{"id":21564,"date":"2023-04-15T21:16:04","date_gmt":"2023-04-15T14:16:04","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21564"},"modified":"2023-04-18T12:32:13","modified_gmt":"2023-04-18T05:32:13","slug":"phoi-hop-thuoc-loi-tieu-tren-thuc-hanh-lam-sang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/phoi-hop-thuoc-loi-tieu-tren-thuc-hanh-lam-sang\/","title":{"rendered":"Ph\u1ed1i h\u1ee3p l\u1ee3i ti\u1ec3u tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng"},"content":{"rendered":"

Ph\u1ed1i h\u1ee3p l\u1ee3i ti\u1ec3u \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng trong c\u00e1c tr\u01b0\u1ee3ng h\u1ee3p kh\u00f4ng th\u1eeba d\u1ecbch \u0111\u1ec3 ph\u00e1t huy t\u1ed1i \u0111a t\u00e1c d\u1ee5ng c\u00f3 \u0111\u01b0\u1ee3c. C\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng g\u1ed3m: T\u0103ng huy\u1ebft \u00e1p, \u0111\u00e1i th\u00e1o nh\u1ea1t….<\/strong><\/p>\n

1. T\u0103ng huy\u1ebft \u00e1p<\/h2>\n

C\u00e1c t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch v\u00e0 l\u1ee3i ti\u1ec3u nh\u1eb9 c\u1ee7a thiazide r\u1ea5t h\u1eefu \u00edch trong \u0111i\u1ec1u tr\u1ecb h\u1ea7u nh\u01b0 t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n b\u1ecb t\u0103ng huy\u1ebft \u00e1p. M\u1eb7c d\u00f9 hydrochlorothiazide l\u00e0 thu\u1ed1c l\u1ee3i ti\u1ec3u \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i nh\u1ea5t cho t\u0103ng huy\u1ebft \u00e1p, chlorthalidone c\u00f3 th\u1ec3 hi\u1ec7u qu\u1ea3 h\u01a1n v\u00ec n\u00f3 c\u00f3 th\u1eddi gian b\u00e1n th\u1ea3i l\u00e2u h\u01a1n.<\/p>\n

Thu\u1ed1c l\u1ee3i ti\u1ec3u quai th\u01b0\u1eddng d\u00e0nh cho b\u1ec7nh nh\u00e2n suy th\u1eadn nh\u1eb9 (MLCT < 30 \u2013 40 mL\/ph\u00fat) ho\u1eb7c suy tim. H\u1ea1n ch\u1ebf l\u01b0\u1ee3ng Na+ \u0103n v\u00e0o (60 \u2013 100 mEq\/24h) \u0111\u00e3 \u0111\u01b0\u1ee3c cho th\u1ea5y l\u00e0m t\u0103ng t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c l\u1ee3i ti\u1ec3u trong t\u0103ng huy\u1ebft \u00e1p v\u00e0 h\u1ea1n ch\u1ebf m\u1ea5t K+ qua th\u1eadn. M\u1ed9t thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef K+ c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u00eam v\u00e0o \u0111\u1ec3 gi\u1ea3m th\u1ea3i K+.<\/p>\n

M\u1eb7c d\u00f9 thu\u1ed1c l\u1ee3i ti\u1ec3u th\u01b0\u1eddng th\u00e0nh c\u00f4ng khi s\u1eed d\u1ee5ng \u0111\u01a1n tr\u1ecb li\u1ec7u, ch\u00fang c\u0169ng \u0111\u00f3ng m\u1ed9t vai tr\u00f2 quan tr\u1ecdng khi ph\u1ed1i h\u1ee3p \u0111\u1ec3 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p, nh\u1ea5t l\u00e0 theo xu h\u01b0\u1edbng hi\u1ec7n nay. C\u00e1c khuy\u1ebfn c\u00e1o \u0111\u1ec1u \u0111\u1ec1 c\u1eadp \u0111\u1ebfn vi\u1ec7c ph\u1ed1i h\u1ee3p thu\u1ed1c s\u1edbm trong \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p.<\/p>\n

Thu\u1ed1c l\u1ee3i ti\u1ec3u khi ph\u1ed1i h\u1ee3p gi\u00fap t\u0103ng c\u01b0\u1eddng hi\u1ec7u qu\u1ea3 c\u1ee7a nhi\u1ec1u thu\u1ed1c, \u0111\u1eb7c bi\u1ec7t l\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n. C\u00e1c thu\u1ed1c gi\u00e3n m\u1ea1ch m\u1ea1nh nh\u01b0 hydralazine ho\u1eb7c minoxidil th\u01b0\u1eddng c\u1ea7n d\u00f9ng \u0111\u1ed3ng th\u1eddi thu\u1ed1c l\u1ee3i ti\u1ec3u v\u00ec thu\u1ed1c gi\u00e3n m\u1ea1ch g\u00e2y gi\u1eef mu\u1ed1i n\u01b0\u1edbc \u0111\u00e1ng k\u1ec3. B\u1eb1ng ch\u1ee9ng ng\u00e0y c\u00e0ng t\u0103ng cho th\u1ea5y spironolactone l\u00e0 thu\u1ed1c duy nh\u1ea5t hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p kh\u00e1ng tr\u1ecb v\u00e0 t\u00e1c d\u1ee5ng n\u00e0y c\u00f3 th\u1ec3 m\u1edf r\u1ed9ng cho b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o.<\/p>\n

L\u1ee3i \u00edch c\u1ee7a l\u1ee3i ti\u1ec3u \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn \u0111\u1eb7c bi\u1ec7t t\u1ed1t \u1edf ba nh\u00f3m b\u1ec7nh nh\u00e2n: b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i, b\u1ec7nh nh\u00e2n da \u0111en v\u00e0 b\u1ec7nh nh\u00e2n b\u00e9o ph\u00ec. Li\u1ec1u th\u1ea5p c\u1ea7n s\u1eed d\u1ee5ng \u0111\u1ec3 gi\u1ea3m t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n l\u00ean chuy\u1ec3n h\u00f3a nh\u01b0 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng. B\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p k\u00e8m suy th\u1eadn c\u1ea7n d\u00f9ng thu\u1ed1c l\u1ee3i ti\u1ec3u quai (ho\u1eb7c metolazone). \u0110\u1ed1i v\u1edbi t\u0103ng huy\u1ebft \u00e1p, l\u1ee3i ti\u1ec3u thiazide li\u1ec1u th\u1ea5p, k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali ho\u1eb7c \u1ee9c ch\u1ebf men chuy\u1ec3n, ch\u1eb9n th\u1ee5 th\u1ec3 l\u00e0 ph\u00f9 h\u1ee3p.<\/p>\n

Chlorthalidone v\u00e0 indapamide thu\u1ed9c nh\u00f3m gi\u1ed1ng thiazide hay \u201cthiazide like\u201d. M\u1ed9t s\u1ed1 d\u1eef li\u1ec7u g\u1ea7n \u0111\u00e2y cho th\u1ea5y chlorthalidone v\u01b0\u1ee3t tr\u1ed9i h\u01a1n hydrochlorothiazide, ho\u1ea1t \u0111\u1ed9ng l\u00e2u h\u01a1n v\u00e0 t\u1ed1t h\u01a1n trong vi\u1ec7c gi\u1ea3m huy\u1ebft \u00e1p v\u1ec1 \u0111\u00eam. C\u1ea3 chlorthalidone v\u00e0 indapamide d\u01b0\u1edbi d\u1ea1ng gi\u1ea3i ph\u00f3ng ch\u1eadm \u0111\u01b0\u1ee3c \u01b0u ti\u00ean trong \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p.<\/p>\n

2. \u0110\u00e1i th\u00e1o nh\u1ea1t<\/h2>\n

B\u1ec7nh \u0111\u00e1i th\u00e1o nh\u1ea1t l\u00e0 do s\u1ea3n xu\u1ea5t thi\u1ebfu ADH (\u0111\u00e1i th\u00e1o nh\u1ea1t th\u1ea7n kinh ho\u1eb7c trung \u01b0\u01a1ng) ho\u1eb7c \u0111\u00e1p \u1ee9ng v\u1edbi ADH kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7 (\u0111\u00e1i th\u00e1o nh\u1ea1t th\u1eadn). B\u1ed5 sung ADH ho\u1eb7c m\u1ed9t trong c\u00e1c ch\u1ea5t t\u01b0\u01a1ng t\u1ef1 c\u1ee7a n\u00f3 ch\u1ec9 c\u00f3 hi\u1ec7u qu\u1ea3 trong b\u1ec7nh \u0111\u00e1i th\u00e1o nh\u1ea1t trung \u01b0\u01a1ng. Thu\u1ed1c l\u1ee3i ti\u1ec3u thiazide c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m tri\u1ec7u ch\u1ee9ng \u0111a ni\u1ec7u v\u00e0 \u0111\u00e1i d\u1eaft trong \u0111\u00e1i th\u00e1o nh\u1ea1t th\u1eadn, kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi b\u1ed5 sung ADH. Liti l\u00e0 m\u1ed9t nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn c\u1ee7a \u0111\u00e1i th\u00e1o nh\u1ea1t th\u1eadn v\u00e0 thu\u1ed1c l\u1ee3i ti\u1ec3u thiazide r\u1ea5t h\u1eefu \u00edch trong vi\u1ec7c \u0111i\u1ec1u tr\u1ecb t\u00ecnh tr\u1ea1ng n\u00e0y. Trong tr\u01b0\u1eddng h\u1ee3p \u0111\u00e1i th\u00e1o nh\u1ea1t th\u1eadn do Li+, hi\u1ec7n \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh hydrochlorothiazide g\u00e2y t\u0103ng th\u1ea9m th\u1ea5u \u1edf v\u00f9ng t\u1ee7y th\u1eadn v\u00e0 \u0111i\u1ec1u ch\u1ec9nh m\u1ed9t ph\u1ea7n m\u1ee9c gi\u1ea3m bi\u1ec3u hi\u1ec7n aquaporin-2 do Li+ g\u00e2y ra.<\/p>\n

hydrochlorothiazide c\u0169ng d\u1eabn \u0111\u1ebfn t\u0103ng bi\u1ec3u hi\u1ec7n c\u1ee7a c\u00e1c ch\u1ea5t v\u1eadn chuy\u1ec3n Na+ trong \u1ed1ng l\u01b0\u1ee3n xa v\u00e0 \u1ed1ng g\u00f3p c\u1ee7a nephron. Nh\u01b0 v\u1eady, th\u1ec3 t\u00edch n\u01b0\u1edbc ti\u1ec3u pha lo\u00e3ng t\u1ed1i \u0111a \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t gi\u1ea3m \u0111\u00e1ng k\u1ec3 b\u1edfi thiazide trong \u0111\u00e1i th\u00e1o nh\u1ea1t th\u1eadn. H\u1ea1n ch\u1ebf natri trong ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng c\u00f3 th\u1ec3 ph\u00e1t huy t\u00e1c d\u1ee5ng c\u00f3 l\u1ee3i c\u1ee7a thiazide tr\u00ean l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u trong b\u1ec7nh c\u1ea3nh n\u00e0y. N\u1ed3ng \u0111\u1ed9 Li+ huy\u1ebft thanh ph\u1ea3i \u0111\u01b0\u1ee3c theo d\u00f5i c\u1ea9n th\u1eadn \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y, v\u00ec thu\u1ed1c c\u00f3 th\u1ec3 gi\u1ea3m \u0111\u1ed9 thanh th\u1ea3i Li+ c\u1ee7a th\u1eadn v\u00e0 t\u0103ng n\u1ed3ng \u0111\u1ed9 Li+ trong huy\u1ebft t\u01b0\u01a1ng \u0111\u1ebfn m\u1ee9c g\u00e2y \u0111\u1ed9c.<\/p>\n

3. S\u1ecfi th\u1eadn<\/h2>\n

Kho\u1ea3ng hai ph\u1ea7n ba s\u1ecfi th\u1eadn c\u00f3 ch\u1ee9a Ca2 + phosphate ho\u1eb7c Ca2 + oxalate. M\u1eb7c d\u00f9 c\u00f3 r\u1ea5t nhi\u1ec1u b\u1ec7nh (c\u01b0\u1eddng c\u1eadn gi\u00e1p, t\u0103ng vitamin D, sarcoidosis, kh\u1ed1i u \u00e1c t\u00ednh) g\u00e2y t\u0103ng canxi ni\u1ec7u, nhi\u1ec1u b\u1ec7nh nh\u00e2n b\u1ecb s\u1ecfi th\u1eadn bi\u1ec3u hi\u1ec7n m\u1ed9t khi\u1ebfm khuy\u1ebft trong t\u00e1i h\u1ea5p thu Ca2 + \u1edf \u1ed1ng l\u01b0\u1ee3n g\u1ea7n. B\u1ea5t th\u01b0\u1eddng n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c l\u1ee3i ti\u1ec3u thiazide, gi\u00fap t\u0103ng c\u01b0\u1eddng t\u00e1i h\u1ea5p thu Ca2 + t\u1ea1i \u1ed1ng l\u01b0\u1ee3n xa v\u00e0 do \u0111\u00f3 l\u00e0m gi\u1ea3m n\u1ed3ng \u0111\u1ed9 Ca2 + trong n\u01b0\u1edbc ti\u1ec3u. L\u01b0\u1ee3ng n\u01b0\u1edbc u\u1ed1ng v\u00e0o n\u00ean \u0111\u01b0\u1ee3c t\u0103ng l\u00ean, nh\u01b0ng l\u01b0\u1ee3ng mu\u1ed1i ph\u1ea3i \u0111\u01b0\u1ee3c gi\u1ea3m, v\u00ec l\u01b0\u1ee3ng mu\u1ed1i natriclorua \u0103n v\u00e0o qu\u00e1 m\u1ee9c s\u1ebd l\u00e0m gi\u1ea3m hi\u1ec7u qu\u1ea3 h\u1ea1 canxi ni\u1ec7u c\u1ee7a thiazide.<\/p>\n

Thu\u1ed1c l\u1ee3i ti\u1ec3u thiazide l\u00e0m gi\u1ea3m l\u01b0\u1ee3ng canxi trong n\u01b0\u1edbc ti\u1ec3u b\u1eb1ng c\u00e1ch th\u00fac \u0111\u1ea9y t\u00e1i h\u1ea5p thu t\u1ea1i \u1ed1ng l\u01b0\u1ee3n g\u1ea7n, do \u0111\u00f3 ch\u00fang \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong t\u0103ng canxi ni\u1ec7u v\u00f4 c\u0103n \u0111\u1ec3 gi\u1ea3m s\u1ef1 h\u00ecnh th\u00e0nh s\u1ecfi th\u1eadn.<\/p>\n

T\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf c\u1ee7a thiazide \u0111\u1ed1i v\u1edbi m\u1ea5t canxi trong n\u01b0\u1edbc ti\u1ec3u c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch t\u1ea1i sao c\u00e1c thu\u1ed1c n\u00e0y c\u00f3 th\u1ec3 l\u00e0m t\u0103ng kho\u00e1ng h\u00f3a x\u01b0\u01a1ng v\u00e0 gi\u1ea3m t\u1ef7 l\u1ec7 g\u00e3y x\u01b0\u01a1ng h\u00f4ng. L\u1ee3i \u00edch n\u00e0y l\u00e0 m\u1ed9t c\u0103n c\u1ee9 cho vi\u1ec7c \u0111i\u1ec1u tr\u1ecb l\u1ee3i ti\u1ec3u li\u1ec1u th\u1ea5p t\u1eeb \u0111\u1ea7u \u1edf b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i b\u1ecb t\u0103ng huy\u1ebft \u00e1p.<\/p>\n

4. T\u0103ng canxi m\u00e1u<\/h2>\n

T\u0103ng canxi m\u00e1u c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t c\u1ea5p c\u1ee9u n\u1ed9i khoa. B\u1edfi v\u00ec thu\u1ed1c l\u1ee3i ti\u1ec3u quai l\u00e0m gi\u1ea3m t\u00e1i h\u1ea5p thu Ca2 + \u0111\u00e1ng k\u1ec3, ch\u00fang c\u00f3 th\u1ec3 kh\u00e1 hi\u1ec7u qu\u1ea3 trong vi\u1ec7c th\u00fac \u0111\u1ea9y l\u1ee3i ti\u1ec3u th\u1ea3i Ca2+. Tuy nhi\u00ean, thu\u1ed1c l\u1ee3i ti\u1ec3u quai c\u00f3 th\u1ec3 g\u00e2y ra s\u1ef1 suy gi\u1ea3m th\u1ec3 t\u00edch r\u00f5 r\u1ec7t. N\u1ebfu \u0111i\u1ec1u n\u00e0y x\u1ea3y ra, thu\u1ed1c l\u1ee3i ti\u1ec3u quai s\u1ebd kh\u00f4ng hi\u1ec7u qu\u1ea3 b\u1edfi v\u00ec s\u1ef1 t\u00e1i h\u1ea5p thu Ca2+ \u1edf \u1ed1ng l\u01b0\u1ee3n g\u1ea7n s\u1ebd \u0111\u01b0\u1ee3c t\u0103ng c\u01b0\u1eddng. Nh\u01b0 v\u1eady, truy\u1ec1n mu\u1ed1i \u0111\u1eb3ng tr\u01b0\u01a1ng ph\u1ea3i \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u quai \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o th\u1ea3i Ca2 + hi\u1ec7u qu\u1ea3.<\/p>\n

C\u00e1ch ti\u1ebfp c\u1eadn th\u00f4ng th\u01b0\u1eddng l\u00e0 truy\u1ec1n t\u0129nh m\u1ea1ch d\u1ecbch mu\u1ed1i \u0111\u1eb3ng tr\u01b0\u01a1ng v\u00e0 furosemide (80 \u2013 120 mg) ti\u00eam t\u0129nh m\u1ea1ch. Khi t\u00e1c d\u1ee5ng l\u1ee3i ti\u1ec3u xu\u1ea5t hi\u1ec7n, t\u1ed1c \u0111\u1ed9 truy\u1ec1n d\u1ecbch c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c kh\u1edbp v\u1edbi t\u1ed1c \u0111\u1ed9 d\u00f2ng n\u01b0\u1edbc ti\u1ec3u \u0111\u1ec3 tr\u00e1nh s\u1ef1 suy gi\u1ea3m th\u1ec3 t\u00edch v\u00e0 c\u00f3 th\u1ec3 b\u00f9 kali clorua v\u00e0o d\u1ecbch truy\u1ec1n \u0111\u1ec3 kh\u00f4ng l\u00e0m gi\u1ea3m kali m\u00e1u.<\/p>\n","protected":false},"excerpt":{"rendered":"

Ph\u1ed1i h\u1ee3p l\u1ee3i ti\u1ec3u \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng trong c\u00e1c tr\u01b0\u1ee3ng h\u1ee3p kh\u00f4ng th\u1eeba d\u1ecbch \u0111\u1ec3 ph\u00e1t huy t\u1ed1i \u0111a t\u00e1c d\u1ee5ng c\u00f3 \u0111\u01b0\u1ee3c. C\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng g\u1ed3m: T\u0103ng huy\u1ebft \u00e1p, \u0111\u00e1i th\u00e1o nh\u1ea1t…. 1. T\u0103ng huy\u1ebft \u00e1p C\u00e1c t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch v\u00e0 l\u1ee3i ti\u1ec3u nh\u1eb9 c\u1ee7a […]<\/p>\n","protected":false},"author":7,"featured_media":21566,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[3],"yoast_head":"\nPh\u1ed1i h\u1ee3p l\u1ee3i ti\u1ec3u tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng<\/title>\n<meta name=\"description\" content=\"Ph\u1ed1i h\u1ee3p thu\u1ed1c l\u1ee3i ti\u1ec3u tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng l\u00e0 quan tr\u1ecdng, tham kh\u1ea3o b\u00e0i vi\u1ebft \u0111\u1ec3 c\u00f3 th\u00eam th\u00f4ng tin trong \u0111i\u1ec1u tr\u1ecb.\" \/>\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=\"Ph\u1ed1i h\u1ee3p l\u1ee3i 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