Y HQC VigT NAM THANG 2 • s g 2/2013
NGHIEN cdu CAN NGUYEN, CAC Y£'U TO LIEN QUAN VA DAC OIEM L A M S A N G CUA BENH VIEM KE
T O M T A T :
Myc tieu: khao sit c3n nguyen, cac yeu to li§n quan va d3c diem lam sang ciia viem ke. Phu'dng phap: tien cffu, mo ta cSt ngang gom 180 benh nhan bl viem ke den kham tai Benh vien Da lieu Trung UOng va Khoa kham benh-Benh vien Bach Mai tff thang 3 den thang 9 n3m 2012. Ket qua: viem ke gSp 6 mpi lira tuoi nhUng hay g§pd nhom dUdi 2 tuoi (16,1%) va tff 16 den dUdi 60 tuoi (62,8%), ty le nff/nam khoang 1,5/1, ngu'di d nong thonchiem 53,9%, nghe nong va lao dong t y do chiem 35,6%, ngUdi co the trang beo chiem 53,9% va hgc sinh - sinh vien la 14,4%.Nguyen nhando nam la 28,9% (trong ddnam Candida la 25%,nam sdi la73,l%, nhiem ca hai loat nam la 1,9%), do vi khuan chiem 24,4% [Staphylococcus aureus:2S%;Pseudomona5 aeruginosa.-13,&°/o;
Streptococci.ii,8%;Proteus.6,8°/o va mot so vi khuan khac). ThUdng ton hay gap la dat do (97,8%), am Udt (67,2%), trdt da (39,4%), bong vay da (30,6%) va mu It gap (3,3%)cay thUdng phat hien dUdc vi khuan. Vj tn hay gap la viem ke ben (31,7%),nach (31,1%); it gap hdn la d co, ke lien mong deu chiem ty le la 15,0% va ke ngdn chan (11,7%). Ket luan: chan doan viem ke chi can dffa vao cac tneu chffng dat do, am udt, trdt nfft va vj tri thUOng ton, nhUng de giup dieu tri hieu qua can phai xet nghiem vi khuan, nam va loai trff benh da khac.
Tdkhoa: viem ke, thu'dng ton, nep gap da, viem quanh mdng.
SUMMARY:
STUDY ON ETIOLOGY, RELATED FACTORS AND CLINICAL MANIFESTATION OF INTERTRIGO
Qbjectives: to investigate etiology, related factors and clinjcai manifestabon of intertrigo.
Method: Aprospective, cross-sectional study was carried out in 180 patients with intertrigo at National Hospital of Dermatology and Venereology and Dermatology Department of Bach Mai hospital, Hanoi- Vietnam from March to September 2012. Results:
Intertrigo can affect people at all ages, particularly children under 2 years old (16.1%) and those from 16- 60 years old (62.8%). The ratio of male to female was 1.5/L There was 53.9% of cases are from rural areas.
35.6% of patients are farmers and general labors; this number in group of pupils and students was 14.4%.
Patents who are obesity accounted for 53.9%.
" B$nh vi$n Bach /Wa/," Benh vien Da lieu Tmng uong Phan bif n khoa hpc: PGS.TS Nguyin Van Thu'6'ng 58
NguySn Thj M y H d * , T r a n V i n Tien**
Regarding to the etiology, fungal infections was 28,9%
(Candida infection: 25%, dermatophytosis: 73.1% and both: 1.9%), bacterial infections was 24.4%
(Staphylococcus aureus. 25%, f^udomonas aeruginosa. 13.6%, Streptococci. 6.8%, Proteus. 6.8%
and some others kinds of bacteria). Common ^ n lesions are rashes or redness (97.8%), moistness (67.2%), erosions (39.4%) and scale (30.6%) while mucus is less common (3.3%) which is often positive with bacteria when cultured.Common sites affected are groins (31.7%), armpits (31.1%) and other less common sites such as neck (15%), buttocks' fold (15%) and toes' folds (11.7%). Conclusions:
Intertngo can be diagnosed based on clinical features such as rashes, moistness and erosions at typical skin sites. However, it requires to conduct bacterial tests for an effective management.
Key words: intertrigo, lesions, skin fdki.
I.
DAT VA'N o f :Viem ke (Intertrigo) la tinh trang viem d nep gap ndi ed 2 mat da tiep xue nhau khi gap cac dieu kien ndng, am, ngam nffdc lau va thieu lu\i thdng khdng khi eung vdi sff cp xat d cac n ^ gap da, nhiem trung. Nguyen nhan viem ke hay gap la do nam, cac loai vl khuan, ngoai ra cdn do eac nguyen nhan khae va cd the gap d mpt so benh khac nhff tieu dffdng, ngffdi cd the tr?ng beo. Cac ke hay bi viem nhff nep tan co, nacfi, ben, ke ngdn tay, ke ngdn ehan, kheo chan, ke lien mdng [ 1 ] . Chan doan viem ke tht de nhUhg viec xac dinh nguyen nhan gay viem ke de dieu tri cdn han che [ 2 ] , [ 3 ] , [ 4 ] , [ 6 ] . De ed them nhtJUg thdng tin ve benh va dieu t n cd hieu qua, chiing tdi tien hanh khao sat can nguyen, cae yeu to lien quan va dae diem lam sang cua viem ke.
II. o d l TUQNG VA PHUONG PHAP NGHIEN CCIU:
2 . 1 . D d i tu'dng nghien cii'u Gom 180 benh nhan den kham va dieu tri tei Benh vien Da Ueu Trung ffdng (BVDLTW) va klioa Da lieu, Benh vien Bach Mai (KDL-BVBM) dffdc chan doan la viem ke, dong y tham gia nghien cffu, tff thang 3 den thang 9 nSm 2012.
Y HQC VI$T NAM THANG 2 • s 6 2/2013 - Tieu chuan Iffa chon gom nhChig benh
nhan dffdc chan doan lam sang la viem ke.
2 . 2 . Phu'dng phap nghiSn cu'u - Phffdng phap nghien cu\j md ta eat ngang, tien cffu, mau thuan tien.
^ - Thu thap sd lieu theo mau benh an thdng nhat gom cae bien sd: tuoi, gidi, nghe nghiep, cae yeu t d anh hffdng. Xae dinh vj trf, ^d Iffdng, mffc dp, cac loai thffdng ton.
- Xff ly sd lieu bang chffdng trinh SPSS 18.0 vdi dp tin cay 9 5 % .
III. KET QUA NGHIEN COU:
3 . 1 . M o t so yeu t o lien quan va can nguyen ciia viem ke
- I^gt so yeu to lien quan den viem ke:
Nhdm benh nhan dffdi 2 tudi chiem 1 6 , 1 % , tff 16 den dffdi 60 la 62,8%. Ty le nff/nam
= 1,5/1. Ty le mac benh d ndng thdn la 53,9%
cao hdn so vdi thanh thj (46,1%), vdi p >0,05.
Gap d benh nhan cd the trang beo la 53,9%, bj tieu dffdng la 4,4%.
Bang 3.1: Phan bo theo benh vl§m ke theo nghe nghiep Nghe nghiep
Tre em(<6 tudi) Hpc sinh. sinh vien Ccin bd van phdng Cdng nhan Ndng dan, tu-do Npitrp'. giup vide
Tong s d 180
7.8 100,0
I ' " ' . ' a " " I ':^ 1 - - - I Nhan xet: t\k em dffdi 6 tudi chiem ty le cao nhat (20,8%), nhdm lam ndng nghiep va nghe t y do chiem ty le la 35,6%, edng nhan chiem 4,4%, hpc sinh- sinh vien la 14,4%, nhdm can bd van phdng la 15%, ngffdi ndi t r d va giup viee chiem ty le thap (7,8%).
Bang 3,2; Oac nquyen nhan B^nh NSm da Vi khuan ViSm da CO- dia ViSm da tiep xuc Vifim da dau Vay nen Viem da thieu item ViSm da ta ibt
Tong sd
cua benh viem i<e
n 52 44 41 27 9 2 4 1
18028,9
%
24,4 22,8 15,0 5,0 1,1 2,2 0,6 100,0
Nh^n xet: ty le viem ke do nam la 28,9%, do vi khuan la 24,4%, mdt sd do cac benh da khae nhff viem da thieu kem, vay nen, viem da taldt it gap hdn.
3.2. Oac diem lam sang cua viem Ice Bang 3.3;ThMnq ton ciia benh viem l<e
Thtrvnq t6n c a ban D4tdo
Thu-anq ton am, u61 Tr(?t da
Mun nude Nirt da IVIu
n
176 12171 55 32 16 6
97,8
%
67,2 39,4 30,6 17,8 8,9 3,3 Nhan xet; dat do chiem 97,8%, am u'dt chiem 67,2'
nuSc la 17,8%; niit da, mil ft gap hon ( 8 , 9 % va 3,3%).
trdt chiem 39,4%; vay da la 30,6%, mun
Y HQC VI$T NAM THANG 2 - SO 2/2013
Bang 3.4: Vi tri thffdng tonVj tri thu'O'ng tdn 1 n Ben 1 57 Nach
Cd Ke liSn mdng Ke ngdn chan Khuyu tay, khoeo chan Nep du'di vO Ke sau tai Vl tri khac
56 27 27 21 14 3 9 26
31.7 %
31,1 15,0 15,0 11,7 7,8 1,7 5,0 14,4
Nhan xet: vj tri hay gap la d ben va nach (31,7% va 31,1%), tiep den la cd va ke lien mdng
(15,0%). Nhffng vj trf it gap hdn la ke sau tai, nep dffdi vu, khuyu tay, khoeo ehan.
IV. BAN LUAN:
4.1. Mot so yeu to lien quan va c3n nguygn ciia viem ke
- Mot so yeu to lien quan den viem ke:
Ket qua khao sat cua chung tdi thay viem ke gap d mpi Iffa tuoi nhffng tap trung nhieu vao hai dp tud'i la tre em dffdi 2 tudi chiem 16,1% va ngffdi ldn trffdng thanh tff 16 den dffdi 60 tudi ehiem 62,8%. Ty le tre em dffdi 2 tudi bi viem ke cao cd the la do chffc nang hang rao (mang chan) cua da tre chffa hoan chinh de bj ton thffdng do nhffng tae dpng cua mdi trffdng, dac biet la nhffng vi tri da d cac ke. Cae nep da d tre nhd thffdng sau hdn nen ludn am ffdt do ff dong cac chat bai tiet nhff mo hdi, nffdc tieu, neu khdng dffdc ve sinh, cham sde tot thi de b\ viem.
Tren lam sang chiing tdi gap nhij'ng chau be bi viem ke do tam cae loai nffde la cay khdng dffdc ve sinh, do rae bdt phan vao ke, do ddng bim lien tuc, ddi khi gap d benh nhan bi viem da ed dja hoac mac mdt sd benh da khac. Viem ke cting hay gap d nhffng ngffdi Idn trffdng thanh dac biet ddi tffdng la hpc sinh, sinh vien ed le la do dieu kien an d, sinh hoat ciia ho thieu ve sinh.
Nhffng ngffdi d dp tudi lao ddng nay hay bj viem ke cd the do dae trffng nghe nghiep hay do thieu cac phffdng tien bao hd lao ddng.
Lien quan giffa gidi tinh va viem ke ehiing tdi thay benh gap d nff (59,4%) nhieu hdn so vdi nam gidl (40,6%), ty le nff/nam khoang 1,5/1.
Ty le viem ke d nff nhieu hdn ed the la do viec lam va sinh hoat eua hp ed tfnh chat dae tliii theo gidi. Phy nff thffdng tham gia eac edng viee ndi trd, cham sdc gia dinh, phai tiep xuc vdi xa phong, cac chat tay rffa nhieu hoac iam cac cdng viec thffdng xuyen tiep xuc vdi nffdc nhff nghe gpi dau, ban nffdc giai khat...
60
Ket qua nghien cffu viem ke phan phdi theo dja dff thay ty le viem ke ngffdi sdng d ndng thdn (53,9%) eao hdn so vdi d thanh thi (46,1%), nhffng sff khac biet chffa cd y nghTa thong Ite.
Ket qua nghien cdu cua Monnappa Divya tai An Op [6] thi ty le viem kengffdi sdng d ndng thdn la 70% eao hdn nhieu so vdi ket qua nghien effu eua chung tdi. Giai thich ket qua nay, chung tdi eho rang cd the la do mau nghien cffu chffa du Idn nen chffa thay sff khac biet; cung ed the do de tai nghien cffu eiia ehiing tdi thffc hien tai eac benh vien d Ha Ndi nen benh nhan thu thap dffdc chii yeu la tai dia ban thanh pho va eac khu vffc ngoai d quanh thanh pho da va dang dude dd thj hda, cdng nghiep hda ndng nghiep nen dieu kien sinh hoat va lao dpng ciia ngffdi dan da dffdc eai thien.
Khao sat mdi lien quan ciia viem ke vdi mpt so benh khac, chiing tdi thay viem ke hay g|p d ngffdi cd the trang beo (53,9%) do nep gap da eua hp sau, thffdng xuyen am ffdt do ff dpng mo hdi va djch tiet. Ty le viem ke kem theo bdnh dai thao dffdng (4,4%) va benh nhan nhiem HIV (0,6%) la rat thap. Cd the la do nhihig benh nhan nay thffdng kham, chffa benh theo ehuyen khoa, ft den chuyen khoa da lieu, trff mpt so trffdng hdp ed viem ke nang.
Phan bd benh viem ke theo nghe nghiep ket
qua bang 3.1 thay viem ke gap nhieu d ndng dan
va ngffdi lao dpng tff do (35,6%). Odi vdi ndng
dan ed le do edng viee cua hp chii yeu la lam
rupng va ehan nudi nen mdi trffdng lam viec
thffdng am ffdt, dieu kien ve sinh kem dae biet la
thieu nhffng phffdng tien bao hp iao ddng nen de
bj viem cac ke nhat la ke cac ngdn tey, chan va
viem quang mdng. Ngffdi lao dpng tff do hay gap
la thd xay do tiep xuc thffdng xuyen vdi vdi, vffa,
Y HQC VIET NAM T H A N G 2 - S6 2/2013 xi mang, mdi trffdng lao ddng d eong ranh hdi
thoi cung tao dieu kien thuan ldi gay viem ke. Ty le viem ke la hpc sinh - sinh vien ehiem 14,4%, chu yeu la do dieu kien an d sinh hoat thieu ve sinh; can bp van phdng la 15,0% thffdng gap d nhffng ngffdi lam nghe le tan hay phue vu. So sanh vdi ket qua nghien cffu cua Mistiaen Patriek va cpng sff [5] thi ty le mac viem ke eao nhat gap d nhdm ngffdi lam ndi t r d va giup viee gia dinh. Sff khac nhau nay ed the do d nffdc ta t i le ngffdi dan tam ndng nghiep va lao ddng tff do eao nen t i le mac cung nhieu hdn.
- Can nguyen gay v i e m ke:
Ket qua nghien cffu bang 3.2 thay viem ke do nam ehiem ty le eao 28,9%, gom ca nam men va nam sdi. Trong dd nam Candida chiem 25%,nam sdi chiem 7 3 , 1 % ; cd 1 trffdng hdp (1,9%) nhiem ca Candida va nam sdi. Viem ke do nam sdi hay gap d d nam gidi trffdng thanh va d eac vj tri ke ben, ke ngdn chan. Oac biet la hpc sinh, sinh vien hay bj viem ke do nam sdi, thffdng bi lay nhiem do sff dung chung do dung nhff ch3n chieu, xd chau rffa, be nffdc, nha tam trong tap the. Viem ke do nam Candida d tre em hay gap d vj t r i ke eo, ben va nach.
ViSm ke do vi khuan ehiem 24,4%, gom cac loai: Staphylococcus aureus (25%),Pseudomonas aemginosa (13,6%), Streptococci (6,8%), Trffc khuan proteus (6,8%) va mdt sd vi khuan khac.
Tren da thffdng xuyen cd nhieu loai vi khuan song cpng sinh, nhat la tu cau (dae biet la tu eau vang) va lien a u (dae biet la lien cau tan huyet nhom A). Chiing chi gay benh khi gap nhffng dieu kien thuan ldi nhff chffc nang mang chan cua da bj tdn thffdng hay ed the giam sffc de khang. C^e cau khuan cd the ddc lap gay viem da nhff ty cau gay nhot, gay hdi chffng bong vay da c^p tmh..., lien eau gay chdc bpng nffde gay viem da bong vay. Cung ed the cae eau khuan phoi hdp gay benh nen hieu hien lam sang eung ed nhffng thay doi va khi xet nghiem phat hien dffdc ca tu cau va lien cau.
Viem ke cijng ed the la bleu hien lam sang eCia mpt sd benh da khac. Viem da ed dia la mot trong nhffng benh da eung hay gap thffdng ton d cac ke (22,8%), dac biet la cac nep gap Idn.
Viem ke do viem da tiep xuc chiem 15,0%, hay gap d ke ngdn tay, nep gap ed, ke nach chu yeu la do mdi trffdng Iam viee, sinh hoat va tiep xuc vdi cac chat tay rffa. Cac benh da khac nhff viem da thieu kem, vay nen, viem da ta lot it gap hdn.
4 . 2 . Oac d i e m l a m sang cua vi§m ke Cae loai hinh thffdng ton viem ke thffdng gSp (ket qua bang 3.3) la dat dd, thffdng tdn am ffdt, trdt da, vay da, myn nffdc, nirt da, mil.
Thffdng tdn dat dd gap d hau het cac benh nhan ehiem 97,8%, chii yeu la dat dd mffc dp vffa.
Thffdng ton am ffdt chiem 67,2%, chii yeu gap d benh nhan viem ke do vi khuan, viem da ta Idt. Thffdng ton trdt da chiem 39,4% cac trffdng hdp, gap d benh nhan viem ke do vl khuan. Trieu chffng bong vay da chiem 30,6%, hay gap d benh nhan viem ke do viem da ed dia, vay nen, viem da dau. Thffdng ton cd mu ehiem ty le thap (3,3%), khi cay mil thffdng phat hien dffdc vi khuan.
Oac diem ve vl trf thffdng ton: hay gap nhat la d ben (31,7%) va nach (31,1%). Thffdng tdn d eac nep gap Idn nay xet nghiem thffdng thay nam sdi. Thffdng tdn d eo va d ke lien mdng deu ehiem ty le la 15,0%, hay gap d tre em, xet nghiem hay thay vi khuan hoac nam Candida va mpt 50 trffdng hdp gap d cac benh da khac nhff benh viem da thieu kem, benh vay nen dao ngffdc... Thffdng ton d ke ngdn ehan ehiem ty le ft hdn (11,7%), xet nghiem hay tim thay nam va vi khuan. It gap nhat la ke sau tai (5,0%).
V. KET LUAN:
Viem ke gap d moi Iffa tuoi nhffng hay gap d nhdm dffdi 2 tudi (16,1%) va tff 16 den dffdi 60 tudi (62,8%), ty le nff/nam khoang 1,5/1, ty le ngffdi d ndng thdn la 53,9%, lam nghe ndng va lao ddng tff do la 35,6%, ngffdi cd the trang beo la 53,9% va hpe sinh - sinh vien la 14,4%.
Ty le viem ke do nam ehiem 28,9% (nam Candida ehiem 25%, nam sdi chiem 7 3 , 1 % , nhiem ea hai loai nam la 1,9%).
Viem ke do vi khuan chiem 24,4%, gom eac loai; Staphylococcus aureus {25°/Q),Pseudomonas aeruginosa (13,6%), Streptococci (6,8%), Tru'c khuanproteus {S,S%), mot sd vi khuan khac.
Thffdng ton hay gap la dat dd (97,8%), am ffdt (67,2%), trdt da (39,4%), bong vay da (30,6%), mil ehiem ty le thap (3,3%), cay mil thffdng phat hien dffdc vi khuan.
Hay gap nhat la viem ke ben (31,7%), nach (31,1%); it gap hdn la d eo va d ke lien mdng deu ehiem ty le la 15,0%. Viem ke ngdn chan chiem ty le la 11,7%, xet nghiem hay thay nam va vl khuan. i t gap nhat la ke sau tai (5,0%).
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Y HQC VigT NAM T H A N G 2 - s 6 2/2013 TAI UEU THAM K H A O :
1. ArnoldHL; Odom RB; James WD.
(1990),"Intertrigo, In: Andrew/'s Diseases of the SkinClinical Dermatology", 8th ed, Philadelphia, Pa:
WB Saunders, pp. 285.
2. Camila K; Janniger, MD; RobertA; at al.(2005),
"Intertrigo and CommonSecondary Skin Infections, American Family Physician, pp. 834-838, 3. Honig P3; Frieden IJ; Kim HJ; Yan AC. (2003),
"Streptococcal intertrigo: an underrecognized condition in children", Pediatrics, 112(6 Pt 1), pp.
1427-1429.
4. Lin ]ing-Yi; Shih Yi-Ling; Ho Hsin-Chun.
(2010), "Foot Bacterial Intertrigo Mimicking Interdigital Tinea Pedis", pp. 34-44-49.
5. Mistiaen Patriek; van Halm-Watter Meike.
(2010), "Prevention and treabnent of intertrigo in large skin folds of adults: a systematic review", pp. 1- 9.
6. Monnappa Divva.(2009), Qinical and etiopathological Study of Intertrio,Dissertation is in partial fulfillment of the requirements for the degree of Doctor Of Medicine in Dennatology, Venereology
& Leprology, Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore, pp. 70-92.
DANH GIA TAG DUNG GIAM DAU CUA GAY TE NGOAI MANG CUfNG
BANG LEVOBUPIVACAIN VA B U P I V A C A I N KET HOP FENTANYL
CHO SAN PHU DE QUA DU^TNG TlT NHIEN
T6M ih:
Muc tieu; Danh gia tac dung giam dau va cac tac dung khong mong muon ciia Levobupivacain va Bupivacain co phdi hdp vdi Fentanyl trong gay te ngoai mang cffng giam dau de qua dUdng tff nhien. Odi tu'dng va phu'dng phap nghien cufu.' 60 san phu dUdc giam dau de bang gay te ngoai mang cffng tai khoa San, Benh vien Bach Mai tff thang 3/2010 den thang 10/20io. Ket qua va ban luan: Dac diem chung ve tuoi trung binh xap xi 26, chieu cao va can n3ng, vi tri gay te la Lj-, la nhff nhau. Hieu qua giam dau; diem dau VAS trUdc gay te deu d mffc 4 - 8 diem (dau vda va dau nhieu), sau gay te diem dau gan nhU nhau va deu cd giam ro ret so vdi trUdc gay te nhdm B la 2,06±0,86; nhom L la 2,00±0,98. Giai doan II (giai doan xdthai): diem VAS nhdm B la 22,90±0,66; nhom L la 3,26±0,78. Khi lam thii thuat san khoa (khau tang sinh mon): diem VAS nhdm B la 1,96±1,24; nhdm L la 2,13±1,30. Thdi gian giam dau sau de ciia hai nhom cijng tu'dng dUOng nhau: nhom B la 8,65±2,89 gid, nhom L la 9,63±3,2 gid. Tac dung ngoai y muon nhU phong be van dgng ciia Levobupivacain ft hon bupivacain, tac dung ngoai y muon khac g5p vdi ty le thap. Ket lu^n: Gay te ngoai mang cirtig bSng Levobupivacain phdi hdp Fentanyl cd tac dung giam dau tot cho cac san phu de du'dng tff nhien va it tac dung ngoai y mudn.
* B^nh vi$n B$ch Mai
Phan bi?n khoa hpc: PGS.TS Ooan Mai Phu'O'ng 62
T r 3 n Thj Kiem*
SUAAMARY:
EVALUATION ON EPIDUfWL ANESTHESIE USED LEVOBUPIVACAIN AND BUVICAIN WITH FENTANYL
FOR ANALGESIE IN LABOURS Objectives: The sudy was perfomed to Epidural anesthesie used levobupivacain or bupivacain combined with fentanyl for analgesie in labours.
Materials and method: 60 labours was used epidural with levobupivacain or bupivacain combined with fentanyl. Resultal: The olds was approximately 26. The weighs and tall were the same in two groups.
VAS score pre-epidural was 4-8 in two groups; post- epidural were decreased to 2.06±0.86 (B group), and 2.00±0.98 (L group); VAS score in the I I stede (put on flest) wenv: 2.90±0.66 in B group and 3.26±0.78 in L group. The effects beside was low. Conclusion: Ifs very good to analgesie by epidural with levobupivacain combined fentanyl in during the labours.
I. O/^T V A N DE: