{"id":18191,"date":"2023-04-12T18:15:15","date_gmt":"2023-04-12T11:15:15","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=18191"},"modified":"2023-04-13T18:26:42","modified_gmt":"2023-04-13T11:26:42","slug":"thong-khi-co-hoc-nam-sap-co-che-sinh-ly-va-hieu-qua","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/12\/thong-khi-co-hoc-nam-sap-co-che-sinh-ly-va-hieu-qua\/","title":{"rendered":"Th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc n\u1eb1m s\u1ea5p: C\u01a1 ch\u1ebf sinh l\u00fd v\u00e0 hi\u1ec7u qu\u1ea3"},"content":{"rendered":"<p><strong>Th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc n\u1eb1m s\u1ea5p l\u00e0 ph\u01b0\u01a1ng ph\u00e1p th\u00f4ng kh\u00ed \u0111\u01b0\u1ee3c cung c\u1ea5p khi b\u1ec7nh nh\u00e2n trong t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p. \u0110\u00e2y l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ea5p (ARDS) nh\u1eb1m c\u1ea3i thi\u1ec7n s\u1ef1 oxy h\u00f3a khi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p th\u00f4ng kh\u00ed truy\u1ec1n th\u1ed1ng kh\u00f4ng \u0111\u1ee7 hi\u1ec7u qu\u1ea3 (v\u00ed d\u1ee5: th\u00f4ng kh\u00ed \u00a0b\u1ea3o v\u1ec7 ph\u1ed5i). C\u01a1 ch\u1ebf sinh l\u00fd c\u1ee7a t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p, li\u00ean quan \u0111\u1ebfn hi\u1ec7u qu\u1ea3 c\u1ee7a c\u01a1 ch\u1ebf n\u00e0y s\u1ebd \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u trong b\u00e0i vi\u1ebft<\/strong>.<\/p>\n<figure style=\"width: 521px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" src=\"https:\/\/cafefcdn.com\/2020\/4\/17\/photo-1-15871290544611664576153.jpg\" alt=\"Tu-the-nam-sap-trong-dieu-tri-ARDS\" width=\"521\" height=\"293\" \/><figcaption class=\"wp-caption-text\">T\u01b0 th\u1ebf n\u1eb1m s\u1ea5p trong \u0111i\u1ec1u tr\u1ecb ARDS<\/figcaption><\/figure>\n<h2>1. C\u01a1 ch\u1ebf sinh l\u00fd t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p<\/h2>\n<p>T\u01b0 th\u1ebf n\u1eb1m s\u1ea5p \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n m\u1eafc ARDS n\u1eb7ng v\u00e0 kh\u00f3 \u0111i\u1ec1u tr\u1ecb. Tuy nhi\u00ean, c\u1ea7n l\u01b0u \u00fd r\u1eb1ng t\u01b0 th\u1ebf n\u00e0y c\u00f3 nhi\u1ec1u ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c bi\u1ebfn ch\u1ee9ng kh\u00f4ng mong mu\u1ed1n. B\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 k\u1ef9 l\u01b0\u1ee1ng \u0111\u1ec3 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh s\u1eed d\u1ee5ng t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p v\u00e0 tr\u00e1nh c\u00e1c bi\u1ebfn ch\u1ee9ng c\u00f3 th\u1ec3 c\u00f3.<\/p>\n<p>T\u01b0 th\u1ebf n\u1eb1m s\u1ea5p thay \u0111\u1ed5i ch\u1ee9ng n\u0103ng h\u00f4 h\u1ea5p v\u1ec1 c\u1ea3 c\u01a1 h\u1ecdc v\u00e0 sinh l\u00fd c\u1ee7a qu\u00e1 tr\u00ecnh trao \u0111\u1ed5i kh\u00ed t\u1ea1i ph\u1ebf nang \u0111\u1ec3 d\u1eabn \u0111\u1ebfn c\u1ea3i thi\u1ec7n oxy h\u00f3a m\u00e1u m\u1ed9t c\u00e1ch \u0111\u00e1ng k\u1ec3. C\u1ea3i thi\u1ec7n oxy h\u00f3a m\u00e1u trong qu\u00e1 tr\u00ecnh th\u00f4ng kh\u00ed t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a s\u1ef1 ph\u1ed1i h\u1ee3p \u0111a y\u1ebfu t\u1ed1. Nh\u00ecn chung, t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p c\u1ea3i thi\u1ec7n trao \u0111\u1ed5i kh\u00ed b\u1eb1ng c\u00e1ch gi\u1ea3m thi\u1ec3u s\u1ef1 ch\u00eanh l\u1ec7ch v\u1ec1 \u00e1p su\u1ea5t xuy\u00ean ph\u1ed1i (transpulmonary pressure) gi\u1eefa m\u1eb7t l\u01b0ng v\u00e0 m\u1eb7t ng\u1ef1c c\u1ee7a l\u1ed3ng ng\u1ef1c, gi\u1ea3m ch\u00e8n \u00e9p l\u00ean m\u1eb7t l\u01b0ng c\u1ee7a ph\u1ed5i v\u00e0 c\u1ea3i thi\u1ec7n t\u01b0\u1edbi m\u00e1u ph\u1ed5i.<\/p>\n<p><strong>Gi\u1ea3m thi\u1ec3u s\u1ef1 ch\u00eanh l\u1ec7ch v\u1ec1 \u00e1p su\u1ea5t xuy\u00ean ph\u1ed1i (transpulmonary pressure &#8211; Ptp)<\/strong> gi\u1eefa m\u1eb7t l\u01b0ng v\u00e0 m\u1eb7t ng\u1ef1c c\u1ee7a l\u1ed3ng ng\u1ef1c &#8211; \u00c1p l\u1ef1c gi\u00fap ph\u1ed5i n\u1edf ra \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 \u00e1p xu\u1ea5t xuy\u00ean ph\u1ed5i, c\u00f3 gi\u00e1 tr\u1ecb b\u1eb1ng ch\u00eanh l\u1ec7ch \u00e1p l\u1ef1c \u0111\u01b0\u1eddng th\u1edf (airway pressure &#8211; Paw) v\u00e0 \u00e1p l\u1ef1c trong khoang m\u00e0ng ph\u1ed5i (pleural pressure &#8211; Ppl). Khi b\u1ec7nh nh\u00e2n n\u1eb1m ng\u1eeda, Ppl \u1edf m\u1eb7t l\u01b0ng c\u1ee7a l\u1ed3ng ng\u1ef1c c\u00f3 gi\u00e1 tr\u1ecb cao h\u01a1n Ppl \u1edf m\u1eb7t tr\u01b0\u1edbc c\u1ee7a l\u1ed3ng ng\u1ef1c, \u0111i\u1ec1u n\u00e0y l\u00e0m cho Ptp \u1edf m\u1eb7t l\u01b0ng c\u00f3 gi\u00e1 tr\u1ecb th\u1ea5p h\u01a1n \u1edf m\u1eb7t tr\u01b0\u1edbc. Nh\u01b0 v\u1eady c\u00e1c ph\u1ebf nang \u1edf m\u1eb7t tr\u01b0\u1edbc l\u1ed3ng ng\u1ef1c s\u1ebd c\u00f3 xu h\u01b0\u1edbng d\u00e3n n\u1edf nhi\u1ec1u h\u01a1n c\u00e1c ph\u1ebf nang \u1edf m\u1eb7t l\u01b0ng. Trong c\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a ARDS, hi\u1ec7n t\u01b0\u1ee3ng ch\u00eanh l\u1ec7ch n\u00e0y tr\u1edf n\u00ean tr\u1ea7m tr\u1ecdng h\u01a1n; d\u1eabn \u0111\u1ebfn k\u1ebft qu\u1ea3 l\u00e0 c\u00e1c ph\u1ebf nang c\u1ee7a m\u1eb7t tr\u01b0\u1edbc l\u1ed3ng ng\u1ef1c c\u00f3 xu h\u01b0\u1edbng b\u1ecb c\u0103ng ph\u1ed3ng qu\u00e1 m\u1ee9c, c\u00f2n c\u00e1c ph\u1ebf nang \u1edf m\u1eb7t sau th\u00ec c\u00f3 nguy c\u01a1 b\u1ecb x\u1eb9p \u0111i. Khi \u0111\u1eb7t b\u1ec7nh nh\u00e2n \u1edf t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p, Ppl l\u00fac n\u00e0y s\u1ebd cao h\u01a1n \u1edf m\u1eb7t ng\u1ef1c v\u00e0 th\u1ea5p h\u01a1n \u1edf m\u1eb7t l\u01b0ng l\u00e0m gi\u1ea3m s\u1ef1 ch\u00eanh l\u1ec7ch Ptp \u1edf hai m\u1eb7t c\u1ee7a l\u1ed3ng ng\u1ef1c. \u0110i\u1ec1u n\u00e0y gi\u00fap l\u00e0m gi\u1ea3m s\u1ef1 c\u0103ng ph\u1ed3ng qu\u00e1 m\u1ee9c \u1edf c\u00e1c ph\u1ebf nang m\u1eb7t tr\u01b0\u1edbc v\u00e0 s\u1ef1 \u0111\u00f3ng x\u1eb9p c\u1ee7a c\u00e1c ph\u1ebf nang m\u1eb7t sau. Nh\u01b0 v\u1eady gi\u1ea3m \u0111\u01b0\u1ee3c nguy c\u01a1 t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do m\u00e1y th\u1edf \u0111\u1ebfn t\u1eeb vi\u1ec7c c\u0103n ph\u1ed3ng qu\u00e1 m\u1ee9c v\u00e0 \u0111\u00f3ng x\u1eb9p l\u1eadp \u0111i l\u1eadp l\u1ea1i c\u1ee7a c\u00e1c ph\u1ebf nang. C\u00f9ng v\u1edbi m\u1ee9c \u00e1p l\u1ef1c d\u01b0\u01a1ng cu\u1ed1i th\u00ec th\u1edf ra (PEEP) ph\u00f9 h\u1ee3p, t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p c\u0169ng c\u00f3 th\u1ec3 gi\u00fap m\u1edf tr\u1edf l\u1ea1i c\u00e1c ph\u1ebf nang \u0111\u00e3 b\u1ecb \u0111\u00f3ng x\u1eb9p \u1edf t\u01b0 th\u1ebf n\u1eb1m ng\u1eeda. C\u00e1c s\u1ef1 ki\u1ec7n n\u00e0y \u0111\u1ec1u gi\u00fap c\u1ea3i thi\u1ec7n th\u00f4ng kh\u00ed v\u00e0 s\u1ef1 oxy h\u00f3a m\u00e1u.<\/p>\n<p><strong>Gi\u1ea3m s\u1ef1 ch\u00e8n \u00e9p ph\u1ed5i<\/strong> &#8211; S\u1ef1 ch\u00e8n \u00e9p l\u00ean ph\u1ed5i c\u1ee7a tim v\u00e0 c\u01a1 ho\u00e0nh c\u00f3 th\u1ec3 gi\u1ea3m b\u1edbt \u1edf t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p. Khi m\u1ed9t b\u1ec7nh nh\u00e2n m\u1eafc ARDS n\u1eb1m ng\u1eeda, tim v\u00e0 c\u01a1 ho\u00e0nh c\u00f3 xu h\u01b0\u1edbng ch\u00e8n \u00e9p l\u00ean c\u00e1c v\u00f9ng nhu m\u00f4 ph\u1ed5i k\u1ebf c\u1eadn. \u00a0Hi\u1ec7n t\u01b0\u1ee3ng n\u00e0y c\u00f3 th\u1ec3 l\u00e0 do c\u00e1c t\u1ea1ng trong \u1ed5 b\u1ee5ng \u0111\u1ea9y c\u01a1 ho\u00e0nh l\u00ean tr\u00ean, t\u00ecnh tr\u1ea1ng n\u00e0y tr\u1edf n\u00ean nghi\u00eam tr\u1ecdng h\u01a1n khi c\u01a1 ho\u00e0nh b\u1ecb m\u1ea5t tr\u01b0\u01a1ng l\u1ef1c khi s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c an th\u1ea7n v\u00e0 d\u00e3n c\u01a1 khi th\u1edf m\u00e1y. S\u1ef1 n\u00e9n b\u1edfi tim v\u00e0 c\u01a1 ho\u00e0nh c\u00f3 th\u1ec3 l\u00e0m n\u1eb7ng th\u00eam hi\u1ec7n t\u01b0\u1ee3ng x\u1eb9p ph\u1ed5i, g\u00e2y gi\u1ea3m oxy h\u00f3a m\u00e1u v\u00e0 t\u0103ng kh\u1ea3 n\u0103ng t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do m\u00e1y th\u1edf. Khi b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u1eb7t \u1edf t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p, tim ng\u00e3 l\u00ean b\u00ean tr\u00ean x\u01b0\u01a1ng \u1ee9c, gi\u1ea3m ch\u00e8n \u00e9p l\u00ean nhu m\u00f4 ph\u1ed5i xung quanh. C\u01a1 ho\u00e0nh l\u00fac n\u00e0y c\u0169ng b\u1ecb \u0111\u1ea9y xu\u1ed1ng d\u01b0\u1edbi, gi\u1ea3m ch\u00e8n \u00e9p l\u00ean nhu m\u00f4 ph\u1ed5i. K\u1ebft qu\u1ea3 l\u00e0 gi\u00fap c\u1ea3i hi\u1ec7n th\u00f4ng kh\u00ed v\u00e0 s\u1ef1 oxy h\u00f3a m\u00e1u.<\/p>\n<p><strong>C\u1ea3i thi\u1ec7n s\u1ef1 t\u01b0\u1edbi m\u00e1u ph\u1ed5i<\/strong> &#8211; Trong ARDS, c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng b\u1ea5t t\u01b0\u01a1ng x\u1ee9ng th\u00f4ng kh\u00ed &#8211; t\u01b0\u1edbi m\u00e1u \u1edf t\u01b0 th\u1ebf n\u1eb1m ng\u1eeda, v\u00ec t\u01b0\u1edbi m\u00e1u cao h\u01a1n nh\u01b0ng ph\u1ed5i th\u00f4ng kh\u00ed k\u00e9m h\u01a1n v\u00e0 c\u00e1c ph\u1ebf nang c\u00f3 nguy b\u1ecb \u0111\u00f3ng s\u1eadp \u1edf m\u1eb7t l\u01b0ng c\u1ee7a l\u1ed3ng ng\u1ef1c. T\u01b0 th\u1ebf n\u1eb1m s\u1ea5p gi\u00fap c\u1ea3i thi\u1ec7n t\u01b0\u01a1ng x\u00fang th\u00f4ng kh\u00ed &#8211; t\u01b0\u1edbi m\u00e1u. Ngo\u00e0i ra, th\u1ef1c nghi\u1ec7m c\u00f2n quan s\u00e1t \u0111\u01b0\u1ee3c r\u1eb1ng c\u00f3 s\u1ef1 t\u0103ng cung l\u01b0\u1ee3ng tim khi chuy\u1ec3n sang t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p. \u0110i\u1ec1u n\u00e0y \u0111\u01b0\u1ee3c cho l\u00e0 do t\u00e1c \u0111\u1ed9ng c\u1ee7a vi\u1ec7c t\u0103ng c\u01b0\u1eddng quy \u0111\u1ed9ng ph\u1ebf nang, m\u1edf ph\u1ed5i v\u00e0 gi\u1ea3m co th\u1eaft m\u1ea1ch ph\u1ed5i do gi\u1ea3m oxy m\u00e1u gi\u00fap t\u0103ng ti\u1ec1n t\u1ea3i c\u1ee7a v\u00e0 gi\u1ea3m h\u1eadu t\u1ea3i c\u1ee7a th\u1ea5t ph\u1ea3i, c\u1ea3i thi\u1ec7n t\u01b0\u1edbi m\u00e1u ph\u1ed5i.<\/p>\n<h2>2. Hi\u1ec7u qu\u1ea3 c\u1ee7a t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p trong \u0111i\u1ec1u tr\u1ecb ARDS<\/h2>\n<p>D\u1ef1a tr\u00ean c\u00e1c c\u01a1 s\u1edf sinh l\u00fd t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p, ng\u01b0\u1eddi ta ghi nh\u1eadn \u0111\u01b0\u1ee3c nh\u1eefng b\u1eb1ng ch\u1ee9ng cho th\u1ea5y l\u1ee3i \u00edch c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p th\u00f4ng kh\u00ed n\u00e0y trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n ARDS n\u1eb7ng v\u00e0 kh\u00f3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n<ul>\n<li>\u0110\u00e3 c\u00f3 nhi\u1ec1u nghi\u00ean c\u1ee9u cho th\u1ea5y r\u1eb1ng \u0111\u1ed1i v\u1edbi h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n m\u1eafc ARDS (l\u00ean \u0111\u1ebfn 70%), th\u1edf d\u01b0\u1edbi t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p c\u00f3 th\u1ec3 t\u0103ng PaO2, cho ph\u00e9p gi\u1ea3m FiO2. V\u00ed d\u1ee5, trong m\u1ed9t nghi\u00ean c\u1ee9u kh\u00f4ng ki\u1ec3m so\u00e1t tr\u00ean 13 b\u1ec7nh nh\u00e2n m\u1eafc ARDS v\u1eeba trung b\u00ecnh v\u1eeba n\u1eb7ng, hai ph\u1ea7n ba s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 ph\u1ea3n \u1ee9ng k\u00e9o d\u00e0i \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 t\u0103ng 10 mmHg trong PaO2 trong 30 ph\u00fat \u0111\u1ea7u ti\u00ean c\u1ee7a th\u1edf d\u01b0\u1edbi t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p, d\u1ef1 b\u00e1o m\u1ed9t s\u1ef1 t\u0103ng PaO2 k\u00e9o d\u00e0i trong hai gi\u1edd ti\u1ebfp theo.<\/li>\n<li>D\u1eef li\u1ec7u th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng hi\u1ec7n c\u00f3 cho th\u1ea5y th\u1edf d\u01b0\u1edbi t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong \u1edf b\u1ec7nh nh\u00e2n m\u1eafc ARDS trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng (t\u1ee9c l\u00e0 PaO2: FiO2 &lt;150 mmHg) \u0111\u01b0\u1ee3c qu\u1ea3n l\u00fd chi\u1ebfn l\u01b0\u1ee3t th\u00f4ng kh\u00ed b\u1ea3o v\u1ec7 ph\u1ed5i. Trong m\u1ed9t ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p, th\u1edf d\u01b0\u1edbi t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong 23%.<\/li>\n<\/ul>\n<p>Khi s\u1eed d\u1ee5ng m\u00e1y th\u1edf nh\u00e2n t\u1ea1o, c\u00e1c chuy\u00ean gia y t\u1ebf t\u1ea1i <a href=\"https:\/\/vinmec.com\/vi\/dangkykham\/\">Vinmec<\/a> lu\u00f4n c\u1eadp nh\u1eadt ki\u1ebfn th\u1ee9c v\u00e0 k\u1ef9 n\u0103ng \u0111\u1ec3 \u00e1p d\u1ee5ng c\u00e1c k\u1ef9 thu\u1eadt ti\u1ebfn b\u1ed9 v\u00e0 cung c\u1ea5p ch\u0103m s\u00f3c t\u1ed1t nh\u1ea5t cho b\u1ec7nh nh\u00e2n<\/p>\n<p>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/p>\n<p>Bloomfield R, Noble DW, Sudlow A. Prone position for acute respiratory failure in adults. Cochrane Database Syst Rev. 2015 Nov 13;2015(11):CD008095. doi: 10.1002\/14651858.CD008095.pub2. PMID: 26561745; PMCID: PMC6464920.<\/p>\n<div class=\"page\" title=\"Page 1\">\n<div class=\"section\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<p>Atul Malhotra, MD. Prone ventilation for adult patients with acute respiratory distress syndrome<em>, Uptodate<\/em>, (Accessed April 11, 2023)<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc n\u1eb1m s\u1ea5p l\u00e0 ph\u01b0\u01a1ng ph\u00e1p th\u00f4ng kh\u00ed \u0111\u01b0\u1ee3c cung c\u1ea5p khi b\u1ec7nh nh\u00e2n trong t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p. \u0110\u00e2y l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ea5p (ARDS) nh\u1eb1m c\u1ea3i thi\u1ec7n s\u1ef1 oxy h\u00f3a khi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p th\u00f4ng kh\u00ed truy\u1ec1n th\u1ed1ng [&hellip;]<\/p>\n","protected":false},"author":37,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[23,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc n\u1eb1m s\u1ea5p: C\u01a1 ch\u1ebf sinh l\u00fd v\u00e0 hi\u1ec7u qu\u1ea3 - Vinmec<\/title>\n<meta name=\"description\" content=\"T\u01b0 th\u1ebf n\u1eb1m s\u1ea5p \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n m\u1eafc ARDS n\u1eb7ng. 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