NGHIN CU TNH HNH TR S SINH C LNG NC I BT THUNG TI KHOA PH SN BNH VIN TRUNG NG HU

BO CO LUN VN TT NGHIP BC S Y KHOA

Ngi hng dn lun vn PGS. Nguyn Khi HU 2009

Sinh vin thc hin Phan Tn Quang

T VN Nc i l mt trong nhng thnh phn ph ca phi thai.Tnh trng ca nc i c lin quan rt cht ch vi s pht trin bnh thng ca thai. Mi bt thng ca nc i v th tch (qu t hay qu nhiu ) hay cht lng u lm tng cao t l t vong v t l mc bnh chu sinh. Cc tnh trng ca nc i lun l nhng du hiu cn thit, bo hiu nhiu tnh trng bnh l ca thai. V th nc i l mt trong nhng i tng nh gi ca thy thuc khi theo di thai nghn. Nghin cu ton din c v s lng v cht lng nc i l rt quan trng trong qu trnh theo di v nh gi s pht trin ca thai nghn.

T VN (tip)Trong cc bt thng v nc i th bt thng v s lng nc i, bao gm a i v thiu i l nhng bt thng hay gp. Nc i c vai tr rt quan trng i vi s pht trin ca thai nhi nn nhng bt thng v lng nc i c th dn n thay i cc ch s ca tr s sinh nh cn nng, chiu cao, vng u, d tt bm sinh, ch s Apgar sau sinh, cc bnh mc phi, Thng th s thay i l theo chiu hng khng thun li cho s pht trin ca tr sau sinh. iu cng gp phn lm tng t l t vong chu sinh ln rt nhiu trong nhm tr s sinh c lng nc i bt thng.

T VN (tip)Xut pht t ngha , chng ti thc hin ti NGHIN CU TNH HNH TR S SINH C LNG NC I BT THUNG TI KHOA PH SN BNH VIN TRUNG NG HU vi cc mc tiu sau: 1. Ngin cu mt s c im ca tr s sinh c lng nc i bt thng. 2. Tm hiu nh hng ca mt s yu t n c im ca tr s sinh c lng nc i bt thng.

I TNG NGHIN CU 1. i tng nghin cu Tt c sn ph vo vin trong thi gian t 1/5/2008 n 31/4/2009, c chn vo mu khi cc iu kin: - c chn on a i hoc thiu i trn lm sng - c cc ch s chn on xc nh a i hoc thiu i trn siu m: ch s nc i (AFI) hoc khoang i ln nht (MVP) tha mn tiu chun chn on. - Xc nh c tui thai. 2. Tiu chun loi tr - Sn ph khng c chn on r rng - Bnh n khng y thng tin lin quan - Khng c siu m chn on - Khng nh gi c tnh trng thai khi chn on

PHNG PHP NGHIN CU 1. Thit k nghin cu Phng php ct ngang m t da trn cc s liu thu thp t nghin cu trn lm sng v hi cu bnh n b sung. 2. Phng tin nghin cu * Cn * Thc o vng u, thc o chiu cao * Bng tnh tui thai v ngy sinh d on * ng nghe tim, phi. 3. Cc bc tin hnh * Khai thc hnh chnh * Khai thc tin s bn thn v gia nh ca m * Cc ch s ca m v con trong ln sinh ny

PHNG PHP NGHIN CU (tip) 4. Cch thc nh gi - nh gi Apgar ( lc 1 pht v 5 pht) + T 7 - 10 im : tr khe mnh + T 4 - 6 im : tr ngt t nh n trung bnh + T 0 - 3 im : tr ngt nng - nh gi lng nc inh gi Th tch nc i (ml) Khoang i ln nht (cm) AFI nh lng AFI nh tnh Hai kch thc i (cm2 ) Thiu i 300 2 5 0/ < 15 Bnh thng 800 - 1500 3-8 8 - 18 BT 15 - 50 a i 2000 8 25 ++ 50

PHNG PHP NGHIN CU (tip)- Cc ch s khc + Ch s nhn trc tr s sinh: gm cn nng, chiu cao v vng u. + S con: phn thnh 1 con, 2 con v 3 con. + Tui m: cc nhm tui: 18 tui, 19 - 34 tui v 35 tui. + a ch: thnh th v nng thn. + Ngh nghip: nng dn, cng nhn, cn b, ngh khc v khng ngh. + Tui thai: 37 tun, 38 - 42 tun, > 42 tun. + Cn nng tr: < 2500 g, 2500 4000 g v 4000 g. + Ngi thai: ngi u, ngi mng, ngi ngang. + Hnh thc sinh: sinh thng, m , sinh th thut. + D tt bm sinh: c d tt hay khng c d tt.

PHNG PHP NGHIN CU (tip)5. X l s liu S liu thu c t nghin cu c x l theo phng php thng k y hc qua cc bc: - Thng k m t cc bin s ca mu. - Cc kt qu tnh ton c thit lp da trn t l % v c biu din di cc hnh thc: bng, biu hnh trn, biu hnh ct. - S dng phn mm thng k SPSS 17.0.

KT QU V BN LUN 1. Phn b gii tnh tr

53.5 %

46.5 %

N Nam

Theo nghin cu ca Nguyn Vit Hng, Trnh Vn Bo (2003) t l tr trai l 53.79%, tr gi l 46.21 %, theo iu tra ca Nguyn Khi v phn b gii tnh ca tr s sinh khu vc Hu l tr trai chim 53.6%, tr gi chim 46.4 %. Nh vy kt qu ca chng ti ging vi cc nghin cu trn.

KT QU V BN LUN (tip) 2. Phn b tui thai non1

7 .1 4

8 8 .4 4

4 .4 2

th n g G i th n g

0%

20%

40%

60%

80%

100%

* Cc t l ny theo Nguyn Vit Hng ln lt l: non 8.8%, thng 83.9%, gi thng 7.3%. * T l non theo t chc Y t Th gii l 5 - 15 %. * T l thai gi thng theo ghi nhn ti gio trnh Sn Ph khoa l 3 12%.

KT QU V BN LUN (tip) 3. Trng lng tr s sinh86.61% < 2500 2500 - 4000 4000

9.82%

3.57%

Theo nghin cu ca Nguyn Vit Hng, t l tr nh cn l 7.53 %, ca Nguyn Khi l 8.37 %. Kt qu ca chng ti t l tr s sinh nh cn cao hn so vi cc nghin cu trn.

KT QU V BN LUN (tip) 4. Ngi thai6.25% 91.96% 1.79% u Mng Ngang

* Theo gio trnh Sn Ph khoa ca i hc Y Dc Hu, t l cc loi ngi thai l: ngi u chim 95.5 96.5 %, ngi mng chim 3 4 %, ngi ngang chim 0.5 1 %. * Theo nghin cu ca Nguyn Th Kim Phng, t l ny l : ngi u 70.7 %, ngi mng chim 27.3 %, ngi ngang chim 1.9 %.

KT QU V BN LUN (tip) 4. Gi tr trung bnh cc ch s nhn trc ca trCh s (trung bnh) Gii tnh Nam N Trung bnh

Trng lng (g) 2943.6 439.3 2839.4 426.7 2891.5 433.1 Chiu cao ( cm) Vng u (cm) 50.02 1.83 30.12 2.41 49.87 1.68 30.05 3.26 49.95 1.76 30.08 2.83

* Kt qu nghin cu ca chng ti ch s nhn trc tr nam v n l tng ng nhau. Kt qu ny tng t kt qu tng kt ca B Y t (2003), nghin cu ca Nguyn Vit Hng,Trn Th Phng Mai, Nguyn Khi. * Trng lng trung bnh ca tr theo Nguyn Vit Hng l 3037 566 g, theo B Y t (2003) l 3110 350 g.

KT QU V BN LUN (tip) 5. Ch s ApgarCh s Apgar Sau 1 pht Sau 5 pht 03 1 (0.89%) 1 (0.89%) 6 2 46 (5.36%) (1.79%) 7 - 10 105 (93.75%) 109 (97.32%)

T l suy h hp tr s sinh ngay sau sinh theo gio trnh Nhi khoa ca B Y t (2007) l t 1 3 %, theo WHO l khong 3%. Nh vy, t l suy h hp ngay sau sinh ca chng ti ( 0.89 + 5.36 %) cao hn so vi t l chung. iu ny c th do nhng tr s sinh c bt thng lng nc i s d b suy h hp hn, c th do km pht trin trong t cung, do kh hoc do bnh l nguyn nhn gy ra bt thng v lng nc i.

KT QU V BN LUN (tip) 6. T l t vong tr T l t vong s sinh theo Grover N. l 1.3%, theo Nguyn Th Kim Phng, t l t vong sau sinh l 1.79%. T l t vong sau sinh ca chng ti l 2.68 %, cao hn cc nghin cu trn. iu ny cho thy t l t vong chu sinh tng cao hn trong nhm tr c bt thng lng nc i. V vy chn on v iu tr sm a i v thiu i cng gp phn lm gim t l t vong tr s sinh.

KT QU V BN LUN (tip) 7. T l a i, thiu iLoi bt thng a i Thiu i Tng cng S trng hp 26 86 112 Tng s sn ph vo vin 5491 T l % 0.47 1.57 2.04

T l a i theo t chc Y t th gii l 0.3 1.3 % , theo tng kt ca bnh vin T D (1998) l 0.22 0.66 %, theo gio trnh Sn Ph khoa ca i hc Y Dc Hu l 0.2 1.6 %. T l thiu i theo t chc Y t th gii l 0.4 3.9 %. Nh vy, t l a i v thiu i trong nghin cu ca chng ti tng ng vi kt qu ca cc nghin cu trn.

KT QU V BN LUN (tip) 8. T l cc loi bt thng nc iLoi a i Thiu i Tng cng S trng hp 26 86 112 T l % 23.21 76.79 100%

86.77% a i Thiu i

26.23%

Nhn xt: Trong bt thng lng nc i, a i chim t l 23.21 %, thiu i chim t l76.79 %.

KT QU V BN LUN (tip) 9. Hnh thc sinh tr bt thng lng nc iHnh thc sinh Loi bt thng a i Sinh thng 18 ( 69.23%) Thiu i 24 (27.91%) 42 (37.5%) Tng

Theo nghin cu ca Nguyn Vit Hng, t l m l 19.38 %, theo Nguyn Vn Din, t l m ti khoa Ph Sn bnh vin trung ng Hu l 31.75 %.

KT QU V BN LUN (tip) 10. Lin quan ch s nhn trc tr s sinh v tui thaiCh s 37 TLTB(g) CCTB(cm) VTB(cm) 49.78 1.47 29.72 2.57 Tui thai (tun) 38 - 42 50.02 1.48 30.08 3.23 42 2991.5 433.1 50.19 1.86 30.13 2.24 < 0.01 < 0.01 < 0.01 2791.7 452.3 2863.3 438.5 P

Kt qu nghin cu ca chng ti cho thy trng lng, chiu cao v vng u trung bnh thp nht nhm tui thai 37 tun v ch s ny tng dn theo tui thai c ngha thng k (p < 0.01). Lubchenco khi nghin cu biu pht trin ca tr trong t cung ghi nhn khi tui thai cng tng th trng lng thai nhi cng tng theo.

KT QU V BN LUN (tip) 11. Lin quan ch s nhn trc tr s sinh v tui mCh s 18 TLTB(g) CCTB(cm) VTB(cm) 2889.3 437.2 48.98 1.48 29.32. 2.27 Tui m 18 - 35 2986.4 435.9 50.11 1.91 30.12 2.13 35 2992.3 422.6 49.84 1.69 29.93 2.35 0.023 0.045 0.034 P

Kt qu nghin cu ca chng ti cho thy, cc ch s nhn trc thp nht nhm tui m 18 c ngha thng k (p < 0.05 ). Theo Nguyn Vit Hng, tui m < 20 c nguy c con nh cn hn so vi cc nhm tui khc. Theo Nguyn Khi, ch s nhn trc tr s sinh thp nht nhm m 19 tui.

KT QU V BN LUN (tip) 12. Lin quan gia cn nng v gii tnh ca trGii < 2500 N Nam Tng 6 5 Cn nng (g) 2500 - 4000 (36.07%) 3 (50.00%) 1 4000 (2.68%) 50 (44.64%) (0.89%) 62 (55.36%) (3.57%) 112 (100%) 0.31 (5.36%) 41 (4.46%) 56 Tng P

Nghin cu ca chng ti cho thy, t l nh cn cao n. Tuy nhin, s khc bit khng c ngha thng k (p > 0.05). Kt qu nghin cu ca Nguyn Khi (1982, 1990), Nguyn Vit Hng, Trn Th Phng Mai (2005) v theo tng kt ca b Y t (2003) cng cho kt lun tng t. Theo , t l tr s sinh nh cn t c s khc bit gia hai gii.

11 (9.82%)

97 (86.61%) 4

KT QU V BN LUN (tip) 13. Lin quan gia cn nng tr s sinh v tui mTui m < 2500 18 18 - 35 35 Tng 3 7 1 Cn nng (g) 2500 - 4000 (1.79%) 0 (6.25%) 2 4000 (0%) (1.79%) (1.79%) 5 97 10 (4.46%) (86.61%) (8.93%) (100%) 0.02 (2.68%) 2 (0.89%) 7 Tng P

(6.25%) 88 (78.57%) 2

11 (9.82%) 97 (86.61%) 4

(3.58%) 112

Kt qu nghin cu cho thy, m 18 tui c nguy c con nh cn cao hn c ngha thng k so vi nhm tui khc (p < 0.05). Kt qu ny tng ng vi kt qu nghin cu ca Nguyn Khi, Nguyn Vit Hng, Trn Th Phng Mai, Nguyn Th Kim Phng.

KT QU V BN LUN (tip) 14. Lin quan gia cn nng v ni c tr ca mCn nng (g) < 2500 2500 - 4000 4000 Tng 8 50 1 Ni c tr Nng thn (7.14%) Thnh ph 3 (2.68%) 11 (9.81%) (86.61%) (3.58%) (100%) < 0.01 Tng P

(46.64%) 47 (41.97%) 97 (0.89%) 3 (2.68%) 4

59 (52.67%) 53 (47.33%) 112

Theo nghin cu ca chng ti, t l sinh con nh cn ca nhng b m nng thn cao hn so vi nhng b m thnh ph c ngha thng k (p < 0.01).

15. Lin quan gia cn nng tr v ngh nghip ca b mCn nng M (g) Nng dn Cng nhn Cn b Ngh khc Khng ngh < 2500 2500 Tng < 2500 2500 Tng 3.57% 27.68% 31.25% 0.89% 26.79% 27.68% 1.79% 14.29% 16.07% 4.46% 15.19% 19.64% 0.89% 8.04% 8.93% B 0.89% 9.82% 10.7% 3.57% 38.39% 41.07% 0% 0% 0% 9.82% 90.1% 100% 2.68% 38.4% 41.1% 0.9% 1.7% 2.6% Tng P

KT QU V BN LUN (tip)

9.87% 90.1% 100%