{"id":6295,"date":"2019-04-02T09:25:39","date_gmt":"2019-04-02T02:25:39","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=6295"},"modified":"2019-04-05T09:28:59","modified_gmt":"2019-04-05T02:28:59","slug":"han-che-su-dung-thuoc-chong-loan-than-cho-benh-nhan-hoi-suc-tich-cuc","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/han-che-su-dung-thuoc-chong-loan-than-cho-benh-nhan-hoi-suc-tich-cuc\/","title":{"rendered":"H\u1ea1n ch\u1ebf s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n cho b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c"},"content":{"rendered":"

\u0110i\u1ec3m nghi\u00ean c\u1ee9u m\u1edbi \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 (NEJM): H\u1ea1n ch\u1ebf s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n cho b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c<\/h2>\n

Trong \u1ea5n b\u1ea3n NEJM Journal Watch (General Meidicne) Year in Review 2018, c\u00e1c Editor c\u1ee7a t\u1ea1p ch\u00ed \u0111\u00e3 \u0111i\u1ec3m l\u1ea1i k\u1ebft qu\u1ea3 c\u1ee7a nh\u1eefng nghi\u00ean c\u1ee9u m\u1edbi v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c an th\u1ea7n tr\u00ean b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c<\/strong>. D\u1eef li\u1ec7u cho th\u1ea5y thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n kh\u00f4ng ng\u0103n ng\u1eeba \u0111\u01b0\u1ee3c c\u00e1c c\u01a1n m\u00ea s\u1ea3ng c\u0169ng nh\u01b0 kh\u00f4ng c\u00f3 t\u00e1c \u0111\u1ed9ng n\u00e0o l\u00ean di\u1ec5n bi\u1ebfn l\u00e2m s\u00e0ng c\u1ee7a m\u00ea s\u1ea3ng.<\/p>\n

Th\u00f4ng th\u01b0\u1eddng thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ki\u1ec3m so\u00e1t k\u00edch \u0111\u1ed9ng \u1edf b\u1ec7nh nh\u00e2n m\u00ea s\u1ea3ng c\u00f3 nguy c\u01a1 c\u00f3 h\u00e0nh vi g\u00e2y th\u01b0\u01a1ng t\u00edch. G\u1ea7n \u0111\u00e2y, ph\u1ea1m vi s\u1eed d\u1ee5ng thu\u1ed1c \u0111\u01b0\u1ee3c m\u1edf r\u1ed9ng tr\u00ean c\u1ea3 \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng \u1edf b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 m\u00ea s\u1ea3ng, c\u0169ng nh\u01b0 \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n suy ngh\u0129 \u1edf b\u1ec7nh nh\u00e2n v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng gi\u1ea3m ho\u1ea1t \u0111\u1ed9ng. Hai th\u1eed nghi\u1ec7m n\u0103m 2018 \u0111\u00e3 cho th\u1ea5y n\u00ean d\u1eebng s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n v\u00ec c\u00e1c m\u1ee5c \u0111\u00edch tr\u00ean.<\/p>\n

Th\u1eed nghi\u1ec7m REDUCE \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n tr\u00ean 1800 b\u1ec7nh nh\u00e2n khoa h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c (ICU) c\u00f3 nguy c\u01a1 m\u00ea s\u1ea3ng t\u1ea1i H\u00e0 Lan. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn ng\u1eabu nhi\u00ean \u0111\u1ec3 s\u1eed d\u1ee5ng ho\u1eb7c haloperidol (1 mg hay 2 mg ba l\u1ea7n\/ ng\u00e0y) ho\u1eb7c gi\u1ea3 d\u01b0\u1ee3c. Nh\u00f3m s\u1eed d\u1ee5ng haloperidol 1 mg \u0111\u00e3 d\u1eebng s\u1edbm do kh\u00f4ng th\u1ea5y t\u00e1c d\u1ee5ng. T\u1ec9 l\u1ec7 t\u1eed vong trong v\u00f2ng 28 ng\u00e0y v\u00e0 90 ng\u00e0y kh\u00f4ng kh\u00e1c bi\u1ec7t gi\u1eefa nh\u00f3m d\u00f9ng haloperidol 2 mg v\u00e0 nh\u00f3m gi\u1ea3 d\u01b0\u1ee3c. T\u1ec9 l\u1ec7 m\u00ea s\u1ea3ng (33%), \u0111\u1ed9 d\u00e0i \u0111\u1ee3t \u0111i\u1ec1u tr\u1ecb t\u1ea1i khoa ICU v\u00e0 t\u1ea1i b\u1ec7nh vi\u1ec7n c\u0169ng nh\u01b0 th\u1eddi gian th\u1edf m\u00e1y l\u00e0 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nhau gi\u1eefa 2 nh\u00f3m (NEJM JW Gen Med ng\u00e0y 1\/4 v\u00e0 JAMA ng\u00e0y 20\/2; 319:680).<\/p>\n

\"thu\u1ed1c<\/p>\n

\u1ede m\u1ed9t th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng kh\u00e1c, h\u01a1n 500 b\u1ec7nh nh\u00e2n trong t\u00ecnh tr\u1ea1ng nguy k\u1ecbch c\u00f3 c\u01a1n m\u00ea s\u1ea3ng (75% \u0111i\u1ec1u tr\u1ecb t\u1ea1i khoa ICU, h\u1ea7u h\u1ebft \u0111\u1ec1u th\u1edf m\u00e1y, kho\u1ea3ng 90% b\u1ec7nh nh\u00e2n gi\u1ea3m v\u1eadn \u0111\u1ed9ng) t\u1ea1i 16 b\u1ec7nh vi\u1ec7n \u1edf Hoa K\u00ec \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng haloperidol, ziprasidon ho\u1eb7c gi\u1ea3 d\u01b0\u1ee3c trong 14 ng\u00e0y. K\u1ebft qu\u1ea3 cho th\u1ea5y kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t n\u00e0o v\u1ec1 t\u1ed5ng s\u1ed1 ng\u00e0y kh\u00f4ng m\u00ea s\u1ea3ng, th\u1eddi gian th\u1edf m\u00e1y, th\u1eddi gian \u0111i\u1ec1u tr\u1ecb t\u1ea1i ICU hay t\u1ec9 l\u1ec7 t\u1eed vong trong 14 ng\u00e0y gi\u1eefa c\u00e1c nh\u00f3m \u0111i\u1ec1u tr\u1ecb, b\u1ea5t k\u1ec3 l\u00e0 m\u00ea s\u1ea3ng th\u1ec3 gi\u1ea3m v\u1eadn \u0111\u1ed9ng hay t\u0103ng v\u1eadn \u0111\u1ed9ng (NEJM JW Gen Med ng\u00e0y 1\/12 v\u00e0 N Engl J Med ng\u00e0y 22\/10; [e-pub]).<\/p>\n

Hai th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ph\u00e2n nh\u00f3m ng\u1eabu nhi\u00ean tr\u00ean \u0111\u00e3 cho th\u1ea5y thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n kh\u00f4ng c\u00f3 vai tr\u00f2 g\u00ec trong vi\u1ec7c d\u1ef1 ph\u00f2ng m\u00ea s\u1ea3ng \u1edf b\u1ec7nh nh\u00e2n ICU v\u00e0 kh\u00f4ng n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u1edf b\u1ec7nh nh\u00e2n m\u00ea s\u1ea3ng gi\u1ea3m v\u1eadn \u0111\u1ed9ng. Thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n c\u00f3 th\u1ec3 c\u00f3 vai tr\u00f2 trong ki\u1ec3m so\u00e1t b\u1ec7nh nh\u00e2n m\u00ea s\u1ea3ng t\u0103ng \u0111\u1ed9ng c\u00f3 nguy c\u01a1 t\u1ef1 g\u00e2y h\u1ea1i cao (nh\u01b0 t\u1ef1 r\u00fat \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n). Tuy nhi\u00ean n\u00ean d\u1eebng thu\u1ed1c ngay khi nh\u1eadn th\u1ea5y thu\u1ed1c c\u00f3 nguy c\u01a1 g\u00e2y h\u1ea1i, nh\u01b0 k\u00e9o d\u00e0i kho\u1ea3ng QT hay vi\u00eam ph\u1ed5i h\u00edt (NEJM JW Gen Med Mar 1 v\u00e0 J Am Geriatr Soc 2017 Dec; 65:2580).<\/p>\n

Ngu\u1ed3n: https:\/\/www.jwatch.org\/na48078\/2018\/12\/27\/nejm-journal-watch-general-medicine-year-review-2018<\/a><\/p>\n

Ng\u01b0\u1eddi t\u1ed5ng h\u1ee3p: Nguy\u1ec5n Th\u1ecb Thu H\u00e0 – \u0110o\u00e0n Th\u1ecb Ph\u01b0\u01a1ng Th\u1ea3o Trung T\u00e2m C\u1ea3nh Gi\u00e1c D\u01b0\u1ee3c Qu\u1ed1c Gia.<\/p>\n

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\u0110i\u1ec3m nghi\u00ean c\u1ee9u m\u1edbi \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 (NEJM): H\u1ea1n ch\u1ebf s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n cho b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c Trong \u1ea5n b\u1ea3n NEJM Journal Watch (General Meidicne) Year in Review 2018, c\u00e1c Editor c\u1ee7a t\u1ea1p ch\u00ed \u0111\u00e3 \u0111i\u1ec3m l\u1ea1i k\u1ebft qu\u1ea3 c\u1ee7a nh\u1eefng nghi\u00ean c\u1ee9u m\u1edbi v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c […]\n","protected":false},"author":1,"featured_media":6296,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-6295","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\/6295","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=6295"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/6295\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/6296"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=6295"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=6295"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=6295"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}