NHÂN một TRƯỜNG hợp VIÊM nôi tâm mạc DO nấm TRÊN VAN NHÂN tạo

NHÂN MỘT TRƯỜNG HỢP VIÊM NÔI TÂM MẠC DO NẤM TRÊN
VAN NHÂN TẠO

Phm Quang Tun, Nguy
 Yn, Nguy
Khoa Ni Tim Mch-BVTW Hu
TÓM TẮT
B 56 tui, nhp vin phu thung mch ch loi
c. Sau phu thut hin st cao. Cy catheter  ch
cho kt qu Staphylococus non coagulas, c  n mi l .
Bu tr  u tr  c
. Bc ct qu c
nhau 4  y Candida parapsilosis. B u tr vi thum
Fluconazole. Sau 8 tuu tr bn chu thut, bnh n
nh ra vin.
Kt lun: VNTMNK do nm trng ch u tr n
phm khi kt qu c  
SUMMARY
CASE REPORT:
INFECTIVE ENDOCARDITIS CAUSED BY CANDIDA PARAPSILOSIS
ON PROSTHETIC VALVES
A 56-year-old woman was hospitalized for an operation of replacement of aortic-
mitral mechanical valves. 10 days after the operation, the patient got a high fever.
Staphylococcus was found on the venous catheter but the blood culture was negative for 9
times in three consecutive days. The patient was under antibiotic treatment but the status was
not improved. Positive blood culture of Candida parapsilosis was done twice. The patient was
given thereafter with Fluconazole. She was discharged after 8 weeks under this treatment
with neither complication nor re-operation.
Conclusion: fungus searching should be considered if the blood culture result is negative for
the bacterial species and the bacterial antibiotics is not effective.

MỞ ĐẦU
 VNTMNK  bi van tim
ng, chim khong 0.5% mm cn phn khi VNTMNK
b u tr u trng mc phi
ti bnh vin. Hi cha VNTMNK do n
khun. Mt phn bng xng hu phu hay do nhiu bnh phi hp.
ng rn chng nht ca VNTM
do n   c, bao gm tc ngh    n ngo   m
c ch lng thi l
hn ch liu tr ni khoa phi kt hp vi phu thut.
BÁO CÁO TRƯỜNG HỢP LÂM SÀNG
B 56 tui, tin s h ng mch ch, h hu tr
nc, b ng mch chp
vin ghi nhng bnh v huyu chng nhi
ng suy tim nh. Bc phu thung mch ch 
hu thut hi
0C
- 40
0C
c. Bnh
c .  tt c m : CTM,
VSS, CRP, cc tiu, cy dch vt m, cy catheter 
 ng hu phu m thay van ng nhi
nng n. Sc chuyn n Khoa Ni Tim mch. Ghi nhn ti Khoa Ni
Tim Mch: Mch: 80 l: 39
0C
. Tn s th 28 l
Ching 60 kg. t mi bn, v mt nhi
Bt. Kt mc mt trng nhm xut huyt  2 c.
 c. Mu, bng thi.  nh,

 ng. Phi ran m  i. n.
Ting, tiu t chu buu lc nhc ti. 
n b
m c
1.
CTM
13/01
01/02
09/02
14/02
17/03
01/04
04/05
18/05
Bch cu
6,22
17,68
17,98
24,71
9,47
6,09
7,61
4,47
Hng cu
4,03
3,69
2,55
3,9
2,92
2,9

2,8
3,7
Hb
13
11,7
8,5
11,9
8,9
9,1
9,0
11
HCT
38,4
34,2
23,15
33,64
28,3
26,97
7,97
30,0

 l:

13/01
01/02
09/02
14/02
17/03
01/04
04/05

18/05
Ure
5,9
11,3
48
35,4
2,5
5,0
9,1
8
Creatinin
64
195
412
111
45
69
118
111
CRP




66.5
54,3
22,1
6,7
VSS 1
h

122
96
76
50
2
h




136
131
112
80

3. INR: -3,5
4. ECG:  kc bit
5. XQ phi: khng c tn thng.


IA quan trng mch ch 
a
IM quan tr
n
p nhc
SM (2D)= 2,2 cm

2

mm, VG ln= 40 mm
IT= 2/4, PAPS= 40 mmHg

gim, EF= 46%


 
Gradt qua VM tt
ng tt
 
Gradt VA max= 95 mmHg



Chm EF= 50%


  
 tt
Gradient qua VM max= 13 mmHg
  
Gradient qua VA max= 28 mmHg



Cho tn, EF= 55%
Cho tn, EF= 55%
ng ngang VG





N ng thc
9,3x14,2 mm
N 
PAPs= 41 mmHg
EF= 56%


7. Cy dch vt m 

8. C
9. Cn: > 9 l
h
cho kt qu 
10. Cm: Kt qu n vi Candida parap
4/04.
Bc ch
u tr the c ki
 u tr ng
c nhii cu tr
trng bc cm. Sau 5
  t qu  u v  
    u tr  ng VNTMNK do n    m
     chuy  ch. Sau 7    t st.
Bp tp, sau 7 tum bn n
nh, cc thc hin th u tr m cho kt qu 
i 3 mu th. ghic thc hi v ng,

lm nhiu so vc, bch cng, XQ phi,
c biy EF ci thin, khi.
Bo tun th ng u
B t
BÀN LUẬN
Mt bc m o,
khi i chng nhi mt s  c
vt m, nhit, VNTMNKi, nhit niu do n
bi chng nhim
u t m, nhim khun huyt
m cy dch vt m y Catheter tnh
mu cho kt qu u tr
ng nhim khun vt m  nhiu tr
ng bi thin. Bm tra pht hin
khc cn,
mi l
h
cho kt qu i vi khuu tr
 VNTMNK c  u tr ng nhi
vi thin. Bp tc cc bim n
t qu cu
tr thung nhii thi
Dn cha Duke c 2003. ng dn v
ch NK c  dng b 
nhng hp VNTMNK. n Duke cc chn
c chm Candida parapsilosis.
vi vi khun c gii
m nm.
To do nm xut hi c gi
m t l ry thp khoc g 

VNTMNK sm.
C. Garzoni [10]    ng h   
nh  gii cho th







sis chim khong 17%.
V u tr n pht ra c th u tr ni
n vi thum hay kt hp ngoi khoa. ng dng dn
ca hip hi bnh nhi   2004 cho ki     mc Candida rng
         u tr vi phu thut thay van
nhi              
fluorocytosine liu dung np tn sau phu thut, nu u
thuu tr t c ch n
c bing hp nhim khun nu
t m dung np tc hi
       u h u nhy cm vi t  i
m. Theo khuyc la ch
i vi thn cao, ng ch ng b suy thn c
u tr  ng ha chn. i
       . Thu  m mi
c J P Talang s  c
mng hu tr   
phu thut. Trong tt c m k  
n lo 
V u tr phu thun thi

ng dnh ch nh phu thui vc
do nm ng dn ca hip hi bnh nhi 2004 cho kii
c Candida r  u tr vi
phu thut thay van nhi. u tr tt vn
phm kt hp vi phu thut li. Tn
u thu  t tuu tr  ng nhii
thin, mc chp nhn lng nhiu,
n t  n ln

  gi ng hu tr 
 n phu thut l   ng hp phi phu thut li m    
Talarmin v ng s ng hp VNTMNK do nm (6 do Candida albicans, do
Candida parapsilosis), ng hp dung thut hp thay van
sau 4-6 tuu tr  kh ng hi ch m, 1
tng hp t  2 do nhim khun nng hu cho kt
qu tn phu thut.
Ligia C Pierrotti [11] nhng hp VNTMNK do nm t 1995-2000, mt
s u tr nc vi thumt s phi hp vi phu thut.
T ng h l t 30 b
 liu). T l t vong gi 
ng s bc do nu
thut van (68.3% so vu thut , p=0.2). T l t vong  bu
tr ni hu tr ni ngou xp x 50%. T l t vong
t gia VNTMNK bin chn chu
tr ni khoa hay phi hp ni ngoi khoa. T  ng: Can thip phu
thui thin t l t i bu tr 
n
KẾT LUẬN
VNTMNK do nm t trong nhng chc  nhng b
o hoc ci vi khu

liu tm cn phc s dng st qu ci
 u tr ngot trong
tng hp c th. Ch ti thng b mt ng hp vim ni tm mc do nm trn
van nhn to iu tr th cng bng phng ph ni khoa, tuy nhin kt qu lu d cn
phi c theo d bnh nhn tip tc.
TÀI LIỆU THAM KHẢO
1. Hu      c nhim khun, Giáo trình sau đại học Tim
mạch họci hc Hu, tr. 89-105.
2. Phm Nguy  c nhim khun, Bệnh học tim mạch tập 2,
Nxb Y h H - 315.
3. Nguyc nhim khun, Siêu âm tim từ căn bản đến nâng
caoi hc Hu, tr. 157-167.
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