TUdng tu, m l u mu ehUa vi khuan Staphylococcus aureus, m l u ddm (ehUa A. baumannii, P. aeruginosa.
tap nhilm S. mitis). ket qua cung ehUng td d quy md pilot thi quy trinh san xuat van on djnh so vdi quy md phdng thi nghiem, ddng thdi giiia cac Id va cac dng dat tieu chuan ddng nhat, thdi gian on (^nh ciia vi khuan trong cac m l u la 15 ngay d dieu kien nhiet dp 25-30''C.
dp am 75%,
KET L U A N - K I E N NGH!
1. Ket luan
Khi nang ed Id tU quy mo phdng thi nghiem len quy md pilot, quy trinh vIn dam bao dupc viec tao ra cac m l u gia djnh mil. ddm dap img ^eu chi ban dau.
M l u da dat dupc tieu chuan ve dp ddng nhat, on dmh trong 15 ngay, phii hpp vdi yeu cau cua mau dimg trong ngoai kiem tra chat lupng xet nghiem.
2. Kien nghj
Ti^n hanh danh gia tac dpng ciia moi trudng (nhiet do, dp am, dieu kien van chuyen) trong qua trinh girt m l u cho cac ddn vi tham gia ngoai kiem.
Tiep tuc theo ddi dp on dinh va do ddng nhat ciia cac m i u sau 15 ngay cho den ndng do vi khuan khi dudi nguQng xet nghiem, nham xae djnh ban diing ciia m l u thuc tec^a m l u .
TAI LIEU THAM KHAO
1. Bp Y te (2013), Thdng tu 01/2013/TT-BYT, hudng din thuc hien quan ly chat lupng xet nghi#m tai cO sd kham benh, chijfa bgnh.
2. Bo Y Te (2009), DUOC diin Vi&t Nam IV, Ha Npi.
3 Tran HUU Tam, Le Thi Thiiy NhU, Le Tat ChSu, Nguyen Dam Chau Bao (2012), Ngoai kiim tra chit luong xet nghiem, NXB Y hpc, TP.HCM.
4. Tran HiJU Tam, Vd Ngpc Nguyen, Truong Quan Thuy, Nguyin T.Thanh Tam, Nguyin HQU Le, Nguyen T.Thanh Hoa, Le Hieu NghTa (2013), Tdi UU hoa dieu kien san xuat mau benh pham gia dinh mu. ddm chda vi khuan thudng gap phuc vu kiem tra chat lUdng xet nghiem vi sinti lam sang". Tap chi Y hpc Thuc hinh, sd 886, tr. 76-80.
5. Nguyen Van Tuan (2014), Phan tich dOli6u wJifi, NXB Tdng hpp TP.HCM.
6. Pham Hiing Van (2006), Ky thuit xdt nghl&m w smti lam sang, NXB Y hpc, TP.HCM.
7. F. H. Kayser (2005), Medical miaobiology, Georg Thieme Veriag, Stuttgart; New York
8. T. P. Whitehead, F. P. Woodford (1981), "External quality assessment of clinical laboratories in the United Kingdom", Journal of clinical pathology, 34 (9), 947-57.
9. Worid Health Organization (2007), Policy and procedures of the WHO/NICD Microbiology External Quality Assessment Programme in Africa, Geneva.
MOT SO DAC DIEM DjCH TE VA YEU TO LIEN QUAN DEN VIEM PHOI CO NHIEM CYTOMEGALOVIRUS AT THE EM TAI BENH VIEN NHI TRUNG UONG
DOAN TH! MAI THANH - Benh vign Nhi Trung uOng, Hi Npi TOM TAT
Nghien cifu tien cOu dupc thuc hien nham md ti mdt so die diim dich ti va yiu to lien quan din VP cd nhiem CMV d tre em dieu tri tai Benh vien Nhi Trung uang (BVNTU) tif 1/2010 din 12/2012. Trong 427 bdnh nhi VP theo tidu chuin eua To chOc Y ti Thi gidi (WHO) lifa tuoi tu 2 -15 tuoi nhap vien dieu tri, kit qua nghien eifu eho thiy ed 246 benh nhi xae dinh dupe vi rOt CMV trong miu chiim (j? le 57,6%, tuoi trung binh 2,2 ±2, 3 thing; lifa tuoi hay gap nhit la nhdm tre 2- 6 thing tuoi (60,89%). Tien sO vang da, thdi gian bi benh kio dii, in hdn hpp li cae si yiu to Hen quan din tinh trang nhiSm CMV/benh nhan VP (p<0,05).
Tif khoa: CMV: Cytomegalovirus, VP: Viem phoi, tinh trang midn dich, djch td, yiu tHien quan.
SUMMARY
SOME EPIDEMIOLOGICAL AND RISK FACTOR CHARACTERISTICS OF CYTOMEGALOVIRUS ASSOCIATED PNEUMONIA IN CHILDREN
A prospective study was conducted to describe some epidemiological and risk factor characteristics of Cytomegalovirus associated pneumonia in children who hospitalized in the National Hospital of Pediatrics in Hanoi from 1/2010 to 12/2012. Among 427 pneumonia patients by the standards of the Worid Health Organization (WHO) aged 1 months to 15 years. Results showed that 246 patients were diagnosed with Cytomegalovirus associated pneumonia (57.6%), aged 2.5 ± 2.2 months. This disease mostly appeared in children from 2 to 6
months of age (60,89%). Neonatal jaundice, a long duration of illness history and mix feeding are risk factors of Cytomegalovirus associated pneumonia (p<0.05).
Keywords: CMV: Cytomegalovirus, pneumonia, epidemiological, risk factor.
DAT VAN DE
Viem phdi (VP) la benh phd bien tren toan th^ gidi vdi tf le mac benh va tf le tir vong dimg hang dIu trong eae benh nhilm khuan cap d tre em, Theo sd lieu cLia To chUc Y te The gidi (WHO), hang nam t? le tre tif vong do viem phdi chiem gan 1/5 sd tre tCf vong tren toan the gidi, 6 Chau Au, tj' le viem phoi chidm tif 30 den 40 tn/dng hpp/1.000 tre/nam [4].
Can nguyen gay viem dudng hd hap d tre em rat da dang nhu vi n i t vi khuan. nam, ky sinh tnjng... Cac nghien cUu tren the gidi eho thay can nguyen gay b&ntl chii yeu la do vi riit ehiem 80-90% tai cac nudc phSt trien [5]. [12]. Tai Viet Nam, nhi^u nghien cifu v^
nguyen nhan viem dudng ho hap dUdi eho d^n nay chO yeu vIn la tim nguyen nhan do vi khuln. Nguyen nhan do vi rut cung dupe de cap den.
CytomegalovinJS (CMV) ia cSn nguyen gay VP chQ yeu d nhdm benh nhan suy giam miln dich (SGMD).
Tren the gidi cung nhu Viet Nam cdn rat it nghidn cifu ve nhilm CMV/benh nh^ji VP trSn ddi tupng benh nhan khong suy giam miln dich [7], [8].
Trong nghien ciJfu nay, ehiing tdi sur dung k j thuat
Y HOC THirC HANH (957) - S6 4/201S
reaj-time PCR nham xac dinh vi mt CMV trong benh pham tTiau cOa benh nhan VP nham md ta mdt sd dac diem djch t l , va yeu td lien quan den tinh trang nhiem CMV/benh nhan VP d tre em dieu tri tai BVNTLT nam 2010-2012.
P H l / O N G P H A P N G H I D N CCfU 1. poi tui;(ng nghien cUu
^Gdm nhOng tre lifa tuoi tU 1 thang - 15 tudi dupe Chan doan Viem phoi dieu tn tai khoa Hd hap - Benh vien Nhi Trung^UPng tU 1/2010 den 12/2012.
Tieu chuan chpn benh nhan: Benh nhan chan doan viem phoi theo tieu chuan ciia Wi-iO 2006:
+ Ho xuat tiet ddm.
+ Nhjp thd nhanh.
+ Rut lom Idng nguc, riit Idm cd lien sudn nang: khd UidnSng, timtai, rdi loan nhjpthd, ngimgthd...
+ Nghe phdi' Ran am nhd hat, cd the kem ran n't, ran ngay...
+ X-quang tim phoi: Dam md to nhd khdng deu, rai rac 2 phdi, tap trung vung rd'n phdi canh tim 2 ben. cd the tap tatng cl 1 thiiy hoac 1 phan thiiy phoi.
Chin doan VP co nhiem CMV [9]:
Benh nhan viem phdi cd xac dmh ADN ciia vi rut CMV trong benh pham mau bang phan img khuech dai ehudi gen PCR.
Tieu chuan lo^i trilc - T r e d u d i 1 t h a n g t u d i .
- B e n h n h a n H I V , s a u g h e p t a n g , s a u g h e p t u y XUdng, s a u d i e u t n h d a c h a L
- N h u n g b e n h n h a n dii t i e u c h u a n t h a m g i a n g h i e n cuTj n h u n g g i a d i n h k h d n g d d n g y t h a m g i a .
2 . T h i e t k e n g h i e n c U u
- N g h i d n c d u m d t a l o a t t r u d n g h p p b e n h ( e a s e s e r i e s s t u d y ) . T r o n g d d t r u d n g h p p b e n h d u p c x a c d i n h la m d t b e n h n h i d u p e c h a n d o a n la v i e m p h d i n h a p v i e n d i e u tri x a c d j n h c d n h i l m C M V b a n g p h a n Cfng k h u e e h d a i c h u d i g e n P C R t r o n g b e n h p h a m m a u , dUdc h d i k y v e t i e n s i f b e n h , b a n t h a n v a g i a d i n h t h e o m l u t>enh a n d a d U d c t h i e t k e s i n .
- Xac d|nh AON eua vi riit trong benh pham bang phan dtig khudch dai chudi gen PCR. Benh pham lay dupc girt den phdng xet nghiem trong vong gid dau, dupc bao quan lanh va dUpc tien hanh tai Phdng Sinh hoc phan tif- Khoa Vi smh, Benh vien Nhi Trung udng
^3]- . ^
+ Mau benh pham: Mau toan phan chdng ddng EDTA (2ml), dich rO^ phe quan hoac djch ndi khi quan.
+ XLT ly benh pham: Bdi vdi laenh pham dich riifa phe quan va djch not khi quan tien hanh ly tam 1500 v/phiit trong 20 phiit, lay dich ndi trong de tach ADN.
+ Tach chid't ADN va bao quan benh pham:
Tach ADN vi nJt theo Kit QIAamp ADN Mini Kit and QIAamp ADN Blood Mini Kit Handbook (Qiagen), bao quan benh pham d -70°C.
+ Real time PCR:
Primer CMV F:
5-TGATCACTGTTCTCTCAGCCAAT -3' Primer CMV R:
5'-TCCTCTGATTCTCTGGTGTCACC -3"
CMV Probe (FAM).
5'CCCGCACTATCCCTCTGTCCTCA -3' Sif dung Quantiteeh probe PCR Mix (Qiagen).
+ Thanh phan master mix:
H p : 4,5 Ml 2X Master Mix: 12,5 ix\
Primer F (45pM)' 1,0^1 PnmerR(45pM): 1.0^1 Probe (FAM) 15pM: 1,0 nl ADN: 5 nl
Tong the tich: 25 jil + ChUdng trinh nhiet' SO^C: 2 phiit 95°C:10phiit 45 chu ky: 95°C: 15giay SS^C. 1 phut
Chay theo chUdng trinh nhiet tren may IQ5.
3. X u ly va phan tich so' lieu: Tat ca cac thdng tin ghi nhan tren benh nhan dupc nhap vao bang bien sd eua phan mem thdng ke STATA 16.0. Sir dung cae thuat toan thdng ke thich hpp,
KET QUA
1. Mot s d dac diem djch te
Bang 1: Mot sd dac diem chung ciia ddi tUdng nghien cUU
TJi6 nhiim CMV t rang ntlOm bSntl ntian ngtiien CLfu
T^ ie Nam/ nff Tu6i tmnq binh
So luonq 246/427 17CW6
T } i 8 % 57.6 2,2/1 2,5±2,2tlians N h a n x e t : T j l e x a c d j n h d U d e C M V t r o n g n h d m b e n h n h a n n g h i e n c i f u c a o ( 5 7 , 6 % ) . N a m n h i e u h d n n U t J l e n a m / n U = 2 , 2 / 1 .
B a n g 2 : P h a n b d t h e o n h d m t u d i cOa d o i t u p n g n g h i e n c i i u ( n = 2 4 6 )
Nhom tuoi
<2t!ianq 2 ^ 6 ttianq 6-<12thanq
> 12 thanq
Nhom CMV (•) (n=181) n 53 102 16 10
%
29.28 56.35 8,8 5.5
Nhom CMV (*)
• (n=246) n 76 150 16 4
%
30.89 60.89 6.5 1,63
P
0.11
a. C h i - s q u a r e d tt
N h a n x e t ' LUa t u d i h a y g a p nha't 2 - 6 t h a n g c h i e m t y le 6 0 , 8 9 % .
K h o n g c d s U k h a c b i e t v e n h d m t u d i giUa hai n h d m b e n h n h a n V P e d n h i e m v a k h d n g ,nhiem_ C M V ^
Bieu do 1: Phan bo benh nh^n tlieo thang trong nim
Y HOC T H V C HANH (957) - S6 4/2015
Nhan xet: Benh ed the xuat hien trong ca nam^
thang mac benh ed ty le cao nhat la thang 11 chiem ty le 15,45% tdng s d ca mac. Xu hudng mac benh ed xu hudng tang vao cae thang mua Thu - Ddng.
Ktiuvuc diat^
DB S.Honq B.BScB6 T.B3cB6 B.Trunq Bo
Tina
Nli6mCMV(-)(n=181) n 138 24 10 9 181
76,24
%
13.26 5,52 4,97 100
Nhom CMV (»
n 159 43 17 27 246
(n=246) 64,63
%
17,48 6,91 10,98 100 Nhan xet:
- Tf le benh nhan mac benh chu yeu la d khu vUc Ddng bang Sdng Hdng (ehieni 64,63%).
- K h d n g c d s U k h a c b i e t g i u a h a i n h d m n g h i e n cifU.
B a n g 4 : P h a n b d b e n h n h a n t h e o d a c d i e m g i a d i n h Dac diem qia dinh
Dia chi Nonqliifln Ttianh Bii Mi6n nDi H x v a n b f i Tieu hoc Tmnq hoc CO scl Tmnqhwphitbonq Tr6n tmng h x phd thong
Hoc van me Ti^uboc Tmnq hoc CO sd Tmnq hoc phd thonq Trdn tmnq hoc ph6 thdnq
Nqhe nqhiep bd Tudd Ndnq nqhiep Can bd cdnq Chile
Nqhe nqhiep me Tudd Ndnq nqhiep Can bd c»nq cbilc
Soiuonq 167 57 22 5 81 140 20 4 88 130 24 91 77 78 97 83 66
T*ie(%) 67,9 23,2 8,9 2,03 32,93 56,91 8,13 1,63 35.77 52.85 9.76 36.99 31,33 31,71 39.43 33.74 26.83 N h a n xet:
- Ty le mac benh d khu vUc ndng thdn la cao nhat vdi 67.9%.
- Da s d bd va me ciia tre cd trinh dp van hda trung hoc phd thdng vdi nghe nghiep da dang.
2. Mot so' yeu to' lien q u a n
Bang 5. Md'i tien quan giiJfa tien sir san khoa, nudi dudng. benh. thai do xit tri vdi viem phdi cd n h i l m CMV
TidnsCr ConthUI Con thii 2 ti^ ien
Du thang Thidu tbSng
Dethudnq Oemn Cdn nang ithi sinh
(<2500q)
Nhdm CMV(-) (n=181) n 105 76 111 70 158 23 64
%
58.0 42,0 61.3 38,7 87.3 12.7 35.4
Nhdm CMV(*) (n=246) n 154 92 166 80 212 34 76
%
62.6 37.4 67.5 32.5 86.2 13.8 30.9
OR. 35%Ci. p 0.8(0.6-1.2)
0.337' 0,8(0.5-1.1)
O.IO"
1.1 (0.6-1.9) 0.738' 0.8(0.7-1.0)
0.331a
Nudi bo Hdn hop (Si?a me
va sOa ngdai) Nbaire
flnha Bdnh vien Vang da so sinh
Nhiim l(huln hd hap cap Di img Ihudc
Ddng khSng sinh Then gian bj benh
(ngdy) Ttidi gian bj benh
< 7 ngay Thdi gian b| benh
^ 7 ngay 49 13 0 179
2 48 86 3
142 27,1
72 0.0 98.9 1.1 26.5 47.5
1.7 78.5 11.9±10.0 (1-14) 60 121
33.2 66.8
48 35 1 240
5 158 106 2 206
19.5
14.2 0,4 97.6 2.0 64.2 43,1 0.8
83.7 14.3*10.3 (1-15) 54 192
21.9 78.1
0.65 (0.41-1.0)
0.06?
2.14 (1.14^) 0.02S'
0.39"
22(0,9-5.1) 0.324' 0.54(02-1.5)
0.467"
4.9(32-73) O.OOC 0.8(0.6-1.2)
0.364' 0,48 (0.08-2.9)
0.359>
1,4(0,8-2,3) 0.164' 0.0069F
N h a n xet:
- Da sd cae ddi tUdng nghien euU la con dau, de thudng, can nang khi sinh tren 2500g. Phan tich xac dinh yeu td lien quan cho thay cac yeu to nhU la con, de non, sinh bang phUdng phap de thudng va yeu to trpng lupng khi sinh tha'p khong phai ia yeu td nguy cO eua VP cd nhilm CMV.
- Da sd tre dUdc nudi dudng bang sQa me va di/oc cham sdc d nha. Yeu td nudi tre bang phudng phap nudi hdn hdp mac dii chiem ty le thap nhung nhom nhilm CMV cao hdn so vdi nhdm khdng nhilm va la yeu td nguy cd gay nhilm CMV vdi OR=2,14 vS p=0.023.
- J^ le tre ed Wen sif vang da sP smh d nhdm nhiem CMV (64,2%) cao hdn. Su khac biet gife 2 nhdm la cd y nghTa thdng ke vdi OR=4.9 va p=0,000._Thdi gian bj benh tmng binh eiia nhdm benh nhan nhilm CMV kfio dai hdn nhdm khdng nhilm CMV va sU khac biet la c6 y nghTa thdng ke vdi p= 0.0069.
B A N LUAN 1. Dac diem djch te
Ty Ig nhiem CMV cua dot tuging nghien ctiu Tren the gidi da cd rat nhieu nghien cUu khang djnh CMV la tac nhan quan tnang khong chi gay benh 3 nhdm benh nhan cd suy giam miln djch bam sinh hay mac phai ma con ed the gay benh ca d nhdm benh nhan cd tien sijr khde manh. Ty le nhilm CMV d benh nhan viem phdi cd ten sif tre khde manh cung Wi5ng hiem va nhe nhU cac nghien cUu da tUng cdng bd. T|
le nhilm CMV cung nhu benh do nhiem CMV thay doi da dang tiiy thudc va Ida tudi hoac tinh trang miSn djch, k e t qua bang 1 cho thay ty le nhilm CMV cl doi tupng nghien ciJfu la 246/427 chiem 57,6%.
Ket qua nghien ciiU cua chung tdi cao hdn k^t qua nghien cUu ciia cac tac gia khac tren the gidi nhi/
Y HOC THVC HANH (957) - s6 4/201S
Adewuyi OA [2], Ivanov IS [10] va Zampoli.
Tuy nhien, ket qua nghien cUu ve t^ le nhilm CMV trong nghien eCfu cGa chung tdi cd thKp hpn so vdi 1 sd tac gia khac tr§n the gidi nhu Restrepo-Gualtros SM va Zhou W.
Lf giai cho sU khac nhau ve ty le nhilm CMV la do cac nghien cOfu khac nhau ve ddi tupng nghien cifU, lUa tuo| cung nhu phUdng phap phat hien vi nJt va benh pham lam xet nghiem.
Phan bo benh nhan theo nhdm tuoi cua doi tupng nghien cOu
Nhilm CMV cd the gap d moi IQa tudi va tang dan theo tudi nhung bSnh do nhilm CMV Vrii thap dan theo tudi. Ket qua nghien cifu the hien d hiiu dd 1 eho thay lUa tudi 2-j6 thang tuoi hay gap nhat chiem ty le 60,98%, ddng thdi day cung la Ida tudi hay phai nhap vien nhieu nhaL Ket qua nay cung phu hpp vdi cae tac gia trong nUdc va the gidi.
Theo k^t qua nghien cUu Khuc VSn Lap tai Benh vien Nhi Trung Udng nam 2009 ve dSc diem lam sang cOa benh do CMV tac gia tha'y rang- dp tudi trung binh ciia benh nhan la 9.44 ± 21,27 thang. Benh nhan nho tudi nhat la 3 ngay va b§nh nhan Idn tudi nhat la 12 tudi, lUa tudi g5p nhieu nhat cung la dudi 12 thang tudi (85,98%), tiip theo la nhdm 1-5 tuoi (10,19%), tudi it gap nhat la nhdm 10-15 tudi (1.27%) [1]. Avila - Aguero ML: tudi tmng binh 11,5 thang (0,3-132 thang) [3],
Tuy nhien, tae gia Adewuyi OA lai eho ket qua trai ngupc la nhilm CMV khong lien quan den \i!a tudi eua bdnh nhan.
De giai thich cho su khac biet ve tudi mac benh eda viem phoi cd nhilm CMV trong cac nghien cUu nhu vay la do each lua chon ddi tUpng nghien ciiU, dSc diem va each thUc cQa cac nghien ciiu la khong ddng nhat.
Phan bo benh nhSn tlieo gidi
Ket qua nghien cUu eOa chiin_g tdi ve phan bd gidi tinh benh nhan viem phdi cd nhiem CMV cho thay sd benh nhan nam nhieu hdn nu" mot each ro ret vdi ty le nam: niJf la 2,2:1. Ket qua nay phu hpp vdi nghien cifu ciia tac gia trong nudc va tren the gidi.
Khuc van Lap ty le benh nhan nam (61,78%) nhilm CMV cao hdn nij"!^ le (38,22%) [1].
Tuy nhien khi phan tich mdi lien quan theo timg nhdm ddi tudng, nhdm tuoi thay rang tJ le benh nhan VP cd nhilm CMV khdng cd sU khac biet vdi nhdm VP khdng nhilm CMV ve gidi tinh cung nhu nhdm tudi (p>
0,05). Ket luan nay phil hdp vdi nghien ciiU ci^a tac gia Sun X.
Mae du vay. cung cd mot vai ket qua trai ngude nhU cCia tac gia Avila - Aguero, tae gia quan sat tha'y t^ le nam nhilm benh thap hdn nu". Tuy nhien sU khae biet la rat it [3].
Va khi tim hieu nguyen nhan eOa su khac biet giij'a hai gidi chiing tdi thay cd su khac biet nhung khi so Scinh giiia hai nhdm benh nhSn thi khdng thay khae biet cd y nghTa thi chiing tdi van ehus tim ra dudc mdt Idi giai chinh xae cho cau hdi nay. Tuy nhien de giai thich hien tUdng tre nam mac benh nhieu hdn d tre
nQ, Cristiana IM.C va cpng su cho rang cd lien quan den gen dieu hda m i l n djch tren nhiem sac the X (X- link), d nd cd gap ddi sd gen nay vi vay kha nang dieu hda miln dich cao hdn nam. Trong nghien cUu khac cae tae gia nhan thay eiing lUa tudi thi phdi ci^a nd trudng thanh hOn d nam gidi vi vay tre nu" ft bi viem phdi hdn [6].
Phan hdbenh nhan theo thdi gian trong nam Theo cae tac gia tren the gidi benh cd nhilm CMV cd the xay ra bat cUthdi diem nao trong nSm va do tfnh chat lay tmyen cGa benh thdng qua tiep xuc dich tiet chifa vi art gay benh cho nen phan bd khdng theo mua hay thang [8].
Tuy nhien theo bieu do 2 cho thay ba thang giao mua 9, 10, 11 la nhung thang ma ed ^ le nhiem vi njt cao nhat. Dieu nay cd the giai thfch la do day la ba thang thdi tiet chuyen miia la dieu kien thuan Idi cho vi khuan phat trien va gay benh gia tang do do sd benh nhan phai nhap vien vi NKHH cap gia tang. Ket qua nay cung phil hpp vdi ket qua nghien ciiu ciia cac tac gia khac tren the gidi.
Phan bo theo viing dja /y
Ket qua d bang 3 cho thay, ty te benh nhan mac benh chfl yeu gap d khu vUc Dong bang Sdng Hdng chiem ty le 69,6%. Ket qua nghien cifu cda chung tdi cung phu hdp vdi tac gia Khuc Van Lap la 69,43% [IJ,
Dac di&n gia dinh vi moi trwcfng s6ng Theo mot sd nghien cifu tren the gidi (Black RE [4],...) cae nudc dang phat trien ed dieu kien cd sd ha tang ddi sdng kinh te xa hdi cdn thap, cdng tac cham sde sifc khde tre em ehUa eao nen nguy cd mac va \.is vong do VP cao hdn d cac nudc phat trien.
Nghien cifu cho thay 67,9% benh nhan den tU ndng thdn (Bang 4). Ket qua tren phu hdp vdi nghien cifU tac gia Sun X tren 7582 tre tU sd sinh den 6 tudi tai Tmng Qudc da sd tre cd nhilm CMV deu cd ngudn gdc tU ndng thon cd dieu kien kinh te thap kem. De giai thfch eho ket qua phan tich tren co the do mien nui cd dieu kien dja ly xa xdi. khd khan trong viec tiep can dieh vu y te nen cd ty le tre den kham va dieu tri thap. Hdn n\ia ndng thdn dieu kien kinh te tha'p, trinh do van hda thap cac ba me lay chdng va smh con sdm ed the la dieu kien lay triiyen CMV tU me sang con trong qua trinh mang thai.
Ve trinh dp hoc va'n ciia cha me benh nhan, va nghe nghiep eua cha me phan anh md'i quan he xa hpi, sU hieu biet, kien thUc nuoi con ciia cae bae eha me cijng anh hudng ket qua cham sdc dieu tn benh ciia tre. Ket qua cho thay da sd benh nhan cd trinh dp hpc van cua bd va me thap ehu yeu la dudi trung hpc phd thdng vdi nghe nghiep da dang va chii yeu la iam ndng nghiep va tU do. Dieu nay phan anh mdi quari^ he xa hpi phUe tap va la dieu kien thuan idi de tre de bj lay nhilm benh. Ket qua nghien cdu nay cung phii hpp cac nghien cUu khac tren the gidi nhu thu nhap thap, trinh dp van hda tha'p kem, dieu kien kinh te thap kem, sd con ddng, gia dinh dong ngudi la eac yeu td nguy co dpc lap de'n ty le nhilm CMV.
Khairi S lai cho y kie'n trai ngUdc nhilm CMV khong lien quan den trinh dp van hda va nghe nghiep
Y HOC THlTC HANH (957) - SO 4/2015
cua bo me.
2. Mot so yeu lien quan den VP co n h i l m CMV Mdr lien quan Uen stir san khoa vdi viem phoi cd nhiim CMV
Con dudng lay truyen cua CMV chii yeu qua tiep xuc vdi djch tiet cd the: djch am dao, sCfa me, mau va cac che pham ci3a mau... [8]. Do dd viee sinh con qua dudng am dao cOa ba me nhilm CMV la yeu td nguy cd de tre tiepxuc vdi djch tiet am dao nhieu hdn va kha nang lay nhiem benh cao hdn. Va d | c biet cae ba me tre trong qua trinh mang thai iA nhiem CMV tien phat thi cd nguy ed tmyen benh cho con cao hdn nhiem tai hoat hoac tai nhilm. NhOng tre nhilm CMV tiiudng ed can nang khi sinh thap hdn tre khong nhilm CMV. Cac tac gia tren the gidi deu thay rang khai thac tien sLf san khoa ddng vai trd quan trpng trong viec dinh hudng benh ly ci^a fa-e. Qua ket qua the hien d bang 5 phan tich mdi lien quan tien sir san khoa cua ti*!, ket qua eho thay da sd benh nhan la con dau, de thudng, 6ii thang can nang khi sinh >2500 g. Phii hdp vdi ket qua nghien cifu eiia cae tae gia tren the gidi.
Ma lien quan tien s&nu6i dudng vdi viem ph&i cd nhiem CMV
Ve tien s^ nudi dudng the hien d bang 5 thi hau het cac benh nhan deu dUde bu sCfa me. Rieng nhdm tre duoc nudi dudng hdn hpp cho thay cd ty le nhiem CMV cao hdn va sU khac biet cd y nghTa thong ke p=0,023.
Dieu nay ed tiie giai thfch CMV cd the lay qua sQa me hoac each eho tre an. Ket qua nay cung phii hpp vdi nghien ciiu ciia tac gia Stader LP phUdng phap cho tre an ciJng la mdt trong yeu to lien quan den tinh trang nhilm CMV. Theo cac tac gia Numazaki K, Sun X sQ'a me la ngudn lay CMV quan ti'png dac biet vdi tre sd sinh non thang can nang thap. Tac gia Sun X cdn nha'n manh sua me la ngudn lay nhilm CMV quan trpng cua tre dudi 6 thang tuoi. Va hai tac gia Ivanow IS [10] va Jim WT cdn nhan manh hdn ty le nhilm CMV tang dan theo thdi gian bu me.
Ket qua nghien eifU thay rang da sd benh nhan nhilm CMV ed tien siJf nudi dudngtai nha va khdng cd sU khac biet giij'a hai nhdm nhilm va khdng nhilm CMV. Dieu nay cd the giai thfch chu yeu benh nhan nghien cifU Uiupc ICia tudi nhd chua di nha tre sd tre phai tiep xuc vdi mdi trudng tap the it. Moi tmdng tap the (nha tre. benh vien...) la dieu kien thuan Ipi de tre cd the lay nhilm CMV cua eae tre khae cd nhilm CMV do tiep xuc: nude tieu, phan, mau, nudc bpt... ciia tre cd nhilm CMV. Ket qua ciia chung tdi cung phu hdp ket qua nghien ciiu eua tac gia Wilms IR [8].
MdS Hen quan giOa yeu td can nang vdi viem ph&i cd nhiim CMV
Can nang khi sinh Uiap va toe do tang trudng cham ciia cae benh nhan cd nhilm CMV da dUdc nhieu tac gia ti-en the gidi de cap den. Va ngUdc lai suy dinh dudng la yeu td nguy cd d i n tdi viem phdi d tre em. Tuy nhien trong ket qua nghien ciiU ciia chiing toi thay rang da so benh nhan cd trpng lUdng khi sinh tren 2500 g va mUe tang can qua cac thang eua hai nhdm benh nhan cd va khdng nhilm CMV khdng cd sU khac biet cd ^ nghTa thdng ke. Ket qua
nay phii hpp vdi Adewuyi OA. Tac gia thay rang tinh trang dinh dudng khong lien quan den viec cd hay khong nhilm CMV [2].
Tuy nhien. ket qua nay khdng phii hdp vdi nghien eifu ciia mot so tac gia tren the gidi. Nhu nhilm CMV cd nguy cd gay de non, can nang khi sinh thap va cham Idn. Ddng thdi tre de non cung la yeu td tang nguy cd lay nhiem CMV qua sua me.
Mdi lien quan giOa ti&i su^ benh, thai dp xii tri v^ Viem ph&i cd nhiim CMV
Dac diem tien sil benh:
Thdi gian bj benh trung binh 14,3 ± 10,3 ngay (1-15 ngay) va keo dai chiem ty le cao b nhdm viem phoi co nhiem CMV va su khae biet cd y nghta thdng ke vdi p<0,05. Ket qua nghien cUu nay ciia chiing tdi cung phil hpp vdi nghien eiifu cua cac tac gia trong niidc va tren the gidi.
Khuc van Lap tiiay rang 87,5% benh nhan viem phdi do nhilm CMV cd thdi gian diln bien benh keo dai tren 1 t u i n [1].
Resti'epo-Gualteros SIVl thdi gian diin bien benh 14 (3-20) ngay.
Tien siir vang da trong thdi ky sd sinh cung dUdc nhieu eae nha khoa hoc tren the gidi quan tam b'ong benh ly nhilm CMV ndi chung va viem phdi cd nhilm CMV ndi rieng. Vi benh ly do nhilm CMV UiUdng xay ra sdm sau sinh va tdn tiiUdng nhieu cd quan: gan, huyet hpc, phdi... trong dd benh ly do CMV tai gan va huyet hpc gay thie'u mau. vang da la benh ly hay gap va thudng di ciing vdi eac benh ly khac do CMV. Viec khai thac tien su* vang da sd smh tU luc nao cijng nhi/
dien bien eiia nd ra sao keo dai nhu the nao ddng vai ti-o quan trpng ti-ong viec tim mdi lien quan vdi VP c6 hay khdng nhilm CMV. "Trong nghien ciru ciia chiing toi 64,2% benh nhan nhiem CMV cd tien sif vang da ti-ong dd nhdm khdng nhilm CMV chi cd 26.5%. Sif khac biet cd y nghla thdng ke vdi p<0,05. Ket qua nay cung phil hdp vdi cac nghien cifu ti-en the gidi nhu Ivanov IS [10], Young Mei X.
KET LUAN
Nghien cifU nay cho thay rang nhutig benh nhi 1 thang den 15 tudi tai Benh vien Nhi Tmng udng b'ong giai doan 1/2010-12/2012 dUpc chan doan VP cd ^ le nhilm CMV la 57.6%. LUa tudi hay gap VP cd nhilm CMV nha't la nhdm tre tU 2 den 6 thang tudi (chiem t?
le 60,89%). Tien s^ vang da, thdi gian bj benh keo dai, an hdn hpp la nhutig yeu td lien quan den tinh trang nhilm CMV/benh nhan VP (p<0,05).
T A I L I E U THAM K H A O
1. Khuc van Lap (2009), ""Nghien cifu dac diem lam sang, can iam sang cac ttie benh do CMV d tre em tai Benh vien Nhi Tmng UOng", Luan van cao hpc, TrUdng Dai hpc Y Ha Noi.
2. Adewruyi O A , MDA S., Kyaw T. (2012), "Incidence of Cytomegalovims (CMV) pneumonia among chidren presenting with severe lower repiratory tract infection at Dr George at Mukhari Hospital'. Are/j Dis Child, 2. pp. 1-539.
3. Avila - Aguero M.L.. Paris M.M . /Mfraro W. et al (2003), ""Ganciclovir therapy in cytomegalovims (CMV) infection in immunocompetent pediatric patients", Int J
Y HOC THUC HANH (957) - s 6 4/2015
Infect Dis 7. pp. 278-81.
4. Black R.E., Cousens S., Johnson H.L et al (2010),
"Globle, regional, and national causes of child mortality in 2008: a systematic analysis", Lacet. 375, pp 1969-87.
5. Bradley J.S.. Byington C L . Shah S.S. et al (2011),
"The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of /VmericaClinieal Infectious Diseases, Clinical Infectious Diseases. 3, pp.1-52.
6. Cristiana MC. Nascimento Can/alho., Heonir Rotha., Rogerio Santos - Jesus (2002), Childhood pneumonia: clinical aspects associated with
hospitalization or death, Braz. J. Infec. Dis, 6(1).
7. Friel T. (2012), Epidemiology, clinical manifestations, and treatment of cytomegalovims infection in immunocompetent hosts, www. 2012. UpToDate.com.
8. Ho M. (2008). The History of cytomegalovims and its diseases". Medical Microbiology and Immunology.
197(2), pp. 65-73.
9. Honda J., Yonemitsu J., Kitajima H. et al (2001), 'Clinical Utility of Capillary Polymerase Chain Reaction for Diagnosis of Cytomegalovims Pneumonia", Scand J Infect Dis. 33. pp. 702-705.
10. Ivanov I.S., Popov N.I., Stefanov R. et al (2012),
"Prevalence of Cytomealovirus infection in hospitalized infants". Folia Medica. 54(4), pp. 45-52.
DIEU TRj QUA KJCH BUONG TR|)MG 0 BENH NHAN THU TINH ONG NGHIEM TAI BENH VIEN PHU SAN TRUNG UDNG
PHAM TH! PHaONG LAN, NGUYEN VIET TIEN, LE HOANG Benh vien Phu san Trung uang
THAM CHI DUNG - Vien Ve sinh Djch ti Trung uong TOM TAT
Nghien cOu md ti cit ngang vdi su tham gia cOa 240 bdnh nhan thu tinh trong ong nghiem (TTTON) tai Tmng tam HP tra sinh sin, Benh vien Phu san Trung uang tif 1/2013-3/2014. trong dd 120 benh nhan ed qua kich buong trOng (QKBT) vi 120 bdnh nhan khdng cd QKBT. Kit qui cho thay so benh nhan khdi benh hoan toan chiim 83.3%, benh thuyen giim la 16,7%.
Khdng cd bdnh nhan nio ghi nhin ti} vong. Cd 43 bdnh nhan choc dich ming bung (30,0%) trong ting si 117 binh nhin cd dich co chudng, trong dd nguai it nhat li 0,4 lit; nhieu nhit la 20,4 lit. Trong 53 bdnh nhan cd dich ming phii, chicd 1 benh nhan can choc dich vdi lupng chpc la 1 lit. Cd 2 benh nhin diiu tri ngoai khoa, trong ddOl trudng hpp md do xoan budng tn^g vi 01 trUdng hpp do vd chiy miu buong trOng.
Cd 75 trudng hap chi can dieu tri npi khoa ddn thuan bing bu dich va chong huyit khoi.
TCr khda: DiSu tri_, qua kich budng trUng, thu tinh trong ing nghiem.
SUMMARY
TREATMENT THERAPY OF OVARIAN HYPERSTIMULATION AMONG IN VITRO FERTILIZATION (IVF) PATIENTS IN THE NATIONAL OBSTETRIC AND GYNECOLOGY HOSPITAL
A cross-sectional descriptive study involving 240 patients of in vitro fertilization (IVF) was conducted at the National Hospital of Gynecology and Obstetrics from January 2013 to March 2014, in which 120 patients with ovarian hyperstimulation and 120 patients without ovarian hyperstimulation. Results showed that parents who fully recovered accounted for 83.3%, 16.7% of remission. No patient was died. There are 43 patients with ascites paracentesis (30.0%) of 117 patients with edema with minimum volume of 0.4 liters;
and maximum of 20.4 liters. In 53 patients with pleural effusion, only 1 patient with ascites paracentesis of about 1 liter. Only 2 patients had surgical treatment, including 01 cases of surgery due to ovarian torsion
and 01 cases of ovarian bleeding. There were 75 eases of single treatment therapy alone with fluids transfusion and anti-thrombosis.
Keywords: Treatment therapy, ovarian hyperstimulation, in vitro fertilization.
DATVAN DE
Kich thich budng trUng la mot qui trinh cd ban trong thu tinh dng nghiem vdi muc dfeh dat dupe sd lUpng nang noan va sd phoi phii hpp nham tang ty le thanh cdng. Mot trong hai tai bien eua thy tinh dng nghiem la qua kfch budng trUng (QKBT). Qua kich budng triing nang bao gdm eae trieu chimg nang ne nhu tran dich mang phdi, mang tim, mang bung, rdi loan ddng mau, tac mach, ca biet cd the dan den tii* vong me (1/45.000-500 000). Cache benh sinh cua QKBT chua dUdc biet rd. Do dd dieu tri QKBT ch^ yeu la dieu tri trieu chimg bao gdm: quan ly lUpng djch, bd sung plasma, bd sung albumin, chdng ddng mau, d i n luu djch mang bung, dich mang phdi, gitj'thai. ThUdng tJ le cd thai sau QKBT cao hdn trung binh, Dieu nay chii yeu do benh nhan tre tuoi, trong chu ky kich thich phdng noan dau tien, benh nhan cd nhieu noan va phdi tdt Mdt sd tac gia bao cao tang tJ le say thai sdm d benh nhan QKBT [1],[2]. Hien nay, ed rat ft cae nghien cifU ve QKBT d Viet Nam. Tai Benh vien Phu san Tmng upng (BVPSTLf) mac dii ky thuat iVF da dupc thuc hien tU nam 2000, nhung chi cd mot vai de tai nghien cUu ve QKBT.
Vi vay, nghien ciru nay nham md ta phUdng phap xu" tri dieu tri QKBT d benh nhan thu tinh dng nghiem tai BVPSTU".
PHUONG P H A P NGHIEN cCfU
1. Dd'i tupng nghien cUu: La cac benh nhan dupc kich thfch phdng noan (KTBT). chpc hiit noan va lam thu tinh trong ong nghiem (IVF). chuyen phdi tUdi tai Tnjng tam h i trd sinh san- BVPSTU" bi QKBT nam
Y HOC THITC HANH (957) - S6 4/2015
