{"id":21639,"date":"2023-04-15T21:28:33","date_gmt":"2023-04-15T14:28:33","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21639"},"modified":"2023-04-17T14:43:25","modified_gmt":"2023-04-17T07:43:25","slug":"thiazide-tu-co-che-den-duoc-dong-duoc-luc-hoc","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/thiazide-tu-co-che-den-duoc-dong-duoc-luc-hoc\/","title":{"rendered":"Thiazide t\u1eeb c\u01a1 ch\u1ebf \u0111\u1ebfn d\u01b0\u1ee3c \u0111\u1ed9ng, d\u01b0\u1ee3c l\u1ef1c h\u1ecdc"},"content":{"rendered":"

Thiazide \u0111\u01b0\u1ee3c h\u1ea5p thu qua \u0111\u01b0\u1eddng u\u1ed1ng, c\u00f3 th\u1ec3 t\u00edch ph\u00e2n ph\u1ed1i b\u1eb1ng ho\u1eb7c l\u1edbn h\u01a1n tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed t\u01b0\u01a1ng \u1ee9ng v\u00e0 li\u00ean k\u1ebft ch\u1ee7 y\u1ebfu v\u1edbi protein huy\u1ebft t\u01b0\u01a1ng. C\u0169ng nh\u01b0 c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u quai, thiazide ph\u1ea3i \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft t\u00edch c\u1ef1c v\u00e0o \u1ed1ng l\u01b0\u1ee3n g\u1ea7n \u0111\u1ec3 g\u1eafn v\u1edbi v\u1ecb tr\u00ed t\u00e1c d\u1ee5ng c\u1ee7a ch\u00fang, do ch\u00fang li\u00ean k\u1ebft v\u1edbi protein tr\u1ecdng l\u01b0\u1ee3ng cao n\u00ean qua c\u1ea7u th\u1eadn m\u1ed9t c\u00e1ch h\u1ea1n ch\u1ebf.<\/strong><\/p>\n

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

Trong khi ph\u00e1t tri\u1ec3n c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf anhydrase carbonic, c\u00e1c nh\u00e0 nghi\u00ean c\u1ee9u \u0111\u00e3 t\u00ecnh c\u1edd ph\u00e1t hi\u1ec7n ra chlorothiazide. Chlorothiazide l\u00e0 m\u1ed9t kh\u00e1m ph\u00e1 t\u00ecnh c\u1edd qua c\u01a1 ch\u1ebf l\u00e0m t\u0103ng b\u00e0i ti\u1ebft clorua. Chlorothiazide nhanh ch\u00f3ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong l\u00e2m s\u00e0ng v\u00e0o n\u0103m 1957, \u0111\u00e1nh d\u1ea5u s\u1ef1 kh\u1edfi \u0111\u1ea7u c\u1ee7a li\u1ec7u ph\u00e1p l\u1ee3i ti\u1ec3u \u0111\u01b0\u1eddng u\u1ed1ng hi\u1ec7u qu\u1ea3.<\/p>\n

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

C\u01a1 ch\u1ebf ho\u1ea1t \u0111\u1ed9ng ch\u00ednh c\u1ee7a thiazide l\u00e0 t\u00e1c \u0111\u1ed9ng v\u00e0o qu\u00e1 tr\u00ecnh v\u1eadn chuy\u1ec3n ch\u1ee7 \u0111\u1ed9ng Na+Cl\u2013, n\u1eb1m trong m\u00e0ng t\u1ebf b\u00e0o \u1edf \u0111o\u1ea1n \u0111\u1ea7u c\u1ee7a \u1ed1ng l\u01b0\u1ee3n xa. Vi\u1ec7c t\u0103ng n\u1ed3ng \u0111\u1ed9 natri trong \u1ed1ng g\u00f3p c\u0169ng l\u00e0m t\u0103ng s\u1ef1 trao \u0111\u1ed5i v\u1edbi kali, d\u1eabn \u0111\u1ebfn gi\u1ea3m kali trong m\u00e1u. S\u1ef1 b\u00e0i ti\u1ebft magie c\u0169ng t\u0103ng l\u00ean khi s\u1eed d\u1ee5ng thiazide. V\u00ec s\u1ef1 t\u00e1i h\u1ea5p thu Na+Cl\u2013 b\u00ecnh th\u01b0\u1eddng \u1edf \u1ed1ng l\u01b0\u1ee3n xa g\u00f3p ph\u1ea7n l\u00e0m lo\u00e3ng d\u1ecbch \u1ed1ng, thiazide c\u00f3 th\u1ec3 l\u00e0m suy gi\u1ea3m kh\u1ea3 n\u0103ng pha lo\u00e3ng c\u1ee7a th\u1eadn nh\u01b0ng b\u1ea3o t\u1ed3n c\u01a1 ch\u1ebf c\u00f4 \u0111\u1eb7c n\u01b0\u1edbc ti\u1ec3u.<\/p>\n

3.D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc v\u00e0 d\u01b0\u1ee3c l\u1ef1c h\u1ecdc<\/strong><\/h2>\n

3.1. D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc<\/h3>\n

T\u1ea5t c\u1ea3 c\u00e1c thiazide \u0111\u01b0\u1ee3c h\u1ea5p thu qua \u0111\u01b0\u1eddng u\u1ed1ng, c\u00f3 th\u1ec3 t\u00edch ph\u00e2n ph\u1ed1i b\u1eb1ng ho\u1eb7c l\u1edbn h\u01a1n tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed t\u01b0\u01a1ng \u1ee9ng v\u00e0 li\u00ean k\u1ebft ch\u1ee7 y\u1ebfu v\u1edbi protein huy\u1ebft t\u01b0\u01a1ng. C\u0169ng nh\u01b0 c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u quai, thiazide ph\u1ea3i \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft t\u00edch c\u1ef1c v\u00e0o \u1ed1ng l\u01b0\u1ee3n g\u1ea7n \u0111\u1ec3 g\u1eafn v\u1edbi v\u1ecb tr\u00ed t\u00e1c d\u1ee5ng c\u1ee7a ch\u00fang, do ch\u00fang li\u00ean k\u1ebft v\u1edbi protein tr\u1ecdng l\u01b0\u1ee3ng cao n\u00ean qua c\u1ea7u th\u1eadn m\u1ed9t c\u00e1ch h\u1ea1n ch\u1ebf.<\/p>\n

Th\u1eddi gian b\u1eaft \u0111\u1ea7u t\u00e1c d\u1ee5ng c\u1ee7a thiazide l\u00e0 kho\u1ea3ng 2 \u2013 3h sau khi d\u00f9ng, \u0111\u1ea1t \u0111\u1ec9nh l\u00e0 t\u1eeb 3 \u2013 6h, v\u1edbi hi\u1ec7u qu\u1ea3 th\u1ea3i natri gi\u1ea3m d\u1ea7n sau 6h \u0111\u1ed1i v\u1edbi h\u1ea7u h\u1ebft c\u00e1c thu\u1ed1c, ngo\u1ea1i tr\u1eeb chlorthalidone. C\u00f3 s\u1ef1 thay \u0111\u1ed5i \u0111\u00e1ng k\u1ec3 v\u1ec1 chuy\u1ec3n h\u00f3a, sinh kh\u1ea3 d\u1ee5ng v\u00e0 th\u1eddi gian b\u00e1n th\u1ea3i gi\u1eefa c\u00e1c thiazide l\u00ean t\u1edbi 60 \u2013 70%. D\u00f9ng c\u00f9ng v\u1edbi th\u1ee9c \u0103n gi\u00fap t\u0103ng c\u01b0\u1eddng h\u1ea5p thu thu\u1ed1c n\u00ean c\u00f3 th\u1ec3 h\u1ea5p thu kh\u00f3 kh\u0103n h\u01a1n khi u\u1ed1ng thu\u1ed1c l\u00fac \u0111\u00f3i.<\/p>\n

M\u1ed9t s\u1ed1 thiazide chuy\u1ec3n h\u00f3a \u1edf gan, v\u00ed d\u1ee5: bentro-\u0080umethiazide, polythiazide, methyclothiazide, indapamide, trong khi nh\u1eefng lo\u1ea1i kh\u00e1c \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft g\u1ea7n nh\u01b0 ho\u00e0n to\u00e0n trong n\u01b0\u1edbc ti\u1ec3u, v\u00ed d\u1ee5: chlorothiazide, hydrochlorothiazide. Chuy\u1ec3n h\u00f3a c\u1ee7a chlorthalidone v\u00e0 metolazone theo c\u1ea3 hai c\u01a1 ch\u1ebf, ch\u1ee7 y\u1ebfu l\u00e0 th\u1eadn (50-80%), m\u1ed9t ph\u1ea7n nh\u1ecf qua m\u1eadt (10%).<\/p>\n

L\u1ee3i th\u1ebf c\u1ee7a c\u00e1c thu\u1ed1c thiazide \u0111\u00f3 l\u00e0 th\u1eddi gian t\u00e1c d\u1ee5ng d\u00e0i (t\u1ed1i thi\u1ec3u 8 -12h). C\u01a1 ch\u1ebf n\u00e0y l\u00e0 y\u1ebfu t\u1ed1 quy\u1ebft \u0111\u1ecbnh t\u00e1c d\u1ee5ng c\u1ee7a ch\u00fang nh\u01b0 l\u00e0 m\u1ed9t thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p. Chlorthalidone \u0111\u1eb7c bi\u1ec7t h\u01a1n so v\u1edbi c\u00e1c thiazide kh\u00e1c nh\u1edd c\u00f3 th\u1eddi gian t\u00e1c d\u1ee5ng r\u1ea5t d\u00e0i, th\u1eddi gian b\u00e1n h\u1ee7y trung b\u00ecnh t\u1eeb 50 \u2013 60h. Thu\u1ed1c ph\u00e2n b\u1ed1 r\u1ed9ng h\u01a1n c\u00e1c thiazide kh\u00e1c, v\u1edbi \u2265 99% thu\u1ed1c \u0111\u01b0\u1ee3c g\u1eafn v\u1edbi anhydrase carbonic trong h\u1ed3ng c\u1ea7u. Tr\u00ean th\u1ef1c t\u1ebf, h\u1ed3ng c\u1ea7u s\u1ebd l\u00e0 n\u01a1i d\u1ef1 tr\u1eef v\u00e0 cho ph\u00e9p d\u00f2ng thu\u1ed1c quay tr\u1edf l\u1ea1i m\u00e1u, t\u1eeb \u0111\u00f3 c\u00f3 th\u1ec3 duy tr\u00ec \u0111\u01b0\u1ee3c t\u00e1c d\u1ee5ng l\u1ee3i ti\u1ec3u \u1edf m\u1ee9c \u0111\u1ed9 th\u1ea5p v\u00e0 \u1ed5n \u0111\u1ecbnh h\u01a1n.<\/p>\n

3.2. D\u01b0\u1ee3c l\u1ef1c h\u1ecdc<\/h3>\n

L\u1ee3i ti\u1ec3u thiazide c\u00f3 r\u1ea5t \u00edt s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 hi\u1ec7u qu\u1ea3 gi\u1eefa li\u1ec1u th\u1ea5p nh\u1ea5t v\u00e0 li\u1ec1u t\u1ed1i \u0111a. M\u1eb7c d\u00f9 c\u00e1c ch\u1ea5t kh\u00e1c nhau s\u1ebd kh\u00e1c nhau v\u1ec1 li\u1ec1u \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 nh\u01b0ng v\u1eabn c\u00f3 s\u1ef1 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng \u1edf m\u1ed9t s\u1ed1 thu\u1ed1c ri\u00eang l\u1ebb \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb t\u1ed1i \u0111a.<\/p>\n

Hi\u1ec7u qu\u1ea3 h\u1ea1 huy\u1ebft \u00e1p c\u1ee7a thiazide kh\u00f4ng mang l\u1ea1i tr\u1ef1c ti\u1ebfp t\u1eeb t\u00e1c d\u1ee5ng l\u1ee3i ti\u1ec3u nhi\u1ec1u, m\u00e0 t\u00e1c d\u1ee5ng \u0111\u00f3 ch\u1ee7 y\u1ebfu l\u00e0 do nh\u1eefng thay \u0111\u1ed5i huy\u1ebft \u0111\u1ed9ng l\u00e2u d\u00e0i \u0111i k\u00e8m. Nh\u1eefng thay \u0111\u1ed5i huy\u1ebft \u0111\u1ed9ng n\u00e0y \u0111\u01b0\u1ee3c g\u00e2y ra b\u1edfi m\u1ed9t m\u1ee9c \u0111\u1ed9 l\u1ee3i ti\u1ec3u c\u1ed1 \u0111\u1ecbnh k\u00e9o d\u00e0i. T\u00e1c \u0111\u1ed9ng l\u00ean huy\u1ebft \u0111\u1ed9ng c\u1ee7a thiazide c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c t\u00e1ch th\u00e0nh giai \u0111o\u1ea1n c\u1ea5p t\u00ednh (1-2 tu\u1ea7n) v\u00e0 m\u1ea1n t\u00ednh (v\u00e0i th\u00e1ng). Trong giai \u0111o\u1ea1n c\u1ea5p t\u00ednh, h\u1ea1 huy\u1ebft \u00e1p ban \u0111\u1ea7u \u0111\u01b0\u1ee3c cho l\u00e0 do gi\u1ea3m th\u1ec3 t\u00edch d\u1ecbch ngo\u1ea1i b\u00e0o v\u00e0 gi\u1ea3m th\u1ec3 t\u00edch l\u00f2ng m\u1ea1ch. V\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng l\u00e2u d\u00e0i, \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn th\u1ec3 t\u00edch huy\u1ebft t\u01b0\u01a1ng v\u00e0 cung l\u01b0\u1ee3ng tim c\u00e0ng gi\u1ea3m d\u1ea7n v\u00e0 tr\u1edf v\u1ec1 m\u1ee9c g\u1ea7n nh\u01b0 b\u00ecnh th\u01b0\u1eddng, do \u0111\u00f3, s\u1ef1 l\u00fd gi\u1ea3i thuy\u1ebft ph\u1ee5c nh\u1ea5t cho vi\u1ec7c t\u00e1c d\u1ee5ng l\u00e2u d\u00e0i c\u1ee7a thiazide trong vi\u1ec7c h\u1ea1 huy\u1ebft \u00e1p l\u00e0 gi\u1ea3m to\u00e0n b\u1ed9 s\u1ee9c c\u1ea3n ngo\u1ea1i bi\u00ean do t\u00ecnh tr\u1ea1ng gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n \u00edt nh\u01b0ng k\u00e9o d\u00e0i.<\/p>\n

3.3. B\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng<\/strong><\/h3>\n

Thu\u1ed1c l\u1ee3i ti\u1ec3u l\u00e0 m\u1ed9t thu\u1ed1c kh\u00f4ng th\u1ec3 thi\u1ebfu trong \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p nhi\u1ec1u n\u0103m qua, trong \u0111\u00f3 thiazide \u0111\u01b0\u1ee3c \u01b0a th\u00edch trong \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p m\u1ea1n t\u00ednh.<\/p>\n

C\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb chung v\u00e0 c\u00e1c b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng<\/p>\n

C\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng trong 40 n\u0103m qua tr\u00ean g\u1ea7n 50.000 b\u1ec7nh nh\u00e2n cho th\u1ea5y h\u1ea1 huy\u1ebft \u00e1p b\u1eb1ng thu\u1ed1c l\u1ee3i ti\u1ec3u d\u1eabn \u0111\u1ebfn gi\u1ea3m c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch. K\u1ebft h\u1ee3p ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p v\u00e0 t\u1ed5ng quan h\u1ec7 th\u1ed1ng cho th\u1ea5y \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c l\u1ee3i ti\u1ec3u thiazide l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 suy tim 41 \u2013 49%, \u0111\u1ed9t qu\u1ef5 kho\u1ea3ng 29-38%, b\u1ec7nh tim m\u1ea1ch v\u00e0nh 14- 21% v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong chung l\u00e0 10-11% so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c. K\u1ebft qu\u1ea3 c\u1ee7a c\u00e1c nghi\u00ean c\u1ee9u n\u00e0y l\u00e0 c\u01a1 s\u1edf cho c\u00e1c khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb chung \u1edf nhi\u1ec1u qu\u1ed1c gia \u1ee7ng h\u1ed9 thiazide l\u00e0 thu\u1ed1c n\u1ec1n t\u1ea3ng \u0111i\u1ec1u tr\u1ecb cho c\u00e1c b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p.<\/p>\n

Hi\u1ec7u qu\u1ea3 c\u1ee7a l\u1ee3i ti\u1ec3u thiazide trong vi\u1ec7c gi\u1ea3m c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch li\u00ean quan \u0111\u1ebfn t\u0103ng huy\u1ebft \u00e1p th\u01b0\u1eddng \u0111\u01b0\u1ee3c coi l\u00e0 t\u00e1c d\u1ee5ng chung c\u1ee7a c\u1ea3 nh\u00f3m, kh\u00f4ng c\u00f3 nghi\u00ean c\u1ee9u so s\u00e1nh tr\u1ef1c ti\u1ebfp c\u00e1c thu\u1ed1c trong nh\u00f3m.<\/p>\n

Thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1ed1ng thiazide (thiazide-like): Chlorthalidone v\u00e0 indapamide l\u00e0 thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1ed1ng thiazide th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, l\u00e0 thu\u1ed1c h\u1ea1 huy\u1ebft \u00e1p m\u1ea1nh h\u01a1n \u0111\u00e1ng k\u1ec3 so v\u1edbi hydrochlorothiazide. Trong m\u1ed9t ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p c\u1ee7a 14 th\u1eed nghi\u1ec7m so s\u00e1nh vi\u1ec7c gi\u1ea3m huy\u1ebft \u00e1p v\u1edbi m\u1ed9t trong ba m\u1ee9c li\u1ec1u hydrochlorothiazide (th\u1ea5p, trung b\u00ecnh, cao) v\u1edbi m\u1ee9c li\u1ec1u t\u01b0\u01a1ng t\u1ef1 c\u1ee7a m\u1ed9t trong nh\u1eefng thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1ed1ng thiazide, gi\u1ea3m huy\u1ebft \u00e1p t\u00e2m thu cao h\u01a1n v\u1edbi chlorthalidone v\u00e0 indapamide (t\u01b0\u01a1ng \u1ee9ng 3,6 v\u00e0 5,1 mmHg). Trong th\u1eed nghi\u1ec7m t\u0103ng huy\u1ebft \u00e1p tr\u00ean ng\u01b0\u1eddi cao tu\u1ed5i, \u0111i\u1ec1u tr\u1ecb b\u1eb1ng indapamide \u0111\u00e3 gi\u00fap gi\u1ea3m \u0111\u00e1ng k\u1ec3 t\u1ef7 l\u1ec7 t\u1eed vong do \u0111\u1ed9t qu\u1ef5 39%, gi\u1ea3m 21% t\u1ef7 l\u1ec7 t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n v\u00e0 gi\u1ea3m 64% t\u1ef7 l\u1ec7 suy tim.<\/p>\n

M\u1ed9t \u0111i\u1ec3m kh\u00e1c bi\u1ec7t quan tr\u1ecdng l\u00e0 th\u1eddi gian t\u00e1c d\u1ee5ng c\u1ee7a chlorthalidone v\u00e0 indapamide d\u00e0i h\u01a1n (24h tr\u1edf l\u00ean so v\u1edbi 6 \u2013 12h v\u1edbi hydrochlorothiazide)<\/p>\n","protected":false},"excerpt":{"rendered":"

Thiazide \u0111\u01b0\u1ee3c h\u1ea5p thu qua \u0111\u01b0\u1eddng u\u1ed1ng, c\u00f3 th\u1ec3 t\u00edch ph\u00e2n ph\u1ed1i b\u1eb1ng ho\u1eb7c l\u1edbn h\u01a1n tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed t\u01b0\u01a1ng \u1ee9ng v\u00e0 li\u00ean k\u1ebft ch\u1ee7 y\u1ebfu v\u1edbi protein huy\u1ebft t\u01b0\u01a1ng. C\u0169ng nh\u01b0 c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u quai, thiazide ph\u1ea3i \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft t\u00edch c\u1ef1c v\u00e0o \u1ed1ng l\u01b0\u1ee3n g\u1ea7n \u0111\u1ec3 g\u1eafn v\u1edbi v\u1ecb tr\u00ed t\u00e1c […]<\/p>\n","protected":false},"author":7,"featured_media":21643,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[12,33],"tags":[3],"yoast_head":"\nThiazide t\u1eeb c\u01a1 ch\u1ebf \u0111\u1ebfn d\u01b0\u1ee3c \u0111\u1ed9ng, d\u01b0\u1ee3c l\u1ef1c h\u1ecdc<\/title>\n<meta name=\"description\" content=\"Thiazide l\u00e0 nh\u00f3m thu\u1ed1c l\u1ee3i ti\u1ec3u \u0111\u01b0\u1ee3c d\u00f9ng ph\u1ed5 bi\u1ebfn b\u00ean c\u1ea1nh nh\u00f3m l\u1ee3i ti\u1ec3u quai. 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