TCNCYH Phu truxyng 74 (3) - 2011
18.40 ± 2.67 mmHg (at 12 months preoperative). The decreased mean postoperative lOP from 13.46 mmHg (42.25%)) to 19.35 mmHg (60.73%). The mean number of glaucoma medications was reduced from 1.17 preoperatively to 0.34 at 12 months postoperatively. All eyes were remainded or increased their visual acuities. The was 27.2,% diffusion bleds, 72.7% functional bleds, 2.9% flat bled after 12 months. There was not complication in operation and posoperation. Conclusion: Trabeculetomy combined AM transplantation is a safe and effective. That should be evaluated as an good option for recurrent glaucoma.
Keywords: trabeculetomy, amniotic membrane transplantation
XAC DINH LOAl VA DO NHAY
C A M V Q I K H A N GSINH CUA VI
K H U A N G A YVIEM TAI GIO'A MAN
T I N HTHUNG
M A N G NHT QTRE EM
Pham Tran Anh Trwdng Dai hoc Y Hd Ndi
Nghien ciru nhim xic djnh loai vi dp nhay cim vdi khang sinh ciia vi khuan giy viem tai giira man tinh thung ming nhT d tre em tai bpnh vien Tai Mui Hpng Trung wang tir 01/02/2010 din 31/03/2010. Phwang phip nghien cwu: 38 bpnh nhi cd viem tai giwa man tinh thiing ming nhT mdt ben hoic ca hai ben dwac thim khim lim sing, mu tai dwac giri den phdng xet nghiem vi sinh ciia Benh vipn Tai Mui Hpng eiy tim vi khuin vi lim khing sinh dd. Phwang phip nghien cuv la tiin ciru, md ta cat ngang cd phin tich. Kit qua: Ti le eiy vi khuan dwang tinh li 78,95%,. Pseudomonas aeruginosa chiim tdi 28,12% chiim ti le cao nhit, tiip theo li Moraceila catarrhalis: 25%, Staphylococcus aureus:
21,87% va Hemophilus Influenzae: 15,62%. Kit qua khang sinh dd cho thiy eic vi khuan niy hiu nhw khing Ipi cie khang sinh phd biin dang sir dung. Kit luin: Hiu hit eic chung vi khuin nhw tu ciu ving, M.catarrhalis, H.influenzae deu khing lai cie khing sinh thdng dung. Cie vi khuan phin lap duvc cdn nhay cim vdi mdt vai khing sinh
cephalcspprin thi he 2, 3 vi cap phdi hvp amoxicilin/clavulanat
TIP khoa: viem tai giu-a man tinh 6- tre em, hinh anh vi khuan hoc, do nhay cam vai khang sinh
I. OAT V A N D ^
Viem tai giu-a (VTG) hien nay l i mdt bdnh rit hay gap trong tai mui hpng, tren khoang 2 - 5% din so theo udc tinh eua To chCre Y t i T h i gidi. Tie nhin giy VTG chu yiu l i vi khuin. 0" Viet Nam, viem tai giu-a man tinh (VTGMT) chiem khoang 3 - 5% cie bdnh ly tai mui hpng d tre em. So benh nhin niy neu khdng dugc diiu trj kjp thdi se ed nhiiu kha ning bj viem tai giu-a man tinh khi trudng thinh. Diiu niy giy trd ngai r i t Idn cho v i n de dieu trj vi diy l i mdt benh dien bien liy nim, giy diec, anh hudng nhiiu d i n phit trien [1, 2, 3].
Vidm tai giu-a man tinh thung ming nhT d tre em ed nhiiu nguydn nhin, trong dd nhiim khuin l i mdt trong nhu-ng nguyen nhin thudng gap nhit vdi muc tieu: Xic djnh loii v i dp nhay cam vdi khing sinh eua vi khuin giy vidm tai giu-a man tinh thung ming nhT d tre em tai benh vipn Tai Mui Hpng Trung uang tCr 01/02/2010 d i n 31/03/2010.
II. D 6 I TU'QNG VA PHU'QNG P H A P 1. Ddi tu'ang
38 benh nhin dip Crng du yeu ciu nghien cu-u dugc chpn tCr 45 trudng hgp bdnh nhin tre em dugc khim ndi soi, do thinh Igc, nhT lugng, chin doin viem tai giii-a man tinh thung ming nhT dugc diiu trj ndi tru v i ngoai tru v i xet nghiem vi khuin djch tai giu-a tai khoa Khim bdnh bdnh vidn Tai Mui Hpng Trung uang.
2. Tieu chuin lya chpn benh nhan
Cd benh i n diy du, dung quy djnh; Ndi soi chup anh mang tai, tinh trang mui hpng; Kit qua thinh luc do, nhT lugng; Kit qua xdt nghiem vi khuin mu tai.
3. Tieu chuin loai trip: Benh nhin khdng dong y tham gia nghien cCru.
4. Phu'ang phap: Tiin eu-u, md ta eit ngang ed phin tich.
5. Nghien ciru vi khuin
TCNCYH Phu trwong 74 (3) - 2011
5.1. Cach lay va van chuyin benh phim tinh chit mu, thanh djch, djch keo, keo nhay, nhiy mu, - Sat khuan ong tai nhiiu lin bing eon 70°; dgi "^"•••
khd khoang 3 - 5 phut. ^•^- '^^ ^ f ^ " " ° ' ^^V P^^" '^P *"' ''^"^" ""^ '^'"
khang sinh do
- Lay benh pham: Dung dung eu hai ndng dua »,-, u » ., -• ^ u- IA • .»• U ^ U , ,, a • » • a Vl khuan duac nuoi cay phan lip va dmh danh vio dng tai dudi kiem soit eua ndi soi qua Id thung ». .u • • roi
r _ , • ^ " theo thuang qui [3].
ming nhT tdi ehd ed nhieu mu, dung silanh hut mu
qua ndng trong. Rut ndng trong, phit mu liy dugc 6. Xu- ly so lieu: chuang trinh Epi - Info 6.0.
vio t i m bdng, cho mu v i o dng liy benh pham ||j_ K l ^ j Q U A bing nhya hoic thuy tinh roi day nip lai ngay,
hoic phit mu trye tiip v i o ong canh thang. J - Ti If cac vi khuin phat hien du'ac trong _ . , . . ,u .' ., u ' .,^ m i u nghien CU'U.
- Benh pham sau khi lay duac chuyen ngay den
Phdng xet nghiem Vi sinh, benh vidn Tai Mui Hong ^rong sd 30 k i t qua eiy vi khuin, duang tinh Trung uang. Tai diy benh phim duac nudi eiy ^8,95%, cd 2 trudng hgp phit hidn ea 2 loai vi ngay d i xic dinh vi khuin va lam khang sinh dd "^^uin trong cung 1 benh phim, chiem 6,66%. Cac xie dinh dd nhay eua vi khuan tim duac vdi khing ^i khuin phan lap dugc chu yeu thupc nhdm Gr (-) sinh. Thdi gian tCr lue liy benh phim ra khdi ea t h i ^^^ *' '^ '^ 68,75 %. Trong nhdm vi khuin Gr(-) thi din luc dugc xet nghiem khdng q u i 2 gid. t^'-^^ khuin mu xanh chiem ti Id cao nhit la
28,12%), tiep dd din M.catarrhalis chiim 25,00%, 5.2. Md ta benh pham ^ Influenzae chiem 15,62%. Trong nhdm vi khuan Md ta djch hut ra v i m i u sac, miii, sd lugng, Qp /+) QQ tu c i u ving.
2. Dp nhay cam ciia cac vi khuIn phan lap du'ac vo-i mpt s6 khang sinh 2.1. Do nhay cam vol khang sinh cua S. aureus
Bang 1. Dp nhay cam vo-i khing sinh cua S.aureus ( n = 7) Khang sinh
Penicillin Ampicillin Amo/clavulanie Oxaeilline Cephalotine Cephalexine Cefuroxime Cefotaxime Cefaclor Erythromycine Azithromyeine Spiramycine Gentamieine Amikacine Chloramphenicol
Nhay cam ( S) (%) 0
11,7 64,7 11,7 64,7 52,9 76,4 76,4 64,7 5,8 25,5 25,5 64,7 76,4 0
Nhay cam trung gian (1) (%>) 11,7
23,5 11,7 0 5,8
0 5,8
0 0 0 5,8
0 0 0 0
Dk khang (R) (%) 88,2 64,7 23,5 88,2 29,4 47,0 17,6 23,5 35,2 94,1 68,5 76,4 35,2 23,5 100,0
Ty le l\hing khing sinh cua S.aureus la rit cao. Die biet S. aureus khing hoin toan vdi eic khing sinh phi biin hien nay nhu: khing 100%) vdi chloramphenicol, khing 88,24%) vdi penicilline, vdi erythromycine l i 94,12%. Khing sinh ed dd nhay cam cao vdi S.aureus l i cefotaxime va amikacine vdi ty Id nhay cam l i 76,47%.
TCNCYH Phu trwong 74 (3)- 2011 2.2. Do nhay cam vdi khang sinh cua
H.irtfluenzae (n = 5)
H. influenzae eung la mdt vi khuin hien dang khing rit nhiiu khing sinh. H.influenzae khing penicillin tdi 100%o, sau dd d i n ampicillin v i spiramycine vdi ty Id lan lugt la 91,67% v i 88,33%. Diy l i vin d i can quan t i m khi lya chpn khing sinh, vi theo k i t qua eua bang tren thi hiu nhu nhu-ng khing sinh hien nay dang dugc su- dung pho biin da bj khing bdi H.influenzae vdi ty le rat cao. Duy ehi ed khing sinh amikacine hau nhu chua khing vdi H.influenzae. Khing sinh cefotaxime cdn nhay cam vdi H.influenzae vdi mu-c dp nhay cam l i 75%.
2.3. Do nhay cam vdi khang sinh cua M.catarrhalis (n = 8)
M.catarrhalis khing rit nhiiu khang sinh d mCre dang bio ddng. iW. catarrhalis khang hoin toin doi vdi penicillin (100%o), t i i p theo l i ampicillin va
spiramycine vdi ti Id 94,74%. Amikacine l i mdt khing sinh thude nhdm aminoglyeosid nhung nhay cam vdi M. catarrhalis v i vin chua bj khing bdi loii niy.
Cie khing sinh cephalosporin thi he 2 v i 3 td ra cdn nhay cam vdi M. catarrhalis. Trong sd dd cd cefotaxime vdi mCrc dd nhay cam dat 73,68%, cefuroxime nhay cam vdi M. catarrhalis d H, Id 68,42%.
4.4. Do nhay cam vdi khang sinh cua P.aeruginosa (n = 9)
P.aeruginosa da khing vdi hiu hit eic khing sinh vdi tl Id rit cao: khing penicillin, ampicillin va spiramycine vdi ty Id 100%o. Thim ehi doi vdi cie khing sinh dugc coi la rit hieu qua vdi hoat phd rdng, ed kha nang chdng lai sy d i khing eua vi khuin thi P.aeruginosa eung cd ty Id d i khing rit cao: lin lugt l i 90%o vdi cephalotin v i 80%
cefuroxime v i amoxycillin + a.clavulanic. Amikacine ed ty Id nhay cam rit cao (90%).
Bang 2. Dp nhay cam vd'i khang sinh ciia P. aeruginosa (n = 9) Khang sinh
Penicillin Ampicillin Amoxycillin + A.clavulanic Cephalotine Cefuroxime Cefotaxime Cefaclor Spiramycine Gentamieine Amikacine
Nhay cam 1 0 0 10 10 10 40 10 0 40 90
(S) (%) Nhay cam trung gian 0 0 10
0 10 1.0 10 0 20
0
(1) (%) Dk khang (R) (%) 100 100 80 90 80 50 80 100
40 10
IV. BAN LUAN
Ti le eiy vi khuin dirang tinh
Trong nghien eCru cua chung tdi, ty Id eiy vi khuan mu tai giu-a duang tinh l i 78,95%. Kit qua nay tuang duang vdi kit qua eua cie tic gia khic nhu: Kit qua eiy vi khuin tai giCra cua Luang Sy Can, Nguyin Hoing San v i cdng su cho tv Id duang tinh la 68,5%) [4], eua Nguyin Hii-u Khdi [5]
li 73,4%, v i gin diy nhit eua Dinh Thj Thu Huang [6] l i 70,1%. Trong so cie vi khuin phin lip dugc, ty Id vi khuin Gr (-) chiim da sd vdi 68,75%, cdn ty
Id vi khuan Gr (+) l i 25%). Ty Id nay tuang duang vdi tl le nghien eCru eua Le Ding Hi, Le Huy Chinh v i cdng sy l i 69,24% [2], cua Dinh Thj Thu Huang l i 76,4% [6]. Die biet ty Id phin lap P.aeruginosa l i 28,12%, v i S. aureus l i 21,87%o, kit qua phin lip niy ciing phii hgp vdi nghidn eCru eua Bernett vdi ty le phin lip dugc cua hai loai vi khuan niy l i 33,3%
mdi loai [7, 8].
Dp nhay cam ciia cac vi khuin phan lap du'ac vai mpt sd khing sinh
S. aureus: l i mpt t i c nhin rit hay g i p trong nhidm khuan hd hap, die biet l i VTGMT [7, 8].
TCNCYH Phu truxyng 74 (3) - 2011
Tu ciu ving vdi dpc td cao, d i khang rit nhiiu khing sinh, die biet l i ehung tu c i u khing metieillin rit khd diiu trj. Trong nghien cCru chung tdi nhin thiy S. aureus da khang hiu hit nhCrng khing sinh quen thude nhu penicilline, ampieilline, oxaeilline, erythromycine... S. aureus cdn nhay cam khi phdi hgp mdt khing sinh nhdm (3 - lactam vdi chit Crc ehi men (3.- lactamase nhu trudng hgp amoxycilline + acid clavulanie, hay mdt so khing sinh cephalosporin t h i he 2,3 nhu cefuroxime, cefaclor, cefotaxime... D i e bidt S.aureus cdn nhay cam vdi eic khing sinh nhdm aminoglyeosid nhu gentamycine, amikacine, vdi ty le nhay cam khi cao, tir 64 - 77%.
Haemophilus influenzae: H. influenzae cung l i mdt trong nhu'ng vi khuan thudng gap nhit trong nhiem trung dudng hd hip. Nhung nam diu thip ky 20, H.influenzae cdn nhay cam vdi mdt sd khing sinh pho thdng nhu amoxycilline, spiramycine...
nhung loai vi khuan niy cd tde dp khing thude rat nhanh. Trong nghien eCru eua chung tdi, H.
influenzae da khang nhiiu loai khing sinh nhu khing penicilline (100%)), khing spiramycine (91,7%)... H. influenzae cdn nhay cam vdi mdt so khing sinh nhu cefotaxime (75%), amikacine (83,3%). Theo nghien cCru cua Dinh Thj Thu Huang [6] thi H. influenzae da khang vdi penicilline v i rovamycine (100%o), khang 86,8% vdi ampieilline, 73,6% vdi cephalotin.
Moraceila catarrhalis: Theo k i t qua khing sinh dd M.catarrhalis eung da khang vdi rit nhiiu khing sinh thdng thudng nhu: penicilline, ampieilline, erythromycin.... Thim ehl vi khuin niy da khing nhiiu vdi cie khing sinh cephalosporin t h i he 2 nhu cefaclor, cefuroxime hay amoxycilline + acid clavulanie vdi ty Id khing cao tCr 40 60%.
M.catarrhalis chl cdn nhay cam vdi mdt sd khang sinh nhdm cephalosporin t h i he 3 nhu cefotaxime hay nhdm aminoglyeosid nhu gentamycine (52,64
%), vdi amikacine (89,47yo).
P.aeruginosa: Theo nhiiu nghien eu-u thi S. aureus va P.aeruginosa l i nhirng vi khuin dien hinh cua VTGMT [9] P.aeruginosa la loai vi khuan ed ty Id Idn nhit trong so cie vi khuin tim thiy trong tai giu-a, trong nghien cCru eua chung tdi ty Id vi khuin nay l i 28,12%o.
Ty le niy tuang duang vdi tic gia Dinh Thj Thu Huang li40,0%[6]. Trong nghien cCru nay, chung tdi thiy
true khuin mu xanh d i khang hoin toin hiu hit cie khing sinh thdng thudng nhu penicilline, spiramycine, ampieilline...Nhdm cephalosporin the he 2,3 cOng bj khing rit nhieu, vdi ty Id cao, tir 80 90%). Tuy nhien trong so dd ed cefotaxime vi gentamieine edn nhay cam vdi ty Id tuang ddi thap l i 40%), chl cd amikacine nhay cam vdi trye khuan mu xanh vdi ty Id cao l i 90%). Ty Id niy eua chiing tdi cung phu hgp vdi cie nghien eCru cua Le Ding H i , Le Huy Chinh [2], Dinh Thj Thu Huang [6].
V. KST LUAN
TCr nhu'ng k i t qua nghidn eu-u benh v i can nguyen vi khuan v i khing sinh do eua 38 benh nhin tai Khoa Khim benh bdnh vien Tai Mui Hpng Trung uang, ehCing tdi dua ra dugc mdt s6 k i t luin nhu sau:
Ty Id benh pham phin lap dugc VK l i 78,95%.
Cac vi khuan thudng gap trong VTGMT vdi ti le nhu sau:
Pseudomonas aeruginose: 28,12%
Moraxella catarrhalis: 25,00%
Staphylococcus aureus: 21,87%
Haemophylus influenzae: 15,62%)
Hiu hit cac ehung vi khuin nhu tu ciu vang, M.catarrhalis, H.influenzae deu khing lai cie khing sinh thdng dung. Cio vi khuan phin lip dugc trong nghien eu-u nay edn nhay cam vdi mpt v i i khing sinh eephalosprin t h i hd 2,3 v i cap phoi hgp amoxicilin/clavulanaL
TAI LIEU THAM KHAQ
1. Nguyin Dinh Bang (1992). Viem tai giii-a man tinh. Cam nang thye hinh tai mui hpng, Bp mdn TMH Oai hpc Y TP Ho Chi Minh. NXB Y hpc
2. Le Dang Ha, Le Huy Chinh, Pham Van Ca va cpng sy (2003). Thdng tin v i sy khing thuoc cua vi khuan g i y benh thudng gip tai Vidt Nam nim 2002, Bio c i o hdi nghj Giim sit vi khuan khing thuoc - Vu Diiu trj - Bd Y t i , 3 -12.
3. Le Thj Hoa (2001). Nghien cCru dd nhgy cam vd.i khing sinh eua Streptoeoeeus pneumoniae, Haemophilus influenzae v i Moraxella catarrhalis phin lip tCr hpng mui tre em dudi 5 tuoi d mdt so cdng dong din eu song xa dd thj, Luin vin thae sy chuydn nginh Vi sinh, OHY H i Ndi 2001.
4. Lu'ang Sy C i n , Nguyin Hoang San va
TCNCYH Phu truxyng 74 (3) - 2011 cong sy (1996). Nhiem khuan hd hip tren cap tinh
dtreem Vi§tNam.Oetii KY01 -10 Bd Y t i Hi Ndi, 20-21.
5. Nguyin HQ'u Khoi (1996). Nhiim khuan i i khi trong viem tai giu-a mu man tinh v i dinh g i i mCre dd nhay cam vdi mdt so khing sinh, Ndi san Tai Mui Hpng (2), Hdi Tai Mui Hpng Viet Nam, H i Ndi, 45 - 48.
6. Dinh Thj Thu Hu-ang (2001). Nghien eu-u lim sing, vi khuan trong viem tai giu-a man tinh d tre em v i vin d i d i khang khing sinh hien nay tai Vien Tai Mui Hpng, Luin van tdt nghidp bic sy chuyen khoa cip II, Dai hpc Y H i Ndi.
7. Barnett ED, Klein JO (1995). The problem of resistant bacteria for the managemetn of acute otitis
media, Pediatr Clin North Am; Vol: 42: 509 -17.
8. BMJ (2000). Quinolone for ear drop for otitis media. Vol: 321, 126 -127 (15 July). From InterneL
9. Dagan R (1998). Can the choice of antibiotics for therapy of acute otitis media be logical?. European Journal of Clinical Microbiology and Infectious Diseases; 17: 15.
10. Gruneberg RN, Felmingham D (1996).
The Alexander Project Group. Result of the Alexander Project: A continuing, multieenter study of the antimicrobial susceptibility of community accquired lower respiratory tract bacterial pathogenes.
Diagnostic Microbiology and Infectious Disease;
Vol: 25, 169-181.
Summary
IDENTIFYING THE COMMONEST MICROORGANISMS ASSOCIATED WITH CHRONIC DISCHARGING EARS BY CHILDREN AND THEIR ANTIMICROBIAL
SENSITIVITIES
Identify the commonest microorganisms associated with chronic discharging ears by children and their antimicrobial sensitivities. Method: Descriptives tudy.This study was carried out from 01/02/2010 to 31/03/2010 in the outpatient deparment of the national ENT Hospital A total of 38 patients with unilateral or bilateral active chronic suppurative otitis media attending the outpatient clinic were included in the study. All patients were evaluated through detailed history and clinical examination. Result: Overall microbiology of 38 samples was studied of which 78.95%o positive cases. Pseudomonas aeruginosa accounted for 28.12%
was the most common isolate, followed by Moraceila catarrhalis: 25%). Then followed by Staphylococcus aureus (21.87%) and Hemophilus Influenzae (15.62%o). Antibiotics sensitivities pattern showed that majority of these bacteria are resistant to most common antibiotics. Conclusion: Commonest organisms isolated from chronic discharging ears were Pseudomonas aeruginosa and Staphylococcus aureus. Majority of isolates of Pseudomonas aeruginosa were sensitive to Amikacin and Ciprofloxacin. The 2"''and 3'''' Cephalosporins and Amox/clavulanie were effective against most of the isolates of those microorganisms.
Keywords: chronic suppurative otitis media, microbiology, antibiotic sensitivity
TY LE MAC, TO' VONG VA MOT S6 YEU TO LIEN QUAN CLiA VIEM P H 6 I THCy MAY
Le Kiin Ngai, Khu Thj Khanh Dung Benh vidn Nhi Trung wong
Nghidn ciru nhdm xdc dinh ty Id mdc, ty Id mdc mdi, ty Id tw vong cua vidm phdi thd mdy (VPTM) vd md td m0t s6 yiu t6 lidn quan tdi VPTM tai cdc khoa hdi sire tich cux: bdnh vien Nhi Trung wong. Kit qud: 120 b$nh nhdn thd mdy dO tidu chuin nghien ciru, vdi tdng s6l162 ngdy thd mdy; Ty Id mdc 26,7%; ty 1$ mdc mdi 27,5/1000 ngdy thd mdy; t^ Id tw vong 46,7%; Lidn quan giCra VPTM vdi gidi (OR = 1,3; p > 0,05); vdi tudii 1 tuin vd > 1 tuin (OR = 0,65; p > 0,05); vdi khoa diiu trjx^ = 3.05; p > 0,05); vdi chin dodn luc vdo vidn: