Tổng hợp các đề tài nghiên cứu khoa học y khoa trẻ em

“Tổng hợp các đề tài nghiên cứu khoa học y khoa trẻ em” bao gồm nhiều đề tài được nghiên cứu với mục tiêu thực trạng để tìm ra một số biện pháp ngăn chặn tình hình suy thận trong hội chứng hư tiên phát ở trẻ em, Tình trạng thiếu máu, suy dinh dưỡng ở trẻ... Mời các bạn cùng tham khảo

TỔNG HỢP CÁC ĐỀ TÀI NGHIÊN CỨU

KHOA HỌC Y KHOA

TRẺ EM

1 Đề tài nghiên cứu khoa học: Nhiễm trùng đường hô hấp cấp tính trẻ em của trường mầm non tại Thành phố Huế

2 Đề tài nghiên cứu khoa học Thiếu máu ở trẻ em Trường Tiểu học của hai xã vùng cao huyện Nam Đông, tỉnh Thừa Thiên Huế

3 Đề tài nghiên cứu khoa học: Tìm hiểu tình hình suy thận trong hội chứng thận hư tiên phát ở trẻ em tại khoa nhi - Bệnh viện Trung ương Huế

4 Đề tài nghiên cứu khoa học: Tìm hiểu một số yếu tố nguy

cơ có liên quan đến viêm phổi nặng ở trẻ em dưới 5 tuổi

5 Đề tài nghiên cứu khoa học Tình trạng suy dinh dưỡng ở học sinh bị một số khuyết tật từ 7 đến 14 tuổi tại Thừa Thiên Huế

JOURNAL OF SCIENCE, Hue University, N 0 61, 2010

ACUTE RESPIRATORY INFECTIONS

IN CHILDREN OF PRE- SCHOOLS IN HUE CITY

Dang Nhu Phon, Nguyen Van Tap

College of Medicine and Pharmacy, Hue University

SUMMARY

Acute respiratory infection (ARI) is a common disease and is the highest cause of death

in children under 5 years of age in many countries In Vietnam, the program to prevent acute respiratory infection started in 1984, and aims to reduce the rate of acute respiratory infections

in children, and reduce mortality caused by this disease However, acute respiratory infections still attract much concern because the incidence of the disease is still high and affect the health

of children This study aims to identify the prevalence of acute respiratory infections in children attending nusery schools in Hue city A cross-sectional survey of 398 children attending nursery schools in Hue city was conducted Through research, we got the following results: (1) the prevalence of acute respiratory infections within two weeks of the survey was 22.36%, (2) the prevalence of acute respiratory infections increased with age, (3) the prevalence of acute respiratory infections did not differ by gender

1 Introduction

Acute respiratory infections (ARI) are a common disease and causes high mortality for children under 5 years old in many countries According to a study by Wajula (1991), the incidence of ARI/ total number of children in Iraq is 39.3%, in Brazil

is 41.8%, in the UK is 30.5%, and in Australia is 34%

The World Health Organization (WHO) states that every year approximately 15 million children die, of which about 5 million die from ARI In Vietnam, ARI in children leads to mobidity and mortality ARI contains 44% of common diseases In the community, the ARI program (1997) indicated that a village with a population of 8000, children under 5 years old spent 1600-1800 times having ARIs each year, of which about 400-450 times children have pneumonia required the treatment A program to prevent acute respiratory infection started in 1984, which aims to reduce the prevalence

of acute respiratory infections in children and reduce mortality caused by this disease

However, currently ARI has attracted much attention because the incidence of

the disease is still high and affects the health of children This study aims to identify the prevalence of acute respiratory infections in pre-school children in Hue city and the distribution of the disease by age and gender

2 Subjects and method

2.1 Research subjects: children in nursery schools in Hue city

2.2 Research Methodology

2.2.1 Study Design: cross-sectional study with random sampling

2.2.2 Sample size: from the formula for calculating the sample size, 398 children

aged 2 to under 6 years old were selected

2.2.3 Data collection techniques

- Criteria for determination of ARI when accompanied by fever and one of the following symptoms: cough, shortness of breath, concave chest on withdrawl, runny nose, sore throat A child was determined not to have an ARI if the criteria are not satisfied

- Age was determined according to the WHO classification and divided into 04 groups:

2 to under 3 years old; 3 to under 4 years old; 4 to under 5 years old and 5 to under 6 years old

2.2.4 Data collection method: A questionnaire was used to gather the variables

Questions about variables with disease or without disease was collected by maternal recall within 2 weeks of the survey

2.2.5 Data analysis: software SPSS 11.5

3 Results

3.1 Characteristics of the study sample

Table 3.1 Distribution of age groups by gender

3.2 The situation of acute respiratory infections

Table 3.2 The situation of acute respiratory infections in the study sample

Chart 3.1 The situation of acute respiratory infections in the study sample

Table 3.3 The situation of acute respiratory infections by age group distribution

Table 3.4 The situation of ARI according to gender distribution

Gender ARI Not.ARI p Total

Male 46 (51.69%) 146 (47.25%)

> 0.05

192 (48.24%) Female 43 (48.31%) 163 (52.75%) 206 (51.76%)

44 45 46 47 48 49 50 51 52 53

Male Female

Chart 3.3 The situation of acute respiratory infections by gender distribution

4 Discussion

4.1 Prevalence of common acute respiratory infections

The research results acquired by (table 3.3.) surveying 398 children under 6 years of age found 89 children suffered from ARI within the past 2 weeks (proportion

of 22.36%) This is prevalence of the disease, according to Dinh Thanh Hue:

"describing the health phenomenon of a population at a certain time."

The author Nguyen Co Viet and colleagues investigated the three provinces of

Ha Nam, Da Nang, Tay Ninh and observed an ARI prevalence is 22.8%

According to Bui Duc Duong, Nguyen Duc Chinh ARI prevalence was 24.4% According to other authors, ARI is the highest rate of infection compared with other diseases The rate of ARI (22.36%) is similar to these authors but lower than the rate found in the studies of Nguyen Thi Man at 37.94% , and Nguyen Huy Binh at 38.67%

On the other hand, a study of Nguyen Tan Vien, Le Thi Ngoc Viet said that the younger children are, the higher ARI proportion is In 0-12 month children, 54.90% had ARI, This rate in children of 13-36 months was 33.28% and 11.28% for children of 37-60 months The participants of our study were older, aged from 2 to under 6 years and the

Rate %

reasons made ARI easy to catch and develop in Hue at this time This is relevant with the comments of the authors Ta Thi Anh Hoa, Nguyen Dinh Huong, Nguyen Tan Vien

4.2 Acute respiratory infections by age group

Table 3.1 Showed that 5- under 6 years of age group got the highest ARI accounting for 65.48%, 4 - under 5 years of age group accounting for 22.88% and under 4 years of age accounting for 11.64% The difference is statistically significant with p <0.05

This result shows that in older children, the rate of ARI is higher This is in contrast to study of other authors

Research by Nguyen Tan Vien, Le Thi Ngoc Viet through 8084 for children of 5 years showed that ARI prevalence of children 2-12 months was 54.90%, 13-36 months

However in our study, the participants were children in pre-schools There are more older children who go to school than younger ones The younger children tend to stay at home or in hospital for care when they are ill, they do not go to school, so we could not join the list of them in our investigation For older children when they get mild sickness, they may continue schooling and thus remained on the books of the investigation The proportion of children in the study is 2 – under 4 years of age is 57 (14.32%), 4 - 5 years old was 124 (31.16%) and 5 to under 6 years of age is 124 (31.16%), so in our study, the older children have a higher ARI rate

Acute respiratory infections according to gender distribution Table 3.4 showed that the rate of males is 48.24% of whom 51.69% are infected with ARI The proportion

of females is 51.76%, of whom 48.31% are infected ARI Results showed that the ARI rate in males is higher than that in females, however, this difference is not statistically significant (p> 0.05)

Nguyen Co Viet and colleagues estimated an ARI prevalence of which males account for 53.1% and females 46.9% This rate has no statistical differences between males and females, which was also the case in the studies of Bui Duc Duong, Nguyen Duc Chinh

5 Conclusions

From the results obtained in this study, we reached the following conclusions:

 The prevalence of acute respiratory infections within two weeks of the survey was 22.36%

 The prevalence of acute respiratory infections increased with age

 The prevalence of acute respiratory infections did not differ by gender

REFERENCES

1 Bộ Y Tế, “ Chương trình nhiểm khuẩn hô hấp cấp tính ở trẻ em”, Đánh giá, phân loại

và xử trí Nhiễm khuẩn hô hấp cấp trẻ em, Hà Nội, (1994), 28-38

2 Bùi Đức Dương, Nguyễn Đức Chính, Tình hình sử dụng dịch vụ y tế cơ sở và khả năng

tiếp cận của trẻ em với chương trình NKHHC, Hội nghị khoa học về lao và bệnh phổi,

Bộ Y Tế, (2001), 103- 104

3 Lê Thị Nga và cộng sự, Tình hình mắc bệnh Nhiễm khuẩn cấp ở trẻ em dân tộc Sán

Dìu và Mông ở Thái Nguyên – Hà Giang”, Hội nghị tổng kết hoạt động ARI , Bộ Y Tế ,

Hà Nội, (1998)

4 Nguyễn Huy Bính, Nghiên cứu tình hình nhiễm khuẩn hô hấp cấp ở trẻ em dưới 5 tuổi

tại phường Vĩnh Hải, thành phố Nha Trang, tỉnh Khánh Hòa Luận văn tốt nghiệp

chuyên khoa I chuyên ngành y tế công cộng, (2007), 33-34

5 Nguyễn Tấn Viên, Lê Thị Ngọc Việt, Một số nhận xét về bệnh NKHHCT ở trẻ dưới 5

tuổi qua 5.084 trường hợp NKHHCT ở trẻ 2 tháng đến 5 tuổi, Kỷ yếu công trình Nhi

khoa, (1994), 358-363

6 Nguyễn Thị Măn, Nghiên cứu tình hình nhiễm khuẩn hô hấp cấp ở trẻ em dưới 5 tuổi

tại phường Thống Nhất, thành phố Biên Hòa, tỉnh Đồng Nai, Luận văn tốt nghiệp

chuyên khoa I chuyên ngành y tế công cộng, (2008), 38

7 Nguyễn Việt Cồ, Bùi Đức Dương, Tình hình sử dụng dịch vụ y tế cơ sở và khả năng tiếp

cận của trẻ em với chương trình NKHHCT, Hội nghị tổng kết hoạt động ARI, Hà Nội,

(2000), 38

8 Tạ Thị Ánh Hoa, Chương trình Quốc gia phòng chống nhiễm khuẩn hô cấp ở trẻ em,

Bài giảng nhi khoa tập 1- Trường Đại học Y Dược Thành phố Hồ Chí Minh, (1997), 484- 486

9 Dhamage.SC, Rajapaksa.LC, Fernando.DN, Risk factors of acute lowers respiratory

tract infections in children under five year of age, Southeast Asian J Trop Med Public

Heath, 27 (1), (1996), 107-10

10 Sow O,Diallo AB, Acute respiratory infections in children: a community based study

comparing a primary healthcenter and a pediatric unit, Republic of Gunnea, Tuber

Lung Dis, (1995), 4-10.

JOURNAL OF SCIENCE, Hue University, N 0 61, 2010

ANEMIA IN PRIMARY SCHOOL-CHILDREN OF TWO HIGHLAND COMMUNES IN NAM DONG DISTRICT, THUA THIEN HUE PROVINCE

Dang Thij Anh Thu, Hoang Trong Sy, Nguyen Van Hoa College of Medicine and Pharmacy, Hue University

SUMMARY

A survey carried out in 2007 of 336 highland school children in Nam Dong district, Thua Thien Hue Province showed that the total rate of anemia was 28.9%, in which it was almost all at mild level (26.2%) and moderate level (2.7%), there were no cases at the serious level; The malnutrition rate of children was 39% According to the stool tests, the rate of children getting hookworm was the highest with 18.2% There was a significant difference between anemia and ethnic groups (the anemia rate of the Kinh children was lower than that of the Catu ones) Moreover, there were other significant differences between anemia and biological factors, including: age, nutritional status, and hookworm infection Factors relating

to anemia were geography, household economic levels, the number of days eating meat and fish

a week, having parents working as farmers, educational levels of mothers and mother’s practice

in feeding children

1 Introduction

In recent decades, although there has been a considerable change of economic conditions, anemia is still an important health issue in many rural and highland areas in Vietnam Particularly for school-age children, it is dangerous, and not only related to their physical and mental health but also affects the long-term development of the community Thuong Nhat commune and Khe Tre town are two poor highland areas of Nam Dong district Basically, people in both areas have a low education level, poor income, traditional customs and habits, topography and so on, which restricts living environment, hygienic conditions, and children’s health Therefore,

socio-objectives of this study are to Determine the rate of anemia of primary school children

in Thuong Nhat commune and Khe Tre Town of Nam Dong district, Thua Thien Hue province, compare this rate of the Katu ethnic group to the Kinh and Find out the relationships between anemia and some factors on this group

2.2 Research method

This was a cross-sectional survey

Children’s weight and height was measured to examine the nutritional condition Blood samples were collected for the measurement of hemoglobin concentration, using the KX-21 machine (Symex, Japan)

Formalin ether technique was used to test stool samples to look for helminthes eggs

Mothers of those children were directly interviewed for more information relating to anemia, the answers were written down using questionnaires

Assessment indicators

- Evaluating children’s anemia status based on the hemoglobin concentration standard (g/dl) of the World Health Organization (Mild anemia: 9.0-11.9g/dl, moderate anemia: 7-8.9g/dl, serious anemia: lower than 7g/dl)

- Evaluating helminthes infection status by whether children had helminthes eggs (including Hookworm’s, Ascaris’or Trichuris’s eggs) in stool samples or not

- Weight and height were used for evaluating nutrition condition of children (If the children are younger than 9 years old, the index of weights over heights based on the conferential population was calculated:

- Lower than -2SD was considered malnutrition

- Equal to or over -2SD was considered normal

For 9 year old children and the older, whose height was over the upper boundary’s height, a BMI indicator was applied

BMI =

Weight Height2Assessment: under 5th centigrade of the conferential population was considered malnutrition, equal and over 5th centigrade of conferential population was considered

normal

- Some other factors were also evaluated, including: children’s infectious status

as well as blood lost status in the six weeks before the study was conducted, household economic levels, the number of days eating meat and fish a week, having parents working as farmers, educational levels of mothers and mother’s practices regarding feeding children

Statistical analysis

All data were coded and entered into EPI INFO version 6.04b and SPSS 15.0 for analysis

3 Results and discussion

3.1 The social- demographic characteristics of the sample

Table 3.1 The social- demographic characteristics of participants

Demography

Khe Tre 172 51.2

p>0.05 Thuong Nhat 164 48.8

Table 3.2 Anemia rate, malnutrition rate and helminthes infection rate of participants

Anemia

Moderate 9 2.7 Mild 88 26.2 Normal 239 71.1 Nutritional status

Malnutrition 131 39.0 Normal 205 61.0

Helminthes infection

Hookworm 61 18.2 Ascaris 14 4.2 Trichuris 5 1.5 The total anemia rate of primary school children in Thuong Nhat commune and Khe Tre town in 2007 was 28.9% All cases were at mild and moderate levels There was no serious anemia This result was similar to the ones of Cao Ba Loi ‘s study and Youssef A ‘s survey (in which, the anemia total rate of primary school children in Lang Son City and Morocco were 29.4% and 31.6%, respectively) Also, it was acceptable according to the rate given by the WHO, the anemia rate of children from 5 to 12 years old is around 37%

The rate of malnutrition was 39.0% In the stool samples, the rate of samples having Hookworm ‘s eggs were highest (18.2%) The stool samples containing other worm ‘s eggs were low This might result from nation collective helminthes worming program for primary school children which are carrying out in Nam Dong district

3.2 Some factors linking to anemia’s status

3.2.1 Biological factors

Table 3.3 Relationships between anemic status and sex, ethnic, age of studied group

Sex

Male 186 61 32.8 2 = 3.13

p > 0.05 Female 150 36 24.0

Compared with the study of Cao Ba Loi et al., the results also pointed out that there was a significant difference in the number of anemic males and anemic females in the studied group, and the relationship between the anemia status and ethnic groups (the Kinh children and other minority children (Tay, Nung,…) was found

Table 3.4 Relationships between anemia ‘s status and nutrition’s status,

common helminthes infections

2

= 5.33

p < 0.05

No 275 72 26.2 Ascaris infection

Yes 14 5 35.7 2 = 0.08

p > 0.05

No 322 92 28.6 Trichuris infection Yes 5 3 60.0 

A significant difference between anemia and children’s nutritional status was found in this study (p>0.05) According to many other surveys, there was a high anemia rate in malnourished children (over 80%) Anemia and malnutrition have a strong link with each other, the more seriously malnourished children get, the worse their anemia is

Evaluating the relationships between helminthes infection and anemia showed that there was a link between Hookworm infection and anemia The research of Ta Thi Tinh also reported that there was no connection between anemia and Ascaris infection

as well as Trichuris infection, but a significant relationship between anemia and Hookworm infection was found

Table 3.5 Relationships between Anemia and infectious or blood lost status in 6 months before

the study was conducted

Although there was no relationship between anemia’s status and blood lost status

as well as infectious status in the six months before the study was conducted, chronic infection and bleeding are factors relating to anemia Therefore, children with chronic infections or who have serious bleeding have had chronic bleeding in the past need to be looked after carefully It is necessary for them to supplement their iron levels with tablest to prevent anemia

3.2.2 Environmental factors

Table 3.6 Relationships between anemia status and demography,

household economic levels and the number of days eating meat and fish a week

Household

economic levels

Under the average 193 73 37.8 

2

= 17.66

Equal or over the average 143 24 16.8

There was a considerable link between household economic levels and anemia status It is reasonable that economic factors influence many other elements, including children nutrition status The research of Ali, on the relationship between demographic-social factors and anemia status in 2001 found the difference between household economic levels and anemia’s status

The children who ate more meat and fish a week have lower rate of anemia Compared with results of the study of Nguyen PH, it also reported that there was a relationship between anemia status and the number of days children ate fish and meat a week Additionally, the survey of Nguyen Chi Tam mentioned that the low frequency of fish and meat intake was a risk factor of anemia among members in family, including the adult

Table 3.7 Relationships between anemia‘s status and having parents working as farmers

Total 331 95 28.7 There was a relationship between anemia status and parents who were farmers The possible reason is that if parents work as farmers their children have more

barefoot and so on, leading to good conditions for hookworm infection Therefore, it can cause anemia

Table 3.8 Relationships between anemia‘s status and educational levels of mothers and

mother’s practice in feeding children

primary schools

Generally, the results showed that the higher the educational levels of mothers, the lower anemia rate found in their children According to the results of a study of Cao Duc Hanh on the anemia status of children from six months to under 15 years old, there was also a link between anemia ‘s status and educational levels of mothers, some other research had a similar conclusion In addition, the connection between anemia status and the mother’s practices of feeding children was found by our study

4 Conclusions

The total anemia rate of primary school children in Thuong Nhat commune and Khe Tre town was 28.9%, all of them were at the mild level (26.2%) and moderate level (2.7%), there were no serious cases of anemia The rate of malnutrition was 39.0% In the stool samples, the rate of samples having hookworm‘s eggs were highest (18.2%)

There was a significant difference between anemia rate of different ethnical groups The rate of anemia in the Katu children was higher than that of the Kinh

Moreover, biological factors relating to anemia were ages, nutritional status, hookworm infection

Environmental factors which have a relationship with anemia status included demography, household economic levels, the number of days eating meat and fish a week, parents working as farmers, educational levels of mothers and the mother’s practice in feeding children

REFERENCES

1 Wilson JD , Braunwald E, Isselbacher KJ Principles of internal medicine vol.1 Ha

Noi: Medical Publishing House 1999:466-471

2 Loi Cao Ba et al Relationships between anemia with intestinal parasitic infection in

school children (6-14 years old) in Quang Lac, Mai Pha, Chi Lang communes of Lang Son city, Lang Son province Malarial and Parasitic diseases preventive Magazine 2005,

vol.1: 77-82

3 Nguyen Chi Tam Nutritional anemia and some relating factors in 11 to 14 year old

children in a rural commune [Master ‘s thesis of community nutrition], Hanoi Medical

University 1996

4 Ta Thi Tinh et al The relationship between anemia‘s status of primary school children

and worm infection in a highland commune of Thanh Hoa Province Studies reported at

National Conference in Malaria – Parasitology – Insects in 2001-2005, Ha noi Medical Publishing House 2006:126-133

5 Quizhpe E et al., Prevalence of Anaemia in Schoolchildren in the Amazon Area of

Ecuador Rev Panam Salud Publica 2003; 13(6):355-361

6 Nguyen PH et al Risk Factors for Anemia in Vietnam Southeast Asian J Trop Med Public Health 2006; 37(6):1213-1223

7 Nguyen Cong Khanh et al Anemia in Vietnamese Children in 1987 20 years of

Prevention and Control of Micronutrient Deficiencies in Vietnam Hanoi Medical Publishing House 2001:102-103

8 Nguyen Thi Ngoc Phuong et al Effects of Anemia on Physical and Behavioral-mental

Development of Children in Budang District Binh Phuoc Province in 2000 20 years of

Prevention and Control of Micronutrient Deficiencies in Vietnam Hanoi Medical

9 World health Organization School-age Children Helminthes Control in School-age

Children Genever: World Health Organization Press 2002:9-10

10 Youssef A et al Prévalence de L’ Anémie Chez les Préadolescents Scolaires dans La

Province de Kénitra au Maroc Cahiers Santé 2004 ;14 :37-42

TÌM HIỂU TÌNH HÌNH SUY THẬN

TRONG HỘI CHỨNG THẬN HƯ TIÊN PHÁT Ở TRẺ EM

TẠI KHOA NHI - BỆNH VIỆN TRUNG ƯƠNG HUẾ

Trong thực hành, để điều trị và tiên lượng HCTHTP một cách đúng đắn, người ta dựa vào thể lâm sàng; sự đáp ứng với corticoid; đặc biệt có biến chứng

suy thận hay không là một yếu tố hết sức quan trọng trong khi can thiệp và tiên lượng [5]

Xuất phát từ những vấn đề trên, chúng tôi tiến hành nghiên cứu đề tài:

“Tìm hiểu tình hình suy thận trong hội chứng thận hư tiên phát (ST / HCTHTP)

ở trẻ em tại Khoa Nhi - Bệnh viện Trung ương Huế “ với 2 mục đích:

1.1 Tìm hiểu tần suất suy thận trong hội chứng thận hư tiên phát ở trẻ em

1.2 Nhận xét đặc điểm lâm sàng và cận lâm sàng của ST / HCTHTP ở trẻ

em

2 ĐỐI TƯỢNG VÀ PHƯƠNG PHÁP

2.1 Đối tượng nghiên cứu: Mẫu nghiên cứu được chọn là tất cả bệnh nhi 

15 tuổi bị HCTHTP vào điều trị tại Khoa Nhi - BVTW Huế từ tháng 1-2002 đến tháng 5-2003

2.2 Tiêu chuẩn chọn bệnh HCTHTP [6]:Theo Hội Nghiên cứu Quốc tế

về Bệnh Thận Trẻ em gồm: Albumin máu  25g/L Protid máu < 60g/L Proteine niệu  50mg/kg/24h

2.1.2.Tiêu chuẩn chẩn đoán ST/ HCTHTP:

2.1.2.1.Suy thận cấp [4][7][8] khi thiểu niệu, vô niệu xảy ra đột ngột (

300ml/24h)

Uré máu >17 mmol/lít (> 100mg%).Créatinine máu >130 mol/lít (> 1,5mg%)

2.1.2.2.Suy thận mạn [6][10] khi có tiền sử bệnh thận trên sáu tháng, tăng

huyết áp, thiếu

máu mạn Créatinine máu >130 mol/L (> 1,5mg%) kéo dài trên sáu tháng

phối hợp giữa phương pháp thực nghiệm và phương pháp mô tả lâm sàng Các bước tiến hành gồm khám lâm sàng, làm xét nghiệm định lượng Urê máu theo phương pháp Kjeldahl và Creatinin máu theo phương pháp Jaffe, xét nghiệm nước tiểu

EPI.INFO 6.0

3 KẾT QUẢ VÀ BÀN LUẬN

3.1.3 Địa dư:

Bảng 3: Phân bố ST / HCTHTP theo địa dư

3.2.1.Số lượng nước tiểu:

Bảng 4: Số lượng nước tiểu khi vào viện

3.2.5 Phân bố ST theo sự đáp ứng với Corticoid của HCTHTP:

Bảng 7: Đáp ứng với Corticoid của HCTHTP có biến chứng suy thận

* Nhận xét: Tử vong trong ST/HCTHTP xảy ra 10,53%, chỉ xảy ra ở STM

giai đoạn cuối

Biểu đồ 2: Diễn tiến điều trị của ST / HCTHTP

3.3 Đặc điểm cận lâm sàng:

3.3.1 Uré và Créatinin máu:

+ STC nồng độ Uré máu trung bình 24,26  9,39 mmol/L, nồng độ

Créatinin máu trung bình 169,38  57,4mol/L

+ STM nồng độ Uré máu trung bình 165,43  50,81mmol/L, nồng độ Créatinin máu trung bình 1738,16  975,36mol/L

Như vậy HCTHTP có STM thì Uré và Créatinin tăng gấp hàng chục lần so với STC

4.2 Đặc điểm lâm sàng suy thận trong HCTHTP ở trẻ em gồm:

+ Phù là triệu chứng gặp ở tất cả các bệnh nhân , đa số ở mức vừa và

nặng

+ Tăng huyết áp: suy thận cấp có 46,15%, suy thận mạn có 83,33%

tăng huyết áp

+ Thiểu-vô niệu trong STC là triệu chứng nổi bật khi vào (76,92%) và

STM thì thiểu - vô niệu chiếm ít hơn (50%), có 33,33% bình thường và 16,67%

có biểu hiện đa niệu

+ Thể lâm sàng HCTHTP không đơn thuần, thể kháng Corticoid và

biến chứng suy thận có mối liên quan chặt chẽ (p < 0,01)

+ Tử vong trong HCTHTP có ST xảy ra chủ yếu là suy thận mạn giai

đoạn cuối, với tỉ lệ chung là 10,53%, và riêng ở nhóm STM tỷ lệ tử vong là 33,33%

Đặc điểm cận lâm sàng :

+ STC: Uré máu = 24,26  9,39 mmol/L, Créatinin máu = 169,38  57,40mol/L, Kali máu bình thường chiếm 92,31%; Natri máu ở giới hạn bình thường chiếm 46,15%

+ STM:Uré máu = 165,43  50,81mmol/L,Créatinin máu = 1738,16  975,36mol/L Hạ Natri máu và tăng Kali máu nặng chiếm tỷ lệ cao (66,67%)

HCTHTP có STM thì Uré và Créatinin tăng gấp hàng chục lần so với STC

+ Có sự liên quan chặt chẽ giữa mức độ giảm Albumine máu nặng và biến chứng suy thận trong hội chứng thận hư tiên phát ở trẻ em (p < 0,05)

ĐỀ NGHỊ

- Tăng cường mạng lưới y tế cơ sở, nhằm phát hiện sớm các trường hợp

HCTHTP trẻ em ở cộng đồng để điều trị sớm, tránh xảy ra các biến chứng (trong đó

có suy thận)

- Tuyên truyền, giáo dục kiến thức về chăm sóc sức khoẻ ban đầu cho mọi người dân, giúp họ tuân thủ chế độ điều trị ngoại trú trong hội chứng thận hư tiên

phát, nhằm giảm tỉ lệ kháng thuốc làm giảm nguy cơ dẫn đến suy thận

TÀI LIỆU THAM KHẢO

3 Hồ Viết Hiếu Tình hình bệnh thận tiết niệu ở trẻ em tại Khoa Nhi BVTW Huế trong 10 năm (1987-1996) Tạp chí Y học thực hành Kỹ

yếu công trình nhi Khoa, Hội nghị khoa học Miền trung lần IV, (1999)

158

6 Nguyễn Đức Quang, Huỳnh Thoại Liên, Lê Thị Ngọc Dung Đặc điểm HCTH kháng Steroid tại Bệnh viện Nhi đồng 1, Thời sự Y Dược học

Nghị Nhi khoa toàn quốc lần thứ X HN (2002) 290 - 296

9 Ito.S Acute renal failure in Nephrotic Syndrome in children Pediatric

Nephrology for Asian practitioner, (6th Asian congeress of Pediatric Nephrology) (1996)

10 Kilis.P, Strusinka Acute Renal Failure in Children with Idiopathic

Nephrotic Syndrome, Pol - Merkuriusz- Lek 2000, Journal Medline Vol

19 (2000) 462 - 476

11 Jean J Conte & F Bouissou Insuffisance rénale chronique de l’enfant

Journees Scientifiques de Nephrologie et de Transplantation Franco - Vietnamiennes (2000)

A STUDY ON RENAL FAILURE

IN IDIOPATHIC NEPHROTIC SYNDROME IN CHILDREN

AT THE PEDIATRIC DEPARTMENT , HUE CENTRAL HOSPITAL

The mortality of renal failure of INS in children is 10.53%, mainly due to the ultimate stage of chronic renal failure , especially in chronic renal failure, the mortality is 33.33% (2/6 cases)

TÌM HIỂU MỘT SỐ YẾU TỐ NGUY CƠ CÓ LIÊN QUAN ĐẾN

VIÊM PHỔI NẶNG Ở TRẺ EM DƯỚI 5 TUỔI

Phan Xuân Mai, Huỳnh Đình Chiến

Trường Đại học Y khoa, Đại học Huế

1 ĐẶT VẤN ĐỀ

Trong những năm gần đây, nhiễm khuẩn hô hấp cấp tính (NKHHCT) đặc biệt là viêm phổi đang là nguyên nhân gây bệnh và tử vong cao nhất cho trẻ em tại các nước đang phát triển [1],[30] Tần suất bị NKHHCT giống nhau ở các nước đang phát triển và đã phát triển nhưng tỷ lệ tử vong bệnh này ở các nước đang phát triển lại cao hơn nhiều Người ta ước tính rằng NKHHCT xảy ra trung bình 4 - 5 đợt / trẻ / năm, đây là gánh nặng to lớn đối với toàn ngành y tế [1],[2],[31]

Tại Việt Nam, chương trình phòng chống NKHHCT quốc gia (còn gọi là chương trình phòng chống viêm phổi) bắt đầu được thực hiện từ năm 1984 nhằm