{"id":22545,"date":"2023-04-18T11:31:15","date_gmt":"2023-04-18T04:31:15","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22545"},"modified":"2023-04-18T12:29:52","modified_gmt":"2023-04-18T05:29:52","slug":"thuoc-gian-mach-uu-tien-dan-tinh-mach-trong-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/thuoc-gian-mach-uu-tien-dan-tinh-mach-trong-dieu-tri\/","title":{"rendered":"Thu\u1ed1c gi\u00e3n m\u1ea1ch \u01b0u ti\u00ean gi\u00e3n t\u0129nh m\u1ea1ch trong \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"<p><strong>Thu\u1ed1c gi\u00e3n m\u1ea1ch l\u00e0 lo\u1ea1i thu\u1ed1c th\u01b0\u1eddng g\u1eb7p trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. C\u00e1c lo\u1ea1i thu\u1ed1c \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp trong b\u00e0i vi\u1ebft bao g\u1ed3m: Nitroglycerin,Nicorndin&#8230; s\u1ebd c\u00f3 trong b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y.<\/strong><\/p>\n<h2><strong>1.Nitroglycerin<\/strong><\/h2>\n<h3>1.1. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng v\u00e0 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a nitroglycerin<\/h3>\n<p>Nitroglycerine l\u00e0 thu\u1ed1c thu\u1ed9c nh\u00f3m thu\u1ed1c gi\u00e3n m\u1ea1ch, c\u00f3 nitrat h\u1eefu c\u01a1 (isosorbide dinitrate, isosorbide mononitrate, amyl nitrite\u2026) c\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch v\u00e0nh m\u1ea1nh v\u00e0 th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong c\u00e1c c\u01a1n \u0111au th\u1eaft ng\u1ef1c.<\/p>\n<p>C\u00e1c nitrate sau khi v\u00e0o t\u1ebf b\u00e0o, d\u01b0\u1edbi t\u00e1c d\u1ee5ng c\u1ee7a aldehyde dehydrogenase ty th\u1ec3(ALDH2), t\u1eeb \u0111\u00f3 sinh ra NO. NO sau \u0111\u00f3 ho\u1ea1t h\u00f3a Guanyl cyclase (GC), ch\u1ea5t n\u00e0y l\u1ea1i t\u0103ng c\u01b0\u1eddng chuy\u1ec3n guanosine triphosphate (GTP) th\u00e0nh guanosine 3\u2032,5\u2032\u2013monophosphate (cGMP) trong c\u01a1 tr\u01a1n m\u1ea1ch m\u00e1u v\u00e0 c\u00e1c m\u00f4 kh\u00e1c. Ch\u1ea5t n\u00e0y t\u0103ng c\u01b0\u1eddng chuy\u1ec3n myosin-LC-PO43 (LC: light chain \u2013 chu\u1ed7i nh\u1eb9) v\u1ec1 myosin-LC g\u00e2y gi\u00e3n c\u01a1. Ngo\u00e0i ra t\u00e1c d\u1ee5ng n\u00e0y tr\u00ean ti\u1ec3u c\u1ea7u c\u0169ng l\u00e0m gi\u1ea3m li\u00ean k\u1ebft fibrinogen v\u1edbi th\u1ee5 th\u1ec3 glycoprotein IIb\/IIIa, g\u00e2y \u1ee9c ch\u1ebf k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u. T\u00e1c d\u1ee5ng thu\u1ed1c l\u00e0m gi\u00e3n t\u1ea5t c\u1ea3 c\u01a1 tr\u01a1n. Do gi\u00e3n \u0111\u1ed9ng m\u1ea1ch v\u00e0 t\u0129nh m\u1ea1ch n\u00ean l\u00e0m gi\u1ea3m h\u1eadu g\u00e1nh v\u00e0 ti\u1ec1n g\u00e1nh t\u01b0\u01a1ng \u1ee9ng (gi\u00e3n t\u0129nh m\u1ea1ch nhi\u1ec1u h\u01a1n), gi\u1ea3m t\u1ea3i cho tim, gi\u00fap tim gi\u1ea3m ti\u00eau th\u1ee5 oxy, l\u00e0m gi\u1ea3m c\u01a1n \u0111au th\u1eaft ng\u1ef1c. Thu\u1ed1c c\u00f3 c\u00e1c t\u00e1c d\u1ee5ng h\u1ea1 huy\u1ebft \u00e1p, gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng tim nh\u01b0ng l\u00e0m t\u0103ng l\u01b0u l\u01b0\u1ee3ng v\u00e0nh, t\u00e1i ph\u00e2n ph\u1ed1i m\u00e1u cho tim, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng v\u00f9ng thi\u1ebfu m\u00e1u, ch\u1ed1ng \u0111\u00f4ng m\u00e1u (ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u) v\u00e0 gi\u00e3n c\u01a1 tr\u01a1n kh\u00e1c bao g\u1ed3m: c\u01a1 tr\u01a1n ti\u00eau h\u00f3a, c\u01a1 tr\u01a1n h\u00f4 h\u1ea5p, c\u01a1 tr\u01a1n sinh d\u1ee5c\u2026<\/p>\n<h3>1.2. C\u00e1ch s\u1eed d\u1ee5ng v\u00e0 li\u1ec1u l\u01b0\u1ee3ng<\/h3>\n<ul>\n<li>D\u1ea1ng ng\u1eadm d\u01b0\u1edbi l\u01b0\u1ee1i: 0,3-0,6 mg m\u1ed7i 5 ph\u00fat d\u00f9ng t\u1ed1i \u0111a 3 l\u1ea7n. S\u1eed d\u1ee5ng khi c\u00f3 tri\u1ec7u ch\u1ee9ng \u0111\u1ea7u ti\u00ean c\u1ee7a c\u01a1n \u0111au th\u1eaft ng\u1ef1c.<\/li>\n<li>Mi\u1ebfng d\u00e1n: 10 \u2013 15 mg d\u00e1n v\u00e0o v\u00f9ng da m\u1ecfng, th\u01b0\u1eddng d\u00e1n tr\u01b0\u1edbc ng\u1ef1c tr\u00e1i. Hi\u1ec7n \u00edt d\u00f9ng v\u00ec kh\u00f3 ki\u1ec3m so\u00e1t n\u1ed3ng \u0111\u1ed9 thu\u1ed1c h\u1ea5p thu v\u00e0o c\u01a1 th\u1ec3.<\/li>\n<li>Nitroglycerin \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch: Thu\u1ed1c c\u00f3 \u0111\u1eb7c t\u00ednh kh\u1edfi \u0111\u1ea7u v\u00e0 k\u1ebft th\u00fac g\u1ea7n nh\u01b0 ngay l\u1eadp t\u1ee9c.<\/li>\n<\/ul>\n<p>T\u1ed1c \u0111\u1ed9 truy\u1ec1n th\u01b0\u1eddng kh\u1edfi \u0111\u1ea7u v\u1edbi 10\u201320 \u00b5g\/ph\u00fat v\u00e0 c\u00f3 th\u1ec3 t\u0103ng d\u1ea7n l\u00ean t\u1edbi 200\u2013 400 \u00b5g\/ph\u00fat n\u1ebfu c\u1ea7n \u0111\u1ec3 gi\u1ea3m tri\u1ec7u ch\u1ee9ng v\u00e0 c\u1ea3i thi\u1ec7n c\u00e1c th\u00f4ng s\u1ed1 huy\u1ebft \u0111\u1ed9ng. M\u1eb7c d\u00f9 thu\u1ed1c ch\u01b0a \u0111\u01b0\u1ee3c <a href=\"https:\/\/www.fda.gov\/\">FDA<\/a> ch\u1ea5p thu\u1eadn trong \u0111i\u1ec1u tr\u1ecb suy tim nh\u01b0ng \u0111\u00e3 v\u1eabn \u0111\u01b0\u1ee3c d\u00f9ng r\u1ed9ng r\u00e3i trong \u0111i\u1ec1u tr\u1ecb suy tim t\u1eeb 20 n\u0103m qua.<\/p>\n<p>Nitroglycerin t\u00e1c d\u1ee5ng l\u00ean t\u0129nh m\u1ea1ch m\u1ea1nh h\u01a1n r\u1ea5t nhi\u1ec1u so v\u1edbi \u0111\u1ed9ng m\u1ea1ch \u1edf li\u1ec1u th\u00f4ng th\u01b0\u1eddng. Li\u1ec1u cao c\u1ee7a nitroglycerin c\u0169ng c\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n ti\u1ec3u \u0111\u1ed9ng m\u1ea1ch v\u00e0 c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m h\u1eadu g\u00e1nh. Do \u0111\u00f3, l\u00e0m t\u0103ng cung l\u01b0\u1ee3ng tim nh\u01b0ng huy\u1ebft \u00e1p v\u1eabn \u0111\u01b0\u1ee3c duy tr\u00ec, l\u00e0m gi\u1ea3m \u00e1p l\u1ef1c mao m\u1ea1ch ph\u1ed5i b\u00edt qua \u0111\u00f3 l\u00e0m gi\u1ea3m tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng.<\/p>\n<p>Hi\u1ec7n ch\u1ec9 c\u00f3 r\u1ea5t \u00edt d\u1eef li\u1ec7u v\u1ec1 t\u00e1c d\u1ee5ng c\u1ee7a nitroglycerin t\u0129nh m\u1ea1ch l\u00ean tu\u1ea7n ho\u00e0n v\u00e0nh \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n suy tim, l\u01b0u l\u01b0\u1ee3ng v\u00e0nh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n khi s\u1eed d\u1ee5ng thu\u1ed1c.<\/p>\n<h3>1.3. T\u00e1c d\u1ee5ng ph\u1ee5 hay g\u1eb7p c\u1ee7a nitroglycerin t\u0129nh m\u1ea1ch<\/h3>\n<ul>\n<li>\u0110au \u0111\u1ea7u: g\u1eb7p \u1edf kho\u1ea3ng 20% b\u1ec7nh nh\u00e2n, khi \u0111au \u0111\u1ea7u nhi\u1ec1u c\u00f3 th\u1ec3 ph\u1ea3i ng\u1eebng truy\u1ec1n. T\u1ee5t huy\u1ebft \u00e1p, bu\u1ed3n n\u00f4n v\u00e0 nh\u1ecbp ch\u1eadm th\u1ec9nh tho\u1ea3ng c\u0169ng x\u1ea3y ra (kho\u1ea3ng 10%).<\/li>\n<li>Kh\u00e1ng nitroglycerin: M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n t\u01b0\u01a1ng \u0111\u1ed1i \u0111\u1ec1 kh\u00e1ng v\u1edbi nitroglycerin t\u0129nh m\u1ea1ch v\u00e0 c\u00f3 th\u1ec3 c\u1ea7n li\u1ec1u r\u1ea5t l\u1edbn \u0111\u1ec3 t\u1ea1o \u0111\u01b0\u1ee3c \u1ea3nh h\u01b0\u1edfng l\u00ean huy\u1ebft \u0111\u1ed9ng. Nguy\u00ean nh\u00e2n v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c r\u00f5 r\u00e0ng; tuy nhi\u00ean kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng v\u1edbi li\u1ec1u v\u01b0\u1ee3t qu\u00e1 500\u00b5g\/ph\u00fat. T\u00ecnh tr\u1ea1ng kh\u00e1ng nitrate x\u1ea3y ra khi c\u00f3 \u0111\u00e1p \u1ee9ng m\u1ea1nh v\u1ec1 huy\u1ebft \u0111\u1ed9ng khi kh\u1edfi tr\u1ecb, sau m\u1ed7i 1-2h l\u1ea1i c\u1ea7n ph\u1ea3i t\u0103ng li\u1ec1u nitroglycerin t\u0129nh m\u1ea1ch \u0111\u1ec3 ti\u1ebfp t\u1ee5c ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c huy\u1ebft \u0111\u1ed9ng.<\/li>\n<\/ul>\n<h2><strong>2<\/strong><strong>. Nicorandil<\/strong><\/h2>\n<h3>2.1. Gi\u1edbi thi\u1ec7u chung<\/h3>\n<p>Nicorandil thu\u1ed9c nh\u00f3m thu\u1ed1c gi\u00e3n m\u1ea1ch, c\u00e1c h\u1ee3p ch\u1ea5t c\u00f3 t\u00e1c d\u1ee5ng k\u00edch ho\u1ea1t k\u00eanh kali n\u00ean c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m gi\u00e3n c\u00e1c \u0111\u1ed9ng m\u1ea1ch. Ngo\u00e0i ra, nicorandil c\u00f3 \u0111\u1eb7c t\u00ednh l\u00e0m gi\u00e3n h\u1ec7 th\u1ed1ng t\u0129nh m\u1ea1ch do trong c\u1ea5u tr\u00fac h\u00f3a h\u1ecdc c\u1ee7a thu\u1ed1c c\u00f3 ch\u1ee9a m\u1ed9t nh\u00f3m nitrate. Do \u0111\u00f3, b\u1eb1ng c\u00e1ch k\u1ebft h\u1ee3p hai c\u01a1 ch\u1ebf gi\u00e3n m\u1ea1ch n\u00e0y, nicorandil \u0111\u1ea1i di\u1ec7n cho m\u1ed9t lo\u1ea1i h\u1ee3p ch\u1ea5t m\u1edbi \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng \u0111i\u1ec1u tr\u1ecb c\u01a1n \u0111au th\u1eaft ng\u1ef1c v\u1edbi t\u00e1c d\u1ee5ng gi\u00e3n c\u1ea3 \u0111\u1ed9ng m\u1ea1ch v\u00e0 t\u0129nh m\u1ea1ch. H\u01a1n n\u1eefa, c\u00e1c b\u1eb1ng ch\u1ee9ng th\u1ef1c nghi\u1ec7m cho th\u1ea5y r\u1eb1ng k\u00edch ho\u1ea1t k\u00eanh kali c\u0169ng c\u00f3 th\u1ec3 t\u1ea1o ra hi\u1ec7u \u1ee9ng b\u1ea3o v\u1ec7 t\u1ebf b\u00e0o tr\u1ef1c ti\u1ebfp b\u1eb1ng c\u00e1ch t\u0103ng c\u01b0\u1eddng c\u00e1c qu\u00e1 tr\u00ecnh sinh l\u00fd b\u00ecnh th\u01b0\u1eddng gi\u00fap b\u1ea3o v\u1ec7 tim ch\u1ed1ng l\u1ea1i c\u00e1c \u1ea3nh h\u01b0\u1edfng c\u1ee7a thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9<\/p>\n<h3>2.2. D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc<\/h3>\n<p>\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh tim m\u1ea1ch, c\u00e1c hi\u1ec7u \u1ee9ng huy\u1ebft \u0111\u1ed9ng c\u1ee7a nicorandil \u0111\u01b0\u1ee3c cho l\u00e0 do c\u00e1c \u0111\u1eb7c t\u00ednh gi\u1ed1ng nh\u01b0 nitrate, bao g\u1ed3m s\u1ef1 gi\u00e3n c\u00e1c \u0111\u1ed9ng m\u1ea1ch v\u00e0nh (t\u1eeb 10 \u0111\u1ebfn 20%) v\u00e0 gi\u1ea3m t\u00e1c \u0111\u1ed9ng co m\u1ea1ch. Ngo\u00e0i ra, do k\u00edch ho\u1ea1t k\u00eanh kali, ti\u00eam t\u0129nh m\u1ea1ch nicorandil (2 mg; 0,1 ho\u1eb7c 0,2 mg\/kg) l\u00e0m gi\u1ea3m s\u1ee9c c\u1ea3n m\u1ea1ch v\u00e0nh (t\u1eeb 24 \u0111\u1ebfn 53%), d\u1eabn \u0111\u1ebfn t\u0103ng l\u01b0u l\u01b0\u1ee3ng m\u00e1u m\u1ea1ch v\u00e0nh (t\u1eeb 26 \u0111\u1ebfn 93%) khi ngh\u1ec9 ng\u01a1i.<\/p>\n<p>\u0110\u01b0\u1eddng u\u1ed1ng nicorandil li\u1ec1u 15 \u2013 40 mg gi\u00fap gi\u1ea3m t\u01b0\u01a1ng t\u1ef1 nh\u01b0ng kh\u00f4ng \u0111\u00e1ng k\u1ec3 v\u1ec1 s\u1ee9c c\u1ea3n m\u1ea1ch v\u00e0nh (t\u1eeb 10 \u0111\u1ebfn 32%) v\u00e0 t\u0103ng l\u01b0u l\u01b0\u1ee3ng m\u00e1u xoang v\u00e0nh (~ 32%) khi g\u1eafng s\u1ee9c \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb NMCT c\u0169. Khi ngh\u1ec9 ng\u01a1i, d\u00f9ng nicorandil ti\u00eam t\u0129nh m\u1ea1ch (2 \u0111\u1ebfn 8 mg; 0,1 ho\u1eb7c 0,2 mg\/kg) ho\u1eb7c khi u\u1ed1ng m\u1ed9t li\u1ec1u duy nh\u1ea5t (5 \u0111\u1ebfn 80mg) l\u00e0m gi\u1ea3m s\u1ee9c c\u1ea3n m\u1ea1ch m\u00e1u to\u00e0n th\u00e2n (t\u1eeb 5 \u0111\u1ebfn 36%) v\u00e0 \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch trung b\u00ecnh (t\u1eeb 5 \u0111\u1ebfn 24%), c\u0169ng nh\u01b0 gi\u1ea3m \u00e1p l\u1ef1c mao m\u1ea1ch ph\u1ed5i b\u00edt (t\u1eeb 14 \u0111\u1ebfn 45%) v\u00e0 \u00e1p l\u1ef1c cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng th\u1ea5t tr\u00e1i (t\u1eeb 10 \u0111\u1ebfn 143%). Gi\u00e3n m\u1ea1ch to\u00e0n th\u00e2n \u0111\u00f4i khi c\u00f3 li\u00ean quan \u0111\u1ebfn s\u1ef1 gia t\u0103ng tho\u00e1ng qua nh\u1ecbp tim khi ngh\u1ec9 \u0111\u1ebfn 18%, m\u1eb7c d\u00f9 \u0111i\u1ec1u n\u00e0y kh\u00f4ng \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y \u1edf b\u1ec7nh nh\u00e2n suy tim sung huy\u1ebft.<\/p>\n<p>Nicorandil \u0111\u1ea1t t\u00e1c d\u1ee5ng t\u1ed1i \u0111a trong v\u00f2ng 1 \u0111\u1ebfn 2 ph\u00fat sau ti\u00eam t\u0129nh m\u1ea1ch ho\u1eb7c 30 \u0111\u1ebfn 60 ph\u00fat sau m\u1ed9t li\u1ec1u u\u1ed1ng duy nh\u1ea5t (20 \u0111\u1ebfn 40 mg) v\u00e0 t\u1ed3n t\u1ea1i \u0111\u1ebfn 8h (40 \u0111\u1ebfn 60 mg).<\/p>\n<h3>2.3. Li\u1ec1u d\u00f9ng<\/h3>\n<p>Li\u1ec1u d\u00f9ng nicorandil n\u00ean \u0111\u01b0\u1ee3c c\u00e1 th\u1ec3 h\u00f3a nh\u1eb1m \u0111\u1ea1t hi\u1ec7u qu\u1ea3 gi\u1ea3m tri\u1ec7u ch\u1ee9ng \u0111au th\u1eaft ng\u1ef1c, \u0111\u1ed3ng th\u1eddi l\u00e0m gi\u1ea3m t\u00e1c d\u1ee5ng ph\u1ee5 gi\u00e3n m\u1ea1ch t\u1ed1i thi\u1ec3u nh\u01b0 \u0111au \u0111\u1ea7u (kho\u1ea3ng 5%) v\u00e0 h\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf.<\/p>\n<p>\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng \u0111au \u0111\u1ea7u khi s\u1eed d\u1ee5ng thu\u1ed1c, li\u1ec1u kh\u1edfi \u0111\u1ea7u th\u1ea5p h\u01a1n c\u1ee7a nicorandil 5 mg hai l\u1ea7n\/24h (ch\u1ec9 trong 2 ng\u00e0y) sau \u0111\u00f3 c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 m\u1eafc v\u00e0 m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a t\u00e1c d\u1ee5ng ph\u1ee5 nh\u01b0 \u0111au \u0111\u1ea7u.<\/p>\n<h2><strong>3.Isosorbide mononitrate<\/strong><\/h2>\n<h3>3.1. Gi\u1edbi thi\u1ec7u chung v\u00e0 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc<\/h3>\n<p>Isosorbide mononitrate (Imdur) l\u00e0 m\u1ed9t nitrate h\u1eefu c\u01a1 . Thu\u1ed1c l\u1ea7n \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c FDA ch\u1ea5p thu\u1eadn v\u00e0o n\u0103m 1991. Isosorbide mononitrate \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00f2ng ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u01a1n \u0111au th\u1eaft ng\u1ef1c do b\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9.<\/p>\n<p>Thu\u1ed1c \u0111\u01b0\u1ee3c coi l\u00e0 m\u1ed9t ch\u1ea5t ch\u1ed1ng \u0111au th\u1eaft ng\u1ef1c b\u1eb1ng c\u00e1ch gi\u00e3n c\u00e1c c\u01a1 tr\u01a1n c\u1ee7a c\u1ea3 \u0111\u1ed9ng m\u1ea1ch v\u00e0 t\u0129nh m\u1ea1ch nh\u01b0ng ch\u1ee7 y\u1ebfu l\u00e0 t\u0129nh m\u1ea1ch \u0111\u1ec3 gi\u1ea3m ti\u1ec1n g\u00e1nh. Isosorbide mononitrate l\u00e0 m\u1ed9t ch\u1ea5t chuy\u1ec3n h\u00f3a ho\u1ea1t \u0111\u1ed9ng c\u1ee7a isosorbide dinitrate v\u00e0 gi\u1ed1ng nh\u01b0 c\u00e1c nitrate h\u1eefu c\u01a1 kh\u00e1c, isosorbide mononitrate ho\u1ea1t \u0111\u1ed9ng nh\u01b0 m\u1ed9t ti\u1ec1n ch\u1ea5t cho ch\u1ea5t chuy\u1ec3n h\u00f3a th\u00e0nh d\u1ea1ng c\u00f3 t\u00e1c d\u1ee5ng, oxit nitric, l\u00e0m trung gian cho ho\u1ea1t \u0111\u1ed9ng tr\u1ecb li\u1ec7u c\u1ee7a isosorbide mononitrate. Isosorbide mononitrate c\u00f3 th\u1eddi gian t\u00e1c d\u1ee5ng d\u00e0i h\u01a1n so v\u1edbi nitroglycerin.<\/p>\n<p>\u1ede li\u1ec1u \u0111i\u1ec1u tr\u1ecb c\u1ee7a isosorbide mononitrate, oxit nitric c\u00f3 t\u00e1c d\u1ee5ng l\u1edbn h\u01a1n \u0111\u1ed1i v\u1edbi c\u00e1c \u0111\u1ed9ng m\u1ea1ch c\u01a1 l\u1edbn h\u01a1n l\u00e0 c\u00e1c \u0111\u1ed9ng m\u1ea1ch nh\u1ecf. G\u00e2y gi\u00e3n \u0111\u1ed9ng m\u1ea1ch d\u1eabn \u0111\u1ebfn gi\u1ea3m s\u1ee9c c\u1ea3n m\u1ea1ch m\u00e1u to\u00e0n th\u00e2n v\u00e0 huy\u1ebft \u00e1p t\u00e2m thu, d\u1eabn \u0111\u1ebfn gi\u1ea3m t\u1ea3i tim. T\u00e1c d\u1ee5ng cu\u1ed1i c\u00f9ng c\u1ee7a isosorbide mononitrate bao g\u1ed3m gi\u1ea3m ti\u00eau th\u1ee5 oxy c\u1ee7a tim, ph\u00e2n ph\u1ed1i l\u1ea1i l\u01b0u l\u01b0\u1ee3ng m\u1ea1ch v\u00e0nh \u0111\u1ebfn c\u00e1c v\u00f9ng thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 th\u00f4ng qua c\u00e1c tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 v\u00e0 gi\u1ea3m co th\u1eaft m\u1ea1ch v\u00e0nh. Oxit nitric c\u0169ng c\u00f3 th\u1ec3 l\u00e0m t\u0103ng t\u1ed1c \u0111\u1ed9 th\u01b0 gi\u00e3n c\u1ee7a c\u01a1 tim, \u0111\u00f3 l\u00e0 m\u1ed9t t\u00e1c d\u1ee5ng b\u00ean ngo\u00e0i t\u00e1c \u0111\u1ed9ng c\u01a1 tr\u01a1n m\u1ea1ch m\u00e1u. Nitrate h\u1eefu c\u01a1 c\u0169ng c\u00f3 th\u1ec3 l\u00e0m gi\u00e3n c\u00e1c lo\u1ea1i c\u01a1 tr\u01a1n kh\u00e1c, bao g\u1ed3m c\u1ea3 c\u01a1 tr\u01a1n th\u1ef1c qu\u1ea3n v\u00e0 c\u01a1 tr\u00f2n. Ho\u1ea1t \u0111\u1ed9ng ch\u1ed1ng \u0111au th\u1eaft ng\u1ef1c c\u1ee7a isosorbide mononitrate \u0111\u00e3 \u0111\u01b0\u1ee3c quan s\u00e1t kho\u1ea3ng 1h sau khi d\u00f9ng thu\u1ed1c v\u00e0 hi\u1ec7u qu\u1ea3 cao nh\u1ea5t \u0111\u1ea1t \u0111\u01b0\u1ee3c t\u1eeb 1 \u2013 4h sau khi d\u00f9ng thu\u1ed1c.<\/p>\n<h3>3.2. Li\u1ec1u d\u00f9ng<\/h3>\n<p>D\u1ea1ng gi\u1ea3i ph\u00f3ng nhanh: S\u1eed d\u1ee5ng li\u1ec1u 5-10 mg hai l\u1ea7n\/24h ban \u0111\u1ea7u (5 mg \u1edf b\u1ec7nh nh\u00e2n nh\u1eb9 c\u00e2n) m\u1ed7i li\u1ec1u c\u00e1ch nhau 7h; t\u0103ng l\u00ean 10 mg m\u1ed7i 12h v\u00e0o ng\u00e0y th\u1ee9 2 ho\u1eb7c 3; duy tr\u00ec: 20 mg m\u1ed7i 12h.<\/p>\n<p>D\u1ea1ng t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i: S\u1eed d\u1ee5ng li\u1ec1u 30-60 mg\/24h m\u1ed9t l\u1ea7n v\u00e0o bu\u1ed5i s\u00e1ng; c\u00f3 th\u1ec3 t\u0103ng l\u00ean 120 mg\/24h m\u1ed9t l\u1ea7n; ch\u1edd \u00edt nh\u1ea5t 3 ng\u00e0y gi\u1eefa c\u00e1c l\u1ea7n t\u0103ng li\u1ec1u, li\u1ec1u t\u1ed1i \u0111a c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng 240 mg\/24h.<\/p>\n<h2><strong>4.Sildenafil<\/strong><\/h2>\n<h3>4.1. Gi\u1edbi thi\u1ec7u chung v\u00e0 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc<\/h3>\n<p>Phosphodiesterase l\u00e0 c\u00e1c enzym th\u1ee7y ph\u00e2n c\u00e1c nucleotide v\u00f2ng \u2013 cGMP v\u00e0 adenosine monophosphate v\u00f2ng \u2013 cAMP. \u00cdt nh\u1ea5t \u0111\u00e3 c\u00f3 11 h\u1ecd isoenzym c\u1ee7a phosphodiesterase \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh. Trong \u0111\u00f3 nh\u00f3m 5-phosphodiesterase (5-PDE) gi\u00e1ng h\u00f3a cGMP th\u00f4ng qua qu\u00e1 tr\u00ecnh th\u1ee7y ph\u00e2n, nh\u1edd \u0111\u00f3 \u1ea3nh h\u01b0\u1edfng t\u1edbi kh\u1ea3 n\u0103ng thay \u0111\u1ed5i tr\u01b0\u01a1ng l\u1ef1c c\u01a1 tr\u01a1n m\u1ea1ch m\u00e1u c\u1ee7a cGMP \u0111\u1eb7c bi\u1ec7t l\u00e0 v\u1edbi h\u1ec7 t\u0129nh m\u1ea1ch c\u1ee7a th\u1ec3 hang d\u01b0\u01a1ng v\u1eadt v\u00e0 h\u1ec7 m\u1ea1ch m\u00e1u ph\u1ed5i. Vi\u1ec7c ph\u00e1t hi\u1ec7n ra sildenafil, m\u1ed9t thu\u1ed1c \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc cao v\u1edbi 5-PDE ban \u0111\u1ea7u l\u00e0 v\u00ec m\u1ee5c ti\u00eau t\u00ecm ra m\u1ed9t li\u1ec7u ph\u00e1p m\u1edbi trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.<\/p>\n<p>Nitric oxide ho\u1ea1t h\u00f3a guanylate cyclase, t\u1eeb \u0111\u00f3 k\u00edch ho\u1ea1t qu\u00e1 tr\u00ecnh t\u1ed5ng h\u1ee3p cGMP. 5-PDE th\u00f4ng th\u01b0\u1eddng s\u1ebd th\u1ee7y ph\u00e2n cGMP. Sildenafil \u1ee9c ch\u1ebf 5-PDE, d\u1eabn t\u1edbi l\u00e0m t\u0103ng cGMP v\u00e0 g\u00e2y t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch.Cho \u0111\u1ebfn hi\u1ec7n nay v\u1eabn ch\u01b0a r\u00f5 t\u1ea1i sao t\u1ebf b\u00e0o c\u01a1 tim b\u00ecnh th\u01b0\u1eddng kh\u00f4ng xu\u1ea5t hi\u1ec7n 5-PDE nh\u01b0ng nh\u1eefng t\u1ebf b\u00e0o c\u01a1 ph\u00ec \u0111\u1ea1i ho\u1eb7c b\u1ecb suy l\u1ea1i ch\u1ee9a ch\u1ea5t n\u00e0y v\u00e0 t\u1ea1i sao thu\u1ed1c \u1ee9c ch\u1ebf 5-PDE \u0111em l\u1ea1i l\u1ee3i \u00edch l\u00e2m s\u00e0ng cho b\u1ec7nh nh\u00e2n t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, ph\u00ec \u0111\u1ea1i th\u1ea5t ph\u1ea3i ho\u1eb7c suy th\u1ea5t ph\u1ea3i.<\/p>\n<p>Sildenafil l\u00e0 thu\u1ed1c\u00a0 \u1ee9c ch\u1ebf 5-PDE \u0111\u01b0\u1eddng u\u1ed1ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh d\u00f9ng cho b\u1ec7nh nh\u00e2n t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i thu\u1ed9c nh\u00f3m I theo WHO v\u00e0 c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng t\u1eeb m\u1ee9c \u0111\u1ed9 v\u1eeba t\u1edbi n\u1eb7ng. C\u00e1c d\u1eef li\u1ec7u cho th\u1ea5y s\u1eed d\u1ee5ng sildenafill an to\u00e0n v\u00e0 \u0111em l\u1ea1i l\u1ee3i \u00edch \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u00f3 ho\u1eb7c kh\u00f4ng k\u00e8m theo suy th\u1ea5t tr\u00e1i. Tuy nhi\u00ean, thu\u1ed1c kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng \u1edf b\u1ec7nh nh\u00e2n &lt; 18 tu\u1ed5i do ch\u01b0a c\u00f3 c\u00e1c b\u1eb1ng ch\u1ee9ng v\u1ec1 hi\u1ec7u qu\u1ea3 v\u00e0 t\u00e1c d\u1ee5ng ph\u1ee5 \u1edf tr\u1ebb em.<\/p>\n<p>Thu\u1ed1c \u0111\u01b0\u1ee3c \u0111\u00e0o th\u1ea3i ch\u1ee7 y\u1ebfu qua gan, tuy nhi\u00ean thu\u1ed1c kh\u00f4ng c\u1ea7n ch\u1ec9nh li\u1ec1u \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n suy gan m\u1ee9c \u0111\u1ed9 nh\u1eb9 \u2013 v\u1eeba.<\/p>\n<h3>4.2. Li\u1ec1u l\u01b0\u1ee3ng v\u00e0 t\u00e1c d\u1ee5ng ph\u1ee5<\/h3>\n<p>Li\u1ec1u sildenafil khuy\u1ebfn c\u00e1o l\u00e0 20mg d\u00f9ng 3 l\u1ea7n\/24h, nh\u1eb1m \u0111i\u1ec1u tr\u1ecb t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i. C\u00e1c r\u1ed1i lo\u1ea1n v\u1ec1 th\u1ecb gi\u00e1c, th\u00ednh gi\u00e1c v\u00e0 r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng d\u01b0\u01a1ng c\u00f3 th\u1ec3 g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng nh\u00f3m thu\u1ed1c n\u00e0y. Kh\u00f4ng c\u00f3 gi\u1ea3i \u0111\u1ed9c \u0111\u1eb7c hi\u1ec7u cho thu\u1ed1c nh\u00f3m \u1ee9c ch\u1ebf 5-PDE trong tr\u01b0\u1eddng h\u1ee3p s\u1eed d\u1ee5ng qu\u00e1 li\u1ec1u ho\u1eb7c t\u00ecnh tr\u1ea1ng t\u1ee5t huy\u1ebft \u00e1p. T\u00e1c d\u1ee5ng ph\u1ee5 g\u1eb7p nhi\u1ec1u h\u01a1n khi d\u00f9ng chung v\u1edbi c\u00e1c nitrate ho\u1eb7c c\u00e1c thu\u1ed1c gi\u00e3n m\u1ea1ch kh\u00e1c.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Thu\u1ed1c gi\u00e3n m\u1ea1ch l\u00e0 lo\u1ea1i thu\u1ed1c th\u01b0\u1eddng g\u1eb7p trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. C\u00e1c lo\u1ea1i thu\u1ed1c \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp trong b\u00e0i vi\u1ebft bao g\u1ed3m: Nitroglycerin,Nicorndin&#8230; s\u1ebd c\u00f3 trong b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y. 1.Nitroglycerin 1.1. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng v\u00e0 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a nitroglycerin Nitroglycerine l\u00e0 thu\u1ed1c thu\u1ed9c nh\u00f3m thu\u1ed1c gi\u00e3n m\u1ea1ch, c\u00f3 nitrat h\u1eefu [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":22550,"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>Thu\u1ed1c gi\u00e3n m\u1ea1ch \u01b0u ti\u00ean d\u00e3n t\u0129nh m\u1ea1ch trong \u0111i\u1ec1u tr\u1ecb<\/title>\n<meta name=\"description\" content=\"Thu\u1ed1c gi\u00e3n m\u1ea1ch \u01b0u ti\u00ean d\u00e3n t\u0129nh m\u1ea1ch trong \u0111i\u1ec1u tr\u1ecb s\u1ebd \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp cu th\u1ec3 trong b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y, bao g\u1ed3m: Nitroglycerin, Sidenafil....\" \/>\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=\"Thu\u1ed1c gi\u00e3n m\u1ea1ch \u01b0u ti\u00ean d\u00e3n t\u0129nh m\u1ea1ch trong \u0111i\u1ec1u tr\u1ecb\" \/>\n<meta property=\"og:description\" content=\"Thu\u1ed1c gi\u00e3n m\u1ea1ch \u01b0u ti\u00ean d\u00e3n t\u0129nh m\u1ea1ch trong \u0111i\u1ec1u tr\u1ecb s\u1ebd \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp cu th\u1ec3 trong b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y, bao g\u1ed3m: Nitroglycerin, Sidenafil....\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/thuoc-gian-mach-uu-tien-dan-tinh-mach-trong-dieu-tri\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-18T04:31:15+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-04-18T05:29:52+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/A310120_1_En_16_Fig6_HTML.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"368\" \/>\n\t<meta property=\"og:image:height\" content=\"293\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"9 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/thuoc-gian-mach-uu-tien-dan-tinh-mach-trong-dieu-tri\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/thuoc-gian-mach-uu-tien-dan-tinh-mach-trong-dieu-tri\/\",\"name\":\"Thu\u1ed1c gi\u00e3n m\u1ea1ch \u01b0u ti\u00ean d\u00e3n t\u0129nh m\u1ea1ch trong \u0111i\u1ec1u tr\u1ecb\",\"isPartOf\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-04-18T04:31:15+00:00\",\"dateModified\":\"2023-04-18T05:29:52+00:00\",\"author\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/dded5c0d4cb1bb77d05cf29ab5f85629\"},\"description\":\"Thu\u1ed1c gi\u00e3n m\u1ea1ch \u01b0u ti\u00ean d\u00e3n t\u0129nh m\u1ea1ch trong \u0111i\u1ec1u tr\u1ecb s\u1ebd \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp cu th\u1ec3 trong b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y, bao g\u1ed3m: Nitroglycerin, Sidenafil....\",\"breadcrumb\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/thuoc-gian-mach-uu-tien-dan-tinh-mach-trong-dieu-tri\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/thuoc-gian-mach-uu-tien-dan-tinh-mach-trong-dieu-tri\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/thuoc-gian-mach-uu-tien-dan-tinh-mach-trong-dieu-tri\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"http:\/\/noithathoaphat.in\/ctv\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Thu\u1ed1c gi\u00e3n m\u1ea1ch \u01b0u ti\u00ean gi\u00e3n t\u0129nh m\u1ea1ch trong \u0111i\u1ec1u tr\u1ecb\"}]},{\"@type\":\"WebSite\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/\",\"name\":\"Vinmec\",\"description\":\"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"http:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/dded5c0d4cb1bb77d05cf29ab5f85629\",\"name\":\"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/\",\"url\":\"http:\/\/2.gravatar.com\/avatar\/50f51f67852bc7e49c0b8b60a1fefe3e?s=96&d=mm&r=g\",\"contentUrl\":\"http:\/\/2.gravatar.com\/avatar\/50f51f67852bc7e49c0b8b60a1fefe3e?s=96&d=mm&r=g\",\"caption\":\"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i\"},\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/viettai304-304gmail-com\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Thu\u1ed1c gi\u00e3n m\u1ea1ch \u01b0u ti\u00ean d\u00e3n t\u0129nh m\u1ea1ch trong \u0111i\u1ec1u tr\u1ecb","description":"Thu\u1ed1c gi\u00e3n m\u1ea1ch \u01b0u ti\u00ean d\u00e3n t\u0129nh m\u1ea1ch trong \u0111i\u1ec1u tr\u1ecb s\u1ebd \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp cu th\u1ec3 trong b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y, bao g\u1ed3m: Nitroglycerin, Sidenafil....","robots":{"index":"noindex","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"og_locale":"en_US","og_type":"article","og_title":"Thu\u1ed1c gi\u00e3n m\u1ea1ch \u01b0u ti\u00ean d\u00e3n t\u0129nh m\u1ea1ch trong \u0111i\u1ec1u tr\u1ecb","og_description":"Thu\u1ed1c gi\u00e3n m\u1ea1ch \u01b0u ti\u00ean d\u00e3n t\u0129nh m\u1ea1ch trong \u0111i\u1ec1u tr\u1ecb s\u1ebd \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp cu th\u1ec3 trong b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y, bao g\u1ed3m: Nitroglycerin, Sidenafil....","og_url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/thuoc-gian-mach-uu-tien-dan-tinh-mach-trong-dieu-tri\/","og_site_name":"Vinmec","article_published_time":"2023-04-18T04:31:15+00:00","article_modified_time":"2023-04-18T05:29:52+00:00","og_image":[{"width":368,"height":293,"url":"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/A310120_1_En_16_Fig6_HTML.jpg","type":"image\/jpeg"}],"author":"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i","twitter_card":"summary_large_image","twitter_misc":{"Written by":"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i","Est. reading time":"9 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/thuoc-gian-mach-uu-tien-dan-tinh-mach-trong-dieu-tri\/","url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/thuoc-gian-mach-uu-tien-dan-tinh-mach-trong-dieu-tri\/","name":"Thu\u1ed1c gi\u00e3n m\u1ea1ch \u01b0u ti\u00ean d\u00e3n t\u0129nh m\u1ea1ch trong \u0111i\u1ec1u tr\u1ecb","isPartOf":{"@id":"http:\/\/noithathoaphat.in\/ctv\/#website"},"datePublished":"2023-04-18T04:31:15+00:00","dateModified":"2023-04-18T05:29:52+00:00","author":{"@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/dded5c0d4cb1bb77d05cf29ab5f85629"},"description":"Thu\u1ed1c gi\u00e3n m\u1ea1ch \u01b0u ti\u00ean d\u00e3n t\u0129nh m\u1ea1ch trong \u0111i\u1ec1u tr\u1ecb s\u1ebd \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp cu th\u1ec3 trong b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y, bao g\u1ed3m: Nitroglycerin, Sidenafil....","breadcrumb":{"@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/thuoc-gian-mach-uu-tien-dan-tinh-mach-trong-dieu-tri\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/thuoc-gian-mach-uu-tien-dan-tinh-mach-trong-dieu-tri\/"]}]},{"@type":"BreadcrumbList","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/thuoc-gian-mach-uu-tien-dan-tinh-mach-trong-dieu-tri\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"http:\/\/noithathoaphat.in\/ctv\/"},{"@type":"ListItem","position":2,"name":"Thu\u1ed1c gi\u00e3n m\u1ea1ch \u01b0u ti\u00ean gi\u00e3n t\u0129nh m\u1ea1ch trong \u0111i\u1ec1u tr\u1ecb"}]},{"@type":"WebSite","@id":"http:\/\/noithathoaphat.in\/ctv\/#website","url":"http:\/\/noithathoaphat.in\/ctv\/","name":"Vinmec","description":"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"http:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/dded5c0d4cb1bb77d05cf29ab5f85629","name":"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/","url":"http:\/\/2.gravatar.com\/avatar\/50f51f67852bc7e49c0b8b60a1fefe3e?s=96&d=mm&r=g","contentUrl":"http:\/\/2.gravatar.com\/avatar\/50f51f67852bc7e49c0b8b60a1fefe3e?s=96&d=mm&r=g","caption":"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i"},"url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/viettai304-304gmail-com\/"}]}},"_links":{"self":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/22545"}],"collection":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/comments?post=22545"}],"version-history":[{"count":5,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/22545\/revisions"}],"predecessor-version":[{"id":24023,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/22545\/revisions\/24023"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/media\/22550"}],"wp:attachment":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/media?parent=22545"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/categories?post=22545"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/tags?post=22545"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}