{"id":20976,"date":"2023-04-14T20:56:46","date_gmt":"2023-04-14T13:56:46","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=20976"},"modified":"2023-04-17T15:43:34","modified_gmt":"2023-04-17T08:43:34","slug":"uc-che-he-raa-va-cac-chong-chi-dinh-tuong-tac-thuoc","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/uc-che-he-raa-va-cac-chong-chi-dinh-tuong-tac-thuoc\/","title":{"rendered":"\u1ee8c ch\u1ebf h\u1ec7 RAA v\u00e0 c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, t\u01b0\u01a1ng t\u00e1c thu\u1ed1c"},"content":{"rendered":"

\u1ee8c ch\u1ebf h\u1ec7 RAA l\u00e0 t\u00e1c \u0111\u1ed9ng l\u00ean h\u1ec7 RAA \u0111\u00e3 ra \u0111\u1eddi v\u00e0 \u0111\u1ebfn nay \u0111\u00e3 tr\u1edf th\u00e0nh nh\u1eefng thu\u1ed1c n\u1ec1n t\u1ea3ng trong \u0111i\u1ec1u tr\u1ecb suy tim, t\u0103ng huy\u1ebft \u00e1p v\u00e0 c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong d\u1ef1 ph\u00f2ng ti\u00ean ph\u00e1t v\u00e0 th\u1ee9 ph\u00e1t nhi\u1ec1u b\u1ec7nh l\u00fd tim m\u1ea1ch. Tuy nhi\u00ean, c\u00f3 nhi\u1ec1u ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c c\u1ee7a lo\u1ea1i thu\u1ed1c n\u00e0y.<\/strong><\/p>\n

1.Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/h2>\n

1.1 H\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn hai b\u00ean:<\/h3>\n

\u1ede b\u1ec7nh nh\u00e2n ch\u1ec9 c\u00f2n m\u1ed9t th\u1eadn ho\u1eb7c h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn hai b\u00ean, do h\u1ec7 th\u1ed1ng tu\u1ea7n ho\u00e0n t\u01b0\u1edbi m\u00e1u th\u1eadn ph\u1ee5 thu\u1ed9c r\u1ea5t nhi\u1ec1u v\u00e0o n\u1ed3ng \u0111\u1ed9 angiotensin II. V\u00ec v\u1eady n\u1ebfu n\u1ed3ng \u0111\u1ed9 angiotensin II b\u1ecb gi\u1ea3m \u0111\u1ed9t ng\u1ed9t s\u1ebd d\u1eabn \u0111\u1ebfn hi\u1ec7n t\u01b0\u1ee3ng gi\u00e3n mao m\u1ea1ch c\u1ea7u th\u1eadn, g\u00e2y gi\u1ea3m t\u01b0\u1edbi m\u00e1u th\u1eadn, g\u00e2y suy th\u1eadn c\u1ea5p, t\u0103ng creatinine m\u00e1u.<\/p>\n

1.2 H\u1eb9p kh\u00edt van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.<\/h3>\n

1.3 C\u00e1c b\u1ec7nh l\u00fd c\u01a1 tim:<\/h3>\n

N\u00ean tr\u00e1nh \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i g\u00e2y t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i; b\u1ec7nh c\u01a1 tim h\u1ea1n ch\u1ebf ho\u1eb7c vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft c\u00f3 t\u00ecnh tr\u1ea1ng huy\u1ebft \u00e1p th\u1ea5p do t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch g\u00e2y t\u1ee5t huy\u1ebft \u00e1p.<\/p>\n

1.4 C\u00e1c b\u1ec7nh m\u00e1u:<\/h3>\n

Thi\u1ebfu m\u00e1u n\u1eb7ng (ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi c\u00e1c thu\u1ed1c gi\u00e3n m\u1ea1ch do nguy c\u01a1 t\u1ee5t \u00e1p), ti\u1ec1n s\u1eed c\u00f3 gi\u1ea3m b\u1ea1ch c\u1ea7u trung t\u00ednh (do nguy c\u01a1 h\u1ea1 b\u1ea1ch c\u1ea7u).<\/p>\n

1.5 B\u1ec7nh porphyria.<\/h3>\n

1.6 Ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 cho con b\u00fa:<\/h3>\n

L\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh. C\u1ea7n l\u01b0u \u00fd khi \u0111i\u1ec1u tr\u1ecb c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u0103ng huy\u1ebft \u00e1p thai k\u1ef3 ho\u1eb7c ti\u1ec1n s\u1ea3n gi\u1eadt do nguy c\u01a1 g\u00e2y d\u1ecb d\u1ea1ng, qu\u00e1i thai, c\u1ea7n d\u1eebng thu\u1ed1c ngay khi nghi ng\u1edd ho\u1eb7c ch\u1ea9n \u0111o\u00e1n c\u00f3 thai.<\/p>\n

1.7 T\u0103ng kali m\u00e1u:<\/h3>\n

C\u1ea7n x\u1eed tr\u00ed t\u00ecnh tr\u1ea1ng t\u0103ng kali m\u00e1u, ng\u1eebng thu\u1ed1c khi kali m\u00e1u > 5,5 mmol\/L. Th\u1eadn tr\u1ecdng khi d\u00f9ng cho b\u1ec7nh nh\u00e2n suy th\u1eadn: Kh\u00f4ng d\u00f9ng khi creatinin m\u00e1u > 220-265 \u03bcmol\/L.<\/p>\n

2. T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n<\/h2>\n

\u00a02.1. Ho<\/h3>\n

Ho l\u00e0 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n m\u00e0 b\u1ec7nh nh\u00e2n hay than phi\u1ec1n nh\u1ea5t khi d\u00f9ng thu\u1ed1c \u01afCMC. Ph\u1ea3i m\u1ea5t m\u1ed9t th\u1eddi gian kh\u00e1 d\u00e0i, c\u00e1c nh\u00e0 khoa h\u1ecdc m\u1edbi ph\u00e1t hi\u1ec7n ra t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n n\u00e0y v\u00ec tr\u00ean th\u1ef1c t\u1ebf nh\u1eefng b\u1ec7nh nh\u00e2n suy tim c\u0169ng c\u00f3 th\u1ec3 c\u00f3 ho do \u1ee9 huy\u1ebft ph\u1ed5i. T\u1ef7 l\u1ec7 ho g\u1eb7p kh\u00e1 cao t\u1eeb 10 \u2013 15%, t\u1ef7 l\u1ec7 n\u00e0y c\u00f3 th\u1ec3 g\u1eb7p v\u1edbi t\u1ea7n su\u1ea5t nh\u1ecf h\u01a1n \u1edf m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u nh\u01b0 5,5% \u1edf nghi\u00ean c\u1ee9u HOPE.<\/p>\n

L\u01b0u \u00fd t\u00ednh ch\u1ea5t ho do t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a thu\u1ed1c \u01afCMC l\u00e0 ki\u1ec3u ho khan, ho k\u00edch th\u00edch ch\u1ee9 kh\u00f4ng ph\u1ea3i t\u00ednh ch\u1ea5t ho do co th\u1eaft ph\u1ebf qu\u1ea3n. T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n n\u00e0y l\u00e0 do thu\u1ed1c \u01afCMC l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 bradykinin v\u00e0 prostaglandin c\u00f3 trong huy\u1ebft t\u01b0\u01a1ng.<\/p>\n

M\u1ed9t s\u1ed1 c\u00e1c nghi\u00ean c\u1ee9u g\u1ee3i \u00fd c\u00f3 th\u1ec3 u\u1ed1ng th\u00eam c\u00e1c thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid (NSAIDs) \u0111\u1ec3 l\u00e0m gi\u1ea3m ho nh\u01b0ng l\u1ea1i l\u00e0m gi\u1ea3m hi\u1ec7u qu\u1ea3 h\u1ea1 huy\u1ebft \u00e1p c\u1ee7a nh\u00f3m thu\u1ed1c n\u00e0y.<\/p>\n

N\u00ean tr\u00ean th\u1ef1c t\u1ebf l\u00e2m s\u00e0ng, n\u1ebfu c\u00f3 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n n\u00e0y th\u00ec b\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c chuy\u1ec3n sang thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3.<\/p>\n

2.2. H\u1ea1 huy\u1ebft \u00e1p<\/h3>\n

Tr\u00ean b\u1ec7nh nh\u00e2n suy tim, c\u00f3 th\u1ec3 g\u1eb7p h\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf \u0111\u1ee9ng do huy\u1ebft \u00e1p th\u1ea5p, t\u00ecnh tr\u1ea1ng n\u00e0y d\u1ec5 x\u1ea3y ra khi b\u1ec7nh nh\u00e2n b\u1ecb gi\u1ea3m natri m\u00e1u, m\u1ea5t n\u01b0\u1edbc, huy\u1ebft \u00e1p n\u1ec1n th\u1ea5p ho\u1eb7c \u1edf ng\u01b0\u1eddi gi\u00e0. \u0110\u1ed1i v\u1edbi nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y c\u1ea7n gi\u1ea3m li\u1ec1u ho\u1eb7c ph\u1ea3i d\u1eebng thu\u1ed1c, kh\u00f4ng d\u00f9ng nh\u00f3m thu\u1ed1c n\u00e0y n\u1eefa.<\/p>\n

V\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng c\u1ee7a h\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf \u0111\u1ee9ng, ch\u1ec9 s\u1ed1 huy\u1ebft \u00e1p kh\u00f4ng c\u1ea7n qu\u00e1 nghi\u00eam ng\u1eb7t v\u00ec nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y th\u00edch nghi t\u1ed1t v\u1edbi m\u1ee9c huy\u1ebft \u00e1p t\u00e2m thu 80 \u2013 90 mmHg.<\/p>\n

2.3. T\u0103ng kali m\u00e1u<\/h3>\n

T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n t\u0103ng kali m\u00e1u c\u00f3 th\u1ec3 g\u1eb7p khi d\u00f9ng ph\u1ed1i h\u1ee3p thu\u1ed1c \u01afCMC v\u00e0 thu\u1ed1c kh\u00e1ng aldosteron ho\u1eb7c k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 ho\u1eb7c l\u1ee3i ti\u1ec3u gi\u1eef kali ho\u1eb7c b\u1ec7nh nh\u00e2n \u0111ang c\u00f3 suy th\u1eadn. Tuy nhi\u00ean, nghi\u00ean c\u1ee9u RALES \u0111\u00e3 ch\u1ee9ng minh s\u1ef1 an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 khi ph\u1ed1i h\u1ee3p m\u1ed9t c\u00e1ch c\u1ea9n tr\u1ecdng spironolactone li\u1ec1u th\u1ea5p v\u1edbi thu\u1ed1c \u01afCMC v\u00e0 l\u1ee3i ti\u1ec3u \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n suy tim n\u1eb7ng. C\u1ea7n ki\u1ec3m tra \u0111\u1ecbnh k\u1ef3 kali m\u00e1u v\u00ec \u0111\u00e2y l\u00e0 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong.<\/p>\n

2.4. T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n l\u00ean ch\u1ee9c n\u0103ng th\u1eadn<\/h3>\n

– T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n l\u00ean ch\u1ee9c n\u0103ng th\u1eadn c\u00f3 th\u1ec3 g\u1eb7p l\u00e0 suy th\u1eadn c\u00f3 h\u1ed3i ph\u1ee5c do t\u00ecnh tr\u1ea1ng t\u1ee5t huy\u1ebft \u00e1p l\u00e0m gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng m\u00e1u qua th\u1eadn. T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n n\u00e0y hay g\u1eb7p \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n suy tim n\u1eb7ng, m\u1ea5t natri v\u00e0 m\u1ea5t n\u01b0\u1edbc do d\u00f9ng thu\u1ed1c l\u1ee3i ti\u1ec3u ho\u1eb7c nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh th\u1eadn kh\u00e1c ho\u1eb7c b\u1ec7nh l\u00fd h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn.<\/p>\n

– Suy th\u1eadn bi\u1ec3u hi\u1ec7n b\u1eb1ng t\u0103ng creatinine m\u00e1u c\u00f3 th\u1ec3 ph\u1ee5c h\u1ed3i v\u00ec sau \u0111\u00f3 c\u00f3 gi\u1ea3m s\u1ee9c c\u1ea3n ngo\u1ea1i vi do thu\u1ed1c s\u1ebd l\u00e0m t\u0103ng cung l\u01b0\u1ee3ng tim v\u00e0 cung l\u01b0\u1ee3ng th\u1eadn \u0111\u1ec3 b\u1ea3o \u0111\u1ea3m m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn v\u00e0 creatinine m\u00e1u s\u1ebd tr\u1edf l\u1ea1i b\u00ecnh th\u01b0\u1eddng. Hi\u1ebfm g\u1eb7p b\u1ec7nh nh\u00e2n b\u1ecb suy th\u1eadn kh\u00f4ng h\u1ed3i ph\u1ee5c do d\u00f9ng thu\u1ed1c \u01afCMC trong tr\u01b0\u1eddng h\u1ee3p ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh l\u00e0 h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn hai b\u00ean. V\u1edbi nh\u1eefng tr\u01b0\u1eddng h\u1ee3p h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn m\u1ed9t b\u00ean, v\u1edbi l\u01b0\u1ee3ng renin tu\u1ea7n ho\u00e0n trong m\u00e1u cao, thu\u1ed1c \u01afCMC c\u00f3 th\u1ec3 g\u00e2y ra t\u1ee5t huy\u1ebft \u00e1p n\u1eb7ng h\u01a1n v\u1edbi t\u00ecnh tr\u1ea1ng thi\u1ec3u ni\u1ec7u ho\u1eb7c t\u0103ng ure huy\u1ebft. \u0110\u1ec3 tr\u00e1nh \u0111i\u1ec1u n\u00e0y x\u1ea3y ra, v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn m\u1ed9t b\u00ean n\u00ean kh\u1edfi \u0111\u1ea7u v\u1edbi li\u1ec1u th\u1ea5p. N\u1ebfu c\u00f3 t\u0103ng creatinin m\u00e1u th\u00ec ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh d\u00f9ng thu\u1ed1c, n\u1ebfu creatinine m\u00e1u ch\u1ec9 t\u0103ng nh\u1eb9 nh\u01b0ng \u1ed5n \u0111\u1ecbnh th\u00ec c\u00f3 th\u1ec3 ti\u1ebfp t\u1ee5c d\u00f9ng.<\/p>\n

2.5. Ph\u00f9 m\u1ea1ch<\/h3>\n

M\u1eb7c d\u00f9 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n n\u00e0y hi\u1ebfm g\u1eb7p (kho\u1ea3ng 0,3% trong nghi\u00ean c\u1ee9u ALLHAT, t\u0103ng l\u00ean 0,6 \u2013 1,6% \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n da \u0111en), nh\u01b0ng l\u1ea1i c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong m\u1eb7c d\u00f9 v\u1edbi t\u1ef7 l\u1ec7 r\u1ea5t th\u1ea5p (t\u1ef7 l\u1ec7 t\u1eed vong l\u00e0 0,2% \u1edf nh\u1eefng nghi\u00ean c\u1ee9u l\u1edbn tr\u00ean 12634 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c d\u00f9ng enalapril trong 24 tu\u1ea7n).<\/p>\n

Nguy\u00ean nh\u00e2n l\u00e0 do sai s\u00f3t trong qu\u00e1 tr\u00ecnh gi\u00e1ng h\u00f3a bradykinin, enzyme dipeptidyl eptidase IV tham gia trong qu\u00e1 tr\u00ecnh n\u00e0y b\u1ecb \u1ee9c ch\u1ebf b\u1edfi c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (v\u00ed d\u1ee5: sitagliptin). Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u1ea5p c\u1ee9u ph\u1ea3i nhanh ch\u00f3ng ti\u00eam d\u01b0\u1edbi da epinephrine, n\u1ebfu c\u1ea7n thi\u1ebft ph\u1ea3i \u0111\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n n\u1ebfu c\u00f3 suy h\u00f4 h\u1ea5p, d\u1eebng ngay thu\u1ed1c \u01afCMC v\u00e0 xem x\u00e9t c\u00f3 th\u1ec3 chuy\u1ec3n sang nh\u00f3m thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 thay th\u1ebf sau \u0111\u00f3.<\/p>\n

2.6. Gi\u1ea3m b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh<\/h3>\n

\u0110\u00e2y l\u00e0 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n hi\u1ebfm g\u1eb7p, \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p d\u00f9ng enalapril li\u1ec1u cao, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n suy th\u1eadn v\u00e0 nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd h\u1ec7 t\u1ea1o keo.<\/p>\n

3. T\u01b0\u01a1ng t\u00e1c thu\u1ed1c<\/h2>\n

3.1. L\u1ee3i ti\u1ec3u v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n<\/h3>\n

Khi ph\u1ed1i h\u1ee3p hai nh\u00f3m thu\u1ed1c n\u00e0y l\u00e0m gi\u1ea3m ti\u1ec1n g\u00e1nh n\u00ean b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 b\u1ecb t\u1ee5t huy\u1ebft \u00e1p ho\u1eb7c ng\u1ea5t, v\u00ec v\u1eady li\u1ec1u l\u1ee3i ti\u1ec3u th\u00f4ng th\u01b0\u1eddng ph\u1ea3i gi\u1ea3m \u0111i m\u1ed9t n\u1eeda tr\u01b0\u1edbc khi k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c \u01afCMC.<\/p>\n

3.2. Thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n v\u00e0 spironolactone ho\u1eb7c eplerenone<\/h3>\n

Nguy c\u01a1 nguy hi\u1ec3m nh\u1ea5t l\u00e0 t\u0103ng kali m\u00e1u v\u00e0 l\u00e0m t\u0103ng creatinin m\u00e1u, ch\u00ednh v\u00ec v\u1eady ph\u1ea3i x\u00e9t nghi\u1ec7m v\u1ec1 sinh h\u00f3a m\u00e1u th\u01b0\u1eddng xuy\u00ean. Kh\u00f4ng n\u00ean k\u1ebft h\u1ee3p hai nh\u00f3m thu\u1ed1c n\u00e0y khi: C\u00f3 ti\u1ec1n s\u1eed d\u00f9ng thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali. Creatinin m\u00e1u > 220 \u03bcmol\/L ho\u1eb7c m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn < 30 mL\/ph\u00fat\/1,73m2 . Kali m\u00e1u > 5 mmol\/L. Khi ph\u1ed1i h\u1ee3p, \u0111\u00f4i khi c\u1ea7n ph\u1ea3i gi\u1ea3m li\u1ec1u thu\u1ed1c \u01afCMC.<\/p>\n

3.3. Thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n v\u00e0 aspirin ho\u1eb7c thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid<\/h3>\n

Bradykinin v\u00e0 prostaglandin \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong c\u01a1 ch\u1ebf gi\u00e3n m\u1ea1ch ngo\u1ea1i vi v\u00e0 gi\u00e3n m\u1ea1ch th\u1eadn. Ch\u00ednh v\u00ec v\u1eady, c\u00e1c thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid, \u0111\u1eb7c bi\u1ec7t l\u00e0 indomethacin l\u00e0m gi\u1ea3m hi\u1ec7u qu\u1ea3 h\u1ea1 huy\u1ebft \u00e1p c\u1ee7a thu\u1ed1c \u01afCMC. C\u1ea7n ki\u1ec3m tra ch\u1ee9c n\u0103ng th\u1eadn th\u01b0\u1eddng xuy\u00ean khi d\u00f9ng ph\u1ed1i h\u1ee3p hai lo\u1ea1i thu\u1ed1c n\u00e0y. M\u1ed9t ph\u00e2n t\u00edch g\u1ed9p tr\u00ean 22000 b\u1ec7nh nh\u00e2n suy tim cho th\u1ea5y hi\u1ec7u qu\u1ea3 c\u1ee7a aspirin v\u00e0 s\u1ef1 k\u1ebft h\u1ee3p gi\u1eefa hai lo\u1ea1i thu\u1ed1c n\u00e0y kh\u00f4ng g\u00e2y t\u1eed vong. Tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng, aspirin li\u1ec1u th\u1ea5p (kho\u1ea3ng 80 mg\/24h) th\u01b0\u1eddng \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c \u01afCMC trong \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n.<\/p>\n

3.4. M\u1ed9t s\u1ed1 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c \u0111\u00e1ng ch\u00fa \u00fd kh\u00e1c<\/h3>\n

Cyclosporin: t\u0103ng nguy c\u01a1 t\u0103ng kali m\u00e1u. Lithium: nguy c\u01a1 l\u00e0m t\u0103ng lithium m\u00e1u.<\/p>\n

B\u1ec7nh vi\u1ec7n \u0110a khoa Qu\u1ed1c t\u1ebf Vinmec<\/b><\/a> c\u00f3 \u0111\u1ed9i ng\u0169 d\u01b0\u1ee3c s\u0129 d\u01b0\u1ee3c l\u00e2m s\u00e0ng v\u00e0 \u0111\u01b0a h\u1ec7 th\u1ed1ng m\u00e1y m\u00f3c, thi\u1ebft b\u1ecb hi\u1ec7n \u0111\u1ea1i \u0111\u1ea1t chu\u1ea9n v\u00e0o c\u00f4ng t\u00e1c th\u0103m kh\u00e1m, ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 c\u00e1c b\u1ec7nh l\u00fd tim m\u1ea1ch.<\/p>\n","protected":false},"excerpt":{"rendered":"

\u1ee8c ch\u1ebf h\u1ec7 RAA l\u00e0 t\u00e1c \u0111\u1ed9ng l\u00ean h\u1ec7 RAA \u0111\u00e3 ra \u0111\u1eddi v\u00e0 \u0111\u1ebfn nay \u0111\u00e3 tr\u1edf th\u00e0nh nh\u1eefng thu\u1ed1c n\u1ec1n t\u1ea3ng trong \u0111i\u1ec1u tr\u1ecb suy tim, t\u0103ng huy\u1ebft \u00e1p v\u00e0 c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong d\u1ef1 ph\u00f2ng ti\u00ean ph\u00e1t v\u00e0 th\u1ee9 ph\u00e1t nhi\u1ec1u b\u1ec7nh l\u00fd tim m\u1ea1ch. Tuy nhi\u00ean, c\u00f3 nhi\u1ec1u ch\u1ed1ng […]<\/p>\n","protected":false},"author":7,"featured_media":20984,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[3],"yoast_head":"\n\u1ee8c ch\u1ebf h\u1ec7 RAA v\u00e0 c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, t\u01b0\u01a1ng t\u00e1c thu\u1ed1c -<\/title>\n<meta name=\"description\" content=\"\u1ee8c ch\u1ebf h\u1ec7 RAA v\u00e0 c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, t\u01b0\u01a1ng t\u00e1c thu\u1ed1c l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. Tham kh\u1ea3o b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y \u0111\u1ec3 n\u1eafm r\u00f5\" \/>\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=\"\u1ee8c ch\u1ebf h\u1ec7 RAA v\u00e0 c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, t\u01b0\u01a1ng t\u00e1c thu\u1ed1c -\" \/>\n<meta property=\"og:description\" content=\"\u1ee8c ch\u1ebf h\u1ec7 RAA v\u00e0 c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, t\u01b0\u01a1ng t\u00e1c thu\u1ed1c l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. Tham kh\u1ea3o b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y \u0111\u1ec3 n\u1eafm r\u00f5\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/uc-che-he-raa-va-cac-chong-chi-dinh-tuong-tac-thuoc\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-14T13:56:46+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-04-17T08:43:34+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/thuoc-uc-che-men-chuyen-593f3.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"500\" \/>\n\t<meta property=\"og:image:height\" content=\"375\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"7 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/uc-che-he-raa-va-cac-chong-chi-dinh-tuong-tac-thuoc\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/uc-che-he-raa-va-cac-chong-chi-dinh-tuong-tac-thuoc\/\",\"name\":\"\u1ee8c ch\u1ebf h\u1ec7 RAA v\u00e0 c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, t\u01b0\u01a1ng t\u00e1c thu\u1ed1c -\",\"isPartOf\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-04-14T13:56:46+00:00\",\"dateModified\":\"2023-04-17T08:43:34+00:00\",\"author\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/dded5c0d4cb1bb77d05cf29ab5f85629\"},\"description\":\"\u1ee8c ch\u1ebf h\u1ec7 RAA v\u00e0 c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, t\u01b0\u01a1ng t\u00e1c thu\u1ed1c l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. Tham kh\u1ea3o b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y \u0111\u1ec3 n\u1eafm r\u00f5\",\"breadcrumb\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/uc-che-he-raa-va-cac-chong-chi-dinh-tuong-tac-thuoc\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/uc-che-he-raa-va-cac-chong-chi-dinh-tuong-tac-thuoc\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/uc-che-he-raa-va-cac-chong-chi-dinh-tuong-tac-thuoc\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"http:\/\/noithathoaphat.in\/ctv\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"\u1ee8c ch\u1ebf h\u1ec7 RAA v\u00e0 c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, t\u01b0\u01a1ng t\u00e1c thu\u1ed1c\"}]},{\"@type\":\"WebSite\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/\",\"name\":\"Vinmec\",\"description\":\"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"http:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/dded5c0d4cb1bb77d05cf29ab5f85629\",\"name\":\"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/\",\"url\":\"http:\/\/2.gravatar.com\/avatar\/50f51f67852bc7e49c0b8b60a1fefe3e?s=96&d=mm&r=g\",\"contentUrl\":\"http:\/\/2.gravatar.com\/avatar\/50f51f67852bc7e49c0b8b60a1fefe3e?s=96&d=mm&r=g\",\"caption\":\"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i\"},\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/viettai304-304gmail-com\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"\u1ee8c ch\u1ebf h\u1ec7 RAA v\u00e0 c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, t\u01b0\u01a1ng t\u00e1c thu\u1ed1c -","description":"\u1ee8c ch\u1ebf h\u1ec7 RAA v\u00e0 c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, t\u01b0\u01a1ng t\u00e1c thu\u1ed1c l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. Tham kh\u1ea3o b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y \u0111\u1ec3 n\u1eafm r\u00f5","robots":{"index":"noindex","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"og_locale":"en_US","og_type":"article","og_title":"\u1ee8c ch\u1ebf h\u1ec7 RAA v\u00e0 c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, t\u01b0\u01a1ng t\u00e1c thu\u1ed1c -","og_description":"\u1ee8c ch\u1ebf h\u1ec7 RAA v\u00e0 c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, t\u01b0\u01a1ng t\u00e1c thu\u1ed1c l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. Tham kh\u1ea3o b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y \u0111\u1ec3 n\u1eafm r\u00f5","og_url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/uc-che-he-raa-va-cac-chong-chi-dinh-tuong-tac-thuoc\/","og_site_name":"Vinmec","article_published_time":"2023-04-14T13:56:46+00:00","article_modified_time":"2023-04-17T08:43:34+00:00","og_image":[{"width":500,"height":375,"url":"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/thuoc-uc-che-men-chuyen-593f3.jpg","type":"image\/jpeg"}],"author":"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i","twitter_card":"summary_large_image","twitter_misc":{"Written by":"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i","Est. reading time":"7 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/uc-che-he-raa-va-cac-chong-chi-dinh-tuong-tac-thuoc\/","url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/uc-che-he-raa-va-cac-chong-chi-dinh-tuong-tac-thuoc\/","name":"\u1ee8c ch\u1ebf h\u1ec7 RAA v\u00e0 c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, t\u01b0\u01a1ng t\u00e1c thu\u1ed1c -","isPartOf":{"@id":"http:\/\/noithathoaphat.in\/ctv\/#website"},"datePublished":"2023-04-14T13:56:46+00:00","dateModified":"2023-04-17T08:43:34+00:00","author":{"@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/dded5c0d4cb1bb77d05cf29ab5f85629"},"description":"\u1ee8c ch\u1ebf h\u1ec7 RAA v\u00e0 c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, t\u01b0\u01a1ng t\u00e1c thu\u1ed1c l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. Tham kh\u1ea3o b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y \u0111\u1ec3 n\u1eafm r\u00f5","breadcrumb":{"@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/uc-che-he-raa-va-cac-chong-chi-dinh-tuong-tac-thuoc\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/uc-che-he-raa-va-cac-chong-chi-dinh-tuong-tac-thuoc\/"]}]},{"@type":"BreadcrumbList","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/uc-che-he-raa-va-cac-chong-chi-dinh-tuong-tac-thuoc\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"http:\/\/noithathoaphat.in\/ctv\/"},{"@type":"ListItem","position":2,"name":"\u1ee8c ch\u1ebf h\u1ec7 RAA v\u00e0 c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, t\u01b0\u01a1ng t\u00e1c thu\u1ed1c"}]},{"@type":"WebSite","@id":"http:\/\/noithathoaphat.in\/ctv\/#website","url":"http:\/\/noithathoaphat.in\/ctv\/","name":"Vinmec","description":"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"http:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/dded5c0d4cb1bb77d05cf29ab5f85629","name":"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/","url":"http:\/\/2.gravatar.com\/avatar\/50f51f67852bc7e49c0b8b60a1fefe3e?s=96&d=mm&r=g","contentUrl":"http:\/\/2.gravatar.com\/avatar\/50f51f67852bc7e49c0b8b60a1fefe3e?s=96&d=mm&r=g","caption":"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i"},"url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/viettai304-304gmail-com\/"}]}},"_links":{"self":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/20976"}],"collection":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/comments?post=20976"}],"version-history":[{"count":2,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/20976\/revisions"}],"predecessor-version":[{"id":23327,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/20976\/revisions\/23327"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/media\/20984"}],"wp:attachment":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/media?parent=20976"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/categories?post=20976"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/tags?post=20976"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}