{"id":5498,"date":"2026-02-07T17:33:15","date_gmt":"2026-02-07T10:33:15","guid":{"rendered":"https:\/\/ykhoataynguyen.com\/site\/?p=5498"},"modified":"2026-02-07T17:33:15","modified_gmt":"2026-02-07T10:33:15","slug":"benh-phoi-tac-nghen-man-tinh-copd-va-benh-tim-mach","status":"publish","type":"post","link":"https:\/\/ykhoataynguyen.com\/site\/benh-phoi-tac-nghen-man-tinh-copd-va-benh-tim-mach\/","title":{"rendered":"B\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh (COPD) v\u00e0 B\u1ec7nh tim m\u1ea1ch"},"content":{"rendered":"<p><strong>1. T\u1ea7m quan tr\u1ecdng v\u00e0 C\u01a1 ch\u1ebf t\u1ed5n th\u01b0\u01a1ng:<\/strong><\/p>\n<ul class=\"gdAMzb\">\n<li>B\u1ec7nh tim m\u1ea1ch v\u00e0 COPD l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u g\u00e2y t\u1eed vong v\u00e0 t\u00e0n ph\u1ebf. COPD l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 tim m\u1ea1ch.<\/li>\n<li>C\u01a1 ch\u1ebf t\u1ed5n th\u01b0\u01a1ng tim m\u1ea1ch\/COPD li\u00ean quan \u0111\u1ebfn c\u00e1c y\u1ebfu t\u1ed1 nh\u01b0: thi\u1ebfu oxy m\u1ea1n t\u00ednh, y\u1ebfu t\u1ed1 vi\u00eam (Hs-CRP), ho\u1ea1t h\u00f3a h\u1ec7 th\u1ea7n kinh giao c\u1ea3m, r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i v\u00e0 th\u0103ng b\u1eb1ng ki\u1ec1m toan, v\u00e0 d\u00f9ng thu\u1ed1c (nh\u01b0 thu\u1ed1c \u0111\u1ed3ng v\u1eadn Beta).<\/li>\n<li>C\u00e1c d\u1ea1ng t\u1ed5n th\u01b0\u01a1ng tim m\u1ea1ch\/COPD bao g\u1ed3m: T\u0103ng \u00e1p ph\u1ed5i v\u00e0 suy tim ph\u1ea3i, suy t\u00e2m tr\u01b0\u01a1ng th\u1ea5t tr\u00e1i, lo\u1ea1n nh\u1ecbp tim, t\u0103ng huy\u1ebft \u00e1p (THA), b\u1ec7nh m\u1ea1ch v\u00e0nh (BMV), v\u00e0 suy tim.<\/li>\n<\/ul>\n<p><strong>2. Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0110i\u1ec1u tr\u1ecb chung:<\/strong><\/p>\n<ul class=\"gdAMzb\">\n<li>Ch\u1ea9n \u0111o\u00e1n BTM\/COPD l\u00e0 kh\u00f4ng d\u1ec5 d\u00e0ng do c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng (kh\u00f3 th\u1edf v\u1ec1 \u0111\u00eam, khi thay \u0111\u1ed5i t\u01b0 th\u1ebf, ho) v\u00e0 h\u00ecnh \u1ea3nh c\u1eadn l\u00e2m s\u00e0ng (XQ ph\u1ed5i, tr\u1eafc nghi\u1ec7m ch\u1ee9c n\u0103ng ph\u1ed5i) c\u00f3 th\u1ec3 ch\u1ed3ng l\u1ea5p.<\/li>\n<li>Nguy\u00ean t\u1eafc chung: Hi\u1ec7n di\u1ec7n b\u1ec7nh k\u1ebft h\u1ee3p kh\u00f4ng l\u00e0m thay \u0111\u1ed5i \u0111i\u1ec1u tr\u1ecb COPD, v\u00e0 b\u1ec7nh k\u1ebft h\u1ee3p c\u0169ng ph\u1ea3i \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb nh\u01b0 b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 COPD.<\/li>\n<li><strong>BMV:<\/strong>\u00a0\u0110i\u1ec1u tr\u1ecb theo h\u01b0\u1edbng d\u1eabn hi\u1ec7n h\u00e0nh; hi\u1ec7u qu\u1ea3 c\u1ee7a thu\u1ed1c \u1ee9c ch\u1ebf beta 1 c\u00f3 ch\u1ecdn l\u1ecdc l\u1edbn h\u01a1n nguy c\u01a1 ti\u1ec1m t\u00e0ng ngay c\u1ea3 khi BN b\u1ecb COPD n\u1eb7ng.<\/li>\n<li><strong>Suy tim:<\/strong>\u00a0Ch\u1eb9n beta l\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh t\u01b0\u01a1ng \u0111\u1ed1i trong hen, nh\u01b0ng kh\u00f4ng ph\u1ea3i ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tuy\u1ec7t \u0111\u1ed1i trong COPD, th\u01b0\u1eddng d\u00f9ng lo\u1ea1i ch\u1eb9n beta ch\u1ecdn l\u1ecdc cao (bisoprolol, metoprolol succinate, ho\u1eb7c nebivolol). Ivabradine c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong BMV \u1ed5n \u0111\u1ecbnh ho\u1eb7c suy tim HFrEF \u1ed5n \u0111\u1ecbnh.<\/li>\n<li><strong>Lo\u1ea1n nh\u1ecbp tim:<\/strong>\u00a0\u0110i\u1ec1u tr\u1ecb \u01b0u ti\u00ean l\u00e0 t\u1ed1i \u01b0u h\u00f3a \u0111i\u1ec1u tr\u1ecb COPD (th\u1edf Oxy, \u0111i\u1ec1u ch\u1ec9nh th\u0103ng b\u1eb1ng ki\u1ec1m toan). Trong nh\u1ecbp nhanh nh\u0129 \u0111a \u1ed5 (MAT), Verapamil v\u00e0 metoprolol l\u00e0 l\u1ef1a ch\u1ecdn \u01b0u ti\u00ean. Trong rung nh\u0129, ki\u1ec3m so\u00e1t t\u1ea7n s\u1ed1 th\u01b0\u1eddng th\u00e0nh c\u00f4ng v\u00e0 an to\u00e0n v\u1edbi \u1ee9c ch\u1ebf Calci NDP v\u00e0 c\u00f3 th\u1ec3 v\u1edbi amiodarone.<\/li>\n<li><strong>THA:<\/strong>\u00a0Thu\u1ed1c \u01b0u ti\u00ean l\u00e0 \u1ee9c ch\u1ebf calcium, l\u1ee3i ti\u1ec3u, \u1ee9c ch\u1ebf RAAS. Tr\u00e1nh d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n (ACEI) do c\u00f3 th\u1ec3 g\u00e2y ho khan.<\/li>\n<li><strong>T\u0103ng \u00e1p ph\u1ed5i v\u00e0 Suy tim ph\u1ea3i:<\/strong>\u00a0\u0110i\u1ec1u tr\u1ecb oxy li\u1ec7u ph\u00e1p r\u1ea5t quan tr\u1ecdng. Th\u1eadn tr\u1ecdng khi d\u00f9ng l\u1ee3i ti\u1ec3u v\u00e0 k\u00edch th\u00edch beta 2. Digoxin c\u00f3 th\u1ec3 d\u00f9ng khi c\u00f3 lo\u1ea1n nh\u1ecbp nhanh tr\u00ean th\u1ea5t ho\u1eb7c k\u00e8m suy tim tr\u00e1i, ho\u1eb7c suy tim ph\u1ea3i qu\u00e1 m\u1ee9c.<\/li>\n<\/ul>\n<p>Link:<a href=\"https:\/\/drive.google.com\/drive\/folders\/1eOOiGz7rwiLjROvfFpRv1GCkmAspKfnD\" rel=\"noopener\">https:\/\/drive.google.com\/drive\/folders\/1eOOiGz7rwiLjROvfFpRv1GCkmAspKfnD<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>1. T\u1ea7m quan tr\u1ecdng v\u00e0 C\u01a1 ch\u1ebf t\u1ed5n th\u01b0\u01a1ng: B\u1ec7nh tim m\u1ea1ch v\u00e0 COPD l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u g\u00e2y t\u1eed vong v\u00e0 t\u00e0n ph\u1ebf. COPD l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 tim m\u1ea1ch. C\u01a1 ch\u1ebf t\u1ed5n th\u01b0\u01a1ng tim m\u1ea1ch\/COPD li\u00ean quan \u0111\u1ebfn c\u00e1c y\u1ebfu t\u1ed1 nh\u01b0: thi\u1ebfu oxy m\u1ea1n t\u00ednh, y\u1ebfu t\u1ed1 vi\u00eam (Hs-CRP), &hellip;<\/p>\n","protected":false},"author":23,"featured_media":5499,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[54,53],"tags":[],"class_list":["post-5498","post","type-post","status-publish","format-standard","has-post-thumbnail","","category-noi-tim-mach","category-noi-tong-quat"],"_links":{"self":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/5498","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/users\/23"}],"replies":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/comments?post=5498"}],"version-history":[{"count":1,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/5498\/revisions"}],"predecessor-version":[{"id":5500,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/5498\/revisions\/5500"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media\/5499"}],"wp:attachment":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media?parent=5498"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/categories?post=5498"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/tags?post=5498"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}