Y Hpc TP. H o Chi Minh * Tap 20 * S£» 1 * 2016 Nghi6n c u u Y hpc
NGUYEN NHAN GAY HO KEO DAI TAI KHOA HO HAP 1 VA HO HAP 2 BENH VIEN NHI DONG 2, T P . H 6 CHI MINH
Nguyin Do Thanh Thdo', Ph^m Thj Minh Hong"
TOMTAT
Muc tieu: Xdc djnh tile cdc nguyen nhdn gay ho keo ddi tai khoa Ho Iwq) 1 vd Ho hc^ 2 Benh viin Nhi dong 2 tii thdng 6/2014 deh thdng 5/2015.
Phuangphap nghien cdu: Md td loat ca.
Ket qud: Co 93 tii ho keo ddi diegc dua vdo nghiin cmi, trong do 66,7% xac dinh duoc nguyen nhdn bao gom viim phoi (55,9%), lao phdi (4,3%), hen (4,3%), di vdt dieimg tha (1,1%), hoi chimg ho do duong hd hop tren (1,1%), vd 33,3% chua ro nguyen nhdn.
Kei lu^m Trong nghien cieu nay, nguyen nhdn gay ho keo ddi d tre em thuang gap nhSi Id viim ph&i.
THkhoa: Ho keo dai, tre em.
ABSTRACT
CAUSES OF CHRONIC COUGH AT CHILDREN'S HOSPTTAL N% HO CHI MINH CTTY Nguyen Do Thanh Thao, Pham I h i Minh Hong *Y Hoc I P . Ho Chi Minh * Vol. 20 - No 1 - 2016:37 - 40
Objective: To determine the causes of chronic cough children admitted to the Respiratory departments at Children's hospital N''2from June 2014 to May 2015.
Study design: Case series.
Results: There were 93 children zvith dirordc cough enrolled in the study. 66,7% of them was determined causes including pneumonia (55,9%), tuberculosis (4,3%), asthrrui (4,3%), foreign body aspiration (!,!%>), upper airway cough syndrome (1,1%), and chronic cough of unknown origin (33,3%).
Conclusion: In this study, the most common cause of chronic cough in children is pneumonia.
Key words: Chronic cough, children
DAT VAN DE quan do vi trung (39,8%), hen, benh trao nguoc da day thuc quan (Gastroesophageal Reflux Ho keo dai dupe dinh nghia la tinh trang ho p j ^ ^ ^ _ ^ g g p , ^^ j , . j ^ ^ ^ ^ ^ ^^ ^^ ^ moi ngay keo dai Ben tiic hon bon tumm, diiehi li le dmii 10% 6 tre emB. Mot nghien a i u Nguyen nhan gay ho keo dai duoc chia lam 2 ^^^ ^ ^ ^^ ^ .^^^ gp ^ ^^^ 45 ggo^ ,^^
nhom dac hieu (hen, viem phe quan keo dai do ^ ^ ^ ^^ 28,57% do hoi chiing chay miii sau, vi khuah, Mnh phoi mu man tinh va dan phe j j 530/^ ^^ ^ | ^ ^^^^ j^g j,g,p_ ^^^.,.,^ j „ ^^^
quan, bat thucmg duong dan khi bam sinh di |,_g2% do di vat duong th6l«. Ho keo dai gay lo vat, ung thu, hit sac, nhiem trimg man tinh benh ijng cho cha me h i , anh huong khong nho d m phoim6ke,nguyennhanngoaiph6i:batthu(mg ^ . j ^ j^^^j j ^ g ^ ^ ^ ^^ ^^^ ^^ j ^ ^ ^^ ^ ^ tim, benh ly tai) va khong dac hieu (hen dang ho, ^,^^ ^^ g^ ^ ^^^ j , g ^ y ^ ^ ^ ^^ ho keo dm ho thoi quen, ho do tai)ra. ^ ^^ f^^ j j , ^ j ~ j ^ ^ ^^ 1,^^. ^j ^^^ ^^^^
Nghien ciiu ciia Marchant JM va cong su cho y , ^ j ^ ^ ^ ^ ^f^ thuc hien de tM nay nhSm thay n g u y ^ nhan thuang gap nhat la viem phe
* Bg m6n NW, Bai hpc Y Duoc TP.Ho Chi Minh
Tiic gid liSn lac: BS. Nguy&i D6 Thanh Thao DT: 0934043153, Email: ndthanhthaobsci'gmail.com
N h i Khoa 37
Nghien cihi Y hpc Y Hpc TP. Ho Chi M i n h * Tap 20 * S 6 1 * 2016
tra loi cau hoi: Nguyen nhan gay ho keo dai 6 tre em nhap khoa Ho hap 1 va 2, benh vien Nhi dong 2 la gj? Ket qua nghi&x cuu nay se giiip cac bac si CO huong tiep can trong viec tim nguyen nhan gay ho keo dai, tu do gjup cho viec tiieo doi va dieu t4 benh tot hon nham giam ftioi gian n3m vien va giam chi phi dieu tri cho benh nhi.
DOIlUCNG-PHU'ONGPHAPNGHIENOLrtj Phuong phap nghi@n cuu
Motaloatca.
Doi hcpng nghien cmi
Tat ca cac tre tCf 1 thang d a i 15 turn nhap khoa Ho hap 1 va 2 BVND2 vi ho keo dai trong thoi gian tix ngay 1/6/2014 d a i ngay 31/5/2015.
Tieu chuIn chpn mau
Tr^ tix 1 thang den 15 luc5 n h | p khoa Ho hap BVND2 duoc chah doan ho keo dai ttioa tieu chuan ho lien tuc moi ngay keo dai it nhai: 4 tU£b.
Thu thap so lieu Iheo b&ih an mau KET QUA NGHIEN CUtJ Dac diem dan s6 nghien cuu
Tre tir 1- 5 tuoi chion 51,6%
Tuoi trung binh nhiip vi|n cua tr^ la 28 ± 2,9 thang, thap nhat la 1 tiiang tuoi va cao nhat la 10 tuoi.
11 le tuong duong nhau giira nam va n u vdi nam chiem 49,5% va nij 50,5%.
Nguyen nhan gay ho keo dai
Cac nguyen nhan trong nghien cuu tiieo thu tu la viem phoi (52 truong hpp -55,9%), lao phdi (4 truong hop - 4>3%), hen (4 truang hop - 4,3%), di vat duong tho (1 truang hpp - 1,1%), viem miii di iing (1 truang hop - 1,1%) va chira ro nguyen nhan (31 truong hgp - 33,3%).
Dac diem lam sang, can lam sang va dieu h i
cua mpt so nguyen nhan tihuong g^p Viem phoi
Co 52 tre ho keo dai duoc chan doan la viem p h ^
Bang 1: Dac diem lam sdng vd dieii tri cua tre viim phdi
T l n s 6 (n=52) Til#(%) Tllncan
- Ctiu^ Chung ngira ho ga - Dinh du&ng + Suy dinh dirang do 1
9 2
17,3 3,8 Trieu chiing ISm sang -S6t
- Ho c6 ddm -Th6 nhanh - Rtjt 16m ngvc/Rut Bm lien siron
- Ran phoi
15 48 19 13 38
28,8 92,3 36.5 25 73,1 C$nldmsdng
- Tang b9ch cau Neutrophil -Tang CRP - Bat t h u ^ g ti€n X^iuang n g i ^ thing
-C4yMTA(*) - IgM Chlamydia bachomaSs + IgM
Mycoplasma pneumoniae (+) 9 9 52 13 2
17,3 ; 17,3 100 25 3,8 DiSutn
Khang sinh + u6ng + u6ng+tTnh mach
+ pnh mach
62 2 36 14
100 3,8 69.2 26,9 Bat tiiuong tren X-quang nguc chii yeu la hinh anh tham nhiem phe nang 1 hoac 2 ben phoi (90,4%). Co 28,8% tim duoc tac nhan gay b&ih, trong do da so la phe cau (46,7%). TSt ca cac truong hop deu dugc dieu tri ngoai tni truoc nhap vien voi nhieu load khang sinh ducmg ucffig. Trong dot nhap vien nay, 100% tre duoc dieu tri khang sinK Thai gian dieu tri Idiang sinh trung binh la 12,7 + 6,2 ngay, ng3n nhat 5 ngay va dai nhat 36 ngay.
Lao phoi
Co 4 tre ho keo dai duoc chan doan la lao phco.
Bdng2:Dacdi^lamsdngvdt£eutriauitrebilao'^m T4ns6
(n=4) Tile 71eni:an
- Chtfa Chung ngira tao - Tiep »lcngu6n lao
- Dinh dirfng + Suy dinh du&ng dO 1
1 1 1
1/4 1/4 1/4
Chuyen D e S4c Khoe Sinh San - Ba M e Tr4 Em
Y Hoc TP. H o Chi Minh * T | p 20 * So 1 * 2016 N g h i e n ciiu Y hpc
Tri$u c h i ^ g ISm sdng -S6tktedii
-SutcSn - Ho c6 ddm - T h * nhanh - Rijt lom ngi^c/RiJt lorn liSn su^n
- Ran phdi
2 2 3 3 3 3
2/4 2/4 3/4 3/4 3/4 3/4 ClnUlnisikng
-TSngCRP -IDR(t) - BM timing tr€n X,<quang ngi/c thing
' Bit thiwng trgn CT-ngut:
1 1 4 4
1/4 1/4 4/4 4/4 Diiutil
Khang sinh + tinh mach Khang lao
4 1
4/4 1/4 Ca 4 tre d ^ khong tang bach cau Neutrophils, chi 1 tre co tang CRP. IDR duong tinh (22nim) ghi nhan 6 1 tr^. Hinh anh X-quang nguc ghi nhan hinh anh viem phoi a ca 4 truong hpp, trong do co 1 truong hop kem theo tran djch mang phoi va 1 truong hop xep phoi. CT nguc cung ghi nh$n tfin thuong dang viem phoi, CO 2 tre kem theo hach cgnh khi q u ^ va 2 tr^ co viem day mang ph^i CA 4 tre deu duoc chuyen.
benh vi^n Pham Ngoc Thach de dieu trj t i ^ . Hen
C6 4 truong hop ho keo dai dupe chan doan la hen.
Bang 3: Dac dian lam sdng vd dHu tri tre bi hen Tansd
(n=4) T1l§
Ti4ncan -ChdmsOa - Gia fTinh hen - Gia dinh dj i>ng
Tri$u chi>ng ISm s i n - Ho c6 dam -Thd nhanh - Rut 15m ngtiC^Ot 16m li^n sirdn
-Ran phdi
1 1 1
1/4 1/4 1/4 3
4 4 4 4
4/4 4/4 4/4 4/4 C$n Idm sdng
- T3ng b^ch d u Neutn^hit - Tang b^ch cdu Eosinophil
3 3
3/4 3/4 Diiutrj
Khdng sinh +u6ng Khi dung
2 4
2/4 4/4
Ca 4 tniong hop deu tCmg ho kho khe truoc day, CO dap iing voi phun khi dung, 1 truang hop ghi nhan ti&i can cham sua, 1 truang hap co anh ruot bi hen va 1 truong hop co me viem miii di ling. Khong ghi nhan truong hop nao bi suy dinh duong. 2 truong hgp da duoc dieu tri du phong hen nhung tu y ngung tiiuoc, sau khi ngung tre b3t dau ho keo dai. Ca 4 tre deu ho dam ve dem lam tre tiiuK gjac khi dang ngu. Co 3/4 tre co tang bach cau Neutrophils theo tuoi, 1 tre CO bach cau Eosinophils > 4%. Ca 4 truong hop deu CO dap iing vol khi dung dan phe'quan, 2 truong hop ket hop them khang sinh duong ucmg.
BANLUAN
Trong nghien ciiu ciia chung toi chi xac dinh duoc 66,7% nguyen nhan co the gay ho keo dai.
Cac nhom nguyen nhan chiing toi xac dinh duoc la viem phoi, hen, lao, di vat duong ho hap va hoi chiing ho do duong ho hap t r ^ , trong do chiem da so la viem phoi (55,9%), cac nguyen nhan khac nhu hen, lao, di vat duong tha, hoi chiing ho do duong ho hap tren chian ti le thap, ian lugt la 4,3%, 4,3%, 1,1% va 1,1%. Nghien cuu ciia tac gia Zgherea D., Sobhan P, Monita M, va cong su thuc hien nam 2012 cho thay 55,8% tre ho keo dai diroc xac dinh la viem phe'quan mii qua noi soi phe quan'^. Tac gja Marchant JM nghien ciiu 108 tre ho keo dai cho thay 45,4%
nguyen nhan do viem phe" quan keo dai, cac nguyen nhan khac nhu hen, trao nguoc da day thuc quan, hoi chiing ho do duong ho hap tren c h i ^ ti le th%) duoi 10%(^.
Co 33,3% tre ho keo dai trong nghien ciiu cua chiing toi chua xac djnh duoc nguyen nhan.
Da so cac truong hop nay co benh canh nhe, kham lam sang khong ghi nhan bat thuong, bilan nhiem trung am tinh va X qutmg phoi binh thuong. Trong dieu kien hien tai a TP.H6 Chi Minh, chiing toi chua thuc hien duoc xet nghiem theo doi pH thuc quan lien tuc trong 24 gio de chan doan xac dmh benh trao nguoc da day Ihuc quan, khong Ihe thuc hien do chiic nang ho hap
N h i Khoa 39
N g h i e n ciiu Y h p c Y Hpc TP. H 6 Chi M i n h * T a p 20 * S S 1 * 2016 cho tre duoi 6 tuoi hoac do khang tro duong dan
khi cho tre duoi 2 tuoi nen kho xac dinh hen o nhiing tre nay. Ngoai ra, chiing toi ciing khong thuc Men dugc mot so xet nghiem chuyen sau khac nhu nia phe'quan ph^'nang hoac sinh t h i ^ qua noi soi phe quan, bilan mien dich nen vi|c
xac dinh day dii cac nguyen nhan cua ho keo dai Cling gap nhieu kho khan.
Ti^r nghien a i u rwy, chiing toi dua ra so do hep can chgin doan nguyen nhan ho keo dai 6 tr^
em nhu sau:
HO KfeO PAl (> 4 t u i o ) I
Xem xit cAc n ^ y ca, tri^a chung cOa;
- Vi£tn ph^ quAn ph6i ->
cay NTA, huyat thanh chan do&n Chlamytlia trachomatis. Mycoplasma pneumoniae
- Dj vpt duong thd -> n^i soi ph^ qiiAn
- Lao -* IDR, BK djch d?
day/dAm, CT SCBH, hpi chin chuydn khoa.
- Di t^t bim sinh ducme hd hfip -» CT acaii - B^nh tim "^ si^u 3m lim, h$i ch^n cbuy£n khoa
•4 X-quang phAi k"™!- Blah tbudug
Trif u chiLhtg tuOi xoang
K E T L U A N
Ty \% ho keo dai 6 tre em dugc xac djnh nguyen nhan la 66,7% vai 3 nguyen nhan thuang gap la viem phoi, lao phoi va h e n TAI LIEU T H A M K H A O
1 Giad R (2015). Approach to chronic cough m children fiKp •llwuiw. uptodale. com.
2. Grad R (2015). Causes of chronic cough in children.
3 Marchant JM. Brent M, Simone MT, Nancy CC, Greg ]S, Chang AB (2006). Evaluation and Outcome of Young ChUdien With Chronic C o u g h Oiral, 129.1132-1141.
4 Tang SP, Liu YL, L D o r ^ L (2011).EIiok^ical analysis of the children with nMv-qjedfic d u o n i c cough i n Fuzhou area of Fu)ian piovince-Zhon^iM £r Kf Za Thi, 49:103.
5 Z ^ w r c a D, SoWian P, Monita M, et i l (2012). Bronchoscopic findings m children with chronic wet cough. Rnlw(rfo,129364
Ngdy nhdn hai bdo- 12/11/2015 Ngdy phin bien nhdn xet bdi bdo: 16/11/2015 Ngdy bdi bdo duac dang: 20/01/2016
C h u y e n D e Siic K h 6 e S i n h S ^ - Ba M e Tr^ Em
