{"id":5469,"date":"2019-03-25T18:39:32","date_gmt":"2019-03-25T11:39:32","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=5469"},"modified":"2019-03-25T18:41:11","modified_gmt":"2019-03-25T11:41:11","slug":"quan-ly-dieu-tri-dau-cap-tinh","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/quan-ly-dieu-tri-dau-cap-tinh\/","title":{"rendered":"Qu\u1ea3n l\u00fd \u0111i\u1ec1u tr\u1ecb \u0111au c\u1ea5p t\u00ednh"},"content":{"rendered":"

C\u00e1c Opioid c\u00f3 th\u1ec3 hi\u1ec7u qu\u1ea3 trong vi\u1ec7c \u0111i\u1ec1u tr\u1ecb \u0111au c\u1ea5p t\u00ednh, \u0111\u1eb7c bi\u1ec7t khi k\u1ebft h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au kh\u00e1c. Tuy nhi\u00ean, c\u00e1c thu\u1ed1c n\u00e0y kh\u00f4ng ph\u1ea3i l\u00fac n\u00e0o c\u0169ng c\u1ea7n thi\u1ebft v\u00e0 \u0111\u00f4i khi g\u00e2y ra nhi\u1ec1u nguy c\u01a1 h\u01a1n l\u1ee3i \u00edch cho b\u1ec7nh nh\u00e2n.<\/p>\n

Theo \u0111\u1ecbnh ngh\u0129a, \u0111au c\u1ea5p t\u00ednh l\u00e0 s\u1ef1 kh\u00f3 ch\u1ecbu t\u1ef1 gi\u1edbi h\u1ea1n, th\u01b0\u1eddng k\u00e9o d\u00e0i t\u1eeb v\u00e0i ph\u00fat \u0111\u1ebfn v\u00e0i tu\u1ea7n nh\u01b0ng d\u01b0\u1edbi 3- 6 th\u00e1ng. N\u00f3 li\u00ean quan \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng m\u00f4 m\u1ec1m ho\u1eb7c x\u01b0\u01a1ng, v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i th\u00e0nh t\u1ef1 ph\u00e1t ho\u1eb7c sau ch\u1ea5n th\u01b0\u01a1ng, v\u1edbi ch\u1ea5n th\u01b0\u01a1ng theo k\u1ebf ho\u1ea1ch (ph\u1eabu thu\u1eadt) ho\u1eb7c kh\u00f4ng theo k\u1ebf ho\u1ea1ch (ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ed9t ng\u1ed9t). Khi c\u00e1c m\u00f4 b\u1ecb th\u01b0\u01a1ng l\u00e0nh, c\u01a1n \u0111au c\u1ea5p t\u00ednh d\u1ea7n d\u1ea7n \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft. C\u01a1n \u0111au kh\u00e1c nhau v\u1ec1 m\u1ee9c \u0111\u1ed9 t\u1eeb nh\u1eb9 \u0111\u1ebfn n\u1eb7ng. M\u1ed9t s\u1ed1 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb, ch\u1eb3ng h\u1ea1n c\u00e1c thu\u1ed1c opioid, \u0111\u01b0\u1ee3c d\u00e0nh ri\u00eang cho nh\u1eefng c\u01a1n \u0111au nghi\u00eam tr\u1ecdng h\u01a1n. Tuy nhi\u00ean, kh\u00f4ng ph\u1ea3i t\u1ea5t c\u1ea3 c\u00e1c c\u01a1n \u0111au c\u1ea5p t\u00ednh \u0111\u1ec1u c\u1ea7n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng opioid. Tr\u00ean th\u1ef1c t\u1ebf 10 \u2013 15 n\u0103m qua \u0111\u00e3 s\u1eed d\u1ee5ng c\u00e1c opioid qu\u00e1 m\u1ee9c v\u00e0 k\u00e9o d\u00e0i h\u01a1n c\u1ea7n thi\u1ebft trong c\u01a1n \u0111au c\u1ea5p t\u00ednh. Vi\u1ec7c gia t\u0103ng k\u00ea \u0111\u01a1n c\u0169ng nh\u01b0 s\u1ef1 s\u1eb5n c\u00f3 c\u00e1c opioid \u0111\u00e3 d\u1eabn \u0111\u1ebfn t\u0103ng l\u1ea1m d\u1ee5ng v\u00e0 s\u1eed d\u1ee5ng sai. C\u00e1c nghi\u00ean c\u1ee9u cho th\u1ea5y r\u1eb1ng nh\u1eefng b\u1ec7nh nh\u00e2n ra vi\u1ec7n \u0111\u01b0\u1ee3c k\u00ea opioid c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng v\u1eabn c\u00f2n s\u1eed d\u1ee5ng opioid 1 n\u0103m sau \u0111\u00f3, so v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n ra vi\u1ec7n kh\u00f4ng \u0111\u01b0\u1ee3c k\u00ea opioid.<\/p>\n

C\u00e1c lo\u1ea1i \u0111au c\u1ea5p t\u00ednh<\/h2>\n

\u0110au c\u1ea5p t\u00ednh c\u00f3 th\u1ec3 thay \u0111\u1ed5i \u0111\u00e1ng k\u1ec3, \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i th\u00e0nh 2 lo\u1ea1i ch\u00ednh: \u0111au t\u1ef1 ph\u00e1t\/ ch\u1ea5n th\u01b0\u01a1ng v\u00e0 \u0111au do th\u1ee7 thu\u1eadt l\u1ef1a ch\u1ecdn\/ theo k\u1ebf ho\u1ea1ch.<\/p>\n

\u0110au t\u1ef1 ph\u00e1t\/ ch\u1ea5n th\u01b0\u01a1ng<\/h3>\n

C\u00e1c t\u00ecnh tr\u1ea1ng \u0111au nh\u1eb9 g\u1ed3m \u0111au \u0111\u1ea7u, nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean ho\u1eb7c \u0111au l\u01b0ng do l\u00e0m vi\u1ec7c c\u00f3 th\u1ec3 t\u1ef1 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng li\u1ec7u ph\u00e1p RICE (rest-ice-compression-elevation), ngh\u0129a l\u00e0 ngh\u1ec9 ng\u01a1i \u2013 ch\u01b0\u1eddm l\u1ea1nh \u2013 b\u0103ng b\u00f3 \u2013 k\u00ea cao, v\u00e0 thu\u1ed1c gi\u1ea3m \u0111au kh\u00f4ng k\u00ea \u0111\u01a1n. C\u00e1c t\u00ecnh tr\u1ea1ng \u0111au v\u1eeba ph\u1ea3i bao g\u1ed3m bong g\u00e2n, c\u0103ng d\u00e2y ch\u1eb1ng, v\u1ebft r\u00e1ch s\u00e2u ho\u1eb7c g\u00e3y x\u01b0\u01a1ng \u0111\u01a1n gi\u1ea3n c\u00f3 th\u1ec3 c\u1ea7n c\u00e1c bi\u1ec7n ph\u00e1p can thi\u1ec7p nh\u01b0 ph\u1eabu thu\u1eadt ngo\u1ea1i khoa nh\u1ecf ho\u1eb7c n\u1eb9p, nh\u01b0ng th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid (NSAID), acetaminophen v\u00e0 li\u1ec7u ph\u00e1p RICE. C\u00e1c t\u00ecnh tr\u1ea1ng \u0111au nghi\u00eam tr\u1ecdng bao g\u1ed3m: ch\u1ea5n th\u01b0\u01a1ng, tai n\u1ea1n xe, c\u1eaft c\u1ee5t chi, b\u1ecfng, c\u00f3 kh\u1ea3 n\u0103ng s\u1ebd li\u00ean quan \u0111\u1ebfn ph\u1eabu thu\u1eadt v\u00e0 th\u1eddi gian n\u1eb1m vi\u1ec7n k\u00e9o d\u00e0i. M\u1ed9t s\u1ef1 k\u1ebft h\u1ee3p m\u1ea1nh h\u01a1n c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au, g\u1ed3m c\u00e1c opioid, c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c y\u00eau c\u1ea7u. T\u1ea5t nhi\u00ean, m\u1ee9c \u0111\u1ed9 \u0111au cho t\u1eebng tr\u01b0\u1eddng h\u1ee3p ph\u1ea3i \u0111\u01b0\u1ee3c c\u00e1 th\u1ec3 h\u00f3a \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n

\u0110au do th\u1ee7 thu\u1eadt l\u1ef1a ch\u1ecdn\/ theo k\u1ebf ho\u1ea1ch<\/h3>\n

C\u00e1c th\u1ee7 thu\u1eadt th\u00f4ng th\u01b0\u1eddng, bao g\u1ed3m ti\u00eam ch\u1ee7ng, m\u1edf t\u0129nh m\u1ea1ch ho\u1eb7c \u0111\u1eb7t \u1ed1ng th\u00f4ng c\u00f3 xu h\u01b0\u1edbng d\u1eabn \u0111\u1ebfn \u0111au c\u1ea5p t\u00ednh nh\u1eb9 th\u01b0\u1eddng \u0111\u01b0\u1ee3c gi\u1ea3m b\u1edbt b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng thu\u1ed1c b\u00f4i lidocain\/prilocaine (EMLA), lidocaine, n\u01b0\u1edbc \u0111\u00e1 ho\u1eb7c thi\u1ebft b\u1ecb nh\u01b0 Buzzy (k\u1ebft h\u1ee3p d\u00f9ng \u0111\u00e1 v\u00e0 m\u00e1y rung). C\u00e1c th\u1ee7 thu\u1eadt \u0111au v\u1eeba ph\u1ea3i bao g\u1ed3m ph\u1eabu thu\u1eadt nha khoa trong ng\u00e0y, ph\u1eabu thu\u1eadt n\u1ed9i soi ho\u1eb7c li\u00ean quan. Lo\u1ea1i \u0111au n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t b\u1eb1ng thu\u1ed1c gi\u1ea3m \u0111au nh\u01b0 c\u00e1c NSAID v\u00e0 acetaminophen. C\u00f3 th\u1ec3 c\u1ea7n t\u1ed5ng c\u1ed9ng 6 \u0111\u1ebfn 8 li\u1ec1u ph\u1ed1i h\u1ee3p opioid v\u00e0 acetaminophen n\u1ebfu \u0111au kh\u00f4ng \u0111\u1ee1 khi d\u00f9ng c\u00e1c NSAID hay acetaminophen. C\u00e1c th\u1ee7 thu\u1eadt g\u00e2y \u0111au nghi\u00eam tr\u1ecdng bao g\u1ed3m c\u00e1c ph\u1eabu thu\u1eadt \u0111\u00f2i h\u1ecfi ph\u1ea3i \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa, nh\u01b0 thay kh\u1edbp ch\u1ec9nh h\u00ecnh, ph\u1eabu thu\u1eadt c\u1ed9t s\u1ed1ng ho\u1eb7c ph\u1eabu thu\u1eadt \u0111\u1ea1i tr\u1ef1c tr\u00e0ng. Nh\u1eefng ph\u1eabu thu\u1eadt n\u00e0y s\u1ebd c\u1ea7n d\u00f9ng k\u1ebft h\u1ee3p c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au v\u00e0 c\u00e1c opioid m\u1ea1nh h\u01a1n, c\u00f3 th\u1ec3 b\u1eaft \u0111\u1ea7u tr\u01b0\u1edbc ph\u1eabu thu\u1eadt (B\u1ea3ng 1).<\/p>\n

B\u1ea3ng \u0111i\u1ec1u tr\u1ecb \u0111au c\u1ea5p t\u00ednh<\/em><\/p>\n\n\n\n\n\n\n\n\n\n\n\n
M\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng<\/em><\/td>\nV\u00ed d\u1ee5<\/em><\/td>\nLi\u1ec7u ph\u00e1p<\/em><\/td>\nC\u1ea7n opioids hay kh\u00f4ng?<\/em>\u00a0<\/em><\/td>\n<\/tr>\n
\u0110au t\u1ef1 ph\u00e1t hay ch\u1ea5n th\u01b0\u01a1ng<\/td>\n<\/tr>\n
Nh\u1eb9<\/td>\nVi\u00eang xoang, \u0111au nh\u1ee9c sau khi l\u00e0m vi\u1ec7c, r\u00e1ch ngo\u00e0i.<\/td>\nRICE, OTC alnagetics<\/td>\nKh\u00f4ng<\/td>\n<\/tr>\n
V\u1eeba ph\u1ea3i<\/td>\nBong g\u00e2n, tr\u1eb7c x\u01b0\u01a1ng, n\u1ee9t x\u01b0\u01a1ng, r\u00e1ch s\u00e2u.<\/td>\nTh\u1ee7 t\u1ee5c ph\u1eabu thu\u1eadt ngo\u1ea1i tr\u00fa \u0111\u01a1n gi\u1ea3n, acetaminophen, RICE<\/td>\nKh\u00f4ng<\/td>\n<\/tr>\n
Nghi\u00eam tr\u1ecdng<\/td>\nTai n\u1ea1n xe, b\u1ecfng, ch\u1ea5n th\u01b0\u01a1ng do c\u1eaft c\u1ee5t.<\/td>\nNh\u1eadp vi\u1ec7n \u0111\u1ec3 ph\u1eabu thu\u1eadt, ch\u0103m s\u00f3c chuy\u00ean s\u00e2u, gi\u1ea3m \u0111au \u0111a ph\u01b0\u01a1ng th\u1ee9c.<\/td>\nC\u00f3<\/td>\n<\/tr>\n
C\u00f3 k\u1ebf ho\u1ea1ch\/t\u1ef1 ch\u1ecdn<\/td>\n<\/tr>\n
Nh\u1eb9<\/td>\nTi\u00eam ch\u1ee7ng, \u0111\u1eb7t \u1ed1ng th\u00f4ng, ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf, sinh thi\u1ebft b\u1ec1 m\u1eb7t, nh\u1ed5 r\u0103ng \u0111\u01a1n gi\u1ea3n.<\/td>\nChu\u1ed3m \u0111\u00e1, \u00f9, capocaine\/ EMLA<\/td>\nKh\u00f4ng<\/td>\n<\/tr>\n
V\u1eeba<\/td>\nPh\u1eabu thu\u1eadt trong c\u00f9ng m\u1ed9t ng\u00e0y (n\u1ed9i soi kh\u1edbp, nh\u1ed5 r\u0103ng nhi\u1ec1u l\u1ea7n \/ r\u0103ng kh\u00f4n, n\u1ed9i soi \u1ed5 b\u1ee5ng, ph\u1eabu thu\u1eadt n\u1ed9i soi, th\u1ee7 thu\u1eadt).<\/td>\nNSAIDs, acetaminophen<\/td>\nC\u00f3 th\u1ec3, \u00edt nh\u1ea5t l\u00e0 6-8 tab c\u1ee7a oploid, acetaminophen, k\u1ebft h\u1ee3p.<\/td>\n<\/tr>\n
Nghi\u00eam tr\u1ecdng<\/td>\nPh\u1eabu thu\u1eadt n\u1ed9i soi kh\u1edbp, c\u1ed9t s\u1ed1ng, \u0111\u1ea1i tr\u1ef1c tr\u00e0ng, m\u1edf \u1ed5 b\u1ee5ng c\u1ea7n n\u1eb1m vi\u1ec7n<\/td>\nGi\u1ea3m \u0111au \u0111a ph\u01b0\u01a1ng th\u1ee9c<\/td>\nC\u00f3.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\u0110I\u1ec0U TR\u1eca<\/h2>\n

\u0110i\u1ec1u tr\u1ecb b\u1eb1ng nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 gi\u1ea3m \u0111au m\u1ed9t c\u00e1ch t\u1ed1i \u01b0u b\u1edfi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00e1c nhau c\u00f3 th\u1ec3 b\u1ed5 sung\/ k\u1ebft h\u1ee3p cho nhau. B\u00ean c\u1ea1nh \u0111\u00f3 c\u00f2n c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m nguy c\u01a1 g\u1eb7p t\u00e1c d\u1ee5ng ph\u1ee5. C\u00e1c \u0111i\u1ec1u tr\u1ecb \u0111a ph\u01b0\u01a1ng ph\u00e1p c\u01a1 b\u1ea3n bao g\u1ed3m: phong t\u1ecfa d\u00e2y th\u1ea7n kinh hay g\u00e2y t\u00ea ngo\u00e0i m\u00e0ng c\u1ee9ng, thu\u1ed1c gi\u1ea3m \u0111au thu\u1ed9c nh\u00f3m opioid hay c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au kh\u00e1c, c\u00e1c lo\u1ea1i thu\u1ed1c b\u1ed5 tr\u1ee3, ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb RICE, v\u1eadt l\u00fd tr\u1ecb li\u1ec7u v\u00e0 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng. C\u00e1c can thi\u1ec7p t\u00e2m l\u00fd nh\u01b0 thi\u1ec1n hay h\u00edt th\u1edf s\u00e2u \u2026 c\u0169ng \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong \u0111i\u1ec1u tr\u1ecb \u0111a ph\u01b0\u01a1ng ph\u00e1p. B\u00e1c s\u0129 v\u00e0 b\u1ec7nh nh\u00e2n th\u01b0\u1eddng qu\u00e1 t\u1eadp trung v\u00e0o vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c, trong khi thu\u1ed1c ch\u1ec9 l\u00e0 m\u1ed9t ph\u1ea7n trong \u0111i\u1ec1u tr\u1ecb.<\/p>\n

THU\u1ed0C GI\u1ea2M \u0110AU NH\u1eb8<\/h3>\n

Thu\u1ed1c gi\u1ea3m \u0111au nh\u1eb9 bao g\u1ed3m c\u00e1c NSAID v\u00e0 acetaminophen (paracetamol), c\u00e1c thu\u1ed1c n\u00e0y \u0111\u01b0\u1ee3c d\u00f9ng r\u1ea5t ph\u1ed5 bi\u1ebfn trong \u0111i\u1ec1u tr\u1ecb c\u00e1c c\u01a1n \u0111au c\u1ea5p t\u00ednh v\u00ec h\u01b0\u1edbng \u0111\u1ebfn m\u1ee5c \u0111\u00edch gi\u1ea3m t\u00ecnh tr\u1ea1ng vi\u00eam t\u1ef1 nhi\u00ean do ch\u1ea5n th\u01b0\u01a1ng. NSAID c\u00f3 th\u1ec3 d\u00f9ng hi\u1ec7u qu\u1ea3 h\u01a1n thu\u1ed1c gi\u1ea3m \u0111au nh\u00f3m opioid v\u00e0\/ho\u1eb7c thu\u1ed1c gi\u00e3n c\u01a1 trong \u0111i\u1ec1u tr\u1ecb \u0111au th\u1eaft l\u01b0ng c\u1ea5p t\u00ednh. C\u00e1c NSAID c\u0169ng hi\u1ec7u qu\u1ea3 trong gi\u1ea3m s\u01b0ng\/\u0111au do c\u0103ng c\u01a1\/ bong g\u00e2n. Trong m\u1ed9t nghi\u00ean c\u1ee9u tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n t\u1eebng tr\u1ea3i qua c\u00e1c ca ph\u1eabu thu\u1eadt ch\u1ec9nh h\u00ecnh, NSAID \u0111\u00e3 mang \u0111\u1ebfn nhi\u1ec1u l\u1ee3i \u00edch nh\u01b0: b\u1ec7nh nh\u00e2n c\u1ea7n \u00edt thu\u1ed1c gi\u1ea3m \u0111au h\u01a1n v\u00e0 \u00edt g\u1eb7p t\u00e1c d\u1ee5ng b\u1ea5t l\u1ee3i h\u01a1n so v\u1edbi b\u1ec7nh nh\u00e2n d\u00f9ng placebo ho\u1eb7c hydrocodone\/acetaminophen.<\/p>\n

T\u1ea5t nhi\u00ean s\u1eed d\u1ee5ng thu\u1ed1c gi\u1ea3m \u0111au c\u0169ng c\u00f3 nh\u1eefng l\u01b0u \u00fd. Acetaminophen n\u00ean tr\u00e1nh d\u00f9ng khi b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng \u0111\u1ed3 u\u1ed1ng c\u00f3 c\u1ed3n hay ng\u01b0\u1eddi c\u00f3 b\u1ec7nh l\u00fd v\u1ec1 gan. B\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, \u0111\u1ed9t qu\u1ef5, b\u1ec7nh li\u00ean quan \u0111\u1ebfn th\u1eadn, lo\u00e9t d\u1ea1 d\u00e0y, tr\u00e0o ng\u01b0\u1ee3c d\u1ea1 d\u00e0y th\u1ef1c qu\u1ea3n (GERD), ho\u1eb7c c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ea3y m\u00e1u kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng NSAIDs. Tuy nhi\u00ean c\u0169ng c\u00f3 nh\u1eefng ngo\u1ea1i l\u1ec7: c\u00e1c NSAID \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc COX-2 nh\u01b0 celecoxib (Celebrex) \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong l\u0129nh v\u1ef1c ph\u1eabu thu\u1eadt v\u00ec n\u00f3 kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ee9c n\u0103ng c\u1ee7a ti\u1ec3u c\u1ea7u hay tr\u1ef1c ti\u1ebfp l\u00e0m t\u0103ng nguy c\u01a1 ch\u1ea3y m\u00e1u (t\u1ea5t c\u1ea3 c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh kh\u00e1c \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng).<\/p>\n

THU\u1ed0C GI\u1ea2M \u0110AU T\u1ea0I CH\u1ed6<\/h3>\n

Menthol, camphor, methyl salicylate, hay s\u1ef1 k\u1ebft h\u1ee3p c\u00e1c h\u1ee3p ch\u1ea5t n\u00e0y s\u1ebd hi\u1ec7u qu\u1ea3 trong gi\u1ea3m \u0111au do ch\u1ea5n th\u01b0\u01a1ng c\u01a1 x\u01b0\u01a1ng kh\u1edbp c\u1ee5c b\u1ed9, t\u1ed1t nh\u1ea5t d\u00f9ng b\u1eb1ng c\u00e1ch xoa b\u00f3p t\u1ea1i v\u00f9ng \u0111au. Mi\u1ec5n l\u00e0 v\u00f9ng da c\u00f2n nguy\u00ean v\u1eb9n, thu\u1ed1c gi\u1ea3m \u0111au t\u1ea1i ch\u1ed7 gi\u00fap r\u00fat ng\u1eafn th\u1eddi gian \u0111au c\u1ee7a c\u01a1 t\u1ed5n th\u01b0\u01a1ng. Hi\u1ec7n nay \u0111\u00e3 c\u00f3 nhi\u1ec1u s\u1ea3n ph\u1ea9m kh\u00f4ng \u0111\u1eaft ti\u1ec1n v\u00e0 c\u00f3 s\u1eb5n \u1edf nh\u00e0 thu\u1ed1c. Tuy nhi\u00ean, c\u00e1c thu\u1ed1c n\u00e0y th\u01b0\u1eddng s\u1eed d\u1ee5ng nhi\u1ec1u l\u1ea7n trong ng\u00e0y theo h\u01b0\u1edbng d\u1eabn v\u00e0 m\u1ed9t s\u1ed1 s\u1ea3n ph\u1ea9m c\u00f3 m\u00f9i kh\u00f3 ch\u1ecbu khi d\u00f9ng.
\nLidocaine hay lidocaine\/prilocaine c\u00f3 hi\u1ec7u qu\u1ea3 trong g\u00e2y t\u00ea t\u1ea1i ch\u1ed7 tr\u01b0\u1edbc khi \u0111\u1eb7t \u1ed1ng th\u00f4ng t\u0129nh m\u1ea1ch hay m\u1edf t\u0129nh m\u1ea1ch. Ch\u1ec9 \u0111\u1ecbnh n\u00e0y c\u1ea7n k\u00ea \u0111\u01a1n v\u00e0 \u0111\u01b0\u1ee3c l\u00e0m \u00edt nh\u1ea5t 15-30 ph\u00fat tr\u01b0\u1edbc khi ti\u1ebfn h\u00e0nh th\u1ee7 thu\u1eadt. Thu\u1ed1c NSAID t\u1ea1i ch\u1ed7 g\u1ed3m mi\u1ebfng d\u00e1n hay gel diclofenac c\u0169ng gi\u00fap gi\u1ea3m \u0111au t\u1ed1t, nh\u01b0ng n\u00f3i chung \u00edt hi\u1ec7u qu\u1ea3, \u0111\u1eb7c bi\u1ec7t tr\u00ean ng\u01b0\u1eddi cao tu\u1ed5i. C\u00e1c ch\u1ec9 \u0111\u1ecbnh n\u00e0y c\u0169ng c\u1ea7n k\u00ea \u0111\u01a1n.<\/p>\n

THU\u1ed0C GI\u1ea2M \u0110AU NH\u00d3M OPIOID<\/h3>\n

Tr\u01b0\u1edbc kia c\u1ea3 b\u1ec7nh nh\u00e2n v\u00e0 b\u00e1c s\u0129 \u0111\u1ec1u lo ng\u1ea1i \u0111au kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb \u0111\u00fang m\u1ee9c, do \u0111\u00f3 h\u1ecd \u0111\u00e3 t\u00ecm \u0111\u1ebfn thu\u1ed1c gi\u1ea3m \u0111au nh\u00f3m opioid. K\u1ebft qu\u1ea3 l\u00e0 d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng l\u1ea1m d\u1ee5ng, d\u00f9ng sai c\u00e1c thu\u1ed1c n\u00e0y. \u0110\u00f4i khi thu\u1ed1c gi\u1ea3m \u0111au opioid \u0111\u01b0\u1ee3c d\u00f9ng trong th\u1eddi gian k\u00e9o d\u00e0i \u0111\u1ec3 gi\u1ea3i quy\u1ebft t\u00ecnh tr\u1ea1ng \u0111au c\u1ea5p t\u00ednh.<\/p>\n

\u0110I\u1ec0U TR\u1eca \u0110AU C\u1ea4P T\u00cdNH B\u1eb0NG THU\u1ed0C GI\u1ea2M \u0110AU NH\u00d3M OPIOID<\/h3>\n

M\u1ed9t v\u00e0i \u0111i\u1ec3m c\u1ea7n xem x\u00e9t khi x\u00e1c \u0111\u1ecbnh ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p nh\u1ea5t cho b\u1ec7nh nh\u00e2n b\u1ecb \u0111au c\u1ea5p t\u00ednh :<\/p>\n

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  1. K\u00ea \u0111\u01a1n opioid kh\u00f4ng gi\u00fap cho b\u1ec7nh nh\u00e2n th\u1ea5y tho\u1ea3i m\u00e1i. V\u1edbi s\u1ef1 gia t\u0103ng chi ph\u00ed \u0111i\u1ec1u tr\u1ecb v\u00e0 chi ph\u00ed t\u00e0i ch\u00ednh li\u00ean quan, \u0111i\u1ec3m s\u1ed1 h\u00e0i l\u00f2ng b\u1ec7nh nh\u00e2n \u0111\u00f3ng m\u1ed9t ph\u1ea7n quan tr\u1ecdng trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. Nh\u00e2n vi\u00ean y t\u1ebf c\u1ea3m th\u1ea5y r\u1eb1ng b\u1ec7nh nh\u00e2n s\u1ebd \u0111\u00e1nh gi\u00e1 h\u1ecd \u0111i\u1ec3m th\u1ea5p n\u1ebfu nh\u01b0 h\u1ecd kh\u00f4ng d\u00f9ng thu\u1ed1c gi\u1ea3m \u0111au opioid. Nh\u01b0ng \u0111i\u1ec1u n\u00e0y kh\u00f4ng \u0111\u00fang. Theo quan s\u00e1t trong khoa c\u1ea5p c\u1ee9u, s\u1ef1 h\u00e0i l\u00f2ng c\u1ee7a b\u1ec7nh nh\u00e2n ho\u00e0n to\u00e0n tr\u00e1i ng\u01b0\u1ee3c v\u1edbi l\u01b0\u1ee3ng thu\u1ed1c gi\u1ea3m \u0111au, opioid hay morphin. \u0110i\u1ec3m s\u1ed1 h\u00e0i l\u00f2ng c\u00f3 li\u00ean quan m\u1eadt thi\u1ebft v\u1edbi s\u1ef1 \u0111\u1ed3ng c\u1ea3m, s\u1ef1 c\u1ea3m th\u00f4ng c\u0169ng nh\u01b0 vi\u1ec7c giao ti\u1ebfp gi\u1eefa b\u1ec7nh nh\u00e2n v\u1edbi nh\u00e2n vi\u00ean y t\u1ebf.<\/li>\n
  2. Opioid l\u00e0 thu\u1ed1c gi\u1ea3i \u00e2u lo. B\u1ec7nh nh\u00e2n v\u00e0 ng\u01b0\u1eddi nh\u00e0 s\u1ebd th\u1ea5y r\u1ea5t lo l\u1eafng sau m\u1ed9t ch\u1ea5n th\u01b0\u01a1ng c\u1ea5p t\u00ednh, v\u00e0 r\u1ea5t c\u00f3 th\u1ec3 s\u1ef1 lo l\u1eafng s\u1ebd k\u00e9o d\u00e0i sau khi ch\u1ea5n th\u01b0\u01a1ng h\u1ed3i ph\u1ee5c. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 b\u00ecnh t\u0129nh h\u01a1n khi h\u1ecd d\u00f9ng opioid. Tuy nhi\u00ean, opioid kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb ch\u1ee9ng lo l\u1eafng n\u00e0y. V\u00ec v\u1eady, nh\u00e2n vi\u00ean y t\u1ebf c\u1ea7n trao \u0111\u1ed5i v\u1edbi b\u1ec7nh nh\u00e2n v\u00e0 ng\u01b0\u1eddi nh\u00e0 v\u1ec1 t\u00ednh an to\u00e0n khi s\u1eed d\u1ee5ng opioid ho\u1eb7c \u0111\u01b0a ra c\u00e1c gi\u1ea3i ph\u00e1p kh\u00e1c hi\u1ec7u qu\u1ea3 h\u01a1n thay th\u1ebf.<\/li>\n
  3. H\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng. Khi m\u1ed9t b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng b\u1ea5t k\u1ef3 m\u1ed9t lo\u1ea1i thu\u1ed1c gi\u1ea3m \u0111au n\u00e0o khi xu\u1ea5t vi\u1ec7n t\u1eeb khoa c\u1ea5p c\u1ee9u hay t\u1eeb b\u1ec7nh vi\u1ec7n, h\u1ecd ph\u1ea3i \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn v\u1ec1 c\u00e1ch s\u1eed d\u1ee5ng thu\u1ed1c v\u00e0 \u0111i\u1ec1u g\u00ec n\u00ean mong \u0111\u1ee3i. Gi\u1ea3 s\u1eed, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn nh\u01b0 sau: \u201cs\u1eed d\u1ee5ng 2 vi\u00ean oxycodone m\u1ed7i 6 gi\u1edd trong tu\u1ea7n \u0111\u1ea7u ti\u00ean. Trong tu\u1ea7n ti\u1ebfp theo, ch\u1ec9 c\u1ea7n s\u1eed d\u1ee5ng 1 vi\u00ean m\u1ed7i 6 gi\u1edd. C\u00f3 th\u1ec3 t\u1eeb t\u1eeb ng\u1eebng oxycodone trong c\u00e1c tu\u1ea7n ti\u1ebfp theo v\u00e0 chuy\u1ec3n sang d\u00f9ng acetaminophen ho\u1eb7c NSAID kh\u00e1c.\u201d<\/li>\n
  4. Ch\u00fa \u00fd \u0111\u1ebfn c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1. Nguy c\u01a1 qu\u00e1 li\u1ec1u ho\u1eb7c \u1ee9c ch\u1ebf h\u00f4 h\u1ea5p do opioid (OSORD) nghi\u00eam tr\u1ecdng h\u01a1n c\u1ea7n ch\u00fa \u00fd tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n v\u00e0 \u0111ang \u0111i\u1ec1u tr\u1ecb c\u00e1c thu\u1ed1c nh\u01b0 benzodiazepine; b\u1ec7nh nh\u00e2n gi\u1ea3m chuy\u1ec3n h\u00f3a ho\u1eb7c b\u00e0i ti\u1ebft thu\u1ed1c; b\u1ec7nh nh\u00e2n r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng ph\u1ed5i; ngo\u00e0i ra c\u1ea7n xem x\u00e9t lo\u1ea1i opioid c\u1ee5 th\u1ec3, c\u0169ng nh\u01b0 l\u1ea7n \u0111\u1ebfn b\u1ec7nh vi\u1ec7n g\u1ea7n nh\u1ea5t c\u1ee7a b\u1ec7nh nh\u00e2n.<\/li>\n
  5. Gi\u1edbi h\u1ea1n s\u1ed1 l\u01b0\u1ee3ng r\u1ea5t quan tr\u1ecdng. N\u1ebfu nh\u00e2n vi\u00ean y t\u1ebf nh\u1eadn th\u1ea5y r\u1eb1ng b\u1ec7nh nh\u00e2n c\u1ea7n 1 \u0111\u1ee3t \u0111i\u1ec1u tr\u1ecb thu\u1ed1c gi\u1ea3m \u0111au opioid trong th\u1eddi gian ng\u1eafn th\u00ec s\u1ed1 l\u01b0\u1ee3ng thu\u1ed1c n\u00ean \u0111\u01b0\u1ee3c gi\u1edbi h\u1ea1n t\u1eeb 10-12 vi\u00ean (d\u00f9ng d\u01b0\u1edbi 3 ng\u00e0y). N\u1ebfu b\u1ec7nh nh\u00e2n c\u1ea7n gi\u1ea3m \u0111au dai d\u1eb3ng sau qu\u00e1 tr\u00ecnh h\u1ed3i ph\u1ee5c th\u00f4ng th\u01b0\u1eddng th\u00ec n\u00ean \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 nhi\u1ec5m tr\u00f9ng hay c\u00e1c bi\u1ebfn ch\u1ee9ng kh\u00e1c c\u00f3 th\u1ec3 x\u1ea3y ra. Vi\u1ec7c k\u1ebft n\u1ed1i gi\u1eefa b\u1ec7nh nh\u00e2n n\u1ed9i tr\u00fa v\u00e0 ch\u0103m s\u00f3c y t\u1ebf ngo\u1ea1i tr\u00fa hay nh\u00e2n vi\u00ean y t\u1ebf l\u00e0 c\u1ea7n thi\u1ebft.<\/li>\n
  6. S\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p hi\u1ec7u qu\u1ea3 nh\u1ea5t \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb \u0111au do ch\u1ea5n th\u01b0\u01a1ng. Kh\u00f4ng ph\u1ea3i t\u1ea5t c\u1ea3 c\u00e1c opioid \u0111\u1ec1u h\u1eefu \u00edch trong \u0111i\u1ec1u tr\u1ecb \u0111au do vi\u00eam ho\u1eb7c \u0111au th\u1ea7n kinh. Tuy nhi\u00ean, methadone, levorphanol, tramadol v\u00e0 tapentadol (Nucyenta) d\u01b0\u1eddng nh\u01b0 c\u00f3 l\u1ee3i \u00edch trong \u0111i\u1ec1u tr\u1ecb \u0111au th\u1ea7n kinh. Ph\u1ea7n l\u1edbn c\u00e1c ph\u1eabu thu\u1eadt nh\u1ecf kh\u00f4ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng opioid, k\u1ec3 c\u1ea3 nh\u1ed5 r\u0103ng kh\u00f4ng ph\u1ee9c t\u1ea1p, ph\u1eabu thu\u1eadt da, th\u1ee7 thu\u1eadt ch\u1ec9nh h\u00ecnh nh\u1ea5t \u0111\u1ecbnh. N\u1ebfu opioid \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, s\u1ebd th\u01b0\u1eddng \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p v\u1edbi m\u1ed9t thu\u1ed1c gi\u1ea3m \u0111au kh\u00e1c, nh\u01b0 acetaminophen ho\u1eb7c NSAID.<\/li>\n
  7. Ng\u0103n ch\u1eb7n s\u1ef1 l\u1ea1m d\u1ee5ng c\u1ee7a b\u00e1c s\u0129. Tr\u01b0\u1edbc khi opioid \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong c\u00e1c c\u01a1n \u0111au c\u1ea5p t\u00ednh, nh\u00e2n vi\u00ean y t\u1ebf n\u00ean xem l\u1ea1i h\u1ed3 s\u01a1 ch\u01b0\u01a1ng tr\u00ecnh qu\u1ea3n l\u00fd thu\u1ed1c k\u00ea toa c\u1ee7a \u0111\u1ecba ph\u01b0\u01a1ng ho\u1eb7c khu v\u1ef1c \u0111\u1ec3 s\u00e0ng l\u1ecdc b\u1ec7nh nh\u00e2n \u0111\u1ebfn mua \u1edf nhi\u1ec1u nh\u00e0 cung c\u1ea5p \u0111\u1ec3 c\u00f3 \u0111\u01b0\u1ee3c l\u01b0\u1ee3ng opioid nh\u1ecf. M\u1ed9t s\u1ed1 ch\u01b0\u01a1ng tr\u00ecnh cung c\u1ea5p k\u1ebft qu\u1ea3 kh\u00e1 nhanh, ngay sau khi m\u1ed9t \u0111\u01a1n thu\u1ed1c \u0111\u01b0\u1ee3c \u0111i\u1ec1n.<\/li>\n<\/ol>\n

    K\u1ebeT LU\u1eacN<\/h2>\n

    C\u00e1c opioid \u0111\u00f3ng m\u1ed9t ph\u1ea7n quan tr\u1ecdng trong \u0111i\u1ec1u tr\u1ecb \u0111au c\u1ea5p t\u00ednh. Ch\u00fang c\u00f3 hi\u1ec7u qu\u1ea3 cao, \u0111\u1eb7c bi\u1ec7t khi k\u1ebft h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au kh\u00e1c, v\u00e0 r\u1ea5t c\u1ea7n cho c\u00e1c t\u00ecnh hu\u1ed1ng \u0111au c\u1ea5p t\u00ednh nghi\u00eam tr\u1ecdng theo k\u1ebf ho\u1ea1ch hay \u0111au do ch\u1ea5n th\u01b0\u01a1ng b\u1ea5t ng\u1edd. Tuy nhi\u00ean, c\u00e1c opioid ph\u1ea3i \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng m\u1ed9t c\u00e1ch th\u1eadn tr\u1ecdng, trong th\u1eddi gian ng\u1eafn nh\u1ea5t c\u00f3 th\u1ec3, \u0111\u1ed3ng th\u1eddi \u0111\u00e1nh gi\u00e1 \u0111\u00fang nguy c\u01a1 g\u1eb7p c\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i, d\u00f9ng sai hay l\u1ea1m d\u1ee5ng thu\u1ed1c.<\/p>\n

    Ngu\u1ed3n t\u00e0i li\u1ec7u<\/h2>\n

    Ng\u01b0\u1eddi d\u1ecbch: Sinh vi\u00ean d\u01b0\u1ee3c Nguy\u1ec5n Hu\u1ef3nh Anh V\u0169 , Tr\u1ea7n Th\u1ecb Thanh Ng\u00e2n \u2013 \u0110\u1ea1i h\u1ecdc Y khoa Ph\u1ea1m Ng\u1ecdc Th\u1ea1ch.<\/p>\n

    Ng\u01b0\u1eddi hi\u1ec7u \u0111\u00ednh: Qu\u1ea3n Th\u1ecb Th\u00f9y Linh \u2013 D\u01b0\u1ee3c s\u0129, \u0110\u1ea1i h\u1ecdc D\u01b0\u1ee3c H\u00e0 N\u1ed9i. Nh\u1ecbp c\u1ea7u D\u01b0\u1ee3c L\u00e2m S\u00e0ng.<\/p>\n

    Ngu\u1ed3n t\u00e0i li\u1ec7u: Lee Kral, PharmD, BCPS v\u00e0 Tejinder Swaran Singh, MD (c\u1eadp nh\u1eadt l\u1ea7n cu\u1ed1i ng\u00e0y 05\/10\/2016). Medical management of acute pain. Practical Pain Management. link:\u00a0https:\/\/www.practicalpainmanagement.com\/resource-centers\/opioid-prescribing-monitoring\/medical-management-acute-pain<\/a><\/p>\n

     <\/p>\n

     <\/p>\n","protected":false},"excerpt":{"rendered":"

    C\u00e1c Opioid c\u00f3 th\u1ec3 hi\u1ec7u qu\u1ea3 trong vi\u1ec7c \u0111i\u1ec1u tr\u1ecb \u0111au c\u1ea5p t\u00ednh, \u0111\u1eb7c bi\u1ec7t khi k\u1ebft h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au kh\u00e1c. Tuy nhi\u00ean, c\u00e1c thu\u1ed1c n\u00e0y kh\u00f4ng ph\u1ea3i l\u00fac n\u00e0o c\u0169ng c\u1ea7n thi\u1ebft v\u00e0 \u0111\u00f4i khi g\u00e2y ra nhi\u1ec1u nguy c\u01a1 h\u01a1n l\u1ee3i \u00edch cho b\u1ec7nh nh\u00e2n. Theo \u0111\u1ecbnh ngh\u0129a, \u0111au c\u1ea5p […]\n","protected":false},"author":1,"featured_media":5470,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-5469","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\/5469","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=5469"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/5469\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/5470"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=5469"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=5469"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=5469"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}