Đặc điểm lâm sàng và tác nhân gây bệnh của bệnh viêm nội nhãn nội sinh ở trẻ em

DAC DIEM LAM SANG VA TAG NHAN GAY BENH

QUA BENH VIEM NOI NHAN NOI SINH QTTRE EM

L^ THI KIM XUAN

T6M TAT

Ap dung thiet ki nghidn cuv md ta cit ngang ket hgp

vdi nghien ciru hoi ciru 389 trw&ng hgp tre em dwgc

chin doin xic dinh li viem mil ndj nhin ngi sinh dieu tn

tai khoa Mit tre em Bgnh vign mit tmng trang tw thing

1 nim 2004 den thing 12 nam 2008. Ket qui eho thay

77,5% bgnh nhin da ta dieu tri hoge dwgc diiu tn tgi

tuyen dtr&i. Hau het bgnh nhan vio vign trong tinh trang

viem mtj ngi nhan rat ngng ne, thi lac phin bigt sing toi

la 31%. Tri ed bgnh toin than ket hgp chiem mgt ty 1$

thap (6,4%,). Tic nhin giy bgnh hay gap nhat li vi

khuan Gram(+) chiem 35,6%, nhiem khuan Gram(-) it

gap han 21,9%,, nam it gap nhat chi chiem 1,5%o.

Tir khoa: viem ngi nhin, ngi sinh, tre em, tic nhin

gay bgnh.

SUMMARY

A reasearch combined two methods of study (emss￾sectional descriptive and retrospective) has been applied

to 387 ehidren were diagnosed and treated endogenous

endophthalmitis In pediatric department in VNIO fmm 1-

2004 to 12/ 2008. The results reveals: 77,5% cases

treated In local hospitals with no impmvment before

coming to VNIO. AH of the patients presented at a late

stage in the diseases with obvious signs such as

chemosis, hypopion, vitreitls... the vision acuity was light

perseption In 31,6%>. Vitreous and aqueous cultures

were positive respectively. Gram-positive were found in

35,6%. Gram-negative in 21,9%o and fungal was in 1,5%.

Keywords: Endogenous, endophthalmitis, children,

DAT VAN Dfe

Vidm ndi nhan la tinh trgng nhiem khuIn cua cac td

chuc ndi nhan nhu djch kinh va thiiy djch cd thi din din

viem toan bp Idp vd ciia nhan d u hay la tinh trgng viem

toan nhan. Cd hai logi vi§m n$i nhan la vi§m npi nhan ndi

sinh va viSm ndi nhan ngogi sinh. Viem npi nhan npi sinh

la do kit qua ciia su phat tan eiia vi khuIn tu eae d nhiem

khuIn tu cac co quan ndi tgng. Viem npi nhan ngogi sinh

la hau qua cua sy nhilm khuIn tryc tilp sau chin

thuong hoac sau phlu thugt. Tren thi gidi viem npi nhan

ndi sinh rit hiim ggp ehi ehilm khoang tu 2-15% viem npi

nhan, trung binh hang nam ggp 5 / 10000 bgnh nhan

nhap vign. Viem ndi nhan npi sinh d tre em Viet nam Igi

kha phd biln ehilm 4/1000 b$nh nhan dilu tri ndi tru,

thu'dng din din giam thj lyc trim trpng, hoac teo nhan

d u . Trong sd cac ylu td anh hudng tdi kit qua dilu tri,

dde lye cua vi sinh vat va thdi gian bit diu duoc dilu tn

la hai ylu td quan trpng nhit. Cac diu hi#u va trigu chung

eua VNNNS phg thgde vao kha nang gay d$c eiia vi sinh

vat. Vide chin doan sdm va dilu tri kjp thdi la co hpi bao

tdn thj lyc cho b$nh nhan. Hi$n nay trSn the aidi cac tac

nhan gay b$nh cd xu hudng gia tang hon la nam dac bi$f

la nim Candida Albicans, sau dd la vi khuIn Gram (+), va

sau ciing la cac vi khuIn Gram (-). Mgc tieu ciia d l tai la

danh gia dac dilm lam sang va tim hiiu tae nhan gay

bgnh ciia benh viem npi nhan npi sinh d tre em dilu tn tgi

bgnh vien Mit trung uong.

06l TU'DNG VA PHU-aNG PHAP

1. Ddi tipp'ng

Nghien cuu hdi cuu 389 tre dupe chin doan viem

npi nhan npi sinh, dilu tri tgi khoa Mit tre em bgnh vien

Mit trung uong tu 01/01/2004 tdi 31/12/2008.

- Tieu chuin lya chon:

+ Benh nhan tudi 5 15 tudi bj viem npi nhan npi

sinh

+ Ho so ghi diy du thdng tin.

- Tieu chuin logi tru:

+ Bgnh nhan viem npi nhan sau chin thuong va sau

phlu thugt.

2. Phuong phap nghien cii'u

Nghien cuu md ta hdi cuu, thu thgp thdng tin tu

bgnh an theo mlu philu nghien cuu.

3. Npi dung nghien CIFU

- Thu thgp eae thdng tin v l dgc dilm lam sang: thdi

gian khdi bgnh, trieu ehUng eo nang, trieu ehUng thyc

thi. Thj lye luc vao vien, tinh trgng djch kinh vong mgc

tren sieu am.

+ cae kham nghiem toan than: xet nghigm cdng thuc

mau va mau ling, HIV, HBsAg, sinh hoa mau Kham noi

khoa, tai mui hpng, rang ham mat, chgp tim phdi.

-t-Tim tac nhan gay bgnh qua soi tuoi, nhuOm soi

bgnh, nudi d y vi khuln.

- Xir li sd ligu bing phin mim SPSS 13.0

KtT QUA VA BA N LUAN

Trong 389 bgnh nhan dupe chin doan viem npi

nhan ndi sinh tu 2004 - 2008 tgi khoa Mit tre em, tudi

tu 1-15, trong dd nam gidi ehilm 55,5% va nir gidi la

45,5%. Viem npi nhan npi sinh ggp d tre em cic viing

ndng thdn la chu ylu tdi 87.9%. Cae viing thanh phd ehi

ed 12.8%. Bgnh nhan dupe dilu tn tgi tuyln dudi va ty

dilu trj chilm 74.55%, bgnh nhan khdng dupe dilu tri

chicd 25.5%.

H I U hit cic benh nhan diu cd eae trieu chung co

nang kinh diln nhu dau nhuc mit 379 benh nhan

(97,4%), chdi mit 344 (88,4%), nhin md 374 (96,1%),

chay nude mit 353 (90,7), sp anh sang 336 (86,4%).

cae kit qua nay tuong ty nhu eae nghien ciru euia cac

tac gia trong va ngoai nudc.

Bang 1: Cae trieu chung thyc thi khi vao vien

Tri0u chirng

Mi mat

Kit mgc

Giac mgc

Binh thu'dng

Sung nd

Co quSp mi

Cuong ty ria

Cuong ty toa lan

Trong

Phil dye

Tua sau giac mac

Hoai tif

Sdmat

114

249

26

173

216

62

296

13

18

%

29,3

64,0

6,7

44,5

55,5

15,9

76,1

3,3

4,6

Y HOC THl/C HANH (751) - SO 2/2011 69