{"id":64443,"date":"2023-01-03T17:34:56","date_gmt":"2023-01-03T10:34:56","guid":{"rendered":"https:\/\/asprou.com\/?p=64443"},"modified":"2023-04-06T15:46:39","modified_gmt":"2023-04-06T08:46:39","slug":"su-dung-luu-tru-xu-ly-opioid-an-toan","status":"publish","type":"post","link":"https:\/\/asprou.com\/khoa-duoc\/su-dung-luu-tru-xu-ly-opioid-an-toan\/","title":{"rendered":"S\u1eec D\u1ee4NG \u2013 L\u01afU TR\u1eee \u2013 X\u1eec L\u00dd OPIOID AN TO\u00c0N"},"content":{"rendered":"\n
Theo th\u1ed1ng k\u00ea c\u1ee7a GLOBOCAN n\u0103m 2020, tr\u00ean to\u00e0n th\u1ebf gi\u1edbi \u01b0\u1edbc t\u00ednh c\u00f3 g\u1ea7n 20.000.000 ca m\u1eafc b\u1ec7nh ung th\u01b0 m\u1edbi (c\u1ea3 hai gi\u1edbi, m\u1ecdi l\u1ee9a tu\u1ed5i). Vi\u1ec7t Nam c\u00f3 h\u01a1n 97.000.000 d\u00e2n th\u00ec c\u00f3 182.563 ca m\u1eafc b\u1ec7nh ung th\u01b0 m\u1edbi, v\u00e0 s\u1ed1 ca t\u1eed vong do ung th\u01b0 trong n\u0103m 2020 l\u00e0 122.690 1<\/sup>. \u0110i\u1ec1u \u0111\u00f3 cho th\u1ea5y t\u1ef7 l\u1ec7 t\u1eed vong do ung th\u01b0 t\u1ea1i Vi\u1ec7t Nam v\u1eabn c\u00f2n kh\u00e1 cao. Ung th\u01b0 giai \u0111o\u1ea1n cu\u1ed1i, \u0111au l\u00e0 m\u1ed9t trong nh\u1eefng tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng xuy\u00ean v\u00e0 g\u00e2y \u1ea3nh h\u01b0\u1edfng nhi\u1ec1u nh\u1ea5t \u0111\u1ebfn cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n2<\/sup>. Nh\u1eb1m c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng cho b\u1ec7nh nh\u00e2n trong c\u00e1c giai \u0111o\u1ea1n b\u1ec7nh, chi\u1ebfn l\u01b0\u1ee3c ch\u0103m s\u00f3c gi\u1ea3m nh\u1eb9 (CSGN) \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ea9y m\u1ea1nh tr\u00ean to\u00e0n c\u1ea7u. Nhu c\u1ea7u CSGN c\u1ee7a b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00e0 c\u00e1c b\u1ec7nh nan y kh\u00e1c ng\u00e0y c\u00e0ng \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn, bao g\u1ed3m c\u1ea3 nhu c\u1ea7u ki\u1ec3m so\u00e1t c\u01a1n \u0111au m\u1ed9t c\u00e1ch \u0111\u1ea7y \u0111\u1ee7 3<\/sup>. Theo khuy\u1ebfn c\u00e1o c\u1ee7a B\u1ed9 Y t\u1ebf, ki\u1ec3m so\u00e1t \u0111au l\u00e0 m\u1ee5c ti\u00eau h\u00e0ng \u0111\u1ea7u trong th\u1ef1c h\u00e0nh CSGN. X\u1eed tr\u00ed \u0111au c\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh t\u1ea1i c\u00e1c c\u01a1 s\u1edf y t\u1ebf, t\u1ea1i nh\u00e0, c\u1ed9ng \u0111\u1ed3ng 4<\/sup>. Opioid \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng trong c\u00e1c c\u01a1n \u0111au t\u1eeb trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng 4<\/sup>. Hi\u1ec7u qu\u1ea3 gi\u1ea3m \u0111au c\u1ee7a opioid tr\u00ean b\u1ec7nh nh\u00e2n ung th\u01b0 \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh 5<\/sup>. Tuy nhi\u00ean vi\u1ec7c s\u1eed d\u1ee5ng opioid tr\u00ean th\u1ef1c t\u1ebf v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c t\u1ed1i \u01b0u. S\u1eed d\u1ee5ng opioid kh\u00f4ng \u0111\u00fang c\u00e1ch, x\u1eed l\u00fd opioid kh\u00f4ng th\u00edch h\u1ee3p \u0111\u00e3 l\u00e0m t\u0103ng kh\u1ea3 n\u0103ng l\u1ea1m d\u1ee5ng thu\u1ed1c t\u1ea1i Hoa K\u1ef3 6<\/sup>. Ng\u01b0\u1ee3c l\u1ea1i, s\u1eed d\u1ee5ng opioid kh\u00f4ng \u0111\u1ee7 li\u1ec1u l\u01b0\u1ee3ng s\u1ebd ki\u1ec3m so\u00e1t c\u01a1n \u0111au kh\u00f4ng hi\u1ec7u qu\u1ea3. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 tr\u00ec ho\u00e3n vi\u1ec7c u\u1ed1ng opioid v\u00ec qu\u00e1 lo l\u1eafng v\u1ec1 b\u1ea5t l\u1ee3i c\u1ee7a thu\u1ed1c ho\u1eb7c lo s\u1ee3 b\u1ecb nghi\u1ec7n 7<\/sup>. \u0110i\u1ec1u \u0111\u00f3 n\u00f3i l\u00ean r\u1eb1ng hi\u1ec3u bi\u1ebft v\u1ec1 s\u1eed d\u1ee5ng opioid kh\u00f4ng ch\u1ec9 quan tr\u1ecdng \u0111\u1ed1i v\u1edbi ng\u01b0\u1eddi l\u00e0m c\u00f4ng t\u00e1c y t\u1ebf m\u00e0 c\u00f2n quan tr\u1ecdng \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n ung th\u01b0 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb gi\u1ea3m \u0111au b\u1eb1ng opioid, c\u00e0ng quan tr\u1ecdng h\u01a1n khi h\u1ecd \u0111ang \u0111\u01b0\u1ee3c CSGN t\u1ea1i nh\u00e0.<\/p>\n\n\n\n B\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn v\u00e0 t\u01b0 v\u1ea5n k\u1ef9 c\u00e1ch s\u1eed d\u1ee5ng, l\u01b0u tr\u1eef v\u00e0 x\u1eed l\u00fd opioid an to\u00e0n tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng. C\u00f3 nhi\u1ec1u kh\u1ea3o s\u00e1t \u0111\u00e3 ch\u1ee9ng minh b\u1ec7nh nh\u00e2n ung th\u01b0 c\u00f3 nguy c\u01a1 s\u1eed d\u1ee5ng kh\u00f4ng \u0111\u00fang c\u00e1ch, l\u01b0u tr\u1eef kh\u00f4ng an to\u00e0n v\u00e0 kh\u00f4ng x\u1eed l\u00fd opioid kh\u00f4ng c\u00f2n s\u1eed d\u1ee5ng8<\/sup>. Reddy A v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 kh\u1ea3o s\u00e1t c\u00e1c m\u00f4 h\u00ecnh l\u01b0u tr\u1eef, s\u1eed d\u1ee5ng v\u00e0 th\u1ea3i b\u1ecf opioid \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0 ngo\u1ea1i tr\u00fa (2014). K\u1ebft qu\u1ea3 b\u00e1o c\u00e1o cho th\u1ea5y 26% s\u1eed d\u1ee5ng opioid kh\u00f4ng an to\u00e0n, 19% c\u1ea5t gi\u1eef opioid \u1edf n\u01a1i d\u1ec5 th\u1ea5y, 69% c\u1ea5t opioid trong t\u1ee7 kh\u00f4ng kh\u00f3a v\u00e0 ch\u1ec9 9% c\u00f3 kh\u00f3a 8<\/sup>. Trong m\u1ed9t nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y, Gregorian R v\u00e0 c\u1ed9ng s\u1ef1 (2020) cho th\u1ea5y nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n v\u1ec1 opioid c\u00f3 kh\u1ea3 n\u0103ng gi\u1eef thu\u1ed1c \u1edf v\u1ecb tr\u00ed c\u00f3 kh\u00f3a cao h\u01a1n so v\u1edbi nh\u1eefng ng\u01b0\u1eddi kh\u00f4ng nh\u1eadn \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n (42,4% so v\u1edbi 12,4%; P<0,0001) 9<\/sup>. \u0110i\u1ec1u \u0111\u00f3 cho th\u1ea5y b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng, l\u01b0u tr\u1eef v\u00e0 x\u1eed l\u00fd opioid an to\u00e0n c\u00f3 xu h\u01b0\u1edbng th\u1ef1c h\u00e0nh t\u1ed1t h\u01a1n, t\u1eeb \u0111\u00f3 h\u1ea1n ch\u1ebf ph\u1ea7n n\u00e0o t\u00ecnh tr\u1ea1ng l\u1ea1m d\u1ee5ng opioid.<\/p>\n\n\n\n C\u1ee5c qu\u1ea3n l\u00fd Th\u1ef1c ph\u1ea9m v\u00e0 D\u01b0\u1ee3c ph\u1ea9m Hoa K\u1ef3 (FDA: Food and Drug Administration) v\u00e0 C\u1ee5c qu\u1ea3n l\u00fd Th\u1ef1c thi Thu\u1ed1c c\u1ee7a B\u1ed9 T\u01b0 ph\u00e1p Hoa K\u1ef3 (DEA: Drug Enforcement Administration) \u0111\u00e3 c\u00f3 c\u00e1c h\u01b0\u1edbng d\u1eabn th\u1ed1ng nh\u1ea5t v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng, l\u01b0u tr\u1eef v\u00e0 x\u1eed l\u00fd opioid 10,11<\/sup>. Nh\u1eefng \u0111i\u1ec1u n\u00ean l\u00e0m v\u00e0 kh\u00f4ng n\u00ean l\u00e0m \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y trong t\u00e0i li\u1ec7u gi\u00e1o d\u1ee5c v\u1ec1 opioid nh\u01b0 sau 12-15<\/sup>.<\/p>\n\n\n\n S\u1eed d\u1ee5ng opioid an to\u00e0n<\/strong><\/p>\n\n\n\n – Ch\u1ec9 s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c opioid do b\u00e1c s\u0129 k\u00ea \u0111\u01a1n.<\/p>\n\n\n\n – D\u00f9ng thu\u1ed1c theo quy \u0111\u1ecbnh, kh\u00f4ng t\u1ef1 \u00fd thay \u0111\u1ed5i li\u1ec1u l\u01b0\u1ee3ng hay t\u1ef1 \u00fd ng\u1eebng d\u00f9ng opioid.<\/p>\n\n\n\n – Kh\u00f4ng d\u00f9ng chung opioid v\u1edbi ng\u01b0\u1eddi kh\u00e1c.<\/p>\n\n\n\n – Kh\u00f4ng u\u1ed1ng r\u01b0\u1ee3u v\u00e0 c\u00e1c lo\u1ea1i thu\u1ed1c b\u1ea5t h\u1ee3p ph\u00e1p kh\u00e1c khi d\u00f9ng thu\u1ed1c gi\u1ea3m \u0111au opioid.<\/p>\n\n\n\n – Cung c\u1ea5p cho b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb danh s\u00e1ch c\u00e1c lo\u1ea1i thu\u1ed1c m\u00ecnh \u0111ang d\u00f9ng.<\/p>\n\n\n\n L\u01b0u tr\u1eef opioid an to\u00e0n<\/strong><\/p>\n\n\n\n – L\u01b0u tr\u1eef thu\u1ed1c gi\u1ea3m \u0111au opioid \u1edf m\u1ed9t n\u01a1i an to\u00e0n m\u00e0 ng\u01b0\u1eddi kh\u00e1c kh\u00f4ng nh\u00ecn th\u1ea5y ngo\u00e0i b\u1ec7nh nh\u00e2n ho\u1eb7c ng\u01b0\u1eddi ch\u0103m s\u00f3c ch\u00ednh gi\u00fap b\u1ec7nh nh\u00e2n qu\u1ea3n l\u00fd thu\u1ed1c.<\/p>\n\n\n\n – C\u1ea5t gi\u1eef opioid n\u01a1i c\u00f3 kh\u00f3a.<\/p>\n\n\n\n – B\u1ea3o qu\u1ea3n thu\u1ed1c c\u00e1ch xa tr\u1ebb nh\u1ecf, thanh thi\u1ebfu ni\u00ean v\u00e0 v\u1eadt nu\u00f4i.<\/p>\n\n\n\n – Kh\u00f4ng n\u00f3i v\u1edbi ng\u01b0\u1eddi kh\u00e1c m\u00ecnh \u0111ang d\u00f9ng thu\u1ed1c gi\u1ea3m \u0111au opioid.<\/p>\n\n\n\n – Theo d\u00f5i s\u1ed1 l\u01b0\u1ee3ng thu\u1ed1c \u0111\u00e3 s\u1eed d\u1ee5ng. B\u00e1o c\u00e1o b\u1ea5t k\u1ef3 lo\u1ea1i thu\u1ed1c n\u00e0o b\u1ecb thi\u1ebfu cho c\u01a1 quan qu\u1ea3n l\u00fd.<\/p>\n\n\n\n X\u1eed l\u00fd opioid an to\u00e0n<\/strong><\/p>\n\n\n\n – N\u1ed9p l\u1ea1i thu\u1ed1c th\u1eeba cho c\u01a1 s\u1edf \u0111\u00e3 c\u1ea5p\/ b\u00e1n thu\u1ed1c khi kh\u00f4ng d\u00f9ng h\u1ebft.<\/p>\n\n\n\n – Kh\u00f4ng chia s\u1ebb ho\u1eb7c cho b\u1ea5t k\u1ef3 ai thu\u1ed1c gi\u1ea3m \u0111au opioid ch\u01b0a s\u1eed d\u1ee5ng.<\/p>\n\n\n\n – M\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u1ea3 trong b\u1ed3n c\u1ea7u n\u1ebfu kh\u00f4ng c\u00f3 s\u1eb5n c\u00e1c ph\u01b0\u01a1ng \u00e1n x\u1eed l\u00fd kh\u00e1c, bao g\u1ed3m buprenorphin, fentanyl, hydrocodon, hydromorphon, methadon, morphin, oxycodon, oxymorphon v\u00e0 tapentadol.<\/p>\n\n\n\n – G\u1ea5p c\u00e1c \u0111\u1ea7u d\u00ednh c\u1ee7a mi\u1ebfng d\u00e1n fentanyl l\u1ea1i v\u1edbi nhau tr\u01b0\u1edbc khi v\u1ee9t b\u1ecf.<\/p>\n\n\n\n T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/strong><\/p>\n\n\n\n 1. GLOBOCAN. Cancer Today. March, 2021. Accessed Jun, 10, 2022. https:\/\/gco.iarc.fr\/<\/a><\/p>\n\n\n\n 2. Wilkie DJ, Ezenwa MO. Pain and symptom management in palliative care and at end of life. Nursing outlook<\/em>. Nov-Dec 2012;60(6):357-64. doi:10.1016\/j.outlook.2012.08.002<\/p>\n\n\n\n 3. Ferrell BR, Temel JS, Temin S, et al. Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update. Journal of clinical oncology : official journal of the American Society of Clinical Oncology<\/em>. Jan 2017;35(1):96-112. doi:10.1200\/jco.2016.70.1474<\/p>\n\n\n\n 4. B\u1ed9 Y t\u1ebf. H\u01b0\u1edbng d\u1eabn ch\u0103m s\u00f3c gi\u1ea3m nh\u1eb9. Quy\u1ebft \u0111\u1ecbnh 183\/Q\u0110-BYT. 2022:1-14.<\/p>\n\n\n\n 5. Koyyalagunta D, Bruera E, Solanki DR, et al. A systematic review of randomized trials on the effectiveness of opioids for cancer pain. Pain physician<\/em>. Jul 2012;15(3 Suppl):Es39-58.<\/p>\n\n\n\n 6. WHO. Opioid overdose. Accessed Jun, 10, 2021. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/opioid-overdose<\/a><\/p>\n\n\n\n 7. Nguyen LM, Rhondali W, De la Cruz M, et al. Frequency and predictors of patient deviation from prescribed opioids and barriers to opioid pain management in patients with advanced cancer. J Pain Symptom Manage<\/em>. Mar 2013;45(3):506-16. doi:10.1016\/j.jpainsymman.2012.02.023<\/p>\n\n\n\n 8. Reddy A, de la Cruz M, Rodriguez EM, et al. Patterns of storage, use, and disposal of opioids among cancer outpatients. The oncologist<\/em>. Jul 2014;19(7):780-5. doi:10.1634\/theoncologist.2014-0071<\/p>\n\n\n\n 9. Gregorian R, Marrett E, Sivathanu V, et al. Safe Opioid Storage and Disposal: A Survey of Patient Beliefs and Practices. J Pain Res<\/em>. 2020;13:987-995. doi:10.2147\/JPR.S242825<\/p>\n\n\n\n 10. FDA. Where and How to Dispose of Unused Medicines. Accessed July, 06, 2021. https:\/\/www.fda.gov\/consumers\/consumer-updates\/where-and-how-dispose-unused-medicines<\/a><\/p>\n\n\n\n 11. DEA. Drug disposal information. Office of Diversion Control, Drug Enforcement Administration, U.S. Department of Justice Web site. Updated September. 9, 2014. Accessed July, 06, 2021. http:\/\/www.deadiversion.usdoj.gov\/drug_disposal\/index.html<\/a><\/p>\n\n\n\n 12. FDA. Safe medicine disposal options. Updated December. 30, 2015. Accessed July, 06, 2021. https:\/\/www.fda.gov\/drugs\/news-events-human-drugs\/safe-medicine-disposal-options<\/a><\/p>\n\n\n\n 13. CDC. U.S. Opioid Dispensing Rate Mapsactive ingredient. Accessed November, 06, 2022. https:\/\/www.cdc.gov\/drugoverdose\/rxrate-maps\/index.html<\/a><\/p>\n\n\n\n