Digoxin l\u00e0 g\u00ec?<\/h2>\n
Digoxin la\u0300 glycosid tim<\/strong> \u0111\u01b0\u1ee3c chi\u1ebft t\u00e1ch t\u01b0\u0300 c\u00e2y d\u01b0\u01a1ng \u0111i\u0323a hoa\u0300ng ti\u0301a. N\u0103m 1785, nha\u0300 ho\u0301a ho\u0323c, th\u01b0\u0323c v\u00e2\u0323t ho\u0323c va\u0300 v\u00e2\u0323t ly\u0301 ho\u0323c ng\u01b0\u01a1\u0300i Anh, William Withering \u0111\u00e3 c\u00f4ng b\u00f4\u0301 k\u00ea\u0301t qua\u0309 nghi\u00ean c\u1ee9u c\u1ee7a m\u00ecnh v\u1ec1 kh\u1ea3 n\u0103ng s\u1eed d\u1ee5ng c\u00e2y Digitalis purpurea \u0111\u00ea\u0309 \u0111i\u00ea\u0300u tri\u0323 phu\u0300 do tim (suy tim sung huy\u00ea\u0301t). Tuy \u0111\u00e3 \u0111\u01b0\u01a1\u0323c s\u01b0\u0309 du\u0323ng tr\u00ean l\u00e2m s\u00e0ng trong th\u1eddi gian d\u00e0i, nh\u01b0ng C\u01a1 quan qu\u1ea3n l\u00fd D\u01b0\u1ee3c ph\u1ea9m v\u00e0 Th\u1ef1c ph\u1ea9m Hoa K\u1ef3 (FDA) ch\u1ec9 ph\u00ea duy\u00ea\u0323t ch\u1ec9 \u0111\u1ecbnh \u0111i\u00ea\u0300u tri\u0323 suy tim cho digoxin v\u00e0o nh\u1eefng n\u0103m cu\u1ed1i c\u1ee7a th\u1eadp ni\u00ean 90. M\u00f4\u0323t chi\u0309 \u0111i\u0323nh kha\u0301c \u0111\u01b0\u1ee3c FDA c\u00f4ng nh\u1eadn la\u0300 \u0111i\u1ec1u tr\u1ecb rung nhi\u0303. Tr\u00ean l\u00e2m s\u00e0ng, digoxin co\u0300n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ngo\u00e0i ch\u1ec9 \u0111\u1ecbnh \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t (off-label) trong \u0111i\u00ea\u0300u tri\u0323 lo\u1ea1n nh\u1ecbp nhanh c\u1ee7a thai nhi, nhi\u0323p nhanh tr\u00ean th\u00e2\u0301t, t\u00e2m ph\u00ea\u0301 m\u1ea1n v\u00e0 t\u0103ng a\u0301p ph\u00f4\u0309i.<\/p>\n C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c d\u1ef1a tr\u00ean kh\u1ea3 n\u0103ng \u01b0\u0301c ch\u00ea\u0301 b\u01a1m Na+-K+-ATPase, t\u0103ng trao \u0111\u00f4\u0309i natri\u00adcalci; la\u0300m t\u0103ng n\u00f4\u0300ng \u0111\u00f4\u0323 calci n\u00f4\u0323i ba\u0300o, d\u1eabn \u0111\u1ebfn t\u0103ng co bo\u0301p c\u01a1 tim. Digoxin cu\u0303ng co\u0301 ca\u0301c \u0111\u0103\u0323c ti\u0301nh c\u01b0\u01a1\u0300ng ph\u00f3 giao ca\u0309m. Do la\u0300m t\u0103ng tr\u01b0\u01a1ng l\u1ef1c ph\u00ea\u0301 vi\u0323 \u01a1\u0309 nu\u0301t xoang nhi\u0303 va\u0300 nu\u0301t nhi\u0303 th\u00e2\u0301t, digoxin la\u0300m ch\u00e2\u0323m nhi\u0323p va\u0300 d\u00e2\u0303n truy\u00ea\u0300n nhi\u0303 th\u00e2\u0301t. Ba\u0309ng 1 to\u0301m t\u0103\u0301t m\u1ed9t s\u1ed1 \u0111\u1eb7c t\u00ednh d\u01b0\u1ee3c l\u00fd quan tr\u1ecdng c\u1ee7a digoxin.<\/p>\n M\u1eb7c d\u00f9 \u0111a\u0303 \u0111\u01b0\u01a1\u0323c ti\u0300m th\u00e2\u0301y t\u01b0\u0300 t\u01b0\u01a1ng \u0111\u1ed1i l\u00e2u, nh\u01b0ng vi\u1ec7c s\u1eed d\u1ee5ng digoxin trong th\u1ef1c h\u00e0nh b\u1ecb h\u1ea1n ch\u1ebf b\u1edfi m\u00f4\u0323t s\u00f4\u0301 y\u00ea\u0301u t\u00f4\u0301 bao g\u1ed3m ph\u1ea1m vi \u0111i\u00ea\u0300u tri\u0323 he\u0323p, y\u00eau c\u1ea7u gia\u0301m sa\u0301t ch\u0103\u0323t che\u0303, c\u00f3 nhi\u1ec1u ta\u0301c du\u0323ng kh\u00f4ng mong mu\u00f4\u0301n va\u0300 kha\u0309 n\u0103ng t\u01b0\u01a1ng ta\u0301c v\u01a1\u0301i nhi\u00ea\u0300u thu\u00f4\u0301c. Tuy v\u00e2\u0323y, digoxin v\u00e2\u0303n co\u0301 vai tro\u0300 nh\u1ea5t \u0111\u1ecbnh trong \u0111i\u00ea\u0300u tri\u0323 suy tim, rung nhi\u0303 va\u0300 c\u00f2n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p kh\u00e1c ngo\u00e0i ch\u1ec9 \u0111\u1ecbnh \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t. V\u01a1\u0301i nh\u01b0\u0303ng chi\u0309 \u0111i\u0323nh na\u0300y, digoxin \u0111\u01b0\u01a1\u0323c coi nh\u01b0 m\u00f4\u0323t li\u00ea\u0323u pha\u0301p thay th\u1ebf h\u01a1n la\u0300 l\u1ef1a ch\u1ecdn \u0111\u00e2\u0300u tay.<\/p>\n Theo ca\u0301c h\u01b0\u01a1\u0301ng d\u00e2\u0303n \u0111i\u00ea\u0300u tri\u0323 hi\u00ea\u0323n nay, digoxin co\u0301 th\u00ea\u0309 \u0111\u01b0\u01a1\u0323c s\u01b0\u0309 du\u0323ng \u0111\u1ec3 b\u00f4\u0309 sung c\u00f9ng che\u0323n beta ho\u0103\u0323c thu\u1ed1c \u01b0\u0301c ch\u00ea\u0301 men chuy\u00ea\u0309n\/ che\u0323n th\u1ee5 th\u1ec3 AT1 trong ki\u00ea\u0309m soa\u0301t suy tim sung huy\u00ea\u0301t. Digoxin la\u0300m ch\u00e2\u0323m nhi\u0323p tim va\u0300 gia\u0309m b\u1ec7nh su\u1ea5t \u01a1\u0309 b\u00ea\u0323nh nh\u00e2n rung nh\u0129. Thu\u1ed1c chu\u0309 y\u00ea\u0301u \u0111\u01b0\u01a1\u0323c s\u01b0\u0309 du\u0323ng nh\u01b0 m\u00f4\u0323t li\u00ea\u0323u pha\u0301p \u0111i\u00ea\u0300u tri\u0323 b\u00f4\u0309 sung cho b\u00ea\u0323nh nh\u00e2n rung nh\u0129 co\u0301 nhi\u0323p tim kh\u00f4ng \u0111\u01b0\u01a1\u0323c ki\u00ea\u0309m soa\u0301t hoa\u0300n toa\u0300n b\u1eb1ng che\u0323n beta. Nh\u01a1\u0300 ta\u0301c du\u0323ng co c\u01a1 d\u01b0\u01a1ng ti\u0301nh, digoxin co\u0301 th\u00ea\u0309 co\u0301 ta\u0301c du\u0323ng trong tr\u01b0\u1eddng h\u1ee3p t\u0103ng a\u0301p \u0111\u00f4\u0323ng ma\u0323ch ph\u00f4\u0309i, tuy nhi\u00ean c\u00e2\u0300n co\u0301 th\u00eam nghi\u00ean c\u01b0\u0301u \u0111\u00ea\u0309 \u0111a\u0301nh gia\u0301 nh\u01b0\u0303ng ta\u0301c \u0111\u00f4\u0323ng l\u00e2u da\u0300i cu\u0309a digoxin v\u1edbi nho\u0301m b\u00ea\u0323nh nh\u00e2n na\u0300y.<\/p>\n Suy tim sung huy\u00ea\u0301t la\u0300 m\u00f4\u0323t da\u0323ng suy gia\u0309m ch\u01b0\u0301c n\u0103ng tim li\u00ean quan \u0111\u1ebfn gi\u1ea3m co bo\u0301p c\u01a1 tim, gia\u0303n t\u00e2m th\u00e2\u0301t\/\u00e1p l\u1ef1c \u0111\u1ed5 \u0111\u1ea7y tim ho\u0103\u0323c ca\u0309 hai y\u1ebfu t\u1ed1 tr\u00ean. Trong suy tim sung huy\u00ea\u0301t, co bo\u0301p cu\u0309a tim gi\u1ea3m, la\u0300m gia\u0309m cung l\u01b0\u01a1\u0323ng tim. Digoxin co\u0301 hi\u00ea\u0323u qua\u0309 tr\u00ean b\u00ea\u0323nh nh\u00e2n suy tim sung huy\u00ea\u0301t nh\u01a1\u0300 \u0111\u0103\u0323c ti\u0301nh co c\u01a1 d\u01b0\u01a1ng ti\u0301nh. M\u0103\u0323c du\u0300 ca\u0301c nghi\u00ean c\u01b0\u0301u \u0111a\u0303 chi\u0309 ra r\u0103\u0300ng digoxin la\u0300m gia\u0309m ty\u0309 l\u00ea\u0323 nh\u00e2\u0323p vi\u00ea\u0323n va\u0300 c\u1ea3i thi\u00ea\u0323n tri\u00ea\u0323u ch\u01b0\u0301ng cu\u0309a suy tim, kh\u1ea3 n\u0103ng la\u0300m gia\u0309m ty\u0309 l\u00ea\u0323 t\u01b0\u0309 vong c\u1ee7a thu\u1ed1c v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh.<\/p>\n Vai tro\u0300 cu\u0309a digoxin trong \u0111i\u00ea\u0300u tri\u0323 suy tim \u0111a\u0303 \u0111\u01b0\u01a1\u0323c \u0111\u00e1nh gi\u00e1 trong nhi\u00ea\u0300u nghi\u00ean c\u01b0\u0301u l\u00e2m s\u00e0ng. Trong m\u00f4\u0323t nghi\u00ean c\u01b0\u0301u mu\u0300 \u0111\u00f4i c\u00f3 ki\u1ec3m so\u00e1t v\u00ea\u0300 vi\u00ea\u0323c s\u01b0\u0309 du\u0323ng digoxin trong \u0111i\u00ea\u0300u tri\u0323 suy tim sung huy\u1ebft, b\u1ec7nh nh\u00e2n c\u00f3 suy gia\u0309m ch\u01b0\u0301c n\u0103ng c\u01a1 tim \u0111\u01b0\u01a1\u0323c l\u1ef1a ch\u1ecdn ng\u1eabu nhi\u00ean \u0111\u1ec3 du\u0300ng digoxin ho\u0103\u0323c placebo trong vo\u0300ng 7 tu\u00e2\u0300n. Nho\u0301m b\u00ea\u0323nh nh\u00e2n du\u0300ng placebo co\u0301 ti\u0300nh tra\u0323ng b\u00ea\u0323nh x\u00e2\u0301u \u0111i nhanh h\u01a1n nhi\u00ea\u0300u so v\u01a1\u0301i nho\u0301m du\u0300ng digoxin. Ch\u01b0\u0301c n\u0103ng cu\u0309a tim, l\u01b0\u01a1\u0323ng gia\u0301 th\u00f4ng qua ph\u00e2n su\u00e2\u0301t t\u00f4\u0301ng ma\u0301u, \u0111\u01b0\u01a1\u0323c ca\u0309i thi\u00ea\u0323n ro\u0303 r\u00ea\u0323t \u01a1\u0309 nho\u0301m b\u00ea\u0323nh nh\u00e2n du\u0300ng digoxin. Nhi\u00ea\u0300u th\u01b0\u0309 nghi\u00ea\u0323m l\u00e2m sa\u0300ng kha\u0301c c\u0169ng cho th\u00e2\u0301y ta\u0301c du\u0323ng co c\u01a1 d\u01b0\u01a1ng ti\u0301nh cu\u0309a digoxin c\u00f3 hi\u1ec7u qu\u1ea3 trong ki\u00ea\u0309m soa\u0301t suy tim sung huy\u00ea\u0301t.<\/p>\n Theo h\u01b0\u01a1\u0301ng d\u00e2\u0303n ki\u00ea\u0309m soa\u0301t suy tim cu\u0309a Tr\u01b0\u01a1\u0300ng m\u00f4n Tim ma\u0323ch Hoa Ky\u0300\/H\u00f4\u0323i Tim Hoa Ky\u0300 n\u0103m 2013 (ACCF\/AHA), digoxin ca\u0309i thi\u00ea\u0323n ca\u0301c tri\u00ea\u0323u ch\u01b0\u0301ng, ch\u00e2\u0301t l\u01b0\u01a1\u0323ng cu\u00f4\u0323c s\u00f4\u0301ng va\u0300 dung n\u1ea1p g\u1eafng s\u1ee9c \u01a1\u0309 b\u00ea\u0323nh nh\u00e2n suy tim \u1edf m\u1ee9c \u0111\u1ed9 nhe\u0323 va\u0300 trung b\u00ecnh, kh\u00f4ng phu\u0323 thu\u00f4\u0323c va\u0300o nhi\u0323p n\u1ec1n c\u1ee7a b\u1ec7nh nh\u00e2n (nhi\u0323p xoang nhi\u0303 bi\u0300nh th\u01b0\u01a1\u0300ng hay rung nhi\u0303). Do \u0111o\u0301, digoxin co\u0301 th\u00ea\u0309 \u0111\u01b0\u01a1\u0323c xem nh\u01b0 m\u00f4\u0323t li\u00ea\u0323u pha\u0301p \u0111i\u00ea\u0300u tri\u0323 b\u00f4\u0309 sung cho b\u00ea\u0323nh nh\u00e2n co\u0301 ca\u0301c tri\u00ea\u0323u ch\u01b0\u0301ng suy tim dai d\u0103\u0309ng du\u0300 \u0111\u00e3 \u0111i\u00ea\u0300u tri\u0323 v\u01a1\u0301i thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n ho\u1eb7c ch\u1eb9n th\u1ee5 th\u1ec3 AT1 hay ca\u0301c thu\u00f4\u0301c che\u0323n beta. Digoxin co\u0300n co\u0301 th\u00ea\u0309 \u0111\u01b0\u01a1\u0323c s\u01b0\u0309 du\u0323ng cho ca\u0301c b\u00ea\u0323nh nh\u00e2n suy tim giai \u0111oa\u0323n C (b\u00ea\u0323nh tim c\u00e2\u0301u tru\u0301c c\u00f3 ca\u0301c tri\u00ea\u0323u ch\u1ee9ng suy tim tr\u01b0\u1edbc \u0111\u00e2y ho\u1eb7c hi\u1ec7n c\u00f3) hay suy tim giai \u0111oa\u0323n D (tri\u00ea\u0323u ch\u01b0\u0301ng suy tim lu\u0301c nghi\u0309 va\u0300 ta\u0301i nh\u00e2\u0323p vi\u00ea\u0323n du\u0300 \u0111\u00e3 \u0111\u01b0\u01a1\u0323c \u0111i\u00ea\u0300u tri\u0323). B\u00ea\u0323nh nh\u00e2n suy tim kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng digoxin ma\u0300 kh\u00f4ng d\u1ef1a tr\u00ean n\u1ec1n thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n ho\u0103\u0323c che\u0323n beta. M\u0103\u0323c du\u0300 digoxin \u0111\u01b0\u01a1\u0323c k\u00ea \u0111\u01a1n cho b\u00ea\u0323nh nh\u00e2n suy tim va\u0300 rung nhi\u0303, khi du\u0300ng \u0111\u00f4\u0300ng th\u01a1\u0300i v\u01a1\u0301i thu\u00f4\u0301c che\u0323n beta, digoxin th\u01b0\u01a1\u0300ng co\u0301 hi\u00ea\u0323u qua\u0309 h\u01a1n trong ki\u00ea\u0309m soa\u0301t \u0111a\u0301p \u01b0\u0301ng t\u00e2m th\u00e2\u0301t, \u0111\u0103\u0323c bi\u00ea\u0323t la\u0300 khi g\u1eafng s\u1ee9c.<\/p>\n Li\u1ec1u kh\u1edfi \u0111\u1ea7u c\u1ee7a digoxin la\u0300 0,125 mg \u0111\u00ea\u0301n 0,25 mg u\u00f4\u0301ng ha\u0300ng nga\u0300y. C\u00e2\u0300n hi\u00ea\u0323u chi\u0309nh li\u00ea\u0300u d\u01b0\u0323a tr\u00ean ch\u01b0\u0301c n\u0103ng th\u00e2\u0323n va\u0300 tu\u00f4\u0309i cu\u0309a b\u00ea\u0323nh nh\u00e2n (b\u1ea3ng 1). N\u00f4\u0300ng \u0111\u00f4\u0323 \u0111i\u0301ch c\u1ea7n \u0111\u1ea1t cu\u0309a digoxin trong huy\u00ea\u0301t thanh v\u01a1\u0301i b\u00ea\u0323nh nh\u00e2n suy tim dao \u0111\u1ed9ng t\u1eeb 0,5 ng\/mL \u0111\u00ea\u0301n 0,9 ng\/mL.<\/p>\n Digoxin co\u0301 t\u00e1c d\u1ee5ng la\u0300m gia\u0309m ca\u0301c tri\u00ea\u0323u ch\u01b0\u0301ng cu\u0309a suy tim. Ta\u0301c du\u0323ng c\u1ee7a thu\u1ed1c tr\u00ean ty\u0309 l\u00ea\u0323 m\u0103\u0301c va\u0300 ty\u0309 l\u00ea\u0323 t\u01b0\u0309 vong cu\u0309a suy tim cu\u0303ng \u0111\u01b0\u01a1\u0323c \u0111a\u0301nh gia\u0301.<\/p>\n M\u00f4\u0323t nghi\u00ean c\u01b0\u0301u ng\u00e2\u0303u nhi\u00ean, mu\u0300 \u0111\u00f4i c\u00f3 \u0111\u1ed1i ch\u1ee9ng gi\u1ea3 d\u01b0\u1ee3c \u0111\u00e3 \u0111\u01b0\u01a1\u0323c th\u01b0\u0323c hi\u00ea\u0323n \u0111\u00ea\u0309 \u0111a\u0301nh gia\u0301 ty\u0309 l\u00ea\u0323 m\u0103\u0301c b\u1ec7nh va\u0300 ty\u0309 l\u00ea\u0323 t\u01b0\u0309 vong \u01a1\u0309 b\u00ea\u0323nh nh\u00e2n suy tim v\u01a1\u0301i ph\u00e2n su\u00e2\u0301t t\u00f4\u0301ng ma\u0301u cu\u0309a th\u00e2\u0301t tra\u0301i <0,45 va\u0300 \u0111\u01b0\u01a1\u0323c \u0111i\u00ea\u0300u tri\u0323 b\u0103\u0300ng digoxin. Kh\u00f4ng c\u00f3 s\u1ef1 kha\u0301c bi\u00ea\u0323t v\u1ec1 \u0111\u1eb7c \u0111i\u1ec3m b\u1ec7nh nh\u00e2n t\u1ea1i th\u1eddi \u0111i\u1ec3m kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb gi\u01b0\u0303a ca\u0301c nho\u0301m, c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c theo do\u0303i v\u1edbi th\u1eddi gian trung b\u00ecnh 37 tha\u0301ng. Ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 ch\u00ednh la\u0300 ty\u0309 l\u00ea\u0323 t\u01b0\u0309 vong\u037e ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 ph\u1ee5 c\u1ee7a nghi\u00ean c\u1ee9u l\u00e0 ti\u00eau ch\u00ed g\u1ed9p t\u01b0\u0309 vong do nguy\u00ean nh\u00e2n tim ma\u0323ch, t\u01b0\u0309 vong do suy tim ti\u00ea\u0301n tri\u00ea\u0309n va\u0300 nh\u1eadp vi\u00ea\u0323n do ca\u0301c nguy\u00ean nh\u00e2n kha\u0301c (ng\u00f4\u0323 \u0111\u00f4\u0323c digoxin).<\/p>\n K\u1ebft qu\u1ea3 ph\u00e2n ti\u0301ch theo d\u1ef1 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb cho th\u1ea5y co\u0301 1181 ca t\u01b0\u0309 vong trong nho\u0301m s\u01b0\u0309 du\u0323ng digoxin va\u0300 1194 ca t\u01b0\u0309 vong trong nho\u0301m du\u0300ng gia\u0309 d\u01b0\u01a1\u0323c (34,8% so v\u1edbi 35,1%, 95% CI 0,91- 1,07, p=0,8 [kh\u00e1c bi\u1ec7t kh\u00f4ng c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea]). S\u00f4\u0301 b\u00ea\u0323nh nh\u00e2n nh\u1eadp vi\u00ea\u0323n trong nho\u0301m du\u0300ng digoxin i\u0301t h\u01a1n nho\u0301m du\u0300ng gia\u0309 d\u01b0\u01a1\u0323c (t\u01b0\u01a1ng \u01b0\u0301ng 910 va\u0300 1180 b\u00ea\u0323nh nh\u00e2n\u037e ty\u0309 su\u00e2\u0301t nguy c\u01a1 0,72, 95% CI 0,66-0,79, p<0,001). Nguy c\u01a1 tr\u00ean ti\u00eau ch\u00ed g\u1ed9p t\u01b0\u0309 vong do suy tim ti\u00ea\u0301n tri\u00ea\u0309n ho\u0103\u0323c n\u0103\u0300m vi\u00ea\u0323n th\u00e2\u0301p h\u01a1n \u1edf nho\u0301m \u0111i\u00ea\u0300u tri\u0323 b\u0103\u0300ng digoxin (1041 va\u0300 1291, p<0,001). K\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u cho th\u1ea5y digoxin kh\u00f4ng c\u00f3 t\u00e1c \u0111\u1ed9ng tr\u00ean t\u01b0\u0309 vong chung, nh\u01b0ng la\u0300m gia\u0309m ro\u0303 r\u00ea\u0323t nguy c\u01a1 nh\u1eadp vi\u00ea\u0323n do suy tim ti\u00ea\u0301n tri\u00ea\u0309n.<\/p>\n Rung nhi\u0303 la\u0300 m\u00f4\u0323t da\u0323ng r\u00f4\u0301i loa\u0323n nhi\u0323p tim ph\u00f4\u0309 bi\u00ea\u0301n, trong \u0111o\u0301 xu\u1ea5t hi\u1ec7n ca\u0301c xung \u0111i\u00ea\u0323n b\u00e2\u0301t th\u01b0\u01a1\u0300ng trong tim, l\u00e0m tim co b\u00f3p kh\u00f4ng nhi\u0323p nha\u0300ng va\u0300 kh\u00f4ng hi\u00ea\u0323u qua\u0309. \u0110i\u1ec1u n\u00e0y d\u1eabn \u0111\u1ebfn \u1ee9 \u0111\u1ecdng ma\u0301u trong tim, gia t\u0103ng kha\u0309 n\u0103ng xu\u00e2\u0301t hi\u00ea\u0323n huy\u1ebft kh\u1ed1i, co\u0301 th\u00ea\u0309 g\u00e2y ra h\u00e2\u0323u qua\u0309 nghi\u00eam tro\u0323ng nh\u01b0 nh\u00f4\u0300i ma\u0301u c\u01a1 tim hay \u0111\u00f4\u0323t quy\u0323. Rung nhi\u0303 co\u0301 th\u00ea\u0309 \u0111\u01b0\u01a1\u0323c ki\u00ea\u0309m soa\u0301t b\u0103\u0300ng ca\u0301c thu\u1ed1c \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn nh\u1ecbp ho\u1eb7c nh\u1ecbp \u0111i\u1ec7u c\u1ee7a tim. Digoxin c\u00f3 hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb rung nhi\u0303 do t\u00e1c d\u1ee5ng ki\u00ea\u0309m soa\u0301t nhi\u0323p tim.<\/p>\n M\u00f4\u0323t nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng b\u1eaft che\u0301o, mu\u0300 \u0111\u00f4i va\u0300 ng\u00e2\u0303u nhi\u00ean \u0111a trung t\u00e2m \u0111a\u0301nh gia\u0301 hi\u00ea\u0323u qua\u0309 cu\u0309a vi\u00ea\u0323c s\u01b0\u0309 du\u0323ng digoxin so v\u01a1\u0301i gia\u0309 d\u01b0\u01a1\u0323c \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n tr\u00ean 43 b\u00ea\u0323nh nh\u00e2n rung nhi\u0303 ki\u0323ch pha\u0301t. B\u1ec7nh nh\u00e2n \u0111\u1ec1u \u226518 tu\u1ed5i, co\u0301 m\u00f4\u0323t ho\u0103\u0323c nhi\u00ea\u0300u \u0111\u01a1\u0323t rung nhi\u0303 t\u1ef1 ch\u1ea5m d\u1ee9t m\u00f4\u0303i tha\u0301ng. Ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 c\u1ee7a nghi\u00ean c\u01b0\u0301u la\u0300 th\u01a1\u0300i gian \u0111\u1ebfn khi xu\u00e2\u0301t hi\u00ea\u0323n m\u00f4\u0323t ho\u0103\u0323c hai \u0111\u01a1\u0323t rung nhi\u0303 \u0111\u01b0\u01a1\u0323c ghi la\u0323i b\u0103\u0300ng thi\u00ea\u0301t bi\u0323 gia\u0301m sa\u0301t \u0111i\u1ec7n tim tr\u00ean b\u00ea\u0323nh nh\u00e2n. Th\u01a1\u0300i gian trung bi\u0300nh gi\u1eefa hai \u0111\u01a1\u0323t rung nhi\u0303 la\u0300 13,5 nga\u0300y \u01a1\u0309 nho\u0301m du\u0300ng placebo va\u0300 18,7 nga\u0300y \u01a1\u0309 nho\u0301m du\u0300ng digoxin (p<0,05). Th\u01a1\u0300i gian trung bi\u0300nh cu\u0309a m\u00f4\u0323t \u0111\u01a1\u0323t rung nhi\u0303 la\u0300 3,5 nga\u0300y \u0111\u00f4\u0301i v\u01a1\u0301i nho\u0301m du\u0300ng gia\u0309 d\u01b0\u01a1\u0323c so v\u01a1\u0301i 5,4 nga\u0300y \u01a1\u0309 nho\u0301m du\u0300ng digoxin (p<0,05). Nhi\u0323p th\u00e2\u0301t trung bi\u0300nh trong m\u00f4\u0323t \u0111\u01a1\u0323t rung nhi\u0303 t\u01b0\u01a1ng \u01b0\u0301ng la\u0300 138\u00b132 nhi\u0323p\/phu\u0301t va\u0300 125\u00b135 nhi\u0323p\/phu\u0301t \u01a1\u0309 nho\u0301m du\u0300ng placebo va\u0300 nho\u0301m du\u0300ng digoxin (p<0,01). K\u1ebft qu\u1ea3 cho th\u1ea5y digoxin gi\u00fap gia\u0309m t\u00e2\u0300n su\u1ea5t xu\u00e2\u0301t hi\u00ea\u0323n ca\u0301c \u0111\u01a1\u0323t rung nhi\u0303 v\u1edbi m\u1ee9c \u0111\u1ed9 t\u01b0\u01a1ng \u0111\u1ed1i h\u1ea1n ch\u1ebf, ch\u1ee7 y\u1ebfu do gi\u1ea3m nhi\u0323p th\u00e2\u0301t h\u01a1n l\u00e0 t\u00e1c d\u1ee5ng ch\u00f4\u0301ng loa\u0323n nhi\u0323p.<\/p>\n M\u00f4\u0323t nghi\u00ean c\u01b0\u0301u thu\u1ea7n t\u00e2\u0323p h\u00f4\u0300i c\u01b0\u0301u th\u1ef1c hi\u1ec7n g\u1ea7n \u0111\u00e2y tr\u00ean 122465 b\u00ea\u0323nh nh\u00e2n m\u01a1\u0301i \u0111\u01b0\u01a1\u0323c ch\u00e2\u0309n \u0111oa\u0301n rung nhi\u0303 (\u0111\u00f4\u0323 tu\u00f4\u0309i trung bi\u0300nh la\u0300 72) cho th\u00e2\u0301y ty\u0309 l\u00ea\u0323 t\u01b0\u0309 vong ti\u0301ch lu\u0303y cao h\u01a1n trong nho\u0301m \u0111i\u00ea\u0300u tri\u0323 b\u0103\u0300ng digoxin so v\u01a1\u0301i nho\u0301m kh\u00f4ng \u0111\u01b0\u01a1\u0323c \u0111i\u00ea\u0300u tri\u0323 (p<0,001). S\u1eed d\u1ee5ng digoxin tr\u1edf th\u00e0nh y\u1ebfu t\u1ed1 \u0111\u1ed9c l\u1eadp \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn nguy c\u01a1 t\u1eed vong sau khi \u0111\u00e3 lo\u1ea1i b\u1ecf c\u00e1c y\u1ebfu t\u1ed1 nhi\u1ec5u kh\u00e1c nh\u01b0 tu\u00f4\u0309i, ch\u01b0\u0301c n\u0103ng th\u00e2\u0323n, tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb va\u0300 ti\u00ea\u0300n s\u01b0\u0309 m\u0103\u0301c ca\u0301c b\u00ea\u0323nh tim ma\u0323ch kha\u0301c. T\u00e1c \u0111\u1ed9ng b\u1ea5t l\u1ee3i tr\u00ean t\u1eed vong c\u1ee7a digoxin trong rung nhi\u0303 c\u00e2\u0300n \u0111\u01b0\u01a1\u0323c nghi\u00ean c\u01b0\u0301u th\u00eam.<\/p>\n Theo h\u01b0\u01a1\u0301ng d\u00e2\u0303n cu\u0309a ACCF\/AHA, k\u00ea\u0301t qua\u0309 l\u00e2m sa\u0300ng li\u00ean quan \u0111\u00ea\u0301n tri\u00ea\u0323u ch\u01b0\u0301ng la\u0300 t\u01b0\u01a1ng t\u01b0\u0323 nhau cho du\u0300 rung nhi\u0303 co\u0301 \u0111\u01b0\u01a1\u0323c ki\u00ea\u0309m soa\u0301t b\u1eb1ng nhi\u0323p ho\u1eb7c nhi\u0323p \u0111i\u00ea\u0323u hay kh\u00f4ng. M\u0103\u0323c du\u0300 hai c\u00e1ch ti\u1ebfp c\u1eadn n\u00e0y t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nhau trong vi\u00eac gi\u1ea3m nh\u1eb9 tri\u00ea\u0323u ch\u01b0\u0301ng, li\u00ea\u0323u pha\u0301p ki\u00ea\u0309m soa\u0301t nhi\u0323p \u0111i\u00ea\u0323u la\u0300m t\u0103ng s\u01b0\u0301c b\u00ea\u0300n v\u1edbi c\u00e1c test g\u1eafng s\u1ee9c. Digoxin la\u0300 m\u00f4\u0323t trong nh\u01b0\u0303ng thu\u00f4\u0301c \u0111\u01b0\u01a1\u0323c du\u0300ng \u0111\u00ea\u0309 ki\u00ea\u0309m soa\u0301t nhi\u0323p tim (\u0111\u01b0\u01a1\u0323c coi l\u00e0 ki\u00ea\u0309m soa\u0301t \u0111\u1ea1t y\u00eau c\u1ea7u khi \u0111a\u0301p \u01b0\u0301ng t\u00e2m th\u00e2\u0301t \u0111a\u0323t 60 \u0111\u00ea\u0301n 80 nhi\u0323p\/phu\u0301t lu\u0301c nghi\u0309 va\u0300 90 \u0111\u00ea\u0301n 115 nhi\u0323p\/phu\u0301t v\u1edbi c\u00e1c test g\u1eafng s\u1ee9c trung b\u00ecnh). Thu\u1ed1c \u0111\u00e2\u0300u tay trong ki\u00ea\u0309m so\u00e1t nhi\u0323p tim bao g\u00f4\u0300m diltiazem, verapamil, esmolol va\u0300 ca\u0301c thu\u00f4\u0301c che\u0323n beta kha\u0301c. So v\u01a1\u0301i digoxin, ca\u0301c thu\u00f4\u0301c na\u0300y \u0111\u01b0\u01a1\u0323c \u01b0u ti\u00ean khuy\u00ea\u0301n ca\u0301o s\u01b0\u0309 du\u0323ng h\u01a1n va\u0300 c\u00f3 b\u1eb1ng ch\u1ee9ng r\u00f5 r\u00e0ng h\u01a1n v\u1ec1 hi\u1ec7u qu\u1ea3. Digoxin kh\u00f4ng \u0111\u01b0\u01a1\u0323c coi la\u0300 thu\u1ed1c \u0111i\u00ea\u0300u tri\u0323 \u0111\u00e2\u0300u tay do ph\u1ea1m vi \u0111i\u00ea\u0300u tri\u0323 he\u0323p (y\u00eau c\u1ea7u theo do\u0303i ch\u0103\u0323t che\u0303) va\u0300 co\u0301 nhi\u00ea\u0300u t\u01b0\u01a1ng ta\u0301c thu\u00f4\u0301c. B\u00ea\u0323nh nh\u00e2n co\u0301 nguy c\u01a1 ng\u00f4\u0323 \u0111\u00f4\u0323c digoxin cao (suy th\u00e2\u0323n, ng\u01b0\u01a1\u0300i cao tu\u1ed5i, c\u00f3 nhi\u1ec1u t\u01b0\u01a1ng t\u00e1c v\u1edbi digoxin) c\u00e2\u0300n \u0111\u01b0\u01a1\u0323c theo do\u0303i th\u01b0\u01a1\u0300ng xuy\u00ean h\u01a1n so v\u01a1\u0301i ca\u0301c b\u00ea\u0323nh nh\u00e2n tre\u0309, kh\u00f4ng co\u0301 ca\u0301c b\u00ea\u0323nh m\u0103\u0301c ke\u0300m ho\u1eb7c kh\u00f4ng d\u00f9ng \u0111\u1ed3ng th\u1eddi nhi\u1ec1u thu\u1ed1c.<\/p>\n T\u0103ng a\u0301p \u0111\u00f4\u0323ng ma\u0323ch ph\u00f4\u0309i la\u0300 b\u00ea\u0323nh l\u00fd ti\u00ea\u0301n tri\u00ea\u0309n trong \u0111o\u0301 l\u01b0u l\u01b0\u01a1\u0323ng ma\u0301u qua \u0111\u00f4\u0323ng ma\u0323ch ph\u00f4\u0309i bi\u0323 ha\u0323n ch\u1ebf d\u00e2\u0303n \u0111\u00ea\u0301n t\u0103ng s\u1ee9c c\u1ea3n c\u1ee7a ma\u0323ch ph\u00f4\u0309i, h\u1eadu qu\u1ea3 cu\u00f4\u0301i cu\u0300ng la\u0300 g\u00e2y suy tim pha\u0309i. T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 a\u0301p l\u01b0\u0323c \u0111\u00f4\u0323ng ma\u0323ch ph\u00f4\u0309i >25 mmHg khi nghi\u0309 ho\u0103\u0323c >30 mmHg khi g\u1eafng s\u1ee9c. Hi\u1ec7n t\u1ea1i, ca\u0301c l\u01b0\u0323a cho\u0323n \u0111i\u00ea\u0300u tri\u0323 cho t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i bao g\u00f4\u0300m li\u00ea\u0323u pha\u0301p h\u00f4\u0303 tr\u01a1\u0323 va\u0300 ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c nh\u01b0 digoxin, l\u01a1\u0323i ti\u00ea\u0309u, warfarin va\u0300 che\u0323n k\u00eanh calci (CCB).<\/p>\n T\u0103ng a\u0301p \u0111\u1ed9ng m\u1ea1ch ph\u00f4\u0309i th\u01b0\u01a1\u0300ng li\u00ean quan \u0111\u00ea\u0301n hoa\u0323t ho\u0301a giao ca\u0309m, do v\u1eady digoxin co\u0301 th\u00ea\u0309 \u0111\u01b0\u01a1\u0323c s\u01b0\u0309 du\u0323ng do \u0111\u0103\u0323c ti\u0301nh h\u1ee7y giao ca\u0309m th\u1ea7n kinh c\u1ee7a thu\u1ed1c n\u00e0y. Ca\u0301c h\u01b0\u01a1\u0301ng d\u00e2\u0303n \u0111i\u00ea\u0300u tri\u0323 t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i hi\u00ea\u0323n t\u1ea1i \u0111\u00ea\u0300 c\u00e2\u0323p ng\u0103\u0301n go\u0323n \u0111\u00ea\u0301n vi\u00ea\u0323c s\u01b0\u0309 du\u0323ng digoxin do hi\u1ec7u qu\u1ea3 c\u1ee7a thu\u1ed1c tr\u00ean cung l\u01b0\u01a1\u0323ng tim va\u0300 n\u1ed3ng \u0111\u1ed9 noradrenalin l\u01b0u h\u00e0nh trong tu\u00e2\u0300n hoa\u0300n. Do \u0111o\u0301, vi\u1ec7c s\u01b0\u0309 du\u0323ng digoxin cho b\u00ea\u0323nh nh\u00e2n t\u0103ng a\u0301p \u0111\u00f4\u0323ng ma\u0323ch ph\u00f4\u0309i c\u1ea7n d\u01b0\u0323a tr\u00ean quy\u1ebft \u0111\u1ecbnh cu\u0309a ba\u0301c s\u0129 l\u00e2m sa\u0300ng. S\u01b0\u0309 du\u0323ng digoxin trong \u0111i\u00ea\u0300u tri\u0323 t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i ch\u01b0a \u0111\u01b0\u01a1\u0323c nghi\u00ean c\u1ee9u \u0111\u1ea7y \u0111\u1ee7 tr\u00ean l\u00e2m s\u00e0ng, \u0111\u1ed3ng th\u1eddi c\u01a1 ch\u00ea\u0301 t\u00e1c d\u1ee5ng v\u00e2\u0303n ch\u01b0a \u0111\u01b0\u01a1\u0323c s\u00e1ng t\u1ecf ho\u00e0n to\u00e0n. Cho \u0111\u1ebfn th\u1eddi \u0111i\u1ec3m hi\u1ec7n t\u1ea1i, ch\u01b0a m\u1ed9t nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng ti\u1ebfn c\u1ee9u ng\u1eabu nhi\u00ean n\u00e0o \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ec3 tr\u1ea3 l\u1eddi c\u00e2u h\u1ecfi n\u00e0y.<\/p>\n B\u00ea\u0323nh nh\u00e2n block nhi\u0303 th\u00e2\u0301t ho\u0103\u0323c block xoang kh\u00f4ng \u0111\u01b0\u01a1\u0323c d\u00f9ng digoxin khi ch\u01b0a \u0111\u1eb7t ma\u0301y ta\u0323o nhi\u0323p. C\u1ea7n th\u00e2\u0323n tro\u0323ng khi ph\u1ed1i h\u1ee3p digoxin v\u01a1\u0301i ca\u0301c thu\u00f4\u0301c co\u0301 kha\u0309 n\u0103ng la\u0300m gia\u0309m ch\u01b0\u0301c n\u0103ng pha\u0301t xung cu\u0309a nu\u0301t xoang ho\u0103\u0323c nu\u0301t nhi\u0303 th\u00e2\u0301t (nh\u01b0 che\u0323n beta, ch\u1eb9n calci kh\u00f4ng ph\u1ea3i nh\u00f3m dihydropyridin). Digoxin co\u0300n co\u0301 nhi\u00ea\u0300u t\u01b0\u01a1ng ta\u0301c thu\u00f4\u0301c kha\u0301c \u0111\u01b0\u01a1\u0323c li\u00ea\u0323t k\u00ea trong ba\u0309ng 2. B\u00e1c s\u0129 c\u00e2\u0300n n\u1eafm ch\u1eafc ca\u0301c t\u01b0\u01a1ng ta\u0301c na\u0300y, gia\u0301m sa\u0301t \u0111\u00f4\u0323c ti\u0301nh digoxin, th\u01b0\u01a1\u0300ng xuy\u00ean theo d\u00f5i n\u1ed3ng \u0111\u1ed9 thu\u1ed1c trong m\u00e1u trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<\/p>\n N\u00ea\u0301u s\u01b0\u0309 du\u0323ng v\u1edbi s\u1ef1 gi\u00e1m s\u00e1t ch\u1eb7t ch\u1ebd v\u1ec1 li\u00ea\u0300u l\u01b0\u01a1\u0323ng va\u0300 ca\u0301c y\u00ea\u0301u t\u00f4\u0301 co\u0301 th\u00ea\u0309 la\u0300m thay \u0111\u00f4\u0309i chuy\u00ea\u0309n ho\u0301a thu\u00f4\u0301c, digoxin \u0111\u01b0\u01a1\u0323c dung na\u0323p t\u00f4\u0301t \u01a1\u0309 b\u00ea\u0323nh nh\u00e2n suy tim. Ca\u0301c ta\u0301c du\u0323ng kh\u00f4ng mong mu\u00f4\u0301n xu\u00e2\u0301t hi\u00ea\u0323n chu\u0309 y\u00ea\u0301u khi digoxin \u0111\u01b0\u01a1\u0323c du\u0300ng v\u01a1\u0301i li\u00ea\u0300u cao, \u0111\u0103\u0323c bi\u00ea\u0323t \u01a1\u0309 b\u00ea\u0323nh nh\u00e2n cao tu\u00f4\u0309i, va\u0300 c\u00e2\u0300n l\u01b0u y\u0301 r\u0103\u0300ng s\u1eed d\u1ee5ng li\u1ec1u cao digoxin th\u01b0\u1eddng kh\u00f4ng \u0111em l\u1ea1i th\u00eam l\u1ee3i \u00edch l\u00e2m sa\u0300ng.<\/p>\n Ca\u0301c ta\u0301c du\u0323ng kh\u00f4ng mong mu\u00f4\u0301n chi\u0301nh cu\u0309a digoxin (ba\u0309ng 3) bao g\u00f4\u0300m loa\u0323n nhi\u0323p tim (m\u00e2\u0301t nhi\u0323p va\u0300 ng\u01b0\u0300ng tim), ca\u0301c tri\u00ea\u0323u ch\u01b0\u0301ng tr\u00ean ti\u00eau ho\u0301a (bu\u00f4\u0300n n\u00f4n, n\u00f4n, cha\u0301n \u0103n) va\u0300 ca\u0301c tri\u1ec7u ch\u1ee9ng th\u00e2\u0300n kinh (r\u00f4\u0301i loa\u0323n thi\u0323 gia\u0301c, m\u00e2\u0301t ph\u01b0\u01a1ng h\u01b0\u01a1\u0301ng, cho\u0301ng m\u0103\u0323t). M\u0103\u0323c du\u0300 ng\u00f4\u0323 \u0111\u00f4\u0323c digoxin th\u01b0\u1eddng xu\u00e2\u0301t hi\u00ea\u0323n khi n\u00f4\u0300ng \u0111\u00f4\u0323 trong huy\u00ea\u0301t thanh >2 ng\/mL, ti\u0300nh tra\u0323ng ng\u00f4\u0323 \u0111\u00f4\u0323c v\u00e2\u0303n co\u0301 th\u1ec3 x\u1ea3y ra \u1edf n\u00f4\u0300ng \u0111\u00f4\u0323 th\u00e2\u0301p h\u01a1n, \u0111\u0103\u0323c bi\u00ea\u0323t khi c\u00f3 r\u00f4\u0301i loa\u0323n \u0111i\u00ea\u0323n gia\u0309i nh\u01b0 x\u1ea3y ra \u0111\u00f4\u0300ng th\u01a1\u0300i ha\u0323 kali va\u0300 t\u0103ng magnesi m\u00e1u.<\/p>\n Do co\u0301 ph\u1ea1m vi \u0111i\u00ea\u0300u tri\u0323 he\u0323p, ng\u00f4\u0323 \u0111\u00f4\u0323c digoxin xa\u0309y ra kha\u0301 th\u01b0\u01a1\u0300ng xuy\u00ean. Ca\u0301c bi\u00ea\u0309u hi\u00ea\u0323n l\u00e2m sa\u0300ng cu\u0309a ng\u00f4\u0323 \u0111\u00f4\u0323c digoxin c\u00e2\u0301p bao g\u00f4\u0300m loa\u0323n nhi\u0323p, cha\u0301n \u0103n, cho\u0301ng m\u0103\u0323t va\u0300 t\u0103ng kali m\u00e1u. Ng\u00f4\u0323 \u0111\u00f4\u0323c digoxin ma\u0323n ti\u0301nh c\u00f3 bi\u00ea\u0309u hi\u00ea\u0323n t\u01b0\u01a1ng t\u1ef1, ngo\u00e0i ra co\u0301 th\u00eam bi\u00ea\u0309u hi\u00ea\u0323n qu\u00e2\u0300ng th\u00e2m m\u0103\u0301t, b\u1ea5t th\u01b0\u1eddng ph\u00e2n bi\u1ec7t ma\u0300u xanh – va\u0300ng, m\u1ea5t th\u1ecb l\u1ef1c, h\u00f4n m\u00ea (ba\u0309ng 3). Kha\u0301ng th\u00ea\u0309 \u0111\u1eb7c hi\u1ec7u cu\u0309a digoxin (DigiFab) \u0111\u01b0\u01a1c s\u01b0\u0309 du\u0323ng \u0111\u00ea\u0309 \u0111i\u00ea\u0300u tri\u0323 ng\u00f4\u0323 \u0111\u00f4\u0323c digoxin. DigiFab li\u00ean k\u00ea\u0301t v\u01a1\u0301i digoxin t\u01b0\u0323 do, ta\u0323o tha\u0300nh m\u00f4\u0323t ph\u01b0\u0301c h\u01a1\u0323p \u0111\u01b0\u01a1\u0323c tha\u0309i tr\u01b0\u0300 qua th\u1eadn, do \u0111\u00f3 la\u0300m gia\u0309m n\u00f4\u0300ng \u0111\u00f4\u0323 digoxin trong huy\u00ea\u0301t thanh.<\/p>\n Vi\u1ec7c s\u1eed d\u1ee5ng digoxin ng\u00e0y c\u00e0ng h\u1ea1n ch\u1ebf do ph\u1ea1m vi \u0111i\u00ea\u0300u tri\u0323 he\u0323p va\u0300 y\u00eau c\u1ea7u gia\u0301m sa\u0301t ch\u0103\u0323t che\u0303. Thu\u1ed1c co\u0301 th\u00ea\u0309 g\u00e2y ra nhi\u00ea\u0300u ta\u0301c du\u0323ng kh\u00f4ng mong mu\u1ed1n va\u0300 c\u00f3 nhi\u00ea\u0300u t\u01b0\u01a1ng ta\u0301c thu\u00f4\u0301c. M\u0103\u0323c du\u0300 v\u00e2\u0323y, digoxin v\u00e2\u0303n c\u00f2n c\u00f3 vai tr\u00f2 nh\u1ea5t \u0111\u1ecbnh trong \u0111i\u00ea\u0300u tri\u0323 suy tim, rung nhi\u0303 va\u0300 c\u00f2n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ngo\u00e0i ph\u1ea1m vi c\u1ea5p ph\u00e9p (off-label). Thu\u1ed1c \u0111\u01b0\u01a1\u0323c coi la\u0300 li\u00ea\u0323u pha\u0301p \u0111i\u00ea\u0300u tri\u0323 b\u00f4\u0309 sung h\u01a1n la\u0300 l\u1ef1a ch\u1ecdn \u0111\u00e2\u0300u tay cho b\u1ec7nh nh\u00e2n.<\/p>\n T\u00e1c gi\u1ea3:\u00a0D\u01b0\u01a1ng Th\u1ecb Thanh Mai, L\u01b0\u01a1ng Anh T\u00f9ng – Trung T\u00e2m C\u1ea3nh Gi\u00e1c D\u01b0\u1ee3c Qu\u1ed1c Gia.<\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" T\u00f3m t\u1eaft Digoxin l\u00e0 glycosid tim co\u0301 ta\u0301c du\u0323ng t\u0103ng s\u1ee9c co b\u00f3p c\u01a1 tim v\u00e0 thay \u0111\u1ed5i cung l\u01b0\u01a1\u0323ng tim, \u0111\u01b0\u1ee3c du\u0300ng \u0111\u00ea\u0309 \u0111i\u00ea\u0300u tri\u0323 suy tim, rung nhi\u0303 v\u00e0 m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p ngo\u00e0i ch\u1ec9 \u0111\u1ecbnh \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t. Thu\u1ed1c \u0111\u01b0\u1ee3c ch\u1ee9ng minh la\u0300m gia\u0309m ty\u0309 l\u00ea\u0323 nh\u00e2\u0323p vi\u00ea\u0323n nh\u01b0ng kh\u00f4ng l\u00e0m gi\u1ea3m […]\n","protected":false},"author":1,"featured_media":7724,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-7723","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\/7723","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=7723"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/7723\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/7724"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=7723"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=7723"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=7723"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}![\"digoxin\"](\"https:\/\/www.vnras.com\/drug\/wp-content\/uploads\/2019\/04\/digoxin_1.jpg\" "\\"\\"")
<\/p>\nDigoxin va\u0300 suy tim<\/h2>\n
Ty\u0309 l\u00ea\u0323 m\u0103\u0301c va\u0300 ty\u0309 l\u00ea\u0323 t\u01b0\u0309 vong cu\u0309a suy tim<\/h2>\n
Digoxin va\u0300 rung nhi\u0303<\/h2>\n
Digoxin va\u0300 t\u0103ng a\u0301p \u0111\u00f4\u0323ng ma\u0323ch ph\u00f4\u0309i<\/h2>\n
Ca\u0309nh ba\u0301o va\u0300 th\u00e2\u0323n tro\u0323ng<\/h2>\n
![\"\"](\"https:\/\/www.vnras.com\/drug\/wp-content\/uploads\/2019\/04\/digoxin_2.jpg\" "\\"\\"")
<\/p>\n![\"\"](\"https:\/\/www.vnras.com\/drug\/wp-content\/uploads\/2019\/04\/digoxin_3.jpg\" "\\"\\"")
<\/p>\n\u0110\u00f4\u0323c ti\u0301nh digoxin<\/h2>\n
K\u00ea\u0301t lu\u00e2\u0323n<\/h2>\n