VIETNAM MEDICAL JOURNAL N°1 - OCTOBER - 2017 than kinh hdn thang diem Glasgow, cho nen cd
kha nang tien lu'dng tiT vong tdt hdn d nhiJng benh nhan hdn me nang [1].
Nghien ciTu eiia Rostam Jalali va Mansour Rezaei (2014), vdi diem eat Glasgow < 5 diem va FOUR < 6 diem thi: Thang diem Glasgow cd Se = 68,4%, Sp = 63,6%, Ac = 64,4%, PVP = 52%, PVN = 77,8%; Thang diem FOUR cd Se = 68,4%, Sp = 77,3%, Ac = 74,0%, PVP = 63,4%, PVN = 81,0%. Theo Marie va CS, nghien ciTu tren 176 b§nh nhan tdn thu'dng nao tai Khoa Hoi sdc ti'ch cu'c - Benh vien Liege ciia Bi nam 2011.
Tac gia so sanh thang diem FpUR va GCS/GLS d ddn vi cham sdc ti'ch ciTc. Tdng diem FOUR ed mdi lien quan vdi GCS va GCS la r = 0,81 vdi p <
0,001 va r = 0,82 vdi p < 0,001. He so kappa miic dp tdt vdi thang diem FOUR (k = 0,75), thang diem Glasgow thi kappa = 0,68 va thang diem GLS la 0,66. Ket luan ciia nghien ciTu cho thay thang diem FOUR la cdng cu tdt cd gia trj tien lu'dng so vdl thang diem GCS va GLS [7].
D. Ledoux va CS (2009), nghien cu'u danh gia va tien lu'dng hdn me bang thang diem Glasgow va thang diem FOUR d Bungari. Ket qua thang diem GCS va FOUR cho thay mdi tu'dng quan chat (r = 0,807). Tong diem FOUR (Hieu chinh theo dd tuoi) cho thay kha nang tien doan eao sau 3 thang (OR = 0,83; 95% O = 0,70 - 0,98, P = 0,03) so vdi tdng sd diem GCS (OR = 0,85;
CI 95% = 0,70 - 1,03, P = 0,09) [3].
Nhu' vay, nghien ciTu ciia chung toi cd ket qua tu'dng tir nhu' cac tae gia trong va ngoai nu'de, dd ia thang di&n Glasgow va FOUR cd gia tri tien lu'dng tLT vong d mii'e tot, nhutig thang diem FOUR danh gia chinh xac hdn so vdi thang di^m Glasgow.
V. KET LUAN
Nghien ciTu tren 80 benh nhan bi rdi loan y
).'Ngnien thu'c va hdn me, so sanh hai thang diem FOUR va Glasgow, chung tdi riit ra ket luan, thang diem hdn me FOUR cd kha nang tien lu'dng ti^
vong ehinh xac hdn thang diem Glasgow:
- Diem cat thang diem Glasgow < 5 cd gia trj tien lu'dng t d vong vdi dp dae hieu 86%, flfi chfnh xac 84%, dp nhay 77% va he sd kappa S mire dong thuan tdt (k = 0,65).
- Thang diem FOUR < 6 cd gia tn tien lu'dng tiT vong vdi dp dac hieu 79%, dp chi'nh xac 82%
va dp nhay cao 9 1 % va he sd kappa cd sir dong thuan tien lu'dng t d vong miTc tdt (k = 0,72).
TAI L l | U T H A M KHAO
1. Vu Anh Nhi, Vo Thanh Dinh (2013). 1^
cu'u tien lu'dng tiT vong bang thang Siem FOUR fl benh nhan hon me". Y hoe TP. Ho Chf Minh, tip 17, phu ban ciia so 1, trang 79-83. i ' 2. Eken C , Kartal M., Bacanii A., Eray|o.
(2009). "Companson of the Full Outline^ of Unresponsiveness Score Coma Scale and (fte Glasgow Coma Scale in an emergency setting population,". European Journal of Emergenty Medicine, vol. 16, no. 1, pp. 29-36. '' 3. Ledoux D., Bruno M., Jonlet S. et al (2009). "H^
outline of unresponsiveness compared with Gl^^otv Coma Scale assessment and outcome predidim h coma,". Critkal Care, vol. 13, artide P107. "-^
t*. Wijdicks E. F. M. (2009). "ainii^i scales W comatose patients: Itie Glasgow Coma 5(3fe"^l historical context and the new FOUR score,". Review|;|
in Neurological Diseases, vol. 3, no. 3, pp. 109-117.'3 5. Wijdicks E. F. M., Bamletand W. R. et a T (2005). Validation of a New Coma Scale: The FOUR score. Annal of Neurology Vol 58 No 4. WtL 6. Teasdale G., Jennett B. (1974). Asse^nm^M
03ma and impaired consciousness: A Piadkal ^^m The Lancet Volume 304, Issue 7872,13, pp 81-64.^
7. Bruno M. A., Ledoux D., Lambennont B., et al (20lM 'XjOnparison of the lull outline of unie^xmsmiesSf^^
(3a^ow Uege Scal^Gla^ow Coma Scale in an ffilsfis/n^
caie i^pcpulat!on,"Heunxf(6(3\CarB,\ci. 15,na3,pp.
447-453.
TINH TRANG TANG CO2 M A U a BENH N H A N VIEM PHOI SUY HO HAP TAI BENH VIEN NHI TRUNG U'O'NG
Mai Thanh Cong*, Nguyen Thi Y^n*
T6IVI TAT
00t van de: Suy ho hap la_^bien ehiTng gay tiT vong ehu yeu d benh nhi viem phoi. Viee phan loai suy
g Dai hgc Y Ha Ngi Chiu trach nhiem chfnh; Mai Thanh Cong Email: [email protected] Ngay nhan bai; 25.7.2017 Ngay phan bien khoa hpc; 8.9.2017 Ngay duyet bai: 13.9.2017
ho hap dira vao tinh trang giam oxy va hoac tSni carbonic trong mau ddng vai tro quan trpng trong^(W trj benh. Muc tieu:)i.ac dinh t / le tang COjva mot®
yeu to lien quan den tang CO2 d tre suy hd^'^^P^
viem phdi tai Benh vien Nhi Trung Udnq. OSIt^^^
va phi/Ong piiap: Nghien eiTu Sen cUu, ^mo^^ta j | ^ ngang 157 benh nhan viem phoi co suy ho hap tuM thang den 5 tuoi nhap vien vao dieu tri tai Benh vim Nhi Trung Udng tir 01/01/2017 - 30/9/2017. / % qua: Ty le tang CO2 gap d 38,9% benh nhan suy ra hap do viem phdi, cao hdn d nhom du'di 1 tuoi (43,7%) so vdi nhdm 1-5 tuoi (19,4%), 6 nhom ro"
TAP CHl V HOC VIET NAM TAP 459 - THANG 10 - SO 1 - 2017 bieu hien kho khe cao hdn nhom khong cd bieu hien
nay (49,2% so vdi 32,7%). Ty le tang CO2 khong cp sii khac biet d nhom tre cd tien sir de non, nghe phoi giam thong khi hoac cd ton thUdng xep phoi, d khi tren Xquang so vdi nhom tre khong c6 nhiTng yeu to nay. KSi luan: Tang CO2 gay toan mau thudng gap d benh nhi viem phdi suy hd hap, nhat la nhdm tre du'di 1 tuoi. Song song vdi viec cung cap oxy, can chii y den cac bien phap dieu trj nham giai thoat CO2.
Tdkhoa: Viem phdi, suy ho hap, tang CO2 mau, tre em.
SUMMARY
HYPERCAPNIA I N PATIENTS WITH RESPIRATORY FAILURE DUE TO PNEUMONIA
ATTHE NATIONAL CHILDREN'S HOSPITAL Background: Respiratory failure is the common cause leading to life-threatening in children with pneumonia. The classification of respiratory failure with hypoxemia and/or hypereapnia plays an important role in the management of respiratory
^ilure. Aim: To determine the rate of hypereapnia and some factors relating to hypereapnia in children with respiratory failure due to pneumonia at the National Children's Hospital. Subject and method: A prospective, cross-sectional descriptive study of 157 patients with respiratory failure due to pneumonia (from 2 months to 5 years old) hospitalized at the National Children's Hospital between 01/01/2017 to 30/09/2017. Result: Hypereapnia was accounted for 38.9% of patients with respiratory failure due to pneumonia, This proportion of the under i-year-old group (43.7%) was higher than the 1-5-year-old group (19.4%). The higher percentage was found in the wheezing group (49.2%) as comparing to the non- wheezing group (32.7%). There is no statistical significant difference in the ratio of hypereapnia in the pretemi and full term children, in the groups diat had reduction of breath sound and atelectasis, emphysema in Xray, as comparing to the non these symptoms groups. Conclusion: Hypereapnia is common in children with respiratory failure due to pneumonia, especially in the under 1-year-old group. Besides oxygen therapy, removing C02 is necessary.
Keywords: Pneumonia, respiratory failure, hypereapnia, children
I. DAT VAN o t
Viem phdi la mdt trong nhUng benh ly phd bien nhat, gay tir vong dang ke d tre em tai cac nu'de dang phat trien. Theo sd lieu thong ke mdi nhat ciia WHO, trong nam 2015, viem phoi la nguyen nhan cua 920 136 ca tiT vong d tre dUdi 5 tudi, chiem 16% nguyen nhan tir vong d lite tuoi nay [1]. Tre mac viem phdi tir vong chii yeu do bien chu'ng suy hd hap.
Cd nhieu each phan loai suy hd hap, tuy nhien phan loai dda vao ket qua khi mau du'dc nhlBu tac gia thong nhat ap dung. Theo ket qua i(hi mau ddng mach, suy hd hap du'dc ehia thanh
3 loai: suy hd hap giam oxy mau (type I, Pa02 <
dOmmhg), suy hd hap tang COj mau (type I I , PaCOj > SOmmHg) va suy hd hap hon hdp (type I I I , PaOz < 60mmHg va PaC02 > SOmmHg) [2].
Trong viem phoi xay ra tinh trang rdi loan trao ddi khf qua mang phe nang-mao mach, nen suy hd hap type I (giam oxy mau) thu'dng phd bien.
Tinh trang tang CO2 mau d benh nhan viem phoi ed suy hd hiip ehu^ du'dc quan tam va nghien eiTu nhieu. Vi vay, diiing tdi thiTc hien de tai nay vdi myc tieu: "Xac dinh ty le iSng CO2 va mot sdyeu td lien quan den lang COz d tre suy ho hap do
\nem phdi tai benh vien Nhi Trung Udng ".
II. o d l TU'ONG VA PHU'aNG PHAP NGHIEN CUTJ 2.1 Doi tu'dng nghien cu'u: 157 benh nhan tir 2 thang den 5 tud'i du'dc chan doan viem phdi cd suy hd hap nhap vien vao dieu tri tai Khoa Cap edu Chong Ode va Khoa Hoi SiTc Hd Hap Benh vien Nhi Trung u'dng td 01/01/2017 - 30/09/2017.
Tieu chuan lu'a chpn: Tieu chuan chan doan viem phdi ciia WHO 2013 [3]:
• l i m sang: tre ed the sdt, ho, khd thd kem theo it nhat mdt trong eae dau hieu;
- T h d nhanh: > 50 ian/phut vdi tre 2 - 1 1 thang, > 40 Ian/phut vdl tre 1 - 5 tuoi
- Riit idm Idng ngi/c
- Nghe phdi: ran am nhd hat, cd the ran rit, ran ngay hoac giam thdng khf
• Xquang: cd hinh anh tdn thudng eiia viem phdi Tieu chuan suy hd hap: Pa02 < 60mmHg (Pa02/Fi02 < 300mmHg vdi benh nhan thd oxy) va hoac PaCOs > SOmmHg [2]
Tiiu chuan loai trd - Tinh trang tang C02 man tinh - Suy hd hap du'dc ho trd may thd - Suy hd hap do eac nguyen nhan khac Phu'dng phap nghien cu'u: Nghien eiru tien eiru, md ta cat ngang. Tat ca eac benh nhan du'dc danh gia iam sang, lam khf mau dpng mach tai thdi diem danh gia tinh trang suy hd hSp. K9 thuat do khf mau: mau dpng mach (ddng mach quay, ddng mach canh tay hoac ddng mach dul) du'dc lay vao mdt xilanh thiiy tiiih va phan tich ket qua trong vdng 15 phut.
Xd ly sd lieu: bang phan mem SPSS 20.0 Ndi dung va dao dire nghien ciTu da du'dc thdng qua hdi ddng xet duyet de cu'dng nghien eiiu eua tru'dng Dai hoc Y Ha Ndi.
III. KET QUA
Tir 01/01/2017 den 30/09/20X7 cd 157 benh nhan dii tieu chuan du'dc du'a vao nhdm nghien edu vdi ket qua nhu' sau:
227
VIETNAM MEDICAL JOURNAL N°1 - OCTOBEF -2017
Bang 1. Oac diem chung eda nhdm nghien edu Nhom
Tuoi Gidi
2 - 1 1 thang 1 - 5 tuoi
Nam NiJ Thdi gian tien t r i i n den suy ho hap
SotreCn = 1 5 7 ) 126
31 95 62
Ty le (»/o) 80,3 19,7 60,5 39,5 8,13 ± 5,78 (nqay)
P
<0,K1
<0,01%
Nhin xet: 80,3% benh nhan viem phdi suy hd hap du'di 1 tubl. l y le tre nam cao hdn tre nif (nam/ni?: 1,5/1). Thdi gian tien trien trung binh tir luc khdi phat trieu chiTng eiia viem phdi cho den khi du'dc chan doan suy hd hap la 8,13 ± 5,78 ngay.
Bang 2. Ty le tang C02, toan mau trong viem phdi cd suy hd hip Nhom tuoi
< 1 tudi 1 - S tuoi
Tdnq p*
PaC02 > SOmmHg 55/126 (43,7%)
6/31 (19,4%) 61/157 (38,9%)
<0,0S
pH < 7,35 55/126 (43,7%)
7/31 (22,6%) 62/157 (39,5%)
<0,05
*Ghl chu: gia tri p so sanh ty le tang CO2, ty ie toan mau 02 nhom tuo Nhan xetljy ie tang CO2 va toan mau trong suy iio iiap do viem piioi ian luWt chiem 38,9% va 39,5%.
Ty ie nay cao hdn d tre dirtffi 1 tuoi so vdi tre 1 - 5 tuoi, su" Ichac biet CO y nghTa thong ke vdi p < 0,05.
Bang 3. Mot sdyeu to lien guan den tang CO2 d benli nhan viem phoi co suy ho hap Yeulof
Tien su* de non Kho l!he Giain thong khi' ph6i
Xquang (1 khf Xquang xep phoi
CRP am ti'nh
« 6 mg/L) Co Khong
Cd Khonq
Co Khonq
Cd Khong
Cd Khong
Cd Khdng
Tang CO2 So tre ( n )
19 42 29 32 8 53 16 45 7 54 41 20
TV le ( % ) 45,2 36,5 49,2 32,7 47,1 37,9 36,4 39,8 53,8 37,5 45,1 30,3
Khong tang CO2 So t r e ( n )
23 73 30 66 9 87 28 68 6 90 50 46
Ty IS VM 54,8 63,5 50,8 67,3 52,9 62,1 63,6 60,2 46,2 62,5 54,9 69,7
P
>o,os
<0,05
>0,05
>0,5
>o,os
>o,m
Nhan xet: Jy letang C02d nhdm cd bieu hien khd khe cao hdn nhdm khdng cd bieu hien nay, sif khac biet cd y nghia thdng ke vdi p < 0,05. Ty le tang CO2 kheng cd su" khac biet d nhdm ijenh nhan cd tien sir de ndn, giam thdng khi hoac cd tdn thu'dng LT khi', xep pho'i tren Xquang ngu'e, CRP khong tang so vdl nhdm khdng cd nhutig yeu te nay.
Bang 4. Bien ddi mot so'chi so huyet hoc va sinh hoa dbSnh nhan viem phoi tang CO,
Chi so Nhdm tang CO2
(n = 6 1 )
Nhom khong tang CO2 (n = 9 6 )
pH
7,31 ± 0,07
HC03 (mmol/L)
28,54 ± 3,25 <o,m
BE i ± 3,76 <0,05
Canxl ion (mmol/L)
1,07 ±0,11 1,11 ± 0,12
>0,05Canxi toan phan (mmol/L)
2,27 ± 0,19
>0,5Natri mau (mmol/L)
Kali mau (mmoi/L)
136,23 ± 5,21 136,42 ± 4,05
>0,5>0,05
4,46 ± 0,74 4,25 ± 0,56
CRP (mg/dL)
14,95 ± 30,09 19,70 ± 38,31
> 0,05So lu'dng bach cau (G/L)
12,12 ± 4,66 12,39 ± 6,44
>0,SHemoglobin (g/L) I 106,1 ± 12,94 I 11178 ± 17,12 " I _> 0,05 ,
Nhan xit: Cd sir khac biet ro ret ve tinh trang toan mau (pH t h i p hdn), tinh trang kiem chuyCT, hda bii trU (HCO3, BE cao hdn), ndng dp hemoglobin trung binh thap hdn d nhdm tang CO2 so voi nhdm khong tang CO2. Khdng co SLT k h k biet co y nghTa thong ke ve cac chi so canxi, natri, !<all, CRP, so lu'dng bach cau giiJa 2 nhdm nay (vdi p > 0,05).TAP CHi Y HOC Vl|T NAM Tij^P 459 - THAHG 10 - SO 1 - 2017 : IV. BAN L U A N
• Tir 01/01/2017 den 30/09/2017, 1S7 tre viem phdi cd suy hd hap d lu^ tudi 2 thang den S tudi du'dc du:a vao nghien ciru, chiing tdi nhan thay 80,3% la tre du'di 1 tudi. Nam 2010, Dao l^inh Tuan nghien ciTu 72 tre viem phoi nang tai Benh vien Nhi Trung ddng, tac gia nhan thay ty le nhom tre du'di 1 tuoi chiem 66,7% [4]. Day la liTa tudi de bj suy hd hap khi mac viem phdi, can tap trung eho chan doan va xd trf de giam nguy cd tir vong". Trong 157 tre, nam ehiem 60,5%, nd ehiem 39,5%. Ty te namind trong nghien ciTu ciia chiing tdi (1,5/1) tu'dng t y vdi tac gia Nguyin Duy Bd, Nguyen Thi Yen nghien cii'u 180 tre 1 - 12 thang viem phdi suy hd hap (2013) ty le nam/ni? la 1,8/1 [5], tae gia Usen S nghien ciTu 1072 tre 3 - 33 thang nhiem khuan hd hap cap (2001) ty le nam/nu' la 1,2/1 [6].
Tat ca eac benh nhan trong nghien ciTu deu du'dc danh gia ve iam sang va xac dinh chan doan suy hd hap bang khf mau ddng mach.
Trong dd, ty le tre viem phdi suy hd hap cd tang COz va toan mau lan lu'dt chiem 38,9% va 39,5%. Ket qua cua chiing tdi thap hdn ket qua trong nghien eiiu ciia Dao I^inh Tuan (2010): ty le tang CO2 va toan mau d 48 tre viem phdi nang i n lu'dt la 79,^1% va 31,25% [ 4 ] ; trong nghien CLTU cua Nguyen Duy Bg d 180 benh nhan viem phdi cd bieu hien suy hd hap tren lam sang (2013) ty le nay lan lu'dt la 60% va 53,9% [S].
Sir khac nhau nay do tieu chuan lu^ chon b i n h nhan trong cae nghien cu'u khdng gidng nhau, cd mau khac nhau va nghien cu'u ciia chiing tdi da lo?i ra nhuYig benh nhan co tinh trang tang CO2 man tinh. Bang 2 cho thay ty le tang CO2 va toan mau d nhdm tre du'di 1 tudi cao hdn nhdm tre 1 - 5 tudi (43,7% so vdi 19,4% va 43,7% so vdi 22,6%), su" khac biet cd y nghTa thong ke vdi p
<0,05. Nhu* vay, tre dUdi 1 tudi bi viem phdi suy ho hap ed ty le tang CO2 cao hdn nhdm tre idn .- cd the do nhutig dac diem ve giai phau, sinh ly he hd hap d lu^ tudi nhd - can chii y tinh trang nay de cd nhiiYig bien phap dieu tri hdp ly ngoai viee eho thd oxy khi Pa02 giam. Tinh trang toan mau chu yeu la toan hd hap, can tap trung giai quyet CO2, khdng phai bii kiem hang loat de dieu chinh roi loan nay.
Ket qua nghien cufu mdt so yeu t d lien quan den tinh trang tang CO2 d benh nhan suy hd hap do viem phdi (bang 3) cho thay ty ie tang COz d nhom benh nhan cd bieu hien khd khe (49,2%) cao hdn d nhdm benh nhan khdng ed bieu hien nay (32,7%), SLT kliac biet nay cd y nghTa thdng
ke vdi p < 0,05. Khd khe la bleu hien ciia tinh trang can trd luong khi thd ra d du'dng dan khf nhd do hien tu'dng viem, phu ne, tae nghen. Tinh trang can trd nay gdp phan vao cd che gay tang CO2 d benh nhan viem phdi suy hd hap. Tuy nhien, ty le tang CO2 lal khdng cd mdi lien quan vdi tien sir de non, giam thdng khi phdi, hinh anh u" khi, xep phoi tren Xquang hoac CRP am tinh (< 6mg/L).
Tlnh trang toan mau mat bii d nhdm benh nhan suy hd hap ed tang C02 eao hdn mdt each rd ret so vdi nhdm khdng tang CO2 (bang 4). Vi vay, viec giai quyet COj de tranh toan mau can du'dc ehu y khi benh nhan viem phoi suy hd hap cd tang CO2. Trong nghien ciTu ciia chiing tdi, nhdm benh nhan viem phdi suy hd hap cd tang CO2 ed ndng dp hemoglobin trung binh (106,1 ± 12,94 g/L) thap hdn nhdm viem phoi suy hd hap khdng tang C02 (111,78 ± 17,12 g/L), sd khac biet ed y nghTa thdng ke vdi p < 0,05. Diiu nay cd the giai thfch bdi ty le tang CO2 gap chii yeu d nhdm benh nhan du'di 1 tudi, la lite tudi rat thu'dng gap thieu mau dinh du8ng. Trong nghien cirXi ciia Dao Minh Tuan, nhdm benh nhan viem phdi nang cung cd nong dp hemoglobin trung binh thap hdn nhdm viem phoi thu'dng (9,8 ± 1,6 g/dL) [4]. Ket qua nay gdi y cho thai dp dieu trj can quan tam den tinh trang thieu mau doi vci benh nhan viem phdi suy hd hap ndi chung, dae biet nhdm viem phdi suy hd hap ed tang COj, vi thieu mau eung la mpt yeu td gdp phan vao thieu oxy, lam nang them tinh trang suy hd hap.
Tuy pH mau ciia nhdm tang COz thap (7,31 ± 0,07), do tinh trang toan hd hap mat bii, nhulig nong dp kali mau trung binh giu'a nhdm tang CO2 va khdng tang CO2 khdng cd SLT khac biet cd y nghTa thdng ke. Ket qua nghien eiTu cung ehi ra khdng cd siT khac biet ve ndng dp canxi, natri, CRP, so lu'dng bach eau giu'a hai nhdm nay.
V. KET LU^N
Ty ie tang CO2 mau gap d 38,9% benh nhan viem phdi ed suy hd hap, nhat la nhdm tre du'di 1 tudi. Song song vdi viec eung cap oxy, can chii y den eae bien phap dieu trj lam giam CO2.
TAI LIEU T H A M KHAO
1. WHOjPneumonia.[http://wvm.who.int/mediacentr e/factsheets/fs331/en/], accessed: 10/06/2016.
2. Gunning K.E (2003). Pathophysiology of respiratory failure and indications for respiratory support. Surg Oxf, 21(3),72-76,
J . World Health Organization, btv. (2013), Pocket book of hospital care for children: guidelines for the management of common childhood illnesses.
VIETNAM MEDICAL JOURNAL N°1 - OCTOBER - 2017 , Dao Hinh Tuan (2011). NhiTng bien doi ve khi
mau, xet nghiem sinh hoa, huyet hgc d benh nhan viem phdi nang tai khoa ho hap benh vien Nhi Tmng L/cJng nam 2010. Y hoc thu'c hanh, 5(765), 73-75._
, Nguyen Duy Bo, Nguyen Thj Yen (2013), lien guan giuS lam sang, Sp02 va khf mau dgng mach
d tre 1-12 diang suy ho hap do viem phoi tai benh vien Nhl Trung U'dng, Dai hoc Y Ha Noi.
, Usen S, Webert M (2001), "Clinical signs of hypoxemia in children with acute lower respiratory infection: indicators of oxygen therapy", int j Tuberc Lung Die; 5(6):505-10.
LAO TAI: HINH THAI LAM SANG vA NHU'NG TIEN BO TRONG CHAN D O A N HIEN NAY
Tdn Cdng Cuomg**, Hoang Thi Phuwng*, Doan Thi Hong Hoa**, Nguyin Van Himg*, Nguyin ViSt Nhung*, Nguyin Thi T6 Uyen** fioan Hdng Anh**.
Tir khoa: Lao tai, hinh thai lam sang, xet nghiSm VI khuan tien tien
SUMMARY
TUBERCULOSIS OTITIS MEDIA, CLINIC PRESENTATIONS AND ADVANCED BACTERIOLOGICAL EXAMINAHON The tuberculous otitis media (TOM) is a rare gjctra- pulmonary localization which is accounted for 0.{M%
to 0,9% of CSOM in developed countries. In recent years, TB patients has an increasing trend, including TOM patients specially m the developing countries, Vietnam ranked 15/30 highest T8 burden countries and ranked 14/27 MDR-TB burden countries. The study describes a retrospective series of 31 cases which suggest a new perspective in diagnostic by revealing sample collections for histopathology and bacteriology. In literature, it used to present as tlie triad: pain- free ear discharge, multiple perforations of tympanic membrane and penpheral facial palsy. Ttie.
clinical features of TOM changed over the years. The' new clinical pattern of TOM should be recognized by clinicians.Our study releaved average of 30 years old with the range of ages from 16 months to 65 years.
Based on the analysis of the cases, it is suggested that TOM should be entertained as a possible diagnosis in patients with atypical OM. There are many similarities existing between TOM and pulmonary tuberculosis.
Firstly, the dinical presentation of TOM today is polymorphic, which can be acute or sub-acute or chronic form. Secondly, they are both the respitory tuberculosis. In this regard, whenever a TOM is diagnosised, lung CT scan is recommended, even when routine chest radiograph is considered normal.
The third, TOM can develop into adhesif OM with hearing loss even after anti-tuberculosis therapy.
There should be a close cooperation between the otologistes and the pneumologistes, early diagnosis ans search for other TB sites. To Impove TOM diagnosis, the samples need to be taken maximum amount to perform histopathology. Beside, the technique of incubation and ECA lavage fluid collection need to be conducted to perform Xpert MTB/RIF and BACTEC.
Key words: tuberculous otitis media, dinic presentations and advanced baeteriological examination.
T O M TaT
Viem_^tai ^giij'a do lao la mot ton thu'dng khu tru ngoai phdi hiem gap, chiem khdang 0,04 den 0,9% d cae nUdc phat trien. Trong vai nam gan day, b^nh lao ed xu hUcJng gia tang trd lai trong _dd cd VTG do lao dae biet d eae nude dang phat tnen. Viet nam hien van la nude c6 ganh nSng benh lao^cao, dii'ng thir i s trong so 30 nude ed tinh hinh dieh te lao cao nhat tren toan cau, va dufng thir 14/27 nu'de co ganh nang ve lao da khang thuoc. Nghien ciru hoi culi mo ta 31 ea lao tai vdl mong mudn ehia xe kinh nghiem trong viec la^ benh pham de chan doan lao tai. Kinli dien, lao tai bieu hien vdi tam chiTnp: chay mii tai Widng dau, mang tai thiing nhieu lo va liet mat. Vdi thdi gian, benh canh lam sang ciia lao tai co nhieu thay ddi. Cac nlia lam sang nen cap nhat nhiJng trieu chirtig mdi eua lao tai. Nghien cirij ciia chimg toi nhan thay lao tai c6j:he gap 6 moi lira tu^di tir 16 thang den 65 tuoi vdi tudi trung binh la 30 tudi. Benh canh lam sang ciia lao tai ngay nay rat da dang, nen khi gap tru'dng hcJp VTG khong dieu hinh trUdc ten phai nghi ngd lao tai. Cd nhieu SLT tu'dng ddng giiJa lao tai va lao phoi ve bieu hien lam sang va Hen tnen. Thir nhat, hinh thai lam sang ciia lao tai ngay nay rat da dang, co the bieu hien dirtJi cap, ban cap va man tinh. thu' hai, lao tai va lao phdi deu la lao cua du'dng ho hap nen khi chan doan lao tai nSn chup cat Idp phdi de tim them khu tru tdn thudng ngay ca khi Xquang phoi co ve binh thu'dng. Thu" ba, sau dieu tn lao tai mot sd trudng hdp chuyen viem tai day; dinh. Can eo sy ket hcJp chat clie vdi nha ho hap^de^chan doan sdm va tim eac tdn thUcJng khac. Oe chan doan lao tai, eac nha chuyen khoa nen chit y each lay benhj)ham. Khi lam mo benh hoc, phai lay toi da benh pham mdi co the tim tliay viing tdn thUOng lao, va khi lay mil lam vi khuin hoc nhU^^ BACTEC va Xpert de tang do tap trung eiia vi khuan phai ii va lay d|ch tai,
*Benh vien Phdi 71/
**Benh viin Tai Mui Hong Tif Chju trach nhiem chinh: Tdn Cong Cu'cfng Email: Drtoncuongent@gmail Ngay nhan bai: 27.7.2017 Ngay phan bien khoa hgc: 20.9,2017 Ngay duyet bai: 28.9.2017 230
