{"id":19452,"date":"2023-04-14T21:06:28","date_gmt":"2023-04-14T14:06:28","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=19452"},"modified":"2023-04-17T15:21:27","modified_gmt":"2023-04-17T08:21:27","slug":"dieu-chinh-thuoc-truoc-phau-thuat-tim","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/dieu-chinh-thuoc-truoc-phau-thuat-tim\/","title":{"rendered":"\u0110i\u1ec1u ch\u1ec9nh thu\u1ed1c tr\u01b0\u1edbc ph\u1eabu thu\u1eadt tim nh\u01b0 th\u1ebf n\u00e0o?"},"content":{"rendered":"

\u0110i\u1ec1u ch\u1ec9nh thu\u1ed1c\u00a0 tr\u01b0\u1edbc \u0111\u00f3 v\u00e0 hi\u1ec7n t\u1ea1i c\u1ee7a b\u1ec7nh nh\u00e2n l\u00e0 r\u1ea5t quan tr\u1ecdng. \u0110\u1eb7c bi\u1ec7t, c\u1ea7n ch\u00fa \u00fd \u0111\u1ebfn c\u00e1c lo\u1ea1i thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u s\u1ebd ti\u1ebfp t\u1ee5c ho\u1eb7c ng\u1eebng tr\u01b0\u1edbc khi ph\u1eabu thu\u1eadt tim, t\u00f9y thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng.<\/strong><\/p>\n

1.C\u00e1c lo\u1ea1i thu\u1ed1c c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh:<\/strong><\/h2>\n
    \n
  • Aspirin (ASA) th\u01b0\u1eddng \u0111\u01b0\u1ee3c d\u00f9ng cho b\u1ec7nh nh\u00e2n thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 c\u01a1 tim. Vi\u1ec7c s\u1eed d\u1ee5ng aspirin tr\u01b0\u1edbc ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c coi l\u00e0 c\u00f3 l\u1ee3i trong vi\u1ec7c gi\u1ea3m thi\u1ec3u\u00a0 t\u1ef7 l\u1ec7 t\u1eed vong sau ph\u1eabu thu\u1eadt tim.
    \nVi\u1ec7c s\u1eed d\u1ee5ng aspirin tr\u01b0\u1edbc ph\u1eabu thu\u1eadt tim \u0111\u01b0\u1ee3c coi l\u00e0 c\u00f3 l\u1ee3i trong vi\u1ec7c gi\u1ea3m thi\u1ec3u t\u1ef7 l\u1ec7 t\u1eed vong sau ph\u1eabu thu\u1eadt, v\u00e0 c\u1ea3i thi\u1ec7n l\u01b0u th\u00f4ng m\u00e1u c\u1ee7a \u0111\u1ed9ng m\u1ea1ch v\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a b\u1eafc c\u1ea7u m\u1ea1ch v\u00e0nh (CABG). Aspirin g\u1eafn k\u1ebft v\u1edbi cyclooxygenase (COX) c\u1ee7a ti\u1ec3u c\u1ea7u, l\u00e0m gi\u1ea3m s\u1ef1 h\u00ecnh th\u00e0nh tromboxan A2 v\u00e0 \u1ee9c ch\u1ebf s\u1ef1 k\u1ebft d\u00ednh c\u1ee7a ti\u1ec3u c\u1ea7u trong su\u1ed1t tu\u1ed5i th\u1ecd c\u1ee7a ch\u00fang (7-10 ng\u00e0y). Do \u0111\u00f3, aspirin s\u1ebd t\u0103ng s\u1ef1 r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u tr\u00ean qu\u00e1 tr\u00ecnh s\u1eed d\u1ee5ng tu\u1ea7n ho\u00e0i ngo\u00e0i c\u01a1 th\u1ec3 (CPB).<\/li>\n
  • M\u1eb7c d\u00f9 vi\u1ec7c s\u1eed d\u1ee5ng aspirin tr\u01b0\u1edbc ph\u1eabu thu\u1eadt t\u0103ng l\u01b0\u1ee3ng m\u00e1u m\u1ea5t trong th\u1eddi gian quanh ph\u1eabu thu\u1eadt, \u0111i\u1ec1u n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c ghi nh\u1eadn \u1edf b\u1ec7nh nh\u00e2n d\u00f9ng li\u1ec1u cao h\u01a1n 81 mg\/ng\u00e0y. Do \u0111\u00f3, khuy\u1ebfn c\u00e1o ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng aspirin 81 mg\/ng\u00e0y cho \u0111\u1ebfn ng\u00e0y ph\u1eabu thu\u1eadt \u0111\u1ed1i v\u1edbi h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n ti\u1ebfn h\u00e0nh b\u1eafc c\u1ea7u m\u1ea1ch v\u00e0nh (CABG). \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n ti\u1ebfn h\u00e0nh c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt tim h\u1edf kh\u00e1c, ng\u1eebng s\u1eed d\u1ee5ng aspirin 3-5 ng\u00e0y tr\u01b0\u1edbc \u0111\u00f3 s\u1ebd \u0111\u1ee7 \u0111\u1ec3 cho ph\u00e9p t\u00e1i t\u1ea1o \u0111\u1ea7y \u0111\u1ee7 ti\u1ec3u c\u1ea7u gi\u1ea3m thi\u1ec3u t\u00e1c d\u1ee5ng ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u.<\/li>\n
  • \u0110\u00e1p \u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n v\u1edbi t\u00e1c d\u1ee5ng ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u c\u1ee7a aspirin r\u1ea5t kh\u00e1c nhau. B\u1ec7nh nh\u00e2n d\u00f9ng li\u1ec1u cao aspirin v\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u, nh\u01b0 b\u1ec7nh Von Willebrand v\u00e0 suy th\u1eadn c\u1ea5p, c\u0169ng c\u00f3 th\u1ec3 g\u00e2y ch\u1ea3y nhi\u1ec1u m\u00e1u. N\u1ebfu nh\u1eadn ra nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y, c\u00f3 th\u1ec3 khuy\u1ebfn c\u00e1o ng\u1eebng aspirin v\u00e0i ng\u00e0y tr\u01b0\u1edbc ph\u1eabu thu\u1eadt.<\/li>\n
  • C\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng s\u1ef1 k\u1ebft d\u00ednh c\u1ee7a ti\u1ec3u c\u1ea7u v\u00e0 s\u1ef1 h\u00ecnh th\u00e0nh thromboxan t\u0103ng cao trong giai \u0111o\u1ea1n sau ph\u1eabu thu\u1eadt, ngay c\u1ea3 v\u1edbi b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng aspirin tr\u01b0\u1edbc ph\u1eabu thu\u1eadt. Do \u0111\u00f3, b\u1ec7nh nh\u00e2n kh\u00e1ng aspirin s\u1ebd g\u00e2y ra nguy c\u01a1 t\u1eafc \u0111\u1ed9ng m\u1ea1ch c\u1ea5y\u00a0 gh\u00e9p cao h\u01a1n.<\/li>\n<\/ul>\n

    2. C\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf P2Y12 <\/strong><\/h2>\n

    L\u00e0 c\u00e1c ch\u1ea5t Thienopyridine, \u1ee9c ch\u1ebf ch\u1ee9c n\u0103ng ti\u1ec3u c\u1ea7u b\u1eb1ng c\u00e1ch t\u00e1c \u0111\u1ed9ng v\u00e0o th\u1ee5 th\u1ec3 adenosin diphosphat (ADP) P2Y12 c\u1ee7a ti\u1ec3u c\u1ea7u, t\u1eeb \u0111\u00f3 \u1ee9c ch\u1ebf s\u1ef1 k\u00edch ho\u1ea1t c\u1ee7a receptor glycoprotein IIb\/IIIa \u0111\u01b0\u1ee3c t\u1ea1o ra b\u1edfi ADP. \u0110i\u1ec1u n\u00e0y d\u1eabn \u0111\u1ebfn \u1ee9c ch\u1ebf s\u1ef1 k\u00edch ho\u1ea1t v\u00e0 k\u1ebft d\u00ednh c\u1ee7a ti\u1ec3u c\u1ea7u. Nh\u1eefng lo\u1ea1i thu\u1ed1c n\u00e0y \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p v\u1edbi aspirin trong m\u1ed9t th\u00e1ng cho b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u1eb7t stent kh\u00f4ng ph\u1ee7 thu\u1ed1c v\u00e0 trong 6-12 th\u00e1ng cho b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u1eb7t stent ph\u1ee7 thu\u1ed1c \u0111\u1ec3 gi\u1ea3m thi\u1ec3u nguy c\u01a1 t\u1eafc ngh\u1ebdn stent. Tuy nhi\u00ean, r\u1ea5t nhi\u1ec1u b\u1ec7nh nh\u00e2n ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng ch\u00fang v\u00f4 th\u1eddi h\u1ea1n sau khi th\u1ef1c hi\u1ec7n can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh qua da(PCI). Ch\u00fang c\u0169ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho b\u1ec7nh nh\u00e2n m\u1eafc h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p v\u00e0 cho nh\u1eefng ng\u01b0\u1eddi c\u00f3 k\u1ebf ho\u1ea1ch th\u1ef1c hi\u1ec7n PCI.<\/p>\n

      \n
    • Clopidogrel \u0111\u01b0\u1ee3c bi\u1ebfn \u0111\u1ed5i t\u1ea1o ra t\u00e1c d\u1ee5ng ch\u1ed1ng ti\u1ec3u c\u1ea7u c\u1ee7a n\u00f3. S\u1ef1 \u0111a d\u1ea1ng gen trong allen CYP2C19 gi\u1ea3m qu\u00e1 tr\u00ecnh chuy\u1ec3n \u0111\u1ed5i n\u00e0y, d\u1eabn \u0111\u1ebfn kh\u00e1ng clopidogrel. Tr\u01b0\u1edbc khi th\u1ef1c hi\u1ec7n PCI, ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c d\u00f9ng m\u1ed9t li\u1ec1u t\u1ea3i 300-600 mg, gi\u1ea3m thi\u1ec3u kho\u1ea3ng 40% s\u1ef1 k\u00edch ho\u1ea1t ti\u1ec3u c\u1ea7u trong v\u00e0i gi\u1edd, sau \u0111\u00f3 l\u00e0 75 mg\/ng\u00e0y. M\u1eb7c d\u00f9 th\u1eddi gian b\u00e1n h\u1ee7y kho\u1ea3ng b\u1ea3y ng\u00e0y, vi\u1ec7c duy tr\u00ec li\u1ec1u clopidogrel sau PCI khuy\u1ebfn c\u00e1o \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n v\u00f4 th\u1eddi h\u1ea1n cho nhi\u1ec1u b\u1ec7nh nh\u00e2n.<\/li>\n
    • Ticagrelor l\u00e0 m\u1ed9t ch\u1ea5t \u1ee9c ch\u1ebf kh\u00f4ng c\u1ea1nh tranh \u0111\u1ea3o ng\u01b0\u1ee3c c\u1ee7a receptor P2Y12, c\u00f3 t\u00e1c d\u1ee5ng kh\u00e1 nhanh v\u00e0 \u1ee9c ch\u1ebf ch\u1ee9c n\u0103ng ti\u1ec3u c\u1ea7u m\u1ea1nh h\u01a1n so v\u1edbi clopidogrel. Ticagrelor v\u00e0 ch\u1ea5t chuy\u1ec3n h\u00f3a c\u1ee7a n\u00f3 \u0111\u1ec1u c\u00f3 t\u00e1c d\u1ee5ng d\u01b0\u1ee3c l\u00fd v\u00e0 \u0111\u1ea1t \u0111\u1ec9nh t\u00e1c d\u1ee5ng sau 1,5 gi\u1edd sau khi u\u1ed1ng li\u1ec1u t\u1ea3i 180 mg, ti\u1ebfp \u0111\u00f3 l\u00e0 90 mg hai l\u1ea7n m\u1ed9t ng\u00e0y. N\u00f3 hi\u1ec7u qu\u1ea3 h\u01a1n clopidogrel trong vi\u1ec7c gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong \u1edf b\u1ec7nh nh\u00e2n m\u1eafc h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p v\u1edbi t\u1ef7 l\u1ec7 ch\u1ea3y m\u00e1u nghi\u00eam tr\u1ecdng t\u01b0\u01a1ng \u0111\u01b0\u01a1ng (12%). N\u00f3 c\u00f3 t\u00e1c d\u1ee5ng tr\u00ean ch\u1ee9c n\u0103ng ti\u1ec3u c\u1ea7u v\u1edbi th\u1eddi gian b\u00e1n h\u1ee7y kho\u1ea3ng 7-8 gi\u1edd, v\u1edbi 80% kh\u00f4i ph\u1ee5c ch\u1ee9c n\u0103ng ti\u1ec3u c\u1ea7u sau 72 gi\u1edd. \u0110i\u1ec1u n\u00e0y cho th\u1ea5y ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n an to\u00e0n n\u1ebfu ticagrelor \u0111\u00e3 \u0111\u01b0\u1ee3c ng\u01b0ng trong v\u00f2ng 72 gi\u1edd, tuy nhi\u00ean v\u1eabn khuy\u1ebfn c\u00e1o ng\u01b0ng s\u1eed d\u1ee5ng n\u00f3 \u00edt nh\u1ea5t 5 ng\u00e0y tr\u01b0\u1edbc ph\u1eabu thu\u1eadt.<\/li>\n
    • Prasugrel l\u00e0 m\u1ed9t ti\u1ec1n ch\u1ea5t \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a th\u00e0nh m\u1ed9t ch\u1ea5t chuy\u1ec3n h\u00f3a ho\u1ea1t \u0111\u1ed9ng, t\u1ea1o ra s\u1ef1 \u0111\u1ed1i kh\u00e1ng kh\u00f4ng \u0111\u1ea3o ng\u01b0\u1ee3c c\u1ee7a receptor P2Y12,c\u01b0\u1eddng \u0111\u1ed9 g\u1ea5p 10 l\u1ea7n so v\u1edbi clopidogrel v\u00e0 t\u1ea1o ra t\u00e1c d\u1ee5ng nhanh h\u01a1n v\u1edbi 50% \u1ee9c ch\u1ebf trong v\u00f2ng m\u1ed9t gi\u1edd. \u0110\u1ed9 \u1ee9c ch\u1ebf ti\u1ec3u c\u1ea7u t\u1ed1i \u0111a l\u00e0 80%. M\u1eb7c d\u00f9 l\u00e0 l\u1ef1a ch\u1ecdn t\u1ed1t h\u01a1n clopidogrel trong vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n m\u1eafc h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p th\u1ef1c hi\u1ec7n PCI, nh\u01b0ng n\u00f3 c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn nguy c\u01a1 ch\u1ea3y m\u00e1u cao v\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng cho b\u1ec7nh nh\u00e2n >75 tu\u1ed5i ho\u1eb7c b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed c\u1ee7a c\u01a1n thi\u1ebfu m\u00e1u n\u00e3o tho\u00e1ng qua (TIA) ho\u1eb7c \u0111\u1ed9t qu\u1ef5. M\u1eb7c d\u00f9 c\u00f3 th\u1eddi gian b\u00e1n h\u1ee7y t\u01b0\u01a1ng \u0111\u01b0\u01a1ng kho\u1ea3ng 7 gi\u1edd, t\u00e1c d\u1ee5ng l\u00ean ch\u1ee9c n\u0103ng ti\u1ec3u c\u1ea7u y\u00eau c\u1ea7u n\u00f3 ph\u1ea3i ng\u01b0ng \u00edt nh\u1ea5t 7 ng\u00e0y tr\u01b0\u1edbc ph\u1eabu thu\u1eadt.<\/li>\n
    • M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u1ea7n ph\u1eabu thu\u1eadt tim m\u1ea1ch m\u1eb7c d\u00f9 \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1eb7t stent g\u1ea7n \u0111\u00e2y. V\u00ed d\u1ee5, m\u1ed9t b\u1ec7nh nh\u00e2n b\u1ecb t\u1eafc \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p t\u00ednh (STEMI) nh\u01b0ng \u0111o\u1ea1n t\u1eafc ngh\u1ebdn ch\u00ednh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111\u1eb7t stent \u0111\u1ec3 t\u00e1i l\u01b0u th\u00f4ng khu v\u1ef1c c\u00f3 nguy c\u01a1 \u0111\u1ed9t qu\u1ef5, v\u00e0 ph\u1eabu thu\u1eadt c\u1ea5p c\u1ee9u \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ec3 gi\u1ea3i quy\u1ebft nh\u1eefng \u0111o\u1ea1n t\u1eafc ngh\u1ebdn c\u00f2n l\u1ea1i. M\u1ed9t v\u00ed d\u1ee5 kh\u00e1c l\u00e0 b\u1ec7nh nh\u00e2n b\u1ecb \u0111au ng\u1ef1c t\u00e1i ph\u00e1t trong v\u00e0i th\u00e1ng sau khi \u0111\u01b0\u1ee3c \u0111\u1eb7t stent ch\u1ee9a thu\u1ed1c.Ng\u1eebng s\u1eed d\u1ee5ng ch\u1ea5t \u1ee9c ch\u1ebf P2Y12 trong m\u1ed9t tu\u1ea7n tr\u01b0\u1edbc ph\u1eabu thu\u1eadt s\u1ebd t\u0103ng nguy c\u01a1 h\u00ecnh th\u00e0nh c\u1ee5c m\u00e1u \u0111\u00f4ng tr\u00ean stent, v\u00ec v\u1eady hai ph\u01b0\u01a1ng ph\u00e1p kh\u1ea3 thi, ngo\u00e0i vi\u1ec7c kh\u00f4ng ng\u1eebng s\u1eed d\u1ee5ng ch\u1ea5t \u1ee9c ch\u1ebf P2Y12, l\u00e0:
      \n(1) ng\u1eebng thu\u1ed1c trong ba ng\u00e0y, ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng aspirin v\u00e0 ph\u1eabu thu\u1eadt v\u1edbi ho\u1ea1t t\u00ednh \u1ee9c ch\u1ebf ti\u1ec3u c\u1ea7u c\u00f2n l\u1ea1i.
      \n(2) ng\u1eebng s\u1eed d\u1ee5ng ch\u1ea5t \u1ee9c ch\u1ebf P2Y12 trong n\u0103m ng\u00e0y tr\u01b0\u1edbc ph\u1eabu thu\u1eadt, ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng aspirin v\u00e0 nh\u1eadp vi\u1ec7n \u0111\u1ec3 s\u1eed d\u1ee5ng m\u1ed9t ch\u1ea5t \u1ee9c ch\u1ebf glycoprotein IIb\/IIIa trong v\u00e0i ng\u00e0y v\u00e0 ng\u1eebng thu\u1ed1c \u0111\u00f3 b\u1ed1n gi\u1edd tr\u01b0\u1edbc ph\u1eabu thu\u1eadt. Sau ph\u1eabu thu\u1eadt, ch\u1ea5t \u1ee9c ch\u1ebf P2Y12 \u0111\u01b0\u1ee3c kh\u1edfi \u0111\u1ed9ng l\u1ea1i s\u1edbm nh\u1ea5t c\u00f3 th\u1ec3 v\u1edbi li\u1ec1u t\u1ea3i.<\/li>\n
    • \u0110\u00e3 c\u00f3 \u0111\u1ec1 xu\u1ea5t r\u1eb1ng s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng fibrinolytic, ch\u1eb3ng h\u1ea1n nh\u01b0 axit tranexamic, c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m m\u1ed9t s\u1ed1 ch\u1ea3y m\u00e1u \u0111\u01b0\u1ee3c ghi nh\u1eadn \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng ng\u1eebng s\u1eed d\u1ee5ng ch\u1ea5t \u1ee9c ch\u1ebf P2Y12 tr\u01b0\u1edbc ph\u1eabu thu\u1eadt.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"

      \u0110i\u1ec1u ch\u1ec9nh thu\u1ed1c\u00a0 tr\u01b0\u1edbc \u0111\u00f3 v\u00e0 hi\u1ec7n t\u1ea1i c\u1ee7a b\u1ec7nh nh\u00e2n l\u00e0 r\u1ea5t quan tr\u1ecdng. \u0110\u1eb7c bi\u1ec7t, c\u1ea7n ch\u00fa \u00fd \u0111\u1ebfn c\u00e1c lo\u1ea1i thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u s\u1ebd ti\u1ebfp t\u1ee5c ho\u1eb7c ng\u1eebng tr\u01b0\u1edbc khi ph\u1eabu thu\u1eadt tim, t\u00f9y thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng. 1.C\u00e1c lo\u1ea1i thu\u1ed1c c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh: Aspirin (ASA) th\u01b0\u1eddng \u0111\u01b0\u1ee3c d\u00f9ng […]<\/p>\n","protected":false},"author":7,"featured_media":19462,"comment_status":"open","ping_status":"open","sticky":false,"template":"blank","format":"standard","meta":[],"categories":[7,33],"tags":[3],"yoast_head":"\n\u0110i\u1ec1u ch\u1ec9nh thu\u1ed1c tr\u01b0\u1edbc ph\u1eabu thu\u1eadt tim nh\u01b0 th\u1ebf n\u00e0o? - Vinmec<\/title>\n<meta name=\"description\" content=\"\u0110i\u1ec1u ch\u1ec9nh thu\u1ed1c tr\u01b0\u1edbc ph\u1eabu thu\u1eadt tim l\u00e0 v\u1ea5n \u0111\u1ec1 r\u1ea5t quan tr\u1ecdng. 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