{"id":21559,"date":"2023-04-16T09:52:03","date_gmt":"2023-04-16T02:52:03","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21559"},"modified":"2023-04-17T12:59:59","modified_gmt":"2023-04-17T05:59:59","slug":"roi-loan-nhip-tu-co-che-benh-sinh","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/16\/roi-loan-nhip-tu-co-che-benh-sinh\/","title":{"rendered":"Thu\u1ed1c r\u1ed1i lo\u1ea1n nh\u1ecbp v\u00e0 ho\u1ea1t \u0111\u1ed9ng \u0111i\u1ec7n t\u1ebf b\u00e0o"},"content":{"rendered":"<p><strong>R\u1ed1i lo\u1ea1n nh\u1ecbp l\u00e0 v\u1ea5n \u0111\u1ec1 hay g\u1eb7p v\u00e0 c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n nh\u1ecbp (Antiarrhythmic drugs \u2013 AADs) ho\u1ea1t \u0111\u1ed9ng b\u1eb1ng c\u00e1ch \u1ee9c ch\u1ebf c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp th\u00f4ng qua t\u00e1c d\u1ee5ng tr\u00ean c\u00e1c k\u00eanh ion v\u00e0 c\u00e1c th\u1ee5 th\u1ec3.\u00a0<\/strong><\/p>\n<h2><strong>1.Gi\u1edbi thi\u1ec7u v\u1ec1 thu\u1ed1c r\u1ed1i lo\u1ea1n nh\u1ecbp<\/strong><\/h2>\n<p>C\u00e1c thu\u1ed1c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb v\u00e0 d\u1ef1 ph\u00f2ng c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp tim \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 thu\u1ed1c ch\u1ed1ng r\u1ed1i lo\u1ea1n nh\u1ecbp tim. C\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n nh\u1ecbp (Antiarrhythmic drugs \u2013 AADs) \u1ee9c ch\u1ebf c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp th\u00f4ng qua t\u00e1c d\u1ee5ng tr\u00ean c\u00e1c k\u00eanh ion v\u00e0 c\u00e1c th\u1ee5 th\u1ec3. M\u1eb7c d\u00f9 ban \u0111\u1ea7u, c\u00e1c thu\u1ed1c n\u00e0y \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n v\u1edbi m\u1ee5c ti\u00eau c\u1ea3i thi\u1ec7n t\u1ef7 l\u1ec7 s\u1ed1ng c\u00f2n \u1edf b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh tim c\u1ea5u tr\u00fac c\u00f3 r\u1ed1i lo\u1ea1n nh\u1ecbp nh\u01b0ng c\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean l\u1edbn \u0111\u00e3 cho th\u1ea5y AADs kh\u00f4ng \u0111\u1ea1t \u0111\u01b0\u1ee3c nh\u1eefng hi\u1ec7u qu\u1ea3 mong mu\u1ed1n.<\/p>\n<p>Vai tr\u00f2 c\u1ee7a c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n nh\u1ecbp tim \u0111\u00e3 c\u00f3 nh\u1eefng thay \u0111\u1ed5i \u0111\u00e1ng k\u1ec3 t\u1eeb khi c\u00f3 nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n nh\u1ecbp m\u1edbi \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n, l\u1ee3i \u00edch \u2013 nguy c\u01a1 c\u1ee7a c\u00e1c thu\u1ed1c n\u00e0y tr\u00ean l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c hi\u1ec3u bi\u1ebft r\u00f5 r\u00e0ng h\u01a1n.<\/p>\n<p>AADs c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n b\u1ecb r\u1ed1i lo\u1ea1n nh\u1ecbp nh\u0129 v\u00e0 th\u1ea5t, h\u1ed7 tr\u1ee3 cho c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb tri\u1ec7t \u0111\u1ec3 nh\u01b0 tri\u1ec7t \u0111\u1ed1t qua \u0111\u01b0\u1eddng \u1ed1ng th\u00f4ng.<\/p>\n<p>Trong m\u1ee5c ti\u00eau d\u1ef1 ph\u00f2ng nguy\u00ean ph\u00e1t v\u00e0 th\u1ee9 ph\u00e1t \u0111\u1ed9t t\u1eed do nguy\u00ean nh\u00e2n tim m\u1ea1ch, AADs \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh kh\u00f4ng hi\u1ec7u qu\u1ea3 b\u1eb1ng m\u00e1y ph\u00e1 rung t\u1ef1 \u0111\u1ed9ng (ICD). R\u1ea5t nhi\u1ec1u thu\u1ed1c \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n nh\u1ecbp tim c\u0169 \u0111\u00e3 b\u1ecb r\u00fat kh\u1ecfi th\u1ecb tr\u01b0\u1eddng, c\u00e1c thu\u1ed1c m\u1edbi h\u01a1n v\u00e0 an to\u00e0n h\u01a1n \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o thay th\u1ebf.<\/p>\n<p>M\u1ed1i quan t\u00e2m l\u1edbn nh\u1ea5t c\u1ee7a c\u00e1c th\u1ea7y thu\u1ed1c l\u00e2m s\u00e0ng g\u1eb7p ph\u1ea3i khi quy\u1ebft \u0111\u1ecbnh kh\u1edfi tr\u1ecb v\u00e0 duy tr\u00ec l\u00e0:<\/p>\n<ul>\n<li>Nguy c\u01a1 xu\u1ea5t hi\u1ec7n c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp m\u1edbi.<\/li>\n<li>R\u1ed1i lo\u1ea1n nh\u1ecbp c\u0169 xu\u1ea5t hi\u1ec7n l\u1ea1i v\u1edbi t\u1ea7n s\u1ed1 d\u00e0y h\u01a1n. T\u00ecnh tr\u1ea1ng ng\u1ed9 \u0111\u1ed9c c\u00e1c thu\u1ed1c AADs.<\/li>\n<li>C\u00f3 r\u1ea5t \u00edt \u0111\u01b0\u1ee3c x\u1ebfp v\u00e0o nh\u00f3m an to\u00e0n khi kh\u1edfi tr\u1ecb trong c\u00e1c khuy\u1ebfn c\u00e1o. S\u1ef1 hi\u1ec3u bi\u1ebft r\u00f5 h\u01a1n v\u1ec1 l\u1ee3i \u00edch v\u00e0 nguy c\u01a1 c\u1ee7a AADs \u0111\u00e3 gi\u00fap vi\u1ec7c s\u1eed d\u1ee5ng nh\u00f3m thu\u1ed1c n\u00e0y hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n h\u01a1n. Vi\u1ec7c c\u00e2n nh\u1eafc c\u1ea9n th\u1eadn t\u00e1c \u0111\u1ed9ng l\u00e0m n\u1eb7ng lv\u00e0 t\u00e1c d\u1ee5ng g\u00e2y \u0111\u1ed9c \u0111\u00e3 d\u1eabn \u0111\u1ebfn vi\u1ec7c nhi\u1ec1u lo\u1ea1i AADs b\u1ecb r\u00fat kh\u1ecfi th\u1ecb tr\u01b0\u1eddng (procainamid, tocainide v\u00e0 bretylium \u0111\u01b0\u1eddng u\u1ed1ng) v\u00e0 m\u1ed9t s\u1ed1 thu\u1ed1c \u00edt \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng (quinidine, phenytoin, mexiletine, disopyramide).<\/li>\n<\/ul>\n<h2><strong>2.\u0110i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a tim<\/strong><\/h2>\n<p>Xung \u0111\u1ed9ng \u0111i\u1ec7n h\u1ecdc c\u1ee7a tim th\u1ef1c t\u1ebf l\u00e0 t\u1ed5ng h\u1ee3p c\u1ee7a h\u00e0ng ngh\u00ecn d\u00f2ng \u0111i\u1ec7n nh\u1ecf do h\u00e0ng ngh\u00ecn t\u1ebf b\u00e0o ri\u00eang r\u1ebd c\u1ee7a tim t\u1ea1o ra. Ho\u1ea1t \u0111\u1ed9ng \u0111i\u1ec7n h\u1ecdc c\u1ee7a m\u1ed9t t\u1ebf b\u00e0o ri\u00eang bi\u1ec7t \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a tim. C\u00e1c t\u1ebf b\u00e0o c\u1ee7a c\u00e1c t\u1ed5 ch\u1ee9c, c\u01a1 tim kh\u00e1c nhau nh\u01b0 c\u01a1 nh\u0129, c\u01a1 th\u1ea5t, His, Purkinje, n\u00fat nh\u0129 th\u1ea5t (AVN) v\u00e0 n\u00fat xoang (SAN) c\u00f3 ki\u1ec3u \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng kh\u00e1c nhau.<\/p>\n<p>\u0110i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng chia th\u00e0nh 5 giai \u0111o\u1ea1n: 0, 1, 2, 3 v\u00e0 4 \u0111\u1ec3 m\u00f4 t\u1ea3 s\u1ef1 ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u00e1c k\u00eanh ion kh\u00e1c nhau ho\u1eb7c \u0111\u01b0\u1ee3c chia th\u00e0nh giai \u0111o\u1ea1n kh\u1eed c\u1ef1c, giai \u0111o\u1ea1n t\u00e1i c\u1ef1c v\u00e0 giai \u0111o\u1ea1n ngh\u1ec9. C\u00e1c t\u1ebf b\u00e0o t\u1ef1 \u0111\u1ed9ng nh\u01b0 t\u1ebf b\u00e0o n\u00fat xoang, n\u00fat nh\u0129 th\u1ea5t c\u00f3 ki\u1ec3u \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng kh\u00e1c \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a t\u1ebf b\u00e0o c\u01a1 nh\u0129, c\u01a1 th\u1ea5t v\u00e0 h\u1ec7 th\u1ed1ng His \u2013 Purkinje (t\u1ebf b\u00e0o \u0111\u00e1p \u1ee9ng nhanh).<\/p>\n<p>C\u00e1c giai \u0111o\u1ea1n c\u1ee7a \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng (\u0110TH\u0110) c\u1ee7a t\u1ebf b\u00e0o :<\/p>\n<ul>\n<li>Giai \u0111o\u1ea1n 4: \u0110i\u1ec7n th\u1ebf qua m\u00e0ng l\u00fac ngh\u1ec9<\/li>\n<\/ul>\n<p>Do s\u1ef1 ch\u00eanh l\u1ec7ch n\u1ed3ng \u0111\u1ed9 ion Na+, Ca++ v\u00e0 K+ \u1edf trong v\u00e0 ngo\u00e0i t\u1ebf b\u00e0o (n\u1ed3ng \u0111\u1ed9 Na+ \u1edf ngo\u00e0i t\u1ebf b\u00e0o cao g\u1ea5p 10 l\u1ea7n \u1edf trong t\u1ebf b\u00e0o, Ca++ ngo\u00e0i t\u1ebf b\u00e0o cao g\u1ea5p 1000 l\u1ea7n trong t\u1ebf b\u00e0o v\u00e0 K+ trong t\u1ebf b\u00e0o cao g\u1ea5p 30 l\u1ea7n ngo\u00e0i t\u1ebf b\u00e0o), l\u00e0m cho t\u1ebf b\u00e0o \u1edf tr\u1ea1ng th\u00e1i ph\u00e2n c\u1ef1c: m\u1eb7t ngo\u00e0i m\u00e0ng t\u1ebf b\u00e0o mang \u0111i\u1ec7n th\u1ebf (+) v\u00e0 m\u1eb7t trong mang \u0111i\u1ec7n (-) v\u00e0 \u0111i\u1ec1u \u0111\u00f3 t\u1ea1o th\u00e0nh tr\u1ea1ng th\u00e1i n\u1ed9i m\u00f4i h\u1eb1ng \u0111\u1ecbnh ph\u00f9 h\u1ee3p v\u1edbi s\u1ef1 s\u1ed1ng b\u00ecnh th\u01b0\u1eddng. S\u1ef1 ch\u00eanh l\u1ec7ch \u0111i\u1ec7n th\u1ebf qua m\u00e0ng t\u1ebf b\u00e0o \u1edf giai \u0111o\u1ea1n n\u00e0y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 \u0111i\u1ec7n th\u1ebf qua m\u00e0ng l\u00fac ngh\u1ec9.<\/p>\n<p>\u0110i\u1ec7n th\u1ebf qua m\u00e0ng l\u00fac ngh\u1ec9 c\u1ee7a c\u00e1c t\u1ed5 ch\u1ee9c tim kh\u00e1c nhau s\u1ebd kh\u00e1c nhau v\u00e0 c\u1ee7a c\u00e1c t\u1ebf b\u00e0o c\u01a1 th\u1ea5t v\u00e0o kho\u1ea3ng -80 \u0111\u1ebfn -90mV.<\/p>\n<ul>\n<li>Giai \u0111o\u1ea1n 0: Kh\u1eed c\u1ef1c nhanh<\/li>\n<\/ul>\n<p>Khi c\u00f3 t\u00e1c \u0111\u1ed9ng c\u1ee7a c\u00e1c xung k\u00edch th\u00edch l\u00ean m\u00e0ng t\u1ebf b\u00e0o l\u00e0m cho c\u00e1c k\u00eanh natri \u0111\u01b0\u1ee3c m\u1edf ra, ion Na+ t\u1eeb ngo\u00e0i t\u1ebf b\u00e0o \u00e0o \u1ea1t \u0111i v\u00e0o trong t\u1ebf b\u00e0o l\u00e0m cho \u0111i\u1ec7n th\u1ebf qua m\u00e0ng t\u1eeb -90mV t\u0103ng v\u1ecdt nhanh l\u00ean t\u1edbi +20mV v\u00e0 t\u1ebf b\u00e0o \u0111\u01b0\u1ee3c kh\u1eed c\u1ef1c. Tr\u00ean \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 b\u1ec1 m\u1eb7t t\u01b0\u01a1ng \u1ee9ng v\u1edbi ph\u1ee9c b\u1ed9 QRS.<\/p>\n<p>\u0110\u1ed9 d\u1ed1c c\u1ee7a giai \u0111o\u1ea1n 0 th\u1ec3 hi\u1ec7n t\u1ed1c \u0111\u1ed9 kh\u1eed c\u1ef1c t\u1ed1i \u0111a (Vmax) c\u1ee7a t\u1ebf b\u00e0o v\u00e0 n\u00f3 \u1ea3nh h\u01b0\u1edfng t\u1edbi t\u1ed1c \u0111\u1ed9 d\u1eabn truy\u1ec1n xung \u0111\u1ed9ng c\u1ee7a t\u1ed5 ch\u1ee9c c\u01a1 tim. C\u00e1c thu\u1ed1c ch\u1ed1ng r\u1ed1i lo\u1ea1n nh\u1ecbp tim nh\u00f3m I l\u00e0m thay \u0111\u1ed5i t\u1ed1c \u0111\u1ed9 pha 0 n\u00ean l\u00e0m ch\u1eadm t\u1ed1c \u0111\u1ed9 d\u1eabn truy\u1ec1n v\u00e0 t\u1ed1c \u0111\u1ed9 kh\u1eed c\u1ef1c t\u1ed1i \u0111a.<\/p>\n<ul>\n<li>Giai \u0111o\u1ea1n 1: T\u00e1i c\u1ef1c nhanh-s\u1edbm<\/li>\n<\/ul>\n<p>Giai \u0111o\u1ea1n n\u00e0y l\u00e0 th\u1eddi k\u1ef3 \u0111\u1ea7u c\u1ee7a qu\u00e1 tr\u00ecnh t\u00e1i c\u1ef1c c\u1ee7a t\u1ebf b\u00e0o v\u00e0 ch\u1ee7 y\u1ebfu l\u00e0 do \u0111\u00f3ng c\u00e1c k\u00eanh natri nhanh. Tuy nhi\u00ean, n\u00f3 c\u0169ng c\u00f2n do d\u00f2ng kali \u0111i ra ngo\u00e0i t\u1ebf b\u00e0o khi k\u00eanh kali m\u1edf ra v\u00e0 sau \u0111\u00f3 \u0111\u00f3ng l\u1ea1i.<\/p>\n<ul>\n<li>Giai \u0111o\u1ea1n 2: Pha cao nguy\u00ean c\u1ee7a \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng<\/li>\n<\/ul>\n<p>\u0110\u00e2y l\u00e0 giai \u0111o\u1ea1n d\u00e0i nh\u1ea5t c\u1ee7a \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng v\u00e0 l\u00e0 s\u1ef1 kh\u00e1c bi\u1ec7t trong \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a t\u1ebf b\u00e0o c\u01a1 tim v\u1edbi t\u1ebf b\u00e0o c\u01a1 x\u01b0\u01a1ng v\u00e0 t\u1ebf b\u00e0o th\u1ea7n kinh. Giai \u0111o\u1ea1n n\u00e0y l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a s\u1ef1 c\u00e2n b\u1eb1ng gi\u1eefa d\u00f2ng natri, canxi \u0111i v\u00e0o v\u00e0 d\u00f2ng kali \u0111i ra ngo\u00e0i t\u1ebf b\u00e0o. Giai \u0111o\u1ea1n n\u00e0y th\u01b0\u1eddng t\u01b0\u01a1ng \u1ee9ng v\u1edbi \u0111o\u1ea1n ST tr\u00ean \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 b\u1ec1 m\u1eb7t.<\/p>\n<ul>\n<li>Giai \u0111o\u1ea1n 3: T\u00e1i c\u1ef1c nhanh<\/li>\n<\/ul>\n<p>C\u00e1c k\u00eanh Ca++ \u0111\u00f3ng l\u1ea1i, trong khi c\u00e1c k\u00eanh K+ ch\u1eadm m\u1ed9t chi\u1ec1u \u0111\u01b0\u1ee3c m\u1edf ra v\u00e0 kh\u1edfi ph\u00e1t vi\u1ec7c m\u1edf c\u00e1c k\u00eanh kh\u00e1c nh\u01b0 k\u00eanh kali nhanh m\u1ed9t chi\u1ec1u d\u1eabn \u0111\u1ebfn d\u00f2ng ion d\u01b0\u01a1ng \u0111i ra ngo\u00e0i t\u1ebf b\u00e0o l\u00e0m cho t\u1ebf b\u00e0o t\u00e1i c\u1ef1c nhanh ch\u00f3ng. K\u00eanh K+ m\u1ed9t chi\u1ec1u nhanh \u0111\u01b0\u1ee3c ho\u1ea1t h\u00f3a v\u00e0 m\u1edf ra \u1edf ph\u1ea7n cu\u1ed1i c\u1ee7a giai \u0111o\u1ea1n 3 v\u00e0 ti\u1ebfp t\u1ee5c sau \u0111\u00f3 \u0111\u1ec3 duy tr\u00ec \u0111i\u1ec7n th\u1ebf ngh\u1ec9 qua m\u00e0ng \u1edf giai \u0111o\u1ea1n 4.<\/p>\n<h3>2.1 \u0110i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a n\u00fat xoang v\u00e0 n\u00fat nh\u0129 th\u1ea5t<\/h3>\n<ul>\n<li>\u0110i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a n\u00fat xoang v\u00e0 n\u00fat nh\u0129 th\u1ea5t kh\u00e1 gi\u1ed1ng nhau v\u00e0 ch\u1ec9 kh\u00e1c nhau<\/li>\n<\/ul>\n<p>ch\u00fat \u00edt \u1edf giai \u0111o\u1ea1n 0 v\u00e0 c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t \u0111\u00e1ng k\u1ec3 v\u1edbi \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a t\u1ebf b\u00e0o \u0111\u00e1p \u1ee9ng nhanh.<\/p>\n<ul>\n<li>\u0110i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a n\u00fat xoang v\u00e0 n\u00fat nh\u0129 th\u1ea5t (c\u00f2n g\u1ecdi l\u00e0 t\u1ebf b\u00e0o c\u00f3 \u0111i\u1ec7n th\u1ebf \u0111\u00e1p \u1ee9ng ch\u1eadm) \u0111\u01b0\u1ee3c chia th\u00e0nh ba giai \u0111o\u1ea1n: 0, 3 v\u00e0 4.<\/li>\n<\/ul>\n<p>Giai \u0111o\u1ea1n 4: Kh\u1eed c\u1ef1c t\u1ef1 ph\u00e1t (\u0110i\u1ec7n th\u1ebf t\u1ea1o nh\u1ecbp)<\/p>\n<ul>\n<li>\u0110i\u1ec7n th\u1ebf qua m\u00e0ng l\u00fac ngh\u1ec9 c\u1ee7a c\u00e1c t\u1ebf b\u00e0o t\u1ea1o nh\u1ecbp v\u00e0o kho\u1ea3ng -60 mV \u0111\u1ebfn -70 mV.<\/li>\n<li>D\u00f2ng ion K+ \u0111i ra gi\u1ea3m d\u1ea7n, l\u00e0m cho s\u1ef1 kh\u1eed c\u1ef1c ch\u1eadm c\u00f9ng v\u1edbi d\u00f2ng Na+ ch\u1eadm \u0111i v\u00e0o v\u00e0 Ca++ \u0111i v\u00e0o qua k\u00eanh canxi lo\u1ea1i L (ICaT) l\u00e0m cho \u0111i\u1ec7n th\u1ebf qua m\u00e0ng t\u1ebf b\u00e0o tr\u1edf l\u00ean d\u01b0\u01a1ng t\u00ednh h\u01a1n v\u00e0 khi \u0111\u1ea1t t\u1edbi \u0111i\u1ec7n th\u1ebf ng\u01b0\u1ee1ng (-40 mV \u0111\u1ebfn -50 mV), t\u1ebf b\u00e0o b\u01b0\u1edbc v\u00e0o pha kh\u1eed c\u1ef1c).<\/li>\n<\/ul>\n<p>Giai \u0111o\u1ea1n 0: Kh\u1eed c\u1ef1c<\/p>\n<ul>\n<li>Ho\u1ea1t \u0111\u1ed9ng \u0111i\u1ec7n h\u1ecdc ch\u1ee7 y\u1ebfu trong giai \u0111o\u1ea1n n\u00e0y ph\u1ee5 thu\u1ed9c v\u00e0o d\u00f2ng canxi \u0111i v\u00e0o qua k\u00eanh canxi lo\u1ea1i L, t\u01b0\u01a1ng ph\u1ea3n v\u1edbi d\u00f2ng natri \u0111i v\u00e0o \u1edf c\u00e1c t\u1ebf b\u00e0o \u0111\u00e1p \u1ee9ng nhanh. Th\u1ef1c t\u1ebf l\u00e0 c\u00e1c k\u00eanh natri \u0111i v\u00e0o h\u1ea7u nh\u01b0 kh\u00f4ng c\u00f3 \u1edf c\u00e1c t\u1ed5 ch\u1ee9c n\u00e0y.<\/li>\n<li>Nh\u00e1nh l\u00ean c\u1ee7a \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng kh\u00f4ng \u0111i th\u1eb3ng \u0111\u1ee9ng nh\u01b0 \u1edf t\u1ebf b\u00e0o \u0111\u00e1p \u1ee9ng nhanh<\/li>\n<\/ul>\n<p>m\u00e0 t\u0103ng l\u00ean t\u1eeb t\u1eeb n\u00ean t\u1ed1c \u0111\u1ed9 d\u1eabn truy\u1ec1n \u1edf t\u1ed5 ch\u1ee9c t\u1ea1o nh\u1ecbp c\u0169ng ch\u1eadm h\u01a1n \u0111\u00e1ng k\u1ec3 so v\u1edbi t\u1ed5 ch\u1ee9c c\u00f3 t\u1ebf b\u00e0o \u0111\u00e1p \u1ee9ng nhanh.<\/p>\n<ul>\n<li>\u0110i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a n\u00fat nh\u0129-th\u1ea5t c\u00f3 t\u1ed1c \u0111\u1ed9 nh\u00e1nh l\u00ean (Vmax) nhanh h\u01a1n \u0111\u00f4i ch\u00fat so v\u1edbi n\u00fat xoang.<\/li>\n<\/ul>\n<p>Giai \u0111o\u1ea1n 3: T\u00e1i c\u1ef1c<\/p>\n<p>D\u00f2ng K+ \u0111i ra t\u0103ng l\u00ean, c\u00e1c k\u00eanh canxi b\u1ea5t ho\u1ea1t nhanh c\u00f9ng v\u1edbi s\u1ef1 gi\u1ea3m \u0111\u1ed3ng th\u1eddi c\u1ee7a d\u00f2ng natri \u0111i v\u00e0o.<\/p>\n<h3>2.2 S\u1ef1 ph\u00e2n b\u1ed1 th\u1ea7n kinh t\u1ef1 \u0111\u1ed9ng<\/h3>\n<ul>\n<li>N\u00fat xoang v\u00e0 n\u00fat nh\u0129 th\u1ea5t c\u00f3 r\u1ea5t nhi\u1ec1u s\u1ee3i th\u1ea7n kinh giao c\u1ea3m v\u00e0 ph\u00f3 giao c\u1ea3m, c\u00f2n \u1edf c\u00e1c t\u1ed5 ch\u1ee9c t\u1ebf b\u00e0o \u0111\u00e1p \u1ee9ng nhanh c\u00f3 r\u1ea5t \u00edt c\u00e1c s\u1ee3i th\u1ea7n kinh ph\u00f3 giao c\u1ea3m. B\u1edfi v\u1eady c\u00f3 s\u1ef1 thay \u0111\u1ed5i tr\u01b0\u01a1ng l\u1ef1c ph\u00f3 giao c\u1ea3m \u1edf n\u00fat xoang v\u00e0 n\u00fat nh\u0129 th\u1ea5t nh\u01b0ng l\u1ea1i kh\u00f4ng c\u00f3 ho\u1eb7c r\u1ea5t \u00edt \u1edf c\u00e1c t\u1ed5 ch\u1ee9c t\u1ebf b\u00e0o \u0111\u00e1p \u1ee9ng nhanh.<\/li>\n<\/ul>\n<ul>\n<li>Tr\u01b0\u01a1ng l\u1ef1c giao c\u1ea3m t\u0103ng d\u1eabn t\u1edbi t\u0103ng t\u00ednh t\u1ef1 \u0111\u1ed9ng, t\u0103ng t\u1ed1c \u0111\u1ed9 d\u1eabn truy\u1ec1n (Vmax) v\u00e0 gi\u1ea3m th\u1eddi gian giai \u0111o\u1ea1n tr\u01a1. Ng\u01b0\u1ee3c l\u1ea1i, t\u0103ng tr\u01b0\u01a1ng l\u1ef1c ph\u00f3 giao c\u1ea3m d\u1eabn t\u1edbi gi\u1ea3m t\u00ednh t\u1ef1 \u0111\u1ed9ng, gi\u1ea3m t\u1ed1c \u0111\u1ed9 d\u1eabn truy\u1ec1n v\u00e0 k\u00e9o d\u00e0i giai \u0111o\u1ea1n tr\u01a1.<\/li>\n<\/ul>\n<p>Nh\u01b0 v\u1eady, s\u1ef1 hi\u1ec3u bi\u1ebft v\u1ec1 vai tr\u00f2 c\u1ee7a c\u00e1c k\u00eanh ion kh\u00e1c nhau trong c\u00e1c giai \u0111o\u1ea1n kh\u00e1c nhau c\u1ee7a \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u00e1c t\u1ebf b\u00e0o \u0111\u00e1p \u1ee9ng nhanh c\u0169ng nh\u01b0 t\u1ebf b\u00e0o \u0111\u00e1p \u1ee9ng ch\u1eadm gi\u00fap cho ch\u00fang ta hi\u1ec3u v\u00e0 n\u1eafm \u0111\u01b0\u1ee3c c\u01a1 ch\u1ebf v\u00e0 v\u1ecb tr\u00ed t\u00e1c \u0111\u1ed9ng ch\u00ednh c\u1ee7a c\u00e1c thu\u1ed1c , qua \u0111\u00f3 c\u00f3 s\u1ef1 l\u1ef1a ch\u1ecdn thu\u1ed1c th\u00edch h\u1ee3p v\u1edbi t\u1eebng lo\u1ea1i r\u1ed1i lo\u1ea1n nh\u1ecbp kh\u00e1c nhau.<\/p>\n<h3>2.3 C\u01a1 ch\u1ebf c\u1ee7a c\u00e1c thu\u1ed1c ch\u1ed1ng r\u1ed1i lo\u1ea1n nh\u1ecbp tim<\/h3>\n<p>C\u01a1 ch\u1ebf ch\u00ednh l\u00e0m kh\u1edfi ph\u00e1t r\u1ed1i lo\u1ea1n nh\u1ecbp tim l\u00e0: r\u1ed1i lo\u1ea1n h\u00ecnh th\u00e0nh xung \u0111\u1ed9ng v\u00e0 r\u1ed1i lo\u1ea1n d\u1eabn truy\u1ec1n xung \u0111\u1ed9ng. AADs ch\u1ee7 y\u1ebfu t\u00e1c \u0111\u1ed9ng v\u00e0o c\u00e1c k\u00eanh ion (v\u00e0\/ho\u1eb7c c\u00e1c th\u1ee5 th\u1ec3) \u1edf tim v\u00e0 c\u00f3 th\u1ec3 t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn nhi\u1ec1u c\u01a1 ch\u1ebf r\u1ed1i lo\u1ea1n nh\u1ecbp kh\u00e1c nhau b\u1eb1ng c\u00e1ch thay \u0111\u1ed5i t\u00ednh k\u00edch th\u00edch, kh\u1ea3 n\u0103ng d\u1eabn truy\u1ec1n v\u00e0 t\u00ednh tr\u01a1 c\u1ee7a tim. M\u1ed9t s\u1ed1 AADs c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn nhi\u1ec1u h\u01a1n m\u1ed9t k\u00eanh ion tim (v\u00e0\/ho\u1eb7c th\u1ee5 th\u1ec3) v\u00e0 do \u0111\u00f3 c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn nhi\u1ec1u h\u01a1n m\u1ed9t c\u01a1 ch\u1ebf lo\u1ea1n nh\u1ecbp tim, trong khi m\u1ed9t s\u1ed1 AADs m\u1edbi h\u01a1n c\u00f3 th\u1ec3 c\u00f3 c\u01a1 ch\u1ebf ho\u1ea1t \u0111\u1ed9ng ho\u00e0n to\u00e0n m\u1edbi. M\u1ed9t s\u1ed1 AADs \u0111\u1eb7c hi\u1ec7u cho m\u1ed9t s\u1ed1 m\u00f4 tim nh\u1ea5t \u0111\u1ecbnh, ch\u1eb3ng h\u1ea1n nh\u01b0 t\u00e2m nh\u0129, t\u00e2m th\u1ea5t ho\u1eb7c n\u00fat xoang ho\u1eb7c n\u00fat nh\u0129 th\u1ea5t, trong khi m\u1ed9t s\u1ed1 thu\u1ed1c kh\u00e1c l\u1ea1i c\u00f3 t\u00e1c d\u1ee5ng chung h\u01a1n.<\/p>\n<h3>2.4 T\u00e1c d\u1ee5ng g\u00e2y ra ho\u1eb7c l\u00e0m n\u1eb7ng c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp tim c\u1ee7a c\u00e1c thu\u1ed1c ch\u1ed1ng r\u1ed1i lo\u1ea1n nh\u1ecbp tim<\/h3>\n<p>T\u1ea5t c\u1ea3 c\u00e1c thu\u1ed1c ch\u1ed1ng r\u1ed1i lo\u1ea1n nh\u1ecbp tim c\u00f3 t\u00e1c d\u1ee5ng d\u1ef1 ph\u00f2ng ho\u1eb7c \u1ee9c ch\u1ebf c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp tim nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 l\u00e0m kh\u1edfi ph\u00e1t c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp m\u1edbi ho\u1eb7c l\u00e0m cho c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp v\u1ed1n c\u00f3 n\u1eb7ng l\u00ean (proarrhythmias). Do \u0111\u00f3 c\u1ea7n s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c ch\u1ed1ng r\u1ed1i lo\u1ea1n nh\u1ecbp m\u1ed9t c\u00e1ch th\u1eadn tr\u1ecdng. T\u00f9y thu\u1ed9c v\u00e0o c\u00e1c \u0111\u1eb7c t\u00ednh c\u1ee7a thu\u1ed1c, t\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi, c\u0169ng nh\u01b0 c\u00e1c y\u1ebfu t\u1ed1 ng\u01b0\u1eddi b\u1ec7nh, c\u00e1c t\u00e1c d\u1ee5ng l\u00e0m n\u1eb7ng l\u00ean c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp sau \u0111\u00e2y c\u00f3 th\u1ec3 g\u1eb7p:<\/p>\n<ul>\n<li>L\u00e0m xu\u1ea5t hi\u1ec7n c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp m\u1edbi nh\u01b0: nh\u1ecbp nhanh th\u1ea5t \u0111\u01a1n d\u1ea1ng, b\u1ec1n b\u1ec9; nh\u1ecbp nhanh th\u1ea5t \u0111a d\u1ea1ng (polymorphology), xo\u1eafn \u0111\u1ec9nh li\u00ean quan t\u1edbi k\u00e9o d\u00e0i kho\u1ea3ng QT, rung th\u1ea5t, c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp tr\u00ean th\u1ea5t ho\u1eb7c nh\u1ecbp ch\u1eadm nh\u01b0 nh\u1ecbp ch\u1eadm xoang ho\u1eb7c block nh\u0129 th\u1ea5t c\u00e1c m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau.<\/li>\n<li>L\u00e0m n\u1eb7ng l\u00ean c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp \u0111\u00e3 c\u00f3 nh\u01b0: s\u1ed1 l\u01b0\u1ee3ng ngo\u1ea1i t\u00e2m thu nh\u0129, th\u1ea5t t\u0103ng l\u00ean, ho\u1eb7c ch\u00f9m \u0111\u00f4i\u2026; chuy\u1ec3n nh\u1ecbp nhanh th\u1ea5t kh\u00f4ng b\u1ec1n b\u1ec9 th\u00e0nh b\u1ec1n b\u1ec9; c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp tim v\u1ed1n c\u00f3 t\u1eeb tr\u01b0\u1edbc tr\u1edf n\u00ean b\u1ec1n b\u1ec9 ho\u1eb7c kh\u00f4ng th\u1ec3 c\u1eaft \u0111\u01b0\u1ee3c c\u01a1n; nh\u1ecbp nhanh th\u1ea5t c\u00f3 t\u1ea7n s\u1ed1 nhanh h\u01a1n v\u00e0 huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh.<\/li>\n<li>L\u00e0m ch\u1eadm d\u1ea7n t\u1ea7n s\u1ed1 nh\u1ecbp nhanh nh\u0129 d\u1eabn t\u1edbi d\u1eabn truy\u1ec1n 1:1 qua n\u00fat nh\u0129-th\u1ea5t, d\u1eabn \u0111\u1ebfn t\u1ea7n s\u1ed1 \u0111\u00e1p \u1ee9ng th\u1ea5t t\u0103ng l\u00ean, m\u00e0 \u0111i\u1ec1u n\u00e0y kh\u00f4ng c\u00f3 tr\u01b0\u1edbc khi d\u00f9ng thu\u1ed1c ho\u1eb7c c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp tim d\u1ec5 d\u00e0ng xu\u1ea5t hi\u1ec7n h\u01a1n khi th\u0103m d\u00f2 \u0111i\u1ec7n sinh l\u00fd tim.<\/li>\n<\/ul>\n<p>S\u1ef1 n\u1eb7ng l\u00ean c\u1ee7a c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp do c\u00e1c thu\u1ed1c ch\u1ed1ng lo\u1ea1n nh\u1ecbp tim g\u00e2y ra th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n m\u1ed9t v\u00e0i ng\u00e0y sau khi s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng r\u1ed1i lo\u1ea1n nh\u1ecbp ho\u1eb7c t\u0103ng li\u1ec1u thu\u1ed1c.<\/p>\n<h2><strong>3.K\u1ebft lu\u1eadn<\/strong><\/h2>\n<p>C\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n nh\u1ecbp (Antiarrhythmic drugs \u2013 AADs) \u1ee9c ch\u1ebf c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp th\u00f4ng qua t\u00e1c d\u1ee5ng tr\u00ean c\u00e1c k\u00eanh ion v\u00e0 c\u00e1c th\u1ee5 th\u1ec3. Vai tr\u00f2 c\u1ee7a c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n nh\u1ecbp tim \u0111\u00e3 c\u00f3 nh\u1eefng thay \u0111\u1ed5i \u0111\u00e1ng k\u1ec3 t\u1eeb khi c\u00f3 nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n nh\u1ecbp m\u1edbi \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n, l\u1ee3i \u00edch \u2013 nguy c\u01a1 c\u1ee7a c\u00e1c thu\u1ed1c n\u00e0y tr\u00ean l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c hi\u1ec3u bi\u1ebft r\u00f5 r\u00e0ng h\u01a1n. C\u00f3 r\u1ea5t \u00edt c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n nh\u1ecbp tim \u0111\u01b0\u1ee3c x\u1ebfp v\u00e0o nh\u00f3m an to\u00e0n khi kh\u1edfi tr\u1ecb trong c\u00e1c khuy\u1ebfn c\u00e1o. S\u1ef1 hi\u1ec3u bi\u1ebft r\u00f5 h\u01a1n v\u1ec1 l\u1ee3i \u00edch v\u00e0 nguy c\u01a1 c\u1ee7a AADs \u0111\u00e3 gi\u00fap vi\u1ec7c s\u1eed d\u1ee5ng nh\u00f3m thu\u1ed1c n\u00e0y hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n h\u01a1n.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>R\u1ed1i lo\u1ea1n nh\u1ecbp l\u00e0 v\u1ea5n \u0111\u1ec1 hay g\u1eb7p v\u00e0 c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n nh\u1ecbp (Antiarrhythmic drugs \u2013 AADs) ho\u1ea1t \u0111\u1ed9ng b\u1eb1ng c\u00e1ch \u1ee9c ch\u1ebf c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp th\u00f4ng qua t\u00e1c d\u1ee5ng tr\u00ean c\u00e1c k\u00eanh ion v\u00e0 c\u00e1c th\u1ee5 th\u1ec3.\u00a0 1.Gi\u1edbi thi\u1ec7u v\u1ec1 thu\u1ed1c r\u1ed1i lo\u1ea1n nh\u1ecbp C\u00e1c thu\u1ed1c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":21633,"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>Thu\u1ed1c r\u1ed1i lo\u1ea1n nh\u1ecbp v\u00e0 ho\u1ea1t \u0111\u1ed9ng \u0111i\u1ec7n t\u1ebf b\u00e0o - Vinmec<\/title>\n<meta name=\"description\" content=\"R\u1ed1i lo\u1ea1n nh\u1ecbp l\u00e0 v\u1ea5n \u0111\u1ec1 hay g\u1eb7p v\u00e0 c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n nh\u1ecbp ho\u1ea1t \u0111\u1ed9ng d\u1ef1a tr\u00ean c\u01a1 ch\u1ebf \u0111i\u1ec7n t\u1ebf b\u00e0o. 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