{"id":20967,"date":"2023-04-14T20:47:07","date_gmt":"2023-04-14T13:47:07","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=20967"},"modified":"2023-04-18T18:01:17","modified_gmt":"2023-04-18T11:01:17","slug":"thuoc-chen-beta-chong-chi-dinh-va-than-trong","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/thuoc-chen-beta-chong-chi-dinh-va-than-trong\/","title":{"rendered":"Thu\u1ed1c ch\u1eb9n beta ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 th\u1eadn tr\u1ecdng"},"content":{"rendered":"<p><strong>Thu\u1ed1c ch\u1eb9n beta c\u00e1c th\u1ebf h\u1ec7 l\u1ea7n l\u01b0\u1ee3t ra \u0111\u1eddi v\u1edbi m\u1ee9c \u0111\u1ed9 ch\u1ecdn l\u1ecdc th\u1ee5 th\u1ec3 ng\u00e0y c\u00e0ng cao, c\u00f9ng v\u1edbi c\u00e1c b\u1eb1ng ch\u1ee9ng thuy\u1ebft ph\u1ee5c qua c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng tr\u00ean nhi\u1ec1u \u0111\u1ed1i t\u01b0\u1ee3ng b\u1ec7nh l\u00fd tim m\u1ea1ch nh\u01b0 t\u0103ng huy\u1ebft \u00e1p, r\u1ed1i lo\u1ea1n nh\u1ecbp tim\u2026 \u0111\u00e3 cho th\u1ea5y vai tr\u00f2 to l\u1edbn v\u00e0 kh\u00f4ng th\u1ec3 thi\u1ebfu c\u1ee7a thu\u1ed1c ch\u1eb9n beta trong k\u1ef7 nguy\u00ean tim m\u1ea1ch hi\u1ec7n \u0111\u1ea1i, tuy nhi\u00ean c\u1ea7n n\u1eafm v\u1eefng c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee7a lo\u1ea1i thu\u1ed1c n\u00e0y.<\/strong><\/p>\n<p><strong>1. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/strong><\/p>\n<p><strong>1.1 <\/strong><strong>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tuy\u1ec7t \u0111\u1ed1i: <\/strong><\/p>\n<ul>\n<li>Nh\u1ecbp tim ch\u1eadm.<\/li>\n<li>Block nh\u0129 th\u1ea5t \u0111\u1ed9 cao.<\/li>\n<li>Suy tim c\u00f3 r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng.<\/li>\n<li>S\u1ed1c tim.<\/li>\n<li>C\u01a1n hen ph\u1ebf qu\u1ea3n ho\u1eb7c co th\u1eaft ph\u1ebf qu\u1ea3n n\u1eb7ng.<\/li>\n<li>B\u1ec7nh m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean n\u1eb7ng n\u1ec1 v\u1edbi tri\u1ec7u ch\u1ee9ng \u0111au do thi\u1ebfu m\u00e1u ngay c\u1ea3 khi ngh\u1ec9 ng\u01a1i.<\/li>\n<li>Tr\u1ea7m c\u1ea3m n\u1eb7ng.<\/li>\n<\/ul>\n<p><strong>1.2 <\/strong><strong>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh t\u01b0\u01a1ng \u0111\u1ed1i: <\/strong><\/p>\n<ul>\n<li>Kho\u1ea3ng PR &gt; 0,24 gi\u00e2y.<\/li>\n<li>Huy\u1ebft \u00e1p t\u00e2m thu &lt; 100 mmHg.<\/li>\n<li>Bi\u1ec3u hi\u1ec7n gi\u1ea3m t\u01b0\u1edbi m\u00e1u chi.<\/li>\n<li>H\u1ed9i ch\u1ee9ng Raynaud.<\/li>\n<li>\u0110au ng\u1ef1c do co th\u1eaft m\u1ea1ch v\u00e0nh.<\/li>\n<li>\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng ph\u1ee5 thu\u1ed9c Insulin v\u1edbi bi\u1ec3u hi\u1ec7n h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft th\u01b0\u1eddng xuy\u00ean.<\/li>\n<li>COPD m\u1ee9c \u0111\u1ed9 n\u1eb7ng.<\/li>\n<\/ul>\n<p><strong>2. Th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng<\/strong><\/p>\n<p><strong>2.1 B\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh<\/strong><\/p>\n<p>S\u1eed d\u1ee5ng ch\u1eb9n beta \u1edf b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh (COPD) l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e0n lu\u1eadn nhi\u1ec1u, nh\u1ea5t l\u00e0 khi COPD l\u00e0 b\u1ec7nh \u0111\u1ed3ng m\u1eafc kh\u00e1 ph\u1ed5 bi\u1ebfn. Vi\u1ec7c s\u1eed d\u1ee5ng ch\u1eb9n beta th\u01b0\u1eddng \u1edf m\u1ee9c d\u01b0\u1edbi t\u1ed1i \u01b0u do lo ng\u1ea1i s\u1ef1 x\u1ea5u \u0111i c\u1ee7a ch\u1ee9c n\u0103ng ph\u1ed5i. D\u1ef1a tr\u00ean c\u00e1c b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng hi\u1ec7n t\u1ea1i, ch\u1eb9n beta c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng cho nh\u1eefng b\u1ec7nh nh\u00e2n COPD n\u1ebfu c\u00f3 nh\u1eefng ch\u1ec9 \u0111\u1ecbnh tim m\u1ea1ch r\u00f5 r\u00e0ng, ngay c\u1ea3 khi COPD m\u1ee9c \u0111\u1ed9 n\u1eb7ng. K\u1ebft qu\u1ea3 t\u1eeb nhi\u1ec1u nghi\u00ean c\u1ee9u t\u1ed5ng h\u1ee3p meta \u2013 analysis \u0111\u00e1nh gi\u00e1 \u1ea3nh h\u01b0\u1edfng ch\u1eb9n beta tr\u00ean ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p c\u0169ng cho th\u1ea5y kh\u00f4ng c\u00f3 kh\u00e1c bi\u1ec7t v\u1ec1 FEV1, FVC gi\u1eefa nh\u00f3m s\u1eed d\u1ee5ng ch\u1eb9n beta v\u00e0 nh\u00f3m s\u1eed d\u1ee5ng gi\u1ea3 d\u01b0\u1ee3c ngay c\u1ea3 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n COPD m\u1ee9c \u0111\u1ed9 n\u1eb7ng.<\/p>\n<p>Tuy nhi\u00ean, hi\u1ec7n nay ch\u01b0a c\u00f3 nhi\u1ec1u b\u1eb1ng ch\u1ee9ng \u1ee7ng h\u1ed9 cho vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c ch\u1eb9n beta \u1edf b\u1ec7nh nh\u00e2n \u0111ang trong \u0111\u1ee3t c\u1ea5p COPD. Do \u0111\u00f3 d\u01b0\u1edbi kh\u00eda c\u1ea1nh l\u00e2m s\u00e0ng, c\u1ea7n h\u1ea1n ch\u1ebf t\u1ed1i \u0111a ch\u1ec9 \u0111\u1ecbnh thu\u1ed1c ch\u1eb9n beta trong \u0111\u1ee3t c\u1ea5p COPD. Trong \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd tim m\u1ea1ch, c\u00e1c khuy\u1ebfn c\u00e1o hi\u1ec7n t\u1ea1i \u0111\u1ec1u \u01b0u ti\u00ean s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c ch\u1eb9n beta d\u1ea1ng ch\u1ecdn l\u1ecdc beta 1.<\/p>\n<p>T\u00f9y thu\u1ed9c t\u1eebng thu\u1ed1c kh\u00e1c nhau m\u00e0 t\u1ef7 l\u1ec7 ch\u1ecdn l\u1ecdc \u03b21\/\u03b22 kh\u00e1c nhau. D\u1ef1a v\u00e0o \u0111\u00f3 gi\u00fap gi\u1ea3m thi\u1ec3u t\u1ed1i \u0111a m\u1ee9c \u0111\u1ed9 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n tr\u00ean h\u00f4 h\u1ea5p.<\/p>\n<p>Carvedilol l\u00e0 m\u1ed9t nh\u00f3m thu\u1ed1c c\u00f3 nhi\u1ec1u b\u1eb1ng ch\u1ee9ng m\u1ea1nh m\u1ebd trong \u0111i\u1ec1u tr\u1ecb suy tim ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m, tuy nhi\u00ean kh\u00f4ng ch\u1ecdn l\u1ecdc beta 1 v\u00e0 c\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch th\u00f4ng qua c\u01a1 ch\u1ebf \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 alpha. C\u00e1c b\u1eb1ng ch\u1ee9ng hi\u1ec7n nay kh\u00f4ng \u1ee7ng h\u1ed9 s\u1eed d\u1ee5ng carvedilol \u1edf b\u1ec7nh nh\u00e2n COPD v\u00ec thi\u1ebfu nhi\u1ec1u d\u1eef li\u1ec7u an to\u00e0n.<\/p>\n<p>T\u00f3m l\u1ea1i, d\u1ef1a tr\u00ean nh\u1eefng b\u1eb1ng ch\u1ee9ng hi\u1ec7n nay, ch\u1ec9 \u0111\u1ecbnh thu\u1ed1c ch\u1eb9n beta \u1edf b\u1ec7nh nh\u00e2n tim m\u1ea1ch c\u00f3 b\u1ec7nh \u0111\u1ed3ng m\u1eafc COPD v\u1eabn c\u1ea7n th\u1eadn tr\u1ecdng do t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a thu\u1ed1c \u0111\u1eb7c bi\u1ec7t tr\u00ean ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p. Do \u0111\u00f3 n\u00ean \u01b0u ti\u00ean s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c ch\u1eb9n beta d\u1ea1ng ch\u1ecdn l\u1ecdc beta 1 v\u00e0 c\u1ea7n ph\u1ea3i theo d\u00f5i r\u1ea5t s\u00e1t v\u1ec1 l\u00e2m s\u00e0ng c\u0169ng nh\u01b0 ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p, \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u th\u1eadn tr\u1ecdng c\u0169ng nh\u01b0 \u0111\u00e1nh gi\u00e1 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c v\u1edbi c\u00e1c thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n \u0111ang s\u1eed d\u1ee5ng kh\u00e1c.<\/p>\n<p><strong>2.2 \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/strong><\/p>\n<p>\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd \u0111\u1ed3ng m\u1eafc th\u01b0\u1eddng g\u1eb7p \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd tim m\u1ea1ch, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p, b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch v\u00e0nh v\u00e0 suy tim. Hi\u1ec7n nay thu\u1ed1c ch\u1eb9n beta \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng kh\u00e1 r\u1ed9ng r\u00e3i v\u00e0 c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd tim m\u1ea1ch tr\u00ean. Tuy nhi\u00ean, ch\u1ec9 \u0111\u1ecbnh tr\u00ean nh\u00f3m b\u1ec7nh nh\u00e2n k\u00e8m theo \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng c\u00f2n m\u1ed9t s\u1ed1 h\u1ea1n ch\u1ebf nh\u1ea5t \u0111\u1ecbnh do nh\u1eefng lo ng\u1ea1i v\u1ec1 kh\u1ea3 n\u0103ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft, \u0111\u1ed3ng th\u1eddi gia t\u0103ng nguy c\u01a1 h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, r\u1ed1i lo\u1ea1n lipid m\u00e1u v\u00e0 t\u0103ng m\u1ee9c \u0111\u1ec1 kh\u00e1ng Insulin.<\/p>\n<p>Tuy nhi\u00ean ch\u1eb9n beta l\u00e0 m\u1ed9t nh\u00f3m thu\u1ed1c kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t, nh\u1eefng thu\u1ed1c v\u1edbi m\u1ee9c \u0111\u1ed9 ch\u1ecdn l\u1ecdc tr\u00ean tim kh\u00e1c nhau s\u1ebd c\u00f3 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n \u1edf nh\u1eefng m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau. Kh\u00f4ng nh\u1eefng v\u1eady, m\u1ed9t s\u1ed1 b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng c\u00f2n cho th\u1ea5y nh\u1eefng t\u00e1c d\u1ee5ng n\u00e0y c\u00f2n ph\u1ee5 thu\u1ed9c v\u00e0o li\u1ec1u \u0111i\u1ec1u tr\u1ecb, ch\u1ebf \u0111\u1ed9 thu\u1ed1c s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p. Thu\u1ed1c ch\u1eb9n beta \u0111\u01b0\u1ee3c cho r\u1eb1ng l\u00e0m t\u0103ng nguy c\u01a1 h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft do t\u00e1c \u0111\u1ed9ng \u0111\u1ed1i kh\u00e1ng catecholamine, d\u1eabn t\u1edbi l\u00e0m lu m\u1edd c\u00e1c tri\u1ec7u ch\u1ee9ng b\u00e1o hi\u1ec7u (warning signs) c\u1ee7a c\u01a1n h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft nh\u01b0 run tay, nh\u1ecbp nhanh\u2026 khi\u1ebfn cho c\u00e1c b\u00e1c s\u0129 kh\u00f3 ph\u00e1t hi\u1ec7n s\u1edbm t\u00ecnh tr\u1ea1ng h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft.<\/p>\n<p>Tuy nhi\u00ean, v\u1ea5n \u0111\u1ec1 n\u00e0y \u00edt th\u1ea5y tr\u00ean th\u1ef1c t\u1ebf l\u00e2m s\u00e0ng do h\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh nh\u00e2n tim m\u1ea1ch \u0111\u1ec1u \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c thu\u1ed1c ch\u1eb9n beta nh\u00f3m ch\u1ecdn l\u1ecdc th\u1ee5 th\u1ec3 beta 1. K\u1ebft qu\u1ea3 t\u1eeb nhi\u1ec1u nghi\u00ean c\u1ee9u l\u1edbn nh\u01b0 MERIT \u2013 HF, CIBIS II, hay COPERNICUS \u0111\u00e3 ch\u1ee9ng minh t\u00ednh an to\u00e0n c\u0169ng nh\u01b0 hi\u1ec7u qu\u1ea3 c\u1ee7a c\u00e1c thu\u1ed1c ch\u1eb9n beta \u1edf b\u1ec7nh nh\u00e2n suy tim.<\/p>\n<p>H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb c\u1ee7a ESC n\u0103m 2019 khuy\u1ebfn c\u00e1o thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m c\u00f9ng v\u1edbi thu\u1ed1c nh\u00f3m \u1ee9c ch\u1ebf men chuy\u1ec3n v\u1eabn l\u00e0 nh\u1eefng ch\u1ec9 \u0111\u1ecbnh \u0111\u1ea7u tay \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb suy tim c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m k\u00e8m \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng nh\u1eb1m l\u00e0m gi\u1ea3m nguy c\u01a1 nh\u1eadp vi\u1ec7n v\u00e0 t\u1eed vong, v\u1edbi m\u1ee9c ch\u1ec9 \u0111\u1ecbnh lo\u1ea1i I, m\u1ee9c b\u1eb1ng ch\u1ee9ng A. Trong khi \u0111\u00f3, \u1edf b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p k\u00e8m theo \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, thu\u1ed1c ch\u1eb9n beta ch\u01b0a ch\u1ee9ng minh \u0111\u01b0\u1ee3c vai tr\u00f2 \u01b0u vi\u1ec7t trong ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p. H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb n\u0103m 2018 c\u1ee7a ESC nh\u1eadn \u0111\u1ecbnh, ch\u1eb9n beta kh\u00f4ng ph\u1ea3i l\u00e0 \u01b0u ti\u00ean h\u00e0ng \u0111\u1ea7u \u0111\u1ec3 h\u1ea1 huy\u1ebft \u00e1p \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng. Trong tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ec9 \u0111\u1ecbnh d\u00f9ng thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m, c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc nebivolol v\u00ec t\u00ednh ch\u1ea5t dung n\u1ea1p t\u1ed1t, \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc beta-1, \u00edt g\u00e2y \u1ea3nh h\u01b0\u1edfng l\u00ean chuy\u1ec3n h\u00f3a v\u00e0 t\u00ecnh tr\u1ea1ng kh\u00e1ng insulin.<\/p>\n<p><strong>2.3 B\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean<\/strong><\/p>\n<p>B\u1ec7nh \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi do h\u1eb9p \u2013 t\u1eafc h\u1ec7 \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi, do s\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a m\u1ea3ng v\u1eefa x\u01a1 m\u00e0 bi\u1ec3u hi\u1ec7n tr\u00ean l\u00e2m s\u00e0ng th\u01b0\u1eddng l\u00e0 c\u00e1c c\u01a1n \u0111au c\u00e1ch h\u1ed3i. Tr\u01b0\u1edbc \u0111\u00e2y, v\u1eabn c\u00f2n nhi\u1ec1u lo ng\u1ea1i v\u00ec s\u1eed d\u1ee5ng ch\u1eb9n beta c\u00f3 th\u1ec3 g\u00e2y co th\u1eaft m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean, g\u00e2y gi\u1ea3m t\u01b0\u1edbi m\u00e1u \u1edf nh\u1eefng tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi \u0111\u1eb7c bi\u1ec7t l\u00e0 giai \u0111o\u1ea1n c\u00f3 thi\u1ebfu m\u00e1u chi tr\u1ea7m tr\u1ecdng. Tuy nhi\u00ean, trong nh\u1eefng nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y \u0111\u00e3 cho th\u1ea5y kh\u00f4ng ghi nh\u1eadn \u0111\u01b0\u1ee3c nh\u1eefng t\u00e1c d\u1ee5ng b\u1ea5t l\u1ee3i r\u00f5 r\u00e0ng khi s\u1eed d\u1ee5ng thu\u1ed1c ch\u1eb9n beta \u1edf b\u1ec7nh nh\u00e2n b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean th\u00f4ng qua c\u00e1c ti\u00eau ch\u00ed th\u1eddi gian \u0111au, qu\u00e3ng \u0111\u01b0\u1eddng \u0111i b\u1ed9, m\u1ee9c \u0111\u1ed9 t\u01b0\u1edbi m\u00e1u chi c\u0169ng nh\u01b0 s\u1ee9c c\u1ea3n m\u1ea1ch chi. K\u1ebft qu\u1ea3 t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u c\u00f3 \u0111\u1ed1i ch\u1ee9ng, \u0111a trung t\u00e2m kh\u00e1c c\u0169ng \u0111\u00e3 ch\u1ee9ng minh t\u00ednh an to\u00e0n c\u1ee7a ch\u1eb9n beta \u1edf b\u1ec7nh nh\u00e2n b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi, ngay c\u1ea3 \u1edf giai \u0111o\u1ea1n thi\u1ebfu m\u00e1u chi tr\u1ea7m tr\u1ecdng.<\/p>\n<p>T\u00f3m l\u1ea1i, m\u1eb7c d\u00f9 c\u00f3 m\u1ed9t s\u1ed1 t\u00e1c d\u1ee5ng d\u01b0\u1ee3c l\u00fd c\u1ee7a thu\u1ed1c ch\u1eb9n beta tr\u00ean m\u1ea1ch m\u00e1u nh\u01b0ng nh\u1eefng t\u00e1c \u0111\u1ed9ng n\u00e0y kh\u00f4ng l\u00e0m \u1ea3nh h\u01b0\u1edfng x\u1ea5u \u0111\u1ebfn ti\u00ean l\u01b0\u1ee3ng \u1edf b\u1ec7nh nh\u00e2n b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean, \u0111i\u1ec1u n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh qua nhi\u1ec1u nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng. Tuy nhi\u00ean, v\u1eabn c\u1ea7n theo d\u00f5i s\u00e1t tr\u00ean l\u00e2m s\u00e0ng khi s\u1eed d\u1ee5ng, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh \u0111ang trong giai \u0111o\u1ea1n thi\u1ebfu m\u00e1u chi tr\u1ea7m tr\u1ecdng ho\u1eb7c n\u1eb7ng h\u01a1n. d. R\u1ed1i lo\u1ea1n lipid m\u00e1u Thu\u1ed1c ch\u1eb9n beta c\u00f3 m\u1ed9t s\u1ed1 t\u00e1c \u0111\u1ed9ng b\u1ea5t l\u1ee3i tr\u00ean chuy\u1ec3n h\u00f3a lipid m\u00e1u, \u0111\u1eb7c bi\u1ec7t \u0111\u1ed1i v\u1edbi nh\u1eefng nh\u00f3m thu\u1ed1c kh\u00f4ng ch\u1ecdn l\u1ecdc tr\u00ean beta 1.<\/p>\n<p>Thu\u1ed1c c\u00f3 th\u1ec3 g\u00e2y t\u0103ng triglyceride, gi\u1ea3m HDL cholesterol. Do \u0111\u00f3, c\u1ea7n th\u1eadn tr\u1ecdng trong khi s\u1eed d\u1ee5ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n h\u1ed9i ch\u1ee9ng chuy\u1ec3n h\u00f3a ho\u1eb7c nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed r\u1ed1i lo\u1ea1n lipid m\u00e1u n\u1eb7ng n\u1ec1.<\/p>\n<p><strong>3. T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n <\/strong><\/p>\n<p><strong>3.1 <\/strong><strong>Nh\u1ecbp tim ch\u1eadm: <\/strong><\/p>\n<p>C\u00e2n nh\u1eafc gi\u1ea3m li\u1ec1u n\u1ebfu nh\u1ecbp qu\u00e1 ch\u1eadm g\u00e2y bi\u1ec3u hi\u1ec7n m\u1ec7t m\u1ecfi, gi\u1ea3m kh\u1ea3 n\u0103ng g\u1eafng s\u1ee9c.<\/p>\n<p><strong>3.2 <\/strong><strong>Block nh\u0129 th\u1ea5t: <\/strong><\/p>\n<p>Do thu\u1ed1c t\u00e1c \u0111\u1ed9ng tr\u00ean d\u1eabn truy\u1ec1n nh\u0129 th\u1ea5t. M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p s\u1eed d\u1ee5ng ch\u1eb9n beta li\u1ec1u cao c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn block nh\u0129 th\u1ea5t ho\u00e0n to\u00e0n, c\u1ea7n ph\u1ea3i can thi\u1ec7p \u0111i\u1ec1u tr\u1ecb v\u00e0 theo d\u00f5i. Block nh\u0129 th\u1ea5t c\u00f3 th\u1ec3 ph\u1ee5c h\u1ed3i l\u1ea1i b\u00ecnh th\u01b0\u1eddng sau khi ng\u1eebng thu\u1ed1c. M\u1ec7t m\u1ecfi v\u00e0 gi\u1ea3m kh\u1ea3 n\u0103ng g\u1eafng s\u1ee9c.<\/p>\n<p><strong>3.3 <\/strong><strong>L\u1ea1nh \u0111\u1ea7u chi: <\/strong><\/p>\n<p>Th\u01b0\u1eddng g\u1eb7p \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng ch\u1eb9n beta kh\u00f4ng ch\u1ecdn l\u1ecdc. M\u1ed9t s\u1ed1 \u00edt tr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n nh\u01b0 h\u1ed9i ch\u1ee9ng Raynaud, t\u00ecnh tr\u1ea1ng n\u00e0y s\u1ebd kh\u00f4ng c\u00f2n sau khi d\u1eebng thu\u1ed1c.<\/p>\n<p><strong>3.4 <\/strong><strong>Co th\u1eaft ph\u1ebf qu\u1ea3n:<\/strong><\/p>\n<p>Ch\u1ee7 y\u1ebfu g\u1eb7p \u1edf c\u00e1c nh\u00f3m thu\u1ed1c ch\u1eb9n beta kh\u00f4ng ch\u1ecdn l\u1ecdc. M\u1ed9t s\u1ed1 thu\u1ed1c l\u00e0m gi\u1ea3m FEV1 sau khi s\u1eed d\u1ee5ng. Kh\u00f4ng s\u1eed d\u1ee5ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n hen ph\u1ebf qu\u1ea3n, th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng \u1edf b\u1ec7nh nh\u00e2n COPD n\u1eb7ng.<\/p>\n<p><strong>3.5 <\/strong><strong>\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng m\u1edbi xu\u1ea5t hi\u1ec7n: <\/strong><\/p>\n<p>Do nh\u1eefng t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n tr\u00ean chuy\u1ec3n h\u00f3a, \u0111\u1eb7c bi\u1ec7t l\u00e0m r\u1ed1i lo\u1ea1n dung n\u1ea1p \u0111\u01b0\u1eddng huy\u1ebft. T\u00e1c d\u1ee5ng n\u00e0y th\u01b0\u1eddng ph\u1ee5 thu\u1ed9c nhi\u1ec1u v\u00e0o lo\u1ea1i thu\u1ed1c v\u00e0 li\u1ec1u \u0111i\u1ec1u tr\u1ecb. C\u00e1c thu\u1ed1c ch\u1ecdn l\u1ecdc th\u1ee5 th\u1ec3 beta 1 th\u01b0\u1eddng \u00edt g\u00e2y t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n tr\u00ean r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a. T\u00e1c \u0111\u1ed9ng tr\u00ean th\u1ea7n kinh trung \u01b0\u01a1ng: c\u00f3 th\u1ec3 g\u00e2y tr\u1ea7m c\u1ea3m, ng\u1ee7 m\u00ea, \u1ea3o gi\u00e1c. Ch\u1ee7 y\u1ebfu g\u1eb7p \u1edf c\u00e1c thu\u1ed1c c\u00f3 t\u00ednh ch\u1ea5t tan trong lipid, c\u00f3 th\u1ec3 v\u01b0\u1ee3t qua h\u00e0ng r\u00e0o m\u00e1u n\u00e3o v\u00e0 t\u00e1c \u0111\u1ed9ng r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n.<\/p>\n<p>Kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 t\u00ecnh tr\u1ea1ng tr\u1ea7m c\u1ea3m n\u1eb7ng. R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c: gi\u1ea3m kh\u1ea3 n\u0103ng c\u01b0\u01a1ng c\u1ee9ng. T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n n\u00e0y \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n khi s\u1eed d\u1ee5ng nebivolol do t\u00ednh ch\u1ea5t gi\u1ea3i ph\u00f3ng NO l\u00e0m c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng c\u01b0\u01a1ng c\u1ee9ng, c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c. T\u0103ng c\u00e2n: th\u01b0\u1eddng g\u1eb7p trong m\u1ed9t v\u00e0i th\u00e1ng \u0111\u1ea7u. C\u01a1 ch\u1ebf th\u1ef1c s\u1ef1 g\u00e2y t\u0103ng c\u00e2n v\u1eabn c\u00f2n nhi\u1ec1u tranh c\u00e3i, c\u00f3 th\u1ec3 c\u00f3 vai tr\u00f2 c\u1ee7a th\u1ee5 th\u1ec3 beta 2.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Thu\u1ed1c ch\u1eb9n beta c\u00e1c th\u1ebf h\u1ec7 l\u1ea7n l\u01b0\u1ee3t ra \u0111\u1eddi v\u1edbi m\u1ee9c \u0111\u1ed9 ch\u1ecdn l\u1ecdc th\u1ee5 th\u1ec3 ng\u00e0y c\u00e0ng cao, c\u00f9ng v\u1edbi c\u00e1c b\u1eb1ng ch\u1ee9ng thuy\u1ebft ph\u1ee5c qua c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng tr\u00ean nhi\u1ec1u \u0111\u1ed1i t\u01b0\u1ee3ng b\u1ec7nh l\u00fd tim m\u1ea1ch nh\u01b0 t\u0103ng huy\u1ebft \u00e1p, r\u1ed1i lo\u1ea1n nh\u1ecbp tim\u2026 \u0111\u00e3 cho th\u1ea5y vai tr\u00f2 to [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":20973,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[12,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - 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