C??c bi???u hi???n h???u COVID- 19

T??m t???t n???i dung

T???ng quan:??

C??c tri???u ch???ng v?? bi???u hi???n h???u COVID ???? xu???t hi???n ??? nhi???u b???nh nh??n t???ng m???c COVID- 19 t????ng ?????i gi???ng c??c tri???u ch???ng sau m???c c??c h???i ch???ng h?? h???p c???p t??nh nghi??m tr???ng (SARS). Do ????, nghi??n c???u nh???m m???c ????ch ph??t hi???n v?? x??c ?????nh c??c ?????c ??i???m, tri???u ch???ng xu???t hi???n sau nhi???m coronavirus v?? m???i li??n quan c???a n?? v???i m???c ????? nghi??m tr???ng c???a b???nh.

Ph????ng ph??p:??

Kho???ng 287 ng?????i t???ng m???c COVID- 19 ???? tham gia nghi??n c???u, m???i ng?????i nh???n ???????c m???t b???ng c??u h???i kh???o s??t chia th??nh 3 ph???n ch??nh b???t ?????u t??? d??? li???u nh??n kh???u h???c, d??? li???u v??? t??nh tr???ng m???c COVID- 19, c??c b???nh ??i k??m kh??c v?? cu???i c??ng l?? d??? li???u v??? c??c bi???u hi???n h???u COVID c???a c??c ?????i t?????ng tham gia nghi??n c???u.

K???t qu???:??

Ch??? c?? 10.8% ?????i t?????ng kh??ng c?? bi???u hi???n g?? sau khi kh???i b???nh trong khi ???? h???u h???t c??c ?????i t?????ng m???c m???t ho???c m???t s??? tri???u ch???ng v?? b???nh h???u COVID. C??c tri???u ch???ng th?????ng g???p l?? m???t m???i (72.8%), c??c bi???u hi???n nghi??m tr???ng h??n nh?? ?????t qu???, suy th???n, vi??m c?? tim v?? x?? ph???i kho???ng m???t v??i ph???n tr??m ???? ???????c b??o c??o. C?? m???i li??n quan ????ng k??? gi???a b???nh n???n v?? m???c ????? nghi??m tr???ng c???a b???nh. Ngo??i ra m???c ????? nghi??m tr???ng c???a COVID- 19 c??ng li??n quan ?????n m???c ????? nghi??m tr???ng c???a c??c bi???u hi???n sau ????.

K???t lu???n:??

Bi???u hi???n h???u COVID- 19 ph???n l???n gi???ng v???i h???i ch???ng h???u SARS. T???t c??? c??c ?????i t?????ng h???i ph???c sau COVID- 19 ph???i ???????c theo d??i l??u d??i ????? ph??t hi???n v?? ??i???u tr??? c??c tri???u ch???ng v?? t??nh tr???ng c?? th??? g???p ph???i khi nhi???m ch???ng virus corona m???i.

1. T???ng quan

B???nh Coronavirus 2019 (COVID- 19) l?? m???t b???nh h?? h???p nghi??m tr???ng do nhi???m ch???ng coronavirus m???i (SARS- CoV- 2). M???t trong nh???ng v???n ????? quan tr???ng nh???t li??n quan ?????n COVID- 19 l?? t???c ????? l??y lan nhanh, h??ng tri???u ng?????i ???? b??? nhi???m b???nh tr??n kh???p th??? gi???i, v?? h??ng tr??m ngh??n tr?????ng h???p t??? vong cho ?????n nay ???? ???????c ghi nh???n. B???nh nh??n c?? c??c tri???u ch???ng kh??c nhau nh?? s???t, ho khan v?? m???t m???i l?? nh???ng bi???u hi???n nh??? trong kho???ng 80% tr?????ng h???p, c??c tr?????ng h???p n??y c?? th??? tr??? n??n nghi??m tr???ng khi ch??ng ti???n tri???n th??nh h???i ch???ng h?? h???p c???p, suy h?? h???p v?? do ????, c???n ph???i t??ng th??m c??c khu ch??m s??c t??ch c???c (ICU). M???c ????? nghi??m tr???ng c???a b???nh li??n quan ?????n tu???i t??c v?? b???nh n???n c???a b???nh nh??n; ng?????i cao tu???i th?????ng ch???u ???nh h?????ng l???n n??n th?????ng r???t c???n ICU. M???c ????? nghi??m tr???ng c???a c??c tri???u ch???ng c??ng li??n quan ?????n th???i gian m???c b???nh, ?????i v???i nh???ng tr?????ng h???p nh???, c??c tri???u ch???ng c?? th??? k??o d??i trong 2 tu???n, trong khi ???? nh???ng tri???u ch???ng n???ng kho???ng 3 ?????n 6 tu???n. Ti???p x??c tr???c ti???p v???i ng?????i b???nh l?? con ???????ng truy???n b???nh ch??nh (gi???a ng?????i v???i ng?????i) do SARS- CoV- 2 l??y lan qua ???????ng kh??ng kh?? ho???c kh?? dung. Ch???n ??o??n COVID- 19 ???????c ph??t hi???n nh??? x??t nghi???m sinh h???c ph??n t??? (PCR), ch???p c???t l???p vi t??nh (CT) v?? x??t nghi???m m??u. ?????i v???i nh???ng tr?????ng h???p nh???, ??i???u tr??? h??? tr??? l?? l???a ch???n duy nh???t bao g???m vitamin, c??c nguy??n t??? vi l?????ng v?? thu???c h??? s???t, trong khi nh???ng tr?????ng h???p suy h?? h???p, li???u ph??p oxy c?? ho???c kh??ng c?? th??? m??y n??n ???????c ??p d???ng t??y tr?????ng h???p c??? th???. R???t nhi???u lo???i thu???c ???? ???????c ????a v??o c??c th??? nghi???m l??m s??ng ????? ho???t ?????ng nh?? m???t ch???t kh??ng virus nh??ng kh??ng c?? k???t qu??? r?? r??ng ????? ch??? ra t??c d???ng ?????i v???i b???nh ??? b???t k??? lo???i thu???c n??o ???????c ??i???u tra. Ngo??i li???u ph??p ??i???u tr??? tri???u ch???ng, corticosteroid nh?? m???t ch???t ch???ng vi??m ????ng vai tr?? quan tr???ng trong c??c tr?????ng h???p n???ng c???a b???nh. H???u h???t c??c b???nh nh??n ???? kh???i b???nh c?? th??? ???????c x??c nh???n b???ng k???t qu??? x??t nghi???m l???i PCR ho???c kh??ng c?? tri???u ch???ng trong v??i ng??y. Tuy nhi??n, nhi???u tr?????ng h???p sau khi kh???i b???nh ???? xu???t hi???n c??c tri???u ch???ng kh??c nhau, kh??c h???n v???i c??c tri???u ch???ng COVID- 19. C??c bi???u hi???n sau h???i ph???c c??ng ???? ???????c nghi??n c???u ??? c??c b???nh nh??n sau khi m???c h???i ch???ng suy h?? h???p c???p n???ng (SARS) n??m 2003 ph???n ??nh nhi???u tri???u ch???ng m?? c??c ?????i t?????ng nghi??n c???u g???p ph???i nh?? m???t m???i, ??au c??, tr???m c???m v?? suy nh?????c. M???t s??? bi???u hi???n n??y l?? m???n t??nh v?? di???n ra trong m???t th???i gian d??i v?? v???y c???n ph???i theo d??i. Nghi??n c???u nh???m m???c ????ch ??i???u tra c??c bi???u hi???n h???u COVID- 19 ????? ph??t hi???n c??c tri???u ch???ng ho???c d???u hi???u kh??c nhau xu???t hi???n tr??n c??c ?????i t?????ng sau khi kh???i b???nh, c??ng ????? t??m ra s??? li??n quan gi???a c??c tri???u ch???ng n??y v???i m???t s??? y???u t??? nh?? tu???i, c??n n???ng, m???c ????? nghi??m tr???ng c???a b???nh ho???c c??c b???nh ??i k??m kh??c.

2. Ph????ng ph??p

C??c ?????i t?????ng nghi??n c???u l?? ng?????i Ai C???p ???? ph???c h???i sau COVID- 19 ???? nh???n ???????c m???t b???ng c??u h???i thu th???p d??? li???u li??n quan ?????n c??c bi???u hi???n sau COVID- 19 c???a h???. B???ng c??u h???i n??y ???????c chia th??nh nhi???u ph???n b???t ?????u t??? d??? li???u nh??n kh???u h???c c???a ?????i t?????ng (tu???i, gi???i t??nh, chi???u cao, m???c ????? s??? d???ng thu???c l??, v?? c??n n???ng), sau ???? l?? d??? li???u v??? t??nh tr???ng trong khi m???c COVID- 19 v?? c??c b???nh ??i k??m kh??c c???a ?????i t?????ng (m???c ????? nghi??m tr???ng c???a b???nh, s??? d???ng c??c vitamin v?? s??? c?? m???t c???a c??c b???nh kh??c), cu???i c??ng l?? c??c d??? li???u v??? bi???u hi???n h???u COVID- 19 (C??c tri???u ch???ng ???? c??, c??c tri???u ch???ng xu???t hi???n m???i, nhu c???u s??? d???ng thu???c v?? ph???c h???i c??c tri???u ch???ng sau m???c COVID- 19).

C??c ph???n ???ng c???a m???i ?????i t?????ng ???????c ph??n t??ch tr?????c h???t ????? ch??? ra t??? l??? xu???t hi???n sau ???? li??n k???t n?? v???i s??? xu???t hi???n c???a c??c bi???u hi???n sau COVID- 19).

Bi???u ????? b??? m???t ????p ???ng ???????c t???o ra b???ng ph???n m???m quy ho???ch th???c nghi???m phi??n b???n 11 (T???p ??o??n Stat- Ease, Minneapolis, Minnesota, M???). C??c y???u t??? th??? hi???n tr??n bi???u ????? b??? m???t ????p ???ng ???? ???????c m?? h??a nh?? sau; Tu???i (1 = 20 ??? 30 tu???i, 2 = 31 ??? 40 tu???i v?? 3 ??? 40 tu???i), T??? l??? m???c b???nh (1 = kh??ng c?? b???nh n???n v?? 2 = hi???n c?? c??c b???nh kh??c), m???c ????? nghi??m tr???ng c???a c??c bi???u hi???n sau COVID- 19 (1 = nh??? v?? 2 = nghi??m tr???ng) v?? M???c ????? nghi??m tr???ng c???a COVID- 19 (H??nh 1 (1 = nh???, 2 = trung b??nh v?? 3 = n???ng) v?? H??nh 2 (0.1 = nh???, 0.2 = trung b??nh, 0.3 = n???ng))

H??nh 1: Bi???u ????? b??? m???t ????p ???ng cho th???y m???i li??n h??? gi???a tu???i, b???nh n???n v?? m???c ????? nghi??m tr???ng c???a COVID- 19

H??nh 2: Bi???u ????? b??? m???t ????p ???ng cho th???y m???i li??n h??? gi???a b???nh n???n, m???c ????? nghi??m tr???ng c???a COVID- 19 v?? m???c ????? nghi??m tr???ng c???a c??c bi???u hi???n sau COVID- 19

3. K???t qu???

D??? li???u nh??n kh???u h???c v?? m???i li??n h??? gi???a qu?? tr??nh m???c COVID- 19 c???a c??c ?????i t?????ng li??n quan ???????c th??? hi???n trong B???ng 1. M???i li??n quan gi???a m???t s??? y???u t??? v?? m???c ????? nghi??m tr???ng c???a b???nh ???????c th??? hi???n trong H??nh 1 v?? 2. C??c bi???u hi???n sau COVID- 19 ???????c th??? hi???n trong B???ng 2 v?? H??nh 3.

B???ng 1: D??? li???u nh??n kh???u h???c c???a c??c ?????i t?????ng m???c COVID- 19

B???ng 2: C??c bi???u hi???n h???u COVID- 19

H??nh 3: T??? l??? c??c bi???u hi???n kh??c nhau h???u COVID- 19 xu???t hi???n tr??n c??c ?????i t?????ng COVID- 19 ???? kh???i b???nh

Nghi??n c???u li??n quan ?????n 287 ?????i t?????ng COVID- 19 ???? kh???i b???nh, 103 nam v?? 184 n???. Tu???i c???a c??c ?????i t?????ng tham gia ???????c bi???u th??? trung b??nh ?? SD l?? 32.3 ?? 8.5 v?? ????? tu???i dao ?????ng t??? 20 ?????n 60 tu???i. Trung b??nh ?? SD c??n n???ng, chi???u cao v?? ch??? s??? kh???i c?? th??? (BMI) l???n l?????t l?? 77 ?? 16.4, 162.9 ?? 15.3 v?? 28.5 ?? 5.2. T??? l??? h??t thu???c ??? nam gi???i l?? 27.2%, trong khi t???t c??? n??? gi???i ?????u kh??ng h??t thu???c. V??? c??c b???nh kh??c, 70.7% ?????i t?????ng kh??ng c?? b???nh n???n, trong khi 7.7% b??? t??ng huy???t ??p v?? 5.2% ????i th??o ???????ng. M???c ????? nghi??m tr???ng c???a c??c tri???u ch???ng COVID- 19 ???????c chia th??nh 3 lo???i, lo???i 1 l?? c??c tr?????ng h???p nh??? ???????c c??ch ly t???i nh?? chi???m 80.2%, lo???i 2 l?? c??c tr?????ng h???p trung b??nh ???????c ??i???u tr??? b???ng li???u ph??p oxy chi???m 14.9% v?? lo???i th??? 3 l?? c??c tr?????ng h???p nghi??m tr???ng ph???i ??i???u tr??? ??? ICU v?? chi???m m???t t??? l??? nh??? (4.9%). Ph??n t??ch c??c bi???u hi???n h???u COVID cho th???y ch??? 10.8% trong t???ng s??? ?????i t?????ng kh??ng c?? bi???u hi???n sau khi kh???i b???nh trong kh?? m???t t??? l??? l???n c??c ?????i t?????ng xu???t hi???n 1 s??? tri???u ch???ng. H???u h???t c??c ?????i t?????ng c???m th???y m???t m???i (72.8%), lo ??u (38%), ??au kh???p (31.4%), ??au ?????u li??n t???c (28.9%), ??au ng???c (28.9%), sa s??t tr?? tu??? (28.6%), tr???m c???m (28.6%) v?? kh?? th??? (28.2%). M???t v??i ph???n tr??m ?????i t?????ng ???????c ph???c h???i m???i ???????c ch???n ??o??n m???c ????i th??o ???????ng (2.4%) (B???ng 2). Ph???n l???n ?????i t?????ng ???? ph???c h???i sau c??c bi???u hi???n h???u COVID- 19 (67.6%), trong khi 32.4% ?????i t?????ng c?? c??c bi???u hi???n dai d???ng. V??? vi???c h??? tr??? dinh d?????ng, 90.6% c??c ?????i t?????ng ???????c b??? sung vitamin t???ng h???p (s???n ph???m t??? thi??n nhi??n ho???c d?????c ph???m) trong th???i gian m???c b???nh.

H???u h???t (83.3%) c??c tr?????ng h???p trung b??nh ??? n???ng li??n quan ?????n nh???ng ng?????i c?? b???nh n???n (????i th??o ???????ng, hen, t??ng huy???t ??p) v?? c??c ?????i t?????ng c?? thai.

M???c ????? nghi??m tr???ng c???a COVID- 19 li??n quan ?????n tu???i v?? c??c b???nh n???n ???????c th??? hi???n trong H??nh 1. Ngo??i ra, m???c ????? nghi??m tr???ng c???a c??c bi???u hi???n h???u COVID- 19 c?? li??n quan ?????n m???c ????? nghi??m tr???ng c???a COVID- 19 (H??nh 2).

4. B??n lu???n

C??c bi???u hi???n h???u COVID- 19 ???? ???????c ghi nh???n cho kho???ng 90% ?????i t?????ng ???? kh???i b???nh v???i m???t lo???t c??c tri???u ch???ng v?? t??nh tr???ng b???nh kh??c nhau, t??? c??c tri???u ch???ng nh??? nh?? ??au ?????u ?????n c??c t??nh tr???ng nghi??m tr???ng h??n nh?? ?????t qu???, suy th???n v?? x?? ph???i. H???i ch???ng sau nhi???m virus ???? ???????c b??o c??o tr?????c ????y sau d???ch SARS. Theo d??i trong 4 n??m cho th???y t??nh tr???ng m???t m???i m???n t??nh v?? ???nh h?????ng ?????n t??m th???n r???t c?? ?? ngh??a l??m s??ng v???i nh???ng ?????i t?????ng sau nhi???m b???nh. Do ????, vi???c qu???n l?? b???nh t???t v??? s???c kh???e t??m th???n c??ng c???n ???????c quan t??m th??ng qua ph????ng ph??p ti???p c???n ??a ng??nh k???t h???p v???i ph???c h???i ch???c n??ng l??u d??i. ?????i v???i nh???ng ?????i t?????ng nghi??n c???u sau nhi???m COVID, b??o c??o m???t ho???c nhi???u tri???u ch???ng th?? nh???ng tri???u ch???ng ???? v???n t???n t???i tr??n c??c ?????i t?????ng ???? trong h??n 20 ng??y k??? t??? l???n x??t nghi???m PCR ??m t??nh cu???i c??ng. M???c ????? nghi??m tr???ng c???a COVID- 19 ???????c ph??n th??nh 3 lo???i sau: C??c tr?????ng h???p nh??? c?? c??c tri???u ch???ng ki???m so??t ???????c v?? c?? th??? ??i???u tr??? t???i nh?? m?? kh??ng c???n s??? d???ng li???u ph??p oxy; C??c tr?????ng h???p trung b??nh c?? tri???u ch???ng kh?? th??? c???n s??? d???ng li???u ph??p oxy; C??c tr?????ng h???p n???ng ???? nh???p vi???n v?? c???n s??? d???ng ICU. T??? m???i li??n quan gi???a tu???i, b???nh n???n v?? m???c ????? nghi??m tr???ng c???a COVID- 19 cho th???y m???i li??n h??? ch???t ch??? gi???a s??? c?? m???t c???a b???nh n???n v?? m???c ????? nghi??m tr???ng c???a h???u COVID- 19. Tu???i c??ng cao th?? vi???c gia t??ng m???c ????? nghi??m tr???ng c???a b???nh c??ng nhi???u. H???u h???t c??c bi???u hi???n ???????c b??o c??o l?? c??c tri???u ch???ng nh??? c?? th??? h???i ph???c m?? kh??ng c???n can thi???p y t??? nh?? m???t m???i, ??au ?????u. C??c tri???u ch???ng kh??c nh?? ??au kh???p hay m???i c?? c??ng ???????c nhi???u ?????i t?????ng b??o c??o v?? c?? th??? x???p v??o bi???u hi???n nh???. Ng?????i ta ghi nh???n th???y c?? nhi???u bi???u hi???n li??n qua ?????n h??? th???n kinh nh?? ??au ?????u li??n t???c, ??au n???a ?????u, tr???m c???m, lo ??u v?? r???i lo???n ??m ???nh c?????ng ch???. C??ng c?? m???t s??? ??t ng?????i c?? c??c bi???n ch???ng nghi??m tr???ng nh?? ?????t qu???, vi??m c?? tim, suy th???n v?? x?? ph???i c???n theo d??i th??m. B??o ph?? c??ng l?? m???t y???u t??? ???nh h?????ng ?????n m???c ????? nghi??m tr???ng c???a b???nh ho???c c??c tri???u ch???ng sau b???nh, nghi??n c???u ch??? ra r???ng ph???n l???n c??c ?????i t?????ng b??? th???a c??n, b??o ph?? kh??ng ???nh h?????ng ????ng k??? ?????n m???c ????? nghi??m tr???ng c???a c??c tri???u ch???ng h???u COVID- 19. C??c bi???u hi???n h???u COVID- 19 ???????c ghi nh???n trong nghi??n c???u n??y c?? th??? ???????c ph??n lo???i th??nh nh???, trung b??nh v?? n???ng (l?? nh???ng tri???u ch???ng ???nh h?????ng ?????n c??c ch???c n??ng c???a c?? quan nh?? x?? ph???i, suy th???n, vi??m c?? tim, lo???n nh???p tim v?? ?????t qu???. C??c tr?????ng h???p m???c b???nh n???ng th?????ng c?? c??c bi???u hi???n h???u b???nh n???ng h??n. T???t c??? c??c tr?????ng h???p c?? tri???u ch???ng n???ng ???????c ch???n ??o??n x??c ?????nh th??ng qua c??c x??t nghi???m v?? ch???n ??o??n h??nh ???nh nh?? ch???p CT ????? ch???n ??o??n x?? ph???i. Tri???u ch???ng th?????ng th???y nh???t l?? m???t m???i c??ng ???????c Tansey v?? c???ng s??? nghi??n c???u th???y sau ?????i d???ch SARS v??o n??m 2003. M???t m???i k??o d??i ??? nh???ng ?????i t?????ng n??y th?????ng k??o d??i trong v??i th??ng, c??c ?????i t?????ng ???????c ki???m tra ?????nh k??? 3 th??ng 1 l???n, th?? c?? h??n 50% th???y m???t m???i. M???t nghi??n c???u kh??c ???? theo d??i c??c ?????i t?????ng h???u SARS trong 4 n??m th?? th???y c?? kho???ng 40.3% ??ng?????i c?? tri???u ch???ng m???t m???i m???n t??nh. Lara v?? c???ng s??? theo d??i c??c tri???u ch???ng t??m th???n kinh nh?? b???nh Alzheimer v?? c??c ?????i t?????ng suy gi???m nh???n th???c nh??? do nhi???m coronavirus m???i n??y, ???? cho th???y c??c tri???u ch???ng c???a c??c ?????i t?????ng tr??? n??n x???u h??n nhi???u trong kho???ng 5 tu???n sau khi kh???i b???nh. Chakraborty v?? c???ng s??? ch??? ra r???ng kho???ng 6% COVID- 19 c?? r???i lo???n ??m ???nh c?????ng ch??? (OCD) ch??? y???u ??? n??? c??ng c?? c??c tri???u ch???ng x???u ??i.

M???t tr?????ng h???p ???? ???????c b??o c??o, ?????i t?????ng n??? 80 tu???i sau khi ???? kh???i COVID- 19 tr?????c ???? kh??ng c?? ti???n s??? b???nh ph???i, ???? ch???t do x?? ph???i 2 b??n. M???t s??? ?????i t?????ng c??n ph??t hi???n b??? vi??m c?? tim sau ????. M???t s??? bi???u hi???n li??n quan ?????n vi???c s??? d???ng thu???c ??i???u tr??? hydroxychloroquine g??y m??? m???t, ?????c bi???t lo???i thu???c n??y c??ng l?? 1 trong nhi???u thu???c c?? trong ph??c ????? ??i???u tr??? cho COVID- 19.

??? c??c ?????i t?????ng ???? kh???i b???nh, PCR ??m t??nh kh??ng c?? ngh??a l?? ???? k???t th??c qu?? tr??nh theo d??i, v?? v???y n??n theo d??i li??n t???c v?? l??u d??i ????? ????nh gi?? c??c tri???u ch???ng sau COVID- 19, ????? c?? bi???n ph??p can thi???p th??ch h???p. Ngo??i ra c??ng c???n t?? v???n cho c??c ?????i t?????ng ????? duy tr?? t???t vi???c tu??n th??? t???t ch??? ????? sinh ho???t, s??? d???ng thu???c n???u c?? ????? ph??t hi???n s???m nh???t tr??nh c??c t??nh tr???ng nguy hi???m.

5. K???t lu???n

H???u h???t c??c ?????i t?????ng nghi??n c???u ?????u c?? 1 ho???c nhi???u tri???u ch???ng sau khi ???? kh???i b???nh (PCR ??m t??nh), c?? th??? ch??? l?? c??c tri???u ch???ng nh??? nh?? m???t m???i, ??au ?????u ho???c c??c bi???u hi???n nghi??m tr???ng h??n nh?? x?? ph???i, ?????t qu???, vi??m c?? tim. M???c ????? nghi??m tr???ng c???a c??c bi???u hi???n h???u COVID- 19 c?? m???i li??n quan ch???t ch??? v???i m???c ????? nghi??m tr???ng c???a b???nh c??ng s??? c?? m???t c???a b???nh n???n. Bi???u hi???n h???u COVID- 19 ph???n l???n gi???ng v???i h???i ch???ng h???u SARS. T???t c??? c??c ?????i t?????ng ???????c sau khi kh???i b???nh ph???i ???????c theo d??i l??u d??i ????? ph??t hi???n v?? ??i???u tr??? c??c tri???u ch???ng v?? t??nh tr???ng c?? th??? xu???t hi???n sau ????.

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Vi??n Minh ???????ng – Chuy??n th???o d?????c tr??? em
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