{"id":25130,"date":"2023-04-19T22:01:07","date_gmt":"2023-04-19T15:01:07","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=25130"},"modified":"2023-04-22T13:14:27","modified_gmt":"2023-04-22T06:14:27","slug":"viem-co-tim-va-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/viem-co-tim-va-dieu-tri\/","title":{"rendered":"Vi\u00eam c\u01a1 tim v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"<p><strong><a href=\"https:\/\/www.vinmec.com\/vi\/benh\/viem-co-tim-3308\/\">Vi\u00eam c\u01a1 tim<\/a> l\u00e0 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng ph\u1ee9c t\u1ea1p t\u1eeb<\/strong> <strong>kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng cho \u0111\u1ebfn c\u00e1c d\u1ea5u hi\u1ec7u suy tim, r\u1ed1i lo\u1ea1n nh\u1ecbp tim\u2026 r\u1ea7m r\u1ed9 n\u1eb7ng n\u1ec1<\/strong> <strong>v\u1edbi ti\u00ean l\u01b0\u1ee3ng t\u1eed vong r\u1ea5t cao.<\/strong><\/p>\n<h2>1.\u0110\u1ecbnh ngh\u0129a, nguy\u00ean nh\u00e2n<\/h2>\n<p>L\u00e0 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng ph\u1ee9c t\u1ea1p t\u1eeb kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng cho \u0111\u1ebfn c\u00e1c d\u1ea5u hi\u1ec7u suy tim, r\u1ed1i lo\u1ea1n nh\u1ecbp tim\u2026 r\u1ea7m r\u1ed9 n\u1eb7ng n\u1ec1 v\u1edbi ti\u00ean l\u01b0\u1ee3ng t\u1eed vong r\u1ea5t cao. Ch\u1ea9n \u0111o\u00e1n nghi ng\u1edd d\u1ef1a v\u00e0o c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng v\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p th\u0103m d\u00f2 kh\u00f4ng x\u00e2m nh\u1eadp. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh d\u1ef1a v\u00e0o c\u00e1c ti\u00eau chu\u1ea9n gi\u1ea3i ph\u1eabu b\u1ec7nh tr\u00ean m\u00f4 b\u1ec7nh sinh thi\u1ebft c\u01a1 tim.<br \/>\n\u0110i\u1ec1u tr\u1ecb bao g\u1ed3m c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng nh\u01b0 \u0111i\u1ec1u tr\u1ecb suy tim, \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n nh\u1ecbp tim v\u00e0 h\u1ed3i s\u1ee9c c\u0169ng nh\u01b0 c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch. Tuy nhi\u00ean, vai tr\u00f2 v\u00e0 t\u00e1c d\u1ee5ng c\u1ee7a c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch v\u1eabn \u0111ang c\u00f2n tranh c\u00e3i v\u00e0 ch\u01b0a \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o trong c\u00e1c khuy\u1ebfn c\u00e1o th\u1ef1c h\u00e0nh v\u1edbi m\u1ee9c \u0111\u1ed9 b\u1eb1ng ch\u1ee9ng cao.<\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-25136 aligncenter\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/tai-xuong-7.jpg\" alt=\"vi\u00eam c\u01a1 tim\" width=\"486\" height=\"307\" \/><\/p>\n<p style=\"text-align: center;\"><strong>H\u00ecnh \u1ea3nh vi\u00eam c\u01a1 tim<\/strong><\/p>\n<p>D\u1ef1a theo nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh,\u00a0 g\u1ed3m m\u1ed9t s\u1ed1 th\u1ec3 sau:<\/p>\n<ul>\n<li>Vi\u00eam c\u01a1 tim do virus: \u0110\u00e2y l\u00e0 th\u1ec3 vi\u00eam c\u01a1 tim ph\u1ed5 bi\u1ebfn nh\u1ea5t. M\u1ed9t s\u1ed1 virus c\u00f3 th\u1ec3 g\u00e2y vi\u00eam c\u01a1 tim g\u1ed3m Coxsackie B, CMV, Dengue, Epstein \u2013 Barr,\u2026<\/li>\n<li>Vi\u00eam c\u01a1 tim do vi khu\u1ea9n: Rickettsia, Treponema pallidum, Leptospira, N. meningitidis, Tropheryma whippelii, Legionella, Salmonella, Psittacosis, Streptococcus,\u2026 l\u00e0 m\u1ed9t s\u1ed1 vi khu\u1ea9n g\u00e2y vi\u00eam c\u01a1 tim th\u01b0\u1eddng g\u1eb7p<\/li>\n<li>Vi\u00eam c\u01a1 tim do\u00a0<a href=\"https:\/\/bvnguyentriphuong.com.vn\/benh-ky-sinh-trung\/cac-khai-niem-ve-ki-sinh-trung\">k\u00fd sinh tr\u00f9ng<\/a>: B\u1ec7nh l\u00e2y truy\u1ec1n qua trung gian l\u00e0 b\u1ecd r\u1ec7p thu\u1ed9c lo\u00e0i Triatoma.<\/li>\n<li>Vi\u00eam c\u01a1 tim do n\u1ea5m: \u0110\u00e2y l\u00e0 th\u1ec3 t\u01b0\u01a1ng \u0111\u1ed1i hi\u1ebfm g\u1eb7p, ch\u1ee7 y\u1ebfu g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd \u00e1c t\u00ednh, ng\u01b0\u1eddi \u0111ang h\u00f3a tr\u1ecb, d\u00f9ng steroid ho\u1eb7c \u0111ang s\u1eed d\u1ee5ng c\u00e1c li\u1ec7u ph\u00e1p \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch. M\u1ed9t s\u1ed1 n\u1ea5m \u0111\u01b0\u1ee3c cho l\u00e0 c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u00eam c\u01a1 tim g\u1ed3m Actinomyces, Aspergillus, Candida, Cryptococcus, Histoplasma.<\/li>\n<li>Vi\u00eam c\u01a1 tim do nhi\u1ec5m \u0111\u1ed9c v\u00e0 chuy\u1ec3n h\u00f3a: R\u1ea5t nhi\u1ec1u lo\u1ea1i thu\u1ed1c, ch\u1ea5t h\u00f3a h\u1ecdc, t\u00e1c nh\u00e2n v\u1eadt l\u00fd c\u00f3 th\u1ec3 g\u00e2y vi\u00eam c\u01a1 tim. M\u1ed9t s\u1ed1 trong \u0111\u00f3 c\u00f3 th\u1ec3 k\u1ec3 \u0111\u1ebfn nh\u01b0 Anthracyclines, Cocain, Catecholamine,\u2026 S\u1ef1 thi\u1ebfu h\u1ee5t Taurine v\u00e0 Carnitine c\u0169ng \u0111\u01b0\u1ee3c cho l\u00e0 c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u00eam c\u01a1 tim.<\/li>\n<li>Vi\u00eam c\u01a1 tim do ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn c\u1ee7a c\u01a1 th\u1ec3: \u0110\u00e2y l\u00e0 ph\u1ea3n \u1ee9ng t\u1ef1 nhi\u00ean c\u1ee7a mi\u1ec5n d\u1ecbch tim do d\u00f9ng thu\u1ed1c. T\u00ecnh tr\u1ea1ng n\u00e0y c\u00f3 th\u1ec3 g\u00e2y suy tim r\u1ea5t nhanh, th\u1eadm ch\u00ed l\u00e0 t\u1eed vong nh\u01b0ng r\u1ea5t hi\u1ebfm g\u1eb7p tr\u00ean l\u00e2m s\u00e0ng. C\u00e1c lo\u1ea1i thu\u1ed1c c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn vi\u00eam c\u01a1 tim g\u1ed3m kh\u00e1ng sinh, thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh, thu\u1ed1c ch\u1ed1ng lao, thu\u1ed1c kh\u00e1ng vi\u00eam kh\u00f4ng steroid, thu\u1ed1c l\u1ee3i ti\u1ec3u,\u2026<\/li>\n<\/ul>\n<h2><strong>2.\u0110i\u1ec1u tr\u1ecb<\/strong><\/h2>\n<h3>2.1. \u0110i\u1ec1u tr\u1ecb suy tim<strong><br \/>\n<\/strong><\/h3>\n<p>\u0110i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh nh\u00e2n suy tim c\u00f3 ph\u00e2n s\u1ed1 t\u1ed1ng m\u00e1u gi\u1ea3m v\u00e0 huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh b\u1eb1ng c\u00e1c thu\u1ed1c nh\u01b0 l\u1ee3i ti\u1ec3u, s\u1eed d\u1ee5ng s\u1edbm \u1ee9c ch\u1ebf men chuy\u1ec3n ho\u1eb7c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 angiotensin v\u00e0 ch\u1eb9n beta giao c\u1ea3m. Trong tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c tr\u00ean c\u00f2n tri\u1ec7u ch\u1ee9ng suy tim, c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p th\u00eam v\u1edbi thu\u1ed1c kh\u00e1ng aldosteron \u0111\u1ec3 t\u0103ng hi\u1ec7u qu\u1ea3 t\u00e1c d\u1ee5ng.<br \/>\n\u1ee8c ch\u1ebf men chuy\u1ec3n v\u00e0 ch\u1eb9n beta giao c\u1ea3m c\u00f3 th\u1ec3 c\u00f3 l\u1ee3i \u00edch \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1 tim c\u00f3 ph\u00e2n s\u1ed1 t\u1ed1ng m\u00e1u gi\u1ea3m. C\u00e1c thu\u1ed1c s\u1ebd gi\u00fap c\u1ea3i thi\u1ec7n t\u1eed vong v\u00e0 c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch kh\u00e1c. M\u1ed9t nghi\u00ean c\u1ee9u tr\u00ean chu\u1ed9t cho th\u1ea5y s\u1eed d\u1ee5ng captopril v\u00e0o ng\u00e0y th\u1ee9 3 \u1edf chu\u1ed9t vi\u00eam c\u01a1 tim do coxsackie virus s\u1ebd gi\u00fap gi\u1ea3m ho\u1ea1i t\u1eed c\u01a1 tim. M\u1eb7t kh\u00e1c, s\u1eed d\u1ee5ng ch\u1eb9n beta giao c\u1ea3m s\u1ebd c\u1ea3i thi\u1ec7n c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch \u1edf chu\u1ed9t vi\u00eam c\u01a1 tim do coxsackie virus.<br \/>\nM\u1eb7c d\u00f9 digoxin c\u00f3 t\u00e1c d\u1ee5ng c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng \u1edf b\u1ec7nh nh\u00e2n suy tim c\u00f3 ph\u00e2n s\u1ed1 t\u1ed1ng m\u00e1u gi\u1ea3m nh\u01b0ng hi\u1ec7u qu\u1ea3 tr\u00ean bi\u1ebfn c\u1ed1 tim m\u1ea1ch v\u00e0 an to\u00e0n v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh th\u1eadm ch\u00ed digoxin l\u00e0m t\u0103ng nguy c\u01a1 t\u1eed vong \u1edf chu\u1ed9t vi\u00eam c\u01a1 tim.<br \/>\nNh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh c\u00f3 th\u1ec3 c\u1ea7n h\u1ed7 tr\u1ee3 tu\u1ea7n ho\u00e0n ngo\u00e0i c\u01a1 th\u1ec3 b\u1eb1ng thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3 th\u1ea5t ho\u1eb7c ECMO (extracorporeal membrane oxygenation).<\/p>\n<h3>2.2. H\u1ed7 tr\u1ee3 th\u1ea5t tr\u00e1i<\/h3>\n<p>H\u1ed7 tr\u1ee3 th\u1ea5t tr\u00e1i \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh khi suy tim c\u1ea5p m\u1ee9c \u0111\u1ed9 n\u1eb7ng ho\u1eb7c tr\u01b0\u1eddng h\u1ee3p s\u1ed1c tim kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa. Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, c\u00e1c thi\u1ebft b\u1ecb n\u00e0y nh\u01b0 c\u1ea7u n\u1ed1i gi\u00fap b\u1ec7nh nh\u00e2n h\u1ed3i ph\u1ee5c sau giai \u0111o\u1ea1vi\u00eam c\u01a1 tim c\u1ea5p m\u1ee9c \u0111\u1ed9 n\u1eb7ng.<\/p>\n<h3>2.3. \u0110i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n nh\u1ecbp tim<\/h3>\n<p>B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 g\u1eb7p c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp nhanh ho\u1eb7c r\u1ed1i lo\u1ea1n nh\u1ecbp ch\u1eadm.<\/p>\n<h4><strong>2.3.1<\/strong><strong>. C\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp nhanh <\/strong><strong>bao g\u1ed3m: Nh\u1ecbp nhanh tr\u00ean th\u1ea5t v\u00e0 nh\u1ecbp nhanh th\u1ea5t.<\/strong><\/h4>\n<p>C\u01a1n nh\u1ecbp nhanh tr\u00ean th\u1ea5t: c\u00f3 th\u1ec3 l\u00e0 kh\u1edfi \u0111\u1ea7u c\u1ee7a t\u00ecnh tr\u1ea1ng suy tim ho\u1eb7c l\u00e0 t\u00e1c nh\u00e2n g\u00e2y suy tim n\u1eb7ng th\u00eam:<\/p>\n<ul>\n<li>Chuy\u1ec3n nh\u1ecbp xoang l\u00e0 \u01b0u ti\u00ean h\u00e0ng \u0111\u1ea7u trong \u0111i\u1ec1u tr\u1ecb c\u00e1c c\u01a1n tim nhanh tr\u00ean th\u1ea5t n\u00e0y.<\/li>\n<li>Chi\u1ebfn l\u01b0\u1ee3c chuy\u1ec3n nh\u1ecbp xoang, ki\u1ec3m so\u00e1t t\u1ea7n s\u1ed1 th\u1ea5t t\u01b0\u01a1ng t\u1ef1 nh\u01b0 chi\u1ebfn l\u01b0\u1ee3c x\u1eed tr\u00ed c\u01a1n tim nhanh tr\u00ean th\u1ea5t.<\/li>\n<li>\u0110\u1ed1i v\u1edbi c\u01a1n tim nhanh th\u1ea5t:<\/li>\n<li>C\u00e1c c\u01a1n nh\u1ecbp nhanh th\u1ea5t kh\u00f4ng b\u1ec1n b\u1ec9 c\u00f3 tri\u1ec7u ch\u1ee9ng c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n nh\u1ecbp.<\/li>\n<li>\u0110\u1ed1i v\u1edbi nh\u1ecbp nhanh th\u1ea5t c\u00f3 tri\u1ec7u ch\u1ee9ng c\u1ea7n x\u1eed tr\u00ed b\u1eb1ng s\u1ed1c \u0111i\u1ec7n, \u0111\u1ed1i v\u1edbi r\u1ed1i lo\u1ea1n nh\u1ecbp t\u00e1i ph\u00e1t n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ngay b\u1eb1ng thu\u1ed1c ch\u1ed1ng r\u1ed1i lo\u1ea1n nh\u1ecbp.<\/li>\n<\/ul>\n<h4><strong>2.3.2<\/strong><strong>. \u0110\u1ed1i v\u1edbi c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp ch\u1eadm <\/strong><strong>c\u00f3 tri\u1ec7u ch\u1ee9ng ho\u1eb7c block nh\u0129 th\u1ea5t ho\u00e0n to\u00e0n<\/strong><\/h4>\n<p>C\u1ea7n \u0111\u1eb7t m\u00e1y t\u1ea1o nh\u1ecbp t\u1ea1m th\u1eddi v\u00e0 theo d\u00f5i t\u00ecnh tr\u1ea1ng nh\u1ecbp tim, c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp n\u00e0y th\u01b0\u1eddng ch\u1ec9 t\u1ea1m th\u1eddi v\u00e0 c\u00f3 th\u1ec3 h\u1ed3i ph\u1ee5c.<\/p>\n<h3>2.4. S\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng<strong><br \/>\n<\/strong><\/h3>\n<p>Ch\u1ec9 \u0111\u1ecbnh d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng\u00a0 bao g\u1ed3m:<\/p>\n<ul>\n<li>C\u00e1c ch\u1ec9 \u0111\u1ecbnh th\u01b0\u1eddng quy nh\u01b0 c\u00f3 b\u1eb1ng ch\u1ee9ng c\u1ee7a t\u1eafc m\u1ea1ch h\u1ec7 th\u1ed1ng ho\u1eb7c huy\u1ebft kh\u1ed1i trong th\u1ea5t tr\u00e1i.<\/li>\n<li>\u0110\u1ed1i v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n rung nh\u0129 c\u1ea7n \u0111\u00e1nh gi\u00e1 nguy c\u01a1 t\u1eafc m\u1ea1ch \u0111\u1ec3 ch\u1ec9 \u0111\u1ecbnh d\u00f9ng ch\u1ed1ng \u0111\u00f4ng.<\/li>\n<li>C\u1ea7n \u0111\u00e1nh gi\u00e1 l\u1ea1i vi\u1ec7c d\u00f9ng ch\u1ed1ng \u0111\u00f4ng n\u1ebfu h\u1ed3i ph\u1ee5c ho\u00e0n to\u00e0n t\u00ecnh tr\u1ea1ng rung nh\u0129 v\u00e0 suy tim.<\/li>\n<\/ul>\n<p>L\u01b0u \u00fd: B\u1ec7nh nh\u00e2n suy tim nh\u1ecbp xoang c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 t\u00ecnh tr\u1ea1ng gi\u1ea3m ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Vi\u00eam c\u01a1 tim l\u00e0 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng ph\u1ee9c t\u1ea1p t\u1eeb kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng cho \u0111\u1ebfn c\u00e1c d\u1ea5u hi\u1ec7u suy tim, r\u1ed1i lo\u1ea1n nh\u1ecbp tim\u2026 r\u1ea7m r\u1ed9 n\u1eb7ng n\u1ec1 v\u1edbi ti\u00ean l\u01b0\u1ee3ng t\u1eed vong r\u1ea5t cao. 1.\u0110\u1ecbnh ngh\u0129a, nguy\u00ean nh\u00e2n L\u00e0 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Vi\u00eam c\u01a1 tim v\u00e0 \u0111i\u1ec1u tr\u1ecb - Vinmec<\/title>\n<meta name=\"description\" content=\"Vi\u00eam c\u01a1 tim c\u1ea5p v\u00e0 \u0111i\u1ec1u tr\u1ecb l\u00e0 v\u1ea5n \u0111\u1ec1 \u0111\u01b0\u1ee3c quan t\u00e2m nhi\u1ec1u khi th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. 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