{"id":31247,"date":"2023-05-03T21:54:00","date_gmt":"2023-05-03T14:54:00","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31247"},"modified":"2023-05-17T01:25:26","modified_gmt":"2023-05-16T18:25:26","slug":"esc-2019-ve-chan-doan-va-quan-ly-thuyen-tac-phoi-cap-phan-1","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/esc-2019-ve-chan-doan-va-quan-ly-thuyen-tac-phoi-cap-phan-1\/","title":{"rendered":"ESC 2019 v\u1ec1 ch\u1ea9n \u0111o\u00e1n v\u00e0 qu\u1ea3n l\u00fd thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p – Ph\u1ea7n 1"},"content":{"rendered":"

\u00a0\u0110\u1ec3 qu\u1ea3n l\u00fd t\u1ed1t c\u00e1c v\u1ea5n \u0111\u1ec1 tim m\u1ea1ch-chuy\u1ec3n h\u00f3a \u0111\u00f2i h\u1ecfi ph\u1ea3i \u0111\u1ecdc \u0111\u1ed3ng th\u1eddi c\u00e1c khuy\u1ebfn c\u00e1o n\u00e0y \u0111\u1ec3 ph\u1ed1i h\u1ee3p \u0111i\u1ec1u tr\u1ecb cho nh\u1eefng ng\u01b0\u1eddi c\u00f3 nhi\u1ec1u r\u1ed1i lo\u1ea1n \u0111\u1ed3ng m\u1eafc.\u00a0 Ch\u00fang t\u00f4i chuy\u1ec3n th\u1ec3\u00a0 c\u00e1c b\u00e0i to\u00e0n v\u0103n H\u01b0\u1edbng d\u1eabn c\u1ee7a ESC sang Ti\u1ebfng Vi\u1ec7t \u0111\u1ec3 qu\u00fd\u00a0 \u0111\u1ed3ng nghi\u1ec7p thu\u1eadn ti\u1ec7n h\u01a1n khi tham kh\u1ea3o, c\u1eadp nh\u1eadt trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p.<\/strong><\/p>\n

\"thuyen-tac-phoi\"
\u1ea2nh m\u00f4 t\u1ea3 thuy\u00ean t\u1eafc ph\u1ed5i<\/figcaption><\/figure>\n

1.T\u1ed5ng quan v\u1ec1 thuy\u00ean t\u1eafc ph\u1ed5i<\/strong><\/h2>\n

1.1. D\u1ecbch t\u1ec5 h\u1ecdc<\/strong><\/h3>\n

Thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch<\/a> (VTE), bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng d\u01b0\u1edbi d\u1ea1ng huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u (DVT) ho\u1eb7c thuy\u00ean t\u1eafc ph\u1ed5i (PE), l\u00e0 h\u1ed9i ch\u1ee9ng tim m\u1ea1ch c\u1ea5p t\u00ednh th\u01b0\u1eddng g\u1eb7p th\u1ee9 ba tr\u00ean to\u00e0n c\u1ea7u sau nh\u1ed3i m\u00e1u c\u01a1 tim v\u00e0 \u0111\u1ed9t qu\u1ef5.<\/p>\n

Trong c\u00e1c nghi\u00ean c\u1ee9u d\u1ecbch t\u1ec5 h\u1ecdc, t\u1ef7 su\u1ea5t ph\u00e1t sinh h\u00e0ng n\u0103m \u0111\u1ed1i v\u1edbi thuy\u00ean t\u1eafc ph\u1ed5i ( PE)\u00a0 dao \u0111\u1ed9ng t\u1eeb 39-115 m\u1ed7i 100 000 d\u00e2n; \u0111\u1ed1i v\u1edbi DVT, t\u1ef7 su\u1ea5t ph\u00e1t sinh n\u1eb1m trong kho\u1ea3ng t\u1eeb 53-162 tr\u00ean 100.000 d\u00e2n s\u1ed1. D\u1eef li\u1ec7u c\u1eaft ngang cho th\u1ea5y r\u1eb1ng t\u1ef7 l\u1ec7 m\u1edbi m\u1eafc VTE cao h\u01a1n g\u1ea7n t\u00e1m l\u1ea7n \u1edf nh\u1eefng ng\u01b0\u1eddi trong \u0111\u1ed9 tu\u1ed5i \u226580 tu\u1ed5i so v\u1edbi khi \u1edf \u0111\u1ed9 tu\u1ed5i 50. Song song \u0111\u00f3, nghi\u00ean c\u1ee9u c\u1eaft d\u1ecdc \u0111\u00e3 cho th\u1ea5y xu h\u01b0\u1edbng t\u1ef7 su\u1ea5t ph\u00e1t sinh thuy\u00ean t\u1eafc ph\u1ed5i h\u00e0ng n\u0103m gia t\u0103ng theo th\u1eddi gian. C\u00f9ng v\u1edbi c\u00e1c kho\u1ea3n chi ti\u00eau \u0111\u00e1ng k\u1ec3 li\u00ean quan \u0111\u1ebfn b\u1ec7nh vi\u1ec7n, ph\u00f2ng ng\u1eeba v\u00e0 gi\u00e1n ti\u1ebfp li\u00ean quan \u0111\u1ebfn VTE (t\u1ed5ng c\u1ed9ng \u01b0\u1edbc t\u00ednh l\u00ean t\u1edbi 8.5 t\u1ef7 euro trong Li\u00ean minh ch\u00e2u \u00c2u), nh\u1eefng d\u1eef li\u1ec7u n\u00e0y cho th\u1ea5y t\u1ea7m quan tr\u1ecdng c\u1ee7a PE v\u00e0 DVT trong qu\u00e1 tr\u00ecnh l\u00e3o h\u00f3a d\u00e2n s\u1ed1 \u1edf ch\u00e2u \u00c2u v\u00e0 c\u00e1c khu v\u1ef1c kh\u00e1c tr\u00ean th\u1ebf gi\u1edbi. H\u01a1n n\u1eefa nh\u1eefng nghi\u00ean c\u1ee9u \u0111\u00f3 g\u1ee3i \u00fd r\u1eb1ng VTE s\u1ebd ng\u00e0y c\u00e0ng t\u1ea1o g\u00e1nh n\u1eb7ng cho c\u00e1c h\u1ec7 th\u1ed1ng y t\u1ebf tr\u00ean to\u00e0n th\u1ebf gi\u1edbi trong nh\u1eefng n\u0103m s\u1eafp t\u1edbi. Thuy\u00ean t\u1eafc ph\u1ed5i\u00a0 c\u00f3 th\u1ec3 g\u00e2y ra \u2264300.000 ca t\u1eed vong m\u1ed7i n\u0103m \u1edf M\u1ef9, x\u1ebfp h\u1ea1ng cao trong s\u1ed1 c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y t\u1eed vong tim m\u1ea1ch. Trong s\u00e1u qu\u1ed1c gia ch\u00e2u \u00c2u v\u1edbi t\u1ed5ng d\u00e2n s\u1ed1 454.4 tri\u1ec7u ng\u01b0\u1eddi, h\u01a1n 370.000 ca t\u1eed vong li\u00ean quan \u0111\u1ebfn VTE trong n\u0103m 2004, theo \u01b0\u1edbc t\u00ednh tr\u00ean c\u01a1 s\u1edf c\u1ee7a m\u00f4 h\u00ecnh d\u1ecbch t\u1ec5 h\u1ecdc. Trong s\u1ed1 nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y, 34% t\u1eed vong \u0111\u1ed9t ng\u1ed9t ho\u1eb7c trong v\u00e0i gi\u1edd sau khi x\u1ea3y ra bi\u1ebfn c\u1ed1 c\u1ea5p t\u00ednh, tr\u01b0\u1edbc khi \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ho\u1eb7c tr\u01b0\u1edbc khi vi\u1ec7c \u0111i\u1ec1u tr\u1ecb c\u00f3 t\u00e1c d\u1ee5ng. C\u00f2n nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00e1c, t\u1eed vong do PE c\u1ea5p t\u00ednh \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n sau khi ch\u1ebft l\u00e0 59% v\u00e0 ch\u1ec9 7% b\u1ec7nh nh\u00e2n trong s\u1ed1 \u0111\u00f3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c thuy\u00ean t\u1eafc ph\u1ed5i tr\u01b0\u1edbc t\u1eed vong. Ph\u00e2n t\u00edch xu h\u01b0\u1edbng theo th\u1eddi gian \u1edf d\u00e2n s\u1ed1 ch\u00e2u \u00c2u, ch\u00e2u \u00c1 v\u00e0 B\u1eafc M\u1ef9 cho th\u1ea5y t\u1ef7 su\u1ea5t t\u1eed vong c\u1ee7a thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p t\u00ednh c\u00f3 th\u1ec3 gi\u1ea3m. Vi\u1ec7c c\u00f3 nhi\u1ec1u ph\u01b0\u01a1ng th\u1ee9c \u0111i\u1ec1u tr\u1ecb v\u00e0 can thi\u1ec7p hi\u1ec7u qu\u1ea3 h\u01a1n v\u00e0 c\u00f3 th\u1ec3 l\u00e0 do tu\u00e2n th\u1ee7 t\u1ed1t h\u01a1n c\u00e1c h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb, c\u00f3 th\u1ec3 \u0111\u00e3 t\u1ea1o ra m\u1ed9t t\u00e1c \u0111\u1ed9ng t\u00edch c\u1ef1c \u0111\u00e1ng k\u1ec3 \u0111\u1ebfn ti\u00ean l\u01b0\u1ee3ng c\u1ee7a PE trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y.\u00a0<\/span><\/p>\n

Tuy nhi\u00ean, c\u0169ng c\u00f3 m\u1ed9t xu h\u01b0\u1edbng ch\u1ea9n \u0111o\u00e1n qu\u00e1 m\u1ee9c (h\u1ea1 ph\u00e2n th\u00f9y ho\u1eb7c th\u1eadm ch\u00ed kh\u00f4ng t\u1ed3n t\u1ea1i) PE trong k\u1ef7 nguy\u00ean hi\u1ec7n \u0111\u1ea1i, v\u00e0 \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn s\u1ef1 s\u1ee5t gi\u1ea3m gi\u1ea3 t\u1ea1o t\u1ef7 su\u1ea5t t\u1eed vong b\u1eb1ng c\u00e1ch th\u1ed5i ph\u1ed3ng m\u1eabu s\u1ed1, t\u1ee9c l\u00e0 t\u1ed5ng s\u1ed1 tr\u01b0\u1eddng h\u1ee3p thuy\u00ean t\u1eafc ph\u1ed5i. H\u00ecnh 1 t\u00f3m t\u1eaft d\u1eef li\u1ec7u hi\u1ec7n c\u00f3 v\u1ec1 xu h\u01b0\u1edbng PE to\u00e0n c\u1ea7u, l\u00e0m n\u1ed5i b\u1eadt t\u1ef7 su\u1ea5t ph\u00e1t sinh t\u0103ng song song v\u1edbi gi\u1ea3m t\u1ef7 su\u1ea5t t\u1eed vong trong kho\u1ea3ng th\u1eddi gian 15 n\u0103m. \u1ede tr\u1ebb em, c\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e3 b\u00e1o c\u00e1o t\u1ef7 su\u1ea5t ph\u00e1t sinh VTE h\u00e0ng n\u0103m l\u00e0 t\u1eeb 53-57 tr\u00ean 100 000 trong s\u1ed1 c\u00e1c b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n, v\u00e0 t\u1eeb 1.4-4.9 tr\u00ean 100 000 trong c\u1ed9ng \u0111\u1ed3ng n\u00f3i chung.<\/span><\/p>\n

\"Xu-huong-ty-le-moi-mac-hang-nam<\/p>\n

1.2. C\u00e1c y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y thuy\u00ean t\u1eafc ph\u1ed5i<\/strong><\/h3>\n

C\u00f3 m\u1ed9t t\u1eadp h\u1ee3p phong ph\u00fa v\u1ec1 y\u1ebfu t\u1ed1 m\u00f4i tr\u01b0\u1eddng v\u00e0 y\u1ebfu t\u1ed1 di truy\u1ec1n th\u00fac \u0111\u1ea9y VTE; danh s\u00e1ch c\u00e1c y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y (nguy c\u01a1) \u0111\u01b0\u1ee3c hi\u1ec3n th\u1ecb trong B\u1ea3ng 3. VTE \u0111\u01b0\u1ee3c coi l\u00e0 h\u1ec7 qu\u1ea3 c\u1ee7a s\u1ef1 t\u01b0\u01a1ng t\u00e1c gi\u1eefa c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 li\u00ean quan \u0111\u1ebfn b\u1ec7nh nh\u00e2n – th\u01b0\u1eddng l\u00e0 h\u1eb1ng \u0111\u1ecbnh v\u00e0 li\u00ean quan \u0111\u1ebfn m\u00f4i tr\u01b0\u1eddng – th\u01b0\u1eddng l\u00e0 t\u1ea1m th\u1eddi. V\u00ec ph\u00e2n lo\u1ea1i c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 t\u1ea1m th\u1eddi v\u00e0 h\u1eb1ng \u0111\u1ecbnh \u0111\u1ed1i v\u1edbi VTE l\u00e0 quan tr\u1ecdng trong vi\u1ec7c \u0111\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng t\u00e1i ph\u00e1t v\u00e0 d\u1ef1a v\u00e0o \u0111\u00f3 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh v\u1ec1 ch\u1ed1ng \u0111\u00f4ng m\u1ea1n t\u00ednh, n\u00ean s\u1ebd \u0111\u01b0\u1ee3c th\u1ea3o lu\u1eadn chi ti\u1ebft h\u01a1n trong ph\u1ea7n 8 c\u1ee7a ph\u00e1c \u0111\u1ed3 n\u00e0y. Ch\u1ea5n th\u01b0\u01a1ng l\u1edbn, ph\u1eabu thu\u1eadt, g\u00e3y x\u01b0\u01a1ng chi d\u01b0\u1edbi v\u00e0 thay kh\u1edbp, v\u00e0 ch\u1ea5n th\u01b0\u01a1ng t\u1ee7y s\u1ed1ng l\u00e0 nh\u1eefng y\u1ebfu t\u1ed1 k\u00edch g\u1ee3i m\u1ea1nh m\u1ebd cho VTE. Ung th\u01b0 l\u00e0 y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y ph\u1ed5 bi\u1ebfn c\u1ee7a VTE. Nguy c\u01a1 m\u1eafc VTE thay \u0111\u1ed5i theo c\u00e1c lo\u1ea1i ung th\u01b0 kh\u00e1c nhau; ung th\u01b0 t\u1ee5y, b\u1ec7nh m\u00e1u \u00e1c t\u00ednh, ung th\u01b0 ph\u1ed5i, ung th\u01b0 d\u1ea1 d\u00e0y v\u00e0 ung th\u01b0 n\u00e3o c\u00f3 nguy c\u01a1 cao nh\u1ea5t. H\u01a1n n\u1eefa, ung th\u01b0 l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 m\u1ea1nh c\u1ee7a t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n sau m\u1eafc VTE. <\/span><\/p>\n

Thu\u1ed1c tr\u00e1nh thai \u0111\u01b0\u1eddng u\u1ed1ng c\u00f3 ch\u1ee9a estrogen c\u00f3 li\u00ean quan v\u1edbi vi\u1ec7c t\u0103ng nguy c\u01a1 VTE v\u00e0 vi\u1ec7c s\u1eed d\u1ee5ng bi\u1ec7n ph\u00e1p tr\u00e1nh thai l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 VTE th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf ph\u1ee5 n\u1eef trong \u0111\u1ed9 tu\u1ed5i sinh s\u1ea3n. C\u1ee5 th\u1ec3 h\u01a1n, thu\u1ed1c tr\u00e1nh thai k\u1ebft h\u1ee3p (ch\u1ee9a c\u1ea3 estrogen v\u00e0 progesterone) c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c t\u0103ng kho\u1ea3ng hai \u0111\u1ebfn s\u00e1u l\u1ea7n r\u1ee7i ro VTE so v\u1edbi m\u1ee9c n\u1ec1n. N\u00f3i chung, nguy c\u01a1 tuy\u1ec7t \u0111\u1ed1i VTE v\u1eabn c\u00f2n th\u1ea5p trong h\u01a1n 100 tri\u1ec7u ng\u01b0\u1eddi s\u1eed d\u1ee5ng thu\u1ed1c tr\u00e1nh thai \u0111\u01b0\u1eddng u\u1ed1ng tr\u00ean to\u00e0n th\u1ebf gi\u1edbi, tuy nhi\u00ean, y\u1ebfu t\u1ed1 nguy c\u01a1 VTE kh\u00e1c, bao g\u1ed3m t\u0103ng t\u1ea1o huy\u1ebft kh\u1ed1i n\u1eb7ng di truy\u1ec1n (severe inherited thrombophilia), s\u1ebd l\u00e0m t\u0103ng nguy c\u01a1 n\u00e0y. Thu\u1ed1c tr\u00e1nh thai k\u1ebft h\u1ee3p th\u1ebf h\u1ec7 th\u1ee9 ba, ch\u1ee9a progestogens nh\u01b0 desogestrel ho\u1eb7c gestodene, c\u00f3 li\u00ean quan \u0111\u1ebfn nguy c\u01a1 VTE cao h\u01a1n c\u00e1c bi\u1ec7n ph\u00e1p tr\u00e1nh thai \u0111\u01b0\u1eddng u\u1ed1ng k\u1ebft h\u1ee3p th\u1ebf h\u1ec7 th\u1ee9 hai, c\u00f3 ch\u1ee9a progestogens nh\u01b0 levonorgestrel ho\u1eb7c norgestrel. M\u1eb7t kh\u00e1c, d\u1ee5ng c\u1ee5 trong l\u00f2ng t\u1eed cung gi\u1ea3i ph\u00f3ng hormone v\u00e0 m\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c ch\u1ec9 ch\u1ee9a progesterone (\u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u1edbi li\u1ec1u tr\u00e1nh thai) kh\u00f4ng li\u00ean quan \u0111\u1ebfn s\u1ef1 gia t\u0103ng \u0111\u00e1ng k\u1ec3 nguy c\u01a1 VTE; do \u0111\u00f3, v\u00e0 sau khi t\u01b0 v\u1ea5n v\u00e0 \u0111\u00e1nh gi\u00e1 r\u1ee7i ro \u0111\u1ea7y \u0111\u1ee7, nh\u1eefng l\u1ef1a ch\u1ecdn n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t cho ph\u1ee5 n\u1eef c\u00f3 ti\u1ec1n s\u1eed b\u1ea3n th\u00e2n ho\u1eb7c ti\u1ec1n s\u1eed gia \u0111\u00ecnh t\u1eebng c\u00f3 VTE. <\/span><\/p>\n

\u1ede ph\u1ee5 n\u1eef sau m\u00e3n kinh \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi hormon thay th\u1ebf, nguy c\u01a1 c\u1ee7a VTE r\u1ea5t kh\u00e1c nhau t\u00f9y thu\u1ed9c v\u00e0o h\u1ee3p ch\u1ea5t s\u1eed d\u1ee5ng. Nhi\u1ec5m tr\u00f9ng l\u00e0 m\u1ed9t k\u00edch g\u1ee3i VTE th\u01b0\u1eddng g\u1eb7p. Truy\u1ec1n m\u00e1u v\u00e0 c\u00e1c thu\u1ed1c k\u00edch th\u00edch t\u1ea1o h\u1ed3ng c\u1ea7u c\u0169ng c\u00f3 li\u00ean quan v\u1edbi t\u0103ng nguy c\u01a1 VTE.<\/span><\/p>\n

\u1ede tr\u1ebb em, thuy\u00ean t\u1eafc ph\u1ed5i th\u01b0\u1eddng c\u00f3 li\u00ean quan \u0111\u1ebfn DVT v\u00e0 hi\u1ebfm khi kh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 k\u00edch g\u1ee3i. B\u1ec7nh l\u00fd m\u1ea1n t\u00ednh nghi\u00eam tr\u1ecdng v\u00e0 \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch trung t\u00e2m \u0111\u01b0\u1ee3c coi l\u00e0 t\u00e1c nh\u00e2n k\u00edch g\u1ee3i g\u00e2y ra PE.<\/span><\/p>\n

\"yeu-to-thuc-day-thuyen-tac-huyet-khoi-tinh-mach\"<\/p>\n

VTE c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem l\u00e0 m\u1ed9t ph\u1ea7n c\u1ee7a chu\u1ed7i c\u00e1c b\u1ec7nh l\u00fd tim m\u1ea1ch v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 ph\u1ed5 bi\u1ebfn nh\u01b0 h\u00fat thu\u1ed1c l\u00e1, b\u00e9o ph\u00ec, t\u0103ng cholesterol m\u00e1u, t\u0103ng huy\u1ebft \u00e1p v\u00e0 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng \u2013 c\u0169ng gi\u1ed1ng trong b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch, \u0111\u1eb7c bi\u1ec7t l\u00e0 x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch. Tuy nhi\u00ean, nh\u1eefng y\u1ebfu t\u1ed1 n\u00e0y c\u00f3 th\u1ec3 l\u00e0 m\u1ed1i li\u00ean quan gi\u00e1n ti\u1ebfp \u00edt nh\u1ea5t l\u00e0 m\u1ed9t ph\u1ea7n qua trung gian bi\u1ebfn ch\u1ee9ng c\u1ee7a b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch v\u00e0nh nh\u01b0 trong tr\u01b0\u1eddng h\u1ee3p h\u00fat thu\u1ed1c l\u00e1 v\u00e0 ung th\u01b0. Nh\u1ed3i m\u00e1u c\u01a1 tim v\u00e0 suy tim l\u00e0m t\u0103ng nguy c\u01a1 thuy\u00ean t\u1eafc ph\u1ed5i. Ng\u01b0\u1ee3c l\u1ea1i, b\u1ec7nh nh\u00e2n m\u1eafc VTE l\u1ea1i t\u0103ng nguy c\u01a1 nh\u1ed3i m\u00e1u c\u01a1 tim v\u00e0 \u0111\u1ed9t qu\u1ef5, ho\u1eb7c thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean sau \u0111\u00f3.<\/span><\/p>\n

1.3. Sinh l\u00fd b\u1ec7nh v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 quy\u1ebft \u0111\u1ecbnh k\u1ebft c\u1ee5c thuy\u00ean t\u1eafc ph\u1ed5i<\/strong><\/h3>\n

Thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p t\u00ednh can thi\u1ec7p v\u00e0o c\u1ea3 qu\u00e1 tr\u00ecnh tu\u1ea7n ho\u00e0n v\u00e0 trao \u0111\u1ed5i kh\u00ed. Th\u1ea5t ph\u1ea3i (RV) suy do qu\u00e1 t\u1ea3i \u00e1p l\u1ef1c c\u1ea5p t\u00ednh \u0111\u01b0\u1ee3c coi l\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh g\u00e2y t\u1eed vong \u1edf PE n\u1eb7ng. \u00c1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i (PAP) t\u0103ng n\u1ebfu >30-50% t\u1ed5ng m\u1eb7t c\u1eaft ngang khu v\u1ef1c c\u1ee7a gi\u01b0\u1eddng \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i b\u1ecb t\u1eafc ngh\u1ebdn do huy\u1ebft kh\u1ed1i. Co m\u1ea1ch do PE, qua gi\u1ea3i ph\u00f3ng ch\u1ea5t trung gian l\u00e0 thromboxane A2 v\u00e0 serotonin, g\u00f3p ph\u1ea7n v\u00e0o s\u1ef1 gia t\u0103ng ban \u0111\u1ea7u trong kh\u00e1ng l\u1ef1c m\u1ea1ch m\u00e1u ph\u1ed5i (PVR) sau PE. T\u1eafc ngh\u1ebdn gi\u1ea3i ph\u1eabu v\u00e0 co m\u1ea1ch do thi\u1ebfu oxy \u1edf v\u00f9ng ph\u1ed5i b\u1ecb \u1ea3nh h\u01b0\u1edfng d\u1eabn \u0111\u1ebfn t\u0103ng PVR v\u00e0 gi\u1ea3m t\u1ef7 l\u1ec7 \u0111\u1ed9ng m\u1ea1ch ho\u1ea1t \u0111\u1ed9ng. S\u1ef1 gia t\u0103ng \u0111\u1ed9t ng\u1ed9t PVR d\u1eabn \u0111\u1ebfn gi\u00e3n th\u1ea5t ph\u1ea3i, l\u00e0m thay \u0111\u1ed5i t\u00ednh ch\u1ea5t co b\u00f3p c\u1ee7a c\u01a1 tim th\u1ea5t ph\u1ea3i th\u00f4ng qua c\u01a1 ch\u1ebf Frank \u2013 Starling. <\/span><\/p>\n

S\u1ef1 gia t\u0103ng \u00e1p su\u1ea5t v\u00e0 th\u1ec3 t\u00edch RV d\u1eabn \u0111\u1ebfn s\u1ef1 t\u0103ng s\u1ee9c c\u0103ng c\u1ee7a th\u00e0nh th\u1ea5t v\u00e0 g\u00e2y gi\u00e3n c\u01a1 th\u1ea5t. Th\u1eddi gian co c\u1ee7a RV b\u1ecb k\u00e9o d\u00e0i, trong khi k\u00edch ho\u1ea1t th\u1ec3 d\u1ecbch th\u1ea7n kinh d\u1eabn \u0111\u1ebfn k\u00edch th\u00edch co b\u00f3p (inotrope) v\u00e0 nh\u1ecbp tim (chronotropic). C\u00f9ng v\u1edbi co m\u1ea1ch h\u1ec7 th\u1ed1ng, c\u00e1c c\u01a1 ch\u1ebf b\u00f9 tr\u1eeb n\u00e0y l\u00e0m t\u0103ng PAP, c\u1ea3i thi\u1ec7n d\u00f2ng ch\u1ea3y qua c\u00e1c gi\u01b0\u1eddng m\u1ea1ch m\u00e1u ph\u1ed5i b\u1ecb t\u1eafc ngh\u1ebdn v\u00e0 do \u0111\u00f3 t\u1ea1m th\u1eddi \u1ed5n \u0111\u1ecbnh huy\u1ebft \u00e1p (HA) h\u1ec7 th\u1ed1ng. Tuy nhi\u00ean, ph\u1ea1m vi th\u00edch \u1ee9ng ngay l\u1eadp t\u1ee9c c\u00f3 gi\u1edbi h\u1ea1n v\u00ec thay \u0111\u1ed5i \u0111\u1ed9t ng\u1ed9t, kh\u00f4ng c\u00f3 th\u00edch nghi tr\u01b0\u1edbc, th\u00e0nh RV m\u1ecfng kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng \u0111i\u1ec1u ch\u1ec9nh PAP trung b\u00ecnh >40 mmHg.<\/span><\/p>\n

K\u00e9o d\u00e0i th\u1eddi gian co RV v\u00e0o k\u1ef3 \u0111\u1ea7u t\u00e2m tr\u01b0\u01a1ng b\u00ean t\u00e2m th\u1ea5t tr\u00e1i (LV) d\u1eabn \u0111\u1ebfn v\u00e1ch li\u00ean th\u1ea5t b\u1ecb \u0111\u1ea9y l\u1ec7ch sang tr\u00e1i. T\u00e2m th\u1ea5t ho\u1ea1t \u0111\u1ed9ng kh\u00f4ng \u0111\u1ed3ng b\u1ed9 c\u00f3 th\u1ec3 tr\u1ea7m tr\u1ecdng h\u01a1n b\u1edfi s\u1ef1 n\u1eb7ng l\u00ean c\u1ee7a block nh\u00e1nh ph\u1ea3i. Do \u0111\u00f3, vi\u1ec7c \u0111\u1ed5 \u0111\u1ea7y LV b\u1ecb c\u1ea3n tr\u1edf trong \u0111\u1ea7u k\u1ef3 t\u00e2m tr\u01b0\u01a1ng v\u00e0 \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn gi\u1ea3m cung l\u01b0\u1ee3ng tim (CO) v\u00e0 g\u00f3p ph\u1ea7n t\u1ee5t huy\u1ebft \u00e1p h\u1ec7 th\u1ed1ng v\u00e0 l\u00e0m r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng. <\/span><\/p>\n

Nh\u01b0 \u0111\u00e3 m\u00f4 t\u1ea3 \u1edf tr\u00ean, k\u00edch ho\u1ea1t qu\u00e1 m\u1ee9c th\u1ea7n kinh th\u1ec3 d\u1ecbch trong PE c\u00f3 th\u1ec3 l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a c\u1ea3 c\u0103ng th\u00e0nh RV b\u1ea5t th\u01b0\u1eddng v\u00e0 s\u1ed1c tu\u1ea7n ho\u00e0n. Vi\u1ec7c t\u00ecm th\u1ea5y s\u1ef1 x\u00e2m nh\u1eadp l\u1edbn c\u1ee7a c\u00e1c t\u1ebf b\u00e0o vi\u00eam trong c\u01a1 tim RV c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u00e3 ch\u1ebft trong v\u00f2ng 48 gi\u1edd do PE c\u1ea5p t\u00ednh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch b\u1edfi n\u1ed3ng \u0111\u1ed9 epinephrine t\u0103ng cao \u0111\u01b0\u1ee3c gi\u1ea3i ph\u00f3ng khi \u2018vi\u00eam c\u01a1 tim\u2019 do PE. Ph\u1ea3n \u1ee9ng vi\u00eam n\u00e0y c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng th\u1ee9 ph\u00e1t \u0111\u00f4i l\u00fac x\u1ea3y ra 24-48h sau PE c\u1ea5p t\u00ednh, m\u1eb7c d\u00f9 PE t\u00e1i ph\u00e1t s\u1edbm c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t s\u1ef1 gi\u1ea3i th\u00edch kh\u00e1c trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y. <\/span><\/p>\n

Cu\u1ed1i c\u00f9ng, m\u1ed1i li\u00ean quan gi\u1eefa n\u1ed3ng \u0111\u1ed9 l\u01b0u h\u00e0nh cao trong m\u00e1u c\u1ee7a c\u00e1c d\u1ea5u \u1ea5n sinh <\/span>h\u1ecdc trong t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim v\u00e0 k\u1ebft c\u1ee5c s\u1edbm b\u1ea5t l\u1ee3i cho th\u1ea5y thi\u1ebfu m\u00e1u RV r\u1ea5t c\u00f3 \u00fd ngh\u0129a v\u1ec1 sinh l\u00fd b\u1ec7nh trong PE giai \u0111o\u1ea1n c\u1ea5p t\u00ednh. M\u1eb7c d\u00f9 nh\u1ed3i m\u00e1u RV sau PE kh\u00f4ng ph\u1ed5 bi\u1ebfn, nh\u01b0ng r\u1ea5t d\u1ec5 c\u00f3 kh\u1ea3 n\u0103ng m\u1ea5t c\u00e2n b\u1eb1ng gi\u1eefa cung v\u00e0 c\u1ea7u oxy d\u1eabn \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng c\u00e1c t\u1ebf b\u00e0o c\u01a1 tim, v\u00e0 l\u00e0m gi\u1ea3m th\u00eam s\u1ee9c co b\u00f3p. H\u1ea1 huy\u1ebft \u00e1p h\u1ec7 th\u1ed1ng l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 quan tr\u1ecdng trong qu\u00e1 tr\u00ecnh n\u00e0y, d\u1eabn \u0111\u1ebfn gi\u1ea3m \u00e1p l\u1ef1c \u0111\u1ea9y v\u00e0nh cho RV \u0111ang b\u1ecb qu\u00e1 t\u1ea3i.<\/span><\/p>\n

T\u00e1c d\u1ee5ng b\u1ea5t l\u1ee3i c\u1ee7a thuy\u00ean t\u1eafc\u00a0 c\u1ea5p t\u00ednh \u0111\u1ed1i v\u1edbi c\u01a1 tim RV v\u00e0 \u0111\u1ed1i v\u1edbi tu\u1ea7n ho\u00e0n \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft trong H\u00ecnh 2.<\/span><\/p>\n

\"tac-dung-bat-loi-cua-PE-cap-tinh-voi-co-tim-RV<\/p>\n

 <\/p>\n

Suy h\u00f4 h\u1ea5p<\/a> trong PE ch\u1ee7 y\u1ebfu l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng. CO th\u1ea5p d\u1eabn \u0111\u1ebfn s\u1ef1 b\u1ea5t b\u00e3o h\u00f2a m\u00e1u t\u0129nh m\u1ea1ch tr\u1ed9n. C\u00e1c khu v\u1ef1c gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng trong c\u00e1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i b\u1ecb t\u1eafc ngh\u1ebdn, k\u1ebft h\u1ee3p v\u1edbi c\u00e1c v\u00f9ng t\u0103ng l\u01b0u l\u01b0\u1ee3ng trong gi\u01b0\u1eddng mao m\u1ea1ch \u0111\u01b0\u1ee3c t\u01b0\u1edbi m\u00e1u b\u1edfi c\u00e1c m\u1ea1ch ph\u1ed5i kh\u00f4ng b\u1ecb t\u1eafc ngh\u1ebdn, d\u1eabn \u0111\u1ebfn b\u1ea5t t\u01b0\u01a1ng h\u1ee3p th\u00f4ng kh\u00ed\/t\u01b0\u1edbi m\u00e1u, g\u00f3p ph\u1ea7n g\u00e2y thi\u1ebfu oxy m\u00e1u. <\/span><\/p>\n

Trong kho\u1ea3ng m\u1ed9t ph\u1ea7n ba s\u1ed1 b\u1ec7nh nh\u00e2n, c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n shunt ph\u1ea3i-tr\u00e1i qua l\u1ed7 th\u00f4ng b\u1ea7u d\u1ee5c b\u1eb1ng si\u00eau \u00e2m tim; shunt n\u00e0y \u0111\u01b0\u1ee3c t\u1ea1o ra b\u1edfi s\u1ef1 ch\u00eanh \u00e1p \u0111\u1ea3o chi\u1ec1u gi\u1eefa t\u00e2m nh\u0129 ph\u1ea3i (RA) v\u00e0 t\u00e2m nh\u0129 tr\u00e1i, v\u00e0 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn thi\u1ebfu oxy m\u00e1u n\u1eb7ng, v\u00e0 m\u1ed9t nguy c\u01a1 thuy\u00ean t\u1eafc n\u00e3o ngh\u1ecbch th\u01b0\u1eddng v\u00e0 \u0111\u1ed9t qu\u1ef5. Cu\u1ed1i c\u00f9ng, ngay c\u1ea3 khi ch\u00fang kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn huy\u1ebft \u0111\u1ed9ng, thuy\u00ean t\u1eafc nh\u1ecf nh\u00e1nh xa c\u00f3 th\u1ec3 t\u1ea1o ra c\u00e1c v\u00f9ng xu\u1ea5t huy\u1ebft ph\u1ebf nang d\u1eabn \u0111\u1ebfn ho ra m\u00e1u, vi\u00eam m\u00e0ng ph\u1ed5i, v\u00e0 tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, nh\u01b0ng th\u01b0\u1eddng nh\u1eb9. Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng n\u00e0y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 \u2018nh\u1ed3i m\u00e1u ph\u1ed5i\u2019. H\u1eadu qu\u1ea3 c\u1ee7a n\u00f3 \u0111\u1ed1i v\u1edbi trao \u0111\u1ed5i kh\u00ed th\u01b0\u1eddng nh\u1eb9, ngo\u1ea1i tr\u1eeb \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 c\u00f3 b\u1ec7nh tim m\u1ea1ch t\u1eeb tr\u01b0\u1edbc. <\/span><\/p>\n

Theo quan \u0111i\u1ec3m sinh l\u00fd b\u1ec7nh \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp \u1edf tr\u00ean, suy RV c\u1ea5p t\u00ednh, \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng ti\u1ebfn tri\u1ec3n nhanh ch\u00f3ng v\u1edbi sung huy\u1ebft h\u1ec7 th\u1ed1ng do gi\u1ea3m l\u00e0m \u0111\u1ea7y v\u00e0\/ho\u1eb7c gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng t\u1ed1ng ra c\u1ee7a RV, l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 quan tr\u1ecdng quy\u1ebft \u0111\u1ecbnh \u0111\u1ed9 n\u1eb7ng l\u00e2m s\u00e0ng v\u00e0 k\u1ebft c\u1ee5c trong thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p t\u00ednh. <\/span><\/p>\n

Theo \u0111\u00f3, c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a suy RV v\u00e0 m\u1ea5t \u1ed5n \u0111\u1ecbnh huy\u1ebft \u0111\u1ed9ng cho th\u1ea5y nguy c\u01a1 cao t\u1eed vong s\u1edbm (l\u00fac n\u1eb1m vi\u1ec7n ho\u1eb7c trong 30 ng\u00e0y). PE nguy c\u01a1 cao \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a b\u1edfi r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng v\u00e0 c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n trong B\u1ea3ng 4<\/span><\/p>\n

\"huyet-dong-khong-on-dinh\"<\/p>\n

L\u00e0 m\u1ed9t t\u00ecnh hu\u1ed1ng \u0111e d\u1ecda t\u00ednh m\u1ea1ng ngay l\u1eadp t\u1ee9c, thuy\u00ean t\u1eafc ph\u1ed5i\u00a0 nguy c\u01a1 cao \u0111\u00f2i h\u1ecfi ch\u1ea9n \u0111o\u00e1n (khi nghi ng\u1edd) v\u00e0 chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb c\u1ea5p c\u1ee9u (khi x\u00e1c nh\u1eadn ho\u1eb7c n\u1ebfu m\u1ee9c \u0111\u1ed9 nghi ng\u1edd l\u00e0 \u0111\u1ee7 cao), nh\u01b0 \u0111\u01b0\u1ee3c n\u00eau trong ph\u1ea7n 7. Tuy nhi\u00ean, kh\u00f4ng c\u00f3 r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng c\u0169ng kh\u00f4ng lo\u1ea1i tr\u1eeb \u0111\u01b0\u1ee3c r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng RV giai \u0111o\u1ea1n \u0111\u1ea7u (v\u00e0 c\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n), v\u00e0 do \u0111\u00f3, t\u0103ng nguy c\u01a1 s\u1edbm li\u00ean quan \u0111\u1ebfn PE. Trong d\u00e2n l\u1edbn n\u00e0y, \u0111\u00e1nh gi\u00e1 th\u00eam (\u0111\u01b0\u1ee3c n\u00eau trong ph\u1ea7n 5 v\u00e0 7) l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 nguy c\u01a1 v\u00e0 \u0111i\u1ec1u ch\u1ec9nh c\u00e1c quy\u1ebft \u0111\u1ecbnh qu\u1ea3n l\u00fd ph\u00f9 h\u1ee3p.<\/span><\/p>\n

T\u00e0i li\u1ec7u tham kh\u1ea3o: 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS) – PubMed (nih.gov)<\/a><\/p>\n

Xem th\u00eam:<\/p>\n

Thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng (vinmecdr.com)<\/a><\/p>\n

Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb thuy\u00ean t\u1eafc ph\u1ed5i (vinmecdr.com)<\/a><\/p>\n

Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi thuy\u00ean t\u1eafc m\u1ea1ch ph\u1ed5i | Vinmec<\/a><\/p>\n

C\u00e1c d\u1ea5u hi\u1ec7u s\u1edbm c\u1ee7a thuy\u00ean t\u1eafc m\u1ea1ch ph\u1ed5i | Vinmec<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

\u00a0\u0110\u1ec3 qu\u1ea3n l\u00fd t\u1ed1t c\u00e1c v\u1ea5n \u0111\u1ec1 tim m\u1ea1ch-chuy\u1ec3n h\u00f3a \u0111\u00f2i h\u1ecfi ph\u1ea3i \u0111\u1ecdc \u0111\u1ed3ng th\u1eddi c\u00e1c khuy\u1ebfn c\u00e1o n\u00e0y \u0111\u1ec3 ph\u1ed1i h\u1ee3p \u0111i\u1ec1u tr\u1ecb cho nh\u1eefng ng\u01b0\u1eddi c\u00f3 nhi\u1ec1u r\u1ed1i lo\u1ea1n \u0111\u1ed3ng m\u1eafc.\u00a0 Ch\u00fang t\u00f4i chuy\u1ec3n th\u1ec3\u00a0 c\u00e1c b\u00e0i to\u00e0n v\u0103n H\u01b0\u1edbng d\u1eabn c\u1ee7a ESC sang Ti\u1ebfng Vi\u1ec7t \u0111\u1ec3 qu\u00fd\u00a0 \u0111\u1ed3ng nghi\u1ec7p thu\u1eadn ti\u1ec7n […]<\/p>\n","protected":false},"author":17,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[20,33],"tags":[],"yoast_head":"\nESC 2019 v\u1ec1 ch\u1ea9n \u0111o\u00e1n v\u00e0 qu\u1ea3n l\u00fd thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p - Ph\u1ea7n 1<\/title>\n<meta name=\"description\" content=\"\u0111\u1ec3 qu\u00fd\u00a0 \u0111\u1ed3ng nghi\u1ec7p thu\u1eadn ti\u1ec7n h\u01a1n khi tham kh\u1ea3o, c\u1eadp nh\u1eadt trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ESC 2019 v\u1ec1 ch\u1ea9n \u0111o\u00e1n v\u00e0 qu\u1ea3n l\u00fd thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p - Ph\u1ea7n 1\" \/>\n<meta property=\"og:description\" content=\"\u0111\u1ec3 qu\u00fd\u00a0 \u0111\u1ed3ng nghi\u1ec7p thu\u1eadn ti\u1ec7n h\u01a1n khi tham kh\u1ea3o, c\u1eadp nh\u1eadt trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/esc-2019-ve-chan-doan-va-quan-ly-thuyen-tac-phoi-cap-phan-1\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-05-03T14:54:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-05-16T18:25:26+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/download.jpg\" \/>\n<meta name=\"author\" content=\"An Huynh Phan Ngoc\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"An Huynh Phan Ngoc\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"13 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/esc-2019-ve-chan-doan-va-quan-ly-thuyen-tac-phoi-cap-phan-1\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/esc-2019-ve-chan-doan-va-quan-ly-thuyen-tac-phoi-cap-phan-1\/\",\"name\":\"ESC 2019 v\u1ec1 ch\u1ea9n \u0111o\u00e1n v\u00e0 qu\u1ea3n l\u00fd thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p - Ph\u1ea7n 1\",\"isPartOf\":{\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-05-03T14:54:00+00:00\",\"dateModified\":\"2023-05-16T18:25:26+00:00\",\"author\":{\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/106da77d14bd9697d17d477cee4fe3b8\"},\"description\":\"\u0111\u1ec3 qu\u00fd\u00a0 \u0111\u1ed3ng nghi\u1ec7p thu\u1eadn ti\u1ec7n h\u01a1n khi tham kh\u1ea3o, c\u1eadp nh\u1eadt trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p.\",\"breadcrumb\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/esc-2019-ve-chan-doan-va-quan-ly-thuyen-tac-phoi-cap-phan-1\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/esc-2019-ve-chan-doan-va-quan-ly-thuyen-tac-phoi-cap-phan-1\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/esc-2019-ve-chan-doan-va-quan-ly-thuyen-tac-phoi-cap-phan-1\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/noithathoaphat.in\/ctv\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"ESC 2019 v\u1ec1 ch\u1ea9n \u0111o\u00e1n v\u00e0 qu\u1ea3n l\u00fd thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p – Ph\u1ea7n 1\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#website\",\"url\":\"https:\/\/noithathoaphat.in\/ctv\/\",\"name\":\"Vinmec\",\"description\":\"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/106da77d14bd9697d17d477cee4fe3b8\",\"name\":\"An Huynh Phan Ngoc\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/\",\"url\":\"http:\/\/1.gravatar.com\/avatar\/17bc5ae83cce85dafb710d1c71eb7825?s=96&d=mm&r=g\",\"contentUrl\":\"http:\/\/1.gravatar.com\/avatar\/17bc5ae83cce85dafb710d1c71eb7825?s=96&d=mm&r=g\",\"caption\":\"An Huynh Phan Ngoc\"},\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/huynhphanngocangmail-com\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"ESC 2019 v\u1ec1 ch\u1ea9n \u0111o\u00e1n v\u00e0 qu\u1ea3n l\u00fd thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p - Ph\u1ea7n 1","description":"\u0111\u1ec3 qu\u00fd\u00a0 \u0111\u1ed3ng nghi\u1ec7p thu\u1eadn ti\u1ec7n h\u01a1n khi tham kh\u1ea3o, c\u1eadp nh\u1eadt trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p.","robots":{"index":"noindex","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"og_locale":"en_US","og_type":"article","og_title":"ESC 2019 v\u1ec1 ch\u1ea9n \u0111o\u00e1n v\u00e0 qu\u1ea3n l\u00fd thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p - Ph\u1ea7n 1","og_description":"\u0111\u1ec3 qu\u00fd\u00a0 \u0111\u1ed3ng nghi\u1ec7p thu\u1eadn ti\u1ec7n h\u01a1n khi tham kh\u1ea3o, c\u1eadp nh\u1eadt trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p.","og_url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/esc-2019-ve-chan-doan-va-quan-ly-thuyen-tac-phoi-cap-phan-1\/","og_site_name":"Vinmec","article_published_time":"2023-05-03T14:54:00+00:00","article_modified_time":"2023-05-16T18:25:26+00:00","og_image":[{"url":"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/download.jpg"}],"author":"An Huynh Phan Ngoc","twitter_card":"summary_large_image","twitter_misc":{"Written by":"An Huynh Phan Ngoc","Est. reading time":"13 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/esc-2019-ve-chan-doan-va-quan-ly-thuyen-tac-phoi-cap-phan-1\/","url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/esc-2019-ve-chan-doan-va-quan-ly-thuyen-tac-phoi-cap-phan-1\/","name":"ESC 2019 v\u1ec1 ch\u1ea9n \u0111o\u00e1n v\u00e0 qu\u1ea3n l\u00fd thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p - Ph\u1ea7n 1","isPartOf":{"@id":"https:\/\/noithathoaphat.in\/ctv\/#website"},"datePublished":"2023-05-03T14:54:00+00:00","dateModified":"2023-05-16T18:25:26+00:00","author":{"@id":"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/106da77d14bd9697d17d477cee4fe3b8"},"description":"\u0111\u1ec3 qu\u00fd\u00a0 \u0111\u1ed3ng nghi\u1ec7p thu\u1eadn ti\u1ec7n h\u01a1n khi tham kh\u1ea3o, c\u1eadp nh\u1eadt trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p.","breadcrumb":{"@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/esc-2019-ve-chan-doan-va-quan-ly-thuyen-tac-phoi-cap-phan-1\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/esc-2019-ve-chan-doan-va-quan-ly-thuyen-tac-phoi-cap-phan-1\/"]}]},{"@type":"BreadcrumbList","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/esc-2019-ve-chan-doan-va-quan-ly-thuyen-tac-phoi-cap-phan-1\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/noithathoaphat.in\/ctv\/"},{"@type":"ListItem","position":2,"name":"ESC 2019 v\u1ec1 ch\u1ea9n \u0111o\u00e1n v\u00e0 qu\u1ea3n l\u00fd thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p – Ph\u1ea7n 1"}]},{"@type":"WebSite","@id":"https:\/\/noithathoaphat.in\/ctv\/#website","url":"https:\/\/noithathoaphat.in\/ctv\/","name":"Vinmec","description":"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/106da77d14bd9697d17d477cee4fe3b8","name":"An Huynh Phan Ngoc","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/","url":"http:\/\/1.gravatar.com\/avatar\/17bc5ae83cce85dafb710d1c71eb7825?s=96&d=mm&r=g","contentUrl":"http:\/\/1.gravatar.com\/avatar\/17bc5ae83cce85dafb710d1c71eb7825?s=96&d=mm&r=g","caption":"An Huynh Phan Ngoc"},"url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/huynhphanngocangmail-com\/"}]}},"_links":{"self":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/31247"}],"collection":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/users\/17"}],"replies":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/comments?post=31247"}],"version-history":[{"count":5,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/31247\/revisions"}],"predecessor-version":[{"id":35246,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/31247\/revisions\/35246"}],"wp:attachment":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/media?parent=31247"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/categories?post=31247"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/tags?post=31247"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}