{"id":33275,"date":"2024-03-13T02:18:43","date_gmt":"2024-03-12T18:18:43","guid":{"rendered":"https:\/\/docquity.com\/?post_type=articles&#038;p=33275"},"modified":"2025-02-11T13:39:41","modified_gmt":"2025-02-11T05:39:41","slug":"huong-dan-dieu-tri-tam-diem-nam-2023-phan-2-2","status":"publish","type":"articles","link":"https:\/\/docquity.com\/vi\/articles\/huong-dan-dieu-tri-tam-diem-nam-2023-phan-2-2\/","title":{"rendered":"H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb t\u00e2m \u0111i\u1ec3m n\u0103m 2023: Ph\u1ea7n 2"},"content":{"rendered":"\n<p>Docquity \u0111\u00e3 gi\u1edbi thi\u1ec7u v\u1edbi qu\u00fd v\u1ecb \u0111\u1ed3ng nghi\u1ec7p b\u00e0i vi\u1ebft \u201cH\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb t\u00e2m \u0111i\u1ec3m n\u0103m 2023: Ph\u1ea7n 1\u201d. Nh\u1eb1m gi\u00fap qu\u00fd v\u1ecb \u0111\u1ed3ng nghi\u1ec7p c\u1eadp nh\u1eadt tr\u1ecdn v\u1eb9n nh\u1eefng \u0111i\u1ec3m quan tr\u1ecdng c\u1ee7a nh\u1eefng h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb c\u1ed1t l\u00f5i, ch\u00fang t\u00f4i xin ti\u1ebfp t\u1ee5c c\u1eadp nh\u1eadt ph\u1ea7n2 \u2013 ph\u1ea7n cu\u1ed1i c\u00f9ng c\u1ee7a chu\u1ed7i T\u00e2m \u0111i\u1ec3m h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb.<\/p>\n\n\n\n<p>\u0110\u1ec3 theo d\u00f5i ph\u1ea7n 1, click \u0111\u1ec3 theo d\u00f5i b\u00e0i vi\u1ebft \u201c<a href=\"https:\/\/docquity.app.link\/apCcfLouAGb\">H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb t\u00e2m \u0111i\u1ec3m n\u0103m 2023: Ph\u1ea7n 1&nbsp;<\/a>\u201c<\/p>\n\n\n\n<p>Trong h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb ph\u1ea7n 2, c\u00e1c \u0111i\u1ec3m ch\u00ednh quan tr\u1ecdng nh\u1ea5t c\u1ee7a c\u00e1c h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb d\u01b0\u1edbi \u0111\u00e2y s\u1ebd \u0111\u01b0\u1ee3c \u0111i\u1ec3m qua:<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-cda3b1918d407d83b37f6c11a848f0aa.png\" alt=\"\" \/><\/figure>\n\n\n\n<p><strong>1. H\u01b0\u1edbng d\u1eabn ki\u1ec3m so\u00e1t xu\u1ea5t huy\u1ebft \u0111\u01b0\u1eddng ti\u00eau h\u00f3a d\u01b0\u1edbi<\/strong><\/p>\n\n\n\n<p>H\u01b0\u1edbng d\u1eabn n\u00e0y c\u1eadp nh\u1eadt h\u01b0\u1edbng d\u1eabn ki\u1ec3m so\u00e1t xu\u1ea5t huy\u1ebft \u0111\u01b0\u1eddng ti\u00eau h\u00f3a c\u1ee7a Hi\u1ec7p h\u1ed9i Ti\u00eau h\u00f3a Hoa K\u1ef3 (ACG) n\u0103m 2016. H\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng thang ph\u00e2n lo\u1ea1i m\u1ee9c \u0111\u1ed9 b\u1eb1ng ch\u1ee9ng GRADE. H\u01a1n n\u1eefa, h\u01b0\u1edbng d\u1eabn c\u0169ng bao g\u1ed3m c\u00e1c h\u01b0\u1edbng d\u1eabn \u0111\u01b0\u1ee3c \u0111\u01b0a ra d\u1ef1a tr\u00ean \u00fd ki\u1ebfn c\u1ee7a c\u00e1c chuy\u00ean gia. Ch\u00fang t\u00f4i s\u1ebd \u0111\u1ec1 c\u1eadp \u0111\u1ebfn c\u00e1c \u0111i\u1ec3m khuy\u1ebfn c\u00e1o quan tr\u1ecdng trong h\u01b0\u1edbng d\u1eabn.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-415dccfe9ff300a830da40e9bdf23afb.png\" alt=\"\" \/><\/figure>\n\n\n\n<p><strong>B\u00e0n lu\u1eadn<\/strong><\/p>\n\n\n\n<p>H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb gi\u1eef nh\u1eefng thay \u0111\u1ed5i quan tr\u1ecdng t\u1eeb c\u00e1c phi\u00ean b\u1ea3n tr\u01b0\u1edbc \u0111\u00e2y v\u00e0 l\u00e0 m\u1ed9t h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb \u0111\u00e1ng \u0111\u1ecdc cho c\u00e1c nh\u00e2n vi\u00ean y t\u1ebf ch\u0103m s\u00f3c th\u01b0\u1eddng xuy\u00ean b\u1ec7nh nh\u00e2n n\u1ed9i tr\u00fa.<\/p>\n\n\n\n<p><strong>2. H\u01b0\u1edbng d\u1eabn \u0111\u00e1nh gi\u00e1, ki\u1ec3m so\u00e1t tr\u1ebb em v\u00e0 tr\u1ebb v\u1ecb th\u00e0nh ni\u00ean b\u00e9o ph\u00ec<\/strong><\/p>\n\n\n\n<p>B\u00e9o ph\u00ec l\u00e0 b\u1ec7nh ph\u1ee9c t\u1ea1p v\u00e0 \u0111a y\u1ebfu t\u1ed1 g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ee9c kh\u1ecfe th\u1ec3 ch\u1ea5t v\u00e0 s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n c\u1ee7a h\u01a1n 14 tri\u1ec7u tr\u1ebb em v\u00e0 tr\u1ebb v\u1ecb th\u00e0nh ni\u00ean Hoa K\u1ef3. Vi\u1ec7n H\u00e0n l\u00e2m Nhi khoa Hoa K\u1ef3 (AAP) c\u00f4ng b\u1ed1 h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb m\u1edbi \u0111\u1ec3 h\u1ed7 tr\u1ee3 \u0111\u00e1nh gi\u00e1 v\u00e0 ki\u1ec3m so\u00e1t b\u1ec7nh nh\u00e2n b\u00e9o ph\u00ec.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-cba31c5ff749099dda1772943564e518.png\" alt=\"\" \/><\/figure>\n\n\n\n<p><strong>B\u00e0n lu\u1eadn<\/strong><\/p>\n\n\n\n<p>Phi\u00ean b\u1ea3n \u0111\u1ea7y \u0111\u1ee7 c\u1ee7a h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb kh\u00e1 d\u00e0i v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem nh\u01b0 s\u00e1ch gi\u00e1o khoa v\u1ec1 b\u1ec7nh b\u00e9o ph\u00ec \u1edf tr\u1ebb em v\u00e0 tr\u1ebb v\u1ecb th\u00e0nh ni\u00ean, bao ph\u1ee7 c\u00e1c y\u1ebfu t\u1ed1 m\u00f4i tr\u01b0\u1eddng, x\u00e3 h\u1ed9i v\u00e0 sinh h\u1ecdc. C\u00e1c \u0111i\u1ec3m ch\u00ednh c\u1ee7a h\u01b0\u1edbng d\u1eabn \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp \u1edf tr\u00ean ch\u1ec9 h\u1ea1n ch\u1ebf trong m\u1ed9t v\u00e0i kh\u00eda c\u1ea1nh ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb nh\u1eadn \u0111\u01b0\u1ee3c nhi\u1ec1u s\u1ef1 quan t\u00e2m tr\u00ean l\u00e2m s\u00e0ng.<\/p>\n\n\n\n<p>Vi\u1ec7c ch\u0103m s\u00f3c hi\u1ec7u qu\u1ea3 cho tr\u1ebb em b\u00e9o ph\u00ec th\u01b0\u1eddng g\u1eb7p nhi\u1ec1u th\u00e1ch th\u1ee9c. R\u00e0o c\u1ea3n l\u1edbn nh\u1ea5t trong \u0111i\u1ec1u tr\u1ecb l\u00e0 c\u00e1c l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb c\u00f2n h\u1ea1n ch\u1ebf v\u00e0 IHBLT c\u01b0\u1eddng \u0111\u1ed9 cao d\u00e0i ng\u00e0y. Vi\u1ec7c h\u1ec7 th\u1ed1ng y t\u1ebf c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng th\u1ef1c hi\u1ec7n v\u00e0 chi tr\u1ea3 cho IHBLT, thu\u1ed1c \u0111i\u1ec1u tr\u1ecb v\u00e0 can thi\u1ec7p cho nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y.<\/p>\n\n\n\n<p><strong>3. \u0110i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n lo\u00e3ng x\u01b0\u01a1ng: H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb c\u1eadp nh\u1eadt<\/strong><\/p>\n\n\n\n<p>Sau khi xem x\u00e9t c\u00e1c y v\u0103n hi\u1ec7n c\u00f3, Hi\u1ec7p h\u1ed9i B\u00e1c s\u0129 Hoa K\u1ef3 (ACP) \u0111\u00e3 c\u1eadp nh\u1eadt h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n lo\u00e3ng x\u01b0\u01a1ng. H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb c\u1eadp nh\u1eadt n\u00e0y ch\u1ec9 h\u1ea1n ch\u1ebf \u1edf c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c v\u00e0 kh\u00f4ng \u0111\u1ec1 c\u1eadp \u0111\u1ebfn c\u00e1c v\u1ea5n \u0111\u1ec1 kh\u00e1c ch\u1eb3ng h\u1ea1n nh\u01b0 gi\u00e1m s\u00e1t m\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-d32c8918332372bb925936406a1cb7d6.png\" alt=\"\" \/><\/figure>\n\n\n\n<p><strong>B\u00e0n lu\u1eadn<\/strong><\/p>\n\n\n\n<p>H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb xem x\u00e9t c\u00e1c b\u1eb1ng ch\u1ee9ng li\u00ean quan \u0111\u1ebfn c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp \u1edf tr\u00ean, v\u1edbi t\u1ef7 l\u1ec7 c\u00e1c bi\u1ebfn c\u1ed1 g\u00e3y x\u01b0\u01a1ng ph\u00f2ng ng\u1eeba v\u00e0 c\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i. Tuy nhi\u00ean, h\u01b0\u1edbng d\u1eabn kh\u00f4ng \u0111\u1ec1 c\u1ea5p \u0111\u1ebfn v\u1ea5n \u0111\u1ec1 g\u00e3y x\u01b0\u01a1ng tr\u1edf l\u1ea1i sau khi ng\u01b0ng denosumab v\u00e0 c\u00f3 \u00fd ki\u1ebfn cho r\u1eb1ng vi\u1ec7c s\u1eed d\u1ee5ng denosumab \u0111\u1ec3 tr\u00e1nh c\u00e1c t\u00e1c \u0111\u1ed9ng b\u1ea5t l\u1ee3i c\u1ee7a biphosphonate kh\u00f4ng ph\u1ea3i l\u00e0 l\u1ef1a ch\u1ecdn t\u1ed1t. C\u00f3 v\u00ed d\u1ee5 cho th\u1ea5y vi\u1ec7c l\u1ef1a ch\u1ecdn t\u00e1c nh\u00e2n anabolic \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n b\u1ecb lo\u00e3ng x\u01b0\u01a1ng nghi\u00eam tr\u1ecdng ch\u1ecdn l\u1ecdc, \u0111i\u1ec1u n\u00e0y c\u00e0ng c\u1ea7n \u0111\u01b0\u1ee3c ch\u00fa \u00fd khi c\u00f3 nhi\u1ec1u t\u00e1c nh\u00e2n anabolic c\u00f3 gi\u00e1 th\u00e0nh r\u1ebb h\u01a1n \u0111\u01b0\u1ee3c l\u01b0u h\u00e0nh tr\u00ean th\u1ecb tr\u01b0\u1eddng. Nh\u00e2n vi\u00ean y t\u1ebf n\u00ean c\u1eadp nh\u1eadt h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb m\u1edbi, nh\u01b0ng c\u0169ng c\u1ea7n tham kh\u1ea3o c\u00e1c b\u00e0i vi\u1ebft chia s\u1ebb \u00fd ki\u1ebfn c\u1ee7a chuy\u00ean gia li\u00ean quan.<\/p>\n\n\n\n<p><strong>4. C\u1eadp nh\u1eadt h\u01b0\u1edbng d\u1eabn c\u1ee7a KDIGO trong ki\u1ec3m so\u00e1t b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng \u1edf b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh th\u1eadn m\u1ea1n<\/strong><\/p>\n\n\n\n<p>Nhi\u1ec1u n\u0103m tr\u01b0\u1edbc, KDIGO c\u00f4ng b\u1ed1 h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb ki\u1ec3m so\u00e1t \u0111\u00e1i th\u00e1o \u0111\u01b0\u1edfng b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh th\u1eadn m\u1ea1n. Trong th\u1eddi gian qua, nhi\u1ec1u b\u1eb1ng ch\u1ee9ng m\u1edbi li\u00ean quan \u0111\u00e3 \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1, KDIGO \u0111\u00e3 c\u00f4ng b\u1ed1 h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb c\u1eadp nh\u1eadt v\u1edbi 13 khuy\u1ebfn c\u00e1o v\u00e0 52 \u0111i\u1ec3m quan tr\u1ecdng trong th\u1ef1c h\u00e0nh cho b\u00e1c s\u0129. H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb c\u1eadp nh\u1eadt t\u1eadp trung chuy\u00ean bi\u1ec7t v\u00e0o c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf k\u00eanh \u0111\u1ed3ng v\u1eadn chuy\u1ec7n sodium \u2013 glucose contransporter 2 (SGLT2i), thu\u1ed1c ch\u1ee7 v\u1eadn th\u1ee5 th\u1ec3 glucagon \u2013 like \u2013 peptide \u2013 1 (GLP-1) v\u00e0 ch\u1ea5t \u0111\u1ed1i kh\u00e1ng mineralocorticoid nonsteroid finerenone.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-ef823ffd47ea799fc2aa2b4e2b92b71d.png\" alt=\"\" \/><\/figure>\n\n\n\n<p><strong>B\u00e0n lu\u1eadn<\/strong><\/p>\n\n\n\n<p>C\u00e1c khuy\u1ebfn c\u00e1o n\u00e0y khi \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng r\u1ed9ng r\u00e3i khi th\u1ef1c h\u00e0nh c\u00f3 th\u1ec3 thay \u0111\u1ed5i s\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh th\u1eadn m\u1ea1n (ch\u1eb3ng h\u1ea1n nh\u01b0 gi\u1ea3m ho\u1eb7c l\u00e0m ch\u1eadm nhu c\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u1edbi c\u00e1c li\u1ec7u ph\u00e1p thay th\u1ebf th\u1eadn) v\u00e0 c\u1ea3i thi\u1ec7n c\u00e1c k\u1ebft c\u1ee5c kh\u00e1c \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng m\u1eafc k\u00e8m b\u1ec7nh th\u1eadn m\u1ea1n. Tuy nhi\u00ean, \u0111\u1ed1i v\u1edbi c\u00e1c li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp \u1edf tr\u00ean, c\u00e1c v\u1ea5n \u0111\u1ec1 b\u1ea5t b\u00ecnh \u0111\u1eb3ng trong \u0111i\u1ec1u tr\u1ecb v\u00e0 ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb c\u1ea7n \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft, c\u00e1c r\u00e0o c\u1ea3n trong \u0111i\u1ec1u tr\u1ecb (ch\u1eb3ng h\u1ea1n nh\u01b0 t\u00ecnh h\u00ecnh kinh t\u1ebf, x\u00e3 h\u1ed9i, gi\u00e1o d\u1ee5c) c\u1ea7n ph\u1ea3i \u0111\u01b0\u1ee3c h\u1ea1n ch\u1ebf \u0111\u1ec3 c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb v\u1edbi c\u00e1c nh\u00f3m thu\u1ed1c n\u00e0y k\u1ecbp th\u1eddi \u0111\u1ec3 c\u1ea3i thi\u1ec7n k\u1ebft c\u1ee5c \u0111i\u1ec1u tr\u1ecb v\u00e0 ph\u00f2ng ng\u1eeba.<\/p>\n\n\n\n<p><strong>5. H\u01b0\u1edbng d\u1eabn li\u1ec7u ph\u00e1p kh\u00e1ng huy\u1ebft kh\u1ed1i chu ph\u1eabu c\u1ee7a CHEST<\/strong><\/p>\n\n\n\n<p>Trong h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb tr\u01b0\u1edbc \u0111\u00e2y v\u1ec1 li\u1ec7u ph\u00e1p kh\u00e1ng huy\u1ebft kh\u1ed1i chu ph\u1eabu, Hi\u1ec7p h\u1ed9i L\u1ed3ng ng\u1ef1c Hoa K\u1ef3 (ACCP) \u0111\u1ec1 c\u1eadp \u0111\u1ebfn gi\u1ea3i ph\u00e1p cho 11 v\u1ea5n \u0111\u1ec1. H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb phi\u00ean b\u1ea3n c\u1eadp nh\u1eadt \u0111\u1ec1 c\u1eadp \u0111\u1ebfn gi\u1ea3i ph\u00e1p cho 43 v\u1ea5n \u0111\u1ec1, s\u1eed d\u1ee5ng c\u00e1ch ti\u1ebfp c\u1eadn c\u00f3 c\u1ea5u tr\u00fac. T\u1ea5t c\u1ea3 c\u00e1c khuy\u1ebfn c\u00e1o \u0111\u1ec1u d\u00e0nh cho b\u1ec7nh nh\u00e2n chu ph\u1eabu \u0111ang \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi c\u00e1c bi\u1ec7n ph\u00e1p ph\u1eabu thu\u1eadt l\u1ef1a ch\u1ecdn.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-6c91c676d9bbb4201fb080cf2eb68814.png\" alt=\"\" \/><\/figure>\n\n\n\n<p><strong>B\u00e0n lu\u1eadn<\/strong><\/p>\n\n\n\n<p>M\u1eb7c d\u00f9 \u0111a s\u1ed1 c\u00e1c khuy\u1ebfn c\u00e1o \u0111\u1ec1u \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc l\u00e0 khuy\u1ebfn c\u00e1o c\u00f3 \u0111i\u1ec1u ki\u1ec7n d\u1ef1a tr\u00ean c\u00e1c b\u1eb1ng ch\u1ee9ng m\u1ee9c \u0111\u1ed9 tin c\u1eady th\u1ea5p ho\u1eb7c r\u1ea5t th\u1ea5p, h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb mang \u0111\u1ebfn ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb v\u1edbi thu\u1ed1c kh\u00e1ng huy\u1ebft kh\u1ed1i d\u1ef1a tr\u00ean c\u00e1c b\u1eb1ng ch\u1ee9ng v\u00e0 \u00fd ki\u1ebfn chuy\u00ean gia m\u1edbi nh\u1ea5t \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1.<\/p>\n\n\n\n<p><strong>6. Khuy\u1ebfn c\u00e1o c\u1ee7a CDC v\u1ec1 k\u00ea \u0111\u01a1n opioid \u0111\u1ec3 gi\u1ea3m \u0111au<\/strong><\/p>\n\n\n\n<p>CDC \u0111\u00e3 c\u1eadp nh\u1eadt h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb v\u1ec1 vi\u1ec7c k\u00ea \u0111\u01a1n opioid. H\u01b0\u1edbng d\u1eabn c\u1eadp nh\u1eadt \u0111\u01b0a ra c\u00e1c khuy\u1ebfn c\u00e1o d\u1ef1a tr\u00ean c\u00e1c nghi\u00ean c\u1ee9u m\u1edbi, b\u00e0n lu\u1eadn v\u1ec1 vi\u1ec7c xu\u1ed1ng thang v\u00e0 ng\u01b0ng opioid, k\u00ea \u0111\u01a1n opioid cho b\u1ec7nh nh\u00e2n v\u00e0 so s\u00e1nh opioid v\u1edbi non-opioid v\u00e0 c\u00e1ch ti\u1ebfp c\u1eadp kh\u00f4ng d\u00f9ng thu\u1ed1c trong ki\u1ec3m so\u00e1t \u0111au.<\/p>\n\n\n\n<p><strong>\u0110i\u1ec3m ch\u00ednh<\/strong><\/p>\n\n\n\n<p>CDC \u0111\u01b0a ra 12 khuy\u1ebfn c\u00e1o li\u00ean quan v\u1ec1 vi\u1ec7c k\u00ea \u0111\u01a1n opioid d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng. Tuy nhi\u00ean, c\u00f3 7 khuy\u1ebfn c\u00e1o \u0111\u1ec1u d\u1ef1a tr\u00ean \u00fd ki\u1ebfn chuy\u00ean gia v\u00e0 c\u00e1c nghi\u00ean c\u1ee9u, v\u00e0 c\u00f3 3 khuy\u1ebfn c\u00e1o d\u1ef1a tr\u00ean c\u00e1c nghi\u00ean c\u1ee9u quan s\u00e1t hay c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-3990f6eb909f90222f7c1836d8377032.png\" alt=\"\" \/><\/figure>\n\n\n\n<p><strong>B\u00e0n lu\u1eadn<\/strong><\/p>\n\n\n\n<p>C\u00e1c nguy\u00ean t\u1eafc chung trong khuy\u1ebfn c\u00e1o n\u00e0y th\u01b0\u1eddng \u0111\u1ec1u \u0111\u00e3 \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn r\u1ed9ng r\u00e3i. C\u00e1c nguy\u00ean t\u1eafc n\u00e0y th\u01b0\u1eddng d\u1ef1a tr\u00ean c\u00e1c th\u1eadn tr\u1ecdng v\u00e0 vi\u1ec7c s\u1eed d\u1ee5ng opioid h\u1ea1n ch\u1ebf v\u1edbi li\u1ec1u nh\u1ecf nh\u1ea5t, trong th\u1eddi gian ng\u1eafn nh\u1ea5t c\u00f3 th\u1ec3, sau khi \u0111\u00e3 th\u1ea3o lu\u1eadn chi ti\u1ebft v\u1edbi b\u1ec7nh nh\u00e2n v\u1ec1 nguy c\u01a1, l\u1ee3i \u00edch v\u00e0 c\u00e1c bi\u1ec7n ph\u00e1p thay th\u1ebf.<\/p>\n\n\n\n<p><strong>7. Khuy\u1ebfn c\u00e1o b\u1ed5 sung: ki\u1ec3m so\u00e1t chu ph\u1eabu v\u1edbi thu\u1ed1c<\/strong><\/p>\n\n\n\n<p>Hi\u1ec7p h\u1ed9i \u0110\u00e1nh gi\u00e1 Chu ph\u1eabu v\u00e0 C\u1ea3i thi\u1ec7n Ch\u1ea5t l\u01b0\u1ee3ng (SPAQI) \u0111\u00e3 c\u00f4ng b\u1ed1 nhi\u1ec1u phi\u00ean b\u1ea3n \u0111\u1ed3ng thu\u1eadn ki\u1ec3m so\u00e1t thu\u1ed1c v\u00e0o n\u0103m 2021 v\u00e0 2022. M\u1ed7i tuy\u00ean b\u1ed1 \u0111\u1ec1u mang \u0111\u1ebfn nh\u1eefng g\u00f3c nh\u00ecn r\u1ed9ng v\u1ec1 c\u00e1c thu\u1ed1c th\u01b0\u1eddng \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n v\u00e0 \u0111\u01b0a ra c\u00e1c khuy\u1ebfn c\u00e1o v\u1ec1 vi\u1ec7c c\u00f3 n\u00ean ti\u1ebfp t\u1ee5c c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb n\u00e0y (trong c\u00e1c ng\u00e0y tr\u01b0\u1edbc khi ph\u1eabu thu\u1eadt v\u00e0 ng\u00e0y ph\u1eabu thu\u1eadt). C\u00e1c tuy\u00ean b\u1ed1 n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 th\u00f4ng qua SPAQI website v\u00e0 Mayo Clinic Proceedings.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-85feb21985da6add58a8dc992fa7a676.png\" alt=\"\" \/><\/figure>\n\n\n\n<p><strong>B\u00e0n lu\u1eadn<\/strong><\/p>\n\n\n\n<p>C\u1ea3 b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n ngo\u1ea1i tr\u00fa v\u00e0 b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n n\u1ed9i tr\u00fa \u0111\u1ec1u c\u1ea3m th\u1ea5y c\u00e1c khuy\u1ebfn c\u00e1o n\u00e0y h\u1eefu \u00edch trong vi\u1ec7c \u0111\u00e1nh gi\u00e1 chu ph\u1eabu. M\u1ed7i t\u00e0i li\u1ec7u bao g\u1ed3m c\u1ea3 c\u00e1c th\u1ea3o lu\u1eadn v\u00e0 b\u1ea3ng t\u1ed5ng k\u1ebft c\u00e1c \u0111i\u1ec3m ch\u00ednh.<\/p>\n\n\n\n<p><strong>8. Ki\u1ec3m so\u00e1t t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft \u1edf b\u1ec7nh nh\u00e2n n\u1ed9i tr\u00fa nh\u01b0ng kh\u00f4ng \u1ed1m n\u1eb7ng<\/strong><\/p>\n\n\n\n<p>V\u00e0o n\u0103m 2012, Hi\u1ec7p h\u1ed9i N\u1ed9i ti\u1ebft c\u00f4ng b\u1ed1 h\u01b0\u1edbng d\u1eabn trong ki\u1ec3m so\u00e1t t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft \u1edf b\u1ec7nh nh\u00e2n n\u1ed9i tr\u00fa nh\u01b0ng kh\u00f4ng \u1ed1m n\u1eb7ng. H\u01b0\u1edbng d\u1eabn n\u0103m 2023 \u0111\u01b0\u1ee3c \u0111\u01b0a ra nh\u1eb1m c\u00f4ng b\u1ed1 c\u00e1c khuy\u1ebfn c\u00e1o c\u1eadp nh\u1eadt.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-b7420f1077b1cefa642fdd77c1a89a39.png\" alt=\"\" \/><\/figure>\n\n\n\n<p><strong>B\u00e0n lu\u1eadn<\/strong><\/p>\n\n\n\n<p>H\u01b0\u1edbng d\u1eabn n\u00e0y \u0111\u01b0\u1ee3c xem l\u00e0 v\u0103n b\u1ea3n xem x\u00e9t ki\u1ec3m so\u00e1t b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng trong b\u1ec7nh vi\u1ec7n. Ba \u0111i\u1ec3m b\u1ed5 sung n\u00ean \u0111\u01b0\u1ee3c l\u01b0u \u00fd: (i) 14\/15 khuy\u1ebfn c\u00e1o trong h\u01b0\u1edbng d\u1eabn \u0111\u01b0\u1ee3c \u0111\u01b0a ra d\u1ef1a tr\u00ean c\u00e1c b\u1eb1ng ch\u1ee9ng m\u1ee9c \u0111\u1ed9 th\u1ea5p ho\u1eb7c r\u1ea5t th\u1ea5p, do \u0111\u00f3 d\u1eabn \u0111\u1ebfn c\u00e1c tuy\u00ean b\u1ed1 khuy\u00ean ngh\u1ecb thay v\u00ec khuy\u1ebfn c\u00e1o m\u1ea1nh; (ii) glucose m\u1ee5c ti\u00eau n\u1eb1m trong kho\u1ea3ng 100 \u2013 180 mg\/dL \u1edf b\u1ec7nh nh\u00e2n n\u1ed9i tr\u00fa \u0111\u01b0\u1ee3c \u0111\u01b0a ra trong h\u01b0\u1edbng d\u1eabn c\u00f3 kh\u00e1c bi\u1ec7t so v\u1edbi c\u00e1c h\u01b0\u1edbng d\u1eabn kh\u00e1c (glucose m\u1ee5c ti\u00eau trong kho\u1ea3ng 140 \u2013 180 mg\/dL) v\u1edbi \u0111a s\u1ed1 b\u1ec7nh nh\u00e2n. C\u00e1c \u0111i\u1ec3m kh\u00e1c bi\u1ec7t n\u00e0y d\u1ef1a tr\u00ean \u00fd ki\u1ebfn chuy\u00ean gia. S\u1ef1 kh\u00e1c bi\u1ec7t n\u00e0y \u0111\u01b0\u1ee3c \u0111\u01b0a ra d\u1ef1a tr\u00ean \u00fd ki\u1ebfn chuy\u00ean gia, v\u00ec kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng m\u1ea1nh cho th\u1ea5y \u0111i\u1ec3m b\u1ea5t l\u1ee3i. T\u1eeb g\u00f3c nh\u00ecn th\u1ef1c h\u00e0nh, kho\u1ea3ng 100 \u2013 180 mg\/dL cho ph\u00e9p \u0111\u01b0a ra m\u1ee5c ti\u00eau linh \u0111\u1ed9ng v\u00e0 th\u1ef1c t\u1ebf h\u01a1n, m\u1eb7c d\u00f9 tr\u00e1nh h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft qu\u00e1 m\u1ee9c l\u00e0 m\u1ed9t trong nh\u1eefng m\u1ee5c ti\u00eau quan tr\u1ecdng; (iii) t\u00e1c nh\u00e2n \u0111i\u1ec1u tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, ch\u1eb3ng h\u1ea1n nh\u01b0 ch\u1ea5t \u1ee9c ch\u1ebf DPP4i \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn \u1edf b\u1ec7nh nh\u00e2n b\u1ecb t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft m\u1ee9c \u0111\u1ed9 nh\u1eb9 &#8211; trung b\u00ecnh. So v\u1edbi c\u00e1c t\u00e1c nh\u00e2n h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft kh\u00e1c, DPP4i c\u00f3 \u00edt t\u00e1c \u0111\u1ed9ng b\u1ea5t l\u1ee3i h\u01a1n.<\/p>\n\n\n\n<p><strong>Ngu\u1ed3n<\/strong><\/p>\n\n\n\n<p>Allan S. Brett. Guideline Watch 2023. New England Journal of Medicine. 2023.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\" \/>\n\n\n\n<p><strong>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\" start=\"1\">\n<li>Sengupta N et al. Management of patients with acute lower gastrointestinal bleeding: An updated ACG guideline. Am J Gastroenterol 2023 Feb 1; 118:208. https:\/\/doi.org\/10.14309\/ajg.0000000000002130<\/li>\n\n\n\n<li>Hampl SE et al. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics 2023 Feb 1; 151:e2022060640. https:\/\/doi.org\/1542\/peds.2022-060640<\/li>\n\n\n\n<li>Qaseem A et al. Pharmacologic treatment of primary osteoporosis or low bone mass to prevent fractures in adults: A living clinical guideline from the American College of Physicians. Ann Intern Med 2023 Jan 3; [e-pub]. https:\/\/doi.org\/10.7326\/M22-1034<\/li>\n\n\n\n<li>Ott SM. Osteoporosis treatment: Not easy. Ann Intern Med 2023 Jan 3; [e-pub]. https:\/\/doi.org\/10.7326\/M22-3580<\/li>\n\n\n\n<li>Navaneethan SD et al. Diabetes management in chronic kidney disease: Synopsis of the KDIGO 2022 clinical practice guideline update. Ann Intern Med 2023 Jan 10; [e-pub]. https:\/\/doi.org\/10.7326\/M22-2904<\/li>\n\n\n\n<li>Saunders M and Laiteerapong N. 2022 clinical practice guideline update for diabetes management of chronic kidney disease: An important first step, more work to do. Ann Intern Med 2023 Jan 10; [e-pub]. https:\/\/doi.org\/10.7326\/M22-3635<\/li>\n\n\n\n<li>Douketis JD et al. Executive summary. Perioperative management of antithrombotic therapy: An American College of Chest Physicians clinical practice guideline. Chest 2022 Nov; 162:1127. https:\/\/doi.org\/10.1016\/j.chest.2022.08.004<\/li>\n\n\n\n<li>Douketis JD et al. Perioperative management of antithrombotic therapy: An American College of Chest Physicians clinical practice guideline. Chest 2022 Nov; 162:e207. https:\/\/doi.org\/10.1016\/j.chest.2022.07.025<\/li>\n\n\n\n<li>Dowell D et al. CDC clinical practice guideline for prescribing opioids for pain \u2014 United States, 2022. MMWR Recomm Rep 2022 Nov 4; 71:1. https:\/\/doi.org\/10.15585\/mmwr.rr7103a1<\/li>\n\n\n\n<li>Dowell D et al. Prescribing opioids for pain \u2014 The new CDC clinical practice guideline. N Engl J Med 2022 Nov 3; [e-pub]. https:\/\/doi.org\/10.1056\/NEJMp2211040<\/li>\n\n\n\n<li>Pfeifer KJ et al. Preoperative management of gastrointestinal and pulmonary medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) consensus statement. Mayo Clin Proc 2021 Dec; 96:3158. https:\/\/doi.org\/10.1016\/j.mayocp.2021.08.008<\/li>\n\n\n\n<li>Oprea AD et al. Preoperative management of medications for psychiatric diseases: Society for Perioperative Assessment and Quality Improvement consensus statement. Mayo Clin Proc 2022 Feb; 97:397. https:\/\/doi.org\/10.1016\/j.mayocp.2021.11.011<\/li>\n\n\n\n<li>Oprea AD et al. Preoperative management of medications for neurologic diseases: Society for Perioperative Assessment and Quality Improvement consensus statement. Mayo Clin Proc 2022 Feb; 97:375. https:\/\/doi.org\/10.1016\/j.mayocp.2011.010<\/li>\n\n\n\n<li>Russell LA et al. Preoperative management of medications for rheumatologic and HIV diseases: Society for Perioperative Assessment and Quality Improvement (SPAQI) consensus statement. Mayo Clin Proc 2022 Aug; 97:1551. https:\/\/doi.org\/10.1016\/j.mayocp.2005.002<\/li>\n\n\n\n<li>Korytkowski MT et al. Management of hyperglycemia in hospitalized adult patients in non-critical care settings: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2022 Aug; 107:2101. https:\/\/doi.org\/10.1210\/clinem\/dgac278<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Docquity \u0111\u00e3 gi\u1edbi thi\u1ec7u v\u1edbi qu\u00fd v\u1ecb \u0111\u1ed3ng nghi\u1ec7p b\u00e0i vi\u1ebft \u201cH\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb t\u00e2m \u0111i\u1ec3m n\u0103m 2023: Ph\u1ea7n 1\u201d. <\/p>\n","protected":false},"author":123,"featured_media":33315,"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":[1437],"articles_languages":[1375],"articles_filters":[],"class_list":["post-33275","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\/33275","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=33275"}],"version-history":[{"count":0,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles\/33275\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media\/33315"}],"wp:attachment":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media?parent=33275"}],"wp:term":[{"taxonomy":"articles_categories","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_categories?post=33275"},{"taxonomy":"articles_tags","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_tags?post=33275"},{"taxonomy":"articles_topics","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_topics?post=33275"},{"taxonomy":"articles_languages","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_languages?post=33275"},{"taxonomy":"articles_filters","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_filters?post=33275"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}