Vị trí của digoxin trong điều trị suy tim

Quang Trí Hồ Huỳnh

doi:10.58354/jvc.99.2022.4

Các tác giả

Hồ Huỳnh Quang Trí Viện Tim TP. Hồ Chí Minh

DOI:

https://doi.org/10.58354/jvc.99.2022.4

Tóm tắt

Qua phân tích các chứng cứ nêu trên và tham khảo các hướng dẫn điều trị hiện hành, có thể kết luận tóm tắt về việc dùng digoxin điều trị suy tim mạn như trong bảng 2.

Bảng 2: Vị trí của digoxin trong điều trị suy tim mạn

Người bệnh suy tim rung nhĩ:
- PSTM <40%: Digoxin và thuốc chẹn bêta là 2 lựa chọn hàng đầu để kiểm soát tần số thất. Có thể
phối hợp 2 thuốc này với nhau nếu đơn trị không đủ để kiểm soát tần số thất.
- PSTM ≥40%: Thuốc chẹn bêta, verapamil và diltiazem là những lựa chọn hàng đầu để kiểm soát tần
số thất. Nếu đơn trị bằng các thuốc này không đủ để kiểm soát tần số thất, xem xét phối hợp thêm
digoxin.
- Dùng liều digoxin ≤0,125 mg/ngày.
- Không dùng digoxin cho người có hội chứng kích thích sớm.
Người bệnh suy tim nhịp xoang:
- PSTM <40%, tình trạng lâm sàng ổn định, đang uống digoxin: tiếp tục dùng.
- PSTM <40%, không đang uống digoxin: Digoxin không phải là thuốc được ưu tiên kê toa. Ưu tiên
dùng các thuốc giảm tử vong và nhập viện vì suy tim (hàng 1: sacubitril/valsartan, chẹn bêta, kháng
aldosterone, ức chế SGLT2; hàng 2: ivabradine nếu tần số tim ≥70/phút). Nếu bệnh nhân vẫn còn
triệu chứng, xem xét phối hợp thêm digoxin để giảm nguy cơ nhập viện.
- Dùng liều digoxin ≤0,125 mg/ngày.
- PSTM ≥40%: không có chỉ định dùng digoxin.

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