{"id":78532,"date":"2024-05-30T14:17:27","date_gmt":"2024-05-30T07:17:27","guid":{"rendered":"https:\/\/vnras.com\/drug\/?p=78532"},"modified":"2024-05-30T16:45:25","modified_gmt":"2024-05-30T09:45:25","slug":"hoi-chung-stevens-johnson","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/hoi-chung-stevens-johnson\/","title":{"rendered":"H\u1ed9i ch\u1ee9ng Stevens-Johnson l\u00e0 g\u00ec? Nguy\u00ean nh\u00e2n, tri\u1ec7u ch\u1ee9ng v\u00e0 c\u00e1ch \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"<p><strong><a href=\"https:\/\/vnras.com\/drug\/hoi-chung-stevens-johnson\/\">H\u1ed9i ch\u1ee9ng Stevens-Johnson<\/a> v\u1edbi t\u1ef7 l\u1ec7 m\u1eafc hi\u1ebfm g\u1eb7p 5\/1.000.000 ca nh\u01b0ng c\u00f3 nguy c\u01a1 g\u00e2y t\u1eed vong cao. B\u1ec7nh c\u00f3 th\u1ec3 kh\u1edfi ph\u00e1t \u1edf b\u1ea5t k\u1ef3 \u0111\u1ed1i t\u01b0\u1ee3ng \u1edf \u0111\u1ed9 tu\u1ed5i n\u00e0o, do \u0111\u00f3 c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb s\u1edbm ngay khi c\u00f3 d\u1ea5u hi\u1ec7u \u0111\u1ec3 tr\u00e1nh bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m. H\u00e3y c\u00f9ng ch\u00fang t\u00f4i t\u00ecm hi\u1ec3u r\u00f5 h\u01a1n v\u1ec1 nguy\u00ean nh\u00e2n, tri\u1ec7u ch\u1ee9ng v\u00e0 c\u00e1ch \u0111i\u1ec1u tr\u1ecb Stevens-Johnson trong b\u00e0i vi\u1ebft sau \u0111\u00e2y.<\/strong><\/p>\n<h2>T\u00d3M T\u1eaeT<\/h2>\n<p>SJS l\u00e0 ph\u1ea3n \u1ee9ng da hi\u1ebfm g\u1eb7p trung gian mi\u1ec5n d\u1ecbch g\u00e2y b\u1ecdng n\u01b0\u1edbc v\u00e0 bong l\u1edbp th\u01b0\u1ee3ng b\u00ec lan r\u1ed9ng. SJS nh\u00ecn chung \u0111\u01b0\u1ee3c k\u00edch ho\u1ea1t do c\u00e1c thu\u1ed1c (eg, c\u00e1c kh\u00e1ng sinh nh\u1ea5t \u0111\u1ecbnh v\u00e0 c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh). B\u1ec7nh nh\u00e2n bi\u1ec3u hi\u1ec7n 1-3 tu\u1ea7n sau ti\u1ebfp x\u00fac v\u1edbi thu\u1ed1c c\u00f3 bi\u1ec3u hi\u1ec7n s\u1ed1t v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c gi\u1ed1ng c\u00fam. T\u1ed5n th\u01b0\u01a1ng da m\u1ee5n n\u01b0\u1edbc (vesiculobullous), \u0111au t\u0103ng v\u00e0 sau c\u00f9ng h\u00ecnh th\u00e0nh c\u00e1c \u1ed5 lo\u00e9t lan r\u1ed9ng, b\u1ecfng n\u00f4ng, l\u1edbn. M\u00e0ng ni\u00eam m\u1ea1c c\u0169ng \u0111\u1eb7c tr\u01b0ng ch\u1ecbu \u1ea3nh h\u01b0\u1edfng v\u00e0 b\u00eanh nh\u00e2n bi\u00eau hi\u1ec7n v\u1edbi lo\u00e9t mi\u1ec7ng, lo\u00e9t sinh d\u1ee5c, v\u00e0\/ho\u1eb7c vi\u00eam k\u1ebft m\u1ea1c n\u1eb7ng. Khi &gt; 30% v\u00f9ng da ch\u1ecbu \u1ea3nh h\u01b0\u1edfng, b\u1ec7nh l\u00fd \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 TEN. SJS v\u00e0 TEN li\u00ean quan \u0111\u1ebfn t\u1ec9 l\u1ec7 t\u1eed vong cao, v\u00ec g\u00e2y gi\u1ea3m th\u1ec3 t\u00edch v\u00e0\/ho\u1eb7c s\u1ed1c nhi\u1ec5m tr\u00f9ng. Ch\u1ea9n \u0111o\u00e1n ch\u1ee7 y\u1ebfu d\u1ef1a v\u00e0o l\u00e2m s\u00e0ng, nh\u01b0ng sinh thi\u1ebft da c\u00f3 th\u1ec3 h\u1ed7 tr\u01a1 ch\u1ea9n \u0111o\u00e1n v\u00e0 lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c. Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb quan tr\u1ecdng nh\u1ea5t l\u00e0 ng\u01b0ng c\u00e1c thu\u1ed1c nghi ng\u1edd. \u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 (b\u00f9 d\u1ecbch h\u1ed3i s\u1ee9c, kh\u00e1ng sinh) c\u00f3 th\u1ec3 c\u00e2n trong \u0111i\u1ec1u tr\u1ecb s\u1ed1c.<\/p>\n<h2>\u0110\u1ecaNH NGH\u0128A<\/h2>\n<ul>\n<li>Ph\u1ea3n \u1ee9ng da hi\u1ebfm g\u1eb7p trung gian mi\u1ec5n d\u1ecbch g\u00e2y bong th\u01b0\u1ee3ng b\u00ec lan r\u1ed9ng, c\u00f3 t\u1ec9 l\u1ec7 t\u1eed vong cao<\/li>\n<li>SJS v\u00e0 TEN kh\u00e1c nhau v\u1ec1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u00eanh (d\u1ef1a v\u00e0o di\u1ec7n t\u00edch b\u1ec1 m\u1eb7t v\u00f9ng da t\u1ed5n th\u01b0\u01a1ng)\n<ul>\n<li>&lt;10%-SJS<\/li>\n<li>10-30%-SJS\/TEN ch\u1ed3ng l\u1eafp<\/li>\n<li>&gt;30%-TEN (SJS n\u1eb7ng)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h2>D\u1ecaCH T\u1ec4<\/h2>\n<ul>\n<li>T\u1ec9 l\u1ec7 m\u1eafc h\u00e0ng n\u0103m: kho\u1ea3ng 5\/1.000.000 ca<\/li>\n<li>\u0110\u1ed9 tu\u1ed5i kh\u1edfi ph\u00e1t: b\u1ea5t k\u1ef3 \u0111\u1ed9 tu\u1ed5i n\u00e0o.<\/li>\n<li>Gi\u1edbi: N\u1eef &gt; Nam (5:3)<\/li>\n<\/ul>\n<h2>NGUY\u00caN NH\u00c2N<\/h2>\n<p>Y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y<\/p>\n<ul>\n<li>Thu\u1ed1c (y\u1ebfu t\u1ed1 kh\u1edfi ph\u00e1t th\u01b0\u1eddng g\u1eb7p nh\u1ea5t, kho\u1ea3ng 80% c\u00e1c tr\u01b0\u1eddng h\u1ee3p)\n<ul>\n<li>Kh\u00e1ng sinh: sulfonamide (eg, TMP\/SMX), aminopenicillins, fifampicin<\/li>\n<li>Corticosteroids<\/li>\n<li>C\u00e1c thu\u1ed1c antiretroviral (eg, nevirapine)<\/li>\n<li>Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9ng kinh: phenytoin, phenobarbital, lamotrigine, valproic acid, carbamazepine, ethosuximide.<\/li>\n<li>Oxicam NSAID (v\u00ed d\u1ee5: piroxicam)<\/li>\n<li>Allopurinol<\/li>\n<li>Sulfasalazine<\/li>\n<\/ul>\n<\/li>\n<li>Nhi\u1ec5m tr\u00f9ng: mycoplasma, CMV, herpes<\/li>\n<li>Hi\u1ebfm: vaccine, th\u1ea3i gh\u00e9p<\/li>\n<li>V\u00f4 c\u0103n<\/li>\n<\/ul>\n<p>Y\u1ebfu t\u1ed1 nguy c\u01a1<\/p>\n<ul>\n<li>Nhi\u1ec5m HIV<\/li>\n<li>Ki\u1ec3u h\u00ecnh HLA nh\u1ea5t \u0111\u1ecbnh<\/li>\n<li>Gen m\u00e3 h\u00f3a cho men CYP<\/li>\n<\/ul>\n<h2>SINH L\u00dd B\u1ec6NH<\/h2>\n<p>B\u00eanh sinh ch\u01b0a \u0111\u01b0\u1ee3c hi\u1ec3u r\u00f5 nh\u01b0ng \u0111\u01b0\u1ee3c cho l\u00e0 li\u00ean quan \u0111\u1ebfn ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn mu\u1ed9n (type IV): t\u0103ng ho\u1ea1t \u0111\u1ed9ng t\u1ebf b\u00e0o cytotoxic T-cell \u0111\u1eb7c hi\u1ec7u cho thu\u1ed1c -&gt; gi\u1ea3i ph\u00f3ng granulysin (m\u1ed9t protein ly gi\u1ea3i t\u1ebf b\u00e0o) kh\u00f4ng r\u00f5 c\u01a1 ch\u1ebf -&gt; ph\u00e1 h\u1ee7y keratinocytes.<\/p>\n<h2>\u0110\u1eb6C \u0110I\u1ec2M L\u00c2M S\u00c0NG<\/h2>\n<p>Pha ti\u1ec1n tri\u1ec7u (b\u1eaft \u0111\u1ea7u 1-3 tu\u1ea7n sau khi d\u00f9ng thu\u1ed1c): s\u1ed1t cao (th\u01b0\u1eddng &gt; 39\u00b0C), m\u1ec7t m\u1ecfi, \u0111au h\u1ecdng, \u0111au c\u01a1, v\u00e0\/ho\u1eb7c \u0111au kh\u1edbp.<\/p>\n<p>C\u00e1c t\u1ed5n th\u01b0\u01a1ng da xu\u1ea5t hi\u1ec7n 1-3 ng\u00e0y sau khi kh\u1ecfi ph\u00e1t tri\u1ec7u ch\u1ee9ng ti\u1ec1n tri\u1ec7u:<\/p>\n<ul>\n<li>Bi\u1ec3u hi\u00ean theo tr\u00ecnh t\u1ef1:<\/li>\n<\/ul>\n<ol>\n<li style=\"list-style-type: none;\">\n<ol>\n<li>D\u00e1t \u0111\u1ecf (purpuric), \u0111au: C\u00f3 th\u1ec3 targetoid, th\u01b0\u1eddng \u1edf m\u1eb7t v\u00e0 th\u00e2n m\u00ecnh<\/li>\n<li>T\u1ed5n th\u01b0\u01a1ng h\u00ecnh th\u00e0nh b\u1ecdng n\u01b0\u1edbc v\u00e0 ho\u1eb7c m\u1ee5n n\u01b0\u1edbc, Nikolsky (+)<\/li>\n<li>Ho\u1ea1i t\u1eed th\u01b0\u1ee3ng b\u1ecb lan r\u1ed9ng v\u00e0 tr\u1ee3t da (nh\u01b0 b\u1ecfng n\u00f4ng di\u1ec7n r\u1ed9ng)<\/li>\n<li>L\u00e0nh: 1-2 tu\u1ea7n sau khi tr\u1ee3t th\u01b0\u1ee3ng b\u00ec v\u00e0 ho\u00e0n to\u00e0n trong v\u00e0i tu\u1ea7n<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<ul>\n<li>M\u00e0ng ni\u00eam m\u1ea1c: lu\u00f4n lu\u00f4n ch\u1ecbu \u1ea3nh h\u01b0\u1edfng<\/li>\n<\/ul>\n<ol>\n<li style=\"list-style-type: none;\">\n<ol>\n<li>Ni\u00eam m\u1ea1c mi\u1ec7ng &amp; h\u1ecdng: vi\u00eam mi\u1ec7ng, l\u01b0\u1ee1i, lo\u00e9t mi\u1ec7ng<\/li>\n<li>Vi\u00eam k\u1ebft m\u1ea1c n\u0103ng, lo\u00e9t gi\u00e1c m\u1ea1c: s\u1ee3 \u00e1nh s\u00e1ng, \u0111au m\u1eaft<\/li>\n<li>Vi\u00eam ni\u1ec7u \u0111\u1ea1o, vi\u00eam sinh d\u1ee5c v\u00e0\/ho\u1eb7c lo\u00e9t quanh h\u1eadu m\u00f4n<\/li>\n<li>Lo\u00e9t th\u1ef1c qu\u1ea3n v\u00e0\/ho\u1eb7c h\u1eb9p (\u00edt g\u1eb7p), nu\u1ed1t kh\u00f3<\/li>\n<li>T\u1ed5n th\u01b0\u01a1ng kh\u00ed qu\u1ea3n (\u00edt g\u1eb7p)<\/li>\n<li>T\u1ed5n th\u01b0\u01a1ng ru\u1ed9t non, \u0111\u1ea1i tr\u00e0ng (hi\u1ebfm g\u1eb7p): ti\u00eau ch\u1ea3y, ti\u00eau ph\u00e2n \u0111en, l\u1ecfng ru\u1ed9t, th\u1ee7ng ru\u1ed9t<\/li>\n<li>C\u00f3 th\u1ec3 ph\u00e1t tri\u1ec3n th\u00e0nh s\u1ed1c<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<p>\u0110i\u1ec3m quan tr\u1ecdng \u0111\u1ec3 ph\u00e2n bi\u1ec7t SJS v\u1edbi SSSS l\u00e0 t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c.<\/p>\n<h2>CH\u1ea8N \u0110O\u00c1N<\/h2>\n<p>SJS ch\u1ee7 y\u1ebfu l\u00e0 ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng (d\u1ef1a v\u00e0o ti\u1ec1n s\u1eed d\u00f9ng thu\u1ed9c v\u00e0 nhi\u1ec5m tr\u00f9ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 HIV) \u0111\u01b0\u1ee3c h\u1ed7 tr\u1ee3 nh\u1edd sinh thi\u1ebft da v\u00e0 c\u00e1c ch\u1ec9 s\u1ed1 x\u00e9t nghi\u1ec7m kh\u00e1c.<\/p>\n<ul>\n<li>Sinh thi\u1ebft da: ho\u1ea1i t\u1eed keratinocyte, th\u00e2m nhi\u1ec5m eosinophil, subepidermal split<\/li>\n<li>Gi\u1ea3m b\u1ea1ch c\u1ea7u<\/li>\n<li>T\u0103ng BUN<\/li>\n<li>T\u0103ng \u0111\u01b0\u1eddng m\u00e1u<\/li>\n<li>T\u0103ng AST, ALT<\/li>\n<\/ul>\n<h2>\u0110I\u1ec0U TR\u1eca<\/h2>\n<ul>\n<li>Ng\u01b0ng c\u00e1c thu\u1ed1c nghi ng\u1edd<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3: gi\u1ed1ng v\u1edbi b\u1ecfng\n<ul>\n<li>B\u00f9 d\u1ecbch h\u1ed3i s\u1ee9c v\u00e0 thay th\u1ebf l\u01b0\u01a1ng d\u1ecbch m\u1ea5t ti\u1ebfp theo<\/li>\n<li>Qu\u1ea3n l\u00fd v\u1ebft th\u01b0\u01a1ng<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb kh\u00e1ng sinh trong tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m tr\u00f9ng huy\u1ebft<\/li>\n<\/ul>\n<\/li>\n<li>Cyclosporin c\u00f3 th\u1ec3 l\u00e0m ch\u1eadm di\u1ec5n bi\u1ebfn<\/li>\n<li>H\u1ed9i ch\u1ea9n chuy\u00ean khoa da li\u1ec5u &amp; m\u1eaft<\/li>\n<\/ul>\n<p>Kh\u00f4ng c\u00f3 \u0111i\u1ec1u tr\u1ecb tuy\u1ec7t \u0111\u1ed1i. Ng\u01b0ng thu\u1ed1c s\u1edbm v\u00e0 \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 li\u00ean quan \u0111\u1ebfn c\u1ea3i thi\u1ec7n k\u1ebft c\u1ee5c.<\/p>\n<h2>C\u00c1C THU\u1ed0C \u0110I\u1ec0U TR\u1eca<\/h2>\n<ul>\n<li>Steroids: \u0110i\u1ec1u tr\u1ecb s\u1edbm v\u1edbi steroids li\u00ean quan \u0111\u1ebfn c\u1ea3i thi\u1ec7n k\u1ebft c\u1ee5c. Steroid u\u1ed1ng 24h-48h t\u1eeb l\u00fac kh\u1edfi ph\u00e1t b\u1ec7nh v\u00e0 gi\u1ea3m d\u1ea7n trong 7-10 ng\u00e0y sau \u0111\u00f3 cho k\u1ebft qu\u1ea3 t\u1ed1t nh\u1ea5t. Dexamethasone 8-16 mg\/d \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o, nh\u01b0ng li\u1ec1u cao h\u01a1n \u0111\u01b0\u1ee3c xem x\u00e9t n\u1ec1u c\u1ea7n thi\u1ebft. Trong tr\u01b0\u1eddng h\u1ee3p \u0111\u00e1p \u1ee9ng ch\u01b0a \u0111\u1ee7, li\u1ec1u corticosteroid c\u00f3 th\u1ec3 t\u0103ng 4mg trong ng\u00e0y ti\u1ebfp theo v\u00e0 \u0111\u00e1nh gi\u00e1 l\u1ea1i trong ng\u00e0y ti\u1ebfp theo. Methylprednisolon \u0111i\u1ec1u tr\u1ecb t\u1ea5n c\u00f4ng (MPT) \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y gi\u00fap gi\u1ea3m n\u1ed3ng \u0111\u1ed9 cytokine ti\u1ec1n vi\u00eam nh\u01b0 interferon-, TNF-a, IL-6 v\u00e0 c\u1ea3i thi\u00ean t\u1ec9 l\u1ec7 s\u1ed1ng c\u00f2n \u1edf b\u1ec7nh nh\u00e2n TEN. Nh\u01b0ng v\u00e0i d\u1eef li\u1ec7u kh\u00e1c cho th\u1ea5y vi\u1ec7c d\u00f9ng steroids li\u00ean quan \u0111\u1ebfn t\u0103ng th\u1eddi gian n\u1eb1m vi\u00ean. Do \u0111\u00f3, vi\u1ec7c d\u00f9ng corticosteroid trong TEN v\u1eabn c\u00f2n tranh c\u00e3i.<\/li>\n<li>Cyclosporin: Thu\u1ed1c \u0111i\u1ec1u h\u00f2a mi\u1ec5n d\u1ecbch th\u1ee9 hai trong \u0111i\u1ec1u tr\u1ecb SJS-TEN. N\u00f3 t\u00e1c \u0111\u1ed9ng l\u00ean granulysin, m\u1ed9t ch\u1ea5t trung gian quan tr\u1ecdng c\u1ee7a ch\u1ebft theo chu tr\u00ecnh keratinocytes, v\u00e0 do \u0111\u00f3, gi\u00fap d\u1eebng di\u1ec5n ti\u1ebfn b\u1ec7nh. Trong m\u1ed9t nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y t\u1eeb \u1ea4n \u0110\u1ed9, cyclosporin li\u1ec1u 3 mg\/kg li\u1ec1u chia 3 l\u1ea7n trong 7 ng\u00e0y v\u00e0 sau \u0111\u00f3 gi\u1ea3m d\u1ea7n trong 7 ng\u00e0y ti\u1ebfp theo.<\/li>\n<li>Tacrolimus: G\u1ea7n \u0111\u00e2y, 1 b\u1ec7nh nh\u00e2n SJS do phenytoin \u0111\u01b0\u1ee3c cho tacrolimus li\u1ec1u 0,12 mg\/kg\/d chia 2 l\u1ea7n. B\u1ec7nh nh\u00e2n cho th\u1ea5y c\u1ea3i thi\u1ec7n \u0111\u00e1ng k\u1ec3 trong v\u00f2ng 48 gi\u1edd. Tacrolimus gi\u1ea3m d\u1ea7n sau 3 ng\u00e0y, v\u1edbi t\u1ed1c \u0111\u1ed9 0,5 mg\/kg\/d.<\/li>\n<li>IVIG: Theo c\u00e1c kh\u1ea3o s\u00e1t g\u1ea7n \u0111\u00e2y, \u0111\u00e2y l\u00e0 thu\u1ed1c \u0111i\u1ec1u h\u00f2a mi\u1ec5n d\u1ecbch th\u01b0\u1eddng d\u00f9ng nh\u1ea5t, \u0111\u01b0\u1ee3c d\u00f9ng trong \u0111i\u1ec1u tr\u1ecb SJS-TEN. N\u00f3 \u0111\u01b0\u1ee3c d\u00f9ng v\u1edbi li\u1ec1u 2g\/kg. IVIG li\u1ec1u th\u1ea5p d\u01b0\u1eddng nh\u01b0 an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 trong TEN. K\u1ebft h\u1ee3p IVIG li\u1ec1u th\u1ea5p v\u00e0 steroids hi\u1ec7u qu\u1ea3 h\u01a1n v\u00ec n\u00f3 l\u00e0m gi\u1ea3m t\u1ec9 l\u1ec7 t\u1eed vong v\u00e0 gi\u00fap ph\u1ee5c h\u1ed3i nhanh so v\u1edbi steroid \u0111\u01a1n \u0111\u1ed9c trong TEN<\/li>\n<li>C\u00e1c \u0111i\u1ec1u tr\u1ecb kh\u00e1c: Cyclophosphamid, l\u1ecdc huy\u1ebft t\u01b0\u01a1ng, NAC t\u0129nh m\u1ea1ch, c\u00e1c thu\u1ed1c sinh h\u1ecdc&#8230;<\/li>\n<\/ul>\n<h2>T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/h2>\n<ol>\n<li>Amboss 2024<\/li>\n<li>Kumar R, Das A, Das S. Management of Stevens-Johnson Syndrome-Toxic Epidermal Necrolysis: Looking Beyond Guidelines, th\u1eddi gian truy c\u1eadp t\u1eeb 30\/05\/2024 t\u1eeb <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29692452\/\" rel=\"noopener\">https:\/\/pubmed.ncbi.nlm.nih.gov\/29692452\/<\/a><\/li>\n<li>T\u00e0i li\u1ec7u v\u1ec1 H\u1ed9i ch\u1ee9ng Stevens-Johnson, t\u1ea3i file <a href=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2024\/05\/Stevens-Johnson-Syndrome-vnras.pdf\">t\u1ea1i \u0111\u00e2y.<\/a><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>H\u1ed9i ch\u1ee9ng Stevens-Johnson v\u1edbi t\u1ef7 l\u1ec7 m\u1eafc hi\u1ebfm g\u1eb7p 5\/1.000.000 ca nh\u01b0ng c\u00f3 nguy c\u01a1 g\u00e2y t\u1eed vong cao. B\u1ec7nh c\u00f3 th\u1ec3 kh\u1edfi ph\u00e1t \u1edf b\u1ea5t k\u1ef3 \u0111\u1ed1i t\u01b0\u1ee3ng \u1edf \u0111\u1ed9 tu\u1ed5i n\u00e0o, do \u0111\u00f3 c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb s\u1edbm ngay khi c\u00f3 d\u1ea5u hi\u1ec7u \u0111\u1ec3 tr\u00e1nh bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m. H\u00e3y c\u00f9ng ch\u00fang t\u00f4i [&#8230;]\n","protected":false},"author":1,"featured_media":78534,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-78532","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/78532","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=78532"}],"version-history":[{"count":2,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/78532\/revisions"}],"predecessor-version":[{"id":78537,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/78532\/revisions\/78537"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/78534"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=78532"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=78532"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=78532"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}