{"id":21007,"date":"2023-04-14T21:25:31","date_gmt":"2023-04-14T14:25:31","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21007"},"modified":"2023-04-17T15:17:52","modified_gmt":"2023-04-17T08:17:52","slug":"verapamil-va-dac-diem-lam-sang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/verapamil-va-dac-diem-lam-sang\/","title":{"rendered":"Verapamil v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m tr\u00ean l\u00e2m s\u00e0ng"},"content":{"rendered":"

Verapamil l\u00e0 m\u1ed9t nh\u00f3m thu\u1ed1c \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc k\u00eanh canxi n\u1eb1m tr\u00ean m\u00e0ng t\u1ebf b\u00e0o c\u01a1 tr\u01a1n m\u1ea1ch m\u00e1u v\u00e0 c\u01a1 tim, do \u0111\u00f3 l\u00e0m gi\u00e1n \u0111o\u1ea1n s\u1ef1 di chuy\u1ec3n c\u1ee7a d\u00f2ng canxi \u0111i v\u00e0o trong t\u1ebf b\u00e0o. <\/strong><\/p>\n

1<\/strong>. C\u01a1 ch\u1ebf <\/strong><\/h2>\n

Verapamil \u1ee9c ch\u1ebf kh\u1eed c\u1ef1c c\u1ee7a v\u00f9ng tr\u00ean v\u00e0 gi\u1eefa c\u1ee7a n\u00fat nh\u0129 th\u1ea5t, do \u0111\u00f3 \u1ee9c ch\u1ebf m\u1ed9t nh\u00e1nh c\u1ee7a v\u00f2ng v\u00e0o l\u1ea1i (reentry circuit) \u2013 \u0111\u01b0\u1ee3c cho l\u00e0 c\u01a1 s\u1edf c\u1ee7a h\u1ea7u h\u1ebft c\u00e1c nh\u1ecbp tim nhanh tr\u00ean th\u1ea5t k\u1ecbch ph\u00e1t.<\/p>\n

T\u0103ng block nh\u0129 th\u1ea5t v\u00e0 s\u1ef1 gia t\u0103ng th\u1eddi k\u1ef3 tr\u01a1 hi\u1ec7u qu\u1ea3 c\u1ee7a n\u00fat nh\u0129 th\u1ea5t l\u00e0m gi\u1ea3m t\u1ed1c \u0111\u1ed9 \u0111\u00e1p \u1ee9ng t\u00e2m th\u1ea5t trong rung nh\u0129 v\u00e0 cu\u1ed3ng nh\u0129. Verapamil kh\u00f4ng l\u00e0m gi\u1ea3m nhi\u1ec1u nh\u1ecbp tim khi ngh\u1ec9, nh\u01b0ng l\u1ea1i c\u00f3 hi\u1ec7u qu\u1ea3 \u1ee9c ch\u1ebf t\u00ecnh tr\u1ea1ng nh\u1ecbp tim nhanh do g\u1eafng s\u1ee9c. V\u1ec1 m\u1eb7t huy\u1ebft \u0111\u1ed9ng, verapamil l\u00e0m gi\u00e3n \u0111\u1ed9ng m\u1ea1ch, cung l\u01b0\u1ee3ng tim v\u00e0 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i kh\u00f4ng t\u0103ng do hi\u1ec7u \u1ee9ng t\u0103ng co b\u00f3p \u00e2m t\u00ednh.<\/p>\n

2.<\/strong>\u00a0Ch\u1ec9 \u0111\u1ecbnh l\u00e2m s\u00e0ng Verapamil: <\/strong><\/h2>\n

\u0110\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh r\u1ed9ng r\u00e3i \u1edf b\u1ec7nh nh\u00e2n \u0111au ng\u1ef1c (bao g\u1ed3m c\u1ea3 \u0111au th\u1eaft ng\u1ef1c \u1ed5n \u0111\u1ecbnh, \u0111au th\u1eaft ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh, \u0111au ng\u1ef1c do co th\u1eaft m\u1ea1ch v\u00e0nh; c\u01a1n nh\u1ecbp nhanh k\u1ecbch ph\u00e1t tr\u00ean th\u1ea5t; THA. T\u00e1c d\u1ee5ng gi\u1ea3m \u0111au ng\u1ef1c c\u1ee7a verapamil t\u01b0\u01a1ng \u0111\u01b0\u01a1ng metoprolol. Hi\u1ec7n nay k\u1ebft h\u1ee3p thu\u1ed1c ch\u1eb9n beta v\u00e0 verapamil kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o do nguy c\u01a1 g\u00e2y nh\u1ecbp ch\u1eadm.<\/p>\n

Trong nghi\u00ean c\u1ee9u INVEST \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh b\u1ecb t\u0103ng huy\u1ebft \u00e1p, verapamil \u0111\u01b0\u1ee3c so s\u00e1nh v\u1edbi atenolol, c\u00f3 th\u1ec3 b\u1ed5 sung thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n trandolapril v\u00e0 sau \u0111\u00f3 b\u1eb1ng thiazide n\u1ebfu c\u1ea7n \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee5c ti\u00eau huy\u1ebft \u00e1p. C\u00e1c k\u1ebft qu\u1ea3 ch\u00ednh l\u00e0 nh\u01b0 nhau nh\u01b0ng verapamil \u00edt g\u00e2y \u0111au th\u1eaft ng\u1ef1c v\u00e0 m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng m\u1edbi.Trong \u0111i\u1ec1u tr\u1ecb \u0111au th\u1eaft ng\u1ef1c th\u1ec3 Prinzmetal, verapamil li\u1ec1u cao c\u00f3 th\u1ec3 c\u1ea7n thi\u1ebft. Vi\u1ec7c ng\u1eebng s\u1eed d\u1ee5ng verapamil \u0111\u1ed9t ng\u1ed9t c\u00f3 th\u1ec3 g\u00e2y c\u01a1n \u0111au th\u1eaft ng\u1ef1c ph\u1ea3n \u1ee9ng (rebound).<\/p>\n

2.1 <\/strong>T\u0103ng huy\u1ebft \u00e1p: <\/strong><\/h3>\n

Verapamil \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn \u0111i\u1ec1u tr\u1ecb cho t\u0103ng huy\u1ebft \u00e1p nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh \u1edf Hoa K\u1ef3. Verapamil c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u, thu\u1ed1c ch\u1eb9n beta, thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n, thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 (ARB) ho\u1eb7c c\u00e1c thu\u1ed1c h\u1ea1 \u00e1p t\u00e1c d\u1ee5ng l\u00ean h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng kh\u00e1c. Trong qu\u00e1 tr\u00ecnh k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c ch\u1eb9n alpha, t\u01b0\u01a1ng t\u00e1c \u1edf gan c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn h\u1ea1 huy\u1ebft \u00e1p qu\u00e1 m\u1ee9c.<\/p>\n

2.2 <\/strong>\u0110i\u1ec1u tr\u1ecb c\u01a1n nh\u1ecbp nhanh tr\u00ean th\u1ea5t: <\/strong><\/h3>\n

Verapamil c\u00f3 th\u1ec3 d\u00f9ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng nh\u1ecbp tim nhanh tr\u00ean th\u1ea5t t\u00e1i \u0111i t\u00e1i l\u1ea1i, v\u00e0 \u0111\u1ec3 ki\u1ec3m so\u00e1t t\u1ea7n s\u1ed1 th\u1ea5t trong rung nh\u0129 m\u1ea1n t\u00ednh c\u00f9ng v\u1edbi digoxin (l\u01b0u \u00fd t\u01b0\u01a1ng t\u00e1c). \u0110\u1ed1i v\u1edbi c\u00e1c c\u01a1n nh\u1ecbp nhanh k\u1ecbch ph\u00e1t tr\u00ean th\u1ea5t, khi kh\u00f4ng c\u00f3 gi\u1ea3m co b\u00f3p c\u01a1 tim, li\u1ec1u bolus t\u1eeb 5 \u0111\u1ebfn 10 mg (0,1 \u0111\u1ebfn 0,15 mg\/kg) trong 2 ph\u00fat s\u1ebd ph\u1ee5c h\u1ed3i nh\u1ecbp xoang trong v\u00f2ng 10 ph\u00fat \u1edf 60% tr\u01b0\u1eddng h\u1ee3p. Tuy nhi\u00ean, hi\u1ec7n nay \u0111\u01b0\u1ee3c thay th\u1ebf ph\u1ea7n l\u1edbn b\u1eb1ng adenosine ti\u00eam t\u0129nh m\u1ea1ch . Verapamil c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho rung nh\u0129 kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 suy ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i, li\u1ec1u truy\u1ec1n t\u0129nh m\u1ea1ch 0,005 mg\/kg\/ph\u00fat (c\u00f3 th\u1ec3 t\u0103ng li\u1ec1u) ho\u1eb7c bolus t\u0129nh m\u1ea1ch 5 mg (0,075 mg\/kg) sau \u0111\u00f3 t\u0103ng g\u1ea5p \u0111\u00f4i li\u1ec1u n\u1ebfu c\u1ea7n. T\u1ea5t c\u1ea3 tr\u01b0\u1eddng h\u1ee3p nh\u1ecbp tim nhanh tr\u00ean th\u1ea5t, bao g\u1ed3m rung nh\u0129 v\u00e0 cu\u1ed3ng nh\u0129 c\u00f3 k\u00e8m \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n ph\u1ee5 (h\u1ed9i ch\u1ee9ng WPW) l\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi verapamil.<\/p>\n

2.3 <\/strong>\u1ee8ng d\u1ee5ng kh\u00e1c c\u1ee7a verapamil: <\/strong><\/h3>\n

Trong b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i, verapamil l\u00e0 thu\u1ed1c ch\u1eb9n k\u00eanh canxi \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 t\u1ed1t nh\u1ea5t. Thu\u1ed1c l\u00e0m gi\u1ea3m c\u00e1c tri\u1ec7u ch\u1ee9ng, gi\u1ea3m ch\u00eanh \u00e1p \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i, c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng v\u00e0 t\u0103ng kh\u1ea3 n\u0103ng g\u1eafng s\u1ee9c t\u1eeb 20% \u0111\u1ebfn 25%. Khi so s\u00e1nh h\u1ed3i c\u1ee9u v\u1edbi propranolol, verapamil d\u01b0\u1eddng nh\u01b0 l\u00e0m gi\u1ea3m t\u1eed vong v\u00e0 t\u0103ng kh\u1ea3 n\u0103ng s\u1ed1ng s\u00f3t sau 10 n\u0103m. M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p b\u1ecb nh\u1ecbp nhanh th\u1ea5t do v\u00f2ng v\u00e0o l\u1ea1i nh\u00e1nh tr\u00e1i v\u00f4 c\u0103n (Idiopathic fascicular left ventricular tachycardia \u2013 IFLVT) th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi tr\u1ebb, b\u1ecb k\u00edch th\u00edch khi g\u1eafng s\u1ee9c c\u00f3 th\u1ec3 \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi verapamil.<\/p>\n

Tuy nhi\u00ean, verapamil c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong cho nh\u1ecbp nhanh th\u1ea5t ph\u1ee9c b\u1ed9 QRS gi\u00e3n r\u1ed9ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi ti\u00eam t\u0129nh m\u1ea1ch. Do \u0111\u00f3, tr\u1eeb khi ch\u1ea9n \u0111o\u00e1n ch\u1eafc ch\u1eafn, n\u1ebfu kh\u00f4ng ph\u1ea3i tr\u00e1nh d\u00f9ng verapamil trong nh\u1ecbp nhanh th\u1ea5t.<\/p>\n

Sau nh\u1ed3i m\u00e1u c\u01a1 tim, verapamil c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng khi ch\u1eb9n beta b\u1ecb ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh. Verapamil 120mg ba l\u1ea7n m\u1ed7i 24h, b\u1eaft \u0111\u1ea7u t\u1eeb 7 \u0111\u1ebfn 15 ng\u00e0y sau giai \u0111o\u1ea1n c\u1ea5p t\u00ednh \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed suy tim v\u00e0 kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u suy tim sung huy\u1ebft (v\u1edbi digoxin v\u00e0 li\u1ec7u ph\u00e1p l\u1ee3i ti\u1ec3u) \u0111\u00e3 gi\u1ea3m t\u00e1i nh\u1ed3i m\u00e1u c\u01a1 tim v\u00e0 t\u1eed vong kho\u1ea3ng 25% sau 18 th\u00e1ng.<\/p>\n

3<\/strong>. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/strong><\/h2>\n

Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee7a c\u00e1c thu\u1ed1c ch\u1eb9n k\u00eanh canxi nh\u00f3m non-DHP:<\/p>\n

C\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee7a verapamil bao g\u1ed3m:<\/p>\n

    \n
  • Qu\u00e1 m\u1eabn v\u1edbi verapamil ho\u1eb7c thu\u1ed1c ch\u1eb9n k\u00eanh canxi kh\u00e1c.<\/li>\n
  • S\u1ed1c tim, suy tim sung huy\u1ebft, huy\u1ebft \u00e1p th\u1ea5p c\u00f3 tri\u1ec7u ch\u1ee9ng.<\/li>\n
  • Suy tim n\u1ebfu th\u1ee9 ph\u00e1t sau nh\u1ecbp nhanh tr\u00ean th\u1ea5t th\u00ec kh\u00f4ng ph\u1ea3i l\u00e0 m\u1ed9t ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, trong khi suy t\u00e2m thu th\u1ea5t tr\u00e1i t\u1eeb tr\u01b0\u1edbc th\u00ec l\u1ea1i l\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh.<\/li>\n
  • Nh\u1ecbp nhanh tr\u00ean th\u1ea5t trong c\u00e1c h\u1ed9i ch\u1ee9ng n\u00fat xoang b\u1ec7nh l\u00fd; h\u1ed9i ch\u1ee9ng ti\u1ec1n k\u00edch th\u00edch; qu\u00e1 li\u1ec1u thu\u1ed1c ch\u1eb9n beta, digitalis, quinidine ho\u1eb7c disopyramide.<\/li>\n
  • Trong h\u1ed9i ch\u1ee9ng Wol-Parkinson-White (WPW) c\u00f3 rung nh\u0129, verapamil ti\u00eam t\u0129nh m\u1ea1ch b\u1ecb ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00ec nguy c\u01a1 d\u1eabn truy\u1ec1n tr\u01b0\u1edbc qua \u0111\u01b0\u1eddng d\u1eabn ph\u1ee5. Verapamil c\u0169ng b\u1ecb ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh trong nh\u1ecbp nhanh th\u1ea5t (ph\u1ee9c b\u1ed9 QRS r\u1ed9ng) do \u1ee9c ch\u1ebf c\u01a1 tim qu\u00e1 m\u1ee9c, c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong. Ngo\u1ea1i l\u1ec7 cho quy t\u1eafc n\u00e0y l\u00e0 nh\u1ecbp nhanh th\u1ea5t do g\u1eafng s\u1ee9c v\u00e0 nh\u1ecbp nhanh th\u1ea5t nh\u1ea1y c\u1ea3m v\u1edbi verapamil.<\/li>\n
  • Block nh\u0129 th\u1ea5t \u0111\u1ed9 cao.<\/li>\n<\/ul>\n

    4<\/strong>. T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n<\/strong>:<\/strong><\/h2>\n

    T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a thu\u1ed1c li\u00ean quan \u0111\u1ebfn t\u00e1c d\u1ee5ng g\u00e2y gi\u00e3n m\u1ea1ch nh\u01b0 \u0111au \u0111\u1ea7u, \u0111\u1ecf b\u1eebng m\u1eb7t v\u00e0 ch\u00f3ng m\u1eb7t. Nh\u1eefng tri\u1ec7u ch\u1ee9ng n\u00e0y c\u00f3 th\u1ec3 gi\u1ea3m b\u1edbt b\u1edfi c\u00e1c ch\u1ebf ph\u1ea9m t\u00e1c d\u1ee5ng d\u00e0i. T\u00e1o b\u00f3n l\u00e0 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n hay g\u1eb7p, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i.<\/p>\n

    \u1ede ng\u01b0\u1eddi l\u1edbn tu\u1ed5i, verapamil c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn ch\u1ea3y m\u00e1u ti\u00eau h\u00f3a. T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n hi\u1ebfm g\u1eb7p c\u00f3 th\u1ec3 bao g\u1ed3m \u0111au l\u1ee3i, \u0111au m\u1eb7t, \u0111au v\u00f9ng th\u01b0\u1ee3ng v\u1ecb, nhi\u1ec5m \u0111\u1ed9c gan v\u00e0 r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n tho\u00e1ng qua.<\/p>\n

    5<\/strong>. Li\u1ec1u d\u00f9ng verapamil <\/strong><\/h2>\n

    T\u1ed5ng li\u1ec1u u\u1ed1ng h\u1eb1ng ng\u00e0y th\u00f4ng th\u01b0\u1eddng l\u00e0 180-360 mg m\u1ed7i 24h, kh\u00f4ng qu\u00e1 480 mg. D\u00f9ng m\u1ed9t l\u1ea7n ho\u1eb7c hai l\u1ea7n m\u1ed7i 24h v\u1edbi d\u1ea1ng c\u00f4ng th\u1ee9c t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i ho\u1eb7c ba l\u1ea7n m\u1ed7i 24h cho c\u00e1c ch\u1ebf ph\u1ea9m t\u00e1c d\u1ee5ng ng\u1eafn.<\/p>\n

    C\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t l\u1edbn v\u1ec1 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc gi\u1eefa c\u00e1c c\u00e1 th\u1ec3, do \u0111\u00f3 c\u1ea7n ph\u1ea3i chu\u1ea9n li\u1ec1u theo c\u00e1 th\u1ec3, li\u1ec1u 120mg m\u1ed7i 24h c\u00f3 th\u1ec3 ph\u00f9 h\u1ee3p cho nh\u1eefng ng\u01b0\u1eddi b\u1ecb suy gan ho\u1eb7c ng\u01b0\u1eddi l\u1edbn tu\u1ed5i.<\/p>\n

    Li\u1ec1u th\u1ea5p l\u00e0 c\u1ea7n thi\u1ebft \u1edf b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i, nh\u1eefng ng\u01b0\u1eddi m\u1eafc b\u1ec7nh th\u1eadn ho\u1eb7c gan ti\u1ebfn tri\u1ec3n ho\u1eb7c khi d\u00f9ng ch\u1eb9n beta \u0111\u1ed3ng th\u1eddi. Verapamil ti\u00eam t\u0129nh m\u1ea1ch \u00edt \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho lo\u1ea1n nh\u1ecbp tim tr\u00ean th\u1ea5t do \u0111\u00e3 c\u00f3 adenosine v\u00e0 thu\u1ed1c ch\u1eb9n beta t\u00e1c d\u1ee5ng ng\u1eafn nh\u01b0 esmolol.<\/p>\n","protected":false},"excerpt":{"rendered":"

    Verapamil l\u00e0 m\u1ed9t nh\u00f3m thu\u1ed1c \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc k\u00eanh canxi n\u1eb1m tr\u00ean m\u00e0ng t\u1ebf b\u00e0o c\u01a1 tr\u01a1n m\u1ea1ch m\u00e1u v\u00e0 c\u01a1 tim, do \u0111\u00f3 l\u00e0m gi\u00e1n \u0111o\u1ea1n s\u1ef1 di chuy\u1ec3n c\u1ee7a d\u00f2ng canxi \u0111i v\u00e0o trong t\u1ebf b\u00e0o. 1. C\u01a1 ch\u1ebf Verapamil \u1ee9c ch\u1ebf kh\u1eed c\u1ef1c c\u1ee7a v\u00f9ng tr\u00ean v\u00e0 gi\u1eefa c\u1ee7a n\u00fat nh\u0129 […]<\/p>\n","protected":false},"author":7,"featured_media":21017,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[12,33],"tags":[3],"yoast_head":"\nVerapamil v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m tr\u00ean l\u00e2m s\u00e0ng - Vinmec<\/title>\n<meta name=\"description\" content=\"Verapamil v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng l\u00e0 nh\u1eefng \u0111i\u1ec1u c\u1ea7n quan t\u00e2m tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng thu\u1ed1c. 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