Dieu tri LAO Y5

7/24/2019 Dieu tri LAO Y5

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PGS.TS. QUANG VN TRPGS.TS. QUANG VN TR

IU TR LAOIU TR LAO


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I CNGI CNG

Lao l mt bnh truyn nhim, ly lan ch yu quang h h!" #o tr$c %hu&n 'ycobact(rium

tub(rculo)i) gy n*n+

nh lao thng g-" nh!t l lao "h.i, chim /0103

t.ng )4 5 lao+

'6 c7n th(o ng m8u 9 b:ch huyt n c8c c; quan

gy< lao mng n=o, lao >;ng %h?", lao tit niu, lao

)inh #@c, lao c8c mng Amng "h.i, mng b@ng, mng

tim+++B, lao rut+++


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I CNGI CNG

Dh&n o8n bnh lao thng cEn cF tr*n nhiu yu t4,nhng "hGi qua C b?c c; bGn< %h8m lm )ng, ch&n

o8n hHnh Gnh AIJB, >Kt nghim 9i %hu&n A)oi tHm M

trong #Nch tit, mB+

IKt nghim l %O thuPt ch&n o8n ;n giGn, chQnh >8c R

"h8t hin # #ng c8c thS lao "h.i cT UV R nguWn

truyn bnh cho >= hi, cXn chYa )?m 9 tQch c$c+

5gy nay, nh c8c thu4c %h8ng lao -c hiu R iu trN

bnh gXn nh chZc chZn A[0 \ ]^^3B nu iu trN lao

mt c8ch chZc chZn 9 nhi*m t_c+


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\ 5hTm C< trong c8c 6 ho:i ts, c8c . b= Pu -c )inh )Gn thPt

chPm, %hng li*n t@c 9 cT %huynh h?ng t$ giGm


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DT 2 nhTm thu4c %h8ng lao< thu4c #it %hu&n, thu4c

%im %hu&n

T*$&9 3% )*$+,5 iam"in, j)oniaki#, xyrakinami),

dtr("tomycin 9 c8c minoglyco)i#() %h8c

T*$&9 )X; )*$+,5 thambuthol 9 c8c thu4c %h8ng

lao %h8c


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T*$&9WT 7,* 78,,*,* ,@/

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%/,@ ;%,@ Z%

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%/,@ ;%,@ )X;

iam"in

j)oniaki# 1

dtr("tomycin 1 1

xyrakinami) 1 1


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IU TR LAOIU TR LAO

1. W9 %$ 4X$ %5 5gEn ngza )$ chvn lvc t bin %h8ng thu4c, ngh{a l

tr8nh )$ th!t b:i ang iu trN

:t c )$ trit %hu&n trong c8c )ang th;ng, ngh{a ltr8nh t8i "h8t 9 )au

'u4n 9Py "hGi "h4i h" nhiu lo:i thu4c lao Qt nh!t l 2

thF cha )s #@ng lXn no ho-c th*m 2 hay C thF thu4cngoi "h8c W ang iu trN


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!. N@$2, %[9 9\, >8, %/,@ 4X$ % -/ xh4i h" thu4c S #it ton #in c8c nhTm UV lao %h8ngtzng lo:i thu4c, ngEn ngza chvn lvc t bin %h8ngthu4c

_ng liu lng S #it hon ton '6, liu th!" )p%hng cT t8c #@ng, liu cao gy ng c thu4c

6hi gian thay .i ty th(o "h8t W iu trN+ 5u cTiam"in thH t4i thiu / th8ng, nu %hng cT iam"in thH

t4i thiu [1]2 th8ng+ 6hi gian t!n cng 2 th8ng+ |ng thu4c "hGi u 9 li*n t@c, t!n cng #ng h}ng

ngy, cng c4 cT thS #ng c8ch ngy hay 2 lXntuXn


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". N*,@ ,@$2, %[9 9*$,@ 6!t cG c8c thS lao nTi chung 9 lao "h.i nTi ri*ng cXn

"hGi iu trN %hi cT biSu hin lm )ng A5 cT MB

xhGi iu trN )?m< tr?c %hi t.n th;ng lan rng xhGi ch&n o8n chQnh >8c< #$a 9o '6AB

xhGi %h8m >Kt %O tr?c %hi iu trN< trz lao c!" tQnh

iu trN "h4i h" Qt nh!t C lo:i thu4c %h8ng lao, _ng, ,

u cho tzng lo:i cng thFc


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]. T9 )* 4X$ % -/ 9^, F*8 -; 9?9 '39 7$ 4B48; >8/ , %/, ' *3$ _$8 4X$ %

Lm c8c >Kt nghim cXn thit 2 th8ngB

j5~ jM Ahng ngy ho-c 21C lXntuXn > ` th8ngB

xh8c W [ th8ng [ th8ngB

ho-c j5~ jM Ahng ngy > ] th8ngB

j5~ jM A2 lXntuXn > w th8ngB


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CC P0C m IU TR LAO 0InN NAYCC P0C m IU TR LAO 0InN NAY

". T*g/ v0O %p !ee"".1. P*?9 4 4X$ % -/52 ~ `~ ho-c / ~

Wm 2 giai o:nacin,

xrothionami#( Dyclo)(rin

]2 th8ng #uy trH< x ' lo>acin xrothionami#(

Dyclo)(rin

P*?9 4 IV>5 cho c8c 5 lao m:n tQnh ho-c %h8ng

thu4c AcT %h8ng )inh WB/ ++Dm AVmB+ '> A>B+ xro+ D)

]2 ++ '> A>B+ xro+ D)


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c. L/ )*?,@ %*$&9

c.1. P*?9 4 4X$ % -/ )*?,@ 4D, %*$&9 ' -/ )*?,@ ,*X$ %*$&9

`B$ 4X )*?,@%*$&9 -/

P*?9 4 4X$ % @z { T* @, 4X$% %& %*B$

~ A dB /1[ th8ng

~ 9 Mluoroquinolin() [1]2 th8ng

~, 9 d t4i thiSu 21C th8ng thu4c

chQch hng thF 2

[ th8ng

~ 9 Mluoroquinolin() [1]2 th8ng

~ 9 A d'B Mluoroquinolin() t4i thiSu21C th8ng thu4c chQch hng thF 2

[1]2 th8ng


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c.!. P*?9 4 4X$ % -/ 4 )*?,@ %*$&9

`B$ 4X )*?,@%*$&9 -/

P*?9 4 4X$ % @z { T* @, 4X$% %& %*B$

~ Mluoroquinolin() t4ithiSu 2 th8ng A t4i thiSu 21C

th8ng thu4c chQch hng thF 2B

]21]w th8ng

9 A dB ~ Mluoroquinolin() t4i thiSu21C th8ng thu4c chQch hng thF 2

]w th8ng

9 A dB ~ Mluoroquinolin() t4i

thiSu 21C th8ng thu4c chQch hngthF 2

]w th8ng

~, 9 A dB Mluoroquinolin() ] thu4cu4ng hng thF 2 t4i thiSu 21C

th8ng thu4c chQch hng thF 2

]w th8ng


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c.". 0,@ |, _$8, -{ 4X$ % -/ 7$ )*?,@ %*$&95 Nguyn tc:

\ ds #@ng b!t cF thu4c nhTm ] c7n nh:y cGm

\ ds #@ng ] thu4c ti*m hng thF 2 AnhTm 2B c7n nh:y cGm

9?i thi gian t4i thiSu l ]2 th8ng ho-c ton b thi gian

iu trN lao

\ ds #@ng ] thF thu4c Mluoroquinolin() th h m?i nh!t nh

mo>ilo>acin\ ds #@ng t!t cG c8c thu4c %iSm %hu&n u4ng hng thF 2

AnhTm `B c7n nh:y cGmB


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Phc iu tr lao khng thuc theo D n phng,

chng !nh lao "uc gia #$%%&'

P*?9 4 IV5 cho 5 lao th!t b:i "h8c W j 9 jj ho-c

%h8ng thu4c AcT %h8ng )inh WB

/ ++Vm+>+xto+D) ]2 ++>+xto+D)

P*?9 4 IV>5 cho c8c 5 lao m:n tQnh ho-c %h8ng

thu4c AcT %h8ng )inh WB

/ ++DmAVmB+'>A>B+xro+D)

]2 ++'>A>B+xro+D)


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T0lO t}I V~ N0 GI IU TRT0lO t}I V~ N0 GI IU TR

T*g/ h F*8, ,@ F*5

5hYng >Kt nghim c; bGn< m(n gan, ilirubun, 5,

cr(atinin, cng thFc m8u, b:ch cXu h:t, tiSu cXu, aci#

uric, thN gi8c, thN l$c+ 6rong qu8 trHnh iu trN< th(o #i lm )ng t4i thiSu mi

th8ng ] lXn+ Vhi cT biSu hin ng c thu4c ho-c ang

tWn t:i bnh gan, thPn tr?c T thH cXn th(o #i )8t c8c

>Kt nghim cT li*n quan+


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?,* @? 4?F ,@ 4X$ % 6 '/5

IKt nghim m )oi tHm M 9 c!y

|in tin hHnh Gnh IJ

iu trN ti" )au thi gian iu trN

6i*u chu&n %hi bnh

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Dieu tri LAO Y5