VIETNAM MEDICAL JOURHAL N'l - FEBRUARY - 2017 thuoc khang anh cua cac chCing anh ESBL phin
l i p dffflc tgl BV 103 (2009-2011)", Tap ehi Y dWde hoc quan sif. Vol 38, No 1, thing 2/2013.
4. Nguyin Thai Stfn, Hoang Vu HCing, "Danh gia doc ti'nh cap cua protein tai t& hdp SEBm t r i n ddng vat thu'c nghiem", Tap chi Y hoc quan sff, Ciic Quin y, BQP, so 295 (1-2/20M), p 18-20.
5. Labinskaia (1978), "Ky thuat nghiin cutJ vi anh
>rat", Medinski, tr. 108-110.
, General requironents for t h e sterility of biological substances (Requirements fd™
Biological substances). I n : WHO Bcpei.
Committee on Biological Standardization. Fortyr:
sixth report. Geneva, World Health Organization, 1998 (WHO Technical Report Series, No. 872).
, Du^c dien Vi$t Nam, lan x u i t ban thu* ttf (2009), Nha xuat ban Y hoc. Ha Npi.
DAC DIEM L A M S A N G M 6 T SO ROI LOAN TAM THAN PHOI HOP tt TRfi TANG D 6 N G GIAM C H O Y TIT 6 DEN 1 4 TUOI
TAI BENH VIEN NHI TRUNG U'ONG
T6MTAT
Muc tiiu: Die diem l i m sang mgt sd rdi loan tam than phcn hdp 6 tre tSng dong giam chCi ^ (ADHD - Attention Deficit Hyperactivity Disorder)tij' 6 den 14 tuS. Boi tifdng va phifdng phap nghien ciht:
Nghiin cffu mo ta cat ngang 96 tre tang d6ng giam chu ^ tai phong kham diuyen l^oa T i m t h i n , Benh vien Nhi Tmng uUng tff nam 2O15-2O16.Ar^^9i/0;ty 1§ ADHD kem ODD la 35,24%, ADHD kem CD: 9,52%, ADHD kem: LATC: 10,48%. R6i lo?n chffe nSng d tre mic ADHD phffi hdp vdi it nhat 01 RLTT: ia dfin chiem 12,5%, dai dam: 2,5% va c i n mong tay: 30%. Roi lo?n TIC nhay mat: 5%, nhun vai: 2,5%, khit miii:
12,5%. Cac r^ loan ngon ngu*: noi ngong: 35%, noi lip; 17,5%, diSn d?t sai tff: 32,5%, noi kho: 15%.
Tiir khda; lam sang, roi loEin tam than phoi hdp, tSng dgng giam chu y, tre em
SUMMARY
CLINICAL CHARACTERISnCS OF SOME COMBINED PSYCHIATRIC DISORDERS AMONG CHILDREN AGED 6 - 1 4 YEARS OLD
W I T H ATTENTION DEFICIT HYPERACnVTTY DISORDER AT NATIONAL
HOSPITAL OF PEDIATRIC Objective: to describe the clinical characteristics of some combined mental disonjers among children aged 6-14 years old with attention deficit hyperactivity disorder. Subject and method: A aoss sectional study was conducted at the psychiatric specialty clinic in the National Hospital of PedlaWc from 2015-2016. A total of 96 children with ADHD were studied. Resuits: the prevalence of ADHD with ODD was 35.24%; with CD
*Benh vidn Nhi Trung udng
Ch[u tradi nhiem difnh: TniWng Thj Mai Hong Email: [email protected] Ngay nhin bai: 15/11/2016 Ngay phan bien khoa hoc: 12/12/2016 Ngay duyet bai: 12/01/2017
Thanh Ngoc Minh*, Trirong Thi Mai H6ng*
was 9.52% and with Depression/Anxiety was 10.48%.
Function disorders combined with at least one psychiatric disonder among children with ADHD;
12.5% fecal incontinence; 2.5% urinary incontinence!^
30% nail biting. TIC disorders: wink 5%; shrugged 2.5%; snort:: 12.5%. Speech disorder: lisp: 35%;
stuttering: 17.5%; misstatement: 32.5%; difficulty with speech: 15%.
Keywords: dinicai, combined psychiatric disorder, attention defidt hyperaclMy disorder, diildren I . e A T V X N O l
Roi loan tang dpng giam diu y (ADHD - Attention Defidt Hyperadivity Disorder) la mot roi loan pho bien d tre em yd\ tf' \h mac dde ti'nti khoang 5% va hien dang co xu hu'dng ngay cang tang[2],[3].ADHD dan tdi nhieu he luy nghiem trong d tre em, dac biet lam l^ng cac nguy cd bj chan thu'dng va roi loan tam than. Theo nghien cuU cua Dalsgaard va cong su* (n3m 2002) cho thay CO SLT lien quan giiJa cac bieu hien roi loan nhan each, toi pnam va hanh vi chong doi xa hgl d tre mIc ADHD, t r e mac ADHD va roi loan hanh vl (CD - Conduct Disorder) co nguy cd ve sau phat' trien rS loan nhan each chong doi xa hS (ASPD) [4]. Mac du vay, cac bang chutig ve m£ai tu'dng quan giiJa cac roi loan tam than vdi ADHD chu'a ro rang, theo ket qua tong hdp 80 bai bao xuat ban quoc te cho thay co 18 bai bao tim ra moi lien quan co y nghia thong ke giuS ADHD vcfi roi loan nhan each, roi loan chong doi xa hpi [7].
Tai Viet Nam, hien chu^ co nhieu nghien ciili ve ADHD va eac roi loan tam than phoi hdp kem theo. Nghien cdu eua Le Thanh Hal va epng stf tren nhom tre ADHD ehu^ cho thay ket qua ve^
moi quan he gii?a ADHD vdi roi loan nhan cach,,f.
chu'ng tram cam, lo au [1]. Nghien eiTu tim hied;
dac di^m lam sang d tre ADHD va cac roi loan
16
TAP CHi Y HPC VigT NAM TAP 451 - THANG 2 - Sg 1 - 2017
tam than kem theo nham ho trcf cong tac phong
ngilci, chan doan va dieu tri cac chutig rot lo?n tam than la dieu ran thiet, dam bao cho tre co du'dc cuoc s5ng i<h6e manh, hanh philc [3].Do vay, de tai nay du'dc tien hanh nham muc deu: "Mo ta dac diem lam sang mgt so roi loan tam than phoi hdp d tre tang dgng glim chuytd 6 deh 14 tuot".
II. BOI TUONG VA PHITONG PHAP NGHllN dJU Ooi tu'tfng nghi@n cthi: Tre em phu hdp vdi die tieu chi: 1) Co rac dau hieu/bieu hien cua ADHD. 2) Tre CO do tuoi tCT 6-14.
III. KET aUA NGHIEN CCTU
Bang 1. Roi loan tam than 6 tre mac ADHD
Ijoai b-Cr cac tre bj bai nao, tre cham phat trien t i m than, tre tiT Icy, tte b| dpng Icinh va be bi ton thuidng he than icinh trung u'dng....
Thcli gian nghi6n cuTu: 09/2015 - 6/2016 Bja d!€m ngliiSn clhi: Phong kham ngoai trii, Khoa Tam than, BVNhi Trung u'dng.
Cd mau va chon mau: 96 tre den kham.
Tiiiet Ice ngliiSn clhi: l«lo ta cat ngang Cong cu TTSL: Phieu dieu tra du'dc xay dung di/a vao muc beu nghien cu\i gom 55 cau hoi chia iam 7 phan.
Phu'dng phap TTSL: Hu'dng din bo me tre dien phieu.
yUi ly so lieu: l^hap li$u va xu' ly phan tich so lieu bang SPSS 16.0
D a c d i e m l^ac ODD Mac CD Mac io a u , tram cam
TONG
G i a m c h u y n 2 0 1 2 1
»/o 9,52
0 4,76 1 0 0
TSnc n 3 0 1 1 4
d o n g
»/o 21,43
0 7,14 1 0 0
K e t h d p n 32 10 9 6 1
•/o 52,46 16,39 14,75 1 0 0
M a c A D H D n 37 10 11 9 6
o/o 38,54 10,42 11,46 1 0 0
Tre mac ADHD thi mlc ODD la 38,54. SU khac biet ty le ADHD giifa cac dang ADHD tre mac phai cd y nghla thong ke vdi Fisher's exact p=0,obl.Tre mac ADHD kem theo CD la 10,42% va tap trung d nhom ADHD dang ket hdp, su" khac biet co y nghTa thdng ke vdi kiem dinh Fisher's exact p=0,044.
Bang 2. Anh hifdng cua ABHB den ODD d tre Dang ADHD
Khong OR
(95%CI) Bieu hien giam
chuy Khong 13,04
58,54 4,72
(1,30-17,16) Bieu hien tang
dong Khong
46,67 6,67
53,33
93,33 <0,001 12,5 (2,72-55,15) ADHD dang ket
hdp Khong
52,46
Mac ADHD Mac 35
11,36
47,54 88,64 <0,001 Khong
38,54 59 61,46 100
TONG I 3 3 I 34,4 I 63 I 65,6 . _ . , Tre macADHD co anh hu'dng den ODD, trong do nguy cd ODD d tre co bieu hien giam chu y rao
gap 4,72 lan so vdi tre khong cd bieu hien, tre mac bieu hi|n tang dong co nguy cd mac ODD rao gap 12,5 tre khong mac, tre mac ADHD dang ket hdp nguy cd mac ODD rao gap 8,61 lan so vdi tre khong mac (p<0,05).
Bang 3. Anh hu'dng cua ADHD den CD d tre
Bi^u hien giam chu y Bieu hien t3ng dpng ADHD dang ket hdp
Mac ADHD TC
m a c Mac Khonq
Mac Khonq
Mac Khonq
Mac Khdng NG
Mac CD n 10 0 10 0 10 0 10
0 9
•/o 12,20
0 13,33
0 16,39
0 10,42
0 9 , 4
K h o n q n 72 2 3 65 30 ^ 5 1 44 86 9 8 7
m a c CD 87,80
%
100 86,67
100 83,61
100 89,58
100 9 0 , 6
VIETNAM MEDICAL JOURNAL N°1 • FEBRUARY • 2017
Tre mac bieu hien giam chii y cd 12,20% mac CD, tre tang dong c6 13,33% mac CD, tre ADHD' ket hdp cd 16,39% riiac CD, tre mac ADHD c6 10,42% mac CD.
Bang 4. Anh hitdng da ADHD den biSu Men io au, trSm cam d tre
LATC I Mac I Khong mac ^ ^ Dang ADHD I n I % I n I %
Bieu hi|n giam
chu y Khong
12,20
4,35 95,65
3,06 (0,37-25,21) Bieu hien tang
dpng Khong
13,33 86,67
96,67 0,1723 4,46 (0,55-36,50) ADHD dang ket
hdp
85,25
Khong 95.45 0,1149 3,63
(0,74-17,74)
Khong 0,00
8,54 100,00 TONG
11,4685 88,54
Tre mSc cac dang ADHD co nguy cd anii hu'dng dSn cac bieu lilen lo au, tram cam. Tuy nhien sir khac biet la khong co y nghTa thong ke (p>0,05).
Bangs. TyiS % roi loan ngon ngit dtre mac ADHD cd rot loan tam than phoi hdp
Dac diem
Roi loan thu'c
the Roi loan
•nc Rdi loan
phat trien ngon ngii'
la dun Oai dam Can monq tay
Nhay mat Nhun vai Hang giong
Khit mui Cham ndi Noi nqonq Ndi lap Nhai ldi Sap xep Idn xon
Dien dat tu* sai Ndi khd
ADHD+ODD 10,81 0,00 32,43
5,41 2,70 5,41 10,81 16,22 35,14 18,92 5,40 37,84 32,43 16,22
ADHD+CD 30,00 10,00 10,00 0,00 10,00
0,00 20,00
20 40 10 0 30 20 20
ADHD +LATC 20,00
0,00 40,00 9,09 0,00 0,09 36,36 18,18 36,36 18,18 9,09 54,55 36,36 9,091
ADHD+RLTT 12,50
2,50 30,00
5,00 2,50 5,00 12,50 20,00 35,00 17,50 5,00 42,50 32,50 15,00 Can mdng tay chiem ty le rao nhat d nhom
mdng tay d nhom ADHD kem it nhat mot RLTT kem lo au tram cam vdi 36,36%.
ADHD kem lo au tram cam vdi ty le la 40%, ty le can la 30%. Khjt mui chiem ty le rao nhat d nhdm ADHD
IV. B/^N LUAN
Nghien cu'u cua chiing toi cho thay ty le mac ADHD kem theo ODD la 38,54%, ty le mac ADHD kem theo CD chiem 9,52%, ADHD kem theo lo au, tram cam chiem 10,48%. Ty le mSc ADHD va mac it nhat 1 roi loan tam than kem theo chiem 38,1%. S^f khac biet ty le ADHD giuS cac dgng ADHD tre mac phai cd */ nghTa thdng k€. Ket qua nay tu'dng t y ket qua nghien cu\i cua Florence Levy va cong sU (2013). K?t qua nghien cuti nay cho thay tre mac ADDH kem theo tram cam chlem 0,38%, ADHD kem theo roi loan hanh vi chiSm 0,82%, ADHD kem theo it nhat mpt roi lo?n hanh vi chiem 2,46% [5]. Nhif vay ket qua nghien cihi cua chung tSi cd ty le cac roi loan kem theo ADHD rao hdn ciia Florence Levy va cong stf (2013), dieu nay dude giai thich do quan the trong nghien cifu cua chung tdi la quan the lam sang d benh vien, trong khi dd nghien
cifu cua Florenra Levy va cong sif tren nhiing quan the tai cong'dong[5].
Trong nghien cifu cua chung tdi tre mac ADHD trpi ve giam chu </ cd 12,2% kem CD, tre ADHD trpi ve tang dong cd 13,33% kem CD, tre ADHD ket hdp cd 16,39% kem CD. Theo Stephen P.Becker va cong sif (2012) CD va ADHD^cd moi lien quan cd y nghTa thong ke [6].
Can mdng tay cd bieu hien d nhdm ADHD kem ODD vdi ty le 32,43%, d nhdm ADHD kem CD vdi ly le 10%, ADHD kem LATC la 40%, cl nhdm ADHD kem RLTT la 30%. Cac kit qua nghien cihi ciia chiing toi cho thay mile dil ADHD*'' dl kem cac RLTT cd bleu hien roi loan thut thS la rao hdn chi d mot vai cac roi lo?n rieng le, tuy v$y khong cd sif khac biet ro rang ve ty le. Dd vay cung can thiet od them cac nghien ciJu nhSnn chutig td anh hudng ciia cac roi loan tam than phoi hdp vdi ADHD den cac roi loan thut the d tre.
18
TAP CHi Y HQC VigT HAM TAP 451 - THANG 2 - S 0 1 - 2017 Nghien etfti eua ehung toi cho thay ty le Tic
nhay mat d nhom ADHD kem ODD la 5 , 4 1 % , d nhom ADHD kem CD khong co bieu hien, nhom ADHD kem AD la 9,09%, nhom ADHD kem it nhat 1 RLTT la 5%. Nhu* vay khi dieu t t i Tie nhay mat ran quan tam dieu t r i phoi hdp den kha nang tre mac cac roi loan lo a u , tram cam. Nhun vai cf nhom ADHD kem ODD cung chiem t y le la 2,7%, d nhom ADHD chiem 10%, d nhom ADHD kem RLTT ehiem 2,5%. Nhom ADHD kem LATC khong co tru'dng hdp nao eo Tie nhun vai.Viec dieu trj Tic nhun vai can quan tam den tre mac CD. Klijt mui d nhom ADHD kem ODD chiem 10,81%, nhom^ADHD kem CD chiem 2 0 % , nhom ADHD kem ikvc cung ehiem 36,36%, nhom ADHD kem RLTT ehiem 12,5%. Viec dieu t n can
\du y den tre mac OD-Nhu" vay, ket qua nghien diu cho thay khong co su* khac biet ve ty le giu^
cac nhom RLTT va ADHD kem RLTT.
Cham noi cao nhat cf nhom ADHD kem theo CO RLTT, nhom ADHD kem CD chiem t y le la 20%.? Nhom ADHD kem ODD chiSm ty le thap nhat'vcfi 16,22%. Noi ngong d nhom ADHD kem CD la 40%, vdi tre noi ngong thi viec dieu trj can quan tam den mac CD.
V . KET LUAN
Roi loan tam than phoi hdp cf tre mac ADHD:
T:^ le ADHD kem ODD la 35,24%, ADHD kem CD: 9,52%, ADHD kem: LATC: 10,48%. Co moi lien quan co y nghla thong ke g i u ^ ADHD va ODD (p<0,05).
R5l loan chu'e nang d^tre mac ADHD phcu hc^ vdi It nhat 01 RLTT: i a dian chiem 12,5%, dai dam: 2,5% va can mong tay: 3 0 % . Roi loan
TIC nhay mat: 5%, nhun vai: 2 , 5 % , hang gipng:
5 % va khit m u i ; 12,5%. Roi loan ngon ngu" cham noi: 2 0 % , noi ngong: 3 5 % , noi lap; 17,5%, nhai Idl: 5%, sap xep Ion x o n : 12,5%, dien dat sai tu*:
32,5%, noi khd: 1 5 % . ' TAI L l | U T H A M KHAO
1. Le Thanh Hai, Thanh N^oc Minh, et al.
( 2 0 1 3 ) . Mdi lien quan giu^ diem tang dgng, giam diu y theo thang do K-SADS-PL va lo au, tram cam d tre t u ky tai t)enh viin Nhi Tmng u'dng.
Tap chl Y hoc thyc hanh, 926. so 7, Tr 40-42 2. American Psychiatric Association (1994).
Diagnostic and Statistical Manual of Mental Disorders. (Fourth edition: DSM-IV).
3. American Psychiatric Assodation (2013).
Diagnostic and Statistical Manual of Mental Disorders. Fifth edition: DSM-5, (Wa^ington:
American Psychiatric Association).
4. Dalsgaanl S, H. S Nielsen^ et al. (2013). Five- fold inaease in national prevalence rates of ADHD medications for children and adolescents writh autism
^jednim disorder, attentran-defidf/hyperacBwty disorder and other psychiatric disonjers. Danish register-based study. Joumai of Child and Adolescent Psydiopharmacdogy, 23,432-439 5. Florence Levy, Deidra 3. Young, et al.
(2013). Ctomorbid ADHD and mental healtii disorders: are these children more likely tn develop reading disorders? ADHD Atten Def Hyp Disord, 5,21-28
6. Stephen P. Becker, Joshua M. Langbergr et al.
(2012). Qinical Utility of tiie Vanderbilt ADHD Diagnostic Parait Rating Scale Gomcxbkjity Screening Scales. 3 Dev Behav Pediati", 33 (3), 221-228.
7. US. Department of Health and Human Services (2012) Attention Defidt Hypeiadi\rity Disocder (ADHD). IN Health, N. I. o. (Ed.) NIH pubfcation
NGHIEN CUU A N H HU'DNG C O A NiraC RfrA RAU QUA VEGY DEN SU"
PHAT TRIEN C O A TRU'NG GIUN DUA VA TRU'NG GIUN MOC/MO Binh Thi Thanh Mai*
nUdc rda rau qua Vegy. Ket qua cho thay d nong dp cao nhat 10 ml/1 nUdc d thdi gian 30 phut, ty le d i ^ tnjfng giun mdq/md 21,63%, di§t 9,31% tnihg' giun dua, d nong do cao 2 ml/1 nUdc d thdi gian 30 p^iit, ty le diet trutig giun moq'md 16,16%, diet 2,57% tamg giun dua, TO'Idtda: Trdng giun dua va giun mdc/md, nUdc rda Vegy.
T 6 M TAT
ChOng toi tien hanh thu" nghiem truhg giun dua va trflhg giun moc/mo d cac nSng do 2 ml/lft nu'dc, 5 ml/if nude, 10 ml/lit nUdc va d cac moc thdi gian khac nhau 5 phut, 10 phCit, 15 phi^t, 30 phiiit, 60 phCit cCia
*Tnf^ Dai hoe YDi^e Hai Phong Chju t r i d i nhiem chinii: Oinh Rij Thanh Mai Email: [email protected] Ngay nhin bai: 6/11/2016 Ngay phan bien khoa hoc: 1/12/2016 Ngay duyet b^i: 12/01/2017
S U M M A R Y
EFFECTS OF VEGETABLES CLEANING U Q U I D VEGY ON ASCARIS A N D
HOOKWORM EGGS
I
