TINH TRANG DINH DU'ONG C O A T R ^ EM NAM VIEN TAI BENH VIEN NHI TRUNG {fONG
Pham Thj Thu Hmrng*, Cao Thi Thu Huong Vifn Dinh du&ng, Hd N^i
T O M T A T
Nghidn cftu nhim xdc djnh tJ 11 suy dinh duftng d bdnh nhdn ndm vi§n tai b|nh vi§n Nhi tmng irong. Dilu b3 d t ngang dd duvc tiln hdnh d 337 tre, tuli td 6 thang din 15tuli. dilu trj tai khoa Ho Hip. Tim mach.
Thin kinh, Huylt hoc. Tit cd cdc dli tircmg dirpc do cdc chi so nhan trie bao gim cdn ndng. chilu cao hodc chilu ddi. phdn loai tinh trgng dinh dirf'ng nhdn trie theo tieu chuin cua WHO 2007. Odnh gid nguy ca dinh du^ng bing cdng cy ddnh gid ting thi chO quan (Subjective Global Assessment - SGA). Kit qui cho thiy: Ty 1$ nh^ can Id 18,2%. t^ 1$ cdi CQC Id 22,5%, suy dmh dudng cap tinh Id 18,1%, trong khi thda cdn chi 1.5%. Nguy or dinh du^ng sd dgng cdng eg SGA Id 43,1% trong do chu ylu suy dinh dud'ng nh^
vd vira diilm 92.4% (134/145). Nguy co dinh dif&ng ttieo SGA cao nhit d khoa Tim mgch, Huylt hpc.
Trong suit thdi gian nim vJdn c6 51% b|nh nhdn sgtcdn.
Td khda: Tinh trgng dmh dirong. suy dinh du*ng, SGA
I. DAT VAN DE
Suy dinh duang bfnh vipn la tinh ttgng phfl biln, ngay ci d nhftmg nude di phit trien [1].
Ty If suy dinh dudng khic nhau theo mftc dp phil trien cua dit nudc. Ty If suy dinh duong d tie em nira vifn eua eae nude d i phit trifin giao dpng tft 6% dfin 32% [1]. Trong khi dfi ty If suy dinh dufing cua cic nudc dang phit triln efi the Ifin ldi 70% [2]. Ty If suy dinh duong thufimg eao 6 nhumg ttfi mic eie bfnh n ^ g , cic bfnh mgn tinh [1]. 0 Vift Nam, lgi thdi diem chung Ifii nghien eftu chua eo nhifiu sfi lipu vfi tinh trang dinh duomg eua ttfi em nim vifn. Nghifin eftu cua bfnh vifn Nhi dongl lien hinh trfin trfi dudi 5 tuli cho tbay ty 1? nhe cin li 17,5% [3]. Nghien eftu efta bfinh vifn Nhi trung uong cho thiy ty If suy dinh dudng efta bfnh nhi nb^p vifn tai khoa Dinh dudng nim 2001 la 46,8 %, nim 2002 li 53,2% [4]. Suy dinh dufimg thudng phfli hpp vfii ting nguy eo nhilm khuan, chgm Hen vet m l sau phau thuit, kfio dii thdi gian nim vifn vi lim ting chi phi difiu ttj [5]. Dfi hgn ehfi cic hau qui do suy
dinh duomg giy ra, can sing lpc de phit bifn sdm cie dli tupng nguy eo dinh dufing, ttfin CO sd dd CO bifn phip ho tta dinh dudng kjp thai..Nghifin eftm cua ehung tfii nhim myc dich xic dinh tinh trang dinh dudng cfta ttfi em nim vifin.
II. PHlTONG PHAP NGHIEN ClTU 2.1 Dli tiryng nghifin cum
Trfi em tft 6 thing den 15 mfii. Tifiu chuin Iya chpn: Nhip vifin ttong vfing 24 gid, tinh nguyfn tham gia ngbien cihi. Tifiu chuin logi trft: Cic bfnh nhin fi ttong tinh ttgng eap cftu, thd miy, hfln mfi, lift.
2.2 Thiet ke nghifin cum
Nghifin eftu cit ngang mfl ti dupc tiln hinh lai 4 khoa cfta Vifn Nhi Trung uong: Khoa Hfl hip. Thin kinh, Tira ragch, Huyfit hpc tu thing 10 nim 2009 din thing I nira 2010.
2.3 C i c ky thuylt su' dung trong nghien cum
'Tdc gia: Ph(im Thi Thu Huong Dja chi: Vi^n Dinh du&ng Di?ntho9i: 04-8211758 Email: drhuongpt@gmail.com
Ngay nh|n bai: 26/01/2015 Ngay phan biln: 16/02/2013 Ngay dang bai: 20/04/2015
Tgp chi Y hpc dy phdng, T§p XXV, Sfl 3 (163) 2015
Difiu tra vien la cin bfl cua Vifin Dinh duang di dupc lap huin vfi cic ky thuit thu thap sfl lifu.
Tit c i benh nhin, ttong vong 24 gifi nhap vifin, du dieu kifn dupc thyc hifn ein ttpng lupmg CO the, do ehifiu cao/cbifiu dii (ttfi <24 thing), dinh gii ehft quan sft dyng cfing ey SGA. Cic thfing tin cua tie vfi ngiy sinh, gidi, chan doin, khoa difiu tii dupc ghi ehep lu bpnh an kit hpp phfing vin mp/eha cua ttfi.
Ky thuit cin trpng lupng vi do ehifiu dai nam/ chilu cao dirng, linh tufii eua tte theo hudng dan efta WHO [6]. Chung toi sft dyng zscore cin n$ng theo tufii (WAZ) dfi dinh gii nhp cin; sft dyng zseore ehifiu dai theo tufii (LAZ) dfli vdi tte <2 tufii ho§c zscore chilu cao theo tuli (HAZ) dfii vfii tte >2 mfli dfi dinh gii cfii cpc; sft dyng zseore cin ning theo ehifiu dii (WLZ) dli vfii ttfi <2 tufii hogc zscore cin ngng theo ehieu cao (WHZ) dfli vdi tte tft 2 den 4 tufli hoic zscore BMI theo tuli (BMIZ) dfli vdi tie > 5 tufli de danh gii giy cfim edn dupc gpi li suy dinh duong cip tinh. Phan loai tinh ttang dinb dudng tbeo cic chi sfi nhin trie dya vao tifiu chuin efta WHO, vdi quin the tham ehifiu WHO [7]. Giy cfim khi WLZ hoie WHZ ho&c BMIZ <-2SD. Nhp ein khi WAZ <-2SD.
Coi cpc khi LAZ hoic HAZ <-2SD. Thfta ean khi WLZ hoic WHZ>2SD hoic BMIZ>1SD.
Dinh gii tfing thfi chft quan (SGA): Su dyng bfi ciu hdi SGA dupc xiy dyng dya theo mlu phieu cua Detsky 1987 [8] dfi phfing vin va thu thip cic thfing tin vfi ve lien su lifin quan den tinh ttang dinh dudng efta ngudi bpnh nhu:
Cie thay doi, bao gfim cin ning, khiu phin in, tin xuat vi sy efi rail efta cie trifu ehftng
dg diy mfit, khi ning van dpng (lifin quao dfin dinh dudng). Tit e i bfnh nhin dupe khim Iim sing dfi phit hifin eic diu hifu lifin quan dfin dinh duang nhim phit bipn cic diu hifu giim md (vi tti co tam diu hoic vftng xuang sufim dufii lai diem gifta vung nich), giim co (vj tri ca tft diu dfti hoic co denta), phu (vj tri mil e i ehin hoic mu bin ehin/m^l tioifie xuong cing ehin), eo chuong (bpng). Cic difiu tra vifin dinh gii nhu ciu ehuyfin boa cua cie tinh ttgng bfnh Iy dang dien ra d bpnh nhin vi eie dau hifu lam sing phfii bpp cung vdi suy dinh dudng dfi di den danh gii toan difn tinh trgng dinh duong efta bpnh nhan. Vipc dinh gii khflng dya vio be thong tinb diem cumg nhie mi dya vio so lupng tifiu chi co cac muc nguy ca dinh duang nhilu hon: Mftc dp A- khfing cfi nguy ca dinh duong, mftc dp B- nguy co dinh du&ng tft nhp din vua, mftc dp C- nguy CO dinh duong ning
2.4 Xir ly va phan tt'ch so lieu
Tinh toin thong ke trfin phan mem SPSS, phifin bin 16.0 (SAS, My). Cic sfl do khfing lifin tt^e sft dyng ty If vi so sinh hai ly If. Kfit qua dupc cfing nhin efi y nghia tbong kfi khi p<0,05
HL KET QUA
Tfing s l 337 dli tupng tham gia nghifin cuu (nam gifii cbiem 61,7%i, nft gidi chifim 38,3%), tie dudi 2 tufli ehiem 59,3%, tifip dfin ttfi tu 2 dfin 4 tuli (24 din 59 thing tuli) chilm 22%, lft 5 din 9 tuoi li 13,1%, tte ttfin 9 lufli ehi ed 5,6%. Ty lp dfli tupng tham gia nghifin cftu tgi cic khoa: Khoa ho hap ehifim 42,1% (khoa thin kinh 34,4 %, khoa huylt hpc 14,2%, khoa lim mgch 9,2%i.
Tap chi Y hpc dy phfing. Tgp XXV, So 3 (163) 2015
Bdng 1. Ty lg suy dinh dvcmg danh gid bing cdc sd do nhdn trie, 0ieo cdc nhdm t u l i
d v d ^ g Nhe cdn Coi CQc Gdy cdm Thda cdn
<2tu6i (n=200) 17.5 (35) 20.0 (40) 17.5 (35) 2.0 (4)
2-4 t u l i (n=74) 18,9(14) 27,5 (19) 13,5(10) 1,4(1)
Nhom t u l i , % (n) 5-9 t u l i
(n=44) 20,4 (9) 27,3(12) 20.4 (9) 0(0)
10-15 t u l l (n=19)
26,3 (5) 36,5 (7) 0(0)
Chung (n=337) 18.2 (58) 22.5 (76) 18.1 (61)
1,5(5) Ty If suy dinh duong nhp can li 18,2 %. Ty If
suy dmh duflng efii epc li 22,5%. Ty le suy dmh duong eip tinh hay cfin gpi li suy dinh dufing
thfi giy cdra li 18,1%. Ty If suy dinh duong nhp can, efii cpc cfi xu hudng ling tbeo nhdm tufli (p>0,05).Tylp thua can tiiip 1,5% (Bing 1).
Bdng 2. Ty l | suy dinh du-dng ddnh gid bing cdng cp SGA, theo t u l i
Odnh gid SGA Khdng cd nguy ca
Nguy CO- dinh dudng td nh? din vda Nguy CX7 dinh du&ng ndng Cdng
<2 t u l i 59.0(118)
36,0 (72) 5.0 (10) 59,3 (200)
Nhom t u l l 2-4 t u l i 51,4(38) 47,3 (35) 1.4(1) 22,0 (74)
%(n) 5-9 tuoi 61,4(27) 38,6 (17) 0,0 (0) 13.1 (44)
10-15 t u l l 47.4 (9) 52,6 (10)
0.0 (0) 5.6 (19)
Cdng 57,0 (192) 39,8 (134) 3.3(11) 100,0 (337)
Su dyng efing eu SGA cho tbay ly If dfii tupng cfi nguy co dinh duflng li 43,1%:
mftc dp nhp dfin vfta (39,8%), mfte dp ning 3,3%. Nhfim tufli 10 den 15 tuoi cfi nguy ca dinh dudng (52,6%) eao hon nhdm tufli kbic
(p>0,05). Khoa Tim maeh cfi ty le nguy ea dinh duflng cao nhil 67,8% (21/31), tilp tiieo li khoa Hfi hip 50,7% (72/142), khoa huyfit bpc 31,2 % (15/48), khoa thin kinh 31,9 % (37/116) (Hinhl).
HA hip Tim m^ch Thin kinh Huylt hpc
BKhdng nguy co OD ONguy ca dinh dufing
Hinh I.Ty 1$ suy dinh dti-dmg ddnh gid bdng cong eg SGA theo cac khoa dilu trj
Tap chi Y hpe dy phdng, Tgp XXV, S l 3 (163) 2015
Hinh 2. Ty 1$ thay doi cdn n|ng trong thdi glan nam vl$n, theo tuli
Ty If giim cin ttong thfii gian nim vipn la 51%. Tre dufii 2 tuli efi ty lp giim can ttong thdi gian nim vifn cao nhat (54,4), tifip theo li lua tufii tft 5 den 9 tufii (52,6%) vi Ifta tuli 2-4 tufli (45,4), tre ttfin 9 mfii cfi ty 1? giim can thip nhil (28,5%t). Trong sfl giira ein ttong thdi gian nim vifin thi tJ If giira <2%
li 30,8% (48/156), giira tu 2 din 5% li 45,5%
(71/156) vi giim >5% la 23,7% (37/156).
IV. BAN LUAN
Trong nghien cuu eua chung tfii, dya vio quin thfi tham ehifiu efta tfl ehftc y te thfi gidi (WHO 2007), ty If suy dinh duflng thfi nh? cin (cin/tufli) li 18,2%, suy dinh dufing man tinh (edi cpc) li 22,5% va suy dinh duong cap tinh (giy edm) la 18,1%. Vdi thfi suy dinh dufimg man tinh va cap tinh, nhom tufii cing cao ty If suy dinh du&ng eing eao. Nghien ciiu efta chung tfii li mflt ttong sfl it nghifin cftu lai bfnh vifn Vipt Nam vfi tinh tixmg dinh dudng efta tre em tft 6 thing den 15 tufii. Trong nghifin cftu cfta chung tfii ty If suy dinh duflng nhp cin cfta ttfi dufii 5 lufii tucmg duang vfii bfnh vifn Nhi Dfing 1 (18,2% so vdi 17,5%) vi cao hon bfnh vifn da khoa tinh Hii duang, nhung ty If suy dinh duflng cip tinh cao hon bfnh vifn Nhi ding 1(18,1 % so vdi 9,3%) [3] vi bfnh vifn Da khoa Hii duong (13,5% so vdi 5,8% d Ifta ttili tii 24-60 tiling) [9]. Ty If suy dinh dudng eua cie bfnh vifn khae nhau, efi nhilu yeu l l inh hufimg nhu yfiu to loai bpnh nhgp vifn (eap tinh, man tinh) dia du, tinh ttang kinh tfi xi hpi
efta tijng viing. Nghifin eftu cua ehftng toi bao gflm ei bfnh man tinh vi eap linh, ttong khi dfi nghien eftu cfta bfnh vien Nhi Dong I chi vfii dfli tupng bfinh cap tinh.
Day li mpt ttong sfl it nghifin cuu fi Vift Nam ip dyng phuang phap SGA sing lpc nguy CO dinh duflng d ttfi em nim vipn. Nguy co dinh dufimg SGA ting tbeo tufli, nhdm tte ttfin 9 tuoi cfi ty lp nguy ca dinh du&ng li 50,6%.
Nghien cuu cua tic gii nguyen Do Huy lgi bfnh vipn da kboa Hii duang cho thay ty le nguy ea suy dinh duomg theo SGA cao fi Ire em nim vien, 33,l%o d tie dudi 24 thing vi 51,4% d tte 24 dfin 60 thing [9]. Trong nghifin eiiu efta ehung tfii cho thiy khoa Tim ragch va khoa Hfl hap ed ty lfi nguy co dinh dufing cao han cic khoa khie. Khoa Tira ragch vi khoa Huyfit hpe li hai khoa eo eie bfnh raan tinh.
Khoa hd hap vi khoa thin kinh la khoa cip linh. Thi nhung ty If nguy co dinh duong theo SGA khie nhau a cie khoa khfing phy thupc vio eip tinh hay man tinh. Cic yfiu lfi eip tinh hay man tinh chi li mfit tifiu ehi ttong phin logi SGA. Nghifin eftu cfta Rojratsirikul (2004) di chi rfi ttong phin logi SGA, cie tifiu chi nhu lifin sft rail can, cic tripu ehftng da diy-mfit la hai ciu hfii cd dfi nh^y nhit. Cic lieu chi nhu lien sft thay dfli cin nSng ttong hai tuin qua, tang nhu eiu ning lupng li cic yeu to phli hpp vdi ty If euli eung cua SGA [11]. Cic nghifin cftu da chi rfl phuang phip SGA dupc dinh gii li cflng ey don giin cd dp nhiy cao khi so sinh vdi nhieu ehi sfl nbu protein nfli tang.
90 Tap ehi Y hpc dy phdng, Tgp XXV, Sfl 3 (163) 2015
sfi do nhin trie, thinh pbin ca thfi v i ed thfi tifin doin eic bifin ehftng sau phiu tiiuat [8, ' I ] . Trong nghifin eum cua ehung tfii, phuang phip SGA cfi dO nhiy 83,5% v i dp d | c hifu li 68,1% so vfii phuong phip dinh gia nhin trie voi cbi so gay cfim (suy dinh duflng eip tinh) dya vio quin till tiiam ehilu efta WHO (khfing till hipn ttong pbin kfit qui
Giam can trong thfii gian nira vifn li tinh ti^g pho bien d bfinh vifn. Ty le giim ein ttong thfii gian nam vifin ttong nghifin cuu cua ehftng tfii la 51%, chft yfiu li mit ean trfin 2% voi ty If 35,3%. Ty If giim cin ttong thdi gian nam vifn ttong nghifin eftu cfta ehiing tfii cao hom nghifin cuu efta benh vipn Nhi Dfing 1 (51% so vdi 28%) [3], nhung Ihip hon nghien cuu ciia Sermet-Gaudelus ttong mot bfinh vifn ohi lai Paris (51% so vdi 65%) [12]. Trong nghien cftu eua ehung tfli khflng cfi difiu kifn dinh gii lien quan dfin tifin lupng bfinh. Tuy nhifin mfit sfi ngbien eftu d i ehi ra mit cin Uong thfii gian ngin lien quan cfi y nghia vdi suy dinh duflng. Cie nghien cftu trfin ngudi Ifin da ehi ra mil cin > I % ttong thdi gian 3 thing phau thuat lien quan vfii ly lfi mae bfnh sau m l [13]. Merritt eho ring mil can >5%
trong vong I thing l i nguflng dfli vdi hiu qui Iim sing bit lpi [14].
V. KET LUij^N
Ty lfi suy dinh du&ng cao d ue em nim vifin, vdi ty If suy duomg nh? ein l i 18,2%, cfii epc li 22,5% v i suy dinh dufimg cap tinh li 18,1%. Ty lp Ue efi nguy ea dinh dufing theo cong cu SGA li 43,1%.
TAI LIEU T H A M KHAO
1. Joosten FM K, Hulst JM. Prevalwjce of malnutri- tion m pediatic hospital pabents. Current opinion in pwhatric 2008; 20: 590-596.
2. Ferreira HS, FianAOS EvoluDon of nutritional status in hospitalized children. Joumal de Pediatna 2002; 78; 491-496.
3. Nguyin Thi Hoa, Hoang Thj Tin, Nguyin Cong Khin. Tmh trang dinh dirSng va ylu t6 nguy co suy dinh dirdngcua benh nhi nfi tni bj bfnh cap dnh tgi benh vifn Nhi Ddng 1. Tap ch! Dinh duong v i th\rc pham, 2008,4{3+4); 202-212.
4. Nguyin Thj Ydn, Luu Thj MJ Thgc Tmh hinh suy dmh duOng d tre em tai benh vifn Nhi trung uong nam 2001 -2002. Tap chi Dinh dirdng va thyc phim, 2006.2(2): 35-40.
5 Kenneth EC. Malnutrition and bad oucome. J Gen intern Med, 2002,17(12): 956-957.
6 WHO. Measureing change in nutritional status.
WHO, Geneva, 1983:12-18 /. WHO. Child growth standards, 2007.
8. Desky AS, McUughlin JR, Baker JP, Johnston N, Whiltaker S, et al. What is subjective global asess- ment of nutrition status'' JPEN J Parenter Enteral Nutr, 1987,11(10): 8-13.
9. Nguyen Do Hi^, Vii Minh Thgc. £)anh gia tinh t i ^ g dinh dudng tre em 6-60 th^ng tudi trong bfnh vi?n bing phuong phap nhln trie va phuong phap SGS. Tgp chi Y t l cong cgng 2013,27(27): 11-15.
10. Rojralsinkul C, Sangkhathat S, Pati^inyokut S.
;^)plicaton of subjective global assessment as a scieening tool for malnutrition in prdiatric surgical patients. J Med Assoc Thai, 2004,87(8): 939-946.
11. Seeker DJ, Jeejeebhoy K. Subjective Global nutri- tion assessmnet for children. Am J Clin Nutr.2007, 85: 1083-1089.
12. Sermet-Gaudelus 1, Poisson-Salomon A, Colomb V, Brusset M, Mosser F, Berrier F, Riour C. Single pedi- atric nutritional nsk score to identify children at risk of mabutribon. Am J Clin Nutr, 2000,72:64-70.
13. Wmdsor JA, Hill GL. Weight loss with physiolog- ical impairment. A basis i n d i c ^ r of surgical risk Ann Surg, 1988, 207:290-296.
14. Merrin RJ, Blackburn GL. Nutntional assessment and metabolic response to illness ofthe hospitalized child, ta: Suskind RM, ed. Text-Bool of pediatric nutrition. New Yoik, Raven press, 198 T 285-307.
Tgp chi Y hpe dy phdng, Tgp XXV, Sfl 3 (163) 2015
NUTRITIONAL STATUS OF CHILDREN HOSPITALIZED AT NATIONAL HOSPITAL OF PEDIATRICS
Pham Thi Thu Huong, Cao Thi Thu Huong National Institute of Nutrition
Study was carried out to identify the prev- alence malnutrition among children inpa- tients at National Hospital of Pediatries. The cross-sectional study was conducted with 337 children inpatients, age from 6m lo 15 y, who were hospitalized in respiratory, cardiology, neurology, and hematology wards. All patients were assessed anthropometric index include body weight, body height/length and classi- fication malnutrition by using WHO criteria (2006). They also were evaluated the nutrition risk by using a Subjective Global Assessment
(SGA) screening tool. The Result showed tiiat the prevalence of underweight was 18.2%, of stunting was 22.5%o (, and of aeute malnutrition was 18.1% while the prevalence of overweight was only 1.5%. The prevalence of malnutri- tion using SGA method was 43.1 %, which was mainly mild and moderate malnutrition 92,4%
(134/145). The highest prevalence of malnutri- tion using SGA classification was at the cardi- ology ward (67.8%). In total, 51% patient lost their body weight during hospitalization.
Keyword: Nutrition status, mahiutrition, SGA
Tgp chi Y hpc dy phdng, Tgp XXV, Sfl 3 (163) 2015