IEU TR BEO PH TRE EM

I. NH NGHA: Beo ph la tnh trang tch tu m bat thng va qua mc tai mo m va cac to

chc khac gay hau qua xau cho sc khoe. Nguyen nhan co the la th phat (noi sinh) hoac nguyen phat (ngoai sinh). Trong pham vi phac o ieu tr ch e cap ti ieu tr beo ph nguyen phat. II. CHAN OAN: 1. Cong viec chan oan: a) Hoi benh s: tot nhat nen lap nhat ky theo doi trong 1 tuan An uong: gi an, mon an, so lng, cam giac khi an, hoat ong khi an. The duc: mon tap, thi gian , cam giac luc tap va sau tap. Hoat ong khac: giai tr, oc sach, xem TV Moi trng xung quanh tre ( nha trng , gia nh,) b) Kham: (xem bang 2, 3, 4) Ch so nhan trac: can nang, chieu cao, nep gap c tam au (cha co thc) Cac dau hieu cua bien chng Cac dau hieu cua nguyen nhan th phat c) e ngh xet nghiem: Thng qui: Lipid mau, Cholesterol, HDL, LDL, VLDL, ng huyet. Cac xet nghiem cua nguyen nhan th phat: noi chung neu chieu cao cua be

> 90 % so vi chuan th khong can lam them xet nghiem nao khac e tm nguyen nhan.

2. Chan oan: a) Chan oan xac nh:

Hien cha co tieu chuan lam sang nao chan oan xac nh 100% beo ph tre em. Hai tieu chuan c e ngh sau ay c ai a so chuyen gia ong y do tnh san co, de thc hien tren lam sang va co y ngha tien lng benh. Can nang theo chieu cao (CN/CC): la phan tram CN thc te cua tre so vi

CN chuan cua CC thc te cua tre. Neu CN/CC > 120% la tre b beo ph. Ch so khoi c the ( Body Mass Index: BMI): tnh theo cong thc sau:

BMI = )(

)(mCCCC

kgCN

Neu BMI > 85th percentile la tre beo ph. b) Chan oan o nang:

Neu CN/CC > 140% hoac BMI > 95th percentile la beo ph nang. c) Chan oan bien chng: xem bang 1, 4

V beo ph la yeu to nguy c cua roi loan chuyen hoa lipid , can phai tam soat tang cholesterol mau tat ca tre ln hn 2 tuoi ( khuyen cao t chng trnh giao duc cholesterol quoc gia , Hoa Ky) d) Chan oan nguyen nhan:

Ch mot so t ( 90% chieu cao chuan theo tuoi th khong can khao sat them nguyen nhan beo ph. III. IEU TR: 1. Muc tieu: 3 loai muc tieu a) Hanh vi: muc tieu nguyen phat cua dieu tr beo ph khong bien chng tre em khong phai la at c can nang ly tng ma la at c thoi quen an uong va sinh hoat khoe manh. Chng trnh ieu tr can phai chu y nhieu en cac ky nang can thiet e thay oi hanh vi va duy tr cac thay oi nay. b) Y hoc: oi vi tre beo ph co bien chng, viec cai thien hoac ieu tr khoi cac bien chng la muc tieu quan trong. c) Can nang: Can phai giam can en BMI < 85th percentile. oi vi cac trng hp sau:

tre ln hn 2 tuoi b beo ph co bien chng , tre ln hn 7 tuoi beo ph nang ( BMI > 95th percentile; CN/CC > 140%). Toc o giam can thch hp la # 500g moi thang.

Cac trng hp con lai muc tieu can nang la duy tr can nang hien tai cua tre, ch BMI giam khi tre cao len.

3. Chng trnh ieu tr: a) Nguyen tac: Giam lng m d tha bang phoi hp thch hp gia tang nang lng tieu

hao va giam cung cap nang lng ong thi phai bao am s tang trng cua tre.

am bao tnh lau dai, de dung nap, khong lam tre cam thay b cach biet b) Chng trnh ieu tr: (bang 5)

Bang 5: Cac thanh phan cua mot chng trnh ieu tr beo ph

Thanh phan e ngh Muc tieu giam can thoa ang

Khi au at c giam 2.55kg; toc o 0.5 2kg/thang

Tiet che Tnh c tong nang lng moi ngay, phan tram nang lng cua cac thanh phan m, protein, va carbohydrate.

Hoat ong thc the Bat au tuy thuoc chc nang ho hap tuan hoan cua tre, vi muc tieu cuoi cung la hoat ong 20-30 phut/ngay (khong tnh cac hoat ong tay chan trng hoc)

ieu chnh hanh vi T kiem soat, giao duc dinh dng, khuyen khch, ieu chnh cac thoi quen an uong, hoat ong thc the, thay oi thai o, cung co va phan thng.

S tham gia cua gia nh

anh gia sinh hoat gia nh, kieu xem tivi, tham van dinh dng cho cha me benh nhi.

Bang 1: Cac bien chng cua beo ph c ghi nhan tre em

Tim mach: - Cao huyet ap - Tang cholesterol mau - Tang triglyceride mau - Tang LDL ( cholestrol ty trong thap ) - Tang VLDL (cholestrol ty trong rat thap ) - Giam HDL (cholestrol ty trong cao )

Ho hap: - Hoi chng Pickwickian - Ngng th luc ngu do tac nghen. - Tang thong kh phe nang nguyen phat - Cac bat thng chc nang phoi.

Noi tiet: - Tang insulin mau va e khang insulin Than kinh: - Gia u nao ( Pseudotumor cerebri) Mien dch: - Giam chc nang mien dch qua trung gian te bao He c xng: - Benh Blount

- Slipped capital femoral epiphysis Tieu hoa: - Benh tui mat ( ac biet soi tui mat )

- Gan nhiem m.

Da: - Acanthosis nigricans

Bang 2: Cac ac trng cua beo ph nguyen phat va th phat ( noi sinh)

Beo ph nguyen phat Beo ph th phat

> 90% cac trng hp < 10% cac trng hp Cao (thng > 50th percentile) Lun (thng < 5th percentile) Thng co tien s gia nh beo ph Tien s gia nh co beo ph

khong thng gap Chc nang tam than bnh thng Cham phat trien tam than Tuoi xng bnh thng hoac ln so tuoi Cham phat trien tuoi xng Tham kham lam sang bnh thng Thng i kem cac dau hieu ac

trng cua nguyen nhan Bang 3: Nguyen nhan beo ph noi sinh

Noi tiet Cac au moi chan oan - Suy giap - Cng nang tuyen thng than

- Cng insulin nguyen phat - Gia nhc can giap - Benh ly vung di oi mac phai

- Tang TSH, tang T4 - Test c che dexamethasone bat thng, tang cortisol t do trong nc tieu 24 gi

- Tang insulin huyet thanh, tang C-peptid - Ha calci mau, tang phospate mau, tang PTH - U vung di oi, nhiem trung, chan thng, sang thng mach mau

Di truyen Cac ac trng kem theo - Prader-Wili - Laurence-Moon/Barddet-Biedl - Altrom - Borjeson-Eorssman-Lehmann - Cohen - Turners

- Beo ph, them an vo o, cham phat trien tam than, nhc nang tuyen sinh duc, le.

- Beo ph , cham phat trien tam than, benh ly vong mac sac to, nhc nang tuyen sinh duc, liet 2 chi di co that.

- Beo ph, viem vong mac sac to, iec, tieu ng.

- Beo ph, cham phat trien tam than, nhc nang sinh duc, giam chuyen hoa, ong kinh.

- Beo ph kieu bung, cham phat trien tam than, nhc c, nhc nang sinh duc.

- Lun, khong phan biet gii tnh, cac bat thng tim , co co mang ( webbed neck), beo ph, kieu gen 45,X

- Loan dng mo m (lipodystrophy) co tnh gia nh - Beckwith-Wiedemann - Sotos - Weaver - Ruvalca

- Ph ai c, dang to au chi, gan ln, acathosis nigricans, e khang insulin, tang triglyceride mau, cham phat trien tam than.

- Khong lo, loi mat, li to, cac tang to. - Cerebral gigantism, tang trng qua phat,

nhc c, cham phat trien tam than van ong. - Hoi chng tang trng qua phat tre nho,

xng trng thanh nhanh, ve mat bat thng

- Cham phat trien tam than, au nho, bat thng khung xng, nhc nang sinh duc, brachymetapody

Bang 4. anh gia cac tnh trang noi khoa lien quan en beo ph:

Cac dau hieu Tnh trang lien quan Benh s: - Cham phat trien - Cham phat trien chieu cao - Nhc au - Kho th ve em - Ngu ngay - au bung - au hong / khp - Vo kinh / thieu kinh

- Cac roi loan di truyen - Suy giap, Cushing, Hoi chng Prader-Wili - Gia u nao - Hoi chng ngng th luc ngu, giam thong kh do beo ph.

- Hoi chng ngng th luc ngu, giam thong kh do beo ph

- Benh ly tui mat - Slipped capital femoral epiphysis - Hoi chng buong trng a nang

Tien s gia nh - Beo ph - Tieu ng khong phu thuoc insulin (NIDDM)

- Benh ly tim mach - Cao huyet ap - Roi loan chuyen hoa lipid

- Benh ly tui mat Tham kham lam sang - Can nang, chieu cao, BMI

- Beo ph kieu bung - Nguy c benh tim mach, Cushing

- Huyet ap - D tat bam sinh - Acanthosis nigricans - Ram long - Cac ng van tm bung - ay mat - Amian - au bung khi tham kham - Tinh hoan khong xuong bu - Han che c ong khp hong - Chan vong kieng

- Roi loan di truyen - NIDDM, e khang insulin - HC buong trng a nang, Cushing - Cushing - Gia u nao - Hoi chng ngng th luc ngu - Benh ly tui mat - Prader-Wili - Slipped capital femoral epiphysis - Benh Blount

3. Bien chng cua chng trnh ieu tr giam can: Benh ly tui mat. ieu nay xay ra khi tre v thanh nien giam can nhanh. Thieu cac chat dinh dng do che o an nang lng qua thap Toc o tang trng co the cham trong qua trnh sut can. Tuy nhien, hau het

cac tre beo ph eu cao nen tac ong len chieu cao luc trng thanh rat t. Hieu qua cua sut can nhanh (>0.5kg/thang) tre nho hn 7 tuoi con cha c biet.

Chng trnh sut can co the lam ton thng xuc cam, tam than. Cac roi loan hanh vi an uong (chan an tam than, cuong an,) co the xay ra. S ban tam, lo lang cua cha me hoac cua ban than tre ve can nang co the lam giam tnh t tin cua tre. Neu can nang, tiet che va hoat ong thc the tr thanh moi xung khac , quan he cua tre vi gia nh co the xau i. Luc nay can phai hoi chan vi chuyen vien tam ly va ngng chng trnh ieu tr cho en khi co the tiep tuc ieu tr ma khong gay ra cac tac dung co hai cho tam sinh ly cua tre.

4. Duy tr: Beo ph la mot benh man tnh can s quan tam suot i ve hanh vi an uong

va loi song khoe manh. Sau khi at c muc tieu ban au, ca gia nh lan tre can phai tch cc duy tr nhng thoi quen tot a at c. Viec tai kham thch hp se giup at c ieu nay, ong thi theo doi c cac bien chng th phat co the xay ra.

Van e Mc o chng c

Khong dung thuoc e ieu tr beo ph tre em nguyen phat

I (WHO 1997)

LU O X TR BEO PH

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Ch so nhan trac

Beo ph D can Hng dan dinh dng

Tai kham 3-6 thang

CC/T>90% Tien can SDD coi coc

Tm nguyen nhan

Bien chng > 7 tuoi Duy tr can nang

CN/CC > 150%

Duy tr can nang Giam can ieu tr

bien chng theo phac o

Giam can

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