nang cho ngud'i b$nh chu'a dong bd.
Trong nhdm nghifin cdu cd 1 tardng hp'p dau khdp chd dOi sau m6. Cac b i l n chdng khdc nhu- nhidm trting, tr^t khdp... khdng g$p tnfdng hcrp ndo, cd t h l do s6 luvng BN chu'a nhieu, thdi gian theo ddi sau md cdn ngSn.
KfeT LUAN
P h l u thu^t thay KGTP mang lai ket qua giam dau tot cho ngydi b#nh thodi hda khdp g6i giai dogn mupn, d i n g thdi mang lai chdc ndng van ddng khdp g i i t i t cho BN, t d dd cai thien chat lyang cudc s6ng.
TAI LIEU THAM KHAO
1. Nguyin Thj Ai (2006), 'Nghien CLFU die d?em lim sang, c$n lim sSng va ap dung cac tieu chuin chin doan benh thoii hda kh&p gii". Luan van thac sy Y hoc Trudng Oai hpc Y Hd Npi.
2. Nguyen Thj Ngpc Lan (2004), Thoai hda kh&p va cot sing". Benh hpc npi khoa T l . NXB Y hpc: tr. 422- 435.
3. Gunston F.H (1971), "Polycentric knee arthroplasty. Prosthetic simulation of normal knee movement; JBJS, 53-B: tr. 272.
4. Nguyin Thdnh Chan & Ngd Bao Khang (2005), "
Ket qua bu&c diu thay kh&p gii toin phin tai Bdnh vi$n
Chin thuong Chinh hinh Sil Gdn-ITO", Y hpc thdnh ph6 H i Chi Minh, 9(2): tr. 134-136.
5. Tm'ang Chi Hdu (2008), 'Kit qua ban dau thay kh&p goi toin phin t^i Bdnh vidn Chin thuang Chinh hinh minh pho Hi Chi Minh". Ky y l u Hpi nghj Chan thuang Chinh hinh thdnh ph6 H 6 Chi Minh lan thd XV:
tr. 69-71.
6. Nguy«i Tien San & Dodn Vidt Qudn (2010), "
Dinh gii kit qua bu&c diu thay toin bp kh&p g& t^
Bdnh vi$n Viet DOc".
7. T D Spector & D J Hart (1994), 'Incidence &
prx}gmssion of osteoarffiritls in women with unilateral knee disease in general population: The effect of obesity". Ann-Rheum-Dis, 53: tr. 565-568.
8. Ranawat C S , Flynn W.F, Saddler S & KK Mansjai (1993), "Long stenn results of the total condylar knee arthmplasty 15-year survivorship sfudy".CIin, Orthop, 286: tr. 94-102.
9. W N Scott, M Rubinstein & G Scuderi (1988),
"Results after total knee arthmplasty", JBJS, 70(8): tr.
1163-1173.
10. Morrison J.B (1970), "The mechanics oftheknee joint in mlaSon to normal walking", J Bioech. 3: tr 51.
THUC TRANG VA MOT SO YEU TO LIEN QUAN DEN N H I I M KHUAN HO HAP CAP TINH CUA THE DUAl 5 TUOI TAI M O T S 6 XA HUYEN QUYNH LUU, TINH NGHE AN
DAM TH! TUYET - Tru&ng Dai hoc Y du&c Thai Nguyen TRAN TH! H A N G - BSnh viSn Da khoa huySn Qufnh luu, tinh Nghi An TOM T A T
SO- d(/ng phuang phip_ diiu tra cSt ngang di nghidn c(ni vi tlnh hinh nhidm khuin hd hip cip tinh vi mdt s6 yiu ti Udn quan den nhiem khuin hd hip cip tlnh & trd dw&l 5 tuil tai 2 xi huydn Qu^nh Luv.
tinh Nghd An chOng tdi thiy:
- TJ? 1$ tri mic nhiim khuin hd hip cip tlnh & dja diim nghiin cQv cdn cao (38,34%), tmng dd t^ Id khdng viim phii: Ho hoic cim lanh (34,54%); Vidm phoi: 3,8%.
- Ty Id mic nhiim khuin hd hip cip tinh cao &
lu^ tuoi to-12 - 35 thing tuii (41,04%).
- Cic yiu td Hdn quan din nhiim khuin hd hip cip tlnh & tri tai dia diim nghidn cuu li: Kiin thiic cOa bS me vi nhiim khuin hd hip cip tinh cho trd kdm, tidm chOng khdng diy du hoac du nhung khdng dung lich, tri cai st/a sdm, lam chudng gia sdc gin nhi. tinh trang nhi, bep dun trong nha, gia dlnh trd c6 ngu&i hOt thudc IS. thudc lio trong nhi.
TO? khda: Nhidm khuin hd hip cap tlnh, Nghd An.
SUIVIIMARY
Using a cmss-sectional survey to study on a situation of acute mspiratory infection in childmn and some nsk factors related to acute respimtory Infection Bt 2 communes in Quynh Luu district - Nghe An pmvlnce, we found that:
The prevalence mte of acute mspiratory infection In childmn In the study ama was still high (38.3%);
the rate of childmn suffering fmm cough and cold was 34.5%; the rate of childmn suffering fmm bmnchitis was 3.8%.
The prevalence rate of acute respiratory infection In children was still high fmm 12 -35 months old (43.8%).
Factors related to the acute respiratory infection In children in the study area are: Mother's knowledge on child cam was closely, Childmn who were not fully vaccinated or wem fully vaccinated but an incorrect schedule, children weaned eariy, animal sheds near the house, a housing condition, a indoor kitchen. Indoor smoking.
Keyv/ords: Acute mspiratory infection, Nghe An.
DAT V A N Dt
Nhidm khuan hd hdp d p Id b$nh p h i b i l n cd ^ 1$
mdc bfinh vd t d vong cao d iri em, d$c bifit do vifim phdi a tre dudi 5 t u l i tai cdc nu'dc dang phdt triln.
Tlieo s l lifiu cCia T 6 chdc Y t l T h l gidi, m6i tri tmng blnh trong 1 ndm m i c n h i l m khudn hd hdp cdp t d 4 - 9 Idn, U'dc tlnh trfin todn cdu m5i nSm c6 khodng 2 tJ l y p i tre mdc n h i l m khudn hd hdp cdp, trong dd khoang 40 trifiu lupt Id vifim p h l i [3].
Y HOC THirC HANH (916) - s6 5/2014
Tgi Vi$t Nam, bdo e t e hdng ndm cOa Bd Y t l cQng cho thdy nhiSm khuSn hfi hdp cdp tinh ludn ndm trong nhbm bfinh c6 t f 1$ mdc vd to* vong cao nhdt aac bifit Id dr Ire dydi 5 tudi. (> nhdng vCing khd khdn, vDng sdu, vDng xa vifim ph& v3n Id nguyfin nhdn gdy t d vong cao nh& d trg em, khodng 90% tofdng hgp t d vong do vifim phli Id d nhdm tie dydi 2 thdng tudi [3] \2].
M i ^ Tmng Id mfit khu w/c md ty Ifi hd ddi nghfio cdn cao, cd nhilu ddn tfic t h i l u s l sinh sdng, trinh d$
nhfin ^ d c cua ngydi ddn khdng d i n g dfiu, kha ndng elp cfin dyp'c vdi cdc d j d i vu y ^ cdn han c h l . TnHig khi dd c y s d vfit chdt cho hoat dfing y t l d tuyin ccr sd d m i l n Tmng cdn nghfio ndn, s6 luvng cdn bd y t l it, nang lyc cOa cdn bd y t l cdn han c h l , mang ludi nhdn vifin y te thdn ban (NVYTTB) hoat ddng cdn cdm chdng. Bdo cdo cua cdc ca s d y te d khu vyc m i l n Trung cho thdy t^ Ifi nhifim khudn hfi hdp cdp tinh d tre em khong gidm, Hidn dd cd mdt s l nghifin cdu v l nhilm khuin hd hdp cdp tinh tre em nhyng cdn le te, chya dya ra dyp'c mdt nhdn djnh Chung n h d t v l tinh hinh bfinh [2].
QuJ'nh Luu, Nghfi An Id mfit huyfin thufic tinh khu vyc miln trung hifin dang trong qua trinh xdy dyng vd phdt triln vdi t i c dfi do thj hda cao tuy nhifin cufic sing cCia ngudi ddn noi ddy vdn cdn gfip rat nhilu khd khdn, cdng tdc chdm sdc sdc khde cho ngudi ddn cdn nhilu hgn c h l . Bfinh nhiem khudn hd hdp cdp tinh d trfi nhd vdn dyp'c cdc ca s d y t l dja phyang bdo cdo Id mfit vdn d l sdc khde cdn dyp'c U'U tifin gidi quylt. Nhyng thyc t l tJ Ifi ndy hifin nay Id bao nhifiu vd nhO'ng y l u t l lifin quan ndo d i n nhilm khudn hd hdp cdp ttnh d tre nhd khu vyc ndy ? d l tra Idi cho vdn d l trdn chCing tdi t i l n hdnh nghifin cdu d l tdi vdi 2 myc tifiu:
DSnh gii thi/c tr^ng nhiim khuin hd hip cip tlnh
& trd du^ 5 tuii t^i mdt si xS huydn Qu^nh Luu, tlnh Nghd An nSm 2013.
XSc dinh mdt sd yiu td lidn quan din nhiim khuin hd hip cip tlnh & trd du&l 5 tuii tai dia diim nghidn ciiu.
OOt TUVNG VA PHUO'NG PHAP NGHIEN CLPU 1. D 6 | lyp'ng nghifin c d u
Bd m? cd con dydi 5 t u l i , trfi em dydi 5 t u l i , s6 sdch, bdo cdo thing kfi cua trgm y t l xd.
2. D|a d i l m nghifin c d u : Huyfin Quj'nh Luu, tinh Nghfi An
3. P h y y n g phdp nghifin ci>u: Ap dgng phyang phdp nghifin cdu mfi ta vdi thilt k l cdt ngang c6 phdn tich ai ddnh gid thyc trgng NKHHC vd phdn tich m|t sfi chl s6: d i l u kifin vfi sinh nhd d, tifim ChCing, cai sda cCia trfi, k i l n thdc cOa bd me tgi cfing ddng d l xdc djnh mfit s i y l u t l cd lifin quan d i n NKHHC [1].
' CO miu nghidn ciiu md ti. du^ tlnh theo cdng thUc tlnh c d miu cho u^ luxrng mdt (j? Id trong quin thi [4].
^ ( p . e )
Trong do: n: cO m l u cdn cd;
Z{i-aB): Hfi s6 gidi hgn tin cdy vdi a= 0,05;
Z ( l - ^ ) = l , 9 6 C& miu md ti cho trd:
p: ty Ifi tre dudi 5 t u l i mdc nhifim khudn hfi hdp cdp = 40,76% [26].
q:1-p = 0,593.
£1 sai so mong muln, dp chinh xdc tyong d i l , chpn E = 0,1 ciJa tylfi p.
Thay vdo cfing thdc ta cd: n = 553 trfi.
Cd mdu tdi thilu can dat trong nghifin cdu md ta Id 553 tre
4. P h y c n g phdp chpn mdu: Chpn mdu chu dich:
Huydn Qu^nh Luu, ft'nh Nghfi An, lfip danh sdch 43 xa, thi trdn trong todn huyfin vd chpn ngfiu nhifin 2 xd d l d i l u tra hd gia dlnh vd khdm tre (xd Qujmh Vdn vd xa Qujnh Thdng).
5. CAc chi so nghien cdv
* ChT sd v l tlnh hinh bfinh nhigm khudn hd hdp cdp tinh d tre T f Ifi NKHHCT cua trfi dudi 5 t u l i . Ty Ifi NKHHCT cua trfi dudi 5 tudi theo cdc nhdm tudi, tJ lfi NKHHCT cua tre em dudi 5 tudi theo gldl.
* Chr sd v l cdc y l u td lifin quan: Tifim chung cua tre, cai sda, kiln thdc m@, tinh trang nhd ...-
6. P h y a n g phdp x d If s6 li^u X y If bdng cdc thufit todn thdng kfi y hpc.
K C T Q U A NGHIEN CLTU
* ThiFc trang n h i l m k h u i n hfi hdp cdp tlnh d trfi d y d i 5 tudi
Bdng 1 T f Ifi mdc NKHHCT cCia trfi dudi 5 tudi tgi
^ a d i l m nghifin cdu NKHHCT Mac NKHHCT
Trong 6&
- Khdng vigm phOi. ho ho3c cdm l^nh - Vi6m ph6i
S6 tre (n) I Ty Ifi (%)
21 38,34 34,54 3,6 Khflng mgc NKHHCT . Nh$n xdt T f Ifi mdc NKHHCT chung cua trfi dydi 5 tudi Id 38,34%.
Phdn loai theo mdc dfi bfinh' T h l khdng vifim phdi; ho hofic cdm lgnh chilm 34,54%; vifim p h l i Id 3,8%.
31.7 41 04 40.91
hang ihany ihang
Bi6u 661. Phan bd ty 1^ NKHHCT theo nhdm tu6l cua tri Nh$n xdt: Ty Ifi mdc NKHHCT tdng ddn theo nhdm t u l i . Nhdm tre t d 12 - 35 thdng tudi cd ty tfi mdc cao nhdt: 41,04%.
Y HOC THirr HANH rti6) - s 6 5/2014
Banq 2. PhSn b6
^^NKHHCT Gidi ^ ^ ^ ^
Nam N&
T6nq
tv 16 NKHHCT Ciia tre theo qidi Mac
n 116 96 212
%
36,02 41,66 38,34
Khonq mac n 206 135 341
%
63,98 58,44 61,66
T6ng 322 231 553 Nhdn xdt: Tre nam tai khu v y c nghifin cdu cd ty le mdc NKHHCT Id 36,02%, t f le mac d tre nO- la 41,56%.
* Kfit qud vfi cdc yfiu t d Men quan dfin nhifim k h u i n hd hdp cdp tinh
Bang 3. Lifin quan gida trinh dp hpc vdn cua me vdi ty lfi mac NKHHCT
~-^(JKHHCT HocvafTm^^^
THCS tro xuonq THPT tr* len
Tong Mac n 172
40 212
43,22
%
26,81 38,34
KtlOn n 226 116 341
mac 56,78
%
74,19 61,66
P,Z2 l 2 =14,3
p <0,05 Nhin xet: Trinh dp hpc van cua cac bd me cd lifin quan tdi ty ie mac NKHHCT d tre. Nhdm tre Id ccn cac ba me cd trinh dd hpc vdn t d bdc THCS trd xuing mdc NKHHCT (43,22%) cao han so vdi nhdm tre con cdc bd me cd trinh dd hpc van t d bac THPT trd len (25,81%) vdi p<0,05.
Bang 4. Lien quan gida nghe nghiep ba me vdi ty le mac NKHHCT
^-JjKHHCT Ngti^ngrtifep^
LSm rugnq Nqtl^ khSc Tong
Mac 200
12 212
%
41,84 16 38,34
Ktiong mac n 278
63 341
%
58,16 84 61,66
P, Z2 X2 = 18,31 p<0,05 (Nghd khac: Giao vien,c6ng chO^, budn bin, ndi tra, nghe tw do)
NhSn xdt: Nghe nghiep cua cac ba m? c6 lifin quan tdi ty le mac NKHHCT d tre. Nhdm tre Id ccn cda cdc bd me ldm rudng mac NKHHCT (41,84%) cao han so vdi nhdm tre con ciia cac ba me Idm cac n g h i khdc (16%), vdi p<0,05
Bdng 5. Lien quan gida k i l n thdc ve benh IjKHHCT cua ba me vdi ty lfi mdc NKHHCT d tre
~"^^--JJKHHCT Kien thti'c"---...^
Kem Trung binh,
khS, tot T6ng
MSC n 175
37 212
42,27
%
26,62 38,34
Khon n 239 102 341
^ mac 57,73
%
73,38 61,66
P. X2 Z2 = 10,78 p<0,05 Nhin xdt: Kiln thdc cham sdc tre cua bd m f cd Nfin quan chdt chfi d i n NKHHCT. Ty le con cua cdc bd me cd k i l n thdc kem mac NKHHCT (42,27%) cao han tf le con cua cdc bd me cd k i l n thdc trung binh, khd va tdt (26,63%), vdi p <0,05
Bang 6. Lifin quan gida can nang khi sinh cua tre vdi ty le mdc NKHHCT
^ ~ ^ NKHHCT ktii smh ^ ^ ^ \
Thip(<2500g) Binh thij6ng (^
2500g) Tonq
Mac n 25 187 212
%
65,56 36,81 38,34
Khonq mac n 20 321 341
%
44.44 63,19 61,66
P, X2
l 2 =6,144 p <0,05
Nhan xdt: Cd mdi lifin quan gida cfin ndng khi sinh cua tre vdi ty le mdc NKHHCT. Nhdm tre cd cfin nang thdp khi sinh cd nguy ca mdc NKHHCT (55,56%) cao han so vdi nhdm tre cd cfin nang binh thydng khi sinh (36,81%) vdi p< 0,05
Bang 7. Lien quan gida thdi gian cai sda cua tre vdi ty Ifi mac NKi^HCT
^-^..^^ NKHHCT T h S i g f t r ^ . cai sOa ^ ^ ^ Cai su'a <18thanq CaisLFa218thang
Tong
M3c n 105
68 173
%
47,73 42,93 42,93
Khong mic n 115 115 230
%
52,27 62,84 57,07
P,]C2 I2
=4,556 p <0,05 f* S6 trd chua cai sua; 150)
Nhin xet: Thdi gian cai sda cua tre cd llSh quan chat che vdi tlnh hinh mdc NKHHCT. Nhdm tre cai sda sdm cd ty Ifi mac NKHHCT (47,73%) cao han so vdi nhdm tre d y a c cai sda dung thdi gian (42,93%).
Vdi p<0,05
Bang 8. Lifin quan gida tinh trang tiem chung vdi ty le mdc NKHHCT
^"---.JJKHHCT Tien chOng~"~----..^
Khong du hole, Ou nhung khong
dunq lich Du dunq lich
Tong
Mac n 30 182 212
%
81,08 35,27 38,34
Khonq mac n 7 334 341
%
18,92 64,73 61,66
P,X2
X2
=30,65 P<0,01 Nhin xdt Tinh trang tifim chung cOng cd lifin quan chat che vdi tinh hinh NKHH dydi cdp cOa tre.
Tre duffc tifim chung khdng day du hodc dd nhyng khdng diing lich cd ty Id mac NKHHCT ( 81,08%) cao han cdc tre dup'c tifim chOng du vd dung Ijch (35,27%) vdi p<0,01
Bang 9. Lifin quan gida tlnh trgng nhd vdi tf Ifi mac NKHHCT
^ - ^ ^ ^ NKHHCT TlnhtrSna,^
nhaa ^ ^
Am thap, tr6ng trai Thoanq, sach se
Tong
Mic n 26 186 212
%
55,32 36,76 38,34
Khdnq mic n 21 320 341
%
44,68 63,26 61,66
P,X2
X2=6,267 P<0,05 Nhan xdt Cd moi lien quan gida tinh trgng nhd d vdi t f Id mac NKHHCT cua tre em. Ty Id tre d trong nhd dm thap, trdng trdi mdc NKHHCT (55,32%) cao hffn tre d trpng nhd thodng, sach se (36,76%) vdi p<0,05.
Bang 10. Ufin quan gida tinh trgng bdp dun trong riha vdi ty Ifi mdc NKHHCT
Trong nha Ngodi nhd Tdng
Mdc Khflng mic 'P.X2
X2= 8,359 p <0,05 Nh$n xdt: Cd mdi lien quan gida tlnh trgng b i p dun trang nhd vdi t f Ifi mdc NKHHCT. Nhdm trd sdng trong cdc hp gia dinh cd b i p dun trong nhd cd t f 1$
mdc NKHHCT (45,19%) cao han SP vdi nhdm trd sdng trong cdc hd gia dtnh s d dung b i p dun ndu ngodi nhd (33,12%) vdi p<0,05.
V HOC THirc HANH (916) - s 6 5/2014
IA Bing 1 1 . Lifin quan gida vdi tinh trang hiit thudc t Ihudc Ido trong gia dlnh vdi t f Ifi mdc NKHHCT
Gia dlnh cd ngu-di hut thudc Id, lao Khflng cd ngydi hilt
thulc Id, ldo Ting
khflng mdc^
X2=
7,365 P<0,05
Nh$n xdt Cd mdi lifin quan gida tinh trgng hut thudc Id, thudc ldo trong gia dinh vdi t f Ifi mdc NKHHCT Nhdm tre s i n g trong cdc hd gia dinh cd ngydi Idn hiit thudc la, ldo ^ong nhd mdc NKHHCT (44,36%) cao han so v&\ tre nhdm sdng trong cac hfi gia dlnh khfing cd ngydi Idn hiit thudc Id, Ido trong nhd (33,11%) vdi p<0,05.
Bdng 12. Lifin quan gida t f lfi mac NKHHCT vdi khodng cdch ti> nhd d i n chudng gia sue
\ N K H H C T qia sOc ^ " - - ^ G^nnhl<10m Xa nhd £10 m
T6ng MSC n 111
53 164
%
49,55 21,46 34,82
Khfln n 113 194 307
q mac
%
50.45 78,54 65,18
P. X2 X2= 6,557
P< 0,05 Nhin xdt Cd moi lifin quan gida khoang cdch t d nhd d i n chuing gia sOc vdi t f Ifi mdc NKHHCT cua trl, tf Ifi tre sdng trong cdc gia dlnh ldm chudng gia sCic gdn nhd dydi 10 mfit mdc NKHHCT (49,55%) cao han so vdi tre d cdc hfi cd chuong gia sOc xa nhd td 10 mfit trd Ifin (21,46%) vdi p<0,05
Bdng 13 Lifin quan gida d i l u kifin kinh te vdi ty Ifi mdc NKHHCT
"^-JjKHHCT TH l(inil14-~..,_
Nghgo Kh&nq nqh6o
Tong Mic n 57 155 212
%
47,50 35,80 38,34
KhOng mac n 63 278 341
%
52,50 64,20 61,66
P,l2 X2=5,444
p< 0,05 Nh$n xd(.' Cd mdi lifin quan gida (^lu kien kinh te vdi tf Ifi mdc NKHHCT Tre d cdc hd nghfio c6 mdc NKHHCT(47,50%) cao han so vdi tre s i n g trong hd khdng nghdo (38,80%). vdi p < 0,05.
BAN LUAN
* Tlnh hinh b^nh NKHHCT d trfi d y d i 5 tudi Khdm Idm sdng cdc tre dudi 5 t u l i tgi 2 xd trong difin nghifin cdu chung tdi thdy tf lfi NKHHCT chung d trl em Id 38,34%. Theo chung tdi, tf le nay la khd cao trong cfing ding nhyng phu hap vdi tinh hinh thyc t l cua khu vyc nghifin cdu K i t qua nghien cdu tai Qufnh Lyu, Nghfi An thap han k i t qua nghien cuu cua tdc gid Mai Anh Tudn v l NKHHCT d tre dudi 5 tuli tgi Chp lyidi, Bdc Kgn ndm 2008 tf le mdc Id 40,7% [26] vd cOng thdp hffn ket qua nghidn cdu cua ChCing tdi v l nhilm khudn hd hap cdp tre em tgi Chp Mdi, Bdc Kgn ndm 2010, tf lfi nhiem khudn hd hdp cdp trl em Id 43,9% [6]. Phdi chdng huyfin Chp M d i - Bdc Kgn Id mfit huyfin miln niii cd nhilu khd khdn ve kinh t l vdn hda xd hfii, chu y l u id ngydi ddn tdc thilu s l , tlnh hlnh bfinh tfit ndi chung vd bfinh tre em ndi rieng Id khd nfing n l Bdi sdng cua ngydi ddn d ddy cdn
gfip nhilu khd khan hon vOng duyfin hai miln trung.
Khi phdn loai NKHHCT theo Ida tudi cua tre tai Aa d i l m nghifin cdu em nhan thdy: T f Ifi mdc NKHHCT chung cd xu hydng tdng cao sau 12 thdng tudi. Cl nhdm tre to 12 den 35 thdng, t f Ifi mdc NKHHCT d nhdm ndy Id 41,04% cao nhdt trong cdc nhdm tudi, cd le d Ida tudi ndy sdc d l khdng cua tre bi han che do khang the t d mg sang trong thdi ky bdo thai dd khfing cdn, kha ndng cung dng cdc khdng the bfi mfit cQng dd het, khandng t y d l khdng cdn dang bj hgn c h l Vi vdy, tre vdn cd t h l cd t f lfi mdc NKHHCT cao d giai dean t d 1 den 3 tudi. Trong nghifin cdu nay, t f le mac NKHHCT khdng giam md van cdn khd cao khi tre duac 36-59 thang tudi (40,91%).
* Cdc yfiu td lifin quan
Trinh dfi hpc vdn cua bd mg ludn Id y l u td dyp'c xem xet trong cdc nghifin cdu v l NKHHCT tre em tai cfing ding. Bd me cd trinh do hpc vdn thdp thi khd ndng t i l p nhfin cac thdng tin y te phd cfip qua cdc phyong tifin truyin thdng dgi chung (ddi, sdch bdo, tivi...) rat han die. Cdng khd khdn han khi tiep nhan cdc thdng tin TT - GDSK t d phia CBYT, K i t qua nghien cdu ciia chiing tdi da chi ra: Nhdm tre Id con cua bd me cd hpc vdn t d bdc THCS trd xudng mdc NKHHCT (43,22%) cao han ty Ifi con cua cdc bd me cd hpc vdn t d THPT trd len (25,81%), vdi p<0,05- Ndm 2010 nhdm nghien cdu dd thyc hifin tai Chp Mdi v l yeu td hpc vdn lien quan d i n NKHHCT tre em va chi ra rdng con cua cac bd mg cd trinh dd td THCS trd xudng cd nguy ca mdc NKHHCT cao gdp 1,79 ldn so vdi con cua cdc bd me cd trinh dfi THPT trd Ifin [6],
Kien thdc, s y h i l u biet cua bd mg v l bfinh NKHHCT cd phdi Id y l u td lifin quan d i n tinh trgng NKHHCT tre em tai (Sa d i l m nghifin cdu hay khdng?
Nghien cdu cua chung tfii dd chi ra rdng cd m i l lifin quan chfit che gida k i l n thdc cua bd mg vdi tf Ifi NKHHCT d tre.
Mpt thyc t l Id dO CBYT cd trinh dfi gidi, dypc trang bi thudc men va cdc phyang tifin y t l ddy du nhung khi bd mp thilu kiln thdc, khdng bilt phdt hifin sdm cdc ddu hieu NKHHCT, chi dua con d i n co sd y t l khi bfinh dd ndng thi kha ndng td vong ciia dda tre Id rdt cao. Khdng cd kiln thdc, hieu bilt dung v l bfinh bd me se khdng thay hoac khdng thdy h i t mdi de dpa d i n tinh mang tre, tu dd se cd thdi dd khfing dung vdi vific chdm sdc tre vd hdu qua la khdng cd hdnh vi tdt vdi vdn de NKHHCT cho con minh.
Ket qua nghien cuu cua chung tdi cho thdy cdc y l u to ve ban thdn tre dupc xem xfit nhu cdn n$ng thdp khi sinh thdp (<2500gam), cai sua khdng hpp ly, tiem Chung khdng ddy du d i u Id nhdng y l u td cd lifin quan den vific gia tdng tinh trgng NKHHC cua tre nhd dudi 5 tudi d khu vyc nghifin cdu
Tre cd cdn ndng thdp khi sinh <2500g vd trfi dfi npn thi sue d l khdng cua tre vdi bfinh tfit kfim han cac tre cdn nfing khi sinh binh thudng, qud trinh phdt tnen ciia nhdng tre ndy thydng chfim vd khd ndng thich nghi vdi mdi trudng thdp, Vdi trfi cdn nfing thdp cdc khdng t h l t d me truyin giam ngay trong thdi gian
Y HOC THUC HANH (916) - S6 5/2014
sau de do dd kha nang mifin d|ch cua tre kfim. Ire de mac cdc bfinh tnjydn nhifim trong do cd NKHHCT.
Sua me cd vai trd quan trpng trpng viec nufli dydng va mifin dich cho tre. Tre cai sda sdm trong nghifin cdu cOa tdc gia Ddm Thj Tuyet ve NKHHCT d Bdc Kan nam 2010 cd nguy ca mac NKHHCT cao gdp 7,82 lan so vdi nhdm tre dyp'c cai sda dOng thdi diem. D i l u ndy giai thich la do ddp dng m i l n djch kfim, chdc nang phdi bj tdn thuang do dydng kinh cua dudng hd hdp tren nhd han vd cd khuynh hudng tdc nghen dydng thd ngoai vi [6] Nghien cdu ndy cOng cho thdy thdi gian cai sda cua tre cd lien quan chat che vdi tinh hinh mac NKHHC. Nhdm tre cai sua sdm cd t f le mac NKHHCT (47,73%) cao han so vdi nhdm tre dugc cai sda dung thdi gian (42,93%).
Tifim chung Id mdt hogt ddng rdt quan trpng trpng chiln lyp'c cham sdc sdc khde tre em. Tre dyac tifim chiing dii, diing ljch sfi tgo d y a c mifin djch ben vdng cho tre chdng lgi cdc bfinh truyen nhifim nguy hiem.
Tre khdng dyp'c tifim phdng day du hoac du nhung khdng diing ljch sfi khdng cd khang the chong lgi cac benh truyin nhifim vd la yeu td Idm gia tang t f lfi mdc NKHHCT d tre nhd. K i t qua nghien cdu cho thdy tiem chiing khdng day du cd lien quan d i n NKHHCT CLia tre vdi p<0,05.
Nghifin cdu cua chiing tdi cho thdy, tre hit phai khdi thudc t d ngydi Idn (hiit thu ddng) Id mdt yeu td Nfin quan den NKHHCT, K i t qua nay cOng phCi hp'p vdi k i t qua nghifin cdu cua tdc gia Henderson A.J.
(2008) [7] vd [Mai Anh Tudn tai huyen Cha Mdi tinh Bdc Kan. Nhdm tre cd b l me hut thudc Id, Ido cd nguy ca mac NKHHCT cao han so vdi nhdm tre cd bd mg khdng hOt thudc [5]. Trong d l tdi ndy, cac y l u td mdi trydng nhy log! nhd d tam bg, dieu kien nhd d dm thdp, bep dun trong nhd, Id nhdng yeu td lifin quan den NKHHCT d tre nhd, k i t qua nghien cdu nay cung phO hpp vdi nghifin cdu ciia Nakai Jame H.
Kilabukp and Satoshi (2007) [8]. Tre phai sdng trong dieu kifin nhd d tam, tinh trang nhd dm thap se dfi bi nhifim Ignh han so vdi tre song trong ^ l u kifin tot han Nhd d qua gan chudng gd, vjt va cac gia sue khdc nhtf trdu, bd, Ip'n thi t f le mac NKHHCT d nhdm tre thydng xuyen phai t i l p xiic vdi cdc yeu td nhy tren cao han hdn nhdm tre it hoac khflng tiep xCic vdi cdc yeu td dd. Thyc t l nhilu ngudi dan biet tdc hai dd nhyng hp vdn khdng thay ddi hdnh vi vi nguy ca mdt trdm gia siic lam hp phai quan tdm tdi vdn d l bao ve gia siic ciia minh nhieu han ma it de y d i n nguy ca cho tre nhd.
K^T LUAN
* Thyc trang benh nhidm khudn hfl hdp cdp tinh d trfi d y d i 5 tufli
T f Id mdc nhilm khuan hd hap cdp tinh chung d tre dydi 5 tudi Id 38,34%.
Phdn logi nhilm khudn hd hdp cdp tinh theo mdc dp:
The khdng viem phdi. hp hoac cam lanh: 34 54%
Vifim phli: 3,8%.
Nhdm tudi mdc nhifim khudn hfl hap cdp finh' cao
nhdt d nhflm tre t d 12 - 35 thdng tudi chilm tf lfi 41,04%.
Gidi tinh: T f le tre nam mac nhifim khudn hfl hdp cap tinh; 36,02%; Tre n d : 41,56%.
* Cdc y l u td lifin quan dfin nhilm khudn hfl hdp cdp tfnh d tre d y d i 5 tufli
Nghe nghifip mg Idm rupng.
Trinh dfl hpc vdn cOa bd me thdp.
K i l n thdc cua bd mg v l nhilm khudn hfl hdp cdp tinh cho tre kem.
Tifim Chung khdng day du.
Can nang thdp khi sinh Thdi gian cai sda cho tre qua sdm.
Ldm chudng gia sOc gdn nhd.
Tinh trgng nhd d dm thdm, trdng trai.
Kinh te gia dinh ngheo.
Logi nhd d tgm.
Gia dinh tre cd ngydi hut thudc la, thudc Ido.
Bep dun trong nhd.
KHUYDN NGHj
- Tdng c y d n g truyen thong giao due sdc khde cho cdc bd me ve phdng chdng NKHHCT cho tre nho.
Tang cudng cdng tac cham sdc trydc sinh, gidm sd tre cd cdn ngng thdp khi sinh, thyc hifin tiem chung day du vd dOng Ijch cho trfi. Gid ve sinh mdi trydng nhd d ddc bifit vdi nhdng hd sdng trong nhd tgm Vfin dflng ngydi ddn Idm chudng gia sOc xa nhd td 10m trd len, hgn che b i p dun trong nhd hoac cfl bien phdp thdng khdi, cdch ly tre vdi khdi bep. Van ddng ngydi Idn trong gia dinh khdng nen hiit thudc Id, Ido trong nhd hoac gan tre.
TAI LIEU THAM K H A O
1. Bd mfln Vfi sinh - Mdi trydng - Djch t l trydng Dgi . hpc Y khoa Thai Nguyfin (2004), Phuang phap nghiin ciiu siic khoe cdng cdng, Giao trinh sau dgi hpc, NXB Y hpc, tr 103-108.
2. Bp Y t l (2006), HQI thao dinh huang xay dijng ki hoach ho^tdpng, tr.1-5.
3. Bp Y t l - Dy an nhiem khuan hd hdp cap tinh tre em (2006), HQI thio dinh hu&ng xay dung ke ho9Ch ho^t dpng, BpYte, HaNpi.
4. Lyu Ngpc Hogt (2008), Thing kd - Tin hpc ung dung trong nghl&n c&u Y hpc, Nhd xuat ban Y hpc, Hd Npi
5 Mai Anh Tudn (2008), Thyc trgng vd mpt sd ylu t l nguy co ve nhiem khuan hd hap cap tinh cua tre dydi 5 tudi tgi mflt so xa mien niii, tlnh Bac Kgn, Lufin van cao hpc, Trydng Dgi hpc Y dyoc Thai Nguyfin.
6. Ddm Thi Tuyit (2010), Mdt s6 die diim djch ti vi hidu qui can thi$p doi vai nhiim khuin hd hip dp & trd dual 5 tuoi t^l huyen ChQT Mdi, tinh Bic K^n, Lufin dn t i l n sy, Trydng Dgi hpc Y - Dypc Thai Nguyfin.
7. Henderson A.J. (2008), 'The effects of tobacco smoke exposure on respiratory health in school-aged children", Paediatric Respimtory Reviews, 9 (1), p. 21 - 28.
8. Nakai Jame H. Kilabuko and Satoshi (2007),
"Effects of cooking fuels on acute respiratory infection in children in Tanzania", intJ.Eviron.Res. Public Health, 4 (1), p. 3 9 - 4 4 .
Y HOC THVC HANH (916) - s6 5/2014
