{"id":21123,"date":"2023-04-15T15:58:35","date_gmt":"2023-04-15T08:58:35","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21123"},"modified":"2023-04-18T12:32:58","modified_gmt":"2023-04-18T05:32:58","slug":"sacubitril-valsartan-co-gi-moi-trong-thuc-hanh-lam-sang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/sacubitril-valsartan-co-gi-moi-trong-thuc-hanh-lam-sang\/","title":{"rendered":"Sacubitril\/valsartan c\u00f3 g\u00ec m\u1edbi trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng?"},"content":{"rendered":"<p><b>Sacubitril\/valsartan<\/b>\u00a0l\u00e0 m\u1ed9t\u00a0lo\u1ea1i thu\u1ed1c k\u1ebft h\u1ee3p \u0111\u1ec3 s\u1eed d\u1ee5ng trong suy tim. N\u00f3 bao g\u1ed3m c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf neprilysin sacubitril v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 angiotensin valsartan. Thu\u1ed1c \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng thay th\u1ebf cho thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n ho\u1eb7c thu\u1ed1c ch\u1eb9n th\u1ee5 th\u1ec3 angiotensin \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ecb suy tim v\u1edbi ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m.<\/p>\n<h2>1. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng<\/h2>\n<p>L\u00e0 m\u1ed9t ph\u00e2n t\u1eed ch\u1ee9a c\u1ea3 valsartan v\u00e0 ch\u1ea5t \u1ee9c ch\u1ebf neprilysin. N\u1eeda ch\u1ee9a valsartan c\u1ee7a ph\u00e2n t\u1eed \u1ee9c ch\u1ebf h\u1ec7 RAA trong khi ph\u1ea7n \u1ee9c ch\u1ebf neprilysin gi\u1ea3m s\u1ef1 gi\u00e1ng h\u00f3a c\u1ee7a peptide l\u1ee3i ni\u1ec7u type B (BNP), do \u0111\u00f3 l\u00e0m t\u0103ng v\u00f2ng \u0111\u1eddi c\u1ee7a BNP trong huy\u1ebft t\u01b0\u01a1ng.<\/p>\n<p>Sacubitril\/Valsartan (LCZ696) l\u00e0 ph\u1ed1i h\u1ee3p c\u1ee7a m\u1ed9t ch\u1ea5t \u1ee9c ch\u1ebf neprilysin (endopeptidase trung t\u00ednh; NEP) th\u00f4ng qua LBQ657, ch\u1ea5t chuy\u1ec3n h\u00f3a ho\u1ea1t \u0111\u1ed9ng c\u1ee7a ti\u1ec1n ch\u1ea5t sacubitril v\u00e0 \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3: Valsartan.<\/p>\n<p>T\u00e1c d\u1ee5ng c\u1ee7a sacubitril\/valsartan tr\u00ean b\u1ec7nh nh\u00e2n suy tim l\u00e0 l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 c\u1ee7a c\u00e1c peptide b\u1ecb tho\u00e1i h\u00f3a b\u1edfi neprilysin nh\u01b0 natriuretic peptide (NP) v\u00e0 \u1ee9c ch\u1ebf \u0111\u1ed3ng th\u1eddi t\u00e1c d\u1ee5ng c\u1ee7a angiotensin II. C\u00e1c NP ph\u00e1t huy t\u00e1c d\u1ee5ng b\u1eb1ng c\u00e1ch k\u00edch ho\u1ea1t c\u00e1c th\u1ee5 th\u1ec3 k\u1ebft h\u1ee3p guanylyl cyclase tr\u00ean m\u00e0ng t\u1ebf b\u00e0o, l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 c\u1ee7a c\u00e1c ch\u1ea5t truy\u1ec1n tin th\u1ee9 hai guanosine monophosphate (cGMP), d\u1eabn \u0111\u1ebfn gi\u00e3n m\u1ea1ch, t\u0103ng th\u1ea3i mu\u1ed1i v\u00e0 l\u1ee3i ti\u1ec3u, t\u0103ng m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn v\u00e0 l\u01b0u l\u01b0\u1ee3ng m\u00e1u th\u1eadn do \u0111\u00f3 \u1ee9c ch\u1ebf gi\u1ea3i ph\u00f3ng renin v\u00e0 aldosterone, gi\u1ea3m ho\u1ea1t \u0111\u1ed9ng giao c\u1ea3m, t\u00e1c d\u1ee5ng ch\u1ed1ng ph\u00ec \u0111\u1ea1i v\u00e0 ch\u1ed1ng qu\u00e1 tr\u00ecnh x\u01a1 h\u00f3a.<\/p>\n<h2>2. C\u00e1c b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng<\/h2>\n<p>Nghi\u00ean c\u1ee9u PARADIGM-HF, Sacubitril\/valsartan cho th\u1ea5y hi\u1ec7u qu\u1ea3 l\u00e2u d\u00e0i so v\u1edbi enalapril tr\u00ean t\u1ea5t c\u1ea3 c\u00e1c ti\u00eau ch\u00ed t\u00e1i nh\u1eadp vi\u1ec7n do \u0111\u1ee3t c\u1ea5p suy tim, t\u1ef7 l\u1ec7 t\u1eed vong tim m\u1ea1ch v\u00e0 t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n \u1edf c\u00e1c b\u1ec7nh nh\u00e2n suy tim m\u1ea1n ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m c\u00f2n tri\u1ec7u ch\u1ee9ng. Th\u1eed nghi\u1ec7m PIONEER-HF cho th\u1ea5y sacubitril\/valsartan c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng ngay t\u1eeb \u0111\u1ea7u \u1edf c\u00e1c b\u1ec7nh nh\u00e2n suy tim m\u1ea1n t\u00ednh c\u00f3 huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh ph\u1ea3i nh\u1eadp vi\u1ec7n v\u00ec \u0111\u1ee3t c\u1ea5p suy tim.<\/p>\n<h2>3. Li\u1ec1u d\u00f9ng<\/h2>\n<p>B\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng thu\u1ed1c \u01afCMC\/\u01afCTT li\u1ec1u trung b\u00ecnh ho\u1eb7c cao (&gt; 10 mg enalapril\/24h ho\u1eb7c &gt; 160 mg valsartan\/24h ho\u1eb7c t\u01b0\u01a1ng \u0111\u01b0\u01a1ng): B\u1eaft \u0111\u1ea7u v\u1edbi sacubitril\/valsartan 100 mg x 2 l\u1ea7n\/24h, t\u0103ng li\u1ec1u g\u1ea5p \u0111\u00f4i sau 2 \u2013 4 tu\u1ea7n, li\u1ec1u t\u1ed1i \u0111a 200 mg x 2 l\u1ea7n\/24h t\u00f9y dung n\u1ea1p.<\/p>\n<p>B\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng li\u1ec1u th\u1ea5p ho\u1eb7c \u0111ang kh\u00f4ng d\u00f9ng thu\u1ed1c \u01afCMC\/\u01afCTT (\u226410 mg enalapril\/24h ho\u1eb7c \u2264 160 mg valsartan\/24h ho\u1eb7c t\u01b0\u01a1ng \u0111\u01b0\u01a1ng): Kh\u1edfi \u0111\u1ea7u v\u1edbi sacubitril\/valsartan 50 mg x 2 l\u1ea7n\/24h, t\u0103ng g\u1ea5p \u0111\u00f4i li\u1ec1u sau 2 \u2013 4 tu\u1ea7n, m\u1ee5c ti\u00eau \u0111\u1ea1t li\u1ec1u 200 mg x 2 l\u1ea7n\/24h t\u00f9y theo kh\u1ea3 n\u0103ng dung n\u1ea1p.<\/p>\n<p>Li\u1ec1u d\u00f9ng m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t: Suy th\u1eadn: MLCT: 60-90 mL\/ph\u00fat\/1,73m2: Kh\u00f4ng c\u1ea7n ch\u1ec9nh li\u1ec1u. MLCT: 30-60 mL\/ph\u00fat\/1,73m2: B\u1eaft \u0111\u1ea7u b\u1eb1ng li\u1ec1u 24mg\/26mg x 2 l\u1ea7n\/24h.<\/p>\n<h2>4. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/h2>\n<ul>\n<li>Ti\u1ec1n s\u1eed ph\u00f9 m\u1ea1ch do s\u1eed d\u1ee5ng \u01afCMC ho\u1eb7c \u01afCTT.<\/li>\n<li>S\u1eed d\u1ee5ng c\u00f9ng v\u1edbi aliskiren \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng ho\u1eb7c suy th\u1eadn do nguy c\u01a1 t\u0103ng kali m\u00e1u v\u00e0 t\u1ee5t huy\u1ebft \u00e1p.<\/li>\n<li>Suy gan m\u1ee9c \u0111\u1ed9 n\u1eb7ng ho\u1eb7c x\u01a1 gan \u1ee9 m\u1eadt.<\/li>\n<li>Ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 cho con b\u00fa.<\/li>\n<li>Kh\u00f4ng s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi thu\u1ed1c \u01afCMC\/\u01afCTT, ph\u1ea3i d\u1eebng \u00edt nh\u1ea5t 36 h tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng sacubitril\/valsartan.<\/li>\n<li>Nh\u1ea1y c\u1ea3m v\u1edbi c\u00e1c th\u00e0nh ph\u1ea7n c\u1ee7a thu\u1ed1c.<\/li>\n<\/ul>\n<h2>5. C\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n th\u01b0\u1eddng g\u1eb7p v\u00e0 x\u1eed tr\u00ed<\/h2>\n<h3>5.1 Huy\u1ebft \u00e1p th\u1ea5p:<\/h3>\n<p>Kh\u00f4ng n\u00ean b\u1eaft \u0111\u1ea7u \u1edf nh\u1eefng b\u1ec7nh c\u00f3 huy\u1ebft \u00e1p t\u00e2m thu &lt;100mmHg.<\/p>\n<p>Sacubitril\/valsartan l\u00e0 m\u1ed9t lo\u1ea1i thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb suy tim v\u00e0 c\u00f3 t\u00e1c d\u1ee5ng h\u1ea1 huy\u1ebft \u00e1p b\u1eb1ng c\u00e1ch \u1ee9c ch\u1ebf h\u1ec7 th\u1ed1ng renin-angiotensin-aldosterone (RAAS) v\u00e0 \u1ee9c ch\u1ebf neprilysin. Valsartan l\u00e0 m\u1ed9t lo\u1ea1i thu\u1ed1c \u1ee9c ch\u1ebf receptor angiotensin II, m\u1ed9t ch\u1ea5t g\u00e2y co th\u1eaft m\u1ea1ch m\u00e1u v\u00e0 t\u0103ng huy\u1ebft \u00e1p. Khi valsartan \u1ee9c ch\u1ebf receptor angiotensin II, n\u00f3 gi\u00fap gi\u00e3n c\u00e1c m\u1ea1ch m\u00e1u v\u00e0 gi\u1ea3m l\u01b0\u1ee3ng ch\u1ea5t g\u00e2y co th\u1eaft n\u00e0y trong c\u01a1 th\u1ec3, gi\u00fap h\u1ea1 huy\u1ebft \u00e1p.<\/p>\n<p>Sacubitril l\u00e0 m\u1ed9t ch\u1ea5t \u1ee9c ch\u1ebf neprilysin, m\u1ed9t enzyme gi\u00fap ph\u00e2n h\u1ee7y c\u00e1c peptit vasoactitve, bao g\u1ed3m c\u1ea3 natriuretic peptide v\u00e0 bradykinin. Khi \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p v\u1edbi valsartan, sacubitril gi\u00fap t\u0103ng l\u01b0\u1ee3ng natriuretic peptide v\u00e0 bradykinin trong c\u01a1 th\u1ec3, gi\u00fap gi\u00e3n c\u00e1c m\u1ea1ch m\u00e1u v\u00e0 gi\u1ea3m huy\u1ebft \u00e1p.<\/p>\n<p>Natriuretic peptide l\u00e0 m\u1ed9t ch\u1ea5t \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t b\u1edfi t\u1ebf b\u00e0o trong tim v\u00e0 c\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch m\u00e1u v\u00e0 gi\u1ea3m huy\u1ebft \u00e1p. Bradykinin c\u0169ng c\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch m\u00e1u v\u00e0 gi\u1ea3m huy\u1ebft \u00e1p, \u0111\u1ed3ng th\u1eddi c\u00f2n l\u00e0m gi\u1ea3m vi\u00eam v\u00e0 gi\u1ea3m \u0111au.<\/p>\n<p>V\u00ec v\u1eady, Sacubitril\/valsartan gi\u00fap h\u1ea1 huy\u1ebft \u00e1p.Khi xu\u1ea5t hi\u1ec7n huy\u1ebft \u00e1p th\u1ea5p c\u1ea7n gi\u1ea3m li\u1ec1u t\u1ea1m th\u1eddi ho\u1eb7c ng\u1eebng s\u1eed d\u1ee5ng thu\u1ed1c, theo d\u00f5i huy\u1ebft \u00e1p th\u01b0\u1eddng xuy\u00ean. \u0110i\u1ec1u ch\u1ec9nh l\u1ea1i c\u00e1c thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng h\u1ea1 \u00e1p kh\u00e1c v\u00e0 t\u00ecm c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c g\u00e2y h\u1ea1 \u00e1p.<\/p>\n<h3>5.2 Ph\u00f9 m\u1ea1ch:<\/h3>\n<p>C\u01a1 ch\u1ebf ph\u00f9 m\u1ea1ch tr\u00ean b\u1ec7nh nh\u00e2n d\u00f9ng Sacubitril\/valsartan li\u00ean quan \u0111\u1ebfn t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch m\u00e1u c\u1ee7a natriuretic peptide v\u00e0 bradykinin. Natriuretic peptide l\u00e0 m\u1ed9t ch\u1ea5t \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t b\u1edfi t\u1ebf b\u00e0o trong tim v\u00e0 c\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch m\u00e1u v\u00e0 gi\u1ea3m huy\u1ebft \u00e1p. Bradykinin c\u0169ng c\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch m\u00e1u v\u00e0 gi\u1ea3m huy\u1ebft \u00e1p, \u0111\u1ed3ng th\u1eddi c\u00f2n l\u00e0m gi\u1ea3m vi\u00eam v\u00e0 gi\u1ea3m \u0111au.<\/p>\n<p>Khi ph\u00f9 m\u1ea1ch xu\u1ea5t hi\u1ec7n c\u1ea7n ng\u1eebng thu\u1ed1c ngay l\u1eadp t\u1ee9c. V\u1ecb tr\u00ed ph\u00f9 m\u1ea1ch th\u01b0\u1eddng g\u1eb7p s\u01b0ng n\u1ec1 \u1edf m\u00f4i v\u00e0 m\u1eb7t, t\u00ecnh tr\u1ea1ng n\u00e0y th\u01b0\u1eddng kh\u00f4ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb m\u1eb7c d\u00f9 thu\u1ed1c kh\u00e1ng histamin c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m tri\u1ec7u ch\u1ee9ng. Khi ph\u00f9 m\u1ea1ch \u1edf thanh qu\u1ea3n c\u00f3 th\u1ec3 \u0111e d\u1ecda t\u1edbi t\u00ednh m\u1ea1ng, c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ngay b\u1eb1ng adrenalin 1mg\/1mL ti\u00eam b\u1eafp (0,3 \u2013 0,5 mL) v\u00e0 c\u00e1c bi\u1ec7n ph\u00e1p \u0111\u1ea3m b\u1ea3o \u0111\u01b0\u1eddng th\u1edf th\u00f4ng tho\u00e1ng.<\/p>\n<h2>6.T\u01b0\u01a1ng t\u00e1c thu\u1ed1c \u01afCMC\/\u01afCTT:<\/h2>\n<p>Khi chuy\u1ec3n t\u1eeb thu\u1ed1c \u01afCMC sang Sacubitril\/valsartan ho\u1eb7c ng\u01b0\u1ee3c l\u1ea1i c\u1ea7n d\u1eebng thu\u1ed1c tr\u01b0\u1edbc \u0111\u00f3 \u00edt nh\u1ea5t 36h \u0111\u1ec3 tr\u00e1nh nguy c\u01a1 h\u1ea1 huy\u1ebft \u00e1p.<\/p>\n<ul>\n<li>Aliskiren: T\u0103ng nguy c\u01a1 t\u0103ng kali m\u00e1u v\u00e0 t\u1ee5t huy\u1ebft \u00e1p.<\/li>\n<li>Lithium: K\u1ebft h\u1ee3p hai thu\u1ed1c nguy c\u01a1 t\u0103ng n\u1ed3ng \u0111\u1ed9 lithium.<\/li>\n<\/ul>\n<p><a href=\"https:\/\/www.vinmec.com\/\"><strong>B\u1ec7nh vi\u1ec7n \u0110a khoa Qu\u1ed1c t\u1ebf Vinmec<\/strong><\/a> c\u00f3 \u0111\u1ed9i ng\u0169 D\u01b0\u1ee3c s\u0129 d\u01b0\u1ee3c l\u00e2m s\u00e0ng v\u00e0 \u0111\u00e3 \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 v\u00e0 \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 c\u00e1c b\u1ec7nh l\u00fd v\u1ec1 tim m\u1ea1ch.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Sacubitril\/valsartan\u00a0l\u00e0 m\u1ed9t\u00a0lo\u1ea1i thu\u1ed1c k\u1ebft h\u1ee3p \u0111\u1ec3 s\u1eed d\u1ee5ng trong suy tim. N\u00f3 bao g\u1ed3m c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf neprilysin sacubitril v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 angiotensin valsartan. Thu\u1ed1c \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng thay th\u1ebf cho thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n ho\u1eb7c thu\u1ed1c ch\u1eb9n th\u1ee5 th\u1ec3 angiotensin \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ecb suy tim v\u1edbi [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":21142,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Sacubitril\/valsartan c\u00f3 g\u00ec m\u1edbi trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng<\/title>\n<meta name=\"description\" content=\"Sacubitril\/valsartan l\u00e0 trong 4 nh\u00f3m thu\u1ed1c \u0111\u01b0\u1ee3c d\u00f9ng trong \u0111i\u1ec1u tr\u1ecb suy tim. 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