{"id":6245,"date":"2024-04-23T10:51:01","date_gmt":"2024-04-23T03:51:01","guid":{"rendered":"https:\/\/jhasim1.com\/?p=6245"},"modified":"2024-07-24T23:58:24","modified_gmt":"2024-07-24T16:58:24","slug":"thuoc-dieu-tri-tang-nhan-ap-nhung-dieu-can-biet","status":"publish","type":"post","link":"https:\/\/jhasim1.com\/thuoc-dieu-tri-tang-nhan-ap-nhung-dieu-can-biet.html","title":{"rendered":"Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng nh\u00e3n \u00e1p – Nh\u1eefng \u0111i\u1ec1u c\u1ea7n bi\u1ebft!"},"content":{"rendered":"

T\u0103ng nh\u00e3n \u00e1p l\u00e0 g\u00ec?<\/strong><\/h1>\n

T\u0103ng nh\u00e3n \u00e1p (TNA) l\u00e0 t\u00ean g\u1ecdi kh\u00e1c c\u1ee7a b\u1ec7nh c\u01b0\u1eddm n\u01b0\u1edbc, glocom hay thi\u00ean \u0111\u1ea7u th\u1ed1ng l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh v\u1ec1 m\u1eaft nguy hi\u1ec3m x\u1ea3y ra do s\u1ef1 t\u00edch t\u1ee5 c\u1ee7a th\u1ee7y d\u1ecbch trong m\u1eaft, l\u00e0m t\u0103ng \u00e1p su\u1ea5t trong nh\u00e3n c\u1ea7u qu\u00e1 m\u1ee9c. B\u1ec7nh t\u0103ng nh\u00e3n \u00e1p n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi s\u1ebd g\u00e2y t\u1ed5n th\u01b0\u01a1ng d\u00e2y th\u1ea7n kinh th\u1ecb gi\u00e1c \u1edf \u0111\u00e1y m\u1eaft, khi\u1ebfn th\u1ecb l\u1ef1c gi\u1ea3m s\u00fat nhanh ch\u00f3ng, th\u1eadm ch\u00ed m\u00f9 l\u00f2a v\u0129nh vi\u1ec5n.<\/strong><\/p>\n

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Trong giai \u0111o\u1ea1n \u0111\u1ea7u, tri\u1ec7u ch\u1ee9ng TNA th\u01b0\u1eddng kh\u00f4ng r\u00f5 r\u1ec7t khi\u1ebfn nhi\u1ec1u ng\u01b0\u1eddi kh\u00f4ng bi\u1ebft l\u00e0 m\u00ecnh m\u1eafc b\u1ec7nh. B\u1ec7nh ti\u1ebfn tri\u1ec3n \u00e2m th\u1ea7m v\u00e0 n\u1eb7ng d\u1ea7n theo th\u1eddi gian, \u0111\u1ebfn khi ph\u00e1t hi\u1ec7n th\u00ec th\u1ecb l\u1ef1c \u0111\u00e3 gi\u1ea3m \u0111i nhi\u1ec1u k\u00e8m theo nh\u1eefng bi\u1ec3u hi\u1ec7n \u0111i\u1ec3n h\u00ecnh nh\u01b0: Nh\u00ecn m\u1edd, nh\u00ecn th\u1ea5y qu\u1ea7ng s\u00e1ng ho\u1eb7c h\u00e0o quang t\u1ecfa tr\u00f2n nh\u01b0 c\u1ea7u v\u1ed3ng khi nh\u00ecn v\u00e0o b\u00f3ng \u0111\u00e8n; \u0111au nh\u1ee9c trong h\u1ed1c m\u1eaft, \u0111au \u0111\u1ea7u; m\u1eaft s\u01b0ng v\u00e0 \u0111\u1ecf; c\u1ea3m gi\u00e1c m\u1eaft c\u0103ng c\u1ee9ng nh\u01b0 h\u00f2n bi khi s\u1edd v\u00e0o. Ng\u01b0\u1eddi b\u1ecb TNA c\u0169ng c\u00f3 tri\u1ec7u ch\u1ee9ng bu\u1ed3n n\u00f4n, n\u00f4n; nh\u1ea1y c\u1ea3m h\u01a1n v\u1edbi \u00e1nh s\u00e1ng v\u00e0 \u00e2m thanh m\u1ea1nh.<\/p>\n

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Nguy\u00ean nh\u00e2n ch\u00ednh g\u00e2y TNA l\u00e0 do k\u00eanh tho\u00e1t th\u1ee7y d\u1ecbch c\u1ee7a m\u1eaft b\u1ecb t\u1eafc ngh\u1ebdn ho\u1eb7c c\u0169ng c\u00f3 th\u1ec3 do m\u1eaft s\u1ea3n xu\u1ea5t d\u01b0 th\u1eeba th\u1ee7y d\u1ecbch. M\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 nguy c\u01a1 l\u00e0m kh\u1edfi ph\u00e1t v\u00e0 th\u00fac \u0111\u1ea9y b\u1ec7nh ti\u1ebfn tri\u1ec3n nh\u01b0 tu\u1ed5i cao ho\u1eb7c di truy\u1ec1n. Nguy c\u01a1 m\u1eafc b\u1ec7nh cao h\u01a1n \u1edf nh\u1eefng ng\u01b0\u1eddi t\u1eeb 60 tu\u1ed5i tr\u1edf l\u00ean v\u00e0\/ho\u1eb7c ti\u1ec1n s\u1eed trong gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi th\u00e2n b\u1ecb TNA. Nh\u1eefng ng\u01b0\u1eddi m\u1eafc b\u1ec7nh m\u1ea1n t\u00ednh nh\u01b0 huy\u1ebft \u00e1p cao, ti\u1ec3u \u0111\u01b0\u1eddng, b\u1ec7nh tim m\u1ea1ch\u2026nguy c\u01a1 m\u1eafc b\u1ec7nh TNA kh\u00e1 cao. Vi\u1ec7c l\u1ea1m d\u1ee5ng k\u00e9o d\u00e0i thu\u1ed1c Corticoid c\u0169ng g\u00e2y TNA\u2026<\/p>\n

T\u00f9y v\u00e0o bi\u1ec3u hi\u1ec7n, m\u1ee9c \u0111\u1ed9 b\u1ec7nh, TNA \u0111\u01b0\u1ee3c chia th\u00e0nh nh\u1eefng lo\u1ea1i sau:<\/strong><\/em><\/h2>\n

TNA g\u00f3c m\u1edf: L\u00e0 d\u1ea1ng ph\u1ed5 bi\u1ebfn nh\u1ea5t x\u1ea3y ra khi g\u00f3c tho\u00e1t th\u1ee7y d\u1ecbch v\u1eabn m\u1edf nh\u01b0ng k\u00eanh tho\u00e1t th\u1ee7y d\u1ecbch b\u1ecb t\u1eafc khi\u1ebfn th\u1ee7y d\u1ecbch tho\u00e1t ch\u1eadm. B\u1ec7nh ti\u1ebfn tri\u1ec3n t\u1eeb t\u1eeb v\u00e0 \u00edt bi\u1ec3u hi\u1ec7n \u1edf th\u1eddi gian \u0111\u1ea7u.<\/p>\n

TNA g\u00f3c \u0111\u00f3ng: L\u00e0 d\u1ea1ng b\u1ec7nh c\u1ea5p t\u00ednh, \u00edt g\u1eb7p h\u01a1n v\u00e0 nguy hi\u1ec3m h\u01a1n glocom g\u00f3c m\u1edf do g\u00f3c tho\u00e1t th\u1ee7y d\u1ecbch b\u1ecb t\u1eafc ho\u00e0n to\u00e0n, nh\u00e3n \u00e1p t\u0103ng nhanh v\u00e0 xu\u1ea5t hi\u1ec7n tri\u1ec7u ch\u1ee9ng r\u1ea7m r\u1ed9, nguy c\u01a1 m\u1ea5t th\u1ecb l\u1ef1c cao n\u1ebfu kh\u00f4ng x\u1eed tr\u00ed k\u1ecbp th\u1eddi.<\/p>\n

TNA s\u1eafc t\u1ed1: B\u1ec7nh th\u01b0\u1eddng g\u1eb7p \u1edf tr\u1ebb em v\u00e0 ng\u01b0\u1eddi b\u1ecb c\u1eadn th\u1ecb do t\u1ebf b\u00e0o \u1edf m\u1ed1ng m\u1eaft b\u1ecb v\u1ee1 khi\u1ebfn c\u00e1c h\u1ea1t s\u1eafc t\u1ed1 t\u00edch t\u1ee5 trong k\u00eanh th\u1ee7y d\u1ecbch v\u00e0 g\u00e2y t\u1eafc ngh\u1ebdn.<\/p>\n

TNA b\u1ea9m sinh: Do b\u1ea5t th\u01b0\u1eddng trong qu\u00e1 tr\u00ecnh ph\u00e1t tri\u1ec3n c\u1ea5u tr\u00fac m\u1eaft khi c\u00f2n trong b\u00e0o thai.<\/p>\n

TNA th\u1ee9 ph\u00e1t: B\u1ec7nh ti\u1ebfn tri\u1ec3n sau khi m\u1eafc m\u1ed9t s\u1ed1 b\u1ec7nh m\u1eaft nh\u01b0 vi\u00eam m\u00e0ng b\u1ed3 \u0111\u00e0o, ti\u1ec3u \u0111\u01b0\u1eddng, ph\u1eabu thu\u1eadt m\u1eaft\u2026<\/p>\n

Hi\u1ec7n nay, b\u1ec7nh TNA \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n th\u00f4ng qua vi\u1ec7c \u0111o nh\u00e3n \u00e1p, \u0111o \u0111\u1ed9 d\u00e0y c\u1ee7a gi\u00e1c m\u1ea1c; ki\u1ec3m tra g\u00f3c tho\u00e1t th\u1ee7y d\u1ecbch c\u1ee7a m\u1eaft. Soi \u0111\u00e1y m\u1eaft \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng d\u00e2y th\u1ea7n kinh th\u1ecb gi\u00e1c ho\u1eb7c ki\u1ec3m tra tr\u01b0\u1eddng th\u1ecb gi\u00e1c t\u1ea1i c\u00e1c c\u01a1 s\u1edf y t\u1ebf chuy\u00ean khoa m\u1eaft \u0111\u1ec3 ph\u00e1t hi\u1ec7n s\u1edbm TNA v\u00e0 c\u00f3 h\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi.<\/p>\n

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Tr\u00ean th\u1ecb tr\u01b0\u1eddng c\u00f3 r\u1ea5t nhi\u1ec1u lo\u1ea1i thu\u1ed1c \u0111i\u1ec1u tr\u1ecb TNA m\u00e0 c\u00e1c b\u00e1c s\u0129 chuy\u00ean khoa m\u1eaft khuy\u00ean d\u00f9ng cho ng\u01b0\u1eddi b\u1ecb b\u1ec7nh. M\u1ed9t s\u1ed1 thu\u1ed1c tra m\u1eaft \u0111ang d\u00f9ng \u0111i\u1ec1u tr\u1ecb TNA hi\u1ec7n nay:<\/strong><\/h3>\n

C\u00e1c ch\u1ea5t t\u01b0\u01a1ng t\u1ef1 Prostaglandin c\u00f3 t\u00e1c d\u1ee5ng t\u0103ng tho\u00e1t th\u1ee7y d\u1ecbch qua m\u00e0ng b\u1ed3 \u0111\u00e0o c\u1ee7ng m\u1ea1c thay v\u00ec thay \u0111\u1ed5i \u0111\u01b0\u1eddng tho\u00e1t th\u00f4ng th\u01b0\u1eddng qua b\u00e8 c\u1ee7ng gi\u00e1c m\u1ea1c nh\u01b0 Bimatoprost, Latanoprost, Tafluprost, Travoprost\u2026<\/p>\n

Thu\u1ed1c ch\u1eb9n beta c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3m s\u1ea3n xu\u1ea5t th\u1ee7y d\u1ecbch nh\u01b0ng kh\u00f4ng \u1ea3nh h\u01b0\u1edfng t\u1edbi k\u00edch th\u01b0\u1edbc \u0111\u1ed3ng t\u1eed nh\u01b0: Timolol, Betaxolol, Carteolol, Levobetaxolol, Levobunolol, Metipranolol\u2026 T\u00e1c d\u1ee5ng ph\u1ee5 thu\u1ed1c ch\u1eb9n beta g\u00e2y ra tri\u1ec7u ch\u1ee9ng huy\u1ebft \u00e1p th\u1ea5p, kh\u00f3 th\u1edf, l\u00e0m nh\u1ecbp tim ch\u1eadm h\u01a1n so v\u1edbi b\u00ecnh th\u01b0\u1eddng, gi\u1ea3m ham mu\u1ed1n v\u1ec1 t\u00ecnh d\u1ee5c, ng\u01b0\u1eddi b\u1ec7nh s\u1ebd th\u1ea5y phi\u1ec1n mu\u1ed9n v\u00e0 m\u1ec7t m\u1ecfi h\u01a1n. B\u1ec7nh nh\u00e2n n\u00ean nh\u1eafm m\u1eaft sau khi nh\u1ecf thu\u1ed1c th\u00ec s\u1ebd gi\u1ea3m thi\u1ec3u \u0111\u01b0\u1ee3c c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5.<\/p>\n

Ch\u1ea5t \u01b0c ch\u1ebf Anhydrase cacbonic c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3m s\u1ea3n xu\u1ea5t th\u1ec3 d\u1ecbch nh\u01b0 Brinzolamide, Dorzolamide. C\u00e1c thu\u1ed1c n\u00e0y c\u00f3 t\u00e1c d\u1ee5ng t\u1ed1t, song \u0111\u00f4i khi g\u00e2y m\u1eaft nh\u00ecn m\u1edd, \u0111au nh\u00f3i v\u00e0 cay m\u1eaft, v\u1ecb \u0111\u1eafng. H\u1ed7n d\u1ecbch nh\u1ecf m\u1eaft Brinzolamid 1% \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh nh\u01b0 m\u1ed9t li\u1ec7u ph\u00e1p \u0111\u01a1n tr\u1ecb li\u1ec7u \u0111\u1ec3 l\u00e0m gi\u1ea3m TNA tr\u00ean b\u1ec7nh nh\u00e2n l\u00e0 ng\u01b0\u1eddi l\u1edbn b\u1ecb TNA ho\u1eb7c gl\u00f4c\u00f4m g\u00f3c m\u1edf kh\u00f4ng \u0111\u00e1p \u1ee9ng ho\u1eb7c c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi c\u00e1c thu\u1ed1c \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 beta, ho\u1eb7c \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 c\u00e1c thu\u1ed1c d\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 beta hay nh\u00f3m thu\u1ed1c t\u01b0\u01a1ng t\u1ef1 Prosgaglandin.<\/p>\n

Ch\u1ea5t \u1ee9c ch\u1ebf Rho kinase l\u00e0m t\u0103ng l\u01b0u l\u01b0\u1ee3ng n\u01b0\u1edbc th\u00f4ng th\u01b0\u1eddng nh\u01b0 Netarsudil.<\/p>\n

C\u00e1c ch\u1ea5t ch\u1ee7 v\u1eadn Cholinergic c\u00f3 t\u00e1c d\u1ee5ng co \u0111\u1ed3ng t\u1eed, t\u0103ng tho\u00e1t th\u1ee7y d\u1ecbch, t\u00e1c \u0111\u1ed9ng tr\u1ef1c ti\u1ebfp nh\u01b0 Carbachol, Pilocarpine; t\u00e1c d\u1ee5ng gi\u00e1n ti\u1ebfp nh\u01b0 Echothiophate iod.<\/p>\n

Ch\u1ea5t ch\u1ee7 v\u1eadn Adrenergic ch\u1ecdn l\u1ecdc alpha-2 c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3m s\u1ea3n xu\u1ea5t th\u1ee7y d\u1ecbch; c\u00f3 th\u1ec3 t\u0103ng tho\u00e1t th\u1ee7y d\u1ecbch qua m\u00e0ng b\u1ed3 \u0111\u00e0o c\u1ee7ng m\u1ea1c; c\u00f3 th\u1ec3 g\u00e2y gi\u00e3n \u0111\u1ed3ng t\u1eed hay d\u00f9ng nh\u01b0: Apraclonidine, Brimonidine, Apraclonidine\u2026 Nh\u00f3m n\u00e0y c\u00f3 th\u1ec3 g\u00e2y ra m\u1ed9t s\u1ed1 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n nh\u01b0 m\u1eaft b\u1ecb ng\u1ee9a, huy\u1ebft \u00e1p t\u0103ng cao, \u0111au \u0111\u1ea7u, m\u1ec7t m\u1ecfi, nh\u1ecbp tim kh\u00f4ng \u0111\u1ec1u, kh\u00f4 mi\u1ec7ng, bu\u1ed3n ng\u1ee7.<\/p>\n

Epinephrine c\u0169ng \u0111\u01b0\u1ee3c d\u00f9ng ch\u1eefa b\u1ec7nh TNA \u1edf m\u1eaft. T\u00e1c d\u1ee5ng c\u1ee7a lo\u1ea1i thu\u1ed1c n\u00e0y v\u1eeba l\u00e0m t\u0103ng t\u1ed1c \u0111\u1ed9 tho\u00e1t ch\u1ea5t l\u1ecfng ra b\u00ean ngo\u00e0i, v\u1eeba l\u00e0m gi\u1ea3m t\u1ed1c \u0111\u1ed9 ti\u1ebft ch\u1ea5t l\u1ecfng c\u1ee7a m\u1eaft. Tuy nhi\u00ean, khi s\u1eed d\u1ee5ng thu\u1ed1c n\u00e0y \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh TNA \u1edf m\u1eaft, c\u1ea7n c\u00f3 s\u1ef1 ch\u1ec9 \u0111\u1ecbnh v\u00e0 t\u01b0 v\u1ea5n t\u1eeb b\u00e1c s\u0129. S\u1eed d\u1ee5ng lo\u1ea1i thu\u1ed1c n\u00e0y, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 g\u1eb7p c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 nh\u01b0 t\u1eafc \u1ed1ng n\u01b0\u1edbc m\u1eaft, nh\u1ecbp tim nhanh h\u01a1n b\u00ecnh th\u01b0\u1eddng, g\u00e2y hi\u1ec7n t\u01b0\u1ee3ng m\u00e0ng k\u1ebft.<\/p>\n

Ngo\u00e0i c\u00e1c thu\u1ed1c tra m\u1eaft n\u00f3i tr\u00ean, trong l\u00e2m s\u00e0ng c\u00f2n d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf men Anhydrase cacbonic d\u1ea1ng u\u1ed1ng ho\u1eb7c d\u00f9ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3m s\u1ea3n xu\u1ea5t th\u1ec3 d\u1ecbch nh\u01b0 Acetazolamide, Methazolamide.<\/p>\n

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Ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c nh\u1ecf m\u1eaft ch\u1ee9a ch\u1ea5t g\u00e2y TNA- Corticoid trong th\u00e0nh ph\u1ea7n s\u1ea3n xu\u1ea5t. Hi\u1ec7n nay, tr\u00ean th\u1ecb tr\u01b0\u1eddng c\u00f3 c\u00e1c lo\u1ea1i thu\u1ed1c nh\u1ecf m\u1eaft ch\u1ee9a th\u00e0nh ph\u1ea7n Corticoid \u0111\u01b0\u1ee3c thay th\u1ebf b\u1eb1ng t\u00ean kh\u00e1c l\u00e0: Polydexa, neodex, polydecaron, dexacol\u2026 Corticoid l\u00e0 m\u1ed9t ch\u1ea5t kh\u00e1ng vi\u00eam m\u1ea1nh, n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nhi\u1ec1u trong c\u00e1c lo\u1ea1i thu\u1ed1c nh\u1ecf m\u1eaft. Tuy v\u1eady, n\u1ebfu ng\u01b0\u1eddi b\u1ecb TNA d\u00f9ng trong th\u1eddi gian d\u00e0i s\u1ebd g\u1eb7p c\u00e1c bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m cho gi\u00e1c m\u1ea1c.<\/p>\n

ThS.L\u00ea Qu\u1ed1c Th\u1ecbnh – Gi\u1ea3ng vi\u00ean Khoa D\u01b0\u1ee3c\u00a0\u00a0<\/strong><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

T\u0103ng nh\u00e3n \u00e1p l\u00e0 g\u00ec? T\u0103ng nh\u00e3n \u00e1p (TNA) l\u00e0 t\u00ean g\u1ecdi kh\u00e1c c\u1ee7a b\u1ec7nh c\u01b0\u1eddm n\u01b0\u1edbc, glocom hay thi\u00ean \u0111\u1ea7u th\u1ed1ng l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh v\u1ec1 m\u1eaft nguy hi\u1ec3m x\u1ea3y ra do s\u1ef1 t\u00edch t\u1ee5 c\u1ee7a th\u1ee7y d\u1ecbch trong m\u1eaft, l\u00e0m t\u0103ng \u00e1p su\u1ea5t trong nh\u00e3n c\u1ea7u qu\u00e1 m\u1ee9c. 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