{"id":25683,"date":"2023-04-21T11:26:43","date_gmt":"2023-04-21T04:26:43","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=25683"},"modified":"2023-04-21T11:41:51","modified_gmt":"2023-04-21T04:41:51","slug":"cac-bien-phap-du-phong-dot-quy-xuat-huyet-nao","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/cac-bien-phap-du-phong-dot-quy-xuat-huyet-nao\/","title":{"rendered":"C\u00e1c bi\u1ec7n ph\u00e1p d\u1ef1 ph\u00f2ng \u0111\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft n\u00e3o"},"content":{"rendered":"

C\u00e1c bi\u1ec7n ph\u00e1p<\/a> d\u1ef1 ph\u00f2ng \u0111\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft n\u00e3o r\u1ea5t quan tr\u1ecdng v\u00ec \u0111\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng lo\u1ea1i \u0111\u1ed9t qu\u1ef5 nguy hi\u1ec3m v\u00e0 c\u00f3 t\u1ec9 l\u1ec7 t\u1eed vong v\u00e0 t\u00e0n ph\u1ebf cao. \u0110\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft n\u00e3o x\u1ea3y ra khi m\u00e1u ch\u1ea3y ra kh\u1ecfi m\u1ea1ch m\u00e1u n\u00e3o v\u00e0 g\u00e2y ra s\u1ef1 t\u1ed5n th\u01b0\u01a1ng v\u00e0 m\u1ea5t ch\u1ee9c n\u0103ng c\u1ee7a c\u00e1c v\u00f9ng n\u00e3o. Vi\u1ec7c \u00e1p d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p d\u1ef1 ph\u00f2ng \u0111\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft n\u00e3o c\u00f3 th\u1ec3 gi\u1ea3m nguy c\u01a1 b\u1ecb \u0111\u1ed9t qu\u1ef5 v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh.<\/strong><\/p>\n

\"Ki\u1ec3m
Ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p l\u00e0 bi\u1ec7n ph\u00e1p d\u1ef1 ph\u00f2ng \u0111\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft n\u00e3o<\/figcaption><\/figure>\n

 <\/p>\n

1. Ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p<\/h2>\n

AHA\/ASA n\u0103m 2010 khuy\u1ebfn c\u00e1o c\u00e1c b\u1ec7nh nh\u00e2n xu\u1ea5t huy\u1ebft n\u00e3o t\u1ef1 ph\u00e1t m\u00e0 kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh d\u00f9ng thu\u1ed1c h\u1ea1 huy\u1ebft \u00e1p th\u00ec v\u1eabn c\u1ea7n ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p ch\u1eb7t ch\u1ebd, nh\u1ea5t l\u00e0 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 v\u1ecb tr\u00ed xu\u1ea5t huy\u1ebft n\u00e3o \u0111i\u1ec3n h\u00ecnh do t\u0103ng huy\u1ebft \u00e1p. Ngo\u00e0i ra, khuy\u1ebfn c\u00e1o duy tr\u00ec huy\u1ebft \u00e1p m\u1ee5c ti\u00eau < 140\/90 mmHg \u0111\u1ec3 d\u1ef1 ph\u00f2ng c\u01a1n \u0111\u1ed9t qu\u1ef5 \u0111\u1ea7u ti\u00ean. C\u00e1c b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p k\u00e8m \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng ho\u1eb7c b\u1ec7nh th\u1eadn, m\u1ee5c ti\u00eau huy\u1ebft \u00e1p < 130\/80 mmHg [110]. C\u00e1c thu\u1ed1c h\u1ea1 \u00e1p bao g\u1ed3m: l\u1ee3i ti\u1ec3u thiazid, ch\u1eb9n k\u00eanh canxi, \u1ee9c ch\u1ebf men chuy\u1ec3n, \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3. C\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, s\u1eed d\u1ee5ng \u1ee9c ch\u1ebf men chuy\u1ec3n\/ \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 l\u00e0 khuy\u1ebfn c\u00e1o IA theo AHA\/ASA 2011. Ch\u1eb9n beta giao c\u1ea3m thu\u1ed9c h\u00e0ng th\u1ee9 2 do t\u00e1c d\u1ee5ng d\u1ef1 ph\u00f2ng c\u00e1c bi\u1ebfn c\u1ed1 m\u1ea1ch m\u00e1u th\u1ea5p h\u01a1n m\u1eb7c d\u00f9 t\u00e1c d\u1ee5ng h\u1ea1 \u00e1p t\u01b0\u01a1ng \u0111\u01b0\u01a1ng.<\/span><\/p>\n

Tuy statin \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o d\u1ef1 ph\u00f2ng \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u ti\u00ean ph\u00e1t (m\u1ee9c b\u1eb1ng ch\u1ee9ng IA) \u0111\u1eb7c bi\u1ec7t n\u1ebfu k\u00e8m y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c nh\u01b0ng m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u cho th\u1ea5y c\u00f3 th\u1ec3 t\u0103ng nguy c\u01a1 xu\u1ea5t huy\u1ebft n\u00e3o khi d\u00f9ng statin. Tuy nhi\u00ean, m\u1ed9t ph\u00e2n t\u00edch meta-analysis tr\u00ean 31 th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 ki\u1ec3m so\u00e1t cho th\u1ea5y \u0111i\u1ec1u tr\u1ecb statin kh\u00f4ng li\u00ean quan \u0111\u1ebfn t\u0103ng c\u00f3 \u00fd ngh\u0129a xu\u1ea5t huy\u1ebft n\u00e3o.<\/span><\/p>\n

Trong nghi\u00ean c\u1ee9u HOPE (Heart Outcomes Prevention Evaluation), th\u00eam ramipril v\u00e0o c\u00e1c \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa kh\u00e1c bao g\u1ed3m kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u, l\u00e0m gi\u1ea3m nguy c\u01a1 t\u01b0\u01a1ng \u0111\u1ed1i \u0111\u1ed9t qu\u1ef5, t\u1eed vong v\u00e0 nh\u1ed3i m\u00e1u c\u01a1 tim 32% so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c.. Ch\u1ec9 40% hi\u1ec7u qu\u1ea3 c\u1ee7a ramipril l\u00e0 do t\u00e1c d\u1ee5ng h\u1ea1 \u00e1p c\u1ee7a thu\u1ed1c, c\u00e1c c\u01a1 ch\u1ebf kh\u00e1c li\u00ean quan \u0111\u1ebfn t\u00e1c d\u1ee5ng b\u1ea3o v\u1ec7 n\u1ed9i m\u1ea1c.<\/span><\/p>\n

Nghi\u00ean c\u1ee9u PROGRESS (Perindopril Protection Against Recurrent Stroke Study) cho th\u1ea5y perindopril c\u00f3 t\u00e1c d\u1ee5ng v\u01b0\u1ee3t tr\u1ed9i so v\u1edbi placebo. M\u1eb7c d\u00f9 b\u1ea3n th\u00e2n thu\u1ed1c kh\u00f4ng \u01b0u th\u1ebf h\u01a1n nh\u01b0ng khi k\u1ebft h\u1ee3p v\u1edbi indapamid gi\u00fap l\u00e0m gi\u1ea3m \u0111\u1ed9t qu\u1ef5 t\u00e1i ph\u00e1t, ph\u1ea7n l\u1edbn hi\u1ec7u qu\u1ea3 n\u00e0y \u0111\u1ebfn t\u1eeb t\u00e1c d\u1ee5ng h\u1ea1 \u00e1p, ng\u01b0\u1ee3c v\u1edbi k\u1ebft qu\u1ea3 c\u1ee7a nghi\u00ean c\u1ee9u HOPE v\u1ec1 ramipril.<\/span><\/p>\n

Nghi\u00ean c\u1ee9u ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) cho th\u1ea5y chlorthalidone hi\u1ec7u qu\u1ea3 h\u01a1n m\u1ed9t ch\u00fat so v\u1edbi lisinopril trong d\u1ef1 ph\u00f2ng \u0111\u1ed9t qu\u1ef5.<\/span><\/p>\n

Nghi\u00ean c\u1ee9u LIFE (Losartan Intervention for Endpoint Reduction in Hypertension Study) ch\u1ee9ng minh r\u1eb1ng \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 (losartan) gi\u1ea3m nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 \u01b0u th\u1ebf h\u01a1n ch\u1eb9n beta giao c\u1ea3m (atenolol).<\/span><\/p>\n

Nghi\u00ean c\u1ee9u MOSES (Morbidity and Mortality after Stroke, Eprosartan Compared With Nitrendipine for Secondary Prevention) cho th\u1ea5y eprosartan \u01b0u th\u1ebf h\u01a1n ch\u1eb9n k\u00eanh canxi nitrendipin trong d\u1ef1 ph\u00f2ng th\u1ee9 ph\u00e1t \u0111\u1ed9t qu\u1ef5 v\u00e0 tai bi\u1ebfn m\u1ea1ch n\u00e3o tho\u00e1ng qua. Nghi\u00ean c\u1ee9u n\u00e0y t\u01b0\u01a1ng \u0111\u1ed1i nh\u1ecf v\u00e0 ph\u1ea7n l\u1edbn c\u00e1c bi\u1ebfn c\u1ed1 l\u00e0 tai bi\u1ebfn m\u1ea1ch n\u00e3o tho\u00e1ng qua.<\/span><\/p>\n

2. Ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft<\/h2>\n

Vi\u1ec7c ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft l\u00e0 m\u1ed9t ph\u1ea7n quan tr\u1ecdng trong d\u1ef1 ph\u00f2ng \u0111\u1ed9t qu\u1ef5 n\u00e3o, \u0111\u1eb7c bi\u1ec7t \u0111\u1ed1i v\u1edbi nh\u1eefng ng\u01b0\u1eddi c\u00f3 nguy c\u01a1 m\u1eafc ti\u1ec3u \u0111\u01b0\u1eddng. \u0110i\u1ec1u n\u00e0y b\u1edfi v\u00ec \u0111\u01b0\u1eddng huy\u1ebft cao c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch v\u00e0 d\u1eabn \u0111\u1ebfn h\u00ecnh th\u00e0nh c\u00e1c c\u1ee5c m\u00e1u \u0111\u00f4ng, l\u00e0m t\u1eafc ngh\u1ebdn m\u1ea1ch m\u00e1u v\u00e0 g\u00e2y ra \u0111\u1ed9t qu\u1ef5.<\/p>\n

C\u00e1c bi\u1ec7n ph\u00e1p ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft bao g\u1ed3m:<\/p>\n

    \n
  • Ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng l\u00e0nh m\u1ea1nh: N\u00ean \u0103n nhi\u1ec1u rau c\u1ee7, hoa qu\u1ea3, th\u1ef1c ph\u1ea9m gi\u00e0u ch\u1ea5t x\u01a1, gi\u1ea3m \u0111\u01b0\u1eddng v\u00e0 ch\u1ea5t b\u00e9o. N\u00ean \u0103n c\u00e1c b\u1eefa \u0103n nh\u1ecf v\u00e0 th\u01b0\u1eddng xuy\u00ean \u0111\u1ec3 gi\u00fap duy tr\u00ec \u0111\u01b0\u1eddng huy\u1ebft \u1ed5n \u0111\u1ecbnh.<\/li>\n
  • T\u1eadp th\u1ec3 d\u1ee5c th\u01b0\u1eddng xuy\u00ean: T\u1eadp th\u1ec3 d\u1ee5c th\u01b0\u1eddng xuy\u00ean c\u00f3 th\u1ec3 gi\u00fap ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 gi\u1ea3m nguy c\u01a1 \u0111\u1ed9t qu\u1ef5.<\/li>\n
  • U\u1ed1ng \u0111\u1ee7 n\u01b0\u1edbc: U\u1ed1ng \u0111\u1ee7 n\u01b0\u1edbc c\u00f3 th\u1ec3 gi\u00fap gi\u1ea3m \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 duy tr\u00ec \u0111\u1ed9 \u1ea9m cho c\u01a1 th\u1ec3.<\/li>\n
  • Theo d\u00f5i \u0111\u01b0\u1eddng huy\u1ebft: \u0110o \u0111\u01b0\u1eddng huy\u1ebft th\u01b0\u1eddng xuy\u00ean v\u00e0 ghi l\u1ea1i k\u1ebft qu\u1ea3 \u0111\u1ec3 theo d\u00f5i v\u00e0 \u0111i\u1ec1u ch\u1ec9nh ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng v\u00e0 t\u1eadp th\u1ec3 d\u1ee5c.<\/li>\n
  • S\u1eed d\u1ee5ng thu\u1ed1c: N\u1ebfu ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng v\u00e0 t\u1eadp th\u1ec3 d\u1ee5c kh\u00f4ng \u0111\u1ee7 \u0111\u1ec3 ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft, b\u00e1c s\u0129 c\u00f3 th\u1ec3 k\u00ea \u0111\u01a1n thu\u1ed1c \u0111\u1ec3 gi\u00fap ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft.<\/li>\n<\/ul>\n

    3. Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng<\/h2>\n

    C\u00e1c bi\u1ec7n ph\u00e1p nh\u01b0 ng\u1eebng h\u00fat thu\u1ed1c, gi\u1ea3m c\u00e2n, h\u1ea1n ch\u1ebf \u0103n mu\u1ed1i v\u00e0 t\u0103ng c\u01b0\u1eddng ch\u1ebf \u0111\u1ed9 \u0103n gi\u00e0u kali c\u00f3 t\u00e1c d\u1ee5ng d\u1ef1 ph\u00f2ng \u0111\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft n\u00e3o b\u1eb1ng c\u00e1ch gi\u1ea3m nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch v\u00e0 huy\u1ebft \u00e1p cao. Ngo\u00e0i ra, vi\u1ec7c ng\u1eebng u\u1ed1ng r\u01b0\u1ee3u, bia c\u0169ng gi\u00fap gi\u1ea3m nguy c\u01a1 xu\u1ea5t huy\u1ebft n\u00e3o.<\/p>\n

    T\u1eadp th\u1ec3 d\u1ee5c l\u00e0 m\u1ed9t bi\u1ec7n ph\u00e1p kh\u00f4ng d\u00f9ng thu\u1ed1c \u0111\u01b0\u1ee3c khuy\u1ebfn kh\u00edch r\u1ea5t m\u1ea1nh m\u1ebd \u0111\u1ec3 d\u1ef1 ph\u00f2ng \u0111\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft n\u00e3o. T\u1eadp th\u1ec3 d\u1ee5c c\u00f3 th\u1ec3 gi\u00fap c\u1ea3i thi\u1ec7n s\u1ee9c kh\u1ecfe tim m\u1ea1ch, gi\u1ea3m huy\u1ebft \u00e1p v\u00e0 c\u1ea3i thi\u1ec7n s\u1ef1 tu\u1ea7n ho\u00e0n m\u00e1u. Theo khuy\u1ebfn c\u00e1o c\u1ee7a Hi\u1ec7p h\u1ed9i Tim m\u1ea1ch Hoa K\u1ef3 \/ Hi\u1ec7p h\u1ed9i \u0110\u1ed9t qu\u1ef5 Hoa K\u1ef3 (AHA \/ ASA), ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng n\u00ean t\u1eadp th\u1ec3 d\u1ee5c v\u1edbi c\u01b0\u1eddng \u0111\u1ed9 trung b\u00ecnh \u00edt nh\u1ea5t 150 ph\u00fat m\u1ed7i tu\u1ea7n.<\/p>\n

    Ngo\u00e0i ra, vi\u1ec7c duy tr\u00ec m\u1ed9t ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng l\u00e0nh m\u1ea1nh v\u00e0 c\u00e2n b\u1eb1ng c\u0169ng r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 d\u1ef1 ph\u00f2ng \u0111\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft n\u00e3o. N\u00ean \u0103n nhi\u1ec1u rau c\u1ee7, hoa qu\u1ea3, th\u1ef1c ph\u1ea9m gi\u00e0u ch\u1ea5t x\u01a1 v\u00e0 gi\u1ea3m \u0111\u01b0\u1eddng v\u00e0 ch\u1ea5t b\u00e9o. Vi\u1ec7c duy tr\u00ec m\u1ed9t l\u1ed1i s\u1ed1ng l\u00e0nh m\u1ea1nh v\u00e0 h\u1ee3p l\u00fd c\u00f3 th\u1ec3 gi\u00fap gi\u1ea3m nguy c\u01a1 b\u1ecb \u0111\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft n\u00e3o v\u00e0 c\u1ea3i thi\u1ec7n s\u1ee9c kh\u1ecfe t\u1ed5ng th\u1ec3.<\/p>\n

    T\u00f3m l\u1ea1i, c\u00e1c bi\u1ec7n ph\u00e1p n\u00e0y c\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ec1u \u0111\u1eb7n v\u00e0 li\u00ean t\u1ee5c \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 b\u1ecb \u0111\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft n\u00e3o v\u00e0 c\u1ea3i thi\u1ec7n s\u1ee9c kh\u1ecfe t\u1ed5ng th\u1ec3. Ngo\u00e0i ra, n\u1ebfu c\u00f3 b\u1ea5t k\u1ef3 tri\u1ec7u ch\u1ee9ng n\u00e0o li\u00ean quan \u0111\u1ebfn \u0111\u1ed9t qu\u1ef5, ng\u01b0\u1eddi b\u1ec7nh n\u00ean \u0111i kh\u00e1m ngay l\u1eadp t\u1ee9c \u0111\u1ec3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi.<\/p>\n

    Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n","protected":false},"excerpt":{"rendered":"

    C\u00e1c bi\u1ec7n ph\u00e1p d\u1ef1 ph\u00f2ng \u0111\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft n\u00e3o r\u1ea5t quan tr\u1ecdng v\u00ec \u0111\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng lo\u1ea1i \u0111\u1ed9t qu\u1ef5 nguy hi\u1ec3m v\u00e0 c\u00f3 t\u1ec9 l\u1ec7 t\u1eed vong v\u00e0 t\u00e0n ph\u1ebf cao. \u0110\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft n\u00e3o x\u1ea3y ra khi m\u00e1u ch\u1ea3y ra kh\u1ecfi m\u1ea1ch m\u00e1u n\u00e3o v\u00e0 g\u00e2y ra s\u1ef1 t\u1ed5n th\u01b0\u01a1ng […]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[10,33],"tags":[3],"yoast_head":"\nC\u00e1c bi\u1ec7n ph\u00e1p d\u1ef1 ph\u00f2ng \u0111\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft n\u00e3o - Vinmec<\/title>\n<meta name=\"description\" content=\"\u0110\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft n\u00e3o g\u00e2y ra s\u1ef1 t\u1ed5n th\u01b0\u01a1ng v\u00e0 m\u1ea5t ch\u1ee9c n\u0103ng c\u1ee7a c\u00e1c v\u00f9ng n\u00e3o. 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