(control lot), and 15 pieces of lot 2 were redivided into 3 groups. Three groups were exposed to lOkGy, 15kGy, 25 kGy of gamma radiation, respectively. Afterward, to compare the alter of bone matrix among lots, groups. Results and conclusion: No differentce was found between the two lots in microscope, no the changed structure of bone matrix. In electron microscope, the collagen fiber bundles in bone matrix irradiated with dose 25kGy were reduced tension and broken some oblique fibers.
Keywords: gamma, collagen
NGHIEN CL/U M O T SO CHI SO HINH THAI CUA PHAN PHU THAI VA TRE SO SINH
Nguyen Dflc H i n h \ Nguyen Thj Thu Ha^
^Trtfdng Dai hgc Y Hi Ngi, 'Benh vien Phu sin Hi Ngi Muc tieu: nghien cdu mdt so chi sd hinh thii ciia phan phu thai vi tre SO sinh dii thing. Ddi tUgng va phuong pbap ngbien cdu: nghiSn cdu tie'n cifu thUe hien trSn 600 trUdng hgp de, thai dii thing tai Benh vien phu sin Trung ugng trong nam 2007. Kit qua: cin ning trung binh cua tre sa sinh li 3250g. Tre sa sinh trai cd cin nang trung binh ban tre sa sinh gii li 150g. Binh rau khi dii thing cd cin ning trung binh li 515g. Diy rdn cd chiiu dii trung binh la 59cm. Kit luan: cin nang trung binh ciia tre sa sinh li 3250g, cin ning trung binh ciia binh rau li 515g vi chiiu dii trung binh ciia day ran la 59cm trong thai dii thing.
Tii khoa: tre sd sinh, can nSng, banh rau, day ro'n
I £)A J V A N D E ~ ^ ^ " P^*^ khde manh, cd mpt thai, de tai benh vien Phu s i n Trung fldng tfl t h i n g 3 den 8 - 2007.
C I c chl so' hinh t h i i nhfl mpt hang sd sinh ly khdng p h i i la b i t bien, dac biet I I trong giai doan
cd nhieu thay ddi nhanh chdng ve kinh te va ddi - Khdng cd bl't thfldng ve thai v l p h l n phu.
sdng. Cac chi sd nay cd y nghla ddng gdp k h i quan 2. Tieu chuan loai tru' trong cho hoat done k h l m chfla benh bane ngay. .,,^ u', i • u --• -
• ° • , o o & / . Khong nhp kmh cuoi cung.
Chung tdi da thtfc hien mpt nghien cflu lien cflu vdi cd mau I I 600 trtfdng hpp de tai benh vien Php s i n
Tmng tfPng trong nam 2007 de n h l m muc tieu: " """hai v l p h l n phu cua thai bl't thfldng.
Tim mgt sd gia tri vi binb thai cda tre sa sinh ^- ^^"^"^"^ P^^P " S " ^ ' ^ " c*^"
(TSS) du thang va pban phu thai. - Nghien ct'fu tien ct'fu. Cd m l u cua nghien cflu Tudi thai tfl 38 den bet 41 t u l n .
- Sin phu bi benh d p tfnh hay man tfnh.
II. DOI TUONG VA PHUONG PHAP NGHIEN CL/U
I I 600 trfldng hpp.
- Dung c l n dla Seca do Dflc s i n xul't, thang bang chia dp chfnh x l c den 50g de c l n cho TSS.
1 . Tieu chuan chon ddi tfldng nghien cu'u Ddng thdi dung c l n nay de do c l n nang cua BR.
Dd'i ttfdng nghien ct'fu la tre so sinh (TSS), b i n h - Do c l n nang TSS ngay sau de khi chfla x l y ra rau (BR) va d l y rdn (DR) cua nhflng s i n php cd du sut can sinh ly.
d c tieu chuan dtfdi day: - C l n BR sau khi md kep DR cho e h l y het
mau, cat DR tdi sat BR, e l t het mang rau.
I I L K E T Q U A 1. Tudi ngu'di benh
Tudi trung binh ci!ia sin phu I I 28,2 ± 4,7 tuoi. San phu ft tudi nhat la 17 tudi, sin phu nhieu tudi nha't la 45 tudi. Nhdm tfl 25 - 29 tudi I I ddng nhat vdi 243 ngtfdi, chiem ty le 40,5%. Nhdm san php tren 39 tudi la ft nha't chi cn 8 ngtfdi, chiem ty le 1,3%.
2. Nghe nghiep
Cln bp: 289 (48,2%); Cong nhan: 61 (10,2%);
Ndng dan: 75 (1 2,5%); Cle nghe khlc: 175 (29,1 % ) .
3. So lan de
Sin phu de con so chiem nhieu nha't vdi ty le 53,8% (vdi 323 san phu). Cd 46 s i n php (chiem ty le 7,7%) de tfl lan thfl ba trd d i .
4. Cach thu'c de cua san phu
- De thfldng vdi 319 s i n phu chiem ty le 53,2%;
- De nhd thu thuat cd 35 trtfdng hop, chidm ty le 5,8%;
- Mo ll'y thai ed 246 trtfdng hpp, chie'm ty le 41,0%.
5. Can nang cua tre sd sinh
- Cd 324 tre trai (chie'm 54%) va 276 tre g i i
(chiem 46%).
- Qua nghien ct'fu 600 trifdng hdp cho thay c l n nang trung binh cua TSS la 3250g.
- Tre nhe can nha't la 1400g, tre nang can nha't la 4900g. Ty le tre ed can nang dfldi 2500g chiem 3,5%.
- Tre trai nang trung binh 3320 ± 440g; tre g i i ed e l n nang trung binh 3170 ± 442 g. TSS trai nang hdn TSS g i i 150g, sfl k h l c biet nay cd y nghfa thd'ng ke vdi p < 0,001
C l n nang TSS cao nha't d nhdm s i n phu cd tudi tfl 30 - 34 (3358 ± 392 g). Nhdm s i n phu dtfdi 20 tudi cd can nang trung binh cua TSS II thi'p nha't (3130 ± 403 g). Sfl k h l c biet can nang cua TSS theo nhdm tudi s i n php I I ed y nghla thdng ke.
C l n nang trung binh cua TSS tang dan theo tudi thai, tha'p nhl't I I nhdm thai 38 tuan (3010 ± 506 g) va cao nha't cho nhdm thai 41 tuan (3452
± 452 g). Sfl k h l c biet n l y cd y nghfa thd'ng ke.
C l n nang cua TSS tang dan theo so' lan de, eon ra nang hdn eon so. Can nang trung binh cua TSS con so I I 31 54 ± 448 g; cua TSS con ra lan 2 I I 3332 ± 409 g va con ra tfl lan 3 trd di la 3500
± 452 g. Sfl k h l c biet nay cd y nghfa thdng ke.
N
~X
SD
< 2 0 10 3130
403 -
Bang 1. Can 2 0 - 2 4
125 3137
475
nang TSS theo tudi me 25 - 2 9
243 3244
428
(g) 3 0 - 34
167 3358
392
35 - 3 9 47 3330
471
> 3 9 8 3321
426
F = 8,78; p< 0,001. ' 6. Can nang cua banh rau
Cin nang trung binh ciia BR la 515 ± 103g. Gidi ban binh thifdng ciia can ning BR li td 390 - 670g.
Cin ning BR ting dan theo tudi thai. SU khac biet naycd y nghia thdng ke.
N
X
SD
< 2 0 10 4 5 7 113
Bang 2.
2 0 - 2 4 125 485 103
Can nang
25 - 2 9 243 504 97
BR theo tudi
3 0 - 3 4 167 546 99
san phu (g)
35 - 3 9 47 553 113
> 39 8 488
86
Chung 600 515 103 F = 7,76; p < 0,001
Bang 3. Can nang BR theo tudi thai (g)
N
X
SD
38 101 474 93
39 153 495 89
40 209 525 97
41 137 558 116
Chung 600 515 103 F= 17,2; p< 0,001
7. Chieu dai day rdn
Bang 4. Chiiu dai DR theo tudi tbai (cm)
38 39 40 41
Chung
101 153 209 137 600
X
57 57 60 6 2 - 59SD 10,4 11,6 10,f 12,7 11,5
F = 4,9; p< 0,021 . ' '
Chieu dil DR trung binh li 59 ± 11,5 cm. Gidi han chiiu dai cua DR di td 44 - 74 cm. Chieu dil DR ting dan theo tudi thai nhdng stt khac biet khdng cd y nghia thdng ke.
, gid'ng n h f l d c nghien cflu k h l c .
IV. BAN LUAN
Ket q u i cua nghien ct'fu nay, can nang trung binh cua BR la 515 ± 103g. Gidi han can nang binh thfldng cua BR khi thai du t h i n g la tfl 390 - 670g. Ket q u i nghien cflu nay cho tha'y tfldng tfl nhfl nghien cflu eua Boy va Hamilton vdi can nang trung binh cua BR la 508g [1], cua Bodyaz- hinei va cdng sfl vdi c l n nang trung bmh cua BR la 5 0 0 - 6 0 0 g 12].
Ket q u i nghien cflu cua chung tdi tflong tfl nhfl t i c g i l Nguydn C I n h Chtfdng (530g) nhflng cd cao hon so vdi t i c g i l Tran Thj Thu Hanh (428g). Can nang cua BR tang dan theo tudi thai (bang 3) cung
Chieu d i i DR trung binh theo nghien cflu cua chung tdi I I 59 ± 11,5em. Gidi ban binh thfldng cua chieu dai DR di tfl 44 - 74cm. Trong nghien cflu eua chung tdi, DR ngan nha't ed chieu d i i 20cin va DR d i i nha't ed chieu dai 105cm.
Ket q u i nghien cflu nay ttfdng tfl nhfl ket q u i nghien cflu cua mpt so' t i c g i l Anh va Phap vdi chieu d i i DR trung binh I I 55cin, gidi han binh thfldng tfl 42 - 70 cm 15, 6, 7]. Theo Fox (1989) chieu d i i DR du t h i n g thay ddi tfl 32 - 100cm, trung binh 54 - 61 cm 18). Theo Bodyazhinei, DR d i i la khi vtfdt 60cm va n g l n la khi dtfdi 40cm
12]. Ket q u i nghien ct'fu cua chung to'i cung tfldng tfl nhfl mpt sd nghien ct'fu trong ntfdc cua Nguyen C I n h Chtfdng (1998) v l Ta Thi H o l i Anh (2005).
C l n nang trung binh cua TSS du t h i n g I I 3250
± 447g. So s i n h vdi mpt sd nghien cflu gan d l y cua d c t i c g i l trong ntfdc cd cung d c h chpn mail thi ket q u i nghien cflu cua chung tdi cao hdn. So sanh vdi d c sd lieu k h l c tren the gidi, nhin chung can nang TSS eua Viet Nam cdn tha'p hon so vdi d c ntfdc chau Au, Bac My nhtfng tifdng difdng vdi d c nfldc chau A. TSS nam cd can nang trung binh cao hdn sd vdi TSS nfl. Sfl chenh lech de'n 150g. Ket q u i nghien cflu n l y h o l n loan phu hpp vdi d c nghien cflu trtfdc d l y .
V . K E T L U A N
Qua nghien cflu 600 trfldng hdp eho tha'y e l n nang trung binh cfla TSS I I 3250g. TSS trai ed cd can nang trung binh hdn TSS g i i la 150g. BR khi du thang cd can nang trung binh la 51 5g. DR cd chieu dai trung binh la 59cm.
T A I L I E U T H A M K H A O
1. Ta Thj Hoai Anh (2005). Nhan xet mpt sd dae diem ve hinh t h i i eua DR trong chuyen da tren s i n php de du t h i n g tai benh vien Phu S i n Trung tfpng. Lu|n van td't nghiep b i c slnpi trfl, Trifdng Dai hpc Y Ha Npi.
2. NguyOn Canh Chfldng (1998). Nghien ct'fu mpt sd chl so' hinh thai d TSS du t h i n g Viet Nam.
Luan van lot nghiep b i c sT npi tru, Trfldng dai hpc Y Ha Npi.
3. Tran Thi Thu Hanh (2004). Mpt sd dac
diem cua BR d nhdm TSS du t h i n g c h | m phat trien trong tfl cung va nhdm TSS dCi t h i n g p h l t trien binh thtfdng. Luan van tdt nghiep b l e sT ndi tru, trtfdng dai hpc Y Ha Npi.
4. Nguydn Thj Ngoe Khanh (1995). Gdp phan tim hieu mpt so' dac diem hinh t h i i cua phu nfl cd thai va TSS. Luan van tdt nghiep bac sl chuyen khoa cap II, Trfldng dai hpc Y Ha Npi.
5. Boy JD and Hamilton | W (1970). Umbilical cord. The human placenta, W Heffer & Son TLD, Cambridge, 209 - 2 1 1 .
6. Bodyazhinei VI (1983). Fertilization, intrauterine development of fetus and fetus membranes. Textbook of Obstetrics, Mir publishers, Moscow, 54 - 74.
7. Cunningham GF, McDonald CP, Gant FN, Lenevo JK, Gilstrap CL (1993). The placenta and fetal membranes. Williams Obstetrics, 19th edition, Appleton & Lange, Norwalk Connecticut, 1 26 - 1 36.
8. Robert L, Goldenberg, Richard O, Suzanne P (1989). Intrauterine growth retardation:
standards for diagnosis. Am j Obstet Gynecol, 161, 2 1 7 - 2 2 7 .
9. Colette C, Philippe E, Willkin P (1983).
Anatomie et histologic du placenta. Traite d'obstetrique, l e r tome, Masson, Paris, 48 - 80.
10. Fox H (1989). The placenta, membranes and umbilical cord. Obstetrics, Churchill Livingstone, Edinburg - London - Melburne and New York, 77 - 79.
Summary
T H E W E I G H T OF N E W B O R N S A N D P L A C E N T A , T H E L E N G T H OF U M B I L I C A L C O R D A T T E R M D E L I V E R I E S
Objectives: to study the weight mean of newborns, placenta and the mean length of umbilical cord at term, Methods: a prospective study in 600 deliveries at term at National hospital for Obstetrics and Gynecology in 2007. Results: the weight mean of newborns is 3250 grs (normal range: 2800 grs to 3700
grs). Male newborns are heavier than female about 150 grs. The mean of placental weight is 515 grs (min:
210 grs and max: 870 grs). The length of umbilical cord is 59 cm (min: 44 cm and max: 74 cm).
Conclusion: At term, the weight mean of newborns is 3250grs, the placenta is 515 grs and umbilical cord is 59 cm of length.
Keywords: new - born, placenta, umbilical cord . ,- ;
GOP PHAN TIM HIEU DAC DIEM LAM SANG,
NGUYEN NHAN GAY CHAY MAU MUI VA CAC PHUONG PHAP XL/ TRI CAM MAU MUI TAI KHOA CAP CLfU HAU P H A U B 7 ,
BENH VIEN TAI MUI HONG TRUNG aONG
' ' > ) : i , . Pham Tran Anh, Pham Khanh Hda ' • • ' • ' ' : Trtfdng Dai hgc Y Ela Ngi Muc tieu: (1) Nghien cdu die dUm lim sang nguyen nhan, mde do ciia chiy miu mui. (2) Khao sat cac phuang phip xd in can thiep dm miu tai benh vien Tai Mui Hgng Trung ttang Ddi tugng va pbuang phap nghien cdu: 143 benh nhin diSu trj tai khoa cap cdu benh vien Tai Miii Elgng Trung uang chgn doin xic djnh la chay miu min. Thidt ke nghien cifu: nghiSn cdu theo phtfang phip Hen cifu, md ta dt ngang cd phin tich. Thdi gian nghien cifu: td thing 3/2005 den thing 2/2006. Kit qua: chiy miu mui (CMM) chiem mdt tyle cao d ngudi trSn 40 tuoi (64%o), ty le nam/nd: 4/1. Da phin benh nhin khdng ed tiin trieu tntdc khi chiy miu miii (60,1 %„), chay mau mill sau chiem 62,9%o. Tai benh vien Tai Miii Hong Trung uang 88,1 % benh nhan dugc sd dung phtfang phip ngi soi dm miu Ke't luan: chiy miu mui da phin khdng cd 'da'u hieu bao trudc, de tii phit, ty IS thanh cdng ngay trong lin ngi soi dm miu diu tiSn 97,6%.
Td khoa: chay mau mdi, ngi soi cam mau
I. D A T V A N D E ^ "^c(c ngoai, tae g i l ShaheenOH [9] cung nghien ru- - - . , - , , - , ^'''^' "•^n qLiln the Idn benh nhan va dfla ra ket Chay mau mui la mot cap cflu hay gap trong
L - I . . -r • . , . , , '^^'s ^'-''c'ng tfl. Ve nguyen nhan, c l e t i c g i l trone chuyen khoa Tai Mui Hpng. C h l y mau mui chie'm , \ > ^'^c g'^ irong vi trf thfl nh3't .,A c> ", - . u- "'^^'^^ ^^ ^^^^ "S°3i deu dtfa ra ty le nhdm benh V! tn thfl nhat ve tan suat gap trong c h l y mau u- L
j , , - , „ „ , - . - , . - .- ,- , , " h a n chfla ro nguyen nhan chiem ty le eao. Ket difdng hd hap tren, va tan suat gap c h l y mau met , ,
lan.trdng sudt cupc ddi la k h o i n g hpn 6 0 % [1]. q u i nghien ct'fu tac g i l Pham Quang H o l i 12] cho tha'y ty le nay la 37,5%, trong khi d nghien ct'fu Tfl thdi cd Hy Lap ( d c h d l y k h d n g 2500 d a t i e g i l L.Frikart et coll 110] ty le nay la 38%
nam), c h l y mau mui da dtfpc dd cap ddn. 6 Viet Nhdm nguyen nhan huyet I p cao theo tac g i l Nam, tac g i l Pham Quang H d i 12] da nghien L.Frikart et coll 110] chiem 33,8%. Tren the gidi ctfu ve c h l y m l u mui va chl ra r i n g dp tudi tren nhidu t i c g i l da nghien cflu vd mdt sd bien p h i p 40 chiem ty le 6 4 % , nam nhidu hon nfl. T i c g i l dd d m mau mui. Feldmann 18] nghien ct'fu tren BUI Thai Vi J6] llm thay chay mau mui d dp tudi Ijch sfl cho tha'y bien phap nhet meches mui da 30 - 49 chiem ty le 4 0 , 2 % va ty le nam nfl la 2 / 1 . dfldc sfl dpng tfl lau va thdi gian benh nhan n l m
