{"id":21156,"date":"2023-04-15T15:56:54","date_gmt":"2023-04-15T08:56:54","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21156"},"modified":"2023-04-18T12:33:15","modified_gmt":"2023-04-18T05:33:15","slug":"thuoc-beta-blocker-trong-suy-tim-va-benh-mach-vanh","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/thuoc-beta-blocker-trong-suy-tim-va-benh-mach-vanh\/","title":{"rendered":"Thu\u1ed1c beta blocker trong suy tim v\u00e0 b\u1ec7nh m\u1ea1ch v\u00e0nh"},"content":{"rendered":"

Thu\u1ed1c beta blocker 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 suy tim, b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, 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 beta blocker trong k\u1ef7 nguy\u00ean tim m\u1ea1ch hi\u1ec7n \u0111\u1ea1i.<\/strong><\/p>\n

1. Suy tim<\/strong><\/h2>\n

Suy tim l\u00e0 m\u1ed9t qu\u00e1 tr\u00ecnh ti\u1ebfn tri\u1ec3n kh\u1edfi \u0111\u1ea7u t\u1eeb sau m\u1ed9t bi\u1ebfn c\u1ed1 l\u00e0m t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim d\u1eabn \u0111\u1ebfn m\u1ea5t ch\u1ee9c n\u0103ng c\u00e1c t\u1ebf b\u00e0o c\u01a1 tim ho\u1eb7c m\u1ea5t kh\u1ea3 n\u0103ng t\u1ea1o ra co b\u00f3p hi\u1ec7u qu\u1ea3.<\/p>\n

1.1<\/strong> C<\/strong>\u01a1 ch\u1ebf b\u00f9 tr\u1eeb trong suy tim: <\/strong><\/h3>\n
    \n
  • Ho\u1ea1t h\u00f3a h\u1ec7 th\u1ea7n kinh giao c\u1ea3m l\u00e0 m\u1ed9t c\u01a1 ch\u1ebf b\u00f9 tr\u1eeb do gi\u1ea3m cung l\u01b0\u1ee3ng tim v\u00e0 \u0111\u00f3ng vai tr\u00f2 h\u1ebft s\u1ee9c quan tr\u1ecdng trong qu\u00e1 tr\u00ecnh sinh l\u00fd b\u1ec7nh c\u1ee7a suy tim. T\u0103ng tr\u01b0\u01a1ng l\u1ef1c h\u1ec7 giao c\u1ea3m s\u1ebd d\u1eabn t\u1edbi l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 norepinephrine trong tu\u1ea7n ho\u00e0n, ho\u1ea1t h\u00f3a receptor beta1<\/li>\n
  • T\u00ecnh tr\u1ea1ng t\u0103ng ho\u1ea1t h\u00f3a th\u1ee5 th\u1ec3 beta 1 d\u1eabn t\u1edbi t\u1ea7n s\u1ed1 tim t\u0103ng, \u0111\u1ed3ng th\u1eddi t\u0103ng s\u1ee9c co b\u00f3p c\u01a1 tim v\u00e0 t\u0103ng cung l\u01b0\u1ee3ng tim.<\/li>\n
  • T\u0103ng nhu c\u1ea7u oxy c\u01a1 tim: D\u01b0\u1edbi t\u00e1c \u0111\u1ed9ng c\u1ee7a t\u0103ng nh\u1ecbp tim v\u00e0 s\u1ee9c co b\u00f3p c\u01a1 tim nh\u1eb1m duy tr\u00ec cung l\u01b0\u1ee3ng tim v\u00e0 huy\u1ebft \u00e1p.<\/li>\n
  • T\u0103ng tr\u01b0\u01a1ng l\u1ef1c h\u1ec7 giao c\u1ea3m c\u00f2n k\u00edch th\u00edch th\u1ee5 th\u1ec3 alpha 1 l\u00e0m co m\u1ea1ch \u1edf ngo\u1ea1i bi\u00ean.<\/li>\n
  • T\u0103ng tr\u01b0\u01a1ng l\u1ef1c giao c\u1ea3m m\u1ea1n t\u00ednh: d\u1eabn t\u1edbi h\u1eadu qu\u1ea3 l\u00e0m ph\u00ec \u0111\u1ea1i c\u01a1 tim, ho\u1ea1i t\u1eed m\u1ea1n t\u00ednh, ch\u1ebft t\u1ebf b\u00e0o c\u01a1 tim theo ch\u01b0\u01a1ng tr\u00ecnh v\u00e0 x\u01a1 h\u00f3a c\u01a1 tim.<\/li>\n<\/ul>\n

    Ph\u1ed1i h\u1ee3p v\u1edbi c\u01a1 ch\u1ebf c\u01b0\u1eddng ho\u1ea1t h\u00f3a h\u1ec7 renin \u2013 angiotensin trong suy tim, c\u01b0\u1eddng h\u1ec7 giao c\u1ea3m g\u00f3p ph\u1ea7n quan tr\u1ecdng trong qu\u00e1 tr\u00ecnh ti\u1ebfn tri\u1ec3n v\u00e0 t\u00e1i c\u1ea5u tr\u00fac c\u01a1 tim (remodeling), d\u1eabn t\u1edbi suy gi\u1ea3m ch\u1ee9c n\u0103ng tim ti\u1ebfn tri\u1ec3n, x\u01a1 h\u00f3a c\u01a1 tim, gi\u00e3n c\u00e1c th\u00e0nh tim.<\/p>\n

    V\u1edbi c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a beta blocker giao c\u1ea3m \u0111\u00e3 \u0111\u1ec1 c\u1eadp \u1edf ph\u1ea7n tr\u00ean, c\u00e1c nh\u00f3m thu\u1ed1c beta blocker t\u00e1c \u0111\u1ed9ng tr\u00ean c\u00e1c th\u1ee5 th\u1ec3 beta, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c th\u1ee5 th\u1ec3 beta 1 tr\u00ean tim, gi\u00fap c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng co b\u00f3p c\u01a1 tim, gi\u1ea3m nh\u1ecbp tim, ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p, h\u1ea1n ch\u1ebf c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp trong suy tim. C\u00e1c d\u1eef li\u1ec7u t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng cho th\u1ea5y thu\u1ed1c beta blocker giao c\u1ea3m \u0111\u00f3ng m\u1ed9t vai tr\u00f2 quan tr\u1ecdng v\u00e0 n\u1ec1n t\u1ea3ng trong \u0111i\u1ec1u tr\u1ecb suy tim m\u1ea1n t\u00ednh.<\/p>\n

    T\u1ea5t c\u1ea3 c\u00e1c th\u1eed nghi\u1ec7m v\u1ec1 thu\u1ed1c beta blocker \u0111\u1ec1 c\u1eadp \u0111\u1ec1u cho th\u1ea5y thu\u1ed1c c\u1ea3i thi\u1ec7n r\u00f5 r\u1ec7t t\u1ef7 l\u1ec7 t\u1eed vong v\u00e0 t\u00e1i nh\u1eadp vi\u1ec7n do suy tim, \u0111\u1eb7c bi\u1ec7t \u1edf suy tim c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m.<\/p>\n

    1.2 Li\u1ec1u d\u00f9ng beta blocker trong suy tim<\/strong><\/h3>\n

    Tuy nhi\u00ean, kh\u00f4ng ph\u1ea3i t\u1ea5t c\u1ea3 c\u00e1c thu\u1ed1c beta blocker \u0111\u1ec1u c\u00f3 hi\u1ec7u qu\u1ea3 tr\u00ean suy tim. C\u00e1c b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng cho th\u1ea5y, ch\u1ec9 4 thu\u1ed1c trong nh\u00f3m beta blocker \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t trong \u0111i\u1ec1u tr\u1ecb suy tim, bao g\u1ed3m metoprolol, bisoprolol, carvedilol v\u00e0 nebivolol.<\/p>\n

    Trong \u0111\u00f3, nebivolol ch\u1ec9 \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t trong khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb suy tim c\u1ee7a H\u1ed9i tim m\u1ea1ch ch\u00e2u \u00c2u \u2013 ESC 2016. Cho t\u1edbi th\u1eddi \u0111i\u1ec3m hi\u1ec7n t\u1ea1i, Tr\u01b0\u1eddng m\u00f4n Tim m\u1ea1ch Hoa K\u1ef3 \u2013 ACC ch\u01b0a \u0111\u01b0a nebivolol v\u00e0o trong danh m\u1ee5c c\u00e1c thu\u1ed1c beta blocker \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o trong \u0111i\u1ec1u tr\u1ecb suy tim.<\/p>\n

    \u0110\u1ed1i v\u1edbi suy tim c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u (EF) b\u1ea3o t\u1ed3n, vai tr\u00f2 c\u1ee7a beta blocker v\u1eabn c\u00f2n nhi\u1ec1u tranh lu\u1eadn. D\u1ef1a tr\u00ean c\u00e1c b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng hi\u1ec7n t\u1ea1i, thu\u1ed1c beta blocker c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i v\u00e0 ti\u00ean l\u01b0\u1ee3ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n suy tim EF gi\u1ea3m v\u00e0 nh\u1ecbp xoang nh\u01b0ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n suy tim c\u00f3 EF b\u1ea3o t\u1ed3n, thu\u1ed1c beta blocker kh\u00f4ng l\u00e0m gi\u1ea3m t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n c\u0169ng nh\u01b0 t\u1eed vong do nguy\u00ean nh\u00e2n tim m\u1ea1ch. Do \u0111\u00f3, c\u1ea3 ESC v\u00e0 AHA \u0111\u1ec1u \u0111\u1ed3ng thu\u1eadn trong khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb suy tim EF b\u1ea3o t\u1ed3n v\u1ec1 vi\u1ec7c kh\u00f4ng s\u1eed d\u1ee5ng thu\u1ed1c beta blocker giao c\u1ea3m m\u1ed9t c\u00e1ch th\u01b0\u1eddng quy cho t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n v\u1edbi m\u1ee5c \u0111\u00edch c\u1ea3i thi\u1ec7n t\u1ef7 l\u1ec7 t\u1eed vong hay c\u1ea3i thi\u1ec7n ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh.<\/p>\n

    C\u1ea7n th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng thu\u1ed1c beta blocker trong tr\u01b0\u1eddng h\u1ee3p suy tim c\u1ea5p m\u1ea5t b\u00f9, suy tim sung huy\u1ebft. Thu\u1ed1c beta blocker t\u00e1c \u0111\u1ed9ng \u1ee9c ch\u1ebf h\u1ec7 giao c\u1ea3m, h\u1ea1n ch\u1ebf c\u00e1c ph\u1ea3n x\u1ea1 giao c\u1ea3m b\u00f9 tr\u1eeb trong \u0111\u1ee3t c\u1ea5p c\u1ee7a suy tim, do \u0111\u00f3 c\u00f3 th\u1ec3 khi\u1ebfn t\u00ecnh tr\u1ea1ng suy tim n\u1eb7ng l\u00ean trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p nh\u01b0 suy tim n\u1eb7ng ho\u1eb7c shock tim. Tuy nhi\u00ean, trong m\u1ed9t ph\u00e2n t\u00edch g\u1ed9p n\u0103m 2015 tr\u00ean kho\u1ea3ng 3000 b\u1ec7nh nh\u00e2n nh\u1eb1m so s\u00e1nh gi\u1eefa hai nh\u00f3m b\u1ec7nh nh\u00e2n \u0111\u1ee3t c\u1ea5p c\u1ee7a suy tim \u0111\u01b0\u1ee3c ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb ho\u1eb7c ng\u1eebng thu\u1ed1c beta blocker giao c\u1ea3m. K\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u cho th\u1ea5y nh\u00f3m ng\u1eebng \u0111i\u1ec1u tr\u1ecb c\u00f3 ti\u00ean l\u01b0\u1ee3ng x\u1ea5u h\u01a1n, th\u1eadm ch\u00ed c\u00f2n t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong n\u1ed9i vi\u1ec7n, t\u1ef7 l\u1ec7 t\u1eed vong ng\u1eafn h\u1ea1n v\u00e0 t\u1ef7 l\u1ec7 t\u00e1i nh\u1eadp vi\u1ec7n.<\/p>\n

    Khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb suy tim hi\u1ec7n h\u00e0nh c\u1ee7a ESC v\u00e0 AHA \u0111\u1ec1u \u0111\u1ed3ng thu\u1eadn vi\u1ec7c duy tr\u00ec s\u1eed d\u1ee5ng beta blocker trong \u0111\u1ee3t c\u1ea5p c\u1ee7a suy tim, tr\u1eeb tr\u01b0\u1eddng h\u1ee3p suy tim n\u1eb7ng r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng ho\u1eb7c shock tim.<\/p>\n

    2<\/strong>. B\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch v\u00e0nh <\/strong><\/h2>\n

    B\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch v\u00e0nh l\u00e0 m\u1ed9t qu\u00e1 tr\u00ecnh di\u1ec5n bi\u1ebfn \u0111\u1ed9ng, m\u1ea3ng x\u01a1 v\u1eefa c\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n l\u1edbn d\u1ea7n v\u00e0 g\u00e2y h\u1eb9p t\u1eafc \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, xen k\u1ebd c\u00e1c giai \u0111o\u1ea1n kh\u00f4ng \u1ed5n \u0111\u1ecbnh do n\u1ee9t v\u1ee1 m\u1ea3ng x\u01a1 v\u1eefa m\u00e0 h\u1eadu qu\u1ea3 l\u00e0 nh\u1eefng bi\u1ebfn c\u1ed1 c\u1ea5p t\u00ednh nh\u01b0 nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p hay c\u00e1c c\u01a1n \u0111au th\u1eaft ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u1eed vong. D\u1ef1a tr\u00ean t\u00ednh ch\u1ea5t t\u01b0\u01a1ng \u0111\u1ed1i \u201c\u1ed5n \u0111\u1ecbnh\u201d ho\u1eb7c kh\u00f4ng \u1ed5n \u0111\u1ecbnh c\u1ee7a m\u1ea3ng x\u01a1 v\u1eefa m\u00e0 bi\u1ec3u hi\u1ec7n tr\u00ean l\u00e2m s\u00e0ng l\u00e0 h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n hay h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p.<\/p>\n

    2.1<\/strong>. Ch\u1ec9 \u0111\u1ecbnh thu\u1ed1c beta blocker trong h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p <\/strong><\/h3>\n

    V\u1edbi t\u00e1c d\u1ee5ng d\u01b0\u1ee3c l\u00fd l\u00e0m gi\u1ea3m t\u1ea7n s\u1ed1 tim, gi\u1ea3m co b\u00f3p c\u01a1 tim v\u00e0 g\u00f3p ph\u1ea7n ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p, thu\u1ed1c beta blocker gi\u00fap l\u00e0m gi\u1ea3m nhu c\u1ea7u ti\u00eau th\u1ee5 oxy c\u01a1 tim, \u0111\u1ed3ng th\u1eddi t\u0103ng t\u01b0\u1edbi m\u00e1u c\u01a1 tim do k\u00e9o d\u00e0i th\u1eddi k\u1ef3 t\u00e2m tr\u01b0\u01a1ng. Kh\u00f4ng nh\u1eefng v\u1eady, thu\u1ed1c beta blocker c\u00f2n l\u00e0m gi\u1ea3m t\u00ednh t\u1ef1 \u0111\u1ed9ng, t\u0103ng ng\u01b0\u1ee1ng k\u00edch th\u00edch c\u01a1 tim, \u1ee9c ch\u1ebf th\u1ea7n kinh giao c\u1ea3m, do \u0111\u00f3 h\u1ea1n ch\u1ebf c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp nguy hi\u1ec3m c\u00f3 nguy c\u01a1 bi\u1ec3u hi\u1ec7n trong giai \u0111o\u1ea1n c\u1ea5p c\u1ee7a nh\u1ed3i m\u00e1u c\u01a1 tim nh\u01b0 c\u00e1c c\u01a1n nh\u1ecbp nhanh th\u1ea5t, rung th\u1ea5t. Thu\u1ed1c beta blocker c\u00f2n \u0111\u01b0\u1ee3c cho l\u00e0 c\u00f3 vai tr\u00f2 hi\u1ec7p \u0111\u1ed3ng \u1ee9c ch\u1ebf k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u v\u00e0 t\u1ed5ng h\u1ee3p thromboxane, gi\u1ea3m ti\u1ebfn tri\u1ec3n c\u1ee7a m\u1ea3ng x\u01a1 v\u1eefa m\u1ea1ch v\u00e0nh.<\/p>\n

    Ng\u00e0y nay, c\u00e1c b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng hi\u1ec7n t\u1ea1i \u0111\u00e3 ch\u1ee9ng minh vai tr\u00f2 quan tr\u1ecdng c\u1ee7a thu\u1ed1c beta blocker trong \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p. Khuy\u1ebfn c\u00e1o m\u1edbi nh\u1ea5t hi\u1ec7n nay c\u1ee7a H\u1ed9i tim m\u1ea1ch ch\u00e2u \u00c2u (ESC) v\u00e0 H\u1ed9i tim m\u1ea1ch Hoa K\u1ef3 (AHA) \u0111\u1ec1u th\u1ed1ng nh\u1ea5t s\u1eed d\u1ee5ng beta blocker giao c\u1ea3m s\u1edbm trong \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p k\u00e8m theo suy tim EF < 40%. Beta blocker c\u0169ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng th\u01b0\u1eddng quy ngay trong th\u1eddi gian n\u1eb1m vi\u1ec7n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u c\u01a1 tim n\u1ebfu kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh.<\/p>\n

    Tuy nhi\u00ean, nh\u1eefng l\u1ee3i \u00edch c\u1ee7a thu\u1ed1c beta blocker \u0111\u00e3 c\u00f3 nhi\u1ec1u thay \u0111\u1ed5i trong k\u1ef7 nguy\u00ean can thi\u1ec7p m\u1ea1ch v\u00e0nh qua da (PCI). PCI \u0111\u00e3 \u0111em l\u1ea1i nh\u1eefng l\u1ee3i \u00edch r\u1ea5t to l\u1edbn, ng\u0103n ng\u1eeba ngay t\u1eeb \u0111\u1ea7u t\u1ed5n th\u01b0\u01a1ng ti\u00ean ph\u00e1t \u1edf c\u01a1 tim. B\u00ean c\u1ea1nh \u0111\u00f3, vai tr\u00f2 c\u1ee7a li\u1ec7u ph\u00e1p kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u, thu\u1ed1c \u1ee9c ch\u1ebf h\u1ec7 th\u1ed1ng renin \u2013 angiotensin, statin v\u00e0 c\u1ea3 \u0111i\u1ec1u tr\u1ecb ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng tim m\u1ea1ch sau nh\u1ed3i m\u00e1u c\u01a1 tim c\u0169ng gi\u00fap c\u1ea3i thi\u1ec7n v\u00e0 ph\u1ee5c h\u1ed3i m\u1ea1nh m\u1ebd c\u00e1c t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim sau nh\u1ed3i m\u00e1u khi\u1ebfn hi\u1ec7u qu\u1ea3 c\u1ee7a thu\u1ed1c beta blocker d\u01b0\u1eddng nh\u01b0 kh\u00f4ng c\u00f2n qu\u00e1 \u201cm\u1ea1nh m\u1ebd\u201d nh\u01b0 so v\u1edbi tr\u01b0\u1edbc th\u1eddi k\u1ef3 can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.<\/p>\n

    2.2.1 <\/strong>Thu\u1ed1c v\u00e0 li\u1ec1u l\u01b0\u1ee3ng: <\/strong><\/h4>\n

    Trong h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p ch\u1ec9 c\u1ea7n s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c beta blocker \u0111\u01b0\u1eddng u\u1ed1ng, trong \u0111\u00f3 \u01b0u ti\u00ean c\u00e1c thu\u1ed1c ch\u1eb9n ch\u1ecdn l\u1ecdc th\u1ee5 th\u1ec3 beta 1 nh\u01b0 metoprolol, bisoprolol hay atenolol.<\/p>\n

      \n
    • Metoprolol 25 \u2013 50 mg m\u1ed7i 6 \u2013 12h. Atenolol 25 \u2013 50 mg m\u1ed7i 12h. Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 c\u1ea7n ch\u1ec9 \u0111\u1ecbnh beta blocker giao c\u1ea3m \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch, c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn metoprolol ho\u1eb7c atenolol.N\u1ebfu b\u1ec7nh nh\u00e2n dung n\u1ea1p \u0111\u01b0\u1ee3c li\u1ec1u t\u0129nh m\u1ea1ch, n\u00ean b\u1eaft \u0111\u1ea7u s\u1edbm b\u1eb1ng li\u1ec1u beta blocker \u0111\u01b0\u1eddng u\u1ed1ng sau \u0111\u00f3.<\/li>\n
    • Metoprolol tartrate truy\u1ec1n t\u0129nh m\u1ea1ch ch\u1eadm, kh\u1edfi \u0111\u1ea7u 5 mg (5 mg m\u1ed7i 1 \u2013 2 ph\u00fat), sau \u0111\u00f3 c\u00f3 th\u1ec3 nh\u1eafc l\u1ea1i sau m\u1ed7i 5 ph\u00fat cho t\u1ed5ng li\u1ec1u kh\u1edfi \u0111\u1ea7u 15 mg.<\/li>\n
    • Atenolol 5 mg truy\u1ec1n t\u0129nh m\u1ea1ch v\u00e0 nh\u1eafc l\u1ea1i li\u1ec1u 5 mg sau 5 ph\u00fat.<\/li>\n<\/ul>\n

      2.2<\/strong>. Ch\u1ec9 \u0111\u1ecbnh thu\u1ed1c beta blocker trong h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n<\/strong><\/h3>\n

      Thu\u1ed1c beta blocker l\u00e0m gi\u1ea3m t\u1ea7n s\u1ed1 tim v\u00e0 co b\u00f3p c\u01a1 tim, gi\u1ea3m s\u1ee9c c\u0103ng th\u00e0nh t\u00e2m th\u1ea5t do \u0111\u00f3 l\u00e0m gi\u1ea3m nhu c\u1ea7u ti\u00eau th\u1ee5 oxy c\u01a1 tim, \u0111\u1ed3ng th\u1eddi khi t\u1ea7n s\u1ed1 tim gi\u1ea3m khi\u1ebfn th\u1eddi gian t\u00e2m tr\u01b0\u01a1ng k\u00e9o d\u00e0i d\u1eabn t\u1edbi t\u0103ng t\u01b0\u1edbi m\u00e1u c\u01a1 tim trong k\u1ef3 t\u00e2m tr\u01b0\u01a1ng. Do \u0111\u00f3, hi\u1ec7n nay thu\u1ed1c beta blocker lu\u00f4n \u0111\u01b0\u1ee3c coi nh\u01b0 m\u1ed9t l\u1ef1a ch\u1ecdn \u0111\u1ea7u ti\u00ean trong ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng \u0111au ng\u1ef1c \u1edf b\u1ec7nh nh\u00e2n h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n.<\/p>\n

      Khuy\u1ebfn c\u00e1o c\u1ee7a ESC n\u0103m 2019 c\u0169ng nh\u1ea5n m\u1ea1nh vai tr\u00f2 c\u1ee7a beta blocker giao c\u1ea3m nh\u1eb1m gi\u1ea3m t\u1ea7n su\u1ea5t v\u00e0 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a c\u01a1n \u0111au th\u1eaft ng\u1ef1c, \u0111\u1eb7c bi\u1ec7t n\u00ean \u01b0u ti\u00ean trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p k\u00e8m theo tri\u1ec7u ch\u1ee9ng c\u1ee7a suy tim. Tuy nhi\u00ean, b\u00ean c\u1ea1nh t\u00e1c d\u1ee5ng ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng \u0111au th\u1eaft ng\u1ef1c, nh\u1eefng b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng hi\u1ec7n nay m\u1edbi ch\u1ec9 kh\u1eb3ng \u0111\u1ecbnh vai tr\u00f2 c\u1ee7a beta blocker trong c\u1ea3i thi\u1ec7n ti\u00ean l\u01b0\u1ee3ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 c\u00f3 nh\u1ed3i m\u00e1u c\u01a1 tim tr\u01b0\u1edbc \u0111\u00f3 ho\u1eb7c k\u00e8m theo suy tim. Ch\u01b0a c\u00f3 b\u1eb1ng ch\u1ee9ng r\u00f5 r\u00e0ng trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p \u0111au ng\u1ef1c \u1ed5n \u0111\u1ecbnh ch\u01b0a c\u00f3 nh\u1ed3i m\u00e1u c\u01a1 tim.L\u1ef1a ch\u1ecdn thu\u1ed1c beta blocker trong \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n:<\/p>\n

      Do hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb \u0111au th\u1eaft ng\u1ef1c c\u1ee7a c\u00e1c thu\u1ed1c beta blocker g\u1ea7n nh\u01b0 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nhau, c\u1ea7n c\u00e2n nh\u1eafc t\u1edbi c\u00e1c y\u1ebfu t\u1ed1 kh\u00e1c nh\u01b0 b\u1ec7nh l\u00fd \u0111i k\u00e8m, t\u00ecnh tr\u1ea1ng suy tim, gi\u00e1 th\u00e0nh, s\u1ed1 l\u1ea7n d\u00f9ng trong ng\u00e0y khi ch\u1ecdn thu\u1ed1c cho b\u1ec7nh nh\u00e2n.<\/p>\n

      N\u00ean l\u1ef1a ch\u1ecdn \u01b0u ti\u00ean c\u00e1c thu\u1ed1c t\u00e1c d\u1ee5ng ch\u1ecdn l\u1ecdc beta 1 (metoprolol, bisoprolol, atenolol) \u0111\u1eb7c bi\u1ec7t \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd \u0111i k\u00e8m nh\u01b0 b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh, b\u1ec7nh m\u1ea1ch m\u00e1u ngo\u1ea1i vi, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng ho\u1eb7c tr\u1ea7m c\u1ea3m.<\/p>\n","protected":false},"excerpt":{"rendered":"

      Thu\u1ed1c beta blocker 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 suy tim, b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, r\u1ed1i lo\u1ea1n nh\u1ecbp tim\u2026 \u0111\u00e3 cho th\u1ea5y vai tr\u00f2 […]<\/p>\n","protected":false},"author":7,"featured_media":21151,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[3],"yoast_head":"\nThu\u1ed1c beta blocker trong suy tim v\u00e0 b\u1ec7nh m\u1ea1ch v\u00e0nh - Vinmec<\/title>\n<meta name=\"description\" content=\"Thu\u1ed1c beta blocker trong suy tim v\u00e0 b\u1ec7nh m\u1ea1ch v\u00e0nh l\u00e0 v\u1ea5n \u0111\u1ec1 quan tr\u1ecdng, tham kh\u1ea3o b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y v\u1ec1 c\u00e1c ch\u1ec9 \u0111\u1ecbnh l\u00e2m s\u00e0ng.\" \/>\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=\"Thu\u1ed1c beta blocker trong suy tim v\u00e0 b\u1ec7nh m\u1ea1ch v\u00e0nh - 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