{"id":30271,"date":"2023-05-01T22:43:37","date_gmt":"2023-05-01T15:43:37","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30271"},"modified":"2023-05-01T22:43:37","modified_gmt":"2023-05-01T15:43:37","slug":"viem-noi-tam-mac-nhiem-khuan-va-du-phong","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/01\/viem-noi-tam-mac-nhiem-khuan-va-du-phong\/","title":{"rendered":"Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n v\u00e0 d\u1ef1 ph\u00f2ng"},"content":{"rendered":"<p><strong><a href=\"https:\/\/www.vinmec.com\/vi\/tim-mach\/thong-tin-suc-khoe\/viem-noi-tam-mac-nhiem-khuan-chan-doan-va-dieu-tri\/\">Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u00e2\u0309n<\/a> (VNTMNK)\u00a0<em>(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<h2>1. \u0110\u1ecbnh ngh\u0129a<\/h2>\n<p>Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u00e2\u0309n (VNTMNK)\u00a0<em>(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<em>(infective endarteritis)<\/em>\u00a0nh\u01b0ng v\u1ec1 l\u00e2m s\u00e0ng v\u00e0 b\u1ec7nh h\u1ecdc c\u0169ng gi\u1ed1ng VNTMNK.<\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"size-medium wp-image-30240 aligncenter\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/18142-300x240.jpg\" alt=\"Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u00e2\u0309n\" width=\"300\" height=\"240\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/18142-300x240.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/18142.jpg 400w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/p>\n<p style=\"text-align: center;\"><strong>Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u00e2\u0309n\u00a0<\/strong><\/p>\n<h2>2. D\u1ef1 ph\u00f2ng vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c<\/h2>\n<p>Theo khuy\u1ebfn c\u00e1o c\u1ee7a ESC v\u1ec1 VNTMNK c\u1eadp nh\u1eadt n\u0103m 2015, kh\u00e1ng sinh d\u1ef1 ph\u00f2ng ch\u1ec9 n\u00ean d\u00f9ng cho b\u1ec7nh nh\u00e2n \u1edf m\u1ee9c nguy c\u01a1 cao \u0111\u1ed1i v\u1edbi VNTMNK, bao g\u1ed3m:<\/p>\n<ul>\n<li>B\u1ec7nh nh\u00e2n v\u1edbi b\u1ea5t k\u1ef3 van nh\u00e2n t\u1ea1o n\u00e0o, bao g\u1ed3m c\u1ea3 van nh\u00e2n t\u1ea1o \u0111\u1eb7t qua \u1ed1ng th\u00f4ng ho\u1eb7c \u0111\u01b0\u1ee3c s\u1eeda van v \u1edbi v\u1eadt li\u1ec7u nh\u00e2n t\u1ea1o.<\/li>\n<li>B\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed VNTMNK.<\/li>\n<li>B\u1ec7nh nh\u00e2n tim b\u1ea9m sinh: (1) tim b\u1ea9m sinh c\u00f3 t\u00edm; (2) tim b\u1ea9m sinh c\u00f3 v\u1eadt li\u1ec7u n h\u00e2n t\u1ea1o, c\u00f3 th\u1ec3 qua ph\u0201u thu\u1eadt ho\u1eb7c can thi\u1ec7p qua da . Li\u1ec7u tr\u00ecnh k h\u00e1ng sinh d \u1ef1 ph\u00f2ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho \u0111\u1ebfn 6 th\u00e1ng sau th\u1ee7 thu\u1eadt, ho\u1eb7c su\u1ed1t \u0111\u1eddi n\u1ebfu c\u00f2n shunt t\u1ed3n l\u01b0u ho\u1eb7c h\u1edf van tim.<\/li>\n<\/ul>\n<h3>2.1 Th\u1ee7 thu\u1eadt c\u1ea7n c\u00f3 kh\u00e1ng sinh d\u1ef1 ph\u00f2ng theo h\u01b0\u1edbng d\u1eabn ESC 2015<\/h3>\n<h4><strong>2.1.1 C\u00e1c th\u1ee7 thu\u1eadt r\u0103ng mi\u1ec7ng<\/strong><\/h4>\n<p>Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng n\u00ean \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho c\u00e1c th\u1ee7 thu\u1eadt nha khoa \u0111\u00f2i h\u1ecfi c\u00e1c thao t\u00e1c qua v\u00f9ng l\u1ee3i ho\u1eb7c v\u00f9ng quanh ch\u00f3p r\u0103ng ho\u1eb7c g\u00e2y th\u1ee7ng ni\u00eam m\u1ea1c mi\u1ec7ng.<\/p>\n<p>Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p: T i\u00eam g\u00e2y t\u00ea t\u1ea1i ch\u1ed7 \u1edf v\u00f9ng kh\u00f4ng b\u1ecb nhi\u1ec5m khu\u1ea9n , \u0111i\u1ec1u tr\u1ecb s\u00e2u r\u0103ng tr\u00ean b\u1ec1 m\u1eb7t, c\u1eaft b\u1ecf ch\u1ec9 kh\u00e2u, x\u1ea1 tr\u1ecb r\u0103ng, thay \u0111\u1ed5i ho\u1eb7c s\u1eeda ch\u1eefa c\u00e1c v\u1eadt li\u1ec7u ph\u1ee5c h\u00ecnh, ch\u1ec9nh h\u00ecnh r\u0103ng mi\u1ec7ng, ni\u1ec1ng r\u0103ng, sau nh\u1ed5 r\u0103ng, ho\u1eb7c ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ebfn m\u00f4i hay ni\u00eam m\u1ea1c mi\u1ec7ng.<\/p>\n<p>Kh\u00e1ng sinh \u0111\u01b0\u1ee3c cho m\u1ed9t li\u1ec1u duy nh\u1ea5t t\u1eeb 30 &#8211; 60 ph\u00fat tr\u01b0\u1edbc th\u1ee7 thu\u1eadt v\u00e0 kh\u00f4ng c\u1ea7n s\u1eed d\u1ee5ng nh\u1eafc l\u1ea1i li\u1ec1u sau th\u1ee7 thu\u1eadt.<\/p>\n<p><em>Ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh d\u1ef1 ph\u00f2ng VNTMNK (theo ESC 2015)<\/em><\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"170\"><em>\u00a0<\/em><\/p>\n<p><strong>T\u00ecnh hu\u1ed1ng<\/strong><\/td>\n<td width=\"178\"><em>\u00a0<\/em><\/p>\n<p><strong>Kh\u00e1ng sinh<\/strong><\/td>\n<td width=\"153\"><em>\u00a0<\/em><\/p>\n<p><strong>Ng\u01b0\u1eddi l\u1edbn<\/strong><\/td>\n<td width=\"161\"><em>\u00a0<\/em><\/p>\n<p><strong>Tr\u1ebb em<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"170\"><em>\u00a0<\/em><\/p>\n<p>Kh\u00f4ng d\u1ecb \u1ee9ng Penicil Ampicillin<\/td>\n<td width=\"178\"><em>\u00a0<\/em><\/p>\n<p>Amoxicillin ho\u1eb7c<\/p>\n<p>Ampicillin<strong>*<\/strong><\/td>\n<td width=\"153\"><em>\u00a0<\/em><\/p>\n<p>2 g u\u1ed1ng ho\u1eb7c \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch<\/td>\n<td width=\"161\"><em>\u00a0<\/em><\/p>\n<p>50 mg\/kg u\u1ed1ng ho\u1eb7c \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch<\/td>\n<\/tr>\n<tr>\n<td width=\"170\"><em>\u00a0<\/em><\/p>\n<p>D\u1ecb \u1ee9ng Penicillin ho\u1eb7c<\/p>\n<p>Ampicillin<\/td>\n<td width=\"178\"><em>\u00a0<\/em><\/p>\n<p>Clindamycin<\/td>\n<td width=\"153\"><em>\u00a0<\/em><\/p>\n<p>600 mg u\u1ed1ng ho\u1eb7c \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch<\/td>\n<td width=\"161\"><em>\u00a0<\/em><\/p>\n<p>20 mg\/kg u\u1ed1ng ho\u1eb7c \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong><em><u>Ch\u00fa th\u00edch:<\/u><\/em><\/strong><\/p>\n<p><em>(*): L\u1ef1a ch\u1ecdn kh\u00e1c l\u00e0 Cephalexin 2 g \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch v\u1edbi ng\u01b0\u1eddi l\u1edbn ho\u1eb7c 50 mg\/kg \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch v\u1edbi tr\u1ebb em, Cefazolin ho\u1eb7c Ceftriaxone 1 g \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch v\u1edbi ng\u01b0\u1eddi l\u1edbn ho\u1eb7c 50 mg\/kg \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch v\u1edbi tr\u1ebb em. Cephalosporin kh\u00f4ng n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb s\u1ed1c ph\u1ea3n v\u1ec7, ph\u00f9 m\u1ea1ch ho\u1eb7c n\u1ed5i m\u1ec1 \u0111ay sau khi u\u1ed1ng penicillin ho\u1eb7c ampicillin do ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng ch\u00e9o.<\/em><\/p>\n<h4>2.1.2 C\u00e1c th\u1ee7 thu\u1eadt li\u00ean quan \u0111\u1ebfn \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p<\/h4>\n<p>Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho c\u00e1c th\u1ee7 thu\u1eadt li\u00ean quan \u0111\u1ebfn \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p, bao g\u1ed3m c\u1ea3: N\u1ed9i soi ph\u1ebf qu\u1ea3n, n\u1ed9i soi thanh qu\u1ea3n, \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n qua mi\u1ec7ng hay qua m\u0169i.<\/p>\n<p>Trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 vi\u00eam \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p, n\u00ean \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh \u1ed5n \u0111\u1ecbnh tr\u01b0\u1edbc th\u1ee7 thu\u1eadt.<\/p>\n<p>Nh\u1eefng b\u1ec7nh nh\u00e2n n\u1eb1m trong nh\u00f3m nguy c\u01a1 cao b\u1ecb VNTMNK khi tr\u1ea3i qua c\u00e1c th\u1ee7 thu\u1eadt \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p c\u00f3 x\u00e2m l\u1ea5n v\u1edbi m\u1ee5c \u0111\u00edch \u0111i\u1ec1u tr\u1ecb c\u00e1c nhi\u1ec5m tr\u00f9ng hi\u1ec7n t\u1ea1i (V\u00ed d\u1ee5: D\u0201n l\u01b0u \u1ed5 \u00e1p xe) n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng kh\u00e1ng sinh c\u00f3 ph\u1ed5 tr\u00ean Staphylococci.<\/p>\n<h4>2.1.3 Th\u1ee7 thu\u1eadt li\u00ean quan \u0111\u1ebfn d\u1ea1 d\u00e0y &#8211; ru\u1ed9t ho\u1eb7c ni\u1ec7u &#8211; sinh d\u1ee5c ho\u1eb7c si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n<\/h4>\n<p>Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho c\u00e1c th\u1ee7 thu\u1eadt nh\u01b0: N\u1ed9i soi d\u1ea1 d\u00e0y, n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng, n\u1ed9i soi b\u00e0ng quang, \u0111\u1ee1 \u0111\u1ebb t\u1ef1 nhi\u00ean qua \u0111\u01b0\u1eddng \u00e2m \u0111\u1ea1o ho\u1eb7c m\u1edf t\u1eed cung l\u1ea5y thai, ho\u1eb7c si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n.<\/p>\n<p>Nh\u1eefng b\u1ec7nh nh\u00e2n \u0111ang c\u00f3 t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng li\u00ean quan \u0111\u1ebfn h\u1ec7 d\u1ea1 d\u00e0y- ru\u1ed9t, sinh d\u1ee5c &#8211; ti\u1ebft ni\u1ec7u \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n nguy c\u01a1 cao, n\u00ean s\u1eed d\u1ee5ng kh\u00e1ng sinh c\u00f3 ph\u1ed5 tr\u00ean c\u00e1c ch\u1ee7ng enterococci (V\u00ed d\u1ee5: Ampicillin, Amoxicillin ho\u1eb7c Vancomycin n\u1ebfu kh\u00f4ng dung n\u1ea1p v\u1edbi nh\u00f3m beta-lactam)<\/p>\n<h4>2.1.4 C\u00e1c th\u1ee7 thu\u1eadt \u1edf da v\u00e0 m\u00f4 m\u1ec1m<\/h4>\n<p>Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho b\u1ea5t c\u1ee9 th\u1ee7 thu\u1eadt n\u00e0o (Ngo\u1ea1i tr\u1eeb b\u1ec7nh nh\u00e2n n\u1eb1m trong nh\u00f3m nguy c\u01a1 cao b\u1ecb VNTMNK \u0111\u01b0\u1ee3c l\u00e0m th\u1ee7 thu\u1eadt do c\u00e1c nhi\u1ec5m tr\u00f9ng da, m\u00f4 m\u1ec1m, c\u01a1 x\u01b0\u01a1ng kh\u1edbp (V\u00ed d\u1ee5: \u00c1p xe) th\u00ec n\u00ean s\u1eed d\u1ee5ng kh\u00e1ng sinh c\u00f3 ph\u1ed5 tr\u00ean staphylococci v\u00e0 streptococci tan huy\u1ebft nh\u00f3m P).<\/p>\n<h2>3. Khuy\u1ebfn c\u00e1o d\u00f9ng kh\u00e1ng sinh ph\u00f2ng ng\u1eeba nhi\u1ec5m khu\u1ea9n khu tr\u00fa v\u00e0 to\u00e0n th\u00e2n <strong>tr\u01b0\u1edbc c\u00e1c th\u1ee7 thu\u1eadt can thi\u1ec7p tim v\u00e0 m\u1ea1ch m\u00e1u<\/strong><\/h2>\n<p>Khuy\u1ebfn c\u00e1o s\u00e0ng l\u1ecdc t\u1ee5 c\u1ea7u v\u00e0ng v\u00f9ng m\u0169i h\u1ecdng \u1edf nh\u1eefng ng\u01b0\u1eddi mang m\u1ea7m b\u1ec7nh, v\u1edbi c\u00e1c ph\u0201u thu\u1eadt tim m\u1ea1ch c\u00f3 chu\u1ea9n b\u1ecb.<\/p>\n<p>D\u1ef1 ph\u00f2ng tr\u01b0\u1edbc th\u1ee7 thu\u1eadt \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho \u0111\u1eb7t m\u00e1y t\u1ea1o nh\u1ecbp ho\u1eb7c m\u00e1y ph\u00e1 rung t\u1ef1 \u0111\u1ed9ng (ICD).<\/p>\n<p><strong><em>C\u00e1c \u1ed5 nhi\u1ec5m khu\u1ea9n ti\u1ec1m t\u00e0ng <\/em><\/strong>c\u1ea7n \u0111\u01b0\u1ee3c lo\u1ea1i tr\u1eeb tr\u01b0\u1edbc ph\u0201u thu\u1eadt \u00edt nh\u1ea5t 2 tu\u1ea7n: Ph\u0201u thu\u1eadt van nh\u00e2n t\u1ea1o, c\u00e1c thi\u1ebft b\u1ecb nh\u00e2n t\u1ea1o trong tim ho\u1eb7c trong m\u1ea1ch m\u00e1u, ngo\u1ea1i tr\u1eeb ph\u0201u thu\u1eadt c\u1ea5p c\u1ee9u.<\/p>\n<p>Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u1edf b\u1ec7nh nh\u00e2n tr\u1ea3i qua ph\u0201u thu\u1eadt thay van ho\u1eb7c \u0111\u1eb7t thi\u1ebft b\u1ecb nh\u00e2n t\u1ea1o trong l\u00f2ng m\u1ea1ch (ho\u1eb7c th\u1ee7 thu\u1eadt qua da).<\/p>\n<p>\u0110i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n m\u1ed9t c\u00e1ch h\u1ec7 th\u1ed1ng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o khi kh\u00f4ng c\u00f3 s\u00e0ng l\u1ecdc nhi\u1ec5m t\u1ee5 c\u1ea7u.<\/p>\n<p>Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng n\u00ean \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u ngay l\u1eadp t\u1ee9c tr\u01b0\u1edbc th\u1ee7 thu\u1eadt v\u00e0 l\u1eb7p l\u1ea1i n\u1ebfu th\u1ee7 thu\u1eadt k\u00e9o d\u00e0i tr\u00ean 48 ti\u1ebfng.<\/p>\n<h2>4. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p d\u1ef1 ph\u00f2ng VNTMNK kh\u00f4ng \u0111\u1eb7c hi\u1ec7u<\/h2>\n<p>C\u00e1c ph\u01b0\u01a1ng ph\u00e1p n\u00e0y n\u00ean \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng cho t\u1ea5t c\u1ea3 m\u1ecdi ng\u01b0\u1eddi n\u00f3i chung, \u0111\u1eb7c bi\u1ec7t c\u1ea7n \u0111\u01b0\u1ee3c t\u0103ng c\u01b0\u1eddng h\u01a1n n\u1eefa \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao VNTMNK.<\/p>\n<p>V\u1ec7 sinh da v\u00e0 r\u0103ng mi\u1ec7ng th\u01b0\u1eddng xuy\u00ean. Theo d\u00f5i r\u0103ng mi\u1ec7ng n\u00ean \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh 2 l\u1ea7n m\u1ed7i n\u0103m \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 m\u1eafc b\u1ec7nh cao v\u00e0 h\u00e0ng n\u0103m \u0111\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f2n l\u1ea1i.<\/p>\n<p>Tr\u00e1nh nhi\u1ec5m khu\u1ea9n v\u1ebft th\u01b0\u01a1ng.<\/p>\n<p>Lo\u1ea1i b\u1ecf ho\u1eb7c l\u00e0m gi\u1ea3m c\u00e1c \u1ed5 mang vi khu\u1ea9n m\u1ea1n t\u00ednh: Ngo\u00e0i da, \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u, \u0111\u01b0\u1eddng r\u0103ng mi\u1ec7ng.<\/p>\n<p>\u0110i\u1ec1u tr\u1ecb kh\u1ecfi c\u00e1c \u1ed5 nhi\u1ec5m khu\u1ea9n (b\u1eb1ng kh\u00e1ng sinh). B\u1ec7nh nh\u00e2n kh\u00f4ng t\u1ef1 \u00fd d\u00f9ng thu\u1ed1c kh\u00e1ng sinh.<\/p>\n<p>Ki\u1ec3m so\u00e1t nhi\u1ec5m khu\u1ea9n ch\u1eb7t ch\u1ebd khi ti\u1ebfn h\u00e0nh b\u1ea5t k\u00ec th\u1ee7 thu\u1eadt n\u00e0o c\u00f3 nguy c\u01a1.<\/p>\n<p>Kh\u00f4ng khuy\u1ebfn kh\u00edch x\u1ecf l\u1ed7 tai hay x\u0103m tr\u1ed5.<\/p>\n<p>H\u1ea1n ch\u1ebf t\u1ed1i \u0111a vi\u1ec7c \u0111\u1eb7t \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch v\u00e0 c\u00e1c th\u1ee7 thu\u1eadt x\u00e2m l\u1ea5n. N\u1ebfu c\u1ea7n \u0111\u1eb7t \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch, \u01b0u ti\u00ean s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch ngo\u1ea1i bi\u00ean h\u01a1n l\u00e0 t\u0129nh m\u1ea1ch trung t\u00e2m v\u00e0 thay \u0111\u01b0\u1eddng truy\u1ec1n ngo\u1ea1i bi\u00ean m\u1ed7i 3 &#8211; 4 ng\u00e0y.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>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 [&hellip;]<\/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":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - 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