TAP CHl Y D U - Q C U M SANG 108 Tap 10 - S6 3/2015
Nghien cu-u dac diim benh nhi thiSu mau thiSu sSt tir 6
^thang dgn 5 tu6i dirffc di§u tri tai Benh vien Trung wo-ng SQuan doi 108
Study iron deficiency anemia in infant patients aged between 6 months
*and 5 years who have been treated at 108 Military Central Hospital
NguySn Thi Anh Dao, Ngnyln Gia Binh Benh vien Trung uang Quan doi 108
T o m tat
Muc tieu: Danh gia mot sd dac diem lam sang va can lam sang ciia cac benh nhi thieu mau thieu sat dupe dieu tri tai Khoa Nhi Benh vien Trung uang Quan ddi 108. BdV tuang va phuang phap. 130 benh nhi thieu mau thieu sat t d 6 thang den 5 tuoi, duqc Ida chon mot each ngau nhien tren benh an va khi den kham dieu tri Nghien cdu md ta, hdi cdu ket h<?p tien cdu. Ket gua va ket luan: Thieu mau thieu sat t h u a n g gap nhat t d 1 den 5 tudi, vdi ty le 46,2%. Nam benh nhi chiem da sd vdi 61,5%, so vdi n d benh nhi (38,5%). Nghien cdu cung da xac dmh dddc t^ le cda mot sd trieu chdng lam sang khac nhu sot, met mdi trieu chdng tren da niem mac, long tdc mdng, van ddng ...ciia nhom benh nhi. Cac chi sd can lam sang bao gom: Sd luong hdng cau cua nhdm nghien cdu la 4,75±0,47 (T/l). Ham luong hemoglobin la 115±13 g/l- Ty le sat dddi mdc binh thddng la 91,5%; ferritin dddi mdc binh thddng la 69,2%. Luang hemoglobin trung binh hdng cau la 26,15 ±6,90 pg. Ndng dp hemoglobin trung binh hdng cau la 322,96± 17,05 g/l. The tich trung binh hdng cau la 77,78 ± 6,96 fl.
TCtkhaa:Jhiiu mau thieu sat, benh nhi, Benh vien TLlQO 108.
Summary
Objective- To evaluate some clinical and paraclinical characteristics of infants with iron deficiency anemia treated at Department of Pediatrics - 108 Military Central Hospital. Subject and method: The research has been carried out on 130 Infants with iron deficiency anemia aged between 6 months and 5 years old who have been randomly selected when they have examinafion and through clinical record.
Descriptive study with retrospective and prospective method. Result and conclusion: Iron deficiency anemia occurs more frequently in children from 1 to 5 years old, with the rate of 46.2%. Male infant patients account for 61.5% while female ones only account for 38.5%. The research has also determined the rate of some other clinical symptoms such as fever, symptoms on skin, mucosa, hair and nail, as vvell as the state of tiredness, activity ... of the infant patient group. The paraclinical parameters include: The number of erythrocyte of the research group is 4.75+0.47 (T/l); the content of hemoglobin is 115+13 g/l;
the rate of iron below normal is 91.5%: fertltin below normal is 69.2%. The normal hemoglobin content of erythrocyte is 26.15 ± 6.90 pg. The normal hemoglobin concentration of erythrocyte is 322.96 ±17.05 g/l The normal volume of erythrocyte is 77.78±6.96 fi.
Keywords: Iron deficiency anemia, infant patients, 108 Military Central Hospital.
Phan bi|n khoa h9C. TS. TONG THI HIEU TAM
JOURNAL OF 108 - CLINICAL MEDICINEW^DPHAR^^
Vol10-N°3/20t5t
1. Oat van de
Thieu mau do thieu sat nSm trong nhdm benh thidu mau dinh dddng, la mot benh ly rSt thuang gap a tre em, dac biet d cac nddc kem va dang phat trien, trong dd cd Viet Nam. Theo bao cao cda Vien dinh dddng Qudc gia, tJ le thie'u mau dinh dUdng d tre em dddi 5 tuoi nam 2008 la 29,2%, con d thanh phd Ho Chi Minh la 11,9%.
Trong nhdng nam gSn day, Khoa Nhi cua Benh vien Trung uang Quan ddi 108 (TI;QD 108) cd so luang benh nhi ddn kham vdi benh ly thieu mau thieu sat la kha cao. Viec dUa ra duac cac diic dllm lam sang va can lam sang, cung nhu mdt sd ye'u td lien quan den benh se gdp phan quan trong trong chan doan, dieu tri va tien lupng cho cac benh nhi nay.
Tuy vay, hien chda cd nghien cdu nao khao sat thUc trang benh ly do tai benh vien. Xuat phat td nhdng ly do tren, chung tdi fidn hanh thuc hien de tai:
•Nghien cilu dac dUm benh nhi thieu mau thiSu sat td 6 thang din 5 tu6i dang diiu tri tgi Benh vien Trung uang Qudn dpi I OS" vdi muc tieu:
Danh gia mdt sd dac dilm lam sang va can lam sang cua cac benh nhi thieu mau thieu sat ddoc dieu tri tai Khoa Nhi, Benh vien Trung dang Quan ddi 108.
2. Ooi tuang va phUdng phap 2. J. Bo; tuang nghien cUu
Gdm 130 benh nhi thieu mau thieu sat td 6 thang den 5 tudi ddac Ida chon mot each ngSu nhien tren benh an va khi den kham, dieu tri.
•Tieu chuan lua chon:
Tre 6 thang den 5 tudi; cd me di cung hoac Cham sdc va hdp tac nghien cdu; hdi cdu tren benh nhi CO du ho sa benh an.
*Tieu chuan loai trd:
Me khdng hep tac nghien cdu; tre tren 5 tudi va tresdsinh.
Tre cd tien sd mac benh ve mau hoac duoc chan doan benh mau ac tinh hoac mdi truydn mau hay cac che pham cua mau; ddi vdi cac benh nhi hdi cdu:
Khdng dd ho sd benh an.
2.2. Phuang phap nghien cOu
- Nghien cdu md ta, hdi cdu ket hep tie'n cdu.
- Sd lieu duec phan tich va xd V/ bSng phdonf phap thdng kS y hoc tren phSn mem SPSS 20.0,
2.2.1. Cdc chi tieu lam sang - Tre met mdi, bleng an, it van dong.
- Sdt, da niem mac, long tdc rndng, nhiSm triing;
xuat huyet dudi da, cham phat trien.
2.2.2. Cdc xet nghiem can /dm 5dng
• Xet nghiem huydt hoc Hdng cau, huydt s k t6, hematocrit, MCV (Thd tich trung binh hdng cau), MCH (Lueng hemoglobin trung binh hong caii)j MCHC (Ndng do hemoglobin trung binh hdng cau).
• Xet nghiem sinh hda: Sat huydt thanh, Femtin.
3. Ket qua
3. J. Ode diem lam sang
Bang 1. Nhom benh nhi theo tuoi
Nhgnxet: Nhdm benh nhi td 1-3 tudi cd chiem^
le cao nhat 46,2%. Nhdm td tren 3 tudi den 5 tuo chiem ty le thap nhat 19,2%.
Bang 2.
Gidi Nam Nd
Tong
Mhom benh nhi th
SolUdng 80 50 130
eo gidi
TJle%
61,5 38,5 100
Nhdn xet: Ty le benh nhi nam/benh nhi
la 1,6:1.
rAP CHi Y DU"OC L A M S A N G 108 Tap 10-So 3/2015 Tyle
sat Da mem Longmong Nliilin Xuat huyet Met moi Kem an II van mac IOC trung dircri da
Bieu do 1 . Cac trieu chdng l i m sang
Nhdn xet: Ty le benh nhi khdng cd trieu chdng d d d i da (98,5%) chiem da sd so v d i c d xuSt huyet sdt (55,40/0) cao hon benh nhan nhi cd t n e u chdng dddi da (l,5«/o); benh nhi khdng met m o , 16 9/o^
sdt (44,6»/.); da niem mac h d n g (93,1%) chie'm da sd thap han cd finh trang met rrro, (83 1%). Ty e benh so vdi xanh tai (6,9%); Idng tdc m d n g binh t h d d n g nhi kem an (65,4%) cao han khong kem 5n ( 4,6 /o).
(99 2%) chiem da sd so vdi bat t h d d n g (0,8"/o); benh Van d d n g binh t h d d n g (73,8»/o) cao hon cac t r d d n g nhi khdng nhiem t r u n g (50,8%) cao han benh nhi hep ludi van d d n g (6,2%).
nhiem t r u n g (49,2%i). Benh nhi khdng xuat huyet 3.2. Mot so xet nghiem chan doan thieu mdu thieu sit
Bang 3. Sd Iddng hdng cau So Idtfng hdng cau (T/l)
Thap (< 4,24) Binh t h u a n g (4,24-6) Cao (> 6)
Tong
n 31 97 2 130
X + S D 4,02 ± 0,23 4,71 ±0,31 6,39 ± 0,42 4,75 + 0,47
Nho nhat 3,0 4,3 6,1 3,0
Ldn nhat 4,2 5,6 6,7 6,7
Ty le %.
23,8 74,6 1,5 100
' Nhdn xet: N h d m t r u n g binh h d n g cau a mdc binh thUdng (4,24 - 6 T/l) chiem ty le cao nhat 74,6%. Sd
••" Iddng h d n g cau cua n h d m nghien cdu la 4,75 + 0,47 (T/l).
Bang 4. Ham litcrng hemoglobin huyet thanh
Hb (gam/I)
<120 120-140
>140
Tong 130
Nho nhat Lcrnnhat Ty le %
64,6%
34,6%
0,8%) J00%
Nhgnxet: N h d m cd t r u n g binh h e m o g l o b i n d d d , 120 gam/I chidm t)l le cao nhat (64,6%). Ham Idang Hb ll pif cda nghien cdu la 115 ± 13 gam/I.
Nhan xet: Nhdm cd ham Iddng siSt huySt thanh dddi 11 micro, trong nghien cdu la 4,88 + 5,63 microgam/l.
Bang 6. Ham Iddng ferritin huyet thanh 3 nhat
igam/l chidm t^ le 91,5%. Ham luqng sat
Ldnnhat Tylc%
11,94 99,7 99,7
69,2 30,8 0,8
Nhdn xet: Nhdm cd ham lUdng ferrifin «12 microgam/l) chie'm ty le (69,2%) cao ferritin binh thddng (30,8%i).
Bang 7. The tich trung binh hong cau nhat
hdn nhdm ham luong
Nhdn xet: Nhdm cd trung binh MCV (75 - 85) chiem t* le cao nhat (63,1 %). Trung binh MCV cdu la 77,78 ± 6,96.
TOO cua nghiil
Bang 8. LUOng hemoglobin trung binh hong cau
Nhan xet: Nhdm cd trung binh MCH thap dddi 28 pg chidm ty le cao nha't (89,2%). Trung bir
nghien cdu la 26,15 ±6,90.
TAP CHl Y DLTOC L A M S A N G 108 Tap 10-S6 3/2015
MCHC(gam/L)
< 3 0 0 3 0 0 - 3 3 0
> 3 3 0 Tong
Bang ^ n 10 70 50 730
. Ndng do hemoglobin trung binh h X ± S D
284,90 ± 17,43 317,47 ±8,63 338,26 ±5,17 322,96±17,05
Nho nhat 248 301 331 248
Dng cau Ldn nhat
298 330 350 350
Ty le %>
7,7 53,8 38,5 100
; Nhdn xet: Nhdm cd t r u n g binh MCHC binh thUdng (300-330 gam/L) chiem ty le cao nhat (53,8%). Nhdm -• thap dddi 300 g a m / L cd 10 benh nhan nhi chiem ty le thap nhat (7,7%o).
4. Ban luan
4.1. Bac diem lam sang
~r 4.1.1. Bac diem benh nhdn theo tuoi va gidi
! i Trong t o n g sd 130 benh nhi, ty le thieu mau i thieu sat cao nhat la n h d m t d 1-3 t u d i (46,2%i) va 7 giam dan t d 3-5 t u d i (19,2%>). Do tre t d 1-3 t u d i nhu
— cau nang Iddng t a n g len va t i n h trang khdng dii sda J i me cho benh nhi dan den tre thieu dinh dUdng, vi
chat. Giai doan 3-5 tudi la giai doan tre khdng phu ' t h u d c vao sda me, nen se dn djnh han ve che dp
d i n h d d d n g .
Ty le thieu mau thieu sat hay gap d tre nam nhieu han tre n d vdi t y le 61,5%), ket qua nay tUong Ijii d d a n g vdi nghien cdu cua Lam Thj My nam 2004, C t r o n g dd t r e t r a i chiem 65,8%) [5].
-^ 4.1.2. Cdc trieu chdng lam sang
-^ Cd t h e ly giai m d t sd trieu chdng n h d sdt, da - ^ xanh t a i , n h d t nhat la do m d t phan n g u y e n nhan
* cua cd t h e t h i e u mau t h i e u sat. T d d d anh h u d n g , . . d e n d a p d n g m i e n dich cua cd t h e , dan den m d t sd phan d n g d a p d n g t r o n g dd cd sdt x u a t hien d tre t h i e u m a u t h i e u sat keo dai. Can dac biet luu t a m d e n ciSc b e n h nhi cd da va niem mac xanh tai n h d t . T h d d n g la n h d n g t r d d n g h d p benh da keo dai va n a n g [9], [10].
* . Trong nghien cdu cua chung tdi chi gap m d t (i t r u d n g hdp Idng tdc m d n g bat t h d d n g , 02 t r d d n g
>1 hdp xuat huyet dddi da. Dieu nay la phu h a p do l i ' l d n g m d n g tdc bat t h d d n g , xuat huyet dUdi da khdng phai la trieu chdng dac hieu cua thieu mau
€,
i o t * thieu sat.
Trong t d n g sd 130 benh nhi, cd 64 benh nhan nhi nhiem trung. Trieu chdng nay cd the xay ra d bat kl tre nao, tuy nhien khi cd the thieu vi chat se t h u a n lei cho m o t sd nhiem trung ca hdi phat tnen.
Met mdi la m d t t r o n g nhdng t n e u chdng cua thieu mau thieu sat keo dai. Tuy nhien, t r o n g nghien cdu chi cd 22 t r d d n g hcjp tre met mdi vdi ty le 16,9%i.
Trieu chdng tre kem an la m d t t r o n g n h d n g nguyen nhan gay thieu mau thieu sat, t r o n g nghien cdu ty le benh nhi kem an chiem 65,4%) cung phu h o p vdi m d t sd nghien cdu [3], [8],
4.2. Mot so xet nghiem chan doan thieu mdu thieu sat
4.2.1. So Idang hong cau
Trong tdng sd benh nhi thieu mau thieu sat, cd 23,8%) benh nhi fiung binh hdng cau dddi mdc binh thddng. Trong dd ca biet cd trddng hdp fiung binh hdng cau thap dddi mdc 3,0 T/l. Sd Iddng hdng cau trung binh trong nghien cdu cua chung tdi la 4,75 ± 0,47 (T/D phu h d p vdi gia t n binh t h d d n g cua tre em Viet Nam.
Theo Lam Thi My, tre em dddi 1 tudi t d 3,5-4 trieu/L.
Tre tren 1 tudi t d 4 - 4 , 5 trieu/L [51.
4.2 2. Ham luang hemoglobin huyet thanh Ham iddng hemoglobin (Hb) cua 130 benh nhi la 115 ± 13 g/l, cd 84 trddng hep ham Iddng Hb thap (108 ± 10 gam/I), chiem ty le cao nhat (64,6%i). Trong khi dd benh nhan nhi cd Hb t r o n g gidi han binh t h d d n g chiem ty le 34,6%). Ham Ideng Hb ciia 130 tre t r o n g nghien cdu nay la giam so vdi chuan hang sd sinh hoc. Theo Nguyen Cdng Khanh tre 6-12 t h a n g t u d i Hb t r u n g binh 100-120g/l cdn tren 1 t u d i dn d i n h t d 120-140g/l 5. Tuy nhien, ket qua cua chung 11
Vol10-N°3/2011
tdi cao h d n kdt q u J (96,09 ± 10,83) cua B m h K m Diep, Pham Trung Kien nghien cdu d trd < 5t tai Benh vien Sa khoa Trung uang Thai Nguyen nam 2009 [2], [41.
4.2.3. Ham iddng sat huyet thanh
Benh nhi cd ham Iddng sat huygt thanh dddi mdc b i n h t h d d n g « 1 1 microgam/l) chidm^ ty le 91 5% Ca biet cd nhdng t r d d n g hap sat thap den mdc chi 0,3 microgam/l. Cd t h i tha'y ti le benh nhan nhi thidu mau do finh trang thidu sat kha cao.
4.2.4 Ham Idang ferritin huyet thanh Co 90 t r o n g t d n g sd 130 benh nhan nhi cd ferrifin dudi mdc binh t h d d n g « 1 2 microgam/l) chiem t)/ le 69,2%. Ferritin thap nhat la 0,37 microgam/l. Ferritin va sat la hai ydu t d khdng t h e thieu ddtJc cho qua trinh tao mau t r o n g ca the.
4.2.5. Tile ticii trung binii iidng cd'u (MCV) Cd 36 t r u d n g hep cd MCV thSp dddi mdc binh t h d d n g « 75 fl), chiem ty le 27,7%. Gia tri MCV cua ca n h d m nghien cdu la 77,78 ± 6,96, tha'p hdn^so vdi qia tri binh t h d d n g nhdng phu hop vdi ket qua nghien cdu cda S i n h Kim Diep, Pham Trung Kien 70,15 + 9 , 2 fl [2], [61, [7],
4.2.6. Luang hemoglobin trung binh hong cdu (MCH) MCH thap dddi mdc binh thddng « 28) cd trung binh la 24,98 + 2,56 pg chiem t)/ tuang ddi cao 89,2%.
Chi sd MCH Chung trong nghien cdu nay (26,15 ± 6,90) la thap han so vdi gia tri binh thddng [61.
4.2.7. IVdng dp Hemoglobin trung binh hong cau (MCHC)
Chi sd MCHC t r o n g nghien cdu cua chung tdi (322,96 ± 17,05 g/l) la phu hop vdi nghien cdu cda D i n h Kim Diep, Pham Trung Kien (322 ± 22) [2], [91.
5. Ket luan
Dac diem benh nhi thieu mau thieu sat den kham va dieu tri tai Khoa nhi Benh vien TUQD 108.
5.7. Lam sdng
- Thieu mau thieu sat thUdng gap nhat t d 1 -5 tuoi, vdi ty le 46,2%, sau do giam d Ida tudi tien hoc dddng.
T^ le nam b e n h nhi la 61,5%, t>f le n d benh nhf
' T« le benh nhi cd trieu chdng sdt la 44,6%; da niem mac xanh tai (6,9»/o); Idng tdc m d n g b e n h j (0 8%); benh nhi n h i l m t r u n g (49,2%). Benh nhi xu|
huye't dUdi da (1,5%); b e n h nhi cd t i n h tr?ng m | m d i (83,1%). Ty le b e n h nhi kem an (65,4%). Ty l | benh nhi Iddi van d d n g (6,2%.).
5.2. Can lam sang
- So Ideng h d n g cSu cda n h d m nghien cdu
4,75 ± 0 , 4 7 (T/l). ..
Benh nhi cd sd Iddng h d n g cau d d d i mdc binb t h d d n g chiem t J 14 23,8%.
- Ham Iddng h e m o g l o b i n cua 130 benh nhi 115 ± 13 g/l. Cd 64,6% t r d d n g h a p hemoglobin diia mdc binh t h d d n g .
- TJ le sat dddi mdc b i n h t h d d n g la 91,5 ^ . - 69,2% fiddng hep ferrifin dddi mdc binh thddng.
- Ldong h e m o g l o b i n t r u n g b i n h hdng cau la 26,15 ± 6,90 pg. , ,
- Ndng dp h e m o g l o b i n t r u n g b i n h hong cau H 322,96 ± 1 7 , 0 5 g/l.
- The tich t r u n g binh h d n g cau la 77,78 ± 6,96tl
Tai l i e u t h a m k h a o
1 Nguyen Phu Duy (2010) Khao sdt tinh trang thiii mdu thieu sdt 6 tre em td6 thdng den 59 thang tui dieu tn tgi Khoa Nhi binh vien Nhat Tan td tirdns i den thdng 7 nam 2010.
2 Dinh Kim Diep, Pham Trung Kien (2010) Tiiieu mi thieu sat d benh nhdn dddi 5 tudi trji khoa Nhi BenI vien da khoa Trung ddng Thdi Nguyin nam 200 Tap chi Y hoc thdc hanh (708) - sd 3.
3 Le Thi Hop, Le Danh Tuyen, Tran Thanh Dd (201 Tmh hinh dinh dddng Viet Nam nam 2009-2010.
4 Nguyen Cdng Khanh (2004) Bgc diem mdu tri e Huyet hoc lam sang nhi khoa. Nha xuat ban Y hi tr. 24-25.
J Lam Thi My (2004) Bgc diem ve mdu tri em I khoa, chddng trinli dai hoc tap II. Nha xuat bai hoc, tr. 155-163.
6 Lam Thi My (2004) Hoi chdng thieu mdu. Tai I hudng dan thUc tap lam sanq chuyen khoa Nh 180-181.
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TAP CHl Y DLtOC L A M S A N G 108 Tap 1 0 - S 6 3/2015
7. Bessman JD, Gilmer PRlr (1983) Improve classification of anemias by MCV and RBW.
Am.J.CIin.Pathol 80:322.
8 I W Booth, M A Aukett (1997) Iron deficiency anemia in infancy and early childhood. Arch Dis Child 76: 549-554.
9. Siimj Giipte, Ravinde, K. Gupta, Ritu Gupta (2001) Iron Deficiency Anemia: Management and Prevention in Children. JK Science 30(4): 160-165.
-10. Chessa K. Lutter (2008) Iron Deficiency In Young Children m Low-Income Countries and New
Approaches for Its Prevention. The Journal of Nutnfion 138.2523-2528.
