TCNCYH Phu trwung 80 (3A) - 2012
and/or gestational age < 31 weeks, the CRIB score ofO-5 risk of death 4 times higher than in- fants with weigh > 1500 g and/or gestational age > 31 weeks (RR = 4 2, p < 0 001). In conclu- sion, CRIB score > 4 has a good ability to analyze between life group and died group. Prema- ture group with CRIB score > 11 had a very high risk of death CRIB score ofO-5 had a higher risk of death if infants weigh < 1500 g and/or gestational age < 31 weeks
K e y w o r d s : P r e m a t u r e , C R I B , l o w w e i g h t , m o r t a l i t y
MOT SO YEU TO LIEN QUAN DEN Tl> VONG CUA TRE DE NON
Vu Van Yen, Pham Thj Xuan Tu, Nguyin Thj Quynh Hu^ng Trwdng Dal hoc Y Ha Noi
Nghidn cuu mdt s l ydu td lien quan din tw vong cua 667 trd dd non nhdp vidn tai khoa Sa smh bdnh vi$n Nhi Trung wang tw 1/3/2008 din 31/07/2008 cho thiy trd de non cd tudi thai 25 - 28 tuin tu vong cao nhit (75,6 %) Nhdm tre cd cdn nang < 1500g cd nguy co tw vong cao gip 4,8 lin Nhdm trd >
2500g (p < 0,001). Nhdm tre cd di tdt bdm sinh cd nguy co tu vong cao gip 5 lin nhdm trd khdng cd di t$t bim sinh. Nhdm trd cd BE < - 5 cd nguy ca tU' vong cao gip gin 3 lin so vai nhom trd co BE> - 5 (p
< 0,001) Nhdni tre cin F1O2 nhd nhit > 0.37 cd nguy ca tw vong cao gip 16 lin so voi nhdm cdn F1O2 <
0.37 (p < 0.001). nhdm trd can F1O2 Idn nhit trong 12h diu nhdp vidn > 0.44 cd nguy co tu vong cao gip 6,9 tin so vdi nhdm cd nhu ciu F/O2 < 0,44 (p < 0.001) Nhom trd cd PaCO^ > 60 mmHg cd nguy co tw vong cao gip 3,4 tin nhdm cd PaCO? < 60 mmHg (p < 0.001) Nhom trd cd than nhidt < 35.5°C c6 nguy ca tw vong cao gip 5 tin nhdm tre co thdn nhiet > 35.5°C Nhdm tre cd dwdng huydt < 2.2 mmol/l cd nguy CO tw vong cao gip 1,87 lan (p < 0,05) va nhdm trd cd dudng huyet > 7.0mmol/l cd nguy cotw vong cao gip 3,65 lin (p < 0,001) so vdi nhdm trd cd dwdng huyit 2.3 - 6,9mmol/l. Nhdm tre cd pH < 7,0 cd nguy ca tw vong cao gip 3 ldn nhdm cd pH > 7 0 (p < 0.001) Tom lai. cdc yiu td lien quan tdi ty Id tw vong Id Tudi thai < 31 tuin; Can ndng < 1500g. Cd di tat bdm sinh. BE < -5 , PaCO? > 60 mmHg. pH <
7,0; Cin FIO? nhd nhit thich hop > 0.37. Cin FiO? Ion nhit thich hap > 0.44: nhidt dd <• 355°C. ha dudng mdu hodc tdng dwdng mdu.
Tir khoa: tre de n o n , n g u y c a , t u ' v o n g , d u ' d n g m a u , ha nhiet dp
I. D A T V A N D E stnh c h i l m 2/3 t i n g s l tir v o n g trong giai Hien nay m i l n a m tren t o a n t h i gidt ed d o a n s a stnh s d m va b i n g 25 - 45 % tir vong 130 trieu tre e m d u a e s i n h ra v d k h o a n g 4 s a sinh [8] Tat Viet N a m theo t h i n g ke eiia trieu tre s a sinh tCr v o n g c h i l m 38%o tir v o n g B d Y T l (2004) ty s u i t c h i t s a s m h t r o n g ca d tre e m . N h u vay m o i g i d ed k h o a n g 4 5 0 tre n u d c la 18,1 % • [3] Nghien c u u tir v o n g cua s a sinh tu- v o n g . c h u y l u t a p t r u n g d eac tre de non vi t h i t r d t h a n h v i n de r i t q u a n n u d c C h a u A va C h a u Phi ( c h i l m 3/4) H a u trong, viec t i m h i l u mdt s l y l u t l lien q u a n h i t (99%o) t i i ' v o n g s a sinh xay ra d eac n u d c t d i t i r vong s a sinh lai c a n g q u a n trong h a n CO t h u n h a p t h i p va t r u n g b i n h , chi 1%o xay ra d l ed c a s d khoa hoc de x u l t mdt s l bien d cac n u d e e o . t h u n h a p cao. C a c n g h i e n c i r u phap ldm g i a m ty le tir v o n g d tre de non. O l d i u chl ra rang ti> v o n g t r o n g 24 g i d d i u s a u tai d u a e t h u c hien n h a m m u c t i e u : Nghien
181
TCNCYH Phu trwang 80 (3A) - 2012 ciru mot so yeu to lien quan den tw vong cua tre de non tal khoa sa smh benh vien Nhi trung wang tw 1/3/2008 din 31/07/2008 II. D 6 | TU'gNG VA PHLfONG P H A P
1. Odi tugng nghien ciru Tieu chuan lya chon benh nhan:
+ Tre de non: ed tudt thai < 37 tuin va co kha nang sing dugc (tuli thai > 22 tuan hodc can nang > 500g).
+ Oilu tri tai khoa Sa stnh, cd ngdy tuli <
28 ngay
Tieu chuin loai trip:
+ Tre du thang (cd tuli that > 37 tuin) + Nhij'ng tre dugc chuyin dt cac benh vien khac trong thdl gian nghien eiru
2. phuang phap nghien cuu Nghien ciru benh ehirng vdt ed mau duae tinh theo edng thu _
. i . - i 4 T ' ' ' i '
Thay so ta cd so benh nhan nghien eiru nc=600.
Cach thu'c tien hanh thu thap s6 lieu + Cdc benh nhan khi vao khoa Sa stnh dugc chpn vao m l u nghien eiru se duac kham iam sang ty my, tiln hanh lam xet nghiem, dilu tri, theo dot Fi02 trong 12 gid d i u nhap vien va 48 gid sau vao vien, cae thdng s l nghien ciru duac ghi nhan theo benh an mlu.
+ Cae xet nghiem dugc thuc hien tai khoa Sinh hoa va khoa Huylt hoe, benh vien Nht Trung uang.
Cac bien so theo thang diem CRIB Tuli thai' tinh theo bang diem danh gia
tudt that Finstrom tai khoa Sa smh benh vien nht Trung uang.
Can ndng: duac do bang mdt can dien tir d khoa sasinh (g).
- Dt tat b i m stnh [2]
+ Dt tat bim sinh gay chit ngay sau de: vo sp, phil bao thai, khdng than.
+ Di tat bim stnh nang (de doa tinh mang d p ) , ttm b i m sinh tim sdm (ehuyin glc ddng mach, than chung ddng mach, thit phat 2 dudng ra, thit trdi 2 dudng vao, tir ehirng Fallot hep ddng maeh phlt nang, bit thudng dgng maeh vanh, hep eo, quat dong mach chit), thilu san thanh khl phe quan, thoat vl hoanh bim sinh
+ Dl tat bam stnh nhe: dt tat vung mat, tay, ehan, ttm bim stnh tim mudn (cdn Ing dpng maeh, thdng lien thit, thdng iien nhT); dao nguac phit tang
- Khl mau
+ Lly mau dpng maeh ddng maeh quay + M l u mau duge dua ngay xuing phdng xet nghiem.
+ Kit qua dugc phan tieh do loai may stnh hoa hien dang ed tai benh vien Nhi Phox plus L
+ Xet nghiem khl mdu duae lly tat thdt dilm vao vien vd sau 48 gid nhap vien.
- FtOj-
+ Ndng dd oxy trong khl thd vao + Ndng dp oxy thieh hap d l Sp02 dat 95 %.
+ K i t qua tu'ng gid duge ghi vao bang theo dot d i u giudng
Kit qua dilu tri: sing hay tir vong, 3. Xu ly sd lieu
Nhap s l lieu bing phln m i m Epidata 3.1.
182
TCNCYH Ptiu trwang 80 (3A) - 2012 sau dd phan tich bang phln m i m SPSS 13 0 va Stata 10.0 vol tinh ty le phln tram. Test t- student, y^ (chi squared), Anova mdt chilu. Test Kuskal-Wallis H
III. KST QUA
1. Mdi lien quan giua ttr vong va nhdm tudi thai, can nang
- Nhdm tre de non cd tudi thai 25 - 28 tuin tu vong cao nhlt (75,6 %) Nhdm tre cd tudi thai 25 - 28 tuin cd nguy eg t u vong cao g l p 12,8 lan so vgi nhdm tre cd tuli thai 31 - 36 tuin (p< 0,001)
- Nhdm tre cd can nang < 1500g cd nguy co tu vong cao glp 4,8 lln nhdm tre > 2500g (p< 0,001).
Bang 1. Mdi lien quan giQ'a tCrvong va nhdm tudi thai, can nang Chi so nghien cu'u T u vong n, (%) Sdng nz (%) RR (Cl 95%); p
"udi thai (tuan)
2 5 - 2 8 29 - <31
31 -36
34 (75,6%) 102 (36%) 98(19,5%)
11 (24,4%) 12,8(6,25-26,11), 0,000 181(64%) 2,3(2,01-4,11), 0,02 405 (80,5%)
Tdng 166(24,9) 501 (75,1%)
79(47,6%) 87(52,4%) 4,8 (2,29 - 10,1), 0,000 Can nang 1500-2499 77(17,6%) 361 (82,4%) 1,1 (0,55 - 2,32); 0,87
(9) 2500 10(15,9%) 63(84,1%) T i n g 166(24,9%) 501(75,1%) 2. Mdi lien quan giira t u vong va dj tat b i m sinh
Bang 2. Mdi lien quan giOa tU' vong va dj tat b i m sinh
Di tat bam sinh TCr vong Song Tdng
n, (%) nz (%) n (%) 32 (50,8%) 33 (49,2%) 65 (9,7%).
Nang 12(100%) 0 12(1,8%) Tong 44(57,1%) 33(42,9%) 77(11,5%) Khdng
Tdng
122(20,7%) 468(79,3%) 166 (24,9%) 501 (75,9%)
590 (88,5%) 667(100%) OR = 5,1 (3,12-8,38), j} = 46,517, p = 0,000
Nhdm tre ed di tat b i m sinh nang tt> vong 100% Nhdm tre cd dt tat bim sinh cd nguy ea ti>
vong cao g l p 5 l l n nhdm tre khong ed dl tat b i m sinh.
Bang 3 eho thly nhdm tre ed BE < - 10 ed nguy ca tu vong cao gap 2,7 l l n , cdn nhdm tre cd - 1 0 < BE< -5 cd nguy ca tir vong cao g l p 2,6 iln so vdt nhdm tre cd BE > -5 (p < 0,001 ).
183
TCNCYH Pt)iJ trwang 80 (3A) - 2012
Nhdm tre cin F1O2 nhd nhlt > 0,37 cd nguy eg l u vong cao g l p 16 lln so vdi nhdm c i n FiOj
< 0,37 (p < 0,001) Nhdm tre c i n FiOj Ion nhlt trong 12h d i u nhap vien > 0,44 cd nguy co tu vong cao g l p 8,9 i l n so voi nhom cd nhu cau FiOz < 0,44 (p < 0,001)
Nhom tre co PaCOz £ 60 mmHg cd nguy eg tu vong cao glp 3,4 lln nhdm cd PaCOz < 60 mmHg (p < 0,001)
3. Mdi lien quan giij'a t u vong va khi mau
Bang 3. Mdi lien quan giua t u vong va khi mau
C h i s d nghien cuu Tir vong n, (%) _ S d n g n 2 ( % ) _ RR (Cl 95%), p
< - 10 48 (37,5%) 80 (63,5%) "' 2,70 (1,75 - 4,17), 0,000 K i l m d u Tu - 9,9 - > - 4,9 40 (36,4%) '7Q'{li3.3%y' 2,6 (1,62-4,07); 0,000 (mmol/l) > - 5 '_J_3 (18,2%) 351(81,8%)"
Tdng
>0,37
<0,37 Tdng
>0,44
<0,44 Tdng
166 (24,9%) 129(59,2%) 37 (8,2%) 166(24,9%) 123(50,4%) 43(10,2%) 166 (24,9%)
501(75,1%) 89 (40,8%) 412(91,8%) 501(75,1%) 57 (49,6%) 380 (89,8%>) 501 (75,1%)
16,1 (10,5-24,8), 0,000
8,9(6.0- 13,4); 0,000
61 (45,2%) 74 (54,8%) 3,4(2,25 - 5,00); 0,000 PaC02 <60 105(19,7%) ^ 2 7 (80.3%)_
Ting 166(24,9%) ' 50r(75ri%_)_
4. Moi lien quan giu'a tie vong va cac yeu td khac
Bang 4. Mdi lien quan giira tir vong va cac yeu td khac Chi so nghien cu'u Tir vong n^ (%) Sdng n2 (%) RR (Cl 95%o); p Than nhiet
(°C)
<35,5
>35,5
<2,2
61 (54,0) 105(19,0) 50 (30,5)
52 (46) 449 (81) 114(69,5)
5,02 (3,3-7,7); 0,000 1,87(1,24-2,83), 0,004 Buong 2,3-6,9 81(19,0) 346(81)
huyet
(mmoi/l) >7,0 35(46,1) 41(53,9) 3,65 (2,19 - 6,08); 0,000 Tdng cdng 166(24,9) 501(75,1)
<7,0 35(46,1) 41(53,9) 3(1,8-4,9), 0,000 pH >7,0 131 (22,2) 460 (77,8)
Tdng 166(24,9) 501(75,1)
Nhdm tre cd than nhiet < 35,5°C co nguy eg tu vong cao g l p 5 lln nhdm tre cd than nhiet
> 35,5°C.
Nhdm tre cd dudng huylt < 2,2 mmol/l cd nguy co tu vong cao g l p 1,87 lln (p < 0,05) va nhdm tre cd duong huylt > 7,0mmol/l cd nguy eg tii vong cao g l p 3,65 l l n (p < 0,001) so vgi nhdm tre co dugng huylt 2,3 - 6,9 mmol/l,
Nhom tre cd pH < 7,0 c6 nguy co ti> vong cao g l p 3 lan nhdm cd pH > 7,0 (p < 0,001).
TCNCYH Phu truung 80 (3A) - 2012 IV. BAN LUAN
Tuoi that cang nhd nguy ca tt> vong cdng cao. Nhdm tre cd tull thai < 28 tuin tir vong cao nhat (75,6%o), nguy ea tu vong cita nhdm tre nay eao g l p 12,8 lln so vdi nhdm tre 31 - 36 tuan (bang 1). K i t qua nay cung phii hgp vdi cac nghien eiru khae [4].
Ben eanh tudi that thi can nang eiia tre cung cd m l i lien quan tdi ty le tCr vong. Nhdm tre cd can nang < 1500g cd nguy ea tir vong cao gap 4,8 lln nhdm tre ed edn nang 2500g (p < 0,05) , ngugc lat nhdm tre cd can ngng 1500 - 2499g khong ed su khae biet vdl nhdm tre ed can nang > 2500g (p > 0,05). Tre cd can nang <1500g cd nguy ca tir vong cao, kit qua nay ciing phu hgp vdt cac nghien ciru khac nhu: T.T. Huang va K T K.Dung (1988) tre ed can nang < 1500g ehilm ty le tir vong 68% trong t i n g s l tre cita nhdm nghien ciru [4], Nguyen Kim Nga (1997) la 51,-7% [6] Trong nghien ciru eiia T r l n Dinh Long (1999) nhdm tre cd can nang < 1500g tt> vong toan bg [5].
Cac dj tat b i m sinh cijng cd m l i lien quan kha Idn tdi ty le t u vong cua tre. Tre bl di tat bam sinh nang trong nghien eiru nay da tir vong 100%). Nhdm tre nay ed dl tat nang v l ttm maeh nhu: dao g l c dpng mach. bit thudng su trd ve eua dpng - tTnh mach, thong san nhT thit. Nhdm tre eo dt tat bam sinh CO nguy ca tir vong eao g l p 5 l l n so vdl nhom tre khdng eo dj tat b i m sinh. TheP T.T Huang va K.T K Dung (1988) ty le tir vong vi dj tgt chilm 6,25%) [4].
K i t qua nghien ciru chF ra nhdm tre ed kiem du BE < - 5 (mmol/l) cd nguy ca tir vong g l p han 2 l l n so vdt nhdm BE > - 5 (mmol/l). Kilm du dac trung cho lugng ktim thira hoge thieu de mau benh nhan cd the trd v l trgng thai acid-base can bang binh thudng. Kiem du am nhieu, ehirng to tinh
trang toan mau nang, do rli loan ehuyen hoa trong t l bag vao mau.
Nhom d n Fi02 > 0,37 cd nguy ea tu vong cao g l p 16 lln nhdm c i n F102< 0,37 (p <
0,001), Tuy nhien theo nghien ciru eiia Buhrer C (2000), sau kht phan tich da biln thay ring FtO? nhd nhlt dpc lap trong tien luang ve tir vong [7]. Oilu ndy cho thly ed le benh nhan eiia chung tdt cdn ed nhung nguyen nhan khac gdy nen su d n thilt phai si> dung nong do oxy tit thilu cao nhu vay
Nhom can FiOj > 44 ed nguy ea tu' vong eao g l p g i n 9 lln nhom ein Fi02< 0,44 (p <
0,001), Theo k i t qua nghien eiru cita Buhrer C (2000), dilm s l FiOa ldn nhlt ddc lap trong anh hudng d i n su phat tnln thin ktnh [7].
O tre de non ldp md each nhiet mong, du tru' md It, trong kht dd dten tich da/ trong luang ca t h i ldn. Do dd, kht tre bi ha than nhiet, tre tang tieu thu nang lugng, oxy va glucose, gay nen toan chuyin hda do giai phong aeid beo tu do va taetat. Theo kit qua nghien ciru ciia ehiing tdi thi nhdm tre cd than nhiet < 35,5°C cd nguy ea tir vong cao g l p 5 lln so vdi nhdm tre ed than nhiet ^ 35,5°C Kit qua nay cung phii hgp vdi cac nghien ciru khdc [4, 6].
Nhdm tre cd dudng huylt < 2,2 mmol/l ed nguy ca tir vong eao g l p g i n 2 lln va nhdm tre ed dudng huylt > 7,0 mmol/l cd nguy ca tu vong cao g l p 3,65 lln so vdi nhdm tre cd dudng huylt 2,3 6,9 mmol/l (p < 0,05).
Oudng huylt eao va thip d i u gay rit loan ehuyin hda
Nhdm tre de non cd pH ^ 7,0 ed nguy ca tir vong eao g l p 3 lan so vdi nhdm tre cd pH
>7,0 (p < 0,001) K i t qua nay cung phit hap vdl nghien ciru khae [1]
Nhdm tre ed PaC02 > 60 mmHg cd nguy ea tir vong g l p 3 lln so vdi nhdm tre co 185
TCNCYH PhiJ truung 80 (3A) - 2012 PaC02 < 60 mmHg PaCO? eao the hien.
trung tam ho h i p bi dc c h l , cae benh tuin hoan lam kem van chuyin mau d i n phli, eac benh eiia dudng d i n khi, lam can trd su luu thong cua khdng khi
V. K £ T LUAN
Cac ylu t l Hen quan tdi ty le tir vong la - T u l i thai < 31 tuan.
-Can nang < 1500g - Cd di tat b i m sinh.
- BE < - 5, PaC02 > 60 mmHg, pH < 7,0, - C i n FIO2 nho nhlt thieh hgp > 0,37;
- C i n FIO2 ldn nhlt thich hap > 0,44;
-Than nhiet <35,5°C,
- Oudng huylt < 2,2 mmol/l hodc dudng huylt > 7,0mmol/l.
TAI LIEU THAM KHAO 1. Pham Le An (2003). Oanh gia gia tn tien lugng nguy ca tir vong tren tre sa sinh non thang nhe can nhap khoa h l i sire NO- II 2000-2002 eua thang dilm CRIB. Y hpc thue hanh (469) 12: 5 9 - 6 2 .
2. Trjnh Van Bao (2004). Di dang bim sinh Nha xult ban Y hoc Ha Ndi. 18-20.
Ktnh te - Xa hoi - Mdi trudng Nien giam thong ke Y t l 13 - 25
4. Td Thanh HiFcng, Khu Thj Khanh Dung (1988). Nguyen nhan tir vong d tre de non tai Vien bao ve sire khoe tre em nam 1984 Ky y l u edng trinh nghien eiru khoa hpc (1980 - 1985) Nha xult ban Y hpc 155 -162, 5. T r l n Oinh Long, Pham Thj Thanh Mai, Khu Thj Khanh Dung (1999). Nguyen nhdn va eae y l u t l nguy ca gay tir vong d tre sa sinh thip can. Tap san Nhi khoa, 8 (3):
147-152.
6. Nguyin Kim Nga, Nguyin Thj Phiic, Nguyen Td Nhir (1997) Nhan xet v l mdt s l y l u to gay tir vong d tre de non Ky ylu cong trinh nghien ciru khoa hoe vien bao ve sue khde tre em, nha xult ban Y hoe 58 - 62
7. Buhrer C, Grimmer I, Metze B, Obladen M (2000). The CRIB (Clinical Risk Index of Babies) score and neurodevelop- mental Impairment at one year corrected age in very low birth weight infants Intensive Care Med. Mar, 26 (3): 325 - 329
8. Lawn J.E, Cousens S, Zupan J (2005).
Neonatal survival 1 4 million eonatal deaths when"? Where? Why'?" www who.int/
child adolescent health/documents/pdfs/
3. 86 Y te (2004). Cae ehi tieu Dan sd Summary
RISK FACTORS OF PREMATURE MORTALITY
This research was to find somes risk factors of mortality of 667 hospitalized premature in the Neonatology Department of The National Hospital of Pediatrics from 1/3/2008 to 7/31/2008. Re- sults showed that the premature group with gestational age 25-28 weeks had the highest mor- tality (75.6%). Infants weight <1500 g had 4.8 times death risk higher than premature > 2500 g (p < 0.001). 100% premature had a severe malformation at birth were died Malformation at birth group was 5 times death risk to compare with group without birth malformation Prema- ture with BE < - 5 had 3 times mortality risk higher than premature with BE >-5 (p < 0.001).
Premature with FIO; >0 37 was 16 times risk of death higher than the group with F/O2 < 0.37 (p
< 0.001). Premature with Fi02 > 0.44 was 8 9 times risk of death higher than the group with F1O2 <0 44 (p< 0.001). Premature with PaCOz ^ 60 mmHg was 3.4 times risk of death higher
18
TCNCYH PhtJ truung 80 (3A) - 2012 than the group having PaCOz < 60 mmHg (p < 0.001). Temperature < 35.5°C was 5 times nsk of death higher than patient with temperature > 35 5°C Glucosemia < 2.2 mmol /1 was 1.87 times nsk of death higher (p < 0.05) and glucosemia >7.0 mmol /1 was 3.6 times risk of death higher than (p < 0.001) than patient having normal glucosemia PH < 7 0 was 3 times risk of death higher than patient with pH> 7.0 (p <0 001). In conclusions, risk factors related with premature mortality were- gestational age < 31 weeks and weight < 1500 g; having birth malformation; BE
< -5. PaC02 ^ 60 mmHg, pH < 7.0; Need minimal suitable F1O2 > 0 37; Need maximal suitable Fi02 ^ 0.44. hypothermia, hypoglucosemia or hyperglucosemia
Keywords: premature, mortality risk, glucosemia, hypothermia
K^T QUA DIEU TRj IMUNOGLOBULIN TREN BENH NHAN TAY.
CHAN MIENG NANG TAI BENH VIEN NHI TRUNG U'aNG
Nguyin Thj Hong Lac'', Pham Nhat An', Vu Thi Minh Phwong'
^Benh vien Nong nghlep,^Benh vien Nhi Trung wang
Bdnh tay chdn mieng do enterovirus gdy ndn la bdnh ly nhidm trung thudng gdp a trd em. Mot sd trwdng hap cd bidn chwng va ddn din tir vong nhanh do ton thwong thin kinh, hd hip va tuin hoan.
Nghidn cwu nhdm nhdn xdt hidu qud diiu th ciia Imunoglobulin Unh mach (IVIG) trong didu th benh tay chdn midng nang tai khoa Truyin nhiim. benh vien Nhi Trung irang Kit qud tw 1/8/2011 din 30/11/2011 cd 44/460 tay chdn midng nang dwac didu th IVIG tai benh vien Nhi Trung wang. Tneu chwng duac ghi nhan diu tidn la sdt cao (97,7%), ndi ban (88,7%), ndn (11.4%) gap nhidu nhit Lua tudi hay gSp Id dwdi 3 tudi Biih chwng thwdng gap trong 2 - 5 ngay diu cua benh Cdc ddu htdu mach nhanh, gidt minh (63.6%) thwdng dwac ghi nhdn Cdn Idm sang bach ciu va tidu ciu tang. CRP binh thwdng.
Didu tri IVIG cho phep cai thidn cdc tneu chwng Idm sdng Bdnh tay chdn midng nang thudng gdp d tre dwdi 3 tudi vdi cdc tndu chirng sdt cao, nd! ban. ndn, giat minh, mach nhanh. Didu tn IVIG kip thdi giup cdi thien bdnh. cin cd cdc nghien cwu sdu han vi vin di nay
Tip khoa: Tay chan mieng, enterovirus
I DAT V A N O E P^^* ^'^'*' ^'^'^ ^^ ^'^ ^'^^ ^^•'^ '•'^°''- Benh tay chan mieng d tre em la benh O Viet Nam trgng nhirng nam g i n ddy truyen nhilm lay tir' ngudi sang ngudi, d i benh xult hien nhilu d miln Nam va hien gay thanh dich do virus coxsaekie A16 vd nay benh da lan rdng ra khlp ea nudc Theo Enterovirus 71 gay ra. Benh tay chan mieng s l lieu eiia Cue Y t l Du phdng, tir ddu nam la "vin de sire khoe dang dugc quan tam d i n 30/11/2011 da co tren 90000 ca mac hang dau d nhilu nudc Chau A - Thai Binh benh d 63 tinh thanh va 153 ea tir vong Tai Duang. Benh gay eac biln chirng nguy hilm benh vien Nht Trung uang, tinh d i n nhu vtem nao, mang nao, vtem ca ttm, phit 30/11/2011 cd tren 600 benh nhan vao dieu phli cap d i n d i n t u vong n l u khdng duac tn ndi tru va 3 benh nhan tii' vong do benh
187
