TCNCYH Phli truung 80 (3A) - 2012
Summary
LEAD POISONING ASSOCIATED WITH FOLK REMEDIES IN CHILDREN:
EPIDEMIOLOGY, CLINICAL AND LABORATORY FEATURES, TREATMENT AND OUTCOME
Objective of this study was to describe epidemiology, clinical and laboratory features, treat- ment and outcome of lead poisoning associated with folk remedies in children admitted to Na- tional Hospital of Pediatrics in November 2011. The results showed that fifteen children with lead poisoning were enrolled. 13/15 of children age < 5 years. Most of them lived in rural areas.
Thuoc cam was the major sources of lead (10/15 patients). The most common presentation were vomiting (11/15), convulsions (11/15). anemia (14/15) Hb (g/dl) mean ± SD: 9.3 ± 1.2 (g/
dl). AST, ALT, Lactac elevated CFS. elevations protein concentration (8/8), mean ± SD 2.5 ± 1.2g/l. No patient was corrected diagnosis after 24 hours admitted. 93% (14/15) of children had BLL > 70 mcg/dl. 20%> (3/15) children died In conculston, folk remedies (thuoc cam) was the major source due to severe lead intoxication.
Keywords; lead poisoning
HIEU QUA VA CAC YEU TO LIEN QUAN KET QUA OlEU TRj ARV a BENH NHI HIV/AIDs TAI PHONG KHAM NGOAI TRU
BENH VIEN NHI NGHE AN
Nguyin Van So'n\ Nguyen Tw Hung'
^Benh vien Nhi Nghe An, ^Trwdng Dai hoc Y Vinh
Tuan thu dieu tn ta yeu to song con quyet dmh sw thanh cong trong diiu th ARV d b§nh nhan HIV/
AIDS Phdng kham ngoai tru benh vidn Nhi Nghe An dwac tnin khai tif thang 8/2008 nhwng cho din nay chwa dwac danh gia vi kit qua cQng nhw sw tuan thd diiu tn cua benh nhi, gia dinh va ngwdi cham sdc tre Nghien ciru dwac thwc hien nhim xac dmh hieu qua. ty le tuan thu diiu tn va mgt s6 yiu td lien quan din tuan thu diiu tn ARV a benh nhi HIV/AIDs tai phong kham ngoai tru benh vien Nhi Nghe An Kit qua nghien ciru cho thiy ty le benh nhi dap u'ng tdt vdi diiu tn rit cao 92,2% Ty le tuSn thu diiu tn ARV la 35,7% Ty le benh nhan co kiin thirc va thwc hanh dung vi tuan thu diiu tn ARV la 84,1% Bdnh nhan cd ngwoi tro giup tuan thu diiu tn cao hon benh nhan khong co ngwdi tra giup Bi duy tri hieu qua diiu tri, duy tn ty Id tuan thu diiu tn ARV keo dai sw sdng cho ngwdi benh cin cung cip cho ngwdi nhiem va ngwdi cham soc tre nhu'ng kiin thirc vi tac dung ciia thudc ARV va tao diiu kien di ho c6 ngwdi tra giup TCf khoa: HIV/AIDs, ARV, tuan thu dilu trj
22
\. DAT VAN DE
Cho d i n nay, dai djch HIV/AIDs da thuc su trd thanh van d l xa hdi, y t l nghiem trpng tren toan clu, khdng cdn mpt quic gia hay vimg lanh t h i nao md khong cd ngudi nhilm [8]
Tai Viet Nam HIV/AIDs da cd mat d h l u hit cac tmh thanh trong ea nudc Sd lieu thing ke cua Bd Y t l , tinh d i n 31/3/2011, so trudng hap nhilm HIV hien cdn sing Id 185.623, so benh nhan AIDs hien cdn sing la 44 701 va da ed 49 912 trudng hp'p tu vong do AIDs. Toan quic cd tdi 70,51% xa/
phudng, 97,53% quan/huyen vd 63/63 tinh/
thanh pho da phat hien cd ngudi nhilm HIV [4,8]
Tai Nghe An tinh d i n 31/8/2011 da phat hien 7680 trudng hap nhilm HIV Trong dd, ed 3719 trudng hp'p npi tmh va 540 trudng hp'p ngoai tfnh chuyin sang AIDs, ed 2113 trudng hp'p tir vong vi-AlDs. 20/20 huyen, thi xa, thanh phi, 379/479 xa , phudng, thi trln cd ngudi nhilm HIV/AIDs [10]. Co 70 tre bj nhilm do me truyln sang (1,1%). Rit nhilu tre em bi m l cci b l hoac me hoac ca b l lan me, phai sing cimg vdi dng ba hoae ho hang
Tuan thil dilu th la y l u t l sing cdn cua dilu tri ARV. D^ tuan thu dilu th t i t ngudi nhilm va nhi>ng ngudi cham soc tre phai duac tu v i n trudc va trong suit qua trinh dilu tri. Tham v i n giup benh nhan hilu t i m quan trong cua tuan thu dilu tn, lai ich eua tuan thil dilu tri tren dap irng lam sang va miln dich vdi HIV. Ngoai ra tuan thii dilu tri cdn giiip benh nhan co kiln thuc v l HIV/
AIDs, tiln t h i n benh, dap irng dilu trj, ding thdi theo ddi tac dung phu cua thuic [1, 2].
Tuan thu dilu tri ARV ddi hoi ngudi benh phai kien tri vi ho phai doi mat vdi nhirng tac dung phu eua thuic, phai su dung thuic suit ddl va nghiem ngat han la phai uIng thudc dung gid mdi ngay, cac benh nhiem triing ca
hdi, nhQ'ng thay d l i trong cude sing. Tit ea nhii'ng dilu nay ed t h i anh hudng d i n qua trinh tuan thii dilu tri. D l danh gid hieu qua cua chuang trinh dilu tn, cham sdc tre HIV/
AIDs va su tudn thii dilu trj ehimg tdi nghien ciru d l tal nay vdi muc tieu:
Xac dinh ket qua diiu tri ARV d benh nhi HIV/AIDs tai phong kham ngoai trii, benh vien Nhi Nghe An.
Xac dinh ty le tuan thu dieu tn ARV va mot so yeu to lien quan din tuan thu diiu tn cua ngwai cham soc tre benh HIV/AIDs.
II. D 6 I TU'gNG VA PHU'aNG PHAP 1. Ddi t y a n g nghien cu>u
- 70 benh nhi HIV/AIDs tir 1-15 tudi da duac dieu tri ARV va theo ddi tal phdng kham ngoai tru benh vien Nhi Nghe An,
- Dia dilm nghien ciru phong kham ngoai tru nhi tai benh vien Nhi Nghe An.
Thdi gian nghien ciru tir thang 8/2008 d i n thang 8/2011
2. Phyang phap nghien CLFU
- Phuang phap nghien ciru Nghien ciru md ta cat ngang
- Thu thap s l lieu: theo m l u benh an - Thule dilu tri theo phdc do du phdng va dilu tri HIV/AIDs cua Bd Y te
3. Tieu c h u i n liFa chon benh nhan HIV/
AIDs vao dieu trj
Benh nhan HlV/AlDs duac bat dau dilu tn khr
- Benh nhan d giai doan I hoac ll cd xet nghiem t l bao CD4 dudi 200 TB/lml mau hoac ty le t l bdo CD4 < 15%.
- Benh nhan d giai doan 111 khi xet nghiem s l lug'ng t l bao CD4 tir 200 - 350 TB/lml mau ,
23
TCNCYH Phu truung 80 (3A) - 2012
- Benh giai doan IV (khdng ke s l luang t l bao CD4). Va gia dinh benh nhan cd cam ket cham sdc dieu tn tre
4. Phyang phap xu' ly so lieu: Cac s l lieu thu dugc se xCv ly theo phuang phap thing ke Y hpc thuc hien tren may vl tinh vdi phln mim SPSS 19.0
I. K £ T QUA
1. Nhirng dac tinh cua mlu nghien cyu
Bang 1. Phan b l theo tuli va gidi
Tu6i
<12th 12-35 th 36 - 59 th
>60th T6ng s6
GiO'i n 2 3 7 28 40
Nam
%
2,5 10 17,5
70 57,1
N n 0 6 6 18 30
lU'
%
0 20 20 60 42,9
T6ng s6 N % 2 2,8 9 13,9 13 18,6 46 65,7 70 100
Ty le benh nhi > 5 Tuli chilm ty le cao han 65,7% (p < 0,05). Ty le benh nhi nam ldn han cd y nghTa so vdi nu (57,1% so vdi 41,9%, p < 0,05)
Bang 2. Tinh trang lam sang sau dilu trj K6t qua
Tir vong Bo digu tri
Giam cac benh nhi§m trung co hoi Han che qua trinh tien tnen cua benh Hoi phuc sire khoe
n 3 3 52/57 59/64 48/64
%
4,3 4,3 91,2 92,2 75,0 Kit qua dieu th glam cdc benh nhilm triing ea hdi 91,2%, han c h l qua trinh tiln thin ciia benh 92,2%, hli phuc sire khoe 75%, Ty le tip vong thip (4,3%).
4. Kien thyc va thyc hanh ciia ngydi cham soc tre v§ tuan thu dilu tn
Bang 3. Kien thyc va thyc hanh cua ngydi cham soc tre v l tuan thu dilu trj ARV {n = 63) Kl4n thu'c va thyc hanh dung
V§ tuan thu tai l<ham theo hen V^ xv^ tri khl bl tac dung phu cua thu6c Ki§n thuc va thuc hanh chung ve tuan thu di^u tn
n 59 57 53
%
93,6 90,5 84,1 63 ngudl cham sdc tre duac khao sat v l kiln thirc va thuc hanh v l tuan thu dieu tn, trong do 93,6% tuan thii tai kham theo hen, 90,5% bilt vd xu tri dung khi bi tac dung phu cua thudc.
Kiln thirc va thue hanh chung diing chiem 84,1%.
Bang 4. NhCpng yeu to lien quan vo'i tuan thu dieu trj (phan tich da bien legist
Y6u ta OR Ngh^ nghiep b6, me (can bo, CN) 1,05
Noi o (thanh thi) 1,63 Nguoi cham soc tre co dieu kien thuan loi va luon quan tam tre 2,47
Tin tuong vao qua trinh di^u tri 1,78 Su dung cac bien phap nhac nho dieu tri 2,93 Co ki§n thirc ve tac dung phu cua thubc 1,86
Cl 95%
0,67- 1,36 1,32-2,19 2,01 -2,84 1,25-2,21 2,45-3,24 1,37-2,56
ic) P
>0,05
<0,05
<0,01
<0,05
<0,01
<0,05 Cac y l u t l lien quan d i n tuan thu dilu trj tdt bao g i m : tre d thanh thi, ngudi cham sdc tre cd dilu kien thuan Ip'i va ludn quan tdm tre, tin tudng vao qua trinh dilu trj, sir dung eae bien phdp nhac nhd dilu tn, cd kiln thire v l tae dung phu eiia thuic Trong do y l u t l lien quan manh la su dung eac bien phap nhac nhd dilu tri (OR = 2,93; p < 0,01).
K i t qua nghien ciru cung cho thay cac y l u IV. BAN LUAN
Nghien ciru da thu thap thdng tin tir 70 benh nhi dang tham gia dilu tn, cham sdc tai phdng kham ngoai tru cua benh vien Nhi Nghe An, trong dd ty le tre em nhdm > 5 tuli chilm 65,7%, eao han t i n g 3 nhdm tuoi <12 thang 12 - 35 vd 36 - 59 va dilu dd chirng to edng tac dilu tra, giam sat cung nhu su quan tam h i tra ciia gia dinh va toan xa hpi cho cdng tac dilu tri, eham sdc d l i tup-ng tre em bi nhiim dang tirng ngay dup'c nang cao Ty le tre nam chilm 57,1% t h i p han vdl ty le trong nghien ciru cua Le Mmh T u i n tai Hd Ndl la 78% [5] Cd 90% tre benh dug'c sing chung vdi gia dinh, day Id nhung y l u t l thuan lai cho ngudi benh trong qua trinh dilu tri ARV
Kiln thirc, thuc hanh va cac y l u t l lien quan dilu tri ARV.
Kit qua nghien ciru cho thly ngudi benh trudc khi dupc dilu tri ARV phai qua 3 l l n t u v i n ca nhan va 3 l l n t u v i n nhdm nen da duac cung elp day du cac kiln thirc; tuy vay kiln thiPC chung diing v l tuan thu dilu tn ARV cua benh nhan la 84,1% trong dd kiln thirc dung v l tac dung phu cua thuic dat 90,5% k i t qua nay d nghien ciru cua Le IVIinh Tuin la 92,6% [5].
td lien quan anh hudng den ket qua dieu tri la benh nhan cd ngudi tra giiip. Kit qua eiing tuang tu vdl nghien ciru eua Le Minh Tuin benh nhan phli hp'p t i t vdi can be y t l thi cd ty le tudn thii dilu tri cao han ngudi khdng phoi hp'p t i t Id 2,93 l l n [5] So vdl kit qua nghien ciru cua Dang Minh Sang thi benh nhan dup'c edng ding tra gliip cham sdc, duac nhan vien y t l eung d p kiln thuc thi tudn thu t i t han [3]. Trong nghien ciru cua Nguyin HQ'U Chi, 79,8% benh nhan trong mau nghien ciru ed tiln sir khdng tuan thii t i t khi dimg thudc [7]. Dilu nay eho thly val trd eua ngudl tra giiip trong tuan thu dilu tn ARV eho benh nhan AIDs la rit quan trpng.
Vi vay trong cong tde theo ddi su tuan thu dilu tn d n ed su trao dli vd lien he mat thilt giira gia dinh vdi nhan vien y t l hoac nhan vien trp' giup cham sdc tai nhd d l kip thdi phat hien nhirng v i n d l khd khdn ma ngudi benh gap phai trong qua trinh dilu tn nham tang cudng viec tuan thu dieu tri eho benh nhan va han che khang thuic d i n d i n thit bai dilu tn Kiln thirc dung v l tae dung phu ed lien quan vdi tudn thii dieu trj ARV Tac dung phu eua thudc cung la mgt y l u t l anh hudng d i n su tuan thu dieu th eua benh nhan. Nhu vay, trong cung d p kiln thirc chg 25
TCNCYH Phu truung 80 (3A) - 2012 ngudl benh cung nhu cho ngudl tra gliip, nhan vien y t l d n chii y nhin manh hudng d i n cdc tac dyng phu cua thule that rd rang, d l hilu, d l nhd nhlt la each xw ly khi gap tac dung phu, nham gdp phln lam tang ty le tuan thu dilu tn han nira cho benh nhan.
V. KET LUAN
Hieu qua dilu tri ARV d benh nhi HIV/
AIDs tai phdng kham ngoai trii, benh vien Nhi Nghe An
- v l lam sang' phln ldn tre glam cdc benh nhiem triing ca hdi (91,2%), han ehi qua trinh tien triln cua benh (92,2%), hli phue sire khoe (75%), Ty le tu vong thip (8,6%)
- v l can lam sang: Ty le t l bao CD4 tang len cd y nghTa sau dilu tn
Ty le tuan thu dieu tn ARV va mdt s l ylu t l Hen quan d i n tuan thii dilu tn.
- H I U hit tuan thii tai kham theo hen (93,6%), biet va xw tri diing khi bi tae dung phu cua thule (90,5%). Kiln thirc vd thuc hanh chung dimg chilm ty le cao (84,1%)
- Cae y l u t l lien quan d i n tuan thu dilu th t i t bao g i m : tre d thanh thi, ngudi cham sdc tre cd dieu kien thuan Ip'i va ludn quan tam tre, tin tudng vao qua trinh dilu tn, sir dung cae bien phap nhlc nhd dilu tn, cd kiln thire v l tac dung phu cua thule
TAI LIEU THAM KHAO 1. Bo Y t l (2005). Quylt dmh 06/2005/QD - BYT v l hudng dan chan doan vd dilu tn HIV/AIDs
2. Bo Y t l (2009). Quylt dmh 3003/2009/
QD - BYT hudng d i n ehln doan va dilu tri
HIV/AlDs.
3. Bo Y t l (2011). Bao cao tinh hinh nhilm HIV/AIDs quy 1 nam 2011 Sd 3070 I- BYT - AIDs: 2
4. Dang Minh Sang (2008). Oanh gia tuan thil dilu tn ARV d benh nhan Lao/HIV, Nghien ciru khoa hgc d p ca sd, Benh vien Pham Ngpc Thach, Sd Y t l TP HCM
5. Le Minh Tuin (2008). Thuc trang tuan thu dilu tn trong dilu tri ARV eiia benh nhan HIV/AIDs dilu trj ngoai trii va mdt s l ylu t l lien quan d 6 Quan, Huyen Thanh p h i Ha Ndl http.//wv™/.hmu-edu-vn/tapchl09/upload/
Le%20Mlnh%20Tuan swf
6. Pham Trung Kien va cpng s y (2011).
Dac dilm lam sang vd kit qua dieu trj benh nhi nhiem HIV/AIDs tai benh vien A Thai Nguyen, Tap chi Y hpc Thuc hanh (781): 155,
7. Nguyin Hyu Chi, Nguyin Trln Chinh, Vo Minh Quang va cong sy (2006).
Dae dilm khang thule eua benh nhan AIDs thit bai dilu tri vdi HARRT tai benh vien Nhiet ddl, Nghien ciru khoa hoe elp ea sd, benh vien Nhiet ddi, Sd Y t l TP HCM
8. Pham Thj Van Hanh (2004). Nghien ciru mdt s l y l u t l dieh t l , bilu hien lam sang va xet nghlem tre em nhilm HIV/AIDs tai benh vien Nhi Trung uang va benh vien Nhi Hai Phdng. Luan van bdc sy ehuyen khoa elp II, Dai hpc Y Ha Ndi
9. Nguyin Van Lam (2010). Tinh hinh dich HIV/AIDs t h i gidi va viet nam Tieu ban HIV/AIDs nhi - Bo Y t l .
10. So- Y t l Nghe An (2011). Bao cao tdng k i t cdng tdc phdng ehing HIV/AIDs nam 2010. s l 35/SYT - HIV/AIDs.
Summary
EFFECTIVENESS AND THE RELATED FACTORS OF ARV THERAPY FOR HIV/AIDs CHILDREN AT OUTPATIENT CLINIC, NGHE AN CHILDREN'S HOSPITAL
Adherence is vital to the success of ARV treatment in patients with HIV/AIDs. Outpatient Clinic Children's Hospital of Nghe An has been deployed since August 2008 but so far have not been evaluated results as well as the adherence of patients, families and caregivers.. The study was carried out to evaluate the effectiveness of antiretroviral treatment, the rate of compliance with ARV treatment and factors related to the adherence. The results showed that the rate of patients respond well to treatment was 92 2%. The rate of compliance with ARV treatment was 95 7% The rate of patients with correct knowledge about adherence to ARV was 84.1% Pa- tients who assisted had higher treatment compliance than patients without the assistance. In conclusion, to maintain the effectiveness of treatment and maintain compliance rate ARV thera- py prolongs survival for patients infected persons should provide knowledge on the effects of ARV drugs and to create conditions is needed.
Keywords: HIV/AIDs, ARV, treatment
THAT BAI DIEU TRj ARV TREN TRE EM NHIEM HIV
Ngd Thi Thu Tuyen', Pham Nhat An\ Nguyin Van Lam' Nguyin HQ'U Anh^, Ho Anh Tudn', Do Thien Hai' 'Benh vien Nhi Trung Wong, ^Truong Dai hoc Y Ha Noi Nghidn cuu hdi c&u duoc thuc hien tren 59 tre tir 1 dSn 16 tu6i duoc chin doan thk bai di4u tn ARV tir thang 10 nam 2005 d&n thang 10 nam 2011 tai phong kham ngoai trii benh vien Nhi Trung Wong Kk qua cho thiy. (re thit bai diiu tri ARV chu yiu tit 5 din 12 tuii chiim 71,2%, tre duac chuyin sang phac ai bac 2 chiim 57,6%. Khi bit diu diiu tn ARV co 72.4% tre a giai doan lam sang 3, 4: tre a giai doan suy giam mien dich nang chiim 94.6%. Tr^ co thit bai vi virus 88.1%, vi MD chiim 76.3%. ca lam sang, miln dich va virus la 35.6%. Thai gian thit bai miin dich trung binh la 23,8 ±12.3 thing. Thai gian tir khi thit bai miin dich din khi duac chuyin sang phac di bac 2 trung binh la 12.6± 10.5thang C654.2%tre khong tuSn thu diiu tri. 67,8% tre mit bi va/hoac me; 52,2% tre biit minh nhiim HIV.
TCr khoa: that bai diiu trj ARV, tuan thil ai§u trj ARV, boc lo nhiSm HIV o" tre
I. BAT V A N D E doi hbi rSt nhieu nguoi than trong gia dinh, BiSu tri thuoc khang virus co hoat luc cao ban be, nhan vien y t§ va cac anh chi tinh (HAART- highly active antiretroviral therapy) nguyen vien hb tro ca vk tuan thu dilu tri va lam virus HIV bi uc che, tre duoc cai thien tam ly [2] That bai dieu tri ARV lam giam dang k i ca v§ can nang, chigu cao va tinh hieu qua dieu tn, xuat hien nhiem trung co than, giup tre khoe manh va hoa nhap cong hoi d i n den anh hudng nghiem trong den d6ng [1]. B i l u tri ARV la dilu tri su6t doi [1], chSt luong cuoc s6ng cua benh nhan [1]
d l k i t qua dilu tri ARV cho tre thanh cong Nghien cuu duoc thuc hien nham phan tich 27
