{"id":18698,"date":"2019-08-01T17:29:20","date_gmt":"2019-08-01T10:29:20","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=18698"},"modified":"2024-09-18T08:01:00","modified_gmt":"2024-09-18T01:01:00","slug":"nsaids","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/nsaids\/","title":{"rendered":"NSAIDs"},"content":{"rendered":"<h2>L\u1ecbch s\u1eed nghi\u00ean c\u1ee9u v\u00e0 ph\u00e1t tri\u1ec3n<\/h2>\n<p>NSAIDs l\u00e0 c\u00e1c thu\u1ed1c kh\u00e1ng vi\u00eam kh\u00f4ng steroid (Nonsteroidal anti-inflammatory drugs), c\u00f3 t\u00e1c d\u1ee5ng chung l\u00e0 h\u1ea1 s\u1ed1t, gi\u1ea3m \u0111au, kh\u00e1ng vi\u00eam, ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u v\u00e0 kh\u00f4ng c\u00f3 c\u1ea5u tr\u00fac steroid.<\/p>\n<p>Vi\u1ec7c ph\u00e1t hi\u1ec7n l\u00e0 NSAID \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c cho l\u00e0 c\u00f4ng lao c\u1ee7a Hippocrates (460\u2013377 tr\u01b0\u1edbc c\u00f4ng nguy\u00ean) khi ph\u00e1t hi\u1ec7n ra t\u00e1c d\u1ee5ng n\u00e0y t\u1eeb n\u01b0\u1edbc chi\u1ebft t\u1eeb v\u1ecf c\u00e2y li\u1ec5u. V\u00e0o n\u0103m 30 tr\u01b0\u1edbc c\u00f4ng nguy\u00ean, Celsus \u0111\u00e3 m\u00f4 t\u1ea3 c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a vi\u00eam v\u00e0 d\u00f9ng n\u01b0\u1edbc chi\u1ebft v\u1ecf c\u00e2y li\u1ec5u \u0111\u1ec3 gi\u1ea3m vi\u00eam. Ng\u00e0y 25\/04\/1763, Edward Stone \u0111\u00e3 vi\u1ebft cho Hi\u1ec7p h\u1ed9i Ho\u00e0ng gia m\u00f4 t\u1ea3 nh\u1eefng quan s\u00e1t c\u1ee7a \u00f4ng v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c tr\u00ean v\u1ecf c\u00e2y li\u1ec5u \u1edf b\u1ec7nh nh\u00e2n s\u1ed1t. Th\u00e0nh ph\u1ea7n ho\u1ea1t \u0111\u1ed9ng trong v\u1ecf c\u00e2y li\u1ec5u, m\u1ed9t glycoside c\u00f3 t\u00ean l\u00e0 salicin, l\u1ea7n \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c ph\u00e2n l\u1eadp b\u1edfi Johann Andreas Buchner n\u0103m 1827. N\u0103m 1829, nh\u00e0 h\u00f3a h\u1ecdc ng\u01b0\u1eddi Ph\u00e1p Henri Leroux \u0111\u00e3 c\u1ea3i ti\u1ebfn quy tr\u00ecnh s\u1ea3n xu\u1ea5t \u0111\u1ec3 thu \u0111\u01b0\u1ee3c 30g salicin tinh khi\u1ebft t\u1eeb 1.5 kg v\u1ecf c\u00e2y.<\/p>\n<p>Sau khi th\u1ee7y ph\u00e2n salicin, ta thu \u0111\u01b0\u1ee3c glucose v\u00e0 salicylic. N\u0103m 1869, Hermann Kolbe \u0111\u00e3 t\u1ed5ng h\u1ee3p salicylate trong ph\u00f2ng th\u00ed nghi\u1ec7m. Ph\u1ea3n \u1ee9ng t\u1ed5ng h\u1ee3p m\u1ed9t acid th\u01a1m t\u1eeb phenol v\u1edbi s\u1ef1 c\u00f3 m\u1eb7t CO<sub>\u00ad2<\/sub> g\u1ecdi l\u00e0 ph\u1ea3n \u1ee9ng Kolbe-Schmitt.<\/p>\n<figure id=\"attachment_18699\" aria-describedby=\"caption-attachment-18699\" style=\"width: 600px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-18699\" src=\"https:\/\/www.vnras.com\/drug\/wp-content\/uploads\/2019\/08\/phan_ung_Kolbe_Schmitt-600x400.jpg\" alt=\"Ph\u1ea3n \u1ee9ng Kolbe-Schmitt.\" width=\"600\" height=\"400\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/08\/phan_ung_Kolbe_Schmitt.jpg 600w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/08\/phan_ung_Kolbe_Schmitt-350x233.jpg 350w\" sizes=\"auto, (max-width: 600px) 100vw, 600px\" \/><figcaption id=\"caption-attachment-18699\" class=\"wp-caption-text\">\u1ea2nh: Ph\u1ea3n \u1ee9ng Kolbe-Schmitt.<\/figcaption><\/figure>\n<p>\u0110\u1ebfn n\u0103m 1897, nh\u00e0 h\u00f3a h\u1ecdc ng\u01b0\u1eddi \u0110\u1ee9c Felix Hoffmann v\u00e0 c\u00f4ng ty Bayer \u0111\u00e3 t\u1ea1o ra m\u1ed9t k\u1ec9 nguy\u00ean m\u1edbi c\u1ee7a d\u01b0\u1ee3c h\u1ecdc khi chuy\u1ec3n acid salicylic th\u00e0nh aspirin (acetylsalicylic acid). C\u00e1c NSAIDs kh\u00e1c nh\u01b0 ibuprofen \u0111\u1ec1u \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n nh\u1eefng n\u0103m sau 1950. N\u0103m 2001, NSAIDs chi\u1ebfm t\u1edbi 70,000,000 \u0111\u01a1n thu\u1ed1c v\u00e0 30 t\u1ef7 li\u1ec1u kh\u00f4ng k\u00ea \u0111\u01a1n (OTC) \u0111\u01b0\u1ee3c b\u00e1n h\u00e0ng n\u0103m t\u1ea1i Hoa K\u1ef3.<\/p>\n<h2>T\u00e1c d\u1ee5ng<\/h2>\n<p>Thu\u1ed1c nh\u00f3m n\u00e0y \u0111\u1ec1u c\u00f3 c\u01a1 ch\u1ebf h\u1ea1 s\u1ed1t, gi\u1ea3m \u0111au, ch\u1ed1ng vi\u00eam v\u00e0 ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u.<\/p>\n<h2>C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng<\/h2>\n<p>T\u00e1c d\u1ee5ng c\u1ee7a NSAIDs l\u00e0 do n\u00f3 \u1ee9c ch\u1ebf sinh t\u1ed5ng h\u1ee3p prostanoid. C\u00e1c prostanoid (v\u00ed d\u1ee5: prostaglandin [PG]E2, PGD2, PGF2\u03b1, thromboxane A2 [TXA2] v\u00e0 prostacyclin [PGI2]) l\u00e0 c\u00e1c ch\u1ea5t truy\u1ec1n tin th\u1ee9 hai nh\u1edd kh\u1ea3 n\u0103ng xuy\u00ean qua m\u00e0ng t\u1ebf b\u00e0o, khu\u1ebfch t\u00e1n qua kh\u00f4ng gian ngo\u1ea1i b\u00e0o v\u00e0 t\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c receptor c\u1eb7p \u0111\u00f4i v\u1edbi protein G \u00e1i l\u1ef1c cao n\u0103m tr\u00ean c\u00f9ng t\u1ebf b\u00e0o ho\u1eb7c c\u00e1c t\u1ebf b\u00e0o l\u00e2n c\u1eadn.<\/p>\n<p>C\u00e1c prostanoid \u0111\u00f3ng nhi\u1ec1u vai tr\u00f2 trong qu\u00e1 tr\u00ecnh sinh l\u00fd c\u0169ng nh\u01b0 b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn ph\u1ea3n \u1ee9ng vi\u00eam, x\u01b0\u01a1ng kh\u1edbp, \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, m\u1ea1ch m\u00e1u, s\u1ef1 h\u00ecnh th\u00e0nh huy\u1ebft kh\u1ed1i, b\u1ec7nh th\u1eadn c\u0169ng nh\u01b0 v\u1eefa x\u01a1 \u0111\u1ed9ng m\u1ea1ch v\u00e0 s\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a v\u1eefa x\u01a1 \u0111\u1ed9ng m\u1ea1ch.<\/p>\n<p>C\u00e1c prostanoid \u0111\u01b0\u1ee3c t\u1ea1o ra t\u1eeb acid arachidonic (AA), nh\u1edd s\u1ef1 x\u00fac t\u00e1c c\u1ee7a phospholipase A2. Sau \u0111\u00f3, AA t\u1ef1 do trong n\u1ed9i b\u00e0o \u0111\u01b0\u1ee3c chuy\u1ec3n th\u00e0nh PGH2 nh\u1edd ho\u1ea1t \u0111\u1ed9ng c\u1ee7a PGH synthase (c\u00f3 t\u00ean cyclooxygenase [COX]-1 v\u00e0 COX-2), sau \u0111\u00f3 PGH2 \u0111\u01b0\u1ee3c chuy\u1ec3n th\u00e0nh c\u00e1c prostanoid nh\u1edd c\u00e1c synthase kh\u00e1c nhau.<\/p>\n<figure id=\"attachment_18700\" aria-describedby=\"caption-attachment-18700\" style=\"width: 600px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-18700\" src=\"https:\/\/www.vnras.com\/drug\/wp-content\/uploads\/2019\/08\/con_duong_cyclooxygenase_chuyen_hoa_acid_arachidonic-600x400.jpg\" alt=\"Con \u0111\u01b0\u1eddng cyclooxygenase c\u1ee7a chuy\u1ec3n h\u00f3a acid arachidonic\" width=\"600\" height=\"400\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/08\/con_duong_cyclooxygenase_chuyen_hoa_acid_arachidonic.jpg 600w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/08\/con_duong_cyclooxygenase_chuyen_hoa_acid_arachidonic-350x233.jpg 350w\" sizes=\"auto, (max-width: 600px) 100vw, 600px\" \/><figcaption id=\"caption-attachment-18700\" class=\"wp-caption-text\">\u1ea2nh: Con \u0111\u01b0\u1eddng cyclooxygenase c\u1ee7a chuy\u1ec3n h\u00f3a acid arachidonic.<\/figcaption><\/figure>\n<p>COX-1 v\u00e0 COX-2 l\u00e0 hai \u0111\u1ed3ng ph\u00e2n enzyme c\u1ee7a nhau (isoenzyme). Ch\u00fang \u0111\u01b0\u1ee3c \u0111i\u1ec1u h\u00f2a kh\u00e1c nhau v\u1ec1 x\u00fac t\u00e1c, phi\u00ean m\u00e3 v\u00e0 h\u1eadu phi\u00ean m\u00e3. COX-1 n\u1eb1m trong th\u00e0nh ph\u1ea7n c\u1ee7a h\u1ea7u h\u1ebft c\u00e1c m\u00f4, gi\u1eef vai tr\u00f2 sinh l\u00fd b\u00ecnh th\u01b0\u1eddng. Trong khi COX-2 l\u1ea1i xu\u1ea5t hi\u1ec7n khi c\u01a1 th\u1ec3 c\u00f3 t\u00ecnh tr\u1ea1ng vi\u00eam.<\/p>\n<p>T\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf COX-2 c\u1ee7a NSAIDs t\u1ea1o ra t\u00e1c d\u1ee5ng h\u1ea1 s\u1ed1t, gi\u1ea3m \u0111au v\u00e0 kh\u00e1ng vi\u00eam c\u1ee7a thu\u1ed1c. Tuy nhi\u00ean \u0111a s\u1ed1 NSAIDs l\u1ea1i \u1ee9c ch\u1ebf c\u1ea3 COX-1 v\u00e0 COX-2, d\u1eabn \u0111\u1ebfn nh\u1eefng t\u00e1c d\u1ee5ng ph\u1ee5 kh\u00f4ng mong mu\u1ed1n c\u1ee7a c\u00e1c thu\u1ed1c n\u00e0y. C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc tr\u00ean COX-2 m\u1edbi gi\u00fap gi\u1ea3m c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 kh\u00f4ng mong mu\u1ed1n c\u1ee7a NSAIDs truy\u1ec1n th\u1ed1ng, tuy nhi\u00ean hi\u1ec7n t\u1ea1i kh\u00f4ng c\u00f3 thu\u1ed1c n\u00e0o ch\u1ec9 \u1ee9c ch\u1ebf COX-2 m\u00e0 kh\u00f4ng \u1ee9c ch\u1ebf COX-1.<\/p>\n<figure id=\"attachment_18701\" aria-describedby=\"caption-attachment-18701\" style=\"width: 600px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-18701\" src=\"https:\/\/www.vnras.com\/drug\/wp-content\/uploads\/2019\/08\/muc_do_chon_loc_cox_2_cua_cac_NSAIDs-600x400.jpg\" alt=\"M\u1ee9c \u0111\u1ed9 ch\u1ecdn l\u1ecdc COX-2 c\u1ee7a c\u00e1c NSAIDs kh\u00e1c nhau in vitro\" width=\"600\" height=\"400\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/08\/muc_do_chon_loc_cox_2_cua_cac_NSAIDs.jpg 600w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/08\/muc_do_chon_loc_cox_2_cua_cac_NSAIDs-350x233.jpg 350w\" sizes=\"auto, (max-width: 600px) 100vw, 600px\" \/><figcaption id=\"caption-attachment-18701\" class=\"wp-caption-text\">\u1ea2nh: M\u1ee9c \u0111\u1ed9 ch\u1ecdn l\u1ecdc COX-2 c\u1ee7a c\u00e1c NSAIDs kh\u00e1c nhau in vitro.<\/figcaption><\/figure>\n<p>Paracetamol (Acetaminophen) th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c coi l\u00e0 m\u1ed9t NSAIDs v\u00ec n\u00f3 kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng kh\u00e1ng vi\u00eam. N\u00f3 \u1ee9c ch\u1ebf COX-2 ch\u1ee7 y\u1ebfu t\u1ea1i th\u1ea7n kinh trung \u01b0\u01a1ng, \u00edt \u1ee9c ch\u1ebf \u1edf ngo\u1ea1i vi.<\/p>\n<p>Aspirin l\u00e0 thu\u1ed1c duy nh\u1ea5t \u1ee9c ch\u1ebf COX-1 kh\u00f4ng h\u1ed3i ph\u1ee5c, c\u00f3 t\u00e1c d\u1ee5ng t\u1ed1t trong \u1ee9c ch\u1ebf k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u \u1edf li\u1ec1u th\u1ea5p, tr\u1edf th\u00e0nh c\u1ee9u tinh cho r\u1ea5t nhi\u1ec1u b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh tim m\u1ea1ch h\u00e0ng n\u0103m.<\/p>\n<h2>M\u1ed9t s\u1ed1 th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng<\/h2>\n<figure id=\"attachment_18702\" aria-describedby=\"caption-attachment-18702\" style=\"width: 600px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-18702\" src=\"https:\/\/www.vnras.com\/drug\/wp-content\/uploads\/2019\/08\/thu_nghiem_lam_sang_cua_thuoc_NSAIDs-600x400.jpg\" alt=\"Th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng thu\u1ed1c NSAIDs\" width=\"600\" height=\"400\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/08\/thu_nghiem_lam_sang_cua_thuoc_NSAIDs.jpg 600w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/08\/thu_nghiem_lam_sang_cua_thuoc_NSAIDs-350x233.jpg 350w\" sizes=\"auto, (max-width: 600px) 100vw, 600px\" \/><figcaption id=\"caption-attachment-18702\" class=\"wp-caption-text\">H\u00ecnh \u1ea3nh: Th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng thu\u1ed1c NSAIDs<\/figcaption><\/figure>\n<p>M\u1ed9t b\u00e0i b\u00e1o ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p th\u1ed1ng k\u00ea nhi\u1ec1u th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng v\u00e0 th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng v\u1ec1 thu\u1ed1c kh\u00e1ng vi\u00eam kh\u00f4ng steroid (NSAIDs), thu\u1ed1c \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc COX-2 (coxib) v\u00e0 t\u00e1c h\u1ea1i c\u1ee7a ch\u00fang tr\u00ean \u0111\u01b0\u1eddng ti\u00eau h\u00f3a c\u1ee7a c\u00e1c t\u00e1c gi\u1ea3 R Andrew Moore, Sheena Derry,\u00a0Ceri J Phillips v\u00e0\u00a0Henry J McQuay v\u1edbi k\u1ebft qu\u1ea3 cho th\u1ea5y b\u1eb1ng ch\u1ee9ng v\u1ec1 t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a coxib so v\u1edbi c\u00e1c NSAIDs kh\u00e1c tr\u00ean xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a l\u00e0 \u00edt h\u01a1n h\u01a1n h\u1eb3n, c\u1ee5 th\u1ec3 gi\u1ea3m 50% trong c\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean l\u1edbn (34,460 b\u1ec7nh nh\u00e2n), ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p c\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean (52,474 b\u1ec7nh nh\u00e2n) v\u00e0 c\u00e1c nghi\u00ean c\u1ee9u quan s\u00e1t l\u1edbn tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng (3093 tr\u01b0\u1eddng h\u1ee3p xu\u1ea5t huy\u1ebft). B\u1eb1ng ch\u1ee9ng v\u1ec1 hi\u1ec7u qu\u1ea3 c\u1ee7a NSAIDs c\u1ed9ng v\u1edbi b\u1ea3o v\u1ec7 d\u1ea1 d\u00e0y b\u1eb1ng thu\u1ed1c \u1ee9c ch\u1ebf ti\u1ebft acid (thu\u1ed1c \u1ee9c ch\u1ebf b\u01a1m proton PPIs v\u00e0 thu\u1ed1c kh\u00e1ng histamine H2 H2As) ch\u1ee7 y\u1ebfu d\u1ef1a tr\u00ean bi\u1ec7n ph\u00e1p thay th\u1ebf n\u1ed9i soi v\u1ebft lo\u00e9t. Th\u00f4ng tin h\u1ea1n ch\u1ebf v\u1ec1 t\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1eddng ti\u00eau h\u00f3a cho th\u1ea5y NSAIDs c\u1ed9ng v\u1edbi PPIs g\u00e2y t\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1eddng ti\u00eau h\u00f3a nhi\u1ec1u h\u01a1n coxib.<\/p>\n<p>M\u01b0\u1eddi m\u1ed9t nghi\u00ean c\u1ee9u quan s\u00e1t \u0111\u00e3 nghi\u00ean c\u1ee9u 1.6 tri\u1ec7u b\u1ec7nh nh\u00e2n, trong \u0111\u00f3 c\u00f3 911,000 ng\u01b0\u1eddi s\u1eed d\u1ee5ng NSAIDs, cho th\u1ea5y 76% (kho\u1ea3ng 65% \u0111\u1ebfn 90%) b\u1ec7nh nh\u00e2n c\u00f3 \u00edt nh\u1ea5t m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 tr\u00ean \u0111\u01b0\u1eddng ti\u00eau h\u00f3a kh\u00f4ng \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n thu\u1ed1c b\u1ea3o v\u1ec7 d\u1ea1 d\u00e0y c\u00f9ng v\u1edbi NSAIDs. Ngo\u1ea1i l\u1ec7 c\u00f3 m\u1ed9t nh\u00f3m c\u00e1c c\u1ef1u chi\u1ebfn binh Hoa K\u1ef3 \u0111\u00e3 b\u1ecb xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u01b0\u1edbc \u0111\u00f3, 75% b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c k\u00ea thu\u1ed1c b\u1ea3o v\u1ec7 d\u1ea1 d\u00e0y c\u00f9ng NSAIDs.<\/p>\n<p>K\u1ebft lu\u1eadn c\u1ee7a nghi\u00ean c\u1ee9u r\u1eb1ng b\u1eb1ng ch\u1ee9ng v\u1ec1 hi\u1ec7u qu\u1ea3 c\u1ee7a s\u1eed d\u1ee5ng thu\u1ed1c b\u1ea3o v\u1ec7 d\u1ea1 d\u00e0y v\u1edbi NSAIDs c\u00f2n h\u1ea1n ch\u1ebf. Trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng, m\u1ed9t s\u1ed1 \u00edt b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh \u0111\u01b0\u1eddng ti\u00eau h\u00f3a \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n s\u1eed d\u1ee5ng thu\u1ed1c, nh\u01b0ng nh\u1eefng ng\u01b0\u1eddi m\u1eafc b\u1ec7nh c\u00f3 th\u1ec3 kh\u00f4ng d\u00f9ng thu\u1ed1c. \u0110\u1ed1i c\u1edbi coxib, t\u00e1c d\u1ee5ng b\u1ea3o v\u1ec7 \u0111\u01b0\u1eddng ti\u00eau h\u00f3a l\u00e0 s\u1eb5n c\u00f3, d\u00f9 c\u00f3 th\u1ec3 kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7.<\/p>\n<p>\u0110\u1ec3 t\u00ecm hi\u1ec3u c\u1ee5 th\u1ec3 v\u1ec1 c\u00e1c th\u1eed nghi\u1ec7m c\u0169ng nh\u01b0 th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng, b\u1ea1n \u0111\u1ecdc xem ph\u1ea7n<em> T\u00e0i li\u1ec7u tham kh\u1ea3o<\/em>.<\/p>\n<h2>D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc<\/h2>\n<p><em>H\u1ea5p thu:<\/em> H\u1ea7u h\u1ebft thu\u1ed1c c\u00f3 b\u1ea3n ch\u1ea5t l\u00e0 acid y\u1ebfu, pK<sub>a<\/sub> kho\u1ea3ng t\u1eeb 3 \u0111\u1ebfn 5, h\u1ea5p thu t\u1ed1t t\u1ea1i ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y v\u00e0 ni\u00eam m\u1ea1c ru\u1ed9t non. M\u1ed9t s\u1ed1 thu\u1ed1c ph\u1ea3i tr\u1ea3i qua qu\u00e1 tr\u00ecnh th\u1ee7y ph\u00e2n m\u1edbi cho ch\u1ea5t c\u00f3 t\u00e1c d\u1ee5ng d\u01b0\u1ee3c l\u00fd (v\u00ed d\u1ee5: aspirin).<\/p>\n<p><em>Ph\u00e2n b\u1ed1:<\/em> Li\u00ean k\u1ebft protein huy\u1ebft t\u01b0\u01a1ng th\u01b0\u1eddng cao (&gt; 95%), ch\u1ee7 y\u1ebfu l\u00e0 albumin, \u00a0do \u0111\u00f3 th\u1ec3 t\u00edch ph\u00e2n b\u1ed1 V<sub>d<\/sub> th\u01b0\u1eddng x\u1ea5p x\u1ec9 th\u1ec3 t\u00edch huy\u1ebft t\u01b0\u01a1ng, V<sub>d<\/sub> th\u01b0\u1eddng d\u01b0\u1edbi 0.2 L\/kg.<\/p>\n<p><em>Chuy\u1ec3n h\u00f3a:<\/em> H\u1ea5u h\u1ebft \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a \u1edf gan, bao g\u1ed3m ph\u1ea3n \u1ee9ng oxy h\u00f3a \u2013 kh\u1eed v\u00e0 li\u00ean h\u1ee3p. Ch\u1ea5t chuy\u1ec3n h\u00f3a kh\u00f4ng c\u00f2n ho\u1ea1t t\u00ednh v\u00e0 \u0111\u01b0\u1ee3c \u0111\u00e0o th\u1ea3i ch\u1ee7 y\u1ebfu qua n\u01b0\u1edbc ti\u1ec3u. M\u1ed9t s\u1ed1 thu\u1ed1c b\u00e0i xu\u1ea5t qua m\u1eadt. Do \u0111\u00f3 \u1edf b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh gan, th\u1eadn, thu\u1ed1c th\u01b0\u1eddng b\u1ecb t\u00edch l\u0169y v\u00e0 th\u1eddi gian b\u00e1n th\u1ea3i k\u00e9o d\u00e0i h\u01a1n b\u00ecnh th\u01b0\u1eddng, c\u1ea7n ch\u1ec9nh li\u1ec1u trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y.<\/p>\n<p><em>Th\u1ea3i tr\u1eeb:<\/em> Th\u1eddi gian b\u00e1n h\u1ee7y (t<sub>1\/2<\/sub>) r\u1ea5t thay \u0111\u1ed5i (ibuprofen v\u00e0 diclofenac c\u00f3 t<sub>1\/2<\/sub> t\u1eeb 2 \u0111\u1ebfn 3 gi\u1edd, trong khi c\u00e1c oxicam c\u00f3 t<sub>1\/2<\/sub> t\u1eeb 20 \u0111\u1ebfn 60 gi\u1edd). Thanh th\u1ea3i to\u00e0n c\u01a1 th\u1ec3 th\u01b0\u1eddng th\u1ea5p v\u00e0 th\u01b0\u1eddng d\u01b0\u1edbi 200 mL\/ph\u00fat.<\/p>\n<h2>Ch\u1ec9 \u0111\u1ecbnh<\/h2>\n<p>NSAIDs d\u00f9ng trong c\u00e1c t\u00ecnh tr\u1ea1ng \u0111au v\u00e0 vi\u00eam c\u1ea5p hay m\u1ea1n t\u00ednh.<\/p>\n<p>Ch\u00fang th\u01b0\u1eddng \u0111\u01b0\u1ee3c d\u00f9ng gi\u1ea3m tri\u1ec7u ch\u1ee9ng t\u1ecfng c\u00e1c tr\u01b0\u1eddng h\u1ee3p sau:<\/p>\n<ul>\n<li>Vi\u00eam x\u01b0\u01a1ng kh\u1edbp.<\/li>\n<li>Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p.<\/li>\n<li>\u0110au th\u1eaft l\u01b0ng.<\/li>\n<li>Vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp.<\/li>\n<li>\u0110au khu\u1ef7u tay.<\/li>\n<li>Nh\u1ee9c \u0111\u1ea7u.<\/li>\n<li>\u0110au n\u1eeda \u0111\u1ea7u.<\/li>\n<li>Gout c\u1ea5p t\u00ednh.<\/li>\n<li>\u0110au b\u1ee5ng kinh.<\/li>\n<li>\u0110au x\u01b0\u01a1ng do di c\u0103n ung th\u01b0.<\/li>\n<li>\u0110au sau ph\u1eabu thu\u1eadt.<\/li>\n<li>C\u1ee9ng c\u01a1 v\u00e0 \u0111au do b\u1ec7nh Parkinson.<\/li>\n<li>S\u1ed1t.<\/li>\n<li>C\u01a1n \u0111au s\u1ecfi th\u1eadn.<\/li>\n<li>Ch\u1ea5n th\u01b0\u01a1ng.<\/li>\n<\/ul>\n<p>Li\u1ec1u d\u00f9ng c\u1ee5 th\u1ec3 ph\u1ee5 thu\u1ed9c t\u1eebng lo\u1ea1i NSAID.<\/p>\n<h2>T\u00e1c d\u1ee5ng ph\u1ee5<\/h2>\n<figure id=\"attachment_18704\" aria-describedby=\"caption-attachment-18704\" style=\"width: 600px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-18704\" src=\"https:\/\/www.vnras.com\/drug\/wp-content\/uploads\/2019\/08\/NSAID_gay_viem_loet_da_day_ta_trang-600x400.jpg\" alt=\"NSAID l\u00e0 m\u1ed9t trong nh\u1eefng nguy\u00ean nh\u00e2n g\u00e2y vi\u00eam lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng\" width=\"600\" height=\"400\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/08\/NSAID_gay_viem_loet_da_day_ta_trang.jpg 600w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/08\/NSAID_gay_viem_loet_da_day_ta_trang-350x233.jpg 350w\" sizes=\"auto, (max-width: 600px) 100vw, 600px\" \/><figcaption id=\"caption-attachment-18704\" class=\"wp-caption-text\">H\u00ecnh \u1ea3nh: NSAID l\u00e0 m\u1ed9t trong nh\u1eefng nguy\u00ean nh\u00e2n g\u00e2y vi\u00eam lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng<\/figcaption><\/figure>\n<p>T\u0103ng nguy c\u01a1 nh\u1ed3i m\u00e1u c\u01a1 tim v\u00e0 \u0111\u1ed9t qu\u1ef5, suy tim \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh tim (tr\u1eeb aspirin).<\/p>\n<p>Nguy c\u01a1 r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng d\u01b0\u01a1ng.<\/p>\n<p>T\u00e1c d\u1ee5ng ph\u1ee5 tr\u00ean h\u1ec7 ti\u00eau h\u00f3a: bu\u1ed3n n\u00f4n, n\u00f4n, kh\u00f3 ti\u00eau, ti\u00eau ch\u1ea3y v\u00e0 n\u1eb7ng nh\u1ea5t l\u00e0 lo\u00e9t ho\u1eb7c xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a.<\/p>\n<p>Ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i tr\u00ean th\u1eadn: NSAIDs gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng t\u01b0\u1edbi m\u00e1u th\u1eadn v\u00e0 m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn, c\u00f3 th\u1ec3 g\u00e2y gi\u1eef mu\u1ed1i v\u00e0 n\u01b0\u1edbc, t\u0103ng huy\u1ebft \u00e1p, suy th\u1eadn. Hi\u1ebfm h\u01a1n l\u00e0 vi\u00eam th\u1eadn k\u1ebd, ho\u1ea1i t\u1eed \u00f4ng th\u1eadn c\u1ea5p&#8230;<\/p>\n<p>Nh\u1ea1y c\u1ea3m \u00e1nh s\u00e1ng: th\u01b0\u1eddng g\u1eb7p v\u1edbi c\u00e1c d\u1eabn ch\u1ea5t c\u1ee7a acid propionic (nh\u01b0 ibuprofen).<\/p>\n<p>G\u00e2y \u0111\u00f3ng \u1ed1ng \u0111\u1ed9ng m\u1ea1ch s\u1edbm \u1edf thai nhi. C\u00f3 li\u00ean quan \u0111\u1ebfn sinh non, s\u1ea9y thai.<\/p>\n<p>C\u00e1c ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn: m\u00e0y \u0111ay, ph\u00f9 m\u1ea1ch, s\u1ed1c ph\u1ea3n v\u1ec7, h\u1ed9i ch\u1ee9ng Stevens-Johnsons, ho\u1ea1i t\u1eed th\u01b0\u1ee3ng b\u00ec nhi\u1ec5m \u0111\u1ed9c&#8230; Tuy c\u00e1c t\u00e1c ph\u1ea3n \u1ee9ng n\u00e0y r\u1ea5t hi\u1ebfm g\u1eb7p nh\u01b0ng v\u1eabn c\u1ea7n th\u1eadn tr\u1ecdng v\u00ec m\u1ed9t khi \u0111\u00e3 x\u1ea3y ra th\u00ec v\u00f4 c\u00f9ng nguy hi\u1ec3m.<\/p>\n<p>Kh\u00e1c: Vi\u00eam m\u00e0ng n\u00e3o v\u00f4 khu\u1ea9n (hi\u1ebfm g\u1eb7p), \u0111au \u0111\u1ea7u, ch\u00f3ng m\u1eb7t, co th\u1eaft \u0111\u01b0\u1eddng th\u1edf, kali huy\u1ebft b\u1ea5t th\u01b0\u1eddng&#8230;<\/p>\n<h2>L\u01b0u \u00fd v\u00e0 th\u1eadn tr\u1ecdng<\/h2>\n<p>Th\u1eadn tr\u1ecdng v\u1edbi ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 cho con b\u00fa. Kh\u00f4ng n\u00ean d\u00f9ng thu\u1ed1c \u1edf 3 th\u00e1ng \u0111\u1ea7u thai k\u00ec. Kh\u00f4ng n\u00ean d\u00f9ng thu\u1ed1c \u1edf tam c\u00e1 nguy\u1ec7t th\u1ee9 ba do nguy c\u01a1 g\u00e2y \u0111\u00f3ng \u1ed1ng \u0111\u1ed9ng m\u1ea1ch s\u1edbm.<\/p>\n<p>Th\u1eadn tr\u1ecdng v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh gan, th\u1eadn ho\u1eb7c ti\u1ec1n s\u1eed b\u1ec7nh gan, th\u1eadn.<\/p>\n<p>Th\u1eadn tr\u1ecdng v\u1edbi c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 tr\u00ean \u0111\u01b0\u1eddng ti\u00eau h\u00f3a c\u1ee7a thu\u1ed1c. Th\u1eadn tr\u1ecdng v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a, \u0111\u1eb7c bi\u1ec7t n\u1ebfu l\u00e0 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a do NSAIDs.<\/p>\n<p>Th\u1eadn tr\u1ecdng v\u1edbi b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p kh\u00f3 ki\u1ec3m so\u00e1t.<\/p>\n<p>Th\u1eadn tr\u1ecdng v\u1edbi b\u1ec7nh nh\u00e2n vi\u00eam ru\u1ed9t (b\u1ec7nh Crohn, vi\u00eam lo\u00e9t \u0111\u1ea1i tr\u00e0ng).<\/p>\n<p>Th\u1eadn tr\u1ecdng v\u1edbi b\u1ec7nh nh\u00e2n \u0111ang b\u1ecb ho\u1eb7c c\u00f3 ti\u1ec1n s\u1eed \u0111\u1ed9t qu\u1ef5, nh\u1ed3i m\u00e1u c\u01a1 tim, b\u1ec7nh m\u1ea1ch v\u00e0nh, suy tim sung huy\u1ebft (tr\u1eeb aspirin).<\/p>\n<p>Th\u1eadn tr\u1ecdng v\u1edbi b\u1ec7nh nh\u00e2n ti\u1ec1n s\u1eed d\u1ecb \u1ee9ng v\u1edbi NSAIDs.<\/p>\n<h2>T\u01b0\u01a1ng t\u00e1c thu\u1ed1c<\/h2>\n<p>S\u1eed d\u1ee5ng NSAIDs \u0111\u1ed3ng th\u1eddi v\u1edbi th\u1ef1c ph\u1ea9m ho\u1eb7c thu\u1ed1c kh\u00e1ng acid: m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p g\u00e2y ch\u1eadm h\u1ea5p thu ho\u1eb7c gi\u1ea3m h\u1ea5p thu.<\/p>\n<p>Aspirin c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m n\u1ed3ng \u0111\u1ed9 huy\u1ebft t\u01b0\u01a1ng c\u1ee7a nhi\u1ec1u NSAIDs kh\u00e1c.<\/p>\n<p>S\u1eed d\u1ee5ng NSAIDs \u0111\u1ed3ng th\u1eddi v\u1edbi c\u00e1c thu\u1ed1c c\u00f3 t\u1ec9 l\u1ec7 g\u1eafn protein huy\u1ebft t\u01b0\u01a1ng cao (nh\u01b0 c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng nh\u00f3m coumarin, sulfonylurea \u0111i\u1ec1u tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2&#8230;) c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u01b0\u01a1ng t\u00e1c \u0111\u1ea9y nhau ra kh\u1ecfi protein huy\u1ebft t\u01b0\u01a1ng, nguy c\u01a1 t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c d\u00f9ng c\u00f9ng nh\u01b0 ch\u1ea3y m\u00e1u, h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft&#8230;<\/p>\n<p>S\u1eed d\u1ee5ng NSAIDs \u0111\u1ed3ng th\u1eddi v\u1edbi c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n (ACEIs), l\u1ee3i ti\u1ec3u: gi\u1ea3m hi\u1ec7u qu\u1ea3 c\u00e1c thu\u1ed1c n\u00e0y, t\u0103ng nguy c\u01a1 suy th\u1eadn.<\/p>\n<p>Methotrexate, lithium: gi\u1ea3m \u0111\u00e0o th\u1ea3i c\u00e1c thu\u1ed1c n\u00e0y.<\/p>\n<p>Thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m nh\u00f3m SSRIs: gi\u1ea3m t\u00e1c d\u1ee5ng \u0111i\u1ec1u tr\u1ecb tr\u1ea7m c\u1ea3m.<\/p>\n<h2>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/h2>\n<p>Qu\u00e1 m\u1eabn c\u1ea3m v\u1edbi c\u00e1c th\u00e0nh ph\u1ea7n c\u1ee7a thu\u1ed1c.<\/p>\n<p>B\u1ec7nh nh\u00e2n suy gan, th\u1eadn n\u1eb7ng.<\/p>\n<p>B\u1ec7nh nh\u00e2n lo\u00e9t \u0111\u01b0\u1eddng ti\u00eau h\u00f3a ti\u1ebfn tri\u1ec3n.<\/p>\n<p>B\u1ec7nh nh\u00e2n ch\u1ea3y m\u00e1u kh\u00f4ng ki\u1ec3m so\u00e1t.<\/p>\n<p>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh aspirin cho tr\u1ebb em d\u01b0\u1edbi 12 tu\u1ed5i do nguy c\u01a1 g\u00e2y h\u1ed9i ch\u1ee9ng Reye.<\/p>\n<h2>Nh\u1eefng l\u00fd do khi\u1ebfn b\u00e1c s\u0129 tim m\u1ea1ch gh\u00e9t NSAIDs<\/h2>\n<p>Ta bi\u1ebft NSAIDs l\u00e0 nh\u1eefng thu\u1ed1c gi\u1ea3m \u0111au ch\u1ed1ng vi\u00eam m\u1ea1nh \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i. Thu\u1ed1c t\u00e1c d\u1ee5ng b\u1eb1ng c\u00e1ch \u1ee9c ch\u1ebf c\u00e1c xyclooxygenaza (COX). T\u1eeb \u0111\u00f3 \u1ee9c ch\u1ebf chuy\u1ec3n h\u00f3a acid arachidonic th\u00e0nh c\u00e1c ch\u1ea5t ti\u1ec1n vi\u00eam nh\u01b0 prostaglandin, prostacyclin v\u00e0 thromboxan. C\u00e2u chuy\u1ec7n \u1edf \u0111\u00e2y l\u00e0:<\/p>\n<p>1. NSAIDs n\u1ed5i ti\u1ebfng v\u1edbi t\u00e1c d\u1ee5ng ph\u1ee5 l\u00ean d\u1ea1 d\u00e0y v\u1edbi c\u01a1 ch\u1ebf \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p prostaglandin E2 d\u1eabn t\u1edbi gi\u1ea3m t\u01b0\u1edbi m\u00e1u d\u1ea1 d\u00e0y, gi\u1ea3m ti\u1ebft ch\u1ea5t nh\u1ea7y b\u1ea3o v\u1ec7, gi\u1ea3m ti\u1ebft bicarbonat, \u1ee9c ch\u1ebf qu\u00e1 tr\u00ecnh l\u00e0nh v\u1ebft th\u01b0\u01a1ng d\u1eabn t\u1edbi vi\u00eam lo\u00e9t hay xu\u1ea5t huy\u1ebft d\u1ea1 d\u00e0y. V\u1ea5n \u0111\u1ec1 l\u00e0 c\u00e1c b\u1ec7nh nh\u00e2n tim m\u1ea1ch th\u01b0\u1eddng ph\u1ea3i s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u ho\u1eb7c thu\u1ed1c kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u. S\u1ef1 k\u1ebft h\u1ee3p thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng v\u00e0 NSAIDs l\u00e0m t\u0103ng cao nguy c\u01a1 ch\u1ea3y m\u00e1u ti\u00eau h\u00f3a. Ch\u1ea3y m\u00e1u ti\u00eau h\u00f3a tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n d\u00f9ng ch\u1ed1ng \u0111\u00f4ng kh\u00f4ng ch\u1ec9 n\u1eb7ng n\u1ec1 m\u00e0 c\u00f2n khi\u1ebfn b\u1ec7nh nh\u00e2n ph\u1ea3i \u0111\u1ed1i m\u1eb7t v\u1edbi nguy c\u01a1 xu\u1ea5t hi\u1ec7n c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch v\u00ec b\u1ec7nh nh\u00e2n th\u01b0\u1eddng ph\u1ea3i ng\u1eebng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u trong m\u1ed9t th\u1eddi gian nh\u1ea5t \u0111\u1ecbnh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb t\u00ecnh tr\u1ea1ng ch\u1ea3y m\u00e1u.<\/p>\n<p>2. NSAIDs c\u00f2n g\u00e2y gi\u1eef mu\u1ed1i, gi\u1eef n\u01b0\u1edbc, gi\u1ea3m t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c l\u1ee3i ti\u1ec3u b\u1edfi NSAIDs g\u00e2y ra gi\u1ea3m t\u01b0\u1edbi m\u00e1u th\u1eadn (c\u00f3 th\u1ec3 d\u1eabn t\u1edbi t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p), t\u0103ng t\u00e1i h\u1ea5p thu Cl- (k\u00e8m theo Na+) d\u1eabn t\u1edbi gi\u1eef mu\u1ed1i n\u01b0\u1edbc v\u00e0 t\u0103ng huy\u1ebft \u00e1p (H\u00ecnh 1). C\u01a1 ch\u1ebf n\u00e0y c\u00f3 th\u1ec3 d\u1eabn t\u1edbi qu\u00e1 t\u1ea3i d\u1ecbch v\u00e0 kh\u1edfi ph\u00e1t suy tim c\u1ea5p, nh\u1ea5t l\u00e0 tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 s\u1eb5n n\u1ec1n suy tim.<\/p>\n<p>3. Aspirin li\u1ec1u th\u1ea5p l\u00e0 m\u1ed9t NSAID ph\u1ed5 bi\u1ebfn \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ea5t ph\u1ed5 bi\u1ebfn trong tim m\u1ea1ch v\u1edbi vai tr\u00f2 \u1ee9c ch\u1ebf k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u. Nh\u01b0ng c\u00e1c NSAID kh\u00e1c c\u0169ng li\u00ean k\u1ebft v\u1edbi COX-1, c\u00f9ng v\u1ecb tr\u00ed t\u00e1c d\u1ee5ng c\u1ee7a aspirin. Kh\u00e1c v\u1edbi aspirin, c\u00e1c lo\u1ea1i NSAID kh\u00e1c li\u00ean k\u1ebft COX-1 theo c\u00e1ch c\u00f3 th\u1ec3 \u0111\u1ea3o ng\u01b0\u1ee3c d\u1eabn t\u1edbi kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng kh\u00e1ng ti\u1ec3u c\u1ea7u b\u1ec1n v\u1eefng. N\u1ebfu aspirin \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng sau NSAIDs, v\u1ecb tr\u00ed COX-1 s\u1ebd b\u1ecb NSAIDs chi\u1ebfm ch\u1ed7. V\u00e0 b\u1edfi th\u1eddi gian b\u00e1n h\u1ee7y trong huy\u1ebft t\u01b0\u01a1ng c\u1ee7a aspirin (Acetylsalicylic acid) ch\u1ec9 l\u00e0 20 -30 ph\u00fat n\u00ean thu\u1ed1c s\u1ebd b\u1ecb \u0111\u00e0o th\u1ea3i tr\u01b0\u1edbc khi c\u00f3 c\u01a1 h\u1ed9i g\u1eafn v\u00e0o th\u1ee5 th\u1ec3 \u0111\u1ec3 ph\u00e1t sinh t\u00e1c d\u1ee5ng (H\u00ecnh 2).<\/p>\n<p>4. C\u00e1c NSAID \u1ee9c ch\u1ebf COX- 2 ch\u1ecdn l\u1ecdc d\u1eabn \u0111\u1ebfn \u1ee9c ch\u1ebf s\u1ea3n xu\u1ea5t prostacyclin nh\u01b0ng kh\u00f4ng l\u00e0m gi\u1ea3m s\u1ea3n xu\u1ea5t thromboxan A2 (v\u00ec kh\u00f4ng ho\u1eb7c \u00edt t\u00e1c d\u1ee5ng l\u00ean COX-1). \u0110i\u1ec1u n\u00e0y d\u1eabn t\u1edbi m\u1ea5t c\u00e2n b\u1eb1ng prostacyclin-thromboxan. Prostacyclin c\u00f3 t\u00e1c d\u1ee5ng \u0111\u1ed1i ng\u01b0\u1ee3c v\u1edbi thromboxan, c\u1ee5 th\u1ec3 l\u00e0: Prostacyclin \u1ee9c ch\u1ebf k\u1ebft t\u1eadp ti\u1ebfu c\u1ea7u v\u00e0 gi\u00e3n m\u1ea1ch. S\u1ef1 m\u1ea5t c\u00e2n b\u1eb1ng n\u00e0y d\u1eabn t\u1edbi t\u0103ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u. H\u1eadu qu\u1ea3 c\u1ee7a n\u00f3 t\u1ea5t nhi\u00ean l\u00e0 t\u0103ng nguy c\u01a1 ph\u00e1t sinh huy\u1ebft kh\u1ed1i. \u0110\u00f3 l\u00e0 l\u00fd do c\u00e1c NSAID kh\u00f4ng ch\u1ecdn l\u1ecdc c\u00f3 xu h\u01b0\u1edbng an to\u00e0n tim m\u1ea1ch t\u1ed1t h\u01a1n c\u00e1c Coxib (ch\u1ecdn l\u1ecdc COX-2), \u0111\u1ed5i l\u1ea1i, t\u00e1c d\u1ee5ng ph\u1ee5 tr\u00ean d\u1ea1 d\u00e0y l\u1ea1i nhi\u1ec1u h\u01a1n.<\/p>\n<figure id=\"attachment_100280\" aria-describedby=\"caption-attachment-100280\" style=\"width: 1200px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/vnras.com\/drug\/?attachment_id=100280#main\" rel=\"attachment wp-att-100280\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-100280\" src=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2024\/09\/li-do-Bac-si-tim-mach-ghet-NSAIDs.jpg\" alt=\" NSAIDs\" width=\"1200\" height=\"800\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2024\/09\/li-do-Bac-si-tim-mach-ghet-NSAIDs.jpg 1200w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2024\/09\/li-do-Bac-si-tim-mach-ghet-NSAIDs-600x400.jpg 600w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2024\/09\/li-do-Bac-si-tim-mach-ghet-NSAIDs-768x512.jpg 768w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2024\/09\/li-do-Bac-si-tim-mach-ghet-NSAIDs-350x233.jpg 350w\" sizes=\"auto, (max-width: 1200px) 100vw, 1200px\" \/><\/a><figcaption id=\"caption-attachment-100280\" class=\"wp-caption-text\">H\u00ecnh 1<\/figcaption><\/figure>\n<figure id=\"attachment_100281\" aria-describedby=\"caption-attachment-100281\" style=\"width: 1200px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/vnras.com\/drug\/?attachment_id=100281#main\" rel=\"attachment wp-att-100281\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-100281\" src=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2024\/09\/li-do-Bac-si-tim-mach-ghet-NSAIDs-2.jpg\" alt=\"NSAIDs\" width=\"1200\" height=\"800\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2024\/09\/li-do-Bac-si-tim-mach-ghet-NSAIDs-2.jpg 1200w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2024\/09\/li-do-Bac-si-tim-mach-ghet-NSAIDs-2-600x400.jpg 600w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2024\/09\/li-do-Bac-si-tim-mach-ghet-NSAIDs-2-768x512.jpg 768w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2024\/09\/li-do-Bac-si-tim-mach-ghet-NSAIDs-2-350x233.jpg 350w\" sizes=\"auto, (max-width: 1200px) 100vw, 1200px\" \/><\/a><figcaption id=\"caption-attachment-100281\" class=\"wp-caption-text\">H\u00ecnh 2<\/figcaption><\/figure>\n<p><em>T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/em><\/p>\n<p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1626078\/\" rel=\"noopener\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1626078\/<\/a><\/p>\n<p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/6352138\" rel=\"noopener\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/6352138<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>L\u1ecbch s\u1eed nghi\u00ean c\u1ee9u v\u00e0 ph\u00e1t tri\u1ec3n NSAIDs l\u00e0 c\u00e1c thu\u1ed1c kh\u00e1ng vi\u00eam kh\u00f4ng steroid (Nonsteroidal anti-inflammatory drugs), c\u00f3 t\u00e1c d\u1ee5ng chung l\u00e0 h\u1ea1 s\u1ed1t, gi\u1ea3m \u0111au, kh\u00e1ng vi\u00eam, ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u v\u00e0 kh\u00f4ng c\u00f3 c\u1ea5u tr\u00fac steroid. Vi\u1ec7c ph\u00e1t hi\u1ec7n l\u00e0 NSAID \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c cho l\u00e0 c\u00f4ng lao c\u1ee7a Hippocrates (460\u2013377 [&#8230;]\n","protected":false},"author":1,"featured_media":18703,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-18698","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/18698","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=18698"}],"version-history":[{"count":3,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/18698\/revisions"}],"predecessor-version":[{"id":100302,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/18698\/revisions\/100302"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/18703"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=18698"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=18698"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=18698"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}