Nghien edu dac A lam sang, can lam sang va ke't qua dilu trj
m m CSP DO i m BSNH viiN m KHOA TINH HA m
' ^ / ^ e n h lieu chay cap khong eon qua 'jj:^xa la doi vdi nguai dan nhat la (j^"^^r)h\mg ngudfi dan ngheo a \Ting kho khan thieu thon ve ve sinh moi trudng va nuac sach, tap quan sinh boat khi ma lau nay hg song trong vimg dich luu hanh. Tuy nhien, van con khong it nhimg nhan dinh ehua day du \'e can benh tieu chay gay thanh dich nay, nhat la moi nguy hiem ciia benh khong dugc nhan biet, xir tri sdm va diing.
Vi vay, ehung toi thuc hien de tai "Dae diem lam sang, can lam sang va ket qua dieu tri benh tieu chay cap do ta tir nam 2008 den nam 2009 tai Benh vien Da khoa tinh Ha Nam" vdi muc tieu sau: 1. Mo ta dac diem lam sang va can lam sang benh lieu chay cap
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Bac SI CKI Tran Van Anh Thac si Bui Hung Thjnh Benh vien Da khoa tinh Hd Nam do ta dieu tri npi tru tai Benh vien Da khoa tinh Ha Nam tir nam 2008 din nam 2009; 2.
Danh gia ket qua dieu tri benh lieu chay cap do la theo phac do cua Bp Y te.
I. Doi tuo'ng va phuong phap nghien cihi
1. Doi tuong nghien ciiu
- Gom 46 benh nhan dugc chan doan xac dinh benh ta theo lieu chuan ciia To chirc Y tl thi giai (WHO) va Bp Y t l Viet Nam;
- Thdfi gian nghien cuu tir nam 2008 den nam 2009;
- Dia diem nghien cim tai Benli vien Da khoa tinli Ha Nam.
* Tieu chuan chgn benh
Benli nhan tieu chay cap, hpi du cac tieu
KHOA HOC VA CONG NGHE HA NAM
chi chan doan benli la do Bp Y tl vii WHO quy djnh.
+ Khai benh cap tinh: thcri gian u benh tir 2 h den 5 ngay;
+ Tieu chay cap (di nhieu Ian, phan nhieu nuac, mat nuac nhanh) co kem non hoac buon non;
+ Ket qua cay phan, soi tuoi co V.cholerae, typ sinh hgc vii typ huyet thanh gay dich.
* r/(?H chudn loai trir
- Nbu'ng benh nhan lieu chay ciip nghi nga do ta khong co nuoi cay phiin, duang tinli vai phay kliuan ta V.cholerae bao gom:
+ Nhirng benh nhan soi phan tim thay phay khuiin nhung nuoi cay am tinh vai phay kliuan ta, nhung benli nhan soi phiin va cay phan deu iim linh;
+ Cac benh nhan lieu chay man tinh hay dgt cap ciia lieu chay man da vii dang dugc dieu trj;
+ Nhu'ng benh nhiin nuoi eiiy phiin duong tinh vai vi khuan khac.
2. Phuong phiip ngliien eiiu
* Thiet ke nghien ciiu
- Nghien ciru mo la hoi cu'u vdi cac bien so sau: tuoi, gioi, dia phuong, nghe nghiep, cac yeu to phoi nhiem, trieu cluing liim simg, Clin linn simg, ket qua dieu tri...
- Tieu chuan ra vien:
+ Het lieu chay, bet non, nguiri benh di lai duge;
+ Tinli trang lam sang on dinli sau 1 luim;
+ Kit qua xet nghiem cay phan 3 lan lien tilp cim tinh, 2 ngiiy/liin deu am tinh.
*Phuong phdp thu thdp so lieu
- Benh lin nghien ciru: theo mau nghien ciru phil hgp \'6i muc tieu nghien ciru;
- Kham liini simg vii cac xet nghiem ciin thilt. dua kit qua \ao niiiu thu thiip sd lieu soan siin.
* Xu l.v so lieu: theo phuang phiip thong ke y hgc. sii dung phiin mem SPSS 16.0.
II. Ket quii nghien eiiu 1. Tuoi-gioi
*Giai: trong long so 46 benh nlian. Nam cd 36 benli nhan (78,3%), Nu co 10 benli nhan (21,7%)), lir 20 tudi din 60 tudi. Dia phuong cd ty le nguai mac benli nhieu nhat la huyen Thanh Liem. vdi 15 benh nhan (32,5%).
2. Nghe nghiep
- Chu yeu benh nlian lii ngudi diin, c6 20/46 benh nhiin, chiem 43,4%.
- Nghe nghiep tu do cd 16/46 benli nhiin, chiim 34.8%o.
3. Noi mac benh
- So benh nhan bi benh lai nlia c6 20/46 benh nhiin, chiem 43,5%).
- So benh nliiin bi benli ci did khac hoac cho linn viec c6 26 benh iiluin chiem 46,5%o.
4. Thoi gian tii' khi mac benh den liic nhiip vien
Benh nhiin den vien truoc 24 h lii 23 benh nhiin (50%)):
- Trong dd: <4 h c6 18 benh nhan, chiem 39,1%).
- Til' 4h den 21 h cd 23 benh nhim, chiem 50%.
5. Benh kem theo
- VicMii dai trimg man tinh cd 8/16 benh nhiin, chiem 50%.
- Viem da diiy ta tning cd 3 benh nhiin, chiem 18,75%.
6. Cac yeu to phoi nliiem va nguy eo' Chii yeu do bcnli nhiin an mam tdm, mam tep 20/46 benh nhiin, chiem 43,5%).
7. Dae diem lam sang
- Mat nuoc ciip dp 11 c6 24/46 benh nhiin.
chilni52.1%o.
- Mat nuac cap dp 111, chiem 21,8%.
* Trieu chirng loan than:
- 100%) so benli nhan nghien cu'u cd bieu hien met mdi, suy kiet.
- Nhiet dp: chii yeu benli nhan khong sdt, cd 40 benli nhan, chiem 86,9%o.
- 6 benh nhiin sot iilic \'a vira chiem . 12.9%.
- Khong cd truirng hgp niio sot cao.
* i ricu cluing toim phiit:
KHOA HOC VA CONG NGHE HA NAM 15
N G H I E N c u t ! - T R A O D O I - liieu chirng loan phat la trieu cbinig
dan den benli nlian vao vien.
- Tieu chay, kliat nuac la ngu}'en nlian chinh chiem 100%, non ra thuc an cd 20 benh nhan, chiem 43.4%.
- Phan dien hinli long loan nuoc due nhu nuac vo gao, Igii cgn trang cd 40 benh nhan, chiim 86.9%o.
8. Dac diem can lani sang
* Xet nghiem cong thiic mau: Benh nlian cd bieu hien co dac mau.
* Xet nghiem sinh hda mau:. 8 benh nlian.
chiem 17,4%o chi sd Creaiinin tang tren 110 mmol/1. 8 benh nlian, chiem 17,4%) chi sd Ure tang tren 10 nimol/1.
- Kali mau tang 5 benli nhan (10,7%o).
- Cd 5 benh nhan cd ban Canci mau, chiim 10.7%o.
9. Cac bien chiing
- 12/46 benli nlian suy than, chiem 26.3%.
- 3/46 benli nlian nliiem toan. chiem 6.5%
10. Dieu trj: Truyen dich va dien giai theo phan dp mat nuac.
- Dua vao phan dp mat nude, benh nhan chu yeu mat nuac dp 11 va dp 111 nen can phai bii dich cang som cang tot. 100%o benh nhan can phai bu dich nga}' sau klii \'ao \ien.
- Lugng dich trwyen trung binh trong 24 gidf dau \'a tdng djch truyen trung binli cho mpt nguai benh a nhdm benli nang (7,558±4,129 ml va 19,132±1L490 ml) cao ban han so vai nlidni benh nlie (2,765±2,537 ml va 7,097±7,228 ml).'
- Trong 4-6 gia dau can thiet lap dudng l^uyen thanli ddng do HA, mach de dieu chinli nuac \'a dien giai.
* Dieu chinh roi loan kiem toan: sd benli nhan can bii NaHC03 theo phan dp liiat nudc, cd 8 benli nlian can bii NaHC03, chiem 66,76%)
* Su dung kliang sinli; theo ket qua tren chiing tdi su dung nhom Quinolon la chii }'eu cd 35 46 benli nhan, chiem 76.1%o.
Nhdm macrolid cd 11 benli nlian, chiem 23,9%.
Ngay nam \ ien, trung binh sau khi diing kliang sinh klii vao \ien. doi vdi Ciprofloxacin \'a Azithromycin lan lugt la 4,63±2.02va3,78±2.14.
Ngay bet trieu ehung lam sang trung binh sau klii dung kliang sinh khi vao vien, doi vai Ciprofloxacin va Azithromycin lan lugt la4,53±L72va3.53±l,58.
III. Ket luan
Qua nghien cim mo ta hoi ciiu 46 benh nhan tieu chay cap do ta tai Benh vien Da klioa tinli Ha Nam chiing toi rut ra ket luan sau:
1. Dac diem lam sang va can lam sang Vi khuan ta tim thay a cac benli nhan cay phan duang tinli trong vu dich la Vibrio cholerae.
Cac dau hieu lam sang ghi nhan dugc d cac benh nlian ta cay phan duong tinli la:
- Tieu chay loan nuac, la due nliu nuoc vo gao (86,9%)). Non cd 43,4%), thudng xay ra sau klii het tieu chay; dau bung dugc ghi nlian cd (26%)), hau nhu benh nhan khdng cd sot, cd chiing chi sot nhe. Khi nliap vien chii } eu benli nlian mat nuac dp 11, chiem 73,9%
va dp III. chiim 21,8%o, chi co 4,3%) la mk nuac dp 1.
- Bien chirng cd suy than cap (15,4%) chii yeu la suy than truac than, nhiem toan cd 6,5%.
- Hematocrit trung binh a benh nlian va vien 111 45,93±4.30%o va tri so >50%o gap chii }'eu a nhdm mat nuac nang.
2. Ve dieu trj
- 100%) benli nlian vao vien deu dugc truyen dich trung binh la 9,9 lit dich cho mpt nguai benli; 100%) dich truyen ban dau la dung dich Natriclorua 0,9%), tiep den la dung dich Ringerlactat, dung dich Glucose.
- Ngay het tieu chay trung binli: 3,9 ngay.
- Nga}' cap phan am tinh la 3,07± 1,74 ngay.
- Ngay nam vien trung binli la 8,74±2,87 ngay.
- Kliong cd benh nlian nao tu vong./.
