TAP CHi Y HOC VIET HAM TAP 4S2 - THANG 3 - SO 2 - 2017
DAC DIEM DICH TE LAM S A N G BENH NHI NGO DOC CHI TAI TRUNG TAM CHONG DOC BENH VIEN BACH MAI
,2^
WTAT
)3t v f n del Chan doan benh nhi ngo doc chl ig de, cac trieu^chLfrig thu'dng lan vdi cac b|nh noi 3, yeu to didi te Iam sang dong vai tro quan trgng I hiTdng ciian doan. Muc t i e u : Danh gia djch te d6c chi d benh nhi dieu tri tai Trung tam chong Binh \nen Bach Mai. Doi tu'dng va phu'dng IR: Nghien cuU hoi cdu mo ta. Tat ca cac benh nhi -dqc chi diiu tri tai Trung t i m diong doc Benh fT^ch Mai tCr 3/2012-9/2013. Khao sat cac yeu to r l ^ nhd gidi, tuoi, dia du, nguon tjep xuc, du^ng ,x'tinh trang lilc vho vien, dac diem nguon su"
g... Ket qua: chCi yeu tap trung d nhom 6-24 ig tuoi (60.2%), nam/nu'=1.2/l, nong thon nhieu thanh pho (85.2% & 14.8%). Nguyen nhan su*
h thuoc cam (96.3%). Ly do suT dung thuoc cam Ma dang; tuS Iu9i (59.8%), loet mieng (16.3%), Itiay (11-5%), Chan an (2.9%), hoi mieng (1.9%), c (7.7%). Hau het la thuoc cam khong ro nguon fee^); 'Mau s§c thuoc chii yeu la da ram
^)|-;£iu!c(ng dung: boi (61.5%), uong (15.4%),
&^), bai k§t hdp an udng (20.2%). So ddt p.i;;&dt (33%), 2 ddt (16%), 3 ddt (1%), tren 3 (50%). Tl le chan doan nham 6 cac aJ sd dieu trj k 82.4%. K€t l u ^ n : Lu'a tuoi thu'dng g^p la nhoni
^ thang (60.2%). Nguon t j ^ xuc gay ngo doc chi chii
^^ thuSc cam gii (96.3%). Da so thuoc cam khong ro
^.goc, dang bao die thuSng dang bot, mau cam. Ti iaa doan nham d tuyen dud^ rat cao (82.4%).
Tu'lfhda: ngo doc chi, benh nhi, djch te ngo doc ttiuoccam
MMARY
LEAD P O I S O N I N G CHILDREN EPIDEMIOLOGY I N POISON CONTROL
CENTER BACH M A I HOSPITAL Background: Lead poisoning, espedally in dren, is not easy to point out. To improve miosis and treatment, we need diniral jemioiogy data about lead poisoning In children.
jective; Assess epidemiology of lead poisoning in liatric patients treated at the poison control center Badi Mai Hospital. Subjects and Methods:
FDspedJve descriptive study. All pediatric patients ited lead poisoning at Poison Control Center at
*l Mai Hospital from 3/2012 to 9/2013.
vng tam Chdng doc Binh win Bach Mai i mon HSCC, Tru&ng Dai hoc Y Ha Npi K>3 Cap cdu Benh viin Badi Mai u tradi nhiem chinh: Ngo Du'c Nggc ail: [email protected] iy nhan bai: 28.12.2016 iy phan bien khoa hoc: 10.2.2017 ly duyet bai: 17.2.2017
Be Hdng Thu', Ngo Dure Ngoc
Epidemiology factors collected indude: gender, age, geography, exposure, intake way, condition at which hospital admited, diaracterisdcs of traditional medidne,... Results: Patients met ail ages, highest is 6-24 months group (60,2%), male/female ratio was 1.2/1. Rural is higher than dty (85.2 vs, 14.8%). Lead poisoning due to using traditional medicine was 104 patieits (96.3%). The reason for using tradibona!
medidne is diverse: furry tongue (59.8%), mouth sores (16.3%), diarrhea (11.5%), anorexia (2.9%), halitosis (1.9%), other (7.7%). Most patients buy tradWohal medidne ftom where have no certain address (68%). Main colour of traditional medidne is orange (66.2%). Etoute of administration: topical (61.5%), drinking (15.4%), eating (2.9%), topical combination ora! (20.2%). Numliers of period uang traditional medicine: 1 period (33%), 2 period (16%), 3 period (1%), more than 3 times (50%). The rate of misdiagnosis at forward fadlity: 84.2%. Conclusion:
The age group 6-24 months is most common (60.2%).
Main source of ©cposure causing lead poisoning is the fake traditional medicine (95.3%). Many traditional medidne is unknown origin, often padage under powder form, orange. Misdiagnosis rate is very high at forward facility (82.4%).
Keyword: lead poisoning, peadiatric patient, lead poisoning epidemiology, orange traditional drug.
I. D A T V A N OE
Tre em bj ngo doc chi cd the bj ton thu'dng nang ne nhu'giat:, hon me, viem nao, suy than...
ttiam chl tu" v o n g [ l ] . Tru'dc day, d Viet Nam rac vu ngo doc chi chi xay ra le te va do 6 nhiem moi tru'dng hoac vo tinh tai nan nhiem chi, nhuhg gan day noi bat len la tinh trang ngo doc chi d tre em cd xu hu'dng tang nhanh, tap trung va quy mo rong khap ca nu'dc. £>ay la mpt tinh trang dang bao dpng ddi hdi phai cd su* quan tam cua toan xa hpi. Tuy nhien, rat nhieu tru'dng hdp chan doan nham hoac khong chan doan do khong nghT tdi ngo doc chi, do cac tri^u chuTig thu'dng lan vdi cac benh npi khoa nhu' roi loan y thu'c, quay khde, bd bu, co giat... [ 2 ] [ 3 ] [ 4 ] . Be cd mpt tieng ndi khoa hpc canh bao va djnh hu'dng chan doan benh nhi ngo doc chi, thong tin ve djch te hpc lam sang ve van de nay la rat can thiet trong thi/c tien lam sang. Chfnh vi vay, chung toi du:a ra nghien cu'u nay nham m u c t i e u :
"Danh gia dich te lam sang ngo doc chi d benh nhi dieu tri tai Trung tam chong doc Benh vien Bach Mai".
VIETNAM MEDICAL JOURNAL N'^ - MARCH - 2017 II. 061 TirONG VA PHl/OfNG PHAP NQHIEN CttU
Tieu chuSn lu'a chon - Tuoi (nam) < 16
- Oydc chan doan xac fflnh la ngo doc chi theo tieu chuan sau [1] [2] [3]:
+ Co tiep xuc v6i cac nguon co chi, hoac co trieu chtfng gdi y
+ Xet nghiem chi mau > lOpg/dl Tieu chuan loai trCf: Cac tre bj cac benh khac nhu*; viem nao, viem mang nao, bai nao do nguyen nhan khac, viem gan virut...
Phu'dng phap nghien cu'u; Hoi cuti phan tfch mo ta loat ca benh, cdmau thuin tien
Cac bien so nghien ci^u
- TuSi, nhom tuoi, gic(i, tien sir benli tat, Jja phu'dng, nguon ti§p xuc, triSu j:hung ngq doc I t vao vien, dudng vao. Ty le chan doan dung (di^
vao ket qua djnh lu'dng chi mau la tieu chuan vai^J - Bac aem thuoc cam: ndi mua, IJ do^diig.
tiiuoc, iSn suat diing, so @n, so li/dng, dirdng diinf' mau sSc, dang che bien, thdi gian diing thuSc •
2.3. XA' 1^ so lieu: So lieu du'dc Yii'ii, bang cac test thong ke phu hdp bang phanr.mem SPSS. Mu'c y nghla a=0,05.
IN. K i t QUA
Nghien ciru tren 108 benh nhi dieu trj tai Trung tam Chong doc Benh vien B^ch I^ai'itfr 3/2012 den 9/2013.
Bang 1. Die diem ve tuoi, gidi.
dladif
Oac diem 1 n Ti le f"/o)
Gi6l Nam
Ni?
61 47
56.5 43.5 Nhom tuoi
<6 thanq 6-<24 thanq 24-72 thanq
>72 thanq
6 65 29 8 Dia du' Thanh pho
Nonq thon
16 92
6 60 27
7 i 14.8
85.2
«i a d Nhin xet Benh nhan nam chiem ty ie cao hdn nif. Trong nghien cu'u gap benh nhan d tat <^
nhom tuoi, trong do nhom tuoi tir 6 den 24 thang c6 ty le cao nhat (60.2%). Benh nhan song d;|
nong thon nhieu hdn d thanh thj.
Bang 2. Trinh do hoc van cua borne tre Trinh do hoc van
Capl Cap 2 Cap 3 Dai hoc/Cao dang
Sau dai hoc
Bo n 5 26 64 11 2
4.6
°/o
24.1 59.3 10.1 1.9|v|e n 7 33 59 9 0
»/o 6.5 30.6 54.6 8.3
0 Nhan xet: trinh dp hpc van cua bo me tre bj ngo doc la kha thap so vdi xa hpi hien tai.
Bang 3. Nguon tiep xuc vdi die chat chi
Nhin xet: Nguon tiep xuc chi cua 108 ddi tu'dng nghien culi chu yeu la tir thuoc cam 96.3%, con.1^
chian 3.7% la xuat phat tCr lang nghe (3 benh nhan) hoac vd tinh nhiem chi qua an udng (1 benh nha|j?
Bang 4. Dac diem thudc cam Thuoc cam
Ly do su' duno TUa lu'di
Loet mienq Tieu chay
Chan an Hdi mienq
n 62 17 12 3 2
Ti l£ (»/o) 59.8 16.3 11.5 2.9
1.9
^1
Jl
TAP CHi Y HOC Vl6r NAM TAP 452 - THANG 3 -Sd'2 -2017 Khac 1 8
Dia chi mua thuoc Cuthe
Khonq ro
71 33 Mau sac thuoc Cam
Xam Hong Vanq Xanh 06 Oen Niu Tranq
69 19 9 8 7 5 4 3 1
7.7 68 32 66.2 18.3 8.7 7.7 6.7 4.8 3.8 2.9 0.9
Nhin xet: Ly do dung thuoc cam cua doi tu'dng chu yeu la tu^ l u ^ chiem 59.6%. Oia chi mua IOC cam khong cu the 31.7%, ron dja chi cu the chiem ty le cao hdn 68.3%. Trong so 104 benh In CO sir" dung thuoc cam, thuoc mau cam dtidc su* dung nhieu nhat 46.2%.
Bing S. sat dung thuoc cam
DCing thuoc 1 n Du'dng diinf
Boi Uonq
An Boi va an udng
So ddt dime 1
2 3
>3
J
64 16 3 21 1
34 17 1 52
Ti Ie (°/o) 61.5 15.4 2.9 20.2
33 16 1 50
Nhin jfefc Trong tong so 104 benh nhan co sir dung thuoc cam, du&ng diing chii yeu la boi tai cho ieiti 61.5%. Benh nhan diing thuoc cam nhieu ddt ktiac nhau > 3 ddt chiem ty le cao nhat 50%.
Bing 6. Chin doin cua dc cdsddieu tri tnf dc khi chuyen den Trung tam Chong doc So lu'dng
:hcin doan 1__
Ngo doc chi Odnq kinh Viem nao, viem manq nao Co qiat chu^ rd nquyen nhan
Suv qan ttian Thieu mau chu'a ro nquyen nhan
Khac Khonq cd chan doan
Tann
n 19
4 5 4 2 1 2 71 108
Ty le (»/o) 17.6
3.7 4.6 3.7 1.9 0.9 1.9 65.7 100 Nhan xet: Trong so 108 benh nhan, chi cd 37 benh nhan cd chan doan (chiem 34.3%), nhuhg i cd 17.6% du'dc chan doan la ngd doc chi va thu'dng chan doan nham vdi b^nh dpng,Idnh (3.7%), lac viem nao mang nao (4.6%).
.BAN LUAN
Ve t u S , gidi va dja d\t: Trong nghien culJ ung l^i, liJa tuoi gSp nhieu nhat la 6-24 thang lem ty le cao nhat ia 60,2%, tiep theo la 24-72 ang chiem 26.9%. Trong nghien cu\i cdu dng tdi ty le benh nhan nam chiem 56.5% rao fn nu' chiem 45.5%, nam/nff la 1.2/1. Ket qua ng tuWng tu" vdi Ngo Tien Bong (nam/nff la 1/1) [2].
Trong nghien culi ty le benh nhan sdng d vting nong thon (85.2%) rao hdn thanh thi (14.8%). O ndng thon hien nay cdn nhieu quan niem lac hau va kha nang tai chfnh nen khdng dda tre benh di kham va dieu tri tai cac cd sd y te ma Iai sff dung cac phu'dng thuoc dan gian de td dieu trj. Od la tinh trang lam cho tinh hinh ngo doc chi cang them phu'c tap, khd kiem soat, dieu trj khd khan. Trong nghien cffu ciia Ngo
VIETHAM MEDICAL JOURHAL N°2 • MARCH - 2017
Tien Dong thi ra 80% bSnh nhan song tai vung nong thon va mien nui [2].
Dac diem ve thuoc cam: Ngudn tiep xuc gay ngd doc chi trong nghien cuU chu yeu la ttr thuoc cam (96.3%), mpt phan rat ft nguon tiep xuc tff lang nghe san xucft, tai che chi hoac vo tinh ngo doc chi do an phai vat chu^ chi (3.7%).
Oay la van de dac biet gay bat ngd Idn cho nhffng ngu'cfi lam rap cffu ban dau benh nhi ngo doc, minh chffng la cd tdi 82,4% chan doan sai do khdng nghT tdi ngd doc chi. Luc dau da so benh nhi dddc chan doan la dpng kinh hoac hdn me chda rd nguyen nhan, vi tru'dc day tren the g i ^ cung nhff Viet Nam deu quan tam ngd doc chi xuEit phat tff d nhiem mdi trffdng (khdi bui, dat, nffdc...), chi md ta ngd doc chi do dung thudc dong y du'di nhffng ca benh lam sang, chffa cd nghiSn cu'u nao cu the ve dac diem lam sang va can iam sang ve ngd doc chi do diJng thuoc ram, thudc te.
Benh nhan dung thudc cam nhieu ddt (> 3 ddt) chiem ty le rao nhat 50%, tiep theo la dung 1 ddt 32.7%. Oieu nay ndi len tinh trang sff dung thudc ram d cac dja phffdng rat thffdng xuyen va khd kiem soat, quan niem sff dung thuoc cam diSu tr| cac benh cua tre em cung nhff ngudi Idn dien ra rat pho bien gay ra tinh trang ngd dde chi man tfnh. Nhffng cung cd 32.7% tre dung chi 1 lan da gay ra tinh trang ngd doc chi, dieu n^y the hien ham Iffdng chi trong thudc cam rat rao, va khi sff dung lien tuc cd the gay ra tinh trang ngo doc chi cap tinh. Nhff vay trong so benh nhan nghien cu'u gom ca benh nhan ngd doc chi man va cap tfnh.
Trong nghien ciJu 104 benh nhan vS nguon gdc thudc cam 71 trffdng hdp cd dja chi cu the (68.3%). Oac biet hieu qua cua thudc ram sau khi sff dung t^ le benh trffdc dd giam di chiem rat rao (93.3%), tffc la thudc ram do cd hieu qua chffa benh mieng lu©l, tuy nhien vd cCitig dde hai. Mau sac thudc ram rat da dang vdi nhieu loai khac nhau nhff ram, vang, hong, dd, xam, den... nhffng mau ram chiem ty le rao nhat, khdng giong nhff nhieu ngu'di quan niem trffdc day thuoc ram la cd mau cam, va mau ram vang la nhffng mau chffa ham Iffdng chi cao chu yeu la chi oxide. Cung nhff cac nghien cuU khac tren the gidi, mau sac cac thudc ddng y d Tay Ban Nha Azarcon (mau ram) cd ham lu'dng chl vd cd raoj/a cd the len den 95% la chi oxide [6].
Chan doan benh cua cd sd dieu trj tru'dc
khi chuyen den: Trong sd 108 benh nhan, d cd 37 benh nhan dffdc chan doan trffdc'Id chuyen den Trung tam Chong doc (34.25%]
nhffng chi cd 17.6% dffdc chan doan la ngo do chl, day la chan doan tff benh vien nhi frurii l/dng hoac la khoa nhi benh vien Saint Paul. Coi Iai ty le chan doan nham tuyen dffdi la 82.4'^
thffdng la chan doan nham vdi benh ddng fefii hoac viem nao, mang nao... Ly do la ngd doc/di khong chan doan dffdc neu khdng ngliT i&i v;
khdng dffdc lam xet nghiem doc chat chi, ma khac khi bieu hien ngd doc ty le co giatchiemtj ie cao, tfnh chat cdn giat la ngan va toan thar nen de nham lan vdi cac trieu chffng trong done Idnh, viem nao,... Hien nay, xet nghiem doc chl chi chi thu'c hien dffdc tai Ha Npi nen cac tinhcc benh nhan ngo doc chi nhieu nhffng kh6ng;cc dieu kien xet nghiem, tff dd de bd sdt chan ddS hoac chan doan mudn.
V. KET IV^N
Ida tudi thffdng gap la nhdm 6-24 thang (60.2%). Ngudn tiep xuc gay ngd doc chi chu yeu la thuoc ram (96.3%). Oa so tihuoc cam kiiong rd nguon goc, dang bao che thudng dang bdt, mau ram. Tf le chan doan nham d tuyeri dffdi rat rao (82.4%). Nhan vien y te khi tiep xuc vdi benh nhi co giat, hdn me chffa ro nguyen nhan, neu khai thac trdng, tien sff cd sff dung thuoc ram hoac thudc ddng y, can phai nghlngfi hoac dat ra chan doan phan biet vdi ngd doc kim loai nang, dac biet la ngd dde chi.
TAI Ll|U THAIVI KHAO
1. Bg YTi(2012). Hu'dng dan chan doan v^rdieijm ngo doc chi. QD-BYT. So 1548: tr 1-5. | H 2. Ngo Tien Oong, Pham Thj Van Anh, Pham
Van Thang (2012). Ngo doc chi d tre em lien quan den sff dung thuoc nam; mot sd dac diS^S te, lam sang, can lam sang va nhan xet ka Qual^
tri. Tap chiy hoc Viet Nam, sS 5: tr 15-16. 'ifl[
3. Flomenbaum, Neal E, Goldfrank et al (200^
Goldfrank's Toxicologic Emergencies 8th ed. ^
91 (2): pp 1208. /m 4. Shukia R, Bornschein R.L, Dietrich K, etal
(1989). Fetal and infant lead exposure: effeds oii growth in stature. Pediatric; 84 (1): pp 604 - 612:, 5. Nguyen Thj Du^2004). Ngo doc chi d tre enij
Trong: Tu" van chan doan va xd trf nhanh ngo i35c cap. Nha xuat ban y hoc (2). Ha Noi, Tr 285-288.
6. Bradman A, Eskenazi B, Sutton P (2010). I ^ deficiency associated with higher blood leadl children living in contaminated environments. B\'m.
Heaitii Persp^ 109 (10): pp 1079 -1084. %
