{"id":20910,"date":"2023-04-14T21:03:52","date_gmt":"2023-04-14T14:03:52","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=20910"},"modified":"2023-04-17T15:25:43","modified_gmt":"2023-04-17T08:25:43","slug":"uc-che-men-chuyen-thuong-dung-trong-thuc-hanh-lam-sang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/uc-che-men-chuyen-thuong-dung-trong-thuc-hanh-lam-sang\/","title":{"rendered":"\u1ee8c ch\u1ebf men chuy\u1ec3n th\u01b0\u1eddng d\u00f9ng trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng"},"content":{"rendered":"

\u1ee8c ch\u1ebf <\/span><\/span>men chuy\u1ec3n <\/span><\/span>d\u1ea1ng angiotensin (thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n angiotensin (ACE)), g\u1ecdi t\u1eaft l\u00e0 thu\u1ed1c <\/span><\/span>men chuy\u1ec3n ch\u1ebf \u0111\u1ed9<\/span><\/span>, t\u00e1c d\u1ee5ng tr\u1ef1c ti\u1ebfp l\u00ean h\u1ec7 th\u1ed1ng RAA, l\u00e0 nh\u00f3m thu\u1ed1c h\u1ebft s\u1ee9c quan tr\u1ecdng m\u00e0 c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng c\u1ea7n n\u1eafm r\u00f5 trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tim m\u1ea1ch.<\/span><\/span><\/strong><\/p>\n

1. Captopril<\/span><\/span><\/h2>\n

1.1 T\u00ean th\u01b0\u01a1ng m\u1ea1i:<\/span><\/span><\/h3>\n

\u00a0Capoten, Captopril STATA. <\/span>H\u00e0m l\u01b0\u1ee3ng: 12,5 mg; <\/span>25 mg; <\/span>50 mg.<\/span><\/span><\/p>\n

1.2 D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc:<\/span><\/span><\/h3>\n

Th\u1ee9c \u0103n l\u00e0m gi\u1ea3m h\u1ea5p th\u1ee5 thu\u1ed1c \u0111\u1ebfn 33% n\u00ean c\u1ea7n d\u00f9ng thu\u1ed1c khi \u0111\u00f3i \u00edt nh\u1ea5t 1h tr\u01b0\u1edbc b\u1eefa \u0103n. Kho\u1ea3ng 50% thu\u1ed1c sau khi \u0111\u01b0\u1ee3c h\u1ea5p th\u1ee5 chuy\u1ec3n h\u00f3a qua gan, sau \u0111\u00f3 \u0111\u01b0\u1ee3c th\u1ea3i tr\u1eeb d\u01b0\u1edbi d\u1ea1ng ho\u1ea1t t\u00ednh t\u1ea1i th\u1eadn. Captopril g\u1eafn v\u1edbi albumin kho\u1ea3ng 25 \u2013 30%, m\u1ed9t ph\u1ea7n g\u1eafn v\u1edbi thiol n\u1ed9i sinh, thu\u1ed1c kh\u00f4ng qua \u0111\u01b0\u1ee3c h\u00e0ng r\u00e0o m\u00e1u n\u00e3o.<\/p>\n

Thu\u1ed1c u\u1ed1ng c\u00f3 t\u00e1c d\u1ee5ng sau 15 ph\u00fat, \u0111\u1ea1t \u0111\u1ec9nh sau 1 \u2013 2h, k\u00e9o d\u00e0i trong 8 \u2013 12h, do \u0111\u00f3 \u0111\u1ec3 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p c\u1ea7n d\u00f9ng thu\u1ed1c \u00edt nh\u1ea5t 2 l\u1ea7n\/24h. Do t\u00e1c d\u1ee5ng nhanh, captopril c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng trong tr\u01b0\u1eddng h\u1ee3p c\u1ea7n h\u1ea1 huy\u1ebft \u00e1p nhanh, v\u00ed d\u1ee5 t\u0103ng huy\u1ebft \u00e1p kh\u1ea9n tr\u01b0\u01a1ng.<\/p>\n

1.3 Li\u1ec1u d\u00f9ng:<\/h3>\n

1.4 Suy tim:<\/h4>\n

Kh\u1edfi tr\u1ecb suy tim v\u1edbi li\u1ec1u \u0111\u1ea7u 6,25 mg (l\u01b0u \u00fd n\u00ean d\u1eebng thu\u1ed1c l\u1ee3i ti\u1ec3u 24h tr\u01b0\u1edbc khi d\u00f9ng). Li\u1ec1u th\u1ea5p h\u01a1n 3 mg c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t nh\u01b0 suy tim sau NMCT. Theo d\u00f5i huy\u1ebft \u00e1p trong th\u1eddi gian sau d\u00f9ng thu\u1ed1c t\u1eeb 15 ph\u00fat \u0111\u1ebfn h\u1ebft 2h, n\u1ebfu kh\u00f4ng x\u1ea3y ra hi\u1ec7n t\u01b0\u1ee3ng t\u1ee5t huy\u1ebft \u00e1p, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng li\u1ec1u 6,25 mg x 1 \u2013 2 l\u1ea7n\/24h sau \u0111\u00f3 t\u0103ng l\u00ean 12,5 mg x 2 l\u1ea7n\/24h v\u00e0 n\u1ebfu c\u1ea7n thi\u1ebft c\u00f3 th\u1ec3 l\u00ean 25 mg x 2 l\u1ea7n\/24h. H\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n dung n\u1ea1p \u0111\u01b0\u1ee3c li\u1ec1u t\u1eeb 37,5 \u2013 50 mg\/24h, trong khi \u0111\u00f3 li\u1ec1u t\u1ed1i \u0111a 100 mg chia 2 \u2013 3 l\u1ea7n\/24h c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng n\u1ebfu ch\u1ee9c n\u0103ng th\u1eadn kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng.<\/p>\n

S\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi c\u00e1c thu\u1ed1c nitrate c\u00f3 th\u1ec3 g\u00e2y t\u1ee5t huy\u1ebft \u00e1p ho\u1eb7c cho\u00e1ng ng\u1ea5t, do \u0111\u00f3 khuy\u1ebfn c\u00e1o n\u00ean d\u1eebng nitrate tr\u01b0\u1edbc khi d\u00f9ng captopril.<\/p>\n

1.5 T\u0103ng huy\u1ebft \u00e1p:<\/h4>\n

Kh\u1edfi \u0111\u1ea7u v\u1edbi li\u1ec1u 12,5 mg x 1 l\u1ea7n trong ng\u00e0y \u0111\u1ea7u, sau \u0111\u00f3 t\u0103ng l\u00ean 2 l\u1ea7n\/24h trong ng\u00e0y ti\u1ebfp theo, ti\u1ebfp t\u1ee5c t\u0103ng li\u1ec1u trong v\u00e0i ng\u00e0y ho\u1eb7c v\u00e0i tu\u1ea7n k\u1ebf ti\u1ebfp \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c li\u1ec1u duy tr\u00ec 25 \u2013 50 mg, chia 2 l\u1ea7n\/24h. \u1ede c\u00e1c b\u1ec7nh nh\u00e2n suy th\u1eadn ho\u1eb7c ng\u01b0\u1eddi gi\u00e0, s\u1eed d\u1ee5ng l\u1ee3i ti\u1ec3u \u0111\u1ed3ng th\u1eddi n\u00ean kh\u1edfi tr\u1ecb v\u1edbi li\u1ec1u th\u1ea5p 6,25 mg, c\u1ea7n theo d\u00f5i s\u00e1t ch\u1ee9c n\u0103ng th\u1eadn v\u00e0 huy\u1ebft \u00e1p \u1edf c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng n\u00e0y.<\/p>\n

2. Enalapril<\/h2>\n

2.1. T\u00ean th\u01b0\u01a1ng m\u1ea1i:<\/h3>\n

Vasotec, Innovace, Renitec, Ednyt. H\u00e0m l\u01b0\u1ee3ng: 2,5mg; 5mg; 10mg; 20 mg.<\/p>\n

\u00a02.2. D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc:<\/h3>\n

Kho\u1ea3ng 60% thu\u1ed1c \u0111\u01b0\u1ee3c h\u1ea5p thu sau khi u\u1ed1ng v\u00e0 kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi th\u1ee9c \u0103n. <\/span>Enalapril l\u00e0 m\u1ed9t ti\u1ec1n ch\u1ea5t c\u1ea7n \u0111\u01b0\u1ee3c th\u1ee7y ph\u00e2n t\u1ea1i gan \u0111\u1ec3 tr\u1edf th\u00e0nh d\u1ea1ng ho\u1ea1t \u0111\u1ed9ng c\u1ee7a enalaprilat. <\/span>V\u00ec v\u1eady so v\u1edbi captopril, thu\u1ed1c c\u00f3 th\u1eddi gian t\u00e1c d\u1ee5ng d\u00e0i h\u01a1n, th\u1eddi gian \u0111\u1ea1t \u0111\u1ec9nh t\u00e1c d\u1ee5ng kho\u1ea3ng 4 \u2013 6h, th\u1eddi gian b\u00e1n hu\u1ef7 11h. <\/span>B\u00e0i thu\u1ed1c \u0111\u01b0\u1ee3c xu\u1ea5t ho\u00e0n to\u00e0n qua th\u1eadn. <\/span>\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n suy gan c\u1ea7n t\u0103ng li\u1ec1u d\u00f9ng thu\u1ed1c.<\/span><\/span><\/p>\n

2.3. Li\u1ec1u d\u00f9ng<\/span>:<\/span><\/span><\/h3>\n

2.3.1 Suy tim:<\/span><\/span><\/h4>\n

Gi\u1ed1ng nh\u01b0 captopril, khi kh\u1edfi \u0111\u1ed9ng v\u1edbi enalapril c\u1ea7n t\u1ea1m d\u1eebng ho\u1eb7c gi\u1ea3m th\u1ea3i thu\u1ed1c l\u1ee3i ti\u1ec3u. <\/span>Tuy nhi\u00ean, n\u1ebfu b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa v\u00e0 theo d\u00f5i huy\u1ebft \u0111\u1ed9ng th\u00ec c\u00f3 th\u1ec3 b\u1ecf qua \u0111i\u1ec1u n\u00e0y. <\/span>Li\u1ec1u kh\u1edfi \u0111\u1ea7u 2,5 mg\/24h, theo d\u00f5i sau 2-6h n\u1ebfu kh\u00f4ng say huy\u1ebft \u00e1p c\u00f3 th\u1ec3 t\u0103ng th\u1ea3i l\u00ean 2,5 mg x 2 l\u1ea7n\/24h. <\/span>Sau v\u00e0i ng\u00e0y c\u00f3 th\u1ec3 t\u0103ng li\u1ec1u l\u00ean 5 \u2013 7,5 mg x 2 l\u1ea7n\/24h (t\u01b0\u01a1ng \u0111\u01b0\u01a1ng 75 \u2013 100 mg captopril). <\/span>Li\u1ec1u t\u1ed1i \u0111a 15 mg x 2 l\u1ea7n\/24h. <\/span>T\u00e0 trung b\u00ecnh dung n\u1ea1p \u1edf b\u1ec7nh nh\u00e2n suy tim kho\u1ea3ng 18 mg nghi\u00ean c\u1ee9u CONSENSUS, 15 mg nghi\u00ean c\u1ee9u V \u2013 HeFT.<\/span><\/span><\/p>\n

2.3.2 T\u0103ng huy\u1ebft \u00e1p:<\/span><\/span><\/h4>\n

Kh\u1edfi \u0111\u1ea7u v\u1edbi li\u1ec1u 2,5 mg\/24h, t\u0103ng li\u1ec1u t\u1eeb 5 \u2013 10 mg sau v\u00e0i ng\u00e0y. <\/span>N\u1ebfu kh\u00f4ng th\u1ec3 ki\u1ec3m tra huy\u1ebft \u00e1p \u00e1p d\u1ee5ng v\u1edbi 10 mg\/24h c\u00f3 th\u1ec3 t\u0103ng li\u1ec1u s\u1eed d\u1ee5ng: 10 mg v\u00e0o bu\u1ed5i s\u00e1ng, 5 mg v\u00e0o bu\u1ed5i t\u1ed1i. <\/span>Li\u1ec1u t\u1ed1i \u0111a 30 mg\/24h, tuy nhi\u00ean trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p THA kh\u00e1ng tr\u1ecb c\u00f3 th\u1ec3 t\u0103ng h\u1ea5p th\u1ee5 \u0111\u1ebfn 40 mg\/24h.<\/span><\/span><\/p>\n

3. Lisinopril<\/span><\/span><\/h2>\n

3.1. <\/span>T\u00ean th\u01b0\u01a1ng m\u1ea1i:<\/span><\/span><\/h3>\n

\u00a0Zestril, Prinivil, Lisopress. <\/span>H\u00e0m l\u01b0\u1ee3ng: 2,5mg; <\/span>5mg; <\/span>10mg; <\/span>20mg.<\/span><\/span><\/p>\n

3.2. <\/span>D\u01b0\u1ee3c h\u1ecdc: <\/span><\/span><\/h3>\n

H\u1ea5p th\u1ee5 t\u1ed1t qua \u0111\u01b0\u1eddng u\u1ed1ng, kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi th\u1ee9c \u0103n. <\/span>Lisinopril l\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n duy nh\u1ea5t tan trong n\u01b0\u1edbc v\u00e0 kh\u00f4ng ti\u1ec1n ch\u1ea5t n\u00ean kh\u00f4ng b\u1ecb chuy\u1ec3n h\u00f3a qua gan. <\/span>Thu\u1ed1c \u0111\u01b0\u1ee3c lo\u1ea1i tr\u1eeb ho\u00e0n to\u00e0n qua th\u1eadn. <\/span>Th\u1eddi gian b\u00e1n h\u1ee7y trong huy\u1ebft t\u01b0\u01a1ng kho\u1ea3ng 13h, nh\u01b0ng th\u1eddi gian b\u00e1n h\u1ee7y \u2013 th\u1ea3i tr\u1eeb d\u00e0i h\u01a1n nhi\u1ec1u, kho\u1ea3ng 30h. <\/span>Sau khi u\u1ed1ng, thu\u1ed1c b\u1eaft \u0111\u1ea7u c\u00f3 t\u00e1c d\u1ee5ng sau 2 \u2013 4h, \u0111\u1ea7u t\u00e1c d\u1ee5ng 4 \u2013 8h, t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i trong 24 \u2013 30h.<\/span><\/span><\/p>\n

\u00a03.3. Li\u1ec1u d\u00f9ng<\/span>:<\/span><\/span><\/h3>\n

3.3.1 Suy tim:<\/span><\/span><\/h4>\n

Kh\u1edfi \u0111\u1ea7u 2,5 mg\/24h, t\u0103ng nh\u1eb9 sau v\u00e0i tu\u1ea7n \u0111\u1ebfn 5 \u2013 20 mg x 1 l\u1ea7n\/24h. <\/span>Li\u1ec1u t\u1ed1i \u0111a t\u1ed1i \u0111a 30 mg\/24h, m\u1ed9t v\u00e0i t\u00e1c gi\u1ea3 nh\u1eadn th\u1ea5y li\u1ec1u > 20 mg\/24h kh\u00f4ng l\u00e0m h\u1ea1 huy\u1ebft \u00e1p th\u00eam. <\/span>Trong nghi\u00ean c\u1ee9u ATLAS, c\u00e1c t\u00e1c gi\u1ea3 nh\u1eadn gi\u1ea3 ph\u00e1t hi\u1ec7n 30 \u2013 35 mg l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 t\u00e1i sinh nh\u1eadp vi\u1ec7n so v\u1edbi 2,5 \u2013 5 mg, tuy nhi\u00ean t\u1ef7 l\u1ec7 t\u1eed vong chung l\u1ea1i kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a.<\/span><\/span><\/p>\n

3.3.2 T\u0103ng huy\u1ebft \u00e1p:<\/span><\/span><\/h4>\n

Li\u1ec1u: 5 \u2013 20 mg\/24h t\u00f9y theo m\u1ee9c huy\u1ebft \u00e1p ban \u0111\u1ea7u, gi\u1edbi h\u1ea1n t\u1ed1i \u0111a 40 mg\/24h.<\/span><\/span><\/p>\n

\u00a04. Perindopril<\/span><\/span><\/h2>\n

4.1. <\/span>T\u00ean th\u01b0\u01a1ng m\u1ea1i: <\/span><\/span><\/h3>\n

Coversyl (Anh), Aceon (M\u1ef9). <\/span>H\u00e0m l\u01b0\u1ee3ng: 2 mg; <\/span>4 mg; <\/span>8mg ho\u1eb7c Coversyl 5mg, 10mg. <\/span>(Perindopril c\u00f3 hai d\u1ea1ng mu\u1ed1i l\u00e0 tert-butylamin ho\u1eb7c arginine d\u1eabn \u0111\u1ebfn c\u00f3 hai d\u1ea1ng h\u00e0m l\u01b0\u1ee3ng t\u01b0\u01a1ng \u1ee9ng l\u00e0 4mg v\u00e0 5mg)<\/span><\/span><\/p>\n

4.2. <\/span>D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc<\/span><\/span><\/h3>\n