Journal af research in viel nam triiititlontd medicine andpharmacy So 4fi - 2016 T i M I HiNH BENH NHI DIEU TRI NQl TRU T.\I KHOA NQl - NHI BENH VIEN Y HOC CO TRUVEN TRUNG UONG Tl/NA.M 2010 - 2014 Situation of pediatric inpatients at pediatric internal medicine department in
the national hospital of traditional medicine from 2010 to 2014
* Pham Thj Kim Dung, ** Djng Minh HSng Trudng Bgi hoc YHa Ndl Tom tit
a- a''- f f '' f° ' ° - " " " ™ * ^'^'" '•*""« ^ *^"* " « "^" "•'• "dl tri tai Khoa Ngi - Nhi benh an da ra vten cua bfnh nhi dieu tri ngi trd tgi khoa Ngl - Nhl Benh vifn YHCT Trung uL cd Iha, gtan vdo vten tir l//20,0 den 31/12/2014 Kit „ud vd ki, lu^n: Khdo sdl lrongs7m7!Z
. . ™ ? //-^.g W/cr fa: rf, c/,u„g on 6fn* chiem ty le cao nhdl (51.47 %): rdi tin chirng nA trl ngu nhuyen (9.14%): cdc chiing thugc tgng phi. kinh phi (5.51%). ^ ^
Tir khoa: Tinh hinh b^nh nhi, Kho. N?i- Nhi B«nh vi|n YHCT Tmng mmg.
-Summarv
SITUATION OF PEDIATl^IC INPATIENTS AT PEDIATRIC INTERNAL MEDICINE DEPARTMENT IN THE NATIONAL HOSPITAL W
TRADITIONAL MEDICINE FRO.M 2010 TO 2014
31/12/2014 ResalKaZr , - ™ ™ , " ' ' " ' '»'"•« " " ' « • ' at the hospilal from 1/1/2010 lo hosnialLhi^Z k f"""^'"""'"-- ' " a five-year survey. Ihe number of bays who slay Inthe
l^'Tjtl'Se'rf;^^^^^^^
times from 74 paltentsTn^oToToSdlZji-ynff • f "{P"''""-" '"/«»«"« ^"creased 4 ai 57%l TherZl^Z ^l^Pol'cnts in 2014 with mainly line 2 health Insurgnce patients JisyaL^r/ZJZnZ7:'a"n HZIV "", * ' " " ' " ™ ' '"' '"^' of encephalitis, 'cerebral
N..iotrHrpi;a''ri°disteLrj'°'"''''"™'°'^™"'^'-^^
Z 1- '"t^^^i^^^^^^^^^^^^^ N.*..h,.h.l:,5/0,/2076
Nghien ciht YDHCT Viet .\iim I. DAT VAN DE
Trong nhiing nam gan day, ciing vdi dd phat tridn ciia nen YHCT, sd lugng bdnh nhi den dieu tri bdng YHCT cung cd khuynh hudng gia tang. Mfi hinh bdnh tat ciia Khoa Npi - Nhi Bdnh vidn Y hpc c6 truydn Trung uong gdn day da bien d6i manh. Dd gop phdn ddnh gid tinh hinh bdnh nhi trong 5 nam trd lai day lam co sd dd ra phuong hudng phdt tridn cua Khoa trong thdi gian sap tdi, nghidn ciiu nay dugc tien hanh nhdm 2 myc tidu:
/. Mo td mgt so dgc diim chung cua cdc benh nhi dieu tri ngi trU tgi Khoa Ngi Nhi Binh vien Y hgc cS truyen Trung uang tiir ndm 2010 - 2014
2. Khdo sdt mo hinh b^nh tgt cda cdc benh nhi dieu tri ngi trd tgi Khoa Ngi-Nhi
II. DOI TUgfNG VA PHUONG PHAP NGHIEN CU'U
2.1. Doi tuong
Toan bp 853 bdnh an da ra vidn cua bdnh nhi didu tri npi tni tai khoa
Nfii - Nhi bdnh vien YHCT Trung uong cd thdi gian vao vipn tiir 1/1/2010 ddn 31/12/2014.
Tieu chuan loai tru: bdnh dn khdng day dii th6ng tin nghien cuu, benh an bd dd quy trinh didu tri va bdnh an ciia tre cd qufic tjch nudc ngoai.
2.2. PhuoTig phap nghien cuu - Thidt ke nghidn ciiu: hfli ciiu, mo ta cat ngang.
Co mdu: 853 bdnh an ra vi?n trong thdi gian nghidn ciiu
- Cach thiic tidn hdnh: thflng tin cua moi bdnh nhi dugc thu thdp theo phieu nghien ciiu thidt kd sdn.
2.3. Thoi gian va dja diem: tir 1/1/2015 ddn 31/5/2015 t?i Khoa Npi - Nhi Bdnh vien Y hpc cfl truydn Trung uong.
III. KET QUA
Qua khao sat 853 bpnh an ra vidn cua bdnh nhi dieu tri npi tni tai Khoa Npi - Nhi cd thdi gian vao vi|n tu 1/1/2010 ddn 31/12/2014, chung toi ghi nhan mpt sfi kdt qua sau:
Journal of research in viet nam traditimal medicine and phannacy
3.1. Mot so dac diem chung cua benh nhi didu fri noi tru
So 48 - 2016
f
Bleu di 1: Phan bo benh nhi theo gioiNhjn xet: Si tre trai diiu tri npi trii la 58,5% cao ban si Ue gai duoc diiu Bang I: Phjn bi benh nhi theo nhom tuoi
So luong (n=853) Tv 16 % tri npi
0-2tu6i 3 - 5 tu6i 6 - 11 m6i 12-I5tu6i
368 203
43,14 23,i 26,73
6,33 Nhjn xet: Tre 0 - 2 moi nhjp vien chiim ty le cao nhit 43,14%.
4.57%
• BAo hi&n tuyin 1
• Sohlimtuy^2
• Virol tuyin
• Tvtuc
Biin di 2: Ph5n bi bfnh nhi Iheo chi dp bao hiim
,\gltien cu:t, YDHCT Vie, .\a
Nhjn xet: Phan lan tre nhjp vien thupc che dp bao hiim tuyin 2 la 71,51 %.
350 300 250
^200
•8 150 100
50 0
Bieu do 3: Tong lir^t diiu tri theo nam
Nhjn xet: S6 luat benh nhi vao diiu tri n6i tni tang din theo thai gian, tu 74 tre nam 2010, tang len 296 tre nam 2014, tang gip 4 lin.
3.2. Mo hinh cac benh thirdng gjp
• DC\46mnao .B$in&)
• NKhHdptlnh
• U$tV11ngo9bi«n mnoc
Biiu do 4: M6 hinh cae bfnh thu-ong g?p
Nhjn xet: Di chfag viem nao chiim ty le cao nhit 52,29%; dfag thii hai la Bai nao 10,08%
^'turnal of research in Ylet nam uattitional medicine and pltamiaci- Bang 2: Ty le benh Iheo YHCT Chung benh
Di chfag on benh Ngu tri, ngu nhuyin Khau nhan oa ta
IGiai thau -I- Hau ty -(- Ty uyen Chfag khac
s i luong (n=853) 439
78
Nhan xet: Di chfag on benh chiim ty le cao nhit 51,47 %, thii hai la chfag ngfl tri, ngu nhuyin va cac chfag thupc kinh phe, tang phi (khai thiu, hiu ty, ty uyen) chiim 9,14%.
IV. BAN LUAN
Trong 5 nam diiu tra, ty le tre trai cao ban tre gai, ty le trai/gai la 1,41.
Ket qua nay phii hpp voi cac nghien Cliu cua mpt si tac gia truac djy a Viet Nam, khi thing ke mo hinh benh tjt nhi khoa. Theo Nguyin Thi Thu Hien, 6 Khoa Nhi B$nh vifn Cham cfa Trung uang, tre trai chiim 63,2%, ly le trai/gai la 1,7 (2011) va tre trai chiim 68,9%, ty le trai/gai la 2,2 (2012) [1]. Theo Dinh Cong Minh, ty I? tre nam xip xi 60% [2]. Co thi cho ring nguyen nhan la do ty le tre nam trong xa hpi luon cao hon tre nir.
Trong Hpi thao quic gia vi mit can bang gioi tinh khi sinh ngay 3/11/2012, TS Duong Quic Trpng bao cao ting quan vi tinh hinh mit cjn bang gioi tinh 6 Viet Nam dang dien ra manh 6 n6ng thon, thanh thj, dac bift la ding bing s6ng Hing, ty |6
S2
211
Tyll(%) 51,47
9,14 5,51 9,14 24,74 nam 2012 la 122,4 tre nam/100 tre nir [3]. Dong thai co quan diim cho ring do tre trai hay hi biin chfag trong thoi ky mang thai, trong khi sinh va sau khi sinh hon tre gai dan din han chi qua trinh phat triin bao thai, hi de non, co dJu hieu benh ly cao hcm tre gji. Mat khac tre trai chi co mpt NST gioi tinh X, Uong khi tre gai c6 hai NST X, ma giao tu mang NST X co siic sing deo dai va khoe manh ban giao Hi mang NST Y. vin di nay ein co them nhiiu nghien cfa truoc khi dua ra kit lujn chinh xac.
Bang 1 cho ta thiy, ire vao viSn chli yeu a Iiia tuii nhfl nhi va mlu giao, chiim 66,94 %. Ty le Ire tren 12 tu6i chiem ty le thip.
Qua biiu di 2 ta thay si iupng benh nhi nhap vien nhieu nhit 6 chi dp bao hiim tuyin 2 (71,51%), bao hiim tuyin 1 dfag thii 2 (14,89%), cac che dp khac chiim ty le thip (<10%).
C6 the ly giai diiu nay la do Khoa moi nhjn dieu trj benh nhi theo chi dp bao hiem ban dau tir 2 nam tra lai day nen ty le benh nhi 6 chi dp bao hiim tuyin
Nghien cim YDHCT Viel \a 1 con thap. Hon nO-a vdi dac thu cua mpt vidn Y hpc cd truyen (YHCT) chii ydu didu tri va phuc hfii cac di chiing thupc chuyen khoa than kinh, co xuong khdp, bdnh !y man tinh, bdnh nhi thudng dugc didu tri giai doan cdp d cac benh vien Y hpc hien dai (YHHD), chuydn qua giai doan phye hoi se dugc didu tri tai ddy nen sfi lugng trd bao hidm tuyen 2 chidm ty le ldn. Cac nhdm dfii tugng khac: bao hidm vugt tuyen, tu die chidm ty le thap (ddu <10%).
Sfi lugt bpnh nhi vao dieu trj npi tni tang dan theo thdi gian, tu 74 tre nam 2010, tang len 4 ldn, ddn 296 trd nam 2014. Didu nay cho thdy Khoa dang trdn da phdt tridn m ^ . Thay vi CO nhidu bdnh nhdn ngudi ldn, ba nam trd l^i ddy, sfi lugng bpnh nhi tang ldn mpt cdch dang ke.
Vd mfi hinh cdc benh thudng gap:
Tre di chiing vidm nao chidm ty Id cao nhdt 52,29% (bang 3.2). Vidm nao la mpt bpnh cap tinh cua h^ thdn kinh trung uong vdi cac trieu chiing chinh la sdt, CO giat, cac rfii loan tri giac va cac tridu chiing r6i loan v|in d^ng.
Bdnh dien bien thudng nang, c6 ty le tu vong va di chiing cao [4]. Trong cac giai doan cdp ciia bdnh, tre cdn dugc didu trj tich cue bang YHHD. Hipn nay v ^ chua cd thuoc didu tri dac hidu cho cdc bdnh nay, chii ydu Id didu tri tridu chiing. Nghidn ciiu vd mfi hinh bdnh tat
tai Khoa Truyen nhiem Bdnh vidn Nhi trung uong [5] ciing cho thay ty 1? cdc benh viem nao mang nao cd sfi lugng benh nhi ldn. Qua khdi giai do?n cap, can tiep tyc phye hfii chiic ndng cho cdc bdnh nhi mang di chiing. Khoa Nfii - Nhi Benh vidn YHCT TW la mpt dia chi tin nhipm cho vide phye hfii chiic nang nay. Khoa dd su dung thu6c YHCT va cac bidn phap khong diing thufic kdt hgp vdi thufic YHHD trong phye hfii chiic nang cho kdt qua tfit.
Dieu tri cac di chiing vidm nao la mpt trong cac thd manh ciia Khoa nen ty 1?
bdnh nhi nam vidn cao hon so vdi cac nhfim bdnh khac.
Xdp thii 2 la bai nao vdi ty Id 10,8%. B^i nao la thuat ngii chi mpt nhom tinh trang bdnh I^ man tinh do mOt phan nao bO bi tfin thuong, dnh huofng den s\r kiem soat van dpng cung nhu tu the. Tripu chiing bpnh khac nhau tliy theo t6n thuong nao. B^i ndo do ton thuong thdn kinh trung uong c6 cdc r6i l o ^ van dpng nhu lipt cac chi, CO Cling CO, chdm phdt triln tinh than, roi loan kha nang hpc tap vd co cdc van de vd thinh gidc, thj giac, ngfin ngCr. Bai nao la mpt dang da tan tat nang ne, diing hang dau trong mo hinh tan tdt d tre em. Do vipc didu trj b^nh bdng cac phuang phdp cua YHHD cdn hgn che ndn YHCT dd la 1 trong nhiing l\ra chpn ciia gia dinh bpnh nhi.
Journal af research in vie, nam tradhional meilleine and phiirntiici- .\o 48-2016 Cac nhiim khuin ho hip cip tinh
dfag thu 3 vol 9,03% bao g i m cac mjt benh: viem amidan, viem VA, viem mui hpng cip, viem phi quan cip, viem p h i quan co that, viem p h i quan phii, viem phii, hen phi quan bpi nhiem,... Khac vai cac nghien cfa tai cac benh vien YHHD v i mo hinh benh tat tre em p h i biin nhit la benh ho hap, nhu tai Khoa Nhi - Benh vien Thanh Nhan la 65,1% [6]. Kit qua nay cao ban chut it so voi ty le mic benh h6 hJp tai Khoa Nhi Benh vien Cham cfa Trung uong (<3,6%). Diiu do co the do Benh vien ChJm cfa Trung uong chu yiu sir dvng cac phuong phap khong diing thuic trong diiu tri phye hii di chfag cac benh ly man tinh ve co xuang khap va thin kinh nen vipc gjp cac benh ly cap tinh cua hf ho hap la khong nhiiu. Mat khac cac benh nay cin diiu trj chu y i u bing thuic YHHD phii hpp cac thuic, nen gjp nhiiu ban cac dii tuang nay a Khoa Npi - Nhi Benh vien Y hpc c i truyen Trung uong, noi dugc su dyng thuoc YHHD phii hpp cung la diiu de hieu.
Lift day VII ngoju bien dfag fliii 4 Irong cac bfnh thuong gjip taj Khoa (5,51%). Cac benh ly khac: dai dam, sit vims, IV ky. DC CTSN,...it gap (diu
<5%).
Ve phan b i benh tjt theo YHc' tuong fag voi cac benh ciia YHHD, ty If m i c cac chfag cua YHCT cung tuong duang. Trong do di chfag 6n benh chiim ty le cao nhit 51,47 %.
Thii hai la chfag ngu Ui, ngu nhuyin (9,14%). Thii ba la cac chfag thupc tang phi, kinh phi: khai thiu, hiu ty, ty uyen (5,51%).
So dT CO su chenh lech giiia ty le mac di chfag viem nao (52,29%) va ty- le mic di chfag on benh (51,47%) la do su quy nap cac ttieu chfag vao ten benh theo YHHD va YHCT co luc chua tuong d i n g Nen ty le tre mic di chfag 6n b6nh co phin thip hon so vai di chfag viem nao.
D6i vori cac benh co su thing nhit va lien kit chat che giiia chin doan YHHD va YHCT thi ty If gjp trong YHHD va YHCT hoan toan triing khorp. Vi du nhu: ty le liet Vil ngoai bien 5,51% (biiu d i 4) ty If khju nhSn oa ta cung la 5,51% (bang 2).
V. KET LU.A.N
Qua khao sat 5 nam tinh hinh dieu trj npi tni tai Khoa Npi - Nhi Benh vien YHCT Trung uong thiy:
I. flac diem chung cua cac bfnh nhi:
- Trc trai vao vien cao hon tre gai, ty le ttai/gai la 1,41. Nhom tuii vao
Nghiea cin, YDllCT Viet Sa vien nhieu nhjt la <2 tuii chiim 43,14%.
- So lupt benh nhi dieu trj npi tni tang dan theo thai gian, tu 74 tre nam 2010 len 296 tte nam 2014, tang gjp 4 lan, vai chu yeu la cac benh nhi bao hiim tuyin 2 (71,51%).
2. Mo hinh benh lat - Theo YHHD: Cac benh hay gjp
nhJt ttong Khoa la di chfag viem n§0 (52,29%), bai nao (10,08%), NKHH cip tinh, lift VII ngoai bien.
- Theo YHCT: Di chfag on benh chiim ty le cao nhit 51,47 %. Thii hai la chfag ngil tti, ngu nhuyen (9,14%).
Thii ba la cac chfag thupc tang phi, kinh phe: khai thiu, hiu ty, ty uyen (5,51%).
TAI LIEU THAM KHAO 1. Nguyen Thj Thu Hien (2014)
Mo hinh binh tgt va phtrong phdp dieu tri benh nhi lai Bfnh vien Cham ciru Trung uang nam 2011 - 2012, Khoa lujn tit nghifp Bac sy y khoa, Trufag Dji hpc Y Ha Npi, Ha Npi.
2. Dinh Cong Minh (2002), Nghien ctiu mo hinh benh tal Ire em diiu tri ngi tru tai binh viin da khoa Uong Bi va Irung tam y le huyin Soc Son nam 2002, Lujn van Thac sy y hpc, Truang Dai hpc Y Ha Npi, Ha Npi.
3. Duong Q u i c Trong. (2012).
Bdo cdo long quan vi tinh hinh mat cdn bing GTKS cia Viet Nam, hgi thdo quoc gia ve mdt cdn bing giai
tinh khi sinh. Tap chi Dan s i & Phat ttiin, 11(140).
4. Vanessa K. Hinson and William R.Tyor. (2001). Update on virus encephalitis. CurenI Opinion in Neurology, 1 4 , 3 6 9 - 3 7 4 .
5. Pham Nhat An, Hoang KIm Lan, Tran Thj Hong Van va cong su-. (2012). Mo hinh bfnh tgt tgi khoa truyen nhiem benh vien Nhi Irung uang Irong 5 ndm 2006-2010. Tap chi nghien cfa Y hpc, phu phuang 80 - 2012(3A), 205.
6. To Van Hai, Vu Thuy Hong.
(2002). Ca cdu binh lot vd yiu to lien quan lai cdc bfnh thtrdng ggp tgi khoa Nhi binh vifn Thanh Nhdn. Nhi khoa, 10,43-51.
