{"id":6795,"date":"2011-04-12T00:46:11","date_gmt":"2011-04-11T17:46:11","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=6795"},"modified":"2019-06-29T01:05:13","modified_gmt":"2019-06-28T18:05:13","slug":"thuoc-giam-dau","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/thuoc-giam-dau\/","title":{"rendered":"S\u1eed d\u1ee5ng h\u1ee3p l\u00fd c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au th\u01b0\u1eddng d\u00f9ng"},"content":{"rendered":"

T\u00f3m t\u1eaft<\/h2>\n
\u0110au<\/strong> l\u00e0 m\u1ed9t tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p tr\u00ean l\u00e2m s\u00e0ng, \u0111\u00f2i h\u1ecfi qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb c\u1ee7a b\u00e1c s\u0129 v\u00e0 t\u01b0 v\u1ea5n c\u1ee7a d\u01b0\u1ee3c s\u0129. Hi\u1ec3u r\u00f5 c\u01a1 ch\u1ebf b\u1ec7nh sinh, ph\u00e2n lo\u1ea1i v\u00e0 c\u00e1ch \u0111\u00e1nh gi\u00e1 \u0111au s\u1ebd gi\u00fap b\u00e1c s\u0129, d\u01b0\u1ee3c s\u0129 \u0111\u00e1nh gi\u00e1, ti\u00ean l\u01b0\u1ee3ng v\u00e0 l\u1ef1a ch\u1ecdn li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p v\u1edbi t\u1eebng t\u00ecnh hu\u1ed1ng c\u1ee5 th\u1ec3.<\/p>\n
\u0110au l\u00e0 m\u1ed9t trong nh\u1eefng tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t, kh\u00f4ng ch\u1ec9 v\u1edbi b\u1ec7nh nh\u00e2n n\u1ed9i tr\u00fa m\u00e0 c\u1ea3 v\u1edbi b\u1ec7nh nh\u00e2n ngo\u1ea1i tr\u00fa. Vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c gi\u1ea3m \u0111au h\u1ee3p l\u00fd<\/strong> kh\u00f4ng ch\u1ec9 gi\u00fap \u0111i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd, c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng m\u00e0 c\u00f2n g\u00f3p ph\u1ea7n gi\u00fap b\u1ec7nh nh\u00e2n t\u0103ng tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb.<\/p>\n
Thu\u1ed1c gi\u1ea3m \u0111au<\/a> hi\u1ec7n t\u1ea1i \u0111\u01b0\u1ee3c T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi ph\u00e2n lo\u1ea1i th\u00e0nh ba nh\u00f3m d\u1ef1a tr\u00ean t\u00e1c d\u1ee5ng d\u01b0\u1ee3c l\u00fd v\u00e0 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb:<\/strong><\/p>\n
\n
Thu\u1ed1c gi\u1ea3m \u0111au nh\u00f3m I<\/strong>: tr\u01b0\u1edbc \u0111\u00e2y g\u1ecdi l\u00e0 thu\u1ed1c gi\u1ea3m \u0111au ngo\u1ea1i bi\u00ean, g\u1ed3m c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00f4ng opioid nh\u01b0 paracetamol, acid acetylsalicylic (aspirin) v\u00e0 thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid (g\u1ecdi t\u1eaft l\u00e0 c\u00e1c NSAID) nh\u01b0 ibuprofen \u1edf li\u1ec1u gi\u1ea3m \u0111au. C\u00e1c thu\u1ed1c nh\u00f3m n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u01a1n \u0111au nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh.<\/li>\n
Thu\u1ed1c gi\u1ea3m \u0111au nh\u00f3m II<\/strong>: g\u1ed3m c\u00e1c thu\u1ed1c opioid y\u1ebfu nh\u01b0 codein v\u00e0 tramadol, th\u00edch h\u1ee3p \u0111i\u1ec1u tr\u1ecb c\u00e1c c\u01a1n \u0111au c\u01b0\u1eddng \u0111\u1ed9 trung b\u00ecnh. Thu\u1ed1c th\u01b0\u1eddng \u0111\u01b0\u1ee3c b\u00e1n tr\u00ean th\u1ecb tr\u01b0\u1eddng k\u1ebft h\u1ee3p v\u1edbi m\u1ed9t thu\u1ed1c gi\u1ea3m \u0111au ngo\u1ea1i bi\u00ean.<\/li>\n
Thu\u1ed1c gi\u1ea3m \u0111au nh\u00f3m III<\/strong>: g\u1ed3m c\u00e1c thu\u1ed1c opioid m\u1ea1nh nh\u01b0 morphin, \u0111i\u1ec1u tr\u1ecb c\u00e1c c\u01a1n \u0111au nghi\u00eam tr\u1ecdng, d\u1eef d\u1ed9i v\u00e0\/ho\u1eb7c kh\u00f4ng c\u00f3 \u0111\u00e1p \u1ee9ng v\u1edbi c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au nh\u00f3m I v\u00e0 nh\u00f3m II.<\/li>\n<\/ul>\n
$\"thu\u1ed1c$ <\/p>\n
M\u1eddi c\u00e1c b\u1ea1n xem th\u00eam b\u00e0i vi\u1ebft:<\/p>\n
\n
S\u1eed d\u1ee5ng h\u1ee3p l\u00fd c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au th\u00f4ng d\u1ee5ng<\/a><\/li>\n
ANSM c\u00f4ng b\u1ed1 t\u00ecnh h\u00ecnh ti\u00eau th\u1ee5 thu\u1ed1c gi\u1ea3m \u0111au opioid t\u1ea1i Ph\u00e1p<\/a><\/li>\n
Qu\u1ea3n l\u00fd \u0111i\u1ec1u tr\u1ecb \u0111au c\u1ea5p t\u00ednh<\/a><\/li>\n<\/ul>\n
N\u1ed9i dung b\u00e0i:<\/h2>\n
\n
\u0110au l\u00e0 m\u1ed9t tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p tr\u00ean l\u00e2m s\u00e0ng, \u0111\u00f2i h\u1ecfi qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb c\u1ee7a b\u00e1c s\u0129 v\u00e0 t\u01b0 v\u1ea5n c\u1ee7a d\u01b0\u1ee3c s\u0129. Hi\u1ec3u r\u00f5 c\u01a1 ch\u1ebf b\u1ec7nh sinh, ph\u00e2n lo\u1ea1i v\u00e0 c\u00e1ch \u0111\u00e1nh gi\u00e1 \u0111au s\u1ebd gi\u00fap b\u00e1c s\u0129, d\u01b0\u1ee3c s\u0129 \u0111\u00e1nh gi\u00e1, ti\u00ean l\u01b0\u1ee3ng v\u00e0 l\u1ef1a ch\u1ecdn li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p v\u1edbi t\u1eebng t\u00ecnh hu\u1ed1ng c\u1ee5 th\u1ec3.<\/li>\n
\u0110au th\u01b0\u1eddng \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i th\u00e0nh ba d\u1ea1ng d\u1ef1a v\u00e0o con \u0111\u01b0\u1eddng sinh l\u00fd g\u00e2y n\u00ean c\u1ea3m gi\u00e1c \u0111au: \u0111au do c\u1ea3m th\u1ee5 th\u1ea7n kinh, \u0111au do nguy\u00ean nh\u00e2n th\u1ea7n kinh v\u00e0 \u0111au do c\u0103n nguy\u00ean t\u00e2m l\u00fd. Tuy nhi\u00ean, tr\u00ean th\u1ef1c t\u1ebf, c\u00e1c qu\u00e1 tr\u00ecnh sinh l\u00fd n\u00e0y c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p v\u1edbi nhau, kh\u00f3 c\u00f3 th\u1ec3 ph\u00e2n bi\u1ec7t r\u00f5 r\u00e0ng nguy\u00ean nh\u00e2n th\u1ef1c s\u1ef1.<\/li>\n
Hi\u1ec7p h\u1ed9i nghi\u00ean c\u1ee9u \u0111au qu\u1ed1c t\u1ebf (International Association for the Study of Pain – IASP) \u0111\u1ecbnh ngh\u0129a: \u201c\u0110au l\u00e0 m\u1ed9t c\u1ea3m gi\u00e1c kh\u00f3 ch\u1ecbu v\u00e0 s\u1ef1 ch\u1ecbu \u0111\u1ef1ng v\u1ec1 c\u1ea3m x\u00fac, ch\u1ee7 y\u1ebfu \u0111i k\u00e8m theo t\u1ed5n th\u01b0\u01a1ng th\u1ef1c s\u1ef1 hay ti\u1ec1m \u1ea9n c\u1ee7a t\u1ed5 ch\u1ee9c ho\u1eb7c m\u00f4 t\u1ea3 nh\u01b0 l\u00e0 t\u1ed5n th\u01b0\u01a1ng t\u1ed5 ch\u1ee9c\u201d. \u0110\u00e2y c\u0169ng l\u00e0 tri\u1ec7u ch\u1ee9ng li\u00ean quan \u0111\u1ebfn nhi\u1ec1u b\u1ec7nh l\u00fd, ch\u1ea5n th\u01b0\u01a1ng, l\u00e0 l\u00fd do s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c th\u00f4ng th\u01b0\u1eddng, thu\u1ed1c c\u1ea5p c\u1ee9u, thu\u1ed1c \u0111i\u1ec1u tr\u1ecb kh\u1edbp, thu\u1ed1c \u0111i\u1ec1u tr\u1ecb th\u1ea7n kinh, … \u0110au l\u00e0 m\u1ed9t h\u00ecnh th\u1ee9c ph\u1ea3n x\u1ea1 b\u1ea3o v\u1ec7 tr\u01b0\u1edbc c\u00e1c y\u1ebfu t\u1ed1 k\u00edch th\u00edch b\u00ean ngo\u00e0i. Tuy nhi\u00ean, trong \u0111i\u1ec1u ki\u1ec7n b\u1ec7nh l\u00fd, c\u1ea3m gi\u00e1c \u0111au k\u00e9o d\u00e0i c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn suy nh\u01b0\u1ee3c nghi\u00eam tr\u1ecdng, c\u1ea3n tr\u1edf s\u1ef1 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb v\u00e0 tin t\u01b0\u1edfng c\u1ee7a b\u1ec7nh nh\u00e2n. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y, c\u01a1n \u0111au, bao g\u1ed3m c\u1ea3 c\u01a1n \u0111au m\u1ea1n t\u00ednh, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn suy ki\u1ec7t, l\u00e0 ngu\u1ed3n g\u1ed1c c\u1ee7a c\u00e1c tri\u1ec7u ch\u1ee9ng tr\u1ea7m c\u1ea3m.<\/li>\n
Chi ti\u1ebft s\u1eed d\u1ee5ng 3 nh\u00f3m thu\u1ed1c gi\u1ea3m \u0111au.<\/li>\n<\/ul>\n
Ngu\u1ed3n g\u1ed1c c\u1ee7a \u0111au<\/h2>\n
T\u1ea5t c\u1ea3 c\u00e1c hi\u1ec7n t\u01b0\u1ee3ng \u0111au \u0111\u1ec1u c\u00f3 chung m\u1ed9t \u0111i\u1ec3m kh\u1edfi \u0111\u1ea7u v\u00e0 m\u1ed9t \u0111i\u1ec3m \u0111\u1ebfn: h\u1ec7 th\u1ea7n kinh. Qu\u00e1 tr\u00ecnh d\u1eabn truy\u1ec1n \u0111au th\u01b0\u1eddng b\u1eaft \u0111\u1ea7u t\u1eeb c\u00e1c th\u1ee5 th\u1ec3 c\u1ea3m nh\u1eadn \u0111au, \u0111i qua c\u00e1c s\u1ee3i d\u1eabn truy\u1ec1n h\u01b0\u1edbng t\u00e2m v\u00e0 truy\u1ec1n v\u1ec1 t\u1ee7y s\u1ed1ng.<\/p>\n
C\u00e1c th\u1ee5 th\u1ec3 c\u1ea3m nh\u1eadn \u0111au<\/h3>\n
C\u00e1c th\u1ee5 th\u1ec3 c\u1ea3m nh\u1eadn \u0111au th\u01b0\u1eddng ch\u1ecbu tr\u00e1ch nhi\u1ec7m ph\u00e1t hi\u1ec7n b\u1ea5t k\u1ef3 hi\u1ec7n t\u01b0\u1ee3ng v\u1eadt l\u00fd, nhi\u1ec7t ho\u1eb7c h\u00f3a h\u1ecdc nguy hi\u1ec3m. C\u00e1c th\u1ee5 th\u1ec3 n\u00e0y bao g\u1ed3m c\u00e1c \u0111\u1ea7u m\u00fat th\u1ea7n kinh t\u1ef1 do, \u0111\u01b0\u1ee3c ph\u00e2n b\u1ed1 tr\u00ean to\u00e0n b\u1ed9 b\u1ec1 m\u1eb7t c\u01a1 th\u1ec3 c\u0169ng nh\u01b0 trong c\u01a1, g\u00e2n ho\u1eb7c th\u1eadm ch\u00ed c\u00e1c c\u01a1 quan n\u1ed9i t\u1ea1ng. M\u1ed7i th\u1ee5 th\u1ec3 chuy\u00ean bi\u1ec7t truy\u1ec1n t\u1ea3i m\u1ed9t th\u00f4ng \u0111i\u1ec7p t\u1ed5n th\u01b0\u01a1ng c\u1ee5 th\u1ec3 nh\u01b0 \u0111au r\u00e1t ho\u1eb7c \u0111au nh\u00f3i.<\/p>\n
C\u00e1c s\u1ee3i th\u1ea7n kinh h\u01b0\u1edbng t\u00e2m d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c \u0111au<\/h3>\n
C\u00e1c s\u1ee3i h\u01b0\u1edbng t\u00e2m d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c \u0111au c\u00f3 tr\u00e1ch nhi\u1ec7m truy\u1ec1n \u0111\u1ea1t th\u00f4ng tin \u0111\u1ebfn h\u1ec7 th\u1ed1ng th\u1ea7n kinh trung \u01b0\u01a1ng, t\u1eeb \u0111\u00f3 t\u1ea1o ra c\u00e1c \u0111\u00e1p \u1ee9ng v\u1edbi k\u00edch th\u00edch t\u1ea1i th\u1ee5 th\u1ec3. \u0110\u00e2y l\u00e0 c\u1ea7u n\u1ed1i gi\u1eefa t\u1ea5t c\u1ea3 c\u00e1c khu v\u1ef1c th\u1ea7n kinh ngo\u1ea1i bi\u00ean c\u1ee7a c\u01a1 th\u1ec3 v\u00e0 t\u1ee7y s\u1ed1ng. C\u00f3 nhi\u1ec1u lo\u1ea1i s\u1ee3i h\u01b0\u1edbng t\u00e2m kh\u00e1c nhau. T\u1ea1i da, th\u1ee5 th\u1ec3 c\u1ea3m nh\u1eadn \u0111au \u0111\u01b0\u1ee3c \u0111\u1ea1i di\u1ec7n b\u1edfi c\u00e1c s\u1ee3i c\u00f3 \u0111\u01b0\u1eddng k\u00ednh nh\u1ecf (A\u03b4 v\u00e0 C). C\u00e1c s\u1ee3i c\u00f3 \u0111\u01b0\u1eddng k\u00ednh l\u1edbn c\u00f3 v\u1ecf myelin h\u00f3a (A\u03b2) tham gia d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c b\u1ea3n th\u1ec3 kh\u00f4ng \u0111au nh\u01b0ng c\u0169ng tham gia v\u00e0o vi\u1ec7c \u0111i\u1ec1u ti\u1ebft th\u00f4ng tin nh\u1eadn c\u1ea3m \u0111au (xem th\u00eam b\u1ea3ng 1 v\u00e0 ghi ch\u00fa).<\/p>\n\n\n\n\n\n\n\n
B\u1ea3ng 1: C\u00e1c lo\u1ea1i s\u1ee3i th\u1ea7n kinh nh\u1eadn c\u1ea3m tr\u00ean da<\/td>\n<\/tr>\n
Lo\u1ea1i s\u1ee3i th\u1ea7n kinh<\/td>\n A\u03b2<\/td>\n A\u03b4<\/td>\n C<\/td>\n<\/tr>\n
\u0110\u01b0\u1eddng k\u00ednh<\/td>\n 6 \u0111\u1ebfn 12 \u00b5m, myelin h\u00f3a<\/td>\n 1 \u0111\u1ebfn 5 \u00b5m, myelin h\u00f3a<\/td>\n 0,2 \u0111\u1ebfn 1,5 \u00b5m, kh\u00f4ng myelin<\/td>\n<\/tr>\n
T\u1ed1c \u0111\u1ed9 d\u1eabn truy\u1ec1n<\/td>\n 35 \u0111\u1ebfn 75 m\/s<\/td>\n 5 \u0111\u1ebfn 30 m\/s<\/td>\n 0,5 \u0111\u1ebfn 2 m\/s<\/td>\n<\/tr>\n
Vai tr\u00f2<\/td>\n Nh\u1eadn c\u1ea3m x\u00fac gi\u00e1c m\u1ee9c \u0111\u1ed9 nh\u1eb9<\/td>\n Nh\u1eadn c\u1ea3m nhi\u1ec7t \u0111\u1ed9 (kh\u00f4ng \u0111au)<\/p>\n
Nh\u1eadn c\u1ea3m \u0111au (li\u00ean quan \u0111\u1ebfn nhi\u1ec7t v\u00e0 c\u01a1 h\u1ecdc)<\/td>\n
Nh\u1eadn c\u1ea3m \u0111au<\/p>\n
(li\u00ean quan \u0111\u1ebfn nhi\u1ec7t, c\u01a1 h\u1ecdc<\/p>\n
v\u00e0 h\u00f3a h\u1ecdc)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Ghi ch\u00fa: Nh\u1eadn c\u1ea3m \u0111au l\u00e0 g\u00ec?<\/h3>\n
Nh\u1eadn c\u1ea3m \u0111au \u0111\u01b0\u1ee3c coi nh\u01b0 l\u00e0 m\u1ed9t ch\u1ee9c n\u0103ng b\u1ea3o v\u1ec7 v\u00e0 b\u00e1o \u0111\u1ed9ng cho c\u00e1c t\u1ed5 ch\u1ee9c trong c\u01a1 th\u1ec3. Th\u1ef1c t\u1ebf, \u0111\u00f3 l\u00e0 qu\u00e1 tr\u00ecnh ho\u1ea1t \u0111\u1ed9ng c\u1ee7a t\u1ea5t c\u1ea3 c\u00e1c hi\u1ec7n t\u01b0\u1ee3ng cho ph\u00e9p t\u00edch h\u1ee3p \u1edf c\u1ea5p \u0111\u1ed9 h\u1ec7 th\u1ed1ng th\u1ea7n kinh trung \u01b0\u01a1ng c\u1ee7a m\u1ed9t k\u00edch th\u00edch \u0111au th\u00f4ng qua k\u00edch ho\u1ea1t th\u1ee5 th\u1ec3 c\u1ea3m nh\u1eadn \u1edf da, c\u01a1 v\u00e0 kh\u1edbp. Qu\u00e1 tr\u00ecnh truy\u1ec1n th\u00f4ng tin c\u1ea3m gi\u00e1c \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi c\u00e1c d\u00e2y th\u1ea7n kinh, t\u1eeb v\u1ecb tr\u00ed \u0111au \u0111\u1ebfn t\u1ee7y s\u1ed1ng v\u00e0 n\u00e3o.<\/p>\n
Tuy nhi\u00ean, s\u1ef1 k\u00edch th\u00edch n\u00e0y ph\u1ea3i v\u01b0\u1ee3t m\u1ed9t ng\u01b0\u1ee1ng nh\u1ea5t \u0111\u1ecbnh m\u1edbi c\u00f3 th\u1ec3 ph\u00e1t xung \u0111i\u1ec7n, hi\u1ec7n t\u01b0\u1ee3ng n\u00e0y \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch b\u1eb1ng “thuy\u1ebft c\u1ed5ng ki\u1ec3m so\u00e1t” (gate control theory). Theo l\u00fd thuy\u1ebft n\u00e0y, khi c\u00f3 k\u00edch th\u00edch \u0111au, c\u00e1c th\u1ee5 th\u1ec3 nh\u1eadn c\u1ea3m \u0111au t\u1ed5n th\u01b0\u01a1ng s\u1ebd m\u00e3 h\u00f3a th\u00f4ng tin \u0111au r\u1ed3i truy\u1ec1n v\u00e0o theo c\u00e1c s\u1ee3i th\u1ea7n kinh d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c \u0111au h\u01b0\u1edbng t\u00e2m (s\u1ee3i A\u03b4 v\u00e0 C) qua h\u1ea1ch gai v\u00e0o s\u1eebng sau t\u1ee7y s\u1ed1ng v\u00e0 ti\u1ebfp x\u00fac v\u1edbi t\u1ebf b\u00e0o neuron th\u1ee9 hai hay t\u1ebf b\u00e0o T (transmission cell) t\u1eeb \u0111\u00f3 d\u1eabn truy\u1ec1n l\u00ean trung \u01b0\u01a1ng. Tr\u01b0\u1edbc khi ti\u1ebfp x\u00fac v\u1edbi t\u1ebf b\u00e0o T, c\u00e1c s\u1ee3i n\u00e0y cho ra m\u1ed9t nh\u00e1nh ti\u1ebfp x\u00fac v\u1edbi neuron li\u00ean h\u1ee3p. Neuron li\u00ean h\u1ee3p \u0111\u00f3ng vai tr\u00f2 nh\u01b0 m\u1ed9t ng\u01b0\u1eddi g\u00e1c c\u1ed5ng, khi h\u01b0ng ph\u1ea5n th\u00ec g\u00e2y ra \u1ee9c ch\u1ebf d\u1eabn truy\u1ec1n tr\u01b0\u1edbc sinap c\u1ee7a s\u1ee3i A\u03b4 v\u00e0 C (\u0111\u00f3ng c\u1ed5ng). Khi ch\u1ec9 c\u00f3 xung \u0111\u1ed9ng t\u1eeb s\u1ee3i A\u03b4 v\u00e0 s\u1ee3i C, neuron li\u00ean h\u1ee3p b\u1ecb \u1ee9c ch\u1ebf n\u00ean c\u1ed5ng m\u1edf, xung \u0111\u1ed9ng \u0111\u01b0\u1ee3c d\u1eabn truy\u1ec1n l\u00ean \u0111\u1ed3i th\u1ecb v\u00e0 v\u1ecf n\u00e3o cho ta c\u1ea3m gi\u00e1c \u0111au. C\u00e1c s\u1ee3i to (A\u03b1 v\u00e0 A\u03b2) c\u0169ng c\u00f3 m\u1ed9t nh\u00e1nh ti\u1ebfp x\u00fac v\u1edbi neuron li\u00ean h\u1ee3p tr\u01b0\u1edbc khi \u0111i l\u00ean tr\u00ean. C\u00e1c xung \u0111\u1ed9ng t\u1eeb s\u1ee3i to g\u00e2y h\u01b0ng ph\u1ea5n neuron li\u00ean h\u1ee3p, l\u00e0m \u0111\u00f3ng c\u1ed5ng, xung \u0111\u1ed9ng \u0111au b\u1ecb ch\u1eb7n l\u1ea1i tr\u01b0\u1edbc khi ti\u1ebfp x\u00fac v\u1edbi t\u1ebf b\u00e0o T l\u00e0m m\u1ea5t c\u1ea3m gi\u00e1c \u0111au.<\/p>\n
T\u1ee7y s\u1ed1ng – tr\u1ea1m d\u1eebng \u0111\u1ea7u ti\u00ean<\/h3>\n
T\u1ea1i c\u00e1c nh\u00e1nh l\u01b0ng c\u1ee7a t\u1ee7y s\u1ed1ng, s\u1ee3i th\u1ea7n kinh d\u1eabn truy\u1ec1n ti\u1ebfp x\u00fac v\u1edbi hai lo\u1ea1i t\u1ebf b\u00e0o th\u1ea7n kinh. Lo\u1ea1i th\u1ee9 nh\u1ea5t ch\u1ec9 ghi nh\u1eadn ch\u1ecdn l\u1ecdc t\u1eeb m\u1ed9t s\u1ed1 lo\u1ea1i s\u1ee3i d\u1eabn truy\u1ec1n chuy\u00ean bi\u1ec7t, lo\u1ea1i th\u1ee9 hai c\u00f3 kh\u1ea3 n\u0103ng ti\u1ebfp nh\u1eadn th\u00f4ng tin t\u1eeb nhi\u1ec1u s\u1ee3i kh\u00e1c nhau (c\u1ea3 s\u1ee3i A\u03b2, A\u03b4 v\u00e0 C) v\u00e0 \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 t\u1ebf b\u00e0o th\u1ea7n kinh h\u1ed9i t\u1ee5. Nh\u1eefng t\u1ebf b\u00e0o th\u1ea7n kinh h\u1ed9i t\u1ee5 n\u00e0y ti\u1ebfp nh\u1eadn d\u1eabn truy\u1ec1n t\u1eeb nhi\u1ec1u v\u00f9ng kh\u00e1c nhau, \u1edf da c\u0169ng nh\u01b0 \u1edf n\u1ed9i t\u1ea1ng, kh\u1edbp ho\u1eb7c c\u01a1. Do \u0111\u00f3, t\u1ed5n th\u01b0\u01a1ng c\u1ee7a t\u1ebf b\u00e0o th\u1ea7n kinh h\u1ed9i t\u1ee5 c\u00f3 th\u1ec3 t\u1ea1o ra c\u1ea3m nh\u1eadn nh\u01b0 c\u01a1n \u0111au lan t\u1ecfa \u1edf kh\u1eafp c\u00e1c khu v\u1ef1c c\u00f3 th\u1ee5 th\u1ec3 m\u00e0 n\u00f3 \u0111i\u1ec1u khi\u1ec3n. \u0110\u00e2y kh\u00f4ng ph\u1ea3i l\u00e0 c\u01a1n \u0111au th\u1ef1c s\u1ef1 g\u00e2y ra b\u1edfi c\u00e1c t\u00e1c nh\u00e2n k\u00edch th\u00edch b\u00ean ngo\u00e0i m\u00e0 t\u1eeb s\u1ef1 gi\u1ea3i m\u00e3 c\u1ee7a h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng. \u0110i\u1ec1u n\u00e0y th\u01b0\u1eddng g\u1eb7p trong c\u01a1n \u0111au th\u1ea7n kinh.<\/p>\n
Ph\u00e2n bi\u1ec7t tri\u1ec7u ch\u1ee9ng \u0111au<\/h2>\n
C\u1ea7n ph\u00e2n bi\u1ec7t r\u00f5 \u0111au ngo\u1ea1i bi\u00ean v\u00e0 \u0111au do th\u1ea7n kinh v\u00ec hai tri\u1ec7u ch\u1ee9ng n\u00e0y c\u00f3 ngu\u1ed3n g\u1ed1c v\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ho\u00e0n to\u00e0n kh\u00e1c nhau.<\/p>\n
\u0110au ngo\u1ea1i bi\u00ean<\/h3>\n
\u0110au ngo\u1ea1i bi\u00ean l\u00e0 tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t, li\u00ean quan \u0111\u1ebfn s\u1ef1 k\u00edch th\u00edch th\u1ee5 th\u1ec3 nh\u1eadn c\u1ea3m, t\u1eeb \u0111\u00f3 k\u00edch ho\u1ea1t th\u00f4ng \u0111i\u1ec7p \u0111au. Do \u0111\u00f3, \u0111au ngo\u1ea1i bi\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au, vi\u1ec7c l\u1ef1a ch\u1ecdn thu\u1ed1c ph\u1ee5 thu\u1ed9c v\u00e0o c\u01b0\u1eddng \u0111\u1ed9 c\u1ee7a nh\u1eadn c\u1ea3m \u0111au.<\/p>\n
Thu\u1ed1c gi\u1ea3m \u0111au c\u00f3 t\u00e1c d\u1ee5ng m\u1ea1nh nh\u1ea5t th\u01b0\u1eddng d\u00f9ng l\u00e0 morphin, m\u1ed9t ho\u1ea1t ch\u1ea5t c\u00f3 c\u01a1 ch\u1ebf t\u01b0\u01a1ng t\u1ef1 enkephalin \u1edf t\u1ee7y s\u1ed1ng v\u00e0 \u1edf n\u00e3o gi\u1eefa (h\u1ec7 th\u1ed1ng n\u00e3o – t\u1ee7y) trong vi\u1ec7c \u1ee9c ch\u1ebf m\u1ea1nh s\u1ef1 gi\u1ea3i ph\u00f3ng ch\u1ea5t P, ch\u1ea5t trung gian h\u00f3a h\u1ecdc gi\u1ea3i ph\u00f3ng t\u1eeb c\u00e1c s\u1ee3i d\u1eabn truy\u1ec1n th\u1ea7n kinh. Do t\u00e1c d\u1ee5ng m\u1ea1nh v\u00e0 tr\u1ef1c ti\u1ebfp n\u00e0y m\u00e0 morphin \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb c\u00e1c c\u01a1n \u0111au d\u1eef d\u1ed9i nh\u01b0 ung th\u01b0, ch\u1ea5n th\u01b0\u01a1ng.<\/p>\n
Ngo\u00e0i morphin, c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au th\u01b0\u1eddng d\u00f9ng kh\u00e1c l\u00e0 paracetamol v\u00e0 c\u00e1c thu\u1ed1c ch\u1ed1ng vi\u00eam c\u00f3 c\u1ea5u tr\u00fac kh\u00f4ng steroid (NSAIDs). C\u00e1c thu\u1ed1c n\u00e0y c\u00f3 t\u00e1c d\u1ee5ng y\u1ebfu h\u01a1n nhi\u1ec1u so v\u1edbi morphin v\u00e0 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb \u0111au nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh.<\/p>\n
\u0110au do th\u1ea7n kinh<\/h3>\n
\u0110au do th\u1ea7n kinh \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi c\u00e1c t\u00e1c \u0111\u1ed9ng tr\u1ef1c ti\u1ebfp l\u00ean h\u1ec7 th\u1ea7n kinh. Trong c\u00e1c ch\u1ea5n th\u01b0\u01a1ng, v\u1ebft c\u1eaft, b\u1ec7nh th\u1ea7n kinh do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng ho\u1eb7c m\u1ed9t s\u1ed1 c\u01a1n \u0111au t\u1ea1i ch\u1ed7 ph\u1ee9c t\u1ea1p kh\u00e1c, v\u1ecb tr\u00ed b\u1ecb t\u00e1c \u0111\u1ed9ng l\u00e0 c\u00e1c d\u00e2y th\u1ea7n kinh ngo\u1ea1i bi\u00ean. Ngo\u00e0i ra, n\u00e3o v\u00e0 t\u1ee7y s\u1ed1ng c\u0169ng c\u00f3 th\u1ec3 b\u1ecb \u1ea3nh h\u01b0\u1edfng v\u00e0 t\u1ef1 g\u00e2y ra c\u1ea3m gi\u00e1c \u0111au, v\u00ed d\u1ee5 nh\u01b0 trong c\u00e1c t\u1ed5n th\u01b0\u01a1ng c\u1ed9t s\u1ed1ng ho\u1eb7c h\u1ed9i ch\u1ee9ng \u0111\u1ed3i n\u00e3o.<\/p>\n
Ki\u1ec3u \u0111au n\u00e0y kh\u00f4ng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au th\u00f4ng th\u01b0\u1eddng m\u00e0 b\u1eb1ng c\u00e1c thu\u1ed1c t\u00e1c d\u1ee5ng l\u00ean th\u1ea7n kinh trung \u01b0\u01a1ng c\u00f3 kh\u1ea3 n\u0103ng \u1ee9c ch\u1ebf c\u1ea3m gi\u00e1c \u0111au ti\u1ec1m \u1ea9n, v\u00ed d\u1ee5 nh\u01b0 thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m, ch\u1ed1ng \u0111\u1ed9ng kinh, ch\u1ed1ng lo\u1ea1n nh\u1ecbp, ch\u1ea5t ch\u1ee7 v\u1eadn c\u1ee7a th\u1ee5 th\u1ec3 NMDA (N-methyl-D-aspartic acid) v\u00e0 c\u00e1c opioid t\u00e1c \u0111\u1ed9ng trung t\u00e2m.<\/p>\n
C\u00e1ch \u0111\u00e1nh gi\u00e1 \u0111au<\/h2>\n
\u0110au l\u00e0 m\u1ed9t tri\u1ec7u ch\u1ee9ng ch\u1ee7 quan c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh. Do \u0111\u00f3 vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 l\u01b0\u1ee3ng gi\u00e1 \u0111au r\u1ea5t ph\u1ee9c t\u1ea1p v\u00e0 kh\u00f3 th\u1ed1ng nh\u1ea5t. B\u1ea3n th\u00e2n b\u1ec7nh nh\u00e2n \u0111\u00f4i khi c\u0169ng kh\u00f4ng \u0111\u1ee7 s\u00e1ng su\u1ed1t \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng c\u1ee7a m\u00ecnh, do c\u00f3 nhi\u1ec1u y\u1ebfu t\u1ed1 \u1ea3nh h\u01b0\u1edfng nh\u01b0 tu\u1ed5i, gi\u1edbi t\u00ednh, kh\u1ea3 n\u0103ng ch\u1ecbu \u0111\u1ef1ng, t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe. \u0110\u1ec3 thu\u1eadn ti\u1ec7n trong \u0111i\u1ec1u tr\u1ecb, m\u1ed9t s\u1ed1 ti\u00eau ch\u00ed v\u00e0 thang \u0111\u00e1nh gi\u00e1 \u0111au \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t.<\/p>\n
C\u00e1c ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 \u0111au<\/h3>\n
M\u1ed9t s\u1ed1 ti\u00eau ch\u00ed ph\u1ea3i \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 \u0111\u1ec3 \u01b0\u1edbc t\u00ednh m\u1ee9c \u0111\u1ed9 c\u1ee7a c\u01a1n \u0111au:<\/p>\n
\n
M\u1ee9c \u0111\u1ed9 \u0111au (\u0111\u00e1nh gi\u00e1 d\u1ef1a tr\u00ean nguy\u00ean nh\u00e2n v\u00e0 ph\u01b0\u01a1ng ti\u1ec7n gi\u1ea3m \u0111au);<\/li>\n
Ki\u1ec3u \u0111au (nh\u00f3i, r\u00e1t, \u00e2m \u1ec9, …);<\/li>\n
V\u1ecb tr\u00ed;<\/li>\n
M\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng;<\/li>\n
Th\u1eddi gian.<\/li>\n<\/ul>\n
Thang \u0111\u00e1nh gi\u00e1 \u0111au<\/h3>\n
Nhi\u1ec1u thang \u0111\u00e1nh gi\u00e1 \u0111au mang t\u00ednh \u0111\u1ecbnh l\u01b0\u1ee3ng ho\u1eb7c \u0111\u1ecbnh t\u00ednh \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n t\u1eeb n\u0103m 2003, cho ph\u00e9p th\u1ef1c hi\u1ec7n c\u00e1c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111\u00e1nh gi\u00e1 ph\u00f9 h\u1ee3p tr\u00ean l\u00e2m s\u00e0ng. M\u1ed9t s\u1ed1 c\u00f4ng c\u1ee5 d\u1ec5 d\u00e0ng s\u1eed d\u1ee5ng nh\u01b0:<\/p>\n
– B\u1ed9 c\u00e2u h\u1ecfi c\u1ee7a McGill-Melaz;<\/p>\n
– Thang h\u00ecnh \u1ea3nh (VAS) (h\u00ecnh 1);<\/p>\n
– B\u1ed9 c\u00e2u h\u1ecfi Cheops (\u00e1p d\u1ee5ng cho tr\u1ebb em 1-7 tu\u1ed5i);<\/p>\n
– Thang DOLOPLUS (\u00e1p d\u1ee5ng trong l\u00e3o khoa).<\/p>\n
$\"\u0111au\"$
H\u00ecnh 1: Thang \u0111\u00e1nh gi\u00e1 \u0111au VAS<\/figcaption><\/figure>\n
Nguy\u00ean t\u1eafc s\u1eed d\u1ee5ng thu\u1ed1c gi\u1ea3m \u0111au<\/h2>\n
Nguy\u00ean t\u1eafc \u0111\u1ea7u ti\u00ean khi s\u1eed d\u1ee5ng thu\u1ed1c gi\u1ea3m \u0111au l\u00e0 nh\u1eafc nh\u1edf b\u1ec7nh nh\u00e2n th\u1ef1c hi\u1ec7n \u0111\u00fang quy \u0111\u1ecbnh v\u00e0 kh\u00f4ng d\u00f9ng thu\u1ed1c gi\u1ea3m \u0111au m\u00e0 kh\u00f4ng c\u00f3 t\u01b0 v\u1ea5n y t\u1ebf. B\u00e1c s\u0129, d\u01b0\u1ee3c s\u0129 khi quy\u1ebft \u0111\u1ecbnh k\u00ea \u0111\u01a1n ho\u1eb7c t\u01b0 v\u1ea5n thu\u1ed1c gi\u1ea3m \u0111au kh\u00f4ng c\u1ea7n \u0111\u01a1n c\u0169ng c\u1ea7n khai th\u00e1c ti\u1ec1n s\u1eed d\u00f9ng thu\u1ed1c. \u0110i\u1ec1u n\u00e0y gi\u00fap l\u1ef1a ch\u1ecdn thu\u1ed1c ph\u00f9 h\u1ee3p v\u1edbi tri\u1ec7u ch\u1ee9ng \u0111au, \u0111\u1ed3ng th\u1eddi tr\u00e1nh \u0111\u01b0\u1ee3c vi\u1ec7c s\u1eed d\u1ee5ng nhi\u1ec1u bi\u1ec7t d\u01b0\u1ee3c c\u00f3 ch\u1ee9a c\u00f9ng m\u1ed9t ho\u1ea1t ch\u1ea5t d\u1eabn \u0111\u1ebfn nguy c\u01a1 qu\u00e1 li\u1ec1u.<\/p>\n
Nguy\u00ean t\u1eafc th\u1ee9 hai l\u00e0 l\u1ef1a ch\u1ecdn thu\u1ed1c gi\u1ea3m \u0111au ph\u1ee5 thu\u1ed9c v\u00e0o b\u1ec7nh nh\u00e2n (c\u01a1 \u0111\u1ecba, tu\u1ed5i, …), lo\u1ea1i \u0111au, c\u01b0\u1eddng \u0111\u1ed9, m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a \u0111au, c\u0169ng nh\u01b0 c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n v\u00e0 t\u01b0\u01a1ng t\u00e1c c\u1ee7a thu\u1ed1c.<\/p>\n
L\u1ef1a ch\u1ecdn thu\u1ed1c gi\u1ea3m \u0111au<\/h3>\n
C\u00e1c thu\u1ed1c gi\u1ea3m \u0111au \u0111\u01b0\u1ee3c chia th\u00e0nh thu\u1ed1c gi\u1ea3m \u0111au trung \u01b0\u01a1ng v\u00e0 thu\u1ed1c gi\u1ea3m \u0111au ngo\u1ea1i vi. Ngo\u00e0i ra, c\u00e1c thu\u1ed1c n\u00e0y c\u00f2n \u0111\u01b0\u1ee3c chia th\u00e0nh c\u00e1c nh\u00f3m I, II, III d\u1ef1a tr\u00ean \u0111\u1eb7c t\u00ednh v\u00e0 m\u1ee9c \u0111\u1ed9 gi\u1ea3m \u0111au. \u0110\u1eb7c \u0111i\u1ec3m v\u00e0 c\u00e1c l\u01b0u \u00fd khi s\u1eed d\u1ee5ng t\u1eebng nh\u00f3m thu\u1ed1c gi\u1ea3m \u0111au s\u1ebd \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y chi ti\u1ebft trong ph\u1ea7n 2 c\u1ee7a b\u00e0i n\u00e0y.<\/p>\n
\u0110i\u1ec1u tr\u1ecb \u0111au ph\u00f9 h\u1ee3p v\u1edbi nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh<\/h3>\n
– M\u1ed9t s\u1ed1 c\u01a1n \u0111au c\u1ea7n \u0111i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh<\/p>\n
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Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, \u0111au ch\u00ednh l\u00e0 tri\u1ec7u ch\u1ee9ng b\u00e1o hi\u1ec7u b\u1ec7nh l\u00fd c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb. Ch\u1ec9 s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au th\u00f4ng th\u01b0\u1eddng kh\u00f4ng th\u1ec3 c\u1ea3i thi\u1ec7n \u0111\u01b0\u1ee3c ho\u00e0n to\u00e0n tri\u1ec7u ch\u1ee9ng. V\u00ed d\u1ee5 trong tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh g\u00fat, c\u1ea7n s\u1eed d\u1ee5ng colchicin; c\u01a1n \u0111au n\u1eeda \u0111\u1ea7u c\u1ea7n \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t b\u1eb1ng thu\u1ed1c tr\u1ecb \u0111au n\u1eeda \u0111\u1ea7u; \u0111au th\u01b0\u1ee3ng v\u1ecb do lo\u00e9t d\u1ea1 d\u00e0y \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1edfi thu\u1ed1c \u1ee9c ch\u1ebf b\u00e0i ti\u1ebft acid d\u1ecbch v\u1ecb; \u0111au do ch\u1ea5n th\u01b0\u01a1ng \u0111\u00f2i h\u1ecfi ph\u1ea3i c\u1ed1 \u0111\u1ecbnh v\u1ecb tr\u00ed ch\u1ea5n th\u01b0\u01a1ng v\u00e0 c\u00e1c can thi\u1ec7p ngo\u1ea1i khoa.<\/li>\n<\/ul>\n
– \u0110i\u1ec1u tr\u1ecb \u0111au do th\u1ea7n kinh: \u0110au th\u1ea7n kinh c\u00f3 t\u00ednh ch\u1ea5t th\u1ee9 ph\u00e1t do m\u1ed9t t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh. Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb lo\u1ea1i \u0111au n\u00e0y \u0111\u01b0\u1ee3c d\u1ef1a tr\u00ean ba lo\u1ea1i thu\u1ed1c gi\u1ea3m \u0111au th\u01b0\u1eddng k\u1ebft h\u1ee3p:<\/p>\n
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Thu\u1ed1c ch\u1ed1ng co gi\u1eadt (gabapentin, pregabalin);<\/li>\n
Thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m (clomipramin, imipramin, amitriptylin);<\/li>\n
Thu\u1ed1c d\u00f9ng ngo\u00e0i nh\u01b0 cao d\u00e1n 5% lidocain, c\u00f3 hi\u1ec7u qu\u1ea3 \u0111\u00e1ng k\u1ec3 li\u00ean quan \u0111\u1ebfn t\u00e1c d\u1ee5ng g\u00e2y t\u00ea v\u00f9ng.<\/li>\n<\/ul>\n
\u0110i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p v\u1edbi \u0111\u1ed1i t\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n<\/h3>\n
V\u1edbi \u0111\u1ed1i t\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng thu\u1ed1c gi\u1ea3m \u0111au, c\u1ea7n \u0111\u1eb7c bi\u1ec7t l\u01b0u \u00fd \u0111\u1ebfn ng\u01b0\u1eddi cao tu\u1ed5i, do \u0111\u00e2y l\u00e0 \u0111\u1ed1i t\u01b0\u1ee3ng c\u00f3 nhi\u1ec1u b\u1ec7nh l\u00fd ph\u1ee9c t\u1ea1p, th\u01b0\u1eddng xuy\u00ean s\u1eed d\u1ee5ng nhi\u1ec1u thu\u1ed1c, \u0111\u1ed3ng th\u1eddi c\u00f3 nhi\u1ec1u y\u1ebfu t\u1ed1 sinh l\u00fd, b\u1ec7nh l\u00fd d\u1eabn \u0111\u1ebfn nguy c\u01a1 t\u0103ng t\u00e1c d\u1ee5ng ph\u1ee5, t\u01b0\u01a1ng t\u00e1c thu\u1ed1c, qu\u00e1 li\u1ec1u thu\u1ed1c. M\u1ed9t s\u1ed1 \u0111i\u1ec3m c\u1ea7n l\u01b0u \u00fd khi d\u00f9ng thu\u1ed1c gi\u1ea3m \u0111au tr\u00ean ng\u01b0\u1eddi cao tu\u1ed5i bao g\u1ed3m:<\/p>\n
– \u0110\u1ed1i v\u1edbi m\u1ed7i lo\u1ea1i thu\u1ed1c gi\u1ea3m \u0111au, c\u1ea7n ch\u00fa \u00fd:<\/p>\n
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S\u1eed d\u1ee5ng li\u1ec1u th\u1ea5p nh\u1ea5t c\u00f3 hi\u1ec7u qu\u1ea3, n\u1ebfu c\u1ea7n thi\u1ebft, t\u0103ng li\u1ec1u t\u1eeb t\u1eeb; ph\u1ea3i th\u01b0\u1eddng xuy\u00ean \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n c\u1ee7a vi\u1ec7c \u0111i\u1ec1u tr\u1ecb, \u0111\u1eb7c bi\u1ec7t l\u00e0 trong tr\u01b0\u1eddng h\u1ee3p \u0111i\u1ec1u tr\u1ecb b\u1ec7nh m\u1ea1n t\u00ednh.<\/li>\n
\u0110i\u1ec1u ch\u1ec9nh kho\u1ea3ng \u0111\u01b0a li\u1ec1u theo th\u1eddi gian t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c v\u00e0 ti\u1ebfn tri\u1ec3n trong ng\u00e0y c\u1ee7a c\u01a1n \u0111au.<\/li>\n
Tr\u00e1nh d\u00f9ng d\u1ea1ng gi\u1ea3i ph\u00f3ng k\u00e9o d\u00e0i.<\/li>\n<\/ul>\n
– Paracetamol n\u00ean \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ea7u ti\u00ean v\u00ec \u0111\u00e2y l\u00e0 thu\u1ed1c gi\u1ea3m \u0111au \u0111\u01b0\u1ee3c dung n\u1ea1p t\u1ed1t nh\u1ea5t. Tuy nhi\u00ean, kh\u00f4ng \u0111\u01b0\u1ee3c b\u1ecf qua t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n tr\u00ean gan: Li\u1ec1u t\u1ed1i \u0111a h\u00e0ng ng\u00e0y l\u00e0 3 g. \u0110\u1ec3 d\u1ef1 ph\u00f2ng, \u0111i\u1ec1u tr\u1ecb n\u00ean b\u1eaft \u0111\u1ea7u \u1edf li\u1ec1u th\u1ea5p nh\u1ea5t: 500 mg, 3 ho\u1eb7c 4 l\u1ea7n m\u1ed7i ng\u00e0y. Li\u1ec1u n\u00e0y v\u1ec1 sau c\u00f3 th\u1ec3 t\u0103ng d\u1ea7n n\u1ebfu c\u1ea7n thi\u1ebft, t\u00f9y thu\u1ed9c v\u00e0o hi\u1ec7u qu\u1ea3 gi\u1ea3m \u0111au \u0111\u1ea1t \u0111\u01b0\u1ee3c. N\u1ebfu li\u1ec1u paracetamol t\u1ed1i \u01b0u kh\u00f4ng \u0111\u1ee7 \u0111\u1ea1t hi\u1ec7u qu\u1ea3 gi\u1ea3m \u0111au, c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh thu\u1ed1c gi\u1ea3m \u0111au b\u1eadc II v\u1edbi li\u1ec1u th\u1ea5p v\u00e0 s\u1eed d\u1ee5ng m\u1ed9t c\u00e1ch th\u1eadn tr\u1ecdng.<\/p>\n
– NSAIDs, bao g\u1ed3m acid acetylsalicylic ch\u1ec9 d\u00f9ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb ng\u1eafn ng\u00e0y:<\/p>\n
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Ng\u01b0\u1eddi cao tu\u1ed5i t\u0103ng nguy c\u01a1 g\u1eb7p t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n, \u0111\u1eb7c bi\u1ec7t l\u00e0 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a v\u00e0 th\u1ee7ng d\u1ea1 d\u00e0y, c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong (trong tr\u01b0\u1eddng h\u1ee3p c\u1ea7n thi\u1ebft, ch\u1ec9 \u0111\u1ecbnh th\u00eam thu\u1ed1c b\u1ea3o v\u1ec7 ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y). C\u1ea7n th\u1eadn tr\u1ecdng \u1edf nh\u1eefng ng\u01b0\u1eddi cao tu\u1ed5i v\u1edbi ch\u1ee9c n\u0103ng th\u1eadn suy gi\u1ea3m: NSAIDs c\u00f3 th\u1ec3 g\u00e2y suy th\u1eadn do l\u00e0m gi\u1ea3m ch\u1ee9c n\u0103ng l\u1ecdc c\u1ea7u th\u1eadn th\u00f4ng qua c\u01a1 ch\u1ebf \u1ee9c ch\u1ebf t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch c\u1ee7a prostaglandin t\u1ea1i th\u1eadn (t\u00e1c d\u1ee5ng n\u00e0y ph\u1ee5 thu\u1ed9c v\u00e0o li\u1ec1u).<\/li>\n<\/ul>\n
M\u1ed9t s\u1ed1 nguy\u00ean t\u1eafc th\u1ef1c h\u00e0nh li\u00ean quan \u0111\u1ebfn thu\u1ed1c gi\u1ea3m \u0111au<\/h3>\n
– N\u00ean b\u1eaft \u0111\u1ea7u b\u1eb1ng c\u00e1c \u0111\u01b0\u1eddng d\u00f9ng \u00edt x\u00e2m l\u1ea5n nh\u1ea5t (d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c h\u1ec7 tr\u1ecb li\u1ec7u qua da) v\u00e0 c\u00e1c li\u1ec7u ph\u00e1p t\u00e2m l\u00fd \u0111\u01a1n gi\u1ea3n nh\u1ea5t. Khi b\u1eaft bu\u1ed9c s\u1eed d\u1ee5ng thu\u1ed1c to\u00e0n th\u00e2n, \u01b0u ti\u00ean d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng. N\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng u\u1ed1ng \u0111\u01b0\u1ee3c, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng tr\u1ef1c tr\u00e0ng. Khi kh\u00f4ng th\u1ec3 d\u00f9ng thu\u1ed1c theo \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng ti\u00eam d\u01b0\u1edbi da ho\u1eb7c ti\u00eam t\u0129nh m\u1ea1ch. Tr\u00e1nh ti\u00eam b\u1eafp v\u00ec g\u00e2y \u0111au.<\/p>\n
– C\u1ea7n d\u1ef1 li\u1ec7u tr\u01b0\u1edbc kh\u1ea3 n\u0103ng t\u00e1i ph\u00e1t c\u1ee7a c\u01a1n \u0111au, \u0111\u1eb7c bi\u1ec7t trong tr\u01b0\u1eddng h\u1ee3p \u0111au m\u1ea1n t\u00ednh. D\u1ef1a tr\u00ean c\u01a1 s\u1edf \u0111\u00f3, l\u00ean k\u1ebf ho\u1ea1ch d\u00f9ng thu\u1ed1c v\u00e0o gi\u1edd c\u1ed1 \u0111\u1ecbnh, ho\u1eb7c truy\u1ec1n t\u0129nh m\u1ea1ch li\u00ean t\u1ee5c \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o c\u01a1n \u0111au kh\u00f4ng xu\u1ea5t hi\u1ec7n tr\u1edf l\u1ea1i.<\/p>\n
– C\u00e2n nh\u1eafc thay \u0111\u1ed5i ph\u00e1c \u0111\u1ed3 khi m\u1ed9t thu\u1ed1c t\u1ecf ra kh\u00f4ng hi\u1ec7u qu\u1ea3 trong v\u00f2ng 24 \u0111\u1ebfn 48 gi\u1edd.<\/p>\n
– Tr\u01b0\u1edbc m\u1ed9t c\u01a1n \u0111au d\u1eef d\u1ed9i, kh\u00f4ng khuy\u1ebfn kh\u00edch d\u00f9ng qua c\u00e1c thang gi\u1ea3m \u0111au c\u1ee7a T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi (WHO) m\u00e0 n\u00ean d\u00f9ng ngay m\u1ed9t opioid m\u1ea1nh.<\/p>\n
– Tr\u01b0\u1edbc khi \u0111i \u0111\u1ebfn m\u1ed9t nh\u00f3m thu\u1ed1c gi\u1ea3m \u0111au m\u1ea1nh h\u01a1n, c\u1ea7n \u0111\u1ea3m b\u1ea3o:<\/p>\n
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Thu\u1ed1c \u0111\u01b0\u1ee3c d\u00f9ng th\u01b0\u1eddng xuy\u00ean trong m\u1ed9t kho\u1ea3ng th\u1eddi gian 24 gi\u1edd;<\/li>\n
T\u1ea7n su\u1ea5t \u0111\u01b0a li\u1ec1u ph\u00f9 h\u1ee3p v\u1edbi th\u1eddi gian t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c gi\u1ea3m \u0111au \u0111ang d\u00f9ng;<\/li>\n
Li\u1ec1u t\u1ed1i \u0111a c\u00f3 th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, trong \u0111i\u1ec1u ki\u1ec7n tu\u00e2n th\u1ee7 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh (li\u1ec1u cho \u0111au trong ung th\u01b0 th\u01b0\u1eddng cao h\u01a1n so v\u1edbi li\u1ec1u th\u00f4ng th\u01b0\u1eddng).<\/li>\n<\/ul>\n
– Kh\u00f4ng c\u1ea7n ph\u1ea3i k\u1ebft h\u1ee3p hai thu\u1ed1c gi\u1ea3m \u0111au c\u00f9ng m\u1ed9t c\u1ea5p \u0111\u1ed9.<\/p>\n
– Vi\u1ec7c s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p thu\u1ed1c gi\u1ea3m \u0111au \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf m\u1ed7i c\u1ea5p c\u1ee7a b\u1eadc thang gi\u1ea3m \u0111au c\u1ee7a WHO, ngay t\u1eeb c\u1ea5p \u0111\u1ed9 1.<\/p>\n
– Khi c\u01a1n \u0111au dai d\u1eb3ng ho\u1eb7c t\u0103ng, c\u1ea7n b\u1ed5 sung m\u1ed9t opioid y\u1ebfu.<\/p>\n
– Ph\u1ea3i t\u0103ng li\u1ec1u ho\u1eb7c s\u1eed d\u1ee5ng m\u1ed9t opioid m\u1ea1nh h\u01a1n n\u1ebfu c\u01a1n \u0111au v\u1eabn ti\u1ebfp t\u1ee5c dai d\u1eb3ng.<\/p>\n
– N\u1ebfu m\u1ed9t thu\u1ed1c gi\u1ea3m \u0111au opioid y\u1ebfu \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u1edbi li\u1ec1u l\u01b0\u1ee3ng t\u1ed1i \u0111a l\u00e0 kh\u00f4ng \u0111\u1ee7, c\u1ea7n ph\u1ea3i d\u00f9ng m\u1ed9t lo\u1ea1i thu\u1ed1c gi\u1ea3m \u0111au m\u1ea1nh h\u01a1n v\u00e0 kh\u00f4ng th\u1eed m\u1ed9t opioid y\u1ebfu kh\u00e1c.<\/p>\n
– Thay v\u00ec k\u1ebft h\u1ee3p m\u1ed9t opioid m\u1ea1nh v\u1edbi m\u1ed9t opioid y\u1ebfu, n\u00ean t\u0103ng li\u1ec1u opioid m\u1ea1nh.<\/p>\n
– Morphin l\u00e0 opioid m\u1ea1nh \u0111\u1ec3 quy chi\u1ebfu trong \u0111i\u1ec1u tr\u1ecb \u0111au do ung th\u01b0. Morphin \u0111\u01b0\u1eddng u\u1ed1ng l\u00e0 m\u1ed9t thu\u1ed1c gi\u1ea3m \u0111au c\u01a1 b\u1ea3n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n ung th\u01b0 kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o giai \u0111o\u1ea1n ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh. Opioid m\u1ea1nh ph\u1ea3i \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ee7 li\u1ec1u l\u01b0\u1ee3ng, theo gi\u1edd c\u1ed1 \u0111\u1ecbnh, d\u00f9 \u0111\u00e3 t\u00ednh tr\u01b0\u1edbc li\u1ec1u nh\u01b0ng trong tr\u01b0\u1eddng h\u1ee3p \u0111au b\u1ea5t ng\u1edd, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng li\u1ec1u “theo y\u00eau c\u1ea7u”.<\/p>\n
– S\u1eed d\u1ee5ng c\u00f9ng l\u00fac hai opioid b\u1ea3n ch\u1ea5t kh\u00e1c nhau l\u00e0 kh\u00f4ng h\u1ee3p l\u00fd: Lo\u1ea1i k\u1ebft h\u1ee3p n\u00e0y l\u00e0 quan \u0111i\u1ec3m d\u1ecb bi\u1ec7t v\u1ec1 d\u01b0\u1ee3c l\u00fd. S\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi m\u1ed9t ch\u1ee7 v\u1eadn to\u00e0n ph\u1ea7n v\u00e0 m\u1ed9t ch\u1ea5t \u0111\u1ed1i v\u1eadn ho\u1eb7c ch\u1ee7 v\u1eadn t\u1eebng ph\u1ea7n ho\u1eb7c th\u1eadm ch\u00ed ch\u1ea5t ch\u1ee7 v\u1eadn m\u1ea1nh c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn gi\u1ea3m ho\u1eb7c m\u1ea5t t\u00e1c d\u1ee5ng v\u00e0 h\u1ed9i ch\u1ee9ng cai thu\u1ed1c. V\u1edbi Durogesic v\u00e0 Oxycontin, \u0111\u1ec9nh \u0111au c\u1ea7n ph\u1ea3i gi\u1ea3m b\u1eb1ng vi\u1ec7c d\u00f9ng d\u1ea1ng gi\u1ea3i ph\u00f3ng nhanh c\u1ee7a c\u00f9ng th\u00e0nh ph\u1ea7n ho\u1ea1t ch\u1ea5t.<\/p>\n
– Thu\u1ed1c gi\u1ea3m \u0111au c\u1ea5p I c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p v\u1edbi opioid y\u1ebfu ho\u1eb7c m\u1ea1nh v\u00ec vi\u1ec7c b\u1ed5 sung m\u1ed9t non-opioid l\u00e0 \u01b0u ti\u00ean h\u01a1n t\u0103ng li\u1ec1u opioid.<\/p>\n
– C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a opioid kh\u00e1c nhau t\u00f9y b\u1ec7nh nh\u00e2n. T\u00e1o b\u00f3n l\u00e0 m\u1ed9t ph\u1ea3n \u1ee9ng ph\u1ee5 th\u00f4ng th\u01b0\u1eddng trong \u0111i\u1ec1u tr\u1ecb d\u00e0i ng\u00e0y b\u1eb1ng opioid. Naloxon, khi ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb suy h\u00f4 h\u1ea5p n\u00ean \u0111\u01b0\u1ee3c d\u00f2 li\u1ec1u cho \u0111\u1ebfn khi kh\u00f4ng c\u00f3 suy h\u00f4 h\u1ea5p nh\u01b0ng kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn t\u00e1c d\u1ee5ng gi\u1ea3m \u0111au.<\/p>\n
– Thu\u1ed1c gi\u1ea3m \u0111au kh\u00f4ng opioid kh\u00f4ng \u0111\u01b0\u1ee3c thay th\u1ebf opioid \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb \u0111au \u1edf ng\u01b0\u1eddi nghi\u1ec7n ma t\u00fay n\u1eb7ng.<\/p>\n
Thu\u1ed1c gi\u1ea3m \u0111au nh\u00f3m I<\/h2>\n
Thu\u1ed1c gi\u1ea3m \u0111au nh\u00f3m I (paracetamol, aspirin v\u00e0 c\u00e1c NSAID) c\u00f3 kh\u1ea3 n\u0103ng dung n\u1ea1p t\u01b0\u01a1ng \u0111\u1ed1i t\u1ed1t. C\u00e1c thu\u1ed1c n\u00e0y kh\u00f4ng g\u00e2y ra s\u1ef1 ph\u1ee5 thu\u1ed9c v\u1ec1 th\u1ec3 ch\u1ea5t ho\u1eb7c tinh th\u1ea7n v\u00e0 t\u1ea5t c\u1ea3 \u0111\u1ec1u c\u00f3 m\u1ed9t t\u00e1c d\u1ee5ng tr\u1ea7n. \u0110\u1ed1i v\u1edbi c\u00e1c c\u01a1n \u0111au c\u1ea5p t\u00ednh c\u00f3 c\u01b0\u1eddng \u0111\u1ed9 t\u1eeb nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh, hi\u1ec7u qu\u1ea3 gi\u1ea3m \u0111au g\u1ea7n nh\u01b0 t\u01b0\u01a1ng t\u1ef1. Trong qu\u00e1 tr\u00ecnh s\u1eed d\u1ee5ng thu\u1ed1c, c\u1ea7n l\u01b0u \u00fd m\u1ed9t s\u1ed1 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n ti\u1ec1m \u1ea9n.<\/p>\n
Paracetamol<\/h3>\n
Paracetamol l\u00e0 thu\u1ed1c c\u01a1 b\u1ea3n trong \u0111i\u1ec1u tr\u1ecb c\u00e1c c\u01a1n \u0111au t\u1eeb nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh c\u0169ng nh\u01b0 trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u1ea7n h\u1ea1 s\u1ed1t. Paracetamol hi\u1ec7n \u0111\u01b0\u1ee3c coi l\u00e0 thu\u1ed1c gi\u1ea3m \u0111au c\u01a1 s\u1edf, \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u01b0u ti\u00ean cho c\u1ea3 ng\u01b0\u1eddi l\u1edbn v\u00e0 tr\u1ebb em do c\u00f3 c\u00e2n b\u1eb1ng l\u1ee3i \u00edch\/nguy c\u01a1 t\u1ed1t. Li\u1ec1u d\u00f9ng c\u1ee7a thu\u1ed1c \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y trong b\u1ea3ng 1.\u00a0<\/em><\/p>\n\n\n\n\n\n
B\u1ea3ng 1: Li\u1ec1u paracetamol<\/td>\n<\/tr>\n
Ng\u01b0\u1eddi l\u1edbn<\/td>\n 3 g\/ng\u00e0y, chia l\u00e0m 4 ho\u1eb7c 6 l\u1ea7n, c\u00e1ch nhau \u00edt nh\u1ea5t 4 gi\u1edd.<\/p>\n
Nh\u00ecn chung, kh\u00f4ng n\u00ean v\u01b0\u1ee3t qu\u00e1 3 g\/ng\u00e0y. Trong tr\u01b0\u1eddng h\u1ee3p \u0111au n\u1eb7ng, li\u1ec1u t\u1ed1i \u0111a c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c t\u0103ng l\u00ean \u0111\u1ebfn 4 g\/ng\u00e0y.<\/td>\n<\/tr>\n
Tr\u1ebb em<\/td>\n 60 mg\/kg\/ng\u00e0y, chia l\u00e0m 4 ho\u1eb7c 6 l\u1ea7n, t\u1ee9c l\u00e0 15 mg\/kg m\u1ed7i 6 gi\u1edd ho\u1eb7c 10 mg\/kg m\u1ed7i 4 gi\u1edd.<\/p>\n
Tr\u00ean th\u1ef1c t\u1ebf, li\u1ec1u s\u1eed d\u1ee5ng th\u01b0\u1eddng cao h\u01a1n, dao \u0111\u1ed9ng t\u1eeb 10 \u0111\u1ebfn 15 mg\/kg m\u1ed7i 4 gi\u1edd, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u0111\u1ed1i v\u1edbi c\u01a1n \u0111au sau ph\u1eabu thu\u1eadt.<\/p>\n
T\u1ed5ng li\u1ec1u kh\u00f4ng \u0111\u01b0\u1ee3c v\u01b0\u1ee3t qu\u00e1 80 mg\/kg\/ng\u00e0y \u1edf tr\u1ebb em c\u00f3 c\u00e2n n\u1eb7ng d\u01b0\u1edbi 37 kg v\u00e0 3 g\/ng\u00e0y \u1edf tr\u1ebb em c\u00f3 c\u00e2n n\u1eb7ng tr\u00ean 37 kg.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Paracetamol c\u00f3 t\u00e1c \u0111\u1ed9ng gi\u1ea3m \u0111au theo c\u1ea3 c\u01a1 ch\u1ebf ngo\u1ea1i vi v\u00e0 trung \u01b0\u01a1ng. Thu\u1ed1c th\u01b0\u1eddng \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au nh\u00f3m II: paracetamol k\u1ebft h\u1ee3p v\u1edbi codein phosphat cho t\u00e1c d\u1ee5ng gi\u1ea3m \u0111au v\u01b0\u1ee3t tr\u1ed9i so v\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng \u0111\u01a1n \u0111\u1ed9c t\u1eebng th\u00e0nh ph\u1ea7n, v\u1edbi hi\u1ec7u qu\u1ea3 gi\u1ea3m \u0111au k\u00e9o d\u00e0i h\u01a1n.<\/p>\n
Paracetamol kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o d\u00f9ng trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111au do vi\u00eam v\u00ec thu\u1ed1c h\u1ea7u nh\u01b0 kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng ch\u1ed1ng vi\u00eam, ng\u01b0\u1ee3c l\u1ea1i v\u1edbi aspirin v\u00e0 NSAID. M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p hi\u1ebfm g\u1eb7p xu\u1ea5t hi\u1ec7n d\u1ecb \u1ee9ng tr\u00ean da v\u00e0 gi\u1ea3m ti\u1ec3u c\u1ea7u. Hai ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh ch\u00ednh c\u1ee7a paracetamol l\u00e0 qu\u00e1 m\u1eabn v\u1edbi thu\u1ed1c v\u00e0 suy gi\u1ea3m ch\u1ee9c n\u0103ng t\u1ebf b\u00e0o gan (ch\u00fa \u00fd 1). R\u00f5 r\u00e0ng, so v\u1edbi NSAID v\u00e0 thu\u1ed1c gi\u1ea3m \u0111au kh\u00e1c, vi\u1ec7c c\u00f3 \u00edt ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh g\u00f3p ph\u1ea7n l\u00e0m t\u0103ng m\u1ee9c \u0111\u1ed9 tin c\u1eady trong vi\u1ec7c s\u1eed d\u1ee5ng paracetamol.<\/p>\n\n\n\n\n
Ch\u00fa \u00fd 1: Th\u00f4ng tin li\u00ean quan \u0111\u1ebfn \u0111\u1ed9c t\u00ednh tr\u00ean gan c\u1ee7a paracetamol<\/td>\n<\/tr>\n
M\u1ee9c li\u1ec1u n\u00e0o c\u00f3 th\u1ec3 g\u00e2y t\u00ecnh tr\u1ea1ng ng\u1ed9 \u0111\u1ed9c paracetamol?<\/p>\n
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Qu\u00e1 li\u1ec1u, t\u1eeb 10 g v\u1edbi li\u1ec1u duy nh\u1ea5t \u1edf ng\u01b0\u1eddi l\u1edbn v\u00e0 150 mg\/kg kh\u1ed1i l\u01b0\u1ee3ng c\u01a1 th\u1ec3 trong m\u1ed9t li\u1ec1u duy nh\u1ea5t \u1edf tr\u1ebb em (t\u00f9y theo kh\u1ea3 n\u0103ng nh\u1ea1y c\u1ea3m c\u1ee7a b\u1ec7nh nh\u00e2n) c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u0103ng men gan.<\/li>\n
Tuy nhi\u00ean, paracetamol c\u00f3 th\u1ec3 g\u00e2y t\u1ed5n th\u01b0\u01a1ng gan ngay c\u1ea3 \u1edf li\u1ec1u \u0111i\u1ec1u tr\u1ecb n\u1ebfu s\u1eed d\u1ee5ng trong th\u1eddi gian d\u00e0i, \u0111\u1eb7c bi\u1ec7t tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ee9c n\u0103ng gan thay \u0111\u1ed5i ho\u1eb7c ng\u01b0\u1eddi cao tu\u1ed5i.<\/li>\n
Paracetamol c\u00f3 m\u1eb7t trong nhi\u1ec1u lo\u1ea1i thu\u1ed1c, k\u1ebft h\u1ee3p d\u01b0\u1edbi nhi\u1ec1u d\u1ea1ng b\u00e0o ch\u1ebf kh\u00e1c nhau, d\u1eabn \u0111\u1ebfn nguy c\u01a1 qu\u00e1 li\u1ec1u kh\u00f4ng ch\u1ee7 \u0111\u00edch khi d\u00f9ng \u0111\u1ed3ng th\u1eddi nhi\u1ec1u ch\u1ebf ph\u1ea9m c\u00f9ng ch\u1ee9a ho\u1ea1t ch\u1ea5t n\u00e0y. C\u1ea7n \u0111\u1ecdc k\u1ef9 th\u00e0nh ph\u1ea7n c\u1ee7a thu\u1ed1c tr\u01b0\u1edbc khi u\u1ed1ng \u0111\u1ec3 tr\u00e1nh t\u00edch l\u0169y paracetamol g\u00e2y qu\u00e1 li\u1ec1u.<\/li>\n<\/ul>\n
T\u1ea1i sao paracetamol g\u00e2y \u0111\u1ed9c?<\/p>\n
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Paracetamol \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a ch\u1ee7 y\u1ebfu \u1edf gan. Hai con \u0111\u01b0\u1eddng chuy\u1ec3n h\u00f3a ch\u00ednh l\u00e0 li\u00ean h\u1ee3p glucuronic v\u00e0 sulfat. Con \u0111\u01b0\u1eddng li\u00ean h\u1ee3p sulfat nhanh ch\u00f3ng b\u00e3o h\u00f2a \u1edf li\u1ec1u cao h\u01a1n li\u1ec1u \u0111i\u1ec1u tr\u1ecb. M\u1ed9t con \u0111\u01b0\u1eddng kh\u00e1c \u0111\u01b0\u1ee3c x\u00fac t\u00e1c b\u1edfi enzym cytochrom P450, h\u00ecnh th\u00e0nh ch\u1ea5t chuy\u1ec3n h\u00f3a trung gian l\u00e0 N-acetyl benzoquinoneimin. Khi s\u1eed d\u1ee5ng v\u1edbi li\u1ec1u th\u00f4ng th\u01b0\u1eddng, ch\u1ea5t n\u00e0y s\u1ebd nhanh ch\u00f3ng \u0111\u01b0\u1ee3c kh\u1eed \u0111\u1ed9c t\u00ednh b\u1edfi glutathion v\u00e0 th\u1ea3i qua n\u01b0\u1edbc ti\u1ec3u sau khi li\u00ean h\u1ee3p v\u1edbi cystein v\u00e0 acid mercapturic. Tuy nhi\u00ean, khi s\u1eed d\u1ee5ng li\u1ec1u qu\u00e1 cao, l\u01b0\u1ee3ng N-acetyl benzoquinoneimin t\u1ea1o th\u00e0nh t\u0103ng l\u00ean, t\u1ea1o ra li\u00ean k\u1ebft c\u1ed9ng h\u00f3a tr\u1ecb v\u1edbi t\u1ebf b\u00e0o gan, g\u00e2y ho\u1ea1i t\u1eed gan.<\/li>\n<\/ul>\n
C\u00e1c tri\u1ec7u ch\u1ee9ng ch\u00ednh khi qu\u00e1 li\u1ec1u paracetamol:<\/p>\n
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T\u00ecnh tr\u1ea1ng bu\u1ed3n n\u00f4n, n\u00f4n, ch\u00e1n \u0103n, xanh xao v\u00e0 \u0111au b\u1ee5ng th\u01b0\u1eddng x\u1ea3y ra trong v\u00f2ng 24 gi\u1edd. Ti\u1ebfp \u0111\u00f3 l\u00e0 t\u00ecnh tr\u1ea1ng t\u0103ng men gan nhanh ch\u00f3ng, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn ho\u1ea1i t\u1eed ho\u00e0n to\u00e0n v\u00e0 kh\u00f4ng th\u1ec3 h\u1ed3i ph\u1ee5c, suy gi\u1ea3m ch\u1ee9c n\u0103ng t\u1ebf b\u00e0o gan, nhi\u1ec5m toan chuy\u1ec3n h\u00f3a v\u00e0 h\u1ed9i ch\u1ee9ng n\u00e3o – gan bao g\u1ed3m c\u1ea3 t\u00ecnh\u00a0tr\u1ea1ng h\u00f4n m\u00ea v\u00e0 t\u1eed vong.\u00a0\u0110\u1ed3ng th\u1eddi, c\u00f3 th\u1ec3 ghi nh\u1eadn s\u1ef1 gia t\u0103ng transaminase gan, lactat dehydrogenase, bilirubin v\u00e0 gi\u1ea3m prothrombin xu\u1ea5t hi\u1ec7n trong v\u00f2ng 12 \u0111\u1ebfn 48 gi\u1edd sau khi u\u1ed1ng.<\/li>\n<\/ul>\n
Nh\u1eefng y\u1ebfu t\u1ed1 nguy c\u01a1 gia t\u0103ng \u0111\u1ed9c t\u00ednh c\u1ee7a paracetamol:<\/p>\n
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M\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 nguy c\u01a1 nh\u01b0 suy gan, nghi\u1ec7n r\u01b0\u1ee3u m\u1ea1n t\u00ednh c\u00f3 th\u1ec3 g\u00e2y ra vi\u00eam gan trong khi s\u1eed d\u1ee5ng paracetamol, ngay c\u1ea3 \u1edf li\u1ec1u \u0111i\u1ec1u tr\u1ecb. Ng\u01b0\u1eddi cao tu\u1ed5i, ng\u01b0\u1eddi suy dinh d\u01b0\u1ee1ng, ph\u1ee5 n\u1eef mang thai, b\u1ec7nh nh\u00e2n d\u00f9ng c\u00e1c thu\u1ed1c c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y t\u0103ng men gan, … c\u00f3 nguy c\u01a1 g\u1eb7p \u0111\u1ed9c t\u00ednh cao h\u01a1n.<\/li>\n<\/ul>\n
C\u00e1c bi\u1ec7n ph\u00e1p c\u1ea7n l\u00e0m khi qu\u00e1 li\u1ec1u:<\/p>\n
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C\u1ea7n chuy\u1ec3n ngay b\u1ec7nh nh\u00e2n \u0111\u1ebfn b\u1ec7nh vi\u1ec7n \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c gi\u1ea3i \u0111\u1ed9c \u0111\u1eb7c hi\u1ec7u c\u1ee7a paracetamol nh\u01b0 N-acetylcystein t\u0129nh m\u1ea1ch ho\u1eb7c \u0111\u01b0\u1eddng u\u1ed1ng, n\u1ebfu c\u00f3 th\u1ec3 tr\u01b0\u1edbc gi\u1edd th\u1ee9 m\u01b0\u1eddi. C\u0169ng c\u1ea7n ti\u1ebfn h\u00e0nh nhanh ch\u00f3ng c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Paracetamol \u00edt c\u00f3 nguy c\u01a1 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c. M\u1ed9t t\u01b0\u01a1ng t\u00e1c th\u01b0\u1eddng \u0111\u01b0\u1ee3c nh\u1ea5n m\u1ea1nh trong c\u00e1c t\u1edd th\u00f4ng tin s\u1ea3n ph\u1ea9m l\u00e0 t\u01b0\u01a1ng t\u00e1c gi\u1eefa paracetamol v\u1edbi thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng l\u00e0m t\u0103ng t\u00e1c d\u1ee5ng c\u1ee7a c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng v\u00e0 nguy c\u01a1 ch\u1ea3y m\u00e1u khi d\u00f9ng paracetamol v\u1edbi li\u1ec1u t\u1ed1i \u0111a (4 g\/ng\u00e0y) trong \u00edt nh\u1ea5t 4 ng\u00e0y.<\/p>\n
C\u1ea7n theo d\u00f5i th\u01b0\u1eddng xuy\u00ean gi\u00e1 tr\u1ecb INR \u0111\u1ec3 c\u00f3 th\u1ec3 ch\u1ec9nh li\u1ec1u c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng trong th\u1eddi gian \u0111i\u1ec1u tr\u1ecb b\u1eb1ng paracetamol v\u00e0 sau khi ng\u1eebng thu\u1ed1c.<\/p>\n
Paracetamol c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111\u01b0\u1ee3c cho ph\u1ee5 n\u1eef mang thai v\u00e0 cho con b\u00fa \u1edf li\u1ec1u khuy\u1ebfn c\u00e1o trong th\u1eddi gian ng\u1eafn. Thu\u1ed1c c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c d\u00f9ng theo \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch. T\u1ed1c \u0111\u1ed9 gi\u1ea3m \u0111au nhanh c\u1ee7a thu\u1ed1c khi s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng d\u00f9ng n\u00e0y cho ph\u00e9p \u0111i\u1ec1u tr\u1ecb \u0111au c\u1ea5p t\u00ednh, \u0111\u1eb7c bi\u1ec7t \u0111\u1ed1i v\u1edbi c\u00e1c c\u01a1n \u0111au h\u1eadu ph\u1eabu.<\/p>\n
Acid acetylsalicylic (aspirin)<\/h3>\n
Acid acetylsalicylic v\u1eeba l\u00e0 m\u1ed9t thu\u1ed1c h\u1ea1 s\u1ed1t, ch\u1ed1ng vi\u00eam, v\u1eeba l\u00e0 m\u1ed9t thu\u1ed1c gi\u1ea3m \u0111au \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111au m\u1ee9c \u0111\u1ed9 nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh. Thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng kh\u00e1 ph\u1ed5 bi\u1ebfn trong b\u1ec7nh th\u1ea5p kh\u1edbp \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u00e1c tri\u1ec7u ch\u1ee9ng vi\u00eam v\u00e0 \u0111au (b\u1ea3ng 2).<\/p>\n
Aspirin c\u00f3 nhi\u1ec1u ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, bao g\u1ed3m: qu\u00e1 m\u1eabn v\u1edbi thu\u1ed1c; b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed hen do s\u1eed d\u1ee5ng salicylat ho\u1eb7c c\u00e1c thu\u1ed1c c\u00f3 c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng t\u01b0\u01a1ng t\u1ef1 bao g\u1ed3m NSAID; ph\u1ee5 n\u1eef \u1edf 3 th\u00e1ng cu\u1ed1i c\u1ee7a thai k\u1ef3 v\u00e0 \u0111ang cho con b\u00fa, b\u1ec7nh nh\u00e2n c\u00f3 lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng giai \u0111o\u1ea1n ti\u1ebfn tri\u1ec3n, c\u00e1c b\u1ec7nh li\u00ean quan \u0111\u1ebfn r\u1ed1i lo\u1ea1n y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u, suy gan n\u1eb7ng, suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn, suy tim kh\u00f4ng ki\u1ec3m so\u00e1t, b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng methotrexat \u1edf li\u1ec1u cao h\u01a1n 15 mg\/tu\u1ea7n ho\u1eb7c c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng khi \u0111ang d\u00f9ng aspirin li\u1ec1u cao trong c\u00e1c b\u1ec7nh l\u00fd v\u1ec1 kh\u1edbp.<\/p>\n
Aspirin c\u0169ng c\u00f3 nhi\u1ec1u t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n:<\/p>\n
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Tr\u00ean ti\u00eau h\u00f3a nh\u01b0 \u0111au b\u1ee5ng, xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a (n\u00f4n ra m\u00e1u, \u0111i ngo\u00e0i ra m\u00e1u, …);<\/li>\n
Tr\u00ean h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng, th\u01b0\u1eddng l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a qu\u00e1 li\u1ec1u (nh\u1ee9c \u0111\u1ea7u, ch\u00f3ng m\u1eb7t, gi\u1ea3m ch\u1ee9c n\u0103ng th\u00ednh gi\u00e1c, \u00f9 tai);<\/li>\n<\/ul>\n\n\n\n\n\n
B\u1ea3ng 2: Li\u1ec1u d\u00f9ng aspirin<\/td>\n<\/tr>\n
Ng\u01b0\u1eddi l\u1edbn<\/p>\n
v\u00e0 tr\u1ebb em c\u00f3 c\u00e2n n\u1eb7ng tr\u00ean 50 kg (kho\u1ea3ng 15 tu\u1ed5i)<\/td>\n
\u0110au v\u00e0 s\u1ed1t:<\/em><\/p>\n
– 1 g\/l\u1ea7n, c\u00f3 th\u1ec3 l\u1eb7p l\u1ea1i sau m\u1ed7i 4 gi\u1edd n\u1ebfu c\u1ea7n, kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 3 g m\u1ed7i ng\u00e0y (2 g \u1edf ng\u01b0\u1eddi cao tu\u1ed5i);<\/p>\n
– S\u1eed d\u1ee5ng thu\u1ed1c \u0111\u1ec1u \u0111\u1eb7n, tu\u00e2n th\u1ee7 ch\u1ebf \u0111\u1ed9 li\u1ec1u k\u1ec3 tr\u00ean c\u00f3 th\u1ec3 gi\u00fap ng\u0103n ch\u1eb7n t\u00e1i ph\u00e1t c\u01a1n \u0111au ho\u1eb7c s\u1ed1t;<\/p>\n
– B\u1ec7nh nh\u00e2n kh\u00f4ng n\u00ean d\u00f9ng aspirin k\u00e9o d\u00e0i tr\u00ean 3 ng\u00e0y \u0111\u1ec3 h\u1ea1 s\u1ed1t v\u00e0 tr\u00ean 5 ng\u00e0y \u0111\u1ec3 gi\u1ea3m \u0111au m\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n c\u1ee7a b\u00e1c s\u0129.<\/p>\n
Aspirin c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u01b0 thu\u1ed1c ch\u1ed1ng vi\u00eam trong vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p v\u1edbi li\u1ec1u t\u1ed1i \u0111a 3-6 g m\u1ed7i ng\u00e0y, chia l\u00e0m 3 ho\u1eb7c 4 li\u1ec1u, c\u00e1ch nhau t\u1ed1i thi\u1ec3u 4 gi\u1edd.<\/td>\n<\/tr>\n
Tr\u1ebb em<\/td>\n C\u1ea7n hi\u1ec7u ch\u1ec9nh li\u1ec1u theo c\u00e2n n\u1eb7ng v\u00e0 ch\u1ecdn d\u1ea1ng b\u00e0o ch\u1ebf ph\u00f9 h\u1ee3p.<\/p>\n
Li\u1ec1u d\u00f9ng h\u00e0ng ng\u00e0y \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o l\u00e0: 60 mg\/kg\/ng\u00e0y, chia l\u00e0m 4 ho\u1eb7c 6 l\u1ea7n; t\u1ee9c l\u00e0 15 mg\/kg m\u1ed7i 6 gi\u1edd ho\u1eb7c 10 mg\/kg m\u1ed7i 4 gi\u1edd.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
– C\u00e1c tri\u1ec7u ch\u1ee9ng tr\u00ean huy\u1ebft h\u1ecdc dai d\u1eb3ng (r\u1ed1i lo\u1ea1n ch\u1ea3y m\u00e1u v\u1edbi s\u1ef1 k\u00e9o d\u00e0i th\u1eddi gian ch\u1ea3y m\u00e1u) k\u00e9o d\u00e0i 4-8 ng\u00e0y sau khi ng\u01b0ng \u0111i\u1ec1u tr\u1ecb v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra nguy c\u01a1 ch\u1ea3y m\u00e1u trong tr\u01b0\u1eddng h\u1ee3p can thi\u1ec7p b\u1eb1ng ph\u1eabu thu\u1eadt;<\/p>\n
– C\u00e1c ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn nh\u01b0 n\u1ed5i m\u1ec1 \u0111ay, ph\u1ea3n \u1ee9ng ph\u1ea3n v\u1ec7, co th\u1eaft ph\u1ebf qu\u1ea3n v\u00e0 ph\u00f9 Quincke.<\/p>\n
Aspirin c\u0169ng c\u00f3 m\u1ed9t s\u1ed1 t\u01b0\u01a1ng t\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, bao g\u1ed3m:<\/p>\n
– Thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh d\u00f9ng c\u00f9ng v\u1edbi aspirin li\u1ec1u cao (tr\u00ean 3 g\/ng\u00e0y) do t\u01b0\u01a1ng t\u00e1c c\u1ea1nh tranh li\u00ean k\u1ebft v\u1edbi protein huy\u1ebft t\u01b0\u01a1ng;<\/p>\n
– Methotrexat (li\u1ec1u >15 mg\/tu\u1ea7n) do t\u0103ng \u0111\u1ed9c t\u00ednh tr\u00ean huy\u1ebft h\u1ecdc.<\/p>\n
L\u01b0u \u00fd r\u1eb1ng aspirin kh\u00f4ng n\u00ean k\u1ebft h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng (d\u00f9 \u1edf li\u1ec1u th\u1ea5p), c\u00e1c NSAID kh\u00e1c, heparin v\u00e0 c\u00e1c thu\u1ed1c t\u0103ng th\u1ea3i acid uric qua n\u01b0\u1edbc ti\u1ec3u.<\/p>\n\n\n\n\n
Ch\u00fa \u00fd 2: C\u00f3 n\u00ean lo ng\u1ea1i h\u1ed9i ch\u1ee9ng Reye?<\/td>\n<\/tr>\n
H\u1ed9i ch\u1ee9ng Reye, tuy r\u1ea5t hi\u1ebfm g\u1eb7p nh\u01b0ng c\u00f3 nguy c\u01a1 xu\u1ea5t hi\u1ec7n \u1edf tr\u1ebb em c\u00f3 d\u1ea5u hi\u1ec7u nhi\u1ec5m virus (\u0111\u1eb7c bi\u1ec7t l\u00e0 th\u1ee7y \u0111\u1eadu, c\u00fam) d\u00f9ng aspirin. H\u1ed9i ch\u1ee9ng n\u00e0y c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n \u1edf nhi\u1ec1u m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau, t\u1eeb n\u00f4n v\u00e0 bu\u1ed3n ng\u1ee7 \u0111\u1ebfn li\u1ec7t, th\u1eadm ch\u00ed t\u1eed vong. Do \u0111\u00f3, aspirin ch\u1ec9 n\u00ean d\u00f9ng cho nh\u1eefng tr\u1ebb em v\u1edbi s\u1ef1 t\u01b0 v\u1ea5n c\u1ee7a b\u00e1c s\u0129 khi c\u00e1c bi\u1ec7n ph\u00e1p kh\u00e1c \u0111\u00e3 th\u1ea5t b\u1ea1i.<\/p>\n
Tr\u01b0\u1eddng h\u1ee3p x\u1ea3y ra n\u00f4n li\u00ean t\u1ee5c, b\u1ecb m\u1ea5t \u00fd th\u1ee9c hay c\u00f3 h\u00e0nh vi b\u1ea5t th\u01b0\u1eddng, c\u1ea7n ng\u1eebng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng aspirin.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
C\u00e1c NSAID kh\u00f4ng ph\u1ea3i lo\u1ea1i salicylat<\/h3>\n
C\u00e1c thu\u1ed1c nh\u00f3m n\u00e0y \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ea7u tay v\u1edbi li\u1ec1u cao \u0111\u1ec3 \u0111\u1ea1t hi\u1ec7u qu\u1ea3 ch\u1ed1ng vi\u00eam v\u00e0 li\u1ec1u th\u1ea5p h\u01a1n trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111au nh\u1eb9 v\u00e0 trung b\u00ecnh: \u0111au r\u0103ng, \u0111au \u0111\u1ea7u, \u0111au n\u1eeda \u0111\u1ea7u, ch\u1ea5n th\u01b0\u01a1ng nh\u1eb9, \u0111au v\u00f9ng tai m\u0169i h\u1ecdng. K\u1ebft h\u1ee3p c\u00e1c thu\u1ed1c n\u00e0y v\u1edbi c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au m\u1ea1nh th\u1eadm ch\u00ed c\u00f3 th\u1ec3 t\u0103ng hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb \u0111au do ung th\u01b0.<\/p>\n
Li\u1ec1u d\u00f9ng c\u1ea7n hi\u1ec7u ch\u1ec9nh theo:<\/p>\n
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Tu\u1ed5i c\u1ee7a b\u1ec7nh nh\u00e2n, c\u1ea7n c\u00e2n nh\u1eafc \u0111\u1ebfn nguy c\u01a1 gi\u1ea3m \u0111\u00e0o th\u1ea3i thu\u1ed1c \u1edf ng\u01b0\u1eddi cao tu\u1ed5i;<\/li>\n
M\u1ed9t s\u1ed1 t\u00ecnh tr\u1ea1ng sinh l\u00fd (ch\u00fa \u00fd tr\u00ean ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 ng\u01b0\u1eddi c\u00f3 ti\u1ec1n s\u1eed d\u1ecb \u1ee9ng);<\/li>\n
C\u01b0\u1eddng \u0111\u1ed9 v\u00e0 \u0111\u1ed9 l\u1eb7p l\u1ea1i c\u1ee7a c\u01a1n \u0111au.<\/li>\n<\/ul>\n
C\u00e1c thu\u1ed1c nh\u00f3m NSAID c\u00f3 nhi\u1ec1u ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ea7n \u0111\u01b0\u1ee3c r\u00e0 so\u00e1t v\u00e0 t\u00f4n tr\u1ecdng nghi\u00eam ng\u1eb7t, bao g\u1ed3m: qu\u00e1 m\u1eabn, d\u1ecb \u1ee9ng v\u1edbi c\u00e1c thu\u1ed1c trong nh\u00f3m, lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng ti\u1ebfn tri\u1ec3n, suy t\u1ebf b\u00e0o gan, suy th\u1eadn n\u1eb7ng, suy tim, ti\u1ec1n s\u1eed m\u1edbi m\u1eafc vi\u00eam ru\u1ed9t v\u00e0 ch\u1ea3y m\u00e1u tr\u1ef1c tr\u00e0ng, m\u1ea5t n\u01b0\u1edbc ho\u1eb7c suy dinh d\u01b0\u1ee1ng, tr\u1ebb em d\u01b0\u1edbi 15 tu\u1ed5i, ph\u1ee5 n\u1eef c\u00f3 thai (t\u1eeb th\u00e1ng th\u1ee9 6) v\u00e0 cho con b\u00fa.<\/p>\n
T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a NSAID bao g\u1ed3m:<\/p>\n
\n
Tr\u00ean ti\u00eau h\u00f3a: \u0111au th\u01b0\u1ee3ng v\u1ecb, kh\u00f3 ti\u00eau, bu\u1ed3n n\u00f4n, n\u00f4n, \u0111au v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng \u0111\u01b0\u1eddng ru\u1ed9t. T\u00e1c d\u1ee5ng nghi\u00eam tr\u1ecdng h\u01a1n hi\u1ebfm khi x\u1ea3y ra: lo\u00e9t v\u00e0 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a.<\/li>\n
Tr\u00ean th\u1eadn: thu\u1ed1c c\u00f3 th\u1ec3 g\u00e2y suy th\u1eadn c\u1ea5p tr\u00ean ng\u01b0\u1eddi b\u1ec7nh c\u00f3 nguy c\u01a1 cao nh\u01b0 x\u01a1 gan ho\u1eb7c b\u1ec7nh th\u1eadn m\u1ea1n t\u00ednh, m\u1ea5t n\u01b0\u1edbc ho\u1eb7c ph\u00f9 (t\u0103ng huy\u1ebft \u00e1p, ph\u00f9 chi d\u01b0\u1edbi), suy tim, \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c l\u1ee3i ti\u1ec3u ho\u1eb7c thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n v\u00e0 b\u1ec7nh nh\u00e2n tr\u00ean 75 tu\u1ed5i. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y, t\u1ed1t nh\u1ea5t tr\u00e1nh s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c NSAID c\u00f3 th\u1eddi gian b\u00e1n th\u1ea3i d\u00e0i v\u00e0 c\u1ea7n theo d\u00f5i ch\u1eb7t ch\u1ebd ch\u1ee9c n\u0103ng th\u1eadn. C\u1ea7n l\u01b0u \u00fd, \u0111\u1ed9c t\u00ednh tr\u00ean th\u1eadn c\u1ee7a c\u00e1c thu\u1ed1c NSAID c\u00f3 th\u1ec3 l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan d\u1eabn \u0111\u1ebfn suy th\u1eadn kh\u00f4ng h\u1ed3i ph\u1ee5c (kh\u00e1c v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p suy th\u1eadn ch\u1ee9c n\u0103ng).<\/li>\n
Tr\u00ean h\u00f4 h\u1ea5p: c\u01a1n hen, co th\u1eaft ph\u1ebf qu\u1ea3n, suy h\u00f4 h\u1ea5p c\u1ea5p, ph\u00f9 ph\u1ed5i, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf b\u1ec7nh nh\u00e2n c\u00f3 c\u01a1 \u0111\u1ecba d\u1ecb \u1ee9ng.<\/li>\n
Tr\u00ean tim m\u1ea1ch: c\u00f3 th\u1ec3 l\u00e0m n\u1eb7ng th\u00eam t\u00ecnh tr\u1ea1ng t\u0103ng huy\u1ebft \u00e1p \u0111ang \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u00e0 gi\u1ea3m t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c h\u1ea1 huy\u1ebft \u00e1p.<\/li>\n
Tr\u00ean da: c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n m\u1ec1 \u0111ay, ph\u00e1t ban, ng\u1ee9a, v\u00e0ng da, h\u1ed3ng ban c\u00f3 m\u1ee5n nh\u1ecf \u1edf da. C\u00e1c ph\u1ea3n \u1ee9ng nghi\u00eam tr\u1ecdng x\u1ea3y ra v\u1edbi t\u1ea7n su\u1ea5t hi\u1ebfm g\u1eb7p nh\u01b0 h\u1ed9i ch\u1ee9ng Lyell, h\u1ed9i ch\u1ee9ng Stevens-Johnson, h\u1ed3ng ban \u0111a d\u1ea1ng, vi\u00eam m\u1ea1ch. \u0110i\u1ec1u tr\u1ecb b\u1eb1ng NSAID k\u00e9o d\u00e0i c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n c\u00e1c ph\u1ea3n \u1ee9ng nhi\u1ec5m \u0111\u1ed9c tr\u00ean da. \u0110\u00f4i khi c\u00f3 th\u1ec3 g\u1eb7p ph\u00f9 Quincke, s\u1ed1c ph\u1ea3n v\u1ec7.<\/li>\n
Tr\u00ean huy\u1ebft h\u1ecdc: thi\u1ebfu m\u00e1u, gi\u1ea3m b\u1ea1ch c\u1ea7u, m\u1ea5t b\u1ea1ch c\u1ea7u h\u1ea1t, gi\u1ea3m ti\u1ec3u c\u1ea7u v\u00e0 gi\u1ea3m huy\u1ebft c\u1ea7u to\u00e0n th\u1ec3. \u0110i\u1ec1u tr\u1ecb k\u00e9o d\u00e0i c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u00e1c d\u1ee5ng ph\u1ee5 nghi\u00eam tr\u1ecdng h\u01a1n nh\u01b0 suy t\u1ee7y.<\/li>\n
Tr\u00ean gan: NSAID c\u00f3 th\u1ec3 g\u00e2y vi\u00eam gan v\u00e0 v\u00e0ng da, g\u00e2y ra nh\u1eefng thay \u0111\u1ed5i nh\u1eb9 c\u00f3 th\u1ec3 h\u1ed3i ph\u1ee5c tr\u00ean ch\u1ee9c n\u0103ng gan (t\u0103ng men gan, t\u0103ng bilirubin). N\u00ean ng\u1eebng thu\u1ed1c n\u1ebfu c\u00e1c b\u1ea5t th\u01b0\u1eddng v\u1ec1 ch\u1ee9c n\u0103ng gan v\u1eabn dai d\u1eb3ng ho\u1eb7c x\u1ea5u \u0111i, ho\u1eb7c k\u00e8m theo c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng c\u1ee7a suy gan.<\/li>\n<\/ul>\n
T\u01b0\u01a1ng t\u00e1c thu\u1ed1c c\u1ee7a NSAID bao g\u1ed3m:<\/p>\n
\n
C\u00e1c thu\u1ed1c khuy\u1ebfn c\u00e1o kh\u00f4ng n\u00ean ph\u1ed1i h\u1ee3p: c\u00e1c NSAID kh\u00e1c, aspirin, thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng, heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n, heparin kh\u1ed1i l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p (\u1edf li\u1ec1u \u0111i\u1ec1u tr\u1ecb ho\u1eb7c s\u1eed d\u1ee5ng tr\u00ean ng\u01b0\u1eddi cao tu\u1ed5i), lithium, methotrexat s\u1eed d\u1ee5ng v\u1edbi li\u1ec1u l\u1edbn h\u01a1n 20 mg\/tu\u1ea7n v\u00e0 pemetrexed (tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 suy th\u1eadn trung b\u00ecnh, n\u1eb7ng).<\/li>\n
C\u00e1c thu\u1ed1c c\u1ea7n th\u1eadn tr\u1ecdng khi d\u00f9ng \u0111\u1ed3ng th\u1eddi: ciclosporin, tacrolimus, l\u1ee3i ti\u1ec3u, thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n, \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 angiotensin II (sartan), methotrexat \u1edf m\u1ee9c li\u1ec1u \u226420 mg\/tu\u1ea7n v\u00e0 pemetrexed (tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ee9c n\u0103ng th\u1eadn b\u00ecnh th\u01b0\u1eddng).<\/li>\n
C\u00e1c thu\u1ed1c c\u1ea7n l\u01b0u \u00fd khi d\u00f9ng \u0111\u1ed3ng th\u1eddi: aspirin \u1edf li\u1ec1u ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u (50-375 mg\/ng\u00e0y), c\u00e1c thu\u1ed1c ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u kh\u00e1c, c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf t\u00e1i thu h\u1ed3i ch\u1ecdn l\u1ecdc serotonin, deferasirox (m\u1ed9t ph\u1ee9c h\u1ee3p t\u1ea1o chelat v\u1edbi s\u1eaft s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb th\u1eeba s\u1eaft), glucocorticoid (tr\u1eeb hydrocortison d\u00f9ng trong li\u1ec7u ph\u00e1p thay th\u1ebf th\u01b0\u1ee3ng th\u1eadn), heparin kh\u1ed1i l\u01b0\u1ee3ng th\u1ea5p hay heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n (li\u1ec1u d\u1ef1 ph\u00f2ng).<\/li>\n<\/ul>\n\n\n\n\n
<\/td>\n<\/tr>\n
Khi s\u1eed d\u1ee5ng li\u1ec1u th\u1ea5p, m\u1ed9t s\u1ed1 NSAID ch\u1ec9 th\u1ec3 hi\u1ec7n t\u00e1c d\u1ee5ng gi\u1ea3m \u0111au m\u00e0 kh\u00f4ng th\u1ec3 hi\u1ec7n t\u00e1c d\u1ee5ng ch\u1ed1ng vi\u00eam: \u22641200 mg\/ng\u00e0y (ibuprofen); <300 mg\/ng\u00e0y (ketoprofen); <680 mg\/ng\u00e0y (naproxen); diclofenac li\u1ec1u \u0111\u01a1n 12,5 mg; <1500 mg\/ng\u00e0y (acid mefenamic).<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
<\/p>\n\n\n\n\n
Aspirin v\u00e0 c\u00e1c NSAID: Nh\u1eefng \u0111i\u1ec1u c\u1ea7n l\u01b0u \u00fd khi t\u01b0 v\u1ea5n cho ng\u01b0\u1eddi b\u1ec7nh<\/td>\n<\/tr>\n
C\u1ea7n l\u01b0u \u00fd khi s\u1eed d\u1ee5ng aspirin v\u00e0 c\u00e1c NSAID cho ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 cho con b\u00fa.<\/p>\n
Ph\u1ee5 n\u1eef c\u00f3 thai:<\/p>\n
\n
Khi s\u1eed d\u1ee5ng thu\u1ed1c trong v\u00f2ng 24 tu\u1ea7n \u0111\u1ea7u thai k\u1ef3, t\u1ea5t c\u1ea3 c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p prostaglandin c\u00f3 th\u1ec3 g\u00e2y ra.<\/li>\n
\u0110\u1ed9c t\u00ednh tr\u00ean tim ph\u1ed5i (\u0111\u00f3ng s\u1edbm \u1ed1ng \u0111\u1ed9ng m\u1ea1ch v\u00e0 t\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i);<\/li>\n
R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn suy th\u1eadn k\u00e8m theo thi\u1ec3u \u1ed1i.<\/li>\n<\/ul>\n
Khi s\u1eed d\u1ee5ng thu\u1ed1c v\u00e0o cu\u1ed1i thai k\u1ef3, ng\u01b0\u1eddi m\u1eb9 v\u00e0 tr\u1ebb s\u01a1 sinh c\u00f3 th\u1ec3 g\u1eb7p nguy c\u01a1:<\/p>\n
\n
K\u00e9o d\u00e0i th\u1eddi gian ch\u1ea3y m\u00e1u, th\u1eadm ch\u00ed sau khi \u0111\u00e3 d\u00f9ng m\u1ed9t li\u1ec1u r\u1ea5t th\u1ea5p;<\/li>\n
\u1ee8c ch\u1ebf co b\u00f3p t\u1eed cung d\u1eabn \u0111\u1ebfn ch\u1eadm m\u1edf c\u1ed5 t\u1eed cung ho\u1eb7c k\u00e9o d\u00e0i th\u1eddi gian sinh.<\/li>\n
Do \u0111\u00f3, n\u00ean h\u1ea1n ch\u1ebf s\u1eed d\u1ee5ng aspirin v\u00e0 NSAID tr\u00ean s\u1ea3n khoa v\u00e0 c\u1ea7n gi\u00e1m s\u00e1t ch\u1eb7t ch\u1ebd c\u1ee7a b\u00e1c s\u0129. C\u00e1c thu\u1ed1c n\u00e0y tuy\u1ec7t \u0111\u1ed1i ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh sau tu\u1ea7n th\u1ee9 24 c\u1ee7a thai k\u1ef3 (kho\u1ea3ng th\u00e1ng th\u1ee9 5).<\/li>\n<\/ul>\n
Ph\u1ee5 n\u1eef cho con b\u00fa:<\/p>\n
\n
Aspirin \u0111\u01b0\u1ee3c b\u00e0i xu\u1ea5t v\u00e0o s\u1eefa m\u1eb9, do \u0111\u00f3 kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng cho ph\u1ee5 n\u1eef cho con b\u00fa.<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
L\u01b0u \u00fd: Thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid c\u00f3 th\u1ec3 g\u00e2y t\u0103ng kali m\u00e1u. Nguy c\u01a1 n\u00e0y t\u0103ng l\u00ean khi s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi: mu\u1ed1i kali, thu\u1ed1c l\u1ee3i ti\u1ec3u ti\u1ebft ki\u1ec7m kali, thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n, thu\u1ed1c \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 angiotensin II, heparin (kh\u1ed1i l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p hay heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n), c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch (ciclosporin, tacrolimus) v\u00e0 trimethoprim.<\/p>\n
Floctafenin<\/h3>\n
Floctafenin l\u00e0 thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng thu\u1ea7n t\u00fay v\u1edbi t\u00e1c d\u1ee5ng gi\u1ea3m \u0111au v\u00e0 ch\u1ec9 d\u00f9ng theo \u0111\u01b0\u1eddng u\u1ed1ng d\u01b0\u1edbi d\u1ea1ng vi\u00ean n\u00e9n 200 mg. Li\u1ec1u d\u00f9ng c\u1ee7a thu\u1ed1c l\u00e0 1 vi\u00ean\/l\u1ea7n, c\u00f3 th\u1ec3 u\u1ed1ng li\u1ec1u ti\u1ebfp theo n\u1ebfu c\u1ea7n, nh\u01b0ng kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 4 vi\u00ean\/ng\u00e0y. C\u1ea7n tu\u00e2n th\u1ee7 kho\u1ea3ng c\u00e1ch t\u1ed1i thi\u1ec3u gi\u1eefa hai l\u1ea7n d\u00f9ng l\u00e0 4-6 gi\u1edd. Trong tr\u01b0\u1eddng h\u1ee3p \u0111au n\u1eb7ng, c\u00f3 th\u1ec3 u\u1ed1ng lu\u00f4n 2 vi\u00ean, sau \u0111\u00f3 khi \u0111\u1ea3m b\u1ea3o kho\u1ea3ng c\u00e1ch t\u1ed1i thi\u1ec3u, u\u1ed1ng ti\u1ebfp 1 vi\u00ean n\u1ebfu c\u1ea7n v\u00e0 kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 4 vi\u00ean\/ng\u00e0y.<\/p>\n
Thu\u1ed1c c\u00f3 m\u1ed9t s\u1ed1 ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i v\u1edbi t\u1ea7n su\u1ea5t r\u1ea5t hi\u1ebfm g\u1eb7p nh\u01b0ng nghi\u00eam tr\u1ecdng, c\u1ea7n ng\u1eebng thu\u1ed1c ngay. Th\u1ef1c t\u1ebf \u0111\u00e3 ghi nh\u1eadn m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p x\u1ea3y ra c\u00e1c ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng \u1edf c\u00e1c m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau, t\u1eeb m\u1ea9n ng\u1ee9a tr\u00ean da \u0111\u1ebfn s\u1ed1c. C\u00e1c ph\u1ea3n \u1ee9ng n\u00e0y c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n sau c\u00e1c tri\u1ec7u ch\u1ee9ng d\u1ecb \u1ee9ng nh\u1eb9: ng\u1ee9a ran \u1edf l\u00f2ng b\u00e0n tay ho\u1eb7c l\u00f2ng b\u00e0n ch\u00e2n, m\u1ea9n \u0111\u1ecf \u0111\u1ed9t ng\u1ed9t \u1edf da m\u1eb7t ho\u1eb7c c\u1ed5, ph\u00e1t ban, ng\u1ee9a h\u1ecdng, c\u1ea3m gi\u00e1c m\u1ec7t m\u1ecfi.<\/p>\n
Nefopam<\/h3>\n
Nefopam l\u00e0 m\u1ed9t thu\u1ed1c gi\u1ea3m \u0111au d\u1ea1ng \u1ed1ng ti\u00eam ch\u1ee9a 20 mg \u0111\u1ec3 ti\u00eam t\u0129nh m\u1ea1ch ho\u1eb7c ti\u00eam b\u1eafp \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng c\u00e1c c\u01a1n \u0111au c\u1ea5p t\u00ednh, bao g\u1ed3m c\u1ea3 \u0111au sau ph\u1eabu thu\u1eadt. Thu\u1ed1c c\u00f3 c\u1ea5u tr\u00fac h\u00f3a h\u1ecdc kh\u00e1c v\u1edbi c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au th\u00f4ng th\u01b0\u1eddng, kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng ch\u1ed1ng vi\u00eam ho\u1eb7c h\u1ea1 s\u1ed1t v\u00e0 kh\u00f4ng g\u00e2y \u1ee9c ch\u1ebf h\u00f4 h\u1ea5p. Tuy nhi\u00ean, thu\u1ed1c c\u00f3 ho\u1ea1t t\u00ednh kh\u00e1ng acetylcholin n\u00ean ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh cho ng\u01b0\u1eddi b\u1ec7nh c\u00f3 ti\u1ec1n s\u1eed r\u1ed1i lo\u1ea1n co gi\u1eadt, nguy c\u01a1 b\u00ed ti\u1ec3u li\u00ean quan \u0111\u1ebfn tuy\u1ebfn ti\u1ec1n li\u1ec7t, glaucom g\u00f3c \u0111\u00f3ng v\u00e0 suy m\u1ea1ch v\u00e0nh. Ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i th\u01b0\u1eddng g\u1eb7p c\u1ee7a nefopam l\u00e0 bu\u1ed3n n\u00f4n v\u00e0 n\u00f4n.<\/p>\n
Thu\u1ed1c gi\u1ea3m \u0111au nh\u00f3m II<\/h2>\n
C\u00e1c thu\u1ed1c gi\u1ea3m \u0111au nh\u00f3m II bao g\u1ed3m c\u00e1c thu\u1ed1c c\u00f3 c\u01a1 ch\u1ebf t\u01b0\u01a1ng t\u1ef1 morphin nh\u01b0ng t\u00e1c d\u1ee5ng gi\u1ea3m \u0111au y\u1ebfu h\u01a1n. \u0110\u00e2y l\u00e0 c\u00e1c opioid y\u1ebfu, th\u01b0\u1eddng s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p v\u1edbi paracetamol. Vi\u1ec7c k\u1ebft h\u1ee3p n\u00e0y \u0111em l\u1ea1i hi\u1ec7u qu\u1ea3 gi\u1ea3m \u0111au t\u1ed1t nh\u01b0ng c\u0169ng ti\u1ec1m \u1ea9n nguy c\u01a1 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a c\u1ea3 hai ho\u1ea1t ch\u1ea5t li\u00ean quan. Thu\u1ed1c gi\u1ea3m \u0111au nh\u00f3m II \u0111\u01b0\u1ee3c d\u00e0nh ri\u00eang cho nh\u1eefng c\u01a1n \u0111au trung b\u00ecnh \u0111\u1ebfn d\u1eef d\u1ed9i. Thu\u1ed1c c\u00f3 th\u1ec3 th\u00edch h\u1ee3p trong \u00edt nh\u1ea5t ba t\u00ecnh hu\u1ed1ng:<\/p>\n
\n
\u0110i\u1ec1u tr\u1ecb th\u1ea5t b\u1ea1i hay kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3 khi d\u00f9ng m\u1ed9t thu\u1ed1c gi\u1ea3m \u0111au nh\u00f3m I;<\/li>\n
\u0110i\u1ec1u tr\u1ecb t\u1ee9c th\u00ec trong c\u00e1c t\u00ecnh hu\u1ed1ng b\u1ec7nh l\u00fd c\u00f3 c\u01a1n \u0111au (sau ch\u1ea5n th\u01b0\u01a1ng, ph\u1eabu thu\u1eadt, …);<\/li>\n
\u0110i\u1ec1u tr\u1ecb thay th\u1ebf b\u1eb1ng \u0111\u01b0\u1eddng u\u1ed1ng sau khi s\u1eed d\u1ee5ng morphin \u0111\u01b0\u1eddng ti\u00eam.<\/li>\n<\/ul>\n
Codein<\/h3>\n
Codein l\u00e0 m\u1ed9t opioid y\u1ebfu, \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a nhanh th\u00e0nh morphin trong c\u01a1 th\u1ec3 v\u1edbi t\u1ef7 l\u1ec7 10%. Do v\u1eady, thu\u1ed1c c\u00f3 th\u1eddi gian t\u00e1c d\u1ee5ng t\u01b0\u01a1ng \u0111\u1ed1i d\u00e0i v\u1edbi hi\u1ec7u l\u1ef1c b\u1eb1ng kho\u1ea3ng 1\/5 so v\u1edbi morphin. Codein k\u1ebft h\u1ee3p v\u1edbi paracetamol ho\u1eb7c aspirin trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p \u0111\u1ec3 t\u0103ng c\u01b0\u1eddng t\u00e1c d\u1ee5ng gi\u1ea3m \u0111au. Li\u1ec1u l\u01b0\u1ee3ng s\u1eed d\u1ee5ng ph\u1ea3i \u0111\u01b0\u1ee3c tu\u00e2n th\u1ee7 nghi\u00eam ng\u1eb7t, \u0111\u1ea3m b\u1ea3o kh\u1ea3 n\u0103ng dung n\u1ea1p thu\u1ed1c (b\u1ea3ng 3).<\/p>\n\n\n\n\n\n
B\u1ea3ng 3: Li\u1ec1u l\u01b0\u1ee3ng codein<\/td>\n<\/tr>\n
Ng\u01b0\u1eddi l\u1edbn<\/td>\n 30-60 mg, l\u1eb7p l\u1ea1i m\u1ed7i 4-6 gi\u1edd (v\u1edbi ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb ho, li\u1ec1u 10 mg m\u1ed7i 3-4 gi\u1edd).<\/td>\n<\/tr>\n
Tr\u1ebb em<\/td>\n Codein trong c\u00e1c d\u1ea1ng siro c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u1edbi li\u1ec1u 1-3 mg\/kg\/ng\u00e0y, kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 6 mg\/kg\/ng\u00e0y \u1edf tr\u1ebb tr\u00ean 1 tu\u1ed5i.<\/p>\n
Khi s\u1eed d\u1ee5ng li\u1ec1u tr\u00ean 10 mg\/kg\/ng\u00e0y, tr\u1ebb c\u00f3 nguy c\u01a1 co gi\u1eadt.<\/p>\n
Opioid y\u1ebfu n\u00e0y \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p v\u1edbi paracetamol trong m\u1ed9t s\u1ed1 ch\u1ebf ph\u1ea9m vi\u00ean n\u00e9n, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng cho tr\u1ebb \u22656 tu\u1ed5i v\u00e0 c\u00e2n n\u1eb7ng tr\u00ean 14 kg.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
\u00a0Ng\u00e0y 06\/10\/2015, C\u1ee5c Qu\u1ea3n l\u00fd D\u01b0\u1ee3c Vi\u1ec7t Nam \u0111\u00e3 c\u00f3 c\u00f4ng v\u0103n s\u1ed1 18905\/QLD-TT cung c\u1ea5p th\u00f4ng tin cho c\u00e1n b\u1ed9 y t\u1ebf v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng codein theo khuy\u1ebfn c\u00e1o g\u1ea7n \u0111\u00e2y c\u1ee7a C\u01a1 quan Qu\u1ea3n l\u00fd D\u01b0\u1ee3c ph\u1ea9m ch\u00e2u \u00c2u. Theo \u0111\u00f3, \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb ho v\u00e0 c\u1ea3m l\u1ea1nh, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh codein cho tr\u1ebb d\u01b0\u1edbi 12 tu\u1ed5i, th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng cho tr\u1ebb t\u1eeb 12 \u0111\u1ebfn 18 tu\u1ed5i c\u00f3 c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 h\u00f4 h\u1ea5p. \u0110\u1ed3ng th\u1eddi, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh codein cho b\u1ec7nh nh\u00e2n mang gen chuy\u1ec3n h\u00f3a thu\u1ed1c nhanh \u1edf t\u1ea5t c\u1ea3 m\u1ecdi l\u1ee9a tu\u1ed5i, ph\u1ee5 n\u1eef cho con b\u00fa. Tr\u01b0\u1edbc \u0111\u00f3, theo c\u00f4ng v\u0103n s\u1ed1 15113\/QLD-\u0110K ng\u00e0y 12\/9\/2013 c\u1ee7a C\u1ee5c Qu\u1ea3n l\u00fd D\u01b0\u1ee3c, codein c\u0169ng b\u1ecb ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh cho tr\u1ebb em d\u01b0\u1edbi 18 tu\u1ed5i v\u1eeba th\u1ef1c hi\u1ec7n c\u1eaft ami\u0111an v\u00e0\/ho\u1eb7c th\u1ee7 thu\u1eadt n\u1ea1o V.A.<\/em>\u00a0<\/em><\/p>\n*
M\u1ed9t s\u1ed1 l\u01b0u \u00fd khi s\u1eed d\u1ee5ng codein:<\/p>\n
\n
Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh codein trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p: qu\u00e1 m\u1eabn v\u1edbi thu\u1ed1c, ho c\u00f3 \u0111\u1eddm, nghi\u1ec7n ma t\u00fay, t\u00ecnh tr\u1ea1ng ph\u1ee5 thu\u1ed9c opioid, suy h\u00f4 h\u1ea5p, hen, suy tim n\u1eb7ng, th\u1eddi k\u1ef3 mang thai v\u00e0 cho con b\u00fa.<\/li>\n
\u1ede li\u1ec1u \u0111i\u1ec1u tr\u1ecb, t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a codein t\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u00e1c opioid kh\u00e1c, m\u1eb7c d\u00f9 hi\u1ebfm g\u1eb7p v\u00e0 nh\u1eb9 h\u01a1n: t\u00e1o b\u00f3n, bu\u1ed3n ng\u1ee7, ch\u00f3ng m\u1eb7t, bu\u1ed3n n\u00f4n, n\u00f4n. \u0110\u1eb7c bi\u1ec7t \u0111\u00e3 ghi nh\u1eadn \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o v\u1ec1 tr\u01b0\u1eddng h\u1ee3p co th\u1eaft ph\u1ebf qu\u1ea3n, d\u1ecb \u1ee9ng ho\u1eb7c suy h\u00f4 h\u1ea5p. Ngo\u00e0i ra, thu\u1ed1c c\u00f2n c\u00f3 nguy c\u01a1 g\u00e2y nghi\u1ec7n, h\u1ed9i ch\u1ee9ng cai thu\u1ed1c cho ng\u01b0\u1eddi d\u00f9ng, k\u1ec3 c\u1ea3 tr\u00ean tr\u1ebb s\u01a1 sinh khi s\u1eed d\u1ee5ng codein cho ng\u01b0\u1eddi m\u1eb9 trong giai \u0111o\u1ea1n mang thai.<\/li>\n<\/ul>\n
M\u1ed9t s\u1ed1 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c li\u00ean quan \u0111\u1ebfn codein:<\/p>\n
\n
C\u00e1c thu\u1ed1c khuy\u1ebfn c\u00e1o kh\u00f4ng d\u00f9ng ph\u1ed1i h\u1ee3p: Opioid ch\u1ee7 v\u1eadn – \u0111\u1ed1i kh\u00e1ng (nalbuphin, buprenorphin, pentazocin) do l\u00e0m gi\u1ea3m t\u00e1c d\u1ee5ng\u00a0gi\u1ea3m \u0111au th\u00f4ng qua c\u01a1 ch\u1ebf c\u1ea1nh tranh l\u00e0m phong b\u1ebf receptor v\u00e0 nguy c\u01a1 xu\u1ea5t hi\u1ec7n h\u1ed9i ch\u1ee9ng cai thu\u1ed1c. Tr\u00e1nh s\u1eed d\u1ee5ng thu\u1ed1c c\u00f9ng v\u1edbi r\u01b0\u1ee3u ho\u1eb7c \u0111\u1ed3 u\u1ed1ng c\u00f3 c\u1ed3n do t\u0103ng t\u00e1c d\u1ee5ng an th\u1ea7n c\u1ee7a thu\u1ed1c.<\/li>\n
C\u00e1c thu\u1ed1c c\u1ea7n l\u01b0u \u00fd khi s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi: thu\u1ed1c gi\u1ea3m \u0111au kh\u00e1c thu\u1ed9c nh\u00f3m morphin, thu\u1ed1c ng\u1ee7 benzodiazepin, barbiturat v\u00e0 c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf th\u1ea7n kinh trung \u01b0\u01a1ng.<\/li>\n<\/ul>\n
Tramadol<\/strong><\/h3>\n
Tramadol \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong c\u00e1c c\u01a1n \u0111au m\u1ee9c \u0111\u1ed9 trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng. \u1ede li\u1ec1u \u0111i\u1ec1u tr\u1ecb, \u0111\u00e2y l\u00e0 m\u1ed9t thu\u1ed1c gi\u1ea3m \u0111au trung \u01b0\u01a1ng c\u00f3 hi\u1ec7u qu\u1ea3 d\u1ef1a tr\u00ean t\u00e1c d\u1ee5ng hi\u1ec7p \u0111\u1ed3ng th\u00f4ng qua 2 c\u01a1 ch\u1ebf:<\/p>\n
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T\u00e1c d\u1ee5ng t\u01b0\u01a1ng t\u1ef1 c\u00e1c opioid th\u00f4ng qua vi\u1ec7c g\u1eafn v\u00e0o th\u1ee5 th\u1ec3 \u03bc c\u1ee7a opioid;<\/li>\n
T\u00e1c d\u1ee5ng tr\u00ean h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng do \u1ee9c ch\u1ebf t\u00e1i thu h\u1ed3i noradrenalin v\u00e0 serotonin, do \u0111\u00f3 ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c s\u1ef1 truy\u1ec1n t\u00edn hi\u1ec7u \u0111au v\u1ec1 th\u1ea7n kinh\u00a0trung \u01b0\u01a1ng.<\/li>\n<\/ul>\n
Khi s\u1eed d\u1ee5ng \u1edf li\u1ec1u \u0111i\u1ec1u tr\u1ecb, thu\u1ed1c \u00edt t\u00e1c \u0111\u1ed9ng tr\u00ean ti\u00eau h\u00f3a, \u00edt \u1ee9c ch\u1ebf h\u00f4 h\u1ea5p h\u01a1n so v\u1edbi morphin.<\/p>\n
C\u00e1c nghi\u00ean c\u1ee9u tr\u00ean \u0111\u1ed9ng v\u1eadt cho th\u1ea5y\u00a0thu\u1ed1c \u00edt g\u00e2y ph\u1ee5 thu\u1ed9c h\u01a1n so v\u1edbi morphin.<\/p>\n
Hi\u1ec7u l\u1ef1c gi\u1ea3m \u0111au c\u1ee7a tramadol b\u1eb1ng kho\u1ea3ng 1\/10 \u0111\u1ebfn 1\/6 morphin.<\/p>\n
Khi s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au nh\u00f3m I, hi\u1ec7u l\u1ef1c gi\u1ea3m \u0111au c\u1ee7a thu\u1ed1c \u0111\u01b0\u1ee3c t\u0103ng c\u01b0\u1eddng.<\/p>\n
Qu\u1ea3n l\u00fd vi\u1ec7c s\u1eed d\u1ee5ng tramadol: Li\u1ec1u l\u01b0\u1ee3ng tramadol ph\u1ee5 thu\u1ed9c nhi\u1ec1u v\u00e0o b\u1ec7nh nh\u00e2n v\u00e0 m\u1ee9c \u0111\u1ed9 \u0111au\u00a0(b\u1ea3ng 4).<\/em><\/p>\n\n\n\n\n
B\u1ea3ng 4: Li\u1ec1u d\u00f9ng c\u1ee7a tramadol<\/td>\n<\/tr>\n
D\u1ea1ng vi\u00ean:<\/p>\n
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C\u01a1n \u0111au c\u1ea5p: li\u1ec1u t\u1ea5n c\u00f4ng 100 mg, li\u1ec1u duy tr\u00ec 50 mg ho\u1eb7c 100 mg m\u1ed7i 4-6 gi\u1edd, kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 400 mg\/24 gi\u1edd.<\/li>\n
C\u01a1n \u0111au m\u1ea1n: li\u1ec1u t\u1ea5n c\u00f4ng 50 ho\u1eb7c 100 mg, li\u1ec1u duy tr\u00ec 50 mg ho\u1eb7c 100 mg m\u1ed7i 4-6 gi\u1edd, kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 400 mg\/24 gi\u1edd.<\/li>\n<\/ul>\n
D\u1ea1ng dung d\u1ecbch ti\u00eam:<\/p>\n
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Tramadol c\u00f3 th\u1ec3 ti\u00eam t\u0129nh m\u1ea1ch ch\u1eadm (2-3 ph\u00fat) ho\u1eb7c pha trong d\u1ecbch truy\u1ec1n.<\/li>\n
C\u01a1n \u0111au n\u1eb7ng: li\u1ec1u t\u1ea5n c\u00f4ng 100 mg. Trong v\u00f2ng 1 gi\u1edd sau li\u1ec1u t\u1ea7n c\u00f4ng, b\u1ed5 sung 50 mg m\u1ed7i 10-20 ph\u00fat, kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 t\u1ed5ng li\u1ec1u 250 mg (bao g\u1ed3m c\u1ea3 li\u1ec1u t\u1ea5n c\u00f4ng). Sau \u0111\u00f3, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng 50 ho\u1eb7c 100 mg m\u1ed7i 4-6 gi\u1edd, kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 600 mg\/ng\u00e0y.<\/li>\n
C\u01a1n \u0111au trung b\u00ecnh: 50 ho\u1eb7c 100 mg trong gi\u1edd \u0111\u1ea7u ti\u00ean.<\/li>\n<\/ul>\n
Tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t:<\/p>\n
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Khi s\u1eed d\u1ee5ng cho b\u1ec7nh nh\u00e2n tr\u00ean 75 tu\u1ed5i (d\u1ea1ng vi\u00ean nang ho\u1eb7c dung d\u1ecbch ti\u00eam), c\u1ea7n k\u00e9o d\u00e0i kho\u1ea3ng c\u00e1ch gi\u1eefa c\u00e1c l\u1ea7n d\u00f9ng (9 gi\u1edd \u0111\u1ed1i v\u1edbi d\u1ea1ng vi\u00ean nang).<\/li>\n
Tr\u01b0\u1eddng h\u1ee3p suy gan, c\u1ea7n gi\u1ea3m li\u1ec1u m\u1ed7i l\u1ea7n \u0111i m\u1ed9t n\u1eeda ho\u1eb7c t\u0103ng kho\u1ea3ng c\u00e1ch \u0111\u01b0a li\u1ec1u l\u00ean 2 l\u1ea7n (12 gi\u1edd).<\/li>\n
Tr\u01b0\u1eddng h\u1ee3p suy th\u1eadn, c\u1ea7n t\u0103ng kho\u1ea3ng th\u1eddi gian gi\u1eefa c\u00e1c l\u1ea7n d\u00f9ng l\u00ean 2 l\u1ea7n (12 gi\u1edd) v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1ed9 thanh th\u1ea3i creatinin <30 ml\/ph\u00fat v\u00e0 tr\u00e1nh s\u1eed d\u1ee5ng cho b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1ed9 thanh th\u1ea3i <10 ml\/ph\u00fat.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Tramadol c\u00f3 m\u1ed9t s\u1ed1 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, bao g\u1ed3m: ti\u1ec1n s\u1eed qu\u00e1 m\u1eabn v\u1edbi tramadol, c\u00e1c opioid, ng\u1ed9 \u0111\u1ed9c c\u1ea5p t\u00ednh ho\u1eb7c d\u00f9ng qu\u00e1 li\u1ec1u c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng (r\u01b0\u1ee3u, thu\u1ed1c ng\u1ee7, thu\u1ed1c gi\u1ea3m \u0111au kh\u00e1c), suy h\u00f4 h\u1ea5p n\u1eb7ng, suy t\u1ebf b\u00e0o gan n\u1eb7ng, tr\u1ebb em d\u01b0\u1edbi 15 tu\u1ed5i (vi\u00ean nang v\u00e0 ti\u00eam), ph\u1ee5 n\u1eef cho con b\u00fa trong tr\u01b0\u1eddng h\u1ee3p \u0111i\u1ec1u tr\u1ecb k\u00e9o d\u00e0i, \u0111\u1ed9ng kinh m\u1ea5t ki\u1ec3m so\u00e1t, k\u1ebft h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf men mono-aminoxidase (IMAO) kh\u00f4ng ch\u1ecdn l\u1ecdc (iproniazid), IMAO ch\u1ecdn l\u1ecdc nh\u00f3m A (moclobemid, toloxaton), IMAO ch\u1ecdn l\u1ecdc nh\u00f3m B (selegilin), kh\u00e1ng sinh linezolid.<\/p>\n
Tramadol ch\u1ec9 n\u00ean s\u1eed d\u1ee5ng sau khi \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 c\u1ea9n th\u1eadn c\u00e2n b\u1eb1ng l\u1ee3i \u00edch\/nguy c\u01a1 d\u1ef1a tr\u00ean b\u1ea3n ch\u1ea5t c\u01a1n \u0111au v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m b\u1ec7nh nh\u00e2n.<\/p>\n
C\u1ea7n s\u1eed d\u1ee5ng th\u1eadn tr\u1ecdng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd, ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o, h\u00f4n m\u00ea ch\u01b0a x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n r\u00f5 r\u00e0ng, r\u1ed1i lo\u1ea1n trung t\u00e2m h\u00f4 h\u1ea5p ho\u1eb7c r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p.<\/p>\n
Tramadol c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n: r\u1ed1i lo\u1ea1n th\u1ea7n kinh – t\u00e2m th\u1ea7n (t\u00f9y thu\u1ed9c v\u00e0o \u0111\u00e1p \u1ee9ng c\u00e1 th\u1ec3, th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi cao tu\u1ed5i), c\u00f3 th\u1ec3 g\u00e2y l\u1eabn l\u1ed9n, \u1ea3o gi\u00e1c, hoang t\u01b0\u1edfng, c\u01a1n co gi\u1eadt khi s\u1eed d\u1ee5ng li\u1ec1u cao ho\u1eb7c \u0111\u1ed3ng th\u1eddi v\u1edbi c\u00e1c thu\u1ed1c l\u00e0m gi\u1ea3m ng\u01b0\u1ee1ng k\u00edch th\u00edch g\u00e2y \u0111\u1ed9ng kinh. C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 bu\u1ed3n n\u00f4n, n\u00f4n, bu\u1ed3n ng\u1ee7, \u0111au \u0111\u1ea7u, ch\u00f3ng m\u1eb7t, v\u00e3 m\u1ed3 h\u00f4i, m\u1ec7t m\u1ecfi, kh\u00f4 mi\u1ec7ng, t\u00e1o b\u00f3n khi s\u1eed d\u1ee5ng k\u00e9o d\u00e0i. C\u00e1c ph\u1ea3n \u1ee9ng hi\u1ebfm g\u1eb7p bao g\u1ed3m: \u0111au th\u01b0\u1ee3ng v\u1ecb, ph\u00e1t ban, suy nh\u01b0\u1ee3c, gi\u1ea3m th\u1ecb l\u1ef1c v\u00e0 r\u1ed1i lo\u1ea1n tim m\u1ea1ch (nh\u1ecbp tim nhanh, h\u1ea1 huy\u1ebft \u00e1p, \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c, t\u0103ng huy\u1ebft \u00e1p). C\u00e1c ph\u1ea3n \u1ee9ng r\u1ea5t hi\u1ebfm g\u1eb7p bao g\u1ed3m: ph\u1ea3n \u1ee9ng ph\u1ea3n v\u1ec7 (m\u1ec1 \u0111ay, ph\u00f9 m\u1ea1ch, co th\u1eaft ph\u1ebf qu\u1ea3n) \u0111\u00f4i khi d\u1eabn \u0111\u1ebfn s\u1ed1c c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong; r\u1ed1i lo\u1ea1n ti\u1ebft ni\u1ec7u (ti\u1ec3u kh\u00f3 v\u00e0\/ho\u1eb7c b\u00ed ti\u1ec3u); r\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p ho\u1eb7c suy h\u00f4 h\u1ea5p n\u1ebfu s\u1eed d\u1ee5ng li\u1ec1u v\u01b0\u1ee3t qu\u00e1 li\u1ec1u khuy\u1ebfn c\u00e1o ho\u1eb7c d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi thu\u1ed1c gi\u1ea3m \u0111au kh\u00e1c; l\u1ec7 thu\u1ed9c thu\u1ed1c, h\u1ed9i ch\u1ee9ng cai thu\u1ed1c sau khi s\u1eed d\u1ee5ng m\u1ed9t th\u1eddi gian d\u00e0i, v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng k\u00edch \u0111\u1ed9ng, lo \u00e2u, c\u0103ng th\u1eb3ng, m\u1ea5t ng\u1ee7, t\u0103ng \u0111\u1ed9ng, run r\u1ea9y v\u00e0 tri\u1ec7u ch\u1ee9ng tr\u00ean ti\u00eau h\u00f3a. T\u0103ng enzym gan \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn trong m\u1ed9t s\u1ed1 ca s\u1eed d\u1ee5ng tramadol.<\/p>\n
T\u01b0\u01a1ng t\u00e1c thu\u1ed1c c\u00f3 th\u1ec3 x\u1ea3y ra khi s\u1eed d\u1ee5ng tramadol:<\/p>\n
\n
Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh d\u00f9ng \u0111\u1ed3ng th\u1eddi: t\u1ea5t c\u1ea3 c\u00e1c IMAO;<\/li>\n
Khuy\u1ebfn c\u00e1o kh\u00f4ng d\u00f9ng \u0111\u1ed3ng th\u1eddi: opioid ch\u1ee7 v\u1eadn – \u0111\u1ed1i v\u1eadn (buprenorphin, nalbuphin, pentazocin), r\u01b0\u1ee3u, carbamazepin v\u00e0 naltrexon;<\/li>\n
C\u00e2n nh\u1eafc khi d\u00f9ng \u0111\u1ed3ng th\u1eddi: thu\u1ed1c gi\u1ea3m \u0111au c\u00f9ng t\u00e1c d\u1ee5ng l\u00ean th\u1ee5 th\u1ec3 morphin, c\u00e1c thu\u1ed1c gi\u1ea3m ho t\u01b0\u01a1ng t\u1ef1 morphin (dextromethorphan, noscapin, pholcodin), c\u00e1c thu\u1ed1c gi\u1ea3m ho morphin (codein, ethylmorphin), benzodiazepin, barbiturat, c\u00e1c thu\u1ed1c an th\u1ea7n kh\u00e1c, thu\u1ed1c \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc t\u00e1i thu h\u1ed3i serotonin, venlafaxin, thu\u1ed1c gi\u1ea3m ng\u01b0\u1ee1ng co gi\u1eadt (bao g\u1ed3m c\u00e1c thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m ba v\u00f2ng v\u00e0 c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf t\u00e1i thu h\u1ed3i serotonin), thu\u1ed1c an th\u1ea7n kinh (phenothiazin v\u00e0 butyrophenon), mefloquin v\u00e0 bupropion.<\/li>\n<\/ul>\n
Vi\u1ec7c s\u1eed d\u1ee5ng tramadol trong th\u1eddi k\u00ec mang thai v\u00e0 cho con b\u00fa c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i. Kh\u00f4ng n\u00ean d\u00f9ng thu\u1ed1c trong 3 th\u00e1ng \u0111\u1ea7u thai k\u1ef3. T\u1eeb th\u00e1ng th\u1ee9 4, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng thu\u1ed1c m\u1ed9t c\u00e1ch th\u1eadn tr\u1ecdng. Trong 3 th\u00e1ng cu\u1ed1i thai k\u1ef3, vi\u1ec7c s\u1eed d\u1ee5ng tramadol k\u00e9o d\u00e0i (\u1edf t\u1ea5t c\u1ea3 c\u00e1c m\u1ee9c li\u1ec1u) c\u00f3 th\u1ec3 g\u00e2y ra h\u1ed9i ch\u1ee9ng cai thu\u1ed1c \u1edf tr\u1ebb s\u01a1 sinh. \u0110\u1eb7c bi\u1ec7t, v\u00e0o cu\u1ed1i thai k\u1ef3, khi s\u1eed d\u1ee5ng li\u1ec1u cao, k\u1ec3 c\u1ea3 trong th\u1eddi gian ng\u1eafn, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn suy h\u00f4 h\u1ea5p \u1edf tr\u1ebb s\u01a1 sinh. \u0110\u1ed1i v\u1edbi ph\u1ee5 n\u1eef cho con b\u00fa, n\u1ebfu c\u1ea7n s\u1eed d\u1ee5ng tramadol d\u00e0i ng\u00e0y, c\u1ea7n ng\u1eebng cho con b\u00fa.<\/p>\n
Thu\u1ed1c gi\u1ea3m \u0111au nh\u00f3m III<\/h2>\n
Trong m\u1ed9t th\u1eddi gian d\u00e0i, c\u00e1c opioid m\u1ea1nh, \u0111\u1eb7c bi\u1ec7t l\u00e0 morphin kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u00fang m\u1ee9c trong th\u1ef1c h\u00e0nh do lo ng\u1ea1i suy h\u00f4 h\u1ea5p v\u00e0 g\u00e2y nghi\u1ec7n. Khi s\u1eed d\u1ee5ng theo \u0111\u01a1n v\u00e0 v\u1edbi m\u1ee5c \u0111\u00edch gi\u1ea3m \u0111au, nguy c\u01a1 dung n\u1ea1p v\u00e0 nguy c\u01a1 g\u00e2y nghi\u1ec7n c\u1ee7a c\u00e1c thu\u1ed1c n\u00e0y \u0111\u01b0\u1ee3c h\u1ea1n ch\u1ebf.<\/p>\n
C\u00e1c thu\u1ed1c gi\u1ea3m \u0111au nh\u00f3m III, c\u00f2n g\u1ecdi l\u00e0 opioid m\u1ea1nh, \u0111\u01b0\u1ee3c chia th\u00e0nh ba nh\u00f3m: ch\u1ea5t ch\u1ee7 v\u1eadn to\u00e0n ph\u1ea7n (morphin), ch\u1ea5t ch\u1ee7 v\u1eadn t\u1eebng ph\u1ea7n (buprenorphin) v\u00e0 ch\u1ea5t \u0111\u1ed1i kh\u00e1ng (nalbuphin). Nguy\u00ean t\u1eafc chung l\u00e0 kh\u00f4ng bao gi\u1edd \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p ch\u1ea5t ch\u1ee7 v\u1eadn t\u1eebng ph\u1ea7n v\u00e0 ch\u1ea5t \u0111\u1ed1i v\u1eadn v\u1edbi ch\u1ea5t ch\u1ee7 v\u1eadn to\u00e0n ph\u1ea7n do t\u00e1c d\u1ee5ng \u0111\u1ed1i kh\u00e1ng c\u1ee7a c\u00e1c thu\u1ed1c.<\/p>\n
Thu\u1ed1c gi\u1ea3m \u0111au opioid<\/h3>\n
Morphin<\/h3>\n
Morphin \u0111\u01b0\u1ee3c coi l\u00e0 thu\u1ed1c tham chi\u1ebfu trong nh\u00f3m thu\u1ed1c gi\u1ea3m \u0111au m\u1ea1nh, m\u1eb7c d\u00f9 c\u01b0\u1eddng \u0111\u1ed9 t\u00e1c d\u1ee5ng c\u1ee7a morphin kh\u00f4ng ph\u1ea3i l\u00e0 m\u1ea1nh nh\u1ea5t. Morphin th\u00edch h\u1ee3p cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111au dai d\u1eb3ng, d\u1eef d\u1ed9i hay kh\u00f3 \u0111i\u1ec1u tr\u1ecb (\u0111\u1eb7c bi\u1ec7t l\u00e0 \u0111au ung th\u01b0). C\u1ea7n thay \u0111\u1ed5i m\u1ed9t s\u1ed1 quan ni\u1ec7m th\u01b0\u1eddng g\u1eb7p v\u1ec1 morphin, g\u00e2y ra n\u1ed7i s\u1ee3 h\u00e3i v\u00f4 c\u1edb cho b\u1ec7nh nh\u00e2n v\u00e0 c\u1ea3n tr\u1edf ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb. Th\u1ef1c t\u1ebf, trong b\u1ed1i c\u1ea3nh \u0111i\u1ec1u tr\u1ecb, thu\u1ed1c kh\u00f4ng g\u00e2y \u1ea3o gi\u00e1c, kh\u00f4ng g\u00e2y ph\u1ee5 thu\u1ed9c v\u00e0 kh\u00f4ng c\u1ea7n h\u1ea1n ch\u1ebf s\u1eed d\u1ee5ng tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n giai \u0111o\u1ea1n cu\u1ed1i. Tuy nhi\u00ean, s\u1eed d\u1ee5ng thu\u1ed1c kh\u00f4ng h\u1ee3p l\u00fd lu\u00f4n k\u00e8m theo nguy c\u01a1 l\u1ec7 thu\u1ed9c thu\u1ed1c.<\/p>\n
N\u00ean \u01b0u ti\u00ean s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng u\u1ed1ng. Li\u1ec1u kh\u1edfi \u0111\u1ea7u th\u00f4ng th\u01b0\u1eddng l\u00e0 60 mg\/ng\u00e0y, ti\u1ebfp theo c\u1ea7n d\u00f2 li\u1ec1u \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh m\u1ee9c li\u1ec1u th\u1ea5p nh\u1ea5t c\u00f3 hi\u1ec7u qu\u1ea3. C\u00e1ch \u0111\u01a1n gi\u1ea3n nh\u1ea5t l\u00e0 s\u1eed d\u1ee5ng morphin d\u1ea1ng t\u00e1c d\u1ee5ng nhanh m\u1ed7i 4 gi\u1edd v\u00e0 ch\u1ec9nh li\u1ec1u m\u1ed7i 8 gi\u1edd b\u1eb1ng c\u00e1ch t\u0103ng li\u1ec1u t\u1eeb 30% \u0111\u1ebfn 50%. Gi\u1eefa c\u00e1c l\u1ea7n d\u00f9ng thu\u1ed1c theo gi\u1edd c\u1ed1 \u0111\u1ecbnh, c\u00f3 th\u1ec3 b\u1ed5 sung li\u1ec1u trung gian hay li\u1ec1u d\u1ef1 ph\u00f2ng n\u1ebfu v\u1eabn c\u00f3 y\u00eau c\u1ea7u gi\u1ea3m \u0111au. V\u00ed d\u1ee5: trong th\u1eddi gian \u0111\u1ea7u ti\u00ean, c\u00f3 th\u1ec3 \u0111\u01b0a thu\u1ed1c m\u1ed7i gi\u1edd. Li\u1ec1u d\u1ef1 ph\u00f2ng t\u01b0\u01a1ng \u0111\u01b0\u01a1ng 10%-15% t\u1ed5ng li\u1ec1u 24 gi\u1edd.<\/p>\n
T\u1ed5ng li\u1ec1u h\u00e0ng ng\u00e0y \u0111\u00e3 s\u1eed d\u1ee5ng l\u00e0 c\u01a1 s\u1edf t\u00ednh li\u1ec1u cho ng\u00e0y h\u00f4m sau v\u00e0 cho 2-3 ng\u00e0y ti\u1ebfp theo cho \u0111\u1ebfn khi \u1ed5n \u0111\u1ecbnh. Khi \u0111\u1ea1t li\u1ec1u \u1ed5n \u0111\u1ecbnh, n\u00ean chuy\u1ec3n \u0111\u1ed5i sang s\u1eed d\u1ee5ng d\u1ea1ng gi\u1ea3i ph\u00f3ng k\u00e9o d\u00e0i (LP). C\u1ea7n x\u00e1c \u0111\u1ecbnh l\u1ea1i li\u1ec1u t\u1ed1i \u01b0u b\u1ea5t c\u1ee9 khi n\u00e0o c\u00f3 s\u1ef1 thay \u0111\u1ed5i v\u1ec1 nguy\u00ean nh\u00e2n \u0111au. Kh\u00f4ng c\u00f3 gi\u1edbi h\u1ea1n t\u1ed1i \u0111a li\u1ec1u morphin cho t\u1ea5t c\u1ea3 c\u00e1c \u0111\u01b0\u1eddng d\u00f9ng.<\/p>\n
Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh s\u1eed d\u1ee5ng morphin trong tr\u01b0\u1eddng h\u1ee3p: qu\u00e1 m\u1eabn v\u1edbi thu\u1ed1c, tr\u1ebb em d\u01b0\u1edbi 6 tu\u1ed5i, suy h\u00f4 h\u1ea5p m\u1ea5t b\u00f9, suy gan n\u1eb7ng (c\u00f3 h\u1ed9i ch\u1ee9ng n\u00e3o gan), b\u1ec7nh c\u1ea5p t\u00ednh (ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o, t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd, kh\u00f4ng c\u00f3 th\u00f4ng kh\u00ed ki\u1ec3m so\u00e1t), \u0111\u1ed9ng kinh kh\u00f4ng ki\u1ec3m so\u00e1t, ph\u1ee5 n\u1eef cho con b\u00fa v\u00e0 khi kh\u00f4i ph\u1ee5c ho\u1eb7c ti\u1ebfp t\u1ee5c m\u1ed9t ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb k\u00e9o d\u00e0i sau khi sinh con.<\/p>\n
Ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i c\u1ee7a thu\u1ed1c c\u00f3 th\u1ec3 x\u1ea3y ra l\u00fac kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb: t\u00e1o b\u00f3n dai d\u1eb3ng, bu\u1ed3n ng\u1ee7, bu\u1ed3n n\u00f4n v\u00e0 n\u00f4n. C\u00e1c ph\u1ea3n \u1ee9ng kh\u00e1c c\u00f3 th\u1ec3 bao g\u1ed3m: h\u01b0ng ph\u1ea5n, \u00e1c m\u1ed9ng, \u0111\u1eb7c bi\u1ec7t \u1edf ng\u01b0\u1eddi cao tu\u1ed5i, l\u00fa l\u1eabn, \u1ea3o gi\u00e1c; suy h\u00f4 h\u1ea5p, c\u00f3 th\u1ec3 ng\u1eebng th\u1edf do qu\u00e1 li\u1ec1u; t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd; b\u00ed ti\u1ec3u v\u00e0 \u1ee9 \u0111\u1ecdng n\u01b0\u1edbc ti\u1ec3u trong tr\u01b0\u1eddng h\u1ee3p ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn ho\u1eb7c h\u1eb9p ni\u1ec7u \u0111\u1ea1o; h\u1ed9i ch\u1ee9ng cai thu\u1ed1c khi ng\u1eebng \u0111\u1ed9t ng\u1ed9t. \u1ede ng\u01b0\u1eddi gi\u00e0 hay b\u1ec7nh nh\u00e2n suy th\u1eadn, c\u00f3 nguy c\u01a1 co gi\u1eadt khi d\u00f9ng qu\u00e1 li\u1ec1u ho\u1eb7c t\u0103ng li\u1ec1u qu\u00e1 nhanh.<\/p>\n
Tr\u01b0\u1eddng h\u1ee3p qu\u00e1 li\u1ec1u opioid c\u00f3 th\u1ec3 x\u1ea3y ra suy h\u00f4 h\u1ea5p v\u1edbi d\u1ea5u hi\u1ec7u nh\u1eadn bi\u1ebft l\u00e0 t\u00ecnh tr\u1ea1ng l\u01a1 m\u01a1. N\u1ebfu x\u1ea3y ra t\u00ecnh tr\u1ea1ng n\u00e0y, c\u1ea7n th\u00f4ng kh\u00ed h\u1ed7 tr\u1ee3 v\u00e0 s\u1eed d\u1ee5ng naloxon.<\/p>\n
Morphin ti\u1ec1m \u1ea9n nhi\u1ec1u nguy c\u01a1 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c. Do \u0111\u00e2y l\u00e0 m\u1ed9t thu\u1ed1c g\u00e2y \u1ee9c ch\u1ebf m\u1ea1nh tr\u00ean h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng, kh\u00f4ng n\u00ean k\u1ebft h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c t\u00e1c d\u1ee5ng t\u01b0\u01a1ng t\u1ef1 opioid, thu\u1ed1c an th\u1ea7n, barbiturat, thu\u1ed1c ng\u1ee7 (benzodiazepin), thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m, thu\u1ed1c kh\u00e1ng histamin H1, thu\u1ed1c h\u1ea1 huy\u1ebft \u00e1p trung \u01b0\u01a1ng (methyldopa), baclofen v\u00e0 thalidomid. Trong khi d\u00f9ng morphin, kh\u00f4ng n\u00ean u\u1ed1ng r\u01b0\u1ee3u.<\/p>\n
– C\u00e1c thu\u1ed1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh d\u00f9ng \u0111\u1ed3ng th\u1eddi: buprenorphin v\u00e0 nalbuphin do c\u1ea1nh tranh v\u1edbi morphin, l\u00e0m m\u1ea5t t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra h\u1ed9i ch\u1ee9ng cai thu\u1ed1c.<\/p>\n
– C\u00e1c thu\u1ed1c c\u1ea7n th\u1eadn tr\u1ecdng khi ph\u1ed1i h\u1ee3p: naltrexon, rifampicin, thu\u1ed1c gi\u1ea3m \u0111au opioid kh\u00e1c (alfentanil, codein, dextromoramid, dihydrocodein, fentanyl, oxycodon, phenoperidin, remifentanil, sufentanil, tramadol), c\u00e1c thu\u1ed1c gi\u1ea3m ho gi\u1ed1ng morphin (dextromethorphan, noscapin, pholcodin), thu\u1ed1c gi\u1ea3m ho c\u00f3 b\u1ea3n ch\u1ea5t morphin (codein, ethylmorphin), barbiturat, benzodiazepin, c\u00e1c thu\u1ed1c an th\u1ea7n kh\u00e1c.<\/p>\n
T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a morphin c\u1ea7n l\u01b0u \u00fd:<\/p>\n
\n
T\u00e1o b\u00f3n l\u00e0 t\u00e1c d\u1ee5ng kh\u00f4ng th\u1ec3 tr\u00e1nh kh\u1ecfi v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c d\u1ef1 ph\u00f2ng v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1ch thay \u0111\u1ed5i ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng, sinh ho\u1ea1t v\u00e0 s\u1eed d\u1ee5ng thu\u1ed1c nhu\u1eadn tr\u00e0ng.<\/li>\n
Bu\u1ed3n n\u00f4n (th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n khi m\u1edbi \u0111i\u1ec1u tr\u1ecb), bu\u1ed3n ng\u1ee7, kh\u00f3 ti\u1ec3u, \u0111\u1ed5 m\u1ed3 h\u00f4i v\u00e0 ng\u1ee9a (nh\u1eefng r\u1ed1i lo\u1ea1n n\u00e0y th\u01b0\u1eddng tho\u00e1ng qua).<\/li>\n
An th\u1ea7n qu\u00e1 m\u1ee9c v\u00e0 kh\u00f3 th\u1edf l\u00e0 d\u1ea5u hi\u1ec7u qu\u00e1 li\u1ec1u c\u1ea7n \u0111\u01b0\u1ee3c x\u1eed tr\u00ed b\u1eb1ng c\u00e1ch ng\u1eebng \u0111i\u1ec1u tr\u1ecb ho\u1eb7c ti\u00eam t\u0129nh m\u1ea1ch naloxon.<\/li>\n<\/ul>\n
S\u1eed d\u1ee5ng morphin trong th\u1eddi k\u00ec mang thai ho\u1eb7c cho con b\u00fa:<\/p>\n
\n
N\u1ebfu c\u00f3 thai ho\u1eb7c cho con b\u00fa, morphin c\u00f3 th\u1ec3 k\u00ea cho ng\u01b0\u1eddi m\u1eb9 n\u1ebfu c\u1ea7n thi\u1ebft. Tuy nhi\u00ean, c\u1ea7n l\u01b0u \u00fd h\u1ed9i ch\u1ee9ng cai thu\u1ed1c c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n \u1edf tr\u1ebb em khi s\u1eed d\u1ee5ng l\u00e2u d\u00e0i.<\/li>\n
Li\u1ec1u cao, th\u1eadm ch\u00ed trong \u0111i\u1ec1u tr\u1ecb ng\u1eafn ngay tr\u01b0\u1edbc ho\u1eb7c trong khi sinh, c\u00f3 th\u1ec3 g\u00e2y ra suy h\u00f4 h\u1ea5p \u1edf tr\u1ebb s\u01a1 sinh.<\/li>\n<\/ul>\n
Fentanyl<\/h3>\n
\u0110\u00e2y l\u00e0 thu\u1ed1c gi\u1ea3m \u0111au m\u1ea1nh c\u00f3 c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng t\u01b0\u01a1ng t\u1ef1 nh\u01b0 morphin nh\u01b0ng t\u00e1c d\u1ee5ng nhanh v\u00e0 k\u00e9o d\u00e0i. T\u00e1c d\u1ee5ng gi\u1ea3m \u0111au c\u1ee7a fentanyl m\u1ea1nh h\u01a1n morphin 100 l\u1ea7n. Fentanyl \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho c\u01a1n \u0111au m\u1ea1n t\u00ednh v\u00e0 nghi\u00eam tr\u1ecdng kh\u00f4ng th\u1ec3 gi\u1ea3i quy\u1ebft \u0111\u01b0\u1ee3c b\u1eb1ng thu\u1ed1c gi\u1ea3m \u0111au opioid kh\u00e1c. M\u1ed9t s\u1ed1 ch\u1ebf ph\u1ea9m fentanyl gi\u1ea3i ph\u00f3ng k\u00e9o d\u00e0i t\u1eeb d\u1ea1ng b\u00e0o ch\u1ebf h\u1ea5p thu qua da \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n \u0111\u1ec3 thay th\u1ebf cho \u0111\u01b0\u1eddng u\u1ed1ng khi c\u01a1n \u0111au \u1ed5n \u0111\u1ecbnh v\u00e0 c\u00f3 \u00edt t\u00e1c d\u1ee5ng ph\u1ee5 h\u01a1n so v\u1edbi morphin.<\/p>\n
Khi b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng fentanyl, ph\u1ea3i c\u00e2n nh\u1eafc \u0111\u1ebfn ph\u00e1c \u0111\u1ed3 opioid tr\u01b0\u1edbc \u0111\u00f3. C\u1ea7n xem x\u00e9t kh\u1ea3 n\u0103ng xu\u1ea5t hi\u1ec7n nguy c\u01a1 l\u1ec7 thu\u1ed9c thu\u1ed1c, t\u00ecnh tr\u1ea1ng b\u1ec7nh nh\u00e2n, v\u00e0 m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a b\u1ec7nh. Do \u0111\u00f3, li\u1ec1u l\u01b0\u1ee3ng kh\u00f4ng n\u00ean c\u1ed1 \u0111\u1ecbnh m\u00e0 \u0111\u01b0\u1ee3c t\u00ednh to\u00e1n d\u1ef1a v\u00e0o t\u1ea5t c\u1ea3 c\u00e1c ti\u00eau ch\u00ed tr\u00ean.<\/p>\n
Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh d\u00f9ng fentanyl trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p: qu\u00e1 m\u1eabn c\u1ea3m, \u0111au c\u1ea5p t\u00ednh ng\u1eafn sau ph\u1eabu thu\u1eadt (do kh\u00f4ng th\u1ec3 ch\u1ec9nh li\u1ec1u trong m\u1ed9t th\u1eddi gian ng\u1eafn), r\u1ed1i lo\u1ea1n nghi\u00eam tr\u1ecdng h\u1ec7 th\u1ea7n kinh v\u00e0 ng\u01b0\u1eddi b\u1ec7nh ch\u01b0a bao gi\u1edd d\u00f9ng opioid.<\/p>\n
Fentanyl c\u00f3 nhi\u1ec1u t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n, bao g\u1ed3m: tr\u00ean tim (nh\u1ecbp tim nhanh\/nh\u1ecbp tim ch\u1eadm, th\u1eadm ch\u00ed lo\u1ea1n nh\u1ecbp); tr\u00ean th\u1ea7n kinh (bao g\u1ed3m nh\u1ee9c \u0111\u1ea7u v\u00e0 ch\u00f3ng m\u1eb7t th\u01b0\u1eddng xuy\u00ean); tr\u00ean da v\u00e0 m\u00f4 d\u01b0\u1edbi da (ng\u1ee9a, ra m\u1ed3 h\u00f4i, ph\u1ea3n \u1ee9ng da t\u1ea1i ch\u1ed7); tr\u00ean ti\u00eau h\u00f3a (bu\u1ed3n n\u00f4n, n\u00f4n, t\u00e1o b\u00f3n, kh\u00f4 mi\u1ec7ng, r\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a); tr\u00ean t\u00e2m th\u1ea7n (bu\u1ed3n ng\u1ee7, ch\u00e1n \u0103n, c\u0103ng th\u1eb3ng).<\/p>\n
M\u1ed9t s\u1ed1 \u0111i\u1ec3m l\u01b0u \u00fd khi s\u1eed d\u1ee5ng thu\u1ed1c:<\/p>\n
\n
C\u1ea7n \u0111i\u1ec1u tr\u1ecb th\u00eam b\u1eb1ng d\u1ea1ng gi\u1ea3i ph\u00f3ng t\u1ee9c th\u00ec khi xu\u1ea5t hi\u1ec7n c\u01a1n \u0111au \u0111\u1ed9t ng\u1ed9t;<\/li>\n
Ch\u00fa \u00fd nguy c\u01a1 suy h\u00f4 h\u1ea5p, c\u00f3 th\u1ec3 t\u1ed3n t\u1ea1i dai d\u1eb3ng k\u1ec3 c\u1ea3 sau khi ng\u1eebng thu\u1ed1c gi\u1ea3i ph\u00f3ng k\u00e9o d\u00e0i (mi\u1ebfng d\u00e1n) v\u00e0 th\u01b0\u1eddng g\u1eb7p \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh ph\u1ed5i m\u1ea1n t\u00ednh. T\u00ecnh tr\u1ea1ng gi\u1ea3m th\u00f4ng kh\u00ed n\u1eb7ng, \u0111e d\u1ecda t\u00ednh m\u1ea1ng, c\u00f3 th\u1ec3 x\u1ea3y ra tr\u00ean tr\u1ebb nh\u1ecf ch\u01b0a bao gi\u1edd s\u1eed d\u1ee5ng opioid;<\/li>\n
Nguy c\u01a1 t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn m\u1ea5t \u00fd th\u1ee9c, ho\u1eb7c h\u00f4n m\u00ea;<\/li>\n
Nguy c\u01a1 h\u1ea1 huy\u1ebft \u00e1p, \u0111\u1eb7c bi\u1ec7t trong tr\u01b0\u1eddng h\u1ee3p gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n;<\/li>\n
Nguy c\u01a1 co gi\u1eadt kh\u00f4ng do \u0111\u1ed9ng kinh \u1edf b\u1ec7nh nh\u00e2n nh\u01b0\u1ee3c c\u01a1;<\/li>\n
Suy gan v\u00e0 suy th\u1eadn;<\/li>\n
H\u1ea5p thu fentanyl c\u00f3 th\u1ec3 t\u0103ng l\u00ean \u1edf b\u1ec7nh nh\u00e2n ti\u1ebfp x\u00fac v\u1edbi nhi\u1ec7t;<\/li>\n
Th\u1eddi gian b\u00e1n th\u1ea3i c\u1ee7a fentanyl k\u00e9o d\u00e0i \u1edf b\u1ec7nh nh\u00e2n cao tu\u1ed5i;<\/li>\n<\/ul>\n
L\u01b0u \u00fd khi s\u1eed d\u1ee5ng thu\u1ed1c tr\u00ean ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 cho con b\u00fa:<\/p>\n
\n
Kh\u00f4ng n\u00ean d\u00f9ng cho ph\u1ee5 n\u1eef c\u00f3 thai do thi\u1ebfu d\u1eef li\u1ec7u v\u1ec1 \u0111\u1ed9 an to\u00e0n tr\u00ean \u0111\u1ed1i t\u01b0\u1ee3ng n\u00e0y;<\/li>\n
Kh\u00f4ng n\u00ean d\u00f9ng cho ph\u1ee5 n\u1eef cho con b\u00fa v\u00ec thu\u1ed1c v\u00e0o \u0111\u01b0\u1ee3c s\u1eefa m\u1eb9.<\/li>\n<\/ul>\n
C\u00e1c t\u01b0\u01a1ng t\u00e1c thu\u1ed1c c\u1ee7a fentanyl t\u01b0\u01a1ng t\u1ef1 morphin.<\/p>\n
Oxycodon<\/h3>\n
Oxycodon l\u00e0 m\u1ed9t ch\u1ee7 v\u1eadn opioid, c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3m \u0111au t\u01b0\u01a1ng t\u1ef1 nh\u01b0 morphin. Hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb ch\u1ee7 y\u1ebfu l\u00e0 gi\u1ea3m \u0111au, gi\u1ea3i lo \u00e2u, ch\u1ed1ng ho v\u00e0 an th\u1ea7n. Thu\u1ed1c gi\u1ea3m \u0111au n\u00e0y \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u00e1c c\u01a1n \u0111au nghi\u00eam tr\u1ecdng ch\u1ec9 c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c gi\u1ea3m \u0111au opioid m\u1ea1nh kh\u00e1c, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u0111au c\u00f3 ngu\u1ed3n g\u1ed1c ung th\u01b0. C\u00e1c d\u1ea1ng u\u1ed1ng t\u00e1c d\u1ee5ng nhanh \u0111\u01b0\u1ee3c d\u00f9ng m\u1ed7i 4-6 gi\u1edd. D\u1ea1ng gi\u1ea3i ph\u00f3ng k\u00e9o d\u00e0i c\u00f3 th\u1eddi gian t\u00e1c d\u1ee5ng kho\u1ea3ng 12 gi\u1edd. Ngo\u00e0i ra c\u00f2n c\u00f3 d\u1ea1ng ti\u00eam 10 v\u00e0 50 mg\/ml.<\/p>\n
T\u00e1c gi\u1ea3:<\/h2>\n
D\u01b0\u01a1ng Th\u1ecb Thanh Mai, L\u00e2m Ho\u00e0ng Anh, Tr\u1ea7n Ph\u01b0\u01a1ng Th\u1ea3o, Ho\u00e0ng H\u00e0 Ph\u01b0\u01a1ng – Trung T\u00e2m C\u1ea3nh Gi\u00e1c D\u01b0\u1ee3c Qu\u1ed1c Gia.<\/p>\n
<\/p>\n
<\/p>\n","protected":false},"excerpt":{"rendered":"
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