Rao vat: Benh Dau da day : Viem xung huyet Hang Vi da day va cach dieu tri.

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Benh Dau da day : Viem xung huyet Hang Vi da day va cach dieu tri.

Tin rao Benh Dau da day : Viem xung huyet Hang Vi da day va cach dieu tri duoc dang vao chu de Cac Dich Vu Khac, khu vuc Ha Noi , the loai Can Ban ngay 15/7/2011 boi Rao Vat. Benh Dau da day : Viem xung huyet Hang Vi da day va cach dieu tri da co tat ca 1813 luot xem.
Benh Dau da day : Viem xung huyet Hang Vi da day va cach dieu tri - Bản không dấu.
Benh Dau da day : Viem xung huyet Hang Vi da day va cach dieu tri - Bản có dấu.

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Benh Dau da day : Viem xung huyet Hang Vi da day va cach dieu tri
Loet da day - ta trang (DD-TT) la mot benh da duoc biet tu thoi co dai. Benh xay ra o moi quoc gia, moi lua tuoi. Ti le benh o cac nuoc la 1 – 3% dan so, va trong suot mot doi nguoi kha nang mac benh loet la 10%. Viec dieu tri benh loet DD - TT da co nhung thay doi lon trong ba thap nien tro lai day voi viec phat trien cac thuoc chong loet the he moi tu thap nien 1970 va viec phat hien va xac dinh vai tro gay benh loet cua vi khuan Helicobacter Pylori tu thap nien 1980.
I. Nguyen nhan va cac yeu to gay ra benh loet DD – TT la gi?
1. Quan niem ve su sinh benh loet duoc hinh thanh tu nhung nam dau cua the ky 20. Do la do su mat quan binh giua 2 luc doi khang tac dong len niem mac DD-TT: (1) Luc tan cong lam pha huy niem mac DD-TT ma tieu bieu la HCl va pepsin cua dich da day va (2) Luc bao ve dam bao su nguyen ven cua thanh DD-TT do hang rao nhay va lop te bao niem mac DD-TT. Theo quan niem nay, bat cu mot tac nhan nao lam gia tang luc tan cong hoac lam giam luc bao ve deu co the gay benh loet DD-TT. Co the minh hoa quan niem nay bang so do duoi day:
Giam Luc Bao Ve Tang Luc Tan Cong
- Giam tuoi mau - Vi khuan H.Pylori niem mac DD-TT - Cac stress
- Thuoc la - Thuoc AINS , Steroids …
- Benh gan man tinh - Ruou .
( xo gan ) Hang rao nhay Lop te bao niem mac
2. Trong so cac tac nhan gay benh neu tren, H. Pylori la nguyen nhan quan trong nhat. Hai nha bac hoc Uc Marshall va Warren da duoc trao tang giai Nobel nho da co cong kham pha ra loai vi khuan nay. Cac thuoc AINS, Steroides co the gay loet o nguoi phai dieu tri dai ngay voi cac thuoc nay. Cac stress ve tam ly than kinh cung co the gay benh loet. Thuoc la lam tang nguy co bi loet, tang ti le tai phat va bien chung cua benh loet. Ruou cung tang ti le tai phat loet.
II. Trieu chung cua benh loet DD-TT nhu the nao?
Chi khoang 50% benh nhan loet DD-TT la co trieu chung dien hinh, 40 – 45% co trieu chung mo ho, khong dien hinh, nhung truong hop nay rat kho chan doan phan biet voi cac benh khac cua DD-TT nhu viem DD-TT, ung thu DD. Co 5 - 10% benh nhan loet hoan toan khong co trieu chung (loet cam), hay gap o nguoi lon tuoi.
1. Con dau loet: la trieu chung dien hinh cua benh loet DD-TT voi cac dac diem (1) Dau thuong vi (vung tren ron va duoi mom xuong uc). (2) Dau co chu ky theo bua an va theo mua. (3) Dau xuat hien hoac tang khi an cac thuc an chua, cay hay khi bi cang thang than kinh va giam khi uong cac thuoc khang axit hay thuoc bang niem mac da day.
2. Cac trieu chung khong dien hinh nhu day bung, o hoi, o chua, cham tieu hoa… rat kho phan biet la do loet hay do mot benh khac cua da day nhu viem DD, ung thu DD, hay chung loan tieu hoa khong do loet. Truong hop nay phai chup Xquang hoac noi soi DD-TT moi chan doan chac chan.
3. Cac truong hop loet cam thuong chi duoc chan doan khi xay ra bien chung.
4. Benh thuong hay tai phat. Truoc day, sau khi duoc chua lanh, co 60 – 80% tai phat trong vong 2 nam. Tu thap nien 80, khi xac dinh duoc vai tro gay benh cua vi khuan H. Pylori, viec dieu tri tiet tru H. Pylori da lam giam ti le tai phat con khoang 10%.
III. Cac bien chung cua benh loet DD-TT la gi?
1. Xuat huyet tieu hoa (chay mau duong tieu hoa): xuat huyet hay chay mau thuong ram ro voi oi ra mau, co hoac khong co di tieu phan den. Benh nhan can duoc nhap vien ngay de dieu tri cap cuu.
2. Thung DD-TT: xuat hien con dau bung dot ngot , du doi vung thuong vi nhu dao dam, thuong co non oi va bung cung nhu go. Bien chung nay phai duoc mo cap cuu, neu khong benh nhan se tu vong.
3. Hep mon vi: luc dau an cham tieu, day bung, nang bung, o nuoc chua nhat la ve buoi chieu; tiep theo benh nhan bi non oi sau an ngay cang thuong hon. Benh nhan thuong gay sut do bi non oi. Bien chung nay phai duoc dieu tri bang phau thuat.
4. Hoa ung thu: ngay nay nguoi ta thay co chung cu nhiem H. Pylori gay viem loet da day lau dai co the dan den ung thu da day.
IV. Lam cach nao de xac dinh bi benh loet DD-TT?
1. Chan doan xac dinh loet DD-TT: truoc day khi benh nhan co con dau loet dien hinh, bac si co the tien hanh dieu tri voi thuoc chong loet. Truong hop cac trieu chung khong dien hinh, phai chup Xquang hoac noi soi de xac dinh benh loet va loai tru cac benh khac cua da day, nhat la ung thu da day. Cac trieu chung giup nghi den ung thu da day la (1) Sut can, chan an. (2) Di cau phan den va co cac trieu chung cua thieu mau man nhu xanh xao, met moi. (3) Dau bung am i vung thuong vi. (4) Nguoi lon tuoi (> 50 tuoi). (5) Co nguoi than trong gia dinh bi ung thu da day
2. Chan doan nhiem H. Pylori: hien nay do can xac dinh co nhiem H. Pylori hay khong de quyet dinh viec dieu tri tiet tru nen can lam xet nghiem chan doan nhiem H. Pylori cho benh nhan. Co nhieu phuong phap chan doan nhiem H. Pylori nhu chan doan qua noi soi va cac xet nghiem khong phai lam noi soi nhu test huyet thanh hoc, test tho urease Phuong phap xet nghiem hien dai nhat hien nay la Pytest (xet nghiem da day bang hoi tho) khac phuc duoc nhuoc diem gay non oi cua noi so, ky thuat PCR…
V. Dieu tri loet DD-TT nhu the nao?
Hien nay viec dieu tri loet DD-TT co the phan ra hai nhom chinh: nhom benh loet DD-TT do nhiem H. Pylori va nhom khong do nhiem H. Pylori. Nhom sau thuong do dung cac thuoc khang viem, thuoc tri dau nhuc,do stress, do benh gan man tinh. Thuoc dieu tri la khang sinh ma chu yeu la Metronidazole hoac Clarithromycin, nhung hien nay hien tuong de khang thuoc da dan xuat hien (47 - 86% voi Metronidazol, 20% voi Clarithromycin va 69% voi Amoxiciclin) lam anh huong nhieu den ket qua dieu tri. Clarithromycin co ty le thanh cong cao hon han so voi Metronidazol, nhung hieu qua cua thuoc se tang hon neu uc che tiet acid day du bang cac thuoc uc che bom proton de lam tang do pH cua da day. .Cac phac do dieu tri chu yeu hien nay la su phoi hop cua 3 hoac 4 loai thuoc trong so : thuoc uc che bom proton - Amoxcycilin - Metronidazol - Clarithromycin va Bismuth hay Tetracyclin.
Hoi Tieu hoa Viet Nam da hop ban nhieu ve cach diet tru chung va thong nhat mot phuong thuc chung de dieu tri Helicobacter Pylori o benh nhan da day ta trang co hieu luc nhat theo tom tat nhu sau:
- Chi dinh tiet tru HP: Loet hanh ta trang; loet da day; viem teo da day man tinh hoat dong; u lympho bao da day hoat hoa thap; ung thu da day chan doan rat som; dieu tri lau dai voi thuoc chong viem khong steroid (NSAID) hay co tien su loet truoc khi dieu tri.
- Co the dung trong cac truong hop: Ung thu da day chan doan muon va da phau thuat; trao nguoc da day thuc quan; viem da day da dieu tri nhieu lan khong giam hay con cai nhung nguoi bi ung thu da day.
- Cong thuc dieu tri: chon mot trong cac phac do sau:
1. Uc che bom proton (PPI) + Clarithromycin (C) 500mg + Amoxiciclin (A) 1000mg dung ngay 2 lan trong it nhat 7 ngay
2. [ PPI + C 500mg + Metronidazol (M) 500mg] x 2 lan x 7 ngay
3. [ PPI + Bismuth (B)200 – 400mg + Tetracyclin (T) 1000mg + M 500mg] x 2 lan x 7ngay
4. [ PPI + B 200 – 400 mg +T 1000mg + A 1000mg] x 2 lan x 7 ngay
5. PPI 2 lan/ngay + [ T 250mg + M 200mg + B 108mg ] x 5lan x 10 ngay
Cac thuoc trung hoa axit truoc day duoc coi la thuoc chinh trong dieu tri VLDDTT. Nhung hien nay chi con su dung nhu thuoc ho tro de lam giam cac trieu chung cua benh VLDDTT, nhu dau bung, an khong tieu…Toa thuoc tri viem loet da day neu chi co thuoc giam dau, chong co that, khang acid... thi tren thuc te chi co loi cho thay thuoc vi benh nhan the nao cung phai tai kham, va co loi cho nha thuoc vi than chu som muon cung tro thanh "khach hang than thiet"! Vay phai lam cach nao?
-San pham tot nhat va thong dung nhat trong dieu tri hien nay la CLROPHILL nhap khau tu Malaisya (trung hoa HCl va pepsin cua dich da day)
-Ket hop voi K-Borini nhap khau tu Ha Lan (tieu diet khuan H.pylori)
Trung tam Tu van va phan phoi san pham
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