Jennifer Abbasi. X\u00e3 lu\u1eadn \u0111\u0103ng tr\u00ean JAMA ng\u00e0y 14\/02\/2018.<\/p>\n
Hai nghi\u00ean c\u1ee9u quan s\u00e1t qui m\u00f4 l\u1edbn \u0111\u01b0\u1ee3c \u0111\u0103ng t\u1ea3i n\u0103m ngo\u00e1i tr\u00ean t\u1ea1p ch\u00ed c\u1ee7a H\u1ed9i Tim m\u1ea1ch Hoa K\u00ec (JACC) \u0111ang l\u00e0m d\u1ea5y l\u00ean c\u00e2u h\u1ecfi v\u1ec1 s\u1ef1 c\u1ea7n thi\u1ebft c\u1ee7a vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c ch\u1eb9n beta sau c\u01a1n \u0111au ng\u1ef1c \u0111\u1ea7u ti\u00ean \u1edf t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n. Theo c\u00e1c t\u00e1c gi\u1ea3, c\u1ea3 hai nghi\u00ean c\u1ee9u \u0111\u1ec1u cho th\u1ea5y l\u1ee3i \u00edch l\u00e0m gi\u1ea3m t\u1ec9 l\u1ec7 t\u1eed vong c\u1ee7a vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c ch\u1eb9n beta \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng nh\u1ea5t \u0111\u1ecbnh, nh\u1ea5n m\u1ea1nh c\u1ea7n c\u00f3 c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c thi\u1ebft k\u1ebf nh\u1eb1m \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 c\u1ee7a c\u00e1c thu\u1ed1c mang t\u00ednh l\u1ecbch s\u1eed n\u00e0y trong th\u1eddi k\u00ec \u0111\u01b0\u01a1ng \u0111\u1ea1i.<\/p>\n
Thu\u1ed1c ch\u1eb9n beta \u0111\u01b0\u1ee3c c\u1ea5p ph\u00e9p v\u00e0o nh\u1eefng n\u0103m 1980 \u0111\u1ec3 s\u1eed d\u1ee5ng tr\u00ean b\u1ec7nh nh\u00e2n \u0111ang h\u1ed3i ph\u1ee5c sau nh\u1ed3i m\u00e1u c\u01a1 tim (NMCT), sau khi c\u00f3 2 th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean qui m\u00f4 l\u1edbn \u2013 BHAT (th\u1eed nghi\u1ec7m thu\u1ed1c ch\u1eb9n beta tr\u00ean b\u1ec7nh nh\u00e2n \u0111au ng\u1ef1c) v\u00e0 th\u1eed nghi\u1ec7m nh\u00f3m nghi\u00ean c\u1ee9u \u0111a trung t\u00e2m \u1edf Na-uy \u2013 cho th\u1ea5y m\u1ed9t c\u00e1ch ch\u1eafc ch\u1eafn r\u1eb1ng c\u00e1c thu\u1ed1c n\u00e0y l\u00e0m gi\u1ea3m nguy c\u01a1 xu\u1ea5t hi\u1ec7n c\u01a1n \u0111au ng\u1ef1c th\u1ee9 hai v\u00e0 t\u1eed vong. C\u00e1c thu\u1ed1c n\u00e0y \u1ee9c ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a hormone norepinephrine, l\u00e0m gi\u1ea3m nh\u1ecbp tim v\u00e0 huy\u1ebft \u00e1p v\u00e0 m\u1edf r\u1ed9ng m\u1ea1ch m\u00e1u gi\u00fap c\u1ea3i thi\u1ec7n l\u01b0u l\u01b0\u1ee3ng m\u00e1u.<\/p>\n
B\u00e0i t\u1ed5ng h\u1ee3p 31 th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean v\u00e0o n\u0103m 1999 \u0111\u00e3 kh\u1eb3ng \u0111\u1ecbnh gi\u00e1 tr\u1ecb c\u1ee9u m\u1ea1ng sau \u0111au ng\u1ef1c c\u1ee7a c\u00e1c thu\u1ed1c n\u00f3i tr\u00ean: t\u1ec9 su\u1ea5t ch\u00eanh v\u1ec1 t\u1ec9 l\u1ec7 t\u1eed vong \u1edf nh\u00f3m d\u00f9ng thu\u1ed1c ch\u1eb9n beta gi\u1ea3m 23% so v\u1edbi nh\u00f3m kh\u00f4ng d\u00f9ng.
\nKhi xem x\u00e9t v\u1ec1 m\u1ee9c \u0111\u1ed9 c\u1ee7a b\u1eb1ng ch\u1ee9ng, Hi\u1ec7p h\u1ed9i Tim m\u1ea1ch Hoa K\u00ec (AHA) v\u00e0 Qu\u0129 H\u1ed9i Tim m\u1ea1ch Hoa K\u00ec (ACCF) khuy\u1ebfn c\u00e1o r\u1eb1ng tr\u1eeb tr\u01b0\u1eddng h\u1ee3p ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n n\u00ean s\u1eed d\u1ee5ng thu\u1ed1c ch\u1eb9n beta sau \u0111au ng\u1ef1c \u0111\u1ec3 d\u1ef1 ph\u00f2ng c\u01a1n \u0111au l\u1ea7n hai v\u00e0 ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c n\u00e0y trong \u00edt nh\u1ea5t 3 n\u0103m.<\/p>\n
Tuy nhi\u00ean thu\u1ed1c ch\u1eb9n beta l\u1ea1i kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u01a1n \u0111\u1ed9c. C\u00e1c h\u01b0\u1edbng d\u1eabn th\u1ef1c h\u00e0nh c\u0169ng khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c kh\u00e1c \u0111\u1ec3 l\u00e0m gi\u1ea3m nguy c\u01a1 \u0111au ng\u1ef1c l\u1ea7n hai v\u00e0 t\u1eed vong. C\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng \u1edf Hoa K\u00ec \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn k\u00ea statin, thu\u1ed1c \u1ee9c ch\u1ebf enzym chuy\u1ec3n angiotensin (ACEI) v\u00e0 thu\u1ed1c ch\u1ed1ng ng\u01b0ng t\u1eadp ti\u1ec3u c\u1ea7u ho\u1eb7c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p sau nh\u1ed3i m\u00e1u. B\u1ec7nh nh\u00e2n c\u0169ng th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u00e1i t\u01b0\u1edbi m\u00e1u b\u1eb1ng thu\u1ed1c ho\u1eb7c ph\u1eabu thu\u1eadt nh\u1eb1m ph\u1ee5c h\u1ed3i l\u01b0u th\u00f4ng m\u00e1u sau \u0111au ng\u1ef1c.<\/p>\n
Tuy v\u1eady, do c\u00e1c th\u1eed nghi\u1ec7m m\u1ea5u ch\u1ed1t n\u00e0y c\u00f3 t\u1eeb tr\u01b0\u1edbc h\u1ea7u h\u1ebft t\u1ea5t c\u1ea3 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb chu\u1ea9n hi\u1ec7n nay, m\u1ed9t s\u1ed1 nh\u00e0 nghi\u00ean c\u1ee9u \u0111\u1eb7t c\u00e2u h\u1ecfi li\u1ec7u thu\u1ed1c ch\u1eb9n beta c\u00f3 c\u00f2n c\u1ea7n thi\u1ebft cho t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p sau NMCT.<\/p>\n
M\u1ed9t trong s\u1ed1 c\u00e1c nh\u00e0 nghi\u00ean c\u1ee9u n\u00eau tr\u00ean l\u00e0 BS. Jennifer G. Robinson, gi\u00e1o s\u01b0 chuy\u00ean ng\u00e0nh d\u1ecbch t\u1ec5 h\u1ecdc v\u00e0 y h\u1ecdc c\u1ee7a \u0110\u1ea1i h\u1ecdc Iowa v\u00e0 l\u00e0 \u0111\u1ed3ng t\u00e1c gi\u1ea3 c\u1ee7a m\u1ed9t trong nh\u1eefng nghi\u00ean c\u1ee9u quan s\u00e1t m\u1edbi \u0111\u00e2y.<\/p>\n
B\u00e0 b\u1eaft \u0111\u1ea7u th\u1eafc m\u1eafc v\u1ec1 l\u1ee3i \u00edch tr\u00ean l\u00e2m s\u00e0ng c\u1ee7a thu\u1ed1c ch\u1eb9n beta khi k\u1ebft h\u1ee3p v\u1edbi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb chu\u1ea9n sau NMCT kh\u00e1c, sau khi nh\u1eadn th\u1ea5y c\u00e1c th\u1eed nghi\u1ec7m g\u1ea7n \u0111\u00e2y kh\u00f4ng cho th\u1ea5y l\u1ee3i \u00edch g\u00ec khi k\u1ebft h\u1ee3p c\u00e1c thu\u1ed1c h\u1ea1 lipid m\u00e1u fenofibrate v\u00e0 niacin v\u1edbi c\u00e1c statin. Theo b\u00e0, vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c ch\u1eb9n beta sau NMCT tr\u00ean n\u1ec1n statin ch\u01b0a bao gi\u1edd \u0111\u01b0\u1ee3c ki\u1ec3m nghi\u1ec7m theo c\u00e1ch n\u00e0y.<\/p>\n
L\u00e0 m\u1ed9t b\u00e1c s\u0129 n\u1ed9i khoa, Robinson bi\u1ebft r\u1eb1ng nhi\u1ec1u b\u1ec7nh nh\u00e2n nh\u1eb7t ra v\u00e0 l\u1ef1a ch\u1ecdn nh\u1eefng thu\u1ed1c m\u00e0 h\u1ecd s\u1ebd u\u1ed1ng trong s\u1ed1 c\u00e1c thu\u1ed1c k\u00ea \u0111\u01a1n nh\u1eb1m m\u1ee5c \u0111\u00edch d\u1ef1 ph\u00f2ng sau \u0111au ng\u1ef1c. R\u1ea5t c\u00f3 th\u1ec3 nh\u1eefng b\u1ec7nh nh\u00e2n t\u00ecm \u0111\u1ebfn thu\u1ed1c ch\u1eb9n beta thay v\u00ec statin hay ACEI s\u1ebd \u0111\u00e1nh \u0111\u1ed5i m\u1ed9t c\u00e1ch sai l\u1ea7m.<\/p>\n
Nh\u1eb1m t\u00ecm ra m\u1ed1i li\u00ean quan n\u00f3i tr\u00ean c\u1ee7a thu\u1ed1c ch\u1eb9n beta v\u00e0 c\u00e1c h\u1ec7 qu\u1ea3, Robinson v\u00e0 \u0111\u1ed3ng nghi\u1ec7p \u0111\u00e3 ph\u00e2n t\u00edch c\u00e1c d\u1eef li\u1ec7u t\u1eeb h\u01a1n 90.000 ng\u01b0\u1eddi h\u01b0\u1edfng l\u1ee3i t\u1eeb ch\u01b0\u01a1ng tr\u00ecnh Medicare tr\u01b0\u1edbc \u0111\u00f3 \u0111\u01b0\u1ee3c nh\u1eadp vi\u1ec7n v\u00ec NMCT c\u1ea5p t\u1eeb n\u0103m 2008 \u0111\u1ebfn 2010; \u0111\u01b0\u1ee3c k\u00ea thu\u1ed1c ch\u1eb9n beta, ACEI ho\u1eb7c thu\u1ed1c \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 angiotensin II (ARB) v\u00e0 statin; v\u00e0 c\u00f2n s\u1ed1ng sau \u00edt nh\u1ea5t 6 th\u00e1ng.
\nCh\u1ec9 c\u00f3 kho\u1ea3ng m\u1ed9t n\u1eeda s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c d\u00f9ng c\u1ea3 3 thu\u1ed1c. Sau 18 th\u00e1ng, c\u00e1c b\u1ec7nh nh\u00e2n ng\u1eebng thu\u1ed1c ch\u1eb9n beta nh\u01b0ng ti\u1ebfp t\u1ee5c d\u00f9ng statin v\u00e0 ACEI ho\u1eb7c ARB c\u00f3 t\u1ec9 l\u1ec7 t\u1eed vong t\u01b0\u01a1ng \u0111\u01b0\u01a1ng c\u00e1c b\u1ec7nh nh\u00e2n d\u00f9ng c\u1ea3 3 thu\u1ed1c. Ng\u01b0\u1ee3c l\u1ea1i, c\u00e1c b\u1ec7nh nh\u00e2n d\u00f9ng thu\u1ed1c ch\u1eb9n beta k\u00e8m theo ch\u1ec9 1 trong c\u00e1c thu\u1ed1c c\u00f2n l\u1ea1i c\u00f3 t\u1ec9 l\u1ec7 t\u1eed vong cao h\u01a1n c\u00e1c b\u1ec7nh nh\u00e2n d\u00f9ng c\u1ea3 3 thu\u1ed1c.
\nTheo Robinson, c\u00e1c k\u1ebft qu\u1ea3 n\u00e0y g\u1ee3i \u00fd r\u1eb1ng c\u00f3 th\u1ec3 kh\u00f4ng c\u1ea7n d\u00f9ng thu\u1ed1c ch\u1eb9n beta mi\u1ec5n l\u00e0 b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng c\u1ea3 statin v\u00e0 ACEI ho\u1eb7c ARB, v\u00e0 mi\u1ec5n l\u00e0 kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh n\u00e0o kh\u00e1c nh\u01b0 suy tim hay r\u1ed1i lo\u1ea1n nh\u1ecbp tim.<\/p>\n
Nghi\u00ean c\u1ee9u c\u0169ng cho th\u1ea5y m\u1ed9t s\u1ed1 \u1ea3nh h\u01b0\u1edfng b\u1ea5t l\u1ee3i c\u1ee7a thu\u1ed1c. B\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng ho\u1eb7c sa s\u00fat tr\u00ed tu\u1ec7 c\u00f3 t\u1ec9 l\u1ec7 t\u1eed vong cao h\u01a1n khi n\u1ebfu ch\u1ec9 d\u00f9ng thu\u1ed1c ch\u1eb9n beta.<\/p>\n
Tuy nhi\u00ean, Robinson c\u1ea3nh b\u00e1o r\u1eb1ng c\u1ea7n c\u00f3 c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean \u0111\u1ec3 bi\u1ec7n gi\u1ea3i c\u00e1c k\u1ebft qu\u1ea3 n\u00e0y tr\u01b0\u1edbc khi c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng l\u1ea1c h\u01b0\u1edbng kh\u1ecfi c\u00e1c h\u01b0\u1edbng d\u1eabn hi\u1ec7n h\u00e0nh. Theo b\u00e0, n\u1ebfu kh\u00f4ng c\u00f3 b\u1ea5t c\u1ee9 y\u1ebfu t\u1ed1 nhi\u1ec5u n\u00e0o trong c\u00e1c nghi\u00ean c\u1ee9u quan s\u00e1t, c\u00f3 th\u1ec3 thu\u1ed1c ch\u1eb9n beta l\u00e0 tuy\u1ec7t \u0111\u1ed1i t\u1ed1t cho t\u1ea5t c\u1ea3 m\u1ecdi ng\u01b0\u1eddi, song hi\u1ec7n gi\u1edd ch\u1ec9 c\u00f3 th\u1ec3 k\u1ebft lu\u1eadn \u0111\u01b0\u1ee3c l\u00e0 \u0111ang c\u00f3 m\u1ed9t s\u1ef1 c\u00e2n b\u1eb1ng v\u1ec1 l\u1ee3i h\u1ea1i.<\/p>\n
Theo c\u00e1c chuy\u00ean gia, c\u00f3 m\u1ed9t nh\u00f3m b\u1ec7nh nh\u00e2n \u0111\u1eb7c bi\u1ec7t c\u00f3 th\u1ec3 kh\u00f4ng c\u1ea7n thu\u1ed1c ch\u1eb9n beta sau \u0111au ng\u1ef1c, \u0111\u00f3 l\u00e0 nh\u1eefng ng\u01b0\u1eddi kh\u00f4ng suy tim.<\/p>\n
V\u00e0o nh\u1eefng n\u0103m \u0111\u1ea7u th\u1eadp ni\u00ean 80, th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean \u0111a trung t\u00e2m \u0111\u1ed1i ch\u1ee9ng v\u1edbi gi\u1ea3 d\u01b0\u1ee3c c\u00f3 t\u00ean l\u00e0 BHAT (t\u00e0i tr\u1ee3 b\u1edfi Vi\u1ec7n nghi\u00ean c\u1ee9u Tim, Ph\u1ed5i v\u00e0 Huy\u1ebft h\u1ecdc qu\u1ed1c gia Hoa K\u00ec), cho th\u1ea5y thu\u1ed1c ch\u1eb9n beta l\u00e0m gi\u1ea3m g\u1ea7n 30% t\u1ec9 l\u1ec7 t\u1eed vong, nh\u01b0ng theo l\u1eddi BS. Sidney Goldstein, ch\u1ee7 t\u1ecbch \u1ee7y ban \u0111i\u1ec1u h\u00e0nh BHAT, nay l\u00e0 tr\u01b0\u1edfng khoa danh d\u1ef1 khoa Tim m\u1ea1ch h\u1ecdc \u1edf B\u1ec7nh vi\u1ec7n Henry Ford v\u00e0 gi\u00e1o s\u01b0 y h\u1ecdc t\u1ea1i \u0110\u1ea1i h\u1ecdc Y khoa Wayne State \u1edf Detroit, t\u1ec9 l\u1ec7 t\u1eed vong gi\u1ea3m m\u1ea1nh nh\u1ea5t \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n suy tim.<\/p>\n
T\u1eeb \u0111\u00f3 \u0111\u00e3 c\u00f3 nhi\u1ec1u th\u1eed nghi\u1ec7m qui m\u00f4 l\u1edbn kh\u1eb3ng \u0111\u1ecbnh l\u1ee3i \u00edch c\u1ee7a c\u00e1c thu\u1ed1c n\u00e0y \u1edf b\u1ec7nh nh\u00e2n suy tim. Tuy nhi\u00ean, theo BS. TS Chris Gale, gi\u00e1o s\u01b0 tim m\u1ea1ch h\u1ecdc t\u1ea1i \u0110\u1ea1i h\u1ecdc Leeds, ch\u01b0a c\u00f3 th\u1eed nghi\u1ec7m qui m\u00f4 l\u1edbn n\u00e0o hi\u1ec7n nay ki\u1ec3m \u0111\u1ecbnh t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c ch\u1eb9n beta tr\u00ean b\u1ec7nh nh\u00e2n \u0111au ng\u1ef1c nh\u01b0ng kh\u00f4ng b\u1ecb suy tim.<\/p>\n
D\u1eabn l\u1eddi BS. Richard Stein, b\u00e1c s\u0129 tim m\u1ea1ch h\u1ecdc, gi\u00e1o s\u01b0 y h\u1ecdc t\u1ea1i Trung t\u00e2m y khoa \u0110\u1ea1i h\u1ecdc New York v\u00e0 l\u00e0 ph\u00e1t ng\u00f4n vi\u00ean c\u1ee7a AHA, ch\u01b0a c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c ch\u1eb9n beta \u1edf b\u1ec7nh nh\u00e2n c\u00f3 ho\u1ea1t \u0111\u1ed9ng tim b\u00ecnh th\u01b0\u1eddng gi\u00fap c\u1ea3i thi\u1ec7n t\u1ec9 l\u1ec7 s\u1ed1ng s\u00f3t sau NMCT.<\/p>\n
Vi\u1ec7c thi\u1ebfu v\u1eafng c\u00e1c d\u1eef li\u1ec7u t\u1eeb c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean d\u1eabn t\u1edbi s\u1ef1 kh\u00f4ng ch\u1eafc ch\u1eafn tr\u00ean l\u00e2m s\u00e0ng c\u0169ng nh\u01b0 c\u00e1c khuy\u1ebfn c\u00e1o m\u00e2u thu\u1eabn nhau. Kh\u00f4ng gi\u1ed1ng nh\u01b0 c\u00e1c h\u01b0\u1edbng d\u1eabn \u1edf Hoa K\u00ec, c\u00e1c h\u01b0\u1edbng d\u1eabn \u1edf ch\u00e2u \u00c2u kh\u00f4ng khuy\u1ebfn c\u00e1o d\u00f9ng ch\u1eb9n beta l\u00e0m thu\u1ed1c d\u1ef1 ph\u00f2ng NMCT \u0111\u1ea7u tay cho t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n.<\/p>\n
M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u quan s\u00e1t g\u1ea7n \u0111\u00e2y g\u1ee3i \u00fd r\u1eb1ng b\u1ec7nh nh\u00e2n kh\u00f4ng suy tim c\u00f3 th\u1ec3 kh\u00f4ng c\u1ea7n d\u00f9ng thu\u1ed1c ch\u1eb9n beta sau NMCT. N\u0103m 2015, m\u1ed9t ph\u00e2n t\u00edch g\u1ed9p 10 nghi\u00ean c\u1ee9u quan s\u00e1t tr\u00ean g\u1ea7n 41.000 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c can thi\u1ec7p m\u1ea1ch v\u00e0nh qua da (PCI) sau NMCT cho th\u1ea5y s\u1eed d\u1ee5ng thu\u1ed1c ch\u1eb9n beta ch\u1ec9 l\u00e0m gi\u1ea3m nguy c\u01a1 t\u1eed vong \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n nh\u1ea5t \u0111\u1ecbnh, bao g\u1ed3m c\u00e1c b\u1ec7nh nh\u00e2n gi\u1ea3m ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u \u2013 m\u1ed9t d\u1ea1ng suy tim \u2013 hay b\u1ec7nh nh\u00e2n \u00edt s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c d\u1ef1 ph\u00f2ng kh\u00e1c.<\/p>\n
H\u01a1n n\u1eefa, trong m\u1ed9t nghi\u00ean c\u1ee9u thu\u1ea7n t\u1eadp quan s\u00e1t tr\u00ean g\u1ea7n 180.000 b\u1ec7nh nh\u00e2n \u0111\u0103ng t\u1ea3i n\u0103m ngo\u00e1i (2017) tr\u00ean JACC, Gale v\u00e0 nh\u00f3m c\u00e1c nh\u00e0 nghi\u00ean c\u1ee9u \u1edf ch\u00e2u \u00c2u kh\u00f4ng th\u1ea5y \u00edch l\u1ee3i tr\u00ean t\u1ec9 l\u1ec7 s\u1ed1ng s\u00f3t \u1edf b\u1ea5t c\u1ee9 th\u1eddi \u0111i\u1ec3m \u0111\u00e1nh gi\u00e1 n\u00e0o trong v\u00f2ng 1 n\u0103m sau nh\u1eadp vi\u1ec7n c\u1ee7a c\u00e1c thu\u1ed1c ch\u1eb9n beta tr\u00ean b\u1ec7nh nh\u00e2n \u0111au ng\u1ef1c kh\u00f4ng suy tim hay r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i (LVSD).<\/p>\n
Ng\u01b0\u1eddi ta c\u0169ng \u0111\u1eb7t ra c\u00e1c c\u00e2u h\u1ecfi v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c ch\u1eb9n beta v\u00f4 th\u1eddi h\u1ea1n \u1edf b\u1ec7nh nh\u00e2n c\u00f3 ho\u1ea1t \u0111\u1ed9ng tim b\u00ecnh th\u01b0\u1eddng. N\u0103m 2016 m\u1ed9t nghi\u00ean c\u1ee9u tr\u00ean g\u1ea7n 2.700 b\u1ec7nh nh\u00e2n \u0111au ng\u1ef1c kh\u00f4ng c\u00f3 suy tim hay LVSD cho th\u1ea5y thu\u1ed1c ch\u1eb9n beta l\u00e0m gi\u1ea3m t\u1ec9 l\u1ec7 t\u1eed vong sau 30 ng\u00e0y nh\u01b0ng kh\u00f4ng l\u00e0m gi\u1ea3m t\u1ec9 l\u1ec7 t\u1eed vong sau 5 n\u0103m, g\u1ee3i \u00fd r\u1eb1ng vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c d\u00e0i h\u1ea1n c\u00f3 th\u1ec3 kh\u00f4ng gi\u00fap c\u1ee9u s\u1ed1ng b\u1ec7nh nh\u00e2n.<\/p>\n
Tr\u1edf l\u1ea1i v\u1edbi Robinson, theo b\u00e0, c\u00e0ng ph\u00e2n t\u00edch vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c ch\u1eb9n beta tr\u00ean c\u00e1c qu\u1ea7n th\u1ec3 kh\u00e1c nhau, c\u00e0ng th\u1ea5y c\u00e1c b\u1eb1ng ch\u1ee9ng cho r\u1eb1ng ch\u00fang ta n\u00ean quay l\u1ea1i \u0111\u00e1nh gi\u00e1 gi\u00e1 tr\u1ecb c\u1ee7a thu\u1ed1c ch\u1eb9n beta.<\/p>\n
M\u1eb7c d\u00f9 trong th\u1eddi \u0111\u1ea1i ng\u00e0y nay r\u1ea5t c\u00f3 th\u1ec3 l\u1ee3i \u00edch c\u1ee7a thu\u1ed1c ch\u1eb9n beta \u0111\u00e3 gi\u1ea3m \u0111i, song theo b\u00e1c s\u0129 tim m\u1ea1ch William H. Frishman, \u00f4ng tin r\u1eb1ng c\u00e1c thu\u1ed1c n\u00e0y v\u1eabn c\u00f2n gi\u00e1 tr\u1ecb b\u1ea3o v\u1ec7 v\u00e0 c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng n\u00ean ti\u1ebfp t\u1ee5c k\u00ea ch\u00fang. Frishman l\u00e0 gi\u00e1o s\u01b0, tr\u01b0\u1edfng khoa y t\u1ea1i \u0110\u1ea1i h\u1ecdc Y New York v\u00e0 l\u00e0 gi\u00e1m \u0111\u1ed1c y khoa Trung t\u00e2m y khoa Westchester, \u0111\u00e3 li\u00ean t\u1ee5c nghi\u00ean c\u1ee9u v\u1ec1 c\u00e1c thu\u1ed1c ch\u1eb9n beta trong 5 n\u0103m qua. N\u1ebfu trong gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi b\u1ecb \u0111au ng\u1ef1c, \u00f4ng s\u1ebd ch\u1ecdn cho h\u1ecd thu\u1ed1c ch\u1eb9n beta, \u0111\u00e2y l\u00e0 c\u00e1c thu\u1ed1c c\u00f3 gi\u00e1 c\u1ea3 th\u1ea5p v\u00e0 ch\u1ec9 c\u1ea7n d\u00f9ng 1 l\u1ea7n\/ng\u00e0y.<\/p>\n
Tuy nhi\u00ean ngay c\u1ea3 Frishman c\u0169ng th\u1eeba nh\u1eadn c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean n\u1ebfu c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh m\u1ed9t c\u00e1ch ph\u00f9 h\u1ee3p v\u1ec1 \u0111\u1ea1o \u0111\u1ee9c s\u1ebd l\u00e0 b\u01b0\u1edbc \u0111i ph\u00f9 h\u1ee3p ti\u1ebfp theo.<\/p>\n
V\u1ec1 ph\u1ea7n BS. Goldstein, m\u1eb7c d\u00f9 t\u1ef1 nh\u1eadn m\u00ecnh l\u00e0 ng\u01b0\u1eddi \u201csay m\u00ea thu\u1ed1c ch\u1eb9n beta\u201d, \u00f4ng c\u0169ng cho r\u1eb1ng \u0111\u00e3 \u0111\u1ebfn l\u00fac ti\u1ebfn h\u00e0nh c\u00e1c th\u1eed nghi\u1ec7m m\u1edbi tr\u00ean lo\u1ea1i thu\u1ed1c c\u0169 n\u00e0y b\u1edfi theo \u00f4ng, kh\u00f4ng ch\u1ec9 c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb hi\u1ec7n h\u00e0nh \u0111\u00e3 thay \u0111\u1ed5i, m\u00e0 qu\u1ea7n th\u1ec3 sau NMCT c\u0169ng \u0111\u00e3 thay \u0111\u1ed5i. R\u1ea5t nhi\u1ec1u ng\u01b0\u1eddi trong th\u1ebf gi\u1edbi hi\u1ec7n \u0111\u1ea1i c\u00f3 tu\u1ed5i \u0111\u1eddi l\u1edbn h\u01a1n nh\u1eefng ng\u01b0\u1eddi trong c\u00e1c th\u1eed nghi\u1ec7m BHAT v\u00e0 Na-uy, c\u00e1c th\u1eed nghi\u1ec7m n\u00e0y bao tr\u00f9m \u0111\u1ebfn \u0111\u1ed9 tu\u1ed5i l\u1ea7n l\u01b0\u1ee3t l\u00e0 69 v\u00e0 75. N\u1eef gi\u1edbi c\u0169ng ch\u01b0a \u0111\u01b0\u1ee3c quan t\u00e2m \u0111\u00fang m\u1ee9c trong c\u00e1c th\u1eed nghi\u1ec7m ban \u0111\u1ea7u.<\/p>\n
N\u00f3i chung, \u0111au ng\u1ef1c ng\u00e0y nay \u00edt quan tr\u1ecdng h\u01a1n, v\u00e0 nh\u01b0 v\u1eady \u0111\u00f2i h\u1ecfi \u0111i\u1ec1u tr\u1ecb \u00edt kh\u1ea9n tr\u01b0\u01a1ng h\u01a1n. H\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh nh\u00e2n trong th\u1eed nghi\u1ec7m BHAT \u0111\u1ec1u c\u00f3 NMCT v\u1edbi \u0111o\u1ea1n ST ch\u00eanh l\u00ean (STEMI), \u0111\u00e2y l\u00e0 m\u1ed9t d\u1ea1ng \u0111au ng\u1ef1c n\u1eb7ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c b\u1eb1ng \u0111i\u1ec7n t\u00e2m \u0111\u1ed3. Song v\u1edbi s\u1ef1 h\u1ed7 tr\u1ee3 c\u1ee7a vi\u1ec7c ch\u1ea9n \u0111o\u00e1n b\u1eb1ng enzym c\u01a1 tim, vi\u1ec7c x\u00e1c \u0111\u1ecbnh NMCT \u0111\u00e3 \u0111\u01b0\u1ee3c m\u1edf r\u1ed9ng cho nhi\u1ec1u b\u1ec7nh nh\u00e2n h\u01a1n v\u1edbi c\u00e1c th\u1ec3 \u0111au ng\u1ef1c \u00edt nghi\u00eam tr\u1ecdng h\u01a1n trong c\u00e1c nh\u00f3m thu\u1ea7n t\u1eadp l\u1ecbch s\u1eed.<\/p>\n
C\u00e2u tr\u1ea3 l\u1eddi c\u00f3 th\u1ec3 \u0111\u1ebfn t\u1eeb d\u1eef li\u1ec7u tim m\u1ea1ch qu\u1ed1c gia c\u1ee7a Th\u1ee5y \u0110i\u1ec3n. Trong th\u1eed nghi\u1ec7m REDUCE-SWEDEHEART, c\u00e1c nh\u00e0 nghi\u00ean c\u1ee9u \u0111\u00e3 ng\u1eabu nhi\u00ean ph\u00e2n b\u1ed1 7000 ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh c\u00f3 ph\u00e2n s\u1ed1 t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i b\u00ecnh th\u01b0\u1eddng \u1edf th\u1eddi \u0111i\u1ec3m 1 \u0111\u1ebfn 7 ng\u00e0y sau NMCT v\u00e0o 1 trong 2 nh\u00f3m d\u00f9ng ho\u1eb7c kh\u00f4ng d\u00f9ng thu\u1ed1c ch\u1eb9n beta. D\u1eef li\u1ec7u khai b\u00e1o s\u1ebd \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh xem thu\u1ed1c ch\u1eb9n beta c\u00f3 l\u00e0m gi\u1ea3m s\u1ed1 tr\u01b0\u1eddng h\u1ee3p NMCT m\u1edbi v\u00e0 t\u1ec9 l\u1ec7 t\u1eed vong do t\u1ea5t c\u1ea3 c\u00e1c nguy\u00ean nh\u00e2n trong kho\u1ea3ng th\u1eddi gian theo d\u00f5i \u01b0\u1edbc t\u00ednh t\u1eeb 1 \u0111\u1ebfn 3 n\u0103m. Theo c\u00e1c t\u00e1c gi\u1ea3, c\u00e1c k\u1ebft qu\u1ea3 s\u1ebd \u0111\u01b0\u1ee3c \u0111\u0103ng t\u1ea3i v\u00e0o kho\u1ea3ng n\u0103m 2020.
\nQuay tr\u1edf l\u1ea1i v\u1edbi Frishman, \u00f4ng nh\u1ea5n m\u1ea1nh r\u1eb1ng cho t\u1edbi nay, thu\u1ed1c ch\u1eb9n beta \u201cv\u1eabn \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c x\u1eed tr\u00ed b\u1ec7nh nh\u00e2n s\u1ed1ng s\u00f3t sau NMCT c\u1ea5p\u201d.<\/p>\n
<\/p>\n","protected":false},"excerpt":{"rendered":"
Thu\u1ed1c ch\u1eb9n beta c\u00f3 c\u1ea7n thi\u1ebft cho t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n sau \u0111au ng\u1ef1c? Jennifer Abbasi. X\u00e3 lu\u1eadn \u0111\u0103ng tr\u00ean JAMA ng\u00e0y 14\/02\/2018. Hai nghi\u00ean c\u1ee9u quan s\u00e1t qui m\u00f4 l\u1edbn \u0111\u01b0\u1ee3c \u0111\u0103ng t\u1ea3i n\u0103m ngo\u00e1i tr\u00ean t\u1ea1p ch\u00ed c\u1ee7a H\u1ed9i Tim m\u1ea1ch Hoa K\u00ec (JACC) \u0111ang l\u00e0m d\u1ea5y l\u00ean c\u00e2u h\u1ecfi v\u1ec1 s\u1ef1 […]\n","protected":false},"author":1,"featured_media":4126,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-4125","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\/4125","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=4125"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/4125\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/4126"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=4125"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=4125"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=4125"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}