Y Hoc TP. H o Chi Minh * Tap 20 * So 1 * 2016 Nghien cihi Y hoc
KHAO SAT LACTATE MAU 6 BENH NHI s 6 c S 6 T XUAT HUYET DENGUE DIEU TRI TAI KHOA CAP CtfU BENH VIEN NHI DONG 1
Danh My Thanh Linh*, PhdngNguyen TheNguyen**
TOMTAT
Dat vdn de -Mi/ic tiSw soi xucd huyei Dmgue dd vd dang tra thanh van dey tecong dSng quan trong tren thi'gi&i noi diung vd tai Viet Nam noi rieng.Trong dim tri sSc SXH-D,vdh Mdqt ra Id 1dm sao ddnh gid diegc mdc do nang cua berih thdng qua cd: chi so sinh hgc thu dugc tie binh nhdn. Lactate mdu giup ddnh gid tinh trang thieii oxy mo va giam tudi mdu he thong. Nhim nghien cdu da ckung minh vdng do ladaie mdu co gid tri tien lugng tren binh nhan ndng. Hien nay rdiung nghien diu veladate mdu tren benh nhdn SXH-D con han chi'.Do do nghien cieu ndy nham mo td nhimg 0c diem, diin tzeh lactate mdu & benh nhi soc SXH-D trong 6 gid dau dieii tri td khoa ccpp cieu benh vien Nhi Dong 1.
Phuang phdp n^iSn cihuNghien cieu tieh cieu motdco phdn tich 81 tre sBc SXH-D nhdp khoa cqj cieu benh din NhiDdng 1 tie thdng 6/2014 dm ihang 6/2015.
Kei ijudLadate mdu ciia benh nhdn soc SXH-D Idc rihap viin Id 3,19 ± 0,99 mmol. Lactate mdu luc nhdp men: a nhdm soc SXH-D nang cao han nhom soc SXH-D (3,96 ± 0,98 mmol/L so vai 3,1 ± 0,96 mmol/L), o nhom du cdn-beo phi cao hem nhom hinh ihucmg (3,49 ± 1,23 mmol/L so vai 3,03 ± 0,79 mmol/L), a nhom co dot dich truym cao phdn tie cao hem nhom khong ^i (3,25 ± 1,05 mmol/L so vdi 2,98 ± 0,71 mmol/L) vd a nhom co suy ho hq) cao hem nhom khong suy ho h^ Id (3,37 ± 1,1 mmol/L so v&i 3,06 ± 0,88 mmol/L).
Ket luatuladate mdu trin benh nhdn sot SXH-D cao hem a nhom soc SXH-D nang, nhom du can beo phi, rihdm co d&i dick truy^ cao ph&n td trong qud trinh diSit tri vd nhom co suy hd hap.
Tie khoa: lactate mdu, s ^ xucd huyM Dengue, soc sot xuM huyB Dmgue.
ABSTRACT
STUDY ON BLOOD LACTATE IN CHILDREN WTTH DENGUE SHOCK SYNDROME IN EMERGENCY DEPARTMENT AT CHILDREN HOSPTTAL 1
Danh My Thanh Linh, Phung Nguyen The Nguyen
* Y Hoc TP. Ho Chi Minh * Vol. 20 - No 1 - 2016:135 -142 Background - Objectives: Dmgue Hemorrhagic Fever has become an important community health problem in the world and also in Viet Nam. One of the issues arises during treating for diildrm with Dmgue shock syndrome is how to access the severity using patients' physiological indicators. Blood lactate related to tissue hypoxia and systemic hypoperfusion. There were researches that showed the value of that blood ladate concmtration in predicting severe patimts. Up to now, however, researches on blood lactate in children with Dmgue Hemorrhagic Fever are still limited. This research aims to describe the ckaraderistics and changes of blood ladate in childrm with Dmgue shock syndrome admitted to the emergency departmmt at Children Hospital 1 within the first 6 hours cf treatment
Methods: prospective, descriptive study of 81 childrm with Dmgue shock syndrome admitted to die emergency departmmt at Children Hospital Ifrom 6/2014 to 6/2015.
Results: The average vdue cf blood lactate in children with Dmgue shock syndrome at admission is 3.19 ±
* B^nh Vien Nhi dong 1 **Dai hpc Y Duoc TP Ho Chi Minh
Tac gid liin Iqc: BS. D a n h M y Thanh Linh BT: 00918 691 750 Emml: [email protected]
Nhi Khoa
Nghien cuu Y hpc Y Hpc TP. Ho Chi Minh * Tap 20 * So 1 * 2016
0.99 mmol. The average value of blood ladate in childrm with severe Dengue shock syndrome at admission (3.96
± 0.98 mmol/L) is higher than in childrm with Dmgue shock syndrome (3.1 ± 0.96 mmol/L). The average vdue cf blood lactate in overweight and obese childrm with Dmgue shodc syndrome at admission (3.43 ± 1.23 mmoUL) is higher than in normal wdght (3.03 ± 0.79 mmol/L). The average value erf blood ladate at admission in childrai with Dmgue s/iocfc syndrome who required colloidid solution fijr treatmmt (3.25 i 1.05 mmol/L) is higher thm in who did not require (2.98 ± 0.71 mmol/L). The average vdue of bhod lactate at admission in children xvilh Dmgue shock syndrome who had respiratory fdlure during treatmmt (3.37 ± 1.1 mmol/L) is higher than in who did not have (3.06 ± 0.88 mmol/L).
ConclusiomThe value of blood ladate at admission : in children zmth severe Dengue shock syndrome is higher than in childrm with Dmgue shock syndrome, in overwdght and obese patimts is higher than in normd wdght, in patimts who required colloidal solution for treattnent is higher than in who did not require, in patients who had respiratory Jidlure during treatment is higher than in who did not have.
Key wcrrds: blood lactate. Dengue Hemorrhagic Fever, Dmgue shock syndrome.
cap cihi benh vien Nhi Dong 1" voi cac mong muoh mo ta nhiing dac diem, dien tieh lactate mau 6 benh nhi soc SXH-D trong 6 gio dan dieu tri.
DiVTVANDE
Theo To chiic Y te The gioi (TCYITG), co tren 2,5 ty nguoi, chimin hon 40% dan so' toan cau CO nguy co mac SXH-D. Hang nam troc tmh CO khoang 50 - 100 trieu ca nhiem vims Dengue, khoang 500.000 ca phai nhap vi§n, ty le ttr vong la 2,5%, vol con so tu vong la 22.000 ngucri moi nam, trong do ph&i Ion la tre em^^^'.
Tai Viet Nam, tj' 1| mac sot xuat huyeVlOO.OOO dan tang Uen tuc, tu 32,5 nam 2000 (24.434 ca) len 120 nam 2009 (105.370 ca), va 78 nam 2011 (69.680 ca). Theo so li$u ciia Vi&n V? sinh Dich te Tnmg t/ong, tinh rieng trong nam 2013, Viet Nam ghi nhan 66.140 trucmg hgp mac SXH-D tai 52 tinh, thanh pho, trong do 42 truong hop tu vongf^^. Cho den nay da co nhieu nghi&i cihi trong va ngoai niroc duoc tieh hanh nham tim ra nhixng thong so va chi scT sinh hoc co gia trj phan anh duoc tinh trang va miic dp nang ciia benh nhan SXH-Dt^"^'^''.
Lactate m^u giiip d i n h gid tinh trang t h i ^ oxy mo va tinh trang giam tuoi mau he thoiig.
Da CO nhieu nghien ciiu chiing minh nSng dp lactate mau c6 gia trj tien lugng tren benh nhan nang'^^*'5,i9) j ^ y nhien hien nay nhimg nghien ciiu ve lactate mau tren benh nhan SXH-D o the gioi ciing nhu t^i Viet Nam v I n con kha han ch^. Do do chiing toi tieh hanh de tai nghien cuu "Khao sat lactate mau 6 benh nhi soc sot xuat huyet Dengue dieu tri tgi khoa
Muc tieu nghien cmi
Khao sat lactate mau 6 b&nh nhi soc sot xua^
huyei Dengue trong 6 gio dau dieu trj tei khoa c ^ ciiu benh vien Nhi Draig 1 tir thang 6/2014 d m thang 6/2015.
E)6lll/QNG-PHLfONGPHAPNGHIENajlJ Tieu chu&i chpn benh
Tat ca benh nhi (< 15 tuoi) duoc dieu trj tai khoa cap ciiu benh vien Nhi Dong 1 ihoa ba tieu chi:
- Duoc chan d o ^ SXH-D theo tieu chufc ciia To Chiic Y Te The Gidi nam 2009^ va phac d6 ciia Bg Y Te ban hanh thang 02/2011*^.
- Lam sang: sot cao dot ngpt, lien tuc tir 2-7 ngay va co it nhai 2 trong cac daii hieu sau: bi&
hien xuai huyet nhu nghiem phap day tlut duong tinh, chain xuai huyet 6 duoi da, chay mau chan rang hoac dxky mau cam. Nhiic dau, chan an, boon non. Da xung h u y ^ phat baa Dau ca, dau khop, nhiic hai ho mat
- Can lam sang: Hematocrit tang cao £ 20%
so voi tri s6^ truoc do aia benh nhan hoac so voi tri so binh thuong theo tuoi. Tieii cau giam nhanh va so lugng < 100.000 / mm^.
Y Hpc TP. Hd Chi Minh * T$p 20 * So 1 * 2016 N g h i e n ctm Y hpc
Co soc voi cac bieu hien: vat va, biit nit hoac li bi; Ignh dau chi, da Ignh ain; mgch nhanh, nh?;
huyei ap kep (hieu ap < 25 nunHg) hoac huyei ap tut hoac khong do duoc; ti^u it. Soc SXH-D dugc chia lam 2 miic dgP-*^.
Soc SXH-D: match nhanh nhe, huyei ap kep hoac tut, kem Iheo da Ignh am, biit nit ho|ic vat va,libi.
Soc SXH-D n|ng: soc ngng, mach nhe kho bat, huyet ap kh6ng do dugc.
Co huyei ihanh chan doan Mac-Elisa Dengue IgM duong tinh ho5c NSl-Ag ducmg tinh va dupe su dong y ciia gja ^ n h benh nhi.
Tieu chuan loai tru;
Cac benh nhi soc SXH-D co kem tinh trgng soc khde nhu soc nhi&n trimg, soc th&i kinh, soc tim, soc phan ve.
Cac benh nhi co cac benh ly gan hay r£4 loan chuyen hoa lam tang hoac gi^m lactate mau.
Thiet k^ nghien cihi
Nghi&i ciiu ti^ a h i mo tk co phein tich C o m l u
Co mau theo cong thiic uoc lugng mot ty le tr&i mpt mau nghien c&vi^
Z , l , , , f ( l - P ) d' vai: a=0,05; 2=1,96; d=0,l
Theo nghien cuu cda tac gia Tatang Puspanjono M., ty le soc SXH-D co tang lactate mau la 73%, nen chpn P = 0,73. Thay vao cong tiiiic ta CO CO mau n=75,71. Vay ca mau it nhai
!a 76 ca.
Lactate mau d cac thai diem va tinh trang dtr can-beo phi Bdng 3: Ladate mdu a cdc thdi di^ vd tinh trang du cdn-beo phi
Thu th^p va xft ly so lieu
Lactate mau dugc lay d ba Ihoi diem liic nhap vien fTo), sau 3 gjo dieu tri fTs) va sau 6 gio dieu tri (Ts). Tiai hanh thu thiip tai ck Ihong tin benh nhan ve lam sang, can lam sang va gia tri lactate mau 6 ba thdi diem To, Ta va Ts.
EHi lieu dugc nhap va xii ly thraig ke bang phan mem SPSS 22.0
KET QUA
Trong thoi gian tii ihang 6/2014 den ttiang 6/2015 CO 81 tre dupe chan doan va dieu tri soc SXH-D tai khoa cap ciiu BV Nhi dong 1 thoa tieu chi ehuah doan va tieu chi loai tru dupe dua vao nghien ciiu.
Gia tri lactate mau 6 cac thod diem TD, TS va Ts Bdng 1: Gid tri ladate mdu a cdc thai diSn To, Ta vd Te
Lactate mdu
To Ta Te
Trung binh 3,19 mmol/L 2,11 mmol/L 1,82 mmol/L
Cao nhit 6,25 mmol/L 4,05 mmol/L 3,96 mmol/L
Thip nhIt 1,47 mmol/L 0,93 mmol/L 0,67 mmoi/L Lactate mau va dp n | n g soc SXH-D Bdng 2: Ladate mdu vd do nang soc SXH-D
Lactate mdu Ta(inmol/L}, M(SD) Lactate mSu T3(mmol/L),
M(SO) Lactate mau T6(mmol/L},
M(SD)
SocSXH- D (n=72) 3,1 (0,96) 2,15 (0,68) 1,88(0,69)
sac SXH-D n|ng (n=9) 3,96 (0,98) 1,83(0,52) 1,35 (0,56)
P 0,013'=
0,173'"
0,032"
(c): t-test; M(SD): trung binh (do lich diumi) Nhan xet co su h&\ quan giiia lactate mau To va Ts voi dp nang ciia set SXH-D.
Lactate mau To (mmol/L)
Lactate mdu Ts (mmol/L) Lactate mdu TR (mmol/L)
lUUSD)
<4 24 lUKSD)
<4 24 M(SD)
Binh ihuimq (n=52) 3,03(0,79) 46 (72.6%) 7 (36,8%) 2,1 (0,68) 51 (63.8%)
1 (100%) 1.86(0.7)
DIP c&n-b6o ptii (n=29]
3.49(1.23) 17 (27,4%) 12 (63,2%) 2.14(0,65) 29 (36,2%) 0(0%) 1.74(0,68)
T i i i g s 6 ( n 4 1 ) 3,19 (0,99) 62 (76.5%) 19(23,5%)
^11 (0.67) 80 (98.8%) 1 (1.2%) 1.82(0,69)
P 0.076"' 0,004"' 0.821''
,(.)
0,461'"' '" •• Fisher exact test:"': x'test: <": t-test; tAiSD): tmng binh (do lech chuSn)
Nhi Khoa
Nghien cihi Y hpc Y Hpc TP. H o Chi M i n h * T$p 20 * S^ 1 * 2016
Nhgn xet: co su lien quan giua lactate mau To ^ 4 mmol/L voi tinh trang d u can- beo phi.
Lactate mau 6 cac thai diem va doi dich truyen cao phan t&
Bdng 4: Ladate mdu a cdc th&i diem vd dot dick truyen CPT trong 6 gig ddu
Lactate mdu To (mmol/L)
Lactate mdu Ta (mmo^) Lactate mdu Te (mmol/L)
M(SD)
<4 24 M(SO)
<4
>4 M(SD)
KlidngddiCPT(n=33) 3.11(0,9) 28 (45,2%) 5 (26,3%) 2,23(0,7) 33(41,2%)
0(0%) 2,01 (0,63)
C6d6iCPT(n=48) 3,25(1,05) 34(54,8%) 14 (73,7%) 2.04 (0.64) 47 (58,8%) 1 (100%) 1.68(0,71)
T6ngs6(n=81) 3,19(0,99) 62 (76,6%) 19 (23,5%) 2,11 (0,67)
" 80(98,8%) 1 (1.2%) 1,82(0,69)
P 0,553'"' 0,114"' 0.21'"'
^(9)
0,037"
<^: Fisher exad test;"": x^ test; <^>: t-test; M(SD): trung binh (dd lich chudn) Nhan xet co su lien quan giiia lactate mau Ts
va doi CPT trong 6 gio dau.
Bdng 5: Ladate mdu a cdc th&i dimt vd ddi djch truyih CPT trong 3 gia ddu
Lactate mdu To (mmol/L)
Lactate mdu T3 (mmoW.) Lactate mdu T6(mmol/L)
M(SD)
<4 24 M(SD)
<4
>4 M(SD)
Khdng dii CPT (|F=49) 3,04 (0,96) 42 (67,7%) 7 (36,8"/o) 2,26(0,68) 48 (60"/.) 1 (100%) 2,01 (0,65)
C6d6iCPT(n=32) 3,44(0,99) 20(32,3"A) 12 (63,2"/i,) 1,9(0.59) 32 (40%) 0(0"/.) 1,52(0,65)
Tdngs6(n=81) 3,19 (0,99) 62 (76,5"A) 19 (23,5"/.) 2,11(0,67) 80 (98,8"/o) 1 (1,2"A) 1,82(0,69)
P 1
0,072"
0,016"' 0,017"
1'"
0,001'"' '•*. Fisher exact test; *'; x^ test; '^; t-ted; MOD): trung bdh (i
Nhgn xet: c6 sir Hen quan giua lactate mau To
> 4 mmoI/L, lactate mau Tava lactate mau Ts voi doi CPT trong 3 gia dau.
Bdng 6: Lactate mdu b cdc thai diem vd liiu HES luc d
Lactate mau or cac thoi d i ^ va lieu cao phan ta luc doi
Lactate mdu To (mmo^) Lactate mdu Ta
(mmol/L) Lactate mdu To
(mmo^) t^(SD)
<4
>4 M(SD)
<4 24 M(SD)
Lilu HES <10ml/kg/gid' (n=42) 3,01 (0,88) 36 (58,1%) 6 (31,6"A) 2,28 (0,71) 41(51,3%) 1 (100"/o) 2,03 (0,67)
U^uHES >10ml/)(g/gio- (n=3g) 3,39(1,07) 26(41,9%) 13(68.4%) 1,93(0,58) 39(48,8%.) 0(0%) 1,59(0,66)
T£ngsd(n=81) 3,19(0,99) 62 (76,5"/.) 19 (23,5%) 2.11 (0,67) 80(98,8%) 1 (1,2"/.) 1,82(0,69)
P 0,09"
0,043"' 0,017'"' 1'"
0,004"
">: Fisher exact test;"": x^test; '^. t-test, M(SD): trung binh (dS lich chum)
Nhan xet: co su lien quan giiia lactate mau To
> 4 mmol/L, lactate mau Ta va lactate mau Ts voi lieu HES liic doi > 10 ml/kg/gio.
Lactate mau ci cac thoi diem va men gan
Chiing toi nhan thay c6 su khac biet co y nghia ihong ke khi so sanh lactate mau o thoi
diem nhap vien (To) giiia 2 nhom co va khong co tang SCOT tren 15 lah (> 600 UI/L), o cac mifc tang SGOT thap hon khong thay co su khac biet CO y nghia thong ke.
Chiing toi khong ghi nhein co su lien quan giira nong do lactate mau voi tai ck cac miic tang SGPT.
Y Hpc TP. H o Chi M i n h * Tap 20 * So 1 * 2016 Nghien cmi Y hpc
Bdng 7: Lactate mdu a cdc thcri dian vd SGOT
Lactate mdu To (mmol/L)
Lactate mdu Ta (mmol/L) Lactate mdu To (mmol/L)
M(SD)
<4 24 M(SD)
<4 24 M(SD)
SGOK600 (n=70) 3.1 (0,92) 57(91.9"/.) 13 (68,4%) 2,07 (0,63) 69(86,3%) 1 (100%) 1,79(0,69)
SGOT £ 600 (n=11) 3.77(1.27)
5(8,1%) 6(31,6%) 2,36(0,85) 11(13,7%) 0(0%) 1,99(0,7)
long sd (n=81) 3.19 (0,99) 62 (76,5"A) 19 (23,5%) 2,11 (0,67) 80(98,8%) 1 (1,2%) 1,82(0,69)
P 0,037"' 0,009"' 0,309"' 1 ' "
0,352'"'
<": Fisher exact test;«": x^ test; <'>: t-test; M(SD): trung binh (do lech chuan) Lactate mau d cac thoi diem va suy ho hap
Bdng 8: Ladate mdu & cdc th&i diem vd suy ho hop
Lactate mdu To (mmol/L)
Lactate mdu T3 (mmol/L) Lactate mdu To (mmol/L)
M(SD)
<4 24 M(SD)
< 4 24 ll«(SD)
Khong SHH(n=46) 3,06 (0.89) 39 (62,9•^) 7(36.8%) 2,11 (0,62) 46(57,5%) 0(0%) 1,88(0,6)
C6SHH(n=35) 3,37 (1,1) 23(37,1%) 12 (63,2%) 2,12 (0,74) 34(42,5%) 1 (100"/.) 1,73(0,8)
Tdngsd(n=81) 3,19 (0,99) 62 (76,5%) 19(23,5%) 2,11 (0,67) 80 (98.8%) 1 (1,2"/.) 1,82(0,69)
P 0,162"' 0,045"' 0,92"
0,432'"
0,322'"' ''>: Fisher exad test; <*': x^ test; '<•'; t-test; M(SD)- trung binh (do lech chum)
Nhan xet: co su lien quan gjiia lactate mau To
> 4 mmoI/L va tinh trang suy h6 hap.
B A N L U > ? L N
Dac d i o n lactate mau d cac thoi diem nhap vien (To), sau 3 gid dieu tii (Ts) va sau 6 gio dieu tri (Ts)
Gia tri lactate mau Iiic nhap vien 6 benh nhi soc SXH-D thap nhai la 1,47 mmol/L, cao nhai la 6,25 mmol/L, trung binh la 3,19 ± 0,99 mmol/L.
K^ qua nghien cihi ciia chung toi gan tuong tu voi Dicky Santosa va CS voi gja trj lactate mau liic vao soc 6 benh nhi soc SXH-D thap nhai la 2 3 mmol/L, cao nhai la 6,2 mmol/L, trung binh la 3,9 +1,17 mmoI/L03>.
Sau dieu tri lactate mau deu giam, cu the sau 3 gio dieu tri gia tri lactate mau trung binh la 2,11 ± 0,67 mmol/L va sau 6 gio dieu tri gia tri lactate mau trung binh la 1,82 + 0,69 mmol/L. Dieu nay cho Ihay benh nhan soc SXH-D dap ling toi voi phac do dieu tri, ra soc tot, cai thi&n tot tinh trang tuoi mau mo va lam giam nong dp lactate mau.
Lactate mau 6 cac thoi diem va dp n ^ g soc SXH-D
Gia tri tmng binh lactate mau 6 Ihoi diem nhap vien 6 benh nhi soc SXH-D la 3,1 ± 0,96 mmol/Lva soc SXH-D nang la 3,96 ± 0,98 mmol/L va su khac biet nay co y ngtua fiiong ke ( p=
0,013). Nhu vay lactate mau 6 thoi diem vao soc CO hen quan voi dp nang ciia soc SXH-D.
Trong soc SXH-D nang benh nhan co tinh t r ^ g gjam tuoi mau he Ihong nang ne hem rai nhieu so voi soc SXH-D bieu hien bang tinh trang mach khong bat dugic, huyei ap khong do dugfc. Chinh tinh trang giam tuoi mau he thong n | n g ne nay da dua den tinh trang thieu oxy mo nghiem trong lam lang cao nong do lactate mau nhieu hon so voi soc SXH-D.
Lactate mau 6 cac thod diem va tmh trang dtr can-beo phi
Trong nghien ciiu ciia chiing toi, cac tre du can beo phi c6 nong do lactate mau trung Imih liic nhap vien cao hon so voi tre binh tiiuong, 3,49 ± 1,23 mmol/L so voi 3,03 ± 0,79 mmol/L. Co 42,4% tre du can-beo phi co miic lactate mau > 4
Nhi Khoa
Nghien cuu Y hgc Y Hpc TP. H o Chi Minh * Tap 20 * Sfi 1 * 2016 mmol/L khi nhap vien, trong khi do chi co 13,5%
tre binh thuong co miic lactate mau £ 4 mmol/L khi nhap vien va sir khac biet nay co y nghia tiiraig ke(p=0,004). Dieu nay cho thay tinh tr?ng giam tinii mau he ihraig va thieii oxy mo xay ra nang ne htm 6 tre soc SXH-D du can-beo pM.
Theo Nguyen Minh Ti& qua nghien ctiu hang loat ca v^ soc SXH-D 6 tie du can-beo phi cho ihay bieii hien Iam sang dia cac truong hpp nay tiiuong nang va dien Hen phiic t^p"!. Theo Ho T6n Thien Nga, SXH-D xay ra tren tre ftiira can- beo pK bi&i hien da dang va phiic tap®. Theo Luong I h i Xuan Khanh, trong SXH-D doi tuong du can-beo pM la mot doi tuong phiic tap va tiem ah nhieii nguy co trong qua trinh dieu triPJ.
Nhu vay can phai co them nhieu n ^ e n ciiu ve SXH-D tren tie du can-beo phi vi co the co nhimg roi loan chuyen hoa dl kem chua duoc phat hien lien tjuan d a i co dia nay.
Lactate mau 6 cac thai diem va viec doi cao phan hi trong qua trinh £ e u tci
Trong nghien ciiu a i a chiing toi, nhom benh nhi soc SXH-D co doi CPT trong qua trinh dieu tri CO gia tri trung binh lactate mau o ihoi di&n n h | p vien cao hon nhom khong doi CPT, 3,25 ± 1,05 mmoI/L so voi 2,98 ± 0,71 mmol/L. Co 37,5%
l>enh nhi soc SXH-D co doi CPT trong 3 gio dau CO miic lactate mau a thai diem nhap vien > 4 mmol/L, trong khi chi co 14,3% benh nhi soc SXH-D khong doi CPT trong 3 gio dau co miic lactate mau 6 thoi di&n nhap vien ^ 4 mmol/L va su khac biet nay co y nghia thong ke (p=0,016).
Nhu vay co hon 1/3 benh nhan soc SXH-D co lactate mau khi nhap vien ^ 4 mmol/L se phai doi sang CPT som trong 3 gio dau.
Dong thoi lactate mau sau 3 gio va 6 gid dieu tri 6 benh nhi duoc doi CPT trong 3 gio dau tiiap hem 6 nhiing benh nhi khong doi CPT; 1,9 mmol/L so voi 2,26 mmol/L va 1,52 mmol/L so vol 2,01 mmol/L va su khac biet nay co y nghia tiiong ke voi p IMI lirot la 0,017 va 0,001. Chung t6i ciing ghi n h | n lactate mau sau 6 gio dieu tri a benh nhi dupe doi CPT trong 6 gio dau thap hon
6 nhiing benh nhi khong doi CPT; 1,68 mmo/L so voi 2,01 mmol/L va si^ khac biet nay cung co y ngjua thong ke voi p=0,037, tuy nhien lactate mau sau 3 gio dieu tri 6 nhung benh nhi c6 doi CPT trong 6 gio va khong doi CPT lai khac nhau khong CO y nghia tiiong ke (p=0,21). Nhu vay v i ^ doi CPT cang som se lam cai thien lactate mau cang nhanh.
Lactate mau 6 cac thai dirai va lieu cao phan tvr luc deii
Chung toi ghi nhan co 33,3% truong hpp co heu HES liic doi > 10 ml/kg/gj6 co lactate mau liic nhap vien > 4 mmoI/L, trong khi chi co 14,3%
truong hop CO lieii HES hie doi < 10 ml/kg/gio co lactate mau liic nhap vi&i > 4 mmol/L va su khac biet nay co y nghia thong ke (p=0,043). Nhu vay CO 1/3 benh nhan soc SXH-D co lactate mau khi nhap vien > 4 mmoI/L se phai doi sang CFT 6 Heu cao > 10 ml/I^gio.
Dong thdi lac:tate mau sau 3 gid va 6 gio dieu tri 6 benh nhi co Ueu HES liic doi > 10 ml/kg/gid thap hon 6 nhung benh nhi co lieu HES liic doi < 10 ml/kg/gid; 1,93 mmol/L so voi 2,28 mmol/L va 1,59 mmoI/L so voi 2,03 mmol/L va su khac biet nay co y nghia thong ke vdi p Ian luot la 0,017 va 0,004.
Tom lai: viec doi CPT sdm (trong 3 gjo dau) va doi d l i ^ cao ^ 10 m^kg/gid) se lam cai fliien nhanh lactate mau.
Lactate mau a cac fhoi diem va men gan Trong nghien ciiu cua chung toi, cac tnrong hop soc SXH-D cd SGOT tang ^ 15 lan (600 Ul/L) cd gia tri trung binh lactate mau hie nhap vien cao hon cac trudng hop soc SXH-D co SGOT tang < 15 lan, 3,77 ± 1,27 mmol/Lso vdi 3,1 ± 0,92 mmoI/L va su khac biet nay co y nghia thong ke (p=0,037). Co doi 54^% tnrong hop soc SXH-D cd SGOT tang S 15 lan cd miic lactate mau S 4 mmol/L, trong khi dii cd 18,6% trudng hgp soc SXH-D cd SGOT tang < 15 lem cd miic lactate mau ^ 4 mmoI/L va su khac biet nay cd y ngtea tihang ke (p=0,009). Dieu nay cd the gjai fliich do gan la co quan chinh chuyen hda lactate mau
Y H p c T P . H o C h i M i n h » T^p 20 * So 1 '^ N g h i e n c u u Y hpc thanh pyruvate nhd men LDH (lactate
dehydrogenase) theo con dudng hieu khi de tao tiianh ATP va CO2. Ngoai ra tai gan lactate mau con duoc su dung de tao lai glucose thong qua qua trinh tan tao dudng ggi la diu trinh Cori'*-*.
Trong SXH-D, vi nit tan cong va gay ton thuang gan, lam gjam tdc dp chuySi hda va dao thai lactate mau. Dong thdi tinh trang soc dan d ^ giam tudi mau he thong, gay tiueii oxy mo, lam tang tfing hgp lactate mau. Chinh hai co che nay da lam lactate mau tSng cao trong soc SXH-D cd ton tiiuong gan. Chung t^i ghi nhan miic do ton thuong gan cd anh hudng d a i tang lactate mau cd y nghia la khi SGOT tang trai 15 1MI SO vdi binh tiiudng (>600 UI/L).
Lactate mau a cac thoi diem va suy ho hap Trong nghien ciiu ciia chiing tdi, nhiing trudng hgp dien ti&i cd suy ho hap deu c6 gia trj trung binh lactate mau d tiidi di&n nhap vien cao hon nhiing trudng hop ciien tioi khdng cd suy hd hap, 3,37 ± 1,1 mmol/Lso vdi 3,06 ± 0,88 mmol/L. Cd 34,3% trudng hgp dien tiei cd suy hd hap CO lactate mau d thdi dian nhap vien >4 mmol/L, tiong khi chi cd 15,2% trudng hop dien tiai khong CO suy ho hSp co lactate mau d thdi diSu nhap vien > 4 mmol/L va su khac biet nay CO y nghia thdng ke (p=0,045). Dieu nay cd the giai ihich do suy hd hap lam nang tfiem tinh trang thieii oxy mo lam tang tong hpp lactate mau theo con dudng y e n khi. Khi co the cd tinh trang gjam oxy hda mau se lie che pyruvate dehydrogenase (PDH) la men xiic tac qua trinh bioi doi pyruvate thanh acetyl coen2yme A (CoA), draig thdi lic che pyruvate carboxylase la men chuyen pyruvate thanh oxaloacetate trong qua trinh tan tao dudng. Dieu nay lam cho pyruvate sinh ra khong duoc chuy&i hda, lam tang nong do pyruvate dan d o i lam tang su tao thanh lactate tii pyruvate.
KETLUAN
Qua nghien cihi dac diem lactate mau tiong 6 gid dau dieu tri tr&i 81 trudng hgp soc SXH-D tai khoa cap a i u Benh vien Nhi Dwig 1 tii ihang
6/2014 d a i thang 6/2015, chiing tdi nit ra mdt so kei l u ^ sau: lactate mau tren benh nhan soc SXH-D cao hon d nhdm soc SXH-D nang, nhdm du can beo phi, nhdm cd dm dich truyen cao phan tu trong qua trinh dieu tri va nhdm cd suy ho hap.
TAI LIEU THAM KHAO
1 Abramson D , Scalea Tli^ Hitchcock R, et al (1993) ' l a c t a t e clearance and survival following injury". / trauma -Medline, 35(4)584^; discussion 588-9.
2. B 9 Y T e ( 2 0 1 1 ) . Q u y e i d i n h v e v w c b a n h a n h " H u 6 n g d S n c h E h doan, ^ e u fri sot xuai huyel Dengue" so 458/QD-BYr, b a o h a n h ngay 16 Ihang 02 n a m 2011. H a N o i
3 Do Van Binh (1997). Mdt sSdSc diein lam sdng bieh da sinh hoa va tSi thuong Ihuc die gan a henh nhdn Dengue xuSl huifet, L u | n van P h o T i o i SiKhoa H g c Y Dupe Hoc Vien Q u a n Y, Ha N ^ . 4 Haleslrap AP (2012). " I h e Monocartxixylate Transporter
Family-Stnicture and Functional Characterization". Critical Review 64 (I), p p 1-9.
5 H o Ton Thien Nga (2D13) Kteio sdi dih tieh dim tri dick truym trong soi xual hta^ Dengue benh nhi thiol cSn-beofMfaiherdi vien Nhi Dmg 2, Luan van th^c sy y hoci Chuyen Nganh Nhi Khoa, Dgi Hoc Y Duigtc Thanh P^o H o Chi Minh.
6 Kalayanaioo) S, Nimmannitya S, et al (1997) "Liver fiinction tests as measures of disease seventy in Dengue patienbs ".
Programme and abstracts of the 46"' annual mating of die American society qftropiad medidne and hy^em ,Horida.
7 Lirong Thi JGian Khanh, D m h Anh TUMI (2011) ' B a c d i S n sot xuat huyel 6 cac benh nhi dir can tai b#nh vi^n Nhj Dong 1 ".
Tap Chi Y Hoc Thanh Pho Ho Chi Minh, Tap 15 (phu ban 3), tr.
50-57.
8 Nguyen D o Nguyen (2006). Phuang phdp nghiSn cim khoa hoc hDnj y WKM. Bo mrai D i d i Te - Khoa Y t e c o n g ccmg, Dai Hoc Y Duvc TP HCM. tr 1-7,21-26,34-i3.
9 N g u y a i Thanh Hiing (2013). IMai tri sot xua't huye't Dengue.
Phdc do dieii tri nhi khoa. N h a xua't ban Y hpc Thanh p h o H o Chi Minh, B | n h vien N h i EJraig 1, tr.42fr427.
10. Nguyen hfinh Tiea (2(X)7). N h a n xet dac di&k lam sang va dieu tri soc sot xua't huyet Dengue ii tre beo phi tai khoa h ^ sue b | n h v i ^ N h i Braig 1. Hm n^i Nhi Uwa Viet - Uc lan 5.
7/9/2007. Thanh P h o H o Chi M n K
j.1. Flian H u u Nguyet Diem (2004). "Suy gan trong sSl xuSl huyS dengue 17 (re em *, Lu^n an T i S i ST y h o c Dai Hpc Y D u q c TP I K C h i M n K
I Z Ray G, Kumar V, Kapoor AK, Dutta AK, Batra S (1999) "Status of antioxidants and oflier biodieinical abnormalities in diildrrai with Dengue fever". / Trop Pediatr, 45(1), p p 4-7.
13. Ta Van Trjun, Hoang Trpng Kim, N g u y i n Trong Lan (2a(S)
"Cac yeu to lien quan d 3 i xuat hayS tieu hoa ticsig soc sot xuat huyet D o i g u e o tre em". Tap dii Y Hgc Thdnh PhS Ho CM Minh, lap 9 (phy ban 3), tr 1-5.
1 4 Traedak S, D d l m g w RP, C h a n s l y ME, et al (2007) "Sraum lactate as a predictor of mortality in patients with infection".
Intensive Care Med 33 (6), p p 970-977
15. Van Beest P, Kuiper M, Spronk PE (2009) ' l a c t a t e : an unusually sensitive parameter of ensuring organ failure". Crit Care Med. 38 (1), p p 337-33a
Nhi Khoa
Nghien cuu Yhoc Y Hpc TP. Ho Chi Minh * Tap 20 * Sd 1 * 2016
16. VanGMpEC;SuhartiCMair«huAT,DobnansWM,vanDer 20. World Health Organization (2009) 'TJengue Guidelines fcr Ven J, Demacker PN, van Der Meer JW p002) "Changes in Diagnosis, TieaUnoit ftevention and Control * plasma fifrid pmfile as a potaitial predkttv trf diniod mibxraie WHOIHnid/NTD/DEN/20(B.l,
m Doigue Haemorrhagic Fever", ainical bijecHous Diseases, 3i, ^. World HealSi Organization (2014). Dengue and severe dengue, pp 1150-1153. FactsheetN°117. WHO Media centre,
17. Voncn C Leioumeau JL ^10) "Lactic addods: recognition,
ki^^=„d««iai=dp,»g„"*-.c„'C«,am,26(2),pp Ngi)«hmbmbm: 2011112015 18 Vier V| Sinh Didi Te Tmng Ifong (2014). Hoi thdo trial tdmi Ngdy phan biin nhan xet bd bdo: 25/11/2015
Ong tdc phong ch^g soi XuM huyei nltm2014,m,N^. , nn/niM/i-.^
19. WedMH,AfifiAA{1970)"Experimentalanddiniralsludieson Ngay bai bao duoc d&ng: 20/01/2016 lactate and pyruvate as indicators of the severity of acute
diculatory faihue (shock)". Caadation, 41 (6), pp 989-1001.
