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\u00a0V\u1ebft x\u01b0\u1edbt:\u00a0<\/i><\/b>Do t\u1ed5n th\u01b0\u01a1ng c\u00e1c t\u1ea7ng tr\u00ean c\u1ee7a da<\/p>\nC\u00c1C TH\u01af\u01a0NG T\u1ed4N C\u01a0 B\u1ea2N<\/b><\/p>\n
1. Th\u01b0\u01a1ng t\u1ed5n l\u1ecfng<\/b><\/p>\n
L\u00e0 nh\u1eefng th\u01b0\u01a1ng t\u1ed5n do ch\u1ee9a 1 ch\u1ea5t l\u1ecfng t\u1ea1o th\u00e0nh, ch\u1ea5t l\u1ecfng \u0111\u00f3 c\u00f3 th\u1ec3 trong, s\u00e1ch, \u0111\u1ee5c, ch\u1ee9a m\u00e1u, m\u1ee7,…<\/p>\n
1.1. M\u1ee5n n\u01b0\u1edbc:\u00a0<\/i><\/b>Sang th\u01b0\u01a1ng <5mm nh\u00f4 cao tr\u00ean m\u1eb7t da ch\u1ee9a n\u01b0\u1edbc trong, m\u1ee5n n\u01b0\u1edbc c\u00f3 th\u1ec3 ch\u1ea3y n\u01b0\u1edbc \u0111\u00f3ng m\u00e0i<\/p>\n
V\u00ed d\u1ee5:<\/i>\u00a0Gh\u1ebb, ch\u00e0m, t\u1ed5 \u0111\u1ec9a…<\/p>\n
1.2. B\u00f3ng n\u01b0\u1edbc<\/i><\/b><\/p>\n
T\u01b0\u01a1ng t\u1ef1 nh\u01b0 m\u1ee5n n\u01b0\u1edbc nh\u01b0ng \u0111\u01b0\u1eddng k\u00ednh l\u1edbn h\u01a1n th\u00f4ng th\u01b0\u1eddng >5mm b\u00f3ng n\u01b0\u1edbc c\u00f3 th\u1ec3 c\u0103ng ho\u1eb7c ch\u00f9ng, d\u1ecbch b\u00ean trong c\u00f3 th\u1ec3 trong, \u0111\u1ee5c, m\u00e1u, m\u1ee7.<\/p>\n
B\u00f3ng n\u01b0\u1edbc bao g\u1ed3m b\u00f3ng n\u01b0\u1edbc ti\u00ean ph\u00e1t v\u00e0 b\u00f3ng n\u01b0\u1edbc th\u1ee9 ph\u00e1t:<\/p>\n
–\u00a0B\u00f3ng n\u01b0\u1edbc ti\u00ean ph\u00e1t:<\/i>\u00a0L\u00e0 b\u00f3ng n\u01b0\u1edbc xu\u1ea5t hi\u1ec7n do b\u1ec7nh nh\u01b0 trong tr\u01b0\u1eddng h\u1ee3p Pemphigus, Duhring.<\/p>\n
–\u00a0B\u00f3ng n\u01b0\u1edbc th\u1ee9 ph\u00e1t:<\/i>\u00a0l\u00e0 do m\u1ed9t t\u00e1c nh\u00e2n n\u00e0o \u0111\u00f3 g\u00e2y n\u00ean nh\u01b0 trong tr\u01b0\u1eddng h\u1ee3p b\u1ecfng l\u1eeda, b\u1ecfng n\u01b0\u1edbc s\u00f4i, b\u1ecfng h\u00f3a ch\u1ea5t,…<\/p>\n
1.3. M\u1ee5n m\u1ee7:\u00a0<\/i><\/b>L\u00e0 nh\u1eefng th\u01b0\u01a1ng t\u1ed5n ch\u1ee9a m\u1ee7 g\u1ed3m c\u00f3:<\/p>\n
–\u00a0M\u1ee5n m\u1ee7 th\u01b0\u1ee3ng b\u00ec:<\/i>\u00a0v\u1ea3y n\u1ebfn m\u1ee7, vi\u00eam m\u1ea1ch m\u1ee5n m\u1ee7.<\/p>\n
–\u00a0M\u1ee5n m\u1ee7 nang l\u00f4ng:<\/i>\u00a0nh\u01b0 vi\u00eam nang l\u00f4ng, nh\u1ecdt,….<\/p>\n
1.4. Nang :\u00a0<\/i><\/b>L\u00e0 t\u00fai ch\u1ee9a d\u1ecbch l\u1ecfng, khi ta \u1ea5n v\u00e0o gi\u1ed1ng nh\u01b0 khi \u1ea5n v\u00e0o nh\u00e3n c\u1ea7u nh\u01b0 u nang tuy\u1ebfn b\u00e3, tr\u1ee9ng c\u00e1 b\u1ecdc.<\/p>\n
2. Th\u01b0\u01a1ng t\u1ed5n m\u1ea5t da:\u00a0<\/b>L\u00e0 th\u01b0\u01a1ng t\u1ed5n l\u00e0m m\u1ea5t \u0111i 1 ph\u1ea7n ho\u1eb7c to\u00e0n ph\u1ea7n c\u1ee7a t\u1ed5 ch\u1ee9c da.<\/p>\n
\u00a0V\u1ebft x\u01b0\u1edbt:\u00a0<\/i><\/b>Do t\u1ed5n th\u01b0\u01a1ng c\u00e1c t\u1ea7ng tr\u00ean c\u1ee7a da<\/p>\n
– L\u1edbp s\u1eebng t\u1ed5n th\u01b0\u01a1ng: C\u00f3 m\u1ed9t v\u1ea1ch tr\u1eafng<\/p>\n
– L\u1edbp gai t\u1ed5n th\u01b0\u01a1ng: Ti\u1ebft huy\u1ebft thanh<\/p>\n
– L\u1edbp nh\u00fa t\u1ed5n th\u01b0\u01a1ng: Ti\u1ebft huy\u1ebft thanh + m\u00e1u<\/p>\n
\u00a0V\u1ebft l\u1edf (tr\u1ee3t):\u00a0<\/i><\/b>Th\u01b0\u1ee3ng b\u00ec b\u1ecb m\u1ea5t nh\u01b0 s\u0103ng giang mai<\/p>\n
\u00a0V\u1ebft lo\u00e9t:\u00a0<\/i><\/b>T\u1ed5n th\u01b0\u01a1ng \u0111\u1ebfn trung b\u00ec ho\u1eb7c h\u1ea1 b\u00ec khi l\u00e0nh \u0111\u1ec3 l\u1ea1i s\u1eb9o nh\u01b0 tr\u01b0\u1eddng h\u1ee3p s\u0103ng h\u1ea1 cam m\u1ec1m<\/p>\n
\u00a0V\u1ebft n\u1ee9t n\u1ebb:\u00a0<\/i><\/b>Th\u01b0\u1eddng th\u1ea5y \u1edf quanh mi\u1ec7ng, m\u0169i, h\u1eadu m\u00f4n, k\u1ebd tay,…<\/p>\n
3. Th\u01b0\u01a1ng t\u1ed5n d\u1ec5 r\u1ee5ng:\u00a0<\/b>L\u00e0 t\u1ed5n th\u01b0\u01a1ng \u1edf tr\u00ean m\u1eb7t da c\u00f3 th\u1ec3 l\u00e0 t\u1ed5 ch\u1ee9c da ho\u1eb7c kh\u00f4ng ph\u1ea3i t\u1ed5 ch\u1ee9c da<\/p>\n
\u00b7\u00a0V\u1ea3y da<\/i><\/b>: L\u00e0 nh\u1eefng m\u1ea3ng th\u01b0\u1ee3ng b\u00ec bong ra kh\u1ecfi l\u1edbp s\u1eebng c\u00f3 th\u1ec3 b\u00ecnh th\u01b0\u1eddng ho\u1eb7c b\u1ec7nh. V\u1ea3y da bao g\u1ed3m v\u1ea3y ti\u00ean ph\u00e1t ho\u1eb7c v\u1ea3y th\u1ee9 ph\u00e1t.<\/p>\n
–\u00a0V\u1ea3y ti\u00ean ph\u00e1t:<\/i>\u00a0Da v\u1ea3y c\u00e1<\/p>\n
–\u00a0V\u1ea3y th\u1ee9 ph\u00e1t:<\/i>\u00a0Ch\u00e0m, lang ben, v\u1ea3y n\u1ebfn, v\u1ea3y ph\u1ea5n h\u1ed3ng…<\/p>\n
\u00b7\u00a0V\u1ea3y ti\u1ebft<\/i><\/b><\/p>\n
Do m\u00e1u, m\u1ee7, huy\u1ebft thanh, ch\u1ea5t b\u00e3, x\u00e1c vi tr\u00f9ng, b\u1ea1ch c\u1ea7u \u0111\u1ecdng l\u1ea1i. T\u00f9y theo nguy\u00ean nh\u00e2n m\u00e0 m\u00e0u c\u1ee7a v\u1ea3y kh\u00e1c nhau.<\/p>\n
V\u00ed d\u1ee5:<\/i>\u00a0V\u1ea3y huy\u1ebft thanh m\u00e0u v\u00e0ng, v\u00e0y m\u00e1u m\u00e0u \u0111en, v\u1ea3y m\u00e1u m\u1ee7 m\u00e0u n\u00e2u…<\/p>\n
Ngo\u00e0i nh\u1eefng th\u01b0\u01a1ng t\u1ed5n tr\u00ean c\u00f2n c\u00f3 nh\u1eefng th\u01b0\u01a1ng t\u1ed5n nh\u01b0 teo da, c\u1ee9ng da, s\u1eb9o, lichen h\u00f3a:<\/p>\n
–\u00a0Teo da:<\/i>\u00a0teo th\u01b0\u1ee3ng b\u00ec, teo b\u00ec ho\u1eb7c teo c\u1ea3 th\u01b0\u1ee3ng b\u00ec v\u00e0 teo b\u00ec: Lupus \u0111\u1ecf m\u00e3n, x\u01a1 c\u1ee9ng b\u00ec khu tr\u00fa, tai bi\u1ebfn da do corticoid.<\/p>\n
–\u00a0C\u1ee9ng da:<\/i>\u00a0Do t\u0103ng qu\u00e1 \u0111\u1ed9 c\u1ee7a collagen trong l\u1edbp b\u00ec: x\u01a1 c\u1ee9ng b\u00ec khu tr\u00fa ho\u1eb7c to\u00e0n th\u1ec3<\/p>\n
–\u00a0S\u1eb9o:<\/i>\u00a0Do t\u1ed5n th\u01b0\u01a1ng ph\u00e1 h\u1ee7y m\u00f4 b\u00ec: s\u1eb9o sau ph\u1eabu thu\u1eadt, s\u1eb9o l\u1ed3i, s\u1eb9o zona.<\/p>\n
–\u00a0Lichen h\u00f3a:<\/i>\u00a0Do c\u00e0o g\u00e3i, c\u1ecd x\u00e1t th\u01b0\u1eddng xuy\u00ean: ch\u00e0m m\u00e3n.<\/p>\n
Trong th\u1ef1c t\u1ebf c\u00e1c th\u01b0\u01a1ng t\u1ed5n th\u01b0\u1eddng k\u1ebft h\u1ee3p v\u1edbi nhau th\u00e0nh t\u1eebng c\u1eb7p nh\u1eefng th\u01b0\u01a1ng t\u1ed5n k\u00e9p.<\/p>\n
V\u00ed d\u1ee5:<\/i>\u00a0H\u1ed3ng ban c\u00f3 v\u1ea3y, h\u1ed3ng ban m\u1ee5n n\u01b0\u1edbc….<\/p>\n
4. C\u00e1ch s\u1eafp x\u1ebfp v\u00e0 ph\u00e2n b\u1ed1 c\u00e1c th\u01b0\u01a1ng t\u1ed5n c\u01a1 b\u1ea3n<\/b><\/p>\n
4.1. C\u00e1ch s\u1eafp x\u1ebfp:<\/i><\/b><\/p>\n
a) S\u1eafp x\u1ebfp theo \u0111\u01b0\u1eddng th\u1eb3ng:<\/i>\u00a0Noevus c\u00f3c, n\u1ea5m Sporotrichose, gi\u00e3n t\u0129nh m\u1ea1ch chi d\u01b0\u1edbi, zona<\/p>\n
b) S\u1eafp x\u1ebfp theo \u0111\u01b0\u1eddng v\u00f2ng:<\/i><\/p>\n
– H\u00ecnh v\u00f2ng: v\u1ea3y ph\u1ea5n h\u1ed3ng, u h\u1ea1t v\u00f2ng, m\u1ec1 \u0111ay, h\u1ed3ng ban v\u00f2ng<\/p>\n
– H\u00ecnh bia: h\u1ed3ng ban \u0111a d\u1ea1ng<\/p>\n
– H\u00ecnh cung: Mycosis fungoides<\/p>\n
– H\u00ecnh \u0111a cung: n\u1ea5m da, m\u1ec1 \u0111ay<\/p>\n
c) S\u1eafp x\u1ebfp th\u00e0nh nh\u00f3m:<\/i><\/p>\n
Khu tr\u00fa t\u1ea1i m\u1ed9t v\u00f9ng c\u01a1 th\u1ec3: m\u1ee5n c\u00f3c, u m\u1ec1m l\u00e2y, vi\u00eam da d\u1ea1ng herpes\u2026<\/p>\n
4.2. Ph\u00e2n b\u1ed1:<\/i><\/b><\/p>\n
T\u1ed5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 ph\u00e2n b\u1ed1 kh\u1eafp c\u01a1 th\u1ec3 nh\u01b0: da \u0111\u1ea7u (v\u1ea3y n\u1ebfn, r\u1ee5ng t\u00f3c, ch\u00e0m ti\u1ebft b\u00e3..), m\u00f4i (ch\u00e0m, vi\u00eam m\u00f4i), chi (lichen ph\u1eb3ng, d\u00e0y s\u1eebng nang l\u00f4ng, ch\u00e0m th\u1ec3 t\u1ea1ng..), m\u1eb7t (m\u1ee5n tr\u1ee9ng c\u00e1, lupus \u0111\u1ecf, ch\u00e0m ti\u1ebft b\u00e3, t\u00e0n nhang, n\u00e1m m\u00e1\u2026), b\u00e0n tay b\u00e0n ch\u00e2n (ch\u00e0m, gh\u1ebb, t\u1ed5 \u0111\u1ec9a, ch\u00e0m t\u0103ng s\u1eebng\u2026), n\u1ebfp (vi\u00eam k\u1ebd, v\u1ea3y n\u1ebfn, n\u1ea5m b\u1eb9n\u2026), b\u1ed9 ph\u1eadn sinh d\u1ee5c (b\u1ec7nh l\u00e2y truy\u1ec1n qua \u0111\u01b0\u1eddng t \u00ec n h d \u1ee5 c, h\u1ed9i ch\u1ee9ng Reiter, h\u1ed3ng ban s\u1eafc t\u1ed1 c\u1ed1 \u0111\u1ecbnh\u2026), ngo\u00e0i ra c\u00f2n g\u1eb7p \u1edf m\u1ed9t s\u1ed1 v\u00f9ng kh\u00e1c nh\u01b0 v\u00f9ng tuy\u1ebfn b\u00e3, v\u00f9ng ph\u01a1i b\u00e0y \u00e1nh s\u00e1ng.<\/p>\n
NHI\u1ec4M \u0110\u1ed8C DA DO THU\u1ed0C \u2013 H\u00d3A M\u1ef8 PH\u1ea8M<\/b><\/p>\n
I.C\u01a1 ch\u1ebf b\u1ec7nh sinh<\/b><\/p>\n
1. S\u01a1 l\u01b0\u1ee3c c\u01a1 ch\u1ebf mi\u1ec5n d\u1ecbch d\u1ecb \u1ee9ng:\u00a0<\/b>Theo Gell v\u00e0 Coombs ph\u00e2n lo\u1ea1i: 4 lo\u1ea1i h\u00ecnh d\u1ecb \u1ee9ng<\/p>\n
a) Type I:<\/b>\u00a0Lo\u1ea1i h\u00ecnh ph\u1ea3n v\u1ec7:<\/p>\n
– Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng:<\/i>\u00a0cho\u00e1ng ph\u1ea3n v\u1ec7, c\u00e1c b\u1ec7nh d\u1ecb \u1ee9ng Atopy, m\u00e0y \u0111ay, ph\u00f9 quincke,\u2026<\/p>\n
– D\u1ecb nguy\u00ean k\u1ebft h\u1ee3p v\u1edbi k\/nguy\u00ean tr\u00ean m\u00e0ng t\u1ebf b\u00e0o mastocyte, ph\u00e2n h\u1ee7y c\u00e1c h\u1ea1t c\u1ee7a t\u1ebf b\u00e0o n\u00e0y, gi\u1ea3i ph\u00f3ng c\u00e1c ho\u1ea1t ch\u1ea5t trung gian. C\u00e1c ho\u1ea1t ch\u1ea5t trung gian nh\u1ea5t l\u00e0 histamin l\u00e0m co th\u1eaft m\u1ea1ch \u1edf n\u00e3o (\u0111au \u0111\u1ea7u, ch\u00f3ng m\u1eb7t, h\u00f4n m\u00ea\u2026) co th\u1eaft ph\u1ebf qu\u1ea3n, t\u0103ng t\u00ednh th\u1ea5m mao m\u1ea1ch, k\u00edch th\u00edch t\u1eadn c\u00f9ng th\u1ea7n kinh \u1edf l\u1edbp d\u01b0\u1edbi da (ng\u1ee9a), co th\u1eaft sau \u0111\u00f3 gi\u00e3n \u0111\u1ed9ng m\u1ea1ch l\u1edbn d\u1eabn \u0111\u1ebfn t\u1ee5t huy\u1ebft \u00e1p.<\/p>\n
b) Type II:<\/b>\u00a0Lo\u1ea1i h\u00ecnh g\u00e2y \u0111\u1ed9c t\u1ebf b\u00e0o:<\/p>\n
Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng:<\/i>\u00a0b\u1ec7nh thi\u1ebfu m\u00e1u tan huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u, gi\u1ea3m ti\u1ec3u c\u1ea7u do thu\u1ed1c.<\/p>\n
c) Type III:<\/b>\u00a0Lo\u1ea1i h\u00ecnh Arthus hay c\u00e1c ph\u1ea3n \u1ee9ng trung gian qua ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch:<\/p>\n
– Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng:<\/i>\u00a0B\u1ec7nh huy\u1ebft thanh, vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p, vi\u00eam c\u1ea7u th\u1eadn, ban xu\u1ea5t huy\u1ebft d\u1ea1ng th\u1ea5p (h\u1ed9i ch\u1ee9ng Schoenlein Henoch ), b\u1ec7nh ph\u1ed5i do n\u1ea5m qu\u1ea1t, vi\u00eam n\u00fat quanh \u0111\u1ed9ng m\u1ea1ch..<\/p>\n
* Ba lo\u1ea1i h\u00ecnh tr\u00ean \u0111\u00e2y thu\u1ed9c nh\u00f3m d\u1ecb \u1ee9ng t\u1ee9c th\u00ec (theo ph\u00e2n lo\u1ea1i kinh \u0111i\u1ec3n)<\/i><\/b><\/p>\n
d) Type IV:<\/b>\u00a0Nh\u00f3m d\u1ecb \u1ee9ng mu\u1ed9n hay qua trung gian qua t\u1ebf b\u00e0o:<\/p>\n
Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng: vi\u00eam da ti\u1ebfp x\u00fac, u h\u1ea1t,\u2026<\/p>\n
* C\u00e1c b\/h da do thu\u1ed1c ph\u1ea7n l\u1edbn l\u00e0 type III v\u00e0 IV<\/i><\/b>.<\/p>\n
2. C\u1ea7n ph\u00e2n bi\u1ec7t d\u1ecb \u1ee9ng da do thu\u1ed1c v\u1edbi c\u00e1c ban do thu\u1ed1c kh\u00f4ng c\u00f3 c\u01a1 ch\u1ebf mi\u1ec5n d\u1ecbch:<\/b><\/p>\n
– T\u00ecnh tr\u1ea1ng d\u1ecb \u1ee9ng: ph\u1ea3n \u1ee9ng khi d\u00f9ng thu\u1ed1c d\u00f9 li\u1ec1u nh\u1ecf, x\u1ea3y ra do thi\u1ebfu h\u1ee5t men di truy\u1ec1n.<\/p>\n
– S\u1ef1 t\u00edch l\u0169y, s\u1ef1 qua li\u1ec1u: m\u1ed9t s\u1ed1 thu\u1ed1c ch\u1ee9a Hg, arsen, v\u00e0ng, belladon, strycnin,\u2026<\/p>\n
– T\u00ecnh tr\u1ea1ng kh\u00f4ng dung n\u1ea1p thu\u1ed1c<\/p>\n
– T\u00e1c d\u1ee5ng ph\u1ee5<\/b>, t\u00e1c d\u1ee5ng th\u1ee9 ph\u00e1t c\u1ee7a thu\u1ed1c<\/p>\n
– Hi\u1ec7n t\u01b0\u1ee3ng Heixheimer<\/p>\n
– Y\u1ebfu t\u1ed1 di truy\u1ec1n, s\u1ef1 b\u1ea5t th\u01b0\u1eddng v\u1ec1 sinh h\u1ecdc, men h\u1ecdc c\u1ee7a m\u1ed7i c\u01a1 \u0111\u1ecba ( thi\u1ebfu men G6PD\u2026)<\/p>\n
II.M\u1ed9t s\u1ed1 thu\u1ed1c hay g\u00e2y d\u1ecb \u1ee9ng v\u00e0 ph\u00e2n bi\u1ec7t c\u00e1c ban do thu\u1ed1c kh\u00f4ng c\u00f3 c\u01a1 ch\u1ebf mi\u1ec5n d\u1ecbch trong nhi\u1ec5m \u0111\u1ed9c da do thu\u1ed1c h\u00f3a m\u1ef9 ph\u1ea9m<\/b><\/p>\n
– Protein:<\/b>\u00a0Huy\u1ebft thanh, vacxin, hormon, polypeptid, insulin, ACTH, tinh ch\u1ea5t n\u1ed9i t\u1ea1ng, men.<\/p>\n
– Kh\u00e1ng sinh:<\/b>\u00a0Penicillin, Streptomycin, Neomycin, Kanamycin, Chloramphenicol, (Tetracyllin, Erythromycin, Griseofulvin \u00edt g\u00e2y d\u1ecb \u1ee9ng h\u01a1n)<\/p>\n
– Sulfamide ch\u1ed1ng khu\u1ea9n, l\u1ee3i ti\u1ec3u, ch\u1ed1ng \u0111\u00e1i \u0111\u01b0\u1eddng<\/p>\n
– Thu\u1ed1c ch\u1ed1ng lao: INH, PAS<\/p>\n
– Thu\u1ed1c g\u00e2y m\u00ea: Procain<\/p>\n
– Thu\u1ed1c gi\u1ea3m \u0111au: Salicilic, d\u1eabn xu\u1ea5t pyrazolon ( aspirin, antypyrin)<\/p>\n
– Thu\u1ed1c ch\u1ed1ng s\u1ed1t r\u00e9t: quinin, nivaquin<\/p>\n
– Thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng: Heparin<\/p>\n
– Thu\u1ed1c an th\u1ea7n, thu\u1ed1c ng\u1ee7: Chlopromazine, barbituric<\/p>\n
– Iod v\u00e0 thu\u1ed1c c\u1ea3n quang c\u00f3 iod<\/p>\n
– Asen h\u1eefu c\u01a1<\/p>\n
– Kim kh\u00ed n\u1eb7ng: Mu\u1ed1i v\u00e0ng, k\u1ebdm, bismuth, th\u1ee7y ng\u00e2n, cromat<\/p>\n
– Danh m\u1ee5c n\u00e0y c\u00f3 xu h\u01b0\u1edbng ng\u00e0y c\u00e0ng m\u1edf r\u1ed9ng. Ngay c\u1ea3 thu\u1ed1c kh\u00e1ng histamin t\u1ed5ng h\u1ee3p, corticoid, m\u1ed9t s\u1ed1 vitamin B1, B6 c\u0169ng c\u00f3 th\u1ec3 g\u00e2y d\u1ecb \u1ee9ng. \u1ede n\u01b0\u1edbc ta nh\u1eefng tr\u01b0\u1eddng h\u1ee3p d\u1ecb \u1ee9ng do thu\u1ed1c nam (nh\u1ea5t l\u00e0 r\u01b0\u1ee3u b\u1ed5, cao\u2026) kh\u00f4ng ph\u1ea3i hi\u1ebfm.<\/p>\n
*\u00a0Ph\u00e2n bi\u1ec7t d\u1ecb \u1ee9ng da do thu\u1ed1c v\u1edbi c\u00e1c ban do thu\u1ed1c kh\u00f4ng c\u00f3 c\u01a1 ch\u1ebf mi\u1ec5n d\u1ecbch:<\/b><\/p>\n
– T\u00ecnh tr\u1ea1ng d\u1ecb \u1ee9ng: Ph\u1ea3n \u1ee9ng khi d\u00f9ng thu\u1ed1c d\u00f9 li\u1ec1u nh\u1ecf, x\u1ea3y ra do thi\u1ebfu h\u1ee5t men di truy\u1ec1n.<\/p>\n
– S\u1ef1 t\u00edch l\u0169y, s\u1ef1 qu\u00e1 li\u1ec1u: M\u1ed9t s\u1ed1 thu\u1ed1c ch\u01b0a Hg, arsen, v\u00e0ng, belladon, Strycnin\u2026<\/p>\n
– T\u00ecnh tr\u1ea1ng kh\u00f4ng dung n\u1ea1p<\/p>\n
– T\u00e1c d\u1ee5ng ph\u1ee5, t\u00e1c d\u1ee5ng th\u1ee9 ph\u00e1t c\u1ee7a thu\u1ed1c<\/p>\n
– Hi\u1ec7n t\u01b0\u1ee3ng Heixheimer<\/p>\n
– Y\u1ebfu t\u1ed1 di truy\u1ec1n, s\u1ef1 b\u1ea5t th\u01b0\u1eddng v\u1ec1 sinh h\u1ecdc, men h\u1ecdc c\u1ee7a m\u1ed7i c\u01a1 \u0111\u1ecba (thi\u1ebfu men G6PD\u2026)<\/p>\n
III.Nguy\u00ean nh\u00e2n, tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a h\u1ed3ng ban \u0111a d\u1ea1ng<\/b><\/p>\n
L\u00e2m s\u00e0ng th\u01b0\u1eddng c\u00f3 2 d\u1ea1ng: H\u1ed3ng ban d\u00e1t s\u1ea9n v\u00e0 h\u1ed3ng ban m\u1ee5n n\u01b0\u1edbc, b\u00f3ng n\u01b0\u1edbc.<\/p>\n
– Sang th\u01b0\u01a1ng<\/i>\u00a0g\u1ed3m c\u00f3: S\u1ea9n, m\u1ee5n n\u01b0\u1edbc, b\u00f3ng n\u01b0\u1edbc, ban xu\u1ea5t huy\u1ebft<\/p>\n
– Sang th\u01b0\u01a1ng \u0111\u1eb7c hi\u1ec7u:<\/i>\u00a0H\u00ecnh tr\u00f2n v\u00e0 nhi\u1ec1u v\u00f2ng li t\u00e2m, \u1edf trung t\u00e2m l\u00f5m c\u00f3 m\u00e0u xanh t\u00edm. Ngo\u00e0i ra c\u00f3 th\u1ec3 c\u00f3 3 v\u00f2ng:<\/p>\n
+ Trung t\u00e2m l\u00e0 m\u1ed9t m\u1ee5n n\u01b0\u1edbc l\u1edbn<\/p>\n
+ \u1ede gi\u1eefa l\u00e0 m\u1ed9t v\u00f9ng \u0111\u1ecf th\u1eabm<\/p>\n
+ Ngo\u00e0i c\u00f9ng l\u00e0 m\u1ee5n n\u01b0\u1edbc nh\u1ecf<\/p>\n
H\u00ecnh \u1ea3nh n\u00e0y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 m\u1ee5n r\u1ed9p \u0111\u1ed3ng t\u1eed. Sang th\u01b0\u01a1ng th\u01b0\u1eddng kh\u00f4ng ng\u1ee9a nh\u01b0ng c\u00f3 c\u1ea3m gi\u00e1c r\u00e1t, b\u1ecfng<\/p>\n
– V\u1ecb tr\u00ed:<\/i>\u00a0th\u01b0\u1eddng \u0111\u1ed1i x\u1ee9ng, \u1edf m\u1eb7t du\u1ed7i t\u1ee9 chi nh\u01b0 khu\u1ef7u, \u0111\u1ea7u g\u1ed1i, c\u1ed5 tay, b\u00e0n tay, l\u00f2ng b\u00e0n tay hi\u1ebfm khi b\u1ecb<\/p>\n
– C\u00e1c thu\u1ed1c th\u01b0\u1eddng g\u1eb7p:<\/b>\u00a0Pyzazoles, thu\u1ed1c kh\u00e1ng vi\u00eam non steroid, sulfamide, barbiturate, hydantoines, penicillin<\/p>\n
* H\u1ed9i ch\u1ee9ng Stevens \u2013 Johnson<\/b>:<\/p>\n
L\u00e2m s\u00e0ng:<\/i>\u00a0L\u00e0 d\u1ea1ng n\u1eb7ng c\u1ee7a h\u1ed3ng ban \u0111a d\u1ea1ng, l\u00e2m s\u00e0ng \u0111\u1ed9t ng\u1ed9t b\u1eb1ng h\u1ed9i ch\u1ee9ng nhi\u1ec5m \u0111\u1ed9c n\u1eb7ng v\u1edbi th\u01b0\u01a1ng t\u1ed5n.<\/p>\n
– T\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c:<\/i><\/p>\n
+ Mi\u1ec7ng v\u00e0 quanh mi\u1ec7ng: H\u1ed3ng ban b\u00f3ng n\u01b0\u1edbc b\u1ec3 nhanh \u0111\u1ec3 l\u1ea1i nh\u1eefng v\u1ebft tr\u1ee3t ch\u1ea3y m\u00e1u, \u0111\u00f3ng m\u00e0i, lo\u00e9t, ni\u00eam m\u1ea1c mi\u1ec7ng h\u00e0m \u0111\u1ec1u b\u1ecb s\u01b0\u1edbt, n\u01b0\u1edbc b\u1ecdt nhi\u1ec1u, \u0103n u\u1ed1ng kh\u00f3<\/p>\n
+ M\u1eaft: Vi\u00eam lo\u00e9t k\u1ebft m\u1ea1c, ph\u00f9 m\u00ed m\u1eaft, xu\u1ea5t huy\u1ebft d\u01b0\u1edbi k\u1ebft m\u1ea1c, c\u00f3 th\u1ec3 \u0111\u1ec3 l\u1ea1i di ch\u1ee9ng qu\u1eb7m mi<\/p>\n
+ Sinh d\u1ee5c v\u00e0 h\u1eadu m\u00f4n: N\u1ed5i b\u00f3ng n\u01b0\u1edbc, v\u1ee1 nhanh \u0111\u1ec3 l\u1ea1i v\u1ebft tr\u1ee3t s\u01b0\u1edbt, lo\u00e9t, d\u1ec5 b\u1ed9i nhi\u1ec5m<\/p>\n
– Da:<\/i>\u00a0Ph\u00e1t ban thu\u1ed9c lo\u1ea1i h\u1ed3ng ban \u0111a d\u1ea1ng, d\u00e1t s\u1ea9n, m\u1ee5n n\u01b0\u1edbc, b\u00f3ng n\u01b0\u1edbc, ban xu\u1ea5t huy\u1ebft<\/p>\n
– L\u00f4ng t\u00f3c m\u00f3ng:<\/i>\u00a0\u0110\u00f4i khi b\u1ecb t\u1ed5n th\u01b0\u01a1ng: Vi\u00eam quanh m\u00f3ng, r\u1edbt m\u00f3ng, r\u1ee5ng t\u00f3c<\/p>\n
– N\u1ed9i t\u1ea1ng:<\/i>\u00a0c\u00f3 th\u1ec3 c\u00f3:<\/p>\n
+ Vi\u00eam ph\u1ed5i kh\u00f4ng \u0111i\u1ec3n h\u00ecnh<\/p>\n
+ Xu\u1ea5t ti\u1ebft ph\u1ebf qu\u1ea3n<\/p>\n
+ Th\u1eadn: Albumin ni\u1ec7u<\/p>\n
+ Th\u1ea7n kinh: H\u1ed9i ch\u1ee9ng m\u00e0ng n\u00e3o<\/p>\n
Di\u1ec5n ti\u1ebfn:<\/i>\u00a0Th\u01b0\u1eddng thu\u1eadn l\u1ee3i trong v\u00f2ng 2-4 tu\u1ea7n, hi\u1ebfm t\u00e1i ph\u00e1t, c\u00e1c d\u1ea1ng n\u1eb7ng ch\u1ee7 y\u1ebfu l\u00e0 do bi\u1ebfn ch\u1ee9ng ph\u1ed5i v\u00e0 m\u1eaft<\/p>\n
Nguy\u00ean nh\u00e2n:<\/b>\u00a0Do thu\u1ed1c c\u1ea3m APC, tetracycllin, promethazin<\/p>\n
* H\u1ed9i ch\u1ee9ng Lyell:<\/b><\/p>\n
Th\u01b0\u1ee3ng b\u00ec nhi\u1ec5m \u0111\u1ed9c ho\u1ea1i t\u1eed l\u00e0 th\u1ec3 \u0111\u1eb7c bi\u1ec7t c\u1ee7a nhi\u1ec5m \u0111\u1ed9c da do thu\u1ed1c r\u1ea5t n\u1eb7ng, bi\u1ec3u hi\u1ec7n b\u1eb1ng s\u1ef1 b\u00f3c t\u00e1ch \u0111\u1ed9t ng\u1ed9t v\u00e0 to\u00e0n b\u1ed9 c\u1ee7a l\u1edbp b\u00ec. D\u1ef1 h\u1eadu x\u1ea5u.<\/p>\n
L\u00e2m s\u00e0ng:<\/i>\u00a0Bi\u1ec3u hi\u1ec7n \u0111\u1ed9t ng\u1ed9t<\/p>\n
– T\u1ed5ng tr\u1ea1ng thay \u0111\u1ed5i:<\/i>\u00a0S\u1ed1t, thi\u1ec3u ni\u1ec7u, \u0111\u00f4i khi b\u00e1n h\u00f4n m\u00ea<\/p>\n
– Da:<\/i>\u00a0Th\u01b0\u1ee3ng b\u00ec tr\u00f3c th\u00e0nh m\u1ea3ng l\u1edbn c\u00f3 nh\u1eefng d\u00e1t \u0111\u1ecf s\u1ea9n lan t\u1ecfa d\u1ea5u hi\u1ec7u Nikolsky (+), c\u00f3 th\u1ec3 xu\u1ea5t huy\u1ebft<\/p>\n
– Ni\u00eam m\u1ea1c:<\/i>\u00a0B\u1ecb t\u1ed5n th\u01b0\u01a1ng tr\u1ee3t lo\u00e9t ni\u00eam m\u1ea1c th\u1ef1c qu\u1ea3n, d\u1ea1 d\u00e0y, m\u00f4i n\u1ee9t n\u1ebb c\u00f3 m\u1ee7 m\u00e1u, mi\u1ec7ng s\u01b0\u1edbt, vi\u00eam k\u1ebft m\u1ea1c, lo\u00e9t gi\u00e1c m\u1ea1c, s\u01b0ng ph\u00f9 m\u1eaft, s\u1ee3 \u00e1nh s\u00e1ng<\/p>\n
– L\u00f4ng t\u00f3c m\u00f3ng:<\/i>\u00a0B\u1ecb t\u1ed5n th\u01b0\u01a1ng ch\u1eadm h\u01a1n<\/p>\n
– N\u1ed9i t\u1ea1ng:<\/i>\u00a0T\u01b0\u01a1ng t\u1ef1 nh\u01b0 h\u1ed9i ch\u1ee9ng Stevens \u2013 Johnson:<\/p>\n
+ Xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a<\/p>\n
+ Vi\u00eam ph\u1ed5i, ph\u1ebf qu\u1ea3n<\/p>\n
+ Vi\u00eam gan, vi\u00eam t\u1ee5y, vi\u00eam th\u1eadn<\/p>\n
Di\u1ec5n ti\u1ebfn<\/b>: Th\u01b0\u1eddng ch\u1ebft trong v\u00e0i ng\u00e0y. Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p l\u00e0nh t\u00ednh, tr\u00f3c v\u1ea3y t\u1eeb ng\u00e0y th\u1ee9 8 \u0111\u1ebfn ng\u00e0y th\u1ee9 15, ng\u1ee9a r\u1ea5t d\u1eef d\u1ed9i, l\u1ea1nh nhi\u1ec1u.<\/p>\n
– D\u1ef1 h\u1eadu t\u00f9y thu\u1ed9c 3 y\u1ebfu t\u1ed1: S\u1ed1t, ph\u00f9, thi\u1ec3u ni\u1ec7u<\/p>\n
– S\u1ef1 l\u00e0nh b\u1ec7nh \u0111\u1ea1t \u0111\u01b0\u1ee3c sau nhi\u1ec1u tu\u1ea7n m\u1ed9t c\u00e1ch kh\u00f3 kh\u0103n v\u00e0 b\u1ec7nh nh\u00e2n tr\u1edf n\u00ean m\u1ed9t ng\u01b0\u1eddi \u0111a c\u1ea3m v\u1edbi m\u1ecdi th\u1ee9 thu\u1ed1c.<\/p>\n
IV.Nguy\u00ean nh\u00e2n, tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a h\u1ed3ng ban n\u00fat<\/b><\/p>\n
– Giai \u0111o\u1ea1n ti\u1ec1n tri\u1ec7u:<\/i>\u00a0Kh\u00f4ng \u0111\u1eb7c hi\u1ec7u, 3-6 ng\u00e0y s\u1ed1t, \u0111au kh\u1edbp \u0111\u00f4i khi \u0111i k\u00e8m b\u1ec7nh c\u1ea3nh \u1edf v\u00f9ng m\u0169i h\u1ecdng<\/p>\n
– Giai \u0111o\u1ea1n to\u00e0n ph\u00e1t:<\/i>\u00a0N\u1ed1t d\u01b0\u1edbi da \u1edf c\u1ed5 tay, c\u1eb3ng ch\u00e2n, m\u1eb7t tr\u01b0\u1edbc x\u01b0\u01a1ng ch\u00e0y. S\u1ed1 l\u01b0\u1ee3ng 3-6 n\u1ed1t ho\u1eb7c nhi\u1ec1u h\u01a1n, b\u00f3p \u0111au v\u00e0 ti\u1ebfn tri\u1ec3n nh\u01b0 1 v\u1ebft b\u1ea7m, vi\u00eam s\u01b0ng n\u00f3ng \u0111\u1ecf \u0111\u1ebfn xanh t\u00edm, \u0111\u1ebfn v\u00e0ng r\u1ed3i bi\u1ebfn m\u1ea5t.<\/p>\n
– Nguy\u00ean nh\u00e2n<\/i>\u00a0do thu\u1ed1c g\u00e2y ra h\u1ed3ng ban n\u00fat c\u00f3 th\u1ec3 r\u1ea5t nhi\u1ec1u: Kh\u00e1ng vi\u00eam non steroid, aspirin, sulfamides.<\/p>\n
* Ngo\u00e0i ra c\u00f2n c\u00f3 c\u00e1c d\u1ea1ng t\u1ed5n th\u01b0\u01a1ng da kh\u00e1c \u00edt g\u1eb7p h\u01a1n v\u00e0 \u0111\u1eb7c bi\u1ec7t nh\u01b0:<\/i><\/p>\n
– Teo v\u00e0 x\u01a1 teo:<\/i>\u00a0Th\u01b0\u1eddng do c\u00e1c thu\u1ed1c B bloquant, bleomycin, lithium<\/p>\n
– Ph\u00e1t ban d\u1ea1ng v\u1ea3y n\u1ebfn v\u00e0 lichen:<\/i>\u00a0C\u00e1c thu\u1ed1c kh\u00e1ng vi\u00eam non steroid, B bloquant, lithium<\/p>\n
– Ho\u1ea1i t\u1eed da do coumarin:<\/i>\u00a0Hi\u1ebfm g\u1eb7p, th\u01b0\u1eddng do d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng nh\u01b0 coumarin<\/p>\n
– Ban brom:<\/i>\u00a0do d\u00f9ng thu\u1ed1c c\u00f3 brom nh\u01b0 thu\u1ed1c ho, thu\u1ed1c an th\u1ea7n, ch\u1ed1ng ng\u1ee9a<\/p>\n
– Ban iode:<\/i>\u00a0c\u00e1c thu\u1ed1c b\u01b0\u1edbu c\u1ed5, thu\u1ed1c c\u1ea3n quang, thu\u1ed1c hen suy\u1ec5n, x\u01a1 c\u1ee9ng \u0111\u1ed9ng m\u1ea1ch<\/p>\n
– Nhi\u1ec5m asenic:<\/i>\u00a0do d\u00f9ng thu\u1ed1c vi\u00ean Asiatic, u\u1ed1ng dung d\u1ecbch Fowler \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb v\u1ea3y n\u1ebfn, \u0111\u1ed9ng kinh, suy\u1ec5n, s\u1ed1t cao ho\u1eb7c u\u1ed1ng n\u01b0\u1edbc c\u00f3 l\u01b0\u1ee3ng l\u1edbn asenic nh\u01b0 th\u1ee3 thuy\u1ec1n l\u00e0m trong x\u00ed nghi\u1ec7p ph\u00e2n b\u00f3n, thu\u1ed1c di\u1ec7t c\u00f4n tr\u00f9ng<\/p>\n
– Ban v\u00e0ng:<\/i>\u00a0C\u00f3 trong thu\u1ed1c \u0111i\u1ec1u tr\u1ecb vi\u00eam \u0111a kh\u1edbp.<\/p>\n
V.Ch\u1ea9n \u0111o\u00e1n<\/b><\/p>\n
1. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/b><\/p>\n
D\u1ef1a v\u00e0o b\u1ec7nh s\u1eed v\u00e0 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng gi\u00fap:<\/p>\n
–\u00a0Khai th\u00e1c b\u1ec7nh s\u1eed:<\/i><\/b>\u00a0\u0110\u00e2y l\u00e0 y\u1ebfu t\u1ed1 quan tr\u1ecdng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/p>\n
–\u00a0Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng:<\/i><\/b>\u00a0R\u1ea5t \u0111a d\u1ea1ng, do v\u1eady ph\u1ea3i c\u00f3 kh\u1ea3 n\u0103ng ph\u00e2n t\u00edch t\u1ed1t. Ch\u1ec9 c\u00f3 d\u1ea1ng h\u1ed3ng ban nhi\u1ec5m s\u1eafc c\u1ed1 \u0111\u1ecbnh t\u00e1i ph\u00e1t l\u00e0 t\u01b0\u01a1ng \u0111\u1ed1i d\u1ec5 ch\u1ea9n \u0111o\u00e1n v\u00e0 c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n ch\u1eafc ch\u1eafn, c\u00e1c d\u1ea1ng kh\u00e1c c\u1ea7n ph\u1ea3i ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi nh\u1eefng b\u1ec7nh da kh\u00e1c.<\/p>\n
–\u00a0C\u1eadn l\u00e2m s\u00e0ng:<\/i><\/b>\u00a0Th\u01b0\u1eddng \u00edt \u00e1p d\u1ee5ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00ec nguy hi\u1ec3m<\/p>\n
2. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/b><\/p>\n
– M\u00e0y \u0111ay do nh\u1eefng nguy\u00ean nh\u00e2n kh\u00e1c<\/p>\n
– Xu\u1ea5t huy\u1ebft d\u01b0\u1edbi da do nh\u1eefng nguy\u00ean nh\u00e2n kh\u00e1c<\/p>\n
– Vi\u00eam tr\u1ee3t lo\u00e9t ni\u00eam m\u1ea1c trong h\u1ed9i ch\u1ee9ng Stevens \u2013 Johnson ph\u00e2n bi\u1ec7t v\u1edbi Herpes, Aphtose…<\/p>\n
– Lo\u1ea1i ph\u00e1t ban d\u1ea1ng d\u00e1t s\u1ea9n: Ph\u00e2n bi\u1ec7t v\u1edbi ch\u00e0m, m\u1ec1 \u0111ay, giang mai II.<\/p>\n
– Lo\u1ea1i b\u00f3ng n\u01b0\u1edbc tr\u1ee3t trong h\u1ed9i ch\u1ee9ng Lyell: Ph\u00e2n bi\u1ec7t v\u1edbi Duhring Brocq, Pemphigus, b\u1ec7nh t\u1ef1 mi\u1ec5n li\u00ean quan \u0111\u1ebfn collagen.<\/p>\n
VI.Ti\u1ebfn tri\u1ec3n v\u00e0 bi\u1ebfn ch\u1ee9ng<\/b><\/p>\n
1. Ti\u1ebfn tri\u1ec3n<\/b><\/p>\n
Di\u1ec5n bi\u1ebfn v\u00e0 d\u1ef1 h\u1eadu thay \u0111\u1ed5i t\u00f9y theo d\u1ea1ng l\u00e2m s\u00e0ng. \u0110a s\u1ed1 kh\u1ea3 quan tr\u1eeb nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng nh\u01b0 h\u1ed9i ch\u1ee9ng Stevens \u2013 Johnson, h\u1ed9i ch\u1ee9ng Lyell.<\/p>\n
C\u00f3 nhi\u1ec1u \u00fd ki\u1ebfn kh\u00e1c nhau v\u1ec1 ti\u00ean l\u01b0\u1ee3ng c\u1ee7a h\u1ed9i ch\u1ee9ng Lyell:<\/p>\n
– Tr\u01b0\u1edbc 1960: t\u1ef7 l\u1ec7 t\u1eed vong 80-100%<\/p>\n
– 1990 theo Thomas. P. Habit t\u1ef7 l\u1ec7 t\u1eed vong 25-100% n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi v\u00e0 \u0111\u00fang c\u00e1ch.<\/p>\n
2. Bi\u1ebfn ch\u1ee9ng<\/b><\/p>\n
– R\u1ed1i lo\u1ea1n n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i<\/p>\n
– B\u1ed9i nhi\u1ec5m d\u1eabn \u0111\u1ebfn nhi\u1ec5m tr\u1eebng huy\u1ebft<\/p>\n
– C\u00e1c bi\u1ebfn ch\u1ee9ng n\u1ed9i t\u1ea1ng: H\u00f4 h\u1ea5p, suy th\u1eadn, suy gan…<\/p>\n
– C\u00e1c bi\u1ebfn ch\u1ee9ng \u1edf m\u1eaft: Vi\u00eam lo\u00e9t gi\u00e1c m\u1ea1c, d\u00ednh mi, qu\u1eb7n mi, x\u01a1 c\u1ee9ng c\u00f9ng \u0111\u1ed3, d\u00ednh k\u1ebft m\u1ea1c, m\u00f9.<\/p>\n
– Bi\u1ebfn ch\u1ee9ng \u1edf ti\u00eau h\u00f3a: H\u1eb9p th\u1ef1c qu\u1ea3n<\/p>\n
– M\u1ea5t m\u00f3ng, thi\u1ec3u d\u01b0\u1ee1ng m\u00f3ng<\/p>\n
VII.\u0110i\u1ec1u tr\u1ecb<\/b><\/p>\n
1. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb<\/b><\/p>\n
– Ng\u01b0ng ngay c\u00e1c thu\u1ed1c nghi ng\u1edd<\/p>\n
– X\u1eed tr\u00ed c\u00e1c v\u1ea5n \u0111\u1ec1 li\u00ean quan \u0111\u1ebfn t\u1ed5ng tr\u1ea1ng, to\u00e0n th\u00e2n. N\u1ebfu c\u00f3 cho\u00e1ng ph\u1ea3i x\u1eed l\u00fd ngay.<\/p>\n
– Ch\u1ed1ng nhi\u1ec5m tr\u00f9ng t\u1ea1i ch\u1ed7 hay to\u00e0n th\u00e2n<\/p>\n
– Vitamin C li\u1ec1u cao c\u1ea7n thi\u1ebft cho m\u1ecdi tr\u01b0\u1eddng h\u1ee3p<\/p>\n
– D\u00f9ng kh\u00e1ng Histamin u\u1ed1ng n\u1ebfu ng\u1ee9a nhi\u1ec1u<\/p>\n
– Corticoid trong tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng<\/p>\n
2. \u0110i\u1ec1u tr\u1ecb t\u1ea1i ch\u1ed7<\/b><\/p>\n
– C\u00e1c tr\u01b0\u1eddng h\u1ee3p ban d\u00e1t s\u1ea9n, m\u00e0y \u0111ay, h\u1ed3ng ban \u0111a d\u1ea1ng,… b\u00f4i thu\u1ed1c d\u1ecbu da ho\u1eb7c corticoid nh\u1eb9<\/p>\n
– V\u1ebft tr\u1ee3t da: B\u00f4i thu\u1ed1c m\u00e0u nh\u01b0 T\u00edm milian, xanh methylen, Esosin 2% ho\u1eb7c Betadin pha lo\u00e3ng<\/p>\n
– V\u1ebft tr\u1ee3t \u1edf ni\u00eam m\u1ea1c, sinh d\u1ee5c: Ch\u1ea5m Glycerin borate.<\/p>\n
3. \u0110i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n<\/b><\/p>\n
– Kh\u00e1ng Histamin: Dimedrol, chlopheniramin, astemisol<\/p>\n
– Vitamin C li\u1ec1u cao<\/p>\n
– Kh\u00e1ng sinh to\u00e0n th\u00e2n khi c\u00f3 d\u1ea5u hi\u1ec7u nhi\u1ec5m tr\u00f9ng. N\u00ean ch\u1ecdn nhwunxg kh\u00e1ng sinh \u00edt g\u00e2y d\u1ecb \u1ee9ng nh\u01b0 nh\u00f3m Macrlid: erythromycin…<\/p>\n
– Corticoid trong tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng nh\u01b0 h\u1ed9i ch\u1ee9ng Stevens \u2013 Johnson, h\u1ed9i ch\u1ee9ng Lyell:<\/p>\n
\u00a0\u0110\u01b0\u1eddng u\u1ed1ng: Prednisolon 1-2mg\/kg\/ng\u00e0y<\/p>\n
\u00a0\u0110\u01b0\u1eddng ti\u00eam, truy\u1ec1n: Depersonlon, Solumedrol 60-150mg\/ng\u00e0y<\/p>\n
\u00a0N\u1ebfu b\u1ec7nh nh\u00e2n \u1ed5n \u0111\u1ecbnh gi\u1ea3m li\u1ec1u nhanh<\/p>\n
– \u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn t\u1ed5ng tr\u1ea1ng ch\u00fang ta ph\u1ea3i x\u1eed tr\u00ed:<\/p>\n
\u00a0H\u1ea1 s\u1ed1t<\/p>\n
\u00a0Truy\u1ec1n d\u1ecbch: Dung d\u1ecbch lactat, dung d\u1ecbch ng\u1ecdt, m\u1eb7n \u0111\u1eb3ng tr\u01b0\u01a1ng<\/p>\n
\u00a0Suy th\u1eadn, thi\u1ec3u ni\u1ec7u: L\u1ee3i ti\u1ec3u…<\/p>\n
– N\u00e2ng cao th\u1ec3 tr\u1ea1ng; \u0111\u1ea3m b\u1ea3o n\u0103ng l\u01b0\u1ee3ng v\u00e0 dinh d\u01b0\u1ee1ng<\/p>\n
– Ch\u0103m s\u00f3c h\u1ed9 l\u00fd, ga tr\u1ea3i gi\u01b0\u1eddng v\u00f4 khu\u1ea9n,… c\u0169ng r\u1ea5t quan tr\u1ecdng \u0111\u1eb7c bi\u1ec7t n\u1ebfu BN b\u1ecb h\u1ed9i ch\u1ee9ng Lyell.<\/p>\n
VIII.Ph\u00f2ng b\u1ec7nh<\/b><\/p>\n
1. \u0110\u1ed1i v\u1edbi c\u1ed9ng \u0111\u1ed3ng<\/b><\/p>\n
Tuy\u00ean truy\u1ec1n \u00fd th\u1ee9c s\u1eed d\u1ee5ng thu\u1ed1c h\u1ee3p l\u00fd, theo ch\u1ec9 \u0111\u1ecbnh c\u1ee7a b\u00e1c s\u0129, kh\u00f4ng t\u1ef1 \u00fd d\u00f9ng thu\u1ed1c ho\u1eb7c nghe ng\u01b0\u1eddi kh\u00e1c<\/p>\n
2. \u0110\u1ed1i v\u1edbi c\u00e1n b\u1ed9 y t\u1ebf:\u00a0<\/b>C\u00f3 ki\u1ebfn th\u1ee9c chuy\u00ean m\u00f4n, n\u1eafm v\u1eefng c\u00e1c t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c<\/p>\n
– Chi k\u00ea nh\u1eefng thu\u1ed1c th\u1eadt c\u1ea7n thi\u1ebft, kh\u00f4ng k\u00ea 1 l\u00fac nhi\u1ec1u lo\u1ea1i thu\u1ed1c<\/p>\n
– Khi bi\u1ebft b\u1ec7nh nh\u00e2n d\u1ecb \u1ee9ng v\u1edbi 1 lo\u1ea1i thu\u1ed1c, h\u00f3a ch\u1ea5t n\u00e0o ph\u1ea3i h\u01b0\u1edbng d\u1eabn c\u1ea9n th\u1eadn b\u1ec7nh nh\u00e2n c\u00e1ch ph\u00f2ng tr\u00e1nh<\/p>\n
– Ph\u00e1t hi\u1ec7n d\u1ecb \u1ee9ng thu\u1ed1c s\u1edbm, t\u00edch c\u1ef1c \u0111i\u1ec1u tr\u1ecb, chuy\u1ec3n l\u00ean tuy\u1ebfn chuy\u00ean khoa k\u1ecbp th\u1eddi c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng<\/p>\n
3. \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n<\/b><\/p>\n
– Nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng trong gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi b\u1ecb nhi\u1ec5m \u0111\u1ed9c da do thu\u1ed1c, h\u00f3a ch\u1ea5t n\u00ean c\u1ea9n th\u1eadn d\u00f9 ti\u1ebfp x\u00fac l\u1ea7n \u0111\u1ea7u<\/p>\n
– N\u00ean d\u00f9ng thu\u1ed1c c\u00f3 ch\u1ec9 \u0111\u1ecbnh, th\u00f4ng b\u00e1o cho b\u00e1c s\u0129 bi\u1ebft th\u1ec3 tr\u1ea1ng d\u1ecb \u1ee9ng c\u1ee7a m\u00ecnh<\/p>\n
– Ki\u1ec3m tra ch\u1ee9c n\u0103ng gan, th\u1eadn, huy\u1ebft \u0111\u1ed3, men G6PD,… tr\u01b0\u1edbc khi d\u00f9ng thu\u1ed1c nh\u1ea5t l\u00e0 nh\u1eefng ng\u01b0\u1eddi l\u1edbn tu\u1ed5i, c\u00f3 b\u1ec7nh m\u1ea1n t\u00ednh v\u1ec1 gan, th\u1eadn,….<\/p>\n
– N\u00ean ghi nh\u1ea1n nh\u1eefng thu\u1ed1c m\u00ecnh d\u00f9ng v\u00e0 theo d\u00f5i sau v\u00e0i ng\u00e0y \u0111\u1ec3 ph\u00e1t hi\u1ec7n s\u1edbm nh\u1eefng bi\u1ec3u hi\u1ec7n \u1edf da, ni\u00eam m\u1ea1c<\/p>\n
– Khi b\u1ec7nh nh\u00e2n b\u1ecb nhi\u1ec5m \u0111\u1ed9c da:<\/p>\n
\u00a0Ng\u01b0ng nh\u1eefng thu\u1ed1c nghi ng\u1edd<\/p>\n
\u00a0Th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng thu\u1ed1c<\/p>\n
\u00a0D\u00f9ng thu\u1ed1c khi th\u1eadt s\u1ef1 c\u1ea7n thi\u1ebft<\/p>\n
VI\u00caM DA C\u01a0 \u0110\u1ecaA<\/b><\/p>\n
I. Nguy\u00ean nh\u00e2n ch\u00e0m th\u1ec3 t\u1ea1ng<\/b><\/p>\n
– Ch\u00e0m th\u1ec3 t\u1ea1ng chi\u1ebfm 2-3% d\u00e2n s\u1ed1 tr\u1ebb em, 1% d\u00e2n s\u1ed1 ng\u01b0\u1eddi l\u1edbn. Xu\u1ea5t \u0111\u1ed9 tr\u00ean d\u00e2n s\u1ed1 n\u00f3i chung \u1edf Hoa K\u1ef3 c\u00f3 th\u1ec3 thay \u0111\u1ed5i t\u1eeb 3-5%. T\u1ef7 l\u1ec7 b\u1ec7nh t\u0103ng l\u00ean \u0111\u1eb7c bi\u1ec7t \u1edf v\u00f9ng \u1ea5m \u00e1p v\u00e0 c\u00e1c \u0111\u1ee3t b\u00f9ng ph\u00e1t theo m\u00f9a, th\u01b0\u1eddng v\u00e0o m\u00f9a xu\u00e2n v\u00e0 m\u00f9a thu. B\u1ec7nh th\u01b0\u1eddng b\u1eaft \u0111\u1ea7u s\u1edbm trong n\u0103m \u0111\u1ea7u ti\u00ean v\u00e0 c\u00f3 th\u1ec3 c\u00f3 nhi\u1ec1u \u0111\u1ee3t trong nhi\u1ec1u n\u0103m sau \u0111\u00f3. Kho\u1ea3ng 60% b\u1ec7nh nh\u00e2n b\u1ecb ch\u00e0m th\u1ec3 t\u1ea1ng \u1edf tu\u1ed5i \u0111\u1ea7u ti\u00ean v\u00e0 30% \u1edf tu\u1ed5i l\u00ean 1-5.<\/p>\n
– Nguy\u00ean nh\u00e2n ch\u00e0m th\u1ec3 t\u1ea1ng ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft r\u00f5. C\u00f3 th\u1ec3 t\u00f9y thu\u1ed9c v\u00e0o t\u00e1c d\u1ee5ng t\u01b0\u01a1ng h\u1ed5 c\u1ee7a nhi\u1ec1u y\u1ebfu t\u1ed1 th\u1ec3 t\u1ea1ng, mi\u1ec5n d\u1ecbch, t\u00e2m l\u00fd, v\u00e0 th\u1eddi ti\u1ebft. B\u1ea3n ch\u1ea5t di truy\u1ec1n gi\u1eef vai tr\u00f2 quan tr\u1ecdng trong ch\u00e0m th\u1ec3 t\u1ea1ng. Kho\u1ea3ng 70% ng\u01b0\u1eddi m\u1eafc b\u1ec7nh n\u00e0y c\u00f3 ti\u1ec1n s\u1eed c\u00e1 nh\u00e2n ho\u1eb7c gia \u0111\u00ecnh c\u00f3 vi\u00eam m\u0169i d\u1ecb \u1ee9ng, vi\u00eam k\u1ebft m\u1ea1c d\u1ecb \u1ee9ng, ch\u00e0m th\u1ec3 t\u1ea1ng ho\u1eb7c hen ph\u1ebf qu\u1ea3n.<\/p>\n
II. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng ch\u00e0m th\u1ec3 t\u1ea1ng<\/b><\/p>\n
1. Ch\u00e0m th\u1ec3 t\u1ea1ng h\u00e0i nhi (ch\u00e0m s\u1eefa hay l\u00e1c s\u1eefa):<\/b><\/p>\n
– X\u1ea3y ra \u1edf tr\u1ebb em 3-6 th\u00e1ng tu\u1ed5i, kh\u1ecfe m\u1ea1nh<\/p>\n
– V\u1ecb tr\u00ed \u1edf m\u1eb7t, 2 m\u00e1, \u0111\u1ed1i x\u1ee9ng c\u00f3 th\u1ec3 lan ra da \u0111\u1ea7u, th\u00e2n m\u00ecnh, t\u1ee9 chi nh\u01b0ng ch\u1eeba c\u00e1c l\u1ed7 t\u1ef1 nhi\u00ean ( m\u1eaft, m\u0169i, mi\u1ec7ng)<\/p>\n
– Kh\u1edfi \u0111\u1ea7u l\u00e0 h\u1ed3ng ban sau \u0111\u00f3 c\u00f3 m\u1ee5n n\u01b0\u1edbc r\u1ecbn n\u01b0\u1edbc \u0111\u00f3ng m\u00e0i v\u00e0 tr\u00f3c v\u1ea9y d\u1ec5 b\u1ecb ch\u1ed1c h\u00f3a. B\u1ec7nh th\u01b0\u1eddng bi\u1ebfn m\u1ea5t tr\u01b0\u1edbc n\u0103m 2 tu\u1ed5i. N\u1ebfu t\u1edbi 2 tu\u1ed5i m\u00e0 ch\u01b0a h\u1ebft b\u1ec7nh c\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n th\u00e0nh ch\u00e0m th\u1ec3 t\u1ea1ng th\u1ef1c s\u1ef1 \u1edf ng\u01b0\u1eddi l\u1edbn.<\/p>\n
– \u0110\u1ee9ng tr\u01b0\u1edbc 1 tr\u1ebb b\u1ecb ch\u00e0m s\u1eefa:<\/p>\n
+ Kh\u00f4ng cho nh\u1eadp vi\u1ec7n v\u00ec m\u00f4i tr\u01b0\u1eddng b\u1ec7nh vi\u1ec7n c\u00f3 th\u1ec3 l\u00e0m cho tr\u1ebb b\u1ecb nhi\u1ec5m tr\u00f9ng th\u00eam.<\/p>\n
+ Kh\u00f4ng n\u00ean ch\u1ee7ng ng\u1eeba, nh\u1ea5t l\u00e0 \u0111\u1eadu m\u00f9a, v\u00ec c\u00f3 th\u1ec3 \u0111\u01b0a \u0111\u1ebfn m\u1ee5n m\u1ee7 d\u1ea1ng th\u1ee7y \u0111\u1eadu: S\u1ed1t cao, s\u1ea9n, m\u1ee5n n\u01b0\u1edbc, b\u00f3ng n\u01b0\u1edbc trung t\u00e2m l\u00f5m cu\u1ed1i c\u00f9ng th\u00e0nh m\u1ee5n m\u1ee7 c\u00f3 qu\u1ea7ng vi\u00eam \u0111\u1ecf, l\u00e0nh \u0111\u1ec3 l\u1ea1i s\u1eb9o nh\u01b0 m\u1eb7t r\u1ed7.<\/p>\n
+ Kh\u00f4ng n\u00ean \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c thu\u1ed1c m\u1ea1nh nh\u01b0 Corticoid, kh\u00e1ng sinh li\u1ec1u cao.<\/p>\n
2. Ch\u00e0m th\u1ec3 t\u1ea1ng \u1edf ng\u01b0\u1eddi l\u1edbn (ch\u00e0m th\u1ec3 t\u1ea1ng th\u1ef1c s\u1ef1):<\/b><\/p>\n
Xu\u1ea5t hi\u1ec7n \u1edf ng\u01b0\u1eddi l\u1edbn ho\u1eb7c tr\u1ebb em b\u1ecb ch\u00e0m s\u1eefa t\u00e1i \u0111i t\u00e1i l\u1ea1i nhi\u1ec1u l\u1ea7n. Nh\u01b0ng c\u01a1n b\u1ed9c ph\u00e1t th\u01b0\u1eddng kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 do y\u1ebfu t\u1ed1 b\u00ean ngo\u00e0i nh\u01b0 d\u1ecb \u1ee9ng ho\u1eb7c y\u1ebfu t\u1ed1 b\u00ean trong nh\u01b0 thai ngh\u00e9n, kinh nguy\u1ec7t.<\/p>\n
* \u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng:<\/i><\/b><\/p>\n
– T\u1ed5n th\u01b0\u01a1ng \u0111a d\u1ea1ng: H\u1ed3ng ban m\u1ee5n n\u01b0\u1edbc, v\u1ea9y, m\u00e0i, v\u1ebft c\u00e0o g\u00e3i, v\u1ebft c\u00e0o x\u01b0\u1edbc, m\u1ea3ng d\u00e0y da lichen h\u00f3a.<\/p>\n
– V\u1ecb tr\u00ed: \u1ede n\u1ebfp g\u1ea5p m\u1eb7t du\u1ed7i chi c\u00f3 t\u00ednh \u0111\u1ed1i x\u1ee9ng.<\/p>\n
– B\u1ec7nh t\u00e1i \u0111i t\u00e1i l\u1ea1i nhi\u1ec1u l\u1ea7n.<\/p>\n
– Ng\u1ee9a d\u1eef d\u1ed9i, b\u1ec7nh nh\u00e2n g\u00e3i li\u00ean t\u1ee5c l\u00e0m da d\u00e0y l\u00ean, l\u00f4ng r\u1ee5ng, m\u00f3ng tay b\u00f3ng l\u00e1ng.<\/p>\n
Ngo\u00e0i ra c\u00f2n m\u1ed9t s\u1ed1 tri\u1ec7u ch\u1ee9ng kh\u00e1c:<\/i><\/p>\n
– Da kh\u00f4 ho\u1eb7c da v\u1ea9y c\u00e1 ( 10% b\u1ec7nh nh\u00e2n)<\/p>\n
– D\u00e0y s\u1eebng nang l\u00f4ng, ch\u00e0m nang l\u00f4ng<\/p>\n
– V\u1ea9y ph\u1ea5n tr\u1eafng: D\u00e1t gi\u1ea3m s\u1eafc t\u1ed1, v\u1ea9y r\u1ea5t k\u00edn<\/p>\n
\u0111\u00e1o, th\u01b0\u1eddng \u1edf v\u00f9ng ph\u01a1i ra \u00e1nh s\u00e1ng.<\/p>\n
– C\u01b0\u1eddm 2 m\u1eaft, d\u1ea5u hi\u1ec7u Darrie. Morgan: C\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a 1 hay 2 n\u1ebfp da \u1edf mi m\u1eaft d\u01b0\u1edbi<\/p>\n
– X\u1ea1m da quanh m\u1eaft.<\/p>\n
III. \u0110i\u1ec1u tr\u1ecb ch\u00e0m<\/b><\/p>\n
1. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb<\/b><\/p>\n
– Th\u0103m d\u00f2 ph\u1ea3n \u1ee9ng da trong giai \u0111o\u1ea1n c\u1ea5p<\/p>\n
– Ngh\u1ec9 ng\u01a1i, \u0103n u\u1ed1ng ch\u1ea5t d\u1ec5 ti\u00eau, \u0103n nh\u1ea1t \u1edf giai \u0111o\u1ea1n c\u1ea5p<\/p>\n
– Tr\u00e1nh c\u00e1c ch\u1ea5t k\u00edch th\u00edch: Tr\u00e0, c\u00e0 ph\u00ea, thu\u1ed1c l\u00e1, r\u01b0\u1ee3u, \u1edbt<\/p>\n
– Kh\u00f4ng \u0111\u01b0\u1ee3c c\u00e0o g\u00e3i, ch\u00e0 s\u00e1t, b\u00f4i nhi\u1ec1u lo\u1ea1i thu\u1ed1c v\u00ec c\u00f3 th\u1ec3 l\u00e0 d\u1ecb \u1ee9ng nguy\u00ean<\/p>\n
– Thay \u0111\u1ed5i khi h\u1eadu n\u1ebfu c\u00f3 th\u1ec3<\/p>\n
– T\u00edch c\u1ef1c t\u00ecm d\u1ecb \u1ee9ng nguy\u00ean \u0111\u1ec3 lo\u1ea1i b\u1ecf nguy\u00ean nh\u00e2n<\/p>\n
2. \u0110i\u1ec1u tr\u1ecb t\u1ea1i ch\u1ed7<\/b><\/p>\n
a. \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng<\/i><\/b><\/p>\n
T\u00f9y theo t\u1eebng giai \u0111o\u1ea1n c\u1ee7a b\u1ec7nh m\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c thu\u1ed1c b\u00f4i ngo\u00e0i da cho th\u00edch h\u1ee3p<\/p>\n
–\u00a0Giai \u0111o\u1ea1n c\u1ea5p:<\/i>\u00a0T\u1ea9m li\u1ec7u t\u1ea1i ch\u1ed5 b\u1eb1ng n\u01b0\u1edbc sinh l\u00fd, thu\u1ed1c t\u00edm, c\u00e1c dung d\u1ecbch m\u00e0u Milian, Eosin…, l\u00e0m gi\u1ea3m vi\u00eam ho\u1eb7c Nitrat b\u1ea1c 1-5%. \u0110\u1eafp n\u01b0\u1edbc \u00e9p t\u1eeb qu\u1ea3 b\u00ed, d\u01b0a gang, d\u01b0a leo.<\/p>\n
–\u00a0Giai \u0111o\u1ea1n b\u00e1n c\u1ea5p:<\/i><\/p>\n
\u00a0H\u1ed3 n\u01b0\u1edbc: Oxyde de Zine, tacl, glycerin, n\u01b0\u1edbc c\u1ea5t<\/p>\n
\u00a0H\u1ed3 k\u1ebdm: Oxyde de Zine, tacl, lanolin, n\u01b0\u1edbc c\u1ea5t v\u1eeba \u0111\u1ee7<\/p>\n
\u00a0Milian<\/p>\n
\u00a0Eosin 1-2%<\/p>\n
–\u00a0Giai \u0111o\u1ea1n m\u1ea1n:<\/i>\u00a0D\u00f9ng ch\u1ea5t l\u00e0m ti\u00eau s\u1eebng, kh\u1eed oxy nh\u01b0 h\u1ed3 Ichtyole, goudron 5-10%, pommade salicilee 5-10%<\/p>\n
b. \u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n<\/i><\/b><\/p>\n
– Do vi khu\u1ea9n: D\u00f9ng thu\u1ed1c s\u00e1t tr\u00f9ng, kh\u00e1ng sinh<\/p>\n
– Do vi n\u1ea5m: D\u00f9ng thu\u1ed1c kh\u00e1ng n\u1ea5m<\/p>\n
– Do k\u00fd sinh tr\u00f9ng: D\u00f9ng thu\u1ed1c di\u1ec7t k\u00fd sinh tr\u00f9ng<\/p>\n
– Do ti\u1ebfp x\u00fac: Lo\u1ea1i b\u1ecf nguy\u00ean nh\u00e2n ti\u1ebfp x\u00fac<\/p>\n
3. \u0110i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n<\/b><\/p>\n
a. \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng<\/i><\/b><\/p>\n
–\u00a0Thu\u1ed1c gi\u1ea3i m\u1eabn c\u1ea3m kh\u00f4ng \u0111\u1eb7c hi\u1ec7u, thay \u0111\u1ed5i c\u01a1 \u0111\u1ecba:<\/i><\/p>\n
\u00fcC\u00e1c thu\u1ed1c h\u01b0\u1edbng m\u1ee1: Hyposulfen, chophytol, methionin…<\/p>\n
\u00fcVitamin C, A, D, PP<\/p>\n
\u00fcTi\u00eam gamma globulin v\u00e0 Histamin<\/p>\n
\u00fc\u0110\u00f4ng y: Kim ng\u00e2n hoa, k\u00e9 \u0111\u1ea7u ng\u1ef1a, l\u00e1 \u0111\u01a1n<\/p>\n
–\u00a0Thu\u1ed1c an th\u1ea7n ch\u1ed1ng ng\u1ee9a:<\/i><\/p>\n
\u00fcKh\u00e1ng histamin: chlopheniramin, astemisol, peritol, promethazin…<\/p>\n
\u00fcAn th\u1ea7n: seduxen, gardenal.<\/p>\n
\u00fc\u0110\u00f4ng y: cao l\u1ea1c ti\u00ean, h\u1ea1t sen, l\u00e1 v\u00f4ng<\/p>\n
b. \u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n<\/i><\/b><\/p>\n
– Vi khu\u1ea9n: D\u00f9ng kh\u00e1ng sinh to\u00e0n th\u00e2n trong tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng<\/p>\n
– Vi n\u1ea5m: Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb n\u1ea5m to\u00e0n th\u00e2n (Griseofulvin, mycostatin, ketoconazol)<\/p>\n
– Thi\u1ebfu sinh t\u1ed1: D\u00f9ng vitamin C, A, D, PP, E, F, B1, B6, B12<\/p>\n
– Gi\u1ea3i d\u1ecb \u1ee9ng \u0111\u1eb7c hi\u1ec7u: Ti\u00eam trong da d\u1ecb \u1ee9ng nguy\u00ean v\u1edbi l\u01b0\u1ee3ng nh\u1ecf t\u0103ng d\u1ea7n<\/p>\n
– \u0110\u1ed1i v\u1edbi corticoid: C\u00f3 t\u00e1c d\u1ee5ng nhanh nh\u01b0ng d\u1ec5 t\u00e1i ph\u00e1t tr\u1edf l\u1ea1i, n\u00ean ch\u1ec9 d\u00f9ng thu\u1ed1c \u1edf giai \u0111o\u1ea1n b\u00e1n c\u1ea5p v\u00e0 kh\u00f4ng n\u00ean d\u00f9ng k\u00e9o d\u00e0i, d\u00f9ng trong \u0111\u1ee3t vi\u00eam da ti\u1ebfp x\u00fac c\u1ea5p \u0111i\u1ec1u tr\u1ecb ng\u1eafn ng\u00e0y.<\/p>\n
IV. Ph\u00f2ng b\u1ec7nh ch\u00e0m<\/b><\/p>\n
1. Ph\u00f2ng b\u1ec7nh c\u1ea5p 1<\/b><\/p>\n
– T\u1ed5 ch\u1ee9c kh\u00e1m ph\u00e1t hi\u1ec7n b\u1ec7nh<\/p>\n
– Gi\u1ea3i quy\u1ebft c\u00e1c v\u1ea5n \u0111\u1ec1 m\u00f4i tr\u01b0\u1eddng, c\u00e1c ch\u1ea5t x\u00fac t\u00e1c li\u1ec7n quan \u0111\u1ebfn c\u01a1 \u0111\u1ecba c\u1ee7a nh\u1eefng ng\u01b0\u1eddi c\u00f3 c\u01a1 \u0111\u1ecba d\u1ecb \u1ee9ng<\/p>\n
– Nh\u1eefng tr\u1ebb sinh ra trong gia \u0111\u00ecnh c\u00f3 t\u1ea1ng d\u1ecb \u1ee9ng c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i, tr\u00e1nh nh\u1eefng y\u1ebfu t\u1ed1 thu\u1eadn l\u1ee3i ph\u00e1t sinh b\u1ec7nh<\/p>\n
– H\u1ea1n ch\u1ebf ti\u1ebfp x\u00fac v\u1edbi nh\u1eefng ch\u1ea5t d\u1ec5 g\u00e2y d\u1ecb \u1ee9ng<\/p>\n
– Lu\u00f4n r\u00e8n luy\u1ec7n 1 c\u01a1 th\u1ec3 kh\u1ecfe m\u1ea1nh, dinh d\u01b0\u1ee1ng t\u1ed1t, ki\u00eang nh\u1eefng th\u1ee9c \u0103n \u0111\u1ed3 u\u1ed1ng k\u00edch th\u00edch: r\u01b0\u1ee3u, bia, thu\u1ed1c l\u00e1, cafe… h\u1ea1n ch\u1ebf nh\u1eefng th\u1ee9c \u0103n d\u1ec5 g\u00e2y d\u1ecb \u1ee9ng: t\u00f4m, cua, \u0111\u1ed3 l\u00ean men…<\/p>\n
– Gi\u1eef v\u1ec7 sinh s\u1ea1ch s\u1ebd, tr\u00e1nh ch\u00e0 s\u00e1t, b\u00f4i nhi\u1ec1u th\u1ee9 thu\u1ed1c l\u00ean da<\/p>\n
2. Ph\u00f2ng b\u1ec7nh c\u1ea5p 2<\/b><\/p>\n
– T\u0103ng c\u01b0\u1eddng ph\u00e1t hi\u1ec7n s\u1edbm b\u1ec7nh, \u0111i\u1ec1u tr\u1ecb \u0111\u00fang b\u1ec7nh v\u00e0 c\u00f3 hi\u1ec7u qu\u1ea3 h\u1ea1n ch\u1ebf chuy\u1ec3n sang th\u1ec3 n\u1eb7ng<\/p>\n
– Th\u0103m h\u1ecfi k\u1ef9 v\u1ec1 ti\u1ec1n s\u1eed b\u1ec7nh \u0111\u1ec3 t\u00ecm nguy\u00ean nh\u00e2n. \u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n l\u00e0 v\u1ea5n \u0111\u1ec1 l\u00fd t\u01b0\u1edfng trong \u0111i\u1ec1u tr\u1ecb ch\u00e0m<\/p>\n
– T\u00edch c\u1ef1c gi\u1ea3i quy\u1ebft c\u00e1c \u1ed5 nhi\u1ec5m tr\u00f9ng, k\u00fd sinh tr\u00f9ng<\/p>\n
– Gi\u1ea3i th\u00edch cho b\u1ec7nh nh\u00e2n hi\u1ec3u v\u00e0 ph\u1ed1i h\u1ee3p \u0111i\u1ec1u tr\u1ecb v\u1edbi b\u00e1c s\u0129 \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c k\u1ebft qu\u1ea3 t\u1ed1t nh\u1ea5t c\u0169ng l\u00e0 c\u00e1ch ph\u00f2ng b\u1ec7nh t\u00edch c\u1ef1c.<\/p>\n
B\u1ec6NH GH\u1eba<\/b><\/p>\n
I. D\u1ecbch t\u1ec5 h\u1ecdc<\/b><\/p>\n
\u1ede TP. H\u1ed3 Ch\u00ed Minh, gh\u1ebb chi\u1ebfm t\u1ef7 l\u1ec7 3,9% s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u1ebfn kh\u00e1m t\u1ea1i b\u1ec7nh vi\u1ec7n Da li\u1ec5u. B\u1ec7nh th\u01b0\u1eddng g\u1eb7p \u1edf tr\u1ebb em v\u00e0 ph\u1ee5 n\u1eef, trong \u0111\u00f3 n\u00f4ng th\u00f4n chi\u1ebfm 7,6% th\u00e0nh ph\u1ed1 chi\u1ebfm 5% trong t\u1ed5ng s\u1ed1 c\u00e1c b\u1ec7nh ngo\u00e0i da.<\/p>\n
* \u0110i\u1ec1u ki\u1ec7n sinh h\u1ecdc c\u1ee7a c\u00e1i gh\u1ebb Sarcoptes scabiei:<\/i><\/b><\/p>\n
– Con c\u00e1i gh\u1ebb g\u00e2y b\u1ec7nh, con \u0111\u1ef1c nh\u1ecf h\u01a1n \u00edt t\u00ecm th\u1ea5y, th\u01b0\u1eddng ch\u1ebft hai ng\u00e0y sau khi giao ph\u1ed1i.<\/p>\n
– Con c\u00e1i tr\u01b0\u1edfng th\u00e0nh d\u00e0i kho\u1ea3ng 400\u00b5m, n\u00f3 sinh s\u1ed1ng b\u1eb1ng c\u00e1ch \u0111\u00e0o h\u1ea7m d\u01b0\u1edbi da( g\u1ecdi l\u00e0 r\u00e3nh gh\u1ebb), gi\u1eefa l\u1edbp s\u1eebng v\u00e0 l\u1edbp h\u1ea1t, th\u1eddi gian s\u1ed1ng trung b\u00ecnh 30 ng\u00e0y. V\u00e0i gi\u1edd sau khi \u0111\u00e0o h\u1ea7m, c\u00e1i gh\u1ebb b\u1eaft \u0111\u1ea7u \u0111\u1ebb tr\u1ee9ng, tr\u1ee9ng ph\u00e1t tri\u1ec3n th\u00e0nh \u1ea5u tr\u00f9ng v\u00e0 tr\u01b0\u1edfng th\u00e0nh trong v\u00f2ng 10 ng\u00e0y.<\/p>\n
– C\u00e1i gh\u1ebb ho\u1ea1t \u0111\u1ed9ng nhi\u1ec1u v\u1ec1 \u0111\u00eam, ch\u1ebft sau r\u1eddi k\u00fd ch\u1ee7 3-4 ng\u00e0y, ch\u1ebft \u1edf nhi\u1ec7t \u0111\u1ed9 600C.<\/p>\n
* \u0110\u01b0\u1eddng l\u00e2y truy\u1ec1n:<\/i><\/b><\/p>\n
– Tr\u1ef1c ti\u1ebfp:<\/i>\u00a0gi\u1eefa ng\u01b0\u1eddi v\u1edbi ng\u01b0\u1eddi, \u0111\u00e2y l\u00e0 \u0111\u01b0\u1eddng l\u00e2y truy\u1ec1n ch\u1ee7 y\u1ebfu.<\/p>\n
– Gi\u00e1n ti\u1ebfp:<\/i>\u00a0qua qu\u1ea7n \u00e1o, ch\u0103n m\u00e0n, \u0111\u1ed3 d\u00f9ng c\u00e1 nh\u00e2n.<\/p>\n
– Ngo\u00e0i l\u00e2y lan theo \u0111\u01b0\u1eddng th\u00f4ng th\u01b0\u1eddng, gh\u1ebb c\u00f2n\u00a0l\u00e2y qua \u0111\u01b0\u1eddng t \u00ec n h d \u1ee5 c<\/i>. \u0110\u00e2y l\u00e0 1 \u0111\u01b0\u1eddng l\u00e2y quan tr\u1ecdng m\u00e0 \u00edt ng\u01b0\u1eddi \u0111\u1ec3 \u00fd \u0111\u1ebfn v\u00e0 c\u0169ng l\u00e0 c\u01a1 s\u1edf \u0111\u1ec3 t\u1ed5 ch\u1ee9 Y t\u1ebf th\u00ea gi\u1edbi x\u1ebfp gh\u1ebb l\u00e0 b\u00eanh l\u00e2y lan qua \u0111\u01b0\u1eddng t \u00ec n h d \u1ee5 c.<\/p>\n
– B\u1ec7nh r\u1ea5t d\u1ec5 l\u00e2y, nh\u1ea5t l\u00e0 khi \u0111i\u1ec1u ki\u1ec7n v\u1ec7 sinh k\u00e9m, nh\u00e0 c\u1eeda ch\u1eadt ch\u1ed9i, ng\u1ee7 chung. N\u1ebfu b\u1ec7nh gh\u1ebb kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n \u0111i\u1ec1u tr\u1ecb s\u1edbm c\u00f3 th\u1ec3 ph\u00e1t th\u00e0nh d\u1ecbch \u0111\u1ecba ph\u01b0\u01a1ng, \u0111\u1eb7c bi\u1ec7t khi th\u1eddi \u0111i\u1ec3m \u0111\u1eddi s\u1ed1ng x\u00e3 h\u1ed9i kh\u00f4ng \u1ed5n \u0111\u1ecbnh nh\u01b0 di c\u01b0, khu d\u00e2n c\u01b0 t\u1eadp trung, k\u00fd t\u00fac x\u00e1, doanh tr\u1ea1i, khu t\u1eadp th\u1ec3\u2026<\/p>\n
II. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 bi\u1ebfn ch\u1ee9ng<\/b><\/p>\n
a. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng:<\/b><\/p>\n
* Th\u1eddi k\u1ef3 \u1ee7 b\u1ec7nh:<\/i><\/b>\u00a0trung b\u00ecnh 2 tu\u1ea7n, 8-10 ng\u00e0y.<\/p>\n
* Tri\u1ec7u ch\u1ee9ng:<\/i><\/b><\/p>\n
– Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng:<\/i>\u00a0ch\u1ee7 y\u1ebfu l\u00e0 ng\u1ee9a<\/p>\n
+ Ng\u1ee9a nhi\u1ec1u v\u1ec1 \u0111\u00eam<\/p>\n
+ Xung quanh c\u00f3 nhi\u1ec1u ng\u01b0\u1eddi b\u1ecb ng\u1ee9a.<\/p>\n
+ Ng\u1ee9a nhi\u1ec1u \u1edf v\u00f9ng da non.<\/p>\n
+ M\u1ee9c \u0111\u1ed9 ng\u1ee9a t\u00f9y c\u01a1 \u0111\u1ecba m\u1ed7i ng\u01b0\u1eddi.<\/p>\n
– Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3:\u00a0<\/i>c\u00f3 3 nh\u00f3m tri\u1ec7u ch\u1ee9ng<\/p>\n
+ Nh\u00f3m tri\u1ec7u ch\u1ee9ng c\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n:\u00a0<\/i>Xu\u1ea5t hi\u1ec7n \u00edt, 20-30%, ng\u00e0y nay c\u00f2n 10% c\u00e1c tr\u01b0\u1eddng h\u1ee3p<\/p>\n
R\u00e3nh gh\u1ebb: c\u00e1i gh\u1ebb \u0111\u00e0o h\u1ea7m d\u01b0\u1edbi da, \u0111i ti\u00eau ngay tr\u00ean da n\u00ean c\u00f3 m\u00e0u n\u00e2u, ngo\u1eb1n ngo\u00e8o, d\u00e0i v\u00e0i milimet, h\u01a1i c\u1ed9m, t\u1eadn c\u00f9ng c\u00f3 m\u1ee5n n\u01b0\u1edbc n\u01a1i con c\u00e1i gh\u1ebb c\u01b0 tr\u00fa.<\/p>\n
+ Nh\u00f3m tri\u1ec7u ch\u1ee9ng gi\u00fap ch\u1ea9n \u0111o\u00e1n:<\/i><\/p>\n
. M\u1ee5n n\u01b0\u1edbc: m\u1ecdc r\u1ea3i r\u00e1c, ch\u1ee9a n\u01b0\u1edbc trong, c\u00e0ng c\u00f3 gi\u00e1 tr\u1ecb khi n\u1eb1m \u1edf v\u00f9ng da non.<\/p>\n
. S\u1ea9n c\u1ee5c ho\u1eb7c s\u1ea9n m\u1ee5n n\u01b0\u1edbc: s\u1ea9n c\u1ee9ng ch\u1eafc m\u00e0u \u0111\u1ecf c\u00f3 th\u1ec3 c\u00f3 m\u1ee5n n\u01b0\u1edbc tr\u00ean \u0111\u1ea7u, k\u00edch th\u01b0\u1edbc kho\u1ea3ng 0.5 cm th\u01b0\u1eddng g\u1eb7p \u1edf tr\u1ebb em, g\u1eb7p \u1edf n\u00e1ch, d\u01b0\u01a1ng v\u1eadt, mu, b\u00ecu, b\u1eb9n\u2026<\/p>\n
+ Nh\u00f3m tri\u1ec7u ch\u1ee9ng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u nh\u01b0ng th\u01b0\u1eddng g\u1eb7p:<\/i><\/p>\n
. V\u1ebft c\u00e0o g\u00e3i: tr\u1ea7y x\u01b0\u1edbc da theo \u0111\u01b0\u1eddng, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn m\u1ee5n m\u1ee7 do thi\u1ebfu v\u1ec7 sinh.<\/p>\n
. V\u1ebft ch\u00e0m h\u00f3a: m\u1ee5n n\u01b0\u1edbc t\u1ee5 th\u00e0nh m\u1ea3ng.<\/p>\n
*\u00a0V\u1ecb tr\u00ed sang th\u01b0\u01a1ng:<\/b><\/i><\/p>\n
L\u00e0 tri\u1ec7u ch\u1ee9ng quan tr\u1ecdng gi\u00fap ch\u1ea9n \u0111o\u00e1n<\/p>\n
Sang th\u01b0\u01a1ng \u1edf kh\u1eafp ng\u01b0\u1eddi tr\u1eeb m\u1eb7t. Th\u01b0\u1eddng g\u1eb7p \u1edf v\u00f9ng da non: k\u1ebd ng\u00f3n tay, m\u1eb7t tr\u01b0\u1edbc c\u1ed5 tay, b\u1edd tr\u01b0\u1edbc n\u00e1ch, quanh r\u1ed1n, n\u1ebfp d\u01b0\u1edbi m\u00f4ng, m\u1eb7t trong \u0111\u00f9i, b\u1ed9 ph\u1eadn sinh d\u1ee5c\u2026 l\u01b0ng v\u00e0 m\u1eb7t \u00edt khi c\u00f3.<\/p>\n
* D\u1ecbch t\u1ec5 h\u1ecdc:<\/i><\/b>\u00a0c\u00f3 nhi\u1ec1u ng\u01b0\u1eddi xung quanh c\u00f9ng b\u1ec7nh, \u0111\u00e2y l\u00e0 1 trong nh\u1eefng ti\u00eau chu\u1ea9n gi\u00fap ch\u1ea9n \u0111o\u00e1n ph\u00f2ng d\u1ecbch.<\/p>\n
b. Bi\u1ebfn ch\u1ee9ng:\u00a0<\/b>N\u1ebfu kh\u00f4ng \u0111i\u1ec1u tr\u1ecb b\u00eanh v\u1eabn c\u00f2n d\u00f9 ng\u1ee9a c\u00f3 gi\u1ea3m.<\/p>\n
* Ch\u00e0m h\u00f3a:<\/i><\/b>\u00a0do c\u00e1i gh\u1ebb ho\u1eb7c thu\u1ed1c b\u00f4i, n\u1ebfu b\u1ec7nh nh\u00e2n \u0111\u00e3 b\u1ecb ch\u00e0m th\u00ec d\u1ec5 b\u1ecb ch\u00e0m h\u00f3a.<\/p>\n
* Vi\u00eam da m\u1ee7:<\/i><\/b>\u00a0th\u01b0\u1eddng th\u1ea5y \u1edf tr\u1ebb v\u1ec7 sinh k\u00e9m, nguy\u00ean nh\u00e2n th\u01b0\u1eddng do li\u00ean c\u1ea7u , c\u00f3 th\u1ec3 lan l\u00ean \u0111\u1ea7u v\u00e0 l\u01b0ng, c\u00f3 th\u1ec3 ch\u1ed1c h\u00f3a, vi\u00eam nang l\u00f4ng, nh\u1ecdt, vi\u00eam h\u1ea1ch.<\/p>\n
* Ti\u1ec3u \u0111\u1ea3n b\u1ea1ch:<\/i><\/b>\u00a0Th\u01b0\u1eddng g\u1eb7p \u1edf tr\u1ebb con b\u1ecb gh\u1ebb n\u1eb7ng<\/p>\n
* T\u0103ng s\u1eebng d\u01b0\u1edbi m\u00f3ng:\u00a0<\/i><\/b>M\u00f3ng c\u00f3 th\u1ec3 tr\u1edf n\u00ean m\u00e0u x\u00e1m, c\u00f3 th\u1ec3 t\u00ecm th\u1ea5y c\u00e1i gh\u1ebb.<\/p>\n
*\u00a0Vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p:<\/b>\u00a0hi\u1ebfm g\u1eb7p, do c\u1ea3m \u1ee9ng v\u1edbi \u0111\u1ed9c t\u1ed1 c\u1ee7a c\u00e1i gh\u1ebb ho\u1eb7c do vi tr\u00f9ng b\u1ed9i nhi\u1ec5m.<\/p>\n
III. \u0110i\u1ec1u tr\u1ecb<\/b><\/p>\n
1. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb:<\/b><\/p>\n
– Ph\u1ea3i ch\u1ea9n s\u1edbm v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1edbm, th\u00edch h\u1ee3p \u0111\u1ec3 tr\u00e1nh bi\u1ebfn ch\u1ee9ng v\u00e0 l\u00e2y lan cho c\u1ed9ng \u0111\u1ed3ng.<\/p>\n
– \u0110i\u1ec1u tr\u1ecb cho ng\u01b0\u1eddi ti\u1ebfp x\u00fac, \u0111i\u1ec1u tr\u1ecb c\u00f9ng l\u00fac v\u1edbi ng\u01b0\u1eddi c\u00f3 b\u1ec7nh trong gia \u0111\u00ecnh \u0111\u1ec3 tr\u00e1nh nguy c\u01a1 t\u00e1i nhi\u1ec5m.<\/p>\n
– V\u1ec7 sinh \u0111\u1ed3 d\u00f9ng c\u00e1 nh\u00e2n: m\u00f9ng m\u00e0n, ch\u0103n chi\u1ebfu, qu\u1ea7n \u00e1o tr\u00e1nh l\u00e2y lan cho c\u1ed9ng \u0111\u1ed3ng v\u00e0 tr\u00e1nh t\u00e1i nhi\u1ec5m.<\/p>\n
– B\u00f4i thu\u1ed1c \u0111\u00fang c\u00e1ch.<\/p>\n
– N\u1ebfu ch\u00e0m h\u00f3a, b\u1ed9i nhi\u1ec5m th\u00ec \u0111i\u1ec1u tr\u1ecb ch\u00e0m h\u00f3a, b\u1ed9i nhi\u1ec5m tr\u01b0\u1edbc.<\/p>\n
2. Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb:<\/b><\/p>\n
– \u0110i\u1ec1u tr\u1ecb t\u1ea1i ch\u1ed7:<\/i><\/b><\/p>\n
+ Thu\u1ed1c l\u1ef1a ch\u1ecdn \u0111\u1ea7u ti\u00ean:<\/i><\/p>\n
Gamma benzene hydrochloride 1%( Lindan) b\u00f4i 1 l\u1ea7n, \u0111\u1ed9c t\u00ednh h\u1ec7 th\u1ea7n kinh, kh\u00f4ng d\u00f9ng cho tr\u1ebb em d\u01b0\u1edbi 2 tu\u1ed5i.<\/p>\n
Permethrine 5%(Elimite) kh\u00f4ng d\u00f9ng cho tr\u1ebb em, b\u00f4i 1 l\u1ea7n, ti\u1ec7n l\u1ee3i nh\u01b0ng \u0111\u1eaft ti\u1ec1n.<\/p>\n
+ Thu\u1ed1c l\u1ef1a ch\u1ecdn thi\u1ebft y\u1ebfu:<\/i><\/p>\n
Benzoate de benzyl 25% (Ascabiol) d\u00f9ng cho tr\u1ebb em d\u01b0\u1edbi 2 tu\u1ed5i g\u00e2y methemglobin, d\u1ec5 g\u00e2y k\u00edch th\u00edch.<\/p>\n
Esdepallethrine (Spagal) d\u1ea1ng phun s\u01b0\u01a1ng s\u1eed d\u1ee5ng \u0111\u01b0\u1ee3c cho ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 tr\u1ebb nh\u1ecf tuy nhi\u00ean m\u1eafc ti\u1ec1n.<\/p>\n
Diethylphtalate (DEP) r\u1ebb ti\u1ec1n, l\u00e0 thu\u1ed1c th\u00edch h\u1ee3p cho c\u1ed9ng \u0111\u1ed3ng.<\/p>\n
+ C\u00e1c thu\u1ed1c kh\u00e1c:<\/i><\/p>\n
M\u1ee1 l\u01b0u hu\u1ef3nh: d\u00f9ng t\u1ed1t cho tr\u1ebb em, hi\u1ec7u qu\u1ea3 kh\u00f4ng cao b\u1ea5t ti\u1ec7n v\u00ec h\u00f4i.<\/p>\n
Crotamiton (Eurax) kh\u00f4ng d\u00f9ng cho tr\u1ebb em d\u01b0\u1edbi 2 tu\u1ed5i v\u00ec g\u00e2y methemoglobin.<\/p>\n
\u0110\u00f4ng y: t\u1eafm n\u01b0\u1edbc l\u00e1 \u0111\u1eafng, l\u00e1 ba ch\u1eb7c, l\u00e1 xoan, l\u00e1 c\u00fac qu\u00ec, l\u00e1 b\u1ea1ch \u0111\u00e0n, b\u00f4i d\u1ea7u \u00e9p h\u1ea1t m\u00e1u ch\u00f3.<\/p>\n
+ C\u00e1ch b\u00f4i thu\u1ed1c:<\/i><\/p>\n
. T\u1eafm v\u1edbi thu\u1ed1c t\u00edm pha lo\u00e3ng 1\/10000, n\u01b0\u1edbc \u1ea5m.<\/p>\n
. Vu\u1ed1t x\u00e0 ph\u00f2ng kh\u1eafp ng\u01b0\u1eddi, nh\u1ea5n m\u1ea1nh \u1edf c\u00e1c n\u1ebfp v\u00e0 r\u1eeda s\u1ea1ch v\u1edbi thu\u1ed1c t\u00edm pha lo\u00e3ng.<\/p>\n
. B\u00f4i thu\u1ed1c kh\u1eafp c\u1ea3 ng\u01b0\u1eddi t\u1eeb c\u1ed5 xu\u1ed1ng ch\u00e2n ng\u00e0y 1 l\u1ea7n v\u00e0o bu\u1ed5i t\u1ed1i, m\u1eb7c qu\u1ea7n \u00e1o s\u1ea1ch, 24h sau m\u1edbi \u0111\u01b0\u1ee3c t\u1eafm.<\/p>\n
. T\u00f9y lo\u1ea1i thu\u1ed1c, b\u00f4i li\u00ean t\u1ee5c cho \u0111\u1ebfn khi kh\u1ecfi. C\u1ea7n thi\u1ebft b\u00f4i th\u00eam 2 tu\u1ea7n \u0111\u1ec3 ng\u1eeba t\u00e1i ph\u00e1t.<\/p>\n
–\u00a0\u0110i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n:<\/b><\/i><\/p>\n
+ Ch\u1ed1ng ng\u1ee9a: th\u01b0\u1eddng d\u00f9ng c\u00e1c kh\u00e1ng Histamin H1: Chlopheniramin<\/p>\n
+ An th\u1ea7n.<\/p>\n
+ Kh\u00e1ng sinh ng\u1eeba b\u1ed9i nhi\u1ec5m: Ivermetin.<\/p>\n
3. \u00c1p d\u1ee5ng th\u1ef1c t\u1ebf:<\/b><\/p>\n
– Gh\u1ebb th\u00f4ng th\u01b0\u1eddng:<\/i><\/b><\/p>\n
+ Thu\u1ed1c kh\u00e1ng Histamin v\u00e0o bu\u1ed5i t\u1ed1i.<\/p>\n
+ B\u00f4i thu\u1ed1c gh\u1ebb.<\/p>\n
–\u00a0Gh\u1ebb b\u1ed9i nhi\u1ec5m:<\/b><\/i><\/p>\n
+ Khu tr\u00fa: b\u00f4i dung d\u1ecbch m\u00e0u ( milian, eosine) v\u00e0o t\u1ed5n th\u01b0\u01a1ng, sau \u0111i\u1ec1u tr\u1ecb nh\u01b0 gh\u1ebb th\u00f4ng th\u01b0\u1eddng.<\/p>\n
+ C\u00f3 d\u1ea5u hi\u1ec7u to\u00e0n th\u00e2n: kh\u00e1ng sinh \u0111\u01b0\u1eddng u\u1ed1ng.<\/p>\n
+ L\u01b0u \u00fd c\u00e1c bi\u1ebfn ch\u1ee9ng to\u00e0n th\u00e2n nh\u01b0 vi\u00eam c\u1ea7u th\u1eadn.<\/p>\n
–\u00a0Gh\u1ebb ch\u00e0m h\u00f3a:<\/b><\/i><\/p>\n
+ \u0110i\u1ec1u tr\u1ecb ch\u00e0m tr\u01b0\u1edbc.<\/p>\n
+ Khi \u1ed5n \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb nh\u01b0 gh\u1ebb th\u00f4ng th\u01b0\u1eddng.<\/p>\n
– Gh\u1ebb Na uy:<\/i><\/b>\u00a0n\u00e2ng t\u1ed5ng tr\u1ea1ng b\u1ec7nh nh\u00e2n, thoa m\u1ee1 Salicyl\u00e9e 2-5% \u0111\u1ec3 ti\u00eau s\u1eebng, sau \u0111\u00f3 b\u00f4i thu\u1ed1c gh\u1ebb. B\u1ec7nh r\u1ea5t l\u00e2y n\u00ean c\u1ea7n c\u00f3 bi\u1ec7n ph\u00e1p ch\u1ed1ng l\u00e2y lan.<\/p>\n
4. Theo d\u00f5i \u0111i\u1ec1u tr\u1ecb:<\/b><\/p>\n
– \u0110i\u1ec1u tr\u1ecb t\u1ed1t: 3-5 ng\u00e0y sau kh\u00f4ng n\u1ed5i sang th\u01b0\u01a1ng m\u1edbi, ng\u1ee9a c\u00f3 th\u1ec3 t\u1ed3n t\u1ea1i kho\u1ea3ng 2 tu\u1ea7n.<\/p>\n
– Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p sau ph\u1ea3i \u0111i\u1ec1u tr\u1ecb l\u1ea1i:<\/p>\n
Ng\u1ee9a tr\u00ean 2 tu\u1ea7n d\u00f9 kh\u00f4ng c\u00f3 sang th\u01b0\u01a1ng m\u1edbi v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng.<\/p>\n
N\u1ed5i sang th\u01b0\u01a1ng m\u1edbi.<\/p>\n
\u0110i\u1ec1u tr\u1ecb kh\u00f4ng \u0111\u00fang ph\u01b0\u01a1ng ph\u00e1p.<\/p>\n
IV. Ph\u00f2ng b\u1ec7nh<\/b><\/p>\n
1. C\u00e1 nh\u00e2n<\/b><\/p>\n
– V\u1ec7 sinh c\u00e1 nh\u00e2n h\u00e0ng ng\u00e0y v\u1edbi x\u00e0 ph\u00f2ng, nh\u1ea5t l\u00e0 k\u1ebd tay, c\u00e1c n\u1ebfp<\/p>\n
– Tr\u00e1nh ti\u1ebfp x\u00fac v\u1edbi ng\u01b0\u1eddi b\u1ecb gh\u1ebb (b\u1eaft tay, ng\u1ee7 chung, gi\u1eb7t v\u00e0 ph\u01a1i \u0111\u1ed3 chung)<\/p>\n
– Tr\u00e1nh ti\u1ebfp x\u00fac v\u1edbi ng\u01b0\u1eddi xung quanh, d\u00f9ng \u0111\u1ed3 \u0111\u1ea1c ri\u00eang, ng\u1ee7 ri\u00eang v\u00e0 \u0111i kh\u00e1m ngay \u0111\u1ec3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n s\u1edbm, tr\u00e1nh bi\u1ebfn ch\u1ee9ng v\u00e0 l\u00e2y lan cho c\u1ed9ng \u0111\u1ed3ng<\/p>\n
2. Gia \u0111\u00ecnh<\/b><\/p>\n
– Khi c\u00f3 ng\u01b0\u1eddi trong gia \u0111\u00ecnh b\u1ecb ng\u1ee9a nh\u1ea5t l\u00e0 v\u00e0o ban \u0111\u00eam ph\u1ea3i ki\u1ec3m tra v\u1ecb tr\u00ed c\u1ee7a gh\u1ebb v\u00e0 cho \u0111i kh\u00e1m b\u1ec7nh s\u1edbm<\/p>\n
– V\u1ec7 sinh m\u00f9ng m\u00e0n, ch\u0103n chi\u1ebfu v\u00e0 \u0111\u1ed3 d\u00f9ng c\u00e1 nh\u00e2n c\u1ee7a ng\u01b0\u1eddi b\u1ecb gh\u1ebb v\u00e0 c\u1ea3 gia \u0111\u00ecnh<\/p>\n
3. C\u00f4ng \u0111\u1ed3ng<\/b><\/p>\n
– Ph\u1ea3i \u0111i\u1ec1u tr\u1ecb c\u1ea3 ng\u01b0\u1eddi ti\u1ebfp x\u00fac m\u1eafc b\u1ec7nh<\/p>\n
– Tuy\u00ean truy\u1ec1n \u0111\u1ec3 c\u1ed9ng \u0111\u1ed3ng c\u00f3 ki\u1ebfn th\u1ee9c ph\u00f2ng tr\u00e1nh gh\u1ebb l\u00e2y lan th\u00e0nh d\u1ecbch<\/p>\n
– T\u1ed5 ch\u1ee9c c\u00e1c \u0111\u1ee3t kh\u00e1m ph\u00e1t hi\u1ec7n gh\u1ebb v\u00e0 \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c trong c\u1ed9ng \u0111\u1ed3ng d\u00e2n c\u01b0, nh\u00e0 tr\u1ebb, doanh tr\u1ea1i, tr\u1ea1i giam, k\u00fd t\u00fac x\u00e1, vi\u1ec7n d\u01b0\u1ee1ng l\u00e3o,…<\/p>\n
\u00a0Di\u1ec7t ngu\u1ed3n l\u00e2y<\/b><\/p>\n
– C\u00e1i gh\u1ebb ch\u1ebft khi r\u1eddi k\u00fd ch\u1ee7 3-4 ng\u00e0y, do \u0111\u00f3 \u0111\u1ec3 qu\u1ea7n \u00e1o trong t\u1ee7 1 tu\u1ea7n sau m\u1edbi m\u1eb7c l\u1ea1i<\/p>\n
– C\u00e1i gh\u1ebb ch\u1ebft \u1edf nhi\u1ec7t \u0111\u1ed9 600C \u0111o \u0111\u00f3 n\u00ean \u0111un s\u00f4i qu\u1ea7n \u00e1o, m\u00f9ng m\u00e0n \u1edf nhi\u1ec7t \u0111\u1ed9 80-900C<\/p>\n
B\u1ec6NH ZONA<\/b><\/p>\n
I. Nguy\u00ean nh\u00e2n v\u00e0 d\u1ecbch t\u1ec5 h\u1ecdc<\/b><\/p>\n
1. Nguy\u00ean nh\u00e2n:<\/b><\/p>\n
Do\u00a0Varicellae zoster virusI\u00a0<\/i>(VZV). Virus n\u00e0y c\u0169ng l\u00e0 t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh th\u1ee7y \u0111\u1eadu. Acid l\u00e0 ADN c\u00f3 h\u00ecnh th\u00e1i gi\u1ed1ng\u00a0virus Herpes Simplex<\/i><\/p>\n
2. D\u1ecbch t\u1ec5 h\u1ecdc<\/b><\/p>\n
– B\u1ec7nh g\u1eb7p \u1edf m\u1ecdi l\u1ee9c tu\u1ed5i nh\u01b0ng th\u01b0\u1eddng th\u1ea5y \u1edf l\u1ee9a tu\u1ed5i tr\u00ean 20, \u0111\u1eb7c bi\u1ec7t l\u00e0 tr\u00ean 50 tu\u1ed5i t\u1ef7 l\u1ec7 m\u1eafc c\u00e0ng cao<\/p>\n
– M\u00f9a ph\u00e1t b\u1ec7nh: R\u1ea3i r\u00e1c kh\u1eafp c\u00e1c m\u00f9a nh\u01b0ng r\u1ed9 l\u00ean v\u00e0o cu\u1ed1i xu\u00e2n v\u00e0 \u0111\u1ea7u h\u00e8<\/p>\n
– T\u1ea7n su\u1ea5t m\u1eb7c b\u1ec7nh gi\u1eefa nam v\u00e0 n\u1eef t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nhau, kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 ch\u1ee7ng t\u1ed9c<\/p>\n
II. C\u01a1 ch\u1ebf b\u1ec7nh sinh<\/b><\/p>\n
C\u00f3 r\u1ea5t nhi\u1ec1u b\u00e0n c\u00e3i:<\/i><\/b><\/p>\n
– Theo Prescott (1996): B\u1ec7nh th\u01b0\u1eddng g\u1eb7p \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n c\u0103n m\u1eafc b\u1ec7nh th\u1ee7y \u0111\u1eadu. Virus sau khi g\u00e2y b\u1ec7nh th\u1ee7y \u0111\u1eadu (nhi\u1ec5m nguy\u00ean ph\u00e1t), h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch c\u1ee7a c\u01a1 th\u1ec3 ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c ho\u1ea1t h\u00f3a \u0111\u1ec3 kh\u00e1ng l\u1ea1i VZV, b\u1ec7nh th\u1ee7y \u0111\u1eadu tho\u00e1i lui. Sau \u0111\u00f3 VZV \u1ea9n trong h\u1ea1ch c\u1ea3m gi\u00e1c v\u00e0 \u0111\u01b0\u1ee3c ho\u1ea1t h\u00f3a di chuy\u1ec3n t\u1eeb th\u1ea7n kinh c\u1ea3m gi\u00e1c ra g\u00e2y b\u1ec7nh zona (t\u00e1i ph\u00e1t) khi c\u00f3 \u0111i\u1ec1u ki\u1ec7n thu\u1eadn l\u1ee3i. C\u01a1 ch\u1ebf c\u1ee7a s\u1ef1 t\u00e1i ho\u1ea1t n\u00e0y hi\u1ec7n ch\u01b0a bi\u1ebft r\u00f5. \u1ede ng\u01b0\u1eddi gi\u00e0, mi\u1ec5n d\u1ecbch \u0111\u1ed1i v\u1edbi VZV n\u00e0y gi\u1ea3m d\u1ea7n \u0111\u1ebfn khi kh\u00f4ng \u0111\u1ee7 s\u1ee9c \u1ee9c ch\u1ebf si\u00eau vi, VZV s\u1ebd t\u1ef1 ho\u1ea1t h\u00f3a, nh\u00e2n l\u00ean g\u00e2y t\u1ed5n th\u01b0\u01a1ng h\u1ea1ch, th\u1ea7n kinh, v\u00f9ng da th\u1ea7n kinh \u0111\u00f3 chi ph\u1ed1i, \u1edf nh\u1eefng ng\u01b0\u1eddi do s\u1ef1 gi\u1ea3m s\u00fat h\u1ec7 mi\u1ec5n d\u1ecbch bao g\u1ed3m:<\/p>\n
\u00fcB\u1ec7nh nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch, \u0111\u1eb7c bi\u1ec7t AIDS..<\/p>\n
\u00fcB\u1ec7nh nh\u00e2n d\u00f9ng c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch<\/p>\n
\u00fcB\u1ec7nh h\u1ec7 t\u1ea1o keo: lupus, x\u01a1 c\u1ee9ng b\u00ec…<\/p>\n
\u00fcB\u1ec7nh v\u1ec1 m\u00e1u: lympho, hogdkin h\u1ea1ch…<\/p>\n
\u00fc\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng, ung th\u01b0<\/p>\n
\u00fcVi\u00eam n\u00e3o m\u00e0ng n\u00e3o do vi tr\u00f9ng<\/p>\n
\u00fcCh\u00e8n \u00e9p r\u1ec5 h\u1ea1ch do b\u01b0\u1edbu hay do nhi\u1ec5m tr\u00f9ng<\/p>\n
\u00fcNg\u01b0\u1eddi l\u1edbn tu\u1ed5i<\/p>\n
\u00fcSau 1 ch\u1ea5n th\u01b0\u01a1ng t\u00e2m l\u00fd v\u00e0 th\u1ec3 ch\u1ea5t<\/p>\n
T\u1ea5t c\u1ea3 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y \u0111\u1ec1u l\u00e0 \u0111i\u1ec1u ki\u1ec7n thu\u1eadn l\u1ee3i \u0111\u1ec3 VZV ho\u1ea1t h\u00f3a g\u00e2y b\u1ec7nh<\/i><\/p>\n
– Theo PTS. Nguy\u1ec5n Xu\u00e2n S\u01a1n (1999): \u0110\u01b0\u1eddng l\u00e2y truy\u1ec1n c\u1ee7a VZV l\u00e2y tr\u1ef1c ti\u1ebfp qua \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p, qua trung gian nh\u1eefng gi\u1ecdt n\u01b0\u1edbc b\u1ecdt, ph\u1ea7n nh\u1ecf qua b\u1ecdng n\u01b0\u1edbc trong zona. Gi\u1ea3 thi\u1ebft v\u1ec1 s\u1ef1 v\u00f9ng l\u00ean c\u1ee7a VZV kh\u00f4ng gi\u1ea3i ngh\u0129a \u0111\u01b0\u1ee3c c\u00e1c tr\u01b0\u1eddng h\u1ee3p l\u00e2y zona \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh tr\u00ean l\u00e2m s\u00e0ng, c\u0169ng nh\u01b0 b\u1ec7nh nh\u00e2n zona c\u00f3 l\u00e2y th\u1ee7y \u0111\u00e2u, zona co ng\u01b0\u1eddi xung quanh.<\/p>\n
III. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/b><\/p>\n
1. Th\u1eddi k\u1ef3 kh\u1edfi ph\u00e1t:<\/b>\u00a0Trung b\u00ecnh 3-5 ng\u00e0y<\/p>\n
–\u00a0Tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n:<\/i><\/b>\u00a0C\u00f3 th\u1ec3 s\u1ed1t nh\u1eb9 380C, kh\u00f3 ch\u1ecbu, nh\u1ee9c \u0111\u1ea7u<\/p>\n
–\u00a0Tri\u1ec7u ch\u1ee9ng t\u1ea1i ch\u1ed7:<\/i><\/b>\u00a0T\u1ea1i v\u00f9ng da \u0111\u01b0\u1ee3c chi ph\u1ed1i b\u1edfi h\u1ea1ch th\u1ea7n kinh b\u1ecb nhi\u1ec5m virus, b\u1ec7nh nh\u00e2n th\u1ea5y n\u00f3ng r\u00e1t, \u0111au nh\u1ee9c, ch\u00e2m ch\u00edch, t\u00ea r\u1ea7n t\u1eebng c\u01a1n ho\u1eb7c li\u00ean t\u1ee5c. S\u1edd v\u00f9ng da \u0111\u00f3 th\u1ea5y t\u0103ng nh\u1ea1y c\u1ea3m.<\/p>\n
2. Th\u1eddi k\u1ef3 to\u00e0n ph\u00e1t<\/b><\/p>\n
a. Th\u1ef1c th\u1ec3<\/i><\/b><\/p>\n
– Tr\u00ean v\u00f9ng da r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c \u0111\u00f3 xu\u1ea5t hi\u1ec7n 1 ho\u1eb7c nhi\u1ec1u m\u1ea3ng h\u1ed3ng ban kh\u00f4ng t\u1ea9m nhu\u1eadn \u0111\u1ee9ng ri\u00eang l\u1ebb, sau \u0111\u00f3 h\u1ecdp l\u1ea1i th\u00e0nh m\u1ea3ng l\u1edbn<\/p>\n
– Kho\u1ea3ng 24h sau xu\u1ea5t hi\u1ec7n nh\u1eefng m\u1ee5n n\u01b0\u1edbc m\u1ecdc th\u00e0nh ch\u00f9m, c\u00e1c m\u1ee5n n\u01b0\u1edbc n\u00e0y h\u1ee3p l\u1ea1i th\u00e0nh nh\u1eefng b\u00f3ng n\u01b0\u1edbc l\u1edbn ch\u1ee9a n\u01b0\u1edbc trong, c\u00f3 th\u1ec3 l\u00f5m \u1edf gi\u1eefa, sau \u0111\u00f3 b\u00f3ng n\u01b0\u1edbc h\u00f3a \u0111\u1ee5c v\u1ee1 ra, kh\u00f4 v\u00e0 \u0111\u00f3ng m\u00e0i.<\/p>\n
– C\u00f3 th\u1ec3 g\u00e2y t\u1ed5n th\u01b0\u01a1ng v\u1edbi nhi\u1ec1u l\u1ee9a tu\u1ed5i kh\u00e1c nhau t\u01b0\u01a1ng x\u1ee9ng v\u1edbi s\u1ef1 b\u1ed9c ph\u00e1t c\u1ee7a nhi\u1ec1u \u0111\u1ee3t li\u00ean ti\u1ebfp.<\/p>\n
–\u00a0V\u1ecb tr\u00ed \u0111\u1eb7c tr\u01b0ng:<\/i>\u00a0T\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng ch\u1ec9 \u1edf 1 b\u00ean c\u01a1 th\u1ec3 kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 \u0111\u01b0\u1eddng gi\u1eefa v\u00e0 trong v\u00f9ng ph\u00e2n b\u1ed1 h\u1ea1ch th\u1ea7n kinh c\u1ea3m gi\u00e1c.<\/p>\n
–\u00a0V\u1ecb tr\u00ed hay g\u1eb7p nh\u1ea5t:<\/i>\u00a0S\u01b0\u1eddn ng\u1ef1c 55%, v\u00f9ng \u0111\u1ea7u 20%, v\u00f9ng th\u1eaft l\u01b0ng 15%, c\u00f9ng c\u1ee5t 5%<\/p>\n
–\u00a0C\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c:<\/i>\u00a0H\u1ea1ch ph\u1ee5 c\u1eadn s\u01b0ng to \u0111au<\/p>\n
C\u00f3 th\u1ec3 c\u00f3 li\u1ec7t TK khu tr\u00fa<\/p>\n
RL TK giao c\u1ea3m: RL ti\u1ebft m\u1ed3 h\u00f4i v\u00e0 v\u1eadn m\u1ea1ch, m\u1ea5t ph\u1ea3n x\u1ea1 d\u1ef1ng l\u00f4ng<\/p>\n
b. C\u01a1 n\u0103ng<\/i><\/b><\/p>\n
C\u1ea3m gi\u00e1c n\u00f3ng b\u1ecfng \u0111au nh\u1ee9c nh\u1ea5t l\u00e0 v\u1ec1 \u0111\u00eam. \u0110\u1ed1i v\u1edbi ng\u01b0\u1eddi l\u1edbn tu\u1ed5i c\u00f3 th\u1ec3 \u0111au nh\u1ee9c d\u1eef d\u1ed9i t\u1eebng c\u01a1n ho\u1eb7c li\u00ean t\u1ee5c g\u00e2y c\u1ea3n tr\u1edf sinh ho\u1ea1t.<\/p>\n
c. To\u00e0n th\u00e2n<\/i><\/b><\/p>\n
Thay \u0111\u1ed5i t\u1eebng tr\u01b0\u1eddng h\u1ee3p, c\u00f3 th\u1ec3 s\u1ed1t, \u0111au m\u1ecfi, ch\u00e1n \u0103n ho\u1eb7c c\u00f3 bi\u1ec3u hi\u1ec7n \u1edf c\u00e1c ph\u1ee7 t\u1ea1ng nh\u01b0 r\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a, gi\u1ea3 t\u1eafc ru\u1ed9t.<\/p>\n
IV. C\u00e1c th\u1ec3 l\u00e2m s\u00e0ng<\/b><\/p>\n
1. Theo v\u1ecb tr\u00ed:<\/b><\/p>\n
+ Zona li\u00ean s\u01b0\u1eddn:<\/i><\/b>\u00a0th\u01b0\u1eddng g\u1eb7p nh\u1ea5t chi\u1ebfm 50%.<\/p>\n
+ Zona c\u1ed5 th\u01b0\u01a1ng t\u1ed5n nhi\u1ec1u r\u1ec5:<\/i><\/b>\u00a0c\u1ed5 ch\u1ea9m ( C1-C3), c\u1ed5 tr\u00ean \u0111\u1ea7u ( C3-C4), c\u1ed5 c\u00e1nh tay( C4-C7).<\/p>\n
+ Zona x\u01b0\u01a1ng c\u00f9ng:<\/i><\/b>\u00a0m\u00f4ng, t\u1ea7ng sinh m\u00f4n, c\u01a1 quan sinh d\u1ee5c ngo\u00e0i.<\/p>\n
2.<\/b>\u00a0\u0110\u1ed1i v\u1edbi c\u00e1c d\u00e2y th\u1ea7n kinh s\u1ecd n\u00e3o:<\/b><\/p>\n
+ Zona m\u1eaft:\u00a0<\/i><\/b>T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh s\u1ed1 V, li\u00ean quan \u0111\u1ebfn nh\u00e1nh tr\u00e1n l\u1ec7 m\u0169i ngo\u00e0i c\u1ee7a nh\u00e1nh m\u1eaft l\u00e0 nh\u00e1nh chi ph\u1ed1i c\u1ea3m gi\u00e1c gi\u00e1c m\u1ea1c, n\u1eb7ng n\u1ec1 nh\u1ea5t, d\u1ec5 bi\u1ebfn ch\u1ee9ng vi\u00eam gi\u00e1c m\u1ea1c d\u1eabn \u0111\u1ebfn \u1ea3nh h\u01b0\u1edfng th\u1ecb l\u1ef1c.<\/p>\n
+ Zona h\u1ea1ch g\u1ed1i( Ramsayhunt):\u00a0<\/i><\/b>T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh VII v\u00e0 th\u1ea7n kinh VIII, t\u1ed5n th\u01b0\u01a1ng khu tr\u00fa \u1edf v\u00e0nh tai, m\u00e0ng nh\u0129, l\u1ed7 tai ngo\u00e0i. Bi\u1ec3u hi\u1ec7n \u0111au tai, gi\u1ea3m th\u00ednh l\u1ef1c, li\u1ec7t m\u1eb7t ngo\u1ea1i bi\u00ean, r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c 1\/3 tr\u01b0\u1edbc l\u01b0\u1ee1i, \u00f9 tai.<\/p>\n
+ Zona mi\u1ec7ng h\u1ea7u:<\/i><\/b>\u00a0t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh IX v\u00e0 X, g\u00e2y kh\u00f3 nu\u1ed1t, ph\u00e1t ban sau th\u00e0nh l\u01b0\u1ee1i, Amygdale, c\u1ed9t tr\u1ee5 hay th\u00e0nh sau b\u00ean c\u1ee7a h\u1ea7u.<\/p>\n
3.<\/b>\u00a0Chia theo h\u00ecnh th\u00e1i h\u1ecdc:<\/b><\/p>\n
+ Zona xu\u1ea5t huy\u1ebft:<\/i><\/b>\u00a0b\u1ecdng n\u01b0\u1edbc ch\u1ee9a m\u00e1u.<\/p>\n
+ Zona ho\u1ea1i th\u01b0:<\/i><\/b>\u00a0t\u1ed5n th\u01b0\u01a1ng lo\u00e9t s\u00e2u, t\u1ea1o nh\u1eefng m\u00e0ng m\u1ee5c ho\u1ea1i t\u1eed, l\u00e2u l\u00e0nh g\u1eb7p \u1edf nh\u1eefng ng\u01b0\u1eddi suy gi\u1ea3m mi\u1ec5n d\u1ecbch.<\/p>\n
+ Zona lan t\u1ecfa:<\/i><\/b>\u00a0th\u01b0\u1eddng g\u1eb7p \u1edf nh\u1eefng ng\u01b0\u1eddi suy gi\u1ea3m mi\u1ec5n d\u1ecbch, t\u1ed5n th\u01b0\u01a1ng lan t\u1ecfa, m\u1ee5n n\u01b0\u1edbc l\u01b0u vong, c\u00e1c m\u1ee5n n\u01b0\u1edbc c\u00f3 l\u00f5m \u1edf gi\u1eefa, c\u00f3 xu\u1ea5t huy\u1ebft ho\u1ea1i t\u1eed v\u00e0 c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn n\u1ed9i t\u1ea1ng nh\u01b0: vi\u00eam ph\u1ed5i, vi\u00eam m\u00e0ng n\u00e3o.<\/p>\n
– Zona \u1edf ng\u01b0\u1eddi nhi\u1ec5m HIV\/AIDS:<\/i><\/b>\u00a0\u0111au nh\u1ee9c d\u1eef d\u1ed9i, b\u1ec7nh c\u1ea3nh n\u1eb7ng n\u1ec1. Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng nh\u01b0 Zona ho\u1ea1i t\u1eed, lan t\u1ecfa, m\u1ee5n n\u01b0\u1edbc l\u01b0u vong, c\u00f3 th\u1ec3 c\u00f3 nhi\u1ec1u Dermatome c\u00f9ng t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed3ng th\u1eddi.<\/p>\n
V. Ti\u1ebfn tri\u1ec3n v\u00e0 bi\u1ebfn ch\u1ee9ng<\/b><\/p>\n
1. Ti\u1ebfn tri\u1ec3n:\u00a0<\/b>S\u1ef1 tho\u00e1i lui trong v\u00f2ng 2 \u0111\u1ebfn 3 tu\u1ea7n v\u00e0 c\u00f3 mi\u1ec5n d\u1ecbch b\u1ec1n v\u1eefng, hi\u1ebfm khi t\u00e1i ph\u00e1t.<\/p>\n
2. Di ch\u1ee9ng v\u00e0 bi\u1ebfn ch\u1ee9ng:<\/b><\/p>\n
– Di ch\u1ee9ng:<\/i><\/b><\/p>\n
+ \u0110au nh\u1ee9c: th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi gi\u00e0, k\u00e9o d\u00e0i kh\u00f3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n
+ Lo\u1ea1n d\u01b0\u1ee1ng: teo da, m\u1ea5t l\u00f4ng, r\u1ed1i lo\u1ea1n ti\u1ebft m\u1ed3 h\u00f4i v\u00e0 v\u1eadn m\u1ea1ch\u2026<\/p>\n
–\u00a0Bi\u1ebfn ch\u1ee9ng:<\/b><\/i><\/p>\n
+ B\u1ed9i nhi\u1ec5m: vi\u00eam lo\u00e9t gi\u00e1c m\u1ea1c d\u1eabn \u0111\u1ebfn gi\u1ea3m ho\u1eb7c m\u1ea5t th\u1ecb l\u1ef1c.<\/p>\n
+ Vi\u00eam n\u00e3o m\u00e0ng n\u00e3o.<\/p>\n
+ Li\u1ec7t d\u00e2y th\u1ea7n kinh s\u1ecd n\u00e3o.<\/p>\n
VI. \u0110i\u1ec1u tr\u1ecb<\/b><\/p>\n
Do b\u1ec7nh c\u00f3 th\u1ec3 \u1ed5n \u0111\u1ecbnh sau 2 tu\u1ea7n n\u00ean v\u1ea5n \u0111\u1ec1 \u0111i\u1ec1u tr\u1ecb ch\u1ee7 y\u1ebfu l\u00e0 gi\u1ea3m \u0111au, ph\u00f2ng b\u1ed9i nhi\u1ec5m: d\u00f9ng thu\u1ed1c di\u1ec7t virus trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t.<\/p>\n
1. Ph\u00f2ng b\u1ed9i nhi\u1ec5m:<\/b><\/p>\n
-T\u1ea1i ch\u1ed7:<\/i>\u00a0thoa dung dich m\u00e0u Eosin, Milian, thu\u1ed1c t\u00edm pha lo\u00e3ng 1\/10000.<\/p>\n
-To\u00e0n th\u00e2n:<\/i>\u00a0d\u00f9ng kh\u00e1ng sinh to\u00e0n th\u00e2n trong tr\u01b0\u1eddng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng lan r\u1ed9ng, \u0111i\u1ec1u ki\u1ec7n ch\u0103m s\u00f3c k\u00e9m, ng\u01b0\u1eddi gi\u1ea3m mi\u1ec5n d\u1ecbch.<\/p>\n
2. Gi\u1ea3m \u0111au:<\/b><\/p>\n
– Thu\u1ed1c gi\u1ea3m \u0111au kh\u00e1ng vi\u00eam Non- Steroide<\/i>: Aspirin, Diclofenac, Ibuprophen.<\/p>\n
– Gi\u1ea3m \u0111au ngo\u1ea1i vi v\u00e0 trung \u01b0\u01a1ng ph\u1ed1i h\u1ee3p:<\/i>\u00a0Acetamynophen+ Codein ho\u1eb7c Acetamynophen + Dextropropoxyphen.<\/p>\n
– Vitamin nh\u00f3m B:<\/i>\u00a0d\u00f9ng li\u1ec1u cao nh\u1eb1m b\u1ea3o v\u1ec7 th\u1ea7n kinh v\u00e0 gi\u1ea3m \u0111au.<\/p>\n
– Corticoide<\/i>\u00a0d\u00f9ng s\u1edbm v\u00e0 ng\u1eafn ng\u00e0y.<\/p>\n
3. Thu\u1ed1c di\u1ec7t virus:<\/b><\/p>\n
+ Ch\u1ec9 \u0111\u1ecbnh:<\/i><\/p>\n
– Ng\u01b0\u1eddi gi\u1ea3m mi\u1ec5n d\u1ecbch.<\/p>\n
– L\u01b0\u1ee3ng CD4< 200 mm3.<\/p>\n
– Zona th\u1ea7n kinh s\u1ecd n\u00e3o( \u0111\u1eb7c bi\u1ec7t Zona m\u1eb7t).<\/p>\n
– Ng\u01b0\u1eddi suy ki\u1ec7t.<\/p>\n
– Zona th\u1ec3 n\u1eb7ng nh\u01b0 lan t\u1ecfa:<\/p>\n
. Acyclovir: 800mg x 5 l\u1ea7n\/ ng\u00e0y x 7 ng\u00e0y u\u1ed1ng.<\/p>\n
. Valacyclovir: 1g x 3 l\u1ea7n\/ ng\u00e0y x 7 ng\u00e0y.<\/p>\n
. Famcyclovir: 500 mg x 3 l\u1ea7n x 7 ng\u00e0y.<\/p>\n
– Suy gi\u1ea3m mi\u1ec5n d\u1ecbch:<\/p>\n
. Ng\u01b0\u1eddi l\u1edbn: Acyclovir 10mg\/kg\/8h x ti\u00eam t\u0129nh m\u1ea1ch.<\/p>\n
. Tr\u1ebb em: Acyclovir 500mg\/m2\/8h x 7 ng\u00e0y t\u0129nh m\u1ea1ch.<\/p>\n
B\u1ec6NH V\u1ea2Y N\u1ebeN<\/b><\/p>\n
I. D\u1ecbch t\u1ec5 h\u1ecdc<\/b><\/p>\n
– L\u00e0 m\u1ed9t b\u1ec7nh da th\u01b0\u1eddng g\u1eb7p chi\u1ebfm 1,5-2% \u1edf Vi\u1ec7t Nam, 2-3% tr\u00ean th\u1ebf gi\u1edbi<\/p>\n
– B\u1ec7nh di truy\u1ec1n b\u1edfi nhi\u1ec1u gen, n\u1ebfu ch\u1ec9 c\u00f3 cha ho\u1eb7c m\u1eb9 b\u1ecb v\u1ea9y n\u1ebfn th\u00ec 8,1% con b\u1ecb b\u1ec7nh, n\u1ebfu c\u1ea3 cha v\u00e0 m\u1eb9 b\u1ecb b\u1ec7nh th\u00ec 41% con b\u1ecb v\u1ea9y n\u1ebfn<\/p>\n
– B\u1ec7nh kh\u1edfi ph\u00e1t \u1edf m\u1ecdi l\u1ee9a tu\u1ed5i, t\u1eeb m\u1edbi sinh v\u00e0i th\u00e1ng tu\u1ed5i ( v\u1ea9y n\u1ebfn t\u00e3 l\u00f3t) \u0111\u1ebfn 18 tu\u1ed5i, nh\u01b0ng \u0111a s\u1ed1 \u1edf tu\u1ed5i 20-30<\/p>\n
– T\u1ea7n su\u1ea5t m\u1eafc b\u1ec7nh \u1edf c\u1ea3 hai ph\u00e1i t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nhau<\/p>\n
– Ch\u1ee7ng t\u1ed9c c\u0169ng tham gia v\u00e0o y\u1ebfu t\u1ed1 sinh b\u1ec7nh<\/p>\n
+ Ng\u01b0\u1eddi Nh\u1eadt B\u1ea3n, Eskimo, T\u00e2y \u1ea4n c\u00f3 t\u1ea7n su\u1ea5t b\u1ec7nh th\u1ea5p<\/p>\n
+ Ng\u01b0\u1eddi da \u0111\u1ecf B\u1eafc v\u00e0 Nam M\u1ef9 h\u1ea7u nh\u01b0 kh\u00f4ng b\u1ecb b\u1ec7nh ho\u1eb7c t\u1ea7n su\u1ea5t r\u1ea5t th\u1ea5p<\/p>\n
– M\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 tham gia g\u00e2y b\u1ec7nh nh\u01b0 ch\u1ea5n th\u01b0\u01a1ng v\u1eadt l\u00fd, nhi\u1ec5m tr\u00f9ng, ch\u1ea5n th\u01b0\u01a1ng t\u00e2m l\u00fd, thu\u1ed1c\u2026<\/p>\n
II. C\u0103n nguy\u00ean sinh b\u1ec7nh<\/b><\/p>\n
C\u0103n nguy\u00ean b\u1ec7nh sinh c\u00f2n nhi\u1ec1u \u0111i\u1ec3m ch\u01b0a s\u00e1ng t\u1ecf, song h\u1ea7u h\u1ebft csc t\u00e1c gi\u1ea3 cho r\u1eb1ng v\u1ea3y n\u1ebfn l\u00e0 1 b\u1ec7nh da di truy\u1ec1n, b\u1ec7nh da do gen, y\u1ebfu t\u1ed1 di truy\u1ec1n, b\u1ec7nh da do gen, y\u1ebfu t\u1ed1 di truy\u1ec1n \u0111\u01b0\u1ee3c th\u1eeba nh\u1eadn, d\u01b0\u1edbi t\u00e1c \u0111\u1ed9ng c\u1ee7a c\u00e1c y\u1ebfu t\u1ed1 kh\u1eddi \u0111\u1ed9ng (nh\u01b0 stress, nhi\u1ec5m khu\u1ea9n, ch\u1ea5n th\u01b0\u01a1ng c\u01a1 h\u1ecdc, v\u1eadt l\u00fd,…) gen g\u00e2y b\u1ec7nh v\u1ea3y n\u1ebfn \u0111\u01b0\u1ee3c kh\u1edfi \u0111\u1ed9ng v\u00e0 sinh ra v\u1ea3y n\u1ebfn.<\/p>\n
1. Gen g\u00e2y b\u1ec7nh v\u1ea3y n\u1ebfn<\/b><\/p>\n
N\u1eb1m tr\u00ean NST s\u1ed1 6 c\u00f3 li\u00ean quan HLA, DR7, B13, B17, BW57, CW6.<\/p>\n
Y\u1ebfu t\u1ed1 di truy\u1ec1n chi\u1ebfm 12,7% (theo Huriez) v\u00e0 29,8% (theo Bolgert), di truy\u1ec1n tr\u1ed9i 60%. Anh em sinh \u0111\u00f4i c\u00f9ng tr\u1ee9ng b\u1ecb v\u1ea3y n\u1ebfn cao \u0111\u1ebfn 75%<\/p>\n
2. Y\u1ebfu t\u1ed1 t\u00e2m l\u00fd<\/b><\/p>\n
C\u0103ng th\u1eb1ng th\u1ea7n kinh (stress) li\u00ean quan \u0111\u1ebfn ph\u00e1t b\u1ec7nh v\u00e0 v\u01b0\u1ee3ng b\u1ec7nh. Tuy nhi\u00ean c\u01a1 ch\u1ebf c\u1ee7a n\u00f3 v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh.<\/p>\n
3. Y\u1ebfu t\u1ed1 nhi\u1ec5m khu\u1ea9n<\/b><\/p>\n
Vai tr\u00f2 c\u00e1c \u1ed5 nhi\u1ec5m khu\u1ea9n khu tr\u00fa li\u00ean quan \u0111\u1ebfn qu\u00e1 tr\u00ecnh ph\u00e1t sinh v\u00e0 ph\u00e1t tri\u1ec3n b\u1ec7nh v\u1ea3y n\u1ebfn (vi\u00eam m\u0169i h\u1ecdng, vi\u00eam amidan…) m\u00e0 ch\u1ee7 y\u1ebfu l\u00e0 vai tr\u00f2 c\u1ee7a li\u00ean c\u1ea7u. Th\u01b0\u1eddng th\u1ea5y \u1edf tr\u1ebb em v\u00e0 v\u1ea3y n\u1ebfn th\u1ec3 gi\u1ecdt, trong c\u00e1c th\u1ec3 nh\u00e0y t\u1ef7 l\u1ec7 ALSO th\u01b0\u1eddng t\u0103ng cao, c\u00e1c t\u1ed5n th\u01b0\u01a1ng tho\u00e1i lui sau \u0111\u1ecdt \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh.<\/p>\n
4. Vai tr\u00f2 c\u1ee7a thu\u1ed1c<\/b><\/p>\n
M\u1ed9t s\u1ed1 thu\u1ed1c g\u00e2y b\u1ec7nh hay l\u00e0m gia t\u0103ng b\u1ec7nh v\u1ea3y n\u1ebfn: kh\u00e1ng s\u1ed1t r\u00e9t t\u1ed5ng h\u1ee3p, ch\u1eb9n beta, mu\u1ed1i thilium, NSAIDs, ph\u1ea3i nh\u1ea5n m\u1ea1nh \u0111\u1ebfn vai tr\u00f2 c\u1ee7a corticoid to\u00e0n th\u00e2n, g\u00e2y ra hi\u1ec7n t\u01b0\u1ee3ng \u201cd\u1ed9i\u201d l\u00e0m b\u1ec7nh nh\u00e2n t\u00e1i ph\u00e1t khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb v\u00e0 ti\u1ebfn tri\u1ec3n sang c\u00e1c th\u1ec3 n\u1eb7ng nh\u01b0 \u0111\u1ecf da to\u00e0n th\u00e2n, v\u1ea3y n\u1ebfn th\u1ec3 m\u1ee5n m\u1ee7.<\/p>\n
5. Vai tr\u00f2 c\u1ee7a ch\u1ea5n th\u01b0\u01a1ng<\/b><\/p>\n
C\u00f3 vai tr\u00f2 trong s\u1ef1 xu\u1ea5t hi\u1ec7n b\u1ec7nh (14%). Hi\u1ec7n t\u01b0\u1ee3ng KOEBNER l\u00e0 s\u1ef1 xu\u1ea5t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng v\u1ea3y n\u1ebfn m\u1edbi tr\u00ean nh\u1eefng v\u00f9ng da b\u1ecb k\u00edch th\u00edch c\u01a1 h\u1ecdc, h\u00f3a h\u1ecdc hay nhi\u1ec7t. Hi\u1ec7n t\u01b0\u1ee3ng n\u00e0y th\u01b0\u1eddng g\u1eb7p tr\u00ean nh\u1eefng v\u1ebft c\u00e0o g\u00e3i, v\u1ebft s\u1eb9o, nh\u1eefng v\u00f9ng da ti\u1ebfp x\u00fac l\u00e2u d\u00e0i v\u1edbi \u00e1nh n\u1eafng hay tr\u00ean c\u00e1c \u0111\u01b0\u1eddng r\u00e1ch da.<\/p>\n
6. Vai tr\u00f2 c\u1ee7a c\u01a1 ch\u1ebf mi\u1ec5n d\u1ecbch v\u00e0 sinh h\u1ecdc<\/b><\/p>\n
Nhi\u1ec1u y\u1ebfu t\u1ed1 sinh h\u1ecdc, mi\u1ec5n d\u1ecbch \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong s\u1ef1 gia t\u0103ng s\u1ef1 sinh th\u01b0\u1ee3ng b\u00ec.<\/p>\n
– \u1ea2nh h\u01b0\u1edfng c\u1ee7a c\u00e1c ch\u1ea5t h\u00f3a h\u01b0\u1edbng \u0111\u1ed9ng b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trong t\u1ed5n th\u01b0\u01a1ng v\u1ea3y n\u1ebfn<\/p>\n
– Thay \u0111\u1ed5i c\u1ee7a s\u1ee5 \u0111i\u1ec1u h\u00f2a chuy\u1ec3n h\u00f3a acid arachidoquin.<\/p>\n
– T\u00e1c \u0111\u1ed9ng c\u1ee7a nh\u1eefng ch\u1ea5t \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch nh\u01b0 Ciclosporin<\/p>\n
7. C\u00e1c y\u1ebfu t\u1ed1 kh\u00e1c:<\/b>\u00a0Y\u1ebfu t\u1ed1 n\u1ed9i ti\u1ebft, virus c\u0169ng tham gia v\u00e0o.<\/p>\n
III. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng, c\u1eadn l\u00e2m s\u00e0ng<\/b><\/p>\n
A. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng:<\/b><\/p>\n
1. T\u1ed5n th\u01b0\u01a1ng c\u0103n b\u1ea3n:\u00a0<\/b>L\u00e0 nh\u1eefng d\u00e1t, m\u1ea3ng h\u1ed3ng ban c\u00f3 v\u1ea9y (\u0111\u00f4i khi l\u00e0 s\u1ea9n c\u00f3 v\u1ea9y) v\u1edbi nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m sau \u0111\u00e2y:<\/p>\n
– H\u1ed3ng ban:<\/i>\u00a0M\u00e0u \u0111\u1ecf t\u01b0\u01a1i kh\u00f4ng t\u1ea9m nhu\u1eadn, gi\u1edbi h\u1ea1n r\u00f5, h\u00ecnh tr\u00f2n hay \u0111a cung, kh\u00f4 l\u00e1ng<\/p>\n
– L\u1edbp v\u1ea9y:<\/i>\u00a0C\u00f3 gi\u1edbi h\u1ea1n r\u00f5, m\u00e0u tr\u1eafng b\u1ea9n, \u0111\u1ee5c hay \u00f3ng \u00e1nh nh\u01b0 mica, l\u1edbp v\u1ea9y c\u00f3 th\u1ec3 che ph\u1ee7 to\u00e0n b\u1ed9 t\u1ed5n th\u01b0\u01a1ng v\u1ea9y n\u1ebfn ho\u1eb7c ch\u1ec9 ph\u1ee7 ph\u1ea7n trung t\u00e2m. B\u1ec1 m\u1eb7t c\u1ee7a v\u1ea9y \u0111\u00f4i khi kh\u00f4ng \u0111\u1ec1u, l\u1edbp v\u1ea9y \u0111\u01b0\u1ee3c c\u1ea5u t\u1ea1o b\u1edfi nh\u1eefng phi\u1ebfn v\u1ea9y m\u1ecfng, kh\u00f4, k\u00edch th\u01b0\u1edbc v\u00e0 chi\u1ec1u d\u00e0y kh\u00e1c nhau, t\u00e1ch ra t\u1ef1 nhi\u00ean hay do va ch\u1ea1m khi thay qu\u1ea7n \u00e1o<\/p>\n
\u0110\u00f4i khi v\u1ea9y \u00edt r\u00f5 r\u00e0ng v\u00e0 ch\u1ec9 ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c nh\u1edd c\u00e0o v\u00e0o t\u1ed5n th\u01b0\u01a1ng<\/p>\n
2. V\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng:<\/b><\/p>\n
T\u1ed5n th\u01b0\u01a1ng khu tr\u00fa \u1edf kh\u1eafp c\u01a1 th\u1ec3 nh\u01b0ng \u0111\u1eb7c tr\u01b0ng nh\u1ea5t l\u00e0 v\u00f9ng t\u1ef3 \u0111\u00e8, c\u00f3 t\u00ednh \u0111\u1ed1i x\u1ee9ng: V\u00f9ng da \u0111\u1ea7u, r\u00eca ch\u00e2n t\u00f3c, \u0111\u1ea7u g\u1ed1i, c\u00f9i ch\u1ecf, c\u00e1c v\u00f9ng x\u01b0\u01a1ng thi\u00eang, m\u1eb7t du\u1ed7i c\u1eb3ng ch\u00e2n, c\u1eb3ng tay, m\u00f3ng. Sang th\u01b0\u01a1ng v\u1ea9y n\u1ebfn c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n \u1edf nh\u1eefng ch\u1ed7 da b\u1ecb ch\u1ea5n th\u01b0\u01a1ng, k\u00edch th\u00edch c\u1ecd x\u00e1t ( nh\u01b0 v\u1ebft g\u00e3i, tr\u1ea7y x\u01b0\u1edbc, ti\u00eam ch\u00edch,\u2026) \u0111\u00f3 g\u1ecdi l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng Koebner<\/p>\n
3. Nghi\u1ec7m ph\u00e1p Brocq:\u00a0<\/b>D\u00f9ng curette n\u1ea1o nh\u1eb9 tr\u00ean b\u1ec1 m\u1eb7t t\u1ed5n th\u01b0\u01a1ng t\u1eeb 30-160 l\u1ea7n, nghi\u1ec7m ph\u00e1p Brocq (+) khi l\u1ea7n l\u01b0\u1ee3t xu\u1ea5t hi\u1ec7n 3 d\u1ea5u hi\u1ec7u sau \u0111\u00e2y:<\/p>\n
– V\u1ebft \u0111\u00e8n c\u1ea7y:<\/i>\u00a0C\u00e1c l\u1edbp v\u1ea9y m\u1ecfng tr\u00ean t\u1ed5n th\u01b0\u01a1ng s\u1ebd l\u1ea7n l\u01b0\u1ee3t tr\u00f3c ra r\u1ea3i r\u00e1c nh\u01b0 khi c\u00e0o nh\u1eb9 tr\u00ean \u0111\u00e8n c\u1ea7y<\/p>\n
– L\u1edbp v\u1ea9y h\u00e0nh:<\/i>\u00a0L\u1edbp v\u1ea9y sau c\u00f9ng s\u1ebd tr\u00f3c th\u00e0nh m\u1ea3ng nguy\u00ean duy nh\u1ea5t ho\u1eb7c r\u00e1ch th\u00e0nh mi\u1ebfng l\u1edbn, m\u00e9p c\u00f2n d\u00ednh v\u00e0o t\u1ed5n th\u01b0\u01a1ng<\/p>\n
– Gi\u1ecdt s\u01b0\u01a1ng m\u00e1u:<\/i>\u00a0Sau khi l\u1edbp v\u1ea9y sau c\u00f9ng tr\u00f3c ra, tr\u00ean b\u1ec1 m\u1eb7t t\u1ed5n th\u01b0\u01a1ng t\u1eeb t\u1eeb c\u00f3 gi\u1ecdt m\u00e1u nh\u1ecf li ti \u0111\u1ecdng l\u1ea1i<\/p>\n
Nghi\u1ec7m ph\u00e1p n\u00e0y l\u00e0 \u0111\u1eb7c tr\u01b0ng c\u1ee7a b\u1ec7nh v\u1ea9y n\u1ebfn nh\u01b0ng th\u01b0\u1eddng ch\u1ec9 (+) khi ch\u01b0a \u0111i\u1ec1u tr\u1ecb ( c\u1ea3 thu\u1ed1c u\u1ed1ng l\u1eabn b\u00f4i)<\/p>\n
4. C\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c:<\/b><\/p>\n
– V\u1ea9y n\u1ebfn kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng t\u1ed5ng qu\u00e1t n\u00e0o, b\u1ec7nh ng\u1ee9a \u00edt ho\u1eb7c kh\u00f4ng ng\u1ee9a. Tri\u1ec7u ch\u1ee9ng ng\u1ee9a c\u00f3 th\u1ec3 g\u1eb7p 25% c\u00e1c tr\u01b0\u1eddng h\u1ee3p<\/p>\n
– C\u00f3 th\u1ec3 g\u1eb7p c\u00e1c tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n v\u00e0 \u0111au \u1edf c\u00e1c kh\u1edbp \u1edf v\u1ea9y n\u1ebfn th\u1ec3 m\u1ee5n m\u1ee7<\/p>\n
B. C\u1eadn l\u00e2m s\u00e0ng:<\/b><\/p>\n
1. T\u0103ng chuy\u1ec3n h\u00f3a \u0111\u01b0\u1eddng, \u0111\u1ea1m, m\u1ee1<\/b><\/p>\n
2. Gi\u1ea3i ph\u1eabu b\u1ec7nh:<\/b><\/p>\n
– L\u1edbp th\u01b0\u1ee3ng b\u00ec:<\/i><\/p>\n
+ C\u00f3 hi\u1ec7n t\u01b0\u1ee3ng t\u0103ng s\u1eebng, d\u00e0y l\u1edbp \u00e1 s\u1eebng<\/p>\n
+ T\u0103ng sinh l\u1edbp t\u1ebf b\u00e0o gai<\/p>\n
+ T\u1ea9m nhu\u1eadn nhi\u1ec1u b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n, c\u00f3 nh\u1eefng Micro abces Munro v\u00f4 tr\u00f9ng<\/p>\n
– L\u1edbp trung b\u00ec:<\/i><\/p>\n
+ Nh\u00fa b\u00ec k\u00e9o d\u00e0i h\u00ecnh tr\u1ee5<\/p>\n
+ M\u1ea1ch m\u00e1u t\u0103ng sinh th\u00e0nh b\u00fai<\/p>\n
IV. Ch\u1ea9n \u0111o\u00e1n, ti\u1ebfn tri\u1ec3n, bi\u1ebfn ch\u1ee9ng<\/b><\/p>\n
A. Ch\u1ea9n \u0111o\u00e1n:<\/b><\/p>\n
1. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh:<\/b>\u00a0D\u1ef1a v\u00e0o:<\/p>\n
– T\u1ed5n th\u01b0\u01a1ng c\u0103n b\u1ea3n<\/p>\n
– V\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng \u0111\u1eb7c bi\u1ec7t<\/p>\n
– Nghi\u1ec7m ph\u00e1p Brocq (+)<\/p>\n
– Gi\u1ea3i ph\u1eabu b\u1ec7nh l\u00fd<\/p>\n
X\u00e9t nghi\u1ec7m vi khu\u1ea9n v\u00e0 n\u1ea5m \u00e2m t\u00ednh nh\u01b0ng c\u1ea7n c\u00f3 \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111\u1eb7c t\u00ednh v\u00f4 khu\u1ea9n c\u1ee7a c\u00e1c t\u1ed5n th\u01b0\u01a1ng, nh\u1ea5t l\u00e0 th\u01b0\u01a1ng t\u1ed5n m\u1ee5n m\u1ee7<\/p>\n
2. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t:<\/b><\/p>\n
a) Ban giang mai d\u1ea1ng v\u1ea9y n\u1ebfn:<\/i><\/b><\/p>\n
L\u00e0 s\u1ea9n h\u1ed3ng ban tr\u00f3c v\u1ea9y, t\u1ea9m nhu\u1eadn, v\u1ea9y \u00edt d\u00ednh v\u00e0 kh\u00f3 tr\u00f3c. Nghi\u1ec7m ph\u00e1p Brocq (+), h\u1ea1ch to\u00e0n th\u00e2n, VDRL (+)<\/p>\n
b) \u00c1 v\u1ea9y n\u1ebfn:<\/i><\/b><\/p>\n
L\u00e0 s\u1ea9n h\u1ed3ng ban tr\u00f3c v\u1ea9y, c\u1ea1o v\u1ea9y tr\u00f3c nguy\u00ean kh\u1ed1i. Nghi\u1ec7m ph\u00e1p Brocq (-), th\u01b0\u1eddng \u1edf th\u00e2n m\u00ecnh<\/p>\n
c) \u00c1 s\u1eebng d\u1ea1ng v\u1ea9y n\u1ebfn:<\/i><\/b><\/p>\n
L\u00e0 h\u1ed3ng ban tr\u00f3c v\u1ea9y gi\u1edbi h\u1ea1n kh\u00f4ng r\u00f5, \u00edt v\u1ea9y. Nghi\u1ec7m ph\u00e1p Brocq (-), v\u1ecb tr\u00ed kh\u00f4ng ch\u1ecdn l\u1ecdc, ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t nh\u1edd m\u00f4 h\u1ecdc<\/p>\n
d) Vi\u00eam da m\u1ee1:<\/i><\/b><\/p>\n
Ph\u00e2n bi\u1ec7t trong v\u1ea9y n\u1ebfn da \u0111\u1ea7u<\/p>\n
e) Vi\u00eam k\u1ebd:<\/i><\/b><\/p>\n
Ph\u00e2n bi\u1ec7t v\u1edbi v\u1ea9y n\u1ebfn n\u1ebfp<\/p>\n
f) V\u1ea9y ph\u1ea5n h\u1ed3ng Gibert<\/i><\/b><\/p>\n
B. Ti\u1ebfn tri\u1ec3n v\u00e0 bi\u1ebfn ch\u1ee9ng:<\/b><\/p>\n
1. Ti\u1ebfn tri\u1ec3n:\u00a0<\/b>R\u1ea5t kh\u00f3 d\u1ef1 \u0111o\u00e1n ti\u1ebfn tri\u1ec3n c\u1ee7a v\u1ea9y n\u1ebfn<\/p>\n
– M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh \u1ed5n \u0111\u1ecbnh, sang th\u01b0\u01a1ng khu tr\u00fa m\u1ed9t s\u1ed1 v\u00f9ng<\/p>\n
– M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh tho\u00e1i lui t\u1ef1 nhi\u00ean ho\u1eb7c tho\u00e1i lui sau \u0111i\u1ec1u tr\u1ecb, nh\u01b0ng r\u1ed3i l\u1ea1i t\u00e1i ph\u00e1t<\/p>\n
– M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh lan r\u1ed9ng t\u1eeb t\u1eeb, nhi\u1ec1u c\u01a1n b\u1ed9c ph\u00e1t li\u00ean t\u1ee5c, sang th\u01b0\u01a1ng lan tr\u00e0n d\u1ec5 \u0111\u01b0a \u0111\u1ebfn \u0111\u1ecf da to\u00e0n th\u00e2n<\/p>\n
Hi\u1ebfm khi b\u1ec7nh kh\u1ecfi h\u1eb3n ho\u00e0n to\u00e0n<\/p>\n
2. Bi\u1ebfn ch\u1ee9ng:\u00a0<\/b>Th\u01b0\u1eddng g\u1eb7p l\u00e0 vi\u00eam kh\u1edbp v\u00e0 \u0111\u1ecf da to\u00e0n th\u00e2n<\/p>\n
a) Vi\u00eam kh\u1edbp:<\/b><\/p>\n
X\u1ea3y ra \u1edf t\u1ea5t c\u1ea3 c\u00e1c kh\u1edbp, c\u00e1c c\u01a1n k\u1ecbch ph\u00e1t v\u00e0 c\u1ee7a \u0111a kh\u1edbp th\u01b0\u1eddng x\u1ea3y ra c\u00f9ng m\u1ed9t l\u00fac. Bi\u1ec3u hi\u1ec7n l\u00e0 vi\u00eam c\u1ee9ng c\u1ed9t s\u1ed1ng, vi\u00eam \u0111a kh\u1edbp, x\u00e9t nghi\u1ec7m Waaler Rose (-). Ti\u1ebfn tri\u1ec3n k\u00e9o d\u00e0i \u0111\u01b0a \u0111\u1ebfn c\u1ee9ng kh\u1edbp, bi\u1ebfn d\u1ea1ng kh\u1edbp<\/p>\n
b) \u0110\u1ecf da to\u00e0n th\u00e2n:\u00a0<\/b>Th\u01b0\u1eddng do \u0111i\u1ec1u tr\u1ecb kh\u00f4ng th\u00edch h\u1ee3p nh\u1ea5t l\u00e0 ng\u01b0ng corticoid to\u00e0n th\u00e2n \u0111\u1ed9t ng\u1ed9t<\/p>\n
c) C\u00e1c bi\u1ebfn ch\u1ee9ng kh\u00e1c:<\/b>\u00a0Nh\u01b0 b\u1ed9i nhi\u1ec5m, ung th\u01b0 da hi\u1ebfm g\u1eb7p<\/p>\n
V. C\u00e1c th\u1ec3 l\u00e2m s\u00e0ng<\/b><\/p>\n
1. Ph\u00e2n chia theo k\u00edch th\u01b0\u1edbc v\u00e0 s\u1ef1 lan r\u1ed9ng t\u1ed5n th\u01b0\u01a1ng<\/b><\/p>\n
a. V\u1ea3y n\u1ebfn gi\u1ecdt<\/i><\/b><\/p>\n
Sang th\u01b0\u01a1ng l\u00e0 nh\u1eefng s\u1ea9n nh\u1ecf h\u00ecnh h\u1ea1t \u0111\u1eadu, m\u00e0u \u0111\u1ecf, kh\u00f4 c\u1ee9ng, l\u00e1ng, \u00edt hay kh\u00f4ng v\u1ea3y, kh\u00f4ng t\u1ea9m nhu\u1eadn, s\u1ed1 l\u01b0\u1ee3ng nhi\u1ec1u, r\u1ea3i r\u00e1c kh\u1eafp n\u01a1i nh\u1ea5t l\u00e0 n\u1eeda ng\u01b0\u1eddi tr\u00ean, th\u01b0\u1eddng ch\u1eeba m\u1eb7t.<\/p>\n
Th\u1ec3 n\u00e0y th\u01b0\u1eddng g\u1eb7p \u1edf tr\u1ebb em v\u00e0 ng\u01b0\u1eddi tr\u1ebb tu\u1ed5i, b\u1ec7nh xu\u1ea5t hi\u1ec7n \u0111\u1ed9t ng\u1ed9t li\u00ean quan \u0111\u1ebfn vi\u00eam amidan, do li\u00ean c\u1ea7u, vi\u00eam tai gi\u1eefa, ch\u1ecbu t\u00e1c d\u1ee5ng t\u1ed1t v\u1edbi tr\u1ecb li\u1ec7u kh\u00e1ng sinh, c\u00f3 th\u1ec3 t\u1ef1 \u0111\u1ee1 v\u00e0 kh\u1ecfi<\/p>\n
C\u1ea7n ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi \u00e1 v\u1ea3y n\u1ebfn th\u1ec3 gi\u1ecdt (c\u00f3 d\u1ea5u hi\u1ec7u bong v\u1ea3y to\u00e0n b\u1ed9 khi c\u1ea1o g\u1ecdi l\u00e0 v\u1ebft g\u1eafn xi) v\u00e0 ph\u00e2n bi\u1ec7t v\u1edbi giang mai II d\u1ea1ng v\u1ea3y n\u1ebfn.<\/p>\n
b. V\u1ea3y n\u1ebfn th\u1ec3 \u0111\u1ed3ng ti\u1ec1n<\/i><\/b><\/p>\n
\u0110\u00e2y l\u00e0 th\u1ec3 \u0111i\u1ec3n h\u00ecnh v\u00e0 ph\u1ed5 bi\u1ebfn nh\u1ea5t, c\u00e1c v\u1ebft, \u0111\u00e1m c\u00f3 k\u00edch th\u01b0\u1edbc 1-4cm \u0111\u01b0\u1eddng k\u00ednh, xu h\u01b0\u1edbng tr\u00f2n nh\u01b0 \u0111\u1ed3ng ti\u1ec1n, s\u1ed1 l\u01b0\u1ee3ng c\u00e1c \u0111\u00e1m c\u00f3 th\u1ec3 \u0111\u1ebfm \u0111\u01b0\u1ee3c v\u00e0i ch\u1ee5c \u0111\u00e1m ho\u1eb7c h\u01a1n n\u1eefa, ti\u1ebfn tri\u1ec3n m\u1ea1n t\u00ednh.<\/p>\n
c. V\u1ea3y n\u1ebfn th\u1ec3 m\u1ea3ng<\/i><\/b><\/p>\n
\u0110\u00e2y l\u00e0 th\u1ec3 m\u1ea1n t\u00ednh \u0111\u00e3 ti\u1ebfn tri\u1ec3n t\u1eeb v\u00e0i n\u0103m tr\u1edf l\u00ean, c\u00f3 t\u00ednh ch\u1ea5t c\u1ed1 th\u1ee7 dai d\u1eb3ng. Th\u01b0\u1eddng c\u00e1c \u0111\u00e1m c\u00f3 k\u00edch th\u01b0\u1edbc 5-10cm \u0111\u01b0\u1eddng k\u00ednh ho\u1eb7c l\u1edbn h\u01a1n khu tr\u00fa \u1edf v\u00f9ng t\u00ec \u0111\u00e8.<\/p>\n
d. V\u1ea3y n\u1ebfn th\u1ec3 to\u00e0n th\u00e2n<\/i><\/b><\/p>\n
Sau nhi\u1ec1u c\u01a1n t\u00e1i ph\u00e1t hay v\u1ea3y n\u1ebfn m\u1ea1n, nh\u1ea5t l\u00e0 khi \u0111i\u1ec1u tr\u1ecb corticoid to\u00e0n th\u00e2n m\u00e0 ng\u01b0ng \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9t ng\u1ed9t, hi\u1ebfm khi xu\u1ea5t hi\u1ec7n t\u1eeb \u0111\u1ea7u<\/p>\n
L\u00e2m s\u00e0ng \u0111\u1ecf da to\u00e0n th\u00e2n tr\u00f3c v\u1ea3y kh\u00f4 c\u00f2n gi\u1eef v\u00f9ng da l\u00e0nh, gi\u1edbi h\u1ea1n r\u00f5, Brocq (+), kh\u00f4ng ng\u1ee9a hay \u00edt ng\u1ee9a. T\u1ed5ng tr\u1ea1ng t\u1ed1t, d\u1ef1 h\u1eadu l\u00e0nh t\u00ednh<\/p>\n
e. \u0110\u1ecf da v\u1ea3y n\u1ebfn to\u00e0n th\u00e2n, \u0111\u1ecf da th\u1ee9 ph\u00e1t<\/i><\/b><\/p>\n
L\u00e0 th\u1ec3 n\u1eb7ng, \u00edt g\u1eb7p. Da to\u00e0n th\u00e2n \u0111\u1ecf t\u01b0\u01a1i b\u00f3ng,ph\u00f9 n\u1ec1, nhi\u1ec5m c\u1ed9m, r\u01b0\u1edbm d\u1ecbch, ph\u1ee7 v\u00e2y m\u1ee1 \u01b0\u1edbt, kh\u00f4ng c\u00f2n v\u00f9ng da n\u00e0o l\u00e0nh,ng\u1ee9a d\u1eef d\u1ed9i, n\u1ebfp k\u1ebd b\u1ecb tr\u1ee3t lo\u00e9t, r\u01b0\u1edbm d\u1ecbch m\u1ee7, n\u1ee9t n\u1ebb, \u0111au r\u00e1t.<\/p>\n
Tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n: S\u1ed1t cao, r\u00e9t run, r\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a, suy ki\u1ec7t d\u1ea7n d\u1ea7n c\u00f3 th\u1ec3 t\u1eed vong do 1 s\u1ed1 b\u1ec7nh nhi\u1ec5m khu\u1ea9n n\u00e0o \u0111\u00f3<\/p>\n
Th\u1ec3 n\u00e0y th\u01b0\u1eddng do \u0111i\u1ec1u tr\u1ecb corticoid to\u00e0n th\u00e2n ng\u01b0ng \u0111\u1ed9t ng\u1ed9t hay bi\u1ebfn ch\u1ee9ng c\u1ee7a \u0111i\u1ec1u tr\u1ecb kh\u00f4ng th\u00edch h\u1ee3p nh\u01b0 d\u1ecb \u1ee9ng DDS…<\/p>\n
2. Ph\u00e2n chia theo h\u00ecnh th\u1ec3<\/b><\/p>\n
a. V\u1ea3y n\u1ebfn lo\u1ea1i h\u1ed3ng ban v\u00f2ng li t\u00e2m<\/i><\/b><\/p>\n
M\u1ea3ng h\u1ed3ng ban gi\u1edbi h\u1ea1n r\u00f5, h\u1ed3ng hay n\u00e2u, r\u00eca l\u00e0 1 v\u00f2ng h\u1ed3ng ban \u0111\u1ecf \u0111\u1eadm, kh\u00f4ng t\u1ea9m nhu\u1eadn, \u0111\u01b0\u1ee3c l\u00f3t ph\u00eda trong b\u1edfi 1 vi\u1ec1n v\u1ea9y r\u1ea5t \u0111i\u1ec3n h\u00ecnh, b\u1ec1 m\u1eb7t m\u1ea3ng ph\u1ee7 v\u1ea9y to. Ch\u1ea9n \u0111o\u00e1n d\u1ec5 khi c\u00f3 v\u1ea3y n\u1ebfn tr\u01b0\u1edbc.<\/p>\n
b. V\u1ea3y n\u1ebfn m\u1ee7<\/i><\/b><\/p>\n
L\u00e0 1 trong nh\u1eefng b\u1ec7nh m\u1ee7 kh\u00f4ng c\u00f3 vi khu\u1ea9n, l\u00e0 1 th\u1ec3 \u0111\u1eb7c bi\u1ec7t c\u1ee7a v\u1ea3y n\u1ebfn v\u1edbi h\u00ecnh \u1ea3nh m\u00f4 h\u1ecdc \u0111i\u1ec3n h\u00ecnh: m\u1ee5n m\u1ee7 d\u1ea1ng x\u1ebfp nhi\u1ec1u ng\u0103n. C\u00f3 2 d\u1ea1ng:<\/p>\n
\u00d8\u00a0V\u1ea3y n\u1ebfn m\u1ee5n m\u1ee7 to\u00e0n th\u00e2n<\/i><\/p>\n
Th\u1ec3 \u0111i\u1ec3n h\u00ecnh v\u00e0 n\u1eb7ng c\u1ee7a Von Zumbusch. Do Zumbusch m\u00f4 t\u1ea3 \u0111\u1ea7u ti\u00ean n\u0103m 1910. Xu\u1ea5t hi\u1ec7n ti\u00ean ph\u00e1t hay tr\u00ean 1 b\u1ec7nh nh\u00e2n v\u1ea3y n\u1ebfn \u0111\u1ecf da, v\u1ea3y n\u1ebfn kh\u1edbp (20-40%).<\/p>\n
Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng g\u1ed3m: S\u1ed1t cao \u0111\u1ed9t ng\u1ed9t, m\u1ec7t m\u1ecfi, da c\u00f3 c\u00e1c \u0111\u00e1m \u0111\u1ecf da lan t\u1ecfa, n\u1ed5i chi ch\u00edt c\u00e1c m\u1ee5n m\u1ee7, \u0111\u01b0\u1eddng k\u00ednh 1-2mm, c\u1ea3m gi\u00e1c r\u00e1t b\u1ecfng. V\u1ec1 sau xu\u1ea5t hi\u1ec7n giai \u0111o\u1ea1n tr\u00f3c v\u1ea3y l\u00e1 r\u1ed9ng k\u00e9o d\u00e0i nhi\u1ec1u tu\u1ea7n c\u00f3 th\u1ec3 r\u1ee5ng t\u00f3c, t\u1ed5n th\u01b0\u01a1ng m\u00f3ng.<\/p>\n
X\u00e9t nghi\u1ec7m m\u00e1u th\u1ea5y Neu cao, VS cao, c\u1ea5y m\u1ee7 kh\u00f4ng m\u1ecdc VK.<\/p>\n
Ti\u00ean l\u01b0\u1ee3ng nh\u00ecn chung t\u1ed1t, hay t\u00e1i ph\u00e1t.<\/p>\n
\u00d8\u00a0V\u1ea3y n\u1ebfn m\u1ee5n m\u1ee7 khu tr\u00fa l\u00f2ng b\u00e0n tay b\u00e0n ch\u00e2n<\/i><\/p>\n
Th\u1ec3 Barber. Bi\u1ec3u hi\u1ec7n b\u1eb1ng m\u1ee5n m\u1ee7 v\u00f4 khu\u1ea9n n\u1ed5i gi\u1eefa \u0111\u00e1m d\u1ea7y s\u1eebng l\u00f2ng ban tay b\u00e0n ch\u00e2n, m\u1ee5n m\u1ee7 ti\u1ebfn tri\u1ec3n th\u00e0nh t\u1eebng \u0111\u1ee3t r\u1ea5t dai d\u1eb3ng.<\/p>\n
3. Ph\u00e2n chia theo v\u1ecb tr\u00ed<\/b><\/p>\n
a. V\u1ea3y n\u1ebfn n\u1ebfp (v\u1ea3y n\u1ebfn \u0111\u1ea3o ng\u01b0\u1ee3c):<\/i><\/b>\u00a0Xu\u1ea5t hi\u1ec7n \u1edf v\u00f9ng n\u1ebfp k\u1ebd: n\u00e1ch, b\u1eb9n, n\u1ebfp d\u01b0\u1edbi v\u00fa, n\u1ebfp k\u1ebd m\u00f4ng. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t n\u1ea5m k\u1ebd do Candida v\u00e0 h\u0103m k\u1ebd do li\u00ean c\u1ea7u<\/p>\n
b. V\u1ea3y n\u1ebfn da \u0111\u1ea7u:<\/i><\/b>\u00a0Th\u01b0\u1eddng l\u00e0 c\u00e1c \u0111\u00e1m \u0111\u1ecf n\u1ec1n c\u1ed9m, b\u1ec1 m\u1eb7t ph\u1ee7 v\u1ea3y tr\u1eafng, th\u01b0\u1eddng m\u1ecdc l\u1ea5n ra tr\u00e1n th\u00e0nh 1 vi\u1ec1n g\u1ecdi l\u00e0 v\u00e0nh v\u1ea3y n\u1ebfn. T\u00f3c v\u1eabn m\u1ecdc xuy\u00ean qua t\u1ed5n th\u01b0\u01a1ng v\u00e0 ho\u00e0n to\u00e0n l\u00e0nh l\u1eb7n. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi \u00e1 s\u1eebng, vi\u00eam da ti\u1ebft b\u00e3.<\/p>\n
c. V\u1ea3y n\u1ebfn \u1edf m\u1eb7t:<\/i><\/b>\u00a0Nh\u1ea1y c\u1ea3m v\u1edbi \u0111i\u1ec1u tr\u1ecb t\u1ea1i ch\u1ed7, \u1edf ng\u01b0\u1eddi c\u00f3 da nh\u1eddn.<\/p>\n
d. V\u1ea3y n\u1ebfn l\u00f2ng b\u00e0n tay, b\u00e0n ch\u00e2n<\/i><\/b><\/p>\n
e. V\u1ea3y n\u1ebfn ni\u00eam m\u1ea1c:<\/i><\/b>\u00a0Th\u01b0\u1eddng kh\u00f4ng c\u00f3 v\u1ea3y, l\u00e1ng, kh\u00f4ng t\u1ea9m nhu\u1eadn<\/p>\n
f. V\u1ea3y n\u1ebfn m\u00f3ng:<\/i><\/b>\u00a0Th\u01b0\u1eddng \u1edf nh\u1eefng th\u1ec3 b\u1ec7nh \u0111\u00e3 l\u00e2u nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 l\u00e0 tri\u1ec7u ch\u1ee9ng \u0111\u1ea7u ti\u00ean. G\u1eb7p 25% tr\u01b0\u1eddng h\u1ee3p. Th\u01b0\u1eddng b\u1ecb 1 l\u00fac c\u1ea3 10 m\u00f3ng, b\u1ea3n m\u00f3ng c\u00f3 h\u1ed1 l\u00f5m nh\u1ecf hay c\u00f3 c\u00e1c \u0111\u01b0\u1eddng k\u1ebd theo chi\u1ec1u d\u1ecdc, ho\u1eb7c m\u00f3ng d\u00f2n v\u1ee5n, d\u00e0y \u1edf b\u1edd t\u1ef1 do, m\u00f3ng h\u1edf.<\/p>\n
4. Chia theo tu\u1ed5i<\/b><\/p>\n
a. V\u1ea3y n\u1ebfn s\u01a1 sinh (v\u1ea3y n\u1ebfn t\u1ea3 l\u00f3t):<\/i><\/b>\u00a0M\u1ed9t s\u1ed1 t\u00e1c gi\u1ea3 coi kh\u00f4ng ph\u1ea3i l\u00e0 v\u1ea3y n\u1ebfn m\u00e0 l\u00e0 vi\u00eam da d\u1ea1ng v\u1ea3y n\u1ebfn m\u1ea3ng \u0111\u1ecf \u0111\u1eadm gi\u1edbi h\u1ea1n r\u00f5, kh\u00f4 l\u00e1ng, chi\u1ebfm ph\u1ea7n che b\u1edfi t\u1ea3 l\u00f3t<\/p>\n
b. \u0110\u1ecf da v\u1ea3y n\u1ebfn b\u1ea9m sinh:<\/i><\/b>\u00a0R\u1ea5t hi\u1ebfm, \u0111\u1ecf da tr\u00f3c v\u1ea3y kh\u00f4 th\u01b0\u1eddng xuy\u00ean, \u00edt nh\u1ea1y c\u1ea3m v\u1edbi \u0111i\u1ec1u tr\u1ecb.<\/p>\n
c. V\u1ea3y n\u1ebfn \u1edf tr\u1ebb em:<\/i><\/b>\u00a0Th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n v\u1ea3y n\u1ebfn gi\u1ecdt, v\u1ea3y n\u1ebfn l\u00f2ng b\u00e0n tay b\u00e0n ch\u00e2n, v\u1ea3y n\u1ebfn \u1edf m\u1eb7t…<\/p>\n
5. V\u1ea3y n\u1ebfn kh\u1edbp<\/b><\/p>\n
G\u1ea7n gi\u1ed1ng vi\u00eam \u0111a kh\u1edbp d\u1ea1ng th\u1ea5p v\u00e0 vi\u00eam c\u1ee9ng c\u1ed9t s\u1ed1ng. \u0110a s\u1ed1 xu\u1ea5t hi\u1ec7n 1 v\u00e0i n\u0103m sau khi c\u00f3 bi\u1ec3u hi\u1ec7n da, th\u01b0\u01a1ng t\u1ed5n \u0111\u1eb7c bi\u1ec7t \u1edf c\u00e1c li\u00ean \u0111\u1ed1t xa, kh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 d\u1ea1ng th\u1ea5p. C\u00f3 2 th\u1ec3 l\u00e2m s\u00e0ng ch\u00ednh l\u00e0:<\/p>\n
a. Vi\u00eam \u0111a kh\u1edbp v\u1ea3y n\u1ebfn m\u1ea1n t\u00ednh ti\u1ebfn tri\u1ec3n:<\/i><\/b>\u00a0Ch\u1ecdn l\u1ecdc \u1edf c\u00e1c li\u00ean \u0111\u1ed1t ca, 80% c\u00f3 vi\u00eam m\u00f3ng k\u00e8m theo, kh\u1edbp s\u01b0ng \u0111au, d\u1ea7n d\u1ea7n s\u01b0ng \u0111au gi\u1ea3m nh\u01b0ng t\u00e1i ph\u00e1t t\u1eebng l\u00fac g\u1ea7n nhau<\/p>\n
b. Th\u1ea5p kh\u1edbp tr\u1ee5c:<\/i><\/b>\u00a0\u0110au th\u1eaft l\u01b0ng \u0111\u00f9i, \u0111au r\u1ec5 th\u1ea7n kinh, \u0111au nhi\u1ec1u v\u00e0o bu\u1ed5i s\u00e1ng k\u00e8m c\u1ee9ng c\u1ed9t s\u1ed1ng bu\u1ed5i s\u00e1ng, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn ph\u00f9<\/p>\n
Nh\u1eefng bi\u1ec3u hi\u1ec7n ngo\u00e0i kh\u1edbp nh\u01b0 c\u1ee5c d\u01b0\u1edbi da, h\u1ea1ch, t\u1ed5n th\u01b0\u01a1ng nh\u00e3n c\u1ea7u th\u00ec hi\u1ebfm<\/p>\n
C\u1eadn l\u00e2m s\u00e0ng:<\/p>\n
– Xquang: H\u00ecnh \u1ea3nh h\u1ee7y ho\u1ea1i x\u01b0\u01a1ng h\u1edbp ho\u1eb7c bi\u1ebfn m\u1ea5t khe kh\u1edbp (v\u00f9ng c\u00f9ng \u2013 ch\u1eadu c\u1ed9t s\u1ed1ng)<\/p>\n
– VS t\u0103ng \u00edt<\/p>\n
– Th\u1eed nghi\u1ec7m Waaler Rose (-)<\/p>\n
Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi vi\u00eam \u0111a kh\u1edbp m\u1ea1n t\u00ednh ti\u1ebfn tri\u1ec3n<\/p>\n
VI. \u0110i\u1ec1u tr\u1ecb<\/b><\/p>\n
1. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb<\/b><\/p>\n
V\u1ea3y n\u1ebfn l\u00e0 1 b\u1ec7nh kh\u00f4ng c\u00f3 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u, ch\u1ec9 t\u1ea1m ddwox v\u1ec1 l\u00e2m s\u00e0ng, sau 1 th\u1eddi gian l\u1ea1i t\u00e1i ph\u00e1t n\u00ean c\u1ea7n gi\u1ea3i th\u00edch cho b\u1ec7nh nh\u00e2n bi\u1ebft r\u00f5 t\u00ecnh tr\u1ea1ng b\u1ec7nh v\u00e0 h\u1ee3p t\u00e1c \u0111i\u1ec1u tr\u1ecb.<\/p>\n
\u0110i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c chia th\u00e0nh 2 giai \u0111o\u1ea1n: t\u1ea5n c\u00f4ng v\u00e0 duy tr\u00ec<\/p>\n
2. \u0110i\u1ec1u tr\u1ecb t\u1ea1i ch\u1ed7<\/b><\/p>\n
a. Thu\u1ed1c ti\u00eau s\u1eebng<\/i><\/b><\/p>\n
Salicilee 3%, 5% hay 10% l\u00e0m bong v\u1ea3y da. Tr\u1ebb em n\u00ean d\u00f9ng m\u1ee1 Salicilee 1-3%<\/p>\n
b. Thu\u1ed1c kh\u1eed oxy<\/i><\/b><\/p>\n
H\u1eafc \u00edn (goudron), d\u1ea7u cade d\u01b0\u1edbi d\u1ea1ng thu\u1ed1c b\u00f4i, x\u00e0 ph\u00f2ng ho\u1eb7c d\u1ea7u g\u1ed9i \u0111\u1ea7u Goudron l\u00e0 thu\u1ed1c c\u1ed5 \u0111i\u1ec3n \u0111i\u1ec1u tr\u1ecb v\u1ea3y n\u1ebfn kh\u00e1 t\u1ed1t. Nh\u01b0\u1ee3c \u0111i\u1ec3m: m\u00f9i h\u1eafc, d\u00e2y b\u1ea9n qu\u1ea7n \u00e1o.<\/p>\n
c. Vitamin D3 v\u00e0 c\u00e1c d\u1eabn xu\u1ea5t<\/i><\/b><\/p>\n
Calcipotriol c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf s\u1ef1 t\u0103ng sinh v\u00e0 bi\u1ec7t h\u00f3a t\u1ebf b\u00e0o s\u1eebng. Thu\u1ed1c \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u1edf v\u1ea3y n\u1ebfn th\u1ec3 m\u1ea3ng hay c\u00e1c th\u1ec3 kh\u00e1c c\u00f3 t\u1ed5n th\u01b0\u01a1ng nhi\u1ec1u h\u01a1n 40% di\u1ec7n t\u00edch c\u01a1 th\u1ec3. B\u00f4i s\u00e1ng v\u00e0 t\u1ed1i, li\u1ec1u l\u01b0\u1ee3ng kh\u00f4ng qu\u00e1 100mg\/tu\u1ea7n<\/p>\n
d. Corticoid:<\/i><\/b><\/p>\n
C\u00f3 t\u00e1c d\u1ee5ng v\u1edbi v\u1ea3y n\u1ebfn nh\u01b0ng hi\u1ec7u qu\u1ea3 gi\u1ea3m d\u1ea7n theo th\u1eddi gian. Th\u01b0\u1eddng d\u00f9ng trong \u0111i\u1ec1u tr\u1ecb t\u1ea5n c\u00f4ng, b\u00f4i h\u00e0ng ng\u00e0y cho \u0111\u1ebfn khi tr\u1eafng da r\u1ed3i gi\u1ea3m d\u1ea7n \u0111\u1ec3 tr\u00e1nh hi\u1ec7n t\u01b0\u1ee3ng \u201cd\u1ed9i\u201d, c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c ti\u00eau s\u1eebng \u0111\u1ec3 t\u0103ng t\u00e1c d\u1ee5ng<\/p>\n
3. \u0110i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n:\u00a0<\/b>C\u00f3 nhi\u1ec1u lo\u1ea1i nh\u01b0ng kh\u00f4ng c\u00f3 lo\u1ea1i n\u00e0o \u0111\u1eb7c tr\u1ecb<\/p>\n
a. Vitamin A:<\/i><\/b>\u00a0Li\u1ec1u cao 200.000 \u2013 300.000UI\/ng\u00e0y<\/p>\n
b. Retinoides<\/i><\/b><\/p>\n
Tigason:<\/i>\u00a0T\u1ea5n c\u00f4ng 1mg\/kg\/ng\u00e0y trong 1 th\u00e1ng<\/p>\n
Duy tr\u00ec 0,5mg\/kg\/ng\u00e0y trong 1-2 th\u00e1ng<\/p>\n
Ch\u1ec9 \u0111\u1ecbnh:<\/i>\u00a0V\u1ea3y n\u1ebfn \u201cvi\u00eam\u201d: \u0111\u1ecf da to\u00e0n th\u00e2n, v\u1ea3y n\u1ebfn m\u1ee7, v\u1ea3y n\u1ebfn th\u00f4ng th\u01b0\u1eddng th\u1ea5t b\u1ea1i v\u1edbi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c<\/p>\n
Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh:<\/i>\u00a0Ph\u1ee5 n\u1eef \u1edf giai \u0111o\u1ea1n ho\u1ea1t \u0111\u1ed9ng sinh d\u1ee5c, n\u1ebfu c\u1ea7n \u0111i\u1ec1u tr\u1ecb th\u00ec b\u1eaft bu\u1ed9c d\u00f9ng c\u00e1c bi\u1ec7n ph\u00e1p tr\u00e0nh thai trong th\u1eddi gian \u0111i\u1ec1u tr\u1ecb v\u00e0 1 n\u0103m sau \u0111i\u1ec1u tr\u1ecb.<\/p>\n
c. Dapson (DDS)<\/i><\/b><\/p>\n
1,5mg\/kg\/ng\u00e0y d\u00f9ng li\u00ean t\u1ee5c 1 th\u00e1ng, t\u00e1c d\u1ee5ng ph\u1ee5 thi\u1ebfu m\u00e1u huy\u1ebft t\u00e1n, d\u1ecb \u1ee9ng…<\/p>\n
d. Corticoid<\/i><\/b><\/p>\n
Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh d\u00f9ng to\u00e0n th\u00e2n v\u00ec d\u1ec5 \u0111\u01b0a \u0111\u1ebfn \u0111\u1ecf da to\u00e0n th\u00e2n, v\u1ea3y n\u1ebfn m\u1ee7 khi ng\u01b0ng thu\u1ed1c<\/p>\n
e. Thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch<\/i><\/b><\/p>\n
Methotrexat 0,2 – 0,4mg\/kg ho\u1eb7c 15-25mg\/tu\u1ea7n ho\u1eb7c Cycloporine A 2,5-5mg\/kg\/ng\u00e0y<\/p>\n
T\u1ea5n c\u00f4ng 3-4 th\u00e1ng<\/p>\n
Duy tr\u00ec 1-2 n\u0103m<\/p>\n
D\u00f9n trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p v\u1ea3y n\u1ebfn n\u1eb7ng, v\u1ea3y n\u1ebfn bi\u1ebfn ch\u1ee9ng kh\u1edbp, v\u1ea3y n\u1ebfn m\u1ee5n m\u1ee7 v\u00e0 v\u1ea3y n\u1ebfn kh\u00e1ng tr\u1ecb. Tuy nhi\u00ean c\u00f3 nhi\u1ec1u t\u00e1c d\u1ee5ng ph\u1ee5 l\u00ean gan, m\u00e1u… c\u1ea7n ph\u1ea3i theo d\u00f5i k\u1ef9.<\/p>\n
f. Vitamin D3:<\/i><\/b>\u00a0S\u1eed d\u1ee5ng t\u1ed1t trong v\u1ea3y n\u1ebfn m\u1ee7<\/p>\n
4. V\u1eadt l\u00fd tr\u1ecb li\u1ec7u<\/b><\/p>\n
– Ng\u00e2m n\u01b0\u1edbc \u1ea5m 36-370C<\/p>\n
– Chi\u1ebfu tia c\u1ef1c t\u00edm li\u1ec1u \u0111\u1ecf da (UVB)<\/p>\n
– T\u1eafm n\u1eafng, t\u1eafm bi\u1ec3n, t\u1eafm b\u00f9n ho\u1eb7c t\u1eafm su\u1ed1i kho\u00e1ng<\/p>\n
– Li\u1ec7u ph\u00e1p P.U.V.A (quang h\u00f3a tr\u1ecb li\u1ec7u)<\/p>\n
5. \u0110i\u1ec1u tr\u1ecb v\u1ea3y n\u1ebfn b\u1eb1ng thu\u1ed1c y h\u1ecdc c\u1ed5 truy\u1ec1n<\/b><\/p>\n
– \u0110\u01a1n h\u1ea1 kh\u00f4 th\u1ea3o \u2013 th\u1ed5 ph\u1ee5c linh<\/p>\n
– N\u01b0\u1edbc s\u1eafc h\u1ea1t ph\u00e1 c\u1ed1 ch\u1ec9<\/p>\n
– Thu\u1ed1c b\u00f4i cao v\u00e0ng<\/p>\n
VII. Ph\u00f2ng b\u1ec7nh<\/b><\/p>\n
\u0110\u1ed1i v\u1edbi ng\u01b0\u1eddi l\u00e0nh ph\u00f2ng b\u1ec7nh kh\u00f4ng c\u00f3 \u00fd ngh\u0129a nhi\u1ec1u, ngo\u1ea1i tr\u1eeb th\u00f4ng b\u00e1o v\u1ec1 v\u1ea5n \u0111\u1ec1 anh em, con c\u1ee7a b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 m\u1eafc nh\u01b0 b\u1ec7nh nh\u00e2n (c\u00f3 t\u00ednh di truy\u1ec1n)<\/p>\n
\u0110\u1ed1i v\u1edbi ng\u01b0\u1eddi b\u1ec7nh:<\/p>\n
– Lu\u00f4n gi\u1eef tinh th\u1ea7n tho\u1ea3i m\u00e1i, tr\u00e1nh c\u00e1c ch\u1ea5n th\u01b0\u01a1ng t\u00e2m l\u00fd<\/p>\n
– Ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng gi\u1ea3m b\u00e9o<\/p>\n
– Tr\u00e1nh d\u00f9ng c\u00e1c ch\u1ea5t k\u00edch th\u00edch: r\u01b0\u1ee3u, bia, cafe, thu\u1ed1c l\u00e1…<\/p>\n
– Kh\u00f4ng d\u00f9ng c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch nh\u01b0 corticoid<\/p>\n
– Tr\u00e1nh ch\u1ea5n th\u01b0\u01a1ng, tr\u1ea7y x\u01b0\u1edbc da<\/p>\n
– Tr\u00e1nh c\u00e1c thu\u1ed1c l\u00e0m kh\u1edfi ph\u00e1t ho\u1eb7c v\u01b0\u1ee3ng b\u1ec7nh v\u1ea3y n\u1ebfn<\/p>\n
– Tr\u01b0\u1eddng h\u1ee3p c\u00f3 bi\u1ebfn ch\u1ee9ng nh\u1ea5t l\u00e0 \u0111au kh\u1edbp,… c\u1ea7n nh\u1eadp vi\u1ec7n tr\u00e1nh m\u1ea5t kh\u1ea3 n\u0103ng lao \u0111\u1ed9ng do c\u1ee9ng kh\u1edbp,…<\/p>\n
B\u1ec6NH N\u1ea4M DA<\/b><\/p>\n
I. D\u1ecbch t\u1ec5 h\u1ecdc<\/b><\/p>\n
1. T\u00ecnh h\u00ecnh m\u1eafc b\u1ec7nh<\/b><\/p>\n
L\u00e0 1 trong nh\u1eefng b\u1ec7nh ngo\u00e0i da r\u1ea5t ph\u1ed5 bi\u1ebfn. Theo th\u1ed1ng k\u00ea c\u00e1c b\u1ec7nh n\u1ea5m da chi\u1ebfm t\u1ef7 l\u1ec7 5% tr\u00ean t\u1ed5ng s\u1ed1 c\u00e1c b\u1ec7nh v\u1ec1 da. T\u1ef7 l\u1ec7 m\u1eafc t\u0103ng l\u00ean trong \u0111i\u1ec1u ki\u1ec7n sinh ho\u1ea1t t\u1eadp th\u1ec3 nh\u01b0: Nh\u00e0 tr\u1ebb, k\u00fd t\u00fac x\u00e1, khu t\u1eadp t\u1ec3, vi\u1ec7n d\u01b0\u1ee1ng l\u00e3o,…<\/p>\n
V\u1ec1 \u0111\u1ecba l\u00fd:<\/i><\/b>\u00a0M\u1ed9t s\u1ed1 ch\u1ee7ng n\u1ea5m ph\u00e2n b\u1ed1 kh\u1eafp th\u1ebf gi\u1edbi nh\u01b0 Candida albicans, Microsporum. M\u1ed9t s\u1ed1 ch\u1ec9 khu tr\u00fa \u1edf v\u00f9ng n\u1ed9i d\u1ecbch, hay ch\u1ec9 ph\u00e2n b\u1ed1 \u1edf 1 s\u1ed1 \u0111\u1ecba d\u01b0 \u0111\u1eb7c bi\u1ec7t<\/p>\n
L\u1ee9a tu\u1ed5i m\u1eafc:<\/i><\/b>\u00a0T\u1ea5t c\u1ea3 m\u1ecdi l\u1ee9a tu\u1ed5i \u0111\u1ec1u m\u1eafc b\u1ec7nh n\u1ea5m, nh\u01b0ng 1 v\u00e0i \u0111\u1ed9 tu\u1ed5i d\u1ec5 m\u1eafc 1 v\u00e0i lo\u1ea1i n\u1ea5m \u0111\u1eb7c hi\u1ec7u.<\/p>\n
– Candida albicans: Tr\u1ebb s\u01a1 sinh v\u00e0 ng\u01b0\u1eddi gi\u00e0<\/p>\n
– Tr\u1ebb d\u01b0\u1edbi 13 tu\u1ed5i: N\u1ea5m t\u00f3c<\/p>\n
– Nam gi\u1edbi th\u01b0\u1eddng b\u1ecb n\u1ea5m b\u1eb9n. N\u1eef gi\u1edbi th\u01b0\u1eddng b\u1ecb n\u1ea5m Candida.<\/p>\n
2. \u0110\u01b0\u1eddng truy\u1ec1n<\/b><\/p>\n
Qua 3 ngu\u1ed3n: ph\u1ea7n l\u1edbn t\u1eeb ng\u01b0\u1eddi sang ng\u01b0\u1eddi, t\u1eeb s\u00fac v\u1eadt v\u00e0 \u00edt h\u01a1n c\u1ea3 l\u00e0 t\u1eeb \u0111\u1ea5t<\/p>\n
S\u1ef1 l\u00e2y truy\u1ec1n c\u00f3 th\u1ec3 do c\u00e1c ch\u1ee7ng n\u1ea5m \u0111\u01b0a t\u1eeb ngo\u00e0i v\u00e0o, qua x\u00e2y x\u00e1t, gai \u0111\u00e2m \u1edf da nh\u01b0 Sprorotrichose… ho\u1eb7c qua c\u00e1c catheter nh\u01b0 candida albicans ho\u1eb7c ti\u1ebfp x\u00fac tr\u1ef1c ti\u1ebfp th\u00f4ng qua v\u1eadt d\u1ee5ng. S\u1ef1 l\u00e2y nhi\u1ec5m n\u1ed9i sinh l\u00e0 do c\u00e1c ch\u1ee7ng n\u1ea5m s\u1ed1ng n\u1ed9i sinh trong c\u01a1 th\u1ec3 chuy\u1ec3n sang giai \u0111o\u1ea1n sinh b\u1ec7nh b\u1eb1ng c\u00e1c t\u0103ng d\u00e2n s\u1ed1 v\u00e0 x\u00e2m nh\u1eadp s\u00e2u v\u00e0o trong t\u1ed5 ch\u1ee9c, th\u01b0\u1eddng do s\u1ee9c \u0111\u1ec1 kh\u00e1ng c\u1ee7a v\u1eadt ch\u1ee7 gi\u1ea3m.<\/p>\n
3. C\u00e1c y\u1ebfu t\u1ed1 thu\u1eadn l\u1ee3i<\/b><\/p>\n
a. M\u00f4i tr\u01b0\u1eddng<\/i><\/b><\/p>\n
\u1ea4m, n\u00f3ng, t\u0103ng ti\u1ebft m\u1ed3 h\u00f4i, thi\u1ebfu v\u1ec7 snh, t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho 1 s\u1ed1 b\u1ec7nh n\u1ea5m ph\u00e1t tri\u1ec3n<\/p>\n
b. Nh\u1eefng thay \u0111\u1ed5i v\u1ec1 m\u1eb7t sinh l\u00fd<\/i><\/b><\/p>\n
Ph\u1ee5 n\u1eef c\u00f3 thai: n\u1ea5m Candida ph\u00e1t tri\u1ec3n<\/p>\n
Ph\u1ee5 n\u1eef d\u00f9ng thu\u1ed1c ng\u00f9a thai<\/p>\n
Tr\u1ebb s\u01a1 sinh v\u00e0 ng\u01b0\u1eddi gi\u00e0<\/p>\n
c. Nh\u1eefng thay \u0111\u1ed5i v\u1ec1 m\u1eb7t b\u1ec7nh l\u00fd:<\/i><\/b>\u00a0B\u1ec7nh n\u1ea5m t\u0103ng trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p:<\/p>\n
– B\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/p>\n
– B\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng kh\u00e1ng sinh<\/p>\n
– D\u00f9ng corticoid v\u00e0 c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch k\u00e9o d\u00e0i<\/p>\n
– C\u00e1c b\u1ec7nh \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ee9c \u0111\u1ec1 kh\u00e1ng c\u01a1 th\u1ec3 nh\u01b0 lao, ung th\u01b0, lupus…<\/p>\n
– C\u00e1c b\u1ec7nh suy gi\u1ea3m mi\u1ec5n d\u1ecbch, \u0111\u1eb7c bi\u1ec7t AIDS<\/p>\n
– C\u00e1c thu\u1ed1c g\u00e2y gi\u1ea3m b\u1ea1ch c\u1ea7u, nh\u1ea5t l\u00e0 bahcj c\u1ea7u h\u1ea1t.<\/p>\n
d. \u0110i\u1ec1u ki\u1ec7n nhi\u1ec7t \u0111\u1ed9, \u0111\u1ed9 \u1ea9m, pH<\/i><\/b><\/p>\n
N\u1ea5m ph\u00e1t tri\u1ec3n t\u1ed1t nh\u1ea5t \u1ecf 25-270C, \u1ea9m \u01b0\u1edbt, pH 5,8-6,8, c\u00f3 th\u1ec3 di\u1ec7t s\u1ee3i n\u1ea5m b\u1eb1ng nhi\u1ec7t ho\u1eb7c b\u1eb1ng c\u00e1c h\u00f3a ch\u1ea5t nh\u01b0 acid salicilic, acid benzoic, iode l\u00e0 tr\u00f3c l\u1edbp s\u1eebng l\u00e0 n\u01a1i \u1edf c\u1ee7a s\u1ee3i n\u1ea5m \u0111\u1ed3ng th\u1eddi l\u00e0m c\u00f4 \u0111\u1eb7c nguy\u00ean snh c\u1ee7a t\u1ebf b\u00e0o n\u1ea5m.<\/p>\n
II. C\u1eadn l\u00e2m s\u00e0ng t\u00ecm n\u1ea5m<\/b><\/p>\n
1. \u0110\u00e8n Wood<\/b><\/p>\n
L\u00e0 \u0111\u00e8n chi\u1ebfu tia t\u1eed ngo\u1ea1i v\u1edbi b\u01b0\u1edbc s\u00f3ng 365mm. Trong ph\u00f2ng t\u1ed1i \u0111\u00e8n Wood c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n nh\u1eefng sang th\u01b0\u01a1ng gi\u1ea3m s\u1eafc t\u1ed1 ho\u1eb7c 1 s\u1ed1 b\u1ec7nh n\u1ea5m ngo\u00e0i da \u0111\u1eb7c bi\u1ec7t l\u00e0 n\u1ea5m da \u0111\u1ea7u.<\/p>\n
– Ph\u00e1t hu\u1ef3nh quang m\u00e0u xnah da tr\u1eddi, m\u00e0u xanh l\u00e1 c\u00e2y t\u00f9y theo m\u1ed7i s\u1ee3i t\u00f3c nhi\u1ec5m vi n\u1ea5m (ph\u00e1t n\u1ed9i v\u00e0 ph\u00e1t ngo\u1ea1i)<\/p>\n
– N\u1ea5m th\u00e2n do Dermatophytes kh\u00f4ng ph\u00e1t hu\u1ef3nh quang<\/p>\n
– D\u00e1t trong b\u1ec7nh lang ben ph\u00e1t hu\u1ef3nh quang m\u00e0u v\u00e0ng<\/p>\n
– Erythrasma c\u00f3 th\u1ec3 ph\u00e1t hu\u1ef3nh quang m\u00e0u h\u1ed3ng cam<\/p>\n
– Nhi\u1ec5m Pseudomonas aeruginosa ph\u00e1t hu\u1ef3nh quang m\u00e0 v\u00e0ng xanh<\/p>\n
2. Soi t\u01b0\u01a1i v\u1edbi KOH<\/b><\/p>\n
L\u00e0 ph\u01b0\u01a1ng ph\u00e1p th\u00f4ng d\u1ee5ng nh\u1ea5t, cho k\u1ebft qu\u1ea3 nhanh v\u00e0 d\u1ec5 th\u1ef1c hi\u1ec7n<\/p>\n
V\u1ea3y s\u1ebd \u0111\u01b0\u1ee3c c\u1ea1o t\u1ea1i r\u00eca sang th\u01b0\u01a1ng ph\u1ebft l\u00ean lam, nh\u1ecf \u0111 KOH 20% l\u00ean soi tr\u1ef1c ti\u1ebfp<\/p>\n
3. C\u1ea5y n\u1ea5m<\/b><\/p>\n
Soi tr\u1ef1c ti\u1ebfp ch\u1ec9 bi\u1ebft l\u00e0 n\u1ea5m hay kh\u00f4ng, mu\u1ed1n bi\u1ebft l\u00e0 n\u1ea5m g\u00ec ph\u1ea3i c\u1ea5y tr\u00ean m\u00f4i t\u01b0\u1eddng Sabuuraud. T\u00f9y theo h\u00ecnh th\u1ec3, m\u00e0u s\u1eafc, \u0111\u1eb7c \u0111i\u1ec3m n\u1ea5m m\u1ecdc tr\u00ean m\u00f4i tr\u01b0\u1eddng m\u00e0 \u0111\u1ecbnh lo\u1ea1i l\u00e0 n\u1ea5m g\u00ec.<\/p>\n
Tuy nhi\u00ean \u00edt s\u1eed d\u1ee5ng tr\u00ean l\u00e2m s\u00e0ng, th\u01b0\u1eddng ch\u1ec9 d\u00f9ng khi nghi\u00ean c\u1ee9u.<\/p>\n
III. Nguy\u00ean nh\u00e2n c\u1ee7a n\u1ea5m t\u00f3c, n\u1ea5m r\u00e2u, n\u1ea5m m\u1eb7t.<\/b><\/p>\n
1. N\u1ea5m t\u00f3c:<\/b><\/p>\n
– N\u1ea5m t\u00f3c lo\u1ea1i g\u00e2y r\u1ee5ng t\u00f3c khu tr\u00fa kh\u00f4ng s\u1eb9o: Nguy\u00ean nh\u00e2n do Trichophyton v\u00e0 Mycrosporum<\/p>\n
– N\u1ea5m t\u00f3c lo\u1ea1i g\u00e2y r\u1ee5ng t\u00f3c khu tr\u00fa c\u00f3 s\u1eb9o: Nguy\u00ean nh\u00e2n do T. Schoenleinii<\/p>\n
2. N\u1ea5m r\u00e2u<\/b>: Nguy\u00ean nh\u00e2n do Trichophyton mentagrophytes hay T.Verrucosum<\/p>\n
3. N\u1ea5m m\u1eb7t:<\/b>\u00a0Nguy\u00ean nh\u00e2n do T.Rubum, T.Mentagrophytes, T.Canis, T.Verrucosum.<\/p>\n
IV. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng n\u1ea5m t\u00f3c, n\u1eafm r\u00e2u, n\u1ea5m m\u1eb7t<\/b><\/p>\n
1. N\u1ea5m t\u00f3c:<\/b><\/p>\n
a) N\u1ea5m t\u00f3c lo\u1ea1i g\u00e2y r\u1ee5ng t\u00f3c khu tr\u00fa kh\u00f4ng s\u1eb9o:\u00a0<\/i><\/b>B\u1ec7nh g\u1eb7p \u1edf m\u1ecdi l\u1ee9a tu\u1ed5i nh\u01b0ng nhi\u1ec1u nh\u1ea5t l\u00e0 tr\u1ebb em t\u1eeb 5-7 tu\u1ed5i ( l\u1ee9a tu\u1ed5i \u0111i h\u1ecdc). Chia l\u00e0m 2 lo\u1ea1i do Trichophyton v\u00e0 Mycrosporum.<\/p>\n
N\u1ea5m t\u00f3c do Mycrosporum<\/i><\/b>:<\/i>\u00a0G\u00e2y ra th\u01b0\u1eddng c\u00f3 t\u1ed5n th\u01b0\u01a1ng vi\u00eam v\u00e0 kh\u00f4ng vi\u00eam, c\u00f3 ngu\u1ed3n g\u1ed1c \u1edf ng\u01b0\u1eddi v\u00e0 s\u00fac v\u1eadt.<\/p>\n
– Ngu\u1ed3n g\u1ed1c \u1edf ng\u01b0\u1eddi: Do M.Audouinii:<\/i><\/p>\n
+ C\u00f3 trung b\u00ecnh 4-6 \u0111\u00e1m r\u1ee5ng t\u00f3c tr\u00f2n ho\u1eb7c b\u1ea7u d\u1ee5c, t\u1eeb 2-6 cm gi\u1edbi h\u1ea1n r\u00f5<\/p>\n
+ V\u1ea9y tr\u1eafng x\u00e1m, \u00edt v\u00e0 m\u1ecbn<\/p>\n
+ T\u00f3c x\u00e9n ng\u1eafn \u0111\u1ec1u, d\u1ec5 nh\u1ed5<\/p>\n
+ T\u00f3c b\u1ec7nh ph\u00e1t hu\u1ef3nh quang xanh l\u00e1 c\u00e2y d\u01b0\u1edbi \u00e1nh s\u00e1ng Wood<\/p>\n
+ \u00cdt th\u1ea5y tr\u00ean da th\u01b0\u1eddng, t\u1ef1 kh\u1ecfi kho\u1ea3ng 15 tu\u1ed5i<\/p>\n
+ Khi l\u00e0nh kh\u00f4ng \u0111\u1ec3 l\u1ea1i s\u1eb9o<\/p>\n
+ C\u1ea7n cho ngh\u1ec9 h\u1ecdc \u0111\u1ec3 tr\u00e1nh l\u00e2y lan<\/p>\n
– Ngu\u1ed3n g\u1ed1c s\u00fac v\u1eadt: Do M.Canis<\/i><\/p>\n
+ \u0110\u1ed1m r\u1ee5ng t\u00f3c nh\u1ecf v\u00e0 \u0111\u1ec1u h\u01a1n k\u00e8m theo vi\u00eam xung quanh t\u1ed5n th\u01b0\u01a1ng<\/p>\n
+ T\u00f3c ph\u00e1t hu\u1ef3nh quang xanh l\u00e1 c\u00e2y d\u01b0\u1edbi \u00e1nh s\u00e1ng Wood<\/p>\n
+ H\u1ebft t\u1ef1 nhi\u00ean kh\u00f4ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb<\/p>\n
+ Kh\u00f4ng c\u1ea7n ngh\u1ec9 h\u1ecdc<\/p>\n
N\u1ea5m t\u00f3c do Trichophyton:<\/i><\/b>\u00a0G\u1eb7p \u1edf tr\u1ebb em v\u00e0 ng\u01b0\u1eddi l\u1edbn, c\u00f3 ngu\u1ed3n g\u1ed1c \u1edf ng\u01b0\u1eddi v\u00e0 s\u00fac v\u1eadt<\/p>\n
– Ngu\u1ed3n g\u1ed1c \u1edf ng\u01b0\u1eddi: Do T.Violaceum<\/i><\/p>\n
+ T\u1ed5n th\u01b0\u01a1ng tr\u00f2n nh\u1ecf gi\u1edbi h\u1ea1n kh\u00f4ng r\u00f5, s\u1ed1 l\u01b0\u1ee3ng nhi\u1ec1u<\/p>\n
+ V\u1ea9y m\u00e0u tr\u1eafng \u0111\u1ee5c. T\u00f3c th\u01b0\u1eddng g\u00e3y s\u00e1t da \u0111\u1ea7u t\u1ea1o th\u00e0nh ch\u1ea5m \u0111en<\/p>\n
+ T\u00f3c x\u00e9n ng\u1eafn kh\u00f4ng \u0111\u1ec1u, t\u00f3c l\u00e0nh xen k\u1ebd t\u00f3c b\u1ec7nh, t\u00f3c c\u00f3 h\u00ecnh ch\u1eef S,Z<\/p>\n
+ T\u00f3c b\u1ec7nh kh\u00f4ng ph\u00e1t hu\u1ef3nh quang xanh l\u00e1 c\u00e2y d\u01b0\u1edbi \u00e1nh s\u00e1ng Wood<\/p>\n
+ T\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng \u0111i k\u00e8m v\u1edbi t\u1ed5n th\u01b0\u01a1ng da v\u00e0 m\u00f3ng<\/p>\n
– Ngu\u1ed3n g\u1ed1c s\u00fac v\u1eadt: Th\u01b0\u1eddng do T. Mentagrophytes<\/i><\/p>\n
+ N\u1ea5m da \u0111\u1ea7u vi\u00eam ( kerion) m\u1ee9c \u0111\u1ed9 vi\u00eam thay \u0111\u1ed5i t\u1eeb nh\u1eb9 \u0111\u1ebfn n\u1eb7ng<\/p>\n
+ T\u1ed5n th\u01b0\u01a1ng l\u00e0 m\u1ea3ng tr\u00f2n t\u1eeb 3-5 cm gi\u1edbi h\u1ea1n r\u00f5, th\u01b0\u1eddng \u1edf v\u00f9ng ch\u1ea9m vi\u00eam, m\u1ee7 ch\u1ea3y ra \u1edf l\u1ed7 ch\u00e2n t\u00f3c, t\u00f3c th\u01b0\u1eddng g\u00e3y kh\u00e1 ng\u1eafn v\u00e0 d\u1ec5 r\u1ee5ng.<\/p>\n
b) N\u1ea5m t\u00f3c lo\u1ea1i g\u00e2y r\u1ee5ng t\u00f3c khu tr\u00fa c\u00f3 s\u1eb9o: Th\u01b0\u1eddng g\u1eb7p b\u1ec7nh Favus<\/i><\/b><\/p>\n
Ch\u1ee7 y\u1ebfu g\u1eb7p \u1edf v\u00f9ng da \u0111\u1ea7u nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 g\u1eb7p \u1edf v\u00f9ng da th\u01b0\u1eddng, l\u00f4ng, m\u00f3ng.<\/p>\n
– Da \u0111\u1ea7u: \u0110\u1ea7y nh\u1eefng m\u00e0i m\u00e0u v\u00e0ng, l\u00f5m, t\u00f3c l\u1ecfng l\u1ebbo d\u1ec5 nh\u1ed5<\/p>\n
– Da th\u01b0\u1eddng: T\u1ed5n th\u01b0\u01a1ng h\u00ecnh \u0111\u00e1y ch\u00e9n, \u0111\u01b0\u1eddng k\u00ednh kho\u1ea3ng 2cm, v\u1ea9y m\u00e0u x\u00e1m, m\u00f9i r\u1ea5t h\u00f4i g\u1ecdi l\u00e0 m\u00f9i chu\u1ed9t ch\u00f9, c\u1ea1y v\u1ea9y da l\u00f5m b\u1ea1c m\u00e0u<\/p>\n
– M\u00f3ng: N\u1ee9t n\u1ebb, d\u00e0y m\u00f3ng kh\u00f4ng \u0111\u1ec1u, \u0111\u00f3ng m\u00e0i \u1edf b\u1edd t\u1ef1 do. Favus th\u01b0\u1eddng g\u1eb7p \u1edf v\u00f9ng \u0110\u00f4ng Nam \u00c1, \u0110\u1ecba Trung H\u1ea3i<\/p>\n
2. N\u1ea5m r\u00e2u:<\/b><\/p>\n
– N\u1ea5m r\u00e2u \u00edt g\u1eb7p h\u01a1n nh\u1eefng lo\u1ea1i kh\u00e1c. Th\u01b0\u1eddng g\u1eb7p \u1edf nh\u1eefng ng\u01b0\u1eddi l\u00e0m ngh\u1ec1 ti\u1ebfp x\u00fac nhi\u1ec1u v\u1edbi s\u00fac v\u1eadt nh\u01b0 c\u00f4ng nh\u00e2n \u1edf n\u00f4ng tr\u1ea1i, ho\u1eb7c ti\u1ebfp x\u00fac v\u1edbi m\u00e8o ch\u00f3 trong nh\u00e0 \u0111\u00f4i khi qua trung gian l\u01b0\u1ee1i dao c\u1ea1o nhi\u1ec5m n\u1ea5m<\/p>\n
– \u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a b\u1ec7nh:<\/i>\u00a0\u0110\u00e1m t\u1ed5n th\u01b0\u01a1ng \u1edf c\u1eb1m th\u01b0\u1eddng c\u00f3 d\u1ea1ng h\u00ecnh tr\u00f2n m\u00e0u h\u1ed3ng x\u00e1m, tr\u00ean m\u1eb7t da th\u01b0\u1eddng c\u00f3 s\u1ea9n \u1edf c\u00e1c nang l\u00f4ng, s\u1ea9n vi\u00eam, s\u1ea9n m\u1ee5n m\u1ee7. Nh\u1eefng s\u1ee3i r\u00e2u th\u00ec d\u1ec5 nh\u1ed5 v\u00e0 d\u1ec5 r\u1ee5ng khi g\u00e3i do ng\u1ee9a<\/p>\n
3. N\u1ea5m m\u1eb7t:<\/b><\/p>\n
– V\u1ecb tr\u00ed:<\/i>\u00a0\u1ede m\u1eb7t tr\u1eeb nh\u1eefng v\u00f9ng da m\u1eb7t c\u00f3 r\u00e2u. Th\u01b0\u1eddng g\u1eb7p \u1edf nh\u1eefng ng\u01b0\u1eddi thoa corticoid k\u00e9o d\u00e0i, ho\u1eb7c ti\u1ebfp x\u00fac v\u1edbi s\u00fac v\u1eadt, ho\u1eb7c nhi\u1ec5m n\u1ea5m \u1edf v\u00f9ng kh\u00e1c tr\u00ean c\u01a1 th\u1ec3. Th\u01b0\u1eddng hay b\u1ecb ch\u1ea9n \u0111o\u00e1n sai v\u00ec t\u1ed5n th\u01b0\u01a1ng \u00edt \u0111i\u1ec3n h\u00ecnh<\/p>\n
– Sang th\u01b0\u01a1ng l\u00e0 m\u1ea3ng h\u1ed3ng ban c\u00f3 v\u1ea9y gi\u1edbi h\u1ea1n ko r\u00f5 b\u1edfi m\u1ed9t b\u1edd vi\u1ec1n k\u00e8m theo c\u00f3 v\u1ea9y nh\u1eb9 ho\u1eb7c c\u00f3 m\u1ee5n n\u01b0\u1edbc, ti\u1ebfn tri\u1ec3n ly t\u00e2m. Th\u01b0\u1eddng \u00edt \u0111\u1ed1i x\u1ee9ng<\/p>\n
V. Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb n\u1ea5m r\u00e2u, n\u1ea5m t\u00f3c, n\u1ea5m m\u1eb7t<\/b><\/p>\n
1. N\u1ea5m t\u00f3c:<\/b><\/p>\n
a) Ch\u1ea9n \u0111o\u00e1n:<\/i><\/b><\/p>\n
– Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/i>\u00a0d\u1ef1a v\u00e0o l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng<\/p>\n
– Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t:<\/i><\/p>\n
+ R\u1ee5ng t\u00f3c Pelade<\/p>\n
+ Ch\u1ed1c do li\u00ean c\u1ea7u khu\u1ea9n<\/p>\n
+ Vi\u00eam nang l\u00f4ng s\u00e2u<\/p>\n
b) \u0110i\u1ec1u tr\u1ecb:<\/i><\/b><\/p>\n
– Griseofulvin 0,25g x 3 l\u1ea7n\/ ng\u00e0y x 1-2 th\u00e1ng<\/p>\n
– Ho\u1eb7c thu\u1ed1c u\u1ed1ng: Ketoconazol 200mg\/ng\u00e0y x 6-8 tu\u1ea7n k\u00e8m theo thu\u1ed1c b\u00f4i n\u1ea5m \u1edf da \u0111\u1ea7u<\/p>\n
– Tr\u01b0\u1eddng h\u1ee3p c\u1ea7n thi\u1ebft c\u1ea1o tr\u1ecdc \u0111\u1ea7u \u0111\u1ec3 mau l\u00e0nh b\u1ec7nh<\/p>\n
– Kh\u00e1ng sinh to\u00e0n th\u00e2n trong b\u1ec7nh Favus<\/p>\n
– C\u00f3 th\u1ec3 ph\u1ed1i h\u1ee3p th\u00eam kh\u00e1ng sinh, corticoid to\u00e0n th\u00e2n trong h\u00ecnh th\u00e1i Kerion li\u1ec1u 1mg\/kg\/ng\u00e0y<\/p>\n
2. N\u1ea5m r\u00e2u:<\/b><\/p>\n
a) Ch\u1ea9n \u0111o\u00e1n:<\/i><\/b><\/p>\n
– Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh:<\/i>\u00a0d\u1ef1a v\u00e0o l\u00e2m s\u00e0ng t\u00ecm u n\u1ea5m, soi t\u01b0\u01a1i v\u1edbi KOH 20% th\u1ea5y b\u00e0o t\u1eed \u0111\u1ed1t<\/p>\n
– Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t:<\/i>\u00a0Vi\u00eam nang l\u00f4ng s\u00e2u: T\u1ed5n th\u01b0\u01a1ng l\u00e0 nh\u1eefng m\u1ee5n m\u1ee7 kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed ti\u1ebfp x\u00fac v\u1edbi s\u00fac v\u1eadt<\/p>\n
b) \u0110i\u1ec1u tr\u1ecb:<\/i><\/b><\/p>\n
– C\u1ea1o r\u00e2u, thoa thu\u1ed1c ch\u1ed1ng n\u1ea5m, n\u1ebfu c\u00f3 Kerion th\u00ec d\u00f9ng kh\u00e1ng sinh<\/p>\n
– Kh\u00f4ng c\u00f3 thu\u1ed1c kh\u00e1ng n\u1ea5m n\u00e0o \u0111i\u1ec1u tr\u1ecb t\u1ecf ra hi\u1ec7u qu\u1ea3, ph\u1ea3i \u0111i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n v\u1edbi Griseofulvin 6-8 tu\u1ea7n ho\u1eb7c Ketoconazol<\/p>\n
3. N\u1ea5m m\u1eb7t:<\/b><\/p>\n
– Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh:\u00a0<\/i><\/b>D\u1ef1a v\u00e0o l\u00e2m s\u00e0ng v\u00e0 x\u00e9t nghi\u1ec7m t\u00ecm n\u1ea5m (+)<\/p>\n
– Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t:<\/i><\/b><\/p>\n
+ Vi\u00eam da ti\u1ebft b\u00e3:<\/i>\u00a0th\u01b0\u1eddng b\u1ecb r\u00e3nh m\u0169i, m\u00e1, \u1ee5 tr\u00e1n, gian m\u00e0y, v\u1ea9y m\u1ee1, li\u00ean quan \u0111\u1ebfn c\u01a1 \u0111\u1ecba t\u0103ng ti\u1ebft b\u00e3 nh\u1eddn<\/p>\n
+ Vi\u00eam da ti\u1ebfp x\u00fac:<\/i>\u00a0Ti\u1ebfn tri\u1ec3n nhanh, c\u00f3 t\u00ednh ch\u1ea5t vi\u00eam r\u00f5, m\u1ee5n n\u01b0\u1edbc, ch\u1ea3y n\u01b0\u1edbc \u0111\u00f3ng m\u00e0i, ng\u01b0ng ti\u1ebfp x\u00fac d\u1ecb nguy\u00ean b\u1ec7nh \u1ed5n \u0111\u1ecbnh, x\u00e9t nghi\u1ec7m n\u1ea5m (-)<\/p>\n
+ Lupus \u0111\u1ecf:<\/i>\u00a0H\u1ed3ng ban c\u00f3 teo da, c\u00f3 t\u0103ng s\u1eebng \u0111i\u1ec3m, b\u00f3p \u0111au, kh\u00f4ng ng\u1ee9a, v\u01b0\u1ee3ng l\u00ean khi ra n\u1eafng<\/p>\n
+ Nh\u1ea1y c\u1ea3m \u00e1nh s\u00e1ng<\/i><\/p>\n
VI. B\u1ec7nh n\u1ea5m Candida albicans<\/b><\/p>\n
1. Nguy\u00ean nh\u00e2n<\/b><\/p>\n
Do C.A, b\u00ecnh th\u01b0\u1eddng c\u00f3 th\u1ec3 t\u00ecm th\u1ea5y trong \u1ed1ng ti\u00eau h\u00f3a, c\u00e1c h\u1ed1c t\u1ef1 nhi\u00ean, ch\u00fang s\u1ed1ng c\u1ed9ng sinh kh\u00f4ng g\u00e2y b\u1ec7nh. N\u1ebfu do d\u00f9ng corticoid ho\u1eb7c kh\u00e1ng sinh b\u1eeba b\u00e3i l\u00e0m m\u1ea5t qu\u00e2n b\u00ecnh vi khu\u1ea9n trong \u0111\u01b0\u1eddng ru\u1ed9t t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho n\u1ea5m C.A ph\u00e1t tri\u1ec3n, t\u0103ng tr\u01b0\u1edfng v\u00e0 g\u00e2y b\u1ec7nh.<\/p>\n
2. L\u00e2m s\u00e0ng<\/b><\/p>\n
–\u00a0Candida ni\u00eam m\u1ea1c:<\/i>\u00a0C\u00f3 c\u00e1c d\u1ea1ng t\u1ed5n th\u01b0\u01a1ng:<\/p>\n
\u00fcCandida \u1edf mi\u1ec7ng: T\u01b0a (\u0111\u1eb9n s\u1eefa), ch\u1ed1c m\u00e9p, l\u01b0\u1ee1i \u0111en<\/p>\n
\u00fcCandida \u1edf ni\u00eam m\u1ea1c sinh d\u1ee5c: Vi\u00eam \u00e2m h\u1ed9, \u00e2 m \u0111 \u1ea1 o; vi\u00eam bao quy \u0111\u1ea7u.<\/p>\n
–\u00a0Candida m\u00f3ng, da:<\/i>\u00a0T\u1ed5n th\u01b0\u01a1ng \u1edf c\u00e1c n\u1ebfp g\u1ea5p l\u1edbn<\/p>\n
T\u1ed5n th\u01b0\u01a1ng \u1edf c\u00e1c n\u1ebfp g\u1ea5p nh\u1ecf<\/p>\n
–\u00a0Candida m\u00f3ng<\/i><\/p>\n
3. Ch\u1ea9n \u0111o\u00e1n<\/b><\/p>\n
–\u00a0Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh:<\/i>\u00a0D\u1ef1a v\u00e0o l\u00e2m s\u00e0ng v\u00e0 x\u00e9t nghi\u1ec7m<\/p>\n
–\u00a0Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t:<\/i>\u00a0T\u1ed5n th\u01b0\u01a1ng g\u00e2y n\u00ean do n\u1ea5m Dermatophyte<\/p>\n
Vi\u00eam k\u1ebd do vi khu\u1ea9n<\/p>\n
4. \u0110i\u1ec1u tr\u1ecb<\/b><\/p>\n
–\u00a0\u0110\u1ed1i v\u1edbi c\u00e1c t\u1ed5n th\u01b0\u01a1ng da:<\/i><\/b>\u00a0Crem ho\u1eb7c m\u1ee1 Mycostatin, Amphotericin B ho\u1eb7c d\u1eabn xu\u1ea5t Imidazol b\u00f4i t\u1ed5n th\u01b0\u01a1ng ng\u00e0y 2 l\u1ea7n. Th\u1eddi gian 2-4 tu\u1ea7n<\/p>\n
–\u00a0\u0110\u1ed1i v\u1edbi t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c:<\/i><\/b>\u00a0R\u1eeda b\u1eb1ng dung d\u1ecbch Bicarbonat \u0111\u1ec3 trung h\u00f2a m\u00f4i tr\u01b0\u1eddng. Sau \u0111\u00f3 d\u00f9ng dung d\u1ecbch Nystatin, Amphotericin, Daktarin… b\u00f4i t\u1ed5n th\u01b0\u01a1ng<\/p>\n
–\u00a0\u0110\u1ed1i v\u1edbi t\u1ed5n th\u01b0\u01a1ng m\u00f3ng:<\/i><\/b>\u00a0\u0110i\u1ec1u tr\u1ecb t\u1ea1i ch\u1ed7 b\u00f4i c\u00e1c thu\u1ed1c m\u1ee1 Imidazol c\u00f3 t\u00e1c d\u1ee5ng t\u1ed1t<\/p>\n
Tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng<\/i><\/b>\u00a0n\u00ean k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c kh\u00e1ng n\u1ea5m to\u00e0n th\u00e2n nh\u01b0 Nystatin u\u1ed1ng, Imidazol.<\/p>\n
VII. Ph\u00f2ng b\u1ec7nh n\u1ea5m<\/b><\/p>\n
1. M\u00f4i tr\u01b0\u1eddng:<\/b><\/p>\n
N\u01a1i \u1edf ph\u1ea3i tho\u00e1ng m\u00e1t, nh\u00e0 c\u1eeda ph\u1ea3i cao r\u00e1o, s\u1ea1ch s\u1ebd, tr\u00e1nh b\u1ee5i b\u1eadm, n\u01b0\u1edbc t\u1eafm \u0111\u1ee7 d\u00f9ng ph\u1ea3i s\u1ea1ch ( n\u01b0\u1edbc m\u01b0a, n\u01b0\u1edbc m\u00e1y, n\u01b0\u1edbc gi\u1ebfng), ph\u1ea3i c\u00f3 x\u00f4, ch\u1eadu, ph\u1ea3i c\u00f3 d\u00e2y ph\u01a1i ngo\u00e0i n\u1eafng. Ch\u0103n chi\u1ebfu ph\u1ea3i \u0111\u1ecbnh k\u1ef3 gi\u1eb7t gi\u0169, tr\u00e1nh \u1ea9m m\u1ed1c<\/p>\n
2. C\u00e1 nh\u00e2n:<\/b><\/p>\n
– Ph\u1ea3i t\u1eafm r\u1eeda s\u1ea1ch s\u1ebd b\u1eb1ng n\u01b0\u1edbc s\u1ea1ch, nhi\u1ec7t \u0111\u1ed9 n\u01b0\u1edbc t\u00f9y theo t\u1eebng m\u00f9a, t\u1eafm d\u00f9ng x\u00e0 ph\u00f2ng ph\u1ea3i th\u00edch h\u1ee3p, tr\u00e1nh x\u00e0 ph\u00f2ng c\u00f3 nhi\u1ec1u ch\u1ea5t ki\u1ec1m qu\u00e1 l\u00e0m kh\u00f4 da, gi\u1ea3m s\u1ee9c ch\u1ed1ng \u0111\u1ee1 c\u1ee7a da ( pH c\u1ee7a da kho\u1ea3ng 4,5-5,5)<\/p>\n
– Sau khi ti\u1ebfp x\u00fac v\u1edbi m\u00f4i tr\u01b0\u1eddng b\u1ea9n nhi\u1ec5m khu\u1ea9n, nhi\u1ec5m n\u1ea5m hay d\u1ea7u m\u1ee1, th\u00ec ph\u1ea3i r\u1eeda tay, ch\u00e2n, k\u1ef3 c\u1ecd s\u1ea1ch s\u1ebd, ch\u00fa \u00fd c\u00e1c n\u1ebfp k\u1ebd<\/p>\n
– \u0110\u1ed1i v\u1edbi ng\u01b0\u1eddi l\u00e0m c\u00f4ng t\u00e1c ch\u1ebf bi\u1ebfn th\u1ef1c ph\u1ea9m, hoa qu\u1ea3, bia th\u00ec c\u1ea7n ph\u00f2ng nhi\u1ec5m n\u1ea5m men g\u00e2y vi\u00eam m\u00f3ng, vi\u00eam da, n\u00ean ph\u1ea3i c\u00f3 g\u0103ng tay, ch\u00e2n \u0111i \u1ee7ng. Sau gi\u1edd l\u00e0m vi\u1ec7c ph\u1ea3i r\u1eeda s\u1ea1ch tay ch\u00e2n v\u00e0 lau kh\u00f4, ch\u00fa \u00fd \u1edf \u0111\u1ea7u m\u00f3ng, n\u1ebfp ,k\u1ebd tay, k\u1ebd ng\u00f3n ch\u00e2n, t\u1ea5t ph\u1ea3i thay h\u00e0ng ng\u00e0y<\/p>\n
– Ng\u0103n ng\u1eeba nhi\u1ec5m n\u1ea5m da l\u00e2y lan, khi c\u00f3 ng\u01b0\u1eddi b\u1ecb n\u1ea5m da th\u00ec n\u00ean c\u00e1ch ly, lu\u1ed9c qu\u1ea7n \u00e1o, ph\u01a1i n\u1eafng, qu\u1ea7n \u00e1o sau khi gi\u1eb7t c\u1ea7n l\u1ed9n tr\u00e1i trong khi ph\u01a1i n\u1eafng<\/p>\n
– Kh\u00f4ng d\u00f9ng chung qu\u1ea7n \u00e1o, gi\u01b0\u1eddng chi\u1ebfu, ch\u0103n \u0111\u1eafp, m\u0169, l\u01b0\u1ee3c, kh\u0103n qu\u00e0ng, gi\u00e0y, t\u1ea5t<\/p>\n
– Tr\u00e1nh m\u1eb7c qu\u1ea7n \u00e1o \u1ea9m \u01b0\u1edbt, qu\u1ea7n l\u00f3t kh\u00f4ng n\u00ean d\u00f9ng v\u1ea3i nilon v\u00e0 qu\u00e1 ch\u1eadt g\u00e2y x\u00e2y x\u00e1t, b\u00ed m\u1ed3 h\u00f4i ( 80% n\u1ea5m g\u00e2y t\u1ed5n th\u01b0\u01a1ng da \u1edf b\u1eb9n, m\u00f4ng, th\u1eaft l\u01b0ng)<\/p>\n
– Khi \u0111\u00e3 x\u00e2y x\u00e1t ph\u1ea3i r\u1eeda s\u1ea1ch b\u1eb1ng thu\u1ed1c s\u00e1t khu\u1ea9n, tr\u00e1nh \u0111i\u1ec1u ki\u1ec7n thu\u1eadn l\u1ee3i cho nhi\u1ec5m khu\u1ea9n, nhi\u1ec5m n\u1ea5m x\u1ea3y ra<\/p>\n
– Kh\u00f4ng \u0111\u01b0\u1ee3c c\u1ea1o da v\u00e0 b\u00f4i c\u00e1c thu\u1ed1c linh tinh nh\u01b0 pin \u0111\u00e8n, khi b\u1ecb ng\u1ee9a vi\u00eam da c\u1ea7n \u0111i kh\u00e1m chuy\u00ean khoa v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u00fang theo ph\u00e1c \u0111\u1ed3, th\u1eddi gian, \u0111\u00fang thu\u1ed1c v\u00e0 li\u1ec1u l\u01b0\u1ee3ng d\u00f9ng<\/p>\n
Tr\u00e1nh n\u1ea5m da \u1edf \u0111\u1ea7u v\u00e0 t\u00f3c: C\u00e1 nh\u00e2n ph\u1ea3i lu\u00f4n lu\u00f4n gi\u1eef s\u1ea1ch da \u0111\u1ea7u, t\u00f3c tr\u00e1nh b\u1ee5i, tr\u00e1nh \u1ea9m \u01b0\u1edbt, c\u1ea7n \u0111\u1ed9i m\u0169 n\u00f3n th\u00edch h\u1ee3p, tr\u00e1nh qua ch\u1eadt v\u00e0 qu\u00e1 b\u00ed, ph\u1ea3i g\u1ed9i \u0111\u1ea7u s\u1ea1ch h\u00e0ng tu\u1ea7n, tr\u01b0\u1eddng h\u1ee3p t\u00f3c nh\u1eddn qu\u00e1 th\u00ec ph\u1ea3i g\u1ed9i nhi\u1ec1u l\u1ea7n h\u01a1n. Khi t\u00f3c kh\u00f4 v\u00e0 nhi\u1ec1u g\u1ea7u th\u00ec n\u00ean g\u1ed9i \u0111\u1ea7u \u00edt h\u01a1n. Kh\u00f4ng n\u00ean d\u00f9ng c\u00e1c lo\u1ea1i x\u00e0 ph\u00f2ng g\u1ed9i \u0111\u1ea7u c\u00f3 nhi\u1ec1u ch\u1ea5t ki\u1ec1m v\u00ec n\u00f3 l\u00e0m t\u00f3c kh\u00f4 d\u1ec5 r\u1ee5ng. N\u00ean g\u1ed9i b\u1eb1ng n\u01b0\u1edbc b\u1ed3 k\u1ebft, x\u00e0 ph\u00f2ng th\u01a1m xong x\u1ea3 b\u1eb1ng n\u01b0\u1edbc s\u1ea1ch, c\u00f3 th\u1ec3 g\u1ed9i b\u1eb1ng chanh, n\u01b0\u1edbc l\u00e1 d\u1ee9a, l\u00e1 b\u01b0\u1edfi.<\/p>\n
B\u1ec6NH L\u1eacU<\/b><\/p>\n
I. Ch\u1ea9n \u0111o\u00e1n v\u00e0 bi\u1ebfn ch\u1ee9ng<\/b><\/p>\n
1. Ch\u1ea9n \u0111o\u00e1n:<\/b><\/p>\n
+ Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh:<\/i><\/b>\u00a0ch\u1ee7 y\u1ebfu d\u1ef1a v\u00e0o<\/p>\n
Ti\u1ec1n s\u1eed ti\u1ebfp x\u00fac sinh d\u1ee5c.<\/i><\/p>\n
Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng:<\/i>\u00a0ti\u1ec3u bu\u1ed1t, ti\u1ec3u r\u00e1t, ti\u1ec3u m\u1ee7, t\u00ednh ch\u1ea5t c\u1ee7a m\u1ee7.<\/p>\n
X\u00e9t nghi\u1ec7m:<\/i>\u00a0soi tr\u1ef1c ti\u1ebfp c\u00f3 song c\u1ea7u khu\u1ea9n Gram(-) n\u1ed9i v\u00e0 ngo\u1ea1i b\u00e0o.<\/p>\n
+ Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t:<\/i><\/b>\u00a0v\u1edbi c\u00e1c b\u1ec7nh vi\u00eam ni\u1ec7u \u0111\u1ea1o kh\u00f4ng do l\u1eadu<\/p>\n
– Chlamydia trachomatic<\/p>\n
– Candida Albicans<\/p>\n
– Trichomonas Vaginalis<\/p>\n
– T\u1ea1p khu\u1ea9n.<\/p>\n
2. Bi\u1ebfn ch\u1ee9ng:<\/b><\/p>\n
+ Bi\u1ebfn ch\u1ee9ng t\u1ea1i ch\u1ed7:<\/i><\/p>\n
C\u00f3 th\u1ec3 g\u00e2y bi\u1ebfn ch\u1ee9ng vi\u00eam nhi\u1ec5m t\u1ea5t c\u1ea3 c\u00e1c c\u01a1 quan sinh d\u1ee5c nam v\u00e0 n\u1eef. N\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi c\u00f3 th\u1ec3 g\u00e2y bi\u1ebfn ch\u1ee9ng n\u1eb7ng nh\u01b0: thai ngo\u00e0i t\u1eed cung, v\u00f4 sinh.<\/p>\n
+ Bi\u1ebfn ch\u1ee9ng to\u00e0n th\u00e2n:<\/i><\/p>\n
Nhi\u1ec5m tr\u00f9ng huy\u1ebft.<\/p>\n
Vi\u00eam kh\u1edbp: kh\u1edbp g\u1ed1i.<\/p>\n
T\u1ed5n th\u01b0\u01a1ng da: s\u1ea9n \u0111\u1ecf, m\u1ee5n m\u1ee7, d\u00e1t h\u00f3a l\u1eadu.<\/p>\n
Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c.<\/p>\n
II. \u0110i\u1ec1u tr\u1ecb v\u00e0 ph\u00f2ng b\u1ec7nh<\/b><\/p>\n
1. \u0110i\u1ec1u tr\u1ecb:<\/b><\/p>\n
a. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb:<\/i><\/b><\/p>\n
– Ch\u1ea9n \u0111o\u00e1n s\u1edbm v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1edbm \u0111\u00fang ph\u00e1c \u0111\u1ed3 \u0111\u1ec3 tr\u00e1nh bi\u1ebfn ch\u1ee9ng , tr\u00e1nh l\u00e2y lan v\u00e0 h\u1ea1n ch\u1ebf kh\u00e1ng thu\u1ed1c.<\/p>\n
– \u0110i\u1ec1u tr\u1ecb cho ng\u01b0\u1eddi b\u1ec7nh v\u00e0 cho c\u1ea3 ng\u01b0\u1eddi ti\u1ebfp x\u00fac sinh d\u1ee5c.<\/p>\n
– Ph\u1ea3i l\u00e0m ph\u1ea3n \u1ee9ng huy\u1ebft thanh \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n giang mai v\u00e0 HIV.<\/p>\n
– \u0110i\u1ec1u tr\u1ecb l\u1eadu k\u1ebft h\u1ee3p v\u1edbi \u0111i\u1ec1u tr\u1ecb Chlamydia Trachomatis.<\/p>\n
– Ch\u1ec9 k\u1ebft lu\u1eadn kh\u1ecfi b\u1ec7nh khi c\u1ea5y 2 l\u1ea7n \u00e2m t\u00ednh ho\u1eb7c kh\u00f4ng ti\u1ebft d\u1ecbch ni\u1ec7u \u0111\u1ea1o khi l\u00e0m nghi\u1ec7m ph\u00e1p t\u00e1i k\u00edch th\u00edch.<\/p>\n
b. Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb:<\/i><\/b><\/p>\n
+ Thu\u1ed1c l\u1ef1a ch\u1ecdn \u01b0u ti\u00ean:<\/i><\/p>\n
Ceftriaxone(Rocephine) 250mg ti\u00eam b\u1eafp li\u1ec1u duy nh\u1ea5t.<\/p>\n
Spectinomycine (Trobicine) 2g ti\u00eam b\u1eafp li\u1ec1u duy nh\u1ea5t.<\/p>\n
Ciprofloxacine (Ciprobay) 500mg u\u1ed1ng li\u1ec1u duy nh\u1ea5t.<\/p>\n
+ Thu\u1ed1c h\u00e0ng th\u1ee9 y\u1ebfu:<\/i><\/p>\n
Sulfamethoxazole\/Trimethoprim (Bactrim, Cotrim) 480mg u\u1ed1ng 10 vi\u00ean\/ ng\u00e0y x 3 ng\u00e0y.<\/p>\n
+ C\u00e1c thu\u1ed1c kh\u00e1c:<\/i><\/p>\n
Cefotaxime (Claforan) 1g ti\u00eam b\u1eafp li\u1ec1u duy nh\u1ea5t.<\/p>\n
Kanamycine 2g ti\u00eam b\u1eafp li\u1ec1u duy nh\u1ea5t.<\/p>\n
Sau khi \u0111i\u1ec1u tr\u1ecb l\u00e2u xong ta c\u00f3 th\u1ec3 d\u00f9ng c\u00e1c thu\u1ed1c sau \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb C. Trachomatis nh\u01b0 Doxycyline, Tetracycline, Erythromycine.<\/p>\n
+ Theo d\u00f5i sau \u0111i\u1ec1u tr\u1ecb:<\/i><\/p>\n
N\u1ebfu \u0111i\u1ec1u tr\u1ecb \u0111\u00fang b\u00eanh nh\u00e2n s\u1ebd h\u1ebft ti\u1ec3u m\u0169 trong v\u00f2ng 2 \u0111\u1ebfn 3 ng\u00e0y, ti\u1ebfu bu\u1ed1t, ti\u1ec3u nhi\u1ec1u l\u1ea7n s\u1ebd gi\u1ea3m trong ng\u00e0y \u0111\u1ea7u v\u00e0 bi\u1ebfn m\u1ea5t trong v\u00f2ng 3 \u0111\u1ebfn 5 ng\u00e0y.<\/p>\n
N\u1ebfu c\u00f2n tri\u1ec7u ch\u1ee9ng l\u00e0m x\u00e9t nghi\u1ec7m l\u1ea1i ho\u1eb7c nu\u00f4i c\u1ea5y l\u00e0m kh\u00e1ng sinh \u0111\u1ed3 \u0111\u1ec3 t\u00ecm kh\u00e1ng sinh th\u00edch h\u1ee3p.<\/p>\n
2.<\/b>\u00a0Ph\u00f2ng b\u1ec7nh:<\/b><\/p>\n
\u0110\u1ed1i v\u1edbi c\u00e1c b\u1ea1n \u0111\u1ed3ng s\u00e0ng v\u00e0 nh\u1eefng ng\u01b0\u1eddi ti\u1ebfp x\u00fac sinh d\u1ee5c ph\u1ea3i \u0111i kh\u00e1m b\u1ec7nh v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi.<\/p>\n
Ph\u1ea3i s\u1ed1ng chung th\u1ee7y 1 v\u1ee3 1 ch\u1ed3ng.<\/p>\n
Khi quan h\u1ec7 t \u00ec n h d \u1ee5 c kh\u00f4ng l\u00e0nh m\u1ea1nh c\u1ea7n ph\u1ea3i c\u00f3 bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba nh\u01b0 s\u1eed d\u1ee5ng bao cao su.<\/p>\n
Tuy\u00ean truy\u1ec1n gi\u00e1o d\u1ee5c y t\u1ebf v\u1ec1 c\u00e1c b\u1ec7nh l\u00e2y truy\u1ec1n qua \u0111\u01b0\u1eddng t \u00ec n h d \u1ee5 c, t\u00e1c h\u1ea1i c\u1ee7a ch\u00fang v\u00e0 c\u00e1c bi\u1ec7n ph\u00e1p ph\u00f2ng ch\u1ed1ng c\u00e1c b\u1ec7nh l\u00e2y truy\u1ec1n qua \u0111\u01b0\u1eddng t \u00ec n h d \u1ee5 c.<\/p>\n
B\u1ec6NH GIANG MAI<\/b><\/p>\n
I. Giang mai th\u1eddi k\u1ef3 1<\/b><\/p>\n
1. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/b><\/p>\n
Giang mai th\u1eddi k\u1ef3 I l\u00e0 giang mai th\u1eddi k\u1ef3 \u0111\u1ea7u c\u1ee7a b\u1ec7nh k\u00e9o d\u00e0i t\u1eeb l\u00fac nhi\u1ec5m b\u1ec7nh \u0111\u1ebfn 45 ng\u00e0y. \u0110\u1eb7c tr\u01b0ng c\u1ee7a b\u1ec7nh trong th\u1eddi k\u1ef3 n\u00e0y l\u00e0 s\u0103ng v\u00e0 h\u1ea1ch.<\/p>\n
a. Th\u1eddi k\u1ef3 \u1ee7 b\u1ec7nh:\u00a0<\/i><\/b>Trung b\u00ecnh 21 ng\u00e0y sau khi quan h\u1ec7 t \u00ec n h d \u1ee5 c, c\u00f3 th\u1ec3 thay \u0111\u1ed5i t\u1eeb 10- 100 ng\u00e0y.<\/p>\n
b. S\u0103ng giang mai:\u00a0<\/i><\/b>Th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ed9 ph\u1eadn sinh d\u1ee5c c\u00f3 6 \u0111\u1eb7c t\u00ednh c\u1ee7a Alfred Fournier:<\/p>\n
– V\u1ebft l\u1ee1 tr\u00f2n hay b\u1ea7u d\u1ee5c k\u00edch th\u01b0\u1edbc t\u1eeb 0,5 -2 cm.<\/p>\n
– Gi\u1edbi h\u1ea1n r\u00f5 v\u00e0 \u0111\u1ec1u \u0111\u1eb7n th\u01b0\u1eddng kh\u00f4ng c\u00f3 b\u1edd.<\/p>\n
– \u0110\u00e1y s\u1ea1ch tr\u01a1n b\u00f3ng l\u00e1ng m\u00e0u \u0111\u1ecf nh\u01b0 th\u1ecbt t\u01b0\u01a1i.<\/p>\n
– B\u00f3p kh\u00f4ng \u0111au.<\/p>\n
– N\u1ec1n c\u1ee9ng.<\/p>\n
– H\u1ea1ch \u0111i k\u00e8m.<\/p>\n
+ V\u1ecb tr\u00ed:<\/i><\/p>\n
C\u01a1 quan sinh d\u1ee5c: nam th\u01b0\u1eddng g\u1eb7p \u1edf r\u00e3nh quy \u0111\u1ea7u, th\u00e2n d\u01b0\u01a1ng v\u1eadt. N\u1eef th\u01b0\u1eddng g\u1eb7p \u1edf \u00e2m h\u1ed9 , \u00e2 m \u0111 \u1ea1 o, \u00e2m v\u1eadt, c\u1ed5 t\u1eed cung.<\/p>\n
Ngo\u00e0i c\u01a1 quan sinh d\u1ee5c: h\u1eadu m\u00f4n, tr\u1ef1c tr\u00e0ng, mi\u1ec7ng m\u00f4i, l\u01b0\u1ee1i Amygdale, ng\u00f3n tay, ng\u00f3n ch\u00e2n, n\u00fam v\u00fa<\/p>\n
+ D\u1ea1ng l\u00e2m s\u00e0ng kh\u00f4ng \u0111i\u1ec3n h\u00ecnh:<\/i><\/p>\n
S\u0103ng \u0111au g\u1eb7p \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ed9i nhi\u1ec5m th\u00eam Staphylococcus Aureus, nhi\u1ec1u s\u0103ng r\u1eddi r\u1ea1c g\u1eb7p \u1edf nh\u1eefng ng\u01b0\u1eddi nhi\u1ec5m th\u00eam HIV.<\/p>\n
+ S\u1ed1 l\u01b0\u1ee3ng:\u00a0<\/i>Th\u00f4ng th\u01b0\u1eddng ch\u1ec9 c\u00f3 1 s\u0103ng, nh\u01b0ng hi\u1ec7n nay ng\u01b0\u1eddi ta nh\u1eadn th\u1ea5y nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p c\u00f3 nhi\u1ec1u s\u0103ng:<\/p>\n
. Nam gi\u1edbi: 23 % c\u00f3 h\u01a1n 1 s\u0103ng, 8% c\u00f3 ph\u00f9 n\u1ec1 k\u00e8m theo Phymosis, 11 % c\u00f3 vi\u00eam m\u1ea1ch b\u1ea1ch huy\u1ebft, vi\u00eam t\u1eafc t\u0129nh m\u1ea1ch th\u00e2n d\u01b0\u01a1ng v\u1eadt.<\/p>\n
. N\u1eef gi\u1edbi: 44% tr\u01b0\u1eddng h\u1ee3p s\u0103ng \u1edf c\u1ed5 t\u1eed cung b\u1ecb b\u1ecf qua kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n.<\/p>\n
c. H\u1ea1ch giang mai:<\/i><\/b><\/p>\n
H\u1ea1ch th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n 5-6 ng\u00e0y sau khi xu\u1ea5t hi\u1ec7n s\u0103ng. H\u1ea1ch th\u01b0\u1eddng \u0111i k\u00e8m v\u1edbi s\u0103ng nh\u01b0 h\u00ecnh v\u1edbi b\u00f3ng, s\u0103ng \u1edf b\u00ean tr\u00e1i h\u1ea1ch \u1edf b\u00ean tr\u00e1i, s\u0103ng \u1edf b\u00ean ph\u1ea3i h\u1ea1ch \u1edf b\u00ean ph\u1ea3i, n\u1ebfu s\u0103ng \u1edf gi\u1eefa th\u00ec h\u1ea1ch xu\u1ea5t hi\u1ec7n 2 b\u00ean.<\/p>\n
\u0110\u1eb7c t\u00ednh c\u1ee7a h\u1ea1ch:<\/i><\/p>\n
– Xu\u1ea5t hi\u1ec7n sau s\u0103ng.<\/p>\n
– C\u00f9ng b\u00ean v\u1edbi s\u0103ng th\u01b0\u1eddng l\u00e0 h\u1ea1ch b\u00ean.<\/p>\n
– S\u1ed1 l\u01b0\u1ee3ng nhi\u1ec1u, t\u1eadp trung th\u00e0nh \u0111\u00e1m l\u1edbn nh\u1ecf kh\u00f4ng \u0111\u1ec1u trong \u0111\u00f3 c\u00f3 h\u1ea1ch l\u1edbn nh\u1ea5t g\u1ecdi l\u00e0 h\u1ea1ch tr\u01b0\u1edfng nh\u00f3m.<\/p>\n
– H\u1ea1ch ch\u1eafc di \u0111\u1ed9ng, kh\u00f4ng vi\u00eam, kh\u00f4ng \u0111au, kh\u00f4ng l\u00e0m m\u1ee7.<\/p>\n
2. D\u1ea1ng l\u00e2m s\u00e0ng \u0111\u1eb7c bi\u1ec7t<\/b><\/p>\n
* S\u0103ng lo\u00e9t:<\/i>\u00a0b\u1ed9i nhi\u1ec5m th\u00eam c\u00e1c lo\u1ea1i vi khu\u1ea9n kh\u00e1c.<\/p>\n
* S\u0103ng vi\u00eam:<\/i><\/p>\n
– S\u0103ng \u1edf ch\u1ed7 \u0111\u01b0\u1eddng ti\u1ec3u, s\u0103ng \u1edf h\u1ed1 thuy\u1ec1n: \u0110ai v\u00e0 ch\u1ea3y m\u1ee7.<\/p>\n
– S\u0103ng \u1edf m\u00f4i l\u1edbn, \u00e2m h\u1ed9: vi\u00eam ph\u1ed1i h\u1ee3p v\u1edbi ph\u00f9 n\u1ec1, sung c\u00f9ng \u1edf 1 b\u00ean.<\/p>\n
– S\u0103ng \u1edf c\u1ed5 t\u1eed cung: \u1edf c\u00e1ch xa l\u1ed7 t\u1eed cung k\u00e8m v\u1edbi h\u1ea1ch \u1edf \u0111\u00e1y t\u00fai c\u00f9ng 1 b\u00ean.<\/p>\n
– S\u0103ng \u1edf Amygdale, \u1edf l\u01b0\u1ee1i, \u1edf m\u00f4i.<\/p>\n
* Giang mai kh\u00f4ng c\u00f3 s\u0103ng:<\/i>\u00a0kho\u1ea3ng 15 \u0111\u1ebfn 30 % tr\u01b0\u1eddng h\u1ee3p do s\u0103ng k\u00edn kh\u00f4ng t\u00ecm th\u1ea5y.<\/p>\n
* Giang mai c\u1ee5t \u0111\u1ea7u:\u00a0<\/i>Do ng\u01b0\u1eddi b\u1ec7nh d\u00f9ng thu\u1ed1c b\u00f4i ho\u1eb7c thu\u1ed1c kh\u00e1ng sinh u\u1ed1ng sau khi b\u1ecb l\u00e2y b\u1ec7nh, l\u00e0m m\u1ea5t s\u0103ng nh\u01b0ng kh\u00f4ng \u0111\u1ee7 l\u00e0m kh\u1ecfi b\u1ec7nh.<\/p>\n
3. Ti\u1ebfn tri\u1ec3n c\u1ee7a s\u0103ng<\/b><\/p>\n
– Kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb:<\/i>s\u0103ng c\u0169ng l\u00e0nh t\u1ef1 nhi\u00ean trong 3-6 tu\u1ea7n v\u00e0 \u0111\u1ec3 l\u1ea1i s\u1eb9o trong 1\/2 \u0111\u1ebfn 1\/3 tr\u01b0\u1eddng h\u1ee3p. Nh\u01b0ng b\u1ec7nh v\u1eabn c\u00f2n v\u00e0 chuy\u1ec3n sang giang mai th\u1eddi k\u1ef3 II.<\/p>\n
– \u0110\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb:\u00a0<\/i>Xo\u1eafn khu\u1ea9n s\u1ebd bi\u1ebfn m\u1ea5t sau 24 \u0111\u1ebfn 48 gi\u1edd, sang s\u1ebd l\u00e0nh trong v\u00f2ng 1 \u0111\u1ebfn 2 tu\u1ea7n v\u00e0 c\u0169ng \u0111\u1ec3 l\u1ea1i s\u1eb9o.<\/b><\/p>\n
4. Bi\u1ebfn ch\u1ee9ng<\/b><\/p>\n
– H\u1eb9p bao quy \u0111\u1ea7u:<\/i>tr\u01b0\u1edbc m\u1ed9t h\u1eb9p da quy \u0111\u1ea7u m\u1edbi xu\u1ea5t hi\u1ec7n ph\u1ea3i ngh\u0129 \u0111\u1ebfn s\u0103ng giang mai \u1edf m\u1eb7t trong bao quy \u0111\u1ea7u.<\/p>\n
– S\u01b0ng bao quy \u0111\u1ea7u ngh\u1ebdn:\u00a0<\/i>Th\u01b0\u1eddng do s\u0103ng giang mai b\u1ecb ch\u1ea5n th\u01b0\u01a1ng hay b\u1ed9i nhi\u1ec5m g\u00e2y ph\u00f9 n\u1ec1.<\/p>\n
– B\u1ed9i nhi\u1ec5m vi khu\u1ea9n:<\/i>l\u00e0m cho s\u0103ng kh\u00f4ng c\u00f2n \u0111i\u1ec3n h\u00ecnh n\u1eefa tr\u1edf th\u00e0nh v\u1ebft lo\u00e9t.<\/p>\n
II. Giang mai th\u1eddi k\u1ef3 2<\/b><\/p>\n
1. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/b><\/p>\n
B\u1eaft \u0111\u1ea7u sau 45 ng\u00e0y xu\u1ea5t hi\u1ec7n s\u0103ng<\/p>\n
T\u1ed5n th\u01b0\u01a1ng \u0111a d\u1ea1ng \u1edf da, ni\u00eam m\u1ea1c, c\u00f3 khi \u1edf n\u1ed9i t\u1ea1ng, t\u1ed5n th\u01b0\u01a1ng kh\u00f4ng s\u00e2u, khi l\u00e0nh kh\u00f4ng \u0111\u1ec3 l\u1ea1i s\u1eb9o.<\/p>\n
* Ban \u0111\u00e0o:<\/i><\/b>l\u00e0 bi\u1ec3u hi\u1ec7n \u1edf da \u0111\u1ea7u ti\u00ean. T\u1ed5n th\u01b0\u01a1ng l\u00e0 nh\u1eefng d\u00e1t m\u00e0u h\u1ed3ng nh\u1ea1t nh\u01b0 m\u00e0u hoa \u0111\u00e0o, kh\u00f3 nh\u00ecn th\u1ea5y \u0111\u01b0\u1eddng k\u00ednh t\u1eeb 5 \u0111\u1ebfn 10mm kh\u00f4ng v\u1ea3y, kh\u00f4ng ng\u1ee9a. V\u1ecb tr\u00ed th\u01b0\u1eddng th\u1ea5y \u1edf th\u00e2n m\u00ecnh t\u1ed3n t\u1ea1i t\u1eeb 1 \u0111\u1ebfn 2 th\u00e1ng.<\/p>\n
* Ban giang mai s\u1ea9n:\u00a0<\/i><\/b>S\u1ea9n tr\u00f2n ch\u1eaf m\u00e0u \u0111\u1ecf \u0111\u1ed3ng, bao quanh s\u1ea9n l\u00e0 m\u1ed9t vi\u1ec1n v\u1ea3y, v\u1ecb tr\u00ed lan t\u1ecfa kh\u1eafp c\u01a1 th\u1ec3, c\u00f3 th\u1ec3 khu tr\u00fa \u1edf long b\u00e0n tay, b\u00e0n ch\u00e2n.<\/p>\n
*\u00a0Ban giang mai kh\u00f4ng \u0111i\u1ec3n h\u00ecnh:<\/b>\u00a0<\/i>R\u1ea5t \u0111a d\u1ea1ng d\u1ec5 nh\u1ea7m l\u1eabn, ban giang mai kh\u00f4ng \u0111i\u1ec3n h\u00ecnh g\u1ed3m c\u00f3:<\/p>\n
– Ban giang mai s\u1ea9n tr\u1ee3t:<\/i>th\u01b0\u1eddng g\u1eb7p \u1edf c\u00e1c n\u1ebfp d\u01b0\u1edbi d\u1ea1ng s\u00f9i \u1ea9m \u01b0\u1edbt.<\/p>\n
– Ban giang mai kh\u1ed5ng l\u1ed3:<\/i>s\u1ea9n ph\u00e2n b\u1ed1 h\u00ecnh v\u00f2ng, d\u1ea1ng v\u00f2ng cung, \u0111a cung \u1edf m\u1eb7t, ph\u1ea7n tr\u00ean c\u01a1 th\u1ec3.<\/p>\n
– Ban giang mai m\u00e0i:<\/i>b\u1ec1 m\u1eb7t ph\u1ee7 l\u1edbp m\u00e0i m\u00e0u v\u00e0ng gi\u1ed1ng nh\u01b0 b\u1ec7nh ch\u1ed1c.<\/p>\n
– Ban giang mai d\u1ea1ng tr\u1ee9ng c\u00e1 ho\u1eb7c d\u1ea1ng th\u1ee7y \u0111\u1eadu:<\/i>m\u1ee5n n\u01b0\u1edbc ho\u1eb7c m\u1ee5n m\u1ee7.<\/p>\n
– Ban giang mai \u1edf da \u0111\u1ea7u:<\/i>gi\u1ed1ng nh\u01b0 m\u1ed9t vi\u00eam nang l\u00f4ng.<\/p>\n
– Ban giang mai d\u1ea1ng v\u1ea3y n\u1ebfn:<\/i>th\u01b0\u1eddng g\u1eb7p \u1edf m\u1eb7t du\u1ed7i chi, b\u1ec1 m\u1eb7t \u0111\u00f3ng nhi\u1ec1u v\u1ea9y nh\u01b0 v\u1ea9y n\u1ebfn.<\/p>\n
* T\u1ed5n th\u01b0\u01a1ng \u1edf ni\u00eam m\u1ea1c( m\u1ea3ng ni\u00eam m\u1ea1c)<\/i><\/b><\/p>\n
– G\u1eb7p \u1edf mi\u1ec7ng, m\u00e9p gi\u1ed1ng nh\u01b0 ch\u1ed1c m\u00e9p th\u01b0\u1eddng g\u1eb7p \u1edf 1 b\u00ean m\u00e9p, \u1edf c\u1ed5 h\u1ecdng, v\u00f2m kh\u1ea9u c\u00e1i, l\u01b0\u1ee1i g\u00e0, \u1edf h\u1eadu m\u00f4n, sinh d\u1ee5c: d\u01b0\u1edbi h\u00ecnh th\u1ee9c c\u1ee7a 1 v\u1ebft n\u1ee9t \u1edf \u0111\u00e1y c\u1ee7a 1 n\u1ebfp g\u1ea5p.<\/p>\n
– D\u00e1t tr\u1ee3t tr\u00f2n, \u0111\u1ecf ho\u1eb7c bao ph\u1ee7 m\u00e0ng tr\u1eafng \u0111\u1ee5c ch\u1ee9a nhi\u1ec1u xo\u1eafn khu\u1ea9n giang mai.<\/p>\n
– Kh\u00f4ng \u0111au, kh\u00f4ng \u0103n s\u00e2u, c\u1ea1nh r\u00f5 v\u00e0 \u0111\u1ec1u.<\/p>\n
– Ti\u1ebfn tri\u1ec3n kho\u1ea3ng 2 tu\u1ea7n l\u1ec5 r\u1ed3i bi\u1ebfn m\u1ea5t d\u00f9 kh\u00f4ng \u0111i\u1ec1u tr\u1ecb, nh\u01b0ng s\u1ebd m\u1ecdc l\u1ea1i.<\/p>\n
– R\u1ea5t d\u1ec5 l\u00e2y.<\/p>\n
* T\u1ed5n th\u01b0\u01a1ng nang l\u00f4ng:<\/i><\/b><\/p>\n
– R\u1ee5ng t\u00f3c:<\/i>m\u1ea3ng r\u1ee5ng t\u00f3c l\u1ed7 ch\u1ed7 nh\u01b0 b\u1ed9 l\u00f4ng th\u00fa b\u1ecb m\u1ed1i m\u1ecdt c\u1eafn. R\u1ee5ng t\u00f3c kh\u00f4ng ho\u00e0n to\u00e0n v\u00f9ng th\u00e1i d\u01b0\u01a1ng, ch\u1ea9m.<\/p>\n
– L\u00f4ng m\u00e0y<\/i>: r\u1ee5ng ph\u1ea7n ngo\u00e0i \u0111u\u00f4i l\u00f4ng m\u00e0y.<\/p>\n
– R\u00e2u:<\/i>t\u1ed5n th\u01b0\u01a1ng nh\u01b0 b\u1ecb c\u1eaft nham nh\u1edf.<\/p>\n
* T\u1ed5n th\u01b0\u01a1ng n\u1ed9i t\u1ea1ng: th\u01b0\u1eddng \u00edt g\u1eb7p<\/i><\/b><\/p>\n
– H\u1ea1ch:<\/i>c\u00f3 nhi\u1ec1u h\u1ea1ch nh\u1ecf, m\u1ec1m, di \u0111\u1ed9ng, kh\u00f4ng \u0111au th\u01b0\u1eddng \u1edf sau c\u1ed5, tr\u00ean r\u00f2ng r\u1ecdc.<\/p>\n
– Nh\u1ee9c \u0111\u1ea7u:<\/i>do vi\u00eam mang n\u00e3o d\u1ecbch trong<\/p>\n
– V\u00e0ng da:<\/i>do t\u1ed5n th\u01b0\u01a1ng gan.<\/p>\n
– Ph\u00f9:<\/i>do t\u1ed5n th\u01b0\u01a1ng th\u1eadn.<\/p>\n
2. C\u1eadn l\u00e2m s\u00e0ng<\/b><\/p>\n
Ph\u1ea3n \u1ee9ng huy\u1ebft thanh d\u01b0\u01a1ng t\u00ednh 100%. Trong tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m HIV ph\u1ed1i h\u1ee3p c\u00f3 th\u1ec3 \u00e2m t\u00ednh, c\u1ea7n ph\u1ea3i l\u00e0m x\u00e9t nghi\u1ec7m tr\u1ef1c ti\u1ebfp t\u1ea1i t\u1ed5n th\u01b0\u01a1ng d\u1ecbch ti\u1ebft c\u1ee7a m\u1ea3ng ni\u00eam m\u1ea1c \u0111\u1ec3 t\u00ecm xo\u00e1n khu\u1ea9n giang mai.<\/p>\n
3. Ch\u1ea9n \u0111o\u00e1n<\/b><\/p>\n
–\u00a0Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/i><\/b>: D\u1ef1a v\u00e0o<\/p>\n
\u00fcTri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/p>\n
\u00fcC\u1eadn l\u00e2m s\u00e0ng: ph\u1ea3n \u1ee9ng huy\u1ebft thnah d\u01b0\u01a1ng t\u00ednh 100%<\/p>\n
–\u00a0Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/i><\/b><\/p>\n
\u00fcV\u1ea3y ph\u1ea5n h\u1ed3ng Gibert<\/p>\n
\u00fcCh\u1ed1c m\u00e9p<\/p>\n
\u00fcV\u1ea3y n\u1ebfn<\/p>\n
\u00fcTr\u1ee9ng c\u00e1<\/p>\n
4. Ph\u00f2ng b\u1ec7nh<\/b><\/p>\n
– Ph\u00f2ng b\u1ec7nh c\u00e1 nh\u00e2n<\/p>\n
\u00fc S\u1ed1ng chung th\u1ee7y 1 v\u1ee3 1 ch\u1ed3ng<\/p>\n
\u00fc D\u00f9ng bao cao su khi quan h\u1ec7 t \u00ec n h d \u1ee5 c kh\u00f4ng l\u00e0nh m\u1ea1nh<\/p>\n
\u00fc Khi ti\u00eam thu\u1ed1c n\u00ean s\u1eed d\u1ee5ng b\u01a1m ti\u00eam 1 l\u1ea7n r\u1ed3i b\u1ecf<\/p>\n
\u00fc Tr\u01b0\u1edbc khi truy\u1ec1n m\u00e1u n\u00ean th\u1eed VDRL v\u00e0 HIV<\/p>\n
– Ph\u00f2ng b\u1ec7nh t\u1eadp th\u1ec3<\/p>\n
\u00fc Gi\u00e1o d\u1ee5c y t\u1ebf cho m\u1ecdi ng\u01b0\u1eddi v\u1ec1 t\u00e1c h\u1ea1i c\u1ee7a b\u1ec7nh<\/p>\n
\u00fc Ph\u00f2ng ch\u1ed1ng t\u1ec7 n\u1ea1n m\u1ea1i d\u00e2m<\/p>\n
\u00fc L\u1ed3ng gh\u00e9p v\u00e0o m\u1ea1ng l\u01b0\u1edbi \u0111a khoa \u0111\u1ec3 ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi<\/p>\n
\u00fc Th\u1eed m\u00e1u tr\u01b0\u1edbc khi k\u1ebft h\u00f4n<\/p>\n
\u00fc \u0110\u0103ng k\u00fd thai ngh\u00e9n \u0111\u1ec3 ph\u00e1t hi\u1ec7n k\u1ecbp th\u1eddi<\/p>\n
III. Ph\u1ea3n \u1ee9ng huy\u1ebft thanh trong ch\u1ea9n \u0111o\u00e1n giang mai<\/b><\/p>\n
Nh\u1eb1m ph\u00e1t hi\u1ec7n kh\u00e1ng th\u1ec3 trong c\u01a1 th\u1ec3 b\u1ec7nh nh\u00e2n v\u1edbi m\u1ee5c \u0111\u00edch:<\/p>\n
– Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh trong tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd m\u1eafc b\u1ec7nh.<\/p>\n
– Ph\u00e1t hi\u1ec7n b\u1ec7nh trong c\u1ed9ng \u0111\u1ed3ng( t\u1ea7m so\u00e1t).<\/p>\n
– Theo d\u00f5i sau \u0111i\u1ec1u tr\u1ecb.<\/p>\n
C\u00f3 2 lo\u1ea1i ph\u1ea3n \u1ee9ng ch\u00ednh:\u00a0<\/b>– Ph\u1ea3n \u1ee9ng \u0111\u1eb7c hi\u1ec7u.<\/p>\n
– Ph\u1ea3n \u1ee9ng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u.<\/p>\n
1. Ph\u1ea3n \u1ee9ng huy\u1ebft thanh kh\u00f4ng \u0111\u1eb7c hi\u1ec7u:<\/b><\/p>\n
C\u00f3 nhi\u1ec1u ph\u1ea3n \u1ee9ng nh\u01b0ng hi\u1ec7n nay ng\u00e0y nay ng\u01b0\u1eddi ta hay d\u00f9ng 2 lo\u1ea1i ph\u1ea3n \u1ee9ng sau:<\/p>\n
* Ph\u1ea3n \u1ee9ng VDRL ( Venereal disease research laboratory)<\/i><\/b>:<\/i>\u00a0hay c\u00f2n g\u1ecdi l\u00e0 ph\u1ea3n \u1ee9ng l\u00ean b\u00f4ng k\u1ebft t\u1ee7a:<\/p>\n
Ng\u01b0\u1eddi ta d\u00f9ng kh\u00e1ng nguy\u00ean cardiolipin \u0111\u01b0\u1ee3c ti\u00eau chu\u1ea9n h\u00f3a nh\u1eb1m ph\u00e1t hi\u1ec7n c\u1ee7a c\u00e1c kh\u00e1ng th\u1ec3 IgM ho\u1eb7c IgG kh\u00f4ng chuy\u00ean bi\u1ec7t. H\u1ed7n h\u1ee3p kh\u00e1ng nguy\u00ean ti\u1ebfp x\u00fac v\u1edbi huy\u1ebft thanh b\u1ec7nh nh\u00e2n giang mai s\u1ebd k\u1ebft c\u1ee5m. Ph\u1ea3n \u1ee9ng n\u00e0y v\u1eeba \u0111\u1ecbnh t\u00ednh v\u1eeba \u0111\u1ecbnh l\u01b0\u1ee3ng:<\/p>\n
– \u0110\u1ecbnh t\u00ednh:<\/i><\/b>\u00a0(-) ph\u1ea3n \u1ee9ng \u00e2m t\u00ednh.<\/p>\n
(+) nghi ng\u1edd.<\/p>\n
(++),(+++),(++++) ph\u1ea3n \u1ee9ng d\u01b0\u01a1ng t\u00ednh.<\/p>\n
– \u0110\u1ecbnh l\u01b0\u1ee3ng:<\/i><\/b>t\u00ednh b\u1eb1ng n\u1ed3ng \u0111\u1ed9 pha lo\u00e3ng huy\u1ebft thanh b\u1ec7nh nh\u00e2n l\u1ea7n l\u01b0\u1ee3t theo h\u1ec7 s\u1ed1 1\/2 l\u0169y th\u1eeba n(1\/2. 1\/4, 1\/8, \u20261\/32, 1\/64)<\/p>\n
. \u01afu \u0111i\u1ec3m:<\/i>\u00a0\u0111\u1ed9 nh\u1ea1y cao, ph\u1ea3n \u1ee9ng \u0111\u01a1n gi\u1ea3n, nhanh, r\u1ebb ti\u1ec1n, gi\u00fap theo d\u00f5i ti\u1ebfn tri\u1ec3n, theo d\u00f5i \u0111i\u1ec1u tr\u1ecb.<\/p>\n
. Khuy\u1ebft \u0111i\u1ec3m:<\/i>\u00a0k\u00e9m \u0111\u1eb7c hi\u1ec7u v\u1edbi nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p d\u01b0\u01a1ng t\u00ednh gi\u1ea3, ph\u1ea3n \u1ee9ng mu\u1ed9n h\u01a1n so v\u1edbi c\u00e1c ph\u1ea3n \u1ee9ng kh\u00e1c.<\/p>\n
* Ph\u1ea3n \u1ee9ng RPR( Rapid plasma regain test):<\/i><\/b><\/p>\n
D\u00f9ng \u0111\u1ec3 ph\u00e1t hi\u1ec7n reagin trong m\u00e1u b\u1ec7nh nh\u00e2n r\u1ea5t nhanh. Ph\u1ea3n \u1ee9ng RPR \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n t\u01b0\u01a1ng t\u1ef1 nh\u01b0 ph\u1ea3n \u1ee9ng VDRL. Tuy nhi\u00ean h\u1ed7n h\u1ee3p kh\u00e1ng nguy\u00ean kh\u00f4ng d\u1eb7c hi\u1ec7u \u0111\u01b0\u1ee3c tr\u1ed9n v\u1edbi c\u00e1c ph\u00e2n t\u1eed carbon, do \u0111\u00f3 s\u1ef1 l\u00ean b\u00f4ng c\u1ee7a ph\u1ea3n \u1ee9ng c\u00f3 th\u1ec3 quan s\u00e1t \u0111\u01b0\u1ee3c b\u1eb1ng m\u1eaft th\u01b0\u1eddng.<\/p>\n
– \u01afu \u0111i\u1ec3m:<\/i><\/p>\n
. \u0110\u1ed9 \u0111\u1eb7c hi\u1ec7u cao.<\/p>\n
. K\u1ebft qu\u1ea3 nhanh.<\/p>\n
. D\u1ec5 l\u00e0m thu\u1eadn l\u1ee3i chi vi\u1ec7c t\u1ea7m su\u1ea5t b\u1ec7nh trong c\u1ed9ng \u0111\u1ed3ng.<\/p>\n
– Khuy\u1ebft \u0111i\u1ec3m:<\/i>\u00a0d\u1ee5ng c\u1ee5 v\u00e0 thu\u1ed1c th\u1eed \u0111\u1ec1u nh\u1eadp n\u00ean gi\u00e1 th\u00e0nh cao.<\/p>\n
2. Ph\u1ea3n \u1ee9ng huy\u1ebft thanh \u0111\u1eb7c hi\u1ec7u:<\/b><\/p>\n
* Ph\u1ea3n \u1ee9ng b\u1ea5t \u0111\u1ed9ng xo\u1eafn khu\u1ea9n (TPI: treponema pallidum immobilization)<\/i><\/b><\/p>\n
Nh\u1eb1m ph\u00e1t hi\u1ec7n kh\u00e1ng th\u1ec3 c\u1ed1 \u0111\u1ecbnh ch\u1ed1ng kh\u00e1ng nguy\u00ean, ghi nh\u1eadn s\u1ed1 % xo\u1eafn khu\u1ea9n b\u1ecb b\u1ea5t \u0111\u1ed9ng khi cho huy\u1ebft thanh c\u1ea7n th\u1eed ti\u1ebfp x\u00fac v\u1edbi treponema pallidum<\/p>\n
– \u01afu \u0111i\u1ec3m:<\/i>\u00a0c\u00f3 t\u00ednh \u0111\u1eb7c hi\u1ec7u cao.<\/p>\n
– Khuy\u1ebft \u0111i\u1ec3m:<\/i>\u00a0k\u1ef9 thu\u1eadt ph\u1ee9c t\u1ea1p, \u0111\u1eaft ti\u1ec1n, ph\u1ea3n \u1ee9ng (+) tr\u1ec5 so v\u1edbi ph\u1ea3n \u1ee9ng huy\u1ebft thanh kh\u00f4ng \u0111\u1eb7c hi\u1ec7u.<\/p>\n
* Ph\u1ea3n \u1ee9ng FTA- abs( Fluorescent treponemal antibody- absorption):<\/i><\/b>\u00a0\u0111\u00e2y l\u00e0 ph\u1ea3n \u1ee9ng mi\u1ec5 d\u1ecbch hu\u1ef3nh quang. N\u1ebfu huy\u1ebft thanh b\u1ec7nh nh\u00e2n c\u00f3 kh\u00e1ng th\u1ec3 th\u00ec ph\u1ee9c h\u1ee3p KN-KT kh\u00e1ng Ig s\u1ebd ph\u00e1t hu\u1ef3nh quang d\u01b0\u1edbi tia c\u1ef1c t\u00edm. Ph\u1ea3n \u1ee9ng n\u00e0y c\u00f3 th\u1ec3 gi\u00fap ta ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c IgM hay IgG nh\u1edd c\u00e1c kh\u00e1ng th\u1ec3 kh\u00e1ng Ig ch\u1ecdn l\u1ecdc.<\/p>\n
– \u01afu \u0111i\u1ec3m:<\/i><\/p>\n
. \u0110\u1ed9 \u0111\u1eb7c hi\u1ec7u cao, hi\u1ebfm khi c\u00f3 d\u01b0\u01a1ng t\u00ednh gi\u1ea3. Ph\u1ea3n \u1ee9ng d\u01b0\u01a1ng t\u00ednh r\u1ea5t s\u1edbm sau khi c\u00f3 sang t\u1eeb 3-5 ng\u00e0y.<\/p>\n
. K\u1ef9 thu\u1eadt trang thi\u1ebft b\u1ecb \u0111\u01a1n gi\u1ea3n.<\/p>\n
– Khuy\u1ebft \u0111i\u1ec3m:<\/i><\/p>\n
. Ph\u1ea3n \u1ee9ng \u0111\u1ecbnh l\u01b0\u1ee3ng kh\u00f4ng c\u00f3 l\u1ee3i v\u00ec l\u01b0\u1ee3ng kh\u00e1ng th\u1ec3 r\u1ea5t \u00edt.<\/p>\n
. Kh\u00e1ng th\u1ec3 d\u00f9ng \u0111\u1ec3 theo d\u00f5i b\u1ec7nh nh\u00e2n sau \u0111i\u1ec1u tr\u1ecb( v\u1eabn d\u01b0\u01a1ng t\u00ednh sau \u0111i\u1ec1u tr\u1ecb, ch\u1ec9 v\u1ec1 \u00e2m t\u00ednh khi \u0111i\u1ec1u tr\u1ecb th\u1eadt s\u1edbm).<\/p>\n
* Ph\u1ea3n \u1ee9ng TPHA( Treponema pallidum hemaggluinnation assay):<\/i><\/b>\u0111\u00e2y l\u00e0 ph\u1ea3n \u1ee9ng ng\u01b0ng k\u1ebft h\u1ed3ng c\u1ea7u: Treponema pallidum g\u1eafn tr\u00ean h\u1ed3ng c\u1ea7u+ huy\u1ebft thanh c\u1ea7n th\u1eed. N\u1ebfu huy\u1ebft thanh c\u00f3 kh\u00e1ng th\u1ec3 \u0111\u1eb7c hi\u1ec7u th\u00ec s\u1ebd k\u1ebft h\u1ee3p v\u1edbi<\/p>\n
kh\u00e1ng nguy\u00ean l\u00e0m cho h\u1ed3ng c\u1ea7u b\u1ecb ng\u01b0ng k\u1ebft.<\/p>\n
– \u01afu \u0111i\u1ec3m:<\/i><\/p>\n
. \u0110\u1ed9 \u0111\u1eb7c hi\u1ec7u cao, r\u1ea5t nh\u1ea1y c\u1ea3m, hi\u1ebfm d\u01b0\u01a1ng t\u00ednh gi\u1ea3.<\/p>\n
. K\u1ef9 thu\u1eadt \u0111\u01a1n gi\u1ea3n, r\u1ebb ti\u1ec1n.<\/p>\n
. K\u1ebft qu\u1ea3 d\u01b0\u01a1ng t\u00ednh s\u01a1m trong giai \u0111o\u1ea1n ti\u1ec1n huy\u1ebft thanh ( sau FTA-abs).<\/p>\n
– Khuy\u1ebft \u0111i\u1ec3m:<\/i><\/p>\n
. Ph\u1ea3n \u1ee9ng \u0111\u1ecbnh l\u01b0\u1ee3ng kh\u00f4ng c\u00f3 l\u1ee3i v\u00ec l\u01b0\u1ee3ng kh\u00e1ng th\u1ec3 r\u1ea5t \u00edt.<\/p>\n
. Kh\u00e1ng th\u1ec3 d\u00f9ng \u0111\u1ec3 theo d\u00f5i b\u1ec7nh nh\u00e2n sau \u0111i\u1ec1u tr\u1ecb( v\u1eabn d\u01b0\u01a1ng t\u00ednh sau \u0111i\u1ec1u tr\u1ecb, ch\u1ec9 v\u1ec1 \u00e2m t\u00ednh khi \u0111i\u1ec1u tr\u1ecb th\u1eadt s\u1edbm).<\/p>\n
3.<\/b>\u00a0Ph\u1ea3n \u1ee9ng d\u01b0\u01a1ng t\u00ednh gi\u1ea3:<\/b>\u00a0th\u01b0\u1eddng g\u1eb7p \u1edf ph\u1ea3n \u1ee9ng huy\u1ebft thanh kh\u00f4ng \u0111\u1eb7c hi\u1ec7u h\u01a1n l\u00e0 ph\u1ea3n \u1ee9ng huy\u1ebft thanh \u0111\u1eb7c hi\u1ec7u. Nguy\u00ean nh\u00e2n g\u00e2y ph\u1ea3n \u1ee9ng huy\u1ebft thanh d\u01b0\u01a1ng t\u00ednh gi\u1ea3 l\u00e0:<\/p>\n
Ph\u1ea3n \u1ee9ng huy\u1ebft thanh kh\u00f4ng \u0111\u1eb7c hi\u1ec7u<\/p>\n
FTA-abs<\/p>\n
C\u1ea5p(< 6 th\u00e1ng)<\/p>\n
M\u00e3n (> 6 th\u00e1ng)<\/p>\n
-C\u00f3 thai.<\/p>\n
-Lupus \u0111\u1ecf do thu\u1ed1c.<\/p>\n
-Nhi\u1ec5m tr\u00f9ng c\u1ea5p.<\/p>\n
-T\u0103ng \u0111\u01a1n nh\u00e2n nhi\u1ec5m tr\u00f9ng.<\/p>\n
-S\u1ed1t r\u00e9t.<\/p>\n
-S\u1edfi.<\/p>\n
-Th\u1ee7y \u0111\u1eadu.<\/p>\n
-Vi\u00eam ph\u1ed5i kh\u00f4ng \u0111i\u1ec3n h\u00ecnh.<\/p>\n
-Vacxin \u0111\u1eadu m\u00f9a.<\/p>\n
-Nghi\u1ec7n ma t\u00fay.<\/p>\n
-B\u1ec7nh m\u1ea1ch m\u00e1u collagen.<\/p>\n
-Gi\u00e0 y\u1ebfu.<\/p>\n
-B\u1ec7nh phong.<\/p>\n
-Ung th\u01b0 di c\u0103n ho\u1eb7c x\u01a1 gan.<\/p>\n
-Vi\u00eam gi\u00e1p Hashimoto.<\/p>\n
-Sarcoidose.<\/p>\n
-Lymphoma.<\/p>\n
-\u0110a u t\u1ee7y.<\/p>\n
-Nghi\u1ec7n ma t\u00fay.<\/p>\n
-Vi\u00eam gan si\u00eau vi.<\/p>\n
-C\u00f3 thai.<\/p>\n
-Nghi\u1ec7n ma t\u00fay.<\/p>\n
-Herpes sinh d\u1ee5c.<\/p>\n
-Lupus ban \u0111\u1ecf.<\/p>\n
-X\u01a1 c\u1ee9ng b\u00ec.<\/p>\n
-Vi\u00eam c\u01a1 b\u00ec.<\/p>\n
-B\u1ec7nh m\u00f4 li\u00ean k\u1ebft ph\u1ed1i h\u1ee3p.<\/p>\n
X\u01a1 gan do r\u01b0\u1ee3u.<\/p>\n
VI\u00caM NI\u1ec6U \u0110\u1ea0O SINH D\u1ee4C KH\u00d4NG DO L\u1eacU<\/b><\/p>\n
I. Vi\u00eam ni\u1ec7u \u0111\u1ea1o sinh d\u1ee5c do\u00a0Chlamydia Trachomonatis<\/i><\/b><\/p>\n
1. Nguy\u00ean nh\u00e2n:\u00a0<\/b>Do\u00a0C.T\u00a0<\/b>\u0111\u01b0\u1ee3c l\u00e2y truy\u1ec1n t\u1eeb ng\u01b0\u1eddi n\u00e0y sang ng\u01b0\u1eddi kh\u1eafc b\u1eb1ng \u0111\u01b0\u1eddng t \u00ec n h d \u1ee5 c ho\u1eb7c qua tr\u1ebb s\u01a1 sinh l\u00fac sanh.<\/p>\n
2. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/b><\/p>\n
B\u1ec7nh nh\u00e2n c\u00f3 c\u1ea3m gi\u00e1c bu\u1ed1t ho\u1eb7c r\u1ea5m r\u1ee9t khi \u0111i ti\u1ec3u, ch\u1ea3y d\u1ecbch nh\u1ea7y v\u00e0ng trong h\u01a1n so v\u1edbi l\u1eadu, kh\u00f4ng h\u00f4i b\u1eb1ng l\u1eadu.<\/p>\n
* C\u00e1c d\u1ea1ng l\u00e2m s\u00e0ng<\/i><\/b><\/p>\n
– Nam gi\u1edbi:<\/i>\u00a0Ngo\u00e0i g\u00e2y vi\u00eam ni\u1ec7u \u0111\u1ea1o\u00a0C.T\u00a0<\/b>c\u00f2n g\u00e2y t\u1ed5n th\u01b0\u01a1ng.<\/p>\n
+ Vi\u00eam m\u00e0o tinh ho\u00e0n<\/p>\n
+ H\u1ed9i ch\u1ee9ng Reiter. Vi\u00eam ni\u1ec7u \u0111\u1ea1o + vi\u00eam k\u1ebft m\u1ea1c<\/p>\n
– N\u1eef gi\u1edbi:<\/i><\/p>\n
+ Vi\u00eam c\u1ed5 t\u1eed cung<\/p>\n
+ Vi\u00eam v\u00f2i tr\u1ee9ng<\/p>\n
+ Ti\u1ec3u kh\u00f3, ti\u1ec3u r\u1eaft<\/p>\n
+ Thai ch\u1ebft l\u01b0u ho\u1eb7c ch\u1ebft l\u00fac s\u01a1 sinh<\/p>\n
– Tr\u1ebb s\u01a1 sinh:<\/i><\/p>\n
+ Vi\u00eam k\u1ebft m\u1ea1c<\/p>\n
+ Vi\u00eam ph\u1ed5i: kh\u00f4ng s\u1ed1t, ho t\u1eebng c\u01a1n gi\u1ed1ng ho g\u00e0.<\/p>\n
3. Ch\u1ea9n \u0111o\u00e1n<\/b><\/p>\n
– Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh:<\/i>\u00a0L\u1ea5y d\u1ecbch x\u00e9t nghi\u1ec7m<\/p>\n
+ Nhu\u1ed9m Gram: B\u1eaft m\u00e0u Gram (-)<\/p>\n
+ Nu\u00f4i c\u1ea5y: C\u1ea5y tr\u00ean m\u00f4 t\u1ebf b\u00e0o \u0111\u1ec3 ph\u00e2n l\u1eadp<\/p>\n
+ Huy\u1ebft thanh ch\u1ea9n \u0111o\u00e1n: Ph\u01b0\u01a1ng ph\u00e1p c\u1ed1 \u0111\u1ecbnh b\u1ed5 th\u1ec3, mi\u1ec5n d\u1ecbch hu\u1ef3nh quang, ELISA (Ezyme-Linked Immuno sorbent-Assay).<\/p>\n
– Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t:<\/i>\u00a0V\u1edbi c\u00e1c b\u1ec7nh l\u00e2y truy\u1ec1n qua \u0111\u01b0\u1eddng sinh d\u1ee5c kh\u00e1c.<\/p>\n
4. \u0110i\u1ec1u tr\u1ecb<\/b><\/p>\n
a) Vi\u00eam ni\u1ec7u \u0111\u1ea1o sinh d\u1ee5c kh\u00f4ng bi\u1ebfn ch\u1ee9ng:<\/i><\/b><\/p>\n
– Azithromycine 1g d\u00f9ng li\u1ec1u duy nh\u1ea5t (nh\u00f3m Macrolide) \u0111\u1ed1i v\u1edbi n\u1eef, nam gi\u1edbi \u0111i\u1ec1u tr\u1ecb th\u1eddi gian t\u1eeb 7-10 ng\u00e0y (li\u1ec1u 1g\/ng\u00e0y)<\/p>\n
– Doxycycline 100mg u\u1ed1ng 2 l\u1ea7n\/ng\u00e0y x 7 ng\u00e0y \u2013 10 ng\u00e0y<\/p>\n
– Ofloxacin 300mg u\u1ed1ng 2 l\u1ea7n\/ng\u00e0y x 7 ng\u00e0y \u2013 10 ng\u00e0y<\/p>\n
*\u0110\u1ed1i v\u1edbi ph\u1ee5 n\u1eef c\u00f3 thai ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh d\u00f9ng Tetracycline, d\u00f9ng:<\/i><\/p>\n
– Erythromycine 500mg u\u1ed1ng 4 l\u1ea7n\/ng\u00e0y x 7 ng\u00e0y \u2013 10 ng\u00e0y<\/p>\n
– Ho\u1eb7c Sulfafurazole 500mg u\u1ed1ng 4 l\u1ea7n\/ng\u00e0y x 7 ng\u00e0y \u2013 10 ng\u00e0y ho\u1eb7c c\u00e1c Sulfamide kh\u00e1c v\u1edbi li\u1ec1u l\u01b0\u1ee3ng t\u01b0\u01a1ng \u0111\u01b0\u01a1ng.<\/p>\n
b) Vi\u00eam ni\u1ec7u \u0111\u1ea1o sinh d\u1ee5c c\u00f3 bi\u1ebfn ch\u1ee9ng:<\/i><\/b><\/p>\n
– Vi\u00eam k\u1ebft m\u1ea1c tr\u1ebb s\u01a1 sinh:<\/i>\u00a0D\u00f9ng<\/p>\n
+ Sirop Erythromycine 50mg\/kg\/ng\u00e0y chia 4 l\u1ea7n\/ng\u00e0y x 14 ng\u00e0y<\/p>\n
– Vi\u00eam ph\u1ed5i tr\u1ebb s\u01a1 sinh:<\/i>\u00a0D\u00f9ng<\/p>\n
+ Sirop Erythromycine 50mg\/kg\/ng\u00e0y chia 4 l\u1ea7n\/ng\u00e0y x 21 ng\u00e0y<\/p>\n
– Tr\u1ebb sinh ra \u1edf nh\u1eefng ng\u01b0\u1eddi m\u1eb9 nhi\u1ec5m\u00a0C.T\u00a0<\/b>nh\u01b0ng kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u b\u1ec7nh h\u1ecdc<\/i><\/p>\n
+ Sirop Erythromycine 50mg\/kg\/ng\u00e0y chia 4 l\u1ea7n\/ng\u00e0y x 14 ng\u00e0y.<\/p>\n
II. Vi\u00eam ni\u1ec7u \u0111\u1ea1o sinh d\u1ee5c do\u00a0Trichomonas Vaginalis\u00a0<\/i>(T.V)<\/b><\/p>\n
1. Nguy\u00ean nh\u00e2n<\/b><\/p>\n
Do T.V (tr\u00f9ng roi \u00e2 m \u0111 \u1ea1 o) s\u1ed1ng trong \u00e2 m \u0111 \u1ea1 o v\u1edbi pH t\u1eeb 5,9-6,8, n\u1ebfu acid qu\u00e1 T.V kh\u00f4ng s\u1ed1ng \u0111\u01b0\u1ee3c. L\u00e2y truy\u1ec1n ch\u1ee7 y\u1ebfu b\u1eb1ng \u0111\u01b0\u1eddng t \u00ec n h d \u1ee5 c.<\/p>\n
2. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/b><\/p>\n
\u00fcNam gi\u1edbi:<\/i><\/b><\/p>\n
Th\u1eddi k\u1ef3 \u1ee7 b\u1ec7nh 8-10 ng\u00e0y nh\u01b0ng c\u00f2n t\u00f9y thu\u1ed9c v\u00e0o s\u1ee9c \u0111\u1ec1 kh\u00e1ng c\u1ee7a m\u1ed7i ng\u01b0\u1eddi.<\/p>\n
B\u1ec7nh nh\u00e2n th\u01b0\u1eddng ng\u1ee9a ni\u1ec7u \u0111\u1ea1o, sau \u0111\u00f3 c\u00f3 m\u1ee7 tr\u1eafng \u0111\u1ee5c nh\u01b0 s\u1eefa, vi\u00eam ni\u1ec7u \u0111\u1ea1o c\u00f3 th\u1ec3 c\u1ea5p ho\u1eb7c m\u1ea1n, giai \u0111o\u1ea1n m\u1ea1n c\u00f3 th\u1ec3 c\u00f3 gi\u1ecdt m\u1ee7 bu\u1ed5i s\u00e1ng<\/p>\n
\u00fcN\u1eef gi\u1edbi:<\/i><\/b><\/p>\n
Vi\u00eam ni\u1ec7u \u0111\u1ea1o chi\u1ebfm 40% \u1edf nh\u1eefng l\u1ee9a tu\u1ed5i c\u00f3 \u0111\u1eddi s\u1ed1ng t \u00ec n h d \u1ee5 c cao.<\/p>\n
C\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng th\u01b0\u1eddng ng\u1ee9a, th\u0103m kh\u00e1m \u00e2m \u0111\u1ecda huy\u1ebft tr\u1eafng nhi\u1ec1u c\u00f3 m\u00e0u v\u00e0ng xanh, b\u1ecdt n\u1ed5i l\u1ee3n c\u1ee3n l\u00ean tr\u00ean huy\u1ebft tr\u1eafng (c\u00f3 b\u1ecdt l\u00e0 tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh), huy\u1ebft tr\u1eafng c\u00f3 m\u00f9i h\u00f4i th\u1ed1i, th\u00e0nh \u00e2 m \u0111 \u1ea1 o ph\u00f9 n\u1ec1, \u0111\u1ecf, \u0111au r\u00e1t (pH>4,5). Tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng c\u00f3 th\u1ec3 vi\u00eam n\u1ed9i m\u1ea1c t\u1eed cung, vi\u00eam bu\u1ed3ng tr\u1ee9ng g\u00e2y n\u00ean tri\u1ec7u ch\u1ee9ng \u0111au b\u1ee5ng.<\/p>\n
3. Ch\u1ea9n \u0111o\u00e1n<\/b><\/p>\n
–\u00a0Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh:<\/i><\/p>\n
+ D\u1ef1a v\u00e0o l\u00e2m s\u00e0ng<\/p>\n
+ XN soi t\u01b0\u01a1i t\u00ecm T.V (+)<\/p>\n
+ Nhu\u1ed9m Gram: \u00edt ch\u00ednh x\u00e1c n\u00ean \u00edt \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng<\/p>\n
+ Nu\u00f4i c\u1ea5y tr\u00ean m\u00f4i tr\u01b0\u1eddng Diamond (+) 97% tr\u01b0\u1eddng h\u1ee3p<\/p>\n
+ Mi\u1ec5n d\u1ecbch: \u00edt ch\u00ednh x\u00e1c n\u00ean \u00edt \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng<\/p>\n
–\u00a0Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t:<\/i>\u00a0V\u1edbi c\u00e1c b\u1ec7nh l\u00e2y truy\u1ec1n qua \u0111\u01b0\u1eddng t \u00ec n h d \u1ee5 c kh\u00e1c<\/p>\n
4. \u0110i\u1ec1u tr\u1ecb<\/b><\/p>\n
– Metrnidazol 2g u\u1ed1ng 1 li\u1ec1u duy nh\u1ea5t<\/p>\n
Tr\u00e1nh d\u00f9ng metronidazol cho ph\u1ee5 n\u1eef c\u00f3 thai trong 3 th\u00e1ng \u0111\u1ea7u v\u00e0 3 th\u00e1ng cu\u1ed1i c\u1ee7a thai k\u00ec<\/p>\n
Tr\u01b0\u1eddng h\u1ee3p x\u00e9t nghi\u1ec7m (+) nh\u01b0ng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u1eabn \u0111i\u1ec1u tr\u1ecb nh\u01b0 tr\u01b0\u1eddng h\u1ee3p c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/p>\n
\u0110i\u1ec1u tr\u1ecb cho nam gi\u1edbi li\u1ec1u k\u00e9o d\u00e0i 7 ng\u00e0y c\u00f3 k\u1ebft qu\u1ea3 co h\u01a1n li\u1ec1u duy nh\u1ea5t<\/p>\n
– Metronidazol 500mg u\u1ed1ng 4 l\u1ea7n\/ng\u00e0y x 7 ng\u00e0y<\/p>\n
– Tr\u1ebb s\u01a1 sinh nhi\u1ec5m T.V: Metronidazol 15mg\/kg\/ng\u00e0y x 5 ng\u00e0y<\/p>\n
T\u00e1c d\u1ee5ng ph\u1ee5:<\/i>\u00a0\u0110au \u0111\u1ea7u, \u00f9 tai, co th\u1eaft c\u1ed5 h\u1ecdng ph\u1ea3i ng\u01b0ng thu\u1ed1c.<\/p>\n
III. Vi\u00eam ni\u1ec7u \u0111\u1ea1o sinh d\u1ee5c do n\u1ea5m\u00a0Candidi Albicans<\/i><\/b><\/p>\n
1. Nguy\u00ean nh\u00e2n<\/b><\/p>\n
Do C.A, b\u00ecnh th\u01b0\u1eddng c\u00f3 th\u1ec3 t\u00ecm th\u1ea5y trong \u1ed1ng ti\u00eau h\u00f3a, c\u00e1c h\u1ed1c t\u1ef1 nhi\u00ean, ch\u00fang s\u1ed1ng c\u1ed9ng sinh kh\u00f4ng g\u00e2y b\u1ec7nh. N\u1ebfu do d\u00f9ng corticoid ho\u1eb7c kh\u00e1ng sinh b\u1eeba b\u00e3i l\u00e0m m\u1ea5t qu\u00e2n b\u00ecnh vi khu\u1ea9n trong \u0111\u01b0\u1eddng ru\u1ed9t t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho n\u1ea5m C.A ph\u00e1t tri\u1ec3n, t\u0103ng tr\u01b0\u1edfng v\u00e0 g\u00e2y b\u1ec7nh.<\/p>\n
2. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/b><\/p>\n
Th\u1eddi gian \u1ee7 b\u1ec7nh kh\u00f3 x\u00e1c \u0111\u1ecbnh. Trung b\u00ecnh 10-20 ng\u00e0y<\/p>\n
\u00fc Nam gi\u1edbi:<\/p>\n
Ng\u1ee9a d\u1ecdc ni\u1ec7u \u0111\u1ea1o, \u0111au r\u00e1t khi quan h\u1ec7 t \u00ec n h d \u1ee5 c, ni\u1ec7u \u0111\u1ea1o ti\u1ebft ra ch\u1ea5t d\u1ecbch m\u00e0u v\u1eb1ng ho\u1eb7c tr\u1eafng<\/p>\n
\u00fc N\u1eef gi\u1edbi:<\/p>\n
\u0110au r\u00e1t, r\u1ea5t kh\u00f3 ch\u1ecbu khi quan h\u1ec7 t \u00ec n h d \u1ee5 c. Th\u0103m kh\u00e1m \u00e2 m \u0111 \u1ea1 o s\u01b0ng \u0111\u1ecf, ph\u00f9 n\u1ec1, c\u00f3 c\u1eb7n tr\u1eafng v\u00f3n nh\u01b0 s\u1eefa b\u00e1m v\u00e0o th\u00e0nh \u00e2 m \u0111 \u1ea1 o v\u00e0 c\u1ed5 t\u1eed cung, huy\u1ebft tr\u1eafng c\u00f3 b\u1ee3n tr\u1eafng l\u1ee3n c\u1ee3n, pH \u00e2 m \u0111 \u1ea1 o <4,5.<\/p>\n
3. Ch\u1ea9n \u0111o\u00e1n<\/b><\/p>\n
–\u00a0Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh:<\/i>\u00a0D\u1ef1a v\u00e0o l\u00e2m s\u00e0ng v\u00e0 x\u00e9t nghi\u1ec7m<\/p>\n
+ L\u1ea5y d\u1ecbch soi t\u01b0\u01a1i th\u1ea5y h\u1ea1t men n\u1ea5m v\u00e0 s\u1ee3i t\u01a1 n\u1ea5m d\u1ec5 d\u00e0ng<\/p>\n
+ C\u1ea5y \u1edf m\u00f4i tr\u01b0\u1eddng Sabouraud trong 2-3 ng\u00e0y n\u1ea5m s\u1ebd m\u1ecdc<\/p>\n
–\u00a0Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t:<\/i>\u00a0V\u1edbi c\u00e1c b\u1ec7nh l\u00e2y truy\u1ec1n qua \u0111\u01b0\u1eddng sinh d\u1ee5c kh\u00e1c<\/p>\n
4. \u0110i\u1ec1u tr\u1ecb<\/b><\/p>\n
C\u00f3 th\u1ec3 d\u00f9ng nhi\u1ec1u lo\u1ea1i thu\u1ed1c kh\u00e1ng n\u1ea5m \u0111\u01b0\u1eddng to\u00e0n th\u00e2n nh\u01b0 d\u1eabn xu\u1ea5t c\u1ee7a Imidazol, ho\u1eb7c nh\u1eefng Polyene<\/p>\n
Thu\u1ed1c \u0111\u1eb7t \u00e2 m \u0111 \u1ea1 o:<\/i><\/b><\/p>\n
– Nystatin 100.000UI \u2013 1.000.000UI \u0111\u1eb7t \u00e2m \u0111\u1ecda m\u1ed7i t\u1ed1i x 14 t\u1ed1i<\/p>\n
– Miconazol ho\u1eb7c Clotrimazol 100mg \u0111\u1eb7t \u00e2 m \u0111 \u1ea1 o m\u1ed7i t\u1ed1i x 7 t\u1ed1i<\/p>\n
– Miconazol ho\u1eb7c Clotrimazol 200mg \u0111\u1eb7t \u00e2 m \u0111 \u1ea1 o m\u1ed7i t\u1ed1i x 3 t\u1ed1i<\/p>\n
BI\u1ec2U HI\u1ec6N NGO\u00c0I DA KHI NHI\u1ec4M HIV\/AIDS<\/b><\/p>\n
Bi\u1ec3u hi\u1ec7n ngo\u00e0i da v\u00e0 ni\u00eam m\u1ea1c khi nhi\u1ec5m HIV\/AIDS<\/b><\/p>\n
1. Nh\u1eefng bi\u1ec3u hi\u1ec7n c\u00f3 nhi\u1ec1u \u0111\u1eb7c tr\u01b0ng cho AIDS<\/b><\/p>\n
1.1. Sarcoma Kaposi (SK):<\/i><\/b><\/p>\n
\u0110\u01b0\u1ee3c Kaposi m\u00f4 t\u1ea3 1872 l\u00e0 m\u1ed9t b\u1ec7nh m\u00e1u m\u1ea1n t\u00ednh c\u1ee7a m\u00f4 li\u00ean k\u1ebft c\u00f3 kh\u1ea3 n\u0103ng tr\u1edf th\u00e0nh \u00e1c t\u00ednh. M\u00e3i \u0111\u1ebfn n\u0103m 1981 b\u1ec7nh n\u00e0y \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 l\u1ea7n \u0111\u1ea7u ti\u00ean \u1edf nh\u1eefng ng\u01b0\u1eddi tr\u1ebb \u0111\u1ed3ng t\u00ednh luy\u1ebfn \u00e1i \u0111\u1eb7c bi\u1ec7t \u1edf nam gi\u1edbi. T\u1ec9 l\u1ec7 SK \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n HIV (+) l\u00e0 kho\u1ea3ng 40% ( ch\u00e2u Phi), 90% ( Haiti), 30% ( M\u1ef9). T\u1ec9 l\u1ec7 SK \u1edf nh\u1eefng nh\u00f3m b\u1ec7nh c\u0169ng kh\u00e1c nhau: 36% ( \u0111\u1ed3ng t\u00ednh luy\u1ebfn \u00e1i), 4,3% ( nghi\u1ec7n h\u00fat ma t\u00fay), 15,6% ( \u0111\u1ed1i t\u01b0\u1ee3ng kh\u00f4ng c\u00f3 nguy c\u01a1 x\u00e1c \u0111\u1ecbnh)<\/p>\n
Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a SK:<\/i><\/b><\/p>\n
– SK xu\u1ea5t hi\u1ec7n d\u01b0\u1edbi d\u1ea1ng d\u00e1t, s\u1ea9n m\u00e0u s\u1eafc \u0111i t\u1eeb h\u1ed3ng nh\u1ea1t \u0111\u1ebfn t\u00edm t\u00e1i \u1edf ng\u01b0\u1eddi da s\u00e1ng v\u00e0 t\u1eeb n\u00e2u \u0111en \u0111\u1ebfn \u0111en \u1edf ng\u01b0\u1eddi da m\u00e0u, nh\u1eefng d\u00e1t n\u00e0y th\u00e2m nhi\u1ec5m v\u00e0 lan t\u1ecfa d\u1ea7n t\u1ea1o n\u00ean nh\u1eefng m\u1ea3ng c\u00f3 \u0111\u01b0\u1eddng k\u00ednh t\u1eeb v\u00e0i cm v\u00e0 c\u00f3 b\u1edd r\u00f5. Tr\u00ean b\u1ec1 m\u1eb7t m\u1ea3ng \u0111\u00f4i khi xu\u1ea5t hi\u1ec7n nhi\u1ec1u c\u1ee5c ho\u1eb7c ngay c\u1ea3 nh\u1eefng b\u01b0\u1edbu ban \u0111\u1ea7u tr\u01a1n v\u00e0 \u0111\u1ec1u, v\u00e0i th\u00e1ng sau t\u1ed5n th\u01b0\u01a1ng lo\u00e9t v\u00e0 tr\u1edf n\u00ean s\u1ea7n s\u00f9i kh\u00f4ng \u0111\u1ec1u<\/p>\n
– \u1ede ch\u00e2n nh\u1eefng th\u01b0\u01a1ng t\u1ed5n c\u00f3 th\u1ec3 b\u1ecb s\u1eebng h\u00f3a hay c\u1ea3 d\u1ea1ng m\u1ee5n c\u00f3c. L\u00fac \u0111\u1ea7u t\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng \u1edf chi d\u01b0\u1edbi, t\u1ed5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 \u0111i k\u00e8m v\u1edbi ph\u00f9 b\u1ea1ch huy\u1ebft. Sau \u0111\u00f3 th\u01b0\u1eddng lan t\u1ecfa \u1edf m\u1eb7t, tai, tay, ch\u00e2n, th\u00e2n m\u00ecnh, b\u00e0n ch\u00e2n, k\u1ebd ng\u00f3n ch\u00e2n, c\u01a1 quan sinh d\u1ee5c, ni\u00eam m\u1ea1c mi\u1ec7ng v\u00e0 kh\u1ea9u c\u00e1i<\/p>\n
– Ngo\u00e0i ra SK c\u00f2n khu tr\u00fa \u1edf n\u1ed9i t\u1ea1ng ( ru\u1ed9t, d\u1ea1 d\u00e0y, ph\u1ed5i, tim, gan, th\u1eadn\u2026) nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y d\u1ef1 h\u1eadu nghi\u00eam tr\u1ecdng<\/p>\n
1.2. S\u1ea9n ng\u1ee9a c\u1ea5p:<\/i><\/b><\/p>\n
\u0110\u00e2y l\u00e0 m\u1ed9t t\u1ed5n th\u01b0\u01a1ng d\u1ea1ng s\u1ea9n- m\u1ee5n n\u01b0\u1edbc r\u1ea5t ng\u1ee9a khu tr\u00fa \u1edf m\u1eb7t du\u1ed7i chi tr\u00ean v\u00e0 sau \u0111\u00f3 xu\u1ed1ng chi d\u01b0\u1edbi, m\u1eb7t v\u00e0 ng\u1ef1c. B.Liautaud (1982) \u0111\u00e3 mi\u00eau t\u1ea3 b\u1ec7nh s\u1ea9n ng\u1ee9a \u1edf b\u1ec7nh AIDS v\u00e0 x\u00e1c \u0111\u1ecbnh t\u1ec9 l\u1ec7 49% v\u00e0 79% trong \u0111\u00f3 s\u1ea9n ng\u1ee9a l\u00e0 bi\u1ec3u hi\u1ec7n \u0111\u1ea7u ti\u00ean tr\u01b0\u1edbc AIDS kho\u1ea3ng 8 th\u00e1ng. Gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n s\u1ea9n ng\u1ee9a \u0111\u1ed1i v\u1edbi nhi\u1ec5m HIV\/AIDS l\u00e0 60%. H\u1ea7u h\u1ebft kh\u00f4ng c\u00f3 tr\u1ecb li\u1ec7u n\u00e0o kh\u1ea3 quan cho tr\u01b0\u1eddng h\u1ee3p n\u00e0y<\/p>\n
1.3 Vi\u00eam da m\u1ee1:<\/i><\/b><\/p>\n
Hi\u1ec7n nay ng\u01b0\u1eddi ta ch\u01b0a bi\u1ebft r\u00f5 nguy\u00ean nh\u00e2n c\u1ee7a tr\u01b0\u1eddng h\u1ee3p n\u00e0y, t\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng \u0111\u1eb7c tr\u01b0ng ( da \u0111\u1ea7u, r\u00e3nh m\u0169i m\u00e1, c\u00f3 th\u1ec3 lan th\u00e0nh h\u00ecnh c\u00e1nh b\u01b0\u1edbm, l\u00f4ng m\u00e0y, tai, v\u00f9ng x\u01b0\u01a1ng \u1ee9c, n\u00e1ch v\u00e0 sinh d\u1ee5c) t\u1ec9 l\u1ec7 70% ( m\u1ed9t s\u1ed1 t\u00e1c gi\u1ea3)<\/p>\n
1.4. S\u1ef1 thay \u0111\u1ed5i m\u00e1i t\u00f3c:<\/i><\/b><\/p>\n
R\u1ee5ng t\u00f3c lan t\u1ecfa th\u01b0\u1eddng th\u1ea5y \u1edf v\u00f9ng tr\u00e1n, th\u00e1i d\u01b0\u01a1ng. Nhi\u1ec1u t\u00e1c gi\u1ea3 th\u1ea5y \u1edf nh\u1eefng b\u00eanh nh\u00e2n AIDS c\u00f3 m\u00e1i t\u00f3c qu\u0103n \u0111\u00e3 thay \u0111\u1ed5i d\u1ea7n tr\u1edf n\u00ean m\u1ecfng manh v\u00e0 m\u1ec1m m\u1ea1i kh\u00f4ng c\u00f2n qu\u0103n n\u1eefa ( 70% tr\u01b0\u1eddng h\u1ee3p) v\u00ec v\u1eady ph\u1ea3i m\u00e3i \u0111\u1ebfn n\u0103m 1982 m\u1edbi \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o ti\u00eau chu\u1ea9n \u0111\u1ec3 ph\u00e1t hi\u1ec7n b\u1ec7nh v\u1ec1 ph\u01b0\u01a1ng di\u1ec7n l\u00e2m s\u00e0ng. Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y c\u00f2n g\u1eb7p \u1edf nh\u1eefng ng\u01b0\u1eddi da \u0111en b\u1ecb lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng, ho\u1eb7c tr\u1ebb em suy dinh d\u01b0\u1ee1ng tuy nhi\u00ean b\u1ec7nh c\u1ea3nh kh\u00e1c nhau<\/p>\n
1.5. Nhi\u1ec5m virus:<\/i><\/b><\/p>\n
a) Herpes:<\/i>M\u1ee5n n\u01b0\u1edbc nh\u1ecf m\u1ecdc th\u00e0nh t\u1eebng \u0111\u00e1m, k\u00e8m theo ng\u1ee9a r\u00e1t v\u1ecb tr\u00ed kh\u00f4ng r\u00f5 r\u00e0ng nh\u01b0 m\u00f4i, sinh d\u1ee5c, nh\u01b0ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 h\u1eadu m\u00f4n, ti\u1ebfn tri\u1ec3n t\u1edbi lo\u00e9t, \u0111au, kh\u00f3 l\u00e0nh v\u00e0 th\u01b0\u1eddng t\u1ed3n t\u1ea1i tr\u00ean 1 th\u00e1ng \u0111\u00f3 l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a AIDS chi\u1ebfm 14-40%<\/p>\n
b) Zona:<\/i>Th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n tr\u01b0\u1edbc 1 th\u00e1ng tr\u01b0\u1edbc khi xu\u1ea5t hi\u1ec7n AIDS d\u01b0\u1edbi d\u1ea1ng ho\u1ea1i t\u1eed n\u1eb7ng r\u1ea5t \u0111au, \u0111\u1ec3 l\u1ea1i s\u1eb9o khi l\u00e0nh ti\u1ebfn l\u01b0\u1ee3ng x\u1ea5u khi zona \u1edf v\u00f9ng \u0111\u1ea7u m\u1eb7t c\u1ed5 tri\u1ec7u ch\u1ee9ng n\u00e0y chi\u1ebfm 85% b\u1ec7nh nh\u00e2n AIDS<\/p>\n
c) U m\u1ec1m l\u00e2y:<\/i>Th\u01b0\u1eddng d\u01b0\u1edbi d\u1ea1ng 1 s\u1ea9n l\u00f5m \u1edf trung t\u00e2m hay g\u1eb7p \u1edf tr\u1ebb em. \u1ede b\u1ec7nh nh\u00e2n AIDS th\u01b0\u01a1ng t\u1ed5n r\u1ea5t nhi\u1ec1u v\u00e0 r\u1ea5t to c\u00f3 th\u1ec3 l\u1ea7m v\u1edbi ung th\u01b0 t\u1ebf b\u00e0o \u0111\u00e1y<\/p>\n
d) B\u1ea1ch s\u1ea3n:<\/i>Th\u01b0\u01a1ng t\u1ed5n tr\u1eafng nh\u1ea1t, d\u00e0y, kh\u00f4ng \u0111\u1ec1u \u1edf c\u1ea1nh l\u01b0\u1ee1i hay nh\u1ea7m v\u1edbi n\u1ea5m Candida albicans. B\u1ec7nh th\u01b0\u1eddng th\u1ea5y \u1edf nh\u1eefng ng\u01b0\u1eddi \u0111\u1ed3ng t\u00ednh luy\u1ebfn \u00e1i. Ban \u0111\u1ea7u b\u1ec7nh cho l\u00e0 do Papilomvirus nh\u01b0ng ng\u00e0y nay ng\u01b0\u1eddi ta cho r\u1eb1ng nguy\u00ean nh\u00e2n l\u00e0 do virus EBV (Epstein Barr Virus) 80% b\u1ec7nh nh\u00e2n trung b\u00ecnh s\u1ebd ph\u00e1t tri\u1ec3n AIDS sau 7 th\u00e1ng<\/p>\n
2. Nh\u1eefng bi\u1ec3u hi\u1ec7n c\u00f3 th\u1ec3 l\u00e0 nhi\u1ec5m tr\u00f9ng c\u01a1 h\u1ed9i ho\u1eb7c l\u00e0 ti\u1ec1n tri\u1ec7u ch\u1ee9ng b\u1ec7nh AIDS<\/b><\/p>\n
2.1. Nhi\u1ec5m n\u1ea5m:<\/i><\/b>Ch\u1ee7 y\u1ebfu l\u00e0 n\u1ea5m Candida albicans, c\u00f3 th\u1ec3 g\u1eb7p \u1edf mi\u1ec7ng, th\u1ef1c qu\u1ea3n, quy \u0111\u1ea7u, \u00e2 m \u0111 \u1ea1 o. Nhi\u1ec1u t\u00e0i li\u1ec7u cho r\u1eb1ng g\u1eb7p 40% \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ecb AIDS. \u0110i\u1ec1u tr\u1ecb Ketoconazol b\u1eb1ng \u0111\u01b0\u1eddng u\u1ed1ng r\u1ea5t c\u00f3 hi\u1ec7u qu\u1ea3<\/p>\n
2.2. Nhi\u1ec5m virus:<\/i><\/b>Herpes, Zona, U m\u1ec1m l\u00e2y, m\u1ee5n c\u00f3c,\u2026<\/p>\n
2.3. Nhi\u1ec5m vi khu\u1ea9n:<\/i><\/b><\/p>\n
–\u00a0Ch\u1ed1c t\u00e1i ph\u00e1t:<\/i>\u00a0T\u00e1i \u0111i t\u00e1i l\u1ea1i nhi\u1ec1u l\u1ea7n tr\u01b0\u1edbc v\u00e0i th\u00e1ng khi AIDS – Vi\u00eam nang l\u00f4ng: C\u00f3 th\u1ec3 b\u01b0\u1edbc \u0111\u1ea7u c\u1ee7a b\u1ec7nh AIDS<\/p>\n
– Nhi\u1ec5m Cytococossis \u1edf da:<\/i>\u00a0Th\u01b0\u1eddng g\u1eb7p 1% t\u1ed5n th\u01b0\u01a1ng l\u00e0 s\u1ea9n m\u1ee5n m\u1ee7 \u0111\u00f4i khi l\u00f5m \u1edf gi\u1eefa<\/p>\n
2.4. Nhi\u1ec5m \u0111\u1ed9c da do thu\u1ed1c (ph\u00e1t ban do thu\u1ed1c):<\/i><\/b><\/p>\n
Nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb nhi\u1ec5m HIV th\u01b0\u1eddng c\u00f3 nh\u1eefng ph\u1ea3n \u1ee9ng \u1edf da kh\u00f4ng dung n\u1ea1p v\u1edbi 1 s\u1ed1 thu\u1ed1c chi\u1ebfm 70-80%, ngo\u00e0i ra 6% nhi\u1ec5m \u0111\u1ed9c da d\u1ea1ng b\u1ecdng n\u01b0\u1edbc (h\u1ed9i ch\u1ee9ng Johnson v\u00e0 Lyell).<\/p>\n
B\u1ec6NH PHONG<\/b><\/p>\n
I. D\u1ecbch t\u1ec5 h\u1ecdc<\/b><\/p>\n
1.T\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh.<\/b><\/p>\n
Tr\u1ef1c khu\u1ea9n Hansen (BH) t\u00ean khoa h\u1ecdc Mycobacterium Leprae do nh\u00e0 b\u00e1c h\u1ecdc ng\u01b0\u1eddi Na Uy Armeuer Hansen ph\u00e1t hi\u1ec7n 1873.<\/p>\n
Tr\u1ef1c khu\u1ea9n h\u00ecnh g\u1eady, kh\u00e1ng c\u1ed3n, kh\u00e1ng toan v\u1ec1 ph\u01b0\u01a1ng di\u1ec7n nhu\u1ed9m, k\u00edch th\u01b0\u1edbc 1,5- 6 micron, nhu\u1ed9m b\u1eaft m\u00e0u \u0111\u1ecf t\u01b0\u01a1i theo ph\u01b0\u01a1ng ph\u00e1p Ziehl- Neelsen.<\/p>\n
Tr\u00ean ti\u00eau b\u1ea3n da tr\u1ef1c khu\u1ea9n phong ch\u1ee7 y\u1ebfu n\u1eb1m \u1edf trung b\u00ec n\u00f4ng v\u00e0 gi\u1eefa, r\u1ea3i r\u00e1c hay th\u00e0nh \u0111\u00e1m(amas), th\u00e0nh c\u1ee5m (globi), th\u1eddi gian th\u1ebf h\u1ec7 14 ng\u00e0y, s\u1ed1ng ngo\u00e0i c\u01a1 th\u1ec3 \u0111\u01b0\u1ee3c 7 ng\u00e0y (theo Rees 1974), \u0111un s\u00f4i gi\u1ebft \u0111\u01b0\u1ee3cBH, ti\u00eam truy\u1ec1n cho s\u00fac v\u1eadt \u0111\u01b0\u1ee3c nh\u01b0ng kh\u00f3, ch\u01b0a nu\u00f4i c\u1ea5y \u0111\u01b0\u1ee3c tr\u00ean m\u00f4i tr\u01b0\u1eddng nh\u00e2n t\u1ea1o.<\/p>\n
2. L\u00e0 b\u1ec7nh l\u00e2y<\/b>, (thuy\u1ebft di truy\u1ec1n \u0111\u00e3 b\u1ecb b\u00e1c b\u1ecf), l\u00e0 b\u1ec7nh l\u00e2y nh\u01b0ng l\u00e2y \u00edt, t\u1ec9 l\u1ec7 l\u00e2y gi\u1eefa v\u1ee3 ch\u1ed3ng l\u00e0 3-6%, l\u00e2y ch\u1eadm, \u1ee7 b\u1ec7nh d\u00e0i 2-3 n\u0103m, l\u00e2y kh\u00f3.<\/p>\n
3. \u0110\u01b0\u1eddng l\u00e2y<\/b>\u00a0: vi khu\u1ea9n x\u00e2m nh\u1eadp ch\u1ee7 y\u1ebfu qua da b\u1ecb x\u00e2y s\u00e1t, b\u1ec7nh nh\u00e2n th\u01b0\u1eddng th\u1ea3i vi khu\u1ea9n ch\u1ee7 y\u1ebfu qua th\u01b0\u01a1ng t\u1ed5n m\u0169i, h\u1ecdng \u1edf giai \u0111o\u1ea1n mu\u1ed9n, ch\u1ee7 y\u1ebfu l\u00e0 b\u1ec7nh nh\u00e2n th\u1ec3 phong u(th\u1ec3 L )v\u00e0 th\u1ec3 phong trung gian (th\u1ec3 B).<\/p>\n
Phong th\u1ec3 L l\u00e2y nhi\u1ec1u h\u01a1n th\u1ec3 phong c\u1ee7 (th\u1ec3T),l\u00e2y gi\u00e1n ti\u1ebfp qua n\u01b0\u1edbc, \u0111\u1ea5t, v\u1eadt d\u1ee5ng l\u00e0 ph\u1ed5 bi\u1ebfn,l\u00e2y tr\u1ef1c ti\u1ebfp ph\u1ea3i trong \u0111i\u1ec1u ki\u1ec7n s\u1ed1ng th\u00e2n thi\u1ebft k\u00e9o d\u00e0i.<\/p>\n
II. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/b><\/p>\n
1. Th\u1eddi k\u1ef3 \u1ee7 b\u1ec7nh<\/b><\/p>\n
Kh\u00f3 x\u00e1c \u0111\u1ecbnh, th\u1eddi gian r\u1ea5t d\u00e0i, trung b\u00ecnh 2-5 n\u0103m, c\u00f3 tr\u01b0\u1eddng h\u1ee3p k\u00e9o d\u00e0i 20 n\u0103m.<\/p>\n
2. Th\u1eddi k\u1ef3 ti\u00ean ph\u00e1t<\/b><\/p>\n
R\u1ea5t ph\u1ee9c t\u1ea1p l\u00e0m cho b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u1ec3 \u00fd \u0111\u1ebfn nh\u01b0: m\u1ec7t m\u1ecfi, m\u1ea5t ng\u1ee7, nh\u1ee9c \u0111\u1ea7u, m\u1ecfi tay ch\u00e2n, \u0111au \u0111\u1ea7u g\u1ed1i, … B\u1ec7nh nh\u00e2n c\u00f3 ch\u00fa \u00fd, lo s\u1ee3 khi th\u1ea5y xu\u1ea5t hi\u1ec7n 1 trong 2 lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng sau:<\/p>\n
–\u00a0T\u1ed5n th\u01b0\u01a1ng da:<\/i><\/b>\u00a0D\u00e1t tr\u1eafng, th\u00e2m, h\u1ed3ng gi\u1edbi h\u1ea1n kh\u00f4ng r\u00f5<\/p>\n
–\u00a0T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh:<\/i><\/b>\u00a0T\u00ea b\u00ec, ki\u1ebfn b\u00f2 ho\u1eb7c m\u1ea5t c\u1ea3m gi\u00e1c 1 v\u00f9ng n\u00e0o \u0111\u00f3, t\u0103ng c\u1ea3m gi\u00e1c. V\u1ecb tr\u00ed th\u01b0\u1eddng g\u1eb7p nh\u01b0 tay, ch\u00e2n, m\u1eb7t, c\u1ed5, m\u00f4ng (theo th\u1ee9 t\u1ef1 v\u00f9ng h\u1edf). Ngo\u00e0i ra c\u00f2n c\u00f3 1 s\u1ed1 tri\u1ec7u ch\u1ee9ng kh\u00f4ng \u0111i\u1ec3n h\u00ecnh nh\u01b0 s\u1ed1 dai d\u1eb3ng, s\u1ed5 m\u0169i,…<\/p>\n
3. Th\u1eddi k\u1ef3 to\u00e0n ph\u00e1t<\/b><\/p>\n
\u00a0T\u1ed5n th\u01b0\u01a1ng da<\/i><\/b><\/p>\n
–\u00a0D\u00e1t:<\/i>\u00a0Th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n s\u1edbm, d\u00e1t to nh\u1ecf kh\u00f4ng \u0111\u1ec1u, \u0111\u1ecf, th\u00e2m, tr\u1eafng, gi\u1edbi h\u1ea1n r\u00f5 ho\u1eb7c kh\u00f4ng r\u00f5 t\u00f9y theo t\u1eebng th\u1ec3.<\/p>\n
–\u00a0C\u1ee7:<\/i>\u00a0N\u1ed5i cao h\u01a1n m\u1eb7t da k\u00edch th\u01b0\u1edbc thay \u0111\u1ed5i, \u0111\u1ee9ng r\u1ea3i r\u00e1c ho\u1eb7c t\u1eadp trung th\u00e0nh t\u1eebng \u0111\u00e1m, m\u1ea3ng, gi\u1edbi h\u1ea1n r\u00f5, b\u1edd cao h\u01a1n, m\u1eb7t da trung t\u00e2m l\u00f5m c\u00f3 xu h\u01b0\u1edbng l\u00e0nh s\u1eb9o.<\/p>\n
–\u00a0D\u00e1t nhi\u1ec5m c\u1ed9m:<\/i>\u00a0Tr\u00f2n ho\u1eb7c b\u1ea7u d\u1ee5c m\u00e0u \u0111\u1ecf b\u00f3ng, gi\u1edbi h\u1ea1n kh\u00f4ng r\u00f5, s\u1ed1 l\u01b0\u1ee3ng nhi\u1ec1u.<\/p>\n
–\u00a0U phong:<\/i>\u00a0Gi\u1edbi h\u1ea1n kh\u00f4ng r\u00f5, \u0111\u1ed1i x\u1ee9ng, th\u00e2m nhi\u1ec5m s\u00e2u m\u00e0u \u0111\u1ecf, b\u1ec1 m\u1eb7t b\u00f3ng nh\u1eb5n, s\u1ed1 l\u01b0\u1ee3ng nhi\u1ec1u.<\/p>\n
\u00a0T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh<\/i><\/b><\/p>\n
–\u00a0R\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c:<\/i>\u00a0M\u1ea5t ho\u1eb7c gi\u1ea3m, t\u0103ng c\u1ea3m gi\u00e1c, th\u00f4ng th\u01b0\u1eddng l\u00e0 m\u1ea5t ho\u1eb7c gi\u1ea3m c\u1ea3m gi\u00e1c (\u0111au, n\u00f3ng, l\u1ea1nh, x\u00fac gi\u00e1c)<\/p>\n
–\u00a0Vi\u00eam d\u00e2y th\u1ea7n kinh:<\/i>\u00a0Hay g\u1eb7p nh\u1ea5t l\u00e0 th\u1ea7n kinh tr\u1ee5, TK quay, TK gi\u1eefa, TK c\u1ed5 n\u00f4ng, TK h\u00f4ng khoeo ngo\u00e0i, TK ch\u00e0y sau, th\u00f4ng th\u01b0\u1eddng ch\u1ec9 nh\u1eadn bi\u1ebft \u0111\u01b0\u1ee3c qua s\u1edd n\u1eafn. D\u00e2y TK vi\u00eam to \u0111\u1ec1u trong phong \u00e1c t\u00ednh, TK c\u00f3 chu\u1ed7i h\u1ea1t, d\u00e2y th\u1eebng trong phong c\u1ee7.<\/p>\n
–\u00a0R\u1ed1i lo\u1ea1n b\u00e0i ti\u1ebft da:<\/i>\u00a0Da v\u00f9ng t\u1ed5n th\u01b0\u01a1ng b\u00f3ng m\u1edd, kh\u00f4, kh\u00f4ng b\u00e0i ti\u1ebft m\u1ed3 h\u00f4i ho\u1eb7c do t\u1ed5n th\u01b0\u01a1ng TK v\u1eadn m\u1ea1ch.<\/p>\n
–\u00a0R\u1ed1i lo\u1ea1n dinh d\u01b0\u1ee1ng:<\/i>\u00a0R\u1ee5ng l\u00f4ng m\u00e0y 1\/3 ngo\u00e0i, l\u00f4ng n\u00e1ch, l\u00f4ng mu, lo\u00e9t \u1ed5 g\u00e0, ti\u00eau x\u01b0\u01a1ng, c\u1ee5t ng\u00f3n.<\/p>\n
–\u00a0R\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng:<\/i>\u00a0Teo c\u01a1 b\u00e0n tay, teo c\u01a1 m\u00f4 c\u00e1i, m\u00f4 \u00fat, c\u01a1 li\u00ean \u0111\u1ed1t, teo c\u01a1 c\u1eb3ng ch\u00e2n tr\u01b0\u1edbc, teo c\u01a1 \u1edf m\u1eb7t…<\/p>\n
\u00a0T\u1ed5n th\u01b0\u01a1ng ng\u0169 quan<\/i><\/b><\/p>\n
–\u00a0M\u0169i:<\/i>\u00a0S\u1ed5 m\u0169i dai d\u1eb3ng, ch\u1ea3y m\u00e1u cam, x\u1eb9p m\u0169i<\/p>\n
–\u00a0Mi\u1ec7ng, thanh qu\u1ea3n:<\/i>\u00a0Vi\u00eam l\u01b0\u1ee1i, h\u1ecdng, thanh qu\u1ea3n \u00e0 kh\u00e0n ti\u1ebfng<\/p>\n
–\u00a0M\u1eaft:<\/i>\u00a0Vi\u00eam gi\u00e1c m\u1ea1c, k\u1ebft m\u1ea1c, m\u1ed1ng m\u1eaft \u00e0 m\u00f9, ho\u1eb7c m\u1eaft kh\u00f4ng nh\u1eafm k\u00edn \u00e0 m\u1eaft th\u1ecf<\/p>\n
\u00a0T\u1ed5n th\u01b0\u01a1ng c\u00e1c c\u01a1 quan kh\u00e1c<\/i><\/b><\/p>\n
Vi\u00eam h\u1ea1ch, x\u1ed1p x\u01b0\u01a1ng, vi\u00eam tuy\u1ebfn n\u1ed9i ti\u1ebft, gan, l\u00e1ch, th\u1eadn, vi\u00eam c\u01a1 quan sinh d\u1ee5c (tinh ho\u00e0n, m\u00e0o tinh ho\u00e0n…)<\/p>\n
III. Ph\u00e2n lo\u1ea1i phong<\/b><\/p>\n
C\u00f3 nhi\u1ec1u c\u00e1ch ph\u00e2n lo\u1ea1i nh\u01b0ng c\u00f3 2 c\u00e1ch sau \u0111\u00e2y \u0111\u01b0\u1ee3c c\u00e1c chuy\u00ean gia th\u1ebf gi\u1edbi ch\u1ea5p nh\u1eadn l\u00e0\u00a0Madrid<\/i><\/b>\u00a0v\u00e0\u00a0Ridley \u2013 Jopling<\/i><\/b><\/p>\n
1. Ph\u00e2n lo\u1ea1i theo Madrid:<\/b>\u00a0Ch\u1ee7 y\u1ebfu d\u1ef1a v\u00e0o l\u00e2m s\u00e0ng n\u00ean r\u1ea5t th\u00edch h\u1ee3p cho c\u00f4ng t\u00e1c tr\u00ean th\u1ef1c \u0111\u1ecba<\/p>\n
–\u00a0Hai th\u1ec3:<\/i>\u00a0Th\u1ec3 T: phong c\u1ee7<\/p>\n
Th\u1ec3 L: phong u<\/p>\n
–\u00a0Hai nh\u00f3m:<\/i>\u00a0Th\u1ec3 I: phong b\u1ea5t \u0111\u1ecbnh<\/p>\n
Th\u1ec3 B: phong trung gian<\/p>\n
2. Ph\u00e2n lo\u1ea1i theo Ridley – Jopling:<\/b>\u00a0D\u1ef1a v\u00e0o mi\u1ec5n d\u1ecbch trung gian t\u1ebf b\u00e0o<\/p>\n
B\u1ec7nh phong \u0111\u01b0\u1ee3c ph\u00e2n th\u00e0nh nhi\u1ec1u th\u1ec3, n\u1eb1m gi\u1eefa 2 c\u1ef1c TT( th\u1ec3 phong c\u1ee7, mi\u1ec5n d\u1ecbch trung gian t\u1ebf b\u00e0o m\u1ea1nh)v\u00e0 LL( phong u CMI y\u1ebfu)l\u00e0 c\u00e1c th\u1ec3 \u0111\u00f3 l\u00e0 BT phong c\u1ee7 trung gian, BB phong trung gian, BL phong th\u1ec3 trung gian c\u1eadn \u00e1c, LLS phong u d\u01b0\u1edbi c\u1ef1c,v\u00e0 phong u c\u1ef1c LLp.<\/p>\n
3. Ph\u00e2n lo\u1ea1i theo vi khu\u1ea9n.<\/b><\/p>\n
\u0110\u1ec3 ti\u1ec7n l\u1ee3i cho vi\u1ec7c \u00e1p d\u1ee5ng \u0111a ho\u00e1 tr\u1ecb li\u1ec7u, chia b\u1ec7nh phong ra l\u00e0m 2 nh\u00f3m, nh\u00f3m \u00edt vi khu\u1ea9n (Pauci Bacilary-PB) v\u00e0 nh\u00f3m nhi\u1ec1u vi khu\u1ea9n (MultiBacilary-MB), m\u1ed7i nh\u00f3m c\u00f3 m\u1ed9t ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb ri\u00eang.<\/p>\n
+ Nh\u00f3m \u00edt vi khu\u1ea9n (PB), \u1edf nh\u00f3m n\u00e0y vi khu\u1ea9n \u00e2m t\u00ednh, th\u01b0\u1eddng l\u00e0 nh\u1eefng b\u1ec7nh nh\u00e2n th\u1ec3 I, T.<\/p>\n
+ Nh\u00f3m nhi\u1ec1u vi khu\u1ea9n (MB), t\u1eeb 1- 6 (+), nh\u00f3m n\u00e0y th\u01b0\u1eddng l\u00e0 nh\u1eefng b\u1ec7nh nh\u00e2n thu\u1ed9c th\u1ec3 B,L.<\/p>\n
IV. Ph\u1ea3n \u1ee9ng Miitsuda v\u00e0 th\u1eed nghi\u1ec7m r\u1ea1ch da<\/b><\/p>\n
1. Ph\u1ea3n \u1ee9ng Mitsuda( th\u1eed nghi\u1ec7m lepromin):\u00a0<\/b>l\u00e0 1 th\u1eed nghi\u1ec7m mi\u1ec5n dich h\u1ecdc \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u1ee9c \u0111\u1ec1 kh\u00e1ng c\u1ee7a c\u01a1 th\u1ec3 \u0111\u1ed1i v\u1edbi M.leprae, \u0111\u00e2y kh\u00f4ng ph\u1ea3i l\u00e0 ph\u1ea3n \u1ee9ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n b\u1ec7nh phong.<\/p>\n
K\u1ef9 thu\u1eadt:<\/i><\/b>ti\u00eam trong da m\u1eb7t tr\u01b0\u1edbc c\u1eb3ng tay 1\/10ml kh\u00e1ng nguy\u00ean lepromin.<\/p>\n
\u0110\u1ecdc ph\u1ea3n \u1ee9ng 2 l\u1ea7n:<\/i><\/b><\/p>\n
– L\u1ea7n 1:<\/i><\/b>\u0111\u1ed9c ph\u1ea3n \u1ee9ng sau 48h ( ph\u1ea3n \u1ee9ng s\u1edbm) g\u1ecdi l\u00e0 ph\u1ea3n \u1ee9ng s\u1edbm c\u1ee7a Fernandez. \u0110\u00e2y l\u00e0 ph\u1ea3n \u1ee9ng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u c\u1ee7a c\u01a1 th\u1ec3 v\u1edbi 1 protein l\u1ea1.<\/p>\n
+ K\u1ebft qu\u1ea3 ph\u1ea3n \u1ee9ng:<\/i><\/p>\n
. \u00c2m t\u00ednh: \u0111\u01b0\u1eddng k\u00ednh h\u1ed3ng ban <5mm.<\/p>\n
. Nghi ng\u1edd: \u0111\u01b0\u1eddng k\u00ednh c\u1ee7a h\u1ed3ng ban v\u00e0 ph\u00f9 n\u1ec1 t\u1eeb 5-10mm.<\/p>\n
. D\u01b0\u01a1ng t\u00ednh 1+: \u0111\u01b0\u1eddng k\u00ednh c\u1ee7a h\u1ed3ng ban t\u1eeb 10- 20mm.<\/p>\n
. D\u01b0\u01a1ng t\u00ednh 2+: \u0111\u01b0\u1eddng k\u00ednh c\u1ee7a h\u1ed3ng ban >20mm.<\/p>\n
–\u00a0L\u1ea7n 2:<\/b><\/i>\u0110\u1ecdc k\u1ebft qu\u1ea3 sau 3 tu\u1ea7n g\u1ecdi l\u00e0 ph\u1ea3n \u1ee9ng mu\u1ed9n hay ph\u1ea3n \u1ee9ng Mitsuda:<\/p>\n
+ K\u1ebft qu\u1ea3 ph\u1ea3n \u1ee9ng:\u00a0<\/i>khi \u0111\u01b0\u1eddng k\u00ednh c\u1ee7a c\u1ee5c:<\/p>\n
.\u00a0<\/b>\u00c2m t\u00ednh: kh\u00f4ng c\u00f3 c\u1ee5c.<\/p>\n
.\u00a0<\/b>Nghi ng\u1edd: <3mm<\/p>\n
.\u00a0<\/b>D\u01b0\u01a1ng t\u00ednh 1+: 3- 5mm<\/p>\n
.\u00a0<\/b>D\u01b0\u01a1ng t\u00ednh 2+: 6-10mm<\/p>\n
.\u00a0<\/b>D\u01b0\u01a1ng t\u00ednh 3+: >10mm ho\u1eb7c c\u00f3 lo\u00e9t.<\/p>\n
Trong 90% tr\u01b0\u1eddng h\u1ee3p ph\u1ea3n \u1ee9ng Fernandez(+) th\u00ec ph\u1ea3n \u1ee9ng Mitsuda(+). Tuy nhi\u00ean trong 15% tr\u01b0\u1eddng h\u1ee3p ph\u1ea3n \u1ee9ng Fernandez (-) th\u00ec ph\u1ea3n \u1ee9ng Mitsuda v\u1eabn (+).<\/p>\n
+ \u00dd ngh\u0129a c\u1ee7a ph\u1ea3n \u1ee9ng Mitsuda:<\/i><\/b><\/p>\n
.\u00a0<\/i><\/b>\u0110\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch<\/i>\u00a0qua trung gian t\u1ebf b\u00e0o c\u1ee7a c\u01a1 th\u1ec3 \u0111\u1ed1i v\u1edbi vi khu\u1ea9n M.leprae.<\/p>\n
.\u00a0<\/b>Gi\u00fap \u00edch trong\u00a0ch\u1ea9n \u0111o\u00e1n ph\u00e2n lo\u1ea1i<\/i>\u00a0b\u1ec7nh phong.<\/p>\n
.\u00a0<\/i><\/b>Gi\u00fap ti\u00ean l\u01b0\u1ee3ng:<\/i>\u00a0ph\u1ea3n \u1ee9ng d\u01b0\u01a1ng t\u00ednh ti\u00ean l\u01b0\u1ee3ng t\u1ed1t, v\u00e0 ng\u01b0\u1ee3c l\u1ea1i.<\/p>\n
.\u00a0<\/i><\/b>\u0110\u00e1nh gi\u00e1 \u1ea3nh h\u01b0\u1edfng c\u1ee7a \u0111i\u1ec1u tr\u1ecb:<\/i>\u00a0t\u1ed1t t\u1eeb \u00e2m t\u00ednh chuy\u1ec3n th\u00e0nh d\u01b0\u01a1ng t\u00ednh v\u00e0 ng\u01b0\u1ee3c l\u1ea1i.<\/p>\n
2. Th\u1eed nghi\u1ec7m r\u1ea1ch da( slit skin smear):<\/b><\/p>\n
\u0110\u1ec3 t\u00ecm vi khu\u1ea9n Hansen ng\u01b0\u1eddi ta ph\u1ea3i l\u00e0m th\u1eed nghi\u1ec7m r\u1ea1ch da t\u1ea1i 2 v\u1ecb tr\u00ed d\u00e1i tai v\u00e0 t\u1ed5n th\u01b0\u01a1ng da, d\u1ecbch m\u00f4 \u0111\u01b0\u1ee3c ph\u1ebft l\u00ean lam k\u00ednh sau \u0111\u00f3 nhu\u1ed9m Ziehl-Neelsen.<\/p>\n
–\u00a0K\u1ebft qu\u1ea3:<\/b><\/i><\/p>\n
+ Ch\u1ec9 s\u1ed1 vi tr\u00f9ng h\u1ecdc( Bacteriological Index, B1):<\/i><\/b>l\u00e0 s\u1ed1 vi khu\u1ea9n tr\u00ean quang tr\u01b0\u1eddng theo nguy\u00ean t\u1eafc c\u1ee7a Ridley-Jopling<\/p>\n
0: kh\u00f4ng th\u1ea5y vi tr\u00f9ng trong 100 quang tr\u01b0\u1eddng.<\/p>\n
1+: 1-10 vi tr\u00f9ng\/100 quang tr\u01b0\u1eddng.<\/p>\n
2+: 1-10 vi tr\u00f9ng\/10 quang tr\u01b0\u1eddng.<\/p>\n
3+: 1-10 vi tr\u00f9ng\/quang tr\u01b0\u1eddng.<\/p>\n
4+: 10-100 vi tr\u00f9ng\/ quang tr\u01b0\u1eddng.<\/p>\n
5+: 100-1000 vi tr\u00f9ng\/ quang tr\u01b0\u1eddng.<\/p>\n
6+:>1000 vi tr\u00f9ng\/ quang tr\u01b0\u1eddng.<\/p>\n
+ Ch\u1ec9 s\u1ed1 h\u00ecnh th\u00e1i ( Morphological Index, MI<\/i><\/b>):<\/i>\u00a0l\u00e0 ph\u1ea7n tr\u0103m vi khu\u1ea9n nguy\u00ean v\u1eb9n \u0111\u1ee9ng ri\u00eang l\u1ebd \u0111\u1ebfm \u0111\u01b0\u1ee3c.<\/p>\n
V. Ph\u1ea3n \u1ee9ng b\u1ec7nh phong<\/b><\/p>\n
1. Ph\u1ea3n \u1ee9ng lo\u1ea1i I:<\/b><\/p>\n
X\u1ea3y ra \u1edf c\u00e1c th\u1ec3 phong trung gian bao g\u1ed3m:<\/p>\n
– Ph\u1ea3n \u1ee9ng l\u00ean c\u1ea5p hay ph\u1ea3n \u1ee9ng \u0111\u1ea3o ngh\u1ecbch: li\u00ean<\/i><\/b>\u00a0quan \u0111\u1ebfn s\u1ef1 gia t\u0103ng c\u1ee7a mi\u1ec5n d\u1ecbch trung gian t\u1ebf b\u00e0o khi\u1ebfn b\u1ec7nh h\u01b0\u1edbng \u0111\u1ebfn phong c\u1ee7. Ph\u1ea3n \u1ee9ng th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n trong 6 th\u00e1ng \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u1edbi bi\u1ec3u hi\u1ec7n c\u00e1c th\u01b0\u01a1ng toonrcos t\u1eeb tr\u01b0\u01a1c sung l\u00ean c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn ho\u1ea1i t\u1eed v\u00e0 lo\u00e9t, c\u00f3 th\u1ec3 vi\u00eam th\u1ea7n kinh c\u1ea5p v\u00e0 abces d\u00e2y th\u1ea7n kinh, t\u1ed5ng tr\u1ea1ng \u00edt b\u1ecb thay \u0111\u1ed5i.<\/p>\n
– Ph\u1ea3n \u1ee9ng xu\u1ed1ng c\u1ea5p:<\/i><\/b>\u00a0li\u00ean quan \u0111\u1ebfn s\u1ef1 gi\u1ea3m s\u00fat mi\u1ec5n d\u1ecbch trung gian t\u00e9 b\u00e0o khi\u1ebfn di\u1ec5n bi\u1ebfn b\u1ec7nh h\u01b0\u1edbng v\u1ec1 c\u1ee5c u bi\u1ec3u hi\u1ec7n s\u1ed1 l\u01b0\u1ee3ng th\u01b0\u01a1ng t\u1ed5n t\u0103ng th\u00eam v\u00e0 \u00edt c\u00f3 t\u00ednh ch\u1ea5t vi\u00eam.<\/p>\n
2. Ph\u1ea3n \u1ee9ng lo\u1ea1i II:\u00a0<\/b>hay c\u00f2n g\u1ecdi l\u00e0 ph\u1ea3n \u1ee9ng h\u1ed3ng ban (erythema nodosum leprosum)<\/p>\n
X\u1ea3y ra ch\u1ee7 y\u1ebfu \u1edf b\u1ec7nh nh\u00e2n phong u v\u00e0 1 \u00edt th\u1ec3 trung gian g\u1ea7n u do s\u1ef1 l\u1eafng \u0111\u1ecdng c\u1ee7a ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch \u1edf th\u00e0nh m\u1ea1ch. Ph\u1ea3n \u1ee9ng th\u01b0\u1eddng x\u1ea3y ra \u1edf 50 % tr\u01b0\u1eddng h\u1ee3p (LL), 25% (BL). Ph\u1ea3n \u1ee9ng th\u01b0\u1eddng x\u1ea3y ra sau 1-2 n\u0103m khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb, c\u0169ng c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n l\u00e2u ng\u00e0y kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb. Tri\u1ec7u ch\u1ee9ng l\u00e0 n\u1ed5i \u0111\u1ed9t ng\u1ed9t nh\u1eefng c\u1ee5c h\u1ed3ng ban \u0111au nh\u1ee9c c\u00f3 th\u1ebf c\u00f3 m\u1ee5n n\u01b0\u1edbc, b\u00f3ng n\u01b0\u1edbc, ho\u1ea1i t\u1eed, lo\u00e9t k\u00e8m theo vi\u00eam kh\u1edbp, vi\u00eam tinh ho\u00e0n, s\u1ed1t, t\u00ecnh tr\u1ea1ng vi\u00eam d\u00e2y th\u1ea7n kinh c\u1ea5p t\u00ednh, c\u1ea7n ph\u1ea3i \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi.<\/p>\n
VI. \u0110i\u1ec1u tr\u1ecb<\/b><\/p>\n
1. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb<\/b><\/p>\n
– \u0110i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n v\u00e0 kh\u00e1m cho c\u1ea3 gia \u0111\u00ecnh ng\u01b0\u1eddi b\u1ec7nh hay ng\u01b0\u1eddi ti\u1ebfp x\u00fac \u0111\u1ec3 ph\u00e1t hi\u1ec7n s\u1edbm v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1edbm<\/p>\n
– \u0110i\u1ec1u tr\u1ecb th\u1eddi gian d\u00e0i v\u00e0 li\u00ean t\u1ee5c t\u00f9y theo th\u1ec3 b\u1ec7nh<\/p>\n
– B\u1ec7nh ph\u1ea3i \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb l\u00e0nh m\u1ea1nh: h\u1ebft vi tr\u00f9ng v\u00e0 kh\u00f4ng t\u00e0n ph\u1ebf<\/p>\n
– X\u00e3 h\u1ed9i b\u1ea3o v\u1ec7 kh\u1ecfi b\u1ecb l\u00e2y lan<\/p>\n
2. C\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb c\u00f3 gi\u00e1 tr\u1ecb hi\u00ean nay<\/b><\/p>\n
– DDS: 100mg\/ng\u00e0y<\/p>\n
– Rifampicin: 300mg\/ng\u00e0y di\u1ec7t VK trong v\u00e0i ng\u00e0y<\/p>\n
– Clofazimin vi\u00ean 100mg, 50mg: hay g\u00e2y x\u1ea1m da, \u0111i\u1ec1u tr\u1ecb t\u1ed1t cho ph\u1ea3n \u1ee9ng phong<\/p>\n
– Thioamid: \u0110\u1ed9c gan, th\u1eadn<\/p>\n
V\u1ea5n \u0111\u1ec1 \u0111\u1eb7c bi\u1ec7t quan t\u00e2m hi\u1ec7n nay l\u00e0 v\u1ea5n \u0111\u1ec1 kh\u00e1ng thu\u1ed1c v\u00e0 vi khu\u1ea9n t\u1ed3n l\u01b0u, cho n\u00ean trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh phong c\u1ea7n ph\u1ea3i k\u1ebft h\u1ee3p nhi\u1ec1u thu\u1ed1c v\u00e0 c\u00f3 ph\u00e1t \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb th\u00edch h\u1ee3p.<\/p>\n
3. \u0110a h\u00f3a tr\u1ecb li\u1ec7u trong b\u1ec7nh phong<\/b><\/p>\n
\u00a0L\u1ee3i \u00edch:<\/i><\/b>\u00a0C\u00f3 4 l\u1ee3i \u00edch:<\/p>\n
– R\u00fat ng\u1eafn th\u1eddi gian \u0111i\u1ec1u tr\u1ecb<\/p>\n
– H\u1ea1n ch\u1ebf \u0111\u01b0\u1ee3c l\u00e2y lan: tr\u01b0\u1edbc d\u00f9ng DDS t\u1eeb 3-6 th\u00e1ng m\u1edbi kh\u1ecfi l\u00e2y, MDT h\u1ebft l\u00e2y t\u1eeb 3-5 ng\u00e0y<\/p>\n
– H\u1ea1n ch\u1ebf \u0111\u01b0\u1ee3c t\u00e0n ph\u1ebf: v\u00ec \u0111i\u1ec1u tr\u1ecb th\u1eddi gian ng\u1eafn<\/p>\n
– Tr\u00e1nh \u0111\u01b0\u1ee3c t\u00ecnh tr\u1ea1ng kh\u00e1ng thu\u1ed1c<\/p>\n
\u00a0Ch\u1ec9 \u0111\u1ecbnh:<\/i><\/b>\u00a0G\u1ed3m 4 \u0111\u1ed1i t\u01b0\u1ee3ng:<\/p>\n
– B\u1ec7nh nh\u00e2n m\u1edbi ph\u00e1t hi\u1ec7n<\/p>\n
– B\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb DDS nh\u01b0ng v\u1eabn c\u00f2n ho\u1ea1t t\u00ednh<\/p>\n
– B\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb DDS b\u1ea5t ho\u1ea1t nh\u01b0ng r\u01a1i v\u00e0o th\u1ec3 L ho\u1eb7c BL (ph\u00f2ng t\u00e1i ph\u00e1t)<\/p>\n
– B\u1ec7nh nh\u00e2n t\u00e1i ph\u00e1t<\/p>\n
\u00a0Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb<\/i><\/b><\/p>\n
–\u00a0\u0110\u1ed1i v\u1edbi PB:<\/i><\/p>\n
Rifampicin 600mg\/th\u00e1ng u\u1ed1ng 1 l\u1ea7n c\u00f3 ki\u1ec3m so\u00e1t<\/p>\n
DDS 100mg\/ng\u00e0y, t\u1ef1 u\u1ed1ng h\u00e0ng ng\u00e0y<\/p>\n
Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb 6 th\u00e1ng sau \u0111\u00f3 ng\u1eebng thu\u1ed1c v\u00e0 theo d\u00f5i trong 2 n\u0103m<\/p>\n
–\u00a0\u0110\u1ed1i v\u1edbi MB:<\/i><\/p>\n
Rifampicin 600mg\/th\u00e1ng u\u1ed1ng 1 l\u1ea7n c\u00f3 ki\u1ec3m so\u00e1t<\/p>\n
Clofazimin 300mg\/th\u00e1ng u\u1ed1ng 1 l\u1ea7n c\u00f3 ki\u1ec3m so\u00e1t<\/p>\n
Clofazimin 50mg\/ng\u00e0y, t\u1ef1 u\u1ed1ng h\u00e0ng ng\u00e0y<\/p>\n
DDS 100mg\/ng\u00e0y, t\u1ef1 u\u1ed1ng h\u00e0ng ng\u00e0y<\/p>\n
Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb 24 th\u00e1ng ho\u1eb7c \u0111\u1ebfn khi BI=0 sau \u0111\u00f3 theo d\u00f5i trong 03 n\u0103m v\u00e0 ng\u1eebng thu\u1ed1c.<\/p>\n
–\u00a0Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb:<\/i><\/p>\n
\u00d8 T\u1ea5t c\u1ea3 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p phong m\u00e0 t\u00ecm th\u1ea5y vi tr\u00f9ng ph\u1ea3i \u0111i\u1ec1u tr\u1ecb ph\u00e1c \u0111\u1ed3 24 th\u00e1ng (I, T, B, L)<\/p>\n
\u00d8 I, B, T kh\u00f4ng t\u00ecm th\u1ea5y vi tr\u00f9ng: \u0111i\u1ec1u tr\u1ecb ph\u00e1c \u0111\u1ed3 6 th\u00e1ng<\/p>\n
\u00d8 BT kh\u00f4ng t\u00ecm th\u1ea5y vi tr\u00f9ng nh\u01b0ng r\u01a1i v\u00e0o c\u00e1c tr\u01b0\u1eddng h\u1ee3p sau \u0111\u00e2y v\u1eabn \u0111i\u1ec1u tr\u1ecb ph\u00e1c \u0111\u1ed3 24 th\u00e1ng:<\/p>\n
\u00b7 Th\u01b0\u01a1ng t\u1ed5n lan t\u1ecfa, vi\u1ec1n b\u1edd \u0111\u1ecf t\u1ea5y<\/p>\n
\u00b7 C\u00f3 th\u01b0\u01a1ng t\u1ed5n v\u1ec7 tinh<\/p>\n
\u00b7 Th\u01b0\u01a1ng t\u1ed5n l\u1edbn<\/p>\n
\u00b7 Nhi\u1ec1u v\u00e0 th\u01b0\u01a1ng t\u1ed5n 2 b\u00ean \u0111\u1ed1i x\u1ee9ng<\/p>\n","protected":false},"excerpt":{"rendered":"
C\u00c1C TH\u01af\u01a0NG T\u1ed4N C\u01a0 B\u1ea2N 1. Th\u01b0\u01a1ng t\u1ed5n l\u1ecfng L\u00e0 nh\u1eefng th\u01b0\u01a1ng t\u1ed5n do ch\u1ee9a 1 ch\u1ea5t l\u1ecfng t\u1ea1o th\u00e0nh, ch\u1ea5t l\u1ecfng \u0111\u00f3 c\u00f3 th\u1ec3 trong, s\u00e1ch, \u0111\u1ee5c, ch\u1ee9a m\u00e1u, m\u1ee7,… 1.1. M\u1ee5n n\u01b0\u1edbc:\u00a0Sang th\u01b0\u01a1ng <5mm nh\u00f4 cao tr\u00ean m\u1eb7t da ch\u1ee9a n\u01b0\u1edbc trong, m\u1ee5n n\u01b0\u1edbc c\u00f3 th\u1ec3 ch\u1ea3y n\u01b0\u1edbc \u0111\u00f3ng m\u00e0i V\u00ed d\u1ee5:\u00a0Gh\u1ebb, ch\u00e0m, …<\/p>\n","protected":false},"author":11,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[84],"tags":[],"class_list":["post-1361","post","type-post","status-publish","format-standard","","category-da-lieu"],"_links":{"self":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/1361","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/comments?post=1361"}],"version-history":[{"count":1,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/1361\/revisions"}],"predecessor-version":[{"id":1362,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/1361\/revisions\/1362"}],"wp:attachment":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media?parent=1361"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/categories?post=1361"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/tags?post=1361"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}