{"id":20270,"date":"2023-04-14T12:47:50","date_gmt":"2023-04-14T05:47:50","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=20270"},"modified":"2023-04-17T16:21:15","modified_gmt":"2023-04-17T09:21:15","slug":"tac-dung-tren-than-cua-thuoc-uc-che-men-chuyen-trong-dieu-tri-suy-tim","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/tac-dung-tren-than-cua-thuoc-uc-che-men-chuyen-trong-dieu-tri-suy-tim\/","title":{"rendered":"T\u00e1c d\u1ee5ng tr\u00ean th\u1eadn c\u1ee7a thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n trong \u0111i\u1ec1u tr\u1ecb suy tim"},"content":{"rendered":"

Thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n (ACE) \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i trong \u0111i\u1ec1u tr\u1ecb suy tim. Trong b\u1ec7nh suy tim, thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n c\u00f2n c\u00f3 c\u00e1c t\u00e1c d\u1ee5ng kh\u00e1c \u0111\u1ed1i v\u1edbi th\u1eadn, bao g\u1ed3m thay \u0111\u1ed5i t\u1ed1c \u0111\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn (GFR), gi\u1ea3m b\u00e0i ti\u1ebft kali c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u0103ng kali m\u00e1u v\u00e0 t\u00e1c d\u1ee5ng thay \u0111\u1ed5i \u0111\u1ed1i v\u1edbi ph\u1ea3n \u1ee9ng b\u00e0i ti\u1ebft natri c\u1ee7a thu\u1ed1c l\u1ee3i ti\u1ec3u.<\/strong><\/p>\n

1. T\u1ed5ng quan<\/h2>\n

Thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n (ACE) \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i trong \u0111i\u1ec1u tr\u1ecb suy tim. C\u00e1c thu\u1ed1c n\u00e0y l\u00e0m gi\u1ea3m s\u1ef1 h\u00ecnh th\u00e0nh angiotensin II, do \u0111\u00f3 l\u00e0m gi\u1ea3m s\u1ee9c c\u1ea3n c\u1ee7a c\u1ea3 ti\u1ec3u \u0111\u1ed9ng m\u1ea1ch v\u00e0 t\u0129nh m\u1ea1ch. T\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch n\u00e0y gi\u00fap c\u1ea3i thi\u1ec7n ngay l\u1eadp t\u1ee9c c\u00e1c tri\u1ec7u ch\u1ee9ng suy tim b\u1eb1ng c\u00e1ch gi\u1ea3m h\u1eadu t\u1ea3i th\u1ea5t tr\u00e1i, do \u0111\u00f3 l\u00e0m t\u0103ng cung l\u01b0\u1ee3ng tim v\u00e0 gi\u1ea3m \u00e1p l\u1ef1c \u0111\u1ed5 \u0111\u1ea7y tim tr\u00e1i v\u00e0 ph\u1ea3i, gi\u00fap c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng t\u1eafc ngh\u1ebdn t\u0129nh m\u1ea1ch ph\u1ed5i v\u00e0 t\u0129nh m\u1ea1ch h\u1ec7 th\u1ed1ng. Do \u0111a t\u00e1c d\u1ee5ng c\u1ee7a ch\u00fang tr\u00ean c\u00e1c c\u01a1 quan \u0111\u00edch kh\u00e1c nhau bao g\u1ed3m tim, m\u1ea1ch m\u00e1u v\u00e0 th\u1eadn, ACE l\u00e0m ch\u1eadm t\u1ed1c \u0111\u1ed9 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng tim ti\u1ebfn tri\u1ec3n v\u00e0 gi\u1ea3m kho\u1ea3ng 25% t\u1ef7 l\u1ec7 t\u1eed vong do tim m\u1ea1ch sau m\u1ed9t \u0111\u1ebfn ba n\u0103m. Ngo\u00e0i ra, vi\u1ec7c s\u1eed d\u1ee5ng ACE sau nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p t\u00ednh c\u00f3 th\u1ec3 b\u1ea3o t\u1ed3n ch\u1ee9c n\u0103ng tim (b\u1eb1ng ch\u1ee9ng l\u00e0 t\u0103ng ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u v\u00e0 l\u00e0m ch\u1eadm m\u1edf r\u1ed9ng t\u00e2m th\u1ea5t) v\u00e0 c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng s\u1ed1ng s\u00f3t l\u00e2u d\u00e0i.<\/p>\n

Trong b\u1ec7nh suy tim<\/a>, ACE c\u00f2n c\u00f3 c\u00e1c t\u00e1c d\u1ee5ng kh\u00e1c \u0111\u1ed1i v\u1edbi th\u1eadn, bao g\u1ed3m thay \u0111\u1ed5i t\u1ed1c \u0111\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn (GFR), gi\u1ea3m b\u00e0i ti\u1ebft kali c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u0103ng kali m\u00e1u v\u00e0 t\u00e1c d\u1ee5ng thay \u0111\u1ed5i \u0111\u1ed1i v\u1edbi ph\u1ea3n \u1ee9ng b\u00e0i ti\u1ebft natri c\u1ee7a thu\u1ed1c l\u1ee3i ti\u1ec3u.<\/p>\n

\"tac-dung-tren-than-cua-thuoc-uc-che-men-chuyen-trong-dieu-tri-suy-tim\"
T\u00e1c d\u1ee5ng tr\u00ean th\u1eadn c\u1ee7a thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n trong \u0111i\u1ec1u tr\u1ecb suy tim<\/figcaption><\/figure>\n

2. \u1ea2nh h\u01b0\u1edfng thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n \u0111\u1ebfn t\u1ed1c \u0111\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn<\/h2>\n

X\u00e9t v\u1ec1 s\u1ef1 c\u1ea3i thi\u1ec7n cung l\u01b0\u1ee3ng tim v\u00e0 l\u01b0u l\u01b0\u1ee3ng m\u00e1u \u0111\u1ebfn th\u1eadn, c\u00f3 th\u1ec3 cho r\u1eb1ng ACE c\u0169ng s\u1ebd l\u00e0m t\u0103ng t\u1ed1c \u0111\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn (GFR). Tuy nhi\u00ean, ph\u1ea3n \u1ee9ng d\u1ef1 ki\u1ebfn \u200b\u200bn\u00e0y ch\u1ec9 x\u1ea3y ra \u1edf 10 \u0111\u1ebfn 25 ph\u1ea7n tr\u0103m b\u1ec7nh nh\u00e2n, trong khi s\u1ef1 gia t\u0103ng n\u1ed3ng \u0111\u1ed9 creatinine huy\u1ebft t\u01b0\u01a1ng l\u00e0 d\u1ea5u hi\u1ec7u ph\u1ed5 bi\u1ebfn h\u01a1n<\/p>\n

Vi\u1ec7c gi\u1ea3m GFR trong b\u1ec7nh suy tim r\u1ea5t c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf nh\u1eefng n\u01a1i m\u00e0 vi\u1ec7c duy tr\u00ec GFR ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ee9c angiotensin II xung quanh cao:<\/p>\n

    \n
  • B\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c l\u1ee3i ti\u1ec3u li\u1ec1u cao c\u00f3 gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n t\u01b0\u01a1ng \u0111\u1ed1i do l\u1ee3i ti\u1ec3u qu\u00e1 m\u1ee9c<\/li>\n
  • B\u1ec7nh nh\u00e2n b\u1ecb h\u1ea1 huy\u1ebft \u00e1p t\u01b0\u01a1ng \u0111\u1ed1i (\u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch trung b\u00ecnh d\u01b0\u1edbi 75 mmHg) sau khi \u0111i\u1ec1u tr\u1ecb, th\u01b0\u1eddng ph\u1ea3n \u00e1nh cung l\u01b0\u1ee3ng tim th\u1ea5p v\u00e0 l\u01b0u l\u01b0\u1ee3ng m\u00e1u \u0111\u1ebfn th\u1eadn th\u1ea5p.<\/li>\n
  • B\u1ec7nh nh\u00e2n c\u00f3 n\u1ed3ng \u0111\u1ed9 natri huy\u1ebft t\u01b0\u01a1ng tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb d\u01b0\u1edbi 137 mEq\/L, \u0111\u00e2y l\u00e0 d\u1ea5u hi\u1ec7u cho s\u1ef1 k\u00edch ho\u1ea1t th\u1ea7n kinh th\u1ec3 d\u1ecbch r\u00f5 r\u1ec7t<\/li>\n
  • B\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh m\u1ea1ch m\u00e1u th\u1eadn \u0111\u00e1ng k\u1ec3, m\u1ed9t ph\u00e1t hi\u1ec7n ph\u1ed5 bi\u1ebfn \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i b\u1ecb suy tim<\/li>\n<\/ul>\n

    V\u1ec1 l\u00fd thuy\u1ebft, ho\u1ea1t \u0111\u1ed9ng renin trong huy\u1ebft t\u01b0\u01a1ng c\u0169ng s\u1ebd x\u00e1c \u0111\u1ecbnh b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 m\u1eafc b\u1ec7nh.\u00a0Tuy nhi\u00ean, \u0111o ho\u1ea1t t\u00ednh renin huy\u1ebft t\u01b0\u01a1ng kh\u00f4ng ph\u1ea3i l\u00e0 m\u1ed9t x\u00e9t nghi\u1ec7m l\u00e2m s\u00e0ng h\u1eefu \u00edch v\u00ec renin tu\u1ea7n ho\u00e0n c\u00f3 th\u1ec3 kh\u00f4ng ph\u1ea3n \u00e1nh ho\u1ea1t \u0111\u1ed9ng c\u1ee7a\u00a0h\u1ec7 th\u1ed1ng renin-angiotensin\u00a0m\u00f4<\/strong>. Do \u0111\u00f3, ngay c\u1ea3 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ho\u1ea1t t\u00ednh renin huy\u1ebft t\u01b0\u01a1ng b\u00ecnh th\u01b0\u1eddng, thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m GFR b\u1eb1ng c\u00e1ch gi\u1ea3m angiotensin II trong th\u1eadn.<\/p>\n

    S\u1ef1 gi\u1ea3m GFR do ACE g\u00e2y ra trong b\u1ec7nh suy tim, \u00edt nh\u1ea5t m\u1ed9t ph\u1ea7n, l\u00e0 do gi\u1ea3m \u01b0u ti\u00ean s\u1ee9c \u0111\u1ec1 kh\u00e1ng ti\u1ec3u \u0111\u1ed9ng m\u1ea1ch ch\u1ea3y trong c\u1ea7u th\u1eadn, d\u1eabn \u0111\u1ebfn gi\u1ea3m \u00e1p l\u1ef1c trong c\u1ea7u th\u1eadn, l\u00e0 \u0111\u1ed9ng l\u1ef1c ch\u00ednh cho qu\u00e1 tr\u00ecnh l\u1ecdc c\u1ea7u th\u1eadn. M\u1ee9c c\u01a1 b\u1ea3n c\u1ee7a l\u1ecdc c\u1ea7u th\u1eadn th\u01b0\u1eddng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u1ee5c h\u1ed3i b\u1eb1ng c\u00e1ch gi\u1ea3m li\u1ec1u thu\u1ed1c l\u1ee3i ti\u1ec3u, do \u0111\u00f3 l\u00e0m gi\u1ea3m s\u1ef1 ph\u1ee5 thu\u1ed9c v\u00e0o angiotensin II c\u1ee7a l\u1ecdc c\u1ea7u th\u1eadn. Ngo\u00e0i ra, n\u00ean tr\u00e1nh s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid n\u1ebfu c\u00f3 th\u1ec3.<\/p>\n

    3. Thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n l\u00e0m t\u0103ng nguy c\u01a1 t\u0103ng Kali m\u00e1u<\/strong><\/h2>\n

    B\u1ec7nh nh\u00e2n b\u1ecb suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn ti\u1ec1m \u1ea9n c\u0169ng c\u00f3 nguy c\u01a1 cao b\u1ecb t\u0103ng kali m\u00e1u sau khi d\u00f9ng ACE. Suy tim ti\u1ebfn tri\u1ec3n c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c gi\u1ea3m natri v\u00e0 n\u01b0\u1edbc \u0111\u1ebfn v\u1ecb tr\u00ed b\u00e0i ti\u1ebft kali \u1edf \u1ed1ng g\u00f3p. Vi\u1ec7c duy tr\u00ec b\u00e0i ti\u1ebft \u0111\u1ee7 kali \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y ph\u1ee5 thu\u1ed9c v\u00e0o vi\u1ec7c t\u0103ng ti\u1ebft aldosterone, m\u1ed9t \u0111\u00e1p \u1ee9ng c\u00f3 th\u1ec3 b\u1ecb suy gi\u1ea3m m\u1ed9t ph\u1ea7n n\u1ebfu gi\u1ea3m s\u1ea3n xu\u1ea5t angiotensin II (v\u00ec angiotensin II l\u00e0 ch\u1ea5t trung gian ch\u00ednh c\u1ee7a s\u1ef1 gia t\u0103ng gi\u1ea3i ph\u00f3ng aldosterone do gi\u1ea3m t\u01b0\u1edbi m\u00e1u). Nguy c\u01a1 t\u0103ng kali m\u00e1u t\u0103ng l\u00ean khi d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u00e0\/ho\u1eb7c t\u0103ng li\u1ec1u thu\u1ed1c \u0111\u1ed1i kh\u00e1ng aldosterone nh\u01b0 spironolactone .<\/p>\n

    4. \u0110\u00e1p \u1ee9ng c\u1ee7a Natri ni\u1ec7u v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u khi d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n<\/strong><\/h2>\n

    M\u1eb7c d\u00f9 ACE th\u01b0\u1eddng l\u00e0m gi\u1ea3m t\u1ed1c \u0111\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn (GFR) do t\u00e1c d\u1ee5ng kh\u00e1c bi\u1ec7t c\u1ee7a ch\u00fang \u0111\u1ed1i v\u1edbi c\u00e1c ti\u1ec3u \u0111\u1ed9ng m\u1ea1ch c\u1ea7u th\u1eadn g\u1ea7n v\u00e0 xa, thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n c\u00f3 th\u1ec3 l\u00e0m t\u0103ng ph\u1ea3n \u1ee9ng b\u00e0i ni\u1ec7u natri \u0111\u1ed1i v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p nh\u1ea5t \u0111\u1ecbnh.<\/p>\n

    S\u1ef1 t\u01b0\u01a1ng t\u00e1c gi\u1eefa thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n v\u00e0 thu\u1ed1c l\u1ee3i ti\u1ec3u c\u00f3 th\u1ec3 quan tr\u1ecdng v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng.\u00a0 B\u1edfi v\u00ec thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n t\u01b0\u01a1ng \u0111\u1ed1i ch\u1ecdn l\u1ecdc \u0111\u1ed1i v\u1edbi \u0111\u1ed9ng m\u1ea1ch th\u1eadn, n\u00ean s\u1ef1 gia t\u0103ng l\u01b0u l\u01b0\u1ee3ng m\u00e1u \u0111\u1ebfn th\u1eadn v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n \u0111\u1ed1i v\u1edbi b\u1ea5t k\u1ef3 s\u1ef1 gia t\u0103ng n\u00e0o v\u1ec1 cung l\u01b0\u1ee3ng tim \u0111\u1ec1u l\u1edbn h\u01a1n so v\u1edbi thu\u1ed1c gi\u00e3n m\u1ea1ch kh\u00f4ng ch\u1ecdn l\u1ecdc nh\u01b0 hydralazine ho\u1eb7c thu\u1ed1c t\u0103ng co b\u00f3p nh\u01b0 dobutamine.<\/p>\n

    5. K\u1ebft lu\u1eadn<\/h2>\n

    Trong b\u1ec7nh suy tim, thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n c\u00f3 c\u00e1c t\u00e1c d\u1ee5ng \u0111\u1ed1i v\u1edbi th\u1eadn, bao g\u1ed3m thay \u0111\u1ed5i t\u1ed1c \u0111\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn (GFR), gi\u1ea3m b\u00e0i ti\u1ebft kali c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u0103ng kali m\u00e1u v\u00e0 t\u00e1c d\u1ee5ng thay \u0111\u1ed5i ph\u1ea3n \u1ee9ng b\u00e0i ti\u1ebft natri.<\/p>\n

     <\/p>\n","protected":false},"excerpt":{"rendered":"

    Thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n (ACE) \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i trong \u0111i\u1ec1u tr\u1ecb suy tim. Trong b\u1ec7nh suy tim, thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n c\u00f2n c\u00f3 c\u00e1c t\u00e1c d\u1ee5ng kh\u00e1c \u0111\u1ed1i v\u1edbi th\u1eadn, bao g\u1ed3m thay \u0111\u1ed5i t\u1ed1c \u0111\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn (GFR), gi\u1ea3m b\u00e0i ti\u1ebft kali c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u0103ng kali m\u00e1u […]<\/p>\n","protected":false},"author":60,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[12,33],"tags":[3],"yoast_head":"\nT\u00e1c d\u1ee5ng tr\u00ean th\u1eadn c\u1ee7a thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n - VinmecDr<\/title>\n<meta name=\"description\" content=\"Thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n c\u00f3 c\u00e1c t\u00e1c d\u1ee5ng kh\u00e1c \u0111\u1ed1i v\u1edbi th\u1eadn, bao g\u1ed3m thay \u0111\u1ed5i t\u1ed1c \u0111\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn, t\u0103ng kali m\u00e1u v\u00e0 s\u1ef1 b\u00e0i ti\u1ebft natri\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"T\u00e1c d\u1ee5ng tr\u00ean th\u1eadn c\u1ee7a thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n - 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