TCNCYH Phu trwang 80 (3A} - 2012
Lyc CAN DU'aNG THQ Q BENH NHI Bl HEN PHE QUAN TU' 5 -12 TUOl
Nguyen Thj Yen\ Trinh Thj Huyen Tranff' ' Trwdng Dai hoc Y Ha Noi, ^Benh vien Nhi Trung wang Nghien cwu sw thay ddi Iwc cdn dwdng thd a 158 bdnh nhan trdn 5 tudi bi hen phe quan sau dung sal- butamol dang hit din khdm, didu tn va tw vin tai khoa Ho hap Nhi bdnh vien Xanh pdn tw 1/9/2009 din 31/10/2010. Kit qua cho thiy tudi gap nhiiu nhit tu' 5 - 9 tudi 61,4%, tre bi hen phi quan trong can va 38.6% trd bi hen phi quan ngoai can Lwc can dwdng thd thi hit vao va thd ra ca trong va ngoai can hen phi quan ddu cd xu hwdng giam din theo tudi. Nhdm trd hen trong con cd luc can dwdng thd Idn han so vdl tre hen ngoai con. Sau khi sw dung Saibutamol. Iwc cdn dwdng thd thi hit vao vd thi thd ra ciia nhdm tre hen trong con glam nhidu hon so vdt nhdm tre hen ngodi can (p < 0.05) Lwc can dudng thd ca hai thi hit vdo vd thd ra gidm din theo Ida tudi Sau sw dung Saibutamol. luc can dwdng thd thi hit vdo vd thd ra diu giam rd. Nhdm tre hen trong can cd luc can dudng thd Idn han so voi tre hen ngoai can. Sau khi su dung Saibutamol lwc can dwdng thd cua nhdm tre hen trong con giam nhidu han so vdi nhdm tre hen ngodi con
Tw khoa: Hen phe quan, lire can du'dng thd, saibutamol
d nudc ta, ky thudt nay mdi duac dua vao ap dung tai benh vien Xanh Pon Ha Ndi vdi he thdng may do luc can Pulmo 9 eiia Phap tai tra va nghien cirg v l irng dung cua I. DAT V A N D E
Hen p h i quan Id tinh trang viem man tinh ctja dudng d i n khl. Benh duac dac trung bdl hien tugng r l i loan thdng khi t i c nghen.
D l danh gia r l i loan thdng khi t i e nghen d tre hen p h i quan ngudi ta eo t h i sir dtjng nhilu phuang phap khae nhau, trong dd do chirc nang ho h i p bang p h i dung k l va do luc can (sire can) dudng thd Id hal phuang phap hien dang duge sir dung nhilu nhlt.
Luc can dudng thd la thdng s l tn/e tilp danh gta mirc co hay gian p h i quan, xae djnh tinh trang r l i loan thong khi t i e nghen mot each khach quan. Khac vdi danh gia chirc nang ho h i p bang p h i dung k l , do lue can dudng thd dugc thuc hien d nhip thd binh thudng, khdng yeu c l u su hap tde qua nhilu d d l i tuang do, nen dugc ap dung phd biln han cho tre em nhd tudi. Oanh gia lue can dudng thd bang ky thuat dao dong manh (Forced Oscillation Technique FOT) la phuang phap dang duac ap dung rdng rai tren t h i gidt, vi vay r i t eo y nghTa d^ ddnh gta hen p h i quan d tre nho [3, 5]. Tuy nhien
phuang phap nay, nhat la tren tre bl hen mdi ehf la budc dau O l tat nay dugc thuc hien nham muc tieu: Nghien ciru sw thay doi lwc can dwdng tha a benh nhi hen phi guan sau .diing saibutamol dang hit
II. D 6 | TUgNG VA PHU'aNG PHAP
1. Ddi tu'ang nghien cii'U
Gom 158 benh nhan tir 5 tuli trd ten, duac chin doan hen p h i quan theo tieu ehuin GINA 2006 d i n kham, dilu tn va tu v i n tat khoa Hd hip Nhi benh vien Xanh pon tir 1/9/2009 d i n 31/10/2010
Tieu chuin chin doan hen p h i quan theo GINA 2006 [6]:
+ D l i vdi tre tren 5 tudt
* Lam sang
Tre CO nhirng dgt ho, khd khe, khd thd, nang nguc tai dt tdt lat
137
TCNCYH Phu trwung 80 (3A) - 2012 - Tneu chirng xult hien hoac nang han v l dem va sang sdm, lam tre thirc gilc
Tneu ehirng xult hien hoae nang han theo miia.
Trieu ehirng xult hien hoac x l u di khi tilp xiie vdl dj nguyen hoac cd y l u t l nguy ea nhu: Hoa ehlt, bui nha, khoi thuic, nhilm vl riit dudng hd hap
- Ngudl benh ed ea dia eham, di ii'ng hoac tlln sir gia dinh co ngudi mac hen hodc cac benh di ung khac
Cac trieu chirng duge eai thien khi sir dijng thuic dieu tn hen,
* Can lam sang N l u benh nhan da duac do luc can dudng thd: luc can dudng thd tang trude dimg thuic vd luc can dudng thd giam sau dung thule gian p h i quan.
+ o i l vdi tre dudi 5 tudi Dua vao lam sang la ehlnh [6]
Lam sang Cae trieu chirng gai y d i n hen.
Cac dat khd khe thudng xuyen, Ho hay khd khe khi van dong.
Ho ve dem dii khdng nhilm vi riit, Khd khe khdng thay ddt theo miia, Trieu chirng v i n edn sau 3 tuit,
•Dtlu tri thu: Cai thien khi dilu trj va x l u di khl ngirng thule.
Phan loai mire dd nang nhe benh hen dua vao tieu chuin GINA 2006.
- Tieu ehuin Icai trir.
- Benh nhan da sir dung thule gian p h i quan trong vdng 6 gid trudc khi do
- Benh nhan cd can khd thd do nguyen nhan khae nhu can hen ttm, tran khl mang phlt, viem phli, di vat dudng thd.
- Benh nhan cd cae benh phot hgp khac
Cudng gidp, loan nhjp tim, suy ttm.
2. PhU'O'ng phap nghien ciru Nghien ciru md ta vdi cd mau thuan lgi.
Cae cht' tieu nghien ciru dugc thu thap theo mdt benh an m i u thing nhlt
Neu benh nhan vao vien nhilu lln se duae tham kham lam sang ky ludng tirng dgt vao vien
Chiing tdi phan thanh hai nhom Hen trong con: La nhii'ng tre ed eac bilu hien iam sang cita hen Ho can, thd khd khe v l dem va sang va nghe phli cd ran rit.
Hen ngoai coir La nhu'ng tre da dugc cac bac sT chin doan hen tir trudc, hien khong cd bteu hien lam sang
- Cae chi tieu nghien ciru
-'- Tull Tinh tuli theo nam, mdi nam la mot tuoi theo Td chirc Y t l T h i gidi.
+ Oo chirc nang hd hip: Oo Iuc can dudng thd bing ky thuat dao ddng manh
* Luc can dudng thd trung binh thi hit vao (Rrsl)
* Luc can dudng thd trung binh thi thd ra (RrsE).
* Lue can dudng thd trung binh thi hit vao va thd ra sau diing saibutamol.
- Cach t l l n hdnh nghien cuu.
* Chuin bl benh nhan trude khi do*
- Chilu cao dung va can nang duae do bang can va thudc do chuin
Tre dugc khai thae tiln sir, benh sir va kham lam sang toan dien trudc khi do
- T i t ca cae thdng tin v l tre duge diln vao mgt mau benh an thing nhlt
' May do Sir dung he thing mdy do liJ'e
TCNCYH PhtJ tmung 80 (3A) - 2012 can Pulmo 9 cOa Phap tal khoa Hd hip Nht
benh vien Xanh pdn. Do luc can dudng thd bing ky thuat dao ddng manh (Forced Oscil- lation Technique - FOT) d t i n s l 8 Hz
* Cach do- X + SD (hPa.s.L ') Tre dugc giai thich d l hgp tae do Tre ngoi yen va thd hoan toan qua mieng.
Tre ngam kin mieng ngam duae n l i vdt qua mot bd phan bang cao su mim.
Mui tre duge bjt kin bang kep mui (panh mim) d§ tranh nhiiu do luu thdng khdng khi vdi mdl trudng ben ngoai.
Tre dwac giir ma de ldm giam luu thdng khdng khi ciia dudng ho h i p tren gay nen nhilu.
Tre dugc do lij'c can dudng thd (Rrs) 2 lln trude khl dung thuoc d l dam bao tinh chinh xac cua ket qua
Sau 10 phut sir dung 200mg ventolin (saibutamol) dang xit, tre dugc do l l n thir 3 de danh gia sw thay d l l ciia cae thdng s l
*Cach xit thudc Tre duac hudng d i n thd ra t i l da trude khi xit, sau dd xjt mdt lln 100 mg k i t hap vdi hit vao t l i da rdi ngirng thd 10 giay, sau do nhac lai mgt l l n xlt nCra r l i
cho tre tilp tuc thd btnh thudng Ooi vdi tre 5 tuli ehung tdt su dung binh xjt Babyhaler d l Xlt thule cho tre.
- Sau mdt lln do kit qua se dugc may tinh tu ddng xd ly vd dua ra k i t qua.
- Oo thi ciia may do: T h i hien su biln thien khang trd theo thdi gian trong ca hat thi hit vao va thd ra
3. XLK ly sd lieu
So lieu dugc nhap vao va xu ly bang phln m i m thing ke y hoc Epl-lnfo 6 04.
He so biln thien CV (coefficient of varia- tion) - 06 leeh chuin / trung binh mlu:
o l so sanh hai gia tn trung binh ehiing tdi dung Anova Test
o l so sanh gia tn trung binh cua cimg mgt nhdm (trudc va sau khi sir dung saibutamol) chiing tdi dijng Students "t" Test
III. KET QUA
1. Phan bd theo tuoi va theo gidi:
Nghien eiru g i m 158 tre hen ed 95 tre nam, 63 tre nir; ty le nam/ nCr la 1,5/1 Tull nho nhlt la 5 tuli, Idn nhlt Id 12 tuli. Tuli gap nhilu nhlt tir 5 - 9 tuoi.
2. Phan loai chan doan hen trong ccrn va ngoai can
Bang 1. Phan loai c h i n doan hen trong va ngoai can Nam NO' ni % nz
Phan loai hen Ngoai can Trong con Chung
42 53 95
68,9 54,6 60,1
19 44 63
%
31,1 45,4 39,9
n 61 97 158
Chung
%
38,6 61,4 100
61,4% tre bl hen p h i quan trong can va 38,6% tre bj hen p h i quan ngodi can
3. Lyc can du'dng t h d thi hit vao d tre hen p h i quan: Luc can dudng thd thi hit vao ca trong va ngoai can hen p h i quan d i u cd xu hudng giam d i n theo tudi Nhdm tre hen trong can cd lue can dudng thd ldn han so vdl tre hen ngoai can Sau kht sir dung Saibutamol, lij-e can dudng thd thi hit vao cua nhdm tre hen trong can giam nhilu han so vdi nhdm tre hen ngoat can.
TCNCYH Phu truung 80 (3A) -2012
Bang 2. Lyc can du'dng t h d thi hit vao (do-n vj hPa.s.L"')
Trong can Ngoai can
Tru'dc dung saibutamol
Sau dung saibutamol
Tru'dc dung saibutamol
Sau dung saibutamol 5
6 7 8 9
> 10 Tdng 4. Lire
8,6 + 2,8 8,3+1,9 6,9 + 2,3 7,2 + 1,5 6,4 + 2,0 5,0+1,5 7,0 + 2,4
5,8 + 2,8 5,8 + 1,4 4,8 + 1,3 5,1 +1,9 4,5 + 1,4 3,5 + 0,9 4,9+1,9
<0,05
< 0,05
<0,05
<0,05
<0,05
<0,05
<0,05
7,9 + 1,5 6,3 + 2,1 6,6+1,6 5,2 + 1,3 4,9+1,4 4,3 + 0,8 6,3 + 1,9 can du'd'ng thd' thi tho' ra 6" tre hen p h i quan
Bang 3. Lire can du'd'ng tho' thi tho' ra (dcrn vi hPa.
6,8+1,3 5,5+1,4 5,6+ 1,3 4,6+1,0 4,1+1,3 3,8 + 0,5 5,2+1,6
S.L')
<0,05
<0,05
<0,05
<0,05
<0,05
<0,05
<0,05
Trong can Ngoai can
Tudi Trudc diing saibutamol
Sau dung saibutamol
Tru'dc dung saibutamol
Sau dimg saibutamol 5
6 7 8 9
>10 Tdng
8,7 + 2,6 8,8 + 2,2 7,4 + 2,3 8,3 + 2,6 7,0 + 1,6 5,5 + 1,6 7,5 + 2,5
6,8 + 2,8 5,9+1,4 4,8+1,3 5,1 +1,9 4,5+1.4 3,5 + 0,9 4,9 + 1,9
<0,05
<0,05
<0,05
<0,05
<0,05
<0,05
<0,05
8,8+1,9 7,5+1,9 7,2 + 1,6 5,8+1,6 5,2 + 1,8 5,1 +1,5 6,7 + 2,2
7,9+1,4 6,4 + 1,0 6,6+1,8 5,4 ±1,7 4,9+1,7 4,7 + 1,1 6,1 ±1,9
<0,05
<0,05
<0,05
<0,05
<0,05
<0,05
<0,05 Luc can dudng thd thi thd ra ca trong vd ngoai can hen p h i quan d i u cd xu hudng glam dan theo tudt Nhdm tre hen trong can ed lue can dudng thd ldn han so vdt tre hen ngoai can.
Sau kht sir dung Saibutamol, lue can dudng thd thi thd ra cua nhdm tre hen trong can gtam nhilu han so vdt nhdm tre hen ngoai can.-
IV. BAN LUAN
Trong nghien eiru ndy, chiing tdi gap hen p h i quan d nhilu lira tuli, tuli nho nhlt la 5 tudi va ldn nhlt la 12 tuli. O Viet Nam, nghien eiru ctja L.T.H. Hanh (2002), ty le tre bi hen p h i quan dudi 5 tuoi la 41,2%.; 5 - 10 tuoi la 42,8% va tren 10 tuli la 16% [2]
Gldi tinh dugc che la mot y l u t l nguy ca cita benh hen p h i quan, nhieu nghien ciru chg thly, hen p h i quan gap nhilu d tre nam
han tre nii', trong nghien ciru cua chiing tdi, 158 tre cd 95 tre nam va 63 tre nu*, ty le nam/
nCr la 1,5/1. Nghien ciru eua ehimg tol tuang t u nghien ciru eiia Mavale Manuel S va cs (2004), ty le nam la 60%., nir la 40% va N T Dung va cdng su (2004) cho thly ty le nam' nir la 1,3: 1 [1j-
Phan loai chin doan hen: Trgng nghien ciru ciJa ehung tdt cht co 6 1 % tre hen trong can, cdn 39%. la tre hen ngoai can. K i t qua nay cd le la do g i n mgt nira so tre nghien
TCNCYH PhtJ trwung 80 (3A) - 2012 ciru den kham va t u v i n hen theo djnh ky.
Ket qua eiia chung tdi cung phit hap vdi k i t qua cua N T.Yin vdi s l tre hen trong can la 68% [4]
LiJ'e can dudng thd' Luc can t h i hien ttnh chit can trd ca hgc cita he thing hd hap, kht cd tie nghen dudng thd lue can se tang len va se giam dt khi sir dung thule gian phe quan. Day Id mgt tieu ehuin co gta tri d l nhUn dinh k i t qua test phue hit p h i quan, mgt trie nghiem giup chin doan hot chirng rli loan thdng khi t i e nghen dae trung cita hen p h i quan
LIJ'C can dudng thd sau diing Saibutamol d tre hen: Luc can dudng thd ca hai thi hit vdo va thd ra eiia nhdm tre nghien ciru gtam ro ret sau diing Saibutamol, su khac biet nay cd y nghia thing ke vdt p < 0,05 Dtlu nay chii'ng to vai tro cita co hep dudng thd doi vdi luc can dudng thd vd vai trd eiia Saibutamol len sy glan nd dudng thd d tre hen p h i quan
Nghien eiru eiia F. Marehal, d tre em Phap bj hen p h i quan, lue can dudng thd thay dll trude va sau khi sir dung Saibutamol tir 30 - 40%) ed gia tri nhu test phuc hll p h i quan duang tinh [5], O tre em Viet Nam chimg tdi nhan thly gia tn ndy t h i p han Oilu nay ed t h i la do nhdm tre hen cua ehiing tdi da phln la da duac chin doan va dtlu tri hen phe quan d i n kilm tra theo dtnh ky,
Luc can dudng thd trudc va sau hit Sai- butamol trong vd ngoai can hen p h i quan tinh theo dan vj (hPas L'^) Trude kht hit 200mg Saibutamol, Kre can dudng thd ea hai thi hit vao va thd ra eua nhdm tre hen trong can d i u cao han nhom tre ngoat can Sau hit Saibutamol, lue can dudng thd ca hat thi hit vao va thd ra ciia nhdm tre hen trong can giam nhilu han nhdm tre hen ngoai can.
K i t qua nay eo the giai thieh la do trong can hen, p h i quan bt co thit, viem nhiem va
phil ne manh han ngoai can hen lam cho tinh dan h l i cua thanh p h i quan giam di, gay nen su khac biet v l c l u trite ca hoc eua dudng thd giii'a tre hen trong va ngoai can d i n den luc can tang len Sau dung Saibuta- mol su khac biet nay khong edn la do Saibut- amol lam giam co thit va tac hep dudng thd.
V. KET LUAN
Luc can dudng thd ca hai thi hit vao vd thd ra giam dan theo lira tuoi.
Sau sir dung Saibutamol luc can dudng thd thi hit vao va thd ra deu giam rd (p<0,05)
Nhdm tre hen trong can ed lue can dudng thd ldn han so vdi tre hen ngoal can
Sau khi sir dung Saibutamol lue can dudng thd eiia nhdm tre hen trong can giam nhieu han so vdi nhom tre hen ngoai can (P<0,05),
TAI LIEU THAM KHAO 1. Nguyen Tien Dung, Bill Kim Thuan (2007). Oae dilm lam sang va can ldm sang hen p h i quan tre em. Tap ehi thdng tin Y dugc, 2' 118- 122
2. Le Thj Hdng Hanh (2002) Mdt so nhan xet v l tinh hinh hen phe quan d tre em tai khoa Hd hip benh vien Nhi Trung uang Tap chi y hoc thuc hdnh 5 48.
3. Nguyen Yen Thi, Demoulin B., Schweitzer C , Bonabel-chone C , Marehal F (2007). Identification of Bronehodilator Re- sponsiveness by Forced Oscillation Admit- tance in Children. Pediatric Research J, Vol 62 (3): 348 - 352
4. Nguyin Thj Y i n , Nguyen Duy Thang, Vu Thi Thuy Lan (2007) Sue can dudng thd d tre hen p h i quan tir 6 - 10 tuli dilu trj tai khoa H6 hip, benh vien Xanh pdn. Tap chl nghien ciru y hgc tdp 55 (6): 81 - 87
TCNCYH Phu trwung 80 (3A) - 2012
5. Farre R., Rotger M., Marehal F., Respir J (13) 761 - 766 Peslin R., Navajas D (1999). Assessment of
Bronchial reactivity by forced oscillation ad- ^- wwfw.ginasthma.org (2006). GINA mittance avoid the upper airway artefae Eur Burden Report.
Summary
AIRWAY RESISTANCE IN PATIENTS WITH ASTHMA FROM 5 TO 12 YEARS OLD
•. The study was conducted to know the change in airway resistance of 158 patients more than 5 years old with asthma after using inhaled saibutamol going to hospital to examination, treated and counseled at the pneumology Department of Saint-Paul Hospital from 1^' Sep 2009 to 3f' Oct 2010. Results showed that the most frequent age was from 5 to 9 years old. 61 4%> of chil- dren with asthma attacks and 38.6%, In children with asthma attack outside. The airway re- sistance of inrespiratory and exrespiratory periods in both asthme outside attacks and asthma attacks tend to decrease with age. Group of children with asthma attack had an ainfl/ay re- sistance higher than the group outside attack After using inhaled Saibutamol. airway resistance of asthmatic children in the attack group In inrespiratory and exrespiratory periods was higher than the group of children with asthma outside attacks (p < 0.05). In conclusion, resistance air- ways both the inrespiratory and exrespiratory periods decreased with age. After using Inhaled Saibutamol, airway resistance of asthmatic children In inrespiratory and exrespiratory periods were clearly reduced. The ainfl/ay resistance of asthmatic children attacks and outside attacks were decreased. After using inhaled Saibutamol, airway resistance of asthmatic children in the attack group was higher than the group of children with asthma outside attacks
Keywords: Asthma, airway resistance, saibutamol
OAC DIEM LAM SANG CUA BENH VIEW! PHE QUAN PHOl a TRE DU'O'I 1 TUOI TAI BENH VIEN NHI TRUNG U'aNG
Vwo'ng Thj Huyen Trang\ Nguyen Thi Yen^
^Benh vien Nhi Trung wang, 'Trudng Dai hoc Y Ha Ndl Vidm phi qudn phdi Id mdt bdnh rit hay gdp d trd em Tuy nhien. tridu chwng Idm sdng cua tre dudi 1 tudi bl vidm phi quan phdi khong diin hinh Dd tdi dwac thwc hidn nhdm md td nhwng ddc didm Idm sang cua benh viem phi qudn phdi a 393 tre dwdi 1 tudi vao diiu tn tai khoa Hd hip, benh vien Nhi Trung uang tw 01/01/2010 din 30/06/2010 Kit qud cho thiy gin mdt nira sd tre mic vidm phi quan phdi ndm d nhdm tudi tu2-6 thang (49.4%,) Ty Id nam/nu Id 2.1/1 Dai da sd ly do din khdm Id ho (96,9%,) 37.4%
benh nhdn nhap vidn vdi vidm phdi rit ndng va 52.9% vdi viem phdi ndng. O nhdm trd dwdi 2 thdng tudt.
cac trieu chwng ndng nhw: khd khe. rut ldm ldng ngwc vd tim tdi gap nhiiu hon so vdi 2 nhom cdn l^i (p < 0.05). Sdt hay gap d Ida tudi tw7 - 12 thang (p < 0,1307; Ty le tre suy dmh dwdng do 2 va 3 bi viem phdi rdt nang chiim ty Id cao (68,2%i) vdi p< 0.05 Trd cang nho bdnh cang cd xu hudng ndng. tre dwdi 2 thdng viem phdi rit ndng gdp tdi 73.6%o vdi p < 0,001. Tdm lai. nhdm tre dwdi 2 thang tudi thudng mdc bdnh ndng han vd cdc tndu chwng ndng cung thwdng gdp hon (p < 0.001). Suy dmh dwdng cd anh hwdng chat che den mirc dd nang cua bdnh (p < 0.05)
TCr khoa: Viem p h i quan phoi, suy dinh du'dng