DACOIEM LAM SANG, CAN LAM SANG BENH sdl NGl/dl LdNTAI BENH VIEN E,VU DICH 2014
Vu Manh Cirtrag', Nguyen Thi Van", Tran Thi Van Ha', Dao Van Chir', Nguyen Van Dung'.
Muc tiiu: Tim hieu dac diem lam sang, can lam sang benh sai a ngiroi Ion, trong vu dich soi nam 2014. Boi tifcmg vd Phuang phdp: Mo ta tien cmi 82 benh nhan tir 16 tuoi tro len, dugc chan doan soi dua vao xet nghiem khang the khang virus soi IgM duong tinh, dieu tri tai Khoa Benh nhiet doi, Benh vien E tii 01/03 - 30/06/2014. Ket qud: Benh nhan mSc sdi nguoi Ion gap o tuoi tir 16 - 46 tuoi, da so sinh song 6 npi thanh Ha Noi (62,2%), Nii chi^m 51,2%. Benh soi bieu hien dien hinh (92,68%). Chua gap bien chiing nang nhu viem phoi, viem nao... 59,8% benh nhan co tinh trang ton thuong te bao gan. 35,4% benh nhan co PCT > 0,25ng/ml (can nhac va bat bupe phai sir dung khang sinh). Kit ludn: Trong vu dich 2014, benh soi dien hinh, khong gap bien chiing nang tren benh nhan nguai Ion, phan Ion gap 6 nhung ngudfi khong ro tien su tiem chung (63,5%). 8,5%) benh nhan van mac soi mac du da dugc tiem phong soi.
Tir khoa: Soi, lam sang soi.
DAT VAN OE
Sdi la benh truyen nhiem, lay theo du'dng ho hap va cd kha nang lay lan thanh djch tai nhutig cpng dong chuS cd mien djch day dii vcfi virus sdi. Theo cac Y van, mac dii vac xin sdi da du'dc du^ vao sir dung trong phong benh[i''^^i, nhuhg theo u'dc tfnh, tren toan cau hang nam van CO khoang 20 nghin tru'dng hdp mac sdit^i. Tai Viet Nam, sau khi chu'dng trinh tiem chiing md rpng du'dc trien khai, theo bao cao, so ca benh sdi da giam di ro ret™. Tuy nhien, nhu'ng nam gan day, dac biet, cuoi nam 2013, mot vu djch sdl da xay ra tai mot so tinh, khu vi/c, sau dd lan ra nhieu tinh thanh pho trong ca nu'dc, trong do co Ha Npi.
Trong dich sdi dau nam 2014, den ngay 19 thang 4 ca nu'dc da co so ca mac 8.500 va cd it nhat 114 ca tir vongt^l Ngay tirdSu vu djch sdl, khoa Benh nhiet ddi Benh vien E da tiep nhan nhieu tnj'dng hdp mac sdi, phan nhieu la ngu'di ldn. De tim hieu dac diem ciia vu djch sdl nay.
'"Khoa Bfnh nhifl doi, Bfnh vifn E Ngay nh$n bii: 07/11/2014 NgAy phan bi$n xong: 14/12/2014.
NgAy duyft d^ng: 28/01/2015
NgtrM chfu trAch nhifm n^i dung khaa IIQC: VU Manh Cuong. Khoa Bfnh nhifl dot Bfnh vifn E
Difn tho^i 0983696522: E-mail vumanlicuongbve@gmait com
cung nhu tim hieu nguyen nhan dien bien bat thu'dng ciia benh sdi d ngu'di tdn, chung toi tien hanh de tai nghien cuti "Dac diem djch te, lam sang, xet nghiem benh sdi ngu'di Idn, tai Benh vien E, vu djch 2014" vdi muc tieu mo ta mpt sd dac diem lam sang va xet nghiem benh sdi ngu'di Idn trong vu djch nay.
DOI Tl/gNG VA PHU'aNG PHAP
Do! tu'dng: Gom 82 benh nhan tir 16 tuoi trd len, du'dc chan doan benh sdi du'a vao ket qua huyet thanh khang the khang virus sdi IgM du'dng tfnh, vao dieu trj npi tru tai Khoa Benh nhiet ddi, Benh vien E trong 04 thang tir 1/3 - 30/6/2014,
Tieu chuan loai triT: Benh nhan khong dong y tham gia nghien cuti; Benh nhan du'di 16 tuoi.
Phu'dng phap: Thiet ke nghien cu'u: Mo ta tien culi.
Benh nhan nghi ngd sdi nhap vien du'dc tien hanh: Hoi tien su* benh, tien su'tiem chiing phong sdi; Kham va danh gia cac dau hieu lam sang; Lam ngay cac xet nghiem:
cong thu'c mau, mau lang, sinh hoa mau, CRP, Procanxl- tonin, HBsAg, anti HCV, chup phoi. Xet nghiem tim khang the IgM vdi virus sdi bang phu'dng phap ELISA. Cac xet nghiem trong nghien cuti du'dc lam tai khoa xet nghiem, Benh vien E va Benh vien Medlatec tiieo che dp tiiu'dng quy. Xij" ly so lieu: Theo phu'dng phap thong ke Y hpc.
T R U Y ^ N H i i M V l g T N A M * s 6 1{9) - 2015 - 2 9
KET QUA
Trong thdi gian nghien ciiti, 130 benh nhan sot phat ban dang sdi nhap vien, trong do co 82 benh nhan tir 16 hJoi trd len, cd ket qua huyet thanh khang the khang virus sdi IgM du'dng tfnh (63,07%).
Dac diem djch t e , lam sang va can lam sang benh sdi
Bang 1 . Mdt s6 dac diem djch t e lam sang Dac diem d[ch t i lam sang
TUOI
Gidi
D i a d i /
Nghe nghiep
Tien sir tiem chiing
1 6 - 2 5 2 6 - 3 5
> 3 5 Nam NO- Noi thanh Mgoai thanh Hoc sinh - smh vien Cong nhSn - Vtin chifc Lao donq t\i do, cl nha Co tiem Ktiong tl^m Khong ra
n
39 38 5 40 42 51 31 ZO 36 26 7 23 52
Vo
47,6 46,3 6,1 48,8 51,2 62,2 37,8 24,4 43,9 31,7 8,5 28 63,5
Trong vu dich nay, lira tuoi hay gap nhat tir 16 - 25 tuoi (47,6%). Nil' gidi chiem uti the, hau het la benh nhan dang song d npi thanh. Benh nhan la cong nhan vien chu'c chiem phan Idn (43,9%). Ve tien sir tiem chiing, da so benh nhan khong biet minh da dUdc tiem chiing hay chu:a (63,5%), van con 8,5% benh nhan van mac sdi mac dii Qa du'dc tiem phong day dii.
Bang 2: Bieu hi@n lam sang
Tri|u chutig lam sdng
Sot
Phat ban
Sot nhe ( f < 3 8 t ) Sot viia (t" 38 - 39"C) Sot cao (r= > 39°C)
So benh nhan (n = 82)
18 52 12
Ty le (%)
21,95 63.41 14,64 Nhiet do trung binh: 38,41 ± 0,65'C. Cao nhat 40"C, thap nhat 37,2"C.
Th&i gian sot trung binh: 3,68 ± 1,19 ngay.
Thcli gian Xuat hiln
Trutic sot Cung sot Sau sot
1 1 80
1<2 1<2 97,6 Tlicfi gan Ifin tai ban tmng binh (ngay)' 3,15 ± 1,05 Xung huyet, viem ket mac m3t 69 84,1
Viem long dudng ho h i p Noi hadi Hat Kophck Tieu chay Sung, dau khdp
82 9 65 60 1
100 11 79,3 73,2 1,2 Ngay dieu tn tmng binh: 6,54 ± 0,146 ngay.
Thap nhat 3 ngay, nhieu nhat 10 ngay.
Cac bieu hien lam sang ciia benh gom sot, cac bi^u hien viem long va phat ban sdi. 100% benh nhan co sot, viem long du'dng ho hap khi vao vien, trong dd chu yeu la sot vira (63,41%). Phat ban thu'dng xuat hien sau sdt (97,6%). Oa so benh nhan c6 bieu hien viem ket mac mat (84,1%). Cd 79,3% so benh nhan cd hat Koplick d hau hpng. Phan Idn benh nhan (73,2%) cd bieu hien viem du'dng tieu hoa gay tieu chay.
Bang 3. Lien quan giffa t r i e u chuTng, bien chu'ng vdi viec t i e m chung
Trieu chihig, bi€n chutig
Phat ban dien hinh (n=76) Phat ban khong flien hinh (n=6) Viem difcing ho hap duiiii {n=18)
C 6 t i e m ( n = 7 )
3 (3,95%) 4 (66,67%) 1 (5,55%)
Khong tiem ( n = 2 3 )
23 (30,26%) Q(0%) 5 (27,77%)
Khong rS (n=52) 50 (65,79%)
2 (33,33%) 12 (66,68%)
Nghien ciru 82 benh nhan sdi, co 76 benh nhan (92,68%) phat ban dien hinh gap d hau het benh nhan khong du'dc tiem ho§c khong nhd tien sir tiem chiing (96,05%), cd 6 benh nhan (7,32%) phat ban khong dien hinh gap d benh nhan da du'dc tiem chiing (66,67%), 18 tru'dng hdp gap bien chiitig viem du'dng ho hap du'di (21,95%) gap hau het d benh nhan khong du'dc hem phdng hay khong rotien sir tiem chiing (94,45%).
Bang 4 . Cong tiiu'c mau Ten xet
nghifm
Hong cau
Bach cau Bach cau da nhan trung tinh Mau lang
Tieu<^u
Binh thu'dng
Nam Nu-
4,0-5,8 X lO'VI 3,9-5,4 X lO'VI 4 - 1 0 X lO'/l
GO-66%
I h (< 15mm) 2h (< 20mm) 150 - 400 X lO'/l
Tmng binh
4,85 ± 0,53
5,76 ± 2,04 80,3 ± 7,64
17,34 ±12,21 33,89 ± 18,36 160,21 ±37,51 Gia trf
< 150 X I C / t
> 150 X lO'/l Cao nhit
6,41
12,8 91,8
70 100 276 n .38 44
Thip nhat
3,67
5,76 59,5
1 4 77
%
46,3 53,7
3 0 - TRUYte NH^M V1$T NAM * s d 1 (9) - 2015
Da so cac benh nhan deu khong co bien loan dang ke ve xet nghiem cong thirc mau. So lu'dng hong cau b^ng binh: 4,85 ± 0,53 x lO^VI- So lu'dng bach cau trung binh: 5,76 ± 2,04 x lO'/l. So lu'dng bach cau da nhan tmng ti'nh: 80,3 ± 7,64%. Gia tii bung binh cao hdn g i ^ ban binh thu'dng (60 - 66%). So lu'dng tieu cau trung binh: 160,21 ± 37,51 x lO^/l. 38 tii/dng hdp (46,3%) cd ha tieu rau (di/cfl 150G/I) nhutig khong kem theo xuat huyet tren lam sang.
Chi so mau lang tang cao hdn gia ti'i binh tiiu'dng: Sau I h cd 43 ti-Udng hdp (52,4%), chi so trung binh 17,34 ± 12,21mm. Sau 2h cd 68 tir/dng hdp (82,9%), chi so trung binh 33,89 ± 18,36mm.
Bang 5. Sinh hoa mau
Bang 6: Gia tri Procanxitonin
Ten xet nghiem
SGOT
Glucose Ure Creatinin Bilimbm TP
Natn Kali Oo Canxi
CRP
SGPT
Binh Uiu'dng
Nam: < 30U/I Nu^ < 19U/I 3,9 - 6,4mmol/l 2,5 - 7,5mmol/l Nam: 62-120Mmol/l tiO: 53-100|jmol/l
< 17Mmol/l 135 - 145mmol/l 3,5 - 5,0mmol/l 98 - 106mmol/I 2,15 - 2,6mmol/l 0 - 6mg/l Nam: < 30U/I
m: < 19U/I
Tning binh I . .
101,32 ± 125 5,85 ± 1,07 3,64 ± 1,13 81,7 ± 18,1 9,62 ± 5,31 133,86 ± 3,81
3,75 ± 0,42 99,54 ± 3 , 1 1 2,14 ± 0,22 25,82 ± 20,2 96,04 ± 110 Giatri
> 2 lan gidi han tren binh thuftng
< 2 lan gidi han tren binh thu'dng 685,1
9,2 7 122 39 148 5,1 110 2,54 78,7 522,7 n 49 33
Thaip nhat
19,8 3,8 4
1,7 125 2,7 93 0,87 1,5 8,4
59,8
%
40,2
Cac chi so danh gia diTcJng mau, chu'c nang than, dien giai do da so trong gidi han binh thUdng.
Co 49 benh nhan (59,8%) co tinh trang ton thu'dng te bao gan, men SGI^ tang cao > 2 lan gidi han tren cua binh thu'cing (d Nam > 60U/I, d Nif > 38U/I). Gia trj trung binh oia SGOT la: 101,32 ± 125U/I, thap nhat la 19,8U/I, cao nhat la 685,1U/I. Gia trj trung binh cua SGFT la: 96,04
± llOU/l, thap nhat la 8,4U/I, cao nhat la 522,7U/I.
73 tru'dng hdp (89%) co chi so CRP cao hdn gia trj binh thuflng. Chi so trung binh la 25,82 ± 20,2mg/l, cao nhat la 78,7mg/l, thap nhat la l,5mg/l.
Gia tri PCT (ng/ml)
<0,05 0,05 - < 0,1
0,1 - < 0,25
0,25 - 0,5
>0,5
Y nghia lam sang
Gia tn binh thudng Khong chi dinh dung khang sinh Khong khuyen cao dCing khang smh, neu tn lieu giam xuong mii'c nay thi tiep tue diing cho hieu qua.
Khuyen cao va can nhac sir dung KS Chi dinh khang smh la bSt buoc
1 16
36
16 13
%
1,2 19,5
36
19,5 15,9 PCT: Tnjng binh 0,37 ± 0,73ng/ml; cao nhat 5,3ng/ml; thap nhat
0,02ng/ml.
29 frUdng hdp (35,4%) PCT > 0,25ng/ml. Oa so benh nhan co PCT tir 0,1 - < 0,25ng/ml (43,9%).
Bang 7: Xet nghiem vi sinh
Ten xet nghiem
IgM anti rubella (-H) I9G anti rubella (-H) HBsAg (+) Trong so BN co Anti-HCV(+) |SGPT>2XULN
Sdiienh nhan 2 (n=82) 2 Cn=S2) 1 (n=49) 1 (n=49)
Ty le % 2,4 2,4 2,04 2,04 Co 2 benh nhan dong nhiem rubella khi nhiem sdi (2,4%), bieu hien lam sang cua 2 benh nhan nay la phat ban khong theo tiiii'tu', co no! hach va co 1 benh nhan co bieu hien viem khdp. Co 2 benh nhan (2,4%) da co tien sir mac Rubella tu" tru'dc.
Trong so 49 benh nhan c6 men SGPT tang cao tren 2 lan gidi han tren cua binh thu'dng, chung toi chi gap 1 tn/dng hdp co HBsAg (•«•) va 1 tru'dng hdp cd anti - HCV (-•-) deu chiem ty le rat thap (2,04%).
Bang 8: Hinh anh XQ tim phoi
Hinh anh ton thu'dng Khong lam (C^ thai) Binh thirdng Hoi chuTig phe quan
So benh nhan 1 63 18
T V i c % 1,22 76,83 21,95
Oa so benh nhan khong cd ton thifdng tren phim chyp XQ tim phoi (76,83%). So benh nhan cd ton thu'dng tai phoi chiem ty le ft (21,95%) vdi bieu hien ton thu'dng chii yeu la viem phe quan. Cd 01 benh nhan (1,22%) khong chup vi dang mang thai 3 thang dau.
T R U Y ^ U l g M V ! $ T N A M * SO 1(9) - 2015 • 3 1
BAN LUAN
D i e diem dich t l benh sdi
Trong nghien ciili cua chung tuoi, benh nhan mac benh sdi gap d mpi lu^ tuoi tir 16 tuoi den 46 tuoi, trung binh: 26,07 + 6,23 tuoi. Liia tuoi hay gap nhat tu' 16 - 25 tuoi (47,6%), day la liia bjoi phan ldn la hpc sinh, sinh vien va nhDhg ngu'di lao dpng tre, thu'dng xuyen phai hpc tap va lam viec trong moi tru'dng t | p the dong due nen rat de m k sdi. Van con mot ty le 6 , 1 % benh nhan tir 35 tuoi trd len bj mac sdi, dieu nay du'dc ly giai den nam 1982, vac xin phong sdi mdi bat d3u difdc du^ vao sir dung d Viet Nam (tnj'dc nam 1980, d Viet Nam cd 100.000 ca mac sdi du'dc ghi nhan moi nam, den nam 1988, ty le bao phu vac xin sdi dat 90%, nhd dd ty le mac benh da giam manh, chi con 10.000 ca mac moi nam). Benh gap nhieu hdn d Nu", nhuTig chu^a cd y nghia thong ke. Dac biet cd 01 benh nhan (1,22%) la phu nu" cd thai 3 thang dau.
Chung toi chu^ co nhiJng thong tin can thiet ve sii phat trien ciia thai nhi nay.
Oa so benh nhan la cong nhan, vien chii'c (43,9%), sau dd den nhom doi tu'dng lao dpng tu" do (31,7%) va hpc sinh, sinh vien (24,4%). Oieu nay cung phii hdp vdi cac nghien culi tru'dc day cho rang benh thu'dng lay lan trong nhu'ng moi tru'dng dong due nhu" nha may, xi nghiep...
Phan Idn benh nhan d khu vUc npi thanh (62,2%). Do Benh vien E nam trong Wiu vi/c npi thanh phfa l a y Bac ciia thanh phd Ha Npi nen da sd benh nhan vao vien la ngu'di dan khu vi/c. Khu vi/c ngoai thanh cijng chiem mpt ty le dang ke (37,8%). Cac benh nhan rai rac 6 khap tat ca cac quan, huyen b-ong npi thanh va ngoai thanh.
Oa so benh nhan khong biet minh da du'dc tiem phong sdi hay chuS (63,5%). Ty le benh nhan chu^ du'dc tiem chiing cung chjem mpt ty le dang ke (28%). Van cdn 8,5% so benh nhan van bi mac sdi sau khi da du'dc tiem phdng sdi day du. Oieu nay cung phu hdp vdi cac nghien cuu tru'dc dayt^ii^].
Dac diem lam sang
Trong vu djch nay, da so benh nhan nhap vien vdi benh canh sdi dien hinh, tuy nhien nhiihg bieu hien nay khong nang ne nhu" d tre nhd. Cac trieu chuhg thu'dng g3p: met mdi, chu yeu sot vu^ (38 - 39°C), cd cac bleu hien viem long nhu' viem duidng ho hap ma chii yeu ia viem long dudng ho hap tren (78%), viem ket mac mat
(84,1%), tieu chay (73,2%). Phat ban sdi thu'dng xuat hien tir ngay thir 3 den ngay thir 5 cua sdt, da so gap phat ban theo Uian tir tiT dau mat xuong than minh gap d hau het benh nhan khong di/dc tiem hoac khong nhd tien sir tiem Chung (96,05%), chiing tdi cung gap 6 truidng hdp (7,32%) phat ban khong dien hinh, nhu' bat dau xuat hien tiT than minh hoac xuat hien ngay toan than. NhiJlig tru'dng hdp ban sdi khong dien hinh gap d benh nhan dong nhiem rubella hoac d ngu'di da dUdc tiem chung (66,67%).
Phan Idn la ban dd tren nen da lanh, la dac diem khac vdi benh rubella (ban dd dang sdi tren nen da xung huyet). Khi bay, ban de lai vet tham tren da (khac vdi rubella, khi ban bay thu'dng khong de lai dau vet)t*>. Co 79,3% so benh nhan co hat Koplick d hau hpng.
Chiing toi cung gap 9 tru'dng hdp (11%) sutig hach ngoai vi trong dd hay gap nhat la hach co, sau mang tai, sau gay. Sd lu'dng hach thu'dng tir 1 - 3 cai, kich thifdc nhd tu" 0,3 - 1cm, di dpng, an dau. Hach se mat di nhanh sau khi het sot.
Ve bien chutig: Benh sdi ngu'di Idn thu'dng khong gay ra nhOrig bien chirng nguy hiem, chi cd 21,95% co bieu hien tai du'dng hd hap du'di nhu' viem phe quan, gSp fl hau het d benh nhan khdng du'dc tiem phdng hay khong rd tien sir tiem chung (94,45%). Cd 1 benh nhan (1,2%) bj viem khdp, xuat hien sau sdt. Sau khi het s5t thi khdp cung on dinh. Khdng thay bieu hien dau cd d 82 benh nhan nghien cuU. Chung tdi cung khong gap tru'dng hdp nao bj viem nao hay cd dau hieu xuat huyet.
Dac diem can lam sang
Da sd cac benh nhan deu khdng cd bien loan dang ke ve cdng thu'c mau hay mot so chi so sinh hoa mau nhiT du'dng mau, chifc nang than, dien giai do. So lu'dng Bach (^u da nhan biing b'nh: 80,3 + 7,64%. Gia tn tmng binh cao hdn gidi ban binh thu'dng (60% - 66%) chuTig td da so benh nhan sdi cd tinh trang bpi nhiem kem theo. Cd 38 mrdng hdp (46,3%) cd ha tieu cau (du'di 150G/I) nhuhg khdng kem theo xuat huyet tren lam sang. K^ qua nay cung phu hdp vdi cac nghien cirtj tru'dc day, benh ly sdi khong gay bien loan b-ong xet nghiem huyet hpc dang k£
Chi so mau lang tang cao hdn gia b-j binh thu'dng: Sau I h cd 43 tru'dng hpp (52,4%), chi so frung binh 17,34 + 12,21mm. Sau 2h cd 68 tru'dng hdp (82,9%), chi so trung binh 33,89 ± 18,36mm. Ket qua cho thay tinh frang dap
3 2 - T R U Y ^ N H l i M V i e T K A M * s 6 1(9)-2015
iihg viem trong benh sdi cung Wia thu'dng gap.
Cd 73 birdng hpp (89%) ra chi so CRP cao hdn gia tii binh thu'dng. Chi so frung binh la 25,82 ± 20,2mg/l, cao nhat ia 78,7mg/l, thap nhat la l,5mg/l. Chimg td frong benh sdi da sd cd dap iihg viem he thdng.
Oiirc nang gan bi bien ddi dang ke, cd 49 benh nhan (59,8%) cd tinh trang ton thiTdng te bao gan, men SGPT teing cao > 2 lan gidi han fren ciia binh thu'dng (d Nam >
60U/I, d NiJ > 38U/I). Gia trj trung binh cua SGOT la:
101,32 ± 125U/I, thap nhat la 19,8U/I, cao nhat la 685,1U/I. Gia tii bung binh cua SGPT la: 96,04 ± llOU/l, ttiap nhat la 8,4U/1, cao nhat la 522,7U/I.
Procanxitonin la macker bleu hien cho nhiem khuan va nhiem khuan huyet. Du'dc san xuat chuyen biet bdi nhiem triing khdng do virus, khdng anh hu'dng bdi nhiem virus hoac cac dap ifng tif mien khac. PCT giiip phan biet du'dc cd nhiem khuan hay khdng nhiem khuan, nhiem khuan do vi khuan hay virus. Tnang nghien cifLi ciia chung toi cd 29 tru'dng hpp (35,4%) PCT > 0,25ng/ml cd khuyen cao, can nhSc va bat buoc diing khang smh vi tinh frang nhiem trimg di kem. Da so benh nhan vao khoa da du'pc dieu tri khang sinh d nha nen frong so 43,9% cd chi so PCT tiJ 0,lng/ml den du'di 0,25ng/ml luc vao vien, chung tdi van tiep tgc diing khang smh de dam bao hieu qua dieu tri.
Ddng nhiem virus: 2 benh nhan ddng nhiem rubella khi nhiem sdi (2,4%), bieu hien lam sang ciia 2 benh nhan nay la phat ban khdng theo tiiif bJ, cd noi hach va cd 1 benh nhan cd bieu hien viem khdp. Cd 2 benh nhan (2,4%) da cd tien sir mac mbella tif tiudc.
Trong so 49 benh nhan cd men SGPT tang cao fren 2 lan gidi han tren ciia binh thu'dng, chung tdi chf gap 1 tiofdng hdp cd HBsAg (+) va 1 tru'dng hdp cd anti - HCV (+) deu chiem ty le rat thap (2,4%). Dieu nay cho thay cung khdng nhat thiet phai lam cac macker ve viem gan virus frong nhDYig benh nhan sdi, vi ban than virus sdi cung gay ton thu'dng te bao gan. Chung tdi nhan thay men gan cung nhanh chong trd ve binh thu'dng khi sdi d giai doan lui benh.
Da so benh nhan khdng cd ton thu'dng tren phim chup XQ tim phoi (76,83%). Sd benh nhan cd ton thu'dng tai phoi chiem ty le it (21,95%) vdi bieu hien ton thu'dng chu yeu la viem phe quan. Cd 01 benh nhan (1,22%) khdng chup vi dang mang thai 3 thang dau.
KFT LUAN
Qua nghien culi 82 benh nhan ngudi ldn mac sdi dieu fri tai Khoa Benh nhiet ddi, Benh vien E trong vu djch 2014, chiing tdi rut ra mpt sd ket luan:
Dac diem djch te va lam sang: (i) Benh nhan mac sdi gap chii yeu d lifa tuoi du'di 35 (93,9%). Nam 48,8%, NiJ 51,2%. 8,5% benh nhan mac sdi mac du da dUdc tiem phdng Sdi; (ii) Da so benh nhan cd bieu hien lam sang sdi dien hinh theo co dien (92,68%); (iii) 6 benh nhan (7,32%) phat ban sdi khdng dien hinh gap d benh nhan da dUdc tiem chung; (liii) Khdng gap bien chuhg nang.
21,95% cd bien chuhg viem phe quan phoi bdi nhiem.
Dac diem can lam sang: (i) 59,8% benh nhan cd tinh trang ton tiiu'dng nhe te bao gan (men SGPT tang cao >
2 lan gidi han fren ciia binh thu'dng); (ii) Procanxitonin >
0,25ng/ml (35,4%).
TAI UEU THAM KHAO
1. WHO (2013). Measles deaths decline, but elimina- tion progress stalls in some regions. Geneva.
2. Measles - United States (2013). Morbidity and Mor- tality Weekly Report (MMWR). Weekly 62(37), 741 - 743.
3. C r c (2012). Measles, Epidemiology and Prevenbon of VaccinePreventable Diseases, The ffnfc Book: Course Texttxx)k, 12th Edition Second Printing. 173 -192.
4. Bd Y te (2014), "Chan doan, dieu fri binh Sdi". Ban hanh kem theo quyit dinh so: 1327/QD-BYT ngay 18/04/2014 cua Bg tiVdng BoYte.
5. "Vietnam minister calls for calm in fece of 8,500 measles cases, 114 fatalities! Health | Thanh Nien Daily".
Thanhniennews.com. Truy cap ngay 19 thang 4 nam 2014.
TRUYiNNHllMVieTNAM* SO 1(9) - 2015 - 3 3
CUNICAU SUBCLINICAL CHARACTERISTICS OF ADULT MEASLES I N E CENTRAL HOSPITAL (OUTBREAK I N 2014}
Summary
Objective: Study characteristics of dinicai, subclinical measles in adults measles outiareak in 2014. Subject and r^ethods: Describe prospective 82 patients aged 16 years or older, diagnosed with measles based on tests Measles vims IgM antibody positive, freated at tiie Department of Tropical Diseases, E - Hospital from 03/01/2014 - 06/30/2014. Results: Patients with measles occur in all age groups from 16 - 46 years old, most of tiiem living in the inner city of Hanoi (62.2%), women accounted for 51.2%. Measles typical complaints (92.68%). No serious
Keywords: Measles, clinical measles.
complications such as pneumonia, encephalitis... 59.8%
of patients with minor injuries to the liver cells. 35.4% of patients with PCT > 0,25ng/ml (considerations and mandatory use of antibiotics). Conclusion: Dunng tiie 2014 outbreak, measles typical, no serious complications encountered in adult patients, most cleariy seen in those without a history of vaccinabon (63.5%). 8.5% of patients still suffered from measles, although these patients had been vaccinated against measles.
34 -TRUY^NHI^VirrNAM*s6l(9)-2015