{"id":22226,"date":"2023-04-16T17:56:17","date_gmt":"2023-04-16T10:56:17","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22226"},"modified":"2023-04-17T14:11:25","modified_gmt":"2023-04-17T07:11:25","slug":"mot-so-benh-tim-mach-dong-mac-voi-copd","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/16\/mot-so-benh-tim-mach-dong-mac-voi-copd\/","title":{"rendered":"M\u1ed9t s\u1ed1 b\u1ec7nh tim m\u1ea1ch \u0111\u1ed3ng m\u1eafc v\u1edbi COPD"},"content":{"rendered":"

B\u1ec7nh nh\u00e2n COPD th\u01b0\u1eddng c\u00f3 th\u00eam nh\u1eefng b\u1ec7nh kh\u00e1c \u0111\u1ed3ng th\u1eddi, g\u1ecdi l\u00e0 b\u1ec7nh \u0111\u1ed3ng m\u1eafc. B\u1ec7nh \u0111\u1ed3ng m\u1eafc c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u00e1ng k\u1ec3 \u0111\u1ebfn bi\u1ec3u hi\u1ec7n v\u00e0 ti\u00ean l\u01b0\u1ee3ng c\u1ee7a b\u1ec7nh nh\u00e2n COPD. B\u1ec7nh \u0111\u1ed3ng m\u1eafc th\u01b0\u1eddng g\u1eb7p \u1edf COPD b\u1ea5t k\u1ef3 m\u1ee9c \u0111\u1ed9 n\u1eb7ng n\u00e0o. D\u01b0\u1edbi \u0111\u00e2y l\u00e0 nh\u1eefng b\u1ec7nh tim m\u1ea1ch \u0111\u1ed3ng m\u1eafc th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n COPD.<\/strong><\/p>\n

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

C\u00f3 th\u1ec3 l\u00e0 b\u1ec7nh \u0111\u1ed3ng m\u1eafc th\u01b0\u1eddng g\u1eb7p nh\u1ea5t, \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o trong 40 – 60% b\u1ec7nh nh\u00e2n COPD. \u0110i\u1ec1u tr\u1ecb huy\u1ebft \u00e1p cao v\u00e0 COPD nh\u01b0 th\u00f4ng th\u01b0\u1eddng. C\u1ea7n ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p<\/a> t\u1ed1t nh\u1ea5t theo h\u01b0\u1edbng d\u1eabn. Vai tr\u00f2 c\u1ee7a c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf \u03b2 ch\u1ecdn l\u1ecdc kh\u00f4ng c\u00f2n n\u1ed5i b\u1eadt.<\/p>\n

M\u1ed9t s\u1ed1 l\u01b0u \u00fd v\u1ec1 thu\u1ed1c tim m\u1ea1ch:<\/p>\n

– Thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n (ACEIs): c\u00f3 th\u1ec3 g\u00e2y ho nh\u01b0ng kh\u00f4ng ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh.<\/p>\n

– Thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 angiotensine (ARBs): kh\u00f4ng g\u00e2y ho, c\u00f3 th\u1ec3 thay th\u1ebf thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n.<\/p>\n

– Thu\u1ed1c \u1ee9c ch\u1ebf k\u00eanh calci: \u0111\u1ed1i kh\u00e1ng s\u1ef1 co th\u1eaft c\u1ee7a c\u01a1 tr\u01a1n ph\u1ebf qu\u1ea3n, c\u00f3 th\u1ec3 t\u0103ng hi\u1ec7u qu\u1ea3 c\u1ee7a thu\u1ed1c ch\u1ee7 v\u1eadn \u03b22.<\/p>\n

– Thu\u1ed1c l\u1ee3i ti\u1ec3u: l\u01b0u \u00fd t\u00e1c d\u1ee5ng gi\u1ea3m K+ trong m\u00e1u nh\u1ea5t l\u00e0 khi d\u00f9ng chung thu\u1ed1c ch\u1ee7 v\u1eadn \u03b22 v\u00e0 corticoid to\u00e0n th\u00e2n. N\u00ean d\u00f9ng k\u00e8m lo\u1ea1i gi\u1eef K+.<\/p>\n

\"T\u0103ng
T\u0103ng huy\u1ebft \u00e1p l\u00e0 b\u1ec7nh \u0111\u1ed3ng m\u1eafc th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf b\u1ec7nh nh\u00e2n COPD<\/figcaption><\/figure>\n

2. Suy tim<\/strong><\/h2>\n

Ch\u1ea9n \u0111o\u00e1n: tri\u1ec7u ch\u1ee9ng c\u1ee7a suy tim v\u00e0 COPD c\u00f3 th\u1ec3 ch\u1ed3ng l\u1ea5p nhau nh\u01b0: kh\u00f3 th\u1edf, kh\u00f3 th\u1edf k\u1ecbch ph\u00e1t v\u1ec1 \u0111\u00eam, kh\u00f3 th\u1edf ph\u1ea3i ng\u1ed3i, nh\u1ea5t l\u00e0 khi kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u \u1ee9 n\u01b0\u1edbc v\u00e0 mu\u1ed1i do d\u00f9ng l\u1ee3i ti\u1ec3u v\u00e0 trong giai \u0111o\u1ea1n \u0111\u1ea7u c\u1ee7a suy tim c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u c\u00f2n b\u1ea3o t\u1ed3n.<\/p>\n

T\u00ecnh tr\u1ea1ng lo\u1ea1n ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng c\u00f3 th\u1ec3 \u0111i k\u00e8m v\u1edbi kh\u00f4ng dung n\u1ea1p g\u1eafng s\u1ee9c v\u00e0 g\u00e2y nh\u1ea7m l\u1eabn v\u1edbi \u0111\u1ee3t c\u1ea5p COPD. C\u00e1c x\u00e9t nghi\u1ec7m t\u0103ng x\u00e1c su\u1ea5t ch\u1ea9n \u0111o\u00e1n suy tim:<\/p>\n

– \u0110i\u1ec7n t\u00e2m \u0111\u1ed3 (ECG): n\u1ebfu ho\u00e0n to\u00e0n b\u00ecnh th\u01b0\u1eddng th\u00ec kh\u00f4ng th\u1ec3 c\u00f3 suy tim, nh\u01b0ng l\u1ea1i kh\u00f4ng c\u00f3 ECG \u201c\u0111i\u1ec3n h\u00ecnh\u201d c\u1ee7a suy tim.<\/p>\n

– BNP (Brain natriuretic peptid): < 35 pg\/ml ho\u1eb7c NT-proBNP (N-terminal pro- brain natriuretic peptide) < 125 pg\/ml th\u00ec kh\u00f4ng th\u1ec3 c\u00f3 suy tim. Trong b\u1ec7nh c\u1ea3nh kh\u00f3 th\u1edf c\u1ea5p, \u0111i\u1ec3m c\u1eaft \u0111\u01b0\u1ee3c \u0111\u1ec1 ngh\u1ecb cao h\u01a1n v\u1edbi NT-proBNP < 300 pg\/mL v\u00e0 BNP < 100 pg\/mL.<\/p>\n

– X-quang: nguy c\u01a1 nh\u1eadn \u0111\u1ecbnh sai c\u00e1c b\u1ea5t th\u01b0\u1eddng v\u00e0 \u0111\u00e1nh gi\u00e1 th\u1ea5p ch\u1ec9 s\u1ed1 tim – l\u1ed3ng ng\u1ef1c.<\/p>\n

– Si\u00eau \u00e2m tim: l\u00e0 x\u00e9t nghi\u1ec7m ch\u1ee7 y\u1ebfu v\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh suy tim, ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u < 40-50%.<\/p>\n

Nh\u1eefng \u0111i\u1ec3m l\u01b0u \u00fd v\u1ec1 \u0111i\u1ec1u tr\u1ecb:<\/p>\n

V\u1ec1 nguy\u00ean t\u1eafc, kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t trong \u0111i\u1ec1u tr\u1ecb suy tim \u1edf ng\u01b0\u1eddi c\u00f3 COPD, g\u1ed3m c\u1ea3 c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf \u03b2. B\u1ec7nh nh\u00e2n n\u00e0o kh\u00f4ng dung n\u1ea1p thu\u1ed1c \u1ee9c ch\u1ebf \u03b2, c\u00f3 th\u1ec3 d\u00f9ng ivabradine (khi nh\u1ecbp tim > 70\/p) ho\u1eb7c digoxin \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 nh\u1eadp vi\u1ec7n v\u00ec suy tim.<\/p>\n

– Thu\u1ed1c l\u1ee3i ti\u1ec3u: gi\u1ea3m tri\u1ec7u ch\u1ee9ng kh\u00f3 th\u1edf v\u00e0 ph\u00f9 \u1edf b\u1ec7nh nh\u00e2n suy tim \u1ee9 huy\u1ebft. L\u01b0u \u00fd l\u1ee3i ti\u1ec3u d\u00f9ng li\u1ec1u cao c\u00f3 th\u1ec3 g\u00e2y ki\u1ec1m chuy\u1ec3n h\u00f3a \u1edf b\u1ec7nh nh\u00e2n COPD l\u00e0m gi\u1ea3m h\u00f4 h\u1ea5p.<\/p>\n

– Thu\u1ed1c \u1ee9c ch\u1ebf \u03b2: thu\u1ed1c nh\u00f3m ch\u1eb9n th\u1ee5 th\u1ec3 \u03b2-1 \u0111\u01b0\u1ee3c khuy\u00ean d\u00f9ng do c\u1ea3i thi\u1ec7n \u0111\u01b0\u1ee3c \u0111\u1ed9 s\u1ed1ng s\u00f3t trong suy tim. N\u00ean d\u00f9ng lo\u1ea1i ch\u1eb9n th\u1ee5 th\u1ec3 \u03b2-1 ch\u1ecdn l\u1ecdc (bisoprolol, metoprolol succinate, v\u00e0 nebivolol). Nguy\u00ean t\u1eafc kh\u1edfi \u0111\u1ea7u b\u1eb1ng li\u1ec1u th\u1ea5p r\u1ed3i t\u0103ng d\u1ea7n l\u00e0 r\u1ea5t quan tr\u1ecdng. Nh\u00f3m \u1ee9c ch\u1ebf \u03b2 kh\u00f4ng ch\u1ecdn l\u1ecdc kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u00ec nguy c\u01a1 cao g\u00e2y co th\u1eaft ph\u1ebf qu\u1ea3n nh\u1ea5t l\u00e0 trong giai \u0111o\u1ea1n b\u1eaft \u0111\u1ea7u. (Ri\u00eang carvedilol c\u0169ng c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf \u03b1 n\u00ean c\u00f3 th\u1ec3 d\u00f9ng).<\/p>\n

– Digoxin: l\u00e0m gi\u1ea3m ch\u1ee9c n\u0103ng ph\u1ed5i do g\u00e2y co m\u1ea1ch ph\u1ed5i. R\u1ea5t \u00edt khi d\u00f9ng, tr\u1eeb khi c\u00f3 rung nh\u0129.<\/p>\n

– Statins: kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3 tr\u00ean suy tim.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb suy tim tr\u01b0\u1eddng h\u1ee3p c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m (reduced ejection fraction, REF): c\u00f3 th\u1ec3 d\u00f9ng c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n (ACE), thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 (ARB), thu\u1ed1c \u1ee9c ch\u1ebf \u03b21 ch\u1ecdn l\u1ecdc, v\u00e0 thu\u1ed1c \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 mineralocorticoid\/ aldosteron. D\u00f9ng li\u1ec1u t\u0103ng d\u1ea7n.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb suy tim tr\u01b0\u1eddng h\u1ee3p c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n (PEF): d\u00f9ng l\u1ee3i ti\u1ec3u \u0111\u1ec3 ki\u1ec3m so\u00e1t t\u00ecnh tr\u1ea1ng \u1ee9 n\u01b0\u1edbc v\u00e0 mu\u1ed1i, \u0111i\u1ec1u tr\u1ecb huy\u1ebft \u00e1p cao v\u00e0 thi\u1ebfu m\u00e1u c\u01a1 tim, ki\u1ec3m so\u00e1t nh\u1ecbp th\u1ea5t \u1edf b\u1ec7nh nh\u00e2n c\u00f3 rung nh\u0129.<\/p>\n

– Suy tim v\u1edbi ph\u00f9 ph\u1ed5i c\u1ea5p n\u00ean s\u1eed d\u1ee5ng th\u00f4ng kh\u00ed kh\u00f4ng x\u00e2m l\u1ea5n k\u00e8m theo \u0111i\u1ec1u tr\u1ecb quy \u01b0\u1edbc.<\/p>\n

3. B\u1ec7nh tim thi\u1ebfu m\u00e1u<\/strong><\/h2>\n

C\u1ea7n \u0111\u00e1nh gi\u00e1 \u1edf t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n COPD. C\u00f3 th\u1ec3 d\u00f9ng b\u1ea3ng t\u00ednh nguy c\u01a1 to\u00e0n th\u1ec3 theo Vi\u1ec7n Tim Ph\u1ed5i Huy\u1ebft h\u1ecdc Hoa K\u1ef3, v\u00e0 \u0111i\u1ec1u tr\u1ecb theo h\u01b0\u1edbng d\u1eabn hi\u1ec7n h\u00e0nh.<\/p>\n

Trong \u0111\u1ee3t c\u1ea5p COPD, b\u1ec7nh nh\u00e2n \u0111\u00e3 c\u00f3 b\u1ec7nh tim thi\u1ebfu m\u00e1u th\u00ec nguy c\u01a1 t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim c\u00e0ng t\u0103ng. Troponine tim t\u0103ng th\u00ec t\u0103ng nguy c\u01a1 t\u1eed vong c\u1ea3 ng\u1eafn h\u1ea1n (trong v\u00f2ng 30 ng\u00e0y) l\u1eabn d\u00e0i h\u1ea1n.<\/p>\n

\u0110i\u1ec1u tr\u1ecb b\u1ec7nh tim thi\u1ebfu m\u00e1u v\u1eabn theo nh\u01b0 c\u00e1c h\u01b0\u1edbng d\u1eabn hi\u1ec7n h\u00e0nh b\u1ea5t k\u1ec3 s\u1ef1 c\u00f3 m\u1eb7t c\u1ee7a COPD v\u00e0 ng\u01b0\u1ee3c l\u1ea1i.<\/p>\n

4. Lo\u1ea1n nh\u1ecbp tim<\/strong><\/h2>\n

T\u1ea7n su\u1ea5t lo\u1ea1n nh\u1ecbp tim \u01b0\u1edbc t\u00ednh kho\u1ea3ng 12-14% b\u1ec7nh nh\u00e2n COPD, trong \u0111\u00f3 rung nh\u0129 th\u01b0\u1eddng g\u1eb7p v\u00e0 li\u00ean quan tr\u1ef1c ti\u1ebfp \u0111\u1ebfn FEV1\u00a0<\/sub>v\u00e0 c\u00e1c \u0111\u1ee3t k\u1ecbch ph\u00e1t. Khi t\u00ecnh tr\u1ea1ng kh\u00f3 th\u1edf n\u1eb7ng l\u00ean th\u01b0\u1eddng hay c\u00f3 rung nh\u0129, v\u00e0 rung nh\u0129 c\u00f3 th\u1ec3 l\u00e0 y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y ho\u1eb7c l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a m\u1ed9t \u0111\u1ee3t k\u1ecbch ph\u00e1t c\u1ea5p.<\/p>\n

C\u00f3 th\u1ec3 ph\u1ea3n \u00e1nh s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a b\u1ec7nh tim thi\u1ebfu m\u00e1u.<\/p>\n

Rung nh\u0129 kh\u00f4ng l\u00e0m thay \u0111\u1ed5i \u0111i\u1ec1u tr\u1ecb COPD. 3 nh\u00f3m thu\u1ed1c LABA, kh\u00e1ng cholinergic v\u00e0 ICS l\u00e0 an to\u00e0n. Tuy nhi\u00ean SABA v\u00e0 theophylline c\u00f3 th\u1ec3 th\u00fac \u0111\u1ea9y rung nh\u0129 v\u00e0 l\u00e0m kh\u00f3 ki\u1ec3m so\u00e1t nh\u1ecbp th\u1ea5t.<\/p>\n

Thu\u1ed1c ch\u1ee7 v\u1eadn \u03b22: d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng d\u00e0i h\u1ea1n g\u00e2y nhi\u1ec1u t\u00e1c d\u1ee5ng tim m\u1ea1ch kh\u00f4ng thu\u1eadn l\u1ee3i \u1edf b\u1ec7nh nh\u00e2n c\u00f3 suy tim do t\u00e1c d\u1ee5ng t\u0103ng t\u00ednh d\u1eabn truy\u1ec1n v\u00e0 t\u0103ng co b\u00f3p, v\u00e0 d\u1ec5 d\u1eabn \u0111\u1ebfn lo\u1ea1n nh\u1ecbp tim.<\/p>\n

5. B\u1ec7nh m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean<\/strong><\/h2>\n

T\u1eafc \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi do x\u01a1 v\u1eefa, th\u01b0\u1eddng k\u00e8m theo x\u01a1 v\u1eefa m\u1ea1ch v\u00e0nh. \u1ea2nh h\u01b0\u1edfng l\u00ean ch\u1ee9c n\u0103ng v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng.<\/p>\n

T\u00f3m l\u1ea1i, hi\u1ec3u bi\u1ebft v\u1ec1 c\u00e1c b\u1ec7nh tim m\u1ea1ch \u0111\u1ed3ng m\u1eafc v\u1edbi COPD l\u00e0 r\u1ea5t quan tr\u1ecdng v\u00ec gi\u00fap nh\u1eadn di\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 nguy c\u01a1 c\u1ee7a b\u1ec7nh nh\u00e2n, t\u1eeb \u0111\u00f3 \u0111\u01b0a ra c\u00e1c bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p.<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n","protected":false},"excerpt":{"rendered":"

B\u1ec7nh nh\u00e2n COPD th\u01b0\u1eddng c\u00f3 th\u00eam nh\u1eefng b\u1ec7nh kh\u00e1c \u0111\u1ed3ng th\u1eddi, g\u1ecdi l\u00e0 b\u1ec7nh \u0111\u1ed3ng m\u1eafc. B\u1ec7nh \u0111\u1ed3ng m\u1eafc c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u00e1ng k\u1ec3 \u0111\u1ebfn bi\u1ec3u hi\u1ec7n v\u00e0 ti\u00ean l\u01b0\u1ee3ng c\u1ee7a b\u1ec7nh nh\u00e2n COPD. B\u1ec7nh \u0111\u1ed3ng m\u1eafc th\u01b0\u1eddng g\u1eb7p \u1edf COPD b\u1ea5t k\u1ef3 m\u1ee9c \u0111\u1ed9 n\u1eb7ng n\u00e0o. D\u01b0\u1edbi \u0111\u00e2y l\u00e0 nh\u1eefng b\u1ec7nh tim m\u1ea1ch […]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[3],"yoast_head":"\nM\u1ed9t s\u1ed1 b\u1ec7nh tim m\u1ea1ch \u0111\u1ed3ng m\u1eafc v\u1edbi COPD - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u1ec7nh \u0111\u1ed3ng m\u1eafc th\u01b0\u1eddng g\u1eb7p \u1edf COPD b\u1ea5t k\u1ef3 m\u1ee9c \u0111\u1ed9 n\u1eb7ng n\u00e0o. 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