{"id":28032,"date":"2023-04-24T22:06:29","date_gmt":"2023-04-24T15:06:29","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28032"},"modified":"2023-04-24T22:06:29","modified_gmt":"2023-04-24T15:06:29","slug":"xu-tri-xuat-huyet-tieu-hoa-khi-dung-thuoc-khang-dong","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/24\/xu-tri-xuat-huyet-tieu-hoa-khi-dung-thuoc-khang-dong\/","title":{"rendered":"X\u1eed tr\u00ed xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a khi d\u00f9ng thu\u1ed1c kh\u00e1ng \u0111\u00f4ng trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p"},"content":{"rendered":"

Thu\u1ed1c kh\u00e1ng \u0111\u00f4ng<\/a> \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nhi\u1ec1u \u1edf c\u00e1c b\u1ec7nh nh\u00e2n tim m\u1ea1ch. Do \u0111\u00f3, bi\u1ebfn ch\u1ee9ng xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a li\u00ean quan \u0111\u1ebfn lo\u1ea1i thu\u1ed1c n\u00e0y g\u1eb7p \u1edf t\u1ea7n su\u1ea5t l\u1edbn. B\u00e0i vi\u1ebft cung c\u1ea5p c\u00e1c th\u00f4ng tin chi ti\u1ebft.<\/strong><\/p>\n

\"Xu\u1ea5t<\/p>\n

Xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a\u00a0<\/strong><\/p>\n

1.X\u1eed tr\u00ed xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a do qu\u00e1 li\u1ec1u kh\u00e1ng vitamin K<\/h2>\n

1.1 Xu\u1ea5t huy\u1ebft nghi\u00eam tr\u1ecdng\/\u0111e d\u1ecda t\u00ednh m\u1ea1ng<\/h3>\n

Khi c\u00f3 \u00edt nh\u1ea5t 1 trong c\u00e1c ti\u00eau chu\u1ea9n sau: (1) Xu\u1ea5t huy\u1ebft kh\u00f4ng ki\u1ec3m so\u00e1t b\u1eb1ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p th\u00f4ng th\u01b0\u1eddng; ,(2) Huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh (HATT < 90 mmHg ho\u1eb7c gi\u1ea3m \u2265 40 mmHg so v\u1edbi huy\u1ebft \u00e1p n\u1ec1n, HATTr \u2264 65 mmHg ho\u1eb7c c\u00f3 d\u1ea5u hi\u1ec7u c\u1ee7a s\u1ed1c; (3) V\u1ecb tr\u00ed xu\u1ea5t huy\u1ebft \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ed1ng c\u00f2n (n\u1ed9i s\u1ecd, n\u1ed9i t\u1ee7y, sau ph\u00fac m\u1ea1c, m\u00e0ng tim, m\u00e0ng ph\u1ed5i, m\u00e0ng b\u1ee5ng, ti\u00eau h\u00f3a…).<\/p>\n

    \n
  • D\u1eebng ngay ch\u1ed1ng \u0111\u00f4ng kh\u00e1ng vitamin K.<\/li>\n
  • T\u00ecm ki\u1ebfm v\u00e0 x\u1eed tr\u00ed c\u1ea7m m\u00e1u \u0111i\u1ec3m xu\u1ea5t huy\u1ebft n\u1ebfu c\u00f3 th\u1ec3.<\/li>\n
  • Truy\u1ec1n t\u0129nh mach ch\u1eadm (trong v\u00f2ng 20 – 60 ph\u00fat) 10 mg vitamin K1 m\u00e0 kh\u00f4ng c\u1ea7n quan t\u00e2m \u0111\u1ebfn x\u00e9t nghi\u1ec7m PT-INR. C\u00f3 th\u1ec3 d\u00f9ng ti\u1ebfp li\u1ec1u vitamin K nh\u01b0 tr\u00ean sau m\u1ed7i 12 gi\u1edd n\u1ebfu PT-INR c\u00f2n cao .<\/li>\n
  • Truy\u1ec1n PCC (Prothrombin complex concentrate – Ph\u1ee9c h\u1ee3p prothrombin c\u00f4 \u0111\u1eb7c) v\u00e0\/ho\u1eb7c FFP (plasma t\u01b0\u01a1i \u0111\u00f4ng l\u1ea1nh) \u0111\u1ec3 \u0111\u1ea3o nhanh PT-INR, li\u1ec1u th\u01b0\u1eddng c\u1ee7a PPC l\u00e0 50 UI\/kg, li\u1ec1u FFP l\u00e0 15 – 30 mL\/kg.<\/li>\n
  • B\u1ed5 sung c\u00e1c ch\u1ebf ph\u1ea9m m\u00e1u t\u00f9y theo t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng v\u00e0 x\u00e9t nghi\u1ec7m:<\/li>\n
  • Truy\u1ec1n kh\u1ed1i h\u1ed3ng c\u1ea7u: D\u1ef1a v\u00e0o m\u1ee9c Hb ho\u1eb7c \u01b0\u1edbc \u0111o\u00e1n t\u00ecnh tr\u1ea1ng m\u1ea5t m\u00e1u c\u1ea5p \u0111ang ti\u1ebfn tri\u1ec3n, m\u1ee5c \u0111\u00edch \u0111\u1ea3m b\u1ea3o l\u01b0\u1ee3ng Hb \u1ed5n \u0111\u1ecbnh.<\/li>\n
  • Truy\u1ec1n ti\u1ec3u c\u1ea7u: Khi c\u00f3 gi\u1ea3m ti\u1ec3u c\u1ea7u v\u1ec1 s\u1ed1 l\u01b0\u1ee3ng ho\u1eb7c ch\u1ea5t l\u01b0\u1ee3ng, m\u1ee5c ti\u00eau duy tr\u00ec s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u > 100 G\/L.<\/li>\n
  • Truy\u1ec1n ch\u1ed1ng ti\u00eau s\u1ee3i huy\u1ebft: D\u00f9ng c\u00e1c thu\u1ed1c ch\u1ed1ng ti\u00eau s\u1ee3i huy\u1ebft nh\u01b0 tranexamic acid n\u1ebfu c\u00f3 t\u00ecnh tr\u1ea1ng t\u0103ng ti\u00eau s\u1ee3i huy\u1ebft.<\/li>\n
  • Theo d\u00f5i s\u00e1t: Ki\u1ec3m tra PT-INR sau 30 ph\u00fat khi truy\u1ec1n PCC ho\u1eb7c FFP, theo d\u00f5i s\u00e1t t\u00ecnh tr\u1ea1ng xu\u1ea5t huy\u1ebft, to\u00e0n tr\u1ea1ng chung b\u1ec7nh nh\u00e2n.<\/li>\n<\/ul>\n

    1.2 Xu\u1ea5t huy\u1ebft nh\u1eb9<\/h3>\n

    X\u1eed tr\u00ed nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y t\u00f9y thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh nh\u00e2n, m\u1ee9c \u0111\u1ed9 m\u1ea5t m\u00e1u, t\u00ecnh tr\u1ea1ng huy\u1ebft \u0111\u1ed9ng, v\u1ecb tr\u00ed xu\u1ea5t huy\u1ebft, kh\u1ea3 n\u0103ng s\u1ebd ti\u1ebfn tri\u1ec3n th\u00e0nh xu\u1ea5t huy\u1ebft n\u1eb7ng, m\u1ee9c PT-INR, c\u00e1c y\u1ebfu t\u1ed1 l\u00e0m t\u0103ng nguy c\u01a1 xu\u1ea5t huy\u1ebft \u0111i k\u00e8m nh\u01b0 suy th\u1eadn, suy gan, t\u0103ng huy\u1ebft \u00e1p.<\/p>\n

    C\u00e1c l\u1ef1a ch\u1ecdn bao g\u1ed3m:<\/p>\n

      \n
    • Ch\u1ec9 d\u1eebng thu\u1ed1c kh\u00e1ng\u00a0 \u0111\u00f4ng kh\u00e1ng vitamin K v\u00e0 theo d\u00f5i. D\u1eebng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng kh\u00e1ng vitamin K v\u00e0 th\u00eam vitamin K .<\/li>\n
    • \u0110\u1ea3o ng\u01b0\u1ee3c \u0111\u00f4ng m\u00e1u t\u00edch c\u1ef1c nh\u01b0 x\u1eed tr\u00ed v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n xu\u1ea5t huy\u1ebft n\u1eb7ng n\u1ebfu b\u1ec7nh nh\u00e2n ti\u1ebfn tri\u1ec3n n\u1eb7ng l\u00ean ho\u1eb7c nguy c\u01a1 cao xu\u1ea5t huy\u1ebft n\u1eb7ng.<\/li>\n
    • C\u1ea7n theo d\u00f5i s\u00e1t t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng, PT-INR \u0111\u1ec3 c\u00f3 ph\u01b0\u01a1ng ph\u00e1p x\u1eed tr\u00ed ph\u00f9 h\u1ee3p.<\/li>\n<\/ul>\n

      2. X\u1eed tr\u00ed xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a khi d\u00f9ng thu\u1ed1c kh\u00e1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng th\u1ebf h\u1ec7 m\u1edbi (DOACs)<\/h2>\n

      2.1 Giai \u0111o\u1ea1n c\u1ea5p<\/h3>\n

      Nguy\u00ean t\u1eafc chung x\u1eed tr\u00ed xu\u1ea5t huy\u1ebft khi d\u00f9ng DOACs: Ng\u01b0ng thu\u1ed1c kh\u00e1ng \u0111\u00f4ng, t\u1eadn d\u1ee5ng m\u1ecdi bi\u1ec7n ph\u00e1p c\u1ea7m m\u00e1u c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c nh\u01b0 bi\u1ec7n ph\u00e1p c\u01a1 h\u1ecdc, c\u00e1c ch\u1ebf ph\u1ea9m \u0111\u00f4ng m\u00e1u, c\u00e1c thu\u1ed1c ch\u1ed1ng ti\u00eau s\u1ee3i huy\u1ebft, c\u00e1c bi\u1ec7n ph\u00e1p l\u1ea5y b\u1ecf thu\u1ed1c (b\u1ec7nh nh\u00e2n u\u1ed1ng d\u01b0\u1edbi 3 gi\u1edd c\u00f3 th\u1ec3 r\u1eeda d\u1ea1 d\u00e0y v\u00e0 d\u00f9ng than ho\u1ea1t t\u00ednh). L\u1ecdc m\u00e1u ch\u1ec9 c\u00f3 hi\u1ec7u qu\u1ea3 v\u1edbi dabigatran nh\u01b0ng kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3 v\u1edbi rivaroxaban.<\/p>\n

      2.2 \u0110i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u<\/h3>\n

      Hi\u1ec7n nay m\u1edbi c\u00f3 antidote c\u1ee7a dabigatran (idarucizumab – bi\u1ec7t d\u01b0\u1ee3c: Praxbind) \u0111\u01b0\u1ee3c ch\u1ea5p nh\u1eadn d\u00f9ng trong l\u00e2m s\u00e0ng; l\u00e0 kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng t\u1eeb ng\u01b0\u1eddi c\u00f3 t\u00e1c d\u1ee5ng trung h\u00f2a hi\u1ec7u qu\u1ea3 thu\u1ed1c kh\u00e1ng \u0111\u00f4ng c\u1ee7a dabigatran.<\/p>\n

      Thu\u1ed1c \u0111\u01b0\u1ee3c FDA ch\u1ea5p thu\u1eadn v\u00e0o 10\/2015 cho 2 ch\u1ec9 \u0111\u1ecbnh:<\/p>\n

        \n
      • \u00a0Ph\u0201u thu\u1eadt c\u1ea5p c\u1ee9u,<\/li>\n
      • Xu\u1ea5t huy\u1ebft \u0111e d\u1ecda t\u00ednh m\u1ea1ng ho\u1eb7c kh\u00f4ng ki\u1ec3m so\u00e1t.<\/li>\n<\/ul>\n

        Li\u1ec1u d\u00f9ng: 5g truy\u1ec1n t\u0129nh m\u1ea1ch chia 2 l\u1ea7n, c\u00e1ch nhau \u00edt nh\u1ea5t 15 ph\u00fat (m\u1ed9t l\u1ea7n 2,5 g\/50 mL n\u01b0\u1edbc mu\u1ed1i sinh l\u00fd truy\u1ec1n t\u0129nh m\u1ea1ch nhanh). Thu\u1ed1c s\u1ebd trung h\u00f2a t\u1edbi g\u1ea7n 99% n\u1ed3ng \u0111\u1ed9 dabigatran. Thu\u1ed1c ch\u1ee7 y\u1ebfu th\u1ea3i qua th\u1eadn, kh\u00f4ng t\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c, v\u00e0 th\u1eddi gian b\u00e1n h\u1ee7y ng\u1eafn.<\/p>\n

        2.3 \u0110i\u1ec1u tr\u1ecb sau xu\u1ea5t huy\u1ebft<\/h3>\n

        \u0110\u00e2y, l\u00e0 v\u1ea5n \u0111\u1ec1 kh\u00f3 kh\u0103n trong l\u00e2m s\u00e0ng. Sau bi\u1ebfn c\u1ed1 xu\u1ea5t huy\u1ebft, c\u1ea7n \u0111\u00e1nh gi\u00e1 l\u1ea1i t\u00ecnh tr\u1ea1ng BN, c\u00e2n nh\u1eafc l\u1ee3i \u00edch v\u00e0 nguy c\u01a1 \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh xem c\u00f3 d\u00f9ng l\u1ea1i hay kh\u00f4ng v\u00e0 d\u00f9ng nh\u01b0 th\u1ebf n\u00e0o.<\/p>\n

        Nguy\u00ean t\u1eafc chung l\u00e0: <\/strong>Li\u1ec1u th\u1ea5p h\u01a1n ho\u1eb7c nh\u01b0 c\u0169 ho\u1eb7c chuy\u1ec3n thu\u1ed1c kh\u00e1c c\u00f9ng nh\u00f3m \u00edt t\u00e1c d\u1ee5ng ph\u1ee5 h\u01a1n.<\/p>\n

          \n
        • Chuy\u1ec3n kh\u00e1ng Vitamin K<\/li>\n
        • Gi\u1ea3m ho\u1eb7c b\u1ecf kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u<\/li>\n
        • D\u00f9ng thu\u1ed1c b\u1ea3o v\u1ec7 (v\u00ed d\u1ee5 thu\u1ed1c PPI d\u1ef1 ph\u00f2ng xu\u1ea5t huy\u1ebft d\u1ea1 d\u00e0y…) Bi\u1ec7n ph\u00e1p kh\u00f4ng thu\u1ed1c thay th\u1ebf<\/li>\n<\/ul>\n

          V\u1edbi xu\u1ea5t huy\u1ebft nh\u1eb9: <\/strong>C\u00f3 th\u1ec3 gi\u1ea3m li\u1ec1u, ho\u1eb7c \u0111\u1ed5i thu\u1ed1c trong nh\u00f3m DOACs (t\u1eeb dabigatran, rivaroxaban sang apixaban n\u1ebfu do xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a nh\u1eb9), ho\u1eb7c \u0111\u1ed5i sang kh\u00e1ng vitamin K<\/p>\n

          V\u1edbi xu\u1ea5t huy\u1ebft n\u1eb7ng: <\/strong>Hi\u1ec7n ch\u01b0a c\u00f3 khuy\u1ebfn c\u00e1o r\u00f5 r\u00e0ng,quy\u1ebft \u0111\u1ecbnh d\u1ef1a tr\u00ean t\u1eebng ng\u01b0\u1eddi b\u1ec7nh c\u1ee5 th\u1ec3. Sau xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a, d\u00f9ng l\u1ea1i DOACs \u00edt nh\u1ea5t sau 48 gi\u1edd c\u1ea7m m\u00e1u (th\u01b0\u1eddng sau m\u1ed9t tu\u1ea7n). Sau giai \u0111o\u1ea1n c\u1ea5p t\u00ednh c\u1ee7a \u0111\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft n\u00e3o, c\u00f3 th\u1ec3 b\u1eaft \u0111\u1ea7u d\u00f9ng l\u1ea1i DOACs sau xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd 14 – 21 ng\u00e0y n\u1ebfu nguy c\u01a1 thuy\u00ean t\u1eafc t\u1eeb tim cao v\u00e0 nguy c\u01a1 xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd t\u00e1i ph\u00e1t th\u1ea5p.<\/p>\n

          3. \u0110i\u1ec1u tr\u1ecb xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a sau can thi\u1ec7p m\u1ea1ch v\u00e0nh qua da<\/h2>\n

          Can thi\u1ec7p m\u1ea1ch v\u00e0nh qua da \u0111\u00e3 v\u00e0 \u0111ang l\u00e0 cu\u1ed9c c\u00e1ch m\u1ea1ng \u0111i\u1ec1u tr\u1ecb b\u1ec7nh m\u1ea1ch v\u00e0nh. T\u00ecnh tr\u1ea1ng xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a (XHTH) sau PCI g\u1eb7p ng\u00e0y c\u00e0ng nhi\u1ec1u tr\u00ean l\u00e2m s\u00e0ng.<\/p>\n

          Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng l\u00e0 XHTH m\u1edbi hay kh\u1edfi ph\u00e1t \u0111\u1ee3t XHTH m\u1ea1n t\u00ednh. XHTH l\u00e0m t\u0103ng nguy c\u01a1 t\u1eed vong, b\u1ec7nh t\u1eadt c\u0169ng nh\u01b0 th\u1eddi gian n\u1eb1m vi\u1ec7n \u0111\u1eb7c bi\u1ec7t \u1edf BN b\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 v\u00e0 suy ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i.<\/p>\n

          3.1 T\u1ef7 l\u1ec7 v\u00e0 nguy c\u01a1 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a sau can thi\u1ec7p \u0110MV qua da<\/h3>\n

          XHTH chi\u1ebfm kho\u1ea3ng 15% c\u00e1c bi\u1ebfn c\u1ed1 xu\u1ea5t huy\u1ebft quanh th\u1ee7 thu\u1eadt, v\u1edbi kho\u1ea3ng 1,2 – 2,4% b\u1ec7nh nh\u00e2n PCI. Thu\u1ed1c kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u l\u00e0m t\u0103ng m\u1ecdi d\u1ea1ng XHTH v\u00e0 ch\u1ee7 y\u1ebfu trong s\u1ed1 xu\u1ea5t huy\u1ebft \u0111e d\u1ecda t\u00ednh m\u1ea1ng l\u00e0 t\u1eeb \u0111\u01b0\u1eddng ti\u00eau h\u00f3a tr\u00ean .<\/p>\n

          Nguy c\u01a1 XHTH s\u1edbm l\u00e0: S\u1eed d\u1ee5ng aspirin hay thienopyridine, \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng t\u00edch c\u1ef1c, ng\u01b0\u1eddi l\u1edbn tu\u1ed5i, PCI ti\u00ean ph\u00e1t trong NMCT c\u1ea5p c\u00f3 ST ch\u00eanh l\u00ean, d\u00f9ng thu\u1ed1c t\u0103ng s\u1ee9c co b\u00f3p, ng\u1eebng tim, thi\u1ebfu m\u00e1u, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, gi\u1edbi n\u1eef, ti\u1ec1n c\u0103n \u0111\u1ed9t qu\u1ef5 n\u00e3o, v\u00e0 suy tim.<\/p>\n

          Nguy c\u01a1 XHTH khi d\u00f9ng l\u00e2u d\u00e0i thu\u1ed1c aspirin: Ti\u1ec1n s\u1eed c\u00f3 xu\u1ea5t huy\u1ebft do lo\u00e9t, hay c\u00f3 \u00edt nh\u1ea5t hai ti\u00eau chu\u1ea9n sau: > 65 tu\u1ed5i, s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi NSAIDs, corticoid, ch\u1ed1ng \u0111\u00f4ng, nhi\u1ec5m vi khu\u1ea9n HP, ti\u1ec1n s\u1eed lo\u00e9t kh\u00f4ng bi\u1ebfn ch\u1ee9ng.<\/p>\n

          Clopidogrel kh\u00f4ng tr\u1ef1c ti\u1ebfp g\u00e2y lo\u00e9t v\u00e0 c\u00f3 t\u1ef7 l\u1ec7 g\u00e2y XHTH th\u1ea5p h\u01a1n aspirin. Ph\u1ed1i h\u1ee3p 2 thu\u1ed1c l\u00e0m t\u0103ng nguy c\u01a1 XHTH l\u00ean kho\u1ea3ng 4 l\u1ea7n v\u00e0 xu\u1ea5t huy\u1ebft n\u1eb7ng 7 l\u1ea7n.<\/p>\n

          S\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi 2 thu\u1ed1c ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u l\u00e0m t\u0103ng nguy c\u01a1 XHTH. Nguy c\u01a1 XHTH ph\u1ee5 thu\u1ed9c v\u00e0o th\u1eddi gian v\u00e0 li\u1ec1u d\u00f9ng 2 thu\u1ed1c. H\u1ea7u h\u1ebft nguy c\u01a1 XHTH xu\u1ea5t hi\u1ec7n s\u1edbm (trong n\u0103m \u0111\u1ea7u ti\u00ean) sau d\u00f9ng 2 thu\u1ed1c.<\/p>\n

          C\u00e1c thu\u1ed1c thienopyridines m\u1edbi h\u01a1n (prasugrel, cangrelor, ticagrelor) c\u0169ng \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u ph\u1ed1i h\u1ee3p v\u1edbi aspirin . T\u1ef7 l\u1ec7 xu\u1ea5t huy\u1ebft kh\u00f4ng li\u00ean quan \u0111\u1ebfn ph\u0201u thu\u1eadt tim dao \u0111\u1ed9ng t\u1eeb 2,4 – 5,5 %.<\/p>\n

          3.2 \u0110i\u1ec1u tr\u1ecb xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a sau can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh<\/h3>\n

          3.2.1 Nguy\u00ean t\u1eafc chung<\/strong><\/h4>\n
            \n
          • Hi\u1ec7n ch\u01b0a c\u00f3 h\u01b0\u1edbng d\u0201n th\u1ed1ng nh\u1ea5t v\u1ec1 \u0111i\u1ec1u tr\u1ecb XHTH \u1edf b\u1ec7nh nh\u00e2n sau can thi\u1ec7p. \u0110i\u1ec1u tr\u1ecb hi\u1ec7n nay ch\u1ee7 y\u1ebfu d\u1ef1a tr\u00ean \u0111\u1ed3ng thu\u1eadn c\u1ee7a c\u00e1c chuy\u00ean gia. Ba nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb c\u01a1 b\u1ea3n l\u00e0:<\/li>\n
          • T\u00f9y theo t\u1eebng c\u00e1 th\u1ec3 b\u1ec7nh nh\u00e2n. Nhanh ch\u00f3ng t\u00ecm ki\u1ebfm \u0111i\u1ec3m xu\u1ea5t huy\u1ebft v\u00e0 c\u1ea7m m\u00e1u. \u0110\u1ea3m b\u1ea3o nhanh ch\u00f3ng \u1ed5n \u0111\u1ecbnh huy\u1ebft \u0111\u1ed9ng, h\u1ed3i s\u1ee9c b\u1ec7nh nh\u00e2n. \u0110\u00e1nh gi\u00e1 ph\u00e2n t\u1ea7ng nguy c\u01a1 XHTH (theo thang \u0111i\u1ec3m Rockall ho\u1eb7c n\u1ed9i soi)<\/li>\n
          • C\u00e2n nh\u1eafc gi\u1eefa l\u1ee3i \u00edch v\u00e0 nguy c\u01a1 (do d\u1eebng thu\u1ed1c hay ti\u1ebfp t\u1ee5c d\u00f9ng thu\u1ed1c ch\u1ed1ng huy\u1ebft kh\u1ed1i).<\/li>\n
          • K\u1ebft h\u1ee3p ch\u1eb7t ch\u1ebd gi\u1eefa b\u00e1c s\u0129 ti\u00eau h\u00f3a v\u00e0 tim m\u1ea1ch.<\/li>\n<\/ul>\n

            3.2.2 \u0110i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3<\/h4>\n
              \n
            • D\u1eebng heparin, thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 GB IIb\/IIIa n\u1ebfu \u0111ang truy\u1ec1n<\/li>\n
            • X\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed xu\u1ea5t huy\u1ebft v\u00e0 c\u1ea7m m\u00e1u n\u1ebfu c\u00f3 th\u1ec3 (N\u1ed9i soi th\u1ef1c qu\u1ea3n d\u1ea1 d\u00e0y, n\u1ed9i soi \u0111\u1ea1i tr\u1ef1c tr\u00e0ng c\u1ea7m m\u00e1u..)<\/li>\n
            • Quy\u1ebft \u0111\u1ecbnh ng\u01b0ng m\u1ed9t ho\u1eb7c hai thu\u1ed1c ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u c\u1ea7n d\u1ef1a tr\u00ean m\u1ee9c \u0111\u1ed9 nguy hi\u1ec3m v\u00e0 v\u1ecb tr\u00ed xu\u1ea5t huy\u1ebft c\u0169ng nh\u01b0 m\u1ee9c \u0111\u1ed9 nguy hi\u1ec3m n\u1ebfu huy\u1ebft kh\u1ed1i trong stent x\u1ea3y ra (v\u1ecb tr\u00ed \u0111\u1eb7t stent,…), th\u1eddi gian sau can thi\u1ec7p, lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng..<\/li>\n<\/ul>\n

              Th\u00f4ng th\u01b0\u1eddng s\u1ebd ng\u01b0ng t\u1ea1m 2 thu\u1ed1c trong v\u00f2ng 24h, \u0111\u00e1nh gi\u00e1 nguy c\u01a1 XHTH theo thang \u0111i\u1ec3m Rockall (l\u00e2m s\u00e0ng v\u00e0 n\u1ed9i soi) v\u00e0 quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb theo di\u1ec5n ti\u1ebfn xu\u1ea5t huy\u1ebft v\u00e0 nguy c\u01a1 theo Rockall.<\/p>\n

              N\u1ebfu xu\u1ea5t huy\u1ebft nh\u1eb9 v\u00e0 trung b\u00ecnh (\u0111i\u1ec3m Rockall < 5), v\u0201n d\u00f9ng ph\u1ed1i h\u1ee3p hai thu\u1ed1c.<\/p>\n

              N\u1ebfu nguy c\u01a1 t\u00e1i ph\u00e1t cao (Rockall \u2265 5 \u0111i\u1ec3m) ng\u01b0ng aspirin, ti\u1ebfp t\u1ee5c clopidogrel. D\u00f9ng l\u1ea1i aspirin sau 2 tu\u1ea7n.<\/p>\n

              N\u1ebfu xu\u1ea5t huy\u1ebft ti\u1ebfp t\u1ee5c ho\u1eb7c c\u00f3 r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng, d\u1eebng c\u1ea3 hai thu\u1ed1c v\u00e0 h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c. B\u1ed3i ph\u1ee5 d\u1ecbch \u0111\u1ec3 tr\u00e1nh gi\u1ea3m th\u1ebf t\u00edch. \u0110\u1ea7u ti\u00ean th\u01b0\u1eddng l\u00e0 mu\u1ed1i \u0111\u1eb3ng tr\u01b0\u01a1ng. Ch\u1ec9 truy\u1ec1n m\u00e1u khi Hb < 80g\/1 v\u00e0 v\u1edbi s\u1ed1 l\u01b0\u1ee3ng t\u1ed1i thi\u1ec3u.<\/p>\n

              Duy tr\u00ec Hb > 90g\/1 (truy\u1ec1n h\u1ed3ng c\u1ea7u l\u1eafng n\u1ebfu c\u1ea7n). Tuy nhi\u00ean l\u1ee3i \u00edch truy\u1ec1n m\u00e1u quanh th\u1ee7 thu\u1eadt c\u00f2n nhi\u1ec1u b\u00e0n c\u00e3i. C\u1ea7n l\u01b0u \u00fd bi\u1ebfn ch\u1ee9ng thuy\u00ean t\u1eafc c\u1ea5p \u1edf BN truy\u1ec1n m\u00e1u v\u00ec nguy c\u01a1 t\u0103ng \u0111\u00f4ng sau truy\u1ec1n m\u00e1u.<\/p>\n

              PPI truy\u1ec1n t\u0129nh m\u1ea1ch 72 gi\u1edd, sau \u0111\u00f3 chuy\u1ec3n sang u\u1ed1ng, \u00edt nh\u1ea5t 8 tu\u1ea7n.<\/p>\n

              Trong tr\u01b0\u1eddng h\u1ee3p XHTH d\u01b0\u1edbi, n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng ngay \u0111\u1ec3 c\u1ea7m m\u00e1u n\u1ebfu c\u00f3 th\u1ec3.<\/p>\n

              N\u1ebfu c\u00e1c bi\u1ec7n ph\u00e1p tr\u00ean kh\u00f4ng hi\u1ec7u qu\u1ea3, \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i khoa hay c\u00e1c bi\u1ec7n ph\u00e1p c\u1ea7m m\u00e1u kh\u00e1c b\u1ea5t c\u1ee9 khi n\u00e0o c\u1ea7n thi\u1ebft.<\/p>\n

              B\u1ec7nh nh\u00e2n c\u1ea7n ph\u1ea3i theo d\u00f5i ch\u1eb7t ch\u1ebd nguy c\u01a1 huy\u1ebft kh\u1ed1i trong stent, \u0111\u1eb7t bi\u1ec7t \u1edf b\u1ec7nh nh\u00e2n d\u00f9ng DES.<\/p>\n

              D\u00f9ng l\u1ea1i thu\u1ed1c ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u:<\/strong><\/p>\n

                \n
              • Hi\u1ec7n ch\u01b0a c\u00f3 s\u1ed1 li\u1ec7u v\u1ec1 th\u1eddi gian v\u00e0 li\u1ec1u t\u1ed1i \u01b0u khi d\u00f9ng l\u1ea1i thu\u1ed1c kh\u00e1ng ti\u1ec3u c\u1ea7u \u1edf b\u1ec7nh nh\u00e2n ph\u1ea3i ng\u01b0ng c\u00e1c thu\u1ed1c n\u00e0y.<\/li>\n
              • Khuy\u1ebfn c\u00e1o hi\u1ec7n nay l\u00e0 d\u00f9ng l\u1ea1i c\u00e1c thu\u1ed1c ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t n\u1ebfu \u0111\u00e3 can thi\u1ec7p n\u1ed9i soi ho\u1eb7c c\u1ea7m m\u00e1u \u1ed5n \u0111\u1ecbnh. D\u00f9ng l\u1ea1i b\u1eaft \u0111\u1ea7u c\u1ea3 2 thu\u1ed1c hay m\u1ed9t thu\u1ed1c t\u00f9y thu\u1ed9c v\u00e0o t\u1eebng ng\u01b0\u1eddi b\u1ec7nh (c\u00e2n nh\u1eafc gi\u1eefa nguy c\u01a1 xu\u1ea5t huy\u1ebft t\u00e1i ph\u00e1t v\u00e0 nguy c\u01a1 huy\u1ebft kh\u1ed1i trong stent). N\u1ebfu d\u00f9ng 1 thu\u1ed1c, d\u00f9ng aspirin ph\u1ed1i h\u1ee3p v\u1edbi PPI c\u0169ng c\u00f3 hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng t\u1ef1 d\u00f9ng clopidogrel \u0111\u01a1n \u0111\u1ed9c. Trong tr\u01b0\u1eddng h\u1ee3p d\u00f9ng clopidogrel, vi\u1ec7c c\u00f3 ho\u1eb7c kh\u00f4ng k\u1ebft h\u1ee3p v\u1edbi PPI c\u0169ng kh\u00f4ng c\u00f3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb.<\/li>\n<\/ul>\n

                D\u1ef1 ph\u00f2ng XHTH \u1edf b\u1ec7nh nh\u00e2n sau can thi\u1ec7p \u0110MV:<\/strong><\/p>\n

                  \n
                • Tr\u01b0\u1edbc ti\u00ean l\u00e0 x\u00e1c \u0111\u1ecbnh xem b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 XHTH kh\u00f4ng, ph\u00e2n lo\u1ea1i nguy c\u01a1 XHTH cho b\u1ec7nh nh\u00e2n.<\/li>\n
                • S\u1eed d\u1ee5ng PPI cho m\u1ecdi BN nguy c\u01a1 XHTH cao (IB). C\u0169ng c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng PPI cho nh\u00f3m nguy c\u01a1 kh\u00f4ng cao (IIB). N\u00ean b\u1eaft \u0111\u1ea7u s\u1edbm ngay sau khi d\u00f9ng 2 thu\u1ed1c ch\u1ed1ng ti\u1ec3u c\u1ea7u. th\u1eddi gian u\u1ed1ng d\u00e0i nh\u1ea5t trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e0 1 n\u0103m. Kh\u00f4ng n\u00ean d\u00f9ng kh\u00e1ng th\u1ee5 th\u1ec3 H2 v\u00ec ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u1ee3i \u00edch nh\u01b0 PPI.<\/li>\n
                • D\u00f9ng aspirin li\u1ec1u th\u1ea5p nh\u1ea5t c\u00f3 hi\u1ec7u qu\u1ea3 (75 – 150 mg\/24h)<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"

                  Thu\u1ed1c kh\u00e1ng \u0111\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nhi\u1ec1u \u1edf c\u00e1c b\u1ec7nh nh\u00e2n tim m\u1ea1ch. Do \u0111\u00f3, bi\u1ebfn ch\u1ee9ng xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a li\u00ean quan \u0111\u1ebfn lo\u1ea1i thu\u1ed1c n\u00e0y g\u1eb7p \u1edf t\u1ea7n su\u1ea5t l\u1edbn. B\u00e0i vi\u1ebft cung c\u1ea5p c\u00e1c th\u00f4ng tin chi ti\u1ebft. Xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a\u00a0 1.X\u1eed tr\u00ed xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a do qu\u00e1 li\u1ec1u kh\u00e1ng […]<\/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":"\nThu\u1ed1c kh\u00e1ng \u0111\u00f4ng v\u00e0 x\u1eed tr\u00ed bi\u1ebfn ch\u1ee9ng xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a<\/title>\n<meta name=\"description\" content=\"Thu\u1ed1c kh\u00e1ng \u0111\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nhi\u1ec1u \u1edf c\u00e1c b\u1ec7nh nh\u00e2n tim m\u1ea1ch. 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