Thieu sot hay gap khi dung
K
hi dung thuoc dieu tri cao huye't ap ngfldi bfnh thd&ng ed cdc thifi'u sdt:- Bieu tri mudn do phdt hien mupn: Cao huylt dp khfing cd trifu chiing dac hifu, khfing ed dd'u hieu tiln bdo nfin dflde phdt hifn mufin, ed khi rdt mufin, thdm chi dfi'n lue xay ra tai biln mdi xdc dinh bfnh.
Ngfldi trfldng thdnh mfii ndm nen khdm sfle khde dinh ky mfit lan d l t i m sodt bfinh trong dd ed cao huyfi't dp. Nhflng ngfldi ed nguy cd cao (tren 40 tuli, cd thfla can hay bdo phi, rfi'i logn md mdu, dai thdo dfldng) it n h l t 6 thang mfit lln phdi do huyfi't dp d l phat hifn bfnh. Khi thay huylt dp eao, nen do lai 3 dot, each nhau mfii thdng. Chi sau 3 dot do ma tri so trung binh cua huyfi't dp deu >
140/90mmHg mdi xde dinh la bi cao huyfi't dp.
- Bieu tri mudn do theo quan niim dung thudc cu: Trfldc day eho r i n g ne'u huye't dp t r e n 140/90mmHg md sau mft ndm
thay dli lli song khfing cd hifu qua hoac ed kem nguy cO (nhfl ddi thdo dfldng) thi mdi dung thulc.
Nay, hfldng dan eua Hpi huyfit dp chdu Au (ESH - 2007, ESH - 2009) vd eiia My (UN-7) qui dinh:
Ngfldi dfldi 80 tuli cao huyfi't dp nfi'u khfing kem theo nguy cd thi khdi diu dilu tri khi huyfi't dp
> 140/90mmHg; eon nfi'u cd ye'u t l nguy CO thi khdi dau dilu tri khi huyet dp > 130/85mmHg (md khfing chd k i t qua vific thay dli Id'i sfi'ng). Nhfl vdy, vifc khdi ddu ddng thud'c sdm han trUdc khd nhiiu. Dung thud'c sdm lam chdm sfl tifi'n trien dfi'n ngng, dfla huyfi't dp vl dieh dilu tri sdm, trdnh ede nguy ed do tdng huyfi't dp.
- Khdng dung dd thudc phdi hgp theo chi dinh: Lifu phdp phfi'i hop d n flu tifin dp dung eho ngfldi nguy ca cao nham ha thd'p huyfi't dp nhanh, tranh tham hpa. Phli hdp thufi'e se h i sung vd ldm tdng hifiu life cua nhau, eho hifiu qud sdm hon, cao hdn dimg ddn; lieu
dung moi thanh phan thip hcfn khi dung ddn, ngn ft gap tdc dung phii.
Tuy nhien mfit so phfi'i hpp c6 ihi gay ra tde dimg phu. Khfing tu f phli hop hay dflng cdc bifit difgc Itep. Chi dflde phfi'i hdp theo chl dinh cua thay thule, khi dflpc chi dinh d n dung du thufi'c du lieu cac thdnh phan phli hdp.
- Tli tdng liiu theo cdm giac chd quan: Khi nhfle diu, khfi chiu.,.
ngfldi bfnh eho la do huyet ap tdng, r l i tfl tang lilu. Thfle ra, cac trifu chflng trfin chfla hdn do huylt dp tang. Tfl tang lilu cd thi gdy tut huylt dp qud mfle, thdm ehi c6 thi gdy truy maeh. Mpt nghien cdu tai cde phdng khdm Phdp eho bilt co 80% ngfldi hi cdc trieu ehflng trSn, thdm ehf huye't dp ed tdng cao chut dinh so vdi huyfi't dp muc tieu, khi dfi'n vifn chi cho ndm nghi d phong chd yen tinh la huyfi't dp trd vl mile mue tifiu md khfing can diJng thuoc hay nhgp vien. Ngfldi bfinh khfing nfin tang lilu ddng theo edm giac chu quan.
^ Trong nghien cflu thfl hai, mang ten COSMOS, mdt nhdm cde nhd nghifin cflu My vd chau Au do GS. Erie Lawitz tfl Vifn Gan Texas, Hoa Ky, phdn nglu nhifin 167 bfnh nhdn cd HCV, kiiu gen la ud lb de cho ufi'ng hai logi thule mdi trong nhdm DAA Id sofosbuuir va simeprevir, mft lln mfii ngdy, trong 12 tuan hodc 24 tudn. Chi sau 12 tuan dilu tri, 93% ngfldi tham gia dflpc chfla khdi (bao gim ca nhiing ngfldi hi xd gan vk trfldc dd khdng ddp flng vdi dilu tri bing interferon).
Mot thudc tri viem gan C sd dijng trong nghidn cdu COSMOS
Bfnh nhan khdng cdn virus trong mdu 3 thdng sau khi ngflng dilu tri. Vifc keo dai thdi gian dilu tri din 24 tudn hodc cd them ribavirin khdng eho bit ky Id fch rd rang ndo.
C h l dp 12 tuan sofosbuvir cdng simeprevir dUBC dung ngp td't. Chi cd it hon 2% ngfldi tham gia bao cdo eae tdc dung phu nghifim trpng hodc phdi ngifng dieu tri do phan dng cua thule.
Theo GS. Lawitz, "Chung tdi nhdn thay mft ty le chfla khdi khoang 93% vdi cM 12 tuan dilu tri. bbg edch sfl dung mdt ehe dd toan b i n g dfldng uing ma khfing dung interferon hoae ribavirin.
Binh luan vl sfl kifn nay, GS. Ed Gane, Gidm d^c cac ddn vi ghep gan tgi Bfinh vifin Auckland City 9 New Zealand cho bilt, trong tfldng lai gin, tit ea cde phac d l dimg thufi'e uong nhdm DAA cd thi eai thifn sfl ha'p thu va thdnh cdng v l dilu tri vifim gan C, gidm bdt gdnh nang sfle khde do cac biln chitog lifin quan d i n gan.
Khi k i t hop vdi xfit nghiem vd dilu tri nhlm my^
tifiu dfl phdng d cdc quan the ngfl&i cd klia ndng gSy truyen nhilm, cdc phae do DAA hy vpng cdn cd thi tifi'n tdi loai bd lay nhilm HCV. 3$£
T H u 6 c & SLfC KHOE so 507 (1.9.2014)
tkuoi^ ckih eao kmStap
DS. BUI V A N UY
- TUy ngdng thudc, khong theo dudi liiu trinh: Cao huyfi't dp Id hfnh man tinh, khdng the ehfla khdi. Dung thud'e Id d l gifl huylt dp on dinh d mflc huylt dp mue tifiu cd the chip nhdn dfldc, goi la kiim sodt huyit dp. Khi tfl ngifng thulc, huyet dp se tang cao, gdy ra tai biln. Ngfl&i cao huylt dp phdi dflng thulc hdng ngdy, deu dan, suit p h i n ddi cdn lgi.
- Ddng thudc khdng dung gid:
Cd ngfl&i dflng thuoc h u y l t dp khdng dung gid, nhd luc ndo dung thulc luc l y la chfla dung. Huylt dp thfldng tang gidm theo ehu ky sinh hpc: gin sdng huyet dp tang dan, khi thfle day tim hoat ddng manh hcfn, huylt dp tang nhanh hdn, tfl 9 - 12 gid trfla d mflc eao n h l t , r l i tha'p ddn vdo buoi chieu, thap nhd^t vdo luc 3 gid sdng, tfl 3 gid sang lai tang ddn theo chu ky.
Mli loai thulc cd thdi gian ban huy rifing. Theo dd, phai uing thufi'e deu dan vdo mft gid nha't dinh trong ngdy. Nfin chpn vdo gi& md huye't dp ed khuynh hfldng tang ( 7 - 8 gid sdng).
- Khdng khdm dinh ky, chi ddng mdi mpt dan thud'e: Ngfldi bfnh chi khdm mdt lan roi dung mai dem thulc dd Id khdng dung.
Cao huyet dp t i l n triln theo hfldng ngay cdng ndng, ed t h i ldm xult hifn hay ndng thfim d c bfnh trong hfi chuing r l i loan chuyen hda, dac bift ed t h i kdm theo cdc ye'u to nguy CO tai cdc cd quan dich. Can phdi dilu chinh thud'c, lilu Ifldng phu hc^ vdi tflng giai doan. Vi du:
khi mdi hi cao huylt dp nhe cd t h i dung chen beta nhUng khi chuyln sang cd nguy ed suy tim simg huyet thi khdng t h i dung thuoc ndy. Can tudn theo lieh hen eua t h i y thud'c khdm lai theo dinh ky.
- Tu xd ly tai biin: Khi hi tai b i l n mach mdu nao (dot quy) ed ngfl&i cho do huylt dp tdng cao, gay vd maeh, r l i tfl dCmg thuoc hg huylt ap. Dung ra, can ha huye't THU6C & stfc KHOE sl507 (1.9.2014)
dp nhimg ha d i n mflc ndo phai do thay thufi'e quye't dinh. Neu tfl dung thud'e ha huyfi't dp, ed t h i dan tdi hg huyet dp qua mflc, mdu khfing de'n dflde cde vung ndo khdc ldm tai bie'n ndng them. Trong trfl&ng hdp nay, t i t n h l t Id k h i n trfldng dfla ngfldi bfinh dfi'n ndi cap cflu, khfing tfl dung thuoc ha huylt dp hay cdc thule khdc.
- Khdng phdi hgp vdi che dd dn vd luyin tdp: Dfii khi ehfla tim hilu ky nen ngfldi bfnh kifing thdi qua (dan tdi thilu ndng Ifldng, dinh difdng) hoae luyfn tap thai qua (cd the bi tai biln). Ngfl&i eao huyet dp nlu khfing kem theo bfinh gi thi dung ehfi' dp an edn dfi'i; ne'u kem theo thfla cdn, bdo phi, roi loan md mdu, dai thao dfldng thi tuy theo benh kem theo md phai dung mft hay mot sd' ehe df dn tie't c h l chat beo, chat dfl&ng, ehdt dam (han che' mfle dn nhiftig khfing kieng ddn tdi hi thifi'u) de lam cho cdc bfnh nay khfing nang them anh hfldng trd lgi dfi'n huye't dp. Ngfldi cao huye't dp cin chpn cdc mdn tap luyen nhe, de, thdi gian chi 30 - 40 phut, dam bao cho tim d$p khdng qud 105 - 125 Ian/phut nhfl cdc mfin di bf vfla, chay bp chgm, t r a n h
cac mdn tgp ngng (tifiu thu tren SOOKcalo/ gid), khd, toe dp eao, thdi gian keo ddi (nhfl ede mfin cd tg, quin vdt, chgy nhanh), khi cd kem theo nguy cd tim maeh phdi kieng tap mft s l mfin (theo chi dinh cua thay thufi'c).
- Khdng kiing khem hodc kieng khem thai qud: Hut thufi'e la, uing rfldu khdng cd lpi cho ngfldi cao huylt dp nhiftig cd ngfldi khdng bd hdn dflde. Ngfldi cao huyfi't dp dung nhilu muli (NaCl) vien sui, thud'c dau dg day (ehfla NaHCOg, Na^COg), my chinh (bdt ngpt - natri glutamat) thi ion natri vao npi bdo tang keo theo calci vdo ndi bao nhieu, ldm tdng co cd thdnh maeh gay tang huylt dp, nhifng ngfldi cao huyfi't dp eung d n ed ion natri d l can hang nfii mdi. Do dd, d n dn t i l t e h l ion natri (NaCl ngfldi binh thfldng dn 13 - 16g/ ngdy, ngfldi eao huylt dp chi dn lOg/
ngay). Nhilu ngfl&i ehfla hilu rd, dflng ehe' dp dn nhat, bd hodn toan mufi'i Id khong dung (khdng cd ldi, md't ngon, rd't khd an).
Khic phue dflde cde thilu sdt trfin thi viec dung thud'c dieu tri se cd hifiu qua, it hi tac dung khdng mong muon. 3^
