{"id":8373,"date":"2019-04-22T08:27:59","date_gmt":"2019-04-22T01:27:59","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=8373"},"modified":"2019-04-26T08:37:22","modified_gmt":"2019-04-26T01:37:22","slug":"tramadol-lien-quan-den-ty-le-tu-vong-cao-hon-so-voi-nsaid-trong-dieu-tri-thoai-hoa-khop","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/tramadol-lien-quan-den-ty-le-tu-vong-cao-hon-so-voi-nsaid-trong-dieu-tri-thoai-hoa-khop\/","title":{"rendered":"Tramadol li\u00ean quan \u0111\u1ebfn t\u1ef7 l\u1ec7 t\u1eed vong cao h\u01a1n so v\u1edbi NSAID trong \u0111i\u1ec1u tr\u1ecb tho\u00e1i h\u00f3a kh\u1edbp"},"content":{"rendered":"<p>Trong m\u1ed9t nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 tr\u00ean h\u01a1n 88.000 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u0103ng tr\u00ean t\u1ea1p ch\u00ed JAMA g\u1ea7n \u0111\u00e2y, <strong>s\u1eed d\u1ee5ng tramadol li\u00ean quan v\u1edbi t\u1ef7 l\u1ec7 t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n cao h\u01a1n so v\u1edbi NSAID<\/strong> \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n cao tu\u1ed5i b\u1ecb tho\u00e1i h\u00f3a kh\u1edbp.<\/p>\n<h2>T\u1ed5ng quan<\/h2>\n<p>Tramadol l\u00e0 l\u1ef1a ch\u1ecdn thay th\u1ebf cho c\u00e1c opioid kh\u00e1c trong qu\u1ea3n l\u00fd \u0111au \u1edf b\u1ec7nh nh\u00e2n tho\u00e1i h\u00f3a kh\u1edbp. C\u00e1c h\u01b0\u1edbng d\u1eabn m\u1edbi nh\u1ea5t c\u1ee7a Vi\u1ec7n Ph\u1eabu thu\u1eadt ch\u1ec9nh h\u00ecnh Hoa K\u1ef3 (AAOS) v\u00e0 Tr\u01b0\u1eddng ban Th\u1ea5p kh\u1edbp h\u1ecdc Hoa K\u1ef3 (ACR) \u0111\u1ec1u khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng tramadol ho\u1eb7c NSAID l\u00e0 l\u1ef1a ch\u1ecdn \u0111\u1ea7u tay trong tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i. C\u00e1c nghi\u00ean c\u1ee9u tr\u01b0\u1edbc \u0111\u00e2y \u0111\u00e3 ti\u1ebfn h\u00e0nh so s\u00e1nh tramadol v\u00e0 NSAID v\u1ec1 hi\u1ec7u qu\u1ea3 gi\u1ea3m \u0111au c\u0169ng nh\u01b0 t\u00e1c \u0111\u1ed9ng c\u00f3 h\u1ea1i. Tuy nhi\u00ean, d\u1ef1a tr\u00ean c\u00e1c b\u1eb1ng ch\u1ee9ng hi\u1ec7n t\u1ea1i, v\u1eabn ch\u01b0a th\u1ec3 k\u1ebft lu\u1eadn m\u1ed1i li\u00ean quan gi\u1eefa tramadol v\u00e0 t\u1ec9 l\u1ec7 t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n so v\u1edbi c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au kh\u00e1c.<\/p>\n<figure id=\"attachment_8376\" aria-describedby=\"caption-attachment-8376\" style=\"width: 450px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-8376\" src=\"https:\/\/www.vnras.com\/drug\/wp-content\/uploads\/2019\/04\/tramadol_1.jpg\" alt=\"tramadol\" width=\"450\" height=\"450\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/04\/tramadol_1.jpg 450w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/04\/tramadol_1-280x280.jpg 280w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/04\/tramadol_1-400x400.jpg 400w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/04\/tramadol_1-350x350.jpg 350w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/04\/tramadol_1-100x100.jpg 100w\" sizes=\"auto, (max-width: 450px) 100vw, 450px\" \/><figcaption id=\"caption-attachment-8376\" class=\"wp-caption-text\">H\u00ecnh \u1ea3nh: C\u00f4ng th\u1ee9c c\u1ea5u t\u1ea1o c\u1ee7a tramadol<\/figcaption><\/figure>\n<h2>Thi\u1ebft k\u1ebf nghi\u00ean c\u1ee9u<\/h2>\n<p>Nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 s\u1eed d\u1ee5ng c\u01a1 s\u1edf d\u1eef li\u1ec7u \u0111i\u1ec7n t\u1eed Health Improvement Network c\u1ee7a Anh.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-8374 aligncenter\" src=\"https:\/\/www.vnras.com\/drug\/wp-content\/uploads\/2019\/04\/tramadol.jpg\" alt=\"tramadol\" width=\"450\" height=\"300\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/04\/tramadol.jpg 450w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/04\/tramadol-350x233.jpg 350w\" sizes=\"auto, (max-width: 450px) 100vw, 450px\" \/><\/p>\n<h2>\u0110\u1ed1i t\u01b0\u1ee3ng nghi\u00ean c\u1ee9u:<\/h2>\n<p>B\u1ec7nh nh\u00e2n 50 tu\u1ed5i c\u00f3 ti\u1ec1n s\u1eed tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i, kh\u1edbp h\u00f4ng ho\u1eb7c kh\u1edbp b\u00e0n tay c\u00f3 th\u0103m kh\u00e1m t\u1ed5ng qu\u00e1t t\u1eeb 1\/2000 \u0111\u1ebfn 12\/2015 v\u00e0 k\u00e9o d\u00e0i \u00edt nh\u1ea5t 1 n\u0103m.<br \/>\nLo\u1ea1i tr\u1eeb nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed ung th\u01b0 ho\u1eb7c c\u00f3 c\u00e1c r\u1ed1i lo\u1ea1n s\u1eed d\u1ee5ng opioid.<\/p>\n<p>C\u00e1c nh\u00e0 nghi\u00ean c\u1ee9u ti\u1ebfn h\u00e0nh 5 nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 gh\u00e9p c\u1eb7p \u0111i\u1ec3m khuynh h\u01b0\u1edbng (propensity score matching) theo th\u1ee9 t\u1ef1 \u0111\u1ec3 so s\u00e1nh t\u1ef7 l\u1ec7 t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n gi\u1eefa nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u1edbi tramadol v\u1edbi nh\u1eefng lo\u1ea1i thu\u1ed1c kh\u00e1c.<\/p>\n<p>C\u00e1c nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 ti\u1ebfn h\u00e0nh tr\u00ean 44.451 b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng tramadol, 2.397 b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng naproxen, 5.674 b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng celecoxib, 2.946 b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng etoricoxib, 16.922 b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng codein.<br \/>\nTu\u1ed5i trung b\u00ecnh c\u1ee7a b\u1ec7nh nh\u00e2n l\u00e0 70 tu\u1ed5i, trong \u0111\u00f3 61,2% b\u1ec7nh nh\u00e2n n\u1eef.<br \/>\nTh\u1eddi gian theo d\u00f5i l\u00e0 1 n\u0103m.<\/p>\n<h2>K\u1ebft qu\u1ea3<\/h2>\n<p>T\u1ef7 l\u1ec7 t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n m\u1ed7i 1000 ng\u01b0\u1eddi-n\u0103m khi so s\u00e1nh gi\u1eefa nh\u00f3m tramadol v\u1edbi c\u00e1c nh\u00f3m kh\u00e1c nh\u01b0 sau:<\/p>\n<ul>\n<li>Tramadol v\u1edbi naproxen: 23,5 v\u1edbi 13,8 (t\u1ef7 s\u1ed1 r\u1ee7i ro [HR], 1,71; \u0111\u1ed9 tin c\u1eady [CI] 95%, 1,41-2,07).<\/li>\n<li>Tramadol v\u1edbi diclofenac: 36,2 v\u1edbi 19,2 (HR 1,88; 95% CI, 1,51-2,35).<\/li>\n<li>Tramadol v\u1edbi celecoxib: 31,2 v\u1edbi 18,4 (HR, 1,70; 95% CI, 1,33-2,17).<\/li>\n<li>Tramadol v\u1edbi etoricoxib: 25,7 v\u1edbi 12,8 (HR, 2,04; 95% CI, 1,37-3,03).<\/li>\n<li>Tramadol v\u1edbi codein: 32,2 v\u1edbi 24,6 (HR, 0,96; 0,83-1,05)<\/li>\n<\/ul>\n<h2>B\u00e0n lu\u1eadn<\/h2>\n<p>C\u00e1c nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng (RCT) lu\u00f4n \u0111\u01b0\u1ee3c xem l\u00e0 c\u00f3 m\u1ee9c \u0111\u1ed9 b\u1eb1ng ch\u1ee9ng cao h\u01a1n so v\u1edbi c\u00e1c nghi\u00ean c\u1ee9u quan s\u00e1t so s\u00e1nh an to\u00e0n. Tuy nhi\u00ean, kh\u00f4ng th\u1ec3 ti\u1ebfn h\u00e0nh m\u1ed9t nghi\u00ean c\u1ee9u RCT l\u1edbn v\u1ec1 t\u00ednh an to\u00e0n c\u1ee7a tramadol. \u0110\u00e2y l\u00e0 m\u1ed9t nghi\u00ean c\u1ee9u quan s\u00e1t \u0111\u01b0\u1ee3c thi\u1ebft k\u1ebf ch\u1eb7t ch\u1ebd v\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a nghi\u00ean c\u1ee9u c\u00f3 th\u1ec3 xem nh\u01b0 b\u1eb1ng ch\u1ee9ng t\u1ed1t nh\u1ea5t c\u00f3 \u0111\u01b0\u1ee3c so s\u00e1nh an to\u00e0n gi\u1eefa tramadol v\u00e0 NSAID.<\/p>\n<p>S\u1eed d\u1ee5ng tramadol li\u00ean quan \u0111\u1ebfn t\u1ec9 l\u1ec7 t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n cao h\u01a1n c\u00f3 \u00fd ngh\u0129a so v\u1edbi NSAID nh\u01b0ng t\u01b0\u01a1ng t\u1ef1 codeine. T\u1eeb nh\u1eefng k\u1ebft qu\u1ea3 n\u00e0y, c\u00e1c b\u00e1c s\u0129 v\u00e0 b\u1ec7nh nh\u00e2n c\u1ea7n ch\u00fa \u00fd c\u00e1c d\u1ea5u hi\u1ec7u nay tri\u1ec7u ch\u1ee9ng v\u1ec1 an to\u00e0n khi s\u1eed d\u1ee5ng tramadol v\u00e0 c\u00e2n nh\u1eafc xem li\u1ec7u nguy c\u01a1 c\u00f3 l\u1edbn h\u01a1n l\u1ee3i \u00edch khi s\u1eed d\u1ee5ng tramadol \u1edf t\u1eebng \u0111\u1ed1i t\u01b0\u1ee3ng. Nh\u1eefng k\u1ebft qu\u1ea3 n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng hi\u1ec7n nay. C\u00e1c t\u00e1c gi\u1ea3 d\u1ef1 \u0111o\u00e1n r\u1eb1ng c\u00e1c h\u01b0\u1edbng d\u1eabn s\u1ebd khuy\u1ebfn c\u00e1o ch\u1ed1ng l\u1ea1i vi\u1ec7c s\u1eed d\u1ee5ng tramadol trong t\u01b0\u01a1ng lai.<\/p>\n<h2>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n<p>Chao Zeng et al. Association of Tramadol With All-Cause Mortality Among Patients With Osteoarthritis. JAMA. 2019; March 12. LINK\u00a0<a href=\"https:\/\/jamanetwork.com\/journals\/jama\/article-abstract\/2727448\" rel=\"noopener\">https:\/\/jamanetwork.com\/journals\/jama\/article-abstract\/2727448<\/a><\/p>\n<p>&nbsp;<\/p>\n<p>T\u1ed5ng h\u1ee3p: Ph\u1ea1m Th\u1ecb Th\u01b0 Th\u01b0, sinh vi\u00ean D16 \u0110\u1ea1i h\u1ecdc y D\u01b0\u1ee3c Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh.<\/p>\n<p>Hi\u1ec7u \u0111\u00ednh: D\u01b0\u1ecdc s\u0129 Tr\u01b0\u01a1ng C\u00f4ng B\u1eb1ng.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Trong m\u1ed9t nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 tr\u00ean h\u01a1n 88.000 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u0103ng tr\u00ean t\u1ea1p ch\u00ed JAMA g\u1ea7n \u0111\u00e2y, s\u1eed d\u1ee5ng tramadol li\u00ean quan v\u1edbi t\u1ef7 l\u1ec7 t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n cao h\u01a1n so v\u1edbi NSAID \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n cao tu\u1ed5i b\u1ecb tho\u00e1i h\u00f3a kh\u1edbp. T\u1ed5ng quan Tramadol l\u00e0 l\u1ef1a ch\u1ecdn thay [&#8230;]\n","protected":false},"author":1,"featured_media":8375,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-8373","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\/8373","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=8373"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/8373\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/8375"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=8373"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=8373"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=8373"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}