Các vị thuốc Nam thông dụng: Phần 1

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"Cây thuốc Nam vị thuốc thông dụng": Phần 1 trình bày các nội dung chính sau: Đại cương một số bệnh thông thường, bệnh cảm lạnh, bệnh động kinh, bệnh hen phế quản, bệnh nhồi máu cơ tim, một số vị thuốc Nam chữa bệnh thông dụng,... Mời các bạn cùng tham khảo để nắm nội dung chi tiết.

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Nội dung Text: Các vị thuốc Nam thông dụng: Phần 1

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Hgi LUAT GIA VIET NAM NHA XUAT B A N HONG OUfC 2D L Y T H A I Ta - H Q A N K I E M - H A Npi OlEN T H O A I : 0 4 . 3 g 2 e D D 2 4 I NOI DAU Email: nhaxuatbanhongduc@yahoo.com LU
[DONGT] T I E U Stf T U E T I N H Tue Tinh Thien SM* (1623-1713), thtfcfng difcfc goi t a t la Tue T i n h hoac Hue T i n h , ngLfcfi l a n g Nghia Phu, tong Van T h a i , huyen TRI LIEU Cam Giang, phii Thifgng Hong (p^ay la t i n h H a i Diiong) difcfc phong la ong to nganh Cay Thuoc Nam va V| Thuoc dtfcfc V i e t N a m va la ngif&i m d dau cho nen y difcfc C O t r u y e n V i e t N a m . Cac bo sach N a m Difoc t h a n hieu va Hong Nghia giac t\i y thuf ciia ong k h o n g chi c6 y nghia t r o n g lich suf y hoc ma ca t r o n g l i c h sijf van hoc Viet N a m . N h i e u the k y lua, Tue T i n h difcfc ton la v i t h a n h thuoc N a m . Tai H a i Difong c m den thcr ong d xa Cam V a n , Cam V u ; d chua H a i T r i e u l a n g Yen T r u n g , nay la chua G i a m , xa Cam Scfn, huyen Cam Giang, c6 tifong Tue T i n h . TIEU sCr Neu nhiJng k e t qua nghien cufu v a n hoc, ngon ngi? hoc V i e t N a m sau nay k h o n g dxia t h e m bang chufng gi m d i t h i t r u y i n thuye't dia phLfOng va nhiJng cong t r i n h n g h i e n cufu chuyen mon khac cho phep k h a n g dinh Tue T i n h l a mot n h a n v a t ' d o i T r a i l . Ong ten la Nguyen Bd Tinh, biet hieu la T r a n g TiJ V6 Dat, que d l a n g Xifa, tong V a n T h a i , huyen Cam Giang, phu Thifcfng Hong (nay la t h o n Nghia Phii, xa Cam V u , huyen Cam Giang, t i n h H a i Difang). Mo coi cha me tU luc 6 tuoi, N g u y i n Ba T i n h dufgc cac nha isif chua H a i T r i e u va chua Giao Thuy nuoi cho an hoc. N a m 22 tuoi, ong dau T h a i hoc s i n h difdi t r i e u vua T r a n D u Tong, nhufng k h o n g ra l a m quan ma d l a i chua d i tu lay phap hieu la Tue T i n h . Nh'jfng ngay di tu cung la nhufng ngay ong chuyen hoc thuoc, l a m thuoc, chufa benh ciVu ngtfcfi. TAU^-'^ (Lt^ttu. i'^pj^
Tue T i n h da k h o n g difng l a i d v i t r i mot thay thuoc chuTa N a m 55 tuoi (1385), Tue T i n h b i difa di cong cho t r i e u d i n h benh, ong con tif m i n h truyen ba phifcfng phap ve s i n h , to chufc nha M i n h . Sang T r u n g Q u o c , ong v i n l a m thuoc, noi tieng, ccf sd chaa b e n h t r o n g nha chua va t r o n g l a n g xom. Co t a i lieu difcrc vua M i n h phong la D a i y T h i e n sir, mat or do, k h o n g ro cho biet, t r o n g 30 nam boat dpng or nong t h o n , Tue T i n h d a x a y n a m nao. Bia van chi d l a n g Nghia Phii (do Nguygn D a n h Nho difng 24 ngoi chua, bien cac chua nay t h a n h y xa chCta benh. soan nam 1697) cung cac t\i lieu khac d dia phifcfng deu ghi n h i / Ong tap hpp nhieu y an: 182 chijfng benh difpc chffa bang 3.873 vay. phifcfng thuoc. Ong cung luon luon nhac nhd moi ngifcfi chu y C O N G ^ I N H Y-DJOC nguyen n h a n gay benh; t i m bien phap phong benh t i c h cifc. Tue T i n h n h a n m a n h tac dung viec r e n luyen t h a n the va sinh N h f l n g nam d t r o n g ni/dc, Tue T i n h da cham chu nghe thuoc: hoat dieu d p . Ong neu phifcfng phap difSng s i n h t o m t a t t r o n g t r o n g cay thuoc, sifu tarn k i n h nghiem chiJa b e n h t r o n g dan 14 chOf: gian, huan luyen y hoc cho c a c tang do. Ong da tong hgp y difgc Be tinh, duang khi, ton than d a n tpc CO truyen t r o n g bo sach gia t r i la bo N a m di/gc t h a n hieu chia l a m 10 khoa. Dac biet, ong c6 bo H o n g N g h i a giac tif Thanh tdm, qua due, thu chdn, luyen hinh. y thif (2 quyen) bien soan bang quoc am, t r o n g do c6 ban thao Tue T i n h con tap hpp nhffng bai thuoc chffa b e n h cho gia 500 vi thuoc nam, vie't b§ng thcf Nom Bifang luat, va b a i "Phu sue. Co the noi, ong da gop phan dat ccf sd cho nganh t h i i y dan thuoc Nam" 630 v i cung bang chOf Nom. Tha van Nom dcfi T r a n tpc cua V i e t N a m . r a t h i e m , neu qua thiTc do la tac phani ciia Tue T i n h t h i chung k h o n g chi gia t r i t r o n g y hoc ma con la tac p h a m quan t r o n g t r o n g l i c h suf van hoc bdi v i day la cac tac p h a m d thcfi k i dau cua van hoc chCf N o m . TiJf bao dcfi nay, gidi y hoc Viet N a m va n h a n dan deu cong n h a n Tue T i n h c6 cong lao to Idn trong viec xay ditag mot quan diem y hoc doc lap, tir chu, sat vdi thiTc te V i e t N a m . C a u noi ciia ong: "Nam dugc tri Nam nhan" the h i e n quan diem day bien chijfng ve moi quan he mat t h i e t giifa con ngiTcri vdi moi trifcfng song xung quanh. Q u a n diem, ay d § n dat ong len ngoi v i cao n h a t ciia nen y hoc co truyen V i e t N a m : Ong T h a n h thuoc N a m ! T r o n g trUdc tac ciia m i n h , ong khong rap khuon theo c a c trifdc tac ciia cac di/i tv\i6c. Ong khong difa k i m , moc, thiiy, hoa, tho len dau ma xep cac cay c6 tru'dc t i e n ! Ong cung phe phan tuf tifdng d i doan ciia nhffng ng\ibi chi t i n vao phu chu ma k h o n g t i n thuoc. Ong da neu ra nhieu phifcfng phap khac nbau de chijta benh nhif: cham, chich, chifcfm, bop, xoa, an, uong, hcf, xong, v.v. Aa^ (LkOu ^d^k
f)6nfl Y gTrt ai|u Nguyen nhdn - Mac dii CO horn 200 virus c6 the gay r a cac trieu chijfng cam lanh, song rhinovirus la thii pham hay gap nhat va r a t d§ lay. Dieu tri PHAN Md DAU K h o n g CO thuo'c chfla khoi cam l a n h . K h a n g s i n h khong c6 tac dung cho'ng l a i virus gay benh. C a c thuo'c khong ke don dimg de D A I Cl/dNG MOT SO BENH chOfa cam l a n h khong chiJa khoi benh cung nhxi khong l a m cho THONG THl/ClNG ' benh n h a n h khoi hofn. Difdi day l a nhijttig iJu va nhixcfc diem ciia mot so' loai thuo'c hay dimg de dieu tri c a m l a n h . -oOo- • Thuo'c gidm dau. Cac thuo'c gidm dau khong ke dan nhu acetaminophen thudng dugc sii dung de dieu tri sot va dau " dau khi bi cam lanh. Can nha rang acetaminophen c6 thi gay ton thuang gan, nhat la khi dung d lieu cao keo ddi. 1. BENH CAM LANH Khong dung aspirin cho tre em vi thuo'c c6 the gay ra hoi chiing Reye — mot benh hiem gap nhUng c6 the gay tH C a m l a n h la mot benh n h i l m trung duomg ho hap t r e n . Co h a n 200 virus k h a c n h a u c6 the gay r a c a m l a n h vcJi nhOfng trieu vong. chijfng k h a c nhau. • Thuo'c xit mui de gidm xung huyet mui. NhUng thuoc nay khong nen dung keo ddi vi c6 the gay viem niem mac mui Dau hi^u va tri^u chiiCng man tinh. T r i e u chufng thiTorng xuat h i e n khoang 1 - 3 ngay sau k h i tiep • Xi ro ho. Cdc loai xi ro ho khong c6 tdc dung dieu tri nguyen xuc v(Si virus v a bao gom: nhdn gdy ho trong cam lanh. Mot so loai chiia nhUng thdnh • Ngat mui hoac chay niiac mui phdn Idm gidm ho, nhiing vai luang qud it nen khong du • Hong ngiia va dau tdc dung hoac c6 the gdy hai cho tri. Trung tdm phbng • Ho chdng benh dich My (CDC) khuyen khong nen diing xi ro ho • Dau ngUdi hoac dau dau nhe cho tre dilai 2 tuoi. Ho do cdm lanh thubng keo ddi it nhat la 2 - 3 tudn. Neu ho keo ddi Idu han, can cho tre di khdm • Hat hai bdc S I . • Chdy nude mdt • Sot nhe Cdc bien phdp tU chdm soc khi hi cdm lanh gom: • Met moi nhe. , • Udng nhieu nUdc. • Nghi ngai day du. • Gin cho phong d luon dm vd dm. 8 • t/u,.^c ez-wju/ge^w'. T.Wt C/wZrt ^a,J
t)6n9 Y gTrt • Siic hong nhieu Idn trong ngay bang nUdc muoi dm hoqc • Ngodi ra con nhieu the khong rd trieu chdng hoac the nhe, udng ni/ac chanh dm pha vai mat ong de lam diu chS hong gidng cdm lanh: chi c6 hat hai, sd mui, ho; cd the gap the bi viem vd gidm ho. ndng, rdt ndng do bien chiing ho hdp, tim mach, than kinh. • Nh6 mui hhng nUdc mudi sinh ly di lam gidm xung huyet Bien chufng mui. • Ho hdp Id bien chitng chii yeu vd ndng nhdt: viem phdi tien Phong benh phdt vd thii. phdt trong do viem phdi tien phat Id nang nhdt: • Rda tay thudng xuyen. nhiet do khong gidm vdo ngdy 3-5 ma tiep diin, kem kho • Ve sinh nhd ciia sach se thong thodng, nhdt Id khi trong gia thd, thd gap, tim tdi, khac ddm cd khi Idn mdu, nhanh dinh CO ngiidi bi cam lanh. chong ddn den suy hd hdp, suy tudn hodn roi tii vong neu • Vdt bd khdn gidy ngay sau khi dung. khong dieu tri. • Benh cum con ddnh thiic nhUng benh tiem tdng nhU viem • Khong dung chung bat dua, vat dung cd nhdn vai ngitdi khdc. tai, viem xoang, viem nhiem di/dng tiet nieu... • Benh cum d phu nd. mang thai hay gay bien chdng phdi • Trdnh tiep xuc Idu v6i ngubi bi cam lanh. hoac sdy thai. Neu mac trong 3 thdng dau c6 the gap benh 2. BENH CUM ly thai, nhdt la ve he thdn kinh trung Uong, khong gay qudi thai. B e n h ciim la benh viem n h i l m cap tinh diTomg ho hap gay nen bori virus cum lay truyen n h a n h , thucfng t h a n h dich. • Benh cum dc tinh hiem gap nhUng tit vong cao, khdi dau nhu cum thudng, roi xudt hien hoi chdng suy ho hdp do phu Trieu chiXng phdi cdp tinh gay tit vong do thieu oxy mdu khong khdc B e n h cum c6 nhieu the lam sang, the thUcfng gap l a : sau thcri phuc duac. gian nung benh ngan, khoang mot ngay, benh khdi phat rat dot Dieu tri ngot: sot, ret r u n nhieu Ian trong ngay, than nhiet tang len 39-40° ngay ngay dau, keo dai 3-5 ngay kem theo la met moi, dau nhiJc • Chii yeu la dieu tri trieu chitng ddi vdi the khong bien chiCng: toan than, dau dau n h u biia bd, dau cac cor xuorng khdp, chan tay r a dieu tri tai nhd, nghi ngai, ndm giudng, udng nhieu nUdc, rori, da kho nong, mat bimg bitog, mat choi, chay nUdc mat, so mui, dung thiCc an Idng dm, bd, dil vitamin, gidu vitamin C ngat mui, dau rat hong, c6 k h i ho tiirc ngUc, khac dcfm hoac chay • Sit dung thudc ha sot khi benh nhdn bi sot cao. Khong diing mau cam, mieng dang, buon non, tao bon. Sau do nhiet do giam khdng sinh de du phbng bien chitng boi nhiim dan, cac trieu chufng toan than giam dan trong 5-7 ngay. Mot so" • Tdi Id mot loai gia vi vd cung Id dugc lieu chda cdm cum rdt benh n h a n cao tudi hay bi met nhugc keo dai, s u binh phuc cham. tot. Til xUa ong cha ta dd biet dung tdi de chda benh cum. • Benh cum d tri em dudi 5 tudi thudng nhe, sot nhu cdm Khdng nhUng vdy tdi con Id dUgc lieu hd trg dieu tri huyet lanh. u tr& so sinh, bieu hien: viem tai, viem chum, viem dp, md mdu cao, tot cho tim, mach, hd trg tieu hoa. Chat thanh qudn cap, cd khi nhi&m doc than kinh nang ne. alicin trong nhUa dau tdi ditgc cho Id cd tdc dung diet vi rut 10 • r/«..:v/v«,v e/;^ n^,^ e / u i w ' ^ ( j ' ^ / v
n h t t n g ciif d o n g k h o n g co muc dich, nhiT be t a y , h e m m o i , n o i l a m chinh, chat nay rat di bi phd huy ngay cd d nhiet do thubng n h a m hoac nuo't k h a n . VI vdy nen ngdm rilau, ngdm dam hoac uong vien nang mem chiCa nhua ddu nhu vien ddu toi Tue Link (dang vien C
f)6ng Y gfrt • Khdm than kinh kiem tra phdn xa, triiang lUc ca, ca lUc, • Bau khdp dU dgi. Gut thubng dnh hudng den khap I6n cila cam gidc, dang di, tU the, phoi hap dgng tdc vd thdng bang, ngon chdn cdi nhung c6 thi xdy ra d bdn chdn, co chdn, dau cung nhu mot so cdu hoi de kiim tra khd ndng tU duy, nhan goi, bdn tay vd c6' tay. Bau thUbng keo ddi 5 den 10 ngdy ma thi2c vd tri nhd. sau da hit. Khd chiu gidm dan sau mot hai tudn, di lai • Xet nghiem mdu de loai trii nhUng nguyen nhdn c6 the gay khdp CO vi rat binh thudng vd khong dau. con CO giat nhU nhiim triing, ngo doc chi, thieu mdu hoac • Khdp bi sUng, ndng vd dd. tiiu dUdng. Nguyen nhdn • Cdc xet nghiem hinh dnh di phdt hien bat thuang trong ndo: dien ndo do, chup CT, chup cong hudng til (MRI), chup Nguyen nhan gay benh gut la do viem or khdrp do sir tich luy cac cat lap phdt positron (PET), chup cat lap vi tinh phdt photon t i n h the urat. Acid uric la mot chat dugc h i n h thanh t\X qua t r i n h dan (SPECT). giang hoa purin. Chat nay c6 mat t u nhien trong ccf the cung nhu trong mot so' loai thuc pham, nhat la phii tang dpng vat. B i n h Dieu tri thiforng acid uric hoa tan trong mau va di/cfc t h a n bai xuat ra • Thuoc chong dgng kinh. ngoai qua mi6c tieu. Neu v i ly do nao do cor the san sinh qua nhieu • Phdu thuat cdt bo vung ndo gay ra can dgng kinh. hoac bai xuat qua i t chat nay t h i acid uric c6 the tich luy, tao • Kich thich day phe vi. thanh nhOfng t i n h h the h i n h k i m sac nhon (urat) trong khdp va cac mo xung quanh khdp, gay dau, viem va sUng. • Che do an kieng nghiem ngat gidu chat beo, protein vd it carbonhydrat de gidm sdn sinh xeton trong ca thi. Xet nghiem vd chdn dodn • Lay dich tie khap bi benh de tim tinh thi acid uric trong 4. BENH GUT bach cdu Benh gut, hay viem khdfp gut, la • Xet nghiem nUdc tiiu di do lilang acid uric dugc bai xuat • mot dang v i e m kh6p dac tritog hai • Xet nghiem mdu do nong do acid uric trong mdu nhufng corn dau dOf doi dot ngot, do va sung or khd'p. Day la mot ro'i loan phiJc Dieu tri tap CO the xay ra d bat ciif ai, song • Bd'i vdi can gut cap, cdc thuoc chdng viem phi steroid nam giori d l bi benh hon phu uuf. Phu (NSAID), nhu ibuprofen vd naproxen co thi lam gidm dau. nu: se bi tang kha nang mac benh sau • Vdi nhUng triiang hap nung, co thi diing corticosteroid nhU k h i man k i n h . prednisone. Cung co thi tiem cortisone vdo khdp bi benh di Dau hi^u va trieu chu'ng gidm dau. NhUng phuang phdp nay c6 nhUng tdc dung phu vd ndi chung khong nen tiem qud 3 Idn/ndm. Dau hieu va trieu chiifng ciia gilt hau nhiT luon la cap t i n h , xay ra dot ngot - thuomg vao ban dem - va khong c6 dau hieu bao • Khi can gut cap dd dugc kiim sodt, co thi dp dung nliUng tru'dfc. bien phdp phong ngiia di Idm cham tdc do sdn sinh acid > uric ciia ca thi hoac tang 13c do bdi xuat. 14 • -'rHc/./v T / w j ; (2./v
t)6ng T gfrt 3 ^ " • Hy thiem thdo, day dau xUang Id hai vi thuoc y hoc cd Nguyen nhdn tre cdi xUcfng truyin quy cua dan toe c6 tinh mat, tdc dung khu phong, trit • Thieu dnh sdng mat trdi: Nhieu tre bi cdi xiiong chi vi cha thdp, hoat huyet, gidm dau, lai gdn cot, tri khap sUng nong me giU gin qud ky hoac khong c6 dieu kien cho tdm ndng do dau, cdc trUdng hap dau lUng moi gdi, dau minh mdy, di (do yeu td dia ly khi hdu, mda dong, vimg nui silang md, lai van dgng dau nhiCc do benh gut. Benh gout bi gay ra do nhd d chat chgi, 6 nhiem moi trUdng...). qua nhieu axit uric trong mdu (con goi Id da axit uric): tren • Tinh trang thieu hut ndng vitamin D cua ngudi m.e trong 420 pmol/L (d nam) hay 380 pmol/L (d n0. Vi vay viec thdi gian mang thai. thai tril Axit Uric Id rat cdn thiet. Thd phuc linh, Ty gidi, Hodng bd c6 tdc dung tang cUdng chiic ndng bdi tiet cua gan • Che do an cua tre thieu cd vitamin D vd canxi, ty le canxi I than, thdm thdp, lai nieu giup ddo thdi acid uric trong mdu photpho thdp: Che do an nhieu phytat (c6 nhieu trong tinh vd chuyin hoa cdc chat khdc Id nguyen nhdn Idm tdng acid bgt), oxalat (c6 nhieu trong rau) vd chat xa cung Idm gidm uric gay nen benh Gut. DUa vdo nhUng dac tinh cua cdc cay hap thu canxi. thudc tren da Idni ra sdn phdm la Gut Tue Linh. Gut Tue TRE BI COI XlfONG Linh cdn c6 sU ket hap bdi ban cua Nhdn sdm, Hodng ki, Thuc dia, NhU huang, Ddo nhdn c6 tdc dung bd khi, gidi Bieu hi^n c6 nguy ca hi cdi xiCafng doc, gidm dau, tdng ciCdng tudn hodn mdu, bdi bd ca the, • Be CO the vdn du cdn ndng vd chiiu cao, tuy nhien phu chdng met moi, suy nhilgc, cdi thien cdc hoat dgng the luc vd huynh cdn chii y cdc trieu chiCng: rang cham mgc, toe rung, tinh than ciia benh nhdn. hay giat minh, biit nit, gc sUa. Ngu khong yen gidc, hay khdc dem, dd mo hoi dau. Xuang bi mem, di bien dang Phong b^nh nhU: dau bep, long ngUc gd, tay chdn cong, trdn do, cd 2 K h o n g CO each nao chae chan ngan ngiTa difcfc corn gut cap b a n budu d dinh dau, thdp cham dong; dac biet, tuy tre bu bam dau hoac ve sau, nhUng bac s i c6 the ke dan mot so' thuoc de l a m nhUng CO nhdo... Ngodi ra, ca the cdn gidm siic de khdng, tre giam nguy cof hoac mufc do nang ciia cac dot benh xay r a sau nay. hay bi nhiim trung ho hap. Neu khong dieu tri kip, be se Nhu-ng thuoc n a y gom allopurinol va probenecid. K h i dirge dung cdi xi/ang that siX nhU: bi tay cdn vd, chdn cong vdng kieng, h a n g ngay, thuoc l a m cham toe dp h i n h t h a n h acid uric v a day ngUc do hoac lep... n h a n h viee thai trijf chat nay r a khoi ca the. Noi chung, giu" nong • Khi thdy be cd nhUng biiu hien tren ban cdn xem lg,i coi dp acid uric trong gidi h a n binh thuomg la chia khoa de phong mdn an cd du cdc chat cdn thiet vd phu hap vdi Ida tudi, sd ngifa benh gut. thich ciia be khong? Mdi ngay, trUdc 10 gid sdng, be cd dugc 5. BENH COI X a O N G - SUY DINH DUClNG cdi bd qudn do de phai ndng 5 phut (vdi tre dudi 18 thdng) hoac diioc chai ngodi trdi it nhdt 30 phut (vdi tri Idn han)? Mot so' cong t r i n h nghien cuu cho tha'y, tre coi xUcfng khong Dm be den bac si de dugc tU vdn hoac chl dinh diing thudc. xay r a rieng le m a di k e m vdfi suy dinh dueng, thie'u v i t a m i n A , Da sd cdc be khi cd bieu hien tren khong phai chl cdi xUang thieu mau... ma cdn cd the bi suy dinh djJdn^Jzemj}]^^ trung khdc do ca the ^ia^t-sif^p^^fikfi^^^^^ THUAM 16 • tiJ^cy\^,^e.iui«.>^pX
Phong b^nh cbi xitorng nang trUc tiep chieu vao da t h i se tao ra nhieu v i t a m i n D. Sau • Trong thdi gian c6 thai va cho con bu, ngudi me nen danh jj^hi ra nang vai phut cho be am ngUcfi rdi me nen cdi bdrt non, vd, thdi gian tdm ndng, di dao ngodi trbi. Nen an uong hap ly, v^n ao hoac quan be cang nhieu cang to't. Khong phai nang qua chu y thiCc phdm gidu vitamin D, canxi de phdng trdnh cdi cda k i n h . Tre nho chua di dugc t h i ba me can bong be' tre ra ngoai xiCang sam cho tre til trong bdo thai vd trong nhUng thdng trdi de tam nang, ne'u tre da t u di duorc t h i can nhac nhd va tao ddu sau de. (Jieu k i e n cho tre ra moi trudng ben ngoai. Ba me dang cho con bu sGa me cung phai t a m nang hang ngay de dam bao cho nhu cau • Cho tre bu me ngay sau sinh, bu hodn todn trong 6 thdng vitamin D ciia chinh ngUdi me ddng thdi c6 dii v i t a m i n D trong , , ddu, sau do cho an bd sung. Chii y cho an ddu ma, thUc hien sOa me de cung cap cho tre. to mdu bdt bqt. Hang ngdy phdi cho tre tdm ndng 5-10 phut de CO du vitamin D. TRE SUY DINH DWNG • Bd sung vitamin D 400 dan vi/ngdy cho tre de non, de thdp Nguyen nhdn can. Mot trong nhUng bien phdp phdng benh cdi xiiong Id - M o t so cong t r i n h nghien ciJu cho thay, cdi xUomg khong xay tang cUdng vitamin D vdo thiic phdm cho bd me vd tre em. ra rieng le ma di kem vdi suy dinh dudng, thie'u v i t a m i n A, thie'u DIEU TRI TRE COI XlfONG mau. Tre suy dinh dudng thudng hay ro'i loan hap thu cac chat, ke Bo xung canxi cho tre ca v i t a m i n D va muo'i khoang; ddng thdi thie'u hut enzym chuyen hoa v i t a m i n D. Ngugc l a i , t i n h t r a n g thie'u v i t a m i n D cung se - Canxi luon can diTofc cung cap cho ca the trong suo't cac giai lam giam sufc de khang ciia ccf the, tang cam n h i l m vdi v i khuan, doan ciia cuoc song, t\i trong bao thai cho den k h i trifdng t h a n h va do do tang nguy ca suy dinh dUdng. Nhieu nghien cilu da chufng ngudi gia. Theo khuyen cao cua Vien D i n h dudng quoc gia Viet minh, tre suy dinh dUdng c6 nguy ca cdi xUang cao han so vdi tre Nam va RDA ciia My, m6i ngay tre em can khoang 500 -l.OOOmg binh thudng. canxi tiiy th^o do tudi. - Tre CO can nang liic de thap (dudi 2.500g) c6 nguy ca coi xUang - SQa va cac che pham ciia sUa n h u sUa chua, banh flan, pho- cao han tre c6 can nang luc de binh thudng. Nguyen nhan la ca mai... la ngudn cung cap canxi quan trong, sau do la dau hu, hai the khong du triJ dii muo'i khoang va vitamin D trong thdi ky bao san (ca nho nguyen xUcfng, tom tep nguyen v6 mdi chufa nhieu thai, ddng thdi he tho'ng men tham gia vao chuyen hoa v i t a m i n canxi), dau cac loai, me, rau xanh... Can chii y la canxi trong sUa D con ye'u. t h i d l hap thu hon la canxi tilf cac ngudn thuc pham khac. - Co hoi chijfng kem hap thu: Tinh trang thie'u v i t a m i n D de Bo xung vitamin D cho tre cdi xUang xay ra d nhOng tre c6 hoi chufng nay. Cac benh tieu chay keo dai, - Ngoai viec cung cap day du cac thUc pham giau v i t a m i n D n h i l m k y sinh trimg dudng ruot, viem gan tac mat deu c6 anh nhu sufa, t n l n g , gan, bor... tre em moi do tudi deu can phai dugc tam hudng den hap thu vitamin D va tang nguy ca cdi xUang. nang nhe 15-20 phut mdi ngay. A n h nang nhe la nang trudc 9 gicf Dieu tri tre suy dinh dU&ng sang hoac 4-5 gid chieu. Can boc 16 da cang nhieu cang tot de anh • Tang so bda an trong ngdy: Cho trk an 5-6 bUa mdi ngdy, 18 • r W c / w e A , ^ > § ^ X k u ^ c n^,^ (Ll^ ' ^ p / . / v •:• 19
f)6ng r g'rt c ^ u 7. BENH NHOI MAU CCl TIM • Mot so xet nghiem khdc nhU chup X quang ngUc, sieu dm tim, chup mach vdnh. Nhdi mau ca t i m hay com dau t i m xay ra k h i dong mach vanh cung cap mau cho t i m bi tac nghen do cue mau dong. Dong mau £)ieu tri nuoi duSng co t i m bi gian doan c6 the gay ton thiTOng hoac pha Cac thuoc thirdng dung dieu t r i con dau t i m gom: huy mot vung co t i m . • Aspirin. Aspirin ngdn can sU hinh thdnh huyet khdi, nhd do Tri^u chiXng duy tri dong mdu chdy qua chd dong mach bi hep. Bay dugc xem Id thuoc du phong huyet khdi duac sH dung nhieu nhdt • Cam gidc ttic, nang hoac dau thdt vung giUa ngUc Mo ddi mot vdi phut hien nay. • Thuoc tieu huyet khdi pha vd cue mdu dong dang Idm tac • Bau Ian til ngUc len bd vai, cdnh tay, xuyen ra sau lUng hocLC dong mdu. tham chi len rdng vd ham, c6 the dau keo ddi d vung thuang vi • Cac thudc chdng dong mdu ngdn cdn siC hinh thdnh huyet khdi nhu clopidogrel (Plavix) vd cac thudc chen thu thi tiiu • Khothd cdu lib/Ilia. _ • Todt mo hoi • Thudc gidm dau. • Chodng ngdt • Nitroglycerin. Bay Id thudc thudng dung de dieu tri dau • Buon non vd non ngUc, CO tac dung Idm gidn mach tqm thdi, cdi thien lugng Nguyen nhdn mdu den tim. • Tac nghen mach vdnh do cue mau dong hinh thdnh khi • Chat chen beta Idm gidn ca tim, cham nhip tim vd gidm mdng bam cholesterol trong dong mach bi vd ra huyet dp giiip tim bam mdu de ddng hern. • Co thdt mach vdnh, nhdt Id do mot so loai ma tuy nhu • Thudc gidm cholesterol, bao gom statin, niacin, fibrat vd cocain. acid mat. Xet nghiem vd chd'n dodn Phdu thuat vd cdc thu thudt khdc Chan doan diTa tren trieu chiing, benh s\i va tham k h a m thiTc - Tao h i n h mach vanh va dat stent: trong thii thuat nay bac si the. Cac xet nghiem giiip ich cho chan doan gom: luon mot ong thong c6 dau gan mot qua bong tiT mot dong mach, thirong la d chan, vao ch6 dong mach tac nghen. Sau do qua bong • Dien tdm do: do ca tim bi ton thuang khong ddn truyen diroc bom cang de md thong dong mach b i tac. Dong thcfi mot xung dien nhu binh thUang, nen dien tdm do c6 the giiip stent mat lirdri k i m loai se duac dat vao de giOr cho dong mach phdt hien vd theo ddi tien trien ctla nhoi mau ca tim. khong b i tac tror l a i . • Xet nghiem mau phdt hien sU c6 mat cda mot so enzym diigc - Phau thuat noi t a t mach vanh: trong do bac sy dung mot gidi phong ra khi ca tim bi td'n thiiang. doan t i n h mach hoac dong mach khau no'i vao dong mach vanh 22 • e/«2« > § i W v T^c n^u.y e/uJa >Se»v/v
vugt qua cho tac nghen (no'i tat qua doan tac nghen) de k h o i phuc 8. BENH PARKINSON dong chay cua mau den t i m . B e n h P a r k i n s o n thuofng tie'n Phong ngiCa *" trien nang dan, bat dSu bang dau - Nho'i mau cof t i m : rat nguy hiem den t i n h mang ngifcfi benh hieu run kho nhan thay c5r mot ben dac biet or ngi/ori gia v i vay viec dung thuoc de phong ngiira mot ban tay. Tuy run la dau hieu noi each thifcfng xuyen la dac biet quan trong. Nhung cac thuoc tay y b^t nhat, song benh cung la nguyen t r o n g dii p h o n g n h d i mau cof t i m dung lau t h i T o r n g mang l a i nhieu nhan pho bien gay cuf dong cham tac dung khong mong muo'n: n h u aspirin gay loet da day ta trang, va Cling nhae. thuoc tieu huyet k h o i gay chay mau, cac thuoc con l a i chi c a i Trieu chvCng thien trieu chutng. • Run. Thildng bdt dau d mot ben ban tay. Tuy nhien nhieu - De tang cudng hieu qua va lam giam tac dung khong mong benh nhan khong bi run rd ret. muon trong phong ngira nhoi mau ccr t i m tren t h i trifdng hien nay • ca dong cham chap. Benh lam giam kha ndng bdt dau cac CO nhieu che pham nhu: cac s a n pham tir Giao co lam lam ha cji dong tuy, dan dan khien cho ngay ca nhitng cu: dong dan huyet ap, tang lifu thong k h i huyet. gidn cUng trd nen kho khdn va mat nhieu thdi gian. - Cac che pham tif hoa hoe nhif Du9ng mach kien nao: giup lam • Cling ca. Thiidng xdy ra d chi va d cS. Ciing co Idm gidm tarn ben viJng thanh mach mau, tang ciTomg sufc chiu diing cua mao van dong vd gay dau. mach, giam md mau; phong n g i T a nhoi mau cor t i m , dau t h a t ngyc, t a i bien mach mau nao. Cac che' pham c6 c h u f a Nattokinase • Bien dang'vd mat thdng bdng. Trong giai doan muon, benh (HOMICIS): dac t m h sinh hoc c i l a nattokinase rat giohg v6i plas- nhan co the bi gu veo vd khong giU diiac thdng bdng. m i n (enzym duy nhat trong ccf the lam tieu huyet kho'i). • Mat cdc dong tdc tU dong nhu chdp mdt, cubi vd vung tay - Nattokinase nang cao kha nang tir nhien cua cof the de lam khi di. Benh nhan co net mat cilng dd, mdt khong chdp vd tan cac cue mau bang mot so' each: Hoa tan fibrin mot each triic mdt kha ndng dien td bdng dieu bp. tiep. Nattokinase cung c6 the lam nang cao sir san xuat eiia ccf the • Thay ddi gigng noi. Gigng noi trd nen yeu at, nhanh hodc vdi plasmin va cac tac nhan hoa tan cue mau dong, bao gom ca dan sac, noi liu nhiu, lap lai td hodc ngap ngdng tritdc khi urokinase (noi bao). noi. - Nattokinase c6 the ngan chan s U chai c u f n g eiia mach mau d • Sa sut tri tue. Trong giai doan muon, mot so benh nhan bi lieu l u o f n g 100 mg/ngay. (5 mot khia canh nao do, nattokinase gidm sut tri nhd vd tdm than. thufc s i r to't h o n thuo'c TPA (plasmin mo), thuo'c hoa tan cac cue Nguyen nhan mau truyen tho'ng, va urokinase. - Cac trieu chijfng ciia benh Parkinson la hau qua cua thie'u hut mot chat dan truyen than k i n h la dopamin trong nao. Dieu nay xay ra k h i cac te'bao nao dac hieu san sinh dopamin b i chet hoac 24 • Tt^^r^^cLi^i^p^^ (Liui^i^d.J. • 25
f)6nfl r gfrt suy giam chufc nang. ChiTa ro nguyen n h a n cua h i e n tLTcfng n a y . cua enzym monoamine oxidase B (MAO B), nha do ngdn NgUcfi ta cho r a n g cac dot bien di truyen hoac doc chat trong moi ngUa gidng hoa dopamin tao thdnh til levodopa. Tdc dung trufofng dong v a i tro trong can benh n a y . phu hiem gap nhUng c6 the gom tuang tdc nang vai cdc thuoc khdc nhu thuoc dieu tri tram cam vd thuoc ngii. Xet nghiem vd chart dodn • Cdc chdt lie che catechol 0-methyltransferase (COMT), gom • Do nhieu nguyen nhdn c6 the gay ra cac trieu chiCng giong tolcapone (Tasmar) vd Entacapone (Comtan). NhUng thuoc benh Parkinson, nen benh rat kho chdn dqflu, nhdt la trong ndy lie che enzym gidng hoa levodopa, nhd do keo ddi tdc glai doan sdni. Hien chila c6 xet nghiem nao chdn dodn xdc dinh can benh nay dung cua levodopa. Thuoc c6 the gay ton thuang gan vd suy gan. • Chdn dodn benh thudng dUa vao tien sit vd khdm than • Cdc chdt chdng tiet acetylcholin, nhU trihexyphenidyl vd kinh, bao gom ddnh gid khd nang di bo, phdi hap dgng tdc benztropine (Cogentin). Tuy nhien, Igi ich khiem ton ciia cOng nhu thUc hien mot so nhiem vu dan gidn bdng tay. thuoc CO the khong tUang xiing vdi nhUng tdc dung phu nhU Chdn dodn sa bo thUdng duqc dat ra neu benh nhdn c6: III Idn vd hoang tUcmg, nhdt Id d benh nhdn tren 70 tudi. • It nhdt 2 den 3 trieu chiing chinh la run, chdm cil dong NhUng tdc dung phu khdc gom khd mieng, buon non, bi tieu vd Cling CO vd tdo bon. • Trieu chiing chi khdi phdt d mot ben ca thi • Thuoc chdng virus. Amantadine (Symmetrel) cd the lam • Run thdy ro hern khi nghi ngai gidm nhdt thbi benh Parkinson nhe giai doan ddu. Thuoc • Phdn ling tot vdi thuoc levodopa cung CO the dugc ket hap vdi lieu phdp carbidopa-levodopa cho benh nhdn giai doan muon, nhdt la khi bi rdi loan van DIEU TRI dgng do carbidopa-levodopa. Tdc dung phu gom sUng ne cd Dieu tri ngi khoa chdn vd not xudt huyet tren da. Levodopa h i e n l a thuoc dieu t r i hieu qua n h a t . Thuoc difqfc Phau thuat chuyen h o a t h a n h dopamin trong nao. T u y n h i e n k h i benh tien - K i c h t h i c h nao sau l a thu that pho bien n h a t de dieu t r i trien, hieu qua ciia levodopa c6 the bi giam di. T a c dung phu ciia benh. T h u thuat n a y bao gom cay mot dien ciic vao sau trong levodopa gom lii i S n , hoang tirdng, ao giac v a ro'i loan v a n dong.. vimg nao c h i pho'i v a n dong. D i e n ciTc dirge no'i vdi mot thiet bi • Chat chii van dopamin, gom pramipexole (Mirapex), cay ngoai da se dieu chinh liTcfng k i c h t h i c h phat r a . ropinirole (Requip), apomorphine (Apokyn). NhUng thuoc nay - T h i i thuat thirdng dircfc c h i dinh cho benh n h a n bi benh giai bdt chuac tdc dung cua dopamin trong nao. Tuy gdn nhU doan muon cd dap ufng khong on dinh vdi thuoc (levodopa). K i c h khong CO hieu qua dieu tri cdc trieu chiing cda benh, song thich nao sau khong c6 hieu qua vdi benh n h a n khong dap ijfng thuoc lam giam phdn nao hieu qua that thubng cua levodopa. vdi carbidopa-levodopa. • Cdc chat lie che MAO B. Nhom thuoc nay gom selegiline (Eldepryl) vd rasagiline (Azilect). Thuoc lie che hoat dong 26 • T / W ^ / w e ^ ^ * ^ ^ ^
9. BENH PHOI TAG NGHEN MAN TINH la Idu ngdy gdy ra. NhUng nhieu chat kich lic khdc cu-ng c6 the gdy COP nhu 6 nhiem khong khi vd khoi bui nghi Benh phoi tac nghen man t i n h (COPD) nghiep. la thuat ngil chung chi mot nhom benh phoi man t i n h gay tac nghen dufofng thc5r Xet nghi^m vd chd'n dodn trong phoi. COPD thiicfng dugc dung de • Xet nghiem cfiiic ndng phoi. Do phe dung c6 the phdt hien chi t i n h trang tac nghen do viem phe quan COPD trUac khi xudt hien trieu chiing benh. Xet nghiem man, k h i phe thung va viem phe quan do ndy cung thudng diiac ddng de theo ddi tien trien benh vd hen. hieu qua dieu tri. Tri^u chiing • Chup X quang phoi de phdt hien khi phe thung - mot trong nhUng nguyen nhdn chink gdy COPD cung nhil loqi trie cac COPD thirofng khofi dau tham lang. Benh benh khdc d phoi hodc suy tim. nhan c6 the khong bieu hien dau hieu va trieu chufng g i cho den k h i phoi b i t o n thiforng dang ke. Nhung • Phdn tich khi mdu dong mgch. Xet nghiem may ndy ddnh mot k h i da xuat hien t h i trieu chiJng thifdng nang dan theo t h d i gid lugng oxy dUgc ph6i dUa vdo mdu vd lugng khi cacbonic gian. Cac trieu chiifng COPD c6 the gom: thai ra. , • Ho dai ddng • Xet nghiem ddm. Phdn tich cac te bdo trong ddm giup xdc • Tdng tiet ddm ddi dinh nguyen nhdn vd logi tril mot so dang ung thu phoi. • Kho thd, nhdt Id khi hoat • Chup cdt l&p vi tinh (CT). Chup CT c6 the giup phdt hien khi phe thUng vd xdc dinh nhUng benh nhdn c6 the phdu thuat. • Thd kho khe • TiCc ngUc Dieu tri • Nhiim trung ho hdp thiibn - B6 thuo'c la la bifdc dau tien cof ban trong ket hoach dieu t r i COPD va la each duy nhat de giuf cho benh khong nang them. Nguyen nhdn ' • Khi phe thUng. Bay Id ben Dieu tri noi khoa nang, phd • Thuoc gian phe quan c6 tdc dung gidn ca d phe quan, Idm huy thdnh phe nang vd cac sgi chun, khien cac tiiu phe quan bi xep xuong khi tha ra vd Idm gidm lugng khi lUu gidm ho vd kho thd. Tiiy theo miCc do benh, c6 thi' ddng thong trong phoi. thudc gidn phe quan tdc dung ngdn trildc khi heat dgng, thudc gidn phe quan tdc dung keo ddi ddng hang ngdy hodc • Viem phe quan man tinh gdy viem vd chit hep phe quan vd cd hai. tieu phe quan, tdng tiet ddm khien phe quan bi bit tac. • Steroid dgng hit Idm gidm viem dudng ho hdp vd gidm kho • Khoi thudc la vd cac chat kich ling khdc. O dai da so cac thd. Song dung thuoc keo ddi c6 the gdy mot so tdc dung triidng hap, ton thilang phoi ddn tai COPD la do hut thuoc phu nhu lodng xUang, tdng huyet dp, due thuy tinh the vd tieu dudng. 28 • "tw./Vu,ve/v.?«/g^,^ Xl^c A'u^ (LUM /t^eVv/v • 29
• Khdng sink chong bgi nhiem. • Ngoi nhieu hoac diing Idu, nhat la khi thiCcmg xuyen ngoi toilet Idu do tdo bon Dieu tri ngog.i khoa • Beo phi • Phdu thuat gidm the tick phSi. • Ghep phd'i. • Thai nghen vd sinh di Xet nghiem vd chdn dodn 10. B E N H T R I - N G U Y E N N H A N , D A U H I E U N H A N B I E T - T r i n g o a i c6 t h e n h i n t h a y b a n g m a t thUcmg. T r i n o i c6 t h e VA H U d N G D I E U T R ! diTcfc p h a t h i e n b a n g t h a m trUc t r a n g , n h u n g d o i k h i t h a m trUc T r i l a b e n h t r o n g do cac t i n h m a c h 6 t r a n g k h o n g g i i i p diTa r a c h a n doan xac d i n h v i t r i n o i thirorng r a t h a u m o n va triJc t r a n g b i siftig va viem. m e m va k h o p h a t h i e n . T i n h t r a n g n a y c6 t h e do t h i r d n g x u y e n - Co x e t n g h i e m k i e m t r a p h a n d u d i ciia d a i t r a n g g o m soi h a u r a n qua miifc t r o n g k h i d i n g o a i hoac do m o n , soi triTc t r a n g hoac soi d a i t r a n g sigma. K i e m t r a r p n g h o n t a n g ap luc a cac t i n h m a c h nay t r o n g k h i gom soi d a i t r a n g o'ng m e m de k i e m t r a t o a n bo d a i t r a n g . X e t m a n g t h a i va m o t so' n g u y e n n h a n k h a c . n g h i e m n a y giup l o a i t r i r nhCfiig t o n t h u o n g gay c h a y m a u k h o n g Dau hi^u va tri^u chvCng c h i of trirc t r a n g m a con d t o a n bo d a i t r a n g . T r i e u c h i i n g ciia t r i thiTomg t u y thuoc vac v i t r i DIEU TRI • T r i n o i ; Binh thucmg khong nhin thdy hoac cam thdy bui Dieu tri nqi tri. Nhung khi ran hoac kich thich do phdn di qua c6 the - N e u b u i t r i c h i gay k h o c h i u d o i c h i i t , c6 t h e d u n g cac l o a i k e m gdy ton thUcmg be mat bui tri vd gay chay mdu. B6i khi viec h a y thuoc m 5 b o i t a i cho hoac c o r t i c o i d , k e t h o p v6i t a r n nirdc a m ran manh c6 thi' khien bui tri noi sa ra ngoai hau mon. h a n g n g a y de l a m g i a m t r i e u chuCng. • T r T n g o a i ; Dang tri ndy thuang gdy dau. Boi khi mdu c6 the li lai trong bui tri ngoai vd tao thdnh cue mdu dong, gdy Dieu tri ngog,i dau, siCng vd viem. Khi bi kich thich, bui tri ngoai c6 the bi • That bui tri. Bdc si se dung day cao su thdt quanh goc bui ngiia hoac chay mdu. tri noi di cdt diit tudn hodn mdu vd Idm bui tri xep di. Nguyen nhdn • Tiem xa: tiem hoa chat vdo xung quanh mach mdu de lam bui tri thu nho lai. T r i CO t h e x a y r a do t a n g ap liic t r o n g cac t i n h m a c h d dau dU(Ji t r i i c t r a n g . N h Q n g n g u y e n n h a n h a y gap n h a t gay t a n g ap lire va • Chieu tia hong ngoai di cdt diit tudn hodn mdu d nhUng bui gay t r i l a : tri noi nhd chdy mdu. • Tdo bon ddn den phai ran nhieu • Phdu thuat cdt bui tri trong trUbng hap cdc bien phdp khdc khong CO kit qua hoac bui tri Ian. • Tieu chay vd phai tdng phdn ra ngoai lien tuc 30 • T/iwi: n « « v e < u « T/wv r\,u.. (LKoa i^d,.u •:• 31
f)6nfl Y g'rt gt^u • Kep bui tri ngan khong cho mdu chdy den bui tri. Bay la Chan dodn phuang phdp khd mai vd c6 mot so' nhugc diem nhu gay B e n h n h i n h a t l a n a m g i d i , sot cao, m o t hoac h a i b e n goc h a m nguy ca tdi phdt vd sa bui tri cao hon ca vai phdu thuat md. sUng, dau, k h o n h a i v a nuo't, dac b i e t l a c6 s U n g n o n g do dau t i n h Phong benh " ' > b j i ! «
, t)6nfl Y gfrt f)6ng r gfrt at|u ho&c dieu tri khong dung each gay teo cd hai tinh hoan, gay Ichoa hoc da xac d i n h difgrc m o t so' k h u y e t t a t g e n c6 l i e n q u a n vdri v6 sinh. b e n h . G i a d i n h c6 m o t t r e b i t i f k y c6 1/20 k h a n a n g c6 dufa con thiif h a i cung b i b e n h . 12. BENH T i ; KY T r e CO t r i e u chiJng t i f k y cung c6 nguy ccf cao b i cac b e n h sau: Tir k y l a m o t r o i l o a n d nao d i • Hoi chiCng X, gay cham phat triin tarn than ^.^, k e m v d i m o t l o a t nhOng v a n de • Xa Cling dang cu, gay ra nhUng Midi u trong nao ve p h a t t r i e n , chu ye'u l a ve giao • Hoi chxing Tourette t i e p v a tifcfng tac v d i x a h o i . B e n h h a y gap of cac be t r a i gap 4 I a n • Dong kinh cac be g a i . Xet nghiem vd chdn dodn Dau hi^u va tri^u chvCng - V i b e n h c6 miifc dp n a n g v a bieu h i e n r a t k h a c n h a u , n e n c6 the r a t k h o c h a n doan. K h o n g c6 x e t n g h i e m dac h i e u nao de - N h i n c h u n g , t r e tiT k y thiTcfng c6 nhijfng v a n de t r o n g 3 l i n h vyc q u a n t r o n g cua qua t r i n h p h a t t r i e n l a k y n a n g giao t i e p , p h a t h i e n r a b e n h . K h a m x e t bao g o m q u a n s a t t r e v a h o i ve sir n g o n ngfir v a h a n h v i . N h i J n g t r e b i b e n h n a n g c6 t h e m a t h o a n p h a t t r i e n v a t h a y d o i t r o n g k y n a n g giao t i e p , k y n a n g n g o n ngO t o a n k h a n a n g giao t i e p hoac t u a n g tac v d i ngiTori k h a c . va h a n h v i cua t r e qua thori g i a n . T r e c6 t h e difgc l a m m o t so' t r a c n g h i e m ve n o i chuyen, n g o n ngfif v a cac v a n de t a m l y . - T r o n g v a i t h a n g hoac v a i n a m dau sau k h i r a dcfi, t r e c6 t h e h o a n t o a n b i n h t h i r d n g , n h i f n g sau do t r e d a n trd n e n k e m dap - M a c dii dau h i e u b e n h thiTomg bieu h i e n k h i t r e diXcfc 18 t h a n g lifng v d i ngiTcfi k h a c . T r e cung k h o chia se t r a i n g h i e m \6i ngiTcfi t u o i , nhiTng c h a n doan c6 k h i p h a i dgri d e n k h i t r e difgrc 2 hoac 3 k h a c , v i du k h i difgc nghe ngifori k h a c doc t r u y e n , t r e k h o n g c h i r a t u o i , k h i b i e u h i e n c h a m p h a t t r i e n n g o n ngif da tror n e n r o r a n g . difgrc biJc t r a n h t r o n g cau chuyen do. K h i I d n l e n , m o t so'tre c6 t h e C h a n doan sdrm l a r a t quan t r g n g v i c a n t h i e p sdrm - trifdrc 3 t u o i h o a n h a p horn v d i ngirc/i x u n g q u a n h v a c6 t h e c6 cuoc s o n g b i n h - thifcfng m a n g l a i k h a n a n g phuc h o i to't n h a t . thuforng hoac g a n b i n h thudrng. T u y n h i e n m o t so' t r e k h a c t i e p tuc Dieu tri b i suy g i a m k h a n a n g n g o n ngO v a giao t i e p , v a c6 nhOfng ro'i l o a n Chifa CO each chiJa k h o i b e n h t i f k y , v a k h o n g c6 b i e n p h a p nao hanh v i tram trong han. p h i i hcfp cho t a t ca. Cac lifa chon dieu t r i c6 t h e g o m : - D a so' t r e tiT k y c h a m hoc ducfc cac kie'n thiifc v a k y n a n g m d i . • Lieu phap hanh vi va giao tiep nhhm gidi quyet nhUng kho T u y n h i e n m o t so' t r e c6 t r i t u e b i n h thuofng hoac k h a t h o n g khan ve giao tiep, ngon ngU vd hanh vi cua tri. m i n h . M o t so' n h o t r e con difgfc x e m l a nhufng " t h a n d o n g " v a c6 nhufng k y n a n g dac b i e t t r o n g m o t l i n i i vUc n h a t d i n h , nhiT nghe • Thudc: thuoc khong cdi thien dugc cac dau hieu chu ye'u tU t h u a t hoac t o a n hoc. ky, nhUng c6 the giiip kiem sodt cac trieu chiing. • Cac lieu phap hd trg, nhu nghe thuat, dm nhac, che do &n Nguyen nhdn dac biet, bo sung vitamin vd mudi khodng v.v... - B e n h tiT k y k h o n g c6 m o t n g u y e n n h a n duy n h a t . B e n h c6 ve l i e n q u a n d e n nliOfng b a t thi/cfng or n h i e u v u n g n a o , v a cac n h a (Lkiu.i^^k • 35 34 • t w . = e / v « w
Tre thiTcfng dap ling to't vdri cac chiTorng t r i n h giao due dugrc cau true ehat che, c6 sir tham gia cua mot nhom cac chuyen gia va bao • Co kinh nguyet Idn dau trUdc 10 tudi. gom nhieu hoat dpng khac nhau de cai thien k y nang ufng xuf, giao • NgUdi My goc Phi (gap 3-9 Idn so vdi ngildi My da trdng). tiep va hanh v i . Tri?u chvCng 13. B E N H U XOTCTCUNG Hau he't u xcf tuf cung, ngay ca k h i ehung r a t Idn, cung c6 the U xor tuT cung la mot kho'i u l a n h khong CO trieu chufng. Thircfng ban se phat hien benh k h i d i k h a m t i n h CO nguon go'c tir to chile ccr trofn tuf phu khoa d i n h k y . cung. Tuoi thi/orng gap tir 35-50 tudi. NhiJng trieu chufng thircfng gap bao gdm: Day la loai u chiu anh hiidng ciia noi • Chay mdu am dao bat thiCdng hoac chdy mdu kinh nhieu tiet to" buong trting k h i Estrogen trong han binh thUcmg, con duqc ggi la rong kinh, rong huyet, doi CQf the tang cao. U xcf tiif cung thiTorng khi con kem theo mdu cue. to ra dien h i n h la trong thai ky, thi/cfng • Tang dp lUc d bang quang c6 thi gay tiiu nhieu Idn va c6 tuf cung b i xof eo nhieu nhan kich thich to nho khae nhau. U xof tuf cam gidc mudn di tiiu vd doi khi bi tieu. cung CO the gay ra rong k i n h , rong huyet, dau vung chau va tieu l a t nhat. • Tang dp lUc d trUc trdng, ddn den tdo bon. • Tang dp lUc d khung chau, cam thdy trhn bung diCdi, dau U xo tuT cung hiem k h i phat t r i e n t h a n h ung thiT. Nhiftig no bung dudi. gap nhieu hon d nhflng phu nu" sau tudi man k i n h . Dau hieu bao dong thifofng gap nhat la khdi u phat t r i e n nhanh va can phai • Thdy bung Idn ra, tdng vong eo. (Co the ban phai ndi rong p h l u thuat. quan, tang ca quan khi mac nhiing khong c6 dau hieu tdng can rd ret) Nguyen nhan • V6 sinh, diCac dinh nghia Id tinh trang khong the c6 thai - U xcf tuf cung phat t r i e n dudri sir kich t h i c h cua hormon estro- sau 1 n&m cd gdng thu thai vd khong sii dung bat ky bien gen diroc san xuat tir nhien trong cof the. Sir phat t r i e n nay c6 the phdp trdnh thai ndo. bat dau or tudi day t h i khoang 20 tudi va thu nho l a i sau tudi man • Khi bdc si khdm benh c6 the phdt hien ra mot khdi d khung k i n h k h i ccf the ngirng san xuat mot so' liTorng Idn estrogen. chau. - U xcf tuf cung CO the nho va khong gay trieu chiing nhimg chung cung c6 the phat trien den mi'c c6 the nang den 3-4 kg. Khi ndo can den sU can thi^p cua y hqc Chung phat t r i e n cham. Mot so' phu nOf b i nhieu u xa c6 the la do Ban nen den bac si k h i c6 nhufng bieu hien sau: di truyen. • Kinh nguyet khong deu hoac luang mdu ra nhieu han, xuat Mot so' yeu to' l i e n quan den sir phat t r i e n cua u xcf tuf cung: huyet giUa ky kinh. • ThiCa can, beo phi • Dau khung chau hoac dau bung. • ChUa tiing sinh con • Sot hoac vd mo hoi dem 36 • 'Zf^^„na.^
^6nfl r STrt gtgu • Tdng vdng bung. ..^ . Thuoc kich thich tie't hormon gonatropin (GnRH) c6 tac dung • Lo Idng ve thai ky hoac khong c6 khd ndng mang thai. che tuye'n yen lam cor the giam tie't estrogen. Su sut giam nong (Jo estrogen trong cor the lam giam kich thudfc ciia kho'i u. Loai Hay l i e n lac vdri b a c si ngay lap tuTc hoac den phong cap cuTu thuoc nay thudng duoc dimg tnrdc p h l u thuat nham lam kho'i u co neu CO nhufng bieu hien sau: lai de giam so' liTcfng mau mat qua qua t r i n h phau thuat hoac cai • Mdu kinh thdm qua nhieu han 3 mieng bdng ve sinh nwi thien cong thiifc mau trudc p h l u thuat. Kich thiTdc ciia kho'i u c6 gid. the giam khoang 50% trong 3 thang sijf dung thuoc. Nhirng kho'i u • Bau bung hoac khung chau nang hoac keo ddi. CO the phat trien trdr l a i neu ngirtig dieu t r i . Han che siif dung each • Chong mat, chodng vdng, thd gap, hodc dau ngUc c6 lien dieu t r i nay lau dai v i chiing c6 nhOfng tac dung phu gay ra do quan den chdy mdu dm dao. t i n h t r a n g giam estrogen trong co the (gio'ng t i n h t r a n g m a n kinh do thuo'c) n h u loang xUcrng, nong bitog va kho am dao. • • Chdy mdu dm dao c6 lien quan den thai ky hoac c6 khd ndng mang thai. - Thuo'c khang hormon R U - 486 (mifepristone). Loai thuo'c nay con cho thay c6 tac dung lam giam dau vung chau, giam ap Dieu tri life d bang quang, va giam dau vimg lifng difdfi. Suf dung lieu thap - Dieu t r i u xcf tuf cung phu thuoc vao trieu chufng, k i c h thudc va de lam giam k i c h thudc kho'i u trUdc p h l u thuat cat bo. Thuo'c con v i t r i c i i a khoi u, tuoi cua ban (khoang thcfi gian tir hien t a i cho CO the giiip t r a n h khong phai phau thuat do no c6 the l a m thu den luc man k i n h ) , y muo'n c6 con va the trang ciia ban. nho k i c h thudc kho'i u. Nhilng tac dung phu ciia thuo'c do giam - Trong hau het cac triXcrng hcfp, viec dieu t r i l a khong can estrogen tuang t u nhu tac dung phu ciia GnRH nhung c6 the i t thiet, dac biet l a neu n h i r ban khong c6 trieu c h i i n g , kho'i u nho gap han. R U - 486 c6 the gay say thai do do can can trong k h i siif hoac ban da qua tuoi man k i n h . Neu benh nhan ra mau am dao dung thuo'c neu muo'n c6 thai. nhieu do u xcf tiT cung c6 the can phai ap dung phuang phap nao - Thuoc nguon goc thdo diCac: Cac dUcfc lieu c6 chiia cac cam mau budng tuf cung. Neu khong c6 bang c h i i n g ac t i n h (ung saponin ca'u true dammaran thucfng c6 kha nang tang m i l n dich thif), thifomg CO the dieu t r i chay mau am dao bang thuoc hormon. CO the manh, giai doc va chong u tot n h U Nhan sam, Tam that, - Theo ddi: bac si se theo doi kich thirdc va sir phat t r i e n ciia T r i n h niit hoang cung, Giao co lam... Trong dan gian T r i n h nuf kho'i u xof theo thcfi gian de chac chan do khong phai la ung thu. hoang cung dirge s i i dung de chiJa ung thuf vu, ung thir tuf cung, ung Neu ban khong c6 nhiJng trieu chiJng n h u chay mau am dao, vimg thir tien l i e t tuye'n. Giao co lam dirqfc chufng m i n h la co tac dung chau va neu kho'i u khong phat trien nhanh, t h i ban khong can k i m ham sir phat trien kho'i u manh va ducfc suf dung cho benh dieu t r i . Tuy nhien, ban cung phai t a i kham va k h a m phu khoa nhan ung t h u nao, phdi, tien liet tuye'n, tuf cung, vii. Viec ke't hofp thifomg xuyen sau m6i 6 thang de kiem tra sii thay doi ciia kho'i u. cac dirge lieu thiTofng dem l a i ke't qua kha quan hofn cho sufe khoe so v6i k h i diing mot loai. Hien t r e n t h i trUcfng co nhieu san pham Dung thuoc: bao che' tir cay T r i n h nilf hoang giiip ho t r g dieu t r i u v u , tiif cung va - Thuoc khang viem khong steroid nhif ibuprofen (Advil hoac buong triifng co hieu qua nhiT san pham That diep l i n h (pho'i hop 2 m o t loai khac) c6 the lam giam dau vung chau do u xof tii cung. dugc lieu quy co tac dung tic che manh s U phat trien c i i a khoi u). x/u..^c e/v^4 /^^../v •:• 3 9 38 • tvwv= ;T««V e/«2«/S^v/v