HIEU QUA LIEU PHAP KHi DUNG H 5 TROf HO HAP TREN BENH NHAN Sdl CO VIEM PHOI NANG (1/2014 - 6/2014)
Nguyin Thj Yen', Nguyin Hai Van', Hoang Thi Kim'.
Muc tiiu: Tim hieu hieu qua cua bien phap khi dung tren benh nhi sai c6 bien chung viera phoi suy ho hap (SHH). Phucmg phdp: Nghien cmi mo ta truac va sau can thiep. 50 benh nhi dugc chan doan xac dinh mSc soi c6 bi^n chung viem ph6i SHH, dieu tri tai Khoa Nhi - Benh vien Benh Nhiet doi Trung uorng, trong giai doan tir 05/01/2014 - 06/06/2014 da dugc chgn vao nghien cuu. Kit qua: Nhom benh nhi mac soi c6 bien chung viem phoi SHH tham gia nghien cuu 0 do tuoi trung binh la 18,1 thang, ngay c6 viem phoi langaythu5,3 ±3,3 cua benh, ngay xuat hien SHH la ngay thii 6,1 ± 3,5 cua benh. Sau giai phap ho trg khi dung, 84% so benh nhi cai thien dugc tinh trang SHH, 16% dien bien nang hon can can thiep tha may. So ngay can h6 trg khi dimg trung binh la 7,3 ± 5,1 ngay, s6 ngay c6 tinh trang SHH trung binh la 5,1 ± 4,6 ngay.
Kit luan: Tren benh nhi mac sai c6 viem phoi SHH, viec ung dung giai phap khi dung da gop phan cai thien tinh trang SHH, han che can thiep tha may.
Tu- khoa: soi, viem phoi tren soi.
DAT VAN DE
Scfi la benh truyen nhilm cap b'nh, c6 kha nang gay tJianh djch, do vi rut gay nen. Benh sdi c6 dac diem: sot cao, bieu hien viem iong, phat ban dang sdi va c6 nhieu bien chung. Sdi la benh do vi rut, nen viec cham soc, dieu tn trieu chiJing la quan trong va can phat hien cac bien chufng l<ip thdi de c6 cac bien phap XLT tri thfch hdp. Theo To chiTc Y te the gi6i, bien chiiTig la nguyen nhan chinh gay nen tu" vong d benh nhi mac sdi, trong do viem phoi la mot trong nhulig bien chuTig nang, hay gap'"-'^^.
Viem phoi tren benh nhan sdi cd the do chinh vi rut sdi, hoac do bpi nhiem vi khuan hoac ket hdp ca 2 nguyen nhant^i't^i. Trong nhuTig tru'dng hdp phoi bj ton thu'dng nang se c6 benh canh viem phoi nang, trong do cd tinh trang suy ho hap (SHH) vdi gia tri cua Sp02 < 90% do tai dau ngdn tayt^i. De giai quyet tinh trang SHH trong viem phoi nang, viec xu" tri lam thong thoang dudng thd, ket
">B$>!h vi?n B4nh iihi?! dm Trung ucmg, N g a y n h a n b a i ; 0 2 / 7 / 2 0 « . Ngiy phan b i | n xong: 12/7/2015- Ngii) d u y ^ t d a n g : 31/7/2015
Ngiroi chiu trSeh nhl^m n^l dung khoa hgc: Nguyin Thi Yin. Khoa Nhi Benh vi?n B?nb nhiel din Trung uang
Dienlhoar 0977540912, E-mail k Iucyl920@gmmt com
hdp vdi cac lieu phap thd Oxy, tmyen djch la cac giai phap quan trong va neu khong hieu qua se can phai can thiep thd may'"''". Mot cau hoi du'dc dat ra la trong nhOTig tru'dng hdp viem phoi nang c6 SHH, ngoai giai phap can thiep thd may, thi cac giai phap khong can thiep nhU khi dung, v6 rung va dam bao cung cap du oxy c6 han che du'dc SHH trong benh sdi khong?.
Oe tra Idi cau hoi nay va vdi muc dich han che thd may trong SHH tren benh nhi mac sdi, chung toi da tien hanh nghien CLAJ: "Hieu qua lieu phap khi dung chong SHH tren benh nhan sdi c6 bien chuiig viem phoi nang".
BOI Tl/QNG VA PHl/aNG PHAP
Dol tUdng nghien cii^: Gom nhiJng benh nhi dUdi 16 tuoi du'dc Chan doan xac djnh benh sdi va cd bien chuTig viem phoi nang suy ho hap.
Oja diem - Thdi gian: Khoa Nhi, Benh vien Benh nhiet ddi Trung u'dng (BVBNDTU), trong giai doan tu"
05/01/2014-06/06/2014.
PhUcfng phap: Thiet l<e nghien cuii: Nghien c(iu mo ta trUdc va sau can thiep; Cach chon mau: Thuan tien c6 chu dich; Tieu chuan chon benh nhSn: La nhiJng benh nhan dUdc chan doan xac djnh mac benh sdi c6 viem phoi
3 4 - T H U Y i N N H l i M V l 6 T N A M * s 6 3(11) - 2015
nang suy ho hap. Cac tieu chuan chan doan sdi, viem phoi, viem phoi nang va phan loai can nguyen gay viem phoi do cac bac sy chuyen Wioa tinyen nhilm danh gia.
Trong nghien culi nay tieu chuan danh gia viem phoi nang CO SHH: khi Sp02 do dau ngon tay < 90%. Phu'dng phap tien hanh: Benh nhan dilCfc cham soc, dieu tri benh sdi theo phac do: "HUd^g d i n chan doan, dieu tii benh Sdi"
cua Bp Y Tel'] va cac quy trinh ISO 9001 - 2008 ciia BVENBTl/. Benh nhi mac sdi du'dc cham soc tai phong each ly. Khi c6 viem phoi du'dc chuyen phdng cap cutj va theo doi. Khang sinh va cac xet nghiem (cong thiJc mau, OV, chup X - Quang phoi) du'dc lam tiieo chl djnh ciia bac sy. Khi cd nghi ngd SHH, chi so Sp02 du'dc danh gia moi 3gid/lan. Khi benh nhi c6 SHH se du'dc tien hanh:
Nam dau cao, hut thong ddm dai, truyen djch (theo y lenh), v6 rung, thd oxy lieu luUng phii hdp theo Ida tuoi.
Neu SHH chu^ cai thien: tien hanh khi dung ngay bang thuoc ventolin + puimicort theo chi ^ n h ciia bac sy.
Moi benh nhi du'dc dung sonde oxy va mask khi dung rieng: Neu sau khi khi dung, tinh trang SHH cai thien (Sp02 > 92%); Tiep tijc theo doi lam sang va tinh trang ho hap; Neu sau 1 Ian khi dung, tinh trang SHH chu^ cai tiiien (hoac neu c6 h'nh trang SHH tai phat): se tien hanh khi dung nhac lai; Neu sau hai Ian can thiep lien tiep, ti'nh ti^ng SHH khong cai thien (Sp02 < 92%): bao cao bac sy chuyen benh nhan thd may xam nhap.
Tu" van giao due dio cha me benh nhan ve benh sdi, hufing d i n each cham soc benh nhi mac sdi, cung nhu' khi benh nhi cd SHH.
Thu thap so lieu: Bang m i u benh an nghien cijfu thiet ke sin.
Phan tich so lieu: Bang phan mem SPSS 16.0.
Dao Site nghien cuti: Oay la quy trinh dieu bi thu'dng quy cua khoa. Moi thong tin ca nhan du'dc bao mat.
KCTQUA
Trong giai doan nghien cutJ c6 201 benh nhi du'dc chan doan xac djnh sdi nhap vien. So benh nhi c6 bien chuYig viem phoi la 92 (45,8%) va so benh nhi cd viem phoi SHH la 50 (24,9%).
Bang 1 : Mot so dac diem cua 50 benh nhi mac sdi CO viem phoi - SHH
DacdtMi Tuoi (thang) - 2 thang - < 12 thang - 13 thang - 5 h o - > 5 tuoi - Tmng tiinh Gioflinh - N a m
-m
- Viem phoi do vi rut - Viem [rfira do vi Wiuan - Viem phoi ket hop
n{%)
35 (70,0%) 10 (20,0%) 5(10,0%) 18,1 ±3,4 (95% a 11,3-24,8)
38 (76,0%) 12(24,0%) S (10,0%) 20 (20,0%) 25 (50,0%) Nhan xet: Tren 50 benh nhi sdi c6 viem phoi nang - SHH cd tuoi tmng binh la 18 thang, trong do 70% la benh nhi du'di 1 tuoi.
Bang 2: Cac bieu hien cua viem phoi, SHH va so ngay can khi dung tren 50 benh nhi viem
phoi nang - SHH
Dac diem Trung binh! Daodong
• Ngay xuat tiien viem phoi (tinh tu" khi sot)
• Ngay xuat hien SHH (t'nh tir khi sot)
• So ngay c6 SHH -So ngay csnMii dung
5,3 ± 3,3 6,1 ± 3,5 5,1 ± 4,6 7,3 ± 5,1
1 - 1 6 1 - 1 6 1 - 1 3 1-29
Nhan xet: Trong nghien cu\j nay, neu tinh theo gia tri trung binh, ngay xuat hien \flem phoi tren benh nhi sdi la ngay thu" 5 cua sot, ngay cd SHH la ngay thu* 6 ciia sot.
So ngay con tinh trang SHH tai dien la 5 ngay va so ngay can thi/c hien khf dung la 7 ngay.
Bang 3: Ket qua cham soc va can thiep khi dung chong SHH
" ^ - ^ ^ m s a n g Ngay viem Ngay xuat So ngay S H K a n Phan loaT^^^--^ J*™ ^^ ^ ^ I * ' •'""A **• " " V Viem phoi do vi
rut (n = 5)
4,0 ± 1,4 4,0 ± 1,4 3,5 ± 2,1 (3-5 ngay) (3-5 ngay) (2-5 ngay) j Viem phoi do vi 5,5 ± 4,1 6,6 ± 6,8 8,3 ± 7,0
khuan (n = 20) (i -16 ngay) (3 -16 ngay) (1-29 ngay) Viem phoi ket hdp I 5,0 ±2,6 > 6,3 ±2,8 6,9 ±2,7 (" = ^5) (1 - IQ ngay) ^ (2 -13 ngay) | (2 -11 ngay)
Nhan xet: Neu tinh theo gia tri trung binh, so ngay a n khi dung trong viem phoi do vi njt sdi la 3 ngay, viem phoi do bpi nhiem vi khuan la 8 ngay va viem phoi ket hdp (vi nJt va vi khuan) la 7 ngay. Sau can thiep cd 3/20
TRUYHINHI&yiVlfTNAM*s6 3(11)-2015 3 5
benh nhi viem phoi do vi khuan va 5/25 benh nhi c6 viem phoi ket hdp van can phai thd may.
^
• T r i SHH can Bi* may
• Tre SHH khong c i n ttifr may
Bieu €o 1 : Ket qua sau khi dung can thiep tren benh nhi viem phoi SHH Nhan xet: Trong 50 benh nhi mac sdi c6 viem phoi SHH sau khi du'dc ho trd khi dung cd 84% benh nhi cai thien, chi c6 16% dien bien nang hdn can can tbiep thd may.
BAN LUAN
Trong giai doan nghien culi 201 benh nhi du'dc chan doan xac djnh mac sdi i ^ du'dc nhan vao dieu tri npi tru.
Di/a tren cac tieu chuan chan doan viem phoi va wem phoi SHH, cd 92 benh nhi bj viem phoi (45,8%), trong do c6 50/201 (24,9%) benh nhi viem phoi cd SHH nang. Cac t / le tren tUdng du'dng vdi ket qua khao sat ciia TCTTTG'".
Nhdm benh nhi cd bien chuTig viem phoi SHH c6 mot so dac diem nhu", tuoi trung binh tinh theo thang la 18,1 thang, nhd nhat la 2 thang tuoi, Idn nhat la 15 tuoi. Ve phan loai cd 5 benh nhi du'dc chan doan viem phoi do chinh vi rut sdi gay nen, 20 benh nhi viem phoi do bgi nhiem vi khuan va 25 benh nhi cd viem phoi ket hop.
Nghien cu\j nay cung cd han che vi chung tdi chu'a cd nhdm ddi chiitig de so sanh ket qua. Tuy nhien, tren nhuhg benh nhan viem phoi nang cd SHH, bang cac giai phap ho trd ho hap thong thu'dng nhu' nam dau cao, hut thong ddm dai, truyen djch, v6 rung, thd oxy khong mang lai hieu qua thi viec can thiep thd may la chi dinh tiep theo
nham ciili song benh nhan™. Vdi giai phap can thiep ho ti-d bang khi dung cho thay 42/50 (84%) benh nhi cd tinh trang SHH du'dc cai tiiien tot va chi cd cd 8/50 (16%) benh nhi c6 tinh ti-ang SHH khong du'dc cai tiiien, can den giai phap ho trd thd may xam nhap. Trong nghien cdu nay, chung toi cung ghi nhan so ngay cd tinh trang SHH tai dien trung binh la 5,1 ± 4,6 ngay va so ngay can khi dung 7,3 ± 5,1 ngay, la tu'dng doi dai. TnDng qua trinh thUc hien quy trinh khi dung, de phdng lay cheo chung tdi cijng da ap dung nguyen tac phdng chong nhiem khuan nhu" tiet triing dung cu, dung Mask va sonde Oxy rieng. Nhu* vay vdi giai phap nay chung tdi da han che bdt du'dc can thiep thd may va tir do han che cong cham soc thd may, ban che du'dc viec lay cheo trong qua trinh Uid may.
Ve benh sinh, vi rut sdi sau khi xam nhap cd the theo du'dng ho hap vao mau roi gay ton thu'dng tai niem mac mui hau, phe quan, du'dng tieu hda, ket mac mat va da.
Tai day xuat hien cac djch xuat tiS: thanh mac, SLT tang sinh cua cac te bao ddn nhan. Tinh trang viem iong nang tren difdng ho hap gay can trd ho hap d i n den SHHt^^t'l Vi vay viec chong viem, chong phu ne, lam thong thoang du'dng thd la van de [fu tierP'^. Bien phap khi dung ven- tolin + puimicort du'a thuoc theo du'dng ho hap, ciling vdi hut ddm dai va dan lutJ tu' tiie la giai phap ddn glan, c6 tac dung chong viem tai cho, lam thong thoang du'dng thd nhanh va ddn gian'^i. Tuy so ngay can phai khi dung tu'dng doi dai, nhulig giai phap nay da gdp phan cai thien tinh trang suy ho hap 6 benh nhan mac sdi cd bien chuTig viem phoi.
KET LUAN
Trong vu djch sdi 2014, bang giai phap khi dung (^eu tri ho trd 50 benh nhi mac sdi c6 viem phoi SHH da cai thien 84% so tru'dng hdp SHH, gdp phan han che thd may va cong cham soc thd may.
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TAI LIEU THAM KHAO
1. WHO (2015). Measles: Reviewed . Fact sheet NO 286.
2. Bo Y te (2014). Hudng dan chan doan, dieu tn benh sdi. Quyet djnh so 1327/QD-BYT ban hanh ngay 18 thang 4 nam 2014 ciia Bp tru'dng Bp Y te.
3. Bp Y te (2014). Hu'dng dan xu" tri Viem phoi cong dong & tre em. Quyet dinh so 101/(5O-BYT ban hanh ngay 09 tiiang 01 nam 2014 ciia Bp tru'dng Bp Y te.
4. Alcdn A, Fabregas N, Torres A (2005). Pathophysi- ology of pneumonia. Clin Chest Med. 26(1), p. 39 - 46.
5. Mani C.S, Murray D.L (2012). Acute pneumonia and its complications. In: Principles and Practice of Pediatric Infectious Diseases. 4, p. 235.
6. Maiz Carro L, Wagner Struwing C (2011). Benefits of nebulized therapy: basic concepts. Arch Bronconeumol.
(47) 6, p. 2 - 7.
EFFECTIVENESS OF NEBULIZED THERAPY TO CONTROL RESPIRATORY FAILURE I N CHILDREN SUFFER FROM MEASLES
ASSOCIATE WITH SERIOUS PNEUMONIA ( 1 / 2 0 1 4 - 6 / 2 0 1 4 )
Summary
Objective: To find out the effectiveness of Nebulized therapy to control respiratory failure in children suffer from measles associated with serious pneumonia. Methods: De- scribed study before and after the intervention. 50 chil- dren suffered from measles associate with serious pneumonia and respiratory failure, treated in Pediatrics Department - National Hospital for Tropical Disease, in the period from 01/05/2014 - 06/06/2014, were selected in the study. Results: Average age of patients participating study was 18.1 months, the day of appearance pneumo- nia was 5.3 ± 3.3 days of sick and the day of appearance
Keywords: Measles, pneumonia on measles.
respiratory failure was 6.1 ± 3.5 days of sick. After nebu- lized support solution, 84% of patients improved respira- tory failure condition, but 16% of patients need a ventilator support: and the average days need a nebulized support solution was 7.3 ± 5.1 days, the average days having respiratory failure was 5.1 ± 4.6 days. Conclusion:
In patients suffering from measles associated with pneu- monia and respiratory failure, the nebulized support solu- tion contributed to improve the respiratory failure situation, limited intervention ventilator.
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