{"id":30268,"date":"2023-05-01T22:44:01","date_gmt":"2023-05-01T15:44:01","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30268"},"modified":"2023-05-01T22:44:01","modified_gmt":"2023-05-01T15:44:01","slug":"viem-noi-tam-mac-nhiem-khuan-va-chi-dinh-phau-thuat","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/01\/viem-noi-tam-mac-nhiem-khuan-va-chi-dinh-phau-thuat\/","title":{"rendered":"Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n v\u00e0 ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt"},"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. T\u1ed5ng quan<\/h2>\n

Th\u1ea3o lu\u1eadn v\u1edbi \u0111\u01a1n v\u1ecb ph\u0201u thu\u1eadt tim m\u1ea1ch v\u1ec1 ch\u1ec9 \u0111\u1ecbnh ph\u0201u thu\u1eadt thay van. Ph\u0201u thu\u1eadt c\u1ea7n \u0111\u1eb7t ra n\u1ebfu t\u00ecnh tr\u1ea1ng nhi\u1ec5m khu\u1ea9n ho\u1ea1t \u0111\u1ed9ng ho\u1eb7c n\u1ebfu suy tim ti\u1ebfn tri\u1ec3n do t\u1ed5n th\u01b0\u01a1ng ph\u00e1 h\u1ee7y van. Th\u1eddi gian th\u00edch h\u1ee3p ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1:<\/p>\n

    \n
  • S\u1ef1 dung n\u1ea1p c\u1ee7a huy\u1ebft \u0111\u1ed9ng v\u1edbi t\u1ed5n th\u01b0\u01a1ng.<\/li>\n
  • T\u00ecnh tr\u1ea1ng nhi\u1ec5m khu\u1ea9n.<\/li>\n
  • S\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a bi\u1ebfn ch\u1ee9ng vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n.<\/li>\n
  • T\u00ecnh tr\u1ea1ng nhi\u1ec5m khu\u1ea9n<\/li>\n
  • Nhi\u1ec5m khu\u1ea9n dai d\u1eb3ng ho\u1eb7c t\u00e1i ph\u00e1t (d\u1ef1a v\u00e0o ch\u1ec9 s\u1ed1 l\u00e2m s\u00e0ng v\u00e0 x\u00e9t nghi\u1ec7m) m\u1eb7c d\u00f9 \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh th\u00edch h\u1ee3p c\u00f3 th\u1ec3 l\u00e0 do vi khu\u1ea9n kh\u00e1ng thu\u1ed1c ho\u1eb7c \u00e1p xe (t\u1ed5 ch\u1ee9c c\u1ea1nh van, ngo\u00e0i tim).<\/li>\n
  • Lo\u1ea1i vi khu\u1ea9n : X em x\u00e9t ph\u0201u thu\u1eadt s\u1edbm v\u1edbi vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c do n\u1ea5m ho\u1eb7c vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c van nh\u00e2n t\u1ea1o do E. coli ho\u1eb7c S. aureus.<\/li>\n<\/ul>\n

    L\u1ef1a ch\u1ecdn ph\u1eabu thu\u1eadt<\/p>\n

    Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c van hai l\u00e1 v\u00e0 van ba l\u00e1 , trong \u0111\u00f3 \u01b0 u ti\u00ean s\u1eeda van n\u1ebfu c\u00f3 th\u1ec3. \u00c1p xe v\u00f2ng van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, c\u00f3 th\u1ec3 c\u1ea7n ph\u0201u thu\u1eadt thay g\u1ed1c \u0111\u1ed9ng m\u1ea1ch ch\u1ee7. X\u1eed tr\u00ed c\u00e1c bi\u1ebfn ch\u1ee9ng th\u1ee7ng v\u00e1ch li\u00ean th\u1ea5t, v\u1ee1 ph\u00ecnh xoang valsalva (n\u1ebfu c\u00f3).<\/p>\n

    Ch\u00fa \u00fd<\/em>: Nguy c\u01a1 t\u1eed vong t\u0103ng th\u00eam do ph\u0201u thu\u1eadt li\u00ean quan \u0111\u1ebfn VNTMNK l\u00e0 2 – 5%.<\/p>\n

    Nguy c\u01a1 t\u1eed vong t\u0103ng n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 s\u1ed1c tim ho\u1eb7c n\u1eb1m vi\u1ec7n k\u00e9o d\u00e0i.<\/p>\n

    3. Ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt VNTMNK van tim b\u00ean tr\u00e1i<\/h2>\n

    Ch\u1ec9 \u0111\u1ecbnh v\u00e0 th\u1eddi \u0111i\u1ec3m ph\u1eabu thu\u1eadt van tim b\u00ean tr\u00e1i trong VNTMNK (van t\u1ef1 nhi\u00ean v\u00e0 van nh\u00e2n t\u1ea1o) (theo ESC 2015)<\/em><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    \u00a0<\/em><\/p>\n

    Ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt<\/strong><\/td>\n

    		\u00a0<\/em><\/p>\n

    T.gian<\/strong><\/td>\n

    		\u00a0<\/em><\/p>\n

    Lo\u1ea1i<\/strong><\/td>\n

    		\u00a0<\/em><\/p>\n

    B.ch\u1ee9ng<\/strong><\/td>\n<\/tr>\n

    1. Suy tim<\/strong><\/td>\n<\/tr>\n
    VNTMNK tr\u00ean van \u0110M ch\u1ee7 ho\u1eb7c VHL t\u1ef1 nhi\u00ean ho\u1eb7c nh\u00e2n t\u1ea1o h\u1edf c\u1ea5p n\u1eb7ng, t\u1eafc ngh\u1ebdn ho\u1eb7c r\u00f2 g\u00e2y ph\u00f9 ph\u1ed5i ho\u1eb7c s\u1ed1c tim kh\u00f4ng ki\u1ec3m so\u00e1t<\/td>\n24h<\/td>\nI<\/td>\nB<\/td>\n<\/tr>\n
    VNTMNK tr\u00ean van \u0110M ch\u1ee7 ho\u1eb7c VHL t\u1ef1 nhi\u00ean ho\u1eb7c nh\u00e2n t\u1ea1o h\u1edf ho\u1eb7c t\u1eafc ngh\u1ebdn n\u1eb7ng g\u00e2y<\/p>\n

    tri\u1ec7u ch\u1ee9ng suy tim ho\u1eb7c r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng<\/p>\n

    tr\u00ean si\u00eau \u00e2m tim<\/td>\n

    		V\u00e0i ng\u00e0y<\/td>\nI<\/td>\nB<\/td>\n<\/tr>\n
    \u00a0<\/em><\/p>\n

    2. Kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c nhi\u1ec5m khu\u1ea9n<\/strong><\/td>\n<\/tr>\n

    Kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c nhi\u1ec5m khu\u1ea9n t\u1ea1i ch\u1ed7 (\u00e1p xe, gi\u1ea3 ph\u00ecnh m\u1ea1ch, \u0111\u01b0\u1eddng r\u00f2, s\u00f9i l\u1edbn th\u00eam)<\/td>\nV\u00e0i ng\u00e0y<\/td>\nI<\/td>\nB<\/td>\n<\/tr>\n
    Nhi\u1ec5m tr\u00f9ng do n\u1ea5m ho\u1eb7c c\u00e1c ch\u1ee7ng vi sinh v\u1eadt \u0111a kh\u00e1ng<\/td>\nV\u00e0i ng\u00e0y\/ 1-2<\/p>\n

    tu\u1ea7n<\/td>\n

    		I<\/td>\nC<\/td>\n<\/tr>\n
    C\u1ea5y m\u00e1u d\u01b0\u01a1ng t\u00ednh dai d\u1eb3ng d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb<\/p>\n

    kh\u00e1ng sinh th\u00edch h\u1ee3p v\u00e0 ki\u1ec3m so\u00e1t c\u00e1c \u1ed5 di b\u1ec7nh<\/td>\n

    		V\u00e0i ng\u00e0y<\/td>\nIIa<\/td>\nB<\/td>\n<\/tr>\n
    VNTMNK tr\u00ean van nh\u00e2n t\u1ea1o g\u00e2y ra b\u1edfi t\u1ee5 c\u1ea7u ho\u1eb7c vi khu\u1ea9n gram (-) kh\u00f4ng thu\u1ed9c nh\u00f3m HACEK<\/td>\nV\u00e0i ng\u00e0y\/ 1-2<\/p>\n

    tu\u1ea7n<\/td>\n

    		IIa<\/td>\nC<\/td>\n<\/tr>\n
    \u00a0<\/em><\/p>\n

    3. D\u1ef1 ph\u00f2ng t\u1eafc m\u1ea1ch<\/strong><\/td>\n<\/tr>\n

    VNTM van \u0110M ch\u1ee7 ho\u1eb7c VHL t\u1ef1 nhi\u00ean ho\u1eb7c nh\u00e2n t\u1ea1o k\u00e8m s\u00f9i dai d\u1eb3ng k\u00edch th\u01b0\u1edbc > 10 mm c\u00f3 1 ho\u1eb7c nhi\u1ec1u l\u1ea7n t\u1eafc m\u1ea1ch d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh th\u00edch h\u1ee3p<\/td>\nV\u00e0i ng\u00e0y<\/td>\nI<\/td>\nB<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    \u00a0<\/em><\/p>\n\n\n\n\n\n
    VNTM van \u0110M ch\u1ee7 ho\u1eb7c VHL t\u1ef1 nhi\u00ean v\u1edbi k\u00edch th\u01b0\u1edbc s\u00f9i > 10 mm, v\u1edbi h\u1eb9p kh\u00edt ho\u1eb7c h\u1edf van n\u1eb7ng v\u00e0 nguy c\u01a1 ph\u0201u thu\u1eadt th\u1ea5p<\/td>\nV\u00e0i ng\u00e0y<\/td>\nIIa<\/td>\nB<\/td>\n<\/tr>\n
    VNTM van \u0110M ch\u1ee7 ho\u1eb7c VHL t\u1ef1 nhi\u00ean ho\u1eb7c nh\u00e2n t\u1ea1o v\u1edbi c\u1ee5c s\u00f9i r\u1ea5t l\u1edbn (> 30 mm)<\/td>\nV\u00e0i ng\u00e0y<\/td>\nIIa<\/td>\nB<\/td>\n<\/tr>\n
    VNTM van \u0110M ch\u1ee7 ho\u1eb7c VHL t\u1ef1 nhi\u00ean ho\u1eb7c nh\u00e2n t\u1ea1o v\u1edbi c\u1ee5c s\u00f9i l\u1edbn (> 15 mm) v\u00e0 kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh ph\u0201u thu\u1eadt kh\u00e1c<\/td>\nV\u00e0i ng\u00e0y<\/td>\nIIb<\/td>\nC<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Ch\u00fa th\u00edch: <\/em><\/strong>VNTMNK: Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n; VHL: Van hai l\u00e1; HACEK: Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella spp.<\/p>\n

    4. Ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt VNTMNK van tim b\u00ean ph\u1ea3i<\/h2>\n

    VNTMNK tr\u00ean van tim b\u00ean ph\u1ea3i th\u01b0\u1eddng l\u00e0 b\u1ec7nh l\u00fd nguy\u00ean ph\u00e1t do l\u1ea1m d\u1ee5ng thu\u1ed1c \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch v\u00e0 nguy c\u01a1 t\u00e1i ph\u00e1t cao n\u1ebfu kh\u00f4ng kh\u1eafc ph\u1ee5c \u0111\u01b0\u1ee3c nguy\u00ean nh\u00e2n. V\u1ea5n \u0111\u1ec1 ph\u0201u thu\u1eadt ch\u1ec9 \u0111\u01b0\u1ee3c \u0111\u1eb7t ra trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p:<\/p>\n

    Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng kh\u00f4ng c\u1ea3i thi\u1ec7n, kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa.<\/p>\n

    T\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh kh\u00f3 ki\u1ec3m so\u00e1t (v\u00ed d\u1ee5: N\u1ea5m) ho\u1eb7c t\u00ecnh tr\u1ea1ng nhi\u1ec5m khu\u1ea9n huy\u1ebft k\u00e9o d\u00e0i > 7 ng\u00e0y d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb \u0111\u1ee7 kh\u00e1ng sinh (th\u01b0\u1eddng g\u1eb7p S. aureus v\u00e0 S. aeruginosa).<\/p>\n

    T\u1ed5 ch\u1ee9c s\u00f9i van ba l\u00e1 v\u0201n c\u00f3 k\u00edch th\u01b0\u1edbc > 20 mm sau thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i t\u00e1i ph\u00e1t do c\u1ee5c s\u00f9i b\u1eafn \u0111i ho\u1eb7c c\u00f3 t\u1eafc m\u1ea1ch ngh\u1ecbch th\u01b0\u1eddng.<\/p>\n

    Suy tim ph\u1ea3i th\u1ee9 ph\u00e1t do h\u1edf van ba l\u00e1 n\u1eb7ng v\u00e0 k\u00e9m \u0111\u00e1p \u1ee9ng v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u.<\/p>\n

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

    Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n (endocarditis) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd nghi\u00eam tr\u1ecdng c\u1ee7a h\u1ec7 th\u1ed1ng tim m\u1ea1ch, khi c\u00e1c vi khu\u1ea9n x\u00e2m nh\u1eadp v\u00e0o t\u1ea7ng trong c\u1ee7a ni\u00eam m\u1ea1c tim, g\u00e2y ra s\u01b0ng v\u00e0 vi\u00eam. N\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1eefa tr\u1ecb k\u1ecbp th\u1eddi, b\u1ec7nh n\u00e0y c\u00f3 th\u1ec3 g\u00e2y ra nh\u1eefng bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m, bao g\u1ed3m suy tim, nh\u1ed3i m\u00e1u c\u01a1 tim, r\u1ed1i lo\u1ea1n nh\u1ecbp tim, hay th\u1eadm ch\u00ed l\u00e0 t\u1eed vong.<\/p>\n

    M\u1eb7c d\u00f9 vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh c\u00f3 th\u1ec3 gi\u00fap ki\u1ec3m so\u00e1t b\u1ec7nh t\u00ecnh, nh\u01b0ng trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, ph\u1eabu thu\u1eadt v\u1eabn l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn t\u1ed1t \u0111\u1ec3 lo\u1ea1i b\u1ecf c\u00e1c t\u1ed5n th\u01b0\u01a1ng tr\u00ean ni\u00eam m\u1ea1c tim, ng\u0103n ch\u1eb7n vi khu\u1ea9n x\u00e2m nh\u1eadp v\u00e0 ph\u00e1t tri\u1ec3n l\u1ea1i. Ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt tr\u00ean vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh d\u1ef1a tr\u00ean nhi\u1ec1u y\u1ebfu t\u1ed1 bao g\u1ed3m tu\u1ed5i, t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe, ch\u1ee7ng lo\u1ea1i vi khu\u1ea9n g\u00e2y ra b\u1ec7nh, m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c tim, v\u00e0 t\u00ecnh tr\u1ea1ng c\u1ee7a van tim.<\/p>\n

    Th\u1ef1c hi\u1ec7n ph\u1eabu thu\u1eadt tr\u00ean vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n \u0111\u00f2i h\u1ecfi s\u1ef1 ph\u1ed1i h\u1ee3p gi\u1eefa c\u00e1c chuy\u00ean gia v\u1ec1 tim m\u1ea1ch, ph\u1eabu thu\u1eadt v\u00e0 nhi\u1ec5m tr\u00f9ng h\u1ecdc. Qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt th\u01b0\u1eddng bao g\u1ed3m lo\u1ea1i b\u1ecf van tim b\u1ecb t\u1ed5n th\u01b0\u01a1ng v\u00e0 thay th\u1ebf b\u1eb1ng van nh\u00e2n t\u1ea1o, ho\u1eb7c s\u1eeda ch\u1eefa v\u1ebft th\u01b0\u01a1ng tr\u00ean van tim. \u0110\u1ec3 \u0111\u1ea3m b\u1ea3o k\u1ebft qu\u1ea3 t\u1ed1t nh\u1ea5t, b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c gi\u00e1m s\u00e1t ch\u1eb7t ch\u1ebd v\u00e0 \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh trong th\u1eddi gian d\u00e0i sau ph\u1eabu thu\u1eadt.<\/p>\n

    Tuy nhi\u00ean, ph\u1eabu thu\u1eadt c\u0169ng mang l\u1ea1i m\u1ed9t s\u1ed1 r\u1ee7i ro v\u00e0 bi\u1ebfn ch\u1ee9ng, bao g\u1ed3m nhi\u1ec5m tr\u00f9ng sau ph\u1eabu thu\u1eadt, xu\u1ea5t huy\u1ebft, suy tim, r\u1ed1i lo\u1ea1n nh\u1ecbp tim, v\u00e0 th\u1eadm ch\u00ed l\u00e0 t\u1eed vong. Do \u0111\u00f3, quy\u1ebft \u0111\u1ecbnh ph\u1eabu thu\u1eadt c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u01b0a ra sau khi c\u00e2n nh\u1eafc k\u1ef9 l\u01b0\u1ee1ng c\u00e1c y\u1ebfu t\u1ed1 r\u1ee7i ro v\u00e0 l\u1ee3i \u00edch.<\/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 ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt<\/title>\n<meta name=\"description\" content=\"Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c\u00a0l\u00e0 nhi\u1ec5m 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