CHUYgN og: Hpl NGH| KHOA HpC NGANH NHI KHOA TOAN QU6C LAN THCf IX
oAc mim
TRE EM BJ NGATNUtrc oi£u
TRJTAI BiNH VigN DA KHOA TRUNG T A M T I I N GIANG
V8 Thj Tiin*, NguySn Vift Tru'dng**, T? Vin Tran
T 6 M TAT
e$t vSn dS: Hdng ndm, VIpt Nam cd khodng 30.000 trd em tCr vong do tal nan thu'dng tich, bong dd ngat nu'dc Id tal nan thu'dng g^p, nhat la dol vdl tid em, vdl ti I? khodng 5% cdc truSng hpp W vong do chSn thu'dng. XCr tri b|nh nhan ngat nude la mdt cap ciu ndi khoa, trong dd viec hoi sic tim phdi Id het sic quan tipng.
Muc tieu: Nghien ciiu djc dIem trd didc chan doan ngat nUdc di/pc dieu trj tal Khoa Nhl Bdnh vIen Oa Khoa Tien Giang nSm 2011.
Phifdng phdp: Md td cdt ngang Ket qua: Nhdm tuoi bj ngat nidc cao nhat la 1-5 tuoi (57%), ty le nam/nu' =1,8; dia diem thu'dng gap la ao ho, kenh rach. Oac diem lam sang khi nhap vien chii y^u la rdi loan y thii'c, viem phoi va suy hd hap. Ode diem can lam sang: Met, Natri mau giam,75% tre cd tinh trang toan chuyen hda. Tinh trang hdn me va suy hd hap cd dnh hu'dng den ket qua dieu trj
WAftife; Ngat nu'dc ABTRACT
CHARACTERISnCS OF DROWING CHILDREN AT ADMISSION IN TTEN GIANG
GENERAL HOSPITAL IN 2011 Background: Every year, Viehiam has about 30,000 children die from Injuries, Including drowlngt is common, especially for children, with a ratio of about 5% of deaths due to injury. To treat drowing patient Is a medical emei^ency, In which the cardiopulmonary resuscitation Is very important.
Object: Study H children diagnosed wi drowing treated at Pediatric depannent of TK Giang General Hospitai In 2011.
Method: Cross - retrospective study Results: Age group the highest drowlr was 1-5 yeare old (57%), percentage of mali female = 1.8, location was ponds and canal Clinical characteristics at admlssk>n were mai disonjers consciousness, pneumonia an respiratoruy failure. Paradinicai characterltk were hematocrit, sodlumemla decreased, 75% i children with metabolic acidosis. Coma an respiratory failure may affect freament outcomes
Keywords: Drowing
i. OAT VAN Oi
Hdng n5m, Vi?t Nam cd Ithoing 30.0(K trd em tu vong do tai nan thuong tich, troni dd ngfit nude Id tai nan thirdng g$p, nh& li doi vdi trd em, vdi ti I? khodng 5% cic hirdng hgp bi vong do chSn thuong(3), (4).
Vdi h$ th6ng kdnh r?ch ddy d}c 41.000kin djlc bi^t Id mjt dp cdng cao ti kha vvc ddng bang Sdng Cdu Long,Vi$t Nam la niifc thupc nhdm 10 nude cd mjt dp sdng kSnh cao nhat th^ gidi, thujn ipi cho Idiai thic vjn tdi thdy va phdt teiSn kinh ti sdng nude, nhung bdn canh dd cOng kdo theo tai lipa ngat nude, djc bi$t Id doi vdi tri em. Ng)!
nude thu&ng xdy ra ti nhiing vung cd nhiJu ao h6, sdng suoi, bSi bidn, nhung thi&i |f phdng ngira can thJn eda con ngudi.
Xd tri b^nh nhan ngat nude Id mpt cf
*B0nh vign Da khoa TlSn Giang, ** Benh vl$n Nhi dong 1 112
Y HQC VigT NAM THANG 9 - S6 PAC BieT/2012 Ciiu n§i khoa, trong dd vi$c h6i siic tim phoi
id hk siic quan topng, quyfa dinh tidn lupng bpnh nh4n.Thue ttang vi$c so ciiu.cdp cOru b$nh nhdn ngat nude ti nude ta cdn chjm chira chuan xac, anh hudng d^n kdt qud dieu tti va di ehiing (3). Chung tdi ti^n hdnh nghien cilu dd tai ndy nhim:
Md ta 1 sd djc diem vd nhjn xdt ket qud dieu trj, cdc ydu to lien quan dfo ngat nude ti tte em didu tti tai Khoa Nhi Benh vijn Da khoa Tidn Giang ndm 2011.
II. oo'l -nXfHG VA PHUONG PHAP N O H I I N eCiu 2.1. Doi tirpng: 14 bpnh nhan dudi 15 tuoi dupc chdn dodn ngat nude dupe di^u tti tai Khoa Nhi Bdnh vijn Da khoa TiSn Giang n9m2011
2.2. Phuong phdp ngbiSn cihi: Hdi ciiu, cit ngang md ta.
- Djc diem dich te: Tu6i, gidi, dia didm xdy ra ngjit nude.
- Ldm sdng:
+ Tinh trang khi vdo vijn: Y thdc, than nhijt, suy hd hip, thin kinh.
+ CJn idm sdng: Cdng thdc mdu, dien gidi do, dirdng huydt, khi mdu, ure, creatinin, Xquang tim phdi.
- K^t qud di^u tti, chia idm 3 loai;
+ Loai tot: Bjnh nhan h6i phyc hodn toan, khdng cd di chung
+ Loai dimg binh: Bjnh nhan khdi nhung cd di ehCmg thin kinh
+ Loai xiu: Trd hon md kdo dai hoJc tu vong.
- Mpt s6 ydu td lien quan ddn kdt qui dieu tri: Roi loan y thijrc, suy hd hip...
- Xii tri sd liju: Theo phuong phap thdng ke y hpc
III. KET QuA
3.1. IViat so a$c diim dich tl:
- Tudi, gidi: Trong ndm 2011 ed 14 tte hi ngat nude vao vijn, ttong dd tte nam ia 9 (64%), tte nir la 5 (36%). Nhdm tudi gjp nhidu nhit la 1-5 mdi vdi 8 benh nhan (57%), hi 5- 10 hidi: 5 bjnh (35,9%), tit 10-15 tu6i:l bjnh nhan (7,1%)
- Bgc diem xdy ra nggt nude Ire em.
Bdng 1; Dia didm Bia aSm Aoho
Sdng sudi Kenh rach Be chUci nude Be bdi
Khac (lu, khap, ranh nude)
n 3 3 5 1 1 1
Vo 21,5%
21,5%
35,7%
7,1%
7,1%
7,1%
-Ldm sang
Sing 2: Lam sdng khi nhjp vijn.
Trieu chii'ng Than nhl dt
<35 dp C TCr 35-37,5 ddC
n 1 6
°/o 7,1%
42,9%
CHUYEN eg: Hpl NGHI KHOA HpC NGANH NHI KHOATOAN QUO'C LAN THOIX
>37,Sdo C Hdhgp NgUng thd Thd nhanh Tim tdi Ran Sm/phdi ThSn kinh Tinh tdo Kich thich Ld md, II bi Honmd Cogljt Coqonq
i
2 10
4 8 2 2 6 7 1 1
50%
14,2%
71,4%
28,4%
56,8%
14,2%
14,2%
42,8%
50%
7,1%
7,1%
Nh§n xii'. B$nh nhdn vio trong tinh trgng sot 50%, tri§u chung h6 h ^ thu6ng £ nghe ph6i c6 ran ^ 56,8%, thd nhanh 71,4%, tri^u churng t h ^ kinh thii6ng g ^ nhat \k i loan "^ thOrc.
3.2. D$c diem can lam sjkng i.2.7. XquangphSi:
- 10 b^nh nhSn chyp X quang phoi c6 hinh 4nh ton thuang phoi la viSm ph6i (100%) Bang 3 : Xdt nghijm mdu lue vdo vijn.
Chiso Huyet hpc Hct<%) Bach cau (G/l) Tieu au (G/l) Sinh hda Du'dng (mmol/l) Ure (mmol/l) Creatinin (mcmol/l) Ion do Na (mmol/l) Kali (mmol/l) Cio (mmol/l) Calcl (mmol/l) Khi mdu PH PaCOj (mmHg) PaOz (mmHg) HCO-, (mmol/l)
n
14 14 14.
14 10 10 11 11 11 11 8 8 8 8
Kaqui
X ± S O 32,8 ± 3,2 13,5 ±7,1 332,64 ± 15,2
7,5 ± 3,6 4,9 ± 2 62,7 ± 27,2 135,5 ±7,1
3,8 ±0,7 '\
101 ± 7,2 1 1,91 ± 0.3 i 1 7,31 ± 0,07 1
32,4 ± 7,5 il 1 75,6 ± 17,0 1
18,8 ±4.6 J
Y HQC VigT NAM THANG 9 • S6' ByjlC BlgT<2012 BE (mmol/l)
SaO, (%) C» cs 6,1 ± 4,6
92,3 ± 10,4 Nh^n xil: Thdi didm nhjp vijn, Het gidm, bach tdng cao, khi mdu cd bieu hijn tinh ttangtoan
3.2.2. Kit qui diiu Iri Bdng 4: Ket qud didu tti.
Ket qua Tot
Trunq binh Xau
n 10
1 3
»/o 71,5%
7,1%
21,4%
Moi lien quan giita tinh tr^g suy ho \ suy h6 hSp.
) khi vio vi^n v6i ket qui di§u trj tinh tr^g
Bang 5: Suy hd hip KSt qui Tot Tmnq binh Xau
Co suy ho hdip 3 1 3
Khdng suy ho hSip 7 0 0
n 10
1 3
P
<0,05 Moi lien quan giOa tri giac khi vao vien vdi ket qua dieu trj v6i tinh trgng h6n mL Bang 6: Mdi Uen c
KSt Qua Tdt Tmnq binh X3u
uan giiia hi giac khi vao vijn vdi ket qua dieu tri vdi tinh trang hdn md.
C6 Hon me 3
r
3 7
Khong cd hon me 7 0 0 7
n 10
1 3 14
P
<0,05
IV. BAN LU$N 4.1. Dich t l :
- Gidi: Ngat nude thudng gjp ti nam nhi^u hon nit, ti IJ nam: nit = 1,8. Nam nhidu hon nii ed le la do nam thudng hidu dpng hon dl bj te xuong ao, muomg, hodc edc vat dung chCta nude. Trd nam cflng thudng di tdm sdng, ao hd, bd boi nhidu hon. Nghidn eiiu cua Ha Hoang Minh eung cho thiy nam nhieu hon nii (nam:nfl =1,5)(2)
Lua tudi tit 1-5 tudi chiem 57%.
Nghien cuu eda ehiing tdi ciing phu hop vdi
cdc nghien eijfu eua Ha Hoang Minh (2), eua Y. Guan (5) vdi 68% gap d Ida tudi nay.
- Nhdm 1-5 tudi ti ndng thdn thudng it din trudng miu giao, ngudi giii cac em thudng la dng bd dd cao tudi, hoJc la anh ch) thuong nhd tudi. Vi thi tee dl bj ngat nude do sir bit ein trdng coi tre ti ngudi idn.
- Dia dilm xay ra ngat nude: Ngat nude xay ra d kenh rach, tiep den la ao hd sdng sudi. Theo nghiSn ciiu eua Ha Hoang Minh, tai Viet Nam: Ao hd, sdng suli, kenh rach ed rit nhilu nen ttd de bi ngat nude ti cic dia
CHUYEN Bg:HplNGH|KHOAHpCNGANHNHIKHOA TOAN QUOC LAN THg IX
dilm ttdn (2). Khic vdi 6 nude ngodi, ngjt nude thudng xdy ra ti cde bl boi gia dinh (5).
4.2. LSm sdng:
- Tai thdi dilm nhjp vidn, phin Idn cdc bjnh nhdn nhjp vijn teong tinh trang s6t, nhit id cdc bjnh nhdn dupc diiu trj tai bjnh vijn huyjn trudc dd, dd dupc sudi im, chilu den tai edc bjnh vijn huyJn rii sau dd mdi chuyin idn bjnh vijn tinh.
- Tri gidc: Hdn md chiim 50%, lo ma 42,8%. Nghien eijfu eua chdng tdi phi hpp vdi nghien ciiu eda Hd Hodng Minh(2), nhung khde vdi tdc gid Y. Guan (5), ti iJ bjnh nhdn tinh chiim cao hon 46,9%.
- Hd hap: Hay gjp nhit Id triJu chung nghe phii cd ran im 56,8%, tim tdi 28,4%, thd nhanh 71,4%
- Ran am id triJu ehiing viem phoi do hit ti bjnh nhan ngat nude, thd nhanh, tim tdi Id diu hiju cua suy hd hip khi nhjp vijn.
43. CJn lam sang
- Ton thuong phdi chd yiu la viem phii (100%)
- Thay dii vl huyit hpc: Bach eiu tdng cao 13,5 + 7,1(G/1) kit hpp vdi sot chung td tinh teang hpi nhilm phdi. Het gidm hem binh thudng do linh ttang pha loUng mau do lupng nude u6ng phai khi ngat nude hip thu vdo mdu va mpt phin do tayin dudi dd ttuyin djch.
Thay ddi ve sinh hda: Dudng mdu ttung binh 7,5±3.6mmol/l, phu hpp vdi cdc nghien ciiu ttong vd ngodi nude, dudng mdu thudng tdng sau khi ngat nude.
- Khi mdu cho thiy pH giam, PaCOi gidm, gidm HCO3 chiing td tinh ttang nhiem toan chuyin hda do thilu oxy kdo ddi.
4.4. Ket qud diiu trj: Tdt chiim 71,5%, ttung bhih 7,1%, xiu 21,4%
- Ti IJ hi vong do ngat nude eda chdng tdi tuong duong vdi nghien cdu cua Hd Hodng Minh, Dinh Vdn Thiic(l 0), (20).
Tim hiiu mii lidn quan gifia nhdm s hd hip vd hdn md lue vdo vijn vdi kit q diiu tr) chdng tdi thiy nhdm bjnh nlii cd 9 hd hip, hdn md cd kit qud diiu ttj kdm hi vdi p < 0,05.
V. KiT LUifiN
Qua nghidn eim 14 bjnh nhi b) ngat nui diiu tti tai Khoa Nhi Bjnh vijn Da Khoa Tii Giang nSm 2011, ehung tdi nhjn thiy:
Ngat nude thudng gjp d ttd tvr !•
tuli, trd nam nhieu hon nii.
Trd din bjnh vijn ttong tinh tr^
viSm phii, suy hd hip, rii loan tri gidc.
Biin dii sinh hda thirdng do tinh tr^ii pha lodng mdu vd nhion toan chuyin hda.
- Kit qud diiu trj: khdi hodn to^
chiim: 71,5%, cd 3 tee tii vong vd 1 ttd ho me khdng hoi phyc.
Mdi lien quan giiia nhdm suy hd h^
vd hdn me luc vao vijn vdi kit qui diiu li cho thiy nhdm bjnh nhi cd suy hd hip, hJi me cd kit qud diiu trj kdm hon.
T A I U | U THAM K H A O
1. Sinh Vin Thuc (2000), Nghien cdu tOr vong 1 tre dudi S nioi vd 1 so bijn phdp lam gitoli vong do dull nude d trd em tai cpng dong, Lii|i
«n tien St y hpc Tnidng D»i hpc Y Hi Nji 2. Hi Hodng Minh (200S), Nhjn xdt djc iliiil
dull nude trd em tai Bjnh vijn Nhi tnnif uong tix 1995-2004, Tap chi Nghi&l ciu J hpc, phu ttang 35 (2), 2005 ttang 105 -109.
3. Nguyen Cdng Khanh (1977X Bull nude C | nang diiu trj y khoa, Nhd xuit ban Y hpc 4 Nguyin Thi >>¥. Vd 'Wn Duih (1999), N0
nui!*;:, Xu tri cip cdu npi khoa, NXB Y h(c.
5. Y. Guan (2003), Characteristics of drowi by different age groups, Injury preventioi 9, p 163-168.