Tiem thuoc vao khop loi ich va nguy co

Tags: trong truong hop, vao khop, tiem vao, thu thuat, hieu qua, nguoi benh, mot so, viec, dung, lam, gan, giam


Tiem thuoc vao khop loi ich va nguy co
Tiem vao khop la thu thuat mang lai nhieu hieu qua nhung viec lam dung se gay ra nhieu tai bien dang tiec.

Dung kim nho tiem vao khop va mot so phan mem quanh khop la mot thu thuat thuong dung tai cac benh vien de dieu tri mot so benh nhat dinh nhu: Thoai hoa khop, viem cac diem bam gan, viem bao khop, viem khop khong nhiem khuan trong mot so benh khop man (nhu viem khop dang thap, viem cot song dinh khop…).

Thuoc tiem vao khop

Thuoc thuong dung tiem vao khop la corticoid, hyaluronate sodium (hyasyn).

Corticoid: Thuong dung la loai dich treo, voi cac biet duoc nhu prednisolone, methylprednisolone, triamcinolone.

Nhung nghien cuu lam sang ve tiem corticoid vao khop goi cho thay: Neu dung lieu duy nhat 20mg triamcinolone (tuong duong voi 25mg prednisolone) thi hieu qua giam dau keo dai duoc tu 1-4 tuan. Neu dung lieu 40mg triamcinolone thi hieu qua giam dau keo dai duoc 16-24 tuan (Raynauld J, 2003). Lieu 40mg triamcinolone cung la lieu khuyen cao cua Hoi Thap khop hoc Hoa Ky. Thuong tiem lap lai lieu nay 3 thang 1 lan, keo dai trong 2 nam. Trong truong hop co tran dich khop gay viem bao hoat dich, luc nay corticoid dong vai tro nhu mot chat lam giam viem nen viec chon loc hut dich song song voi viec tiem corticoid vao khop lam cho viec dap ung thuoc tot hon.

Rieng viec tiem corticoid vao gan de chua cac ton thuong mang hoat dich gan, mo quanh gan, noi bam tan gan va chinh tai gan tuy duoc ap dung nhung den nay chua co co so ly luan vung chac cung nhu chua co chung cu lam sang thuyet phuc chung minh hieu qua nhung lai gap nhieu tai bien. Tru viec tiem vao ngon tro bieu hien thoai hoa gan va viem co mot so cai thien (Lambert, 1992) con hau het cac thuc nghiem tiem vao gan trong truong hop viem chu vai (rotator cuff tendinopathy) viem loi cau ngoai (khuyu tennis) va viem gan got (achiles) deu khong dem lai hieu qua tot hon so voi nhom chung.

Hyaluronate sodium (hyasyn)

Hyaluronate la chat tu nhien trong co the nguoi, co nong do cao trong mo khop va dich khop voi vai tro boi tron, giam xoc, bao ve khop. Su giam hyaluronate trong dich khop, su mat sun khop la diem chu yeu trong thoai hoa khop. Thuoc co tac dung: Lam giam dau (do lam giam sinh PEG, giam sinh bradykinin, uc che cam thu dau). khang viem (do ngan can sinh PGE, ngan tac dung cua cytokin). Uc che thoai hoa sun khop, thuc day tong hop te bao sun khop.

Nghien cuu lam sang cho thay: Voi nguoi benh tren 40 tuoi, dau khop goi co gai xuong, giam dich khop co nang hoac cung khop sau 5 tuan dieu tri dung thuoc khang viem khong steroid va paracetamol ket hop voi hyaluronate sodium (voi lieu moi tuan 25mg x 5 tuan) co toi 93% nguoi benh het dau, neu dung thuoc khang viem khong steroid va paracetamol ma khong ket hop voi hyaluronate sodium thi chi co 10% nguoi benh co tac dung hieu qua tuong tu (Thai Thi Hong Anh, 2005).

Ngoai viec co the gay sung do tai cho, viec tiem corticoid, hyaluronate sodium vao khop khong co tac dung phu nao dang ke. Truoc day co lo ngai viec tiem corticoid vao khop co the thuc day qua trinh pha huy khop va teo co, nay nhieu nghien cuu cho rang qua trinh tien trien nay khong phai do su thuc day cua corticoid tiem vao khop ma do ban chat von co cua benh.

Trong khi chua co mot thuoc nao chua khoi (ngoai tru viec thay khop ton kem) thi viec tiem corticoid, hyaluronate sodium vao khop dap ung mong moi cua nguoi benh: Cai thien duoc cac trieu chung va an toan co chi phi thap.

Nhung tai bien do lam dung thu thuat tiem vao khop

Thuc hien thu thuat tiem vao khop tai nha hay tai tuyen y te co so chua co du dieu kien thuong co cac sai sot.

Ve chi dinh: Thay thuoc chuyen khoa xuong khop chi cho dung thu thuat tiem vao khop khi dung thuoc khang viem khong steroid khong co hieu qua (benh o muc nang) va khong cho dung trong truong hop viem khop nhiem khuan hoac nhiem khuan tai vung da tiem khop. Do nguoi benh thich dung thu thuat tiem vao khop (vi thay nguoi khac dung co ket qua nhanh) va do nguoi lam dich vu y te tai nha hoac tai tuyen y te co so chua du trinh do nen da chi dinh cho moi truong hop viem khop ke ca truong hop nhe la khong can thiet va chi dinh cho ca truong hop viem khop nhiem khuan.

Mot so nguoi con dung mot hoac nhieu thu thuoc khac nhu vitamin B12, khang sinh, cac khang viem khong steroid hoac tron lan chung voi dich treo corticoid tiem vao khop. Viec dung cac thuoc tren la khong dung chi dinh, viec tron lan thuoc voi nhau hoac tron voi dich treo corticoid lam pha hong dang bao che. Dieu nay se gay ra hau qua xau: gay phan ung viem manh o mang hoat dich, lam ton hai den cac to chuc hoat dich, sun khop, lam khop bi sung to dau, dan den dinh khop, mat chuc nang hoat dong khop.

Ve cach tiem: Do khong nam duoc vi tri giai phau, thieu thanh thao khi thao tac nen khong tiem dung vao vi tri, thuoc khong di toi noi can, hieu qua se kem. Nguy hiem hon, neu tiem chech vao co, xuong, mach mau, day than kinh quanh khop se gay ra hau qua rat xau nhu teo co, xop xuong, lam mat chuc nang van dong khop. Ngoai ra, do tiem nhieu lan vao mot vi tri va tiem qua nong se lam teo da, mat sac to da tai cho. Hiem gap hon, co khi nguoi benh qua so hai, do tiem qua nhanh hay tiem chech vao mach mau nguoi benh co the bi choang vang, va mo hoi, tuc nguc, kho tho.

Ve co so trang bi: Tai nha hoac tai mot so tuyen y te co so thuong chua co phong tiem va trang bi dam bao vo khuan toan than, dan den huy hoai xuong khop, dinh khop, nhiem trung huyet rat nghiem trong co the lam tan phe hay tu vong neu khong phat hien som va xu ly bang khang sinh dac hieu, lieu cao.

Muon thuc hien thu thuat tiem vao khop phai co thay thuoc chuyen khoa khop chi dinh, co kien thuc giai phau, tay nghe kha de tiem dung vao vi tri can; phai co noi, trang bi dam bao vo khuan. Nguoi benh khong nen de dai chap nhan thu thuat nay tai nha, tai cac tuyen y te co so khong co du cac dieu kien tren vi rat de dan den tai bien nguy hiem.

DS. BUI VAN UY (Bao Suc khoe Doi song)

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