Y HOC VIET NAM THANG 4 - SO 2/2010
khac Cling da xiy ra riii ro: Cong an, hge sinh cao (chiem 60,11% tdng sd ngucri nhiim), tilp trudng Cao dang Y te, nhan vien bio ve. de'n la tinh due khic gidi (7,74%).
IV. KET LUAN
Tfnh tdi ngay 30/6/2009, luy tfch cic trudng hgp HIV (+) tren dia bin tinh Quang Ninh li 17.917 ngudi, sd ngudi cd dia chi quin ly l i 7.042 ngudi, sd edn lai l i ngudi ngoai tinh.
Hai dja phuong ed sd nhiim cao nhit Ii TP Ha Long 2.592 ngudi va Thj xa Cim phi 1.701 ngudi (chiem 36,81% va 24,16% sd nhiim toan tinh).
Sd ngudi nhiim chii yeu l i nam chiem ty le 85,5%, nii gidi chi chiem ty le 15,5%. Sd ngudi nhiim HIV d do tudi 20 - 39 la chii yeu ehiem 89,33%, tre em dudi 15 tudi la 2,36%. Ty le nhiim HIV b ddi tugng tiem ehieh ma tiiy l i khi
TAI LIEU T H A M K H A O
1. Ban chi dao Phong chdng HIV/AIDS tinh Quang Ninh (2009), Bao cao Tong ke't cong tac phong chdng HIV/AIDS cac nam tir 2004 de'n 6 thang diu nam 2009.
2. Benh vien Lao va benh phdi Trung uong (2009), Bao cao boat dong phong chong benh lao- lao/HIV trong viing bien gidi Vi6t Nam - Trung Qudc tai Quang Ninh-10/2009.
3. Benh vien Lao va benh phoi Trung uong (2009), Bao cao Tong ket hoat dgng Tieu du an LIFEGAP Lao/HIV tai Quang Ninh tai khoa 2008 - 2009.
NGHIEN CiKU DAC DIEM LAM SANG VIEM TAI THANH DjCH Of TRE EM
Luong Hong Chau*
T O M T A T
Dat van de: viem tai thanh djch (VTTD) l i sir if djch trong tai giOa phia sau mang nhT con nguygn ven, thudng gap d tre em.
Muc tieu: nghien ciru dac diem lam sang cua bfnh VTTD.
Ooi tirgng va phifOng phap: nghien ciru tien h^nh trSn 300 tre bj VTTD.
Ket qua: t;^ 16 d 1-3 tudi: 60%, ttr phat hifn nghe kem:
5,3%, nhung do thinh luc don Sm: chi thuc hifn tre trSn 4 tudi: 100% giam thfnh luc, nhT lugng: 100% co bie'n do'i, chay mui: 100%.
Ket luan: VTTD gap nhieu nhat d tre lira tud'i nha tre, rat ft tr^ tu phat hien nghe kem (5,3%), chay mui la dau hif u thudng gap, nhT lugng thay ddi tuy giai doan, thfnh luc dd don am: suy giam thfnh luc 100%.
Tdkh03:V\&m tai thanh dich, nghe kem.
S U M M A R Y
Research on signs and symptoms of otitis media with effusion
Background: otitis media with effusion (OME) is an inflammation of the middle ear with a collection of liquid in the middle ear space, no perforation of the tympanic membrane.Purpose: to study signs and symptoms of OME.
Materials ands Methods: pesereption and prospective research was done on 300 patients with OME. Results: the peak age-specific attack rate occurs between 1-3 years (60%). Childrend complain of hearing loss: 5,3 %, but pure tone audiogram on children over 4 years shows 100%
hearing loss, all patients have running nose. Conclusion:
OME is most common in children 1-3 years, very rare children complain of hearing loss, 100% children have running nose, tympanogram and audiogram are useful and important to diagnosis and follow up OME. Keywords: otitis media with effusion, hearing loss.
I. OAT VAN OE
VTTD la su li dieh trong tai giiia phfa sau ming nhi con nguyen ven, khdng cd cic trieu chirng ciia viem cip, dich tai giiia cd the la thanh dich, djch keo, djch nhiy...VTTD la benh gap nhilu nhit d tre em, day la liia tudi dang hinh thinh ngon ngii va phat trien tri tue do dd se lam cham su phit trien eiia tre.
Diln bie'n eua benh kin dao, tir tir, bin than tre va e i bd me gia dinh rit khd nhan biet. BSnh thudng tien trien giy suy giam nghiem trgng tdi thinh luc, cd the gay ra cac bien chii'ng nguy hiem. Do dd VTTD d tre em cin phii dugc quan tam, theo doi chu d i o de ed the phat hien v i dilu trj kip thdi. O Viet Nam ciing nhu tren the gidi da ed rit nhilu tie gii nghien eiiu ve van d l nay.
Tuy nhiSn d nhiing tuye'n y te co sd khdng cd dieu kien chan doin thi benh thudng bi bd qua.
Do dd chung tdi tien hanh nghien curu d l tai niy vdi Muc tieu nghien culi : Md t i dac diem lam sang eua benh VTTD d tre em.
II. odi TUONG VA PHUONG PHAP NGHIEN CQU L Doi tugng nghien cihi
Gdm 300 benh nhan tre em < 14 tudi tdi khim tai phdng khim khoa Tai thin kinh ciia
benh vien TMH trung uong tir thing 1/2006 tdi thing 1/2009 dugc ehan doan la VTTD.
2. Tieu chuan lira chgn:
- Benh nhan nghe kem mgt hoae hai tai.
- Khdng cd tiln sir viem tai. Hien khdng chay mil tai.
- Kham TMH bing bg ngi soi Kazl stort vdi dng ngi soi 0 do co nhd 2.7 mm de dinh gia tinh trang tai giiia ciing nhu tinh trang mfli hgng, tai:
ming nhi cd anh vang, cd djch vdi hinh anh miic nude miie hoi, ed bgt khi, mang nhT xep...
- Do thinh luc, nhi lugng: cd giim thinh luc, nhT dd ed bien ddi: ehuyen v l i p luc am, hinh ddi, hinh vom, nhi dd phang.
Tit ca tre em diu dugc hdi benh bing bg cau hdi de dinh gii tiln sir benh va cac ye'u td lien quan.
3. Tieu chuan loai tru":
- Benh nhin hien chay mil tai, cd tiln sir ehiy mil tai.
- Benh nhan khdng ddng y tham gia nghien ciiu.
4. Phuong phap nghien cihi: nghien ciiu md ti, tien ciiu.
Xir ly sd lieu bang phin mlm thdng ke y hoe SPSS
III. KET QUA NGHIEN COU VA BAN LUAN 1. Phan bd cua VTTD theo tudi va gidi . Bang 1. Phan bd theo tudi
Do tuoi
Sd benh nhan T9 If %
Tieu hoc +PTTHCS 7-14 tuoi
40 13,3%
Miu giao 4- 6 tuoi
75 25%
Nha tre 1-3 tuol 180 60%
Tre nhu nhi
< Ituoi 05 1,7%
Bang 1 cho ta thiy: 13,3% sd benh nhan trong do tudi tieu hge va PTTHCS, 25% sd benh nhan trong do tudi miu giio, 60% sd benh nhin trong do tudi nhi tre, ehi ed 1,7% sd benh nhin trong do tudi nhfl nhi. Ket qua nay phii hop vdi ke't qua eua cac tic gia khac tren the gidi [ 2], [3] Ii VTl/D dat dinh b do tudi 2. Vi theo cac nghien ciai cd mgt su lidn quan chit che giu'a cau true eua vdi nhT, tinh trang vi6m nhiim b Id vdi vdi tinh trang viem nhiim d tai giuia. O do tudi eiia tre nhd eiu triic giai phiu chua hoan chinh cua vdi nhT thudng ngin va rong hon. Id dd eao hon, khdi VA thudng qui phit sau dd giam din kieh thude ciing vdi dd tudi cang ldn d tre.
- Phan bd ciia VTTD theo gidi: Nam : 155 :51,7%.NQ: 145 : 48,3%
BSnh gap nhieu d nam hon nu' nhung su khac biet khdng cd y nghTa thdng ke.
Y HOC VIET NAM THANG 4 - SO 2/2010
2. Tan suat mac benh d 1 tai, 2 tai Bang 2. Tin suit mic benh d 1 tai, 2 tai
Sd benh nhan Ty le %
Tai phai 59 19,7%
Tai trai 40 13,3%
Hai tai 201 67%
Bang 2 cho thiy : 67% sd benh nhan bi VTTD c i hai tai, 19,7% sd benh nhan ehi bi tai phii, 13,3% sdbdnh nhan chi bi tai trii. r • . •. ' • , ;
3. Tan sua't mac benh theo miia.
Bang 3. Tin suit mie benh theo mua.
Miia Sd benh nhan
T^ le %
Miia dong - xuan 190 63,3%
Miia he- thu 110 36,7
Bang 3 eho tha'y: 63,3% benh nhan thudng mic benh vao mua dong - xuan, ehi cd 36,7% sd benh nhan thudng mic benh vao miia he - thu. Theo cic nghien eiiu vio mua ddng - xuan d miln Bic li miia ed nhiet do xudng thip nhit, do im lai cao do dd benh nhan thudng bj nhung dgt viem mui hgng cip, neu nhiing dgt viem mui hgng cap nay khdng dugc quan tam va dieu trj dung thi se din den viem tai li djch.
4. Trieu chii'ng CO nang:
4.1. Nghe kem: trong 260 tre dudi 7 tudi thi khdng tu biet nghe kem, chi ed 104 tre (40%) duge bd me hoac thiy cd giao phit hien ra. Cd 40 tre tir 7 - 14 tudi : ehi ed 16 tre (40%) tu phit hien nghe kem.
Nhu vay VTTD d tre nhd khdng duge quan tam va tham kham TMH kip thdi rit dl bj bd sdt.
4.2. Chdy mdi: ' Bang 4. Tinh trang chiy mfli:
Tmh trang chay mui Sd benh nhan
l<j If %
Chay mui nhay 90 30%
Chay mui xanh dac 210 70%
Bang 4 eho thay: 70% sd benh nhan ed hien tugng chay mui xanh dac, 30% sd benh nhan cd hien tugng ehay mui nhiy. Nhu vay 100% sd benh nhan tdi khim diu trong tinh trang ehay mui cie mure dd. Dilu nay chirng td mdi lien quan mat thiet gifla viem mui hgng d tre em tdi tinh trang viem nhiim d tai giiia.
4.3. Solan chdy mdi trong mpt ndm Bang 5. Sd lin ehay mui trong mgt nam
So lan chay mui(n) Sd benh nhan
Ty If %
< 3 l a n 5
1,7% '
3 - < 6 40 13,3%
N>6 255 85%
Bang 5 eho thiy: 85% sd benh nhan cd hien tugng ehay mfli tren 6 lin trong mdt nam, 1,7% sd benh nhan ehiy mui dudi 3 lan trong mgt nam. Day la nhung benh nhi ed do tudi dudi 12 thing la Ilia tudi edn miln djch cua me nen vin trinh dugc nhung dgt viem mui hgng cip. Ttr ket qua nay chiing ta tha'y su cin thiet eua viec ve sinh mui hgng de phdng tranh eic benh ly tai giua.
5. Kham tai mui hgng: Chiing tdi tien hanh khim ndi soi 100% sd benh nhin, ddi vdi tre em be
5.1. Khdm tai:
- Ming nhT cd ve binh thudng hoac hoi 16m, kem sing: 60 ( 20%) - Ming nhT inh vang, 16m: 126 ( 42%)
- Ming nhT cd bgt khf hoac miic nudc - hoi: 114 ( 38%)
Nhan xet: Nhu vay cd den 20% so benh nhan cd ming nhT gin nhu binh thudng, ne'u khdng cd kinh nghiem hoac khdng cd eic tham khim can lam sing se bj bd sdt. 80 % benh nhan mang nhT ed thay ddi r6 ret.
5.2. Khdm mdi hqng Bang 6: Khim mfli hgng
Ket qua kham Sd benh nhan
Ty le %
VA qua phat 7 2,3%
A qua phat 14 4,7%
VA, A qua phat 279 93%
Bang 6 cho thiy: 100% sd tre em cd VTTD diu ed VA, A qua phit hoae ca A, VA qui phat. Trong dd 93% sd tre ed e i A, VA qua phit. Theo eic tie gia nudc ngoai [1], [2], [6], nhflng benh nhin ed VA, A qui phit bao gid eflng cd ty le VTTD nhilu hon ea vl tan suit cung nhu miie do. Diy ed le la nhflng d viem ke can tin edng tai giu'a theo co che viem nguge ddng. Mat khac, theo cie tie gia Nhat, be mat eiia td chiic VA cdn ddng vai trd la ldp ming vi khuan, kho chiia Haemophilus influenzae.
6. Do thinh luc, nhT lugng 6.1. Bdng 7: Ket qud nhi luqng
Dang nhi do Sd benh nhan
T9 If %
DangI 0 0
Dang II 15 5%
Dang III 100 33,3%
Dang IV 155 51,7%
Dang V 30 10%
Dang VI 0 0 Bang 7 eho thiy : 85% sd benh nhan ed nhT dd dang III, IV (Cd djeh trong hdm tai) ehi ed 5% sd benh nhin cd nhT dd dang II (cd ap luc im trong hdm nhT). 10% sd benh nhin cd nhT dd dang V (Cd hien tucmg xep nhT). Khdng cd benh nhan nao cd nhT dd dang VI (dang viem tai dfnh ed giin doan xuong con).
6.2. Bdng 8: Ket qud do thinh life dd: Chung tdi tien hanh do thinh luc don am eho 115 benh nhan trong do tudi miu giao v i PTTHCS ( >4 tudi)
Miirc do diec Sd b§nh nhan
T9 le %
Diec nhe 20 17,4%
Diec trung binh 95 82,6%
Diec nang 0 0
Bang 8 eho thay : 82,6% sd benh nhan nghe kem d miic do trung binh, 17,4% sd benh nhan nghe kem d mue do nhe, 0 ed benh nhan nao nghe kem miie do nang. VI tat e i cic benh nhan trong nghien ciiu cua ehiing tdi diu chua tien trien tdi giai doan viem tai dinh cd giin doan xuong con.
IV. KET LUAN
1- Phan bd cua VTTD theo tudi va gidi : 60% so benh nhan trong do tudi nha tre, 25% sd
benh nhan trong do tudi miu giao. 13,3% sd benh nhan trong do tudi tieu hge v i PTTHCS, ehi cd
1,7% sd benh nhin trong do tudi nhfl nhi.
- Phan bd cua VTTD theo gidi :Nam :155 : 51,7%, N u : 145 : 48,3%
2- Tan sua't mac benh a 1 tai, 2 tai :
67% so benh nhan bi VTTD e i hai tai, 19,7% sd benh nhan ehi bj tai phai, 13,3% sd benh nhan ehi bj tai trai.
3- Tan sua't mac benh theo mua : 63,3%
benh nhan thudng mie benh vio miia ddng, chi
Y HOC VIET NAM THANG 4 - SO 2/2010
cd 36,7% sd benh nhan thu'dng m i c benh v i o miia he.
4- Trieu chung co nang:
- Nghe kem: trong 300 tre chi cd 16 tre nhdm tudi 7- 14 tu' phat hien nghe kem.
- Chay mui: 100% cd c h i y mui, 8 5 % e h i y mui tren 6 lan trong mdt nam, 1,7% sd benh nhan chay mui du'di 3 lan trong mdt nam
5- Kham Tai mui hgng:
- Tai: 80% mang nhT cd bie'n ddi rd ret: anh vang, CO bgt khi, co mii'c nu'dc, hoi...
- Miii hgng: 100% sd tre em cd VTTD deu cd VA, A qua phat hoac ca A,VA qua phat. Trong dd 9 3 % so tre cd ca A, VA qua phat.
6- Do thinh luc, nhT lugng
- Ket q u i nhT lugng; 8 5 % sd benh nhan cd nhT dd dang III, IV (Cd djch trong hdm tai) chi cd 5% sd benh nhan cd nhT dd dang II (Cd ap lue am trong hdm nhT). 10% so benh nhan ed nhT dd dang V (Cd hien tugng xep nhT). Khdng ed benh nhan nghe benh nhan nao cd nhT dd dang VI (dang viem tai dfnh cd gian doan xuong con).
- Kit qua do thi'nh lue dd: 82,6% sd benh nhan nghe kem d miic do trung binh, 17,4% nghe kem d miie do nhe, 0 ed benh nhan nao nghe kem miic do nang.
TAI UEU THAM KHAO ,' , i 1. Bluestone & Klein.( 2001). Otitis Media In
Infant and Children. W.B. Saunders Company.
2. Bluestone,C. D. Disease.s and Disorders of the Eustachian Tube Middle Ear. Otolaryngology.
1991, 26,1289-1315.
3. Hall, J. W; Chandler, D.Tympanometry in Clinical Adiology. Handbook of clinical audiology. 1994, 20, 2X3- 299.
4. Margolis, R. H; Hunter, L. L. Audiologic Evaluation of the Otitis Media Patient. Otitis Media : the pathogenesis aproach. 1991. 877- H97.
5. Margolis, R. H; Hunter, L. L. Tympanometric evaluation of middle ear funtion in children with otitis media . Annals of Otology, Rhinology and Laryngology, 1994, Vol 103, 34- 38.
6. Paparella, M. M; .Jung, T. T. K; Goycoolea, M.
V. Otitis Media with Effusion. Otolaryngology.
1991,27, 1317- 1342.
