{"id":22638,"date":"2023-04-17T07:51:52","date_gmt":"2023-04-17T00:51:52","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22638"},"modified":"2023-04-18T12:30:39","modified_gmt":"2023-04-18T05:30:39","slug":"tong-quan-ve-thuoc-van-mach","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/tong-quan-ve-thuoc-van-mach\/","title":{"rendered":"T\u1ed5ng quan v\u1ec1 thu\u1ed1c v\u1eadn m\u1ea1ch"},"content":{"rendered":"<p><strong>Thu\u1ed1c v\u1eadn m\u1ea1ch 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 v\u00e0 ng\u00e0y c\u00e0ng tr\u1edf th\u00e0nh nh\u1eefng thu\u1ed1c n\u1ec1n t\u1ea3ng trong \u0111i\u1ec1u tr\u1ecb m\u1ed9t s\u1ed1 h\u1ed9i ch\u1ee9ng tim m\u1ea1ch quan tr\u1ecdng.<\/strong><\/p>\n<h2><strong>1.Ph\u00e2n lo\u1ea1i thu\u1ed1c v\u1eadn m\u1ea1ch<\/strong><\/h2>\n<p>Hi\u1ec7n nay, ch\u01b0a c\u00f3 m\u1ed9t th\u1ed1ng nh\u1ea5t ph\u00e2n lo\u1ea1i n\u00e0o v\u1ec1 c\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng tr\u00ean l\u00e2m s\u00e0ng. Do m\u1ed7i thu\u1ed1c kh\u00e1c nhau \u0111\u1ec1u t\u00e1c \u0111\u1ed9ng tr\u00ean c\u00e1c receptor kh\u00e1c nhau, c\u00e1c receptor n\u00e0y g\u00e2y ra c\u00e1c hi\u1ec7u \u1ee9ng kh\u00e1c nhau tr\u00ean nhi\u1ec1u c\u01a1 quan kh\u00e1c nhau trong c\u01a1 th\u1ec3; ch\u00ednh v\u00ec v\u1eady t\u00e1c d\u1ee5ng c\u1ee7a m\u1ed7i thu\u1ed1c tr\u00ean l\u00e2m s\u00e0ng l\u00e0 ph\u1ee9c t\u1ea1p v\u00e0 kh\u00f3 d\u1ef1 \u0111o\u00e1n ch\u00ednh x\u00e1c, do \u0111\u00f3 c\u00e1c ph\u00e2n lo\u1ea1i c\u00e1c thu\u1ed1c ch\u1ec9 mang t\u00ednh ch\u1ea5t t\u01b0\u01a1ng \u0111\u1ed1i.<\/p>\n<h2><strong>2.Ph\u00e2n lo\u1ea1i theo c\u1ea5u t\u1ea1o h\u00f3a h\u1ecdc<\/strong><\/h2>\n<p>C\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c chia th\u00e0nh hai nh\u00f3m theo c\u1ea5u tr\u00fac ph\u00e2n t\u1eed, bao g\u1ed3m catecholamin v\u00e0 non-catecholamin. C\u00e1c thu\u1ed1c catecholamin l\u1ea1i \u0111\u01b0\u1ee3c chia nh\u1ecf h\u01a1n th\u00e0nh hai nh\u00f3m nh\u1ecf g\u1ed3m catecholamin t\u1ef1 nhi\u00ean v\u00e0 c\u00e1c catecholamin t\u1ed5ng h\u1ee3p.<\/p>\n<h3>2.1. C\u00e1c catecholamin:<\/h3>\n<p>L\u00e0 h\u1ee3p ch\u1ea5t h\u1eefu c\u01a1 c\u00f3 ch\u1ee9a nh\u00e2n catechol v\u00e0 m\u1ed9t chu\u1ed7i b\u00ean amin. C\u00f3 nh\u1eefng catecholamin \u0111\u01b0\u1ee3c t\u1ed5ng h\u1ee3p t\u1ef1 nhi\u00ean trong c\u01a1 th\u1ec3 ng\u01b0\u1eddi, \u0111\u00f3ng vai tr\u00f2 nh\u01b0 nh\u1eefng hormon ho\u1eb7c ch\u1ea5t truy\u1ec1n t\u00edn hi\u1ec7u th\u1ea7n kinh (neurotransmitter): epinephrine, norepinephrine, dopamine.<\/p>\n<p>C\u00e1c catecholamine t\u1ed5ng h\u1ee3p nh\u01b0 phenylephrine (lo\u1ea1i b\u1ecf 1 nh\u00f3m hydroxyl c\u1ee7a nh\u00e2n th\u01a1m -phenyl trong ph\u00e2n t\u1eed epinephrine n\u00ean c\u00f3 th\u1eddi gian b\u00e1n th\u1ea3i d\u00e0i h\u01a1n v\u00ec kh\u00f4ng b\u1ecb chuy\u1ec3n h\u00f3a b\u1edfi COMT), isoproterenol (t\u01b0\u01a1ng t\u1ef1 epinephrine nh\u01b0ng c\u00f3 ch\u1ee9a g\u1ed1c &#8211; isopropylamine), dobutamine (c\u1ea5u tr\u00fac ph\u00e2n t\u1eed l\u1edbn, thay th\u1ebf nguy\u00ean t\u1eed hydro c\u1ee7a g\u1ed1c amine trong ph\u00e2n t\u1eed epinephrine b\u1eb1ng 2-(3,4-dihydroxyphenyl)ethyl; b\u1edfi v\u1eabn c\u00f2n nh\u00e2n catechol n\u00ean b\u1ecb b\u00e1n th\u1ea3i r\u1ea5t nhanh b\u1edfi COMT).<\/p>\n<h3>2.2. C\u00e1c non-catecholamin:<\/h3>\n<p>Bao g\u1ed3m c\u00e1c thu\u1ed1c nh\u01b0 milrinone, levosemindan hay vasopressin.<\/p>\n<h2><strong>3.Ph\u00e2n lo\u1ea1i d\u1ef1a v\u00e0o \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn huy\u1ebft \u0111\u1ed9ng<\/strong><\/h2>\n<p>V\u1ec1 t\u00e1c d\u1ee5ng l\u00ean huy\u1ebft \u0111\u1ed9ng, c\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch \u0111\u01b0\u1ee3c chia th\u00e0nh hai nh\u00f3m ch\u00ednh: Thu\u1ed1c g\u00e2y co m\u1ea1ch (vasoconstrictor) v\u00e0 thu\u1ed1c g\u00e2y t\u0103ng s\u1ee9c co b\u00f3p c\u01a1 tim (inotrope). M\u1eb7c d\u00f9 v\u1eady, c\u00e1c thu\u1ed1c g\u00e2y co m\u1ea1ch c\u0169ng c\u00f3 c\u00e1c \u0111\u1eb7c t\u00ednh g\u00e2y t\u0103ng co b\u00f3p c\u01a1 tim, trong khi c\u00e1c thu\u1ed1c g\u00e2y t\u0103ng s\u1ee9c co b\u00f3p c\u01a1 tim c\u0169ng c\u00f3 t\u00e1c \u0111\u1ed9ng nh\u1ea5t \u0111\u1ecbnh tr\u00ean m\u1ea1ch m\u00e1u, v\u00ec v\u1eady hi\u1ec7n nay ng\u01b0\u1eddi ta c\u00f2n chia ra <strong>ba nh\u00f3m<\/strong> thu\u1ed1c v\u1eadn m\u1ea1ch:<\/p>\n<ul>\n<li>Thu\u1ed1c co m\u1ea1ch \u2013 t\u0103ng s\u1ee9c co c\u01a1 tim (inoconstrictor): epinephrine,norepinephrine, dopamine.<\/li>\n<li>Thu\u1ed1c gi\u00e3n m\u1ea1ch-t\u0103ng s\u1ee9c co b\u00f3p c\u01a1 tim (inodilator): dobutamine, milrinone\u2026<\/li>\n<li>Thu\u1ed1c co m\u1ea1ch (vasoconstrictor): phenylephrine, vasopressin\u2026<\/li>\n<\/ul>\n<h2><strong>4.Ph\u00e2n lo\u1ea1i d\u1ef1a v\u00e0o v\u1ecb tr\u00ed, c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng<\/strong><\/h2>\n<p>C\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch c\u00f2n \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i theo \u0111\u00edch t\u00e1c d\u1ee5ng (c\u00e1c receptor), bao g\u1ed3m:<\/p>\n<ul>\n<li>C\u00e1c thu\u1ed1c t\u00e1c \u0111\u1ed9ng l\u00ean receptor adrenergic: epinephrine, norepinephrine, dobutamine\u2026<\/li>\n<li>Thu\u1ed1c t\u00e1c \u0111\u1ed9ng tr\u00ean receptor dopaminergic: dopamine.<\/li>\n<li>Thu\u1ed1c t\u00e1c \u0111\u1ed9ng l\u00ean receptor vasopressin (ch\u1ee7 y\u1ebfu l\u00e0 receptor V1): vasopressin. Thu\u1ed1c \u0111i\u1ec1u h\u00f2a t\u00edn hi\u1ec7u phosphodiesterase n\u1ed9i b\u00e0o: milrinone, amrinone.<\/li>\n<\/ul>\n<h2><strong>5.C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng<\/strong><\/h2>\n<h3><strong>5.1. C\u00e1c receptor<\/strong><\/h3>\n<p>C\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch t\u00e1c d\u1ee5ng th\u00f4ng qua c\u00e1c receptor t\u1ea1i c\u00e1c c\u01a1 quan \u0111\u00edch, hi\u1ec3u bi\u1ebft \u0111\u1ea7y \u0111\u1ee7 v\u1ec1 s\u1ef1 ph\u00e2n b\u1ed1 c\u00e1c receptor v\u00e0 t\u00e1c d\u1ee5ng c\u1ee7a t\u1eebng lo\u1ea1i thu\u1ed1c v\u1eadn m\u1ea1ch l\u00ean c\u00e1c receptor l\u00e0 \u0111i\u1ec1u c\u1ed1t l\u00f5i \u0111\u1ec3 s\u1eed d\u1ee5ng hi\u1ec7u qu\u1ea3 c\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch.<\/p>\n<h4>5.1.1. Alpha-adrenergic receptor<\/h4>\n<p>C\u00e1c receptor alpha c\u00f3 chung m\u1ed9t nh\u00f3m c\u00e1c ch\u1ee9c n\u0103ng, bao g\u1ed3m co c\u01a1 tr\u01a1n m\u1ea1ch m\u00e1u, co \u0111\u1ed9ng m\u1ea1ch v\u00e0nh. Ho\u1ea1t h\u00f3a receptor \u03b11 g\u00e2y t\u00e1c d\u1ee5ng ch\u1ee7 y\u1ebfu l\u00e0m co c\u00e1c c\u01a1 tr\u01a1n, c\u1ee5 th\u1ec3 l\u00e0m co c\u01a1 tr\u01a1n th\u00e0nh m\u1ea1ch, g\u00e2y co m\u1ea1ch. Ho\u1ea1t t\u00ednh c\u1ee7a receptor \u03b11 c\u00f2n l\u00e0m thay \u0111\u1ed5i chuy\u1ec3n h\u00f3a v\u00e0 t\u0103ng s\u1ee9c co c\u01a1 tim th\u00f4ng qua c\u00e1c c\u01a1 ch\u1ebf ch\u01b0a \u0111\u01b0\u1ee3c r\u00f5 r\u00e0ng. Ho\u1ea1t h\u00f3a c\u00e1c receptor h\u1eadu synap \u03b12 g\u00e2y gi\u00e3n m\u1ea1ch th\u00f4ng qua s\u1ef1 s\u1ea3n xu\u1ea5t nitric oxide. Ph\u1ed1i h\u1ee3p gi\u1eefa c\u00e1c ho\u1ea1t \u0111\u1ed9ng co m\u1ea1ch \u2013 gi\u00e3n m\u1ea1ch c\u1ee7a receptor alpha gi\u00fap \u0111i\u1ec1u ch\u1ec9nh s\u1ef1 t\u01b0\u1edbi m\u00e1u, nh\u1ea5t l\u00e0 \u0111\u1ed1i v\u1edbi tu\u1ea7n ho\u00e0n c\u1ee7a m\u1ea1ch v\u00e0nh.<\/p>\n<h4>5.1.2. Beta-adrenergic receptor<\/h4>\n<p>Ho\u1ea1t h\u00f3a receptor \u03b21 ch\u1ee7 y\u1ebfu g\u00e2y \u1ea3nh h\u01b0\u1edfng tr\u00ean tim. C\u00e1c ch\u1ea5t c\u00f3 ho\u1ea1t t\u00ednh \u0111\u1ed3ng v\u1eadn receptor \u03b21 l\u00e0m t\u0103ng t\u1ea7n s\u1ed1 tim, t\u0103ng s\u1ee9c co c\u01a1 tim, t\u1eeb \u0111\u00f3 l\u00e0m t\u0103ng hi\u1ec7u n\u0103ng co b\u00f3p c\u1ee7a tim v\u00e0 t\u0103ng cung l\u01b0\u1ee3ng tim. T\u1ea7n s\u1ed1 tim t\u0103ng l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a t\u0103ng t\u00ednh t\u1ef1 \u0111\u1ed9ng n\u00fat xoang, t\u0103ng t\u00ednh t\u1ef1 \u0111\u1ed9ng v\u00e0 kh\u1ea3 n\u0103ng d\u1eabn truy\u1ec1n xung \u0111\u1ed9ng c\u1ee7a c\u01a1 t\u00e2m th\u1ea5t, t\u0103ng t\u1ed1c \u0111\u1ed9 d\u1eabn truy\u1ec1n xung \u0111\u1ed9ng qua n\u00fat nh\u0129 th\u1ea5t. T\u0103ng th\u1ec3 t\u00edch nh\u00e1t b\u00f3p \u0111\u1ea1t \u0111\u01b0\u1ee3c nh\u1edd k\u1ebft qu\u1ea3 c\u1ee7a t\u0103ng s\u1ee9c co c\u01a1 tim. Ho\u1ea1t h\u00f3a receptor \u03b22 l\u00e0m gi\u00e3n c\u00e1c c\u01a1 tr\u01a1n. \u0110\u1ed1i v\u1edbi c\u00e1c gi\u01b0\u1eddng m\u1ea1ch c\u1ee7a h\u1ec7 th\u1ed1ng m\u1ea1ch v\u00e0nh, m\u1ea1ch t\u1ea1ng v\u00e0 m\u1ea1ch c\u01a1 v\u00e2n, ho\u1ea1t h\u00f3a receptor \u03b22 g\u00e2y t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch. Th\u00eam v\u00e0o \u0111\u00f3 receptor \u03b22 c\u00f2n l\u00e0m t\u0103ng t\u1ea7n s\u1ed1 tim v\u00e0 t\u0103ng s\u1ee9c co c\u01a1 tim, d\u00f9 t\u00e1c d\u1ee5ng n\u00e0y kh\u00f4ng nhi\u1ec1u.<\/p>\n<h4>5.1.3. Dopaminergic receptor<\/h4>\n<p>\u0110\u00e3 c\u00f3 tr\u00ean 7 lo\u1ea1i receptor dopaminergic \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n, trong \u0111\u00f3 receptor D4 l\u00e0 lo\u1ea1i \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y \u1edf tim ng\u01b0\u1eddi. Th\u00f4ng qua receptor dopaminergic, dopamine l\u00e0m t\u0103ng cung l\u01b0\u1ee3ng tim th\u00f4ng qua t\u0103ng s\u1ee9c co c\u01a1 tim v\u00e0 \u1edf nh\u1eefng m\u1ee9c li\u1ec1u nh\u1ea5t \u0111\u1ecbnh, l\u00e0m t\u0103ng t\u1ea7n s\u1ed1 tim. T\u1ea1i th\u1eadn, dopamine t\u00e1c \u0111\u1ed9ng tr\u00ean receptor D1 v\u00e0 D2 g\u00e2y t\u00e1c \u0111\u1ed9ng l\u1ee3i ti\u1ec3u v\u00e0 t\u0103ng th\u1ea3i natri. Tr\u00ean m\u1ea1ch m\u00e1u ph\u1ed5i, c\u00e1c receptor D1, D2, D4 v\u00e0 D5 g\u00e2y ra c\u00e1c t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch.<\/p>\n<h4>5.1.4. Vasopressin receptor<\/h4>\n<p>Vasopressin l\u00e0 m\u1ed9t peptid gi\u00fap \u0111i\u1ec1u h\u00f2a s\u1ef1 gi\u1eef n\u01b0\u1edbc c\u1ee7a c\u01a1 th\u1ec3, c\u00f2n \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn l\u00e0 hormon ch\u1ed1ng b\u00e0i ni\u1ec7u, \u0111\u01b0\u1ee3c gi\u1ea3i ph\u00f3ng khi c\u01a1 th\u1ec3 b\u1ecb m\u1ea5t n\u01b0\u1edbc, l\u00e0m th\u1eadn t\u0103ng gi\u1eef n\u01b0\u1edbc (m\u00e0 kh\u00f4ng gi\u1eef mu\u1ed1i), gi\u00fap c\u00f4 \u0111\u1eb7c v\u00e0 gi\u1ea3m th\u1ec3 t\u00edch n\u01b0\u1edbc ti\u1ec3u.<\/p>\n<p>Thu\u1ed1c c\u0169ng l\u00e0m t\u0103ng huy\u1ebft \u00e1p nh\u1edd t\u00e1c d\u1ee5ng co m\u1ea1ch (trung b\u00ecnh) th\u00f4ng qua ho\u1ea1t h\u00f3a c\u00e1c receptor V1 \u1edf c\u00e1c gi\u01b0\u1eddng mao m\u1ea1ch nh\u01b0ng ch\u1ee7 y\u1ebfu l\u00e0 c\u00e1c c\u01a1 tr\u01a1n \u1edf ti\u1ec3u \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean. Khi ho\u1ea1t h\u00f3a c\u00e1c receptor n\u00e0y \u1edf m\u1ee9c \u0111\u1ed9 cao, s\u1ee9c c\u1ea3n m\u1ea1ch s\u1ebd t\u0103ng l\u00ean \u0111\u00e1ng k\u1ec3 v\u00e0 tr\u1edf th\u00e0nh m\u1ed9t c\u01a1 ch\u1ebf b\u00f9 tr\u1eeb quan tr\u1ecdng gi\u00fap gi\u1eef m\u1ee9c huy\u1ebft \u00e1p b\u00ecnh th\u01b0\u1eddng khi c\u01a1 th\u1ec3 \u1edf tr\u1ea1ng th\u00e1i s\u1ed1c gi\u1ea3m th\u1ec3 t\u00edch.<\/p>\n<p>Trong c\u00e1c \u0111i\u1ec1u ki\u1ec7n sinh l\u00fd th\u00f4ng th\u01b0\u1eddng, ho\u1ea1t h\u00f3a receptor V1 g\u00e2y co m\u1ea1ch nh\u01b0ng kh\u00f4ng l\u00e0m thay \u0111\u1ed5i huy\u1ebft \u00e1p v\u00ec c\u00f3 s\u1ef1 b\u00f9 tr\u1eeb c\u1ee7a ph\u1ea3n x\u1ea1 baroreceptor.<\/p>\n<p><a href=\"https:\/\/www.vinmec.com\/\"><strong>B\u1ec7nh vi\u1ec7n \u0110a khoa Qu\u1ed1c t\u1ebf Vinmec<\/strong><\/a> c\u00f3 \u0111\u1ed9i ng\u0169 D\u01b0\u1ee3c s\u0129 d\u01b0\u1ee3c l\u00e2m s\u00e0ng v\u00e0 \u0111\u00e3 \u0111\u01b0a h\u1ec7 th\u1ed1ng m\u00e1y m\u00f3c, thi\u1ebft b\u1ecb hi\u1ec7n \u0111\u1ea1i \u0111\u1ea1t chu\u1ea9n v\u00e0o c\u00f4ng t\u00e1c th\u0103m kh\u00e1m, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 c\u00e1c b\u1ec7nh l\u00fd v\u1ec1 tim m\u1ea1ch v\u00e0 h\u1ed3i s\u1ee9c c\u1ea5p c\u1ee9u.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Thu\u1ed1c v\u1eadn m\u1ea1ch 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 v\u00e0 ng\u00e0y c\u00e0ng tr\u1edf th\u00e0nh nh\u1eefng thu\u1ed1c n\u1ec1n t\u1ea3ng trong \u0111i\u1ec1u tr\u1ecb m\u1ed9t s\u1ed1 h\u1ed9i ch\u1ee9ng tim m\u1ea1ch [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":22630,"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>T\u1ed5ng quan v\u1ec1 thu\u1ed1c v\u1eadn m\u1ea1ch<\/title>\n<meta name=\"description\" content=\"Thu\u1ed1c v\u1eadn m\u1ea1ch l\u00e0 lo\u1ea1i thu\u1ed1c th\u01b0\u1eddng d\u00f9ng. 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