{"id":27370,"date":"2023-04-23T13:25:27","date_gmt":"2023-04-23T06:25:27","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=27370"},"modified":"2023-05-02T09:43:28","modified_gmt":"2023-05-02T02:43:28","slug":"kiem-soat-dau-truoc-dieu-tri-noi-nha-voi-truong-hop-viem","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/kiem-soat-dau-truoc-dieu-tri-noi-nha-voi-truong-hop-viem\/","title":{"rendered":"Ki\u1ec3m so\u00e1t \u0111au tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha v\u1edbi tr\u01b0\u1eddng h\u1ee3p vi\u00eam."},"content":{"rendered":"

B\u00e0i vi\u1ebft n\u00e0y n\u1ed9i dung h\u01b0\u1edbng v\u1ec1 t\u1ed5ng quan k\u1ef9 thu\u1eadt ki\u1ec3m so\u00e1t \u0111au tr\u00ean tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha t\u1ea1i gh\u1ebf r\u0103ng b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p g\u00e2y t\u00ea t\u1ea1i ch\u1ed7, \u0111\u1ed3ng th\u1eddi \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 t\u00ea v\u1edbi tr\u01b0\u1eddng h\u1ee3p m\u00f4 b\u1ecb vi\u00eam. C\u00f9ng t\u00ecm hi\u1ec3u th\u00eam trong b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y<\/strong><\/p>\n

1. T\u1ed5ng quan v\u1ec1 ki\u1ec3m so\u00e1t \u0111au tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p g\u00e2y t\u00ea t\u1ea1i ch\u1ed7<\/h2>\n

Ki\u1ec3m so\u00e1t \u0111au tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb trong n\u1ed9i nha th\u1ef1c h\u00e0nh l\u00e0 g\u00e2y t\u00ea t\u1ea1i ch\u1ed7 \u0111\u1ec3 ng\u0103n ch\u1eb7n s\u1ef1 d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c t\u1eeb c\u00e1c \u0111\u1ea7u t\u1eadn c\u00f9ng th\u1ea7n kinh trong m\u00f4 t\u1ee7y v\u00e0 m\u00f4 nha chu c\u1ee7a r\u0103ng \u0111ang \u0111i\u1ec1u tr\u1ecb. M\u1eb7c d\u00f9 c\u00e1c lo\u1ea1i thu\u1ed1c t\u00ea th\u01b0\u1eddng l\u00e0 an to\u00e0n, nh\u01b0ng nh\u00e0 l\u00e2m s\u00e0ng v\u1eabn n\u00ean n\u1eafm r\u00f5 li\u1ec1u d\u00f9ng, t\u00e1c d\u1ee5ng ph\u1ee5 v\u00e0 nguy c\u01a1 d\u1ecb \u1ee9ng c\u1ee7a thu\u1ed1c. Thu\u1ed1c t\u00ea t\u1ea1i ch\u1ed7 g\u1eafn k\u1ebft c\u00e1c k\u00eanh canxi n\u1eb1m tr\u00ean m\u00e0ng t\u1ebf b\u00e0o c\u1ee7a neuron c\u1ea3m gi\u00e1c, ng\u0103n ch\u1eb7n s\u1ef1 x\u00e2m nh\u1eadp c\u1ee7a c\u00e1c ion natri v\u00e0o c\u00e1c s\u1ee3i th\u1ea7n kinh.<\/p>\n

\"kiem-soat-dau\"
C\u1ea5u tr\u00fac ch\u00ednh c\u1ee7a c\u00e1c ti\u1ec3u \u0111\u01a1n v\u1ecb a v\u00e0 B c\u1ee7a k\u00eanh natri \u0111\u00f3ng m\u1edf theo \u0111i\u1ec7n th\u1ebf (voltage-gated sodium channel). Ti\u1ec3u \u0111\u01a1n v\u1ecb a bao g\u1ed3m 4 mi\u1ec1n t\u01b0\u01a1ng \u0111\u1ed3ng (DI \u2013 DIV), m\u1ed7i mi\u1ec1n c\u00f3 6 \u0111o\u1ea1n xo\u1eafn a li\u00ean m\u00e0ng (S1 \u2013 S6). \u0110o\u1ea1n S4 c\u1ee7a m\u1ed7i mi\u1ec1n ch\u1ee9a l\u01b0\u1ee3ng acid amin t\u00edch \u0111i\u1ec7n (+) v\u00e0 t\u1ea1o th\u00e0nh m\u1ed9t ph\u1ea7n c\u1ee7a sensor \u0111i\u1ec7n th\u1ebf. C\u00e1c m\u1ed1i n\u1ed1i li\u00ean k\u1ebft \u0111o\u1ea1n S5 v\u00e0 S6 t\u1ea1o th\u00e0nh m\u1ed9t mi\u1ec7ng ph\u00eda ngo\u00e0i c\u1ee7a k\u00eanh v\u00e0 l\u00e0 b\u1ed9 l\u1ecdc. C\u00e1c li\u00ean k\u1ebft t\u1ebf b\u00e0o ch\u1ea5t gi\u1eefa DIII v\u00e0 DIV ch\u1ee9a m\u1ed9t b\u1ed9 ph\u1eadn k\u1ecb n\u01b0\u1edbc quan tr\u1ecdng, ho\u1ea1t \u0111\u1ed9ng nh\u01b0 m\u1ed9t \u201cn\u1eafp \u0111\u1eady\u201d (hinged lid \u2014 h) v\u00e0 ch\u1ecbu tr\u00e1ch nhi\u1ec7m cho s\u1ef1 kh\u1eed nhanh. S\u1ef1 kh\u1eed ch\u1eadm ph\u1ee5 thu\u1ed9c m\u1ed9t ph\u1ea7n v\u00e0o l\u01b0\u1ee3ng c\u00f2n l\u1ea1i n\u1eb1m \u1edf l\u1edbp ngo\u00e0i c\u1ee7a k\u00eanh. Ti\u1ec3u \u0111\u01a1n v\u1ecb a c\u00f3 ch\u1ee9a m\u1ed9t v\u00e0i v\u1ecb tr\u00ed receptor cho \u0111\u1ed9c t\u1ed1 th\u1ea7n kinh (neurotoxin) (kh\u00f4ng \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y \u1edf \u0111\u00e2y). L\u01b0\u1ee3ng acid amin \u1edf \u0111o\u1ea1n S6 c\u1ee7a DI, DIII v\u00e0 DIV \u1edf khoang b\u00ean trong c\u1ee7a k\u00eanh t\u1ea1o th\u00e0nh v\u1ecb tr\u00ed g\u1eafn k\u1ebft thu\u1ed1c t\u00ea t\u1ea1i ch\u1ed7 v\u00e0 c\u0169ng c\u00f3 li\u00ean quan \u0111\u1ebfn c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh v\u00e0 ch\u1ed1ng lo\u1ea1n nh\u1ecbp nh\u01b0 lidocaine, mexiletine, carbamazepine v\u00e0 phenytoin. S\u1ef1 \u1ee9c ch\u1ebf k\u00eanh natri c\u1ee7a nh\u1eefng lo\u1ea1i thu\u1ed1c n\u00e0y t\u01b0\u01a1ng \u0111\u1ed1i y\u1ebfu \u1edf tr\u1ea1ng th\u00e1i ngh\u1ec9, nh\u01b0ng m\u1ea1nh h\u01a1n n\u1ebfu m\u00e0ng t\u1ebf b\u00e0o b\u1ecb kh\u1eed c\u1ef1c (s\u1ef1 \u1ee9c ch\u1ebf n\u00e0y t\u00f9y thu\u1ed9c c\u00e1ch s\u1eed d\u1ee5ng (\u201cuse-dependent\u201d blockade). M\u1ed9t chu\u1ed7i acid amin \u0111\u01b0\u1ee3c b\u1ea3o t\u1ed3n t\u1ea1i v\u00f2ng l\u1eb7p gian b\u00e0o gi\u1eefa DII v\u00e0 DIII li\u00ean k\u1ebft ankyrin G (Ank) v\u00e0 r\u1ea5t quan tr\u1ecdng cho vi\u1ec7c nh\u1eafm m\u1ee5c ti\u00eau \u0111\u1ebfn c\u00e1c mi\u1ec1n \u0111\u1eb7c bi\u1ec7t c\u1ee7a t\u1ebf b\u00e0o. V\u00f2ng l\u1eb7p n\u1ed9i b\u00e0o l\u1edbn gi\u1eefa DI v\u00e0 DIII c\u00f3 ch\u1ee9a m\u1ed9t v\u00e0i v\u1ecb tr\u00ed \u0111i\u1ec1u ch\u1ebf phosphoryl (P) b\u1eb1ng protein kinase A v\u00e0 C. Mi\u1ec1n t\u1eadn c\u00f9ng b\u1eb1ng carboxyl li\u00ean k\u1ebft v\u1edbi ti\u1ec3u \u0111\u01a1n v\u1ecb B, c\u00e1c ph\u1ea7n g\u1eafn kh\u00e1c v\u00e0 protein khung t\u1ebf b\u00e0o. C\u00e1c ti\u1ec3u \u0111\u01a1n v\u1ecb B ph\u1ee5 l\u00e0 c\u00e1c protein v\u1edbi m\u1ed9t m\u00e0ng t\u1ebf b\u00e0o duy nh\u1ea5t, m\u1ed9t mi\u1ec1n t\u1eadn c\u00f9ng b\u1eb1ng amino ngo\u1ea1i b\u00e0o d\u00e0i \u0111\u01b0\u1ee3c glycosyl h\u00f3a, c\u00f3 c\u1ea5u tr\u00fac gi\u1ed1ng v\u1edbi immunoglobulin, c\u00f3 t\u00ednh \u0111\u1ed3ng nh\u1ea5t v\u1edbi c\u00e1c ph\u1ea7n t\u1eed k\u1ebft d\u00ednh t\u1ebf b\u00e0o v\u00e0 m\u1ed9t \u0111u\u00f4i ng\u1eafn t\u1eadn c\u00f9ng C n\u1ed9i b\u00e0o. Nh\u1eefng ti\u1ec3u \u0111\u01a1n v\u1ecb n\u00e0y \u0111i\u1ec1u ch\u1ec9nh m\u1ee5c ti\u00eau v\u00e0 s\u1ef1 v\u1eadn \u0111\u1ed9ng c\u1ee7a k\u00eanh.<\/figcaption><\/figure>\n

Vi\u1ec7c n\u00e0y gi\u00fap ch\u1eb7n s\u1ef1 kh\u1eed c\u1ef1c v\u00e0 ho\u1ea1t \u0111\u1ed9ng d\u1eabn truy\u1ec1n d\u1ecdc theo neuron, ng\u0103n ch\u1eb7n hi\u1ec7u qu\u1ea3 d\u1eabn truy\u1ec1n \u0111au v\u00e0 c\u00e1c t\u00edn hi\u1ec7u c\u1ea3m gi\u00e1c kh\u00e1c nhau. V\u00ec \u0111au l\u00e0 m\u1ed9t c\u1ea3m gi\u00e1c ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c t\u1ea1o ra khi k\u00edch th\u00edch c\u00e1c s\u1ee3i c\u1ea3m gi\u00e1c c\u1ee7a m\u00f4 t\u1ee7y, n\u00ean c\u1ea7n thi\u1ebft th\u1ef1c hi\u1ec7n g\u00e2y t\u00ea t\u1ee7y to\u00e0n b\u1ed9 \u0111\u1ec3 c\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha, c\u0169ng nh\u01b0 nhi\u1ec1u h\u00ecnh th\u1ee9c \u0111i\u1ec1u tr\u1ecb ph\u1ee5c h\u1ed3i kh\u00e1c tr\u00ean r\u0103ng c\u00f2n t\u1ee7y s\u1ed1ng.<\/p>\n

2. Vi\u00eam l\u00e0m gi\u1ea3m hi\u1ec7u qu\u1ea3 t\u00ea<\/h2>\n

Kh\u1ea3 n\u0103ng t\u00ea hi\u1ec7u qu\u1ea3 th\u01b0\u1eddng kh\u00f3 \u0111\u1ea1t \u0111\u01b0\u1ee3c trong qu\u00e1 tr\u00ecnh vi\u00eam. T\u1ee7y r\u0103ng s\u1ed1ng nh\u01b0ng b\u1ecb vi\u00eam l\u00e0m kh\u00f3 kh\u0103n khi g\u00e2y t\u00ea, \u0111\u1eb7c bi\u1ec7t l\u00e0 g\u00e2y t\u00ea ch\u1eb7n d\u00e2y th\u1ea7n kinh r\u0103ng d\u01b0\u1edbi (inferior alveolar nerve \u2013 IAN) \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb r\u0103ng c\u1ed1i l\u1edbn h\u00e0m d\u01b0\u1edbi. Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, g\u00e2y t\u00ea v\u1edbi t\u1ee7y r\u0103ng vi\u00eam ch\u1ec9 b\u1eb1ng ch\u1eb7n IAN c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng th\u1ea5t b\u1ea1i h\u01a1n l\u00e0 th\u00e0nh c\u00f4ng, v\u1edbi t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u00e0 kho\u1ea3ng 25 \u2013 40%. C\u00f3 nhi\u1ec1u gi\u1ea3 thi\u1ebft \u0111\u01b0\u1ee3c \u0111\u01b0a ra \u0111\u1ec3 gi\u1ea3i th\u00edch cho s\u1ef1 gi\u1ea3m t\u00e1c d\u1ee5ng c\u1ee7a g\u00e2y t\u00ea t\u1ea1i ch\u1ed7 tr\u00ean r\u0103ng vi\u00eam t\u1ee7y. Cho t\u1edbi nay, gi\u1ea3 thi\u1ebft \u0111\u01b0\u1ee3c ch\u1ea5p nh\u1eadn nhi\u1ec1u nh\u1ea5t l\u00e0 d\u1ef1a v\u00e0o quan \u0111i\u1ec3m t\u00ednh d\u1ebbo c\u1ee7a neuron (neuronal plasticity).<\/p>\n

T\u00ednh d\u1ebbo c\u1ee7a neuron (neuroplasticity) m\u00f4 t\u1ea3 thu\u1ed9c t\u00ednh v\u1ed1n c\u00f3 c\u1ee7a c\u00e1c neuron \u0111\u01a1n l\u1ebb v\u00e0 m\u00f4 th\u1ea7n kinh ph\u1ee9c t\u1ea1p (v\u00ed d\u1ee5 nh\u01b0 n\u00e3o ho\u1eb7c t\u1ee7y s\u1ed1ng) \u0111\u1ec3 th\u00edch nghi v\u1edbi th\u01b0\u01a1ng t\u00edch ho\u1eb7c b\u1ec7nh t\u1eadt c\u0169ng nh\u01b0 nh\u1eefng thay \u0111\u1ed5i c\u1ee7a m\u00f4i tr\u01b0\u1eddng. C\u1ee5 th\u1ec3 h\u01a1n, c\u00e1c neuron c\u1ea3m gi\u00e1c b\u1ecb thay \u0111\u1ed5i khi \u0111\u1ea7u t\u1eadn c\u00f9ng c\u1ee7a ch\u00fang b\u1ecb t\u1ed5n th\u01b0\u01a1ng ho\u1eb7c m\u00f4 xung quanh b\u1ecb vi\u00eam. S\u1ed1 l\u01b0\u1ee3ng, lo\u1ea1i receptor v\u00e0 ch\u1ea5t d\u1eabn truy\u1ec1n th\u1ea7n kinh (neurotransmitter) c\u00f3 trong m\u1ed9t lo\u1ea1i th\u1ea7n kinh c\u1ea3m gi\u00e1c nh\u1ea5t \u0111\u1ecbnh ho\u1ea1t \u0111\u1ed9ng r\u1ea5t m\u1ea1nh v\u00e0 thay \u0111\u1ed5i \u0111\u1ec3 \u0111\u00e1p \u1ee9ng v\u1edbi c\u00e1c y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng v\u00e0 c\u00e1c ch\u1ea5t trung gian g\u00e2y vi\u00eam. Cu\u1ed1i c\u00f9ng, nh\u1eefng thay \u0111\u1ed5i n\u00e0y c\u00f3 th\u1ec3 khi\u1ebfn cho neuron t\u1ed3n t\u1ea1i \u0111\u01b0\u1ee3c \u1edf tr\u1ea1ng th\u00e1i nh\u1ea1y c\u1ea3m, khi \u0111\u00f3 ch\u00fang d\u1ec5 b\u1ecb k\u00edch ho\u1ea1t h\u01a1n b\u1edfi c\u1ea3 k\u00edch th\u00edch \u0111au v\u00e0 kh\u00f4ng \u0111au. Nh\u1eefng thay \u0111\u1ed5i \u1edf m\u1ee9c \u0111\u1ed9 ph\u00e2n t\u1eed n\u00e0y l\u00e0 c\u01a1 s\u1edf c\u1ee7a nh\u1eefng quan s\u00e1t l\u00e2m s\u00e0ng v\u1ec1 t\u00ecnh tr\u1ea1ng t\u0103ng nh\u1ea1y c\u1ea3m v\u00e0 lo\u1ea1n c\u1ea3m \u0111au (allodynia) khi b\u1ecb t\u1ed5n th\u01b0\u01a1ng. C\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng v\u1ec1 bi\u1ec3u hi\u1ec7n c\u1ee7a lo\u1ea1n c\u1ea3m \u0111au \u1edf c\u00e1c d\u00e2y ch\u1eb1ng nha chu b\u1ecb vi\u00eam bao g\u1ed3m \u0111au khi c\u1eafn ho\u1eb7c khi g\u00f5 nh\u1eb9 l\u00ean r\u0103ng. M\u1ed9t v\u00ed d\u1ee5 \u0111i\u1ec3n h\u00ecnh v\u1ec1 s\u1ef1 t\u0103ng nh\u1ea1y c\u1ea3m khi m\u00f4 t\u1ee7y b\u1ecb vi\u00eam l\u00e0 ph\u1ea3n \u1ee9ng \u0111au qu\u00e1 m\u1ee9c tr\u01b0\u1edbc m\u1ed9t k\u00edch th\u00edch l\u1ea1nh. Khi g\u00e2y t\u00ea t\u1ea1i ch\u1ed7, c\u00e1c ch\u1ea5t trung gian g\u00e2y vi\u00eam \u1ea3nh h\u01b0\u1edfng tr\u1ef1c ti\u1ebfp \u0111\u1ebfn bi\u1ec3u hi\u1ec7n v\u00e0 ho\u1ea1t \u0111\u1ed9ng c\u1ee7a m\u1ed9t v\u00e0i k\u00eanh natri quan tr\u1ecdng, do \u0111\u00f3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn kh\u1ea3 n\u0103ng b\u1ecb k\u00edch th\u00edch c\u1ee7a c\u00e1c neuron c\u1ea3m gi\u00e1c v\u00e0 hi\u1ec7u qu\u1ea3 c\u1ee7a vi\u1ec7c g\u00e2y t\u00ea.<\/p>\n

3. K\u00eanh natri ph\u1ee5<\/h2>\n

C\u00e1c k\u00eanh natri \u0111\u01b0\u1ee3c chia l\u00e0m 2 nh\u00f3m ri\u00eang bi\u1ec7t d\u1ef1a tr\u00ean s\u1ef1 nh\u1ea1y c\u1ea3m v\u1edbi tetrodotoxin (TTX). C\u00e1c k\u00eanh Nav1.8 v\u00e0 Nav1.9 l\u00e0m trung gian cho d\u00f2ng \u0111i\u1ec7n kh\u00e1ng TTX (TTX \u2212 R). K\u00eanh Nav1.8 \u0111\u01b0\u1ee3c bi\u1ec3u hi\u1ec7n \u1edf m\u1ee9c \u0111\u1ed9 cao h\u01a1n d\u01b0\u1edbi t\u00ecnh tr\u1ea1ng vi\u00eam, v\u00e0 s\u1ef1 bi\u1ec3u hi\u1ec7n t\u0103ng l\u00ean \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh khi th\u1ef1c hi\u1ec7n nghi\u00ean c\u1ee9u tr\u00ean t\u1ee7y r\u0103ng ng\u01b0\u1eddi. \u0110i\u1ec1u quan tr\u1ecdng l\u00e0, t\u0103ng bi\u1ec3u hi\u1ec7n c\u1ee7a k\u00eanh Nav1.8 s\u1ebd l\u00e0m gi\u1ea3m hi\u1ec7u qu\u1ea3 c\u1ee7a lidocaine trong vi\u1ec7c ng\u0103n ch\u1eb7n s\u1ef1 d\u1eabn truy\u1ec1n th\u1ea7n kinh. Do \u0111\u00f3, vi\u1ec7c t\u0103ng c\u01b0\u1eddng Nav1.8 th\u01b0\u1eddng g\u1eb7p trong m\u00f4 t\u1ee7y vi\u00eam, c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n g\u00e2y kh\u00f3 kh\u0103n cho g\u00e2y t\u00ea t\u1ea1i ch\u1ed7 tr\u00ean l\u00e2m s\u00e0ng khi th\u1ef1c hi\u1ec7n c\u00e1c th\u1ee7 thu\u1eadt \u0111i\u1ec1u tr\u1ecb nha khoa. C\u00e1c k\u00eanh natri kh\u00e1c c\u0169ng c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c l\u00e0m trung gian d\u1eabn truy\u1ec1n \u0111au trong vi\u00eam. K\u00eanh Nav1.7 \u0111\u01b0\u1ee3c t\u0103ng c\u01b0\u1eddng trong nhi\u1ec1u ki\u1ec3u \u0111au do vi\u00eam \u1edf \u0111\u1ed9ng v\u1eadt v\u00e0 c\u1ea3 \u1edf ng\u01b0\u1eddi. T\u00f3m l\u1ea1i, nhi\u1ec1u k\u00eanh natri c\u00f3 li\u00ean \u0111\u1ebfn s\u1ef1 nh\u1ea1y c\u1ea3m c\u1ee7a c\u00e1c neuron c\u1ea3m gi\u00e1c. M\u1ed9t s\u1ef1 thay \u0111\u1ed5i bi\u1ec3u hi\u1ec7n quan c\u1ee7a c\u00e1c k\u00eanh natri, \u0111\u1eb7c bi\u1ec7t l\u00e0 Nav1.8, c\u00f3 th\u1ec3 ch\u1ecbu tr\u00e1ch nhi\u1ec7m cho nh\u1eefng quan s\u00e1t l\u00e2m s\u00e0ng th\u1ea5y gi\u1ea3m hi\u1ec7u qu\u1ea3 c\u1ee7a g\u00e2y t\u00ea t\u1ea1i ch\u1ed7 t\u1ea1i n\u01a1i vi\u00eam.<\/p>\n

Ngu\u1ed3n: Clinical Guide for Optimal Treatment Outcome – Springer International Publishing Switzerland 2017<\/span><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

B\u00e0i vi\u1ebft n\u00e0y n\u1ed9i dung h\u01b0\u1edbng v\u1ec1 t\u1ed5ng quan k\u1ef9 thu\u1eadt ki\u1ec3m so\u00e1t \u0111au tr\u00ean tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha t\u1ea1i gh\u1ebf r\u0103ng b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p g\u00e2y t\u00ea t\u1ea1i ch\u1ed7, \u0111\u1ed3ng th\u1eddi \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 t\u00ea v\u1edbi tr\u01b0\u1eddng h\u1ee3p m\u00f4 b\u1ecb vi\u00eam. C\u00f9ng t\u00ecm hi\u1ec3u th\u00eam trong b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y […]<\/p>\n","protected":false},"author":21,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[28,33],"tags":[],"yoast_head":"\nKi\u1ec3m so\u00e1t \u0111au tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha v\u1edbi tr\u01b0\u1eddng h\u1ee3p vi\u00eam. - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u00e0i vi\u1ebft t\u1ed5ng quan ki\u1ec3m so\u00e1t \u0111au \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha b\u1eb1ng g\u00e2y t\u00ea t\u1ea1i ch\u1ed7 v\u00e0 \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 t\u00ea v\u1edbi tr\u01b0\u1eddng h\u1ee3p m\u00f4 b\u1ecb vi\u00eam. 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