{"id":21554,"date":"2023-04-15T21:25:53","date_gmt":"2023-04-15T14:25:53","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21554"},"modified":"2023-04-17T14:44:04","modified_gmt":"2023-04-17T07:44:04","slug":"amiodarone-trong-thuc-hanh-benh-ly-tim-mach","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/amiodarone-trong-thuc-hanh-benh-ly-tim-mach\/","title":{"rendered":"Amiodarone  trong th\u1ef1c h\u00e0nh b\u1ec7nh l\u00fd tim m\u1ea1ch"},"content":{"rendered":"<p><strong>Amiodarone c\u00f3 c\u1ea5u tr\u00fac t\u01b0\u01a1ng t\u1ef1 nh\u01b0 thyroxine v\u00e0 l\u00e0 m\u1ed9t d\u1eabn xu\u1ea5t c\u00f3 iode c\u1ee7a benzofuran iode. Ban \u0111\u1ea7u thu\u1ed1c \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh v\u00e0 tr\u1edf n\u00ean ph\u1ed5 bi\u1ebfn nh\u01b0 l\u00e0 m\u1ed9t thu\u1ed1c ch\u1ed1ng \u0111au th\u1eaft ng\u1ef1c \u1edf ch\u00e2u \u00c2u trong nh\u1eefng n\u0103m 1960.<\/strong><\/p>\n<h2><strong>1.Bi\u1ec7t d\u01b0\u1ee3c<\/strong><\/h2>\n<p>Cordarone: \u1ed1ng 150mg, vi\u00ean 200mg.<\/p>\n<h2><strong>2.D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc<\/strong><\/h2>\n<ul>\n<li>Amiodarone r\u1ea5t \u01b0a lipid n\u00ean thu\u1ed1c d\u1ec5 th\u1ea5m v\u00e0o v\u00e0 t\u00edch l\u0169y trong c\u00e1c m\u00f4 m\u1ee1, gan, ph\u1ed5i, da\u2026v\u00e0 \u0111\u01b0\u1ee3c gi\u1ea3i ph\u00f3ng tr\u1edf l\u1ea1i huy\u1ebft t\u01b0\u01a1ng d\u1ea7n d\u1ea7n n\u00ean thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i.<\/li>\n<li>Thu\u1ed1c g\u1ea7n nh\u01b0 li\u00ean k\u1ebft to\u00e0n b\u1ed9 v\u1edbi protein huy\u1ebft t\u01b0\u01a1ng v\u00e0 t\u1eadp trung \u1edf c\u01a1 tim (g\u1ea5p 10- 50 l\u1ea7n n\u1ed3ng \u0111\u1ed9 trong huy\u1ebft t\u01b0\u01a1ng) c\u0169ng nh\u01b0 \u1edf t\u1ed5 ch\u1ee9c m\u1ee1, gan, ph\u1ed5i (g\u1ea5p 100 l\u1ea7n n\u1ed3ng \u0111\u1ed9 huy\u1ebft t\u01b0\u01a1ng).<\/li>\n<li>Sinh kh\u1ea3 d\u1ee5ng \u0111\u01b0\u1eddng u\u1ed1ng r\u1ea5t thay \u0111\u1ed5i v\u00e0 v\u00e0o kho\u1ea3ng t\u1eeb 35% \u0111\u1ebfn 65% v\u00e0 n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh trong huy\u1ebft t\u01b0\u01a1ng \u0111\u1ea1t \u0111\u01b0\u1ee3c 3-7h sau khi u\u1ed1ng. M\u1ed9t li\u1ec1u tr\u00ean 10g, th\u01b0\u1eddng l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 b\u00e3o h\u00f2a to\u00e0n b\u1ed9 t\u1ed5 ch\u1ee9c b\u00e9o n\u00ean c\u1ea7n ph\u1ea3i m\u1ea5t nhi\u1ec1u tu\u1ea7n tr\u01b0\u1edbc khi \u0111\u1ea1t \u0111\u01b0\u1ee3c tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh.<\/li>\n<li>Thu\u1ed1c \u0111\u01b0\u1ee3c \u0111\u00e0o th\u1ea3i qua gan v\u00e0o \u0111\u01b0\u1eddng m\u1eadt. Amiodarone \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a \u1edf gan th\u00e0nh ch\u1ea5t chuy\u1ec3n h\u00f3a ch\u00ednh c\u1ee7a n\u00f3 l\u00e0 desethylamiodarone. Th\u1eddi gian b\u00e1n h\u1ee7y trong huy\u1ebft t\u01b0\u01a1ng sau khi s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch t\u1eeb 4,8h \u0111\u1ebfn 68,2h. N\u1ed3ng \u0111\u1ed9 tr\u1ecb li\u1ec7u trong huy\u1ebft t\u01b0\u01a1ng dao \u0111\u1ed9ng t\u1eeb 1 \u00b5g\/mL \u0111\u1ebfn 2,5 \u00b5g\/mL, c\u00f3 th\u1ec3 \u0111o \u0111\u01b0\u1ee3c nh\u01b0ng kh\u00f4ng c\u00f3 s\u1ef1 t\u01b0\u01a1ng \u1ee9ng v\u1edbi hi\u1ec7u qu\u1ea3 l\u00e2m s\u00e0ng. \u0110\u00e0o th\u1ea3i ch\u1eadm v\u00e0 c\u1ef1c k\u1ef3 thay \u0111\u1ed5i v\u1edbi th\u1eddi gian b\u00e1n h\u1ee7y t\u1eeb 13 ng\u00e0y \u0111\u1ebfn 103 ng\u00e0y (trung b\u00ecnh l\u00e0 60 ng\u00e0y). Thu\u1ed1c c\u0169ng \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft kh\u00f4ng \u0111\u00e1ng k\u1ec3 qua th\u1eadn v\u00e0 do \u0111\u00f3 kh\u00f4ng c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u \u1edf b\u1ec7nh nh\u00e2n suy th\u1eadn. Amiodarone v\u00e0 desethylamiodarone kh\u00f4ng th\u1ec3 \u0111\u01b0\u1ee3c lo\u1ea1i b\u1ecf b\u1eb1ng th\u1ea9m ph\u00e2n ph\u00fac m\u1ea1c ho\u1eb7c l\u1ecdc m\u00e1u.<\/li>\n<\/ul>\n<h2><strong>3.C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng v\u00e0 t\u00ednh ch\u1ea5t d\u01b0\u1ee3c l\u00fd<\/strong><\/h2>\n<h3><strong>3.1 T\u00e1c d\u1ee5ng l\u00ean \u0111i\u1ec7n sinh l\u00fd t\u1ebf b\u00e0o tim<\/strong><\/h3>\n<ul>\n<li>M\u1eb7c d\u00f9 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i l\u00e0 AADs nh\u00f3m III nh\u01b0ng amiodarone l\u00e0 m\u1ed9t lo\u1ea1i thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng \u0111i\u1ec7n sinh l\u00fd r\u1ea5t ph\u1ee9c t\u1ea1p. Th\u1ef1c ra n\u00f3 l\u00e0 m\u1ed9t nh\u00f3m ri\u00eang bi\u1ec7t do c\u00e1c \u0111\u1eb7c t\u00ednh \u0111i\u1ec7n sinh l\u00fd bao g\u1ed3m c\u1ea3 4 nh\u00f3m theo ph\u00e2n lo\u1ea1i c\u1ee7a Vaughan Williams. Ngo\u00e0i c\u00e1c \u0111\u1eb7c t\u00ednh \u1ee9c ch\u1ebf \u0111a k\u00eanh, amiodarone c\u00f2n t\u01b0\u01a1ng t\u00e1c v\u00e0 c\u00f3 th\u1ec3 \u1ee9c ch\u1ebf c\u00e1c th\u1ee5 th\u1ec3 tr\u00ean b\u1ec1 m\u1eb7t t\u1ebf b\u00e0o v\u00e0 c\u00e1c ph\u00e2n t\u1eed kh\u00e1c.<\/li>\n<li>M\u1ed9t \u0111\u1eb7c \u0111i\u1ec3m kh\u00e1 th\u00fa v\u1ecb l\u00e0 t\u00e1c d\u1ee5ng c\u1ea5p t\u00ednh c\u1ee7a thu\u1ed1c (s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch) kh\u00e1c bi\u1ec7t \u0111\u00e1ng k\u1ec3 so v\u1edbi t\u00e1c d\u1ee5ng l\u00e2u d\u00e0i (s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng u\u1ed1ng). Khi s\u1eed d\u1ee5ng l\u00e2u d\u00e0i, t\u00e1c d\u1ee5ng \u0111i\u1ec7n sinh l\u00fd \u0111\u00e1ng ch\u00fa \u00fd nh\u1ea5t c\u1ee7a amiodarone l\u00e0 k\u00e9o d\u00e0i t\u00e1i c\u1ef1c v\u00e0 th\u1eddi k\u1ef3 tr\u01a1 c\u00f3 hi\u1ec7u qu\u1ea3 c\u1ee7a t\u1ea5t c\u1ea3 c\u00e1c t\u1ed5 ch\u1ee9c c\u1ee7a tim, m\u1ed9t t\u00e1c d\u1ee5ng \u0111\u1eb7c tr\u01b0ng c\u1ee7a c\u00e1c thu\u1ed1c ch\u1ed1ng r\u1ed1i lo\u1ea1n nh\u1ecbp nh\u00f3m III.<\/li>\n<li>Cho \u0111\u1ebfn nay, c\u01a1 ch\u1ebf ch\u00ednh x\u00e1c t\u00e1c d\u1ee5ng ch\u1ed1ng lo\u1ea1n nh\u1ecbp c\u1ee7a amiodarone v\u1eabn c\u00f2n ch\u01b0a r\u00f5 r\u00e0ng. C\u00e1c th\u00ed nghi\u1ec7m tr\u00ean \u0111\u1ed9ng v\u1eadt \u0111\u00e3 cho th\u1ea5y amiodarone k\u00e9o d\u00e0i th\u1eddi gian \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng v\u00e0 th\u1eddi k\u1ef3 tr\u01a1 \u1edf t\u00e2m nh\u0129, t\u00e2m th\u1ea5t, n\u00fat nh\u0129 th\u1ea5t v\u00e0 h\u1ec7 th\u1ed1ng HisPurkinje. Amiodarone c\u00f3 xu h\u01b0\u1edbng t\u00e1c d\u1ee5ng m\u1ea1nh trong vi\u1ec7c k\u00e9o d\u00e0i \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng v\u00e0 t\u00e1i c\u1ef1c \u0111\u1ed3ng \u0111\u1ec1u, v\u00e0 c\u00f3 l\u1ebd v\u00ec l\u00fd do n\u00e0y, nguy c\u01a1 xo\u1eafn \u0111\u1ec9nh l\u00e0 th\u1ea5p. N\u00f3 c\u0169ng phong t\u1ecfa c\u00e1c k\u00eanh natri \u1edf tr\u1ea1ng th\u00e1i b\u1ea5t ho\u1ea1t, l\u00e0m ch\u1eadm qu\u00e1 tr\u00ecnh kh\u1eed c\u1ef1c giai \u0111o\u1ea1n 4 \u1edf n\u00fat xoang v\u00e0 l\u00e0m ch\u1eadm s\u1ef1 d\u1eabn truy\u1ec1n n\u00fat nh\u0129 th\u1ea5t. Amiodarone c\u00f2n \u1ee9c ch\u1ebf c\u00e1c th\u1ee5 th\u1ec3 <em>\u03b1 <\/em>v\u00e0 <em>\u03b2 <\/em>theo c\u01a1 ch\u1ebf kh\u00f4ng c\u1ea1nh tranh, \u1ee9c ch\u1ebf c\u00e1c k\u00eanh canxi lo\u1ea1i L v\u00e0 ng\u0103n c\u1ea3n chuy\u1ec3n \u0111\u1ed5i thyroxine th\u00e0nh triiodothyronine. Khi d\u00f9ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch, thu\u1ed1c c\u00f3 th\u1ec3 g\u00e2y gi\u00e3n m\u1ea1ch v\u00e0nh v\u00e0 m\u1ea1ch ngo\u1ea1i bi\u00ean.<\/li>\n<li>Amiodarone c\u00f3 d\u1ea1ng u\u1ed1ng v\u00e0 d\u1ea1ng s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch v\u00e0 m\u1ed7i d\u1ea1ng c\u00f3 c\u00e1c \u0111\u1eb7c t\u00ednh \u0111i\u1ec7n sinh l\u00fd kh\u00e1c nhau. Khi s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch, amiodarone th\u1ec3 hi\u1ec7n \u0111\u1eb7c t\u00ednh \u1ee9c ch\u1ebf k\u00eanh natri v\u00e0 canxi, bi\u1ec3u hi\u1ec7n s\u1ef1 ph\u1ee5 thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng s\u1eed d\u1ee5ng v\u00e0 c\u00f3 t\u00e1c d\u1ee5ng l\u1edbn h\u01a1n t\u1ea1i c\u00e1c m\u00f4 \u0111\u00e3 \u0111\u01b0\u1ee3c kh\u1eed c\u1ef1c, n\u00ean thu\u1ed1c r\u1ea5t hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t do thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9. Khi \u0111i\u1ec1u tr\u1ecb duy tr\u00ec b\u1eb1ng amiodarone \u0111\u01b0\u1eddng u\u1ed1ng, thu\u1ed1c ch\u1ee7 y\u1ebfu k\u00e9o d\u00e0i th\u1eddi gian \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng v\u00e0 th\u1eddi k\u1ef3 tr\u01a1 nh\u01b0ng kh\u00f4ng th\u1ec3 hi\u1ec7n s\u1ef1 ph\u1ee5 thu\u1ed9c ngh\u1ecbch \u0111\u1ea3o t\u00ecnh tr\u1ea1ng s\u1eed d\u1ee5ng.<\/li>\n<\/ul>\n<h3><strong>3.2 T\u00e1c d\u1ee5ng \u0111i\u1ec7n sinh l\u00fd c\u1ee7a amiodarone l\u00ean c\u00e1c t\u1ed5 ch\u1ee9c tim:<\/strong><\/h3>\n<ul>\n<li>N\u00fat xoang v\u00e0 c\u01a1 nh\u0129: l\u00e0m ch\u1eadm t\u1ea7n s\u1ed1 nh\u1ecbp xoang. K\u00e9o d\u00e0i th\u1eddi gian \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng v\u00e0 th\u1eddi k\u1ef3 tr\u01a1 c\u00f3 hi\u1ec7u qu\u1ea3 c\u1ee7a c\u01a1 nh\u0129.<\/li>\n<li>N\u00fat nh\u0129 th\u1ea5t: l\u00e0m ch\u1eadm d\u1eabn truy\u1ec1n v\u00e0 k\u00e9o d\u00e0i th\u1eddi k\u1ef3 tr\u01a1 c\u00f3 hi\u1ec7u qu\u1ea3 c\u1ee7a n\u00fat nh\u0129 th\u1ea5t.<\/li>\n<li>H\u1ec7 th\u1ed1ng His-Purkinje v\u00e0 c\u01a1 th\u1ea5t: k\u00e9o d\u00e0i th\u1eddi gian \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng v\u00e0 th\u1eddi k\u1ef3 tr\u01a1 c\u00f3 hi\u1ec7u qu\u1ea3 c\u1ee7a h\u1ec7 th\u1ed1ng His-Purkinje v\u00e0 c\u01a1 th\u1ea5t. Gi\u1ea3m t\u00ednh t\u1ef1 \u0111\u1ed9ng v\u00e0 t\u1ed1c \u0111\u1ed9 d\u1eabn truy\u1ec1n c\u1ee7a c\u00e1c t\u1ed5 ch\u1ee9c n\u00e0y.<\/li>\n<\/ul>\n<h3><strong>3.3 Nh\u1eefng thay \u0111\u1ed5i \u0111i\u1ec7n t\u00e2m \u0111\u1ed3<\/strong><\/h3>\n<p>Nh\u1eefng thay \u0111\u1ed5i ch\u1ee7 y\u1ebfu tr\u00ean \u0110T\u0110 g\u1ed3m: k\u00e9o d\u00e0i kho\u1ea3ng PR v\u00e0 kho\u1ea3ng QTc, l\u00e0m xu\u1ea5t hi\u1ec7n s\u00f3ng U v\u00e0 thay \u0111\u1ed5i h\u00ecnh d\u1ea1ng s\u00f3ng T.<\/p>\n<h3><strong>3.4 \u1ea2nh h\u01b0\u1edfng huy\u1ebft \u0111\u1ed9ng<\/strong><\/h3>\n<ul>\n<li>L\u00e0m gi\u00e3n c\u01a1 tr\u01a1n m\u1ea1ch m\u00e1u v\u00e0 c\u1ea3i thi\u1ec7n d\u00f2ng m\u00e1u trong m\u1ea1ch v\u00e0nh t\u1edbi c\u01a1 tim.<\/li>\n<li>T\u00e1c d\u1ee5ng l\u00ean c\u00e1c m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean d\u1eabn t\u1edbi l\u00e0m gi\u1ea3m ti\u00eau th\u1ee5 oxy v\u00e0 c\u00f4ng co b\u00f3p c\u1ee7a th\u1ea5t tr\u00e1i.<\/li>\n<li>Khi s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch, thu\u1ed1c c\u00f3 th\u1ec3 g\u00e2y h\u1ea1 huy\u1ebft \u00e1p do t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch.<\/li>\n<\/ul>\n<h2><strong>4.T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n<\/strong><\/h2>\n<ul>\n<li>T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n kh\u00e1 th\u01b0\u1eddng g\u1eb7p v\u00e0 c\u00f3 th\u1ec3 dao \u0111\u1ed9ng t\u1eeb 15% trong n\u0103m \u0111\u1ea7u ti\u00ean \u0111\u1ebfn 50% khi s\u1eed d\u1ee5ng l\u00e2u d\u00e0i. Amiodarone k\u00e9o d\u00e0i kho\u1ea3ng PR, QRS v\u00e0 QT,nh\u01b0ng t\u1ef7 l\u1ec7 b\u1ecb xo\u1eafn \u0111\u1ec9nh l\u00e0 r\u1ea5t hi\u1ebfm, c\u00f3 l\u1ebd, do c\u00e1c \u0111\u1eb7c t\u00ednh \u1ee9c ch\u1ebf \u0111a k\u00eanh v\u00e0 \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 <em>\u03b2<\/em>. Kh\u00f4ng th\u1ea5y t\u00e1c d\u1ee5ng gi\u1ea3m s\u1ee9c co b\u00f3p c\u01a1 tim \u0111\u00e1ng k\u1ec3 n\u00e0o \u1edf li\u1ec1u duy tr\u00ec. Nh\u1ecbp ch\u1eadm xoang v\u00e0 block nh\u0129 th\u1ea5t c\u0169ng c\u00f3 th\u1ec3 x\u1ea3y ra.<\/li>\n<li>H\u1ea1 huy\u1ebft \u00e1p hay g\u1eb7p khi s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch do t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i ch\u1eb7t ch\u1ebd.<\/li>\n<li>Amiodarone c\u00f3 kh\u00e1 nhi\u1ec1u t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n ngo\u00e0i tim, trong \u0111\u00f3 nghi\u00eam tr\u1ecdng nh\u1ea5t l\u00e0 vi\u00eam ph\u1ed5i k\u1ebd d\u1eabn \u0111\u1ebfn x\u01a1 ph\u1ed5i. T\u1ef7 l\u1ec7 x\u01a1 h\u00f3a ph\u1ed5i dao \u0111\u1ed9ng t\u1eeb 1% \u0111\u1ebfn 7% v\u00e0 r\u1ea5t kh\u00f3 d\u1ef1 \u0111o\u00e1n v\u00e0 kh\u00f3 ph\u00e1t hi\u1ec7n. \u0110\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng khu\u1ebfch t\u00e1n carbon monoxide (DLCO) l\u00e0 x\u00e9t nghi\u1ec7m s\u00e0ng l\u1ecdc t\u1ed1t nh\u1ea5t.<\/li>\n<li>T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n t\u1ea1i tuy\u1ebfn gi\u00e1p c\u0169ng r\u1ea5t th\u01b0\u1eddng g\u1eb7p, c\u1ea3 c\u01b0\u1eddng gi\u00e1p v\u00e0 suy gi\u00e1p \u0111\u1ec1u c\u00f3 th\u1ec3 x\u1ea3y ra.<\/li>\n<li>Nhi\u1ec5m \u0111\u1ed9c gan c\u00f3 th\u1ec3 x\u1ea3y ra nh\u01b0ng \u00edt khi ti\u1ebfn tri\u1ec3n th\u00e0nh x\u01a1 gan.<\/li>\n<li>C\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n ngo\u00e0i tim \u0111\u00e1ng k\u1ec3 kh\u00e1c bao g\u1ed3m t\u0103ng m\u1eabn c\u1ea3m v\u1edbi \u00e1nh n\u1eafng m\u1eb7t tr\u1eddi, \u0111\u1ed5i m\u00e0u da h\u01a1i xanh, \u1ea3nh h\u01b0\u1edfng th\u1ea7n kinh trung \u01b0\u01a1ng v\u00e0 ngo\u1ea1i bi\u00ean(y\u1ebfu, kh\u00f3 \u0111i l\u1ea1i \u0111\u1eb7c bi\u1ec7t \u1edf ng\u01b0\u1eddi cao tu\u1ed5i) v\u00e0 hi\u1ebfm g\u1eb7p h\u01a1n, vi\u00eam th\u1ea7n kinh th\u1ecb gi\u00e1c d\u1eabn \u0111\u1ebfn m\u1ea5t th\u1ecb l\u1ef1c. H\u1ea7u h\u1ebft t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb amiodarone l\u00e2u d\u00e0i \u0111\u1ec1u xu\u1ea5t hi\u1ec7n c\u00e1c vi h\u1ea1t l\u1eafng \u0111\u1ecdng l\u1edbp s\u1eebng, nh\u01b0ng ch\u00fang \u00edt quan tr\u1ecdng v\u1ec1 l\u00e2m s\u00e0ng.<\/li>\n<\/ul>\n<p>Ph\u1ea7n l\u1edbn c\u00e1c ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i th\u1ee9 ph\u00e1t c\u1ee7a amiodarone c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u1eed l\u00fd d\u1ec5 d\u00e0ng v\u00e0 kh\u00f4ng c\u1ea7n ph\u1ea3i ng\u1eebng thu\u1ed1c. V\u00ec h\u1ea7u h\u1ebft c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a amiodarone, ph\u1ee5 thu\u1ed9c v\u00e0o li\u1ec1u l\u01b0\u1ee3ng v\u00e0 th\u1eddi gian \u0111i\u1ec1u tr\u1ecb, v\u00ec v\u1eady n\u00ean s\u1eed d\u1ee5ng li\u1ec1u th\u1ea5p nh\u1ea5t c\u00f3 hi\u1ec7u qu\u1ea3 \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb duy tr\u00ec l\u00e2u d\u00e0i. M\u1eb7c d\u00f9 v\u1eady, s\u00e0ng l\u1ecdc th\u01b0\u1eddng xuy\u00ean c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n l\u00e0 r\u1ea5t c\u1ea7n thi\u1ebft. Khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb, t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c ghi \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 12 chuy\u1ec3n \u0111\u1ea1o, ch\u1ee5p X quang ph\u1ed5i, \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p, x\u00e9t nghi\u1ec7m \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3 v\u00e0 ch\u1ee9c n\u0103ng gan, th\u1eadn v\u00e0 tuy\u1ebfn gi\u00e1p. Kh\u00e1m m\u1eaft \u0111\u1ecbnh k\u1ef3 ho\u1eb7c khi c\u00f3 gi\u1ea3m th\u1ecb l\u1ef1c. Ki\u1ec3m tra ch\u1ee9c n\u0103ng gan v\u00e0 ch\u1ee9c n\u0103ng tuy\u1ebfn gi\u00e1p m\u1ed7i 6 th\u00e1ng. \u0110i\u1ec7n t\u00e2m \u0111\u1ed3 v\u00e0 Xquang ng\u1ef1c th\u1eb3ng n\u00ean \u0111\u01b0\u1ee3c l\u00e0m h\u1eb1ng n\u0103m. C\u00e1c th\u0103m d\u00f2 \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n m\u1edbi xu\u1ea5t hi\u1ec7n tri\u1ec7u ch\u1ee9ng kh\u00f3 th\u1edf ho\u1eb7c kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c ho\u1eb7c n\u1ebfu c\u00f3 b\u1ea5t th\u01b0\u1eddng tr\u00ean Xquang ng\u1ef1c m\u00e0 tr\u01b0\u1edbc \u0111\u00f3 kh\u00f4ng c\u00f3.<\/p>\n<h2><strong>5.Ch\u1ec9 \u0111\u1ecbnh<\/strong><\/h2>\n<ul>\n<li>Amiodarone hi\u1ec7n \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh r\u1ed9ng r\u00e3i \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n nh\u1ecbp nh\u0129 v\u00e0 th\u1ea5t m\u1eb7c d\u00f9 th\u1ef1c t\u1ebf l\u00e0 lo\u1ea1i thu\u1ed1c n\u00e0y hi\u1ec7n ch\u1ec9 \u0111\u01b0\u1ee3c FDA ph\u00ea chu\u1ea9n cho c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t tr\u01a1 v\u00e0 nguy hi\u1ec3m \u0111\u1ebfn t\u00ednh m\u1ea1ng. Hi\u1ec7n nay thu\u1ed1c \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh ch\u1ee7 y\u1ebfu trong:<\/li>\n<li>Rung th\u1ea5t.<\/li>\n<li>Nh\u1ecbp nhanh th\u1ea5t: Nh\u1ecbp nhanh th\u1ea5t m\u1ea5t m\u1ea1ch, nh\u1ecbp nhanh th\u1ea5t c\u00f3 dung n\u1ea1p huy\u1ebft \u0111\u1ed9ng t\u1ed1t h\u01a1n, nh\u1ecbp nhanh th\u1ea5t \u0111\u01a1n d\u1ea1ng ho\u1eb7c nhi\u1ec1u d\u1ea1ng (kh\u00f4ng ph\u1ea3i xo\u1eafn \u0111\u1ec9nh), nh\u1ecbp nhanh th\u1ea5t kh\u00f4ng b\u1ec1n b\u1ec9 c\u00f3 tri\u1ec7u ch\u1ee9ng.<\/li>\n<li>Gi\u1ea3m c\u00e1c nh\u00e1t s\u1ed1c c\u1ee7a m\u00e1y ICD do c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t.<\/li>\n<li>Nh\u1ecbp nhanh tr\u00ean th\u1ea5t, nh\u1ecbp nhanh nh\u0129 do v\u00f2ng v\u00e0o l\u1ea1i, nh\u1ecbp nhanh b\u1ed9 n\u1ed1i \u1ed5 ngo\u1ea1i v\u1ecb.<\/li>\n<li>Rung nh\u0129, cu\u1ed3ng nh\u0129 \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 h\u1ed9i ch\u1ee9ng Wol|-Parkinson-White. Duy tr\u00ec nh\u1ecbp xoang v\u00e0 d\u1ef1 ph\u00f2ng c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp nh\u0129 sau ph\u1ee5c h\u1ed3i nh\u1ecbp xoang nh\u1ea5t l\u00e0 sau ph\u1eabu thu\u1eadt.<\/li>\n<\/ul>\n<p><a href=\"https:\/\/www.vinmec.com\/\" target=\"_blank\" rel=\"nofollow noopener\"><b>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 v\u00e0 \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 c\u00e1c b\u1ec7nh l\u00fd tim m\u1ea1ch.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Amiodarone c\u00f3 c\u1ea5u tr\u00fac t\u01b0\u01a1ng t\u1ef1 nh\u01b0 thyroxine v\u00e0 l\u00e0 m\u1ed9t d\u1eabn xu\u1ea5t c\u00f3 iode c\u1ee7a benzofuran iode. Ban \u0111\u1ea7u thu\u1ed1c \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh v\u00e0 tr\u1edf n\u00ean ph\u1ed5 bi\u1ebfn nh\u01b0 l\u00e0 m\u1ed9t thu\u1ed1c ch\u1ed1ng \u0111au th\u1eaft ng\u1ef1c \u1edf ch\u00e2u \u00c2u trong nh\u1eefng n\u0103m 1960. 1.Bi\u1ec7t d\u01b0\u1ee3c Cordarone: \u1ed1ng 150mg, vi\u00ean 200mg. 2.D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc Amiodarone [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":21630,"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>Amiodarone trong th\u1ef1c h\u00e0nh b\u1ec7nh l\u00fd tim m\u1ea1ch - Vinmec<\/title>\n<meta name=\"description\" content=\"Amiodarone trong th\u1ef1c h\u00e0nh b\u1ec7nh l\u00fd tim m\u1ea1ch l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p v\u00e0 quan tr\u1ecdng. 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