{"id":21672,"date":"2023-04-15T21:23:01","date_gmt":"2023-04-15T14:23:01","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21672"},"modified":"2023-04-17T14:45:02","modified_gmt":"2023-04-17T07:45:02","slug":"ket-hop-loi-tieu-tren-thuc-hanh-lam-sang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/ket-hop-loi-tieu-tren-thuc-hanh-lam-sang\/","title":{"rendered":"K\u1ebft h\u1ee3p l\u1ee3i ti\u1ec3u tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng"},"content":{"rendered":"

K\u1ebft h\u1ee3p l\u1ee3i ti\u1ec3u tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng trong c\u00e1c tr\u01b0\u1ee3ng h\u1ee3p th\u1eeba d\u1ecbch \u0111\u1ec3 ph\u00e1t huy t\u1ed1i \u0111a t\u00e1c d\u1ee5ng c\u00f3 \u0111\u01b0\u1ee3c.<\/strong> Ch\u1ec9 \u0111\u1ecbnh ph\u1ed5 bi\u1ebfn c\u1ee7a c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u l\u00e0 t\u00ecnh tr\u1ea1ng \u1ee9 d\u1ecbch \u1edf ngo\u1ea1i bi\u00ean, ph\u00f9 ph\u1ed5i do b\u1ec7nh tim, b\u1ec7nh th\u1eadn ho\u1eb7c c\u00e1c b\u1ec7nh m\u1ea1ch m\u00e1u g\u00e2y gi\u1ea3m t\u01b0\u1edbi m\u00e1u th\u1eadn.<\/strong><\/p>\n

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

Vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u th\u01b0\u1eddng l\u00e0m gi\u1ea3m ph\u00f9 kho\u1ea3ng k\u1ebd m\u00e0 kh\u00f4ng l\u00e0m m\u1ea5t d\u1ecbch trong huy\u1ebft t\u01b0\u01a1ng. Tuy nhi\u00ean, n\u1ebfu s\u1eed d\u1ee5ng l\u1ee3i ti\u1ec3u qu\u00e1 nhanh, m\u1ea1nh l\u00e0m l\u1ee3i ti\u1ec3u qu\u00e1 m\u1ee9c c\u00f3 th\u1ec3 g\u00e2y ra thi\u1ebfu m\u00e1u t\u1ea1ng v\u00e0 d\u1eabn \u0111\u1ebfn v\u00f2ng xo\u1eafn b\u1ec7nh l\u00fd nh\u01b0 \u0111\u00e3 \u0111\u1ec1 c\u1eadp trong ph\u1ea7n l\u1ee3i ti\u1ec3u qu\u00e1 m\u1ee9c. Do \u0111\u00f3, c\u1ea7n theo d\u00f5i t\u00ecnh tr\u1ea1ng huy\u1ebft \u0111\u1ed9ng c\u0169ng nh\u01b0 c\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a t\u1eebng b\u1ec7nh \u0111\u1ec3 c\u00f3 li\u1ec1u l\u01b0\u1ee3ng ph\u00f9 h\u1ee3p.<\/p>\n

2.C\u00e1c ch\u1ec9 \u0111\u1ecbnh c\u1ee5 th\u1ec3<\/strong><\/h2>\n

2.1. Suy tim<\/strong><\/h3>\n

Ph\u00f9 li\u00ean quan \u0111\u1ebfn suy tim th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u quai. Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, gi\u1eef mu\u1ed1i v\u00e0 n\u01b0\u1edbc tr\u1edf n\u00ean nghi\u00eam tr\u1ecdng th\u00ec s\u1ef1 k\u1ebft h\u1ee3p thiazide v\u00e0 thu\u1ed1c l\u1ee3i ti\u1ec3u quai l\u00e0 c\u1ea7n thi\u1ebft.<\/p>\n

Trong suy tim nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh c\u00f3 \u1ee9 n\u01b0\u1edbc, thu\u1ed1c l\u1ee3i ti\u1ec3u l\u00e0 li\u1ec7u ph\u00e1p tr\u1ecb li\u1ec7u \u0111\u1ea7u tay. S\u1ef1 l\u1ef1a ch\u1ecdn c\u1ee7a thu\u1ed1c l\u1ee3i ti\u1ec3u g\u1ed3m thiazide, furosemide, c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali nh\u01b0 spironolactone v\u00e0 eplerenone. C\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali c\u00f3 nhi\u1ec1u b\u1eb1ng ch\u1ee9ng l\u00e0m gi\u1ea3m t\u1eed vong trong suy tim n\u1eb7ng nh\u01b0 \u0111\u00e3 n\u00eau trong m\u1ee5c 6, ngo\u00e0i ra c\u00f2n t\u00e1c d\u1ee5ng gi\u1ea3m nguy c\u01a1 r\u1ed1i lo\u1ea1n nh\u1ecbp. M\u1ed9t ph\u00e2n t\u00edch h\u1ed3i c\u1ee9u cho th\u1ea5y r\u1eb1ng vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c l\u1ee3i ti\u1ec3u kh\u00f4ng gi\u1eef kali trong nghi\u00ean c\u1ee9u SOLVD c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng t\u1eed vong do lo\u1ea1n nh\u1ecbp tim. Ng\u01b0\u1ee3c l\u1ea1i, m\u1ed9t thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali \u0111\u01a1n \u0111\u1ed9c ho\u1eb7c k\u1ebft h\u1ee3p v\u1edbi m\u1ed9t thu\u1ed1c l\u1ee3i ti\u1ec3u kh\u00f4ng gi\u1eef kali th\u00ec kh\u00f4ng g\u00e2y t\u0103ng nguy c\u01a1 t\u1eed vong do r\u1ed1i lo\u1ea1n nh\u1ecbp tim. \u1ee8c ch\u1ebf men chuy\u1ec3n c\u1ed9ng v\u1edbi l\u1ee3i ti\u1ec3u kh\u00f4ng gi\u1eef kali c\u0169ng kh\u00f4ng l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong do r\u1ed1i lo\u1ea1n nh\u1ecbp.<\/p>\n

\u0110i\u1ec1u tr\u1ecb l\u1ee3i ti\u1ec3u t\u1eebng b\u01b0\u1edbc trong suy tim c\u00f3 tri\u1ec7u ch\u1ee9ng sung huy\u1ebft kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e2n \u0111\u1ecbnh r\u00f5 r\u00e0ng b\u1eb1ng c\u00e1c th\u1eed nghi\u1ec7m \u0111\u1ea7y \u0111\u1ee7 nh\u01b0ng c\u00e1c k\u1ebft h\u1ee3p ti\u1ec1m n\u0103ng l\u00e0:<\/p>\n

    \n
  • \u00a0Thu\u1ed1c l\u1ee3i ti\u1ec3u thiazide v\u1edbi \u1ee9c ch\u1ebf men chuy\u1ec3n,<\/li>\n
  • \u00a0Furosemide li\u1ec1u th\u1ea5p v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n,<\/li>\n
  • \u00a0Thiazide v\u1edbi furosemide li\u1ec1u th\u1ea5p c\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n<\/li>\n
  • Spironolactone ho\u1eb7c eplerenone th\u00eam v\u00e0o nh\u1eefng thu\u1ed1c kh\u00e1c.<\/li>\n<\/ul>\n

    \u0110\u1ed1i v\u1edbi suy tim sung huy\u1ebft n\u1eb7ng, khi sung huy\u1ebft v\u00e0 ph\u00f9 l\u00e0 tri\u1ec7u ch\u1ee9ng n\u1ed5i b\u1eadt, \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u th\u01b0\u1eddng l\u00e0 v\u1edbi furosemide v\u00e0 d\u00f9ng l\u1ee3i ti\u1ec3u s\u1edbm. Li\u1ec1u c\u1ee7a furosemide c\u1ea7n thi\u1ebft trong suy tim kh\u00e1ng thu\u1ed1c c\u00f3 th\u1ec3 r\u1ea5t cao (500 \u2013 1500 mg h\u1eb1ng ng\u00e0y), c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc truy\u1ec1n t\u0129nh m\u1ea1ch li\u00ean t\u1ee5c. Ngo\u00e0i ra, c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u thiazide, kh\u00e1ng aldosterone theo chi\u1ebfn l\u01b0\u1ee3c phong t\u1ecfa nephron tu\u1ea7n t\u1ef1.<\/p>\n

    Thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n:\u00a0\u1ee8c ch\u1ebf men chuy\u1ec3n hi\u1ec7n nay l\u00e0 thu\u1ed1c ti\u00eau chu\u1ea9n cho t\u1ea5t c\u1ea3 c\u00e1c giai \u0111o\u1ea1n suy tim. Trong suy tim sung huy\u1ebft, t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c l\u1ee3i ti\u1ec3u c\u00f3 th\u1ec3 b\u1ecb \u1ee9c ch\u1ebf b\u1edfi gi\u1ea3m t\u01b0\u1edbi m\u00e1u th\u1eadn v\u00e0 s\u1ef1 co m\u1ea1ch do h\u00ecnh th\u00e0nh renin, v\u1edbi m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn th\u1ea5p l\u00e0m gi\u1ea3m b\u00e0i ti\u1ebft natri. Do \u0111\u00f3 thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n l\u00e0 b\u1ed5 sung h\u1ee3p l\u00fd \u0111\u1ec3 l\u1ee3i ti\u1ec3u. Ch\u00fang c\u00f3 t\u00e1c d\u1ee5ng l\u1ee3i ti\u1ec3u gi\u00e1n ti\u1ebfp b\u1eb1ng c\u00e1ch \u1ee9c ch\u1ebf gi\u1ea3i ph\u00f3ng aldosterone. Ch\u00fang c\u0169ng gi\u00fap duy tr\u00ec kali v\u00e0 magie t\u1ebf b\u00e0o.<\/p>\n

    2.1.1 Suy tim kh\u00f4ng th\u1eeba d\u1ecbch:<\/h4>\n

    C\u00e1c tr\u01b0\u1eddng h\u1ee3p suy tim ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i gi\u1ea3m n\u1eb7ng m\u00e0 kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u ph\u00f9 v\u00e0 th\u1eeba d\u1ecbch ngo\u1ea1i bi\u00ean v\u1eabn c\u00f3 ch\u1ec9 \u0111\u1ecbnh d\u00f9ng thu\u1ed1c l\u1ee3i ti\u1ec3u nh\u00f3m kh\u00e1ng aldosterone (m\u1ee9c \u0111\u1ed9 I-A). Nh\u00f3m thu\u1ed1c n\u00e0y \u0111\u00e3 c\u00f3 nh\u1eefng b\u1eb1ng ch\u1ee9ng m\u1ea1nh m\u1ebd trong vi\u1ec7c gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong \u1edf c\u00e1c b\u1ec7nh nh\u00e2n suy tim c\u00f3 ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i gi\u1ea3m v\u00e0 \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o \u0111i\u1ec1u tr\u1ecb ti\u00eau chu\u1ea9n trong t\u1ea5t c\u1ea3 c\u00e1c khuy\u1ebfn c\u00e1o.<\/p>\n

    2.1.2 Thu\u1ed1c l\u1ee3i ti\u1ec3u s\u1eed d\u1ee5ng l\u00e2u d\u00e0i cho b\u1ec7nh suy tim<\/h4>\n

    K\u00e9o d\u00e0i \u0111i\u1ec1u tr\u1ecb l\u1ee3i ti\u1ec3u li\u1ec1u cao c\u00f3 th\u1ec3 c\u00f3 h\u1ea1i do:<\/p>\n

      \n
    • \u00a0K\u00edch ho\u1ea1t th\u00eam h\u1ec7 renin-angiotensin v\u00e0 h\u1ec7 th\u1ed1ng th\u1ea7n kinh giao c\u1ea3m<\/li>\n
    • \u00a0H\u1ea1 natri m\u00e1u ( h\u1ea1 kali m\u00e1u, \u00edt g\u1eb7p h\u01a1n l\u00e0 h\u1ea1 magie m\u00e1u). T\u00e1c h\u1ea1i ti\u1ec1m t\u00e0ng l\u00e2u d\u00e0i c\u1ee7a thu\u1ed1c l\u1ee3i ti\u1ec3u kh\u00f4ng gi\u1eef kali trong suy tim \u0111\u01b0\u1ee3c nh\u1ea5n m\u1ea1nh trong m\u1ed9t ph\u00e2n t\u00edch th\u1ee9 c\u1ea5p c\u1ee7a 7.788 b\u1ec7nh nh\u00e2n t\u1eeb th\u1eed nghi\u1ec7m DIG. Nh\u1eefng t\u00e1c gi\u1ea3 n\u00e0y nh\u1ea5n m\u1ea1nh vi\u1ec7c s\u1eed d\u1ee5ng th\u01b0\u1eddng xuy\u00ean thu\u1ed1c l\u1ee3i ti\u1ec3u \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng tri\u1ec7u ch\u1ee9ng ho\u1eb7c tri\u1ec7u ch\u1ee9ng t\u1ed1i thi\u1ec3u m\u00e0 kh\u00f4ng c\u00f3 \u1ee9 n\u01b0\u1edbc c\u00f3 th\u1ec3 g\u00e2y h\u1ea1i.<\/li>\n<\/ul>\n

      Trong \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c l\u1ee3i ti\u1ec3u, lu\u00f4n l\u01b0u \u00fd r\u1eb1ng cung l\u01b0\u1ee3ng tim \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n suy tim \u0111\u01b0\u1ee3c duy tr\u00ec m\u1ed9t ph\u1ea7n b\u1edfi \u00e1p l\u1ef1c \u0111\u1ed5 \u0111\u1ea7y cao. Do \u0111\u00f3, s\u1eed d\u1ee5ng thu\u1ed1c l\u1ee3i ti\u1ec3u qu\u00e1 m\u1ee9c c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m tr\u1edf v\u1ec1 c\u1ee7a m\u00e1u t\u0129nh m\u1ea1ch v\u00e0 l\u00e0m gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n. Gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m nghi\u00eam tr\u1ecdng cung l\u01b0\u1ee3ng tim n\u1ebfu \u00e1p l\u1ef1c \u0111\u1ed5 \u0111\u1ea7y th\u1ea5t tr\u00e1i gi\u1ea3m xu\u1ed1ng d\u01b0\u1edbi 15mmHg, cu\u1ed1i c\u00f9ng c\u0169ng d\u1eabn \u0111\u1ebfn r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn do gi\u1ea3m \u00e1p l\u1ef1c t\u01b0\u1edbi m\u00e1u.<\/p>\n

      D\u00f9ng l\u1ee3i ti\u1ec3u k\u00e9o d\u00e0i c\u00f3 th\u1ec3 g\u00e2y t\u00ecnh tr\u1ea1ng nhi\u1ec5m ki\u1ec1m chuy\u1ec3n h\u00f3a, l\u00e0 m\u1ed9t t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n kh\u00e1c c\u00f3 th\u1ec3 l\u00e0m t\u1ed5n h\u1ea1i th\u00eam \u0111\u1ebfn ch\u1ee9c n\u0103ng tim. Bi\u1ebfn ch\u1ee9ng n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng b\u1ed5 sung K+ v\u00e0 ph\u1ee5c h\u1ed3i th\u1ec3 t\u00edch n\u1ed9i m\u1ea1ch b\u1eb1ng n\u01b0\u1edbc mu\u1ed1i \u0111\u1eb3ng tr\u01b0\u01a1ng; tuy nhi\u00ean, suy tim n\u1eb7ng c\u00f3 th\u1ec3 h\u1ea1n ch\u1ebf vi\u1ec7c b\u00f9 d\u1ecbch ngay c\u1ea3 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 d\u00f9ng l\u1ee3i ti\u1ec3u qu\u00e1 m\u1ee9c. Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, s\u1eed d\u1ee5ng acetazolamide l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn h\u1ee3p l\u00fd.<\/p>\n

      M\u1ed9t r\u1ed1i lo\u1ea1n kh\u00e1c khi d\u00f9ng l\u1ee3i ti\u1ec3u k\u00e9o d\u00e0i l\u00e0 t\u00ecnh tr\u1ea1ng h\u1ea1 kali m\u00e1u, c\u1ea7n l\u01b0u \u00fd khi d\u00f9ng k\u00e8m digitalis, do c\u00f3 th\u1ec3 l\u00e0m tr\u1ea7m tr\u1ecdng th\u00eam r\u1ed1i lo\u1ea1n nh\u1ecbp tim. C\u00f3 th\u1ec3 ph\u00f2ng tr\u00e1nh b\u1eb1ng c\u00e1ch cho b\u1ec7nh nh\u00e2n gi\u1ea3m l\u01b0\u1ee3ng Na+ \u0103n v\u00e0o trong khi d\u00f9ng thu\u1ed1c l\u1ee3i ti\u1ec3u, b\u1ed5 sung kali \u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef K+.<\/p>\n

      2.2 B\u1ec7nh th\u1eadn v\u00e0 suy th\u1eadn<\/h3>\n

      V\u1ea5n \u0111\u1ec1 quan t\u00e2m l\u00e0 \u0111i\u1ec1u tr\u1ecb l\u1ee3i ti\u1ec3u c\u00f3 th\u1ec3 l\u00e0m thay \u0111\u1ed5i m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng ho\u1eb7c ti\u00ean l\u01b0\u1ee3ng c\u1ee7a suy th\u1eadn c\u1ea5p. \u0110i\u1ec1u n\u00e0y l\u00e0 do suy th\u1eadn c\u1ea5p \u201ckh\u00f4ng thi\u1ec3u ni\u1ec7u\u201d c\u00f3 k\u1ebft qu\u1ea3 t\u1ed1t h\u01a1n so v\u1edbi suy th\u1eadn c\u1ea5p \u201cthi\u1ec3u ni\u1ec7u\u201d (l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u < 400-500 mL\/24h). H\u1ea7u nh\u01b0 t\u1ea5t c\u1ea3 c\u00e1c nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ec3 gi\u1ea3i quy\u1ebft c\u00e2u h\u1ecfi n\u00e0y \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng li\u1ec7u ph\u00e1p l\u1ee3i ti\u1ec3u gi\u00fap \u0111i\u1ec1u ch\u1ec9nh d\u1ecbch trong th\u1eddi gian ng\u1eafn \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n suy th\u1eadn c\u1ea5p, nh\u01b0ng n\u00f3 kh\u00f4ng c\u00f3 t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn ti\u00ean l\u01b0\u1ee3ng l\u00e2u d\u00e0i.<\/p>\n

      Nhi\u1ec1u b\u1ec7nh v\u1ec1 c\u1ea7u th\u1eadn, ch\u1eb3ng h\u1ea1n nh\u01b0 nh\u1eefng b\u1ec7nh li\u00ean quan \u0111\u1ebfn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng ho\u1eb7c lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng, g\u00e2y gi\u1eef mu\u1ed1i n\u01b0\u1edbc \u1edf th\u1eadn. Nguy\u00ean nh\u00e2n c\u1ee7a vi\u1ec7c gi\u1eef natri n\u00e0y kh\u00f4ng \u0111\u01b0\u1ee3c bi\u1ebft ch\u00ednh x\u00e1c nh\u01b0ng n\u00f3 c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn s\u1ef1 r\u1ed1i lo\u1ea1n \u0111i\u1ec1u h\u00f2a vi tu\u1ea7n ho\u00e0n th\u1eadn v\u00e0 ch\u1ee9c n\u0103ng \u1ed1ng th\u1eadn qua vi\u1ec7c gi\u1ea3i ph\u00f3ng c\u00e1c ch\u1ea5t co m\u1ea1ch, prostaglandin, cytokine v\u00e0 c\u00e1c ch\u1ea5t trung gian kh\u00e1c. Khi ph\u00f9 ho\u1eb7c t\u0103ng huy\u1ebft \u00e1p xu\u1ea5t hi\u1ec7n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y, li\u1ec7u ph\u00e1p l\u1ee3i ti\u1ec3u c\u00f3 th\u1ec3 r\u1ea5t hi\u1ec7u qu\u1ea3.<\/p>\n

      M\u1ed9t s\u1ed1 d\u1ea1ng b\u1ec7nh th\u1eadn, \u0111\u1eb7c bi\u1ec7t l\u00e0 b\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn t\u0103ng kali m\u00e1u \u1edf giai \u0111o\u1ea1n t\u01b0\u01a1ng \u0111\u1ed1i s\u1edbm c\u1ee7a suy th\u1eadn. \u0110i\u1ec1u n\u00e0y th\u01b0\u1eddng l\u00e0 do nhi\u1ec5m acid \u1ed1ng th\u1eadn type IV. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y, thu\u1ed1c l\u1ee3i ti\u1ec3u quai ho\u1eb7c thiazide s\u1ebd t\u0103ng c\u01b0\u1eddng b\u00e0i ti\u1ebft K+ b\u1eb1ng c\u00e1ch t\u0103ng l\u01b0\u1ee3ng mu\u1ed1i \u0111\u1ebfn \u1ed1ng g\u00f3p .<\/p>\n

      B\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh th\u1eadn d\u1eabn \u0111\u1ebfn h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 th\u01b0\u1eddng g\u1eb7p nhi\u1ec1u v\u1ea5n \u0111\u1ec1 ph\u1ee9c t\u1ea1p trong \u0111i\u1ec1u ch\u1ec9nh kh\u1ed1i l\u01b0\u1ee3ng d\u1ecbch. Nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n \u1ee9 n\u01b0\u1edbc d\u01b0\u1edbi d\u1ea1ng c\u1ed5 tr\u01b0\u1edbng ho\u1eb7c ph\u00f9 nh\u01b0ng b\u1ecb gi\u1ea3m th\u1ec3 t\u00edch huy\u1ebft t\u01b0\u01a1ng do gi\u1ea3m \u00e1p l\u1ef1c keo huy\u1ebft t\u01b0\u01a1ng. \u0110\u00e2y l\u00e0 tr\u01b0\u1eddng h\u1ee3p r\u1ea5t th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh th\u1eadn \u201cthay \u0111\u1ed5i t\u1ed1i thi\u1ec3u\u201d. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y, s\u1eed d\u1ee5ng thu\u1ed1c l\u1ee3i ti\u1ec3u c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m th\u00eam th\u1ec3 t\u00edch huy\u1ebft t\u01b0\u01a1ng, l\u00e0m gi\u1ea3m MLCT v\u00e0 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn h\u1ea1 huy\u1ebft \u00e1p th\u1ebf t\u01b0 th\u1ebf. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y, li\u1ec7u ph\u00e1p l\u1ee3i ti\u1ec3u c\u00f3 th\u1ec3 c\u00f3 l\u1ee3i nh\u01b0ng c\u1ea7n theo d\u00f5i ch\u1eb7t ch\u1ebd.<\/p>\n

      Khi suy th\u1eadn n\u1eb7ng (MLCT <5 mL\/ph\u00fat), thu\u1ed1c l\u1ee3i ti\u1ec3u \u00edt c\u00f3 l\u1ee3i, b\u1edfi v\u00ec m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn kh\u00f4ng \u0111\u1ee7 \u0111\u1ec3 t\u1ea1o ho\u1eb7c duy tr\u00ec \u0111\u00e1p \u1ee9ng th\u1ea3i natri. Tuy nhi\u00ean, m\u1ed9t s\u1ed1 l\u01b0\u1ee3ng l\u1edbn b\u1ec7nh nh\u00e2n v\u00e0 th\u1eadm ch\u00ed b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o, v\u1edbi m\u1ee9c \u0111\u1ed9 suy th\u1eadn nh\u1eb9 h\u01a1n (MLCT 5-15 mL\/ph\u00fat), v\u1eabn c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c l\u1ee3i ti\u1ec3u.<\/p>\n

      Trong vi\u1ec7c l\u1ef1a ch\u1ecdn thu\u1ed1c l\u1ee3i ti\u1ec3u cho b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh th\u1eadn, c\u00f3 m\u1ed9t s\u1ed1 l\u01b0u \u00fd nh\u01b0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh d\u00f9ng acetazolamide v\u00ec n\u00f3 g\u00e2y b\u00e0i ti\u1ebft NaHCO3 v\u00e0 c\u00f3 th\u1ec3 l\u00e0m tr\u1ea7m tr\u1ecdng th\u00eam nhi\u1ec5m toan. Thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali c\u00f3 th\u1ec3 g\u00e2y t\u0103ng kali m\u00e1u. Thu\u1ed1c l\u1ee3i ti\u1ec3u thiazide \u0111\u01b0\u1ee3c cho l\u00e0 kh\u00f4ng hi\u1ec7u qu\u1ea3 khi MLCT gi\u1ea3m xu\u1ed1ng d\u01b0\u1edbi 30 mL\/ph\u00fat. Li\u1ec1u cao thu\u1ed1c l\u1ee3i ti\u1ec3u quai (l\u00ean \u0111\u1ebfn 500 mg\/24h furosemide) ho\u1eb7c k\u1ebft h\u1ee3p c\u1ee7a metolazone (5 -10 mg\/24h) v\u1edbi furosemide (40 \u2013 80 mg\/24h) c\u00f3 th\u1ec3 c\u00f3 \u00edch trong vi\u1ec7c \u0111i\u1ec1u tr\u1ecb qu\u00e1 t\u1ea3i th\u1ec3 t\u00edch \u1edf b\u1ec7nh nh\u00e2n l\u1ecdc m\u00e1u ho\u1eb7c ti\u1ec1n l\u1ecdc m\u00e1u.<\/p>\n

      2.3. X\u01a1 gan<\/h3>\n

      B\u1ec7nh gan khi c\u00f3 ph\u00f9 n\u1ec1 v\u00e0 c\u1ed5 tr\u01b0\u1edbng k\u1ebft h\u1ee3p v\u1edbi t\u0103ng \u00e1p l\u1ef1c th\u1ee7y t\u0129nh v\u00e0 gi\u1ea3m \u00e1p l\u1ef1c keo huy\u1ebft t\u01b0\u01a1ng th\u00ec li\u1ec7u ph\u00e1p l\u1ee3i ti\u1ec3u th\u01b0\u1eddng h\u1eefu \u00edch. Tuy nhi\u00ean, b\u1ec7nh nh\u00e2n x\u01a1 gan th\u01b0\u1eddng kh\u00e1ng v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u quai v\u00ec gi\u1ea3m b\u00e0i ti\u1ebft thu\u1ed1c v\u00e0o d\u1ecbch \u1ed1ng th\u1eadn v\u00e0 v\u00ec n\u1ed3ng \u0111\u1ed9 aldosterone cao. Ng\u01b0\u1ee3c l\u1ea1i, ph\u00f9 do x\u01a1 gan \u0111\u00e1p \u1ee9ng v\u1edbi spironolactone v\u00e0 eplerenone. S\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a thu\u1ed1c l\u1ee3i ti\u1ec3u quai v\u00e0 kh\u00e1ng th\u1ee5 th\u1ec3 aldosterone mang l\u1ea1i l\u1ee3i \u00edch \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n. C\u1ea7n th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng thu\u1ed1c \u0111\u1ed1i kh\u00e1ng aldosterone \u1edf b\u1ec7nh nh\u00e2n x\u01a1 gan k\u00e8m suy th\u1eadn v\u00ec nguy c\u01a1 g\u00e2y t\u0103ng kali m\u00e1u.<\/p>\n

      \u0110i\u1ec1u quan tr\u1ecdng c\u1ea7n l\u01b0u \u00fd l\u00e0 s\u1eed d\u1ee5ng qu\u00e1 m\u1ea1nh thu\u1ed1c l\u1ee3i ti\u1ec3u trong b\u1ec7nh n\u00e0y c\u00f3 th\u1ec3 g\u00e2y m\u1ed9t s\u1ed1 r\u1ed1i lo\u1ea1n nh\u01b0 gi\u1ea3m th\u1ec3 t\u00edch n\u1ed9i m\u1ea1ch, h\u1ea1 kali m\u00e1u v\u00e0 nhi\u1ec5m ki\u1ec1m chuy\u1ec3n h\u00f3a. H\u1ed9i ch\u1ee9ng gan th\u1eadn v\u00e0 b\u1ec7nh n\u00e3o gan c\u00f3 th\u1ec3 x\u1ea3y ra khi s\u1eed d\u1ee5ng thu\u1ed1c l\u1ee3i ti\u1ec3u qu\u00e1 m\u1ee9c \u1edf b\u1ec7nh nh\u00e2n x\u01a1 gan. Tolvaptan li\u1ec1u th\u1ea5p, \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 h\u1eefu \u00edch trong \u0111i\u1ec1u tr\u1ecb m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n b\u1ecb x\u01a1 gan b\u1ecb h\u1ea1 natri m\u00e1u ho\u1eb7c qu\u00e1 t\u1ea3i d\u1ecbch.<\/p>\n

      2.4. Ph\u00f9 v\u00f4 c\u0103n<\/h3>\n

      Ph\u00f9 v\u00f4 c\u0103n l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf ph\u1ee5 n\u1eef t\u1eeb 20 \u2013 30 tu\u1ed5i. M\u1eb7c d\u00f9 \u0111\u00e3 c\u00f3 nhi\u1ec1u nghi\u00ean c\u1ee9u, sinh l\u00fd b\u1ec7nh v\u1eabn c\u00f2n ch\u01b0a r\u00f5 r\u00e0ng. B\u1ec7nh n\u00e0y c\u00f3 th\u1ec3 ch\u1ec9 c\u1ea7n h\u1ea1n ch\u1ebf l\u01b0\u1ee3ng mu\u1ed1i \u0103n v\u00e0o ho\u1eb7c c\u00f3 th\u1ec3 th\u00eam spironolactone. T\u1ea5t \u00e1p l\u1ef1c c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng tuy r\u1eb1ng l\u1ee3i \u00edch r\u1ea5t thay \u0111\u1ed5i tu\u1ef3 v\u00e0o nghi\u00ean c\u1ee9u.<\/p>\n

       <\/p>\n","protected":false},"excerpt":{"rendered":"

      K\u1ebft h\u1ee3p l\u1ee3i ti\u1ec3u tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng trong c\u00e1c tr\u01b0\u1ee3ng h\u1ee3p th\u1eeba d\u1ecbch \u0111\u1ec3 ph\u00e1t huy t\u1ed1i \u0111a t\u00e1c d\u1ee5ng c\u00f3 \u0111\u01b0\u1ee3c. Ch\u1ec9 \u0111\u1ecbnh ph\u1ed5 bi\u1ebfn c\u1ee7a c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u l\u00e0 t\u00ecnh tr\u1ea1ng \u1ee9 d\u1ecbch \u1edf ngo\u1ea1i bi\u00ean, ph\u00f9 ph\u1ed5i do b\u1ec7nh tim, b\u1ec7nh th\u1eadn ho\u1eb7c c\u00e1c b\u1ec7nh m\u1ea1ch m\u00e1u g\u00e2y gi\u1ea3m […]<\/p>\n","protected":false},"author":7,"featured_media":21679,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[12,33],"tags":[3],"yoast_head":"\nK\u1ebft h\u1ee3p l\u1ee3i ti\u1ec3u tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng - Vinmec<\/title>\n<meta name=\"description\" content=\"K\u1ebft h\u1ee3p l\u1ee3i ti\u1ec3u tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p trong c\u00e1c b\u1ec7nh l\u00fd th\u1eeba d\u1ecbch nh\u01b0 suy tim, x\u01a1 gan...\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"K\u1ebft h\u1ee3p l\u1ee3i ti\u1ec3u tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng - Vinmec\" \/>\n<meta property=\"og:description\" content=\"K\u1ebft h\u1ee3p l\u1ee3i ti\u1ec3u tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p trong c\u00e1c b\u1ec7nh l\u00fd th\u1eeba d\u1ecbch nh\u01b0 suy tim, x\u01a1 gan...\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/ket-hop-loi-tieu-tren-thuc-hanh-lam-sang\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-15T14:23:01+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-04-17T07:45:02+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/20220616_013537_773710_thuoc-coversyl-plus.max-1800x1800-1.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"500\" \/>\n\t<meta property=\"og:image:height\" content=\"500\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"9 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/ket-hop-loi-tieu-tren-thuc-hanh-lam-sang\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/ket-hop-loi-tieu-tren-thuc-hanh-lam-sang\/\",\"name\":\"K\u1ebft h\u1ee3p l\u1ee3i ti\u1ec3u tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng - Vinmec\",\"isPartOf\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-04-15T14:23:01+00:00\",\"dateModified\":\"2023-04-17T07:45:02+00:00\",\"author\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/dded5c0d4cb1bb77d05cf29ab5f85629\"},\"description\":\"K\u1ebft h\u1ee3p l\u1ee3i ti\u1ec3u tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p trong c\u00e1c b\u1ec7nh l\u00fd th\u1eeba d\u1ecbch nh\u01b0 suy tim, x\u01a1 gan...\",\"breadcrumb\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/ket-hop-loi-tieu-tren-thuc-hanh-lam-sang\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/ket-hop-loi-tieu-tren-thuc-hanh-lam-sang\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/ket-hop-loi-tieu-tren-thuc-hanh-lam-sang\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"http:\/\/noithathoaphat.in\/ctv\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"K\u1ebft h\u1ee3p l\u1ee3i ti\u1ec3u tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng\"}]},{\"@type\":\"WebSite\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/\",\"name\":\"Vinmec\",\"description\":\"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"http:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/dded5c0d4cb1bb77d05cf29ab5f85629\",\"name\":\"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/\",\"url\":\"http:\/\/2.gravatar.com\/avatar\/50f51f67852bc7e49c0b8b60a1fefe3e?s=96&d=mm&r=g\",\"contentUrl\":\"http:\/\/2.gravatar.com\/avatar\/50f51f67852bc7e49c0b8b60a1fefe3e?s=96&d=mm&r=g\",\"caption\":\"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i\"},\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/viettai304-304gmail-com\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"K\u1ebft h\u1ee3p l\u1ee3i ti\u1ec3u tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng - Vinmec","description":"K\u1ebft h\u1ee3p l\u1ee3i ti\u1ec3u tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p trong c\u00e1c b\u1ec7nh l\u00fd th\u1eeba d\u1ecbch nh\u01b0 suy tim, x\u01a1 gan...","robots":{"index":"noindex","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"og_locale":"en_US","og_type":"article","og_title":"K\u1ebft h\u1ee3p l\u1ee3i ti\u1ec3u tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng - Vinmec","og_description":"K\u1ebft h\u1ee3p l\u1ee3i ti\u1ec3u tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p trong c\u00e1c b\u1ec7nh l\u00fd th\u1eeba d\u1ecbch nh\u01b0 suy tim, x\u01a1 gan...","og_url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/ket-hop-loi-tieu-tren-thuc-hanh-lam-sang\/","og_site_name":"Vinmec","article_published_time":"2023-04-15T14:23:01+00:00","article_modified_time":"2023-04-17T07:45:02+00:00","og_image":[{"width":500,"height":500,"url":"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/20220616_013537_773710_thuoc-coversyl-plus.max-1800x1800-1.jpg","type":"image\/jpeg"}],"author":"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i","twitter_card":"summary_large_image","twitter_misc":{"Written by":"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i","Est. reading time":"9 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/ket-hop-loi-tieu-tren-thuc-hanh-lam-sang\/","url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/ket-hop-loi-tieu-tren-thuc-hanh-lam-sang\/","name":"K\u1ebft h\u1ee3p l\u1ee3i ti\u1ec3u tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng - Vinmec","isPartOf":{"@id":"http:\/\/noithathoaphat.in\/ctv\/#website"},"datePublished":"2023-04-15T14:23:01+00:00","dateModified":"2023-04-17T07:45:02+00:00","author":{"@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/dded5c0d4cb1bb77d05cf29ab5f85629"},"description":"K\u1ebft h\u1ee3p l\u1ee3i ti\u1ec3u tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p trong c\u00e1c b\u1ec7nh l\u00fd th\u1eeba d\u1ecbch nh\u01b0 suy tim, x\u01a1 gan...","breadcrumb":{"@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/ket-hop-loi-tieu-tren-thuc-hanh-lam-sang\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/ket-hop-loi-tieu-tren-thuc-hanh-lam-sang\/"]}]},{"@type":"BreadcrumbList","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/ket-hop-loi-tieu-tren-thuc-hanh-lam-sang\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"http:\/\/noithathoaphat.in\/ctv\/"},{"@type":"ListItem","position":2,"name":"K\u1ebft h\u1ee3p l\u1ee3i ti\u1ec3u tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng"}]},{"@type":"WebSite","@id":"http:\/\/noithathoaphat.in\/ctv\/#website","url":"http:\/\/noithathoaphat.in\/ctv\/","name":"Vinmec","description":"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"http:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/dded5c0d4cb1bb77d05cf29ab5f85629","name":"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/","url":"http:\/\/2.gravatar.com\/avatar\/50f51f67852bc7e49c0b8b60a1fefe3e?s=96&d=mm&r=g","contentUrl":"http:\/\/2.gravatar.com\/avatar\/50f51f67852bc7e49c0b8b60a1fefe3e?s=96&d=mm&r=g","caption":"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i"},"url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/viettai304-304gmail-com\/"}]}},"_links":{"self":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/21672"}],"collection":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/comments?post=21672"}],"version-history":[{"count":1,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/21672\/revisions"}],"predecessor-version":[{"id":21680,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/21672\/revisions\/21680"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/media\/21679"}],"wp:attachment":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/media?parent=21672"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/categories?post=21672"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/tags?post=21672"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}