{"id":25113,"date":"2023-04-19T22:01:44","date_gmt":"2023-04-19T15:01:44","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=25113"},"modified":"2023-04-22T13:13:56","modified_gmt":"2023-04-22T06:13:56","slug":"tang-ap-dong-mach-phoi-va-cac-thuoc-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/tang-ap-dong-mach-phoi-va-cac-thuoc-dieu-tri\/","title":{"rendered":"T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i v\u00e0 c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i<\/a> l\u00e0 \u0111i\u1ec1u th\u01b0\u1eddng g\u1eb7p trong l\u00e2m s\u00e0ng.Q<\/strong>ua h\u01a1n ba<\/strong> th\u1eadp k\u1ef7 nghi\u00ean c\u1ee9u thu\u1ed1c \u0111i\u1ec1u tr\u1ecb, hi\u1ec7n t\u1ea1i \u0111\u00e3 c\u00f3 b\u1ed1n nh\u00f3m thu\u1ed1c<\/strong> \u0111\u01b0\u1ee3c ch\u1ea5p nh\u1eadn trong \u0111i\u1ec1u tr\u1ecb t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i<\/strong>.<\/strong><\/p>\n

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

Tr\u01b0\u1edbc n\u0103m 1995 kh\u00f4ng c\u00f3 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u cho t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i (t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i). Qua h\u01a1n ba th\u1eadp k\u1ef7 nghi\u00ean c\u1ee9u thu\u1ed1c \u0111i\u1ec1u tr\u1ecb, hi\u1ec7n t\u1ea1i \u0111\u00e3 c\u00f3 b\u1ed1n nh\u00f3m thu\u1ed1c \u0111\u01b0\u1ee3c ch\u1ea5p nh\u1eadn trong \u0111i\u1ec1u tr\u1ecb t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i bao g\u1ed3m:<\/p>\n

    \n
  • \u00a0C\u00e1c thu\u1ed1c gi\u1ed1ng prostacyclin.<\/li>\n
  • \u00a0Thu\u1ed1c \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 endothelin.<\/li>\n
  • \u00a0Thu\u1ed1c \u1ee9c ch\u1ebf phosphodiesterase \u2013 5.<\/li>\n
  • Thu\u1ed1c k\u00edch th\u00edch tr\u1ef1c ti\u1ebfp guanin cyclase h\u00f2a tan.<\/li>\n<\/ul>\n

    C\u00e1c nghi\u00ean c\u1ee9u tr\u01b0\u1edbc \u0111\u00e2y v\u1ec1 c\u00e1c thu\u1ed1c \u0111\u01b0\u1ee3c ch\u1ea5p nh\u1eadn \u0111i\u1ec1u tr\u1ecb t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i ch\u1ee7 y\u1ebfu l\u00e0 d\u1eef li\u1ec7u t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean, b\u1ec7nh ch\u1ee9ng, c\u1ee1 m\u1eabu t\u01b0\u01a1ng \u0111\u1ed1i nh\u1ecf, th\u1ef1c hi\u1ec7n trong th\u1eddi gian ng\u1eafn t\u1eeb 12-16 tu\u1ea7n, ch\u1ee9ng minh s\u1ef1 c\u1ea3i thi\u1ec7n v\u1ec1 kh\u1ea3 n\u0103ng ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c, ph\u00e2n \u0111\u1ed9 c\u01a1 n\u0103ng v\u00e0 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m huy\u1ebft \u0111\u1ed9ng. Tuy nhi\u00ean, g\u1ea7n \u0111\u00e2y \u0111\u00e3 c\u00f3 c\u00e1c nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c thi\u1ebft k\u1ebf ti\u1ebfn c\u1ee9u, c\u1ee1 m\u1eabu l\u1edbn h\u01a1n v\u1edbi th\u1eddi gian theo d\u00f5i l\u00e2u d\u00e0i h\u01a1n \u0111\u00e1nh gi\u00e1 v\u1ec1 t\u1ef7 l\u1ec7 t\u1eed vong v\u00e0 t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh trong nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y. C\u00e1c b\u1eb1ng ch\u1ee9ng \u1ee7ng h\u1ed9 hi\u1ec7u qu\u1ea3 v\u1ec1 s\u1ed1ng c\u00f2n c\u1ee7a c\u00e1c \u0111i\u1ec1u tr\u1ecb hi\u1ec7n t\u1ea1i ch\u1ee7 y\u1ebfu thu \u0111\u01b0\u1ee3c t\u1eeb c\u00e1c ph\u00e2n t\u00edch quan s\u00e1t h\u1eadu \u0111\u1ecbnh tr\u00ean c\u01a1 s\u1edf c\u00e1c d\u1eef li\u1ec7u c\u00f3 \u0111\u1ed1i ch\u1ee9ng trong qu\u00e1 kh\u1ee9 v\u00e0 c\u00e1c ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p (meta analysis).
    \nM\u1ed9t \u0111i\u1ec1u c\u1ea7n nh\u1ea5n m\u1ea1nh c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 tr\u00ean b\u1ec7nh nh\u00e2n t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i v\u00f4 c\u0103n, t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u00f3 t\u00ednh gia \u0111\u00ecnh, t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i li\u00ean quan v\u1edbi b\u1ec7nh m\u00f4 li\u00ean k\u1ebft v\u00e0 t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i do s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c g\u00e2y ch\u00e1n \u0103n (thu\u1ed1c ch\u1eefa b\u00e9o ph\u00ec). V\u00ec v\u1eady c\u00e1c ngo\u1ea1i suy cho b\u1ec7nh nh\u00e2n thu\u1ed9c c\u00e1c d\u01b0\u1edbi nh\u00f3m kh\u00e1c trong t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u1ea7n \u00e1p d\u1ee5ng th\u1eadn tr\u1ecdng, \u0111\u1ed3ng th\u1eddi c\u00e1c k\u1ebft lu\u1eadn n\u00e0y kh\u00f4ng \u00e1p d\u1ee5ng cho c\u00e1c nh\u00f3m t\u0103ng \u00e1p m\u1ea1ch m\u00e1u ph\u1ed5i kh\u00e1c ngo\u00e0i nh\u00f3m I.<\/p>\n

    \"T\u0103ng<\/p>\n

    C\u01a1 ch\u1ebf t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i<\/strong><\/p>\n

     <\/p>\n

    2.C\u00e1c d\u1eabn xu\u1ea5t c\u1ee7a prostacyclin<\/h2>\n

    2.1. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng v\u00e0 ch\u1ec9 \u0111\u1ecbnh c\u1ee7a nh\u00f3m d\u1eabn xu\u1ea5t prostacyclin<\/h3>\n

    2.1.1<\/strong>. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng<\/strong><\/h4>\n

    Prostacyclin \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh do s\u1ef1 gi\u00e1ng h\u00f3a acid arachidonic s\u1eed d\u1ee5ng enzym t\u1ed5ng h\u1ee3p prostacyclin, enzym n\u00e0y b\u1ecb gi\u1ea3m s\u00fat trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i. S\u1ef1 thi\u1ebfu h\u1ee5t enzym n\u00e0y d\u1eabn t\u1edbi qu\u00e1 tr\u00ecnh chuy\u1ec3n h\u00f3a c\u1ee7a acid arachidonic chuy\u1ec3n sang con \u0111\u01b0\u1eddng t\u1ed5ng h\u1ee3p thromboxan (l\u00e0 m\u1ed9t ch\u1ea5t g\u00e2y co m\u1ea1ch v\u00e0 th\u00fac \u0111\u1ea9y k\u1ebft d\u00ednh ti\u1ec3u c\u1ea7u), g\u00f3p ph\u1ea7n v\u00e0o c\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i. T\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch v\u00e0 ch\u1ed1ng ph\u00e2n b\u00e0o c\u1ee7a prostacyclin I2 nh\u1edd t\u1ea1o ra AMP v\u00f2ng. Prostacyclin v\u00e0 c\u00e1c d\u1eabn xu\u1ea5t c\u1ee7a n\u00f3 c\u00f2n c\u00f3 t\u00e1c d\u1ee5ng ch\u1ed1ng ng\u01b0ng k\u1ebft ti\u1ec3u c\u1ea7u.<\/p>\n

      \n
    • C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a c\u00e1c ch\u1ea5t d\u1eabn xu\u1ea5t prostacyclin.<\/li>\n<\/ul>\n

      Prostacyclin (PGI2) \u0111\u01b0\u1ee3c t\u1ea1o th\u00e0nh t\u1eeb acid arachidonic chuy\u1ec3n h\u00f3a t\u1ea1i th\u1ebf b\u00e0o n\u1ed9i m\u00f4 v\u00e0 t\u00e1c \u0111\u1ed9ng l\u00ean t\u1ebf b\u00e0o c\u01a1 tr\u01a1n qua trung gian th\u1ee5 th\u1ec3 prostacyclin (IP), l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 adenosine monophosphate v\u00f2ng (cAMP), k\u1ebft qu\u1ea3 l\u00e0 g\u00e2y gi\u00e3n m\u1ea1ch v\u00e0 gi\u1ea3m t\u0103ng sinh. B\u1edfi v\u1eady, m\u1ed9t trong c\u00e1c li\u1ec7u ph\u00e1p \u0111\u1eb7c hi\u1ec7u cho t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i l\u00e0 s\u1eed d\u1ee5ng c\u00e1c ch\u1ea5t d\u1eabn xu\u1ea5t prostacyclin \u0111\u1ec3 t\u00e1c \u0111\u1ed9ng l\u00ean t\u1ebf b\u00e0o c\u01a1 tr\u01a1n.<\/p>\n

      2.1.2<\/strong>. Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb<\/strong><\/h4>\n

      C\u00e1c thu\u1ed1c nh\u00f3m prostacyclin \u0111\u01b0\u1ee3c H\u1ed9i Thu\u1ed1c v\u00e0 th\u1ef1c ph\u1ea9m Hoa K\u1ef3 (US FDA) ch\u1ea5p nh\u1eadn s\u1eed d\u1ee5ng tr\u00ean b\u1ec7nh nh\u00e2n t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i. Vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c n\u00e0y \u1edf b\u1ec7nh nh\u00e2n t\u0103ng \u00e1p m\u1ea1ch m\u00e1u ph\u1ed5i do suy tim t\u00e2m thu (t\u0103ng \u00e1p m\u1ea1ch m\u00e1u ph\u1ed5i nh\u00f3m 2) l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 s\u1ed1ng c\u00f2n, \u0111\u1ed3ng th\u1eddi l\u00e0m t\u0103ng lu\u1ed3ng th\u00f4ng trong ph\u1ed5i v\u00e0 t\u00ecnh tr\u1ea1ng thi\u1ebfu oxy m\u00f4 \u1edf b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh nhu m\u00f4 ph\u1ed5i (T\u0103ng \u00e1p m\u1ea1ch m\u00e1u ph\u1ed5i nh\u00f3m 3).
      \nHi\u1ec7n t\u1ea1i c\u00f3 3 thu\u1ed1c thu\u1ed9c nh\u00f3m prostacyclin v\u00e0 b\u1ed1n \u0111\u01b0\u1eddng s\u1eed d\u1ee5ng \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn bao g\u1ed3m:<\/p>\n

        \n
      • Epoprostenol d\u1ea1ng truy\u1ec1n t\u0129nh m\u1ea1ch.<\/li>\n
      • Treprostinil d\u1ea1ng truy\u1ec1n t\u0129nh m\u1ea1ch, d\u1ea1ng ti\u00eam d\u01b0\u1edbi da, d\u1ea1ng kh\u00ed dung v\u00e0 d\u1ea1ng u\u1ed1ng.<\/li>\n
      • Iloprost d\u1ea1ng kh\u00ed dung.<\/li>\n<\/ul>\n

        Vi\u1ec7c l\u1ef1a ch\u1ecdn lo\u1ea1i prostacyclin n\u00e0o, \u0111\u01b0\u1eddng d\u00f9ng n\u00e0o ph\u1ee5 thu\u1ed9c v\u00e0o \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 v\u1ec1 ph\u00eda b\u1ec7nh nh\u00e2n. M\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 ch\u1ee7 y\u1ebfu d\u1ef1a tr\u00ean ph\u00e2n \u0111\u1ed9 c\u01a1 n\u0103ng theo T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi (WHO), tuy nhi\u00ean c\u0169ng d\u1ef1a tr\u00ean m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c. C\u00e1c y\u1ebfu t\u1ed1 v\u1ec1 ph\u00eda b\u1ec7nh nh\u00e2n bao g\u1ed3m: s\u1ef1 ch\u1ea5p nh\u1eadn c\u1ee7a b\u1ec7nh nh\u00e2n v\u1ec1 \u0111\u01b0\u1eddng d\u00f9ng thu\u1ed1c, s\u1ef1 h\u1ed7 tr\u1ee3 v\u1ec1 m\u1eb7t x\u00e3 h\u1ed9i, t\u1ea7n su\u1ea5t \u0111\u1ebfn kh\u00e1m t\u1ea1i b\u1ec7nh vi\u1ec7n chuy\u00ean khoa c\u00f3 nh\u00e2n vi\u00ean y t\u1ebf \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o chuy\u00ean s\u00e2u c\u00f3 th\u1ec3 gi\u00fap h\u1ecd trong theo d\u00f5i v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.<\/p>\n

        2<\/strong>.2. Bosentan<\/strong><\/h3>\n

        2.2.1<\/strong>. L\u1ecbch s\u1eed thu\u1ed1c<\/strong><\/h4>\n

        Bosentan l\u00e0 ch\u1ea5t \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 endothelin k\u00e9p. N\u0103m th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean b\u1ec7nh ch\u1ee9ng \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n bao g\u1ed3m: Study-351; BREATH-1, BREATH-2, BREATH-5 v\u00e0 EARLY, c\u00f3 k\u1ebft qu\u1ea3 th\u1ec3 hi\u1ec7n s\u1ef1 c\u1ea3i thi\u1ec7n v\u1ec1 ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c, ph\u00e2n \u0111\u1ed9 c\u01a1 n\u0103ng, th\u00f4ng s\u1ed1 huy\u1ebft \u0111\u1ed9ng, c\u00e1c th\u00f4ng s\u1ed1 v\u1ec1 si\u00eau \u00e2m tim v\u00e0 th\u1eddi gian \u0111\u1ebfn khi c\u00f3 di\u1ec5n bi\u1ebfn l\u00e2m s\u00e0ng x\u1ea5u \u0111i, h\u1ea7u h\u1ebft c\u00e1c nghi\u00ean c\u1ee9u c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n tr\u00ean b\u1ec7nh nh\u00e2n giai \u0111o\u1ea1n b\u1ec7nh n\u1eb7ng, m\u1ee9c \u0111\u1ed9 tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng NYHA III,IV.
        \nTrong nghi\u00ean c\u1ee9u EARLY, bosentan \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho b\u1ec7nh nh\u00e2n t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i tri\u1ec7u ch\u1ee9ng nh\u1eb9 (NYHA II). B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ng\u1eabu nhi\u00ean ph\u00e2n nh\u00f3m s\u1eed d\u1ee5ng bosentan ho\u1eb7c gi\u1ea3 d\u01b0\u1ee3c trong 26 tu\u1ea7n. K\u1ebft qu\u1ea3 ch\u1ec9 ra s\u1ef1 c\u1ea3i thi\u1ec7n \u0111\u00e1ng k\u1ec3 v\u1ec1 gi\u00e1 tr\u1ecb s\u1ee9c c\u1ea3n m\u1ea1ch ph\u1ed5i nh\u01b0ng kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t \u0111\u00e1ng k\u1ec3 v\u1ec1 qu\u00e3ng \u0111\u01b0\u1eddng \u0111i b\u1ed9.
        \n\u1ede b\u1ec7nh nh\u00e2n h\u1ed9i ch\u1ee9ng Eisenmenger, bosentan l\u00e0m gi\u1ea3m ch\u1ec9 s\u1ed1 s\u1ee9c c\u1ea3n m\u1ea1ch ph\u1ed5i, gi\u1ea3m \u00e1p l\u1ef1c \u0110MP trung b\u00ecnh v\u00e0 t\u0103ng kh\u1ea3 n\u0103ng ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c.<\/p>\n

        2.2.2<\/strong>. D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc v\u00e0 \u0111\u01b0\u1eddng d\u00f9ng<\/strong><\/h4>\n

        Bosentan l\u00e0 thu\u1ed1c h\u1ea1 \u00e1p l\u1ef1c \u0110MP \u0111\u01b0\u1eddng u\u1ed1ng \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c H\u1ed9i thu\u1ed1c v\u00e0 th\u1ef1c ph\u1ea9m Hoa K\u1ef3 ch\u1ea5p thu\u1eadn n\u0103m 2001.<\/p>\n

        2.2.3<\/strong>. Li\u1ec1u d\u00f9ng v\u00e0 c\u00e1ch d\u00f9ng<\/strong><\/h4>\n

        Li\u1ec1u khuy\u1ebfn c\u00e1o kh\u1edfi \u0111\u1ea7u l\u00e0 62,5 mg x 2 l\u1ea7n\/24h, t\u0103ng d\u1ea7n li\u1ec1u l\u00ean 125 mg x 2 l\u1ea7n\/24h sau 4 tu\u1ea7n.<\/p>\n

        2.3<\/strong>.<\/strong> T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a c\u00e1c thu\u1ed1c nh\u00f3m \u0111\u1ed1i kh\u00e1ng th\u1ee5 <\/strong>th\u1ec3 endothelin<\/strong><\/h3>\n

        2.3.1 <\/strong>C\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n bao g\u1ed3m: <\/strong><\/h4>\n

        Ph\u00f9 m\u1ea1ch ngo\u1ea1i vi, kh\u1ea3 n\u0103ng g\u00e2y \u0111\u1ed9c gan, thi\u1ebfu m\u00e1u, t\u00e1c d\u1ee5ng g\u00e2y d\u1ecb d\u1ea1ng thai v\u00e0 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c-thu\u1ed1c v\u1edbi m\u1ed9t s\u1ed1 ch\u1ea5t k\u00edch th\u00edch ho\u1eb7c \u1ee9c ch\u1ebf cytochrome P450.
        \nBosentan g\u00e2y t\u0103ng transaminase gan 10 \u2013 15% b\u1ec7nh nh\u00e2n v\u00e0 ph\u1ee5 thu\u1ed9c li\u1ec1u. V\u00ec l\u00fd do n\u00e0y, C\u01a1 quan thu\u1ed1c v\u00e0 th\u1ef1c ph\u1ea9m Hoa K\u1ef3 khuy\u1ebfn c\u00e1o b\u1eaft bu\u1ed9c x\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gan h\u00e0ng th\u00e1ng \u1edf t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng bosentan. \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng ambrisentan v\u00e0 macitentan kh\u00f4ng y\u00eau c\u1ea7u ph\u1ea3i x\u00e9t nghi\u1ec7m men gan h\u1eb1ng th\u00e1ng tuy nhi\u00ean c\u1ea7n \u0111\u1ecbnh k\u1ef3 x\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gan nh\u01b0 m\u1ed9t ph\u1ea7n trong \u0111\u00e1nh gi\u00e1 th\u01b0\u1eddng quy c\u00e1c b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n suy tim ph\u1ea3i v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng gan.
        \nPh\u00f9 ch\u00e2n c\u00f3 th\u1ec3 g\u1eb7p \u1edf 28% b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb v\u1edbi ambrisentan, \u00edt g\u1eb7p h\u01a1n \u1edf b\u1ec7nh nh\u00e2n d\u00f9ng bosentan. Nguy\u00ean nh\u00e2n g\u00e2y ph\u00f9 ch\u00e2n ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft r\u00f5 nh\u01b0ng kh\u1ea3 n\u0103ng li\u00ean quan \u0111\u1ebfn t\u00e1c d\u1ee5ng gi\u1eef n\u01b0\u1edbc nhi\u1ec1u h\u01a1n t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch ngo\u1ea1i vi. T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n n\u00e0y c\u00f3 th\u1ec3 kh\u1ed1ng ch\u1ebf b\u1eb1ng s\u1eed d\u1ee5ng l\u1ee3i ti\u1ec3u ph\u1ed1i h\u1ee3p v\u00e0 kh\u00f4ng c\u1ea7n ng\u1eebng s\u1eed d\u1ee5ng thu\u1ed1c ch\u00ednh \u1edf h\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh nh\u00e2n. Nh\u00ecn chung kh\u00f4ng n\u00ean b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb c\u00e1c thu\u1ed1c n\u00e0y khi b\u1ec7nh nh\u00e2n \u0111ang c\u00f3 t\u00ecnh tr\u1ea1ng suy tim ph\u1ea3i cho t\u1edbi khi t\u00ecnh tr\u1ea1ng \u1ee9 huy\u1ebft \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb c\u01a1 b\u1ea3n.<\/p>\n

        2.3.2 <\/strong>T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a bosentan:<\/strong><\/h4>\n
          \n
        • Gi\u1eef n\u01b0\u1edbc\/ph\u00f9 ngo\u1ea1i bi\u00ean.<\/li>\n
        • C\u00f3 th\u1ec3 th\u1ea5y gi\u1ea3m hematocrit\/hemoglobin li\u00ean quan \u0111\u1ebfn li\u1ec1u, th\u01b0\u1eddng trong v\u00e0i tu\u1ea7n \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u1edbi s\u1ef1 \u1ed5n \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 sau 4 \u0111\u1ebfn 12 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb. Theo d\u00f5i huy\u1ebft s\u1eafc t\u1ed1 tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb, sau 1 v\u00e0 3 th\u00e1ng, v\u00e0 c\u1ee9 sau 3
          \nth\u00e1ng. Gi\u1ea3m \u0111\u00e1ng k\u1ec3 l\u01b0\u1ee3ng huy\u1ebft s\u1eafc t\u1ed1 \u0111\u00f2i h\u1ecfi ph\u1ea3i \u0111\u00e1nh gi\u00e1 th\u00eam \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3.<\/li>\n
        • Nhi\u1ec5m \u0111\u1ed9c gan: Bosentan c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng transaminase (ALT ho\u1eb7c AST \u22653 l\u1ea7n ULN) v\u00e0 trong m\u1ed9t s\u1ed1 \u00edt tr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 x\u1ea3y ra t\u0103ng n\u1ed3ng \u0111\u1ed9 bilirubin. Theo d\u00f5i transaminase h\u1eb1ng th\u00e1ng sau \u0111\u00f3. \u0110i\u1ec1u ch\u1ec9nh li\u1ec1u n\u1ebfu
          \nt\u0103ng men gan x\u1ea3y ra m\u00e0 kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng t\u1ed5n th\u01b0\u01a1ng gan ho\u1eb7c t\u0103ng bilirubin. \u0110\u00e3 c\u00f3 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p hi\u1ebfm x\u01a1 gan kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c sau khi \u0111i\u1ec1u tr\u1ecb k\u00e9o d\u00e0i (> 12 th\u00e1ng) \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb nhi\u1ec1u b\u1ec7nh l\u00fd v\u00e0 \u0111i\u1ec1u
          \ntr\u1ecb b\u1eb1ng thu\u1ed1c. C\u0169ng \u0111\u00e3 c\u00f3 tr\u01b0\u1eddng h\u1ee3p suy gan. N\u00ean ng\u1eebng \u0111i\u1ec1u tr\u1ecb \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n t\u0103ng transaminase k\u1ebft h\u1ee3p v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng t\u1ed5n th\u01b0\u01a1ng gan (m\u1ec7t m\u1ecfi b\u1ea5t th\u01b0\u1eddng v\u00e0ng da, bu\u1ed3n n\u00f4n, n\u00f4n, \u0111au b\u1ee5ng v\u00e0\/ho\u1eb7c s\u1ed1t) ho\u1eb7c t\u0103ng bilirubin (\u22652 l\u1ea7n ULN). Tr\u00e1nh s\u1eed d\u1ee5ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 transaminase huy\u1ebft thanh c\u01a1 b\u1ea3n> 3 l\u1ea7n ULN \u1edf m\u1ee9c c\u01a1 b\u1ea3n (vi\u1ec7c theo d\u00f5i nhi\u1ec5m \u0111\u1ed9c gan c\u00f3 th\u1ec3 kh\u00f3 kh\u0103n h\u01a1n) ho\u1eb7c suy gan t\u1eeb trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng. S\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o gan (t\u0103ng transaminase> 3 l\u1ea7n ULN) v\u00e0 bilirubin t\u0103ng \u22652 l\u1ea7n ULN l\u00e0 m\u1ed9t d\u1ea5u hi\u1ec7u cho
          \nkh\u1ea3 n\u0103ng nhi\u1ec5m \u0111\u1ed9c gan nghi\u00eam tr\u1ecdng. T\u0103ng transaminase ph\u1ee5 thu\u1ed9c v\u00e0o li\u1ec1u, th\u01b0\u1eddng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng, x\u1ea3y ra c\u1ea3 s\u1edbm v\u00e0 mu\u1ed9n trong \u0111i\u1ec1u tr\u1ecb, ti\u1ebfn tri\u1ec3n ch\u1eadm v\u00e0 th\u01b0\u1eddng h\u1ed3i ph\u1ee5c sau khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb ho\u1eb7c ng\u1eebng
          \nthu\u1ed1c. T\u0103ng transaminase c\u0169ng c\u00f3 th\u1ec3 t\u1ef1 \u0111\u1ea3o ng\u01b0\u1ee3c trong khi ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb bosentan. C\u00e2n nh\u1eafc l\u1ee3i \u00edch c\u1ee7a vi\u1ec7c \u0111i\u1ec1u tr\u1ecb so v\u1edbi nguy c\u01a1 nhi\u1ec5m \u0111\u1ed9c gan khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb \u1edf b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng WHO-FC II.<\/li>\n
        • Qu\u00e1 m\u1eabn c\u1ea3m: Ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn, bao g\u1ed3m ph\u1ea3n \u1ee9ng thu\u1ed1c v\u1edbi t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan v\u00e0 tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n (DRESS), s\u1ed1c ph\u1ea3n v\u1ec7, ph\u00e1t ban v\u00e0 ph\u00f9 m\u1ea1ch \u0111\u00e3 \u0111\u01b0\u1ee3c quan s\u00e1t.<\/li>\n
        • R\u1ed1i lo\u1ea1n sinh tinh tr\u00f9ng: Bosentan c\u00f3 th\u1ec3 c\u00f3 \u1ea3nh h\u01b0\u1edfng x\u1ea5u \u0111\u1ebfn s\u1ef1 sinh tinh tr\u00f9ng, s\u1ed1 l\u01b0\u1ee3ng tinh tr\u00f9ng gi\u1ea3m \u0111\u00e3 \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y \u1edf nam gi\u1edbi trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<\/li>\n
        • Thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i: c\u00f3 th\u1ec3 g\u1eb7p, c\u1ea7n ng\u1eebng ngay bosentan<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"

          T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i l\u00e0 \u0111i\u1ec1u th\u01b0\u1eddng g\u1eb7p trong l\u00e2m s\u00e0ng.Qua h\u01a1n ba th\u1eadp k\u1ef7 nghi\u00ean c\u1ee9u thu\u1ed1c \u0111i\u1ec1u tr\u1ecb, hi\u1ec7n t\u1ea1i \u0111\u00e3 c\u00f3 b\u1ed1n nh\u00f3m thu\u1ed1c \u0111\u01b0\u1ee3c ch\u1ea5p nh\u1eadn trong \u0111i\u1ec1u tr\u1ecb t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i. 1. Gi\u1edbi thi\u1ec7u chung Tr\u01b0\u1edbc n\u0103m 1995 kh\u00f4ng c\u00f3 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u cho t\u0103ng […]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[],"yoast_head":"\nT\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i v\u00e0 c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb - Vinmec<\/title>\n<meta name=\"description\" content=\"T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i v\u00e0 c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb l\u00e0 \u0111i\u1ec1u \u0111\u01b0\u1ee3c \u0111\u1eb7t ra trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. 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