{"id":29976,"date":"2023-05-01T22:56:37","date_gmt":"2023-05-01T15:56:37","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29976"},"modified":"2023-05-01T22:56:37","modified_gmt":"2023-05-01T15:56:37","slug":"ho-van-dong-mach-chu-va-chi-dinh-noi-ngoai-khoa","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/01\/ho-van-dong-mach-chu-va-chi-dinh-noi-ngoai-khoa\/","title":{"rendered":"H\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7\u00a0v\u00e0 ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb n\u1ed9i, ngo\u1ea1i khoa"},"content":{"rendered":"

H\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/a>\u00a0l\u00e0 t\u00ecnh tr\u1ea1ng x\u1ea3y ra khi van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 kh\u00f4ng \u0111\u00f3ng k\u00edn. Van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u00e0 l\u00e1 van ng\u0103n c\u00e1ch gi\u1eefa \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 t\u00e2m th\u1ea5t tr\u00e1i, c\u00f3 nhi\u1ec7m v\u1ee5 \u0111\u00f3ng m\u1edf, cho ph\u00e9p m\u00e1u ch\u1ec9 \u0111i theo m\u1ed9t chi\u1ec1u nh\u1ea5t \u0111\u1ecbnh.<\/strong><\/p>\n

1.Nguy\u00ean nh\u00e2n<\/h2>\n

1.1 Nguy\u00ean nh\u00e2n t\u1ea1i van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/strong><\/h3>\n

Di ch\u1ee9ng b\u1ec7nh th\u1ea5p tim (th\u01b0\u1eddng k\u1ebft h\u1ee3p v\u1edbi h\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 c\u0169ng nh\u01b0 h\u1eb9p ho\u1eb7c h\u1edf van hai l\u00e1), vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n, tho\u00e1i h\u00f3a v\u00e0 v\u00f4i h\u00f3a (k\u00e8m h\u1eb9p van \u0110M ch\u1ee7), van \u0110M ch\u1ee7 hai l\u00e1 van, ch\u1ea5n th\u01b0\u01a1ng.<\/p>\n

1.2 Nguy\u00ean nh\u00e2n t\u1ea1i g\u1ed1c \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/h3>\n

Do t\u0103ng huy\u1ebft \u00e1p, t\u00e1ch th\u00e0nh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, h\u1ed9i ch\u1ee9ng Marfan. C\u00e1c nguy\u00ean nh\u00e2n hi\u1ebfm g\u1eb7p kh\u00e1c: T\u1ea1o x\u01b0\u01a1ng b\u1ea5t to\u00e0n, vi\u00eam \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 do giang mai, vi\u00eam kh\u1edbp – c\u1ed9t s\u1ed1ng (vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp, Reiter…), vi\u00eam \u0111\u1ed9ng m\u1ea1ch (Takayasu, t\u1ebf b\u00e0o kh\u1ed5ng l\u1ed3) …<\/p>\n

2.Sinh l\u00fd b\u1ec7nh<\/h2>\n

Khi van b\u1ecb h\u1edf, th\u1ec3 t\u00edch nh\u00e1t b\u00f3p t\u0103ng l\u00ean do m\u00e1u ph\u1ee5t ng\u01b0\u1ee3c tr\u1edf v\u1ec1 t\u1eeb \u0110M ch\u1ee7 v\u00e0o th\u1ea5t tr\u00e1i. Cung l\u01b0\u1ee3ng tim \u0111\u01b0\u1ee3c duy tr\u00ec b\u1eb1ng c\u00e1ch gi\u00e3n th\u1ea5t tr\u00e1i \u0111\u1ec3 t\u0103ng th\u1ec3 t\u00edch nh\u00e1t b\u00f3p nh\u01b0ng l\u00e0m t\u0103ng qu\u00e1 m\u1ee9c th\u1ec3 t\u00edch cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng. Qu\u00e1 t\u1ea3i th\u1ec3 t\u00edch k\u00e9o d\u00e0i v\u00e0 ti\u1ebfn tri\u1ec3n d\u1ea7n d\u0201n t\u1edbi c\u01a1 tim gi\u00e3n l\u1edbn, suy ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i v\u00e0 h\u1eadu qu\u1ea3 cu\u1ed1i c\u00f9ng l\u00e0 suy tim bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng.<\/p>\n

\"H\u1edf<\/p>\n

H\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/strong><\/p>\n

3.\u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng<\/h2>\n

Trong h\u1edf van \u0110M ch\u1ee7 c\u1ea5p t\u00ednh, tri\u1ec7u ch\u1ee9ng kh\u00f3 th\u1edf g\u1eb7p ph\u1ed5 bi\u1ebfn, t\u0103ng cung l\u01b0\u1ee3ng tim trong tr\u1ea1ng th\u00e1i th\u1ea5t tr\u00e1i kh\u00f4ng \u0111\u00e0n h\u1ed3i, \u00e1p l\u1ef1c cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng th\u1ea5t tr\u00e1i t\u0103ng d\u0201n \u0111\u1ebfn ph\u00f9 ph\u1ed5i, t\u1ee5t huy\u1ebft \u00e1p v\u00e0 s\u1ed1c tim.<\/p>\n

Trong h\u1edf van \u0110M ch\u1ee7 m\u1ea1n t\u00ednh, ban \u0111\u1ea7u kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng. \u00c1p l\u1ef1c cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng th\u1ea5t tr\u00e1i th\u1ea5p do gi\u00e3n th\u1ea5t tr\u00e1i. Qu\u00e1 t\u1ea3i th\u1ec3 t\u00edch m\u00e3n t\u00ednh d\u0201n \u0111\u1ebfn suy th\u1ea5t tr\u00e1i v\u00e0 suy tim m\u1ea1n t\u00ednh.<\/p>\n

\u0110au th\u1eaft ng\u1ef1c, tri\u1ec7u ch\u1ee9ng t\u00e1ch th\u00e0nh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 (v\u00ed d\u1ee5: \u0110au ng\u1ef1c lan ra sau l\u01b0ng).<\/p>\n

C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c.<\/p>\n

M\u1ea1ch n\u1ea3y m\u1ea1nh, ch\u00ecm s\u00e2u, d\u1ea5u hi\u1ec7u Corrigan (c\u00f3 th\u1ec3 nh\u00ecn th\u1ea5y m\u1ea1ch c\u1ea3nh \u0111\u1eadp)<\/p>\n

D\u1ea5u hi\u1ec7u De Musset<\/u><\/strong>: \u0110\u1ea7u g\u1eadt g\u00f9 theo nh\u1ecbp \u0111\u1eadp c\u1ee7a tim.<\/p>\n

D\u1ea5u hi\u1ec7u M\u00fcller<\/u><\/strong>: L\u01b0\u1ee1i g\u00e0 \u0111\u1eadp theo nh\u1ecbp tim.<\/p>\n

D\u1ea5u hi\u1ec7u Traube<\/u><\/strong>: \u201cS\u00fang l\u1ee5c b\u1eafn v\u00e0o x\u01b0\u01a1ng \u0111\u00f9i\u201d ti\u1ebfng m\u1ea1ch \u0111\u1eadp m\u1ea1 n h nghe b\u1eb1ng \u1ed1ng nghe t\u1ea1i \u0111\u1ed9ng m\u1ea1ch \u0111\u00f9i.<\/p>\n

D\u1ea5u hi\u1ec7u Quincke<\/u><\/strong>: X ung mao m\u1ea1ch c\u00f3 th\u1ec3 nh\u00ecn th\u1ea5y \u1edf m\u00f3ng tay.<\/p>\n

D\u1ea5u hi\u1ec7u Duroziez<\/u><\/strong>: T i\u1ebfng th \u1ed5i t\u00e2m thu v\u00e0 t\u00e2m tr\u01b0\u01a1ng nghe th\u1ea5y tr\u00ean \u0111\u1ed9ng m\u1ea1ch \u0111\u00f9i khi \u0111\u1ed9ng m\u1ea1ch \u0111\u01b0\u1ee3c n\u00e9n b\u1eb1ng ng\u00f3n tay.<\/p>\n

M\u1ecfm tim di l\u1ec7ch v\u1ec1 d\u01b0\u1edbi b\u00ean, \u0111\u1eadp m\u1ea1nh v\u00e0 lan r\u1ed9ng h\u01a1n. C\u00f3 th\u1ec3 c\u1ea3m th\u1ea5y rung miu v\u00f9ng m\u1ecfm.<\/p>\n

Nghe tim<\/u><\/em><\/strong><\/p>\n

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  • Ti\u1ebfng T2 c\u00f3 th\u1ec3 b\u00ecnh th\u01b0\u1eddng (ho\u1eb7c to h\u01a1n) n\u1ebfu h\u1edf van do b\u1ec7nh l\u00fd g\u1ed1c \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 c\u00f3 th\u1ec3 \u00eam nh\u1eb9 ho\u1eb7c m\u1ea5t n\u1ebfu h\u1edf van do b\u1ec7nh l\u00fd van. Ti\u1ebfng T3 c\u00f3 th\u1ec3 nghe th\u1ea5y khi th\u1ea5t tr\u00e1i gi\u00e3n ho\u1eb7c suy tim giai \u0111o\u1ea1n s\u1edbm.<\/li>\n
  • Ti\u1ebfng th\u1ed5i t\u00e2m thu t\u1ed1ng m\u00e1u t\u01b0\u01a1ng t\u1ef1 nh\u01b0 h\u1eb9p van \u0110M ch\u1ee7 c\u00f3 th\u1ec3 nghe th\u1ea5y (nguy\u00ean nh\u00e2n h\u1ed7n h\u1ee3p c\u1ee7a h\u1eb9p\/ h\u1edf van \u0110M ch\u1ee7 ho\u1eb7c do d\u00f2ng m\u00e1u cu\u1ed9n khi th\u1ec3 t\u00edch nh\u00e1t b\u00f3p t\u0103ng).<\/li>\n
  • Ti\u1ebfng th\u1ed5i c\u1ee7a h\u1edf van \u0110M ch\u1ee7 c\u00f3 \u00e2m s\u1eafc cao, th\u00ec t\u00e2m tr\u01b0\u01a1ng s\u1edbm ngay sau ti\u1ebfng T2. Ti\u1ebfng n\u00e0y nghe r\u00f5 nh\u1ea5t khi b\u1ec7nh nh\u00e2n t\u01b0 th\u1ebf ng\u1ed3i v\u00e0 ng\u1ea3 ra tr\u01b0\u1edbc trong th\u00ec th\u1edf ra. Nghe r\u00f5 nh\u1ea5t d\u1ecdc theo b\u1edd tr\u00e1i tr\u00ean x\u01b0\u01a1ng \u1ee9c (\u0111\u00f4i khi d\u1ecdc theo b\u1edd ph\u1ea3i n\u1ebfu gi\u00e3n g\u1ed1c \u0111\u1ed9ng m\u1ea1ch ch\u1ee7). Th\u1eddi gian c\u1ee7a ti\u1ebfng th\u1ed5i t\u00e2m tr\u01b0\u01a1ng t\u01b0\u01a1ng quan v\u1edbi m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a h\u1edf van \u0110M ch\u1ee7.<\/li>\n
  • Ti\u1ebfng rung Austin Flint nghe \u0111\u01b0\u1ee3c \u1edf gi\u1eefa t\u00e2m tr\u01b0\u01a1ng v\u00f9ng m\u1ecfm tim g\u00e2y b\u1edfi d\u00f2ng m\u00e1u xu\u00f4i chi\u1ec1u qua l\u1ed7 van hai l\u00e1 b\u1ecb h\u1eb9p khi \u00e1p l\u1ef1c th\u1ea5t tr\u00e1i t\u0103ng v\u00e0 d\u00f2ng h\u1edf van \u0110M ch\u1ee7 tr\u00e0o ng\u01b0\u1ee3c h\u01b0\u1edbng tr\u1ef1c ti\u1ebfp v\u1ec1 l\u00e1 tr\u01b0\u1edbc van hai l\u00e1.<\/li>\n<\/ul>\n

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

    4.1 \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa<\/strong><\/p>\n

    H\u1edf van \u0110M ch\u1ee7 nh\u1eb9 ho\u1eb7c v\u1eeba kh\u00f4ng tri\u1ec7u ch\u1ee9ng v\u1edbi th\u1ea5t tr\u00e1i b\u00ecnh th\u01b0\u1eddng<\/strong>: T heo d\u00f5i \u0111\u1ecbnh k\u1ef3 (m\u1ed7i 1 – 2 n\u0103m) b\u1eb1ng si\u00eau \u00e2m tim.<\/p>\n

    H\u1edf van \u0110M ch\u1ee7 n\u1eb7ng kh\u00f4ng tri\u1ec7u ch\u1ee9ng v\u1edbi th\u1ea5t tr\u00e1i b\u00ecnh th\u01b0\u1eddng<\/strong>: T heo d\u00f5i \u0111\u1ecbnh k\u1ef3 m\u1ed7i 6 th\u00e1ng ho\u1eb7c s\u1edbm h\u01a1n n\u1ebfu xu\u1ea5t hi\u1ec7n tri\u1ec7u ch\u1ee9ng. L\u1ee3i \u00edch c\u1ee7a thu\u1ed1c gi\u00e3n m\u1ea1ch c\u00f2n g\u00e2y tranh c\u00e3i.<\/p>\n

    H\u1edf van \u0110M ch\u1ee7 n\u1eb7ng v\u1edbi r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i ho\u1eb7c c\u00f3 tri\u1ec7u ch\u1ee9ng:<\/p>\n

    C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a suy tim su ng huy\u1ebft \u0111\u00e1p \u1ee9ng v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u quai v\u00e0 digoxin trong l\u00fac chu\u1ea9n b\u1ecb ph\u0201u thu\u1eadt.<\/p>\n

    Thu\u1ed1c gi\u00e3n m\u1ea1ch (thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n, thu\u1ed1c ch\u1eb9n k\u00eanh canxi) gi\u00fap gi\u1ea3m tri\u1ec7u ch\u1ee9ng t\u1ed1t v\u00e0 c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n huy\u1ebft \u0111\u1ed9ng.<\/p>\n

    \u0110au ng\u1ef1c c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng nitrat nh\u01b0ng n\u00ean th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng thu\u1ed1c ch\u1eb9n beta.<\/p>\n

    T\u0103ng huy\u1ebft \u00e1p ph\u1ed1i h\u1ee3p c\u00f3 th\u1ec3 l\u00e0m n\u1eb7ng th\u00eam h\u1edf van \u0110M ch\u1ee7 do v\u1eady c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng quy.<\/p>\n

    H\u1edf van \u0110M ch\u1ee7 c\u1ea5p t\u00ednh n\u1eb7ng:<\/p>\n

    K huy\u1ebfn c\u00e1o ph\u0201u thu\u1eadt c\u1ea5p c\u1ee9u<\/p>\n

    C\u00e1c thu\u1ed1c nitroprusside v\u00e0 v\u1eadn m\u1ea1ch (dopamine, dobutamine) c\u00f3 t\u00e1c d\u1ee5ng t\u1ea1m th\u1eddi tr\u01b0\u1edbc khi ph\u0201u thu\u1eadt do l\u00e0m t\u0103ng cung l\u01b0\u1ee3ng tim v\u00e0 gi\u1ea3m \u00e1p l\u1ef1c th\u1ea5t tr\u00e1i cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng.<\/p>\n

    Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi b\u00f3ng \u0111\u1ed1i xung \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 (IABP) .<\/p>\n

    S\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c ch\u1eb9n beta m\u1ed9t c\u00e1ch th\u1eadn tr\u1ecdng v\u00ec ch\u00fang l\u00e0m gi\u1ea3m c\u01a1 ch\u1ebf b\u00f9 tr\u1eeb b\u1eb1ng t\u0103ng nh\u1ecbp tim.<\/p>\n

    V\u1edbi b\u1ec7nh nh\u00e2n Marfan, ch\u1eb9n beta giao c\u1ea3m v\u00e0\/ho\u1eb7c losartan <\/em><\/strong>c\u00f3 th\u1ec3 l\u00e0m ch\u1eadm s\u1ef1 gi\u00e3n g\u1ed1c \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 gi\u1ea3m bi\u1ebfn ch\u1ee9ng, n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t \u0111i\u1ec1u tr\u1ecb c\u1ea3 tr\u01b0\u1edbc v\u00e0 sau ph\u0201u thu\u1eadt.<\/p>\n

    4.2 \u0110i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt<\/h3>\n

    H\u1edf van \u0110M ch\u1ee7 kh\u00f4ng tri\u1ec7u ch\u1ee9ng v\u1edbi ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i b\u00ecnh th\u01b0\u1eddng c\u1ea7n theo d\u00f5i \u0111\u1ecbnh k\u1ef3. M\u1ed9t khi c\u00e1c tri\u1ec7u ch\u1ee9ng xu\u1ea5t hi\u1ec7n ho\u1eb7c c\u00f3 b\u1eb1ng ch\u1ee9ng c\u1ee7a r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i \u0111\u00e1ng k\u1ec3 xu\u1ea5t hi\u1ec7n, ph\u0201u thu\u1eadt thay van ho\u1eb7c g\u1ed1c \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t. Trong tr\u01b0\u1eddng h\u1ee3p ranh gi\u1edbi n\u00ean theo d\u00f5i th\u01b0\u1eddng xuy\u00ean m\u1ed7i 2 \u0111\u1ebfn 4 th\u00e1ng.<\/p>\n

    Thay van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n h\u1edf van \u0110M ch\u1ee7 n\u1eb7ng c\u00f3 tri\u1ec7u ch\u1ee9ng, ho\u1eb7c h\u1edf van \u0110M ch\u1ee7 n\u1eb7ng kh\u00f4ng tri\u1ec7u ch\u1ee9ng v\u00e0 EF \u2264 50%, gi\u00e3n th\u1ea5t tr\u00e1i n\u1eb7ng (\u0111\u01b0\u1eddng k\u00ednh th\u1ea5t tr\u00e1i cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng >65 mm ho\u1eb7c cu\u1ed1i t\u00e2m thu th\u1ea5t tr\u00e1i \u2265 50 mm), ho\u1eb7c ph\u0201u thu\u1eadt \u0111\u1ed3ng th\u1eddi khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh b\u1eafc c\u1ea7u ch\u1ee7 v\u00e0nh, thay van tim kh\u00e1c ho\u1eb7c g\u1ed1c \u0110M ch\u1ee7.<\/p>\n

    Ph\u0201u thu\u1eadt s\u1eeda van c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c l\u00e1 van b\u00ecnh th\u01b0\u1eddng, h\u1edf van \u0110M ch\u1ee7 do gi\u00e3n g\u1ed1c \u0110M ch\u1ee7.<\/p>\n

    \"H\u01b0\u1edbng<\/p>\n

    H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 (AHA 2014)<\/strong><\/p>\n

    HoC: H\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7; ERO: Di\u1ec7n t\u00edch l\u1ed7 h\u1edf hi\u1ec7u d\u1ee5ng; LVEF: Ph\u00e2n s\u1ed1 t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i; LVESD: \u0110\u01b0\u1eddng k\u00ednh th\u1ea5t tr\u00e1i cu\u1ed1i t\u00e2m thu; LVEDD: \u0110\u01b0\u1eddng k\u00ednh th\u1ea5t tr\u00e1i cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

    H\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7\u00a0l\u00e0 t\u00ecnh tr\u1ea1ng x\u1ea3y ra khi van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 kh\u00f4ng \u0111\u00f3ng k\u00edn. Van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u00e0 l\u00e1 van ng\u0103n c\u00e1ch gi\u1eefa \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 t\u00e2m th\u1ea5t tr\u00e1i, c\u00f3 nhi\u1ec7m v\u1ee5 \u0111\u00f3ng m\u1edf, cho ph\u00e9p m\u00e1u ch\u1ec9 \u0111i theo m\u1ed9t chi\u1ec1u nh\u1ea5t \u0111\u1ecbnh. 1.Nguy\u00ean nh\u00e2n 1.1 Nguy\u00ean nh\u00e2n t\u1ea1i […]<\/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":"\nH\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7\u00a0v\u00e0 ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb n\u1ed9i, ngo\u1ea1i khoa - Vinmec<\/title>\n<meta name=\"description\" content=\"H\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7\u00a0l\u00e0 t\u00ecnh tr\u1ea1ng x\u1ea3y ra khi van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 kh\u00f4ng \u0111\u00f3ng k\u00edn. 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