{"id":27758,"date":"2023-04-24T16:53:35","date_gmt":"2023-04-24T09:53:35","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=27758"},"modified":"2023-04-24T16:53:35","modified_gmt":"2023-04-24T09:53:35","slug":"thuyen-tac-dong-mach-phoi-trong-thuc-hanh-lam-sang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/24\/thuyen-tac-dong-mach-phoi-trong-thuc-hanh-lam-sang\/","title":{"rendered":"Thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng"},"content":{"rendered":"

Thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i<\/a> c\u00f3 th\u1ec3 g\u00e2y \u0111\u1ed9t t\u1eed n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi. B\u00e0i vi\u1ebft cung c\u1ea5p c\u00e1c th\u00f4ng tin v\u1ec1 b\u1ec7nh n\u00e0y.<\/strong><\/p>\n

\"Thuy\u00ean<\/p>\n

Thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i<\/strong><\/p>\n

1.Ch\u1ea9n \u0111o\u00e1n<\/h2>\n

1.1 Tri\u1ec7u ch\u1ee9ng<\/strong><\/h3>\n

Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a thuy\u00ean t\u1eafc \u0110MP \u0111a d\u1ea1ng v\u00e0 kh\u00f4ng \u0111\u1eb7c hi\u1ec7u. C\u1ea7n t\u00ecm ngay l\u1eadp t\u1ee9c c\u00e1c d\u1ea5u hi\u1ec7u ch\u1ee9ng t\u1ecf m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh nh\u00e2n tr\u00ean l\u00e2m s\u00e0ng, g\u1ed3m: s\u1ed1c, t\u1ee5t huy\u1ebft \u00e1p k\u00e9o d\u00e0i (Huy\u1ebft \u00e1p t\u00e2m thu < 90 mmHg ho\u1eb7c t\u1ee5t huy\u1ebft \u00e1p \u2265 40 mmHg, trong \u00edt nh\u1ea5t 15ph\u00fat, m\u00e0 kh\u00f4ng c\u00f3 r\u1ed1i lo\u1ea1n nh\u1ecbp tim m\u1edbi xu\u1ea5t hi\u1ec7n, thi\u1ebfu d\u1ecbch ho\u1eb7c nhi\u1ec5m tr\u00f9ng<\/em><\/strong>). C\u00e1c d\u1ea5u hi\u1ec7u kh\u00e1c g\u1ed3m:<\/p>\n

    \n
  • Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng: Kh\u00f3 th\u1edf khi ngh\u1ec9 ng\u01a1i hay khi g\u1eafng s\u1ee9c, \u0111au ng\u1ef1c ki\u1ec3u m\u00e0ng ph\u1ed5i, kh\u00f2 kh\u00e8, ho m\u00e1u.<\/li>\n
  • Kh\u00e1m l\u00e2m s\u00e0ng: Th\u1edf nhanh; nh\u1ecbp tim nhanh, T2 m\u1ea1nh; ran \u1ea9m\/n\u1ed5 ph\u1ed5i; rung thanh gi\u1ea3m; t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i; s\u01b0ng, \u0111au, n\u00f3ng \u0111\u1ecf chi d\u01b0\u1edbi n\u1ebfu c\u00f3 k\u00e8m theo HKTMSCD. \u0110\u00e1nh gi\u00e1 nguy c\u01a1 thuy\u00ean t\u1eafc \u0110MP tr\u00ean l\u00e2m s\u00e0ng: S\u1eed d\u1ee5ng thang \u0111i\u1ec3m Wells ho\u1eb7c Geneva c\u1ea3i ti\u1ebfn.<\/li>\n<\/ul>\n

    1.2 Chi\u1ebfn l\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n (Theo ESC 2019):<\/h3>\n

    1.2.1 B\u1ec7nh nh\u00e2n nghi ng\u1edd thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u00f3 nguy c\u01a1 cao (s\u1ed1c ho\u1eb7c t\u1ee5t HA)<\/strong><\/h4>\n
      \n
    • B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111i ch\u1ee5p MSCT \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i: Ch\u1ee5p MSCT x\u00e1c nh\u1eadn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb t\u00e1i t\u01b0\u1edbi m\u00e1u n\u1ebfu c\u00f3 thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.<\/li>\n
    • B\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 \u0111i ch\u1ee5p MSCT do t\u00ecnh tr\u1ea1ng b\u1ec7nh n\u1eb7ng ho\u1eb7c c\u01a1 s\u1edf kh\u00f4ng c\u00f3 \u0111i\u1ec1u ki\u1ec7n: Si\u00eau \u00e2m tim c\u1ea5p c\u1ee9u t\u1ea1i gi\u01b0\u1eddng, c\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh ti\u00eau s\u1ee3i huy\u1ebft c\u1ea5p c\u1ee9u n\u1ebfu tr\u00ean si\u00eau \u00e2m c\u00f3 t\u0103ng g\u00e1nh th\u1ea5t ph\u1ea3i ho\u1eb7c th\u1ea5y huy\u1ebft kh\u1ed1i trong c\u00e1c nh\u00e1nh l\u1edbn \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i. Si\u00eau \u00e2m tim c\u0169ng gi\u00fap lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y s\u1ed1c, t\u1ee5t \u00e1p kh\u00e1c. Ngo\u00e0i ra c\u00f3 th\u1ec3 si\u00eau \u00e2m tim t\u1ea1i gi\u01b0\u1eddng, si\u00eau \u00e2m t\u0129nh m\u1ea1ch chi d\u01b0\u1edbi \u0111\u1ec3 h\u1ed7 tr\u1ee3 ch\u1ea9n \u0111o\u00e1n.<\/li>\n<\/ul>\n

      1.2.2 B\u1ec7nh nh\u00e2n nghi ng\u1edd thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i kh\u00f4ng c\u00f3 s\u1ed1c ho\u1eb7c t\u1ee5t HA<\/h4>\n

      Nguy c\u01a1 thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i tr\u00ean l\u00e2m s\u00e0ng th\u1ea5p\/trung b\u00ecnh (\u0110i\u1ec3m Wells r\u00fat g\u1ecdn \u2264 1): \u0110\u1ecbnh l\u01b0\u1ee3ng D-dimer <\/strong>huy\u1ebft thanh<\/p>\n

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      • D-dimer t\u0103ng: <\/em><\/strong>Ch\u1ee5p MSCT \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u0111\u1ec3 x\u00e1c nh\u1eadn ch\u1ea9n \u0111o\u00e1n.<\/li>\n
      • D-dimer kh\u00f4ng t\u0103ng: <\/em><\/strong>Lo\u1ea1i tr\u1eeb thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.<\/li>\n<\/ul>\n

        Nguy c\u01a1 thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i tr\u00ean l\u00e2m s\u00e0ng cao (\u0110i\u1ec3m Wells r\u00fat g\u1ecdn > 1): Ch\u1ee5p MSCT \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh.<\/p>\n

        1.3 Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/h3>\n
          \n
        • C\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c g\u00e2y s\u1ed1c, t\u1ee5t huy\u1ebft \u00e1p, ho\u1eb7c \u0111au ng\u1ef1c, kh\u00f3 th\u1edf: nh\u01b0 nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1ed3i m\u00e1u c\u01a1 tim th\u1ea5t ph\u1ea3i, vi\u00eam ph\u1ed5i thu\u1ef3, suy tim tr\u00e1i c\u1ea5p, t\u0103ng \u00e1p l\u1ef1c \u0110MP ti\u00ean ph\u00e1t, c\u01a1n hen ph\u1ebf qu\u1ea3n, vi\u00eam m\u00e0ng ngo\u00e0i tim, \u00e9p tim c\u1ea5p, tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i, g\u00e3y x\u01b0\u01a1ng s\u01b0\u1eddn, vi\u00eam kh\u1edbp s\u1ee5n s\u01b0\u1eddn, \u0111au c\u01a1, \u0111au th\u1ea7n kinh li\u00ean s\u01b0\u1eddn.<\/li>\n<\/ul>\n

          1.4 Ph\u00e2n t\u1ea7ng nguy c\u01a1<\/h3>\n

          Ph\u00e2n t\u1ea7ng nguy c\u01a1 sau khi ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh thuy\u00ean t\u1eafc \u0110MP gi\u00fap \u0111\u1ecbnh h\u01b0\u1edbng chi\u1ebfn l\u01b0\u1ee3c x\u1eed tr\u00ed. Vi\u1ec7c n\u00e0y d\u1ef1a tr\u00ean t\u00ecnh tr\u1ea1ng huy\u1ebft \u0111\u1ed9ng, c\u00e1c th\u00f4ng s\u1ed1 l\u00e2m s\u00e0ng qua thang \u0111i\u1ec3m PESI hay sPESI , ch\u1ee9c n\u0103ng th\u1ea5t ph\u1ea3i (si\u00eau \u00e2m tim, ch\u1ee5p c\u1eaft l\u1edbp<\/em>), c\u00e1c d\u1ea5u \u1ea5n sinh h\u1ecdc (men tim, D-dimer, NT-proBNP<\/em>).<\/p>\n

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          • Nguy c\u01a1 cao: <\/strong>L\u00e0 thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u00f3 s\u1ed1c v\u00e0\/ho\u1eb7c t\u1ee5t \u00e1p, c\u1ea7n c\u00f3 chi\u1ebfn l\u01b0\u1ee3c t\u00e1i th\u00f4ng s\u1edbm.<\/li>\n
          • Nguy c\u01a1 kh\u00f4ng cao: <\/strong>L\u00e0 thuy\u00ean thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i kh\u00f4ng c\u00f3 s\u1ed1c v\u00e0 t\u1ee5t \u00e1p, ti\u1ebfp t\u1ee5c ph\u00e2n t\u1ea7ng nguy c\u01a1 d\u1ef1a tr\u00ean c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng<\/li>\n
          • Nguy c\u01a1 trung b\u00ecnh (PESI \u0111\u1ed9 III-IV ho\u1eb7c sPESI \u22651): <\/strong>Ti\u1ebfp t\u1ee5c ph\u00e2n t\u1ea7ng nguy c\u01a1 b\u1eb1ng x\u00e9t nghi\u1ec7m v\u00e0 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh<\/li>\n
          • Nguy c\u01a1 trung b\u00ecnh – cao: <\/strong>T\u0103ng g\u00e1nh th\u1ea5t ph\u1ea3i v\u00e0\/ho\u1eb7c gi\u00e3n th\u1ea5t ph\u1ea3i tr\u00ean si\u00eau \u00e2m tim v\u00e0\/ho\u1eb7c CT tim, k\u00e8m theo t\u0103ng c\u00e1c marker t\u1ed5n th\u01b0\u01a1ng tim (troponin T ho\u1eb7c I) v\u00e0\/ho\u1eb7c suy tim (BNP, NT-proBNP). C\u1ea7n theo d\u00f5i s\u00e1t sau khi cho thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng, s\u1eb5n s\u00e0ng t\u00e1i t\u01b0\u1edbi m\u00e1u n\u1ebfu c\u1ea7n.<\/li>\n
          • Nguy c\u01a1 trung b\u00ecnh – th\u1ea5p: <\/strong>Th\u0103m d\u00f2 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh v\u00e0 x\u00e9t nghi\u1ec7m \u0111\u1ec1u kh\u00f4ng c\u00f3 b\u1ea5t th\u01b0\u1eddng ho\u1eb7c ch\u1ec9 m\u1ed9t trong hai b\u1ea5t th\u01b0\u1eddng. C\u1ea7n cho thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng v\u00e0 nh\u1eadp vi\u1ec7n theo d\u00f5i.<\/li>\n
          • Nguy c\u01a1 th\u1ea5p (PESI \u0111\u1ed9 I, II ho\u1eb7c sPESI = 0): <\/strong>Cho thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng, c\u00e2n nh\u1eafc cho b\u1ec7nh nh\u00e2n ra vi\u1ec7n s\u1edbm v\u00e0 \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa.<\/li>\n<\/ul>\n

            2.\u0110i\u1ec1u tr\u1ecb<\/h2>\n

            2.1 \u0110i\u1ec1u tr\u1ecb h\u1ed3i s\u1ee9c<\/strong><\/h3>\n

            2.1.1 H\u1ed3i s\u1ee9c h\u00f4 h\u1ea5p<\/em><\/strong><\/h4>\n
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            • Th\u1edf oxy qua k\u00ednh ho\u1eb7c m\u1eb7t n\u1ea1: \u0110\u1ea3m b\u1ea3o SpO\u2082 > 90%.<\/li>\n
            • Th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o: Ch\u1ec9 \u0111\u1ecbnh \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n, th\u1edf m\u00e1y cho b\u1ec7nh nh\u00e2n thuy\u00ean t\u1eafc \u0110MP c\u1ea5p c\u00f3 s\u1ed1c, suy h\u00f4 h\u1ea5p. N\u00ean th\u1edf m\u00e1y mode VCV v\u1edbi th\u1ec3 t\u00edch kh\u00ed l\u01b0u th\u00f4ng th\u1ea5p (Vt: 6 mL\/kg) \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o \u00e1p l\u1ef1c cao nguy\u00ean < 30 cmH\u2082O.<\/li>\n<\/ul>\n

              2.1.2 H\u1ed3i s\u1ee9c huy\u1ebft \u0111\u1ed9ng<\/em><\/strong><\/p>\n

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              • Truy\u1ec1n d\u1ecbch: \u0110\u1eb7t \u0111\u01b0\u1eddng truy\u1ec1n ngo\u1ea1i vi v\u00e0 truy\u1ec1n kh\u00f4ng qu\u00e1 500 mL d\u1ecbch mu\u1ed1i \u0111\u1eb3ng tr\u01b0\u01a1ng cho b\u1ec7nh nh\u00e2n thuy\u00ean t\u1eafc \u0110MP c\u1ea5p.<\/li>\n
              • Thu\u1ed1c v\u1eadn m\u1ea1ch: Khi b\u1ec7nh nh\u00e2n t\u1ee5t huy\u1ebft \u00e1p. C\u00f3 th\u1ec3 s\u1eed d\u1ee5ng Dobutamine, ph\u1ed1i h\u1ee3p v\u1edbi Noradrenaline (\u00edt nguy c\u01a1 g\u00e2y t\u0103ng nh\u1ecbp tim h\u01a1n Dopamine, hay Adrenaline).<\/li>\n<\/ul>\n

                2.2 \u0110i\u1ec1u tr\u1ecb t\u00e1i t\u01b0\u1edbi m\u00e1u<\/h3>\n

                2.2.1 \u0110i\u1ec1u tr\u1ecb thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft<\/strong><\/h4>\n
                2.2.1.1 Ch\u1ec9 \u0111\u1ecbnh:<\/strong><\/h5>\n
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                • \u0110\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n thuy\u00ean t\u1eafc \u0110MP c\u1ea5p c\u00f3 s\u1ed1c, t\u1ee5t huy\u1ebft \u00e1p; \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb cho, b\u1ec7nh nh\u00e2n thuy\u00ean t\u1eafc \u0110MP c\u1ea5p nguy c\u01a1 t\u1eed vong s\u1edbm \u1edf m\u1ee9c trung b\u00ecnh cao v\u00e0 c\u00f3 r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng. Ngo\u00e0i ra, c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc ch\u1ec9 \u0111\u1ecbnh cho t\u1eebng tr\u01b0\u1eddng h\u1ee3p ch\u1ecdn l\u1ecdc nh\u01b0:<\/li>\n
                • Ph\u1ea3i h\u1ed3i sinh tim ph\u1ed5i, m\u00e0 nghi ng\u1edd nguy\u00ean nh\u00e2n ng\u1eebng tim l\u00e0 do thuy\u00ean t\u1eafc \u0110MP.<\/li>\n
                • C\u00f3 b\u1eb1ng ch\u1ee9ng c\u1ee7a huy\u1ebft kh\u1ed1i lan r\u1ed9ng (tr\u00ean phim c\u1eaft l\u1edbp vi t\u00ednh, ho\u1eb7c c\u00f3 v\u00f9ng gi\u1ea3m t\u01b0\u1edbi m\u00e1u r\u1ed9ng tr\u00ean x\u1ea1 h\u00ecnh\/th\u00f4ng kh\u00ed t\u01b0\u1edbi m\u00e1u ph\u1ed5i).<\/li>\n
                • C\u00f3 huy\u1ebft kh\u1ed1i di \u0111\u1ed9ng trong bu\u1ed3ng tim ph\u1ea3i. C\u00f3 gi\u1ea3m oxy m\u00e1u n\u1eb7ng.<\/li>\n
                • C\u00f3 thuy\u00ean t\u1eafc \u0110MP ph\u1ed5i k\u00e8m theo t\u1ed3n t\u1ea1i l\u1ed7 b\u1ea7u d\u1ee5c.<\/li>\n<\/ul>\n
                  2.2.1.2\u00a0 \u00a0<\/em>Li\u1ec1u d\u00f9ng v\u00e0 theo d\u00f5i<\/em>:<\/h5>\n
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                  • Thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o hi\u1ec7n nay l\u00e0 rt-PA (Alteplase): 100 mg trong v\u00f2ng 2 gi\u1edd ho\u1eb7c 0,6 mg\/kg trong v\u00f2ng 15 ph\u00fat (t\u1ed1i \u0111a 50 mg)<\/li>\n
                  • Th\u1eddi gian<\/em>: Ti\u00eau s\u1ee3i huyet c\u00f3 hi\u1ec7u qu\u1ea3 cao nh\u1ea5t khi \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb trong v\u00f2ng 48 ti\u1ebfng k\u1ec3 t\u1eeb khi xu\u1ea5t hi\u1ec7n tri\u1ec7u ch\u1ee9ng. Tuy nhi\u00ean, v\u0201n c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc ch\u1ec9 \u0111\u1ecbnh \u1edf b\u1ec7nh nh\u00e2n b\u1ecb thuy\u00ean t\u1eafc \u0110MP t\u1eeb 6 – 14 ng\u00e0y.<\/li>\n
                  • Ph\u1eabu thu\u1eadt l\u1ea5y huy\u1ebft kh\u1ed1i, ho\u1eb7c can thi\u1ec7p l\u1ea5y huy\u1ebft kh\u1ed1i b\u1eb1ng \u1ed1ng th\u00f4ng (catheter)<\/li>\n
                  • C\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf trung t\u00e2m ngo\u1ea1i khoa\/can thi\u1ec7p c\u00f3 \u0111\u1ea7y \u0111\u1ee7 trang thi\u1ebft b\u1ecb, v\u00e0 kinh nghi\u1ec7m. \u0110\u01b0\u1ee3c c\u00e2n nh\u1eafc ch\u1ec9 \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n thuy\u00ean t\u1eafc \u0110MP c\u1ea5p c\u00f3 s\u1ed1c, t\u1ee5t \u00e1p nh\u01b0ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb ti\u00eau s\u1ee3i huy\u1ebft, ho\u1eb7c \u0111i\u1ec1u tr\u1ecb ti\u00eau s\u1ee3i huy\u1ebft th\u1ea5t b\u1ea1i. \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u1ea5p c\u00f3 huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh, ph\u0201u thu\u1eadt l\u1ea5y huy\u1ebft kh\u1ed1i ho\u1eb7c can thi\u1ec7p l\u1ea5y huy\u1ebft kh\u1ed1i b\u1eb1ng catheter \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc ch\u1ec9 \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n nguy c\u01a1 t\u1eed vong s\u1edbm \u1edf m\u1ee9c trung b\u00ecnh cao, c\u00f3 ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb t\u00e1i t\u01b0\u1edbi m\u00e1u nh\u01b0ng nguy c\u01a1 xu\u1ea5t huy\u1ebft cao n\u1ebfu d\u00f9ng ti\u00eau s\u1ee3i huy\u1ebft.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"

                    Thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u00f3 th\u1ec3 g\u00e2y \u0111\u1ed9t t\u1eed n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi. B\u00e0i vi\u1ebft cung c\u1ea5p c\u00e1c th\u00f4ng tin v\u1ec1 b\u1ec7nh n\u00e0y. Thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i 1.Ch\u1ea9n \u0111o\u00e1n 1.1 Tri\u1ec7u ch\u1ee9ng Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a thuy\u00ean t\u1eafc \u0110MP \u0111a d\u1ea1ng v\u00e0 kh\u00f4ng \u0111\u1eb7c hi\u1ec7u. C\u1ea7n […]<\/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":"\nThuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng - Vinmec<\/title>\n<meta name=\"description\" content=\"Thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u00f3 th\u1ec3 g\u00e2y \u0111\u1ed9t t\u1eed n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi. 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