Kev ua txhaum ntawm kev ua haujlwm ntawm lub plab zom mov tsawg kawg ib zaug, tab sis tshwm sim hauv txhua tus neeg. Tab sis muaj xws li pathologies ntawm lub plab zom mov uas tsis tsuas yog ua rau tsis xis nyob, tab sis kuj tuaj yeem ua rau muaj kev phom sij rau kev noj qab haus huv. Kab mob gastroreflux tshwm sim nyob rau hauv yuav luag ib nrab ntawm lub ntiaj teb cov pej xeem. Nws yuav tsum tau kho kom tiav, nrog rau kev hloov hauv kev ua neej.
Kev piav qhia dav dav
Reflux yog ib qho physiological lossis pathological reflux ntawm gastric kua rau hauv txoj hlab pas. Hauv thawj kis, nws tshwm sim tam sim tom qab noj zaub mov hnyav, tab sis tsis nrog cov tsos mob, thiab kuj tsis ua haujlwm. Pathological xav tau kev kho mob thiab hloov kev noj haus.
Kab mob Gastroreflux yog ib qho mob ntev, uas yog tus cwj pwm los ntawm cov kab mob plab hnyuv rov qab mus rau hauv txoj hlab pas, tsis hais txog kev noj zaub mov. Nyob rau tib lub sijhawm, nws cov phab ntsa yog khaus, cov mucous membrane puas thiab tus neeg xav tias tsis xis nyob. Acid muab pov tseg los ntawm cov zaub mov hauv qabsphincter. Koj yuav tsum tau nrog xws li ib tug pathology yuav luag tag nrho koj lub neej. Txawm li cas los xij, kev noj zaub mov kom raug thiab kev ua neej nyob ua rau muaj kev zam txim mus ntev.
Kab mob Gastroreflux tuaj yeem yog ob qho tib si kev ywj pheej thiab cov tsos mob. Feem ntau, nws qhov ua rau yog txoj kev tsis ncaj ncees ntawm lub neej, kev ua yuam kev hauv kev noj haus. Pawg pheej hmoo suav nrog cov neeg mob uas muaj hnub nyoog 50 xyoo.
Kev tshwm sim
GERD tsis yog ib yam kab mob yooj yim. Nrog pom kev noj qab nyob zoo, kev cuam tshuam ntawm qhov tsis zoo ua rau muaj kev ua rau muaj kev ntxhov siab. Cov laj thawj hauv qab no tuaj yeem ua rau tus kab mob gastroreflux:
- haus cov dej haus caffeinated thaum lawv txo cov suab nrov ntawm cov hlab ntaws qis;
- smoking;
- cev xeeb tub (lub sijhawm no, lub nra thiab lub siab ntawm cov kabmob hauv nruab nrog cev nce);
- obesity;
- kev quav cawv;
- diaphragmatic hernia;
- nce intra-abdominal siab;
- nrawm noj nrog nqos cua ntau;
- plab hnyuv thiab duodenal rwj;
- muaj ntau cov tsiaj rog hauv cov zaub mov;
- pab plab plab khoob;
- hnav khaub ncaws ua rau lub plab hnyav;
- mob plab;
- ntshai nias load;
- nce acidity ntawm pais plab kua txiv.
Kev tshuaj ntsuam genetic predisposition rau cov kab mob ntawm lub plab zom mov tuaj yeem ua rau muaj kev loj hlob ntawm pathology. Kev ntxhov siab ntau zaus thiab kev ua lub cev tsis muaj zog tuaj yeem ua rau tus neeg mob hnyav dua.
Cov tsos mob ntawm pathology
Cov tsos mob ntawm tus kab mob gastroreflux yog:
- Xav tias muaj puv hauv siab thiab txoj hlab pas, nrog rau qhov mob hauv epigastrium, larynx.
- Muaj los yog hmo ntuj hnoos.
- Ntau caj pas.
- Tooth enamel puas.
- Heartburn uas yuav mob zuj zus thaum khoov dua, tom qab qoj ib ce, thaum pw.
- Belching nrog iab lossis qaub saj.
- Hiccup.
- mob nqos.
- Nyob salivation.
- Ntsuab xeev khuam thiab ntuav.
- ua pa tsis zoo.
- Kev quav quav.
Kab mob Gastroreflux hauv cov menyuam yaus yog tshwm sim los ntawm regurgitation, quav quav, ua tsis taus pa, tsis qab los noj mov. Feem ntau, cov menyuam mos yuav ntxhov siab thaum pub mis.
Kev faib kab mob
Cov tsos mob ntawm tus kab mob gastroreflux feem ntau nyob ntawm nws hom. Muaj xws li kev faib tawm ntawm pathology:
- Tsis yog erosive. Hauv qhov no, tsis muaj qhov tshwm sim ntawm esophagitis, txawm hais tias qhov rov qab reflux ntawm gastric kua yog tam sim no.
- Nyob zoo. Ntawm no tus neeg mob tsim ulcers thiab erosions. Qhov tob ntawm cov ntaub so ntswg puas yuav txawv.
- Barrett's esophagus. Cov kab mob pathology no tau kuaj pom hauv 60% ntawm txhua tus neeg mob. Qhov no yog theem kawg ntawm kev loj hlob ntawm tus kab mob. Nws yog tus cwj pwm los ntawm metaplasia ntawm squamous stratified epithelium. Ntawm no esophagitis provokes kev loj hlob ntawm tus mob precancerous.
Kab mob gastroesophageal reflux tuaj yeem ua rau muaj teeb meem loj, yog li nws yuav tsum tau kho kom meej.
theem kab mob kev loj hlob
Cov kua txiv plab muaj hydrochloric acid, uas yuav tsum tau rau kev zom cov protein. Qhov no yog ib qho kev txhoj puab heev ib puag ncig, los ntawm qhov uas lub plab mucosa tiv thaiv zoo. Feem ntau, cov kua txiv hmab txiv ntoo tsis nkag mus rau hauv txoj hlab pas, yog li nws cov phab ntsa tsis xav tau ib qho kev thaiv tshwj xeeb. Hauv kab mob gastroesophageal reflux, lub sphincter qis tsis tuaj yeem khaws cov kua qaub hauv plab. Nws rov qab mus rau hauv txoj hlab pas thiab ua rau nws puas tsuaj.
Cov tsos mob ntawm tus kab mob gastroreflux hauv cov neeg laus thiab menyuam yaus kuj nyob ntawm nws qhov hnyav:
- Thawj. Tsis muaj kev hloov pauv loj hauv cov phab ntsa ntawm txoj hlab pas. Cov mucosa tuaj yeem ua xim liab, me me yaig tuaj yeem tshwm sim rau ntawm nws. Lub cev nws tus kheej muaj peev xwm tiv taus kev puas tsuaj, yog li tus neeg tsis hnov qhov tsis xis nyob. Nrog rau kev kuaj pom tus kab mob raws sijhawm ntawm theem no, tus neeg mob tsis muaj qhov tshwm sim.
- Second. Erosive lesion npog txog li 20% ntawm cov mucosal nto. Qhov no tsis ua rau cov khaubncaws sab nraud povtseg.
- Thib peb. Qhov txhab qhov txhab nthuav. Erosions ua tob, cuam tshuam rau cov leeg nqaij. Cov tsos mob nyob mus ib txhis. Cov theem no yog qhov tshwm sim los ntawm kev kub ntxhov thaum tsaus ntuj, thiab thaum pw ntawm sab xis, qhov mob hnyav tshwm sim.
- Plaub. Ntawm no, ulcers twb kuaj nyob ib ncig ntawm tag nrho cov ncig ntawm txoj hlab pas. Qhov qis sphincter kuj raug rau cov txheej txheem erosive.
- Thib tsib. Nyob rau theem no thoob plawscaws pliav tshwm nyob rau saum npoo ntawm lub mucosa, uas yuav provoke stenosis ntawm txoj hlab pas. Tus neeg mob muaj peev xwm lees txais cov khoom noj ua kua nkaus xwb. Feem ntau, nws xav tau kev phais nyob rau theem no.
Thaum kawg ntawm kab mob gastroesophageal, kev pheej hmoo ntawm kev tsim oncology nce, yog li nws yog qhov zoo dua mus ntsib kws kho mob thaum thawj cov tsos mob tshwm sim.
YKev kuaj mob ntawm pathology
Ua ntej pib kho tus kab mob gastroreflux, nws yog ib qho tsim nyog yuav tsum tau kuaj xyuas kom meej. Tus kws kho mob tshwj xeeb yuav tsum paub txog hom thiab qhov hnyav ntawm cov kab mob pathology, muaj cov teeb meem tshwm sim. Thaum kuaj tau tus kab mob, cov kev tshawb fawb hauv qab no tau muab:
- kuaj ntshav, kuaj lub siab.
- Helicobacter test. Cov kab mob no ua rau muaj kev loj hlob ntawm gastritis thiab plab ulcers.
- Gastroscopy. Kev kuaj mob tsawg kawg nkaus, uas tus kws kho mob tuaj yeem kuaj xyuas cov kab mob ntawm phab ntsa ntawm txoj hlab pas, ntsuas qhov kev puas tsuaj.
- ntsuas cov kua qaub ntawm lub plab. Nws tuaj yeem ua ib leeg lossis txhua hnub. Nyob rau hauv thawj rooj plaub, ib tug nyias catheter thiab ib tug sojntsuam yog siv, uas captures lub reflux ntawm cov kua rau hauv txoj hlab pas. Qhov thib ob yuav tsum muaj cov tshuaj ntsiav tshwj xeeb uas tawm nrog cov quav.
- kuaj ultrasound ntawm lub plab zom mov.
- X-ray lossis scintigraphy nrog qhov sib txawv nruab nrab. Ntawm no nws muaj peev xwm txiav txim siab ib qho hernia ntawm lub diaphragm, lub plab rwj. Cov pathologies no feem ntau ua rau gastroesophagealCov tsos mob.
- Proton twj inhibitor test.
- Manomeria ntawm sab esophageal sphincter (kev txiav txim ntawm nws lub suab).
- ECG.
- YElectrogastrography. Nws muab rau kev txiav txim siab ntawm cov hluav taws xob ua haujlwm ntawm lub plab. Cov hluav taws xob txuas nrog rau tus neeg mob daim tawv nqaij (xws li hauv electrocardiogram). Kev kuaj mob tau ua txhua hnub. Qee zaum yuav tsum tau noj cov tshuaj stimulants.
- Kev kuaj mob ntawm cov ntaub so ntswg puas. Nws yog qhov tsim nyog rau qhov xav tias Barrett's esophagus lossis mob qog noj ntshav.
Txhawm rau txiav txim siab gastroesophageal reflux nrog esophagitis, koj yuav tsum tsis tsuas yog mus rau tus kws kho mob plab, tab sis kuj mus rau lwm tus kws kho mob: tus kws kho plawv, kws kho mob.
Nyob zoo ib tsoom niam txiv kwv tij neej tsa sawv daws.
Tsis muaj kev kho tshwj xeeb rau tus kab mob gastroreflux. Kev kho mob yog tsom rau kev tshem tawm cov tsos mob, nrog rau kev tiv thaiv cov teeb meem thiab rov tshwm sim dua. Cov tshuaj ua lub hauv paus ntawm kev kho mob:
- H2-histamine receptor blockers: Cimetidine, Famotodin, Nizatidine. Cov tshuaj no txo qis cov tshuaj hydrochloric acid uas tsim tawm, txo qhov kev ua phem ntawm cov kua txiv hmab txiv ntoo.
- Proton twj tso kua mis inhibitors: Omeprozol, Lansoprozol. Cov tshuaj no txo cov hydrochloric acid hauv cov kua txiv hmab txiv ntoo. Thaum sau cov tshuaj no, tus kws kho mob yuav tsum coj mus rau hauv tus account qee qhov nuances: piv txwv li, "Omeprazole" yog contraindicated rau cov niam uas muaj menyuam.
- Prokinetics: "Domperidone" (ib qho tshuaj tiv thaiv uastuaj yeem ua rau muaj kev cuam tshuam ntawm lub plab zom mov), "Cisapride" (cov tshuaj no txhim kho plab hnyuv motility).
- Antacids: Gaviscon, Phosphalugel. Cov nyiaj no txo cov acidity ntawm cov kua txiv hmab txiv ntoo, tiv thaiv cov mucous membrane ntawm nws cov teebmeem tsis zoo. Txawm li cas los xij, lawv tuaj yeem txo qhov nqus ntawm lwm yam tshuaj. Lawv yuav tsum tau ceev faj rau cov neeg uas tsis muaj ntshav siab. Thiab qee cov kws tshaj lij suav tias cov tshuaj tiv thaiv tsis yog cov tshuaj tiv thaiv uas ntseeg tau tshaj plaws.
Tshuaj tsuas tuaj yeem txo cov tsos mob ntawm gastroesophageal reflux. Txhawm rau txhim kho cov nyhuv, koj yuav tsum tau ua ib ce tshwj xeeb. Lawv ntxiv dag zog rau cov leeg ntawm lub diaphragm thiab txoj hlab pas, thiab tiv thaiv kab mob reflux ntawm gastric kua.
Yog tias kev kho mob ntawm cov tsos mob ntawm tus kab mob gastroreflux nrog cov tshuaj tsis ua haujlwm, ces tus neeg mob raug txiav txim. Lwm qhov kev qhia rau nws yog:
- kab mob nrawm nrawm;
- muaj teeb meem hauv lwm yam kabmob hauv nruab nrog cev (lub plawv, ntsws);
- luag;
- malignant qog.
Cov kev cuam tshuam kev phais hauv qab no tuaj yeem paub qhov txawv:
- Endoscopic plication. Nws yog feem ntau siv los ntshav. Cov cuab yeej no tseem tuaj yeem nqa cov ntaub so ntswg rau biopsy.
- Radiofrequency ablation ntawm txoj hlab pas.
- Kev siv nyiaj siv cov cuab yeej laparoscopic. Ntawm no lub plab yog sutured nyob ib ncig ntawm txoj hlab pas mus rau lub diaphragm.
- Nkauj tawm tshiabesophagus uas tau raug stenosis. Tom ntej no, qhov chaw cuam tshuam yog hloov nrog ib feem ntawm txoj hnyuv.
Kev cuam tshuam kev phais yog qhov ntsuas hnyav uas tsis tas yuav ua rau muaj txiaj ntsig zoo. Tsis tas li ntawd, cov teeb meem feem ntau tshwm sim tom qab nws. Kev kho mob ntawm cov kab mob no yuav tsum ua kom tiav thiab xav kom tus neeg mob ceev faj tus cwj pwm rau lawv tus kheej noj qab haus huv.
kev kho neeg zoo
Kev kho tus kab mob gastroreflux nrog pej xeem cov kev kho mob yog nqa tawm tsis tau tsuas yog nyob rau hauv thaum ntxov ua sawv ntawm txoj kev loj hlob ntawm pathology, tab sis kuj mus tawm tsam nws cov advanced daim ntawv. Tab sis nws yog ib qho tseem ceeb kom nco ntsoov tias lwm cov tshuaj tsuas yog ib txoj kev pab xwb. Ua ntej siv nws, koj yuav tsum sab laj nrog koj tus kws kho mob. Cov zaub mov hauv qab no yuav pab tau:
- qos yaj ywm nyoos. Txhawm rau tshem tawm cov tsos mob, nws txaus los zom ib qho me me ntawm cov zaub peb zaug hauv ib hnub. Koj tuaj yeem siv cov kua txiv hmab txiv ntoo tshiab. Nws yuav tsum tau noj peb zaug ib hnub twg rau ib nrab ib teev ua ntej noj mov. Koj yuav tau haus kua txiv ntev.
- Muaj. Nws muaj peev xwm tshem tawm qhov tshwm sim ntawm kub siab thiab ntim cov mucous daim nyias nyias, tiv thaiv nws txoj kev puas tsuaj los ntawm cov kua txiv hmab txiv ntoo.
- Celery Rau kev kho mob, kua txiv los ntawm cov hauv paus hniav ntawm cov nroj tsuag yog xav tau. Nws yog tsim nyog los siv 1 tbsp. l. peb zaug ib hnub.
- Sea buckthorn roj. Nws muaj qhov txhab kho, rov tsim dua tshiab, tiv thaiv inflammatory thiab antibacterial nyhuv. Koj yuav tsum haus nws hauv 1 tsp. ib hnub. Rosehip roj muaj cov nyhuv tib yam.
- Marshmallow cag. Tawm ntawm nwsnpaj ib decoction. Qhov no yuav tsum tau 6 g ntawm raw cov ntaub ntawv thiab 200 ml ntawm boiled dej. Cov sib tov yuav tsum tau boiled nyob rau hauv ib tug da dej rau ib nrab ib teev. Tom qab ntawd, cov kua yog lim thiab haus 100 ml peb zaug ib hnub.
- Nkauj tshuaj ntsuab. Yuav tsum tau 2 tbsp. l. plantain, 1 tbsp. l. St. John lub wort thiab 0.5 liv ntawm boiling dej. Ncuav tshuaj ntsuab rau hauv ib lub tais enamel. Tshuaj yej yog infused rau 30 feeb. Infusion yog siv thaum sawv ntxov, 0.5 khob ua ntej noj mov.
- Nkauj tshuaj ntsuab. Ncuav 50 g ntawm chamomile paj thiab yarrow tshuaj ntsuab rau hauv lub lauj kaub, ncuav 0.5 liv ntawm boiling dej. Nws yuav siv sij hawm 10 feeb kom infuse. Haus no tshuaj yej peb zaug ib hnub.
- Flax noob. Yuav tsum tau 2 tbsp. l. qhuav raw cov ntaub ntawv thiab ½ liter ntawm boiling dej. Nws yog qhov zoo dua los ua cov tshuaj thaum hmo ntuj, raws li nws yuav tsum tau infused rau 8 teev. Cov kua strained yuav tsum tau noj 100 ml ua ntej noj mov. Lub sijhawm ntawm chav kho mob yog 6 lub lis piam.
- Birch bark. Nws yuav tsum tau crushed rau hauv hmoov thiab noj nyob rau hauv 0.5 tsp. txhua hnub. Nws yuav tsum tau ntxuav nrog dej ntau lossis tshuaj yej tsis muaj zog.
- mob plawv mob hnyav pab kov yeej cov noob taub dag. Yuav tau noj ib txhais tes me me.
- Nkauj tshuaj ntsuab. Yuav tsum tau 1 liter dej, 1 tbsp. l. crushed aloe nplooj, 2 tbsp. l. grape nplooj, 1 tbsp. l. elecampane paus, 4 tbsp. l. hypericum paj. Boil qhov sib tov rau 15-20 feeb tshaj qis cua sov. Nws yuav siv sij hawm 30 feeb kom infuse. Nws yog ib qho tsim nyog yuav tau siv cov tshuaj peb zaug hauv ib hnub ua ntej noj mov (ib nrab teev). Rau kev kho mob, nws raug tso cai siv cov kua txiv aloe ntshiab. Nws yog noj nyob rau hauv ob peb tee diluted nyob rau hauv 1 tbsp. l. dej.
- Rawalmonds. Nws pab txo qis kev siv cov tsos mob thiab kub siab. Walnut muaj ib lub hnab ntim thiab analgesic, tshem tawm spasm. Koj tuaj yeem hloov cov khoom nrog almond roj.
- Daj liab dos. Lub taub hau ntawm zaub yuav tsum tau txiav mus rau lub xeev ntawm gruel, do nrog 1 tbsp. l. granulated qab zib thiab cia nws brew rau 10 feeb. Cov tshuaj yog siv ua ntej thiab tom qab noj mov. Lub sijhawm ntawm chav kho mob yog 2 lub hlis.
- Kua cider vinegar. Nws tuaj yeem yog 1-2 tsp. ntxiv rau tshuaj yej es tsis txhob txiv qaub, thiab kuj dilute nrog dej.
- YPropolis tincture.
Thaum siv cov zaub mov pej xeem, nws tsis pom zoo kom noj cov cawv cawv. Lawv tuaj yeem ua rau mob hnyav rau lub xeev ntawm tus neeg. Ua ntej siv tshuaj ntsuab, nws kuj yog ib qho tseem ceeb kom paub tseeb tias tus neeg mob tsis ua xua rau lawv. Qhov no muaj tseeb tshwj xeeb rau cov khoom siv muv. Qee lub sij hawm muaj kev tso cai los ua ke.
Txoj Cai Noj Qab Haus Huv
Nyob rau hauv lub xub ntiag ntawm tus kab mob gastroreflux, kev noj haus ua lub luag haujlwm tseem ceeb hauv kev tiv thaiv kev rov qab los. Nws yog ua raws li cov hauv qab no:
- cais tawm ntawm kev noj zaub mov muaj rog, ntsim thiab kib, nrog rau cov khoom noj kaus poom, ncuav qab zib;
- txiav luam yeeb thiab haus cawv, qab zib qab zib;
- koj tsis tuaj yeem haus kas fes lossis tshuaj yej dub muaj zog ntawm lub plab khoob, vim tias cov dej haus no cuam tshuam rau kev ua haujlwm ntawm cov hlab ntsha hauv qis, txo nws lub suab;
- txiv hmab txiv ntoo, dos thiab qej, txiv lws suav, chocolate tsis suav nrog hauv cov ntawv qhia;
- yuav tsum muaj nyob hauv kev noj hausfermented mis nyuj khoom, cereals, nag hmo lub khob cij, lean ntses, zaub zaub.
Cov zaub mov yuav tsum yog feem ntau thiab tsis tu ncua. Koj yuav tsum tau ua raws li kev noj haus tsis yog thaum lub sijhawm kho, tab sis kuj thaum lub sijhawm zam txim.
Yuav muaj teeb meem thiab tiv thaiv kab mob
Yog tias gastroreflux pathology tsis kho, dhau sijhawm nws yuav ua rau muaj teeb meem:
- Hloov ntawm squamous esophageal epithelium nrog ib lub cylindrical. Qhov no qhia txog kev loj hlob ntawm tus mob precancerous. Nyob rau tib lub sijhawm, qhov kev siv ntawm cov tsos mob txo qis, vim tias qhov chaw ntawm txoj hlab pas ua rau qis dua. Tus neeg mob pib xav txog kev txhim kho tus mob, vim hais tias cov cim qhia tau hais. Qhov no yog qhov txaus ntshai ntawm qhov teeb meem no.
- Ntsim los ntshav los ntawm cov ntaub so ntswg puas.
- Nyob ntawm txoj hlab pas hauv cov menyuam yaus lossis cov neeg laus. Nyob rau hauv rooj plaub no, ib nrab los yog ua tiav kev thaiv ntawm cov zaub mov tsim. Tus mob no yuav tsum tau muaj kev phais mob tam sim ntawd.
- Muaj kev pheej hmoo ntawm kev ua pa thiab mob plawv.
- Nplaim ntawm daim tawv nqaij. Lawv tsis tsuas yog ua rau tsis xis nyob xwb, tab sis kuj tiv thaiv cov zaub mov pub dawb.
Tsis yog tag nrho cov teeb meem no tuaj yeem tshem tawm sai sai. Qee tus tuaj yeem ua rau tuag taus.
Tus kab mob no tsis tso cai rau tus neeg mob ua lub neej ib txwm muaj, yog li nws yog qhov zoo dua tsis pub nws txoj kev loj hlob lossis rov tshwm sim dua. Txhawm rau ua qhov no, koj yuav tsum ua raws li kev tiv thaiv hauv qab no:
- Kev haus luam yeeb thiab haus cawv. Thiab tsis yognws tsim nyog haus luam yeeb thiab haus cawv txawm tias tom qab cov tsos mob ploj mus. Qhov no yuav ua rau rov qab los.
- Ua raws li cov hauv paus ntsiab lus ntawm kev noj zaub mov kom raug thiab tsim nyog, tshem tawm cov zaub mov tsis zoo los ntawm cov ntawv qhia zaub mov.
- Sim noj tsuas yog zaub mov sov. Cov tais diav kub los yog txias dhau tuaj yeem ua rau cov kab mob hauv cov hlab pas ua rau puas tsuaj thiab ua rau muaj kev mob hnyav.
- Tsis txhob ua haujlwm ntev ib nrab-khoov.
- Tsis txhob nqa qhov hnyav (ntau dua 10 kg), thiab tseem tsis suav nrog kev ntxhov siab hnyav ntawm cov leeg plab.
- Pw nrog tsa taub hau nkaus xwb.
- Ntau lub cev hnyav.
- Tsis txhob mus pw tom qab noj hmo. Tom qab noj mov, 2-3 teev yuav tsum dhau.
- Nws tsis pom zoo kom kho nrog dej qab zib. Yog thaum xub thawj nws pab, ces nws siv muaj qhov opposite nyhuv.
- Haus ib khob dej sov nrog txiv qaub thaum sawv ntxov. Nws yog qhov zoo tshaj los ua qhov no 15-20 feeb ua ntej noj tshais.
Kab mob Gastroreflux ntawm plab tuaj yeem tshwm sim rau txhua tus neeg, tsis hais hnub nyoog lossis poj niam txiv neej. Txawm li cas los xij, nws tuaj yeem zam tau yog tias koj ua raws li cov cai ntawm lub neej nquag thiab cov lus qhia ntawm cov kws tshaj lij.
