{"id":3245,"date":"2025-03-11T09:58:38","date_gmt":"2025-03-11T02:58:38","guid":{"rendered":"https:\/\/hienbacsi.com\/?p=3245"},"modified":"2025-03-11T09:59:59","modified_gmt":"2025-03-11T02:59:59","slug":"lieu-phap-chen-beta-cho-benh-nhan-xo-gan-co-tang-ap-cua-nhung-cap-nhat-moi","status":"publish","type":"post","link":"https:\/\/hienbacsi.com\/index.php\/2025\/03\/11\/lieu-phap-chen-beta-cho-benh-nhan-xo-gan-co-tang-ap-cua-nhung-cap-nhat-moi\/","title":{"rendered":"Li\u1ec7u ph\u00e1p ch\u1eb9n beta cho b\u1ec7nh nh\u00e2n x\u01a1 gan c\u00f3 t\u0103ng \u00e1p c\u1eeda: nh\u1eefng c\u1eadp nh\u1eadt m\u1edbi."},"content":{"rendered":"\n

ThS BS Tr\u1ea7n H\u1eefu Hi\u1ec1n<\/mark><\/strong><\/p>\n\n\n\n

T\u1ed1t nghi\u1ec7p b\u1eb1ng DIU \u0110H Corse C\u1ed9ng Ho\u00e0 Ph\u00e1p<\/mark><\/strong><\/p>\n\n\n\n

Th\u00e0nh vi\u00ean H\u1ed9i Nghi\u00ean C\u1ee9u Gan Ch\u00e2u \u00c2u EASL t\u1eeb 2018 \u0111\u1ebfn nay<\/mark><\/strong><\/p>\n\n\n\n

1. Gi\u1edbi thi\u1ec7u<\/strong><\/p>\n\n\n\n

X\u01a1 gan l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd m\u1ea1n t\u00ednh ti\u1ebfn tri\u1ec3n, \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 thay th\u1ebf m\u00f4 gan b\u00ecnh th\u01b0\u1eddng b\u1eb1ng m\u00f4 s\u1eb9o, d\u1eabn \u0111\u1ebfn t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda. M\u1ed9t trong nh\u1eefng bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng c\u1ee7a x\u01a1 gan l\u00e0 t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda, g\u00e2y gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n, v\u1ee1 gi\u00e3n t\u0129nh m\u1ea1ch v\u00e0 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a. Thu\u1ed1c ch\u1eb9n beta (beta-blockers) \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong ki\u1ec3m so\u00e1t bi\u1ebfn ch\u1ee9ng n\u00e0y, gi\u00fap c\u1ea3i thi\u1ec7n ti\u00ean l\u01b0\u1ee3ng cho b\u1ec7nh nh\u00e2n x\u01a1 gan.<\/p>\n\n\n\n

B\u00e0i vi\u1ebft n\u00e0y s\u1ebd tr\u00ecnh b\u00e0y c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng, ch\u1ec9 \u0111\u1ecbnh l\u00e2m s\u00e0ng v\u00e0 h\u01b0\u1edbng d\u1eabn li\u1ec1u d\u00f9ng c\u1ee7a thu\u1ed1c ch\u1eb9n beta trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n x\u01a1 gan, d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng y h\u1ecdc hi\u1ec7n c\u00f3.<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

2. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c ch\u1eb9n beta trong x\u01a1 gan<\/strong><\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

T\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda trong x\u01a1 gan c\u00f3 hai c\u01a1 ch\u1ebf ch\u00ednh:<\/p>\n\n\n\n

\u2022 T\u0103ng kh\u00e1ng l\u1ef1c trong gan (intrahepatic resistance): G\u1ed3m y\u1ebfu t\u1ed1 c\u1ea5u tr\u00fac (x\u01a1 h\u00f3a, n\u1ed1t t\u00e1i t\u1ea1o) v\u00e0 \u0111\u1ed9ng l\u1ef1c h\u1ecdc (co th\u1eaft vi m\u1ea1ch trong gan).<\/p>\n\n\n\n

\u2022 T\u0103ng l\u01b0u l\u01b0\u1ee3ng m\u00e1u \u0111\u1ebfn gan (splanchnic hyperemia): H\u1ec7 m\u1ea1ch t\u1ea1ng gi\u00e3n ra do t\u0103ng s\u1ea3n xu\u1ea5t nitric oxide, d\u1eabn \u0111\u1ebfn t\u0103ng l\u01b0u l\u01b0\u1ee3ng m\u00e1u v\u00e0o h\u1ec7 t\u0129nh m\u1ea1ch c\u1eeda.<\/p>\n\n\n\n

Thu\u1ed1c ch\u1eb9n beta t\u00e1c \u0111\u1ed9ng theo ba c\u01a1 ch\u1ebf ch\u00ednh nh\u1eb1m l\u00e0m gi\u1ea3m \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda:<\/p>\n\n\n\n

1. Ch\u1eb9n th\u1ee5 th\u1ec3 \u03b21 (\u03b21-adrenergic blockade) – Carvedilol, NSBB<\/p>\n\n\n\n

\u2022 Gi\u1ea3m cung l\u01b0\u1ee3ng tim \u2192 gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng m\u00e1u v\u00e0o h\u1ec7 t\u0129nh m\u1ea1ch c\u1eeda.<\/p>\n\n\n\n

\u2022 Gi\u1ea3m ho\u1ea1t h\u00f3a h\u1ec7 th\u1ea7n kinh giao c\u1ea3m v\u00e0 h\u1ec7 RAA \u2192 gi\u1ea3m gi\u1eef mu\u1ed1i n\u01b0\u1edbc.<\/p>\n\n\n\n

2. Ch\u1eb9n th\u1ee5 th\u1ec3 \u03b22 (\u03b22-adrenergic blockade) – NSBB, Carvedilol<\/p>\n\n\n\n

\u2022 Co m\u1ea1ch t\u1ea1ng \u2192 gi\u1ea3m l\u01b0\u1ee3ng m\u00e1u \u0111\u1ed5 v\u1ec1 gan, gi\u1ea3m \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda.<\/p>\n\n\n\n

3. Ch\u1eb9n th\u1ee5 th\u1ec3 \u03b11 (\u03b11-adrenergic blockade) – Carvedilol<\/p>\n\n\n\n

\u2022 Gi\u00e3n m\u1ea1ch trong gan \u2192 gi\u1ea3m kh\u00e1ng l\u1ef1c trong gan, c\u1ea3i thi\u1ec7n tu\u1ea7n ho\u00e0n c\u1eeda ch\u1ee7.<\/p>\n\n\n\n

Nh\u01b0 v\u1eady, carvedilol c\u00f3 t\u00e1c d\u1ee5ng m\u1ea1nh h\u01a1n so v\u1edbi c\u00e1c thu\u1ed1c ch\u1eb9n beta kh\u00f4ng ch\u1ecdn l\u1ecdc (NSBB: non-selective beta-blockers) nh\u01b0 propranolol v\u00e0 nadolol, do v\u1eeba ch\u1eb9n \u03b21, \u03b22 v\u1eeba ch\u1eb9n \u03b11.<\/p>\n\n\n\n

\u2e3b<\/p>\n\n\n\n

3. Ch\u1ec9 \u0111\u1ecbnh c\u1ee7a thu\u1ed1c ch\u1eb9n beta trong x\u01a1 gan<\/strong><\/p>\n\n\n\n

Ch\u1ec9 \u0111\u1ecbnh c\u1ee7a thu\u1ed1c ch\u1eb9n beta trong x\u01a1 gan d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng y h\u1ecdc v\u00e0 m\u1ee9c \u0111\u1ed9 khuy\u1ebfn c\u00e1o, \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i nh\u01b0 sau:<\/p>\n\n\n\n

3.1. Ph\u00f2ng ng\u1eeba tr\u01b0\u1edbc ti\u00ean ph\u00e1t (Pre-primary prophylaxis)<\/strong><\/p>\n\n\n\n

\u2022 Nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng (RCT) kh\u00f4ng cho th\u1ea5y hi\u1ec7u qu\u1ea3 trong vi\u1ec7c ng\u0103n ch\u1eb7n s\u1ef1 h\u00ecnh th\u00e0nh gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n ho\u1eb7c l\u00e0m ch\u1eadm ti\u1ebfn tri\u1ec3n c\u1ee7a x\u01a1 gan.<\/p>\n\n\n\n

\u2022 Kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh s\u1eed d\u1ee5ng thu\u1ed1c ch\u1eb9n beta trong giai \u0111o\u1ea1n n\u00e0y.<\/p>\n\n\n\n

3.2. Ph\u00f2ng ng\u1eeba ti\u00ean ph\u00e1t xu\u1ea5t huy\u1ebft do v\u1ee1 gi\u00e3n t\u0129nh m\u1ea1ch (Primary prophylaxis of variceal bleeding)<\/strong><\/p>\n\n\n\n

\u2022 B\u1ec7nh nh\u00e2n x\u01a1 gan m\u1ea5t b\u00f9 c\u00f3 gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n l\u1edbn ho\u1eb7c nguy c\u01a1 cao \u2192 Ch\u1ec9 \u0111\u1ecbnh d\u00f9ng NSBB ho\u1eb7c carvedilol.<\/p>\n\n\n\n

\u2022 M\u1ee9c \u0111\u1ed9 khuy\u1ebfn c\u00e1o: GRADE 1, Level 1a (b\u1eb1ng ch\u1ee9ng m\u1ea1nh).<\/p>\n\n\n\n

3.3. Ph\u00f2ng ng\u1eeba t\u00e1i ph\u00e1t xu\u1ea5t huy\u1ebft (Secondary prophylaxis of variceal bleeding)<\/strong><\/p>\n\n\n\n

\u2022 \u00c1p d\u1ee5ng cho b\u1ec7nh nh\u00e2n \u0111\u00e3 t\u1eebng xu\u1ea5t huy\u1ebft do v\u1ee1 gi\u00e3n t\u0129nh m\u1ea1ch.<\/p>\n\n\n\n

\u2022 K\u1ebft h\u1ee3p NSBB ho\u1eb7c carvedilol v\u1edbi ph\u01b0\u01a1ng ph\u00e1p th\u1eaft t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n n\u1ed9i soi (EVL).<\/p>\n\n\n\n

\u2022 M\u1ee9c \u0111\u1ed9 khuy\u1ebfn c\u00e1o: GRADE 1, Level 1a.<\/p>\n\n\n\n

3.4. Ph\u00f2ng ng\u1eeba t\u00e1i ph\u00e1t xu\u1ea5t huy\u1ebft d\u1ea1 d\u00e0y (Gastric varices bleeding)<\/strong><\/p>\n\n\n\n

\u2022 Hi\u1ec7u qu\u1ea3 c\u1ee7a NSBB trong ph\u00f2ng ng\u1eeba t\u00e1i ph\u00e1t xu\u1ea5t huy\u1ebft do gi\u00e3n t\u0129nh m\u1ea1ch d\u1ea1 d\u00e0y kh\u00f4ng r\u00f5 r\u00e0ng.<\/p>\n\n\n\n

\u2022 RCT cho th\u1ea5y cyanocrylate c\u00f3 hi\u1ec7u qu\u1ea3 h\u01a1n NSBB trong ki\u1ec3m so\u00e1t ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t.<\/p>\n\n\n\n

\u2022 Kh\u00f4ng c\u00f3 khuy\u1ebfn c\u00e1o m\u1ea1nh v\u1ec1 s\u1eed d\u1ee5ng NSBB \u0111\u01a1n \u0111\u1ed9c trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y.<\/p>\n\n\n\n

3.5. B\u1ec7nh l\u00fd d\u1ea1 d\u00e0y do t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda (Portal hypertensive gastropathy – PHG)<\/strong><\/p>\n\n\n\n

\u2022 M\u1ed9t nghi\u00ean c\u1ee9u RCT cho th\u1ea5y NSBB c\u00f3 th\u1ec3 gi\u00fap gi\u1ea3m ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t \u1edf b\u1ec7nh nh\u00e2n PHG.<\/p>\n\n\n\n

\u2022 M\u1ee9c \u0111\u1ed9 khuy\u1ebfn c\u00e1o: GRADE 1, Level 1b.<\/p>\n\n\n\n

\u2e3b<\/p>\n\n\n\n

4. H\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng v\u00e0 li\u1ec1u d\u00f9ng<\/strong><\/p>\n\n\n\n

4.1. Propranolol<\/strong><\/p>\n\n\n\n

\u2022 Li\u1ec1u kh\u1edfi \u0111\u1ea7u: 20-40 mg u\u1ed1ng m\u1ed7i 12 gi\u1edd.<\/p>\n\n\n\n

\u2022 T\u0103ng li\u1ec1u: 20 mg m\u1ed7i 2-3 ng\u00e0y \u0111\u1ebfn khi \u0111\u1ea1t m\u1ee5c ti\u00eau.<\/p>\n\n\n\n

\u2022 Li\u1ec1u t\u1ed1i \u0111a:<\/p>\n\n\n\n

\u2022 320 mg\/ng\u00e0y n\u1ebfu kh\u00f4ng c\u00f3 c\u1ed5 tr\u01b0\u1edbng.<\/p>\n\n\n\n

\u2022 160 mg\/ng\u00e0y n\u1ebfu c\u00f3 c\u1ed5 tr\u01b0\u1edbng.<\/p>\n\n\n\n

\u2022 M\u1ee5c ti\u00eau: Nh\u1ecbp tim 55-60 bpm, huy\u1ebft \u00e1p t\u00e2m thu \u226590 mmHg.<\/p>\n\n\n\n

\u2022 Theo d\u00f5i: \u0110\u00e1nh gi\u00e1 nh\u1ecbp tim v\u00e0 dung n\u1ea1p thu\u1ed1c t\u1ea1i m\u1ed7i l\u1ea7n t\u00e1i kh\u00e1m.<\/p>\n\n\n\n

4.2. Nadolol<\/strong><\/p>\n\n\n\n

\u2022 Li\u1ec1u kh\u1edfi \u0111\u1ea7u: 20-40 mg u\u1ed1ng m\u1ed7i ng\u00e0y m\u1ed9t l\u1ea7n.<\/p>\n\n\n\n

\u2022 T\u0103ng li\u1ec1u: 20 mg m\u1ed7i 2-3 ng\u00e0y \u0111\u1ebfn khi \u0111\u1ea1t m\u1ee5c ti\u00eau.<\/p>\n\n\n\n

\u2022 Li\u1ec1u t\u1ed1i \u0111a:<\/p>\n\n\n\n

\u2022 160 mg\/ng\u00e0y n\u1ebfu kh\u00f4ng c\u00f3 c\u1ed5 tr\u01b0\u1edbng.<\/p>\n\n\n\n

\u2022 80 mg\/ng\u00e0y n\u1ebfu c\u00f3 c\u1ed5 tr\u01b0\u1edbng.<\/p>\n\n\n\n

\u2022 Theo d\u00f5i: T\u01b0\u01a1ng t\u1ef1 propranolol.<\/p>\n\n\n\n

4.3. Carvedilol<\/strong><\/p>\n\n\n\n

\u2022 Li\u1ec1u kh\u1edfi \u0111\u1ea7u: 6.25 mg u\u1ed1ng m\u1ed7i ng\u00e0y m\u1ed9t l\u1ea7n.<\/p>\n\n\n\n

\u2022 Sau 3 ng\u00e0y: T\u0103ng l\u00ean 6.25 mg hai l\u1ea7n\/ng\u00e0y.<\/p>\n\n\n\n

\u2022 Li\u1ec1u t\u1ed1i \u0111a:<\/p>\n\n\n\n

\u2022 12.5 mg\/ng\u00e0y (n\u1ebfu kh\u00f4ng c\u00f3 t\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch).<\/p>\n\n\n\n

\u2022 Xem x\u00e9t 25 mg\/ng\u00e0y n\u1ebfu c\u00f3 t\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch.<\/p>\n\n\n\n

\u2022 Theo d\u00f5i: \u0110\u00e1nh gi\u00e1 huy\u1ebft \u00e1p, dung n\u1ea1p thu\u1ed1c, nh\u1ecbp tim.<\/p>\n","protected":false},"excerpt":{"rendered":"

ThS BS Tr\u1ea7n H\u1eefu Hi\u1ec1n T\u1ed1t nghi\u1ec7p b\u1eb1ng DIU \u0110H Corse C\u1ed9ng Ho\u00e0 Ph\u00e1p Th\u00e0nh vi\u00ean H\u1ed9i Nghi\u00ean C\u1ee9u Gan Ch\u00e2u \u00c2u EASL t\u1eeb 2018 \u0111\u1ebfn nay 1. Gi\u1edbi thi\u1ec7u…<\/p>\n","protected":false},"author":1,"featured_media":3243,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[131],"tags":[67,84,51],"jetpack_featured_media_url":"https:\/\/hienbacsi.com\/wp-content\/uploads\/2025\/03\/img_6396-1.jpg","_links":{"self":[{"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/posts\/3245"}],"collection":[{"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/comments?post=3245"}],"version-history":[{"count":2,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/posts\/3245\/revisions"}],"predecessor-version":[{"id":3247,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/posts\/3245\/revisions\/3247"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/media\/3243"}],"wp:attachment":[{"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/media?parent=3245"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/categories?post=3245"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/tags?post=3245"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}