sinh trong nhdm dCing cefuroxim la 90 lp, nhdm ddi chdng Id 461 lp), rfiung ta Wifing chi tiet kiem d u p c tidn thudc md chOng ta cdn tiet kigm dupc tigu hao vdt dyng di kfim viec tigm thudc nhu bam tiem, bdng bdng, con... vd giam bdt d u p c cdng viec tiem truydn cho nhdn vien y td, giOp giam bdp ap lue cdng viec.
Ngodi ra cfing vigc thu gom don rac thai y td cung giam bdt han. Dieu ndy dac biet ed y nghTa han khi bdnh vi$n Dai hoc Y Hd Ndi ngay cdng trd thdnh dja didm Ipa chpn khdm ehda bgnh eCia nhieu ngudi ddn han, ngn dp luc ldm viec qud tai tai bgnh vifin cQng ngdy cdng gia tdng ban.
Nhu vdy, s d dung khang sinh d u phdng ed tinh hifiu qua kinh td cao hon nhidu so vdi vigc s d dyng khdng sinh dieu tri thudng quy.
KET L U A N Hi^u qud trfin Idm sang
Khdng bgnh nhan nao trong nhdm khdng sinh d u phfing phai chuyen ddi phdc do sang khang sinh didu trj.
Khfing benh nhan ndo xuat hien sdt sau md, 93,33% bpnti nhan sau md d ca hai nhdm vet md ddu khd.
Thdi gian nam vign sau md eua nhfim dung cefuroxim Id 3,8 ngdy, nhdm ddi chdng la 4 ngdy, khflng ed sp khac nhau ve thdi gian n i m vifin sau md gida hai nhdm,
Hifiu qud vd kinh tfi
Mdi b§nh nhan trong nhdm ddng khang sinh d u phdng dd tidt kigm duac khoang 1.000 000 ddng chi phi lifin quan den khdng sinh so vol nhfim ddi chdng,
ngodi ra frong nhfim nay cdn tiet kigm dupc Bin bfing, bdng, o6n sat khuan, bam tiem cho 371 mOi tigm.
Nhdn vifin y te tiet ki$m d u p c 371 l i n tifim cho b$nh nhdn.
Gidm cdng lao dfing cho nhdn vign v0 sinh do giam rdc thai ve y te di kem vi$e tigm thudc nhii^
bdng, bdng, bam tierfi...
T A I L I E U THAM K H A O
1. Ngd Van Todn, Nguyen Tmng Smh (1999), "Nh§n xfit budc d i u ve s d dyng khang sinh dp phdng (Cephapirine) trong p h l u thugt chan thuong chinh hinh", Tgp chi ngogi khoa sd 3, tr.8-12.
2. Dgng Qudc Ai, Ha Vfin Quyet (2012), "Danh gia kdt qua cat tui mgt nfii soi tai Bfinh vifin Dgi hgc Y Hd Nfii", Ngogi khoa sfi 4 / 2 0 1 2 , 1 1 - 1 8 .
3. Diem Ddng Binh, Nguyfin Cudng Thjnh (2009),
"Phau thudt cat tui mat nfii soi d ngudi cao tudi", Tgp clii y dupc iam sang 108, tfip 4, sd 1/2009,102 - 1 0 5 .
4. Trin Bao Long, Nguyfin Thj Hfi (2008), "Banh gia quy trinh cham sdc bfinh nhan sau md cat tdi mdt nqi soi cfi su dung khang sinh dp phdng Unasyn tgi bfinh vi$n Vifit Ddc", Tgp chi Y hpc Vigt Nam, Sd 2, tr. 36 - 42. '•'-
5. Maryanne McGuckin, Judy AShea, J. Sanfofd Schwartz (1999), "Infection and Antimicrobial Use in Laparoscopic Cholecystectomy", Infection control arid hospital epidemiology, vol 20, No 9, pp 624 - 626.
6. Hodng T u i n Vigt, Nguyfin Hoang Llnh, Bui Quang King (2008), "Kdt qua difiu tn e l t tui mdt nfii soi tgi b^nh vifin da khoa Sai Gdn", Y Hpc TP. Hd Chi Minh, Tfip 12, Phy banSd4, tr. 81 - 8 6 .
DAC DIEM l i M SANG, XQUANG SAU RANG MAT BEN RANG HAM SOA Of TRE EM 5-8 TUDI
V d TRU'ONG NHLT NGQC, D O A N THANH TUNG, PHAM H O A N G T U A N - Tru&ng d?i hgc YHiN0l N G U Y I N TAT TUAN - Tru&ng Cao ding y teHi Tinh TOM T A T
Muc tidu nghien cuv: Nhin xet die diem lim sing. X quang siu ring mit bdn rang him sua d tri em 5-8 tuii. Dii tugng nghidn cdu: Trd em tu 5-8 tudi cd siu mit bdn ring him sda den khim tai Tmng tim Ky thuit cao - Vidn Dio tao Ring Him Mit-Trudng DH Y Hi Ndi vi khoa rang tre em - Binh vidn Ring him m§t tmng uang Hi Ndi tu thing 4- 10/2013. Phuong phip nghien cuu: Md ta cit ngang. Ket qui nghien cuu: Tmng tong sd 119 trd td 5-8 tudi din khim cd 369 ring him sua bi sau mat bdn (38,76%), hay gap nhat la vj tri giua hai ring him sda (86,3%). Rang him sua thd nhit him du&i hay gip nhit chiim 37,9%. Tf Id tdn thuang den tdy li 42,8%, da sd cd biin chung vidm quanh eudng. Vi hinh inh X quang: Khoang cieh td Id siu din sung tdy nhd, thudng li 1-2 mm, phim cinh ein nhay vdi siu ring sdm a mat ben. Kit luan: Tf Id siu ring him sua d mit bin rat cao, thudng gip a him dudi han him trin, tf 1$ tin thuong tuy cao.
Tu khda: Siu ring mit bdn, siu ring him sda, siu ring tri em.
SUMMARY
Research objective: This study was conducted^
assess the clinical features, x-ray chamcteristkis of pmximal primary molar teeth caries in children from 5-8 years. Research subjects: Children aged 5-8 years diagnosed with pmximal caries of primary molars at the hight technle eentm of odonto- Stomatology-Hanoi medical University and department of peadiatrics of Hanoi National odonto- Stomatological Institut fmm April - Oct. 2013.
Research methods: Cross-sectional descriptive study. Results and conclusions: in 119 patients, we found that them are 369 primary molars with pmximal tooth caries (38.76%). The majority of caries posi^^
located between two primary molars (86.3%). The first lower primary molars are the most fmquer^
occured of this lesion (86.30%). The pulpitis rate is especialy high (42.8%) and most of its has
Y HOC THUC HANH (905) - s 6 2/Mtf
oon^)lk^tion cS apical inflammation. X-ray images flowed that the distan<x between floor o f caries hole and pulp hom is about 1-2 mm. Bitewing x-ray is us^ul for detection proximal tooth caries eariy.
Keywords: pmximal tooth caries, primary molar tooth caries, pediatric dental caries...
D^TWAN Dt
Theo Td chdc Y t i Thd gidi, sdu rdng dupc xem nhu la tai hpa toan c l u t h d ba. O tre em, bdnh sdu rdng Id mflt trcng nhdng b$nh rdng mi$ng phd bidn nhit. Sdu rdng sda thudng tien t r i l n nhanh, ndu WiOng dupe difiu trj se d i n ddn bien chdng vifim tuy, vifim quanh cudng ldm anh hudng tdi m i m rdng VTnh
\riln, sdc khde cua tre h o l e phai nhd sdm rdng sda trudc tudi thay sinh ly.
Ndm 2010, theo ket qud didu tra ciJa Vign Ddo tgo Rdng Hdm Mdt thuc hi^n tgi 5 tinh, thdnh phd trfin ca nudc tilt cd ddn 81,6% tre t d 4-8 tudi bj sdu rdng sda, 16,3% bj sdu rang vTnh v i i n [1]. Vdi bfi rdng sda thl gdp phin Idn la sdu rdng hdm sua, d i e bidt Id d ham dudi [2]. Vj tri sau rdng thudng gap la d mdt bfin va rit nhidu trudng hop chi cd thd phat hign khi chyp X_quang rdng.
Chiing tdi tiin hanh nghifin cdu nay vdi mye tifiu:
Nhdn xfit d$e d i l m lam sfing, X quang sdu rdng mat bfin rdng hdm sda d tre em 5-8 tudi d Tmng tdm Ky thudt eao Rdng Hdm Mdt-Trudng Dai hpc Y Hd Npi vd khoa Rdng tre em-Bdnh vign Rdng Hdm Mdt Trung uang Hd Nfii ndm 2013.
D O I TU'P'NG VA PHU'aNG P H A P NGHIEN CO'U 1. Ddi t u p n g nghifin c d u
Ld cde bdnh nhdn ddn khdm tai Trung tdm Ky thudt cao Vidn Ddo tgo Rdng Hdm Mat vd khoa rdng trfi em-Bgnh vi^n Rdng Hdm Mdt Tmng uang Hd Nfii.
Nghifin cdu dupc tiin hdnh t d 1/4/2013 ddn 30/9/2013,
Tifiu chuin Ipa chpn: Trfi em tudi t d 5-8 cd sdu m§t bfin rdng hdm sua, trg hpp tdc va bd mp trfi ddng y cho trd tham gia nghifin cuu
Tigu chuin logi trd: Trd khfing hpp tae hodc bd m? tri khdng ddng y tham gia nghifin cdu, cac rang hdm sda lung lay nhidu hodc ed tdn thuong nha chu chua dupe d i i u trj.
2. Phuiffng phdp nghifin c d u
Nghifin cdu dupe thidt kd theo phuang phdp mfi td cit ngang. Chpn m l u thudn tign bao gdm t i t cd cdc b$nh nhdn ddp dng du tifiu c h u i n Ipa chpn den khdm vd d i i u trj trong thdi gian nghifin cdu.
Cdc budc tidn hdnh nghifin cdu' (1)Hoi bgnh sd.
(2) Khdm ldm sdng. (3) C h i n dodn
Xd ly sd li$u: s d ligu dupe Idm sach, md hda vd nhdp bang p h i n m i m Epidata 3.1. Phdn tich bing phin m i m SPSS 16.
Dgo ddc nghign cdu: Bd mp cua tre d i u dupc giai ttilch v i nghign cdu. Trd tham gia nghifin cdu khi cd sy hpp tdc cua tre vd s p ddng y cua bd mg. Quy trinh khdm vd didu th dugc dim bdo dd khdng gdy ra b i t Ityinh hudng x i u ndo cho trd. Mpi thdng tin cCia dd tdi chl phyc vy nghifin cdu.
K £ T QUA NGHIEN CCru
1. M$t s 6 thong tin chung cOa ddi t u v n g nghifin c d u
Tdng sd tre t d 5-8 tudi den khdm Id 119 tre vdi 369 rdng hdm sda bj sdu mdt bgn c6 mfit sd ddc didm sau:
Bdng 1. Mfit sd thfing tin chung cOa b^nh nhdn Th6nq tin diunq vfi BN
Gidi Sd rdng ham sua bi sdu
theo gicri Phdn bd rang sdu m$t
bfin theo tudi Phan bd rang sau m$t
bfin theo ham
Nam Nir Nam
Nu 5 tudi 6 tuoi 7 tudi 8 tuoi Ham tren Hdm du6i
N 62 57 171 198 37 37 26 19 160 209
53,1
%
46,9 46,3 53,7 31,1 31,1 21,1 16 43,4 56,6 Trong nghifin cdu cOa chOng tdi hay g | p n h i t la rang hdm sua thd n h i t hdm dudi (37,9%) vd rdng hdm sda thd nhat hdm trfin (25,5%). RSng hdm sua thd hai d ham dudi (18,7%) hay gdp han cdc rdng ham sda thd hai hdm trfin (17,8%).
2. D$c didm lam sdng Bdng 2: Tinh trang b$nh ly tuy
Tinh tranq Chua tdn thi/onq tuy Vifim tuy khfinq hoi phgc
Chet tuy Tdnq
Tdnq 211 35 123 369
57,2
%
9.5 33,3 100%
P 0,000 Trong tdng sd 369 rdng hdm sda sdu m$t bfin ed 211 rdng hdm sua chua ton thuang tdi tOy, trong dd cd 32 rdng hdm sda sdu ca phia g i n va xa tdeh rdi nfin tdng sd Id sdu mdt bfin chua anh hudng tdi tuy la 235 Id sdu.
Bdng 3. Phfin logi 15 sdu theo" site and size"
S6 lupng va ty Ifi N
%
Size 1 21 8,9
Size 2 161 68.5
Size 3 48 20,4
Size 4 5 2.1
Tdng 235 100 Trong sd cdc rdng hdm sda bj sdu ni$t bfin g i n : hay gdp nhit Id rang 55 (24,6%), rdng 65 (23,7%) d hdm trfin vd rdng 75 (17,8%), rdng 85 (15,3%) d hdm dudi,
Sdu mdt bfin g i n hay gdp n h i t Id rdng hdm sda thd hai hdm trfin vdi 57 rdng (48,3%) vd rdng hdm sua thd hai hdm dudi vdi 39 rdng (33,0%). Sdu mat bfin xa hay gap n h i t id rdng hdm sua thd nhit hdm dudi vdi 101 rdng (59,7%) vd rdng hdm sda thd n h i t ham trfin vdi 54 rdng (32,0%).
3. D$c difim X quang
Trong tdng sd 369 rdng hdm sda sdu mdt bfin, ehiing tdi tien hdnh chyp phim tai ehS cho 59 rdng hdm sua trong dd 43 rdng hdm sda cd khodng cdch t d lfi sdu tdi sdng tuy < 2mm (72,9%) cdn lgi 16 rdng hdm sda cd khoang edch > 2mm (27,1 %).
Bang 4. So sdnh kha ndng phdt hign id sdu mdt bgn sdm gida tren iam sdng vd trgn X quani
L5 sau dupc phdt hifin Trfin iam sang Trfin X quang
Sd trudng hpp
~VHOC THUC HANH (905) - S 6 2/2014
Sd 16 sdu phdt hi^n trfin X quang nhieu han sd Id sdu trfin ldm sdng nhung khi so sanh bang thugt todn x2 s u khac nhau ndy khfing cd y nghta thdng kfi vdi p>0,65.
B A N LUAN
1. Dac didm Chung cDa ddi tirg-ng nghifin ci>u TTieo nghifin cdu, ty le trd hay gap n h i t Id 5 vd 6 tudi (ddu 31,1%) sau dd giam d i n d 7 tudi (21,1%) ^vd 8 tudi (16%). D i l u ndy cung phD hpp vdi ddc diem bfinh ly chung cua rdng tre em. Khi rang hdm Idn vTnh vifin thd n h i t mpc, thudng lOc 6 tudi, cdc khoang trdng blnh thudng bat dau ddng lgi vd hinh thanh cac mat tiep xGc, ty lg sau rdng mdt bfin tdng Ign ddng ke. Ty lp sdu rdng rang hdm sda cao nhung lai it dupc dieu trj, ddn den bj v d d i n , ch? cdn chdn rang hoac phai nhd sdm. N h i t la cac Id sau mdt ben, tidn trien nhanh vd ty 1$ vdo tuy cao. Khi cdc rang hdm sda cua tre bi m i t sdm thi ty le sdu rdng giam xudng theo thdi gian d cdc tudi tiep theo. Theo Vu Thj My Anh va Trdn ThOy Nga ty lfi sdu rdng sda t h i p nhit d tre 2 tudi, cao nhat d tre 6 tudi va giam d i n do nhd rang sdm vd thay rdng [7], [8].
Trong nghign cdu, chiing tdi nhan t h i y hay gap sdu rang mdt bfin hay gap d rang hdm sda thd n h i t nhieu hon rang hdm sda thu hai va hdm dudi hay gap hon hdm trfin. Rdng ham sua thu n h i t hdm dudi (37,9%) vd rdng hfim sda thd nhat ham tren (25,5%) chidm ty lfi cao nhit. Kdt qua nay ngupc lgi so vdi mdt sd nghifin edu khde eho r i n g sdu rdng hdm sua thd hai gdp nhidu han rdng ham sua thd nhit (Lg Thj Hanh Quyfin vd Nguyin Thj Van) Id do cdc tde gia trudc thudng tinh ca sdu mat nhai, rat hay gdp d cde rdng hdm sua thd hai do giai phdu hd rdnh sdu han rdng ham sda thd n h i t [9],
2. Dac didm Idm sdng vd X quang
Theo nghifin cdu, trong sd 235 lfi sdu cd sp tidn tridn r i t nhanh t d size 1 (8,9%) Ifin size 2 (68,5%) sau dd giam xudng d size 3 (20,4%) va size 4 (2,1%) cd thd do tdng ty 1$ bidn ehdng tuy Idm giam ty Id size 3 vd size 4. Da sd Id sdu mdt ben nam d v| tri gida hai rdng hdm sda (86,3%) tdc Id d phia xa rdng hdm sda thd nhit vd phia g i n ciia rang hdm sua thd hai, nhilu han h i n so vdi so lfi sdu d phia g i n rang hdm sda thd nhit vd d phia xa rdng hdm sda thd hai (13,7%).
Ty lfi b3n tiiuang hay chet tuy d sdu mgt bfin xa hay gdp nhat Id d rang hdm sua thd nhit hdm dudi (57,3%) vd rang hdm sua thd nhit hdm trfin (29,3%), It gdp d cfic rang hdm sda thd hai. Cdc ty le nay tuang dng vdi ty 1$ phdn bd cCia cdc rang ham sua theo mdt bfin xa.
Ty le ton tiiuong hay chdt tCiy d sdu mdt bfin g i n khfing tuang dng vdi ty 1$ phan bd cua cae rang hdm sda Uieo mat ben g i n . Cd sp gia tang ty le ton thuang hay chit tuy d nhdm rdng hdm sua thd hai hdm dudi (40,9%) vd rdng ham sua tiid nhit hdm dudi (13,6%), ddc bi#t Id rdng hdm sua tiiu hai hdm dudi.
Dac diem X quang: Trong tdng sd 59 rdng hdm sda dupc khao sdt b i n g phim tai chfi, t h i y phan ldn lfi sdu cd khoang cdch tdi budng tuy Id < 2mm (72,9%) dieu ndy ndi Ifin thue te Id h i u h i t tri d i n
khdm mudn, khi cd d i u higu dau do id sdu g i n tOy.
Trong thdi gian nghifin c d u chOng tfii chyp dupc 25 phim cdnh ^ n trfin 16 tre, phdt hifin 8 rSng hdm sda bj sdu sdm, cdc lfi sdu nay deu khdng tim t h i y dupc trfin phim cdn chdp. Ngoai vific tre khflng hpp tde thi tre cd vdm mi§ng vd sdn mifing can hay trd nhgy cam, khi c i n lgi gdy kich thich ndn thl cQng khdng chup d u p c ldm hgn chd chf <Snh chyp phim. Sy khdc biet giua phat hidn l5 sdu tren Idm sdng vd X quang khdng cd y nghTa thdng kfi vi gidi han cua nghifin edu vd vi ed t h l nhdng rang hdm sua cd nguy ca cao dd x u l t hifin 15 sdu mdt bfin ti'fin lam sang.
K ^ t LUAN
Dae d i i m ldm sdng: Ty 1$ rang hdm sda c6 sdu rdng mat bfin cao, hay gdp n h i t Id cdc l3 sdu d vi trfgida hai rang ham sda. Rdng ham sua thd nhit hay gdp hon rdng ham sda thd hai va ham dudi hay g$p hon hdm tren. Ggp nhiiu nhit Id rang ham sua thd nhit hdm dudi 37,9%. Ty 1$ tdn tiiuang hay chet tiiiy tuong dng vdi ty i$ phdn bd. Ty 1# tdn thuang hay chet tiiy rdt cao, da s6 Id dd bj bidn chdng viling quanh eudng. Sdu m^.
bfin xa hay ggp nhit Id ede rang hdm sda tiid nhit, $ 1$
tdn tiiuang tiiy tuang dng ty 1$ phdn bd. Sdu mdt bgn g i n hay gdp nhit Id ede rdng hdm sda thd hai, ty lfi tdn thuang tOy khdng tuang dng vdi ty 1$ phdn bd, ^ l^tdn thuang tOy d rdng hdm sua tiid nhit vd rdng hdm sda thu hai hdm dudi cao han.
X quang: Khoang edch t d lfi sdu ddn sdng tDy nhd, thudng Id 1 - 2 mm, phim cdnh c i n nhgy vdi sdu rang sdm d mat ben.
T A I Lltii THAM K H A O
1. Mai binh Hung (1998). Bgnh sau rang. Bdi gidng RHM Nhd xuat ban y hpc. Tr. 9.
2. Vo Tm'ang Nhu Ngpc (2013). Bgnh sdu rdng d tre em. Rang tre em. Nha xudt ban gido dye Vigt Nam. Tr.
97-100.
3. Hodng T d HCing (2003). Giai phlu rdng sda. Giai phau rang NXB Y hpc. Tr. 195 - 203.
4. Nguyen Thj Van (2002). Nhgn xet Idm sang vd danh gia kdt qua ^ e u trj vifim tuy rang sda bing phuong phfip l i y tiiy 1 phan. Lugn vdn tdt nghigp bdcsT chuyen khoa c i p II. Trudng Dgi hpe Y Hd Nfii.
5. Bernadatte Drummond, Nicky Kilpatrick, Roland Bryant (1997), Dental caries and restorative paediatric dentistry. Pp. 55-81
6. Bullock L , C. Hong, D. Jhun. S. Kirshenblatt, M.
Kovifsari, et C. Picardo (2009), Diagnostic threshold for the treatment of proximal caries by bitewing radiograf^:
An evidence-based study of the Literature. Community Dentistry DEN 207 Y. PP 74-85.
^ 7. VD Thj My Anh (2000). "Gdp phin chin dodn vd dieu tri vifim tOy rdng sua cho hpc sinh m l u gido vd ti^
hoc". Lugn van tdt nghigp Thgc sJ y hpc. Trudng!??' hoc Y H a Nfii-Tr.23-29.
8. Tran Thuy Nga (1994). Kdt qud Stku tra sdc Mide rang migng tre em. Tgp chi thfing tin mdi Rdng Hto Mgt. Tr. 2.
9. Le Thj Hgnh Quygn, Nguyen Thj Vdn (2009).
Ddnh gia tinh hinh sdu rang d tre em 8-10 tudi t^i trudng tidu hpc PhCi Luu-My Ddc-Hd Tdy. Tgp chi Y hijc ttiyrc hanh. Tgp 681. Tr 43-44.
Y HOC THUC HANH (905) - S6 2/2014
