Y HOC VIET HAM THAHG 3 - S 6 2/2015
AP DUNG C 6 N G CU DANH GIA TONG THE CHU QUAN TRONG DANH GlA T I N H TRANG DINH DUffNG C O A TRE EM NAIM VI6N
Pham Thi Thu Hu-ong*, Cao Thi Thu Hlnmg'
T 6 M TAT
Danh gia tong the chii quan (SGA- Subjective Global Assessment) la mpt cong cu danh gia tinh trang dinh duBng benh nhan nam vien. SGA da dUdc sir dung rpng i^i tren die gidi trong thiJt hanh lam sang v i nghien d i l l d ngudi tru'dng thanh. Muc tieu: Xae dinh SGA la c6ng CM danh gia dnh trang dinh dudng d b-e em nSm vien tai Viet Nam. Phu'dng phap: DEu tra cSt ngang tat c l tre em tir 6 thang den 15 tudi nhap vlfn tai khoa Ho hap, Tim m?ch. Than kinh, Huy€t hQC t^i benh vien Nhi tmng Udng. So lieu thu thap bao gdm can ning, chieu cao/chieu dai v l danh gii SGA. Suy dinh dudng gay com dupe phan loai theo Beu chuan oJa Td chut Y t f die gidl (WHO). Phan loai tinh trang dinh dudng theo SGA: dinh dudng tot (A), suy dinh dudng tir nh? den viia (B), suy dinh dudng n|ng (C). KSt q u i : 192 tri (57%) SGA A, 134 (39,8%) SGA B, 11 (3,3%) SGA C SGA 00 dp nhay la 83,5% v l dp die hl|u II 68,1%. Kei l u | n : SGA la cong cu dinh gii tinh b^ng dinh dudng d fre em Viet Nam.
Tdkhda; SGA, Suy dinh dudng, tinh trang dinh dudng, tr^ em, b^nll vien
SUIVIIVIARY
A P P U C A n O N SUBJECTIVE GLOBAL ASSESSMENT TOOL TO ASSESS NUTRITIONAL STATUS OF HOSPITALIZED
PEDIATRIC P A H E N T S Subjective global assessment - SGA is a tool to assess nutritional status of hospitalized patients. The SGA tool has been widely used in the wodd on clinical practice and research in adult patients. Objective: To detennlne whethe tiie SGA is a tool to assess nutritional status of hospitalized pediati-ic patients In Vietnam. Methods: A cross sectional survey was Implemented in alt children from 6 montiis to 15 years of age admitted in selected wards: Respiratory diseases. Cardiovascular diseases. Neurological diseases. Hematological diseases at National Hospital of Pediatilcs. Data was collected as Anthropometric measurements (body weight, height /length) and SGA tool. Wasting was defined based on the criteria of the
* V i ^ Dinh dudng
Chiu ti'lch nhiem chinh: Pham Thj Thu Huong Email: driiuongptfligmail.com Ot: 0912.417.339 Ngiy nh|n b l i : 5.2.2015
Ngiy phan bien khoa hpc: 30.2.2015 Ngiy duy^ bli: 5.3.2015
World Health Organization (Vi/HO). Classification of nutritional status according to SGA: well nourished (A), mild to moderate malnounshed (B), severely malnourished (C). Results: 192 children (57%) SGA A, 134 children (39.8%) SGA B, 11 children (3.3%) S(5A C. A validation test of tiie SGA showed a sensitivity of 83.5% and specificity of 68.1%, Conclusion; The SGA is a tool to assess nutritional status of children in Vietnam.
Keywords: SGA, malnutrition, nutritional status, pediatric, hospital
I. OAT V A N o t
Suy dinh dudng benh v i | n thudng phoi li«p vdi tang nguy ed nhiem khuan, eham lien cli|m vet md sau phau t h u i t , xuat h i l n c l e h|u qua lam sang, keo d i i thdi gian nam v i l n va lam ting chi phi dieu trj [ 4 ] . Cae hau qua nay cd thS giam hole n g I n ngira neu eae trUdng hdp suy dinh dudng dUde phat h i | n sdm de cd bien phap ho trd kjp thdi. Trong tliUe hanh lam sang, rieng 14 cac sd do khach quan nhU sd do nhan trie (can nang, chieu cao), sinh hda (albumin, prealbumin..) cd dp nhay kem khi danh gia eae thay doi tinh tr?ng dinh dUSng cap tinh [3].
PhUdng phap SGA dUde danh gia la cdng a) ddn gian cd dp nhay eao khi so sanh vdl nhilu ehi sd nhu protein npi t ^ n g , sd do n h i n trie va thanh phan ed the va cd t h ^ t i l n d o l n cae blen ehilrig sau phau thuat [1,5]. Tuy nhiln cac nghiin cud I p dung SGA de s i n g Ipc suy dinh dudng d tre em mac eae benh ndi khoa edn chua nhieu. Nghiin cifu eiia chiing tdi nham mue dich xae dinh SGA la edng cu sang Ipc va d i n h gll suy dinh dudng d tre em nSm vlen tai Viet Nam
II. 0 6 l TU'DNG VA P H u m i G PHAP N G H I E N CI3U 2 . 1 . D o i t y a n g n g h i e n c i f u
337 tre tU 6 t h i n g tudi den 15 tuoi nh|p v i | n tai 4 khoa ciia benh vien Nhi Trung Udng;
Hd hap, Tim mach, t h a n idnh, H u y i t hoc tif Uiang 20/10/2009 den 31/12/2009 va gia dinh ciia tre ki/ ddng y tham gia nghiin cUu. Cac ddi tUdng bj loal trir ra khdl nghlen eiru bao gdm: tre nhap vlen trong tinh trang cap ciru, tre da nSm
ue
Y Hpc VIET HAM THAHG 3 - Sd 2Q015
vien >1 ngay, cac trudng hpp khdng thu thap
duVc 50 lieu
2.2. Phu'dng phap nghien ciifu: Bleu fra eat ngang md ta dUdc tien hanh sau khi hpi ddng dao dde nghiin euli eiia Vien Dinh dudng phi duyet
2.3. Thu thap sd lieu: €)ieu tra viln la can bp eiia vien Dinh duSng, da dupe tap huan ve cle ky thuat thu thap sd lieu
Tit ca benh nhan, trong vdng 24 gid nhap viln, dii dieu kiln dupe UiUe hien can trpng ludng ed Uie, do chieu cao/chieu dal, dinh gia chii quan sU dung cdng cu SGA [2]. Cac thdng Un cda tre ve ngay sinh, gidi, ehan doan, khoa dieu trj dui^e ghi eliep tU benh an ket hpp phdng van mp/cha eiia tre.
Sd ll|u dupe nhap tren phan mem Access.
Chi 50 WLZ, WHZ, BI^IZ, zseore chieu eao theo tudi dUde tinh toan dua vao sd lieu tham khao ciia WHO (2006) v l phan mem Wtio anthro [6].
Phan tich sd lieu tren phan mem SPSS, philn ban 16.0 (SAS, My). Bd nhay, dp die hieu, gia tri tien doan dUdng tinh va am tinh, ty ie dUdng b'nh gia, ty le am tinh gia so sanh giiia phUdng phap SGA va phuOng phap nhan trac dupe tlnh theo edng thUc tai bang 1
III. KET QUA
3.1, Thdng tin vie dol tuOng nghiin cii'u Tdng sd 337 ddi tUpng tham gia nghiin eiili, trang dd nam gidi chiem 61,7%, nii' gidi ehiem 38,3%, ehii yeu la tre dUdi 2 tudi chlem 59,3%, Ulp den tre tU 2 den 4 tudi (24 din 59 thing) ehiem 22%, tU 5 den 9 tudi II 13,1%, tre trin 9 tudi chi cd 5,6%. Ty le ddi tuang tham gia nghiin cUu tai cle khoa: khoa lid hap ehiem 42,1%, khoa than kinh 34,4 %, khoa huyet hoc 14,2%, khoa tim maeh 9,2% (bang 2)
Chisd Bp nhly Op dac hi|u Gia trj tiln doan dUdng tinh (PV*)
Gia trj tiln doan am b'nh (PV) T"/ II dudng tinh gia
Ty ie am tinh gia
Cong thu'c tlnh TP TP+FN
TN
TN+FN
TP TP+FP
TN TN-l-FN
FP FP+TN
FN FN-I-TP TP: so trudng hdp suy dinh du9ng du'dc phan
loai theo SGA dong thdi cung du'dc phan loai suy dinh du9ng gay com; TN: s6 tru'dng hop khong suy dinh duSng theo phan loai SGA dong thdi cung du^c phan loai khong suy dinh dUdng gay
BAng2.
com; FP: so tru'dng hdp suy dinh du3ng dui?e phan loal theo SGA nhu'ng khong suy dinh du3ng gay edm; FN: So tru'dng hdp khong suy dinh du@ng theo phan loai SGA nhulig du'dc phan loai suy dinh du@ng gay com
Ble diem ciia ddi tUdnq nqhien cifu Cic chi sd Gidi
Nam Nif Tudi (nam)
6 thing den 23 thang (dudi 2 tudi) 24thang den 59 Hiang (2 den 4 tuoi) 5 tudi den 9 tuoi
10 tudi din 15 tudi Khoa
Hdhap Timm?ch Than kinh Huyet hpc
n 208 129 200 74 44 19 142 31 116 48
»/o
61,7
38,3
59,3
22,0
13,1
5,6
42,1
9,2
34,4
14,2
Y HOC VlgT NAM T H A N G 3 • S 6 ' 2 Q 0 1 5
3.2. So sanh tinh trang dinh du'dng theo ciic so do nhan trac va cong cy SGA Ket qua bang 3 cho thay, nhdm tre suy dinh duSng theo SGA cd cae gia trj trung binh Zseore e6a chi so cao theo tuoi, can nang theo chieu dal/ehieu eao thap hdn co y nghTa thong ke (p<0,001) so vdl nhdm tre cd SGA binh thu'dng
Bing 3. So sanh tinh tranq dinh dudng theo phan loal SGA va cae sd do nhan trie
Cac chi sd Zseore eao theo tudi Zseore can theo eao
Phan loai SGA SDD (n=145)
-1,08 ± 1,68 -1,23 ±1,69
Binh thu'dng (n=192) -0,61 ± 1,53 -0,08 ± 1,37
P i4ann Whitney test
<0,001
<0,001 A^/i94. Phan loal tinh
PhSn lo^i SGA Suy dinh dudng Khdnq suy dinh duSnq
TSng
ranq dinh dudnq theo SGA va theo nhan trie PhSn lo3l chi sd n h i n t r i e Suy dinh du9ng
g i y com TP(61) FN (12)
73
Khdng suy dinh duSng g i y cdm
FP (84) TN (180) 264
Tong 145 192 337 KH qui bang 4 cho Uiay, odng cu SGA ehan
doln dung 83,5% (61/73) benh nhan suy dinh dudng gay cdm va 68,1% (180/264) benh nhan khdng suy dinh dudng gay cdm. Dp nhay eiia edng cu S(3A la 83,5% v l dp die hi|u eiia SGA la 68,1%
61 t r i dUde phin loai suy dinh dudng theo SGA cDng dude phan loai suy dinh dudng giy cdm bang chi sd nhan trie, ty II dUdng tinh thIt aia SGA II 42,1% (61/145) va 180 tre dUde phin loal khdng suy dinh dudng theo SGA cung dupe phin loai khdng suy dinh dudng giy edm bSng ehi sd nhan tiic, iy l | am tinh thIt eua edng cu SGA II 93,7% (180/192)
84 trd dUdc chan doan suy dinh dudng theo SGA nhutig thUe s^f khdng bi suy dinh dudng gay cdm, ty Ip dUdng tinh gia la 31,9 % (84/264)
12 tre dude chan doln khdng suy dinh dudng Uieo SGA nhuhg thUc sU b| suy dinh dudng gay cdm, ty i | am b'nh gia la 16,4 % (12/73) IV. BAN LU$N
Dp nhly aia mpt phudng phap II kha ning phit hien diing cac trudng hpp cd van de su'c khde va dp d|e hi|u la kha ning phat hipn diing nhihig budng hdp khdng ed van de sdc khde dang quan lam. Mdt phudng phip sing Ipe hoae dinh gll dinh dudng dupe ehpn sii' dung troiig UHH: lilnh llm sang khi phudng phap dd ddn gian, de sU dung, cd dp nhay va dp d|c hieu eao.
Kit qui nghien eiiu ciia chung tdi chi ra SGA cd dp nh|y va dd d^c hi|u cao de phat hl?n cae txi suy dinh duBng gay cdm, tudng irtig 83,6%
v l 68,1%. Kit qua niy phii hop vdi nghien ctiu eiia Baker [1]. Baker II ngUdi dau tiln so sanli phan loai tinh trang dinh dudng SGA vdi phudng phip nhan trac d binh nhan phau thuat duSng tieu hda eho thay piiudng phap SGA ed dp nhay la 82%, dp die hieu la 72%. Trang nghiin ciiu niy, tae gia edn ehi ra benh nhan dUde phin loal suy dinh dudng theo SGA trude phlu thu|t co nguy ed biin chirtig sau phau thuat nhieu hdn nhirtig ngUdI dupe phin loai SGA d mUc dinh dudng tdt. 06 nhay eiia cdng cu SGA trong nghiin cUu ciia chiing tdi thap hdn nghiin cijii ciia Thoresen, nhurig ed dp dae hieu tUdng duang. Nghiin eiiu eiia Thoresen tren ddi tuljng ung thu eho thay, edng eu SGA cd d$ nhly 93%, dp die hieu 61%[6]. Cae nghlen eiru vdi khia eanh dinh gll tinh phii hdp cua phUdng phap SGA so vdi d e phUdng phap nhan trie cho thay kit qui khae nhau. Bd la do cae quan tiie benh nhan khic nhau. Cac yeu td khae cung gdp piian vao kit qua dd II kinh nghl|m eiia ngUdi dSu tra. Vi vay cdng tie tap huan ddng mdt val trd quan trpng de tiiu thap sd ll|u ehinh xae.
Nhdhg tre dUde phan iopi suy dinh dudng theo SGA ed trung binh zseore ehllu cao theo hjoi, ein ning theo chieu eao, eao hdn eo y nghia thdng ke (p<0,001) so vdi cac tre dupe phan loai khdng suy dinh dudng. Nhan xet niy ciia Chung tdi tUdng tU kit qua nghiin cifti eiia Seeker cung tien hanh nghien cUu trin dpi tUpng benh nhin nhi [5]
118
Y HQC VIET NAM THANG 3 - 3 0 2/2015
Nghien eiiu eua ehung tot da chi ra eong eu SGA CO do nhay va dp dac hieu cao de xae dinh cac tre em suy dinh duSng, dang ed nguy ed suy dinh dudng. Ap dung eong cu SGA trong sang Ipc va danh gia tinh trang dinh duSng, giup eho eong tae ho t r d dinh dudng sdm nham giam t y le suy dinh dudng, giam eae bien chu'ng lien quan den dinh du@ng.
V. K ^ L U A N
Phu'dng phap danh gia tlnh trang dinh du@ng theo rang cu SGA ddn gian, co do nhay va dp dac hieu cao de phat hien dung cac tru'dng hdp suy dinh duQng va khong suy dinh du@ng. Cdng eu SGA can du'dc thyc hien d cac benh vien de sang Ipc, danh gia tinh trang dinh du^ng eua tre em
TAIUIUTHAMKHAO
1 . Baker JP, Detsky AS, Wesson DE, e t al (1982). Nutritional assessment: a comparison of dinical Judgment and objective measurement.
New EnglandJoumal of Medidne. 306,969-972
Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, Jeejeebhoy KN (1987). What is subjective global assessment of nutritional status? JPEN J Pa/vnter Enteral IVutr,mi),8-13.
Elmore MP, Wagner DR, Knoll DM, et al (1994). Developing an effective adult nutrition screening tool for a community hospital. J Am Diet Assoc. 94(10), 1113-8
Kenneth EC (2002). Malnutrition and bad oucome. J Gen Mem Med. 17(12), 956-957 Seeker D3, Jeejeebhoy K (2007). Subjective Global nutrition assessmnet for children. Am J Oin Nutr. 85,1083-9
Thoresen L, Fjeldtad I , Krogstad K, e t a l (2002). Nutrition status of patient with advanced cancer; the value of using the subjective global assessment of nutritional stetus as a screening tool. Paliiat Medicine. 16,33-42
WHO (2006). Child growth standards. Geneva:
World Health Organization. Available at:
http;//www.who.int/ehildgrowth/standards/en/,htt p://www.who.inVchildgrowth/standards/tedinlcal _reporVen/index.html
NGHitU Ciru VAI TRO CUA SIEU AM NOI TRITC TRANG
B A N H GIA GIAI DOAN UNG THU- TRirC TRANG
T6MTAT
Mvc tISu nghien cihi:
1. Dinh gia vai trd cOia sieu am nol tri/c trang Chan dodn glal doan kh5l u va dl cSn haeh (uT- uN) ung thu tn/c b-ang
2. Tim hieu mot s5 yeu to lien quan tdi ket qua eOa sl§u 3m nOl trut trang
Phu'dng ph^p: Dinh gia mot phUdng phip eh^n doin- den cu\j
60 b#nh nhSn ung thu* tn/c trang du'dc lam sieu I m npi tri/c tring trude mo danh gii glal doan sau dd du'dc phSu ttiuSt triet cSn v i so sanh vdi ket qui giii phau benh sau m6 (ty le chan doin dicing glai doan T v i N, do nh^y, do d$c hl^u)
* Khoa ngoai T i n trieu - Benh vlen K Chiu trich nhiem chinh: Pham Vin Binh Email: [email protected] Dt: 0904145909 Ngiy nh$n b i i : 4.2.2015
Ngiy phin blen khoa hpe: 30.2.2015 Ngiy duyet b i i : 5.3.2015
P h ^ m v a n B i n h * , T r 4 n D i n h T S n *
Ket qua: 25 (41,6%) BN nam, 35 (58,4%) BN nff-Tufil trung binh 59,6. 40 (66,7%) ea u tn/e tring thap, 17 (28,3%) ca tmng binh, 3 (5%) ca u tn/c tring cao, 12 (20%) ca u chiem 1/3 chu vl, 48 (80%)ca u chiem tren VJ chu vi. Ty le chan doan dung cua sieu am nol trut tring giai doan khoi u 66,7%, dl cin h^di 56,6% (do nhay l i 94,1%, dp die hi§u 79%)
K ^ tu^n: sieu am npi trut trang danh g i i glai doan ung thu' trUc trang i p dung tai Benh vlen K e61^' le ehan doan di^ng: khoi u 66,7%, di cin hach 58,3%
(dp nhay 94,1%, dp die hieu 79%). The tich ehu vi khoi u va kinh nghiem ciiia bic sy lam sieu i m c6 khi ning anh hudng tdi ket qua cua sieu i m n$l true tring.
SUMIVIARY
THE ROLE OF TRANSRECTAL ULTRASOUND I N THE EVALUATION
OF RECTAL CANCER STAGING Objectives:
1, Assess the role of transrectal ultrasound in the diagnosis of T and N staging (uT - uN) of rectal cancer
