{"id":2508,"date":"2022-11-10T22:53:43","date_gmt":"2022-11-10T15:53:43","guid":{"rendered":"https:\/\/vitezcom.com\/?p=2508"},"modified":"2022-11-10T23:17:32","modified_gmt":"2022-11-10T16:17:32","slug":"nguyen-tac-dieu-tri-va-cham-soc-giam-nhe-trong-ung-thu","status":"publish","type":"post","link":"https:\/\/vitezcom.com\/en\/nguyen-tac-dieu-tri-va-cham-soc-giam-nhe-trong-ung-thu\/","title":{"rendered":"Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb v\u00e0 ch\u0103m s\u00f3c gi\u1ea3m nh\u1eb9 trong ung th\u01b0"},"content":{"rendered":"<ol>\n<li><strong><u>NGUY\u00caN T\u1eaeC \u0110I\u1ec0U TR\u1eca B\u1ec6NH UNG TH\u01af<\/u><\/strong><\/li>\n<\/ol>\n<p style=\"padding-left: 40px;\">Ung th\u01b0 l\u00e0 b\u1ec7nh l\u00fd \u00e1c t\u00ednh c\u1ee7a t\u1ebf b\u00e0o, do t\u1ebf b\u00e0o t\u0103ng sinh m\u1ed9t c\u00e1ch v\u00f4 h\u1ea1n \u0111\u1ed9, v\u00f4 t\u1ed5 ch\u1ee9c, kh\u00f4ng tu\u00e2n theo quy lu\u1eadt ph\u00e1t tri\u1ec3n v\u00e0 c\u01a1 ch\u1ebf ki\u1ec3m so\u00e1t c\u1ee7a c\u01a1 th\u1ec3. B\u1ec7nh ung th\u01b0 c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb kh\u1ecfi n\u1ebfu \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n s\u1edbm, \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi, \u0111\u00fang ph\u01b0\u01a1ng ph\u00e1p v\u00e0 \u0111\u00fang nguy\u00ean t\u1eafc. Mu\u1ed1n c\u00f3 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n ung th\u01b0 \u0111\u1ea1t \u0111\u01b0\u1ee3c t\u1ed1i \u01b0u, ch\u00fang ta ph\u1ea3i th\u1ef1c hi\u1ec7n t\u1ed1t c\u00e1c nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb sau \u0111\u00e2y.<\/p>\n<p style=\"padding-left: 40px;\"><strong>1.1 Ph\u1ed1i h\u1ee3p c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb<\/strong><\/p>\n<p style=\"padding-left: 40px;\">C\u00e1c ph\u01b0\u01a1ng ph\u00e1p ch\u00ednh \u0111i\u1ec1u tr\u1ecb ung th\u01b0 hi\u1ec7n nay l\u00e0:<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Ph\u1eabu thu\u1eadt<\/li>\n<li>X\u1ea1 tr\u1ecb<\/li>\n<li>Ho\u00e1 tr\u1ecb<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb tr\u00fang \u0111\u00edch<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 40px;\">C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u00f3i tr\u00ean ch\u1ec9 th\u1ef1c hi\u1ec7n \u0111\u01a1n tr\u1ecb li\u1ec7u trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u01a1p b\u1ec7nh \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n s\u1edbm v\u00e0 lo\u1ea1i ung th\u01b0 nh\u1ea1y c\u1ea3m v\u1edbi ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb, c\u00f2n \u0111a s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p ung th\u01b0 l\u00e0 ph\u1ea3i ph\u1ed1i h\u1ee3p c\u00e1c ph\u01b0\u01a1ng ph\u00e1p th\u00ec m\u1edbi c\u00f3 th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb t\u1ed1t v\u00ec:<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>\u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a t\u1ed5 ch\u1ee9c v\u00e0 t\u1ebf b\u00e0o ung th\u01b0 l\u00e0: Ph\u00e1t tri\u1ec3n nhanh t\u1ea1i ch\u1ed7, x\u00e2m l\u1ea5n m\u1ea1nh ra c\u00e1c t\u1ed5 ch\u1ee9c xung quanh v\u00e0 di c\u0103n xa.<\/li>\n<li>\u0110a s\u1ed1 BN UT khi \u0111\u1ebfn v\u1edbi th\u1ea7y thu\u1ed1c th\u00ec b\u1ec7nh \u0111\u00e3 \u1edf giai \u0111o\u1ea1n mu\u1ed9n.<\/li>\n<li>S\u1ef1 \u0111\u00e1p \u1ee9ng c\u1ee7a m\u1ed7i lo\u1ea1i UT v\u1edbi t\u1eebng ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb r\u1ea5t kh\u00e1c nhau, v\u00ec v\u1eady khi ph\u1ed1i h\u1ee3p c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 s\u1ebd \u0111\u01b0a l\u1ea1i hi\u1ec7u qu\u1ea3 cao h\u01a1n.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 40px;\"><strong>1.2 X\u00e1c \u0111\u1ecbnh m\u1ee5c \u0111\u00edch \u0111i\u1ec1u tr\u1ecb.<\/strong><\/p>\n<p style=\"padding-left: 40px;\">M\u1ee5c \u0111\u00edch \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n ung th\u01b0 l\u00e0:<\/p>\n<p style=\"padding-left: 40px;\">\u0110i\u1ec1u tr\u1ecb tri\u1ec7t c\u0103n<\/p>\n<p style=\"padding-left: 40px;\">\u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3<\/p>\n<p style=\"padding-left: 40px;\">\u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng (ch\u0103m s\u00f3c gi\u1ea3m nh\u1eb9).<\/p>\n<p style=\"padding-left: 40px;\">\u0110\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c m\u1ee5c \u0111\u00edch c\u1ea7n ph\u1ea3i c\u00f3 ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c v\u00e0 c\u1ee5 th\u1ec3 cho t\u1eebng b\u1ec7nh nh\u00e2n.<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c lo\u1ea1i ung th\u01b0 nguy\u00ean ph\u00e1t: C\u0103n c\u1ee9 v\u00e0o k\u1ebft qu\u1ea3 gi\u1ea3i ph\u1eabu b\u1ec7nh l\u00fd (\u0111\u00e2y l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng v\u00e0 l\u00e0 ti\u00eau chu\u1ea9n b\u1eaft bu\u1ed9c), ph\u00e2n chia th\u00e0nh c\u00e1c nh\u00f3m nh\u1ecf \u0111\u1ec3 hi\u1ec3u r\u00f5 b\u1ea3n ch\u1ea5t c\u1ee7a t\u1ed5 ch\u1ee9c ung th\u01b0 gi\u00fap cho ta ti\u00ean l\u01b0\u1ee3ng v\u00e0 ch\u1ec9 \u0111\u1ecbnh ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb th\u00edch h\u1ee3p.<\/li>\n<li>X\u00e1c \u0111\u1ecbnh \u0111\u00fang giai \u0111o\u1ea1n b\u1ec7nh: Ph\u1ea3i c\u0103n c\u1ee9 v\u00e0o k\u1ebft qu\u1ea3 th\u0103m kh\u00e1m l\u00e2m s\u00e0ng, c\u1eadn l\u00e2m s\u00e0ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n giai \u0111o\u1ea1n b\u1ec7nh. Vi\u1ec7c x\u00e1c \u0111\u1ecbnh giai \u0111o\u1ea1n b\u1ec7nh \u0111\u1ed1i v\u1edbi t\u1eebng lo\u1ea1i ung th\u01b0 c\u00f3 kh\u00e1c nhau tuy nhi\u00ean th\u00f4ng d\u1ee5ng nh\u1ea5t hi\u1ec7n nay l\u00e0 x\u1ebfp lo\u1ea1i ung th\u01b0 theo h\u1ec7 th\u1ed1ng TNM c\u1ee7a T\u1ed5 ch\u1ee9c ch\u1ed1ng ung th\u01b0 qu\u1ed1c t\u1ebf (UICC) cho t\u1eebng b\u1ec7nh nh\u00e2n v\u1edbi m\u1ed7i lo\u1ea1i ung th\u01b0 c\u1ee5 th\u1ec3.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 40px;\"><strong>1.3 L\u1eadp k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb.<\/strong><\/p>\n<p style=\"padding-left: 40px;\">\u0110\u1ec3 l\u1eadp k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb cho m\u1ed9t b\u1ec7nh nh\u00e2n ung th\u01b0 ph\u1ea3i c\u0103n c\u1ee9 v\u00e0o:<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng.<\/li>\n<li>Ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh.<\/li>\n<li>Ch\u1ea9n \u0111o\u00e1n gi\u1ea3i ph\u1eabu b\u1ec7nh l\u00fd.<\/li>\n<li>M\u1ee5c \u0111\u00edch c\u1ee7a \u0111i\u1ec1u tr\u1ecb.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 40px;\">K\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb v\u00e0 ch\u0103m s\u00f3c ph\u1ea3i to\u00e0n di\u1ec7n v\u00e0 chi ti\u1ebft cho t\u1eebng giai \u0111o\u1ea1n, \u0111i\u1ec1u n\u00e0y c\u00f3 vai tr\u00f2 quan tr\u1ecdng quy\u1ebft \u0111\u1ecbnh hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p style=\"padding-left: 40px;\">Khi l\u1eadp k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb vi\u1ec7c l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u1edfi \u0111\u1ea7u cho b\u1ec7nh nh\u00e2n (Ph\u1eabu thu\u1eadt, x\u1ea1 tr\u1ecb hay ho\u00e1 tr\u1ecb) l\u00e0 h\u1ebft s\u1ee9c quan tr\u1ecdng g\u00f3p ph\u1ea7n v\u00e0o th\u00e0nh c\u00f4ng hay th\u1ea5t b\u1ea1i.<\/p>\n<p style=\"padding-left: 40px;\"><strong>1.4 <\/strong><strong>B\u1ed5 sung v\u00e0 \u0111i\u1ec1u ch\u1ec9nh k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb.<\/strong><\/p>\n<p style=\"padding-left: 40px;\">Trong qu\u00e1 tr\u00ecnh th\u1ef1c hi\u1ec7n k\u1ebf ho\u1ea1ch v\u00e0 theo d\u00f5i k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb, th\u1ea5y nh\u1eefng \u0111i\u1ec3m, nh\u1eefng bi\u1ec7n ph\u00e1p kh\u00f4ng ph\u00f9 h\u1ee3p ho\u1eb7c b\u1ec7nh nh\u00e2n c\u00f3 di\u1ec5n bi\u1ebfn b\u1ea5t th\u01b0\u1eddng th\u00ec ph\u1ea3i b\u1ed5 sung, \u0111i\u1ec1u ch\u1ec9nh k\u1ebf ho\u1ea1ch nh\u1eb1m \u0111\u1ea1t \u0111\u01b0\u1ee3c k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb t\u1ed1i \u01b0u nh\u1ea5t, \u0111\u1ed3ng th\u1eddi h\u1ea1n ch\u1ebf c\u00e1c bi\u1ebfn ch\u1ee9ng c\u00f3 th\u1ec3 x\u1ea9y ra cho b\u1ec7nh nh\u00e2n.<\/p>\n<p style=\"padding-left: 40px;\"><strong>1.5 Theo d\u00f5i k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb.<\/strong><\/p>\n<p style=\"padding-left: 40px;\">Ung th\u01b0 l\u00e0 m\u1ed9t b\u1ec7nh c\u00f3 nguy c\u01a1 di c\u0103n xa cao, r\u1ea5t d\u1ec5 t\u00e1i ph\u00e1t v\u00e0 c\u00f3 nhi\u1ec1u bi\u1ebfn ch\u1ee9ng sau \u0111i\u1ec1u tr\u1ecb, v\u00ec v\u1eady vi\u1ec7c theo d\u00f5i ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh v\u00e0 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb, th\u00f4ng qua kh\u00e1m \u0111\u1ecbnh k\u1ef3 cho BN l\u00e0 m\u1ed9t vi\u1ec7c l\u00e0m b\u1eaft bu\u1ed9c nh\u1eb1m m\u1ee5c \u0111\u00edch:<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Ph\u00e1t hi\u1ec7n v\u00e0 kh\u1eafc ph\u1ee5c c\u00e1c bi\u1ebfn ch\u1ee9ng do \u0111i\u1ec1u tr\u1ecb g\u00e2y n\u00ean<\/li>\n<li>Ph\u00e1t hi\u1ec7n s\u1edbm di c\u0103n v\u00e0 t\u00e1i ph\u00e1t c\u1ee7a ung th\u01b0 .<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 40px;\">Trong 2 n\u0103m \u0111\u1ea7u y\u00eau c\u1ea7u kh\u00e1m \u0111\u1ecbnh k\u1ef3 2 \u2013 3 th\u00e1ng\/l\u1ea7n, nh\u1eefng n\u0103m ti\u1ebfp theo 6 th\u00e1ng \/l\u1ea7n cho \u0111\u1ebfn h\u1ebft cu\u1ed9c \u0111\u1eddi c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n<ol start=\"2\">\n<li><strong><u>CH\u0102M S\u00d3C GI\u1ea2M NH\u1eb8 TRONG UNG TH\u01af<\/u><\/strong><\/li>\n<\/ol>\n<p style=\"padding-left: 40px;\"><strong>2.1 Kh\u00e1i ni\u1ec7m v\u1ec1 ch\u0103m s\u00f3c gi\u1ea3m nh\u1eb9<\/strong><\/p>\n<p style=\"padding-left: 40px;\">B\u1ec7nh ung th\u01b0 (UT) th\u01b0\u1eddng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n \u1edf giai \u0111o\u1ea1n mu\u1ed9n, \u0111i\u1ec1u tr\u1ecb kh\u00f3 kh\u0103n v\u00ec v\u1eady b\u1ec7nh nh\u00e2n (BN) UT ph\u1ea3i g\u00e1nh ch\u1ecbu ha\u0300ng loa\u0323t bi\u1ebfn ch\u1ee9ng do b\u1ec7nh t\u1eadt v\u00e0 bi\u1ebfn ch\u1ee9ng c\u1ee7a c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb g\u00e2y n\u00ean. Ngo\u00e0i ra ng\u01b0\u1eddi b\u1ecb b\u1ec7nh UT c\u00f2n b\u1ecb ch\u1ea5n th\u01b0\u01a1ng t\u00e2m l\u00fd n\u1eb7ng n\u1ec1 b\u1edfi s\u1ef1 kh\u1ee7ng ho\u1ea3ng tinh th\u1ea7n g\u00e2y n\u00ean. \u1ede BNUT \u0111au l\u00e0 tri\u1ec7u ch\u1ee9ng kh\u1edfi \u0111\u1ea7u, ph\u1ed5 bi\u1ebfn v\u00e0 \u0111i\u1ec1u tr\u1ecb nhi\u1ec1u khi r\u1ea5t kh\u00f3 kh\u0103n. V\u00ec v\u1eady ch\u0103m s\u00f3c gi\u1ea3m nh\u1eb9 (CSGN) cho BNUT l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 quan tr\u1ecdng c\u1ea7n ph\u1ea3i \u0111\u01b0\u1ee3c quan t\u00e2m \u0111\u00fang m\u1ee9c.<\/p>\n<p style=\"padding-left: 40px;\">Theo T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi (TCYTTG): Ch\u0103m s\u00f3c gi\u1ea3m nh\u1eb9 l\u00e0 ho\u1ea1t \u0111\u1ed9ng nh\u1eb1m c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh v\u00e0 gia \u0111\u00ecnh ng\u01b0\u1eddi b\u1ec7nh, nh\u1eefng ng\u01b0\u1eddi \u0111ang \u0111\u1ed1i m\u1eb7t v\u1edbi nh\u1eefng v\u1ea5n \u0111\u1ec1 li\u00ean quan t\u1edbi s\u1ef1 \u1ed1m \u0111au \u0111e do\u1ea1 \u0111\u1ebfn t\u00ednh m\u1ea1ng, th\u00f4ng qua s\u1ef1 ng\u0103n ng\u1eeba v\u00e0 l\u00e0m gi\u1ea3m g\u00e1nh n\u1eb7ng h\u1ecd ch\u1ecbu \u0111\u1ef1ng b\u1eb1ng c\u00e1ch nh\u1eadn bi\u1ebft s\u1edbm, \u0111\u00e1nh gi\u00e1 to\u00e0n di\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111au v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 kh\u00e1c, th\u1ec3 l\u1ef1c, t\u00e2m l\u00fd x\u00e3 h\u1ed9i v\u00e0 t\u00e2m linh.<\/p>\n<p style=\"padding-left: 40px;\">Theo B\u1ed9 Y t\u1ebf Vi\u1ec7t Nam: Ch\u0103m s\u00f3c gi\u1ea3m nh\u1eb9 cho b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00e0 AIDS l\u00e0 s\u1ef1 k\u1ebft h\u1ee3p nhi\u1ec1u bi\u1ec7n ph\u00e1p \u0111\u1ec3 l\u00e0m gi\u1ea3m s\u1ef1 \u0111au kh\u1ed5 v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh th\u00f4ng qua s\u1ef1 ph\u00f2ng ng\u1eeba, ph\u00e1t hi\u1ec7n s\u1edbm v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111au v\u00e0 nh\u1eefng v\u1ea5n \u0111\u1ec1 t\u00e2m l\u00fd v\u00e0 th\u1ef1c th\u1ec3 kh\u00e1c, v\u00e0 cung c\u1ea5p s\u1ef1 t\u01b0 v\u1ea5n v\u00e0 h\u1ed7 tr\u1ee3 t\u1eadp trung v\u00e0o nh\u1eefng v\u1ea5n \u0111\u1ec1 x\u00e3 h\u1ed9i v\u00e0 t\u00e2m linh m\u00e0 b\u1ec7nh nh\u00e2n v\u00e0 gia \u0111\u00ecnh \u0111ang ph\u1ea3i g\u00e1nh ch\u1ecbu.<\/p>\n<p style=\"padding-left: 40px;\">C\u1ea3 hai \u0111\u1ecbnh ngh\u0129a \u0111\u1ec1u nh\u1ea5n m\u1ea1nh v\u1ec1:<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>\u0110\u1ed1i ph\u00f3 l\u1ea1i s\u1ef1 ch\u1ecbu \u0111\u1ef1ng \u0111au \u0111\u1edbn b\u1eb1ng c\u00e1ch ph\u00f2ng ng\u1eeba v\u00e0 l\u00e0m gi\u1ea3m n\u00f3 \u1edf m\u1ecdi d\u1ea1ng.<\/li>\n<li>T\u1eadp trung kh\u00f4ng ch\u1ec9 v\u00e0o nh\u1eefng v\u1ea5n \u0111\u1ec1 th\u1ef1c th\u1ec3 m\u00e0 c\u00f2n nh\u1eefng v\u1ea5n \u0111\u1ec1 v\u1ec1 t\u00e2m l\u00fd, x\u00e3 h\u1ed9i v\u00e0 t\u00e2m linh.<\/li>\n<li>N\u00e2ng cao t\u1ed1i \u0111a ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 40px;\"><strong>2.2 \u0110\u00e1nh gi\u00e1 v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111au<\/strong><\/p>\n<p style=\"padding-left: 40px;\">Nhi\u1ec1u nghi\u00ean c\u1ee9u cho th\u1ea5y 79% s\u1ed1 BN UT cho bi\u1ebft, h\u1ecd c\u00f3 \u0111au ngay t\u1eeb khi b\u1ec7nh \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n, tr\u00ean 90% s\u1ed1 BN UT giai \u0111o\u1ea1n cu\u1ed1i c\u00f3 \u0111au trung b\u00ecnh v\u00e0 \u0111au n\u1eb7ng. C\u00e1c nghi\u00ean c\u1ee9u c\u0169ng cho bi\u1ebft \u0111au do UT th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb tho\u1ea3 \u0111\u00e1ng do:<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>C\u00e1c th\u1ea7y thu\u1ed1c th\u01b0\u1eddng kh\u00f4ng \u0111\u00e1nh gi\u00e1 \u0111\u00fang m\u1ee9c s\u1ef1 \u0111au \u0111\u1edbn m\u00e0 BN c\u1ea3m th\u1ea5y.<\/li>\n<li>C\u00e1c th\u1ea7y thu\u1ed1c nghi ng\u1edd th\u00f4ng b\u00e1o v\u1ec1 \u0111au c\u1ee7a BN.<\/li>\n<li>C\u00e1c BN \u0111\u00f4i khi kh\u00f4ng th\u00f4ng b\u00e1o \u0111\u00fang m\u1ee9c \u0111au c\u1ee7a h\u1ecd v\u00ec h\u1ecd c\u1ea3m th\u1ea5y s\u1ebd kh\u00f4ng gi\u1ea3i quy\u1ebft \u0111\u01b0\u1ee3c v\u00e0 h\u1ecd s\u1ee3 ph\u1ea3i d\u00f9ng thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111au.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 40px;\"><u>2.2.1 Kh\u00e1i ni\u1ec7m v\u1ec1 \u0111au.<\/u><\/p>\n<p style=\"padding-left: 80px;\">Theo \u0111\u1ecbnh ngh\u0129a c\u1ee7a Hi\u1ec7p h\u1ed9i Qu\u1ed1c t\u1ebf nghi\u00ean c\u1ee9u \u0111au ( IASP, 1979) \u201c\u0111au l\u00e0 m\u1ed9t tr\u1ea3i nghi\u1ec7m c\u1ee7a c\u1ea3m gi\u00e1c v\u00e0 c\u1ea3m x\u00fac kh\u00f3 ch\u1ecbu k\u1ebft h\u1ee3p v\u1edbi m\u1ed9t t\u1ed5n th\u01b0\u01a1ng c\u1ee7a m\u00f4 hi\u1ec7n t\u1ea1i ho\u1eb7c s\u1ebd ph\u00e1t tri\u1ec3n, ho\u1eb7c \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 b\u1eb1ng c\u00e1c ng\u00f4n t\u1eeb v\u1ec1 t\u1ed5n th\u01b0\u01a1ng nh\u01b0 v\u1eady\u201d.<\/p>\n<p style=\"padding-left: 80px;\">Th\u1ef1c t\u1ebf cho th\u1ea5y \u0111au l\u00e0 tri\u1ec7u ch\u1ee9ng s\u1edbm nh\u1ea5t b\u00e1o hi\u1ec7u b\u1ec7nh t\u1eadt nh\u01b0ng c\u0169ng c\u00f2n l\u00e0 tri\u1ec7u ch\u1ee9ng t\u1ed3n l\u01b0u trong v\u00e0 sau qu\u00e1 tr\u00ecnh b\u1ec7nh t\u1eadt. Tri\u1ec7u ch\u1ee9ng \u0111au n\u00f3i chung bao g\u1ed3m hai y\u1ebfu t\u1ed1 c\u1ea5u th\u00e0nh ch\u1ee7 y\u1ebfu l\u00e0 c\u01a1 th\u1ec3 (th\u1ea7n kinh) v\u00e0 t\u00e2m l\u00fd ( c\u1ea3m x\u00fac).<\/p>\n<p style=\"padding-left: 80px;\">Trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng, khi th\u0103m kh\u00e1m b\u1ec7nh nh\u00e2n, ng\u01b0\u1eddi th\u1ea7y thu\u1ed1c th\u01b0\u1eddng c\u1ed1 g\u1eafng t\u00ecm ki\u1ebfm ph\u00e1t hi\u1ec7n m\u00f4 t\u1ed5n th\u01b0\u01a1ng g\u00e2y \u0111au. Tuy nhi\u00ean, theo R.Melzack v\u00e0 P.D. Wall l\u00e0 nh\u1eefng ng\u01b0\u1eddi \u0111\u00e3 \u0111\u1ec1 ra l\u00fd thuy\u1ebft c\u1ed5ng ki\u1ec3m so\u00e1t t\u1eeb 1965, \u201c c\u00f3 nh\u1eefng th\u01b0\u01a1ng t\u00edch kh\u00f4ng g\u00e2y \u0111au v\u00e0 c\u00f3 nh\u1eefng \u0111au \u0111\u1edbn kh\u00f4ng c\u00f3 th\u01b0\u01a1ng t\u00edch\u201d. C\u00e2u n\u00f3i \u0111\u00f3 ph\u1ea3n \u00e1nh th\u1ef1c t\u1ebf trong \u0111\u1eddi s\u1ed1ng c\u1ee7a con ng\u01b0\u1eddi v\u00e0 trong y h\u1ecdc nh\u01b0 c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111au do c\u0103n nguy\u00ean t\u00e2m sinh.<\/p>\n<p style=\"padding-left: 40px;\"><u>2.2.2 Nguy\u00ean nh\u00e2n c\u1ee7a \u0111au<\/u><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>T\u1ed5n th\u01b0\u01a1ng m\u00f4 th\u1ef1c s\u1ef1 do kh\u1ed1i u, thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9, nhi\u1ec5m tr\u00f9ng, ph\u1ea3n \u1ee9ng vi\u00eam, ch\u1ea5n th\u01b0\u01a1ng, c\u00e1c th\u1ee7 thu\u1eadt y h\u1ecdc can thi\u1ec7p, \u0111\u1ed9c t\u00ednh c\u1ee7a thu\u1ed1c, v.v\u2026<\/li>\n<li>T\u1ed5n th\u01b0\u01a1ng m\u00f4 h\u1ecdc ti\u1ec1m t\u00e0ng do c\u00e1c b\u1ec7nh th\u1ef1c th\u1ec3 \u0111\u00e3 \u0111\u01b0\u1ee3c nh\u1eadn bi\u1ebft m\u00e0 nh\u1eefng t\u1ed5n th\u01b0\u01a1ng m\u00f4 h\u1ecdc kh\u00f3 x\u00e1c \u0111\u1ecbnh, v\u00ed d\u1ee5 nh\u01b0 b\u1ec7nh \u0111au s\u1ee3i c\u01a1, \u0111\u1ed9c t\u1ed1 \u2026<\/li>\n<li>C\u00e1c y\u1ebfu t\u1ed1 t\u00e2m l\u00fd: tr\u1ea1ng th\u00e1i lo l\u1eafng, c\u0103ng th\u1eb3ng t\u00e2m l\u00fd ho\u1eb7c r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n nh\u01b0 tr\u1ea7m c\u1ea3m c\u00f3 th\u1ec3 g\u00e2y \u0111au ho\u1eb7c l\u00e0m cho \u0111au th\u1ef1c th\u1ec3 n\u1eb7ng h\u01a1n, v\u00e0 \u0111au th\u1ef1c th\u1ec3 m\u1ea1n t\u00ednh c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n nh\u01b0 tr\u1ea7m c\u1ea3m v\u00e0 lo l\u1eafng. \u0110au m\u1ea1n t\u00ednh do t\u00e2m l\u00fd k\u00e9o d\u00e0i s\u1ebd d\u1eabn \u0111\u1ebfn \u0111au th\u1ef1c th\u1ec3.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 40px;\"><u>2.2.3 Ph\u00e2n lo\u1ea1i \u0111au.<\/u><\/p>\n<p style=\"padding-left: 80px;\">\u0110au c\u00f3 th\u1ec3 ph\u00e2n th\u00e0nh : \u0111au c\u1ea3m th\u1ee5, \u0111au th\u1ea7n kinh, \u0111au c\u1ea5p t\u00ednh, m\u1ea1n t\u00ednh.<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>\u0110au c\u1ea3m th\u1ee5 : \u0111au do k\u00edch th\u00edch c\u00e1c c\u1ea3m th\u1ee5 \u0111au khi c\u00e1c th\u1ea7n kinh c\u1ea3m gi\u00e1c \u0111i\u1ec1u ho\u00e0 \u0111au c\u00f2n nguy\u00ean v\u1eb9n. \u0110au c\u1ea3m th\u1ee5 \u0111\u01b0\u1ee3c chia th\u00e0nh 2 nh\u00f3m l\u00e0 \u0111au th\u00e2n th\u1ec3 v\u00e0 \u0111au t\u1ea1ng :\n<ul>\n<li>\u0110au th\u00e2n th\u1ec3: c\u00e1c c\u1ea3m th\u1ee5 \u0111au \u1edf da, m\u00f4 m\u1ec1m v\u00e0 c\u01a1 ho\u1eb7c x\u01b0\u01a1ng b\u1ecb k\u00edch th\u00edch v\u00e0 \u0111au th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111\u1ecbnh khu. \u0110au \u1edf da th\u01b0\u1eddng bu\u1ed1t, b\u1ecfng r\u00e1t ho\u1eb7c nh\u00f3i. \u0110au c\u01a1, x\u01b0\u01a1ng th\u01b0\u1eddng \u00e2m \u1ec9 nh\u01b0ng c\u00f3 th\u1ec3 tr\u1edf n\u00ean \u0111au t\u0103ng khi c\u1eed \u0111\u1ed9ng.<\/li>\n<li>\u0110au t\u1ea1ng : c\u00e1c c\u1ea3m th\u1ee5 \u0111au c\u1ee7a c\u00e1c t\u1ea1ng \u0111\u1eb7c v\u00e0 t\u1ea1ng r\u1ed7ng b\u1ecb k\u00edch th\u00edch do di c\u0103n, ch\u00e8n \u00e9p, s\u01b0ng to ho\u1eb7c vi\u00eam nhi\u1ec5m c\u00e1c c\u01a1 quan do b\u1ea5t k\u1ef3 nguy\u00ean nh\u00e2n g\u00ec. \u0110au n\u00e0y th\u01b0\u1eddng kh\u00f4ng khu tr\u00fa v\u00e0 g\u00e2y ra c\u1ea3m gi\u00e1c b\u1ecb d\u1ed3n n\u00e9n, ch\u00e8n \u00e9p.<\/li>\n<\/ul>\n<\/li>\n<li>\u0110au th\u1ea7n kinh: g\u00e2y ra do t\u1ed5n th\u01b0\u01a1ng m\u00f4 th\u1ea7n kinh, \u0111\u1eb7c \u0111i\u1ec3m \u0111au b\u1ecfng r\u00e1t, nh\u01b0 \u0111i\u1ec7n gi\u1eadt, kim ch\u00e2m ho\u1eb7c t\u0103ng c\u1ea3m (\u0111au do c\u00e1c t\u00e1c nh\u00e2n k\u00edch th\u00edch m\u00e0 b\u00ecnh th\u01b0\u1eddng kh\u00f4ng g\u00e2y \u0111au) \u1edf nh\u1eefng v\u00f9ng b\u1ecb chi ph\u1ed1i b\u1edfi c\u00e1c d\u00e2y th\u1ea7n kinh b\u1ecb t\u1ed5n th\u01b0\u01a1ng.<\/li>\n<li>\u0110au c\u1ea5p t\u00ednh, \u0111au m\u1ea1n t\u00ednh: Leriche ( 1936) \u0111\u00e3 ph\u00e2n bi\u1ec7t hai lo\u1ea1i \u0111au: \u0111au c\u1ea5p t\u00ednh ( l\u00e0 tri\u1ec7u ch\u1ee9ng \u0111au) v\u00e0 \u0111au m\u1ea1n t\u00ednh ( l\u00e0 b\u1ec7nh \u0111au). \u0110au c\u1ea5p t\u00ednh di\u1ec5n ra d\u01b0\u1edbi m\u1ed9t th\u00e1ng, th\u01b0\u1eddng ch\u1ec9 b\u00e1o c\u00f3 t\u1ed5n th\u01b0\u01a1ng m\u00f4 c\u1ee5 th\u1ec3 g\u00e2y t\u0103ng ho\u1ea1t \u0111\u1ed9ng k\u00edch th\u00edch h\u1ec7 th\u1ea7n kinh. N\u1ebfu \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p, \u0111au s\u1ebd h\u1ebft v\u00e0 nh\u01b0 v\u1eady \u0111au c\u00f3 ch\u1ee9c n\u0103ng b\u1ea3o v\u1ec7 c\u01a1 th\u1ec3. \u0110au m\u1ea1n t\u00ednh, k\u00e9o d\u00e0i t\u1eeb ba \u0111\u1ebfn s\u00e1u th\u00e1ng v\u00e0 c\u00f3 th\u1ec3 di\u1ec5n ra l\u00e2u h\u01a1n th\u1eddi gian d\u1ef1 ki\u1ebfn kh\u1ecfi b\u1ec7nh; nh\u01b0 v\u1eady kh\u00f4ng c\u00f3 ch\u1ee9c n\u0103ng b\u1ea3o v\u1ec7 m\u00e0 c\u00f3 th\u1ec3 l\u00e0m suy gi\u1ea3m s\u1ee9c kh\u1ecfe v\u00e0 ch\u1ee9c n\u0103ng c\u01a1 th\u1ec3 c\u1ee7a b\u1ec7nh nh\u00e2n.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 40px;\"><u>2.2.4 \u0110\u00e1nh gi\u00e1 \u0111au<\/u><\/p>\n<p style=\"padding-left: 80px;\">\u0110\u00e1nh gi\u1ea3 \u0111au c\u1ea7n t\u1ef7 m\u1ef7, khai th\u00e1c ti\u1ec1n s\u1eed c\u1ee7a BN v\u1ec1 nh\u1eefng v\u1ea5n \u0111\u1ec1 sau:<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Tr\u00ecnh t\u1ef1 th\u1eddi gian: \u0110au b\u1eaft \u0111\u1ea7u khi n\u00e0o?. \u0110au k\u00e9o d\u00e0i bao l\u00e2u?<\/li>\n<li>V\u1ecb tr\u00ed: \u0110au \u1edf \u0111\u00e2u?, c\u00f3 m\u1ea5y v\u1ecb tr\u00ed \u0111au?, \u0111au c\u00f3 lan xuy\u00ean kh\u00f4ng?<\/li>\n<li>M\u1ee9c \u0111\u1ed9 \u0111au:\n<ul>\n<li>\u0110\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 \u0111au th\u00f4ng th\u01b0\u1eddng ng\u01b0\u1eddi ta s\u1eed d\u1ee5ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111\u01a1n gi\u1ea3n v\u00e0 c\u00f3 gi\u00e1 tr\u1ecb nh\u01b0: thang \u0111i\u1ec3m s\u1ed1, ho\u1eb7c thang \u0111i\u1ec3m h\u00ecnh \u1ea3nh.<\/li>\n<li>M\u1eb7c d\u00f9 \u0111au l\u00e0 c\u1ea3m gi\u00e1c ch\u1ee7 quan, nh\u01b0ng BN c\u00f3 th\u1ec3 ch\u1ec9 ra m\u1ed9t c\u00e1ch t\u01b0\u01a1ng \u0111\u1ed1i ch\u00ednh x\u00e1c m\u1ee9c \u0111\u1ed9 \u0111au c\u1ee7a h\u1ecd b\u1eb1ng vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c thang \u0111i\u1ec3m, v\u00ec v\u1eady ch\u00fang t\u1ea1o \u0111i\u1ec1u ki\u1ec7n thu\u1eadn l\u1ee3i cho \u0111i\u1ec1u tr\u1ecb gi\u1ea3m \u0111au t\u1ed1i \u01b0u.<\/li>\n<li>S\u1eed d\u1ee5ng c\u00f9ng m\u1ed9t thang \u0111i\u1ec3m \u0111\u1ec3 theo d\u00f5i \u0111au c\u1ee7a BN theo th\u1eddi gian.<\/li>\n<li>M\u1ed7i BN c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng c\u00e1c thang \u0111i\u1ec3m m\u1ed9t c\u00e1ch kh\u00e1c nhau v\u00e0 \u0111i\u1ec1u tr\u1ecb gi\u1ea3m \u0111au kh\u00f4ng ch\u1ec9 d\u1ef1a tr\u00ean thang \u0111i\u1ec3m \u0111au m\u00e0 c\u00f2n c\u0103n c\u1ee9 v\u00e0o t\u00ecnh tr\u1ea1ng c\u1ee7a BN tr\u00ean l\u00e2m s\u00e0ng.<\/li>\n<\/ul>\n<\/li>\n<li>\u0110\u1eb7c \u0111i\u1ec3m, t\u00ednh ch\u1ea5t c\u1ee7a \u0111au, y\u00eau c\u1ea7u BN m\u00f4 t\u1ea3 \u0111au \u0111\u1ec3 c\u00f3 th\u1ec3 ph\u00e2n bi\u1ec7t \u0111au th\u1ea7n kinh v\u00e0 \u0111au c\u1ea3m th\u1ee5, \u0111au h\u1ed7n h\u1ee3p \u2026<\/li>\n<li>Y\u1ebfu t\u1ed1 \u0111i\u1ec1u h\u00f2a: \u0110i\u1ec1u g\u00ec l\u00e0m \u0111au t\u0103ng l\u00ean ho\u1eb7c l\u00e0m gi\u1ea3m c\u01a1n \u0111au ?<\/li>\n<li>Nh\u1eefng \u0111i\u1ec1u tr\u1ecb tr\u01b0\u1edbc \u0111\u00e2y: bi\u1ec7n ph\u00e1p, thu\u1ed1c gi\u1ea3m \u0111au \u0111\u00e3 s\u1eed d\u1ee5ng ?<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 80px;\"><em><u>2.2.4.1 \u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 \u0111au theo thang \u0111i\u1ec3m VAS (visual analog scales)<\/u><\/em><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>C\u00f4ng c\u1ee5 n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 \u0111au hi\u1ec7n t\u1ea1i v\u00e0 m\u1ee9c \u0111\u1ed9 c\u1ee7a \u0111au trong qu\u00e1 kh\u1ee9.<\/li>\n<li>M\u1ee9c \u0111\u1ed9 \u0111au t\u1eeb 0 \u0111\u1ebfn 10, gi\u1ea3i th\u00edch b\u1eb1ng l\u1eddi cho BN hi\u1ec3u c\u00e1ch t\u1ef1 \u0111\u00e1nh gi\u00e1 \u0111i\u1ec3m \u0111au cho b\u1ea3n th\u00e2n tr\u00ean th\u01b0\u1edbc hi\u1ec3n th\u1ecb s\u1ed1.<\/li>\n<li>Ghi l\u1ea1i m\u1ee9c \u0111\u1ed9 \u0111au c\u1ee7a BN \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb, theo d\u00f5i v\u00e0 so s\u00e1nh gi\u1eefa c\u00e1c l\u1ea7n kh\u00e1m<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 80px;\"><em><u>2.2.4.2 \u0110\u00e1nh gi\u00e1 \u0111au theo n\u00e9t m\u1eb7t Wong-Baker<\/u><\/em><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>L\u00e0 c\u00f4ng c\u1ee5 \u0111\u01a1n gi\u1ea3n v\u00e0 ph\u00f9 h\u1ee3p v\u1edbi tr\u1ebb em, BN c\u00e2m \u0111i\u1ebfc, ng\u01b0\u1eddi b\u1ea5t \u0111\u1ed3ng ng\u00f4n ng\u1eef<\/li>\n<li>L\u00e0 c\u00f4ng c\u1ee5 ph\u00f9 h\u1ee3p nh\u1ea5t \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a \u0111au hi\u1ec7n t\u1ea1i.<\/li>\n<li>Gi\u1ea3i th\u00edch cho ng\u01b0\u1eddi ch\u0103m s\u00f3c bi\u1ebft m\u1ee9c \u0111\u1ed9 \u0111au tr\u00ean m\u1ed7i h\u00ecnh c\u1ee7a khu\u00f4n m\u1eb7t.<\/li>\n<li>Quan s\u00e1t v\u00e0 ch\u1ecdn m\u1ed9t khu\u00f4n m\u1eb7t m\u00f4 t\u1ea3 \u0111\u00fang nh\u1ea5t c\u01b0\u1eddng \u0111\u1ed9 \u0111au hi\u1ec7n t\u1ea1i, c\u00f3 th\u1ec3 tham kh\u1ea3o th\u00eam \u00fd ki\u1ebfn c\u1ee7a ng\u01b0\u1eddi ch\u0103m s\u00f3c<\/li>\n<li>Ghi l\u1ea1i m\u1ee9c \u0111\u1ed9 \u0111au c\u1ee7a BN \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb, theo d\u00f5i v\u00e0 so s\u00e1nh gi\u1eefa c\u00e1c l\u1ea7n kh\u00e1m.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 40px;\"><u>2.2.5 \u0110i\u1ec1u tr\u1ecb \u0111au<\/u><\/p>\n<p style=\"padding-left: 80px;\"><em><u>2.2.5.1 C\u00e1c nguy\u00ean l\u00fd c\u1ee7a \u0111i\u1ec1u tr\u1ecb \u0111au trong UT.<\/u><\/em><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Kh\u00f4ng \u0111\u01b0\u1ee3c tr\u00ec ho\u00e3n vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111au, t\u1ea5t c\u1ea3 c\u00e1c BN c\u00f3 \u0111au ph\u1ea3i \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb nh\u1eb1m gi\u1ea3m b\u1edbt s\u1ef1 \u0111au \u0111\u1edbn v\u00e0 \u0111\u1ec3 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng cho h\u1ecd t\u1ea1i b\u1ea5t k\u1ef3 giai \u0111o\u1ea1n n\u00e0o c\u1ee7a b\u1ec7nh.<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb v\u00e0 qu\u1ea3n l\u00fd \u0111au l\u00e0:\n<ul>\n<li>Lo\u1ea1i tr\u1eeb \u0111au, ho\u1eb7c l\u00e0m gi\u1ea3m m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a \u0111au \u0111\u1ebfn m\u1ee9c BN c\u00f3 th\u1ec3 ch\u1ecbu \u0111\u1ef1ng \u0111\u01b0\u1ee3c.<\/li>\n<li>D\u1ef1 ph\u00f2ng \u0111au t\u00e1i di\u1ec5n.<\/li>\n<li>L\u00e0m cho BN c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c c\u00e1c ho\u1ea1t \u0111\u1ed9ng b\u00ecnh th\u01b0\u1eddng c\u1ee7a h\u1ecd trong cu\u1ed9c s\u1ed1ng h\u00e0ng ng\u00e0y.<\/li>\n<\/ul>\n<\/li>\n<li>Tin t\u01b0\u1edfng v\u00e0o m\u00f4 t\u1ea3 v\u1ec1 \u0111au v\u00e0 hi\u1ec7u qu\u1ea3 c\u1ee7a \u0111i\u1ec1u tr\u1ecb gi\u1ea3m \u0111au c\u1ee7a BN bao g\u1ed3m c\u1ea3 nh\u1eefng BN \u0111\u00e3 s\u1eed d\u1ee5ng opioid.<\/li>\n<li>Ph\u1ed1i h\u1ee3p c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 c\u00f3 th\u1ec3 \u0111\u1ea1t hi\u1ec7u qu\u1ea3 gi\u1ea3m \u0111au (c\u1ea3 can thi\u1ec7p d\u00f9ng thu\u1ed1c hay kh\u00f4ng d\u00f9ng thu\u1ed1c).<\/li>\n<li>T\u00ecm nguy\u00ean nh\u00e2n \u0111au \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb n\u1ebfu c\u00f3 th\u1ec3.<\/li>\n<li>C\u00e1 th\u1ec3 ho\u00e1 c\u00e1c can thi\u1ec7p v\u00e0 li\u1ec1u gi\u1ea3m \u0111au.<\/li>\n<li>Ch\u00fa \u00fd c\u00e1c v\u1ea5n \u0111\u1ec1 t\u00e2m l\u00fd x\u00e3 h\u1ed9i, v\u00ec n\u00f3 c\u00f3 th\u1ec3 g\u00e2y ra ho\u1eb7c l\u00e0m \u0111au n\u1eb7ng h\u01a1n ho\u1eb7c l\u00e0m gi\u1ea3m hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb. V\u00ec v\u1eady qu\u1ea3n l\u00fd \u0111au to\u00e0n di\u1ec7n \u0111\u00f2i h\u1ecfi ph\u1ea3i quan t\u00e2m \u0111\u1ebfn c\u00e1c v\u1ea5n \u0111\u1ec1 t\u00e2m l\u00fd x\u00e3 h\u1ed9i.<\/li>\n<li>Qu\u1ea3n l\u00fd \u0111au c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n t\u1ea1i c\u00e1c c\u01a1 s\u1edf y t\u1ebf, t\u1ea1i nh\u00e0 v\u00e0 t\u1ea1i c\u1ed9ng \u0111\u1ed3ng.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 80px;\"><em><u>2.2.5.2 Thang gi\u1ea3m \u0111au 3 b\u1eadc c\u1ee7a WHO<\/u><\/em><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Thang gi\u1ea3m \u0111au 3 b\u1eadc c\u1ee7a WHO, ti\u1ebfp c\u1eadn t\u1eebng b\u01b0\u1edbc \u0111\u1ed1i v\u1edbi \u0111au do UT<\/li>\n<li>\u0110\u01b0\u1eddng d\u00f9ng thu\u1ed1c: \u0111\u01b0\u1eddng u\u1ed1ng \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u01b0u ti\u00ean s\u1eed d\u1ee5ng h\u01a1n<\/li>\n<li>C\u00e1 nh\u00e2n ho\u00e1 li\u1ec1u \u0111i\u1ec1u tr\u1ecb: Li\u1ec1u ch\u00ednh x\u00e1c l\u00e0 li\u1ec1u \u0111\u1ee7 \u0111\u1ec3 gi\u1ea3m \u0111au cho m\u1ed9t c\u00e1 th\u1ec3 BN.<\/li>\n<li>Theo d\u00f5i s\u00e1t \u0111\u00e1p \u1ee9ng c\u1ee7a \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb cao nh\u1ea5t v\u00e0 gi\u1ea3m \u0111\u1ebfn m\u1ee9c th\u1ea5p nh\u1ea5t c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 80px;\"><em><u>2.2.5.3 C\u00e1c thu\u1ed1c h\u1ed7 tr\u1ee3 gi\u1ea3m \u0111au<\/u><\/em><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>C\u00e1c thu\u1ed1c h\u1ed7 tr\u1ee3 c\u00f3 th\u1ec3 gi\u1ea3m \u0111au m\u1ed9t c\u00e1ch \u0111\u1ed9c l\u1eadp, ho\u1eb7c t\u0103ng hi\u1ec7u qu\u1ea3 gi\u1ea3m \u0111au v\u00e0 gi\u00fap gi\u1ea3m li\u1ec1u c\u1ee7a c\u00e1c thu\u1ed1c NSAID v\u00e0 c\u00e1c opioid.<\/li>\n<li>C\u00e1c ch\u1ec9 \u0111\u1ecbnh ch\u00ednh: C\u00f3 \u00edch trong c\u00e1c \u0111au th\u1ea7n kinh. M\u1ed9t s\u1ed1 thu\u1ed1c h\u1ed7 tr\u1ee3 c\u00f3 th\u1ec3 c\u00f3 \u00edch trong \u0111i\u1ec1u tr\u1ecb \u0111au x\u01b0\u01a1ng v\u00e0 co th\u1eaft c\u01a1. Khi m\u1ed9t trong nh\u1eefng lo\u1ea1i \u0111au n\u00e0y b\u1ecb nghi ng\u1edd v\u00e0 \u0111au kh\u00f4ng \u0111\u01b0\u1ee3c gi\u1ea3m m\u1ed9t c\u00e1ch tho\u1ea3 \u0111\u00e1ng v\u1edbi m\u1ed9t NSAID ho\u1eb7c acetaminophen, h\u00e3y b\u1ed5 sung th\u00eam m\u1ed9t thu\u1ed1c h\u1ed7 tr\u1ee3.\n<ul>\n<li>\u0110au th\u1ea7n kinh: Gabapentin. li\u1ec1u d\u00f9ng: b\u1eaft \u0111\u1ea7u 300 mg v\u00e0o bu\u1ed5i t\u1ed1i, li\u1ec1u t\u1ed1i \u0111a 3600 mg\/ng\u00e0y.<\/li>\n<li>\u0110au x\u01b0\u01a1ng: Biphosphonate 4mg truy\u1ec1n t\u0129nh m\u1ea1ch 4 tu\u1ea7n\/ l\u1ea7n<\/li>\n<li>\u0110au c\u01a1: Myonal, mydocalm \u2026<\/li>\n<li>Ch\u1ed1ng co th\u1eaft (\u0111au t\u1ea1ng), c\u00e1c thu\u1ed1c kh\u00e1ng cholinergic d\u00f9ng trong c\u00e1c co th\u1eaft c\u01a1 \u0111\u01b0\u1eddng ti\u00eau ho\u00e1 nh\u1eb9: papaverin, nospa \u2026<\/li>\n<li>C\u00e1c thu\u1ed1c ch\u1ed1ng lo \u00e2u: diazepam, stablon, olanzapin\u2026<\/li>\n<li>Ch\u1ed1ng tr\u1ea7m c\u1ea3m: Amitriptyline, li\u1ec1u d\u00f9ng: b\u1eaft \u0111\u1ea7u 10-25mg v\u00e0o bu\u1ed5i t\u1ed1i, li\u1ec1u t\u1ed1i \u0111a 200 mg\/ng\u00e0y. T\u00e1c d\u1ee5ng ph\u1ee5: l\u01a1 m\u01a1, h\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf \u0111\u1ee9ng<\/li>\n<li>Corticosteroid (Prednisolone, dexamethasone, solumedrol..,).T\u00e1c d\u1ee5ng ph\u1ee5: r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n, lo \u00e2u, b\u1ec7nh c\u01a1, t\u0103ng \u0111\u01b0\u1eddng m\u00e1u.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 80px;\"><em><u>2.2.5.4 S\u1eed d\u1ee5ng c\u00e1c opioids<\/u><\/em><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>C\u00e1c opioids nh\u1eb9<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 120px;\">\u0110\u1ed1i v\u1edbi \u0111au trung b\u00ecnh ho\u1eb7c \u0111au dai d\u1eb3ng m\u1eb7c d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c NSAID ho\u1eb7c acetaminophen kh\u00f4ng hi\u1ec7u qu\u1ea3, s\u1eed d\u1ee5ng opioid t\u00e1c d\u1ee5ng nh\u1eb9 k\u00e8m theo ho\u1eb7c kh\u00f4ng k\u00e8m theo m\u1ed9t NSAID ho\u1eb7c acetaminophen.<\/p>\n<p style=\"padding-left: 120px;\">Opioid t\u00e1c d\u1ee5ng y\u1ebfu n\u00ean \u0111\u01b0\u1ee3c cho li\u1ec1u th\u01b0\u1eddng xuy\u00ean \u0111\u1ec3 duy tr\u00ec t\u00e1c d\u1ee5ng gi\u1ea3m \u0111au, n\u1ebfu BN c\u00f3 r\u1ed1i lo\u1ea1n gi\u1ea5c ng\u1ee7 ban \u0111\u00eam do opioids, c\u00f3 th\u1ec3 cho li\u1ec1u g\u1ea5p \u0111\u00f4i (li\u1ec1u g\u00e2y ng\u1ee7).<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Codein: Li\u1ec1u d\u00f9ng: b\u1eaft \u0111\u1ea7u 30-60 mg m\u1ed7i 3-4 gi\u1edd, li\u1ec1u t\u1ed1i \u0111a 360 mg\/ng\u00e0y. Khuy\u1ebfn c\u00e1o cho \u0111au nh\u1eb9, n\u1ebfu BN kh\u00f4ng \u0111\u01b0\u1ee3c gi\u1ea3m \u0111au tho\u1ea3 \u0111\u00e1ng v\u1edbi codein, \u0111au v\u1eabn dai d\u1eb3ng k\u00e9o d\u00e0i n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng opioid m\u1ea1nh nh\u01b0 morphine.<\/li>\n<li>Tramadol (d\u1ea1ng ph\u1ed1i h\u1ee3p v\u1edbi acetaminophen )<\/li>\n<li>Dextroproxyphene: hi\u1ec7n nay kh\u00f4ng d\u00f9ng.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>C\u00e1c opioid m\u1ea1nh<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 120px;\">\u0110\u1ed1i v\u1edbi nh\u1eefng BN \u0111au kh\u00f4ng li\u00ean t\u1ee5c, opioid t\u00e1c d\u1ee5ng nh\u1eb9 c\u00f3 th\u1ec3 l\u00e0 \u0111\u1ee7. Tuy nhi\u00ean \u0111\u1ed1i v\u1edbi nh\u1eefng BN \u0111au li\u00ean t\u1ee5c ho\u1eb7c ph\u1ed1i h\u1ee3p c\u1ea3 \u0111au li\u00ean t\u1ee5c v\u00e0 \u0111au kh\u00f4ng li\u00ean t\u1ee5c ng\u00e0y c\u00e0ng t\u1ed3i t\u1ec7, khuy\u00ean d\u00f9ng c\u00e1c thu\u1ed1c opioid c\u00f3 t\u00e1c d\u1ee5ng m\u1ea1nh k\u00e9o d\u00e0i.<\/p>\n<p style=\"padding-left: 120px;\">C\u00e1c thu\u1ed1c opioid c\u00f3 t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i \u0111\u01b0\u1ee3c \u01b0a d\u00f9ng v\u00ec ch\u00fang duy tr\u00ec n\u1ed3ng \u0111\u1ed9 thu\u1ed1c trong m\u00e1u h\u1eb1ng \u0111\u1ecbnh v\u00e0 v\u00ec v\u1eady t\u00e1c d\u1ee5ng gi\u1ea3m \u0111au \u1ed5n \u0111\u1ecbnh h\u01a1n so v\u1edbi c\u00e1c opioid t\u00e1c d\u1ee5ng nh\u1eb9 v\u00e0 ng\u1eafn.<\/p>\n<p style=\"padding-left: 120px;\">\u0110\u1ec3 ch\u1ecdn li\u1ec1u opioid c\u00f3 t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i, b\u1eaft \u0111\u1ea7u cho BN m\u1ed9t thu\u1ed1c t\u00e1c d\u1ee5ng ng\u1eafn v\u00e0 x\u00e1c \u0111\u1ecbnh li\u1ec1u chu\u1ea9n \u0111\u1ec3 ki\u1ec3m so\u00e1t \u0111au.<\/p>\n<p style=\"padding-left: 120px;\">Opioid c\u00f3 t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i ch\u1ec9 n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec1u \u0111\u1eb7n theo gi\u1edd ( t\u1ea1i nh\u1eefng kho\u1ea3ng th\u1eddi gian \u0111\u1ec1u \u0111\u1eb7n trong ng\u00e0y ho\u1eb7c trong tu\u1ea7n).<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Morphin sulfate:<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 200px;\">Li\u1ec1u u\u1ed1ng: b\u1eaft \u0111\u1ea7u v\u1edbi 5mg, \u0111\u00e1nh gi\u00e1 l\u1ea1i sau 60 ph\u00fat. N\u1ebfu \u0111au c\u00f2n n\u1eb7ng, g\u1ea5p \u0111\u00f4i li\u1ec1u h\u00e0ng gi\u1edd. Sau khi m\u1ed9t li\u1ec1u c\u00f3 t\u00e1c d\u1ee5ng \u0111\u01b0\u1ee3c t\u00ecm ra cho thu\u1ed1c \u0111\u1ec1u \u0111\u1eb7n 4 gi\u1edd 1 l\u1ea7n. C\u00f3 th\u1ec3 t\u0103ng li\u1ec1u 50-100% sau m\u1ed7i ng\u00e0y n\u1ebfu v\u1eabn \u0111au dai d\u1eb3ng.<\/p>\n<p style=\"padding-left: 200px;\">Li\u1ec1u ti\u00eam t\u0129nh m\u1ea1ch ho\u1eb7c d\u01b0\u1edbi da: b\u1eaft \u0111\u1ea7u v\u1edbi 2-5mg ti\u00eam t\u0129nh m\u1ea1ch ho\u1eb7c ti\u00eam d\u01b0\u1edbi da.<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Mi\u1ebfng d\u00e1n da Fentanyl: t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i 48-72 gi\u1edd, r\u1ea5t c\u00f3 \u00edch cho nh\u1eefng BN kh\u00f3 u\u1ed1ng thu\u1ed1c do bu\u1ed3n n\u00f4n, kh\u00f3 nu\u1ed1t ho\u1eb7c r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng d\u1ea1 d\u00e0y ru\u1ed9t. C\u01a1 ch\u1ebf ho\u1ea1t \u0111\u1ed9ng: Fentanyl, m\u1ed9t lipophile, khu\u1ebfch t\u00e1n trong c\u00e1c l\u1edbp m\u1ee1 c\u1ee7a da v\u00e0 sau \u0111\u00f3 v\u00e0o m\u00e1u, v\u00ec th\u1ebf \u0111\u1eb7t mi\u1ebfng d\u00e1n v\u00e0o m\u1ed9t v\u00f9ng c\u01a1 th\u1ec3 v\u1edbi l\u1edbp m\u1ee1 d\u01b0\u1edbi da nh\u01b0 b\u1ee5ng, c\u00e1nh tay ho\u1eb7c m\u00f4ng.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 200px;\">C\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, mi\u1ebfng d\u00e1n kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng cho:<\/p>\n<p style=\"padding-left: 200px;\">Nh\u1eefng BN suy m\u00f2n kh\u00f4ng c\u00f3 l\u1edbp m\u1ee1 d\u01b0\u1edbi da.<\/p>\n<p style=\"padding-left: 200px;\">Nh\u1eefng BN s\u1ed1t do s\u1ef1 t\u0103ng h\u1ea5p thu, c\u00f3 th\u1ec3 t\u0103ng \u0111\u1ed9c t\u00ednh.<\/p>\n<p style=\"padding-left: 200px;\">Nh\u1eefng BN nhi\u1ec1u m\u1ed3 h\u00f4i v\u00ec mi\u1ebfng d\u00e1n s\u1ebd kh\u00f4ng d\u00ednh.<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Nh\u1eefng t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a opioid.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 120px;\">Nguy c\u01a1 c\u1ee7a c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 nghi\u00eam tr\u1ecdng c\u1ee7a c\u00e1c opioid l\u00e0 r\u1ea5t nh\u1ecf khi c\u00e1c quy t\u1eafc k\u00ea \u0111\u01a1n chu\u1ea9n \u0111\u01b0\u1ee3c tu\u00e2n th\u1ee7. Ch\u1ec9 \u0111\u1ecbnh li\u1ec1u th\u1ea5p nh\u1ea5t c\u1ee7a opioid m\u00e0 c\u00f3 th\u1ec3 gi\u1ea3m \u0111au ho\u00e0n to\u00e0n ho\u1eb7c t\u1edbi m\u1ee9c \u0111\u1ed9 ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c \u0111\u1ed1i v\u1edbi BN.<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 th\u00f4ng th\u01b0\u1eddng: bu\u1ed3n n\u00f4n, n\u00f4n, an th\u1ea7n, t\u00e1o b\u00f3n. Bu\u1ed3n n\u00f4n v\u00e0 t\u00e1o b\u00f3n th\u01b0\u1eddng h\u1ebft trong v\u00f2ng 1 tu\u1ea7n.<\/li>\n<li>Th\u1eadn tr\u1ecdng khi x\u00e1c \u0111\u1ecbnh li\u1ec1u opioid \u1edf ng\u01b0\u1eddi gi\u00e0 v\u00e0 nh\u1eefng BN suy gan th\u1eadn v\u00ec h\u1ecd s\u1ebd nh\u1ea1y c\u1ea3m h\u01a1n v\u1edbi thu\u1ed1c v\u00e0 s\u1ebd c\u00f3 nh\u1eefng t\u00e1c d\u1ee5ng ph\u1ee5 nh\u01b0 an th\u1ea7n \u1edf nh\u1eefng li\u1ec1u th\u1ea5p h\u01a1n. B\u1eaft \u0111\u1ea7u v\u1edbi li\u1ec1u th\u1ea5p v\u00e0 t\u0103ng d\u1ea7n m\u1ed9t c\u00e1ch ch\u1eadm r\u00e3i.<\/li>\n<li>Suy h\u00f4 h\u1ea5p: Khi t\u00ecnh tr\u1ea1ng suy h\u00f4 h\u1ea5p g\u00e2y ra b\u1edfi s\u1ef1 qu\u00e1 li\u1ec1u opioid, \u0111\u01b0\u1ee3c b\u00e1o tr\u01b0\u1edbc b\u1edfi t\u00ecnh tr\u1ea1ng ng\u1ee7 g\u00e0. V\u00ec v\u1eady, \u0111i\u1ec1u tr\u1ecb \u0111au t\u00edch c\u1ef1c b\u1eb1ng opioid \u00edt nh\u1ea5t \u0111\u1ebfn khi t\u00e1c d\u1ee5ng an th\u1ea7n x\u1ea3y ra l\u00e0 an to\u00e0n.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 120px;\">Tr\u01b0\u1eddng h\u1ee3p suy h\u00f4 h\u1ea5p n\u1eb7ng, pha 0.4 mg naloxone trong 9ml natrichlorid 9\u2030 v\u00e0 ti\u00eam 1ml c\u1ee9 1-2 ph\u00fat\/l\u1ea7n cho \u0111\u1ebfn khi nh\u1ecbp th\u1edf tr\u1edf v\u1ec1 b\u00ecnh th\u01b0\u1eddng.<\/p>\n<p style=\"padding-left: 40px;\"><strong>2.3 T\u01b0 v\u1ea5n v\u00e0 h\u1ed7 tr\u1ee3 t\u00e2m l\u00fd<\/strong><\/p>\n<p style=\"padding-left: 40px;\"><u>2.3.1 Vai tr\u00f2 c\u1ee7a t\u01b0 v\u1ea5n v\u00e0 h\u1ed7 tr\u1ee3 t\u00e2m l\u00fd<\/u><\/p>\n<p style=\"padding-left: 40px;\">T\u01b0 v\u1ea5n v\u00e0 h\u1ed7 tr\u1ee3 t\u00e2m l\u00fd l\u00e0 m\u1ed9t nh\u00f3m c\u00e1c can thi\u1ec7p h\u1ed7 tr\u1ee3 nh\u1eb1m gi\u00fap BN ho\u1eb7c ng\u01b0\u1eddi th\u00e2n c\u00f3 th\u1ec3 v\u01b0\u1ee3t qua nh\u1eefng kh\u1ee7ng ho\u1ea3ng t\u00e2m l\u00fd, nh\u1eefng \u0111au bu\u1ed3n qu\u00e1 m\u1ee9c do b\u1ec7nh t\u1eadt g\u00e2y n\u00ean.<\/p>\n<p style=\"padding-left: 40px;\">M\u1ed9t ng\u01b0\u1eddi \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh l\u00e0 UT, \u0111i\u1ec1u g\u00ec s\u1ebd x\u1ea3y ra v\u1edbi h\u1ecd ngay l\u00fac \u0111\u00f3?, ng\u01b0\u1eddi th\u1ea7y thu\u1ed1c ph\u1ea3i l\u00e0m g\u00ec v\u00e0 ph\u1ea3i th\u00f4ng b\u00e1o \u201ctin d\u1eef\u201d \u0111\u00f3 nh\u01b0 th\u1ebf n\u00e0o \u0111\u1ec3 c\u00f3 l\u1ee3i nh\u1ea5t cho ng\u01b0\u1eddi b\u1ec7nh v\u00e0 gia \u0111\u00ecnh c\u1ee7a h\u1ecd?<\/p>\n<p style=\"padding-left: 40px;\">T\u1ea5t c\u1ea3 c\u00e1c BN \u0111\u1ec1u c\u00f3 m\u1ed9t ph\u1ea3n \u1ee9ng v\u1ec1 c\u1ea3m x\u00fac \u0111\u1ed1i v\u1edbi b\u1ec7nh hi\u1ec3m ngh\u00e8o, tuy nhi\u00ean \u1edf m\u1ed7i ng\u01b0\u1eddi m\u1ed7i m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau. C\u00e1c nghi\u00ean c\u1ee9u cho th\u1ea5y kho\u1ea3ng 70% BN UT c\u00f3 lo\u1ea1n th\u1ea7n m\u00e0 \u0111a s\u1ed1 l\u00e0 tr\u1ea7m c\u1ea3m, do lo l\u1eafng qu\u00e1 m\u1ee9c v\u00e0 \u0111au bu\u1ed3n khi bi\u1ebft m\u00ecnh b\u1ecb b\u1ec7nh UT.<\/p>\n<p style=\"padding-left: 40px;\">Ng\u01b0\u1eddi th\u1ea7y thu\u1ed1c c\u00e2\u0300n ph\u1ea3i co\u0301 s\u01b0\u0323 \u0111a\u0301nh gia\u0301 t\u00e2m ly\u0301 cu\u0309a BN ngay t\u01b0\u0300 khi b\u00ea\u0323nh \u0111\u01b0\u01a1\u0323c ch\u00e2\u0309n \u0111oa\u0301n \u0111\u00ea\u0309 t\u01b0 v\u00e2\u0301n va\u0300 h\u00f4\u0303 tr\u01a1\u0323 t\u00e2m ly\u0301 ki\u0323p th\u01a1\u0300i, ta\u0323o ni\u00ea\u0300m tin cho ng\u01b0\u01a1\u0300i b\u00ea\u0323nh ti\u00ea\u0301p c\u00e2\u0323n ca\u0301c ph\u01b0\u01a1ng pha\u0301p \u0110T v\u01a1\u0301i t\u00e2m ly\u0301 v\u01b0\u0303ng va\u0300ng \u0111\u00ea\u0309 chi\u00ea\u0301n th\u0103\u0301ng b\u00ea\u0323nh t\u00e2\u0323t.<\/p>\n<p style=\"padding-left: 40px;\">Th\u01b0\u0323c t\u00ea\u0301 thi\u0300 s\u1ef1 kh\u1ee7ng ho\u1ea3ng v\u1ec1 c\u1ea3m x\u00fac, v\u00e0 tinh th\u1ea7n cu\u0309a BN th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c ca\u0301c th\u00e2\u0300y thu\u00f4\u0301c \u0111\u00e1nh gi\u00e1 \u0111\u1ea7y \u0111\u1ee7 ho\u1eb7c kh\u00f4ng h\u1ec1 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 b\u1edfi v\u00ec :<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>\u0110\u00e1nh gi\u00e1 v\u1ec1 t\u00e2m l\u00fd x\u00e3 h\u1ed9i v\u00e0 tinh th\u1ea7n th\u00f4ng th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c d\u1ea1y trong tr\u01b0\u1eddng y<\/li>\n<li>V\u00ec v\u1eady c\u00e1c th\u1ea7y thu\u1ed1c l\u00e2m s\u00e0ng kh\u00f4ng \u00fd th\u1ee9c \u0111\u01b0\u1ee3c r\u1eb1ng:\n<ul>\n<li>H\u1ecd c\u00f3 th\u1ec3 gi\u00fap BN v\u01b0\u01a1\u0323t qua nh\u1eefng n\u1ed7i \u0111au v\u1ec1 tinh th\u1ea7n<\/li>\n<li>T\u01b0 v\u1ea5n cho BN m\u1ee5c ti\u00eau v\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb, \u0111\u1ec3 h\u1ecd t\u1ef1 nguy\u00ean, h\u1ee3p t\u00e1c v\u1edbi th\u1ea7y thu\u1ed1c trong ch\u0103m s\u00f3c v\u00e0 \u0111i\u1ec1u tr\u1ecb.<\/li>\n<li>Gi\u00fap cho BN v\u00e0 ng\u01b0\u1eddi nh\u00e0 BN ph\u01b0\u01a1ng ph\u00e1p chi\u1ebfn \u0111\u1ea5u v\u1edbi b\u1ec7nh t\u1eadt m\u1ed9t c\u00e1ch t\u00edch c\u1ef1c.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 40px;\">Ng\u00e0y nay, \u1edf c\u00e1c n\u01b0\u1edbc pha\u0301t tri\u00ea\u0309n l\u00e0 c\u00e1c th\u1ea7y thu\u1ed1c l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 v\u1eeba \u0111\u00e1nh gi\u00e1 m\u1ed9t c\u00e1ch hi\u1ec7u qu\u1ea3 s\u1ef1 \u0111au kh\u1ed5 v\u1ec1 t\u00e2m l\u00fd x\u00e3 h\u1ed9i v\u00e0 tinh th\u1ea7n v\u1eeba c\u00f3 th\u1ec3 can thi\u1ec7p m\u1ed9t c\u00e1ch c\u00f3 hi\u1ec7u qu\u1ea3 \u0111\u1ec3 l\u00e0m cho BN v\u00e0 ng\u01b0\u1eddi th\u00e2n c\u1ee7a h\u1ecd v\u01b0\u1ee3t qua kh\u1ee7ng ho\u1ea3ng tinh th\u1ea7n.<\/p>\n<p style=\"padding-left: 40px;\"><u>2.3.2 N\u1ed9i dung c\u1ee7a \u0111\u00e1nh gi\u00e1 v\u00e0 t\u01b0 v\u1ea5n h\u1ed7 tr\u1ee3 t\u00e2m l\u00fd x\u00e3 h\u1ed9i<\/u><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>\u0110\u00e1nh gi\u00e1 tr\u1ea1ng th\u00e1i c\u1ea3m x\u00fac: K\u1ebft h\u1ee3p v\u1edbi quan s\u00e1t, nh\u1eefng c\u00e2u h\u1ecfi \u0111\u0103\u0323t ra cho BN l\u00e0 c\u00e1ch t\u1ed1t nh\u1ea5t \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 tra\u0323ng tha\u0301i t\u00e2m ly\u0301 va\u0300 ca\u0309m xu\u0301c cu\u0309a m\u1ed7i BN c\u1ee5 th\u1ec3.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 80px;\">H\u1ecfi xem BN s\u1ebd ph\u1ea3n \u1ee9ng nh\u01b0 th\u1ebf n\u00e0o v\u1edbi th\u1ef1c t\u1ebf b\u1ecb b\u1ec7nh. C\u00e2n nh\u1eafc k\u1ec3 t\u00ean m\u1ed9t ph\u1ea3n \u1ee9ng th\u00f4ng th\u01b0\u1eddng, v\u00ed d\u1ee5 nh\u01b0: bi\u1ebft g\u00ec v\u1ec1 c\u0103n b\u1ec7nh c\u1ee7a m\u00ecnh, lo l\u1eafng, \u0111au bu\u1ed3n, tuy\u1ec7t v\u1ecdng, hay cam ch\u1ecbu m\u1ed9t m\u00ecnh, c\u00f3 tin l\u00e0 b\u1ec7nh c\u1ee7a b\u1ea1n l\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c kh\u00f4ng ?.<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>\u0110\u00e1nh gi\u00e1 ho\u00e0n c\u1ea3nh x\u00e3 h\u1ed9i\n<ul>\n<li>Nh\u1eefng nhu c\u1ea7u thi\u1ebft y\u1ebfu trong gia \u0111\u00ecnh c\u1ee7a BN.<\/li>\n<li>T\u00ecnh tr\u1ea1ng t\u00e0i ch\u00ednh c\u1ee7a BN.<\/li>\n<li>Nh\u1eefng ng\u01b0\u1eddi ch\u0103m s\u00f3c cho BN.<\/li>\n<li>S\u1ef1 h\u1ed7 tr\u1ee3 c\u1ee7a ngu\u1eddi th\u00e2n v\u00e0 c\u1ed9ng \u0111\u1ed3ng \u0111\u1ed1i v\u1edbi BN v\u00e0 gia \u0111\u00ecnh.<\/li>\n<\/ul>\n<\/li>\n<li>N\u1ed9i dung t\u01b0 v\u1ea5n v\u00e0 h\u1ed7 tr\u1ee3:\n<ul>\n<li>T\u01b0 v\u1ea5n ti\u1ebft l\u1ed9 t\u00ecnh tr\u1ea1ng b\u1ec7nh t\u1eadt cho BN v\u00e0 ng\u01b0\u1eddi nh\u00e0.<\/li>\n<li>T\u01b0 v\u1ea5n ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb, ch\u0103m s\u00f3c, dinh d\u01b0\u1ee1ng \u2026<\/li>\n<li>T\u01b0 v\u1ea5n v\u1ec1 c\u00e1c m\u1ed1i quan h\u1ec7 x\u00e3 h\u1ed9i: Vi\u1ec7c l\u00e0m, ch\u1ebf \u0111\u1ed9 b\u1ea3o hi\u1ec3m \u2026<\/li>\n<li>T\u01b0 v\u1ea5n chuy\u1ec3n tuy\u1ebfn \u0111\u1ebfn c\u00e1c c\u01a1 s\u1edf h\u1ed7 tr\u1ee3 \u0111i\u1ec1u tr\u1ecb, ch\u0103m s\u00f3c ph\u00f9 h\u1ee3p.<\/li>\n<li>H\u1ed7 tr\u1ee3 l\u1eadp k\u1ebf ho\u1ea1ch cho t\u01b0\u01a1ng lai.<\/li>\n<li>BN UT \u1edf giai \u0111o\u1ea1n cu\u1ed1i va\u0300 gia \u0111i\u0300nh ho\u0323 lu\u00f4n lo l\u0103\u0301ng va\u0300 mu\u00f4\u0301n bi\u00ea\u0301t khi na\u0300o thi\u0300 s\u01b0\u0323 s\u00f4\u0301ng cu\u0309a ng\u01b0\u01a1\u0300i b\u00ea\u0323nh k\u00ea\u0301t thu\u0301c ?. \u0110i\u00ea\u0300u \u0111o\u0301 la\u0300 t\u00e2\u0301t y\u00ea\u0301u nh\u01b0ng s\u01b0\u0323 d\u01b0\u0323 \u0111oa\u0301n th\u01a1\u0300i \u0111i\u00ea\u0309m chi\u0301nh xa\u0301c la\u0300 kha\u0301 kho\u0301 kh\u0103n. Nh\u01b0ng v\u01a1\u0301i tha\u0301i \u0111\u00f4\u0323 \u00e2n c\u00e2\u0300n va\u0300 chia se\u0309 cu\u0309a ng\u01b0\u01a1\u0300i th\u00e2\u0300y thu\u00f4\u0301c se\u0303 giu\u0301p ho\u0323 v\u01b0\u01a1\u0323t qua nh\u01b0\u0303ng th\u01a1\u0300i kh\u0103\u0301c kho\u0301 kh\u0103n, t\u01b0 v\u00e2\u0301n cho ho\u0323 nh\u01b0\u0303ng vi\u00ea\u0323c c\u00e2\u0300n thi\u00ea\u0301t pha\u0309i la\u0300m nh\u01b0 :<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 160px;\">Vi\u00ea\u0301t di chu\u0301c, ph\u00e2n chia t\u00e0i s\u1ea3n.<\/p>\n<p style=\"padding-left: 160px;\">N\u00f3i l\u1eddi t\u1ea1m bi\u1ec7t.<\/p>\n<p style=\"padding-left: 40px;\"><u>2.3.3 C\u00e1i ch\u1ebft nh\u00e2n \u0111\u1ea1o<\/u><\/p>\n<p style=\"padding-left: 40px;\">T\u1ef1 v\u1eabn c\u00f3 s\u1ef1 h\u1ed7 tr\u1ee3 c\u1ee7a th\u1ea7y thu\u1ed1c ho\u1eb7c c\u00e1i ch\u1ebft nh\u00e2n \u0111\u1ea1o:<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>T\u1ef1 v\u1eabn c\u00f3 s\u1ef1 h\u1ed7 tr\u1ee3 c\u1ee7a th\u1ea7y thu\u1ed1c: Ng\u01b0\u1eddi b\u1ec7nh t\u1ef1 v\u1eabn b\u1eb1ng thu\u1ed1c, th\u00f4ng tin ho\u1eb7c c\u00e1c ph\u01b0\u01a1ng ti\u1ec7n kh\u00e1c do th\u1ea7y thu\u1ed1c cung c\u1ea5p v\u1edbi m\u1ee5c \u0111\u00edch \u0111i \u0111\u1ebfn t\u1eed vong ho\u1eb7c th\u00fac \u0111\u1ea9y nhanh c\u00e1i ch\u1ebft.<\/li>\n<li>C\u00e1i ch\u1ebft nh\u00e2n \u0111\u1ea1o (Euthanasia): Ng\u01b0\u1eddi th\u1ea7y thu\u1ed1c c\u00f3 h\u00e0nh vi ch\u1ee7 \u00fd g\u00e2y t\u1eed vong cho BN<\/li>\n<li>C\u1ed1 \u00fd g\u00e2y t\u1eed vong cho b\u1ec7nh nh\u00e2n:<\/li>\n<li>L\u00e0 b\u1ea5t h\u1ee3p ph\u00e1p \u1edf h\u1ea7u h\u1ebft t\u1ea5t c\u1ea3 c\u00e1c n\u01b0\u1edbc<\/li>\n<li>\u0110\u01b0\u1ee3c coi l\u00e0 v\u00f4 \u0111\u1ea1o \u0111\u1ee9c trong m\u1ecdi ho\u00e0n c\u1ea3nh<\/li>\n<li>Nghi\u00eam c\u1ea5m m\u1ecdi h\u00e0nh vi c\u1ed1 \u00fd g\u00e2y t\u1eed vong cho ng\u01b0\u1eddi b\u1ec7nh<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>2.4 M\u1ed9t s\u1ed1 n\u1ed9i dung ch\u0103m s\u00f3c gi\u1ea3m nh\u1eb9 kh\u00e1c<\/strong><\/p>\n<p style=\"padding-left: 40px;\"><u>2.4.1 X\u1eed tr\u00ed kh\u00f3 th\u1edf<\/u><\/p>\n<p style=\"padding-left: 40px;\">T\u1ef7 l\u1ec7 kh\u00f3 th\u1edf tr\u00ean nh\u1eefng BN c\u00f3 c\u00e1c b\u1ec7nh hi\u1ec3m ngh\u00e8o l\u00e0 12-74%.,nguy\u00ean nh\u00e2n c\u1ee7a kh\u00f3 th\u1edf \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>T\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng th\u1edf (do u, do ch\u1ea5t ti\u1ebft)<\/li>\n<li>Co th\u1eaft ph\u1ebf qu\u1ea3n<\/li>\n<li>Thi\u1ebfu m\u00e1u<\/li>\n<li>Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i<\/li>\n<li>Vi\u00eam ph\u1ed5i<\/li>\n<li>Ph\u00f9 ph\u1ed5i<\/li>\n<li>Ngh\u1ebdn m\u1ea1ch ph\u1ed5i<\/li>\n<li>Lo l\u1eafng\u2026<\/li>\n<li>\u0110\u00e1nh gi\u00e1 v\u00e0 x\u1eed tr\u00ed chung kh\u00f3 th\u1edf<\/li>\n<li>K\u1ebft h\u1ee3p v\u1edbi \u0111\u1ebfm t\u1ea7n s\u1ed1 th\u1edf v\u00e0 b\u00e1o c\u00e1o ch\u1ee7 quan c\u1ee7a BN l\u00e0 s\u1ef1 \u0111\u00e1nh gi\u00e1 \u0111\u00e1ng tin c\u1eady nh\u1ea5t. \u0110o \u0111\u1ed9 b\u00e3o h\u00f2a oxy ho\u00e1 m\u00e1u, \u0111\u1ecbnh l\u01b0\u1ee3ng kh\u00ed m\u00e1u kh\u00f4ng nh\u1ea5t thi\u1ebft t\u01b0\u01a1ng quan v\u1edbi s\u1ef1 kh\u00f3 th\u1edf \u1edf BN UT.<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n c\u01a1 b\u1ea3n, d\u1ef1a tr\u00ean nh\u1eefng m\u1ee5c ti\u00eau \u0111\u1eb7c bi\u1ec7t c\u1ee7a BN n\u1ebfu ph\u00f9 h\u1ee3p. V\u00ed d\u1ee5, \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i b\u1eb1ng kh\u00e1ng sinh, \u0111i\u1ec1u ch\u1ec9nh thi\u1ebfu m\u00e1u n\u1eb7ng b\u1eb1ng c\u00e1c s\u1ea3n ph\u1ea9m c\u1ee7a m\u00e1u, s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u trong ph\u00f9 ph\u1ed5i, ch\u1ecdc d\u1ecbch m\u00e0ng ph\u1ed5i trong tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i\u2026<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb c\u00e1c tri\u1ec7u ch\u1ee9ng. C\u1ea3m gi\u00e1c kh\u00f3 th\u1edf c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb, b\u1eb1ng c\u00e1c thu\u1ed1c oipioid, c\u00e1c thu\u1ed1c gi\u1ea3i lo \u00e2u v\u00e0 c\u00e1c bi\u1ec7n ph\u00e1p can thi\u1ec7p kh\u00f4ng d\u00f9ng thu\u1ed1c.<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb kh\u00f3 th\u1edf b\u1eb1ng opioid (gi\u1ed1ng nh\u01b0 \u0111i\u1ec1u tr\u1ecb gi\u1ea3m \u0111au) l\u00e0 th\u00edch h\u1ee3p, v\u00e0 n\u1ebfu \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng m\u1ed9t c\u00e1ch h\u1ee3p l\u00fd, n\u00f3 c\u00f3 th\u1ec3 k\u00e9o d\u00e0i s\u1ef1 s\u1ed1ng v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng m\u00e0 kh\u00f4ng d\u1eabn t\u1edbi s\u1ef1 ph\u1ee5 thu\u1ed9c v\u1ec1 t\u00e2m l\u00fd (nghi\u1ec7n).<\/li>\n<li>C\u00e1c opioid t\u00e1c \u0111\u1ed9ng \u1edf c\u1ea3 ngo\u1ea1i vi l\u1eabn trung \u01b0\u01a1ng.<\/li>\n<li>\u1ede nh\u1eefng BN kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed d\u00f9ng opioid, li\u1ec1u th\u1ea5p c\u00f3 th\u1ec3 c\u00f3 t\u00e1c d\u1ee5ng. V\u00ed d\u1ee5: morphine u\u1ed1ng 5 mg ho\u1eb7c ti\u00eam t\u0129nh m\u1ea1ch\/ ti\u00eam b\u1eafp th\u1ecbt 3mg, 2 \u2013 4 gi\u1edd m\u1ed9t l\u1ea7n theo nhu c\u1ea7u.<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb kh\u00f3 th\u1edf khi BN c\u00f3 bi\u1ec3u hi\u1ec7n c\u1ee7a lo \u00e2u, n\u00ean k\u1ebft h\u1ee3p v\u1edbi m\u1ed9t thu\u1ed1c gi\u1ea3i lo \u00e2u nh\u01b0 benzodiazepine. V\u00ed d\u1ee5: Lorazepam 0,5-2 mg u\u1ed1ng 1 gi\u1edd\/ l\u1ea7n theo nhu c\u1ea7u cho \u0111\u1ebfn khi tr\u1ea5n t\u0129nh l\u1ea1i, sau \u0111\u00f3 c\u00f3 th\u1ec3 cho li\u1ec1u th\u01b0\u1eddng xuy\u00ean theo gi\u1edd, 4-8 gi\u1edd\/l\u1ea7n \u0111\u1ec3 gi\u1eef s\u1ef1 b\u00ecnh t\u0129nh.<\/li>\n<li>Nh\u1eefng can thi\u1ec7p kh\u00f4ng d\u00f9ng thu\u1ed1c \u0111\u1ed1i v\u1edbi kh\u00f3 th\u1edf:\n<ul>\n<li>M\u1edf c\u1eeda s\u1ed5, gi\u1eef t\u1ea7m nh\u00ecn h\u01b0\u1edbng ra b\u00ean ngo\u00e0i ( n\u1ebfu c\u00f3 th\u1ec3).<\/li>\n<li>H\u1ea1n ch\u1ebf s\u1ed1 l\u01b0\u1ee3ng ng\u01b0\u1eddi trong ph\u00f2ng.<\/li>\n<li>\u0110\u1ed9ng vi\u00ean BN, l\u00e0m d\u1ecbu b\u1edbt s\u1ef1 lo l\u1eafng.<\/li>\n<li>Gi\u1ea3m nhi\u1ec7t \u0111\u1ed9 ph\u00f2ng.<\/li>\n<li>Lo\u1ea1i b\u1ecf nh\u1eefng k\u00edch th\u00edch t\u1eeb m\u00f4i tr\u01b0\u1eddng nh\u01b0 kh\u00f3i thu\u1ed1c l\u00e1.<\/li>\n<li>Thay \u0111\u1ed5i t\u01b0 th\u1ebf BN.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 40px;\"><u>2.4.2 X\u1eed tr\u00ed bu\u1ed3n n\u00f4n v\u00e0 n\u00f4n<\/u><\/p>\n<p style=\"padding-left: 40px;\">Nguy\u00ean nh\u00e2n c\u1ee7a bu\u1ed3n n\u00f4n v\u00e0 n\u00f4n \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>C\u00e1c \u0111\u1ed9c t\u1ed1 (\u0111\u1ed9c t\u1ed1 virus, vi khu\u1ea9n), c\u00e1c thu\u1ed1c (Ho\u00e1 ch\u1ea5t \u0111i\u1ec1u tr\u1ecb UT, c\u00e1c opioid, kh\u00e1ng sinh), c\u00e1c ch\u1ea5t t\u1eeb ph\u1ea3n \u1ee9ng vi\u00eam, r\u1ed1i lo\u1ea1n chuy\u1ec3n ho\u00e1 \u2026<\/li>\n<li>S\u1ef1 k\u00edch th\u00edch ho\u1eb7c nh\u1ea1y c\u1ea3m c\u1ee7a h\u1ec7 th\u1ed1ng ti\u1ec1n \u0111\u00ecnh<\/li>\n<li>Ho\u00e1 tr\u1ecb li\u1ec7u, x\u1ea1 tr\u1ecb li\u1ec7u \u1edf v\u00f9ng b\u1ee5ng<\/li>\n<li>T\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd<\/li>\n<li>Lo l\u1eafng, b\u1ed3n ch\u1ed3n.<\/li>\n<li>Vi\u00eam lo\u00e9t d\u1ea1 d\u00e0y, \u1ed1ng ti\u00eau ho\u00e1<\/li>\n<li>T\u1eafc ru\u1ed9t<\/li>\n<li>T\u00e1o b\u00f3n<\/li>\n<li>R\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 40px;\">X\u1eed tr\u00ed tri\u1ec7u ch\u1ee9ng n\u00f4n v\u00e0 bu\u1ed3n n\u00f4n<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>X\u00e1c \u0111\u1ecbnh v\u00e0 lo\u1ea1i b\u1ecf nguy\u00ean nh\u00e2n c\u01a1 b\u1ea3n n\u1ebfu c\u00f3 th\u1ec3<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb thu\u1ed1c ph\u1ea3i c\u00f3 c\u01a1 s\u1edf v\u00e0 d\u1ef1a tr\u00ean ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t, \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng v\u1ec1 sinh l\u00fd b\u1ec7nh ho\u1eb7c c\u0103n nguy\u00ean c\u00f3 th\u1ec3 ph\u00f9 h\u1ee3p nh\u1ea5t<\/li>\n<li>C\u00e1c lo\u1ea1i thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong x\u1eed tr\u00ed n\u00f4n v\u00e0 bu\u1ed3n n\u00f4n<\/li>\n<li>Kh\u00e1ng dopamin: haloperidol, prochlorperazine<\/li>\n<li>Kh\u00e1ng histamin ( ch\u1eb9n H1): diphenhydramine<\/li>\n<li>Kh\u00e1ng cholinergics: scopolamine<\/li>\n<li>Kh\u00e1ng serotonin: osetron<\/li>\n<li>C\u00e1c ch\u1ea5t prokinetic: metoclopramide<\/li>\n<li>Kh\u00e1ng acid: \u1ee8c ch\u1ec3 H2 (ranitidine), \u1ee9c ch\u1ebf b\u01a1m proton (omeprazole)<\/li>\n<li>C\u00e1c thu\u1ed1c kh\u00e1c: dexamethasone, lorazepam<\/li>\n<li>B\u00f9 n\u01b0\u1edbc, \u0111i\u1ec7n gi\u1ea3i<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 40px;\"><u>2.4.3 X\u1eed tr\u00ed t\u00e1o b\u00f3n<\/u><\/p>\n<p style=\"padding-left: 40px;\">T\u00e1o b\u00f3n \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 s\u1ef1 kh\u00f3 ch\u1ecbu li\u00ean quan \u0111\u1ebfn gi\u1ea3m t\u1ea7n s\u1ed1 \u0111i ngo\u00e0i. Ti\u00eau chu\u1ea9n Rome: c\u00f3 2 ho\u1eb7c nhi\u1ec1u h\u01a1n c\u00e1c ti\u00eau chu\u1ea9n sau:<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>G\u1eafng s\u1ee9c \u00edt nh\u1ea5t 25% th\u1eddi gian.<\/li>\n<li>Ph\u00e2n c\u1ee9ng \u00edt nh\u1ea5t 25% th\u1eddi gian.<\/li>\n<li>\u0110i ngo\u00e0i kh\u00f4ng h\u1ebft ph\u00e2n \u00edt nh\u1ea5t 25% th\u1eddi gian.<\/li>\n<li>\u2264 3 l\u1ea7n \u0111i ngo\u00e0i\/ tu\u1ea7n.<\/li>\n<li>Nguy\u00ean nh\u00e2n c\u1ee7a t\u00e1o b\u00f3n \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0<\/li>\n<li>Do thu\u1ed1c: opioid, kh\u00e1ng cholinergic, s\u1eaft, thu\u1ed1c ch\u1eb9n k\u00eanh canxi\u2026<\/li>\n<li>Gi\u1ea3m nhu \u0111\u1ed9ng ru\u1ed9t<\/li>\n<li>T\u1eafc ru\u1ed9t<\/li>\n<li>Nh\u1eefng b\u1ea5t th\u01b0\u1eddng v\u1ec1 chuy\u1ec3n ho\u00e1 nh\u01b0 t\u0103ng canxi m\u00e1u<\/li>\n<li>Ch\u00e8n \u00e9p c\u1ed9t s\u1ed1ng<\/li>\n<li>M\u1ea5t n\u01b0\u1edbc<\/li>\n<li>X\u1eed tr\u00ed t\u00e1o b\u00f3n<\/li>\n<li>Nh\u1eefng bi\u1ec7n ph\u00e1p chung bao g\u1ed3m thi\u1ebft l\u1eadp th\u00f3i quen \u0111i ngo\u00e0i b\u00ecnh th\u01b0\u1eddng cho m\u1ed9t BN c\u1ee5 th\u1ec3, \u0111i v\u1ec7 sinh th\u01b0\u1eddng xuy\u00ean, ho\u1ea1t \u0111\u1ed9ng, u\u1ed1ng n\u01b0\u1edbc, t\u0103ng c\u00e1c ch\u1ea5t x\u01a1.<\/li>\n<li>Bi\u1ec7n ph\u00e1p d\u00f9ng thu\u1ed1c: nhu\u1eadn tr\u00e0ng k\u00edch th\u00edch, nhu\u1eadn tr\u00e0ng th\u1ea9m th\u1ea5u, nhu\u1eadn tr\u00e0ng t\u1ea9y s\u1ea1ch ( c\u00e1c ch\u1ea5t l\u00e0m m\u1ec1m ph\u00e2n), c\u00e1c ch\u1ea5t b\u00f4i tr\u01a1i, c\u00e1c ch\u1ea5t th\u1ee5t th\u1ec3 t\u00edch l\u1edbn.\n<ul>\n<li>C\u00e1c thu\u1ed1c nhu\u1eadn tr\u00e0ng k\u00edch th\u00edch nhu \u0111\u1ed9ng ru\u1ed9t: senna, sorbitol<\/li>\n<li>C\u00e1c thu\u1ed1c nhu\u1eadn tr\u00e0ng th\u1ea9m th\u1ea5u. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng: k\u00e9o n\u01b0\u1edbc v\u00e0o l\u00f2ng ru\u1ed9t. Ch\u00fang duy tr\u00ec ho\u1eb7c t\u0103ng th\u00e0nh ph\u1ea7n ph\u00e2n \u1ea9m trong ph\u00e2n v\u00e0 t\u0103ng th\u1ec3 t\u00edch ph\u00e2n n\u00f3i chung. Y\u00eau c\u1ea7u b\u00f9 n\u01b0\u1edbc t\u1ed1t. V\u00ed d\u1ee5: lactulose, sorbitol<\/li>\n<li>C\u00e1c thu\u1ed1c nhu\u1eadn tr\u00e0ng t\u1ea9y ( c\u00e1c ch\u1ea5t l\u00e0m m\u1ec1m ph\u00e2n). C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng: t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho s\u1ef1 ph\u00e2n hu\u1ef7 c\u1ee7a m\u1ee1 trong n\u01b0\u1edbc v\u00e0 t\u0103ng th\u00e0nh ph\u1ea7n n\u01b0\u1edbc trong ph\u00e2n. V\u00ed d\u1ee5: thu\u1ed1c th\u1ee5t natri docusate, natri biphosphate<\/li>\n<li>C\u00e1c ch\u1ea5t prokinetic. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng: k\u00edch th\u00edch \u0111\u00e1m r\u1ed1i Auerbach \u1edf ru\u1ed9t, t\u0103ng nhu \u0111\u1ed9ng c\u1ee7a ru\u1ed9t v\u00e0 s\u1ef1 di chuy\u1ec3n c\u1ee7a ph\u00e2n.V\u00ed d\u1ee5 : metoclopramide<\/li>\n<li>C\u00e1c thu\u1ed1c k\u00edch th\u00edch b\u00f4i tr\u01a1n. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng: b\u00f4i tr\u01a1n ph\u00e2n v\u00e0 k\u00edch th\u00edch \u0111\u1ea1i tr\u00e0ng, v\u00ec v\u1eady l\u00e0m t\u0103ng nhu \u0111\u1ed9ng ru\u1ed9t v\u00e0 s\u1ef1 di chuy\u1ec3n c\u1ee7a ph\u00e2n.V\u00ed d\u1ee5: dung d\u1ecbch paraffin<\/li>\n<li>C\u00e1c ch\u1ea5t th\u1ee5t th\u1ec3 t\u00edch l\u1edbn. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng: l\u00e0m m\u1ec1m ph\u00e2n b\u1eb1ng c\u00e1ch t\u0103ng th\u00e0nh ph\u1ea7n n\u01b0\u1edbc trong ph\u00e2n, l\u00e0m c\u0103ng gi\u00e3n \u0111\u1ea1i tr\u00e0ng v\u00e0 g\u00e2y ra nhu \u0111\u1ed9ng.V\u00ed d\u1ee5: th\u1ee5t n\u01b0\u1edbc \u1ea5m.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 40px;\"><u>2.4.4 X\u1eed tr\u00ed ti\u00eau ch\u1ea3y<\/u><\/p>\n<p style=\"padding-left: 40px;\">Ti\u00eau ch\u1ea3y l\u00e0 t\u00ecnh tr\u1ea1ng t\u0103ng s\u1ed1 l\u1ea7n \u0111i ngo\u00e0i.v\u00e0 ph\u00e2n l\u1ecfng h\u01a1n b\u00ecnh th\u01b0\u1eddng, nguy\u00ean nh\u00e2n c\u1ee7a ti\u00eau ch\u1ea3y:<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ru\u1ed9t<\/li>\n<li>Thu\u1ed1c, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c ho\u00e1 ch\u1ea5t ch\u1ed1ng UT<\/li>\n<li>Ch\u1ea3y m\u00e1u \u0111\u01b0\u1eddng ti\u00eau ho\u00e1<\/li>\n<li>K\u00e9m h\u1ea5p thu ( suy t\u1ee5y, gan, b\u1ec7nh \u0111\u01b0\u1eddng ru\u1ed9t\u2026)<\/li>\n<li>Stress<\/li>\n<li>C\u00e1c thu\u1ed1c nhu\u1eadn tr\u00e0ng ( d\u00f9ng qu\u00e1 nhi\u1ec1u)<\/li>\n<li>X\u1ea1 tr\u1ecb v\u00e0o \u1ed5 b\u1ee5ng.<\/li>\n<li>X\u1eed tr\u00ed ti\u00eau ch\u1ea3y<\/li>\n<li>Khuy\u1ebfn kh\u00edch BN u\u1ed1ng ORESOL, n\u01b0\u1edbc ch\u00e1o, x\u00fap v\u1edbi s\u1ed1 l\u01b0\u1ee3ng \u00edt.<\/li>\n<li>Cho BN \u0103n th\u1ee9c \u0103n m\u1ec1m v\u00e0 gi\u00e0u n\u0103ng l\u01b0\u1ee3ng chia th\u00e0nh nhi\u1ec1u b\u1eefa nh\u1ecf. Tr\u00e1nh nh\u1eefng \u0111\u1ed3 \u0103n c\u00f2n th\u00f4 v\u00e0 c\u00f3 ch\u1ea5t x\u01a1. Tr\u00e1nh nh\u1eefng \u0111\u1ed3 u\u1ed1ng l\u00e0m cho ti\u00eau ch\u1ea3y n\u1eb7ng h\u01a1n nh\u01b0 r\u01b0\u1ee3u v\u00e0 c\u00e1c ch\u1ea5t cafeine.<\/li>\n<li>V\u1ec7 sinh th\u01b0\u1eddng xuy\u00ean, gi\u1eef s\u1ea1ch v\u00f9ng sinh d\u1ee5c v\u00e0 h\u1eadu m\u00f4n. \u0110\u1ed1i v\u1edbi nh\u1eefng BN ti\u00eau ch\u1ea3y k\u00e9o d\u00e0i, d\u00f9ng qu\u1ea7n \u00e1o kh\u00f4 v\u00e0 m\u1ec1m, thay th\u01b0\u1eddng xuy\u00ean.<\/li>\n<li>B\u00f4i kem ho\u1eb7c c\u00e1c thu\u1ed1c quanh h\u1eadu m\u00f4n \u0111\u1ec3 tr\u00e1nh g\u00e2y t\u1ed5n th\u01b0\u01a1ng da<\/li>\n<li>Tr\u00e1nh d\u00f9ng nh\u1eefng thu\u1ed1c l\u00e0m t\u0103ng nhu \u0111\u1ed9ng nh\u01b0 c\u00e1c thu\u1ed1c nhu\u1eadn tr\u00e0ng ho\u1eb7c metocloperamide<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb khu\u1ea9n n\u1ebfu c\u00f3<\/li>\n<li>Gi\u1ea3i quy\u1ebft nguy\u00ean nh\u00e2n: B\u00e1n t\u1eafc do u \u0111\u1ea1i tr\u00e0ng ho\u1eb7c ph\u00e2n b\u1ecb l\u00e8n ch\u1eb7t do t\u00e1o b\u00f3n (\u1edf nh\u1eefng BN d\u00f9ng c\u00e1c thu\u1ed1c opioid).<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 40px;\"><u>2.4.5 Ch\u00e1n \u0103n\/ Suy m\u00f2n<\/u><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Ch\u00e1n \u0103n l\u00e0 m\u1ea5t \u0111i s\u1ef1 ngon mi\u1ec7ng l\u00e0m cho BN gi\u1ea3m \u0103n ( k\u1ec3 c\u1ea3 s\u1ed1 l\u01b0\u1ee3ng th\u1ee9c \u0103n\/ b\u1eefa v\u00e0 s\u1ed1 b\u1eefa \u0103n)<\/li>\n<li>Suy m\u00f2n l\u00e0 s\u1ef1 s\u1ee5t c\u00e2n kh\u00f4ng ch\u1ee7 \u00fd v\u00e0 x\u00e9t nghi\u1ec7m m\u00e1u c\u00f3 protein, albumin m\u00e1u gi\u1ea3m, thi\u1ebfu m\u00e1u.<\/li>\n<li>H\u1ed9i ch\u1ee9ng suy m\u00f2n th\u01b0\u1eddng g\u1eb7p trong c\u00e1c kh\u1ed1i u \u0111\u1eb7c \u00e1c t\u00ednh, b\u1ec7nh tim giai \u0111o\u1ea1n mu\u1ed9n, suy gan th\u1eadn, b\u1ec7nh ph\u1ed5i giai \u0111o\u1ea1n mu\u1ed9n v\u00e0 nhi\u1ec5m HIV\/AIDS.<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb ch\u00e1n \u0103n\/ suy m\u00f2n\n<ul>\n<li>\u0110\u00e1nh gi\u00e1 v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y suy m\u00f2n: ti\u00eau ch\u1ea3y, \u0111au, bu\u1ed3n n\u00f4n, n\u00f4n\u2026, c\u00e1c b\u1ec7nh k\u1ebft h\u1ee3p nh\u01b0: nhi\u1ec5m tr\u00f9ng nh\u01b0 lao ph\u1ed5i, tr\u1ea7m c\u1ea3m, v.v\u2026.<\/li>\n<li>Khuy\u1ebfn kh\u00edch BN \u0103n nh\u01b0ng kh\u00f4ng \u00e9p bu\u1ed9c v\u00ec c\u01a1 th\u1ec3 kh\u00f4ng ti\u1ebfp nh\u1eadn th\u1ee9c \u0103n n\u00ean BN c\u00f3 th\u1ec3 n\u00f4n ra.<\/li>\n<li>Cung c\u1ea5p nh\u1eefng th\u1ee9c \u0103n y\u00eau th\u00edch, nh\u1eefng th\u1ee9c \u0103n m\u1ec1m v\u00e0 gi\u00e0u n\u0103ng l\u01b0\u1ee3ng, cho BN \u0103n nhi\u1ec1u b\u1eefa nh\u1ecf.<\/li>\n<li>Dinh d\u01b0\u1ee1ng qua \u1ed1ng th\u00f4ng m\u0169i \u2013 d\u1ea1 d\u00e0y ho\u1eb7c \u1ed1ng m\u1edf th\u00f4ng d\u1ea1 d\u00e0y \u1edf nh\u1eefng BN UT giai \u0111o\u1ea1n mu\u1ed9n kh\u00f4ng th\u1ec3 t\u1ef1 \u0103n u\u1ed1ng \u0111\u01b0\u1ee3c.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/p>\n<ol>\n<li>Ung th\u01b0 h\u1ecdc \u0111\u1ea1i c\u01b0\u01a1ng, H\u1ecdc vi\u1ec7n Qu\u00e2n Y, NXBQ\u0110ND, 2010<\/li>\n<li>Ch\u0103m s\u00f3c gi\u1ea3m nh\u1eb9 m\u1ee5c ti\u00eau v\u00e0 ch\u01b0\u01a1ng tr\u00ecnh. T\u00e0i li\u1ec7u t\u1eadp hu\u1ea5n c\u1ee7a B\u1ed9 Y t\u1ebf v\u00e0 WHO, 2008.<\/li>\n<li>Nguy\u1ec5n B\u00e1 \u0110\u1ee9c, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh ung th\u01b0. NXBYH, 2007<\/li>\n<li>Oxford Textbook of Palliative Medicine. 3rd Edition. Eds Doyle D, Hanks G, Cherny N, and Calman K. Oxford: Oxford University Press, 2004.<\/li>\n<\/ol>\n<p>&nbsp;<\/p>","protected":false},"excerpt":{"rendered":"<p>NGUY\u00caN T\u1eaeC \u0110I\u1ec0U TR\u1eca B\u1ec6NH UNG TH\u01af Ung th\u01b0 l\u00e0 b\u1ec7nh l\u00fd \u00e1c t\u00ednh c\u1ee7a t\u1ebf b\u00e0o, do t\u1ebf b\u00e0o t\u0103ng sinh m\u1ed9t c\u00e1ch v\u00f4 h\u1ea1n \u0111\u1ed9, v\u00f4 t\u1ed5 ch\u1ee9c, kh\u00f4ng tu\u00e2n theo quy lu\u1eadt ph\u00e1t tri\u1ec3n v\u00e0 c\u01a1 ch\u1ebf ki\u1ec3m so\u00e1t c\u1ee7a c\u01a1 th\u1ec3. B\u1ec7nh ung th\u01b0 c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb kh\u1ecfi n\u1ebfu \u0111\u01b0\u1ee3c&#8230;<\/p>","protected":false},"author":3,"featured_media":2515,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[61],"tags":[],"class_list":["post-2508","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-hot"],"_links":{"self":[{"href":"https:\/\/vitezcom.com\/en\/wp-json\/wp\/v2\/posts\/2508","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vitezcom.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vitezcom.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vitezcom.com\/en\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/vitezcom.com\/en\/wp-json\/wp\/v2\/comments?post=2508"}],"version-history":[{"count":5,"href":"https:\/\/vitezcom.com\/en\/wp-json\/wp\/v2\/posts\/2508\/revisions"}],"predecessor-version":[{"id":2514,"href":"https:\/\/vitezcom.com\/en\/wp-json\/wp\/v2\/posts\/2508\/revisions\/2514"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vitezcom.com\/en\/wp-json\/wp\/v2\/media\/2515"}],"wp:attachment":[{"href":"https:\/\/vitezcom.com\/en\/wp-json\/wp\/v2\/media?parent=2508"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vitezcom.com\/en\/wp-json\/wp\/v2\/categories?post=2508"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vitezcom.com\/en\/wp-json\/wp\/v2\/tags?post=2508"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}