{"id":30278,"date":"2023-05-03T15:00:15","date_gmt":"2023-05-03T08:00:15","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30278"},"modified":"2023-05-03T15:00:15","modified_gmt":"2023-05-03T08:00:15","slug":"viem-noi-tam-mac-theo-doi-va-quan-ly-benh-nhan-ngoai-tru","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/viem-noi-tam-mac-theo-doi-va-quan-ly-benh-nhan-ngoai-tru\/","title":{"rendered":"Theo d\u00f5i v\u00e0 qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n ngo\u1ea1i tr\u00fa b\u1ec7nh vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c"},"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.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. <\/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

C\u00e1c t\u1ed5n th\u01b0\u01a1ng van tim do VNTMNK c\u00f3 xu h\u01b0\u1edbng di\u1ec5n bi\u1ebfn x\u1ea5u \u0111i theo th\u1eddi gian. Do \u0111\u00f3, c\u1ea7n theo d\u00f5i \u0111\u1ecbnh k\u1ef3. B\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng van nh\u1eb9 (h\u1edf van hai l\u00e1 nh\u1eb9, h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, h\u1edf van ba l\u00e1 nh\u1eb9), kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng ti\u00ean l\u01b0\u1ee3ng t\u1ed1t v\u00e0 kh\u00f4ng c\u1ea7n t\u00e1i kh\u00e1m th\u01b0\u1eddng xuy\u00ean.<\/p>\n

2. H\u1ecfi b\u1ec7nh<\/h2>\n

C\u00f3 b\u1ea5t c\u1ee9 ti\u1ebfn tri\u1ec3n n\u00e0o k\u1ec3 t\u1eeb l\u1ea7n kh\u00e1m cu\u1ed1i kh\u00f4ng? C\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng tim m\u1ea1ch m\u1edbi kh\u00f4ng?<\/p>\n

C\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng g\u1ee3i \u00fd VNTMNK kh\u00f4ng? (S\u1ed1t, s\u1ee5t c\u00e2n, \u0111au kh\u1edbp, \u0111au l\u01b0ng\u2026 C\u00f3 \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng VNTMNK \u0111\u1ea7y \u0111\u1ee7 kh\u00f4ng?<\/p>\n

H\u1ecfi v\u1ec1 c\u00e1c thu\u1ed1c \u0111ang d\u00f9ng v\u00e0 thay \u0111\u1ed5i n\u1ebfu c\u00f3, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng v\u00e0 kh\u00e1ng ng\u01b0ng t\u1eadp ti\u1ec3u c\u1ea7u.<\/p>\n

3. Kh\u00e1m l\u00e2m s\u00e0ng<\/h2>\n

\u0110o nh\u1ecbp tim, huy\u1ebft \u00e1p. Kh\u00e1m tim ph\u1ed5i \u0111\u1ec3 ph\u00e1t hi\u1ec7n d\u1ea5u hi\u1ec7u suy tim, ph\u00f9 ph\u1ed5i, t\u1ed5n th\u01b0\u01a1ng van tim.<\/p>\n

4. X\u00e9t nghi\u1ec7m<\/h2>\n

C\u1ea7n theo d\u00f5i \u0111i\u1ec7n t\u00e2m \u0111\u1ed3, si\u00eau \u00e2m tim qua th\u00e0nh ng\u1ef1c (\u00b1 X-quang ph\u1ed5i) v\u00e0 so s\u00e1nh v\u1edbi k\u1ebft qu\u1ea3 tr\u01b0\u1edbc \u0111\u00f3 nh\u1eb1m \u0111\u00e1nh gi\u00e1 ti\u1ebfn tri\u1ec3n tri\u1ec7u ch\u1ee9ng. L\u01b0u \u00fd c\u00e1c x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng tan m\u00e1u \u1edf b\u1ec7nh nh\u00e2n c\u00f3 van nh\u00e2n t\u1ea1o.<\/p>\n

4.1 Si\u00eau \u00e2m tim<\/h3>\n

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.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. Si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n (SATQTQ) nh\u1ea1y h\u01a1n cho t\u1ed5n 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 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).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

4.2 C\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1c<\/h3>\n

C\u00f4ng th\u1ee9c m\u00e1u:<\/strong> 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.<\/p>\n

Sinh h\u00f3a:<\/strong> Suy th\u1eadn, c\u00f3 th\u1ec3 k\u00e8m theo r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i. C\u00f3 th\u1ec3 t\u0103ng ALT, AST, GGT.<\/p>\n

\u0110i\u1ec7n t\u00e2m \u0111\u1ed3:<\/strong> Block nh\u0129 th\u1ea5t ho\u1eb7c r\u1ed1i lo\u1ea1n d\u0201n truy\u1ec1n (hay g\u1eb7p trong \u00e1p xe g\u1ed1c \u0111\u1ed9ng m\u1ea1ch ch\u1ee7).Bi\u1ebfn \u0111\u1ed5i kh\u00f4ng \u0111\u1eb7c hi\u1ec7u ST\/T. Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p (hi\u1ebfm g\u1eb7p).<\/p>\n

X-Quang ng\u1ef1c th\u1eb3ng:<\/strong> 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).<\/p>\n

5. C\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t<\/h2>\n

V\u1edbi t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c khuy\u00ean t\u00e1i kh\u00e1m s\u1edbm h\u01a1n d\u1ef1 ki\u1ebfn n\u1ebfu c\u00f3 b\u1ea5t k\u1ef3 thay \u0111\u1ed5i n\u00e0o v\u1ec1 tri\u1ec7u ch\u1ee9ng.<\/p>\n

H\u1eb9p van hai l\u00e1<\/em><\/strong>: N\u1ebfu h\u1eb9p nh\u1eb9 kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng t\u00e1i kh\u00e1m m\u1ed7i 2 n\u0103m. N\u1ebfu h\u1eb9p v\u1eeba ho\u1eb7c n\u1eb7ng (ho\u1eb7c c\u00f3 tri\u1ec7u ch\u1ee9ng) n\u00ean t\u00e1i kh\u00e1m m\u1ed7i n\u0103m 1 l\u1ea7n.<\/p>\n

H\u1edf van hai l\u00e1: <\/em><\/strong>B \u1ec7nh nh\u00e2n c\u00f3 h\u1edf van hai l\u00e1 nh\u1eb9 kh\u00f4ng tri\u1ec7u ch\u1ee9ng c\u00f3 th\u1ec3 kh\u1eb3ng \u0111\u1ecbnh l\u1ea1i ch\u1ea9n \u0111o\u00e1n v\u00e0 d\u1eebng t\u00e1i kh\u00e1m. H\u1edf v\u1eeba \u0111\u1ebfn n\u1eb7ng ho\u1eb7c c\u00f3 tri\u1ec7u ch\u1ee9ng c\u1ea7n t\u00e1i kh\u00e1m \u00edt nh\u1ea5t m\u1ed7i n\u0103m 1 l\u1ea7n.<\/p>\n

H\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7: <\/em><\/strong>H\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 nh\u1eb9 kh\u00f4ng tri\u1ec7u ch\u1ee9ng c\u00f3 th\u1ec3 t\u00e1i kh\u00e1m sau m\u1ed7i 2 – 3 n\u0103m. H\u1eb9p v\u1eeba tr\u1edf l\u00ean ho\u1eb7c c\u00f3 tri\u1ec7u ch\u1ee9ng n\u00ean t\u00e1i kh\u00e1m h\u1eb1ng n\u0103m. H\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 kh\u00edt ho\u1eb7c h\u1eb9p v\u1eeba c\u00f3 tri\u1ec7u ch\u1ee9ng n\u00ean x \u00e9t thay van.<\/p>\n

H\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7: <\/em><\/strong>B \u1ec7nh nh\u00e2n c\u00f3 h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 nh\u1eb9 kh\u00f4ng tri\u1ec7u ch\u1ee9ng c\u00f3 th\u1ec3 kh\u1eb3ng \u0111\u1ecbnh l\u1ea1i ch\u1ea9n \u0111o\u00e1n v\u00e0 d\u1eebng t\u00e1i kh\u00e1m. H\u1edf v\u1eeba ho\u1eb7c c\u00f3 tri\u1ec7u ch\u1ee9ng n\u00ean t\u00e1i kh\u00e1m h \u00e0 ng n\u0103m. N\u1ebfu th\u1ea5t tr\u00e1i gi\u00e3n ho\u1eb7c h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 n\u1eb7ng, xem x\u00e9t ph\u0201u thu\u1eadt thay van.<\/p>\n

Van nh\u00e2n t\u1ea1o: <\/em><\/strong>T\u00e1i kh\u00e1m h \u00e0 ng n\u0103m. Sau m\u1ed5 tr\u00ean 8 n\u0103m, b\u1ec7nh nh\u00e2n c\u00f3 van sinh h\u1ecdc t\u00e1i kh\u00e1m m\u1ed7i 6 th\u00e1ng do t\u1ef7 l\u1ec7 tho\u00e1i ho\u00e1 van cao. Khi c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng van m\u1edbi, c\u1ea7n cho b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n \u0111\u00e1nh gi\u00e1 ngay. Khi ph\u00e1t hi\u1ec7n h\u1edf van, c\u1ea7n theo d\u00f5i s\u00e1t b\u1eb1ng si\u00eau \u00e2m tim 2D v\u00e0 Doppler m\u1ed7i 3 – 6 th\u00e1ng.<\/p>\n

6. K\u1ebft lu\u1eadn<\/p>\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, v\u00e0 b\u1ec7nh nh\u00e2n sau khi \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u1ea1i b\u1ec7nh vi\u1ec7n th\u01b0\u1eddng c\u1ea7n theo d\u00f5i v\u00e0 qu\u1ea3n l\u00fd t\u1ea1i nh\u00e0 trong th\u1eddi gian d\u00e0i. Vi\u1ec7c theo d\u00f5i v\u00e0 qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n ngo\u1ea1i tr\u00fa n\u00e0y r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o b\u1ec7nh nh\u00e2n h\u1ed3i ph\u1ee5c t\u1ed1t v\u00e0 tr\u00e1nh c\u00e1c bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m.<\/p>\n

Ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng v\u00e0 l\u1ed1i s\u1ed1ng l\u00e0nh m\u1ea1nh c\u0169ng r\u1ea5t quan tr\u1ecdng trong qu\u00e1 tr\u00ecnh h\u1ed3i ph\u1ee5c, c\u1ea7n h\u1ea1n ch\u1ebf ti\u00eau th\u1ee5 \u0111\u1ed3 u\u1ed1ng c\u00f3 c\u1ed3n, thu\u1ed1c l\u00e1 v\u00e0 c\u00e1c ch\u1ea5t k\u00edch th\u00edch kh\u00e1c \u0111\u1ec3 gi\u1ea3m thi\u1ec3u t\u00e1c \u0111\u1ed9ng ti\u00eau c\u1ef1c \u0111\u1ebfn tim m\u1ea1ch. B\u00ean c\u1ea1nh \u0111\u00f3, c\u1ea7n t\u1eadp luy\u1ec7n th\u1ec3 d\u1ee5c \u0111\u1ec1u \u0111\u1eb7n \u0111\u1ec3 gi\u1eef cho c\u01a1 tim kh\u1ecfe m\u1ea1nh v\u00e0 t\u0103ng c\u01b0\u1eddng s\u1ee9c kh\u1ecfe t\u1ed5ng th\u1ec3.<\/p>\n

Ngo\u00e0i ra, b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c gi\u00e1o d\u1ee5c v\u1ec1 b\u1ec7nh l\u00fd, c\u00e1c bi\u1ebfn ch\u1ee9ng c\u00f3 th\u1ec3 x\u1ea3y ra v\u00e0 c\u00e1ch ph\u00f2ng ng\u1eeba \u0111\u1ec3 tr\u00e1nh t\u00e1i ph\u00e1t b\u1ec7nh, c\u1ea7n \u0111\u01b0\u1ee3c cung c\u1ea5p th\u00f4ng tin \u0111\u1ea7y \u0111\u1ee7 v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh v\u00e0 ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng, c\u0169ng nh\u01b0 h\u01b0\u1edbng d\u1eabn c\u00e1c bi\u1ec7n ph\u00e1p ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe c\u01a1 b\u1ea3n \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 t\u1ef1 qu\u1ea3n l\u00fd b\u1ec7nh t\u1ed1t h\u01a1n khi \u1edf nh\u00e0.<\/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.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 […]<\/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 theo d\u00f5i v\u00e0 qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n ngo\u1ea1i tr\u00fa<\/title>\n<meta name=\"description\" content=\"Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m 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