TAP CHl Y HOC VIET NAM TAP 465 - THANG 4 - SO 2 - 2018 5. Bo Y te (2012), Thong tU so 15/2012/TT-BYT ngay
12 thang 9 nam 2012 cua Bo tn/dng Bo Y te quy i^nh ve dteu kten chung bao dam an toan itii/c pham dot vdi cd sd san xuat, kinh doanh thUc pham.
6. B9 Y te (2012), Thdng t y so 30/2012/rr-BYT ngay 5/12/2012 eita Bg tn/dng Bg Y te guy dinh ve dieu kien an toan thUc pham doi vdi cd sd kinh doanh dich Vli an uong, kinti doanh thffe an dudng phd
. Bo Y te (2006), "Quyet dmh so 4128/2001/QO- BYT ngay 03/10/2001 cita Bg tru'dng Bp Y te ve viec " Quy dmh ve dteu kien dam bao, an ban thyc pham tat cac nha an , bep an tap the va cac co sd kinh doanh , che bien suat an san ", Cic van ban guy pham phip luat ve ve sinh an toan thu'c pham tap I, Nha xuat ban Y hoc. Ha Noi, tr.388-393.
VAI TRO CUA SIEU AM TRU-aC SINH TRONG QUAN LY BENH TAC TA TRANG BAM SINH TAI BENH VIEN VIET DU'C GIAI DOAN 2010 - 2015
Nguyen Viet Hoa', Vu Hong Tuan'"^
TOIVI TAT
Muc tieu: Oanh gia ket q^ua dieu tri benh nhi tic ta traiig bam sinh tai benh vien Viet Dffc giai doan tii nam 2010 den nam 2015. Boi iUdng va phUcfng phap nghien cdu: Hot cffu 43 trffdng hop tac ta trang bam sinh tat khoa phlu thuat nhi benh vten Viet OiTc tu" thang nam 2010 den nam 2015. Kei qui:
100% benh nhi deu dUdc sieu am trUdc sinh, thUc hien d nhieu cd sd khac nhau. Cd 27 benh nhi co chan doan tru'dc smh la tac ta trang. Cac dau hieu tren sieu am tru'dc sinh: Da oi 72,1%, dau hieu bdng doi da day gap 55,8%, dau hteu Vi/htrlpDOJ gap 2 tru'dng hop chtem 4,9%. Thdi gian du'dc mo, thdt gian nam vien cita nhom cd chan doan tru'dc smh thap hdn nhdm khong dyoc chan doan tru'dc smh co y nghfa thdng ke (p<0,05). Kei luan: Sieu am tru'dc sinh co vai trd quan trpng trong, viec phat hien benh. Quan ly cac tru'dng hdp cd chan doan trUdc smh giiip ket qua dieu tri tdt hdn.
Tu'khda:Thc ruot sd sinh, t i e ta trang.
SUIVIIVIARY
THE ROLES OF PRENATAL DIAGNOSIS I N MANAGEMENT OF CONGENITAL DUODENAL OBSTRUCTION I N VIETDUC
HOSPITAL FROM 2 0 1 0 TO 2015 Objectives: To evaluate the roles of prenatal . ultrasound in management of congenital duodenal obstruction in VietDuc hospital from 2010 to 2015.
Material and method: Retrospective case series, 43 patients with congenital duodenal obstruction treated at department pediatnc in Viet Due hospital from 2010 to 2015. Results: Prenatal ultrasound was peiformed forall patients (100%) at different medical levels. The image on prenatal ultrasonography is "double bubble"
55,8%, many amniotic fluid 72,1%, the Whirlpool sign 4,9%. The time operation, the hospitalization time is lower in group with prenatal diagnosis. Conclusion:
'Khoa phau thuit nhi - Benh vien Viet Ode.
^Bd mon ngoai • Tru'dng dai hoc YHi Noi.
Chiu trach nhiem chfnh: Vij Hong Tuan Email: [email protected] Ngay nhan bai: 23.2.2018 Ngay phan bien khoa hoc: 4.4.2018 Ngay duyet bai: 11.4.2018
Prenatal ultrasonography has an important role in the detection. Management of prenatal dtagnosts.results in better treatment outcomes.
Keywords: Congenital intestme, duodenal obstruction.
I. OAT VAN OE
Tae ta trang bam sinh (TTBS) la sy bit tae hoan toan hay khong hoan toan ta trang do cac nguyen nhan bam sinh. Tac TTBS la he qua eiia mot vai khuyet tat phoi hgc trong sy phat trien tien trang nhU sy tiinh thanh ong hay sff quay bat thudng, Cac bat thydng ve phoi hpc cita cac ed quan ian can nhy tuy, tTnh mach effa, dong mach mac treo trang tren... cung cd the dan tdi t i c ta trang [1] La mdt cap effu ngoai khoa can dffdc chan doan va xff trf kip thdi.
Tac TTBS can dyOc chan doan sdm va dieu trj sdm tranh eho tre bj rdi loan nydc va dien giai, thang bang kiem toan, viem phoi, hau qua cd the dan tdi tff vong. Bieu hien lam sang sdm ciia tac TTBS la tre non trong vong 24 den 48 gid dau sau sinh, chat ndn la sij^ lan djch mat (80% la tac dydi nhu ta trang). Tac ta trang co the chan doan sdm nhd sieu am trydc sinh, phydng phap nay da dydc lam tff thap ky 70, bieu hien tren sieu am trydc smh la sy gian cua da day va doan dau ta trang ciia thai nhi (hinh qua bdng doi) kem theo da di ciia ngydi me.
Sieu am cimg vdi choc oi con dem lai thong tin ve dj tat ket hdp nhy hpi chffng Down, benh tim la nliffng di tat hay di kem vdi tae TTBS [2]. Viec chan doan trydc smh sdm giiip thay thudc va gia dinh lap ke hoach cham sdc, hoi sffc va can thiep sdm_ sau khi tre ra ddi.
O Viet Nam, vdi sy phat trien ciia sieu am trffdc sinh va hinh thanh eae trung tam chan doan trydc sinh tren ca nydc nen viec chan doan tac rupt sd sinh ngay cang sdm nen eac benh nhan TTBS ngay cang dydc quan ly sdm. Chinh vi vay chung thoi thyc hien nghien cull nay
VIETNAM MEDICAL JOURNAL H°2 - APRIL - 2018 nham danh gta vai trd cita sieu am trydc stnh
trong quan ly dieu trj eiia eac benh nhi tac ta trang bam sinh dieu trj tai khoa phau thuat nhi va tre sd sinh - benh vien Viet Dffc giai doan 2010 den nam 2015.
II. DOI TU'ONG VA PHU'OFNG PHAP NGHIEN Cl}U 2.1 Ool tu'dng:
- Tieu ehuan lya chon: Tat ca cac benh nhi ehan doan trong mo la tac ta trang.
- Tieu ehuan ioai trff: Cae benh nhi ehan doan tac rudt sd sinh khi md ra nguyen nhan la cac thydng ton khac nhu': teo ruot, tae rupt phan xu, gian dai trang bam sinh, xoan rupt, dj tat hau mdn trffc trang...
Trong giai doan nghien effu cd 43 trffdng hdp tre sd sinh tae ta trang dffdc mo tai khoa.
2.2. Phu'dng phap nghien cffu: Nghien cffu mo ta hoi cffu
Cach thffc thu thap benh an nghien cffu dot vdi eac benh nhan hoi cffu:
- Tra cffu so ra vao vien ciia khoa phau thuat nhi Benh vien Viet Dffc tff thang 1 nam 2010 den thang 1 nam 2015. Tff do lap danh sach benh nhan gom ten, tuot, chan doan lam sang, ngay ra vao vien.
- Tra ma benh an ciia tffng benh nhan tai phong ho sd lffu trff benh vien Viet Offc theo phan loai benh quoc te ICD 10.
- Kiem tra ho sd, ddi chieu phii hdp vdi ehi tieu, mdi lay vao nghien effu.
- Vao theo benh an mau da thiet ke trydc.
2.3. Cac chi tieu nghien cu'u:
- Ty le benh nhan du'dc ehan doan trydc sinh.
- cite hinh anh tren sieu am trydc sinh: tinh trang di, dau hieu bdng doi da day, dau hieu tang nhu dong, dau hieu Whirlpool.
- Cac dj tat phoi hdp.
- Thdi gian nam vien.
III. K^TQUA NGHIEN CO'U
Benh nhan vao vien sdm nhat la 1 ngay, nhieu nhat la 40 ngay. Trung binh la 6,16 ± 2,84 ngay. Tudi thai nhd nhat la 32 tuan, gia nhat la 41 tuan. De thieu thang (<37 tuan) ed 17 BN (39,5%), dii thang (Tff 37 - 41 tuan) cd 26 BN (60,5%).
Sieu am chan doan trydc sinh: Tat ca cac toTdng hdp (100%) deu dffdc sieu am trffdc sinh.
Bang 1. Lien quan ctf sd lam sieu im va kei qui
""^^^^ Ket luan
^"•^si|u am Cdsd ^ - ^
Benh vien san C Benh vien tinh
T a c t a trang 15
9 n 19 12
T y l e
78,9 75,0
Benh vien huyen Phonq Icham tif
Tonq 1 3 28
5 7 43
~ l o l _ « S
65,15 Bang Z Cac dau hieu tren sieu am tnfdcariR Dau hieu tren sieu a m
Tinh trang oi Hinh qua honq doi Quai ruot qian Dau hieu Whiripool
Da oi Binh thu'dnq Thieu 61
Co Khonq
Co Khonq
Co Khonq Di tat khac
n 31 12 0 24 19 6 37
2 41 1
T y l e ( % |
_Mz.
27,9 '.0 55,8 "
+1,2 14 86 4,9 95,1 2,2 Cd 27 benh nhan 62,8% vao vien vtili chan doan trydc smh la tac l i trang, 16 benh ntian khdng cd chan doan trydc sinh.
Bing 3. Liin quan gida tinh trang oi id iudi thai
"^•^^--Tiahtrang 61 Tuoi ttiar~"^^--~~-^
Oil thang Thieu thanq
Tong
Da oi 15 16 3 1
Binh thu'dng
2 10 12
Tong 17 26 43 Nhin xit: Sff khac nhau giffa tinh trang da oi d me va tudi thai khi sinh khong co y ngiiia thdng ke vdi p > 0,05
Bing 4: Di tai ket hdp D i t a t
HC Dov;n Tim bam sinh Dl tat tiet nieu Benh iy mat
Tong so
Sdluong 4 1 1 1 7
TV 16 (»/o) 9,3 2,3 2,3 2,3 16,3 Bing 5: So sanh thdf gian dUdc dian dtim xac i^nh aia 2 nhdm cd va khd/ig cd CBTS
Nhdm
Cd COTS Khdng cd CDTS Tong so
Chan doan sdm (< 48 gid sau bleu
hten benh) 26
5 31
Chan doan muon (>
48 ^ i d sau bieu hien benh)
1 11 12
Tong so 11 16 41 IVhanxet:Ty le chan doan sdm phu thuoc vao viec trffdc dd cd chan doan trffdc sinh la tac TTBS vdi P < 0,05 (Test chinh xac Fisher).
Bang 6. Lien quan thdi gian dieu di ra chi'n doan trUdc sinh
Tuoi mo (nqay) Thdi qian nam vien(nqav)
Co COTS
1,7 9,7
Khonga CBTS
^_i?—
12,3
TAP CHi Y HOC VigT NAM T^P 465 - THAHG 4 - SO 2-2018 Nhin xit: Sff khac biet ve tuoi mo va thdt
gian nam vten giffa 2 nhom la khac biet ed y nghTa thong ke vdi p< 0,05.
IV. BAN LU;QLN
Tac ta trang bam sinh la benh ly co the chan doan sdm nhd sieu am trffdc sinh. Hinh anh
"qua bdng doi" la dau hieu dten hinh cua benh va la tteu chuan vang cho chan doan [2,3]. t u y nhten, de tim dffdc hinh anh dien hinh tren, bac si lam sieu am cung phat cd ktnh nghiem. Ngoat ehan doan ^ c ta txang, mpt so di tat hinh thai khac va rot loan nhiem sac the cung duUc chan doan trffdc sinh. Chinh vi vay, trong nghien effu ciia chung tdt, ty le dj tat bam stnh phdt hdp va ty le hot chffng Dovi/n thap. Nguyen nhan cd the do khi phat hten da di tat dac biet la dj tat nang, hay bat thffdng nhiem sac thi cac gta dinti se diidc tff van bd thai khi thai cdn nhd.
trong nghien cffu nay tat ca cac ba me cd eon trong nhdm sd sinh deu dffdc sieu am chan doan trffdc sinh (100%) tat nhteu cd sd khac nhau. Sieu am ngay nay da t r d thanh phd bien d nffdc ta, va dffdc sff dung de chan doan rat rong rat trong tat ca cac linh vffc, dac biet la san phu khoa. Cac may sieu am dffdc trang bi den tat ca cac tuyen huyen tham t r i xa va nhteu phong pham tff. Mac du vay chat Iffdng sieu am khdng dong deu d cac tuyen vi phu thupc nhieu vao kien thffc va kinh nghiem cua ngu'di Iam sieu am.
Trong nghien cffu nay. Tac ta trang dddc chan doan chu yeu vao 3 thang cuoi cua that kj', trong nghien ciiu nay tuot thai dffdc chan doan sdm nhat la 20 tuan, muon nhat la 37 tuan, trung binh la 30,4 tuan, trong do cd 28 trffdng hdp dffdc chan doan TTTBS chiem 6 5 , 1 % . Ty le n^y tffdng tff nhff nghien ciiff cua H.Q.Quan [7]
Ty le chan doan chinh xac TTTBS dy^ vao sieu am trffdc sinh d benh vien phu san Trung ffdng la cao nhat vdi 78,9%, thap nhat d cac benh vien huyen chi la 20%. So sanh ty le ket luan tac ruot d cac cd sd thay cd sd khac biet ro rang vdt p<0,05.
Tinh trang da oi dffdc ghi nhan trong nghien cuff nay la 31 benh nhan chiem 7 2 , 1 % , trong dd CO 15 benh nhan de non va 16 benh nhan de dij thang. l*1oi ngay thai nhi nuot vao khoang 500 - 700 mi djch oi, mot cd che quan trpng trong dieu hoa the tich nffdc oi. Oa ot xay ra kht cd sff t i c nghen Iffu thdng cua ruot, dac biet la tac cao ciia ong tieu hoa [ 1 ] . Kimble kht nghien cii^i 80 benh nht TR ttiay rang da oi d me khi cd that xuat hien d 100% teo thffc quan, 8 0 % teo ta trang loai I, 100% d teo ta trang loai I I I va 24% khi teo d
hong hoi trang [ 1 ] .
Ruot xoay bat toan (RXBT) co the gay tac ta trang do day chang t^dd hoac xoan rupt, vdi bteu hten tac rupt cao vimg ta -hong trang. Day la bat thffdng tieu hda, 90% ed bieu hien trong nam dau ddi. Benh canh ndn di dich xanh reu rat thu'dng gap, vtec xac djnh nguyen nhan la can thiet, giup cho nha ngoai khoa co that dp tieh cffc, khan cap hdn neu nhff ta xoan rupt do fOCBT. Do dd vtec phat hten dau hteu dao vi tri tmh mach mac treo trang tren va dau tiieu Whirlpool rat quan trpng cho viec gdp phan xac djnh ehan doan. Trong nghien cffu, chung tdt ght nhan dau hieu V\/hirpool cd 2 trffdng hdp, va mo ra dung la 2 trffdng hdp nay cd tac ta trang do day Chang Ladd. Cdn theo nghien cffu cita Couture dau hteu Whirlpool cd dp nhay va dp dac hteu cao eho phat hien RXBT [ 6 ] .
Trong nghien ciiff chi rd thdi gian chan doan xac djnh, thdi gian dddc md, thdi gian nam vien ciia nhdm tre cd CDTS thap hdn nhdm khong cd CDTS, sff khac blet nay ed y nghTa thdng ke vdt p < 0,05. Dieu nay hoan toan phii hdp vdi eac nghien cuff khac, cho thay vai trd quan ly benh nhi quan trong cua sieu am trffdc stnh[2,3].
Do vay khi sieu am djnh ky phat hien nhiitig bat thffdng nhff da di, cd dau hteu "day da gay" nghi ngd hpi chutig Down thi can choc oi tam xet nghem nhiem sac the va theo dot ky bang steu am de chan doan tac ta trang sdm kem theo cd dj lat khac khdng. Chan doan trydc stnh giup tff van dinh chi thai ed dj lat nang khdng ehffa dffdc hoae sau chffa van bj tan phe va giup cho chan doan sdm di tat saij sinh de benh nhi dffdc dieu tri sdm de t i n g ty te thanh cong cua dieu trj sau sinh, gtam thdi gian dteu trj.
V. KET L U A N
Sieu am trffdc stnh cd the chan doan cac trffdng hdp benh nht tac ta trang va phat hten cac di tat phot hdp, gtup eho viec quan ly sau sinh tdt hdn, giam thieu thdi gian chan doan va thdi gian nam vten. Oe ket qua chi'nh xac can thffc hten d cac trung tam chan doan trffdc sinh va cd bien phap quan ly sau sinh ro rang tai cac cd sd cd kha nang mo benh ly d tre sd sinh.
T A I L I ^ U THAtVI K H A O
1. Sweed, Y. (2006). Duodenal obstruction (Vol.
Pediatric Surgery); Springer.
2. Bailey, P. V., Tracy, T. F., Jr., Connors, R. H., Mooney, D. P., Leuris, J. E., & Weber, T. R.
(1993). Congenital duodenal obstruction: a 32-
VIETHAM MEDICAL JOURNAL N°2 - APRIL • 2018 year review. J Pediatr Surg, 28(1), 92-95.
. Alehossein M (2012). Diagnostic Accuracy of Ultrasound in Determining the Cause of Bilious Vomitmg in Neonates.Iranian Journal of Radiology.
9(4), 190-194.
. Alois H (2011). "Transabdominal ultrasound of the gastrointestinal tract",European Course Book.
', Lawrence, M. J., Ford, W. D., Furness, M. E., Hayward, T., & Wilson, T. (2000). Congenital
duodenal obstruction: early antenatal 6. Couture A (2008). "Bowel Obstrudioti m
Neonates and Children", in Gastrointestinal Traa Sonography in Fetuses and Children, Couture A, Baud C, Editors, Springer: Germany, pp. 131-251 7. Hong Qui Quan (2011), " Chan doin tac'ti
trang bam sinh tai benh vien Viet Ddc giai doan 2004-2011"^ Luan van tot nghiep bac sy noi ttii
Dai hoc y Ha Not. '
TOI U'U HOA QUY TRINH CHIET XUAT MANGIFERIN Tir BAI THUOC BACH HO NHAN SAM THANG GIA VI - GN16
BANG PHAN MEM TIN HOC MODDE 8.0
Vu Binh Dirong', Ngo Thi Tuyet Mai', Nguyin Son Nam"
40% EtOH for 30 minutes at 55°C with ratio of solvent/feed was 11:1 (v/w, L/kq) in 2 tunes, ADDJicatton of this for exb-action of this remedv. the extracted vield archived 95.63%. Conclusion: This pnxedure can be apolied tn the modernization and dilli]
fomis oreoaretion of added Bach hoc Nhan sam RemaV.
Keywords: mangifenne, BHNST remedy, optimization, extraction,
1. DAT VAN OE
Bai thuoc Bach ho' Nhan sam thang nguyen mau gom cac vi thuoc Thach cao (Gypsum), Cam thao (Radix glycyrrhizae), Tri mau {Rhizama Anemarrhenae), Nhan sam (Radix Ginseng), Nganh me (Semen Oryzae Sativae), ia bai thuoc co phu'cfng ed tac dung thanh nhiet giai thu", tran kinh, sinh tan, ehi khat. Tuy nhien, de tang tliem tac dung tang sii'c ben cd tim eung nhu" Iclia nang chju ddng ganh nang nhiet bdi nang nong do bien doi khi hau da gia ttiem vi Oan sam (Radix Salviace lactlflorae). Bai thudc da di/flc nghien cu'u tac dung du'dc ly tren dpng vat thu'c nghiem va thiJ' lam sang cho thay cd ket qua kha quan trong dieu trj say nang say ndng [3,5]. Cac nghien cung chi ra rang cac thanh phan co tac dung ha nhiet chu yeu nhu' magiferir, sasarpogenin trong Tri mau, ton canxi trong Thach eao [4]. Tuy nhien, bai thuoe nay cd tan dang sd dijng dudi dang thude sac. Dang thuoc nay cd nhieu nhu'dc diem nhu': the tieh cong kenh, khd van chuyen, bao quan, sCr dung va do dn djnh khong cao. Vi vay, de gop phan^nang eao tiieu qua sd dung ciia bai thudc nay anco eac nghien cdu hien dai hda bat thudc nhu'chiet xuat hoat chat, bao che cao dmh ehuan, chuyen dang bao ehe hien dai. Trong tjai bao nay, chiJng toi thdng bao l<et qua nghien ctrtJ chiet xuat mangiferin (hoat chat eo tac dung trong Tri man) td bai thuoc Bach ho nhan sam thang gia ^ (BHNST). Day ta giai doan dau tien cua qua trinh nghien cu'u hien dai hoa bai thudc nay.
TOIVI TAT
Muc tieu. Khao sat cac yeu to anh hu'dng va li/a chon dUdc cac dteu kten toi Uu trong quy trinh chiet xuat hoat chat mangiferin tiT bai thuoc Bach ho nhan sam thatig gia vt. Odi tUdng nghien cdu Bai thuoc Bach ho nhan sam thang gia vi. PhUdng phap nghien cdu. chiet xuat mangiferin trong bat thuoc bang phUcJng phap chiet sieu am, tot Uu hoa cac dieu kien chiet xuat bang phan mem Modde 8.0, dmh lu'dng hoat chat mangiferin bang HPLC. Ket qua nghien ahr. Da u'ng dung phan mem tin hgc Modde 8,0 de tot u\j hoa cac yeu to anh hi/dng tdi hteu suat chiet xuat hoat chat mangiferin tir bai thuoc Bach ho nhan sam thang gia vj GN16, ket qua da lu'a chgn dUOc cac dieu kien tdi t/u gom: Sir dung phu'Ong phap chiet sieu am, dung mot chiet la EtOH 40% vdi ty le 11/1, tien hanh chiet xuat 2 lan trong 30 phijt 6 nhiet dp 65"C, Vdt cac dieu kien da lUa chon, hieu suat chiet xuat thu hot hoat chat dat 95,63%. Ket luan: Toi Uu hda du'cfc cac dieu kien trong^quy trinh chiet xuat mangiferin ti!c bat thuoc Bach ho nhan sam thang gia VI vdt hieu suat cao. Vdt ket qua nay c6 the (Tng dung trong nghien ctJU hien dai hda cung nhU san xuat cac dang bao che mdt tir bat thuoc nay.
SUIVIMARY
OPTIMIZATION OF MANGIFERIN EXTRACTION FROM ADDED BACH HO NHAN
SAM REMEDY BY MODDE 8.0 SOFTWAVE Obiective: Evaluate the extracting parameters on the mangifenne extraction procedure from added Bach ho nhan sam remedy. Materials: Added Bach tio nhan sam remedv remedv. Method. Ultrasonic extraction method usinq Modde 8.0 to optimize extraction parameters, quantitative analysis of manqifenne bv HPLC. Results:Ths. optimal condition was established including solvent of extraction was 'Hoc vien Quin y
^ Binh vien TW Quin doi 108 Chiu trach nhiem chinh: VQ Binh DUcfng Email: [email protected] Ngay nhan bat: 18.2.2018 Ngay ph^n bien khoa hoc: 30.3.2018 Ngay duyet bai: 11.4.2018
