{"id":21571,"date":"2023-04-15T21:21:39","date_gmt":"2023-04-15T14:21:39","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21571"},"modified":"2023-04-17T14:45:51","modified_gmt":"2023-04-17T07:45:51","slug":"khang-thuoc-loi-tieu-trong-thuc-hanh-lam-sang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/khang-thuoc-loi-tieu-trong-thuc-hanh-lam-sang\/","title":{"rendered":"Kh\u00e1ng thu\u1ed1c l\u1ee3i ti\u1ec3u trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng"},"content":{"rendered":"<p><strong>Kh\u00e1ng thu\u1ed1c l\u1ee3i ti\u1ec3u l\u00e0 t\u00ecnh tr\u1ea1ng \u0111\u00e1p \u1ee9ng gi\u1ea3m d\u1ea7n v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u, \u0111\u00e2y l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn m\u1ed9t qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 k\u00e9o d\u00e0i th\u1eddi gian n\u1eb1m vi\u1ec7n.<\/strong><\/p>\n<h2><strong>1.Kh\u00e1ng l\u1ee3i ti\u1ec3u:<\/strong><\/h2>\n<p>Kh\u00e1ng thu\u1ed1c l\u1ee3i ti\u1ec3u l\u00e0 t\u00ecnh tr\u1ea1ng \u0111\u00e1p \u1ee9ng gi\u1ea3m d\u1ea7n v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u, \u0111\u00e2y l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn m\u1ed9t qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 k\u00e9o d\u00e0i th\u1eddi gian n\u1eb1m vi\u1ec7n. T\u1ea7m quan tr\u1ecdng c\u1ee7a kh\u00e1ng l\u1ee3i ti\u1ec3u \u0111\u01b0\u1ee3c ch\u1ee9ng minh r\u00f5 h\u01a1n b\u1edfi nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y \u0111\u00e3 nh\u1ea5n m\u1ea1nh ph\u1ea3n \u1ee9ng l\u1ee3i ti\u1ec3u nh\u01b0 l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 d\u1ef1 b\u00e1o, c\u00f3 gi\u00e1 tr\u1ecb ti\u00ean l\u01b0\u1ee3ng \u0111\u1ed9c l\u1eadp t\u1ef7 l\u1ec7 t\u1eed vong v\u00e0 t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh suy tim n\u1eb7ng h\u01a1n.<\/p>\n<h2><strong>2.D\u1ecbch t\u1ec5<\/strong><\/h2>\n<ul>\n<li>G\u1eb7p kho\u1ea3ng 20-30% b\u1ec7nh nh\u00e2n suy tim.<\/li>\n<li>C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1: huy\u1ebft \u00e1p th\u1ea5p, t\u0103ng ur\u00ea m\u00e1u, suy tim do b\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 v\u00e0 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng\u2026<\/li>\n<li>L\u00e0 y\u1ebfu t\u1ed1 d\u1ef1 b\u00e1o \u0111\u1ed9c l\u1eadp gia t\u0103ng t\u1eed vong trong giai \u0111o\u1ea1n nh\u1eadp vi\u1ec7n v\u00e0 s\u1edbm sau khi xu\u1ea5t vi\u1ec7n, t\u0103ng t\u1ef7 l\u1ec7 t\u00e1i nh\u1eadp vi\u1ec7n do suy tim m\u1ea5t b\u00f9.<\/li>\n<\/ul>\n<h2><strong>3.C\u01a1 ch\u1ebf kh\u00e1ng l\u1ee3i ti\u1ec3u quai<\/strong><\/h2>\n<p>Kh\u00e1ng l\u1ee3i ti\u1ec3u do gi\u1ea3m n\u1ed3ng \u0111\u1ed9 thu\u1ed1c l\u1ee3i ti\u1ec3u t\u1ea1i v\u1ecb tr\u00ed t\u00e1c \u0111\u1ed9ng \u1edf th\u1eadn, nguy\u00ean nh\u00e2n do:<\/p>\n<ul>\n<li>Ph\u00f9 n\u1ec1 th\u00e0nh ru\u1ed9t d\u1eabn \u0111\u1ebfn gi\u1ea3m s\u1ef1 h\u1ea5p thu thu\u1ed1c v\u00e0o tu\u1ea7n ho\u00e0n c\u01a1 th\u1ec3 l\u00e0m ch\u1eadm \u0111\u1ea1t \u0111\u01b0\u1ee3c n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh.<\/li>\n<li>Suy th\u1eadn: Thu\u1ed1c l\u1ee3i ti\u1ec3u quai c\u00f3 li\u00ean k\u1ebft cao v\u1edbi albumin huy\u1ebft t\u01b0\u01a1ng, c\u00e1c acid h\u1eefu c\u01a1 nh\u01b0 ur\u00ea m\u00e1u c\u00f3 th\u1ec3 t\u00edch t\u1ee5 v\u00e0 c\u1ea1nh tranh v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u quai. \u0110i\u1ec1u n\u00e0y, k\u1ebft h\u1ee3p v\u1edbi t\u01b0\u1edbi m\u00e1u th\u1eadn k\u00e9m, d\u1eabn \u0111\u1ebfn gi\u1ea3m n\u1ed3ng \u0111\u1ed9 thu\u1ed1c l\u1ee3i ti\u1ec3u t\u1ea1i th\u1eadn. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 n\u1ed3ng \u0111\u1ed9 albumin huy\u1ebft t\u01b0\u01a1ng th\u1ea5p, thu\u1ed1c l\u1ee3i ti\u1ec3u quai c\u0169ng b\u1ecb gi\u1ea3m t\u00e1c d\u1ee5ng. H\u01a1n n\u1eefa thay \u0111\u1ed5i n\u1ed3ng \u0111\u1ed9 natri m\u00e1u khi d\u00f9ng thu\u1ed1c l\u1ee3i ti\u1ec3u quai c\u0169ng g\u00f3p ph\u1ea7n l\u00e0m cho thu\u1ed1c gi\u1ea3m hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb khi d\u00f9ng k\u00e9o d\u00e0i. S\u1ef1 ho\u1ea1t ho\u00e1 h\u1ec7 th\u1ed1ng hormone th\u1ea7n kinh: h\u1ec7 renin-angiotensin-aldosterone t\u0103ng gi\u1eef natri l\u00e0m gi\u1ea3m t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c l\u1ee3i ti\u1ec3u.<\/li>\n<\/ul>\n<p>C\u01a1 ch\u1ebf \u0111\u00e1p \u1ee9ng b\u00f9 tr\u1eeb t\u1ea1i \u1ed1ng th\u1eadn v\u1edbi c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u: d\u00f9ng l\u1ee3i ti\u1ec3u k\u00e9o d\u00e0i l\u00e0m k\u00edch th\u00edch t\u0103ng sinh v\u00e0 ph\u00ec \u0111\u1ea1i c\u00e1c t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 \u1ed1ng th\u1eadn, t\u0103ng ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u00e1c men Na+K+ATPase, do \u0111\u00f3 t\u0103ng gi\u1eef mu\u1ed1i v\u00e0 n\u01b0\u1edbc.<\/p>\n<h2><strong>4.Chi\u1ebfn l\u01b0\u1ee3c \u0111\u1ec3 v\u01b0\u1ee3t qua t\u00ecnh tr\u1ea1ng kh\u00e1ng l\u1ee3i ti\u1ec3u<\/strong><\/h2>\n<p>Ti\u1ebfp c\u1eadn ban \u0111\u1ea7u cho m\u1ed9t b\u1ec7nh nh\u00e2n c\u00f3 t\u00ecnh tr\u1ea1ng kh\u00e1ng l\u1ee3i ti\u1ec3u l\u00e0 lo\u1ea1i tr\u1eeb s\u1ef1 kh\u00f4ng tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb l\u1ee3i ti\u1ec3u v\u00e0 ch\u1ebf \u0111\u1ed9 \u0103n h\u1ea1n ch\u1ebf natri. C\u00e1c thu\u1ed1c c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n v\u00e0o vi\u1ec7c kh\u00e1ng thu\u1ed1c, ch\u1eb3ng h\u1ea1n nh\u01b0 thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid n\u00ean ng\u1eebng s\u1eed d\u1ee5ng.<\/p>\n<h3><strong>4.1 K\u1ebft h\u1ee3p c\u00e1c nh\u00f3m thu\u1ed1c trong \u0111i\u1ec1u tr\u1ecb kh\u00e1ng l\u1ee3i ti\u1ec3u<\/strong><\/h3>\n<p>Li\u1ec1u c\u1ee7a furosemide c\u1ea7n thi\u1ebft trong suy tim kh\u00e1ng thu\u1ed1c c\u00f3 th\u1ec3 r\u1ea5t cao (500 \u2013 1500 mg h\u1eb1ng ng\u00e0y). Ngo\u00e0i ra, k\u1ebft h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u thiazide, kh\u00e1ng aldosterone, c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u kh\u00e1c theo nguy\u00ean t\u1eafc phong t\u1ecfa nephron tu\u1ea7n t\u1ef1 v\u00e0 n\u00ean c\u00e2n nh\u1eafc cho dopamine kh\u00f4ng li\u00ean t\u1ee5c n\u1ebfu \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi l\u1ee3i ti\u1ec3u quai.<\/p>\n<p>Phong t\u1ecfa nephron tu\u1ea7n t\u1ef1 l\u00e0 m\u1ed9t nguy\u00ean t\u1eafc quan tr\u1ecdng y\u00eau c\u1ea7u b\u1ed5 sung l\u1ea7n l\u01b0\u1ee3t c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u t\u00e1c \u0111\u1ed9ng l\u00ean c\u00e1c v\u1ecb tr\u00ed kh\u00e1c nhau t\u1ea1i th\u1eadn khi c\u00f3 t\u00ecnh tr\u1ea1ng kh\u00e1ng thu\u1ed1c: thu\u1ed1c l\u1ee3i ti\u1ec3u quai, thiazide, r\u1ed3i thu\u1ed1c \u0111\u1ed1i kh\u00e1ng aldosterone v\u00e0 c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u kh\u00e1c.<\/p>\n<p>K\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u quai th\u01b0\u1eddng \u01b0u ti\u00ean s\u1eed d\u1ee5ng metolazone h\u01a1n l\u1ee3i ti\u1ec3u thiazide. \u0110i\u1ec1u n\u00e0y c\u00f3 \u00fd ngh\u0129a v\u1ec1 m\u1eb7t c\u01a1 ch\u1ebf, v\u00ec metolazone c\u00f3 t\u00e1c \u0111\u1ed9ng tr\u00ean \u1ed1ng l\u01b0\u1ee3n g\u1ea7n. Nghi\u00ean c\u1ee9u so s\u00e1nh tr\u1ef1c ti\u1ebfp metolazone v\u1edbi m\u1ed9t lo\u1ea1i thu\u1ed1c l\u1ee3i ti\u1ec3u thiazide kh\u00e1c, bendroumethiazide, cho th\u1ea5y c\u1ea3 hai lo\u1ea1i thu\u1ed1c n\u00e0y \u0111\u1ec1u \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n \u0111\u00e1ng k\u1ec3 l\u1ee3i ti\u1ec3u. Ph\u1ea7n l\u1edbn c\u00e1c kinh nghi\u1ec7m l\u00e2m s\u00e0ng trong suy tim xu\u1ea5t ph\u00e1t t\u1eeb s\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a thiazide v\u00e0 thu\u1ed1c l\u1ee3i ti\u1ec3u quai v\u00e0 s\u1ef1 k\u1ebft h\u1ee3p n\u00e0y \u0111\u00e3 ch\u1ee9ng minh t\u00ednh hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n khi s\u1eed d\u1ee5ng. Vi\u1ec7c b\u1ed5 sung thiazide v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u quai c\u00f3 t\u00e1c d\u1ee5ng l\u1ee3i ti\u1ec3u m\u1ea1nh, \u0111\u00f4i khi g\u00e2y r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i bao g\u1ed3m h\u1ea1 natri m\u00e1u v\u00e0 h\u1ea1 kali m\u00e1u \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n, v\u00e0 c\u00f3 nguy c\u01a1 l\u00e0m suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn.<\/p>\n<p>Ph\u1ea7n l\u1edbn (65 -70%) t\u00e1i h\u1ea5p thu natri x\u1ea3y ra \u1edf \u1ed1ng l\u01b0\u1ee3n g\u1ea7n. V\u00ec v\u1eady, d\u00f9ng th\u00eam m\u1ed9t thu\u1ed1c kh\u00e1c t\u00e1c \u0111\u1ed9ng t\u1ea1i v\u1ecb tr\u00ed n\u00e0y s\u1ebd t\u0103ng c\u01b0\u1eddng l\u1ee3i ti\u1ec3u, v\u00ed d\u1ee5 nh\u01b0 acetazolamide. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y \u0111\u00e3 s\u1eed d\u1ee5ng li\u1ec7u ph\u00e1p ph\u1ed1i h\u1ee3p c\u1ea3 acetazolamide v\u1edbi chlorthalidone \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n kh\u00e1ng l\u1ee3i ti\u1ec3u quai.<\/p>\n<p>Manitol c\u0169ng ho\u1ea1t \u0111\u1ed9ng trong \u1ed1ng l\u01b0\u1ee3n g\u1ea7n \u0111\u1ec3 th\u00fac \u0111\u1ea9y l\u1ee3i ti\u1ec3u th\u00f4ng qua th\u1ea9m th\u1ea5u, v\u00e0 c\u0169ng l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn b\u1ed5 sung cho li\u1ec7u ph\u00e1p k\u1ebft h\u1ee3p. M\u1ed9t nghi\u00ean c\u1ee9u kh\u00f4ng ng\u1eabu nhi\u00ean \u1edf 122 b\u1ec7nh nh\u00e2n suy tim c\u1ea5p t\u00ednh \u0111\u00e3 ch\u1ee9ng minh l\u1ee3i ti\u1ec3u hi\u1ec7u qu\u1ea3 \u1edf 80,3% b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng furosemide v\u00e0 manitol ph\u1ed1i h\u1ee3p truy\u1ec1n d\u1ecbch, tuy nhi\u00ean vi\u1ec7c s\u1eed d\u1ee5ng manitol \u1edf c\u00e1c b\u1ec7nh nh\u00e2n suy tim ph\u1ea3i \u0111\u01b0\u1ee3c theo d\u00f5i h\u1ebft s\u1ee9c ch\u1eb7t ch\u1ebd do c\u00f3 nguy c\u01a1 g\u00e2y ph\u00f9 ph\u1ed5i c\u1ea5p.<\/p>\n<p>D\u00f9ng l\u00e2u d\u00e0i li\u1ec1u th\u1ea5p \u0111\u1ed1i kh\u00e1ng aldosterone \u1edf b\u1ec7nh nh\u00e2n suy tim c\u00f3 li\u00ean quan \u0111\u1ebfn c\u1ea3i thi\u1ec7n t\u1ef7 l\u1ec7 t\u1eed vong \u0111\u1ed3ng th\u1eddi c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng sung huy\u1ebft. Trong th\u1eed nghi\u1ec7m c\u1ee7a 100 b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n v\u00ec suy tim c\u1ea5p t\u00ednh, \u00edt \u0111\u00e1p \u1ee9ng v\u1edbi l\u1ee3i ti\u1ec3u quai vi\u1ec7c b\u1ed5 sung spironolactone l\u00e0m gi\u1ea3m tri\u1ec7u ch\u1ee9ng v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng th\u1eadn. M\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c cho th\u1ea5y nh\u1eefng l\u1ee3i \u00edch thu\u1ed1c \u0111\u1ed1i kh\u00e1ng aldosterone \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ec1 kh\u00e1ng v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u quai. Trong 21 b\u1ec7nh nh\u00e2n \u0111\u1ec1 kh\u00e1ng v\u1edbi bumetanide, vi\u1ec7c b\u1ed5 sung spironolactone gi\u00fap l\u00e0m t\u0103ng kh\u1ea3 n\u0103ng l\u1ee3i ti\u1ec3u v\u00e0 c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n<p>K\u1ebft h\u1ee3p thu\u1ed1c l\u1ee3i ti\u1ec3u th\u1ea3i n\u01b0\u1edbc nh\u00f3m \u0111\u1ed1i kh\u00e1ng vasopressin (Tolvaptan): Trong nghi\u00ean c\u1ee9u QUEST \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n c\u1ee7a tolvaptan trong suy tim th\u1eeba d\u1ecbch, cho th\u1ea5y gi\u1ea3m r\u00f5 r\u1ec7t c\u00e2n n\u1eb7ng v\u00e0 c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng sung huy\u1ebft.<\/p>\n<h3><strong>4.2 Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c<\/strong><\/h3>\n<p>Ph\u01b0\u01a1ng ph\u00e1p c\u1ea3i thi\u1ec7n t\u01b0\u1edbi m\u00e1u th\u1eadn \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 l\u00e0 chi\u1ebfn l\u01b0\u1ee3c \u0111\u1ec3 c\u1ea3i thi\u1ec7n \u0111\u00e1p \u1ee9ng l\u1ee3i ti\u1ec3u. Li\u1ec1u th\u1ea5p c\u1ee7a dopamine (&lt;3 \u03bcg\/kg\/ph\u00fat) c\u00f3 t\u00e1c d\u1ee5ng ch\u1ecdn l\u1ecdc tr\u00ean c\u00e1c th\u1ee5 th\u1ec3 dopamine trong m\u1ea1ch m\u00e1u th\u1eadn, th\u00fac \u0111\u1ea9y s\u1ef1 gi\u00e3n m\u1ea1ch v\u00e0 t\u0103ng l\u01b0u l\u01b0\u1ee3ng m\u00e1u th\u1eadn. Trong nghi\u00ean c\u1ee9u dopamine \u1edf 60 b\u1ec7nh nh\u00e2n suy tim c\u1ea5p t\u00ednh, li\u1ec1u th\u1ea5p dopamine k\u1ebft h\u1ee3p v\u1edbi li\u1ec1u th\u1ea5p furosemid truy\u1ec1n li\u00ean t\u1ee5c c\u00f3 hi\u1ec7u qu\u1ea3 nh\u01b0 truy\u1ec1n li\u1ec1u cao furosemide cho l\u1ee3i ti\u1ec3u trong khi b\u1ea3o v\u1ec7 \u0111\u01b0\u1ee3c c\u1ea7u th\u1eadn.<\/p>\n<p>Nesiritide l\u00e0 m\u1ed9t peptide B-natriuretic t\u00e1i t\u1ed5 h\u1ee3p c\u1ee7a con ng\u01b0\u1eddi \u0111\u00e3 ch\u1ee9ng minh c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng kh\u00f3 th\u1edf trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng nh\u1ecf. Tuy nhi\u00ean, k\u1ebft qu\u1ea3 c\u1ee7a c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng l\u1edbn cho th\u1ea5y nesiritide kh\u00f4ng gi\u00fap ki\u1ec3m so\u00e1t t\u00ecnh tr\u1ea1ng kh\u00e1ng l\u1ee3i ti\u1ec3u. Nghi\u00ean c\u1ee9u b\u1ec7nh nh\u00e2n suy tim c\u1ea5p m\u1ea5t b\u00f9 s\u1eed d\u1ee5ng nesiritide \u1edf 7.141 b\u1ec7nh nh\u00e2n \u0111\u00e3 d\u00f9ng thu\u1ed1c l\u1ee3i ti\u1ec3u cho th\u1ea5y thu\u1ed1c c\u1ea3i thi\u1ec7n kh\u00f3 th\u1edf \u1edf th\u1eddi \u0111i\u1ec3m 6 v\u00e0 24h, nh\u01b0ng kh\u00f4ng l\u00e0m c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng g\u1eafng s\u1ee9c.<\/p>\n<p>M\u1eb7c d\u00f9 kh\u00f4ng c\u00f3 khuy\u1ebfn c\u00e1o, dung d\u1ecbch mu\u1ed1i \u01b0u tr\u01b0\u01a1ng t\u0129nh m\u1ea1ch \u0111\u01b0\u1ee3c coi l\u00e0 m\u1ed9t chi\u1ebfn l\u01b0\u1ee3c h\u1ee9a h\u1eb9n \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ec1 kh\u00e1ng v\u1edbi l\u1ee3i ti\u1ec3u quai. N\u01b0\u1edbc mu\u1ed1i \u01b0u tr\u01b0\u01a1ng s\u1ebd k\u00e9o n\u01b0\u1edbc t\u1ef1 do t\u1eeb kho\u1ea3ng k\u1ebd v\u00e0o m\u1ea1ch m\u00e1u. Ngo\u00e0i vi\u1ec7c t\u0103ng l\u01b0u l\u01b0\u1ee3ng m\u00e1u m\u1ea1ch v\u00e0nh v\u00e0 th\u1eadn, n\u01b0\u1edbc mu\u1ed1i \u01b0u tr\u01b0\u01a1ng c\u1ea3i thi\u1ec7n vi\u1ec7c cung c\u1ea5p natri v\u00e0o v\u00f2ng l\u1eb7p c\u1ee7a Henl\u00e9, do \u0111\u00f3 kh\u00f4i ph\u1ee5c m\u1ed9t s\u1ed1 t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c l\u1ee3i ti\u1ec3u quai. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u \u0111\u00e3 b\u00e1o c\u00e1o l\u1ee3i ti\u1ec3u t\u1ed1t h\u01a1n, c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng th\u1eadn v\u00e0 nh\u1eadp vi\u1ec7n ng\u1eafn h\u01a1n khi b\u1ed5 sung n\u01b0\u1edbc mu\u1ed1i \u01b0u tr\u01b0\u01a1ng \u1edf 1.771 b\u1ec7nh nh\u00e2n \u0111\u1ec1 kh\u00e1ng v\u1edbi l\u1ee3i ti\u1ec3u quai suy tim NYHA III. Theo d\u00f5i trung b\u00ecnh 57 th\u00e1ng, nh\u00f3m s\u1eed d\u1ee5ng furosemide c\u1ed9ng v\u1edbi n\u01b0\u1edbc mu\u1ed1i \u01b0u tr\u01b0\u01a1ng \u00edt l\u1ea7n nh\u1eadp vi\u1ec7n h\u01a1n (18,5 so v\u1edbi 34,2%; P &lt;0,0001) v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong th\u1ea5p h\u01a1n (12,9 so v\u1edbi 23,8%; P &lt;0,0001) so v\u1edbi nh\u00f3m ch\u1ec9 d\u00f9ng furosemide m\u1ed9t m\u00ecnh.<\/p>\n<p>L\u1ecdc m\u00e1u li\u00ean t\u1ee5c ho\u1eb7c si\u00eau l\u1ecdc: ch\u1ec9 \u0111\u1ecbnh khi b\u1ec7nh nh\u00e2n tr\u01a1 v\u1edbi l\u1ee3i ti\u1ec3u, dopamine v\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00e1c th\u1ea5t b\u1ea1i, nh\u1eb1m m\u1ee5c \u0111\u00edch lo\u1ea1i b\u1ecf d\u1ecbch th\u1eeba ra kh\u1ecfi c\u01a1 th\u1ec3. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o khuy\u1ebfn c\u00e1o H\u1ed9i Tim M\u1ea1ch ch\u00e2u \u00c2u t\u1eeb n\u0103m 2012. \u0110\u00e2y l\u00e0 ph\u01b0\u01a1ng th\u1ee9c l\u1ecdc m\u00e1u \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh b\u1eb1ng v\u00f2ng tu\u1ea7n ho\u00e0n ngo\u00e0i c\u01a1 th\u1ec3, n\u01b0\u1edbc v\u00e0 c\u00e1c ch\u1ea5t ho\u00e0 tan \u0111\u01b0\u1ee3c lo\u1ea1i b\u1ecf b\u1eb1ng c\u01a1 ch\u1ebf \u0111\u1ed1i l\u01b0u v\u00e0 si\u00eau l\u1ecdc.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Kh\u00e1ng thu\u1ed1c l\u1ee3i ti\u1ec3u l\u00e0 t\u00ecnh tr\u1ea1ng \u0111\u00e1p \u1ee9ng gi\u1ea3m d\u1ea7n v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u, \u0111\u00e2y l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn m\u1ed9t qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 k\u00e9o d\u00e0i th\u1eddi gian n\u1eb1m vi\u1ec7n. 1.Kh\u00e1ng l\u1ee3i ti\u1ec3u: Kh\u00e1ng thu\u1ed1c l\u1ee3i ti\u1ec3u l\u00e0 t\u00ecnh tr\u1ea1ng \u0111\u00e1p \u1ee9ng gi\u1ea3m [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":21616,"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>Kh\u00e1ng thu\u1ed1c l\u1ee3i ti\u1ec3u trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng - Vinmec<\/title>\n<meta name=\"description\" content=\"Kh\u00e1ng thu\u1ed1c l\u1ee3i ti\u1ec3u l\u00e0 v\u1ea5n \u0111\u1ec1 \u0111\u01b0\u1ee3c quan t\u00e2m khi s\u1eed d\u1ee5ng l\u1ee3i ti\u1ec3u trong th\u1eddi gian d\u00e0i. 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