{"id":21593,"date":"2023-04-15T21:19:05","date_gmt":"2023-04-15T14:19:05","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21593"},"modified":"2023-04-17T14:47:01","modified_gmt":"2023-04-17T07:47:01","slug":"loi-tieu-giu-kali-tu-co-che-den-duoc-dong-hoc","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/loi-tieu-giu-kali-tu-co-che-den-duoc-dong-hoc\/","title":{"rendered":"L\u1ee3i ti\u1ec3u gi\u1eef kali: t\u1eeb c\u01a1 ch\u1ebf \u0111\u1ebfn d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc"},"content":{"rendered":"<p><strong>L\u1ee3i ti\u1ec3u gi\u1eef kali c\u00f3 t\u00e1c d\u1ee5ng \u1edf \u1ed1ng l\u01b0\u1ee3n xa, \u1ee9c ch\u1ebf kh\u1ea3 n\u0103ng t\u00e1i h\u1ea5p thu natri b\u1eb1ng c\u00e1ch trao \u0111\u1ed5i v\u1edbi kali, tr\u1ef1c ti\u1ebfp l\u00ean c\u00e1c t\u1ebf b\u00e0o (triamteren, amilorid) ho\u1eb7c b\u1eb1ng c\u00e1ch \u0111\u1ed1i kh\u00e1ng v\u1edbi aldosteron.<\/strong><\/p>\n<h2><strong>1.C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng<\/strong><\/h2>\n<p>Thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali \u0111\u01b0\u1ee3c ph\u00e2n th\u00e0nh hai nh\u00f3m:<\/p>\n<ul>\n<li>Nh\u00f3m (1): \u0110\u1ed1i kh\u00e1ng c\u1ea1nh tranh v\u1edbi aldosterone t\u1ea1i c\u00e1c th\u1ee5 th\u1ec3 chuy\u1ec3n ho\u00e1 mu\u1ed1i n\u01b0\u1edbc \u1edf \u1ed1ng l\u01b0\u1ee3n xa v\u00e0 \u1ed1ng g\u00f3p g\u1ed3m spironolactone, eplerenone.<\/li>\n<li>Nh\u00f3m (2): \u1ee8c ch\u1ebf h\u1ea5p thu natri \u1edf m\u00e0ng t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 \u1ed1ng th\u1eadn g\u1ed3m amiloride, triamterene.<\/li>\n<\/ul>\n<h3>1.1 C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a nh\u00f3m \u0111\u1ed1i kh\u00e1ng c\u1ea1nh tranh aldosterone:<\/h3>\n<p>B\u00ecnh th\u01b0\u1eddng, th\u1eadn t\u00e1i h\u1ea5p thu natri \u1edf \u1ed1ng l\u01b0\u1ee3n xa v\u00e0 \u1ed1ng g\u00f3p. Vi\u1ec7c t\u00e1i h\u1ea5p thu n\u00e0y \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n th\u00f4ng qua c\u00e1c th\u1ee5 th\u1ec3 nh\u1ea1y c\u1ea3m v\u1edbi aldosterone v\u00e0 th\u00f4ng qua ho\u1ea1t h\u00f3a b\u01a1m natri-kali ph\u1ee5 thu\u1ed9c ATP. \u0110\u1ec3 \u0111\u1ea3m b\u1ea3o c\u00e2n b\u1eb1ng \u0111i\u1ec7n th\u1ebf, khi natri \u0111\u01b0\u1ee3c t\u00e1i h\u1ea5p thu th\u00ec kali ho\u1eb7c hydro \u0111\u01b0\u1ee3c \u0111\u1ed3ng th\u1eddi ti\u1ebft v\u00e0o trong l\u00f2ng \u1ed1ng l\u01b0\u1ee3n xa v\u00e0 \u1ed1ng g\u00f3p. Spironolactone v\u00e0 eplerenone l\u00e0 ch\u1ea5t \u0111\u1ed1i kh\u00e1ng c\u1ea1nh tranh c\u1ee7a aldosterone, do thu\u1ed1c c\u00f3 c\u00f4ng th\u1ee9c g\u1ea7n gi\u1ed1ng v\u1edbi aldosterone. Do v\u1eady, thu\u1ed1c s\u1ebd g\u1eafn v\u00e0o c\u00e1c th\u1ee5 th\u1ec3 chuy\u1ec3n ho\u00e1 mu\u1ed1i n\u01b0\u1edbc nh\u1ea1y c\u1ea3m v\u1edbi aldosterone, t\u1eeb \u0111\u00f3 ch\u00fang l\u00e0m gi\u1ea3m qu\u00e1 tr\u00ecnh trao \u0111\u1ed5i natri v\u1edbi kali v\u00e0 hydro.<\/p>\n<h3>1.2 C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a nh\u00f3m \u1ee9c ch\u1ebf h\u1ea5p thu natri:<\/h3>\n<p>Amiloride v\u00e0 triamterene l\u00e0 c\u00e1c d\u1eabn xu\u1ea5t pteridine. Ch\u00fang ch\u1eb7n c\u00e1c k\u00eanh natri \u1edf bi\u1ec3u m\u00f4 l\u00f2ng \u1ed1ng (k\u00eanh ENaC), \u1ee9c ch\u1ebf k\u00eanh trao \u0111\u1ed5i natri-proton, khi\u1ebfn \u0111i\u1ec7n th\u1ebf tr\u00ean bi\u1ec3u m\u00f4 l\u00f2ng \u1ed1ng gi\u1ea3m v\u00e0 l\u00e0m gi\u1ea3m s\u1ef1 ti\u1ebft kali v\u00e0o trong l\u00f2ng \u1ed1ng. V\u1edbi c\u01a1 ch\u1ebf n\u00e0y, thu\u1ed1c t\u00e1c d\u1ee5ng gi\u1eef kali \u0111\u1ed9c l\u1eadp v\u1edbi ho\u1ea1t \u0111\u1ed9ng c\u1ee7a aldosterone. Ngo\u00e0i ra, amiloride c\u0169ng gi\u00fap gi\u1eef l\u1ea1i magie v\u00e0 c\u00f3 l\u1ee3i \u00edch \u0111\u1eb7c bi\u1ec7t v\u1edbi t\u1ef7 l\u1ec7 t\u01b0\u01a1ng \u0111\u1ed1i nh\u1ecf b\u1ec7nh nh\u00e2n da \u0111en b\u1ecb t\u0103ng huy\u1ebft \u00e1p m\u00e0 c\u00f3 n\u1ed3ng \u0111\u1ed9 renin v\u00e0 aldosterone th\u1ea5p v\u00e0 c\u00f3 khi\u1ebfm khuy\u1ebft di truy\u1ec1n trong k\u00eanh natri bi\u1ec3u m\u00f4. Nh\u01b0 v\u1eady, hai c\u01a1 ch\u1ebf c\u1ee7a c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali l\u00e0 \u0111\u1ec1u l\u00e0m \u1ee9c ch\u1ebf t\u00e1i h\u1ea5p thu natri, gi\u1ea3m b\u00e0i xu\u1ea5t Kali, do \u0111\u00f3 nhi\u1ec1u ion natri kh\u00f4ng \u0111\u01b0\u1ee3c t\u00e1i h\u1ea5p thu trong \u1ed1ng g\u00f3p s\u1ebd k\u00e9o theo n\u01b0\u1edbc v\u00e0o l\u00e0m t\u0103ng l\u1ee3i ti\u1ec3u, \u0111\u1ed3ng th\u1eddi gi\u1eef l\u1ea1i kali trong m\u00e1u. Ho\u1ea1t \u0111\u1ed9ng kh\u00e1ng aldosterone c\u0169ng ph\u1ee5 thu\u1ed9c v\u00e0o n\u1ed3ng \u0111\u1ed9 prostaglandin m\u00e1u. C\u00e1c thu\u1ed1c kh\u00e1ng vi\u00eam kh\u00f4ng steroid \u1ee9c ch\u1ebf vi\u1ec7c s\u1ea3n xu\u1ea5t prostaglandin (\u0111\u1ec3 ch\u1ed1ng vi\u00eam, gi\u1ea3m \u0111au), do \u0111\u00f3, l\u00e0m gi\u1ea3m n\u1ed3ng \u0111\u1ed9 prostaglandin m\u00e1u, l\u00e0m gi\u1ea3m t\u00e1c d\u1ee5ng c\u1ee7a c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali.<\/p>\n<h2><strong>2.D\u01b0\u1ee3c \u0111\u1ed9ng v\u00e0 d\u01b0\u1ee3c l\u1ef1c h\u1ecdc<\/strong><\/h2>\n<p>Spironolactone l\u00e0 m\u1ed9t steroid t\u1ed5ng h\u1ee3p, ho\u1ea1t \u0111\u1ed9ng \u0111\u1ed1i kh\u00e1ng v\u1edbi aldosterone l\u00e0 hormone chuy\u1ec3n ho\u00e1 mu\u1ed1i n\u01b0\u1edbc. Thu\u1ed1c \u0111\u01b0\u1ee3c h\u1ea5p thu qua \u0111\u01b0\u1eddng u\u1ed1ng (~65%) v\u00e0 g\u1eafn v\u1edbi protein (90%). Thu\u1ed1c c\u00f3 th\u1eddi gian b\u00e1n th\u1ea3i ng\u1eafn ch\u1ec9 1,5h v\u00e0 c\u1ea7n tr\u1ea3i qua qu\u00e1 tr\u00ecnh chuy\u1ec3n h\u00f3a \u1edf gan th\u00e0nh c\u00e1c ch\u1ea5t ho\u1ea1t \u0111\u1ed9ng. Trong \u0111\u00f3, hai ch\u1ea5t hi\u1ec7u qu\u1ea3 nh\u1ea5t l\u00e0 7- thiomethylspirolactone v\u00e0 canrenone; c\u1ea3 hai \u0111\u1ec1u c\u00f3 th\u1eddi gian b\u00e1n h\u1ee7y kho\u1ea3ng 15 -20h v\u00e0 l\u00e0 ch\u1ea5t t\u00e1c \u0111\u1ed9ng ch\u00ednh t\u1ea1o ra ph\u1ea7n l\u1edbn hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb c\u1ee7a spironolactone. Spironolactone v\u1eabn duy tr\u00ec hi\u1ec7u qu\u1ea3 trong suy th\u1eadn v\u00ec kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn. Thu\u1ed1c g\u1eafn k\u1ebft ch\u1eb7t ch\u1ebd v\u00e0 \u1ee9c ch\u1ebf m\u1ea1nh c\u00e1c th\u1ee5 th\u1ec3 c\u1ee7a androgen, do \u0111\u00f3 g\u00e2y ra c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n tr\u00ean nam gi\u1edbi nh\u01b0 v\u00fa to, bi\u1ec3u hi\u1ec7n n\u1eef h\u00f3a.<\/p>\n<p>Eplerenone r\u1ea5t gi\u1ed1ng v\u1edbi spironolactone, tuy nhi\u00ean thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng ch\u1ecdn l\u1ecdc h\u01a1n r\u1ea5t nhi\u1ec1u tr\u00ean c\u00e1c th\u1ee5 th\u1ec3 c\u1ee7a c\u00e1c hormone chuy\u1ec3n h\u00f3a mu\u1ed1i n\u01b0\u1edbc. Thu\u1ed1c c\u00f3 \u00e1i l\u1ef1c k\u00e9m h\u01a1n v\u00e0i tr\u0103m l\u1ea7n \u0111\u1ed1i v\u1edbi c\u00e1c th\u1ee5 th\u1ec3 androgen v\u00e0 progesterone khi so s\u00e1nh v\u1edbi spironolactone, do \u0111\u00f3 thu\u1ed1c \u00edt c\u00f3 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n tr\u00ean nam gi\u1edbi khi d\u00f9ng k\u00e9o d\u00e0i. Thu\u1ed1c kh\u00f4ng ph\u1ea3i chuy\u1ec3n h\u00f3a th\u00e0nh ch\u1ea5t ho\u1ea1t \u0111\u1ed9ng t\u1ea1i gan.<\/p>\n<p>Finerenone l\u00e0 m\u1ed9t ho\u1ea1t ch\u1ea5t m\u1edbi \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n c\u1ee7a nh\u00f3m n\u00e0y, c\u0169ng c\u00f3 c\u01a1 ch\u1ebf t\u00e1c \u0111\u1ed9ng gi\u1ed1ng spironolactone nh\u01b0ng t\u00e1c d\u1ee5ng ch\u1ecdn l\u1ecdc h\u01a1n, g\u1eafn k\u1ebft \u00edt h\u01a1n v\u1edbi c\u00e1c th\u1ee5 th\u1ec3 progesterone v\u00e0 androgen gi\u1ed1ng nh\u01b0 eplerenone. Tuy nhi\u00ean, thu\u1ed1c n\u00e0y c\u00f3 n\u1ed3ng \u0111\u1ed9 t\u1eadp trung t\u1ea1i m\u00f4 c\u01a1 tim v\u00e0 th\u1eadn t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nhau, c\u00f2n spironolactone th\u00ec t\u1eadp trung \u1edf th\u1eadn nhi\u1ec1u h\u01a1n trong khi eplerenone c\u00f3 s\u1ef1 t\u00edch lu\u1ef9 thu\u1ed1c \u1edf th\u1eadn cao g\u1ea5p 3 l\u1ea7n so v\u1edbi \u1edf tim. Ch\u00ednh v\u00ec t\u00e1c d\u1ee5ng n\u00e0y,nerenone c\u00f3 th\u1ec3 ch\u1ee9ng minh \u0111\u01b0\u1ee3c l\u1ee3i \u00edch trong vi\u1ec7c b\u1ea3o v\u1ec7 tim m\u1ea1ch. Finerenone \u00edt g\u00e2y t\u0103ng kali m\u00e1u so v\u1edbi spironolactone v\u00e0 eplerenone, c\u01a1 ch\u1ebf \u0111\u01b0\u1ee3c cho l\u00e0 do n\u1ed3ng \u0111\u1ed9 thu\u1ed1c t\u1ea1i th\u1eadn kh\u00f4ng cao, ngo\u00e0i ra thu\u1ed1c l\u00e0m gi\u1ea3m huy\u1ebft \u00e1p \u00edt h\u01a1n so v\u1edbi spironolactone v\u00e0 eplerenone.<\/p>\n<p>Triamterene v\u00e0 amiloride c\u0169ng \u0111\u01b0\u1ee3c h\u1ea5p thu qua \u0111\u01b0\u1eddng u\u1ed1ng (~50%). Triamterene c\u00f3 th\u1eddi gian b\u00e1n th\u1ea3i (3-6h) v\u00e0 th\u1eddi gian t\u00e1c d\u1ee5ng t\u01b0\u01a1ng \u0111\u1ed1i ng\u1eafn. Triamterene chuy\u1ec3n ho\u00e1 t\u1ea1i gan t\u1ea1o th\u00e0nh c\u00e1c ch\u1ea5t ho\u1ea1t \u0111\u1ed9ng v\u00e0 c\u00e1c s\u1ea3n ph\u1ea9m chuy\u1ec3n ho\u00e1, c\u00e1c ch\u1ea5t n\u00e0y th\u1ea3i ch\u1ee7 y\u1ebfu qua \u0111\u01b0\u1eddng n\u01b0\u1edbc ti\u1ec3u. Khi c\u00f3 t\u1ed5n th\u01b0\u01a1ng \u1edf gan ho\u1eb7c th\u1eadn th\u00ec \u0111\u1ec1u \u1ea3nh h\u01b0\u1edfng \u0111\u00e1ng k\u1ec3 \u0111\u1ebfn sinh kh\u1ea3 d\u1ee5ng c\u1ee7a triamterene do thu\u1ed1c \u0111\u01b0\u1ee3c chuy\u1ec3n ho\u00e1 \u1edf gan v\u00e0 ch\u1ea5t chuy\u1ec3n h\u00f3a sau \u0111\u00f3 \u0111\u01b0\u1ee3c ti\u1ebft v\u00e0o d\u1ecbch \u0111\u1ea7u \u1ed1ng th\u1eadn. Do c\u00f3 th\u1eddi gian b\u00e1n th\u1ea3i ng\u1eafn n\u00ean thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nhi\u1ec1u l\u1ea7n trong ng\u00e0y. Triamterene n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng th\u1eadn tr\u1ecdng khi d\u00f9ng c\u00f9ng c\u00e1c ch\u1ea5t c\u00f3 nguy c\u01a1 \u0111\u1ed9c v\u1edbi th\u1eadn kh\u00e1c v\u00ec thu\u1ed1c c\u00f3 li\u00ean quan \u0111\u1ebfn s\u1ef1 h\u00ecnh th\u00e0nh s\u1ecfi th\u1eadn, vi\u00eam th\u1eadn k\u1ebd v\u00e0 suy th\u1eadn c\u1ea5p.<\/p>\n<p>Amiloride c\u00f3 th\u1eddi gian b\u00e1n th\u1ea3i d\u00e0i h\u01a1n nhi\u1ec1u (17-26h) so v\u1edbi triamterene, \u0111\u1ea1t \u0111\u01b0\u1ee3c tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh trong m\u00e1u kho\u1ea3ng 2 ng\u00e0y sau khi d\u00f9ng. Thu\u1ed1c \u0111\u01b0\u1ee3c \u01b0u ti\u00ean s\u1eed d\u1ee5ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh gan v\u00ec n\u00f3 kh\u00f4ng c\u1ea7n chuy\u1ec3n ho\u00e1 qua gan. Tuy nhi\u00ean, c\u00f3 s\u1ef1 gia t\u0103ng n\u1ed3ng \u0111\u1ed9 v\u00e0 t\u00edch l\u0169y nhanh ch\u00f3ng khi d\u00f9ng tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh th\u1eadn m\u1ea1n t\u00ednh. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y, c\u1ea7n gi\u1ea3m li\u1ec1u v\u00e0\/ho\u1eb7c gi\u1ea3m t\u1ea7n su\u1ea5t d\u00f9ng thu\u1ed1c \u0111\u1ec3 tr\u00e1nh nguy c\u01a1 t\u0103ng kali m\u00e1u.<\/p>\n<div class=\"content-article\">\n<div class=\"long-content no-limit\">\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<\/div>\n<\/div>\n<div class=\"comment-post\">\n<div class=\"count-list\">\n<div class=\"view\"><\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>L\u1ee3i ti\u1ec3u gi\u1eef kali c\u00f3 t\u00e1c d\u1ee5ng \u1edf \u1ed1ng l\u01b0\u1ee3n xa, \u1ee9c ch\u1ebf kh\u1ea3 n\u0103ng t\u00e1i h\u1ea5p thu natri b\u1eb1ng c\u00e1ch trao \u0111\u1ed5i v\u1edbi kali, tr\u1ef1c ti\u1ebfp l\u00ean c\u00e1c t\u1ebf b\u00e0o (triamteren, amilorid) ho\u1eb7c b\u1eb1ng c\u00e1ch \u0111\u1ed1i kh\u00e1ng v\u1edbi aldosteron. 1.C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng Thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali \u0111\u01b0\u1ee3c ph\u00e2n th\u00e0nh hai nh\u00f3m: Nh\u00f3m [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":21599,"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>L\u1ee3i ti\u1ec3u gi\u1eef kali t\u1eeb c\u01a1 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