{"id":11170,"date":"2019-06-02T14:55:01","date_gmt":"2019-06-02T07:55:01","guid":{"rendered":"https:\/\/pharmog.com\/wp\/?p=11170"},"modified":"2025-01-08T23:23:51","modified_gmt":"2025-01-08T16:23:51","slug":"su-dung-hop-ly-an-toan-heparin-khong-phan-doan","status":"publish","type":"post","link":"https:\/\/pharmog.com\/wp\/su-dung-hop-ly-an-toan-heparin-khong-phan-doan\/","title":{"rendered":"S\u1eed d\u1ee5ng h\u1ee3p l\u00fd, an to\u00e0n heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n"},"content":{"rendered":"

Theo Canhgiacduoc<\/em><\/strong><\/p>\n

S\u1eec D\u1ee4NG H\u1ee2P L\u00dd, AN TO\u00c0N HEPARIN KH\u00d4NG PH\u00c2N \u0110O\u1ea0N<\/strong><\/p>\n

\u00a0Ho\u00e0ng H\u00e0 Ph\u01b0\u01a1ng, Tr\u1ea7n Thu Th\u1ee7y d\u1ecbch<\/em><\/p>\n

T\u00f3m t\u1eaft<\/strong><\/p>\n

Heparin l\u00e0 m\u1ed9t ch\u1ea5t mucopolysacarid sulfat t\u1ef1 nhi\u00ean, chi\u1ebft xu\u1ea5t t\u1eeb \u0111\u1ed9ng v\u1eadt. Kh\u1ed1i l\u01b0\u1ee3ng ph\u00e2n t\u1eed heparin dao \u0111\u1ed9ng trong kho\u1ea3ng 5000 \u0111\u1ebfn 30000 dalton. \u0110\u1ea1i ph\u00e2n t\u1eed n\u00e0y kh\u00f4ng h\u1ea5p thu qua \u0111\u01b0\u1eddng u\u1ed1ng, do \u0111\u00f3 c\u1ea7n s\u1eed d\u1ee5ng theo \u0111\u01b0\u1eddng ti\u00eam d\u01b0\u1edbi da ho\u1eb7c ti\u00eam t\u0129nh m\u1ea1ch. C\u00e1c heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb bi\u1ebfn ch\u1ee9ng huy\u1ebft kh\u1ed1i t\u1eafc m\u1ea1ch ho\u1eb7c trong c\u00e1c can thi\u1ec7p ph\u1eabu thu\u1eadt c\u00f3 nguy c\u01a1 huy\u1ebft kh\u1ed1i cao. Heparin kh\u00f4ng qua \u0111\u01b0\u1ee3c nhau thai n\u00ean c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng cho ph\u1ee5 n\u1eef c\u00f3 thai. Thu\u1ed1c c\u00f3 th\u1eddi gian b\u00e1n th\u1ea3i ng\u1eafn n\u00ean c\u1ea7n ti\u00eam thu\u1ed1c 2 \u0111\u1ebfn 3 l\u1ea7n\/ng\u00e0y. C\u1ea7n theo d\u00f5i ch\u1eb7t ch\u1ebd k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m \u0111\u00f4ng m\u00e1u \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o m\u1ee9c \u0111\u1ed9 ch\u1ed1ng \u0111\u00f4ng ph\u00f9 h\u1ee3p v\u00e0 k\u1ecbp th\u1eddi ph\u00e1t hi\u1ec7n c\u00e1c nguy c\u01a1 ch\u1ea3y m\u00e1u ho\u1eb7c gi\u1ea3m ti\u1ec3u c\u1ea7u.<\/p>\n

T\u1eeb kh\u00f3a:<\/p>\n

N\u1ed9i dung b\u00e0i<\/strong><\/p>\n

Heparin ti\u00eau chu\u1ea9n (hay c\u00f2n g\u1ecdi l\u00e0 heparin t\u1ef1 nhi\u00ean, heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n) l\u00e0 m\u1ed9t\u00a0 mucopolysacarid sulfat t\u1ef1 nhi\u00ean c\u00f3 kh\u1ed1i l\u01b0\u1ee3ng ph\u00e2n t\u1eed\u00a0 l\u1edbn (5000 \u0111\u1ebfn 30000 dalton). Ho\u1ea1t ch\u1ea5t glycosaminoglycan n\u00e0y \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh t\u1eeb c\u00e1c ph\u00e2n t\u1eed polyme kh\u00e1c nhau c\u00f3 c\u1ea5u t\u1ea1o ch\u00ednh l\u00e0 c\u00e1c \u0111\u01a1n v\u1ecb disacarid trisulfat: acid\u00a0L-iduronic-2-O-sulfat v\u00e0 D-glucosamin-N-sulfat, 6-O-sulfat.<\/p>\n

Heparin \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n t\u1eeb n\u0103m 1916 v\u00e0 \u0111\u1ebfn nay v\u1eabn c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong \u0111i\u1ec1u tr\u1ecb do c\u00f3 ho\u1ea1t t\u00ednh ch\u1ed1ng \u0111\u00f4ng m\u1ea1nh.\u00a0 Heparin tr\u00ean th\u1ecb tr\u01b0\u1eddng \u0111\u01b0\u1ee3c chi\u1ebft xu\u1ea5t v\u00e0 tinh ch\u1ebf t\u1eeb m\u00e0ng nh\u00e0y ru\u1ed9t l\u1ee3n ho\u1eb7c ph\u1ed5i c\u1ee7a b\u00f2, d\u01b0\u1edbi d\u1ea1ng mu\u1ed1i calci ho\u1eb7c natri\u00a0(b\u1ea3ng 1, l\u01b0u \u00fd 1)<\/em>.<\/p>\n

\"http:\/\/magazine.canhgiacduoc.org.vn\/Uploads\/Tinymce\/image001.jpg\"<\/p>\n

\"http:\/\/magazine.canhgiacduoc.org.vn\/Uploads\/Tinymce\/a1.png\"<\/p>\n

\"http:\/\/magazine.canhgiacduoc.org.vn\/Uploads\/Tinymce\/a2.png\"<\/p>\n

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C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng – T\u00ednh ch\u1ea5t d\u01b0\u1ee3c l\u00fd<\/strong><\/p>\n

Heparin l\u00e0 thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng ti\u00eam, t\u00e1c \u0111\u1ed9ng l\u00ean qu\u00e1 tr\u00ecnh \u0111\u00f4ng m\u00e1u v\u00e0 c\u1ea3n tr\u1edf s\u1ef1 h\u00ecnh th\u00e0nh c\u1ee5c m\u00e1u \u0111\u00f4ng. Heparin g\u1eafn v\u00e0o antithrombin (hay c\u00f2n g\u1ecdi l\u00e0 antithrombin III)\u00a0(b\u1ea3ng 1, l\u01b0u \u00fd 2)<\/em>, l\u00e0m t\u0103ng r\u00f5 r\u1ec7t kh\u1ea3 n\u0103ng \u1ee9c ch\u1ebf n\u1ed9i sinh c\u1ee7a antithrombin \u0111\u1ed1i v\u1edbi\u00a0 c\u00e1c y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c y\u1ebfu t\u1ed1 (IIa) (thrombin), (Xa) (y\u1ebfu t\u1ed1 Stuart) v\u00e0 (XIIa) (y\u1ebfu t\u1ed1 Hageman). Do v\u1eady, heparin c\u00f3 ho\u1ea1t t\u00ednh ch\u1ed1ng \u0111\u00f4ng t\u1ee9c th\u1eddi, m\u1ea1nh, kh\u00f4ng ch\u1ec9 ph\u1ee5 thu\u1ed9c v\u00e0o n\u1ed3ng \u0111\u1ed9 heparin m\u00e0 c\u00f2n ph\u1ee5 thu\u1ed9c v\u00e0o n\u1ed3ng \u0111\u1ed9 antithrombin v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u. C\u00e1c x\u00e9t nghi\u1ec7m heparin huy\u1ebft t\u01b0\u01a1ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111o ho\u1ea1t t\u00ednh c\u1ee7a heparin. N\u1ed3ng \u0111\u1ed9 n\u00e0y dao \u0111\u1ed9ng t\u00f9y thu\u1ed9c v\u00e0o d\u1ea1ng thu\u1ed1c, li\u1ec1u heparin s\u1eed d\u1ee5ng, li\u1ec1u n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c theo \u0111\u01a1n v\u1ecb qu\u1ed1c t\u1ebf (IU). Heparin c\u00f3 th\u1eddi gian b\u00e1n th\u1ea3i kh\u00e1 ng\u1eafn n\u00ean c\u1ea7n ph\u1ea3i ti\u00eam nhi\u1ec1u l\u1ea7n trong ng\u00e0y\u00a0(b\u1ea3ng 2)<\/em>.<\/p>\n

 <\/p>\n

Ch\u1ec9 \u0111\u1ecbnh<\/strong><\/p>\n

– \u0110i\u1ec1u tr\u1ecb huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u trong giai \u0111o\u1ea1n c\u1ea5p<\/em>\u00a0bao g\u1ed3m t\u1eafc m\u1ea1ch ph\u1ed5i, nh\u1ed3i m\u00e1u c\u01a1 tim c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 s\u00f3ng Q, \u0111au th\u1eaft ng\u1ef1c th\u1ec3 kh\u00f4ng \u1ed5n \u0111\u1ecbnh, t\u1eafc \u0111\u1ed9ng m\u1ea1ch ngo\u00e0i n\u00e3o v\u00e0 m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u.<\/p>\n

– D\u1ef1 ph\u00f2ng huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch v\u00e0\/ho\u1eb7c \u0111\u1ed9ng m\u1ea1ch<\/em>\u00a0trong ph\u1eabu thu\u1eadt\u00a0(l\u01b0u \u00fd 3)<\/em>, \u0111\u1ed1i v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n n\u1eb1m l\u00e2u ng\u00e0y sau b\u1ec7nh l\u00fd c\u1ea5p t\u00ednh (nh\u1ea5t l\u00e0 sau nh\u1ed3i m\u00e1u c\u01a1 tim, suy tim, sau tai bi\u1ebfn m\u1ea1ch m\u00e1u n\u00e3o do thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 k\u00e8m theo li\u1ec7t chi d\u01b0\u1edbi \u1edf b\u1ec7nh nh\u00e2n suy th\u1eadn n\u1eb7ng).<\/p>\n

– D\u1ef1 ph\u00f2ng \u0111\u00f4ng m\u00e1u<\/em>\u00a0trong l\u1ecdc m\u00e1u ngo\u00e0i th\u1eadn ho\u1eb7c c\u00e1c tr\u01b0\u1eddng h\u1ee3p l\u1ecdc m\u00e1u ngo\u00e0i c\u01a1 th\u1ec3\u00a0(l\u01b0u \u00fd 3)<\/em>.<\/p>\n

 <\/p>\n

Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/strong><\/p>\n

Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tuy\u1ec7t \u0111\u1ed1i:<\/em><\/strong><\/p>\n

– V\u1edbi t\u1ea5t c\u1ea3 c\u00e1c ch\u1ebf \u0111\u1ed9 li\u1ec1u (bao g\u1ed3m c\u1ea3 \u0111i\u1ec1u tr\u1ecb v\u00e0 d\u1ef1 ph\u00f2ng) :<\/p>\n

+ B\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed gi\u1ea3m ti\u1ec3u c\u1ea7u n\u1eb7ng typ II (gi\u1ea3m ti\u1ec3u c\u1ea7u g\u00e2y ra do heparin) khi s\u1eed d\u1ee5ng heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n ho\u1eb7c heparin kh\u1ed1i l\u01b0\u1ee3ng ph\u00e2n t\u1eed\u00a0 th\u1ea5p.<\/p>\n

+ B\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd ch\u1ea3y m\u00e1u b\u1ea9m sinh.<\/p>\n

– V\u1edbi li\u1ec1u \u0111i\u1ec1u tr\u1ecb :<\/p>\n

+ B\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan d\u1ec5 b\u1ecb ch\u1ea3y m\u00e1u.<\/p>\n

+ B\u1ec7nh nh\u00e2n c\u00f3 t\u00ecnh tr\u1ea1ng ch\u1ea3y m\u00e1u ho\u1eb7c nguy c\u01a1 ch\u1ea3y m\u00e1u li\u00ean quan \u0111\u1ebfn r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng.<\/p>\n

+ B\u1ec7nh nh\u00e2n b\u1ecb ch\u1ea3y m\u00e1u n\u1ed9i s\u1ecd.<\/p>\n

Ngo\u00e0i ra, kh\u00f4ng bao gi\u1edd \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n g\u00e2y t\u00ea ngo\u00e0i m\u00e0ng c\u1ee9ng ho\u1eb7c g\u00e2y t\u00ea t\u1ee7y s\u1ed1ng trong l\u00fac \u0111ang s\u1eed d\u1ee5ng ph\u00e1c \u0111\u1ed3 heparin \u1edf li\u1ec1u \u0111i\u1ec1u tr\u1ecb.<\/p>\n

Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh t\u01b0\u01a1ng \u0111\u1ed1i:<\/em><\/strong><\/p>\n

– V\u1edbi li\u1ec1u \u0111i\u1ec1u tr\u1ecb:<\/p>\n

+ B\u1ec7nh nh\u00e2n b\u1ecb tai bi\u1ebfn m\u1ea1ch n\u00e3o do thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 ti\u1ebfn tri\u1ec3n \u1edf giai \u0111o\u1ea1n c\u1ea5p, c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c (v\u1edbi tai bi\u1ebfn m\u1ea1ch n\u00e3o do t\u1eafc m\u1ea1ch, th\u1eddi gian ch\u1edd l\u00e0 72 gi\u1edd).<\/p>\n

+ B\u1ec7nh nh\u00e2n c\u00f3 vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c c\u1ea5p (tr\u1eeb tr\u01b0\u1eddng h\u1ee3p s\u1eed d\u1ee5ng c\u00e1c thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3)<\/p>\n

+ B\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p ch\u01b0a \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t.<\/p>\n

– V\u1edbi li\u1ec1u d\u1ef1 ph\u00f2ng: trong 24 gi\u1edd \u0111\u1ea7u sau khi ch\u1ea3y m\u00e1u n\u1ed9i s\u1ecd.<\/p>\n

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Ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 cho con b\u00fa<\/strong><\/p>\n

– Ph\u1ee5 n\u1eef c\u00f3 thai:<\/em>\u00a0heparin kh\u00f4ng qua \u0111\u01b0\u1ee3c nhau thai. Ch\u01b0a c\u00f3 b\u00e1o c\u00e1o v\u1ec1 \u0111\u1ed9c t\u00ednh \u0111\u1ed1i v\u1edbi b\u00e0o thai hay d\u1ecb t\u1eadt li\u00ean quan \u0111\u1ebfn heparin tr\u00ean \u0111\u1ed9ng v\u1eadt c\u0169ng nh\u01b0 tr\u00ean ng\u01b0\u1eddi. Tuy nhi\u00ean, khi s\u1eed d\u1ee5ng cho ph\u1ee5 n\u1eef c\u00f3 thai, c\u1ea7n h\u1ebft s\u1ee9c th\u1eadn tr\u1ecdng do nguy c\u01a1 ch\u1ea3y m\u00e1u nhau thai v\u00e0 t\u1eed cung, \u0111\u1eb7c bi\u1ec7t v\u00e0o th\u1eddi \u0111i\u1ec3m chuy\u1ec3n d\u1ea1. Do \u0111\u00f3, khi c\u00f3 d\u1ef1 \u0111\u1ecbnh g\u00e2y t\u00ea ngo\u00e0i m\u00e0ng c\u1ee9ng, ph\u1ea3i ng\u1eebng s\u1eed d\u1ee5ng heparin.<\/p>\n

– Ph\u1ee5 n\u1eef \u0111ang cho con b\u00fa:<\/em>\u00a0heparin kh\u00f4ng b\u00e0i xu\u1ea5t v\u00e0o s\u1eefa m\u1eb9 v\u00e0 c\u0169ng kh\u00f4ng h\u1ea5p thu qua \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, n\u00ean c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng cho ph\u1ee5 n\u1eef \u0111ang cho con b\u00fa.<\/p>\n

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T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n<\/strong><\/p>\n

– Ch\u1ea3y m\u00e1u:<\/em>\u00a0c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 nh\u01b0 c\u00f3 t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan d\u1ec5 ch\u1ea3y m\u00e1u, suy th\u1eadn ho\u1eb7c m\u1ed9t s\u1ed1 b\u1ec7nh k\u1ebft h\u1ee3p c\u00f3 th\u1ec3 l\u00e0m n\u1eb7ng th\u00eam t\u00ecnh tr\u1ea1ng ch\u1ea3y m\u00e1u. \u0110\u00e2y l\u00e0 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n th\u01b0\u1eddng g\u1eb7p khi s\u1eed d\u1ee5ng heparin.<\/p>\n

– Gi\u1ea3m ti\u1ec3u c\u1ea7u\u00a0<\/em>(th\u01b0\u1eddng g\u1eb7p):<\/p>\n

+ Gi\u1ea3m ti\u1ec3u c\u1ea7u typ 1 do h\u00ecnh th\u00e0nh \u0111\u00e1m k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u: l\u00e0 d\u1ea1ng gi\u1ea3m ti\u1ec3u c\u1ea7u ph\u1ed5 bi\u1ebfn nh\u1ea5t, th\u01b0\u1eddng \u1edf m\u1ee9c trung b\u00ecnh (>100000 ti\u1ec3u c\u1ea7u\/mm3), xu\u1ea5t hi\u1ec7n s\u1edbm (tr\u01b0\u1edbc ng\u00e0y \u0111i\u1ec1u tr\u1ecb th\u1ee9 5) v\u00e0 kh\u00f4ng c\u1ea7n ph\u1ea3i ng\u1eebng heparin do tri\u1ec7u ch\u1ee9ng ch\u1ec9 tho\u00e1ng qua.<\/p>\n

+ Gi\u1ea3m ti\u1ec3u c\u1ea7u nghi\u00eam tr\u1ecdng typ 2 (gi\u1ea3m ti\u1ec3u c\u1ea7u do heparin): theo c\u01a1 ch\u1ebf mi\u1ec5n d\u1ecbch, hi\u1ebfm g\u1eb7p h\u01a1n. Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y c\u1ea7n ng\u1eebng s\u1eed d\u1ee5ng heparin.<\/p>\n

– T\u1ee5 m\u00e1u:<\/em>\u00a0c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf v\u1ecb tr\u00ed ti\u00eam, th\u01b0\u1eddng khi ti\u00eam d\u01b0\u1edbi da, h\u1ea7u h\u1ebft do kh\u00f4ng tu\u00e2n th\u1ee7 \u0111\u00fang k\u1ef9 thu\u1eadt ti\u00eam ho\u1eb7c s\u1eed d\u1ee5ng d\u1ee5ng c\u1ee5 ti\u00eam kh\u00f4ng ph\u00f9 h\u1ee3p.<\/p>\n

– Lo\u00e3ng x\u01b0\u01a1ng:<\/em>\u00a0c\u00f3 th\u1ec3 x\u1ea3y ra khi \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec1u cao trong th\u1eddi gian d\u00e0i.<\/p>\n

– T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n kh\u00e1c:<\/em>\u00a0m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 th\u1ea5y t\u0103ng enzym gan transaminase, gamma GT, hi\u1ebfm g\u1eb7p h\u01a1n l\u00e0 t\u0103ng b\u1ea1ch c\u1ea7u \u01b0a acid.<\/p>\n

 <\/p>\n

T\u01b0\u01a1ng t\u00e1c thu\u1ed1c<\/strong><\/p>\n

– T\u01b0\u01a1ng t\u00e1c thu\u1ed1c c\u1ea7n tr\u00e1nh:<\/em><\/p>\n

+ Aspirin \u1edf li\u1ec1u gi\u1ea3m \u0111au, h\u1ea1 s\u1ed1t v\u00e0 c\u00e1c thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid (NSAID)\u0111\u01b0\u1eddng to\u00e0n th\u00e2n: ph\u1ed1i h\u1ee3p c\u00e1c thu\u1ed1c n\u00e0y v\u1edbi heparin c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 ch\u1ea3y m\u00e1u do \u1ee9c ch\u1ebf ch\u1ee9c n\u0103ng ti\u1ec3u c\u1ea7u v\u00e0 l\u00e0m t\u1ed5n th\u01b0\u01a1ng l\u1edbp m\u00e0ng nh\u00e0y tr\u00ean ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng. Do \u0111\u00f3, n\u00ean s\u1eed d\u1ee5ng m\u1ed9t thu\u1ed1c gi\u1ea3m \u0111au h\u1ea1 s\u1ed1t kh\u00f4ng thu\u1ed9c nh\u00f3m salicylat. N\u1ebfu nh\u1ea5t thi\u1ebft ph\u1ea3i s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p v\u1edbi m\u1ed9t thu\u1ed1c NSAID, c\u1ea7n gi\u00e1m s\u00e1t ch\u1eb7t ch\u1ebd d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng v\u00e0 x\u00e9t nghi\u1ec7m.<\/p>\n

+ Dextran 40 (\u0111\u01b0\u1eddng ti\u00eam): t\u0103ng nguy c\u01a1 ch\u1ea3y m\u00e1u do \u1ee9c ch\u1ebf ch\u1ee9c n\u0103ng ti\u1ec3u c\u1ea7u. C\u1ea7n \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u heparin \u0111\u1ec3 c\u00e1c ch\u1ec9 s\u1ed1 x\u00e9t nghi\u1ec7m v\u1ec1 kh\u1ea3 n\u0103ng ch\u1ed1ng \u0111\u00f4ng m\u00e1u kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 1,5 l\u1ea7n gi\u00e1 tr\u1ecb gi\u1edbi h\u1ea1n tr\u00ean c\u1ee7a m\u1eabu \u0111\u1ed1i chi\u1ebfu trong su\u1ed1t th\u1eddi gian ph\u1ed1i h\u1ee3p v\u00e0 sau khi \u0111\u00e3 ng\u1eebng Dextran 40.<\/p>\n

– T\u01b0\u01a1ng t\u00e1c thu\u1ed1c c\u1ea7n th\u1eadn tr\u1ecdng:<\/em><\/p>\n

+ Aspirin khi s\u1eed d\u1ee5ng \u1edf li\u1ec1u ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u c\u0169ng nh\u01b0 c\u00e1c ch\u1ea5t ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u kh\u00e1c (ticlopidin, clopidogrel, thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 GPIIb\/IIIa ti\u1ec3u c\u1ea7u, dipyridamol): c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 ch\u1ea3y m\u00e1u, c\u1ea7n gi\u00e1m s\u00e1t ch\u1eb7t ch\u1ebd.<\/p>\n

+ C\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb huy\u1ebft kh\u1ed1i: t\u0103ng nguy c\u01a1 ch\u1ea3y m\u00e1u, c\u1ea7n gi\u00e1m s\u00e1t ch\u1eb7t ch\u1ebd.<\/p>\n

 <\/p>\n

Ph\u1ed1i h\u1ee3p thu\u1ed1c<\/strong><\/p>\n

C\u00e2n nh\u1eafc \u0111\u1ebfn vi\u1ec7c chuy\u1ec3n d\u1ea7n t\u1eeb heparin sang c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng (thu\u1ed1c kh\u00e1ng vitamin K) ngay khi c\u00f3 th\u1ec3. C\u00f3 th\u1ec3 b\u1eaft \u0111\u1ea7u c\u00e1c thu\u1ed1c kh\u00e1ng vitamin K trong kho\u1ea3ng ng\u00e0y th\u1ee9 1 \u0111\u1ebfn ng\u00e0y th\u1ee9 3 c\u1ee7a chu tr\u00ecnh \u0111i\u1ec1u tr\u1ecb, \u0111\u1ec3 th\u1eddi gian s\u1eed d\u1ee5ng heparin kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 7 \u0111\u1ebfn 10 ng\u00e0y. Do thu\u1ed1c kh\u00e1ng vitamin K c\u1ea7n th\u1eddi gian nh\u1ea5t \u0111\u1ecbnh \u0111\u1ec3 ph\u00e1t huy t\u00e1c d\u1ee5ng n\u00ean ch\u1ec9 d\u1eebng heparin khi ch\u1ec9 s\u1ed1 INR (international normalized ratio) trong hai ng\u00e0y li\u00ean ti\u1ebfp \u0111\u1ec1u n\u1eb1m trong kho\u1ea3ng \u0111i\u1ec1u tr\u1ecb mong mu\u1ed1n (kho\u1ea3ng \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c quy\u1ebft \u0111\u1ecbnh t\u00f9y thu\u1ed9c v\u00e0o b\u1ec7nh l\u00fd c\u1ee5 th\u1ec3). Trong giai \u0111o\u1ea1n n\u00e0y, c\u1ea7n gi\u00e1m s\u00e1t th\u1eddi gian cephalin ho\u1ea1t h\u00f3a (x\u00e9t nghi\u1ec7m aPTT) \u0111\u1ec3 tr\u00e1nh nguy c\u01a1 ch\u1ea3y m\u00e1u.<\/p>\n

 <\/p>\n

L\u1eddi khuy\u00ean<\/strong><\/p>\n

– C\u1ea7n ch\u1ecdn v\u1ecb tr\u00ed ti\u00eam heparin \u1edf m\u00f4 d\u01b0\u1edbi da v\u00f9ng b\u1ee5ng th\u1eaft l\u01b0ng ph\u00eda tr\u01b0\u1edbc v\u00e0 ph\u00eda sau \u1edf c\u1ea3 hai b\u00ean, c\u00f3 th\u1ec3 thay \u0111\u1ed5i l\u00fac b\u00ean tr\u00e1i, l\u00fac b\u00ean ph\u1ea3i. \u0110\u01b0a kim ti\u00eam vu\u00f4ng g\u00f3c, kh\u00f4ng nghi\u00eang. Ng\u01b0\u1eddi ti\u00eam d\u00f9ng ng\u00f3n tr\u1ecf v\u00e0 ng\u00f3n c\u00e1i \u0111\u1ec3 k\u00e9o l\u1edbp da l\u00ean, ti\u00eam v\u00e0o ph\u1ea7n da v\u1eeba k\u00e9o \u0111\u1ed3ng th\u1eddi gi\u1eef v\u1ecb tr\u00ed tay trong su\u1ed1t th\u1eddi gian ti\u00eam.<\/p>\n

– C\u00e1c x\u00e9t nghi\u1ec7m tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb bao g\u1ed3m: c\u00f4ng th\u1ee9c m\u00e1u, th\u1eddi gian cephalin ho\u1ea1t ho\u00e1 (\u0111\u1ec3 ph\u00e1t hi\u1ec7n b\u1ec7nh l\u00fd c\u00f3 nguy c\u01a1 ch\u1ea3y m\u00e1u ti\u1ec1m t\u00e0ng), th\u1eddi gian Quick, s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u.<\/p>\n

– C\u1ea7n gi\u00e1m s\u00e1t th\u01b0\u1eddng xuy\u00ean k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 c\u1ee7a ph\u00e1c \u0111\u1ed3 ch\u1ed1ng \u0111\u00f4ng, \u00edt nh\u1ea5t l\u00e0 h\u00e0ng ng\u00e0y, l\u1ea7n l\u1ea5y m\u1eabu x\u00e9t nghi\u1ec7m \u0111\u1ea7u ti\u00ean c\u1ea7n \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh ch\u00ednh x\u00e1c gi\u1eefa hai l\u1ea7n ti\u00eam \u0111\u1ea7u ti\u00ean (t\u1ee9c l\u00e0 4 \u0111\u1ebfn 6 gi\u1edd sau m\u0169i th\u1ee9 nh\u1ea5t, n\u1ebfu b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh 2 ho\u1eb7c 3 m\u0169i\/ng\u00e0y).<\/p>\n

T\u00f9y theo m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3, c\u00f3 th\u1ec3 c\u1ea7n th\u00eam x\u00e9t nghi\u1ec7m:<\/p>\n

+ Th\u1eddi gian cephalin ho\u1ea1t h\u00f3a (gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng l\u00e0 40 gi\u00e2y). Gi\u00e1 tr\u1ecb n\u00e0y c\u1ea7n n\u1eb1m trong kho\u1ea3ng 1,5 \u0111\u1ebfn 3 l\u1ea7n m\u1eabu \u0111\u1ed1i chi\u1ebfu t\u00f9y theo m\u1ee9c nh\u1ea1y c\u1ea3m c\u1ee7a ch\u1ea5t ph\u1ea3n \u1ee9ng s\u1eed d\u1ee5ng.<\/p>\n

+ Ho\u1ea1t t\u00ednh anti-Xa (n\u1ed3ng \u0111\u1ed9 heparin trong m\u00e1u) l\u00e0 m\u1ed9t x\u00e9t nghi\u1ec7m \u0111\u1eb7c hi\u1ec7u v\u00e0 c\u1ea7n n\u1eb1m trong kho\u1ea3ng 0,2 \u0111\u1ebfn 0,6 IU\/ml (\u01b0u ti\u00ean th\u1ef1c hi\u1ec7n trong tr\u01b0\u1eddng h\u1ee3p th\u1eddi gian cephalin ho\u1ea1t h\u00f3a cho gi\u00e1 tr\u1ecb b\u1ea5t th\u01b0\u1eddng, b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c v\u00e0 trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 d\u1ea5u hi\u1ec7u vi\u00eam).<\/p>\n

– Th\u1eddi gian l\u1ea5y m\u00e1u \u0111\u00f3ng vai tr\u00f2 \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng:<\/p>\n

+ Trong tr\u01b0\u1eddng h\u1ee3p truy\u1ec1n t\u0129nh m\u1ea1ch li\u00ean t\u1ee5c, n\u1ed3ng \u0111\u1ed9 heparin trong m\u00e1u \u0111\u1ea1t m\u1ee9c c\u00e2n b\u1eb1ng, c\u00f3 th\u1ec3 l\u1ea5y m\u00e1u \u0111\u1ecbnh l\u01b0\u1ee3ng t\u1ea1i m\u1ecdi th\u1eddi \u0111i\u1ec3m.<\/p>\n

+ Trong tr\u01b0\u1eddng h\u1ee3p ti\u00eam t\u0129nh m\u1ea1ch ho\u1eb7c ti\u00eam d\u01b0\u1edbi da, c\u1ea7n l\u1ea5y m\u00e1u t\u1ea1i th\u1eddi \u0111i\u1ec3m 3\/4 kho\u1ea3ng \u0111\u01b0a li\u1ec1u gi\u1eefa hai l\u1ea7n ti\u00eam.<\/p>\n

– Vi\u1ec7c gi\u00e1m s\u00e1t t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n b\u1eb1ng nhi\u1ec1u c\u00e1ch kh\u00e1c nhau:<\/p>\n

+ Ki\u1ec3m tra s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u th\u01b0\u1eddng xuy\u00ean (d\u1ef1 ph\u00f2ng gi\u1ea3m ti\u1ec3u c\u1ea7u).<\/p>\n

+ \u0110\u1ecbnh l\u01b0\u1ee3ng antithrombin.<\/p>\n

+ Ki\u1ec3m tra n\u1ed3ng \u0111\u1ed9 hemoglobin (huy\u1ebft s\u1eafc t\u1ed1), c\u00f4ng th\u1ee9c m\u00e1u.<\/p>\n

 <\/p>\n

Nh\u1eefng \u0111i\u1ec3m c\u1ea7n ch\u00fa \u00fd trong tr\u01b0\u1eddng h\u1ee3p qu\u00e1 li\u1ec1u<\/strong><\/p>\n

Qu\u00e1 li\u1ec1u c\u00f3 th\u1ec3 x\u1ea3y ra sau khi ti\u00eam m\u1ed9t li\u1ec1u l\u1edbn heparin v\u00e0 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn bi\u1ebfn ch\u1ee9ng ch\u1ea3y m\u00e1u. Nguy c\u01a1 ch\u1ea3y m\u00e1u t\u1ef7 l\u1ec7 v\u1edbi m\u1ee9c \u0111\u1ed9 gi\u1ea3m kh\u1ea3 n\u0103ng \u0111\u00f4ng m\u00e1u v\u00e0 \u0111\u1ed9 b\u1ec1n th\u00e0nh m\u1ea1ch \u1edf m\u1ed7i b\u1ec7nh nh\u00e2n.<\/p>\n

X\u1eed tr\u00ed qu\u00e1 li\u1ec1u: c\u00f3 th\u1ec3 d\u00f9ng thu\u1ed1c gi\u1ea3i \u0111\u1ed9c l\u00e0 protamin sulfat (Protamin Choay), m\u1ed9t thu\u1ed1c trung h\u00f2a heparin do t\u1ea1o th\u00e0nh ph\u1ee9c h\u1ee3p b\u1ea5t ho\u1ea1t. 100 \u0111\u01a1n v\u1ecb kh\u00e1ng heparin (UAH) c\u1ee7a protamin c\u00f3 th\u1ec3 trung h\u00f2a ho\u1ea1t t\u00ednh c\u1ee7a 100 \u0111\u01a1n v\u1ecb heparin (IU). Li\u1ec1u protamin c\u1ea7n thi\u1ebft \u0111\u1ec3 gi\u1ea3i \u0111\u1ed9c ph\u1ee5 thu\u1ed9c v\u00e0o li\u1ec1u heparin \u0111\u00e3 ti\u00eam, th\u1eddi gian b\u00e1n th\u1ea3i c\u1ee7a ch\u1ebf ph\u1ea9m\u00a0heparin
\nv\u00e0 th\u1eddi gian k\u1ec3 t\u1eeb l\u00fac ti\u00eam heparin. C\u00e1c y\u1ebfu t\u1ed1 n\u00e0y c\u00f3 th\u1ec3 d\u00f9ng \u0111\u1ec3 xem x\u00e9t gi\u1ea3m li\u1ec1u thu\u1ed1c gi\u1ea3i \u0111\u1ed9c. Tuy nhi\u00ean, c\u0169ng c\u1ea7n ch\u00fa \u00fd \u0111\u1ebfn c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n ti\u1ec1m t\u00e0ng khi s\u1eed d\u1ee5ng thu\u1ed1c n\u00e0y.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Theo Canhgiacduoc S\u1eec D\u1ee4NG H\u1ee2P L\u00dd, AN TO\u00c0N HEPARIN KH\u00d4NG PH\u00c2N \u0110O\u1ea0N \u00a0Ho\u00e0ng H\u00e0 Ph\u01b0\u01a1ng, Tr\u1ea7n Thu Th\u1ee7y d\u1ecbch T\u00f3m t\u1eaft Heparin l\u00e0 m\u1ed9t ch\u1ea5t mucopolysacarid sulfat t\u1ef1 nhi\u00ean, chi\u1ebft xu\u1ea5t t\u1eeb \u0111\u1ed9ng v\u1eadt. Kh\u1ed1i l\u01b0\u1ee3ng ph\u00e2n t\u1eed heparin dao \u0111\u1ed9ng trong kho\u1ea3ng 5000 \u0111\u1ebfn 30000 dalton. \u0110\u1ea1i ph\u00e2n t\u1eed n\u00e0y kh\u00f4ng h\u1ea5p thu qua […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[373],"tags":[],"class_list":["post-11170","post","type-post","status-publish","format-standard","hentry","category-duoc-lam-sang"],"_links":{"self":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/11170","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/comments?post=11170"}],"version-history":[{"count":1,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/11170\/revisions"}],"predecessor-version":[{"id":11174,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/11170\/revisions\/11174"}],"wp:attachment":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/media?parent=11170"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/categories?post=11170"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/tags?post=11170"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}