{"id":26909,"date":"2023-04-23T21:36:58","date_gmt":"2023-04-23T14:36:58","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=26909"},"modified":"2023-04-23T21:36:58","modified_gmt":"2023-04-23T14:36:58","slug":"cap-cuu-nhoi-mau-co-tim-cap-co-st-chenh-len","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/cap-cuu-nhoi-mau-co-tim-cap-co-st-chenh-len\/","title":{"rendered":"C\u1ea5p c\u1ee9u nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p c\u00f3 ST ch\u00eanh l\u00ean"},"content":{"rendered":"

Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p<\/a> l\u00e0 khi c\u00f3 t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim c\u1ea5p k\u00e8m theo b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a thi\u1ebfu m\u00e1u c\u01a1’ tim, ngh\u0129a l\u00e0 c\u00f3 s\u1ef1 t\u0103ng v\u00e0\/ho\u1eb7c gi\u1ea3m c\u1ee7a troponin v\u1edbi \u00edt nh\u1ea5t m\u1ed9t gi\u00e1 tr\u1ecb cao h\u01a1n b\u00e1ch ph\u00e2n v\u1ecb th\u1ee9 99 c\u1ee7a kho\u1ea3ng tham chi\u1ebfu tr\u00ean.<\/strong><\/p>\n

\"Nh\u1ed3i<\/p>\n

Nh\u1ed3i m\u00e1u c\u01a1 tim<\/strong><\/p>\n

1.\u0110\u1ecbnh ngh\u0129a<\/h2>\n

\u0110\u1ecbnh ngh\u0129a to\u00e0n c\u1ea7u l\u1ea7n th\u1ee9 t\u01b0 v\u1ec1 nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p (ESC 2018): Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p l\u00e0 khi c\u00f3 t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim c\u1ea5p k\u00e8m theo b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a thi\u1ebfu m\u00e1u c\u01a1’ tim, ngh\u0129a l\u00e0 c\u00f3 s\u1ef1 t\u0103ng v\u00e0\/ho\u1eb7c gi\u1ea3m c\u1ee7a troponin v\u1edbi \u00edt nh\u1ea5t m\u1ed9t gi\u00e1 tr\u1ecb cao h\u01a1n b\u00e1ch ph\u00e2n v\u1ecb th\u1ee9 99 c\u1ee7a kho\u1ea3ng tham chi\u1ebfu tr\u00ean, k\u00e8m theo \u00edt nh\u1ea5t m\u1ed9t trong c\u00e1c d\u1ea5u hi\u1ec7u sau:<\/p>\n

    \n
  • Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a thi\u1ebfu m\u00e1u c\u01a1 tim<\/li>\n
  • D\u1ea5u hi\u1ec7u thi\u1ebfu m\u00e1u m\u1edbi tr\u00ean \u0111i\u1ec7n t\u00e2m \u0111\u1ed3<\/li>\n
  • Xu\u1ea5t hi\u1ec7n s\u00f3ng Q b\u1ec7nh l\u00fd<\/li>\n
  • B\u1eb1ng ch\u1ee9ng m\u1edbi v\u1ec1 m\u1ea5t s\u1ed1ng c\u00f2n c\u01a1 tim ho\u1eb7c r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng v\u00f9ng ph\u00f9 h\u1ee3p v\u1edbi c\u0103n nguy\u00ean thi\u1ebfu m\u00e1u.<\/li>\n<\/ul>\n
      \n
    • Ph\u00e1t hi\u1ec7n huy\u1ebft kh\u1ed1i \u0111\u1ed9ng m\u1ea1ch v\u00e0nh tr\u00ean ch\u1ee5p m\u1ea1ch ho\u1eb7c gi\u1ea3i ph\u0201u t\u1eed thi (kh\u00f4ng d\u00f9ng cho nh\u1ed3i m\u00e1u c\u01a1 tim type 2 v\u00e0 3).<\/li>\n<\/ul>\n

      Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p c\u00f3 th\u1ec3 chia th\u00e0nh 5 type t\u00f9y thu\u1ed9c v\u00e0o c\u0103n nguy\u00ean:<\/p>\n

        \n
      • Type 1: Do b\u1ec7nh l\u00fd x\u01a1 v\u1eefa – huy\u1ebft kh\u1ed1i.<\/li>\n
      • Type 2: Do m\u1ea5t c\u00e2n b\u1eb1ng cung – c\u1ea7u oxy c\u01a1 tim,<\/li>\n
      • Type 3: B\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng, \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 g\u1ee3i \u00fd nh\u1ed3i m\u00e1u c\u01a1 tim nh\u01b0ng \u0111\u1ed9t t\u1eed tr\u01b0\u1edbc khi x\u00e9t nghi\u1ec7m men tim, (4) Type 4a: NMCT li\u00ean quan th\u1ee7 thu\u1eadt PCI \u2264 48 gi\u1edd, type 4b: Huy\u1ebft kh\u1ed1i trong stent, type 4c: T\u00e1i h\u1eb9p li\u00ean quan \u0111\u1ebfn PCI,<\/li>\n
      • NMCT li\u00ean quan \u0111\u1ebfn CABG.<\/li>\n<\/ul>\n

        Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n NMCT c\u1ea5p c\u00f3 ST ch\u00eanh l\u00ean (STEMI) tr\u00ean \u0111i\u1ec7n t\u00e2m \u0111\u1ed3:<\/p>\n

          \n
        • ST ch\u00eanh l\u00ean (t\u00ednh t\u1eeb \u0111i\u1ec3m J) \u00edt nh\u1ea5t \u1edf 2 chuy\u1ec3n \u0111\u1ea1o li\u00ean ti\u1ebfp: (1) \u2265 2,5 mm \u1edf nam<\/li>\n
        • < 40 tu\u1ed5i; \u2265 2 mm \u1edf nam \u2265 40 tu\u1ed5i ho\u1eb7c \u2265 1,5 mm \u1edf n\u1eef \u1edf chuy\u1ec3n \u0111\u1ea1o V2 – V3; v\u00e0\/ ho\u1eb7c (2) \u2265 1 mm \u1edf c\u00e1c chuy\u1ec3n \u0111\u1ea1o kh\u00e1c.<\/li>\n
        • NMCT th\u00e0nh d\u01b0\u1edbi: Chuy\u1ec3n \u0111\u1ea1o tr\u01b0\u1edbc tim ph\u1ea3i (V3R, V4R) ch\u00eanh l\u00ean \u2265 0,5 mm. ST ch\u00eanh xu\u1ed1ng \u1edf \u0111\u1ea1o tr\u00ecnh V1 – V3 g\u1ee3i \u00fd thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 c\u01a1 tim, \u0111\u1eb7c bi\u1ec7t khi \u0111o\u1ea1n cu\u1ed1i s\u00f3ng T d\u01b0\u01a1ng (t\u01b0\u01a1ng \u0111\u01b0\u01a1ng \u0111o\u1ea1n ST ch\u00eanh l\u00ean); ST ch\u00eanh l\u00ean \u2265 0,5 mm ghi \u1edf chuy\u1ec3n \u0111\u1ea1o V7 – V9 l\u00e0 d\u1ea5u hi\u1ec7u nh\u1ed3i m\u00e1u th\u00e0nh sau.<\/li>\n<\/ul>\n

          2.X\u1eed tr\u00ed ban \u0111\u1ea7u v\u00e0 c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa kh\u00e1c:<\/h2>\n
            \n
          • B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c n\u1eb1m ngh\u1ec9 ng\u01a1i tuy\u1ec7t \u0111\u1ed1i t\u1ea1i gi\u01b0\u1eddng.<\/li>\n
          • Th\u1edf oxy n\u1ebfu c\u00f3 t\u00ecnh tr\u1ea1ng gi\u1ea3m \u0111\u1ed9 b\u00e3o h\u00f2a oxy m\u00e1u (Sa0\u2082 < 90%) ho\u1eb7c Pa0\u2082 < 60 mmHg, kh\u00f4ng ch\u1ec9 \u0111\u1ecbnh th\u1edf oxy th\u01b0\u1eddng quy \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n Sp0\u2082 > 90%.<\/strong><\/li>\n
          • Gi\u1ea3m \u0111au ng\u1ef1c b\u1eb1ng morphin \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch n\u1ebfu c\u00f2n \u0111au ng\u1ef1c nhi\u1ec1u.<\/li>\n
          • S\u1eed d\u1ee5ng thu\u1ed1c an th\u1ea7n nh\u1eb9 (benzodiazepine) n\u1ebfu b\u1ec7nh nh\u00e2n lo l\u1eafng, k\u00edch th\u00edch nhi\u1ec1u. .<\/li>\n
          • Thu\u1ed1c kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u v\u00e0 thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng <\/strong>theo khuy\u1ebfn c\u00e1o c\u1ee7a ESC n\u0103m 2018<\/li>\n
          • Statin li\u1ec1u cao<\/strong>: S\u1eed d\u1ee5ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, b\u1ea5t k\u1ec3 n\u1ed3ng \u0111\u1ed9 LDL-C tr\u01b0\u1edbc \u0111\u00f3. C\u00f3 th\u1ec3 d\u00f9ng atorvastatin (40 – 80 mg) ho\u1eb7c rosuvastatin (20 – 40 mg).<\/li>\n<\/ul>\n

            Thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m (BB):<\/strong><\/p>\n

              \n
            • N\u00ean d\u00f9ng ch\u1eb9n beta giao c\u1ea3m \u0111\u01b0\u1eddng u\u1ed1ng trong v\u00f2ng 24 gi\u1edd <\/em>n\u1ebfu kh\u00f4ng c\u00f3 suy tim c\u1ea5p, cung l\u01b0\u1ee3ng th\u1ea5p; nguy c\u01a1 b\u1ecb s\u1ed1c tim ho\u1eb7c c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh kh\u00e1c (metoprolol, bisoprolol, carvedilol).<\/li>\n
            • N\u1ebfu trong giai \u0111o\u1ea1n c\u1ea5p kh\u00f4ng s\u1eed d\u1ee5ng \u0111\u01b0\u1ee3c th\u00ec n\u00ean \u0111\u00e1nh gi\u00e1 l\u1ea1i khi b\u1ec7nh nh\u00e2n \u1ed5n \u0111\u1ecbnh \u0111\u1ec3 b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng l\u1ea1i s\u1edbm.<\/li>\n
            • Thu\u1ed1c \u1ee9c ch\u1ebf h\u1ec7 renin – angiotensin – aldosteron (\u1ee9c ch\u1ebf men chuy\u1ec3n ho\u1eb7c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3)<\/li>\n<\/ul>\n

              Thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n <\/em>(\u01afCMC)<\/strong> n\u00ean \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng s\u1edbm trong 24 gi\u1edd sau nh\u1ed3i m\u00e1u c\u01a1 tim v\u00e0 k\u00e9o d\u00e0i v\u00f4 th\u1eddi h\u1ea1n \u1edf t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i d\u01b0\u1edbi 40% v\u00e0 nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 THA, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng ho\u1eb7c b\u1ec7nh th\u1eadn m\u1ea1n \u1ed5n \u0111\u1ecbnh, tr\u1eeb khi c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh.<\/p>\n

              Thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3<\/strong> <\/em>\u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u c\u01a1 tim v\u1edbi ph\u00e2n s\u1ed1 t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i d\u01b0\u1edbi 40%, kh\u00f4ng dung n\u1ea1p \u0111\u01b0\u1ee3c thu\u1ed1c \u01afCMC.<\/p>\n

              Thu\u1ed1c kh\u00e1ng aldosterone khuy\u1ebfn c\u00e1o \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n:<\/strong><\/p>\n

                \n
              • Sau NMCT v\u00e0 kh\u00f4ng c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn \u0111\u00e1ng k\u1ec3 (Creatinine > 220 mmol\/L \u1edf nam ho\u1eb7c > 170 mmol\/L \u1edf n\u1eef) ho\u1eb7c t\u0103ng Kali m\u00e1u (Kali > 5,0 mmol\/L).<\/li>\n
              • \u0110ang s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n v\u00e0 ch\u1eb9n beta giao c\u1ea3m li\u1ec1u \u0111i\u1ec1u tr\u1ecb v\u00e0 c\u00f3 ph\u00e2n s\u1ed1 t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i EF \u2264 40 %, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, ho\u1eb7c suy tim.<\/li>\n<\/ul>\n

                Thu\u1ed1c kh\u00e1ng KTTC v\u00e0 ch\u1ed1ng \u0111\u00f4ng tr\u01b0\u1edbc v\u00e0 sau can thi\u1ec7p \u0110M qua da:<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
                \u00a0<\/em><\/strong><\/p>\n

                Khuy\u1ebfn c\u00e1o<\/strong><\/td>\n

                		M\u1ee9c \u0111\u1ed9<\/strong><\/p>\n

                khuy\u1ebfn<\/strong><\/p>\n

                c\u00e1o<\/strong><\/td>\n

                		M\u1ee9c \u0111\u1ed9<\/strong><\/p>\n

                b\u1eb1ng<\/strong><\/p>\n

                ch\u1ee9ng<\/strong><\/td>\n<\/tr>\n

                Li\u1ec7u ph\u00e1p kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u<\/em><\/strong><\/td>\n<\/tr>\n
                S\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng KTTC \u1ee9c ch\u1ebf P2Y12 m\u1ea1nh (ticagrelor ho\u1eb7c prasugrel), ho\u1eb7c Clopidogrel n\u1ebfu c\u00e1c thu\u1ed1c tr\u00ean kh\u00f4ng c\u00f3 s\u1eb5n ho\u1eb7c c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng tr\u01b0\u1edbc khi ti\u1ebfn h\u00e0nh PCI v\u00e0 duy tr\u00ec tr\u00ean 12 th\u00e1ng n\u1ebfu kh\u00f4ng c\u00f3 CC\u0110 ho\u1eb7c nguy c\u01a1 xu\u1ea5t huy\u1ebft cao.<\/td>\nI<\/td>\nA<\/td>\n<\/tr>\n
                Aspirin (\u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch n\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng nu\u1ed1t) \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t \u1edf t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n n\u1ebfu kh\u00f4ng c\u00f3 CC\u0110.<\/td>\nI<\/td>\nB<\/td>\n<\/tr>\n
                Thu\u1ed1c \u1ee9c ch\u1ebf GP IIb\/IIIa n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t cho c\u1ee9u v\u00e3n \u1edf nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u1ebfu c\u00f3 b\u1eb1ng ch\u1ee9ng kh\u00f4ng c\u00f3 d\u00f2ng ch\u1ea3y (no – reflow) ho\u1eb7c huy\u1ebft kh\u1ed1i ph\u1ee9c t\u1ea1p<\/td>\nIIa<\/td>\nC<\/td>\n<\/tr>\n
                Cangrelor c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u00e0 ch\u01b0a \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ch\u01b0a \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi P2Y12.<\/td>\nIIb<\/td>\nA<\/td>\n<\/tr>\n
                Li\u1ec7u ph\u00e1p ch\u1ed1ng \u0111\u00f4ng<\/em><\/strong><\/td>\n<\/tr>\n
                Thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng \u1edf t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c kh\u00e1ng KTTC trong th\u1eddi gian PCI th\u00ec \u0111\u1ea7u.<\/td>\nI<\/td>\nC<\/td>\n<\/tr>\n
                Khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng th\u01b0\u1eddng quy Heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n (UFH)<\/td>\nI<\/td>\nC<\/td>\n<\/tr>\n
                \u1ede b\u1ec7nh nh\u00e2n c\u00f3 gi\u1ea3m ti\u1ec3u c\u1ea7u do heparin (HIT), bivalirudin \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng khi can thi\u1ec7p PCI th\u00ec \u0111\u1ea7u<\/td>\nI<\/td>\nC<\/td>\n<\/tr>\n
                Heparin tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem x\u00e9t s\u1eed d\u1ee5ng<\/p>\n

                th\u01b0\u1eddng quy<\/td>\n

                		IIa<\/td>\nA<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

                 <\/p>\n\n\n\n\n\n\n\n\n
                Li\u1ec1u thu\u1ed1c kh\u00e1ng KTTC v\u00e0 ch\u1ed1ng \u0111\u00f4ng \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u01b0\u1ee3c can thi\u1ec7p t\u00e1i<\/em><\/strong><\/p>\n

                t\u01b0\u1edbi m\u00e1u<\/em><\/strong><\/td>\n<\/tr>\n

                Kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u<\/strong><\/td>\n<\/tr>\n
                Aspirin<\/strong><\/td>\nLi\u1ec1u n\u1ea1p 150 – 300 mg \u0111\u01b0\u1eddng u\u1ed1ng sau \u0111\u00f3 duy tr\u00ec 75 – 100 mg\/24h.<\/td>\n<\/tr>\n
                Clopidogrel<\/strong><\/td>\nLi\u1ec1u n\u1ea1p 300 mg \u0111\u01b0\u1eddng u\u1ed1ng, sau \u0111\u00f3 duy tr\u00ec 75 mg\/24h.<\/td>\n<\/tr>\n
                C\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng ngo\u00e0i \u0111\u01b0\u1eddng u\u1ed1ng<\/strong><\/td>\n<\/tr>\n
                UHF<\/strong><\/td>\nLi\u1ec1u n\u1ea1p 60 Ul\/kg t\u0129nh m\u1ea1ch (li\u1ec1u t\u1ed1i \u0111a 4000 IU) sau \u0111\u00f3 truy\u1ec1n t\u0129nh m\u1ea1ch v\u1edbi li\u1ec1u 12 Ul\/kg (t\u1ed1i \u0111a 1000 IU\/h) cho 24 – 48h. M\u1ee5c ti\u00eau aPTT: 50 – 70s ho\u1eb7c 1,5 – 2 l\u1ea7n theo d\u00f5i t\u1ea1i th\u1eddi \u0111i\u1ec3m 3, 6, 12 v\u00e0 24h.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n","protected":false},"excerpt":{"rendered":"

                Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p l\u00e0 khi c\u00f3 t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim c\u1ea5p k\u00e8m theo b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a thi\u1ebfu m\u00e1u c\u01a1’ tim, ngh\u0129a l\u00e0 c\u00f3 s\u1ef1 t\u0103ng v\u00e0\/ho\u1eb7c gi\u1ea3m c\u1ee7a troponin v\u1edbi \u00edt nh\u1ea5t m\u1ed9t gi\u00e1 tr\u1ecb cao h\u01a1n b\u00e1ch ph\u00e2n v\u1ecb th\u1ee9 99 c\u1ee7a kho\u1ea3ng tham chi\u1ebfu tr\u00ean. Nh\u1ed3i m\u00e1u c\u01a1 tim […]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[23,33],"tags":[],"yoast_head":"\nC\u1ea5p c\u1ee9u nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p c\u00f3 ST ch\u00eanh l\u00ean - Vinmec<\/title>\n<meta name=\"description\" content=\"Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p t\u1ea1i m\u1ed9t s\u1ed1 khoa l\u00e2m s\u00e0ng kh\u00e1c. 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