VIETNAM MEDICAL JOURHAL H°2 • MARCH - 2017 d i u la nhifng b$nh nhi dSng nhiem. Song, nhiem
trOng CMV cd m5i lien quan vdi sir gia tang nguy cd tu' vong, dieu nay cd t h i la chi diem cua m o t can nguyen chuS difdc nhan dang [ 4 ] . Ti l i t!i vong do PJP trong nghien cihj cira chung^toi cao hdn cac nghiin cifu Idiac cd le la do b i n h nhi vao v i i n trong tinh tr?ng suy ho hap n?ng, trong khi I(h4ng sinh dieu tr| PJP la cotrimoxazol d Viet Nam chi c6 dang uong. Theo Graham, S. M. va c$ng s y d Malawi, phan Idn t r i tCr vong d do tu3i 2 den 6 thang va PJP lien quan den 5 7 % tru'dng hdp tiJ vong. Pitcher, R. D. va cdng sti nghien ciJu t r i n 113 trudng hdp n h i l m PJP, thay 5 9 % trudng hdp cd nhiem trung hd hap ^ n g nhiem;
43% tu' vong t ^ i b i n h v i i n . Nghien cu'u cija Morrow B. 1^. cho thay ngiiy cd trf vong d t r i nhilm PJP cao hdn tre i<h6ng nhiem PJP (39,5%
vs. 21,4%; OR 1,85; 9 5 % a, 1,15-2,97; p = 0,01) [ 5 ] . B i i u nay cho thay PJP la rao can chinh trong v i i c giam ty l i trf vong d b i n h nhan viem phoi nSng tai c^c cdng ddng cd djch HIV/AIDS.
Lien qiian den ty le t i f vong crja tCrtig loai virus, vi khuSn, Punpanich W. va cgng sif giii nhan CMV cd mSi l i i n quan ch^t che vdi HIV d c i c benh nhl trf vong do v i i m phoi (OR = 14,4; 9 5 % c i , 6,7-30,8) [ 6 ] . Ket qua n g h i i n cilu cr!ra chring tdi trinh bay d bang 3.7 cho thay rt l i trf d nhdm xet nghiim dutJng tinh vdi vi khuan gram am la 10/42 (23,8%), trong khi d nhdm gram du'dng la 0/11 (0%). NhUv^y, dieu trj can nguyin v i i m phoi do vi khuan gram I m gap nhieu khd khan hdn so vdi dieu trj v i i m phoi do vi khuan gram difdng.
V . Kfr L U $ N
; 13,3% b i n h nhi n h i l m HIV/AIDS mSc v i i m phoi trf vong, trong dd tinh trang suy dinh du'dng va suy hd help lam tSng nguy c d trf vong. Suy hd
hap vdi Sp02 < 8 0 % cd nguy c d try vong cao gap 4,46 lan so vdi nhdm cd Sp02 > 8 0 % (p<0,05)^
- Ty l i trf vong d nhdm PJP cao nhat (62,5%), tiep den la nhdm dong n h i l m vi khuan va virus (18,5%), nhdm virus (8,8%) va vi khuan (8,3%)..l - Trong c^c r a n n g u y i n vi khuan ty i i trf vong g^p chu yeu d nhdm gram am (23,8%).
- 9 5 , 7 % s d b i n h nhan t t f vong d giai doan suy giam mien djch nang, cao gap 8,8 lan' v&
91,2% s d b i n h nhan trf vong cd tai luring HIV >
5000 copies/ml, nguy c d trf vong d nhom nay cao g i p 6,62 lan so vdi nhdm cd tai lUtJng virut du'di 5000 copies/mi.
TAI LI|U THAM KHAO
1 . Vu Thien An ( 2 0 1 3 ) . Mo ta cac tnfdng hdp (]3nci nhiem HIV/Lao tai phong kham ORG b§nh vien Nhi ddng 2 trong giai do^n 2010 ~ 2013. tap chi yhoc thi/c hinh, 889 - 890, 335 - 338.
z. Graham S. M., L, Mankhambo et al. (2011).
Impact of human immunixleficiency virus infecfen on the etiology and outcome of severe pneumonia In Malawlan children. Pediatr tnfedt Os J, 30(1), 33-38.
3. Gray D. M. and H. X Zar (2010). Commijn^
acquired pneumonia in HIV-infected children; a gkibal perspective. Cy/rQo/>jft///77yiferfl6(3), 208-216; j , , 4. Kitchin O. P., R. Masekela e t al. (2012)V Outcome of human immunodeficiency virus' exposed and -infected children admitted to a pediatric intensive care unit for respiratory failure.
Pediatr Crit Care Med.Vil^), 516-519.
5. Morrow B. M., N. Y. Hsaio e t al. (2010).
Pneumocystis pneumonia In South African children with and without human immunodeficiency 'ifus Infection in the era of highly active antlretrcillral therapy Pediatr Infect IXs 3, 29(6), 535-539. *?
6. Punpanich W., M. Groome e t al. (2011).
Systematic review on the etiology and antifiolic treatment of pneumonia in hijman immunodeficiency virus-infected children. Perf/afr Infect Dis J, 30(10), el92-202.
r. WHO (2b'07). Guidelines fyr Treatment cf Pneumonia infected ch/idren under one revision, 29.
NGHIEN CU'U MOI LIEN QUAN GIU'A NONG DO DU'O'NG HUYET
VA M O T S O X E T N G H I E M H O A S I N H 6" BENH NHAN
NHOI MAU c a TIM CAP VAo CAP CU'U
Nguyin Van Chi*
T 6 M T A T . C^t vHn d e : Binh nhan nhoi mau cd tim (NMCT) cap vao cap c ^ cd tang du'dng huyet la rat ttiirdng gIp tai cic khoa cap crJu, nong do du'dng huyet cao ' CO gay tdn thu'dng as tim va tac dpng xau tdi cac chl
* Khoa dp afu A 9, Benh vien Bach Mai so xet nghl§m hda sinh hay khong?. M^c tiSu:
Chju trach nhi?m chinh: Nguyen VIn Chi Nghien ciiU rrioi lien quan giu'a nong do du&ng'hrr^b Email: [email protected] va mpt so xet nghl§m hda sinh ciia berih nh§n N ^ ^ Ngay nhan bai: 28.12.2016 cap \rao cap crjtU. Ooi tu'dng va pliu'dng p h % . . Ngay ph j n bl|n khoa hoc: 13.2.2017 ncjhi6n cifu; 93 BN co tlnh trang du'dng huyi: ( e t t f f l i Ngay duySt bai: 27.2.2017 "'"'= - " ' ' " " " * '^^^ - ^ l O "iQ/di) dutfc phathiq^
180
TAPCHiYHOCVlgTNAMTAP452-THANG3-S62-2017
^ , n h | p vien cap d i l i co dii tieu chuan chifn doan
*|ffer. BN audc XN ^ n h iu^ng nong dd OH tinh mach (TM), va cac xet nghiem hoa sinh, h u y ^ hpc, duttc Ii6i b|nh, thSm Idiam iani sang va lam b^nh an theo mau nghien CU\J, diup danh g i l miJc dd tSn thuWng DMV.
Kit qua: hlong dp DH cua cSc BN trong nghien cult
^ vao vien gap 55,9% d mdc vds (11,1 - 16,6 mnjol/i) va 44,09% d miJc cao (>16,7 mmol/l). Cac xet nghiem hoa sinh: Troponin, CRP, a<-MB, proBNP d mii'c cao. Nong do OH luc nhap vi?n c^ng cao thi nong d§ troponin, O^P, CK-I^B v^ praBNP c6 xu hui5ng cang cao. K a luan: BN NMCT cap JOT nong dg DH luc nh§p v i ^ cao thi cac )a^ ve diu Sn ton thuttng tim cang cao.
Key word: nhoi mau cd tim, di/cfng huyet, troponin, proBNP, CRP.
SUMMARY
f
"RESEARCH CORRELATION BETWEEN LOOD S U G A R L E V E L S A N D SOME TESTS^ A H E N T S B I O C H E M I S T R Y SEIZURES I N _iEMERGENCY SUPPLY
^Patients w/iOi myocandial infarction lyperglycemia is very common in the Sehcy department, hyperglycemia can damage Eeart muscle and cause negative impacts on tiie
^ o r s biochemical tsst Objective: To study the oation, between btood sugar levels and some biochemical tests of acute MI patients in emergency department. Subjects and Methods: 93 acute MI (BtJents with blood glucose level > 11.1 mmol/t (or>200 mg/dl) were treated at Emergency o^artment. Patients were tested glycemia, and biochemical t ^ t s , hematology, asked ptients, physical examination and medical research farm, assessing coronary lesions. Results: The blood sugar level of the patiente at the hospital admission were 55.9% in moderate level (from 11.1 to 16.6 mmol/l) and 44.09% high level (>16,7 mmot/l). Biochemical tests: Troponin, CRP, CK-MB, proBNP high level. The -blood sugar level the higher the concentration of -ibpbnin, CRP, CK-MB arid proBNP tend to increase.
tjConclusion: Acute I^I patients with hyperglycemia had heart damage markers higher.
I.DjBkTVANOE
C^c BN NMCT vao cap CLTU thu'dng gap mpt ty le khSng nh6 co nong do £)H cao, tru'dc d o BN chu^ dddc chan (Joan dai thao du'dng (DTD), tinh tr?ng tSng dddng huyet (DH) cl BN NMCT cap lam viJng ccf tim ton thutJng lan rong do lam g ! ^ tu'di mau dgng mach vanh (DMV), lam tang tiet cathecholamin, nguy cd tang dong, h$u qua , la lam tang nguy cd tu* vong ngay ca khi d3 ducfc ' thiTc hien cac \d/ thuat can thiep DMV hoac lam ' nang UiSm cac di d i i i h g tim mach sau nhoi mau.
Viec nghien culi cac thay doi cua mpt so xet nghiem c^n lam sang d b f nh nhan nhoi mau cd tim cap cd tang du'dng huyet de tiJ* dd cd thai dp xO* tri dung tru'dc tinh trang tang DH d benh nhan NMCT cap la rat can thiet, Hien t a i , cac
nghiSn ciJu ve cac thay doi cCia mpt so xet nghiem can lam sang d benh nhan nhoi mau cd tim (£p CO tang du'dng huyet cdn ft cac nghien cull. Td nhihig h? do trSn, dS t a i : " Nghiin cuti m&
lien quan giuS nong dp di^ng huy& va mot sdxet nghiem hda sinh d binh nhin NMCT tap vao cap cuU"dude thut hien iai Benh vien Badi Mai.
II. {>6l T U V N G V A PHirONG PHAP N G H i i N CI>U 2 . 1 . O o i t U t f n g n g h i e n c(tu'. Nghien culi gom 93 BN cd du tieu chuan nghien ciiU, cd tinh trang TDH mdi du'dc phat hien khi nhap vien cSp ciJu do NMCT cap trong thdi gian nghien ciJli 1/2007 den 5/2010 tai Khoa cap culj va Vien 71m mach Quoc gia B$nh vien Badi Mai.
Cd du tieu chuan c^an doan ting DH:
Benh nhan chu^ duWc chan doan DTD tnidc do.
Ket qua XN nong dp DH iam d thc^ diem nhap vien d mii'c DH > 11,1 mmol/l (hay >200 mg/dl) kh6ng truyen TM dung dich cd d u ^ n g .
Cd dli tiiu diuan chan doan NMCT tap:
Lim sang: dau ngu'c nhu* bdp nghet sau joTdng LTC keo dai trSn 20 phut, khong d d Idii dfing nitroglycerin, cd the kem theo khd t h d , buon non, va mo hoi,.. Dien tam da Xuat hien sdng Q mdi (rpng it nhat 30 ms va sau 0,20 mV) d it nhat 2 chuyen dao trong rac mien chuyen dao sau: D2, D3 va aVF;Vl d§n V6; D l va aVL, hoac xuat hi$n doan ST chSnh len hoac chenh xuong ( > 0,10 mV) d It nhat 2 chuyen dao trong so cac mien chuyen dao ndi tren. HoSc, sif xuat hi$n mdi bloc nhanh trai hoan toan trong benh canh lam sang ndi t r i n . Tang cac men dm. CK-MB tang tren 5%, troponin T tang rao > 0,1 ng/ml. Chan dpan xac djnh NMCT cap khi cd ^ 2 deu diuan
Tieu diuan lo^i tru'! BN da d u ^ c chan doan DTD tur tru'dc. Benh nhan cd mpt b | n h ly npi tiet thupc nhdm benh gay roi loan chuyen hoa glucose nhu' u tuy thu'dng than, hpi chutig Cushing, dang dieu trj cortia)id,... BN cd mpt benh npi khoa nang n h i / suy than man, suy gan, phinh t)dc tach quai dpng mach chu, ton thu'dng phoi nang,... BN du'di 15 tuoi, BN co thai.
2.2. PhUcfng p h a p n g h i & n c i h i Viiet ke nghien cut:: ta nghien cuU m5 ta tien cCfli, khong doi chutig.
Quy hinh nghien cuV: BN du'dc chan doan NMCT clip, du'dc su" t n cap cdu ban dau NMCT cap va du'dc lam mot mau XN djnh lu'dng nong dp duidng huyet tTnh mach (DH TM), ghi nhan cac thong t i n tien su", bdnh suf, tham kham lam sang, Iam cac xet nghiem hda sinh phu hdp va du'dc ghi chep theo doi vao benh an nghien cutJ -
VIETKAM MEDICAL .lOURNAL N'2 • MARCH • 2017
10 den khi kSt thuc nghien ciili. So lieu cua horn BN trong nghien cu'u dddc phan tich cac lay doi bat thuflng trong mot so XN cSn iam ang, dac biet ia XN hoa sinh d cac benh nhan ong nhom nghien cihj.
I. KET QUA NGHIEN CU'U
Nghien ciiu dddc tien hanh tren 93 BN NI»1CT ap CO du tieu chuan nong do DH luc nhap vien 11,1 mmoi/L, chuS du'iJc chan doan BTO trucic 6, CO tuoi trung binh la 64,9±10,2. Hau het BN
•ong nghien cihj c6 dp tuoi tir > 61tuoi.
3.1. Nong dp du'dng huyet khi nhip vien Bing 1. Ndng do DH khi vio' vien cda cac ihdm BN nghien ctfu
CK-MB (UI /I)
M
proBNP Cpmoiyi) CRP (mq/di) Creatinin (umol/i) Choles TP (mmoi/i) Triqlycerit(mmoi/l) HDL (mmoi/i) LDL (mmoi/n HbAlc %
100,53 ± 69,1b 1354,5±919,4
4,56±2,74 103,71±32,B
5,22+2,15 2,31±1,25 1,02±0,25 3,09 ±1,21 7,64±1,32
931
, 9 a *• 9 3 1
%m mu mm 889
88a 90JI Nhan xet Nong dp troponin, Cjgp proBNP, CRP trung binh khi vao vien la kha ca so v(S cac nghien culi khac.
3.3. Lien quan giifa ndng dd 0Hldcnh$
viin va troponin ^
Mii'c SH khi vao vl|n 11,1-16,6 mmoi/i
s 16,7 mmoi/i TSng
So lu'dng 52 41 93
T*IS 55,91i>/o 44,09%
100%
^hin xet: Khong cd sd khac biet nhieu ve mu'c IH lOc nhap vien d mu'c vda (li,l-16,6 mmol/) a mu'c rao (> 16,7).
3.2. Cac dli sff hoa Sinh khi nhip vi$n Bang 2. Cac dac di^m xet nghiem hda sinh
•va cac BN trong nghien cuii /dii nhjp vi$n
^ .^•i^f^^
.Am
A
Tropontn T (nE'nil)
Thdng so
Troponin T (ng/ml) 1,55+1,16 So lu'dng
93
Bleu do l:Tu'dng quan giuci ndng dp DH v troponin T tai thdi diem nhap vien.
Nhin xet: Nong dp du'dng huyet tai thi diem nhap vien cd tu'dng quan ddng bien chE che vdi nong dp troponin T, vdi r = 0,53.
3.4. Moi lien quan giifa nong do dtfdng huyet vi blen chu'ng Bing3. Uen quan giifa nong dd DH va blen chu'ng Mii'c OH khi vao vi^n (mmol/l)
Suy tim sung huyet Soc tim
11,1- 16,6 mmoi/i (n= 52) 27 (51,9%) 8 (15,38%)
>16,7mmoi/i 1
(n=41) P 26 (63,4%) <0,05 15 (28,8%) 1 <0,05 NhfnxetiT)/ ie BN bj suy tim sung huyet va soc tim co xu hu'Sng tang ien theo mu'c do tang 6 I cac BN nghien cihi, co sir khac biit giuS cac mu'c du'cfng huyet, vcli (p>0,05).
V. BAN LUAN
4.1. Dac diim tudi b$nh nhin trong tghiSn ctfu: Tuoi trung binh cua cac Bl^ trong ighien cufu la 64,89+10,22, chu yeu gap 6 iCra uoi > 61 tuoi, tu'dng ttr vdi tuoi cua cac BN rong nghien cihi cua tac gia Nguyen Thj Bach
^en. Tuoi CLia BN trong nghien CLTU cua tic gia wan CC van der Horst ia 62,5 ± 12,6 tuoi;
ighien ciJu cua tac gia Ischa Stranders ia 64,1 :11,9 [3],[6]. ^
4.2. Die diem vSXN hda sinh cua cic BN (mng nghlSn cuti: Nong do OH iuc nhap vien :ua cac BN trong nghien ciju la kha cao do :hung toi chi chon nhung BN Ni»1CT cap co nong io OH iiic nhap vien >11,1 mmol/l va tru'dc do
chuS diTdc chan doan BTO. Mu'c OH luc nha vien tu'dng du'dng vdi mu'c OH trong nghien cO cua tac gia Maimberg. Nong do troponin T, 0 CK-MB, CRP,... trong nghien diu cao hdn ro nghia vdi ket qua cua tac gia Nguyen Thj Tii Hoai, Nguyin Thj Bach Yen, Masaharu [2],[3].
Lien quan giufa nong do DH iuc nhS vien va suy tim sung huyet; Ty ie BN bj si tim sung huyet tang ien theo mu'c nong dp 0 iuc nhap vien d cac nhom BN, moi quan h| ni cho thay xu hu'dng OH cang cao dong nghia v viec ton thu'dng cd tim cang nang ne hdn, k<
qua nay cung phii hdp vdi ket qua nghiln*ci cua Sarah Capes (2002) cung cho thay nguy i suy tim xung huyet, soc tim va nguy cd tu* Vol
TAP CHi Y Hpc VI$T NAM TJJLP 452 - THANG 3 - SO 2 - 2Q17 aia nhutig BN cd tang DH cao gap 3,9 lan so vdi
nhutig_BN_cd du'dng mau thap [ 4 ] .
M m lien q u a n giffa nong do O H va bien chuHg soc t i m : Nhdm BN bi soc tim luc nhap vien nhdm T B H d mu'c vda (11,1-16,6 mmol/) Ihap hdn so vdi nhdm BN luc nhap vien cd DH d mufc cao (>16,7 mmol/l), t y le BN bj soc tim a3 xu hu'dng tang len theo mifc dp tang DH d cac nhdm BN, tang OH lam giam su'c co bdp cd t i m , dan b5i suy d i t f c nang co bdp cua cd t i m . Nghien oil] cua Sarah cung thay tang DH cd nguy cd bi soc tim cao hdn gap 3,1 (an so vdi nhdm khdng
^ n g du'dng h u y ^ [ 4 ] .
Lien quan giu'a nong do Di^ luc n h a p wen va troponin: Ndng dp troponin tang tu'dng quan dong bien chat che vdi ndng dp D H , vdi r=0,53. Troponin la mdt marker sinh hpc dac hieu cao ddi vdi c d t i m , nong dp troponin tang ttfdng uhg v&\ mdc do tmn tiiu'dng cd t i m , DH cao lam cho ndng dp troponin cung tang cao, cung cd nghla la ton thu'dng cd tim cung nang ne hdn. Cd che cua moi quan he DH va troponin chu^ tiiyc su" du'dc ly giai thda dang, nhutig cd nhieu nghien culi de cap den vi^ sir dung insuline de Idem soat DH lam giam ndng dp troponin d benh nhan NMCT cap cd tang D H . V. KET LUAN
Mil lien quan giifd nong dp DH va mot so XN hoa sinh cua cic BN trong nghiin tihi: Cac xet nghiem hoa sinh Troponin, CRP, CK-MB, proBNP d muTc cao. Nong dp DH Idc nhap
vien cang cao thi nong do troponin, CRP, CK-MB va proBNP co xu hudng cang cao.
TAI L l f U T H A M K H A O
1 . Nguyin Thi Dung va CS (2002) - Nhoi mau ai tim cap tai benh vien Viet Tiep Hai Phong tif 01/01/1997 den 30/12/2000. Tap chf tim mach hpc; So 29:248-263.
2. Nguyen Th| Thu Hoai, Nguyen Lan Vi^t, Pham Gia Khai (2006) - Nghien cuti gia tri cua chi so Tei trong danh gia chut nang that trai va du" bao^suy tim u" huyet d cac benh nhan nhoi mau cd tim cap - Tap tri tim madi hoc Viet Nam; So 3 ^ : 15 - 20.
3. Nguyen Thj Bach Yen ra cs (1996) -Tmh hinh benh mach vanh qua 130 intc^g hdp nam vien tai vien Urn mach trong 5 nam (1991-1995} -Tap chi Tim mach hoc; So 8: trang:l-5.
4. Sarah E Capes, Dereck Hunt> Klas Maimberg, Hertzd C Gerstran (2000) - ^ess hypagi^xmia in pad&its mth and without diabetes: a systmnatk:
overview- Lancet; 355: 773 - 778.
5. Otten M Amber , Jan Paul Ottervanger et al (2013) - Age-d^iendent dfff^&Kes in diabetes and acute hyperglycemia between men and vmmen mth ST-elevation myocardial intardkm: a a^iort study- DiabetDlogy & M^abolic Syndrome 2013,5:34 6. I w a n CC van der Horst, Maarten WN Nijsten,
Mathijs Vogelzang and Felix Zijistra (2008) - Peisistent hyperglycemia is an independent predictor of outcome in acute myocardial iniarction-CardiovascuiarDiabetoiogy, 6:2 7. Filip Jasklewicz, Karolina Supel, Wlodzimierz
Koniarek, Marzenna Zlelinska (2014) - Admission hyperglycemia in patients with acute coronary syndrome complicated by cardiogenic shodc- Cardiology Joumai 2014; 1-12.
TINH HINH BENH VONG MAC TRE DE NON TRONG SO T R i Bt NON TAI THANH PHO D A NANG
T O M T A T
:^-L Bfflih vong mac tre de non hiSn nay la moi de doa ..^t i&n den sir m6 Ida cua tre em. Nghien drtj tien ctfu p2d9 baih nhi, hen hanh trong 12 thang td 3/2010 den
"^ 3 ^ 0 l i tai Benh vien Mat Oa Nang dio thay: ty le mac benh chiem 14,35% trong so tre de non d tat ca cac.
giai doan. Tn^ig so tre de non, so ran dieu trj laser vong mac la 2,39%. Can n|ng la mpt yeu to lien quan chat chS doi vdi t)aih: tre c6 can nang t r ^ 1500 Gr
*Benh vien Mat Di NSng
Chju tradi nhiem chinh: Nguyen Quoc E)at Eniail: [email protected] Ngay nhan bai: 13.01.2017 Ngay phan bien khoa hpc: 28.2.2017 Ngay duyet bai: 6.3.2017
Nguyen Quoc D^t*
diJ CO binh (3,82%) cijng khong co ca nao can dieu tri. Ngoai ra kha ning xay ra benh con lien quan den binh toan than ciia me, ngat thd ciia con, nSm Idng ap dai ngay, chuyen m^u... chu* khong chi do mdc dp thieu thang. Reft can Ihiet phai to chu'e kham mat tani soat cho tat ca tre de non, phat hien, dieu trj kip thdi va theo doi lau dai. Can cd ke hoadi tuyen truyen giao dye sau rpng iden thu'c ve su'c khde sinh san cung nhu' su" nguy hiem cua benh i^ vong mac tre de non.
Td" khda: Benh voiig mac tre de non, tre sinh thieu thang.
S U M M A R Y
THE S I T U A T I O N OF RETINOPATHY OF PREMATURITY AMONG THE PREMATURE
DELIVERY C H I L D R E N
