VIETNAM MEDICAL JOURNAL N°1 - OCTOBER - 2017 Journal of Environmental Research and Public
Health, 1, 21-25.
4. El-Sayed I. H., Lotfy M., El-Khawaga O. Y., et al. (2006), "Prominent free radicals scavenging activity of tannic acid in lead-induced oxidative stress in experimental mice". Toxicology and Industnal Health, 22, pp. 157-163.
5. Flora G., Gupta D., Tiwari A. (2013), "Preventive efficacy of bulk and nanocurcumin against lead- induced oxidative stress in mice", Biol Trace Mm Res, 152, pp. 31-40.
6. Khan D. A., Qayyum S., Saleem S., et al.
(2012), "Lead- induced oxidative stress adversely affects health of the occupational worterr Toxicology and Industrial Health, 24, pp. 611-618.'
KHAO SAT MOT SO DAC DIEM LAM SANG VA NGUYEN NHAN SUY HO HAP CAP CUA TRE S a SINH
TAI BENH VIEN DA KHOA NONG NGHIEP NAM 2 0 1 6
T6M TAT
Nghien ciTu hoi ciru md ta dUpe tien hanh tren 51 ho so benh an eiia tre sd sinh bi suy ho hap cap tai Trung tam SO sinh, Benh vien Da khoa Nong nghiep.
Ket qua cho thay ty le tre scf sinh n^am mac suy^ho hap cao hdn tre nd; Tre sd sinh de mo co ty le mac benh suy ho hap cao hdn tre de thu'dng; Bleu hien lam sang hay gap nhat la tim moi, thd nhanh, co keo cd lien sUdn, thd ren va nguyen nhan hang dau gay suy ho hap tre so sinh la viem phoi va bSnh tim bam sinh.
Tdkhoa: Suy ho hap cap, tre sd sinh SUIVIIVIARY
SURVEY ON CLINICAL CHARACTERISTICS AND CAUSE OF ACUTE RESPIRATORY FAILURE OF NEWBORNS AT GENERAL HOSPITAL OF AGRICULTURE 2016 A retrospective descriptive study was conducted on 51 recorcls of newborn with acute respiratory failure at the Neonatal Center, General Hospital of Agriculture.
The results showed that the rate of newborns with respiratory distress was higher than that of girls;
Newborns with a cesarean section have a higher inadence of respiratory failure than normal births; The most oDmmon clinical manifestations are pumlent liposuction, shortness of breath, intemiittent torsion, respiratnry distress and the leading cause of respiratory failure are pneumonia and congenital heart disease.
Keywords: zcute respiratory failure. Neonatal
I.OATV^NOE
Suy hd hap (SHH) la mdt hdi chiTng ciia nhieu nguyen nhan gay nen, la tinh trang benh ly rat hay gap d thdi ky sd sinh, nhat la trong nhutig gid dau sau sinh do day la giai doan tre thich nghi tiT mdi tru'dng t d eung eiia me chuyen sang
*Benh vien Da khoa Nong nghiep Chiu trach nhiem chinh: Hoang Cdng Trang Email: congtrang,[email protected] Ngay nhan bai: 17.7.2017 Ngay phan bien khoa hpc: 30.8.2017 Ngay duyet bai: 12.9.2017
Hoang Cdng Trang*, Ha Hfru Tung* ^
cupe song mdi tru'dng ben ngoai. SHH ed the xuat hien ngay sau de, sau do vai gid hoac v&i ngay tiiy thude vao nguyen nhan. SHH cap hay gap d nhiJng tre sd sinh cd yeu t d nguy ed nhu' de non, de ngat, can nang thap, thai gia thang, nhiem ' khuan bao thai,....[l], [2], [3]. SHH cap la nguyen nhan gay tir vong hang Siu eiia tre sd sinh.
Tren the gidi, hang nam cd khoang 8 trieu tre sd sinh chet, chlem 2/3 tdng sd chet ciia tre duljl 1 tudi, trong dd 2/3 sd tre sd sinh chet trong tuan dau va 2/3 sd nay chet trong 24 gid dau ' [4]. Theo Martin nghien ciTu tai My cho thay ty le sd sinh suy hd hap la 5,l%o tu'dng du'dng vdi . 24.000 tre sd sinh moi nam [5].
6 Viet Nam cung tu'dng tiT nhd vay, b' le tif vong tre sd sinh chiem 50 - 70% tong so tiTvong tre du'di 1 tudi [6]. Theo Nguyen Thj Kieu Nhi va cdng SlT nghien cii'u tai khoa San benh vien tru'dng dai hoe Y Hue (2007) ty le tre sd sinh suy hd hap la 12,5% [7].
Tai Benh vien da khoa Ndng nghiep, theo Nguyen Thj Hdng Lac va cdng siT nghien cirtJ ve md hinh benh tat sd sinh cho thay; Suy ho hap sd sinh khdng do nhllm triing dij'ng hang thiJ ba trong md hinh benh tat, ehiem 9,7%. Tuy^ nhien ehda od mdt de tai nao nghien culi ve dac diem lam sang, nguyen nhan, tre sd sinh bj SHH d i u tjt tai trung tam sd sinh Benh vien da khoa Nong nghiep.
Chinh vi nhiJng ly do dd, chiing tdi tien hanh^
nghien ciTu de tai vdi muc tieu "1^6 ta mpt so dac diem iam sang va nguyen nhan suy ho hip cap cua tre sd sinh dieu tri tai Trung tam sd sinh, Benh vien da khoa nong nghiep nam 2016"
II. £)6l TU'ONG VA PHyONG P H A P N G H I I N CIJU Boi tddng nghien edu: Ho sd benh an cua tre sd sinh (du'di 28 ngay tudi) du'dc chan doan suy hd hap cap dieu trj tai Trung tam sd sinh, Benh vien da khoa Ndng nghiep nam 2016
208
TAP CHi Y HQC VigT MAM TAP 459 - THANG 10 - SO 1 - 2017
Bia diem nghiSn edu: Trung tam sd sinh - lenh vien da khoa Ndng nghiep
ndi gian nghien edu-. Tir 01/1/2017 den 11/1/2017
ThietJ(e nghiSn edu: Hoi ciTu md ta Cd m l u va each chpn mau: Toan bp Ho sd
•k\h an cua tre sd sinh (du'di 28 ngay tuoi) du'dc
;lian doan suy hd hap cap ^ u trj tai Trung tam sd linh, Benh vien da khoa Ndng nghiep nam 2016.
Phin tich va xdly so lieu: Sd lieu sau khi hu thap, du'dc lam sach va nhap bSng phan nem SPSS 16.0
Bang 3.2. Rdi loan nhip thd Roi loan nhip tlid
Thd khonq deu Thd Cham Thd nhanh Khonq roi loan nhip thd
N = 5 1 5 5 25 19
Ty le »/o 9,8 9,8 49,0 37,3
II. KET QUA NGHIEN CU'U Bang 3.1. dac diem benh nhan
Dac diem Gidi Nam NO-
S o c a 33 18
ighien cCfu Ty le % 64,7 35,3 Phifdng phap de
De mo De thi/dnq
33 18
64,7 35,3 Tuoi suy ho hap
Ttf Oh den difdi 7 nqav 1 39 Tir 7 den 28 ngay | 12
76,5 23,5
Nhin xet: Trong 51 benh nhan thi ed 32 tre suy hd hap roi loan nhjp thd thi (chlem ty le 62,7%), cdn khdng cd rdi loan nhjp thd cd 19 tre suy hd hap (ehiem ty le 37,3%)
- Trong eae dang roi loan nhjp thd rdi loan thd nhanh ehiem ty le_nhieu nhat vdi 49%
Bang3.3. Tyle bleu h^ gang sdc edhdh^
Gang sii'e cd h d hap Thd ren Di dong ngu'e bunq Phap phdnq canh mui
Rut Idm hom tfc Co keo cd lien su'dn
Khdnq
N = 5 1 18
7 10 11 20 22
Ty le % 35,3 13,7 19,6 21,6 39,2 43,1
Nhin xet: Tre sd sinh nam bj suy hd hap cd J3 tre (ehiem ty le 64,7%) va tre so sinh nu" bi juy hd hap ed 18 tre (chiem t / le 35,3%). Ty le nac benh nam va nu" cd SLT khac biet (p < 0,05).
Ty le nam/nu' la 1,8/1. Tre sd sinh de mo bj suy id tiap ed 33 tre (chlem ty le 64,7%) va tre sd
;inh de thu'dng bj suy hd hap cd 18 tre (chiem ty e 35,3%). Ty le mac benh giij^ tre de thu'dng va ie mo cd sd kliac biet (p < 0,05). Tre xuat hien
;uy hd hap trong thdi gian du'di 7 ngay tudi ed
!9 tre (chiem b/ le 76,5%) va tre xuat hien suy 10 hap trong thdi gian sau 7 ngay cd 12 tre
^chiem ty le 23,5%. SLT khac biet nay cd y ngTa :hdngke(p < 0,05).
Bang 3.6. Phin loai nguyen nhin gay binh suy ho hip
Nhan xet: Khdng ed gang siTe ed hd hap cd 22 tre suy hd hap (ehiem ty le 43,1%) va cd gang sire hd hap 29 tre suy hd hap (chiem ty le 56,9%). Trong nhutig tre cd bieu hien gang siTc hd hap thi thd ren va keo ed lien su'dn ehiem ty le nhieu nhat lan lu'dt la 35,3% va 39,2%
Bing 3.4. Ty IS bieu hien lim sang tim eda sdsinh suy ho hap
Tim Tim dau chi Tim toan than
Tim moi So BN cd tim Khdnq cd tim Tong so
N = 5 1 9 11 35 43 8 5 1
Ty le % 17,7 21,6 68,6 84,3 15,7 100 Nhin xet:T\m la bleu hien lam sang hay gap nhat, ehiem 84,3 %. Trong dd tim mdi la bleu hien thu'dng gap va de phat hien nhat trong suy hd hap sd sinh.
I
Bleu do 3.1. Nguyen nhan gay benh suy ho hap sdsinh
Nhan xet: Benh viem phoi va tim bam sinh la 2 nguyen nhan hang dau gay suy hd hap d tre sd inh vdi so lu'dng'tre bi la lu'dt la 15 tre (chiem ty le 29,4%) va 14 tre (chiem ty le 27,5%).
VIETHAM MEDICAL JOURNAL N°1 - OCTOBER - 2017
Bang 3.5. Bleu hlin bat thu'd so cd guan
CO quan He thonq tuan hoan
Phdi Tieu hda
N = 5 1 11 24 17
ng t^l mdt Ty le »/o
21,6 47,1 33,3 Nhin xet: Cac bieu hien ve tuan hoan nhu', mach nhanh, mach giam va tieng thdi tai tim cd ty le 21,6%
- Cac trieu chiTng kham tai phdi nhu' la ri rao phe nang giam, nghe cd ran tai phoi chiem 4 7 , 1 % eae tru'dng hdp suy hd hap sd sinh
- Cae bieu hien tai ed quan tieu hda cung la trieu chuTig thu'dng gap, chiem 33,3%. Trong dd bd bii, bu kem, ndn trd la cac bieu hien thu'dng gap nhat.
IV. BAN LUAN
4 . 1 . Mot so d i e diem cua b i n h nhan sd sinh suy ho hap: Ty le nam/nu' la 1,8:1 ket qua nay cho thay, ty le tre nam bj suy hd hap sd sinh gap 1,8 lan tre niJ*. Ket qua na^ cung phii hdp vdi mpt nghien CLTU ciia Nguyen Thanh Ut va cdng SLT nam 2002 da chi ra rang ty le nam/nu" la 2,3:1. Theo quan sat ciia chiing tdi nhan thay ty le sinh la con trai cung dang gia tang trong nhutig nam gan day d Viet Nam ndi chung cung nhu' Benh vien Da khoa Ndng nghiep ndi rieng.
De mo/de thu'dng la 1,8:1. Qua ket qua nay cd the thay de md la mdt phu'dng phap de chii ddng, khdng diing vdi sinh ly, ty le thuan vdi suy hd hap sau sinh. Tuy nhien hien nay ty le de mo tai Khoa San benh vien Oa khoa Ndng nghiep ngay cang tang do niiieu nguyen nhan, tiT chi dinh bat budc cita thay thuoc den nhu'ng quan niem ve de chii ddng chpn ngay, chpn gid ciia ngu'di nha.
Ve thdi gian nhap vien: suy hd hap gap chii yeu 1 tuan sau sinh, chiem ty le 76,5%, day la giai doan tre phai thich nghi do chuyen tiT mdi tru'dng tii cung ciia ngudi me sang mdi taTdng ben ngoai.
Ket qua nay phii hdp vdi eae nghien eiTu ciia cac tac gia Lawn JE nghien ciTu 4 trieu tre em chet tren toan cau nam 2005 thi t / le nay ia 99%.
4.2. Bieu hien lam sang: Qua nghien ciTu ciia chung tdi cho thay tim la bleu hien hay gap nhat trong suy ho hap sd sinh, chiem 84,3%, trong do tim mdi la bieu hien nhieu nhat. Tiep theo la bieu hien rdi loan ve nhjp thd bao gdm:
thd nhanh, thd cham, thd khdng deu, chiem 62,8%. Cac bieu hien ciia gang siTc cd ho hap cung hay gap chiem 56,9% vdi hai bieu hien chinh la co keo cd lien su'dn va thd ren. Bieu
hien tai phdi nhu" la ri rao phe nang giam & ran tai phdi cung la nhii'ng bleu hien hay gap, ehiem 4 7 , 1 % . Ve bleu hien cua tim mach nhiT la mach tang, mach giam, nghe cd tieng thdi tai tim, ehiem 21,5%. Cac bieu hien tai du'dng tieu hoa ciing hay gap chii yeu nhu": tre bd bii, bu kem, an hay ndn trd ehiem 33,33%
4.3. Nguyen nhan cua suy ho hap sd sinh: Theo nghien ciTu ciia chung tdi cho thay;
viem phdi va Tim bam sinh la hai nguyen nhin hay gap nhat vdi t / le lan lu'dt la 29,4% va 27,6%. Ket qua nay ed SLT khac biet vdi mpt so nghien ctrli tren the gidi nhu' tac gia Lawn 3E nghien ciTu 4 trieu tre em chet tren toan cau nam 2005 cho thay sinh non (28%), nhiem khuan nang (26%), va ngat (23%) la nhiihg nguyen nhan hang dau gay tir vong d tre sd sinh. Tuy nhien day la mdt nghien ciTu rdng khap tren toan cau va nghien cii'u ve nguyen nhan gay ra tiT vong d tre sd sinh. Cae con sd tiT vong cao d tre sd sinh la d cac nu'de trung - nam chau A va t / le cao nhat thu'dng d chau Phi can Sahara vdi dieu kien kinh te cdn khd khan va su' cham sdc y te eua chinh phu cdn han che.
Tai Viet Nam, theo tac gia Nguyen Thj Xuan Hu'dng thi nguyen nhan ehinh gay ra suy lid hap va tir vong d tre sd sinh la De non, viem phdi va ngat. Trong ket qua nghien edu eiia ehiing t6i, thi viem phoi va tim bam sinh cd ty le eao hdn eae nhdm khac nhu' de non, binh mang trong, Hpi ehiTng hit cd the ly giai du'dc nhu': trung tam sd sinh ngoai viec tiep nhan benh nhan tiT khoa San chuyen sang thi cdn thu dung dieu tri mpt lu'dng Idn sd sinh tiT ngoai vao, nhdm benh stJ nay chii yeu la viem phdi. Do vj tri dja ly Benh vien ndng nghiep rat gan cac Benh vien tuySn Trung u'dng, eac tru'dng hdp chuyen da sdm, thai non thang hay cd cac yeu t d tien \ddng khd thi benh nhan thu'dng xin chuyen len eae benh vien Trung u'dng. Ty Je tim bam sinh eua chiing toi cao hdn rat nhieu so vdi eac nghien eiTu khacvi trong nghien eiTu nay chimg tdi khdng phan loai ra cac tat bam sinh khac nhau tai tim.
V. KET L U A N
Qua nghien culi 51 tru'dng hdp suy hd hap sd sinh dieu tri tai Trung tam sd sinh Benh vien Oa khoa Ndng nghiep chimg tdi nhan thay:
Ty le nam/nu" la 1,8:1 Ty le de md/de thu'dng la 1,8:1 Bleu hien lam sang: Tim mdi, thd nhanh, co keo cd lien su'dn, thd ren la nhii'ng trieu chiitig hay gap nhat.
TAP CHl Y HOC VigT MAM TijiP 459 - THANG 10 - SO 1 - 2017 Ve nguyen nhan: Vidm phdi va Tim bam sinh
la hai nguyen nhan hang i ^ u gay ra suy hd hap a tre sd sinh dieu trj tai Trung tam sd sinh, Benh vien Oa khoa Ndng nghiep.
TAI Ll|U T H A M KHAO
1. Bo mon nhi - Oai hpc Y Ha Noi (2009). "Baigiang nhi khoa tap 1"
2. V^n nghien culi su'c khoe tre em. "Bai giang bac
^ dinh hddhg nhl Baidenon, suy ho hap so sinh"
3. BS mon Nhi - Dai hpc Y DUde Thanh pho Ho Chi Minh. 'Hgi chuhg suy ho hap d tre so smh"
4. Malavi K.Witte - Acute respiratory failure - Pediatric intensive care 1998- p95 - 97 5. Martin J.A., Hamilton B.E., Sutton P.D., Ventura
S.J., Menacker F. (2003), Births: final data for 2002, Natl Vital Stat Rep, (52), pp. I l l - 13 6. Bp Y te (2003). "Chi thi so 04/2003/CT-BYT ve
viec tang cu'dng cham soc tre sO sinh nhim giam tu'vong so sinh"
7. Nguyen Thj Kfeu Nhl, Nguyin Thien Thuy^
(2007). "Hieu qua viec chMm soc tre sd sinh de non thang nhe can tai khoa san Benh vien tru'dng Dai hoc Y Hue"
PHAN TICH CHI PHI - HIEU QUA LAU D A I CCTA TICAGRELOR SO VOX CLOPIDOGREL TRONG BIEU TRI HOI CHU'NG MACH V A N H CAP:
KET QUA SO" B O Tir NGHIEN CU'U PLATO VA DU" UEU TAI VIET NAM
D6 Van D u n g \ Nguyin Thi Thu Thuy',Ph^m Manh Hung^, Hoang Van Sy' TOIVI TAT
B$tvande: Ngay nay hpi chirng vanh cap (HCVC) la mot trong nhuTig benh ly tim mach pho bien vdi nhieu bien chulig n5ng ne anh hu'dng den chat lu'dng cugc song cua ngiTdi benh. Ticagrelor - lieu phap khang ket t|p tieu cau kep da dUpc chiTng minh ve hieu qua va do an toan so vdi clopidogrel trong dieu trj cung nhu" phdng ngCTa eac bien chuhg cap tinh va tai phat ciia hpi chutig vanh cap (HCVC) bSng nhieu nghien oTu lam sang, S\%r\ hinh la nghien eiTu lam sang nc|au nhien pha III PLATO. Tuy nhien, trong JhiTc hanh lam sang ngoai hieu qua va do an toan de lUa chon thuoc (3n thiet phai can nhae tfnh ehi phi 7 hieu qua, dSc biet ddi vdi qudc gia dang phat trien v6i nguon ngan sach y te ban hep nhu" Viet Nam. Vi vay myc tieu eua nghien ciTu la phan tich chi phi - hieu qua ciia ticagrelor (TIC) so vdi clopidogrel (CLO) trong dieu tn HCVC tai Viet Nam. Bdi tu'dng: Chi phi - hieu qua ciia TIC so vdi CLO trong dieu tri HCVC du'dc the hien thong qua chi so gia tang ehi phi - hieu qua ICER (Incremental eost-effediveness ratio). Phu'dng phap:
Mo hinh hoa bang md hinh cay quyet djnh mo phong 1 nam dieu trj HCVC bang TTC hoac CLO di/a tren dCT lieu PLATO va mo hinh Markov mo phong toan thdi gian sdng ciia ngUdi benh sau 1 nam dieu tri. Thong so dau vao cua md hinh bao gom tan so chuyen, ehi phi va hieu qua du'cJc danh gia dya tren nghien ciTu lam sang pha I I I PLATO, tong quan tai lieu y van, hdi c(fu du" lieu ngUdi benh nam 2017 tai benh vien Chp Ray vS Vien Tim mach quoc gia, benh vien Bach Mai.
Oil phi bVc tiep y te du'dc phan b'ch bao gom ehi phi
'Dai hoc Ydudc TPHo Chi Minh
^ Vien Tim mach Quoc gia, Benh vien Bach Mai Chiu bach nhiem ehinh: Nguyen Thi Thu Thiiy Email: Dal hoc Y du'dc TP HCM Ngay nhan bai: 19.7.2017 Ngay phan bien khoa hoe: 8.9.2017 Ngay duyet b^i: 15.9.2017
ngay giUdng, xet nghiem chan doan, dich vu thu thuat, thuoc, vat tu" y te. Khau hao 3% dude sir dunp cho chi phi va hjeu qua. Phan tich dp nhay xac suat dUdc sir dung de danh gia mifc do anh hu'dng ciia sy khSng ehac chan trong gia tri cac thong sd dau vad cita mo hinh. Keigua:T\nh tren toan thdi gian sdng, so vdi phac do CLO, phac do TIC eo chi phi dieu trj cao hdn 1.197.424 VND va dong thdi lam gia tang them 0,1531 nam sdng (LYG) va 0,1319 nam song co chat lUcJng (QALY). cFii so gia tang chi phi-hieu qua (ICER) *cua TIC so vdi CLO cd gia tri 7.822.017 VND/LYG va 9.077.584 VND/QALY. Vdi nguSng chi tra eua Viet Nam tu'dng iTng vdi GDP dau ngu'di (47,1 trieu VND), gia trj nay thap hdn ngUdng chi tra. Ket luan: Nghien CLI\J' dUa tren di? lieu PLATO^va diT lieu tai benh vien Bach Mai va benh vien Chd Ray cho thay phac do TIC cd ehi phi - hieu qua so vdi phac do CLO trong dieu tri HCVC.
Td khoa: t3cagrelor,clopidogrel,hpi chuYig mach vanh cap, chi p h i - hieu qua.
SUMIVIARY
LONG-TERM COST-EFECTIVENESS OF nCAGRELOR VERSUS CLOPIDOGREL I N
TREATMENT OF ACUTE CORONARY SYNDROMES: A PRIMARY ANALYSIS FROM
PLATO STUDY AND DATA I N VIETNAM Background and objectives: Nowadays, acute coronary syndrome f ACS) has become one of the most common cardiovascular diseases with many serious events, influenelnq the quality of life of patients.
Ticagrelor - an new agent in anti-olatelet therapy has been proved to be efRcacv and safe compared with clopidoqrel in treatment and prevention of cardiovascular events for patients with acute coronary syndrome (ACS) by many clinical researches, the most typical from those was randomised clinical trial phase III PLATO. However, the eost-effeetiveness of ticagrelor should be considered in clinical practice due
