{"id":3247,"date":"2023-01-03T09:45:08","date_gmt":"2023-01-03T02:45:08","guid":{"rendered":"https:\/\/benhvienthaihoa.vn\/2023\/01\/03\/bai-5-tinh-hinh-lam-dung-corticosteroid-va-cac-hau-qua-nghiem-trong\/"},"modified":"2025-06-22T23:23:55","modified_gmt":"2025-06-22T16:23:55","slug":"bai-5-tinh-hinh-lam-dung-corticosteroid-va-cac-hau-qua-nghiem-trong-2","status":"publish","type":"post","link":"https:\/\/benhvienthaihoa.vn\/en\/bai-5-tinh-hinh-lam-dung-corticosteroid-va-cac-hau-qua-nghiem-trong-2\/","title":{"rendered":"B\u00e0i 5: T\u00ecnh h\u00ecnh l\u1ea1m d\u1ee5ng corticosteroid v\u00e0 c\u00e1c h\u1eadu qu\u1ea3 nghi\u00eam tr\u1ecdng"},"content":{"rendered":"

Corticoids hay c\u00f2n g\u1ecdi l\u00e0 corticosteroids, glucocorticosteroid l\u00e0 nh\u1eefng steroids \u0111\u01b0\u1ee3c v\u1ecf th\u01b0\u1ee3ng th\u1eadn s\u1ea3n xu\u1ea5t (n\u1ed9i sinh) hay t\u1ed5ng h\u1ee3p (ngo\u1ea1i sinh: Prednisone, Methylprednisolone, dexamethasone..) c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong chuy\u1ec3n h\u00f3a mu\u1ed1i, \u0111\u01b0\u1eddng, m\u1ee1, ch\u1ea5t \u0111\u1ea1m \u0111\u1ec3 duy tr\u00ec c\u00e1c ch\u1ee9c n\u0103ng s\u1ed1ng c\u1ee7a c\u01a1 th\u1ec3.<\/p>\n

T\u00e1c d\u1ee5ng nh\u00f3m thu\u1ed1c corticoid<\/em><\/p>\n

Corticosteroid \u0111\u01b0\u1ee3c \u1ee9ng d\u1ee5ng trong y h\u1ecdc \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec1u tri\u1ec7u ch\u1ee9ng v\u00e0 b\u1ec7nh vi\u00eam nhi\u1ec5m. C\u00e1c ch\u1ec9 \u0111\u1ecbnh ph\u1ed5 bi\u1ebfn c\u1ee7a corticoid:<\/p>\n

– Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p.<\/p>\n

– D\u1ef1 ph\u00f2ng stress tr\u00ean b\u1ec7nh nh\u00e2n n\u1eb7ng.<\/p>\n

– Hen ph\u1ebf qu\u1ea3n\/B\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh.<\/p>\n

– Ch\u1ed1ng vi\u00eam t\u1ea1i ch\u1ed7: vi\u00eam k\u1ebft m\u1ea1c do d\u1ecb \u1ee9ng, eczecma, vi\u00eam m\u0169i d\u1ecb \u1ee9ng.<\/p>\n

– Suy th\u01b0\u1ee3ng th\u1eadn.<\/p>\n

– H\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0.<\/p>\n

V\u00e0 r\u1ea5t nhi\u1ec1u c\u00e1c ch\u1ec9 \u0111\u1ecbnh kh\u00e1c (trong \u0111\u00f3 c\u00f3 c\u1ea3 ch\u1ec9 \u0111\u1ecbnh ch\u01b0a ph\u00f9 h\u1ee3p nh\u01b0ng v\u1eabn t\u00ecnh h\u00ecnh l\u1ea1m d\u1ee5ng corticoid v\u1eabn x\u1ea3y ra).<\/p>\n

\"\"<\/p>\n

C\u00e1c t\u00e1c d\u1ee5ng b\u1ea5t l\u1ee3i c\u1ee7a corticoid<\/em><\/p>\n

B\u00ean c\u1ea1nh nh\u1eefng t\u00e1c d\u1ee5ng c\u00f3 l\u1ee3i, c\u00e1c thu\u1ed1c corticoid g\u00e2y ra m\u1ed9t lo\u1ea1t c\u00e1c ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i c\u1ee7a thu\u1ed1c (ADR) bao g\u1ed3m xu\u1ea5t hi\u1ec7n h\u1ed9i ch\u1ee9ng Cushing, t\u0103ng c\u00e2n, lo\u00e3ng x\u01b0\u01a1ng, g\u00e3y x\u01b0\u01a1ng, r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n v\u00e0 nh\u1eadn th\u1ee9c, \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, teo da, m\u1ee5n tr\u1ee9ng c\u00e1, r\u1eadm l\u00f4ng v\u00e0 gi\u1ea3m s\u1eafc t\u1ed1.<\/p>\n

C\u00e1c ADR ng\u00e0y c\u00e0ng x\u1ea3y ra nhi\u1ec1u h\u01a1n khi s\u1eed d\u1ee5ng corticosteroid m\u00e0 kh\u00f4ng c\u00f3 s\u1ef1 gi\u00e1m s\u00e1t y t\u1ebf v\u00e0 ch\u1ee7 y\u1ebfu khi ch\u00fang \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u00ec nh\u1eefng l\u00fd do kh\u00f4ng li\u00ean quan \u0111\u1ebfn b\u1ec7nh t\u1eadt.<\/p>\n

C\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 t\u00ecnh h\u00ecnh l\u1ea1m d\u1ee5ng corticoid<\/em><\/p>\n

M\u1ed9t nghi\u00ean c\u1ee9u \u1edf Irag c\u00f3 m\u1eabu g\u1ed3m 141 kh\u00e1ch h\u00e0ng c\u1ee7a nh\u00e0 thu\u1ed1c (98 ph\u1ee5 n\u1eef v\u00e0 43 nam gi\u1edbi) y\u00eau c\u1ea7u corticoid to\u00e0n th\u00e2n (OCS) m\u00e0 kh\u00f4ng c\u1ea7n toa b\u00e1c s\u0129.Tu\u1ed5i trung b\u00ecnh c\u1ee7a h\u1ecd l\u00e0 28,4 (\u00b1 10,9) tu\u1ed5i. H\u01a1n m\u1ed9t n\u1eeda s\u1ed1 ng\u01b0\u1eddi tham gia (N=75, 53,2%) c\u00f3 b\u1eb1ng trung h\u1ecdc c\u01a1 s\u1edf ho\u1eb7c tr\u00ecnh \u0111\u1ed9 h\u1ecdc v\u1ea5n th\u1ea5p h\u01a1n. Dexamethasone l\u00e0 OCS \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn nh\u1ea5t (N=84, 59,6 %). T\u0103ng c\u00e2n (N=51, 36,2%) v\u00e0 v\u1ea5n \u0111\u1ec1 nhi\u1ec5m tr\u00f9ng t\u00e1i \u0111i t\u00e1i l\u1ea1i (N=41, 29,1%) l\u00e0 nh\u1eefng t\u00e1c d\u1ee5ng ph\u1ee5 ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf nh\u1eefng ng\u01b0\u1eddi tham gia. M\u1ed9t l\u1ea7n m\u1ed7i ng\u00e0y l\u00e0 t\u1ea7n su\u1ea5t OCS ph\u1ed5 bi\u1ebfn nh\u1ea5t \u0111\u01b0\u1ee3c nh\u1eefng ng\u01b0\u1eddi tham gia s\u1eed d\u1ee5ng (N=57, 40,4%).<\/p>\n

Kho\u1ea3ng m\u1ed9t n\u1eeda (N=68, 48,2%) s\u1ed1 ng\u01b0\u1eddi tham gia \u0111\u00e3 d\u00f9ng OCS trong v\u00f2ng ch\u01b0a \u0111\u1ea7y ba th\u00e1ng. B\u1ea1n b\u00e8 c\u1ee7a nh\u1eefng ng\u01b0\u1eddi tham gia l\u00e0 nh\u1eefng ng\u01b0\u1eddi gi\u1edbi thi\u1ec7u ch\u00ednh (N=40, 28,4 %) cho vi\u1ec7c s\u1eed d\u1ee5ng OCS m\u00e0 kh\u00f4ng c\u1ea7n toa b\u00e1c s\u0129. T\u00e1c d\u1ee5ng b\u1ea5t l\u1ee3i ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf nh\u1eefng ng\u01b0\u1eddi tham gia l\u00e0 th\u1ecb l\u1ef1c k\u00e9m (29,1 %).<\/p>\n

Trong nghi\u00ean c\u1ee9u n\u00e0y, 66% ng\u01b0\u1eddi tham gia kh\u00f4ng bi\u1ebft v\u1ec1 t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a OCS, \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn vi\u1ec7c tin r\u1eb1ng OCS kh\u00f4ng c\u1ea7n \u0111\u01a1n thu\u1ed1c. T\u01b0\u01a1ng t\u1ef1, m\u1ed9t nghi\u00ean c\u1ee9u tr\u01b0\u1edbc \u0111\u00e2y cho th\u1ea5y 83,5% nh\u1eefng ng\u01b0\u1eddi l\u1ea1m d\u1ee5ng OCS ngh\u0129 r\u1eb1ng vi\u1ec7c s\u1eed d\u1ee5ng ch\u00fang l\u00e0 an to\u00e0n. .Nh\u1eefng ph\u00e1t hi\u1ec7n n\u00e0y ch\u1ee9ng minh th\u1ef1c t\u1ebf l\u00e0 m\u1ed9t n\u1eeda s\u1ed1 ng\u01b0\u1eddi tham gia \u0111\u00e3 kh\u00f4ng h\u1ecfi d\u01b0\u1ee3c s\u0129 tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng OCS.<\/p>\n

Th\u1ef1c tr\u1ea1ng hi\u1ec7n nay<\/em><\/p>\n

Tuy nhi\u00ean, v\u1edbi th\u1ef1c tr\u1ea1ng t\u1ea1i Vi\u1ec7t Nam hi\u1ec7n nay ng\u01b0\u1eddi b\u1ec7nh c\u00f3 th\u1ec3 d\u1ec5 d\u00e0ng mua \u0111\u01b0\u1ee3c nh\u00f3m thu\u1ed1c n\u00e0y k\u1ec3 c\u1ea3 khi kh\u00f4ng c\u00f3 \u0111\u01a1n c\u1ee7a b\u00e1c s\u0129 v\u00e0 kh\u1ea3 n\u0103ng tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb k\u00e9m c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh th\u00ec t\u00ecnh tr\u1ea1ng l\u1ea1m d\u1ee5ng nh\u00f3m thu\u1ed1c n\u00e0y c\u00e0ng \u0111\u00e1ng lo ng\u1ea1i.<\/p>\n

C\u00f3 nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n t\u1ef1 mua thu\u1ed1c theo \u0111\u01a1n c\u0169 kh\u00f4ng \u0111i kh\u00e1m l\u1ea1i ho\u1eb7c t\u1ef1 \u00fd ra c\u00e1c hi\u1ec7u thu\u1ed1c mua thu\u1ed1c v\u1ec1 d\u00f9ng theo kinh nghi\u1ec7m truy\u1ec1n mi\u1ec7ng, th\u1ea5y hi\u1ec7u qu\u1ea3 gi\u1ea3m \u0111au, ch\u1ed1ng vi\u00eam t\u1ee9c th\u00ec ngay sau khi s\u1eed d\u1ee5ng th\u00ec cho r\u1eb1ng \u0111\u00f3 l\u00e0 \u201cth\u1ea7n d\u01b0\u1ee3c\u201d n\u00ean \u0111\u00e3 d\u00f9ng th\u01b0\u1eddng xuy\u00ean. B\u00ean c\u1ea1nh \u0111\u00f3, nhi\u1ec1u b\u1ec7nh nh\u00e2n c\u00f2n t\u00ecm \u0111\u1ebfn c\u00e1c lo\u1ea1i thu\u1ed1c \u0111\u00f4ng y, thu\u1ed1c nam v\u00ec ngh\u0129 n\u00f3 \u201cl\u00e0nh h\u01a1n\u201d thu\u1ed1c t\u00e2y m\u1eb7c d\u00f9 kh\u00f4ng bi\u1ebft ngu\u1ed3n g\u1ed1c xu\u1ea5t x\u1ee9, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c b\u1ec7nh nh\u00e2n m\u1eafc c\u00e1c b\u1ec7nh l\u00fd m\u1ea1n t\u00ednh: \u0111au kh\u1edbp, g\u00fat, vi\u00eam m\u0169i xoang, d\u1ecb \u1ee9ng\u2026; m\u00e0 nh\u00f3m thu\u1ed1c n\u00e0y r\u1ea5t kh\u00f3 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c th\u00e0nh ph\u1ea7n c\u0169ng nh\u01b0 li\u1ec1u l\u01b0\u1ee3ng corticoid trong \u0111\u00f3, ch\u1ec9 \u0111\u1ebfn khi c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a vi\u1ec7c l\u1ea1m d\u1ee5ng corticoid n\u1eb7ng n\u1ec1 m\u1edbi \u0111\u1ebfn g\u1eb7p c\u00e1c b\u00e1c s\u0129 v\u00e0 ph\u00e1t hi\u1ec7n ra t\u00e1c h\u1ea1i c\u1ee7a n\u00f3.<\/p>\n

Vi\u1ec7c s\u1eed d\u1ee5ng corticoid nh\u01b0 con dao hai l\u01b0\u1ee1i. V\u00ec v\u1eady, \u0111\u1ec3 ph\u00e1t huy hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb v\u00e0 h\u1ea1n ch\u1ebf c\u00e1c t\u00e1c d\u1ee5ng b\u1ea5t l\u1ee3i c\u1ee7a nh\u00f3m thu\u1ed1c n\u00e0y; c\u00e1c b\u00e1c s\u0129 khuy\u1ebfn c\u00e1o, ng\u01b0\u1eddi b\u1ec7nh c\u1ea7n tu\u00e2n th\u1ee7 li\u1ec7u tr\u00ecnh \u0111i\u1ec1u tr\u1ecb v\u00e0 ch\u1ec9 d\u00f9ng thu\u1ed1c khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh c\u1ee7a b\u00e1c s\u0129.<\/p>\n

Khuy\u1ebfn c\u00e1o cho b\u1ec7nh nh\u00e2n<\/em><\/p>\n

– Ch\u1ec9 s\u1eed d\u1ee5ng corticoid khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh v\u00e0 \u0111\u01a1n thu\u1ed1c r\u00f5 r\u00e0ng t\u1eeb b\u00e1c s\u0129.<\/p>\n

– N\u00ean s\u1eed d\u1ee5ng corticoid v\u00e0o bu\u1ed5i s\u00e1ng, SAU KHI \u0102N.<\/p>\n

– Kh\u00f4ng t\u1ef1 \u00fd t\u0103ng li\u1ec1u, b\u1ecf li\u1ec1u ho\u1eb7c ng\u01b0ng thu\u1ed1c \u0111\u1ed9t ng\u1ed9t khi ch\u01b0a h\u1ecfi \u00fd ki\u1ebfn b\u00e1c s\u0129.<\/p>\n

– Theo d\u00f5i huy\u1ebft \u00e1p, \u0111\u01b0\u1eddng huy\u1ebft th\u01b0\u1eddng xuy\u00ean \u0111\u1ec3 ph\u00f2ng ng\u1eeba c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 do corticoid.<\/p>\n

– \u0110o m\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng m\u1ed7i 6-12 th\u00e1ng, b\u1ed5 sung calcium v\u00e0 vitamin D h\u00e0ng ng\u00e0y n\u1ebfu ph\u1ea3i s\u1eed d\u1ee5ng corticoid k\u00e9o d\u00e0i.<\/p>\n

– Ki\u1ec3m tra m\u1eaft \u0111\u1ecbnh k\u1ef3 m\u1ed7i 6-12 th\u00e1ng \u0111\u1ec3 ph\u00f2ng ng\u1eeba bi\u1ebfn ch\u1ee9ng \u0111\u1ee5c th\u1ee7y tinh th\u1ec3.<\/p>\n

– Kh\u00f4ng t\u1ef1 \u00fd s\u1eed d\u1ee5ng Corticoids v\u1edbi thu\u1ed1c kh\u00e1ng vi\u00eam gi\u1ea3m \u0111au kh\u00e1c (t\u00e2y y, \u0111\u00f4ng y) m\u00e0 ch\u01b0a h\u1ecfi \u00fd ki\u1ebfn b\u00e1c s\u0129.<\/p>\n

– N\u1ebfu c\u00f3 d\u1ea5u hi\u1ec7u ph\u00f9, r\u1ed1i lo\u1ea1n h\u00e0nh vi, tr\u00ed nh\u1edb, tr\u1ea7m c\u1ea3m,\u2026b\u00e1o ngay cho b\u00e1c s\u0129 \u0111\u1ec3 \u0111\u01b0\u1ee3c x\u1eed l\u00fd k\u1ecbp th\u1eddi.<\/p>\n

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

    \n
  1. Bashar G. Alfetlawi, et al., Evaluating Factors Related to the Abuse of Oral Corticosteroids among Community Pharmacy Customers: Using Theory of Reasoned Action, PUBMED, Published online 2020 Feb 28. doi: 10.24926\/iip.v11i1.2936.<\/li>\n
  2. Topical corticosteroids: information on the risk of topical steroid withdrawal reactions, GOV.UK.<\/li>\n
  3. Meriem Hadjilah, Sarah Fiala,Oral corticosteroids abuse for the purpose of weight gain : First assessment in Algeria, https:\/\/doi.org\/10.21203\/rs.3.rs-2046646\/v1<\/a>.<\/li>\n
  4. Use and abuse of systemic corticosteroid therapy, Sciencedirect, <\/em>https:\/\/doi.org\/10.1016\/S0190-9622(79)80029-8<\/a>.<\/li>\n<\/ol>","protected":false},"excerpt":{"rendered":"

    Corticoids hay c\u00f2n g\u1ecdi l\u00e0 corticosteroids, glucocorticosteroid l\u00e0 nh\u1eefng steroids \u0111\u01b0\u1ee3c v\u1ecf th\u01b0\u1ee3ng th\u1eadn s\u1ea3n xu\u1ea5t (n\u1ed9i sinh) hay t\u1ed5ng h\u1ee3p (ngo\u1ea1i sinh: Prednisone, Methylprednisolone, dexamethasone..) c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong chuy\u1ec3n h\u00f3a mu\u1ed1i, \u0111\u01b0\u1eddng, m\u1ee1, ch\u1ea5t \u0111\u1ea1m \u0111\u1ec3 duy tr\u00ec c\u00e1c ch\u1ee9c n\u0103ng s\u1ed1ng c\u1ee7a c\u01a1 th\u1ec3. T\u00e1c d\u1ee5ng nh\u00f3m thu\u1ed1c corticoid CorticosteroidLeer M\u00e1s<\/p>","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[57],"tags":[],"class_list":["post-3247","post","type-post","status-publish","format-standard","hentry","category-bai-viet-y-khoa"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/benhvienthaihoa.vn\/en\/wp-json\/wp\/v2\/posts\/3247","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/benhvienthaihoa.vn\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/benhvienthaihoa.vn\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/benhvienthaihoa.vn\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/benhvienthaihoa.vn\/en\/wp-json\/wp\/v2\/comments?post=3247"}],"version-history":[{"count":1,"href":"https:\/\/benhvienthaihoa.vn\/en\/wp-json\/wp\/v2\/posts\/3247\/revisions"}],"predecessor-version":[{"id":3248,"href":"https:\/\/benhvienthaihoa.vn\/en\/wp-json\/wp\/v2\/posts\/3247\/revisions\/3248"}],"wp:attachment":[{"href":"https:\/\/benhvienthaihoa.vn\/en\/wp-json\/wp\/v2\/media?parent=3247"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/benhvienthaihoa.vn\/en\/wp-json\/wp\/v2\/categories?post=3247"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/benhvienthaihoa.vn\/en\/wp-json\/wp\/v2\/tags?post=3247"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}