{"id":21550,"date":"2023-04-15T21:14:08","date_gmt":"2023-04-15T14:14:08","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21550"},"modified":"2023-04-18T18:48:25","modified_gmt":"2023-04-18T11:48:25","slug":"digoxin-va-nhung-van-de-tren-thuc-hanh-lam-sang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/digoxin-va-nhung-van-de-tren-thuc-hanh-lam-sang\/","title":{"rendered":"Digoxin v\u00e0 nh\u1eefng v\u1ea5n \u0111\u1ec1 tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng"},"content":{"rendered":"<p><strong>Digoxin l\u00e0 m\u1ed9t glycoside tr\u1ee3 tim \u0111\u01b0\u1ee3c chi\u1ebft xu\u1ea5t t\u1eeb c\u00e2y mao \u0111\u1ecba ho\u00e0ng (digitalis lanata),<\/strong><strong>\u00a0\u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb suy tim, th\u01b0\u1eddng \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p c\u00f9ng m\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c kh\u00e1c v\u00e0 c\u0169ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nh\u1ecbp tim kh\u00f4ng \u0111\u1ec1u<\/strong><\/p>\n<h2><strong>1.D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc<\/strong><\/h2>\n<ul>\n<li>Digoxin \u0111\u01b0\u1ee3c h\u1ea5p thu kho\u1ea3ng 60-80% sau u\u1ed1ng v\u00e0 n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh \u0111\u1ea1t \u0111\u01b0\u1ee3c sau 1-3h. Khi u\u1ed1ng sau b\u1eefa \u0103n, s\u1ef1 h\u1ea5p thu thu\u1ed1c ch\u1eadm \u0111i nh\u01b0ng t\u1ed5ng l\u01b0\u1ee3ng thu\u1ed1c \u0111\u01b0\u1ee3c h\u1ea5p thu v\u1eabn kh\u00f4ng \u0111\u1ed5i.<\/li>\n<li>V\u00e0o kho\u1ea3ng 25% digoxin trong huy\u1ebft t\u01b0\u01a1ng g\u1eafn v\u1edbi protein huy\u1ebft t\u01b0\u01a1ng.<\/li>\n<li>Ch\u1ec9 m\u1ed9t l\u01b0\u1ee3ng nh\u1ecf (16%) digoxin \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a v\u00e0 s\u1ef1 chuy\u1ec3n h\u00f3a kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o cytochrome P450. Thu\u1ed1c c\u0169ng kh\u00f4ng \u1ee9c ch\u1ebf v\u00e0 sinh ra P450.<\/li>\n<li>Thu\u1ed1c \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft qua th\u1eadn d\u01b0\u1edbi d\u1ea1ng kh\u00f4ng \u0111\u1ed5i v\u00e0 th\u1eddi gian b\u00e1n h\u1ee7y 36-48h.<\/li>\n<li>Digoxin \u0111i qua h\u00e0ng r\u00e0o m\u00e1u n\u00e3o v\u00e0 rau thai, n\u1ed3ng \u0111\u1ed9 digoxin \u1edf thai nhi t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi \u1edf ng\u01b0\u1eddi m\u1eb9.<\/li>\n<\/ul>\n<h2>2.C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng v\u00e0 t\u00ednh ch\u1ea5t d\u01b0\u1ee3c l\u00fd<\/h2>\n<ul>\n<li>Digoxin g\u1eafn v\u00e0o enzyme Na+\/K+ ATPase \u1edf m\u00e0ng t\u1ebf b\u00e0o, m\u1ed9t enzyme \u0111i\u1ec1u ph\u1ed1i l\u01b0\u1ee3ng Na+ v\u00e0 K+ \u1edf trong t\u1ebf b\u00e0o v\u00e0 \u1ee9c ch\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a enzyme d\u1eabn t\u1edbi l\u00e0m suy gi\u1ea3m s\u1ef1 v\u1eadn chuy\u1ec3n ch\u1ee7 \u0111\u1ed9ng Na+ \u0111i ra v\u00e0 K+ \u0111i v\u00e0o trong t\u1ebf b\u00e0o (t\u1ef7 l\u1ec7 3:2), k\u1ebft qu\u1ea3 l\u00e0 Na+ d\u1ea7n d\u1ea7n t\u0103ng v\u00e0 K+ gi\u1ea3m nh\u1eb9 \u1edf trong t\u1ebf b\u00e0o. S\u1ef1 t\u0103ng Na+ \u1edf trong t\u1ebf b\u00e0o g\u00e2y ra gi\u1ea3m trao \u0111\u1ed5i Na+ v\u00e0 Ca++ qua m\u00e0ng t\u1ebf b\u00e0o m\u00e0 b\u00ecnh th\u01b0\u1eddng s\u1ef1 trao \u0111\u1ed5i n\u00e0y c\u00f3 t\u1ef7 l\u1ec7 3:1 ngh\u0129a l\u00e0 c\u00f3 3 ion Na+ t\u1eeb ngo\u00e0i \u0111i v\u00e0o trong t\u1ebf b\u00e0o \u0111\u1ed5i 1 ion Ca++ t\u1eeb trong t\u1ebf b\u00e0o \u0111i ra ngo\u00e0i t\u1ebf b\u00e0o. K\u1ebft qu\u1ea3 l\u00e0 l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 Ca++ trong t\u1ebf b\u00e0o.<\/li>\n<li>Digoxin l\u00e0m gi\u1ea3m \u0111i\u1ec7n th\u1ebf ngh\u1ec9 qua m\u00e0ng ho\u1eb7c \u0111i\u1ec7n th\u1ebf t\u00e2m tr\u01b0\u01a1ng t\u1ed1i \u0111a (pha 4), d\u1eabn t\u1edbi l\u00e0m ch\u1eadm t\u1ed1c \u0111\u1ed9 kh\u1eed c\u1ef1c pha 0 v\u00e0 t\u1ed1c \u0111\u1ed9 d\u1eabn truy\u1ec1n.<\/li>\n<li>Gi\u1ea3m th\u1eddi gian \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng d\u1eabn t\u1edbi l\u00e0m r\u00fat ng\u1eafn th\u1eddi gian QT v\u00e0 t\u0103ng \u0111\u00e1p \u1ee9ng c\u1ee7a c\u01a1 tim v\u1edbi c\u00e1c k\u00edch th\u00edch.<\/li>\n<li>T\u00e1c d\u1ee5ng c\u00f3 l\u1ee3i c\u1ee7a digoxin th\u00f4ng qua t\u00e1c d\u1ee5ng tr\u1ef1c ti\u1ebfp \u0111\u1ebfn t\u00e1c t\u1ed5 ch\u1ee9c c\u1ee7a tim v\u00e0 t\u00e1c d\u1ee5ng gi\u00e1n ti\u1ebfp \u0111\u1ebfn h\u1ec7 tim m\u1ea1ch qua trung gian t\u00e1c d\u1ee5ng c\u1ee7a h\u1ec7 th\u1ea7n kinh t\u1ef1 \u0111\u1ed9ng v\u00e0 th\u1ea7n kinh-n\u1ed9i ti\u1ebft. T\u00e1c d\u1ee5ng c\u1ee7a h\u1ec7 th\u1ea7n kinh t\u1ef1 \u0111\u1ed9ng g\u1ed3m:<\/li>\n<li>T\u00e1c d\u1ee5ng c\u01b0\u1eddng th\u1ea7n kinh ph\u1ebf v\u1ecb: ch\u1ee7 y\u1ebfu \u0111\u1ed1i v\u1edbi n\u00fat xoang v\u00e0 n\u00fat nh\u0129 th\u1ea5t, l\u00e0m gi\u1ea3m t\u00ednh t\u1ef1 \u0111\u1ed9ng, gi\u1ea3m t\u00ednh d\u1eabn truy\u1ec1n v\u00e0 k\u00e9o d\u00e0i th\u1eddi k\u1ef3 tr\u01a1 c\u1ee7a c\u00e1c t\u1ed5 ch\u1ee9c n\u00e0y.<\/li>\n<li>T\u0103ng nh\u1eadn c\u1ea3m c\u1ee7a th\u1ee5 th\u1ec3 nh\u1eadn \u00e1p c\u1ee7a xoang c\u1ea3nh, d\u1eabn t\u1edbi t\u0103ng ho\u1ea1t t\u00ednh ph\u00f3 giao c\u1ea3m v\u00e0 gi\u1ea3m ho\u1ea1t t\u00ednh c\u1ee7a h\u1ec7 th\u1ea7n kinh giao c\u1ea3m v\u00e0 h\u1ec7 renine-angiotensine (t\u00e1c d\u1ee5ng h\u1ee7y ho\u1ea1t th\u1ea7n kinh \u2013 hormone). \u1ede li\u1ec1u \u0111i\u1ec1u tr\u1ecb (0,5-0,9 ng\/mL), t\u00e1c d\u1ee5ng tr\u1ef1c ti\u1ebfp v\u00e0 gi\u00e1n ti\u1ebfp c\u1ee7a digoxin l\u00e0:<\/li>\n<li>N\u00fat xoang v\u00e0 c\u01a1 nh\u0129: l\u00e0m gi\u1ea3m nh\u1eb9 t\u1ea7n s\u1ed1 nh\u1ecbp xoang.<\/li>\n<li>V\u1edbi c\u01a1 nh\u0129: digoxin r\u00fat ng\u1eafn th\u1eddi gian \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng v\u00e0 gi\u1ea3m th\u1eddi k\u1ef3 tr\u01a1 c\u00f3 hi\u1ec7u qu\u1ea3.<\/li>\n<li>N\u00fat nh\u0129 th\u1ea5t: l\u00e0m gi\u1ea3m t\u1ed1c \u0111\u1ed9 d\u1eabn truy\u1ec1n, k\u00e9o d\u00e0i th\u1eddi k\u1ef3 tr\u01a1 c\u00f3 hi\u1ec7u qu\u1ea3 n\u00ean ph\u00e1 v\u1ee1 v\u00f2ng v\u00e0o l\u1ea1i c\u00f3 s\u1eed d\u1ee5ng n\u00fat nh\u0129 th\u1ea5t trong c\u01a1 ch\u1ebf c\u1ee7a c\u01a1n nh\u1ecbp nhanh tr\u00ean th\u1ea5t (C\u01a1n AVNRT, AVRT) v\u00e0 l\u00e0m ch\u1eadm \u0111\u00e1p \u1ee9ng t\u1ea7n s\u1ed1 th\u1ea5t trong rung nh\u0129.<\/li>\n<\/ul>\n<p>H\u1ec7 th\u1ed1ng His-Purkinje v\u00e0 c\u01a1 th\u1ea5t: \u1ede li\u1ec1u \u0111i\u1ec1u tr\u1ecb thu\u1ed1c \u00edt \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn d\u1eabn truy\u1ec1n c\u0169ng nh\u01b0 t\u00ednh t\u1ef1 \u0111\u1ed9ng c\u1ee7a His-Purkinje v\u00e0 c\u01a1 th\u1ea5t. Thu\u1ed1c g\u00e2y r\u00fat ng\u1eafn th\u1eddi gian \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng v\u00e0 giai \u0111o\u1ea1n tr\u01a1 c\u1ee7a His-Purkinje v\u00e0 c\u01a1 th\u1ea5t d\u1eabn \u0111\u1ebfn r\u00fat ng\u1eafn th\u1eddi gian kho\u1ea3ng QT.<\/p>\n<p>\u0110\u01b0\u1eddng d\u1eabn truy\u1ec1n ph\u1ee5 nh\u0129-th\u1ea5t (c\u1ea7u Kent): digoxin l\u00e0m r\u00fat ng\u1eafn th\u1eddi k\u1ef3 tr\u01a1 c\u1ee7a \u0111\u01b0\u1eddng ph\u1ee5 trong h\u1ed9i ch\u1ee9ng Wol|-Parkinson-White n\u00ean l\u00e0m cho xung \u0111\u1ed9ng c\u1ee7a rung nh\u0129 \u0111i xu\u1ed1ng th\u1ea5t qua \u0111\u01b0\u1eddng ph\u1ee5 t\u0103ng d\u1eabn t\u1edbi \u0111\u00e1p \u1ee9ng t\u1ea7n s\u1ed1 th\u1ea5t t\u0103ng v\u00e0 c\u00f3 nguy c\u01a1 tho\u00e1i tri\u1ec3n th\u00e0nh rung th\u1ea5t.<\/p>\n<p>\u1ede n\u1ed3ng \u0111\u1ed9 cao h\u01a1n 1ng\/mL ho\u1eb7c n\u1ed3ng \u0111\u1ed9 g\u00e2y nhi\u1ec5m \u0111\u1ed9c, digoxin c\u00f3 th\u1ec3 g\u00e2y: nh\u1ecbp ch\u1eadm xoang ho\u1eb7c ng\u1eebng xoang, k\u00e9o d\u00e0i th\u1eddi gian d\u1eabn truy\u1ec1n nh\u0129 th\u1ea5t ho\u1eb7c block nh\u0129 th\u1ea5t. \u1ede m\u1ee9c nhi\u1ec5m \u0111\u1ed9c, digoxin c\u0169ng c\u00f3 th\u1ec3 g\u00e2y t\u0103ng ho\u1ea1t t\u00ednh th\u1ea7n kinh giao c\u1ea3m v\u00e0 c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n v\u00e0o g\u00e2y ra r\u1ed1i lo\u1ea1n nh\u1ecbp tim.<\/p>\n<ul>\n<li>T\u0103ng Ca++ trong t\u1ebf b\u00e0o v\u00e0 t\u0103ng tr\u01b0\u01a1ng l\u1ef1c th\u1ea7n kinh giao c\u1ea3m s\u1ebd g\u00f3p v\u00e0o l\u00e0m t\u0103ng t\u1ed1c \u0111\u1ed9 kh\u1eed c\u1ef1c t\u00e2m tr\u01b0\u01a1ng t\u1ef1 ph\u00e1t (pha 4) v\u00e0 t\u0103ng nguy c\u01a1 xu\u1ea5t hi\u1ec7n h\u1eadu kh\u1eed c\u1ef1c mu\u1ed9n v\u00e0 nh\u01b0 v\u1eady t\u0103ng nguy c\u01a1 kh\u1edfi ph\u00e1t r\u1ed1i lo\u1ea1n nh\u1ecbp qua trung gian h\u1eadu kh\u1eed c\u1ef1c.<\/li>\n<\/ul>\n<ul>\n<li>S\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a t\u0103ng t\u00ednh t\u1ef1 \u0111\u1ed9ng v\u00e0 \u1ee9c ch\u1ebf d\u1eabn truy\u1ec1n trong h\u1ec7 th\u1ed1ng His-Purkinje c\u00f3 nguy c\u01a1 sinh ra c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp nh\u01b0: nh\u1ecbp nhanh th\u1ea5t, xo\u1eafn \u0111\u1ec9nh v\u00e0 rung th\u1ea5t.<\/li>\n<\/ul>\n<p>Nghi\u00ean c\u1ee9u DIG (Digitalis investigation Group Trial) \u0111\u00e3 cho th\u1ea5y khi n\u1ed3ng \u0111\u1ed9 digoxin huy\u1ebft t\u01b0\u01a1ng &gt;1 ng\/mL th\u01b0\u1eddng k\u1ebft h\u1ee3p v\u1edbi t\u1ef7 l\u1ec7 t\u1eed vong t\u0103ng.<\/p>\n<p>Thay \u0111\u1ed5i tr\u00ean \u0111i\u1ec7n t\u00e2m \u0111\u1ed3: \u1edf n\u1ed3ng \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb nh\u1eefng thay \u0111\u1ed5i tr\u00ean \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 c\u00f3 th\u1ec3 g\u1ed3m:<\/p>\n<ul>\n<li>T\u1ea7n s\u1ed1 nh\u1ecbp xoang gi\u1ea3m nh\u1eb9 ho\u1eb7c kh\u00f4ng \u0111\u1ed5i.<\/li>\n<li>K\u00e9o d\u00e0i kho\u1ea3ng PR do t\u00e1c d\u1ee5ng l\u00e0m ch\u1eadm d\u1eabn truy\u1ec1n trong n\u00fat nh\u0129 th\u1ea5t.<\/li>\n<li>Th\u1eddi gian QRS \u00edt thay \u0111\u1ed5i nh\u01b0ng kho\u1ea3ng QT th\u01b0\u1eddng ng\u1eafn l\u1ea1i.<\/li>\n<li>\u1ede li\u1ec1u ng\u1ea5m digoxin c\u00f3 th\u1ec3 th\u1ea5y thay \u0111\u1ed5i c\u1ee7a \u0111o\u1ea1n ST cong v\u00f5ng h\u00ecnh \u0111\u00e1y ch\u00e9n v\u00e0<\/li>\n<\/ul>\n<p>cong tr\u00e1i chi\u1ec1u QRS. D\u1ea5u hi\u1ec7u ng\u1ea5m thu\u1ed1c ch\u01b0a ph\u1ea3i l\u00e0 nhi\u1ec5m \u0111\u1ed9c nh\u01b0ng c\u1ea7n ph\u1ea3i theo d\u00f5i ch\u1eb7t ch\u1ebd h\u01a1n \u0111\u1ec1 ph\u00f2ng nhi\u1ec5m \u0111\u1ed9c.<\/p>\n<p>T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n<\/p>\n<ul>\n<li>M\u1ec7t m\u1ecfi, \u0111au c\u01a1, ch\u00e1n \u0103n.<\/li>\n<li>N\u00f4n, bu\u1ed3n n\u00f4n.<\/li>\n<li>Nh\u1ecbp ch\u1eadm qu\u00e1 m\u1ee9c, block nh\u0129 th\u1ea5t \u0111\u1ed9 II, III.<\/li>\n<li>R\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t nh\u01b0: ngo\u1ea1i t\u00e2m thu th\u1ea5t (NTT\/T), NTT\/T nh\u1ecbp \u0111\u00f4i, nh\u1ecbp nhanh th\u1ea5t, rung th\u1ea5t\u2026 nh\u1ea5t l\u00e0 \u1edf b\u1ec7nh nh\u00e2n c\u00f3 gi\u1ea3m kali, magie m\u00e1u.<\/li>\n<\/ul>\n<h2><strong>3.Ch\u1ec9 \u0111\u1ecbnh<\/strong><\/h2>\n<p>Trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y, qua nh\u1eefng d\u1eef li\u1ec7u ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p t\u1eeb nh\u1eefng nghi\u00ean c\u1ee9u \u0111\u00e3 cho th\u1ea5y s\u1eed d\u1ee5ng digoxin trong rung nh\u0129 c\u00f3 nguy c\u01a1 l\u00e0m t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong, cho n\u00ean ch\u1ec9 \u0111\u1ecbnh c\u1ee7a digoxin \u0111\u00e3 c\u00f3 nh\u1eefng thu h\u1eb9p \u0111\u00e1ng k\u1ec3:<\/p>\n<ul>\n<li>Gi\u1ea3m \u0111\u00e1p \u1ee9ng t\u1ea7n s\u1ed1 th\u1ea5t c\u1ea5p trong rung nh\u0129, cu\u1ed3ng nh\u0129: Digoxin ch\u1ec9 l\u00e0 thu\u1ed1c \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn h\u00e0ng th\u1ee9 2 b\u1ed5 sung th\u00eam v\u00e0o khi c\u00e1c thu\u1ed1c \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u0111\u1ea7u ti\u00ean (first line) nh\u01b0 ch\u1eb9n beta, verapamil, diltiazem ch\u01b0a \u0111\u1ea1t hi\u1ec7u qu\u1ea3 ki\u1ec3m so\u00e1t t\u1ea7n s\u1ed1 tim \u1edf b\u1ec7nh nh\u00e2n c\u00f3 EF \u2265 0% ho\u1eb7c ch\u1eb9n beta li\u1ec1u th\u1ea5p ho\u1eb7c amiodarone \u1edf b\u1ec7nh nh\u00e2n c\u00f3 EF \u2264 40% (theo khuy\u1ebfn c\u00e1o c\u1ee7a ESC 2016).<\/li>\n<\/ul>\n<ul>\n<li>Trong ki\u1ec3m so\u00e1t t\u1ea7n s\u1ed1 th\u1ea5t l\u00e2u d\u00e0i trong rung nh\u0129, cu\u1ed3ng nh\u0129: digoxin c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn l\u00e0 thu\u1ed1c \u0111\u1ea7u ti\u00ean ho\u1eb7c l\u00e0 thu\u1ed1c th\u1ee9 2 k\u1ebft h\u1ee3p b\u1ed5 sung khi thu\u1ed1c \u0111\u1ea7u ti\u00ean (ch\u1eb9n beta ho\u1eb7c verapamil ho\u1eb7c diltiazem) ch\u01b0a \u0111\u1ea1t hi\u1ec7u qu\u1ea3 ki\u1ec3m so\u00e1t t\u1ea7n s\u1ed1 mong mu\u1ed1n.<\/li>\n<\/ul>\n<p>\u0110i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng nh\u1ecbp nhanh tr\u00ean th\u1ea5t \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 WPW.<\/p>\n<ul>\n<li>Digoxin \u0111\u01b0\u1ee3c xem x\u00e9t \u0111\u1ec3 ki\u1ec3m so\u00e1t t\u1ea7n s\u1ed1 trong nh\u1ecbp nhanh nh\u0129 \u1edf b\u1ec7nh nh\u00e2n c\u00f3 thai, n\u1ebfu c\u00e1c thu\u1ed1c ch\u1eb9n beta th\u1ea5t b\u1ea1i v\u00e0 BN kh\u00f4ng c\u00f3 h\u1ed9i ch\u1ee9ng WPW.<\/li>\n<\/ul>\n<h2><strong>4.Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/strong><\/h2>\n<ul>\n<li>Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p.<\/li>\n<li>Block nh\u0129 th\u1ea5t \u0111\u1ed9 II, III, nh\u1ecbp ch\u1eadm.<\/li>\n<li>Rung nh\u0129 \u1edf b\u1ec7nh nh\u00e2n c\u00f3 h\u1ed9i ch\u1ee9ng Wol|-Parkinson-White: digoxin r\u00fat ng\u1eafn th\u1eddi k\u1ef3 tr\u01a1 c\u1ee7a \u0111\u01b0\u1eddng ph\u1ee5 d\u1eabn t\u1edbi t\u0103ng s\u1ed1 xung \u0111\u1ed9ng c\u1ee7a rung nh\u0129 \u0111i qua \u0111\u01b0\u1eddng ph\u1ee5 xu\u1ed1ng t\u00e2m th\u1ea5t v\u00e0 nh\u01b0 v\u1eady t\u1ea7n s\u1ed1 th\u1ea5t r\u1ea5t nhanh v\u00e0 c\u00f3 th\u1ec3 tho\u00e1i tri\u1ec3n th\u00e0nh rung th\u1ea5t.<\/li>\n<li>H\u1ed9i ch\u1ee9ng suy n\u00fat xoang.<\/li>\n<\/ul>\n<h2><strong>5.Li\u1ec1u l\u01b0\u1ee3ng v\u00e0 c\u00e1ch s\u1eed d\u1ee5ng<\/strong><\/h2>\n<ul>\n<li>Li\u1ec1u l\u01b0\u1ee3ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch: 1,0-1,5 mg\/24h, chia l\u00e0m 2-3 l\u1ea7n, m\u1ed7i l\u1ea7n 1 \u1ed1ng 0,5 mg v\u00e0 c\u00e1ch nhau 8h. Sau khi \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3, n\u00ean chuy\u1ec3n sang s\u1eed d\u1ee5ng thu\u1ed1c \u0111\u01b0\u1eddng u\u1ed1ng \u0111\u1ec3 duy tr\u00ec.<\/li>\n<li>Li\u1ec1u l\u01b0\u1ee3ng \u0111\u01b0\u1eddng u\u1ed1ng:t\u1eeb 0,25-0,5 mg\/24h chia l\u00e0m 1-2 l\u1ea7n, khi \u0111\u00e3 \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 ki\u1ec3m so\u00e1t t\u1ea7n s\u1ed1 th\u1ea5t c\u00f3 th\u1ec3 chuy\u1ec3n sang li\u1ec1u duy tr\u00ec.<\/li>\n<\/ul>\n<h2><strong>6.T\u01b0\u01a1ng t\u00e1c thu\u1ed1c<\/strong><\/h2>\n<ul>\n<li>C\u00e1c thu\u1ed1c l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 digoxin huy\u1ebft thanh: amiodarone, quinidine, verapamil, propafenone, itraconazole, alprazolam, and spironolactone: khi s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi ph\u1ea3i xem x\u00e9t gi\u1ea3m li\u1ec1u digoxin.<\/li>\n<li>Erythromycin, clarithromycin v\u00e0 tetracycline l\u00e0m t\u0103ng s\u1ef1 h\u1ea5p thu digoxin.<\/li>\n<li>Rifampicin l\u00e0m t\u0103ng b\u00e0i ti\u1ebft digoxin qua th\u1eadn.<\/li>\n<li>C\u00e1c thu\u1ed1c ch\u1eb9n th\u1ee5 th\u1ec3 beta giao c\u1ea3m, ch\u1eb9n k\u00eanh canxi nondihydropyridine,ecainide, disopyramide l\u00e0m gi\u1ea3m d\u1eabn truy\u1ec1n qua n\u00fat nh\u0129 th\u1ea5t n\u00ean khi s\u1eed d\u1ee5ng c\u00f9ng digoxin c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 block nh\u0129-th\u1ea5t.<\/li>\n<\/ul>\n<p>Tham kh\u1ea3o nhi\u1ec1u b\u00e0i vi\u1ebft chuy\u00ean s\u00e2u c\u1ee7a Vinmec <a href=\"http:\/\/www.vinmecdr.com\">t\u1ea1i \u0111\u00e2y<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Digoxin l\u00e0 m\u1ed9t glycoside tr\u1ee3 tim \u0111\u01b0\u1ee3c chi\u1ebft xu\u1ea5t t\u1eeb c\u00e2y mao \u0111\u1ecba ho\u00e0ng (digitalis lanata),\u00a0\u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb suy tim, th\u01b0\u1eddng \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p c\u00f9ng m\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c kh\u00e1c v\u00e0 c\u0169ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nh\u1ecbp tim kh\u00f4ng \u0111\u1ec1u 1.D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc Digoxin \u0111\u01b0\u1ee3c h\u1ea5p thu kho\u1ea3ng 60-80% sau [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":21551,"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 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Digoxin v\u00e0 nh\u1eefng v\u1ea5n \u0111\u1ec1 tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng - Vinmec<\/title>\n<meta name=\"description\" content=\"Digoxin v\u00e0 nh\u1eefng v\u1ea5n \u0111\u1ec1 tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng l\u00e0 \u0111i\u1ec1u \u0111\u01b0\u1ee3c quan t\u00e2m. 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