TiJlP CHI Y DirpC Hpc CAN THP - s6 11-12/2018
6. Quach Ngoc Ngdn (2013), Ddc diim ldm sdng vd vi sinh cita viem phdi cdng ddng a tre tir 2 thdng din 5 tudi tgi Benh viin Nhi Ddng Cdn Tha, Luan van thac si thanh phd Hd Chi Minh.
7. Nguyin Thi Thanh Nhan, Phan Huu Nguyet Diim, Biii Thi Mai Phuofng (2012), "So sanh dac diem tdn thucmg tren phim X quang phoi giita cac nhom viem phdi cpng ddng tai thdi diem nhap vien d tre tir 2 - 59 ihang tai khoa Hd hap Benh vien Nhi Ddng 1", Y Hgc Thdnh Phd Hd Chi Minh, 16( 1), tt.69 - 75.
8. Huynh Van Tudng, Phan Huu Nguyet Diem, Tran Anh Tuan (2012), "Dac diSm lam sang va vi sinh cua viSm phdi cgng dong nang d tre tft 2 - 59 thang t^i khoa H6 hap Benh vi?n Nhi Ddng 1". YHgc Thdnh Phd HS Chi Minh, 16( 1), tt.76 - 80.
9. Nguyen Due Vinh (2014), Khdo sdt dgc diem ldm sdng, cgn ldm sdng cua viim phdi do vi trimg a tre em nhgp vien khoa Hd hdp Benh viin Nhi Bdng Cdn Tho ndm 2013 - 2014, Luan van tdt nghiep bac sT da khoa Can Tha.
10. Williams D. J. va cs (2015), "Association of White Blood Cell Count and C-Reactive Protein with Outcomes m Children Hospitalized for Commimity-acquired Pneumonia", Pediatric Infectious Disease, 34(7), pp.792 - 793.
11. Palafox H. G. M, Hortensia Reyes, Onofre Munoz, Homero Martinez (2000), "Diagnostic value of tachypnoea in pneumonia defined radiologically". Arch Dis Child, 82, pp.41 - 45.
(Ngdy nhdn hdi: 16/11/2017 - Ngdy duyit ddng: 02/01/2018)
K H A O S A T TIIVH H I N H D i E U T R I DU* PHONG H E N PHE QUAN Of TRE EM 6 - 1 5 T U O I M A C B E N H H E N KEM VIEM IVIUI DI UTNG TAI P H O N G K H A M HEN B E N H VTEN N H I D O N G CAN T H O 2015 - 2017
Nguyin Thanh Hdi", Li Thi Thuy Loan Trucmg Dgi hoc Y Dugc Cdn Tha
*Email:nthai@ctump. edu. vn TOM T A T
Bgt vdn de; Tdn sudt binh nhdn mdc hen kit hgp vdi viem mHi diung (VAG)U) chiim ti 14 59% - 85% tiiy nghien cuu [11]. Mgc tiiu nghiin cuu: Xdc dinh dgc diim dich te, ldm sdng, cgn ldm sdng, diiu trj dg phdng eua binh hen phi qudn cd kem viem mui di img a tre em. Doi turgng vd phuang ph^ nghiin cOu: nghiin ciiu md td cdt ngang. Chgn nhimg benh nhi tii 6 tuoi den 15 tudi mdc benh hen kim viem mui dj tmg tgi phdng khdm hen. binh vien Nhi ddng Cdn Tha tir thdng 01/2015 din thdng 10/2017. Ket qud: ed 107 mau, viim hd hdp 40.2% khi hgu Ignh 23,4%, thuc an 17,8%. Tudi khdi phdt khd khe > 2 tudi (68,2%.) tudi dugc chdn dodn hen nhdm < 7 mdi (63,5%). Ldm sdng tre cd nhdy mUi (93,5%), chdy nude mui (90,7%) vd nghet mui (73,8%), ngira mui (12,3%), VMDlf logi trung binh - ngng (44,9%), VMDlfloginhe (55,1%), khd kM ban ngdy trin 1 Idn/tudn 54,2%, khd khe vi dim >2 idn/thdng (65,5%), can hen bdt ch0 (86%), thtic gidc vidim 62,6%, mdc dg ngng benh hen bdt ddu can thiip la hen bgc II (91,6%). Can ldm sdng: gid tri cua FEVl > 80% (52,4%), FEVl < 60% (14.3%). PEF < 60% (61,9%). PEF > 80%
(22,9%),sd lugng bgch edu di toan trong mdu ngogi vi >400 tb/mm^ (58,0%). Hiiu qud dieu tr\ du phdng hen kem VMDlf sau 3 thdng cd kiim sodt tdt (57%), sau 6 thdng ed kiim sodt tdt (65,4%), sau 9 thdng cd kiim sodt tdt (72,8%), sau 12 thdng cd kiim sodt tdt (69,6%). Kit lugn: Biiu trf dg phdng hen kem viim mui df ung cd hiiu qua kiim sodt tdt sau 12 thdng gdn 70%.
Tirkhda: viem muidj ling, hen phi qudn
451
TAP CHi Y DirpC Hpc CAN THP - SP 11-12/2018
ABSTRACT
STUDY ON PREVENTIVE T R E A T M E N T ASTHMA IN PATIENTS A G E D 6 - 15 YEARS O L D DISEASE O F A L L E R G I C RHINITIS ASSOCIATED WITH ASTHMA A T T H E OUTPATIEN D E P A R T M E N T CAN T H O PEDIATRICS
HOSPITAL F R O M 2015 TO 2017
Nguyen Thanh Hai, Le Thi Thuy Loan Background, the incidence of asthma associated with allergic rhinitis is 59% - 85%
depending on the study [11]. Objective: Determination of epidemiological, clinical, laboratory, and prophylactic properties of asthma associated with childhood allergic rhinitis. Research methods: cross sectional description study.Choose children aged 6 to 15 years old with asthma with allergic rhinitis at asthma clinie,Can Tho Pediatrics Hospital from January 2015 to October 201/.Results: Results obtained 107 samples, respiratory disease 40.2%, cold climate 23.4%, food 17.8%, age of onset of wheezing > 2 years (68.2%,), age group diagnosed with asthma < 7 years old (63.5%), age of allergic rhinitis < 7 years old (56.1%). Symptoms of young children with sneezing (93.5%), runny nose (90.7%) and stuffy nose (73.8%), nasal itching (12.3%), moderate lo severe allergic rhinitis (44.9%), mild allergic rhinitis (55.1%), wheezing on a once a week 54.2%.
wheezing at night> twice a month (65.5%). sudden asthma (86%). wake up at night 62.6%, the severity of asthma who started intervention was second-degree asthma (91.6%). Subclinical:
values for FEVl> 80% (52.4%). FEVl <60% (14.3%). PEF <60% (61.9%), PEF> 80%
(22.9%),number of eosinophil counts peripheral blood>400tb/mm3 (58.0%).Effeetively treat asthma with allergic rhinitis after 3 months with good control (57%), after 6 months with good contiol (65.4%), after 9 months with good control (72.8%), after 12 months with good control (69, 6%). Conclusion: Prevention tieatment of asthma with allergic rhinitis was well controlled after 12 months of nearly 70%.
Keyword: allergic rhinitis, asthma I. D ^ T VAN B E
Sy hien dien cfta VMDU* thudng ldm cho b^nh hen ngng hon: tdng nguy ca xuat hien con hen, tdn suat nh^p vien vd nhdp cap cftu vi con hen nang, khd kiem soat ban ttong dieu tri dy phdng [11]. Chinh vi ly do do chung tdi thyc hien de tdi nghien cftu ve
"Khdo sat tinh hinh diSu tri dy phdng hen phS qudn d tte em 6 - 1 5 tudi mdc benh hen kem viem mui di ftng tai phdnh kham hen Benh vien Nhi ddng Cdn Tha 2 0 1 5 - 2 0 1 7 . " vdi cdc muc tiSu nhu sau:
1. Xdc dinh ti IS mgt sd dac diem dich t§ cua benh hen phS quan cd kem viSm miii di ftng d tte em
2. Md td ddc diSm lam sang vd can lam sdng ciia benh hen phe quan cd kem viSm miii di ftng d tte em
3. Xac dinh ti IS va thdi diSm ddp ftng vdi diSu tti dy phdng hen phe quan theo GINA II. DOI TlTpNG VA PHlTONG P H A P NGHIEN ClTU
2.1. Doi tirong nghien cihi: Tre em tft 6 - 15 tudi mdc bSnh hen phS qudn kem viSm mfti di ung. Nghien cftu dugc thyc hien tu thdng 01/2015 dSn thang 10/2017 tgi phdng khdm hen Benh vien Nhi ddng Can Tho.
2.2. Phironng phap nghien cihi
2.2.1 Thiet ke nghien cihi: nghiSn cftu mo td cdt ngang 2.2.2 C& mau: Trong nghien cftu ndy chftng tdi thu dugc 107 mdu 452
TAP CHfY Dl/PC Hpc CAN THP - s6 11-12/2018
2.2.3. Phirffng phap chon m l u : Chgn mau khdng xdc sudt, ldy ttgn mdu trong thdi gian nghiSn cftu.
2.2.4. Ndi dung nghien cun
- Dac diSm dich te cua benh hen phS quan cd kem VMDU d tte em: tudi, gidi, noi cu trft, yeu td khoi phdt con hen, khd khe, tudi chan doan hen, tiSn sft gia dinh
-DiSn tien ldm sang vd ket qua can lam sang cfta benh hen phe quan cd kem viem miii di ftng d tte em
- DiSu tri dy phdng hen phS quan theo GINA d 3 cdp do 2.2.5. Phircmg phap thu thap so lieu
- Tam sodt benh nhdn HPQ cd kem V M D L T tft 6 dSn 15 tudi den kham vd diSu tri tai Phdng kham hen, Benh vien Nhi ddng Can Tha ttong thdi gian nghiSn cftu.
- Khdm lam sang, hdi tien sft benh theo tiSu chuan ciia GINA vd ARIA - Lam cdc xet nghiSm hd ttg: sd lugng bgch cau ai toan ttong mdu ngoai vi, do chftc ndng hd hdp.
- Chgn benh nhan ngau nhiSn: HPQ cd kem VMDU" dugc theo doi va can thiep bang diSu tri du phdng benh VMDU* vdi HI antihistamin thS he 2 (Loratadin liSu 0,2mg/kg Ueu duy nhdt/ngdy, udng x 4 tuan lien tuc cho mdi dgt dieu tri, tdi kham cd thS keo dai thSm tft 2 - 4 tudn Loratadin) theo phdc dd diSu tri cfta ARIA. Mdt dgt diSu tri dugc xac dinh khi benh nhi cd bieu hien dgt cdp cua VMDU".
- Dugc diSu tri dy phdng benh HPQ theo phac do: Bac II: dung corticoides MDI:
Flixotide (Fluticasone propionate (HFA)) 125 mcg;l-2 nhdt xit/ldn. Bdc III: diing corticoides MDI + p2 giao cdm chdm keo dai MDI. Seretide (Salmeterol/Fluticatione propionate: liSu 25/50 meg ho&: 25/125 meg)
- Khdm dinh ky moi thang 1 ldn cho moi benh nhan, kham khi cd dgt c ^ (HPQ hodc VMDU). Danh gid' hieu qua sau 3 thang, 6 thdng, 9 thang, 12 thang theo doi va dieu tri dy phdng liSn tuc theo mftc do kiem soat hen GINA
2.2.6 Phuang phdp xft Ii sd lieu: Sd liSu thu thdp dugc nhap va phdn tich bdng phdn mSm SPSS 18.0.
IH. K E T Q U A (n=107)
3.1.Bac diSm dich te cua benh hen phe quan kem viem mui di tmg Bdng 1. Ddc diSm dich te hgc cua benh hen kem YMpU"
Bac diem dich t i hoc Yeu to gay Idioi phat:
Vi6m ho hap Khi hau l^nh Thuc an
Khac Tu6i khoi phat kho khe:
< 2
> 2 Tuoi Sage chan doan hen:
< 7 tuoi
>7 - 9 tuoi
> 9 - 11 tuSi
>11tuoi
So lirong 43 25 19 9 34 73 68 23 14 2
TYle%
40,2 23,4 17,8 8,4 31,8 68,2 63,5 21,5 13,1 1,9
453
TAP CHI Y Dirge Hpc CAN THg - SP 11-12/2018
Yeu td khdi phdt con hen phan ldn la viem hd hdp 40,2% vd khi hau Ignh 24,4%, tudi khdi phdt khd khe > 2 tudi 68,2%, tudi chdn dodn hen < 7 ttidi 63,5%
3.2. Diin ti^n lam sang vd cdn lam sdng cua bSnh hen kem viSm mui di ung:
Bang 2. Dien bien lam sdng cda bfnh hen kem VMDt]' Dien bien lam sans
Trieu chiing:
Nhay miii Chay mui Ngh^t mui Ngira miii Phan loai viem mui di ling:
Nhe Trang binh- nang TSn suat khd khe ban ngay:
<1 lan/tuan
>1 lanAuan Tan suat kho khe ve dem:
<2 lin/thang
>2 Ian/thing 1 lan/tuSn Tinh chat con hen:
Nhap cap cuu vi con hen nang Kham b?nh vi hen kem VMDlT Miic dp n§ng b?nh hen:
Hen bfic 11 Hen bac 111
S61iTQmfi 100 97 79 11 59 48 49 58 32 69 6 21 87 98 9
Tv le % 93,5 90,7 73,8 12,3 55,1 44,9 45,8 54,2 30,0 65,5 5,5 19.7 81,3 91,6 8,4 Lam sang hen kem viem miii di ftng la nhdy mui 93,5%, chdy miii 90,7%, viSm mui di ftng loai nhe 55,1%, tdn sudt khd khe ban nag2y >lldn/tuan 54,2%, khd khd ve dSm
> 2ldn/thang 65,5%, cd 19,7% nhdp cdp cftu vi can hen ngng, chu yeu hen bgc II 91,6%
Bdng 3. ket qua can lam sang cfta benh hen kem VMDU"
Itet qua c^n lam sang Gia tri FEVl
Gia tri PEF
<60 n % 15 (14,3) 65 (61,9)
60-80 n % 35 (33,3) 16 (15,2)
>80 n % 55 (52,4) 24 (22,9) Gia tri FEV1>80% 52,4%, Gid ttiPEF<60% 61,9%. Bgch cau ai toan: sd lugng bgch cau di toan ttong mau ngogi vi >400 tb/mm^ (58,0%), ti IS >4% 71,4%.
3.3. Diiu tri dy phong hen phe quan kem VMOU* theo GINA d* 3 c^p d^
Bang 4. Di^u tri du phdng hen phS quan theo GINA DiSn tri d^ ph6ng hen
phe quan Kiem sodt tot KiSm soat 1 phan
Sau 3 thang n % 61 (57,0) 19 (17,8)
Sau 6 thang n % 70 (65,4) 18 (16,8)
Sau 9 thang n % 75 (72,8) 12 (11,7)
Sau 12 thang n % 64 (69,6) 12 (13,0) Phdn ldn kiSm sodt hen tdt ttSn 55%
IV, B A N L U ^
4.1.Dac diim d}ch t l cua b^nfa hen phe quan kem viem mui di irng
TfyP CHI Y Dirge Hpc CXN THP - SP 11-12/2018
Cac yiu to gay khoi phat com hen: ySu td nghi gay khdi phat can hen chiSm ti IS cao Id viSm hd hdp (40,2%), khi hgu lanh (23,4%). Thftc dn la ySu td gdy khai phdt can hen chi chiSm 17,8%. KSt qud ngjiiSn ciru cfta Phiong Minh Thinh, Nguyen Thi Nggc Dung nam 2013, cac di nguySn hd hdp gdy khdi phat can hen la mat bui nhd chiSm ti IS cao nhdt 67,2%, ndm mdc 30%, con gian 26,2%, Idng thft 17,2% [9].
Tudi khdi phat khd khe: tte khdi phdt khd khe sau 2 tudi (68,2%). Theo kSt qua nghien cftu cfta Phimg Minh Thinh vd cdng sy, khdo sdt ttSn 519 benh nhdn hen kem VMDU thupc nhiSu nhdm tudi, tudi khdi phdt con hen ddu tiSn 6 nhdm tre em vdi tudi trung binh Id 5,9 tudi. [9]
Tuoi chdn doan hen: tudi dugc chdn dodn hen 63,5% d nhdm < 7 tudi; tft 7 tudi dSn 9 tudi chiSm ti IS thdp hon: 21,5%. NghiSn cftu cua Phftng Chi Thien vd cgng sy, khdo sat 159 tte mdc benh hen, nhom tudi mdc benh chiSm ti IS cao la tft 6 tudi dSn duoi 10 tudi chiem 59,7%, nhdm tft 10 tudi dSn duoi 15 tudi Id 40,3%. Trong khi do, sd nam mdc benh dugc chdn doan hen ttong nhdm nghiSn cftu la each thdi diSm khdo sat chiSm da sd la tft I d^n5 ndm: 64,7%, kSdSn Id tft 6 - 1 0 nam: 18,9% va dudi 1 ndm: 11,3% [7].
4.2. Dien tien lam sang va cdn ldm sdng ciia benh hen kem VMDU"
Dgc diem lam sang: Cac trieu chihig VMOlT & bSnh hen phe quan: nhay mui (93,5%), chdy nude miii (90,7%), nghet mui (73,8%) vd ngfta miii (12,3%). Theo Trdn Doan Trung Cang va cdng sy, ti IS cac tri^u chftng cua VMDU" ttong nhdm nghien cftu la:
hdt hoi, sd mui cd ti IS tuang duong nhau: 98,75%, ke dSn la trieu chftng cfta ngfta mui:
95% vd thdp nhdt la trieu chftng nghet mui: 90,63% [1]. Phan loai VMDlT: VMDU" gian dogn mftc dp nhe chiSm da sd 55,1%, mftc dO tnmg binh - ndng it ban chiSm 44,9%. Ket qud nghien cuu cua Tran Doan Trung Cang va cgng sy, ttong 94 mdu nghiSn cftu benh nhan mac hen kem VMDU" cua tdc gid, VMDLT gidn doan mftc do nhe Id 33,3% cao ban mftc do tnmg bmh - n g n g la 29,31%, ti IS cdn lgi la thS dai ddng [1]. Tan suat hen trong thang qua: tdn su^t trieu chftng kho khe ban ngay > 1 Idn/tudn 54,2% . Le Thanh Hdi vd c0ng sy nam 2011, nghien ciiu 143 benh nhi mdc benh hen tudi tft 6 - 15 tudi, cac tac gid ghi nhdn mftc do nang cua con hen: ngng: 18,18%, tnmg bmh: 57,34%, nhe: 18,18% [5], tdn sudt khd khe vS dem nhieu ban 2 ldn ttong thang 65,5%. Mu-c do nang bSnh hen bat dau can thiep dieu tri: Theo kSt qua nghiSn cftu cua chftng tdi, mftc dg nang benh hen bdt ddu can tiiiep da sd Id hen bgc II (91,6%), cdn hen bdc III chiSm ti thdp 8,4. Phan logi hen theo GINA cho thdy ti IS b?nh nhdn hen c6 kSt hgp vdi VMDLT giam ddn khi bgc hen nang ISn, cu tiiS la hen bdc I, II, III, IV tiii ti le nay lan lugt la 82,6%; 77,9%; 74,2%; vd 70,5% [9]. '
Dac diem cdn ldm sang:
Ve cdc gid tri ciia FEVl: gia tii cfta FEVl d mftc FEVl > 80% (52,4%). NghiSn cftu cua Bui Thi Huong va cdng sy tren nhdm bSnh nhan hen cd kem hogc khdng kem theo VMDLT, tdc gia nhdn thdy gia tri cfta FEVl cd f nghia ttong viSc ddnh gia hi^u qua cfta viec kiSm sodt hen. NSu FEVl < 60%, hieu qua kiim soat hen kem [5]. Ket qua nghiSn cftu cfta Trinh Manh Hftng ghi nhdn gia tti cfta FEVl cfta nhdm mac benh hen cd gia tti rdt thdp: 60% [2].
v l cac gia tri cua PEF: nhdm < 60% (62%), kS dSn la > 80% (23%) sau khi dftng corticoid dy phdng, PEF dgt mftc trung binh ttong 2 tudn, PEF trung binh tiSp tyc tdng va mftc dao dpng cua PEF ttong ngdy giam xudng ttong khoang 3 thang diSu tri dy phdng.
PEF dao ddng qud mftc, ggi y kiSm sodt hen chua hieu qua va tang nguy co xudt hien can kich phat [12].
TAP CHi Y Dirge Hpc CAN THP - s 6 11-12/2018
Bach cau ai toan trong mau ngoai vi >400 tb/mm^ (58%). Le Thi Minh Huong nghien cftu tten 143 benh nhi hen cd kem VMDLT, vdi kSt qud BC di toan tdng chiSm 44,4% ttong khi nhdm benh nhdn cd ket qua BC di toan khdng tdng chiSm 55,6% [4].
4.3. Dieu tri dy phdng hen phe quan kem VMOU* theo GINA d 3 cap do Hi^u qua viec kiSm soat hen sau 3 thdng dieu tr; dy phong: hi^u qud kiSm soat hen sau 3 thdng diSu tri du phdng bdng corticoid MDI (dung Flixotide (Fluticasone propionate (HFA)) 125 meg; 1-2 nhdt xitAdn cho hen bdc II vd Seretide (Salmeterol/Fluticatione propionate: lieu 25/50 meg hodc 25/125 meg) cho hen b|ic III, song song vdi diSu tri VMDU bdng Loratadin lOmg/vien vdi liiu 0,2mg/kg/lieu duy nhdt ttong ngay x 4-8 tudn. KSt qud ghi nhgn dugc: kiSm sodt tdt 57%, kiSm sodt 1 phan chiem ti le thdp nhdt 17,8%. KSt qua nghiSn cftu cfta Bfti Thi Huong va cdng sy d nhdm bSnh nhdn hen kem VMDLT, sau 3 thai^ diSu tri dy phdng: nhdm kiSm sodt hodn toan chiem ti IS 18,2 %, kS dSn la nhdm kiSm soat 1 phan:
31,8% vd nhdm khdng kiem sodt chiem 50% [5],
Hieu qua cua vi^c kiim soat hen sau 6 - 9 thang dieu tri dy phong: Trong nhdm nghiSn cftu, hi$u qua kiSm sodt hen sau 6 thdng dieu tri du phdng Id: kiSm sodt t6t chiSm ti IS cao 65,4%, k l den la kiSm sodt 1 phdn 16,8% .HiSu qua sau 9 thdng diSu hi ciia nhdm nghiSn cftu vdi mftc dp kiem soat tdt chiem ti I? cao 72,8%, kS dSn la kiSm soat 1 phdn 11,7%. Phimg Chi Thien va cgng su nghien cftu 159 tte mac benh hen tft 6 t u d i - 15 tudi bang phuong phap md td cat ngang kSt hgp vdi hoi cftu ttong 6 thang. Vdi ket qua diSu tri du phdng hen dgt dugc d mftc kiSm sodt t6t vai ti IS rdt thdp, chi chiem 7%, da so benh nhdn chua dugc kiSm soat hogc kiem soat 1 phan: 93%. Sd bSnh nhdn khdm theo djnh ky chi cd 5%, 95% cdn lgi Id khdm dieu tri theo dgt benh (khi cd con hen cap) [8].
Ve hieu qua kiem soat hen sau 12 thang diiu tri du phdng: Trong so 93 truang hgp (bd tdi kham 14 trudng hgp) benh nhi mdc benh hen kem VMDU", hiSu qud kiem sodt hen sau 12 thdng dieu tri Id: kiem sodt tdt chiSm ti IS cao 69,6%, ke den la kiSm sodt 1 phdn 13,0%. Theo doi 255 tte hen dugc theo ddi vd diSu tri dy phdng, tdc gia Nguyin Thanh Phudc vd cdng sy ghi nhdn: ti IS tai kham thudng xuySn Id 69,4%, cd nghia la cd dSn gan 1/3 so bSnh nhdn bd tdi khdm va theo ddi (30,6%) [6].
V. K E T LUAN
l.Dgc diem dich tl cua bSnh hen phi quan kSm viem mui di li'ng
- YSu td gay khdi phdt can hen: Viem hd hdp 40,2%, khi hgu Ignh 23,4%, thftc dn 17,8%.
- Cdc yiu td liSn quan: tudi khdi phdt khd khe: > 2 tudi (68,2%), tudi dugc chdn dodn hen nhdm < 7 tudi (63,5%).
2. Dien tien lam sdng va c^n ldm sdng cfta bSnh hen kem VMDU*
Dgc diem lam sdng: nhdy mui 93,5%, chay nude mui 90,7%, nghet mui 73,8%., VMDU" gidn dogn mftc do nhe: 55,1%, mftc do trung binh - ngng: 44,9%, khd khe ban ngay > 1 Idn/tudn (54,2%), khd khe vS dem > 2 Idn/thdng^ (65,5%), can hen bdt chgt 86,0%, thftc giac v l dem 62,6%. Mftc do nang b$nh hen bdt ddu can thiep: bgc II (91,6%), bgc III: (8,4%).
Dac diim c§n lam sang: Gia tri FEVl < 60 % (14,3%), > 80% (52,4%). Gid tri PEF < 60 % (61,9%) vd > 80% (22,9%). Hgi chftng han chS 21,9%, cd h^i chftng tdc nghen 44,7%. So lugng bach cdu di toan ttong mdu ngogi vi > 400tb/mm (58%)
TAP CHi Y DirglC HOC CAN T H P - S O 11-12/2018
,3. Di^u tri dv phong heo phe quan kem VMDU" theo GINA tf 3 c4p 36: hieu qua Idem soat hen di^u tri du phong sau 3 thang c6 ki^m soat t6t 57%, sau 6 thang ki8m scat tot 65,4%, sau 9 thang kifim soat tdt 72,8%, sau 12 thang ki6m soat t6t 69,6%.
TAI L i f u THAM KHAO
1. Trin Doan Trung Can, Nguyin Thi Ngoc Dung, Le Thi Tuyjt Lan (2009), "Khao sat ti le hen kem theo cr benh nhan vi^m mui xoang man co bieu hien di ung va Skin Prick Test dirong tinh", Yligc Tp. Hd ChiMinh, 13(1), tt. 256-263.
2. Trinh Manh Hiing (2012), "Tim hieu cac dau hieu lam sang o nguoi benh co con hen phi quan miic d<i nling",!' hoc thuc hanh (802)-s6 1/2012.
3. Le Thi Minh Huong, Le Thanh Hai (2013), "Moi lien quan giira viem miii di ung va hen phe quan tre em tai Benh vi^n Nhi Trung uong". Tap chi Y hqc thuc hanh, 866(4), tr.
152-154.
4. L6 Thi Mmh Huong, Le Thanh Hai (2013)," Mpt so dac diem djch tl hpc lam sang hen phe quan tre em tai Benh vien Nhi Trung uong nam 20ir',FApe TTnic/idn/i (870)- so 5/2013.
5. Bui Thi Huong, Biii Van DSn, Hoang Thi Llim (2016), "Dinh gia mirc dp kiem soat hen bang ACT doi vcri benh nhan cau lac bo hen Benh vien Dai hpc Y Ha Npi",ro/j chi nghien ciu y hQC, 99(1)-2016.
6. Nguyen Thanh Phuoc, Pham Thi Minh Hong (2012), "Tinh hinh quan ly hen o tre em duoi 5 tu6i flieo GEMA 2009 tai Benh vien Nhi ddng 2, Tp Ha Chi Minh",!'Ape Tp HS CWMin/i, tap 6, Phu ban ciia so 1 - 2012.
7. Phiing Chi Thien va cong sir (2013), "Nghien ciru thuc trans mac benh hen phe quan va mpt so yeu to lien quan cr hpc smh tieu hpc, trung hoc Le Hong Phong, Ngo Quyen, Hai Ph6ng",y/ipc (Auc Aon* (878)-s6 8/2013
8. Phiing Chi Thien va cpng sir (2013), " Nghien ciiu thirc trang mic benh va kiim spat hen phi quan of hoc sinh tiiu hpc, trung hpc Le H6ng Phong, Ngo Quyin, Hai Ph6ng",y Ape rAuc AdnA (878> s6 8/2013.[9]
9. Phiing Minh Thinh, Nguyin Thi Ngoc Dung, Le Thi Tuylt Lan (2013), "IChao sat mli lien quan giaa viem miii di irng va hen phe quan", 7Ape Tp. Ho ChiMinh, 17(1), tr. 90- 96.
10. Bousquet J et all (2008), "Allergic Rhinitis and its Impact on AsUuna (ARIA) 2008 Update (in collaboration with the World Health Organization, GA2LEN* and AllerGen«»)V'te'-gy, 63 (86), pp. 8-160.
11. Hanes L.S, Issa E, Proud D et al (2006), "Stronger nasal responsiveness to cold air m individuals with rhinitis and asthma, compared with rhinitis alone", Clin Exp Allergy, 36(1), pp. 26-31.
12. Liu A. H, Joseph D. Spahn, Covar R.A (2016), "Childhood asduna". Nelson's Textbook of Pediatrics, 20di ed, WB Saunder, Philadelphia, pp 1095-1115.
(Ngdy nhdn bai: 10/11/2017-Ngay duyet dang: 05/01/2018)
457