{"id":26399,"date":"2023-04-22T13:07:19","date_gmt":"2023-04-22T06:07:19","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=26399"},"modified":"2023-04-22T13:07:19","modified_gmt":"2023-04-22T06:07:19","slug":"thuoc-tim-mach-dung-tren-benh-nhan-covid-19-co-gi-luu-y","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/thuoc-tim-mach-dung-tren-benh-nhan-covid-19-co-gi-luu-y\/","title":{"rendered":"COVID-19 v\u00e0 vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c tim m\u1ea1ch"},"content":{"rendered":"

COVID-19<\/a> (Coronavirus disease 2019) \u0111ang l\u00e0 \u0111\u1ea1i d\u1ecbch to\u00e0n c\u1ea7u do virus SARS-CoV-2<\/strong> g\u00e2y ra. B\u1ec7nh x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c kh\u1edfi<\/strong> \u0111\u1ea7u t\u1eeb khu ch\u1ee3 Hoa Nam b\u00e1n v\u00e0 gi\u1ebft m\u1ed5 nhi\u1ec1u lo\u1ea1i \u0111\u1ed9ng v\u1eadt hoang d\u00e3 t\u1ea1i th\u00e0nh ph\u1ed1 V\u0169<\/strong> H\u00e1n thu\u1ed9c t\u1ec9nh H\u1ed3 B\u1eafc, Trung Qu\u1ed1c. Sau \u0111\u00f3 b\u1ec7nh l\u00e2y lan nhanh ch\u00f3ng sang c\u00e1c n\u01b0\u1edbc<\/strong> l\u00e2n c\u1eadn nh\u01b0 Nh\u1eadt B\u1ea3n, H\u00e0n Qu\u1ed1c, r\u1ed3i \u0111\u1ebfn c\u00e1c n\u01b0\u1edbc kh\u00e1c \u1edf ch\u00e2u \u00c1 c\u0169ng nh\u01b0 c\u00e1c ch\u00e2u l\u1ee5c<\/strong> kh\u00e1c.<\/strong><\/p>\n

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

Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng th\u01b0\u1eddng g\u1eb7p c\u1ee7a b\u1ec7nh bao g\u1ed3m c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a vi\u00eam \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p nh\u01b0 s\u1ed1t, ho, \u0111au h\u1ecdng. M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n sau \u0111\u00f3 xu\u1ea5t hi\u1ec7n kh\u00f3 th\u1edf r\u1ed3i ti\u1ebfn tri\u1ec3n th\u00e0nh h\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p ti\u1ebfn tri\u1ec3n (ARDS) v\u00e0 c\u00f3 ti\u00ean l\u01b0\u1ee3ng r\u1ea5t n\u1eb7ng. Nhi\u1ec1u nghi\u00ean c\u1ee9u ch\u1ee9ng minh ng\u01b0\u1eddi c\u00f3 b\u1ec7nh l\u00fd tim m\u1ea1ch nh\u01b0 t\u0103ng huy\u1ebft \u00e1p, b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh\u2026 l\u00e0 nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng d\u1ec5 m\u1eafc b\u1ec7nh COVID-19. M\u1eb7t kh\u00e1c h\u1ecd c\u0169ng l\u00e0 nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng nguy c\u01a1 c\u00f3 c\u00e1c k\u1ebft c\u1ee5c l\u00e2m s\u00e0ng x\u1ea5u h\u01a1n.<\/p>\n

\"COVID-19<\/p>\n

COVID-19 v\u00e0 thu\u1ed1c tim m\u1ea1ch<\/strong><\/p>\n

2. S\u1eed d\u1ee5ng thu\u1ed1c tim m\u1ea1ch \u1edf b\u1ec7nh nh\u00e2n covid-19<\/h2>\n

Nh\u01b0 \u0111\u00e3 \u0111\u1ec1 c\u1eadp \u1edf ph\u1ea7n tr\u00ean, ng\u01b0\u1eddi b\u1ec7nh COVID-19 c\u00f3 m\u1ed9t t\u1ef7 l\u1ec7 kh\u00e1 cao c\u00f3 ti\u1ec1n s\u1eed m\u1eafc b\u1ec7nh l\u00fd tim m\u1ea1ch nh\u01b0 t\u0103ng huy\u1ebft \u00e1p, b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh\u2026 M\u1eb7t kh\u00e1c, c\u00e1c nghi\u00ean c\u1ee9u ghi nh\u1eadn t\u00ecnh tr\u1ea1ng t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim, t\u0103ng \u0111\u00f4ng, suy tim, r\u1ed1i lo\u1ea1n nh\u1ecbp tim\u2026 \u1edf b\u1ec7nh nh\u00e2n COVID-19. V\u00ec v\u1eady, vi\u1ec7c ti\u1ebfp t\u1ee5c\/ng\u1eebng s\u1eed d\u1ee5ng ho\u1eb7c b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c tim m\u1ea1ch c\u1ea7n \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc k\u1ef9 l\u01b0\u1ee1ng c\u0169ng nh\u01b0 \u0111\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng t\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb COVID-19 \u0111\u1ec3 c\u00f3 chi\u1ebfn l\u01b0\u1ee3c s\u1eed d\u1ee5ng thu\u1ed1c h\u1ee3p l\u00fd.<\/p>\n

2.1. Thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n, \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3<\/h3>\n

Men chuy\u1ec3n d\u1ea1ng angiotensin II (angiotensin-converting enzyme 2 \u2013 ACE2) \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 m\u1ed9t \u0111\u1ed3ng th\u1ee5 th\u1ec3 (co-receptor) cho virus SARS-CoV-2 x\u00e2m nh\u1eadp v\u00e0o t\u1ebf b\u00e0o c\u01a1 th\u1ec3 v\u00e0 \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong di\u1ec5n bi\u1ebfn b\u1ec7nh h\u1ecdc c\u1ee7a COVID-19. ACE2 t\u00ecm th\u1ea5y \u1edf nhi\u1ec1u n\u01a1i trong c\u01a1 th\u1ec3 nh\u01b0 h\u1ec7 ti\u00eau ho\u00e1, tim v\u00e0 th\u1eadn v\u00e0 nh\u1ea5t l\u00e0 \u1edf ph\u1ed5i. M\u1ed9t s\u1ed1 d\u1eef li\u1ec7u g\u1ee3i \u00fd, s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n ho\u1eb7c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 c\u00f3 th\u1ec3 l\u00e0m t\u0103ng bi\u1ec3u l\u1ed9 ACE2 t\u1eeb \u0111\u00f3 l\u00e0m t\u0103ng kh\u1ea3 n\u0103ng nhi\u1ec5m virus. Tuy nhi\u00ean, m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u kh\u00e1c l\u1ea1i \u0111\u01b0a ra k\u1ebft qu\u1ea3 ng\u01b0\u1ee3c l\u1ea1i, vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n ho\u1eb7c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 gi\u00fap ACE2 t\u0103ng kh\u1ea3 n\u0103ng b\u1ea3o v\u1ec7 ph\u1ed5i. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u quan s\u00e1t v\u1edbi c\u1ee1 m\u1eabu kh\u00e1 l\u1edbn g\u1ea7n \u0111\u00e2y cho th\u1ea5y vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c tim m\u1ea1ch nh\u01b0 \u1ee9c ch\u1ebf men chuy\u1ec3n, \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3, ch\u1eb9n beta giao c\u1ea3m, thu\u1ed1c l\u1ee3i ti\u1ec3u, thu\u1ed1c ch\u1eb9n k\u00eanh canxi kh\u00f4ng l\u00e0m t\u0103ng nguy c\u01a1 m\u1eafc b\u1ec7nh c\u0169ng nh\u01b0 nguy c\u01a1 ti\u1ebfn tri\u1ec3n n\u1eb7ng \u1edf b\u1ec7nh nh\u00e2n nhi\u1ec5m SARS-CoV-2.
\nNh\u01b0 v\u1eady, hi\u1ec7n kh\u00f4ng r\u00f5 r\u00e0ng vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n ho\u1eb7c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 s\u1ebd mang l\u1ea1i l\u1ee3i \u00edch t\u1ed1t hay nguy c\u01a1 x\u1ea5u cho ng\u01b0\u1eddi b\u1ec7nh COVID-19.
\nH\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p c\u1ee7a H\u1ed9i Tim m\u1ea1ch ch\u00e2u \u00c2u 2020 nh\u1ea5n m\u1ea1nh: B\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p n\u00ean tu\u00e2n theo c\u00e1c h\u01b0\u1edbng d\u1eabn theo khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft k\u1ec3 c\u1ea3 \u0111ang m\u1eafc COVID-19.
\nTrong tr\u01b0\u1eddng h\u1ee3p s\u1ed1c, vi\u1ec7c d\u1eebng thu\u1ed1c ho\u1eb7c ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n ho\u1eb7c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 tu\u1ef3 thu\u1ed9c v\u00e0o t\u1eebng c\u00e1 nh\u00e2n. H\u1ed9i Tim m\u1ea1ch Canada khuy\u00ean b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p n\u00ean ti\u1ebfp t\u1ee5c ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p b\u1eb1ng thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n, \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 ho\u1eb7c \u1ee9c ch\u1ebf angiotensin\/sacubitril d\u00f9 b\u1ec7nh nh\u00e2n m\u1eafc COVID-19.
\nT\u01b0\u01a1ng t\u1ef1 nh\u01b0 v\u1eady, c\u00e1c chuy\u00ean gia t\u1eeb M\u1ef9 nh\u1eadn \u0111\u1ecbnh c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n ho\u1eb7c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 v\u1eabn n\u00ean ti\u1ebfp t\u1ee5c ch\u1ec9 \u0111\u1ecbnh cho c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 ho\u1eb7c \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m virus SARS-CoV-2.
\nNh\u01b0 v\u1eady, c\u00e1c th\u1eed nghi\u1ec7m \u0111\u1ebfn th\u1eddi \u0111i\u1ec3m hi\u1ec7n t\u1ea1i ch\u01b0a ch\u1ee9ng minh \u0111\u01b0\u1ee3c l\u1ee3i \u00edch ho\u1eb7c nguy c\u01a1 khi s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n v\u00e0 \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 \u1edf b\u1ec7nh nh\u00e2n
\nCOVID-19. M\u1ed9t s\u1ed1 H\u1ed9i tim m\u1ea1ch c\u00f3 uy t\u00edn tr\u00ean th\u1ebf gi\u1edbi v\u1eabn khuy\u1ebfn c\u00e1o ng\u01b0\u1eddi b\u1ec7nh COVID-19 v\u1eabn c\u00f3 th\u1ec3 duy tr\u00ec ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p b\u1eb1ng c\u00e1c thu\u1ed1c k\u1ec3 tr\u00ean n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh v\u00e0 \u0111ang \u0111i\u1ec1u tr\u1ecb \u1ed5n \u0111\u1ecbnh.<\/p>\n

Gi\u1ea3 thuy\u1ebft v\u1ec1 t\u01b0\u01a1ng t\u00e1c c\u1ee7a SARS-CoV-2 v\u1edbi h\u1ec7 th\u1ed1ng Renin-AngiotensinAldosterone. H\u00ecnh tr\u00ean m\u00f4 t\u1ea3 b\u01b0\u1edbc \u0111\u1ea7u x\u00e2m nh\u1eadp t\u1ebf b\u00e0o m\u00e0 ch\u1ee7 y\u1ebfu l\u00e0 ph\u1ebf b\u00e0o II c\u1ee7a SARS-CoV-2. Sau khi virus g\u1eafn v\u1edbi th\u1ee5 th\u1ec3 ch\u1ee9c n\u0103ng l\u00e0 ACE2. Sau khi h\u00ecnh th\u00e0nh t\u00fai n\u1ed9i b\u00e0o ch\u1ee9a ph\u1ee9c h\u1ee3p c\u1ee7a virus, s\u1ed1 l\u01b0\u1ee3ng ACE2 m\u00e0ng ng\u00e0y c\u00e0ng gi\u1ea3m, d\u1eabn t\u1edbi t\u00edch l\u0169y angiotensin II. S\u1ef1 ho\u1ea1t h\u00f3a t\u1ea1i ch\u1ed7 c\u1ee7a h\u1ec7 th\u1ed1ng renin-angiotensin-aldosterone c\u00f3 th\u1ec3 g\u00e2y t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i.<\/p>\n

2<\/strong>.2. Thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m<\/strong><\/h3>\n

N\u00ean c\u00e2n nh\u1eafc gi\u1ea3m li\u1ec1u c\u00e1c thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m nh\u01b0 metoprolol, carvedilol, propranolol v\u00e0 labetalol n\u1ebfu b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh d\u00f9ng chloroquine ho\u1eb7c hydroxychloroquine \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb COVID-19.
\nC\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 tr\u00ean tim m\u1ea1ch c\u1ee7a chloroquine ho\u1eb7c hydroxychloroquine bao g\u1ed3m:g\u00e2y \u0111\u1ed9c tr\u1ef1c ti\u1ebfp cho t\u1ebf b\u00e0o c\u01a1 tim, l\u00e0m n\u1eb7ng th\u00eam t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd c\u01a1 tim s\u1eb5n c\u00f3, c\u00f3 nguy c\u01a1 l\u00e0m thay \u0111\u1ed5i d\u1eabn truy\u1ec1n trong c\u01a1 tim: block nh\u0129 th\u1ea5t, block nh\u00e1nh, xo\u1eafn \u0111\u1ec9nh, nh\u1ecbp nhanh th\u1ea5t v\u00e0 rung th\u1ea5t.
\nChloroquine l\u00e0 thu\u1ed1c \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb s\u1ed1t r\u00e9t v\u00e0 m\u1ed9t s\u1ed1 b\u1ec7nh nh\u01b0 lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng, x\u01a1 c\u1ee9ng b\u00ec, b\u1ec7nh da nh\u1ea1y c\u1ea3m \u00e1nh s\u00e1ng\u2026 Thu\u1ed1c n\u00e0y c\u00f3 t\u00e1c d\u1ee5ng ng\u0103n c\u1ea3n s\u1ef1 nh\u00e2n l\u00ean c\u1ee7a virus do l\u00e0m t\u0103ng pH ti\u1ec3u th\u1ec3 n\u1ed9i b\u00e0o, ngo\u00e0i ra trong in vitro thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a virus SARS-CoV-2. Chloroquine c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf cytochrom CYP2D6 \u1edf gan, do \u0111\u00f3 c\u00f3 kh\u1ea3 n\u0103ng l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 c\u00e1c thu\u1ed1c ch\u1eb9n beta chuy\u1ec3n h\u00f3a qua CYP2D6 nh\u01b0 metoprolol, carvedilol, propranolol v\u00e0 labetalol. Ch\u00ednh v\u00ec v\u1eady n\u00ean c\u00e2n nh\u1eafc gi\u1ea3m li\u1ec1u c\u00e1c thu\u1ed1c ch\u1eb9n beta tr\u00ean khi d\u00f9ng k\u00e8m chloroquine ho\u1eb7c hydroxychloroquine. M\u1eb7t kh\u00e1c c\u1ea7n theo d\u00f5i s\u00e1t nh\u1ecbp tim v\u00e0 huy\u1ebft \u00e1p c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh.
\nThu\u1ed1c lopinavir\/ritonavir c\u0169ng c\u00f3 m\u1ed9t s\u1ed1 t\u00e1c d\u1ee5ng ph\u1ee5 li\u00ean quan t\u1edbi d\u1eabn truy\u1ec1n trong tim bao g\u1ed3m: G\u00e2y k\u00e9o d\u00e0i \u0111o\u1ea1n QT, g\u00e2y block nh\u0129 th\u1ea5t \u0111\u1ed9 cao v\u00e0 xo\u1eafn \u0111\u1ec9nh. Ch\u00ednh v\u00ec v\u1eady c\u1ea7n c\u00e2n nh\u1eafc k\u1ef9 thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m khi d\u00f9ng k\u00e8m c\u00e1c thu\u1ed1c n\u00e0y \u1edf b\u1ec7nh nh\u00e2n COVID-19.
\n\u0110\u1ed1i v\u1edbi fingolimod: Thu\u1ed1c c\u00f3 c\u00e1c t\u00e1c ph\u1ee5 tr\u00ean tim m\u1ea1ch nh\u01b0 g\u00e2y t\u0103ng huy\u1ebft \u00e1p, g\u00e2y block nh\u0129 th\u1ea5t, nh\u1ecbp ch\u1eadm, k\u00e9o d\u00e0i \u0111o\u1ea1n QT. Do \u0111\u00f3, kh\u00f4ng n\u00ean ch\u1ec9 \u0111\u1ecbnh thu\u1ed1c n\u00e0y cho c\u00e1c b\u1ec7nh nh\u00e2n sau nh\u1ed3i m\u00e1u c\u01a1 tim, \u0111au th\u1eaft ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh, suy tim c\u1ea5p, tai bi\u1ebfn m\u1ea1ch n\u00e3o bao g\u1ed3m c\u1ea3 tai bi\u1ebfn m\u1ea1ch n\u00e3o tho\u00e1ng qua, block nh\u0129 th\u1ea5t \u0111\u1ed9 cao, h\u1ed9i ch\u1ee9ng suy n\u00fat xoang v\u00e0 QTc \u2265 500ms.<\/p>\n

2<\/strong>.3. Thu\u1ed1c ch\u1eb9n k\u00eanh canxi<\/strong><\/h3>\n

Thu\u1ed1c ch\u1eb9n k\u00eanh canxi nh\u00f3m dihydropyridine nh\u01b0 verapamil ho\u1eb7c diltiazem c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m ch\u1eadm \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n, t\u0103ng th\u1eddi gian tr\u01a1 v\u00e0 l\u00e0m ch\u1eadm nh\u1ecbp tim. C\u1ea7n c\u00e2n nh\u1eafc, l\u01b0u \u00fd khi s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c n\u00e0y khi b\u1ec7nh nh\u00e2n COVID-19 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng chloroquine\/hydroxychloroquine ho\u1eb7c fingolimod ho\u1eb7c lopinavir\/ritonavir.
\nNh\u00f3m thu\u1ed1c ch\u1eb9n k\u00eanh canxi nondihydropyridine nh\u01b0 amlodipine, felodipine, lacidipine\u2026 v\u1eabn c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh cho c\u00e1c b\u1ec7nh nh\u00e2n COVID-19.<\/p>\n

2<\/strong>.4. C\u00e1c thu\u1ed1c ch\u1ed1ng r\u1ed1i lo\u1ea1n nh\u1ecbp\u00a0<\/strong><\/h3>\n

Nh\u00f3m IA <\/strong>(quinidine, procainamide, disopyramide) v\u00e0 c\u00e1c thu\u1ed1c ch\u1ed1ng r\u1ed1i lo\u1ea1n nh\u1ecbp nh\u00f3m III (amiodarone, sotalol, bretylium, ibutilide, dofetilide)
\nC\u00e1c thu\u1ed1c n\u00e0y l\u00e0m k\u00e9o d\u00e0i \u0111o\u1ea1n QT v\u00ec v\u1eady c\u1ea7n c\u1ea9n tr\u1ecdng khi d\u00f9ng c\u00f9ng c\u00e1c thu\u1ed1c nh\u01b0 chloroquine\/hydroxychloroquine ho\u1eb7c fingolimod ho\u1eb7c lopinavir\/ritonavir \u1edf ng\u01b0\u1eddi b\u1ec7nh COVID-19. Ngo\u00e0i ra c\u1ea7n th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng \u1edf b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim,suy tim\u2026<\/p>\n

2<\/strong>.5. Digoxin<\/strong><\/h3>\n

C\u1ea7n c\u00e2n nh\u1eafc khi s\u1eed d\u1ee5ng digoxin \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb k\u00e8m c\u00e1c thu\u1ed1c nh\u01b0 chloroquine\/hydroxychloroquine ho\u1eb7c fingolimod ho\u1eb7c lopinavir\/ritonavir \u1edf b\u1ec7nh nh\u00e2n COVID-19.<\/p>\n

2<\/strong>.6. Thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng kh\u00e1ng vitamin K<\/strong><\/h3>\n

Thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng kh\u00e1ng vitamin K nh\u01b0 warfarin c\u00f3 th\u1ec3 c\u00f3 t\u01b0\u01a1ng t\u00e1c v\u1edbi thu\u1ed1c kh\u00e1ng virus ribavirin. Hi\u1ec7n ch\u01b0a c\u00f3 c\u00e1c b\u1eb1ng ch\u1ee9ng v\u1ec1 m\u1ee9c \u0111\u1ed9 gi\u1eefa c\u00e1c t\u01b0\u01a1ng t\u00e1c tr\u00ean n\u00ean ch\u01b0a c\u1ea7n thay \u0111\u1ed5i li\u1ec1u ch\u1ed1ng \u0111\u00f4ng tuy nhi\u00ean c\u1ea7n theo d\u00f5i ch\u1eb7t ch\u1ebd x\u00e9t nghi\u1ec7m INR \u0111\u1ec3 \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng cho ph\u00f9 h\u1ee3p.
\nC\u1ea7n h\u1ebft s\u1ee9c l\u01b0u \u00fd khi s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng kh\u00e1ng vitamin K v\u1edbi thu\u1ed1c kh\u00e1ng virus l\u00e0 lopinavir\/ritonavir.<\/p>\n

2.7. Thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng tr\u1ef1c ti\u1ebfp \u0111\u01b0\u1eddng u\u1ed1ng (DOAC)<\/strong><\/h3>\n

Thu\u1ed1c lopinavir\/ritonavir c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng t\u1edbi n\u1ed3ng \u0111\u1ed9 c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng t\u00e1c d\u1ee5ng tr\u1ef1c ti\u1ebfp n\u1ebfu c\u00e1c thu\u1ed1c n\u00e0y chuy\u1ec3n h\u00f3a qua CYP3A4. Ch\u00ednh v\u00ec v\u1eady, n\u1ebfu ng\u01b0\u1eddi b\u1ec7nh COVID-19 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng lopinavir\/ritonavir th\u00ec apixaban n\u00ean gi\u1ea3m 50% li\u1ec1u \u0111i\u1ec1u tr\u1ecb.
\nKh\u00f4ng n\u00ean s\u1eed d\u1ee5ng rivaroxaban khi ng\u01b0\u1eddi b\u1ec7nh c\u00f3 ch\u1ec9 \u0111\u1ecbnh d\u00f9ng lopinavir\/ritonavir.
\nKh\u00f4ng c\u1ea7n ch\u1ec9nh li\u1ec1u rivaroxaban khi b\u1ec7nh nh\u00e2n COVID-19 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng tocilizumab ho\u1eb7c sarilumab. \u0110\u1ed1i v\u1edbi dabigatran, c\u1ea7n s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng n\u00e0y c\u1ea9n th\u1eadn khi k\u1ebft h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c lopinavir\/ritonavir do t\u01b0\u01a1ng t\u00e1c c\u00f3 th\u1ec3 l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng nh\u01b0ng ch\u01b0a c\u00f3 khuy\u1ebfn c\u00e1o ch\u1ec9nh li\u1ec1u khi c\u1ea7n ph\u1ed1i h\u1ee3p thu\u1ed1c trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y.<\/p>\n

2<\/strong>.8. Thu\u1ed1c kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u<\/strong><\/h3>\n

Thu\u1ed1c lopinavir\/ritonavir c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng t\u1edbi chuy\u1ec3n ho\u00e1 c\u1ee7a c\u00e1c thu\u1ed1c ch\u1ed1ng ng\u01b0ng t\u1eadp ti\u1ec3u c\u1ea7u n\u1ebfu c\u00e1c thu\u1ed1c n\u00e0y chuy\u1ec3n ho\u00e1 qua cytochrome CYP3A4 nh\u01b0 clopidogrel v\u00e0 ticagrelor. Clopidogrel s\u1ebd gi\u1ea3m t\u00e1c d\u1ee5ng, ng\u01b0\u1ee3c l\u1ea1i ticagrelor s\u1ebd t\u0103ng t\u00e1c d\u1ee5ng khi d\u00f9ng k\u00e8m thu\u1ed1c kh\u00e1ng virus lopinavir\/ritonavir. V\u00ec v\u1eady, kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi clopidogrel ho\u1eb7c ticagrelor v\u1edbi lopinavir\/ritonavir \u1edf b\u1ec7nh nh\u00e2n COVID-19. N\u00ean c\u00e2n nh\u1eafc prasugrel n\u1ebfu kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u1edf ng\u01b0\u1eddi b\u1ec7nh khi d\u00f9ng lopinavir\/ritonavir.
\nKh\u00f4ng c\u1ea7n ch\u1ec9nh li\u1ec1u clopidogrel v\u00e0 prasugrel khi d\u00f9ng c\u00f9ng c\u00e1c thu\u1ed1c trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb COVID-19 l\u00e0 remdesivir, tocilizumab v\u00e0 sarilumab.<\/p>\n

2<\/strong>.9. Statin<\/strong><\/h3>\n

Thu\u1ed1c kh\u00e1ng virus lopinavir\/ritonavir c\u00f3 th\u1ec3 t\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c statin th\u00f4ng qua \u1ee9c ch\u1ebf CYP3C4. N\u00ean kh\u1edfi \u0111\u1ea7u v\u1edbi li\u1ec1u th\u1ea5p nh\u1ea5t c\u1ee7a rosuvastatin v\u00e0 atorvastatin, sau \u0111\u00f3 t\u0103ng li\u1ec1u n\u1ebfu c\u00f3 th\u1ec3:<\/p>\n

    \n
  • \u0110\u1ed1i v\u1edbi rosuvastatin n\u00ean \u0111\u1ec3 li\u1ec1u t\u1ed1i \u0111a l\u00e0 10 mg\/24h.<\/li>\n
  • \u0110\u1ed1i v\u1edbi atorvastatin n\u00ean \u0111i\u1ec1u ch\u1ec9nh v\u00e0 \u0111\u1ec3 li\u1ec1u t\u1ed1i \u0111a l\u00e0 20 mg\/24h.<\/li>\n
  • Pravastatin v\u00e0 pitavastatin c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng c\u00f9ng lopinavir\/ritonavir \u1edf b\u1ec7nh nh\u00e2n COVID-19.
    \nKh\u00f4ng n\u00ean ch\u1ec9 \u0111\u1ecbnh lovastatin v\u00e0 simvastatin k\u1ebft h\u1ee3p v\u1edbi lopinavir\/ritonavir.<\/li>\n<\/ul>\n

    3<\/strong>. M\u1ed9t s\u1ed1 thu\u1ed1c kh\u00e1c<\/strong><\/h3>\n

    M\u1ed9t s\u1ed1 l\u01b0u \u00fd, c\u00f3 m\u1ed9t s\u1ed1 thu\u1ed1c kh\u00e1ng virus nh\u01b0 bevacizumab, eculizumab ch\u01b0a r\u00f5 t\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c thu\u1ed1c tim m\u1ea1ch nh\u01b0ng c\u00e1c thu\u1ed1c n\u00e0y c\u00f3 m\u1ed9t s\u1ed1 t\u00e1c d\u1ee5ng ph\u1ee5 tr\u00ean h\u1ec7 th\u1ed1ng tim m\u1ea1ch.<\/p>\n

      \n
    • \u0110\u1ed1i v\u1edbi bevacizumab, thu\u1ed1c c\u00f3 th\u1ec3 g\u00e2y \u0111\u1ed9c tr\u1ef1c ti\u1ebfp tr\u00ean c\u01a1 tim, l\u00e0m n\u1eb7ng t\u00ecnh tr\u1ea1ng tim \u1edf b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd c\u01a1 tim t\u1eeb tr\u01b0\u1edbc, g\u00e2y c\u01a1n t\u0103ng huy\u1ebft \u00e1p v\u00e0 c\u00f3 th\u1ec3 g\u00e2y bi\u1ebfn c\u1ed1 thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i.<\/li>\n
    • \u0110\u1ed1i v\u1edbi eculizumab, thu\u1ed1c c\u00f3 th\u1ec3 g\u00e2y t\u0103ng huy\u1ebft \u00e1p, nh\u1ecbp ch\u1eadm v\u00e0 ph\u00f9 ngo\u1ea1i bi\u00ean.
      \nNgo\u00e0i ra, c\u00e1c thu\u1ed1c b\u1ed5 tr\u1ee3 kh\u00e1c c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u1edf ng\u01b0\u1eddi b\u1ec7nh COVID-19 c\u00f3 th\u1ec3 c\u00f3 t\u00e1c d\u1ee5ng ph\u1ee5 tr\u00ean h\u1ec7 th\u1ed1ng tim m\u1ea1ch nh\u01b0 interferon, methylprednisolon v\u00e0 tocilizumab.<\/li>\n
    • \u0110\u1ed1i v\u1edbi interferon, thu\u1ed1c c\u00f3 th\u1ec3 g\u00e2y t\u00e1c d\u1ee5ng \u0111\u1ed9c tr\u00ean c\u01a1 tim, l\u00e0m n\u1eb7ng t\u00ecnh tr\u1ea1ng b\u1ec7nh tim n\u1ebfu ng\u01b0\u1eddi b\u1ec7nh c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh tim m\u1ea1ch, g\u00e2y t\u1ee5t huy\u1ebft \u00e1p, r\u1ed1i lo\u1ea1n nh\u1ecbp tim, b\u1ec7nh c\u01a1 tim v\u00e0 nh\u1ed3i m\u00e1u c\u01a1 tim.<\/li>\n
    • \u0110\u1ed1i v\u1edbi methylprednisolon, thu\u1ed1c g\u00e2y gi\u1eef n\u01b0\u1edbc, r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i v\u00e0 t\u0103ng huy\u1ebft \u00e1p.T\u00e1c d\u1ee5ng ph\u1ee5 tr\u00ean h\u1ec7 th\u1ed1ng tim m\u1ea1ch c\u1ee7a tocilizumab g\u1ed3m t\u0103ng huy\u1ebft \u00e1p, t\u0103ng n\u1ed3ng \u0111\u1ed9 cholesterol.<\/li>\n<\/ul>\n

      COVID-19 l\u00e0 m\u1ed9t \u0111\u1ea1i d\u1ecbch to\u00e0n c\u1ea7u v\u1edbi s\u1ed1 l\u01b0\u1ee3ng ng\u01b0\u1eddi m\u1eafc l\u1edbn. Nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh tim m\u1ea1ch nh\u01b0 t\u0103ng huy\u1ebft \u00e1p, b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, suy tim\u2026 l\u00e0 nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng n\u1eb7ng khi nhi\u1ec5m SARS-CoV-2. S\u1eed d\u1ee5ng thu\u1ed1c tim m\u1ea1ch \u1edf ng\u01b0\u1eddi b\u1ec7nh COVID-19 c\u1ea7n th\u1eadn tr\u1ecdng v\u00ec nhi\u1ec1u thu\u1ed1c tim m\u1ea1ch c\u00f3 t\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1ng virus.<\/p>\n

      Vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c tim m\u1ea1ch c\u1ea7n c\u00e2n nh\u1eafc c\u1ee5 th\u1ec3 t\u1eebng tr\u01b0\u1eddng h\u1ee3p, c\u1ea7n c\u00e2n b\u1eb1ng gi\u1eefa l\u1ee3i \u00edch v\u00e0 nguy c\u01a1 khi d\u00f9ng thu\u1ed1c \u0111\u1ec3 mang l\u1ea1i l\u1ee3i \u00edch l\u1edbn nh\u1ea5t cho ng\u01b0\u1eddi b\u1ec7nh. C\u1ea7n nhi\u1ec1u hi\u1ec3u bi\u1ebft v\u1ec1 virus SARS-CoV-2 c\u0169ng nh\u01b0 v\u1ec1 t\u01b0\u01a1ng t\u00e1c gi\u1eefa c\u00e1c thu\u1ed1c tim m\u1ea1ch v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1ng virus \u0111\u1ec3 c\u00f3 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb t\u1ed1t nh\u1ea5t cho ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n

       <\/p>\n","protected":false},"excerpt":{"rendered":"

      COVID-19 (Coronavirus disease 2019) \u0111ang l\u00e0 \u0111\u1ea1i d\u1ecbch to\u00e0n c\u1ea7u do virus SARS-CoV-2 g\u00e2y ra. B\u1ec7nh x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c kh\u1edfi \u0111\u1ea7u t\u1eeb khu ch\u1ee3 Hoa Nam b\u00e1n v\u00e0 gi\u1ebft m\u1ed5 nhi\u1ec1u lo\u1ea1i \u0111\u1ed9ng v\u1eadt hoang d\u00e3 t\u1ea1i th\u00e0nh ph\u1ed1 V\u0169 H\u00e1n thu\u1ed9c t\u1ec9nh H\u1ed3 B\u1eafc, Trung Qu\u1ed1c. Sau \u0111\u00f3 b\u1ec7nh l\u00e2y lan nhanh ch\u00f3ng sang […]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[12,33],"tags":[],"yoast_head":"\nCOVID-19 v\u00e0 vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c tim m\u1ea1ch<\/title>\n<meta name=\"description\" content=\"Thu\u1ed1c tim m\u1ea1ch d\u00f9ng tr\u00ean b\u1ec7nh nh\u00e2n COVID-19 c\u00f3 g\u00ec l\u01b0u \u00fd l\u00e0 v\u1ea5n \u0111\u1ec1 \u0111\u01b0\u1ee3c quan t\u00e2m trong \u0111\u1ea1i d\u1ecbch to\u00e0n c\u1ea7u. 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