{"id":749,"date":"2023-04-08T00:28:20","date_gmt":"2023-04-07T17:28:20","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=749"},"modified":"2023-04-17T10:25:27","modified_gmt":"2023-04-17T03:25:27","slug":"khang-dong-trong-huyet-khoi-tinh-mach-sau-chi-duoi","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/08\/khang-dong-trong-huyet-khoi-tinh-mach-sau-chi-duoi\/","title":{"rendered":"Thu\u1ed1c kh\u00e1ng \u0111\u00f4ng t\u0129nh m\u1ea1ch s\u00e2u chi d\u01b0\u1edbi: c\u01a1 ch\u1ebf v\u00e0 c\u00e1ch d\u00f9ng"},"content":{"rendered":"

\"\"<\/h1>\n

Huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u chi d\u01b0\u1edbi<\/strong><\/a> (DVT) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd ph\u1ed5 bi\u1ebfn, g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m . B\u1ec7nh x\u1ea3y ra khi huy\u1ebft kh\u1ed1i h\u00ecnh th\u00e0nh trong t\u0129nh m\u1ea1ch s\u00e2u v\u00e0 ng\u0103n c\u1ea3n l\u01b0u l\u01b0\u1ee3ng m\u00e1u tr\u1edf v\u1ec1 tim. C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh g\u1ed3m \u0111au, s\u01b0ng, \u0111\u1ecf v\u00e0 n\u00f3ng \u1edf ch\u00e2n. Vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng \u0111\u00f4ng l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p quan tr\u1ecdng trong \u0111i\u1ec1u tr\u1ecb huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u \u1edf chi d\u01b0\u1edbi. Thu\u1ed1c kh\u00e1ng \u0111\u00f4ng gi\u00fap ng\u0103n ng\u1eeba s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a huy\u1ebft kh\u1ed1i v\u00e0 gi\u1ea3m nguy c\u01a1 t\u00e1i ph\u00e1t huy\u1ebft kh\u1ed1i \u1edf b\u1ec7nh nh\u00e2n<\/strong><\/p>\n

1. C\u01a1 ch\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a thu\u1ed1c\u00a0 kh\u00e1ng \u0111\u00f4ng<\/h1>\n

C\u00e1c lo\u1ea1i kh\u00e1ng \u0111\u00f4ng th\u00f4ng d\u1ee5ng nh\u01b0 heparin, warfarin, dabigatran, apixaban, rivaroxaban v\u00e0 edoxaban \u0111\u1ec1u c\u00f3 c\u01a1 ch\u1ebf ho\u1ea1t \u0111\u1ed9ng kh\u00e1c nhau trong vi\u1ec7c ng\u0103n ch\u1eb7n s\u1ef1 h\u00ecnh th\u00e0nh v\u00e0 ph\u00e1t tri\u1ec3n c\u1ee7a c\u1ee5c m\u00e1u \u0111\u00f4ng trong t\u0129nh m\u1ea1ch s\u00e2u c\u1ee7a chi d\u01b0\u1edbi.<\/p>\n

Heparin l\u00e0 m\u1ed9t lo\u1ea1i kh\u00e1ng \u0111\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng ng\u1eafn h\u1ea1n, ho\u1ea1t \u0111\u1ed9ng b\u1eb1ng c\u00e1ch k\u00edch ho\u1ea1t ch\u1ea5t \u1ee9c ch\u1ebf t\u01b0\u01a1ng t\u1ef1 antithrombin III, gi\u00fap ng\u0103n ch\u1eb7n s\u1ef1 h\u00ecnh th\u00e0nh c\u00e1c c\u1ee5c m\u00e1u \u0111\u00f4ng m\u1edbi.<\/p>\n

Warfarin l\u00e0 m\u1ed9t lo\u1ea1i kh\u00e1ng \u0111\u00f4ng d\u00e0i h\u1ea1n, ho\u1ea1t \u0111\u1ed9ng b\u1eb1ng c\u00e1ch\u00a0kh\u00e1ng vitamin K \u00a0\u1ee9c ch\u1ebf h\u00ecnh th\u00e0nh c\u00e1c y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u\u00a0II , VII , IX , X\u00a0, gi\u00fap ng\u0103n ch\u1eb7n s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a c\u1ee5c m\u00e1u \u0111\u00f4ng.<\/p>\n

DOACs (Direct Oral Anticoagulants) l\u00e0 m\u1ed9t nh\u00f3m thu\u1ed1c kh\u00e1ng \u0111\u00f4ng th\u1ebf h\u1ec7 \u00a0m\u1edbi, bao g\u1ed3m Rivaroxaban, Apixaban, Edoxaban, Dabigatran v\u00e0 Betrixaban. Ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u00e1c thu\u1ed1c DOACs ng\u0103n ch\u1eb7n s\u1ef1 k\u1ebft h\u1ee3p gi\u1eefa y\u1ebfu t\u1ed1 kh\u00e1ng Xa v\u00e0 fibrin, do \u0111\u00f3 ng\u0103n ch\u1eb7n s\u1ef1 h\u00ecnh th\u00e0nh c\u1ee7a huy\u1ebft kh\u1ed1i. C\u00e1c thu\u1ed1c kh\u00e1ng IIa (dabigatran) ng\u0103n ch\u1eb7n s\u1ef1 k\u1ebft h\u1ee3p gi\u1eefa thrombin v\u00e0 fibrin, do \u0111\u00f3 c\u0169ng ng\u0103n ch\u1eb7n s\u1ef1 h\u00ecnh th\u00e0nh c\u1ee7a huy\u1ebft kh\u1ed1i. C\u00e1c DOACs c\u00f3 nh\u1eefng \u01b0u \u0111i\u1ec3m so v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1ng \u0111\u00f4ng truy\u1ec1n th\u1ed1ng nh\u01b0 heparin v\u00e0 warfarin, bao g\u1ed3m: C\u01a1 ch\u1ebf ho\u1ea1t \u0111\u1ed9ng nhanh h\u01a1n v\u00e0 hi\u1ec7u qu\u1ea3 h\u01a1n, k h\u00f4ng y\u00eau c\u1ea7u gi\u00e1m s\u00e1t \u0111\u1ecbnh k\u1ef3 c\u1ee7a ch\u1ec9 s\u1ed1 \u0111\u00f4ng m\u00e1u, C\u00f3 \u00edt t\u00e1c d\u1ee5ng ph\u1ee5 h\u01a1n v\u00e0 \u00edt t\u01b0\u01a1ng t\u00e1c thu\u1ed1c h\u01a1n.<\/p>\n

2. C\u00e1ch d\u00f9ng v\u00e0 l\u01b0u \u00fd khi d\u1eed d\u1ee5ng<\/h1>\n

2.1 Heparin<\/h2>\n

Heparin l\u00e0 m\u1ed9t lo\u1ea1i thu\u1ed1c kh\u00e1ng \u0111\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ng\u0103n ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb DVT.<\/p>\n

Heparin c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng d\u01b0\u1edbi d\u1ea1ng ti\u00eam t\u0129nh m\u1ea1ch ho\u1eb7c ti\u00eam d\u01b0\u1edbi da. Li\u1ec1u l\u01b0\u1ee3ng heparin ti\u00eam t\u0129nh m\u1ea1ch l\u00e0 80-100 UI\/kg\/ng\u00e0y chia \u0111\u1ec1u th\u00e0nh nhi\u1ec1u l\u1ea7n trong ng\u00e0y. Li\u1ec1u l\u01b0\u1ee3ng heparin ti\u00eam d\u01b0\u1edbi da l\u00e0 5000 UI 2 l\u1ea7n\/ng\u00e0y ho\u1eb7c 7500 UI 1 l\u1ea7n\/ng\u00e0y. Heparin c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 nh\u01b0 ch\u1ea3y m\u00e1u v\u00e0 gi\u1ea3m ti\u1ec3u c\u1ea7u<\/p>\n

2.2 Warfarin<\/h2>\n

Warfarin c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c u\u1ed1ng d\u01b0\u1edbi d\u1ea1ng vi\u00ean nang. Li\u1ec1u kh\u1edfi \u0111\u1ea7u c\u1ee7a warfarin l\u00e0 5-10 mg\/ng\u00e0y v\u00e0 sau \u0111\u00f3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh d\u1ef1a tr\u00ean ch\u1ec9 s\u1ed1 \u0111\u00f4ng m\u00e1u ( PT , aPPT, INR ) c\u1ee7a b\u1ec7nh nh\u00e2n. M\u1ee5c ti\u00eau c\u1ee7a ch\u1ec9 s\u1ed1 \u0111\u00f4ng m\u00e1u \u1edf b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng warfarin INR\u00a0kho\u1ea3ng 2-3.<\/p>\n

Warfarin c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 nh\u01b0 ch\u1ea3y m\u00e1u v\u00e0 d\u1ec5 t\u01b0\u01a1ng t\u00e1c v\u1edbi m\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c kh\u00e1c<\/p>\n

3.3 Dabigatran<\/h2>\n

Dabigatran c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c u\u1ed1ng d\u01b0\u1edbi d\u1ea1ng vi\u00ean nang. Li\u1ec1u l\u01b0\u1ee3ng c\u1ee7a dabigatran l\u00e0 150 mg 2 l\u1ea7n\/ng\u00e0y.<\/p>\n

Dabigatran c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 nh\u01b0 ch\u1ea3y m\u00e1u v\u00e0 ti\u00eau ch\u1ea3y,<\/p>\n

3. S\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng \u0111\u00f4ng trong c\u00e1c giai \u0111o\u1ea1n c\u1ee7a huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u chi d\u01b0\u1edbi<\/h1>\n

3.1 Giai \u0111o\u1ea1n kh\u1ea9n c\u1ea5p<\/h2>\n

Khi b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 \u0111au, ph\u00f9 v\u00e0 s\u01b0ng t\u1ea1i ch\u1ed7 h\u00ecnh th\u00e0nh c\u1ee5c m\u00e1u \u0111\u00f4ng, thu\u1ed1c kh\u00e1ng \u0111\u00f4ng s\u1ebd \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ng\u0103n ch\u1eb7n s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a c\u1ee5c m\u00e1u \u0111\u00f4ng v\u00e0 gi\u1ea3m nguy c\u01a1 c\u00e1c bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m nh\u01b0 \u0111\u1ed9t qu\u1ef5 v\u00e0 suy tim. Heparin l\u00e0 lo\u1ea1i thu\u1ed1c kh\u00e1ng \u0111\u00f4ng th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong giai \u0111o\u1ea1n n\u00e0y.<\/p>\n

3.2 Giai \u0111o\u1ea1n m\u1ea1n t\u00ednh<\/h2>\n

Khi c\u1ee5c m\u00e1u \u0111\u00f4ng \u0111\u00e3 h\u00ecnh th\u00e0nh v\u00e0 g\u00e2y ra c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 \u0111au, s\u01b0ng, v\u00e0 vi\u00eam t\u1ea1i ch\u1ed7 c\u1ee5c m\u00e1u \u0111\u00f4ng, c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1ng \u0111\u00f4ng kh\u00e1c nh\u01b0 warfarin, dabigatran, apixaban, rivaroxaban v\u00e0 edoxaban s\u1ebd \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ng\u0103n ch\u1eb7n s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a c\u1ee5c m\u00e1u \u0111\u00f4ng v\u00e0 gi\u1ea3m nguy c\u01a1 c\u00e1c bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m.<\/p>\n

3.3 Gai \u0111o\u1ea1n ph\u00f2ng ng\u1eeba t\u00e1i ph\u00e1t<\/h2>\n

Sau khi b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u00e0 c\u1ee5c m\u00e1u \u0111\u00f4ng \u0111\u00e3 b\u1ecb tan ho\u00e0n to\u00e0n, c\u00e1c thu\u1ed1c kh\u00e1ng \u0111\u00f4ng c\u0169ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 t\u00e1i ph\u00e1t c\u1ee7a b\u1ec7nh. Lo\u1ea1i thu\u1ed1c kh\u00e1ng \u0111\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong giai \u0111o\u1ea1n n\u00e0y th\u01b0\u1eddng l\u00e0 warfarin ho\u1eb7c c\u00e1c lo\u1ea1i kh\u00e1ng \u0111\u00f4ng tr\u1ef1c ti\u1ebfp nh\u01b0 dabigatran, apixaban, rivaroxaban v\u00e0 edoxaban.<\/p>\n

 <\/p>\n

Vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng \u0111\u00f4ng l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p quan tr\u1ecdng trong \u0111i\u1ec1u tr\u1ecb huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u \u1edf chi d\u01b0\u1edbi. Theo c\u00e1c nghi\u00ean c\u1ee9u v\u00e0 th\u1ef1c ti\u1ec5n, thu\u1ed1c kh\u00e1ng \u0111\u00f4ng gi\u00fap ng\u0103n ng\u1eeba s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a huy\u1ebft kh\u1ed1i v\u00e0 gi\u1ea3m nguy c\u01a1 t\u00e1i ph\u00e1t huy\u1ebft kh\u1ed1i \u1edf b\u1ec7nh nh\u00e2n.<\/p>\n","protected":false},"excerpt":{"rendered":"

Huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u chi d\u01b0\u1edbi (DVT) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd ph\u1ed5 bi\u1ebfn, g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m . B\u1ec7nh x\u1ea3y ra khi huy\u1ebft kh\u1ed1i h\u00ecnh th\u00e0nh trong t\u0129nh m\u1ea1ch s\u00e2u v\u00e0 ng\u0103n c\u1ea3n l\u01b0u l\u01b0\u1ee3ng m\u00e1u tr\u1edf v\u1ec1 tim. 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