{"id":21624,"date":"2023-04-15T21:25:18","date_gmt":"2023-04-15T14:25:18","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21624"},"modified":"2023-04-17T14:44:18","modified_gmt":"2023-04-17T07:44:18","slug":"thuoc-loi-tieu-quai-va-co-che-tac-dung","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/thuoc-loi-tieu-quai-va-co-che-tac-dung\/","title":{"rendered":"Thu\u1ed1c l\u1ee3i ti\u1ec3u quai v\u00e0 c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng"},"content":{"rendered":"<p><strong>Thu\u1ed1c l\u1ee3i ti\u1ec3u quai \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n t\u1eeb nh\u1eefng n\u0103m 1960. Furosemide l\u00e0 thu\u1ed1c l\u1ee3i ti\u1ec3u quai \u0111\u1ea7u ti\u00ean v\u00e0 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf Hoa K\u1ef3, sau \u0111\u00f3 l\u00e0 bumetanide v\u00e0 torsemide.<\/strong><\/p>\n<h2><strong>1.Gi\u1edbi thi\u1ec7u chung<\/strong><\/h2>\n<p>Thu\u1ed1c l\u1ee3i ti\u1ec3u quai \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n t\u1eeb nh\u1eefng n\u0103m 1960. Furosemide l\u00e0 thu\u1ed1c l\u1ee3i ti\u1ec3u quai \u0111\u1ea7u ti\u00ean v\u00e0 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf Hoa K\u1ef3, sau \u0111\u00f3 l\u00e0 bumetanide v\u00e0 torsemide.<\/p>\n<h2><strong>2.C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng<\/strong><\/h2>\n<p>T\u1ea5t c\u1ea3 c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u quai \u0111\u1ec1u g\u1eafn v\u1edbi k\u00eanh \u0111\u1ed3ng v\u1eadn chuy\u1ec3n Na+-K+-2Cl\u2013 \u1edf nh\u00e1nh l\u00ean quai Henle. C\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u quai g\u00e2y \u1ee9c ch\u1ebf tr\u1ef1c ti\u1ebfp s\u1ef1 t\u00e1i h\u1ea5p thu natri, kali v\u00e0 clo do \u0111\u00f3 t\u0103ng th\u1ea3i tr\u1eeb c\u00e1c ion n\u00e0y. Thu\u1ed1c cho ph\u00e9p th\u1ea3i t\u1edbi 20-25% l\u01b0\u1ee3ng natri \u0111\u01b0\u1ee3c l\u1ecdc qua c\u1ea7u th\u1eadn v\u00e0 c\u00f3 th\u1ec3 l\u00e0m th\u1ea3i t\u1edbi 30% l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u \u0111\u01b0\u1ee3c l\u1ecdc qua c\u1ea7u th\u1eadn. C\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u quai c\u0169ng c\u00f3 ho\u1ea1t t\u00ednh g\u00e2y t\u0103ng th\u1ea3i canxi v\u00e0 magie do \u1ee9c ch\u1ebf kh\u1ea3 n\u0103ng t\u00e1i h\u1ea5p thu NaCl d\u1eabn \u0111\u1ebfn \u1ee9c ch\u1ebf s\u1ef1 t\u00e1i h\u1ea5p thu c\u00e1c cation ho\u00e1 tr\u1ecb 2 nh\u01b0 canxi v\u00e0 magie, nguy\u00ean nh\u00e2n do gi\u1ea3m ch\u00eanh l\u1ec7ch \u0111i\u1ec7n th\u1ebf \u1edf m\u00e0ng t\u1ebf b\u00e0o.<\/p>\n<h2><strong>3.D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc v\u00e0 d\u01b0\u1ee3c l\u1ef1c h\u1ecdc<\/strong><\/h2>\n<h3>3.1. D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc<\/h3>\n<p>C\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u quai h\u1ea7u h\u1ebft \u0111\u01b0\u1ee3c g\u1eafn v\u1edbi albumin huy\u1ebft thanh (&gt; 95%). \u0110\u1ec3 ph\u00e1t huy t\u00e1c d\u1ee5ng, ch\u00fang ph\u1ea3i \u0111\u01b0\u1ee3c ti\u1ebft v\u00e0o l\u00f2ng \u1ed1ng th\u00f4ng qua c\u00e1c k\u00eanh v\u1eadn chuy\u1ec3n anion nh\u1ea1y c\u1ea3m v\u1edbi probenecid n\u1eb1m trong \u1ed1ng l\u01b0\u1ee3n g\u1ea7n. Qu\u00e1 tr\u00ecnh n\u00e0y c\u00f3 th\u1ec3 b\u1ecb ch\u1eadm l\u1ea1i khi n\u1ed3ng \u0111\u1ed9 acid h\u1eefu c\u01a1 n\u1ed9i sinh t\u0103ng cao, nh\u01b0 trong b\u1ec7nh th\u1eadn m\u1ea1n t\u00ednh, c\u0169ng nh\u01b0 s\u1eed d\u1ee5ng chung v\u1edbi m\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c c\u00f3 chung c\u01a1 ch\u1ebf v\u1eadn chuy\u1ec3n, bao g\u1ed3m salicylat v\u00e0 thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid.<\/p>\n<p>C\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u quai \u0111ang \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng c\u00f3 sinh kh\u1ea3 d\u1ee5ng, th\u1eddi gian b\u00e1n h\u1ee7y v\u00e0 s\u1ef1 chuy\u1ec3n h\u00f3a kh\u00e1c nhau. Furosemide \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i nh\u1ea5t, nh\u01b0ng n\u00f3 kh\u00f4ng ph\u1ea3i thu\u1ed1c c\u00f3 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc thu\u1eadn l\u1ee3i nh\u1ea5t trong nh\u00f3m; H\u1ea5p thu c\u1ee7a thu\u1ed1c dao \u0111\u1ed9ng t\u1eeb 10 \u2013 100%. S\u1ef1 h\u1ea5p thu c\u1ee7a bumetanide v\u00e0 torsemide bi\u1ebfn thi\u00ean \u00edt h\u01a1n, dao \u0111\u1ed9ng t\u1eeb 80 \u2013 100%.<\/p>\n<p>Furosemide v\u00e0 bumetanide t\u00e1c d\u1ee5ng nhanh, th\u1eddi gian b\u00e1n h\u1ee7y r\u1ea5t ng\u1eafn (kho\u1ea3ng 1,5h). \u0110\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb x\u1ea3y ra trong v\u00f2ng v\u00e0i ph\u00fat sau khi ti\u00eam t\u0129nh m\u1ea1ch, trong khi \u0111\u1ea1t \u0111\u1ec9nh t\u00e1c d\u1ee5ng sau khi u\u1ed1ng kho\u1ea3ng 30-90 ph\u00fat. V\u1edbi c\u1ea3 hai c\u00e1ch d\u00f9ng, t\u00e1c d\u1ee5ng l\u1ee3i ti\u1ec3u duy tr\u00ec trong kho\u1ea3ng 2 \u2013 3h, v\u00e0 c\u00f3 th\u1ec3 k\u00e9o d\u00e0i \u0111\u1ebfn 6h. B\u1edfi v\u00ec t\u00e1c d\u1ee5ng ng\u1eafn, furosemide v\u00e0 bumetanide ph\u1ea3i \u0111\u01b0\u1ee3c d\u00f9ng nhi\u1ec1u l\u1ea7n m\u1ed7i ng\u00e0y \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o duy tr\u00ec n\u1ed3ng \u0111\u1ed9 thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng. Torsemide c\u00f3 th\u1eddi gian b\u00e1n h\u1ee7y trong huy\u1ebft t\u01b0\u01a1ng d\u00e0i h\u01a1n (kho\u1ea3ng 3-4h), c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c d\u00f9ng v\u1edbi kho\u1ea3ng c\u00e1ch d\u00e0i h\u01a1n.<\/p>\n<p>Furosemide c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft nguy\u00ean d\u1ea1ng ban \u0111\u1ea7u qua n\u01b0\u1edbc ti\u1ec3u (kho\u1ea3ng 50%), g\u1eafn v\u1edbi acid glucuronic \u1edf th\u1eadn. Do \u0111\u00f3, t\u00ecnh tr\u1ea1ng suy th\u1eadn s\u1ebd l\u00e0m k\u00e9o d\u00e0i th\u1eddi gian b\u00e1n th\u1ea3i trong huy\u1ebft t\u01b0\u01a1ng c\u0169ng nh\u01b0 th\u1eddi gian t\u00e1c d\u1ee5ng. Bumetanide v\u00e0 torsemide \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a ch\u1ee7 y\u1ebfu \u1edf gan. Trong b\u1ec7nh gan, th\u1eddi gian b\u00e1n h\u1ee7y trong huy\u1ebft t\u01b0\u01a1ng c\u1ee7a bumetanide v\u00e0 torsemide k\u00e9o d\u00e0i h\u01a1n, v\u00e0 t\u00e1c d\u1ee5ng ch\u00fang c\u00f3 th\u1ec3 t\u0103ng l\u00ean m\u1ed9t c\u00e1ch b\u1ea5t th\u01b0\u1eddng.<\/p>\n<h3>3.2. D\u01b0\u1ee3c l\u1ef1c h\u1ecdc<\/h3>\n<p>Thu\u1ed1c v\u00e0o t\u0129nh m\u1ea1ch s\u1ebd k\u00edch th\u00edch h\u1ec7 th\u1ed1ng renin-angiotensin-aldosterone \u1edf t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 \u0111o\u1ea1n \u0111\u1ea7u \u1ed1ng l\u01b0\u1ee3n xa, g\u00e2y co m\u1ea1ch, t\u0103ng h\u1eadu g\u00e1nh v\u00e0 gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng m\u00e1u th\u1eadn. Tuy nhi\u00ean, t\u00e1c \u0111\u1ed9ng n\u00e0y ch\u1ec9 l\u00e0 t\u1ea1m th\u1eddi v\u00ec ph\u1ea3n \u1ee9ng giai \u0111o\u1ea1n hai x\u1ea3y ra trong v\u00f2ng 5 \u2013 15 ph\u00fat sau \u0111\u00f3. Giai \u0111o\u1ea1n th\u1ee9 hai \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 gia t\u0103ng gi\u1ea3i ph\u00f3ng t\u1eeb th\u1eadn c\u00e1c ch\u1ea5t gi\u00e3n m\u1ea1ch, d\u1eabn \u0111\u1ebfn gi\u00e3n t\u0129nh m\u1ea1ch, gi\u1ea3m ti\u1ec1n g\u00e1nh v\u00e0 \u00e1p l\u1ef1c \u0111\u1ed5 \u0111\u1ea7y th\u1ea5t. C\u00e1c t\u00e1c d\u1ee5ng sau c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch s\u1ef1 c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng g\u1ea7n nh\u01b0 ngay l\u1eadp t\u1ee9c \u1edf b\u1ec7nh nh\u00e2n b\u1ecb ph\u00f9 ph\u1ed5i c\u1ea5p. V\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng k\u00e9o d\u00e0i, s\u1ebd k\u00edch ho\u1ea1t h\u1ec7 th\u1ed1ng th\u1ea7n kinh giao c\u1ea3m, \u0111\u00e2y l\u00e0 s\u1ef1 b\u00f9 tr\u1eeb t\u1ef1 nhi\u00ean nh\u1eb1m b\u1ea3o v\u1ec7 \u1ed5n \u0111\u1ecbnh th\u1ec3 t\u00edch l\u00f2ng m\u1ea1ch d\u1eabn \u0111\u1ebfn s\u1ef1 suy gi\u1ea3m t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c l\u1ee3i ti\u1ec3u, hay t\u00ecnh tr\u1ea1ng kh\u00e1ng l\u1ee3i ti\u1ec3u.<\/p>\n<h2><strong>4.Ch\u1ec9 \u0111\u1ecbnh<\/strong><\/h2>\n<p>L\u1ee3i ti\u1ec3u quai l\u00e0 thu\u1ed1c l\u1ee3i ti\u1ec3u t\u00e1c d\u1ee5ng m\u1ea1nh nh\u1ea5t, hi\u1ec7u qu\u1ea3 nh\u1ea5t, th\u01b0\u1eddng \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u0111\u1ec3 gi\u1ea3m tri\u1ec7u ch\u1ee9ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb ph\u00f9 do suy tim sung huy\u1ebft, x\u01a1 gan v\u00e0 h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0.<\/p>\n<h3>4.1 B\u1ec7nh th\u1eadn<\/h3>\n<p>B\u1ec7nh th\u1eadn l\u00e0m gi\u1ea3m t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c l\u1ee3i ti\u1ec3u khi d\u00f9ng li\u1ec1u th\u00f4ng th\u01b0\u1eddng, do \u0111\u00f3 c\u1ea7n ph\u1ea3i d\u00f9ng li\u1ec1u l\u1edbn h\u01a1n \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c t\u00e1c d\u1ee5ng l\u1ee3i ti\u1ec3u mong mu\u1ed1n. C\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n b\u1eb1ng c\u00e1ch t\u0103ng d\u1ea7n li\u1ec1u thu\u1ed1c l\u1ee3i ti\u1ec3u quai cho \u0111\u1ebfn khi x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c li\u1ec1u hi\u1ec7u qu\u1ea3 ho\u1eb7c \u0111\u1ebfn khi \u0111\u1ea1t li\u1ec1u t\u1ed1i \u0111a c\u1ee7a thu\u1ed1c.<\/p>\n<p>C\u00f3 th\u1ec3 th\u1eed truy\u1ec1n li\u00ean t\u1ee5c n\u1ebfu li\u1ec1u ng\u1eaft qu\u00e3ng kh\u00f4ng \u0111\u1ee7 t\u00e1c d\u1ee5ng. Tuy nhi\u00ean, tr\u01b0\u1edbc khi truy\u1ec1n li\u00ean t\u1ee5c n\u00ean d\u00f9ng li\u1ec1u n\u1ea1p tr\u01b0\u1edbc \u0111\u1ec3 gi\u1ea3m th\u1eddi gian \u0111\u1ea1t \u0111\u01b0\u1ee3c n\u1ed3ng \u0111\u1ed9 \u1ed5n \u0111\u1ecbnh trong m\u00e1u. T\u1ed1c \u0111\u1ed9 truy\u1ec1n li\u00ean t\u1ee5c \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh d\u1ef1a tr\u00ean ch\u1ee9c n\u0103ng th\u1eadn.<\/p>\n<p>B\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee5c ti\u00eau th\u1ea3i natri m\u1eb7c d\u00f9 s\u1eed d\u1ee5ng li\u1ec1u t\u1ed1i \u0111a l\u1ee3i ti\u1ec3u quai c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n nh\u1edd vi\u1ec7c s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u kh\u00e1c. Chi\u1ebfn l\u01b0\u1ee3c n\u00e0y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 phong t\u1ecfa l\u1ea7n l\u01b0\u1ee3t c\u00e1c v\u1ecb tr\u00ed c\u1ee7a c\u1ea7u th\u1eadn hay phong t\u1ecfa nephron tu\u1ea7n t\u1ef1 theo c\u01a1 ch\u1ebf kh\u00e1c nhau b\u1ed5 sung v\u00e0 t\u0103ng c\u01b0\u1eddng t\u00e1c d\u1ee5ng cho nhau.<\/p>\n<p>Th\u1ee9 nh\u1ea5t, th\u1eddi gian b\u00e1n th\u1ea3i d\u00e0i h\u01a1n c\u1ee7a c\u00e1c thu\u1ed1c t\u00e1c \u0111\u1ed9ng \u1edf \u1ed1ng l\u01b0\u1ee3n xa c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m t\u00e1c d\u1ee5ng c\u1ee7a vi\u1ec7c th\u1ea3i natri v\u1edbi c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u quai t\u00e1c d\u1ee5ng ng\u1eafn.<\/p>\n<p>Th\u1ee9 hai, s\u1eed d\u1ee5ng l\u00e2u d\u00e0i thu\u1ed1c l\u1ee3i ti\u1ec3u quai c\u00f3 th\u1ec3 g\u00e2y ra ph\u00ec \u0111\u1ea1i c\u00e1c t\u1ebf b\u00e0o \u0111o\u1ea1n xa, t\u0103ng c\u01b0\u1eddng t\u00e1i h\u1ea5p thu natri t\u1ea1i v\u1ecb tr\u00ed n\u00e0y v\u00e0 l\u00e0m gi\u1ea3m t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c.<\/p>\n<h3>4.2 Suy tim sung huy\u1ebft<\/h3>\n<p>Thu\u1ed1c l\u1ee3i ti\u1ec3u quai \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n suy tim khi c\u00f3 \u1ee9 tr\u1ec7 mu\u1ed1i, n\u01b0\u1edbc gi\u00fap l\u00e0m gi\u1ea3m tri\u1ec7u ch\u1ee9ng suy tim v\u1edbi m\u1ee9c \u0111\u1ed9 I m\u1ee9c b\u1eb1ng ch\u1ee9ng C theo khuy\u1ebfn c\u00e1o c\u1ee7a ACC\/AHA 2013.<\/p>\n<p>Ba bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng ch\u00ednh c\u1ee7a t\u00ecnh tr\u1ea1ng qu\u00e1 t\u1ea3i th\u1ec3 t\u00edch \u1edf b\u1ec7nh nh\u00e2n suy tim l\u00e0 sung huy\u1ebft ph\u1ed5i, ph\u00f9 ngo\u1ea1i bi\u00ean v\u00e0 t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1ea3nh.<\/p>\n<p>Thu\u1ed1c l\u1ee3i ti\u1ec3u ti\u00eam t\u0129nh m\u1ea1ch (d\u01b0\u1edbi d\u1ea1ng bolus ho\u1eb7c truy\u1ec1n li\u00ean t\u1ee5c) m\u1ea1nh h\u01a1n li\u1ec1u u\u1ed1ng t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u00e0 \u0111\u00f4i khi \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho b\u1ec7nh kh\u00f4ng \u1ed5n \u0111\u1ecbnh ho\u1eb7c b\u1ec7nh nh\u00e2n n\u1eb7ng.<\/p>\n<p>Li\u1ec1u kh\u1edfi \u0111\u1ea7u v\u00e0 ch\u1ec9nh li\u1ec1u:<\/p>\n<ul>\n<li>Li\u1ec1u bolus ti\u00eam t\u0129nh m\u1ea1ch ban \u0111\u1ea7u th\u00f4ng th\u01b0\u1eddng l\u00e0 20 \u2013 40 mg ho\u1eb7c g\u1ea5p 2,5 l\u1ea7n<\/li>\n<li>Li\u1ec1u u\u1ed1ng kh\u00f4ng hi\u1ec7u qu\u1ea3 tr\u01b0\u1edbc \u0111\u00f3; n\u1ebfu kh\u00f4ng c\u00f3 \u0111\u00e1p \u1ee9ng, c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u1eb7p l\u1ea1i sau m\u1ed7i 2h v\u1edbi li\u1ec1u g\u1ea5p \u0111\u00f4i, khi c\u1ea7n c\u00f3 th\u1ec3 \u0111\u1ebfn li\u1ec1u t\u1ed1i \u0111a. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn b\u00ecnh th\u01b0\u1eddng, li\u1ec1u ti\u00eam t\u0129nh m\u1ea1ch t\u1ed1i \u0111a th\u01b0\u1eddng l\u00e0 40 \u2013 80 mg furosemide, 20 \u2013 40 mg torsemide, ho\u1eb7c 1 \u2013 2 mg bumetanide.<\/li>\n<\/ul>\n<p>B\u1ec7nh nh\u00e2n suy th\u1eadn c\u1ea7n li\u1ec1u bolus t\u1ed1i \u0111a cao h\u01a1n t\u1edbi 160 \u2013 200 mg furosemide,100 \u2013 200 mg torsemide ho\u1eb7c 4 \u2013 8 mg bumetanide.<\/p>\n<p>\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n suy tim m\u1ea1n t\u00ednh, li\u1ec1u b\u1eaft \u0111\u1ea7u u\u1ed1ng th\u00f4ng th\u01b0\u1eddng l\u00e0 20 \u2013 40 mg furosemide. N\u1ebfu m\u1ed9t b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi li\u1ec1u ban \u0111\u1ea7u, n\u00ean t\u0103ng li\u1ec1u thay v\u00ec d\u00f9ng c\u00f9ng m\u1ed9t li\u1ec1u hai l\u1ea7n m\u1ed9t ng\u00e0y. N\u1ebfu c\u00f3 \u0111\u00e1p \u1ee9ng t\u1ed1t nh\u01b0ng ng\u1eafn, c\u00f3 th\u1ec3 c\u1ea7n d\u00f9ng thu\u1ed1c th\u01b0\u1eddng xuy\u00ean h\u01a1n.<\/p>\n<p>Li\u1ec1u t\u1ed1i \u0111a 1 l\u1ea7n c\u1ee7a furosemide u\u1ed1ng l\u00e0 40 \u2013 80 mg cho b\u1ec7nh nh\u00e2n c\u00f3 m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn b\u00ecnh th\u01b0\u1eddng. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb suy th\u1eadn, c\u00f3 th\u1ec3 d\u00f9ng li\u1ec1u t\u1ed1i \u0111a cao h\u01a1n 160 \u2013 200 mg furosemide (li\u1ec1u t\u1ed1i \u0111a h\u1eb1ng ng\u00e0y l\u00e0 600 mg).<\/p>\n<p>Torsemide v\u00e0 bumetanide \u0111\u01b0\u1ee3c h\u1ea5p thu nhi\u1ec1u h\u01a1n furosemide. Li\u1ec1u u\u1ed1ng ban \u0111\u1ea7u th\u00f4ng th\u01b0\u1eddng c\u1ee7a torsemide l\u00e0 5 \u2013 10 mg v\u1edbi li\u1ec1u t\u1ed1i \u0111a 1 l\u1ea7n 100 mg (li\u1ec1u t\u1ed1i \u0111a h\u1eb1ng ng\u00e0y l\u00e0 200 mg). Li\u1ec1u bumetanide ban \u0111\u1ea7u th\u00f4ng th\u01b0\u1eddng l\u00e0 0,5 \u2013 1,0 mg v\u1edbi li\u1ec1u t\u1ed1i \u0111a 1 l\u1ea7n l\u00e0 5 mg (li\u1ec1u t\u1ed1i \u0111a h\u1eb1ng ng\u00e0y l\u00e0 10 mg).<\/p>\n<p>B\u1ec7nh nh\u00e2n b\u1ecb ph\u00f9 n\u1ec1 k\u00e9o d\u00e0i kh\u00f4ng \u0111\u00e1p \u1ee9ng khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c l\u1ee3i ti\u1ec3u \u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c ti\u00eam t\u0129nh m\u1ea1ch n\u00ean c\u00e2n nh\u1eafc chuy\u1ec3n sang d\u00f9ng thu\u1ed1c l\u1ee3i ti\u1ec3u quai \u0111\u01b0\u1eddng u\u1ed1ng h\u1ea5p thu cao h\u01a1n (v\u00ed d\u1ee5: torsemide ho\u1eb7c bumetanide thay cho furosemide) ho\u1eb7c s\u1eed d\u1ee5ng li\u1ec1u cao furosemide \u0111\u01b0\u1eddng u\u1ed1ng, truy\u1ec1n t\u0129nh m\u1ea1ch li\u00ean t\u1ee5c v\u00e0 n\u00ean b\u1ed5 sung thu\u1ed1c l\u1ee3i ti\u1ec3u lo\u1ea1i thiazide v\u00e0 s\u1eed d\u1ee5ng thu\u1ed1c \u0111\u1ed1i kh\u00e1ng aldosterone (spironolactone ho\u1eb7c eplerenone).<\/p>\n<p>Khi d\u00f9ng c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u kh\u00f4ng \u0111\u00e1p \u1ee9ng, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng l\u1ecdc m\u00e1u n\u1ebfu c\u00f3 th\u1ec3 \u0111\u1ec3 lo\u1ea1i b\u1ecf d\u1ecbch th\u1eeba.<\/p>\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 gi\u00e0u kinh nghi\u1ec7m 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>Thu\u1ed1c l\u1ee3i ti\u1ec3u quai \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n t\u1eeb nh\u1eefng n\u0103m 1960. Furosemide l\u00e0 thu\u1ed1c l\u1ee3i ti\u1ec3u quai \u0111\u1ea7u ti\u00ean v\u00e0 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf Hoa K\u1ef3, sau \u0111\u00f3 l\u00e0 bumetanide v\u00e0 torsemide. 1.Gi\u1edbi thi\u1ec7u chung Thu\u1ed1c l\u1ee3i ti\u1ec3u quai \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n t\u1eeb nh\u1eefng n\u0103m 1960. Furosemide l\u00e0 thu\u1ed1c l\u1ee3i [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":21626,"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>Thu\u1ed1c l\u1ee3i ti\u1ec3u quai v\u00e0 c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng<\/title>\n<meta name=\"description\" content=\"Thu\u1ed1c l\u1ee3i ti\u1ec3u quai c\u00f3 c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng nh\u01b0 th\u1ebf n\u00e0o, tham kh\u1ea3o b\u00e0i vi\u00eat v\u1ec1 c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng \u0111\u1ec3 hi\u1ec3u h\u01a1n v\u1ec1 nh\u00f3m thu\u1ed1c n\u00e0y.\" \/>\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 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