{"id":30275,"date":"2023-05-01T22:43:16","date_gmt":"2023-05-01T15:43:16","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30275"},"modified":"2023-05-01T22:43:16","modified_gmt":"2023-05-01T15:43:16","slug":"viem-noi-tam-mac-nhiem-khuan-o-mot-so-truong-hop-dac-biet","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/01\/viem-noi-tam-mac-nhiem-khuan-o-mot-so-truong-hop-dac-biet\/","title":{"rendered":"Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n \u1edf m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t"},"content":{"rendered":"

Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n<\/a> van nh\u00e2n t\u1ea1o chi\u1ebfm kho\u1ea3ng 20% t\u1ed5ng s\u1ed1 ca VNTMNK v\u00e0 c\u00f3 xu h\u01b0\u1edbng t\u0103ng d\u1ea7n. Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p \u0111\u00e3 c\u00f3 bi\u1ebfn ch\u1ee9ng ho\u1eb7c c\u0103n nguy\u00ean do Staphylococcal, n\u1ea5m th\u01b0\u1eddng c\u00f3 ti\u00ean l\u01b0\u1ee3ng x\u1ea5u n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ph\u0201u thu\u1eadt.<\/strong><\/p>\n

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

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

1.T\u1ed5ng quan<\/h2>\n

Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n van nh\u00e2n t\u1ea1o chi\u1ebfm kho\u1ea3ng 20% t\u1ed5ng s\u1ed1 ca VNTMNK v\u00e0 c\u00f3 xu h\u01b0\u1edbng t\u0103ng d\u1ea7n. Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p \u0111\u00e3 c\u00f3 bi\u1ebfn ch\u1ee9ng ho\u1eb7c c\u0103n nguy\u00ean do Staphylococcal, n\u1ea5m th\u01b0\u1eddng c\u00f3 ti\u00ean l\u01b0\u1ee3ng x\u1ea5u n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ph\u0201u thu\u1eadt. C\u00e1c b\u1ec7nh nh\u00e2n VNTMNK van nh\u00e2n t\u1ea1o ch\u01b0a c\u00f3 bi\u1ebfn ch\u1ee9ng ho\u1eb7c kh\u00f4ng do c\u0103n nguy\u00ean Staphylococci hay n\u1ea5m n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i c\u1ea9n th\u1eadn v\u00e0 l\u00e2u d\u00e0i do nguy c\u01a1 bi\u1ebfn c\u1ed1 mu\u1ed9n.<\/p>\n

Li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u1ed1t nh\u1ea5t cho b\u1ec7nh nh\u00e2n VNTMNK van nh\u00e2n t\u1ea1o hi\u1ec7n c\u00f2n \u0111ang \u0111\u01b0\u1ee3c tranh lu\u1eadn. C\u00f3 nhi\u1ec1u nghi\u00ean c\u1ee9u ch\u1ec9 ra r\u1eb1ng vi\u1ec7c ph\u0201u thu\u1eadt \u0111em l\u1ea1i l\u1ee3i \u00edch tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb suy ch\u1ee9c n\u0103ng van nh\u00e2n t\u1ea1o n\u1eb7ng (h\u1eb9p, h\u1edf van), suy tim do t\u1ed5n th\u01b0\u01a1ng van nh\u00e2n t\u1ea1o, t\u1ed5n th\u01b0\u01a1ng \u00e1p xe, r\u00f2 ch\u00e2n van, nhi\u1ec5m tr\u00f9ng dai d\u1eb3ng kh\u00f3 ki\u1ec3m so\u00e1t.<\/p>\n

Ch\u1ec9 \u0111\u1ecbnh ph\u0201u thu\u1eadt c\u1ea5p c\u1ee9u trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 suy tim c\u1ea5p, ph\u00f9 ph\u1ed5i, s\u1ed1c tim (t\u01b0\u01a1ng t\u1ef1 VNTMNK tr\u00ean van t\u1ef1 nhi\u00ean).<\/p>\n

2.Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n tr\u00ean van nh\u00e2n t\u1ea1o.<\/h2>\n

Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh cho b\u1ec7nh nh\u00e2n VNTMNK tr\u00ean van nh\u00e2n t\u1ea1o:<\/p>\n\n\n\n\n\n\n
VNTMNK van nh\u00e2n t\u1ea1o s\u1edbm (< 2 th\u00e1ng sau ph\u1eabu thu\u1eadt thay van)<\/em><\/strong><\/td>\n<\/tr>\n
Nguy\u00ean nh\u00e2n: Ph\u1ed5 bi\u1ebfn l\u00e0 t\u1ee5 c\u1ea7u v\u00e0ng, t\u1ee5 c\u1ea7u kh\u00f4ng c\u00f3 men coagulase, tr\u1ef1c khu\u1ea9n gram \u00e2m, n\u1ea5m.<\/p>\n

Y\u1ebfu t\u1ed1 nguy c\u01a1: Ti\u1ec1n s\u1eed VNTMNK, n\u1eb1m vi\u1ec7n d\u00e0i ng\u00e0y, th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn v\u1ebft m\u1ed5, ti\u00eam truy\u1ec1n t\u0129nh m\u1ea1ch.<\/p>\n

L\u00e2m s\u00e0ng: Th\u01b0\u1eddng c\u00f3 h\u1edf c\u1ea1nh ch\u00e2n van, h\u1edf v\u00f2ng van, \u00e1p xe v\u00e0 s\u1ed1c tim.<\/p>\n

\u0110i\u1ec1u tr\u1ecb: C\u1ea7n ph\u0201u thu\u1eadt s\u1edbm, t\u1ef7 l\u1ec7 t\u1eed vong cao (45 – 75%).<\/td>\n<\/tr>\n

VNTMNK van nh\u00e2n t\u1ea1o trung gian (2 – 12 th\u00e1ng sau ph\u1eabu thu\u1eadt thay van)<\/em><\/strong><\/td>\n<\/tr>\n
Nguy\u00ean nh\u00e2n: giao thoa gi\u1eefa nguy\u00ean nh\u00e2n c\u1ee7a VNMTNK s\u1edbm v\u00e0 mu\u1ed9n, th\u01b0\u1eddng g\u1eb7p t\u1ee5 c\u1ea7u kh\u00f4ng c\u00f3 men coagulase. \u0110i\u1ec1u tr\u1ecb: T\u01b0\u01a1ng t\u1ef1 VNMTNK s\u1edbm.<\/p>\n

VNTMNK van nh\u00e2n t\u1ea1o mu\u1ed9n (> 12 th\u00e1ng sau ph\u0201u thu\u1eadt thay van)<\/p>\n

C\u00e1c t\u00e1c nh\u00e2n ph\u1ed5 bi\u1ebfn t\u01b0\u01a1ng t\u1ef1 nh\u01b0 tr\u00ean van t\u1ef1 nhi\u00ean: Staphylococci, Streptococci, S. bovis, Enterococci.<\/p>\n

Y\u1ebfu t\u1ed1 nguy c\u01a1: Th\u1ee7 thu\u1eadt x\u00e2m l\u1ea5n, nhi\u1ec5m khu\u1ea9n r\u0103ng mi\u1ec7ng.<\/p>\n

\u0110i\u1ec1u tr\u1ecb: Kh\u00e1ng sinh \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch, x\u00e9t ph\u0201u thu\u1eadt thay van, nguy c\u01a1 t\u1eed vong<\/p>\n

cao nh\u01b0ng th\u1ea5p h\u01a1n so v\u1edbi VNTMNK van nh\u00e2n t\u1ea1o s\u1edbm.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

3. Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n tr\u00ean tim b\u1ea9m sinh<\/h2>\n

VNTMNK tr\u00ean tim b\u1ea9m sinh hi\u1ec7n c\u00f2n \u00edt c\u00e1c nghi\u00ean c\u1ee9u m\u1ed9t c\u00e1ch h\u1ec7 th\u1ed1ng, th\u00f4ng tin ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c l\u1ea5y t\u1eeb c\u00e1c d\u1eef li\u1ec7u h\u1ed3i c\u1ee9u \u1edf c\u00e1c trung t\u00e2m chuy\u00ean ng\u00e0nh. Xu h\u01b0\u1edbng b\u1ecb VNTMNK tr\u00ean qu\u1ea7n th\u1ec3 ng\u01b0\u1eddi m\u1eafc tim b\u1ea9m sinh cao g\u1ea5p 15 – 140 l\u1ea7n<\/u> <\/em><\/strong>so v\u1edbi qu\u1ea7n th\u1ec3 d\u00e2n s\u1ed1 n\u00f3i chung. Ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh c\u00f3 t\u1ef7 l\u1ec7 b\u1ecb VNTMNK tr\u00ean tim b\u1ea9m sinh cao h\u01a1n tr\u1ebb em (0,1%\/n\u0103m so v\u1edbi 0,04%\/n\u0103m).<\/p>\n

Th\u00f4ng li\u00ean nh\u0129 v\u00e0 b\u1ec7nh l\u00fd van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u00f3 nguy c\u01a1 VNTMNK th\u1ea5p; trong khi \u0111\u00f3, b\u1ec7nh van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 hai l\u00e1 van, th\u00f4ng li\u00ean th\u1ea5t l\u1ea1i c\u00f3 nguy c\u01a1 VNTMNK cao h\u01a1n. Nguy c\u01a1 b\u1ecb VNTMNK c\u0169ng t\u0103ng l\u00ean khi ph\u1ed1i h\u1ee3p nhi\u1ec1u t\u1ed5n th\u01b0\u01a1ng tim tr\u00ean c\u00f9ng m\u1ed9t b\u1ec7nh nh\u00e2n.<\/p>\n

T\u1ef7 l\u1ec7 t\u1eed vong do VNTMNK tr\u00ean tim b\u1ea9m sinh kho\u1ea3ng 4 – 10%. Ti\u00ean l\u01b0\u1ee3ng th\u01b0\u1eddng t\u1ed1t h\u01a1n so v\u1edbi VNTMNK tr\u00ean b\u1ec7nh l\u00fd tim m\u1eafc ph\u1ea3i. D\u1ef1 ph\u00f2ng ti\u00ean ph\u00e1t c\u00f3 vai tr\u00f2 quan tr\u1ecdng nh\u1ea5t \u0111\u1ed1i v\u1edbi ng\u01b0\u1eddi c\u00f3 b\u1ec7nh l\u00fd tim b\u1ea9m sinh<\/p>\n

Ph\u0201u thu\u1eadt ch\u1ec9 \u0111\u01b0\u1ee3c \u0111\u1eb7t ra khi \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa th\u1ea5t b\u1ea1i, xu\u1ea5t hi\u1ec7n c\u00e1c bi\u1ebfn c\u1ed1 v\u1ec1 huy\u1ebft \u0111\u1ed9ng tr\u1ea7m tr\u1ecdng ho\u1eb7c c\u00f3 nguy c\u01a1 cao c\u1ee7a thuy\u00ean t\u1eafc m\u1ea1ch n\u1eb7ng n\u1ec1 do nhi\u1ec5m khu\u1ea9n.<\/p>\n

Ph\u0201u thu\u1eadt s\u1eeda ch\u1eefa c\u00e1c d\u1ecb t\u1eadt tim b\u1ea9m sinh \u0111\u01b0\u1ee3c ghi nh\u1eadn gi\u00fap l\u00e0m gi\u1ea3m nguy c\u01a1 b\u1ecb VNTMNK t\u00e1i ph\u00e1t, tuy nhi\u00ean ch\u01b0a c\u00f3 c\u00e1c nghi\u00ean c\u1ee9u m\u1ed9t c\u00e1ch h\u1ec7 th\u1ed1ng.<\/p>\n

4. Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n tr\u00ean thi\u1ebft b\u1ecb \u0111i\u1ec7n t\u1eed c\u1ea5y gh\u00e9p trong<\/h2>\n

VNTMNK tr\u00ean thi\u1ebft b\u1ecb c\u1ea5y gh\u00e9p trong tim l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd r\u1ea5t n\u1eb7ng, nguy c\u01a1 t\u1eed vong cao. \u0110\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng lan r\u1ed9ng \u0111\u1ebfn c\u00e1c d\u00e2y \u0111i\u1ec7n c\u1ef1c, c\u00e1c van tim ho\u1eb7c b\u1ec1 m\u1eb7t n\u1ed9i m\u1ea1c tim <\/em><\/strong>(ph\u00e2n bi\u1ec7t v\u1edbi nhi\u1ec5m tr\u00f9ng c\u1ee5c b\u1ed9 t\u1ea1i v\u1ecb tr\u00ed c\u1ea5y m\u00e1y).<\/p>\n

Nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p do c\u00e1c ch\u1ee7ng Staphylococci, trong \u0111\u00f3 kho\u1ea3ng 50% tr\u01b0\u1eddng h\u1ee3p c\u00f3 kh\u00e1ng methicillin. Do \u0111\u00f3, Vancomycin \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn s\u1eed d\u1ee5ng \u0111\u1ea7u ti\u00ean cho \u0111\u1ebfn khi c\u00f3 k\u1ebft qu\u1ea3 vi khu\u1ea9n h\u1ecdc. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb 4 – 6 tu\u1ea7n cho t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p v\u00e0 \u00edt nh\u1ea5t 2 tu\u1ea7n sau khi r\u00fat b\u1ecf d\u1ee5ng c\u1ee5 c\u1ea5y gh\u00e9p. Nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 th\u00e1o b\u1ecf d\u1ee5ng c\u1ee5 c\u1ea5y gh\u00e9p > 24 ti\u1ebfng m\u00e0 m\u0201u c\u1ea5y m\u00e1u sau \u0111\u00f3 v\u0201n d\u01b0\u01a1ng t\u00ednh th\u00ec v\u0201n n\u00ean duy tr\u00ec li\u1ec7u ph\u00e1p kh\u00e1ng sinh \u00edt nh\u1ea5t 4 tu\u1ea7n.<\/p>\n

Khuy\u1ebfn c\u00e1o v\u1ec1 \u0111i\u1ec1u tr\u1ecb v\u00e0 d\u1ef1 ph\u00f2ng VNTMNK tr\u00ean thi\u1ebft b\u1ecb \u0111i\u1ec7n t\u1eed c\u1ea5y gh\u00e9p trong tim (theo ESC 2015)<\/em><\/p>\n\n\n\n\n\n\n\n\n\n
Khuy\u1ebfn c\u00e1o<\/strong><\/td>\nM\u1ee9c khuy\u1ebfn<\/strong><\/p>\n

c\u00e1o<\/strong><\/td>\n

M\u1ee9c b\u1eb1ng ch\u1ee9ng<\/strong><\/td>\n<\/tr>\n
A. \u0110i\u1ec1u tr\u1ecb<\/strong><\/td>\n<\/tr>\n
1. Li\u1ec7u ph\u00e1p kh\u00e1ng sinh l\u00e2u d\u00e0i v\u00e0 th\u00e1o b\u1ecf thi\u1ebft b\u1ecb c\u1ea5y gh\u00e9p \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o khi ch\u1ea9n \u0111o\u00e1n ch\u1eafc ch\u1eafn VNTMNK do thi\u1ebft b\u1ecb c\u1ea5y gh\u00e9p trong tim.<\/td>\nI<\/td>\nC<\/td>\n<\/tr>\n
2. Th\u00e1o b\u1ecf ho\u00e0n to\u00e0n thi\u1ebft b\u1ecb c\u1ea5y gh\u00e9p trong tim n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc khi c\u00f3 t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng \u1ea9n gi\u1ea5u m\u00e0 kh\u00f4ng t\u00ecm ra c\u0103n nguy\u00ean r\u00f5 r\u00e0ng n\u00e0o kh\u00e1c.<\/td>\nIIa<\/td>\nC<\/td>\n<\/tr>\n
3. B\u1ec7nh nh\u00e2n van t\u1ef1 nhi\u00ean ho\u1eb7c van nh\u00e2n t\u1ea1o k\u00e8m theo c\u00f3 thi\u1ebft b\u1ecb c\u1ea5y gh\u00e9p trong tim, d\u00f9 kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng c\u1ee7a nhi\u1ec5m tr\u00f9ng thi\u1ebft b\u1ecb c\u1ea5y gh\u00e9p c\u0169ng c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc vi\u1ec7c th\u00e1o b\u1ecf thi\u1ebft b\u1ecb c\u1ea5y gh\u00e9p.<\/td>\nIIb<\/td>\nC<\/td>\n<\/tr>\n
B. C\u00e1ch th\u1ee9c th\u00e1o b\u1ecf thi\u1ebft b\u1ecb c\u1ea5y gh\u00e9p<\/strong><\/td>\n<\/tr>\n
1. Th\u00e1o b\u1ecf qua da \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u00ean t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n VNTMNK tr\u00ean thi\u1ebft b\u1ecb c\u1ea5y gh\u00e9p trong tim, th\u1eadm ch\u00ed c\u1ee5c s\u00f9i > 10 mm.<\/td>\nI<\/td>\nB<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
2. Ph\u0201u thu\u1eadt th\u00e1o b\u1ecf n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc n\u1ebfu th\u00e1o b\u1ecf qua da kh\u00f4ng kh\u1ea3 thi ho\u1eb7c kh\u00f4ng tri\u1ec7t \u0111\u1ec3 ho\u1eb7c khi c\u00f3 t\u00ecnh tr\u1ea1ng VNTMNK g\u00e2y ph\u00e1 h\u1ee7y van ba l\u00e1 n\u1eb7ng.<\/td>\nIIa<\/td>\nC<\/td>\n<\/tr>\n
3. Ph\u0201u thu\u1eadt th\u00e1o b\u1ecf c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5 ch\u1ee9c s\u00f9i l\u1edbn > 20 mm.<\/td>\nIIb<\/td>\nC<\/td>\n<\/tr>\n
\u00a0<\/strong><\/p>\n

C. C\u1ea5y l\u1ea1i thi\u1ebft b\u1ecb<\/strong><\/td>\n<\/tr>\n

1. Sau khi th\u00e1o b\u1ecf thi\u1ebft b\u1ecb, c\u1ea7n thi\u1ebft ph\u1ea3i \u0111\u00e1nh gi\u00e1 l\u1ea1i m\u1ee9c \u0111\u1ed9 c\u1ea7n thi\u1ebft c\u1ee7a vi\u1ec7c c\u1ea5y l\u1ea1i thi\u1ebft b\u1ecb.<\/td>\nI<\/td>\nC<\/td>\n<\/tr>\n
2. Khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh c\u1ea5y l\u1ea1i thi\u1ebft b\u1ecb, tr\u00ec ho\u00e3n v\u00e0i ng\u00e0y<\/p>\n

\u0111\u1ebfn v\u00e0i tu\u1ea7n n\u1ebfu c\u00f3 th\u1ec3 (*)<\/td>\n

IIa<\/td>\nC<\/td>\n<\/tr>\n
3. Khi b\u1ec7nh nh\u00e2n b\u1ecb ph\u1ee5 thu\u1ed9c v\u00e0o m\u00e1y t\u1ea1o nh\u1ecbp, s\u1eed d\u1ee5ng d\u00e2y t\u1ea1o nh\u1ecbp c\u1ed1 \u0111\u1ecbnh k\u1ebft n\u1ed1i v\u1edbi h\u1ec7 th\u1ed1ng m\u00e1y \u0111i\u1ec1u khi\u1ec3n b\u00ean ngo\u00e0i c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc nh\u01b0 m\u1ed9t b\u01b0\u1edbc c\u1ea7u n\u1ed1i tr\u01b0\u1edbc khi c\u1ea5y l\u1ea1i thi\u1ebft b\u1ecb.<\/td>\nIIb<\/td>\nC<\/td>\n<\/tr>\n
4. M\u00e1y t\u1ea1o nh\u1ecbp t\u1ea1m th\u1eddi kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng th\u01b0\u1eddng quy<\/td>\nIII<\/td>\nC<\/td>\n<\/tr>\n
\u00a0<\/strong><\/p>\n

D. D\u1ef1 ph\u00f2ng VNTMNK<\/strong><\/td>\n<\/tr>\n

1. D\u1ef1 ph\u00f2ng kh\u00e1ng sinh \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u01b0\u1edbc khi c\u1ea5y gh\u00e9p thi\u1ebft b\u1ecb trong tim (**)<\/td>\nI<\/td>\nB<\/td>\n<\/tr>\n
2. C\u00e1c \u1ed5 nhi\u1ec5m tr\u00f9ng ti\u1ec1m t\u00e0ng n\u00ean \u0111\u01b0\u1ee3c lo\u1ea1i b\u1ecf \u00edt nh\u1ea5t 2 tu\u1ea7n tr\u01b0\u1edbc khi c\u1ea5y gh\u00e9p thi\u1ebft b\u1ecb trong tim (tr\u1eeb khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh kh\u1ea9n c\u1ea5p)<\/td>\n\u00a0<\/strong><\/p>\n

IIa<\/td>\n

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

C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

(*) C\u00e1c m\u1eabu c\u1ea5y m\u00e1u n\u00ean \u00e2m t\u00ednh \u00edt nh\u1ea5t 72 ti\u1ebfng tr\u01b0\u1edbc khi c\u1ea5y l\u1ea1i thi\u1ebft b\u1ecb m\u1edbi.<\/em><\/p>\n

(**) Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng 1 ti\u1ebfng tr\u01b0\u1edbc th\u1ee7 thu\u1eadt. \u01afu ti\u00ean nh\u00f3m Cephalosporin th\u1ebf h\u1ec7 th\u1ee9 nh\u1ea5t, Oxacillin. Vancomycin, Teicoplanin, Daptomicin \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng thay th\u1ebf khi b\u1ec7nh nh\u00e2n d\u1ecb \u1ee9ng ho\u1eb7c c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi c\u00e1c Cephalosporin ho\u1eb7c \u1edf c\u00e1c trung t\u00e2m c\u00f3 nguy c\u01a1 vi khu\u1ea9n kh\u00e1ng oxacillin cao.<\/em><\/p>\n

5. Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n tr\u00ean ph\u1ee5 n\u1eef mang thai<\/h2>\n

VNTMNK tr\u00ean ph\u1ee5 n\u1eef mang tha<\/em><\/strong>i \u0111ang l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c l\u1edbn \u0111\u1ed1i v\u1edbi c\u00e1c b\u00e1c s\u0129 tim m\u1ea1ch b\u1edfi d\u1ec5 nh\u1ea7m l\u0201n trong ch\u1ea9n \u0111o\u00e1n v\u00e0 kh\u00f3 kh\u0103n trong \u0111i\u1ec1u tr\u1ecb. B\u1ec7nh kh\u00e1 hi\u1ebfm g\u1eb7p, kho\u1ea3ng 0 – 1,2% trong nh\u00f3m ph\u1ee5 n\u1eef c\u00f3 b\u1ec7nh tim, \u0111\u1eb7c bi\u1ec7t \u1edf ph\u1ee5 n\u1eef mang van nh\u00e2n t\u1ea1o. T\u1ef7 l\u1ec7 t\u1eed vong m\u1eb9 kho\u1ea3ng 11 – 33% (th\u01b0\u1eddng do suy tim v\u00e0 thuy\u00ean t\u1eafc m\u1ea1ch), t\u1ef7 l\u1ec7 t\u1eed vong thai kho\u1ea3ng 14 – 29%.<\/p>\n

\u0110i\u1ec1u tr\u1ecb VNTMNK \u1edf ph\u1ee5 n\u1eef mang thai <\/em><\/strong>t\u01b0\u01a1ng t\u1ef1 nh\u01b0 \u1edf ng\u01b0\u1eddi kh\u00f4ng mang thai. L\u01b0u \u00fd nh\u1eefng kh\u00e1ng sinh c\u00f3 th\u1ec3 g\u00e2y \u0111\u1ed9c ti\u1ec1m t\u00e0ng cho thai. M\u1ed9t s\u1ed1 lo\u1ea1i kh\u00e1ng sinh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong c\u1ea3 thai k\u1ef3 nh\u01b0 Penicillin, Ampicillin, Amoxicillin, Oxacillin, Erythromycin, Daptomycin v\u00e0 c\u00e1c Cephalosporin.<\/p>\n

Ph\u1eabu thu\u1eadt kh\u1ea9n tr\u01b0\u01a1ng <\/em><\/strong>n\u00ean \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh khi b\u1ec7nh nh\u00e2n xu\u1ea5t hi\u1ec7n s\u1ed1c tim ho\u1eb7c suy tim do h\u1edf van c\u1ea5p. Ch\u1ec9 \u0111\u1ecbnh ph\u0201u thu\u1eadt trong tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m tr\u00f9ng kh\u00f3 ki\u1ec3m so\u00e1t ho\u1eb7c \u0111\u1ec3 ng\u0103n ng\u1eeba nguy c\u01a1 thuy\u00ean t\u1eafc m\u1ea1ch c\u1ea7n \u0111\u00e1nh gi\u00e1 c\u1ea9n th\u1eadn v\u00e0 c\u00e2n nh\u1eafc nguy c\u01a1 c\u1ee7a thai nhi khi ti\u1ebfn h\u00e0nh ph\u0201u thu\u1eadt v\u00e0 nguy c\u01a1 c\u1ee7a m\u1eb9 khi ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa \u0111\u01a1n thu\u1ea7n. Quy\u1ebft \u0111\u1ecbnh can thi\u1ec7p s\u1ea3n khoa v\u00e0 tim m\u1ea1ch c\u1ea7n c\u00e2n nh\u1eafc l\u1ee3i \u00edch c\u1ee7a s\u1ea3n ph\u1ee5 v\u00e0 thai nhi. C\u1ea7n trao \u0111\u1ed5i \u0111\u1ea7y \u0111\u1ee7 l\u1ee3i \u00edch v\u00e0 nguy c\u01a1 n\u00e0y cho s\u1ea3n ph\u1ee5, gia \u0111\u00ecnh. T\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c \u1edf s\u1ea3n ph\u1ee5 c\u1ea7n \u0111\u01b0\u1ee3c tham v\u1ea5n \u00fd ki\u1ebfn \u0111a chuy\u00ean khoa.<\/p>\n

D\u1ef1 ph\u00f2ng VNTMNK tr\u00ean ph\u1ee5 n\u1eef mang thai <\/em><\/strong>t\u01b0\u01a1ng t\u1ef1 nh\u01b0 tr\u00ean ng\u01b0\u1eddi kh\u00f4ng mang <\/em>thai. Ch\u1ec9 \u0111\u1ecbnh d\u00f9ng kh\u00e1ng sinh d\u1ef1 ph\u00f2ng trong qu\u00e1 tr\u00ecnh chuy\u1ec3n d\u1ea1 c\u00f2n \u0111ang l\u00e0 v\u1ea5n \u0111\u1ec1 g\u00e2y tranh c\u00e3i. V\u1edbi c\u00e1c khuy\u1ebfn c\u00e1o hi\u1ec7n t\u1ea1i, kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh d\u1ef1 ph\u00f2ng VNTMNK th\u01b0\u1eddng quy cho ph\u1ee5 n\u1eef mang thai k\u1ec3 c\u1ea3 chuy\u1ec3n d\u1ea1 \u0111\u01b0\u1eddng t\u1ef1 nhi\u00ean hay ph\u0201u thu\u1eadt l\u1ea5y thai, quan tr\u1ecdng l\u00e0 vai tr\u00f2 c\u1ee7a vi\u1ec7c gi\u1eef v\u1ec7 sinh v\u00e0 \u0111\u1ea3m b\u1ea3o v\u00f4 khu\u1ea9n cho th\u1ee7 thu\u1eadt.<\/p>\n

6. Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c v\u00f4 khu\u1ea9n<\/h2>\n

Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c (VNTM) v\u00f4 khu\u1ea9n c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 VNTM Libman-Sacks <\/em><\/strong>\u0111\u1eb7c tr\u01b0ng b\u1edfi c\u00e1c t\u1ed5 ch\u1ee9c s\u00f9i v\u00f4 tr\u00f9ng <\/em><\/strong>bao g\u1ed3m c\u00e1c s\u1ee3i fibrin v\u00e0 s\u1ef1 ng\u01b0ng t\u1eadp ti\u1ec3u c\u1ea7u tr\u00ean van tim, kh\u00f4ng \u1ea3nh h\u01b0\u1edfng hay ph\u00e1 h\u1ee7y \u0111\u1ebfn c\u00e1c c\u1ea5u tr\u00fac d\u01b0\u1edbi van.<\/p>\n

VNTM v\u00f4 khu\u1ea9n <\/em><\/strong>th\u01b0\u1eddng g\u1eb7p tr\u00ean c\u00e1c b\u1ec7nh ung th\u01b0, b\u1ec7nh m\u00f4 li\u00ean k\u1ebft (lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng c\u00f3 h\u1ed9i ch\u1ee9ng kh\u00e1ng phospholipid), r\u1ed1i lo\u1ea1n mi\u1ec5n d\u1ecbch, t\u00ecnh tr\u1ea1ng t\u0103ng \u0111\u00f4ng, nhi\u1ec5m khu\u1ea9n huy\u1ebft, b\u1ecfng n\u1eb7ng, m\u1eafc c\u00e1c b\u1ec7nh m\u1ea1n t\u00ednh nh\u01b0 lao, AIDS, h\u1ed9i ch\u1ee9ng ure m\u00e1u cao.<\/p>\n

\u0110i\u1ec1u tr\u1ecb <\/em><\/strong>ch\u1ee7 y\u1ebfu l\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh n\u1ec1n. N\u1ebfu kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n, heparin tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p ho\u1eb7c warfarin (thu\u1ed1c \u1ee9c ch\u1ebf tr\u1ef1c ti\u1ebfp thrombin ho\u1eb7c y\u1ebfu t\u1ed1 Xa kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3 trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y). Duy tr\u00ec ch\u1ed1ng \u0111\u00f4ng l\u00e2u d\u00e0i v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 h\u1ed9i ch\u1ee9ng kh\u00e1ng phospholipid.<\/p>\n

Ph\u1eabu thu\u1eadt s\u1eeda\/ thay van <\/em><\/strong>kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o th\u01b0\u1eddng quy trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y tr\u1eeb khi b\u1ec7nh nh\u00e2n c\u00f3 thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i t\u00e1i ph\u00e1t d\u00f9 \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng v\u1edbi li\u1ec1u hi\u1ec7u qu\u1ea3. C\u00e1c ch\u1ec9 \u0111\u1ecbnh ph\u0201u thu\u1eadt kh\u00e1c t\u01b0\u01a1ng t\u1ef1 nh\u01b0 trong VNTMNK. V\u1edbi c\u0103n nguy\u00ean ung th\u01b0, c\u1ea7n c\u00f3 s\u1ef1 ti\u1ebfp c\u1eadn \u0111a chuy\u00ean ng\u00e0nh.<\/p>\n","protected":false},"excerpt":{"rendered":"

Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n van nh\u00e2n t\u1ea1o chi\u1ebfm kho\u1ea3ng 20% t\u1ed5ng s\u1ed1 ca VNTMNK v\u00e0 c\u00f3 xu h\u01b0\u1edbng t\u0103ng d\u1ea7n. Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p \u0111\u00e3 c\u00f3 bi\u1ebfn ch\u1ee9ng ho\u1eb7c c\u0103n nguy\u00ean do Staphylococcal, n\u1ea5m th\u01b0\u1eddng c\u00f3 ti\u00ean l\u01b0\u1ee3ng x\u1ea5u n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ph\u0201u thu\u1eadt. Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u00e2\u0309n 1.T\u1ed5ng quan Vi\u00eam n\u1ed9i […]<\/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 \u1edf m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t<\/title>\n<meta name=\"description\" content=\"Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n van nh\u00e2n t\u1ea1o chi\u1ebfm kho\u1ea3ng 20% t\u1ed5ng s\u1ed1 ca vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n v\u00e0 c\u00f3 xu h\u01b0\u1edbng t\u0103ng d\u1ea7n.\" \/>\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\" 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