H6| NGHI TOAN QUfiC V6 CAC BgNH NHigM TRPNG VA HIV/AIDS 6 TRg EM NAM 2013 NGHIEN CU'U DAC DIEM DICH TE HOC LAM S A N G BENH UON VAN
TAI BENH VIEN NHI TRUNG UONG
T 6 M TAT
Nghien cii'u tat ca cac benh nhan dUdc chan doan uon van tai iKnh vien Nhi Trung i/Ong trong 10 nSm tu' 2003 den 2012 theo phifdng ph^p hoi ciiu mo ta hS stf b?nh an. Ket qua cho thay: co 23 benh nhan du tieu chuHn chSn doan.
Benh phan bo rai rac theo n3m va cf hau het cac tinh Dong Bac va Bac Trung bp. 91.3% benh nhan tim thay du'dng vao vdi vet thu'dng hay gap nhat (56.5%) la do vat nhpn dam (gai, dinh, que), vj tri vet thu'dng thu'dng gap la chi du'di (62.5%). 87% benh nhan cd thdi gian u benh tren 7 ngay, 69.6% cd thdi gian khdi phat tren 24 gid. Hau het benh nhan cd bleu hien ciitig ham (91.3%), M nuot (91.3%), CO cutig (95.7%), co giat (86.96%). Phan Idn benh nhan khong sdt khi nhap vien (53.17%). Dieu tri thu'dng keo dai (31.57 ± 18.99 ngay), ty le bien chiJng cao (34.8%) ty le tiJ vong va nang xin ve 8.7%"
SUMMARY
RESEARCH ON CHARACTERISTIC CLINICAL EPIDEMIOLOGY OF TETANUS AT AHP Study on all patients with diagnosis as tetanus at National Hospital of Pediatric from 2003 to 2012. Results: there were 23 patients who were diagnosed tetanus. This disease was sporadic and appeared at almost East Northern and North middle provinces. 91.3% patients had wounds. The most common wounds were puncture wounds (56.5%), the most common site of wounds was lower limbs (62.5%). 87%
patients had incubation period longer than 7
* B^nh vien Nhi Trung Uang
Plain bien klioii lipc: PCS.TS. Kliu Thj KhSnh Dung 96
Pham Nhat An*, Vu Thi Minh Phirong*
days, 69.6% patients had period of onset over 48 hours. Almost of patients had trismus (91.3%), dysphagia (91.3%), muscle rigidity (95.7%) and muscle spasms (86.96%). Most of''patients had no fever on admission (53.17). Treatment was usually long (31.57±18.99 days), rate of complications was high (34.8%). Rate of death and withdrawal from treatment was 8.7%
I.OATVXNOI
U6n van la benh truyen nhilm cSp tinh gay nen bai trirc khuan Clostridium tetani.
Benh lay qua da va niem mac ton thirong.
Bieu hien lam sang la tinh trang co cihig co va cac ccm co giat tren nen co ciing.Mac dii v5c xin phdng uon van da dugc su dung rong rai nhung benh van con pho bien tren toan thj gicri.d My. giai doan tir nam 1998 - 2OO0 binh quan moi nam cd 43 ca uon van duoc bao cao. ty le tii vong la 18%.Viet Nam la nude dang phat trien cd ty le mac uon van cao.Benh dien bien phirc tap, dieu tri thudng keo dai va cdn gay tir vong.Chiing toi tiln hanh nghien cuu nay nham muc tieu: mo ta dac diem dich tl hoc lam sang benh uon vSn tai benh vien Nhi trung uong trong 10 nSm (tir 2003 din 2012) va tim hiSu 1 sd yk 16 lien quan.
II. OOI TU'IJNG VA PHU'aNG PHAP NGHIEN CUU floi tiTffng nghien cihi:
- Tat ca tre em dugc chin doan u6n van(theo Bai giang truyin nhilm - HVQY 2009) dieu tri tai benh vien Nhi Trung uong tirthang 1/2003 din thang 12/2012 - Tieu chuan chan doan u6n van:
Y HQC VI$T NAM THANG 10 - S6 2/2013
+ Co vet thuang nghi nga la dirong vao + Khai benh dau tien la cung ham, sau do CO Cling cac ca theo thu tu: dku, mat, than minh va tu chi.
+ Can giat cung Icich phat tren nen cac can CO cung.
+ Chua dugc tiem vac xin phong uon van.
- Tieu chuan phan loai mu'c do benli:
Trieu chirng Ubenh Thai gian khai phat Do khit ham Con giat ciing Kho nuot Un tac dam dai Kho tha Nhiem toan mau
s6t
Mach Huyet ap Va mo hoi
Yira
>15 ng^y
>48 gicf
>2 cm Ngan,thua(<10
can/24 gio)
- -
Nhe
<39 dp C 90-120 lan/phiit
Binh thucmg It
Nang 6-14 ngay 24-48 gia 1-2 cm Dai, mau(>10
con/ngay) + + Roret
+ 39-40 do C 120-140 Ian/phut
Cao Nhieu
Rat nang
<6 ngay
< 24 gia
< 1cm Dai, lien tuc, hang tram ccm, tim tai, ngimg tho
+++
+++
Nang, tim tai, roi loan nhip tha, ngimg tha
+++
>40 do C
> 140 lan/phiit Cao hoac tut
Rat nhieu - Tieu chuan loai trir: uon van so sinh
III. KET QUA VA BAN LUAN
Qua thu th^p s6 lieu chung toi thdy: trong 10 nam tir thang 1/2003 din thang 12/2012 cd 23 benh nhan dugc chjn doan lam sang mjc benh uon van tai benh vien Nhi Trung uong
3.1, Bac aiSm djch te ciia nhom nghien cuu 3.1.1. Phan bi bfnh theo nam
Biiu td 1: Biiu dd phan bd benh theo nam so c.l mdc theo n.im
2i)()-l 2004 2(»)S 2U(.Ki / n i l / ^niiH .'IKIM . ' ( i l o 2(il 1 Nhan xet: Benh phan bd rai rac hang nam, khdng tao thanh dich
Hpi NGHj TOAN QU6C \lt CAC BgNH NHI^M TRONS VA HIV/AIDS 6 T R 6 EM NAM 2013
3.1.2. Phdn bo theo tja tu
Hinh 1: B4n do phan b6 b?nh theo dja phuang
Nh^n xit: Bfnh phan bd rai r^c d hau het cac tinh Ddng BSc va Bac trung bd: sd ca bfnh d cac tinh la BSc Giang: 2, BJc Ninh: 1, Ha Nam: 1. Ha Ndi: 3, Ha TTnh: 2, Hai Duong: I, Hung Yen: 2, Lang Son: 1, Nam Dinh: 1, Ngh? An: 2, Ninh Binh: 2, Phu Thp: 1, Quang Ninh: 1, Thanh Hda: 2, Tuyen Quang: 1
3.1.3. Tuoi, gi&i
Tudi mic benh trung binh: 9.95 ±3.11. Ion nhat: 15 tuoi, nhd nhdt: 3 tudi Biiu td 2; Phan bd b$nh theonhdm tudi
Phan bd t h e o nhdm t u 6 l i
-1% >• * ^ 1 5 - 1 0
• >1D
Nhftt xit: Nhdm tuoi thudng gap nh& la 5 din 10 tudi. Ty le nara/nO: 1.33/1 98
Y H p c VI$T NAM T H A N G 10 - S6 2/2013
3,1,4. Tiin s^tiemphbng uon vdn
87% benh nh&i khong ro tiin sir tiem phong, 1 benh nhan (4.3%) khong dugc tiem phong, 2 b6nh nhSn (8.7% co tiem phong)
3.2. D3c diem lam sang 3.2.1. Bac diem vit thieomg
Bdng 1: Bac digm v6t thuang a bgnh nhan u6n van Dac diem dirdng v^o Tim thSy dirfmg vao
Vjtri
Hinh thii
Nhiem triing vit thirtfng Idii v&o vien
Cd Khdng Chi tren Chi dudi Than minh Dau m^t cd
Vet thuong do vat nhon dam Vet thuang rach hoSc tray xuoc da Gay xuang hd
Dudng vao tir rang Cd
khong
So lyQug 21
2 3 15
1 2 13 6 1 1 3 20
Tyle 91.3%
8.7%
13.0%
65.2%
4.3%
8.7%
56.5%
26.1%
4.3%
4.3%
13.0%
87.0%
Nh^n xit: 8.7% benh nhan khong tim thay ducmg vao. Trong so benh nhan tim dugc duang vao thi vi tri vet thuong hay gap nh4t la chi duoi, kieu vet thuong thuong gap la do v^t nhon dam (bao gom dim phai dinh, dam phai gai, que choc, bam 16 tai). Vet thuong rach da hoSc tray xuoc chiem 26.1% (trong
do CO 1 benh nhan co duang vao la not thuy d^u). 1 benh nhan co ducmg vao tir gay xuong ho va 1 benh nhan co duong vao tu rang sau. Hau het benh nhan khi den vien cac v8t thuong da lanh. Ket qua nay tuong duong voi Luong Thj Quynh Nga
3.2.2. Thdi gian u binh vd thdi gian khdriphat Bang 2; Thdi gian u benh theo mirc dd nang ciia benh
Vira N9ng RitnSng TSng
<6 ngay n 1 0 0 1
%
4.8 0.0 0.0 4.8
7-14 ngjy n 3 6 2 11
%
14.3 28.6 9.5 52.4
>15 ngay n 6 2 0 8
%
28.6 9.5 0.0 38.1
Khdng ro n 1 0 0 1
%
4.8 0.0 0.0 4.8
tong n II 8 2 21
%
52.4 38.1 9.5 100 Nhfn xit; Chi cd 1 benh nhan cd thoi gian u
b?nh dudi 6 ngay va d muc dp vira. 52.4% cd tlidi gian ii benh tir 7 ddn 14 ngay va 72.7%
trong sd dd d mile do njng va rit nang.
38.1% b?nh nhan cd thai gian khdi phat dai
hem 15 ngay va 75% trong sd dd d mirc dp viia, 25% d mite dp nang. khdng cd benh nhan nao rdt nang. KSt qua nay tuong duong vdi nghien cuu ciia Nguyin Van Nhung
HOl NGHI T O A N Q U 6 C V g CAC B$NH NHI^M TRCING VA HIWAIDS 6 TRfe EM NAM 2013
Bang 3:
Vila NSng Rat nang Ting
Thdi gian khdi phat theo mirc dp nJIng cua bdnh
<24 gid n 1- 1 2 4
%
4,3 4.3 8.7 17.4
24-48 gid- n 7 5 0 12
%
30.4 21.7 0.0 52.2
>48 gid n 4 3 0 7
%
17.4 13.0 0.0 30.4
Tong n 12 9 2 23
%
52.2 39.1 8.7 100 Nh^n xit: 17.4% b?nh nhan c6 th6i gian khdi phat du6i 24 gio trong do 75% la nSng va rit nang, 52.5% b?nh nhan co thoi gian khdi phat tir 24-48 gia trong do 41.7% nSng va 58.3%
vira. 30.4% b?nh nhan co th6fi gian khoi phdt >48 gid trong do 42.9%) nang va 57.1% vira
3.2.3. Mirc dg b$nh
Bieu do 3: Muc dp n^ng cua b?nh
MU'C d<> n ^ n g c u i i b ^ n h 8 7
vu'a
• n a n g
N/tdn xet: Ty le benh nhan nang va rdt nang chiem 47.8%. Trong nghien ciru cOa Nguyen Van Nhung ty le nay la 56.6%
3.2.4. Cdc iri^u chirng ldm sdng
Biiu do 4: Cac trieu chung lam sang benh u6n van
BIPAI T i f i J T i E N H L I Y E T A P T A N ' . -
CHEN Ni>iJ'.
MACHNHAIsJH
?,|-.1 RAN PHi'il T A N O T I E T
i ; o ' : . i A T KHO N L I O T J CLfNiJHAM 1 CCiCLrMG 1
. 6
,, . . ,
b i e u
s j 8 I
i e n l a m sang
"1 nl
ui20 1
^ ' 2 , 1
i r |
2
Nhfn xit: Hau het benh nhan cd trieu chimg ciing ham, khd nudt, co cirng va co gi^t. Hon 50% benh nhan khdng sdt khi vao vien
Y HQC Vier NAM THANG 10 - SO 2/2013 3.2.S. Ty 1$ benh nhan co cic bien chdfng
Bang4:Ty ie gap cac bien chirng ciia benh uon van Loet
NKQ
Nhiem triing benh vien Mau+NKQ Catheter NUdc tieu
1
Tong
Di chu'ng Tur vong hoac nang xin ve Tong
Nhin xet: Ty le bien chiing cao (9/23 benh nhan), trong dd chu yeu la nhiem triing benh vien lien quan den thd may (7/9 benh nhan). Vj tri nhiem triing thudng gap nhat la npi khi quan (4/7 benh nhan)
3,2.6. Kit qua di'eu tii
Thdi gian dieu trj trung binh la 31.56±18.99 ngay, ngan nhat la 7 ngay, dai nhat la 96 ngay Ty le khdi, di chu'ng, tir vong va nang xin ve:
Bang S: Ket qua diSu tri
Khong thd mciy Md khi quan Noi khi quan
Tong
Khdi 15 (65.2%)
3 (13%)
2 (8.7%)
20 (87%)
Di chii'ng 0 1 (4.3%)
0 1 (4.3%)
TV hoac nang xin ve
0 2 (8.7%)
2 (8.7%)
2 (8.7%)
Tong 15 (65.2%)
6 (26.1%)
2 (8.7%)
23 (100%) Nhfn xet: Cd 2 benh nhan Hi vong va nang xin ve (chiem 8.7%), 1 benh nhan di chimg nao (chiem 4.3%). Trong nghien cihi ciia LUdng Thj Quynh Nga ty le tii vong la 20%, Vu Dinh Phu ty le tu' vong d nhom tuoi 41-60 la 4.5%, nhdm tuoi >60 la 14%
IV.KITLUAN 4.1. fiac di€m djch te
Trong i o nam ctiung tdi thay cd 23 benh nhan uon vandUpc dieu tn tai l3enh vien Nhi Trung Udng.Nhdm tudi mac benh cao nhat la nhom tir 5 den 10 tudi.Nam mac benh nhieu hdn nD'.Benh xuat hien rai rac hang nam d hau het cac tinh thanh
4.2, Dac diem lam sang
Vet thu'dng thu'dng gap nhat la do vat nhpn dam, vi tri vet thu'dng hay gap la chi du'di. Phan Ich benh nhan cd thdi gian ii benh tir 7-14 ngay va thdi gian khdi phat tif 24-48 gid.Cac trieu chirhg cutig ham, khd nudt, co cirng va co giat xuat hien d hau het benh nhan. Hdn 50% benh nhan khdng sdt khi nliap vien.Ty le bien chijng cao, chii yeu la nhiem triing benh vien lien quan den thd may. Thdi gian dieu trj keo dai. Ty le tir vong 8.7%
TAI LIEU THAM KHAO
1. Bill Oai va cs Benh uon van. Benh hpc Truyen nhiem. Nha xuat ban Y hpc. 2009:
425-434
2. Lu'dng Thi Quynh Nga. Nghien ciiu 1 so dac diem d benh nhan uon van dieu tn tai benh vien da khoa trung uHng Thai Nguyen (2008-2012) 3. Nguyin Van Nhung, Nghien ciai mpt so dac
diem iam sang, can lam sang d benh nhan uon van dieu tri tai benh vien Nhiet ddi Trung Udng. YHTH(857) 2013; 85-88
4. Vu Oinh Phil. Mdt sd yeu to tien IUdng benh nhan uon van dieu tri tai benh vien Nhiet ddi Trung uong. YHTH(816) 2012; 124-126 5. Patrick B Hinfey. Tetanus. 2013
emedicine.medscape.com/article/229594- overview
6. Nelson textbook
101
