{"id":11654,"date":"2023-09-15T15:00:53","date_gmt":"2023-09-15T07:00:53","guid":{"rendered":"https:\/\/docquity.com\/?post_type=articles&p=11654"},"modified":"2025-02-11T13:36:58","modified_gmt":"2025-02-11T05:36:58","slug":"bao-cao-ca-ap-xe-sau-khi-cay-may-tao-nhip","status":"publish","type":"articles","link":"https:\/\/docquity.com\/vi\/articles\/bao-cao-ca-ap-xe-sau-khi-cay-may-tao-nhip\/","title":{"rendered":"B\u00c1O C\u00c1O CA: \u00c1p xe sau khi c\u1ea5y m\u00e1y t\u1ea1o nh\u1ecbp"},"content":{"rendered":"\n

M\u1ede \u0110\u1ea6U<\/strong><\/p>\n\n\n\n

Lo\u1ea1n nh\u1ecbp c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb v\u00e0 c\u1ea5y m\u00e1y t\u1ea1o nh\u1ecbp. M\u1eb7c d\u00f9 m\u00e1y t\u1ea1o nh\u1ecbp mang \u0111\u1ebfn nh\u1eefng l\u1ee3i \u00edch cho b\u1ec7nh nh\u00e2n, tuy nhi\u00ean, c\u00e1c ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i li\u00ean quan \u0111\u1ebfn c\u1ea5u tr\u00fac c\u01a1 h\u1ecdc c\u1ee7a m\u00e1y t\u1ea1o nh\u1ecbp v\u1eabn lu\u00f4n l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 c\u00f2n t\u1ed3n \u0111\u1ecdng1<\/sup>. V\u1edbi b\u1ea3n ch\u1ea5t l\u00e0 m\u1ed9t quy tr\u00ecnh x\u00e2m l\u1ea5n, c\u1ea5y m\u00e1y t\u1ea1o nh\u1ecbp c\u00f3 li\u00ean quan \u0111\u1ebfn nh\u1eefng bi\u1ebfn ch\u1ee9ng chu v\u00e0 h\u1eadu ph\u1eabu. Nh\u1eefng bi\u1ebfn ch\u1ee9ng n\u00e0y bao g\u1ed3m xu\u1ea5t huy\u1ebft, tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i, ch\u00e8n \u00e9p tim, \u0111i\u1ec7n c\u1ef1c l\u1ea1c ch\u1ed7, nhi\u1ec5m tr\u00f9ng, g\u00e3y d\u00e2y \u0111i\u1ec7n c\u1ef1c2<\/sup>.<\/p>\n\n\n\n

B\u00e0i vi\u1ebft \u0111\u1ec1 c\u1eadp \u0111\u1ebfn tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n 90 tu\u1ed5i b\u1ecb nhi\u1ec5m tr\u00f9ng (c\u00f3 \u00e1p xe) \u1edf v\u00f9ng \u0111\u1eb7t m\u00e1y t\u1ea1o nh\u1ecbp, m\u1eddi qu\u00fd \u0111\u1ed3ng nghi\u1ec7p c\u00f9ng theo d\u00f5i3<\/sup>.<\/p>\n\n\n\n

B\u1ec6NH C\u1ea2NH<\/strong><\/p>\n\n\n\n

B\u1ec7nh nh\u00e2n n\u1eef, 90 tu\u1ed5i \u0111\u1ebfn ph\u00f2ng kh\u00e1m Da li\u1ec5u v\u00e0o th\u00e1ng 05 n\u0103m 2022 do n\u1ed5i ban \u0111\u1ecf \u1edf ng\u1ef1c tr\u00ean b\u00ean tr\u00e1i. Sau khi b\u1ecb ph\u00e1t ban kho\u1ea3ng 6 ng\u00e0y, b\u1ec7nh nh\u00e2n b\u1ecb s\u1ed1t cao, \u1edbn l\u1ea1nh v\u00e0 t\u1ed5ng tr\u1ea1ng r\u1ea5t y\u1ebfu, k\u00e8m theo \u0111\u00f3 l\u00e0 c\u1ea3m gi\u00e1c \u0111au v\u00e0 s\u01b0ng \u1edf ng\u1ef1c tr\u00ean b\u00ean tr\u00e1i.<\/p>\n\n\n\n

Ban \u0111\u1ea7u, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa b\u1eb1ng amoxicillin v\u00e0 acetaminophen, sau \u0111\u00f3 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c b\u1ed5 sung th\u00eam clindamycin v\u00e0o ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb. Sau \u0111\u00f3, b\u1ec7nh nh\u00e2n b\u1eaft \u0111\u1ea7u c\u00f3 c\u1ea3m gi\u00e1c bu\u1ed3n n\u00f4n, n\u00f4n, s\u1ed1t 38\u25e6C v\u00e0 c\u01a1n \u0111au \u1edf ng\u1ef1c kh\u00f4ng gi\u1ea3m, v\u00ec v\u1eady b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c n\u1eb1m vi\u1ec7n \u1edf khoa Da li\u1ec5u.<\/p>\n\n\n\n

Ti\u1ec1n s\u1eed<\/em><\/strong><\/p>\n\n\n\n

B\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c c\u1eaft b\u1ecf tuy\u1ebfn v\u00fa v\u00e0 x\u1ea1 tr\u1ecb ng\u1ef1c b\u00ean tr\u00e1i do ung th\u01b0 v\u00fa 30 n\u0103m tr\u01b0\u1edbc \u0111\u00e2y. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c c\u1ea5y m\u00e1y t\u1ea1o nh\u1ecbp 2 bu\u1ed3ng (DDD pacemaker) \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb ch\u1ee9ng nh\u1ecbp ch\u1eadm 7 n\u0103m tr\u01b0\u1edbc \u0111\u00e2y. B\u1ec7nh nh\u00e2n c\u0169ng c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9, vi\u00eam t\u00fai th\u1eeba \u0111\u1ea1i tr\u00e0ng v\u00e0 lo\u00e9t d\u1ea1 d\u00e0y. B\u1ec7nh nh\u00e2n \u0111ang \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng molsidomine, nebivolol v\u00e0 rivaroxaban. M\u1ed9t ng\u00e0y tr\u01b0\u1edbc khi nh\u1eadp vi\u1ec7n, b\u1ec7nh nh\u00e2n \u0111\u1ebfn th\u0103m kh\u00e1m t\u1ea1i ph\u00f2ng kh\u00e1m tim m\u1ea1ch \u0111\u1ec3 ki\u1ec3m tra m\u00e1y t\u1ea1o nh\u1ecbp. K\u1ebft qu\u1ea3 th\u0103m kh\u00e1m kh\u00f4ng cho th\u1ea5y c\u00f3 s\u1ef1 b\u1ea5t th\u01b0\u1eddng.<\/p>\n\n\n\n

Th\u0103m kh\u00e1m l\u00e2m s\u00e0ng<\/em><\/strong><\/p>\n\n\n\n

B\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n trong t\u00ecnh tr\u1ea1ng suy nh\u01b0\u1ee3c, da t\u00e1i nh\u1ee3t. T\u1ea7n s\u1ed1 tim c\u1ee7a b\u1ec7nh nh\u00e2n \u1ed5n \u0111\u1ecbnh, 90 nh\u1ecbp\/ph\u00fat. Nghe tim ghi nh\u1eadn \u00e2m th\u1ed5i t\u00e2m thu \u00e2m s\u1eafc cao. V\u00f9ng ng\u1ef1c tr\u00ean b\u00ean tr\u00e1i c\u00f3 v\u00f9ng s\u01b0ng \u0111\u1ecf, l\u1ed9 r\u00f5 g\u1edd v\u00e0 \u0111au nhi\u1ec1u khi \u1ea5n. V\u00f9ng s\u01b0ng n\u00e0y \u0111\u01b0\u1ee3c \u0111\u1ecbnh v\u1ecb \u1edf s\u00e1t b\u00ean tr\u00ean m\u00e1y t\u1ea1o nh\u1ecbp. Da \u1edf v\u00f9ng s\u01b0ng m\u1ec1m, c\u0103ng, h\u01a1i b\u00f3ng, c\u1ea3m th\u1ea5y di \u0111\u1ed9ng khi s\u1edd (h\u00ecnh 1).<\/p>\n\n\n\n


H\u00ecnh 1.<\/strong> Kh\u1ed1i s\u01b0ng \u1edf v\u00f9ng ng\u1ef1c tr\u00ean b\u00ean tr\u00e1i c\u1ee7a b\u1ec7nh nh\u00e2n<\/p>\n\n\n\n

Ngo\u00e0i ra, ph\u00e1t hi\u1ec7n th\u1ea5y c\u00f3 ph\u00f9 c\u1ee5c b\u1ed9 \u1edf c\u00e1nh tay b\u00ean tr\u00e1i (k\u00e9o d\u00e0i t\u1eeb vai \u0111\u1ebfn n\u1eeda tr\u00ean c\u00e1nh tay). V\u00f9ng da \u1edf ng\u1ef1c tr\u00e1i c\u1ee7a b\u1ec7nh nh\u00e2n teo v\u00e0 thay \u0111\u1ed5i s\u1eafc t\u1ed1 da (d\u1ea5u hi\u1ec7u c\u1ee7a ph\u1ea3n \u1ee9ng x\u1ea1 tr\u1ecb – b\u1ee9c x\u1ea1 xu\u1ea5t hi\u1ec7n mu\u1ed9n) (h\u00ecnh 2).<\/p>\n\n\n\n


H\u00ecnh 2.<\/strong> V\u00f9ng da b\u00ean ng\u1ef1c tr\u00e1i b\u1ec7nh nh\u00e2n teo, thay \u0111\u1ed5i s\u1eafc t\u1ed1 da<\/p>\n\n\n\n

K\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m<\/em><\/strong><\/p>\n\n\n\n


K\u1ebft qu\u1ea3 x quang ng\u1ef1c th\u1ea5y m\u1ea5t g\u00f3c s\u01b0\u1eddn ho\u00e0nh, g\u1ee3i \u00fd tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i (h\u00ecnh 3). K\u1ebft qu\u1ea3 si\u00eau \u00e2m m\u00f4 m\u1ec1m v\u00f9ng d\u01b0\u1edbi \u0111\u00f2n b\u00ean tr\u00e1i cho th\u1ea5y c\u00f3 v\u00f9ng d\u1ecbch t\u0103ng s\u00e1ng, k\u00edch th\u01b0\u1edbc 54x49x20 mm, khu tr\u00fa xung quanh m\u00e1y t\u1ea1o nh\u1ecbp n\u1eb1m s\u00e2u 5mm, \u0111\u1ed3ng th\u1eddi th\u1ea5y r\u00f5 ph\u00e2n b\u1ed1 m\u1ea1ch m\u00e1u \u1edf g\u1edd c\u1ee7a v\u00f9ng ch\u1ea5t l\u1ecfng (h\u00ecnh 4).<\/p>\n\n\n\n


H\u00ecnh 3.<\/strong> X quang ng\u1ef1c th\u1ea5y m\u1edd g\u00f3c s\u01b0\u1eddn ho\u00e0nh<\/p>\n\n\n\n


H\u00ecnh 4.<\/strong> K\u1ebft qu\u1ea3 si\u00eau \u00e2m m\u00f4 m\u1ec1m<\/p>\n\n\n\n

Ch\u1ea9n \u0111o\u00e1n<\/em><\/strong><\/p>\n\n\n\n

Trong th\u1eddi gian n\u1eb1m vi\u1ec7n, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n b\u1edfi b\u00e1c s\u0129 tim m\u1ea1ch v\u00e0 \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn c\u00f3 t\u00ecnh tr\u1ea1ng vi\u00eam \u1edf v\u00f9ng c\u1ea5y m\u00e1y t\u1ea1o nh\u1ecbp. K\u1ebft qu\u1ea3 si\u00eau \u00e2m qua th\u1ef1c qu\u1ea3n kh\u00f4ng ph\u00e1t hi\u1ec7n th\u1ea5y m\u1ea3nh s\u00f9i, nh\u01b0ng th\u1ea5y r\u00f5 t\u00ecnh tr\u1ea1ng h\u1eb9p \u0111\u1ed9ng m\u1ea1ch ch\u1ee7. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n \u00e1p xe v\u00f9ng c\u1ea5y m\u00e1y t\u1ea1o nh\u1ecbp.<\/p>\n\n\n\n

\u0110i\u1ec1u tr\u1ecb<\/em><\/strong><\/p>\n\n\n\n

B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh (ceftriaxone v\u00e0 clindamycin), n\u00e2ng cao tay tr\u00e1i v\u00e0 gel nh\u00f4m acetate. T\u00ecnh tr\u1ea1ng vi\u00eam c\u1ee7a b\u1ec7nh nh\u00e2n gi\u1ea3m sau khi \u0111i\u1ec1u tr\u1ecb (CRP 115.61 mg\/L, b\u1ea1ch c\u1ea7u 9.86×103<\/sup>\/\u03bcL, procalcitonin b\u00ecnh th\u01b0\u1eddng). B\u1ec7nh nh\u00e2n thi\u1ebfu m\u00e1u dai d\u1eb3ng v\u1edbi x\u00e9t nghi\u1ec7m t\u00ecm m\u00e1u \u1ea9n trong ph\u00e2n d\u01b0\u01a1ng t\u00ednh. V\u00ec t\u00ecnh tr\u1ea1ng \u00e1p xe khu v\u1ef1c xung quanh m\u00e1y t\u1ea1o nh\u1ecbp, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c chuy\u1ec3n \u0111\u1ebfn khoa Tim m\u1ea1ch \u0111\u1ec3 g\u1ee1 b\u1ecf h\u1ec7 th\u1ed1ng t\u1ea1o nh\u1ecbp. Sau khi g\u1ee1 m\u00e1y t\u1ea1o nh\u1ecbp, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 tim m\u1ea1ch nh\u01b0ng kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh c\u1ea5y m\u00e1y t\u1ea1o nh\u1ecbp cho b\u1ec7nh nh\u00e2n n\u00ean th\u1ee7 thu\u1eadt t\u00e1i \u0111\u1eb7t m\u00e1y t\u1ea1o nh\u1ecbp ch\u01b0a \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh.<\/p>\n\n\n\n

B\u00c0N LU\u1eacN<\/strong><\/p>\n\n\n\n

C\u1ea5y m\u00e1y t\u1ea1o nh\u1ecbp \u0111\u01b0\u1ee3c xem l\u00e0 bi\u1ec7n ph\u00e1p hi\u1ec7u qu\u1ea3 \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n lo\u1ea1n nh\u1ecbp tim. Bi\u1ec7n ph\u00e1p n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n theo th\u1eddi gian v\u1ec1 t\u00ednh an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 \u0111\u1ec3 g\u00e2y ra \u00edt bi\u1ebfn ch\u1ee9ng nh\u1ea5t c\u00f3 th\u1ec3 [2]. H\u01a1n n\u1eefa, c\u1ea5y m\u00e1y t\u1ea1o nh\u1ecbp \u0111ang tr\u00ean \u0111\u01b0\u1eddng tr\u1edf th\u00e0nh bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng quy do \u0111\u1eb7c \u0111i\u1ec3m d\u1ecbch t\u1ec5 t\u0103ng v\u1ec1 m\u1eb7t tu\u1ed5i t\u00e1c v\u00e0 t\u1ef7 l\u1ec7 m\u1eafc benehjt im m\u1ea1ch. Tuy nhi\u00ean, v\u1eabn c\u00f2n t\u1ed3n \u0111\u1ecdng nhi\u1ec1u bi\u1ebfn ch\u1ee9ng g\u00e2y nguy hi\u1ec3m c\u1ee7a m\u00e1y t\u1ea1o nh\u1ecbp. K\u1ebft qu\u1ea3 m\u1ed9t nghi\u00ean c\u1ee9u cho th\u1ea5y t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ebfn ch\u1ee9ng li\u00ean quan \u0111\u1ebfn m\u00e1y t\u1ea1o nh\u1ecbp x\u1ea3y ra trong v\u00f2ng 3 th\u00e1ng sau khi c\u1ea5y l\u00e0 kho\u1ea3ng g\u1ea7n 70% b\u1ec7nh nh\u00e2n4<\/sup>, bi\u1ebfn ch\u1ee9ng s\u1edbm (trong v\u00f2ng 2 tu\u1ea7n) l\u00e0 6.7% v\u00e0 bi\u1ebfn ch\u1ee9ng mu\u1ed9n (sau 2 tu\u1ea7n) l\u00e0 7.2%4<\/sup>.<\/p>\n\n\n\n

\u0110\u1ed1i v\u1edbi tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp trong b\u00e0i, bi\u1ebfn ch\u1ee9ng x\u1ea3y ra do nhi\u1ec5m khu\u1ea9n h\u1ec7 th\u1ed1ng t\u1ea1o nh\u1ecbp. Nguy c\u01a1 nhi\u1ec5m tr\u00f9ng thi\u1ebft b\u1ecb tim m\u1ea1ch \u0111i\u1ec7n t\u1eed c\u1ea5y \u0111\u01b0\u1ee3c l\u00e0 kho\u1ea3ng 0.5 \u2013 1% trong v\u00f2ng 6 \u2013 12 th\u00e1ng5<\/sup>. B\u1ec7nh nh\u00e2n x\u1ea3y ra nh\u1eefng bi\u1ebfn ch\u1ee9ng n\u00e0y th\u01b0\u1eddng c\u00f3 tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh c\u1ee7a vi\u00eam: s\u01b0ng, n\u00f3ng, \u0111\u1ecf v\u00e0 \u0111au. C\u00e1c bi\u1ec3u hi\u1ec7n h\u1ec7 th\u1ed1ng nh\u01b0 s\u1ed1t > 38\u25e6C, \u1edbn l\u1ea1nh, \u0111\u1ed5 m\u1ed3 h\u00f4i tr\u1ed9m, kh\u00f3 ch\u1ecbu v\u00e0 s\u1ee5t c\u00e2n c\u0169ng \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o. S\u1ed1c nhi\u1ec5m khu\u1ea9n th\u01b0\u1eddng x\u1ea3y ra \u1edf < 10% b\u1ec7nh nh\u00e2n6<\/sup>.<\/p>\n\n\n\n

Nghi\u00ean c\u1ee9u c\u1ee7a Konstantinos v\u00e0 c\u1ed9ng s\u1ef1 cho th\u1ea5y y\u1ebfu t\u1ed1 nguy c\u01a1 th\u01b0\u1eddng g\u1eb7p nh\u1ea5t c\u1ee7a nhi\u1ec5m tr\u00f9ng bao g\u1ed3m \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, b\u1ec7nh th\u1eadn, b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh, s\u1eed d\u1ee5ng corticoid, b\u1ec7nh \u00e1c t\u00ednh, suy tim v\u00e0 s\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng \u0111\u00f4ng7<\/sup>. Nghi\u00ean c\u1ee9u c\u1ee7a Birnie l\u1ea1i cho th\u1ea5y y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00f4ng th\u1ec3 \u0111i\u1ec1u ch\u1ec9nh th\u01b0\u1eddng g\u1eb7p c\u1ee7a nhi\u1ec5m tr\u00f9ng thi\u1ebft b\u1ecb tim m\u1ea1ch \u0111i\u1ec7n t\u1eed c\u1ea5y \u0111\u01b0\u1ee3c bao g\u1ed3m ti\u1ec1n s\u1eed ph\u1eabu thu\u1eadt, tu\u1ed5i tr\u1ebb, suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn, suy gi\u1ea3m mi\u1ec5n d\u1ecbch v\u00e0 lo\u1ea1i ph\u1eabu thu\u1eadt8<\/sup>. M\u1eb7t kh\u00e1c, nghi\u00ean c\u1ee9u c\u1ee7a Tarakji cho th\u1ea5y r\u1eb1ng y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a nhi\u1ec5m tr\u00f9ng thi\u1ebft b\u1ecb tim m\u1ea1ch \u0111i\u1ec7n t\u1eed c\u1ea5y \u0111\u01b0\u1ee3c bao g\u1ed3m ti\u1ec1n s\u1eed ph\u1eabu thu\u1eadt, ti\u1ec1n s\u1eed lo\u1ea1n nh\u1ecbp, \u0111\u1ecba l\u00fd, lo\u1ea1i thi\u1ebft b\u1ecb, ch\u1ec9 s\u1ed1 kh\u1ed1i c\u01a1 th\u1ec3, th\u1eddi gian k\u00e9o d\u00e0i c\u1ee7a ph\u1eabu thu\u1eadt, v\u1ecb tr\u00ed c\u1ea5y, th\u1eddi gian s\u1eed d\u1ee5ng kh\u00e1ng sinh glycopeptide chu ph\u1eabu v\u00e0 s\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng \u0111\u00f4ng v\u00e0\/ho\u1eb7c thu\u1ed1c kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u [9]. D\u1ef1a theo nh\u1eefng nghi\u00ean c\u1ee9u n\u00e0y, c\u00f3 th\u1ec3 th\u1ea5y b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp trong b\u00e0i c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 nhi\u1ec5m tr\u00f9ng thi\u1ebft b\u1ecb tim m\u1ea1ch \u0111i\u1ec7n t\u1eed c\u1ea5y \u0111\u01b0\u1ee3c bao g\u1ed3m s\u1eed d\u1ee5ng kh\u00e1ng \u0111\u00f4ng, b\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 v\u00e0 ch\u1ec9 s\u1ed1 kh\u1ed1i c\u01a1 th\u1ec3 th\u1ea5p3<\/sup>.<\/p>\n\n\n\n

Vi sinh v\u1eadt g\u00e2y nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o trong c\u00e1c nghi\u00ean c\u1ee9u c\u00f3 nhi\u1ec1u s\u1ef1 kh\u00e1c bi\u1ec7t10, 11<\/sup>. Tuy nhi\u00ean, t\u1ed5ng h\u1ee3p k\u1ebft qu\u1ea3 t\u1eeb nhi\u1ec1u y v\u0103n th\u1ea5y lo\u00e0i Staphylococcal l\u00e0 vi sinh v\u1eadt ph\u1ed5 bi\u1ebfn nh\u1ea5t g\u00e2y nhi\u1ec5m tr\u00f9ng \u1edf b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c c\u1ea5y thi\u1ebft b\u1ecb tim m\u1ea1ch \u0111i\u1ec7n t\u1eed. Tr\u01b0\u1eddng h\u1ee3p \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp trong b\u00e0i c\u0169ng do vi khu\u1ea9n thu\u1ed1c lo\u00e0i Staphylococcal. \u0110\u1ec3 x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n nhi\u1ec5m tr\u00f9ng, c\u1ea5y m\u00e1u l\u00e0 th\u1ee7 thu\u1eadt c\u1ea7n thi\u1ebft. Si\u00eau \u00e2m qua th\u1ef1c qu\u1ea3n c\u0169ng n\u00ean \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ch\u1ec9 \u0111\u1ea1o ho\u1eb7c valve tim c\u00f3 li\u00ean quan v\u00e0 x\u00e1c \u0111\u1ecbnh k\u00edch th\u01b0\u1edbc m\u1ea3nh s\u00f9i. X\u00e9t nghi\u1ec7m ph\u00f2ng lab c\u0169ng c\u00f3 vai tr\u00f2 quan tr\u1ecdng \u0111\u1ec3 x\u00e1c nh\u1eadn s\u1ef1 c\u00f3 m\u1eb7t c\u1ee7a nhi\u1ec5m tr\u00f9ng, do v\u1eady, x\u00e9t nghi\u1ec7m leukocyte, CRP, procalcitonin v\u00e0 t\u1ed1c \u0111\u1ed9 l\u1eafng h\u1ed3ng c\u1ea7u n\u00ean \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh. Tuy nhi\u00ean, c\u0169ng n\u00ean l\u01b0u \u00fd r\u1eb1ng c\u00e1c d\u1ea5u ch\u1ec9 vi\u00eam c\u1ee7a x\u00e9t nghi\u1ec7m ph\u00f2ng lab c\u00f3 th\u1ec3 n\u1eb1m trong kho\u1ea3ng b\u00ecnh th\u01b0\u1eddng, ngay c\u1ea3 khi nhi\u1ec5m tr\u00f9ng \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn r\u00f5 r\u00e0ng6<\/sup>.<\/p>\n\n\n\n

Bi\u1ec7n ph\u00e1p ki\u1ec3m so\u00e1t nhi\u1ec5m khu\u1ea9n bao g\u1ed3m kh\u00e1ng sinh, d\u1eabn l\u01b0u qua m\u1ea1ch v\u00e0 d\u1eabn l\u01b0u b\u1eb1ng ph\u1eabu thu\u1eadt v\u00e0 c\u00f3 th\u1ec3 ph\u1ea3i c\u1ea5y l\u1ea1i thi\u1ebft b\u1ecb. Ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh kinh nghi\u1ec7m c\u0169ng nh\u01b0 c\u00f4 l\u1eadp \u1ed5 nhi\u1ec5m n\u00ean \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh nhanh ch\u00f3ng ngay sau khi l\u1ea5y m\u1eabu. Kh\u00e1ng sinh kinh nghi\u1ec7m n\u00ean c\u00f3 ph\u1ed5 tr\u00ean nh\u1eefng vi khu\u1ea9n \u0111i\u1ec3n h\u00ecnh v\u00e0 c\u00e2n nh\u1eafc \u0111\u1ebfn t\u00ecnh tr\u1ea1ng \u0111\u1ec1 kh\u00e1ng \u1edf \u0111\u1ecba ph\u01b0\u01a1ng. B\u1ea5t k\u1ef3 t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng n\u00e0o li\u00ean quan \u0111\u1ebfn thi\u1ebft b\u1ecb c\u0169ng c\u1ea7n ph\u1ea3i th\u00e1o b\u1ecf thi\u1ebft b\u1ecb ho\u00e0n to\u00e0n. Ph\u00e2n t\u00edch vi sinh \u0111\u1ea7u \u0111i\u1ec7n c\u1ef1c v\u00e0 m\u1eabu ph\u1ebft thu \u0111\u01b0\u1ee3c trong qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 t\u1ed1i \u01b0u h\u00f3a kh\u00e1ng sinh n\u1ebfu \u0111\u1ecbnh danh \u0111\u01b0\u1ee3c vi sinh v\u1eadt g\u00e2y b\u1ec7nh. Ch\u1ec9 \u0111\u1ecbnh c\u1ea5y l\u1ea1i thi\u1ebft b\u1ecb c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 l\u1ea1i v\u00e0 n\u00ean \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh \u1edf b\u00ean ng\u01b0\u1ee3c l\u1ea1i so v\u1edbi v\u1ecb tr\u00ed tr\u01b0\u1edbc \u0111\u00f3 [6]. \u1ede tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp trong b\u00e0i, b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u01b0\u1ee3c c\u1ea5y l\u1ea1i thi\u1ebft b\u1ecb v\u00ec thi\u1ebft b\u1ecb t\u1ea1o nh\u1ecbp kh\u00f4ng c\u00f2n c\u1ea7n thi\u1ebft cho b\u1ec7nh nh\u00e2n. \u0110\u00e2y c\u0169ng l\u00e0 \u0111i\u1ec3m th\u00fa v\u1ecb c\u1ee7a ca l\u00e2m s\u00e0ng n\u00e0y, v\u00ec quy tr\u00ecnh ki\u1ec3m so\u00e1t tim m\u1ea1ch th\u01b0\u1eddng quy v\u00e0 t\u00e1i \u0111\u00e1nh gi\u00e1 nhu c\u1ea7u k\u00e9o d\u00e0i \u0111i\u1ec1u tr\u1ecb b\u1eb1ng m\u00e1y t\u1ea1o nh\u1ecbp c\u00f3 th\u1ec3 h\u1ed7 tr\u1ee3 ph\u00f2ng ng\u1eeba c\u00e1c bi\u1ebfn c\u1ed1 mu\u1ed9n li\u00ean quan \u0111\u1ebfn thi\u1ebft b\u1ecb t\u1ea1o nh\u1ecbp. \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c c\u1ea5y thi\u1ebft b\u1ecb t\u1ea1o nh\u1ecbp, ngay c\u1ea3 nh\u1eefng quy tr\u00ecnh th\u0103m kh\u00e1m da li\u1ec5u c\u0169ng n\u00ean ki\u1ec3m tra m\u00f4 m\u1ec1m d\u01b0\u1edbi da \u1edf khu v\u1ef1c c\u1ea5y m\u00e1y t\u1ea1o nh\u1ecbp. C\u0169ng n\u00ean l\u01b0u \u00fd r\u1eb1ng kh\u00f4ng ph\u1ea3i t\u1ea5t c\u1ea3 nh\u1eefng sang th\u01b0\u01a1ng da li\u1ec5u \u1edf khu v\u1ef1c c\u1ea5y thi\u1ebft b\u1ecb \u0111\u1ec1u g\u1ee3i \u00fd nhi\u1ec5m tr\u00f9ng li\u00ean quan \u0111\u1ebfn thi\u1ebft b\u1ecb.<\/p>\n\n\n\n

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T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/strong><\/p>\n\n\n\n

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  1. Boink GJ, Christoffels VM, Robinson RB, Tan HL. The past, present, and future of pacemaker therapies. Trends Cardiovasc Med. 2015; 25(8): 661-673. doi:10.1016\/j.tcm.2015.02.005<\/li>\n\n\n\n
  2. Cl\u00e9menty N, Fernandes J, Carion PL, et al. Pacemaker complications and costs: a nationwide economic study. J Med Econ. 2019; 22(11): 1171-1178. doi:10.1080\/13696998.2019.1652186<\/li>\n\n\n\n
  3. Rybak-d\u2019obyrn, J, Macho\u0144, NJ, Lewandowska, JA, Owczarczyk-Saczonek, A, Placek, W. Abscess after cardiac pacemaker implantation: A case report. Clin Case Rep. 2023; 11:e7639. doi:10.1002\/ccr3.7639<\/li>\n\n\n\n
  4. Kiviniemi MS, Pirnes MA, Er\u00e4nen HJ, Kettunen RV, Hartikainen JE. Complications related to permanent pacemaker therapy. Pacing Clin Electrophysiol. 1999; 22(5): 711-720. doi:10.1111\/j.1540-8159.1999.tb00534.x<\/li>\n\n\n\n
  5. Nielsen JC, Gerdes JC, Varma N. Infected cardiac-implantable electronic devices: prevention, diagnosis, and treatment. Eur Heart J. 2015; 36(37): 2484-2490. doi:10.1093\/eurheartj\/ehv060<\/li>\n\n\n\n
  6. D\u00f6ring M, Richter S, Hindricks G. The diagnosis and treatment of pacemaker-associated infection. Dtsch Arztebl Int. 2018; 115(26): 445-452. doi:10.3238\/arztebl.2018.0445<\/li>\n\n\n\n
  7. Polyzos KA, Konstantelias AA, Falagas ME. Risk factors for cardiac implantable electronic device infection: a systematic review and meta-analysis. Europace. 2015; 17(5): 767-777. doi:10.1093\/europace\/euv053<\/li>\n\n\n\n
  8. Birnie DH, Wang J, Alings M, et al. Risk factors for infections involving cardiac implanted electronic devices [published correction appears in J Am Coll Cardiol. 2020 Feb 25;75(7):840\u2013841] [published correction appears in J Am Coll Cardiol. 2020 Aug 11;76(6):762]. J Am Coll Cardiol. 2019; 74(23): 2845-2854. doi:10.1016\/j.jacc.2019.09.060<\/li>\n\n\n\n
  9. Tarakji KG, Krahn AD, Poole JE, et al. Risk factors for CIED infection after secondary procedures: insights from the WRAP-IT trial. JACC Clin Electrophysiol. 2022; 8(1): 101-111. doi:10.1016\/j.jacep.2021.08.009<\/li>\n\n\n\n
  10. Sohail MR, Uslan DZ, Khan AH, et al. Risk factor analysis of permanent pacemaker infection. Clin Infect Dis. 2007; 45(2): 166-173. doi:10.1086\/518889<\/li>\n\n\n\n
  11. Shah H, Mehmood M, Salahudin M, Altaf A. Risk factor for cardiac permanent pacemaker infection. J Nepal Health Res Counc. 2019; 17(2): 158-162. Published 2019 Aug 4. doi:10.33314\/jnhrc.v0i0.1272<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    M\u1ede \u0110\u1ea6U Lo\u1ea1n nh\u1ecbp c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb v\u00e0 c\u1ea5y m\u00e1y t\u1ea1o nh\u1ecbp. M\u1eb7c d\u00f9 m\u00e1y t\u1ea1o nh\u1ecbp mang \u0111\u1ebfn nh\u1eefng l\u1ee3i \u00edch cho b\u1ec7nh nh\u00e2n, tuy nhi\u00ean, c\u00e1c ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i li\u00ean quan \u0111\u1ebfn c\u1ea5u tr\u00fac c\u01a1 h\u1ecdc c\u1ee7a m\u00e1y t\u1ea1o nh\u1ecbp v\u1eabn lu\u00f4n l\u00e0 m\u1ed9t v\u1ea5n …<\/p>\n

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