2. Phpm Quang Ngpc (1995), " Xdy dyng tieu chuan vdi md xuong ghep ddng loai". Tap chi Ngopi khoa, 25(3), tr 14-21".
3. Nguyin Dire Thing (2004), "Nghien euu dieu trj phiu thudt viem quanh rang bdng ghep bpt xuong ddng loai ddng khd khip khodng", Lupn dn tien sy Y hpe.
Trudng Dpi hpc Y Hd Npi.
4. Bodner L. (1996), "Effect of decalcified freeze- dried bone allograft on the healing of jaw defects after cyst enucleation", J Oral Maxillofac Surg, 54(11), pp.
1282-6.
5. Saad A.Y. and Abdellatief E.M. (1991),
"Healing assessment of osseous defects of periapical lesions associated with failed endodontically treated teeth with use of freeze-dried bone allograft". Oral Surg Oral Med Oral Pathol, 71(5), pp. 612-7.
6. Yoshiura K., Weber A.L., Runnels S. , et al.
(2003), "Cystic lesions of the mandible and maxilla", Neuroimaging Clin N Am, 13(3), pp. 485-94.
7. Zhe C. and Tingchun W. (1982),
"Reconstruction of mandibular defects with composite autologous iliac bone and freeze-treated allogeneic rib grafts", J Oral Maxillofac Surg, 40(1), pp. 29-33.
THEO DO! TIEN TRIEN CAN THI Of HOC SINH PHO THONG SAU BA NAM DEO KJNH
TRAN MINH DAT, HA HUY TAI - Benh vien Mit TW HUYNH BA HUY - ECF
TOMTAT
Mgc tieu: Dinh gii mirc dg tiin triin can thj d hgc sinh pho thdng (HSPT) sau 3 nam deo kinh khim lai t^i BV Mat TW nam 2009. Phwong phap va doi twgng:
Hoi ciru va md ta cit ngang tren 13 HSPT (26 mit). Ket qua: Mirc dg tiin trien c$n thj tmng binh trong 3 nam li 1,98D ± 0,61D. Mirc tang can thi trung binh a nu- la 2,08 D, a nam la 1,67 D. Dg tuoi 12-13 cd mirc tang can thj nhanh nhat (2,35D/3 nam), dg tuii 16-18 cd mirc tang thip nhat (1.52D/3 nam). Nhdm bat diu dee kinh vdi so tir 2D trd xuong cd mirc tang la 1,61D/3 nam va nhdm vdi so tir 2D trd len cd mux: tang la 2,5D/3 nam. Ket luan: Mirc tang can thj trung binh trong 3 nam d HSPT la 1,98D ± 0,61 D. Mirc tang can thj trung binh a nif cao hon nam; Dg tuii 12-13 cd mirc tang can thj cao nhat trong cic nhdm nghien ciru; Nhdm hgc sinh bat diu deo kinh vdi so tir 2D trd xudng cd mirc tang thap han nhdm vdi so tir 2D tro len.
Tir khoa: Can thi, tiin triin egn thi, hgc sinh pho thdng.
SUMMARY
A 3-year longitudinal study of myopia progression in school children examined in National Eye Hospital
Purpose: To evaluate the progression of myopia in school children wearing glasses more than 3 years examined in National Eye Hospital in the year 2009.
Methods and objectives: Retrospective and cross sectional descriptive study on 13 myopic children (26 eyes). Results: The average myopic progression rate of 3 year was 1.98D ± 0.61D; The myopic increase in female was 2.08 D and in male: 1.67D. Myopic progression rate in children group aged of 12-13 was fastest: 2.35D/3 years; Progression rate of group wearing glasses at beginning with pQv!er more than 2 D was 2,5D/3 years and with power < 2D was 1.61D/3 years. Conclusions: The mean rate of myopic progression in weared glasses children/ 3 year was
1.98D. The'.myopic increase rate in female higher than male. Myopic progression rate in children group aged of
12-13 year old is fastest in 5 studied age groups;
Children in group wearing glasses with more than 2 D at beginning have progression rate higher than group
wearing glasses with power < 2 D at the begining Key words: Myopia, myopic progression, school children.
DATVANOe
Ty Ip tre em bj epn ngdy cdng tdng cao Id mpt van de sipc khoe cd y nghTa xa hpi. Mpt khde miPC tien trien cua cpn thj hdng ndm d tre em da dupc deo kinh cQng dupc rat nhiiu ngudi quan tdm ca trong ngdnh nhdn khoa va ca trong nhdn ddn vi nd lien quan tdi nhieu yeu td nguy CO trong sinh hopt vd hpe tpp cua tre em, lien quan tdi ede bipn phdp nham han ehi tde dp tang can thj vd la noi lo lang nhiiu khi thdi qud eua cdc bpc phg huynh. 0 Vipt Nam, tu trudc tdi nay da cd khd nhiiu nghien CLPU v i ty Ip mac tdt khue xp d tre em, nhat Id cpn thj nhu'ng cd rat it nghien cuu theo ddi vd ddnh gid ve miPC dp tien then cua cpn thj hdng ndm cung nhu cdc giai doan trong thdi ky hpe sinh phd thdng vd ede nghien ciru tim hieu v i cdc yeu td lien quan tdi tiin trien cpn thj. Trong khi tren t h i gidi cd khd nhiiu tdi lieu d i cap tdi ede van de dd. Chung tdi tien hdnh nghien euu ndy tpi Phdng kham Bpnh vipn mat TW ndm 2009 nhdm ddnh gid sy tien triin cpn thj d hpc sinh phd thdng da deo kinh qua thdi gian theo ddi tu 1 nam din 3 nam, qua dd tim hiiu mpt sd yiu td lien quan tdi tiin triin eua epn thj. Trong khudn khd bdi bdo ndy, chi xin gidi thipu kit qua ddnh gid tiin triin can thj d nhQ'ng HSPT da dupe deo kinh sau 3 ndm theo ddi.
0 6 l TU'O'NG VA PHU'ONG PHAP NGHIEN Cl>U 1. Doi tudng nghien ciiru
Hpc sinh trong dp tudi 6-18 dupc chan dodn Id can thj vd da deo kinh vdi thdi gian khoang 3 ndm (trong tdng sd 150 hpe sinh dd deo kinh tren 1 ndm) den khdm lai tai BV mat TW tu thdng 6/2009, vdi cdc dieu kipn:
benh nhdn (BN) cd sd khdm bpnh cu dupc ghi chep rd rdng v i kit qua kham, thu' kinh vd do khue xp cua cdc lan khdm trude day 1 ndm vd 2 nam. Cf cdc lan khdm :
trudc, thj lye vdi kinh deo phai dpt 10/10. | 2. PhUdng phap nghien curu j - Thiit ke nghien euu: Phuong phdp hdi euu vd md j
ta eat ngang. = - Miu nghien cipu: 13 hpc sinh (Vdi 26 mat) dd dwgc
deo kinh trong khpang 3 nam. (Trong co miu ehung Id 150 hpe sinh dd dupc deo kinh )
78 Y HOC THl/C HANH (727) - SO 7/2010
3. Npi dung va each thiPC nghien ciPU 3.1. Kham xet benh nhan
- Hdi bpnh: Tien sir ban thdn vd gia dinh lien quan tdi can thi.
- Thu thdp dQ' lipu tif sd khdm benh eu: thdi gian khdm, kit qua do khue xg (KX), thj lye, sd kinh deo cua mdi lan khdm
-Do khue xa: bang khue xp ke ty dpng vd soi bdng dong tii' sau rd thudc lipt dieu tiet nhanh (Cyclogyl)
- Thip thj lye khdng kinh vd thj lye vdi kinh dang deo, neu khdng dpt 10/10 thi chinh Ipi sd kinh theo kit qua khiie xp mdi do de dat dupe thj tyc 10/10.
- Khdm bdn phan trudc vd soi ddy mdt BN. Xdc djnh bpnh mat khde kem theo.
3.2. Tieu chuin phan loai
- Cach tinh dp khiie xa: Dp KX cau tuong duong (SE)=ppcau + 1/2dptry
- v i miPC dp can thj: Cpn nhp: <3 D; Trung binh: 3-6 D; Ngng: >6 D.
- Nhdm tudi:Tpi thdi diim nghien cuu vd tudi BN bat dau deo kmh: Chia thdnh 5 nhdm : 6-9 tudi; 10-11; 12- 13; 14-15 vd 16-18 tudi.
3.3. Tieu chuin danh gia
- Chia nhdm ddnh gid tien triin can thj: Dya vdo thdi gian dd deo kinh chia BN thdnh nhdm dd deo kinh 1 ndm, 2 ndm vd nhdm da deo kinh 3 ndm.
- Ddnh gid egn thj: BN dupe ehan dodn Id egn thj neu deo kinh tu - 0,5D trd len, tinh gid trj eua egn thj theo don vj tung 0,5 D. Dya theo miPC dp can thj ban dau de ehia thdnh 2 nhdm ddnh gid tiin trien: Nhdm can thj ban dau < 2 D vd nhdm can thj ban dau >2D.
- Ddnh gia miPC dp tiin triin cua can thj: Dya vdo sd kinh cho thj lye tdt nhat (10/10) qua cdc lan khdm, mirc dp tien triin cua egn thj dupc xdc djnh Id: TT = SKi - SKo Trong dd TT Id miPC dp tien triin can thj, SKo Id sd kinh ban ddu eua BN. SKi Id sd kinh mdi chinh tgi thdi diem nghien euu.
Niu TT < 0,5D/ndm Id tien triin chgm, TT: 0,5- ID/
nam Id tiin triin trung binh vd TT >1D/nam Id tiin triin nhanh
3.4. SLP ly S6 lieu
So lipu dupe nhgp vd SLP ly theo cdc phan mim Epilnfo, SPSS vdi cdc thugt todn thdng ke. Excel.
KtT QUA NGHIEN CLPU VA B A N L U A N 1. Mptsd dae diem chung cua benh nhan
- Gidi tinh: Trong miu nghien cifu ehung vdi tdng sd 150 BN, nQ' chiem 60%, nem chiem 40%. Trong dd sd hpc sinh da deo kinh tren 3 ndm Id 17%.
- Tudi: Tudi trung binh eug BN trong'nhdm nghien CLPU Id 12,8 ± 2,2 tudi, thep nhat Id 7 tudi, cao nhat Id 17 tudi.
Nhdm tudi chiim ti trong cao nhat Id 12-15 tudi (65,3%), tiip dinid nhdm tudi 10-11 (18,7%), it nhat Id 2 nhdm tudi 6-9 tudi vd 16-18 tudi (8%)
- Phdn bd theo dja ly: hpc sinh sdng d thdnh phd chiim 61,3%, ndng thdn: 38,7%. Hpc sinh_sdng d Hd Npi Id 64%, cdn 36% din tif cdc tinh khde. ,
2. Danh gia t i i n trien can thj trong 3 nam 2.1. Tiin triin can thj chung
Trong sd m ^ ehung Id 150 hpe sinh dupe nghien CLPU chi cd 13 hpe sinh (26 mat) cd thdi gian deo kinh >
3 ndm. Khdng cd hpe sinh ndo khdng tdng sd kinh, 100% hpc sinh deu tang dp can vdi muc trung binh tich
luy trong 3 ndm Id 1,98D ± 0,61 D. Kit qua ndy eung tuong Lfng vdi muc tang can thj trung binh sau 1 ndm deo kinh trong nghien euu ndy Id: 0;60 ± 0,507. Kit qua cua ehung tdi thap hon so vdi nghien cuu eua Saw S.M vd Tong L.voi mue tien triin trung binh trong 3 ndm d tre tu 7-9 tudi Id 2,1 ID, ed t h i Id do dp tudi trung binh trong nhdm nghien CLPU cua chung tdi eao hon (tu 6-13 tudi).
2.2. Tiin trien can thi theo gid'i Bang 1. Tiin triin can thj theo gidi
TientrietTlD)—-—_____
Tien then trung binh 1 nSm Tiin trien trung binh 2 nam Tien triin trung binh 3 ndm Tien trien trung binh /ndm
Nam 0,54 1,21 1,67 0,57
NCP 0,68 1,5 2,08 0,71 Tiin triin egn thj trung binh 1 ndm, 2 ndm, 3 nam d nu' diu cao hon d nam cd y nghTa thdng ke vdi p<0,05.
Tiin triin trung binh hdng nam d nQ' Id 0,71 D/ndm, d nam Id 0,57D/ndm, so kit qua nghien ciru eua ehung tdi vdi eua Saw S.M vdi mue tiin triin trung binh d nu' Id 0,66D/nam vd d nam Id 0,56D/ndm thi tien then d nam bang nhau edn tiin trien d nu' eao hon khdng nhiiu (chenh nhau 0,05D).
Nghien cipu eua Fan D.S hay cua Lam CS vd Edwards M cung kit ludn tiin triin d nu' nhanh hon d nam. Cd t h i giai thich Id nhin chung ede hpe sinh nu' cham hpe vd thich dpc sdeh hon Id choi the thao hay hogt dpng ngodi trdi hon cdc em nem. Cdc em nQ' cQng day thi sdm hon so vdi nam nen tdng trudng eo the cQng nhanh hon so vdi cung dp tudi, dieu ndy ddn den tiin triin egn thj cung se nhanh hon.
2.3. Tiln trien can thi theo dp tudi
Ddnh gid tiin triin can thj trong 3 ndm theo dp tudi, bang 3.2 cho thay muc dp tiin trien edn thj trung binh trong 3 ndm nhgnh nhat Id d dp tudi tu 10-13 tudi, ehdm nhat Id 16-18 tudi, tuong ty nhu tiin triin can thj trong 2 ndm vd 1 nam.
Bang 2. Tiin triin cdn thj theo dp tudi
^ • ^ - T h i ^ i a n Tuoi~~~-^
6-9 10-11 12-13 14-15 16-18
1 nam 0,57 0,59 0,73 0,56 0,40 - ,
2 ndm 1,16 1,52 1,58 1,17 0,81
3 ndm 1,79 2,19 2,35 1,83 1,52 Nhiiu tde gia eho rang tiin triin egn thj d tre em ed lien qugn mgt thiit den sy phdt triin todn thdn, tudi day thi Id giai dogn co the tdng trirdng nhanh nhat nen tiin thin can thj cung tdng nhanh. Dp tudi tiin triin nhanh nhat trong nhdm nghien euu eua chung tdi Id 10-13 tudi tuong irng vdi tudi day thi d tre em Viet'Nam.
Tiih triin can thj ehdm nhat d.dp 16-18 tudi, dieu ndy phii hpp vdi nhgn -xet eua mdt sd y vdn ciia My: d tudi 15-16 thi sy tien iripn eua egn thj se chgm hoge dung han.
2.4. Tiin trien can thj theo mu'c do can thj liic b i t ddu deo kinh
Bang 3,:Tiin triin can thj theo muc dp can thj lue bat dau deo kinh
Y HOG JHl/C HANH (727) - SO 7/2010 79
-—r__ '^^°^
TientrieiTXD)~-—-____
Tien trien trung binh 1 nam Tien then trung binh 2 nam Tien trien trung binh 3 nam Tien then trung binh /nam
<2D 0,52 1,22 1,61 0,56
>2D 0,69 1,71 2,50 0,82 Tat ca 3 doi tupng deo kinh dwgc ddnh gid sau 1 ndm, 2 ndm vd 3 ndm cd ehung mpt quy luat Id d nhdm hpe sinh cd sd kinh liie bat dau deo tren 2D thi d i u tdng nhanh hon nhdm ed sd kinh bdt dau deo dudi 2 D. Mue tdng trung binh d nhdm bat ddu deo kinh vdi sd t u 2D trd xudng Id 0,56D/ndm vd nhdm tren 2D Id 0,82D/ndm.
Theo nghien ciru eua Saw S.M, t i i n triin d nhdm cd muc can thj ban dau dudi 2D Id 0,56D/nam vd nhdm t u 2D trd len Id 0,65D/ndm, nhu vdy nghien cuu cua chiing tdi cd nhdm can thj tren 2D t i i n then nhanh hon, cd t h i do ehiing tdi Idy mdc t u tren 2D edn Saw S.M. tinh ca BN t u can 2 D trd len.
Mpt sd tdc gia khde n h u Parssinen 0 , Fan C S hay Lam C.S cung ed nhdn xet Id mue dp can thj ban dau cdng cao thi t i i n then can thj edng nhanh.
Theo cua chung tdi thi nhdm ddi tupng xuat hipn can thj (bat dau deo kinh) tru'dc 10 cd tudi ed mue t i i n triin can thj nhanh hon vdi s y khde biet cd y nghTa thdng ke vdi nhdm tre xuat hien can thj sau 10 tudi, tuong t y k i t qua nghien cuu ciia Saw S.M.
K i t qua nghien ciru d bang 3.4. eho thay t i i n triin can thj nhanh nhat Id d nhdm 6-9 tudi (2,16D), khde biet cd y nghTa thdng ke so vdi 2 nhdm khde tren 10 tudi (1,89 vd 1,85D eho moi nhdm). Muc ndy ed chenh lech ddng k i so vdi sd lieu nghien cuu cua Kartz J Id 1,28D, cua Leung Id 1,23D hay cua Yang Id 1,5D.
Bang 4. Tien triin can thj theo tudi bat dau deo kinh
6-9
10-11 12-13
Trung binh
2,16
1,89 1,85
SD 0,633
0,640 0,603
Thap nhat
1,25 1,75
1,25
Cao nhat 2,75 3,5
KET LUAN
- Mire dp t i i n triin can thj trung binh trong 3 ndm Id 1,98D±0,61D.
- MLPC tang egn thj trung binh trong 3 ndm d nO' ego hon nam (2,08 D so vdi 1,67 D)
- Nhdm bat dau deo kinh d dp 6-9 tudi ed t i i n trien egn thj nhanh nhat (2,16D/ 3 nam), chgm nhdt la nhdm tren 12 tudi (1,85D)
- Muc dp egn thj lue bat dau deo kinh cdng eao thi t i i n trien egn thj edng nhanh. Nhdm bdt dau deo kinh vdi sd t u 2D trd xudng cd muc tdng Id 1,61D/3 ndm va nhdm vdi sd t u 2D trd len cd mue tang Id 2,5D/3 ndm.
- Trong 5 nhdm tudi dupe nghien euu thi nhdm 12- 13 tuoi ed miPC tien then cdn thj cao nhat trong 3 nam (2,35D/3 ndm), sau dd tdi nhdm 10-11 tudi (2,190/3 nam). Cham nhat Id nhdm 16-18 tudi (1,52D/3ndm)
TAI LIEU THAM KHAO
1. Fan D. S, et al. (2004) "Prevalence, incidence, and progression of myopia of school children in Hong Kong". Invest Ophthalmol Vis Sci. 45(4)
2. Goss D. A (1994) "Effect of spectacle correction on the progression of myopia in children-a literature review". J Am Optom Assoc. 65(2): tr. 117-28.
3. Goss D. A and Rainey B. B (1998) "Relation of childhood myopia progression rates to time of year". J Am Optom Assoc. 69(4): tr. 262-6.
4. Goss D. A (1990) "Variables related to the rate of childhood myopia progression". Optom Vis Sci. 67(8).
5. Hyman L, et al. (2005) "Relationship of age, sex, and ethnicity with myopia progression and axial elongation in the correction of myopia evaluation trial".
Arch Ophthalmol. 123(7): tr. 977-87.
6. Jensen H (1995) "Myopia in teenagers. An eight- year follow-up study on myopia progression and risk factors". Acta Ophthalmol Scand. 73(5).
7. Lin L.L (2001) "Epidemiologic study of the prevalence and severity of myopia among school children in Taiwan in 2000". J Formes Med Assoc. 100.
8. Mantyjarvi M. (1985) "Predicting of myopia progression in school children". J Pediatr Ophthalmol Srrad/smus. 22(2): tr. 71-5.
9. Ong E , et al. (1999) "Effects of spectacle intervention on the progression of myopia in children".
Optom Vis Sci. 76(6): tr. 363-9.
10. Parssinen O and Lyyra A. L (1993) "Myopia and myopic progression among schoolchildren: a three- year follow-up study". Invest Ophthalmol Vis Sci. 34(9):
tr. 2794-802.
NHAN XET KET QUA DlTflTC DAU TRONG DIEU TRj UNG THlT MO DEM
D I A N GTIEU
HDAGIAI DOAN MUON
D A N GGLIVEC (IMATINID) TAI DENH VIEN K
TOM T A T
Nghien ewu nay dwgc thuc hien tai Benh vien K tir thing 2/2007 din thing 3/2010, vdi 35 benh nhan u md dem dwong tieu hda (GIST) ac tinh giai doan mugn, dwgc diing Glivec hang ngiy vdi liiu 400mg, cho kit qua nhw sau:
- Ti Ig dip img hoan tgan li 2,9%,; dip ung 1 phin li 62,7%o; benh giir nguyen la 28,6%o; tiin triin li 2,9%,;
DO HUNG KIEN, N G U Y E N T U Y E T MAI, N G U Y I N THj THANH T H O Y va CS
Khoa Ngi I, Benh vien K.
mgt bgnh nhan dimg diiu tri (2,9%,).
- Khdng cd benh nhin nao tir vong trong diiu trj.
Phan Idn cic benh nhan dung nap thudc tot, ch! cd 2 trwdng hgp phai giam liiu 300 mg/ngay, 1 tnrdng hgp phai giam liiu 200mg/ngay do ha bach cau, mgt mdi. !
- Cac tic dung phu diu xiy ra a mirc di? /, // khdng phai can thiep dae biet
Tw khda: u md dgm dwang tieu hda, ic tinh, Glivec
80 Y HOC THl/C HANH (727) - SO 7/2010
