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Khi xay ra tac dung phu cua thuoc chong lao: Nguoi benh khong tu y dung thuoc

Bai viet nay dung chu khong voi nghia bat buoc chu khong dung chu khong nen voi nghia khuyen nhu: Tai sao vay? Xin bat dau bang 2 truong hop lam sang.

Truong hop thu nhat: Benh nhan N.T.T. 22 tuoi, que o Dai Dong, Van Lam, Hung Yen. Nguoi benh duoc phat hien lao phoi tu 3 thang truoc, uong thuoc chong lao duoc nua thang, di ung thuoc nen bo tri. Vao Khoa hoi suc cap cuu Benh vien Lao va Benh phoi Trung uong ngay 10/2 vi ho ra mau voi hai phoi ton thuong nang ne. Duoc cap cuu kip thoi va tho may nen da giu duoc sinh mang, nhung con ton thuong nang ne hai phoi chua tri tiep nhu the nao? Nguoi me da noi ho: Chau khong dam bo tri nua dau.

Truong hop thu hai: Benh nhan LMC 53 tuoi song o khu Vinh Ho, Ha Noi, duoc phat hien lao phoi tu thang 7/2007, uong thuoc duoc gan mot thang roi bo cung voi ly do di ung thuoc. Ngay 25/2 benh nhan nhap Khoa hoi suc cap cuu Benh vien Lao va Benh phoi trong tinh trang suy ho hap rat nang. Da duoc tho may xam nhap nhung do hai phoi bi pha huy hoan toan nen tu vong ngay 29/2.

Vay cac thuoc chong lao gay tac hai gi cho nguoi benh?

+ Streptomycin: Nguy hiem nhat la gay soc phan ve, cho nen hien nay bat buoc phai thu phan ung truoc khi tiem. Thuoc con gay chong mat, diec, suy than, viem gan...

+ Isoniazid (rimifon) co the gay sot, man ngua, trung ca, cac bieu hien than kinh nhu: te bi, mat ngu, me sang, kich dong, co giat. Tang men gan, roi loan noi tiet: vu to...

+ Rifampicin: thuoc co the gay: sot cao, kho tho kieu hen, choang, ha huyet ap... cac roi loan mau nhu: Tan hong cau, giam tieu cau, giam bach cau. Gay: suy than cap, man ngua. Cac roi loan gan: tang men gan, tang bilirubin, tham chi teo gan cap...

+ Pyrazinamid: gay tang men gan, xam da, man ngua, dau khop do tang axit uric...

+ Ethambutol: Gay suy than, viem than kinh thi giac voi cac bieu hien: giam thi luc, am diem trung tam, hep thi truong va mu mau xanh va do...

Theo tac gia Hoang Tich Huyen theo doi tren 1.194 nguoi benh lao tai Thai Binh:

+ Co 47 (3,94%) nguoi benh co phan ung voi thuoc. Trong so do phan ung voi rimifon: 1,2%, voi viem hon hop rifamyxin + rimifon: 1,8%, streptomycin: 1,32%, pyrazinamid: 0,92% va ethambutol: 0%.

+  Cac bieu hien cua phan ung doc hai la: Streptomycin gay ban do, may day, chong mat, viem than, soc phan ve; Rifampicin + rimifon (hoac rimifon) gay viem gan.

Pyrazinamid gay dau khop.

+ Tan suat cua cac doc hai la:  Viem gan: 44,08%; Dau khop: 23,4%; Chong mat: 12,77%;   Soc: 8,51%; Da: 8,51%; Viem than: 2,13%.

Nguoi benh lao khi co nhung phan ung do thuoc chong lao neu khong duoc theo doi sat va huong dan se bo dieu tri. Viec bo tri lam cho benh tiep tuc tien trien, gay ton thuong nang ne hon va rat nguy hiem la lam cho vi khuan lao khang lai cac thuoc chong lao. Dieu tri lai khong khoi benh va tro thanh nguon lay gieo rac benh lao khang thuoc trong cong dong.

Xin nhac lai, khi thuoc chong lao gay nhung phan ung doc hai nguoi benh khong duoc tu y bo tri ma phai den ngay cac co so y te dang theo doi va cham soc de bao cao. Nguoc lai nhan vien y te cham soc phai kip thoi phat hien, giai thich huong dan va kip thoi xu ly. Nguoi benh se duoc chi dinh tuy theo muc do va loai phan ung doc hai:

Ngung thuoc de phan ung co hai khong nang ne hon; Xac dinh thuoc gay phan ung; Su dung lieu phap giai man cam de dung thuoc lai; Su dung thuoc de han che nhung phan ung co hai; Tiep tuc dieu tri bang nhung thuoc khong gay phan ung va su dung nhung thuoc chong lao khac thay the de bao dam nguyen tac dieu tri. 

BS. Binh Lam (Benh vien Lao va Benh phoi TW)