{"id":21107,"date":"2023-04-15T15:59:56","date_gmt":"2023-04-15T08:59:56","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21107"},"modified":"2023-04-17T15:01:50","modified_gmt":"2023-04-17T08:01:50","slug":"thuoc-uc-che-men-chuyen-va-nhung-dieu-can-biet","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/thuoc-uc-che-men-chuyen-va-nhung-dieu-can-biet\/","title":{"rendered":"Thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n v\u00e0 nh\u1eefng \u0111i\u1ec1u c\u1ea7n bi\u1ebft"},"content":{"rendered":"

Thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n d\u1ea1ng angiotensin (Angiotensin-converting enzyme (ACE) inhibitors), g\u1ecdi t\u1eaft l\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n(UCMC), t\u00e1c d\u1ee5ng tr\u1ef1c ti\u1ebfp l\u00ean h\u1ec7 RAA, l\u00e0 nh\u00f3m thu\u1ed1c h\u1ebft s\u1ee9c quan tr\u1ecdng m\u00e0 c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng c\u1ea7n n\u1eafm r\u00f5 trong th\u1ef1c h\u00e0nh \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tim m\u1ea1ch<\/strong><\/p>\n

1.G<\/strong>i\u1edbi thi\u1ec7u chung <\/strong><\/h2>\n

T\u1eeb \u0111\u1ea7u nh\u1eefng n\u0103m 1980 khi vai tr\u00f2 c\u1ee7a h\u1ec7 Renin-angiotensin-aldosterone (RAA) trong c\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd tim m\u1ea1ch \u0111\u01b0\u1ee3c l\u00e0m s\u00e1ng t\u1ecf, nh\u1eefng lo\u1ea1i thu\u1ed1c t\u00e1c \u0111\u1ed9ng l\u00ean h\u1ec7 RAA \u0111\u00e3 ra \u0111\u1eddi v\u00e0 \u0111\u1ebfn nay \u0111\u00e3 tr\u1edf th\u00e0nh nh\u1eefng thu\u1ed1c n\u1ec1n t\u1ea3ng trong \u0111i\u1ec1u tr\u1ecb suy tim, t\u0103ng huy\u1ebft \u00e1p v\u00e0 c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong d\u1ef1 ph\u00f2ng ti\u00ean ph\u00e1t v\u00e0 th\u1ee9 ph\u00e1t nhi\u1ec1u b\u1ec7nh l\u00fd tim m\u1ea1ch.<\/p>\n

Thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n d\u1ea1ng angiotensin (Angiotensin-converting enzyme (ACE) inhibitors), g\u1ecdi t\u1eaft l\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n, t\u00e1c d\u1ee5ng tr\u1ef1c ti\u1ebfp l\u00ean h\u1ec7 RAA, l\u00e0 nh\u00f3m thu\u1ed1c h\u1ebft s\u1ee9c quan tr\u1ecdng m\u00e0 c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng c\u1ea7n n\u1eafm r\u00f5 trong th\u1ef1c h\u00e0nh \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tim m\u1ea1ch.<\/p>\n

2.P<\/strong>h\u00e2n lo\u1ea1i<\/strong><\/h2>\n

\u00a02.1. Ba nh\u00f3m thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n<\/strong><\/h3>\n

D\u1ef1a v\u00e0o d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc, c\u00f3 th\u1ec3 chia thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n th\u00e0nh ba nh\u00f3m:<\/p>\n

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  • Nh\u00f3m th\u1ee9 nh\u1ea5t l\u00e0 nh\u00f3m thu\u1ed1c c\u00f3 t\u00ednh ch\u1ea5t h\u1ed7n h\u1ee3p ho\u1ea1t t\u00ednh (\u0111\u1ea1i di\u1ec7n l\u00e0 captopril), c\u00f3 ngh\u0129a l\u00e0 nh\u00f3m thu\u1ed1c n\u00e0y khi v\u00e0o c\u01a1 th\u1ec3 s\u1ebd \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a, v\u00e0 c\u1ea3 ch\u1ea5t chuy\u1ec3n h\u00f3a l\u1eabn thu\u1ed1c ban \u0111\u1ea7u \u0111\u1ec1u c\u00f3 ho\u1ea1t t\u00ednh.<\/li>\n
  • Nh\u00f3m th\u1ee9 hai l\u00e0 nh\u00f3m thu\u1ed1c \u0111\u01b0\u1ee3c coi l\u00e0 \u201cti\u1ec1n ch\u1ea5t\u201d (v\u1edbi \u0111\u1ea1i di\u1ec7n l\u00e0 enalapril, zofenopril). C\u00e1c thu\u1ed1c n\u00e0y ch\u1ec9 c\u00f3 ho\u1ea1t t\u00ednh khi \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a t\u1ea1i gan th\u00e0nh d\u1ea1ng acid.<\/li>\n
  • Nh\u00f3m th\u1ee9 ba l\u00e0 nh\u00f3m thu\u1ed1c tan trong n\u01b0\u1edbc, kh\u00f4ng b\u1ecb chuy\u1ec3n h\u00f3a trong c\u01a1 th\u1ec3 v\u00e0 \u0111\u01b0\u1ee3c th\u1ea3i tr\u1eeb qua th\u1eadn (v\u00ed d\u1ee5 nh\u01b0 lisinopril).<\/li>\n<\/ul>\n

    2.2. M\u1ed9t s\u1ed1 kh\u00e1c bi\u1ec7t c\u1ee7a c\u00e1c lo\u1ea1i thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n <\/strong><\/h3>\n

    C\u00e1c lo\u1ea1i \u1ee9c ch\u1ebf men chuy\u1ec3n (\u01afCMC) c\u00f3 t\u00e1c d\u1ee5ng nhanh v\u00e0 ng\u1eafn nh\u01b0 captopril c\u00f3 l\u1ee3i th\u1ebf h\u01a1n khi \u0111i\u1ec1u tr\u1ecb c\u00e1c tr\u01b0\u1eddng h\u1ee3p THA kh\u1ea9n tr\u01b0\u01a1ng so v\u1edbi c\u00e1c \u01afCMC c\u00f3 \u0111\u1ec9nh t\u00e1c d\u1ee5ng mu\u1ed9n h\u01a1n, do kh\u1ea3 n\u0103ng h\u1ea1 huy\u1ebft \u00e1p nhanh ch\u00f3ng.<\/p>\n

    C\u00e1c lo\u1ea1i \u01afCMC c\u00f3 th\u1eddi gian t\u00e1c d\u1ee5ng ng\u1eafn nh\u01b0 captopril, enalapril c\u00f3 l\u1ee3i th\u1ebf h\u01a1n trong \u0111i\u1ec1u tr\u1ecb suy tim do gi\u1ea3m \u0111\u01b0\u1ee3c nguy c\u01a1 t\u1ee5t huy\u1ebft \u00e1p th\u00ec \u0111\u1ea7u k\u00e9o d\u00e0i v\u00e0 n\u1ebfu trong tr\u01b0\u1eddng h\u1ee3p t\u1ee5t huy\u1ebft \u00e1p x\u1ea3y ra vi\u1ec7c d\u1eebng thu\u1ed1c c\u0169ng gi\u00fap ph\u1ee5c h\u1ed3i huy\u1ebft \u00e1p nhanh h\u01a1n, do \u0111\u00f3 c\u0169ng gi\u1ea3m nguy c\u01a1 g\u00e2y suy th\u1eadn.<\/p>\n

    C\u00e1c \u01afCMC kh\u00f4ng ph\u1ea3i ti\u1ec1n ch\u1ea5t nh\u01b0 lisinopril c\u00f3 t\u00e1c d\u1ee5ng nhanh h\u01a1n do kh\u00f4ng ph\u1ea3i tr\u1ea3i qua chu tr\u00ecnh chuy\u1ec3n h\u00f3a, \u0111\u1ed3ng th\u1eddi c\u0169ng \u00edt b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi s\u1ef1 chuy\u1ec3n h\u00f3a c\u1ee7a c\u00e1c thu\u1ed1c d\u00f9ng k\u00e8m v\u00e0 ch\u1ee9c n\u0103ng gan. Hi\u1ec7n t\u01b0\u1ee3ng ph\u00f9 m\u1ea1ch c\u0169ng \u00edt g\u1eb7p h\u01a1n \u1edf captopril so v\u1edbi enalapril, quinapril, ramipril.<\/p>\n

    M\u1ed9t s\u1ed1 \u01afCMC kh\u00e1c c\u00f2n c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf renin ti\u1ebft ra t\u1eeb c\u00e1c m\u00f4 c\u01a1 quan kh\u00e1c, b\u1edfi v\u00ec h\u1ec7 th\u1ed1ng renin \u2013 angiotensin kh\u00f4ng ch\u1ec9 c\u00f3 m\u1eb7t \u1edf m\u1ea1ch m\u00e1u v\u00e0 th\u1eadn m\u00e0 c\u00f2n hi\u1ec7n di\u1ec7n \u1edf tim, gan, n\u00e3o, tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn v\u00e0 m\u1ed9t s\u1ed1 m\u00f4 c\u01a1 quan kh\u00e1c. Do \u0111\u00f3, v\u1ec1 m\u1eb7t l\u00fd thuy\u1ebft gi\u00fap l\u00fd gi\u1ea3i ph\u1ea7n n\u00e0o s\u1ef1 kh\u00e1c bi\u1ec7t trong t\u00e1c d\u1ee5ng c\u1ee7a c\u00e1c lo\u1ea1i \u01afCMC kh\u00e1c nhau. V\u00ed d\u1ee5: quinapril v\u00e0 ramipril c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m t\u00e1i c\u1ea5u tr\u00fac c\u01a1 tim do kh\u1ea3 n\u0103ng ng\u1ea5m v\u00e0 g\u1eafn v\u00e0o m\u00f4 c\u01a1 tim, l\u00e0m \u1ee9c ch\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u00e1c angiotensin c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb c\u01a1 tim\u2026 C\u00e1c lo\u1ea1i \u01afCMC t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i c\u00f3 th\u1eddi gian b\u00e1n h\u1ee7y t\u1eeb 24 \u2013 48h nh\u01b0 cilazapril, perindopril, quinapril, ramipril, zofenopril, trong \u0111\u00f3 zofenopril c\u00f3 th\u1eddi gian t\u00e1c d\u1ee5ng d\u00e0i g\u1ea5p 5 l\u1ea7n captopril.<\/p>\n

    3.C<\/strong>\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng<\/strong><\/h2>\n

    C\u00e1c ho\u1ea1t \u0111\u1ed9ng c\u1ee7a enzyme chuy\u1ec3n (ACE) ch\u1ee7 y\u1ebfu di\u1ec5n ra t\u1ea1i n\u1ed9i m\u00f4 m\u1ea1ch m\u00e1u c\u1ee7a ph\u1ed5i, l\u01b0\u1edbi m\u1ea1ch m\u00e1u v\u00e0 c\u1ea3 trong \u0111\u1ed9ng m\u1ea1ch v\u00e0nh. Angiotensinogen \u0111\u01b0\u1ee3c sinh ra t\u1ea1i gan, sau \u0111\u00f3 d\u01b0\u1edbi t\u00e1c \u0111\u1ed9ng c\u1ee7a enzyme renin s\u1ebd chuy\u1ec3n th\u00e0nh angiotensin I. Enzyme renin n\u00e0y \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh t\u1eeb trong t\u1ebf b\u00e0o c\u1eadn ti\u1ec3u c\u1ea7u th\u1eadn v\u00e0 c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y t\u0103ng ti\u1ebft enzyme n\u00e0y l\u00e0:<\/p>\n

      \n
    • \u00a0Gi\u1ea3m d\u00f2ng m\u00e1u t\u1edbi th\u1eadn (V\u00ed d\u1ee5: trong tr\u01b0\u1eddng h\u1ee3p thi\u1ebfu m\u00e1u ho\u1eb7c t\u1ee5t \u00e1p).<\/li>\n
    • Gi\u1ea3m n\u1ed3ng \u0111\u1ed9 natri t\u1ea1i \u1ed1ng th\u1eadn.<\/li>\n
    • K\u00edch th\u00edch th\u1ee5 th\u1ec3 \u03b2 adrenergic. Enzyme chuy\u1ec3n d\u1ea1ng angiotensin kh\u00f4ng nh\u1eefng c\u00f3 vai tr\u00f2 gi\u00fap chuy\u1ec3n angiotensin I th\u00e0nh angiotensin II m\u00e0 c\u00f2n l\u00e0m tho\u00e1i gi\u00e1ng bradykinin th\u00e0nh nh\u1eefng peptid b\u1ea5t ho\u1ea1t. Ch\u00ednh v\u00ec v\u1eady, thu\u1ed1c \u01afCMC l\u00e0 nh\u00f3m thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch do n\u00f3 ng\u0103n c\u1ea3n s\u1ef1 h\u00ecnh th\u00e0nh c\u1ee7a angiotensin II v\u00e0 gi\u1eef cho bradykinin kh\u00f4ng b\u1ecb tho\u00e1i gi\u00e1ng. Angiotensin II sau khi \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh t\u1eeb angiotensin I th\u00f4ng qua renin s\u1ebd t\u00e1c \u0111\u1ed9ng l\u00ean c\u00e1c th\u1ee5 th\u1ec3 AT (Angiotensin receptor) m\u00e0 trong \u0111\u00f3 ch\u1ee7 y\u1ebfu l\u00e0 c\u00e1c th\u1ee5 th\u1ec3 AT-1 d\u1eabn \u0111\u1ebfn nh\u1eefng \u1ea3nh h\u01b0\u1edfng ho\u1ea1t \u0111\u1ed9ng ch\u1ee9c n\u0103ng tr\u00ean nhi\u1ec1u c\u01a1 quan.<\/li>\n<\/ul>\n

      Angiotensin II kh\u00f4ng ch\u1ec9 \u0111\u01b0\u1ee3c t\u1ea1o ra d\u01b0\u1edbi t\u00e1c d\u1ee5ng c\u1ee7a enzyme chuy\u1ec3n d\u1ea1ng m\u00e0 c\u00f2n b\u1edfi enzyme chymase. Tuy nhi\u00ean, vai tr\u00f2 c\u1ee7a lo\u1ea1i enzyme n\u00e0y v\u1eabn c\u00f2n \u0111ang tranh lu\u1eadn v\u00e0 tr\u00ean th\u1ef1c t\u1ebf thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3 h\u01a1n so v\u1edbi nh\u00f3m thu\u1ed1c \u01afCMC n\u00ean c\u0169ng d\u1ec5 hi\u1ec3u khi kh\u00f4ng c\u00f3 nhi\u1ec1u c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng v\u1ec1 s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf enzyme chymase.<\/p>\n

      C\u00f3 \u00edt nh\u1ea5t hai th\u1ee5 th\u1ec3 c\u1ee7a angiotensin II \u0111\u00f3 l\u00e0 AT-1 v\u00e0 AT-2. Nh\u00f3m thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 li\u00ean k\u1ebft \u0111\u1eb7c hi\u1ec7u v\u1edbi c\u00e1c th\u1ee5 th\u1ec3 AT-1, l\u00e0 c\u00e1c th\u1ee5 th\u1ec3 \u0111\u1ea3m nhi\u1ec7m ph\u1ea7n l\u1edbn t\u00e1c d\u1ee5ng sinh l\u00fd c\u1ee7a angiotensin II, ng\u0103n c\u1ea3n kh\u00f4ng cho angiotensin II g\u1eafn v\u00e0o th\u1ee5 th\u1ec3 v\u00e0 do \u0111\u00f3 l\u00e0m m\u1ea5t hi\u1ec7u l\u1ef1c c\u1ee7a angiotensin II. \u1ede thai nhi, AT-1 c\u00f3 vai tr\u00f2 k\u00edch th\u00edch t\u0103ng tr\u01b0\u1edfng, ch\u00ednh v\u00ec v\u1eady thu\u1ed1c \u01afCMC v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh d\u00f9ng \u1edf ph\u1ee5 n\u1eef c\u00f3 thai. Ng\u01b0\u1ee3c l\u1ea1i, th\u1ee5 th\u1ec3 AT2 l\u1ea1i c\u00f3 vai tr\u00f2 k\u00ecm h\u00e3m s\u1ef1 t\u0103ng tr\u01b0\u1edfng c\u1ee7a thai nhi \u1edf giai \u0111o\u1ea1n cu\u1ed1i c\u1ee7a thai k\u1ef3. \u1ede ng\u01b0\u1eddi l\u1edbn, vai tr\u00f2 c\u1ee7a th\u1ee5 th\u1ec3 AT-2 v\u1eabn c\u00f2n ch\u01b0a \u0111\u01b0\u1ee3c l\u00e0m s\u00e1ng t\u1ecf v\u00e0 c\u00f2n nhi\u1ec1u tranh lu\u1eadn. Angiotensin II c\u00f3 t\u00e1c d\u1ee5ng k\u00edch th\u00edch tuy\u1ebfn v\u1ecf th\u01b0\u1ee3ng th\u1eadn ti\u1ebft ra aldosteron l\u00e0m t\u0103ng t\u00e1i h\u1ea5p thu n\u01b0\u1edbc v\u00e0 natri \u1edf \u1ed1ng th\u1eadn.<\/p>\n

      \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n suy tim, n\u1ed3ng \u0111\u1ed9 aldosteron c\u00f3 th\u1ec3 t\u0103ng h\u01a1n 20 l\u1ea7n so v\u1edbi ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng. Aldosteron c\u00f3 t\u00e1c \u0111\u1ed9ng x\u1ea5u l\u00ean tim do th\u00fac \u0111\u1ea9y qu\u00e1 tr\u00ecnh x\u01a1 h\u00f3a c\u01a1 tim v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng n\u1ed9i m\u1ea1c th\u00e0nh m\u1ea1ch. Angiotensin II th\u00fac \u0111\u1ea9y qu\u00e1 tr\u00ecnh gi\u1ea3i ph\u00f3ng norepinephrine t\u1eeb t\u1eadn c\u00f9ng c\u00e1c d\u00e2y th\u1ea7n kinh v\u00e0 l\u00e0m gia t\u0103ng ho\u1ea1t \u0111\u1ed9ng c\u1ee7a h\u1ec7 adrenergic.<\/p>\n

      Ngo\u00e0i ra, angiotensin II c\u00f2n l\u00e0m t\u0103ng t\u00e1c d\u1ee5ng co m\u1ea1ch th\u00f4ng qua k\u00edch th\u00edch th\u1ee5 th\u1ec3 \u03b11. Do t\u00e1c d\u1ee5ng \u0111i\u1ec1u h\u00f2a c\u1ee7a th\u1ea7n kinh ph\u1ebf v\u1ecb n\u00ean t\u1ea7n s\u1ed1 tim kh\u00f4ng t\u0103ng nhi\u1ec1u trong khi v\u1eabn c\u00f2n hi\u1ec7n t\u01b0\u1ee3ng co th\u1eaft m\u1ea1ch ngo\u1ea1i bi\u00ean. Ngo\u00e0i t\u00e1c d\u1ee5ng l\u00e0m c\u1ea3n tr\u1edf s\u1ef1 h\u00ecnh th\u00e0nh angiotensin II, c\u00e1c thu\u1ed1c \u01afCMC c\u00f2n \u0111\u1ed3ng th\u1eddi \u1ee9c ch\u1ebf s\u1ef1 tho\u00e1i gi\u00e1ng bradykinin. Bradykinin th\u00fac \u0111\u1ea9y n\u1ed9i m\u1ea1c th\u00e0nh m\u1ea1ch t\u0103ng ti\u1ebft c\u00e1c ch\u1ea5t gi\u00e3n m\u1ea1ch l\u00e0 nitric oxide v\u00e0 c\u00e1c prostaglandin (prostacyclin v\u00e0 prostaglandin E2). Thu\u1ed1c \u01afCMC l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 bradykinin, trong khi nh\u00f3m thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 th\u00ec kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3 n\u00e0y do kh\u00f4ng t\u00e1c \u0111\u1ed9ng v\u00e0o qu\u00e1 tr\u00ecnh tho\u00e1i gi\u00e1ng c\u1ee7a bradykinin, do \u0111\u00f3 nh\u00f3m thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 \u00edt g\u1eb7p nh\u1eefng t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n do bradykinin g\u00e2y ra nh\u01b0 ho ho\u1eb7c ph\u00f9 m\u1ea1ch so v\u1edbi nh\u00f3m \u01afCMC.<\/p>\n","protected":false},"excerpt":{"rendered":"

      Thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n d\u1ea1ng angiotensin (Angiotensin-converting enzyme (ACE) inhibitors), g\u1ecdi t\u1eaft l\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n(UCMC), t\u00e1c d\u1ee5ng tr\u1ef1c ti\u1ebfp l\u00ean h\u1ec7 RAA, l\u00e0 nh\u00f3m thu\u1ed1c h\u1ebft s\u1ee9c quan tr\u1ecdng m\u00e0 c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng c\u1ea7n n\u1eafm r\u00f5 trong th\u1ef1c h\u00e0nh \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tim m\u1ea1ch 1.Gi\u1edbi thi\u1ec7u chung T\u1eeb \u0111\u1ea7u […]<\/p>\n","protected":false},"author":7,"featured_media":20923,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[3],"yoast_head":"\nThu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n v\u00e0 nh\u1eefng \u0111i\u1ec1u c\u1ea7n bi\u1ebft - Vinmec<\/title>\n<meta name=\"description\" content=\"Thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng r\u1ea5t quan tr\u1ecdng. 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