{"id":30245,"date":"2023-05-01T22:44:33","date_gmt":"2023-05-01T15:44:33","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30245"},"modified":"2023-05-01T22:44:33","modified_gmt":"2023-05-01T15:44:33","slug":"viem-noi-tam-mac-nhiem-khuan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/01\/viem-noi-tam-mac-nhiem-khuan\/","title":{"rendered":"Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n v\u00e0 theo d\u00f5i trong \u0111i\u1ec1u tr\u1ecb"},"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\u00a0<\/strong><\/p>\n

2.Kho\u1ea3ng th\u1eddi gian \u0111i\u1ec1u tr\u1ecb<\/h2>\n

Xu h\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh trong th\u1eddi gian ng\u1eafn c\u00f2n tranh c\u00e3i.<\/p>\n

Th\u1eddi gian \u0111i \u1ec1u tr\u1ecb kh\u00e1c nhau t\u00f9y thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a t\u00ecnh tr\u1ea1ng nhi\u1ec5m khu\u1ea9n v\u00e0 c\u00e1c vi khu\u1ea9n g\u00e2y b\u1ec7nh. \u0110i\u1ec1u tr\u1ecb kh\u00e1ng sinh \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch n\u00ean \u0111\u01b0\u1ee3c duy tr\u00ec trong \u00edt nh\u1ea5t 2 tu\u1ea7n v\u00e0 th\u00f4ng th\u01b0\u1eddng t\u1eeb 4 – 6 tu\u1ea7n. Sau \u0111\u00f3, b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 l\u1ea1i t\u00ecnh tr\u1ea1ng nhi\u1ec5m khu\u1ea9n.<\/p>\n

Sau khi ho\u00e0n t\u1ea5t li\u1ec7u tr\u00ecnh kh\u00e1ng sinh ti\u00eau chu\u1ea9n nh\u01b0 tr\u00ean, n\u1ebfu l\u00e2m s\u00e0ng \u1ed5n \u0111\u1ecbnh v\u00e0 kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh ph\u0201u thu\u1eadt<\/p>\n

T\u01b0 v\u1ea5n d\u1ef1 ph\u00f2ng VNTMNK cho c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u00e3 c\u00f3 ti\u1ec1n s\u1eed VNTMNK. Theo d\u00f5i l\u00e2u d\u00e0i c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng van do VNTMNK.<\/p>\n

3. Theo d\u00f5i \u0111i\u1ec1u tr\u1ecb<\/h2>\n

B\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i li\u00ean t\u1ee5c trong qu\u00e1 tr\u00ecnh n\u1eb1m vi\u1ec7n v\u00e0 c\u1ea3 sau khi xu\u1ea5t vi\u1ec7n \u0111\u1ec3 ph\u00e1t hi\u1ec7n s\u1edbm c\u00e1c t\u00ecnh tr\u1ea1ng VNTMNK ti\u1ebfn tri\u1ec3n (kh\u00f4ng\/ k\u00e9m \u0111\u00e1p \u1ee9ng) ho\u1eb7c VNTMNK t\u00e1i ph\u00e1t.<\/p>\n

3.1 Theo d\u00f5i tr\u00ean l\u00e2m s\u00e0ng B\u1ec7nh c\u1ea3nh c\u1ee7a VNTMNK ti\u1ebfn tri\u1ec3n<\/h3>\n

Nguy\u00ean nh\u00e2n:<\/strong> Kh\u00e1ng thu\u1ed1c, nhi\u1ec5m khu\u1ea9n \u0111\u1ed3ng m\u1eafc (qua \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch, mi\u1ec7ng, m\u0169i h\u1ecdng, ph\u00e2n, n\u01b0\u1edbc ti\u1ec3u…), thuy\u00ean t\u1eafc m\u1ea1ch do nhi\u1ec5m khu\u1ea9n.<\/p>\n

C\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a nhi\u1ec5m khu\u1ea9n k\u00e9o d\u00e0i , s\u1ed1t dai d\u1eb3ng , s\u1ef1 t\u1ed3n t\u1ea1i l\u00e2u d\u00e0i c\u1ee7a c\u00e1c tri\u1ec7u ch\u1ee9ng h\u1ec7 th\u1ed1ng.<\/p>\n

S\u1ed1t dai d\u1eb3ng c\u0169ng c\u00f3 th\u1ec3 do d\u1ecb \u1ee9ng kh\u00e1ng sinh (th\u01b0\u1eddng g\u1eb7p v\u1edbi Penicillin): Bi\u1ec3u hi\u1ec7n gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u, t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan, protein ni\u1ec7u. Khi \u0111\u00f3, c\u1ea7n c\u00e2n nh\u1eafc thay \u0111\u1ed5i ho\u1eb7c d\u1eebng kh\u00e1ng sinh trong 2 – 3 ng\u00e0y.<\/p>\n

Ti\u1ebfng th\u1ed5i m\u1edbi \u1edf tim ho\u1eb7c d\u1ea5u hi\u1ec7u c\u1ee7a suy tim n\u1eb7ng l\u00ean. C\u00f3 d\u1ea5u hi\u1ec7u ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh c\u1ea3nh thuy\u00ean t\u1eafc m\u1ea1ch m\u1edbi.<\/p>\n

C\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n<\/strong><\/p>\n

Bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh:<\/strong> xu\u1ea5t hi\u1ec7n \u1edf 15- 30% b\u1ec7nh nh\u00e2n b\u1ecb VNTMNK (\u0111\u1eb7c bi\u1ec7t do S.aureus), trong \u0111\u00f3 ph\u1ea7n l\u1edbn l\u00e0 thuy\u00ean t\u1eafc m\u1ea1ch do c\u1ee5c s\u00f9i b\u1eafn \u0111i. Khi \u0111\u00e3 c\u00f3 bi\u1ebfn ch\u1ee9ng thuy\u00ean t\u1eafc m\u1ea1ch n\u00e3o, c\u1ea7n ti\u1ebfn h\u00e0nh ph\u0201u thu\u1eadt tim s\u1edbm (n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh); tr\u1eeb khi b\u1ec7nh nh\u00e2n \u0111ang b\u1ecb h\u00f4n m\u00ea ho\u1eb7c c\u00f3, b\u1eb1ng ch\u1ee9ng xu\u1ea5t huy\u1ebft n\u00e3o tr\u00ean phim ch\u1ee5p CT ho\u1eb7c CHT. Khi b\u1ec7nh nh\u00e2n c\u00f3 xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd, vi\u1ec7c ph\u0201u thu\u1eadt n\u00ean c\u00e2n nh\u1eafc l\u00f9i l\u1ea1i \u2265 1 th\u00e1ng.<\/p>\n

Ph\u00ecnh m\u1ea1ch do nhi\u1ec5m khu\u1ea9n (vi ph\u00ecnh m\u1ea1ch h\u00ecnh n\u1ea5m)<\/strong>: c\u00e1c d\u1ea5u hi\u1ec7u tr\u00ean l\u00e2m s\u00e0ng kh\u00e1 \u0111a d\u1ea1ng: thi\u1ebfu h\u1ee5t th\u1ea7n kinh, \u0111au \u0111\u1ea7u, l\u0201n l\u1ed9n, c\u00e1c c\u01a1n co gi\u1eadt… Ch\u1ee5p CT ho\u1eb7c CHT s\u1ecd n\u00e3o gi\u00fap ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh v\u1edbi \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 ,\u0111\u1eb7c hi\u1ec7u cao. V\u1ee1 vi ph\u00ecnh m\u1ea1ch h\u00ecnh n\u1ea5m c\u1ea7n \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc, \u0111i\u1ec1u tr\u1ecb b\u1eb1ng can thi\u1ec7p th\u1ee7 thu\u1eadt n\u1ed9i m\u1ea1ch ho\u1eb7c ph\u0201u thu\u1eadt th\u1ea7n kinh c\u1ea5p. N\u1ebfu ch\u01b0a v\u1ee1, b\u1ec7nh nh\u00e2n ph\u1ea3i \u0111\u01b0\u1ee3c theo d\u00f5i s\u00e1t b\u1eb1ng vi\u1ec7c l\u1eb7p l\u1ea1i CT\/ CHT s\u1ecd n\u00e3o k\u1ebft h\u1ee3p li\u1ec7u ph\u00e1p kh\u00e1ng sinh t\u00edch c\u1ef1c; trong tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n \u0111\u00e3 c\u00f3 ch\u1ec9 \u0111\u1ecbnh ph\u0201u thu\u1eadt tim s\u1edbm th\u00ec can thi\u1ec7p n\u1ed9i m\u1ea1ch n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc tr\u01b0\u1edbc ph\u0201u thu\u1eadt.<\/p>\n

Bi\u1ebfn ch\u1ee9ng \u1edf l\u00e1ch:<\/strong> T\u01b0\u1eddng g\u1eb7p thi\u1ebfu m\u00e1u l\u00e1ch do thuy\u00ean t\u1eafc m\u1ea1ch, \u0111a s\u1ed1 kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng. N\u1ebfu tr\u00ean m\u1ed9t b\u1ec7nh nh\u00e2n c\u00f3 s\u1ed1t dai d\u1eb3ng, s\u1ed1t t\u00e1i ph\u00e1t, \u0111au b\u1ee5ng v\u00e0 nhi\u1ec5m khu\u1ea9n huy\u1ebft c\u1ea7n ngh\u0129 \u0111\u1ebfn \u00e1p xe l\u00e1ch, d\u00f9 kh\u00e1 hi\u1ebfm g\u1eb7p. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh b\u1eb1ng CT, CHT ho\u1eb7c si\u00eau \u00e2m l\u00e1ch; \u0111i\u1ec1u tr\u1ecb b\u1eb1ng li\u1ec7u ph\u00e1p kh\u00e1ng sinh t\u00edch c\u1ef1c v\u00e0 d\u0201n l\u01b0u \u1ed5 \u00e1p xe, ch\u1ec9 \u0111\u1ecbnh ph\u0201u thu\u1eadt khi li\u1ec7u ph\u00e1p n\u1ed9i khoa k\u00e9m \u0111\u00e1p \u1ee9ng ho\u1eb7c \u1ed5 \u00e1p xe qu\u00e1 l\u1edbn.<\/p>\n

Vi\u00eam c\u01a1 tim v\u00e0 vi\u00eam m\u00e0ng ngo\u00e0i tim<\/strong>: vi\u00eam c\u01a1 tim th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn vi\u1ec7c h\u00ecnh th\u00e0nh \u1ed5 \u00e1p xe v\u00e0 c\u00e1c \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch, vi\u1ec7c xu\u1ea5t hi\u1ec7n c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t g\u1ee3i \u00fd c\u00f3 t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim k\u00e8m theo, th\u01b0\u1eddng ti\u00ean l\u01b0\u1ee3ng k\u00e9m. Tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim c\u00f3 th\u1ec3 g\u1eb7p, g\u1ee3i \u00fd VNTMNK \u0111ang ti\u1ebfn tri\u1ec3n. Tr\u00e0n m\u1ee7 m\u00e0ng ngo\u00e0i tim hi\u1ebfm g\u1eb7p v\u00e0 c\u1ea7n ph\u1ea3i d\u0201n l\u01b0u.<\/p>\n

R\u1ed1i lo\u1ea1n d\u0201n truy\u1ec1n trong tim:<\/strong> xu\u1ea5t hi\u1ec7n \u1edf 1 – 15% c\u00e1c tr\u01b0\u1eddng h\u1ee3p (ch\u1ee7 y\u1ebfu l\u00e0 r\u1ed1i Jo\u1ea1n nh\u1ecbp ch\u1eadm), li\u00ean quan \u0111\u1ebfn ti\u00ean l\u01b0\u1ee3ng x\u1ea5u v\u00e0 nguy c\u01a1 t\u1eed vong cao;r th\u01b0\u1eddng do t\u1ed5 ch\u1ee9c nhi\u1ec5m khu\u1ea9n lan r\u1ed9ng \u0111\u1ebfn v\u00f9ng d\u0201n truy\u1ec1n. Trong tr\u01b0\u1eddng h\u1ee3p xu\u1ea5t hi\u1ec7n c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp nhanh, g\u1ee3i \u00fd bi\u1ebfn c\u1ed1 thuy\u00ean t\u1eafc \u0110MV do c\u1ee5c s\u00f9i b\u1eafn \u0111i.<\/p>\n

C\u00e1c bi\u1ec3u hi\u1ec7n \u1edf h\u1ec7 c\u01a1 x\u01b0\u01a1ng kh\u1edbp:<\/strong> C\u00e1c tri\u1ec7u ch\u1ee9ng \u0111au kh\u1edbp, \u0111au c\u01a1, \u0111au l\u01b0ng th\u01b0\u1eddng’ g\u1eb7p. Th\u1ea5p kh\u1edbp c\u00f3 th\u1ec3 l\u00e0 bi\u1ec3u hi\u1ec7n \u0111\u1ea7u ti\u00ean c\u1ee7a VNTMNK, d\u1ec5 g\u00e2y l\u1ea1c h\u01b0\u1edbng trong ch\u1ea9n \u0111o\u00e1n. N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 \u0111au c\u1ed9t s\u1ed1ng, c\u1ea7n ngh\u0129a \u0111\u1ebfn bi\u1ebfn ch\u1ee9ng vi\u00eam t\u1ee7y x\u01b0\u01a1ng c\u1ed9t s\u1ed1ng. Ngo\u00e0i ra c\u00f3 th\u1ec3 g\u1eb7p vi\u00eam kh\u1edbp ngo\u1ea1i bi\u00ean, vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp,…<\/p>\n

Suy th\u1eadn c\u1ea5p:<\/strong> g\u1eb7p \u1edf 6 – 30% b\u1ec7nh nh\u00e2n VNTMNK. Nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 do: ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch vavi\u00eam c\u1ea7u th\u1eadn vi\u00eam m\u1ea1ch; thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch th\u1eadn; r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng do suy tim n\u1eb7ng l\u00ean, shock nhi\u1ec5m tr\u00f9ng, sau ph\u0201u thu\u1eadt tim; \u0111\u1ed9c t\u00ednh do d\u00f9ng kh\u00e1ng sinh k\u00e9o d\u00e0i (vancomycin, aminoglycoside); \u0111\u1ed9c t\u00ednh do thu\u1ed1c c\u1ea3n quang.<\/p>\n

5.2 Theo d\u00f5i tr\u00ean c\u1eadn l\u00e2m s\u00e0ng<\/h3>\n

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

Si\u00eau \u00e2m tim th\u01b0\u1eddng xuy\u00ean (h\u00e0ng tu\u1ea7n) \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb, nh\u1ea5t l\u00e0 khi c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng kh\u00e1 th\u1ea7m l\u1eb7ng, s\u1ef1 ph\u00e1 h\u1ee7y van v\u00e0 ti\u1ebfn tri\u1ec3n c\u1ee7a \u00e1p xe, t\u1ed5 ch\u1ee9c s\u00f9i trong bu\u1ed3ng tim.<\/p>\n

\u0110\u1ea7u \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch \u0111\u1eb7t d\u00e0i ng\u00e0y th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n c\u00e1c fibrin \u201ch\u00ecnh l\u00e1\u201d, c\u00f3 th\u1ec3 nh\u00ecn th\u1ea5y tr\u00ean si\u00eau \u00e2m qua th\u1ef1c qu\u1ea3n: Khi \u0111\u00f3 n\u00ean thay \u0111\u1ed5i \u0111\u01b0\u1eddng truy\u1ec1n v\u00e0 l\u1ea5y b\u1ec7nh ph\u1ea9m \u0111\u1ea7u \u0111\u01b0\u1eddng truy\u1ec1n \u0111\u1ec3 nu\u00f4i c\u1ea5y.<\/p>\n

H\u00ecnh \u1ea3nh \u201cs\u00f9i\u201d c\u00f3 th\u1ec3 kh\u00f4ng ph\u1ea3i do nhi\u1ec5m khu\u1ea9n c\u00f3 th\u1ec3 kh\u00f4ng do nhi\u1ec5m khu\u1ea9n .<\/p>\n

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

C\u1ea7n l\u00e0m \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 h\u00e0ng ng\u00e0y n\u1ebfu ph\u00e1t hi\u1ec7n block nh\u0129 – th\u1ea5t ho\u1eb7c r\u1ed1i lo\u1ea1n d\u0201n truy\u1ec1n g\u1ee3i \u00fd t\u00ecnh tr\u1ea1ng nhi\u1ec5m khu\u1ea9n \u0111ang lan r\u1ed9ng.<\/p>\n

X\u00e9t nghi\u1ec7m vi sinh<\/strong><\/p>\n

C\u1ea5y m\u00e1u l\u1eb7p l\u1ea1i (\u0111\u1eb7c bi\u1ec7t ch\u00fa \u00fd n\u1ebfu b\u1ec7nh nh\u00e2n v\u0201n c\u00f2n s\u1ed1t).<\/p>\n

K\u1ebft qu\u1ea3 kh\u00e1ng sinh \u0111\u1ed3 c\u1ea7n l\u00e0m MIC v\u1edbi aminoglycosid v\u00e0 vancomycin, l\u1ef1a ch\u1ecdn li\u1ec1u kh\u00e1ng sinh th\u00edch h\u1ee3p. Ch\u00fa \u00fd: Gentamycin c\u00f3 th\u1ec3 g\u00e2y \u0111\u1ed9c t\u00ednh tr\u00ean tai n\u1ebfu s\u1eed d\u1ee5ng k\u00e9o d\u00e0i.<\/p>\n

C\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1c<\/strong><\/p>\n

T\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u th\u01b0\u1eddng xuy\u00ean. Theo d\u00f5i ch\u1ee9c n\u0103ng gan, th\u1eadn th\u01b0\u1eddng xuy\u00ean.<\/p>\n

Theo d\u00f5i CRP th\u01b0\u1eddng xuy\u00ean, m\u00e1u l\u1eafng m\u1ed7i 2 tu\u1ea7n.<\/p>\n

T\u1ed5ng ph\u00e2n t\u00edch t\u1ebf b\u00e0o m\u00e1u th\u01b0\u1eddng xuy\u00ean, t\u0103ng hemoglobin v\u00e0 b\u1ea1ch c\u1ea7u gi\u1ea3m tr\u1edf v\u1ec1 ng\u01b0\u1ee1ng b\u00ecnh th\u01b0\u1eddng l\u00e0 g\u1ee3i \u00fd \u0111i\u1ec1u tr\u1ecb th\u00e0nh c\u00f4ng.<\/p>\n

N\u00ean \u0111 \u1ecbnh l\u01b0\u1ee3ng m ag ie huy\u1ebft thanh khi \u0111i\u1ec1u tr\u1ecb G entamycin.<\/p>\n

Ch\u1ee5p phim CT, CHT \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u1ea7n \u0111\u00e1nh gi\u00e1 bi\u1ebfn ch\u1ee9ng c\u1ee7a VNTMNK.<\/p>\n","protected":false},"excerpt":{"rendered":"

Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u00e2\u0309n (VNTMNK)\u00a0(infective endocarditis)\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. 1. \u0110\u1ecbnh ngh\u0129a Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u00e2\u0309n (VNTMNK)\u00a0(infective endocarditis)\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 […]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[],"yoast_head":"\nVi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n v\u00e0 theo d\u00f5i trong \u0111i\u1ec1u tr\u1ecb - Vinmec<\/title>\n<meta name=\"description\" content=\"Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u00e2\u0309n\u00a0l\u00e0 nhi\u1ec5m khu\u00e2\u0309n m\u00e0ng trong c\u1ee7a tim do vi khu\u1ea9n ho\u1eb7c vi n\u1ea5m, v\u00e0 hi\u1ebfm do Chlamydia hay Rickettsia.\" \/>\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=\"Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n v\u00e0 theo d\u00f5i trong \u0111i\u1ec1u tr\u1ecb - 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