mpt sd axit beo bao hda: lauric (r = 0,34), mynstic (r = 0,45), palmitic (r = 0,30) va cung cd tuong quan thudn vdi axit eicosapentaenoic (r =0,56); vdi cde axit beo khac thi chUa thay ed tuong quan ro ret, ed thd do sd lUdng mdu nghien cifu cdn nhd. Ham lupng triglycerid cd tuong quan thuan vdi hdm luong axit palmitic {r = 0,41) va stearic (r = 0,50). Jp le axit beo bdo hda eao trong mau dupe xem Id khdng tdt bdi nd lam tdng ludng LDL-cholesterol trong mau va Idm giam hap thu LDL- cholesterol d gan, luong LDL du thira trong mdu se bam vao thdnh mach vd dim tdi hinh thdnh cae mang xdviJTaddng maeh.
K^T LUAN
Bang sac ky khi khoi phd da xac dmh dupc 17 axit beo tif do trong huyet tuOng benh nhdri dai thdo dudng typ 2 vd ngudi binh thudng, vdi tdng ham luong Idn luPt Id 235,2 ± 51,1 va 197,6 ± 40,3 mg/l, trong dd cae axi'f palmitic, stearic, oleic, linoleic, myristic vd lauric chiem tren 96% tdng lupng axit beo tif do d ca hai nhdm,
Benh nhan dai thdo duPng typ 2 cd hdm luong cdc axit beo bao hda (82,5%) trong huyet tuong cao hon so vdi ngudi binh thudng (76,5% ); tdng lupng axit beo khong bao hda (17,5%) thap hdn so vdi ngUdi binh ttiUdng (31,7%). T^ le stearie/palmitic trong huyet d nhdm benh nhan dai thao dudng typ 2 (0,54) cao hdn d ngudi binh thudng (0,44),
Ham lupng mpt sd axit beo tiT do trong huyet tuOng benh nhan dai thao duPng typ 2 cd tuong quan thuan vLte phai vdi ham luOng tnglycerid va cholesterol,
TAI LIEU THAM KHAO
1, Bergman R N., & Ader M. (2000), Free fatty acids and pathogenesis of type 2 diabetes mellitus. Trends in Endocrinology and Metabolism. 11 351-356.
2. Geleijnse J. M,, Giltay E, J,, Grobbee D. E,, Donders A. R. T,, & Kok F. J. (2002), Blood pressure response to fish oil supplementation: Metaregression analysis of randomized trials. Journal of Hypertension, 20:
1493-1499.
3. Helms B, & van Meer G. (2006), Lipidome and disease. FEES Letters, 580 5429
4. Lapolla A., Sartore G,, della Rovere G. R., et al, (2006), Plasma fatty acids and lipoproteins in type 2 diabetic patients. Diabetes- Metabolism Research and Reviews, 22: 226-231.
5 Lee T. H., Hoover R. L., Williams J. D., et al, (1985), Effect of dietary enrichment with eicosapentaenoic and doeosahexaenoie acids on in vitro neutrophil and monocyte leukotriene generation and neutrophil function New England Journal of Medicine, 312, 1217-1224,
6, Ivlalsuzaka T,, Shimano H., Yahagi N., et al, (2002), Cloning an characterization of a mammalian fatty acyl- CoA elongase as lipogenic enzyme regulated by SREBPs. Journal of Lipid Research, 43' 911-920.
7 Matsuzaka T„ Shimano, H., Yahagi N., et al, (2007), Cmcial role of a long-chain falty axit elongase, Elovie, in obesity-induced insulin resistance. Nature Medicine, 13: 1193-1202
8 Mjos S. A., & Grahl-Nielsen O, (2006), Prediction of gas chromatographic retention of polyunsaturated fatty axit melhyl esters. Journal of Chromatography A, 1110 171-180.
9. Moon Y. A„ Shah N, A., Mohapatra S., Wamngton J. A., & Horton J, D. (2001), Identification of a mammalian long chain fatty acyl elongase regulated by sterol regulatory element-binding proteins. Journal of Biological Chemistry, 276, 45358-45366.
10 Slumvoll M„ Goldstein B. J , & van Haeften T. W.
(2005), Type 2diabetes' Principles of pathogenesis and therapy. The Lancet, 365: 1333-1346
TRIEU CHUfNG LAM SANG CUA TRE B| TIEU DAM TIEN PHAT TAI KHOA KHAM BENH - BENH VIEN NHI TRUNG U0NG
TOM TAT
Muc tieu: md ti ddc diim iam sang eda tri bi tiiu dim tien phat
Dii tuang va phuang phip nghidn cinj: Nghien cdu md ta tit ca eae tre dugc chin dodn tiiu dim tidn phat Irdn 5 tuii din khim tai khoa Kham benh- Benh vien Nhi Tmng uang trong vdng 6 thang (tU thing 08/2012 din thang 02/2013).
Kit qui: tudi tiiu dim tmng binh la 6.71 ± 1 45 tuoi. Tpid nam/nd= 4.8/1. 40%, tre bitiiu dim 4-6 lin irong mdt tuin. Tmng binh sd dem tiiu dam trong tuin d nhdm tri ed uong nude dem (4.8 ± 1.86 dem) cao hdn nhdm tre khdng udng nddc ddm (3.3 ± 1.23 dem).
Thing binh sd ddm tiiu dim trong tuin d nhdm tre cd iiin s&gia dinh (47 ± 1.98 ddm) eao han hin nhom tre
^iidng cd tiin sdgia dinh (3.4 ± 0.93 ddm) 42.9%, sd
T R A N H U Y K I N H , N G U Y I N TH! Q U V N H H U ' O N G Bg mdn Nhi, Trudng Dai hgc Y Hd Ngi NGUYiN AN GIANG - Benh vien 4, Qudn Khu IV
tre thi chiu dp luc tdphia gia dinh Tiiu dim inh hudng din giac ngd cue cha me chiim tp Id eao (41.5%,).
Kit luan: Trung binh sd dem tiiu dim trong tuin eao hon hin d nhdm tre cd udng nudc dem va nhdm cd tiin sd gia dinh bi tHu dim 42.9% sd tre chiu ip lue td phia gia dinh nhu bi dinh, ming khi Ire lieu dam. 41.5%, cha me cam thiy bi inh hudng nhieu den giac ngd.
Tdkhda: tiiu dam, tam ly, tao bdn SUMMARY
Objective To descnbe the clinical signs of children with primary enuresis.
Methods The study describes all children diagnosed with primary enuresis of 5-year-old at the Out-Clinie Department of National Hospital of
Y H(3C THUC HANH (879) - sO 9/2013
Paediatrics within 6 months (fmm 08/2012 to January 02/2013).
Results: The average age of the primary enuresis 6.71 ± 1.45 years old Male/female = 4.8/1.40% wem pnmary enumsis (4-6 times per week). The avemge number of enuresis per week is higher in the gmup drinking at night (4 8±1.86 night of enuresis) than infants not drink at night (3.3±1.23 night of enumsis).
The avemge number of enuresis per week is higher In the gmup of childmn with family history of enuresis (4.7
± 1.98 nights of enumsis) is higher than infants without a family history (3.4 ± 0.93 nights of enumsis).
Conclusion: The avemge number of enumsis per week is higher in the gmup drinking at night and in the gmup of childmn with family history of enumsis.
Keywords: enuresis, psychology, constipation DAT VA'N Di
Tieu dam la tinh trang tieu khdng tU ehii trong lue ngu d tre tren 5 tudi, Ody Id roi loan dudng tieu rdt thudng gdp d tre em, d Australian benh chidm 18.9%
tre em d dp tudi tif 5 - 1 2 tudi. Thdng thuPng, tieu dam ehl la mdt tinh trang sinh \y binh thudng trong qua trinh phat tnen ciia tre, chi cd mdt tp le nhd (5- 10%) Id ed rdi loan thuc sucdn dieu tri.
Tieu dam thudng cd anh huong Idn ve mdt tmh than ddi vdi ban thdn tre vd ea cha me, Tre bi benh thudng thieu tutin, xau hd anh hudng tieu cUe tdi viee hoe tap, chat luong cudc sdng va viec giao tiep vdi ban be, gia dinh. Nhieu nghien eiifu da ehl eho thay, anh hudng ve mat tinh than eOa benh cdn quan trpng hon anh hudng ve mat the chat [1, 2]. Hdn nu'a benh cdn anh hudng tdi kinh te cDa cdc gia dinh cd tre bj dai dam, d Chdu Au Udc tinh mpt gia dinh cd con bj dai dam phai tdn them 1000 Dola mdi nam eho nhDng van de lien quan den viec ddi dam eiia tre Tren the gidi, da cd nhieu cdng trinh nghien eifu ve tieu dam d tre em tir do da ed cdc chien lUpc dieu tn dUOc thUe hien, dem lai si/ eai thien dang ke ve tien tnen benh va chat lUOng cudc sd'ng cua ngUdi benh. 6 Viet Nam ehua ed nhieu nghien edu ve cdn benti nay chinh vi vdy md ehiing tdi thuc hien de tdi ndy nham md ta d$e diim lam sang eda tri bi tiiu dam tidn phdt lai khoa Kham bdnh - Bdnh vidn Ntii Tmng Uang.
DOI TUONG VA PHUONG PHAP NGHIAN cOU Td't ea eae tre dUdc chan doan tieu dam tien phat tren 5 tudi den kham tai khoa Kham benh- Benh vidn Nhi Trung LTong trong vdng 6 thang (tirthang 08/2012 den thang 02/2013),
Tieu chuan loai tar tre bi tieu dam thif phat (cd giai doan khdng tieu dam keo dai tren 6 thang), tre cd benh than tidt nieu thuc the, tre ed benh ly tam than kinh, tre cd benh ndi tiet
PhiTdng phap nghien cuu:
Nghien cidi mo ta vdi cd mdu dUdc tinh theo cdng thifc
^ _ , . P ( 1 - P ) Trong dd;
n. sd benh nhdn can nghien eiJfu;
a = 0,05;
Z^.<„^=1,96;
P = 10%;
d: la sai sd khi Udc luong t^ Id.
Thay sd vdo ta cd n= 30
Jxi duPe kham, Idm xet nghiem dd loai tor Ti^u dat hode ed tidu khdng tu ehO hoac tieu n Sd lUdng niidc tieu tinh tren 24 gid > 4 ml/kg/h Cao huydt dp dupe tinh theo bach phdn vi Chdm tdng tn/dngl: chieu cao, can ndng thdp < - 2SD
Chdm phat trien tinh than van ddng.
Co gidt
Oidn giai do mau bat thudng. ure mau duOc lam bang phirdng phap Enzym UV, may Olympus AU.400 tai khoa smh hda
Creatinin mau tdng. Creatinin mdu dupc tien hanh theo phuong phap Jaffa kinetic (khdng khxl tap) tren may HITACHI 717 tai khoa smh hda.
Sieu dm ed di tdt than tiet nieu
Cac thdng so thu thdp gdm tuoi, gidi, sd lupng nudc udng 24 gid, sd lUdng nudc tieu 24 gid, so lan tieu dam ban dem, tao bdn, tien sCf gia dinh cd ngudi bi tieu dam. Lo lang CLia tre. nguOng ngiing, sp hai, chan chudng khi bi tieu dam, sir mat ngii ciia gia dinh tre.
K§'T Q U A N G H I E N CLTU
Chiing tdi cd 35 benh nhan trong dd: tudi tmng binh 6.71 ± 1,45 tudi. Tudi thap nhd't Id 5 tudi. Tudi cao nhd't la 10 tudi. Tre < 6 tudi chiem 22,9%, tre > 6 tudi chiem 77,1%, Tre nam gap nhieu hdn tre nUvdi ty le nam/nCf = 4.8/1.
Trieu chumg lam sang Bang 1, Sd dem tieu dam mdi tuan Sd dem b^u dam mt» tuan
1-3 4 - 6 7
n = 35 15 14 6
42.9
%
40.0 17.1 Nhan xet: g d p nhieu nhd't Id 4-6 lan tieu dam trong mdt tuan (40%)
Bang 2 Cae yeu to lien quan tdi tieu dam Cdc y€u Id lidn quan
TSobdn C6 Khdnq
Tmng binh sd ddm tieu dam/tuan
4,0 ±212 42±1.65 Ttung binh luong nudc Udnq/24h
NiKKIiiu/24h Udng nuiSc ddm
Cd Khdng Tidn s^ gia djnh cd
nqucfl* bi ti^u dam Cd Khdng
161 ±0198 (lit) 1.71 ± 0.05 (mftqjl)
Tmng binh sd ddm dl lidu/tuin
4.8 ±1.86 3.3 + 1.23 Tmng binh sd ddm dai damAuan
4.7 ±1.98 3.4 ±0.93
P
0.781
0.011
0.013 Nhdn xet,
Trung binh sd deni tieu dam trong tuan d nhdm tre ed udng nude dem cao hdn nhom tre khdng udng nuflc dem vdi p=0.011.
Y HOC THLTC HANH (879) - S6 9/2013
Trung binh sd dem tieu dim trong tuan d nhdm tre CO tidn sCf gia dinh cao hdn h i n nhdm tre khdng cd tidn sijf gia dinh vdi p=0.013.
Anh hudng ve m|it tam ly doi vdi tre va gia dinh Bang 3: Ap lud tdm 1:^ vdi tre
Ap luc vdi tr6 tif Gia dinh Cdngd6ng
So bl m3nq Ban trfiu Ban bd xa Idnh
n(%) 15 (42,9%) 18 (51 4%) 4(11,5%) Nhdn xet: 42.9% sd tre thi ehiu dp luc tif phia gia dinh do bd me hode ngudi chdm tre se danh, mang.., khi tre cd hanh vi tieu dam.
45,0%
40,0%
35,0%
30,0%
25,0%
Ann Iv6ng l«n Anh hiriing lin Anh hiring ISn Anh hiriing I6n cfing u^c linh cim vy kmh l6 gia dinh gidc ngu
Bleu do 1: Anh hudng ddi vdi cha, me tr^
Nhan xet: Tieu dam anh hudng den giac ngCi ciia cha me chiem tp le cao (41.5%).
BAN L U A N
Tao bdn cd the gay ra ca dai dam nguyen phat va thif phat va Id mot trong nhCirig yeu td lam ndng them tinh trang benh, Tao bdn thudng dupc phat hien qua hoi benh sii" nhung khdng phai tat ea ede tnJdng hop tao bon deu ed the chan doan dUa vao lam sang Nhd't la tre d lira tudi den trudng, cha me tre ddi khi khdng theo ddi duoe tan suat d\ dai tien ciia tre, Theo tac gia Steve J. Hodges, can phai chup X quang de xac dmh luong phdn tdn di/ trong Idng true trang eua tre va tac gia nhan thay rang phan Idn nhdm tre mac benh thudng cd lifOng phdn trong true trang nhieu hon so vdi nhiJing tre khdng mac benh, Viee dieu tri tre dai dam khi khdng kiem scat dUOe het tre tao bdn phu thupc nhieu vdo kmh nghiem cCia bae sT, Neu tre cd tao bon nhung lai bo sdt thi ddn den kha ndng khdng dap ifng vdi dieu tn ddi dam tien phat bang honnon. Cae nghien CLfu cho thay 83% sd tre dai dam ed tao bdn khi duoe chi dinh sijf dung thude nhuan trdng hoac thudc thut khong edn dai dam sau 3 thang [3]. Dieu nay ehi ra rang can quan tam hdn de phdt hien tao bdn vd dieu tri kjp thdi nham nang cao hieu qua dieu tn tieu dam.
Tmng binh sd dem dai dam trong tuan 6 nhdm tre CO udng nUde dem cao hdn nhdm tre khdng udng nUdc flem vdi p<0.05. Sieu nay cang nhan manh them vai trd quan trong trong viec gido due eiia cha me de thay ddi thdi quen udng nude d tre, nham mang lai hieu qua
dieu tri cao, thdm ehi chi can thay ddi thdi quen udng nudc ma khdng can eae bidn phap dieu tri khac
Tnjng binh sd dem dai dam trong tuan d nhdm tre cd tien sif gia dinh eao hdn han nhdm tre khdng ed tien si^gia dinh vdi p < 0.05,
Cd 62.9% tre bi dai dam duOc hoi eho biet tre ehiu ap luc tam ly tif phia edng ddng cu the la tre ngUOng vdi ban be ciing trang lira, cimg ldp khi minh bi ddi d i m , thay khd chiu xau hd ve ban than... con sd nay trong nghien eifu eCia Morison MJ (2000) la 60% [4].
42.9% sd tre thi ehju dp luc tU phia gia dinh do bd me hodc ngudi chdm tre se danh, mang,,. khi tre cd hdnh vi dai ddm, ty le ndy theo nghidn eifu eiia Butler RJ nam 2004 Id 30% [5]. Mirc do anh hudng den giae ngO cDa cha me la kha eao, cd 41,5% cha me cam thay bi anh hudng nhieu den giac ngii vi hanh vi dai dam eiia con minh. Dieu ndy noi len mtifc dd anh hudng eiia hanh vi ddi dam eOa tre len gia dinh tre va chinh ban than tre Id rat dang ke. Can cd lieu phdp tam \p phu hdp, nham tranh nhung anh hudng khdng dang cd len tdm \p ciia tre vd cha me tre, dieu ma hien tal vdn chUa dupc thuc hien mpt each eo he thdng,
KET LUAN
+ Tnjng binh sd dem tieu dam trong tuan d nhom tre,
Cd udng nUde dem eao hdn nhdm tre khong udng nude dem,
Cd tien sit gia dinh bi tieu dam cao hOn han nhdm tre khdng cd tien sCf gia dinh.
+ Co 62.9% tre bi tieu dam dUOc hdi cho biet tre chiu dp luc tam \p tir phia cdng ddng eu the la tre nguong vdi ban be eilng trang lira, thd'y khd ehiu xau hd ve ban than, 42 9% sd tre chju dp lUc tir phia gia dinh nhu bi danh, mang khi tre tieu dam,
+ 41,5% cha me cam thd'y bj anh hudng nhieu den gid'c ngCi vi hanh vl tieu dam eda con minh,
TAI LIEU THAM KHAO
1. Van Dommelen P, Kamphuis M, et al (2009). The short- and long-term effects of simple behavioral inten/enlions for nocturnal enuresis in young children: a randomized controlled trial The Journal of Pediatrics Volume 154 (5): 662-666.
2. Bailey JN. Omitz Elvl, Gehricke JG, Gabikian P, Russell AT (1999) Transmission of pnmary nocturnal enuresis and attention deficit hyperactivity disorder, Acfa Paed/afr. 88:1364-8.
3. O'Regan S, Yazbeck S, Hamberger B, Schick E (2005) Bedwetting and toileting problems in cliildren Med JAusf. 182(4)1190-195
4. Morison MJ, et al. (2000) 'You feel helpless, that's exactly it': parents' and young people's control beliefs about bed-wetting and the implications for practice. J Adv Wi/rs;31(5):1216-27
5 Butler RJ, Heron J (2008) The prevalence of infrequent bedwetting and noctumal enuresis in childhood: A large British cohort, Scandinavian Journal of Umlogy and Nephrology 42- 257-64
Y HOC THLTC HANH (879) - SO 9/2013