Lê Thị Cúc

1. 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(JcPhuc1
, 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,ICtieu: Khao sat tinh hinh kiem scat hen phS quan (HPQ) atre em theo GINA 2014 tai Khoa Nhi
t6nghqpI,Trung tam Nhi khoa Benh vien Trung uong HuS. Phuong phap: Nghien ciru c~t ngang duoc
tiSnhanhtren 123 benh 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
oghienctru1ft4,49 ± 3,25. S6 IUQ'ngbenh nhi nam: 80 (65,04%), nu: 43(34,96%). HPQ b~c 2 (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€mtY I~Ian hrot Ii 28,46% vi 17,07%, khong co HPQ b~c 4 (keo dai nang). Qua danh gia rmrc
dQki6mscat HPQ theo GINA 2014, chung toi ghi nhan tY I~ HPQ kiSm scat t6t Ii 17,07%, kiSm scat
mQtphdn1ft43,09% vi khong kiSm scat Ii 39,84%. K~t lu~n: Nghien cuu cho thAymire dQkiSm scat
lienquanvoi cac d?c tinh nlnr diSu tri du phong, tuan thu diSu tri, hiSu bi~t cua b6 my vS thuoc du phong
henvab~chen; khong lien quan dSn tai kham dinh ky.
TitkluJa: 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
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 to
GINA2014at 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 General
Pediatrics1from 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
findingof the study, the proportion of asthma step 2 (Mild persistent) was 54.47%. The figures for
asthmastep1(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
asthmacontrolaccording 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
levelofcontrol 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: ngocphuc91@yahoo.com.vn
-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

2. 1.D~TVANDE 2. DOl TUONG vA PHUONG
Hen 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 ciru
hfip 6 mroc ta cling nhu nhieu mroc tren th~ gioi, Tfit ca cac benh nhi dap irng dtl tieu chu§n
Theo bao cao cua T6 chirc Y t~ th~ gioi (WHO), nghien ciru (Benh nhi diroi 15 tu6i da duoc ch§n
narn 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 Khoa
ngiroi m~c hen, chiern 6 - 8% dan s6 6 nguoi
Nhi t6ng hop 1, Trung tam Nhi khoa Benh vi~n
16n va hon 10% 6 tre em duoi 15 tu6i, uoc tinh
Trung uong Hu~ trong thai gian nr thang 05 nam
d~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 ciru
tir vong do hen, trong do nh nhieu tnrong hop a. Thi~t k~ nghien ciru: Phuong phap mo ta
tir vong c6 thS phong ngua diroc [2]. Benh hen c~t ngang
khong 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 cua
trien 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~ntrong
muon. 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 dlnhbi
Xuelt 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 minhc6
ii tre em t(li Khoa Nhi tang lu;p I, Trung tam t~c nghen ph~ quan va h6i phuc duoi tac dung cua
Nhi khoa B?nh vi?n Trung trang Hul", nh~m thuoc gian ph~ quan (tre 2: 5 tuoi), Tre < 5 tu6i,cAD
2 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~ quan
2. 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~m
D~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~u
phut va hon 1 IAn! ky trieu chirng chung b§t Icy
tuftn 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/tuAn
c~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. 3.KET QuA vA BAN LU~ Bang 3. Phan b6 hen phS quan theo mire do nang
3.1. 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 HuS
trong thai gian ill thang 5 nam 2014 dSn thang 2
nam 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 100Tong
Nhgn 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 va
Nil
X±SD 4,38± 4,73 ± 4,49±
3,41 2,94 3,25
Nhgnxet: Tu6i trung binh cua d6i nrong nghien
elm 1114,49 ± 3,25,
Mu-c d9 n~ng SalU'crng Ty I~ (%)
ciia HPQ
B~c I,Tung 35 28,46
con ng~n
B~c 2,Keo dai 67 54,47
nh~
B~c 3, Keo dai 21 17,07
trung binh
Bac 4, Keo dai
° °n~ng
T6ng 123 100
Nhdn xet: Hen phS quan keo dai nhe chiem tY
l~ cao nhat (54,47%), Khong c6 tnrong hQ'P hen
keo dai nang,
Bang 4.Mll'c dQ ki8m scat hen phS quan
Tinh Ki" KiA Khongem em
trang 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 tY
1~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 thong
D~cdi~m . M9tph§n ki~m so at ke
* DiSu tri du phong
C6 21 53 16
P = 0,000
Khong
° ° 33
* Tuan thu diSu tri
C6 18 12 3
P = 0,000
Khong 3 41 13
* Hi kharn dinh ky
C6 17 39 12
P = 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,pchiY Dune hoc - Truong Bl;li hoc Y DU'Q'c Hu~ - se B~c bi~t 121

4. * 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 ° ° 21
Nhdn xet: Nghien ciru nhan thdy mire dQ kiern scat HPQ lien quan voi cac d~c tinh dieu tri dlph'
tuan thu diSu tri, nhan bi8t thuoc co tac dung du phong va b~c hen theo mire dQ nang. M6i nrong
co y nghia thong ke (p < 0,05).
3.2.Bim lu~n
3.2.1. D(ie iliim vi il8i tuong nghien ctru
Qua nghien ciru 123b~nh nhi, c6 hon 65%
benh nhan hen ph8 quan trong nghien ciru la
nam, ti l~ nam:mi la 1,86: 1. K8t qua nay tuong tu
nghien ciru cua Le Thj Minh Huang, tre nam m~c
hen phS quan cao hon tre nu voi tY l~ la nam.nu la
1,85: 1 [4]. 0 tre em, tre trai c6 nguy co m~c hen
phS quan cao hon tre gai la do nhfmg tre trai nay
c6 nhieu y8u t6 bArn sinh thuan lei cho sir phat
sinh t~c nghen ph8 quan [3].
Trong s6 cac d6i nrong tham gia nghien ciru tir
1 dSn 14 tu6i, tu6i trung binh cua benh nhi trong
nghien ciru la 4,49 ± 3,25.
3.2.2. D(ie iliim vi b{ie hen
Chung 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 qua
cua nghien ciru cling phu hop voi tac gia Nguyen
Van 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 cong
d6ng vi v~y nhieu tnrong hop hen ph8 quan a
rmrc dQ nhe se khong duoc ti8p can. Vi v~y c6
th~ giai thich sir khac biet voi cac nghien ciru
tren th8 gioi, trong d6 hen ph8 quan a tre em chu
ySu la tha nhe.
3.2.3. D(ie iliim vi kiim sodt hen
Nhfrng nghien ciru g§n day cho thdy ti l~
ki~m scat hen con thdp va thay d6i a nrng qucc
gia. Nghien ciru ki~m soat hen theo tieu chi lam
sang 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 scat
mdt phan, 53,4% khong ki~m scat [11]. SIl khac
nhau 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 tfnh
quan cua nguoi lam nghien ciru, benh nhih
than nhan benh nhi. Trong nghien ciru ctiaNguy
Thi Ngoc danh gia a l§n tai kham dAutien
bang tr~c nghiern ACT [5]. Con chung toi
gia khi benh nhan vao 'vi~n voi tieu chu~nkil
scat trong 4 tu§n qua cua GINA 2014 va ghi
ti I~ HPQ ki~m soat t6t la 17,07%, HPQ ki€m
mot ph§n la 43,09% va HPQ khong ki6m soat
39,84%, So voi nghien ciru cua Nguy~n Thj
thi 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 soothell
cdc iI(ie tinb
Vi~c diSu tri dir phong va tuan thu di~utri 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 nghienen
nay cho thdy diSu trj du phong va tuan thtidi~u~
anh hU011g d8n rmrc dQ kiem scat (p<o,OS),
Hi~u bi8t cua b6 my vS hen tre em, ma n
la cac thuoc diSu tri dir phong la mQt y@uta
tiSp c6 lien quan d8n hieu qua cua viec ki~m
hen [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 trongvilne
3 thang [9]. N ghien ciru cho thdy m6i nrong qua
giira 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~

5. 4.KETLU~
HenphSquan b~c 2 (keo did nhe) chiern tY l~
cao nhAtla 54,47%, hen phS quan b~c 1 (tung can
Dg~n) va b~c 3 (keo dai trung binh) co tY l~ lfrn
hrqt 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 la
43,09% va hen phS quan khong kiem soat Iii
39,84%. Mire d¢ kiem soat lien quan voi cac d~c
tinh b~c hen, di~u tri dir phong va viec tai kharn
thuong xuyen cua benh nhan; khong lien quan
dSn 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, Ha
N~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 Trung
ur:mg",Tap chi Y hoc Vi?t Nam, t~p 332, tr.157-163.
S. Nguy~nThiNgoc, Phan Hfru Nguyet Di~m (2008),
Danhgiatlnh gia tri cua bang CoACT trong hrong
giaki~msoat hen suy~n 6'tre ill 4 - II tu6i tai Benh
vi~nNhid6ng I TP.HCM. Luan van t6t nghiep Bac
sinQitru,DH Y Duoc TPHCM.
6. Tr§nQuy (2007), "Dich t~ hoc hen ph6 quan va
tiSpc~nchuong trlnh khoi dQng toan du v~ phong
ch6nghen 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 tren
6 tu6i nhdp vien, Luan van Thac sy Y hoc, tnrong
D~i hoc Y Hfl NQi.
8. Bloomberg GR, Christina Banister, Randal S
(2009). Socioeconomis, family, and pediatric
practice factors that affect level of asthma control.
Pediatrics, 123, pp. 829 - 835.
9. GINA (2014), Global Strategy for Asthma
Management and Prevention.
10.Lai CK, De Guia TS, Kim YY, Kuo SH et al (2003),
Asthma control intheAsia - Pacific Region: theAsthrna
Insights 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 Asia
according to the Global Initiative for Asthma
(GINA) criteria. J Allergy Clin Immunol, 121(2),
S95 (abstract).
r,p chiY DIfQ'c hqc - !r'u'img Dai hoc Y DU'Q'c Hu~ - se f)~c bi~t 123