Thuoc dieu tri viem loet dai truc trang chay mau

Thứ sáu, 01 Tháng sáu 2012, 10:41 GMT+7

Can nguyen cua benh chua ro rang, thuong xay ra o nguoi tre, voi bieu hien lam sang chu yeu la dau bung, tieu chay, phan mau kem theo sot va sut can, benh man tinh tien trien tung dot, de lai nhieu bien chung nhu ap-xe hau mon, hep dai trang, chay mau tram trong, phinh dai trang nhiem doc, ung thu hoa...

Viem loet dai truc trang chay mau la benh thuong gap o chau Au va Bac My, nhung thoi gian gan day dang co xu huong tang len o chau A. Viec dieu tri cho den nay con gap rat nhieu kho khan, mot so thuoc sau thuong duoc dua vao su dung trong dieu tri.

Corticoid

Day la thuoc co hieu qua trong dieu tri cac dot cap nang hoac vua, nhat la the viem dai trang toan bo hoac dai trang trai. Ngoai tac dung uc che mien dich, thuoc con co tac dung khang viem, dac biet la uc che men phospho lipase A2 nen ngan chan su phong thich cua acid arachidonic tu cac phospholipid.

- Trong dot tien trien muc do nang cua viem loet dai truc trang chay mau, co the dung prednisolon duong tinh mach trong vong 10 - 14 ngay, sau do giam dan lieu tuy theo dap ung va tien trien cua dieu tri, neu khong dap ung thi dat van de cat dai trang.

- Trong dot tien trien muc do vua va nhe co the dung corticoid duong uong voi lieu tuy theo tinh trang benh ly va can nang cua benh nhan.

Neu benh nhan dung corticoid tren 3 thang ma dap ung khong tot thi dat van de cat bo dai trang.

Tac dung phu cua thuoc dac biet khi dung lieu cao keo dai: phu, roi loan nuoc va dien giai, teo co, loang xuong, loet hoac chay mau tieu hoa, kinh nguyet khong deu, ram long..

Chong chi dinh: nhiem virut, nhiem nam dieu tri dac hieu khong khoi, goute, loet da day ta trang, viem gan cap do virut.

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Hinh minh hoa

Sulfasalazin va cac dan chat

Salicylazo - sulfapyridin duoc cau tao boi acid 5 amino salicylic duoc noi voi mot sulfamid la sulfapyridin bang cau noi N - N. Hai chat nay se duoc tach doi trong long dai trang nho vi khuan co men azo - reductase, nen vua co tac dung khang viem vua co tac dung khang khuan.

Nhom thuoc nay thuong co hieu qua trong dot tien trien nhe hoac trung binh, trong viem dai trang trai hoac dai trang sigma - truc trang. Va co the dung phoi hop voi corticoid de cho hieu qua dieu tri cao hon.

Tuy theo tinh trang cua benh ma su dung mot trong cac che pham nhu sulfasalazin, olssalazin, mesalazin, pentasa, voi lieu luong khac nhau. Co the su dung vien mesalazin 500mg loai dat hau mon trong truong hop viem hau mon.

Tac dung phu thuong gap la cham tieu, buon non, nhuc dau, ngoai ra co mot so tac dung phu hiem gap hon nhung nang hon do la noi ban, giam bach cau hat, thieu mau huyet tan, benh phoi ke.

Mot so thuoc khac

- Azathioprin (imuran): co hieu qua trong mot so truong hop nang, khi dung thuoc can chu y bach cau hat, khi luong bach cau hat trong mau ngoai vi < 1,5 G/L thi khong dung. Thuoc chong chi dinh o benh nhan co ton thuong o gan, nguoi co tien su benh gan va phu nu co thai.

- Cyclosporin: moi duoc dua vao su dung voi hieu qua kha tot. Tuy nhien khi dung can chu y den tac dung phu cua thuoc nhu tang huyet ap, roi loan chuc nang than, roi loan chuc nang gan, roi loan tieu hoa, doi khi co nhuc dau, ban di ung, thieu mau nhe.

Ngoai viec su dung thuoc cung can chu y den che do an uong va sinh hoat cua benh nhan, dong vien benh nhan bang cac lieu phap tam ly, trong truong hop thieu hut men lactase thi khong cho benh nhan dung sua, trong dot tien trien khau phan an can han che chat xo. Khong dung cac che pham cua thuoc phien, thuoc chong tieu chay va thuoc khang cholin vi co the gay ra phinh dai trang. Dac biet trong truong hop co bien chung phinh dai trang nhiem doc, benh nhan phai duoc theo doi va dieu tri trong trung tam hoi suc tich cuc.

Viem loet dai truc trang chay mau can duoc theo doi thuong xuyen 6 thang 1 lan bang soi dai trang va sinh thiet nhieu manh o dai trang va dai trang sigma de kip thoi phat hien giai doan loan san nang hoac la giai doan dau cua tien trien ung thu, dac biet, mot so nghien cuu gan day cho thay benh nhan co dung them acid folic khi su dung salicylazo - sulfapyridin se lam giam ty le loan san dai trang, tu do lam giam nguy co ung thu dai trang.

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