{"id":13166,"date":"2023-12-28T18:50:09","date_gmt":"2023-12-28T10:50:09","guid":{"rendered":"https:\/\/docquity.com\/?post_type=articles&p=13166"},"modified":"2025-02-11T13:38:42","modified_gmt":"2025-02-11T05:38:42","slug":"hydrocortisone-don-tri-va-phoi-hop-bien-phap-nao-hieu-qua-hon-o-benh-nhan-soc-nhiem-khuan-2","status":"publish","type":"articles","link":"https:\/\/docquity.com\/vi\/articles\/hydrocortisone-don-tri-va-phoi-hop-bien-phap-nao-hieu-qua-hon-o-benh-nhan-soc-nhiem-khuan-2\/","title":{"rendered":"Hydrocortisone \u0111\u01a1n tr\u1ecb v\u00e0 ph\u1ed1i h\u1ee3p – bi\u1ec7n ph\u00e1p n\u00e0o hi\u1ec7u qu\u1ea3 h\u01a1n \u1edf b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n?"},"content":{"rendered":"\n

S\u1ed1c nhi\u1ec5m khu\u1ea9n x\u1ea3y ra v\u1edbi kho\u1ea3ng 1.7 tri\u1ec7u ca nh\u1eadp vi\u1ec7n \u1edf Hoa K\u1ef3, c\u00f3 kho\u1ea3ng h\u01a1n 1\/3 tr\u01b0\u1eddng h\u1ee3p s\u1ed1c nhi\u1ec5m khu\u1ea9n n\u1ed9i tr\u00fa c\u00f3 k\u1ebft c\u1ee5c t\u1eed vong1<\/sup>. \u0110\u1ec3 ki\u1ec3m so\u00e1t b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n, c\u1ea7n ph\u1ea3i l\u1ef1a ch\u1ecdn thu\u1ed1c v\u1eadn m\u1ea1ch \u0111\u1ec3 c\u1ea3i thi\u1ec7n huy\u1ebft \u00e1p. \u1ede b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n c\u1ea7n ph\u1ea3i \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c v\u1eadn m\u1ea1ch, h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb khuy\u1ebfn c\u00e1o n\u00ean b\u1ed5 sung corticosteroid, c\u1ee5 th\u1ec3 l\u00e0 hydrocortisone li\u1ec1u 200 mg\/ng\u00e0y2<\/sup>. Khuy\u1ebfn c\u00e1o n\u00e0y \u0111\u01b0\u1ee3c \u0111\u01b0a ra d\u1ef1a tr\u00ean k\u1ebft qu\u1ea3 c\u1ee7a c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng, ph\u00e2n t\u00edch g\u1ed9p cho th\u1ea5y corticosteroid c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m th\u1eddi gian s\u1ed1c v\u00e0 \u0111\u1ed3ng th\u1eddi gi\u1ea3m nh\u1eb9 t\u1ef7 l\u1ec7 t\u1eed vong 3 \u2013 6<\/sup>. M\u1ed9t th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng \u2013 COIITSS cho th\u1ea5y ph\u1ed1i h\u1ee3p hydrocortisone\/fludrocortisone c\u00f3 th\u1ec3 gi\u1ea3m c\u00f3 \u00fd ngh\u0129a t\u1ef7 l\u1ec7 t\u1eed vong so v\u1edbi hydrocortisone \u0111\u01a1n tr\u1ecb7<\/sup>. M\u1ed9t nghi\u00ean c\u1ee9u v\u1ec1 v\u1ea5n \u0111\u1ec1 t\u01b0\u01a1ng t\u1ef1 c\u0169ng v\u1eeba \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 cu\u1ed1i th\u00e1ng 03\/20238<\/sup>. B\u00e0i vi\u1ebft t\u00f3m t\u1eaft k\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u \u0111\u1ebfn qu\u00fd \u0111\u1ed3ng nghi\u1ec7p, \u0111\u1ec3 h\u1ed7 tr\u1ee3 qu\u00fd \u0111\u1ed3ng nghi\u1ec7p trong vi\u1ec7c c\u00e2n nh\u1eafc \u0111\u01b0a ra l\u1ef1a ch\u1ecdn ki\u1ec3m so\u00e1t b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n.<\/p>\n\n\n\n

T\u00f3m t\u1eaft nghi\u00ean c\u1ee9u<\/strong><\/p>\n\n\n\n

Nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh tr\u00ean t\u1ed5ng c\u1ed9ng 88,275 b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t b\u1eb1ng thu\u1ed1c v\u1eadn m\u1ea1ch norepinephrine v\u00e0 \u0111\u1ed3ng th\u1eddi b\u1eb1ng hydrocortisone trong v\u00f2ng 3 ng\u00e0y nh\u1eadp vi\u1ec7n. Trong s\u1ed1 88,275 b\u1ec7nh nh\u00e2n n\u00e0y, c\u00f3 85,995 (97.4%) b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng hydrocortisone \u0111\u01a1n tr\u1ecb v\u00e0 2280 (2.6%) b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u1ed1i h\u1ee3p hydrocortisone\/fludrocortisone. S\u1ed1 ng\u00e0y theo d\u00f5i trung v\u1ecb c\u1ee7a nghi\u00ean c\u1ee9u l\u00e0 6 ng\u00e0y \u1edf b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u1ed1i h\u1ee3p hydrocortisone\/fludrocortisone v\u00e0 5 ng\u00e0y \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng hydrocortisone \u0111\u01a1n trj.<\/p>\n\n\n\n

Ti\u00eau ch\u00ed ch\u00ednh c\u1ee7a nghi\u00ean c\u1ee9u l\u00e0 k\u1ebft c\u1ee5c g\u1ed9p c\u1ee7a t\u1eed vong trong b\u1ec7nh vi\u1ec7n ho\u1eb7c \u0111\u01b0\u1ee3c xu\u1ea5t vi\u1ec7n do ti\u00ean l\u01b0\u1ee3ng qu\u00e1 n\u1eb7ng. Ti\u00eau ch\u00ed ph\u1ee5 l\u00e0 t\u1eed vong trong b\u1ec7nh vi\u1ec7n, s\u1ed1 ng\u00e0y kh\u00f4ng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c v\u1eadn m\u1ea1ch, s\u1ed1 ng\u00e0y kh\u00f4ng n\u1eb1m vi\u1ec7n cho t\u1edbi ng\u00e0y th\u1ee9 28.<\/p>\n\n\n\n

K\u1ebft qu\u1ea3 cho th\u1ea5y th\u1eddi gian trung v\u1ecb c\u1ee7a \u0111i\u1ec1u tr\u1ecb l\u00e0 3 ng\u00e0y \u1edf c\u1ea3 2 nh\u00f3m nh\u00f3m ph\u1ed1i h\u1ee3p hydrocortisone\/fludrocortisone v\u00e0 hydrocortisone \u0111\u01a1n tr\u1ecb. Trong s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u1ed1i h\u1ee3p hydrocortisone\/fludrocortisone, c\u00f3 1076 (47.2%) tr\u01b0\u1eddng h\u1ee3p t\u1eed vong trong b\u1ec7nh vi\u1ec7n ho\u1eb7c \u0111\u01b0\u1ee3c xu\u1ea5t vi\u1ec7n do ti\u00ean l\u01b0\u1ee3ng qu\u00e1 n\u1eb7ng. Con s\u1ed1 n\u00e0y \u1edf nh\u00f3m hydrocortisone \u0111\u01a1n tr\u1ecb l\u00e0 50.8% (43,669 b\u1ec7nh nh\u00e2n). Khi ph\u00e2n t\u00edch \u0111i\u1ec1u ch\u1ec9nh TMLE, ph\u1ed1i h\u1ee3p hydrocortisone\/fludrocortisone c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m 3.7% nguy c\u01a1 tuy\u1ec7t \u0111\u1ed1i t\u1eed vong ho\u1eb7c xu\u1ea5t vi\u1ec7n do ti\u00ean l\u01b0\u1ee3ng qu\u00e1 n\u1eb7ng khi so v\u1edbi hydrocortisone \u0111\u01a1n tr\u1ecb.<\/p>\n\n\n\n

T\u1ef7 l\u1ec7 t\u1eed vong trong b\u1ec7nh vi\u1ec7n \u1edf nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u1ed1i h\u1ee3p hydrocortisone\/fludrocortisone l\u00e0 39.3% v\u00e0 \u1edf nh\u00f3m hydrocortisone \u0111\u01a1n tr\u1ecb l\u00e0 42.7%. S\u1ed1 ng\u00e0y kh\u00f4ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c v\u1eadn m\u1ea1ch v\u00e0 s\u1ed1 ng\u00e0y kh\u00f4ng n\u1eb1m vi\u1ec7n nhi\u1ec1u h\u01a1n \u1edf nh\u00f3m ph\u1ed1i h\u1ee3p hydrocortisone\/fludrocortisone khi so v\u1edbi nh\u00f3m hydrocortisone \u0111\u01a1n tr\u1ecb.<\/p>\n\n\n\n

K\u1ebft lu\u1eadn<\/strong><\/p>\n\n\n\n

Nghi\u00ean c\u1ee9u n\u00e0y \u0111\u00e3 cho th\u1ea5y ph\u1ed1i h\u1ee3p hydrocortisone\/fludrocortisone c\u00f3 th\u1ec3 l\u00e0m t\u0103ng c\u01a1 h\u1ed9i s\u1ed1ng s\u00f3t, l\u00e0m gi\u1ea3m th\u1eddi gian n\u1eb1m vi\u1ec7n v\u00e0 \u0111\u1ed3ng th\u1eddi gi\u1ea3m th\u1eddi gian s\u1ed1c \u1edf b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n so v\u1edbi fludrocortisone \u0111\u01a1n tr\u1ecb. K\u1ebft qu\u1ea3 n\u00e0y t\u01b0\u01a1ng t\u1ef1 k\u1ebft qu\u1ea3 c\u1ee7a th\u1eed nghi\u1ec7m COIITSS.<\/p>\n\n\n\n

N\u1ebfu qu\u00fd v\u1ecb \u0111\u1ed3ng nghi\u1ec7p c\u00f3 nhu c\u1ea7u tham kh\u1ea3o th\u00eam v\u1ec1 c\u00e1ch ki\u1ec3m so\u00e1t b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n qua c\u00e1c v\u00ed d\u1ee5 th\u1ef1c t\u1ebf, vui l\u00f2ng tham kh\u1ea3o 2 b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y:<\/p>\n\n\n\n

1\/ Ph\u1ea7n 1: X\u1eed tr\u00ed b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n? Nh\u1eefng v\u00ed d\u1ee5 th\u1ef1c t\u1ebf (pleaes help me to add hyperlink: https:\/\/docquity.app.link\/GhMp7sNbWyb<\/a>)<\/p>\n\n\n\n

2\/ Ph\u1ea7n 2: X\u1eed tr\u00ed b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n? Nh\u1eefng v\u00ed d\u1ee5 th\u1ef1c t\u1ebf (pleae help me to add hyperlink: https:\/\/docquity.app.link\/dO2q2qTbWyb<\/a> )<\/p>\n\n\n\n

\n\n\n\n

T\u00e0i li\u1ec7u tham kh\u1ea3o<\/strong><\/p>\n\n\n\n

    \n
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  2. Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021;49(11):e1063-e1143. doi:10.1097\/CCM.0000000000005337<\/li>\n\n\n\n
  3. Gordon AC, Mason AJ, Thirunavukkarasu N, et al; VANISH Investigators. Effect of early vasopressin vs norepinephrine on kidney failure in patients with septic shock: the VANISH randomized clinical trial. JAMA. 2016;316(5):509-518. doi:10.1001\/jama.2016.10485<\/li>\n\n\n\n
  4. Sprung CL, Annane D, Keh D, et al; CORTICUS Study Group. Hydrocortisone therapy for patients with septic shock. N Engl J Med. 2008;358(2):111-124.<\/li>\n\n\n\n
  5. doi:10.1056\/NEJMoa071366<\/li>\n\n\n\n
  6. Low-dose corticosteroids for adult patients with septic shock: a systematic review with meta-analysis and trial sequential analysis. Intensive Care Med. 2018;44(7):1003-1016. doi:10.1007\/s00134-018-5197-6<\/li>\n\n\n\n
  7. Rochwerg B, Oczkowski SJ, Siemieniuk RAC, et al. Corticosteroids in sepsis: an updated systematic review and meta-analysis. Crit Care Med. 2018;46(9):14111420. doi:10.1097\/CCM.0000000000003262<\/li>\n\n\n\n
  8. Annane D, Cariou A, Maxime V, et al; COIITSS Study Investigators. Corticosteroid treatment and intensive insulin therapy for septic shock in adults: a randomized controlled trial.JAMA. 2010;303(4):341-348. doi:10.1001\/jama.2010.2<\/li>\n\n\n\n
  9. Bosch NA, Teja B, Law AC, Pang B, Jafarzadeh SR, Walkey AJ. Comparative Effectiveness of Fludrocortisone and Hydrocortisone vs Hydrocortisone Alone Among Patients With Septic Shock. JAMA Intern Med. 2023 Mar 27:e230258. doi: 10.1001\/jamainternmed.2023.0258.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    S\u1ed1c nhi\u1ec5m khu\u1ea9n x\u1ea3y ra v\u1edbi kho\u1ea3ng 1.7 tri\u1ec7u ca nh\u1eadp vi\u1ec7n \u1edf Hoa K\u1ef3, c\u00f3 kho\u1ea3ng h\u01a1n 1\/3 tr\u01b0\u1eddng h\u1ee3p s\u1ed1c nhi\u1ec5m khu\u1ea9n n\u1ed9i tr\u00fa c\u00f3 k\u1ebft c\u1ee5c t\u1eed vong1. \u0110\u1ec3 ki\u1ec3m so\u00e1t b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n, c\u1ea7n ph\u1ea3i l\u1ef1a ch\u1ecdn thu\u1ed1c v\u1eadn m\u1ea1ch \u0111\u1ec3 c\u1ea3i thi\u1ec7n huy\u1ebft \u00e1p. \u1ede b\u1ec7nh nh\u00e2n s\u1ed1c …<\/p>\n

    Hydrocortisone \u0111\u01a1n tr\u1ecb v\u00e0 ph\u1ed1i h\u1ee3p – bi\u1ec7n ph\u00e1p n\u00e0o hi\u1ec7u qu\u1ea3 h\u01a1n \u1edf b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n?<\/span> Read More »<\/a><\/p>\n","protected":false},"author":123,"featured_media":13167,"comment_status":"closed","ping_status":"closed","template":"","meta":{"content-type":"","inline_featured_image":false,"site-sidebar-layout":"default","site-content-layout":"default","ast-global-header-display":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","footnotes":""},"articles_categories":[1370],"articles_tags":[],"articles_topics":[1440],"articles_languages":[1375],"articles_filters":[],"class_list":["post-13166","articles","type-articles","status-publish","has-post-thumbnail","hentry","articles_categories-medical-content-vi","articles_languages-vietnamese-vi"],"_links":{"self":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles\/13166","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles"}],"about":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/types\/articles"}],"author":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/users\/123"}],"replies":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/comments?post=13166"}],"version-history":[{"count":0,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles\/13166\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media\/13167"}],"wp:attachment":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media?parent=13166"}],"wp:term":[{"taxonomy":"articles_categories","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_categories?post=13166"},{"taxonomy":"articles_tags","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_tags?post=13166"},{"taxonomy":"articles_topics","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_topics?post=13166"},{"taxonomy":"articles_languages","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_languages?post=13166"},{"taxonomy":"articles_filters","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_filters?post=13166"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}