Ha huyet ap sau an xay ra khi huyet ap tam thu cua benh nhan giam it nhat 20 mmHg d td the ngoi hoac nam ngda trong vdng 120 phut sau bda an.Tuy ha huyet ap sau an khac vdi ha huye'ta[r]
(1)•••••I Tap chi
Nghien ctiuduoc
SThong tin thudc
JOURNAL OF PHARMACEUTICAL RESEARCH AND DRUG INFORMATION
TRU0NG DAI HOC Dl/OC HA NOI
Oja chi: 13-15 LeThanh Tong - Hoan Kiem - Ha Noi Website: http://hup.edu.vn
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Nghien cufu bao chenhu tirong nho mat piroxicam
Bao Minh Huy, LeThi Ngpc
Truing Bai hoc DM Ha Not
Phan tich chi phi y te trVc tiep cua benh ung thu tai Khoa A6 -Benh vien Trung ifctng Qua n dpi 108 nam 2011
Nguyen Thi Thanh Huong', Nguyen OUc Canh', Nguyen BUc Trung2
1 Tracing Bai hoc Dupe Ha Not; 'Berth vien Trung uang Quart dpi 108
Oinh lupng dong thcri lamivudin, zidovudin va nevirapin thuoc khang HIV phoi hpp bang dien di mao quan
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Truing Dai hoc Dupe Ha Npi
Thong tin thuoc - canh giac dufqc
24 Ha huyet ap sau an va huyet ap to the
NgUcri dich: Tran Thuy Ngan.Vu Dang Hoang
Nguon: US Pharm 2011;37(2):44-S
Diem tin hoat dong
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(3)THONG TIN THU6C - CANH GlAC DUOC
Ha huyet ap sau an va huyet ap tU the
Ngudi dich: Tran Thuy Ngan, Vu Oang Hoang Nguon: US Pharm 2011;37(2):44-50
Hg huyet ap la thubt ngCt tuong 661 mo td huyet ap hg thap hon so vdi chi so b'tnh thudng cua benh nhan 66 Do khdng cd dinh nghia chudn chohg huyet dp, viec xdc dinh tan sudt va ty le mac cua benh thudng gap khd khan Tren thuc te.dmgtso benh nhdn, huyet dp thdp duocxem Id binh thudng Benh nhan co huyet dp tam thu khodng 90-100 mmHg thgm chicd theco tuoi tho trung binh cao hon so vdi benh nhdn co chi so huyet dp binh thudng
Mac du chda can lo ngai huyet ap thap hon 120/80 mmHg, nhdng neu benh nhan cd trieu chdng lien quan den huyet ap nhd chdng mat, choang vang, cam giac khat qua mUc thi can dude kiem tra them (bang 1) Nhdng trieu chUng la ket qua cua su giam tudi mau d cac to chut quan trgng, neu keo dai cd the dan tdi pha huy to chde Trong cac trudng hop nghiem hon, benh nhan cd the nga't Vdi mot so benh nhan, huyet ap cd the suy nhudc nen can phai nghi ngoi tren giudng Ha huyet ap dot ngqt cd the gay nguy hiem den tinh mang Ha huyet ap sau an (PPH) va huyet ap tuthe (OH) nam nhdng roi loan tim mach thddng gap nhat dan den nga va ngat
Bang Jrieu chdng da huyet ap -Chdng mat hoac choang vang; - Ngat;
- Cam giac mat nude va khat bat thudng; - Mat tap trung;
- Nhin md; - Buon ndn;
- Cam thay lanh, da am udt, nhqt nhat; -Thd nhanh va nong;
- Met mdi; -Tram ciim
Cofche benh sinh
Huyet ap dupe dieu hda bdi nhieu co che lien quan vdi nhau.Theo phuong trinh thuy lUc hoc, huyet ap dqng mach la tich so cua toe ddng mau dupe mo ta bdi cung luqng tim (cardiac output - CO) va sue
can mach phoi (pulmonary vascular resistance - PVR): BP = CO x PVR
Hai yeu to lien tuc dieu hda huyet ap thong qua co quan chinh la cac tieu dqng mach, cac tieu tinh mach sau mao mach va tim.Than kiem soat huyet ap gian tiep thong qua tri the tich djch nqi mach Vdi co quan nay, huyet ap dude kiem soat nhd phan xa thu cam nhan ap thong qua cac day than kinh t q chu ket hop vdi co che the dich Ngoai ra, cac chat hoat mach td nqi mac mach mau nhu nitric oxyd va endothelin-1 cung dieu hda huyet ap bang each thay doi sdc can mach mau
Sinh ly benh
Ha huyet ap cd the thay doi cung ludng tim hoac sdc can mach phoi Bai viet trao doi ve kieu huyet ap: huyet ap sau an va huyet aptu the Can luu y, hai kieu huyet ap cd co che cpng hop vdi hon la co che hiep dong
Ha huyet ap sau an
(4)THONG TIN THUOC - CANH GIAC D'dOC
Bang Cdcyeu to cua baa an anh hddng den hoi chdng huyet ap sau an (PPH)
Thdi gian an: BQa sang va bUa trifa co nguy CO gay PPH cao hon
Thanh phan bCta an: Cac bufa an giau carbohydrat, ngheo protein co nguy co gay PPH cao hon Dac biet, viec nap glucose co the dan tdi PPH
Nhiet there an: Thud an co nhiet cang cao thi nguy co huyet ap cang cao
Khoiluong bda an: An nhieu nhung an it buta thudng gay PPH nhieu hon so vdi viec an nhieu bda vdi loqng nhd hon
Ddocsmen khuyen benh nhan duytri td the nam ngda sau bda an Dac biet, each cd the giup ich nhdng benh nhan mac ca huyet ap sau an va huyet ap to the Odi vdi ngudi cao tuoi, udng du nude la yeu td quan giup ngan ngUa huyet ap sau an Viec lUa chon bien phap dieu tri hieu qua hien tuong ddi han che Cho den nay, cac thudc nhUcafein va octreotid da duqc sd dung; acarbose dang giai doan nghien cUu thd nghiem
Cafein: Mac du cafein duqc cho la cd tac dung ddi khang vdi cac thudc gian mach, co che van chUa duqc hieu biet day du Tuy nhien, viec sU dung cafein trUdc bUa an vdi lieu 60-200 mg (tUdng dudng -2 tach ca phe) cd the lam giam nguy co huyet ap sau an d mot so benh nhan Cafein cd tac dung phu la gay tieu chay, run, rdi loan giac ngu va tim dap nhanh Octreotid: Octreotid duoc sU dung de dieu tri benh nhan tang huyet ap cao tudi mac hdi chUng huyet ap sau an va benh nhan suy giam chUc nang he than kinh tU chu Thudc cd tac dung thong qua tang lUu luqng mau ndi tang va lUc can mach mau cang tay cung nhu ngan sU giai phdng cac hormon tuyen va dudng rudt Tuy nhien, octreotid cd gia kha cao Thudc duqc chi djnh tiem dudi da vdi lieu Bang Cdc nguyen nhan gay hg huyet dp td the (OH)
nhat 25-50 microgam trUdc bUa an Cac tac dung phu cd the gap cua thudc bao gdm dau tai noi tiem, tieu chay, budn ndn va rung tdc
Acarbose: Acarbose cd tac dung lam giam nguy co huyet ap sau an d nhUng benh nhan suy giam chUc nang he than kinh tU chu Mot phan thong qua lam giam phan huy carbohydrat phUc hop, acarbose Uc che hoat dqng cua alpha-glucosidase, lam giam bai tiet insulin (cd tac dung gian mach) va cac hormon dudng tieu hda khac Dieu cung cd the giai thich tai khau phan carbohydrat bUa an cd tac dung huyet ap Idn nhat Acarbose dupe chi dinh dung trUdc bUa an 20 phut vdi lieu 100 mg x Ian/ Cac tac dung phu thudng gap bao gdm dau bung, tieu chay va day hoi
Cac thudc nhu midodrin, dihydroergotamin, indomethacin, diphenhydramin, cimetidin, fludrocortison va vasopressin cung cd tac dung d cac mUc khac viec kiem soat huyet ap sau an
Ha huyet ap t u t h e
Theo Hiep hdi Than kinh TU chu Hoa Ky (American Autonomic Society) va Vien Than kinh hoc Hoa Ky (American Academy of Neurology), huyet ap tuthe duqc dinh nghia la sU giam huyet ap tam thu it nhat 20 mmHg hoac huyet ap tam truong it nhat 10 mmHg vdng phut d tuthe dUng Can kiem soat hieu qua huyet ap tU the vi day la dau hieu du doan nguy co tU vong benh tim mach, dac biet d ngudi cao tudi va benh nhan dai thao dudng Ty le mac huyet ap tuthe d ngudi cao tudi la 5-30%, phu thudc vao benh nhan cd huyet ap tam thu hay huyet ap tam truong Ha huyet ap tuthe cd the ca nguyen nhan than kinh hoac khdng lien quan den than kinh Cac nguyen nhan duoc chia nhdm: thudc, rdi loan than kinh tUchu, giam lUu luqng mau va cac rdi loan khac (bang 3)
Giam lifti lifting mau Xuat huyet, bong, nhiem trung, tieu nhieu hoac mo hoi nhieu, tang fluting huyet va dai thao nhat, benh Addison, u tuyen tuy, tieu chay man tinh, tang huyet ap benh mach than, mat mudi benh than, bieng an tam than
Thuoc Thuoc Igi tieu, chen alpha, chen beta, thuoc dieu tri benh Parkinson, chong tram cam vong, sildenafil, cac nitrat, insulin, con, thuoc gay nghien, phenothiazin, vincristin, Uc che giao cam, kich thich giao cam, thuoc an than thU yeu
Roi loan than kinh tif chu
Hoi chUng Shy-Drager (suy thoai hoat dong cua he than kinh giao cam tien va hau hach), benh nao ting thuy, hoi chUng medullary plate, mat ngon ngufdo ton thtrong viing Wernicke, benh nao, nhoi mau nao da 6, xo cUng rai rac, chUng thoai hoa dang tinh hot, hoi chUng Bradbury-Eggleston
Khac Loan nhip tim, dau that nguc, suy tim, mach pho'i, u myxoma tam nht, tang kali mau, hoi chUng can tan tao ac tinh
(5)THONG TIN THUOC-CAnHGIACDUOC i <
Viec dieu tri chu yeu nham cai thien trieu chdng va loai bo cac nguyen nhan nen Co the khuyen khich benh nhan tang cubing bo sung muoi va nude nhu bddc dieu trj dau tien Cac bien phap khdng dung thuoc de kiem soat huyet ap ta the bao gom dung giadng co doc giup ep tinh mach va thqc hien cac dpng tac chong huyet ap trade bat dau dieu trj bang thuoc Mot so dpng tac chong huyet ap nen dapc thdc hien khoang 30 giay moi Ian ddpc Met ke bang
Bang Mot so dpng tat chong huyet dpddi vdi huyet dp td the Kieng chan;
Bat cheo chan vao va co lai; Co cd dai;
Cui ngadi tdvung eo; Dam chan cham tai cho; Nang cao hai chan
Bat ky thuoc nao benh nhan dang sd dung cung cd the lien quan den cac trieu chdng cua benh nhan va kha nang can ddpc lam rd trddc bat dau dieu trj. 6 mot so trddng hpp, huyet ap cd the sd dung cac thuoc dong thdi Neu Ipi ich cua viec ngdng sd dung thuoc nghi ngd gay huyet ap khong vdpt trpi hon nguy co, can can nhac dung cac
(Anh ti/lieu Internet)
bien phap khac de kiem soat huyet ap Ngoai ra, can tranh tang huyet ap d tdthe nam ngda (tac dung phu thddng gap dung thuoc dieu trj huyet ap) va suy tim sung huyet, dac biet d benh nhan dai thao dddng hoac mac benh thieu mau cue bo cotim
Bien phap dieu tri bang thuoc
Thuoc cd the kiem soat tot huyet ap tdthe' neu dupe sd dung dung each Mot so thuoc ddpc Met ke dddi day ddpc sd dung tren lam sang de dieu trj huyet ap td the nhdng chi djnh cd the da ddpc phe duyet hoac chda ddpc phe duyet chinh thdc cda co qaan quan ly ddpc pham
Fludrocortison
Fludrocortison la mot mineralocorticoid lam tang the tich ngoai long mach va tang nhay cam alpha-adrenergic Liea thddng dung la 0,1-0,2 mg/ngay, nhdng cung cd the tang len 0,4-0,6 mg/ngay Nen sd dung fludrocortison d lieu thap nhat cd hieu qua thuoc cd the lam qua tai djch, cung nhd gay kali maa va/hoac magnesi mau Cd the can bo sung kali cho benh nhan dung lieu cao Tuy nhien, viec dieu trj bj han che thuoc cd the gay tang huyet ap d td the nam ngda Ngoai ra, benh nhan cdng cd the gap dad dau, phu va tang can
(6)THONG TIN THUOC - CANH GlAC D'JQC Midodrin
Midodrin la mot tien thuoc chUa co hoat tinh; sau dung qua dudng uong, thuoc dupe chuyen hoa desglymidodrin chu van chon loc alpha,-adrenergic Desglymidodrin co tac dung cao hon 15 Ian midodrin Day la chat co mach, co tac dung tot dieu trj huyet ap tuthe' nguyen nhan than kinh Midodrin khong co hieu qua tren benh nhan huye'taptuthe'dogiam khdi lupng djch.Thuoc cung co tac dung lam tang huyet ap tam thu dtUtheddng, giam cam giac choang vang, tang thdi gian co kha nang ddng va di cua ngudi benh
Lieu khdi dau dupe khuyen cao cua midodrin la 2,5 mg x2-3 lan/ngay (dudng udng) va tang lieu tCrtu" den 10 mg x lan/ngay chi doi vdi benh nhan cd dap dng vdi bien phap dieu trj ban dau Thuoc bat dau cd tac dung sau 0,5-1 gid va keo dai tdi da gid Vdi lieu phap dieu trj toi Uu, nen trai rdng lieu dua tren thdi diem benh nhan gap phai trieu chdng nang nha't Midodrin gay tang huyet ap d tU the nam ngda tren khoang 25% benh nhan; cd the giam tac dung bang each dung thudc it nha't gid trUdc di ngu hoac ke nghieng giudng cua benh nhan Can khuyen khich benh nhan theo ddi huyet ap thudng xuyen de phat hien trudng hpp tang huyet apqua mute tuthe nam ngda Benh nhan cung cd the gap gian ddng td, ndi da ga, dj cam, ngufa da dau, ngda toan than Chdng chi djnh trudng hpp cd benh than, bi tieu, benh tim, u tuyen thupng than hoac nhiem ddc tuyen giap
Pyridostigmin
Pyridostigmin cd tac dung cai thien tuong ddi it nhung cd the nhan thay ddi vdi huyet ap tU the ma khdng gay tang huyet ap d tU the nam ngda Pyridostigmin dc che acetylcholinesterase, lam tang dan truyen than kinh d hach tren dudng truyen phan xa nhan ap giao cam. 6 mot so benh nhan, suy giam chut nang than kinh td chu anh hudng den chat dan truyen than kinh acetylcholin Do lam giam chuyen hda acetylcholin thong qua acetylcholinestease, pyridostigmin cai thien huyet ap the ddng, dac biet la huyet ap tam truong
Pyridostigmincd tac dung d benh nhan huyet ap tuthe nhe vdi lieu 30-60 mg x 2-3 lan/ngay Thudc cd the dupe dung ket hpp vdi midodrin mg cho cac trudng hpp huyet aptuthe nang hon nhung sUket hpp chUa dupe nghien cUu day du Thudc cd cac tac dung phu lien quan tdi he cho linergic nhu dau
co that vung bung, tieu chay, budn ndn va ndn, tieu nhieu Ian, co ddng td, md mat va tang tiet nude bpt Cac tac dung phu nghiem trpng hon bao gdm block nhi that, loan nhjp tim, hoac tang huyet ap, ngat, ngdng tim, co that phe quan, phu phdi, Met, co giat va phan ve
Chdng chi djnh dung thudc cho benh nhan tac tieu hda hoac viem phuc mac Than trpng sddung vdi benh nhan hen phe quan, benh tim mach, ddng kinh, cUdng giap, Parkinson, suy than hoac loet da day-tatrang
Epoetin alpha
Epoetin alpha cd tac dung cai thien tinh trang thieu mau thudng lien quan den cac rdi loan than kinh tu chu Thudc giup tang huyet ap d tu the ddng va cai thien trieu chdng thay ddi tu the d benh nhan huyet ap tu the Lieu thudng dung la 25-75 Ul/kg x lan/tuan tiem dudi da hoac tiem tTnh mach Thong thudng, benh nhan dupe ke don sat bo sung de lam tang hematocrit Dupe si nen trao ddi vdi benh nhan nhCfng phan dng phu tren dudng tieu hda cd the gap phai sd dung che pham bd sung sat Ngoai ra, erythropoietin cung gay tang huyet ap d tuthe nam ngda, tang cam giac ngon mieng va tang cam giac vui ve
Droxidopa (l-threo-3,4-dihydroxyphenylserine hoac l-DOPS)
Droxidopa la mot aminoacid, dupe chuyen hda noradrenalin cdthe Benh nhan gap cac rdi loan suy giam chut nangthan kinh tu chu (nhu benh Parkinson) thudng mac huyet ap t u t h e thieu chat dan truyen than kinh noradrenalin Thudc cd tac dung bd sung chat dan truyen nay, nhd kiem soat huyet ap tuthe De dieu trj huyet ap tu the nguyen nhan than kinh, droxidopa dupe khuyen cao sCrdung vdi lieu khdi dau 100 mg x Ian/ ngay; cd the tang dan den lieu tdi da 1,8 g/ngay chia lam cac lieu nhd
Vai tro cua ddpc si
Dupe si ddng vai trd quan trpng cham sot; dieu trj cho benh nhan huyet ap tuthe, td viec theo ddi deu dan huyet ap cua benh nhan den tu van benh nhan ve sinh hoat/ldi song va sCr dung thudc hpp ly Ngoai ra, dupe si cung can khuyen khich ngudi benh thong bao lai cac thudc dang sd dung cd the cac thudc lai cd anh hudng den trj so huyet ap
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