{"id":21091,"date":"2023-04-15T15:55:13","date_gmt":"2023-04-15T08:55:13","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21091"},"modified":"2023-04-17T16:10:19","modified_gmt":"2023-04-17T09:10:19","slug":"nifedipine-va-cac-van-de-trong-thuc-hanh","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/nifedipine-va-cac-van-de-trong-thuc-hanh\/","title":{"rendered":"Nifedipine v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 trong th\u1ef1c h\u00e0nh"},"content":{"rendered":"

Nifedipine c\u00f3 kh\u1ea3 n\u0103ng l\u00e0m gi\u00e3n m\u1ea1ch ngo\u1ea1i vi nhanh ch\u00f3ng, nh\u1edd \u0111\u00f3 h\u1ea1 c\u01a1n t\u0103ng huy\u1ebft \u00e1p n\u1eb7ng v\u00e0 ch\u1ea5m d\u1ee9t c\u01a1n co th\u1eaft m\u1ea1ch v\u00e0nh. Vi\u00ean nang nifedipine c\u00f3 t\u00e1c d\u1ee5ng ng\u1eafn \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u \u0111\u1ea7u ti\u00ean \u1edf ch\u00e2u \u00c2u v\u00e0 Nh\u1eadt B\u1ea3n l\u00e0 Adalat, v\u00e0 sau \u0111\u00f3 tr\u1edf th\u00e0nh thu\u1ed1c v\u1edbi t\u00ean bi\u1ec7t d\u01b0\u1ee3c procardia b\u00e1n ch\u1ea1y nh\u1ea5t t\u1ea1i M\u1ef9<\/strong>.<\/p>\n

1<\/strong>. Gi\u1edbi thi\u1ec7u chung <\/strong><\/h2>\n

Nifedipine c\u00f3 kh\u1ea3 n\u0103ng l\u00e0m gi\u00e3n m\u1ea1ch ngo\u1ea1i vi nhanh ch\u00f3ng, nh\u1edd \u0111\u00f3 h\u1ea1 c\u01a1n t\u0103ng huy\u1ebft \u00e1p n\u1eb7ng v\u00e0 ch\u1ea5m d\u1ee9t c\u01a1n co th\u1eaft m\u1ea1ch v\u00e0nh. Vi\u00ean nang nifedipine c\u00f3 t\u00e1c d\u1ee5ng ng\u1eafn \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u \u0111\u1ea7u ti\u00ean \u1edf ch\u00e2u \u00c2u v\u00e0 Nh\u1eadt B\u1ea3n l\u00e0 Adalat, v\u00e0 sau \u0111\u00f3 tr\u1edf th\u00e0nh thu\u1ed1c v\u1edbi t\u00ean bi\u1ec7t d\u01b0\u1ee3c procardia b\u00e1n ch\u1ea1y nh\u1ea5t t\u1ea1i M\u1ef9. \u1ede th\u1eddi \u0111i\u1ec3m ban \u0111\u1ea7u thu\u1ed1c \u0111\u01b0\u1ee3c cho l\u00e0 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb c\u01a1 b\u1ea3n \u0111au th\u1eaft ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh, nh\u1ea5t l\u00e0 b\u1ec7nh nh\u00e2n co th\u1eaft m\u1ea1ch v\u00e0nh.<\/p>\n

Tuy nhi\u00ean, t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch ngo\u1ea1i vi v\u00e0 h\u1ea1 huy\u1ebft \u00e1p nhanh ch\u00f3ng d\u1eabn \u0111\u1ebfn t\u0103ng nh\u1ecbp tim ph\u1ea3n x\u1ea1 do ho\u1ea1t h\u00f3a h\u1ec7 giao c\u1ea3m, v\u00ec th\u1ebf c\u00f3 th\u1ec3 g\u00e2y thi\u1ebfu m\u00e1u c\u01a1 tim, t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n nghi\u00eam tr\u1ecdng n\u00e0y d\u1eabn t\u1edbi ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh s\u1eed d\u1ee5ng thu\u1ed1c trong c\u01a1n \u0111au th\u1eaft ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh. Ng\u00e0y nay, vi\u00ean nang nifedipine t\u00e1c d\u1ee5ng ng\u1eafn ch\u1ec9 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh ch\u1ecdn l\u1ecdc \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u01a1n co th\u1eaft \u0111\u1ed9ng m\u1ea1ch v\u00e0nh ho\u1eb7c hi\u1ec7n t\u01b0\u1ee3ng Raynaud. Hi\u1ec7n nay c\u00e1c DHP \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn l\u00e0 c\u00e1c thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i.<\/p>\n

2<\/strong>. Ch\u1ec9 \u0111\u1ecbnh l\u00e2m s\u00e0ng<\/strong><\/h2>\n

2.1 <\/strong>T\u0103ng huy\u1ebft \u00e1p <\/strong><\/h3>\n

C\u00e1c nifedipine t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i do hi\u1ec7u qu\u1ea3 h\u1ea1 \u00e1p t\u1ed1t v\u00e0 \u00edt t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n nghi\u00eam tr\u1ecdng. Nghi\u00ean c\u1ee9u INSIGHT s\u1eed d\u1ee5ng nifedipine GITS cho th\u1ea5y t\u1ef7 l\u1ec7 t\u1eed vong v\u00e0 c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch ch\u00ednh t\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u nh\u01b0ng \u00edt b\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, g\u00fat ho\u1eb7c b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean h\u01a1n trong khi t\u1ef7 l\u1ec7 suy tim l\u1ea1i nhi\u1ec1u h\u01a1n.<\/p>\n

Li\u1ec1u d\u00f9ng 30-60 mg (d\u1ea1ng gi\u1ea3i ph\u00f3ng ch\u1eadm \u2013 extended release) u\u1ed1ng m\u1ed9t l\u1ea7n\/24h, c\u00f3 th\u1ec3 t\u0103ng li\u1ec1u sau 7-14 ng\u00e0y, kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 90mg\/24h (Adalat LA) ho\u1eb7c 120mg\/24h (Nifedipin XL, Procardia XL).<\/p>\n

2.2 <\/strong>H\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n<\/strong><\/h3>\n

Nghi\u00ean c\u1ee9u ACTION (n = 7800) tr\u00ean b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh \u1ed5n \u0111\u1ecbnh, 80% b\u1ec7nh nh\u00e2n \u0111\u00e3 nh\u1eadn \u0111i\u1ec1u tr\u1ecb ch\u1eb9n beta, l\u1ee3i \u00edch ch\u00ednh c\u1ee7a vi\u1ec7c ph\u1ed1i h\u1ee3p th\u00eam nifedipine t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i l\u00e0 l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 suy tim, \u00edt ph\u1ea3i ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh v\u00e0 ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u ch\u1ee7 v\u00e0nh h\u01a1n. Trong nghi\u00ean c\u1ee9u h\u1ed3i c\u1ee9u \u1edf b\u1ec7nh nh\u00e2n THA (HA kh\u1edfi \u0111i\u1ec3m 151\/85 mmHg gi\u1ea3m xu\u1ed1ng 136\/78 mmHg), suy tim m\u1edbi xu\u1ea5t hi\u1ec7n gi\u1ea3m 38% v\u00e0 \u0111\u1ed9t qu\u1ef5 m\u1ee9c \u0111\u1ed9 n\u1eb7ng gi\u1ea3m 32%, kh\u00f4ng thay \u0111\u1ed5i t\u1eed vong do tim m\u1ea1ch. Trong khi nifedipine d\u1ea1ng vi\u00ean nang t\u00e1c d\u1ee5ng ng\u1eafn l\u00e0m t\u0103ng nh\u1ecbp tim c\u00f3 th\u1ec3 l\u00e0m n\u1eb7ng th\u00eam c\u01a1n \u0111au th\u1eaft ng\u1ef1c th\u00ec c\u00e1c ch\u1ebf ph\u1ea9m gi\u1ea3i ph\u00f3ng ch\u1eadm khi\u1ebfn nh\u1ecbp tim kh\u00f4ng thay \u0111\u1ed5i, c\u00f3 t\u00e1c d\u1ee5ng ch\u1ed1ng \u0111au th\u1eaft ng\u1ef1c v\u00e0 m\u1ee9c \u0111\u1ed9 an to\u00e0n x\u1ea5p x\u1ec9 b\u1eb1ng v\u1edbi c\u00e1c thu\u1ed1c ch\u1eb9n beta. Li\u1ec1u kh\u1edfi \u0111\u1ea7u 30-60 mg m\u1ed9t l\u1ea7n\/24h (d\u1ea1ng gi\u1ea3i ph\u00f3ng ch\u1eadm), c\u00f3 th\u1ec3 t\u0103ng li\u1ec1u sau 7-14 ng\u00e0y, kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 120 mg\/24h.<\/p>\n

2.3 <\/strong>C\u01a1n Prinzmetal: <\/strong><\/h3>\n

Nifedipine l\u00e0m gi\u1ea3m tri\u1ec7u ch\u1ee9ng \u0111au. Thu\u1ed1c kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o trong h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p. C\u00e1c ch\u1ec9 \u0111\u1ecbnh kh\u00e1c<\/p>\n

2.4 <\/strong>Hi\u1ec7n t\u01b0\u1ee3ng Raynaud: <\/strong><\/h3>\n

Li\u1ec1u 30 \u2013 120 mg (d\u1ea1ng gi\u1ea3i ph\u00f3ng ch\u1eadm) \u0111\u01b0\u1eddng u\u1ed1ng m\u1ed9t l\u1ea7n\/24h.<\/p>\n

2.5 <\/strong>T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i: <\/strong><\/h3>\n

u\u1ed1ng 30 mg (d\u1ea1ng gi\u1ea3i ph\u00f3ng ch\u1eadm) m\u1ed7i 12h, c\u00f3 th\u1ec3 t\u0103ng t\u1edbi 120-240 mg\/24h (c\u1ea7n theo d\u00f5i s\u00e1t).<\/p>\n

3<\/strong>. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 th\u1eadn tr\u1ecdng <\/strong><\/h2>\n

3.1 <\/strong>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh: <\/strong><\/h3>\n
    \n
  • Qu\u00e1 m\u1eabn v\u1edbi nifedipine v\u00e0 c\u00e1c thu\u1ed1c ch\u1eb9n k\u00eanh canxi kh\u00e1c.<\/li>\n
  • S\u1ed1c tim, suy tim c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng ho\u1eb7c suy ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i, t\u1ee5t huy\u1ebft \u00e1p.<\/li>\n
  • H\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 kh\u00edt, b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i c\u00f3 t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i.<\/li>\n
  • \u0110au ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh, nh\u1ed3i m\u00e1u c\u01a1 tim. D\u1ea1ng gi\u1ea3i ph\u00f3ng t\u1ee9c th\u00ec (ng\u1eadm d\u01b0\u1edbi l\u01b0\u1ee1i, u\u1ed1ng) kh\u00f4ng c\u00f2n \u0111\u01b0\u1ee3c d\u00f9ng cho \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p c\u1ea5p c\u1ee9u hay kh\u1ea9n tr\u01b0\u01a1ng.<\/li>\n<\/ul>\n

    Ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c chuy\u1ec3n ho\u00e1 m\u1ea1nh qua enzym CYP3A4 (rifampicin, rifabutin, phenobarbital, phenytoin, carbamazepine) l\u00e0m gi\u1ea3m hi\u1ec7u qu\u1ea3 c\u1ee7a nifedipine.<\/p>\n

    3.2 <\/strong>Th\u1eadn tr\u1ecdng: <\/strong><\/h3>\n

    S\u1eed d\u1ee5ng th\u1eadn tr\u1ecdng n\u1ebfu s\u1eed d\u1ee5ng trong v\u00f2ng 4 tu\u1ea7n sau NMCT. Suy gan, suy th\u1eadn. B\u1ec7nh nh\u00e2n x\u01a1 gan c\u1ea7n xem x\u00e9t gi\u1ea3m li\u1ec1u. Th\u1eadn tr\u1ecdng khi ph\u1ed1i h\u1ee3p v\u1edbi quinidine. C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf CYP3A (ketoconazole, uconazole, clarithromycin, erythromycin, n\u01b0\u1edbc b\u01b0\u1edfi, saquinavir\u2026) c\u00f3 th\u1ec3 \u1ee9c ch\u1ebf chuy\u1ec3n ho\u00e1 nifedipine l\u00e0m t\u0103ng t\u00e1c d\u1ee5ng khi d\u00f9ng ph\u1ed1i h\u1ee3p. D\u1ea1ng gi\u1ea3i ph\u00f3ng ch\u1eadm c\u00f3 ch\u1ee9a lactose kh\u00f4ng n\u00ean d\u00f9ng \u1edf b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh l\u00fd kh\u00f4ng dung n\u1ea1p v\u1edbi lactose.<\/p>\n

    Nifedipine t\u00e1c d\u1ee5ng ng\u1eafn k\u00e9m an to\u00e0n h\u01a1n c\u00e1c thu\u1ed1c ch\u1eb9n k\u00eanh canxi kh\u00e1c trong \u0111i\u1ec1u tr\u1ecb \u0111au ng\u1ef1c, t\u0103ng huy\u1ebft \u00e1p. Tr\u00e1nh s\u1eed d\u1ee5ng d\u1ea1ng ph\u00f3ng th\u00edch nhanh \u1edf b\u1ec7nh nh\u00e2n cao tu\u1ed5i do nguy c\u01a1 t\u1ee5t \u00e1p v\u00e0 g\u00e2y thi\u1ebfu m\u00e1u c\u01a1 tim. B\u1ec7nh nh\u00e2n b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i kh\u00f4ng c\u00f3 t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i c\u0169ng c\u1ea7n th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng do gi\u1ea3m h\u1eadu g\u00e1nh c\u00f3 th\u1ec3 l\u00e0m n\u1eb7ng th\u00eam tri\u1ec7u ch\u1ee9ng. \u1ede b\u1ec7nh nh\u00e2n c\u00f3 thai, nifedipine ch\u1ec9 n\u00ean s\u1eed d\u1ee5ng khi l\u1ee3i \u00edch \u0111\u01b0\u1ee3c cho l\u00e0 l\u1edbn h\u01a1n nguy c\u01a1 (nguy c\u01a1 thai k\u1ef3 lo\u1ea1i C).<\/p>\n

    4<\/strong>. T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n <\/strong><\/h2>\n
      \n
    • T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n nghi\u00eam tr\u1ecdng x\u1ea3y ra li\u00ean quan \u0111\u1ebfn gi\u1ea3m co b\u00f3p c\u01a1 tim n\u1ebfu d\u00f9ng \u1edf b\u1ec7nh nh\u00e2n r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i. Hi\u1ebfm khi g\u1eb7p t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n h\u1ea1 huy\u1ebft \u00e1p qu\u00e1 m\u1ee9c g\u00e2y thi\u1ebfu m\u00e1u c\u01a1 quan, c\u1ee5 th\u1ec3 l\u00e0 thi\u1ebfu m\u00e1u c\u01a1 tim ho\u1eb7c th\u1eadm ch\u00ed nh\u1ed3i m\u00e1u, thi\u1ebfu m\u00e1u n\u00e3o v\u00e0 v\u00f5ng m\u1ea1c, suy th\u1eadn.<\/li>\n
    • C\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n th\u01b0\u1eddng g\u1eb7p li\u00ean quan \u0111\u1ebfn t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch: ph\u00f9 m\u1eaft c\u00e1 ch\u00e2n (nh\u01b0ng kh\u00f4ng ph\u1ea3i do suy tim) g\u1eb7p \u1edf 10-30% ; n\u1ebfu c\u1ea7n, c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1ch gi\u1ea3m li\u1ec1u, d\u00f9ng thu\u1ed1c l\u1ee3i ti\u1ec3u th\u00f4ng th\u01b0\u1eddng ho\u1eb7c ph\u1ed1i h\u1ee3p \u1ee9c ch\u1ebf men chuy\u1ec3n.<\/li>\n<\/ul>\n

      Nifedipine t\u1ef1 n\u00f3 c\u0169ng c\u00f3 t\u00e1c d\u1ee5ng l\u1ee3i ti\u1ec3u nh\u1eb9. C\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n kh\u00e1c: hoa m\u1eaft, ch\u00f3ng m\u1eb7t (23-27%), \u0111\u1ecf b\u1eebng m\u1eb7t, \u0111au \u0111\u1ea7u (10-23%), n\u00f3ng ng\u1ef1c (11%), bu\u1ed3n n\u00f4n (11%). C\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n \u00edt g\u1eb7p kh\u00e1c bao g\u1ed3m: chu\u1ed9t r\u00fat, \u0111au c\u01a1, h\u1ea1 kali m\u00e1u (th\u00f4ng qua t\u00e1c d\u1ee5ng l\u1ee3i ti\u1ec3u), ho (6%), t\u00e1o b\u00f3n<\/p>\n","protected":false},"excerpt":{"rendered":"

      Nifedipine c\u00f3 kh\u1ea3 n\u0103ng l\u00e0m gi\u00e3n m\u1ea1ch ngo\u1ea1i vi nhanh ch\u00f3ng, nh\u1edd \u0111\u00f3 h\u1ea1 c\u01a1n t\u0103ng huy\u1ebft \u00e1p n\u1eb7ng v\u00e0 ch\u1ea5m d\u1ee9t c\u01a1n co th\u1eaft m\u1ea1ch v\u00e0nh. Vi\u00ean nang nifedipine c\u00f3 t\u00e1c d\u1ee5ng ng\u1eafn \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u \u0111\u1ea7u ti\u00ean \u1edf ch\u00e2u \u00c2u v\u00e0 Nh\u1eadt B\u1ea3n l\u00e0 Adalat, v\u00e0 sau \u0111\u00f3 tr\u1edf th\u00e0nh thu\u1ed1c v\u1edbi t\u00ean […]<\/p>\n","protected":false},"author":7,"featured_media":21102,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[12,33],"tags":[3],"yoast_head":"\nNifedipine v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 trong th\u1ef1c h\u00e0nh - Vinmec<\/title>\n<meta name=\"description\" content=\"Nifedipine v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 trong th\u1ef1c h\u00e0nh l\u00e0 v\u1ea5n \u0111\u1ec1 \u0111\u01b0\u1ee3c quan t\u00e2m trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tim m\u1ea1ch. 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