{"id":30239,"date":"2023-05-01T22:45:33","date_gmt":"2023-05-01T15:45:33","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30239"},"modified":"2023-05-01T22:45:33","modified_gmt":"2023-05-01T15:45:33","slug":"viem-noi-tam-mac-nhiem-khuan-va-bieu-hien-lam-sang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/01\/viem-noi-tam-mac-nhiem-khuan-va-bieu-hien-lam-sang\/","title":{"rendered":"Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n v\u00e0 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng"},"content":{"rendered":"

Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u00e2\u0309n<\/a> (VNTMNK)\u00a0(infective endocarditis)<\/em>\u00a0l\u00e0 nhi\u1ec5m khu\u00e2\u0309n m\u00e0ng trong c\u1ee7a tim do vi khu\u1ea9n ho\u1eb7c vi n\u1ea5m, v\u00e0 m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p hi\u1ebfm do Chlamydia hay Rickettsia. <\/strong><\/p>\n

1. \u0110\u1ecbnh ngh\u0129a<\/h2>\n

Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u00e2\u0309n (VNTMNK)\u00a0(infective endocarditis)<\/em>\u00a0l\u00e0 nhi\u1ec5m khu\u00e2\u0309n m\u00e0ng trong c\u1ee7a tim do vi khu\u1ea9n ho\u1eb7c vi n\u1ea5m, v\u00e0 m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p hi\u1ebfm do Chlamydia hay Rickettsia. Nhi\u1ec5m khu\u00e2\u0309n m\u00e0ng trong c\u1ee7a \u0111\u1ed9ng m\u1ea1ch (shunt \u0111\u1ed9ng \u2013 t\u0129nh m\u1ea1ch, \u1ed1ng \u0111\u1ed9ng m\u1ea1ch c\u00f2n t\u1ed3n t\u1ea1i, h\u1eb9p eo \u0111\u1ed9ng m\u1ea1ch ch\u1ee7) tuy g\u1ecdi \u0111\u00fang t\u00ean l\u00e0 vi\u00eam n\u1ed9i m\u1ea1c \u0111\u1ed9ng m\u1ea1ch nhi\u1ec5m khu\u00e2\u0309n\u00a0(infective endarteritis)<\/em>\u00a0nh\u01b0ng v\u1ec1 l\u00e2m s\u00e0ng v\u00e0 b\u1ec7nh h\u1ecdc c\u0169ng gi\u1ed1ng VNTMNK.<\/p>\n

\"Vi\u00eam<\/p>\n

Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u00e2\u0309n<\/strong><\/p>\n

2. T\u00e2\u0300n su\u00e2\u0301t m\u0103\u0301c b\u00ea\u0323nh<\/strong>:<\/h2>\n
    \n
  • T\u00e2\u0300n su\u00e2\u0301t m\u1eafc b\u1ec7nh trung b\u00ecnh l\u00e0 3-6\/100.000 ng\u01b0\u1eddi v\u00e0 \u1edf ng\u01b0\u1eddi ti\u00eam ch\u00edch ma t\u00fay l\u00e0 1.6\/100.000 ng\u01b0\u1eddi m\u1ed7i n\u0103m.<\/li>\n
  • Tu\u1ed5i trung b\u00ecnh t\u1eeb 36-69, t\u00e2\u0300n su\u00e2\u0301t m\u0103\u0301c b\u1ec7nh t\u0103ng theo tu\u1ed5i (5\/100.000 ng\u01b0\u1eddi \u1edf \u0111\u1ed9 tu\u1ed5i d\u01b0\u1edbi 50 tu\u1ed5i; 15\/100.000 ng\u01b0\u1eddi \u0111\u1ed9 tu\u1ed5i tr\u00ean 65); ti\u0309 l\u1ec7 nam\/n\u1eef l\u00e0 2\/1; ti\u0309 l\u1ec7 t\u1eed vong trung b\u00ecnh trong b\u1ec7nh vi\u1ec7n l\u00e0 16% (11-26%).<\/li>\n
  • Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n (VNTMNK) r\u1ea5t \u0111a d\u1ea1ng – ph\u1ee5 thu\u1ed9c v\u00e0o t\u1ed5n th\u01b0\u01a1ng c\u1ea5u tr\u00fac tim, \u0111\u1ed9c l\u1ef1c vi khu\u1ea9n v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 ngo\u00e0i tim. M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n nhi\u1ec5m li\u00ean c\u1ea7u th\u01b0\u1eddng c\u00f3 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng k\u00edn \u0111\u00e1o; trong khi b\u1ec7nh nh\u00e2n nhi\u1ec5m t\u1ee5 c\u1ea7u v\u00e0ng th\u01b0\u1eddng c\u00f3 d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng r\u1ea7m r\u1ed9.<\/li>\n
  • Tr\u00ean l\u00e2m s\u00e0ng, c\u1ea7n ngh\u0129 \u0111\u1ebfn VNTMNK n\u1ebfu c\u00f3 tam ch\u1ee9ng Osler<\/strong>: S\u1ed1t, thi\u1ebfu m\u00e1u, ti\u1ebfng th\u1ed5i m\u1edbi \u1edf tim.<\/li>\n<\/ul>\n

    3. Tri\u1ec7u ch\u1ee9ng t\u1ea1i tim m\u1ea1ch<\/h2>\n

    Ti\u1ebfng th\u1ed5i m\u1edbi xu\u1ea5t hi\u1ec7n t\u1ea1i tim do t\u1ed5n th\u01b0\u01a1ng van tim, d\u00e2y ch\u1eb1ng v\u00e0 c\u1ea5u tr\u00fac c\u01a1 tim; c\u00f3 th\u1ec3 g\u00e2y suy tim ti\u1ebfn tri\u1ec3n, ph\u00f9 ph\u1ed5i c\u1ea5p, s\u1ed1c tim.<\/p>\n

    Block n\u00fat nh\u0129 th\u1ea5t \u0111\u1ed9 cao (x\u1ea3y ra \u1edf 2 – 4% b\u1ec7nh nh\u00e2n vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n).<\/p>\n

    Nh\u1ecbp tim nhanh, t\u1ee5t huy\u1ebft \u00e1p (trong b\u1ec7nh c\u1ea3nh s\u1ed1c nhi\u1ec5m khu\u1ea9n).<\/p>\n

    \u00c1p xe t\u1ed5 ch\u1ee9c c\u1ea1nh van tim c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf 25% \u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, 1 – 5% \u1edf van hai l\u00e1 nh\u01b0ng hi\u1ebfm khi x\u1ea3y ra \u1edf van ba l\u00e1, hay g\u1eb7p nh\u1ea5t \u1edf van nh\u00e2n t\u1ea1o. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a \u00e1p xe kh\u00e1 r\u1ea7m r\u1ed9 v\u1edbi bi\u1ec3u hi\u1ec7n c\u1ee7a nhi\u1ec5m khu\u1ea9n h\u1ec7 th\u1ed1ng.<\/p>\n

    Vi\u00eam m\u00e0ng ngo\u00e0i tim: b\u1ec7nh nh\u00e2n \u0111au ng\u1ef1c, nghe tim c\u00f3 ti\u1ebfng c\u1ecd m\u00e0ng ngo\u00e0i tim.<\/p>\n

    4. C\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng do l\u1eafng \u0111\u1ecdng ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch<\/h2>\n
      \n
    • T\u1ea1i da: Ch\u1ea5m xu\u1ea5t huy\u1ebft (th\u01b0\u1eddng g\u1eb7p nh\u1ea5t), xu\u1ea5t huy\u1ebft d\u01b0\u1edbi m\u00f3ng tay; n\u1ed1t Osler; t\u1ed5n th\u01b0\u01a1ng Janeway.<\/li>\n
    • T\u1ea1i m\u1eaft: N\u1ed1t Roth, xu\u1ea5t huy\u1ebft k\u1ebft m\u1ea1c, xu\u1ea5t huy\u1ebft v\u00f5ng m\u1ea1c h\u00ecnh ng\u1ecdn l\u1eeda. T\u1ea1i th\u1eadn: \u0110\u00e1i m\u00e1u vi th\u1ec3, vi\u00eam c\u1ea7u th\u1eadn, suy th\u1eadn.<\/li>\n
    • T\u1ea1i n\u00e3o: B\u1ec7nh n\u00e3o nhi\u1ec5m \u0111\u1ed9c.<\/li>\n
    • T\u1ea1i c\u01a1 x\u01b0\u01a1ng kh\u1edbp: \u0110au kh\u1edbp, vi\u00eam kh\u1edbp.<\/li>\n<\/ul>\n

      5. D\u1ea5u hi\u1ec7u nhi\u1ec5m khu\u1ea9n h\u1ec7 th\u1ed1ng<\/h2>\n

      5.1 Tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n<\/h3>\n

      C\u1ea3m gi\u00e1c m\u1ec7t m\u1ecfi, ch\u00e1n \u0103n, g\u1ea7y s\u00fat c\u00e2n.<\/p>\n

      S\u1ed1t, gai r\u00e9t ho\u1eb7c r\u00e9t run, ra m\u1ed3 h\u00f4i tr\u1ed9m; s\u1ed1t c\u00f3 th\u1ec3 k\u00e9o d\u00e0i nhi\u1ec1u tu\u1ea7n – nhi\u1ec1u th\u00e1ng n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb.<\/p>\n

      T\u00ecnh tr\u1ea1ng nhi\u1ec5m khu\u1ea9n k\u00e9o d\u00e0i <\/em>g\u00e2y thi\u1ebfu m\u00e1u<\/em>, ng\u00f3n tay d\u00f9i tr\u1ed1ng, l\u00e1ch to.<\/p>\n

      Tri\u1ec7u ch\u1ee9ng c\u1ee7a \u1ed5 nhi\u1ec5m khu\u1ea9n nguy\u00ean ph\u00e1t: V\u00f9ng r\u0103ng mi\u1ec7ng, h\u1ecdng, da, \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p, \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, ti\u1ebft ni\u1ec7u…<\/p>\n

      5.2 Thuy\u00ean t\u1eafc m\u1ea1ch do nhi\u1ec5m khu\u1ea9n<\/h3>\n

      Thuy\u00ean t\u1eafc m\u1ea1ch h\u1ec7 th\u1ed1ng c\u00f3 th\u1ec3 g\u1eb7p t\u1eeb 20 – 45% b\u1ec7nh nh\u00e2n v\u00e0 c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf b\u1ea5t c\u1ee9 v\u1ecb tr\u00ed n\u00e0o (\u0111\u1ed9ng m\u1ea1ch n\u00e3o, chi, m\u1ea1ch v\u00e0nh, gan, th\u1eadn, l\u00e1ch, m\u1ea1c treo…)<\/p>\n

      Thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i g\u1eb7p trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c \u1edf van ba l\u00e1. 40% b\u1ec7nh nh\u00e2n \u0111\u00e3 ti\u1ec1n s\u1eed huy\u1ebft kh\u1ed1i c\u00f3 th\u1ec3 b\u1ecb huy\u1ebft kh\u1ed1i t\u00e1i ph\u00e1t.<\/p>\n

      Nguy c\u01a1 thuy\u00ean t\u1eafc m\u1ea1ch ph\u1ee5 thu\u1ed9c v\u00e0o vi khu\u1ea9n (ph\u1ed5 bi\u1ebfn v\u1edbi nhi\u1ec5m vi khu\u1ea9n Gram \u00e2m, t\u1ee5 c\u1ea7u v\u00e0ng ho\u1eb7c n\u1ea5m Candida) v\u00e0 k\u00edch th\u01b0\u1edbc c\u1ee5c s\u00f9i (g\u1eb7p \u1edf 30% b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ea5y s\u00f9i tr\u00ean si\u00eau \u00e2m tim, 40% v\u1edbi s\u00f9i < 5 mm v\u00e0 65% v\u1edbi s\u00f9i > 5 mm).<\/p>\n

      Khai th\u00e1c k\u1ef9 v\u1ec1 ti\u1ec1n s\u1eed b\u1ec7nh nha khoa, nhi\u1ec5m khu\u1ea9n, ph\u0201u thu\u1eadt, d\u00f9ng thu\u1ed1c \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch, d\u1ee5ng c\u1ee5 can thi\u1ec7p gi\u00fap \u0111\u1ecbnh h\u01b0\u1edbng vi khu\u1ea9n g\u00e2y b\u1ec7nh.<\/p>\n

      C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n<\/p>\n\n\n\n\n\n\n\n\n\n\n
      \u00a0<\/strong><\/p>\n

      \u00a0<\/strong><\/p>\n

      \u00a0<\/strong><\/p>\n

      \u00a0<\/strong><\/p>\n

      \u00a0<\/strong><\/p>\n

      \u00a0<\/strong><\/p>\n

      Nguy c\u01a1 cao<\/strong><\/td>\n

      		\u00a0<\/strong><\/p>\n

      Van tim nh\u00e2n t\u1ea1o.<\/p>\n

      Ti\u1ec1n s\u1eed vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n. B\u1ec7nh l\u00fd van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.<\/p>\n

      H\u1edf van hai l\u00e1 ho\u1eb7c b\u1ec7nh van hai l\u00e1 ph\u1ed1i h\u1ee3p (h\u1eb9p v\u00e0 h\u1edf). B\u1ec7nh tim b\u1ea9m sinh c\u00f3 t\u00edm.<\/p>\n

      C\u00f2n \u1ed1ng \u0111\u1ed9ng m\u1ea1ch.<\/p>\n

      B\u1ec7nh tim b\u1ea9m sinh shunt tr\u00e1i – ph\u1ea3i ch\u01b0a \u0111\u01b0\u1ee3c s\u1eeda ch\u1eefa (tr\u1eeb th\u00f4ng li\u00ean nh\u0129)<\/p>\n

      T\u1ed3n t\u1ea1i shunt trong tim v\u00e0 shunt ch\u1ee7 – ph\u1ed5i.<\/td>\n<\/tr>\n

      <\/td>\nH\u1eb9p van hai l\u00e1 \u0111\u01a1n \u0111\u1ed9c.<\/td>\n<\/tr>\n
      <\/td>\nSa van hai l\u00e1 g\u00e2y ra d\u00f2ng ph\u1ee5t ng\u01b0\u1ee3c ho\u1eb7c van x\u01a1 c\u1ee9ng.<\/td>\n<\/tr>\n
      <\/td>\nB\u1ec7nh van ba l\u00e1.<\/td>\n<\/tr>\n
      \u00a0<\/strong><\/p>\n

      Nguy c\u01a1 trung<\/strong><\/p>\n

      b\u00ecnh<\/strong><\/td>\n

      		H\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.<\/p>\n

      B\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i.<\/td>\n<\/tr>\n

      <\/td>\nVan \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 hai l\u00e1 van.<\/td>\n<\/tr>\n
      <\/td>\nTho\u00e1i ho\u00e1 van \u1edf ng\u01b0\u1eddi gi\u00e0.<\/td>\n<\/tr>\n
      <\/td>\nHuy\u1ebft kh\u1ed1i bu\u1ed3ng tim (sau nh\u1ed3i m\u00e1u c\u01a1 tim).<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

       <\/p>\n\n\n\n\n
      Nguy c\u01a1 th\u1ea5p<\/strong><\/td>\nB\u1ea5t th\u01b0\u1eddng van ba l\u00e1 kh\u00f4ng g\u00e2y h\u1eb9p\/h\u1edf van.<\/p>\n

      Sa van hai l\u00e1 nh\u01b0ng kh\u00f4ng g\u00e2y ra d\u00f2ng ph\u1ee5t ng\u01b0\u1ee3c. Th\u00f4ng li\u00ean nh\u0129 \u0111\u01a1n \u0111\u1ed9c.<\/p>\n

      B\u1ec7nh tim b\u1ea9m sinh c\u00f3 shunt tr\u00e1i – ph\u1ea3i \u0111\u00e3 ph\u0201u thu\u1eadt s\u1eeda ch\u1eefa,<\/p>\n

      kh\u00f4ng c\u00f2n shunt t\u1ed3n d\u01b0.<\/p>\n

      Canxi ho\u00e1 v\u00f2ng van hai l\u00e1.<\/p>\n

      Ti\u1ec1n s\u1eed b\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 v\u00e0\/ho\u1eb7c c\u1ea7u n\u1ed1i ch\u1ee7 v\u00e0nh. M\u00e1y t\u1ea1o nh\u1ecbp v\u0129nh vi\u1ec5n.<\/p>\n

      U nh\u1ea7y nh\u0129 tr\u00e1i.<\/td>\n<\/tr>\n

      C\u00e1c y\u1ebfu t\u1ed1 t\u0103ng nguy c\u01a1 vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n<\/strong><\/p>\n

      C\u00f3 \u0111o\u1ea1n m\u1ea1ch nh\u00e2n t\u1ea1o ho\u1eb7c th\u00f4ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch.<\/p>\n

      Ti\u1ec1n s\u1eed nhi\u1ec5m khu\u1ea9n, v\u00ed d\u1ee5: S\u1eed d\u1ee5ng thu\u1ed1c \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch, vi\u00eam quanh r\u0103ng n\u1eb7ng, ung th\u01b0 bi\u1ec3u m\u00f4 \u0111\u1ea1i tr\u00e0ng.<\/p>\n

      \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng, suy th\u1eadn, nghi\u1ec7n r\u01b0\u1ee3u, suy gi\u1ea3m mi\u1ec5n d\u1ecbch. \u0110\u1eb7t \u0111\u01b0\u1eddng truy\u1ec1n trung t\u00e2m g \u1ea7n \u0111\u00e2y.<\/p>\n

      Trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c y\u1ebfu t\u1ed1 nguy c\u01a1 r\u00f5 r\u00e0ng.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

      6. K\u1ebft lu\u1eadn<\/h2>\n

      Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd nghi\u00eam tr\u1ecdng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn m\u1ea1ch m\u00e1u v\u00e0 c\u01a1 tim. B\u1ec7nh g\u00e2y ra s\u1ef1 vi\u00eam nhi\u1ec5m c\u1ee7a n\u1ed9i t\u00e2m m\u1ea1c do vi khu\u1ea9n x\u00e2m nh\u1eadp v\u00e0o c\u01a1 th\u1ec3. Tri\u1ec7u ch\u1ee9ng bao g\u1ed3m s\u1ed1t cao, \u0111au ng\u1ef1c, m\u1ec7t m\u1ecfi v\u00e0 kh\u00f3 th\u1edf. N\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi, vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m nh\u01b0 suy tim, nhi\u1ec5m tr\u00f9ng m\u00e1u v\u00e0 th\u1eadm ch\u00ed l\u00e0 t\u1eed vong.<\/p>\n

       <\/p>\n","protected":false},"excerpt":{"rendered":"

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