{"id":22617,"date":"2023-04-17T07:54:31","date_gmt":"2023-04-17T00:54:31","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22617"},"modified":"2023-04-17T11:02:20","modified_gmt":"2023-04-17T04:02:20","slug":"thuoc-gian-mach-nhom-uu-tien-tren-dong-mach","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/thuoc-gian-mach-nhom-uu-tien-tren-dong-mach\/","title":{"rendered":"Thu\u1ed1c gi\u00e3n m\u1ea1ch nh\u00f3m \u01b0u ti\u00ean tr\u00ean \u0111\u1ed9ng m\u1ea1ch: c\u01a1 ch\u1ebf v\u00e0 ch\u1ec9 \u0111\u1ecbnh"},"content":{"rendered":"

Thu\u1ed1c gi\u00e3n m\u1ea1ch (vasodilator drugs) c\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n c\u01a1 tr\u01a1n th\u00e0nh m\u1ea1ch do \u0111\u00f3 l\u00e0m gi\u00e3n m\u1ea1ch m\u00e1u. Gi\u00e3n \u0111\u1ed9ng m\u1ea1ch l\u00e0m gi\u1ea3m s\u1ee9c c\u1ea3n h\u1ec7 th\u1ed1ng v\u00e0 gi\u1ea3m \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch. Gi\u00e3n t\u0129nh m\u1ea1ch l\u00e0m gi\u1ea3m \u00e1p l\u1ef1c m\u00e1u trong t\u0129nh m\u1ea1ch do \u0111\u00f3 gi\u1ea3m ti\u1ec1n g\u00e1nh c\u1ee7a tim.<\/strong><\/p>\n

1.Gi\u1edbi thi\u1ec7u chung<\/strong><\/h2>\n

Thu\u1ed1c gi\u00e3n m\u1ea1ch (vasodilator drugs) c\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n c\u01a1 tr\u01a1n th\u00e0nh m\u1ea1ch do \u0111\u00f3 l\u00e0m gi\u00e3n m\u1ea1ch m\u00e1u. Gi\u00e3n \u0111\u1ed9ng m\u1ea1ch l\u00e0m gi\u1ea3m s\u1ee9c c\u1ea3n h\u1ec7 th\u1ed1ng v\u00e0 gi\u1ea3m \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch. Gi\u00e3n t\u0129nh m\u1ea1ch l\u00e0m gi\u1ea3m \u00e1p l\u1ef1c m\u00e1u trong t\u0129nh m\u1ea1ch do \u0111\u00f3 gi\u1ea3m ti\u1ec1n g\u00e1nh c\u1ee7a tim. C\u00e1c thu\u1ed1c gi\u00e3n m\u1ea1ch c\u00f3 t\u00e1c d\u1ee5ng h\u1ed7n h\u1ee3p l\u00e0m gi\u00e3n c\u1ea3 \u0111\u1ed9ng m\u1ea1ch v\u00e0 t\u0129nh m\u1ea1ch, do \u0111\u00f3 c\u00f3 hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb suy tim, t\u0103ng huy\u1ebft \u00e1p v\u00e0 \u0111au th\u1eaft ng\u1ef1c.<\/p>\n

Trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng, ngo\u00e0i \u1ee9ng d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb \u0111au th\u1eaft ng\u1ef1c, suy tim, t\u0103ng huy\u1ebft \u00e1p, m\u1ed9t s\u1ed1 thu\u1ed1c gi\u00e3n m\u1ea1ch c\u00f2n c\u00f3 hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd kh\u00e1c (v\u00ed d\u1ee5: ngo\u00e0i t\u00e1c d\u1ee5ng gi\u1ea3m s\u1ee9c co b\u00f3p c\u01a1 tim, t\u0103ng hi\u1ec7u qu\u1ea3 h\u1ea1 huy\u1ebft \u00e1p, m\u1ed9t s\u1ed1 thu\u1ed1c nh\u00f3m ch\u1eb9n k\u00eanh canxi c\u00f2n l\u00e0m gi\u1ea3m d\u1eabn truy\u1ec1n c\u1ee7a tim, ng\u0103n ng\u1eeba c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp tim.<\/p>\n

2.C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a c\u00e1c nh\u00f3m thu\u1ed1c gi\u00e3n m\u1ea1ch<\/strong><\/h2>\n

Thu\u1ed1c gi\u00e3n m\u1ea1ch c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i d\u1ef1a tr\u00ean v\u1ecb tr\u00ed t\u00e1c d\u1ee5ng (\u0111\u1ed9ng m\u1ea1ch hay t\u0129nh m\u1ea1ch) ho\u1eb7c theo c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c. M\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c ch\u1ee7 y\u1ebfu l\u00e0m gi\u00e3n \u0111\u1ed9ng m\u1ea1ch (hydralazin) trong khi nh\u1eefng lo\u1ea1i kh\u00e1c ch\u1ee7 y\u1ebfu t\u00e1c \u0111\u1ed9ng tr\u00ean h\u1ec7 t\u0129nh m\u1ea1ch (nitroglycerin). Tuy nhi\u00ean, nh\u01b0 \u0111\u00e3 n\u00f3i \u1edf tr\u00ean h\u1ea7u h\u1ebft c\u00e1c thu\u1ed1c gi\u00e3n m\u1ea1ch c\u00f3 \u0111\u1eb7c t\u00ednh gi\u00e3n \u0111\u1ed9ng m\u1ea1ch v\u00e0 t\u0129nh m\u1ea1ch h\u1ed7n h\u1ee3p (thu\u1ed1c gi\u00e3n m\u1ea1ch h\u1ed7n h\u1ee3p; v\u00ed d\u1ee5: thu\u1ed1c ch\u1eb9n alpha, thu\u1ed1c \u1ee9c ch\u1ebf h\u1ec7 angiotensin).<\/p>\n

3.C\u01a1 s\u1edf s\u1eed d\u1ee5ng thu\u1ed1c gi\u00e3n m\u1ea1ch<\/strong><\/h2>\n

3.1. Thu\u1ed1c gi\u00e3n \u0111\u1ed9ng m\u1ea1ch<\/h3>\n

Thu\u1ed1c gi\u00e3n \u0111\u1ed9ng m\u1ea1ch gi\u1ea3m \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch do l\u00e0m gi\u1ea3m s\u1ee9c c\u1ea3n m\u1ea1ch h\u1ec7 th\u1ed1ng d\u1eabn t\u1edbi gi\u1ea3m h\u1eadu g\u00e1nh th\u1ea5t tr\u00e1i, t\u0103ng th\u1ec3 t\u00edch nh\u00e1t b\u00f3p v\u00e0 cung l\u01b0\u1ee3ng tim; gi\u1ea3m th\u1ee9 ph\u00e1t ti\u1ec1n g\u00e1nh t\u00e2m th\u1ea5t v\u00e0 \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch. Thu\u1ed1c gi\u00e3n \u0111\u1ed9ng m\u1ea1ch l\u00e0m gi\u1ea3m h\u1eadu g\u00e1nh, d\u1eabn t\u1edbi gi\u1ea3m nhu c\u1ea7u oxy c\u1ee7a tim v\u00e0 do \u0111\u00f3 c\u1ea3i thi\u1ec7n t\u1ef7 l\u1ec7 cung\/c\u1ea7u oxy, gi\u1ea3m ti\u00eau th\u1ee5 oxy c\u01a1 tim, t\u0103ng kh\u1ea3 n\u0103ng t\u01b0\u1edbi m\u00e1u m\u1ea1ch v\u00e0nh, c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng \u0111au th\u1eaft ng\u1ef1c. Nhu c\u1ea7u oxy gi\u1ea3m v\u00ec s\u1ee9c c\u0103ng th\u00e0nh t\u00e2m th\u1ea5t gi\u1ea3m khi \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 gi\u1ea3m. M\u1ed9t s\u1ed1 thu\u1ed1c gi\u00e3n m\u1ea1ch c\u0169ng c\u00f3 th\u1ec3 \u0111\u1ea3o ng\u01b0\u1ee3c ho\u1eb7c ng\u0103n ng\u1eeba co th\u1eaft \u0111\u1ed9ng m\u1ea1ch, do \u0111\u00f3 c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m c\u00e1c c\u01a1n \u0111au th\u1eaft ng\u1ef1c. H\u1ea7u h\u1ebft c\u00e1c lo\u1ea1i thu\u1ed1c gi\u00e3n \u0111\u1ed9ng m\u1ea1ch c\u0169ng l\u00e0m gi\u00e3n t\u0129nh m\u1ea1ch; ngo\u1ea1i tr\u1eeb, hydralazine gi\u00e3n m\u1ea1ch tr\u1ef1c ti\u1ebfp c\u00f3 t\u00ednh ch\u1ecdn l\u1ecdc v\u1edbi h\u1ec7 th\u1ed1ng \u0111\u1ed9ng m\u1ea1ch c\u00f3 tr\u1edf kh\u00e1ng.<\/p>\n

3.2. Thu\u1ed1c gi\u00e3n t\u0129nh m\u1ea1ch<\/h3>\n

Thu\u1ed1c gi\u00e3n t\u0129nh m\u1ea1ch l\u00e0m gi\u1ea3m \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch, l\u00e0m gi\u1ea3m ti\u1ec1n g\u00e1nh l\u00ean tim do \u0111\u00f3 l\u00e0m gi\u1ea3m cung l\u01b0\u1ee3ng tim,\u0111\u1ed3ng th\u1eddi l\u00e0m gi\u1ea3m nhu c\u1ea7u oxy c\u01a1 tim, do v\u1eady h\u1eefu \u00edch trong \u0111i\u1ec1u tr\u1ecb \u0111au th\u1eaft ng\u1ef1c. Nhu c\u1ea7u oxy gi\u1ea3m v\u00ec gi\u1ea3m ti\u1ec1n g\u00e1nh d\u1eabn \u0111\u1ebfn gi\u1ea3m s\u1ee9c c\u0103ng th\u00e0nh t\u00e2m th\u1ea5t.<\/p>\n

Gi\u1ea3m \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch l\u00e0m gi\u1ea3m \u00e1p l\u1ef1c th\u1ee7y t\u0129nh mao m\u1ea1ch g\u1ea7n, l\u00e0m gi\u1ea3m qu\u00e1 tr\u00ecnh l\u1ecdc c\u1ee7a mao m\u1ea1ch v\u00e0 gi\u1ea3m ph\u00f9. Do \u0111\u00f3, thu\u1ed1c gi\u00e3n t\u0129nh m\u1ea1ch c\u00f2n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb suy tim c\u00f9ng v\u1edbi c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c v\u00ec thu\u1ed1c gi\u00fap gi\u1ea3m t\u00ecnh tr\u1ea1ng ph\u00f9 ph\u1ed5i v\u00e0 \/ ho\u1eb7c ph\u00f9 to\u00e0n th\u00e2n do suy tim.<\/p>\n

Do \u0111\u00f3 nh\u1eefng thay \u0111\u1ed5i c\u1ee7a tim v\u00e0 m\u1ea1ch m\u00e1u \u0111\u1ed1i v\u1edbi thu\u1ed1c gi\u00e3n t\u0129nh m\u1ea1ch r\u1ea5t ph\u1ee9c t\u1ea1p khi t\u00e1c \u0111\u1ed9ng c\u1ea3 tr\u1ef1c ti\u1ebfp v\u00e0 gi\u00e1n ti\u1ebfp \u0111\u1ec1u c\u00f3 vai tr\u00f2. Nh\u1eefng t\u00e1c d\u1ee5ng quan tr\u1ecdng nh\u1ea5t v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng cho b\u1ec7nh nh\u00e2n bao g\u1ed3m \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft d\u01b0\u1edbi \u0111\u00e2y.<\/p>\n

Thu\u1ed1c gi\u00e3n t\u0129nh m\u1ea1ch s\u1ebd l\u00e0m gi\u1ea3m:<\/p>\n

    \n
  • \u00c1p l\u1ef1c t\u0129nh m\u1ea1ch v\u00e0 ti\u1ec1n g\u00e1nh.<\/li>\n
  • Cung l\u01b0\u1ee3ng tim.<\/li>\n
  • \u00c1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch. Nhu c\u1ea7u oxy c\u1ee7a c\u01a1 tim.<\/li>\n
  • Qu\u00e1 tr\u00ecnh l\u1ecdc t\u1ea1i mao m\u1ea1ch v\u00e0 ph\u00f9 n\u1ec1 m\u00f4.<\/li>\n<\/ul>\n

    3.3. Thu\u1ed1c gi\u00e3n m\u1ea1ch h\u1ed7n h\u1ee3p<\/h3>\n

    Nh\u01b0 \u0111\u00e3 tr\u00ecnh b\u00e0y \u1edf tr\u00ean, h\u1ea7u h\u1ebft c\u00e1c thu\u1ed1c gi\u00e3n m\u1ea1ch ho\u1ea1t \u0111\u1ed9ng tr\u00ean c\u1ea3 \u0111\u1ed9ng m\u1ea1ch v\u00e0 t\u0129nh m\u1ea1ch, do \u0111\u00f3 \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 thu\u1ed1c gi\u00e3n m\u1ea1ch h\u1ed7n h\u1ee3p (ho\u1eb7c c\u00e2n b\u1eb1ng). C\u00e1c ngo\u1ea1i l\u1ec7 \u0111\u00e1ng ch\u00fa \u00fd l\u00e0 hydralazine (ch\u1ea5t l\u00e0m gi\u00e3n \u0111\u1ed9ng m\u1ea1ch) v\u00e0 nitrate h\u1eefu c\u01a1 (ch\u1ea5t l\u00e0m gi\u00e3n t\u0129nh m\u1ea1ch).<\/p>\n

    4.Nh\u00f3m thu\u1ed1c \u01b0u ti\u00ean gi\u00e3n \u0111\u1ed9ng m\u1ea1ch<\/strong><\/h2>\n

    4.1. Ch\u1ec9 \u0111\u1ecbnh chung<\/strong><\/h3>\n

    Thu\u1ed1c gi\u00e3n \u0111\u1ed9ng m\u1ea1ch th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p v\u00e0 t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, suy tim v\u00e0 \u0111au th\u1eaft ng\u1ef1c. Thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m gi\u1ea3m \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch b\u1eb1ng c\u00e1ch gi\u1ea3m s\u1ee9c c\u1ea3n m\u1ea1ch h\u1ec7 th\u1ed1ng. Hi\u1ec7u qu\u1ea3 tr\u00ean nh\u00f3m b\u1ec7nh nh\u00e2n suy tim nh\u1edd l\u00e0m gi\u1ea3m t\u1ea3i h\u1eadu g\u00e1nh th\u1ea5t tr\u00e1i, gi\u00fap t\u0103ng th\u1ec3 t\u00edch nh\u00e1t b\u00f3p, t\u0103ng cung l\u01b0\u1ee3ng tim v\u00e0 gi\u00e1n ti\u1ebfp gi\u1ea3m ti\u1ec1n g\u00e1nh v\u00e0 \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch th\u1ee9 ph\u00e1t.<\/p>\n

    C\u00e1c thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n \u0111\u1ed9ng m\u1ea1ch c\u0169ng c\u00f3 t\u00e1c d\u1ee5ng tr\u00ean nh\u00f3m b\u1ec7nh nh\u00e2n \u0111au th\u1eaft ng\u1ef1c v\u00ec b\u1eb1ng c\u00e1ch gi\u1ea3m h\u1eadu g\u00e1nh, l\u00e0m gi\u1ea3m nhu c\u1ea7u oxy c\u01a1 tim ngo\u00e0i ra m\u1ed9t s\u1ed1 thu\u1ed1c c\u00f2n l\u00e0m gi\u1ea3m s\u1ef1 co th\u1eaft m\u1ea1ch v\u00e0nh.<\/p>\n

    4.2. Hydralazine<\/strong><\/h3>\n

    Hydralazine l\u00e0 m\u1ed9t trong nh\u1eefng thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ea7u ti\u00ean trong \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p t\u1eeb nh\u1eefng n\u0103m 1950.<\/p>\n

    4.2.1. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng v\u00e0 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc<\/h4>\n

    Cho \u0111\u1ebfn nay ng\u01b0\u1eddi ta v\u1eabn ch\u01b0a hi\u1ec3u r\u00f5 c\u01a1 ch\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a thu\u1ed1c n\u00e0y, nh\u01b0ng d\u01b0\u1eddng nh\u01b0 thu\u1ed1c c\u00f3 t\u00e1c \u0111\u1ed9ng m\u1ea1nh v\u00e0 tr\u1ef1c ti\u1ebfp g\u00e2y gi\u00e3n c\u00e1c c\u01a1 tr\u01a1n c\u1ee7a m\u1ea1ch m\u00e1u, ch\u1ee7 y\u1ebfu l\u00e0 ti\u1ec3u \u0111\u1ed9ng m\u1ea1ch. V\u1ec1 c\u01a1 b\u1ea3n, thu\u1ed1c kh\u00f4ng t\u00e1c \u0111\u1ed9ng l\u00ean t\u0129nh m\u1ea1ch. Hydralazine ch\u1ee7 y\u1ebfu gi\u00e3n ti\u1ec3u \u0111\u1ed9ng m\u1ea1ch \u1edf th\u1eadn v\u00e0 ngo\u1ea1i bi\u00ean, ngo\u00e0i ra c\u0169ng c\u00f3 t\u00e1c d\u1ee5ng \u00edt l\u00ean m\u1ea1ch v\u00e0nh, m\u1ea1ch t\u1ea1ng.<\/p>\n

    Hydralazine c\u00f3 th\u1ec3 d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng do c\u00f3 kh\u1ea3 n\u0103ng h\u1ea5p thu nhanh t\u1eeb \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. Tuy nhi\u00ean, sinh kh\u1ea3 d\u1ee5ng bi\u1ebfn \u0111\u1ed5i nhi\u1ec1u v\u00e0 ph\u1ee5 thu\u1ed9c v\u00e0o kh\u1ea3 n\u0103ng acetyl h\u00f3a c\u1ee7a gan (ki\u1ec3u nhanh v\u00e0 ki\u1ec3u ch\u1eadm). C\u00f3 th\u1ec3 g\u1eb7p h\u1ed9i ch\u1ee9ng gi\u1ed1ng lupus do hydralazine \u1edf nh\u00f3m acetyl h\u00f3a ch\u1eadm v\u00e0 th\u01b0\u1eddng tho\u00e1i tri\u1ec3n khi d\u1eebng thu\u1ed1c. Nh\u00f3m acetyl h\u00f3a nhanh c\u00f3 th\u1ec3 s\u1ebd c\u1ea7n d\u00f9ng li\u1ec1u hydralazine cao h\u01a1n b\u00ecnh th\u01b0\u1eddng. D\u00f9ng hydralazine l\u00e2u ng\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn thi\u1ebfu vitamin B6.<\/p>\n

    \u0110\u00e1p \u1ee9ng l\u00e2u d\u00e0i c\u1ee7a hydralazine tr\u00ean nh\u00f3m b\u1ec7nh nh\u00e2n suy tim: \u00edt bi\u1ebfn \u0111\u1ed5i nh\u1ecbp tim, l\u00e0m gi\u1ea3m s\u1ee9c c\u1ea3n m\u1ea1ch h\u1ec7 th\u1ed1ng v\u00e0 t\u0103ng kho\u1ea3ng 50% cung l\u01b0\u1ee3ng tim do \u0111\u00f3 \u00edt l\u00e0m thay \u0111\u1ed5i huy\u1ebft \u00e1p. Tr\u00ean b\u1ec7nh nh\u00e2n h\u1edf van hai l\u00e1 ho\u1eb7c h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, thu\u1ed1c l\u00e0m t\u0103ng \u0111\u00e1ng k\u1ec3 th\u1ec3 t\u00edch t\u1ed1ng m\u00e1u (do gi\u1ea3m d\u00f2ng tr\u00e0o ng\u01b0\u1ee3c). Tuy nhi\u00ean, thu\u1ed1c ch\u01b0a ch\u1ee9ng minh \u0111\u01b0\u1ee3c s\u1ef1 c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng g\u1eafng s\u1ee9c v\u1ec1 d\u00e0i h\u1ea1n.<\/p>\n

    4.2.2. Li\u1ec1u l\u01b0\u1ee3ng v\u00e0 c\u00e1ch s\u1eed d\u1ee5ng<\/h4>\n

    Cho t\u1edbi ng\u00e0y nay v\u1eabn ch\u01b0a ho\u00e0n to\u00e0n x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c ch\u00ednh x\u00e1c li\u1ec1u hydralazine cho nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 suy tim n\u1eb7ng. Do t\u00ednh hi\u1ec7u qu\u1ea3 c\u1ee7a c\u00e1c thu\u1ed1c gi\u00e3n m\u1ea1ch kh\u00e1c nh\u01b0 \u1ee9c ch\u1ebf men chuy\u1ec3n ho\u1eb7c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 n\u00ean hydralazine ch\u1ec9 \u0111\u01b0\u1ee3c coi l\u00e0 thu\u1ed1c thu\u1ed9c nh\u00f3m th\u1ee9 hai.<\/p>\n

    Li\u1ec1u kh\u1edfi \u0111\u1ea7u c\u1ee7a hydralazine d\u00f9ng trong th\u1eed nghi\u1ec7m A-HeFT l\u00e0 37,5 mg x 3 l\u1ea7n\/24h v\u00e0 t\u0103ng d\u1ea7n t\u1edbi li\u1ec1u 75 mg x 3 l\u1ea7n\/24h. Li\u1ec1u cao nh\u1ea5t hydralazine l\u00e0 1200 mg\/24h \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb suy tim, tuy nhi\u00ean h\u1ed9i ch\u1ee9ng \u201cgi\u1ed1ng lupus\u201d x\u1ea3y ra \u1edf 15\u201320% b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c d\u00f9ng li\u1ec1u cao h\u01a1n 400 mg\/24h. T\u00ecnh tr\u1ea1ng gi\u1eef n\u01b0\u1edbc c\u0169ng kh\u00e1 ph\u1ed5 bi\u1ebfn khi d\u00f9ng li\u1ec1u cao hydralazine.<\/p>\n

    4.2.3. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n<\/h4>\n
      \n
    • Hydralazine ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 ti\u1ec1n s\u1eed lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng, suy tim t\u0103ng cung l\u01b0\u1ee3ng v\u00e0 t\u00e2m ph\u1ebf m\u1ea1n c\u0169ng nh\u01b0 h\u1eb9p hai l\u00e1, h\u1eb9p van \u0110MC, vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft. Thu\u1ed1c kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u1edf ph\u1ee5 n\u1eef c\u00f3 thai.<\/li>\n
    • Th\u1eadn tr\u1ecdng s\u1eed d\u1ee5ng thu\u1ed1c \u1edf li\u1ec1u cao \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p c\u00f3 th\u1ec3 g\u00e2y ra nh\u1ecbp nhanh ph\u1ea3n x\u1ea1, ph\u00f9 v\u00e0 \u0111au th\u1eaft ng\u1ef1c. C\u00e1c ph\u1ea3n \u1ee9ng n\u00e0y \u00edt g\u1eb7p \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n suy tim n\u1eb7ng do s\u1ef1 \u0111\u00e1p \u1ee9ng c\u1ee7a c\u00e1c th\u1ee5 th\u1ec3 \u00e1p l\u1ef1c k\u00e9m. N\u1ebfu d\u00f9ng hydralazine cho b\u1ec7nh nh\u00e2n suy tim ph\u1ea3i theo d\u00f5i do h\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf v\u00e0 nh\u1ecbp tim nhanh ph\u1ea3n \u1ee9ng trong giai \u0111o\u1ea1n \u0111\u1ea7u. Theo d\u00f5i \u0111\u1ecbnh k\u1ef3 x\u00e9t nghi\u1ec7m m\u00e1u (s\u1ed1 l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u, b\u1ea1ch c\u1ea7u, kh\u00e1ng th\u1ec3 kh\u00e1ng nh\u00e2n) v\u00e0 n\u01b0\u1edbc ti\u1ec3u (h\u1ed3ng c\u1ea7u, protein).<\/li>\n
    • Th\u1eadn tr\u1ecdng v\u00e0 gi\u1ea3m li\u1ec1u thu\u1ed1c \u1edf b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng gan th\u1eadn ph\u1ea3i d\u00f9ng k\u00e9o d\u00e0i ho\u1eb7c c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh m\u1ea1ch m\u00e1u n\u00e3o.<\/li>\n<\/ul>\n

      4.3. Thu\u1ed1c ch\u1eb9n k\u00eanh canxi \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch<\/strong><\/h3>\n

      4.3.1. Nicardipine<\/h4>\n

      4.3.1.1 C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng v\u00e0 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc:<\/h5>\n

      Nicardipine l\u00e0 thu\u1ed1c thu\u1ed9c nh\u00f3m ch\u1eb9n k\u00eanh canxi th\u1ebf h\u1ec7 2 (dihydropyridine) tan trong n\u01b0\u1edbc, t\u00e1c d\u1ee5ng ch\u1ecdn l\u1ecdc tr\u00ean k\u00eanh L, c\u00f3 t\u00e1c d\u1ee5ng tr\u00ean c\u01a1 tr\u01a1n m\u1ea1ch m\u00e1u h\u01a1n c\u01a1 tim, l\u00e0m gi\u00e3n m\u1ea1ch v\u00e0nh v\u00e0 m\u1ea1ch n\u00e3o. Thu\u1ed1c l\u00e0m gi\u1ea3m nhanh huy\u1ebft \u00e1p nh\u01b0ng c\u00f3 r\u1ea5t \u00edt t\u00e1c \u0111\u1ed9ng tr\u00ean co b\u00f3p c\u01a1 tim v\u00e0 kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n t\u0129nh m\u1ea1ch. T\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch c\u1ee7a nicardipin \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n THA nhi\u1ec1u h\u01a1n \u1edf ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng. \u1ede b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd m\u1ea1ch v\u00e0nh, c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i, nicardipine truy\u1ec1n t\u0129nh m\u1ea1ch l\u00e0m t\u0103ng cung l\u01b0\u1ee3ng tim, th\u1ec3 t\u00edch nh\u00e1t b\u00f3p v\u00e0 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u nh\u01b0ng kh\u00f4ng t\u00e1c \u0111\u1ed9ng l\u00ean \u00e1p l\u1ef1c th\u1ea5t tr\u00e1i cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng.Thu\u1ed1c c\u00f3 th\u1ec3 dung n\u1ea1p t\u1ed1t khi truy\u1ec1n li\u00ean t\u1ee5c t\u1edbi 14 ng\u00e0y.<\/p>\n

      4.3.1.2 Li\u1ec1u l\u01b0\u1ee3ng v\u00e0 c\u00e1ch d\u00f9ng:<\/h5>\n

      Nicardipin ch\u1ec9 n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng b\u1edfi c\u00e1c th\u1ea7y thu\u1ed1c c\u00f3 kinh nghi\u1ec7m v\u00e0 trong m\u00f4i tr\u01b0\u1eddng c\u00f3 kh\u1ea3 n\u0103ng theo d\u00f5i t\u00edch c\u1ef1c (theo d\u00f5i huy\u1ebft \u00e1p li\u00ean t\u1ee5c). T\u1ed1c \u0111\u1ed9 truy\u1ec1n ph\u1ea3i th\u1eadt ch\u00ednh x\u00e1c b\u1eb1ng s\u1eed d\u1ee5ng b\u01a1m ti\u00eam \u0111i\u1ec7n ho\u1eb7c b\u1ea7u \u0111\u1ebfm gi\u1ecdt. Huy\u1ebft \u00e1p v\u00e0 nh\u1ecbp tim ph\u1ea3i \u0111\u01b0\u1ee3c theo d\u00f5i li\u00ean t\u1ee5c \u00edt nh\u1ea5t 5 ph\u00fat\/l\u1ea7n trong khi truy\u1ec1n cho \u0111\u1ebfn khi \u0111\u1ea1t \u0111\u01b0\u1ee3c li\u1ec1u \u1ed5n \u0111\u1ecbnh v\u00e0 ti\u1ebfp t\u1ee5c theo d\u00f5i t\u1edbi 12h sau khi d\u1eebng truy\u1ec1n. Thu\u1ed1c ph\u1ea3i \u0111\u01b0\u1ee3c pha lo\u00e3ng \u0111\u1ebfn n\u1ed3ng \u0111\u1ed9 0,1 \u2013 0,2 mg\/mL tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng tr\u1eeb khi \u0111\u01b0\u1ee3c truy\u1ec1n qua \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch trung t\u00e2m.<\/p>\n

      Li\u1ec1u nicardipine thay \u0111\u1ed5i theo t\u1eebng l\u1ee9a tu\u1ed5i v\u00e0 \u0111\u1ed1i t\u01b0\u1ee3ng:<\/p>\n

        \n
      • \u0110\u1ed1i v\u1edbi ng\u01b0\u1eddi l\u1edbn tr\u01b0\u1edfng th\u00e0nh li\u1ec1u \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o kh\u1edfi \u0111\u1ea7u truy\u1ec1n li\u00ean t\u1ee5c nicardipine v\u1edbi t\u1ed1c \u0111\u1ed9 3-5 mg\/h trong 15 ph\u00fat \u0111\u1ea7u, c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c t\u0103ng l\u00ean theo m\u1ee9c t\u0103ng 0,5 ho\u1eb7c 1 mg c\u1ee9 sau 15 ph\u00fat. T\u1ed1c \u0111\u1ed9 truy\u1ec1n kh\u00f4ng \u0111\u01b0\u1ee3c v\u01b0\u1ee3t qu\u00e1 15 mg\/h. Li\u1ec1u duy tr\u00ec khi huy\u1ebft \u00e1p \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee5c ti\u00eau n\u00ean gi\u1ea3m li\u1ec1u d\u1ea7n d\u1ea7n, th\u01b0\u1eddng l\u00e0 t\u1eeb 2 \u0111\u1ebfn 4 mg\/h, \u0111\u1ec3 duy tr\u00ec hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb. N\u00ean chuy\u1ec3n sang thu\u1ed1c huy\u1ebft \u00e1p \u0111\u01b0\u1eddng u\u1ed1ng: ng\u1eebng nicardipine ho\u1eb7c gi\u1ea3m li\u1ec1u trong khi c\u00f3 th\u1ec3 b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng thu\u1ed1c h\u1ea1 \u00e1p \u0111\u01b0\u1eddng u\u1ed1ng. Khi thu\u1ed1c h\u1ea1 \u00e1p \u0111\u01b0\u1eddng u\u1ed1ng \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u n\u00ean xem x\u00e9t kho\u1ea3ng th\u1eddi gian b\u1eaft \u0111\u1ea7u c\u00f3 t\u00e1c d\u1ee5ng. Ti\u1ebfp t\u1ee5c theo d\u00f5i huy\u1ebft \u00e1p cho \u0111\u1ebfn khi \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 mong mu\u1ed1n.<\/li>\n
      • \u0110\u1ed1i v\u1edbi ng\u01b0\u1eddi cao tu\u1ed5i: C\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng c\u1ee7a nicardipine kh\u00f4ng \u0111\u1ee7 nh\u1eefng b\u1ec7nh nh\u00e2n tr\u00ean 65 tu\u1ed5i \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ph\u1ea3n \u1ee9ng c\u1ee7a ng\u01b0\u1eddi cao tu\u1ed5i v\u1edbi thu\u1ed1c. Tuy nhi\u00ean, b\u1ec7nh nh\u00e2n cao tu\u1ed5i c\u00f3 th\u1ec3 nh\u1ea1y c\u1ea3m h\u01a1n v\u1edbi nicardipine do suy gi\u1ea3m ch\u1ee9c n\u0103ng gan, th\u1eadn. N\u00ean truy\u1ec1n nicardipine li\u00ean t\u1ee5c v\u1edbi li\u1ec1u 1 \u2013 5 mg\/h, t\u00f9y thu\u1ed9c v\u00e0o huy\u1ebft \u00e1p v\u00e0 t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng. Sau 30 ph\u00fat, t\u00f9y thu\u1ed9c v\u00e0o \u0111\u00e1p \u1ee9ng t\u1ed1c \u0111\u1ed9 n\u00ean \u0111\u01b0\u1ee3c hi\u1ec7u ch\u1ec9nh theo m\u1ee9c t\u0103ng 0,5 mg\/h. T\u1ed1c \u0111\u1ed9 kh\u00f4ng \u0111\u01b0\u1ee3c v\u01b0\u1ee3t qu\u00e1 15 mg\/h.<\/li>\n
      • B\u1ec7nh nh\u00e2n suy gan: Nicardipine n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng th\u1eadn tr\u1ecdng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y. V\u00ec nicardipine \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a \u1edf gan n\u00ean s\u1eed d\u1ee5ng ch\u1ebf \u0111\u1ed9 li\u1ec1u t\u01b0\u01a1ng t\u1ef1 nh\u01b0 \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n cao tu\u1ed5i \u1edf b\u1ec7nh nh\u00e2n suy ch\u1ee9c n\u0103ng gan ho\u1eb7c gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng m\u00e1u gan.<\/li>\n
      • B\u1ec7nh nh\u00e2n suy th\u1eadn: Nicardipine n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng th\u1eadn tr\u1ecdng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y. \u1ede m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n suy th\u1eadn v\u1eeba, \u0111\u1ed9 thanh th\u1ea3i creatinine th\u1ea5p h\u01a1n \u0111\u00e1ng k\u1ec3 v\u00e0 v\u00f9ng cao h\u01a1n d\u01b0\u1edbi \u0111\u01b0\u1eddng cong (AUC). Do \u0111\u00f3 n\u00ean s\u1eed d\u1ee5ng c\u00e1c ch\u1ebf \u0111\u1ed9 li\u1ec1u t\u01b0\u01a1ng t\u1ef1 nh\u01b0 \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n cao tu\u1ed5i \u1edf b\u1ec7nh nh\u00e2n suy th\u1eadn.<\/li>\n<\/ul>\n
        4.3.1.3 Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/h5>\n
          \n
        • Qu\u00e1 m\u1eabn v\u1edbi b\u1ea5t c\u1ee9 th\u00e0nh ph\u1ea7n n\u00e0o c\u1ee7a thu\u1ed1c. H\u1eb9p kh\u00edt van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.<\/li>\n
        • \u0110au ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh ho\u1eb7c nh\u1ed3i m\u00e1u c\u01a1 tim trong v\u00f2ng 8 ng\u00e0y \u0111\u1ea7u.<\/li>\n
        • T\u0103ng huy\u1ebft \u00e1p ph\u1ea3n \u1ee9ng (v\u00ed d\u1ee5, c\u00f3 shunt \u0111\u1ed9ng \u2013 t\u0129nh m\u1ea1ch, h\u1eb9p eo \u0111\u1ed9ng m\u1ea1ch ch\u1ee7,\u2026).<\/li>\n
        • B\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n di truy\u1ec1n kh\u00f4ng dung n\u1ea1p fructose<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"

          Thu\u1ed1c gi\u00e3n m\u1ea1ch (vasodilator drugs) c\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n c\u01a1 tr\u01a1n th\u00e0nh m\u1ea1ch do \u0111\u00f3 l\u00e0m gi\u00e3n m\u1ea1ch m\u00e1u. Gi\u00e3n \u0111\u1ed9ng m\u1ea1ch l\u00e0m gi\u1ea3m s\u1ee9c c\u1ea3n h\u1ec7 th\u1ed1ng v\u00e0 gi\u1ea3m \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch. Gi\u00e3n t\u0129nh m\u1ea1ch l\u00e0m gi\u1ea3m \u00e1p l\u1ef1c m\u00e1u trong t\u0129nh m\u1ea1ch do \u0111\u00f3 gi\u1ea3m ti\u1ec1n g\u00e1nh c\u1ee7a tim. 1.Gi\u1edbi thi\u1ec7u chung […]<\/p>\n","protected":false},"author":7,"featured_media":22620,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[12,33],"tags":[3],"yoast_head":"\nThu\u1ed1c gi\u00e3n m\u1ea1ch nh\u00f3m \u01b0u ti\u00ean tr\u00ean \u0111\u1ed9ng m\u1ea1ch<\/title>\n<meta name=\"description\" content=\"Thu\u1ed1c gi\u00e3n m\u1ea1ch nh\u00f3m \u01b0u ti\u00ean tr\u00ean \u0111\u1ed9ng m\u1ea1ch l\u00e0 v\u1ea5n \u0111\u1ec1 \u0111\u01b0\u1ee3c quan t\u00e2m. 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