NGHIEN CU'U KHOA HOC
DANH GIA KHUC XA NHAN CAU
TREN TRE CO BENH VONG MAC TRE DE NON
C va TitiBich Thuy*, Nguyin Vdn Huy* J
TOM TAT
Muc tieu: ddnh gid tinh hinh tdt khuc xg tren tre co benh vong mac tre de non dugc khdm, diiu tri vd theo doi tai Binh viin Mdt Trung uong vd nhdn xet ty li tdt khuc xg giiea nhom cdn diiu tri vd nhom tu thodi trien.
Doi tuong va phuo'ng phap: 58 tre co benh ROP dugc khdm, diiu tri vao theo doi tai Binh viin Mdt Trung uang vd diegc xdc dinh khuc xg bdng phuang phdp soi bong dong tie Thiit ki nghiin eim mo td Idm sdng tiin eim, khong co nhom chimg.
Ket qua: 58 tre vdi 114 mdt do dugc khuc xg, trong do ty li co tdt khiic xg Id 96,5%, can thi 37,7%, viin thi 30,7%, loan thi 28,1%, lech khiic xg d 39,7% so binh nhdn. Ty li can thi khde nhau giiea hai nhom cdn dieu tri vd khong cdn dieu tri (nhom tu thodi trien) 61,1% vd 16,6%. Miic do can thi cao (>-5D) d nhom cdn dieu tri Id 84,3% vd d nhom tu thodi triin la 15,7%o. Ty li thi luc >8/10 trudc chinh kinh Id 7,2% vd sau chinh kinh la 23,6%.
Ket luan: Can thi Id tdt khiic xg hay gap d tre co binh vong mac tre de non. Ty li vd miic do can thi CO khac nhau giiea nhom cdn dieu tri vd nhom tu thodi triin.
Tir khoa: binh vong mac tre de non.
I. DAT VAN DE
Benh vdng mac tre de non (Retinopathy of Prematurity - ROP) cdn gpi la xa san sau thi thuy tinh. Day la mot tinh trang benh Iy ciia mit do su phat trien bat thudng ciia mach mau vdng mac.
Benh thudng xay ra d nhung tre de thieu thang, nhe can va dae biet la cd tien su thd oxy cao ap keo dai.
Neu khdng dupe phat hien va dieu trj kjp thdi benh cd the dan den mil loa do td chire xa tang sinh, co keo gay bong vong mac. Tuy nhien, nhilu tre em mac dil da dugc dieu trj tot, benh thoai triln hoan toan sau dieu trj nhung ket qua vl mat chiic nang van rat han che do tat khiic xa va nhugc thj. Do vay, viec nghien cuu ve tinh trang khiic xa d tre '^Benh vien Mdt Trung uang
mac benh vong mac tre de non nham hoan thien chu trinh dieu trj la het siic can thiet.
Nghien ciiu nay nham 2 muc tieu
/. Ddnh gid tinh trgng khiic xg trin tre mac benh vong mac tre de non dugc khdm, diiu tri vd theo doi tai Binh viin Mdt Trung uang.
2. Nhdn xet ty li tdt khuc xg giUa nhom cdn diiu tri vd nhom tu thodi triin.
II. DOI T l / O N G VA P H i r O N G P H A P 1. Doi tuong nghien ciiu
Tat ca nhung tre cd benh vong mac tre de non dugc kham, dieu trj va theo ddi tai Benh vien Mit Trung uang tir nam 2001.
NGHIEN CU'U KHOA HOC
1.1. Tieu chudn liea chgn binh nhdn nghiin cieu - Tre cd benh vong mac tre de non cd dieu kien kham va theo doi diy du.
- Tudi khi nghien ciiu > 2 (cd thi phdi hgp do dugc khuc xa)
1.2. Tieu chudn loai trie binh nhdn
- Tre bj ROP nhung kem theo cac benh tai mit va toan than, cham phat trien tri tue khong cho phep tham kham va do khuc xa.
2. Phuong phap nghien cuu 2.1. Thiit ki nghiin ciiru
Day la nghien ciiu mo ta lam sang khong cd doi chiing, tien ciiu.
2.2. Phieang tiin nghiin ciru
Phuang tiin khdm mdt: phuong tien kham mit, phuong tien do khuc xa cd san tai Benh vien Mat Trung uong.
Phucmg tiin theo doi: phieu nghien ciiu ROP cua khoa Mit tre em.
2.3. Cach thiec nghien cieu Khdm idm sdng
Hdi benh: kham benh danh gia tinh trang nhan cau, van nhan, day mat
- Do khiic xa bang phuang phap soi bdng ddng tli.
Tra 2 gigt dung djch Cyclogyl 1 %o trudc khi do 45 phut, khoang each giira 2 lan tra thudc la 10 phiit.
Danh gia tinh trang tat khuc xa: Gia trj tat khuc xa dugc xac djnh bang gia trj ciia tuong duong cau (spherical equivalent: SE)
SE = eiu-H/2fru
- Xac dinh la can thi khi SE < 0,00D, can thj cao khi SE > - 5D, viin thj khi SE > 0,00D, viin thj cao khi SE > + 3D, loan thj khi dp loan thj > ID va lech khuc xa 2 mat khi chenh lech so D giira 2 mit > ID.
Xielysolieu
Cac sd lieu, nhan xet dugc ghi chep chi tilt vao m i u benh an sau do tap hgp va xu ly so lieu
theo thuat toan thong ke y hgc, test yj (vai sir trg giiip cua phan mem Epi - Info 6.0).
III. KET QUA VA BAN LUAN 1. Dac diem benh nhan
1.1. Bac diim binh nhdn theo gidi, tuoi
Khi tien hanh do khuc xa 116 mat cua 58 benh nhan chi do dugc 114 mat chiem 98,27%), cdn hai mat khong do dugc khuc xa do giac mac chop va cd ket qua sieu am true nhan cau dai.
Sd benh nhan nam la 32 (55,2%) va nii la 26 (44,8%).
Ti le nam - nii khong cd su khac biet ed y nghTa thdng ke(p> 0,05).
Khi so sanh vdi cac nghien cun khac ve benh vong mac tre de non, ty le cua chung toi ciing tuong ddng vdi cac tac gia.
Bdng 1. Ty li nam - nie trong cdc nghiin cieu cda cdc tdc gid
^^^^^^^^ Tyle Tac gia ^~^^~~~,^^^
Larsson (2002) Phan Hdng Mai (2006) Lermann (2006)
Nguyen Xuan Tinh (2008) [1]
N.V.Huy (2009)
Nam 52,8%
53,3%
43,0%
53,1%
55,2%
Nu 46,2%
46,7%
57,0%
46,9%
44,8%
Ty le %
2 3 4 S 6 7 Tu6i
Biiu do 1. Ddc diim binh nhdn theo tuoi Tuoi nhd nhat trong nghien ciiu la 2 tuoi, tuoi ldn nhat 7 tudi, dp tuoi hay gap tir 3 - 5 tuoi.
NGHIEN CU'U KHOA HOC
1.2. Sd mdt theo nhom diiu tri vd tu thodi triin Trong nghien ciru nay cd 54 mat (46,5%o) phai dilu tri va 62 mit (53,5%)) khdng dieu trj ma tu thoai trien. Nhu vay, khong phai toan bp benh vong mac d tre de non deu can phai phau thuat ngay d thdi diem tre con qua non yeu ma cd mot ty le rat Idn benh co the tu thoai trien.
2. Tinh trang tat khiic xa
2.1. Suphdn bo cdc loai tdt khiic xa
Trong so 114 mat do dupc khuc xa chi cd 4 Bdng 2. Ty ii can d tre
mat (3,5%o) la chinh thj, hay gap nhat la can thj 43 mit (37,7%), viin thj 35 mit (30,7%) va loan thj 32 mat (28,1 %)). Nhu vay, ty Ie tat khuc xa trong nhdm dieu trj va ca nhdm tu thoai trien rat cao 110/114 mat, chiem ty le 96,49%). Dieu nay cho thay sir can thiet kiem tra muc dp khuc xa d tre de non ngay khi ed the giiip tranh dugc nhugc thj va lac sdm.
Khi nghien ciiu tinh hinh khuc xa d tre de non, mac dil cd su khac biet ve ty le can thj nhung cac tac gia deu dua ra nhan djnh chung la: trong sd mat khong chinh thj thi ty Ie can thj la cao nhat. \ j^ r de non titeo cdc tdc gid
~~~--...,__^ Tat khiic xa
Tac gia ~~-~~~-,._^^
Nissenkorn(1983)[5]
DarIow(I997) Choi (1999) [4]
Nguyin Xuan Tjnh (2008) Nguyen Van Huy (2009)
Can 50%
2 1 % 67,2%
26,2%
37,7%
Vien
18%
30,7%
Loan
11%
28,1%
Chinh thj
3,5%
2.2. Tmh itinh lieh khdcxa
Bdng 3. Phdu bd lech khiic xa theo binh nhdn Lech khiic xa
Cd Khong Tong
So benh nhan 23 35 58
Ty le % 39,7 60,3 100,0
^~^~-^^ Nhom Tat ^ - - - ^ ^ ^ kliiJC xa ^ ~ ^ ^ ^
Loan thj Chinh thj Tong
Dieu trj 14(26,0%)
0 (0%) 54(100%)
T u thoai trien 18(30,2%)
4 (6,6%) 60(100%) Bang tren cho thay cd 23 benh nhan bj lech
khiic xa (39,7%) va 35 benh nhan khdng bj lech khuc xa (60,3%).
2.3. Tdt khuc xg theo nhdm diiu tri vd nhdm tu thodi triin
Bang 4. Phdn bo tdt khiic xa titeo nhom diiu tri vd nhom tu thodi triin
^ ^ ^ Nhom T a t ^ ^ ^
kliiJc xa ^ ^ ^ ^ ^ Can thi
Vien thi
Dieu trj 33(61,1%)
7(12,9%)
T u thoai trien 10(16,6%) 28 (46,6%)
Trong sd 54 mat da dieu tri, cd 33 mat bj can thj (61,1%)), d nhdm benh tu thoai trien ty Ie nay la 16,6%). Su khac biet nay cd y nghTa thdng ke (p < 0,05). So sanh vdi cac nghien ciiu trude day diu nhan thay nhiing mat phai dieu trj cd ty le bj can thj va muc do can thj cao hon so vdi nhung mit khdng cin dieu trj benh tu thoai trien. Trong nghien cuu cua chiing toi, d nhirng mat dieu trj laser, ty le can thj la 61,1%), cao hon rat nhieu so vai nhung mit tu thoai trien la 16,6%). ' •'*'•- ''*''
NGHIEN CLTU KHOA HOC
Bdng 5. Ty ii can tiii d nhdm diiu tri titeo cdc tdc gid
^~~~~~~~---..__^^ Can thj Tac gia ^~""~~-~-~-,_^^
K.Algawi(1994) M. Okeefe(1996) Tianna(I997) Choi (1999) Ospina
E.M Cloone(2000) Nguyen Van Huy (2009)
Tyle 40,0%
45,5%
71,0%
67,2%
62,0%
50,0%
61,1%
Ty Ie can thi d nhdm dieu trj trong nghien cuu ciia chiing tdi cao hon cua K. Algawi (1994) va M. Okeefe (1996), thip hon Tianna (1997) va gan tuong duong vdi mot sd tac gia khac nhu Choi (1999), Ospina [3], [4], [6].
Bdng 6. Pitdn bo muc dp can thi nhom diiu tri vd niidm tu thodi triin
^^^^~~-~..,_^^ Nhom Tat khiic x^r"~~~--^.^
SE <-5D
>-5D MSE
Dieu trj 31 (68,9%) 14(31,1%)
-4,87D
Khong dieu trj 16(84,3%)
3(15,7%) - 2,22D Muc dp can thj cao d nhdm dieu trj la 82,4%), nhdm tu thoai trien la 17,6%, su khac biet cd y nghTa thong ke (p < 0,05).
Khi tinh tlieo tuong duong cau chung toi nhan thay muc dp can thj trung binh d nhom phai dieu trj la- 4,87D cao hon nhdm benh tu tlioai trien -2,22D. Su khac biet cd y ngliTa thdng ke (p < 0,05). Ket qua cua chiing toi gan tuong tu vdi ket qua ciia Shani va Choi. Ty Ie can thj cao trong nhdm dieu tri trong nghien cuu cua Choi (1999) la 26,2% va ciia Shani (2004) la 29,6%.
2.4. Tmh itinh thi iiec
Bdng 7. Phdn bo tiii iuc Thj luc
So mat Ty le %
Khong kinh
<3/10 28 54,9
3/10 <
<8/10 19 37,2
>8/10 4 7,2
Co kinh
<3/10 18 35,3
3/10 <
<8/10 21 41,1
>8/10 12 23,6 Trong so 51 mat thu dupe thi Iuc, cd 28 mat thj Iuc < 3/10 chilm ty le 54,9%o, so mit cd thj lire til- 3/10 < 8/10 la 19 mit chilm 37,2%, chi cd 4 mit thj lire > 8/10 chilm 1,2%,. Sau khi dugc chinh kinh, sd mat cd thj luc < 3/10 giam di dang ke cdn 18 mat chiem 35,3%), so mat cd thj Iuc tu 3/10 din 8/10 la 21 mat chiem 4,1%), cd 12 mat dat dugc thi luc > 8/10 chilm 23,6%). Dilu nay cho thiy, viec xac djnh khiic xa va chinh kinh sdm la het sue can thiet de tranh nhugc thj.
IV. KET LUAN
• 96,5%) sd mat ciia tre cd benh ROP do dupe khiic xa khi d dp tudi > 2 tuoi.
• The loai tat khiic xa hay gap nhat tren tre de non la can thj chilm 37,7%) va lech khuc xa chilm 39,7%.
• 0 nhdm treed benh ROP can dilu trj, ty le can thi la61,l% v a d t r e nhdm cd benh ROP tu thoai triln la 16,6%.
• Viec xac djnh khuc xa va chinh kinh cho tre co benh ROP la hit sue cin thilt, 7,2% s6 mit co thj luc
> 8/10 trudc khi chinh kinh, ty le nay sau chinh kinh la 23,6%.
NGHIEN CLfu KHOA HOC
TAI LIEU THAM KHAO
1. NGUYEN X U A N T I N H (2008), Nghien cina dac diem ton thuong benh vong mac tre de non va hieu qua dieu trj cua laser, Ludn dn tiin syy hgc, Trudng Dai hgc Y Ha Ngi.
2. ALGAWI K, GOGGIN M AND O'KEEFE M (1994), "Refractive outcome following diode laser versus cryotherapy for eyes with retinopathy of prematurity.", British Journal of Ophthalmology, 78:612-614.
3. MI YOUNG CHOI, IN KI PARK, YOUNG SUK YU (2000), "Long term refractive outcome in eye of preterm infants with and without retinopathy of
prematurity: comparision of keratometric of value, axial length, anterior chamber depth, and lens thickness.", British Journal of Ophthalmology, M: 138-143.
4. NISSENKORN I, YASSUR Y, MASHKOWSKl D, SHERF I AND BEN SIRA 1 (1983), "Myopia in premature babies without retinopathy of prematurity", British Journal of Ophthalmology, 61: 170-1973.
5. ROBINSON R., O'KEEFE M. (1993),
"Follow-up study on premature infants with and without retinopathy of prematurity", 5n7/5/zJbMr«(3/
of Ophthalmology, 11: 91-94. ,; •
SUMMARY
EVALUATION OF REFRACTIVE ERRORS THE EYES WITH RETINOPATHY OF PREMATURITY (ROP)
Aims: to assess the situation ofractive enoy on children with Rop examined and Teated in vnio.
M.tt\\oAs: 58 kids with treated ROP are assessed using by retinoscopy method. j Results: myopia comes first at 96.5%, small eye or hyperopia the second at 31%, then astigmatism at
28%. Note that nearly 40% of eyes acquired anisometropia. Eyes with laser treatment have higher incidence of refractive errors than those with spontaneous regression and no treatment. However, wearing glasses continues to be a helpful method in 30% of abnormal eyes.
Conclusion: myopia is the common refractive error in eyes with treated ROP.
Key words: retinopathy of prematurity (ROP).
