{"id":30242,"date":"2023-05-03T14:59:29","date_gmt":"2023-05-03T07:59:29","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30242"},"modified":"2023-05-03T14:59:29","modified_gmt":"2023-05-03T07:59:29","slug":"can-lam-sang-chan-doan-viem-noi-tam-mac-nhiem-khuan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/can-lam-sang-chan-doan-viem-noi-tam-mac-nhiem-khuan\/","title":{"rendered":"Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n v\u00e0 c\u1eadn 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. C\u1eadn l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n<\/h2>\n\n\n\n\n\n\n\n
C\u1eadn l\u00e2m s\u00e0ng<\/strong><\/td>\nCh\u00fa \u00fd<\/strong><\/td>\n<\/tr>\n
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C\u1ea5y m\u00e1u<\/strong><\/td>\n

–\u00a0 C\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t, <\/em>tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng kh\u00e1ng sinh, kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o s\u1ed1t.<\/em><\/p>\n

–\u00a0 T\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c c\u1ea5y m\u00e1u t\u1ed1i thi\u1ec3u 3 l\u1ea7n<\/em>, m\u1ed7i l\u1ea7n 2 v\u1ecb tr\u00ed kh\u00e1c nhau, c\u00e1ch \u00edt nh\u1ea5t 30 ph\u00fat, tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb<\/p>\n

kh\u00e1ng sinh; t\u1ed1i thi\u1ec3u l\u1ea5y \u0111\u01b0\u1ee3c 10ml m\u00e1u\/chai, b\u1ec7nh ph\u1ea9m c\u1ea7n \u0111\u01b0\u1ee3c nu\u00f4i c\u1ea5y trong c\u1ea3 m\u00f4i tr\u01b0\u1eddng k\u1ef5 kh\u00ed v\u00e0 hi\u1ebfu kh\u00ed.<\/p>\n

–\u00a0 \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh, xem x\u00e9t tr\u00ec ho\u00e3n li\u1ec1u \u0111i\u1ec1u tr\u1ecb ti\u1ebfp theo \u0111\u1ec3 c\u1ea5y m\u00e1u.<\/p>\n

–\u00a0 Khi \u0111\u00e3 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c c\u0103n nguy\u00ean vi khu\u1ea9n, c\u00f3 th\u1ec3 c\u1ea5y m\u00e1u l\u1ea1i<\/p>\n

sau 48 – 72 gi\u1edd \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n

–\u00a0 C\u1ea7n y\u00eau c\u1ea7u nu\u00f4i c\u1ea5y k\u00e9o d\u00e0i (c\u1ea5y n\u1ea5m) tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n nghi ng\u1edd VNTMNK tr\u00ean van nh\u00e2n t\u1ea1o, c\u00f3 ti\u1ec1n s\u1eed d\u00f9ng thu\u1ed1c \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch, nh\u1eefng b\u1ec7nh nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch.<\/td>\n<\/tr>\n

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Si\u00eau \u00e2m tim<\/strong><\/td>\n

–\u00a0 Si\u00eau \u00e2m tim qua th\u00e0nh ng\u1ef1c (SATQTN) c\u00f3 th\u1ec3 quan s\u00e1t, \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c c\u00e1c t\u1ed5n th\u01b0\u01a1ng van tim (th\u01b0\u1eddng g\u1eb7p h\u1edf van) v\u00e0\/ho\u1eb7c h\u00ecnh \u1ea3nh t\u1ed5 ch\u1ee9c s\u00f9i k\u00edch th\u01b0\u1edbc > 2 mm.<\/p>\n

–\u00a0 Si\u00eau \u00e2m \u0111\u00e1nh gi\u00e1 c\u00e1c bi\u1ebfn ch\u1ee9ng: Th\u1ee7ng\/ r\u00e1ch l\u00e1 van, \u0111\u1ee9t d\u00e2y ch\u1eb1ng c\u1ed9t c\u01a1, t\u1ed5n th\u01b0\u01a1ng v\u00f2ng van, h\u1edf c\u1ea1nh ch\u00e2n van.<\/p>\n

–\u00a0 Si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n (SATQTQ) nh\u1ea1y h\u01a1n cho t\u1ed5n<\/p>\n

th\u01b0\u01a1ng \u00e1p xe g\u1ed1c \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 van hai l\u00e1, th\u01b0\u1eddng \u00e1p d\u1ee5ng khi si\u00eau \u00e2m qua th\u00e0nh ng\u1ef1c m\u1edd. SATQTQ c\u0169ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh<\/p>\n

tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n \u0111ang mang v\u1eadt li\u1ec7u nh\u00e2n t\u1ea1o (van tim, thi\u1ebft b\u1ecb c\u1ea5y gh\u00e9p trong tim).<\/p>\n

–\u00a0 Si\u00eau \u00e2m tim b\u00ecnh th\u01b0\u1eddng c\u0169ng kh\u00f4ng lo\u1ea1i tr\u1eeb \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n.<\/p>\n

–\u00a0 SATQTN ho\u1eb7c SATQTQ n\u00ean l\u1eb7p l\u1ea1i sau 5 – 7 ng\u00e0y trong tr\u01b0\u1eddng h\u1ee3p SATQTQ ban \u0111\u1ea7u c\u0169ng kh\u00f4ng quan s\u00e1t th\u1ea5y t\u1ed5 ch\u1ee9c s\u00f9i nh\u01b0ng tr\u00ean l\u00e2m s\u00e0ng v\u0201n c\u00f3 nghi ng\u1edd.<\/td>\n<\/tr>\n

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

C\u00f4ng th\u1ee9c m\u00e1u<\/strong><\/td>\n

Thi\u1ebfu m\u00e1u h\u1ed3ng c\u1ea7u \u0111\u1eb3ng s\u1eafc (c\u1ea7n lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n thi\u1ebfu m\u00e1u kh\u00e1c), t\u0103ng b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh, c\u00f3 th\u1ec3 c\u00f3 gi\u1ea3m ti\u1ec3u c\u1ea7u.<\/td>\n<\/tr>\n
\u00a0<\/strong><\/p>\n

Ure v\u00e0 \u0111i\u1ec7n gi\u1ea3i<\/strong><\/td>\n

Suy th\u1eadn, c\u00f3 th\u1ec3 k\u00e8m theo r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i (c\u1ea7n ki\u1ec3m tra \u0111i\u1ec7n gi\u1ea3i nhi\u1ec1u l\u1ea7n trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb).<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\u00a0<\/strong><\/p>\n

Ch\u1ee9c n\u0103ng gan<\/strong><\/td>\n

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

C\u00f3 th\u1ec3 t\u0103ng ALT, AST, GGT.<\/td>\n<\/tr>\n

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

M\u00e1u l\u1eafng\/CRP<\/strong><\/td>\n

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

T\u0103ng trong pha c\u1ea5p c\u1ee7a nhi\u1ec5m khu\u1ea9n.<\/td>\n<\/tr>\n

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N\u01b0\u1edbc ti\u1ec3u<\/strong><\/td>\n

–\u00a0\u00a0 H\u1ed3ng c\u1ea7u ni\u1ec7u vi th\u1ec3, c\u00f3 th\u1ec3 c\u00f3 protein ni\u1ec7u.<\/p>\n

–\u00a0 C\u1ea5y n\u01b0\u1edbc ti\u1ec3u n\u1ebfu c\u00f3 nghi ng\u1edd nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u.<\/td>\n<\/tr>\n

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Mi\u1ec5n d\u1ecbch<\/strong><\/td>\n

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

– T\u0103ng \u0111a d\u00f2ng Ig huy\u1ebft thanh, b\u1ed5 th\u1ec3.<\/td>\n<\/tr>\n

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

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

\u0110i\u1ec7n t\u00e2m \u0111\u1ed3<\/strong><\/td>\n

– Block nh\u0129 th\u1ea5t ho\u1eb7c r\u1ed1i lo\u1ea1n d\u0201n truy\u1ec1n (hay g\u1eb7p trong \u00e1p<\/p>\n

xe g\u1ed1c \u0111\u1ed9ng m\u1ea1ch ch\u1ee7).<\/p>\n

–\u00a0\u00a0 Bi\u1ebfn \u0111\u1ed5i kh\u00f4ng \u0111\u1eb7c hi\u1ec7u ST\/T.<\/p>\n

–\u00a0\u00a0 Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p (hi\u1ebfm g\u1eb7p).<\/td>\n<\/tr>\n

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X-quang ng\u1ef1c<\/strong><\/td>\n

C\u00f3 th\u1ec3 b\u00ecnh th\u01b0\u1eddng ho\u1eb7c d\u1ea5u hi\u1ec7u c\u1ee7a ph\u00f9 ph\u1ed5i n\u1ebfu suy tim c\u1ea5p. Ngo\u00e0i ra c\u00f3 th\u1ec3 t\u00ecm th\u1ea5y c\u00e1c t\u1ed5n th\u01b0\u01a1ng nhi\u1ec5m khu\u1ea9n \u0111a \u1ed5 t\u1ea1i ph\u1ed5i ho\u1eb7c c\u00e1c d\u1ea5u hi\u1ec7u do thuy\u00ean t\u1eafc nhi\u1ec5m khu\u1ea9n (VNTMNK van ba l\u00e1).<\/td>\n<\/tr>\n
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C\u1ed9ng h\u01b0\u1edfng t\u1eeb<\/strong><\/td>\n

–\u00a0 \u0110\u00e1nh gi\u00e1 t\u1ed5 ch\u1ee9c c\u1ea1nh van, gi\u1ea3 ph\u00ecnh g\u1ed1c \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/p>\n

v\u00e0 r\u00f2.<\/p>\n

–\u00a0 Ph\u00e1t hi\u1ec7n c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u1edf n\u00e3o \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng.<\/td>\n<\/tr>\n

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Kh\u00e1m r\u0103ng h\u00e0m m\u1eb7t<\/strong><\/td>\n

T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c ch\u1ee5p phim X-quang r\u0103ng to\u00e0n c\u1ea3nh v\u00e0 c\u00f3 \u00fd ki\u1ebfn c\u1ee7a nha s\u0129.<\/td>\n<\/tr>\n
\u00a0<\/strong><\/p>\n

Kh\u00e1m da<\/strong><\/td>\n

Ph\u00e1t hi\u1ec7n c\u00e1c t\u1ed5n th\u01b0\u01a1ng da b\u1ea5t k\u1ef3 v\u1ecb tr\u00ed n\u00e0o c\u00f3 kh\u1ea3 n\u0103ng nhi\u1ec5m khu\u1ea9n.<\/td>\n<\/tr>\n
\u00a0<\/strong><\/p>\n

Th\u00f4ng kh\u00ed\/t\u01b0\u1edbi m\u00e1u<\/strong><\/p>\n

V\/Q scan<\/strong><\/td>\n

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

Ph\u00e1t hi\u1ec7n t\u1eafc m\u1ea1ch ph\u1ed5i trong tr\u01b0\u1eddng h\u1ee3p vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n c\u00e1c van b\u00ean ph\u1ea3i.<\/td>\n<\/tr>\n

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Ph\u1ea3n \u1ee9ng huy\u1ebft thanh<\/strong><\/td>\n

K\u1ebft t\u1ee7a Aspergillus; kh\u00e1ng th\u1ec3 Candida (t\u0103ng hi\u1ec7u gi\u00e1); test ng\u01b0ng k\u1ebft b\u1ed5 th\u1ec3 \u0111\u1eb7c hi\u1ec7u cho Coxiella burnetii, Chlamydia; kh\u00e1ng th\u1ec3 Brucella agglutinins, Legionella, Bartonella.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n\n
Si\u00eau \u00e2m \u1ed5 b\u1ee5ng, m\u1ea1ch t\u1ea1ng, chi, c\u1ea3nh<\/strong><\/td>\n–\u00a0\u00a0 T\u00ecm \u1ed5 nhi\u1ec5m tr\u00f9ng trong \u1ed5 b\u1ee5ng (n\u1ebfu c\u00f3).<\/p>\n

–\u00a0\u00a0 \u0110\u00e1nh gi\u00e1 c\u00e1c bi\u1ebfn c\u1ed1 t\u1eafc m\u1ea1ch do c\u1ee5c s\u00f9i b\u1eafn \u0111i.<\/td>\n<\/tr>\n

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

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

Ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh<\/strong><\/td>\n

–\u00a0\u00a0\u00a0 Ch\u1ea9n \u0111o\u00e1n v\u00e0 can thi\u1ec7p trong tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd c\u00f3 bi\u1ebfn c\u1ed1 t\u1eafc \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p do c\u1ee5c s\u00f9i b\u1eafn \u0111i.<\/p>\n

–\u00a0\u00a0\u00a0 Ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh tr\u01b0\u1edbc m\u1ed5 tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 c\u1ee7a b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch v\u00e0nh k\u00e8m theo.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

B\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng c\u1ee7a VNTMNK r\u1ea5t \u0111a d\u1ea1ng, kh\u00f4ng \u0111\u1eb7c hi\u1ec7u v\u00e0 kh\u00f3 ch\u1ea9n \u0111o\u00e1n.<\/p>\n

C\u1ea7n ngh\u0129 \u0111\u1ebfn VNTMNK \u1edf b\u1ec7nh nh\u00e2n c\u00f3 s\u1ed1t k\u00e9o d\u00e0i ch\u01b0a r\u00f5 nguy\u00ean nh\u00e2n, thi\u1ebfu m\u00e1u, d\u1ea5u hi\u1ec7u t\u1ed5n th\u01b0\u01a1ng tim (nh\u01b0 ti\u1ebfng th\u1ed5i m\u1edbi xu\u1ea5t hi\u1ec7n), nhi\u1ec5m khu\u1ea9n huy\u1ebft v\u00e0 t\u1eafc m\u1ea1ch.<\/p>\n

3. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n VNTMNK c\u1ee7a Duke s\u1eeda \u0111\u1ed5i<\/h2>\n

\u0110\u01b0\u1ee3c ph\u00e1t tri\u1ec3n v\u00e0o n\u0103m 1994, \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eeda \u0111\u1ed5i v\u00e0 b\u1ed5 sung n\u0103m 2000, c\u00f3 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 99% v\u00e0 \u0111\u1ed9 nh\u1ea1y kho\u1ea3ng 92%.<\/p>\n

3.1 Ti\u00eau chu\u1ea9n ch\u00ednh: Hai ti\u00eau chu\u1ea9n<\/h3>\n

C\u1ea5y m\u00e1u d\u01b0\u01a1ng t\u00ednh:<\/strong><\/p>\n

Ph\u00e2n l\u1eadp \u0111\u01b0\u1ee3c l\u1ecda i khu\u1ea9n \u0111i\u1ec3n h\u00ecnh g\u00e2y VNTMN K t\u1eeb 2 m\u0201u c\u1ea5y m\u00e1u ri\u00eang bi\u1ec7t:<\/p>\n

Strep. viridans, S trep. bovis, nh\u00f3m HACEK (g\u1ed3m Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, v\u00e0 Kingella spp.), Staphylococcus aureus , ho\u1eb7c Enterococci m\u1eafc ph\u1ea3i t\u1eeb c\u1ed9ng \u0111\u1ed3ng m\u00e0 kh\u00f4ng c\u00f3 \u1ed5 nhi\u1ec5m khu\u1ea9n nguy\u00ean ph\u00e1t.<\/p>\n

C\u1ea5y m\u00e1u d\u01b0\u01a1ng t\u00ednh dai d\u1eb3ng:<\/strong><\/p>\n

D\u01b0\u01a1ng t\u00ednh \u2265 2 m\u0201u c\u1ea5y m\u00e1u l\u1ea5y c\u00e1ch nhau > 12 gi\u1edd, ho\u1eb7c<\/p>\n

C\u1ea3 3 hay \u0111a s\u1ed1 trong \u2265 4 m\u0201u c\u1ea5y m\u00e1u ri\u00eang bi\u1ec7t (m\u0201u \u0111\u1ea7u v\u00e0 m\u0201u cu\u1ed1i l\u1ea5y c\u00e1ch nhau \u00edt nh\u1ea5t 1 gi\u1edd).<\/p>\n

M\u1ed9t m\u0201u c\u1ea5y m\u00e1u d\u01b0\u01a1ng t\u00ednh v\u1edbi Coxiella Burnetii ho\u1eb7c n\u1ed3ng \u0111\u1ed9 kh\u00e1ng th\u1ec3 IgG pha 1 cho C. Burnetti > 1:800.<\/p>\n

H\u00ecnh \u1ea3nh h\u1ecdc d\u01b0\u01a1ng t\u00ednh (*):<\/strong><\/p>\n

Si\u00eau \u00e2m tim d\u01b0\u01a1ng t\u00ednh:<\/p>\n

T\u1ed5 ch\u1ee9c s\u00f9i di \u0111\u1ed9ng trong bu\u1ed3ng tim. \u00c1p xe, gi\u1ea3 ph\u00ecnh, r\u00f2.<\/p>\n

H\u1edf c\u1ea1nh ch\u00e2n van tim nh\u00e2n t\u1ea1o m\u1edbi. H\u1edf van m\u1edbi xu\u1ea5t hi\u1ec7n.<\/p>\n

3.2 Ti\u00eau chu\u1ea9n ph\u1ee5: 5 ti\u00eau chu\u1ea9n<\/h3>\n
    \n
  • B\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 VNTMNK (B\u1ea3ng 7.1) ho\u1eb7c s\u1eed d\u1ee5ng thu\u1ed1c \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch. S\u1ed1t > 38 \u0111\u1ed9 C.<\/li>\n
  • T\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u: Thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch h\u1ec7 th\u1ed1ng, thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i nhi\u1ec5m khu\u1ea9n, ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch h\u00ecnh n\u1ea5m, xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd, xu\u1ea5t huy\u1ebft k\u1ebft m\u1ea1c, t\u1ed5n th\u01b0\u01a1ng Janeway.<\/li>\n
  • C\u00e1c d\u1ea5u hi\u1ec7u mi\u1ec5n d\u1ecbch: Vi\u00eam c\u1ea7u th\u1eadn, n\u1ed1t Osler, v\u1ebft Roth, y\u1ebfu t\u1ed1 d\u1ea1ng th\u1ea5p (+).<\/li>\n
  • B\u1eb1ng ch\u1ee9ng nhi\u1ec5m khu\u1ea9n: C\u1ea5y m\u00e1u d\u01b0\u01a1ng t\u00ednh nh\u01b0ng kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111\u01b0\u1ee3c ti\u00eau ch u\u1ea9n ch\u00ednh ho\u1eb7c c\u00f3 b\u1eb1ng ch\u1ee9ng huy\u1ebft thanh h\u1ecdc v\u1ec1 vi khu\u1ea9n ph\u00f9 h\u1ee3p v\u1edbi vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n.<\/li>\n<\/ul>\n

    6. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/h2>\n

    Ch\u1ea9n \u0111o\u00e1n VNTMNK ch\u1eafc ch\u1eafn: 2 ti\u00eau chu\u1ea9n ch\u00ednh<\/u> <\/strong>ho\u1eb7c 1 ti\u00eau chu\u1ea9n ch\u00ednh + 3 ti\u00eau<\/u> chu\u1ea9n ph\u1ee5<\/u> <\/strong>ho\u1eb7c 5 ti\u00eau chu\u1ea9n ph\u1ee5<\/u><\/strong><\/p>\n

    Ch\u1ea9n \u0111o\u00e1n VNTMNK c\u00f3 kh\u1ea3 n\u0103ng: 1 ti\u00eau chu\u1ea9n ch\u00ednh + 1 ti\u00eau chu\u1ea9n ph\u1ee5 <\/u><\/strong>ho\u1eb7c 3 ti\u00eau<\/u> chu\u1ea9n ph\u1ee5.<\/u><\/strong><\/p>\n

    Ch\u1ea9n \u0111o\u00e1n Jo\u1ea1i tr\u1eeb VNTMNK: C\u00f3 ch\u1ea9n \u0111o\u00e1n thay th\u1ebf kh\u00e1c; c\u00e1c tri\u1ec7u ch\u1ee9ng th uy\u00ean gi\u1ea3m sau \u2264 4 ng\u00e0y d\u00f9ng9 kh\u00e1ng sinh; k h\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng gi\u1ea3i ph\u0201u c\u1ee7a VNTMNK tr\u00ean ph\u0201u thu\u1eadt hay gi\u1ea3i ph\u0201u b\u1ec7nh; k h\u00f4ng c\u00f3 ti\u00eau chu\u1ea9n nghi ng\u1edd VNTMNK nh\u01b0 tr\u00ean.<\/p>\n

    (*) Khuy\u1ebfn c\u00e1o c\u1ee7a H\u1ed9i tim m\u1ea1ch Ch\u00e2u \u00c2u n\u0103m 2015 c\u00f3 \u0111\u01b0a th\u00eam hai ti\u00eau chu\u1ea9n trong m\u1ee5c ch\u1ea9n \u0111o\u00e1n d\u1ef1a tr\u00ean h\u00ecnh \u1ea3nh h\u1ecdc:<\/p>\n

    Ho\u1ea1t \u0111\u1ed9ng b\u1ea5t th\u01b0\u1eddng quanh v\u1ecb tr\u00ed \u0111\u1eb7t van nh\u00e2n t\u1ea1o ph\u00e1t hi\u1ec7n b\u1edfi PET\/CT v\u1edbi 18F-FDG (\u00e1p d\u1ee5ng cho van nh\u00e2n t\u1ea1o \u0111\u00e3 \u0111\u01b0\u1ee3c thay tr\u00ean 3 th\u00e1ng) ho\u1eb7c SPECT\/CT v\u1edbi b\u1ea1ch c\u1ea7u \u0111\u01b0\u1ee3c \u0111\u00e1nh d\u1ea5u ph\u00f3ng x\u1ea1.<\/p>\n

    C\u00e1c t\u1ed5n th\u01b0\u01a1ng c\u1ea1nh ch\u00e2n van \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn b\u1edfi CLVT tim.<\/p>\n

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

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