ee1 kh\u1ed1i thai ngo\u00e0i t\u1eed cung th\u1ea5p h\u01a1n khi d\u00f9ng ph\u00e1c \u0111\u1ed3 nh\u1ecb li\u1ec1u (OR: 0.65, 95% CI 0.26 \u2013 1.63), tuy nhi\u00ean kh\u00f4ng c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea.<\/li>\n<li>Th\u1eddi gian theo d\u00f5i trung b\u00ecnh ng\u1eafn h\u01a1n kho\u1ea3ng 7,9 ng\u00e0y khi s\u1eed d\u1ee5ng ph\u00e1c \u0111\u1ed3 nh\u1ecb li\u1ec1u (OR: 1.53, 95% CI: 1.01 \u2013 2.30), tuy nhi\u00ean t\u00e1c d\u1ee5ng ph\u1ee5 l\u1ea1i nhi\u1ec1u h\u01a1n.<\/li>\n<\/ul>\n<p>So s\u00e1nh gi\u1eefa ph\u00e1c \u0111\u1ed3 \u0111\u01a1n li\u1ec1u v\u00e0 \u0111a li\u1ec1u cho th\u1ea5y kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t trong t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng, th\u1eddi gian theo d\u00f5i v\u00e0 t\u1ef7 l\u1ec7 ph\u1eabu thu\u1eadt do v\u1ee1 kh\u1ed1i thai ngo\u00e0i t\u1eed cung.<\/p>\n<p>C\u00e1c k\u1ebft qu\u1ea3 tr\u00ean cho th\u1ea5y ph\u00e1c \u0111\u1ed3 nh\u1ecb li\u1ec1u c\u00f3 l\u1ee3i h\u01a1n so v\u1edbi \u0111\u01a1n li\u1ec1u, \u0111\u1eb7c bi\u1ec7t tr\u00ean nh\u00f3m b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 th\u1ea5t b\u1ea1i v\u1edbi \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa TNTC nh\u01b0 n\u1ed3ng \u0111\u1ed9 hCG cao hay kh\u1ed1i thai l\u1edbn. Nh\u00f3m t\u00e1c gi\u1ea3 c\u0169ng nh\u00ecn nh\u1eadn r\u1eb1ng do c\u00f2n \u00edt RCTs v\u1ec1 ch\u1ee7 \u0111\u1ec1 n\u00e0y n\u00ean k\u1ebft qu\u1ea3 so s\u00e1nh c\u00f2n m\u1ed9t s\u1ed1 \u0111i\u1ec3m y\u1ebfu, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng nghi\u00ean c\u1ee9u so s\u00e1nh gi\u1eefa \u0111\u01a1n li\u1ec1u v\u00e0 \u0111a li\u1ec1u, v\u1eabn ch\u01b0a th\u1ec3 k\u1ebft lu\u1eadn ch\u1eafc ch\u1eafn ph\u00e1c \u0111\u1ed3 \u0111a li\u1ec1u cho t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng cao h\u01a1n, n\u00ean hi\u1ec7n nay, kh\u00f4ng th\u1ec3 xem ph\u00e1c \u0111\u1ed3 \u0111a li\u1ec1u l\u00e0 l\u1ef1a ch\u1ecdn \u0111\u1ea7u tay trong \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>L\u01b0\u1ee3t d\u1ecbch t\u1eeb: Two Dose versus Single Dose of Methotrexate for Treatment of Ectopic Pregnancy: a Meta-Analysis &#8211; American Journal of Obstetrics and Gynecology \u2013 Jan 2019 &#8211; DOI: <a href=\"https:\/\/doi.org\/10.1016\/j.ajog.2019.01.002\" rel=\"noopener\">https:\/\/doi.org\/10.1016\/j.ajog.2019.01.002<\/a><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>B\u00e1c s\u0129 L\u00ea Ti\u1ec3u My l\u00e0m vi\u1ec7c t\u1ea1i B\u1ec7nh vi\u1ec7n M\u1ef9 \u0110\u1ee9c Thai ngo\u00e0i t\u1eed cung (TNTC) x\u1ea3y ra kho\u1ea3ng 2% trong t\u1ed5ng s\u1ed1 c\u00e1c thai k\u1ef3 v\u00e0 hi\u1ec7n nay v\u1eabn l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u li\u00ean quan \u0111\u1ebfn t\u1eed vong m\u1eb9 trong ba th\u00e1ng \u0111\u1ea7u thai k\u1ef3. V\u1edbi s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a k\u1ef9 thu\u1eadt [&#8230;]\n","protected":false},"author":1,"featured_media":5407,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-5405","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\/5405","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=5405"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/5405\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/5407"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=5405"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=5405"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=5405"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}