{"id":27572,"date":"2023-04-23T21:43:03","date_gmt":"2023-04-23T14:43:03","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=27572"},"modified":"2023-04-23T21:43:03","modified_gmt":"2023-04-23T14:43:03","slug":"thuoc-uc-che-thu-the","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/thuoc-uc-che-thu-the\/","title":{"rendered":"Thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 trong suy tim m\u1ea1n"},"content":{"rendered":"

C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 AT1 c\u1ee7a angiotensin II (ARB) l\u00e0 m\u1ed9t nh\u00f3m thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh suy tim<\/a> m\u1ea1n c\u00e1c b\u1ec7nh tim m\u1ea1ch kh\u00e1c v\u00e0 huy\u1ebft \u00e1p cao.<\/strong><\/p>\n

\"suy
thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 trong suy tim m\u1ea1n<\/figcaption><\/figure>\n

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

Thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 n\u00ean \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n suy tim hay b\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng (EF \u2264 40%) .<\/p>\n

Nh\u01b0 thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n, thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 gi\u00fap gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong v\u00e0 m\u1eafc b\u1ec7nh (gi\u00fap c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng, m\u1ee9c \u0111\u1ed9 dung n\u1ea1p v\u1edbi g\u1eafng s\u1ee9c v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u00f9ng v\u1edbi l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 c\u1ea7n ph\u1ea3i nh\u1eadp vi\u1ec7n) v\u00e0 c\u00f2n gi\u00fap c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng tim ho\u1eb7c \u00edt nh\u1ea5t l\u00e0 ng\u0103n c\u1ea3n s\u1ef1 suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i sau n\u00e0y.<\/p>\n

Thu\u1ed1c ARB \u1ee9c ch\u1ebf tr\u1ef1c ti\u1ebfp th\u1ee5 th\u1ec3 AT1 n\u01a1i angiotensin II g\u00e2y ra t\u00e1c d\u1ee5ng tr\u00ean c\u00e1c t\u1ed5 ch\u1ee9c \u0111\u00edch nh\u01b0 m\u1ea1ch, th\u1eadn, tim,… gi\u00fap gi\u00e3n m\u1ea1ch, c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng t\u00e2m th\u1ea5t v\u00e0 gi\u1ea3m \u00e1p l\u1ef1c m\u00e1u. Kh\u00e1c v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n, c\u00e1c thu\u1ed1c ARB kh\u00f4ng l\u00e0m t\u0103ng bradykinin n\u00ean \u00edt g\u00e2y ra c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 nh\u01b0 ho khan, ph\u00f9 m\u1ea1ch (g\u1eb7p kh\u00e1 ph\u1ed5 bi\u1ebfn khi d\u00f9ng ACE-I).<\/p>\n

C\u00e1c thu\u1ed1c ARB \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh khi b\u1ec7nh nh\u00e2n kh\u00f4ng dung n\u1ea1p \u0111\u01b0\u1ee3c v\u1edbi thu\u1ed1c\u1ee9c ch\u1ebf men chuy\u1ec3n ho\u1eb7c kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng \u0111i\u1ec1u tr\u1ecb v\u1edbi ARNI. Tuy nhi\u00ean, c\u00e1c thu\u1ed1c ARB c\u0169ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 th\u1eadn tr\u1ecdng t\u01b0\u01a1ng t\u1ef1 nh\u01b0 thu\u1ed1c ACE-I, v\u00ed d\u1ee5 nh\u01b0 b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed d\u1ecb \u1ee9ng v\u1edbi thu\u1ed1c ARB, b\u1ec7nh nh\u00e2n b\u1ecb suy gan ho\u1eb7c suy th\u1eadn n\u1eb7ng, ph\u1ee5 n\u1eef mang thai ho\u1eb7c cho con b\u00fa,…<\/p>\n

2. C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 trong suy tim m\u1ea1n<\/h2>\n
    \n
  • Candesartan: Li\u1ec1u kh\u1edfi \u0111\u1ea7u th\u01b0\u1eddng l\u00e0 4 mg m\u1ed7i ng\u00e0y, t\u00f9y thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng b\u1ec7nh c\u1ee7a b\u1ec7nh nh\u00e2n, li\u1ec1u c\u00f3 th\u1ec3 t\u0103ng l\u00ean \u0111\u1ebfn 32 mg m\u1ed7i ng\u00e0y.<\/li>\n
  • Losartan: Li\u1ec1u kh\u1edfi \u0111\u1ea7u th\u01b0\u1eddng l\u00e0 50 mg m\u1ed7i ng\u00e0y, t\u00f9y thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng b\u1ec7nh c\u1ee7a b\u1ec7nh nh\u00e2n, li\u1ec1u c\u00f3 th\u1ec3 t\u0103ng l\u00ean \u0111\u1ebfn 150 mg m\u1ed7i ng\u00e0y.<\/li>\n
  • Valsartan: Li\u1ec1u kh\u1edfi \u0111\u1ea7u th\u01b0\u1eddng l\u00e0 40 mg, u\u1ed1ng hai l\u1ea7n m\u1ed7i ng\u00e0y, t\u00f9y thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng b\u1ec7nh c\u1ee7a b\u1ec7nh nh\u00e2n, li\u1ec1u c\u00f3 th\u1ec3 t\u0103ng l\u00ean \u0111\u1ebfn 160 mg hai l\u1ea7n m\u1ed7i ng\u00e0y.<\/li>\n<\/ul>\n

    \u00a0<\/strong><\/p>\n

    3. T\u00e1c d\u1ee5ng ph\u1ee5<\/h2>\n
      \n
    • T\u0103ng kali m\u00e1u<\/li>\n
    • S\u01b0ng ph\u00f9 d\u01b0\u1edbi da do gi\u1eef n\u01b0\u1edbc (ph\u00f9 m\u1ea1ch)<\/li>\n
    • H\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf<\/li>\n
    • T\u00ecnh tr\u1ea1ng u\u1ec3 o\u1ea3i, l\u01a1 m\u01a1<\/li>\n
    • Ti\u00eau ch\u1ea3y<\/li>\n
    • Ph\u00e1t ban<\/li>\n
    • Kh\u00f3 ti\u00eau<\/li>\n
    • Bu\u1ed3n n\u00f4n, n\u00f4n<\/li>\n
    • \u0110au c\u01a1 ho\u1eb7c x\u01b0\u01a1ng<\/li>\n<\/ul>\n

      C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 AT1 c\u1ee7a angiotensin II (ARB) c\u00f3 th\u1ec3 g\u00e2y ra t\u00e1c d\u1ee5ng ph\u1ee5 nh\u01b0 ch\u00f3ng m\u1eb7t v\u00e0 ph\u00f9 m\u1ea1ch, tuy nhi\u00ean, t\u00e1c d\u1ee5ng ph\u1ee5 n\u00e0y r\u1ea5t hi\u1ebfm g\u1eb7p.<\/p>\n

      C\u00e1c thu\u1ed1c ARB c\u0169ng c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ee9c n\u0103ng th\u1eadn, kali m\u00e1u v\u00e0 huy\u1ebft \u00e1p t\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf enzyme chuy\u1ec3n angiotensin (ACE). Tuy nhi\u00ean, ARB th\u01b0\u1eddng kh\u00f4ng g\u00e2y ra t\u00e1c d\u1ee5ng ph\u1ee5 nh\u01b0 ho v\u00e0 \u00edt g\u00e2y ra t\u00e1c d\u1ee5ng ph\u1ee5 tr\u00ean protein ni\u1ec7u v\u00e0 gi\u1ea3m b\u1ea1ch c\u1ea7u.<\/p>\n

      Tuy nhi\u00ean, nh\u01b0 c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c, c\u00e1c thu\u1ed1c ARB c\u0169ng c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 kh\u00e1c, bao g\u1ed3m l\u00e0m t\u0103ng c\u00e1c ch\u1ec9 s\u1ed1 th\u1eadn, m\u1ea5t c\u00e2n b\u1eb1ng \u0111i\u1ec7n gi\u1ea3i, suy gan ho\u1eb7c suy th\u1eadn, t\u0103ng nguy c\u01a1 nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ec3u, v\u00e0 c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 kh\u00e1c.<\/p>\n

      Thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 angiotensin II \u0111\u1ec1u \u0111\u01b0\u1ee3c c\u1ea3nh b\u00e1o c\u00f3 th\u1ec3 g\u00e2y h\u1ea1i \u0111\u1ebfn thai nhi v\u00e0 l\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh trong thai k\u1ef3. Vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c n\u00e0y trong khi mang thai c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c v\u1ea5n \u0111\u1ec1 cho thai nhi, bao g\u1ed3m:<\/p>\n

        \n
      • D\u1ecb t\u1eadt tim v\u00e0 m\u1ea1ch m\u00e1u<\/li>\n
      • Suy th\u1eadn<\/li>\n
      • Thi\u1ebfu m\u00e1u<\/li>\n
      • Suy dinh d\u01b0\u1ee1ng<\/li>\n
      • T\u0103ng nguy c\u01a1 s\u1ea3y thai, thai ch\u1ebft l\u01b0u v\u00e0 sinh non<\/li>\n<\/ul>\n

        Do \u0111\u00f3, ph\u1ee5 n\u1eef \u0111ang mang thai ho\u1eb7c nghi ng\u1edd c\u00f3 thai n\u00ean tr\u00e1nh s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 angiotensin II. N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 k\u1ebf ho\u1ea1ch mang thai ho\u1eb7c \u0111ang chu\u1ea9n b\u1ecb mang thai, n\u00ean th\u00f4ng b\u00e1o cho b\u00e1c s\u0129 \u0111\u1ec3 \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn v\u00e0 thay \u0111\u1ed5i ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p.<\/p>\n

        4. S\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 trong suy tim m\u1ea1n<\/h2>\n

        Vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c ARB c\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n d\u01b0\u1edbi s\u1ef1 gi\u00e1m s\u00e1t c\u1ee7a b\u00e1c s\u0129 v\u00e0 tu\u00e2n th\u1ee7 \u0111\u00fang li\u1ec1u l\u01b0\u1ee3ng v\u00e0 ch\u1ec9 \u0111\u1ecbnh c\u1ee7a nh\u00e0 s\u1ea3n xu\u1ea5t \u0111\u1ec3 tr\u00e1nh c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 kh\u00f4ng mong mu\u1ed1n. N\u1ebfu b\u1ec7nh nh\u00e2n g\u1eb7p ph\u1ea3i b\u1ea5t k\u1ef3 t\u00e1c d\u1ee5ng ph\u1ee5 n\u00e0o, n\u00ean th\u00f4ng b\u00e1o ngay cho b\u00e1c s\u0129 \u0111\u1ec3 c\u00f3 h\u01b0\u1edbng x\u1eed l\u00fd k\u1ecbp th\u1eddi. L\u01b0u \u00fd r\u1eb1ng t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 angiotensin II c\u00f3 th\u1ec3 kh\u00e1c nhau t\u00f9y thu\u1ed9c v\u00e0o t\u1eebng lo\u1ea1i thu\u1ed1c v\u00e0 t\u1eebng b\u1ec7nh nh\u00e2n. N\u1ebfu b\u1ec7nh nh\u00e2n g\u1eb7p b\u1ea5t k\u1ef3 t\u00e1c d\u1ee5ng ph\u1ee5 n\u00e0o khi s\u1eed d\u1ee5ng thu\u1ed1c, c\u1ea7n th\u00f4ng b\u00e1o cho b\u00e1c s\u0129 \u0111\u1ec3 \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn x\u1eed l\u00fd k\u1ecbp th\u1eddi.<\/p>\n

        C\u00e1ch s\u1eed d\u1ee5ng th\u00f4ng th\u01b0\u1eddng c\u1ee7a c\u00e1c thu\u1ed1c ARB:<\/p>\n

          \n
        • U\u1ed1ng thu\u1ed1c theo \u0111\u00fang li\u1ec1u l\u01b0\u1ee3ng v\u00e0 l\u1ecbch tr\u00ecnh \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh b\u1edfi b\u00e1c s\u0129. Tr\u00e1nh d\u00f9ng qu\u00e1 li\u1ec1u ho\u1eb7c d\u1eebng thu\u1ed1c \u0111\u1ed9t ng\u1ed9t m\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh.<\/li>\n
        • C\u00e1c thu\u1ed1c ARB th\u01b0\u1eddng \u0111\u01b0\u1ee3c u\u1ed1ng m\u1ed9t l\u1ea7n m\u1ed7i ng\u00e0y v\u00e0o c\u00f9ng th\u1eddi \u0111i\u1ec3m, c\u00f3 th\u1ec3 u\u1ed1ng tr\u01b0\u1edbc ho\u1eb7c sau b\u1eefa \u0103n.<\/li>\n
        • N\u00ean u\u1ed1ng thu\u1ed1c ARB v\u00e0o c\u00f9ng gi\u1edd m\u1ed7i ng\u00e0y \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb t\u1ed1i \u0111a.<\/li>\n
        • N\u1ebfu b\u1ecf u\u1ed1ng thu\u1ed1c trong m\u1ed9t ng\u00e0y n\u00e0o \u0111\u00f3, kh\u00f4ng n\u00ean u\u1ed1ng g\u1ea5p \u0111\u00f4i li\u1ec1u l\u01b0\u1ee3ng v\u00e0o ng\u00e0y ti\u1ebfp theo. Thay v\u00e0o \u0111\u00f3, n\u00ean u\u1ed1ng \u0111\u00fang li\u1ec1u l\u01b0\u1ee3ng v\u00e0o ng\u00e0y ti\u1ebfp theo nh\u01b0 b\u00ecnh th\u01b0\u1eddng.<\/li>\n
        • N\u1ebfu b\u1ec7nh nh\u00e2n th\u1ea5y b\u1ea5t k\u1ef3 t\u00e1c d\u1ee5ng ph\u1ee5 n\u00e0o khi s\u1eed d\u1ee5ng thu\u1ed1c ARB, c\u1ea7n th\u00f4ng b\u00e1o ngay cho b\u00e1c s\u0129 \u0111\u1ec3 \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn x\u1eed l\u00fd k\u1ecbp th\u1eddi.<\/li>\n
        • Kh\u00f4ng n\u00ean d\u1eebng thu\u1ed1c ARB m\u1ed9t c\u00e1ch \u0111\u1ed9t ng\u1ed9t m\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh b\u1edfi b\u00e1c s\u0129, v\u00ec \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 g\u00e2y ra t\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9t ng\u1ed9t v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 kh\u00e1c.<\/li>\n
        • N\u1ebfu b\u1ec7nh nh\u00e2n \u0111ang s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c, c\u1ea7n th\u00f4ng b\u00e1o cho b\u00e1c s\u0129 \u0111\u1ec3 tr\u00e1nh t\u01b0\u01a1ng t\u00e1c thu\u1ed1c kh\u00f4ng mong mu\u1ed1n.<\/li>\n<\/ul>\n

          N\u00f3i chung, vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 angiotensin II c\u1ea7n ph\u1ea3i \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n d\u01b0\u1edbi s\u1ef1 gi\u00e1m s\u00e1t c\u1ee7a b\u00e1c s\u0129 v\u00e0 tu\u00e2n th\u1ee7 \u0111\u00fang li\u1ec1u l\u01b0\u1ee3ng v\u00e0 ch\u1ec9 \u0111\u1ecbnh c\u1ee7a nh\u00e0 s\u1ea3n xu\u1ea5t \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb v\u00e0 tr\u00e1nh c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 kh\u00f4ng mong mu\u1ed1n.<\/p>\n

           <\/p>\n

          \u00a0<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

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