{"id":4237,"date":"2017-07-21T09:17:37","date_gmt":"2017-07-21T02:17:37","guid":{"rendered":"https:\/\/yhoccongdong.org\/du-an-khac\/2018\/08\/17\/viem-mui-di-ung\/"},"modified":"2024-03-17T02:51:51","modified_gmt":"2024-03-16T19:51:51","slug":"viem-mui-di-ung-nhip-cau-duoc-lam-sang","status":"publish","type":"post","link":"https:\/\/yhoccongdong.com\/du-an-khac\/viem-mui-di-ung-nhip-cau-duoc-lam-sang\/","title":{"rendered":"Vi\u00eam m\u0169i d\u1ecb \u1ee9ng"},"content":{"rendered":"<p><strong><em>Bi\u00ean d\u1ecbch: SV \u0110\u1eb7ng Th\u1ecb Huy\u1ec1n Trang \u0110H Y d\u01b0\u1ee3c H\u00e0 N\u1ed9i<\/em><\/strong><\/p>\n<p><strong><em>Hi\u1ec7u \u0111\u00ednh: TS. DS. V\u00f5 Th\u1ecb H\u00e0 &#8211; Nh\u1ecbp c\u1ea7u d\u01b0\u1ee3c l\u00e2m s\u00e0ng<\/em><\/strong><\/p>\n<p><span style=\"line-height: 1.6em;\"> Vi\u00eam m\u0169i d\u1ecb \u1ee9ng (VMDU)\u00a0theo m\u00f9a (s\u1ed1t m\u00f9a c\u1ecf kh\u00f4 \u2013 t\u00ean ti\u1ebfng anh &#8220;hay fever&#8221;) \u1ea3nh h\u01b0\u1edfng t\u1edbi 10-15% ng\u01b0\u1eddi M\u0129, v\u00e0 h\u00e0ng tri\u1ec7u b\u1ec7nh nh\u00e2n c\u1ea7n thu\u1ed1c OTC \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb. C\u00e1c tri\u1ec7u ch\u1ee9ng vi\u00eam m\u0169i d\u1ecb \u1ee9ng x\u1ea3y ra sau m\u1ed9t \u0111\u00e1p \u1ee9ng vi\u00eam, li\u00ean quan \u0111\u1ebfn gi\u1ea3i ph\u00f3ng histamin do l\u1eafng \u0111\u1ecdng c\u00e1c d\u1ecb nguy\u00ean g\u00e2y d\u1ecb \u1ee9ng \u1edf ni\u00eam m\u1ea1c m\u0169i. C\u00e1c kh\u00e1ng nguy\u00ean \u0111\u00f3ng vai tr\u00f2 l\u00e0 t\u00e1c nh\u00e2n g\u00e2y VMDU \u1edf \u0111\u00e2y g\u1ed3m c\u00e1c lo\u1ea1i ph\u1ea5n hoa, b\u00e0o t\u1eed n\u1ea5m m\u1ed1c. VMDU m\u1ea1n t\u00ednh l\u00e0 th\u1ec3 b\u1ec7nh k\u00e9o d\u00e0i nhi\u1ec1u n\u0103m v\u00e0 nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh th\u01b0\u1eddng do kh\u00f3i b\u1ee5i, l\u00f4ng c\u00e1c lo\u1ea1i \u0111\u1ed9ng v\u1eadt.\u00a0\u00a0Trong s\u1ed1 \u0111\u00f3, \u1edf m\u1ed9t v\u00e0i BN, b\u1ec7nh th\u01b0\u1eddng n\u1eb7ng l\u00ean v\u00e0o m\u00f9a h\u00e8. <\/span><\/p>\n<table style=\"width: 500px;\" border=\"1\" cellspacing=\"1\" cellpadding=\"1\">\n<tbody>\n<tr>\n<td>Nh\u1eefng \u0111i\u1ec1u b\u1ea1n c\u1ea7n bi\u1ebft<\/td>\n<\/tr>\n<tr>\n<td>Tu\u1ed5i<\/p>\n<ul>\n<li>Tr\u1ebb s\u01a1 sinh, tr\u1ebb em, ng\u01b0\u1eddi gi\u00e0<\/li>\n<\/ul>\n<p>Th\u1eddi gian m\u1eafc b\u1ec7nh<\/p>\n<p>Tri\u1ec7u ch\u1ee9ng<\/p>\n<ul>\n<li>Ch\u1ea3y n\u01b0\u1edbc m\u0169i<\/li>\n<li>Xung huy\u1ebft m\u0169i<\/li>\n<li>Ng\u1ee9a m\u0169i<\/li>\n<li>M\u1eaft \u0111\u1eabm n\u01b0\u1edbc<\/li>\n<li>K\u00edch \u1ee9ng m\u1eaft<\/li>\n<li>Ch\u1ea3y n\u01b0\u1edbc m\u1eaft<\/li>\n<li>H\u1eaft h\u01a1i<\/li>\n<\/ul>\n<p>Ti\u1ec1n s\u1eed<\/p>\n<p>B\u1ec7nh m\u1eafc k\u00e8m<\/p>\n<ul>\n<li>Eczema<\/li>\n<li>Hen suy\u1ec5n<\/li>\n<\/ul>\n<p>Thu\u1ed1c<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2 id=\"tuoi\">Tu\u1ed5i<\/h2>\n<p>C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a VMDU c\u00f3 th\u1ec3 kh\u1edfi ph\u00e1t \u1edf b\u1ea5t k\u1ef3 l\u1ee9a tu\u1ed5i n\u00e0o, nh\u01b0ng th\u01b0\u1eddng \u1edf tr\u1ebb em v\u00e0 ng\u01b0\u1eddi tr\u1ebb tu\u1ed5i h\u01a1n (l\u1ee9a tu\u1ed5i hay m\u1eafc b\u1ec7nh nh\u1ea5t t\u1eeb 20-30 tu\u1ed5i). C\u00f3 m\u1ed1i li\u00ean quan gi\u1eefa ti\u1ec1n s\u1eed gia \u0111\u00ecnh d\u1ecb \u1ee9ng v\u00e0 b\u1ec7nh. Do \u0111\u00f3, con c\u00e1i nh\u1eefng b\u1ec7nh nh\u00e2n VMDU c\u00f3 nguy c\u01a1 m\u1eafc b\u1ec7nh cao h\u01a1n b\u00ecnh th\u01b0\u1eddng. Nguy c\u01a1 m\u1eafc b\u1ec7nh c\u0169ng gi\u1ea3m d\u1ea7n theo \u0111\u1ed9 tu\u1ed5i. Do \u0111\u00f3, y\u1ebfu t\u1ed1 tu\u1ed5i t\u00e1c ph\u1ea3i \u0111\u01b0\u1ee3c xem x\u00e9t khi ch\u1ec9 \u0111\u1ecbnh thu\u1ed1c cho b\u1ec7nh nh\u00e2n. V\u1edbi nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng tr\u1ebb tu\u1ed5i th\u01b0\u1eddng ph\u1ea3i lo h\u1ecdc h\u00e0nh, thi c\u1eed, ki\u1ec3m tra n\u00ean c\u1ea7n c\u00e2n nh\u1eafc c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb, t\u1ed1t nh\u1ea5t n\u00ean tr\u00e1nh d\u00f9ng thu\u1ed1c c\u00f3 th\u1ec3 g\u00e2y bu\u1ed3n ng\u1ee7 tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n n\u00e0y.<\/p>\n<h2 id=\"thoi-gian-mac-benh\">Th\u1eddi gian m\u1eafc b\u1ec7nh<\/h2>\n<p>Nhi\u1ec1u b\u1ec7nh nh\u00e2n m\u00f4 t\u1ea3 b\u1ecb VMDU theo m\u00f9a khi m\u00e0 l\u01b0\u1ee3ng ph\u1ea5n hoa ph\u00e1t t\u00e1n nhi\u1ec1u h\u01a1n. C\u00e1c tri\u1ec7u ch\u1ee9ng b\u1ec7nh c\u00f3 th\u1ec3 b\u1eaft \u0111\u1ea7u v\u00e0o th\u00e1ng 4 khi m\u00e0 ph\u1ea5n hoa ph\u00e1t t\u00e1n, v\u00e0 m\u00f9a d\u1ec5 m\u1eafc VMDU \u1edf mi\u1ec1n nam n\u01b0\u1edbc Anh c\u00f3 th\u1ec3 s\u1edbm h\u01a1n 1 th\u00e1ng so v\u1edbi mi\u1ec1n b\u1eafc. Cao \u0111i\u1ec3m b\u1ec7nh VMDU l\u00e0 v\u00e0o gi\u1eefa th\u00e1ng 5 t\u1edbi th\u00e1ng 7- kho\u1ea3ng th\u1eddi gian ph\u1ea5n hoa r\u1ed9 nhi\u1ec1u nh\u1ea5t trong n\u0103m v\u00e0 \u0111i\u1ec1u ki\u1ec7n th\u1eddi ti\u1ebft thu\u1eadn l\u1ee3i cho ph\u00e1t tri\u1ec3n b\u1ec7nh. V\u00ec th\u1ebf r\u1ea5t nhi\u1ec1u BN t\u00ecm \u0111\u1ebfn c\u00e1c D\u01b0\u1ee3c s\u0129 \u0111\u1ec3 \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n. M\u1ed9t v\u00e0i b\u1ec7nh nh\u00e2n b\u1ecb c\u1ea3m l\u1ea1nh m\u00f9a h\u00e8, c\u00f3 l\u1ebd trong v\u00e0i tu\u1ea7n, c\u00f3 th\u1ec3 l\u00e0 do VMDU. B\u00e0o t\u1eed n\u1ea5m c\u0169ng l\u00e0 m\u1ed9t nguy\u00ean nh\u00e2n nh\u01b0ng g\u00e2y b\u1ec7nh h\u01a1i mu\u1ed9n h\u01a1n, th\u01b0\u1eddng v\u00e0o t\u1eadn th\u00e1ng 12. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 m\u1eafc nh\u1eefng tri\u1ec7u ch\u1ee9ng nh\u01b0 c\u1ea3m nh\u1eb9 trong m\u1ed9t th\u1eddi gian d\u00e0i m\u00e0 kh\u00f4ng h\u1ec1 bi\u1ebft h\u1ecd b\u1ecb VMDU m\u1ea1n t\u00ednh.<\/p>\n<p>Ph\u00e2n lo\u1ea1i VMDU g\u1ed3m:<\/p>\n<ul>\n<li>VMDU gi\u00e1n \u0111o\u1ea1n: B\u1ec7nh k\u00e9o d\u00e0i \u00edt h\u01a1n 4 ng\u00e0y trong 1 tu\u1ea7n ho\u1eb7c \u00edt h\u01a1n 4 tu\u1ea7n.<\/li>\n<li>VMDU dai d\u1eb3ng: K\u00e9o d\u00e0i h\u01a1n 4 ng\u00e0y 1 tu\u1ea7n v\u00e0 tr\u00ean 4 tu\u1ea7n<\/li>\n<li>VMDU m\u1ee9c \u0111\u1ed9 nh\u1eb9: BN ng\u1ee7 ngh\u1ec9, ho\u1ea1t \u0111\u1ed9ng, l\u00e0m vi\u1ec7c &#8230;.b\u00ecnh th\u01b0\u1eddng; c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00f4ng \u0111\u00e1ng lo ng\u1ea1i.<\/li>\n<li>VMDU m\u1ee9c \u0111\u1ed9 trung b\u00ecnh: m\u1ed9t hay nhi\u1ec1u c\u00e1c ho\u1ea1t \u0111\u1ed9ng nh\u01b0 ng\u1ee7 ngh\u1ec9, l\u00e0m vi\u1ec7c, h\u1ecdc t\u1eadp &#8230; kh\u00f4ng \u0111\u01b0\u1ee3c nh\u01b0 b\u00ecnh th\u01b0\u1eddng, c\u00e1c tri\u1ec7u ch\u1ee9ng \u0111\u00e1ng lo ng\u1ea1i.<\/li>\n<\/ul>\n<h2 id=\"trieu-chung\">Tri\u1ec7u ch\u1ee9ng<\/h2>\n<p><em> <strong> Ch\u1ea3y n\u01b0\u1edbc m\u0169i <\/strong> <\/em><\/p>\n<p>L\u00e0 tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p c\u1ee7a b\u1ec7nh. N\u01b0\u1edbc m\u0169i th\u01b0\u1eddng lo\u00e3ng, trong, nhi\u1ec1u n\u01b0\u1edbc, nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 chuy\u1ec3n sang \u0111\u1eb7c h\u01a1n, c\u00f3 m\u00e0u v\u00e0 c\u00f3 m\u1ee7. Nh\u1eefng tri\u1ec7u ch\u1ee9ng n\u00e0y g\u1ee3i \u00fd t\u1edbi m\u1ed9t nhi\u1ec5m tr\u00f9ng th\u1ee9 ph\u00e1t, m\u1eb7c d\u00f9 vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh kh\u00f4ng c\u00f3 g\u00ec thay \u0111\u1ed5i. V\u00e0 kh\u00f4ng c\u1ea7n thi\u1ebft ph\u1ea3i s\u1eed d\u1ee5ng kh\u00e1ng sinh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng th\u1ee9 ph\u00e1t n\u00e0y.<br \/>\nNgh\u1eb9t m\u0169i<\/p>\n<p>\u0110\u00e1p \u1ee9ng vi\u00eam g\u00e2y ra b\u1edfi t\u00e1c nh\u00e2n g\u00e2y d\u1ecb \u1ee9ng, g\u00e2y xung huy\u1ebft, l\u00e0m gi\u00e3n c\u00e1c mao m\u1ea1ch m\u0169i, k\u1ebft qu\u1ea3 l\u00e0 g\u00e2y ngh\u1eb9t m\u0169i. N\u1ebfu t\u00ecnh tr\u1ea1ng ngh\u1eb9t m\u0169i nghi\u00eam tr\u1ecdng c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn \u0111au \u0111\u1ea7u, v\u00e0 \u0111\u00f4i khi l\u00e0 \u0111au tai. Nhi\u1ec5m tr\u00f9ng th\u1ee9 ph\u00e1t nh\u01b0 vi\u00eam tai gi\u1eefa, vi\u00eam xoang c\u00f3 th\u1ec3 x\u1ea3y ra. (xem trang 21)<\/p>\n<h3><\/h3>\n<p><strong> <em> Ng\u1ee9a m\u0169i <\/em> <\/strong><\/p>\n<p>Ng\u1ee9a m\u0169i th\u01b0\u1eddng x\u1ea3y ra. \u0110\u00f4i khi c\u00f2n c\u00f3 th\u1ec3 b\u1ecb k\u00edch \u1ee9ng, ng\u1ee9a \u1edf v\u00f2m mi\u1ec7ng.<\/p>\n<p><em> <strong> C\u00e1c bi\u1ec3u hi\u1ec7n \u1edf m\u1eaft <\/strong> <\/em><\/p>\n<p>M\u1eaft c\u00f3 th\u1ec3 b\u1ecb k\u00edch \u1ee9ng, ch\u1ea3y n\u01b0\u1edbc m\u1eaft; do t\u1eafc \u1ed1ng l\u1ec7. Nguy\u00ean nh\u00e2n c\u0169ng l\u00e0 do b\u1ecb k\u00edch \u1ee9ng b\u1edfi ph\u1ea5n hoa, g\u00e2y \u0111\u00e1p \u1ee9ng vi\u00eam t\u1ea1i ch\u1ed7. Nh\u1eefng k\u00edch \u1ee9ng t\u1ea1i m\u0169i do ph\u1ea5n hoa c\u00f3 th\u1ec3 c\u0169ng g\u00f3p m\u1ed9t ph\u1ea7n g\u00e2y ra c\u00e1c bi\u1ec3u hi\u1ec7n nh\u01b0 tr\u00ean t\u1ea1i m\u1eaft. M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n vi\u00eam m\u0169i d\u1ecb \u1ee9ng tr\u1ea7m tr\u1ecdng c\u00f3 th\u1ec3 t\u0103ng nh\u1ea1y c\u1ea3m v\u1edbi \u00e1nh s\u00e1ng, v\u00ec v\u1eady n\u00ean \u0111eo k\u00ednh r\u00e2m \u0111\u1ec3 tr\u00e1nh ti\u1ebfp x\u00fac tr\u1ef1c ti\u1ebfp v\u1edbi \u00e1nh s\u00e1ng.<\/p>\n<h3><\/h3>\n<p><strong> <em> H\u1eaft h\u01a1i <\/em> <\/strong><\/p>\n<p>Trong VMDU, \u0111\u00e1p \u1ee9ng b\u1ec7nh th\u01b0\u1eddng b\u1eaft \u0111\u1ea7u b\u1eb1ng tri\u1ec7u ch\u1ee9ng h\u1eaft h\u01a1i, sau \u0111\u00f3 \u0111\u1ebfn ch\u1ea3y n\u01b0\u1edbc m\u0169i, v\u00e0 ti\u1ebfp \u0111\u1ebfn l\u00e0 ng\u1ea1t m\u0169i. C\u00e1c tri\u1ec7u ch\u1ee9ng b\u1ec7nh th\u01b0\u1eddng t\u0103ng l\u00ean v\u1ec1 s\u00e1ng v\u00e0 t\u1ed1i, b\u1edfi v\u00ec ph\u1ea5n hoa s\u1ebd l\u01a1 l\u1eedng trong kh\u00f4ng kh\u00ed c\u1ea3 ng\u00e0y, sau khi \u0111\u01b0\u1ee3c ph\u00e1t t\u00e1n v\u00e0o bu\u1ed5i s\u00e1ng v\u00e0 d\u1ea7n l\u1eafng xu\u1ed1ng v\u00e0o bu\u1ed5i t\u1ed1i. M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u0169ng c\u00f3 th\u1ec3 m\u00f4 t\u1ea3 l\u1ea1i r\u1eb1ng b\u1ec7nh c\u1ee7a h\u1ecd n\u1eb7ng h\u01a1n v\u00e0o nh\u1eefng ng\u00e0y nhi\u1ec1u gi\u00f3 &#8211; khi ph\u1ea5n hoa \u0111\u01b0\u1ee3c ph\u00e1t t\u00e1n nhi\u1ec1u h\u01a1n; gi\u1ea3m khi tr\u1eddi m\u01b0a, ho\u1eb7c l\u00e0 sau m\u01b0a, khi kh\u00f4ng kh\u00ed tr\u1edf n\u00ean trong l\u00e0nh v\u00e0 \u00edt ph\u1ea5n hoa bay l\u01a1 l\u1eedng.<\/p>\n<p>Ng\u01b0\u1ee3c l\u1ea1i, v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc do d\u1ecb \u1ee9ng n\u1ea5m m\u1ed1c, c\u00e1c tri\u1ec7u ch\u1ee9ng s\u1ebd n\u1eb7ng th\u00eam trong \u0111i\u1ec1u ki\u1ec7n th\u1eddi ti\u1ebft \u1ea9m \u01b0\u1edbt.<\/p>\n<h2 id=\"tien-su\">Ti\u1ec1n s\u1eed<\/h2>\n<p>VMDU tr\u1edf n\u00ean ph\u1ed5 bi\u1ebfn v\u00e0o v\u00e0i n\u0103m tr\u1edf l\u1ea1i \u0111\u00e2y. B\u1ec7nh c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf b\u1ea5t k\u00ec \u0111\u1ed9 tu\u1ed5i n\u00e0o, v\u00ec v\u1eady kh\u00f4ng quan tr\u1ecdng l\u00e0 b\u1ec7nh nh\u00e2n \u0111\u00e3 c\u00f3 ti\u1ec1n s\u1eed m\u1eafc VMDU ch\u01b0a. S\u1ed1 ca m\u1eafc VMDU t\u0103ng l\u00ean trong su\u1ed1t th\u1eadp k\u1ef7 qua. T\u00ecnh tr\u1ea1ng \u00f4 nhi\u1ec5m, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u00f4 nhi\u1ec5m \u1edf khu \u0111\u00f4 th\u1ecb \u0111\u00e3 g\u00f3p ph\u1ea7n to l\u1edbn g\u00e2y n\u00ean v\u1ea5n n\u1ea1n n\u00e0y. Vi\u00eam m\u0169i m\u1ea1n t\u00ednh v\u00e0 vi\u00eam m\u0169i d\u1ecb \u1ee9ng theo m\u00f9a c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e2n bi\u1ec7t b\u1edfi th\u1eddi gian xu\u1ea5t hi\u1ec7n tri\u1ec7u ch\u1ee9ng v\u00e0 di\u1ec5n bi\u1ebfn b\u1ec7nh. B\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed m\u1eafc VMDU tr\u01b0\u1edbc \u0111\u00f3 c\u1ea7n \u0111\u01b0\u1ee3c d\u01b0\u1ee3c s\u0129 t\u01b0 v\u1ea5n, khi c\u00e1c tri\u1ec7u ch\u1ee9ng n\u1eb7ng th\u00eam v\u00e0o nh\u1eefng th\u00e1ng m\u00f9a h\u00e8.<\/p>\n<h2 id=\"cac-dau-hieu-nguy-hiem-va-yeu-to-lien-quan\">C\u00e1c d\u1ea5u hi\u1ec7u nguy hi\u1ec3m v\u00e0 y\u1ebfu t\u1ed1 li\u00ean quan<\/h2>\n<p>Khi xu\u1ea5t hi\u1ec7n c\u00e1c bi\u1ec3u hi\u1ec7n nh\u01b0: t\u1ee9c ng\u1ef1c, th\u1edf kh\u00f2 kh\u00e8, kh\u00f3 th\u1edf hay ho, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c khuy\u00ean n\u00ean l\u1eadp t\u1ee9c g\u1eb7p b\u00e1c s\u0129. B\u1edfi nh\u1eefng d\u1ea5u hi\u1ec7u n\u00e0y c\u00f3 th\u1ec3 b\u00e1o tr\u01b0\u1edbc cho m\u1ed9t c\u01a1n hen kh\u1edfi ph\u00e1t.<\/p>\n<p><strong> <em> Th\u1edf kh\u00f2 kh\u00e8 <\/em> <\/strong><\/p>\n<p>C\u00e1c bi\u1ec3u hi\u1ec7n nh\u01b0 kh\u00f3 th\u1edf, c\u00f3 th\u1ec3 k\u00e8m theo ho l\u00e0 g\u1ee3i \u00fd s\u1ebd d\u1eabn \u0111\u1ebfn m\u1ed9t c\u01a1n hen sau \u0111\u00f3. M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n ch\u1ec9 b\u1ecb hen trong m\u00f9a m\u1eafc VMDU (hen theo m\u00f9a). Giai \u0111o\u1ea1n n\u00e0y c\u00f3 th\u1ec3 kh\u00e1 nghi\u00eam tr\u1ecdng v\u00e0 y\u00eau c\u1ea7u c\u1ea7n \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n. B\u1ec7nh hen theo m\u00f9a th\u01b0\u1eddng kh\u00f4ng c\u00f3 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u tay th\u00edch h\u1ee3p b\u1edfi c\u00e1c c\u01a1n hen xu\u1ea5t hi\u1ec7n kh\u00f4ng th\u01b0\u1eddng xuy\u00ean, v\u00ec v\u1eady, nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y c\u00f3 nguy c\u01a1 cao h\u01a1n b\u1ecb c\u01a1n hen do kh\u00f4ng d\u00f9ng thu\u1ed1c ph\u00f2ng.<\/p>\n<h3><\/h3>\n<p><strong> <em> \u0110au tai m\u1eb7t <\/em> <\/strong><\/p>\n<p>T\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u1ea3m l\u1ea1nh v\u00e0 c\u1ea3m c\u00fam (xem trang 21), VMDU ho\u00e0n to\u00e0n c\u00f3 th\u1ec3 \u0111\u1eabn \u0111\u1ebfn m\u1ed9t nhi\u1ec5m tr\u00f9ng th\u1ee9 ph\u00e1t \u1edf tai gi\u1eefa (vi\u00eam tai gi\u1eefa), ho\u1eb7c \u1edf xoang (vi\u00eam xoang). C\u1ea3 2 nhi\u1ec5m tr\u00f9ng th\u1ee9 ph\u00e1t n\u00e0y \u0111\u1ec1u g\u00e2y \u0111au dai d\u1eb3ng k\u00e9o d\u00e0i.<\/p>\n<p><strong> <em> Vi\u00eam k\u1ebft m\u1ea1c m\u1ee7 <\/em> <\/strong><\/p>\n<p>Ch\u1ea3y n\u01b0\u1edbc m\u1eaft v\u00e0 k\u00edch \u1ee9ng m\u1eaft th\u01b0\u1eddng \u0111i k\u00e8m v\u1edbi VMDU. \u0110\u00f4i khi, vi\u00eam k\u1ebft m\u1ea1c do d\u1ecb \u1ee9ng r\u1ea5t ph\u1ee9c t\u1ea1p v\u00e0 l\u00e0 m\u1ed9t nhi\u1ec5m tr\u00f9ng th\u1ee9 ph\u00e1t; v\u1edbi nh\u1eefng bi\u1ec3u hi\u1ec7n nh\u01b0: \u0111au m\u1eaft (c\u1ea3m gi\u00e1c nh\u01b0 m\u1eaft c\u00f3 s\u1ea1n), m\u1eaft \u0111\u1ecf h\u01a1n, n\u01b0\u1edbc m\u1eaft b\u00ecnh th\u01b0\u1eddng trong bi\u1ebfn th\u00e0nh c\u00f3 m\u00e0u v\u00e0 d\u00ednh (c\u00f3 m\u1ee7). Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, BN c\u1ea7n th\u00f4ng b\u00e1o v\u1edbi nh\u00e2n vi\u00ean y t\u1ebf.<\/p>\n<h2 id=\"thuoc\">Thu\u1ed1c<\/h2>\n<p>D\u01b0\u1ee3c\u00a0s\u0129 ph\u1ea3i lu\u00f4n h\u1ecfi ti\u1ec1n s\u1eed d\u00f9ng thu\u1ed1c c\u1ee7a BN, t\u1ea5t c\u1ea3 thu\u1ed1c k\u00ea \u0111\u01a1n v\u00e0 thu\u1ed1c kh\u00f4ng k\u00ea \u0111\u01a1n. Nh\u1edd \u0111\u00f3 m\u1edbi c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n ra t\u01b0\u01a1ng t\u00e1c thu\u1ed1c ti\u1ec1m t\u00e0ng gi\u1eefa c\u00e1c thu\u1ed1c \u0111\u01b0\u1ee3c d\u00f9ng v\u00e0 c\u00e1c kh\u00e1ng histamin \u0111i\u1ec1u tr\u1ecb. C\u1ea7n thi\u1ebft ph\u1ea3i t\u00ecm hi\u1ec3u nh\u1eefng thu\u1ed1c m\u00e0 BN \u0111\u00e3 d\u00f9ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng b\u1ec7nh, \u0111\u1eb7c bi\u1ec7t trong tr\u01b0\u1eddng h\u1ee3p BN c\u00f3 ti\u1ec1n s\u1eed VMDU. B\u00ean c\u1ea1nh \u0111\u00f3 ng\u01b0\u1eddi DS c\u1ea7n nh\u1eadn bi\u1ebft c\u00e1c t\u01b0\u01a1ng t\u00e1c thu\u1ed1c l\u00e0m t\u0103ng c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 nh\u01b0 l\u01a1 m\u01a1, ng\u1ee7 g\u00e0 do d\u00f9ng kh\u00e1ng histamin ph\u1ed1i h\u1ee3p c\u00e1c thu\u1ed1c kh\u00e1c. T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n g\u00e2y bu\u1ed3n ng\u1ee7 n\u00e0y c\u00f3 th\u1ec3 g\u00e2y nguy hi\u1ec3m cho b\u1ec7nh nh\u00e2n l\u00e0m m\u1ed9t s\u1ed1 ng\u00e0nh ngh\u1ec1 nh\u1ea5t \u0111\u1ecbnh, hay trong khi l\u00e1i xe.<\/p>\n<h3><\/h3>\n<p><strong> <em> Th\u1ea5t b\u1ea1i trong \u0111i\u1ec1u tr\u1ecb <\/em> <\/strong><\/p>\n<p>N\u1ebfu \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c thu\u1ed1c OTC kh\u00f4ng ki\u1ec3m so\u00e1t t\u1ed1t c\u00e1c tri\u1ec7u ch\u1ee9ng b\u1ec7nh, l\u00fac n\u00e0y b\u1ec7nh nh\u00e2n c\u1ea7n t\u1edbi th\u0103m kh\u00e1m b\u00e1c s\u0129, \u0111\u1ec3 gi\u00fap b\u1ec7nh nh\u00e2n tin t\u01b0\u1edfng \u0111i\u1ec1u tr\u1ecb v\u00e0 c\u00f3 th\u00eam hi\u1ec3u bi\u1ebft v\u1ec1 VMDU, t\u1eeb \u0111\u00f3 ki\u1ec3m so\u00e1t b\u1ec7nh t\u1ed1t h\u01a1n. \u0110\u1ed3ng th\u1eddi c\u0169ng gi\u00fap BN chu\u1ea9n b\u1ecb t\u1ed1t cho m\u00ecnh n\u1ebfu BN t\u00e1i ph\u00e1t VMDU v\u00e0o m\u00f9a sau.<\/p>\n<table style=\"width: 500px;\" border=\"1\" cellspacing=\"1\" cellpadding=\"1\">\n<tbody>\n<tr>\n<td>Khi n\u00e0o c\u1ea7n \u0111i kh\u00e1m b\u1ec7nh<\/td>\n<\/tr>\n<tr>\n<td>Kh\u00f2 kh\u00e8, kh\u00f3 th\u1edf<\/p>\n<p>T\u1ee9c ng\u1ef1c<\/p>\n<p>Vi\u00eam tai<\/p>\n<p>Vi\u00eam xoang<\/p>\n<p>Vi\u00eam k\u1ebft m\u1ea1c c\u00f3 m\u1ee7<\/p>\n<p>Th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2 id=\"thoi-gian-dieu-tri\">Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb<\/h2>\n<p>Nhanh ch\u00f3ng \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng\u00a0\u00a0ngay trong nh\u1eefng ng\u00e0y \u0111\u1ea7u. N\u1ebfu sau 5 ng\u00e0y, t\u00ecnh tr\u1ea1ng b\u1ec7nh kh\u00f4ng c\u00f3 ti\u1ebfn tri\u1ec3n, b\u1ec7nh nh\u00e2n c\u1ea7n l\u1eadp t\u1ee9c t\u1edbi kh\u00e1m b\u1ec7nh \u0111\u1ec3 \u0111\u01b0\u1ee3c b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb th\u00edch h\u1ee3p.<\/p>\n<h2 id=\"quan-ly-benh\">Qu\u1ea3n l\u00fd b\u1ec7nh<\/h2>\n<p>Qu\u1ea3n l\u00fd b\u1ec7nh ph\u1ee5 thu\u1ed9c c\u00e1c tri\u1ec7u ch\u1ee9ng mang t\u00ednh ch\u1ea5t li\u00ean t\u1ee5c hay gi\u00e1n \u0111o\u1ea1n, m\u1ee9c \u0111\u1ed9 nh\u1eb9 hay trung b\u00ecnh. \u0110i\u1ec1u tr\u1ecb g\u1ed3m: kh\u00e1ng histamin, steroid d\u00f9ng theo \u0111\u01b0\u1eddng m\u0169i, Natri cromoglycat d\u1ea1ng b\u00e0o ch\u1ebf cho m\u1eaft v\u00e0 m\u0169i. C\u00e1c kh\u00e1ng histamin kh\u00f4ng k\u00ea \u0111\u01a1n v\u00e0 thu\u1ed1c x\u1ecbt m\u0169i steroid kh\u00e1 c\u00f3 hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb VMDU. L\u1ef1a ch\u1ecdn thu\u1ed1c \u0111i\u1ec1u tr\u1ecb ph\u1ea3i ph\u00f9 h\u1ee3p v\u00e0 c\u0103n c\u1ee9 v\u00e0o c\u00e1c tri\u1ec7u ch\u1ee9ng b\u1ec7nh v\u00e0 ti\u1ec1n s\u1eed b\u1ec7nh nh\u00e2n. Nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n VMDU c\u00f3 th\u1ec3 ch\u1ec9 c\u1ea7n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c OTC v\u1edbi s\u1ef1 t\u01b0 v\u1ea5n c\u1ee7a d\u01b0\u1ee3c s\u0129. N\u1ebfu b\u1ec7nh nh\u00e2n \u0111\u00e3 d\u00f9ng thu\u1ed1c OTC tr\u00ean nh\u01b0ng kh\u00f4ng c\u00f3 \u0111\u00e1p \u1ee9ng t\u1ed1t, c\u1ea7n t\u1edbi b\u00e1c s\u0129 \u0111\u1ec3 \u0111\u01b0\u1ee3c kh\u00e1m b\u1ec7nh tr\u1ef1c ti\u1ebfp. L\u00fac n\u00e0y ng\u01b0\u1eddi d\u01b0\u1ee3c s\u0129 l\u1ea1i c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c t\u01b0 v\u1ea5n, h\u01b0\u1edbng d\u1eabn \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng ch\u00ednh x\u00e1c c\u00e1c thu\u1ed1c \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1c s\u0129 k\u00ea \u0111\u01a1n (v\u00ed d\u1ee5 nh\u01b0: h\u01b0\u1edbng d\u1eabn d\u00f9ng c\u00e1c thu\u1ed1c steroid d\u1ea1ng x\u1ecbt, lo\u1ea1i thu\u1ed1c ph\u1ea3i \u0111\u01b0\u1ee3c d\u00f9ng th\u01b0\u1eddng xuy\u00ean \u0111\u1ec3 l\u00e0m gi\u1ea3m c\u00e1c tri\u1ec7u ch\u1ee9ng VMDU cho BN)<\/p>\n<h3><\/h3>\n<p><strong> <em> C\u00e1c kh\u00e1ng histamin <\/em> <\/strong><\/p>\n<p>Nhi\u1ec1u d\u01b0\u1ee3c s\u0129 d\u00f9ng kh\u00e1ng histamin nh\u01b0 ch\u1ec9 \u0111\u1ecbnh \u0111\u1ea7u tay trong \u0111i\u1ec1u tr\u1ecb VMDU t\u1eeb nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh, k\u1ec3 c\u1ea3 VMDU gi\u00e1n \u0111o\u1ea1n hay li\u00ean t\u1ee5c. C\u00e1c kh\u00e1ng histamin t\u00e1c d\u1ee5ng t\u1ed1t trong \u0111i\u1ec1u tr\u1ecb l\u00e0m gi\u1ea3m nh\u1eb9 c\u00e1c tri\u1ec7u ch\u1ee9ng h\u1eaft h\u01a1i, s\u1ed5 m\u0169i; nh\u01b0ng l\u1ea1i \u00edt c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m gi\u1ea3m ng\u1ea1t m\u0169i. M\u1ed9t v\u00e0i kh\u00e1ng histamin kh\u00f4ng g\u00e2y bu\u1ed3n ng\u1ee7 s\u1eb5n c\u00f3 trong danh m\u1ee5c thu\u1ed1c OTC g\u1ed3m: acrivastin, cetirizin v\u00e0 loratadin. T\u1ea5t c\u1ea3 c\u00e1c thu\u1ed1c n\u00e0y \u0111\u1ec1u c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3m nh\u1eb9 tri\u1ec7u ch\u1ee9ng kh\u00f3 ch\u1ecbu c\u1ee7a VMDU v\u00e0 c\u00f3 \u01b0u \u0111i\u1ec3m \u00edt g\u00e2y bu\u1ed3n ng\u1ee7 h\u01a1n c\u00e1c kh\u00e1ng histamin th\u1ebf h\u1ec7 c\u0169.<\/p>\n<p>Cetirizin v\u00e0 loratadin ch\u1ec9 d\u00f9ng 1 l\u1ea7n\/1 ng\u00e0y, trong khi acrivastin l\u1ea1i d\u00f9ng 3 l\u1ea7n\/1 ng\u00e0y. Loratadin kh\u00f4ng k\u00ea \u0111\u01a1n c\u00f3 th\u1ec3 d\u00f9ng cho tr\u1ebb em tr\u00ean 2 tu\u1ed5i, cetirizin ch\u1ec9 \u0111\u1ecbnh \u0111\u01b0\u1ee3c cho tr\u1ebb em tr\u00ean 6 tu\u1ed5i v\u00e0 acrivastin l\u00e0 tr\u00ean 12 tu\u1ed5i.<\/p>\n<p>C\u1ea3 3 thu\u1ed1c tr\u00ean h\u1ea7u nh\u01b0 kh\u00f4ng g\u00e2y t\u00e1c d\u1ee5ng ph\u1ee5 bu\u1ed3n ng\u1ee7, c\u00f3 th\u1ec3 khuy\u00ean b\u1ec7nh nh\u00e2n th\u1eed \u0111i\u1ec1u tr\u1ecb trong v\u00f2ng 1 ng\u00e0y tr\u01b0\u1edbc khi l\u00e1i xe hay v\u1eadn h\u00e0nh m\u00e1y m\u00f3c. Loratadin c\u00f3 t\u00e1c d\u1ee5ng an th\u1ea7n h\u01a1n 2 thu\u1ed1c c\u00f2n l\u1ea1i, tuy nhi\u00ean r\u1ea5t hi\u1ebfm x\u1ea3y ra tai n\u1ea1n do t\u00e1c d\u1ee5ng g\u00e2y bu\u1ed3n ng\u1ee7 c\u1ee7a thu\u1ed1c n\u00e0y.<\/p>\n<h3><\/h3>\n<p>Acrivastin, cetirizin v\u00e0 loratadin c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p d\u1ecb \u1ee9ng da kh\u00e1c nh\u01b0 d\u1ecb \u1ee9ng da k\u00e9o d\u00e0i, m\u00e0y \u0111ay.<\/p>\n<p>C\u00e1c kh\u00e1ng histamin th\u1ebf h\u1ec7 c\u0169 nh\u01b0 promethazin v\u00e0 diphenhydramin c\u00f3 th\u1ec3 g\u00e2y t\u00e1c d\u1ee5ng an th\u1ea7n g\u00e2y ng\u1ee7. Qu\u1ea3 th\u1ef1c, trong th\u1ef1c t\u1ebf, \u1edf M\u1ef9 c\u00e1c thu\u1ed1c n\u00e0y \u0111\u01b0\u1ee3c b\u00e1n kh\u00f4ng k\u00ea \u0111\u01a1n m\u1ed9t c\u00e1ch r\u1ed9ng r\u00e3i \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb ch\u1ee9ng r\u1ed1i lo\u1ea1n gi\u1ea5c ng\u1ee7 nh\u1ea5t th\u1eddi (xem trang 318). Th\u1eddi gian b\u00e1n th\u1ea3i (t1\/2) c\u1ee7a diphenhydrazin l\u00e0 5-8 gi\u1edd ng\u1eafn h\u01a1n so v\u1edbi t1\/2 c\u1ee7a promethazin l\u00e0 8-12 gi\u1edd, n\u00ean \u00edt g\u00e2y t\u00edch l\u0169y thu\u1ed1c, do \u0111\u00f3 \u00edt g\u00e2y bu\u1ed3n ng\u1ee7 h\u01a1n promethazin.<\/p>\n<p>M\u1ed9t s\u1ed1 thu\u1ed1c kh\u00e1ng histamine th\u1ebf h\u1ec7 c\u0169 kh\u00e1c t\u01b0\u01a1ng \u0111\u1ed1i \u00edt t\u00e1c d\u1ee5ng an th\u1ea7n , nh\u01b0 chlorphenamine (chlorpheniramine). C\u00f3 th\u1ec3 do b\u1ec7nh nh\u00e2n dung n\u1ea1p v\u1edbi t\u00e1c d\u1ee5ng an th\u1ea7n c\u1ee7a thu\u1ed1c. Nh\u00ecn chung t\u00e1c d\u1ee5ng kh\u00e1ng cholinergic c\u1ee7a histamin th\u1ebf h\u1ec7 m\u1edbi l\u00e0 \u00edt h\u01a1n th\u1ebf h\u1ec7 c\u0169.<\/p>\n<h3><\/h3>\n<p><em> <strong> T\u01b0\u01a1ng t\u00e1c thu\u1ed1c <\/strong> <\/em><\/p>\n<p>T\u00e1c d\u1ee5ng an th\u1ea7n g\u00e2y ng\u1ee7 c\u1ee7a c\u00e1c kh\u00e1ng histamine th\u1ebf h\u1ec7 c\u0169 t\u0103ng l\u00ean khi BN u\u1ed1ng r\u01b0\u1ee3u, d\u00f9ng k\u00e8m c\u00e1c thu\u1ed1c g\u00e2y ng\u1ee7, gi\u1ea3m \u0111au, an th\u1ea7n. Do \u0111\u00f3 c\u1ea7n khuy\u1ebfn c\u00e1o cho BN.<\/p>\n<p>N\u1ed3ng \u0111\u1ed9 trong huy\u1ebft t\u01b0\u01a1ng c\u1ee7a c\u00e1c kh\u00e1ng histamin th\u1ebf h\u1ec7 m\u1edbi c\u00f3 th\u1ec3 b\u1ecb t\u0103ng b\u1edfi ritonavir. Amprenavir v\u00e0 cimetindin c\u00f3 th\u1ec3 l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 loratadine trong m\u00e1u. V\u1ec1 m\u1eb7t l\u00fd thuy\u1ebft, c\u00e1c histamine b\u1ecb \u0111\u1ed1i kh\u00e1ng t\u00e1c d\u1ee5ng b\u1edfi betahistine.<\/p>\n<h3><\/h3>\n<p><strong> <em> T\u00e1c d\u1ee5ng ph\u1ee5 <\/em> <\/strong><\/p>\n<p>TDKMM l\u1edbn nh\u1ea5t c\u1ee7a c\u00e1c kh\u00e1ng histamine th\u1ebf h\u1ec7 c\u0169 l\u00e0 g\u00e2y bu\u1ed3n ng\u1ee7. Ngo\u00e0i ra, do c\u01a1 ch\u1ebf kh\u00e1ng c\u1ea3 h\u1ec7 cholinergic n\u00ean c\u00e1c kh\u00e1ng histamin th\u1ebf h\u1ec7 c\u0169 c\u00f2n c\u00f3 th\u1ec3 g\u00e2y kh\u00f4 mi\u1ec7ng, nh\u00ecn m\u1edd, t\u00e1o b\u00f3n, b\u00ed ti\u1ec3u. Nh\u1eefng TDKMM n\u00e0y s\u1ebd gia t\u0103ng n\u1ebfu BN d\u00f9ng k\u00e8m theo c\u00e1c thu\u1ed1c kh\u00e1ng cholinergic kh\u00e1c nh\u01b0: thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m 3 v\u00f2ng, thu\u1ed1c an th\u1ea7n.<\/p>\n<p>\u1ede n\u1ed3ng \u0111\u1ed9 r\u1ea5t cao, c\u00e1c kh\u00e1ng histamine c\u00f3 th\u1ec3 g\u00e2y t\u00e1c d\u1ee5ng k\u00edch th\u00edch th\u1ea7n kinh trung \u01b0\u01a1ng h\u01a1n l\u00e0 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf, v\u00e0 th\u01b0\u1eddng hay g\u1eb7p \u1edf tr\u1ebb em h\u01a1n. \u1ede n\u1ed3ng \u0111\u1ed9 g\u00e2y \u0111\u1ed9c, c\u0169ng \u0111\u00e3 c\u00f3 nh\u1eefng b\u00e1o c\u00e1o ca l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o. Theo nh\u01b0 k\u1ebft qu\u1ea3 ch\u1ec9 ra, kh\u00e1ng histamine c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n \u0111\u1ed9ng kinh, tuy nhi\u00ean v\u1ec1 m\u1eb7t l\u00fd thuy\u1ebft l\u1ea1i c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u nguy c\u01a1 kh\u00e1c.<\/p>\n<p>Kh\u00e1ng histamin ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tuy\u1ec7t \u0111\u1ed1i cho b\u1ec7nh nh\u00e2n glaucom g\u00f3c h\u1eb9p v\u00e0 glaucom g\u00f3c \u0111\u00f3ng, b\u1edfi v\u00ec c\u01a1 ch\u1ebf kh\u00e1ng cholinergic c\u1ee7a thu\u1ed1c c\u00f3 th\u1ec3 g\u00e2y t\u00e1c d\u1ee5ng t\u0103ng nh\u00e3n \u00e1p. Th\u1eadn tr\u1ecdng d\u00f9ng thu\u1ed1c cho ng\u01b0\u1eddi b\u1ecb b\u1ec7nh gan v\u00e0 ng\u01b0\u1eddi ph\u00ec \u0111\u1ea1i tuy\u1ebfn ti\u1ec1n li\u1ec7t.<\/p>\n<h3><\/h3>\n<p><em> <strong> C\u00e1c thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m th\u00f4ng m\u0169i <\/strong> <\/em><\/p>\n<p>D\u00f9ng u\u1ed1ng hay nh\u1ecf c\u00e1c thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m th\u00f4ng m\u0169i m\u1ed9t c\u00e1ch \u0111\u01a1n \u0111\u1ed9c ho\u1eb7c ph\u1ed1i h\u1ee3p v\u1edbi kh\u00e1ng histamin trong th\u1eddi gian ng\u1eafn \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng ngh\u1eb9t m\u0169i. V\u1edbi nh\u1eefng b\u1ec7nh m\u1edbi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb, d\u00f9ng c\u00e1c thu\u1ed1c nh\u01b0 corticosteroid \u0111\u01b0\u1eddng m\u0169i (VD:betaclomethason) hay Natri cromoglicat c\u00f3 t\u00e1c d\u1ee5ng t\u1ed1t do gi\u00fap l\u00e0m th\u00f4ng m\u0169i, nh\u1edd \u0111\u00f3 thu\u1ed1c c\u00f3 th\u1ec3 ph\u00e2n b\u1ed1 v\u00e0o ni\u00eam m\u1ea1c m\u0169i. Tuy nhi\u00ean c\u00e1c thu\u1ed1c d\u00f9ng t\u1ea1i ch\u1ed7 n\u00e0y c\u00f3 th\u1ec3 g\u00e2y hi\u1ec7n t\u01b0\u1ee3ng \u201cd\u1ed9i ng\u01b0\u1ee3c\u201d ( l\u00e0m t\u0103ng ngh\u1eb9t m\u0169i), \u0111\u1eb7c bi\u1ec7t n\u1ebfu d\u00f9ng k\u00e9o d\u00e0i; do \u0111\u00f3 khuy\u1ebfn c\u00e1o kh\u00f4ng d\u00f9ng qu\u00e1 1 tu\u1ea7n. C\u00e1c thu\u1ed1c t\u00e1c d\u1ee5ng th\u00f4ng m\u0169i \u0111\u01b0\u1eddng u\u1ed1ng th\u01b0\u1eddng c\u00f3 ch\u1ee9a th\u00e0nh ph\u1ea7n pseudoephedrin. C\u00e1ch d\u00f9ng, t\u01b0\u01a1ng t\u00e1c thu\u1ed1c, TDKMM xem trong ph\u1ea7n b\u1ec7nh \u201cC\u1ea3m l\u1ea1nh v\u00e0 c\u1ea3m c\u00fam\u201d ( trang\u00a0\u00a024-25)<\/p>\n<p><strong> <em> C\u00e1c thu\u1ed1c nh\u1ecf m\u1eaft <\/em> <\/strong><\/p>\n<p>Th\u00e0nh ph\u1ea7n g\u1ed3m 1 kh\u00e1ng histamin ph\u1ed1i h\u1ee3p v\u1edbi 1 ch\u1ea5t c\u01b0\u1eddng giao c\u1ea3m v\u00e0 r\u1ea5t s\u1eb5n c\u00f3 tr\u00ean th\u1ecb tr\u01b0\u1eddng, t\u00e1c d\u1ee5ng \u0111i\u1ec1u tr\u1ecb c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00f3 ch\u1ecbu \u1edf m\u1eaft kh\u00e1 t\u1ed1t \u0111\u1eb7c bi\u1ec7t v\u1edbi nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u00e1c tri\u1ec7u ch\u1ee9ng n\u00e0y l\u00e0 gi\u00e1n \u0111o\u1ea1n. T\u00e1c d\u1ee5ng c\u01b0\u1eddng giao c\u1ea3m nh\u01b0 co m\u1ea1ch, l\u00e0m gi\u1ea3m k\u00edch \u1ee9ng v\u00e0 gi\u1ea3m \u0111\u1ecf m\u1eaft. C\u0169ng ch\u00ednh b\u1edfi t\u00e1c d\u1ee5ng g\u00e2y co m\u1ea1ch n\u00e0y, m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u1ea3m th\u1ea5y \u0111au nh\u00f3i, ch\u00e2m ch\u00edch l\u1ea7n \u0111\u1ea7u d\u00f9ng thu\u1ed1c. C\u00e1c thu\u1ed1c nh\u1ecf m\u1eaft c\u00f3 th\u00e0nh ph\u1ea7n g\u00e2y co m\u1ea1ch nh\u01b0 tr\u00ean kh\u00f4ng n\u00ean ch\u1ec9 \u0111\u1ecbnh cho ng\u01b0\u1eddi b\u1ec7nh t\u0103ng nh\u00e3n \u00e1p ho\u1eb7c nh\u1eefng ng\u01b0\u1eddi \u0111eo k\u00ednh \u00e1p tr\u00f2ng.<\/p>\n<h3><\/h3>\n<p><strong> <em> Thu\u1ed1c x\u1ecbt m\u0169i steroid <\/em> <\/strong><\/p>\n<p>Thu\u1ed1c x\u1ecbt m\u0169i beclomethason (d\u1ea1ng x\u1ecbt n\u01b0\u1edbc h\u01a1n l\u00e0 d\u1ea1ng phun m\u00f9) v\u00e0 b\u00ecnh x\u1ecbt m\u0169i \u0111\u1ecbnh li\u1ec1u fluticasone c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh VMDU theo m\u00f9a.<\/p>\n<p>Thu\u1ed1c x\u1ecbt m\u0169i steroid \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng xuy\u00ean trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p VMDU t\u1eeb trung b\u00ecnh t\u1edbi n\u1eb7ng. Thu\u1ed1c l\u00e0m gi\u1ea3m c\u00e1c tri\u1ec7u ch\u1ee9ng vi\u00eam do \u0111\u00e1p \u1ee9ng d\u1ecb \u1ee9ng. B\u1ec7nh nh\u00e2n c\u1ea7n s\u1eed d\u1ee5ng thu\u1ed1c n\u00e0y th\u01b0\u1eddng xuy\u00ean trong su\u1ed1t th\u1eddi gian b\u1ec7nh \u0111\u1ec3 \u0111\u1ea1t t\u00e1c d\u1ee5ng t\u1ed1t nh\u1ea5t. N\u1ebfu xu\u1ea5t hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u VMDU,b\u1ec7nh nh\u00e2n c\u1ea7n d\u00f9ng thu\u1ed1c trong v\u00e0i ng\u00e0y \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c t\u00e1c d\u1ee5ng \u0111\u1ea7y \u0111\u1ee7.<\/p>\n<p>TDKMM c\u1ee7a thu\u1ed1c bao g\u1ed3m: kh\u00f4 v\u00e0 k\u00edch \u1ee9ng m\u0169i h\u1ecdng, ch\u1ea3y m\u00e1u cam; c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 kh\u00e1c r\u1ea5t hi\u1ebfm x\u1ea3y ra. Thu\u1ed1c x\u1ecbt m\u0169i clometasone v\u00e0 beclometasone c\u00f3 th\u1ec3 d\u00f9ng cho ng\u01b0\u1eddi tr\u00ean 18 tu\u1ed5i t\u1ed1i \u0111a trong 3 th\u00e1ng. Khuy\u1ebfn c\u00e1o kh\u00f4ng n\u00ean d\u00f9ng thu\u1ed1c cho ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 b\u1ec7nh nh\u00e2n glaucom.<br \/>\nC\u1ea7n c\u1ea3nh b\u00e1o cho b\u1ec7nh nh\u00e2n d\u00f9ng steroid \u0111\u01b0\u1eddng u\u1ed1ng t\u00e1c d\u1ee5ng m\u1ea1nh do TDKMM c\u00f3 th\u1ec3 x\u1ea3y ra. Do \u0111\u00f3, ng\u01b0\u1eddi d\u01b0\u1ee3c s\u0129 c\u1ea7n gi\u1ea3i th\u00edch cho b\u1ec7nh nh\u00e2n v\u1ec1 thu\u1ed1c c\u0169ng nh\u01b0 c\u00e1c t\u00e1c \u0111\u1ed9ng c\u1ee7a n\u00f3 t\u1edbi c\u01a1 th\u1ec3.<\/p>\n<h3><\/h3>\n<p><em> <strong> Natri cromoglicat: <\/strong> <\/em><\/p>\n<p>Natri cromoglicat l\u00e0 thu\u1ed1c b\u00e1n kh\u00f4ng k\u00ea \u0111\u01a1n ph\u1ed5 bi\u1ebfn, c\u00f3 d\u1ea1ng b\u00e0o ch\u1ebf nh\u1ecf m\u0169i , x\u1ecbt m\u0169i v\u00e0 nh\u1ecf m\u1eaft. N\u1ebfu d\u00f9ng \u0111\u00fang, thu\u1ed1c cho hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb r\u1ea5t t\u1ed1t. B\u1ec7nh nh\u00e2n n\u00ean d\u00f9ng thu\u1ed1c \u00edt nh\u1ea5t 1 tu\u1ea7n tr\u01b0\u1edbc m\u00f9a b\u1ec7nh v\u00e0 d\u00f9ng th\u01b0\u1eddng xuy\u00ean sau \u0111\u00f3. Thu\u1ed1c h\u1ea7u nh\u01b0 kh\u00f4ng g\u00e2y t\u00e1c d\u1ee5ng ph\u1ee5, c\u00f3 th\u1ec3 ch\u1ec9 g\u00e2y k\u00edch \u1ee9ng m\u0169i nh\u1eb9.<\/p>\n<p>Thu\u1ed1c nh\u1ecf m\u1eaft cromoglicat c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m gi\u1ea3m nh\u1eb9 c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00f3 ch\u1ecbu \u1edf m\u1eaft ngay c\u1ea3 khi b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi kh\u00e1ng histamine. N\u00ean nh\u1ecf thu\u1ed1c th\u01b0\u1eddng xuy\u00ean 4 l\u1ea7n\/1 ng\u00e0y \u0111\u1ec3 c\u00f3 hi\u1ec7u qu\u1ea3 t\u1ed1t nh\u1ea5t. Th\u00e0nh th\u1ea7n thu\u1ed1c nh\u1ecf m\u1eaft cromoglicat c\u00f3 ch\u1ee9a ch\u1ea5t s\u00e1t khu\u1ea9n benzalkonium, v\u00e0 kh\u00f4ng n\u00ean d\u00f9ng cho ng\u01b0\u1eddi \u0111eo k\u00ednh \u00e1p tr\u00f2ng.<\/p>\n<h3><\/h3>\n<p><strong> <em> C\u00e1c kh\u00e1ng histamin d\u00f9ng t\u1ea1i ch\u1ed7 <\/em> <\/strong><\/p>\n<p>\u0110i\u1ec1u tr\u1ecb t\u1ea1i ch\u1ed7 ni\u00eam m\u1ea1c m\u0169i<\/p>\n<p>Azelastine l\u00e0 1 d\u1ea1ng thu\u1ed1c x\u1ecbt d\u00f9ng \u0111i\u1ec1u tr\u1ecb VMDU. BNF \u0111\u01b0a ra g\u1ee3i \u00fd n\u00ean b\u1eaft \u0111\u1ea7u d\u00f9ng thu\u1ed1c tr\u01b0\u1edbc t\u1eeb 2-3 tu\u1ea7n tr\u01b0\u1edbc m\u00f9a b\u1ec7nh. \u0110\u00e2y \u0111\u01b0\u1ee3c coi l\u00e0 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb thay th\u1ebf cho ng\u01b0\u1eddi cao tu\u1ed5i v\u00e0 tr\u1ebb em tr\u00ean 5 tu\u1ed5i. L\u01b0u \u00fd khi x\u1ecbt thu\u1ed1c, BN n\u00ean gi\u1eef th\u1eb3ng \u0111\u1ea7u, tr\u00e1nh \u0111\u1ec3 thu\u1ed1c xu\u1ed1ng h\u1ecdng g\u00e2y v\u1ecb kh\u00f3 ch\u1ecbu.<\/p>\n<p>L\u1eddi khuy\u00ean<\/p>\n<ul>\n<li>\u0110\u00f3ng c\u1eeda k\u00ednh \u00f4 t\u00f4 v\u00e0 th\u00f4ng gi\u00f3 khi l\u00e1i xe, n\u1ebfu kh\u00f4ng ph\u1ea5n hoa c\u00f3 th\u1ec3 bay v\u00e0o b\u00ean trong, v\u1edbi m\u1eadt \u0111\u1ed9 l\u1edbn, c\u00f3 th\u1ec3 g\u00e2y d\u1ecb \u1ee9ng.<\/li>\n<li>B\u1ee5i b\u1ea9n l\u00e0 m\u1ed9t nguy c\u01a1 g\u00e2y VMDU. Do \u0111\u00f3, th\u01b0\u1eddng xuy\u00ean lau d\u1ecdn nh\u00e0 c\u1eeda s\u1ea1ch s\u1ebd, gi\u1ea3m b\u1ee5i b\u1ea9n t\u1edbi m\u1ee9c th\u1ea5p nh\u1ea5t c\u00f3 th\u1ec3 gi\u1ea3m thi\u1ec3u nguy c\u01a1 m\u1eafc b\u1ec7nh. T\u1ed1t nh\u1ea5t n\u00ean s\u1eed d\u1ee5ng m\u00e1y h\u00fat b\u1ee5i, lo\u1ea1i m\u00e1y n\u00e0y c\u0169ng \u0111\u01b0\u1ee3c b\u00e1n r\u1ed9ng r\u00e3i tr\u00ean th\u1ecb tr\u01b0\u1eddng.<\/li>\n<\/ul>\n<h2 id=\"ca-lam-sang-vmdu\">Ca l\u00e2m s\u00e0ng VMDU<\/h2>\n<p><strong> Ca 1 <\/strong><\/p>\n<p>M\u1ed9t nam thanh ni\u00ean \u0111\u1ebfn kh\u00e1m v\u00e0o cu\u1ed1i th\u00e1ng 3. Anh ta mu\u1ed1n b\u1ea1n c\u00f3 th\u1ec3 t\u01b0 v\u1ea5n th\u00eam cho m\u00ecnh v\u1ec1 VMDU. Khi \u0111\u01b0\u1ee3c h\u1ecfi, anh ta n\u00f3i ch\u01b0a t\u1eebng b\u1ecb VMDU tr\u01b0\u1edbc \u0111\u00f3, nh\u01b0ng m\u1ed9t v\u00e0i ng\u01b0\u1eddi b\u1ea1n c\u1ee7a anh \u1ea5y \u0111\u00e3 m\u1eafc VMDU v\u00e0 anh \u1ea5y ngh\u0129 m\u00ecnh c\u0169ng b\u1ecb t\u01b0\u01a1ng t\u1ef1. B\u1ec7nh nh\u00e2n b\u1ecb ch\u1ea3y n\u01b0\u1edbc m\u1eaft nh\u1eb9, n\u01b0\u1edbc m\u1eaft trong, th\u1edf kh\u00f2 kh\u00e8 m\u1ea5y h\u00f4m nay. Ngo\u00e0i ra c\u00f2n ch\u1ea3y n\u01b0\u1edbc m\u0169i v\u00e0 h\u01a1i ngh\u1eb9t m\u0169i. D\u00f9 kh\u00f4ng ph\u1ea3i l\u00e1i xe, nh\u01b0ng anh ta c\u00f2n l\u00e0 sinh vi\u00ean v\u00e0 c\u00f3 k\u1ef3 thi v\u00e0o tu\u1ea7n t\u1edbi. B\u1ec7nh nh\u00e2n ch\u01b0a d\u00f9ng b\u1ea5t c\u1ee9 thu\u1ed1c g\u00ec.<\/p>\n<p><strong> <em> Quan \u0111i\u1ec3m c\u1ee7a d\u01b0\u1ee3c s\u0129 <\/em> <\/strong><\/p>\n<p>B\u1ec7nh nh\u00e2n l\u1ea7n \u0111\u1ea7u ti\u00ean m\u1eafc VMDU v\u1edbi nh\u1eefng tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh. Trong \u0111\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n \u1edf m\u0169i g\u00e2y kh\u00f3 ch\u1ecbu nh\u1ea5t: ch\u1ea3y n\u01b0\u1edbc m\u0169i, ng\u1ea1t m\u0169i, v\u00ec v\u1eady khuy\u00ean ng\u01b0\u1eddi b\u1ec7nh n\u00ean d\u00f9ng thu\u1ed1c x\u1ecbt m\u0169i corticosteroid, c\u00e2n nh\u1eafc \u0111\u00e3 \u0111\u1ee7 18 tu\u1ed5i hay ch\u01b0a. N\u1ebfu b\u1ec7nh nh\u00e2n n\u00e0y d\u01b0\u1edbi 18 tu\u1ed5i, c\u00f3 th\u1ec3 d\u00f9ng kh\u00e1ng histamin u\u1ed1ng hay d\u00f9ng t\u1ea1i ch\u1ed7, l\u01b0u \u00fd c\u1eadu thanh ni\u00ean n\u00e0y s\u1eafp thi, n\u00ean tr\u00e1nh kh\u00e1ng histamin th\u1ebf h\u1ec7 c\u0169 g\u00e2y bu\u1ed3n ng\u1ee7 l\u00e0 t\u1ed1t nh\u1ea5t. M\u1eaft b\u1ec7nh nh\u00e2n b\u1ecb k\u00edch \u1ee9ng nh\u1eb9, kh\u00f4ng \u0111\u00e1ng quan ng\u1ea1i l\u1eafm. B\u1ec7nh nh\u00e2n ch\u01b0a d\u00f9ng b\u1ea5t c\u1ee9 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb g\u00ec t\u1eeb tr\u01b0\u1edbc, do \u0111\u00f3 c\u00f3 th\u1ec3 khuy\u00ean d\u00f9ng acrivastin, loratadine ho\u1eb7c cetirizine. N\u1ebfu sau v\u00e0i ng\u00e0y, c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00f4ng \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n, khuy\u00ean b\u1ec7nh nh\u00e2n \u0111i g\u1eb7p b\u00e1c s\u0129.<\/p>\n<h3><\/h3>\n<p><strong> <em> Quan \u0111i\u1ec3m c\u1ee7a b\u00e1c s\u0129 <\/em> <\/strong><\/p>\n<p>V\u1edbi tr\u01b0\u1eddng h\u1ee3p n\u00e0y, thu\u1ed1c x\u1ecbt m\u0169i corticosteroid c\u00f3 hi\u1ec7u qua h\u01a1n c\u1ea3. N\u1ebfu b\u1ec7nh nh\u00e2n ch\u01b0a \u0111\u1ee7 18 tu\u1ed5i, kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng thu\u1ed1c OTC n\u00e0y, c\u00f3 th\u1ec3 th\u1eed \u0111i\u1ec1u tr\u1ecb b\u1eb1ng acrivastine, loratadine ho\u1eb7c cetirizine. M\u1eb7c d\u00f9 th\u00f4ng th\u01b0\u1eddng c\u00e1c thu\u1ed1c tr\u00ean \u0111\u1ec1u kh\u00f4ng g\u00e2y bu\u1ed3n ng\u1ee7, tuy nhi\u00ean tr\u00ean m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n, t\u00e1c d\u1ee5ng ph\u1ee5 n\u00e0y v\u1eabn c\u00f3 th\u1ec3 x\u1ea3y ra. Do \u0111\u00f3, khuy\u00ean b\u1ec7nh nh\u00e2n kh\u00f4ng u\u1ed1ng li\u1ec1u \u0111\u1ea7u ti\u00ean ngay tr\u01b0\u1edbc k\u00ec thi. N\u1ebfu c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00f4ng c\u1ea3i thi\u1ec7n, c\u1ea7n c\u00e2n nh\u1eafc l\u1ea1i l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb. \u0110\u1ed3ng th\u1eddi, n\u1ebfu d\u00f9ng kh\u00e1ng histamin kh\u00f4ng ki\u1ec3m so\u00e1t t\u1ed1t c\u00e1c tri\u1ec7u ch\u1ee9ng k\u00edch \u1ee9ng \u1edf m\u1eaft, c\u00f3 th\u1ec3 cho BN d\u00f9ng th\u00eam thu\u1ed1c nh\u1ecf m\u1eaft natri cromorglicat s\u1ebd t\u1ed1t h\u01a1n. Ch\u00fa \u00fd c\u00e2n nh\u1eafc ch\u1ecdn kh\u00e1ng histamin th\u1ebf h\u1ec7 c\u0169 v\u00ec m\u1ed9t s\u1ed1 BN kh\u00f4ng b\u1ecb t\u00e1c d\u1ee5ng ph\u1ee5 g\u00e2y bu\u1ed3n ng\u1ee7 c\u1ee7a thu\u1ed1c.<\/p>\n<p><strong> Ca 2 <\/strong><\/p>\n<p>M\u1ed9t ph\u1ee5 n\u1eef g\u1ea7n 30 tu\u1ed5i mu\u1ed1n \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n. B\u1ec7nh nh\u00e2n gi\u1edbi thi\u1ec7u b\u1ecb VMDU, ng\u1ea1t m\u0169i, kh\u00f3 th\u1edf. Khai th\u00e1c ti\u1ec1n s\u1eed cho th\u1ea5y b\u1ec7nh nh\u00e2n \u0111\u00e3 m\u1eafc c\u00e1c tri\u1ec7u ch\u1ee9ng tr\u00ean trong v\u00e0i ng\u00e0y,ng\u00e0y m\u1ed9t n\u1eb7ng th\u00eam. B\u1ec7nh nh\u00e2n b\u1ecb VMDU su\u1ed1t m\u00f9a h\u00e8 v\u00e0 lu\u00f4n ph\u1ea3i u\u1ed1ng chlorphenamin d\u1ea1ng vi\u00ean n\u00e9n \u0111\u1ec3 ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng, hi\u1ec7n t\u1ea1i v\u1eabn \u0111ang d\u00f9ng thu\u1ed1c n\u00e0y. BN b\u1ecb eczema kh\u00e1 n\u1eb7ng t\u1eeb l\u00fac nh\u1ecf, th\u1ec9nh tho\u1ea3ng v\u1eabn m\u1eafc l\u1ea1i. V\u00e0i ng\u00e0y tr\u01b0\u1edbc b\u1ec7nh nh\u00e2n c\u00f3 th\u1edf kh\u00f2 kh\u00e8, nh\u01b0ng kh\u00f4ng ho: c\u1ea3 ho khan hay ho c\u00f3 \u0111\u1eddm. B\u1ec7nh nh\u00e2n ch\u01b0a d\u00f9ng b\u1ea5t c\u1ee9 thu\u1ed1c g\u00ec kh\u00e1c ngo\u00e0i chlorphenamin \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n<h3><\/h3>\n<p><em> <strong> \u00dd ki\u1ebfn c\u1ee7a d\u01b0\u1ee3c s\u0129 <\/strong> <\/em><\/p>\n<p>B\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed VMDU, \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u1ed1t b\u1eb1ng chlorphenamin u\u1ed1ng. Tuy nhi\u00ean v\u00e0i ng\u00e0y l\u1ea1i \u0111\u00e2y, b\u1ec7nh n\u1eb7ng h\u01a1n v\u00e0 c\u00f3 th\u1edf kh\u00f2 kh\u00e8. BN kh\u00f4ng c\u00f3 v\u1ebb l\u00e0 c\u00f3 m\u1ed9t nhi\u1ec5m tr\u00f9ng v\u00f9ng ng\u1ef1c l\u00e0 nguy\u00ean nh\u00e2n c\u1ee7a nh\u1eefng tri\u1ec7u ch\u1ee9ng t\u0103ng n\u1eb7ng tr\u00ean. B\u1ec7nh nh\u00e2n n\u00ean \u0111i kh\u00e1m b\u00e1c s\u0129 ngay, tr\u01b0\u1edbc khi c\u00f3 th\u1ec3 g\u1eb7p c\u00e1c bi\u1ec3u hi\u1ec7n g\u1ee3i \u00fd \u0111\u1ebfn t\u00ecnh tr\u1ea1ng nguy hi\u1ec3m h\u01a1n nh\u01b0 hen ph\u1ebf qu\u1ea3n.<\/p>\n<p><em> <strong> \u00dd ki\u1ebfn c\u1ee7a b\u00e1c s\u0129 <\/strong> <\/em><\/p>\n<p>N\u00ean kh\u00e1m b\u00e1c s\u0129 ngay. G\u1ea7n nh\u01b0 ch\u1eafc ch\u1eafn ph\u1ee5 n\u1eef n\u00e0y m\u1eafc b\u1ec7nh hen theo m\u00f9a. B\u00ean c\u1ea1nh \u0111i\u1ec1u tr\u1ecb VMDU theo t\u01b0 v\u1ea5n c\u1ee7a d\u01b0\u1ee3c s\u0129, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 d\u00f9ng 1 steroid d\u1ea1ng h\u00edt nh\u01b0 beclomethason s\u1ebd c\u00f3 hi\u1ec7u qu\u1ea3 t\u1ed1t. Ngo\u00e0i ra, ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 b\u1ec7nh, c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh thu\u1ed1c c\u01b0\u1eddng \u03b2-adrenergic nh\u01b0 salbutamol d\u1ea1ng h\u00edt. Tuy nhi\u00ean, s\u1ebd kh\u00f3 kh\u0103n cho b\u00e1c s\u0129 khi trong v\u00f2ng kho\u1ea3ng 10 ph\u00fat v\u1eeba ph\u1ea3i th\u0103m kh\u00e1m,\u00a0\u00a0cung c\u1ea5p th\u00f4ng tin cho b\u1ec7nh nh\u00e2n, gi\u1ea3i th\u00edch v\u1ea5n \u0111\u1ec1, l\u00fd do ph\u1ea3i \u0111i\u1ec1u tr\u1ecb v\u00e0 k\u0129 th\u1ee5\u00e2t s\u1eed d\u1ee5ng d\u1ea1ng thu\u1ed1c h\u00edt.<\/p>\n<h2><span style=\"color: #000000; font-size: 18px;\"> T\u00e0i li\u1ec7u tham kh\u1ea3o <\/span><\/h2>\n<p>1. Alison Blenkinsopp, Paul Paxton\u00a0and John Blenkinsopp.\u00a0Symptoms in the Pharmacy &#8211; A Guide to management of common illnesses\u00a07th.<\/p>\n<p>2. <a href=\"http:\/\/nhipcauduoclamsang.blogspot.fr\/2015\/04\/viem-mui-di-ung-vmdu.html\" target=\"_blank\" rel=\"noopener noreferrer\"> http:\/\/nhipcauduoclamsang.blogspot.fr\/2015\/04\/viem-mui-di-ung-vmdu.html <\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a vi\u00eam m\u0169i d\u1ecb \u1ee9ng c\u00f3 th\u1ec3 kh\u1edfi ph\u00e1t \u1edf b\u1ea5t k\u1ef3 l\u1ee9a tu\u1ed5i n\u00e0o, nh\u01b0ng th\u01b0\u1eddng \u1edf tr\u1ebb em v\u00e0 ng\u01b0\u1eddi tr\u1ebb tu\u1ed5i h\u01a1n.<\/p>\n","protected":false},"author":339,"featured_media":4367,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5146,9993,5172],"tags":[3599,3601,3602,3603,3600],"series":[1054],"coauthors":[986],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.8 - 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