TCNCYH Phu truung 80 (3A) - 2012 6. Kliegman MR. (2006). Birth injury. germinal matrix - intraventricular hemorrhage Textbook of pediatrics, 15"^ Ed; 4 6 5 - 4 7 1 . of the premature infant, clinical feature and
7. Volpe JJ. (2005). Cranial hemorrhage diagnosis. Neonatology (11) 421 - 426.
Summary
CLINICAL FEATURES OF MENINGEAL CEREBRAL HEMORRHAGE IN PREMATURE BABIES
Meningeal cerebral hemorrhage in the premature baby is dangerous disease with neurologic sequence and high mortality rate. This study was to determine some clinical features of 434 premature baby with 134 children with meningeal cerebral hemorrhage and 225 children without meningeal cerebral hemorrhage. Results showed that the severe acute respiratory failure was seen 83.6% patients. 78.4% patients had anemia, Unconscious was accounted for 59 7%.
16 4% had no clinical manifestations. Unconscious as clinical symptoms was the highest speci- ficity (91.6%) for meningeal cerhbral hemorrhage, then the acute respiratory failure 83.1% and hypotonia (82 2%). Hemorrhagic symptoms was the highest specificity (95.5%>), then acute ane- mia (82.2%) and hypothermia (60%). The rate of meningeal cerebral hemorrhage was met with the highest combination hyalin membrane disease (53%), then a large patent ductus arteriosus (24 6%). In conclusion, the most frequent clinical feature was severe acute respiratory failure then was anemia and unconscious. Hemorrhagic symptoms was the highest specificity (95.5%>) Hyalin membrane disease was the most common in meningeal cerebral hemorrhage disease Keywords: premature, hyalin membrane disease, respiratory failure. Meningeal cerebral hemorrhage
DANH GIA BU'aC OAU CHAT LU'O'NG SONG O TRE EM SAU VIEM MANG NAO MU
Nguyin Phuvmg Hanh, Nguyin Van Lam, Pham Nhat An Nguyin Thanh Liem, Thanh Ngoc Minh, Nguyin Thj Hong Thuy Nguyin TuyitXwryng, Lai Thu Ha, Nguyen Xuan Nam Benh vien Nhi Trung wang Vidm mang nao mO Id bdnh dd lai cac di chwng thin kmh nang ni, gay nen cac vin di vi hoc tap,.
giao tiip va phat then xa hdi ciia tre, chit Iwang sing vi thi se hi giam siit. Nghidn cu'u nay nhim muc tieu ddnh gid chit luung sdng cua bdnh nhdn viem mang nao mu sau l<hi ra vien va tim hiiu mot s l yiu td lidn quan. Tudi trung binh cua benh nhdn nghien ciru la 39 ±18.6 thang. Khoang thai gian dwoc danh gia chit Iwang sdng sau khi tre bi bdnh la 25.6 ± 10 thdng. Co sw khac bidt vi chit twang sdng giOa nhdm benh vd nhdm chirng ca vi s6 diim lidn quan din chdt Iwang sing chung lin chirc nang sinh ly, cdm xuc, xd hdi, hoc dwdng (p < 0,001). Tuy nhidn, khdng xdc dinh dwac sw lien quan glQ-a chit Iwang sing cOa tre vdi cdc yiu td cdn nguyen gdy benh, can thidp ngoai khoa khi diiu tn, khu vwc sdng hay mirc dd r)ghe kdm Kit qud nghtdn ciru cho thiy chit Iwang sdng cua 'tre em sau viem mdng ndo mii bi giam sut so vdi cdc trd binh thwang
TCr khoa: chit liFcrng song, viem mang nao mu, tre em
45
TCNCYH Phu tnjung 80 (3A) - 2012
I. DAT V A N D ^
Viem mang nao mu la benh hay gap d tre em tai cdc nudc dang phat tnln trong dd ed Viet Nam [2] Day la mdt benh nhilm trung nang, khdng nhirng cd t h i gay tir vong md cdn d l lai nhirng hau qua di chirng lau dai do t i n thuang thin kinh [5 - 8]. Cac dl chung nay gay nen cac v i n d l v l hoc tap, glao tilp va phat tnln xa hoi cua tre [3, 5 - 8]. Benh vien Nhi Trung uang hang nam tiep nhan tren 200 benh nhan dugc cac tuyln chuyin d i n vdl chin doan viem mang nao mu [1]
Chiing ta da co nhirng nghien ciru v l tinh trang benh nhan trong khi nam vien nhung chua cd mgt theo ddi nao that diy dii cho benh nhan khi v l nha Sau ra vien, chit lugng sing eiia nhii'ng benh nhan ra sao?
Y l u t l nao co tac dgng ldn nhlt d i n chit lugng sing cua cae benh nhan"? Tra ldi nhCrng cau hoi cua nghien ciru nay. nhom nghien ciru nay mong muon dua ra duac nhirng ldi khuyen va hudng d i n ap dung duge eho cac ca sd y - t l tuyln dudi va gia dinh benh nhan nhim nang cao chit lugng
•phue hdi chirc nang va cham sdc sire khoe toan dien cho benh nhan di chung sau viem mang nao mu. Muc tieu:
Danh gia chat luang sdng cua benh nhan viem mang nao mu sau ra vien.
Tim hieu mot s6 yiu td anh huang chat Iwang sdng cua benh nhan sau viem mang naomu
II. D6\ TU'O'NG VA PHU'CNG P H A P Doi tugng nghien euu: Benh nhi dugc ehln dodn viem mang nao mu dieu tri tal benh vien Nhi Trung uang tir thang 01/2007 d i n thang 12/2010
Tieu chuin lya chpn;
- Tir 2 -18 tuoi vao thdi dilm nghien eiru, - Cac benh nhan dugc chin doan xac dmh viem mang nao mii tien phat bang ket qua sol cly hoac bing kT thuat PCR tim vi khuan trong dich nao tuy
Tieu chuin loai trir"
Benh nhan viem mang nao mu sau chin thuang hay phlu thuat sg nao, cd shunt dich nao tiiy, ca dja suy glam miln djch (benh nhan HIV/AIDs, ung thu, ghep tang)
Viem mang nao mil tai phat.
Cd bit thudng v l nhan thire hay hanh vi trudc khi bj viem mang nao mil.
Bi chin thuang so nao sau dgt dieu tri viem mang nao mii.
Thilt ke nghien ciru;
Muc tieu 1: phan tieh benh - chirng (nhdm- benh; d l i tugng nghien ciru, nhdm chirng.
anh chi em rudt ciing gldi va gan tudi nhlt vdi tuoi benh nhan hoac mdt tre cung gidi, gan tuli nhlt trong khu vue sing ldn can).
Muc tieu 2- Nghien ciru md ta d t ngang cd phan tieh.
Thdi gian t i l n hanh nghien ciru- tir thdng 04/2010 d i n m a n g 10/2011
Bg eau hdi nghien ciru nghien ciru su dung bg cong cu "chit lugng song tre em" (Pediatric Quality of Life Inventory PedsQL™) eua tac gia James W Varnl (Hca Ky). Bp cau hoi nay da dugc ap dung cho han 350 nghien ciru v l chit luang sing d tre em tren t h i gidi bj cac nhdm benh khac nhau. Bp cdng cu gdm 23 cau hoi. Dilm ting hgp chit iugng sdng tinh tir 0 - 100 vdl 0 la thip nhlt va 100 la dilm cao nhlt
TCNCYH Phu truung 80 (3A) - 2012
Chirc nang smh ly (8 cau)
Diem tdng hap Chirc nang cam xuc (5 cau)
Chirc nang xa hdi (5 cau) Chirc nang nha trudng (5 cau)
D i l m tdng hap sue khoe t h i chat
Dilm ehlt ' r-.'^ . i , . , > luang sinq
Diem tong hgp sue khoe tam ly xa hgi chung
Cac budc tlln hanh nghien ciru:
Budc 1 Dua vao h i sa luu trij' de lua chon benh nhan phu hgp tieu chuan va mdl cha me benh nhan va benh nhan tham gia nghien ciru.
Budc 2: Hoan thanh bo cau hoi danh gia chat Iwang song PedsQL™ ve tinh trang d l i tuang la con minh vd doi tugng chwng da duge xac dmh trudc.
Bude 3: Viec kham sire khde va kham thin kinh tong quat duac thue hien bdi nhdm cac bae sT cua nghien ciru da qua tap huln Cac benh nhan sau do se duge danh gia phat tnln tam van ddng bang test Denver II va kham Tai mui hong, do thinh luc.
Cac kit qua lam sang va xet nghiem duge ghi lal trong ho sa benh an nghien ciru khoa hoc
Xu- ly va phan tieh s l lieu; So lieu nghien ciru duac nhap vao bang Excel va xw 11 bang phln m i m SPSS 18.0. Thuat toan t-test dugc SU' dung de so sanh su khac biet v l chit lugng song gii>a nhdm benh va chirng.
Su khac biet dugc col la ed y nghTa thing ke khl p < 0,05. Phan tieh hll quy dwac su dung d l phan tieh mli tuang quan giii'a ehlt luang sing va cac biln s l khae.
III. KtT QUA
1. Mo ta dac d i l m benh nhan nghien CLPU Nghien euu cd 24 benh nhan tham gia vdl nhdm ehirng gom 24 tre do cha me ciia lua ehpn la anh chl em rudt hoac anh chi em hp song g i n nha vdi tre Cac tre bi mic benh viem mang nao mu khi khoang 12,9 thang (Nhd nhlt 2 thang, Ldn nhlt: 82 thang) Thdi gian tir liie bl benh d i n thdi dilm nghien eiru ta25,6± 10,0 thang.
Trong s l 24 tre, vl khuln gay benh chu y l u la Hlb (13 tre, ehilm ty le 54 2%), sau do . la Phi clu (9 tre, ty le 37,5%) va ed 2 tre la do vi khuln khac (ehiem 8,3%). Cd 41,67%
benh nhdn (10 tre) c i n can thiep ngoai khoa khl dilu tn benh (lly I can dudi mang eung, d i n luu nao thit ra ngoai hoac dat d i n luu nao thit - 1 bung), cdn lal 58.33% benh nhan chf dilu th ndl khoa.
Bang 1. So sanh mot so dac diem djch te giCna 2 nhdm benh va chirng
Gioi
Nam NO'
Benh n, (%) 13(54,2%) 11 (45,8%)
Chirng n2 (%) 8 (50%) 8 (50%)
P 0,614
Khu vuc sing
Tuol hien tal (thang)
Thanh thi Nong thon
8 (33,3%) 16(66,7%) 39,0 (±18,6)
8 (33,3%) 16 (66,7%) 91,4 (±46,7)
1.000 0.001
TCNCYH Phu tnjung 8V (3A} - 2012
Bang 1 so sanh dac dilm dich t i cua nhdm benh vd chirng. Tuli nhdm chirng (91,4 ± 46,7 thang) cao han nhdm benh (39 ± 18,6 thang) (khae biet cd y nghTa thing ke p ^ 0,001) do nghien eiru ehi ggi duac cac tre nhd mdi mie benh trong thdl gian g i n day Dac dilm ve khu vuc sing vd gidi la tuang duang (p > 0,05).
2. Danh gia chit lu^ang song
Bang 2. So sanh chit lu^ang song giira nhom benh va chu>ng
Chirc nang sinh ly Chirc nang cam xiic Chirc nang xa hoi Chirc nang nha tru'crng Oilm ting ho'p sire khoe t h i chit Dilm ting hop sire khoe tam ly xa hoi CLS chung
Nhom benh (SD) 91,21 (12, 09) 85,31 (14,43) 90,94(16,75) 78,49 (27.92) 91.21 (12, 09) 87.14(14.58) 88,78(10,69)
Nhom chii'ng (SD) 99,22(1,80) 96,56 (6,76) 100,00(0,00) 100.00(0,00) 99.22(1,80) 98.50 (2.75) 98,78(1,93)
P*
0.012 0,006 0,042 0,029 0.012 0.005 0,001
* SLl' dung Wllcoxon Signed Ranks Test d l kilm dinh (phan phli gia tri cua dilm chit lugng sing trong nghien ciru khong chuin).
Co su khac biet v l chat luong sing giua nhom benh va nhom chirng ca v l dilm chung lln chirc nang sinh ly, cam xiic, xa hoi, nha trucrng.
3. M i l lien quan giira chit Iu'o'ng sing ciia benh nhan sau viem mang nao mu vai cac ylu td khac
Vi khuln gay benh Khu vyc song Can thiep ngoai Giam thinh lyc Hlb Phe cau Thanh
thi Nong
thon" 0 6 Khong 0 6 Khdng Dilm chit „_ n-
, oo,U/
luo'ng M l KM slng(SD) ( " ' ^ 5 '
90,82 (10,09)
90,35 87,48 (11,20) (10,89)
90.27 86.90 87,11 86,62 (10,57) (11.18) (10,71) (12,32)
0,408 0,570' 0,524 0.945
P*: kiem dinh Mann-Whitney-U,
Khong CO m i l liln quan giOa chit luong sing cua benh nhan sau VMNiVI vol cac y l u to vi khuln gay benh, khu vuc sing, tinh trang nghe kem hay can thiep ngoai khoa.
Kit qua ciJa nghien ciru cho thay co mot ty le Ion benh nhan co cac bilu hien cua r l i loan tang dong tu' nhe d i n nang (chilm 79,2%) Mac dii hanh vi tang dpng ciia tre khong co m i l lien quan giOa dilm chit lugng sing chung (p = 0,18) nhu'ng lai cd m l i lien quan vcri diem t i n g hop sire khoe tam ly xa hgi (p = 0,05)
TCNCYH PhiJ truung 80 (3A) - 2012
Khong tang dpng Tang dgng nhe Tang dong vira Tang dong nang Gia tri p*
n 5 7 6 6
D i l m c h i t Iu'o'ng sdng Chung
92,17 95,95 84,52 79,9 0,18
D i l m tdng hap sire khoe tam ly xa hoi
95,83 96.46 85.10 71,00 0.05 IV. BAN LUAN
Vdi mdt nghien ciru v l ehlt lugng song ciia cac benh nhan da ra vien duge mdt thdi gian dai, viec thuylt phue dugc benh nhan tdi tham gia nghien ciru la khdng d i ddng vi t h i k i t qua bao cao trong nghien ciru nay vdl 24 benh nhan chi la nhirng danh gia budc d i u Tren t h i gidi, cac nghien eiru v l chit luang sing cua tre sau khl bl viem mang nao mu cung khdng nhilu va nghien eiru chua tim thly nghien ciru nao sir dung bang cau hdi ehlt luang sing PedsQL™ d l danh gia cho tre sau viem mang nao mu.
Vi sir dung bd eau hdi PedsQL™ nghien ciru nay da danh gia duac chit luang sing ciia cac tre tir 2 tuli trd len trong khi vdi bd cau hoi HU13 md mdt s l nghien eiru danh gia ehlt lugng sing cho tre viem mang nao mii khdc chl danh gia dugc eho tre tren 5 tuli.
Ro rang la tuli trung binh cua tre trong nghien ciru nay t h i p han so vdi cac nghien ciru khdc [3, 4].
D l i tugng bao ham trong nghien ciru nay cung khac vdi nghien ciru d cac nude phat tnln khac la vi khuan gay benh chu y l u la Hlb.
Benh nhan viem mang nao mil do Hlb khdng dugc tinh din trong cac nghien eiru v l ehlt lugng sdng sau viem mang nag mil khac [3, 4].
Su khae biet v i chit lugng sing glCr'a nhdm benh va nhdm chirng la r i t rd rang Giam sut ve chit lugng sdng cua tre sau viem mang nao mu cung rit rd rang trong cac nghien eiru trudc day 182 tre bi VMNM
khdng do HI tai Ha Lan khi so sanh dilm chit luang sing cua quin t h i mau cung giam rd ret 69 tre bi viem mdng nao mu do p h i c l u tai Anh khi so sanh vdi nhdm chirng cung ed su khae biet rd v l chit lugng song [3, 4].
Su khdng khdc biet giQ'a v l chit lugng sing giQ'a nhdm viem mang nao mu do phi elu, HI, giira nhdm cd va khdng can thiep ngoai, giQ'a nhdm ndng thdn va thanh thj cho thly khong co anh hudng cua cac y l u t l vi khuln gay benh, ean thiep ngoai khoa va khu vuc sdng len chit lugng sing cua eae tre sau viem mdng nao mu. Khdng cd su khae biet ve ehlt luang song giC^a nhdm cd va khdng nghe kem cd t h i giai thieh do mlu eua nghien ciru nay khdng dii ldn nen khdng tim duge su khdc biet cd y nghTa thing ke Tuy nhien, kit qua nghien ciru ydl 182 tre tai Ha Lan cung da tirng kit luan tuang tu khi tim mil Hen quan glCra chit luang sing cua tre va su nghe kem.
Cac roi loan v l phat triln tam thin v i n cdn it duac quan tam vd di sau nghien ciru d Viet Nam. NhQ'ng nam g i n day thi ty le tre dugc phat hien cae r i l loan nay cung tang len nhung con s l g i n 80% tre ed eae r l i loan tang dong that su gay ngac nhien. K l ca d cac nghien ciru tren t h i gidi v l tre sau viem mang nao mii cung chua tap trung nhilu vao loai di chirng nay. Mli lien quan cd y nghTa thing ke vdi ehlt lugng sing cua tre v l sire khde tam ly xa hpi cang cho thly c i n cd su quan tam v l cac r l i loan nay han khi theo ddl cho tre sau viem mang nao mu
49
TCNCYH Phu truung 80 (3A) - 2012 Mlu nghien ciru qua be va vlecchgn mlu thuan tien lam k i t qua eiia nghien eiru khdng dai dien dugc chg eac tre bi viem mang nao mu d Viet Nam. Nhom nghien ciru nhan thly cac gia dinh khdng ddng y tham gia vdo nghien eiru thudng ed hoan canh khd khan va tre bi viem mang nao mil cd ve lai la nhu'ng tre bi di ehirng nang han vd gia dinh khdng ed dugc su quan tam d n thilt vdl tre.
V. K^T LUAN
Chit luang sing ciia tre em sau viem mang nao mu bj giam siit so vdi cac tre binh thudng Chua xac dinh dugc su lien quan giii'a chit lugng sing ciia tre vdi cac y l u t l can nguyen gay benh, can thiep ngoai khoa khi dieu tri, khu vuc sing hay tinh trang nghe kem R I I !oan tang ddng la y l u t l anh hudng cd y nghia thing ke d i n dilm ting hgp sire khoe tam ly xa hgi ciia tre
T A I LIEU THAM K H A O 1. Lam, N.V et al (2009). Nghien ciru tinh nhay cam va tinh khang khang sinh eiia vi khuln gay viem mang nao mil d tre em tai benh vien Nhi Trung uang Tap chi Nhi khoa, 2 ( 3 & 4 ) 125-132.
2. Viet, V.T., P.N. An, and L.P. Phat (2000). Tim hieu mpt s l y l u t l nguy ea tu vong do viem mang nao nhilm khuln d tre em Nhi khoa Ky y l u cong trinh nghien ciru
khoa hoc nam 2000 396 - 405
3. Irene Koomen et al (2005). Academic and Behavioral Limitations and Health- Related Quality of Life in School - Age Survi- vors of Bacterial Meningitis Quality of Life Research 14 (6)-1563 -1572
4. Legood, R et al (2009). Health related quality of life in survivors of pneumococcal meningitis Acta Paediatrica. 98 543 - 547.
5. Pikis, A et al (1996). Long-Term Se- quelae of Pneumococcal Meningitis in Chil- dren. Clinical Pediatnes. 35 (2); 72 - 78.
6. Ramakrishnan, M et al (2009). Seque- lae due to bacterial meningitis among African children; a systematic literature review. BMC Medicine 7 (47).
7. Rianne Oostenbrink et al (2002). Se- quelae after Bactenal Meningitis in Child- hood Scandinavian Journal of Infectious Dis- eases 34 (5); 379 - 382.
8. Saha SK et al (2009). Neurodevelop- mental sequelae in pneumococcal meningitis cases in Bangladesh' a comprehensive follow -up study. Clin Infect Dis. 48 (Sup 2)- 90 - 96.
9. Varni JW et al (1999). The PedsQLa Measurement Model for the Pediatric Quality of Life Inventory. Medical Care 37 (2).
126-139.
Summary
LONG TERM QUALITY OF LIFE IN CHILDREN WITH BACTERIAL MENINGITIS Sequelae of bactenal meningitis cause problems with learning, communication and social development, leading to decrease quality of life We conducted this study to measure health- related quality of life of suvivors of childhood meningitis and to seek some associated factors.
Mean age of follow-up was 39 ± 18.6 months. The time of measunng was 25 6 ± 10 months after illness. On the PedsQL™, meningitis children differed from control children in general score as well as physical function, emotional function, social function and school funtion score.
However, there were no association between health-related quality of life and factors such as causative organisms, surgical Intervention, living area and hearing loss. This study concludes that children with bacterial meningitis have poorer health-related quality of life.
Keywords: quality of life, meningitis, children 50
