Tình hình kiểm soát Hen Phế Quản ở trẻ em theo GINA 2014 tại khoa Nhi Tổng hợp I,...

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TiNH HiNH KIEM SOAT HEN PHE QUAN OTRE EM THEO GINA 2014 TJ;\IKHOA NHI TONG HQ'P I, TRUNG TAM NHI KHOA Bt;NH VIt;N TRUNG U'O'NG HUE Nguyln Ng(JcPhuc 1 , is Thj Cucf (1)Sinh vien Y6D, Truong Dai hoc Y Duac Hui (2)Br5 man Nhi, Truong Dai hoc Y Duac Hui Tom tit M1,IC tieu: Khao sat tinh hinh kiem scat hen phS quan (HPQ) a tre em theo GINA 2014 tai Khoa Nhi t6nghqp I, Trung tam Nhi khoa Benh vien Trung uong HuS. Phuong phap: Nghien ciru c~t ngang duoc tiSnhanhtren 123benh nhi HPQ diSu trj tai Khoa nhi t6ng hop I, Trung tam Nhi Khoa Benh vien Trung 1l000gHuS, thai gian tir thang 5/2014 dSn thang 02/2015. K~t qua: Tu6i trung binh cua benh nhan trong oghien ctru1ft4,49 ± 3,25. S6 IUQ'ngbenh nhi nam: 80 (65,04%), nu: 43(34,96%). HPQ b~c2 (hen keo diinhe) chism tY I~ cao nhAt Ii 54,47%, HPQ b~c 1 (hen tirng can ngan) vi b~c 3 (hen keo dai trung blnh) chi€m tY I~ Ian hrot Ii 28,46% vi 17,07%, khong co HPQ b~c 4 (keo dai nang). Qua danh gia rmrc dQki6mscatHPQtheo GINA 2014, chung toi ghi nhan tY I~ HPQ kiSm scat t6t Ii 17,07%, kiSm scat mQt phdn1ft43,09% vi khong kiSm scat Ii 39,84%. K~t lu~n: Nghien cuu cho thAymire dQkiSm scat lienquanvoicac d?c tinh nlnr diSu tri du phong, tuan thu diSu tri, hiSu bi~t cua b6 my vSthuoc du phong hen va b~chen; khong lien quan dSn tai kham dinh ky. Tit kluJa: Hen phi quem, bdc hen, ki?m sodt t6t, kiem soat mtit phdn, khong kiim soat. Abstract SITUATION OF ASTHMA CONTROL IN CHILDREN ACCORDING TO GINA 2014 GUIDELINEATTHE DEPARTMENT OF GENERAL PEDIATRICS I, PEDIATRIC CENTER, HUE CENTRAL HOSPITAL Nguyen Ngoc Phuc', Le Thi Cue! (1)The 6'''year student, Hue University of Medicine and Pharmacy (2)Department of Pediatrics, Hue University of Medicine and Pharmacy Objective:This study aims at investigating the situation of asthma control in children according to GINA 2014at Department of General Pediatrics 1, Pediatric center in Hue Central Hospital. Method: Thecross-sectionalstudy was carried out on 123asthmatic patients diagnosed and treated atthe General Pediatrics 1from May 2014 to Feb 2015. Results: The average age of patients investigated was 4.49+ 3.25 yearsold. Subjects of the study included 68 (67.3%) males and 33 (32.7%) females. From the finding of the study, the proportion of asthma step 2 (Mild persistent) was 54.47%. The figures for asthma step 1(Intermittent) and 3 (Moderate persistent) were much lower, at about 28.46% and 17.07%, respectively. Step 4 (Servere persistent)was zero percent. Through the evaluation of the situation of asthma control according to GINA 2014, the rate of asthma control has been found with 17.07% well- controlled, 43.09% partly-controlled and 39.84% uncontrolled. Conclusion: The study showed that the level of control related to features such as preventive treatment (p=O.OOO), the frequency of patients' followup(p=O,OOO), asthma preventive medicine (p =0.000) and asthma steps (p = 0.000), but not to theperiodicre-examination. Key words:Asthma, asthma-step, well-controlled, partly-controlled, uncontrolled. -Dia chi lien h?: Nguyin Ngoc Phuc * email: [email protected] -Ngay nh~n bai: 24/3/2015 * Ngay d6ngy dang: 19/4/2015 * Ngay xu at ban: 021512015 T~peMY Dune hoc - Truong D~i hoc Y Dune Hu~ - s6 D~c bi~t 119

Transcript of Tình hình kiểm soát Hen Phế Quản ở trẻ em theo GINA 2014 tại khoa Nhi Tổng hợp I,...

TiNH HiNH KIEM SOAT HEN PHE QUANOTRE EM THEO GINA 2014 TJ;\IKHOA NHI TONG HQ'P I,TRUNG TAM NHI KHOA Bt;NH VIt;N TRUNG U'O'NG HUE

Nguyln Ng(JcPhuc1, is Thj Cucf(1)Sinh vien Y6D, Truong Dai hoc Y Duac Hui

(2)Br5 man Nhi, Truong Dai hoc Y Duac HuiTom titM1,ICtieu: Khao sat tinh hinh kiem scat hen phS quan (HPQ) a tre em theo GINA 2014 tai Khoa Nhi

t6nghqpI,Trung tam Nhi khoa Benh vien Trung uong HuS. Phuong phap: Nghien ciru c~t ngang duoctiSnhanhtren 123 benh nhi HPQ diSu trj tai Khoa nhi t6ng hop I, Trung tam Nhi Khoa Benh vien Trung1l000gHuS,thai gian tir thang 5/2014 dSn thang 02/2015. K~t qua: Tu6i trung binh cua benh nhan trongoghienctru1ft4,49 ± 3,25. S6 IUQ'ngbenh nhi nam: 80 (65,04%), nu: 43(34,96%). HPQ b~c 2 (hen keodiinhe)chism tY I~ cao nhAt Ii 54,47%, HPQ b~c 1 (hen tirng can ngan) vi b~c 3 (hen keo dai trungblnh) chi€mtY I~ Ian hrot Ii 28,46% vi 17,07%, khong co HPQ b~c 4 (keo dai nang). Qua danh gia rmrcdQki6mscat HPQ theo GINA 2014, chung toi ghi nhan tY I~ HPQ kiSm scat t6t Ii 17,07%, kiSm scatmQtphdn1ft43,09% vi khong kiSm scat Ii 39,84%. K~t lu~n: Nghien cuu cho thAy mire dQkiSm scatlienquanvoi cac d?c tinh nlnr diSu tri du phong, tuan thu diSu tri, hiSu bi~t cua b6 my vS thuoc du phonghenva b~chen; khong lien quan dSn tai kham dinh ky.

Tit kluJa: Hen phi quem, bdc hen, ki?m sodt t6t, kiem soat mtit phdn, khong kiim soat.

AbstractSITUATION OF ASTHMA CONTROL IN CHILDREN ACCORDING TO GINA 2014

GUIDELINEAT THE DEPARTMENT OF GENERAL PEDIATRICS I, PEDIATRIC CENTER,HUE CENTRAL HOSPITAL

Nguyen Ngoc Phuc', Le Thi Cue!(1)The 6'''year student, Hue University of Medicine and Pharmacy

(2)Department of Pediatrics, Hue University of Medicine and Pharmacy

Objective:This study aims at investigating the situation of asthma control in children according toGINA2014at Department of General Pediatrics 1, Pediatric center in Hue Central Hospital. Method:Thecross-sectionalstudy was carried out on 123 asthmatic patients diagnosed and treated at the GeneralPediatrics1 from May 2014 to Feb 2015. Results: The average age of patients investigated was 4.49+3.25 yearsold. Subjects of the study included 68 (67.3%) males and 33 (32.7%) females. From thefindingof the study, the proportion of asthma step 2 (Mild persistent) was 54.47%. The figures forasthmastep 1(Intermittent) and 3 (Moderate persistent) were much lower, at about 28.46% and 17.07%,respectively.Step 4 (Servere persistent)was zero percent. Through the evaluation of the situation ofasthmacontrol according to GINA 2014, the rate of asthma control has been found with 17.07% well-controlled,43.09% partly-controlled and 39.84% uncontrolled. Conclusion: The study showed that thelevelof control related to features such as preventive treatment (p=O.OOO),the frequency of patients'followup (p=O,OOO),asthma preventive medicine (p =0.000) and asthma steps (p = 0.000), but not totheperiodicre-examination.

Key words:Asthma, asthma-step, well-controlled, partly-controlled, uncontrolled.

-Dia chi lien h?: Nguyin Ngoc Phuc * email: [email protected] nh~n bai: 24/3/2015 * Ngay d6ngy dang: 19/4/2015 * Ngay xu at ban: 021512015

T~peMY Dune hoc - Truong D~i hoc Y Dune Hu~ - s6 D~c bi~t 119

1.D~TVANDE 2. DOl TUONG vA PHUONGHen phe quan la benh viern man tinh duong NGHIEN CUu

h6 hfip, kha ph6 bien trong cac benh duong h6 2.1. DBi tU'<}'Ilgnghien ciruhfip 6 mroc ta cling nhu nhieu mroc tren th~ gioi, Tfit ca cac benh nhi dap irng dtl tieu chu§nTheo bao cao cua T6 chirc Y t~ th~ gioi (WHO), nghien ciru (Benh nhi diroi 15 tu6i da duoc ch§nnarn 2007 tren th~ gioi c6 khoang 300 trieu doan hen ph~ quan theo tieu chuan GINA2014va

nguoi nha d6ng y tham gia nghien cuu) tai Khoangiroi m~c hen, chiern 6 - 8% dan s6 6 nguoi

Nhi t6ng hop 1, Trung tam Nhi khoa Benh vi~n16n va hon 10% 6 tre em duoi 15 tu6i, uoc tinh Trung uong Hu~ trong thai gian nr thang 05 namd~n nam 2025 con s6 nay tang len d~n 400 trieu 2014 d~n thang 02 narn 2015.nguoi [6] . Hang narn c6 khoang 250.000 nguoi 2.2. Phuong phap nghien cirutir vong do hen, trong do nh nhieu tnrong hop a. Thi~t k~ nghien ciru: Phuong phap mo tatir vong c6 thS phong ngua diroc [2]. Benh hen c~t ngangkhong thS chtra khoi hoan toan nhung c6 thS b. Cong cu nghien ciru:kiern scat duoc [1]. Tai Vi~t Nam, dang phat Chdn doan HPQ theo gai y ehdn Goon cuatrien rnang luoi kiSm soat hen tir cac benh vien GINA 2014 [9J, dua vao :Trung trong d~n cac Tinh. Tuy nhien da s6 moi - Tieu chufrn lam sang: ho, kho khe, kho tho,chi dung lai 6 viec chfrn dean va di@u tri can Ul'C nguc.hen dp. Viec duy tri theo doi va quan ly benh - Ti@n sir :nhan hen chira dat ducc hieu qua nhir mong + Ho, kho khe tai phat (kho khe ~ 2 l~n trongmuon. Tai Thira Thien Hue, chira c6 nhimg d@ 12 thang gAn day nhat).

+ Tre nhfi nhi kho khe kern kh6 tho ~ 3 IAn.tai nghien ciru danh gia v6 tinh trang kiSm scat

+ Ban than c6 co dia di ung.hen d~c biet la dBi voi hen ph~ quan (y tre em. + Cha my ho~c cac thanh vien trong gia dlnhbiXuelt phat tir thirc ti~n d6, chung t6i ti~n hanh hen hojic c6 co dia di irng,d@ tai: "Tinh trang kiim soot hen phi qulin _C~n lam sang: Cac xet nghiem chirng minhc6ii tre em t(li Khoa Nhi tang lu;p I, Trung tam t~c nghen ph~ quan va h6i phuc duoi tac dung cuaNhi khoa B?nh vi?n Trung trang Hul", nh~m thuoc gian ph~ quan (tre 2: 5 tuoi), Tre < 5 tu6i, cAD2 muc tieu : loai tnr cac benh c6 t~c nghen ph~ quan,

1. Danh gia phdn loai Me hen ph€ quem. - Test di@u tri: Tinh trang t~c nghen ph~ quan2. Danh gia kiem soat hen pM quan va mot s6 cua tre h6i phuc diroc (bien melt) sau khi dung

y€u t6 lien quan. thuoc gian ph~ quan hojic ph6i h9P corticoid.

Danh gia kdm soat hen trong 4 twin qua theo GINA 2014[9]

Ki~m soat phAn Ki~m soat tat Kh6ng ki~mD~c di~m (b~t ki 1-2 tri~u clnrng) soat

Tre:s 5 tuBi Tre 2: 6 tuBi

Trieu clnrng ban ngay Keo dai hon vai ~ 21An/tuAn Kh6ng c6 belt C6 tir 3 tri~uphut va hon 1 IAn! ky trieu chirng chung b§t Icytuftn nao trong cac trong cac tri.~u.

trieu clurng da clnrng da lieu.Trieu chirng ban dem/ C6 C6 neu.Ho dem do hen

Nhu cau dung thuoc Hon 1 IAn/tuAn ~ 2 lAn/tuAnc~t con

Gioi han hoat dQng thS C6 (it chay nhay, C6 (it chay nhay,luc ch6ng met) ch6ng met)

Tap chi Y DU'Q'choc -'Truong f)~i hoc Y Dune Hu~ - Sa f)~c bj~t

Bte

3. KET QuA vA BAN LU~ Bang 3. Phan b6 hen phS quan theo mire do nang3.1. K~t qua: Qua nghien ciru 123 benh nhan

hen ph~ quan diSu trj tai Khoa Nhi t6ng hop 1,trung tam Nhi khoa Benh vien Trung irong HuStrong thai gian ill thang 5 nam 2014 dSn thang 2nam 20IS, chung toi ghi nhan duoc :

Bang 1. Gioi tinh

GiOitinh Sa,IU',?,ng Ty I~ (%)

Nam 80 65,04

Nil 43 34,96),

123 100TongNhgn xet: Ty l~ benh nhan hen phS quan

nam:nilIf! 1,86: 1.

Bang 2. Tu6i trung binh cua d6i nrong nghien ciru

!uai Nam Nil Nam vaNil

X±SD 4,38± 4,73 ± 4,49±3,41 2,94 3,25

Nhgnxet: Tu6i trung binh cua d6i nrong nghienelm 1114,49 ± 3,25,

Mu-c d9 n~ng SalU'crng Ty I~ (%)ciia HPQ

B~c I,Tung 35 28,46con ng~n

B~c 2,Keo dai 67 54,47nh~

B~c 3, Keo dai 21 17,07trung binh

Bac 4, Keo dai ° °n~ng

T6ng 123 100

Nhdn xet: Hen phS quan keo dai nhe chiem tYl~ cao nhat (54,47%), Khong c6 tnrong hQ'P henkeo dai nang,

Bang 4.Mll'c dQ ki8m scat hen phS quan

Tinh Ki" KiA Khongem emtrang soat tAt SOllt kiAem

ki~m soat m9t ph§n soat

N= 123 21 53 49

% 17,07 43,09 39,84

Nhdn xet: HPQ ki8m scat mQt phan chiem tY1~cao nhat la 43,09%.

Bang 5. MQt s6 yeu t6 lien quan d6n mire dQ ki8m scat hen

~

Ki~m soat tAt Ki~m soat Khfing, $.

Y nghia thongD~cdi~m . M9tph§n ki~m so at ke

* DiSu tri du phong

C6 21 53 16P = 0,000

Khong ° ° 33

* Tuan thu diSu tri

C6 18 12 3P = 0,000

Khong 3 41 13

* Hi kharn dinh ky

C6 17 39 12P = 0,800

Khong 4 14 4

• Nh~nbiSt thu6c c6

ticdungdir phong hen

Dung 19 7 2 p = 0,000

Chua dung.

2 46 14

r,p chiY Dune hoc - Truong Bl;li hoc Y DU'Q'c Hu~ - se B~c bi~t 121

* Hen ph8 quan

I---- B_~c_l -4 1_8__ -+__ 1_3_-4 4_---; P = 0,000

B~c 2 3 40 24

B~c 3 ° ° 21Nhdn xet: Nghien ciru nhan thdy mire dQ kiern scat HPQ lien quan voi cac d~c tinh dieu tri d\lph'

tuan thu diSu tri, nhan bi8t thuoc co tac dung du phong va b~c hen theo mire dQ nang. M6i nrongco y nghia thong ke (p < 0,05).

3.2.Bim lu~n3.2.1. D(ie iliim vi il8i tuong nghien ctruQua nghien ciru 123b~nh nhi, c6 hon 65%

benh nhan hen ph8 quan trong nghien ciru lanam, ti l~ nam:mi la 1,86: 1. K8t qua nay tuong tunghien ciru cua Le Thj Minh Huang, tre nam m~chen phS quan cao hon tre nu voi tY l~ la nam.nu la1,85: 1 [4]. 0 tre em, tre trai c6 nguy co m~c henphS quan cao hon tre gai la do nhfmg tre trai nayc6 nhieu y8u t6 bArn sinh thuan lei cho sir phatsinh t~c nghen ph8 quan [3].

Trong s6 cac d6i nrong tham gia nghien ciru tir1 dSn 14 tu6i, tu6i trung binh cua benh nhi trongnghien ciru la 4,49 ± 3,25.

3.2.2. D(ie iliim vi b{ie henChung Wi ghi nhan tren 80% cac d6i tuong

nghien ciru c6 HPQ tung can ng~n va keo dai nhe,khong c6 tnrong hop hen keo dai nang. K8t quacua nghien ciru cling phu hop voi tac gia NguyenVan Toan, voi ti l~ HPQ keo dai nhe (55,66%)va HPQ tung can ng~n (35,85%) la chu y8u [7].M~t khac, day khong phai la nghien ciru tai congd6ng vi v~y nhieu tnrong hop hen ph8 quan armrc dQ nhe se khong duoc ti8p can. Vi v~y c6th~ giai thich sir khac biet voi cac nghien cirutren th8 gioi, trong d6 hen ph8 quan a tre em chuySu la tha nhe.

3.2.3. D(ie iliim vi kiim sodt henNhfrng nghien ciru g§n day cho thdy ti l~

ki~m scat hen con thdp va thay d6i a nrng quccgia. Nghien ciru ki~m soat hen theo tieu chi lamsang Bloomberg GR : 24% kiern soat t6t, 20%kiern soat mot ph§n va 56% khong kiern soat [8],AIRIAP 2: 2,5% ki~m scat t6t, 44,0% ki~m scatmdt phan, 53,4% khong ki~m scat [11]. SIl khacnhau giffa cac nghien ciru la do viec lua chon tieu

chuan danh gia, thai di~m danh gia va vi~c 'gia dira tren cac tieu chi lam sang mang tfnhquan cua nguoi lam nghien ciru, benh nhi hthan nhan benh nhi. Trong nghien ciru ctiaNguyThi Ngoc danh gia a l§n tai kham dAutienbang tr~c nghiern ACT [5]. Con chung toigia khi benh nhan vao 'vi~n voi tieu chu~nkilscat trong 4 tu§n qua cua GINA 2014 va ghiti I~ HPQ ki~m soat t6t la 17,07%, HPQ ki€mmot ph§n la 43,09% va HPQ khong ki6m soat39,84%, So voi nghien ciru cua Nguy~n Thjthi ti I~ dat ki~m soat t6t thdp hon nghien cim 'chung t6i (3% so voi 17,07%).

3.2.4. D(ie iliim vi mu-e ilp kiim soothellcdc iI(ie tinb

Vi~c diSu tri dir phong va tuan thu di~u tri I'ki~m soat hen t6t hon, lam giarn b~c hen, gi'nguy co xudt hien can hen dp cling nhu lagiam~I~ nhap vien cua hen ph8 quan, Trong nghienennay cho thdy diSu trj du phong va tuan thti di~u~anh hU011g d8n rmrc dQ kiem scat (p<o,OS),

Hi~u bi8t cua b6 my vS hen tre em, ma nla cac thuoc diSu tri dir phong la mQt y@utatiSp c6 lien quan d8n hieu qua cua viec ki~mhen [10]. Nghien ciru da cho thdy vi~c nh~nb'dung thu6c co tac dung diSu tri dir phong cor'quan voi mire dQ ki~m soat hen phS quan (]tre(p<0,05).

Theo GINA (20 14), dn xem xet dSn vi~cgia.b~c diSu tri khi da duy tri ki~m soat t6t trongvilne3 thang [9]. N ghien ciru cho thdy m6i nrong quagiira mire dQ ki~m scat va b~c HPQ (p<O,OS),

M6i tuong quan gitra tai kham dinh ky VI

mire dQ ki~m scat hen kh6ng c6 y nghia th6ngki(p>0,05). C6 Ie dn c6 nghien ciru 16n hon d€d~gia m6i lien quan nay.

122 Tap chi Y DU'Q'choc - Truong f)~i hoc Y DU'Q'cHu~ - S6 D~cb~

4.KETLU~HenphSquan b~c 2 (keo did nhe) chiern tY l~

cao nhAtla 54,47%, hen phS quan b~c 1 (tung canDg~n) va b~c 3 (keo dai trung binh) co tY l~ lfrnhrqt lit28,46% va 17,07%, khong co HPQ b~c 4'.~eodai nang).

Hen phS quan kiem soat t6t

17,07%, hen phS quan kiSm soat m¢t phAn la43,09% va hen phS quan khong kiem soat Iii39,84%. Mire d¢ kiem soat lien quan voi cac d~ctinh b~c hen, di~u tri dir phong va viec tai kharnthuong xuyen cua benh nhan; khong lien quandSn tu6i, gioi va nhan biSt thuoc co tac dung dir

chiern ty l~ phong hen; khong lien quan dSn vi~c tai kham,TAl LI~U THAM,JiliA.O

I. Nguy€nNang An (2004), HQi thao chuyen d~Nhiingti~n bQmoi trong kiem soat hen ph~ quan,

Tp.H6Chi Minh.2. Benh vien Nhi Trung uong (2008), Tai li?u tdp

hucin cham sac suc khoe Ire em tai cong d6ng, HaN~i,5/2008.

3.BQmen Nhi, tnrong Dai hoc Y Duoc Tp.HCM(2006), "Hen ph6 quan 6' tre em", Nhi khoa Dai hoc,

t~p1, tr 336.4. L€ ThiMinh Huong. (2007), "Danh gia buoc d~u

tinhhinhquan Iy hen tre em tai benh vien Nhi Trungur:mg",Tap chi Y hoc Vi?t Nam, t~p 332, tr.157-163.

S. Nguy~nThi Ngoc, Phan Hfru Nguyet Di~m (2008),Danhgia tlnh gia tri cua bang CoACT trong hronggiaki~msoat hen suy~n 6' tre ill 4 - II tu6i tai Benhvi~nNhid6ng I TP.HCM. Luan van t6t nghiep Bacsi nQitru,DH Y Duoc TPHCM.

6. Tr§nQuy (2007), "Dich t~ hoc hen ph6 quan vatiSpc~nchuong trlnh khoi dQng toan du v~ phongch6nghen ph6 quan", Hen phi quem va d~rphong

hen phi quem, Nha xuat ban Y hoc, tr.14-15.7. Nguyen Van Toan (2012), Nghien CUll nguyen nhdn

va mot s6 yiu t6 lien quan a ire hen pM quem tren6 tu6i nhdp vien, Luan van Thac sy Y hoc, tnrongD~i hoc Y Hfl NQi.

8. Bloomberg GR, Christina Banister, Randal S(2009). Socioeconomis, family, and pediatricpractice factors that affect level of asthma control.Pediatrics, 123, pp. 829 - 835.

9. GINA (2014), Global Strategy for AsthmaManagement and Prevention.

10. Lai CK, De Guia TS, Kim YY, Kuo SH et al (2003),Asthma control in theAsia - Pacific Region: theAsthrnaInsights and Reality inAsia - Pacific (~) study,1.

Allergy Clin Immunol, III (2), pp. 263-268.II. Wong G, Gunasekera K, Hong J, et al (2008).

AIRIAP 2: Childhood asthma control in Asiaaccording to the Global Initiative for Asthma(GINA) criteria. J Allergy Clin Immunol, 121(2),S95 (abstract).

r,p chi Y DIfQ'c hqc - !r'u'img Dai hoc Y DU'Q'c Hu~ - se f)~c bi~t 123