4. Vd Thanh Quang, Hd Minh Lpi (2013)," Wem mui dj Ong". Ludn dn tiln sT Y hpc.
5. VQ Vdn San (2002), 'Nghidn cOv nhung ddc ddm Idm sdng cua benh
vidm mQi dj Ong nghd nghidp do bui bong -lend cdng ty ddt thdm Hdi
Phdng". Lugn dn tiln sy Y hpc. Hoc vidn qudn Y.
6. VQ Minh Thyc (2003), "Oe tdi tieu chuin hda ($
nguy&n mat bui nha Dennatophagddes Pteronyssinus ung dung trong ldm sdng", D l tdi d p Bfl Y t l fr 6-29
7. Ellwood.P, Asher.M.I. Beasley.R, Clayton.T.Q, Stewart.A.W (2005), 'The Intemational study of astiima and aller^s in childhood (ISAAC): phase three mtionale andmethodsT, Int J Tuberc Lung Dis.
THUC TRANG TRE BAI NAO VAO BIEU TRj
TAI KHOA PHUC HOI CHl)C NANG- BENH VIEN NHI TRUNG UONG NAM 2014
T6M TAT
6g/ ndo (BN) Id mdt nhdm nhung rdi lo^n cOa hd thin kinh tmng uong do tdn thucrng ndo khdng tien tridn gdy ra cdc rdi lo^n vd v$n ddng h$u qui Idm han chd cho trd tmng sinh ho$t tdi thidu hdng ngdy.tide tinh, tf Id mic bai ndo 2-2,5/1000 trd sinh ra sdng;
khoing 30- 40% tdng sd trd khuydt tit [7],[11].
Hdi cOu 1.537 trd khuydt tdt ddn khdm vd ddu tn t^i khoa Phue hdi ehOe ndng (PHCN)- B$nh vi$n Nhi Tnjng tfang tO 1/1/2014-31/12/2014. Tf 1$ trd dg/ ndo 28,89% (444/1.537). Tin suit trd BN nam/nu' ld;1,55/1.Tr6 BN c6 dd tudi tmng binh 33,64 ± 23,28 thdng, nhd tudi nhit 6 thdng; nhdm tudi >12- 24 thdng(31,53%). thip nhit nhdm >48 thdng (10.81%).
BN thd CO cOng hay g$p nhit Id 63,51%. thd thit didu thdp nhit 1,8%. Trd bi BN do cdc nguydn nhdn tmng sinh (33.10%) vd sau sinh (29,05%) hay gdp nhdt, nguydn nhdn tnrdc sinh 14,41% vd vin cdn 23.44%
chua tim dupe nguydn nhdn. Bidu hi$n Idm sdng, BN thd n$ng 27,79%, thd tmng binh 65,50%. Kdt qud didu trj tdt 15,76%, khd 44,36%.
TCP khda: Thi/e trang, b$i ndo, khoa Phije hdi chOc ndng, bdnh vidn, nhi tmng uang.
SUMMARY
Cerebral palsy (CP) is a disonjer of the devetopment of movement and posture, causing activity limitations attributed to nonpmgressive di^uriianees of the fetal or infant bmin that may also affed adivity of children. Estimated that the incidence of cerebral palsy is 2-2,5/1000 live births, accounting for about 30-40% of children with disabilities[7],[11].
We retrospective studied on 1,537 disabled children who wem admitted for examination and treatment at the department of Rehabil'rtation - HospM of Pediatrics fmm 1/1/2014 to 31/12/2014. Results:
The rate of cerebmi palsy: 28.89%. Children with cerebral palsy males than females by 1,55 times;
average aged: 33.64 ± 23.28 months, minimum 6 months. The pementage highest gmup >12- 24 months (31534%), the lowest gmup > 48 month (10.81%). Spasticity cerebral in the most common type (63.51%); ataxia is only 1,8%. Childmn with cerebral palsy causes of birth accounted for the highest:
(33.10%) Mowed by postiiatal causes (29.05%) and prenatal (14.41%) and remains unexplained high (23.44%). In clinical level, the severe safe is 27.79%.;
modemte sate:65.50%. The results of treatment have
N G U Y I N VAN T C I N G , TRUONG THj MAI HONG
good responese:15,76%; 44.36% minimal msponse.
Keywords: research and reality. Cerebral palsy, department of rehabifitatton, hospitals, pediatric central
DATVAND^
"Bgl ndo Id mflt nhdm cdc r i l logn cda hd tfiln kinh tfung uang gdy ndn bdi t i n thuang ndo khdng tiln trien dnh hudng vdo giai dogn trudc sinh, trong khi sinh vd sau sinh cho den 5 tuii vdi cde biln thidn bao gom r l i logn vdn dpng, tinh t h i n , gidc quan vd hdnh vi'[11],[7].Cdc r i i logn v l vdn dflng gdy trd- nggi nhilu nhit cho trd trong sinh hogt t i i thieu hdng ngdy. Do dd, phye h i i chd-c ndng (PHCN) vdn dflng eho tre Id v i n d l h i t sdc d n tiiilt. Tgi Bflnh vidn Nhi Trung uang dd ed nhilu tdc gia nghidn cd-u v l fre bgi ndo nhung thye trang bai ndo hdng ndm vdn cd nhllu thay d i i , xult phdt h> thyc t l ndy ehdng t i i tien nghidn cd-u d l tdi ndy nhim myc tidu: 'Bdnh gid thuc tr^ng trd b^i ndo vdo ddu tri td khoa Phijc Hdi ChOc Ndng- B$nh vi$n Nhi Tmng uong ndm 2014'.
D6\ TUVNG, PHU'ONG P H A P NGHliN CO'U 1. Thdi gian nghidn cd-u: ndm 2015
2. Dja diim nghidn cd-u: khoa PHCN- Benh vipn Nhi Tmng uang.
3. D i i tupng: 444 h i sa tfe dupe chin dodn vd dilu bgi ndo.
4.,Tidu chuin c h i n dodn Ddu hi$u c h i n dodn tre bgl ndo [6]
Chdm phdt triln vdn dflng thd: chdm lly, ngii, bd, quy, du-ng. di.
- Chdm phdt triln vdn dflng tinh: ky ndng su- dyng bdn tay.
- Chdm phdt triln ky ndng giao tilp vd ngdn ngO- (frong 12 tfidng dIu).
- Chdm phdt friln tri tup: ch$m t i l p tfiu, hpc khd khdn hodc khflng di hpe.
- Lipt cde ddy tiidn kinh sp ndo: ed till Ide, syp ml, md. diic, mdo midng...
- Cde d I u hiflu khde: tre bai ndo cd till bj cong vpo cflt sing, dflng kinh
5. Phuang phdp: h i i euu h i sa trdn 444 trd BN d i n khdm vd d i l u tri tgi khoa PHCN- Benh vien Nhi tu- 1/1/2014-31/12/2014.
6. Sd- ly s i lidu: p h i n m i m y hpc SPSS 16.0.
Y HOC THV'C HANH (971) - S 6 7/20IS
7. PhSn iositheo Stanley (2000) dua ra phan lo?i v^bain9o[10]
K £ T QUA NGHIEN C i h j 1. M$t s i d$c di6m cua trd b^l nao B5ng1:T9ldbainao theo gidi
Gidi Nam NO Tdng
n 270 174 444
Tyld%
60,81 39,19 100 Ty Id bgi ndo ed sy khde biflt giO-a tre nam (60,81%) vd frd nQ-(39,19) frong dd nam cao g i p 1,55 l l n nQ-.
Bdng 2. Phdn b i tfieo nhdm t u l i cda tre bai ndo Tlidnq tudi
0-12
>12-24
>24-36
>36-48
>48 Tdnq
n 79 140 119 58 48 444
T* Id % 17,79 31,53 26.80 13.07 10.81 100 Ty Id nhdm bail frd bgi ndo cao Id: 12- 24 tfidng (31,53%) vd 24 -36 tfidng (26,80%).
Bdng 3. Phdn b i tf^ theo bgi ndo tiieo n g h l nghiflp cdamp
l^hd nghidP Oflng nhdn vidn chl>c
Cflng nhdn Nflng dfln Khde
Tvld%
28.37
T6ng | 444 1 10Q Ty id t r i bgl ndo cd mp ldm cong nhdn eao nhdt Bdng 4. Phdn
Thd bdnh Coci>nq Phdi hpp Mda vdn Nhdc TUdtdidu
Tdnq
loai thS binh b n 262
60 31 63 8 444
^indo Tv Id %
63,51 13,51 6,98 1416 1,80 100 Trd bgi ndo thi ddu hidu tfd co cd-ng ea cd ty Id cao nhit (63,51 %), till tfilt d i l u hro-ng d i i hilm gdp 1,8%.
Bdng 5. Phdn b i bgi ndo tfieo nguydn nhdn trudrc, trong vd sau sinh.
Cdc bdnh mdc phii Tnfdcsinh Trong sinh Sau sinh Chua rfl nguydn nhdn
Tflng
n 64 147 129 104 444
Ty!d%
14.41 33.10 29.05 23.44 100 Trd mle bgi ndo do cdc nguydn nhdn trong sinh chilm ty Ifl cao nhdt (33,10%); sau sinh (29,05%);
chua tfm thIy nguydn nhdn 23,44%.
Bdng 6. Phdn Ipaj theo md-e dfl ngng cda bdnh
Ndng Ting
Tyld%
Mdc dfl vi>a chilm ty Ifl cao 65,5%, md-e dfl nhp chilm 6,53%.
Bang 7. Kel qua dieu trj Ket qua 6\eu tn
The CO cirng The mua vo'n Th^ that dieu
Th6 nheo Phoi h(?p Tflng
Tot 50 (17,73%)
g (29,03%)
1 (12,5%)
5 (7,9%)
5 (8,3%)
70 (15.76%)
Kha 146 (51.77%)
14 (45,16%)
4 (50%)
13 (20,6%)
20 (33,33%)
197 (44,36%)
Trung binh
86 (30,04%)
8 (25,8%)
3 (37,5%)
45 (71,42%)
35 (58,33%)
177 (39,86%)
Tflng 282 31 8 63 60 444 The mua vdn cd ket qua dieu In tdt han so vdi cdc the khde
T h i nheo cd ket qua dieu In tuang doi thap; ty 1$
lot vd khd < 50%
BAN LUAN
Ty le Ire bai ndo tren tdng so tre bi khuyet tat chiem 28,89% (444/1.537), ly le nay tuong nhu mpt sd tac gia trong nude trudc day [5]. Tan suat nay cao hon cua Tran Thi Thu Hd la nam/nii' 1,35/1 [4], Doan Thj MinhXuanJI]
Tan suat Ire bai nao nam/nu' trong nghien cipu cua chung Idi la: 1,55/1. Kel qua nay_phu hap vdi nghien cd-u cua Tran Trpng Hai [61, Nguyen Thi Minh thuy [3].
Tre bai nao cd do luoi trung binh 33,64 ± 23,28 thdng, nhd nhat 6 thang, Idn nhat 132 thang. Ty le tre bai ndo den khdm vd dieu tri co phan bd cao d ccic nhom tudi > 12- 24 thang (31,53%) vd >24- 36 th^ng (26,80%), I h i p n h l l nhom >48 thang (10,81%). Ket qua ndy tuang t u kel qua cua mpt sd trung lam PHCN trong ca nude [3j,[ 2]. Kel qua nghien ciru ciia Chung tdi thay cd tdi 68,91% Ire BN > 12 thang tuoi, Oieu ndy cd le do cac trudng hop BN khd phdt hidn sdm Vi vdy, chan doan sdm BN la mpt van de cin dupe quan lam.
Ty le Ire bai nao cd me lam cdng nhan cao nhit (33,18%), thap nhat la ndng dan (17,11%) Phan 16'n trong so nay sdng a ngoai thanh, dieu kien kinh le vd _ chdm sdc thai san han hep
Cac the cua bai nao duac gay ra bdi cac ton thuang khde nhau cua nao: bat thudng cau Injc ndo, tac dong cua moi tnj'dng len cau true nao hoac bit thudng v l gen Bai nao gay ra khdng phai chi do bit thudng ve cau Imc ma cdn do anh hudng cCia thfl'i gian lac dpng Thdi ky thai nghen. quy 1 va 2 cua bSo thai la thdi ky phdl then vd nao, quy 3 Id qud trinh bi^t hod cua cdc le bao than kinh, khi tdn thuang dau quy 3 anh hudng chu yeu den chat trdng, cdn cudi quy 3 anh hudng chu yeu den chai xam Chinh vl vay vi^n hdn lam than kinh hpc My khuyen cao tat ca cac tre bgi ndo can chup IMR de xac dinh nguyen nhan cua CP Id Ion thuang cau true nao, chan thuang dac biel ia lidn quan den sinh non, di tat vd phat tnen nao. Xac dinh cau true bat thudng ndo se cung cap mdt chan dodni cuoi cung eua 'bai nao', Trong nghien cuu nay. Ire bgi nao do cdc nguyen nhan trong sinh chiem ty le cao nhat (33,10%), tiep den nguyen n_hdn sau sinl (29,05%), tm-dc sinh 14,41% Nhung vdn cdn ty Id e"
Y HOC THUC HANH (971) - SO 7/201
chu-a tim thay nguijeMriii'tidn 23,44%, tuy nhifen d^y Id nghi&n ciiu hoi c4iiiijn||aft vi#c xdc djnh chinh xdc nguygn nhan cua biQi|^0'c6n h ^ Chd, c4n c6 nghign ci/u dai hon de xae^flintedilnh xdc nguyfin nhSn cOa bai n§o vd co cac bi0n phdp phdng ngi>a, can thi$p kjp thcfi cho tre bai n a o * ^ .ilr.'
Trong nghien c L R l ^ a dlCing toi tid BN thi dSu hi$u tre CO cLfng chiem t j 1$ cao n h ^ (63,51%), miia v&n (6,98%) tiep den cdc;thS phoi h m dii^m 13,51%, mem nheo 14,18%;lhS th^t iKeu th^p nh& 1,8%. K ^ qua nay tu'cng tu- cOa Nguyen Minh ThOy (73% vd 2,6%) [83, Tran Thj Thu Hd (62,6% vd 1,3%) [5], Tuy nhien nghien ci>u cOaMeber A vd Broch H [9], th^ that dieu va the miia vdhMai cag hon 14,3% vd 7%, c6 th^
su khac biet lien quan dSn'Chung t6c, di^u ki$n chdm soc y te c6 vai tro trong s y phdn b6 t j 1$ th4 bgi ndo.
Ve miic 66 BN, nghifen ciru cOa chiing toi thay c6 SLf khac biet giCra 3 mi>c d$, trong d6 mi>c Od vi>a chiem da so 65,50%, n$ng 27.79%, 6,53% vd mi>c dd nhe chiem ty le thap nh4t 6,53%.
Ve ket qua dieu trj, k^t qua nghiSn ci>u cua chOng toi cho thSy, tat c i ( ^ b$nh nhdn d^u ddp i>ng v i ^ dieu tri PHCN, tuy nhlSn k^t qud t6t c6n th^p 17,75%, so vol khS 44,35%. KdX qud ndy phCi ht^^p vdri k ^ qud cua Doan Thi Minh Xudn, T r i n Thj Thu Hd, NguySn Thi Minh Thuy [5],t1],[3]. Cdc k^t qud diSu tri c i n phy thupc vao th^ benh, giai do^n phdt hi$n b$nh. K^t qua cua Chung toi thaV t h i miia vb'n ddp Ong t6t nhdi 29,03%; the nheo t h i p nUk 7,9%. Tuy nhifen, hi0n nay da c6 nhieu phu-ong phdp d i l u trj dang du'tp'c t i l n hdnh dieu tn cho tre bgi ndo nhu> tidm d^c t6 t h i n kinh Botulinum tuyp A a m$t s6 trung tdm PHCN, bu-d-c d I u mang lai ket qua khd qudn. Tnang nghifin ciru ndy do diJ lieu con it nen c l h mOt nghi6n c<ni thu- nghi|m d i l u tn de danh gia hi^u qud dieu trj cua Botulinum toxin tuyp A cho tre bai ndo.
K^TLUAN
- Ti> hoi CU'U n6i dJu trfen 1.537 t r i khuyit tdt d i n kham va dieu tri tai khoa PHCN- Benh vi$n Nhi Tmng uong ti>1/1/2014-31/12/2014, cho thIy ty l§ t r i BN c6n khd cao 28.89%, d | t u l i tnjng binh Id 33,64 ± 23,28
i n h l t Id 6 thdng t u i i . . . . m g l p 1.55 l l n nO-.
T h i CO cOng chilm t j 1$ cao (63,51%), t h i thIt dilu hilm g$p (1,8%).
- Tre bi BN do cdc nguySn nhdn trong sinh cao nhit (33,10%), sau sinh (29,05%), chua rO nguyfin nhdn bai ndo cdn cao 23,44%.
f r d BN mi>c dO vOa c^ilm da s6: (65,5%). MLFC dd ndng chilm 27,92%
- K i t qud d i l u trj: t i t 15,76%. khd 44,36%. T h i mua vdn cd k i t qud d i l u trj t i t n h i t 29,03%, the nhgo k i t qud d i l u tri thap 7,9%
TAI UEU THAM K H A O
1. Dodn Minh Xuan vd cs (1999). 'Nh$n xet tinh hinh vd kdt qui p/i(jc hdi chuc nSng trd bai nao tai Tmng tdm PHCN tre tan tdt TT-Hud". Bdo cdo tgi HOi nghj Khoa hoc nO nganh y t i Thira ThiSn-Hul.
2. Hodng Trung Thflng (20010). "Tinh hinh trd em bai nao Unh Khanh Hoa". Ky y l u cdng trinh nghien ci>u khoa hoc- Hdi Phuc hdi chi>c nang Vi^t Nam. Nhd xult ban Y hoc, tr. 277-80.
3. Nguyin Thj Minh Thuy (2004) (2004). "Nghien cdu dgc diem djch td hoc b^i nSo vd danh gid hidu qud cua mot so bidn phap phye hdi chdc nang vdn dOng cho tre ttai nao tai cdng ddng 6nh Hd Tdy". Lu$n dn Tien sT Y hoc, 2004,
4. Trin Thj Thu Ha va cs (2001). "Budc dao nghidn CifU hidu qud cda Cerebrc^sin trong phuc hdi chOc ndng b$i ndo & b^ em'. Ky y l u cdng trinh ngh'iSn ci>u khoa hpc - Hdi phye hdi chile ndng Vi§t Nam, sd 7, Nhd xult ban Y hoc, tr. 246-54.
5. T i l n Thj Thu Hd (2002) "Nghidn ciru mdt so dgc ddm dfch te, ldm sdng vd nhu cdu phuc hdi chuc ndng a tre bai nao'. Ludn dn Tiln sT Y hoc, Trudng Dgi hgc Y Hd NOi.
6. Trin Trong Hai (1995), "Phuc hdi chdc nSng cho te bai nSo'. Vdt ly trj liOu phgc hii chCrc ndng, Nhd xult ban Y hoc Hd Nfli. tr. 634-647.
7. Vu Duy Chinh (2002). 'Ap dung thang do ludng chOc ndng v$n d&ng ifid ddnh gid hi$u qui c4c ky thudt tao thudn van d^g tnxig phuc hdi chuc ndng trd bai nSo dudi 5 tudi°. Lugn vdn Thgc s j y hoc, Trudng Dgi hijc Y Hd Ndi.
8. Boyd, R.N.. et al (2013).. "Australian Cerebral Palsy Child Study: protocol of a prospective population based study of motor and brain development of preschool aged chiklren vflth cerebral palsy". BMC Neurol. 13: p. 57.
9. Meberg, A. and H. Broch (2004), "Etiology of cerebral pals/". J Perinat Med,. 32(5): p. 434-9.
10. Stanley F.J. B.E., Alberman E (2000)."How common are cerebral palsies". Cerebral Palsies:
Epidemiology and Causal Pathways, Mac Keith Press,: p.
22-39.
DANH GIA KET QUA PHAU THUAT NOI SOI U GIAP TRANG LANH TINH TAI BENH VIEN DAI HOC Y HA NOI
L^ VAN Q U A N G , N G U Y I N X U A N HAU, N G U Y I N TH! THANH LOAN
T6M TAT
M(JC tidu: Bdnh gid kdt qud sdm phau thu$t ndi soi u gidp tr^ng Idnh tlnh tai bdnh vidn Ogj hoc YHd Ndi
Ddi tur?ng vd phuong phdp: nghidn cdu md td tidn cOu 30 bdnh nhdn chdn dodn u gi^ frgng Idnh tlnh duve phdu thudt ndi soi (g/ B$nh vidn Dai hoc Y Hd Ndi t(/04/2014 ddn 04/2015
Trudng D^i hgc Y Hd N^i
Kdt qud: tmng binh Id 38,2± 9.8 tudi, t^ 1$ nam/nO' Id 1/ 6,5; ty Id 1 u trdn ldm sdng 93,3%, u fhCiy trdi 66,7%. kich thudc u tmng binh 18.7±6.7 mm; trdn ^u dm. u TIF^DS 3 chidm 53,3%, u don Ode 53,3%, u thuy trdi 53,3%; u2bdn 26.7%; Xdt nghidm td bdo hgc t^i u Idnh tlnh 100%. Thdi gian md tmng binh 75 phut;
YHOC i HUC H A N H (971) - S6 7/2015
