DAC DIEM LAM SANG VA DICH NAO

TAP CHl Y HQC VigT NAM TAP 465 - THANG 4 • SO 2 - 2018

DAC DIEM LAM SANG VA DICH NAO - TUY GIAI DOAN SOM CUA HOI CHU'NG GUILLAIN - BARRE

T O M TAT

Ctf sd: Hpi ehiitig Guillain - Barre la nguyen nhan hang dau gay ra Met chi kieu ngoai vi cap tfnh tien trien. Chan doan sdm hpi chu'ng Guillain - Barre dong vai tro het su'c quan trpng vi cac phu'Ong phap dieu tn da chimg minh se eai Oiien ket qua neu diidc ap dung tir giai doan sdm.Tuy nhien, trong giai doan nay chan doan thydnp g5p khd khan do trieu chijfrig lam sang chUa dien hmh. Muc tieu: Mdta nhCTng bieu hien lam sang d benh nhan mac hpi chu'ng Guillain - Barre trong tuan dSu tien ciia benh. Phu'dng phap: Chung toi \iia chgn vao nghien cirti nhUng benh nhan dieu tri noi tru tai Khoa Than kinh Benh vien Bach Maitrong tuan dau tien ciia benh co chan doan cudi ciing kht ra vien la Hpi ehufng Guillain - Barre. Ket qua: Tudi tnJng binh cua nghien ciTu la 38,2. Ty le nam^la 52,5%, nu' ta 47,5%. Tien trieu hay gap nhat la nhiem Idiuan ho hap chiem 30%. Da so benh nhan (50%) khdi phat benh cd trieu chiTng te bi tay chan. 72,5%

yeu ccJ trong tuan dau tien cita benh, 55% yeu cc( Uu the hai chan jidn hai tay, 100% cd sU doi ximg giiJa hai ben cd the. Giam hoac mat phan xa gan - xUdng d 77,5% benh nhan. Roi loan cam giac chii quan gap d 77,5% benh nhan. 65% benh nhan eo bi^u hien phan ly proteiri - te bao trong dich nao - tiiy. Ket luan:

Tneu chirng lam sang cita hpi chiTng Guillain - Barre trong giai doan sdm ndi bat ta yeu cO kieu ngoai vi, giam hoSc mat phan xa gan xucfn^ va phan ly protein - te bad trong djch nao - tuy. Co 1/4 so benh nhan chu^a ed bieu hien lam sang va djch nao - tiiy dien hinh gay khd khan cho ctian doan xac djnh.

Tdkhda: Hot chiTng Gulllain-Barre.

SUMMARY

CLINICAL FEATURES AND CEREBROSPINAL FLUID OF GUILLAIN-BARRE SYNDROME I N

EARLY STAGE

Guillain-Barre syndrome (GBS) is the mam cause of acute progressive peripheral neuropathy. Early diagnosis of GBS plays the important role in helping clinicians applv effective treatments right from the onset.However, eariv diagnosis is often difficult todue to not typical dinieal symptoms. Aims:To describe abnormal changes in clinical eharacteristicsof Guillain- Barre syndrome patients in the first week of onset in order to find out early signs of this disease. Methods:

We selected the inpatients who had a final diagnosis of Guillain-Barre syndromein the Neurology Department of Bach Mai Hospital. Results: The

*Dal hoc Y Hi Ngi.

**Benh vien Bach Mai Chiu trach nhiem chinh: Vo Hong Khoi Eniail: drvohohgkhoi@yahoo.com.vn Ngay nhan bai: 2.2.2018 Ngay phan bien khoa hpc: 29.3.2018 Ngay duySt b^i: 11.4.2018

Phan Ti^n Lpc*, Vo H^ng Khoi**

average age of the patients was 38.2. The rate of male was 52.5% and female was 47.5%. The most common indicating sign was respiratory infection (30%). Most of patients (50%) presented numbness at the onset. 72.5% had muscle weakness in the first week of the disease, 55% at the infenor limbs, 100%

had symmetry between the two sides of the body.

Decreased tendon reflexes in 77.5% of patients.

Sensory symptoms occurred in 77.5% of cases. In 65% of patients, there was evidence of albumin- cytotogic dissociation in the cerebrospinal fluid.

Conclusions: Clinical manifestations of Guillain-Barre syndrome in early stage were peripheral muscle weakness, decreased or absent reflexes and albumin- cytologic dissociaton tn the cerebrospinal fluid.

Definitive diagnoses were difficult m a quarter of the patients without typical clinical symptoms.

Keywords: Guillain-Barre syndrome I. DAT VAN DE

Hoi chu'ng Guillain-Barre la benh iy tu' mien gay tdn thu'dng nhieu r l va day than kinh cap ti'nh vdi bleu hien lam sang liet mem kem theo mat hoac giam phan xa gan xu'dng, rdi loan cam giac va phan ly protein- te bao trong djeh nao - tuy [1]. Hpi chirng Guillain - Barre la nguyen nhan hang dau gay liet chi kieu ngoai vi cap tinh tien trien, vdi ty le mac hang nam tren the gidi tir 1,1 den 1,8/100.000 ngu'di. Bieu hien lam sang la Net cac ehi tien trien, hat ben, tu'dng doi dot xirng, miTc dd liet tien trien trong vdng 12 gid va dat dinh trong vdng 28 ngay .Da sd tru'dng hdp, benh tiep tuc tien trien trong tir 1 den 3 tuan sau khi khdi phat trieu chu'ng, 2/3 sd benh nhan khdng the tii di mdt minh khi yeu cd dat mu'c toi da, suy hd hap gap d khoang 25% benh nhan [ 2 ] .

Cac bien phap dieu tri dac hieu nhu': truyen tmh mach lieu cao globulin mien dich hoac tach loai huyet tu'dng da du'dc ehufng minh cd hieu qua giup han che nhu'ng dien bien nang va riit ngan thdi gian dieu tri ciia benh. NhiT vay, viec chSn doan va dieu trj sdm ddng vai trd rat quan trpng trong viec eat thien ket qua dieu trj cua benh nhan. Trong pham vi bai nay, ehiing toi dira ra mpt vai nhan dinh ve dae diem lam sang trong giai doan sdm ciia hpi chirng Guillain - Barre, vdi mong mudn giup cho thiTc tianh lam sang xac djnh sdm du'dc benh va trong viec nghien cii'u benh nay tai Viet Nam.

IL OOI TU'ONG VA PHU'CFNG PHAP N G H I I N C O U

VIETNAM MEDICAL JOURNAL N°2 - APRIL - 2018

1. Doi tu'dng nghiin cihi: Chung tdi tien hanh \da chpn 40 benh nhan vao dieu trj ndi trii ^ i Khoa Than kinh Benh vien Baeh Mai o : ehan doan ra vien ta hot chuiig Guillain - Barre. Tieu chuan lua chpn cac benh nhan dentrong vdng 7 ngay ke tir khi cd trieu chiTng dau tien ciia benh va du'dc lam chan doan dien - than kinh trong giai doan nay. Tieu chuan loai trir la nhij'ng benh nhan den mudn sau 7 ngay dau eua benh va khdng du'dc chan doan dien - than kinh trong 7 ngay dau.

2. Phiftfng phap nghien cuii: Chung tdi tien hanh nghien ciTu theo phu'dng phap md ta

eat ngang. Cac benh nhan tham gia nghien ciru du'dc hdi benh, tham kham lam sang ti mi va thi/e hien chan doan dien - than kinh. Tat ca benh nlian deu du'dc tien hanh cac xet nghiem cd ban bao gom: cdng thii'c mau ngoai vi, sinh hda mau: dien glal d d , men cd, men gan, chitc nang than, ddng mau cd ban. Tat ea cac tru'dng hdp deii du'dc iam xet nghiem djch nao - tiiy trong vdng 7 ngay dau tien ciia benh.

Cac dii' lieu nghien cdu duWc dien vao mau benh an nghien euli thdng nhat, nhap va xCf ly so lieu su'dung phan mem thdng ke y hgc SPSS 16.0, III. KET QUA NQHIEN CU'U

1 . Dac diem nhom nghien cu'u:

< 20 tuoi 21 - 30 tuoi 3 1 - 4 0 tuoi 41 - 50 tuoi 51 - 60 tuoi 61 - 70 tuoi

>70 tuoi Tong

Nam So benh

nhan 3 6 4 7 1 0 0 2 1

Ty le (%) 7,5 15,0 10,0 17,5 2,5

0 0 52,5

Nir So benh

nhan 0 7 2 4 4 1 1 19

Ty le (%) 0 17,5

5,0 10,0 10,0 2,5 2,5 47,5

Tong So benh

nhan 3 13 6 11 5 1 1 4 0

Ty le (%) 7,5 32,5 15,0 27,5 12,5 2,5 2,5 100 Nhan xet: Ty le benh nhan nam (52,5%) gap nhieu hdn nu' (47,5%)su' khac biet nghia tiiong ke (vdi p > 0,05). Nhdm 21 den 30 tudi ehiem ty le eao nhat (32,5%), sau 41 - 50 tuoi (27,5%). Tuoi trung binh la 38,2 ± 13,6.

3. T r i f u chu'ng khdi phat

khdng eo y dd la nhdm

Sau phau thuat Khonq ro tien trieu

Tong so

2 14 4 0

5,0 35,0 100 Nhanxet'Tien trieu hay gap nhat la nhiem khuan hd hap chiem 30%, sau dd la nhiem khuan tieu hda (20%). Cd 35% benh nhan khdng rd tien trieu.

4 . Pac diem yeu ctf

[ . :Nh0n xet: Da so benh nhan (50%) khdi

^ h l t benh bang te bl tay chan, 30% benh nhan m ^ l a t hien yeu tay ehan ngay tir kht khdi phat.

paC kieu khdi phat tu' than kinh sp nhu' nham mat khong kin (liet VII ngoai vi) hay nhin ddi (Net van nhan) ciing chiem 10%.

2. TiSn trieu:

Tien trieu Nhigm khuan ho hap Nhiem khuan tieu hoa Sot, viem nhiem khac

So benh nhan

12 8 4

T y i e

»/o 30,0 20,0 10,0

Trieu chu'ng

Yeu chi

Tinh chat doi xijYig t a y - chan

Khonq veu chi Co yeu chi

U'u the ngon chi LTu the goc

chi Tonq Yeu ttr chi bang

nhau Yeu u'u the tay Yeu UTJ the chan

Tong

So benh nhan

11 4

25 40 13 5 22 4 0

TyiS

•A 27,5 10,0 62,5 100 32,5 12,5 55,0 100

Nhan xet: Co 72,5% benh nhan co bieu hien yeu cd trong tuan dau ciJa benh, ty le.yeu cd u'u the 6 goc chi chiem 62,5%, chi 10% ylu

TAP CHi Y HOC VI^T HAM TAP 465 - THAHG 4 - SO 2 - 2018 Cd u\j the d ngpn ehi. Yeu cd uli the d chan

chiem da sd vdi 55% sd tru'dng hdp, chi 12,5%' yeu u\i the cd tey, 100% yeu cd ddi xdng hat ben cd the.

5. Phan xa gSn - xu'tfng

Nh$n xet: Phan xa gan - xu'dng giam, mat d 77,5% chiem ty le eao hdn nhdm cd phan xa gan -xu'dng binh thu'dng (22,5%). Khac biet cd y nghTa thdng ke (vdi p < 0,05).

6. R O I io

TSbi Kien bo Bono rat Dau nhCrc cd khdp Khong roi ioan cam giac Td'ng

Nhan x£

an cam giac So tru'dng

h*p 25 4 0 2 9 40 t: Co tdi 77

chil quan T y l i

»/o 62,5 10,0

0 5,0

22,5

100

5% ben

»/o

77,5

22,5 P = 0 , 0 0 1 h nhan cd rdi loan cam giac chii quan trong giat doan sdm. Rot loan cam giac kieu te bi chiem 62,5%.

7. Liet than kinh so - nao

Nhan xet: Ty leliet day VII cao nhat chiem 27,5%,'liet day IX, X chiem 15%, liet I I I - IV - VI gap d i o % sd benh nhan.

8. Rian ly pn^ein te bao trong dich nao - tuy

Nhan xet: 65% benh nhan cd bleu hien phan ly protein - te bao trong djch nao - tiiy.

Djeh nao - tiiy khdng phan ly protein - te bao chiem 35%.

IV. BAN LUAN

Hot chu'ng Guillain - Barre la nguyen nhan hang dau gay liet mem cac chi cap tmh tien trien, tuy nhien trong giai doan dau eiia benh, cae trieu chuYig tam sang thu'dng khdng dien hinh khien ehan doan va dieu tri sdm benh edn gap nhieu khd khan. 6 Viet Nam, chu^ cd nhieu nghien ciTu phan tich dae diem lam sang ciia benh trong giai doan sdm nay.

Du" lieu nghien ciiXi ciia chung tdi cho thay, trong 40 benh nhan du'dc ehpn vao nghien eiru, sd benh nhan nam (52,5%) gap nhieu hdn benh nhan nu' (47,5%). Benh gap d hau het cac lu'a tudi, trong dd hay gap nhat d nhdm tuoi 21 - 30 (32,5%) sau dd la nhdm 41 - 50 tudi (27,5%).

Tudi trung binh ciia nhdm nghien cdu la 38,2 ± 13,6 tudi. Tru'dc kht khdi phat cac trieu chutig than kinh, 30% benh nhan ed tien trieu la nhiem khuan du'dng ho hap, 20% nhiem khuan tieu hda, 10% cd cac bieu hien nhilm khuan khac.

Cac ket qua nay phii hdp vdi cac nghien eiTu trong va ngoai nu'dc [ 3 ] .

Ve trieu chii'ng khdi phat benh: 50% benh nhan bat dau khdi phat bang te bi tay chan, 30% benh nhan yeu ed, cac bieu hien liet than kinh so nhu' nhin dot, sup mi chiem 20%. Den cuoi tuan dau cua benh, ty le benh nhan cd yeu cd la 72,5%. Nhu' vay van cd tdt gan 30% cac tru'dng hdp khdng ed bleu hien yeu cd trong tuan dau tien. 6 nhutig benh nhan cd bleu hien yeu cd, da so benh nhan (55%) cd yeu cd hat chan u'u the hdn hat tay, 100% cd sir dot xirng gida hat ben ed the. Cae ket qua nay phii hdp vdi cae dac diem du'dc ghi nhan trong y van cung nhu' cac nghien eiTu tru'dc day [ 3 ] .

VIETHAM MEDICAL JOURNAL H''2 - APRIL - 2016 Mat phan xa gan - xu'dng la trieu chu'ng rat

quan tn?ng va rat thu'dng gap d benh nhan mac hpi chii'ng Guillain - Barre. bay la mdt dau hieu quan tnDng giup ngu'di thay thudc lam sang hu'dng d§n ehan doan hdi chu'ng Guillain - Barre [4]. Trang nghien ciru eiia ehung tdi, phan xa gan - xu'dng giam hoac mat d 77,5% nhu'ng van edn bao tdn d 22,5% tru'dng hdp. Oieu nay khien cho viec chan doan xae djnh tren lam sang gap khd khan d ^A so benh nhan.

Rdi loan cam giac chii quan gap d 77,5% sd benh nhan, thu'dng gap nhat la te bi (62,5%).

Liet eac day than ktnh sp cung la trieu chu'ng thu'dng du'dc ghi nhan d nhiitig benh nhan mac benh viem nhieu re va day than kinh cap tinh.

Trong nghien cirtj nay, liet day than ktnh VII ngoai vi la hay gap nhat, cliiem t^ le 27,5%.

Xet nghiem djch nao - tiiy la xet nghiem ddng vai trd rat quan trpng trong chan doan benh nhiit la khi phu'dng phap chan doan dien - than kinh ehu^ du'dc ap dung rdng rai [5].Trong nghien ciTu eiia chimg tdi, 100% benh nhan du'dc xet nghiem dich nao - tiiy, vdi 65% benh nhan cd phan iy protein - te bao, cd 35% benh nhan chu^ cd bien dot bat thu'dng trong xet nghiem djch nao - tity trong tuan dau ciia benh.

V. KET LUJ^N

Hot ehutig Guillain - Barre vdi trieu ehiTng lam sang noi bat la yeu cd cae ehi kieu ngoai vi, giam hoae mat phan xa gan - xu'dng, phan ly protetn- te bao trong djeli nao - tuy va thu'dng cd cac bieu hien rot loan cam giac chii quan. Tuy nhien trong giai doan sdm cua benh, gan 30% benh nhan ed trieu ehirng lam sang ed the khdng day du va dien hinh.Oieu nay gay khd khan trong chan doan xac dinh va dieu tri sdm cho benh nhan neu ehi di/a vao trieu ehirng lam sang va xet nghiem dich nao - tiiy.

TAI LIEU T H A M KHAO

1. Asbury A.K (2000), New concepts of Guillain - Barre syndrome, J Child Neurol, 15(3), 183-191.

^. McGrogan A., Madle G. C , Seaman H. E,et al (2009). The epidemiology of Guillain-Barre syndrome worldwide. A systematic literature review. Neuroepldemiology, 32(2), 150-163.

3. Chroni E, Papapetropoulos S, Gioldasis G, et al (2004), Guillain - Barre syndrome In Greece;

seasonality and other clinico -epidemiological features, Eur J Neurol, 11(6), 383-388.

4. Nguyen Tuan Lu'dng (2011), Nghien cuU d$c diem lim sang vp dien smh ly than kinh cua binh nhin viim da re vi diy than kmh cip tmh, Liian van Thac si Y hoc, Dai hpc Y Ha Noi.

5. Fokke C, van den Berg B, Drenthen J, et al (2014), Diagnosis of Guillain - Ban^ syndrome and validation of Bnghton cntena, asm, 137(Pt 1), 33-43.

DANH GIA KIEN THITC, THAI DO CUA CHA/ME HOAC NGirai CHAM SOC CHINH VE PHAT HIEN SffM KHUYET TAT

tf TRE EM TAI HUYEN QUYNH PHU T I N H T H A I BINH Pham Thi Tinh*, Pham Thi Dung*, Pham Bich Phirong*

T O M TAT

Muc tieu: Tim hieu kien thCfc, thai do ciia cha me/ngu'di hoac ngu'di cham sdc chfnh ve phat hien sdm khuyet tat ii tre em tai huyen Quynh Phu, tiiih Thai Binh, tir do xay di/ng ke hoach trang bj cac kien tiiirc, ky nang ve phat hien sdm khuyet tat d tre em cho cac doi tuong nay. Phddngj/hip: Nghien culi mo ta cat ngang 182 bo/me (hoac ng^Udi cham sdc chinh) trong cac gia dinh cd tre 0 - 6 tuoi bi khuyet tat trong toan huyen. Ket qui nghien cdu: Ty le doi tu'dng nghien ciJU co kien thirc diing ve khuyet tat diiem 51,6%j^ Kien thu'c diing ve phat hien sdm khuyet tat chiem 47,8%. 60,4% ddi tu'dng nghien eiru

*Trudng Dal hoc YDudc Thii Binh Chiu traeh nhiem chinh: Pham Thi Tinh Email: phamtinh_ytb@yahoo.eom Ngay nhan bai: 6.2.2018 Ngay phan bien khoa hoc; 28.3.2018 Ngay duyet bai: 10.4.2018

chon diing do tuoi de phat hien sdm khuyet t|it 6 tre em. 51,6% doi tu'dng nghien ciru cho rang phat hien sdm khuyet tat de can thiep sdm. Nhan li/c ttiam gia phat hien sdni khuyet tat du'dc \iia chon nhiieu nhat la can bo yte (97,8%).

Td khoa: Tre khuyet tat, phat hien sdm khuyet tat.

SUMMARY

AN EVALUATION ON KNOWLEDGE, ATTITUDES OF PARENTS OR PRIMARY CARETAKERS ON EARLY DETECTION OF DISABIUTY I N CHILDREN I N QUYNH PHU

DISTRICT, T H A I B I N H PROVINCE Objectives: To study the knowledge and attitudes of parents or caretakers on early detection of childhood disability in Quynh Phu district. Thai Binh province, and to develop a plan to equip these subjects with knowledge and skills on early detecting disability in children. Methods: A cross-sectional study was carried out onl82 parents (or primary

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