TAP CHfY Dl/ffC HQC CXN T H f f - S O 13-14/2018
4. Bill QudcThing (2005), "Khao sat yeu td dich te, lam sang va can lam sang tren nhiing benh nhi nhiem triing huyet ttr vong", YHgc Thdnhphd Hd ChiMinh, 9(1), trang.104-108.
5. Cao Viet Tiing, Pham Van Thdng, LS NamTra (2005). "Nghien ciru dac didm lam sang va cgn Iam sang sdc nhilm khuan tre em tai khoa hdi sue cap cuu b?nh vien Nhi Trung iJcmg", Tgp chi nghiin ciru Y hgc, 34(2), pp. 45-53.
6. Brierley J, Carcillo J A, Choong K, et al. (2009), "Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine", Crit Care Med, 37(2), pp.666-688.
7. Cartaya J. M., Rovira L. E., Segredo Y.. et a/.(2014), "Implementing ACCM Critical Care Guidelines for Septic Shock Management in a Cuban Pediatric Intensive Care Unit", MEDICC Review, 14,pp.47-54.
8. ChenX C, YangY F, WangR, etal.{20\5), "Epidemiology and microbiology of sepsis in mainland China in the first decade of the 21st century". International Journal of Infections Diseases 31,pp.9-I4.
9. Dellinger R P, Carlet J M, Masur H, et a/.(2004), "Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock". Intensive Care Med, 30, pp.536-555.
lO.Dellinger R P, Levy M M, Rhodes A et al (2013), "Surviving Sepsis Campaign:
International Guidelines for Management of Severe Sepsis and Septic Shock: 2012", Crit Care Med, 41, pp.580-637.
11 .Goldstein B, Giroir B, Randolph A, et i3!/.(2005), "International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfiinction in pediatrics", Pediatr Crit Care Med, 6, pp.2-8.
12.Khan M. R., Maheshwari P. K., Masood K., et al. (2012), "Epidemiology and Outcome of Sepsis in a Tertiary Care PICU of Pakistan", Indian JPediati, 79(11), pp. 1454-1458.
13.Kutko M C, Calarco M P, Flaherty M B. et al (2003), "Mortality rates in pediatric septic shock with and without multiple organ system failure", Pediatr Crit Care Med, 4, pp.333- 337.
14.Sarthi M., Lodha R., Vivekanandhan S., et a'/.(2007), "Adrenal status m children with septic shock using low-dose stimulation test", Pediatr Crit Care Med, 8, pp.23-28.
1 S.Watson R. S., Carcillo J. A., Linde-Zwirble W. T., et al.(2003), "The Epidemiology of Severe Sepsis in Children in the United States", Am JRespir Crit Care Med, 167, pp.695-701.
(Ngdynhgn bai: 13/11/2017-Ngdy duyjt dang: 04/01/2018)
KHAO SAT B | ; N H TIM M A C H VA D A N H Glk K E T QUA DIEU TRI T^I KHOA TIM M A C H BENH VIEN NHI D 6 N G C A N THO NAM 2015
Trirffng Ngpc Phir&c*, Nguyin Phtr&c Sang vd cdng su Trucmg Dgi hgc Y Dugc Can Tha
* Email:[email protected] TOM TAT
Bgt van ^: Bjnh tim mach M vd dmg la mgt tivng nhiing bjnh tgt todn cdu ldm dnh hucmg sue khoe ch) ngudi ldn vd tdng trumg ch) tre em ChSi dodn binh vdphdt hijn cdc biin chdng sdm ffup dieu tri cd hiiu qua ldm cdi thien chdt lugng cugc sdng cho tii. Mgc tiiu nghiin dm: chimg tdi thuc hijn di ted ndy vdi muc tieu- Md tddgc diem bjnh tim mgch vd ddnh gid ^t qud dieu tri bjnh tim mgch tgi khoa Tm mgch Bjnh vien Nhi ddng Cdn Tha ndm 2015. Boi tirgng vd phuang phdp: Nghiin ciiu mdtd cdt ngang.
TAP CHl Y Dl/QfC HQC CAN THff - SO 13-14/2018
K& qud: Khdo s^ HI benh nhi mdc bjnh tim mgch (2 thing din 15 tudi) tir thdng 8 ndm 2014 din thdng 4 nam 2015, cho kit qud nhr sau: ty sd nir: nam Id 1,06:1 Cd 68,9% tre mdc bjnh TBS dudi 12 thdng, 83,8%
tre mdc bjnh tim mgch mdc phdi cd do tudi tu 5 trd lin. Bjnh TBS Id chi yiu (66.7%). Trong nhdm tre binh TBS. thdng lien thdt chiim ty li CCK) nhdt 31.1 % thdng lien nhi 16.2%. tu chmg Fallot 13,5%. Trong nhdm bjnh tim mgch mdc phdi, tdng huyit dp chim ty li cao nhdt 64.9%. rdi logn nhip tim 27%, Kawasaki 8,1%
Cdc bien chiing throng ggp cita bjnh tim bdm smh gdm viem phdi (79,7%), suy dinh du&ng (45,9%), suy tim (25,7%), tdng t^ phdi (25,7%). O ca hai nhdm bjnh TBS vd tim mgch mdc phdi. hdu hit tre thuyen
^m trieu chung dugc ra vijn vd theo doi. Ket lugn: Binh TBS chiim da sd trong cdc bjnh tim mgch tre em vdi bien chiing viim phdi vd suy dinh duang chim ty li cao. Hdu hit tre thuyen gidm bjnh, dugc ra vijn theo doi tiep, tiep din tre cdn can thijp ngogi khoa tim bdm sink
Tir khda: tim bdm sinh (TBS), tim mgch mdc phdi, tie em A B S T R A C T
I N V E S T I G A T E C A R D I O V A S C U L A R D I S E A S E S A N D E V A L U A T E O U T C O M E S I N T R E A T M E N T O F C A R D I O V A S C U L A R D I S E A S E A T
C A R D I O L O G Y U N I T , C A N T H O P E D I A T R I C H O S P I T A L IN 2015 Truong Ngoc Phuoc, Nguyen Phuoc Sang et al Can Tho University of Medicine and Phamarcy Background: Cardiovascular disease has been the one of the global disease affecting the health of adults and children's growth. Diagnose and detect complications early effective treatment to help improve the quality of life for children. Should we make this topic with the Objectives;To describe the characteristics of cardiovascular diseases and evaluate outcomes in treatment of cardiovascular diseases at cardiolgy unit. Can Tho Pediatric Hospital in 2014-2015.
Materials and methods: Cross-sectional descriptive stuify. Results: The survey of 111 patients with cardiovascular diseases (2 months of age to 15 years old) from August 2014 to April 2015 gave the following results. The female: male ratio was 1,06:1. There were 68,9% of children (with congenital heart disease) under 12 months old, 83,8% of children (with acquired heart disease) aged 5 and older. Congenital heart disease is primarily (66,7%). In group of congenital heart disease, ventrical septal defect recorded highest proportion of 31,1%, artiial septal defect with 16.2%. Tetralogy of Fallot with 13,5%. In the group of patients with acquired cardiovascular disease, hypertension accounted for the highest percentage 64,9%, the proportion of arrhythmia and Kawasaki were 27% and 8,1%. Common complications of congenital heart diseases include pneumonia (79,7%>), malnutrition (45,9%), heart failure (25,7%), pulmonary hypertension (25,7%f Conclusion: congenital heartdiseases were major in children with heart disease.
Pneumonia and malnutition accounted for high percentage. Most patients remissed and discharged from hospital, next, the child will need a cardiac surgical intervention.
Key words: congenital heart diseases, acquired heart disease, children.
I. Di^T V A N D E
Trong nhiing thap ky vua qua, benh tim mach da vd dang trd thanh mpt tixjng nhihig gdnh ndng bdnh tat toan cdu. Bdnh tim mach khdng chi anh hudng nghidm ttgng ddn sue khde cua ngudi ldn ma cdn tac d^ng ddn sv phat tridn mgi mgt ciia tte em [7].
6 Viet Nam, cdng tdc chdm sdc siirc khde ban ddu ciing nhu mang ludi y t^ co sd that su chua dugc hoan tiiien [ I ] , trang thiet hi chua ddy du ndn viec du phdng benh tim bdm smh, chdn dodn sdm cdn ban chd do dd bdnh nhi nhdp vi$n vdi cac bidn chiimg ndng va tir vong cdn nhidu [3], [7]. Ben cgnh cdc benh tim bdm sinh, cac benh ly^ mac phai nhu tdng huydt dp, Kawasaki, rdi loan nhip tim.. .cung gdp phdn khdng nhd vao ty Id tir vong ciing nhu anh hudng ddn su phat trien, hgc tap ciia ttd
129
TAP CHI Y Dl/QC HQC CAN THff - SO 13-14/2018
Hien nay, tai Viet Nam ndi chung va Can Tho noi rieng chua co nhidu nghidn cim vd tinh hinh chung cac bdnh tim mach d tte em. Nhdm muc dich bidt dugc ddc didm benh tim mach d tte em va didu tri bdnh tim mgch tai Bdnh vien Nhi ddng Cdn Tho, chiing tdi tidn hdnh dd tai "Khao sat benh tim mach vd danh g i i ket qua di^u tri t^i khoa Tim mach B^nh vifn Nhi dong C^n Tho" nam 2015" vdi 2 mijic tidu:
- Md td dgc diim bjnh tim mgch tgi khoa Tim mgch Benh vien Nhi ddng Cdn Tha ndm 2015.
- Ddnh gid kit qud diiu tri binh tim mach tgi khoa Tim mgch Benh vijn Nhi ddng Cdn Tha ndm 2015.
II. DOI TirONG VA PHlTONG PHAP N G H l i N ClTu
- Doi tugng nghidn cttu: benh nhi tir 2 thang ddn 15 tu6i dugc kham lam sang can thdn va cd can ldm sang phii hgp dd chan doan xdc dinh mac b?nh tim mach.
- Phuang phdp nghien cim: tiiidt kd nghidn cuu md td cat ngang, vdi cd mdu la 111.
Cdc bdnh nhi thda tidu chudn chgn mau dugc thu thgp thdng tin theo phidu thu thdp sd lieu va xd IJ bdng phdn mdm thdng kd SPSS 18.0.
III. KET QUA NGHIEN CUtJ - Sac diim chung:
Ty id nam la 48,6% vaty Id nil: la 51,4%, ty sd nii/nam = 1,06/1. Ci rihdmtte mdc TBS cd 68,9% tte dudi 12 tiiang, ty Id ttd mdc TBS ttdn 5 tudi chidm ty Id thdp nhdt 8,1%.
Hdu hdt bdnh nhi tun mach mdc phai ndm ttong do tudi tten 5 tudi chidm 83,8%.
- Ty 1^ bdnh tim m^ch:
Bdnh tim bam sinh chidm da sd ttong nghidn cuu vdi ty le la 66,7%.
Bang 1. Ty Id cdc bdnh tim bam sinh (n=74) B^nh tim bam siDh
Thong lieD that Thong lien nhT Tft chihig Fallot Con ong dong mach
Kenh nhT thk Cac di tit tim khac
Ting
S6 benh nhi 23 12 10
T t le (%) 31,1 16J 13,5 05 1 6,8 03
21 74
4,1 28.3 100 Bdng 2. Ty le cac b^nh tim mach mic phai (n=37)
Tim mach m^c phai Tang huy^t &p Roi loan nhip tim
Kawasalti Tong
So b^nh nhi 24 10 03 37
Ty IS (%) 64,9%
27 8,1 100 - Bien chimg cua bdnh tim m^ch
Bang 3. Ty Id timg bien chung ttong nhdm tim bdm sinh Bien chihig
Viem phdi Suy dinh dirdng
Sny tim Tang ap phoi
So benh nhi (N=74) 59 34 19 19
TylS(%) 79,7 45,9 25,7 25,7
TiDlP CHI Y Dl/grc HQC CAN THff - SO 13-14/2018 - Ket qua dieu tri
Bang 4. Ket qua didu tti theo nhdm bdnh K^t qua Thuyen giam, ra vien va theo doi
Thuydn giam, chuydn ddn tuyen tren phdu thuat Nang, chuyen Hdi sue tichcirc - chong doc didu tri Nang, chuydn tuy^n tren didu tri
ImErat^^^^^^^^^^^^Hp^^
" T S ^ T ^ ^ ^ ^ ^
TBS 38 51,4%
21 28,4%
14 18,9%
01 1,4%
00 0%
74 100%
TMMP 31 83,8%
00 0%
04 10,8%
02 5,4%
00 0%
37 100%
Bang 5. So ngay nam vien Nhom benh Tim bam sinh Tim mach mac phai
±SD (ngay) 8,34±3,54
8,05±4,2
Nhieu nhat (ngay) 21
It nhat (ngay) 02 21 1 02 IV. BAN L U ^
Dac diim chung:
- Kdt qua nghien cuu cua chimg tdi ty Id nam vd ntt tuong duang nhau, ldn lugt la 48,6% vd 51,4%, ty sd nu/nam = 1,06/1. Kdt qua nay phu hgp vdi nghien cuu cua cdc tdc gia ttong nude. Le Tlu Hal Ydn nghien cttu 125 bditii nhi mdc bdnh TBS nhan thdy cd 60 tiudng hgp Id nam, 65 trudng hgp la nil, chidm ty Id ldn lugt la 48% vd 52% [5]. Truang Bich Thuy va Vang Kidn Dugc khdo sat ttdn 543 bdnh nhi vao vien vi benh TBS ghi nhan ty sd nam/na = 1,04/1 [4].
-Kdt qua cua chdng tdi ghi nhgn, d nhdm ttd bdnh tim inach bam sinh cd ddn 68,9% ttd dudi 12 thang, ty Id tte mdc tim bdm sinh ttdn 5 tudi chidm ty Id tiidp nhdt 8,1%.
Hdu hdt bdnh nhi tim mgch mdc phai ndm ttong do tudi ttdn 5 chidm 83,8%. Kdt qua ciia chdng tdi tuong tir nghidn cihi Le Thi Hai Ydn trong sd 125 bdnh nhi TBS nhap vien cd 76 bdnh nhi dudi 12 thdng tudi chidm ty le cao nhdt (60,8%), sd bdnh nhi ttdn 5 hidi chidm ty Id tiidp nhdt 12% [5].
Ty 1$ cdc bdnh tim mach:
- Tre bdnh TBS chidm dsL sd tiung nghien cttu ciia chung tdi, cd ddn 2/3 (66,7%) ttd mdc benh tun bdm sinh trong tdng sd cdc trudng hgp benh tim nhap khoa Tim mach. Theo nghidn cuu ciia Borzouee M vd Jannati M tiren 1.817 benh nhi mdc bdnh tim mgch d Iran trong tiidi gian 3 nam, tte mdc bdnh tim bdm sinh Id chu ydu vdi ty Id 76% [6], cao hon so vdi kdt qua ciia chiing tdi. Giai tiiich dieu nay la do Borzouee M va cs nghien cihi tren ca nhiing tre so sinh trong khi nghidn cuu cua cbiir^ tdi khdng bao gdm ddi tugng ndy.
- Ty Id cac bdnh tim mgch bdm sinh: thdng lien that chidm ty Id cao nhat 31,1%, tiidng lidn nhT chidm 16,2%, tii chimg Fallot 13,5%, cdn dng ddng mach 6,8%. Kdt qua ndy, tuong tu nghien cuu cua Nguyen Van Cuong vdi thdng Uen thdt chidm ty Id 34,8%, thdng lien nhi 13,3%, tu chiing Fallot 13,7%, cdn dng dong mach 12,9% [2].
131
TAP CHI Y Dl/QfC HQC CAN THff - s 6 13-14/2018
- Ty Ie cac benh tim mgch mdc phai: tdng huydt ap 64,9%, rdi logn nhip tim 27%, Kawasaki 8,1%.
Bien chung cua bdnh tim m^ch
- Chiing tdi nhgn thdy viem ph6i la bidn chung thudng ggp d bdnh nhi mdc benh tim bdm sinh vdi ty Id 79,7%, ke ddn Id suy dinh dudng vdi ty Id 45,9%, suy tim va tang dp phdi chidm ty Id bdng nhau 25,7%. Kdt qua cua chiing tdi tuong tu tdc gia Nguyen V5n Cuang [2] va Ld Thi Hdi Ydn [5] vdi bidn chdng thudng gap nhdt la vidm phdi va suy dinh dudng.
Kit qua diiu tri bSnh tim mach:
- Ci nhom bdnh tim bdm sinh, ty le ttd thujjen gidm tri^u chung va dugc ra vi?n theo ddi Id 51,4%, 28,4% tte dugc chuydn ddn tuydn tten can thiep ngoai khoa, tte ngng hon chuydn ddn khoa Hoi siic tich cue - chdng ddc Id 18,9%, chuydn tuydn ttdn do benh nang la 1,4%.
- Ci nhom tim mgch mdc phdi, t;y Id tte thuyen giam tridu chung va dugc ra vien theo ddi Id 83,8%, tte ngng hon chuydn ddn khoa Hdi sue tich cue - chdng ddc la 10,8%, chuydn tuydn trdn la 5,4%.
- Sd ngay ndm vidn trung binh ciia cd 2 nhdm bdnh tim bam sinh va mac phai lan lugt la 8,34 ± 3,54 va 8,05 ± 4,2 ngay, ttong do nhidu nhat 21 ngay va it nhdt 2 ngay.
Khdng cd sir khac biet vd sd ngay ndm vien giua cdc nhdm cd va khdng bidn chung V. KET LUAN
B?nh tim bam sinh thudng ggp d dudi 5 tudi nhdt la do tudi dudi 12 thang. Bien chdng cua bdnh tim bdm sinh cdn nhidu, ttong do vidm phdi va suy dinh duong tiiuong ggp nhdt. Hdu het tte dugc didu tri thuyen giam tri?u chung va ra vien theo ddi tidp.
TAI LIEU THAM KHAO
1. Bp Y Te (2013), Bdo cdo chung tdng quan ngdnh y ti ndm 2013, Ha Ndi, tt 11-42.
2. Nguyen Van Cuang (2010), Nghiin ciiu tinh hinh bjnh tim bdm sinh a tre em tgi Bjnh vi?n Nhi ddng Can Tha, Luan an chuyen khoa cap n, Tnrdng Dfii h(?c Y Dugc Hud, tr.46-54.
3. Hoang Trpng Kim (2006), Nhi Khoa chuang trinh dgi hgc. Tip 2, Nha xudt ban Y hpc, tr.43- 67.
4. Tmong Bich Thiiy va Van Kiing Dugc (2012), "Dac diim benh tim bdm sinh d tre em tai B?nh vien Da khoa Kidn Giang", Yhgc Thdnhj)hd Ho ChiMinh, Tap 16, tt.96-101.
5. Ld Thi Hai Yen (2008), Nghien ciiu nhiing bien chung thudng gap trong bjnh tim bdm sinh
& tre em dieu tri tgi khoa nhi Bjnh vijn Tnmg Uang Hue, Ludn van Thac sy Y hpc, Tnrong Dgi hpc Y Dugc Hue, tt63-64.
6. Borzouee M and Jannati M (2008), "Disttibution and Characteristics of the Heart Disease in Pediatric Age Group in Southern Iran", Iranian Cardiovascular Research Journal, 2(1), pp.48-51.
7. Suzanne M (2010), "Mortality Resulting From Congenital Heart Disease Among Children and Adults in the United States, 1999 to 2006", Circulation, Vol.122, pp.2254-2263.
(Ngdynhgn bdi: 13/11/2017-Ngdy duyjt ddng: 04/01/2018)
