Y HOC VIET NAM THANG 5 - SO 2/2015
NGHIEN CU'U DAC DIEM LAM SANG ROI LOAN TRAM C A M SAU SINH
a B A M E CO CON DU'6'1 3 T H A N G T U O I D I E U T R I NOI TRU
TAI BENH VIEN NHI TRUNG U'QNG
Tran Thanh Tii*, Nguyen Mai Huong*, Tran Ngoc Anh*
T O M TAT
Muc tieu: Mo ta dac iJiem lam sang cua roi loan tram cam sau sinh is ba me co con du'di 3 thang tuoi dang dieu tn ngi tru tai benh vien Nhi Trung i/Ong;
nhan xet mpt so yeu to lien quan va nhu'ng tac dgng cua tram cam den tre va ba me.
Doi tu'tfng, phUcfng phap nghien ciiu: SCrdung phi/dng phap nghien cdu mo ta cat ngang tren 94 ba me CO con tLT 2 tuan,- 3 thang tuoi, dang dieu tr; ngi tru tai benh vien Nhi Trung u'dng.
ket qua: Diem trung binh thang danh gia tram cam sau sinh PDSS la 68,76 ± 24,59, co 21,28% tren 80 diem, dong th6i so nay cung du'cJc chan doan mgt giai doan tram cam. Cac trieu chiTng thu'dng gap nhat bao gom: khi sac tram (100%), mat quan tam thi'ch thu (100%), met moi giam hoat dgng (100%), roi loan giac ngu (100%),*r6i loan an uong sut can (90%), bi quan U/Ong lai (WVo) va giam t y trgng tu" tin (75%).
Cac yeu to lien quan t6i tram cam sau sinh la: stress khi mang thai, sinh non thang, nam vien tren 3 tuan, khong hai long moi tru'dng benh vien. Ty le chim soc con tot va td cham soc ban tlian tot thap hon 6 nhom tram cam so vdi nhom khong tram cam (55% vs 80,08%; 35% vs 77,03%).
Ket luan: Can phat hien sdm cac dau hieu tram cam sau sinh de co bien phap ho trd, can thiep phu hdp
TW khoa: Jvam cam sau sinh
S U M M A R Y
CLINICAL FEATURES AND RISK FACTORS OF POSTPARTUM DEPRESSION I N W O M A N
HAVING BABIES UNDER 3 MONTHS HOSPITALIZED I N NATIONAL HOSPITAL
OF PEDIATRICS
Objectives: To describe clinical features of postpartum depression in woman having babies under 3 months hospitalized in National Hospital of Pediatrics; to
Method: That was a cross sectional study enrolled 94 motiiers whose children under 3 months were treating in National Hospital of Pediatncs.
* Benh vien Nhi Trung udng Chiu trach nhiem chfnh: Tran Thanh Tu Email; [email protected] Ot: 0913555188 Ngay nh?n bai: 07/3/2015
Ngay phan bien khoa hoc: 20/3/2015 Ngay duyet b^i: 27/3/2015
Results: The average score of PDSS (Postpartum Depression Screening Scale) was 68,76 ± 24,59.
21,28% of mothers had PDSS over 80 and they also had been diagnosed as a episode of depression. The common symptoms were: depressed mood (100%), lost of interests (100%), fatigue (100%), insomnia (100%), poor appetite (90%), pessimistic in future (85%) and low self-confidence (75%). Some factors related to postpartum depression; prenatal stress, prematuration, long duration stay in hospital and dissastifaction with hospital environment. Mothers with postpartum depression took care their children and themselves not well as mothers without depression (55% vs 80,08%; 35% vs 77,03%).
Conclusions: Pospartum Depression shoulded be detected early.
I. DAT VAN OE
Qua trinh mang thai va sinh de la thdi ky xay ra nhieu bien doi ve sinh ly va tam ly trong ddi song ngu'di phu nu". Trong do, tram cam sau sinh (postpartum depression) la mpt roi loan cam xue nghiem trpng, co the gay ra nhu'ng anh hu'dng den su'e khoe cua chinh ngu'di me cung nhu" cac moi quan he giiJa ngu'di me va cac thanh vien khac trong gia dinh. Dac biet, tram cam sau sinh tac dpng tieu cy'c tdi su" cham sdc diTa tre mdi ra ddi, gay ra nhdng anii hu'dng ve sir phat trien cam xue, hanh vi, nhan each cua du'a tre sau nay. Y van the gidi va Viet Nam cung da ghi nhan du'dc mpt so tru'dng hdp me tu" sat va xam hai con do nhO'ng van de roi loan cam xue tram trpng trong benh canh tram cam sau sinh.
Ty le tram cam sau sinh la khoang 10- 30%, thay doi theo tu'ng quoc gia tuy thupc vao tieu chuan ehan doan, eong cu \da chpn, thdi gian phat hien va cae yeu to nguy ed cua nhom quan the khac nhau. Tai Viet Nam, theo Lam Xuan Dien [1] ty le nay la 12,5%. Cd che benh sinh cua roi loan nay la su" ket hdp giu^
yeu to npi tiet va tam ly xa hoi. Co nhieu yeu to du'dc cho rang cd lien quan tdi tram cam sau sinh, VI du nhu* sifc khde tam than ngu'di me tru'dc iuc mang thai, tai bien khi sinh, kho khan trong nuoi du'dng eham soc tre, thieu trd giup kinh te xa hpi... Trong tru'dng hdp 6da tre bi 6m
Y HOC VIET HAM THANG 5 - S O 2/2015
phai nam vien, thi nhuTig io iang ve van de benh
tat ciia tre, kho khan phat sinh khi nam vien dieu trj, thay doi ve sinh hoat, gid giac an ngu...^ la nhuTig tac nhan co anh fii/dng i6n va co the lam gia tang ty ie tram cam sau sinh. Theo tac gia Pham Ngoc Thanh [2] trong so nhffng ba me co con sinh non dang nam tach me tai khoa sd sinh benh vien Nhi Dong 1 co tdi 70,8% co dau hieu cua tram cam. Mac dCi tram cam sau sinh co ty ie kha cao nhu" vay, nhu'ng roi loan nay hien nay van chu'a du'dc quan tam dung mu'c, chu^ diTdc phat hien sdm va dieu tn kip thdi nham tranh nhu'ng hau qua dang tiec.
Vdi mong muon tim hieu them ve van de tram cam sau sinh ciia ba me co con bj benh dang dieu trj tai benh vien, chung toi tien hanh de tai: Nghien cufu die dli'm lam sing roi loan trim cam sau sinh cl bi me co con ditdl 3 thing tuoi dieu tri ngi tri tai binh vl$n Nhi Trung Wdng, vdi hai muc tieu:
1. Mo ti die diem lim sang roi loan tiim cim^
sau sinh d dc ba me cd con du'di 3 thing tuoi dang dieu trl noi tru tai Benh vien Nhi Trung Wdng.
2. Nhin xet mot so yeu to iien quan vi mot so tac dgng ciia roi loan tram cam sau sinh len tre vi me.
II. fifil TUqlNG VA PHLTOWG PHAP NGHIEN COU 2.1. Soi tu'dng nghiSn cu'u: Gom 94 ba me cd con tif 2 tuan tuoi den 3 thang tuoi dang dieu trl tai khoa SO sinh. Ho hap va Than kinh benh viin' Nhi trung Udng trong thdi gian tif 1/20H- 6/2014.
III. KITQUA
3.1. e | c diem chung cua doii tu'dng nghien cu'u Bang i ; Bac diem ngu'di me
Tieu chuan loai trir: Ngu'di me bj cham phat trien tri tue, benh iy tam than khac; tre dang trong tinh trang cap dsa, tre phai nam tach me;
khong dong y tham gia nghien ciru
2.2. Phu'dng phap nghien cu'u: phu'dng phap mo ta cat ngang
2.3. Cac bu'dc tien hanh nghien cihi:
Chon doi tu'dng nghien ciru la cac ba me co con tir 2 tuan den 3 thang tuoi hien dang dieu trj noi tril tai benh vien Nhi Trung u'dng, phit hdp vdi tieu chuan iua chpn va tieu chuan loal trir.
Thirc hien pinong van ca nhan tri/c tiep nham lam benh an nghien ciru va thang danh gia tram cam sau sinh PDSS. t^c doi tu'dng nghien ciru co diem danh gia qua PDSS tren 80 se du'iJc kham bdi bac sy tam than nham chan doan xac djnh roi loan tram cam.
Cong cu danh gia: Nghien cifti siS dung thang danh gia tram cam sau sinh PDSS (Postpartum Depression Screening Scale) do hai tac gia Beck va Gable phat trien nam 2000. Thang nay bao gom 7 muc: Roi loan an, ngii; Lo au/cam giac mat an toan; Khong Sn dinh ve cam xCic; Tam trl hon loan; Cam giac niat y thiic ve ban than; Cam giac CO loi/xau ho; Y nghi tLf sat. Moi muc bao gom 5 cau, moi cau du'dc cham diem tif 1 (rat khong dung) den 5 (rat dung). Theo Moriss-Rush va Bernstein (2002), thang diem nay cd do nhay la 94% va do dac hieu la 98% , tong diem tren 80 la CO dau hieu ciia tram cam sau sinh.
2.4. Xif ly so lieu: So lieu thu thap du'dc phan tich va xii ly bang phan mem Epi Info.
Tuoi me
Nghe nghiep
Bja chi
Du'di 20 tuoi 20-30 tuoi Tren 30 tuoi That nghiep/Noi trd
Kinh doanh Lao dgng chan tay
Lao dpng tri dc Thanh thi Nong thon Mien nui
So lu'dng 2 74 18 16 26 37 15 36 46 12
Ty lg % 2,13 78,72 19,14 17,02 27,65 39,36 15,96 38,3 48,94 12,76
Nhin xit: Phan Idn cac ba me la nhifng ngu'di trong dp tuoi tif 20-30, chlem 78,72%. Tuoi trung
binh cua ngu'di me la: 27,65 + 4,43
Y HOC VIET NAM THANG 5 - SO 2/2015
Bing2:^ac6\em con
Thang tuoi
Tuoi thai khi sinh
Khoa phong
Tif 2 tuan - 1 thanq 1-2 thanq 2-3 thanq 28 - du'di 33 tuan 33 - drfdi 37 tuan 37 tuan trd ien
Khoa sd sinh Khoa ho hap Khoa than kinh
So lu'dng 53 24 17 24 21 49 56 25 13
Ty le °/o 56,38 25,53 18,09 25,53 22,34 52,13 59,57 26,59 13,84
Nhin xet: Tre du'di 1 thang tuoi chiem ty le cao nhat: 67,02%. Ty le tre de du thang va non thang la x'ap xi nhu" nhau (47,87% vs 52,13%).
3.2. Dac diem cac trieu chu'ng tram cam sau sinh Bang3:T6ng so diem
Du'di 60 diem 60-80 diem
So lu'dng 48 26
Tren 80 diem 20 Ty le »/o
51,06 27,66 21,28
^//jfef/'Diem thap nhat ia; 39, diem cao nhat la: 151. Diem trung binh: 68,76 ± 24,59 Bing 4; Cac trieu chirnq tram cam tronq nhom ba me co diem PDSS tren 80
Trieu chu'ng Khi sac tram Mat quan tam thich thu Met moi, giam hoat dong Giam chu y
Y tu-dnq bi toi Y tu'dng, hanh vi tU sat Giam tu' trong, tu' tin Bi quan vao tu'dng lai Roi loan qiac nqil Roi loan an uonq, silt can Roi loan chifc nanq tinh due
So lu'dng 20 20 20 14 9 4 15 17 20 18 2
Ty le % 100 100 100 70 45 20 75 85 100 90 10
Nhinxet'Tat ca nhu'ng ba me cd diem so PDSS sau khi du'dc tham kham ve SLfc khoe tam than deu cd du tieu chuan chan doan mpt giai doan tram cam.
3.3. Mdt so yeu to lien quan va tac dong cua tram cam sau sinh Bing 5: Mpt so yeu to lien quan
Con dau long De non Sinh con gai Stress tam ly tru'dc sinh Tre mae benh man ti'nh Nam vien tren 3 tuan Thieu trd giup ngu'di than Khong hai Idng moi tru'dng benh vien
Khong tram cam
35
47,2943,24 40,54
14,81
"Kho"khan kinh te | 25 | 33,78 | 10 J 50 | 0,14 Nhin xet: Sinh con non thang, cd stress tam ly tru'dc khi sinh, nam vien tren 3 tuan va khong hai long moi tru'dng benh vien la nhu'ng yeu to co moi lien quan tdi tram cam sau sinh.
0,008 0,048
<0,01
Y HOC VIET NAM THANG 5 - SO 2/201S
Bieu do J ; Tram cam sau sinh va kha nang cham sdc tre
90,00%
80 00%
70,00%
60,00%
50,00%
'10.00%
30,00%
20,00%
10,00%
0,00%
- -
j n li II M -
Duoj \ n brum SO Khdn ] tra m cam |
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y..
TreiiSddiein
1 Tram
cam 1" I 'li.iiu soc lot
^I'iumisoccliuj toi Ilaii iiliii kiioiisi the cluini soc
Nhin xet: Ty le ba me cham sdc tre chu^ tot cao hdn d nhdm tram cam.
B/ei/dS2;Tram cam sau sinh va kha nang tu'cham sdc ban than
10 0 0 % O OD"-i,
l-I.iiinhnkli.
L-hVM toi i m l j i e n i
Khong tram cam Tram cam
Nhan xet'Ty le ba me tiT cham sdc ban than chira tdt cao hdn rd ret d nhom tram cam.
IV. BAN LUAN
Nghien cu'u du'dc thu'c hien tren 94 ba me cd con ttr 2 tuan den 3 thang tuoi dang dieu tri ndi tru tai 3 khoa trong benh vien Nhi trung u'dng:
khoa sd sinh, khoa than kinh va khoa ho hap.
Viec sinh con la mpt bien cd Idn trong cuoc ddi moi ngu'di phu nd, tuy nhien khi ngu'di me chu'a kjp thich nghi vdi hoan canh mdi, du'a tre mdi sinh ra trong thdi gian ngan da bi benh va phai nam vien dieu trj thi dd thu'c sd la mot stress tam ly cd anh hu'dng rat sau sac den cam xue, suy nghi cua ngu'di me. Luc nay viec phat hien sdm nhu'ng dau hieu tram cam de kjp thdi cd bien phap nang dd, ho trd, tri lieu la dieu rat quan jrpng nham tranh du'dc nhuVig hau qua xau CO the xay ra cho ca me va eon.
Trong nghien cu'u cua chung tdi, cd 20 ba
me, chiem ty le 21,28% cd diem sd thang PDSS
tren 80 diem, dong thdi ve lam sang cung ed day
du cac tieu chuan chan doan cua mpt giai doan
tram cam. Ty le nay tu'dng tu" nhu'mpt nghien
cu'u tai Thai Lan cung sd dung thang diem PDSS
cua tac gia Vinadda Piyasil (2011): 22%. Cac
trieu chu'ng thu'dng gap nhat cua nhii'ng ba me
nay bao gom; khi sac tram (100%), mat quan
tam thich thu (100%), met mdi giam hoat dpng
(100%), rdi loan giac ngu (100%), rdi loan'an
udng sut can (90%), bi quan tu'dng lai (85%) va
giam td trpng ttr tin (75%). Khi thi/c hien thang
danh gia PDSS cho tat ea cac ba me chiing tdi
thay rang cac nhdm trieu chirng cd ty le gap
nhieu nhat la cac rdi loan an ngii (12,49 + 5 14)
lo au/cam giac khdng an toan (11,92 ± 4^34) va
Y HOC VIET NAM THANG 5 - SO 2/2015
khdng on dinh ve cam xiic (10,84 ± 4,86). Ket qua nay phu hdp vdi ket qua nghien ciru ciia Pham Ngoc Thanh [ 2 ] : 85,7% ba me da khde that nhieu khi tiep xiic, hau het deu giam quan tam thich thii tdi nhu'ng hoat dpng tru'dc kia, 100% ba me cd rdi loan giac ngii [ 2 ] . Ngoai nhii'ng van de ve cam xue anh hu'dng tdi an ngu ciia ngu'di me, yeu to mdi tru'dng benh vien cd nhieu han che nhu' chat chdi, ndng, dieu kien an nghi cho ngu'di nha benh nhan chu'a du'dc tdt, Tat ca nhu'ng dieu nay da anh hu'dng gian tiep den su'e khde ngu'di me trong nhu'ng ngay con minh nam vien. Trong nghien ciru, mac dii khdng cd tru'dng hdp nao xuat hien nhu'ng bieu hien loan than kem theo tram cam nhu'ng cd 4 tru'dng hdp chiem ty le 4,25% cd y tu'dng tir sat.
Day la nhdm ddi tu'dng can cd sd nang d d kjp thdi ve phia gia dinh va nhu'ng trj lieu can thiet cua can bd y te nham han che nhCTng rui ro cd the xay ra cho ca ba me va tre em.
Trong nghien ciTu ciia chiing toi, cac yeu to nhu" sinh non thang, stress tam ly tru'dc sinh, nam vien tren 3 tuan va khdng hai Idng mdi tru'dng benh vien la cac cac yeu t d cd mdi lien quan ed y nghia thdng ke vdi tram cam sau sinh, Ket qua nay phii hdp vdi nhieu nghien ciru khac trong nu'de cung nhu" tren the gidi nhu' Lu'dng Bach Lan (2008)[3], Vinadda Piyasil (2011).
Sire khde va su' phat trien eiia tre sd sinh va tre nhd phu thupe rat Idn vao ngu'di cham sdc ma cu the ia ngu'di me. Dac biet vdi nhiJng tre dang dieu tri ndi tru thi^^.sy' eham sde tre, tuan thii theo nhii'ng hu'dng dan ve cham sdc ciia can bd y te ddng vai trd het sire quan trpng, anh hu'dng tdi ket qua dieu trj, han che nhii'ng bien chu'ng, tac dung khdng mong muon va riit ngan thdi gian nam vien. Tuy vay trong bieu do 1, cd the thay rang trong nhdm ba me tram cam ehi cd 55% t i / d a n h gia cham sdc con tdt so vdi 80,08%
cua nhdm khdng tram cam. Trong nghien ciTu ciia tae gia Kathleen F. va epng siT (2012), nhD'ng ngu'di mac tram cam sau sinh it cho con bii hdn so vdi ngu'di khong mac tram cam. i^dt nghien ciitJ khac tac gia Piteo A.M. (2013) [7] cho biet cd moi lien quan giiJa viee tre ngii khdng ngon giac vdi nhutig roi loan giac ngii ciia ngu'di me, ma day chinh la mpt trong nhu'ng trieu ehirng ttiu'dng gap nhat eiia tram cam sau sinh.
Ve phia ngu'di me, theo Hannah Woolhouse va epng sd khi nghien cifu theo ddi dpc 1057 ba me, trong 3 thang dau, tram cam sau sinh cd the gay nhuVig anh hu'dng den su'e khde eiia ngu'di me: met mdi (67%), dau lu'ng (47%), cac van de sda me (37%). 6 nghien ciTu eiia chung tdi, ty le cac ba me tir cham sdc ban than tdt thap hdn rd ret trong nlidm tram cam sau sinh: 3 5 % vs
77,03%). Dieu nay cd the anh hu'dng tdi sire khde ciia chinh hp, dong thdi neu cac ba me khdng dii sifc khde de cham sdc con khi tre phai nam vien trong thdi gian dai thi ciing se gian tiep anh hu'dng tdi hieu qua dieu tri ciia tre.
V. KET LUAN
Nghien ciru tren 94 ba me cd con tir 2 tuan-3 thang tudi dang dieu t n npi trii tai benh vien Nhi Trung u'dng ghi nhan du'dc cac ket qua:
21,28% mac roi loan tram cam sau sinh, trong dd cac dau hieu thu'dng gap nhat la khi sac tram (100%), mat quan tam thich thii (100%), met mdi giam hoat dpng (100%), rdi loan giac ngii (100%), roi loan an udng siit can (90%), bi quan tu'dng lai (85%) va giam tu" trpng t y tin (75%).
Sinh non, cd stress tam ly tru'dc sinh, nam vien tren 3 tuan, khdng hai Idng mdi tru'dng benh vien la mdt sd yeu t d lien quan tdi ty le tram cam sau sinh.
Tram cam sau sinh anh hu'dng den kha nang cham sdc tre va tiT cham sdc ban than cua ngu'di me.
TAI LIEU THAIVI KHAO
1. Lam Xuan Ofen, Le Qudc Nam (2002). Khao sat ty le roi loan tram cam sau sanh d cac san phu den sanh tai benh vien Jd Du. Ky yeu cac cong trinh nghien c&u khoa hpc nam 2002, benh vien tam than thanli pho Ho Chi Minh.
2. Pham Ngpc Thanh, Isabella Santarelli, Pham Thj' Yen Trinh, Du'dng To Tran (2011). Tram cam d ba me co con sinh non dang nam vien tai khoa so sinh - benh vien Nhi dong 1. Tap chf Y hpc thanh pho Ho ChfMinh,^ tap 15, so 3, tr. 70.
3. Lu'dng Bach Lan, Huynh Nguyen Khanh Trang (2008), Ty le va yeu td hen quan tram cam sau sanh 6 ba me co tre gul du'Bng nhi tai benh vien Hung Vi/dng. Tap chi Y hoc thanh pho Ho Chf Minh, Vol 13 - Supplement of No 1, p. 104 - 108 4. Corinna Reck, Daniela Noe, Jakob
Gerstenlauer, Eva Stehle (2011). Effects of postpartum anxiety disorder and depression on maternal self-confidence; Infant Behavior and Development, vol 35, 264-272.
3. Dwenda K- .Gjerdingen, Barbara P. Yawn (2007)." Postpartum' Depression Screening:
Importance, Methods, Barriers, and Recommendations for Practice. JABFM, Vol. 20 No.
3: 280-288.
D. Kathleen.^ F., Panagiota Kitsantas, Albert Brito, Carol "S. (2012), Postpartum Depression, infant feeding practices and infant weight gam at SIX month of age. National Association of Pediatric Nurse Practitioners, Elsevier Inc.
7. Piteo A.M. et al (2013). Posnatal depression mediates the relationship between infant and maternal sleep disuption and family dysfunction.
Early Human Development, vol 89, p. 69-74
