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Than hu - Dung thuoc gi?

Than hu la mot hoi chung sinh hoa va lam sang dac trung boi su mat nhieu protein qua nuoc tieu, gay giam albumin huyet tuong, bieu hien bang phu va nhieu roi loan khac nhu roi loan lipid mau, roi loan dong mau... Hoi chung than hu la hoi chung nang nhat cua benh than.

Cac nguyen nhan gay ra hoi chung than hu duoc chia lam hai nhom: Hoi chung than hu nguyen phat bao gom: benh cau than thay doi toi thieu, xo cau than o - cuc bo, benh cau than mang...; Hoi chung than hu thu phat sau cac benh: dai thao duong, luput ban do he thong, than thoai hoa bot, hoi chung ban dang thap Schonlein - Henoch, viem mach hoai tu, nhiem khuan cap tinh, nang, keo dai, nhiem khuan huyet, ky sinh trung (sot ret P. Malariae, Schistosomiasis, Filariosis), virut (viem gan B, C; HIV), ung thu phoi, dai trang, da day, thuc quan, ung thu hac to, cac u lympho tang sinh ac tinh, benh da u tuy xuong, thuoc chua thuy ngan, khang sinh, D-penicillamin, thuoc chong viem khong steroid. Cac nguyen nhan khac cung co the gay hoi chung than hu nhu: mang thai, benh hong cau hinh liem, su dung heroin, sarcoidosis, hoi chung Guillain - Barre, sau cat than, bam sinh...

Ton thuong than do than hu tren phim Xquang.

Thuoc dung trong dieu tri hoi chung than hu

Viec dieu tri hoi chung than hu thuong phuc tap va keo dai. Trong thuc te co nhieu nguoi sau khi uong thuoc thay het phu, nghi rang benh da khoi nhung thuc ra dau hieu giam phu khong co nghia la benh da suy giam ma phai can cu vao xet nghiem mau va nuoc tieu moi co the ket luan tien trien cua benh.

Dieu tri hoi chung than hu can tuan thu nhung nguyen tac sau: dieu tri nguyen nhan gay benh, dieu tri nham lam giam protein nieu, dieu tri bao ton chuc nang than, dieu tri giam trieu chung, phoi hop che do dinh duong dieu tri.

Dieu tri trieu chung: Giam phu thong qua che do an giam muoi, nuoc. Su dung cac thuoc loi tieu: hay dung la furosemid, co the phoi hop nhom loi tieu tiet kiem kali nhu spironolacton. Nang ap luc keo huyet tuong bang truyen albumin phoi hop che do an giau protein. Dieu tri tang huyet ap bang che do an giam muoi. Cac nhom thuoc ha ap hay duoc dung la thuoc uc che men chuyen angiotensin, thuoc chen kenh canxi. Bo sung canxi, vitamin D, sat va cac yeu to vi luong khac. Dieu tri roi loan mo mau. Dieu tri du phong bien chung nhiem khuan, tac mach, cac bien chung do thuoc.

Trong thuc te, cac thay thuoc hay dung nhat trong dieu tri hoi chung than hu la nhom thuoc corticoid. Chung ta biet rang vo thuong than tiet ra 3 loai hormon la: androgen, corticoid tham gia chuyen hoa muoi nuoc glucocorticoid co tac dung chong viem va tham gia chuyen hoa trong co the. Cac thuoc chung ta dung hien nay la nhom thu ba nham muc dich chong viem. Corticoid co tac dung chong viem nho doan goc gan voi nhan chinh la cortison. Cac corticoid duoc phan loai phu thuoc vao thoi gian tac dung. Loai tuc thoi gom cortisol, hydrocortison, prednisolon. Tac dung trung binh gom prednisolon, methylprednisolon, triamcinolon. Tac dung keo dai gom dexamethazon, betamethazon.

Cac thuoc co tac dung keo dai thi manh nhat nhung cung lam uc che truc duoi doi thuong than ro nhat. Trong thuc te, dung corticoid buoi sang la tot nhat vi cong duoc ca hai loai noi sinh va ngoai sinh. Hon nua khi thoi gian ban huy cua thuoc ngan, nong do giam xuong van kich thich tuyen thuong than san xuat tiep tuc. Cac che pham it gay uc che thuong than la prednison, prednisolon, methylprednisolon. Hien nay prednison duoc su dung nhieu vi tac dung ngan, manh va re. Mot so chu y khi dung nhom thuoc nay: chi dung lieu du, lieu toi thieu co tac dung, co the chi la 1mg. Thay doi lieu theo tinh trang benh. Khi can chon lua duong dung tiem hay uong phai theo chi dinh chuyen khoa, trong truong hop thong thuong thi nen dung cac san pham chung nhat, thong dung. Nen dung thuoc vao buoi sang vi ly do sinh ly, giam toi da nguy co uc che nguoc truc tuyen yen - duoi doi - thuong than. Su dung cach ngay cung co the han che nguy co nay. Khi giam lieu phai tu tu de tranh cac bien chung.

Ngoai nhom thuoc corticoid co the dung cac thuoc uc che mien dich khac nhu chlorambucil, cyclosporin A...

Ngoai viec dung thuoc, che do an dieu tri hoi chung than hu dong vai tro rat quan trong. Can tuan thu nguyen tac: han che muoi, nuoc khi co phu, tang huyet ap, che do an han che muoi con co the lam giam protein nieu. Cung cap du luong protein can thiet cho co the va bu lai luong protein mat di qua nuoc tieu. Han che protein khi co suy than tam thoi.

Khi bi hoi chung than hu phai co che do theo doi sat sao hang thang tai cac co so chuyen khoa, tranh su dung thuoc khong dung dan den suy than.

ThS.BS. Nguyen Vinh Hung