{"id":30866,"date":"2023-05-03T14:56:07","date_gmt":"2023-05-03T07:56:07","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30866"},"modified":"2023-05-03T14:56:07","modified_gmt":"2023-05-03T07:56:07","slug":"tiep-can-lam-sang-nhip-nhanh-that","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/tiep-can-lam-sang-nhip-nhanh-that\/","title":{"rendered":"Ti\u1ebfp c\u1eadn l\u00e2m s\u00e0ng nh\u1ecbp nhanh th\u1ea5t"},"content":{"rendered":"<p><strong>Nh\u1ecbp nhanh th\u1ea5t l\u00e0 r\u1ed1i lo\u1ea1n nh\u1ecbp nhanh khi c\u00f3 tr\u00ean 3 ph\u1ee9c b\u1ed9 th\u1ea5t li\u00ean ti\u1ebfp, c\u00f3 t\u1ea7n s\u1ed1 t\u1eeb &gt; 100 c\/ph \u0111\u1ebfn 250 c\/ph, th\u01b0\u1eddng c\u00f3 ph\u1ee9c b\u1ed9 QRS r\u1ed9ng (\u2265120 msec) xu\u1ea5t hi\u1ec7n khi ho\u1ea1t \u0111\u1ed9ng kh\u1eed c\u1ef1c \u1edf th\u1ea5t ch\u1eadm b\u1ea5t th\u01b0\u1eddng, c\u00f3 ngu\u1ed3n g\u1ed1c ngo\u00e0i h\u1ec7 th\u1ed1ng d\u1eabn truy\u1ec1n b\u00ecnh th\u01b0\u1eddng.<\/strong><\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone wp-image-30869 size-medium\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/AV-1-300x121.png\" alt=\"nhip-nhanh-that\" width=\"300\" height=\"121\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/AV-1-300x121.png 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/AV-1.png 744w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/p>\n<p>&nbsp;<\/p>\n<h2>1. Nguy\u00ean nh\u00e2n v\u00e0 ph\u00e2n lo\u1ea1i nh\u1ecbp nhanh th\u1ea5t<\/h2>\n<p><strong>1.1. Nguy\u00ean nh\u00e2n<br \/>\n<\/strong>&#8211; \u00a0C\u00e1c b\u1ec7nh tim b\u1ea9m sinh: \u0110ang b\u1ecb ho\u1eb7c sau m\u1ed5 c\u00f3 th\u1ec3 g\u00e2y ra lo\u1ea1n nh\u1ecbp th\u1ea5t.<br \/>\n&#8211; \u00a0C\u00e1c r\u1ed1i lo\u1ea1n di truy\u1ec1n g\u1ed3m c\u00f3 c\u00e1c b\u1ec7nh c\u00e1c k\u00eanh ion v\u00e0 b\u1ec7nh c\u01a1 tim:<br \/>\n&#8211; \u00a0B\u1ec7nh k\u00eanh ion:<strong><br \/>\n<\/strong>+ H\u1ed9i ch\u1ee9ng QT d\u00e0i.<br \/>\n+ H\u1ed9i ch\u1ee9ng Brugada.<br \/>\n+ Nh\u1ecbp nhanh th\u1ea5t \u0111a h\u00ecnh do catecholamine.<br \/>\n&#8211; \u00a0C\u00e1c b\u1ec7nh c\u01a1 tim:<strong><br \/>\n<\/strong>+ <a href=\"https:\/\/vinmec.com\/vi\/tim-mach\/thong-tin-suc-khoe\/benh-co-tim-phi-dai-nhung-dieu-can-biet\/\">B\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i<\/a>.<br \/>\n+B\u1ec7nh c\u01a1 tim th\u1ea5t ph\u1ea3i g\u00e2y lo\u1ea1n nh\u1ecbp (ARVC).<br \/>\n+ Lo\u1ea1n s\u1ea3n c\u01a1 Duchenne (DMD).<br \/>\n+ H\u1ed9i ch\u1ee9ng Barth.<br \/>\n&#8211; \u00a0B\u1ec7nh tim m\u1eafc ph\u1ea3i:<br \/>\n+ B\u1ec7nh m\u1ea1ch v\u00e0nh, th\u01b0\u1eddng sau nh\u1ed3i m\u00e1u ho\u1eb7c b\u1ec7nh m\u1ea1ch v\u00e0nh m\u1ea1n.<br \/>\n+ Vi\u00eam c\u01a1 tim.<br \/>\n+ B\u1ec7nh Chagas do k\u00fd sinh tr\u00f9ng Trypanosoma cruzi.<br \/>\n+ K\u00e9o d\u00e0i QTc m\u1eafc ph\u1ea3i: r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a h\u1ea1 kali, gi\u1ea3m magie, ch\u00e1n \u0103n<br \/>\ndo t\u00e2m th\u1ea7n.<br \/>\n+ B\u1ec7nh n\u1ed9i s\u1ecd.<br \/>\n+ Do thu\u1ed1c nh\u01b0 quinidine ho\u1eb7c procainamide.<br \/>\n+ Hi\u1ebfm g\u1eb7p do u tim.<br \/>\n&#8211; \u00a0C\u00e1c nguy\u00ean nh\u00e2n t\u1ef1 ph\u00e1t:<strong><br \/>\n<\/strong>+ Nh\u1ecbp th\u1ea5t gia t\u0103ng.<br \/>\n+ Nh\u1ecbp nhanh th\u1ea5t \u0111\u01b0\u1eddng ra th\u1ea5t ph\u1ea3i.<br \/>\n+ Nh\u1ecbp nhanh th\u1ea5t tr\u00e1i t\u1ef1 ph\u00e1t.<br \/>\n<strong>1.2. Ph\u00e2n loai<br \/>\nN\u1ebfu \u0111\u1ef1a v\u00e0o h\u00ecnh th\u00e1i c\u1ee7a ph\u1ee9c b\u1ed9 QRS:<\/strong><\/p>\n<ul>\n<li>VT \u0111\u01a1n h\u00ecnh: H\u00ecnh d\u1ea1ng ph\u1ee9c b\u1ed9 QRS kh\u00f4ng thay \u0111\u1ed5i v\u00e0 \u1ed5n \u0111\u1ecbnh, m\u1eb7c d\u00f9 c\u00f3 th\u1ec3 c\u00f3 nh\u1eefng thay \u0111\u1ed5i tinh t\u1ebf trong h\u00ecnh th\u00e1i trong ph\u1ee9c b\u00f4 QRS v\u00e0 ST- T.<\/li>\n<li>VT \u0111a h\u00ecnh: ng\u01b0\u1ee3c l\u1ea1i v\u1edbi \u0111\u01a1n h\u00ecnh, ph\u1ee9c b\u1ed9 QRS thay \u0111\u1ed5i h\u00ecnh d\u1ea1ng. N\u1ebfu VT \u0111a h\u00ecnh \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n tr\u00ean c\u01a1 s\u1edf QT k\u00e9o d\u00e0i b\u1ea9m sinh ho\u1eb7c m\u1eafc ph\u1ea3i th\u00ec g\u1ecdi l\u00e0 xo\u1eb5n \u0111\u1ec9nh (torsades de points: TdP).<\/li>\n<\/ul>\n<p><strong>N\u1ebfu d\u1ef1a v\u00e0o th\u1eddi gian c\u1ee7a c\u01a1n nh\u1ecbp nhanh<\/strong>, c\u00f3 hai lo\u1ea1i:<strong><br \/>\n&#8211; <\/strong>VT t\u1ea1m th\u1eddi: khi c\u01a1n ch\u1ec9 k\u00e9o d\u00e0i \u2264 30s<br \/>\n&#8211; VT dai d\u1eb3ng: khi c\u01a1n k\u00e9o d\u00e0i &gt; 30 s.<\/p>\n<h2>2. Y\u1ebfu t\u1ed1 nguy c\u01a1<\/h2>\n<p>&#8211; C\u00e1c nguy c\u01a1 ph\u1ee5 thu\u1ed9c nguy\u00ean nh\u00e2n: n\u1ebfu nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb, lo\u1ea1n<br \/>\nnh\u1ecbp th\u1ea5t c\u00f3 th\u1ec3 gi\u1ea3i quy\u1ebft.<br \/>\n&#8211; C\u00e1c lo\u1ea1n nh\u1ecbp do di truy\u1ec1n v\u00e0 m\u1ed9t s\u1ed1 b\u1ec7nh tim kh\u00e1c hi\u1ec7n nay c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 nguy c\u01a1 lo\u1ea1n nh\u1ecbp d\u1ef1a v\u00e0o nhi\u1ec1u y\u1ebfu t\u1ed1 ch\u1ec9 d\u1ea5u.<br \/>\n+ Nh\u01b0 y\u1ebfu t\u1ed1 QRS ph\u00e2n \u0111o\u1ea1n \u0111\u01b0\u1ee3c cho l\u00e0 ch\u1ec9 d\u1ea5u nguy c\u01a1 VT, VF cho \u0111\u1ed9t t\u1eed \u1edf ng\u01b0\u1eddi c\u00f3 H\u1ed9i ch\u1ee9ng Brugada.<br \/>\n+ Thay \u0111\u1ed5i lu\u00e2n phi\u00ean \u0111i\u1ec7n th\u1ebf s\u00f3ng T \u0111\u01b0\u1ee3c coi l\u00e0 m\u1ed9t ch\u1ec9 d\u1ea5u nguy c\u01a1 cho lo\u1ea1n nh\u1ecbp nguy hi\u1ec3m \u1edf c\u00e1c b\u1ec7nh nh\u00e2n suy tim n\u1eb7ng v\u00e0 m\u1ed9t s\u1ed1 tr\u1ea1ng th\u00e1i kh\u00e1c.<\/p>\n<h2>3. Ch\u1ea9n \u0111o\u00e1n<\/h2>\n<p><strong>3.1 X\u00e1c \u0111\u1ecbnh s\u1ef1 \u1ed5n \u0111\u1ecbnh huy\u1ebft \u0111\u1ed9ng:<br \/>\n&#8211; D\u1ef1a v\u00e0o bi\u1ebfn \u0111\u1ed5i \u00fd th\u1ee9c, tri\u1ec7u ch\u1ee9ng suy tim, \u0111au ng\u1ef1c, gi\u1ea3m t\u01b0\u1edbi m\u00e1u chi<\/strong> (ch\u00e2n tay l\u1ea1nh) v\u00e0 \u0111\u1ed9ng h\u1ecdc huy\u1ebft \u00e1p.<br \/>\n&#8211; N\u1ebfu kh\u00f4ng \u1ed5n \u0111\u1ecbnh c\u1ea7n \u0111i\u1ec1u tr\u1ecb ngay l\u1eadp t\u1ee9c b\u1eb1ng s\u1ed1c \u0111i\u1ec7n chuy\u1ec3n nh\u1ecbp.<br \/>\n&#8211; B\u1ec7nh \u1ed5n \u0111\u1ecbnh, \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng t\u1eadp trung g\u1ed3m:<br \/>\n+ B\u1ec7nh s\u1eed.<br \/>\n+ Kh\u00e1m th\u1ef1c th\u1ec3.<br \/>\n+ C\u00e1c x\u00e9t nghi\u1ec7m.<br \/>\n+ C\u00e1c nghi\u1ec7m ph\u00e1p ch\u1ea9n \u0111o\u00e1n \u1edf c\u00e1c b\u1ec7nh nh\u00e2n l\u1ef1a ch\u1ecdn.<br \/>\n+ M\u1ee5c ti\u00eau ch\u00ednh \u0111\u00e1nh gi\u00e1 ban \u0111\u1ea7u \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n l\u00e0m s\u00e1ng t\u1ecf c\u00e1c \u0111i\u1ec1u ki\u1ec7n c\u01a1 b\u1ea3n li\u00ean quan \u0111\u1ebfn c\u00e1c bi\u1ebfn c\u1ed1 nh\u01b0: suy tim, thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 c\u01a1 tim, ph\u1ea3n \u1ee9ng thu\u1ed1c, ho\u1eb7c b\u1ea5t th\u01b0\u1eddng \u0111i\u1ec7n gi\u1ea3i.<\/p>\n<p><strong>3.2. D\u1ef1a v\u00e0o d\u1ecbch t\u1ec5<br \/>\n&#8211; Nh\u1ecbp nhanh th\u1ea5t chi\u1ebfm 80% c\u00e1c lo\u1ea1n nh\u1ecbp nhanh c\u00f3 QRS r\u1ed9ng.<\/strong><br \/>\n&#8211; Nh\u1ecbp nhanh th\u1ea5t chi\u1ebfm 90% c\u00e1c lo\u1ea1n nh\u1ecbp nhanh c\u00f3 QRS r\u1ed9ng \u1edf c\u00e1c b\u1ec7nh nh\u00e2n sau nh\u1ed3i m\u00e1u.<br \/>\n<strong>3.3. L\u00e2m s\u00e0ng<br \/>\n&#8211; B\u1ec7nh nh\u00e2n \u1ed5n \u0111\u1ecbnh khi kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng.<\/strong><br \/>\n&#8211; B\u1ec7nh nh\u00e2n kh\u00f4ng \u1ed5n \u0111\u1ecbnh khi c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng.<br \/>\n<strong>3.3.1. Ti\u1ec1n s\u1eed b\u1ec7nh tim:<\/strong> s\u1ef1 c\u00f3 m\u1eb7t c\u1ee7a b\u1ec7nh tim c\u1ea5u tr\u00fac, \u0111\u1eb7c bi\u1ec7t b\u1ec7nh m\u1ea1ch v\u00e0nh v\u00e0 MI tr\u01b0\u1edbc, g\u1ee3i \u00fd m\u1ea1nh m\u1ebd VT.<br \/>\n&#8211; Th\u1eddi gian nh\u1ecbp tim nhanh: n\u1ebfu \u0111\u00e3 t\u00e1i ph\u00e1t &gt; 3 n\u0103m nhi\u1ec1u kh\u1ea3 n\u0103ng SVT.<br \/>\nS\u1ef1 xu\u1ea5t hi\u1ec7n \u0111\u1ea7u ti\u00ean MI g\u1ee3i \u00fd m\u1ea1nh m\u1ebd VT.<br \/>\n&#8211; Thu\u1ed1c s\u1eed d\u1ee5ng (n\u1ebfu c\u00f3): nhi\u1ec1u thu\u1ed1c th\u00fac \u0111\u1ea9y lo\u1ea1n nh\u1ecbp.<br \/>\n+ QT k\u00e9o d\u00e0i do thu\u1ed1c: hay g\u1eb7p nh\u1ea5t l\u00e0 VT \u0111a h\u00ecnh, g\u1ecdi l\u00e0 xo\u1eafn \u0111\u1ec9nh (TDP).<br \/>\n+ Thu\u1ed1c ch\u1ed1ng lo\u1ea1n nh\u1ecbp nh\u00f3m I.<br \/>\n+ Digoxin: c\u00f3 th\u1ec3 g\u00e2y ra h\u1ea7u h\u1ebft c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp tim, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf n\u1ed3ng \u0111\u1ed9 tr\u00ean 2,0 ng\/ml (2,6 mmol\/L).<\/p>\n<p>+ Thu\u1ed1c l\u1ee3i ti\u1ec3u: l\u00e0 m\u1ed9t nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn c\u1ee7a h\u1ea1 kali m\u00e1u v\u00e0 magi\u00ea.<br \/>\n&#8211; S\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a m\u00e1y t\u1ea1o nh\u1ecbp tim ho\u1eb7c ICD.<strong><br \/>\n3.3.2. Tu\u1ed5i<br \/>\n&#8211; <\/strong>Tr\u00ean 35 tu\u1ed5i c\u00f3 kh\u1ea3 n\u0103ng l\u00e0 VT.<br \/>\n&#8211; VT ph\u1ea3i \u0111\u01b0\u1ee3c xem x\u00e9t \u1edf b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i, \u0111\u1eb7c bi\u1ec7t c\u00f3 ti\u1ec1n s\u1eed gia<br \/>\n\u0111\u00ecnh lo\u1ea1n nh\u1ecbp th\u1ea5t ho\u1eb7c \u0111\u1ed9t t\u1eed s\u1edbm do tim.<br \/>\n<strong>3.3.3. Tri\u1ec7u ch\u1ee9ng:<\/strong> nh\u1eefng bi\u1ec3u hi\u1ec7n nghi\u00eam tr\u1ecdng g\u1ed3m \u0111au ng\u1ef1c, ng\u1ea5t, s\u1ed1c, co gi\u1eadt v\u00e0 ng\u1eebng tim.<br \/>\nKh\u00e1m th\u1ef1c th\u1ec3:<strong><br \/>\n<\/strong>Ph\u00e1t hi\u1ec7n g\u1ee3i \u00fd b\u1ec7nh tim m\u1ea1ch g\u1ed3m:<br \/>\n+ C\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a suy tim c\u1ea5p ho\u1eb7c m\u00e3n t\u00ednh.<br \/>\n+ V\u1ebft m\u1ed5 x\u01b0\u01a1ng \u1ee9c nh\u01b0 l\u00e0 b\u1eb1ng ch\u1ee9ng ph\u1eabu thu\u1eadt tim tr\u01b0\u1edbc \u0111\u00f3.<br \/>\n+ C\u00e1c di ch\u1ee9ng c\u1ee7a b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean ho\u1eb7c \u0111\u1ed9t qu\u1ef5.<br \/>\n+ C\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a m\u00e1y t\u1ea1o nh\u1ecbp tim ho\u1eb7c ICD. C\u00f3 th\u1ec3 ph\u00e2n bi\u1ec7t m\u00e1y t\u1ea1o nh\u1ecbp v\u00e0 m\u00e1y kh\u1eed rung tim b\u1eb1ng k\u00edch th\u01b0\u1edbc, h\u00ecnh d\u1ea1ng v\u00e0 tr\u00ean XQ.<br \/>\n+ T\u1ea1o ra s\u1ef1 thay \u0111\u1ed5i ti\u1ebfng tim nghe th\u01b0\u1eddng xuy\u00ean h\u01a1n khi t\u1ea7n s\u1ed1 tim ch\u1eadm h\u01a1n. S\u00f3ng Cannon &#8220;A&#8221; khi ki\u1ec3m tra m\u1ea1ch \u0111\u1eadp \u1edf c\u1ed5.<br \/>\n<strong>3.3.4. C\u00e1c nghi\u1ec7m ph\u00e1p gi\u00fap ch\u1ea9n \u0111o\u00e1n<\/strong>: ch\u00fa \u00fd ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 x\u1eed l\u00fd c\u00e1c bi\u1ebfn ch\u1ee9ng.<br \/>\n<strong>&#8211; Xoa xoang c\u1ea3nh<br \/>\n<\/strong>C\u00f3 th\u1ec3 c\u00f3 \u0111\u00e1p \u1ee9ng sau:<br \/>\n. Ch\u1eadm xu\u1ed1ng t\u1eeb t\u1eeb v\u00e0 sau \u0111\u00f3 l\u1ea1i t\u0103ng tr\u1edf l\u1ea1i.<br \/>\n. Trong nh\u1ecbp nhanh nh\u0129 v\u00e0 cu\u1ed3ng nh\u0129, nh\u1ecbp th\u1ea5t c\u00f3 th\u1ec3 ch\u1eadm t\u1ea1m th\u1eddi.<br \/>\n. V\u1edbi SVT (AVNRT ho\u1eb7c AVRT) c\u00f3 th\u1ec3 c\u1eaft c\u01a1n b\u1eb1ng xoa xoang c\u1ea3nh.<br \/>\n. VT n\u00f3i chung l\u00e0 kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng. Hi\u1ebfm khi c\u1eaft \u0111\u01b0\u1ee3c VT.<br \/>\n<strong>Can thi\u1ec7p b\u1eb1ng thu\u1ed1c<em><br \/>\n<\/em><\/strong>Kh\u00f4ng d\u00f9ng m\u1ed9t s\u1ed1 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb SVT \u0111\u1ec3 l\u00e0m ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t SVT v\u00e0 VT do nguy hi\u1ec3m ( verapamil, adenosine, ho\u1eb7c beta blockers).<br \/>\n&#8211; C\u00e1c \u0111i\u1ec1u g\u1ee3i \u00fd cho ch\u1ea9n \u0111o\u00e1n d\u1ef1a v\u00e0o \u0111\u00e1p \u1ee9ng v\u1edbi thu\u1ed1c bao g\u1ed3m:<br \/>\n+ C\u1eaft lo\u1ea1n nh\u1ecbp b\u1eb1ng lidocaine g\u1ee3i \u00fd kh\u00f4ng ch\u1ee9ng minh c\u01a1 ch\u1ebf l\u00e0 VT. Hi\u1ebfm khi l\u00e0 SVT, \u0111\u1eb7c bi\u1ec7t AVRT, \u0111\u01b0\u1ee3c c\u1eaft v\u1edbi lidocaine.<br \/>\n+ C\u1eaft lo\u1ea1n nh\u1ecbp b\u1eb1ng digoxin, verapamil, diltiazem, ho\u1eb7c adenosine ng\u1ee5 \u00fd m\u1ea1nh m\u1ebd SVT.<br \/>\n+ C\u1eaft lo\u1ea1n nh\u1ecbp b\u1eb1ng procainamide ho\u1eb7c amiodarone kh\u00f4ng ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c l\u00e0 VT hay SVT.<\/p>\n<p><strong>T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/strong> Ph\u00e1c \u0111\u1ed3 b\u1ec7nh vi\u00ean Nh\u00e2n d\u00e2n 115<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Nh\u1ecbp nhanh th\u1ea5t l\u00e0 r\u1ed1i lo\u1ea1n nh\u1ecbp nhanh khi c\u00f3 tr\u00ean 3 ph\u1ee9c b\u1ed9 th\u1ea5t li\u00ean ti\u1ebfp, c\u00f3 t\u1ea7n s\u1ed1 t\u1eeb &gt; 100 c\/ph \u0111\u1ebfn 250 c\/ph, th\u01b0\u1eddng c\u00f3 ph\u1ee9c b\u1ed9 QRS r\u1ed9ng (\u2265120 msec) xu\u1ea5t hi\u1ec7n khi ho\u1ea1t \u0111\u1ed9ng kh\u1eed c\u1ef1c \u1edf th\u1ea5t ch\u1eadm b\u1ea5t th\u01b0\u1eddng, c\u00f3 ngu\u1ed3n g\u1ed1c ngo\u00e0i h\u1ec7 th\u1ed1ng d\u1eabn truy\u1ec1n [&hellip;]<\/p>\n","protected":false},"author":16,"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 - 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