5. Nguydn DSng Tuan (2004), Md hinh ehd'n thuang vd gdnh ndng bdnh tdt t^i mdt s6 ca sd y ti huydn Dd Luang ndm 2003 Luan vdn chuydn khoa I - Y td cdng cong -Trudng Dai hpc Y td cdng cdng.
6. Jacobs G, Aeron-Thomas A vd Astrop (2000), Estimating global road fatalities, Crowthorne, Transport Research Laboratory, 2000.
7 World health Organization (2008), Regional report on status of road safety the South - East Asia Region, chapter 3. p. 14.
8. World Health Organization (2013), Global status report on road safety 2013, vww.who.int/entitv/qho/road safetv/mortalitv/en/ access date 05/7/2013.
OAC DIEM L A M S A N G . CAN L A M S A N G VANG DA TRE $ 0 SINH NON THANG TAI BENH VIEN DA KHOA TRUNG lATNG THAI NGUYEN
NGUYEN
NGUYIN NGUYIN
TOM T A T
Bdn canh nhdng hdi chdng Idn nhu Suy hd hip sd sinh, Nhiim trung sa sinh thi Vang da so sinh Id mdt hdi chdng thudng gdp tmng thuc hdnh nhi khoa hdng ngay. Bdnh nhdn can duge chdn dodn vd diiu tn dimg di tranh cho tre bi de doa tinh mang hodc sdng vdi di chdng thdn kmh ndng ni. Di tim hiiu ddc diim Idm sang can Idm sang sa sinh non thdng vang da tdng bilirubin tu do. ChUng tdi tiin hdnh nghidn eifu trdn 310 Ire so smh non thang vdng da dHu tri tai khoa nhi bdnh vien da khoa trung uang Thdi Nguydn theo phuang phdp md ti cit ngang. Kit qua cho thiy da sd vang da xuit hien 49-72 gid sau sinh, vang da dugc phat hien khi tre vang den vung 3, viing 4, van cdn nhdng tri dugc phdt hidn vang da mudn khi da cd biiu hidn tridu chdng tin thuong nao, cd mdi tUOng quan thuan gida mUc do vang da tren Idm sang vd bilimbin mdu tu do.
Vang da chQ yiu xay ra d tre cd me mang nhdm mau 0, con mang nhdm mau B, tri cdng non can ndng cang thip cd mifc bilirubin mdu cang thd'p, tre cd biiu hien ton thuang nao khi bilirubin todn phan tmng binh 261.75 ±100.8. bilimbm GT tmng binh 247.72±95.79.
Co 37.1%o khdng ed yiu td ddi khdng nhdm mau me con hd ABO, 99.6% tre vang da cd suy hd hap sau di, 40.4%o tre vang da ehua tim thay nguydn nhdn, 22.6%, cd yiu Id doi khdng nhdm mau me con hd ABO, 17.1%, me va ndi trdn 6 gid, ch! cd 6.5%, co me dung thuoc kich smh (Oxytocin). Cdn 13.3%, tre vdng da dugc danh gia mdc dd vang da trdn Idm sang khdng tuang xdng vdi mdc bilirubin d cung mdt thdi diim. O nhdm tri dudi 35 tuin cd tin si giim protein mau eung nhU albumin nhiiu han nhdm tri td 35 tuan den dudi 37 tuan.
Tdkhda: vang da so sinh.
SUMMARY
Besides the major syndromes such as neonatal respiratory distress, neonatal infections, the newborn Jaundice is a common syndrome in pediatnc practice daily. Patients should be diagnosed and treated properly to avoid children with life-threatening or life with severe neurological sequelae To explore the clinical charactenstics subclinical premature newborn jaundice hyperbilirubinemia freedom. We conducted a
THj MAI - Bi^nh vi^n da khoa tinh San La V A N S O N - Trudng Dai hpc Y Dupc Thdi Nguyen Vi$7 HUNG - Cyc Quan lyKCB
study on 310 preterm newborn jaundice treated at pediatric hospitals in the state central cmss-sectional descriptive methods. The results showed that the majority of jaundice appear 49-72 hours after birth, jaundice is detected when the golden child 3, the 4, sftf/
young jaundice is detected late when symptoms had damage brain injury, with a positive con-elation bebfl/een the degree of clinical jaundice and hyperbilirubinemia freedom. Jaundice occurs mainly in children whose mothers take 0 blood group, blood type B child bearing, children as young as lower weight, lower blood bilirubin levels, children show signs of brain damage when bilirubin average 261.75 + 100.8, indirect biiimbin average 247.72 ± 95.79. 37.1%
have no countervailing factors mother ABO blood group. 99.6%o of children with jaundice after birth wrf/i respiratory distress, jaundice 40.4% of children had not found the cause. 22.6%, had blood group factor antagonists mother ABO, down 17.1 %o mom amniotic leak in 6 hours, only 6.5% have used drugs fc/rf/i mother (oxytocin). And 13.3% of children were jaundiced assessment of clinical jaundice with a bilimbin is not proportionate at the same time. In infants less than 35 weeks may reduce the frequency of blood proteins albumin and more children aged 35 weeks to less than 37 weeks.
Keywords: newborn Jaundice.
D A T VAN oi
Vang da d tre sO sinh (VDSS) la hien tuong sinh ly xay ra d phan Idn tre sd sinh lien quan tdi ddc diem ve ehuyen hda bilimbin trong cd the tre d nhijng ngdy dau sau sinh. Vang da duoc xem la binh thudng khi d ti'd dO thdng cd bilinjbin <14,8 mg% va d tre thieu thang
<10mg%, vdi dieu kidn' tre bii tdt, nude tieu vdng, ia phan vang 2-3 lan/ngay. Tai Khoa nhi BVDKTUTN trong 5 nam 2001-2005VDTBILTD30% d tre dii thang vd 36.75% tre de non [8] vd Bao Mmh Tuyet nghien cifu ndm 2009 ty le vang da tdng Bilimbin TD d tre 6e non la 67,9% trong tdng sd so sinh vdng da. Theo Nguydn Thi Xuan Huong va cdng sU trong 3 ndm tif 2008 - 2010 tai Khoa nhi BVDKTUTN t j Id tre sd sinh non thang la 53,6% trong do cd 20,3% bi vang da [71,
Y HOC THirc HANH (879) - S6 9/2013
nghien cifU d bdnh vien nhi TU (2005) ciia Khu Thi Khanh Dung Vang da tang bilirubin TD d tre de non chidm 63,57% trong tdng sd so sinh vdng da, Nguydn Qujnh Nga tre de non vdng da benh ly chidm 67,8%.
Vang da nhan nao Id mot trong sdu nguyen nhan hdng dau gdy tLJ- vong d tre so sinh [2],[12] d BVDKTLT Thai Nguyen ndm 2009 cd 38,8% tre sd sinh vao vien vi vang da tang bilirubin tu do, trong dd cd 3,1% tre phai dieu trj thay mau va 9,2% tre tCf vong hoac didn bidn ndng xin_ve[8I Vang da so sinh .benh ly tuy thudng gdp nhung dd bj bo qua, mpt sd trijdng hdp khi phdt hidn dd qua mudn vi cd the didn bidn tir vang da tdng bilirubin tu do nang sang giai doan vang nhdn nao thudng xay ra rat nhanh vd phite tap cd khi chi trong vdng vdi gid [3], [4]. Vide nghien cifu vang da benh ly sd smh non thang la hd't sife cdn thie't. Nham gdp phan ndng cao hieu qua didu tn han chd bien chimg vang da nhan va t j Id td vong sd smh chiing tdi tidn hanh nghien ciili de tai "Nghien cifu dac diem lam sdng, can Idm sdng va ede yeu td lien quan den vdng da d tre so sinh non thang tat Benh vien da khoa tmng uong Thai Nguyen" vdi muc tieu. Md ta ddc diem lam sdng can Idm sdng cCia vang da do tdng bilimbin tu do d tre so sinh non thang tai benh vien da khoa trung uong Thai Nguyen ndm 2012.
fid'l T U O N G V A PHl/ONG PHAP NGHIEN CUU Odi tupng nghien ciifu: Tre so sinh non thdng (dudi 37 tuan) bang hodc dudi 28 ngdy tudi bi vang da do tang Bilimbin gian tiep, bilirubin toan phan trong mau tren 7mg%
Phuong phap nghien cihj: Nghien eifu md ta cat ngang.
KET QUA^NGHI^N CLfU 1. B i c diem (am sang.
Bang 1. Thdi diem xuat hien vang da Thcrt Mm xua( hign vanq da (GitJ)
Dua 24 TCf24den48 Tif49(len72 Tren 72 Khdrtqrathcrtdigm
Z
N 10 68 120 112 0 310
T J I 6 % 32 21.9 387 36.1 0 100 Nhan xet P h a n Idn tre x u a t h i e n v a n g d a tU 4 9 den 72 gid c h i e m t y l e 3 8 . 7 % .
B a n g 2 : T h d i d i e m x u a t h i e n v a n g d a t h e o c a n nang:
can nang (gram) D i « 1500
Taisooa*
dmji2000 TiI2000aen
dua 2500 I N
Thffl di^m xuat hifin v^nq da
<24 N(%) 0(0) 6 (1.9)
4 (1.3)
10 (3.2)
Til 2448 N(%) 119(3 5)
22 (7.1)
35 (11.3)
68 (21.9)
Ti/49-72 N(%) 10(32) 51 (16 5)
59 (19) 120 (38 7)
qi«)
>72 N(%) 8(26) 38 (12 3)
66 (21.3)
112 (36.1)
P
015
N h d n x e t ; K e t q u a b a n g 2 c h o t h a y k h o n g c d s U khac bidt c d ^ nghTa t h d n g k d ( p > 0 , 0 5 ) giu'a c a c n h d m can n d n g v d t h d i d i e m xua't h i e n v a n g d a .
Bleu do 1: Thdi diem xuat hiSn vang da theo tu^l N h a n x e t , K d t q u a b i e u d d 1 e h o t h a y d a s d t r e v a n g d a xua't h i e n d t h d i d i e m 4 9 d e n 7 2 g i d , n h i e u n h a t la d tre 3 2 d e n d u d i 35 t u a n , it n h a t d t r e d u d i 3 2 t u a n .
B a n g 3. N d n g d p b i l i r u b i n t m n g b i n h t h e o v i i n g v a n g d a k h i d u p c p h a t h i e n ( t h e o K r a m e r )
vong 1 2 3 4 b X P
n 3 41 204 59
3 310
%
1 132 6b.a 19 1 100
Bilirubin trunq binti (umqM) TqSn ph^n
40 2± 25.9 207.56±58.6 233.7t 58.52 279 64± 72.93 511.47+64.89 239 81± 72.76
<0 05 GiSn figp 31+22.3 187 64± 65.93 217.31+59 69 264 93+7113 486±71.08 223 25+73.76
<005 TnlctiSp 8.83+4 14 21.21+30.66 14.22+1197 14 58+5.82 25 27+7.65 1527±15.15
>005 N h d n x e t K e t q u a b a n g 3 c h o t h a y d a s o v a n g d a duOc p h a t h i e n k h i v d n g v i i n g 3 e h i e m 6 5 . 8 % t u o n g d u o n g m i r e b i l i r u b i n T P t m n g b i n h 2 3 3 . 7 ± 5 8 . 5 2 M p t s d rat it p h d t h i e n d v i i n g 1 v d v i m g 5 c h i e m 1 % .
6 0 0 1 5 0 0 4 0 0 - 3 0 0 2 0 0
0
if'
v i i n g v a n g d a
y ^ 4 . 0 8 X + 5 7 . 8 7 ,
--- "•— I
• __ R ' = 0 2 1 l !
Bieu do 2. TuVng quan giiia viing vang da va bilimbin mau gian tiep
N h a n xet* C d s u t u o n g q u a n t h u a n m i f e d o vUa giu'a v i i n g v d n g d a t r e n l a m s a n g v a n d n g d o bilirubin m a u g i a n tiep t m n g b i n h ( R O . 4 2 6 ) .
B a n g 4 B i e u h i e n t h a n k m h v a m i f c b i l i m b i n t U d n g i f n g .
Tn6u chOng
hiSn than Itintl (c6 vang da ntian)
Co Libi
R6i loan ntiip thd Giam phan
imqbo Con ttm Tai
n 3 5 10 2
%
1 1.6 32 0.6
bllTPTB (umol/!) 26413±
107.8 212.78±
383 215.15t
38.3 272 95±
78 bllGTTB (^imoifl) 205+
1.057 199.38+
28.7 203 33+
5473 257.9±
83 P 0.00 2
VHOCTHlJC HANH (879) - S6 9/2013
Tang tniong li;o conh?
Ll bi vi giSm Ph^n Unq bO Ll bl vi con Wm
Ul Gidm phSn i:mg
buvaRLNT Giam phan Ung bU va con Km tai RLNT va con tim
lai Glim PLf bu.tangTLco,
con tim lai Libi.mStPLfbi,
PINT, con ttm lai. Tang Tl co
nhe
z
2 1 1 1 2 3 1
1
32 0.6 0.3 0.3 0,3 0.6 1
0.3
0.3
10.3 351.5±
65.8 180.3 183 3 412.1 374 4 t 1.074 205.03t
75.86 475.2
5044
261.75±
100 8 333 1±
59.68 174.6 169.7 398.8 352.15±
90.72 194 53±
7258 4313
483.3
247.12i 9579
Su tuong ximg vijng VDva bit cunq thcfl dilm
KhOng tuong xUng
Vung vang da
>mUc bit Vung vang
da
<miic bit Tuonq xUnq Nha n x e t : T r
••
21
20 269 )na?
%
6.8
6.5 86.8
mir
Diautr Co N(%) 16(5.2)
18(58) 234(75.5)
vanq da KliOngN(%)
5(16)
2(0.6) 35(113) CO 41(13.3
P
0.338
%1 tre khdng tuong xifng gQ'a vung vdng da va xet nghiem bilirubin d ciing thdi diem.
Bang 6 Tan xuat eae nguyen nhdn hay yeu td benh ly gay vang da theo tudi
~~~^-Jaj^ai (tuan) Cacy^ul6cBiflti~-~^_
KhOng c6 ylu td a« khang Nti« ABO
me-con 06 ySutSdS khang
NM ABO me-con KhOngrd nguyen nhan (chua iam duoc xn nhom mau me con) Tre CO suy ha hap
saud^
MedungthuiK oxytoxin Me v9 n 61 Iran 6 gio
<32 N(%) 21 (6.8)
9(2.9)
21 (6 8) 39 (18 7) 0(0) 8(26)
32-<35 N(%) 62 (20)
32(104)
48(15.5) 105 (50.3) 10 (3 2) 29 (9.4)
35-<37 N(%) 32 (10.3) 29 (9.3)
56(181) 64 (30.6) 10(3.2) 16 (5.2)
a%)
115(37.1) 70 (22.6)
125 (40.4) 208 (99.6) 20(65) 53(17.1) Nhan xet' Ket qua bang 6 cho thay tan xuat vang da vi yeu td ehinh d tre td 32 ddn dUdi 35 tuan la cao nhat, d tre dudi 32 tuan la thd'p nhd't. Tre vang da cd
suy hd hdp sau de cd tan xudt cao nhat (99.6%), tiep theo Id tre vdng da ehua tim thdy nguyen nhan (40.4%), khdng ed ydu td ddi khang me con he ABO (37.1%). cd ydu td ddi khang nhdm mau me con he ABO (22.6%), me vd ri di tren 6 gid (17,1%), cudi ciing Id me dung thude kfch sinh (Oxytocin) 6.5%.
2. Ode diem can lam sdng.
Bang 7. Ddc diem nhdm mdu con he ABO:
Nhan xet- Cd 32 (10,3%) tre cd bidu hidn trieu chifng thdn kinh, ed sU khde bidt cd •j/ nghTa thd'ng ke (P=0,002 <0.05) giLfa ede nhdm cd tndu ehirng ton thuong than kmh ve mifc dd bilirubin TP trung binh va bilirubinGT trung binh.
Bang 5. TUdng xifng giita vung vang da va mifc dd bilimbin.
Nhbm Mau ha ABO cOa con B A AB 0 X
N 86 41 8 53 188
Tylc%
4574 2181 4.25 282 100 NhSn xet' Ph^n Idn tre vang da non thang co nhom mau B (45.74%), it nhat 1^ tre co nhom mau AB chiem 4.25%
Bang 8. Oac diem nhom mau me he ABO.
Nh6m Mau ha ABO cija me B A AB 0
z
N 77 59 14 113 263
Tjl6%
2927 2243 5.32 42.97 100 N h d n x e t : P h a n Idn m e e d a t r e n o n t h a n g vdng da c d n h d m m d u O e h i e m 4 2 . 9 7 % , it nhd't la m e c d nhom m a u A B .
B a n g 9 M i f c d d b i h m b i n t m n g b i n h l u c tiiidc dieu tri v a n g d a c i j a t r e t h e o c d n n a n g .
Trong luong(gram)
<1500 1500-<2000 2000-<250O
S P
29 117 164 310
MUc dfl bilimbin tnjnq binh(mmolil) TP
208 44±
67086 239.141
65.069 252.25±
76.495 239.81±
72.76
< 0 0 5 TT 126651
4.069 162368+
16.1 15041±
15.66 1527115.16
> 0 0 5 GT 195.771 65.415 21292+
66.771 235471 77.76 223.251
73.77
<0.05 N h a n x e t K e t q u a b a n g 9 c h o t h a y c o s i t l<hac tJiet CO ^ nghTa t h o n g ke ( P < 0 . 0 5 ) v e mCfc d o bilinjbin giiia c a c n h o m c a n n S n g C a n n S n g c a n g c a o thi bilirubin c a n g I d n .
B a n g 1 0 . M i l t d o b i l i t u b i n t t u n g b i n h i i j c trtldc dieu t n v a n g d a t h e o t u o i t h a i
Tufli thai (tuan)
MUc da bilinjbin liung binhtmmoM) TP
21589165.17 202316335 GT
234.741 74.68 223.251
73.77 TT 15831 18.21 15,331 •
18i1 15.27ir.
15,16.1
<0.05l Nhan xet: Ket qua cho thay c6 sit lihac biet c6, nghia thong ke p<0.05) ve mi:fc do biliixjbin giDa nh6i duOi 32 tuan tuoi va nhom tCr 35 den dudi 37 tuan tlid TUOI thai cang cao thi bilinjbin cang Idn. i
Y H O C T H l J C H A N H ( 8 7 9 ) . s d 9/200
B a n q 1 1 : P h a n b 6 c § n l a m Tudi thai (luSn)
oacdi^m NSng dfl Hb
<14!i/dl Dudng huy^l
<400mgil PratemTP huyet<48(g/l) BilimblnGT(TB)
(mmolil) Albumin huyfit
<30qil PT<70%
Du0i32 n 16 17 29 51 27 42
5.2
%
55 9.4 202 3 1
6335 8.7 13.5
s ^ n g t h e o t u o i t h a i TU 32-35 n 39 65 43 142 41 99
126
%
21 139 221.31 75.12 13.2 31.9
T i t 3 5 - < 3 7 n 24 48 18 117
7.7
%
15.5
5.8 2341 74.67 24 1 7.7 85 1 274
P 0.253
0.294
0.0 0 029 00 0.219 N h d n x e t : k e t q u a c u a b a n g 1 1 e h o thd'y t q n x u a t v a n g d a c d p r o t e i n T P d u d i 4 8 g/1, a l b u m i n huye't dUdi 3 0 g / l , m i f c b i l i r u b i n G T t r u n g b i n h d c d c t u d i t h a i Id khae n h a u .
B A N L U A N
1 . B a n l u a n v e d a c d i e m l a m s a n g - Thdi diem xua't hien vdng da tmng binh theo tuoi*
Oa phan tre xuat hien vang da d thdi diem 49 den 72 gid chiem 38.7%. thdi diem xua't hienvdng da sdm tnide 49 gid da phan tre ed bdnh nhiem khuan kem theo tnJdc khi vdng da va tre ed suy hd hap kem theo ket qua nay phii hdp vdi nghien cifU ciia Nguydn Th[
Tlianh, Tran Thi Hai Vdn [9],[11] .Thdi diem vdng da d ca 3 nhdm tudi de non la tUdng duong nhau
- Ndng dd bilimbin tmng binh theo mifC do vdng da tren lam sang. Da so tre vdng da dudc phdt hidn khi vang d vimg 3 chiem 65.8%, vimg 4 (19%), mdt sd rat it duac phat hien d vung 1(1%),vung 5(1%) (bang 3).
Ndng do bllimbin d lan xet nghiem dau tidn cho thd'y da phIn d mifc do thap (bilirubin<250 j.imol/) va vifa (bilirubin 250 den dudi 340 nmolfl) ket qua nay cung phii hdp nghien cilU eua Bdo minh Tuyet 2009 [8], Nguyin _Bich Hodng 2008[6]. So vdi nghien etfu cCia Pham Dd Ngoc Diep [2] ndng do bilirubin eda chung tdi thap hdn, dieu ndy cd the do nghien cifu eua chiing toi tren tre sd sinh non thang da phan dUdc nam theo doi tai vien dudc phdt hien sdm.
- Co mdi tuong quan thudn giu^ mut do vang da tren lam sdng va ndng dd bilimbin mdu (bieu do 2), didu nay cung tUdng tu nhU sd dd ciia Kramer. Tuy nhien bilimbin mdu tmng binh tUOng img theo tUng viing vang da tren ldm sang trong nghien cifu cua chOng toi eao hdn d nhdm tre vdng da viing 2 cd ndng do bihmbinGT tmng binh (187.64± 65.93iimo/l), d nhom tre vdng da viing 5 trong nghien ciru ciia ehiing toi den (486±71.08nmol/l). Do tre de nori thudng cd ndng do albumin thap, lai hay e6 suy hd hd'p va mot sd tre den mudn vdi mife bilirubin qua eao. Can theo ddi dieu tri chidu den sdm eho nhOfng tre de non ed vdng da vung 2, 3 tranh bd sdt ddn den hdu qua dang tide anh hudng ddn tUdng lai cCia tre.
-Bieu hien trieu chimg than kinh.Trong^nghien cifu cOa chimg tdi cd'32/310 (10.3%) tre cd bieu hien tneu chifng tdn thUdng than kinh, da phan id bieu hien giam phan dng bii cd 15/32 trUdng hdp ehidm 46.87% ngoai ra con bieu hidn rdi loan nhip thd 10/32, li bi 6/32, tang
trudng lUc cd nhe 3/32. cdn tim tai 8/32, mat phan xa bii 1/32. tdng tmong lUc cd 1/32. Cd khi bieu hidn tneu ehiing tdn thuong than kinh ngay khi bilirubin mau todn phan trung binh 280^imol/l (15mg/dl). Dieu nay rat ed y nghTa de tuvdn eho cae bd me vd gia dinh, can bd y te trong vide theo ddi didu tri chieu den sdm cho nhung tre de non cd vdng da tranh chdm trd d i n de'n hdu qua dang tide anh hudng ddn tuong lai eua tre.
-Sutuong xifng giCfa viing vang da khi bat dau phdt hidn vdi mife dd bilirubin.Trong nghien cifu cCia chiing tdi cd 86.8% Id cd sU tUOng xifng giCfa vung va xet nghiem bilimbin khi bat dau danh gia vang da, 13.3%
Id khdng tUdng ximg giu'a viing vang da tren lam sang va mifC do bilimbin d ciing mdt thdi diem bat dau vdng da. Cd le do mdu da ciia so sinh non thang do hdn tre dii thang sU danh gia mifc do vang da tre de non tren Idm sdng eung khd chinh xac hdn, hon rvJa viec danh gia bang mat thudng rat chu quan vd dd sai lech, Mac dii sU khac biet nay ehua cd y nghTa thdng ke (P>0.05) giua nhdm cd tUong xifng va khdng tUdng xdng giu'a mifc dp vang da va bilimbin trong vide dieu tn vdng da.
Nhung day cCJng la van de phai chii y d tre sd sinh non thdng cd gang eac ed sd y td phai lam dUdc xet nghidm bilimbin cho tre, cdc den ehieu vang da la phuong tien khdng the thidu de dieu tn tre vang da benh ly eung nhu nhijfng tre vdng da nang cung can duoc trang bi, he thd'ng bac sy vd dieu dudng cung can phai dUde dao tao lien tuc de cd kinh nghiem phat hien, dieu tn.
-Xet ve tan xuat cac yeu td benh ly cd the la nguyen nhdn gay tang bilimbin mau d 310 tre b\ vdng da chiing tdi thay dai bd phdn 227/310 cd dieu kien thudn loi (eon bi suy hd hap cd 208/310 tre.^tre cd me diing thudc oxytocin 20/310, tre co me v3 ri di tren 6 gid 53/310),115/310 (37 1%) tre co vang da khd^g eo yeu td ddi khang nhom mau me con he ABO, ket qua nay ve co ban eung phii hop vdi thdng ke ve nguyen nhdn vang da eiia mot sd tae gia khde [1,12],
2. Oac diem can lam sang.
'Ty le nhdm mdu eon Trong nghien^cdu ciia chung tdi chua lam dUoc nhieu xet nghiem chd'n doan nguyen nhan huyet tdn khac cung nhu chua Idm dude hidu gid khang the de khdng dmh cd bat ddng nhdm mau me con he ABO that su khdng, nhung kdt qua eua chimg tdi eho thd'y da phan tre vang da mang nhdm mau B (86/188 45.74%), 113/263 (43%) tre vang da cd me mang nhdm mau O.
-MUc dd bllimbin trung binh liic tmdc dieu tn theo cdn nang va tuoi thai Luong bilirubin todn phan va gian tidp tang cf mire do thd'p va vUa, tuoi thai cang nhd, can nang edng thd'p thi luong bilirubin toan phan va gian tiep cang thd'p su khac biet nay la cd y nghTa thdng kd (P<0.05). Nghien ciru ciia ehung tdi cijng phii hdp vdi nghien cifu ciia Pham Ngoc Han nam 2011 tai benh vien Viet Nam - Cu Ba, Dong Hdi [5], nhUng nguoc vdi ghi nhan ciia y van jVang da tang bilirubin d tre sd sinh t / le nghieh vdi tudi thai), dieu nay cd le Id do tre de non dUOe theo ddi ngay sau de tai phdng dudng nhi nen duoc phat hien vdng da sdm ndn mite bilimbin cdn thd'p
Y HOC THlTC HANH (879) - S6 9/2013
- s u phdn bd can lam sdng theo tudi thai Theo kd't qua bang 11, cho thay chu ydu tre vdng da cOa chdng tdi la khdng ed Protein todn phan dudi 48 g/l (220/310 ehiem 71%), khdng cd Albumin huyet dUdi 30 g/l (218/310 ehiem 70.3%). Protein todn phdn dUdi 48 g/l tap chung ehd yeu d nhdm tudi dUdi 32 tudn chidm 32,2% vd tif 32 den dudi 35 tuan (47 8%), cdn nhdm tir 35 ddn dudi 37 tudn thi ehiem t j Id It hdn (20%).
Albumin huydt dudi 30 g/l ci nhdm trd dudi 32 tudn ehiem (29.3%) vd tir 32 dd'n dudi 35 tudn (44.6%), cdn nhdm tU 35 dd'n dudi 37 tudn thi chidm t j Id it hdn (26.1%). SU khac biet ndy Id ed ^ nghTa thdng kd p<
0.05. dieu ndy eung diing vdi ghi nhdn cOa y vdn (trd cdng non thi lUdng albumin cdng giam) do tre cdng non bd may tieu hda ehua hodn chinh dU trir albumin han che, hap thu vd tieu hda kem.
- Trong nghien cifU cua ehung tdi da phan trd vdng da khdng cd giam Hb dudi 14g/dl cung khdng cd sU khde bidt vd ndng dd Hb trong eae nhdm tudi thai non thdng vdng da, dieu ndy ed the do da phdn tre vdng da cija chiing tdi duoc xet nghiem ngay trong ngay ddu sau sinh ndn ndng dd Hb cdn cao ddc thu eiia tre trong tuan dau sau smh
- Trong nghien cifu cua chung tdi thay da phdn tre vdng da khdng cd xet nghiem dudng huyet dudi 400 mg/dl ( dudi 2,2 mmol/1). Khdng ed sU khac bidt eo •y nghTa thdng ke ve tan xua't mac vdng da gida cdc nhdm tudi thai (p>0 05). Kdt qua nay tuong ifng vdi mdt sd tdc gia khac [1, 10].
- Trong nghien eifu eua chimg tdi thay da phan tre vdng da ed xet nghiem Prothrombin (PT) <70%
(226/310 chiem 72.9%).
KET LUAN
1. Ve lam sang da sd benh nhi vang da dUdc phat hidn khi vdng den viing 3, ehu ydu vang davdo thdi diem 49 den 72 gid 38,7%, ehi cd 3.2% vang da xua't hien dudi 24 gid, vdng da xuat hidn nhidu nhat d nhdm tudi tu 32 ddn dUdi 35 tuan ehidm 45.8%, ft nhd't d nhdm tudi dudi 32 tuan 16.5%. Cd 10.3% tre cd bieu hien tneu chirng tdn nguy co ton thUdng nao, tUOng img vdi mifc bilirubin gian tidp tmng binh 247.12±95.79nmol/l, khi bilimbin tdng 483.3^mol/l thi tre ed tdn thUdng nao thUc sU (Tdng tnJdng IUC cO rdi loan nhip thd). Cd 13 3% la danh gia mUe do vdng da tren ldm sdng khdng tuong xdng vdi mifc dp tdng bilirubin theo Kramer.Trong 310 tre cd 185 cdp dupe xet nghiem nhdm mdu me con cd 70 cap (chidm 37.8%) cd ydu td ddi khang nhdm mau me con he ABO, khdng cd cdp ndo ed bat ddng nhdm mdu me eon thupc he Rh(D).
2. Ve can Idm sdng ed 188 tre duoe lam xet nghiem nhdm mau cd 86 tre Id nhdm mau B (45.74%). Cd 263 tre vang da cd me duoc xet nghiem nhdm mau cd 113 (36 5%) me mang nhdm mau O. Oa phan tre vdng da cd mite dp bilimbin tang d mifc thd'p va vifa cd hen quan thudn ddn tudi thai, Cd sutuong quan thuan giu'a VLing vdng da va bilirubin mdu gian tiep.Ty Id giam
protein mau, giam albumin mau d cac milfc tuoi thai la khde nhau,
KHUYEN NGHj
- Cdn cd eae ldp tap huan djnh kJ kien thCfc vd vang da so sinh eho cdc nu' hd sinh vd ly tudng hdn la cho ede bd me dang mang thai d cae eo sd khde nhau
- Cdn chidu ddn sdm dU phdng cho tat ca benh nhi non thdng ma cd vdng da
TAI L i f U THAM KHAO
1. Trdn* Lidn Anh (2002), "Nghidn eOu mgt si ddc diim ldm sdng vd budc diu ddnh gid kit qui thay mau cho tri sa sinh vdng da tdng Bilimbin gian tiip tiong mdu", Ludn vdn tdt nghidp Bac sy ehuyen khoa II, Hd Ndi.
2, Pham Dd Ngoc Diep (2003), "Ddnh gid hidu qua diiu tri vang da tdng Bilirubin tt/ do d tri sa sinh bkng chiiu ddn halogen tai khoa sa sinh bdnh vidn Saint - Paul". LuSn vdn tdt nghiep Bac sy chuydn khoa II, Ha Noi.
3 Khu Thj Khdnh Dung, Nguyin Kim Nga va cs (2007)," Vdng da tang bilimbin gian tidp d ti'd sd sinh, dSc didm ldm sdng, xet nghidm, mdt sd yeu td lien quan va ket qua can thidp". Tap chi Nhi khoa Viet Nam, tdp 15 (sd 1), B o Y t d , t r . 3 2 - 4 6 .
4, Bui Thj Thuy DUOng (2008), 'Nghidn cilU hieu qua dieu tn vdng da Idng bilimbin gian tiep bang den Raag ddng anh sang xanh d tre so smh du thdng tai khoa Sd sinh Benh vien Nhi Tmng Uong", Luan van tdt nghiep Bac sTchuydn khoa cap II, Dai hpe Y Hd Ndi.
5, Pham Thj Ngoc Hdn (2010), "Nghien cilU tinh hinh vang da tdng Bilimbin tU do d tre so sinh dupc dieu tri tai BV Viet Nam - Cu Ba Ddng Hdi", Tap ehi Y hoc Viet Nam, tdp 385, Tong hpi Y hpc Viet Nam, ti", 239 - 244.
6. Nguyen Bich Hoang (2011), "ThUc trang vang da tdng bilimbin TD vd hieu qua dieu tri chieu den LED lai khoa nhi BVOKTU Thai Nguyen", Hdi thao nhi khoa thang 5/2011. Hoi nhi khoa Thai Nguyen, tr.59
7. Nguyin Thj Xudn Huong vd cdng sU (2012), "Tinh hinh benh tdt va tCf vong so sinh tai khoa Nhi benh vien DDKTW Thai Nguyen trong 3 nam (2008 - 2010)", Tap ehl Yhge thuc hdnh (sd 3/2012), tr 9.
8 Nguyin Ngoc Siem, Lam Thi My (2005), "Gia tri cua phuong phdp do bilimbin qua da d tre sd sinh vang da tang bilirubin gidn tidp". Tap chi nghidn cdu khoa hgc. tap 38 (so 5), Bo y te - Dai hpc Y Ha Npi, tr. 24 - 27.
9, Nguydn Thi Ttianti va cs (2006), "Tinh hinhvangda tang bilimbin tU do tai khoa sd sinh benh vien Tre em Hai Phong", Tap chi Y hgc Vidt Nam. sd 2," tap 336, tr,28 - 32, 10, Ddo Mmh Tuyet (2009), "Danh gia kit qua di4u tn vdng da tdng bilimbin tu do bdng tidu phap anh sang tai khoa Nhi bdnh vidn Da khoa tmng uang Thdi Ngaydif, ludn vdn thac sy y hpc. Thai Nguyen.
11, Ngd Mmh Xuan vd es(2008), "Hieu qua cija dan den Photobed hai mdt tu che trong dieu tri vdng da sd smh do tang Bilimbin gian tiep tai khoa So smh benh vien Tir Du", Tap chi Y hoe TP. Hi Chi Minh sd 12, tr.126- 129.
12, E. Burgos, S. K Schmitt, D. K. Stevenson, C. S Phibbs (2008), "Readmission for neonatal jaundice in California, 1991 2000", trends and implications.
Pediatrics. 121(4), p. 864 - 869,
Y HOC THUC HANH (879) - SO 9/2013
