{"id":22605,"date":"2023-04-17T07:56:06","date_gmt":"2023-04-17T00:56:06","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22605"},"modified":"2023-04-17T11:00:21","modified_gmt":"2023-04-17T04:00:21","slug":"dieu-tri-dau-nguc-trong-benh-ly-tim-mach","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/dieu-tri-dau-nguc-trong-benh-ly-tim-mach\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb \u0111au ng\u1ef1c trong b\u1ec7nh l\u00fd tim m\u1ea1ch"},"content":{"rendered":"

\u00a0\u0110i\u1ec1u tr\u1ecb \u0111au ng\u1ef1c l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p v\u00e0\u00a0 thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 gi\u1ea3m \u0111au v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng li\u00ean quan \u0111\u1ebfn b\u1ec7nh tim ho\u1ea1t \u0111\u1ed9ng b\u1eb1ng c\u00e1ch l\u00e0m gi\u1ea3m s\u1ef1 co th\u1eaft c\u1ee7a c\u00e1c \u0111\u1ed9ng m\u1ea1ch v\u00e0 t\u0103ng l\u01b0u l\u01b0\u1ee3ng m\u00e1u \u0111\u1ebfn tim.<\/strong><\/p>\n

1.Trimetazidine<\/strong><\/h2>\n

1.1. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng<\/h3>\n

Trimetazidine l\u00e0 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111au ng\u1ef1c t\u00e1c d\u1ee5ng c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng\u00a0 th\u00f4ng qua \u0111i\u1ec1u ch\u1ec9nh chuy\u1ec3n ho\u00e1 n\u0103ng l\u01b0\u1ee3ng c\u01a1 tim l\u00e0m gi\u1ea3m nhu c\u1ea7u oxy c\u01a1 tim. Trimetazidine \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn l\u00e0 ch\u1ea5t \u1ee9c ch\u1ebf pFOX v\u00ec \u1ee9c ch\u1ebf m\u1ed9t ph\u1ea7n qu\u00e1 tr\u00ecnh oxy h\u00f3a acid b\u00e9o trong c\u01a1 tim. Trong thi\u1ebfu m\u00e1u c\u01a1 tim, acid b\u00e9o chuy\u1ec3n h\u00f3a d\u1ea1ng oxy ho\u00e1, nhu c\u1ea7u oxy cho m\u1ed7i \u0111\u01a1n v\u1ecb ATP sinh ra t\u0103ng l\u00ean. Trimetazidine \u1ee9c ch\u1ebf m\u1ed9t ph\u1ea7n enzym c\u1ea7n thi\u1ebft cho qu\u00e1 tr\u00ecnh oxy h\u00f3a acid b\u00e9o (3-ketoacyl-CoA thiolase hay LC-3KAT), ng\u0103n c\u1ea3n s\u1ef1 gi\u1ea3m m\u1ee9c ATP n\u1ed9i b\u00e0o, b\u1ea3o t\u1ed3n m\u1ee9c n\u0103ng l\u01b0\u1ee3ng phosphate cao n\u1ed9i b\u00e0o trong t\u1ebf b\u00e0o c\u01a1 tim, do \u0111\u00f3 \u0111\u1ea3m b\u1ea3o ch\u1ee9c n\u0103ng h\u1ee3p l\u00fd c\u1ee7a b\u01a1m ion v\u00e0 k\u00eanh Na+\/K+ xuy\u00ean m\u00e0ng trong khi v\u1eabn duy tr\u00ec c\u00e2n b\u1eb1ng n\u1ed9i m\u00f4 t\u1ebf b\u00e0o, c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng chuy\u1ec3n ho\u00e1 c\u1ee7a m\u00f4 c\u01a1 tim.<\/p>\n

Ranolazine l\u00e0 ch\u1ea5t \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn trong nh\u00f3m n\u00e0y nh\u01b0ng t\u00e1c d\u1ee5ng n\u00e0y l\u1ea1i b\u1ecb m\u1ea5t trong l\u00e2m s\u00e0ng. Trimetazidine \u1ee9c ch\u1ebf LC-3KAT \u1edf \u0111\u1ed9 t\u1eadp trung \u0111\u1ea1t \u0111\u01b0\u1ee3c v\u00e0 ch\u1ee9ng minh c\u00f3 hi\u1ec7u qu\u1ea3 trong \u0111au th\u1eaft ng\u1ef1c \u1ed5n \u0111\u1ecbnh, b\u00ean c\u1ea1nh \u0111\u00f3 thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng ch\u1ed1ng thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 t\u1ed1t nh\u01b0ng kh\u00f4ng l\u00e0m \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn huy\u1ebft \u0111\u1ed9ng.<\/p>\n

Trimetazidine \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh hi\u1ec7u qu\u1ea3 v\u00e0 t\u00ednh an to\u00e0n qua c\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng. Hi\u1ec7u qu\u1ea3 c\u1ee7a trimetazidine th\u1ec3 hi\u1ec7n tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n t\u00ednh, k\u1ec3 c\u1ea3 khi d\u00f9ng \u0111\u01a1n \u0111\u1ed9c ho\u1eb7c khi ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c nh\u00f3m thu\u1ed1c ch\u1ed1ng \u0111au th\u1eaft ng\u1ef1c kh\u00e1c, ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 l\u00e0 gi\u1ea3m tri\u1ec7u ch\u1ee9ng \u0111au ng\u1ef1c v\u00e0 t\u0103ng kh\u1ea3 n\u0103ng g\u1eafng s\u1ee9c..<\/p>\n

V\u1edbi \u01b0u \u0111i\u1ec3m kh\u00f4ng \u1ea3nh h\u01b0\u1edfng t\u1edbi huy\u1ebft \u0111\u1ed9ng, thu\u1ed1c \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb gi\u1ea3m tri\u1ec7u ch\u1ee9ng \u0111au ng\u1ef1c trong h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n t\u00ednh c\u1ee7a ESC 2019: Thu\u1ed1c \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh nh\u01b0 li\u1ec7u ph\u00e1p th\u1ee9 ph\u00e1t \u0111\u1ec3 gi\u1ea3m t\u1ea7n su\u1ea5t \u0111au ng\u1ef1c v\u00e0 t\u0103ng dung n\u1ea1p g\u1eafng s\u1ee9c \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng dung n\u1ea1p ho\u1eb7c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh ho\u1eb7c tri\u1ec7u ch\u1ee9ng kh\u00f4ng c\u1ea3i thi\u1ec7n khi d\u00f9ng ch\u1eb9n beta giao c\u1ea3m, ch\u1eb9n k\u00eanh canxi v\u00e0 nitrates t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i (Ch\u1ec9 \u0111\u1ecbnh lo\u1ea1i IIa \u2013 B); thu\u1ed1c c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc l\u1ef1a ch\u1ecdn \u0111\u1ea7u ti\u00ean \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb \u1edf b\u1ec7nh nh\u00e2n nh\u1ecbp ch\u1eadm ng\u01b0\u1ee1ng ranh gi\u1edbi v\u00e0 huy\u1ebft \u00e1p th\u1ea5p \u0111\u1ec3 gi\u1ea3m t\u1ea7n su\u1ea5t \u0111au ng\u1ef1c v\u00e0 t\u0103ng dung n\u1ea1p g\u1eafng s\u1ee9c (Ch\u1ec9 \u0111\u1ecbnh lo\u1ea1i IIb \u2013 C); \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n, li\u1ec7u ph\u00e1p ph\u1ed1i h\u1ee3p gi\u1eefa m\u1ed9t thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m ho\u1eb7c m\u1ed9t thu\u1ed1c ch\u1eb9n k\u00eanh canxi v\u1edbi trimetazidine c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn tu\u1ef3 thu\u1ed9c v\u00e0o nh\u1ecbp tim, huy\u1ebft \u00e1p v\u00e0 m\u1ee9c \u0111\u1ed9 dung n\u1ea1p (Ch\u1ec9 \u0111\u1ecbnh lo\u1ea1i IIb \u2013 B).<\/p>\n

1.2. Ch\u1ec9 \u0111\u1ecbnh v\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/h3>\n
    \n
  • Ch\u1ec9 \u0111\u1ecbnh: Ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng \u0111au th\u1eaft ng\u1ef1c \u1edf b\u1ec7nh nh\u00e2n c\u00f3 h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n.<\/li>\n
  • Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh: B\u1ec7nh Parkinson, c\u00f3 tri\u1ec7u ch\u1ee9ng Parkinson, run, h\u1ed9i ch\u1ee9ng ch\u00e2n kh\u00f4ng ngh\u1ec9 v\u00e0 c\u00e1c r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng c\u00f3 li\u00ean quan kh\u00e1c (run c\u01a1, c\u1ee9ng c\u01a1\u2026).Suy th\u1eadn n\u1eb7ng v\u1edbi MLCT < 30 mL\/ph\u00fat. M\u1eabn c\u1ea3m v\u1edbi trimetazidine.<\/li>\n<\/ul>\n

    1.3. Li\u1ec1u d\u00f9ng v\u00e0 theo d\u00f5i<\/h3>\n
      \n
    • Li\u1ec1u: Trimetazidine MR 35 mg x 2 l\u1ea7n\/24h, u\u1ed1ng trong b\u1eefa \u0103n.<\/li>\n
    • B\u1ec7nh nh\u00e2n suy th\u1eadn m\u1ee9c \u0111\u1ed9 trung b\u00ecnh (MLCT 30 \u2013 60 mL\/ph\u00fat): gi\u1ea3m li\u1ec1u c\u00f2n Trimetazidine MR 35 mg x 1 l\u1ea7n\/24h, u\u1ed1ng trong b\u1eefa \u0103n s\u00e1ng.<\/li>\n
    • Theo d\u00f5i c\u00e1c bi\u1ec3u hi\u1ec7n m\u1eabn c\u1ea3m.<\/li>\n<\/ul>\n

      2.Nicorandil<\/strong><\/h2>\n

      2.1. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng<\/h3>\n

      Nicorandil l\u00e0 m\u1ed9t ch\u1ea5t ho\u1ea1t h\u00f3a k\u00eanh kali, b\u1ea3n ch\u1ea5t l\u00e0 m\u1ed9t d\u1eabn xu\u1ea5t nitrat c\u1ee7a nicotinamide, c\u01a1 ch\u1ebf ho\u1ea1t \u0111\u1ed9ng gi\u1ed1ng v\u1edbi nitrat. Nicorandil t\u00e1c d\u1ee5ng th\u00f4ng qua l\u00e0m m\u1edf k\u00eanh kali d\u1eabn t\u1edbi gi\u00e3n \u0111\u1ed9ng m\u1ea1ch v\u00e0 l\u00e0m gi\u1ea3m h\u1eadu g\u00e1nh c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

      2.2. Ch\u1ec9 \u0111\u1ecbnh v\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/h3>\n
        \n
      • Ch\u1ec9 \u0111\u1ecbnh: D\u00f9ng ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c (ch\u1eb9n beta giao c\u1ea3m\u2026) \u0111\u1ec3 ph\u00f2ng ng\u1eeba c\u01a1n \u0111au th\u1eaft ng\u1ef1c.<\/li>\n
      • Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh: S\u1ed1c tim; suy ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i v\u1edbi \u00e1p l\u1ef1c \u0111\u1ed5 \u0111\u1ea7y th\u1ea5p v\u00e0 h\u1ea1 huy\u1ebft \u00e1p; b\u1ec7nh nh\u00e2n m\u1eabn c\u1ea3m v\u1edbi nicorandil; ph\u1ee5 n\u1eef c\u00f3 thai ho\u1eb7c \u0111ang cho con b\u00fa.<\/li>\n
      • Th\u1eadn tr\u1ecdng s\u1eed d\u1ee5ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n thi\u1ebfu m\u00e1u n\u1eb7ng, huy\u1ebft \u00e1p t\u00e2m thu th\u1ea5p, ph\u00f9 ph\u1ed5i c\u1ea5p, nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p c\u00f3 suy ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i c\u1ea5p, \u00e1p l\u1ef1c \u0111\u1ed5 \u0111\u1ea7y th\u1ea5t tr\u00e1i th\u1ea5p. Th\u1eadn tr\u1ecdng s\u1eed d\u1ee5ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n l\u00e1i xe ho\u1eb7c v\u1eadn h\u00e0nh m\u00e1y m\u00f3c.<\/li>\n<\/ul>\n

        2.3. Li\u1ec1u d\u00f9ng v\u00e0 theo d\u00f5i<\/h3>\n
          \n
        • Khuy\u1ebfn c\u00e1o li\u1ec1u 10 mg x 2 l\u1ea7n\/24h. C\u00f3 th\u1ec3 t\u0103ng d\u1ea7n li\u1ec1u theo \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng, li\u1ec1u t\u1ed1i \u0111a 30 mg x 2 l\u1ea7n\/24h.<\/li>\n
        • Gi\u1ea3m li\u1ec1u xu\u1ed1ng 5 mg x 2 l\u1ea7n\/24h n\u1ebfu b\u1ec7nh nh\u00e2n xu\u1ea5t hi\u1ec7n t\u00e1c d\u1ee5ng ph\u1ee5 \u0111au \u0111\u1ea7u. Theo d\u00f5i: Theo d\u00f5i huy\u1ebft \u00e1p trong th\u1eddi gian s\u1eed d\u1ee5ng thu\u1ed1c.<\/li>\n
        • Hay g\u1eb7p t\u00e1c d\u1ee5ng ph\u1ee5 \u0111au \u0111\u1ea7u, \u0111\u1eb7c bi\u1ec7t \u1edf b\u1ec7nh nh\u00e2n m\u1edbi s\u1eed d\u1ee5ng thu\u1ed1c. C\u00f3 th\u1ec3 kh\u1edfi \u0111\u1ea7u v\u1edbi li\u1ec1u th\u1ea5p \u0111\u1ec3 gi\u1ea3m t\u00e1c d\u1ee5ng ph\u1ee5 n\u00e0y.<\/li>\n<\/ul>\n

          2.4. T\u01b0\u01a1ng t\u00e1c thu\u1ed1c<\/h3>\n
            \n
          • Thu\u1ed1c h\u1ea1 huy\u1ebft \u00e1p: Nicorandil l\u00e0m t\u0103ng t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c h\u1ea1 huy\u1ebft \u00e1p d\u00f9ng c\u00f9ng<\/li>\n
          • Glucocorticoid: khi d\u00f9ng c\u00f9ng nicorandil l\u00e0m t\u0103ng nguy c\u01a1 lo\u00e9t d\u1ea1 d\u00e0y, n\u00ean tr\u00e1nh d\u00f9ng c\u00f9ng nhau. Thu\u1ed1c \u1ee9c ch\u1ebf 5-phosphodiesterase (sildenafil, tadalafil, vardenafil): Nicorandil c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u1ee5t huy\u1ebft \u00e1p n\u1eb7ng, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh d\u00f9ng k\u1ebft h\u1ee3p, c\u1ea7n ng\u1eebng nicorandil \u00edt nh\u1ea5t 48h tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng nh\u00f3m thu\u1ed1c n\u00e0y.<\/li>\n<\/ul>\n

            3.Ivabradine<\/strong><\/h2>\n

            Thu\u1ed1c \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc k\u00eanh If c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 thu\u1ed1c l\u00e0m gi\u1ea3m nh\u1ecbp tim th\u00f4ng qua \u1ee9c ch\u1ebf ho\u1ea1t h\u00f3a t\u00e1i c\u1ef1c k\u00eanh natri \u1edf n\u00fat xoang.<\/p>\n

            3.1. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng<\/h3>\n
              \n
            • Ivabradine l\u00e0m gi\u1ea3m t\u1ea7n s\u1ed1 tim, do t\u00e1c \u0111\u1ed9ng \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc v\u00e0 \u0111\u1eb7c hi\u1ec7u k\u00eanh ion If \u2013 k\u00eanh ion n\u00e0y ki\u1ec3m so\u00e1t s\u1ef1 kh\u1eed c\u1ef1c t\u00e2m tr\u01b0\u01a1ng t\u1ef1 ph\u00e1t \u1edf n\u00fat xoang v\u00e0 \u0111i\u1ec1u h\u00f2a t\u1ea7n s\u1ed1 tim.<\/li>\n
            • T\u00e1c d\u1ee5ng tr\u00ean tim c\u1ee7a thu\u1ed1c l\u00e0 \u0111\u1eb7c hi\u1ec7u v\u1edbi n\u00fat xoang m\u00e0 kh\u00f4ng c\u00f3 \u1ea3nh h\u01b0\u1edfng t\u1edbi c\u00e1c th\u1eddi gian d\u1eabn truy\u1ec1n trong nh\u0129, nh\u0129 \u2013 th\u1ea5t, trong th\u1ea5t c\u0169ng nh\u01b0 kh\u00f4ng c\u00f3 \u1ea3nh h\u01b0\u1edfng t\u1edbi s\u1ef1 t\u00e1i c\u1ef1c th\u1ea5t ho\u1eb7c t\u1edbi s\u1ef1 co c\u01a1 tim.<\/li>\n
            • Th\u00f4ng th\u01b0\u1eddng ivabradine s\u1ebd l\u00e0m gi\u1ea3m kho\u1ea3ng 10 nh\u1ecbp khi ngh\u1ec9 v\u00e0 l\u00fac g\u1eafng s\u1ee9c. Vi\u1ec7c l\u00e0m gi\u1ea3m t\u1ea7n s\u1ed1 tim s\u1ebd l\u00e0m gi\u1ea3m c\u00f4ng c\u1ee7a tim v\u00e0 l\u00e0m gi\u1ea3m ti\u00eau th\u1ee5 oxy c\u01a1 tim.<\/li>\n
            • \u01afu \u0111i\u1ec3m c\u1ee7a thu\u1ed1c l\u00e0 kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng tr\u00ean d\u1ea1 d\u00e0y v\u00e0 c\u01a1 tr\u01a1n h\u00f4 h\u1ea5p.<\/li>\n<\/ul>\n

              3.2. Ch\u1ec9 \u0111\u1ecbnh<\/h3>\n
                \n
              • \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng \u1edf c\u00e1c b\u1ec7nh nh\u00e2n h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n kh\u00f4ng dung n\u1ea1p ho\u1eb7c c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi ch\u1eb9n beta giao c\u1ea3m.<\/li>\n
              • K\u1ebft h\u1ee3p ivabradine cho nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng, \u0111\u00e3 d\u00f9ng ch\u1eb9n beta giao c\u1ea3m li\u1ec1u t\u1ed1i \u01b0u m\u00e0 nh\u1ecbp tim \u226570 nh\u1ecbp\/ph\u00fat.<\/li>\n<\/ul>\n

                3.3. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/h3>\n
                  \n
                • Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh: H\u1ed9i ch\u1ee9ng suy n\u00fat xoang, nh\u1ecbp ch\u1eadm xoang, s\u1ed1c tim v\u00e0 nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p, trong th\u1eddi gian 4 tu\u1ea7n sau \u0111\u1ed9t qu\u1ef5 n\u00e3o, block xoang nh\u0129, block nh\u0129 th\u1ea5t c\u1ea5p III, h\u1ed9i ch\u1ee9ng QT d\u00e0i b\u1ea9m sinh, ng\u01b0\u1eddi ph\u1ee5 thu\u1ed9c m\u00e1y t\u1ea1o nh\u1ecbp, c\u00f3 thai v\u00e0 \u0111ang cho con b\u00fa.<\/li>\n
                • Th\u1eadn tr\u1ecdng: H\u1ed9i ch\u1ee9ng ti\u1ec1n k\u00edch th\u00edch, t\u1ea7n s\u1ed1 tim th\u1ea5p (<70 nh\u1ecbp\/ph\u00fat, sau t\u1ed5n th\u01b0\u01a1ng n\u00e3o, huy\u1ebft \u00e1p th\u1ea5p < 90\/50 mmHg, vi\u00eam v\u00f5ng m\u1ea1c, suy ch\u1ee9c n\u0103ng gan (tr\u00e1nh n\u1ebfu suy gan n\u1eb7ng), suy th\u1eadn n\u1eb7ng (MLCT < 15 mL\/ph\u00fat).<\/li>\n<\/ul>\n

                  3.4. Li\u1ec1u d\u00f9ng v\u00e0 theo d\u00f5i<\/h3>\n
                    \n
                  • Li\u1ec1u d\u00f9ng:<\/li>\n<\/ul>\n

                    Kh\u1edfi \u0111\u1ea7u: Th\u01b0\u1eddng d\u00f9ng kh\u1edfi \u0111\u1ea7u 5 mg \u00d7 2 l\u1ea7n\/24h.<\/p>\n

                    Sau 3-4 tu\u1ea7n c\u00f3 th\u1ec3 t\u0103ng l\u00ean 7,5 mg \u00d7 2 l\u1ea7n\/24h n\u1ebfu c\u1ea7n ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng h\u01a1n n\u1eefa. N\u1ebfu b\u1ec7nh nh\u00e2n cao tu\u1ed5i (tr\u00ean 75 tu\u1ed5i) ho\u1eb7c kh\u00f4ng dung n\u1ea1p v\u1edbi li\u1ec1u 5mg \u00d7 2 l\u1ea7n\/24h c\u00f3 th\u1ec3 gi\u1ea3m li\u1ec1u c\u00f2n 2,5 mg \u00d7 2 l\u1ea7n\/24h.<\/p>\n

                      \n
                    • Theo d\u00f5i khi \u0111i\u1ec1u tr\u1ecb:<\/li>\n<\/ul>\n

                      Ki\u1ec3m tra HA v\u00e0 nh\u1ecbp tim tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb v\u00e0 sau khi thay \u0111\u1ed5i li\u1ec1u.<\/p>\n

                      N\u1ebfu kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng ph\u1ee5 sau 4 tu\u1ea7n c\u00e2n nh\u1eafc t\u0103ng li\u1ec1u n\u1ebfu c\u1ea7n ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng h\u01a1n n\u1eefa.<\/p>\n

                      3.5. T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n<\/h3>\n
                        \n
                      • C\u00e1c r\u1ed1i lo\u1ea1n th\u1ecb gi\u00e1c: t\u00e1c d\u1ee5ng ph\u1ee5 hay g\u1eb7p nh\u1ea5t.<\/li>\n
                      • T\u00e1c d\u1ee5ng tr\u00ean \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n: nh\u1ecbp ch\u1eadm, block nh\u0129 th\u1ea5t \u0111\u1ed9 1, ngo\u1ea1i t\u00e2m thu th\u1ea5t c\u00f3 th\u1ec3 x\u1ea3y ra trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb. \u0110au \u0111\u1ea7u: x\u1ea3y ra trong giai \u0111o\u1ea1n \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb. Ch\u00f3ng m\u1eb7t: c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn nh\u1ecbp ch\u1eadm. R\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a: bu\u1ed3n n\u00f4n, n\u00f4n, ti\u00eau ch\u1ea3y.<\/li>\n<\/ul>\n

                         <\/p>\n","protected":false},"excerpt":{"rendered":"

                        \u00a0\u0110i\u1ec1u tr\u1ecb \u0111au ng\u1ef1c l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p v\u00e0\u00a0 thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 gi\u1ea3m \u0111au v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng li\u00ean quan \u0111\u1ebfn b\u1ec7nh tim ho\u1ea1t \u0111\u1ed9ng b\u1eb1ng c\u00e1ch l\u00e0m gi\u1ea3m s\u1ef1 co th\u1eaft c\u1ee7a c\u00e1c \u0111\u1ed9ng m\u1ea1ch v\u00e0 t\u0103ng l\u01b0u l\u01b0\u1ee3ng m\u00e1u \u0111\u1ebfn tim. 1.Trimetazidine 1.1. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng Trimetazidine l\u00e0 thu\u1ed1c […]<\/p>\n","protected":false},"author":7,"featured_media":22611,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[3],"yoast_head":"\n\u0110i\u1ec1u tr\u1ecb \u0111au ng\u1ef1c trong b\u1ec7nh l\u00fd tim m\u1ea1ch<\/title>\n<meta name=\"description\" content=\"Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111au ng\u1ef1c th\u01b0\u1eddng g\u1eb7p trong \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd tim m\u1ea1ch, tham kh\u1ea3o b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y \u0111\u1ec3 hi\u1ec3u h\u01a1n v\u1ec1 c\u00e1c lo\u1ea1i 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 property=\"og:title\" content=\"\u0110i\u1ec1u tr\u1ecb 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