N g h i e n Clhi Y hpc Y Hpc TP. Hb Chi M m h * Tap 16 * P h u ban ciia So 1 * 2012
KHAO SAT CAC BAT THl/dNG Nl/^C TIEU B A N G Q U E THlf NU'DC TIEU TAI HAI TRU'O'NG TIEU HOC
VA TRUNG HOC - TP HO CHI MINH
Nguyen Thi Phuang Thdo*, Ddo Bich Thuy*, Hodng Vii Diem Thuy***, Trdn Thf Mgng Hiep***
TOM
TATMuc tieu: Nghien cieu nhdm xdc dinh ty li ci'm nhieng bdi thieang nudc tieii a tre Ididng trieu didng tgi trudng Tieii hoc Nguyen Thanh Tuyen qudn 3 vd tneimg trung hgc ca sa Truang Cong EHnh qudn Binh Thanh TP.Ho Chi Minh.
Phiamg phdp: Nghiin cieu cdt ngang diegc thuc him tu thdng 09/2009 dai 12/2009 tren 546 ti-e Idioe mgnh tit 6 dm 14 tuoi Viec tdm sodt dugc thuc him bdng que thie nudc tieu 10 thong so'.
Kei qud: Trong 546 tre kJioe mgnh (286 nam, 260 nir), co 35 (6,41%) trudng hgp bdi thudng nuac tim d tong phdn tich nudc tieu lan ^u vd chi cdn 3 (0,55%) trudng hgp bdi thuimg a Ian 2. Trong nhom nhieng tre bdi thieang nuac tieu Idn 1, co 2,75% tre tieu dgm dan dgc, 2,56% tiai mdu dan dgc, 0,37%
tieu bach cau don dgc, 0,37% tieu nitrit dan dgc, 0,37% timi bgcli cau ket hop vai nitrit vd khong ghi nhdn trucmg hgp tieu mdu kei hgp tieu dgm. Cd 3 trudng hgp c6 bdi thudng nudc tieu lan 2 deu la tieu Hong cdu vd nhung t'am sodt ghi nhgn: 1 tnedng hgp thieii mdu tdn huyei do thieii men G6PD, 1 tnrdng hgp than ie nudc vd 1 tnrdng hgp hep bao quy dau.
Kei luan: Que thu nudc tiai Utuc Men a hgc sinh Idide manh tqi 2 truang c^ 1 vd c^ 2 tgi TP. Ho Qii Minh plidt hien rdi it bdi ^udng, tuy nhien vdn giiip phdt hien dugc binh a tre Ididng triiu diung.
Tit kltoa: Benh than nguyin phdt; Viem dm bethan; Nitrit; Leucocyte esterase ABSTRACT
UKINE SCREENING TEST IN CHKDREN AT TWO PRIMARY AND JUNIOR HIGH SCHOOL - HO CHI MINH CTTY
Nguyen Thi Phuong Thao, Dao Bieh Thuy, Hoang Thi Diem Thuy, Tran Thi Mong Hiep
* Y Hoc TP. Ho Chi Minh * Vol. 16 - Supplement of No 1 - 2012:42 - 47 Objective: This study attempted to determine die prevalence of urinary abnormalites in asymptomatic children in Nguyen Thanh Tuyen primary school (Distrid 3) and Truong Cong Dinh junior high school (Bmh Thanh Distiict) in Ho Chi Minh dty.
Methods: A cross - sectional stiidy from 09/2(X)9 to 12/2009 loas conducted in 546 apparently healthy chddrenfrom 6 to 14 years of age Urinary screening zoos perfarmed with &ie dipstidc method.
Results: In 546 apparently badthy diildren (286 bays, 260 girls), urinary abnormalities were ducted in 35 (6.41%) subjects at tlie first screening and only 3 (0.55%) cases at the second screening. Of tlie children who had urinary cdmormalities at the first sceening isokted protdnuria was found in 2.75% of the cases, isolated bemiduria in 2.56%, leukocyte esterase in 0.37%, nitrit positive in 0.37% and combined leidaxyte esterase and nitrit in 0.37%. No case with combined liematuria and protdnuria was found Hematuria was found in all die 3
* Tmong D^i Hoc Y Khoa Pham Ngoc Thach " Khoa Than - Npi Tiet BV Nhi Dong 2
Tac^d lien Iqc. TS.BS Tran Tht Mgng Hiep DT: 0908198104 Email: [email protected]
42 Hpi nghi Khoa Hpc Ky Thuat Tnrong Dai Hpc Y Pham Ngpc Thach 2012
Y Hpc TP. Hb Chi Minh ^ Tap 16 * Phu ban cua So 1 * 2012 Nghien cmi Y hpc
patiaits with unnary d^noniwlilics at tlw second screming and investigation sliowed G6PD deficiency anaemia in 1 case, hydronephrosis in 1 case and phimosis in 1 case.
Conclusion: Urine screening test in healthy primary and junior high school children in Ho Chi Minh dty showed vay law rate of urine abnonnalities, but can deted underlying disease in asymptomatic childrm.
Keywords: Primary rend disease; Pyelonephritis; Nitiit; Laicocyte esterase
Tat ea nhiing ehuang trinh nay deu dua tren que thu nuoc tieu nhanh, day la mot phuong tien chi phi thap, don gian, de sii dung, CO dp nhay cao rat thich hpp voi cac chuong trinh tam soat, dac biet trong viec phat hien nhiem triing tieu'^'.
Tai Viet Nam chua co mpt ehuong trinh ism soat nhimg bat thuang nuoc tieu 6 tre em de co the xac dinh dupe ty le tieu bach cau, tieu nitrit tieu dam, tieu mau, qua do phat hien som nhiing benh ly lien quan.
Do vay chung toi tien hanh nghien ciru nay nhktn khao sat ty le bat thuong nuac tieu 6 tre em khoe m ^ tir 6 - 1 4 tuoi being que thii nuoc tieu 10 fhong so. Qua do, chung toi hi vpng se dong gop dupe them mpt so dii lieu ve ty le bat thudng nuoc tieii cua tre em khoe manh 6 thanh pho Ho Chl Minh.
P H l / O N G PHAP NGHIEN CUtJ D A T V A N D E
Bat thuong nuoc tieu la mpt hong nhiing dau hieu phan anh benh ly he than nieu nhu nhiem trimg tieu, viem cau than, benh than mo ke, di tat bam sinh he nieu... hay mot so benh ly toan than nhu benh Lupus do, benh ban xuat huyet Henoch-Sehonlein, hpi chiing tan huyet tang ure huyet... Nhiing benh nay neu khong duoc phat hien va dieu tri kip thoi se dan den suy than man, ma dien tien lau dai, tat yeii la benh than giai doan cuoi.
Suy than man, 6 tre em gay anh huang nghiem trpng den su tang truong, phat trieh, cupc song gja dinh, kha nang hpe tap va cuoi cung dua den chi dinh dieu tri chay than nhan tgo va thay the than'-". Do vay, viec phat hien som b?nh t h ^ m?n 6 tre la van de quan trpng anh huong den dieu tri va tien lupng. Trong nhung nam gan day, mpt so chuang trinh fam soat bat thudng nuoc tieu o tre em trong dp tuoi di hpe da dupe trien khai tai mpt so quoc gia nhu Thuong Hai (Trung Quoc), Singapore, Nhat Ban, Iran, Han Quoc, Dai Loan nham phat hien benh than 6 giai doan som, da cho thay hieu qua trong viec giam ganh nang dieu tri ciia benh than man 6 nhiing nuoc phat trieh ciing nhu dang phat trien'*-''"''-*.
Tai Nhat Ban, chuong trinh nay da tro thanh thuang quy, b3t dau duoe thuc hien tir nam 1974 va keo dai cho den nay. Nam 2004, theo nghien oiu 6 tre tir 6-14 tuoi ty le tieu dam don dpc la 0,11%, tieu mau don dpc 0,83%, tieu dam ket hpp tieu mau 0,05%'-''.
Tai Thupng Hai, mpt nghien ciiu tir thang 3- 10/2003 eho thay ty le tieu dam don dpc la 0,51%, tieu mau don dpc 0,46%, tieu dam ket hop tieii mau la 0,07%""'.
Nghien cuu cat ngang dupe thuc hien iu tiiang 09/2009 den 12/2009 b^n cae tire hioi tii 6- 14 tuoi, khong co trieu chiing va h^n sii benh ly than nieu truoc do tai trudng Tieu hpc Nguyin Thanh Tuyen, Quan 3 va trudng THCS Truong Cong Djnh, Quan Bmh Thanh, TP. Ho Chi Minh. Cd mau dupe uoc tinh la 493 he vdi dp tin cay mong muon la 95%.
Mau nghien cuu tai Trudng Tieu hpe Nguyen Thanh Tuyen, Quan 3, TP. Ho Chi Minh bao gom khoi lop 1 (IA, ID), khoi ldp 2 (2A, 2B), khoi ldp 3 (3B, 3D), khoi ldp 4 (4B, 4E) vakhdildp5(5C,5D).
Mau nghien a i u tai Trudng THCS Truong Cong Dinh, Quan Binh Thanh, TP. Ho Chi Minh bao gom khoi ldp 6 (6-2), khoi ldp 7 (7-1), khoi ldp 8 (8-5) va khoi ldp 9 (9-3).
Cac tre dupe chpn vao 16 nghien ciiu bao gom cac tre khdng ed trieu chiing va tien sii
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N g h i e n cihi Y hpc Y Hpc TP. H b Chi M i n h * Tap 16 * P h u b a n ciia So 1 * 2012
benh ly than nieu, khong mae benh, khong van dpng the luc manh, khong gang siic trudc khi lay mau mpt ngay va khdng uong vitamin C trudc dd. Doi vdi tre nii dang hanh kinh thi khdng lay mau, lay lai sau khi sach kinh.
Ve each thu thap so lieu, budc 1, chung tdi tien hanh lap ho so nhiing tre dupe dua vao nghien ciiu, ehpn ngau nhien mdi khoi ldp tir 1 den 2 ldp (45 - 70 tre), gap va pho bien cho tire ve muc tieu ciia nghien ciiu, each thiic lay nudc tieu, glii thu ngd va giay dong thuan tham gia nghien aiu, bang cau hdi, td hudng dan phuang phap lay nude tieu va Ip dimg nudc tieu cho tre.
Sau dd, budc 2 la khao sat mau nudc tieu lan thii nhat. Can nang, chieu cao, nhiet dp (do bang nhiet ke dien tir), huyet ap (sir dung may do huyet ap bang tay) dupe ghi nhan trude ngay lay mau nudc tieu. Sau dd tien hanh tiiu thap mau nudc tieu, bang tra Idi cau hdi vao dau buoi sang. Mau nude tieu la mau dau hen dupe lay sau khi tre thiic day theo bang hudng dan da glii trudc dd. Tim hanh thir mau nudc tieu ngay sau khi thu thap dupe, khong de mau luu qua 2 gid.
Ve dung cu, sir dung que thir 10 thong so nhan hieu LJRS-10 (Urine Reagent Strips for Urinalysis), duoc san xuat bdi TECO DIAGNOSTICS ANAHEIM, CA 92807 U.S.A.
Ve each thiic tien hanh thu nudc tieu, chiing tdi lae deu Ip dung mrdc tieu, nhung ngap que thir trong mau nude tieu, lay que thii ra khdi Ip dung nude tieu va chd dpe ket qua sau 1 phiit M I U thii dupe dpc tgi cho lan lupt bdi hai bac si mpt each rieng biet, doi chieu va tiiong nhat ket qua. Sau dd ghi ket qua vao phieu tiiu tiiap va len danh sach nhiing tre cd ket qua bat tiiudng trong mlu thir nudc tieu lan nhat va thong bao cho tre va phu huynh biet, de nghi tien hanh lay mau thir Ian hai.
Thuc hien budc 3 bao gom khao sat mau nudc tieu lan hai. Tre ed mau thu nudc heii lan nhat bat tiiudng dupe tieh hanh lay mau thii nudc tieii lan hai sau 7 ngay. Sau do, tien hanh lay mau va thu thap kef qua tiieo cae budc
tuong tu Ian thii nhat va len danh sach nhiing tre cd ket qua bat thudng trong mau thu nude tieu Ian hai va giri giay bao ket qua cho tre va phu huynh.
Budc 4 bao gom viec dinh hudng nguyen nhan gay bat thudng nudc tieu tren nhiing tre cd bat thudng nudc tieii Ian hai, lien he qua dien thoai va de nghi phu huynh hpp tac dua tre d&i benh vien Nhi dong 2 de khao sat them va thue hioi cac xet nghiem: cdng thiic mau, creatinin mau, tdng phan tich nudc tieu (TPTNT) bling may, dam rueu/ creatinin nieu, sieu am he nieu va cay nudc tieii.
Chiing toi sir dung phan mem Stata/MP 10.0 de xac dinh ian suat cac bien so va lap bang.
KETQUA
Trong tiidi gian fir thang 09/2009 den tiiang 12/2009, ed 546 ti^ dupe khao sat h^ng dd 351 (64%) tre thupc nhdm cap 1 (tir 6-10 tuoi) va 195 (36%) tie tiiupe nhdm cap 2 (tii 11-14 hioi), ty le nam/nii la 1,1A. Dp tuoi trung binh ciia dan so nghien ciiu la 9,61 ± 0,11 tuoi.
Cd 35 trudng hpp ed bat thudng nudc tieii tren tong so 546 tie ehiem 6,41%. Hau het cae bat thudng nudc tieu d miie dp vet va 1+. Rieng bat ihudng hong tau trong nude tieu tap trung nliieu d miic dp 3i- (bang 1).
Bdng 1: Phdn bo'muc do duang tinh cua nhung boJ diudng nudc tieu
Vet 1*
2*
3t
BachcSu
2 0 1 1
Dam
10 5 0 0
H6ng cau
1 5 4 6 Tre tieu bach cau khong kem mtrit chiem ty le rat tiiap (0,37%) (bang 2).
Bdng 2: Ty li tre tiai bgeh cdu khong kem tiai nitrit Bach clu
Am tinh Difong tinti
Tong
S 6 l u ^ ^ 544
2 546
Tyl?(%) 99,63
0,37 100,00 Tre tieu nitrit khong kem bach cau cung chiem ty Ie rat thap (0,37%) (bang 3).
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Y Hpc TP. Hb Chi Minh » Tap 16 * Phu ban cua So 1 ' 2012 Nghien ciru Y hpc
Binf! 3: Ti Ic tre tiai mtrit khing kim hach mi B^ch ciu + Nitrit
Am tinh Difffng tinh
Tong
Soiipgng 544
2 546
TylfC/.) 99,63
0,37 100,00 Tre beu dam don dpc ehiem ty le 2,75%
(bang 4).
Bdng 4: Ty le tre tiai dgm dan dgc Dgm
Am tinh IDLrcmg tinh
Tong
SdlipOTg 531
15 546
Tylf(%) 97,25
2,75 100,00 Tre tieu mau dem doc chiem tj' le tuong la 2,56% (bang 5).
Bdng 5: Tif le tre tmt nmt dtm doc Himg clu
Am tinh Duung tinh
Tfing
S6iirang 532
14 546
TylfCA) 97,44
266 100,00 Khong phat hien trudng hop nao ed tieii dam ket hop vdi tieii mau.
Tat ca (100%) cac bat tiiudng nudc tieu lan hai deu la tieu mau, ehiem ty le 8,57% tren 35 trudng hop ed bat thudng nudc tieii Ian nhat va ehiem 0,55% dan so nghien cihi (n = 546). Tat ca nhiing trudng hop tieu mau deu 6 miic dp 3+
(bang 6).
Bdng 6: Phdn bo'tre bdi thudng nudc tieu a TPTNT ldn hai so vdi lan nhdi
Bltttiifong B^ch cau don d$c
Nitrit dart doc Bach cau + Nitrit
Dam Hong cau 0?m + H6ng d u
Amft'nli 35 35 35 35 32 35
DiKmg tinli 0 0 0 0 3(3+)
0 Trong 3 trudng hpp co bat thudng Ian 2, cac xet nghiem ^ m soat nguyen nhan cho fhay cd 1 trudng hpp thieu mau tan huyet do thieu G6PD, 1 trudng hop than ir nude dp 1 va 1 trudng hpp hep da quy dau.
BAN LUAN Ket qua TPTNT Ian nhat
Ket qua TPTNT Ian nhat eiia chiing toi ed ty
le bat thudng nudc tieii la 6,41%, xap xi vdi tac gia Shajari (4,7%)"=', Rao (7,2%)'"", Kaplan (9,00%)*^' va cao hon so vdi ket qua cua tac gia Murakami (0,75%)<^*. Tuy nhien tiiap hon nhieu 50 vdi cac tac gia Plata (30,26%)^* va Tran Thanh Phong (>47%)"'". Mpt trong rtiiiing nguyen nhan la do chung tdi, Plata va Tran Thanh Phong xac dinh ty le bat tiiudng dua tren 4 tiidng so: badi cau, nitrit, dam va mau cdn eae tae gia co ty le tiiap han chi dua tren 2 tiidng so la dam va mau.
Xet rieng ty le bat tiiudng tieii dam, mau ciia chung toi la 5,3% tiii vln eao hon so vdi eae tac gia Murakami va Shajari.
Tioi dam
Trong nghien ciiu ciia chung toi, ty le tieu dam la 2,75%, cao hon Murakami (0,37%^ va Kaplan (l,60%)'2l Nhiing tnrdng hpp bat thudng tieii dam lan nhat hoan toan bieii hien d mik dp vet va 1+.
Tied mdu
Ty le tieu mau ciia chiing toi la 2,56% cao han Murakami (0,94%)'^) va Shajari (1,00%)'!^', gan 50% tieu mau la 3<-.
Tiai dam kei hap tiat mdu
Chung tdi khong ghi nhan dupe trudng hop tieu mau ket hpp vdi dam, trong khi theo tae gia Tran Thanh Phong ty le nay la 2,2%. Tac gia Tran Thanh Phong nghien ciiu d ca 2 doi tupng trudng hpc va benh vien khac vdi dan so nghien Cliu ciia ehiing toi.
Tieu bach cdu
Ty le tieii b?ch eau cua chiing toi la 0,37%
tiiap hon vdi cac tac gia Shajari (0,40%))'-'), Kaplan (0,65%)P), Plata (12,50%)'^ va Tran Thanh Phong (38,30%)"^).
Tim nitrit
Ty le tieu nitiit eiia ehiing toi la 0,37% thap han Shajari (Q,60%f'-^ va Tran Thanh Phong (4,60%)o^). Do dp nhay cua nitiit tiiap, tiiudng phoi hop vdi tieu bach cau de chain doan nhiem trimg tieu nen vdi dan so nghien euu ciia chiing tdi trong cdng dong nhiing tre em khdng trieu chiing thi kha nang duong finh se tiiap hem so
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Nghien cihi Y hpc Y Hpc TP. Ho Chi Minh * Tap 16 * Phu ban cua So 1 * 2012
vdi mau ldn hon cua tac gia Sfiajari va mau b-ong benh vien cua tac gia Tran Thanh Phong.
Tteu bach cdu ket hap nitrit
Ty le ti-e tieu bach cau kef hpp tieii nitiit ia 0,37% thap hon tac gia Tran Tfianh Phong (4,60%). Tuong tiJ vdi tieu bach cau, tieii nitrit d tren, dan so nghien ciiu aia chiing toi la frong cpng dong khae vdi tac gia Tran Thanh Phong.
Ty Ie bat fhudng bach cau va nitrit trong nghien ciiu eiia chiing tdi thap hon nhieu so vdi cac nghien ciiu ciia Shajari, Kaplan, Plata (4,6,7) cd the do trong qua trinh chpn mau chiing toi da tien hanh chpn mau thuan tien tai hai trudng Tieu hpc Nguyin Thanh Tuyen va THCS Truang Cdng Dinh la hai truong tap trung hau het cac em d npi fhanh (eu the la quan 3 va quan Binh Thanh). Ben canh dd, do han che ve nhieu mat ehiing tdi chi ti&i hanh nghien cuu vdi ed mau tuong doi nhd so vdi cac chuong trinh ^ m soat cua cae tac gia khac dupe thuc hien tren dien rpng, quy md ldn.
Ket qua TPTNT lan hai
Tu 35 trudng hop bat thudng nudc tieu Ian nhat, chung toi tien hanh TPTNT Ian 2 va chi edn 3 trudng hpp bat thudng. Ket qua bat fhudng nude tieu Ian hai chi tap trung d tieu mau don dpc vdi ty le la 0,55%. Ty le nay kha tuang ddng vdi ty le tieii mau don ddc trong bat fhudng Ian hai d nhdm aia cae tac gia Murakami {0,67%^ va Rao (0,46%)"'". Cd the fhay su chenh lech ty le bat thudng nudc tieu d hai Ian TPTNT bx)ng nghien cuu oia chiing tdi kha Idn. P^u het tap trung d nhdm bat thudng tieii mau va tieu dam.
Tir ty le tieii mau 2^6% Ian dau, Ian hai giam cdn 0,55%. Nhiing trudng hpp bat tiiudng tieii mau d miic dp vet, 1+ Ian nhat deu cho ket qua am ti'nh d Ian tfiir hai. Trong 6 trudng hop bat thudng tieii mau Ian nhat d miic dd 3+ tiii ket qua Ian hai cd 3 tivdng hpp cho ket qua am tinh deu tap tiung d nii, cap 2 va qua tim hieii chiing toi nhan thay rang kef qua bat thudng Ian nhat cd the da bi sai lech do cac em lay nudc tieu quanh chu ky kinh nguyet (cd nghia la cac em
gan den ngay hanh kinh hoac sau khi het kinh vai ngay). Do dd, chiing tdi nhan fhay rang beu chuah chpn mau frong nghien ciiu ciia chiing toi ehua that su chat ehe, chua loai het trudng hpp gay nhieu. Con lai 3 trudng hpp duong tinh d miie dp 3+, trong dd ed 2 tre nam va 1 tre nii.
Kef qua nay cho thay dp chinh xae eiia que (hir nudc tieii se cao hon khi duong tinh d muc dp cao hoac cd su ket hpp oia nhieu thdng so bat thudng (nhu tieu dam ket hpp tieii mau). Eh'eu nay phu hpp vdi ket luan ciia mdt so tac gia Pafel, Simerville, Rehmanifs-^i-i^).
TCr ty Ie tieu dam 2,75% Ian dau, Ian hai giam con 0%. Nhung trudng hop bat fhudng tieii dam Ian nhat hoan toan bieii hien d miic dp vet va 1+, khdng ghi nhan trudng hpp tieu dam 2+, 3+, do dd cd tiie day chi la nhiing trudng hop duang gia hoac tieii dam sinh Iy, thoang qua.
Tieu dam la mpt bat fhudng pho bieh d tre em, cd the thoang qua hoae keo dai bieii hien cho mpt tinh trang benh hoac cd the la lanh tinh.
Ty Ie tieu dam d ca hai gidi deu tang theo tud'i"'.
Nhan dinh nay phii hpp vdi ket luan ciia tac gia Miltenyi va eho thay tieii dam d mik 29-238 mg, d dp tuoi 10-16 la cao hon so vdi 15-68 mg d nhimg dp tud'i nhd han'^'. Dieu nay giai fhieh cho viec tim fhay "vet" va duong tinh miie dp nhe thudng thay,trong xet nghiem tieii dam tre em^^t.
Trong TPTNT lan hai, ty le tieu bach a u , nitrit CLia chiing tdi la 0% so vdi ty le tieu bach (3U, nitiit Ian lupt oia eac tac gia Tran Thanh Phong la 12,2%"^' va 1,0% va tieu bach eau eua Kaplan la 0,50%^^*. Su khac biet nay cd the la do chiing tdi chi thue hien S m soat tren nhiing tre khde manh, trong khi dd tac gia Tran Thanh Phong thuc hien tren ca hai nhdm doi tupng la tre dang di hpc va tre khdng cd trieu chiing, ti'en sir benh than nieu den kham tai benh vien. Ben canh dd su khac biet ve dp tuoi ciia dan so nghien ciiu cung cd the la mpt nguyen nhan.
Dan so nghien ciiu ciia tac gia Tran Thanh Phong d dp tudi tir 0-10 tuoi (miam non va tieu hpc), ciia Kaplan frong dp tudi 5-6 tudi (bat dau
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Y Hpc TP. Ho Chi Minh * Tap 16 * Phu ban ciia So 1 * 2012 Nghien cuu Y hpc
di hpc), cdn dan sd nghien ciiu cua chiing toi la tii 6-14 tuoi (tieu hpc va THCS).
Trong Ian TPTNT Kn nhat cd 8 tiudng hpp tieii bach cau, tieii nitiit Tuy nhien d Ian thir tiiii hai till khdng edn budng hop nao, vi tiie chiing toi da khdng tiie xac dinh duoc finh hang nhiem bimg tieu oia cac em Dieu nay la do ehiing tdi da khdng thue hien cay nudc tieu ngay eho cac em CO bat tiiudng d Ian nhat va cd the nhiem bimg tieii khdng tiieu chiing d cac em da tu gidi han. Theo y van nhimg budng hop nhiem trimg tieu khdng trieu chiing d tre khde manh thi khdng khuyen eao dieu tn khang sinh*^-^.
Trong 3 trudng hpp cd tieu mau d Ian tong phan tieh nudc tieii lan 2, chiing tdi da tien hanh kham lam sang va ed nhirng xet nghiem ban dau trong dieu kien cho phep nhu: TPTNT bang may, dam nieu/ creatinin nieu, sieu am he meu, cay nude tieii, xet nghiem mau, creatinin mau.
Bude dau, ehiing tdi ehi xae dinh dupe mot trudng hpp cd tinh trang thieu mau tan huyet do thieii men G6PD. Trong hai trudng hpp con lai, cd mot trudng hap than li nude dp 1 va mot trudng hpp hep bao quy dau can theo ddi va tai kham dinh ky.
Qua eac ket qua nghien ciiu tren day, chung tdi ghi nhan rang d tie nhd tuoi, bat thudng tien que fam soat thudng la Leucocyte esterase va Nitrit, tiong khi o tie ldn tud'i hon hoae tre tuoi hpc dudng thi bat thudng dupe tim thay chu yeu la hong cau.
Viec fam soat sdm cac bat tiiudng dudng nieu cd the lam gjam dieh tien den suy than man d tie em va lam giam ganh nang aia cac benh tiian man'"''.
KETLUAN
Ty le bat thudng nudc tieii Ian nhat la 6,41%
va ty le bat tiiudng nudc tieii Ian hai la 0.55%, Can ed nhiing ehuang trinh t'am soat nhiing bat fhudng nudc tieu d tre em trong cpng ddng. Ddi vdi nhiing trudng hpp cd TPTNT lan nhat bat thudng c'an lam lai
TPTNT lan hai. Doi vdi nhiing hardng hpp co bat thudng nudc tieii keo dai c ^ theo ddi va thuc hien cac khao sat chuyen sau de xac dinh nguyen nhan. Can cd mpt nghien ciiu vdi quy md rpng han, chpn mau ngau nhien, tieu chuan chpn mau chat che nham tang dp chinh xac cho nghien ciiu qua dd, xac dinh dupe ty le bat thudng nudc tieu trong cdng dong.
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Hpi nghi Khoa Hpc Ky Thuat Tmdng Dai Hpc Y Pham Ngpc Thach 2012
