TAP CHl Y DUOC L A M S A N G 108 Tgp 6 - SO 5/2011
Bu'O'c dau tim hieu nhirng nguyen nhan va yeu to gay xuat hien con kho tho* dau tien tren ngu'ol benh hen phe quan
The Initial Step to Identify Reasons and Factors which Create the First Breathlessness on Asthma Patients
Trinh IVIanh Hung Benh vien Him Nghi Hd Noi
Tom tat
De tim hieu nhUng nguyen nhan va yeu to lam xuat hien con kho thd dau tien tren ngudi benh HPQ, qua nghien cUu chung toi nhan thay: nhUng nguyen nhan va yeu to mang tinh chat viem nhiem chiem ty le cao nhl't (36,36%), dien hinh la sau khi bj viem mui xoang dj Ung cd 23,43% so ngUdi benh se xuat hien con khd t h d dau tien cua HPQ. Sau do la nhQng yeu to mang tinh dj nguyen chiem ty le la 34,61%, hay gap nhat la nguon dj nguyen bui, bp nha chiem ty le 18,88%. Viec phong tranh va dieu trj dUt diem cac benh viem nhiem dudng ho hap, cung nhU tranh tiep xuc vdi nhUng yeu to mang ti'nh dj nguyen (bui, bp nha...), chat khi' thcii (khoi than, xang dau...), khong sU dung thuoc va hoa chat bUa bai...la gop phan lam giam nguy co xuat hien con khd t h d dau tien, cung nhu nhUng cdn khd t h d sau nay tren ngudi benh hen phe quan.
TU khda: hen phe quan, nguyen nhan va yeu td S u m m a r y
To identify the factors and reasons which create the first breathlessness on asthma patients, studying showed that the reasons and factors of infection element have the highest percentage (36.36%); typically, suffering allergy sinusitis rhinitis, 24.43% of the patients will have the first breathlessness of asthma. Next are allergens factors (34.61%), the most are house dust and mite (18.88%). The prevention and treatment of the airway infection and avoiding the contact with the allergen factors (house dust and mite...), waste gas (coal, gasoline and petrol...), without using a lot of medicine, chemicals..., contribute to reducing the risk of occurring the first breathlessness and later as well of the asthma patients.
Keywords: asthma, the reasons and factors
T. D a t van d e
Benh hen phe quan ed the do nhieu nguyen nhan va yeu t d k h i c nhau gay nen. Trong sd nhUng nguyen n h i n va yeu t d quan t r g n g dugc nhieu t i e g i l quan t a m va lUu y, d d la nan d nhiem m d i trUdng sdng: bui dUdng p h d , bui nha, khdi (than, thudc la, hUdng...), chat thai, dieu kien khi hau khac nghiet, sU d u n g thudc va hda chat bUa bai, eude sdng khan
Phan bien khoa hoc: PGS. TS. NGUYEN OlNH TifN
trUdng c i n g t h i n g (nhieu stress)... Chinh nhUng nguyen n h i n va yeu t d tren, da la nhUng dieu kien de xuat hien cdn hen dau tien, lam tang ty le c l e benh nhiem khul'n va dj Ung d u d n g hd hap, dien hinh la viem phe q u i n , viem mui hgng cap va man, viem mui dj Ung, hen phe q u i n (HPQ). Do v l y , viee x l e djnh chinh xac nhUng nguyen n h i n va yeu t d gay benh se g i u p cho q u i trinh p h d n g benh, ehl'n doan va dieu trj dat hieu q u i cao hdn.
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Ngudi ta nhan thi'y d mdt sd nUde ed khi hau khic nghiet (ed sU thay ddi rd ret ve nhiet dp, do am, ap suit... trong tUng ngay, theo tUng mua khic nhau), d i e biet I I d nhUng nude chju I n h hudng cua gid mua, gan bien... thi ty le HPQ rl't eao. Thdng ke eua nhieu t i e g i l eho thi'y d nhUng nUde n i m gan bien va cd dieu kien khi hau khic nghiet, ty le HPQ d khu vUc, nude dd thudng t i n g eao. Vi du d mdt sd noi n h u : New Zeland: 19% d i n sd bj HPQ, Tristan da eunha: ty le HPQ 11%, Maldives: 28% d i n sd bj HPQ.
N i m 1993, G. Dutau v l J. Just [8] nghien eUu tren 200 dUa tr^ bj HPQ da nhan tha'y cd rat nhieu nguyen n h i n v l yeu td thuan Igi ed the l l m khdi p h i t con khd thd dau tien, dUng dau I I nhdm viem phe q u i n (viem tieu phe q u i n t i i phit), tiep theo hay gap II nhUng tr^ hay ed trieu ehUng trao nguge thuc q u i n , ngoai ra cdn cd the la elc nguyen nhan va yeu td thuan Igi khIe nhU: cle benh viem mui xoang, hit khdi thudc II thudng xuyen mdt elch thu ddng, ed sU bat thudng ve he thdng mien djch the djch (IgE t i n g , thieu hut IgG va IgA), v.v...
Viec n g i n ngUa elc nguyen n h i n va yeu td nhiem khuan, dj Ung dudng hd hap, khdng sU dung thude, hoa chat mdt each bUa bai, ve sinh mdi trudng sdng, khdng hut thudc... cd the gdp phan l l m g i i m sU xuat hien v l phat trien cua benh HPQ.
Chinh vi nhUng ly do tren, chung tdi thUe hien de tai nay n h i m muc tieu sau:
Tim hieu nhUng nguyen nhan, yeu td lam xua't hien can khd thd dau tien d nhUng ngUdi benh hen phe q u i n , de tU dd ehung ta ed bien phap phdng ngUa n h i m g i i m bdt sU xuat hien cdn khd thd dau tien, cung nhu sau n i y d ngudi benh HPQ.
2. Doi ti/gng va phUorng p h i p nghien ciiru 2.1. Doi tUOng nghiin cdu
Bao gdm 406 ngUdi benh dugc ehl'n doan xac djnh la HPQ, dua vao 4 tieu chui'n cua Bd mdn Dj Ung va Khoa Dj ijfng MDLS Benh vien Bach IVlai, dugc tham hdi mdt each chi tiet, dugc hudng dan thuc hien theo mau khai thac tien sCf dj Ung (mau
23b Bd mdn Dj Ung v l Khoa Dj Ung IVIDLS Benh Vi^n Bach IVlai).
2.2. Phuong phip nghiin cdu: tien cdu, mo ti Khai t h i e tien sCf dj Ung theo mau 23b nhim x l e djnh ngUdi benh ed lien quan den nhiJng nguyen n h i n , yeu td l l m xuat hien can kho tiid dau tien.
- Cle sd lieu dugc y.KS ly theo thuat toan thong ke y hge.
3. Ket q u i nghien cuTu
3.1. Tuoi xuat hiin cOn kho th& dau tiin Qua khai thIe tien sU dj Ung (TSDLO cl nhan, con khd thd dau tien hay xuat hien vao lUa tuoi nao, tren tdng sd 406 ngUdi benh HPQ cho ket qui:
Bing 1 . LUa tudi xuat hien can khd thd lan dau STT
1 2 3 4 5
Tuoi xuat hien con hen lan dau
<15 1 5 - < 2 5 2 5 - < 3 5 35 - <45 4 5 - < 5 5 Tong so
n
178 106 82 30 10 406
Tyle%
43,84 26,10 20,19 7,34 2,46 100 Cd 69,94% sd ngUdi benh HPQ, con kho thd dau tien x u l t hien < 25 tuoi. Oac biet d nhdm tuoi
< 15, ed 23 dUa tr^ ed can khd thd dau tien khi < 6 tudi. ft gap ngudi benh cdn khd thd dau tien xuat hien tU45 tudi trd len (2,46%).
3.2. NhCifng nguyin nhin va yeu to sau gay xui't hiin con kho th&dau tiin
Cd 120/406 (29,56%) sd ngudi benh khdng xac djnh rd, chi cd 286/406 (70,44%) la xle djnh ro nhUng nguyen nhan va yeu td lam xuat hien cdn khd thd dau tien, dUa vao nhUng nguyen nhan va yeu td hay gap, chung tdi tU chia lam 3 nhdm cu the nhusau:
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TAP CHi Y DUOC LAM S A N G 108 Tap 6 - S O 5/2011
3.2.7. NhUng nguyin nhdn, yeu td mang tinh viim nhiem:
Bing 2. Nguyen nhin va yeu td mang tinh viem nhiem
2.3- NhUng nguyin nhdn, yeu td hay gap khdc Bing 4. NhUng nguyen nhin, yeu td hay gap khIe
STT 1 2
3
4
Nguyen nhan va yeu to Viem mui xoang dj Ung Viem dudng ho hap tren (amidan, hong, xoang...) Viem dudng ho hap dudi (viem phe quan, viem phoi...)
Do virus (sau khi m i c mgt so benh do virus) Tong so
n 67 24
9
4 104/
286
Ty le % 23,43
8,39
3,14
1,40
36,36
STT 1 2 3
4
Nguyen nhan va yeu to Khi t h i i (khdi than, xang dau, huong...) Do nghe nghiep Yeu to thdi tiet (gio mua, dp am, nhiet dp...) Bui cong nghiep (sgi.
len, hoa chat, bui than...
)
Tong so
n 27 22 19
15
8 3 / 2 8 6
Ty le % 9,44 7,69 6,64
5,24
29,02
Trong nhUng nguyen nhan, yeu td lam xult hien con khd thd dau tien d ngudi benh HPQ, thi yeu td mang tinh viem nhiem chiem ty le eao nhl't II 36,36% so vdi elc yeu td khic, eu the: sau viem mOi xoang dj Ung 23,43%, sau dd II viem dUdng hd hap tren 8,39%...
3.2.2. NhUng nguyin nhdn vd yeu td mang tinh di nguyin (DN)
NhUng nguyen nhin, yeu td hay gap khic lam x u l t hien con khd thd dau tien ehiem ty le II:
29,02%, eu the: sau khi hit phii khi t h i i : 9,44%, do nghe nghiep: 7,69%...
3. Anh \\\i&x\q yeu to mua/nam vdi siT xuat hien con kho thor or ngUcri HPQ
Bing 5. Anh hUdng yeu td mua/nim
B i n g 3. Nguyen n h i n va yeu t d
STT 1 2
3
4
5
Nguyen nhan, yeu to DN la bui nha, bg nha DN la long sue vat (cho, meo, long vij...) DN la thUc an
(tom, cua, sUa...) DN la thuoc
( k h i n g sinh, g i i m dau...) DN la phan hoa
Tong so
mang tinh DN:
n 54 18
15
9
3 9 9 / 2 8 6
Ty le % 18,88
6,29
5,24
3,14
1,05 34,61
MCia
Dong Xuan Ha Thu
Co lien quan Khong lien quan Tong so
HPQ nhom 1 n
23 15 6 9 53 26 79
% 29,11 18,99 7,59 11,39 67,09 32,91 100
HPQ nhom II n
57 28 17 13 115
9 124
% 45,97 22,58 13,71 10,48 92,74 7,26
100
NhUng nguyen nhan va yeu td mang tinh dj nguyen chiem ty le la 34,61%, hay gap la: bui nha, bg nha: 18,88%, Idng sue vat: 6,29%...
Ta ed the nhan thay mua Ddng Xuan la hai mua ma cae trieu ehUng l l m sing eua HPQ hay xuat hien nhieu nhat.
4. Ban luan
1- De tim hieu nhUng nguyen nhin, yeu td l l m xuat hien edn khd thd dau tien tren ngUdi benh HPQ, qua vieq t h i m hdi mdt elch chi tiet va thUe
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hien theo mau khai thac tien sCr dj Ung, chung tdi nhan thi'y: nhUng nguyen n h i n v l yeu td mang tinh chat viem nhiem chiem ty le cao n h l t (36,36%), dien hinh la sau khi bj viem mui xoang dj Ung cd 23,43% sd ngudi benh se x u l t hien can khd t h d dau tien eua HPQ. Sau dd I I nhUng yeu td mang tinh dj nguyen ehiem ty le I I 34,61%, hay gap nhat I I ngudn di nguyen bui, bg n h i ehiem ty le 18,88%. Viee phdng t r l n h v l dieu trj dUt diem cle benh viem nhiem dudng hd hap, cung n h u t r l n h tiep xue vdi nhUng yeu td mang tinh dj nguyen (bui, bg n h i . . . ) , chat khi t h i i (khdi than, x I n g dau...), khdng sU dung thudc v l hda chat bUa b l i . . . I I gdp phan l l m g i i m nguy co xuat hien con khd t h d dau tien, cung n h u nhUng eon khd t h d sau n i y tren ngudi benh hen phe q u i n .
6 Viet Nam, do dieu kien khic nghiet cua khi h l u nhiet ddi gid mua, gan bien, do am eao... do dd, viec nghien eUu mdi lien quan giUa eae mua/nam vdi sU x u l t hien can khd t h d tren nhdm benh HPQ cd vai trd quan trgng trong viec q u i n ly, phdng v l dieu trj benh mdt elch ed hieu q u i ban.
5. Ket luan
Qua nghien eUu nhUng nguyen nhin, yeu td lam xuat hien con khd thd dau tien tren ngudi benh HPQ, chung tdi nhan thay: nhUng nguyen n h i n v l yeu td mang tinh viem nhiem chiem ty le eao nhat (36,36%), dien hinh I I sau khi bj viem mui xoang dj Ung ed 23,43% sd ngudi benh se xuat hien con khd t h d dau tien eua HPQ. Sau dd la nhUng yeu td mang tinh dj nguyen chiem ty le la 34,61%, hay gap nhat la ngudn dj nguyen bui, bg nha ehiem ty le 18,88%. Ngoai ra, ehung tdi cdn nhan thay nhUng yeu td nhU: khi t h i i
(khdi than, xang dau, hUdng...), thdi tiet (gio mua, dd am, nhiet dp...), bui cdng nghiep (sgi, len, hoa chat, bui than...) cung la nhUng yeu to quan t r g n g lam xuat hien cdn khd thd dau tien tren ngudi benh HPQ.
Tai lieu tham khio
1. Nguyen Nang An, Phan Quang Doan, Le Hong Van va cong sU. Ty li binh dj Ung vd cdc chi tiiu chdc nang phoi ciia hgc sinh mdt s6 trudng pho thdng d ngi thanh Hd Ndi Cong trinh nghien cUu khoa hpc - B.V Bacfi Mai, 1995-1996,203-210.
2. Dao Van Chinh. Binh hen phi qudn. Bach khoa thii b^nh hgc, tap 1,1991,169-173.
3. M.L Burn, F.C. Miskelly. Enviromental factors and symptoms in infant at high risk of allergyj - Epidemiol- Community - Health 6 -1989,43(2), 125 -132
4. R.J. Davies Impact of the environment on allergy patients. Systemic and Topical Treatment a dual approach to allergy patients. Bartok Room, Convention Centre, Budapet, Hungari, 6 -1996,4- 7 5. D. Gustafsson, K. Andersson, I. Fagerlund, et al...;
Significance of indoor environment for tiie development of allergic symptoms in children followed up to 18 months of age. Allergy -1996, 51 (11), 789-795.
6. N. Koya, Suzuki, M. Hara. The investigation of asthmatic children by multiple factor analysis. Tiie influence of 17 allergic factors on atopic dermatitis and allergic rhinitis in asthmatic children. Arerugi, 11 -1989,38(11), 1255-1267.
7. H.V. Loveren, R. Sram, C. Nolan Environment and immunity. Air pollution epidemiology reports series Report number 11 Proceeding of a workshop help in Brussels 5-1996, 7-16.
8. G. Dutau, J. Just Asthme du nourrisson et de I'enfant. Division Sandoz Pharma, 1993,5-50.
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