TCNCYH Phu trWdng 62 (3) - 2009
van td't nghiep bac sT Ndi tru Dai hpc Y Difpc sang va can lam sang d 23 benh n h i n t r i n djch Thanh phd' Ho chf M i n h . tr. 29 - 34. m i n g phdi do lao v l ung thfl. Hpi t h i o khoa hpc
6. Nguyen Xuan Trieu ( 1994). Dac diem lam benh phdi. Vien lao v l benh phdi, t | p 4, tr. 62.
Summary
D I A G N O S T I C V A L U E OF T H E PCR - BK I N T U B E R C U L O U S PLEURAL E F F U S I O N
Objective: (1) To define the diagnostic value of the PCR - BK for tuberculous pleural effusion. (2) The relation between PCR - BK of pleural fluid and somes clinical and paraclinical features of the tuberculous pleural effusion. Material: 127 patients suffer from tuberculous pleural effusion were treated in the Respiration department of Bachmai hospital. Method: prospective. Results: 32.3% cases have positive PCR - BK. There is not any relation between PCR - BK and somes the clinical, paraclinical features of the
•tuberculous pleural effusion (onset, fever and Mantoux, ESR).
Keyword: tuberculous pleural effusion, polymerase chain reaction - Bacillus de Kok (PCR - BK)
NGHIEN CLfu DAC DIEM LAM S A N G , CAN L A M S A N G VA
VI KHUAN TRONG HEN PHE QUAN BOI N H I § M
Dang Quang H u y \ Tran Hoang Thanh^
•^ ,, . ^Sinh vien Dal hgc Y Ha Ngi -Dai hgc Y Hi Ngi
Muc tieu: (1) Tim hieu dac diem lam sing vi can lim sing eiia HPQ bdi nhiSm. (2) Xic djnh cic loai vi khuan trong HPQ bdi nhidm. Boi tugng va phuang pbap ngbien cdu: hoi cdu 124 benh nhan HT'Q bdi nhiim, trong dd cd 79,8%o nd vi 61,3%o trudng hgp dugc dieu trj tai khoa Hd ha'p benh vien Bach Mai. Ket qua va ket luan: khd thd (87,1 %o) li ly do via vien chinh ciia benh nhin va 13%o trUdng hgp vao vien trong tlnh trang suy hd hi'p dp. HPQ bdi nhidm xay ra quanh nam, khdng ed sU khic biet ve miia. 97,6%o trudng hgp cd tien sd HPQ. 62,9%o trudng hgp cd sd dung thudc dt vi ngda can tai nha (sd dung thud'c dang xjt lal thtfdng xay ra HPQ bdi nhidm the vda vi nang). Trong HPQ bdi nhiim cic tneu chdng thudng gap lin lugt:
khd thd (100%o), ho khac ddm due (76,6%o), 41,1%o cd sdi cd cd (25,8%o), ndi ngat quang (28,2%o). Ran rit li trieu chdng thudng gap nhii khi khim phdl vdi 98,5%o, Hep den la ran ngiy vdi 89,5%o, ran am, ran nd vi n rio phe nang giim chl gap vdi 37,9%o vi 32,3%o tuang dng Ve can lam sing dai da sdbenh nhin deu cd sd lugng bach ciu trung Hnh vi td'c do ling miu tang. 13%o benh nhan suy hd hap cap cd tang PaCO, miu.
23,3%o trudng hgp cay vl khuan duang Hnh d ddm vi 71 % phit hien dugc d lin dy diu tien. Cic vi khuan thudng gap nhat trong HPQ bdi nhiim li: K. pneumonia, A. Baumannilyi P. aeruginosa.
Td khda: ben phe quan boi nhiim
LDATVANDE day nfldc ta la mdt trong nhflng nifdc d Chau A cd Hien nay tren the gidi cd k h o i n g 300 trieu ty le hen cao n h i t . Cung nhfl benh phdi t i c ngfldi m l c hen p h i q u i n va theo thdng ke g i n nghen man tfnh, hen p h i q u i n la ganh nang cua
b i n than ngifdi benh, gia dinh va xa hdi. Cac em hpc sinh p h i i nghi hpc, ngfldi lao dpng phai nghi viec m l ly do khdng cd gl k h l c dd I I cdn hen va dac biet I I hen p h i q u i n bdi nhiein. De gdp p h l n kiem seat hen cung nhfl dieu trj hen td't hdn, can cd nhflng nghien ciiU s l u hdn. Muc tieu cua d l t i i n h l m :
7. Nghien cii'u dac diem lam sang, can lam sang ciia HPQ boi nhiem.
2. Xac dinh cac loai vi khuan gay benh trong hen phe quan boi nhiim.
11. DOI TUONG VA PHU'ONG PHAP NGHIEN CL/U
1. Do'i tfldng nghien cii'u
Tieu chuan chgn benh nhsm: d c benh nhan dfldc c h i n dean hen p h i q u i n , d i i u trj tai khoa Hd h i p - Benh vien Bach Mai theo tieu c h u i n cua GINA. Tieu chuan bdi nhiem khi cd mdt trong cac d i u hieu nhiem k h u i n nhfl sd't, khac ddm due, phdi cd ran am hoac ran nd, sd' Ifldng bach cau tang (bach c l u da nhan trung tinh), td'c dp mau l i n g tang, CRP tang.
Tiiu chuan loai trif: HPQ khdng nhiem trung, COPD dpt c i p , cdn hen t i m , lae phdi.
2. Phu'dng phap nghien cii'u: hdi cflu. T i t c l hd so benh I n cua d c benh nhan HPQ bdi nhiem dflpc thu thap tai phdng lflu trfl hd sd benh vien Bach Mai trong thdi gian 4 nam tfl 1/1/2003 d i n 31/12/2007. Thdng tin khai thae dfldc d mdi mdt trfldng hpp d i u dflpc ghi vao mdt benh I n m l u . I I L K E T Q U A
1. Dac diem chung
1.1. Tudi va gidi: 6 1 , 3 % d nfl v l nam 38.7%.
Nhdm tudi > 45 (79,8%). Trong nhdm tudi > 45:
nfl (53,53%), nam (35,37%), sfl khac biet cd y nghla thdng ke (p < 0,05).
1.2. Nghi nghiep: ndng d i n chiem ty le cao n h i t : 35% (42/1 24).
Mua: HPQ bdi n h i i m x i y ra quanh nam vdi tan suit tfldng dfldng sfl k h l c biet khdng cd y nghTa thd'ng ke (p > 0,05).
2. Lam sang va can lam sang 2.1. Lam sang
Ly do vao vien: thfldng gap n h i t la khd thd (n = 108, chiem 87.1%).
a. Tien sif mic cic benh co the lam khd kiem soil hen.
Bang 1. Tiin sd ban than vi cac benb kem tbeo co the lam can HPQ khd kiem soat (n = 36)
B^nh Hut thud'c 11 Viem xoang Viem mui di Rdi loan t i m Tdng
flng than kinh
n 14 13 6 3 36
(%) (11,29) (10,48) (4,84) (2,42) (29,03)
Nban xet: 14 benb nban (chiem 11,29%o) cd tien Sit hut thudc la, trong khi dd tien sd viem xoang gap d 13 benb nhan (chiem 10,48%o).
b. Da'u hieu nhiem trung: ho khac ddm due (76,6%), 4 1 , 1 % cd sd't, ran am vdi 37,9%. 83,9%
trfldng hpp cd so Ifldng bach cau m l u tang, trong dd 7 9 , 8 % cd tang bach cau da n h i n trung tfnh, 74,07% (40/54) cd td'c dp l i n g mau tang.
c. Kham phdi'. ran rft 98,5%, ran n g l y 89,5%, ran i m ran nd v l rl r i o phe nang g i l m chi gap vdi 37,9% va 3 2 , 3 % tfldng flng.
d. Cac trieu chdng khic: cd cfl 25,8%, ndi n g i t quang 28,2%.
e. Thdi gian khdi phit benh trddc khi nhap vien: dai da so benh n b i n d i u vao vien sau 1 tuan benh khdi phat.
f. Tlnh trang sd dung cac thudc cit va ngita can hen trddc khi vio vien: Seretide va Salbutamol la 2 thud'c dflpc sfl dung phd bie'n n h i t vdi ty le
TCNCYH PhtJ trWdng 62 (3) - 2009
l l n Ifldt la 2 7 , 4 % va 2 6 , 6 % . HPQ bdi n h i i m gap dflpc do khf m l u cd 6 (13%) benh n h i n bj suy d nhdm dung thudc dang xjt (80,8%) nhieu hdn so hd h i p , 7 (15,2%) benh n h i n cd tang PaC02.
vdi d c nhdm khac. Xet rieng nhdm benh n h i n Toan mau gap d 3, benh nhan (1 benh n h i n HPQ bdi n h i i m dung thud'c dang xjt thi nhdm (2,2%) toan chuyen hda, 2 benh nhan (4,3%) HPQ nhe cd tan suit x u i t hien cdn t h i p hdn d c toan hd h i p .
nhdm k h l c va chi b l n g 1/2 sd Ifldng benh n h i n ^ p ^ ^ ^ ^ ^ P ^ Q ^ . p^Q^ > 60 m m H g chu yeu cua nhdm HPQ vfla va nang (p < 0,05). ggp ^ ^^flng benh n h i n HPQ nhe v l vfla, trong 2.2. Can lam sang khi dd vdi nhflng benh nhan cd cdn HPQ nang, a. Sd luang bach cau: khi nhap vien 8 3 , 9 % P^O^ ^ l i rdng tfl < 50 d i n > 90 m m H g .
trfldng hdp, cd so Ifldng bach cau, 78,53% bach e. Phan bd PaCOz'. PaCOz tap trung v l chu y i u c l u da nhan trung tfnh khi nhap vien tang khi < 45 m m H g dd'i vdi d c benh nhan cd cdn HPQ v i e vien. nhe va vfla, d nhflng benh n h i n cd cdn HPQ
b. Tdc do mau lang: 5 4 % sd benh nhan cd tdc " ^ n g thi mflc dp p h l n t i n cua PaCOj rdng va chu dp lang mau tang. yeu > 50 m m H g .
c. Khi mau dgng mach: 46/1 24 benh n h i n f- Nudi ca'y tim vi khuan Bang 2. Ket qua nuoi cay tim vi khuan qua tat ca cac lin (n = 133)
Mau ddm So' lu'dt benh nhan ca'y So' ca'y (+) % To'ng
Ddm
Xanh VIng Trlng due
17 44 45
5 11 11
29,4 25,0 23,9
31 23,3%
Trong 26 4 15,4 Djch rfla phe quan 5 1 20
Nhan xet: cac benh nhan ddac ca'y tdi da 4 lan va tdng sd lan ca'y la 133 kfat, trong dd 31 (23,3%o) tntdng hgp dddng tinh. Cd 1/5 (20%o) ktat benh nhan ddac ca'y dich rda phe quan ditang tlnh - A.Baumannii. Trong nhdm ca'y ddm, ddm mau xanh cho ty le cay ditang tinh cao nha't 29,4%,, ddm mau vang va mau tring due cho ket qua ditang tinh lan ktat li 25%o va 23,9%o tntdng hap. Tuy nhien stt khac bISt nay khong cd y nghia thdng ke (p > 0,05). Cay ddm trong cho tl le ditang tinh tha'p nha't (18,9%o).
g. Ca'y vi khuan ditang tinh: 71 % trfldng hdp cay vi khuan dfldng tinh ngay lan dau tien, 19.4% trfldng hdp p h i i c i y tdi l l n thfl 2 mdi tim dfldc vi k h u i n g l y benh.
h. Ty le ca'y ddm (+) theo mifc do nang nhe ciia can HPQ (n = 133): ty le c i y ddm (+) cua c l 3 nhdm HPQ nhe, vfla va nang l l n Iflpt la 22,58%; 18,87% va 28,57%, sfl k h l c biet n l y khdng cd y nghTa thdng ke (p > 0,05).
/. Sit thifdng gap cua cac loai vi khuan trong HPQ bdi nhiim.
Bhng 3. Mde do thudng gap cua cac loai vi khuan (n = 33)
C i y ddm va dich rfla phe quan
Ten vi khuan A.Baumanii K.Pneumonia P.Aeruginosa A.Junii E.Coli
n 10 8 5 3 2
(%)
(30,3) (24,2) (15,2) (9,1) (6,1) Citrobacter Freundii Pheomix
S.Aureus
Chryseomonas Luteola Acinetobacter Lowffii Burkhol cepacia
(3,0) (3,0) (3,0) (3,0) (3,0)
Tdng 33 (100)
Nhan xet: trong sd 31 benh nhan nuoi cay vi khuan gay benh dUOng tinh, cd 2 trUdng hgp dong nhiim ca 2 loai vi khuan (bdnh nhan sd 9 va 32). B$nh nhan sd 9 tim thay P. aeruginosa va K. Pneu- monia; benh nhan sd 32 tim tha'y P. aeruginosa va Staphylococcus aureus. Trong 33 ktat vl khuan duac tim thay, A. Baumanii chiem tdi gin 1/3 cac trddng hap, vdi 30,3%o, Ki Pneumonia ddng thd 2 vdi 24,2%o; P. aeruginosa 15,2%o. Mde do phd bien cua 3 loai vi khuan nay khdng cd stf khac biet cd y nghTa thdng ke (p > 0,05). , • .: .
j. Sit Hen quan giifa 3 loai vi khuan thddng gap vdi mde do nang cua HPQ bdi nhiim.
Bang 4. Lien quan cda 3 loai vi khuan thUdng gap vdi mde do nang ciia HPQ boi nhiem (n = 23)
,
Con HPQ nang Cdn HPQ vfla Cdn HPQ nhe Tdng
A. Baumannii n 5 3 2 10
(%)
(50) (30) (20) (100)
K. Pneumonia n
4 1 3 8
(%)
(50) (12,5) (37,5) (100)
P. aeruginosa n 3 1 1 5
(%)
(60) (20) (20) (100) Nhin xet: 3 loai vi khuan hay gap nha't chu yeu gap d nhdm cd can HPQ nang vdi ty le 50%o va 60%o.
IV. BAN LUAN
1. Tuo'i: nhdm tudi > 45 (79,8%) I I nhdm tudi thfldng gap n h i t trong nghien cflu cua chung t d i . T i i p theo sau nhdm nay I I nhdm > 50 tudi (43,5%). Sfl khac biet gifla 2 nhdm cd y nghTa thd'ng ke (p < 0,05). Ke't q u i nghien cflu cua
chung tdi cung tfldng tfl nhfl ket q u i nghien cflu cua d c t i c gia khac [3, 1, 5, 4 ] .
2. G i d i : N f l gidi la dd'i tflpng gap n h i i u n h i t vdi (51,3%) v l nam (38,7%). Sfl khac biet gifla-'2 nhdm cd y nghTa thd'ng ke (p < 0,05). Ke't qua nay cung tfldng tfl nhfl k i t qua nghien cflu cua trong
TCNCYH PhtJ trWdng 62 (3) - 2009
va ngoai nfldc [2, 3, 6, 4, 5].
3. Nghe nghiep: 54%) sd trfldng hdp I I ndng dan va cdng nhan. Ket qua nay cung tfldng tfl nhfl cua D I o Thj Lan [1 ] vdi ty le gap 50,9%.
4. Miia: khdng t h i y cd sfl khac biet v l tan suit xuit hien HPQ bdi nhiem gifla d c mua trong nam.
5. Lam sang
Ly do vao vien: khd thd la ly do chinh k h i i n benh nhan v i o vien.
Cac yiu to thuan lai va benh kem theo co the gay kiem soat hen kho khan: chung tdi gap 2 benh chu yeu dd I I hut thud'c la (11,29%) va viem xoang man (10,48%). K i t q u i nghien cflu eua chung tdi cung tfldng tfl nhfl cCia Le Thi Kim Cue [31 vdi ty le 1 1 , 1 % . Tuy nhien, do sd' benh n h i n cd d c benh kem theo nay q u i it nen chung tdi khdng cd binh luan gi.
Cac trieu chdng ca nang va toan than: 100%
benh nhan d i u cd khd thd. Sfl khac biet nay so vdi k i t qua cua Le Thi Kim Cue [31 khdng chl cd HPQ bdi nhiem ma cdn cd d HPQ thdng thfldng.
6/46 (1 3%) trfldng hdp cd suy hd h i p trong nghien cflu cua chung tdi. K i t qua nay tfldng tfl nhfl ket qua cua Dao Thj Lan [1 ] .
Ran rft (98,5%), ran ngay (89,5%). Ket q u i nay cung tflpng dfldng nhfl cua Dinh Thj Thu Trang [2] vdi ty le gap 9 2 , 2 7 % va cua Le Thj Kim Cue [3] vdi 96,43% trfldng hdp. D i i u n l y chflng td tlnh trang co that p h i quan kha phd b i i n trong HPQ bdi n h i i m . Ben canh dd ran i m va ran nd chung tdi gap vdi ty le 37,9% va 32,8% trfldng hdp. K i t qua nghien cflu cua chung tdi cao hdn cua D I o Thj Lan [1] chi gap trong 2 5 % trfldng hdp. Sfl khac biet nay cd the do dd'i tfldng nghien cflu khac nhau, khdng chi HPQ bdi n h i i m ma cdn cd c l HPQ thdng thfldng.
6. Can lam sang
83,9% trfldng hdp cd tang bach cau, sd Ifldng
bach cau trung binh la 13,85 + 5,14. 40/54 sd benh nhan dflpc lam xet nghiem m l u lang tang d 7 4 , 1 % trfldng hdp. Dieu nay chflng td yeu to' n h i i m trung trong HPQ bdi nhiem.
Khf m l u ddng mach: 45/124 benh n h i n dfldc lam xet nghiem khf m l u cd 5 trfldng hdp suy hd h i p chiem 1 3%, 15,2% trfldng hdp cd PaC02 tang
> 45 m m H g . K i t q u i nghien cflu cua chung tdi tfldng tfl nhfl cua Dao Thj Lan [1] vdi 15% va
13,3% tfldng flng.
Nudi c i y vi khuan: trong tdng so' 1 33 Ifldt c i y cd 33 lan c i y phat hi€n cd vi k h u i n vdi ty le 23,3% (benh pham chu yeu la ddm, cd 5 trfldng hdp djch p h i quan). Trong 33 Iflpt c i y vi k h u i n dfldng tfnh d c vi khuan thfldng gap n h i t lan Ifldt A. Baumannii (30,3%), K. Pneumonia (24,2%) va P. aeruginosa (1 5,2%). Khac biet vdi k i t qua cua chung tdi Lieberman va cdng sfl [4] da tim dfldc vdi ty le 4 9 % (bao gdm c l virus), dac biet vi khuan g l y benh d day chij y i u I I cac vi k h u i n khdng dien hinh (91,2%), trong khi d c vi khuan dien hinh nhfl tu cau vang chi gap vdi ty le 8,8%
trfldng hdp.
Mdt diem can lflu t i m de'n trong nghien cflu cua chung tdi la phan Idn ket qua dfldng tinh d i u thu dfldc d lan c i y dau tien. Ngoai ra chung tdi cdn t h i y ty le c i y vi khuan dfldng tinh cdn phu thudc vao mflc dp nang cua benh cd nghTa I I 3 loai vi khuan tren thfldng gap hdn d d c benh n h i n HPQ bdi nhiem nang. Them nfla, c l e vi khuan tren d i u d tren nhflng benb n h i n cd tien sfl HPQ lau nam.
V. KETLUAN
1. Dac diem lam sang va can lam sang ciia HPQ bpi nhiem
- 5 1 , 3 % n f l v l 79,8% la ndng d i n .
- Khd thd I I ly do chfnh khien benh n h i n di k h l m . - Benh xay ra khdng cd sfl k h l c biet v l mua.
- 62,9% trfldng hpp cd sfl dyng thudc tai nha de ngfla cdn hoac cat cdn, trong dd nhflng benh nhin suf dung thud'c dang xjt hay bi HPQ bdi nhiem vfla va nang hdn.
- 75,6% khac ddm due, sd't (41,1%), cd cfl va doan hdn vdi 25% va 28,2% tfldng flng. 93,5% ran ngly v l 89,9% ran rit II nhflng bieu hien co that phe quan thfldng gap nhit trong HPQ bdi nhiem.
- 13% trfldng hpp cd bieu hien suy hd hip, 1 5,2% cd PaCOj tang tren 45 mmHg.
- 83,9% trfldng hpp cd so Ifldng bach cau tang, trong dd 79,8% tang bach cau da nhin trung tinh.
74,1 % trfldng hdp cd td'c dp lang mau tang.
2. Vi khuan gay benh trong HPQ bpi nhiem - 23,3% ciy vi khuan ddm dfldng tfnh.
- Ty le ciy dfldng tinh khdng phu thudc vao mau sac ddm va mflc dp nang cua benh
- 7 1 % trfldng hdp ciy ddm lan dau cho k i t qui dfldng tinh.
- 3 vi khuin gly benh trong HPQ bdi nhiim lan Ifldt la A. Baumannii, K. Pneumonia va P. aeruginosa vdi tan suit 30,3%, 24,2% va 15,2%
tfldng flng. Ngoai ra d c vi khuan nay thfldng gap d nhflng benh nhan cd tien sfl HPQ lau nam.
TAI LIEU T H A M KHAO
1. Dao Thj Lan (2007). Nhan xet tlnh hinh diiu tri HPQ theo GINA 2005 tai khoa Hd Hap,
b#nh vi$n Bach Mai. Khda lu|n td't nghiep bac sT Y khoa.
2. Dinh Thi Thu Trang (2007). Dinh g i l chflc nang hd hip v l cdng thflc bach cau tren nhflng benh nhin HPQ tai khoa dj flng v l miin dich lam sing, benh vien Bach Mai. Khda luan tdt nghiep bac sT y khoa.
3. Le Thj Kim Cue (2003). Tim hieu lam sang, dieu trj HPQ tai khoa Hd Hap, benh vien Bach Mai nam 2002, khda luan td't nghiep bac sT y khoa.
4. David Lieberman, Devora Lieberman, Shmuel Printz, Miriam Ben - Yaakov, Zilia Lazarovich, Bella Ghana, Maureen G.Friedman, Bella Dvoskin, Maija Leinonen and Ida Boldur (2002). Atypical pathogen infection in adults with acute exacerbation of bronchial asthma, American journal of respiratory and critical care medicine, vol 157-2003.
5. Harry Teichtahl, Nicholas Buckmaster and Eric Pertnikovs (1997). The incidence of respiratory tract infection in adults requiring hospitalization for asthma. Chest, available at www.chestjournal.org.
6. P J Cook, P Davies, W Tunnicliffe, J G Ayres, D Honeybourne and R Wise (1998), Chlamydia pneumoniae and asthma, Deparment of respiratory medicine, Birmingham Heartlands Hospital, Bordesley Green, Birmingham B9 5SS, UK.
Summary
CLINICAL A N D PARACLINICAL FEATURES OF ACUTE EXACERBATION OF INFECTIOUS BRONCHIAL ASTHMA
Objective: (1) To study the clinical and paraclinical features of acute exacerbation of infectious bronchial asthma. (2) To identify bacteriology in the acute exacerbation of infectious bronchial asthma.
Material: 124 patients with acute exacerbation of infectious bronchial asthma, consist of 79.8% female and 61.3% men were treated in the Respiratory department of Bachmai hospital. Method: reprospective.
Results: dyspnea is a main cause of hospitalization and respiratory failure in 13% cases with bight PaC02.
The acute exacerbation of infectious bronchial asthma can happen at any time of the year. 97.6% cases
TCNCYH PhtJ trWdng 62 (3) - 2009
have history of bronchial asthma. 62,9% cases using bronchodllaters at home previously (serious infectious bronchial asthma was more often happened in cases using aerozole bronchialdilator). Symptoms of the acute exacerbation of infectious bronchial asthma are often dyspnia (100%), sputum (76.6%, fiver (41.1 % ) . Wheezing is the most symptom of acute exacerbation of infectious bronchial asthma. Tridor was seen in 25.8% cases. All the most of patients have bight leucocytes and erythrocytes sedimentation rate.
23.3% cases were cultured positive, in which A. Baumannii, K. Pneumonia and P. aeruginosa are predominantly in the acute exacerbation of infectious bronchial asthma.
Keyword: acute exacerbation of infectious bronchial asthma
NGHIEN CLfu DAC DIEM LAM S A N G VA CAN LAM S A N G
CUA BENH N H A N GIAN PHE QUAN BOI NHIEM CO TRL/C KHUAN ML) XANH
Tran Hoang Thanh Dai hgc Y Ha Ngi
Muc tieu: nghien cdu die diem lam sing vi can lam sang cua gian phi quan (CPQ) cd true khuan mu xanh. Bdi tugng va pbuang pbap ngbien cdu: hoi cdu 66 bdnh nhan CPQ bdi nhiem cd tri/c khuan mu xanh dugc dieu trj tai khoa Hd ha'p - Benh vien Bach Mai dugc chia lam 2 nhdm: nhdm true khuan mu xanh duang tinh vi nhdm am Hnh de so sinh (nhdm ehdng). Kit qua va kit luan: ve lim sing: 64,7%o benh nhan li nd, tudi trung binh li 49, ndng dan vi cdng nhan li hai nghe cd nhieu ngudi mac benh nhat Dai da sd benh nhin di vio vien nhieu lin (57,6%o vio vien td 2 lan trd len). Thdi gian nam vidn trung binh:
21,9 - 9,1 ngiy. Cic tridu chdng hay gap: 64,7%o sdt (gin 1/2 trudng hgp chl sdt nhe). 93,9%o bdnh nhin cd khac ddm mu, trong dd 60,6%, cd lugng mu td 50 - 200 ml/ngiy; 58,1 %o mu miu xanh. 1/2 trudng hgp cd khd thd, 27,3%o cd mdng tay khum vi 100%o khim phdi cd ran Udt. Ve can lim sang: Han 1/2 trudng hgp cd bach cau tang, dac biet bach cau da nhan trung tinh, 700% benh nhan cd miu ling tang (49,75 + 20,68 mm trung binh sau 1 gid va 70,22 + 28,47 mm sau 2 gid). 58,6%o soi phe quan cd mu trong long phe quan, 70%o trudng hgp cd tdn thuang ca 2 ben vi 76,7%o cd tdn thuang td 3 thuy trd len tren CT - can phdi. Dang tdn thuang chii yeu li hinh tui phdl hgp vdi tring hat hoac hinh tru (36,7%o vi 23,3%o). 12,8%o cay ddm cd phdi hgp vdi cac vi khuan khic. Khang khing sinh ciia P. aeruginosa ngay cing tang Tuy nhien, khing khang sinh cua P. aeruginosa vdi Ticarcillin, Piperacin/Tazobactam vi vdi cephalosporin thi he 3 vin cdn d mde 0%o, 9,1% vi 27,3%o tuang dng
Tir khoa: gian pbi quan, trUc khuan mu xanh
I. DAT VAN DE khuan mu xanh (P. aeruginosa) c b i l m mdt ty le Gian p h i q u i n (GPQ) la mdt benh ly thfldng khdng cao, nhflng dieu trj lai h i t sflc khd khan do gap d c l e Cd sd Y t l do n b i l u nguyen nhan gay ra. dac tfnh khang khang sinh cua loai vi khuan nay.
Trong q u i trinh d i i n bien cua benh, cd nhflng ddt D l h i i u biet sau sac them v l lam sang, can lam c i p (sdt, khac ddm due, khd thd) do bdi n h i i m d c sang cua d c ddt bdi n h i i m do trflc khuan mu xanh loai vi khuan k h l c nhau, trong do boi n h i i m trflc d c l e benh nhan gian p h i q u i n nham giup thay
