N g h i e n ciiu Y hoc Y Hoc TP. Ho Chi Minh * Tap 20 * So 1 * 2016
KHAO SAT l i LE VIEM DA CO DIA VA CAC YEU T6 LIEN QUAN DEN DO NANG CUA BENH 6 TRE EM Tlf 2 THANG DEN DUOH 5 TUOI
TAI QUAN I THANH P H 6 H 6 CHI MINH
Nguyen Thj HongHuyen*, Pham Thj Minh Hang*
TOMTAT
Dat van de: Viem da ca dja (VDCD) la mot benh ly veda phobiai b tri em. Viec dim dodn s&m vd nhan biei cac ym to lien quan den ti le mdc vd do nang cua VDCD co the giiip tre trdnh cac yeu to lam nang han tinh trang benh vd cai thiin chat luong cuoc sSng.
Muc tieu: Xdc dinh ti le VDCD cua tre em tie 2 thdng deh 5 turn tai quan 1 thanh pho Ho Chi Minh, dac dian lam sdng vd phan loai do nang cua VDCD a tre duoi 5 tuoi vd mm lien quan giiia cac dac diem dich tihgc, lam sdng vai ti le mdc vd do nang cua VDCD.
Phuangphap nghien ciiu: Nghiin aiu (NC) cat ngang.
Kei qua: Tong so 662 tre, turn trung binh 21,5±18,36 thdng; tre gmltrcd 325/337. Ti le mdc VDCD Id 15,3%. Ton thuong chit yeit la mat (81,2%), tay (35,6%), chan (28,7%), than minh (16,8%); cd 2 vi tri:
33/101(32,6%), 3 vj tri (9%), 4 vi tri (3%). Da so tre co him hien do da (77,23%), sung vd son sui (64%), ri nuoc (8,9%), tray xuac do gdi (29,7%), vei lan da (21,8%) vdkhoda (63,4%). 22% tre bi mai ngii, 86% ngiea da ddng ke. Gid tri SCORAD trung hinh deddnh gia do nang Id 18,21±8,16. Da s&VDCD nhe (77,2%), trung Unh (22,8%), khong co truong hap nang. TTiuoc duong am da diing trong 16,8%, Corticoid tai cho (10%), cd 2 (3%).
Tien can binh di Ong ban than vd gia dinh, tiq) xdc Idioi thuoc Id, nuoi thu cung trong nhd (A kha nang lam tang ti le mac VDC!D. Bu me co the lam giam ti le binh. Ton thuang tren 2 vi tri, sang thuong da a tay, chan co lien quan deh VDCD nang.
Kei luan: Ti le mac VDCD a tre tie 2 thdng deh duoi 5 turn tai quan I thanh pho Ho Chi Minh la 15,3%.
Hau Mi tre khong dugc dieu tri toi uu. Tien can di ung cua ban than vd gia dinh; cac ym to moi tnebng (khoi thuoc Id, nuoi thd cung) w the Id yeii to'nguy ca cua VDCD. Bu me co hieu qua bao vi trong VDCD. Tan thuang tren 2 vi tri, sang thuang da a tay, chan, vd dang do da tuang quan co y nghia deh do nang cim VDCD.
Tit khoa: Viem da cadia, thang diem SCORAD, yeu to nguy co.
ABSTRACT
TO INVESTIGATE THE PREVALENCE OF ATOPIC DERMATTUS (AD) AND FACTORS RELATED TO SEVERTTY OF AD IN CHILDREN FROM 2 MONTHS TO 5 YEARS
IN DISTRICT I, HO CHI MINH CTFY
Nguyen Thi Hong Huyen, Pham Thi Minh Hong*Y Hoc TP. Ho Chi Minh * Vol. 20 - No 1 - 2016:18 - 24 Background: Atopic dermatitis (AD) is a common skin condition in children. The early diagnosis in infancy and identifying factors related to the prevalence and severity cfAD can help children to avoid jizctors that make their condition worse and to improve their quality of life.
Objective: To determine the prevalence of AD in children from 2 nwnths to 5 years old in District 1, Ho Chi Minh City, clinical characteristics, classify severity cfAD and the relationship between clinical characteristics and the prevalence and severity of AD.
' Bp mon Nhi, Dai hoc Y Duoc TP.HCM
Tac gia lien lac: BS. Nguyin Thi Hong Huyen DT: 0975455091 Email: ghonghuyen®gmailcom
Y Hoc TP. Ho Chi Minh * T^p 20 * S 5 1 * 2016 Nghien cmi Y hpc
Materials and methods: Cross-sectional study.
Results: There were 662 children with average age 215 (18.6) months enrolled in the study. The prevalence of AD was 15.37o. Lesions on face, hands, legs and trunk were 81.2%, 35.6%, 28.7%, and 16.8%, respectively. At the same time, lesions on 2 positions 3 positions and 4 positions of the body were 32.6%, 9% and 3%, respectively.
The clinical characteristics of AD were redress (77.23%), swelling and crusting (64%), dryness (63.4%), lichenification (29.7%), scratch marks (21.8%) and oozing (8.9%). Itching was the most common symptom of children with AD (86%), and the result was insomnia (22%). The average SCORAD was 18.2 (8.2). There was 77.2% and 22.8% cf children with mild and moderate AD, respectively. There was not any severe case The skin moisturizer, topical steroids and both were used in 16.8%, 10%, and 3%, respectively. The family and personal history of other atopic diseases, secondhand smoking and raising pets were related to the higher prevalence of AD in children. On the contrary, breastfeeding was associated with the lower. The lesions on more than 2 positions, on hands, on legs were related to the severe AD.
Conclusion: The prevalence of AD in children from 2 months to 5 years old in District 1, Ho Chi Minh City was 15.3%. Most children did not get optimal treatment for AD. The history of other atopic diseases, secondhand smoking and raising pets were risks Jnctors for AD. Breastfeeding was a protective factor against the development ofAD.
Keywords: atopic dermatitis, objective SCORAD, risk factor.
DAT VAN DE
Viem da co dia (VDCD) la mot benh ly ve da pho bien 6 tre em, chiem ti le 8,7 dea 18,1 % tre em tren toan the'gioi "^t. Benh thuang khoi phat tnioc 5 tuoi, 60% trong naui dau, 30% trong 5 nam dau va chi 10% kh6i benh tix 6 d&i 20 tuoi.
VDCD la mpt chah doan dua vao lam sang nen neii duoc chan doan som co the giiip cai thien chat luong cuoc song cho tre cimg nhu cha me tre, dSng thoi con giiip tien luong som nhiing tre CO nguy CO bieu hien benh sau nay. Do do, chiing toi thuc hien d^ tai nay nham xac dinh ti le mac, dac diem lam sang; cac yeii to' lien quan deh ti. le mac va miic do nang ciia VDCD 6 tre tCr 2 thang den duoi 5 tuoi
PHl/ONG PHAP NGHIEN CUtl Thiet ke nghien cuu
Nghien ciiu cat ngang.
D£>i hxpng nghien ciiru
Tre duoi 5 tuoi cu tni tai qugn I thanh pho Ho Chi Minh.
Tieu chuan chon mau
Tre < 12 thang: lay tat ca cac tre d a i kham va chich ngua tai 10 tram y te cua 10 phuong 6
quan 1. Tre tir 12 thang deh 5 tuoi: chia thanh 4 nhom theo 4 dp tuoi khac nhau: 12 thang deh duoi 24 thang; 24 thang den duoi 36 thang; tir 36 thang den duoi 48 thang; va t u 48 thang deh duoi 60 thang. Thu thap danh sach 100 tr^
6 moi nhom tuoi. Chia deu 100 tre trong moi nhom cho 10 truong mam non. Tai moi truong mam non, lap danh sach so' tre thuoc timg nhom tuoi. La'y tong s& tre co dugc chia cho 10 de CO khoang each mau. Tien hanh chon mau ngau nhien don theo khoang each da tinh 6 tren theo tung nhom tuoi.
Comlu
Ap dung cong thiic tinh co mau aia nghien cihi cat ngang mo ta:
N=Z2i-./2.p.(l-p)/d2
Voi: a = 0,05 xac xuat sai lam loai I; d = 0,05 sai so;; Zi-3;2 = 1,96, a miic chpn a= 0,05; p =0,3 <'') Vay CO mau N = 323. Vi day la nghien ciiu cong dong nen cd mau duoc chon la 323 x 2 = 646.
Xu ly va phan tich so lieu
Thu thap va xii ly so lieu bang phan mem SPSS 17.0 va EXCEL 2010.
Nhi Khoa
Nghien cuu Y hoc Y Hoc TP. Ho Chi Minh » T§p 20 * So 1 * 2016
KET QUA
Dac diem dan so nghien cihi
Tong so 662 tre. Tuoi trung bmh la 21,5±18,36 thang. Ti le be trai/gai tuong duong nhau. 88,2%
tre duoc bii me.
Tim can di Ong
1,2% tre hi viem miii dj ling; 16% tre kho khe chua dupe chah doan hen; 1,7% tre dupe chah doan hen, 7,5% tre di ling tiiiic an (1,3% di ling tning, 1,8% di ling sua, cac thiic an khac nhu hii san.. chiein 4,4%). Tien can di ling gia dinh (ba me hay chi em mot) c h i ^ 26,9% tre dugic nghien ciiu.
B^c di^ moi inedng song
30,8% tr^ hit khoi thuoc la thu dong, 10,9%
tre CO tiep xiic true tie'p voi v?t nuoi nhu cho, meo... trong nha; 6,8% tre gia dinh co trraig cac loai cay co hoa theo mua.
Dac d i l m VDCD
Co tong cong 101 tre mac VDCD, chiem ti le la 15,3%. Da so tre chi bieii hien ton thuong 6 1 vj tri tren ca the. Trong do, sang thuong chu ye'u o mat, co diiran 81,2%. Mot vai tre, sang thuong bieu hien 6 nhieu vj tri khac nhau, rai rac toan than.
Tinh chat ton thuang VDCD
Bang 1: Dac diem tinh died ton thuang da (n=101) '^-i'- T^oJhifbng v ' - ' \ '
66 da Sl,ng t4y/ s^n sCii
Ri nud'C/ vSy tilt Cdo xuo'c do gai DSy da vd nSp lln da
(lichen il6a) Khd da viing Ididng co t6n
ttiirong
• ' ^ t r t - 78 64 g 30 22 64
tlttCK)
77,23%
63,4%
8,9%
29,7 21,78%
63,4%
22% tre mS't ngu va 86% tr§ co trieu chiing ngiia dang ke duac ghi nh$n.
BgmngVDCB
Gia tri trung binh cua thang diem SCORAD danh gia miic do nang la 18,21+8,16; gia tri Ion nhat la 46 va thap nhal la 6. VDCD nhe
(SCORAD < 25) 78/101 truong hep (77,2%), 23/101 tnitmg hop VDCD trung binh (SCORAD 25 - 50) (22,8%), va khdng co tniimg hgrp nang (SCORAD > 50).
TMi hmh dieu tri VDCD Bang 2.- Tmh Mnh dim tri VDCB (n-lOIJ
Ptiifcng ttii>c didu trj Coilicoid thoa da
Kem di,&ng am Phoi ho'p 2 thuoc Gieu trj Vhkc KhSng di4u tri KhSng r6 dieu trj
T4ns4 10 17 3 7 54 10
Ti l# (%) 10%
16,8%
3%
7%
53%
10%
LiSn quan giu:a d^c diem dich te hpc, lam sang den ti I^ mIc VDCD
Ti le mac VDCD cao nhat 6 nhom ttr 24 - 36 thang 19%, va thap nhS't 6 nhom 12 - 24 thang 12%, khac nhau khong y nghia thong ke. Kha nang mac benh 6 nhom tre dupe bii me thap hon nhom khong bii me voi ti so chenh (OR) la 0,27 (p=0,001).
Lien quan giOa tim can di Ong vd ti 1$ mdc VDCD
Benh ly dj iing ciia tr^ (viem miii di ling, kho khe, hen, hay di ling thiic an) Uen quan co y nghia d&i ti 1| mac VDCD. Tre bi viem miii dj ling CO kha nang VDCD cao gap 9,6 lan so voi tre khong benh. Tre kho khe, hen lan lupft co kha nang VDCD cao gap 9,3 lan; 7 lan so voi nhom con lai. Nhom tie co di lir^ ihiic an kha nang irmc VDCD cao hon 6,23 lan binh thuang. Kha nang VDCD cao gap 6,1 Isui o nhom ghi nhgn hen can b^nh dj l i i ^ gia (Snh (p<i),05).
Liin quan gi^ moi truong song vd ti le mdc VDCD
T i ^ xiic khoi thuoc la; v^t nuoi lam tang kha nang mic VDCD lan lugt gap 4,4 lan; 3,9 lah so voi nhom khong tiep xiic. Trong cay co hoa trong nha lam tang kha nang mac VDCD gap 2 IMI. (P<0,05).
Y Hoc TP. H6 Chi Minh * Tap 20 * So 1 * 2016 Nghien cihi Y hpc
Bdttg 3: Phan tich hoi nguy ca cim VDCB
" " • j ^ M m ••'^
Tien can gia dinh Tiep xiic khoi thuoc IS Tiep xDc vat nuoi TilpxOccSycdhoa
Bu me Vigm miii di Cmg
Hen Khbkh^
Driiiigthi>can
quy logistic da hien cac ym to
|?i», l'.Wt:95%
6,97 3,4 2,51
1,8 0,37 3,407 4,78 3,56 3,013
4,02-12,15 1,95-5,92 1,23-5,15 0,73-4,48 0,18-0,73 0,54-21,7 2,67-8,54 0,72-17,72 1,33-6,8
P
<0,001 0,001 0,012 0,202 0,004 0,19
<0,001 0,12 0,008 Phan tich hoi qui Logistic da bi&i cho thay:
ti&i can benh di ling gia ffinh; tiep xiic khoi thuo'c la, vat nu6i; mac hen, va dj ling thiic an tuong quan co y ngMa thong ke lam tang ti le VDCD. Bii me liun giam nguy co VDCD.
Lien quan dac diem dich te hpc, lam sang den dp n ^ g VDCD
BChong CO su khac nhau ve miic dp nang giiia cac nhom tuoi, gioi tinh. Sua me khong lien quan CO y nghia thong ke len miic do nang ciia VDCD.
(p=0,64).
Lien quan giUa tien can di iing va do nang VDCB
Mac dong Ihoi cac benh ly di ling khac o tre (viem miii di ling; kho khe; hen; di ling thiic an) va tien can benh dj ling gia (£nh khong Hen quan co y nghia deh dp nang ciia VDCD.
Lien quan giOa moi tniong song vd do ndng VDCB
Moi truong song ciia tre tu ngay sau sanh khong lien quan co y ngMa den dp n | n g VDCD, gia tri SCORAD trung binh cung khac nhau khong y nghia giiia cac nhom.
Li&i quan giiia dac diein ton thuong va do n g n g V D C D
Lien quan giUa vj tri ton thuang vd do ng.ng VDCB
Ton thuang da tren 2 vi tri co kha nang nang hon nhom chi 6 1 vi tri, gia tri SCORAD trung
binh ciia 2 nhom nay khac nhau co y nghia thong ke.
Bang 4: Gid tri SCORAD trung binh giiea 2 nhom ton thuong 1 vd nhieU vi tri
Vitri t6nthiKmg
1 »i tri
£2vjtri
G l i Hi SCORAD trung binh
14,53±5,1 22,8±8,9
P"
< 0,001
*PhepkiimT
Lien qimn giOa vi tri ton thuang vd do nang VDCD
Bang 5: Gid tri SCORAD trung binh cua c^c vitri ton thuang
VI tn tSnthuvng
Mat Tay Chan Tlian minh
Gii trj SCORAD trung blnli
17,67±7,8 21,82±9,64 24,96±9,05 23,34±8,64
P' 0,168
< 0,001
< 0,001 0,008
*Phipki^T
Ton thuang a tay (tiiuong a k h u ^ tay), va chan (thuang 6 goi) lam tang nguy ca VDCD nang so voi nhom khong co sang thuong vi tri nay, tuong quan nay co y nghia thong ke.
Liin quan giUa tinh chdi t6n thuang da vd dd nang cua VDCB
Bang 6. Gid tri SCORAD trung binh ciia cdc vi tri ton thucmg
ViW tdnthmmg
Do da Simg Ri nu'oc Vetxm^dog§i
Daydayianda KhOda
Qia tri SCORAD trung binh 18.58±8,04 19,41±8,42 22,69±8,38 24,36±9,1 23,88±10,63
19,5*8,03 P*
0,167 0,02 0,072
< 0,001
< 0,001 0,12 Simg tay da, nhieu vet xuoc do gai, day da/lMn da co Uen quan den dp nang ciia VDCD.
BAN LUAN
Trong nghien ciiu, co 262 tr^ trong dp tuoi ttr 2 thing d&i dual 12 thang (39,6% dan so'nghien ciiu), va 100 tre cho tung nhom tuoi 12 thang d a i duoi 24 thang; 24 thang d&i duoi 36 thang; tii 36 thang deh duoi 48 thang; va tu" 48 tiiang deh
Nhi Khoa
Nghien cuu Y hpc Y Hpc TP. H6 Chi Minh * Tap 20 * Sg 1 * 2016
duoi 60 thang. Sa di co su li;i:a chpn khac nhau vay vi Iheo ghi nhan ciia y van, VDCD thuong khoi phat som: 45% tre khoi phat trong vong 6 thang dau sau sanh, 60% trong 1 nam dau tien ciia cuoc s6hg(*'. Nhieu nghien ciiu co ket qua tuong tLf, nhu nghien ciiu PASTURE tai 5 vimg nong thon 6 Chau Au (2012) ti le khai benh truoc 12 tiiang la 59,8%, voi ti le mac VDCD chung la 27,1%^. O Vi?t Nam, Le Minh Huong va CS (2012) ghi nhan ti le mac VDCD a tre nhu nhi la 26,6%<i'**. Vi vay, chiing toi uu tien lua chon ire trong dp tu5i nhu nhi (2-12 thang) voi so' lugng nhieu han cac nhom tuoi khac. Trong nghi&i ciiu, ti le tre trai/gai gan bang 1, ke't qua nay phii hop voi y van va cac nghien ciiu ciia nhom COPSAC tai Dan Mach (2010), Jin-Ok Baek tai Han Quoc (2013), va Le Tlu Minh Huong tai Ha NpiP'"").
E>ua tren tieu chuan chah doan ciia Vuong Quoc Anh, ti le mac VDCD trong dan so nghien ciiu ciia chung toi la 15,3%. Theo y van, ti le VDCD gan day la 8,7 deh 18,1% tre em tren toan the giai, thay doi tuy theo quo'c gja va khu vuc.
Tai chau A, tiieo Jin-Ok Baek (2013) ti le VDCD 6 duoi 6 tuoi la 18%i^. Tai Viet Nam, tiieo nghien cihi ciia tac gia Le Minh Huang (2012) ti le VDCD duoc chah doan d tre nhu nhi la 26,6%"'^.
Qua nghien ciiu, VDCD thuang gap nhieu nhat d mat voi 82 truong hpp (81,2%), nhieu truong hpp ton thuong tren nhieu vi tri khac nhau. Ke't qua nay phii hpp voi nghien ciiu cua Sheelagh (2001) va Almira (2010)W. Da so cac ton thuong da dugc ghi nhan liic kham la bieu hien sang thuong cap tinh voi do da (77,23%), sung tay/ sIm siii, mpt so ri dich tai vimg ton thuong. Qua nghien ciiu, 78/101 (77%) tre ngiia da anh huong d&i sinh hoeit, 22/101 (22%) tire co bieu hien mat ngii.
Danh gia dp nang VDCD d\ra tren thang diem SCORAD, 78/101 tnxan^ hpp (77,2%) la VDCD nhe; va 23/101 tiiiong hpp (22,8%) la VDCD trung binh, khong co truong hop nang.
Ket qua nay phu hpp vol tac gia Carsten Flohr (2014), 85,7% VDCD nhe va 14,3% VDCD miic
tiimg binh - nang; Sugiura H (1998), VDCD nhe chiem 86,1%, VDCD mife trung binh - nang chiein 13,9%"'«. Nhung kei qua nay Igi thap hon ciia tac gia Aygegul Akan (2014), 23,4% la VDCD nhe; 59,1% trung binh, va 17,6% nquig; su khac nhau nay do dupe tien hanh tren doi tugng tre da chem doan VDCD kham tai phong kham chuyen khoa Dj ling, nen ti le tre VDCD nang se cao hon<". Hon nua, phan loai dp nang theo thang diem SCORAD cung con n h i ^ tranh cai.
Nhung gem day nhat thong nhat phan loai SCORAD nhu trong nghien a i u cua chiing toio^.
Trong 101 truong hop VDCD, 17 truang hpp dupe dieu tri bang kem duong am; 10 truong hop six dung Corticoid tai cho; 3 truong hpp dieu tri ket hpp; va c6 d&i 71 truang hop, ke ca trong VDCD miic dp trung - nang khong duoc dieu tri, ket qua nay khong phu hop vol phac do ciia vien Han Lam ChSu Au ve cac benh di ling va mi&i djch lam sang; cho thay van con su thieu thong nhat trong kehoach dieu tri VDCD, lam cho viec dieu tri thuoc cham tre, anh huong deh su phuc hoi ciia da ciing nhu chat lupng cuoc song ciia tre.
Kha nang mac benh ciia nhom tre khong dupe bii me cao han nhom dupe bii me, phu hpp voi nghien ciiu ciia Jin-Ok Baek (2013) va Le Thi Minh Huong (2014)<'"». Tuy nhien. Sun Hee Choi (2012) thay khong khac nhau giiia bii me va nguy co VDCD ciia tre duoi 2 tuoi tai Han Quoc'^'.
TiCTi can mac hoi, viem miii di iing va di ling thiic an tuong quan co y nghia, lam tang ti le VDCD. Nghien cuu ciia Lise Stensen (2008) va Jin-Ok Baek (2013) cung cho ket qua tuong tuP*.
Phil hpp voi y van: VDCD, hen va viem miii di ling gop chung thanh bp 3 cimg caii thanh n&i
"tang di iing". Eichenfield (2003) ghi nh|in co 80% tre VDCD phat tri&i thanh hen va viem miii di ling*^*'. Cac nghien ciiu ve dich te hoc cho thay moi lien quan giiia VDCD va cac benh ly di iing khac ciia tre nhu hen va viem miii di iing voi ti so' chenh (OR) thay doi tii 1,17 o cac nuoc dang phat trien d s i 2,69 6 cac nuoc cong nghiep
Y Hpc TP. H o Chi M i n h » T a p 20 * So 1 * 2016 N g h i e n cuu Y hpc hoa'"). Tien can gia dinh anh huong co y nghia
dffli ti le mac VDCD. That vay, y van ghi nhan 60% bo hay me VDCD co con cai mSc benh tuong tu, neii ca hai deu benh co deh 80% con mac benh*^^. Nhieu nghien a i u d chSu A lan chau Au cung co ket qua tuong tu^"). Tuy nhien, chiing toi khong tiie xac dinh chinh xac dupe tinh trang dot bim hen quan. Do chinh la han che ciia de tai nay.
Tiq) xiic khoi thuoc la, vgt nuoi, trraig cay co hoa lien quan co y nghia deh ti le mac VDCD.
Ket quel kha phii hpp voi Jin-Ok Baek (2013) va Le Thi Minh Huong (2014)ai'». Do do, c ^ tgo yeu to moi truang la mpt p l w i quan trong de phong ngira, giam ti le VDCD 6 tre.
Tien can benh ly di iing ciia ban than hay gia dinh deu Hen quan khong y nghia d&i miic dp nang cua VDCD. Nhieu nghien ciiu khac ciing khSng tim thay lien quan''-*'. Tuy nhien, qua cac nghien ciiu dich te hpc, mac d6ng thai cac benh ly di iing khac (hen, viem miii di ixng) dupe xem la mot trong cac yeii to anh huong, giiip tien doan dp nang ciia VDCD(i5i. Theo Ben-Gashu (2004), song a thanh thi, mac hen va viem miii di iing a tre em la nhung yeu tcT nguy co ciia VDCD nang(*'. So di co su khac nhau vi chiing toi khong the tie'p tuc theo doi tre trong th6i gian dai de danh gia chinh xac nguy co. Tien can benh li di iing gia ffinh khong hen quan d&i miic dp nang VDCD.
Cac yeii to' moi truong s6hg anh huong khong y nghia den miic dp nang cua VDCD. K S qua nay phu hop voi Ricci (2006) va Ay§egul Akan (2014)i"'i3). Theo Langan (2009), nuoi tiiii cung trong nha co the dong vai tro true tie'p lam xaii di miic dp nang ciia VDCD vol OR = 0,22 (0,10-0,34)''). Nhin chung, yeu to moi truong duong nhu tuong quan khong y nghia deh dp nang ciia VDCD.
Chiing toi nhan thay ton thuong da tir 2 vi tri tro len; ton thuang tap trung 6 tay va chan Uen quan den dp nang ciia VDCD. Theo ghi
nhan ciia y van, ton thuong 6 goi va khuyu tay a tre em co anh huong co y nghia len miic d6 nang cua b?nh . Sung tSy da, co nhieu vet xuoc do gai, day da/lan da co Uen quan deh d6 n | n g ciia VDCD. Phii hpp voi Cosickic A (2010), do da, sung tay, kho da va day da/lSn da Uen quan co y nghia deh miic dp nang VDCD va tong diem SCORADf^.
KETLUAN
Qua nghien ciiu, chiing toi nhan thay VDCD la mfit benh kha pho bi^h chiem ti le kha cao la 15,3%. VDCD miic dp trung binh chiem ti le cao, nhung chi CO 17% tre duoc dieu trj thuoc dac trj.
Tien can di iing ban than va gia dinh; tiep xuc voi khoi thuo'c la, phan hoa; va nuoi thii cung co U&\ quan, lam gia tang ti le mac VDCD. Tre bii me CO ti le mac VDCD ttiSp hon. Tioi can di iing ban tMn va gia iSnh; tie'p xiic voi khoi thuoc la, phan hoa; va nuoi thii cung; duoc bii siia me hay khong deu khong Uen quan d a i dp nang ciia VDCD. Nhiing ton thuong tren 2 vi tri tren co ttie; ^ n thuang ^ p trung o da tay va chan co ti 1&
VDCD nang - trung binh cao han. Nen thuc hien nghien ciiu voi thiet k&'nghien ciiu doan he tim ciiu chat che hon de co the ket luan chinh xac v^
cac yeu to ti&n lupng nang trong VDCD.
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Ngdy nhan bai bao: 12/11/2015 Ngdy phan biin nhan xit bdi bdo: 16/11/2015 Ngdy bdi bdo dugc dang: 10101/2016
