{"id":288,"date":"2026-01-22T02:01:19","date_gmt":"2026-01-22T02:01:19","guid":{"rendered":"https:\/\/thuoc115.com\/suckhoe\/?p=288"},"modified":"2026-01-22T16:05:27","modified_gmt":"2026-01-22T16:05:27","slug":"tong-hop-nghien-cuu-ve-xuat-tinh-som-o-nam-gioi","status":"publish","type":"post","link":"https:\/\/thuoc115.com\/suckhoe\/tong-hop-nghien-cuu-ve-xuat-tinh-som-o-nam-gioi\/","title":{"rendered":"T\u1ed5ng h\u1ee3p nghi\u00ean c\u1ee9u v\u1ec1 xu\u1ea5t tinh s\u1edbm \u1edf nam gi\u1edbi"},"content":{"rendered":"\n<p><strong>\u0110i\u1ec1u tr\u1ecb b\u1eb1ng Y h\u1ecdc c\u1ed5 truy\u1ec1n<\/strong><\/p>\n\n\n\n<p>Trong l\u0129nh v\u1ef1c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng <strong>Y h\u1ecdc c\u1ed5 truy\u1ec1n (YHCT)<\/strong>, c\u00e1c <strong>ch\u1ebf ph\u1ea9m th\u1ea3o d\u01b0\u1ee3c d\u00f9ng ngo\u00e0i<\/strong> ng\u00e0y c\u00e0ng nh\u1eadn \u0111\u01b0\u1ee3c nhi\u1ec1u s\u1ef1 quan t\u00e2m trong vi\u1ec7c ki\u1ec3m so\u00e1t <strong>xu\u1ea5t tinh s\u1edbm<\/strong>. C\u00e1c b\u1eb1ng ch\u1ee9ng hi\u1ec7n c\u00f3 cho th\u1ea5y m\u1ed9t s\u1ed1 c\u00f4ng th\u1ee9c YHCT b\u00f4i ngo\u00e0i, ch\u1eb3ng h\u1ea1n nh\u01b0 <strong>d\u1ea1ng x\u1ecbt th\u1ea3o d\u01b0\u1ee3c<\/strong> (g\u1ed3m <strong>T\u1ebf t\u00e2n, \u0110inh h\u01b0\u01a1ng, B\u1ecd ng\u1ef1a ti\u00eau \u2013 Mantis ootheca, Ph\u1ee5 t\u1eed, Ch\u1ec9 th\u1ef1c, Qu\u1ea3 t\u1ea7m xu\u00e2n, S\u01a1n tra, V\u1ecf qu\u1ea3 hoa ti\u00eau T\u1ee9 Xuy\u00ean<\/strong>), c\u00f3 t\u00e1c d\u1ee5ng <strong>b\u1ed5 th\u1eadn<\/strong> v\u00e0 <strong>c\u1ed1 tinh<\/strong>. (Asarum (t\u1ebf t\u00e2n &#8211; n\u00f3ng), Clove (\u0111inh h\u01b0\u01a1ng), Mantis Ootheca (tang phi\u00eau di\u00eau), Aconite (ph\u1ee5 t\u1eed ch\u1ebf), Zhi Shi Ch\u1ec9 x\u00e1c, Rosehip (n\u1ee5 t\u1ea7m xu\u00e2n), Hawthorn Fruit (S\u01a1n tra), and Sichuan Pepper Fruit Peel h\u1ea1t ti\u00eau t\u1ee9 xuy\u00ean)<\/p>\n\n\n\n<p><strong>Trong m\u1ed9t nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng c\u00f3 \u0111\u1ed1i ch\u1ee9ng, Ying-Dong Cui (67) \u0111\u00e3 ph\u00e2n ng\u1eabu nhi\u00ean 90 b\u1ec7nh nh\u00e2n xu\u1ea5t tinh s\u1edbm<\/strong> th\u00e0nh ba nh\u00f3m:<\/p>\n\n\n\n<p>Nh\u00f3m Y h\u1ecdc c\u1ed5 truy\u1ec1n (x\u1ecbt th\u1ea3o d\u01b0\u1ee3c, n = 30),<\/p>\n\n\n\n<p>Nh\u00f3m li\u1ec7u ph\u00e1p gi\u1ea3m c\u1ea3m gi\u00e1c (thi\u1ebft b\u1ecb t\u1ef1 \u0111\u1ed9ng, n = 30),<\/p>\n\n\n\n<p>Nh\u00f3m \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p (x\u1ecbt th\u1ea3o d\u01b0\u1ee3c + li\u1ec7u ph\u00e1p gi\u1ea3m c\u1ea3m gi\u00e1c, n = 30),<\/p>\n\n\n\n<p>v\u1edbi th\u1eddi gian \u0111i\u1ec1u tr\u1ecb li\u00ean t\u1ee5c 6 tu\u1ea7n.<\/p>\n\n\n\n<p>K\u1ebft qu\u1ea3 cho th\u1ea5y t\u1ef7 l\u1ec7 hi\u1ec7u qu\u1ea3 chung l\u1ea7n l\u01b0\u1ee3t l\u00e0 65,5%, 67,9% v\u00e0 89,7% \u1edf nh\u00f3m YHCT, nh\u00f3m gi\u1ea3m c\u1ea3m gi\u00e1c v\u00e0 nh\u00f3m \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p. Nh\u00f3m k\u1ebft h\u1ee3p cho th\u1ea5y s\u1ef1 c\u1ea3i thi\u1ec7n r\u00f5 r\u1ec7t h\u01a1n v\u1ec1 th\u1eddi gian ti\u1ec1m t\u00e0ng xu\u1ea5t tinh trong \u00e2m \u0111\u1ea1o (IELT) v\u00e0 Ch\u1ec9 s\u1ed1 xu\u1ea5t tinh s\u1edbm Trung Qu\u1ed1c so v\u1edbi c\u00e1c nh\u00f3m \u0111\u1ed1i ch\u1ee9ng. \u0110i\u1ec1u n\u00e0y cho th\u1ea5y x\u1ecbt th\u1ea3o d\u01b0\u1ee3c c\u00f3 th\u1ec3 k\u00e9o d\u00e0i th\u1eddi gian xu\u1ea5t tinh th\u00f4ng qua t\u00e1c d\u1ee5ng g\u00e2y t\u00ea t\u1ea1i ch\u1ed7 k\u1ebft h\u1ee3p v\u1edbi b\u1ed5 th\u1eadn \u2013 c\u1ed1 tinh.<\/p>\n\n\n\n<p>\u01afu \u0111i\u1ec3m c\u1ee7a c\u00e1c ph\u01b0\u01a1ng ph\u00e1p n\u00e0y n\u1eb1m \u1edf t\u00e1c \u0111\u1ed9ng tr\u1ef1c ti\u1ebfp t\u1ea1i ch\u1ed7, hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u1ed1i b\u1ec1n v\u1eefng v\u00e0 t\u00e1c d\u1ee5ng ph\u1ee5 nh\u1eb9. Tuy nhi\u00ean, ch\u00fang \u0111\u00f2i h\u1ecfi tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb l\u00e2u d\u00e0i v\u00e0 kh\u1edfi t\u00e1c d\u1ee5ng ch\u1eadm, do \u0111\u00f3 ph\u00f9 h\u1ee3p v\u1edbi nhi\u1ec1u nh\u00f3m b\u1ec7nh nh\u00e2n kh\u00e1c nhau. Ngo\u00e0i ra, hi\u1ec7u qu\u1ea3 v\u00e0 \u0111\u1ed9 an to\u00e0n c\u1ee7a nhi\u1ec1u ch\u1ebf ph\u1ea9m th\u1ea3o d\u01b0\u1ee3c Trung Qu\u1ed1c d\u00f9ng ngo\u00e0i \u0111\u00e3 \u0111\u01b0\u1ee3c c\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng ch\u1ee9ng minh, gi\u00fap ch\u00fang tr\u1edf th\u00e0nh l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 trong qu\u1ea3n l\u00fd xu\u1ea5t tinh s\u1edbm.<\/p>\n\n\n\n<p>C\u00e1c b\u00e0i thu\u1ed1c Y h\u1ecdc c\u1ed5 truy\u1ec1n ph\u1ed1i h\u1ee3p c\u0169ng \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong \u0111i\u1ec1u tr\u1ecb xu\u1ea5t tinh s\u1edbm (68). Theo l\u00fd lu\u1eadn Y h\u1ecdc c\u1ed5 truy\u1ec1n, xu\u1ea5t tinh s\u1edbm c\u00f3 m\u1ed1i li\u00ean quan ch\u1eb7t ch\u1ebd v\u1edbi nhi\u1ec1u y\u1ebfu t\u1ed1 nh\u01b0 th\u1eadn h\u01b0, huy\u1ebft \u1ee9, \u0111\u00e0m th\u1ea5p v\u00e0 kh\u00ed tr\u1ec7. Do \u0111\u00f3, nhi\u1ec1u b\u00e0i thu\u1ed1c thang v\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u00e2m c\u1ee9u c\u1ee7a Y h\u1ecdc c\u1ed5 truy\u1ec1n nh\u1eb1m \u0111\u1ea1t \u0111\u01b0\u1ee3c c\u00e1c t\u00e1c d\u1ee5ng nh\u01b0 b\u1ed5 th\u1eadn \u00edch kh\u00ed, ho\u1ea1t huy\u1ebft h\u00f3a \u1ee9, l\u1ee3i th\u1ea5p tr\u1eeb \u0111\u00e0m v\u00e0 \u0111i\u1ec1u h\u00f2a t\u1ea1ng ph\u1ee7 (69).<\/p>\n\n\n\n<p>V\u00ec v\u1eady, c\u00e1c b\u00e0i thu\u1ed1c Y h\u1ecdc c\u1ed5 truy\u1ec1n l\u00e0 l\u1ef1a ch\u1ecdn ph\u00f9 h\u1ee3p trong \u0111i\u1ec1u tr\u1ecb xu\u1ea5t tinh s\u1edbm nguy\u00ean ph\u00e1t do r\u1ed1i lo\u1ea1n t\u1ea1ng ph\u1ee7, c\u0169ng nh\u01b0 xu\u1ea5t tinh s\u1edbm th\u1ee9 ph\u00e1t li\u00ean quan \u0111\u1ebfn c\u0103ng th\u1eb3ng c\u1ea3m x\u00fac ho\u1eb7c stress. Yu v\u00e0 c\u1ed9ng s\u1ef1 (70) cho th\u1ea5y vi\u1ec7c u\u1ed1ng li\u00ean t\u1ee5c h\u1ea1t c\u1ed1m Kim K\u00ea Ph\u1ed1i H\u1ee3p (Compound Jinji Granules) trong 4 tu\u1ea7n \u0111\u00e3 c\u1ea3i thi\u1ec7n r\u00f5 r\u1ec7t c\u00e1c ch\u1ec9 s\u1ed1 th\u1eddi gian \u0111\u01b0a v\u00e0o (IL \u2013 insertion latency), t\u1ea7n su\u1ea5t xu\u1ea5t tinh (EF) v\u00e0 t\u1ea7n su\u1ea5t giao ph\u1ed1i (MF) tr\u00ean m\u00f4 h\u00ecnh chu\u1ed9t th\u00ed nghi\u1ec7m.<\/p>\n\n\n\n<p>Ngo\u00e0i ra, c\u00e1c b\u00e0i thu\u1ed1c thang nh\u01b0 S\u01a1 Can \u00cdch \u0110\u1edfm Ph\u01b0\u01a1ng (Shugan Yidan Fang) v\u00e0 Khi\u1ec1u Th\u01b0\u1ee3c Ph\u01b0\u01a1ng (Qiaoshao Prescription) cho th\u1ea5y t\u00e1c d\u1ee5ng t\u00edch c\u1ef1c trong \u0111i\u1ec1u tr\u1ecb xu\u1ea5t tinh s\u1edbm th\u00f4ng qua \u0111i\u1ec1u h\u00f2a n\u1ed3ng \u0111\u1ed9 dopamine v\u00e0 serotonin. C\u00e1c b\u00e0i thu\u1ed1c n\u00e0y \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn r\u1ed9ng r\u00e3i v\u1ec1 kh\u1ea3 n\u0103ng c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c nam gi\u1edbi v\u00e0 k\u00e9o d\u00e0i th\u1eddi gian xu\u1ea5t tinh (71, 72).<\/p>\n\n\n\n<p>H\u01a1n n\u1eefa, c\u00e1c c\u00f4ng th\u1ee9c thu\u1ed1c Y h\u1ecdc c\u1ed5 truy\u1ec1n c\u00f3 nh\u1eefng \u01b0u \u0111i\u1ec3m nh\u01b0 th\u00e0nh ph\u1ea7n \u0111a v\u1ecb, t\u00e1c \u0111\u1ed9ng \u0111a m\u1ee5c ti\u00eau v\u00e0 linh ho\u1ea1t theo tri\u1ec7u ch\u1ee9ng c\u00e1 th\u1ec3, t\u1eeb \u0111\u00f3 n\u00e2ng cao t\u00ednh \u0111\u1eb7c hi\u1ec7u v\u00e0 hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb xu\u1ea5t tinh s\u1edbm. Nh\u1eefng k\u1ebft qu\u1ea3 tr\u00ean cho th\u1ea5y \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p Y h\u1ecdc c\u1ed5 truy\u1ec1n v\u00e0 Y h\u1ecdc hi\u1ec7n \u0111\u1ea1i hi\u1ec7u qu\u1ea3 h\u01a1n so v\u1edbi ch\u1ec9 d\u00f9ng SSRIs \u0111\u01a1n thu\u1ea7n, mang l\u1ea1i ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb to\u00e0n di\u1ec7n h\u01a1n cho b\u1ec7nh nh\u00e2n xu\u1ea5t tinh s\u1edbm (73)<\/p>\n\n\n\n<p>B\u00c0I THU\u1ed0C KINH \u0110I\u1ec2N TH\u01af\u1edcNG D\u00d9NG<\/p>\n\n\n\n<p>Kim t\u1ecfa c\u1ed1 tinh ho\u00e0n \u2192 Th\u1eadn kh\u00ed h\u01b0, tinh kh\u00f4ng c\u1ed1<\/p>\n\n\n\n<p>L\u1ee5c v\u1ecb \u0111\u1ecba ho\u00e0ng ho\u00e0n \u2192 Th\u1eadn \u00e2m h\u01b0<\/p>\n\n\n\n<p>Tri b\u00e1 \u0111\u1ecba ho\u00e0ng ho\u00e0n \u2192 \u00c2m h\u01b0 h\u1ecfa v\u01b0\u1ee3ng<\/p>\n\n\n\n<p>Giao th\u00e1i ho\u00e0n \u2192 T\u00e2m Th\u1eadn b\u1ea5t giao<\/p>\n\n\n\n<p>Ti\u00eau dao t\u00e1n gia gi\u1ea3m \u2192 Can u\u1ea5t<\/p>\n\n\n\n<p>Thanh t\u00e2m b\u1ed5 th\u1eadn. B\u00e0i thu\u1ed1c: Thi\u00ean m\u00f4n 15g, th\u1ee5c \u0111\u1ecba 15g, nh\u00e2n s\u00e2m 10g, ho\u00e0ng b\u00e1 9g, sa nh\u00e2n 4g, cam th\u1ea3o 6g, ho\u00e0ng li\u00ean 3g, t\u00e1o nh\u00e2n 8g, \u0111\u0103ng t\u00e2m th\u1ea3o 9g, ng\u0169 v\u1ecb t\u1eed 9g, m\u1eabu l\u1ec7 20g.<\/p>\n\n\n\n<p>Thanh t\u00e2m h\u1ecfa : <a href=\"https:\/\/thuoc115.com\/hoanglien\/\" type=\"link\" id=\"https:\/\/thuoc115.com\/hoanglien\/\">Ho\u00e0ng li\u00ean<\/a>, li\u00ean t\u00e2m,<\/p>\n\n\n\n<p><a href=\"https:\/\/thuoc115.com\/toantaonhan\/\" type=\"link\" id=\"https:\/\/thuoc115.com\/toantaonhan\/\">Toan t\u00e1o nh\u00e2n<\/a> ,vi\u1ec5n ch\u00ed, <a href=\"https:\/\/thuoc115.com\/phucthan\/\" type=\"link\" id=\"https:\/\/thuoc115.com\/phucthan\/\">ph\u1ee5c th\u1ea7n<\/a><\/p>\n\n\n\n<p>Thanh th\u01b0\u1ee3ng ti\u00eau tr\u00fac di\u1ec7p, sa s\u00e2m, <\/p>\n\n\n\n<p>Tang phi\u00eau ti\u00eau<\/p>\n\n\n\n<p>Kim anh t\u1eed<\/p>\n\n\n\n<p>Li\u00ean nh\u1ee5c<\/p>\n\n\n\n<p>Toan t\u00e1o nh\u00e2n<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><thead><tr><th>T\u00ecnh hu\u1ed1ng<\/th><th>N\u00ean d\u00f9ng<\/th><\/tr><\/thead><\/table><\/figure>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td>T\u00e2m h\u1ecfa th\u1ef1c<\/td><td>Ho\u00e0ng li\u00ean, Chi t\u1eed<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td>T\u00e2m phi\u1ec1n nh\u1eb9<\/td><td>Li\u00ean t\u00e2m, Tr\u00fac di\u1ec7p<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td>T\u00e2m \u00e2m h\u01b0<\/td><td>Sinh \u0111\u1ecba, Huy\u1ec1n s\u00e2m<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td>T\u00e2m Th\u1eadn b\u1ea5t giao<\/td><td>Ho\u00e0ng li\u00ean (li\u1ec1u th\u1ea5p) + Vi\u1ec5n ch\u00ed<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td>T\u1ea3o ti\u1ebft do lo \u00e2u<\/td><td>An th\u1ea7n &gt; t\u1ea3 h\u1ecfa<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p>Xu\u1ea5t tinh s\u1edbm (PE) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p c\u1ee7a h\u1ec7 sinh s\u1ea3n nam gi\u1edbi, g\u00e2y \u1ea3nh h\u01b0\u1edfng nghi\u00eam tr\u1ecdng \u0111\u1ebfn ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh v\u00e0 b\u1ea1n t\u00ecnh. Hi\u1ec7n nay, PE \u0111\u01b0\u1ee3c xem l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd sinh h\u1ecdc \u2013 t\u00e2m l\u00fd \u2013 x\u00e3 h\u1ed9i v\u1edbi c\u0103n nguy\u00ean ph\u1ee9c t\u1ea1p v\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111a d\u1ea1ng.<\/p>\n\n\n\n<p>C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf t\u00e1i h\u1ea5p thu serotonin c\u00f3 ch\u1ecdn l\u1ecdc (SSRIs) d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng l\u00e0 l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb h\u00e0ng \u0111\u1ea7u cho PE, nh\u1edd nh\u1eefng \u01b0u \u0111i\u1ec3m nh\u01b0 \u0111\u1ed9 an to\u00e0n cao, kh\u1edfi ph\u00e1t t\u00e1c d\u1ee5ng nhanh v\u00e0 kh\u00f4ng x\u00e2m l\u1ea5n. Tuy nhi\u00ean, thu\u1ed1c g\u00e2y t\u00ea t\u1ea1i ch\u1ed7, li\u1ec7u ph\u00e1p h\u00e0nh vi v\u00e0 t\u00e2m l\u00fd, c\u00e1c ph\u01b0\u01a1ng ph\u00e1p h\u1ed7 tr\u1ee3 b\u1eb1ng thi\u1ebft b\u1ecb, c\u0169ng nh\u01b0 y h\u1ecdc c\u1ed5 truy\u1ec1n (YHCT) \u0111\u1ec1u c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u01b0 nh\u1eefng li\u1ec7u ph\u00e1p thay th\u1ebf cho c\u00e1c b\u1ec7nh nh\u00e2n kh\u00f4ng dung n\u1ea1p SSRIs.<\/p>\n\n\n\n<p>C\u00f9ng v\u1edbi s\u1ef1 ph\u00e1t tri\u1ec3n nhanh ch\u00f3ng c\u1ee7a c\u00f4ng ngh\u1ec7, m\u1ed9t s\u1ed1 ph\u01b0\u01a1ng ph\u00e1p m\u1edbi\u2014nh\u01b0 li\u1ec7u ph\u00e1p s\u00f3ng xung k\u00edch ngo\u00e0i c\u01a1 th\u1ec3 c\u01b0\u1eddng \u0111\u1ed9 th\u1ea5p (Li-ESWT) v\u00e0 k\u00edch th\u00edch \u0111i\u1ec7n th\u1ea7n kinh qua da (TENS)\u2014th\u1eadm ch\u00ed c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n PE th\u00f4ng qua c\u00e1c c\u01a1 ch\u1ebf nh\u01b0 \u0111i\u1ec1u h\u00f2a d\u1eabn truy\u1ec1n th\u1ea7n kinh v\u00e0 c\u1ea3i thi\u1ec7n vi tu\u1ea7n ho\u00e0n t\u1ea1i ch\u1ed7. \u0110\u00e2y \u0111\u1ec1u l\u00e0 nh\u1eefng h\u01b0\u1edbng \u0111i quan tr\u1ecdng cho \u0111i\u1ec1u tr\u1ecb PE nam gi\u1edbi trong t\u01b0\u01a1ng lai.<\/p>\n\n\n\n<p>Trong b\u00e0i t\u1ed5ng quan ng\u1eafn n\u00e0y, ch\u00fang t\u00f4i s\u1ebd tr\u00ecnh b\u00e0y chi ti\u1ebft c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u00f3i tr\u00ean.<\/p>\n\n\n\n<p>Gi\u1edbi thi\u1ec7u<\/p>\n\n\n\n<p>Xu\u1ea5t tinh s\u1edbm (PE) \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 t\u00ecnh tr\u1ea1ng kh\u00f3 ki\u1ec3m so\u00e1t xu\u1ea5t tinh, th\u1eddi gian xu\u1ea5t tinh trong \u00e2m \u0111\u1ea1o r\u1ea5t ng\u1eafn, k\u00e8m theo s\u1ef1 kh\u00f3 ch\u1ecbu ho\u1eb7c c\u0103ng th\u1eb3ng cho b\u1ea3n th\u00e2n ng\u01b0\u1eddi b\u1ec7nh ho\u1eb7c b\u1ea1n t\u00ecnh, v\u00e0 k\u00e9o d\u00e0i tr\u00ean s\u00e1u th\u00e1ng (1). PE l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 ph\u1ed5 bi\u1ebfn \u1edf nam gi\u1edbi thu\u1ed9c m\u1ecdi nh\u00f3m tu\u1ed5i, \u1ea3nh h\u01b0\u1edfng \u0111\u00e1ng k\u1ec3 \u0111\u1ebfn tr\u1ea1ng th\u00e1i t\u00e2m l\u00fd v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a c\u1ea3 ng\u01b0\u1eddi b\u1ec7nh l\u1eabn b\u1ea1n t\u00ecnh. Theo b\u00e1o c\u00e1o, 20%\u201330% nam gi\u1edbi tr\u00ean to\u00e0n th\u1ebf gi\u1edbi b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi c\u00e1c m\u1ee9c \u0111\u1ed9 PE kh\u00e1c nhau (2).<\/p>\n\n\n\n<p>Do s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 ch\u1ee7ng t\u1ed9c, khu v\u1ef1c \u0111\u1ecba l\u00fd c\u0169ng nh\u01b0 c\u00e1ch \u0111\u1ecbnh ngh\u0129a PE, c\u00e1c d\u1eef li\u1ec7u d\u1ecbch t\u1ec5 h\u1ecdc hi\u1ec7n c\u00f3 cho th\u1ea5y s\u1ef1 ch\u00eanh l\u1ec7ch \u0111\u00e1ng k\u1ec3. H\u01b0\u1edbng d\u1eabn c\u1ee7a Hi\u1ec7p h\u1ed9i Y h\u1ecdc T\u00ecnh d\u1ee5c Qu\u1ed1c t\u1ebf (ISSM) v\u00e0 Hi\u1ec7p h\u1ed9i Ti\u1ebft ni\u1ec7u ch\u00e2u \u00c2u (EAU) cho th\u1ea5y t\u1ef7 l\u1ec7 hi\u1ec7n m\u1eafc chung l\u1ea7n l\u01b0\u1ee3t l\u00e0 19,8% t\u1ea1i Th\u1ed5 Nh\u0129 K\u1ef3 v\u00e0 25,8% t\u1ea1i Trung Qu\u1ed1c (3, 4). C\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a PE c\u00f3 li\u00ean quan \u0111\u1ebfn nhi\u1ec1u b\u1ec7nh l\u00fd k\u00e8m theo v\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1, ch\u1eb3ng h\u1ea1n nh\u01b0 t\u0103ng nh\u1ea1y c\u1ea3m quy \u0111\u1ea7u, tu\u1ed5i cao, h\u00fat thu\u1ed1c, u\u1ed1ng r\u01b0\u1ee3u, r\u1ed1i lo\u1ea1n t\u00e2m l\u00fd, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 t\u0103ng huy\u1ebft \u00e1p.<\/p>\n\n\n\n<p>Qu\u00e1 tr\u00ecnh xu\u1ea5t tinh b\u00ecnh th\u01b0\u1eddng l\u00e0 m\u1ed9t s\u1ef1 ki\u1ec7n sinh l\u00fd ph\u1ee9c t\u1ea1p, li\u00ean quan \u0111\u1ebfn h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng, th\u1ea7n kinh ngo\u1ea1i bi\u00ean, h\u1ec7 n\u1ed9i ti\u1ebft v\u00e0 h\u1ec7 sinh s\u1ea3n (5). B\u01b0\u1edbc \u0111\u1ea7u ti\u00ean trong \u0111i\u1ec1u tr\u1ecb PE th\u01b0\u1eddng l\u00e0 \u0111i\u1ec1u ch\u1ec9nh l\u1ed1i s\u1ed1ng, bao g\u1ed3m ng\u1eebng h\u00fat thu\u1ed1c, h\u1ea1n ch\u1ebf r\u01b0\u1ee3u bia, t\u1eadp luy\u1ec7n th\u1ec3 d\u1ee5c, v\u00e0 tr\u00e1nh th\u1ee9c khuya. Khi PE ch\u1ee7 y\u1ebfu do y\u1ebfu t\u1ed1 c\u1ea3m x\u00fac ho\u1eb7c t\u00e2m l\u00fd g\u00e2y ra, vi\u1ec7c gi\u1ea3m lo \u00e2u v\u00e0 s\u1eed d\u1ee5ng thu\u1ed1c \u0111i\u1ec1u h\u00f2a t\u00e2m tr\u1ea1ng c\u00f3 th\u1ec3 mang l\u1ea1i hi\u1ec7u qu\u1ea3. \u0110\u1ed3ng th\u1eddi, s\u1ef1 tham gia c\u1ee7a b\u1ea1n t\u00ecnh c\u0169ng \u0111\u01b0\u1ee3c xem l\u00e0 m\u1ed9t h\u01b0\u1edbng ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c.<\/p>\n\n\n\n<p>C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb PE hi\u1ec7n nay ch\u1ee7 y\u1ebfu bao g\u1ed3m thu\u1ed1c \u1ee9c ch\u1ebf t\u00e1i h\u1ea5p thu serotonin c\u00f3 ch\u1ecdn l\u1ecdc (SSRIs) \u0111\u01b0\u1eddng u\u1ed1ng, thu\u1ed1c g\u00e2y t\u00ea t\u1ea1i ch\u1ed7, li\u1ec7u ph\u00e1p t\u00e2m l\u00fd, li\u1ec7u ph\u00e1p h\u00e0nh vi, li\u1ec7u ph\u00e1p h\u1ed7 tr\u1ee3 b\u1eb1ng thi\u1ebft b\u1ecb, y h\u1ecdc c\u1ed5 truy\u1ec1n, \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf PDE5, li\u1ec7u ph\u00e1p s\u00f3ng xung k\u00edch c\u01b0\u1eddng \u0111\u1ed9 th\u1ea5p, k\u00edch th\u00edch th\u1ea7n kinh ch\u00e0y qua da, v\u00e0 can thi\u1ec7p ph\u1eabu thu\u1eadt (H\u00ecnh 1). Trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng, l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p ph\u00f9 h\u1ee3p nh\u1ea5t c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111\u01b0a ra d\u1ef1a tr\u00ean t\u00ecnh tr\u1ea1ng c\u1ee5 th\u1ec3 c\u1ee7a t\u1eebng b\u1ec7nh nh\u00e2n.<\/p>\n\n\n\n<p>Trong s\u1ed1 \u0111\u00f3, SSRIs v\u1eabn l\u00e0 m\u1ed9t trong nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i nh\u1ea5t nh\u1edd kh\u1ea3 n\u0103ng d\u00f9ng theo nhu c\u1ea7u, hi\u1ec7u qu\u1ea3 r\u00f5 r\u00e0ng v\u00e0 kh\u1edfi ph\u00e1t t\u00e1c d\u1ee5ng nhanh (6). Tuy nhi\u00ean, m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u00e1p \u1ee9ng ho\u1eb7c \u0111\u00e1p \u1ee9ng k\u00e9m, \u0111\u1ed3ng th\u1eddi c\u00f3 th\u1ec3 g\u1eb7p c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n nh\u01b0 \u0111au \u0111\u1ea7u, bu\u1ed3n ng\u1ee7, m\u1ea5t ng\u1ee7 v\u00e0 run, \u0111i\u1ec1u n\u00e0y th\u00fac \u0111\u1ea9y vi\u1ec7c t\u00ecm ki\u1ebfm nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb an to\u00e0n h\u01a1n v\u00e0 c\u00f3 t\u00ednh \u0111\u00edch cao h\u01a1n (7, 8). B\u00e0i vi\u1ebft n\u00e0y s\u1ebd tr\u00ecnh b\u00e0y chi ti\u1ebft c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb PE kh\u00e1c nhau d\u1ef1a tr\u00ean nh\u1eefng ti\u1ebfn b\u1ed9 nghi\u00ean c\u1ee9u hi\u1ec7n nay.<\/p>\n\n\n\n<p><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/blobs\/a59a\/12708263\/f16ce06aa13b\/fendo-16-1718109-g001.jpg\" alt=\"\"\/><\/figure>\n\n\n\n<p>\u0110i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c: Thu\u1ed1c \u1ee9c ch\u1ebf t\u00e1i h\u1ea5p thu serotonin c\u00f3 ch\u1ecdn l\u1ecdc (SSRIs)<\/p>\n\n\n\n<p>C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf t\u00e1i h\u1ea5p thu serotonin c\u00f3 ch\u1ecdn l\u1ecdc (SSRIs) ho\u1ea1t \u0111\u1ed9ng b\u1eb1ng c\u00e1ch \u1ee9c ch\u1ebf c\u00f3 ch\u1ecdn l\u1ecdc s\u1ef1 t\u00e1i h\u1ea5p thu serotonin (5-HT) v\u00e0o neuron ti\u1ec1n synap, l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 5-HT trong khe synap, t\u1eeb \u0111\u00f3 t\u0103ng c\u01b0\u1eddng d\u1eabn truy\u1ec1n th\u1ea7n kinh serotonin. T\u00e1c \u0111\u1ed9ng k\u00e9o d\u00e0i c\u1ee7a 5-HT l\u00ean c\u00e1c th\u1ee5 th\u1ec3 h\u1eadu synap s\u1ebd \u1ee9c ch\u1ebf cung ph\u1ea3n x\u1ea1 xu\u1ea5t tinh, cu\u1ed1i c\u00f9ng d\u1eabn \u0111\u1ebfn l\u00e0m ch\u1eadm qu\u00e1 tr\u00ecnh xu\u1ea5t tinh (9).<\/p>\n\n\n\n<p>C\u00e1c SSRIs nh\u01b0 paroxetine, fluoxetine v\u00e0 sertraline \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u00f3 kh\u1ea3 n\u0103ng k\u00e9o d\u00e0i \u0111\u00e1ng k\u1ec3 th\u1eddi gian xu\u1ea5t tinh trong \u00e2m \u0111\u1ea1o (IELT). Trong sinh l\u00fd h\u1ecdc xu\u1ea5t tinh, th\u1ee5 th\u1ec3 5-HT1a \u0111\u00f3ng vai tr\u00f2 ho\u1ea1t h\u00f3a, trong khi s\u1ef1 ho\u1ea1t h\u00f3a c\u1ee7a th\u1ee5 th\u1ec3 5-HT1b v\u00e0 5-HT2c l\u1ea1i c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf xu\u1ea5t tinh (10, 11).<\/p>\n\n\n\n<p>H\u01a1n n\u1eefa, c\u00e1c nghi\u00ean c\u1ee9u cho th\u1ea5y d\u00f9ng SSRIs h\u1eb1ng ng\u00e0y hi\u1ec7u qu\u1ea3 h\u01a1n so v\u1edbi d\u00f9ng theo nhu c\u1ea7u trong vi\u1ec7c tr\u00ec ho\u00e3n xu\u1ea5t tinh, qua \u0111\u00f3 kh\u1eb3ng \u0111\u1ecbnh vai tr\u00f2 then ch\u1ed1t c\u1ee7a 5-HT trong \u0111i\u1ec1u h\u00f2a ph\u1ea3n x\u1ea1 xu\u1ea5t tinh (12). C\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng c\u0169ng x\u00e1c nh\u1eadn r\u1eb1ng paroxetine c\u00f3 th\u1ec3 k\u00e9o d\u00e0i th\u1eddi gian giao h\u1ee3p v\u00e0 c\u1ea3i thi\u1ec7n m\u1ee9c \u0111\u1ed9 h\u00e0i l\u00f2ng t\u00ecnh d\u1ee5c \u1edf b\u1ec7nh nh\u00e2n xu\u1ea5t tinh s\u1edbm (PE), v\u00e0 nh\u1eefng t\u00e1c d\u1ee5ng n\u00e0y c\u00f3 li\u00ean quan \u0111\u1ebfn s\u1ef1 t\u0103ng c\u01b0\u1eddng d\u1eabn truy\u1ec1n th\u1ea7n kinh serotonin (13). Do \u0111\u00f3, t\u0103ng n\u1ed3ng \u0111\u1ed9 5-HT t\u1ea1i synap \u0111\u01b0\u1ee3c xem l\u00e0 m\u1ed9t bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c hi\u1ec7u qu\u1ea3 \u0111\u1ed1i v\u1edbi PE.<\/p>\n\n\n\n<p>Tr\u00ean l\u00e2m s\u00e0ng, c\u00e1c SSRIs \u0111\u01b0\u1ee3c chia th\u00e0nh hai nh\u00f3m l\u00e0 d\u00f9ng theo nhu c\u1ea7u v\u00e0 d\u00f9ng h\u1eb1ng ng\u00e0y, s\u1ef1 ph\u00e2n lo\u1ea1i n\u00e0y li\u00ean quan ch\u1eb7t ch\u1ebd \u0111\u1ebfn \u0111\u1eb7c \u0111i\u1ec3m d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a t\u1eebng thu\u1ed1c. Dapoxetine, v\u1edbi th\u1eddi gian b\u00e1n th\u1ea3i ng\u1eafn, l\u00e0 SSRI \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n chuy\u00ean bi\u1ec7t cho \u0111i\u1ec1u tr\u1ecb PE theo nhu c\u1ea7u. Ng\u01b0\u1ee3c l\u1ea1i, paroxetine v\u00e0 sertraline c\u00f3 th\u1eddi gian b\u00e1n th\u1ea3i d\u00e0i h\u01a1n, ph\u00f9 h\u1ee3p cho vi\u1ec7c s\u1eed d\u1ee5ng h\u1eb1ng ng\u00e0y. C\u00e1c nghi\u00ean c\u1ee9u cho th\u1ea5y n\u1ed3ng \u0111\u1ed9 paroxetine trong huy\u1ebft t\u01b0\u01a1ng \u0111\u1ea1t tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh sau kho\u1ea3ng 13 ng\u00e0y k\u1ec3 t\u1eeb khi b\u1eaft \u0111\u1ea7u d\u00f9ng thu\u1ed1c h\u1eb1ng ng\u00e0y (14).<\/p>\n\n\n\n<p>C\u00e1c v\u1ecb thu\u1ed1c \u0111\u00f4ng y gi\u00fap \u1ee9c ch\u1ebf t\u00e1i h\u1ea5p thu c\u00f3 ch\u1ecdn l\u1ecdc SSRIs<\/p>\n\n\n\n<p>C\u1ecf x\u1ea1 h\u01b0\u01a1ng<\/p>\n\n\n\n<p>Nh\u00f3m S\u01a1n tra, ti\u1ec3u m\u1ea1ch, b\u00e1ch h\u1ee3p, toan t\u00e1o nh\u00e2n, trong \u0111\u00f3 toan t\u00e1o nh\u00e2n l\u00e0 ok nh\u1ea5t, sau \u0111\u00f3 l\u00e0 l\u1ea1c ti\u00ean<\/p>\n\n\n\n<p>Th\u1ef1c t\u1ebf l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng l\u1ea1c ti\u00ean, toan t\u00e1o nh\u00e2n, th\u00eam \u0111an s\u00e2m gi\u00fap \u1ee9c ch\u1ebf t\u00e1i h\u1ea5p thu serotonin ok<\/p>\n\n\n\n<p>Kim t\u1ecfa c\u1ed1 tinh ho\u00e0n<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Hi\u1ec7u qu\u1ea3 theo t\u1eebng tr\u1ee5c:<\/h3>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><thead><tr><th>Tr\u1ee5c<\/th><th>V\u1ecb thu\u1ed1c<\/th><\/tr><\/thead><tbody><tr><td>Serotonin<\/td><td><strong>Toan t\u00e1o nh\u00e2n<\/strong><\/td><\/tr><tr><td>GABA \u2013 an th\u1ea7n<\/td><td><strong>L\u1ea1c ti\u00ean<\/strong><\/td><\/tr><tr><td>Tu\u1ea7n ho\u00e0n \u2013 BDNF<\/td><td><strong>\u0110an s\u00e2m<\/strong><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p>C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf t\u00e1i h\u1ea5p thu serotonin c\u00f3 ch\u1ecdn l\u1ecdc (SSRIs) l\u00e0 l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb h\u00e0ng \u0111\u1ea7u cho xu\u1ea5t tinh s\u1edbm, \u0111\u1eb7c bi\u1ec7t ph\u00f9 h\u1ee3p v\u1edbi xu\u1ea5t tinh s\u1edbm nguy\u00ean ph\u00e1t ho\u1eb7c xu\u1ea5t tinh s\u1edbm th\u1ee9 ph\u00e1t khi \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p v\u00e0 li\u1ec7u ph\u00e1p h\u00e0nh vi kh\u00f4ng mang l\u1ea1i hi\u1ec7u qu\u1ea3 (15). SSRIs c\u0169ng \u0111\u01b0\u1ee3c xem l\u00e0 li\u1ec7u ph\u00e1p d\u01b0\u1ee3c l\u00fd tuy\u1ebfn \u0111\u1ea7u trong \u0111i\u1ec1u tr\u1ecb PE, nh\u1ea5t l\u00e0 khi li\u1ec7u ph\u00e1p h\u00e0nh vi th\u1ea5t b\u1ea1i (15).<\/p>\n\n\n\n<p>Li\u1ec7u ph\u00e1p ph\u1ed1i h\u1ee3p SSRIs v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf phosphodiesterase-5 (PDE-5), ch\u1eb3ng h\u1ea1n nh\u01b0 tadalafil, \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 k\u00e9o d\u00e0i th\u1eddi gian xu\u1ea5t tinh t\u1ed1t h\u01a1n so v\u1edbi d\u00f9ng SSRIs \u0111\u01a1n thu\u1ea7n. M\u1ed9t nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng cho th\u1ea5y vi\u1ec7c k\u1ebft h\u1ee3p tadalafil v\u1edbi paroxetine ho\u1eb7c dapoxetine hi\u1ec7u qu\u1ea3 h\u01a1n so v\u1edbi \u0111i\u1ec1u tr\u1ecb \u0111\u01a1n tr\u1ecb b\u1eb1ng SSRI, \u0111\u1eb7c bi\u1ec7t \u1edf b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i (16).<\/p>\n\n\n\n<p>C\u1ea7n nh\u1ea5n m\u1ea1nh r\u1eb1ng dapoxetine hi\u1ec7n l\u00e0 thu\u1ed1c duy nh\u1ea5t \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t ch\u00ednh th\u1ee9c \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb xu\u1ea5t tinh s\u1edbm, trong khi c\u00e1c SSRIs kh\u00e1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng theo h\u00ecnh th\u1ee9c ngo\u00e0i ch\u1ec9 \u0111\u1ecbnh (off-label) (17). So v\u1edbi dapoxetine, c\u00e1c thu\u1ed1c nh\u01b0 paroxetine, sertraline v\u00e0 fluoxetine v\u1ed1n \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n ban \u0111\u1ea7u \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb tr\u1ea7m c\u1ea3m v\u00e0 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong l\u00e2m s\u00e0ng nh\u1eb1m l\u00e0m ch\u1eadm xu\u1ea5t tinh th\u00f4ng qua t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a ch\u00fang (18). Tuy nhi\u00ean, kh\u00e1c v\u1edbi dapoxetine c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m h\u1ea5p thu nhanh v\u00e0 th\u1ea3i tr\u1eeb nhanh, c\u00e1c thu\u1ed1c n\u00e0y c\u00f3 kh\u1edfi ph\u00e1t t\u00e1c d\u1ee5ng ch\u1eadm h\u01a1n v\u00e0 th\u1eddi gian b\u00e1n th\u1ea3i d\u00e0i h\u01a1n. Do \u0111\u00f3, c\u1ea7n d\u00f9ng h\u1eb1ng ng\u00e0y \u0111\u1ec3 \u0111\u1ea1t n\u1ed3ng \u0111\u1ed9 thu\u1ed1c \u1ed5n \u0111\u1ecbnh trong m\u00e1u, \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u00e1c d\u1ee5ng ph\u1ee5 xu\u1ea5t hi\u1ec7n th\u01b0\u1eddng xuy\u00ean h\u01a1n ho\u1eb7c k\u00e9o d\u00e0i h\u01a1n nh\u01b0 ch\u00f3ng m\u1eb7t, bu\u1ed3n n\u00f4n v\u00e0 xu\u1ea5t tinh mu\u1ed9n (19, 20).<\/p>\n\n\n\n<p>Ngo\u00e0i ra, vi\u1ec7c s\u1eed d\u1ee5ng l\u00e2u d\u00e0i c\u00f3 th\u1ec3 l\u00e0m suy gi\u1ea3m ch\u1ea5t l\u01b0\u1ee3ng tinh tr\u00f9ng v\u00e0 g\u00e2y ra c\u00e1c tri\u1ec7u ch\u1ee9ng cai thu\u1ed1c (21, 22). M\u1eb7c d\u00f9 c\u1ea3 li\u1ec7u ph\u00e1p ph\u1ed1i h\u1ee3p v\u00e0 \u0111\u01a1n tr\u1ecb b\u1eb1ng SSRIs \u0111\u1ec1u c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n\u2014nh\u01b0 ch\u00f3ng m\u1eb7t, bu\u1ed3n n\u00f4n, xu\u1ea5t tinh mu\u1ed9n ho\u1eb7c gi\u1ea3m ham mu\u1ed1n t\u00ecnh d\u1ee5c\u2014nh\u1eefng t\u00e1c d\u1ee5ng n\u00e0y nh\u00ecn chung \u1edf m\u1ee9c \u0111\u1ed9 ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c (23).<\/p>\n\n\n\n<p>T\u00f3m l\u1ea1i, SSRIs l\u00e0 l\u1ef1a ch\u1ecdn tuy\u1ebfn \u0111\u1ea7u trong \u0111i\u1ec1u tr\u1ecb xu\u1ea5t tinh s\u1edbm, v\u1edbi nhi\u1ec1u \u01b0u \u0111i\u1ec3m r\u00f5 r\u1ec7t v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn linh ho\u1ea1t d\u00f9ng theo nhu c\u1ea7u ho\u1eb7c d\u00f9ng h\u1eb1ng ng\u00e0y, t\u00f9y theo s\u1ef1 kh\u00e1c bi\u1ec7t v\u00e0 nhu c\u1ea7u c\u00e1 th\u1ec3 c\u1ee7a t\u1eebng b\u1ec7nh nh\u00e2n. Trong t\u01b0\u01a1ng lai, c\u00e1c nghi\u00ean c\u1ee9u c\u1ea7n ti\u1ebfp t\u1ee5c khai th\u00e1c nh\u1eefng c\u01a1 ch\u1ebf ngo\u00e0i con \u0111\u01b0\u1eddng 5-HT nh\u1eb1m t\u1ed1i \u01b0u h\u00f3a chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb PE.<\/p>\n\n\n\n<p>Thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m ba v\u00f2ng (Tricyclic antidepressants \u2013 TCAs)<\/p>\n\n\n\n<p>C\u00e1c thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m ba v\u00f2ng (TCAs) ch\u1ee7 y\u1ebfu \u0111\u1ea1t \u0111\u01b0\u1ee3c t\u00e1c d\u1ee5ng l\u00e0m ch\u1eadm xu\u1ea5t tinh th\u00f4ng qua vi\u1ec7c \u1ee9c ch\u1ebf t\u00e1i h\u1ea5p thu serotonin (5-HT) t\u1ea1i m\u00e0ng ti\u1ec1n synap c\u1ee7a neuron, t\u1eeb \u0111\u00f3 l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 5-HT v\u00e0 t\u0103ng c\u01b0\u1eddng d\u1eabn truy\u1ec1n th\u1ea7n kinh. Trong nh\u00f3m n\u00e0y, clomipramine l\u00e0 thu\u1ed1c \u0111\u1ea1i di\u1ec7n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u00e0 nghi\u00ean c\u1ee9u r\u1ed9ng r\u00e3i nh\u1ea5t trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng.<\/p>\n\n\n\n<p>Choi JB v\u00e0 c\u1ed9ng s\u1ef1 (24) \u0111\u00e3 ph\u00e2n ng\u1eabu nhi\u00ean 159 b\u1ec7nh nh\u00e2n xu\u1ea5t tinh s\u1edbm v\u00e0o nh\u00f3m gi\u1ea3 d\u01b0\u1ee3c (n = 53) v\u00e0 nh\u00f3m d\u00f9ng clomipramine (n = 106). Sau 12 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb, nh\u00f3m clomipramine cho th\u1ea5y th\u1eddi gian xu\u1ea5t tinh trong \u00e2m \u0111\u1ea1o (IELT) v\u00e0 \u0111i\u1ec3m PETT \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n r\u00f5 r\u1ec7t so v\u1edbi nh\u00f3m gi\u1ea3 d\u01b0\u1ee3c. Tuy nhi\u00ean, 15,7% b\u1ec7nh nh\u00e2n b\u1ecb bu\u1ed3n n\u00f4n v\u00e0 4,9% b\u1ecb ch\u00f3ng m\u1eb7t. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c clomipramine kh\u00f4ng c\u00f3 t\u00ednh ch\u1ecdn l\u1ecdc cao \u0111\u1ed1i v\u1edbi t\u00e1i h\u1ea5p thu 5-HT so v\u1edbi c\u00e1c SSRIs. Do c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf t\u00e1i h\u1ea5p thu k\u00e9p c\u1ea3 5-HT v\u00e0 norepinephrine, clomipramine th\u01b0\u1eddng \u0111\u01b0\u1ee3c x\u1ebfp l\u00e0 l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb h\u00e0ng hai khi SSRIs kh\u00f4ng hi\u1ec7u qu\u1ea3 (25).<\/p>\n\n\n\n<p>C\u00e1c b\u1eb1ng ch\u1ee9ng hi\u1ec7n nay cho th\u1ea5y clomipramine c\u00f3 kh\u1ea3 n\u0103ng k\u00e9o d\u00e0i \u0111\u00e1ng k\u1ec3 th\u1eddi gian xu\u1ea5t tinh, th\u1ec3 hi\u1ec7n hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb t\u1ed1t \u0111\u1ed1i v\u1edbi xu\u1ea5t tinh s\u1edbm. Tuy nhi\u00ean, TCAs d\u1ec5 g\u00e2y t\u00e1c d\u1ee5ng ph\u1ee5 kh\u00e1ng cholinergic v\u00e0 nguy c\u01a1 tim m\u1ea1ch, bao g\u1ed3m kh\u00f4 mi\u1ec7ng, t\u00e1o b\u00f3n, nh\u00ecn m\u1edd, ch\u00f3ng m\u1eb7t v\u00e0 h\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf (26, 27). V\u00ec v\u1eady, vi\u1ec7c ph\u00e1t tri\u1ec3n c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf t\u00e1i h\u1ea5p thu k\u00e9p c\u00f3 t\u00ednh ch\u1ecdn l\u1ecdc cao nh\u1eb1m gi\u1ea3m c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 kh\u00e1ng cholinergic v\u00e0 c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n kh\u00e1c l\u00e0 r\u1ea5t c\u1ea7n thi\u1ebft.<\/p>\n\n\n\n<p>D\u1eabu v\u1eady, TCAs v\u1eabn \u0111\u1eb7c bi\u1ec7t ph\u00f9 h\u1ee3p trong \u0111i\u1ec1u tr\u1ecb xu\u1ea5t tinh s\u1edbm th\u1ee9 ph\u00e1t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u1ed3ng m\u1eafc tr\u1ea7m c\u1ea3m v\u00e0 xu\u1ea5t tinh s\u1edbm.<\/p>\n\n\n\n<p>TCAs c\u00f3 th\u1ec3 d\u00f9ng th\u00eam m\u1eabu l\u1ec7, kh\u1ed5ng l\u1ec7, t\u1ee9c l\u00e0 tr\u1ecdng tr\u1ea5n an th\u1ea7n lo\u1ea1i nh\u1eb9 nh\u00e0ng h\u01a1n trong vi\u00ean ho\u00e0n. Vi\u1ec5n ch\u00ed, th\u1ea1ch x\u01b0\u01a1ng b\u1ed3 th\u00ec n\u00f3 h\u01a1i n\u1eb7ng<\/p>\n\n\n\n<p><strong>Thu\u1ed1c \u1ee9c ch\u1ebf phosphodiesterase-5 (PDE-5 inhibitors)<\/strong><\/p>\n\n\n\n<p>C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf phosphodiesterase-5 (PDE-5) l\u00e0 nh\u1eefng thu\u1ed1c kinh \u0111i\u1ec3n trong \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng d\u01b0\u01a1ng (ED), ti\u00eau bi\u1ec3u nh\u01b0 sildenafil v\u00e0 tadalafil. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a ch\u00fang ch\u1ee7 y\u1ebfu li\u00ean quan \u0111\u1ebfn vi\u1ec7c \u1ee9c ch\u1ebf s\u1ef1 ph\u00e2n h\u1ee7y cGMP, l\u00e0m t\u0103ng gi\u00e3n c\u01a1 tr\u01a1n th\u1ec3 hang v\u00e0 t\u0103ng l\u01b0u l\u01b0\u1ee3ng m\u00e1u \u0111\u1ed9ng m\u1ea1ch \u0111\u1ebfn d\u01b0\u01a1ng v\u1eadt (28).<\/p>\n\n\n\n<p>Th\u1ee9 nh\u1ea5t, c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf PDE-5 gi\u00fap t\u0103ng \u0111\u1ed9 c\u1ee9ng c\u1ee7a d\u01b0\u01a1ng v\u1eadt, t\u1eeb \u0111\u00f3 n\u00e2ng cao s\u1ef1 t\u1ef1 tin t\u00ecnh d\u1ee5c v\u00e0 gi\u1ea3m lo \u00e2u, qua \u0111\u00f3 gi\u00e1n ti\u1ebfp c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng ki\u1ec3m so\u00e1t xu\u1ea5t tinh. Th\u1ee9 hai, nh\u1eefng thu\u1ed1c n\u00e0y c\u00f3 th\u1ec3 l\u00e0m t\u0103ng ng\u01b0\u1ee1ng xu\u1ea5t tinh b\u1eb1ng c\u00e1ch gi\u1ea3m tr\u01b0\u01a1ng l\u1ef1c th\u1ea7n kinh giao c\u1ea3m t\u1ea1i ni\u1ec7u \u0111\u1ea1o, tuy\u1ebfn ti\u1ec1n li\u1ec7t v\u00e0 c\u00e1c v\u00f9ng li\u00ean quan kh\u00e1c (29).<\/p>\n\n\n\n<p>C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf PDE-5 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho xu\u1ea5t tinh s\u1edbm th\u1ee9 ph\u00e1t, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u1ed3ng th\u1eddi m\u1eafc r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng d\u01b0\u01a1ng. B\u1eb1ng ch\u1ee9ng cho th\u1ea5y trong m\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean tr\u00ean 160 b\u1ec7nh nh\u00e2n v\u1eeba ED v\u1eeba PE, \u0111\u01b0\u1ee3c chia th\u00e0nh nh\u00f3m d\u00f9ng tadalafil (n = 80) v\u00e0 nh\u00f3m gi\u1ea3 d\u01b0\u1ee3c (n = 80), sau 3 th\u00e1ng u\u1ed1ng tadalafil 5 mg m\u1ed7i ng\u00e0y, IELT trung b\u00ecnh (\u0111\u1ed9 l\u1ec7ch chu\u1ea9n) \u1edf nh\u00f3m tadalafil t\u0103ng t\u1eeb 37 (11,24) gi\u00e2y l\u00ean 120,5 (47,37) gi\u00e2y. K\u1ebft qu\u1ea3 n\u00e0y cho th\u1ea5y thu\u1ed1c \u1ee9c ch\u1ebf PDE-5 c\u00f3 th\u1ec3 k\u00e9o d\u00e0i \u0111\u00e1ng k\u1ec3 th\u1eddi gian xu\u1ea5t tinh, \u0111\u1ed3ng th\u1eddi c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng c\u01b0\u01a1ng (30).<\/p>\n\n\n\n<p>H\u01a1n n\u1eefa, nh\u01b0 Mohseni Rad H. v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 ch\u1ee9ng minh, li\u1ec7u ph\u00e1p ph\u1ed1i h\u1ee3p thu\u1ed1c \u1ee9c ch\u1ebf PDE-5 v\u1edbi SSRIs c\u00f3 t\u00e1c d\u1ee5ng hi\u1ec7p \u0111\u1ed3ng, hi\u1ec7u qu\u1ea3 h\u01a1n so v\u1edbi \u0111i\u1ec1u tr\u1ecb \u0111\u01a1n tr\u1ecb v\u1ec1 m\u1eb7t IELT. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 do t\u00e1c \u0111\u1ed9ng \u0111i\u1ec1u h\u00f2a b\u1ed5 sung l\u1eabn nhau \u1edf c\u1ea3 m\u1ee9c \u0111\u1ed9 th\u1ea7n kinh \u2013 m\u1ea1ch m\u00e1u v\u00e0 h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng (16). V\u00ec v\u1eady, thu\u1ed1c \u1ee9c ch\u1ebf PDE-5 cung c\u1ea5p m\u1ed9t l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb b\u1ed5 sung quan tr\u1ecdng cho xu\u1ea5t tinh s\u1edbm, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n k\u00e8m r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng d\u01b0\u01a1ng.<\/p>\n\n\n\n<p><strong>Nh\u00f3m n\u00e0y v\u1ec1 th\u1ea3o d\u01b0\u1ee3c c\u00f3<\/strong><\/p>\n\n\n\n<p><a href=\"https:\/\/thuoc115.com\/damduonghoacbac\/\" type=\"link\" id=\"https:\/\/thuoc115.com\/damduonghoacbac\/\">D\u00e2m d\u01b0\u01a1ng ho\u1eafc<\/a> (Icariin) c\u00f3 t\u00e1c d\u1ee5ng b\u1eb1ng 1\/10 \u0111\u1ebfn 1\/20 tadalafil<\/p>\n\n\n\n<p><a href=\"https:\/\/thuoc115.com\/bakichtim\/\" type=\"link\" id=\"https:\/\/thuoc115.com\/bakichtim\/\">Ba k\u00edch<\/a><\/p>\n\n\n\n<p>M\u1eadt nh\u00e2n (t\u0103ng testoteron t\u1ef1 do), gi\u1ea3m stress, kh\u00e1ng vi\u00eam<\/p>\n\n\n\n<p>C\u00e1c lo\u1ea1i h\u1ed7 tr\u1ee3 : K\u1ef3 t\u1eed, nh\u00e2n s\u00e2m, \u0111inh l\u0103ng, nh\u1ee5c thung dung<\/p>\n\n\n\n<p>\u00d4n b\u1ed5 th\u1eadn d\u01b0\u01a1ng d\u00f9ng h\u1ea1t c\u00e2y h\u1eb9 (c\u1eebu th\u00e1i t\u1eed)<\/p>\n\n\n\n<p>Thu\u1ed1c g\u00e2y t\u00ea t\u1ea1i ch\u1ed7<\/p>\n\n\n\n<p>Thu\u1ed1c g\u00e2y t\u00ea t\u1ea1i ch\u1ed7 l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p ph\u1ed5 bi\u1ebfn trong \u0111i\u1ec1u tr\u1ecb xu\u1ea5t tinh s\u1edbm (PE). C\u00e1c t\u00e1c nh\u00e2n n\u00e0y bao g\u1ed3m lidocaine, procaine, benzocaine, tetracaine v\u00e0 nhi\u1ec1u ch\u1ebf ph\u1ea9m ph\u1ed1i h\u1ee3p, v\u1edbi c\u00e1c \u01b0u \u0111i\u1ec3m nh\u01b0 d\u1ec5 s\u1eed d\u1ee5ng, kh\u1edfi ph\u00e1t t\u00e1c d\u1ee5ng nhanh v\u00e0 \u00edt t\u00e1c d\u1ee5ng ph\u1ee5 to\u00e0n th\u00e2n. Ch\u00fang \u0111\u1eb7c bi\u1ec7t ph\u00f9 h\u1ee3p trong \u0111i\u1ec1u tr\u1ecb xu\u1ea5t tinh s\u1edbm nguy\u00ean ph\u00e1t v\u00e0 th\u1ee9 ph\u00e1t do t\u0103ng nh\u1ea1y c\u1ea3m quy \u0111\u1ea7u (31). C\u00e1c nghi\u00ean c\u1ee9u cho th\u1ea5y vi\u1ec7c s\u1eed d\u1ee5ng d\u1ea1ng x\u1ecbt g\u00e2y t\u00ea ch\u1ee9a lidocaine v\u00e0 prilocaine, v\u1edbi ba nh\u00e1t x\u1ecbt tr\u01b0\u1edbc khi giao h\u1ee3p kho\u1ea3ng 5 ph\u00fat, c\u00f3 th\u1ec3 k\u00e9o d\u00e0i th\u1eddi gian xu\u1ea5t tinh v\u00e0 n\u00e2ng cao m\u1ee9c \u0111\u1ed9 h\u00e0i l\u00f2ng t\u00ecnh d\u1ee5c (32).<\/p>\n\n\n\n<p>Nh\u1eefng thu\u1ed1c n\u00e0y ho\u1ea1t \u0111\u1ed9ng b\u1eb1ng c\u00e1ch phong b\u1ebf c\u00e1c k\u00eanh natri t\u1ea1i nh\u1eefng v\u00f9ng c\u1ee5 th\u1ec3 nh\u01b0 quy \u0111\u1ea7u v\u00e0 r\u00e3nh v\u00e0nh, t\u1eeb \u0111\u00f3 gi\u1ea3m d\u1eabn truy\u1ec1n xung th\u1ea7n kinh v\u00e0 l\u00e0m suy gi\u1ea3m c\u1ea3m gi\u00e1c t\u1eeb d\u00e2y h\u00e3m v\u00e0 v\u00f9ng v\u00e0nh quy \u0111\u1ea7u, \u0111\u1ea1t \u0111\u01b0\u1ee3c t\u00e1c d\u1ee5ng g\u00e2y t\u00ea t\u1ea1i ch\u1ed7 (33).<\/p>\n\n\n\n<p>Trong m\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng tr\u00ean 150 b\u1ec7nh nh\u00e2n xu\u1ea5t tinh s\u1edbm, nh\u00f3m can thi\u1ec7p \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng x\u1ecbt lidocaine 5%, trong khi nh\u00f3m \u0111\u1ed1i ch\u1ee9ng d\u00f9ng x\u1ecbt gi\u1ea3 d\u01b0\u1ee3c n\u1ec1n c\u1ed3n. K\u1ebft qu\u1ea3 cho th\u1ea5y vi\u1ec7c b\u00f4i x\u1ecbt lidocaine 5% l\u00ean quy \u0111\u1ea7u tr\u01b0\u1edbc giao h\u1ee3p 10\u201320 ph\u00fat \u0111\u00e3 c\u1ea3i thi\u1ec7n \u0111i\u1ec3m AIPE, k\u00e9o d\u00e0i th\u1eddi gian xu\u1ea5t tinh trong \u00e2m \u0111\u1ea1o (IELT) v\u00e0 t\u0103ng t\u1ea7n su\u1ea5t giao h\u1ee3p so v\u1edbi nh\u00f3m \u0111\u1ed1i ch\u1ee9ng. C\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n ghi nh\u1eadn ch\u1ec9 l\u00e0 t\u00e1c d\u1ee5ng ph\u1ee5 t\u1ea1i ch\u1ed7 \u1edf m\u1ee9c \u0111\u1ed9 ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c (34).<\/p>\n\n\n\n<p>M\u1eb7c d\u00f9 thu\u1ed1c g\u00e2y t\u00ea t\u1ea1i ch\u1ed7 nh\u00ecn chung \u0111\u01b0\u1ee3c xem l\u00e0 an to\u00e0n trong \u0111i\u1ec1u tr\u1ecb PE, ch\u00fang v\u1eabn c\u00f3 th\u1ec3 g\u00e2y ra m\u1ed9t s\u1ed1 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n. Ph\u1ed5 bi\u1ebfn nh\u1ea5t l\u00e0 t\u00ea quy \u0111\u1ea7u qu\u00e1 m\u1ee9c, c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m kho\u00e1i c\u1ea3m t\u00ecnh d\u1ee5c. M\u1ed9t s\u1ed1 \u00edt b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 g\u1eb7p ng\u1ee9a ho\u1eb7c ban \u0111\u1ecf t\u1ea1i ch\u1ed7, nh\u01b0ng c\u00e1c tri\u1ec7u ch\u1ee9ng n\u00e0y th\u01b0\u1eddng nhanh ch\u00f3ng h\u1ebft sau khi r\u1eeda s\u1ea1ch thu\u1ed1c (35, 36). Benzocaine, m\u1ed9t thu\u1ed1c g\u00e2y t\u00ea kh\u00e1c, c\u0169ng c\u00f3 kh\u1ea3 n\u0103ng gi\u1ea3m \u0111\u1ed9 nh\u1ea1y c\u1ea3m c\u1ee7a d\u01b0\u01a1ng v\u1eadt v\u00e0 k\u00e9o d\u00e0i th\u1eddi gian xu\u1ea5t tinh. \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1ed9 nh\u1ea1y c\u1ea3m quy \u0111\u1ea7u cao, vi\u1ec7c s\u1eed d\u1ee5ng bao cao su ho\u1eb7c kh\u0103n lau ch\u1ee9a benzocaine c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb thay th\u1ebf (37).<\/p>\n\n\n\n<p>T\u00f3m l\u1ea1i, thu\u1ed1c g\u00e2y t\u00ea t\u1ea1i ch\u1ed7 c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 c\u1ea3 xu\u1ea5t tinh s\u1edbm nguy\u00ean ph\u00e1t v\u00e0 th\u1ee9 ph\u00e1t, \u0111\u1eb7c bi\u1ec7t ph\u00f9 h\u1ee3p v\u1edbi b\u1ec7nh nh\u00e2n t\u0103ng nh\u1ea1y c\u1ea3m quy \u0111\u1ea7u ho\u1eb7c kh\u00f4ng dung n\u1ea1p thu\u1ed1c u\u1ed1ng hay kh\u00f4ng mu\u1ed1n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c \u0111\u01b0\u1eddng u\u1ed1ng. Trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng, c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn c\u00e1c d\u1ea1ng b\u00e0o ch\u1ebf kh\u00e1c nhau t\u00f9y theo s\u1edf th\u00edch c\u00e1 nh\u00e2n, v\u00e0 \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u d\u00f9ng d\u1ef1a tr\u00ean hi\u1ec7u qu\u1ea3 c\u0169ng nh\u01b0 kh\u1ea3 n\u0103ng dung n\u1ea1p. C\u00e1c thu\u1ed1c n\u00e0y gi\u00fap gi\u1ea3m nh\u1ea1y c\u1ea3m d\u01b0\u01a1ng v\u1eadt v\u00e0 k\u00e9o d\u00e0i th\u1eddi gian xu\u1ea5t tinh; m\u1eb7c d\u00f9 c\u00f3 th\u1ec3 g\u00e2y gi\u1ea3m kho\u00e1i c\u1ea3m t\u00ecnh d\u1ee5c, nh\u01b0ng t\u00e1c d\u1ee5ng ph\u1ee5 n\u00e0y th\u01b0\u1eddng tho\u00e1ng qua v\u00e0 c\u00f3 th\u1ec3 ki\u1ec3m so\u00e1t, kh\u1eb3ng \u0111\u1ecbnh t\u00ednh an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u00e0y.<\/p>\n\n\n\n<p>https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC12708263<\/p>\n\n\n\n<p>Nh\u00f3m n\u00e0y v\u1ec1 th\u1ea3o d\u01b0\u1ee3c c\u00f3 kh\u00e1 nhi\u1ec1u lo\u1ea1i d\u00f9ng d\u1ea1ng x\u1ecbt nh\u01b0 b\u1ea1c h\u00e0 v\u00e0 c\u00e1c lo\u1ea1i nh\u01b0 b\u00e0i sau<\/p>\n\n\n\n<p><\/p>\n\n\n\n<p>C\u00f3 80 t\u00e0i li\u1ec7u tham kh\u1ea3o \u1edf cu\u1ed1i b\u00e0i, c\u00f3 th\u1eddi gian th\u00ec nghi\u00ean c\u1ee9u ti\u1ebfp. <\/p>\n\n\n\n<p>Theo nghi\u00ean c\u1ee9u ch\u00ednh th\u1ed1ng th\u00ec c\u00f3 c\u00e1c th\u1ec3 sau :<\/p>\n\n\n\n<p>1.Th\u1ec3 \u00e2m h\u01b0 h\u1ecfa v\u01b0\u1ee3ng  <\/p>\n\n\n\n<p>Ho\u00e0ng li\u00ean thanh t\u00e2m \u1ea9m, k\u1ebft h\u1ee3p gia \u0111\u0103ng t\u00e2m th\u1ea3o, ng\u0169 v\u1ecb t\u1eed, m\u1eabu l\u1ec7, long c\u1ed1t, <\/p>\n\n\n\n<p>Ho\u1eb7c d\u00f9ng ho\u00e0ng b\u00e1, sa nh\u00e2n, ng\u0169 v\u1ecb t\u1eed, m\u1eabu l\u1ec7, long c\u1ed1t, toan t\u00e1o nh\u00e2n, l\u1ea1c ti\u00ean<\/p>\n\n\n\n<p>2.Th\u1ec3 t\u00e2m t\u1ef3 h\u01b0 <\/p>\n\n\n\n<p>Gia v\u1ecb kim anh t\u1eed, khi\u1ebfm th\u1ef1c, n\u1ebfu kh\u00ed trung h\u1ea1 h\u00e3m gia th\u0103ng ma, s\u00e0i h\u1ed3<\/p>\n\n\n\n<p>3.Th\u1ec3 th\u1ea5p nhi\u1ec7t n\u1ed9i \u00f4n<\/p>\n\n\n\n<p>Ho\u00e0ng b\u00e1, ph\u1ee5c linh thanh nhi\u1ec7t l\u1ee3i th\u1ea5p<\/p>\n\n\n\n<p>\u0110an s\u00e2m, li\u00ean t\u00e2m, x\u01b0\u01a1ng b\u1ed3 : Thanh t\u00e2m an th\u1ea7n<\/p>\n\n\n\n<p>4.Th\u1ec3 th\u1eadn h\u01b0 b\u1ea5t c\u1ed1 : T\u1ea3 quy ho\u00e0n<\/p>\n\n\n\n<p>5.Th\u1ec3 th\u1eadn d\u01b0\u01a1ng h\u01b0 d\u00f9ng b\u00e0i h\u1eefu quy ho\u00e0n<\/p>\n\n\n\n<p>d\u01b0\u01a1ng nuy th\u00eam v\u1ecb T\u1ecfa d\u01b0\u01a1ng, Ba k\u00edch, Ng\u00f4 c\u00f4ng \u0111\u1ec3 \u00f4n th\u1eadn d\u01b0\u01a1ng,<\/p>\n\n\n\n<p>N\u1ebfu tinh d\u1ecbch lo\u00e3ng th\u00eam D\u00e2m d\u01b0\u01a1ng ho\u1eafc, Tang t\u1eed, T\u1eed h\u00e0 sa \u0111\u1ec3 b\u1ed5 th\u1eadn sinh tinh.<\/p>\n\n\n\n<p>N\u1ebfu k\u00e8m t\u1ef3 kh\u00ed h\u01b0, l\u00fac m\u1ec7t m\u1ecfi ho\u1ea1t tinh n\u1eb7ng h\u01a1n, ch\u00e1n \u0103n, t\u1ef1 h\u00e3n, th\u00ec th\u00eam v\u1ecb \u0110\u1eb3ng s\u00e2m, Ho\u00e0ng k\u1ef3, B\u1ea1ch tru\u1eadt.<\/p>\n\n\n\n<p>N\u1ebfu th\u1eadn h\u01b0 b\u1ea5t c\u1ed1 th\u00ec ngo\u00e0i c\u00e1c v\u1ecb b\u1ed5 th\u1eadn c\u00f2n th\u00eam c\u00e1c v\u1ecb c\u1ed1 s\u00e1p, c\u00f3 th\u1ec3 d\u00f9ng b\u00e0i \u201cKim t\u1ecfa c\u1ed1 th\u1eadn ho\u00e0n\u201d, \u201cTh\u1ee7y l\u1ee5c nh\u1ecb ti\u00ean \u0111an\u201d.<\/p>\n\n\n\n<p>N\u1ebfu ho\u1ea1t tinh v\u1ed1n do t\u00e2m th\u1eadn b\u1ea5t giao ph\u00e1t tri\u1ec3n th\u00e0nh, th\u00ec ngo\u00e0i c\u00e1c v\u1ecb b\u1ed5 th\u1eadn tinh c\u00f2n th\u00eam v\u1ecb d\u01b0\u1ee1ng t\u00e2m an th\u1ea7n, c\u00f3 th\u1ec3 d\u00f9ng b\u00e0i \u201cBan long ho\u00e0n\u201d ho\u1eb7c \u201cTang phi\u00eau ti\u00eau t\u00e1n\u201d.<\/p>\n<!-- relpost-thumb-wrapper --><div class=\"relpost-thumb-wrapper\"><!-- filter-class --><div class=\"relpost-thumb-container\"><style>.relpost-block-single-image, .relpost-post-image { margin-bottom: 10px; 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