{"id":22627,"date":"2023-04-18T11:32:07","date_gmt":"2023-04-18T04:32:07","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22627"},"modified":"2023-04-18T12:29:04","modified_gmt":"2023-04-18T05:29:04","slug":"thuoc-van-mach-trong-thuc-hanh-lam-sang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/thuoc-van-mach-trong-thuc-hanh-lam-sang\/","title":{"rendered":"Thu\u1ed1c v\u1eadn m\u1ea1ch trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng"},"content":{"rendered":"<p><strong>Thu\u1ed1c v\u1eadn m\u1ea1ch \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 c\u1ea3i thi\u1ec7n v\u00e0 h\u1ed7 tr\u1ee3 huy\u1ebft \u0111\u1ed9ng trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng, suy s\u1ee5p huy\u1ebft \u0111\u1ed9ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c tr\u01b0\u1eddng h\u1ee3p s\u1ed1c.Ng\u00e0y nay, th\u01b0\u1eddng xuy\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng t\u1ea1i c\u00e1c \u0111\u01a1n v\u1ecb \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c (ICU) \u0111\u1ec3 duy tr\u00ec huy\u1ebft \u0111\u1ed9ng cho nh\u1eefng b\u1ec7nh nh\u00e2n n\u1eb7ng nh\u01b0 m\u1ed9t bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 quan tr\u1ecdng.<\/strong><\/p>\n<h2><strong>1.Nguy\u00ean t\u1eafc s\u1eed d\u1ee5ng thu\u1ed1c v\u1eadn m\u1ea1ch<\/strong><\/h2>\n<ul>\n<li>C\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u1eb1m \u0111i\u1ec1u tr\u1ecb c\u00e1c r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng c\u00f3 li\u00ean quan t\u1edbi s\u1ed1c.<\/li>\n<li>Trong h\u1ea7u h\u1ebft c\u00e1c t\u00ecnh hu\u1ed1ng c\u1ea5p c\u1ee9u, thu\u1ed1c v\u1eadn m\u1ea1ch \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u bi\u1ebfn s\u1ef1 tu\u1ea7n ho\u00e0n c\u1ee7a m\u00e1u, t\u00e1i l\u1eadp t\u01b0\u1edbi m\u00e1u m\u00f4 v\u00e0 c\u01a1 quan.<\/li>\n<li>L\u1ef1a ch\u1ecdn thu\u1ed1c v\u1eadn m\u1ea1ch ph\u00f9 h\u1ee3p d\u1ef1a v\u00e0o t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng, c\u00e1c \u0111\u00e1nh gi\u00e1 v\u1ec1 cung l\u01b0\u1ee3ng tim, th\u1ec3 t\u00edch nh\u00e1t b\u00f3p, s\u1ee9c c\u1ea3n m\u1ea1ch h\u1ec7 th\u1ed1ng, t\u00ecnh tr\u1ea1ng d\u1ecbch, t\u00ecnh tr\u1ea1ng co hay gi\u00e3n m\u1ea1ch.<\/li>\n<li>S\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch c\u1ea7n hi\u1ec3u r\u00f5 c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng, t\u00e1c d\u1ee5ng, li\u1ec1u d\u00f9ng, c\u00e1ch d\u00f9ng c\u1ee7a t\u1eebng lo\u1ea1i thu\u1ed1c.<\/li>\n<li>Lu\u00f4n theo d\u00f5i s\u00e1t t\u00ecnh tr\u1ea1ng, \u0111\u00e1p \u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u1ec3 c\u00f3 nh\u1eefng \u0111i\u1ec1u ch\u1ec9nh ph\u00f9 h\u1ee3p.<\/li>\n<\/ul>\n<h2><strong>2.Ch\u1ec9 \u0111\u1ecbnh<\/strong><\/h2>\n<h3><strong>2.1. Adrenaline (Epinephrine)<\/strong><\/h3>\n<h4>2.1.1. \u0110\u1eb7c \u0111i\u1ec3m t\u00e1c d\u1ee5ng c\u1ee7a adrenaline<\/h4>\n<p>Adrenaline c\u00f3 ho\u1ea1t t\u00ednh \u0111\u1ed3ng v\u1eadn c\u1ea3 receptor alpha v\u00e0 beta adrenergic, do \u0111\u00f3 t\u00e1c d\u1ee5ng h\u1ebft s\u1ee9c \u0111a d\u1ea1ng, g\u00e2y th\u00e1ch th\u1ee9c khi s\u1eed d\u1ee5ng tr\u00ean l\u00e2m s\u00e0ng.<\/p>\n<p>T\u00e1c d\u1ee5ng adrenaline ph\u1ee5 thu\u1ed9c v\u00e0o li\u1ec1u:<\/p>\n<ul>\n<li>Li\u1ec1u t\u1eeb 2 \u0111\u1ebfn 10 \u00b5g\/ph\u00fat, t\u00e1c d\u1ee5ng c\u1ee7a adrenaline tr\u00ean c\u00e1c receptor beta l\u00e0 ch\u1ee7 \u0111\u1ea1o. T\u00e1c d\u1ee5ng ho\u1ea1t h\u00f3a \u03b21 l\u00e0m t\u0103ng t\u1ea7n s\u1ed1 tim, t\u0103ng th\u1ec3 t\u00edch nh\u00e1t b\u00f3p, v\u00ec v\u1eady l\u00e0m t\u0103ng cung l\u01b0\u1ee3ng tim c\u0169ng nh\u01b0 t\u0103ng nhu c\u1ea7u ti\u00eau th\u1ee5 oxy c\u1ee7a c\u01a1 tim. T\u00e1c \u0111\u1ed9ng ho\u1ea1t h\u00f3a c\u00e1c receptor \u03b22, g\u00e2y gi\u00e3n c\u01a1 tr\u01a1n t\u1ea1i c\u00e1c ti\u1ec3u \u0111\u1ed9ng m\u1ea1ch c\u1ee7a c\u01a1 v\u00e2n, ph\u1ea7n n\u00e0o \u0111\u1ed1i ngh\u1ecbch l\u1ea1i t\u00e1c \u0111\u1ed9ng co m\u1ea1ch g\u00e2y ra b\u1edfi c\u00e1c receptor alpha t\u1ea1o n\u00ean nhi\u1ec1u t\u00e1c \u0111\u1ed9ng kh\u00e1c nhau tr\u00ean m\u1ee9c HA trung b\u00ecnh.<\/li>\n<li>Li\u1ec1u cao h\u01a1n 10 \u00b5g\/ph\u00fat, adrenaline g\u00e2y ho\u1ea1t h\u00f3a \u01b0u th\u1ebf receptor alpha, g\u00e2y co m\u1ea1ch, l\u00e0m t\u0103ng HA trung b\u00ecnh th\u00f4ng qua t\u0103ng t\u1ed5ng s\u1ee9c c\u1ea3n ngo\u1ea1i vi.<\/li>\n<\/ul>\n<p>Adrenaline c\u00f3 nguy c\u01a1 g\u00e2y r\u1ed1i lo\u1ea1n nh\u1ecbp, thi\u1ebfu m\u00e1u c\u01a1 tim, co m\u1ea1ch t\u1ea1ng m\u1ea1nh \u1edf li\u1ec1u cao, l\u00e0m t\u0103ng nguy c\u01a1 thi\u1ebfu m\u00e1u t\u1ea1ng ( \u0111\u1eb7c bi\u1ec7t c\u00e1c t\u1ea1ng trong \u1ed5 b\u1ee5ng).<\/p>\n<h4>2.1.2. Ch\u1ec9 \u0111\u1ecbnh adrenaline<\/h4>\n<ul>\n<li>Trong c\u1ea5p c\u1ee9u ng\u1eebng tu\u1ea7n ho\u00e0n, v\u00f4 t\u00e2m thu, nh\u1ecbp ch\u1eadm.<\/li>\n<li>Vai tr\u00f2 \u0111\u1ea7u tay, t\u1ed1i quan tr\u1ecdng trong ph\u1ea3n \u1ee9ng ph\u1ea3n v\u1ec7, \u0111\u1eb7c bi\u1ec7t l\u00e0 s\u1ed1c ph\u1ea3n v\u1ec7. H\u1ed7 tr\u1ee3 huy\u1ebft \u0111\u1ed9ng trong \u0111i\u1ec1u tr\u1ecb s\u1ed1c nhi\u1ec5m khu\u1ea9n n\u1eb7ng, s\u1ed1c tim.<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb co th\u1eaft ph\u1ebf qu\u1ea3n nghi\u00eam tr\u1ecdng ( trong hen ph\u1ebf qu\u1ea3n nguy k\u1ecbch, b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh n\u1eb7ng).<\/li>\n<li>Nh\u1ecbp ch\u1eadm c\u00f3 tri\u1ec7u ch\u1ee9ng ho\u1eb7c bloc nh\u0129 th\u1ea5t kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi atropin ho\u1eb7c t\u1ea1o nh\u1ecbp ngo\u00e0i.<\/li>\n<\/ul>\n<h3><strong>2.2. Noradrenaline (Norepinephrine)<\/strong><\/h3>\n<h4>2.2.1. \u0110\u1eb7c \u0111i\u1ec3m t\u00e1c d\u1ee5ng c\u1ee7a noradrenaline<\/h4>\n<ul>\n<li>Noradrenaline t\u00e1c \u0111\u1ed9ng l\u00ean c\u1ea3 receptor \u03b1 v\u00e0 \u03b2. L\u00e0 \u0111\u1ed3ng v\u1eadn c\u1ee7a c\u1ea3 receptor \u03b11 v\u00e0 \u03b12, ho\u1ea1t h\u00f3a receptor \u03b21 y\u1ebfu h\u01a1n adrenalin, t\u00e1c \u0111\u1ed9ng tr\u00ean receptor \u03b22 th\u00ec y\u1ebfu h\u01a1n nhi\u1ec1u.<\/li>\n<li>T\u0103ng s\u1ee9c c\u1ea3n m\u1ea1ch h\u1ec7 th\u1ed1ng (v\u1edbi t\u00e1c d\u1ee5ng tr\u00ean receptor \u03b11).<\/li>\n<li>T\u0103ng s\u1ee9c co c\u01a1 tim, nh\u01b0ng t\u00e1c d\u1ee5ng n\u00e0y v\u1eeba \u0111\u1ee7 \u0111\u1ec3 duy tr\u00ec cung l\u01b0\u1ee3ng tim kh\u00f4ng \u0111\u1ed5i (khi s\u1ee9c c\u1ea3n h\u1ec7 th\u1ed1ng t\u0103ng). Khi t\u0103ng li\u1ec1u noradrenaline c\u00f3 th\u1ec3 l\u00e0m t\u0103ng ho\u1ea1t h\u00f3a receptor \u03b21, t\u0103ng h\u1ed3i l\u01b0u t\u0129nh m\u1ea1ch, do v\u1eady c\u00f3 th\u1ec3 l\u00e0m t\u0103ng cung l\u01b0\u1ee3ng tim. Tr\u00ean t\u1ea7n s\u1ed1 tim, do ph\u1ea3n x\u1ea1 baroreceptor, noradrenalin c\u00f3 th\u1ec3 g\u00e2y gi\u1ea3m t\u1ea7n s\u1ed1 tim. Khi d\u00f9ng v\u1edbi li\u1ec1u cao, do t\u00e1c d\u1ee5ng tr\u00ean receptor \u03b21 t\u0103ng, norepinephrine c\u00f3 th\u1ec3 l\u00e0m t\u0103ng t\u1ea7n s\u1ed1 tim.<\/li>\n<\/ul>\n<h4>2.2.2. Ch\u1ec9 \u0111\u1ecbnh d\u00f9ng noradrenaline<\/h4>\n<ul>\n<li>Noradrenaline \u0111\u01b0\u1ee3c coi l\u00e0 thu\u1ed1c v\u1eadn m\u1ea1ch \u0111\u1ea7u tay cho t\u1ea5t c\u1ea3 c\u00e1c t\u00ecnh tr\u1ea1ng s\u1ed1c, bao g\u1ed3m c\u1ea3 nh\u1eefng s\u1ed1c kh\u00f4ng ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c nguy\u00ean nh\u00e2n (s\u1ed1c tim, s\u1ed1c nhi\u1ec5m khu\u1ea9n, s\u1ed1c gi\u1ea3m th\u1ec3 t\u00edch\u2026).<\/li>\n<li>Noradrenaline \u0111\u01b0\u1ee3c khuy\u00ean d\u00f9ng trong t\u00ecnh hu\u1ed1ng s\u1ed1c tim, \u0111\u1eb7c bi\u1ec7t s\u1ed1c tim do nh\u1ed3i m\u00e1u c\u01a1 tim. C\u00e1c khuy\u1ebfn c\u00e1o g\u1ea7n \u0111\u00e2y \u01b0u ti\u00ean s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p noradrenaline v\u00e0 dobutamine, thay v\u00ec dopamine trong c\u00e1c t\u00ecnh hu\u1ed1ng s\u1ed1c tim.<\/li>\n<\/ul>\n<h3><strong>2.3. Dobutamine<\/strong><\/h3>\n<h4>2.3.1. \u0110\u1eb7c \u0111i\u1ec3m t\u00e1c d\u1ee5ng c\u1ee7a dobutamine<\/h4>\n<ul>\n<li>Dobutamine l\u00e0m t\u0103ng s\u1ee9c co b\u00f3p c\u01a1 tim, t\u1eeb \u0111\u00f3 t\u1ea1o ra t\u00e1c d\u1ee5ng l\u00e0m t\u0103ng th\u1ec3 t\u00edch nh\u00e1t b\u00f3p, t\u0103ng cung l\u01b0\u1ee3ng tim ph\u1ee5 thu\u1ed9c li\u1ec1u.<\/li>\n<li>Dobutamine l\u00e0m gi\u1ea3m nh\u1eb9 s\u1ee9c c\u1ea3n m\u1ea1ch h\u1ec7 th\u1ed1ng, tr\u1eeb khi s\u1eed d\u1ee5ng v\u1edbi li\u1ec1u cao ( &gt; 10 \u2013 15 \u00b5g\/kg\/ph\u00fat), v\u00ec l\u00fac n\u00e0y t\u00e1c d\u1ee5ng tr\u00ean receptor \u03b11 chi\u1ebfm \u01b0u th\u1ebf. V\u00ec v\u1eady, t\u00e1c d\u1ee5ng tr\u00ean HA c\u1ee7a dobutamine l\u00e0 r\u1ea5t kh\u00f3 \u0111\u1ec3 d\u1ef1 \u0111o\u00e1n tr\u01b0\u1edbc, ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 thay \u0111\u1ed5i c\u1ee7a cung l\u01b0\u1ee3ng tim (CO) v\u00e0 s\u1ee9c c\u1ea3n m\u1ea1ch h\u1ec7 th\u1ed1ng (SVR) so v\u1edbi m\u1ee9c n\u1ec1n ban \u0111\u1ea7u.<\/li>\n<li>Dobutamine \u1ea3nh h\u01b0\u1edfng t\u1edbi t\u1ea7n s\u1ed1 tim, t\u00e1c d\u1ee5ng n\u00e0y ph\u1ee5 thu\u1ed9c li\u1ec1u, do \u0111\u00f3 s\u1ebd \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn th\u1ec3 t\u00edch nh\u00e1t b\u00f3p. Dobutamine li\u1ec1u th\u1ea5p (&lt; 5 \u00b5g\/kg\/ph\u00fat) l\u00e0m t\u0103ng th\u1ec3 t\u00edch nh\u00e1t b\u00f3p th\u00f4ng qua t\u00e1c d\u1ee5ng t\u0103ng s\u1ee9c co c\u01a1 tim m\u00e0 kh\u00f4ng l\u00e0m t\u0103ng nh\u1ecbp qu\u00e1 nhi\u1ec1u nh\u01b0ng v\u1edbi li\u1ec1u cao (&gt;10 \u00b5g\/kg\/ph\u00fat) dobutamine g\u00e2y gi\u1ea3m th\u1ec3 t\u00edch nh\u00e1t b\u00f3p do t\u00e1c \u0111\u1ed9ng g\u00e2y nh\u1ecbp nhanh, l\u00e0m gi\u1ea3m th\u1eddi gian \u0111\u1ed5 \u0111\u1ea7y th\u1ea5t th\u00ec t\u00e2m tr\u01b0\u01a1ng. S\u1eed d\u1ee5ng dobutamine k\u00e9o d\u00e0i g\u00e2y t\u00ecnh tr\u1ea1ng kh\u00e1ng thu\u1ed1c do hi\u1ec7n t\u01b0\u1ee3ng \u0111i\u1ec1u h\u00f2a gi\u1ea3m c\u1ee7a receptor \u03b21, v\u00ec v\u1eady \u0111\u00f2i h\u1ecfi li\u1ec1u d\u00f9ng cao h\u01a1n \u0111\u1ec3 \u0111\u1ea1t hi\u1ec7u qu\u1ea3 l\u00e2m s\u00e0ng.<\/li>\n<\/ul>\n<h4>2.3.2. Ch\u1ec9 \u0111\u1ecbnh Dobutamine<\/h4>\n<ul>\n<li>C\u00e1c ch\u1ec9 \u0111\u1ecbnh ch\u1ee7 y\u1ebfu:<\/li>\n<\/ul>\n<p>C\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i g\u00e2y n\u00ean: s\u1ed1c tim, gi\u1ea3m cung l\u01b0\u1ee3ng tim, t\u1ee5t huy\u1ebft \u00e1p, gi\u1ea3m t\u01b0\u1edbi m\u00e1u t\u1ea1ng (r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c, t\u0103ng men gan, suy th\u1eadn ch\u1ee9c n\u0103ng\u2026) t\u0103ng \u00e1p l\u1ef1c \u0111\u1ed5 \u0111\u1ea7y t\u00e2m th\u1ea5t tr\u00e1i cu\u1ed1i th\u00ec t\u00e2m tr\u01b0\u01a1ng (\u226518 mmHg) trong c\u00e1c b\u1ec7nh c\u1ea3nh suy tim c\u1ea5p ho\u1eb7c \u0111\u1ee3t c\u1ea5p m\u1ea5t b\u00f9 suy tim m\u1ea1n t\u00ednh.<\/p>\n<p>Dobutamine s\u1eed d\u1ee5ng \u0111\u1ec3 h\u1ed7 tr\u1ee3 huy\u1ebft \u0111\u1ed9ng trong nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p c\u00f3 HA t\u00e2m thu &lt; 100 mmHg, s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch kh\u00e1c trong s\u1ed1c tim ( noradrenalin, adrenalin\u2026)<\/p>\n<p>Nh\u1ecbp ch\u1eadm c\u00f3 tri\u1ec7u ch\u1ee9ng kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi atropin ho\u1eb7c t\u1ea1o nh\u1ecbp ngo\u00e0i.<\/p>\n<ul>\n<li>M\u1ed9t s\u1ed1 ch\u1ec9 \u0111\u1ecbnh kh\u00e1c:<\/li>\n<\/ul>\n<p>H\u1ed7 tr\u1ee3 huy\u1ebft \u0111\u1ed9ng cho b\u1ec7nh nh\u00e2n suy tim n\u1eb7ng trong ph\u1eabu thu\u1eadt ho\u1eb7c c\u00e1c th\u1ee7 thu\u1eadt ch\u1ea9n \u0111o\u00e1n ph\u1ee9c t\u1ea1p.<\/p>\n<p>H\u1ed7 tr\u1ee3 huy\u1ebft \u0111\u1ed9ng cho b\u1ec7nh nh\u00e2n suy tim khi l\u00e2m s\u00e0ng m\u1ec7t nhi\u1ec1u.<\/p>\n<p>\u0110i\u1ec1u tr\u1ecb b\u1eafc c\u1ea7u \u1edf b\u1ec7nh nh\u00e2n suy tim v\u1edbi \u0111i\u1ec1u tr\u1ecb n\u1ec1n t\u1ea3ng (v\u00ed d\u1ee5: \u1ee9c ch\u1ebf men chuy\u1ec3n, ch\u1eb9n beta giao c\u1ea3m).<\/p>\n<p>Li\u1ec7u ph\u00e1p b\u1eafc c\u1ea7u cho b\u1ec7nh nh\u00e2n suy tim tr\u01a1 trong th\u1eddi gian ch\u1edd gh\u00e9p tim ho\u1eb7c \u0111\u1eb7t thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3 c\u01a1 h\u1ecdc.<\/p>\n<p>Li\u1ec7u ph\u00e1p duy tr\u00ec li\u00ean t\u1ee5c cho b\u1ec7nh nh\u00e2n suy tim giai \u0111o\u1ea1n cu\u1ed1i \u0111i\u1ec1u tr\u1ecb gi\u1ea3m nh\u1eb9 v\u00e0 ch\u0103m s\u00f3c t\u1ea1i nh\u00e0 ho\u1eb7c vi\u1ec7n d\u01b0\u1ee1ng l\u00e3o.<\/p>\n<p>H\u1ed7 tr\u1ee3 huy\u1ebft \u0111\u1ed9ng cho b\u1ec7nh nh\u00e2n h\u1ed3i t\u1ec9nh sau ph\u1eabu thu\u1eadt tim.<\/p>\n<p>\u0110\u1ec3 c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng th\u1eadn v\u00e0 l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u \u1edf b\u1ec7nh nh\u00e2n suy tim \u1ee9 huy\u1ebft n\u1eb1m vi\u1ec7n c\u00f3 bi\u1ec3u hi\u1ec7n gi\u1ea3m cung l\u01b0\u1ee3ng, khi c\u00e1c \u0111i\u1ec1u tr\u1ecb c\u01a1 b\u1ea3n v\u00e0 thu\u1ed1c l\u1ee3i ti\u1ec3u k\u00e9m hi\u1ec7u qu\u1ea3.<\/p>\n<p>H\u1ed7 tr\u1ee3 ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t ph\u1ea3i khi c\u00f3 suy th\u1ea5t ph\u1ea3i.<\/p>\n<p>\u0110\u00e1nh gi\u00e1 d\u1ef1 tr\u1eef co b\u00f3p t\u00e2m th\u1ea5t (tr\u00e1i ho\u1eb7c ph\u1ea3i) trong c\u00e1c nghi\u1ec7m ph\u00e1p g\u1eafng s\u1ee9c. \u0110\u00e1nh gi\u00e1 h\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 n\u1eb7ng \u1edf b\u1ec7nh nh\u00e2n cung l\u01b0\u1ee3ng th\u1ea5p v\u00e0 ch\u00eanh \u00e1p qua van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 th\u1ea5p.<\/p>\n<p>\u0110\u00e1nh gi\u00e1 t\u01b0\u1edbi m\u00e1u c\u01a1 tim trong c\u00e1c nghi\u1ec7m ph\u00e1p g\u1eafng s\u1ee9c nh\u01b0: Si\u00eau \u00e2m tim g\u1eafng s\u1ee9c, c\u1ed9ng h\u01b0\u1edfng t\u1eeb c\u01a1 tim g\u1eafng s\u1ee9c \u0111\u00e1nh gi\u00e1 t\u01b0\u1edbi m\u00e1u c\u01a1 tim\u2026<\/p>\n<h2><strong>3.Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/strong><\/h2>\n<p>C\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tuy\u1ec7t \u0111\u1ed1i, tr\u1eeb khi b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ghi nh\u1eadn c\u00f3 d\u1ecb \u1ee9ng v\u1edbi thu\u1ed1c.<\/p>\n<h2><strong>4.T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n<\/strong><\/h2>\n<p><a href=\"https:\/\/www.heart.org\/\">Theo h\u1ed9i tim m\u1ea1ch h\u1ecdc Hoa K\u1ef3<\/a>,t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a c\u00e1c lo\u1ea1i thu\u1ed1c v\u1eadn m\u1ea1ch v\u00e0 thu\u1ed1c t\u0103ng s\u1ee9c co b\u00f3p c\u01a1 tim ph\u1ee5 thu\u1ed9c v\u00e0o c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng. \u0110\u1ed1i v\u1edbi c\u00e1c lo\u1ea1i thu\u1ed1c c\u01b0\u1eddng beta giao c\u1ea3m, r\u1ed1i lo\u1ea1n nh\u1ecbp l\u00e0 m\u1ed9t trong nh\u1eefng t\u00e1c d\u1ee5ng ph\u1ee5 ph\u1ed5 bi\u1ebfn nh\u1ea5t. M\u1ed9t s\u1ed1 t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee5 th\u1ec3 s\u1ebd \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 \u1edf \u0111\u00e2y.<\/p>\n<h3><strong>4.1. Adrenaline (Epinephrine)<\/strong><\/h3>\n<ul>\n<li>Nh\u1eefng t\u00e1c d\u1ee5ng ph\u1ee5 do b\u1ea3n th\u00e2n c\u01a1 ch\u1ebf t\u00e1c \u0111\u1ed9ng th\u1ea7n kinh c\u1ee7a thu\u1ed1c nh\u01b0: nh\u1ecbp nhanh, lo l\u1eafng, b\u1ed3n ch\u1ed3n, run r\u1ea9y, ch\u00f3ng m\u1eb7t, nh\u1ee9c \u0111\u1ea7u, bu\u1ed3n n\u00f4n, n\u00f4n, \u0111\u1ecf b\u1eebng v\u00e0 \u0111\u1ecf da m\u1eb7t v\u00e0 da.<\/li>\n<li>T\u0103ng huy\u1ebft \u00e1p v\u00e0 t\u0103ng h\u1eadu g\u00e1nh.<\/li>\n<li>C\u00f3 th\u1ec3 l\u00e0m cho t\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u c\u01a1 tim t\u1ed3i t\u1ec7 h\u01a1n.<\/li>\n<li>Gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng m\u00e1u \u0111\u1ebfn da v\u00e0 ru\u1ed9t, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 v\u00e0 ho\u1ea1i t\u1eed. G\u00e2y co m\u1ea1ch th\u1eadn, c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng m\u00e1u qua th\u1eadn v\u00e0 m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn. H\u1ea1 kali m\u00e1u v\u00e0 t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft.<\/li>\n<li>C\u00f3 th\u1ec3 g\u00e2y ra t\u00ecnh tr\u1ea1ng t\u0103ng nh\u00e3n \u00e1p g\u00f3c \u0111\u00f3ng.<\/li>\n<li>T\u0103ng nguy c\u01a1 ph\u00e1t tri\u1ec3n c\u00e1c kh\u1ed1i u l\u00e0nh th\u01b0\u1ee3ng th\u1eadn. G\u00e2y ho\u1ea1i t\u1eed m\u00f4 c\u1ee5c b\u1ed9 n\u1ebfu x\u1ea3y ra tho\u00e1t thu\u1ed1c ngo\u1ea1i m\u1ea1ch.<\/li>\n<li>Trong m\u1ed9t s\u1ed1 b\u1ec7nh c\u1ea3nh \u0111\u1eb7c bi\u1ec7t, adrenaline c\u00f2n c\u00f3 th\u1ec3 g\u00e2y ra nh\u1eefng t\u00e1c d\u1ee5ng ph\u1ee5 kh\u00f3 l\u01b0\u1eddng nh\u01b0 sau:<\/li>\n<li>C\u00f3 th\u1ec3 g\u00e2y t\u1ee5t huy\u1ebft \u00e1p trong tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n m\u00e0 ch\u01b0a \u0111\u01b0\u1ee3c b\u1ed3i ph\u1ee5 \u0111\u1ea7y \u0111\u1ee7.<\/li>\n<li>C\u00f3 th\u1ec3 g\u00e2y ra t\u00ecnh tr\u1ea1ng \u201cqu\u00e1 m\u1ee9c nh\u1ea1y c\u1ea3m\u201d v\u1edbi noradrenaline n\u1ebfu d\u00f9ng k\u1ebft h\u1ee3p, khi\u1ebfn huy\u1ebft \u00e1p kh\u00f3 ki\u1ec3m so\u00e1t.<\/li>\n<li>Khi c\u00f3 c\u1ea3n tr\u1edf \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i, adrenaline c\u00f3 th\u1ec3 l\u00e0m t\u1ec7 h\u01a1n t\u00ecnh tr\u1ea1ng huy\u1ebft \u0111\u1ed9ng do gi\u1ea3m th\u1ec3 t\u00edch nh\u00e1t b\u00f3p v\u00e0 cung l\u01b0\u1ee3ng tim.<\/li>\n<\/ul>\n<h3><strong>4.2. Noradrenaline (Norepinephrine)<\/strong><\/h3>\n<p>V\u1edbi c\u01a1 ch\u1ebf v\u00e0 \u0111\u00edch t\u00e1c \u0111\u1ed9ng c\u00f3 nhi\u1ec1u \u0111i\u1ec3m chung v\u1edbi adrenaline, noradrenaline c\u0169ng g\u00e2y ra nhi\u1ec1u t\u00e1c d\u1ee5ng ph\u1ee5 t\u01b0\u01a1ng t\u1ef1. C\u1ee5 th\u1ec3 nh\u01b0 sau:<\/p>\n<ul>\n<li>Nh\u1ecbp nhanh, r\u1ed1i lo\u1ea1n nh\u1ecbp tim.<\/li>\n<li>T\u0103ng huy\u1ebft \u00e1p.<\/li>\n<li>L\u00e0m t\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u c\u01a1 tim t\u1ec7 h\u01a1n. Ho\u1ea1i t\u1eed m\u00f4 n\u1ebfu x\u1ea3y ra tho\u00e1t thu\u1ed1c ngo\u1ea1i m\u1ea1ch.<\/li>\n<li>Gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng m\u00e1u \u0111\u1ebfn d\u1eabn \u0111\u1ebfn thi\u1ec3u d\u01b0\u1ee1ng th\u1eadm ch\u00ed ho\u1ea1i t\u1eed c\u00e1c c\u01a1 quan b\u1ed9 ph\u1eadn \u201ckh\u00f4ng s\u1ed1ng c\u00f2n\u201d, \u0111\u1eb7c bi\u1ec7t l\u00e0 da v\u00e0 ru\u1ed9t.<\/li>\n<li>Co m\u1ea1ch th\u1eadn c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng m\u00e1u th\u1eadn. T\u0103ng \u0111\u01b0\u1eddng huy\u1ebft.<\/li>\n<\/ul>\n<p>Ngo\u00e0i ra, vi\u1ec7c d\u1eebng s\u1eed d\u1ee5ng noradrenaline qu\u00e1 nhanh c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u1ee5t huy\u1ebft \u00e1p \u0111\u1ed9t ng\u1ed9t, v\u00ec v\u1eady noradrenaline ph\u1ea3i \u0111\u01b0\u1ee3c \u201ccai\u201d m\u1ed9t c\u00e1ch t\u1eeb t\u1eeb, \u0111i k\u00e8m v\u1edbi s\u1ef1 theo d\u00f5i s\u00e1t v\u00e0 li\u00ean t\u1ee5c c\u00e1c tr\u1ecb s\u1ed1 huy\u1ebft \u00e1p.<\/p>\n<h3><strong>4.3. Dobutamine<\/strong><\/h3>\n<ul>\n<li>V\u1edbi c\u01a1 ch\u1ebf k\u00edch th\u00edch c\u00e1c th\u1ee5 th\u1ec3 beta, dobutamine mang \u0111\u1ebfn t\u00e1c d\u1ee5ng nh\u01b0 t\u0103ng t\u1ea7n s\u1ed1 tim, t\u0103ng s\u1ee9c co b\u00f3p v\u00e0 t\u0103ng t\u00ednh k\u00edch th\u00edch c\u1ee7a c\u01a1 tim, n\u00e2ng huy\u1ebft \u00e1p, k\u00e8m theo \u0111\u00f3 l\u00e0 s\u1ef1 gi\u00e3n nh\u1eb9 m\u1ea1ch ngo\u1ea1i bi\u00ean v\u00e0 gi\u00e3n ph\u1ebf qu\u1ea3n. C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c c\u0169ng ch\u1ee7 y\u1ebfu \u0111\u1ebfn t\u1eeb ch\u00ednh c\u01a1 ch\u1ebf t\u00e1c \u0111\u1ed9ng c\u1ee7a n\u00f3.<\/li>\n<li>Nh\u1ecbp nhanh.<\/li>\n<li>T\u0103ng ngo\u1ea1i t\u00e2m thu th\u1ea5t (\u1edf kho\u1ea3ng 5% b\u1ec7nh nh\u00e2n theo m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u). M\u1eb7c d\u00f9 t\u0103ng huy\u1ebft \u00e1p t\u00e2m thu l\u00e0 m\u1ed9t t\u00e1c d\u1ee5ng ph\u1ed5 bi\u1ebfn c\u1ee7a dobutamine, trong m\u1ed9t s\u1ed1 \u00edt tr\u01b0\u1eddng h\u1ee3p, t\u1ee5t huy\u1ebft \u00e1p c\u00f3 th\u1ec3 x\u1ea3y ra do gi\u1ea3m s\u1ee9c c\u1ea3n m\u1ea1ch h\u1ec7 th\u1ed1ng. C\u00f3 th\u1ec3 g\u00e2y t\u00ecnh tr\u1ea1ng vi\u00eam m\u1ea1ch (nh\u1ea5t l\u00e0 khi s\u1eed d\u1ee5ng k\u00e9o d\u00e0i) 1 \u2013 3% c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng dobutamine c\u00f3 th\u1ec3 bu\u1ed3n n\u00f4n, nh\u1ee9c \u0111\u1ea7u,\u0111au th\u1eaft ng\u1ef1c, \u0111au ng\u1ef1c kh\u00f4ng \u0111\u1eb7c hi\u1ec7u, \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c, kh\u00f3 th\u1edf, n\u1ed5i m\u1ea9n da,s\u1ed1t,\u2026 v\u00e0 c\u0169ng \u0111\u00e3 ghi nh\u1eadn nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u00f3 gi\u1ea3m ti\u1ec3u c\u1ea7u. Gi\u1ea3m nh\u1eb9 n\u1ed3ng \u0111\u1ed9 kali m\u00e1u.<\/li>\n<li>\u0110\u1eb7c bi\u1ec7t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 c\u1ea3n tr\u1edf \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i ( h\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i..) dobutamine c\u00f3 th\u1ec3 khi\u1ebfn t\u00ecnh tr\u1ea1ng c\u1ea3n tr\u1edf \u0111\u01b0\u1eddng ra tr\u1edf n\u00ean n\u1eb7ng n\u1ec1 h\u01a1n.<\/li>\n<li>Dobutamine ch\u1ee9a natri metabisulfate, c\u00f3 th\u1ec3 g\u00e2y ra nh\u1eefng ph\u1ea3n \u1ee9ng m\u1eabn c\u1ea3m \u1edf b\u1ec7nh nh\u00e2n c\u00f3 hen.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Thu\u1ed1c v\u1eadn m\u1ea1ch \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 c\u1ea3i thi\u1ec7n v\u00e0 h\u1ed7 tr\u1ee3 huy\u1ebft \u0111\u1ed9ng trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng, suy s\u1ee5p huy\u1ebft \u0111\u1ed9ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c tr\u01b0\u1eddng h\u1ee3p s\u1ed1c.Ng\u00e0y nay, th\u01b0\u1eddng xuy\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng t\u1ea1i c\u00e1c \u0111\u01a1n v\u1ecb \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c (ICU) \u0111\u1ec3 duy tr\u00ec huy\u1ebft \u0111\u1ed9ng cho nh\u1eefng b\u1ec7nh nh\u00e2n n\u1eb7ng [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":22630,"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 v\u1eadn m\u1ea1ch trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng<\/title>\n<meta name=\"description\" content=\"Thu\u1ed1c v\u1eadn m\u1ea1ch trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng s\u1eed d\u1ee5ng. 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