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Nghien cuuduoc S Thong tin thuoc

JOURNAL OF PHARMACEUTICAL RESEARCH AND DRUG INFORMATION

TRl/CfNG DAI HOC DLTOC HA NQI D|a chi: 13-15 LeThanh Tong - Hoan Kiem - Ha Noi Website: http://hup.edu.vn

ISSN 1859-364X

Nghien cuiiduoc Thong tin thuoc immv nun ui e HIK (tlA

I

MUC LUC Bai nghien cufu

2 Nghien cuu tong hop mafenid acetat tiTalcol benzylic sd dung phan Ung Ritter

Nguyen Van Giang', Nguyen Van Hai', Bui PhucTien1

Nguyen Binh Luyen1, Chu Ngpc Khanh2, Nguyen Nhu Lam3

' Wang Bgi hoc Dux Ha Hoi 'Tracing Cao dang Dux Phu Tho

3 Wen Song Le HSu Trdc

Dinh luung saponin toan phan trong Giao co lam dung gypenosid XVII lam chat ddi chieu

Nguyen Thi Kieu Anh1, Pham Tuan Anh1, Nguyen Thu Huong1, Pham Thanh Suol2, Nguyen Thi Thu Ha3, Tran Quang Luc3

' Tracing Bai hoc Bux Ha Not 'Tracing Bgi hoc YDaac Can Tha

'CongtyCophw Traphaco

0Yig dung sac ky long hieu nang cao trong dieu che nguyen lieu lam chat chuan voi cac dong phan quang hoc evodiamin

Nguyen Thi Ngoc Van, Pham Thanh Suol Truing Bai hocY Dux Can Tha

1Q Cac triterpenoid phan lap tu" phan doan n-hexan qua Ngu vj tuTnam (Schisandra sphenanthera Rehder. E.H Wilson in Sargent)

Tran Thanh Ha1, Nguyen Minh Khdi'.OoThi Ha1, Dao Thi Thanh Hien2

'ViinDuoclieu ' Tracing Bgi hoc Dux Ha Hoi

Trien khai mo hinh gay tang acid uric huyet thanh man tinh tren chuot cong trang thifc nghiem va ap dung danh gia tac dung cua cao phan doan n-butanol Hythiem

Nguyen Thuy Duong, Nguyen Thi Thuy Tracing Bai hoc Dux Ha Hoi

2 7 Phan tich gop ve vai tro cua metformin trong dieu tri tang can tren benh nhan sur dung cac thudc an than kinh khdng dien hinh

Nguyen Thj Hong Nhung, Nguyen Thanh Hai Truing Bgi hoc Bagc Ha Hoi

Thong tin thudc - Canh giac dupe 3 4 Sur dung thudc dieu trj ho d tre em

Nguyen Tien Phap, Luang Anh Tung, Hoang Ha Phuong Hguon: Australian Presaibertgp 37, so 4, trang 115-119

Diem tin hoat dong Hoi ngh; cac bi thu chi bo trien khai cdng tac thang 4 va trao cac Quyet dinh khen thUdng cua Dang uy Khdi cac trudng Dai hoc, Cao dang cho tap the, ca nhan cd thanh tich nam 2015

4Q Hoi nghj Khoa hoc - Cdng nghe tudi tre cac trudng Dai hoc, Cao dang Y - DUoc Viet Nam Ian thuf XVIII

T<5NGBI6NTAP PGS.TS. Nguyen Dang Hoa

PHOTONG BIENTAP GS.TS. Nguyen Thanh Binh

BAN THI/ Kt PGS.TS. Nguyen Thi Kieu Anh ThS. 06 Ngoc Cuong ThS. Tran Thu Thuy

BAN BIENTAP PGS.TS. Phung Hoa Binh PGS.TS. Nguyen Nggc Chien PGS.TS. Oinh Thj Thanh Hai GS.TS. Nguyen Hai Nam PGS.TS. Tran Van On PGS.TS. Nguyen Viet Than GS.TS. Thai Nguyen Hung Thu PGS.TS. Nguyen Hoang Anh PGS.TS. Vu Gang Hoang TS. Nguyen Thi Lien Huong PGS.TS. 06 Quyen CN. Pham Van Tuoi

HOI OONG CO VAN GS.TS. Hoang Thi Kim Huyen GS.TS. Pham Thanh Ky GS.Oang Hanh PhUc TS.Truong Quoc Cudng ThS. Cao Hung Thai OS. Nguyen Thi PhUdng Cham

THIET KE

Le Phong Son

TOA SOAN

Phong Quan ly Khoa hoc 13-15LeThanhT6ng-Ha Ngi Oien Thoai: 04.3.8245437 Fax: 04.3.9335642 Email: tapchincd-ttt@hup.edu.vn

ISSN 1859-364X

Giayphep so: 70/GP-BTTTT Ngay 30/3/2015

In tai: Nha may in BgTdng tham muu

So 2/20161 Nghien cOu duoc Thong tin thudc I i

Suf dung thuoc dieu tri ho or tre em Nguyen Tien Phap, Luong Anh Tung, Hoang Ha PhUOng

Nguon: Australian Prescriber tap 37, so 4, trang 115-119

TOM TAT

• Phdc do dieu tri ho d tre em phu thugc nhieu vao viec ddnh gid chinh xdc tinh trang benh nhan. Tuy nhien, dddi tuong nay, kho chan dodn chinh xdc ngay tgi thdi diem ban ddu, khi cdc trieu chCrng mdixudt hien.

• Tracing hop ho cap thudng do virus va thddng khdng co chi dinh dieu tri ddc hieu. Co the can dieu tri khan cap trong trudng hop benh nhan co tien sCi lien guan den cdc tinh trgng roi loan nghiem trgng nhd viem phoi hope mac di vat.

• Khi dieu tri ho man tinh tren tre em, can sCr dung cdc phdc do dieu tri nhi khoa chuyen biet. Trdnh sCt dung thuoc theo kinh nghiem ma khong xem xet nguyen nhan cu the.

• Trong tradng hop khdng tim duoc nguyen nhan cu the gay ho, ho man tinh co ddm (keo ddi it nhdt 4 tudn) thudng la viem phequdn keo ddi do vi khudn. Co the chi dinh khdng sinh trong tradng hop nay.

Gidi thieu

Ho la mot trong nhdng trieu chCrng thudng gap cua cac benh nhan den hieu thuoc hoac phdng kham d Uc. Khoang mot phan ba (28,7%) cac trudng hop can di kham bac si va mot phan tu (23%) cac trudng hop can nghi hoc hoac nghl lam. Odi khi khdng the chan doan chinh xac dupe ngay tai thdi diem tre bat dau cd bieu hien ho.

Ho cap ti'nh

Ho cap tinh d tre bieu hien d nhieu trudng hop benh ly, t it nguyen nhan do virus cd the tu khdi den

cac benh ho hap cap tinh nghiem trong hoac con cap cua mot benh ly nen man tinh. Ge cd mot phac do dieu trj phu hop, can danh gia benh dung. Khi danh gia, can xem xet cac yeu to:

• Thdi gian ho (cap < 2 tuan, con ban cap 2-4 tuan, man tinh > 4 tuan).

•Tlnh chat cua ho (ho ga, ho khan hoac ho cd ddm). • Van de ve khd thd va tien sdbenh dudng ho hap. • Trieu chdng khd khe kem theo. • Cac trieu chdng khac nhu sut can, chan an hoac

phat ban. • Tien sd lien quan den mien djch. Khi chan doan phan biet, can luu y nguy co hit

phai dj vat, viem phoi va cac nhiem trung khac nhu ho ga va cac benh ly nen d phoi nhu gian phe quan.

Nhiem trung du'dng ho hap tren cap tinh khdng hien chifng

NgUdi ta cho rang, tre em thudng cd 6-12 Ian nhiem khuan ho hap cap moi nam. Tuy nhien, mot nghien cUu vdi sUtham gia cua 600 gia dinh cho thay sd dot ho thap hon con so Udc tlnh nay va cd lien quan den tuoi cua tre (xem bang dUdi).Thdi gian moi dot ho trung binh khoang 6,3 ngay (dao dpng trong khoang 1 -70 ngay) va tre nhd thudng cd thdi gian moi dot ho dai hon (6,8 ngay d nhdm tuoi nhd nhat va 5,5 ngay d nhdm tuoi Idn nhat).

Bang ty le nhiem trung dddng ho hap tren cap tinh khdng bien chdng d tre em vd ngadi tre tuoi d Uc

Tuoi (nam) So dot ho trung binh moi nam

0-1 3,8

2-3 3,3

4-5 2,8

6-10 2,2

11-20 2

34 Nghien cOuduoc Thong tin thuoc S62/2016

Dieu tri Dieu tri hotrpvan la bien phap chinh trong trUdng

hop nhiem trung dudng ho hap cap tinh do virus. Paracetamol va ibuprofen la cac thuoc dupe sddung hieu qua de dieu tri trieu chUng trong trudng hop nay. Khdng nen sd dung cac thuoc ban khdng can ke don (OTC) vdi tac dung dieu trj ho va cam lanh, do hieu qua chUa dupe chUng minh day du va cd nguy co gap tac dung khdng mong mudn. Co quan Quan ly Dupe pham Uc (TGA) khuyen cao khdng nen sddung nhdng thuoc nay d tre em dudi 6 tuoi va chi dung cho tre em 6-11 tuoi khi cd chi djnh cua bac sy.

Mat ong va tinh dau bac ha dang xoa cd the lam giam ho ve dem. Tre tren 1 tuoi nen dung mot thia ca phe mat ong trUdc khi di ngu. Tranh dung mat ong cho tre dudi 1 tuoi do nguy co ngp dpc do dpc to cua vi khuan Clostridium botulinum phat trien trong mat ong (thudng gpi la benh botulism).

Can tranh sd dung khang sinh dieu tri cho trudng hop ho cap tinh lien quan den nhiem trung dudng ho hap tren mdc dp nhe, do trong cac trudng hop nay, ho thudng cd nguyen nhan tU virus. Mot tong quan mdi dupe cdng bo tren trang Cochrane cho thay trong trudng hop da chan doan hoac nghi ngd nhiem cum d tre khde manh, khi sd dung oseltamivir, thdi gian can thiet de cac trieu chUng bat dau cai thien da giam 29 gid (khoang tin cay 95% la 12-47 gid, p = 0,001). Tuy nhien, khdng cd hieu qua nao dupe chUng minh tren tre mac hen phe quan. Oseltamivir cd the lam giam nguy co viem tai giUa d tre 1 -5 tuoi, dac biet khi dung trong 12 gid dau, tuy nhien viec dung thuoc cd the lam tang dang ke nguy co bj ndn. Ki thuat PCR (polymerase chain reaction) cd the sd dung de chan doan cum nhanh.

Kiem soat ho cap tinh can sUtUvan va hudng dan ve:

• Thdi gian keo dai du kien cua dot ho (thudng tU 5-7 ngay, cd the len den 3 tuan).

• Khi nao can den kham lai va khi nao can di cap cdu (vi du: nghi ngd do dj vat, thd nhanh, khd thd, ndn, khdng an dupe, sot dai dang, ngu lim).

•Tranh phoi nhiem thu dpng vdi khdi thuoc la. Cdc nguyen nhan dac biet gay ho cap tinh Mot so benh dac biet can phai dupe xem xet khi

tre cd bieu hien ho cap tinh. Trong do, nhieu benh cd cac trieu chUng va dau hieu dac trung.

Viem thanh khi phe quan cap Dac trung cua viem thanh khi phe quan cap la tinh

trang khdi phat cap hoac ban cap vdi dau hieu ho khan lien tuc, khan tieng, thd rit cd hoac khdng kem theo dau hieu tac nghen dudng ho hap tren. Benh thudng bat dau bang nhiem virus dudng ho hap tren (vdi cac bieu hien nhu chay nude mui, dau hong, cd the kem theo sot) va thudng xuat hien d tre 1-6 tuoi. Tre nam ngoai dp tuoi nay hoac vdi trieu chUng thd rit nang hoac tai phat hoac vdi cac trieu chUng khac can dupe danh gia than trpng ve ton thUOng dudng ho hap.Tre cd hien tupng thd rit do nguyen nhan vi khuan nhu viem khi quan, viem nap thanh quan thudng cd bieu hien nghiem trpng hon.

Trong trudng hop viem thanh khi phe quan cap, sd dung prednisolon 1-2 mg/kg dudng uong trong hai ngay lien tiep dem lai hieu qua. Cd the dung dexamethason 0,15 mg/kg dudng udng de thay the. Trudng hop viem thanh khi phe quan cap nang, khi tre tiep tuc cd dau hieu thd rit ngay ca luc nghi, tang met mdi, cd bieu hien nhip tim nhanh, cd the kem theo kha nang xuat hien giam oxy mau (nhu ngu Ijm, tang quay khdc), can dua ngay tdi benh vien. Tranh nhUng can thiep nhu kiem tra hong, do cd the lam nang them tinh trang tac nghen dudng ho hap.

Viem phoi Tre mac viem phoi thudng kem theo ho, sot va thd

nhanh, nhUng ddi khi xuat hien sot va dau bung tren. Cac dau hieu nang bao gom thd rit va co rut co lien sUdn.Thd khd khe thudng khdng xuat hien khi mac viem phoi do vi khuan.

Khdng nhat thiet phai chup X-quang long ngUc thudng quy d tat cac tre nghi ngd viem phoi. Tuy nhien, can can nhac chup neu tre cd trieu chUng khdng dien hinh (viem phoi tai phat, sot keo dai, dau hieu cua tran dich mang phoi) hoac trudng hop viem phoi nang can nhap vien.

Cac khuyen cao ve viec sd dung khang sinh thay doi tuy theo dp tuoi cua tre, tinh huong thUc te, cac benh ly mac kem (yeu to nguy CO), tinh trang giam oxy mau, cac trieu chufng khac ngoai dudng ho hap (nhu ndn), thdi gian va mdc dp nang cua cac trieu chUng va sU xuat hien cac bien chUng. Can tham khao cac hudng dan dieu tri lien quan den sddung khang sinh. Doi vdi tre cd tinh trang khdi phat ban cap va trieu chUng ho dang chu y (cd the hoac khdng kem theo dau dau hay dau hong) hoac trudng hop khdng cai thien, can nghi ngd viem phoi do Mycoplasma.

Chi djnh nhap vien cho viem phoi mac phai tai cpng ddng bao gom:

So 2/2016 Nghien cilu duoc Thong tin thuoc 35

THONG TIN THUOC - CANH GlAC DUOC

• Tre dudi 6 thang tuoi vdi nghi ngd viem phoi do vi khuan.

• Trieu chdng lam sang cua viem phoi d mut do trung binh hoac nang, bao gom giam oxy mau va bieu hien suy ho hap.

• Benh mac kem hoac cd cac yeu to quan trong cd the lam nang them tinh trang benh nhu suy giam mien djch, benh tim bam sinh, gian phe quan.

• TrUdng hop nghi ngd hoac da chan doan xac dinh viem phoi lien quan den cac tac nhan gay benh cd the lam tang mUc do nguy hiem cua benh nhu tu cau vang khang methicilin (MRSA) mac phai tai cpng dong.

• Mat nude hoac khdng cd kha nang sddung thuoc qua dudng udng.

• Phu huynh qua lo au, cang thang. • Gia dinh khdng cd du dieu kien de cham sdc

thi'ch hop hoac tuan thd ke hoach dieu tri. • Tre cd dau hieu nhiem doc nhu nhpt nhat, ti'm tai,

ngu lim hoac quay khdc lien tuc. • Viem phoi cd bien chUng, vi du nhu viem mu

mang phoi. • Dap Ung kem sau 48 gid sd dung khang sinh

dudng udng. Tat ca tre cd nghi ngd viem phoi can dupe theo ddi

thudng xuyen de dam bao cac trieu chUng hoi phuc hoan toan. Khong nhat thiet phai tien hanh X-quang long nguc thudng quy trong trUdng hop viem phoi don gian, trd khi cd cac trieu chUng keo dai.

Viem tieu phe quan Tre dudi 2 tuoi cd bieu hien cap cua ho, thd nhanh

(cd hoac khdng kem theo bieng an) va thudng cd tien sd nhiem virus cd the cd viem tieu phe quan virus. Kham lam sang cd the ghi nhan tinh trang tang phdng phoi vdi dau hieu thd khd khe va ran no tren dien rdng khi nghe long ngUc. Virus hop bao ho hap la loai phd bien nhat gay viem tieu phe quan.

Tre nhd vdi trieu chUng ngUng thd, giam oxy mo (dp bao hda oxy < 92%), mat nude hoac an kem can den benh vien de thd oxy, cd the hoac khdng kem theo bu nUdc.Tinh trang cua tre thudng xau di trong 72 gid dau trudc khi bat dau cd dau hieu cai thien. Ho cd the keo dai trong 2-3 tuan sau khi cac trieu chUng khac mat di. Khdng cd bang chdng nao ung hp cho viec sd dung thudng quy khang sinh, corticoid hay thuoc gian phe quan trong viem tieu phe quan do virus.

Hoqa Ho ga thudng cd bieu hien ho keo dai tU 2 tuan

i l

trd len vdi cac con ho bde phat, thudng cd tieng rit khi hit thd va d cudi moi con ho hoac ndn sau ho. Nen chan doan xac djnh bang phuong phap PCR, sd dung tarn bong vd trung hoac bom tiem de hut djch mui - hong. Neu cd nghi ngd rd rang tren lam sang, cd the bat dau khang sinh trudc khi nhan ket qua xet nghiem. Cd the dung clarithromycin (7,5 mg/kg, len den 500 mg dudng uong, moi 12 gid trong 7 ngay) hoac erythromycin (10 mg/kg, len den 250 mg dudng udng, moi 6 gid trong 7 ngay). Dieu trj sdm se gdp phan cai thien cac trieu chUng (trong vdng 1-2 tuan dau khdi phat cac trieu chUng) va rut ngan thdi gian nhiem trung. Benh nhan hiem khi nhiem trung sau khi ho qua 3 tuan va khdng nen dung khang sinh vaothdi diem nay.

HO MAN TINH

Nquyen nhan thddnq qqp qdy ho man tinh d tre em khac vdi d nqddi Idn nen nhdnq bien phap tiep can kiem sodtcho nqddi trudnq thanh hddnq den hen, viem mui vd benh trao nqUpc dq day -thdc qudn khonq ddoc dp dunq. Mot nqhien cdu tren 346 benh nhdn den khdm tqi Khoa Ho hap Nhi cho thay, cdc chan dodn pho bien nhat bao qdm viem phe qudn keo ddi do vi khudn (41%), hen phe qudn (15,9%) vd qidn phe qudn (9%). Tronq 13,9% so tre em cd trieu chdnq ho ddOc qidi quyet ma khdnq cd chdn dodn cu the.

Tien sdve ho hap vd cdc thdm khdm cunq nhu viec sd dunq so do sau se qiup ich cho viec ddnh qid va chdn dodn ho man tinh.

Viem phi qudn keo dai do vi khudn Viem phe quan keo dai do vi khuan la nguyen

nhan pho bien nhat gay ra ho cd ddm man tinh d tre em (theo sd lieu nghien cdu tai Uc). Benh dupe djnh nghia nhUsau:

• Ho keo dai tren 4 tuan. • Dap Ung vdi 2 tuan dieu trj bang khang sinh. • Khdng cd cac dau hieu dac biet gpi y nguyen

nhan gay ho khac. Tien sd nhiem virus trudc do kha phd bien. Viem

phe quan keo dai do vi khuan thudng phd bien d tre nam nhieu hon nU va trong dp tudi td 1 -3 tudi.

Nhiem khuan dudng hd hap dudi thudng dupe

36 Nghien ciiu duoc Thong tin thudc I So 2/2016

SO DO T I E P C A N D I E U T R I HO MAN T I N H O T R E E M

DANH GIA Tien sir: dac tinh cua ho, cac dhu hieu gg i y cho benh ly san co ( v i du nhu ho ga), thd khd khc hoac tai nhiem khuan ho hap dudi , kho an uong, cac thuoc dang su dung, co van de ve phat trien than kinh, dinh duong kem, that bai trong phac do dieu tr i trudc do. T h a m kham: bien dang long nguc, ngdn hinh chuy, thinh chan thay bat thudng. C a n nhac: chup X-quang long nguc, co the can nhac do dung t ich ho hap.

Khdng cd cac chan doan dac bi?t

<

Ho cd ddm Ho khan

Cd ddu hieu cua v iem phe quan keo dai do v i khuan

Khong cd dau hicu dac biet

f Khang sinh \^ + nhac lai dot dieu tr i

X. neu can y

y T r i hoa f va theo \ . sau do

I dieu tri \. doi chat, •cham lai y

Cd cac chan doan dac biet nhu hen hoac gian phe quan

< >

Kham va dieu tr i theo chan doan, can nhac

hoi chan chuyen khoa

Neu tiep tuc ho

Can nhac dieu t r i thu nhu dung thudc gian phe quan), can nhac hoi chan

chuyen khoa

Sot do tren giup cai thien dang ke chat lugng cuoc song va lam giam thdi gian ho. Phuong phap tiep can nay difa tren viec xac djnh nguyen nhan gay ra ho (qua tien sd va tham kham). Co the ket hop them do dung tich ho hap (6 tre lorn hon 5 tuoi) va X-quang long ngifc. Can nhac hoi chan chuyen khoa trong trtfong hop:

• Ho man tinh (>4 tuan) vdi can nguyen gay benh khdng ro rang (cd the kem chgm tang can). • Nghi ngddi tat dddng ho hap nhulo do thuc qudn-khiqudn, di dang vdng mqch. • Ho vd cho an khd khan (nghi ngd lien quan den kha nang hit vao cua tre). • Dqc diem Idm sang cua benh phoi man tinh, vidu ngdn hinh chuy. • Cdc bat thudng khi khdm nhUran dphoi. 'Viem phoi tai phat. • Bat thudng tren X-quang long nguc hope ket qua do dung tich ho hap. • Khdng dap Ung vdi dieu tri, vidu trong hen phe qudn.

phat hien qua mau djch rda phe quan phe nang va tinh trang viem difdng ho hap. Cac chung vi khuan thudng kem theo tang bach cau trung tinh gqi y den chinh duoc phat hien la Haemophilus influenzae,

S6 2/2016 Nghien CLIU duoc Thong tin thuoc 37

THONG TIN THUOC-CANHGlACDJOC

Moraxella catarrhalis va Streptococcus pneumoniae. Sau khi loai trd cac nguyen nhan khac gay ra ho man tinh, nen bat dau mot deft dieu tri keo dai 2 tuan bang amoxicilin-clavulanat. Can theo doi tre trong 2-3 tuan tiep theo de dam bao ho dupe hoi phuc hoan toan. X-quang long nguc nen dupe tien hanh trong tat ca mpi trudng hop khi nghi ngd nguyen nhan gay ho man tinh khac hoac tre van tiep tuc ho sau khi dung khang sinh.

ChUng gian phe quan Chung gian phe quan la mot nguyen nhan quan

trpng khac dan tdi ho cd ddm d tre va can dupe can nhac trong trudng hop tre cd cac dau hieu sau kem theo:

• Ho man tinh cd ddm keo dai tren 8 tuan. • Hai hoac nhieu hon cac dot ho man tinh cd ddm

(keo dai tit 4 tuan trd len) trong 1 nam cd dap ufng vdi khang sinh.

• Hinh anh X-quang long ngut bat thudng keo dai tren 6 tuan mac du da dieu tri bang phac do khang sinh phu hop.

Phac do khang sinh thudng dope sd dung ngay khi khdi phat ho cd ddm d tre bi gian phe quan. Viec lua chpn khang sinh dUa tren nudi cay vi khuan d dOdng ho hap dOdi, mo hinh khang khang sinh va cac trieu chdng lam sang. Neu cac trieu chOng khdng dap ting nhanh chdng va thda dang vdi khang sinh dOdng uong, benh nhan can dope nhap vien va so1 dung khang sinh theo dOdng tinh mach. Nen phoi hop vdi cac bien phap vat ly tri lieu deu dan, tap the due, tranh cac yeu to khdi phat (nhd khdi thuoc) va tiem phdng dinh ki.

Hen va ho man tinh Mac do hen cd the la nguyen nhan gay ho man

tinh, benh ho man tinh don thuan khdng kem theo

cac trieo chuing khac d tre em hiem khi do hen. Cac trieu chung khac thddng xuat hien trong hen la thd khd khe, khd thd, t u t ngpc hoac han che cac hoat dpng lien quan den gang SLfc. Cac yeu to nguy co thudng gap bao gom cham ca dia, viem mui di Ling, cac benh ly dj uTig hoac tien sd gia dinh cd mac hen.

Do dung tich ho hap va cac nghiem phap danh gia dap Ling dudng thd (nhu nghiem phap gang sud) dtre tren 5 tuoi cd the giup ich trong chan doan hen. So cd mat cua cac yeu to co dia khdng giup phan biet hen vdi nhQng nguyen nhan khac gay ho man tinh.Thong tin ve dap ufng cua benh nhan vdi phac do dieu trj hen trudc day cd the cd ich, tuy nhien, dap dng tot vdi thuoc gian phe quan trong mot dot dieu trj rieng le khdng cd nghia la tre bj hen. Cd the tham khao hudng dan dieu trj hen cua Uc tren trang thong tin cua Hoi dong Quoc gia ve Hen suyen cua Uc (www.nationalasthma.org.au/ handbook) hoac hudng dan chan doan va dieu trj hen phe quan tre em cua Bp Yte; (Hudng dan chan doan va dieu trj mot sd benh thudng gap d tre em, ban hanh kem theo Quyet djnh so 3312/QD-BYT ngay 07/8/2015 cua Bp trUdng Bp Yte).

Ket luan

Viec chan doan chinh xac ho 6 tre em phu thupc vao danh gia day du tien sd va tham kham lam sang nham hudng tdi phac do dieu trj phu hop. Ban chat va mute dp man tinh cua ho la nhCfng thong tin quan trpng giup djnh hudng chan doan cac nguyen nhan dac biet gay ra ho. Cac hudng dan va so do tiep can dieu trj ho lam tang kha nang chan doan chinh xac va cd the giup lua chpn phac do dieu trj ho hieu qua cho tre.

38 Nghien cQu duoc Thong tin thudc So 2/2016