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BOYTE BENH VIENNHITRUNGUONG BAOC A O NGHIE M T H U C A P B 0DET A I KHOAHQC C O N G N G HE NGHIENCUIJDACDIEMPMSANG,XETNGHIE\ M,MOTSOYE IJTOLIENQUANVABIENPHAPCANTHIEPV A N G DATANGBILIRUBINGIANTIEPOTRESOSINH CoquanquanlydeHi :BoYté Coquanc h u t r i d e tai :BNHVIENNHITRUNGUONG Chiinhiémdetai :TS.KhuThJKh:inhDung HANO :11/2006 ‘ MUCLUC Trang Datvande Chcong1.Tongquan 1.1.Lichsi r nghiénc iru l.2.Dicht é hocvangd a sosinh 1.3 Suhinhthanh,c6utrimvadactinhciiabilirubin 1.4 C:icnguyénnhang6yvangdatangbilirubinGT ’ tréso sinh 1.5 Chando:inphdnbi(tvangda Chaong2.D6ituongvaphuongph:i pnghiénciiu 15 2.1.Diadiemnghiénerm 15 2.2 Doituong 15 2.3 Phuongphapnghiénciiu 17 2.4.Xirlysolieu 22 Chuong3.Kétqu:inghiénciiu 23 3.1.Mfitsodacdiéml6msangcuaviingdaKingbilirubinGTcrtrésosinh 24 3.2.Dacdiémcan16msang 31 3.3 Cécyéutoliénquandenvangda 37 3.4 Diéutri 40 Chnong4.Banluan 47 4.1.Dacdieml6mséng 47 4.2.Dacdiemcnl6mséng 52 4.3.C:icyéutonguycc 56 4.4.KétquédiéutrJ 60 Chuong5.Ketluan 62 Kiénngh) 64 DéinggopciiadéHi 67 CACCHUVIETTAT BilirubinGT Biliru Bilirubingi:intiepBilirubi binTPBilirubinT T ntoanphanBilirubintriictiépBi BilirubinT D BDNM lirubintudo me—conCTM-TC B6tdongnhfi mmiiumeconC o n g thi CoombsTT icméu-tiéuc6uCoombstritetiép CoombsGT CoombSgi:intiep G6PD Glucose6 phosphatd e h y d r o g y n a s e HC Hfingc6uhemoglo HbHC binHfingclulucii LHGK Hi(ugiékh:ingtht:Khéngth TKT KBDNMme——con Khfingbritdongnhfi mméumecon MD MiéndichTruongl TLC ircccVangnhfinn5 VNN o Vangdatangbilirubingiéntic:p(GT)1émptbiéuhinkh:ithuénggapotrés sinh, 70 9otré dii th:ingv a 9otré thie u t h : i n g t r o n g t u d n d d u c u a cuoc song[24 ] Dasoc:ictruéngh p p vilngdasosinh lavéngdasinh1y.Vangdaso sinhditcicxemlavangdabenhlykhicosutangsénxu6tq u:i mitevasugiémdaot h a i bilirubint r o n g nhfmgn g a y dausausinh,t u o n g ring vcrinong bilirubinT P I1 , mg9o.Bieuhiénnayg a p ci5-259ct r é s o sinh[ ] , [43],[44],[54] TaiM y , h a n g n a m cfit i r 9os o t r é s o sinh,t r o n g s o t r i e u t r é m o i sinh,cotrieuc h i i r i g vangdatrén l6ms a n g Vangd a ciingchinhlamotnguyennh6nh a y g a p nh6ttaintréphéit:iin h p vi(nnhfmgngayd lus a u sinh[12] CiVietNam,theoCamNgocPhuong, vangdasosinhgapo509otrédii th:ingvadacbic:tgan1009otrédénon[10] CiV i e n N h i t r u n g n o n g n a m 0 c o , 9os o t reS o sinhv a o vi(n v i vangdatangbilirubinGT,28,8'7csfinayph:iithayin:iutrongdfitonthuongth6nk i n h gap61,29c[ ] TheoNg6MinhXuanta i b(nh vienTitDiithiinhph0 HoChiMin h,vangnh:innaocoxuhuérngtangddn,nam1995gap147truéingh pp,nam1996cfi158tr uéinghpp,nam1997la238truénghpp[12] Vangd a sosinhtuythuénggap nhimg d e bfiqua,dodfitinhtrangv a n g dauangd e doan h i é m d f i c th6nk i n h h a y x é y r a t ro ng nhfmgt r u é n g hppphéthi(n quam u o n dié u nayk h n g c h i x éyr a cinhfmgt r é nonthé ng, b e n h y , macongaponhtmgtrédiith:ingkhoémanhtr ongnhfmgtu$nd:iusausinh Diénb i é n t i t g i a i doan v i i n g d a so sinhng dotangb i l i r u b i n G T sangg iaidoanviingdanhttnthuéngxayrar4tnhanhva phiictapdfiikhichitrongvongvatgif Trong diéu kiénhientaioViet Nam,vi(cchando:in vatheodfii véngdascisinhcic4ctuyénytéccsoconnhiéukh6khan,chuaccisuphfiihppchatc hégiiracécnhastkhoavanhikhoa,chuacokéhoachtheodfiitréconguycccao tainhanhamph:ithienskinviingda,chando:invadieutrikipthoicactruéngh o p va ng d a benhl y ' Diéunay cothedo benhv a n g d a sci sinhchuadunechittrongd iingmiic,thi n chiconbibfisothoacbJxemthuéngcimotsoncii Ccirdtnhieunguyennh6nd¾t‹iivéngdatangbilirubinGT,trongdogapkh0aftg3 0odoBDNM me-concfinr6tnhieuc:ictruénghopcannguyenvchuacodieukienxacdinh dune Cacnghienciiu vévangdacrnuoctaclingdaduocdécapchityeuvélinhvucdiéu trimaitdec6ptoidacdiém16msangciiavangdatheo nguyénnhilnciingnhumobsoyéut6liénquandenviingda Chichvivfiyeditingremtié’nhbnhnghiéncribdéi‹i‹“NghiénciiudacdiemI:tins ang,c:inI:innsang,motskiyeutoliénquanvabiénph:ipcanthiépt:ingbilirubi ngi:intiepiitrésnsinh”vé'i2ninetiéunhusau 2.hinhgiiifiiéiiquzidiéutricfiiéifdenrzithaymci uelmfré’scrsinht a i B e“nhriéi in h i Truiignong CHUONG1.TONGQUAN 1.1.L)chsirnghiénciiu Cacnhasinhlyhocdaghinhannhiiiigtruonghppvéngdasosinhtitratsom.Ngayt uth6kjthii18,Morgagniva congsudamota15diiatré véngda.Bieuhi(n16msang,dichtéhocciiaviingdascisinhducictimth6ytrongcécsfilieucii ay vanthégioiotheky19,vangdadau tienxuathiencmatsaudfilandinxuongthan,rfiich6n,tay vabienmat theochiéunguciclai.Hiéntupngnaylacodinhvadficlapvoic:icyéuthnguycc[55] Chando:inxacdinhbangc:ichdinhlupngbilirubini n: i u Theonghiénct ruciiacactiicgiangvoiMy,mircbilirubint rung binhtrongméurontréscisinhbi nhthitétigla1,4-1,9mg/dL[44] CPP(CollaborativePerinatalProject)nghienciiutren35000trétirnam1 959—1966vaothéidiem48htufii,959cnhfmgtré du th:ingl i i c mciisinhcon6ngdobilirubinkhfingvrrotqu:i12,9mg/dL,chiém6, 2Woonguéida trang;4,5%trédadenco bilirubinin:iua13mg/dL[44] Maiselnghienciiu2297tré canuangtrén2500g,trucic3ngaytuoico 69ntrécobilirubinin:iutrén13mg/dL[44] Nghiénc t i u c i i a Newmanv a cfingsu chothilyl 9otrédatrang,4,49otrédaden,239« tréDfingAcoluongbilirubinin:iutrénl3mgJdL[44] fiArgentina,7,4Qotrésosinhbitsiiamec6bilirubinin:iutrén17mg/dL[44] Nfiichung mitedI gciiabilirubinméuphuthuficvaochii ngt6c,ched o v a cécyéutokh:ie Trénthegmthéngn:tincortftnhieuc:ienghienciiu v6tiI(mac,nguyén nhan vac : i c y é u t o n g u y c c , ciingn h u c a c b i ( n p h : i p d i é u t r i v é n g d a t g bilirubinGT otrésosinh.Nongdfibilirubinmaub i n h thuéngcinguéiléinla0,31mgJdL.citréem3,39oGfimucbilirubink h f i n g vuotquéling/ dL, 8,2okhfi ngvuotqn:i1,5mgJdL[44] .NghiénciiuoVi(tnam TaA n h H o a , n g h i é n c i i u t a i B é n h v i e n b é o v e s i i c khoét rée m n a m 1976chothayc o trongs o 25trévangd a duocthayi n : i u d a codfiuhieuV NN[8] Trong2 nam1 9 9 , taiVi6nNhitrung n o n g c c i trévang d a uangphaithayin:iu,83Woc obilirubin>20mg/dL,43Wotfibilirubin>30mgJdL[1] Nam19962000,clingt a i v i ( n N h i t r u n g n o n g t i l ( véngd a khin h a p vi(ndacod6uhi(ut onthirongnaola13,7-33,99c ,ti1(titvongciiac:ictruéngh o p VNNkhfingduoc thayin:iulé63,89o-72,3Wo[2],[3],[51 Nam1 9 , BenhvienNhiDongIco147truéinghopVNN.Nam1 9 la 158truétnghpp.Nam1997la238truérnghpp ©benhvienTitDti,nam1 9 la29truénghop,nam1 9 la6truéngh pp [4][12] 1.2 DJchtéhocvangdasnsinh Nhieunghienemuchoth4ytren569ctréscisinhvangdab(nhlykhfingrimthay nguy6nn h n M a t k h i i c , n g u c r i t a c l i n g c h i i n g m i n h d u n e r a n g c o nhiéuyéutolienquandentangbilirubinmau,séducicmotatrongbangduoid6y[ 17],[44] Bdng1.1.C:ieyéutii anhhuiingdénrilingdobilirubinin:in[5],[341, [36] Yéutitnguyc‹i Anhhufmgdénutingdobilirubinin:iu Tang Giam Chiingtoc Genhoacyeutogiadinh Mediingthuoc Nhfmgdiiatréciinghuyét thongtrufic dobivangda Tuoicao Déiduéing Tunghuyétép Ufingt h u o c t r é n h t h a i t r o n Hiitthufic g thétikithuthai Ra méu6m dao3th:ingdtiu Kemhuyétthanhth:ip Phenobarbital MeperidineR eserpineAspir Oxytoxin Diazepam Gtiytétuysong Promethazine Kiéusinh Sinhduéngdufii Voois‹im Clinuangthap DenonGiéri nam Chaink e p ron Bilirubinin:iudayroncao ChAmthé iphfinsu Bfime Cungc6pthiéucaloSut cilnsinhlynhiéu Zn,mghuyétthanhthap Diingthuocchocon Chloralhydrate Kh:ic D6cao in Chloralhydrate HeroinPhenytoi nAntipyrineRu ou