{"id":59921,"date":"2022-07-14T11:45:22","date_gmt":"2022-07-14T04:45:22","guid":{"rendered":"https:\/\/asprou.com\/?p=59921"},"modified":"2023-04-06T15:46:52","modified_gmt":"2023-04-06T08:46:52","slug":"ngo-doc-paracetamol-acetaminophen-benh-hoc-dieu-tri-va-bien-phap-phong-tranh","status":"publish","type":"post","link":"https:\/\/asprou.com\/khoa-duoc\/tin-tuc-khoa-duoc\/ngo-doc-paracetamol-acetaminophen-benh-hoc-dieu-tri-va-bien-phap-phong-tranh\/","title":{"rendered":"NG\u1ed8 \u0110\u1ed8C PARACETAMOL (ACETAMINOPHEN): B\u1ec6NH H\u1eccC, \u0110I\u1ec0U TR\u1eca V\u00c0 BI\u1ec6N PH\u00c1P PH\u00d2NG TR\u00c1NH"},"content":{"rendered":"\n

Ng\u1ed9 \u0111\u1ed9c paracetamol (Acetaminophen=APAP) do qu\u00e1 li\u1ec1u l\u00e0 lo\u1ea1i ng\u1ed9 \u0111\u1ed9c c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y t\u1eed vong v\u00e0 ng\u00e0y c\u00e0ng ph\u1ed5 bi\u1ebfn v\u00ec thu\u1ed1c n\u00e0y d\u1ec5 mua, d\u1ec5 s\u1eed d\u1ee5ng, c\u00f3 trong nhi\u1ec1u bi\u1ec7t d\u01b0\u1ee3c kh\u00e1c nhau. Th\u1eadt v\u1eady, APAP c\u00f3 trong tr\u00ean 100 ch\u1ebf ph\u1ea9m kh\u00f4ng k\u00ea \u0111\u01a1n bao g\u1ed3m nhi\u1ec1u ch\u1ebf ph\u1ea9m d\u00e0nh cho tr\u1ebb em d\u01b0\u1edbi d\u1ea1ng l\u1ecfng, d\u1ea1ng nang \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb ho v\u00e0 c\u1ea3m l\u1ea1nh. Nhi\u1ec1u lo\u1ea1i thu\u1ed1c k\u00ea theo \u0111\u01a1n c\u0169ng c\u00f3 APAP.<\/strong>
Nguy\u00ean nh\u00e2n c\u1ee7a ng\u1ed9 \u0111\u1ed9c \u0111\u01b0\u1ee3c li\u1ec7t k\u00ea theo b\u1ea3ng d\u01b0\u1edbi \u0111\u00e2y:<\/p>\n\n\n\n

\"\"
Tham kh\u1ea3o: Heard K, Bui A, Mlynarchek SL, Green JL, Band GR, Clark RF, Kazer E, Koff RS, Dart RC: Toxicity from repeated dose of acetaminophen in children: assessment of causality and dose in reported cases. American Journal of Therapeutics 2014, 21(3):174-183.<\/figcaption><\/figure>\n\n\n\n

B\u1ec7nh h\u1ecdc vi\u00eam gan do acetaminophen<\/strong>
APAP \u0111\u01b0\u1ee3c h\u1ea5p thu nhanh ch\u00f3ng v\u00e0 ho\u00e0n to\u00e0n \u1edf d\u1ea1 d\u00e0y -ru\u1ed9t. \u0110\u1ea1t n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh trong v\u00f2ng 4 gi\u1edd sau khi qu\u00e1 li\u1ec1u \u0111\u1ed1i v\u1edbi d\u1ea1ng ch\u1ebf ph\u1ea9m ph\u00f3ng th\u00edch t\u1ee9c th\u00ec nh\u01b0ng s\u1ebd ch\u1eadm h\u01a1n khi d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi c\u00e1c thu\u1ed1c l\u00e0m ch\u1eadm s\u1ef1 l\u00e0m r\u1ed7ng d\u1ea1 d\u00e0y (nh\u01b0: c\u00e1c opioid, thu\u1ed1c kh\u00e1ng cholinergic) ho\u1eb7c qu\u00e1 li\u1ec1u ch\u1ebf ph\u1ea9m ph\u00f3ng th\u00edch ch\u1eadm.<\/p>\n\n\n\n

  • t1\/2 kho\u1ea3ng 2-4 gi\u1edd cho t\u1ea5t c\u1ea3 ch\u1ebf ph\u1ea9m APAP.<\/li>
  • G\u1eafn v\u00e0o protein huy\u1ebft t\u01b0\u01a1ng: Ch\u1ec9 g\u1eafn \u0111\u1ed9 20-50 % khi ng\u1ed9 \u0111\u1ed9c c\u1ea5p APAP.<\/li>
  • Sau li\u1ec1u \u0111i\u1ec1u tr\u1ecb, c\u00f3 90-100% thu\u1ed1c t\u00ecm th\u1ea5y trong n\u01b0\u1edbc ti\u1ec3u trong ng\u00e0y \u0111\u1ea7u, ch\u1ee7 y\u1ebfu sau khi \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a \u1edf gan b\u1eb1ng ph\u1ea3n \u1ee9ng li\u00ean h\u1ee3p v\u1edbi acid glucuronic (~60%), acid sulfuric (~35%), ho\u1eb7c cysteine (~3%). \u1ede tr\u1ebb em APAP \u00edt b\u1ecb glucuronyl h\u00f3a so v\u1edbi ng\u01b0\u1eddi l\u1edbn. M\u1ed9t t\u1ec9 l\u1ec7 nh\u1ecf APAP \u0111\u01b0\u1ee3c N-hydroxyl h\u00f3a qua cytochrome P450 (CYP 2E1) \u0111\u1ec3 th\u00e0nh l\u1eadp ch\u1ea5t trung gian N-acetyl-benzoquinoneimine (NAPQI). \u0110\u00f3 l\u00e0 ch\u1ea5t \u00e1i \u0111i\u1ec7n t\u1eed v\u00ec thi\u1ebfu 1 electron \u0111\u1ec3 t\u1ea1o th\u00e0nh n\u1ed1i h\u00f3a h\u1ecdc \u1ed5n \u0111\u1ecbnh n\u00ean ch\u1ea5t n\u00e0y c\u00f3 \u0111\u1ed9 ph\u1ea3n \u1ee9ng r\u1ea5t cao. NAPQI ch\u1ec9 \u1ed5n \u0111\u1ecbnh khi ph\u1ea3n \u1ee9ng v\u1edbi nh\u00f3m sulfhydryl c\u1ee7a glutathione (GSH, ch\u1ea5t cho electron g\u1ecdi l\u00e0 ch\u1ea5t \u00e1i nh\u00e2n) th\u00e0nh acid mercapturic kh\u00f4ng \u0111\u1ed9c \u0111\u1ec3 th\u1ea3i tr\u1eeb qua n\u01b0\u1edbc ti\u1ec3u. \u1ede li\u1ec1u \u0111\u1ed9c \u0111\u01b0\u1eddng sulfat h\u00f3a v\u00e0 \u0111\u01b0\u1eddng glucuronyl h\u00f3a b\u1ecb b\u1ea3o h\u00f2a n\u00ean c\u00f3 nhi\u1ec1u h\u01a1n APAP \u0111i qua \u0111\u01b0\u1eddng CYP 2E1 v\u00e0 b\u1ecb chuy\u1ec3n h\u00f3a th\u00e0nh NAPQI. Khi GSH c\u1ea1n \u0111\u1ebfn 70-80% th\u00ec NAPQI g\u1eafn v\u1edbi \u0111\u1ea1i ph\u00e2n t\u1eed c\u1ee7a gan, \u0111\u1eb7c bi\u1ec7t l\u00e0 protein c\u1ee7a ti th\u1ec3 t\u1ebf b\u00e0o gan t\u1ea1o NAPQI-protein-adduct. Ti\u1ebfn tr\u00ecnh n\u00e0y kh\u00f4ng h\u1ed3i ph\u1ee5c. S\u1ef1 th\u00e0nh l\u1eadp adduct n\u00e0y d\u1eabn \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng oxy h\u00f3a t\u1ebf b\u00e0o gan (oxidative hepatocyte injury) \u0111\u01b0a \u0111\u1ebfn ho\u1ea1i t\u1eed t\u1ebf b\u00e0o gan. S\u1ef1 c\u1ea1n GSH c\u0169ng khi\u1ebfn cho NAPQI g\u1eafn v\u00e0o c\u00e1c \u0111\u1ea1i ph\u00e2n t\u1eed c\u1ee7a t\u1ebf b\u00e0o l\u00e0m r\u1ed1i lo\u1ea1n h\u1ec7 th\u1ed1ng enzyme.<\/li><\/ul>\n\n\n\n
    \"\"
    Qu\u00e1 tr\u00ecnh chuy\u1ec3n h\u00f3a v\u00e0 g\u00e2y \u0111\u1ed9c gan c\u1ee7a paracetamol.<\/figcaption><\/figure>\n\n\n\n

    Tri\u1ec7u ch\u1ee9ng vi\u00eam gan do ng\u1ed9 \u0111\u1ed9c APAP<\/strong><\/p>\n\n\n\n

    Kh\u00f4ng gi\u1ed1ng h\u1ea7u h\u1ebft t\u00e1c nh\u00e2n g\u00e2y vi\u00eam gan kh\u00e1c, vi\u00eam gan do APAP l\u00e0 c\u1ea5p t\u00ednh l\u00fac kh\u1edfi \u0111\u1ea7u, di\u1ec5n ti\u1ebfn nhanh, c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m l\u00e0 t\u0103ng r\u00f5 r\u1ec7t aminotransferase huy\u1ebft t\u01b0\u01a1ng (th\u01b0\u1eddng >3000IU\/L) v\u00e0 li\u00ean quan t\u1edbi t\u0103ng INR. D\u1ea5u hi\u1ec7u kh\u1edfi \u0111\u1ea7u ng\u1ed9 \u0111\u1ed9c APAP th\u01b0\u1eddng nh\u1eb9, kh\u00f4ng \u0111\u1eb7c hi\u1ec7u v\u00e0 kh\u00f4ng ph\u1ea3i l\u00e0 d\u1ef1 \u0111o\u00e1n \u0111\u00e1ng tin c\u1eady \u0111\u00f4c gan sau \u0111\u00f3. Nh\u01b0 v\u1eady \u0111o l\u01b0\u1eddng n\u1ed3ng \u0111\u1ed9 APAP huy\u1ebft thanh l\u00e0 quan tr\u1ecdng b\u1ea5t c\u1ee9 khi n\u00e0o nghi ng\u1edd qu\u00e1 li\u1ec1u APAP. D\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng ng\u1ed9 \u0111\u1ed9c APAP g\u1ed3m 4 giai \u0111o\u1ea1n theo b\u1ea3ng 1.<\/p>\n\n\n\n

    B\u1ea3ng 1: C\u00e1c giai \u0111o\u1ea1n ng\u1ed9 \u0111\u1ed9c APAP<\/strong><\/p>\n\n\n\n

    \"\"<\/figure>\n\n\n\n

    B\u1ea3ng 2: M\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng gan theo n\u1ed3ng \u0111\u1ed9 acetaminophen trong m\u00e1u<\/strong><\/p>\n\n\n\n

    \"\"<\/figure>\n\n\n\n

    Li\u1ec1u \u0111i\u1ec1u tr\u1ecb: 10-15 mg\/kg\/li\u1ec1u (tr\u1ebb em), 325-1000 mg\/li\u1ec1u (ng\u01b0\u1eddi l\u1edbn)<\/p>\n\n\n\n

    Li\u1ec1u t\u1ed1i \u0111a: 80 mg\/kg\/ng\u00e0y (tr\u1ebb em), 4 g\/ng\u00e0y (ng\u01b0\u1eddi l\u1edbn)<\/p>\n\n\n\n

    Li\u1ec1u \u0111\u1ed9c: Ng\u01b0\u1eddi l\u1edbn li\u1ec1u duy nh\u1ea5t 10-15 g (150-250 mg\/kg) ho\u1eb7c >12 g\/24 gi\u1edd<\/p>\n\n\n\n

    Li\u1ec1u c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y t\u1eed vong: 20-25 g Li\u1ec1u \u0111\u1ed9c thay \u0111\u1ed5i gi\u1eefa c\u00e1c c\u00e1 th\u1ec3. Y\u1ebfu t\u1ed1 l\u00e2m s\u00e0ng l\u00e0m b\u1ec7nh nh\u00e2n b\u1ecb t\u1ed5n th\u01b0\u01a1ng b\u1edfi APAP g\u1ed3m c\u00f3: nghi\u1ec7n r\u01b0\u1ee3u m\u1ea1n, c\u00e1c thu\u1ed1c c\u1ea3m \u1ee9ng CYP2E1 c\u1ee7a gan, suy dinh d\u01b0\u1ee1ng, \u0111a h\u00ecnh gene (Polymorphisms of genes) v\u00e0 tu\u1ed5i cao.<\/p>\n\n\n\n

    Ch\u1ea9n \u0111o\u00e1n ng\u1ed9 \u0111\u1ed9c acetaminophen<\/strong><\/p>\n\n\n\n

    T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n b\u1ecb nghi ng\u1edd ng\u1ed9 \u0111\u1ed9c APAP n\u00ean l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m sau \u0111\u00e2y: \u0110o n\u1ed3ng \u0111\u1ed9 APAP trong huy\u1ebft thanh, x\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gan (AST, ALT, bilirubin to\u00e0n ph\u1ea7n), PT v\u00e0 INR, ch\u1ea5t \u0111i\u1ec7n gi\u1ea3i, BUN, creatinin.<\/p>\n\n\n\n

    T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n nghi ng\u1edd qu\u00e1 li\u1ec1u do c\u1ed1 \u00fd: \u0110o n\u1ed3ng \u0111\u1ed9 salicylate huy\u1ebft thanh, \u0111o \u0111\u01b0\u1eddng huy\u1ebft (l\u1ea5y m\u00e1u \u1edf ng\u00f3n tay), ECG.<\/p>\n\n\n\n

    \u0110\u1ec3 ti\u00ean \u0111o\u00e1n nguy c\u01a1 \u0111\u1ed9c gan t\u1ed1t nh\u1ea5t l\u00e0 d\u1ef1a v\u00e0o th\u1eddi gian u\u1ed1ng \u0111\u1ebfn khi \u0111o n\u1ed3ng \u0111\u1ed9 APAP trong huy\u1ebft thanh. Sau khi  qu\u00e1 1 li\u1ec1u c\u1ea5p APAP ph\u00f3ng th\u00edch t\u1ee9c th\u00ec n\u00ean \u0111o n\u1ed3ng \u0111\u1ed9 APAP 4 gi\u1edd sau khi u\u1ed1ng thu\u1ed1c. N\u1ebfu \u0111\u00e3 u\u1ed1ng APAP tr\u00ean 4 gi\u1edd tr\u01b0\u1edbc khi nh\u1eadp vi\u1ec7n th\u00ec ph\u1ea3i \u0111o ngay.<\/p>\n\n\n\n

    N\u1ed3ng \u0111\u1ed9 thu\u1ed1c \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 d\u1ef1a v\u00e0o to\u00e1n \u0111\u1ed3 Rumark Matthew \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh nhu c\u1ea7u \u0111i\u1ec1u tr\u1ecb ng\u1ed9 \u0111\u1ed9c qu\u00e1 li\u1ec1u APAP. To\u00e1n \u0111\u1ed3 n\u00e0y ch\u1ec9 \u00e1p d\u1ee5ng khi ng\u1ed9 \u0111\u1ed9c c\u1ea5p li\u1ec1u duy nh\u1ea5t APAP, kh\u00f4ng \u00e1p d\u1ee5ng to\u00e1n \u0111\u1ed3 n\u00e0y trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p sau: u\u1ed1ngA PAP >24 gi\u1edd tr\u01b0\u1edbc khi nh\u1eadp vi\u1ec7n, d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng d\u01b0\u1edbi li\u1ec1u \u0111i\u1ec1u tr\u1ecb l\u1eadp l\u1ea1i nhi\u1ec1u l\u1ea7n ho\u1eb7c qu\u00e1 li\u1ec1u do ti\u00eam t\u0129nh m\u1ea1ch. To\u00e1n \u0111\u1ed3 n\u00e0y d\u1ef1a tr\u00ean s\u1ed1 l\u01b0\u1ee3ng l\u1edbn b\u1ec7nh nh\u00e2n qu\u00e1 li\u1ec1u APAP m\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ch\u1ea5t gi\u1ea3i \u0111\u1ed9c (antidote). Li\u00ean quan gi\u1eefa n\u1ed3ng \u0111\u1ed9 APAP v\u1edbi th\u1eddi gian u\u1ed1ng thu\u1ed1c \u0111\u01b0\u1ee3c xem nh\u01b0 ti\u00ean \u0111o\u00e1n ng\u1ed9 \u0111\u1ed9c gan. B\u1ec7nh nh\u00e2n kh\u00f4ng \u0111i\u1ec1u tr\u1ecb c\u00f3 n\u1ed3ng \u0111\u1ed9 APAP tr\u00ean \u0111\u01b0\u1eddng n\u1ed1i 200 \u03bcg\/ml (1320 \u03bcmol\/ml) l\u00fac 4 gi\u1edd v\u00e0 25 \u03bcg\/ml (165 \u03bcmol\/ml) l\u00fac 16 gi\u1edd \u0111\u01b0\u1ee3c suy \u0111o\u00e1n l\u00e0 ng\u1ed9 \u0111\u1ed9c gan. C\u00f3 60% tr\u01b0\u1eddng h\u1ee3p ng\u1ed9 \u0111\u1ed9c gan n\u1eb7ng (AST>1000 IU\/L) v\u00e0 t\u1ec9 l\u1ec7 t\u1eed vong l\u00e0 5%. B\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi n\u1ed3ng \u0111\u1ed9 APAP tr\u00ean \u0111\u01b0\u1eddng n\u1ed1i 300 \u03bcg\/mL (1985 \u03bcmol\/mL) t\u1ea1i 4 gi\u1edd v\u00e0 37,5 \u03bcg\/mL (250 \u03bcmol\/mL) l\u00fac 16 gi\u1edd l\u00e0 ng\u1ed9 \u0111\u1ed9c gan cao,\u00a0 t\u1ec9 l\u1ec7 \u0111\u1ed9c gan n\u1eb7ng c\u1ee7a tr\u01b0\u1eddng h\u1ee3p n\u00e0y l\u00e0 90% v\u00e0 m\u1ee9c \u0111\u1ed9 t\u1eed vong \u0111\u1ebfn 24%. B\u1ec7nh nh\u00e2n c\u00f3 n\u1ed3ng \u0111\u1ed9 APAP d\u01b0\u1edbi \u0111\u01b0\u1eddng n\u1ed1i c\u00f3 th\u1ec3 ng\u1ed9 \u0111\u1ed9c gan nh\u01b0ng kh\u00f4ng n\u1eb7ng v\u00e0 kh\u00f4ng c\u00f3 b\u00e1o c\u00e1o t\u1eed vong.<\/p>\n\n\n\n

    \u0110i\u1ec1u tr\u1ecb ng\u1ed9 \u0111\u1ed9c acetaminophen<\/strong>:<\/p>\n\n\n\n

    Ch\u00eca kh\u00f3a \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 l\u00e0 b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb tr\u01b0\u1edbc khi c\u00f3 t\u1ed5n th\u01b0\u01a1ng gan. T\u1ed5n th\u01b0\u01a1ng gan \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n b\u1eb1ng t\u0103ng ALT (trong v\u00f2ng 8 gi\u1edd c\u1ee7a ng\u1ed9 \u0111\u1ed9c c\u1ea5p).<\/p>\n\n\n\n

    • U\u1ed1ng than ho\u1ea1t (activated charcoal) cho t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n trong v\u00f2ng 4 gi\u1edd sau khi u\u1ed1ng APAP, tr\u1eeb khi c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh. Tuy nhi\u00ean, n\u1ebfu nh\u1eadp vi\u1ec7n tr\u00ean 4 gi\u1edd sau khi u\u1ed1ng APAP th\u00ec d\u00f9ng than ho\u1ea1t c\u0169ng c\u00f3 l\u1ee3i.<\/li>
    • N-acetylcystein (NAC) \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh khi:<\/li>
    • N\u1ed3ng \u0111\u1ed9 APAP \u0111\u01b0\u1ee3c \u0111o \u2265 4 gi\u1edd sau khi ng\u1ed9 \u0111\u1ed9c 1 li\u1ec1u c\u1ea5p, ngh\u0129a l\u00e0 tr\u00ean \u201c\u0111\u01b0\u1eddng \u0111i\u1ec1u tr\u1ecb\u201d c\u1ee7a to\u00e1n \u0111\u1ed3 Rumark Matthew.<\/li>
    • Kh\u00f4ng ghi nh\u1eadn n\u1ed3ng \u0111\u1ed9 APAP\/huy\u1ebft t\u01b0\u01a1ng v\u00e0 c\u00f2n nghi ng\u1edd v\u1ec1 vi\u1ec7c u\u1ed1ng APAP.<\/li>
    • Kh\u00f4ng bi\u1ebft th\u1eddi gian u\u1ed1ng APAP v\u00e0 n\u1ed3ng \u0111\u1ed9 APAP > 10 \u03bcg\/mL (66 \u03bcmol\/mL).<\/li>
    • C\u00f3 b\u1ea5t c\u1ee9 b\u1eb1ng ch\u1ee9ng n\u00e0o v\u1ec1 ng\u1ed9 \u0111\u1ed9c gan khi tr\u01b0\u1edbc \u0111\u00e2y c\u00f3 u\u1ed1ng APAP.<\/li>
    • B\u1ec7nh nh\u00e2n cho bi\u1ebft ho\u1eb7c B\u00e1c s\u0129 nghi ng\u1edd b\u1ec7nh nh\u00e2n c\u00f3 d\u00f9ng APAP li\u1ec1u cao l\u1eadp l\u1ea1i, b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 \u0111\u1ed9c gan do APAP, v\u00e0 n\u1ed3ng \u0111\u1ed9 APAP >10 \u00b5g\/mL (66 \u03bcgmol\/mL)<\/li><\/ul>\n\n\n\n

      Ch\u1ebf \u0111\u1ed9 li\u1ec1u NAC \u0111\u01b0\u1eddng u\u1ed1ng<\/strong><\/p>\n\n\n\n

      • Ch\u1ebf \u0111\u1ed9 li\u1ec1u \u0111\u01b0\u1eddng u\u1ed1ng \u0111\u01b0\u1ee3c ch\u1ea5p nh\u1eadn cho ph\u1ee5 n\u1eef kh\u00f4ng mang thai, \u0111\u01b0\u1eddng d\u1ea1 d\u00e0y ru\u1ed9t b\u00ecnh th\u01b0\u1eddng v\u00e0 kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng \u0111\u1ed9c gan.<\/li>
      • Li\u1ec1u t\u1ea5n c\u00f4ng 140 mg, sau \u0111\u00f3 d\u00f9ng 17 li\u1ec1u 70 mg\/kg m\u1ed7i 4 gi\u1edd.<\/li>
      • N\u1ebfu c\u00f3 \u00f3i m\u1eefa trong v\u00f2ng 1 gi\u1edd do u\u1ed1ng NAC n\u00ean nhanh ch\u00f3ng l\u1eadp l\u1ea1i li\u1ec1u n\u1ebfu c\u00f3 th\u1ec3.<\/li>
      • C\u00f3 th\u1ec3 ch\u1ea5m d\u1ee9t \u0111i\u1ec1u tr\u1ecb sau 24-36 gi\u1edd d\u00f9ng thu\u1ed1c n\u1ebfu n\u1ed3ng \u0111\u1ed9 APAP d\u01b0\u1edbi 10 \u03bcg\/mL v\u00e0 b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng \u0111\u1ed9c gan ti\u1ebfn tri\u1ec3n v\u00e0 duy tr\u00ec t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng t\u1ed1t.<\/li><\/ul>\n\n\n\n

         Ch\u1ebf \u0111\u1ed9 li\u1ec1u NAC \u0111\u01b0\u1eddng ti\u00eam t\u0129nh m\u1ea1ch<\/strong><\/p>\n\n\n\n

        • N\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng sinh h\u00f3a \u0111\u1ed9c gan (nh\u01b0 INR <2), d\u00f9ng ch\u1ebf \u0111\u1ed9 IV 21 gi\u1edd: li\u1ec1u t\u1ea5n c\u00f4ng 150 mg\/kg trong 60 ph\u00fat, sau \u0111\u00f3 50 mg\/kg truy\u1ec1n trong 4 gi\u1edd, truy\u1ec1n li\u1ec1u cu\u1ed1i 100 mg\/kg trong 16 gi\u1edd c\u00f2n l\u1ea1i.<\/li>
        • N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 b\u1eb1ng ch\u1ee9ng sinh h\u00f3a suy gan (nh\u01b0 INR >2), d\u00f9ng ch\u1ebf \u0111\u1ed9 21 gi\u1edd : Li\u1ec1u t\u1ea5n c\u00f4ng 150 mg trong 60 ph\u00fat, sau \u0111\u00f3 truy\u00ean 100 mg\/kg cu\u1ed1i c\u00f9ng, truy\u1ec1n trong 16 gi\u1edd c\u00f2n l\u1ea1i, sau \u0111\u00f3 truy\u1ec1n li\u00ean t\u1ee5c NAC 6,25 mg\/kg\/gi\u1edd \u0111\u1ebfn khi INR <2.<\/li>
        • Ch\u1ebf \u0111\u1ed9 li\u1ec1u IV \u0111\u01b0\u1ee3c ch\u1ea5p nh\u1eadn cho t\u1ea5t c\u1ea3 tr\u01b0\u1eddng h\u1ee3p ng\u1ed9 \u0111\u1ed9c APAP v\u00e0 \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 thay th\u1ebf cho b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng (\u00f3i m\u1eefa kh\u00f3 ch\u1eefa, lo\u00e9t d\u1ea1 d\u00e0y), b\u1ec7nh nh\u00e2n ng\u1ed9 \u0111\u1ed9c gan r\u00f5 r\u1ec7t (INR >2) v\u00e0 ph\u1ee5 n\u1eef mang thai.<\/li>
        • \u0110i\u1ec1u tr\u1ecb ch\u1ed1ng n\u00f4n: C\u00f3 th\u1ec3 d\u00f9ng ch\u1ea5t \u0111\u1ed1i kh\u00e1ng receptor 5-HT3 (ondansetron) ho\u1eb7c metoclopropamid.<\/li><\/ul>\n\n\n\n

          Bi\u1ec7n ph\u00e1p ph\u00f2ng tr\u00e1nh qu\u00e1 li\u1ec1u paracetamol<\/strong><\/p>\n\n\n\n

          • \u0110\u1ed9c gan do paracetamol ph\u1ee5 thu\u1ed9c li\u1ec1u d\u00f9ng n\u00ean c\u1ea7n ki\u1ec3m so\u00e1t ch\u1ebf \u0111\u1ed9 li\u1ec1u d\u00f9ng.<\/li>
          • Nh\u00e0 s\u1ea3n xu\u1ea5t c\u1ea7n ghi r\u00f5 tr\u00ean nh\u00e3n th\u00e0nh ph\u1ea7n v\u00e0 c\u00e1ch s\u1eed d\u1ee5ng.<\/li>
          • D\u01b0\u1ee3c s\u0129 v\u00e0 ng\u01b0\u1eddi s\u1eed d\u1ee5ng c\u1ea7n th\u1ef1c hi\u1ec7n c\u00e1c \u0111i\u1ec1u sau \u0111\u00e2y:<\/li><\/ul>\n\n\n\n

               + \u0110\u1ecdc k\u1ef9 h\u01b0\u1edbng d\u1eabn tr\u00ean nh\u00e3n thu\u1ed1c \u0111\u1ec3 s\u1eed d\u1ee5ng \u0111\u00fang theo khuy\u1ebfn c\u00e1o.<\/p>\n\n\n\n

               + Hi\u1ec3u r\u00f5 c\u00e1c thu\u1ed1c \u0111ang s\u1eed d\u1ee5ng v\u00e0 c\u00e1c bi\u1ec7t d\u01b0\u1ee3c c\u00f3 paracetamol.<\/p>\n\n\n\n

               + Bi\u1ebft c\u00e1c thu\u1ed1c kh\u00f4ng \u0111\u01b0\u1ee3c ph\u1ed1i h\u1ee3p v\u1edbi paracetamol.<\/p>\n\n\n\n

            • V\u1edbi tr\u1ebb em c\u00e0ng th\u1eadn tr\u1ecdng h\u01a1n \u0111\u1ec3 tr\u00e1nh l\u1eabn l\u1ed9n h\u00e0m l\u01b0\u1ee3ng thu\u1ed1c, d\u1ee5ng c\u1ee5 \u0111o l\u01b0\u1eddng, li\u1ec1u d\u00f9ng v\u00e0 \u0111\u1ec3 thu\u1ed1c xa t\u1ea7m tay tr\u1ebb em.<\/li><\/ul>\n\n\n\n

              ThS. Tr\u1ea7n Th\u1ecb Thu H\u1eb1ng (Gi\u1ea3ng vi\u00ean ch\u00ednh, B\u1ed9 m\u00f4n D\u01b0\u1ee3c l\u00fd-D\u01b0\u1ee3c l\u00e2m s\u00e0ng, Khoa D\u01b0\u1ee3c HIU)<\/em><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

              Ng\u1ed9 \u0111\u1ed9c paracetamol (Acetaminophen=APAP) do qu\u00e1 li\u1ec1u l\u00e0 lo\u1ea1i ng\u1ed9 \u0111\u1ed9c c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y t\u1eed vong v\u00e0 ng\u00e0y c\u00e0ng ph\u1ed5 bi\u1ebfn v\u00ec thu\u1ed1c n\u00e0y d\u1ec5 mua, d\u1ec5 s\u1eed d\u1ee5ng, c\u00f3 trong nhi\u1ec1u bi\u1ec7t d\u01b0\u1ee3c kh\u00e1c nhau. Th\u1eadt v\u1eady, APAP c\u00f3 trong tr\u00ean 100 ch\u1ebf ph\u1ea9m kh\u00f4ng k\u00ea \u0111\u01a1n bao g\u1ed3m nhi\u1ec1u ch\u1ebf ph\u1ea9m d\u00e0nh cho tr\u1ebb em d\u01b0\u1edbi d\u1ea1ng l\u1ecfng, d\u1ea1ng nang \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb ho v\u00e0 c\u1ea3m l\u1ea1nh. Nhi\u1ec1u lo\u1ea1i thu\u1ed1c k\u00ea theo \u0111\u01a1n c\u0169ng c\u00f3 APAP.<\/p>\n","protected":false},"author":82,"featured_media":59943,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":""},"categories":[1796,2267],"tags":[],"yoast_head":"\nNG\u1ed8 \u0110\u1ed8C PARACETAMOL (ACETAMINOPHEN): B\u1ec6NH H\u1eccC, \u0110I\u1ec0U TR\u1eca V\u00c0 BI\u1ec6N PH\u00c1P PH\u00d2NG TR\u00c1NH - Tr\u01b0\u1eddng \u0110\u1ea1i h\u1ecdc Qu\u1ed1c t\u1ebf H\u1ed3ng B\u00e0ng<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/asprou.com\/khoa-duoc\/tin-tuc-khoa-duoc\/ngo-doc-paracetamol-acetaminophen-benh-hoc-dieu-tri-va-bien-phap-phong-tranh\/\" \/>\n<meta property=\"og:locale\" content=\"vi_VN\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"NG\u1ed8 \u0110\u1ed8C PARACETAMOL (ACETAMINOPHEN): B\u1ec6NH H\u1eccC, \u0110I\u1ec0U TR\u1eca V\u00c0 BI\u1ec6N PH\u00c1P PH\u00d2NG TR\u00c1NH - Tr\u01b0\u1eddng \u0110\u1ea1i h\u1ecdc Qu\u1ed1c t\u1ebf H\u1ed3ng B\u00e0ng\" \/>\n<meta property=\"og:description\" content=\"Ng\u1ed9 \u0111\u1ed9c paracetamol (Acetaminophen=APAP) do qu\u00e1 li\u1ec1u l\u00e0 lo\u1ea1i ng\u1ed9 \u0111\u1ed9c c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y t\u1eed vong v\u00e0 ng\u00e0y c\u00e0ng ph\u1ed5 bi\u1ebfn v\u00ec thu\u1ed1c n\u00e0y d\u1ec5 mua, d\u1ec5 s\u1eed d\u1ee5ng, c\u00f3 trong nhi\u1ec1u bi\u1ec7t d\u01b0\u1ee3c kh\u00e1c nhau. Th\u1eadt v\u1eady, APAP c\u00f3 trong tr\u00ean 100 ch\u1ebf ph\u1ea9m kh\u00f4ng k\u00ea \u0111\u01a1n bao g\u1ed3m nhi\u1ec1u ch\u1ebf ph\u1ea9m d\u00e0nh cho tr\u1ebb em d\u01b0\u1edbi d\u1ea1ng l\u1ecfng, d\u1ea1ng nang \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb ho v\u00e0 c\u1ea3m l\u1ea1nh. 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