{"id":26564,"date":"2023-04-22T13:05:20","date_gmt":"2023-04-22T06:05:20","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=26564"},"modified":"2023-04-22T13:05:20","modified_gmt":"2023-04-22T06:05:20","slug":"chen-beta-giao-cam-va-cac-chi-dinh-lam-sang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/chen-beta-giao-cam-va-cac-chi-dinh-lam-sang\/","title":{"rendered":"Ch\u1eb9n beta giao c\u1ea3m v\u00e0 c\u00e1c ch\u1ec9 \u0111\u1ecbnh l\u00e2m s\u00e0ng"},"content":{"rendered":"<p><strong>Ch\u1eb9n beta giao c\u1ea3m l\u1ea7n l\u01b0\u1ee3t ra \u0111\u1eddi v\u1edbi m\u1ee9c \u0111\u1ed9 ch\u1ecdn l\u1ecdc th\u1ee5 th\u1ec3 ng\u00e0y c\u00e0ng cao, c\u00f9ng v\u1edbi c\u00e1c b\u1eb1ng ch\u1ee9ng thuy\u1ebft ph\u1ee5c qua c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng tr\u00ean nhi\u1ec1u \u0111\u1ed1i t\u01b0\u1ee3ng b\u1ec7nh l\u00fd tim m\u1ea1ch nh\u01b0 t\u0103ng huy\u1ebft \u00e1p, r\u1ed1i lo\u1ea1n nh\u1ecbp tim\u2026 \u0111\u00e3 cho th\u1ea5y vai tr\u00f2 to l\u1edbn v\u00e0 kh\u00f4ng th\u1ec3 thi\u1ebfu c\u1ee7a thu\u1ed1c ch\u1eb9n beta trong k\u1ef7 nguy\u00ean tim m\u1ea1ch hi\u1ec7n \u0111\u1ea1i.<\/strong><\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\" wp-image-26569 aligncenter\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/propranolol-300x300.png\" alt=\"Ch\u1eb9n beta\" width=\"307\" height=\"307\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/propranolol-300x300.png 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/propranolol-1024x1024.png 1024w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/propranolol-150x150.png 150w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/propranolol-768x768.png 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/propranolol.png 1476w\" sizes=\"(max-width: 307px) 100vw, 307px\" \/><\/p>\n<p style=\"text-align: center;\"><strong>Thu\u1ed1c ch\u1eb9n beta v\u00e0 c\u00e1c ch\u1ec9 \u0111\u1ecbnh l\u00e2m s\u00e0ng<\/strong><\/p>\n<h2><strong>1.T\u0103ng huy\u1ebft \u00e1p <\/strong><\/h2>\n<p>Thu\u1ed1c ch\u1eb9n h\u1ec7 beta gi\u00fap l\u00e0m h\u1ea1 huy\u1ebft \u00e1p ngay c\u1ea3 trong khi ngh\u1ec9 ho\u1eb7c khi g\u1eafng s\u1ee9c, h\u1ea1 \u00e1p khi t\u0103ng huy\u1ebft \u00e1p t\u00e2m thu hay t\u0103ng \u0111\u1ed3ng th\u1eddi c\u1ea3 huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng. Thu\u1ed1c t\u00e1c \u0111\u1ed9ng v\u00e0o nhi\u1ec1u giai \u0111o\u1ea1n trong c\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a t\u0103ng huy\u1ebft \u00e1p v\u00e0 c\u01a1 ch\u1ebf \u0111i\u1ec1u h\u00f2a huy\u1ebft \u00e1p c\u1ee7a c\u01a1 th\u1ec3 gi\u00fap gi\u1ea3m huy\u1ebft \u00e1p hi\u1ec7u qu\u1ea3 v\u00e0 duy tr\u00ec ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p t\u1ed1t.<\/p>\n<p>C\u00e1c nghi\u00ean c\u1ee9u RCT v\u00e0 c\u00e1c ph\u00e2n t\u00edch g\u1ed9p t\u1eeb nhi\u1ec1u th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng \u0111\u00e3 ch\u1ee9ng minh hi\u1ec7u qu\u1ea3 c\u1ee7a thu\u1ed1c ch\u1eb9n beta so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c trong gi\u1ea3m c\u00f3 \u00fd ngh\u0129a nguy c\u01a1 tai bi\u1ebfn m\u1ea1ch n\u00e3o, suy tim c\u0169ng nh\u01b0 c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch kh\u00e1c \u1edf b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p.<\/p>\n<p>Trong m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u kh\u00e1c khi so s\u00e1nh \u0111\u1ed1i \u0111\u1ea7u gi\u1eefa hi\u1ec7u qu\u1ea3 c\u1ee7a c\u00e1c thu\u1ed1c ch\u1eb9n beta v\u1edbi c\u00e1c nh\u00f3m thu\u1ed1c h\u1ea1 \u00e1p kh\u00e1c c\u0169ng th\u01b0\u1eddng cho k\u1ebft qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng trong h\u1ea1 \u00e1p v\u00e0 d\u1ef1 ph\u00f2ng m\u1ed9t s\u1ed1 bi\u1ebfn c\u1ed1 tim m\u1ea1ch. Tuy nhi\u00ean, c\u00e1c nghi\u00ean c\u1ee9u RCT d\u1ef1a tr\u00ean ti\u00eau ch\u00ed t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u00edch c\u0169ng cho th\u1ea5y vai tr\u00f2 c\u1ee7a ch\u1eb9n beta c\u00f2n nhi\u1ec1u h\u1ea1n ch\u1ebf so v\u1edbi c\u00e1c thu\u1ed1c h\u1ea1 \u00e1p kh\u00e1c nh\u01b0 thu\u1ed1c nh\u00f3m \u1ee9c ch\u1ebf h\u1ec7 RAS hay ch\u1eb9n k\u00eanh canxi trong d\u1ef1 ph\u00f2ng tai bi\u1ebfn m\u1ea1ch m\u00e1u n\u00e3o, d\u00e0y th\u1ea5t tr\u00e1i, t\u00e1i c\u1ea5u tr\u00fac m\u1ea1ch m\u00e1u nh\u1ecf\u2026<\/p>\n<p>Tuy nhi\u00ean, ch\u1eb9n beta giao c\u1ea3m l\u00e0 m\u1ed9t nh\u00f3m thu\u1ed1c kh\u00f4ng thu\u1ea7n nh\u1ea5t v\u1ec1 t\u00e1c d\u1ee5ng d\u01b0\u1ee3c l\u00fd v\u00e0 m\u1ee9c \u0111\u1ed9 ch\u1ecdn l\u1ecdc tr\u00ean th\u1ee5 th\u1ec3. M\u1ed9t s\u1ed1 thu\u1ed1c c\u00f2n c\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch (nebivolol, labetalol, carvedilol). Trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y, vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c ch\u1eb9n beta c\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch ng\u00e0y c\u00e0ng t\u0103ng l\u00ean. C\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 nebivolol \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng thu\u1eadn l\u1ee3i h\u01a1n \u0111\u1ed1i v\u1edbi huy\u1ebft \u00e1p trung t\u00e2m, \u0111\u1ed9 c\u1ee9ng \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng n\u1ed9i m\u1ea1c, \u00edt \u1ea3nh h\u01b0\u1edfng x\u1ea5u \u0111\u1ebfn ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c, kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn m\u1ee9c \u0111\u1ed9 \u0111\u1ec1 kh\u00e1ng insulin v\u00e0 t\u1ef7 l\u1ec7 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng m\u1edbi m\u1eafc.<\/p>\n<p>Do \u0111\u00f3, thu\u1ed1c ch\u1eb9n beta v\u1eabn gi\u1eef \u0111\u01b0\u1ee3c vai tr\u00f2 trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh t\u0103ng huy\u1ebft \u00e1p d\u00f9 c\u00f3 m\u1ed9t s\u1ed1 h\u1ea1n ch\u1ebf. Thu\u1ed1c ch\u1eb9n beta v\u1eabn \u0111\u01b0\u1ee3c coi l\u00e0 m\u1ed9t trong c\u00e1c nh\u00f3m thu\u1ed1c c\u01a1 b\u1ea3n \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb h\u1ea1 \u00e1p. Tuy nhi\u00ean, ch\u1ec9 n\u00ean \u01b0u ti\u00ean khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh b\u1eaft bu\u1ed9c kh\u00e1c \u0111i k\u00e8m. V\u00ed d\u1ee5: Suy tim c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m, c\u01a1n \u0111au th\u1eaft ng\u1ef1c do b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, sau nh\u1ed3i m\u00e1u c\u01a1 tim, b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t nh\u1ecbp tim, hay s\u1eed d\u1ee5ng thay th\u1ebf nh\u00f3m \u1ee9c ch\u1ebf men chuy\u1ec3n\/\u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p n\u1eef gi\u1edbi c\u00f3 k\u1ebf ho\u1ea1ch mang thai.<\/p>\n<h3><strong>1.1 Thu\u1ed1c v\u00e0 li\u1ec1u l\u01b0\u1ee3ng: <\/strong><\/h3>\n<h4><strong>1.1.1 \u0110\u1ed1i v\u1edbi t\u0103ng huy\u1ebft \u00e1p nguy\u00ean ph\u00e1t: <\/strong><\/h4>\n<ul>\n<li>Metoprolol 25 \u2013 50 mg\/24h, t\u1ed1i \u0111a kh\u00f4ng qu\u00e1 400 mg\/24h<\/li>\n<li>Nebivolol 5 \u2013 10 mg\/24h, kh\u00f4ng qu\u00e1 40 mg\/24h<\/li>\n<li>Bisoprolol 2,5 \u2013 5 mg\/24h, kh\u00f4ng qu\u00e1 20 mg\/24h<\/li>\n<\/ul>\n<h4><strong>1.1.2 \u0110\u1ed1i v\u1edbi t\u0103ng huy\u1ebft \u00e1p \u1edf b\u1ec7nh nh\u00e2n t\u00e1ch th\u00e0nh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7: <\/strong><\/h4>\n<ul>\n<li>Esmolol: Kh\u1edfi \u0111\u1ea7u bolus 1000 \u03bcg\/kg sau \u0111\u00f3 truy\u1ec1n t\u0129nh m\u1ea1ch li\u00ean t\u1ee5c 150 \u2013 300 \u03bcg\/kg\/ph\u00fat.<\/li>\n<li>Labetalol: Kh\u1edfi \u0111\u1ea7u li\u1ec1u 20 mg trong th\u1eddi gian tr\u00ean 2 ph\u00fat sau \u0111\u00f3 l\u00e0 40 \u2013 80 mg m\u1ed7i 10 ph\u00fat (li\u1ec1u t\u1ed1i \u0111a 300 mg) cho t\u1edbi khi c\u00f3 \u0111\u00e1p \u1ee9ng. Duy tr\u00ec b\u1eb1ng truy\u1ec1n li\u00ean t\u1ee5c v\u1edbi t\u1ed1c \u0111\u1ed9 2 \u2013 10 mg\/ph\u00fat, t\u1ed5ng li\u1ec1u t\u1ed1i \u0111a 300 mg.<\/li>\n<\/ul>\n<h2><strong>2.R\u1ed1i lo\u1ea1n nh\u1ecbp tim <\/strong><\/h2>\n<p>Thu\u1ed1c ch\u1eb9n beta hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb c\u1ea3 c\u00e1c c\u01a1n nh\u1ecbp nhanh tr\u00ean th\u1ea5t v\u00e0 c\u00e1c c\u01a1n nh\u1ecbp nhanh th\u1ea5t, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u0111\u1ed1i v\u1edbi c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp do thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 c\u01a1 tim ho\u1eb7c trong t\u00ecnh tr\u1ea1ng c\u01b0\u1eddng catecholamine. <strong>\u00a0<\/strong><\/p>\n<p>Thu\u1ed1c t\u00e1c \u0111\u1ed9ng tr\u00ean n\u00fat xoang, n\u00fat nh\u0129 th\u1ea5t, h\u1ec7 th\u1ed1ng l\u01b0\u1edbi Purkinje, m\u00f4 c\u01a1 nh\u0129 v\u00e0 c\u01a1 t\u00e2m th\u1ea5t. C\u01a1 ch\u1ebf l\u00e0m gi\u1ea3m AMP n\u1ed9i b\u00e0o d\u1eabn \u0111\u1ebfn thay \u0111\u1ed5i t\u1ed1c \u0111\u1ed9 t\u00e1i c\u1ef1c t\u1ea1i n\u00fat xoang v\u00e0 ngay t\u1ea1i c\u00e1c \u1ed5 ngo\u1ea1i v\u1ecb sinh ra do t\u0103ng t\u00ednh t\u1ef1 \u0111\u1ed9ng, \u0111\u1ed3ng th\u1eddi gi\u1ea3m d\u00f2ng canxi \u0111i v\u00e0o n\u1ed9i b\u00e0o l\u00e0m t\u0103ng t\u00ednh ch\u1ecbu k\u00edch th\u00edch t\u1ebf b\u00e0o c\u01a1 tim kh\u1ecfi c\u00e1c t\u00e1c \u0111\u1ed9ng kh\u1edfi k\u00edch ngo\u1ea1i lai (triggers). Tr\u00ean \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n kho\u1ea3ng PR k\u00e9o d\u00e0i, trong khi \u0111\u00f3 ph\u1ee9c b\u1ed9 QRS kh\u00f4ng bi\u1ebfn \u0111\u1ed5i. Ri\u00eang sotalol c\u00f3 th\u1ec3 g\u00e2y kho\u1ea3ng QT d\u00e0i.<\/p>\n<h2><strong>3.C\u01a1n nh\u1ecbp nhanh k\u1ecbch ph\u00e1t tr\u00ean th\u1ea5t<\/strong><\/h2>\n<ul>\n<li>Trong m\u1ee5c n\u00e0y \u0111\u1ec1 c\u1eadp \u0111\u1ebfn c\u01a1n nh\u1ecbp nhanh k\u1ecbch ph\u00e1t tr\u00ean th\u1ea5t v\u1edbi hai c\u01a1 ch\u1ebf do v\u00f2ng v\u00e0o l\u1ea1i n\u00fat nh\u0129 th\u1ea5t (AVNRT) v\u00e0 v\u00f2ng v\u00e0o l\u1ea1i nh\u0129 th\u1ea5t (AVRT). \u0110\u1eb7c \u0111i\u1ec3m chung c\u1ee7a c\u00e1c c\u01a1n nh\u1ecbp nhanh k\u1ecbch ph\u00e1t tr\u00ean th\u1ea5t n\u00e0y l\u00e0 \u0111\u1ec1u c\u00f3 vai tr\u00f2 c\u1ee7a n\u00fat nh\u0129 th\u1ea5t trong c\u01a1 ch\u1ebf h\u00ecnh th\u00e0nh v\u00f2ng v\u00e0o l\u1ea1i \u0111\u1ec3 duy tr\u00ec c\u01a1n nh\u1ecbp nhanh. Do \u0111\u00f3, t\u00e1c \u0111\u1ed9ng l\u00e0m gi\u1ea3m d\u1eabn truy\u1ec1n qua n\u00fat nh\u0129 th\u1ea5t c\u1ee7a thu\u1ed1c ch\u1eb9n beta c\u00f3 th\u1ec3 c\u1eaft \u0111\u01b0\u1ee3c c\u00e1c c\u01a1n nh\u1ecbp nhanh, ph\u1ee5c h\u1ed3i nh\u1ecbp xoang.<\/li>\n<li>Thu\u1ed1c d\u00f9ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u01b0u ti\u00ean s\u1eed d\u1ee5ng. Thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m kh\u00f4ng t\u00e1c \u0111\u1ed9ng l\u00ean d\u1eabn truy\u1ec1n qua \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n ph\u1ee5 nh\u0129 th\u1ea5t. Trong tr\u01b0\u1eddng h\u1ee3p rung nh\u0129 \u1edf b\u1ec7nh nh\u00e2n c\u00f3 h\u1ed9i ch\u1ee9ng Wol \u2013 Parkinson \u2013 White, kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng ch\u1eb9n beta giao c\u1ea3m (c\u0169ng nh\u01b0 digoxin v\u00e0 c\u00e1c thu\u1ed1c ch\u1eb9n k\u00eanh canxi nh\u00f3m verapamil, diltiazem) v\u00ec t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho c\u00e1c xung \u0111\u1ed9ng d\u1eabn to\u00e0n b\u1ed9 qua \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n ph\u1ee5 m\u00e0 kh\u00f4ng \u0111i qua n\u00fat nh\u0129 th\u1ea5t, d\u1eabn \u0111\u1ebfn \u0111\u00e1p \u1ee9ng th\u1ea5t r\u1ea5t nhanh, c\u00f3 th\u1ec3 g\u00e2y suy s\u1ee5p huy\u1ebft \u0111\u1ed9ng.<\/li>\n<\/ul>\n<h3><strong>3.1 Thu\u1ed1c v\u00e0 li\u1ec1u l\u01b0\u1ee3ng:<\/strong><\/h3>\n<ul>\n<li>Esmolol: 0,5 mg\/kg ti\u00eam bolus t\u0129nh m\u1ea1ch ho\u1eb7c 0,05 \u2013 0,3 mg\/kg\/ph\u00fat truy\u1ec1n t\u0129nh m\u1ea1ch li\u00ean t\u1ee5c.<\/li>\n<li>Metoprolol: 2,5 \u2013 15 mg truy\u1ec1n t\u0129nh m\u1ea1ch trong \u0111\u00f3 ti\u00eam bolus 2,5 mg<\/li>\n<li>Trong tr\u01b0\u1eddng h\u1ee3p duy tr\u00ec nh\u1ecbp xoang: Metoprolol 25 \u2013 50 mg\/24h Bisoprolol 2,5 \u2013 5 mg\/24h<\/li>\n<\/ul>\n<h2><strong>4.Rung nh\u0129 v\u00e0 cu\u1ed3ng nh\u0129 <\/strong><\/h2>\n<p>Trong rung nh\u0129 ho\u1eb7c cu\u1ed3ng nh\u0129, thu\u1ed1c ch\u1eb9n beta gi\u00fap ki\u1ec3m so\u00e1t t\u1ea7n s\u1ed1 th\u1ea5t c\u1ea3 khi ngh\u1ec9 v\u00e0 khi g\u1eafng s\u1ee9c do c\u01a1 ch\u1ebf l\u00e0m k\u00e9o d\u00e0i th\u1eddi k\u1ef3 tr\u01a1 c\u1ee7a n\u00fat nh\u0129 th\u1ea5t. Ch\u1eb9n beta kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh nh\u1eb1m chuy\u1ec3n nh\u1ecbp trong rung nh\u0129. Hi\u1ec7u qu\u1ea3 duy tr\u00ec nh\u1ecbp xoang sau chuy\u1ec3n nh\u1ecbp \u1edf b\u1ec7nh nh\u00e2n rung nh\u0129 c\u0169ng c\u00f2n nhi\u1ec1u h\u1ea1n ch\u1ebf, thu\u1ed1c ch\u1ee7 y\u1ebfu hi\u1ec7u qu\u1ea3 trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p rung nh\u0129 do c\u01b0\u1eddng catecholamine th\u00f4ng qua c\u01a1 ch\u1ebf trung gian adrenergic, v\u00ed d\u1ee5: rung nh\u0129 khi g\u1eafng s\u1ee9c, c\u01b0\u1eddng gi\u00e1p, hay sau ph\u1eabu thu\u1eadt.<\/p>\n<p>Trong \u0111\u00f3, thu\u1ed1c ch\u1eb9n beta \u0111\u01b0\u1ee3c xem nh\u01b0 l\u00e0 ch\u1ec9 \u0111\u1ecbnh \u01b0u ti\u00ean h\u00e0ng \u0111\u1ea7u nh\u1eb1m d\u1ef1 ph\u00f2ng rung nh\u0129 \u1edf b\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt. K\u1ebft qu\u1ea3 t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u cho th\u1ea5y thu\u1ed1c ch\u1eb9n beta l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 rung nh\u0129 t\u1eeb 40 c\u00f2n 20% \u1edf b\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u n\u1ed1i ch\u1ee7 v\u00e0nh v\u00e0 t\u1eeb 60 c\u00f2n 30% \u1edf b\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt thay van tim. Trong giai \u0111o\u1ea1n c\u1ea5p c\u1ee7a rung nh\u0129, c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng ch\u1eb9n beta giao c\u1ea3m k\u1ebft h\u1ee3p v\u1edbi c\u00e1c nh\u00f3m thu\u1ed1c kh\u00e1c nh\u01b0 digoxin, ch\u1eb9n k\u00eanh canxi nh\u00f3m verapamil hay diltiazem nh\u1eb1m ki\u1ec3m so\u00e1t nhanh t\u1ea7n s\u1ed1 th\u1ea5t.<\/p>\n<p>Trong giai \u0111o\u1ea1n ki\u1ec3m so\u00e1t t\u1ea7n s\u1ed1 d\u00e0i h\u1ea1n, ch\u1eb9n beta cho th\u1ea5y l\u1ee3i \u00edch v\u01b0\u1ee3t tr\u1ed9i h\u01a1n so v\u1edbi digoxin. Tuy nhi\u00ean, tr\u00ean th\u1ef1c t\u1ebf l\u00e2m s\u00e0ng, c\u00f3 th\u1ec3 \u0111\u1ed3ng th\u1eddi k\u1ebft h\u1ee3p c\u00e1c nh\u00f3m thu\u1ed1c \u0111\u1ec3 duy tr\u00ec t\u1ea7n s\u1ed1 tim \u1ed5n \u0111\u1ecbnh trong kho\u1ea3ng t\u1ed1i \u01b0u 70 \u2013 80 nh\u1ecbp\/ph\u00fat. \u0110\u1ed1i v\u1edbi tr\u01b0\u1eddng h\u1ee3p rung nh\u0129 k\u00e8m theo suy tim, \u0111\u1eb7c bi\u1ec7t suy tim c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m, ki\u1ec3m so\u00e1t t\u1ea7n s\u1ed1 th\u1ea5t b\u1eb1ng ch\u1eb9n beta l\u00e0 \u01b0u ti\u00ean h\u00e0ng \u0111\u1ea7u.<\/p>\n<p>M\u1eb7c d\u00f9, trong rung nh\u0129, hi\u1ec7u qu\u1ea3 c\u1ee7a ch\u1eb9n beta tr\u00ean c\u1ea3i thi\u1ec7n ti\u00ean l\u01b0\u1ee3ng \u1edf b\u1ec7nh nh\u00e2n suy tim t\u1ecf ra h\u1ea1n ch\u1ebf so v\u1edbi trong nh\u1ecbp xoang. C\u00e1c th\u1eed nghi\u1ec7m li\u00ean quan \u0111\u1ebfn thu\u1ed1c ch\u1eb9n beta \u1edf b\u1ec7nh nh\u00e2n rung nh\u0129 k\u00e8m theo suy tim ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m kh\u00f4ng cho th\u1ea5y gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n khi so s\u00e1nh v\u1edbi gi\u1ea3 d\u01b0\u1ee3c. T\u00e1c d\u1ee5ng n\u00e0y v\u1ed1n \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh r\u1ea5t r\u00f5 r\u00e0ng \u1edf b\u1ec7nh nh\u00e2n suy tim k\u00e8m theo nh\u1ecbp xoang. Nh\u01b0 v\u1eady \u0111i\u1ec1u th\u00fa v\u1ecb \u1edf \u0111\u00e2y l\u00e0 hi\u1ec7u qu\u1ea3 c\u1ea3i thi\u1ec7n ti\u00ean l\u01b0\u1ee3ng \u1edf b\u1ec7nh nh\u00e2n suy tim c\u1ee7a thu\u1ed1c ch\u1eb9n beta d\u01b0\u1eddng nh\u01b0 b\u1ecb \u201cm\u1ea5t \u0111i\u201d khi c\u00f3 xu\u1ea5t hi\u1ec7n t\u00ecnh tr\u1ea1ng rung nh\u0129. Quan \u0111i\u1ec3m n\u00e0y c\u0169ng kh\u00e1 nh\u1ea5t qu\u00e1n tr\u00ean c\u01a1 s\u1edf b\u1eb1ng ch\u1ee9ng t\u1eeb nhi\u1ec1u nghi\u00ean c\u1ee9u RCT.<\/p>\n<p>M\u1eb7c d\u00f9 v\u1eady, hi\u1ec7n nay c\u00e1c khuy\u1ebfn c\u00e1o m\u1edbi nh\u1ea5t v\u1eabn \u01b0u ti\u00ean thu\u1ed1c ch\u1eb9n beta l\u00e0 l\u1ef1a ch\u1ecdn \u0111\u1ea7u ti\u00ean trong ki\u1ec3m so\u00e1t t\u1ea7n s\u1ed1 th\u1ea5t \u1edf b\u1ec7nh nh\u00e2n rung nh\u0129 c\u00f3 k\u00e8m suy tim do thu\u1ed1c c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng r\u00f5 r\u1ec7t v\u00e0 \u0111\u01b0\u1ee3c dung n\u1ea1p t\u1ed1t \u1edf h\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh nh\u00e2n. T\u01b0\u01a1ng t\u1ef1 nh\u01b0 rung nh\u0129, thu\u1ed1c ch\u1eb9n beta c\u0169ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong cu\u1ed3ng nh\u0129 v\u00e0 c\u01a1n nh\u1ecbp nhanh nh\u0129 \u0111\u01a1n \u1ed5 nh\u1eb1m ki\u1ec3m so\u00e1t t\u1ea7n s\u1ed1 th\u1ea5t khi cu\u1ed3ng nh\u0129 c\u00f3 \u0111\u00e1p \u1ee9ng th\u1ea5t nhanh, ho\u1eb7c \u0111\u1ec3 ki\u1ec3m so\u00e1t t\u1ea7n s\u1ed1 th\u1ea5t k\u00e9o d\u00e0i khi kh\u00f4ng th\u1ec3 tri\u1ec7t \u0111\u1ed1t RF ho\u1eb7c b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 nguy\u1ec7n v\u1ecdng tri\u1ec7t \u0111\u1ed1t.<\/p>\n<h3><strong>4.1 Thu\u1ed1c v\u00e0 li\u1ec1u l\u01b0\u1ee3ng: <\/strong><\/h3>\n<ul>\n<li>Bisoprolol: \u0111i\u1ec1u tr\u1ecb l\u00e2u d\u00e0i li\u1ec1u d\u00f9ng t\u1eeb 1,25 \u2013 20 mg u\u1ed1ng 1 l\u1ea7n\/24h<\/li>\n<li>Carvedilol: \u0111i\u1ec1u tr\u1ecb l\u00e2u d\u00e0i li\u1ec1u d\u00f9ng t\u1eeb 3,125 \u2013 50 mg u\u1ed1ng 2 l\u1ea7n\/24h<\/li>\n<li>Metoprolol: ki\u1ec3m so\u00e1t t\u1ea7n s\u1ed1 tim giai \u0111o\u1ea1n c\u1ea5p li\u1ec1u d\u00f9ng 2,5 \u2013 10 mg bolus t\u0129nh m\u1ea1ch, ki\u1ec3m so\u00e1t d\u00e0i h\u1ea1n d\u00f9ng t\u1ed5ng li\u1ec1u 100 \u2013 200 mg\/24h<\/li>\n<li>Esmolol: ki\u1ec3m so\u00e1t t\u1ea7n s\u1ed1 tim giai \u0111o\u1ea1n c\u1ea5p 0,5 mg\/kg bolus t\u0129nh m\u1ea1ch trong th\u1eddi gian tr\u00ean 1 ph\u00fat sau \u0111\u00f3 duy tr\u00ec 0,05 \u2013 0,25 mg\/kg\/ph\u00fat.<\/li>\n<\/ul>\n<h2><strong>5.R\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t <\/strong><\/h2>\n<p>C\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t th\u01b0\u1eddng g\u1eb7p l\u00e0 ngo\u1ea1i t\u00e2m thu th\u1ea5t v\u00e0 c\u00e1c c\u01a1n nh\u1ecbp nhanh th\u1ea5t m\u00e0 c\u01a1 ch\u1ebf th\u01b0\u1eddng kh\u1edfi ph\u00e1t c\u00e1c \u1ed5 ngo\u1ea1i v\u1ecb n\u1eb1m trong t\u00e2m th\u1ea5t. M\u1eb7t kh\u00e1c, ch\u1eb9n beta c\u0169ng c\u00f3 hi\u1ec7u qu\u1ea3 t\u1ed1t tr\u00ean c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t li\u00ean quan t\u1edbi c\u01b0\u1eddng catecholamine nh\u01b0 sau g\u1eafng s\u1ee9c, sau nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p ho\u1eb7c \u1edf b\u1ec7nh nh\u00e2n r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t do nh\u1ea1y c\u1ea3m v\u1edbi catecholamine nh\u01b0 ngo\u1ea1i t\u00e2m thu th\u1ea5t t\u1eeb \u0111\u01b0\u1eddng ra th\u1ea5t ph\u1ea3i \u1edf ng\u01b0\u1eddi tr\u1ebb tu\u1ed5i. Kh\u00f4ng nh\u1eefng v\u1eady, thu\u1ed1c ch\u1eb9n beta \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 gi\u1ea3m t\u1ef7 l\u1ec7 rung th\u1ea5t, c\u0169ng nh\u01b0 l\u00e0 t\u1ef7 l\u1ec7 \u0111\u1ed9t t\u1eed v\u00e0 t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n \u1edf b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p, suy tim sung huy\u1ebft.<\/p>\n<p>Ch\u1eb9n beta c\u0169ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c ch\u1ed1ng r\u1ed1i lo\u1ea1n nh\u1ecbp kh\u00e1c \u0111\u1ec3 d\u1ef1 ph\u00f2ng c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t. Hai nghi\u00ean c\u1ee9u \u0111a trung t\u00e2m l\u1edbn l\u00e0 CAMIAT v\u00e0 EMIAT v\u1ec1 hi\u1ec7u qu\u1ea3 c\u1ee7a amiodarone \u1edf b\u1ec7nh nh\u00e2n sau nh\u1ed3i m\u00e1u c\u01a1 tim cho th\u1ea5y thu\u1ed1c ch\u1eb9n beta c\u00f3 t\u00e1c d\u1ee5ng hi\u1ec7p \u0111\u1ed3ng nh\u1eb1m gi\u1ea3m nguy c\u01a1 r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong.<\/p>\n<p>\u1ede b\u1ec7nh nh\u00e2n h\u1ed9i ch\u1ee9ng QT d\u00e0i b\u1ea9m sinh, bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m nh\u1ea5t l\u00e0 c\u00e1c c\u01a1n xo\u1eafn \u0111\u1ec9nh c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u1eed vong. Thu\u1ed1c ch\u1eb9n beta \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng t\u1eeb nh\u1eefng n\u0103m 1970 nh\u1eb1m gi\u1ea3m nguy c\u01a1 xu\u1ea5t hi\u1ec7n c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t nguy hi\u1ec3m g\u00e2y \u0111\u1ed9t t\u1eed. Tr\u00ean th\u1ef1c t\u1ebf c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng cho th\u1ea5y thu\u1ed1c l\u00e0m gi\u1ea3m c\u00f3 \u00fd ngh\u0129a t\u1ea7n su\u1ea5t c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch v\u00e0 t\u1eed vong. M\u1eb7c d\u00f9 v\u1eady, c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u01b0\u1ee3c ng\u0103n ng\u1eeba \u1edf kho\u1ea3ng 70% s\u1ed1 b\u1ec7nh nh\u00e2n v\u00e0 c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t nguy hi\u1ec3m v\u1eabn c\u00f3 th\u1ec3 x\u1ea3y ra. Nh\u00f3m b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng nguy c\u01a1 cao v\u00e0 kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi thu\u1ed1c n\u00ean \u0111\u01b0\u1ee3c c\u1ea5y m\u00e1y ph\u00e1 rung t\u1ef1 \u0111\u1ed9ng ICD \u0111\u1ec3 d\u1ef1 ph\u00f2ng \u0111\u1ed9t t\u1eed. Trong tr\u01b0\u1eddng h\u1ee3p \u0111\u00f3, ch\u1eb9n beta giao c\u1ea3m \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh hi\u1ec7p \u0111\u1ed3ng v\u1edbi ICD nh\u1eb1m gi\u1ea3m t\u1ea7n su\u1ea5t t\u00e1i ph\u00e1t c\u01a1n v\u00e0 gi\u1ea3m s\u1ed1 l\u1ea7n shock \u0111i\u1ec7n c\u1ee7a m\u00e1y ph\u00e1 rung. M\u1eb7c d\u00f9 mang l\u1ea1i r\u1ea5t nhi\u1ec1u hi\u1ec7u qu\u1ea3 trong ki\u1ec3m so\u00e1t c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t li\u00ean quan \u0111\u1ebfn t\u0103ng tr\u01b0\u01a1ng l\u1ef1c giao c\u1ea3m nh\u01b0ng \u0111\u1ed1i v\u1edbi c\u00e1c c\u01a1n nh\u1ecbp nhanh th\u1ea5t c\u00f3 c\u01a1 ch\u1ebf v\u00f2ng v\u00e0o l\u1ea1i (v\u00ed d\u1ee5: c\u00e1c c\u01a1n nh\u1ecbp nhanh th\u1ea5t c\u00f3 k\u00e8m theo b\u1ec7nh tim c\u1ea5u tr\u00fac ho\u1eb7c s\u1eb9o nh\u1ed3i m\u00e1u c\u01a1 tim), ch\u1eb9n beta cho th\u1ea5y hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u1ed1i h\u1ea1n ch\u1ebf trong d\u1ef1 ph\u00f2ng t\u00e1i ph\u00e1t c\u01a1n.<\/p>\n<h3><strong>5.1 Thu\u1ed1c v\u00e0 li\u1ec1u l\u01b0\u1ee3ng: <\/strong><\/h3>\n<ul>\n<li>Metoprolol succinate: u\u1ed1ng 25 \u2013 100 mg\/l\u1ea7n, 1 \u2013 2 l\u1ea7n\/24h.<\/li>\n<li>Bisoprolol: u\u1ed1ng 2,5 \u2013 10 mg, 1 l\u1ea7n\/24h.<\/li>\n<li>Atenolol: u\u1ed1ng 25 \u2013 100 mg\/24h. 4.5.<\/li>\n<\/ul>\n<h2><strong>6.M\u1ed9t s\u1ed1 ch\u1ec9 \u0111\u1ecbnh kh\u00e1c:<\/strong><\/h2>\n<p>Ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 c\u1ea5p. Ch\u1eb9n beta trong t\u00e1ch th\u00e0nh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u1eeba c\u00f3 t\u00e1c d\u1ee5ng h\u1ea1 huy\u1ebft \u00e1p v\u1eeba c\u00f3 t\u00e1c d\u1ee5ng ki\u1ec3m so\u00e1t nh\u1ecbp tim, nh\u1eb1m gi\u1ea3m thi\u1ec3u nguy c\u01a1 x\u1ea3y ra bi\u1ebfn c\u1ed1 n\u1ee9t v\u1ee1 v\u00e0 t\u1eed vong.<\/p>\n<p>Thu\u1ed1c ch\u1eb9n beta th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch nh\u1eb1m h\u1ea1 huy\u1ebft \u00e1p \u0111\u1ebfn m\u1ee9c m\u1ee5c ti\u00eau nhanh nh\u1ea5t c\u00f3 th\u1ec3 trong kho\u1ea3ng huy\u1ebft \u00e1p t\u00e2m thu t\u1eeb 100 \u2013 120 mmHg v\u00e0 nh\u1ecbp tim trong kho\u1ea3ng 60 \u2013 80 nh\u1ecbp\/ph\u00fat. C\u00f3 th\u1ec3 ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c h\u1ea1 \u00e1p kh\u00e1c nh\u01b0 \u1ee9c ch\u1ebf h\u1ec7 RAS ho\u1eb7c c\u00e1c thu\u1ed1c ch\u1eb9n k\u00eanh canxi \u0111\u1ec3 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p nhanh v\u00e0 t\u1ed1t h\u01a1n.<\/p>\n<p><a href=\"https:\/\/www.vinmec.com\/\"><strong>B\u1ec7nh vi\u1ec7n \u0110a khoa Qu\u1ed1c t\u1ebf Vinmec<\/strong><\/a>\u00a0\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 tim m\u1ea1ch, \u0111\u1eb7c bi\u1ec7t ph\u1eabu thu\u1eadt b\u1ec7nh m\u1ea1ch v\u00e0nh.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ch\u1eb9n beta giao c\u1ea3m l\u1ea7n l\u01b0\u1ee3t ra \u0111\u1eddi v\u1edbi m\u1ee9c \u0111\u1ed9 ch\u1ecdn l\u1ecdc th\u1ee5 th\u1ec3 ng\u00e0y c\u00e0ng cao, c\u00f9ng v\u1edbi c\u00e1c b\u1eb1ng ch\u1ee9ng thuy\u1ebft ph\u1ee5c qua c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng tr\u00ean nhi\u1ec1u \u0111\u1ed1i t\u01b0\u1ee3ng b\u1ec7nh l\u00fd tim m\u1ea1ch nh\u01b0 t\u0103ng huy\u1ebft \u00e1p, r\u1ed1i lo\u1ea1n nh\u1ecbp tim\u2026 \u0111\u00e3 cho th\u1ea5y vai tr\u00f2 to l\u1edbn v\u00e0 [&hellip;]<\/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":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Ch\u1eb9n beta giao c\u1ea3m v\u00e0 c\u00e1c ch\u1ec9 \u0111\u1ecbnh l\u00e2m s\u00e0ng<\/title>\n<meta name=\"description\" content=\"Ch\u1eb9n beta giao c\u1ea3m v\u00e0 c\u00e1c ch\u1ec9 \u0111\u1ecbnh l\u00e2m s\u00e0ng l\u00e0 v\u1ea5n \u0111\u1ec1 \u0111\u01b0\u1ee3c quan t\u00e2m. 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