BNH N THUC T QUY BO HM Y T

BNH VN A KHOA TRUNG NG TP CN TH

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I. I TNG BNH
Bnh nhn: V Thj Lan Sinh nm: 1953 N Cn nng: 60kg
Chn on:
- Cao huyt p v cn( nguyn pht).
- Bnh tim do thiu mu cuc b man.
- Vim da dy v t trng.
- Thoi ha da khp.
n thuc:
1. Bihasal (2.5 mg) 30 vin
Sng 1 vin
2. Bidocar (clopidogrel bisulfat 75 mg) 30 vin
Sng 1 vin
3. Vasotrate ( 30 mg) 30 vin
Chiu 1 vin
4. Coversyl tab 5 mg ( peridopril) 15 vin
Sng vin
5. Tatanol codein vin ung 14 vin
Sng 1 vin, chiu 1 vin
6. Myvita calcium ( si) 7 vin
Sng 1 vin lc no
II. CN BNH:
1. Tng hu!t " #$ cn % ngu&n "ht':
- Nguyn nhn tng huyt p khng duoc bit, loai tng huyt p ny chim 90% dn s tng huyt p.
- Cc yu t nguy co ch yu: tin s gia dnh c bnh tim mach, ht thuc, ri loan lipid huyt, tiu dung,
ngui cao tui, dn ng, phu n sau mn kinh, .
- Triu chng: phn ln tng HA khng c triu chng cu th, khi c triu chng tng huyt p th thung lc
ny d l bin chng hoc tnh trang tng HA d nng.
- Bin chng tng HA xy ra ch yu trn tim, no, thn, mt, mach mu.
(. Bnh t)* +o th)!u *u c,c -. */n:
- L bnh xy ra khi cung cp oxygen ca mach vnh khng dp ng d nhu cu oxygen ca co tim.
- Nguyn nhn:
+ Gim luu luong mu/ dng mach vnh (hep do mng xo va hoc do co tht mach vnh)
+ Tng nhu cu oxy ca co tim ( tng nhjp tim, tng co co tim do kch thch giao cm khi gng sc, khi
bj stress .)
+ Gim nng d oxygen trong mu.
- Triu chng: xy ra nhng con dau tht nguc ko di vi giy dn vi pht, kh th, dau c hoc dau vai,
cnh tay.
- Bin chng: loan nhjp, suy tim, nhi mu co tim,.
0. 1)&* +/ +2 #2 t t32ng:
- L bnh xy ra do su mt cn bng ca hai qu trnh bo v - hy hoai. C 3 nhm:
+ Lot da dy- t trng do tng tit acid djch vj.
+ Lot da dy do s dung NSADS
+ Lot da dy do nhim Hb ( Helicobacter pylori)
- Triu chng: bnh nhn thung bj dau hoc nng rt vng thuong vj, ri loan tiu ha ( to bn, nn ma,
bun nn,.)
- Bin chng: xut huyt tin ha, hep mn vj, ung thu da dy,.
4. Tho) h56 6 7h8":
- Thoi ha khp l tnh trang xung cp tin trin ca sun khp, c th do tu nhin hay do mt yu t no d
thc dy.Bn canh d l su diu chinh khng hop l ca nhng thnh phn k cn l bao khp v xuong ,
khin cho din bin ngy cng xu di,khp gim kh nng vn dng , dau v dn dn bj bin dang .
- Triu chng:Bnh nhn co, dui ,di lai kh khn, ci xung ,dng ln, quay ngang du dau, di khi do thn
kinh bj chn p lm cho dau dc xung dui chn...
- Nguyn nhn:Ngui cao tui, co quan khp xuong bj lo ha, phu n sau mn kinh..
- Bin chng:mt kh nng vn dng ,khp bj bin dang.
III. 9:C TI;< I=< T>? CH@ BNH NHAN BBNG TH<C:
- at HA muc tiu (140/90 mmHg)
- Ti lp lai su cn bng gia nhu cu tiu thu oxy v su cung cp oxy cho t bo co tim bng cch:
+Tng cung cp oxy: tng luu luong mach vnh (gin mach vnh).
+Gim nhu cu s dung oxy:gim hoat dng tim, gim luu luong mu v tim, gim khng luc ngoai
bin.
+Chng hnh thnh cuc mu dng: dng thuc Aspirin, Clopidogel,..
- Chng cc yu t gy lot da dy T trng: Dng thuc khng acid, khng Histamin H2 ,c ch bom proton,
thuc dit H.pylori: khnh sinh ,..
- Tng cung cc yu t bo v Da dy T trng: Sucrafat, Bismuth, Misoprostol..
- iu trj thoi ha khp bng cch dng thuc gim dau ( Paracetamol, Paracetamol + codein ), thuc khng
vim (Glucosamin,.).
I1. CCNG D:NG CEF CGC TH<C T>@NG HN:
I. B)h6J6K (.L*g %ho/t chMt B)Jo"3oKoK Nu*636t (.L*g'
Bisoprolol l tc nhn di khng thu th 1 adrenergic c tnh chn lc cao trn tim, lm gim nhjp tim nn c tc
dung bo v tim lu di.
- Chi djnh: Tng huyt p, dau tht nguc, suy tim.
- Phn ng phu: Ha huyt p tu th, nhjp chm, ph, kh th, mt mi, dau du, dj ng da,..
- Tuong tc:
+ Thuc diu trj tim mach (thuc chen knh canxi:Verapamil, Diltiaem, Nifedipin) :lm tng tc dung
ha HA ca Bisoprolol.
+ Thuc diu trj trm cm, bnh Pakinson( tr MAO-B) ,dng kinh:Tng tc dung ha HA ca
Bisoprolol.
+ Thuc cha Clonidine: Tng HA c th xy ra (Tng HA hi ng ) cng nhu lm gim qu mc nhjp
tim v dn truyn tim
+ Thuc chng loan nhjp (Disopyramide, Quinidine, hoc Aminodarone) tc dung ln dn truyn tim
v nhjp tim c th manh ln
+ Thuc trj tiu dung (nsulin hoc cc thuc tiu dung dung ung ) du hiu luong dung huyt
qu thp c th bj che lp (nhu du hiu mach nhanh)..
+ Thuc gim dau v chng vim (c ch prostaglandin) do tc dung ha HA c th bj gim......
- Chng chi djnh:
+ Mn cm vi thuc.
+ Suy tim cp, suy tim mt b.
+ Sc do tim.
+ Dng dng thi vi cc thuc c ch MAO.
+ ang bj bnh tuyn thuong thn (u t bo ua crom).
+ Nhim toan chuyn ha, tt nghn dung h hp.
+ Phu n c thai ,dang cho con b.
- Liu dng:
Tng huyt p 1vin x 1 ln /ngy.
Cch dng thi gian dng:
Ung thuc vi nhiu nuc , ung vo bui sng khi di hoc lc dng dim tm, khng duoc nhai.
- tr khi qu liu (ti da 2000mg):
Ngung s dung thuc, diu trj bng cch tim tnh mach Atropin (1-2 mg). Nu cn c th theo sau 1 liu truyn
tnh mach 25mcg soprenaline, glucagon cng c th duoc dng vi liu 1-5mg.
mt s bnh nhn c th xy ra co tht ph qun v suy tim: diu trj co tht ph qun bng cch tim tnh
mach Aminophylline v diu trj suy tim bng thuc tro tim mach (Digitalis) v thuc loi tiu.
(. B)+oc63 %CKo")+og3OK -)JuKN6tO PL*g'
L cht c ch kt tp tiu cu
- Chi djnh:
+ Gim cc bin c huyt khi do xo va dng mach.
+ au tht nguc khng n djnh.
+ Nhi mu co tim.
- Chng chi djnh :
+ Bnh nhn mn cm vi thuc
+ Suy gan nng
+ Bnh nhn bj chy mu bnh l nhu lot tiu ha hoc chy mu trong no.
+ Phu n cho con b
- Tuong tc thuc:
Thn trng khi phi hop vi Aspirin, thuc khng vim khng steroid, Heparin, afarin, thuc tan
huyt khi do lm tng nguy co chy mu.
- Tc dung phu:
Mn nga,dau bung , kh tiu, tiu chy, bun nn, nn, vim da dy, chy mu cam, ban xut
huyt.Him khi bj xut huyt gim tiu cu v mt bach cu hat.
Cch dng Liu dng:
Ngy ung 1 ln vo bui sng sau khi n, ung vi nhiu nuc
- tr qu liu:
Truyn tiu cu nhm do nghjch tc dung duoc l ca clopidogrel.
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- Chi djnh:
Du phng con dau tht nguc do bnh dng mach vnh, diu trj suy tim nng , tng HA dng mach
phi.
- Chng chi djnh:
+ Huyt p thp (HA ti da 100 mmHg).
+ Tng nhn p.
+ Tng p luc ni s.
Thn trng :Phu n c thai, cho con b.
- Tuong tc thuc:
Thuc khi dng chung vi ruou s lm gim tc dung gin mach v gy ha huyt p tu th dng
nghim trng.
Khi dng cng vi Disopyramid phosphat th tc dung chng tit nuc bt ca Disopyramid cn tr su
ha tan ca vim ngm sosorbide dinitrate.
- T dung phu:
Ha HA, nhjp tim nhanh ,nhc du ,chong vng ,bun nn, nn, tiu chy, dau co, ni ban nga..
- Cch dng Liu dng:
Dng 30-60mg, ngy 01 ln(c th tng ln 120mg/ngy 1 ln).
Dng vo bui sng lc mi thc dy.
- tr khi qu liu:
Gy nn, s dung than hoat tnh bng dung ung trong trung hop ha huyt p nng , truc ht
bnh nhn nn duoc dt tu th nm nga, k cao chn. Truyn djch dung TM nu cn.
4. Co#O3JK % RO3)+o"3)K L*g '
L thuc c ch men chuyn Angiotensin
- Chi djnh:
+ Tng HA dng mach.
+ Bnh dng mach vnh n djnh.
- Chng chi djnh:
+ Dj ng vi thuc.
+ Tin s ph mach: khi s dung AC, tu pht, di truyn,.
+ Phu n c thai, cho con b.
- Tuong tc thuc:
+ Thuc loi tiu gi kali, mui kali v lithium.
- Tc dung phu:
+ Nhc du, chng mt, ri loan thj gic, tai, ha HA, ho khan, ban d, kh th, RLTH, ri loan vj gic,
mt mi, co cng co, .
+ Tng kali huyt, tng enim gan, tng bilirubin huyt thanh.
- Liu dng- cch dng:
2.5-10 mg/ ngy , mi ngy mt ln, ung vi nhiu nuc vo bui sng truc ba n.
- l khi c tc dung phu.
Ngung thuc nu sung mt, mi, lui, hoc hng gy kh th, kh nut.
L. T6t6noK co+O)n % FcOt6*)no"hOn S co+O)n "hot"h6t'.
- Chi djnh:
+ Gim dau nhanh trong cc trung hop dau tht lung, dau du, dau dy thn kinh, dau ton thn,
dau co.
+ iu trj ho khan.
- Chng chi djnh:
+ Bnh nhn mn cm vi thuc.
+ Bnh nhn suy gan nng, suy h hp, hen suyn.
+ Phu n c thai, cho con b.
+ Tr em cn nng dui 15kg.
- Tuong tc thuc:
Khng dng chung vi thuc gim dau hung thn, ruou, thuc c ch TKT, dn xut morphin.
- Tc dung phu:
To bn, bun ng, chng mt, bun nn, nn. Rt him khi bj co tht ph qun, dj ng da, c ch h
hp.
- Ch dng- liu dng:
1 vin/ ln, 1-3 ln/ ngy, ung vi nhiu nuc sau khi n. Mi ln dng cch nhau t nht 4h.
T. 9#)t6 c6Kc)u* % chU6 cc *u) cV6 c6Kc) c6Kc)gKuconoK6ct6tW c6Kc) c63-on6tWX'
- Chi djnh:
+ Chng long xuong.
+ Phng nga tnh trang gim su khong ha xuong giai doan tin v hu mn kinh.
+ iu trj trung hop ci xuong, nhuyn xuong.
- Chng chi djnh:
+ Mn cm vi thuc.
+ Tng calci huyt, calci niu, si calci, vi ha m, suy thn nng.
- Cch dng- liu dng:
+ Ha tan 1 vin trong 250-300 ml nuc chn.
+ Dng 1-2 vin/ ngy.
1. NHYN Z[T HN TH<C:
- Cc thuc k trong don chi djnh nhn chung ph hop vi chn don bnh, hm luong, cch dng dng, khng
c tuong tc thuc.
- Tuy nhin:
+ bnh nhn ny c thm bnh vim da dy- t trng nhung khng thy thuc diu trj, ta c th
thm thuc diu trj lot da dy- t trng cho bnh nhn.
+ Do bnh nhn bj lot da dy- t trng nn thn trng khi s dung vin si, v th ta c th thay th
dang calci si bng dang vin nn thng thung.
+ Vasotrate nn ung vo bui sng lc mi thc dy khng nn ung vo lc chiu ( nhu chi djnh).
1I. T 1\N CH@ BNH NHAN:
- Bnh nhn nn n nhiu rau, tri cy, sn phm sa c calci t bo, gim m bo ha, m ton phn v
cholesterol. n han ch mui: mi ngy dng khng qu 6g NaCl.
- n diu d, dng gi, khng nn n nhng thc n cay, chua, nuc ung c ga.
- Sng lac quan, thoi mi, bt stress.
- Nghi ngoi v lm vic hop l, nn ng -10 ting/ dm, ban ngy nn nghi trua 30-60 pht.
- Trong trung hop thoi ha khp nng c th s dung cc dung cu h tro nhu: dai, gy, bnh nhn c th tp
vt l trj liu, tp Yoga.
1II. T]I ^I< THF9 _H`@:
- T hung dn s dung thuc.
- Bo sc khe v di sng
- Duoc luc hc.
- Duoc l ( b mn Duoc l- Duoc lm sng trung HYD Cn Tho).