Y HQC VigT NAM THANG 5 - SO 1/2013 trong khi HDPN mach tang len 130,2 ± 18,06
( p < 0,05). Ket qua nay cung tUdng tU so vdi cac ket qua nghien cUu cua Grasso, Wofgang Oczenski, Xiu ming [ 4 ] , [ 7 ] . Do vay ehung toi thay rang HDPN bang CPAP 40/40 la thii thuat an toan.
V. KET LUAN
Thii thuat HOPN CPAP 40/40 gliip cai thien oxy hda mau d BN ARDS, dac biet d nhuHg BN dUde TXhTT trcing 2 ngay dau. Trong nghien cdu eiia chiing tdi oxy hda mau tang 33% so vcfi trUdc HDPN va hieu qua ciia cai thien oxy hda mau keo dai 3 gid.Thii thuat HDPN CPAP 40/40 an toan, trang nghien euli eiia chiing toi khong gap cac bien ehimg nguy hiem nhUTKMP, va roi loan nhip tim. Gap bien ehirtig nhe thoang qua d thdi diem HDPN nhU tut HA, sau HOPN HA trd ve binh thUdng.
TAI LIEU T H A M K H A O
1. Bui NghTa Thjnh (2003), BUdc dau danh gia hieu qua thii thuat huy dong phe nang trong thong khf nhan tao d benh nhan ARDS, Luan van Bac sy noi tru
b^nh vifn chuySn nganh H6i sUc cap cuU, Tru^
D^ihgc YHa NOI.
.L. Borges J. B. MD; Amato H. B. (2006), "Reversibility of Lung Collapse and Hypoxemia in Early Acute Respiratory Distress Syndrome", Amencan Joum^ of Re^ratory and Oidal C^re Medidne, 174: 268 - 278.
3. Constantin 3M, Jaber S, Futier E, et ai, (2008)"
Respiratory effects of different recmiment maneuvers in acute respiratory distress syndrome"
Crit care. 12 (2): R50.
4 Grasso S, Mascia L, Del Turco M, et al, (2002),"
Effects of recruiting maneuvers in patient with acute respiratory distress syndrome venblated with protective ventilatory strategy" y^nestfjesw^/, 96: 795-802. «.
5 Lapinsky S.E., Aubin M, Mehta S., et al, (1999),
"Safety and efficacy of a sustained inflation for alveolar recruitment in ARDS", Intensive cars Medicine,2S, 1297-301.
6. Moran I , Mancebo J, Suarez F, et al, (2011)"
Acute physiologic Effects of a stepwise recmiment maneuvers in acute respiratory distress syndrome"
Minerrva medica.
7. Oczenski W, Hermann C, et al, (2005), Recruiment maneuvers dunng prone positioning in patients with acute respiratory distress syndrome"
CritCareMed, 33(1):54-61.
DANH GIA THUC TRANG TRE RAI NAO 0-5 TUOI TAI RENH VIEN NHI HAI DimNG NAM 2012
TOM T A T
Bai nao la nhom roi loan than kinh trung Udng do ton thuong nao khong tien tnen tac dpng vao eac giai doan trUdc, trong, va sau khi sinh cho den 5 tuoi vdi hau qua de Iai la nhij'ng bat thudng ve van dong, tam than, hanh vi va giac quan [1], [3]. Nghien cUu mot so dac diem ciia 75 tre bai nao tir 0-5 tuoi benh vien Nhi Hai DUdng nam 2012. trong do ty le nam / nU la 4/1. Tre bi bai nao >1 - 2 tuoi la eao nhat (56%) va do tuoi > 2 - 3 CO ty le thap nhat (5,3 % ) . Tre mac bai nao d nong thon (62,7%) cao hdn 6 thanh thi (37,3%), Tre bai nao dUcfc phat hien thong qua cac dau hieu nhan biet sdm: Tre cham phat tnen (94,7%); Kho be Sm (89,3%); Bii sac, bii kho (65,3%); Co cUng (61,3%);
MUm nheo (38,7%). Tre bai nao la con dau long ehiem ty le cao nhat (80%). Mgt so yeu to nguy cd gay bai nao, gom cac yeu to thupc ngUdi me: Tuoi ciia me khi sinh tre tren 35 co ty le con bi bai nao eao nhat (14,7 %) va me la nong dan sinh eon bi bai nao chiem ty le cao nhat (46,7%). Nguyen nhan gay bai nao co
* Tru'dng Dai hoc Ky thuat Y te'Hai DUOng Phan bien khoa hoc: PGS.TS. Vu Dinh Chinh 118
Pham Thj Nhuyen*
ty le khac nhau trong timg nhom, trUdc khi sinh;
14,7%i, Trong khi sinh: 65,3%. Sau khi sinh: 9,3 %va chua ro nguyen nhan: 10,7%.
Til* khoa: Bai nao, Benh vien Nhi, Hai DUdng
SUMMARY
Cerebral palsy is a group of central nen/e system disorders by brain damage does not progress to the stage of impact before, during, and after birth through age 5 with the consequences for the motor abnormalities, mental , senses and behavior [1], [3].
Research some of the characteristics of 75 children with cerebral palsy aged 0-5 Children's Hospital of Hai Duong in 2012. in which the proportion of male / female is 4 / 1 . Children with cerebral palsy > 1-2 years old was the highest (56%) and age > 2-3 has the lowest percentage (5.3%). Children with cerebral palsy in rural areas (62.7%) than in urban areas (37.3%).
Children with cerebral palsy are detected through early identification: Child grovrth retardation (94.7%); was
Y HOC VIET NAUfl THANG 5 - SO 1/2013 identification: Child growth retardation (94.7%); was
difficult holding (89.3%); Suck choking, difficulty breastfeeding (65.3%), have the same (61.3%); Soft bland (38.7%). Children with cerebral palsy is the first child the highest proportion (80%). Some risk factors of cerebral palsy, including elements of the mother, maternal age younger than 35 with the rate of cerebral palsy was highest (14.7%) and parents are farmers birth palsy brain accounts for the highest percentage (46.7%). Causes of cerebral palsy have different proportions in each group, before birth: 14.7%, while birth:
55.3%. After birth: 9.3%j, and unknown causes' 10.7%.
I.
OAT VANo f
Bai nao la mgt dang da tan tat nang ne duTig vi trf hang dau trong mo hinh tan tat d tre em. Ti le mac bai nao: khoang 2/1000 tre smh ra song; chiem khoang 3 0 - 4 0 % tong so tre khuyet tat [2], [ 7 ] . Tre bai nao khong the vui ehdi, hpc tap nhu' eae tre khae, khong the t i / cham soc ban than, la ganh nang cho gia dinh va xa hpi. Tuy nao da ton thu'dng khong t r d lai binh thu'dng difdc nhu'ng phat hien sdm, dieu tri sdm, ap dung eae bien phap phue hoi chirc nang phii hdp se giup nhieu tre bai nao cd the hda nhap eong dong va doe lap trong sinh hoat hang ngay [2], [7]. Tai tinh Hai Du'dng, chu'a cd tae gia nao nghien cu'u day dii ve tre bai nao, vi vay nghien etiu de tai: "Danh gia thdc trang tre bai nao 0-5 tudi tai Benh vien Nhl Hai Dddng nam 2012"\a thi/e s i / can thiet. Muc tieu nghien ciTu:
1. Mo ta dac diem eiia tre bai nao tai Benh vien Nhi tinh Hal Du'dng. 2. Khao sat yeu to nguy ed ciia tre bai nao tai Benh vien Nhi tinh Hai Du'dng.
It. oo'l n / d N G VA PHUONG PHAP NGHIEN CCfU 1 . t>\a d i e m : Benh vien Nhi Hai Du'dng.
2. Thdi gian nghien cii'u: nam 2912 3. D61 tu'dng nghien cii'u: 75 tre bai nao td
• 0-5 tuoi va dude si/ dong y eiia than nhan.
Dau hliu chan doan [ 3 ] :
-Cham phat trien van dong tho: eham lay, ngoi, bo, quy, dirng, d i .
- Cham phat trien van dpng tinh: ky nang sir dung ban tay.
- Cham phat trien ky nang giao tiep va ngon ngD"(trong 12 thang dau).
- Cham phat trien tri tue: cham tiep thu, hoe kilo khan hoac khong di hgc.
- Roi loan dieu hda cam giac.
- Liet cac day than kinh so nao: co the lac, sup mi, mil, diec, meo mieng...
- Cac dau hieu khac; tre bai nao eo the bj cong veo cot song, dong kinh
Mot so yiu to nguy cd gay bai nao [5]:
me tuoi cao, me Iao ddng nang nhoc - Nguyen nhan: tru'dc sinh, trong sinh, sau smh va chu'a ro nguyen nhan.
4. Thiet ke nghien cii'u: Mo ta eat ngang, 5. Cac bu'dc tien hanh:
- Phan chuan bf: Thiet ke bg eau hdi, tap huan dieu tra vien thir nghiem bg eau hdi, ehinh sira bo eau hoi va in an bp cau hoi,
- Phan thu thap thong tin: Oieu tra vien sir dung bo cau hdi de tthu thap so lieu du'di si/
giam sat ciia giang vien Khoa Vat ly tn lieu/Phue hdi ehire nang.
- Van de dao ddc trong nghien cdu: Cae thong tin thu thap du'dc gitT bi mat. Nghien eiru du'dc su' dong y eua ban than va gia dinh eiia tre Bai nao.
- Xd ly so lieu: So lieu du'dc ma hoa va xd ly bang phan mem thong ke SPSS 16.0. thuat toan du'dc diing la thong ke so lu'dng, ty Ie %.
III. KET QUA NGHIEN COU
1 . Mpt so dac diem ciia tre bai nao trong nghien cii'u:
Bang 1 : Phan bd' ty le mac bai nao theo gidi:
Gidi Nam Nif Tonq
So ll/dnq 60 15 75
TV leCVo) 80 20 100 Nhan xet Ty le mac bai nao ed su" khac nhau giCa nam (80%) va nti' (20%)
Bang 2: Phan bo ty le mae bai nao theo tuo'i Nhom tuo'i So Itfdng Ty le ( % )
0 - 1
• 1 - 2
Tong 18 42
24 56
Nhan xet: Ty le tre mae bai nao trong dd tud'i 1 - 2 la cao nhat {
Bang 3: Phan bd ty le mac bai nao theo khu vu'c:
Kliu VlfC Thanh thi
^Jong thon Tonq
So li/cjnq 28 47 75
Ty IS ( % ) 37,3 62,7 100 Nhan xet: Ty le tre mae bainao d nong thon (62,7%) cao hdn d thanh thj (37,3%).
Y HQC VigT NAM THANG 5 - SO 1/2013 Bang 4 : Phan bS dau hieu sdm nhat Inlen scim tre
Dau liieu s6m Bu sSc, bu kho Kho be am
Mem nheo
n 26 23 8 1 29 46
34,7
%
30,6 10,7 5,3 38,7 61,3
bai nao Co n 49 52 67 71 46 29
65,3
%
69,4 89,3 94,7 61,3 38,7
Tonq n 75 75 75 75 75 75
100
%
100 100 100 100 100 Nhan xet.: Trong cac trieu chu'ng ciia tre bai nao thi dau hieu tre cham phat trien hdn cac tre l<hac chiem ty le cao nhat (94,7%)
2. Mot so yeu to nguy cd cua t r e bai nao trong nghien citu Bang 5: Phan bo ty ie mac bai nao theo 1
Thu'tu* Tan sinh Thii nhat
ThCr2 Thir 3 Thir 4 Tonq
l u ' t u ' i a n smh:
So Iu'onq 60
6 4 5 75
Ty le (»/o) 80
8 5,3 6,7 100 Nhanxet:Tre bai nao la con dau Idng chiem ty le cao nhat (80%)
Bang 6; Phan bo ty ie mac bai nao theo tuoi ciia me l<hi sinh tre;
Tuoi cua me khi sinh tre
< 2 0 3 0 - 3 5
> 35 Tong
So lutfng 7 57 11 75
Ty l i (Vo) 9,3 76 14,7 100 Nhan xet Ty le tre mae bai nao eo me sinh tre d dd tudi 30-35 la cao nhat (76%).
Bang 7: Phan bo ty ie mac bai nao lien quan den nqhe nqhiep ciia me Nqhe nqhiep
Conq nhan vien chirc Conq nhan Nonq dan Khac Tong
So Iu'onq 23
9 35 8 75
Ty le (Vo) 30,7
12 46,7 10,6 100 Nhan xet: Ty le tre bai nao cd me lam nghe ndng nghiep eao nhat (46,7%).
Bang 8: Phan bd ty le mac bai nao theo nguyen nhan Nguyen nhan
Tru'dc sinh Tronq sinh Sau sinh Chu'a ro nguyen nhan
Tong
So lu'dng 11 49 7 8 75
T v l e C / o ) 14,7 65,3 9,3 10.7 100 Nhan xit: Tre bai nao do nguyen nhan trong sinh la eao nhat (65,3%) Bang 9 : Phan bo tre bai nao theo cac nquyer
Nguyen nhan l^e bl ciim tronq 3 thanq dau I^e bl chan thuonq Me bl suv dmh diTdnq tronq Tonq
nhan tru'dc l(hisinh So ii/dnq
5 4 2 11
Ty le ( % ) 6,6 5,4 2,7 14,7 Nhan xet Me bi ciim trong 3 thang cKu tnang thai ky chiem ty le cao nhat (6,6'
Y HOC VI^T NAM THANG 5 - SO 1/2013 Bang 1 0 : Phan bd tre bai nao theo nquyen nhan trong khi sinh
Nquven nhan De mo Can thiep san khoa De non Can nang dUdi 2,5 kg Be nqat Vang da
Tonq
So 1 l/dng 3 5 6 11 17 7 49
Ty le (O/o) 4 6,7
8 14,6 22,7 9,3 65,3 Nhan xet. Nguyen nhan trong sinh thi so' tre bi de ngat ehiem ty le eao nhat (22,7%).
Bang 1 1 : Phan bo tre bai nao theo cac nquyen nhan sau khi sinh Nguyen nhan
Chan thuonq dau, nao Xuat huyet nao U nao khonq tien trien Viem nao / viem manq nao
Tong
So lu'dng 1 2 1 3 7
Ty le (%) 1,3 2,6 1,3 4,1 9,3 Nhan xet Nguyen nhan sau khi sinh do tre bi viem nao / viem mang nao ehiem ty le eao nhat (4,1
IV. BAN LUAN
1 . Nghien cu'u m o t so dac diem cua tre bai nao:
1.1 Phan bd ty li bai nao theo gidi nam/nd\a 4 / 1 . Theo mpt nghien cdu khae [6]
thi ty le nam/nff la 1,35/1. Nguyen nhan su" khac biet ed the do khac nhau ve: quy mo nghien cu'u, dia diem, tinh trang mat can bang gidi tinh dang xay ra trong nhffng nam gan day (tre trai nhieu hdn tre gai).
1.2 Ty l i mdc bai nao theo tudi: Dp tuoi
>1 - 2 la eao nhat (56%) va do tuoi > 2 - 3 co ty le thap nhat (5,3 % ) . Ly do chenh leeh ldn giffa 2 nhom tuoi eo the la: Benh bai nao dffOc phat hien sdm tff khi tre tff 1-2 tuoi, den eac nhom tuoi tiep theo, hau het tre da dffdc chan doan roi va dang dffdc dieu t n tai cae cd sd Vat ly tn lieu/Phuc hoi chffc nang khac nhau tff trung ildngden dia phffdng.
1.3 Tri mic bai nao d nong thon (62,7%) cao hdn d thanh thi (37,3%), dieu do khong kho ly giai, bdi vi: dan so nong thon cao hdn thanh thi nen ty le tre bai nao d nong thon cijng cao hdn.
1.4 Mgt sddau hieu nhan biet sdm: Hau het (94,7%) tre dffdc phat hien bai nao do tre Cham phat trien hdn eae tre khae hoac tff khi mdi sinh da khd be I m (89,3%); Bu sac, bu kho (65,3%); Co cu'ng chan tay hoae toan than (51,3%) hoac bi mem nheo (38,7%).
2. Mot so y e u t o nguy cO ciia tre bai nao trong nghien cu'u
2.1 Tre bai nao la con dau long chiem ty li cao nhat (80%), cd the do ngu'di me lan dau tien mang thai nen chu'a co kinh nghiem, tham tri eac ed sd y te chu'a lu'a ehon va tu" van dimg du'dng sinh (sinh thu'dng hay can thiep) cung nhff cd sd y te (tuyen du'di hay tuyen tren)
2.2 Tre bai nao co me sinh tre khi tudi trin 35\a cao nhat (14,7 % ) . Dieu nay da du'dc khang dmh tren thu'c te va y van: ngffdi me sinh con d do tudi tren 35 thi nguy cd mae bai nao eao, do vay ket qua nghien effu la phii hdp vdi mpt so tai lieu [ 3 ] , [ 4 ] .
2.3. Nguyen nhan gay bai nao co ty le khac nhau trong tffng nhdm: Tru'dc khi sinh:
14,7%, Trong khi sinh: 65,3%, Sau khi sinh: 9,3
% va chu'a ro nguyen nhan: 10,7%.
2.3.1 TrWdc khi sinh {\^,l''h), trong dd hau het ia do benh eiia me trong 3 thang dau eiia t h a i k y ( 8 % ) .
2.3.2 Trong khi sinh (65,3%). Trong dd de non ehiem ty le eao nhat (32%) phu hcfp vdi mot nghien effu [6] ty le tre de non la 33,8% va tai lieu khae ve ty le bai nao d mot so nu'dc phat tnen: mot nffa cae tru'dng hdp bai nao la do sinh non [10]. Nhff vay, sinh non la mdt yeu to nguy cP eao gay ra bai nao d tre. Ty le tre bai nao bi nhe can la 11,9% thap hPn so vdi mot so ket qua nghien effu [ 6 ] , [ 8 ] : can nang liie sinh < 2,5 kg la 36,2%, Theo mot tai lieu [ 5 ] : Ty le tre bai nao CO can nang luc de thap la 35,2%. Theo Werner David [9] nhffng dffa tre bi nhe can eo nguy ed mac benh bai nao nhieu hdn gap 100 lan nhffng dffa tre eo trpng Iffdng binh thu'dng.
Y HOC VIET NAM THANG 5 - s 6 1/2013 Ty le ngat khi sinh la 8 % thap hdn so vdi
nghien cffu khac [6] la 30,8%. Mgt so nghien effu [ 6 ] , [8] da chi ra rang: khong phai tat ca tre bai nao co tien sff bi ngat khi sinh la do chfnh yeu to ngat gay nen ma cd the ehi la hau qua.
Cac yeu to khae gay ra tinh trang thieu oxy man ti'nh d thai nhi va lam ton thffdng nao trffdc sinh nhff: eac bien chiitig trong thai ky, cua nhau thai, benh maeh mau thai nhi, chuyen da bat thffdng [6]
2.4.3. Sau sinh (9,3%): Theo mot tai lieu [3] khoang 70% trffdng hdp bai nao xay ra trffdc khi sinh, 20% xay ra trong qua trinh sinh de va 10% xay ra trong hai nam dau ddi. Sff khae nhau nay ed the la do nghien effu ciia chung to! quy mo nhd hdn va quan diem ve ngat trong cd ehe benh sinh eiia bai nao van chffa ro rang.
V. KET LUAN
Ket qua nghien cffu 75 tre bai nao tff 0-5 tud'i benh vien Nhi Hai Dffdng nam 2012: Ty le nam/nff la 4 / 1 ; Tre bj bai nao > 1 - 2 tud'i la cao nhat (56%) va tre bai nao d nong thdn (62,7%)o hdn d thanh pho; Hau het la con dau long (80%). Ty le tre bai nao eao nhat ciia cae ba me tren 35 (14,7 % ) va la ndng dan (46,7%). Nguyen nhan gay bai nao eao nhat la trong khi sinh (65,3%), tiep den trffdc khi sinh: 14,7%, sau khi sinh (9,3
% ) ; cdn 10,7%. chffa ro nguyen nhan: Phat hien tre bai nao thong qua cac dau hieu nhan biet sdm: Tre cham phat tnen (94,7%); Khd be am (89,3%); Bu sac, bu kho (65,3%); Co cirng (61,3%); Mem nheo (38,7%).
TAI LIEU T H A M K H A O
1, Tran Thj Thu Ha ( 2 0 0 2 ) , "Nghien cuii mpt so' dSc diem dich te, lom sang va nhu cau phue hdi diik nSng dtre bai nao", Luan an Tien sy Y hoe, TrUdng Dai hoc YHa Noi.
i.. Tran Thi Thu Ha ( 2 0 0 5 ) , " Phat hien sdm, can tivep sdm mot so dang tan tat d Viet Nam", NXB y hoc, Ha Noi 2005.
J Tran Tr^ng Hai, "Bai nao va phue hoi ch&c nSng". NXB y hoc, 1993, trang 7, 8, 10, 64.
1. TS. Tran Trpng Hai, TS. Tran Thj Thu Ha, TS.
Tran Van Chu'dng ( 2 0 0 4 ) , "Nghien cud vehoat ddng Phue hdi chdc nang du'a vao edng dong tai Vietnam (1987-20(M)", Ha npi 2004.
5. Tran Trong Hai, "PKT^dua vao wngdong', NXBc^
due, trang 70, 71. 78
u. Nguyen Thi Hung, Nguyen Thj Thu Thao (2009), "Dac diem lam sang va phan loai cua 130 tru'dng hdp bai nao".
7. Pham Thj Nhuyen, "Glao trinh hoat dong tri lieu", Tru'dng Dai hoe Ky thuat Y te Hai Du'dng, 2011.
NGHIEN CUU NHIEM RUBELLA 0 PHU NUf MANG THAI TAI BENH VIEN PHU SAN TRUNG UONG NAM 2009 -2011
TOM T A T
Muc tieu: "Xae dinh ty IS nhiem mdi rubella d nhij'ng phu nd mang thai cd nghi ngd nhiem rubella tren iam S3ng".t)6\ tu'dng va phu'dng phap nghien ciru: c6 mau 777 phu nff mang thai c6 it nhat mot trong cac dau hieu nhU sot, phat ban va noi hach td 2009 den 2011: la thdi gian ngay tru'dc, trong va ket thiic dich; Phuong phap nghien cffu: mo ta tien cffu.
Ket qua: Ty le nhilm mdi rubella IgM(+) 68,1%, sd nhiem IgM ( + ) IgG(-) la 7,2%, Ty le phat hien nhiem mbella theo tuo'i thai: 5 tuan: 40,8%; 6-12 tuan: 60,8%;
13-18 tuan: 77,7%. Ty le nhilm mdi rubella IgM(+):
Phu nu' mang thai co sot 81,0%, co phat ban 79,1%); noi hach 85,7% co ca 3 trieu chiilig 85,6%. Ty le dinh ehi
* Benh vien phu san trung UOng
Phan bien khoa hgc: PGS.TS. Dang Thi Minh Nguyet 122
Le Hoai Chu'dng*
thai nghen 81,9%, trong do thai > 18 tuan nhilm rubella IgM(+) 30,3%. Ty le thai nhilS tuan nhiem rubella vdi xet nghiem nudc 6i PCR(+) 46%. Ty le tre sa smh IgG(+) 98,6%, nhiem rubella IgM(-i-) 27,77o
SUMMARY
RESEARCH OF RUBELLA INFECTION IN PREGNANT WOMEN IN NH OF OB-GYN 2009 - 2011
Objective: "Determinate the rate of new rubella infection in pregnant women having suspected rubella symptoms". Material and method: sampling size; 777 pregnant women having at least one of the signs as fever, rash, lymphatic nodes; Study time from _2009 to 2011: before, during and after rubella
