- . i G S . B S .

T R A N V A N KY , \ " A
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______________________________

DIE U TRI
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N H I KHOA
DONG Y
JG U Y E N
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N H A XUAT BA N Y HOC
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Giao sir Bac si T R A N V A N K Y

Vien Y Dime hoc dan toe Thanh pho Ho Chi Minh

D ltlJ T R I
NHI KHOA DONG Y
(T A I B A N C O S U A C H U A V A B O SU N G )

NHA XUAT BAN Y HOC

C hi nhanh Thanh pho Ho C hi M inh

LCTI GIOI THIEU

(Lan xuat ban thirnhat)

Nirac ta co mot nen y hex: co truyen dan t6c, vai nhieu kinh nghiem phong
phu ve y va dupe, trong do co nhi khoa.
Sau gan 20 nam lam cong lac thira ke phat huy nhirng krnh nghiem cua nhi
khoa co truyen, limg biroc ket hop vcri nhi khoa hien dai. Bac si Tran Van Ky da
co nhirng hieu biet tuxrng doi sau, co nhihig kinh nghiem thuc te trong khi van
dung nhirng kinh nghiem cua nhi khoa co truyen va da bien soan cuon: Dieu tri
Nhi khoa dong y.
Tap sach nho nay dugc viet diroi dang ket hgp buoc dau giixa y hpc hifn dai
va y hoc co truyen dan tpc.
Ve cach viet, tac gia da dung ngon ngir hi$n dai de trinh bay cac van de.
Ve npi dung tac gia dfe cap trong phan ly luan ca ki6n thuc hifn dai va co
truyen, trong cac phan ten benh, nguyen nhan benh ly, chSn doan, tien luqmg
benh noi theo hien dai, phan difeu tri chu yu vi6t theo ly luan va kinh nghigm c6
truyen co ket horp ca phan chira benh cua nhan dan.
Day la mot cach viet phu hop vai trinh do hieu biet va kinh nghiem thuc te
con co han cua can bo lam cong tac thira ke phat huy kinh nghiem cua y hpc co
truyen va ket hap chat che giira y hpc hien dai va y hpc co truyen dan toe. No co
iru diem la co nhieu kha nang giup cho cac thay thuoc si} dung kinh nghiem co
truyen de dang hem cach viet hoan toan co truyen. Song do noi dung ket hop
giira y hpc hien dai va y hoc co truyen rat kho, do trinh do tac gia co han nen kho
tranh khoi thieu sot can^dirpc ban doc gop y bo sung.
Dii sao, day cung la mot tai lieu tot co tac dung gop phan thuc day dua y hpc
co truyen vao itganh nhi, tao dieu kien de ket hpp Nhi khoa hien dai va co truyen
tien tai xay dung nganh Nhi khoa Viet Nam.
Vai niem tin tuang nhu vay. chung toi xin tran trong giai thieu cuon Nhi
khoa dong y " vai ban doc va dong nghiep.

Ha noi, thang 11 nam 1978

Quyen vien truong Vien dong y
Bac sT H O A N G B A O C H A U

u o n

n o i dA u

(L A N X U A T BA N T H U NHAT)

Cuon D iiu tri N hi khoa dong y " dux?c bien soan theo tinh than ket hop giua
y hqc hi$n dai va y hoc co truyen dan toe nham phyc vu cong tac day m^nh ket
hop y hQC cd truytn dan tqc vai y hoc hien dpi trong nganh Nhi. lam tai lieu hoc
tfip va tham khao cho sinh vien chuyen khoa N hi co truyen dan toe dong thin
giup cac b$n ddng nghiep muon img dung y hoc co truyen dan toe trong cong tac
dieu tri N h i khoa.
N oi dung sach gom 2 phan chinh:
- Phin I la ph3n dai cuong gom co cac myc: Dac diem sinh ly va b^nh ly cua
tre em; ChSn doan theo y hpc co truyen (chu yeu la lit chan). Bipn chimg Nhi
khoa (gicri thieu 3 phep bien chimg: Bien chimg theo bat cinmg, bien chimg theo

t$ng phu va bien chimg benh sot (cap tinh cua tre em), Dieu trj Nhi khoa gom
nhung nguyen tac can thiet khong the thieu dmjrc trong cong tac chan doan va
d iiu tri cac benh tre em bang y hoc co truyen dan tqc.
- Phan 11 la phan benh hoc:

Trong phan nay ch i gun thieu mot so benh mil kha nans y hoc co truyen dieu
tri co k it qua tot hoac ket h(rp vm y hoc hien dai. hieu qua dieu in va phony
b$nh dupe nang cao.
Trong moi benh thi ten benh. Nguyen nhan benh (y, Chan doan. Trieu chimg.
Tien Iirong, Phong benh deu luan theo y hoc hien dai dong thin ket hop gidi

thieu -nhirng kien thuc co ban cua y hoc co truyen dan toe de nghien ciru
Ve phan dieu tri timg benh chu yeu gicri thieu nhung nguyen tac va phu*mg
phap dieu trj theo y hoc co truyen bang bien chimg luan tri, bang nhtmg bai
thuoc kinh nghiem ma cac vj thuoc thuvng la thuoc nam de kiem va de bao che
Ngoai ra timg loai benh co gim thieu them cac phutmg phap ditu tri khac nhu
cham ciru, xoa bop, giac, chich It...
T A C G IA

LOT NOI DAU

(Lan tai ban)
Ket hap Y hoc co truyen dan toe vai Y hoc hien dai. xay dung mot nen Y hoc
Viet Nam vung inanh la quan diem ca ban cua nganh Y te nirt'rc ta da dutrc the
che hoa trong Hien phap cua nunc Cong Hoa Xa Hoi C'hu NghTa Viet Nam.
La mot thay thuoc co han 45 nam tuoi nghe va da han 35 nam lam cong viec
nghien ciru, giang day. bien soan tai lieu va chua benh bang Y hoc co truyen, toi
luon co gang quan triet tinh than do. Tir nam 1978, toi da bien soan quyen D IE U
T R I N H I K H O A DONG Y duai dang ket htrp Y hoc co truyen dan toe vai Y hoc
hien dai duac nhieu ban doc va ban dong nghiep hoan nghenh co vu. Trong lan
tai ban nay, ehung toi co sira chua bo sung them cho tai lieu diroc tot han.
Hy vong cuon D IE U T R I N HI KH O A DONG Y duac tai ban lan nay se la
mot tai lieu tham khao bo ich cho cac ban dong nghiep va ban doc. Va mot lan
nira xin chan thanh cam cm nhieu ban dong nghiep va ban doc da co vu gop y
kien, xin chan thanh cam cm Chi nhanh Nha Xuat ban Y hoc TP. Ho Chi Minh
da tich circ giup da cho viec tai ban quyen sach duac thuan lai.

Thanh pho Ho C hi M inh ngay 26 thang 3 nam 1997

G S.B S. T R A N V A N K Y

MUC LUC
L a i gidi thieu (Lan xuat han th iin lia t).....................................................^
L a i noi dan (Lan xuat han thunhat)...................................................... {
L a i m adau ............................................................................................ 5
Phan thir n hit: D A I C U O N G v k N H I K H O A ..................................... 9
Su phat trien cua Nhi khoa trong Y hoc co truyen Phurrng Dong............ 9
Dac diem ve sinh ly benh ly tre em..................................................... 12
Dac diem chan doan Nhi khoa dong Y .................................................16
Tuchan trong Nhi khoa.................................................................. 16
Bien chung Nhi khoa I I ............. ^......................................................... 21
1) Bien chimg theo bat cucrng I I ......................................................21
2) Bi?n chimg theo tang phu.......................................................... 22
3) Bien chimg sot cap tinh tre em....................................................26
Dieu tri nhi khoa..................................................................................29
I. Nhimg nguyen tac dieu tri benh tre cm ........................................ 29
II . Nhung phirong phap dieu tri theo Y hoc co truyen..................... 30
- Tam phep tri benh nhi khoa....................................................31
- Cac phircmg phap chira benh ben ngoai bang thuoc................. 33
- Phuong phap chira bpnh khong dung thuoc..............................35
III . Nhung dieu can chu y trong ket hop dieu tri bang thuoc T a y ....40
- Dac diem dung thuoc Tay trong nhi khoa................................40
- Mot so thuoc Tay can ducrc chu y luc sudung......................... 40
Thuoc khang sinh................................................................ 40
Thuoc Sulfamid................................................................... 42
Thuoc Corticoid.................................................................. 43

Phhn th iih ai: D IE U T R I N H I K H O A ................................................. 46

Hoga .................................................................................................. 46
Quai bj ................................................................................................ 50
Vieni gan virut ....................:............................................................... 56

StTi ..............................................................................................

62

Sol xuat huyel ..................................................................................... 68

Thuy dau .............................................................................................72
Viem n ao .............................................................................................76
Bai liet tre e m ...................................................................................... 82
Benh lao. lao phoi ............................................................................... 87
Sot ret ..................................................................................................93
Viem durmg ho hap tren cap tinh ....................................................... 100
lira irueng

..................................................................................... 104

Viem phe quan cap ........................................................................... 107

Ban xuat huyet di img ....................................................................... 111
Dai dam .............................................................................................114
Hen phe quan tre em ......................................................................... 116
Tieu chav tre em ....................... ....................................................... 123
S un dmh duong ................................................................................. 130
Viem cau than c a p ............................................................................. 136
Nhiem khuan dircmg tieu.................................................................... 141
Hoi chimg than h ir............................................................................. 145
Bcng ky sinh (rung durmg ruot .......................................................... 151
Choc 16.............................................................................................. 162
Benh nhot .......................................................................................... 164
Benh ghe ........................................................................................... 166
Ham ke .............................................................................................. 168
Cham tre em ..................................................................................... 169
Tai lieu tham khao chinh ............................................................ ...... 172

phAn i

DAI CUONG Vfi NHP KHOA

S U PHAT TRlfiN CUA NHI KHOA TRONG
N fiN Y HOC CO TRUYfiN PHUONG DONG
Ciing vai cac khoa noi. ngoai. phu san, nhi khoa da duac h'inh lhanh va phat
tricn scrm trong nen Y hoc co truyen phuung Dong.
O

Trung Quoc tCr dai Tan-Han. hern 2400 nam ve truoc da co thay thuoc nhi

khoa. Theo sir ghi chep cua cuon siir ky Bien Thuoc liet truyen: "Bien Thuoc la
nguoi thay thuoc noi tieng... Den Ham Duong nghe noi nguoi Tan rat yeu tre, da
lam thay thuoc nhi khoa . Truoc .cong nguyen mot the ky, thai Han Thanh De,
nha tu y L y Tru Quoc viet cuon ANH NHI PH UO NG gom 19 tap, Luu Huong
viet cuon T H A I G IA O L U A N neu ro tan quan trong cua ve sinh truoc luc sanh.
Trong cung thoi gian nay, nen y hoc co Hy Lap phuimg Tay, trong nhirng tac
pham cua Hyppocrates (truoc cong nguyen 460 nam) va cua Galen (130) nhung
bai ve nhi khoa chi duoc ghi chep le te.
Duoi dai Tiiy Duong (the ky thu 3 den thir 10) tac pham L U T IN K IN H cua
V U PH U O N G la mot cuon sach nhi khoa som nhat the giai. Dac biet Duong thai
y da qui djnh dao lao thay thuoc chuyen khoa nhi 5 nam tot nghiep (luc nay gpi
la thieu tieu nhi), va cung la nuoc da to chiic day chuyen khoa nhi som nhat the
giai. Trong quyen C H U B E N H N G U Y E N H A U L U A N cua SA O N G U Y E N
H U O N G co mo ta ti mi nhung chung hau benh tre em. TON T U M A O (581-682,
dori Duong) viet quyen T H IE N K IM PH U O N G chia benh nhi khoa lam 9 loai va
da chi ra tam quan trpng cua ve sinh. khong khi, mat trai, ren luyen than the va

ky 1 1hi a t uuoi duong tre em Nam 752. V L r(JN(.J DAO viet cuon N G O A I DA! Bl
Y E U phan benh ire em lam 86 loai va ilui (hap nhieu bai ihuoc tri benh nhi Khoa
1

ir the ky thir 10 den the k> lliir 14 (thai dai long Kim Nguyen), nganh nhi

khoa da phat trien inanh tai Trung Quoc. Sach IH A N H HI E PH UO NG da chu

\ phan biet s<n va dau mua Den (he ky 11, thai v dai I ong phan y hpc thanh 9
khoa trong do co nhi khoa rieng Thai bay gia co danh v I IfcN A 1 (1023 - 1104)
tac gia cuon T IE U NHI D UO C C H U N G T R U C Q U YH T duyc noi tieng va
ngiroi dai ton lii ong thanh nhi khoa.
Den the ky thu 12 co L U U PH UO N G, V U O N G I.1CH V U O N G D E cung
bien soan cuon A IJ AU T A N T H U gom 40 tap co cac phan bao due anh nhi.
benh tre so sinh, benh di tat bam smh, benh he tieu hoa v.v..., la mot bo sach nlu
khoa Urn <r thai dai niiy
The1 ky thu 1.3 co T R A N V A N T R U N G vifet cu6 n TIELU NHI D A U CHAN
PH U O N G I I AN va cuon TlfeU NHI B EN H N G U Y E N PH U O N G L U A N Va
nhieu tac pham khac cua nhieu nha nhi khoa viet nhucuon T IE U NHI V E SINH
TO N G V I L U A N (vo danh) cuf>n H O AT A U TAm T H U cua T A N G THIB
V IN H . Cac sach deu chu trong mo la benh thong thuong tre em. nguyen nhan
benh. chan doan va dieintn Trong luc a phuong t ay mai den the kv thu 15 men
co nhung lac gia viet sach chuyen ve nhi khoa nhu Bhgcllaclus (nguoi Y . 1472)
Metlinger (1473 nguai Dire) Roelems <1483. ngui'n B i) va Thomas Phaer (nguoi
Anh, 1545). Tir ihe ky thur 14 den the ky thu 20, thanh tich cua nhi khoa dong y
ve mat phong benh la sir phai trien cua phuong phap phong benh dau mua, benh
uon van cua tre s<t sinh. Vac* the kv thir 15 K H A U B1NH trong sach TO AN AU
T A M GIAVlichi ro nhirng nguyen nhan gay benh tre em bao gom an uong that
thuong. tinh chi thay doi va cac nhan to ben ngoai nhu khi hau, chan thuong.
trung thu can. Den the ky thu 16, T IEN K H A l trong cu6 n B A O A N H N H IE P
Y E U (1556) de xuat phuang phap dot giay ron de phong benh uon van ron Ire w
sinh.
Nam 168k thay dau y nguoi Giang Tay. Truong Vi&m da chiing dau rong rai
trong nhan diin, co phat minh lan ve mien dich hoc va so sahh viVi sy phat minh
ve phuong phap chiing dau cua -nguoi Anh Jenner (1795) ihi y hpc phuong Dong
da di truoc han 1 the ky. Ngoai ra con nhi&u hoc gia nhi khoa khac nhu V A N
T O A n vai tac pham The Y D.tu Chan Tam Phap. gom 2 tap 28 chutmg noi we
benh dau mua kha diy dii, V lfO N G K H A N G D U O N G vidt cu6n A U K H O A
C H U N G T R I C H U A N T H A n G. H A D IN H v iii cudn AU K H O A T H lfiT
C A N H deu la nhung sach co gia tri ve nhi khoa.

10

DGn thd ky thu 17 va 18. co TRAN PHUC CHINH vitu cu6 n AU AU T A P

T H A N H (1750) va NGO K H IE M cung mot so tac gia viet cuon Y TONG KIM
G IA M co ph^n A U K H O A T A M PH A P Y&U QUYfeT hucmg din diy du vphuong phap chan doan va dieu tri tre cm hang dong y.
O

Viet Nam cac hoc gia dong y cung rat som chu y den nhi khoa. Tu dai

Tran (1310) vi danh y T R IN H T R A N G T U dung bua dung hot xuyen khung cho
tre em deo phong benh. The ky thu 14 co CHU V A N AN viet tap y an chua mot
so benh cap tinh tre em. Thien sudanh y T U E TINH viet tac pham NAM DUOC
T H A N H IE U gom 10 cuon co cuon 9 chuyen ve nhi khoa da mo ta day du cach
xem xet benh va huong dan nhung kinh nghiem dieu trj. Nam 1455. N G U Y E N
T R U C soan bp B A O AN H LU O N G PH UO NG ban ve nhi khoa co phan xoa bop
chua benh tre em.
Den the ky tliu 18 then Hau Le, L E HU U T R A C (bit hieu HAI TH U Q N G
L A N O N G ) da nhieu nam day cong nghien ciru nhirng sach kinh dien cua y hpc
co truyen Trung Quoc thira ke kinh nghiem chira benh dan gian Viet Nam, da
soan thanh bo sach H A I T H U Q N G Y TONG TAM L IN H g6 m 55 cu6 n trong do
co cuon A U A U T U T R I day ve cach xem va chua benh tre em va cuon M A
C H A N C H U A N T H A N G tap trung phan tich sau ve y ly benh soi, cach phong
benh va phuong phap dieu tri rat toan dien. Nam 1780. N G U Y E N G IA PH AN
soan bo L IE U DICH PH UO N G PH A P TO AN T A P noi ve cach tn va ph6 ng
benh dich, rat co g ii tri trong cong tac phong va chira benh tre em. Nam 1741,
T R IN H

D O N PH A C

viet curin HO AT NHAN TO A T Y U TA N G

BO.

N G U Y fiN THE; L K 'H vit cu6n T IE U NHI KH O A (1772) va nhiC>u tac pham
nhi khoa vo danh khac nhu HO AT AU TAM PH A P D A I TH AN H . N G U TOAN
T lfiU N H I KHO A. T IE U NHI DA Dfi V A N G O A I KHOA, T IE U NHI T A P
B E N H , T IE U N H I TONG LU A N . v.v... la nhung sach rat co gia tri tham khao
trong cong tac dieu iri benh tre em.
'Nhin qua su phat trien cua nhi khoa trong nen Y hoc co truyen phuong dong,
chung ta thay dupe cac hoc gia dong y da rat scrm chu y den nhi khoa. xay dung
nganh nhi tu lau thanh mot khoa doc lap, da viet nhieu tac pham ve nhi khoa co
nhieu gia tri ve ly luan va thuc tien. Do la nhung di san y hpc rat qui gia, chung
ta can hpc tp thira ke nghien ciru va phat huy nhung tinh hoa cua nen Y hpc co
truyen trong nganh nhi cua nuoc ta ngay cang co them nhieu kha nang phuc vu
sue khoe tre em chung ta them kien khang de xay dung dat nuoc ta them giau
manh.

LI

DAC DIEM SINH LY GIAI PHAU

VA BENH LY CHUNG
(chi nhac qua nhirng gi can chu y)
D A C D lfeM G IA I P H A U V A S IN H L Y
Tre em la mot ca the hat dau sinh ra, Ion len va khong ngimg phai men (khac
vai ngirdi lan la mot ca the on dinh. khong hoac it thay d6i). Y hoc co truyen
nhan thuc: Ca the tre em co dac diem la am duong deu non kem (tri am tri
duang), am thuong bat tuc. duong thuong hiru dir hoac ty thurmg bat tuc can
thuong hiru dir (de b| roi loan tieu hoa. sot cao de co giat) hoac thuan duong chi
the (chuyen hoa co ban cao) va co hien tuong bien chimg (luon luon Ion len va
trudng thanh)
Nhung dac diem giai phau sinh li cu the theo y hoc hi?n dai (soluw:):
1/. Ve he ho hap: khoang mui hep. niC'm mac nhieu mach mau, long mui chira
co hoac it... nen tre de bj cam va luc cam de bi kho thd, chay mau cam... Hfiu
hong hep, lai co nhieu mao mach, hach lam ba nen luc nhiem trung, niem mac
phu ne gay kho thd...

21. Ve he lieu hoa: Niem mac mieng mong, nuoc mieng it nen mieng kho de
mac benh nam. Sau 6 lhang, tuyen nuoc bot phat trien tiet djch tang va bit dau
moc rang de chay nuoc rai. Da day tre mm sanh vj tri cao va ngang. co tam V|
yeu ma co that mon vi phat trien manh nen de non tra. Tre dum 3 tuoi gan.co the
sir thay duoi ba sui'm phai khong phai benh ly. Tre em co true trang yeu nen d&
mac chimg sa true trang...

?>/. Ve he tuan hoan: Tim tre em to him nguoi Ion so vai trpng luong ca tbe,
hinh hen iron va rong chieu ngang, luoi mao mach rat phat trien. tieng um nghe
ro ngan va nhanh han Tre cang nho mach cang nhanh (ire so sinh 160-l-UVI
phut, duoi 1 tuoi 120 lan/1 phut, duoi 5 tuoi 1 (X)lan/phut, tre Uen 10 luoi gin nhu
nguoi lan. Huyet ap tre thap han nguoi Ion va vong tuSn hoan ngin hon. Cong
thuc tinh huyet ap tre tren 1 tuoi:
H A M = (80 + 2 x

so

tuoi) mmHg.HA= 2/3 H A

H A = Huyet ap tam thu. Ha, = Huyet ap tam tnromg.)

4/. Ve he tiet meu: Than tre to han ngudi lan so vai trong luong co the* v i
thap han ve vi tri (tre dudi 2 tuoi). Long be thin va nieu quan rpng. Nieu dan tre

12

nu ngan. gan h^u mon nen 6k nhtcm khuan ucl niu. Tre cang nho so lan lieu
cang nhieu va giam dan so voi tuoi do hong dai lo ra. So luong nuoc tieu tang
dan theo voi tuoi, co the tinh theo cong thuc:
So luong nuoc tieu trong 24 gio = 600 + lOOx (so tuoi - 1) ml.
5/. Ve h than kinh: Da tre so sinh da co xuc giac, cam giac dau va nong,
lanh. nhay cam voi cam giac lanh nhimg phan xa kem voi cam giac dau nen can
chu y tranh nong vi de gay bong. Tre so sinh da co phan ung voi mui thoi, mat
da co phan ung voi anh sang nhung tai nghe con kem.

6/. H ? xuong: Xuong cua tre em mem, phat trien chua hoan chinh nen can
chu y den tu the nam ngoi cua tre. nam mpt ben hoac nam ngua lau deu co the
gay bep dau. tap ngoi qua som se gay veo lung, nhung gay xuong de lanh. Tre
thuong moc rang tu thang thu 6 ho?c thu 8 , so rang co the tinh theo cong thuc:
So rang = So thang - 4.
7/. He co: Co bap cua tre co nhieu nuoc, it dam mo va muoi khoang nen tre
tieu chay de gay mat nuoc. Trong may thang dau co hien tupng tang truong luc
cosinh ly.

8/. He da: Da tre mem mai co nhieu mao mach. Tuyen mo o da phat trien tot
tre 3-4 thang da co tuyen mo hoi nhung chua hoat dpng nen kha nang dieu hoa
nhiet kem. (7 tie da co chuv nung ho hap manh. ngoai ra da con co nhieu chirc
nang khac nhu chuyen hoa nuoc. cau tao men, san sinh vitamin D. chat mien
dich...

9/. Su tang truong cua tre: C a the cua tre tang nhanh trong nam dau khi ra
dm. eham lai o nam thu hai va lai tang nhanh d tuoi day th'i. chu yeu ve can nang
va chieu cao.
(1) Can nang: Binh quan cua ire moi sanh du lhang la 2.9 - 3,0kg (can
nang duoi 2,5kg coi nhu tre de non hoac suy dinh duong bao thai). Tre 6 thang
can nang gap doi luc sanh va 1 tuoi can nang gap 3 luc sanh, tre len 2 tuoi can
nang co the tang gap 4 lan luc sanh. Can nang cua tre sau 2 tuoi co the tinh theo
cong thuc:
Can nang (K g) = 9 + 1,5 (so tuoi - 1).
(2) Chieu cao: Chieu cao cua tre luc sanh trung binh 48 - 50cm va len 1
tuoi chieu cao tang gap ruoi luc sanh (trong 12 thang tang 23 - 25cm). Co the
tinh chieu cao trcn I tucVi theo cong (hue: Chieu cao (cm ) = 75 + 5 (so tuoi - 1)

13

(3) Vong dau Luc sanh trung binh 30 - 32cm. tre 12 thing khoang 5052cm
(4) Vong ngirc: Luc sanh nho hon vong dau khoang 1cm. 6 thang vong
nyirc hang vong dau va viatt len vong dau irong nhung thang sau.
(5) Ty le can d6 i cua co the: Nhin chung d tre dau turmg doi to. chan
tirtrng doi ngan so vdi toan than.
- ChiOu cao diiu / chic'u cao loan than: Tre so sinh: 1/4. tre 2 tuoi: 1/5.
tre 6 tuoi: 1/6. tre 12 tuoi: 1/7. Nguoi lem: 1/8.
- Chi6u dai tay va chan tre so sinh bang 1/3 chieu cao. cang Ion ty le
tang d5n. luc trinrng thanh chieu din ta> bang 45% chieu cao va chieu dai chan
bang 50% chieu cao.

10/. Su phat trien ve van dong, ngon ngu va tri tue cua tre em:
a. Ve van dong: Tre len 2 thang biet ngang dau, 4 thang cuoi ra ueng. 7
thang biet bo. ngoi. 9 -12 thang co the biet dung va di chap chung
b. Ve ngon ngu va tri tue: Tre 2 thang KTet theo nguoi !dn. khoc cudi ro
bat dau phat am, 3 thang nhan ra me. 5 thang biet quen la, 7 thang noi dupe ba,
ba, 10 - I I thang biet noi Ueng kep va lam theo ngudi Ion, 2 tuoi da noi dupe cau
dai 3 - 4 tir. Noi chung su phat trien van dong tri tue va ngon ngu tuy thuoc vao
su hoan thien va phat trien cua nao, sin. khoe va su toan vcn cua cac giac quan
cung vdi su giao due cua gia dinh xa hoi moi trudng song cua tre
D A C D IE M B E N H L Y :
A. Dac diem chong:
; TrA ha m-.c benh ngoai cam (benh nhiem) va benh ve ty vi. Do tre men ra
den, su thich nghi voi moi truong. sue de khang cua co the con yeu kem nen de
mac benh ngoai cam (do luc dam: Phong han thu thap tac hoa gay nen). Tre rat
de mac benh duong ho hap vi phe chu bi mao, dieu hoa am lanh. tang phe con
non yeu, chuc nang bao ve bi mao kem thi la khi de xam nhap ma gay benh. Mat
khac, d tre em ty (hau thien chi ban) thuong la bat tuc (men tieu hoa chua phat
trien) nen de mac benh ve ly vi (roi loan tieu chay do thuong thuc, ty hu). Luc
mac benh ngoai cam de gay sot cao co giat (do chuc nang dieu hoa nhiet kem. he
than kinh chua phat trien) dong y cho la do co the am duong deu yeu kem ttri am
tri duong).

14

2. Benh chuyen bien nhanh: Cung do sue chiing do cua co the veu. ta khi de
xam nhap vao ly, benh nhe cung co the chuyen bien nguy kich neu khong chira
kjp thoi.
3. Benh de hoi phuc: Dc tre em la mot co the dang phat trien va benh cap
tinh nhieu, it phuc tap nen neu chua tri kip thoi thi benh chong hoi phuc. Cho
nen doi voi tre em cong tac phong benh la cuc ky quan trong va khi mac benh
phai chira kip thoi.
B.

Dac diem benh ly theo timg lua tuoi: Doi voi tre em d moi then ky Ion

len do dSc diem sinh ly co khac nen tinh hinh benh ly co khac, nen ngudi thay
thuoc nhi khoa can nam de bao ve sue khoe cho tre duoc tot. Sir phat trien cua
tre em tir luc thu thai cho den tuoi truong thanh co the chia lam 6 thoi ky do dac
*

'

diem sinh ly ma benh tat mac phai co khac.

1. Thai ky bao thai: Tir khi trung thu thai den khi tre ra doi, trung binh
270 - 280 ngay. Sir phat trien cua thai nhi phu thupc hoan toan vao nguoi me.
Benh ly chu yeu la do sir roi loan ve hinh thai thai nhi (dj tat bam sinh) (3 thang
dau cua bao thai) va su phat trien cua thai nhi (suy dinh duong, say thai, chet
luu...)
Nhirng yeu to phia nguoi me lam anh hudng thai nhi:Tuoi tac, so lan de
khoang cach giira cac lan de, tinh trang dinh duong, dieu kien lao dong, tinh
than, benh tat. Vi du: Luc co thai 3 thang dau neu nguoi me mac benh do virut
de gay dj dang cho tre. trong 6 thang sau neu mac benh nhieu. tinh than cang
thang, an uong thieu kem, lao dong nang nhoc deu co the gay de non. suy dinh
duong bao thai, say thai. de non...

2. Thai ky sasin h: Thcri gian 1 thang sau khi sanh tre co nhung dac diem
sinh ly nhu bat dau thd bang phoi, he tuan hoan, he tieu hoa bat dau lam viec, tre
bu me nhung co the rat non yeu, he than kinh b| ire che tre ngu suot ngay, bong
da, sut can, vang da sinh ly...
Benh thuong gap: Nhiem trimg da, nhiem trung ron, de gay nhiem khuan
toan than nang. benh d| dang tien thien, benh do chan thuong san khoa nhu xut
huyet nao, liet...

3. Thai ky bu me: La thoi ky trong mot nam cua tre (tu I thang den 12
thang): Tre phat trien nhanh nhung co thi'; con non yeu, de mac benh nhifim
khuan, b?nh roi loan tieu hoa, suy dinh duong. Can het sue chj'i y phong benh
nhiem va benh ve dinh duong.

15

4. Thin kv ring s/hi. Tir I den 7 luoi thuong chia ra luoi vurm ire v i luoi
mau giao (4 - 6 tuoi) Do tiep xuc nhieu tre de mac benh lay ( I - 3 luoi) nhu s*n
ho ga. thuy dau. viem duong ho hap. benh d| ung nhu hen. me da>. benh suy
dinh duong, roi loan tieu hoa. Chu y giao due eho tre dao due va tap quan ve
sinh tot de phong benh.
5. Thai kv ihidu nicn: Tuoi tir 7 den 15 la then ky rang vlnh vien thay dan
rang sua. Tre de mac benh nhiem triing can chu y bnh thap tim, benh thieu mau.
benh dj dang do tu the (gii lung, veo cQt song...).

6. Thai ky day thi: Tiiy theo giai va moi truong song. Tre gai bat dau tir
13 -14 tuoi den 18 tuoi. Tre nam tir 15 - 16 tuoi den luoi 19-20. Then ky nay co
the tre Ion nhanh, bien doi nhieu ve tam sinh ly. Hoat dong noi tieu sinh due
chiem uu the. Tre it mac benh nhiem. neu mac benh lao de bi nang, de mac benh
roi loan ve tam than, tim mach. bat dau phat hien benh ve sinh dye.

DAC DIEM CHAN DOAN NHI KHOA DONG Y

Pham vi bai nay chu yeu giai thieu ve tir chan va bat cuong trong nhi khoa.
T U C H A N T R O N G N H I K H O A : Trong nhi khoa cung nhu noi khoa. bon
phep vong, van, van. thiet deu can thiet de thu thap tu lieu benh ly da\ du chu
chan doan duoc chinh kuc nhung tu> tinh hinh benh ly va tuoi tac cua tre ma
ngutn thay thuoc can chu y den mat nao nhieu hem. Nhi khoa duorc goi la a khoa
la doi voi nhirng tre durn 3 tuoi. con tre tren 3 tuoi phat trien binh thuong deu co
the tu ke benh cua minh duoc nhung can co thai do diu hien va dong tac nhe
nhang cua ngudi thay thuoc khong lam cho benh nhi so de co su hop tac lot
trong khi hoi va kham benh.
I.

Vong chan: Chu yeu nhin hinh thai (co dong thai), than sac, mieu khieu va

chi van.

1) Hinh thai: thin sic:

-

Co the tre beo tot. phat trien can doi, tinh than lanh loi, sac da hong hao

tuoi nhu|n. toe day den: Tre khoa manh.

16

- C(T

the gay com, hung to dit tco, tinh than u i u . sac da xanh nhat xam vang.

toe thira dimg nguoc: Tre yeu om coi xircrng, chimg cam tich..
- Di dang bam sinh thuong gap: Khuyet moi. khuyet vom khau cai. him tay
sau ngon ...Dan don ngd ngan do than kinh nao phat due cham. chimg Dao. chan
thuong san khoa. di chung cac benh nao (thuong kem liet chi)... (Cac mat khac
nhu nguoi Ion)

2) M ieu khicu (gom tai. mat. mui. mom. tien am. hau am):
( 1) Tai: Tai chay mu vang thoi la trieu chung nhiet doc (viem tai giua) tre sot
cao ma chop tai lanh chu y len sdi.
(2) Mat: Mat do la can nhiet. mat vang la trieu chung thap nhiet (viem gan
tac ong dan mat...) benh nhi sot kem mat do chay nuoc mat so anh sang chu y
benh sdi. mat do co ri vang chu y viem mang tiep hap... Long trang mat co
nhung cham xanh. chu y tre co giun lai ... Mi mat phu la phu thung.
(3) Mui: M ui ngat chay nuoc trong la cam phong han. chay nuoc vang la
phong nhiet. thuong xuyen chay nuoc mui trong la viem mui di ung, chay nude
vang la viem mui man. Dot ngot phat hien tre chay nuoc mui thoi, chu y di tat
trong mui, chay nuoc mui thoi keo dai chu y chung viem mui thoi (Ozena)...
Canh mui nhap phong kem quanh moi tim tai la tre thieu Oxv. tuy muc do nang
nhe khac nhau co the la phe khi nghich (truong hop hen suyen) hoac phe khi hir.
phe khi tuyet (truong hop viem phoi nang).
(4) Mom: (bao gom moi. rang lai. mien mac mom. hong, luoi):
- Moi: Hong tuoi nhuan la hinh thuong. Moi do tuin la chung nhiet. moi kho
la am hu tan dich ton thuong. moi nhai nhat la chimg han. huyC't hu. moi lia tim
bain chu v huyet u. quanh moi tim tai la tre thieti Oxy.. Sul moi la d) dang lien
thien, moi day len chu y phu hay do d| img.
- Rang loi: So rang mix' theo dung tuoi la co the tre khoe manh. neu cham
mix' rang chu v chung coi \uimg. Rang kho, loi sung do la vi nhiet. ke rang liri
chay niau la vi hoa hoc. sac lai tai nhat la chung huyet hu ...
- Niem mac mom: Co dam Id loet co mang trang chu y benh tira. viem mom
do vi nhiet dong y goi la nga khau sang. Truong hirp benh noi sol ma d niem
mac mom co cham do vien trang chu y benh nhi len sdi ...
- Hau hong: Hong do. hanh nhan do dau sung la nhu nga (viem Amidan) Yet
hau dau. sot cao. giong khan hong amidai|TfrmJihg' trang chu y benh h?ich hau

17

- Lirm Xem lirm (thiol chan) La phan quan trong trong vong chan Sac luoi
hinh thuong cua tre mau hong nhat tinn nhuan. neu chat lirm mau hong nhol lai
la huytl hu. mau ti'a tim la khi huyet ir tre. chat lum do lham la on la nhap phan
dinh huyOl. Ilrti do kho khong co reu la am hu kho tan dich. mat luoi co gai do la
nhiC1 ihinh. Reu lum iring la han. vang la nhiet. Reu luoi vang da> la thap nhiel
hoac nhu ihuc tich. reu luoi troc nhu hinh dia do la hieu hien tv hir

Reu luoi

day nhdt la dam lhap.

- Tien am. hau am: Tien am chi bo phan sinh d^ic va nieu dao. hau am la hau
mon Tre nam dai khong co khong se la khde manh Dai se ihinmg la khi kem
dai sung to day la am nang tich thuy. dai sung to cung. dung lay an nho lai hoac
mil di la chiing san khi (ihoat vj hen). Tre nu tien am (am dao) do va xuat tiel
nhieu la chung thap nhiet (viem am dao) neu ngira chu y co giun kim hay tniing
roi. ire nu lieu nhieu lan. lo dai do. dai buol chu y thap nhiet duong nieu (viem
duung tiet nieu). Viing quanh tien am hoac hau am da do lay la lhap nhiet (viem
da do la lot). Luc dai lien, ire ran sa true trang (loi dotn) thuong do khi hu ...

Xem thop (doi vai tri' duiri 18 thang):

Tre em cham nhat den I nam ruoi la thop trudc phai kin neu thop con hd la
than khi kem (thuong la trieu chung coi xuong). Tre em sol ma thop phinh cang
la nhiet thinh. nguoc lai neu thop lom la trieu chung am hu. tan dich hao ion.

4)

Chi van: Xem chi van la xem tmh mach nho nong cua ngon iro phia ngon

cai Xem chi van chi dung doi voi ire duoi 3 tuoi. Xem chi van chu yeu la xem 3
mat: Phu train, dai ngan va mau sac.
- Chi van phu (nguoi lhay thuoc linn nhe ngon cai len chi van co the lam
mat) la trieu chung benh nhe. ta khi d phan hieu. Chi van tram (ngudi thay thuoc
luoi manh ngon cai mdi mat chi van) la benh ben irong. ta khi da vao phan ly.
- Chi van dai ngan: Chi van chi hien len den doi I cua ngon trd (luc den
phong quan) la benh nhe. neu hien len dot thu hai ngon iro (tuc den khi quan) la
benh tram trong han. con neu chi van xuyen len den mong lay (tuc xuyen giapi
la bieu hien benh nguy kich can cap cuu kip then.
- Mau sac chi van: Chi van d ire khde co mau hong luoi. neu do tham la
nhiet thinh. mau hong nhai la hu han. mau xanh la ineu chimg phong. mau lia
lham hoac bam tim la hien tuong khi huyet ir ire. Tinh chal benh ly cua chi van
phan anh unh hinh mau luan hoan ngoai vi song co nhieu yeu to anh hudng din
su tha> doi cua chi van nhu (hdi tiel. mau da. hinh dang von co cua tinh mach
nen kel qua xem chi van cung la lu lieu tham khao

18

II. Van chan: Gom nghe va ngiri.

1) Nghe tieng khde va giQng noi: Khoc tieng to. giong noi to la chung
thuc, co the khde, khoc nho, noi nho la chiing hir co the yeu.
- Khoc thet timg con chu y dau hung giun, giun chui ong mat. tre nho can
canh giac long rupt (tre khong chju bu, non sira).
- Khoc hay lac dau co sot la co dau dau. Khoc ma khong co nuoc mat la tan
djch hao ton, chiing am hu. Sot cao hon me noi sang la nhiet nhap tam bao.
- Tre mac benh giong noi khan, chan tay mat la ngoai cam phong han,
truong hop benh nang lau ngay ma giong noi nhu tieng vjt keu trong hong la phe
khi sap tuyet.

2) Nghe tieng thd va ho: Thd kho ma suyen la phe khi uat, thd kem tieng
kho khe d hong la dam tr. chiing hao. thd yeu la phe khi hu, thd tho la phe khi
thuc.
- Ho timg tieng kem so mui nuoc trong la ngoai cam phong han. Ho tieng to
co luc la phe thuc, ho tieng nho yeu la phe hu, ho khan la phe tao. ho timg con
do mat tia tai la ho ga.

3) Ngui mui vi: Mom tre co mui hoi la vi nhiet. co miii chua la thuc tich.
an khong tieu. Phan thoi kham la dai trang tich nhiet. phan long nhieu chat
khong tieu. khong miii lanh hoi la ty hu han. Nude tieu vang khai la bang quang
thap nhiet. nude tieu trong khong mui la huhan.
III. Van chan: Doi vdi tre thuong hoi benh qua ngudi trong gia dinh tre. tre
Urn co the hoi true tiep.
Noi dung hoi ve tinh hinh benh ly. tinh hinh an ngu tieu tieu. nong. lanh mo
hoi cung nhu ngudi Ion. Ngoai ra tuy tinh hinh benh ly ma chu y hoi them ve
tinh hinh phat trien co the cua tre. che do nuoi day tre. dieu kien sinh hoat. tinh
hinh thai nghen va sanh de cua me (doi vdi bcMih co dj dang bam sinh I tinh hinh
tiem chung. tiep xuc vdi benh tat (doi vdi benh lay).
IV . Thiet chan: Gom xem mach va so nan cac phan co the cua tre.

19

BIEN CHUNG NHI KHOA

Bien chimg cua y hpc co truyen la phuong phap quy nap cac trieu chung thu
nhap Iren lam sang thanh nhung the benh hoac nhirng hoi chimg benh ly Trong
nhi khoa thui'mg quy nap benh theo bat cutmg, theo tang phu, theo ve khi' dinh
huyet (neu la benh truyen nhiem, sot do ngoai cam).
I. B IE N C H U N G T H E O B A T C U O N G :
La cach quy nap cac trieu chiing thanh 8 loai: Am duong, Han nhiet, Bieu ly,
Hu thuc. No noi len vj tri. tinh chat cua benh va trang thai khde. yeu cua co the
benh nhi, tren co so do chon phuong phap dieu trj thich hop. Sau day gidi thieu
dac diem benh ly cua timg loai:
1. Bieu, ly:
Noi len giai doan benh va tinh hinh benh nang nh$.
- Chiing d bieu: Thuong la thoi ky dau cua b$nh ngoai cam, bnh nhe,
thuong co nhung bieu hien nhu sot, so lanh, ra mo hoi (ho$c khong), dau dSu, so
mui. lac nui, reu luoi trang mdng, mach phu.
- Chimg d ly: Thuong la benh da xam nhap vao tang phu, la giai doan loan
phat cua benh nhiem trung. I rieu chiing chu yeu la sot cao tre quay khde. but
rut. khat nude. Nang thi me man. hon me, co giat, dai tien tao. tieu tien vang. reu
luoi vang day, mach sac ...
2. Han, nhiet:
La hai loai tinh chat benh ly doi lap nhau (cung la hai loai phan ling khac han
nhau cua co the khi co benh).
Xac dinh tinh chat benh ly nay de dung thuoc mat hay thuoc nong luc dieu
tri.
- Chimg han: Co bieu hien la so lanh, khong sot hoac sot khong cao. chan
tay mat lanh, khong khat nude hoac thich nude nong. Nude tieu irong nhieu.
phan long. Chat luoi nhpt. reu trang, mach cham. Chung han thuong gap trong
truong hop cam lanh mac benh lau ngay co the suy nhupc...
- Chimg nhiet: Gap nhieu d tre em co bieu hien chu yeu la: Sot, mat do, khat
nude, tieu ti?n vang, dai tien tao, chat ludi do. reu luoi vang, mach sac. Thuong
gap luc bnh nhi cam phai nhiet ta. thoi ky toan phat phat benh cua benh lay.

3. H it, thuc:
Chung hu la chi err the hu nhirtTc. phan ung vm nguyen nhan benh yeu. chung
thuc la chi ta khi thuc (sue tan cong cua nguyen nhan henh manh). ca the benh
nhi khoe va phan ung cua ca the doi van nguyen nhan benh manh Phan biet cac
chimg hu thuc dua vao cac mat sau:

a) Thai gian mac benh Benh men phat thuong la chimg ihuc. benh lau
ngay thuong la chimg hu

b) C a the benh nhi khoe. yeu Co the benh nhi khoe. phat due diy du mic
benh thuong bieu hien chung thuc Nguoc lai co the hu yeu, bam thu tien thien
bat tuc luc mac benh thuong bieu hien chimg h u ...

c) K ei hop c.ic incu chimg lam sang: V i du: Mach co luc. tieng khoc to,
chan tay cu dong khoe la chimg thuc; mach vo luc. tieng khoc, noi nho ho|c
khoc khong ra tieng >.han tay cu dong yeu la chimg hu..
Phan biet hu thuc de luc chua benh dung thuoc b6i bo chinh khi la chinh
hoac dung thuoc cong ta la chinh.
4. Am, duong:
Tat ca cac chiing benh dfeu bao gom trong 2 hpi chung Ion la am va duong:
cho nen trong bat cuong. am va duong la 2 cuong long quat. Chung 6 btfeu,
chiing thuc \a chung nhiet thuoc duong Chimg a ly, chung hu va chung ban
thuoc am.
Tren lam sang cac bieu hien benh ly co khi kha phuc tap. cac chimg irai
nguoc nhau co khi cung ton tai tren mot benh nhi trong cung mot thoi gian. cho
nen van dung hat cuong trong bien chung cung phai rat linh hoat. Nhu trong
chiing a bieu van co bieu hu. bieu thiic. bieu han. bieu nhiet. Co khi bieu han ly
nhiet. co khi trong hu co thuc. trong thuc co hu. V i vay, can qui nap tot cac tnu
chiing de chan doan duoc chinh xac va dieu tri co ket qua.
II. B IE N C H U N G T H E O T A N G P H U :
Hpc thuyet tang phu phan chia su hoat dong sinh ly cua co the thanh nhirng
don vi chirc nang theo 5 tang (tam, can, ly, phS, than) va 6 phu (dom. vi. tifcu
trang. dai trang bang quang va lam tieu). M di khi chuc nSng sinh ly cua mot tang
hay phu bi roi loan tren lam sang thuong co nhiu trieu chung rieng Net. va
ngudi thay thuoc dua vao do de chin doan. Quy n?p theo tang phu thuong dung
doi voi cac benh noi tang (benh n $ thuong). Sau d ly chi gidi thiu tom til mpt
so hoi chung benh Iv cua cac t*uig va phuong phap difeu t r i.

22

1. Hoi chung benh ly cua tam:

Chuc nang sinh ly chu yeu cua lam la: l am chu huyet mach. chu than khi.
khai khieu d luoi, do do benh ly cua tam co lien quan den su roi loan cua he
thong tuan hoan va than kinh (bao gom than kinh trung uong va than kinh thuc
vat). Nhung hoi chung cua tam gom:

a)

Tam khi hu: Tim dap hoi hop, kho tho (luc hoat dong tang them), ra

mo hoi (tu han), luoi nhat, mach te vo luc, kem theo sac mat nhat. met moi hay
thd dai. Phep chira la bo tam an than, bai thuoc thuong dung la Bo tarn dan.

h) Tam duimg suy: Nhirng trieu chimg tren nang han: Neu Tam duong hu
thoat benh nhi sac mat tai nhat, loan than va mo hoi, chan tay lanh, thd yeu.
quanh moi tim tai, mach vi kho bat (nhu trieu chung suy tim cap, truy tim mach).
Phep chua la hoi duong cuu nghich cap ciru dung bai Nhan sam tir nghich thang
cho uong ket hap tiem thuoc tra tim mach, chong choang nang huyet ap.

c ) Tam hoa vuong: Tre quay khoc but rut. loet mom luoi, tieu tien vang it,
dau luoi do, reu vang, mach sac (trudng hop viem luoi viem loet mom). Phep
chira la thanh tam hoa. dung bai Thanh tam hoan (khoa nhi) hoac Hoang lien giai
doc thang. Neu co loet boi Nga khau tan (khoa nhi) tai cho.

d) Dam hoa nhieu tam: Co trieu chung tinh khi that thudng, cudi noi vo
nghTa, khoc la hoac chui. danh ngudi. mat tri. luoi do, reu day nhat vang. mach
hoat sac. Phep chua la thanh tam. hoa dam dung bai On dam thang gia vi.

e) Nhiet nhap tam bao: Tre em mac benh nhiem trimg, sot cao. me man
noi sang hon me co giat, lucri cung, chat luoi do, reu ludi vang, mach hoat sac
hoac te sac. Phep chua la thanh nhiet giai doc khai khieu dung vai cac loai iliuoc
Yen cung ngiru hoang hoan, Tu tuyet don hoac Mai sung trau (simg te giuc nei
co), uong vai nude sac Thach xuong bo tuoi. Ket hap cham Nhan trung. Hap
coc, chich Thap tuyen...

2. Hoi chung benh ly cua can:

Chuc nang sinh ly chu yeu cua can la: Can tang huyet, chu so tiet (co vai tro
chi huy, dieu tiet chuc nang cac tang phu trong ca the), khai khieu ra d mat. Do
do benh ly cua can co lien quan den su roi loan cua he thong than kinh, he tieu
hoa va mQt so chuc nang cua h? tim mach. Nhung hoi chimg bnh ly ciia Can
thuong gap d tre em la:

a)

Can hoa vuqng: Sac mat do, mat do, co khi chay mau mui. u lai hoa

mat, dau dau, co khi run giat, mom dang, d?i tien tao, tieu tien vang. ria ludi do.

23

reu vang, mach huyen sac (trirung hup \iem lhan co huyet ap cao) Phep chua la
hinh can giung hoa dung hai Long dam la can lhang gia giam

b) Can am bai luc: bieu hien dau dau chong mat hoa mai, mat mo. long
han chan lay nong hoac cam thay te dai (nhu trong henh thieu sinh to A. benh
teo thi than kinh) mach te sac, 1utri thon chat do. Phep chua la tu duong can am.
thirung diing hai Ky cut dia hoang lhang gia vj.

c) Can phong noi dong: Trong cac henh nhiem trung. ire sot cao co giai
(do nhiet circ sinh phong) hoac di chung cua henh nao (do am hu phong dong)
Tuy tinh hinh cu the dung phep thanh nhiet hinh can tire phong, hai Thanh on hai
doc am sac uong ket hop cham Khuc tri. Hop coc, Thai sung hoac phep lu am
tuc phong. hai Tire phong hoan ket hop cham Tam am giao. Am lang luyen

d) Can d('rm thap nhiet: An kem. bung day, sircm dau, da mai vang. nuoc
lieu vang, reu lum vang nhat, mach sac co lire (truong hop viem gan cap linh)
Phep chira la thanh loi thap nhiel d can dam thuong dung hai Nhan Iran chi lu
thang.
3. Hoi chung benh ly cua ty:
Churc nang sinh ly chu yeu cua ty la: Ty thong huyet, chu van hoa (bao gom
chuyen hoa ihuc an, hap thu chat dinh duong va liru thong dich the uong coihe).
ty chii ca nhuc. Nhir vay. chuc nang cua ty co cjuan he den mau. he tieu hoa va
he ca van dong. Nhirng hoi chimg benh ly chu yeu cua ty la:

a) Ty dinrng hu: Tre ca the suy nhuae, gay met moi. sac mat vang. an
kem. tieu king hoac phan Ion nhon khong tieu (tre suy dinh during, tieu chay keo
dai...). Phep chua la kien ty hoa vi dung Com bo ty (khoa nhi).
- Neu ty hu tich tre: Ngoai trieu chimg tren kem bung day. phan thoi kham
Phep chira lii kien ty tieu tich. thirong dung bai Tieu cam ly ty tan
- Neu ty hu thap tre: (ty hu thuy thung) Ngoai nhirng trieu chime tren kem
piii toan than, dai it. reu lum day nhat (truxmg hap phu suy dinh durmg. phu than
hir nhiem ma...). Phep chua la kien ty lai thap, thuong dung bai Huong sa luc
quan hap Tir linh tan hoac Ngu bi am

b) Ty khong thong huyet: Sac mat tai nhat, xuat huyet durn da. chai luoi
nhat, ia co mau (trudng hcrp xuat huyet do giam tieu cau). Phep chua la bo ty
nhiep huyet. thirong dung la bai Quy ty lhang gia giam.

24

c)

Ty khi ha ham (trung khi ha ham): Tieu chay hoac ly. kco dai bien

chung loi dom, Ire em mac benh ihoat vi ben hoac sa da day.. Phep chira la ich
khi thang duong, thuong dung hai Bo trung ich khi thang gia giam.
4. Hoi chung benh ly cua phe:
Chuc nang sinh ly chu yeu cua phe la: Phe chu khi. phe chu bi mao. phe
trieu bach mach, khai khieu d mui. Nhu vay, chik nang cua phe cung la chuc
nang cua he ho hap va co tac dung dieu tiet the dich va tuan hoan trong ca the.
Nhung hoi chung benh ly chinh cua phe co:

a) Phe khi'hir: Tieng ho yeu, hai thd ngan gap, ddm loang ngudi met moi.
an it, sac mat trang bech, hay do mo hoi (tu han). Gap d truong hap viem phe
quan man, ... Phep chua la bd phe ich khi, thuong dung bai Sam linh bach truat
tan gia giam.

b) Phe am h ir Ho khan khong co ddm hoac it ddm, co luc ddm co mau,

co luc sot nhe ve dem, ra mo hoi trom, long ban chan tay nong, ma do, mach te
sac, chat ludi do, than ludi thon. Thudng gap trong bnh lao phoi. Phep chua la
tu am nhuan phe, thudng dung bai Thanh tao cuu phe thang gia giam.

c ) Phe nhiet: Ho, kho thd, ddm vang dac kem theo sot cao hoac nhe, co
khi ho co mau, nguc tuc dau, chat luoi do, reu vang, mach sac co luc Phep chira
la thanh phe, chi khai. binh suyen, thudng dung hai Ma hanh thach cam thang
hoac Ta bach tan, Sa sam mach dong thang gia giam. Ngoai ra, con co nhirng hoi
chung han dam uat phe. dam nhiet be phe deu la nhirng hoi chimg benh ly cua
phe.
5. Hoi chung benh ly cua than:
Chuc nang sinh ly chu yeu cua than la: Than tang tinh, than chu cot, chu
thuy, khai khieu d tai. Nhu vay, chuc nang cua than la chuc nang cua he tiet
nieu, sinh due va co lien quan den noi tiet, xuong. Nhirng hoi chung benh ly cua
than d tre em thudng gan lien vdi cac tang khac nhu phe, ty, can, tam. Nhung hoi
chung thudng gap co:

a)

Phe thpn luong hu (phe than am hu): Ho lau ngay ddm it, ca the suy

mon co luc ho ra mau, lung goi moi, sot nhe buoi chieu, dem ra mo hoi trom.
ma do m$t bung nong, ludi do reu it, mach te sac hoac t6 nhuoc. Thudng gap d
benh hen lau ngay, lao phoi va benh gian phe quan d thcri ky cudi. Phep chua la
tu bo phe th^n, thudng dung bai Mach vi dia hoang thang gia giam.

h) T\ than dinmp hu: Nguoi met moi. ii noi hoi ihd ngan. chan lay lanh.
sa lanh. lieu long phan khong tieu keo din. an kem hoac phu loan than, hung day
trim dich. Chat luoi nhoi. mach te nhuoc tram tri vo luc. Thmrng gap d ire lieu
chay keo dai hoac henh viem cau than man. than hu nhiem mo. Phep chua la on
ho ty than, neu phu dung Chan vu thang. neu lieu long keo dai dung Ly trung
thang hop Tir than hoan gia giam

c) Can lhan am hu: Bieu hien chu yeu la dau dau hoa mat. u tai. dau sudn.
kho co. lung goi moi dau. ra mo hoi trom. long ban chan lay nong. ludi do. mach
te sac. Thuong gap

it

tre em mac benh sol cao keo dai, sau do co the suy nhuoc

thieu mau. hoac tre mac henh huyet ap cao, viem da khdp dang lhap v.v.. Phep
chira la tu bo can than, thudng dung hai Ky cuc dia hoang hoan gia giam.

d) Than duimg hu: tinh than met moi, it hoat dong, chan lay mat lanh.
lung goi dau moi, hay dai dem hoac dai dam, chat luoi nhpt. mach tram tri vo
luc. Thudng gap trong bnh dai dam d ire em ho^c hen lau ngay. co the suy
nhuoc. Phep chira la on bo lhan duong. thudng dung bai Bai vi hoan.
ej Than dm hu: Dau lung, dau dau, hoa mai, u lai hoac lh| luc giam, mat
ngu, long ban chan lay nong, mo hoi trom, ludi do, mach te sac. Thudng gap d
thoi ky phuc hoi trong cac benh sot keo dai d tre em. Phep chua la tu bd than am.
thudng dung hui luc \i d|a hoang hoan gia giam.
Tren day la nhirng hoi chimg henh ly chinh cua tang thmrng gap irong cac
henh noi tang d tre em Ngoai ra con co cac hoi chimg henh ly ket ht/p giua cac
tang trong bien chimg nhi khoa nhu : Tam phe khi hu, lam ty luong hu. tam lhan
hat giao. can \i hat hoa. phe ty luong hu. can hoa pham phe v.v... va cac hoi
chimg henh ly cua cac phu nhu: Vi nhiet. dai trimg thap nhiet. dai trang lao ket.
bang quang thap nhiet cung can phai nam trong luc bien chimg
III. B IE N CHLTS'G S 6 T C A P T IN H CT T R E E M
Benh sot cap tinh tre em (phan Ion la benh lay) thudng do ngoai cam va deu
dien bien theo mot qui luat nhat dinh (thudng qua ba thdi ky: Bai diu. loan phai
va lui benh) cho nen co the van dung bat cuong, ket hop vdi cach qui nap theo
ve khi dmh huyet cua benh on. Nhirng hoi chung b$nh ly trong qua trinh phai
trien cua benh phan chia nhu sau:
a) Chung d bieu: (then ky bai dau cua bnh sdi, b$nh d phan ve) Do linh
chat cua ta khi va phan ung cua co the, co the chia ba ihS khac nhau:

( 1) Chung bieu han: Sol nhe gai ret, dau minh, dau, khong khat. mui tac
hat hori, so mui, nuoc mui trong, reu ludi trang mong, mach phu. Phep chua la
tan on giai bieu thirong dung bai Thong x| thang hoac Tieu thanh long gia giam
(2) Chung bieu nhiet: Sot cao co mo hoi, khong so ret, khat nuoc, ho, dau
dau, reu luoi vang mong. mach phu sac. Phep chira la tan lirong giai bieu, thuong
dung bai Ngan kieu tan hoac Tang cuc am gia giam.
(3) Chung bieu thap Dau minh nang, dau, met moi, hoac co sot so lanh.
non hoac buon non, ia long, chan an, khong khat, reu ludi trang day nhdt, mach
hoat hoac nhu te. Phep chira la giai bieu hoa thap thirong dung bai Hoac huong
chinh khi tan gia giam.
b) Chung ban bieu ban ly: Han nhiet vang lai sot giao dong, mat hoa, mom
dang, hong kho, buon non, sudn dau, reu luoi trang vang, mach huyen sac
(chimg thieu duong gap d mot so tre em viem gan do virus, sot ret). Phep chira la
hoa giai thudng dung bai Tieu sai ho thang gia giam.
c) Chung v ly: (Ta khi da vao phan khi, phin dinh va huyfet: Giai doan toan
phat cua bnh sot tre em). Thudng gap cac the b?nh sau:
(1) Chimg thuoc phan khi: Sot cao, so nong, ra mo hoi nhieu, khat nude
tre quay but rut, non, ludi do. reu vang, mach hong dai. Benh thuoc chiing kinh
duong nnnh, phep chira la thanh nhiet sinh tan, thudng dung bai Bach ho thang
gia giam. Neu sot cao mo hoi tao bon. bung day dau, quay nhieu, co khi noi sang
me man, mach tram co luc, benh thuoc chiing phu duong minh. phep chira la
thanh nhiet thong ha, thirong dung bai Dai thira khi hoac Dieu vi thira khi thang
gia giam.
(2) Chung thuoc phan dinh: Benh sot cao lien tuc, dem nang han, mom
kho, quay khoc but rut, ludi do tham, mach te sac, co khi me man noi sang. Phep
chira la Thanh dinh tu am khai thieu thudng dung bai thanh dinh thang gia giam.
(3) Chung thuqc phin huyet: Benh nhi sot cao lien tuc, quay but rut, me
man hoac hon me kem phat ban chan hoac chay mau rang, mau mui, dai tien co
mau (trudng hap sot xuat huyet) hoac kem co giat (hpi chimg nao, mang nao).
ludi do tham, m^ich sac. Phep chua la thanh nhiet luong huyet giai doc, thudng
dung bai Thanh on bai dpc am ket hop bai Te giac dja hoang gia giam, hoac xuat
huyet nhifiu them Nhp n6 i, Hoa hoe, Trac ba diep (sao chay), Sam tam th5t; co
co git gia them bpt Giun dat. Xac ve siu. Thin sa ket hop cham Nhan trung,
Thai xung, Hpp coc, chich Thap tuyen, Thieu thuong.

27

Ngoai ra trong thm k\ toan phat. chimg (V Iv co the co cac biirn chimg nhir
Vong am (da kho. thop. mat 16m, dai it. moi IuxVi kho. do. mach kho han. hoac
vong dinrng (nhiet do khong len, chan tay lanh, loan than \a mo hoi. huyet ap
tut) can co hien phap ciru am (Sinh mach tan), hoi dinmg (Sam phu lhang. Doc
sam thang), va cac phinrng phap cap ciru tich cut' nhir: Tro tim, nang ap. iruycn
dich cua y hoc hien dai.

28

DIEU TRI NHI KHOA

I. NHlfNG NGUYEN T A C Dlku TRI BENH TRE EM
1. Nam vimg nguyen nhan gay benh:
La nguyen lae co ban luc chua benh de chon dung phep chira. dung thuoc
khong lang phi thuoc ma dal ket qua tot. Y hpc co truyen noi: "Tri benh lai cau
ky ban" luc la phai dieu tri nguyen nhan gay benh. Vi du: Doi von benh ia chay
tre em phai tim nguyen nhan gi, neu do an uong (hi chi can dieu chinh an uong
hoac chi can cho thuoc cam ia la duac. neu do nhiem trung Coli duirng ruol. mai
phai dung den khang sinh. Ve Y hpc co truyen cung , neu ia chay do luong thuc
thi chi dung Binh vi tan la khoi, neu do nhiel thi phai dung Cat can cam lien
thang, nhung neu do ly hu thi phai dung bo ty hoac Huang sa luc quan tu thang...
2. Ph ai thong thao cap cuti va chua trieu chung:
Tuy chua nguyen nhan la ca ban de giai quyet benh tat nhung do d^c diem ca
the tre em non yeu nen benh de chuyen bien nhanh, co khi nguy kjch cho nen
nguoi thay thuoc nhi khoa phai thong thao cap cuu, chua trieu chung. Y hpc co
truyen da neu len nguyen tac "Cap tac trj lieu, hoan tdc tri ban", y la neu benh la
cap linh co trieu chung ngu\ kich. nhut dinh phai tri trieu chung truoc de cuu \an
sinh menh; nhung neu la benh den lir 'ir thi phai kiem tra tim nguyen nhan de
dieu tri cho lot. (Tren lam sang benh tre cm den vai tinh trang cap cuu la nhieu.
V i du: Nhu tinh trang ia cha> nhung den vai tinh trang mat nuoc da kho. thop
16m. mat trung mach nho thi phai truyen nuirc nham can bang dich the. tra urn
mach la cap cuu hoac tre viC-m hong nhung sot cao co giat thi nhat dinh phai
dung thuoc an than la chinh. sau do mai dung khang sinh manh chua ia chay,
viem hong ...). Doi vai benh man tinh co them benh cap tinh cung vav. bao gia
cung phai chua benh cap linh truoc. V i du: Mot benh nhi bi than hu nhiem mo
(dang dung thuoc chira kien ty hanh thuy), mac them benh viem duong ho hap
tren sot cam phong nhiet. thi phai dung bai Ngan kieu tan de giai trir bieu truoc
luc het can sot roi mai dung tra lai phuong phap kien ty hanh thuv. Tat nhiin
cung co luc vua chira trieu chung, vira chua nguyen nhan benh nhu trong benh ia
chay mat nuoc, phai vira truyen bo dung dich vira phai dung khang sinh phai
chfing nhifim trung. Y hpc co truyen goi la tieu ban kiem tri .
3. Chua benh dong thoi nang cao sue chong do cua co the:

29

hoc co truyen cho rang: Mac henh la do chinh khi suy. ta khi nhan do moi

xam nhap duac Do la quan diem rat dung. Chinh khi la sue chong da cua ca the.
ta khi la nguyen nhan gay henh. That vay luc nguoi khoe manh thi rat kho mac
benh. Cho nen luc chira henh, cho thuoc de duoi ta khi (chong nhiem thing)
d6 ng then phai cho thuoc de nang cao siic khoe toan dien nhu cac loai sinh to.
thudc bo am, bo duong. thuoc tra tim tang lire, co che do an uong. che do nghi
ngon thich hap. Tat nhien cung tuy tinh hinh benh nhan ma cach co tri khac
nhau V i du: Tre viem phoi neu co kem suy dinh duong se dung thuoc khac vai
tre viem phoi ma co the von khoe manh Loai truoc ngoai viec dung khang sinh
phai dung them thuoc tro luc, tra tim. co khi phai truyen mau; con doi voi loai
benh sau co the chi can tiem hay uong thuoc khang sinh chong viem.
4. Phai biet ket hop y hoc hien daivoi y hoc co truyen dan toe:
Can ket hop y hoc hien dai voi Y hpc co truyen dan tpc trong dieu tri benh
tre em de dat hieu qua cao va tiet kiem duoc thuoc. V i du: D 6 i voi benh ia chay
mat nuoc tre em da kho, mat trung, moi do, sot cao thupc the nhiet ta.

dich

suy ton, neu chi dung phep chua duong am thanh nhiet sinh tan chi ta nhu Cat
can cam lien thang gia Nhan sam. O mai thi hoi phuc cham la truySn th&m nuoc.
Ngupc lai ia chay keo dai thi dung phep chira kien ty tieu thuc (doi voi thd ty hu
thuc tich) se dat ket qua tqt han la dung cac loai thu6c bo xung men tu hoa
(pepsin, axit clohydric pha loang ..). chat sap trang hoac co khi dung cac loai
khang sinh khong can thiet ma chang co tac dung. Doi vdi benh bai liet thoi ky
phat trien, va thdi ky phuc hoi thi dung cham cuu xoa bop hoac chon chi la tdt
han ca.
5. Dieu tri can kip thoi, dung thuoc phai than trong:
Benh tre em chuyen bien nhanh, cham mot chut benh se co the uy hifep tinh
mang cho nen xu tri phai kip then nhat la luc co chi djnh cap cuu, y lenh cua bac
sT phai dupe thuc hien ngay. Mat khac do ca the tre em khi huyet non yeu (tri am
tri duong) nen dung thuoc phai dung chi dinh. lieu luong phai than trong, nhung
loai thuoc tan dupe de gay di ung. phai hoi ky tien su dung thuoc, nhung loai
thuoc nam. thuoc bac qua han. qua nhiet. qua cay, qua nong, co dpc, cong phat
manh luc sudung cang phai than trong
II. N H U N G P H U O N G P H A P D IE U T R I T H E O Y H O C C 6 T R U Y E N
DAN TO C
Phuong phap dieu tri co truyen rat phong phu da d?ng (nhu cham cuu, chich,
le, xoa bop. tiem vao huyet, go kim hoa mai, r^ch da...). Phuong phap dung

30

thuoc co 2 cach: Moi la dung bai thuoc co kinh nghiem. gia tru>en de chira benh.
Vi du Phuong phap chua tri bang Kho tri tan, chira hen bang Vien hen. vien MP;
bin thuoc chira dau da day bang Bol nghe. La khoi; hai la cach bien chimg luan
tri dua vao Tu chan. Bat cuong de qui nap benh roi dua yao bat phap (8 phep
chua benh) de chon thuoc ke dim cho thich hop, hoac theo co phuong (nhu Ngan
kieu an, Luc vi. Quy ty...) gia giam. Phuong phap dieu tri noi khoa co truyen chu
yeu dua vao nguyen tac dieu chinh co the (Y hoc co truyen quan mem rang trang
thai benh ly la trang thai co the mat thang bang am duong). nhu chinh tri (la
dung thuoc nong de tri chung han. dung thuoc mat, lanh de tri chimg nhiet. luc
tao bon thi dung thuoc thong ha. luc ia long thi dung thuoc co sap), phan tri (luc
co chung chan han gia nhiet bieu hien nguoi nong van dung thuoc nong nhu Phu
tu. Can khuong hoac luc tre ia long nhung do nhiet ket van dung Thira khi thang
thong nhan thong dung v.v...). Ngoai ra, moi luong y dua vao kinh nghiem ban
than va tiiy theo tinh hinh thuoc san co d dja phuong va thoi tiet khi hau de dung
thuoc.
Sau day gidi thieu cac phuong phap thudng dung trong dieu tri benh tre em
1. T A M P H E P T R I B E N H N H I KHO A (B A T PH AP)
Y hpc co truyen dung tir chan (Vong, Van, Van, Thiet) kiem tra nam tinh
hinh benh. roi qui nap benh theo K hoi chung Jdn (Bat-cuimg.. Am duong, Han
nhiet. Bieu lv', Hu thur) va dune X phep chinh (bat phap) hoac chon vi thuoc
(hoac huyet vi) thich hop de chua benh.
So luoc gidi thieu S phep chira benh trong nhi khoa nhu sau:
1) Lam ra mo hoi (Phep han cung goi la giai bieu I:
La phep dung thuoc de lam ra mo hoi va qua do giup co the chong dd benh
tat. Co the dung xong.
Chi dinh: Dung doi vdi benh nhe, benh sot nhiem trung d giai doan dau co
trieu chung dau dau. gai ret. hat hoi so mui.
Nhirng vi thuoc thudng dung: Kinh gidi, Tia to. Que chi, Ma hoang, Bac ha,
Man kinh tu. Cue hoa ...
2)Gay non (Phep tho):
La phep lam cho n6n, it dung trong nhi khoa.
Chi djnh: Ngp doc thuc in , dam tic.
Nhung vi thuoc thudng dung: Qua dfe, La ngau, Muoi an hoac dung long ga,
ngon tay kich thich 6 hpng gay n6n.

31

3) Thong dai tien (Phep hai:

Lu phep dung thuoc de lining dai tien hoac nhuan trang
Chi dinh: Tao bon lau ngay. das bung an khong lieu, rut phu trong benh than
hu nhiem md, nhiem doc thuc an
Thu6c thudng dung la: Dai hoang. Mang tieu. Vung. Ba dau Tuy theo sue
khoe cua benh nhj madung loai thuoc thich hop.
4) Hoa giai (Phep hoa):
La phep dung cac loai thuoc co tinh chat hoa giai (vira co tinh chat phat hieu.
vira co tinh chat thanh ly) de chua chung ban bieu ban ly.
Chi dmh chung s6 t ret hoac benh sol ret keo dai nhiet dp dao dong luc sot,
luc ret, nguc sudn day tuc, mieng dang buon non (chung thieu duong)
Thuoc thudng dung: Sai ho, Bach thuoc. Thudng son.
5) Lam am (Phep on):
Dung thuoc nong de chua benh co trieu chung han lanh: ngudi mat chan tay
lanh, an khong tieu, ia long, mach tram tri, reu ludi trang, nude tieu trong...
Chi dinh: Ia chay the han, suy dinh dudng the ly vi hu han, lhan hu nhiem
md, mot trudng hop tre em choang, truy tim .mach va hau het cac benh man tinh
the hir han.
,

Thuoc thudng dung: Gung kho, Te tan, Phu tu. Bach truat. Dang sam. Nham
sam. Chich thao. Huong phu, Ngai ciru ...
6) Lam mat (Phep thanh):
Cung la phep thanh nhiet giai doc. lhanh nhiet lircmg huyet la phep dung cac
loai thuoc mat de chua benh co trieu chung nong sot.
Chi dinh: Benh di ung co sot cao, benh nhiem trung giai doan toan phat. cac
benh nhot co sung nong do dau ...
Thuoc thudng dung: Sinh d?a, Huycn sam. Thaeh cao. Tri mau. La tre. La
sen, Hoang lien. Cat can, Hoang ba. Hoang cam. Chi lu ... (co rat nhieu cac loai
thuoc thao moc).
7) Lam tieu (Phep tieu):
La phep dung ihuoc de lam cho mat di cac hien tugmg co udQng tich lu trong
co the nhu tich thuc. u huyet, u nude, tich ddm, khi tre.

32

Chi dinh: Cac trieu chung ir huyet nlm sung lay do ung nhot. sang chan ngoai
khoa dung cac loai thuoc hanh huyet nhir: Dao nhan. Hong hoa. Nhu imrng. Moc
duoc, Dan sam. Ich mau.
LT nude irong cac chung phu. dung thuoc len llniy nhu: Y di. Phuc linh. Xa
lien, Dang tam, Rau ngo ...
Tich ddm trong cac benh viem phe quan. hen suyen dung: Boi mau. Tran bi.
Trac ba diep, Cam thao ...
Tich thuc trong benh suy dinh dudng, roi loan lieu hoa, kem an. bung day
dung cac thuoc Mach nha, Som tra, Than khiic, Huong phu, Hanh nhan.
8) Boi bo (Phep bo):
La phep dung thuoc de chua nhung benh hu yeu.
Chi dinh va cac thuoc thudng dung:
Bo am: Cac chung am hu: Da kho. hap sot, long ban chan tay nong, chat ludi
do, tieu tien vang, dai tien co luc tao bon, mach te sac, mo hoi trom, thudng gap
trong cac benh nhiem trung thdi ky phuc hoi. V( thuoc thudng dung: Sa sam,
Mach mon, Thach loc, Hoang tinh, Ngoa true, Quy ban, Miet giap.
Bo duong: Cac chung duong hu: Ngudi met moi, chan tay lanh, tre cham biet
di, an kem trong cac benh suy nhuoc. V| thuoc thudng dung: Loc nhung, Rau
thai, Ich tri nhan. Tho ty tu. Tuc doan. Nhuc thung dung.
Bo khi: Cac chung khi hu: Met moi. an kem, hai thd ngan, roi loan tieu hoa.
dai dam, loi dom, thoal vi ben, sa da day ... Vj thuoc thudng dung: Hoang ky.
Bach truat. Dang sam, Nhan sam, Hoai son.
Bo huyet: Cac chung huyet hu thieu mau: Moi ludi nhat, sac da tai nhat, hay
hoa mSt, u tai. mach te sac, trong cac benh thieu mau, suy dinh dudng. viem da
khdp tidn trien. Vi thuoc thudng dung: Duang quy, Ha thu o. Thuc dia, A giao,
Cau ky tu...
Ngoai phep bo am duong. khi huyet con co the bo cac tang nhu bo tam dung:
Hat sen. Long nhan; Bo can dung: Duong quy, Bach thuoc: Bo ty dung: Dang
sam, Bach truat: Bo phe dung Mach mon, Ngu vi tu; Bo than dung: Thuc dja,
Phu tu v.v...
2. C A C PH U O N G P H A P C H U A B EN H BEN NGO AI B A N G THUO C
1. Xong:
La lam ra mo hoi bang hoi cua thuoc dot chay hoac hai cua thuoc nau chin.
V i dg: Dung cac loai thuoc ccS tinh dau nhu; La budi, Sa, Tia to. Huong nhu, niu

33

nude xong chua sol cam: dung cay rau miii (cay ngo) lam ruvnj nhi dal len hep
lhan xong khoi chua sin: dung Thirong iruat. Hoang ha doi hun kln>i chua cham
hep xuc v. \...
2. Tam ngam:
La plicp dung nude ihuoc lam chira henh nhu lam nude la Xoan chira ghe. goi
nude Voi chira choc Id goi nude Bo ket chira chay ran...
3. Boi. dap. chinVm:
Nhu dung dau mo Cho. hot Nga khau lan hoi cham ire em: hoi xoa dau Choi
chira dau khdp: dap La ngai cuu gia nat vao ron chira dau hung ia long: dap ()c
sen gia nho vao long han chan chua phi).
4. Dan:
Dung cao thuoc che vdi dau vung, sap ong chira cac henh nhot. dau nhuc
xuong c ir ...
5. Ngam, sue:
Ngain. sue nude Muoi chua dau rang, nin'rc San dau can chira viem hong
6. Thoi mui:
Dung thuoc hot Thuong truat thoi vao mui chira viem mui.
Ngoai ia. con nhirng phuirng phap khac nhu thut. dat ihuoc hau mon. am
dao...

34

V PH U O N G P H A P C H U A BEN H KHONC. DUNG TH U fSc

1. Xoa bop:
Xoa bop la moi phuong phap dieu tri dupe dung lau dm trong Y hoc co
truyen. Xoa bop co tac dung tang cuong chuyen hoa co bap. gia tang khi huyet
luu thong va cai thien trang thai than kinh.
Xoa bop loan than duoc dung nhieu trong phep duong sinh. dieu tri suy
nhuoc than kinh, suy nhuoc co the, dieu tri cac benh teo co bien dang cung khdp
va co kha nang dieu tri benh man tinh nhir viem dai trang man. viem loet da day
hanh ta trang, loan nhip lim, viem phe quan man tinh v.v...
2. Veo da cot song:
La mpt phuong phap dieu tri co truyen co lac dung tang cuong chuyen hoa
cua co the, giup cho khi huyet luu thong.
Phuong phap la: Dung 2 ngon cai va ngon tro cua hai ban lay vira veo vira
day da doc cpt song tir huyet Phong phu den huyet Truong cuong ket hop day
mot so huyet nhu Phe du, Ty du. Than du... Lam tir dudi len 3 - 5 lan moi ngay
(den muc da nong va hong len la dupe). Moi ngay sang ngu day hoac toi truoc
luc ngu, m6 i tuln (7 ngay) la mot lieu trinh. Cung co the tuy benh keo dai 10 20 ngay, co the de tre nghi 2 - 3 ngay tiep tuc lieu trinh 2. Dung chira cac benh
suy dinh dudng, tre em chan an. roi loan lieu hoa keo dai.
3. G iac (bau):
La mpt phuong phap co truyen lau doi, dung sue nong lam giam ap luc trong

6 ng giac de hut da cang len, co tac dyng giam dau, tieu viem.
Thudng chon huyet de giac tuy tinh hinh benh tat. O tre em thudng dung de
chua cac benh: Viem phe quan keo dai, Viem phoi (thdi ky phuc hoi keo dai), tre
em r6 i loan tieu hoa, dau co khdp v.v...
Giac h^ng ngay hoac cach nhat, 10-15 phut 1 lan va 10 - 20 lan la mot'lieu
trinh.
4. Cham cuu:
Cham cuu la phuong phap kich thich len huyet vi d viing da bang kim hoac
sue nong... de dat muc dich chua benh tai cho loan than. Ve co che tac dung cua
cham ciru co 2 hpc thuyet dang luu y:
Hpc ihuyet than kinh the dich dupe nhieu nha Y hpc hien dai tan thanh cho
rkng cham va cuu len cac viing cua da co tac dung kich thich than kinh va lam

35

lhav doi trang thai cua llic dich. nhu do lam giam dau va lain cho to chuc. co
quan mac henh hoi phuc
Hoc thuyct kinh lac thudng duoc cac nha Y hoc co iruven giai ihi^h iir vira
cho rang chain ciru chu veu lac dung len he kinh lac irong co ihc dc dieu chinh
trang thin henh l\ cua co the
Cham ciru co nhieu hinh thuc Cham hang kim nho thao cham) vao huyet
(chamI; dung sue nong cua moi Ngai kich thich len huy cl iv.iaii. lien- (thuoc)
vao huyet; dung kim hoa mai go vao huyet, go vao viing. go vao dmmg kinh.
chon mot doan chi cat gut vao \iing c<r hap de dliy iri mot kith thich lau dai
(chira co hot. co teo): kich thich vao cac viing d loa tai de chira benh. dung ngon
tay de tac dong len huyet; dung dien mot chieu hoac xung dien tac dong len
huyet .... chich nan mau.
Pham vi chira benh tre em cua chain ciru rong, va duoc dung ral rong rai Vi
du Cham ciru diing trong cap ciru nhi khoa nhu: sot cao cham Khiic tri. Thieu
thuong. Dai chiiy; co giat chain Nhan trung. Hop coc. Thai xung. non cham N 6i
dinh. Thirong tinh. Hup coc; dau hung cap (do giun) cham Trung quan. Than
khuyet (ciru). Thien xu. Tuc tam ly, Tir phiing ...

Cham ciru trong chua henh cap linh nhu: Ho ga cham Ngu te. Liet khuyet: ia
chay cap cham hoac ciru Tuc tam ly. Than khuyet (ciru): viem Amidan cham
Hop coc. Thai uyen. Thieu thuong (chich)...

Chum ciru dung trong chua henh man tinh nlnr: Roi loan tieu hoa keo dai
chain Tir phung, Tiic tam ly; hen suyen cham Thien dot. Chien trung. Noi quan.
Suyen tuc.

Di chung bai liei. di chung viem nao la nhung benh duoc dieu tri co

ket qua tot bang chain ciru. chon chi

Nhung dieu can chu \ luc chain cun chira benh tre em:
a) Nguoi thay thuoc phai chuan hi kim sac, khong ri. da tiet trung tot. bong,
con vo trung de sat trung da truoc luc chain.
b) Chuan hi tu the cho benh nhi (ngoi. nam). Doi tre nho can nguoi nha hoac
y ta be va giude tranh day dua luc cham.
c) Ky thuat cham phai thanh thao de cham dung huyet va khong dau
d) Mdi chain lan dau tien nen chon it huy et. doi vcVi benh cap linh cham kim
ve \a rut ngay; doi voi benh man tinh co the luu kim. Rut kim ngay hoac luu kim
con tuy thuoc tinh chat benh ly va \; tri cham.
e) Khong cuu cac huy et d dau v a mat. Luc cuu chu y do nong tranh hong da.

36

BANG C H A M C L T l)IEl

He

Ten chung

thong

henh

Ho

Cam sol

hap
Viem mui

I R ( ( H l ' N C B E N H NHI K H O A

Huvet thinVng dung

Cham o'

( 6 the phoi

loa tai

hop

Dai chuy, Phong tri. Hup

Tran, mui

coc, Nghinh huirng, Thien dot.

trong

An duong, H<*p coc. Phong tri,

Phoi. mui

Nghinh huong.

trong

Chay mau cam Nghinh huirng. Hup coc

Viem amidan

Giap xa. H<rp coc, Thieu thuong Dien ami

(chich)

dan. noi
tiet. phoi

Viem hong

Giap xa. Hap coc, Thieu thuang.

thanh quan
Ho ga

Dinh suyen. Thien dot, Khuc tri.

Hap coc, Ngu te, Thai uyen.

Tieu

Chan an

Noi quan. Hgrp coc, Tuc tam ly.

hoa

Viem mom

Dia thuirng. Giap xa, Hop coc.

Li rang

Ham tren: Ha quan. Hirp coc.

Ham duiri: Giap xa, Hirp coc.

Co that

111611

vi Tuc tam ly. Noi quan, Hup coc. Than mon

(ca nang)

Than mon. An mien 2.

Viem da day

Noi quan. Tuc tam ly, Trung

va ruot

quan. Quan nguyen. Hop coc.

Sa da day

Khi hai, Tuc lam ly, Trung quan

Giun chui ong Nghinh huirng xuyen Tir bach,

cuu Thien xu

Dirm. Than

mat

Cu khuyet. Tuc lam ly, Hcrp coc, mon. Giao

Giun duong

Thien xu. Duong lang tuyen.

ruot

Tuc lam ly, Dai hoanh.

Co that ruot

Hop coc. Tuc tam ly

Duong lang tuyen

cam

Giao cam.

cuu Thien

(Bung dau

than mon.

xu. Khi hai.

quan)

lieu truong Trung quan

Tac ruot do

Hap coc. Tuc tam ly. Khi hai.

liet (ca nang)

Thien xu. Thuong cu hu.

Tao bon (do

Chi cau, Tuc tam ly. Hap coc.

37

ihoiquen)
Non mua

Noi quan. Hcrp coc. Tuc lain ly

Than mom.
Da da>.
Giao cam

Than

Mat ngu

An mien 2. Noi quan. Than

mon. Tuc tam ly.

kinh
Mua von

Dai chuy. Phong tri. An mien 2.

Tuc lam ly.

Dau dau

Vung Iran: An duirng. Duirng

bach. Hirp coc
Vung gay: Phong tri, Liet
khuyet
Vung ben: Thai duirng, Dau
duy. Hop coc.
Vung dinh: Bach hoi, Hop coc.

Dong kinh

Dai chuy, An mien 2, Bach hpi,

Tuc tam ly. Than mon, Noi quan Tim, Than

Dau day than

Hoan khieu Uy trung, Thira scm, mon

kinh toa

Duirng lang tuyen, Tuc tam ly,

Giai khe. Con Ion.

Liet day than

Duong bach. Ty true khong, Dja

kinh mat

ihuimg. Giap xa,

E phong. Nghinh huirng. Hop
coc.

Viem da than
kinh

Chi tren: Dai chuy, Kien ngung.

cuu vung da

Khuc tri. Noi quan, hpp coc

viem

Chi diron: Phuc tho, duirng lang

tuyen, Tuc tam ly. Giai khe, Dai
truong du.
Nac cuc

Noi quan, Chuong mon, Thien

dot.

Co giat

Nhan trung, Hpp coc, Thai

Xung

Cam

A mon, Thupng liem tuyen.

Dung tuyen, Hpp coc.

Ngu giat minh Dai chuy, Bach hpi. An Mien 2

38

Than mon

Sup mi

Duong bach xuyen den Ngu

you. Ty true khong. Hup coc.

Dau day than

Noi quan, A tin huyet

Go kiin hoa

kinh lien sudn

mai tai clio

dau
Tim

Tim nliip

mach

nhanh timg dm Tuc tam ly.

Than mon. Noi quan, Gian sir.

Tim. than
mon. giao
cam

Huyet ap cao

Hop coc, Tuc lam ly, Thai xung. Than mon.

Khuc tri.

Gan. Than.

Choang, huyet Noi quan, Nhan Trung, To Lieu. Tim. tuyen

thuirng

ap tyt

than, giao
cam
Cac

Dai rat (co tht Khi hai. Am lang tuyen Tam am

Thai gian dai

loai

bang quang ca giao, Quan nguyen.

them ciru

khac

nang)
Me day

Khuc tri. phong thi, huyet hai.

Phoi. than
mon.Npi
tiC;t

Cling gay (ca

Dai chuy. Phong tri kien tinh.

Co. Than

Xoa an lai co

mon

nang)
Diec (nang tai) Nhi mon. Thinh cung. Ngoai
quan.
Lac mat

Lac trong: Ty iruc khong xuyen

Dong tir lieu. Hap coc
Lac ngoai: Toan true xuyen
Tinh minh; Hirp coc.

Viem mang

Ty true khong, Thai dirang

tiep hap
Dai dam, loi

Quan nguyen. Khi hai, Tam am

dom

giao, Bach hpi, Truong cuong

39

h i. n h u n g

i)ii';u c a n c m

v t r o n g K fer h o p o if e t t r i u X n g

THUOC TAY
Trong nln khoa, viec sudung thuoc tay phoi horp vtn thuoc done v trong dieu
tri benh la riit c5n tlnc-t. cho non lam ngudi thay thuoc nln khoa dong hay tay y
cun" deu phai nam vung kien thuc co ban vc thuoc lay. Bai nay chi nham gun
thieu vdi cac ban dong nghiep nhung loai thuoc lay thudng dung irong nhi khoa.
Nhung dac diem dung thuoc tay trong nhi khoa:
- Tre em do cu the con non yeu. khi huyet chua day du cho nen luc dung
thuoc tay phai het sire than trong. phai nam chac tac dung va chong chi dinh va
tac hai doi vdi cu the cua lung loai thuoc, lieu luong va cach dung (uong. chich
bap hay chich mach mau) neu chua nam vung tot nhat la khong dung.
- Lieu luong thuoc dung cho ire em thudng tinh theo can nang cua ire. vi du:
mot dua be 5 tuoi bj viem phoi. nang 18kg can dung Ampicilin de phoi hop dieu
tri thi phai dung lieu trong 24 gid la: lOOmg x 18 - 18(X)mg tuc l,8g/ngay (tinh
theo lieu dung Ampicilin IOOmg/kg/ngaoy) neu ham lupng cua thuoc la 0.5/vien
thi phai cho benh nhi uong 4 vien chia 4 lan uong trong ngay. Noi chung. liSu
luong thuoc dung cho tre em la cao hon doi vdi ngudi ldn (so vdi can nang) nhat
la thuoc an than, chong co giat. thuoc trp tim ...
- Tre em dudi 3 tuoi. he than kinh chua phat due day du luc mac benh ngoai
cam, sot cao de co giat cho nen luc dung ihuoc ha sot nen ket hop vdi thuoc an
than.
- Tre em co the non yeu (tri am. tri duong) ma duong thudng huu du. am
thudng bat tuc (thuan duong chi the) nen luc mac benh on sol cao hoac tieu chay.
chan am de bi ton thuong (mat nude) nen phuong phap truyen djch de bo xung
tan dich trong dieu tri la khong the thieu, neu khong co dieu kien, doi vdi tre sot
cao cho uong du nude (co them it muoi, dudng hoac djch O R E S O L ) la can thiet.
- Tre nho chuc nang gan than deu chua hoan chinh, kha nang giai doc rat
kem nen dung thuoc lieu cao va keo dai phai het sue than trong nhir
Chloromycetin, Pyramidon gay giam bach cau, Streptomycin gay diec ...
M ot so thuoc tay can duoc chu y luc sir dung:
T H U 6 C K H A N G SIN H (Tru sinh)
Tru sinh la loai thuoc duoc che tu cac chat do cac loai nam, vi khuin hoac vi
sinh vat khac sinh ra trong qua irinh sinh san, va dupe san xuit Ning hda hqc
tong hpp, co tac dung giet chet hoac uc che cac vi sinh v$t phat triin. Hien nay

40

co hang tram loai khang sinh duoc dung lrong y hoc va ngay cang co nhieu
khang sinh nidi. Ve lac dung, khang sinh co the chia lam 2 loai: Loai giel vi
khuan nhu Penicilin Streptomycin. Neomycin... Loai uc che vi khuan nhu:
Chloromycetin, Tetracyclin, Erythromycin...
-

Can su dung hap ly thuoc khang sinh. Thuoc khang sinh rat can trong dieu

tri benh nhiem trung nhung cung vi the ma nhieu thay thuoc da lam dung. Nen
can neu ro nhirng tac hai cua thuoc nhu sau:
- Dung nhieu khang sinh hay it qua cung lam cho vi trung nhan thuoc
(quen thuoc, khang thuoc). Mot so khong it benh nhi bi nhiem doc do dung
khang sinh hoac dj ung vdi thuoc khang sinh. Moi loai khang sinh deu it nhieu
co h^i cho ca the, V i du: Penicilin gay di ung co the chet, Chloromycetin gay ire
che chuc nang t<u> mau cua tuy sinh benh thieu mau suy tuy, Tetracyclin gay roi
I091 tieu hoa, Neomycin, Streptomycin gay diec, Kanamycin gay ton thuang than
v.v...
- Dung khang sinh keo dai co the gay roi loan tieu hoa keo dai do loan
khuan, nhiem trung lan thu 2 do nam hoac tap trimg khac gay viem mom, viem
ruQt.
- Dung khang sinh keo dai con uc che hoac giel chet mot so vi khuan von
ccS ich lai cho ca the nhu loai vi khuan san sinh sinh to K, sinh to B d ruot gay
nen xuat huyet, roi loan tieu hoa.
- Dung khang sinh qua nhieu va tuy tien cung da lam cho nhieu loai vi
triing quen thuoc nhu tu cau khuan quen thuoc Penicilin, vi khuan lao quen
Streptomycin, va nhieu loai vi khuan de quen thuoc nhu true khuan ly. true
khuan mu xanh, coli dai trang ...
Muon tranh tac hai cua thuoc, luc dung chu y:
1. Coi trong phuong phap dieu tri long hap, dung dung chi dinh cua thuoc.
luc can va co dieu kien phai lam khang sinh do, khong nen tuy tien dung khang
sinh trong benh do virut gay nen.
2. Chu y dung thuoc nam doi vdi loai benh chua co chi dinh hoac khong can
dung khang sinh, nhat la doi vdi benh do virut.
3. Luc dung khang sinh phai dung dung lieu luang va du liu trinh.
4. Trudc khi dung khang sinh phai hoi ky tien su di ung. nhirng phan ung
trong luc dung, phai theo doi lam sang cung nhu din lam nhirng xet nghiem cSn

41

thiet. lain let da trude luc tiem Ienuilin. theo doi bach cau I ul dung
Chloromycetin...
5.

Phai lhan trong dung khang sinh trong trunng hirp benh nhi bi benh lhan

chin, nang kem nlur tranh dung khang sinh hoac dung \ai lieu luimg lhap han.
then gian cach quang keo dai
THUO C S U L F A M ID
- Tinh chat va chi dinh dung thuoc: Sulfa co tac dung lit the vi khuan.
Thuoc dung uong co the hap thu nhanh vao to chuc va dich the. co tac dung loi
ca vdi vi khuan Gram - va vi khuan Gram + Tac dung on dinh. kho gay t>Qi
nhiem co nhieu loai men it gay hai ca the. Co the de lau khong bien chat. Tinh
khang khuan cua cac loai Sulfa gan giong nhau nhung do tinh hinh hap thu cua
cac to chuc irong ca the doi vdi lung loai thuoc khac nhau nen tac dung chua
benh co khac Co rat nhieu loai Sulfa, cac loai thudng dung la: Sulfadiazine (SD)
Sulfathiazol (S.T) Sulfamerazine (S .M l) Sulfamethazine (SM 2) Sulfaguamdine
(S.G).
- Tac hai cua thuoc va luc dung can chu y: Sulfa co tac hai tren 4 mat:
1. Thuoc vao gan chuyen hoa thanh chat kho hoa lan. kei tinh d tieu quan
than gay dai mau. bi dai. co khi gay suy than.
2. Thuoc co the gay sot va ban chan di ung
3. Thuoc lam giam bach cau hat, gay thieu mau lan huyet.
4. Thuoc kich thich irudng vi gay buon non. non. ia chay. Trong qua trinh si>
dung can chu y :
1) Chu y hoi lien su di ung do Sulla.
2) Trudng hop tiem bap SD 10 - 20% phai tiem sau va xa vung than kinh
iranh gay viem than kinh. tiem tTnh mach dung dung dich < 5% va tiem cham
3) Trong thdi gian uong thuoc phai uong nhieu nude, va co the diing them
kem Bicarbonat Na. xet nghiem nude tieu. Co the dung 2. 3 loai cung mot luc
long lieu bang mot loai iranh duac huyet nieu mil tac dung khong giam.
4) Trong thdi gian dung ihuoc. neu sot giam lai lang hoac khong giam sot
ma cac trieu chung khac giam thi phai nghi den sol do thuoc phai ngirng thuoc
5) Phai kiem tra mau ngoai vi de kip thdi phat hien nhiem dpc co quan
tao mau.

42

6)

Trudng hap co benh gan. lhan phai han che ilung Sulla \a khong nen

dung Sulla co lac dung lau cho tre sa sinh. ire de non va phu nu co mang (vi
thuoc gay di dang).
T H U 6 C CORT1COID
Corlicoid la mot loai ihuoc hien duac dung kha rong rai trong y hoc vi tac
dyng nhieu mat cua thuoc va da duac su dung nhieu trong dieu tri benh ire em
Thuoc co rat nhieu loai va nhieu ten thuoc khac nhau nhu Hydrocortisone,
Prednisone (Cortancyl) Prednisolone (Hydrocortancyl), Cortisone, Dexamethasone (Decadron) Betamethasone (Celeslene) Triamcinolone... (Kenacort)
Methylprednisolone (Medrol)...
Tac dyng dupe ly cua thuoc rat da dang, qui lai hien co cac mat sau:
1. Lam giam tinh qua man doi vai nhiem trung va mot so chat doc, uc che
phan ung viem do do lam nhe cac trieu chung nhiem doc, lam giam xuat tiet
trong b^nh cham, dj ung thuoc benh phu, tran dich mang tim, mang bung, mang
phoi.
2. Cai thien tr<mg thai tham tbau cua day mach mao quan cua than, nha
do lam het protein nuoc tieu trong benh than hu nhiem ma.
3. Gia tang chuyen hoa dam, lam tang dudng huyet va tang glycogen d
gan cho nen luc dung thuoc tre an ngon, len can.
4. Lam giam su xa hoa te bao chong dupe hien lupng dinh trong cac benh
viem mang.
5. Luc dung thuoc huyet ap tang, te bao ai toan giam, te bao bach cau
trung tinh tang, doi vdi benh thieu mau, thuoc lam tang hong cau va vdi benh
xuat huyet do giam tieu cau, thuoc co the lam tang lieu cau.
Chi djnh dung thuoc: Thuoc dupe dung co ket qua doi vdi cac benh sau:
1) Benh cua to chuc lien ket: Phong lhap (thap tim), benh dang thap. ban
di ung, Luput ban do. viem ca bi. viem nut quanh dong mach, benh cung bi ...
2) Benh dj ung nhu hen phe quan, cham, d| ung thuoc. ban irang di ung ...
3) Nhung benh nhiem trung nang, co nhiem trung huyet, lao ke. nhirng
benh nhiem trung ma lam sang co trieu chung nhiem doc nang.
4) Nhimg benh ve mau nhu benh bach cau cap, benh thieu mau do dung
/

_ >

huyet, benh suy tuy. benh ban chan do tieu cau ha...
5) B$nh g^n. than: Hon me gan, viem gan the ac linh. than hu nhiem md.
6) Benh bong n^ng.

43

7) Henh ngoai da: Cham, viem da. choc la

X) Bcnli mat V iem giac mac. viem vong mac. viem thi i I i .'ip l n h

Lieu luong va each dung Corticoid: Tuy henh ma lieu lining v .1 ^.icli dung co
khac.
1. Trirung hup nhiem trung nang. nhiem doe va choang qua man Dung lieu
cao thdi gian ngiin Hydrocortisone 4 - Kmg/kg/24gid Sau 3 ngay giam lieu va
ngirng thuoc.
2. Truong hup benh keo dai nhu viC'm mahg phoi lao. benh thap khdp cap.
dung I - 3 thang: Prednisone hoac Prednisolone 1 - 2mg/kg/24gid vdi lieu gialti
dan
3. Trudng hop dung thuoc cach doan: Trong cac bnh keo dai nhu lhan hu
nhiem md. Luput ban do. xo cung bi... Nen dung nhu sail:
1) Lieu trinh va lieu luong, nen dung lieu luong giam dan. V i du:
Prednisone bat dau I - 2ing/kg/24gid cho den luc benh ca ban khoi thi giam lieu
0,5 - lmg/kg/24gid trong 2 - 4 tuan. sail do thi dung thuoc cach nhat hoac trong
I tuan dung thuoc 4 ngay nghi 3 ngay, dung thuoc 3 ngay nghi 4 ngay. v.v...
Trong 5 - 6 thang cho d&n vai nam va theo doi benh.
2) Chon thuoc: Chon loai thuoc d kiem. neil dung I loai trong I thdi
gian benh tai phat co the thay loai khac.
3) Chi dinh ngung thuoc: Dung thuoc den luc benh khoi. den luc dung
cach doan 5 - 1 0 ngay ma khong tai phat. co the ngung thuoc. Trunc luc ngung
thuoc trong thdi gian 4 - 6 tuan nen gia them ACTH dung gian doan de giup to
nang vo tuyen thuong than hoi phuc.
Tac hai cua thuoc
1) Do tac dung chong viem ma thuoc lam giam kha nang thuc bao cua he
thong te bao ludi. khang the trong mau giam co lai cho boi nhiem hoac nhiem
trung lan toa nhu thuoc co the lam cho benh lao khu tru thanh lao lan toa. benh
thuy dau nang han..
2) Do chong xa ma thuoc lam cho vet thuong ngoai khoa kho lien, benh loet
da day co the nang horn, chay mau. thung da day.
3) Dung lau thuoc gay nen nhu hoi chimg Cushing: M d ty dudi dau mai trang
iron, Lung trau . da moc long...
4) Thuoc gay hien tuong xuong loang. mat ch it vdi, a Ire con d vpo cqi sdng
hoac gay xuong dai luc va cham manh.

44

5) Thuoc gay mi loan chat dien giai chu yeu la lam tang tich lu Natri. lang
hai tiel Kali, va lam mat Calci
6) Thuoc con gay nhirng bien chimg khac nhau nhu huyet ap cao. dai dudng,
than kinh hung phan ...
Nhung dieu can chu y luc dung ihuoc va nhirng trudng hop chong chi dinh
cua thuoc:
1) Doi vai benh nhiem trung: Luc dung ihuoc phai theo doi hien tuang boi
nhiem va phai dung kem theo 1, 2 loai khang sinh. Tririrng hap benh man linh
dung lau co the khong can khang sinh nhung phai theo doi can than Phai than
trong dung thuoc doi vdi benh nhan ma test Mantoux dirang linh va co licp xuc
voi benh thuy dau.
2) Che dp an: Dung thuoc then gian dai can cho an du dam. Co the han che
muoi, cho them Kali va Calci.
3) Luc muon ngung thuoc phai giam lieu lir tir, khong dupe ngung thuoc dot
ngpt.
4) Khong dung thufic khi benh nhi co benh cao huyet ap, benh dai duong,
loet d? day, b$nh tam thin ...
Tren day chi giai thieu 3 loai thuoc dupe dung nhieu nhal Irong dieu tri nhi
khoa ket hop vdi thuoc lay. Con doi vdi cac loai thuoc khac van theo dung
nguyen lac la muon ket hpp thuoc lay phai nam chac tac dung dupe ly cua thuoc,
chi dinh va chong chi dinh cung nhirng tac hai do thuoc gay ra.

45

PHAN II

DIEU TRI NHI KHOA

HO GA
(Pertussis, Whooping Cough)
Ho ga la moi benh lay cap tinh dudng ho hap. Ty le mac benh lit cao a tre
duoi 5 tuoi (tren 80%), tre cang nho mac benh cang nang va de phat sinh biin
chung. Tre da mac benh it khi mac lai. hien co Vacxin phong benh. Thoi gian
mac benh keo dai kho khoi cua benh anh hudng nhieu den sue khoe cua tre nin
phong benh cho tre la het sue quan trong. Dong y goi chung ho ga la bach nh$t
khai (ho mot tram ngay) hoac don khai (ho con).
N G U YEN NHAN B EN H :
Ho ga do vi khuan Bordetella (truoc goi la vi khuan Bordet-Gengou tim ra
nam 1906) lay qua ducrng ho hap, 90% tre em tiep xuc de mac benh nen benh
thudng phat (hanh djch. Nguon lay la tre mac benh. Benh pho bien d tie dudi 7
tuoi nhung tre Idn cung co the mac. 70% cac trudng hop chet vi ho ga la tre dudi
1 tuoi.
Y

hoc co truyen cho rang nguyen nhan benh la nhiem doc thdi ta. phe mat

chuc nang tuyen thong sinh dam uat khi tre, nhiet ta gay t6n thuong phe lac nen
chay mau mui, mat (co tac gia cho la can kinh uat nhiet).
T R IE U C H U N G L A M S A N G :
Thdi ky nung benh: I - 3 tuin. D iin bifen benh qua 3 thdi ky:

46

/ Thin ky khiri phut huy \icin Ions: (ho. hat luri so mui. cha\ nuac miii. sol
hay khong...) la thdi ky lay manh nhat. cay \i khuan 90'/ cJ ltjTng tinh. cong tlurc
mau chua lhay doi, keo dai I - 2 luan

2.

Thai ky ho am : Tre ho timg trang dai. do mat tia tai. cuoi can co tieng rit

nhir ga gay. cac can noi tiep roi non derm rai co khi lan mau. 1 huirng kem theo
nhirng trieu chiing chay mau dudi kel mac mat. loci day chang dm'n lutri. mi mat
phu ne, phoi co ran rirran ngay. Tre so sinh khong co c(rn ho dien hinh nhung co
nhung can kho thd tim tai, keo dai 2 - 4 tuan.

Thai ky lu i berth. Sau 3 - 6 tuan ho thua dan, sire khoe tre hoi phuc nhung
ho keo dai 1 - 2 thang mon het.
X E T N G H IE M : Mau: Bach cau tang nhieu vao cuoi tuan (hir 2, co khi len tai
20.000 - 50.000c/mm', ty 1 te bao lam ba tang (ren 60 - 70%. Cay vi khuan
djch hpng hoac ho true tiep vao dla cay cang sonm duong tinh cang cao.
Xac dinh khang the IgA khang B. Pertussis trong nhdt mui hpng giup xac
djnh chan doan.
B IE N C H U N G V A D I C H U N G :
Thuong gp a tre nho va suy dinh dudng. Cac bien chimg thuong gap: Viem
phoi ke, viem phoi dom, dan phe quan. xep phoi, tran khi phe mac, viem tai
giua, xuat huyet (niem mac mat, mui, chay mau dudi da) su\ dinh duang. benh
nao do ho ga (co giat, hon me...) de lai di chiing mil, liet. dan don. cham Idn ...
Ron loi, loi dom (sa true trang) thoal v| ben do ho nhieu.
Tre so sinh. (re coi xuong, suy dinh duong de mac vuhn phoi, viem nao do ho
ga, Tre dang b| lao phoi, ho ga lam cho benh nang them can het siic luu y.
C H A N D O A N B E N H V A C H A N D O AN PH A N B IE T :
- Chan doan benh chu yeu dua vao: Trieu chiing lam sang va tinh hinh dich
benh lich sir tiep xuc ciia tre. Cay vi khuan duxrng tinh. mau bach cau cao giup
xac djnh benh nhung ke( qua am linh, cong (hue mau binh thudng khong loai trir
dupe ho ga.
- Tre nho con ho khong dien hinh chu y phan biet:
(1) Viem phe quan cap co the co ho con nhung ngan. dem ngay con ho nhu
nhau (ho ga thudng con ho dem nang ngay nhe).
(2) Lao h<ich lam ba d ron phoi: Do chen ep co the co ho con nhung con ho
cung khong khac biet ve ngay dem. Dua vao xet nghiem mau toe do huyet tram
tang, chyp phoi de phan bi^t.

47

D I L I TK1:
1) Nhirng dieu can chu y:
- Met SUV chu y che do cham soc an uong nghi ngm cua henh nhi Durx' nghi
ngoi day dii. Iranh kich thich tam than. C'hc do an do tieu an nhieu lan. du nmrc
va chat dinh duang sinh to.
- Tre henh khong bien chung \a Ion tuoi co the san soc tai nha va dung thuoc
nam. cham ciru. Tre co bien chiing va duoi I tuoi nhat thiet phai duoc theo doi
dieu tri tai benh vien.
- Tre mac benh phai duoc cach ly duong ho hap it nhat 40 ngay ke tir khi
mac benh Tre co tiep xuc phai dupe each ly theo doi va cho uong thuoc nam
phong benh.
2) Dieu tri bang dong y: (chu yeu doi vai tre lan va khong co bien chung)
- Phep chua: Thanh nhiet giai doc giang khi hoa dam chi khai
- Bai thuoc: Tuy theo tinh hinh va giai doan benh co the chon cac bai thuoc
sau:
(1) Ma hanh thach cam lhang gia vr Ma hoang 4

6g. Hanh nhan 4 - 6g Cam

thao 2 - 4g, Thach cao 12 - 20g, Tien ho 8 - I2g. Cat canh 8 - I2g. Tran bi 4 6g, Boi mau 4 - 8g, do 300ml sac con 100ml chia nhieu lan (3 - 4 lan) uong
trong ngay. Chi dinh thai ky dau va co ho am. Truong hap non gia Gung tmn 8g
che ban ha 6 - 8g.
(2) Ta bach tan gia giam: Tang bach bi 8 - !2g. Dia cot bi 8 - I2g. Cam thao
2 - 4g. Cat canh 8 - 12g, Tri mau 6 - 8g. Tran hi 4 - ftg. True nhu 6 - 8g. Ban ha
che 4 - 6g. Gung tuoi 6 - 8g. sac uong nhu tren
(3) Sa sam mach dong thang gia giam: Sa sam 8 - 12g, Mach mon 8 - 12g.
Tang diep 8 - 12g, Sinh bien dau 8 - lOg, Thien hoa phan 8 - 12g, Lien nhuc 8 I2g, Y di 8 - 12g. Tran bi 4 - 6g, Son tra 4 - 6g. Than khuc 4 - 6g, Cam thao 2 4g. sac uong nhu tren.
- Gia giam: Bai ( I ) va (2) dung cho thai ky khai phat va ho con. Trong then
ky ho con neu dam nhieu gia: La bac tii. To tii, hoac Qua lau nhan, B6i mau moi
thu 4 - 8g. non nhieu gia them Cau dang. Vien chi moi thu 4g. hoac Xac ve 2g,
truong hop chay mau gia: A giao 6 - 8g hoa thuoc hoac Chi tu (sao chay) 6 - 8g,
Trac ba diep (sao den) 6 - 8g.
Bai (3) chu yeu dung cho thoi ky lui benh co tac dyng Ur am thanh nhifel bo
khi kien ty. Neu tre nguoi yeu met moi nhieu co lh gia thuoc bo khi nhu Dang

48

sam (hoac Nhan sam). Bach truat. moi (hi>6 - lOg (dung nhan sam hang nua lieu
Dang sam). neu am huyet hir ra mo hoi trom. nguoi gay nong. sac da tai nhat
hoac viing hung gia them Duong qui, Hoang ky, Ha thu o moi ihir 8 - 12g, Sinh
dia 8 - 12g. La dau 6 - 12g, Ngu vi tu 4 - 6g.
- G id i thieu mot so bai thuoc kinh nghiem don gian: Vira co tac dung
chua benh vira co tac dung phong benh.
(1) La lie tuori lOg, La chanh 3 - 5 la. La xuong song tuoi 20 - 30g, Rau ma
tuiTi

20 - 30;.'. Nghe vang nuong 3 lat, sac nuoc uong ngay chia 3 - 4 lan. Dung

trong thoi ky moi phat va phong benh tot.

(2) Ngu tinh thao, Bach bo moi thu 20g, Tran bi 8g sac nuoc uong.
(3) Dung djch toi tuoi 50%, tre tren 5 tuoi moi lan uong tu 10 den 20ml, ngay
4 lan, tre duoi 4 tuoi giam nua.
(4) Mat ga say kho tah mid tron duong. Tre duoi 1 tuoi, I cai chia 3 ngay, tre
tir I - 2 tuoi, I cai chia 2 ngay, tre 3 - 5 tuoi m6i ngay 1 cai deu chia 2 lan uong.
(5) Nuoc sic la trie ba diep tuoi: Lupng moi ngay: 1 tuoi: 20g, 1 - 5 tlioi: 30
- 50g, 6 - 1 0 tuoi: 60 - lOOg. Cho nuoc 200 - 400ml sac con 30 - 90ml, ngay
uong 6 lan moi lan 15 - 50ml, mpt li?u trinh 7 ngay (sach Trung y bi phuong dai
toan xb thang 3/1991 tr. 592 tap ha).
- Dieu tri bang cham cuu: Co the dung don thuan hoac phoi hpp. co tac
dung giam con ho.
- Cong thuc I : Tu phung, Noi quan, Hpp coc, Chich tu phung nan mau
truoc, sau do cham Noi quan, Hpp coc, kich thich manh khong Luu kim, hoac
Liru kim tuy tre Ion nho. Non gia than non, Noi quan, dom nhieu gia Phong
long, Tuc tam ly, ho co mau gia Xich tr^ch, Khong toi.
- Cong thu 2: Phe du, Phong tri, Hpp coc, thu thuat cham va gia huyet
nhu tren dung cho thdi ky so khoi.
- G iac va chich mau cac huyet Phe du, Phong mon. ngay I lan trong ky
ho con.
- Ket hop thuoc tay: Trong cac truong hpp sau day nen kSt hpp thu6c tay:

1.

Tre duoi I tuoi va co the suy dinh duong: Ket hpp thuoc dong y voi tru

sinh: Erythromycin 40mg/kg/ngay hoac Ampicilin 100 - 200mg/kg/ngay, tre so

sinh 75mg/kg/ngay.

49

Ire vao thrri ky ho com da dung thuoc nam \a 4.(1.1111 am tir ' Jet) Ml nj!a>

ma khong giam ho hoac ho co xu huong tang tin nen ket hirp dung iru 'inh nhu
tren
3.

Truong h<Tp dem ho nhieu tre quay khoc. hoac non nhieu. oho thuoc va

cham khong giam nen ket hop dung diuoc an thai) las y Phenobarbual S
l()mg/lan hoac Valium lmg/kg/l lan ngay 1 - -2 lan uVa'ium cung c t e r n la
Seduxen, Diazepam).
Phong benh:
1. Tiem ngira ho ga theo 4tch: Vacxin bach hau. iunn van. ho ca. nim d.m 1
mui lien tiep vao khang khu 2, 3. 4 sau sanh. Nam sau tiem nhac lai 1 mui *tu I
den 23 thang)
2. Thuc hien nghiem chinhiche d cach ly vacach ly kiem dich trong ikhi cc
dich
3. Cho u6ng 'thudc nam phong benh doi vdri tre co tiep

kuc,

doi vai tre su)

dinh duang nen cho uong Erythromycin 40mg/kg/ngay *5 ngay.

BENH QUAI BI
(Mumps, Epidemic Parotitis).
N G U Y EN NHAN B EN H :
Benh quai h| la mot benh lay cap tinh do virut thuoc nhom Paramyxovirus c<
ai tinh dac biet vai to chuc cac tuyen (tuyen nuoc hot, tuyen tuy. tinh hoan ..) v
he than kinh. Theo quan niem hien nay, quai bi la mot benh luan than, virut ga
viem true than kinh nguyen phat kem djnh cu thu phat tai cac tuyen.
Nguon lay benh duy nhat la nguoi mang virut, quai b| (mac benh hoac khon
bieu hien benh ly (the an) khoang 1/3 - Vi truong hap), benh lay chu yeu qu
duang ho hap do tiep xuc, virut trong nuoc boi, nuoc hai tha cua nguoi benh v
nguoi mang virut truyen sang nguoi lanh, thai gian lay lan nhieu nhai la cut
then ky nung benh va 5 - 6 ngay sau khi bieu hien benh, mac du'au 2 tuan va
con tim thay virut 6 tre mac benh. Nuoc tieu bnh nhi vln co the truyen benl
Benh ly chu yeu la tuyen va to chuc xung quanh xung. tv huyfet, te bao tuyen ph
ne hoai tu. ong tuyen phu ne te bao thuong bi roi rung, khong hoa mu.

50

hot co iruycn con goi henh quai hi la Tra lai" do phong on la doc xatn

nluip kinh ihicu dinrng lain cho khi huyet ngung tre gay dau sung. Kinh thieu
duang va quyet am la linrng quan hieu ly nen a tre lan co the gay viem linh
hoan, viem buong trung. Neu on doc thinh noi nhap tam bao gay sot cao hon me
co giat (Irieu chung viem nao mang nao).
Ty le mac benh cao a lira tuoi 3-14 (chu yeu 5 - 9 tuoi) va thanh men 18 20 luoi. Mien djch sau mac benh la lau dai.
T R IE U C H U N G L A M S A N G :
Thai gian u benh: 2 - 3 tuan, virul phai trien 6 niem mac mieng, vao mau gay
viem cac lang phu, luy iheo vj tri khu tru cua virul ma bieu hien lam sang khac
nhau.
1. Viem tuyen mang tai:
Viem tuyen mang tai la the pho . len (tren 70% cac truong hop) va dien hinh
cua benh quai bj. Tre sot, nhuc dau, sol thudng 38 - 39"c, mel moi, an ngu kem,
sau 1 ngay sung tuyen mang tai da cang dau khong do, bat dau dau nhuc 1 ben
nhanh chong lan sang ben doi dien (2/3 truong hap). Vung sung to thuong lay
dai tai lam trung tam. Cac hach goc duoi ham va truoc lai thuong bj sung. Viem
niem mac mieng hpng kem theo phu ne quanh 16 ong Stenon. Co khi viem ca
tuyen nuoc bot dudi ham. duoi luoi nen mat banh ra benh nhi nuot dau, nuoc bot
il va quanh.
Lui benh: 4 - 5 ngay sau. sung giam dan va khoang 1 - 2 tuan benh hoi phuc,
khong bao gia hoa mu hoac de lai di chung.
2. Viem tinh hoan:
Viem tinh hoan hay gap a tuoi thanh nien (20 - 30%) trudng hop co the gap a
ire tren 12 tuoi, thudng xuat hien vao ngay thu 5 - 8 sau khi sung tuyen mang tai
giam, benh nhi sot trd lai kem ret run, non, tinh hoan sung dau biu dai cang do 3
- 4 ngay, co the keo dai 3 -4 tuan. Viem tinh hoan co the lan sang ben doi dien 2
- 3 ngay sau (20 - 25% trudng hap). Sau 2 - 6 thang tinh hoan bj viem nho han
binh thudng. Viem tinh hoan co the tien phat khong kem theo viem tuyen mang
tai (kho chan doan neu khong co dich).
3. Viem buong trung: 2 - 5 % trudng hpp. Chi g$p a tre tuoi day thi voi trieu
chung dau bung dudi d 1 hay 2 ho chau hoac rong kinh. Co the gay vo sinh. Kho
chan doan.

51

4. Viem tuy cap: Co trieu chimg dau bung cap. sot. tieu long chan an Rat
hiern gap

it

ire cm.

5. Viem nao mang nao: Sot kem theo ret run Co dau hieu mang nao. Nhuc
dau. non. Ii bi. cung gay. Kernig ( +) thirong xuat hien vao nca> thu * - 7 cua
benh sau khi sung tuyen mang tai (ca biet co the xay ra Irimrc hoac muon hon 2
3 luan). Tre hon me co giat.
6. Ton thuong giay than kinh so:
Thudng gap ton thuong dr giay II, V II. V III.
Viem giay thSn kinh thi giac gay giartl thj luc va thi trudng Phan Idn hoi
phuc nhung cung co the gay teo than kinh thi va tnu.
Liet mat ngoai bien mot ben.
Di6c co the phuc hoi (phan Ion) hoac khong phuc hoi.
X E T N G H IE M :
Mau bach cauigiam 4000 - 5000/mm (cd khi binh thudng) ty le lympho tang
40 - 60%. Amylaza mau kSng gip nhieu !an trii fe6 binh thudng {'birth thudng la 30
don vi WoklgemutH).
Thay doi nude nao tuy trong the viem nao mang nao: Albumin tang it, b^ch
cau tang nhieu chu yeu la lymphd.

C H A N D O A N V A C H A N D O AN P H A N B IE T :
1. Chan doan xac djnh dua vao:
- Tinh hinh dang co dich. co lich su tiep xuc trong vong 2 - 3 tuan trudc.
-Trieu chung lam sang va ket qua xet nghiem thong thudng
- Xet nghiem dac hieu: Phan lap virut tu mau (2 ngay dau) trong nude bot,
dich nao tuy (trong tuan dau) nude tieu cua benh nhi (12 ngay dau).
- Chan doan huyet thanh: Nghiem phap uc che ngung ket hong cau. ky thuat
mien dich huynh quang, E L IS A , mien dich phong xa.
2. Chan doan phan biet:

I ) Viem tuyen mang tai can chu y phan biet:

- Viem tuyen mang tai co mu do vi khuan. An mu chay ra d lo Stcnon. Bach
cau tang, tuyen sung nong do...
- Viem tuyen mang lai do virut Coxsackie A: Kho nu6t. loet niem m$c
mieng ral dau.
- Viem hach co va hach trudc tai: Bach hau, bnh ting don bao nhiem trung.

52

2)

Viem linh hnan Chu y phan biet 2vdi viem tinh hoan do nhiem trimg cap

(do vi khuan va virut (Coxsackie ft).

D lfell T R I:
1. Nhung dieu can chu y:

- Bfenh nhi phai duoc nghi ngoi lai giudng, cach ly cho den khi het sot va
^ung 7 ngay. Che do an long, han long nen tuy tinh hinh benh ly, bao dam du
chat dinh dtidng, an trai cay nhieu sinh to, kieng cac chat cay, nong. Chu y ve
sinh rang mieng, sue mieng bang nude muoi nhat, nude sac kim ngan hoa
Nhung dd dimg co chat xuarti&t mom mui nhu khan lau. bat dua an ong nho phai
lupc tript trung phcri nang. Nhung ngudi phuc vu tiepxtic phai mang khau trang
2. Dieu tri bang dong y:

I ) Dung thuoc theo bien chung:

Phep chua chinh la sa phong thanh nhiet giai dpc tieu sung, tuy theo the benh
n$ng nhe dung thuoc co khac.
a) The nhe: Ngoai sung dau tai cho khong co trieu chung toan than ro
rpt hoac chi sot dau dau nhe.
- Phep chua: S a phong thanh nhi?t giai dpc
- Bai thuoc: Ngan kieu tan gia giam
Kinh gidi 6 - 8g. Bac ha 6 - 8g. Phong phong 8 - lOg, Kim ngan hoa 12g, Ha
kho thao 12g, Lien kieu 8 - lOg. Thuyen thoi 2g, Cam thao 4g, Dai tao 3 qua sac
nude uong ngay I thang. Thuoc dSp va boi ngoai: Dung 1 trong nhung bai sau
b) The nang: (On doc thinh): Sung dau nhieu, sot cao, tinh than met
moi, hoac quay khoc, non khat nude, chat ludi do tham, reu vang, mach hoat sac.
- Phep chua: Thanh nhiet giai dpc hoat huyet tieu sung.
- Bai thudc: Pho te tieu dpc am gia giam.
Kim ngan hoa 12 - 16g. Hoang dim 12g, He kho thao 12g, B6 cong anh I2g.
Lien kifeu 8 - 12g. Huyen sam 12g, Thach cao song 20 - 40g, Chi tu 8 - I2g.
Xuyen son giap 8 - 12g (sac trudc) Xich thupc 8 - 12g, Ngu linh chi 4 - lOg
- Gia giam: Mang tai sung to cung gia: Con bo, Hai tao moi thu 12g, Dai tien
tao gia D^i hoang (cho sau) 4 - 6g, bifen chung tinh hoan dau gia: Le chi hach
(h^t vai) 8 - 12g, Huong phu che 6 - 8g, non, bu6n non gia: True nhu 8 - lOg.
khat nude nhieu gia: Mach mon I2g, Sinh dja 12g, sot cao hon me co giat (viem

53

nao mang nao) cho uong Yen cung Nguu hoang hoac (.In hui> J ' rn I - 2g kc
h(rp ihuoc hoi Jap ngoai.

2) Gun ihicu mot so bin ihuoc kinh nghiem:

(1) Hoang ihj giai doc thang: Lien kieu. Ngan (hoa, Phong phong. Hoang
cam. Cam thao. Kinh gidi. Dam true diep. Ha kho thao. Dai thanh diep moi tliir
lOg tir 4 den 8 tuoi: MC>> ngay I lhang. tren 8 luoi moi v; gia them 3g. sac 2 lan
chia 3 lan uong (TfUng Quoc trimg y hi phuong loan lijp xh. 1991. tr 549) dUng
tri 2()4 ca deu khoi trong 4 ngay.
(2) Kinh ban giai doc thang: Ban lam can 12 - 2Qg. Lien keu IS - I2g. Hoang
cam 6 1 I2g, Kinh gidi. Bac ha moi lhu 3 - 6g, Ngiru bitfig ilt 6

I2g. Bo cong

anh 12 - 20g, Huyen sam 9 - I5g sac uong da tri 3(X) ca deu khoi (Trung Quoc
trung y bi phuong tr. 556).
(3) Luc vj tieu doc am: Ban lam can I5g. Nhan dohg dang I5g. Ha kho thao,
Bach cuong tam, Xich thuoc. Lien kieu moi thu lOg sac uong da tri 50 ca uong 2
- 5 lhang deu khoi (sach Trung Quoc trung v bi phuong tr 5.54).
(4) Mot so bai thuoc don gian :
- Tho phuc linh, Ha kho thao moi lhu40g sac uong.
- Kim ngan hoa, Cam thao dat moi ihtr 40g sac uong.
- Rau sam 200 - 400g hoac La diep ca 100 200g sac uong.
- Rau muong 200 - 400g sac dac uong.

3) Thuoc boi hoac dap ngoai: Doi vdi benh cung rat quan trong.
(1) Giun dat song iron chung von dirdng trang lupng bang nhau nua gid dinn
mot chat nude nhu mat ong loc qua de dung hoac Iron voi luimg Vazcrlin luong
gap 2 - 3 lan bac len bep che thanh cao mem dap ngoai 6 lan/ngay: Tn 12 ca deu
het sung tir 1 den 7 ngay (Trung Quoc y bi phuong tr. 549).
(2) Oc dong tron vdi luong dam vua du gia thanh ho dap len ngay 3

5 lan

(Trung Quoc trung y bi phuong tr. 552).

(3) Song hoang tan: Hoang lien, Dai hoang, Ngo thu du moi thu lOg. Nam
tinh 7g tan thanh bot mm hoa vdi nude la dap vao long ban chan lien 3 toi da in
200 ca trong 2 - 3 ngay khoi (Trung Quoc trung y bi phuong tr. 555).
(4) Muc lau loai tot mai phet len vung sung.
(5) Hat gac gia nat tron giam thanh boi ngoai.
(6) Bd cong anh. Hoa cuc dai luyng bang nhau gia nat Iron giam dip ngoai.

54

(7) Rau Niim hoac la voi voi gia nat Jap.

(K) Frac ha diep. Xa tien thao luong hang nhau gia nat dap
(9) Bot thanh dai lOg hoa vdi long trang trung ga dap ngoai
(10) Dau xanh M)g tron vdi giam dap ngoai.
Ket hop thuoc tay: Tay y chua co thuoc dac tri.
-Trudng hop dau nhieu, mat ngu cho Seduxen (Valum)5mg/1 vien uong
- Viem tinh hoan: Cho uong Prednisolon vien I - 2mg/ngay. trong 7 - 10
ngay.
- Chong viem tuy, truyen Glucoz 10% ket hop, giam dau hang Alropin.
- Trudng hcrp viem nao mang nao: Chong phu nao bang Manitol I - 3g/kg
dung djch 20% nho nhpt tinh mach, Prednison 5 - lOmg/kg tiem tinh mach.
Dieu chinh nude, dien giai, thd oxy luc can.
Phong b$nh:
- Cach ly benh nhi tir luc sung cho den sau khi het sung 7 ngay.
- Benh nhi phali nkm nghi tai giudng trong thdi gian s6t dfe tranh bifen chimg.
- Mac quan lot chat dfe treo tinh hoan (chong viem tinh hoan).
Tai tai nha tre va mau giao neu phat hien co benh nhi phai cach ly cac chau
khac, theo doi chat che trong thdi gian 3 tuan, co the chon cho tre uong phong
cac hai thuoc don gian tren day.
- Vacxm chong giam hoat 0.5ml tiem dudi da cho tre 5 - 10 tuoi.
Ket luan:
Quai bi la mot henh de lav nen luc phat hien henh can chu y phong henh tot.
Benh tuy lien lurrng noi chung la tot nhung co the gay hau qua lai hai cho tre vi
nhung the benh va bien chimg nang. Phep thanh nhiet giai doc cua dong y co the
dieu tri tot viem tuyen mang tai can dutrc pho bien rong rai.

VIEM GAN VIRUT

(Epidemic hepatitis)
N G U YEN NHAN BEN H :
V/iem t in co the (Jo nhieu Virut gay ra. Thmrng gap nhat la cae loai: Viem
fcan A Ju "i'a t viem gan A (H A V , Hepatitis A virus) con goi la viem gan truyen
nhiem (Infectious Hepatitis) lay truyen chu yeu qua duong tieu hoa. Viem gan B
do virut viem gan B (H B V , Hepatitis B virus) con goi la viem gah huyet thanh
(serum hepatitis) I5y truyen chu yeu qua dudng U6m. truyen mau. viem gan
khong A khong B do virut kh6ng A khong B (N A N B V , non A non B virus) lay
truyen chii yeu qua truyen mau. Ca 3 loai virut tuy co cau true hinh thai neng
biet nhung lai gay benh canh lam sang giong nhau. Mat khac ca 3 loai viem gan
deu co the xay ra cung mot luc trong mpt tp the nhirng kho phat hien vi trong
mot vu dich da so benh nhan la the khong trifeu chimg va khong vang da.
Nguon bfenh la ngudi bfenh va ngudi mang virut. Mpt benh nhan co the mac
ca 3 loai vielti gan.
T R lfeU C H U N G L A M SA N G :
Bieu hien lam sang the thong thudng cua H B V va H A V (tre rat it gap loai
H N A N B ):
- Thai ky nung henh. H AV: 15-45 ngay, H B V : 60-160 ngay. N A N B V 60
ngay.
- Thai ky third \iing da: 4 - 8 ngay. tre sot nhe, met moi, chan an. tieu chay
hay tao bon. Xet nghiem mau: Transammaz tang cao.
- Thai ky vans da: Bdt sot van chan an. nude tieu vang dam. da vang. cung
mac mat vang. phan hen bac mau. Gan ta an dau luc. Mpt so benh nhi ngira loan
than, met moi thich nam, mot so it lach to. Then gian nay khoang tu 2 den 6 tuan
- Thai ky hoi phuc. Da mat vang nhat dan, benh nhi lanh Ipi him. an biet
ngon dan. gan nho dan. Tir 1 den 3 thang. benh nhi hoi phuc binh thudng Co
mot so benh nhi tuy chuc nang gan da hoi phuc binh thudng nhung tneu chung
roi loan tieu hoa con keo dai an khong biet ngon, bung dy ...
C A C T H E B E N H L A M SA N G G A P 6 T R E E M :
I . The viem gan cap thong thudng (nhu mo ta phin tren).

2. The viem gan khong vang <Ja. Trong mot vu djch thinrng chiem l\ le can
co the gap 3 - 12 lan the vang da Benh nhi chi met mot. kem an so ma. \ung
gan dau. gan to, bung day. Co khi chang co trieu chung lam sang, kham phat
hien gan to va chuc nang gan suy giam.
3. The kich phat (con goi the ac tinh, the teo gan cap. viem gan toi cap) Benh
cap dien, benh nhi sot cao. hon me, gan teo, bung trudng co nude. chan phu. da
co not xuat huyet, chay mau mui, tieu ra mau, co giat. Benh nhi chet trong vai
ngay hoac vai thang, ty le tir vong co the cao tai 80% mot so chuyen tKinh x
gan.
4. The viem gan keo dai: chu yeu la benh hoi phuc cham, benh nhi met ^no.
chan an keo dai, gan con to, chuc nang gan hoi phuc cham nhung d tre c

ien

lirgmg van tot.

5. Viem gan man tinh: Benh keo dai trong 1 nam, benh nhi an kem, met n >
ca the suy nhuoc, co dau hieu dan mao mach (mech sao, mach chan nhen;. chu
nang gan suy giam, dien di huyet thanh: Albumin giam, A/G dao nghic-*
Gamma-globulin tang cao, tuy tinh hinh benh ly con chia ra: Viem gan man on
djnh, ton thuong gan nhe khu tru va viem gan man hoat dong kem hoac khong
kem theo xa gan, tien lupng kem.
X E T N G H IE M :
- Mau ngoai vi, toe do huyet tram co the tang cao trong thdi ky chua ang va
tra lai binh thudng luc vang da. Bach cau giam d thdi ky chua vang da

a binh

thudng luc vang da xuat hien.

- Billirubin huyet thanh tang tren lmg%, co the tang tdi 10mg%.
- Sac to mat muoi mat nude tieu duong tinh.
-

G PT

(transaminase

glutamique

pyruvique)

tang

nhici

! m

(transaminase glutamique oxalo-acetique (hoi chung huy hoai te bao gan,

GO T
nh

thudng: GOT: l,5Mml/ml/h, GPT: l,3Mml 1/ml/h). Giai ioa;' trudc vang c . ,
transaminase tang rat cao gap 5-10 lan tri gia binh thudng.
- Phan ung Gros duong tinh. thu nghiem Mac Lagan cuoi man dau bit diu
tang.
- Tim chung cd virut; H BsA G (khang nguyen be mat cua virut viem gan B )
duirng tinh trong H B V , con doi vdi H A V thi phan lap virut trong phan va xuat
hien IgM khang H A V uong huyet thanh.
- Cac phuong phap kiem tra gan bang sieu am va sinh thiet gan.

57

C H A N D O A N V A C H A N D O A N PH A N HI FT:
- Chan doan dira vao:
1

) Yeu to dich te: Tinh hinh dich henh. tiep xiic benh nhan vans: da. Iich su

truyen mau. tiem chung. cham ciru. tiem thuoc chira rang
2) Trieu chiing lam sang: Roi loan tieu hoa, vang da. gan

10.

xuat huyet. nwn.

tieu vang.
3) Transaminaz tang, phat hien cac khang nguyen. khang the trong huyet
thanh nhu HBsAg trong 2 - 5 thang dau. IgM khang H A V trong 4 9 tuan le dau
va cac khang the trong then gian sau
- Chan doan phan biet:
1) Viem gan thai ky dau va the khong vang du de bi bo qua do nghi viem
duong ho hap tren, roi loai tieu hoa. Can canh giac hoi ro iich su uep xuc va nnh
hinh dich benh.
2) Vieiti gan do nhiem doc, nhiem trung huyet da cac benh fhuung han, viem
ruot do true khuan coli co the gay viem gan vang da, GOT, GPT mau tang song
cac benh co sot keo dai va trieu chung rieng.
3) Vang da do benh xoan trung: Cac trieu ichtmg ban chan, co bip dau.
albumin nieu. co xoan trung trong mau. thu nghiem ngung ket huvet thanh ( +).
4) Vang da do tac mat: O tre sa sinh. vang da do hep ong dan mat bim sinh
vang da tang dan ma khong co trieu chung viem gan.
5) Vang da do huyet tan: Thudng kem theo thieu mau. benh phat trien cap.
xet nghiem mau de phan biet
6) Viem gan do nhiem dot thuoc: Chu y hoi tien sir uong thuoc nhu dung
thuoc co thach tin. Rimifon, Chlorpromazin, thuoc chong ung thu
7 ) Dau bung cap do viem gan can phan biet von viem ruot thua. giun chui ong
mat, giun duang ruot...
T IE N LLTONG: Viem gan tre em noi chung tien luong tot do te bao gan 6 tre
co nang luc tai sinh manh, benh phuc hoi trong khoang 2 tuan, it khi keo dai
The viem gan khong vang da tien lupng tot. Nhung trudng hap sau day tien
luong kem:
- Vang da keo dai de gay teo gan, viem gan men.
- Viem gan ac tinh de gay teo gan tu vong cao.
- Tre nho dudi 6 thang mac benh de chuyen thanh ac tinh.

58

- Henh nhi it duoc nghi ngcn cham soc. che do dinh din'mg kem. che Ji> dieu
tri ihieu tich cuu toan dien va kip thdi lam cho henh keo dai chuyen thanh man
tinh
DlfeU TRI:
1) Nhung dieu can chu y trong dieu trj viem gan tre em:
- Tre mac henh viem gan nhat ihiel phai nam vien. cach ly duong tieu hoa it
nhat 30 ngay sau khi phat hien vang da. benh chua khoi. thcri gian cach ly dai
hem. Nhan vien y te phai chu y tu bao ve tranh bj lay henh.
- Tre phai duac nghi ngcn day du tai giudng trong thdi ky vang da, chuc
nang gan chua hoi phuc va duoc nghi ngai it nhat them 1 thang sau khi khoi
benh.
- Che do an du chit dinh dudng nhieu dudng, dam va giau chat sinh to. trai
cay. kieng hoac han che cac chat beo md chat cay nong.
2) Dieu trj bang ddng y:
Theo dong y, viem gan virut vang da thuoc pham tru chung hoang dan,
phuong phap dieu trj chinh la: Thanh nhiet tru thap, luong huyet giai doc (doi
vdi viem gan cap, the viem gan toi cap) sa can kien ty hoa vi tieu thuc (doi vdi
the khong vang da, thdi ky hoi phuc) hoat huyet hoa u (doi vdi viem gan man
hoac co xct gan), tuy theo the benh va thdi ky mac benh ma van dung phep chua
thich hop.
(I)

Viem gan cap (vang da hoac khong vang da the thap nhiet): Benh nhi sot

cao hoac nhe, vang da hoac khong, kem an buon non, bung day scr md tieu tien
vang dai tien tao hoac long. Vung gan an dau, mach hoat sac reu ludi vang day.
- Phep chua: Thanh nhiet loi thap, hoa vi tieu thuc.
- Bai thuoc: Nhan Iran thang hop binh vj tan gia giarr..
Nhan tram 16g. Hoang ba 12g. Chi tu 12g, Tran bi 4 - 6g, Hu phac 6 - 8g.
Thuirng truat 6 - lOg. Cam thao 4g, Than khuc 4 - 8g. Uat kim 4 - 6g, Thong
lliao 4 - 6 g,
Sot cao: Gia Hoang cam. Sai ho moi thu 8 - 12g, thap nang gia: X a tien. Rau
ngo m6 i thu I2g, non. buon non gia: True nhu 8 - 12g. Gung tuoi 2 - 3 lai, vang
da nang gia Long dam thao 8 - lOg, dai tien tao gia: Dai hoang 4 - 6g (cho sau)
viing gan dau nhifeu, gan to gia: Xich thugc 8 - 12g Don sam 8 - 12g, bung d5y
gia: Mpc huong, Sa nhan moi thur 6 - 8g.

crt

(2) Viem gan kich phat ( the toi capi (nhiet dot ihinh) Benh phai nHaah. m *
cao vang da nang khat nude, nguv bung day luc. ire hon me noi vang. chay mau
cam hoac tieu ra mau. co ban xuat huyet. ('hai luoi do lham. reu lirn vang kho
mach huyen sac hoac te sac.
- Phep chira: Thanh nhiel giai d6c luong huyei khai khieu.
- Bai ihuoc: Te giac. Dja hoang thang gia giam
Nhan trim 2()g, Xich thuoc I2g. D|a hoang tuoi I2g, Boi simg trau (min) 12
20g, Dom bi 12g. Huyen sam I2g, Chi tu 8 - 12g. Kim ngan hoa 12

20g. sac

uong.
Neu xuat huyet nhieu gia them: Sam tam lhat (bot) 6 - 8g cho vao ihuoc
uong. Sol cao hon me cho them: Yen cung. Nguu hoang hoan I - 2g/lan
Doi vdi the viem gan kjch phai can ket hop chat che vdi phuong phap dieu in
cap cuu Y hpc hien dai.
(3) Viem gan thdi ky hoi phuc, the kfctt din. viem gan man linh: Thudng gSp

2 the benh chinh sau:

a) Can vi bat hoa: benh nhi khong sot, da het vang hoac vang nhe. gan con
to, vung gan co luc con dau luc hoac an dau, an kem hay day bung reu ludi
trang hoac vang nhe mach huyen.
- Phep chira: So can kien ty hoa \i
- Ba: thuoc: Tieu dao lan gia giam
Dinmg qui 8 - 12g. Sai ho 8 - 12g. Bach iliuoc 8 - I2g. Don sam K - !2g. l_;al
kim 6 - l()g. Bach iruat 8 - 12g. Hoai son 8

I2g, Ha ihu 6 8 - I6g. Tran hi -I -

6g, Hau phac 6 - 8g. Bach linh 8 - 12g. Chich thao 2 - 4g, Benh nhi met moi
nhieu gia Nhan sam 4 - 6g (sac rieng uong) hoac Dang sam 8 - I2g. Hoang k\ X
- I6g. con vang da gia: Nhan (ran. Xa lien thao moi thur 12 - Iftg sa. uong I
thang/ngay.
b) The khi huyet ir tre: Benh nhi gan to. dau luc. an dau lang. than lurh tim
reu lirdi vang mach huyen sac hoac maeh tram khan
- Phep chua: So can ly khi. hoai huyei hoa u
- Bai thuoc: Tieu dao tan hop Dao hong lu sat gia giam
Duong qui 8 - I2g. Sai ho 8 - !2g. Xich ihuoc 8 - I2g. Dom sam 8 - I2g. U i
kim 8 - I2g. Xuyen khung 6 - lOg. Dao nhan 6 - I2g. Hong hoa 6 - I2g. Bacf
rul 8 - 12g. Bach linh 8 - I2g, Triin bi (<- 8g. Hau phac 6 - 8g.

60

Gan to ctrng hoik them lach lo gia: Miet giap, Mau Ic cho moi thu 12 - I fig.
bung hay day hoi gia: M

qc

huong, Sa nhan moi ihu 6

8g. an kem gia: Mach

nha . Son tra moi thu 6 - 8g. sic uong 1 lhang/l ngay chia 3 lan
Gicn thieu mot so bai thuoc kinh nghiem:
f l ) Nhan tran 40g, Chi tir I2g, Cam thao day 20g.
(2) Nhan tran, Rau ngo moi thu 40 - 60g sac uong.
(3) Nhan tran, Rau ma moi thu 40 - 60g.
(4) Bo cong anh, Cam thao day moi thu-40 - 60g.
(5) Re co tranh, Rau diep ca moi thu 30 - 40g.
Lieu lugrng tren dung cho 1 ngay, tuy dieu kien co the dung 1 trong cac bai
tren, dung cho cac the viem gan vang da hoac khong, cap hoac keo dai nhirng
trieu chung chung la nhe, uong trong thdi gian tu 3 den 6 thang, thuoc co the
dung uong phong benh trong thdi gian co dich trong thdi gian I - 2 thang.
K et hop thuoc tay:
Hien nay chira co tl\u6c dac hieu tay y dieu trj cac loai viem gan, nhung doi
vdi cac the viem gan kich phat, the u mat vang da keo dai, co the ket hop dung:
- Truyen Gluco/.a 10%, Lieu luvrng 3 - 4g/kg/ngay.
- Prednison I - 2mg/kg/24gid trong thdi gian 2 - 4 luan voi lieu giam dan.
dot voi the loi cap va u mai vang da keo dai lac dung lot.
-

Tru

sinh:

Erythromycin

40mg/kg/ngay

hoac

Ampicilin

100

200mg/kg/ngay irong trudng hop nang chong boi nhiC'in hoac khi du.,t
Corticoid.
- Neu xuat huyet nhieu. co the truyen mau hay huyet tuong.
PH O N G B E N H :
1. Bien phap chung: Chu y giao due y thCrc phong benh cho moi ngudi ve ve
sinh an uong, phan nude rac, diet ruoi. Day cho tre thoi quen ve sinh: Khong dira
tay vao mom. khong choi dat. rua sach tay trudc luc an va sau khi di tieu, khong
uong nude la va an trai cay song.
2. Cach ly dudng lieu hoa benh nhi viem gan, it nhat 30 ngay sau khi phat
hifen vang da, neu chua khoi thdi gian dai hon. Thuc hien nghiem tuc che do
cach ly trong cong lac chuyen mon.

ftl

Nhung ire song Irong vung co dich henh nen uong I irong nhun;j hai thuoc

nam don gian iren day trong thdi gian 15 - 30 ngay trong then gian luu hanh
henh hoac:
- Phong viem gan A cho (at ca nhung ngudi tiep xiic voi henh nhan viem gan
A hang: I) Tiem huyet (hanh Immuno-glohdlin (SIG ) 0.02ml/kg neu thin gun
luQ tru d vung co dich dudi 3 thang, neu d lau hon cho lien 0.06ml/kg/5 thang I
lan. 2) Tiem Vacin antj H A V cho cac doi tupng tren.
- Phong viem gan B can chu y: I ) Thuc hien (ruycn mau: An (nan. chon loc
va kiem tra ngudi cho mau kHong mac henh viem gan B trong tien nu. khong co
HBsAG va anti Hbc. 2) Dung cu tiem chich. kim ch3m cuu nen dung mot lan
hoac hap tiet trimg chu dao. 3) Doi vm ngudi chua tiem phong ma co uep xuc
vdi H B V thi tiem H B IG phoi hop vdi Vacin HB. Khong nen tiem chung cho phu
ni> co thai. Lieu H B IG 0.06ml/f.g tiem bap vdi ngudi tiep xuc Vdi tre mn dc
mil me co HBsA ( +) cho H B IG 0,5m I . tiem bap trong 12 gid sau de. sau do cho
chung vacin.
Ket luan:
Viem gan virut la mot benh lay nguy hiem doi vdi tre va la mot benh co the
phong duoc cho nen phai tich cuu thuc hien cac bien phap phong benh Luc mac
henh phai duoc chua som va cach ly kip thoi tranh lay lan l ay y chira co thuoc
dac hieu. Phuong phap chua theo dong y chu yeu la thanh nhiet tru (hap luong
huyet giai doc. cac loai thuoc nam rat san d cac dja phmmg. can phai hien benh
cach ly va chira k;p then. Nen cho benh nhi dieu tri tai benh vien de co che do
cach ly tot, che do cham soc an uong nghi ngm day du. luc benh nang co hien
chimg co sir ket hop chat che vdi cac hien phap cap cuu lay y ihi kha nang khoi
benh duoc mau chong va hoan thien.

BENH SOI
(measles)
N G U Y EN N H AN B EN H :
Sdi la mot benh sot ban truyen do virut sdi gay (hanh dich. Tinh lay truyen
cao trite tiep cho tre mac benh thong qua dudng ho hap. Dong y nhan thuc do 2
nguyen nhan: Thai doc va thdi khi Tuoi m ic benh cao: Tir 6 lhang - 5 tud<

K ).

T R IE U C H U N G L A M S A N G :
1. Chiing thuan:
- Thai gian u henh (rung hinh Iren dudi 10 ngay (6-18 ngay).
- Phai benh qua 3 thdi ky:
1) G iai doan sol (sa khai) trung binh 3 - 5 ngay, sot dot ngot va tang dan,
viem hong ho mai do chay nude sa anh sang... Kem theo met moi dau dau, chan
an, tieu long... Mot, hai ngay sau kham niem mac mom co not Koplik (cham
tr5ng vien do).
2) G iai doan sdi moc: Ban sdi moc sau khi sot 3 - 5 ngay bat dau tu sau
tai gay dSu mat, lung roi den nguc bung va tay chan. Ban sudi mau hong nhat bat
dau rdi r$c co the ket thanh dam, hcri noi len mat da, giua cac ban soi co khoang
da binh thudng. Sot van tiep tuc cao hoac ha dan (neu sdi mpc nhanh va het
deu). Sot cao co the lam cho tre me man co giat.
3) G iai doan soi bay: Neu khong co bien chung, thudng sau 3 den 5 ngay
sdi nh?t va chuyen mau tham trinh tu theo nhu luc mpc dS lai vay trang nho va
khong bao gid co seo. Tre tinh than tot dan len an kha hon, bot moi met va 1 - 2
tuan sue khoe b$nh nhi hoi phuc.
2. Chung nghjch: (thudng la co bien chiing hoac tre ca the yeu suy dinh
dudng)

1) Nhung bieu hien cua chung nghich:

- Sdi mpc chua day da lan, mpc khong theo trinh tu thong thudng.
- Thai gian sdi mpc, sac mat tai nhpt chan tay lanh.
- Sot keo dai ma sdi chua mpc hoac sdi mpc da day ma con sot cao.
- Sot qua cao lien tuc hon me co giat, kho thd quanh moi tim tai.
- Sdi da bay ma benh nhi tinh than con met khong chju an.

2) Nhung bien chung thuong g$p:

(1) Viem phoi (viem phoi dom, viem phoi ke...) thudng la nang, bieu hien
nhieu the: Tim mach, ho hap, tieu hoa than kinh, nhiem trung huyet.
(2) Viem thanh quan.
(3) Viem tai giua.
(4) Viem rupt.
(5) Viem nao mang nao vao giai doan sdi mpc hay sdi bay. tu vong cao
(20 - 4 0 % ) ho$c de lai di chung liet dan don.

63

16 ) Nhung hien chimg khac nhu viem mang uep hirp. \icm ln;i t i * m*
(do thieu vitamin A ) viem mom. Mem rnom hoai tu dau ma cumi

\ j bitn

chimg thuong den voi cac tre nho ducn 1 tuoi. ire >u> dinh duirng. dieu kien \an
soc nuoi duong kem. thieu ve smh.
Mot s6 benh co the phat ra do boi nhiem trong qua trinh benh soi d<' hoi nhu
ho ga. bach hau thiiy dau can duoc luu \
T IE N LU O N G :
- D 6 i vcn chung thuan. tre Ion tuoi va thuong ngay khoe manh. ^he do dinh
duong cham soc ve sinh tot.
- Tuoi cang be benh cang nang, tre de non suy dinh duong de mac bien
chung.
- Soi co bien chung viem nao mang nao, viem ,ph6 i nang ly le tu vong cao tu

5 d i n 10% . viem nao duoc cuu song thudng de lai di chung than kinh tam than
tram uong.
- Benh nhi lao mac benh soi. lao nang ten de phat men thanh lao ke lao
mang phoi.
CH AN DO AN:
- Chan doan xac dinh chu yen dua vao:
1)

Lam sang Phat ban kem sot ho viem hong, mat do chay nure mat. dau

Koplik
2 1 Tre co tiep xuc soi va chua mac soi
3 1 Xet nghiem dac hieu co:
- Phan lap virut trong nhot hong, mau trong 5 ngay dau cua benh
- Phat hien khang nguyen virut soi trong chat nhav mui bang ky thuat mien
dich huynh quang
- Hieu gia khang the virut son tang gap 4 lan.
- Chan doan phan biet vo i cac benh phat ban:
1) Phong chan (rubella, german measles): Sot viem dudng ho hap nhe. ban
chan nho rcn rac lan nhanh toan than, khong troc vay. sung hach sau tai va gay.
2) Cap chan tre nho (roseola infantilis, exanthema subitum): S 6 t cao dot
ngoi. sot ha. xuat hien ban chan, noi len or da mau do tuoi dao ban. tneu chung
lain vang nhe.

64

3)

Sol linh hong nlncl (scarlet lever): Ban chan moc (hanh dam lien khong co

phan da lanh, hong do dau, lirfri do (ham, co vong xanh (ai quanh mieng. (roc
vay limg mang, irieu chung loan lhan nang
DlfeU T R |:
1 . Nguyen tac chung trong dieu tri benh soi:
- Tay y chira co ihuoc dac hieu. chu yeu la coi trong che do. cham soc ve
sinh dinh dudng, dieu tri irieu chung va cac hien chung.
- Dieu tri bang dong y la chinh (chu yeu voi chung thuan) ket hop chat che
vai tay y chira cac trieu chimg va bien chimg nang.
2 . D ieu trj dong y theo bien chung:

Doi vdi chung thuan:

1) Giai doan sa khai:
- Phep chira: Tan lirong thau bieu:
- Phiromg dupe: Thang ma cat can thang (thang ma, cat can, xich thupc, cam
thao) (Diem thj tieu nhi phuong luan).
Thang ma 6 g, Cat can I2g, Xich thuoc 12g, Thuyen thoi 3g, Bac ha 4g (cho
sau) Kim ngan hoa 12g Nguu bang tu 6g, Kinh giai 6 g ho gia Hanh nhan, Tien
ho, Cat canh, non gia Gimg tuoi. Che ban ha. True nhir...
Sot cao keo dai ma son chira moc roi lan dung rau miii ca cay tuoi gia vdi
rircru xat toan than.
2) Giai doan sdi moc:
- Phep chua: Thanh nhiet giai doc thau chan:
- Bai thuoc: Thanh giai thau bieu thang.
Thach cao song 16 - 20g, Lien kieu 12g, Huyen sam 12g, Cat can 12g, Kim
ngan hoa 16g, Thuyen thoi 3g, Cam thao 4g, sac uong.
Hoac bai: La tre 20g, Sai dat ! 6 g. Mach mon I 6 g, Cat can 12g, Kim ngan
hoa 16g, Sa sam I2g, Cam thao dat I2g sac uong.
3) Giai doan sdi bay:
- Phep chua: Dudng am thanh nhiet.
- Bai thuoc: Sa sam mach dong thang (on benh dieu bien) (sa sam. Ngoc true
m^ich mon, Tang diep. Thien hoa phan. Sinh bien dau. Cam thao).

65

Sa sam. Mach mon. Tang diep. Thien hoa phan. Sinh bien dau moi thi> I2g.
1.6 can linn 4()g Cam thao 4g sac uong An kem gia Ke noi kim hg. Ctx nha I2g.
Than khuc Kg

D oi voi chiing nghich:

I ) Viem phoi do sen (d6c sdi bi* phe)
- Phep chira: Tuyen phe giai doc.
- Ma hanh thach cam tlkihg gia vj
Ma hoang 8g, Hoang cdm I2g. Hanh nhan 8g. Thach cao 16 - 20g. Cat can
lOg. La diep ca 1 2g, Cain thao 4g sac ueing.
2) Viem thanh quan (nhiet doc thurmg cong yet hau) ho khan, kho tho
nang tim tai ...
- Phep chira: Thanh nhiei giai doc Ion yet heia derm:
- Bai thuoc: Huyen sam. Ngiru hang. Boi mail m6i thu I2g. Cat can 6 g. Cam
thao 4g, Qua lau nhan 16g. Kinh gioi 8g. Xa can 8 - I2g. Lo can tuoi 40g. sac
uong.
3) Viem ruot (tihidt dpc nhp dai trang) soi mpc 'khong deu, tieu long 5 -

10 lan/ngay, phan xanh chat khong tieu.

- Phep chua: Thanh nWfet thau chin chi t.
- Bin ihuoc: Thanh nhiet thau bieu thang herp cat can Can lien thang gia
giam: Cat c.n 12g. Kim ngan hoa 12g. Thuyen thoi 4g. l hang ma 6 g, Hoang
cam 6 g. Hoiir.g In n 6 g. Bach bien dau 12g. Hau phac 6 g, Phong phong 8g. Bach
truat S - ! 2 g, Gimg lirm 8g sac uong.
4) Viem nao (nhiei nhap lam bao): Me man hon me, sot cao co giat gay
cung...
- Phep chua: Lircmg huyet giai dpc tuc phong khai khieu.
- Bai thuoc: Te giac dja hoang thang gia giam.
BeM simg trau 20g (sac truck) Xich thupc 12g, Dem bi 12g. Huyen sam 16g.
Sinh dia 12g. Thach xuong b6 lOg, True diep 12g, Chu sa (bpt mm goi neng lg.
sac thuoc xong cho bot chu sa khuay deu 3 - 4 lan uong trong ngay)
Benh sot cao co giat nang can ket herp cac loai thuoc nhu: An cung Nguu
hoiing hoan. Chi bao don. Tu tuyet dem.
K et hop cham cuu trong dieu trj:
Chu yeu phoi herp dieu tri trieu chimg va cap cuu.

66

- Sol cao: Dai chuy. khuc iri hirp coc Ihieu ihinrng (chich mau i
- Kho thd dam nhieu: Xich trach. Liel khuyet. Phong long
- Hon me co giai: Nhan trung. Than mon. Hop coc. Thai xung. Thap
tuyen (chich mau).
- Hong dau, khan giong: Liern tuyen, Hop coc.
- Ia chay: Thien khu. Tuc tam ly.
- Non mua: Noi dinh. Hop coc, noi quan.
C ac bai thuoc nam kinh nghiem:
1) La diep ca tirai 100 - 200g sac nude chia 3 - 4 lan uong trong ngay.
2) Rau mui (ngo) ca cay dung hat cang to! gia nat von rurru xat khap
ngudi luc sdi kho moc. Hoac la mui xong khoi.
3) La noc sdi turn lOOg, Re say tuoi. Re co tranh tircri moi thu lOOg -

200 g dung doc vi hoac chung sac nude uong.

4) Luc sdi moc it kho thd (bien chung viem phoi) dung 1 con bo cau hoac
ga trong ta mo tim con dap dap len vung mom uc sau 30 phut het kho thd sdi
mpc deu.
Ket hop thuoc tay va cac phutmg phap Y hoc hien dai:
1) Chu y che do san soc dinh duong: Benh nhi duoc nghi ngoi day du.
cham soc tai nha hay benh vien tuy nang nhe. Phong benh nhi thoang. khong co
gio liia. Thuc an nhieu trai cay du chat dinh duang, uong du nude cho uong nude
mia lau nudng cang tot. Ve sinh rang mieng hang ngay, nho mat vdi thuoc
cloramphenicol, khi tieu chay cho tre uong nude chao muoi, O R ESO L, tiep tuc
cho bu me.
2) Dung khang sinh khi co bpi nhiem.Trudng hpp viem nao viem phoi
nang dung corticoid ket hpp. truyen dich gucoza uu truong, thd oxy luc kho thd.
D u phong: Tiem phong sdi cho tre luc 9 thang
- Phat hien benh va cach ly sdm.
- Doi vdi cac chau co tiep xuc va cho uong cac loai thuoc nam nhu la
difep ca, udng nude re tranh, la noc sdi. uong bpt san day, mudp ngot... Tuy dia
phuong, hoac tiem bap gamma globulin neu co.
- Trong thdi gian co dich khong nen cho tre nho ra dudng di chai nhieu
nai nh5t la cac cho, rap hat.

67

SOT XU AT HUYET DENGUE

(BREAKBOUL FEVER)
N G U YfeN N H A N BfcNH:
S 6 t xual huyet Dengue (quen goi la sot xuat huyei) la henh nhiem cap do
virut Dengue gay thanh dich. Virut duoc truyen tir ngurri henh sang ngum lanh
qua muoi Aedes aegypti la chinh. Trong thien nlnen virul nay co o khi. meo,
chuot Benh lan phat gay dich quanh nam. tap trung nhieu vao cac thang 6 . 7, 8.
9, nhieu a cac tinh mien nam Vifet Nam. Tre tir 3 den 9 tuoi mac benh cao. Ck:
lira tuoi khac cung co the mac henh nhung * honn.
T R IE U C H U N G L A M SA N G :
- Thai gian u benh: Tir 3 den 10 ngay, trung binh 4 - 6 ngay.
- Co 4 loai trieu chiing lam sang chu yeu:
1. Sot dot ngpt, cao lien tuc tir 3 den 7 ngay, kem theo infet moi loan than,
roi loan tieu hoa: Chan an dau bung tao bon hoac lieu chay. day hung, oi sot cao
co giat (thirong a tre nho) dau dau, mem rtlac mfil do xung huyet.
2. Dau minh may ca khap, dau nhieu ca lung.
3. Cac trieu chiing xuat huyet: Cham hoac mang xuat huyet duoi da. chay
mau cam mau chan rang, tririmg herp nang co xual huyei lieu hn.i. Hci nieu. nan.
co benh nhi bieu hien gan to, not hach 6 co. Dau day that <+).
4. Truong hop nang bieu hien soc: ha nhiet do, da tai. mach v i te kho bai.
benh nhi vat va. huyet ap ha. huyet ap ket. chan tay lanh. Ty le iir vnng do soc
co ihe 10 - 40%. Soc thurong bieu hien vao ngay thii 3 den thu 6
X E T N G H IE M M A U :
Bach cau giam hay binh ihinrng. Tieu cau giam dirc'n 100*KX)/mm. dung tich
hong cau (hematocrit) tang tren 40%. Xet nghiem dung tich hong cau nen uen
hanh 3 4 gio I lan. de phat hien soc som.
C H A N D O A N : Chu yeu dira \a o : Cac trieu chiing lam sang Sot. xuat huyet.
giam tieu cau. dau day lhal duang tinh. dung tich hong cau tang irong mot vu
dich thi khong kho. Thirong phan 4 mire dy trong chan doan de co bien phap
dieu tri thich hop:
- Do 1: Sot va trieu chiing chung, khong co trieu chimg xuat huyet.
- D q 2: Ngoai nhung trieu chung dQ 1, co thfim xuit huyet.

68

- Dp 3: Co trifeu chimg suy luan hoan: Mach nhanh nho. huyei ap ha. huyei
ap kpt, da lai, chan lay lanh, ire vat va
- Do 4. Soc nang, khong do dupe huyet ap. mach vi te kho hai
Chan doan virut. (nhu: phan lap huyet thanh, huyet tuong, phan lap tu muoi
co y nghla phai hien va du doan djch benh. Can phan biet voi cac benh co ban
xung huyet, ban xuat huyet a ire em nhu sdi, phong chan, tinh hong nhiet, xuat
huyet do nhiem khuan, do dj ung, do nhiem doc, benh suy tuy cap. benh mau ac
tinh (ung thu mau) ... Nhung khong kho vi moi benh deu co lam sang rieng.
T IE N

LUgfNG:

Tuy thuoc muc dp nang nhe cua benh: Dp I va 2 tien lupng tot neu dupe
chua trj kjp thoi, dp 4 thuong ty le tu vong cao.
D IE U T R I:
I. Nguyen tic chung trong dieu trj sot xuat h u ylt:
1.

Het sue coi trpng che dp cham soc, an uong theo doi benh: Benh nhan

phai dupe dieu trj tai benh vien. Ch 6 dp an ban long hay long tuy tinh hinh benh
nhung du chat va lupng nuoc, dung nuoc hoa qua ket hpp voi O R ESO L. Chfe do
theo doi benh phai chat che: Mach nhiet do huyet ap 1 - 2 gid 1 l&n, dung tich
hong cau 3 - 4 gid I lan theo chi dmh cua thay ihuoc.
2 Can ket herp chat che 2 phuong phap dieu tri dong va tay y de khong
cho benh lien trien xau di. Chi dmh cua dong y chu yeu la do I va 2. Doi vdi sol
xuat huyei co soc, phai ket hpp chat che vdi lay y.
3. Thdi ky hoi phuc can uong thuoc dong y de benh nhi hoi phuc dupe l6 t
hon.
II. Dieu tri bang Y hoc co truyen:

I)

D oi vai do I: Sot met moi, kem an hoac buon non, chat ludi do. reu

vang, mach sac...

- Phep chua: Thanh nhiei giai doc.
- Bai ihuoc: Thanh on bai doc am gia giam.
Kim ngan hoa

12g

Sinh dia

I2g

Thach cao song 20 - 30g

Simg trau bot

20g

Huyen sam

lOg

Don bi

12g

Xich thupc

lOg

Lien kieu

lOg

Gung tucn

12g

Cam thao

4g

69

- Gia giam: Khat nuirc gia Math mon lOg Cai i.'m

Non ; l Khinmi: han

ha.
- Day hung. Jau hung. Cua hau phai (i - Xg 1ran hi f>g. met nhieu Nham sam
Hg. Boi sung irau. Thach cat' sac inrirc. ihuoc sac chia 2 -I lan \rong ngay

2) Doi v<ri Jo 2: Ngoai nhirng dieu tri tren henh nhi co xual huyei
- Phep chira: Thanh nhiC-t linmg huyei giai doc
- Bai thuoc: le giac Dia hoang thang hop lhanh on bai doc am gia giam
Dung bai thuoc iren. tuy theo tinh hinh \uat huyei gia vi: Chay mau rang, mau
cam gia: Trac ba diep sao chay 6g. Gung chay 4g
Tieu lien co mau: Chi tu sat) chay 6g. Bach mao can sao chay 6g
Dai tien co mau: Dai hoang sao den 4 - 6g Nho noi sao 8 - I()g
Noi ban do gia: Thuyen thoi 2g. Bach cuong lam: 8 - l()g.
Trudng hop sot cao co giat gia. Cau dang 8g. Giun dat (kho) 8 - lOg Chusa
lg. Me man li bi gia: Thach xuong bo 8 - 12g. Ngoai ra neu co dung them cac
loai Ihuoc: Yen cung. Nguu hoang hoan. CHi hao dem, Tir tuyet don co tac dunj;
ha sot chong co gifii.

3 ) D oi vdi do 3 va 4: La giai doan co soc truy lim mach chan lay lanh.
huyet ap ha mach kho b a i... do am kiet duong thoal.
- Phep chira: Hoi duirng cuu nghich.
- Bai ihuoc: Sam phu thang gia vi.
Nhan sam 8 - 12g. Thuc dia 12 - 16g, Thuc phu tu4 - ftg, Mach dons I2g.
Ngu vi tu4 - 6 g. Ket hop ciru 2 huyet Dong tuyen. Tuc lam ly de nang ap

4) Thoi ky hoi phuc: Thudng bieu hien 2 the benh.

(1) Ty khi hu (hoac ly duong hu): Met moi, chan lay lanh. chan an ra
mo hoi nude tieu irong. dai tien long.
- Phep chua: Bo ty ich khi
- Bai ihuoc: Huong sa luc quan 4 - 8g x 2lan/ngay udng vdi nude com Hoac
bai: Sam linh, Bach truat lan gia giam: Dang sam 12g. Bien dau I2g. Nhuc khau

8g. Hoai son 12g, Tran bi 6g. Y di lOg, Lien nhuc 12g. Mach nha 8g. Ke noi
kim 8 - 12 g.
(2) V j am bat tuc: Chan an, mom khai moi kho tieu tien it tao hon chai
ludi do thon, mach te sac nhuoc.
- Phep chua: Duong am sinh tan.

70

- Bai thuoc: Ich vi thang (Huvcn sam Ifig. Mach mon

Thach hoc I2g. san day I 2y. Coc nha Kg. lhan khuc 6

Sinh Jia I 2ti)

Ky. C hi vac Kg. Ma

nhan I 2 g. Muong trau 8 - 12 g

Nhung bai thuoc kinh nghiem:
1. Nude sac giun dal (10 - 20g) cho uong luc sol cao ( k/n khoa nhi Vien
D.Y.)
2. Co nho noi tutn 100 - 200g gia nat lay nin'rc turn uong hoa voi nuoc soi
nguoi co lac dung cam mau.
3. Rau ngo, Re say tucri. Re co iranh luoi moi thur lOOg (chon 2 trong cac thu)
sac uong luc dai it.
4. Nuoc mia lau nudng cho uong suot trong thai gian benh. nude rau ma tuai,
hot s5n day cho uong khong han che.
5. Hai hai thuoc dung cho sot xuat huyet khong soc lai Vien nhi Ha Noi:
Bai 1: La tre 20g, Co nho noi 20g, Re co tranh 16g, La trac ba I 6g, Rau ma
16g, Gung tuai 6 g sic vdi 500ml nude con 300ml chia uong 3 lan trong ngay.
Bai 2: Kim ngan hoa 20g, Co nhp noi 20g, Hoa hoe 16g. Qua danh danh 12g,
Xuyen khung 12g sic vdi 500ml con 300ml chia 2 - 3 lan uong trong ngay.

6 . Bai thuoc nam chua sot xuat huyet tai benh vien Cha Quan TP. Ho Chi
Minh: Co nho noi 20g (hoac Trac ba diep lOg) Hoa hoe 15g, Vo quao (nuc nac)
lOg. Sai dat 3()g, do nude ngam duac lieu sac con /i, sac 3 lan Jo chung co lai
50ml. Tre nho dudi 1 tuoi. 6,25ml. 2 - 5 tuoi: 12,5ml, 6-12 tuoi: 25ml. 13 - 15
tuoi: 50ml
Cham cuu phoi hop trong dieu tri sot xuat huyet:
- Sot cao: Dai chuy, Khuc tri, Thap tuyen (chich mau) Thieu thuong (chich
mau).
- Hon me, co giat: Nhan trung. Hop coc, Thap tuyen.
- Day bung, non, buon non: Trung quan, Noi dinh, Herp coc, Tuc tam ly.
- Chan tay lanh. huyet ap ha: Cuu tuc tam ly, Dong tuyen, Khi hai
Ket hop tay y: Theo phac do cua Vien nhi Ha Npi (Trung inmg):

I.

D oi vai S X H d<? I va 2: Bu nude dien giai sdm bang dudng uong dung goi

O R E S O L co 3,5g Nacl , 2, 5g bicarbonat, Na 1, 5g Kcl, 20g glucoza pha trong 1

lit nude dun soi nguQi uong 150ml/kg/ngay.
H ? nhi^t: (neu sot tren 30 dp; Chudm mat, uong Paracetamol dudi 1 tuoi):

71

60mg/lan. I - 3tuoi: 60 - 120mg/lan. 3 - 6lu6 i: 120 - IKOmg/lan. ^

1 2luoi

180 - 240mg/lan
- An than: Seduxen: 0.2 - 0.8mg/kg/ngay neu benh nhi vai \ j
- Vitamin C: 0. Ig x 3 - 4vien/ngay uong them nude hoa qua
- Theo doi hematocrit, neu co hieu hien tang tre Hon nhieu to dau hieu mat
nin'rc, truyen dich dien giai nhir do 3.

2 . D oi vai sot xuat huyet (Jo

- 4. soc Dengue

Truyen dich co dien giai tot nhat la Ringer Lactat. neu khong co dung dung
djch Nacl 0,99f, glucoza 10%. 120 - I50ml/kg/24gid. truyen nhanh trong 4 gio
dau het 1/3 so luong, con lai truyen tiep Trudng hop da co soc ro nen bu ngay
khoi luong huyet tuong da thoat mach cho huyet tuong 10 - 20 ml/kg hoac
Dextran trong luong phan tu tren 40.000, lieu 10 - 15ml/kg, truyen 10

20 ml/kg/gid sau do tiep tuc cho cac dung djch dien giai cho den I

' at soc

danh gia bang do mach, huyet ap nude tieu thai ra. Khi soc da phut. ioi giam toe
*

I*

'

do truyen xliong lOml/kg/gid va ngdng tryyen khi the tich hong cau dudi 40*X
Trong khi truyen dich chu y iheo doi dien giai <46 de dieu chinh hop ly dien giai
va tinh trang nhiem toan. Trudng hop chay mau n<ing, thieu mau nen cho truyen
mau tuoi hay la huyet tuong giau tieu cau 20 ml/kg co tac dung cam mau va
chong thieu m&u.
Phong benh:
- Trong thdi gian co dich nen cho tre trong do tuoi de mic benh (2 lOt)
uong nhirng bai thuoc kinh nghiem tren co tac dung phong benh.
- Tich cuc thjc hien nam man chong muoi dot.
- Phat dong phong triio loan dan chong muoi va diet muoi, khong de co ao tii
nude dong, rac rudi. nude ban
- Canh giac cac benh sot cua ire nhat la trong mua dich de cho tre dupe dieu
tri va theo doi sdm.

THUY DA U
(varicella, chickenpox)
Thuy dau la mot loai benh lay cap tinh d tre em do virut thuy dau tinh la>
truyen manh. Tre tu I - 6 tuoi de mac benh. Dae diem 15m sang 1 la nhung not

72

phong nude not len lung dpi d da vung lhan minh la chinh. do do co ten la ihuy
dau,con goila thuy hao.
N G U Y E N N HAN VA B EN H L Y :
Tre mac henh cung co the l& ngudi lern la nguon lay duy nhat. Virul thong
qua bui bam di vao dudng ho hap hoac do true tiep tiep xuc vai chat bai tiet cua
not phong. Y hoc co truyen cho rang benh do ngoai cam phong nhiet thai ta, ket
hpp vdi ben trong ca the co thap trpc u tre ma sinh cac not phong nude d da.
Benh ta xam nhap phan ldn d phan khi rat it vao phan dinh va huyet nen benh
thudng la nhe.
Dac diem benh ly la nhung not hoai tu d da, niem mac va ca d ca quan noi
tang nhu thuc quan, gan, tuy, be than, tuyen thuong than, bang quang. tu cung. O
da va niem mac bat dau co nhimg not phong cham do, hinh thanh nhung not
phong nude trong, chong trd thanh due roi kho di tham lai, troc vay ma khong
thanh s<?o.
T R IE U C H U N G L A M SA N G :
- Thdi ky nung benh: 10 - 24 ngay trung binh 14 - 16 ngay.
- Phat benh dot ngot mpc len d da cac not cham do kem theo sot. thudng
dudi 39'c, benh nhi quay khoc it ngu kem an. Co khi sot truxk roi mdi moc cac
not cham do. Not phdng nude mpc nhieu d than minh va dau chan tay it. cung co
trudng hpp ca long ban lay chan deu co. Cac cham do mpc timg dpt, thuirng sau
vai gidden I ngay bien thanh mun phong nude, sau vai ngay not phong kho lom
xuong, dong vay va sau vai ngay, co khi 1, 2 tuan mdi hoan toan troc vay. Trong
thdi gian mac benh khoang 3 - 5 ngay, nhung not phong mpc len timg den. nen
luc kham thay cac not thuy dau khac nhau tren ca the benh nhi. d niem mac
mom, mat, hpng cung co the mpc cac not thuy dau. O nhirng benh nhi nho tuoi
va ca thS yeu, benh thudng nang, keo dai cham hoi phuc, de boi nhiem ngoai da
ho$c de co bien chung phoi, viem nao. 0 nhung tre dang trj benh bang corticoid,
neu mac thuy dau t*nh de lan rpng gay hoai tu nang.
B IE N C H U N G :
Bfnh nhi thuy dau co the co nhimg bien chung: Viem phoi ke. viem lai
xuong chum, viem nao. viem thi than kinh, viem da thin kinh va boi nhim
ngoai da nhung it g$p.

73

H E N LU O N G :
Doi voi ire khoc va co mj chain sot loi. henh thtnrni' la nhe Doi vcn tre co rhc
veu suv dinh dirung can het sire chu y chc do cham soc ve sinh an uong vi dc
inac hien chunj. thi lien lupng kem.
C H A N D O AN V A C H A N D O AN P H A n B IE T :
Chan doan chu yeu dira vao Kinh ihinh djch benh, lich su dep xuc ciua ire va
nliung dac diem cua irieuiclumg lam sang.
O nhung ntn co dich dau mua hang 11am, can chu y phan biet
Thuy dau

Dau mua
Tuoi

Bat ky tuoi nao.

Phan Ion tre em duoi 6 tuoi

Chung dau

Da lau hoac chua.

Khong lien quan

Trieu chimg

Nang sol cao, sau 3 ngay

Nhe dau moc cung hoac *au soi 1

toan than

dau moc.

- 2 ngay

Trinh tu moc

Moc cung 1 luc mai va

Mpc timg dpt truoc sau khong iteu

va phan bo

chan tay nhieu mihh il.

dau vaminh nhieu, chan lay it

Hinh (hai dau

Hinh iron to nho gan

Not lo nho khong deu. khong ron

bang nhaU. giuaco lom

dau. nong,an de vo

(ron dau) not dau an sau

vao da.
Mau sac

Dau mau vang. boc mu,

Dau boc nuoc trong hoac due

chan dau co viing do ro.

trang, khong co mu. chan dau co

vang do khong ro.

Ket vay va

Ket vay cham. vay day.

Ket vay nhanh. vay mong, luc troc

troc vay

troc vav co seo

vay khong seo.

Then gian

Dai. thuong 18 ngay hoac

Ngan. do 5 - 7 ngay.

hem.
Tien lupng

Xau

T 6t

D lfeu T R I:
1. Che do cham soc an uong:
- Khong de benh nhi di chcn de tranh lay lan ho|ic bpi nhilm benh.
- Cai ngan mong tay benh nhi hoac boc bkng vai d6 iranh gai tray noi dau
- Tranh tam benh nhi bang nuoc la va tranh gio lanh.

74

- C hu y ve sinh da, lhay quan ao hang ngay. nen luoc an quan hang nuoc soi
trong thai gian mac benh
- Khong cho benh nhi an nhirng chat dau mo cay nong. an nhieu rau qua (rat
cay. an cac loai dau, an chao Jiiu xanh co lac dung lhanh nhiei giai doc.
2. Dieu trj dong y (hco bien chiing:
Thudng gap co 2 the:
1. The phong nhiet kiem thap: Sot dau dau, nget mui. so mui; ho hai ihcri
chan sac hong nhuan, phong nude trong, tieu tieu b'rnh thurmg. reu trang mong.
mach thu sac.
- Phep chua: Sa phong thanh nhiet trir thap
- Bai thuoc: Ngan kieu tan gia giam
Kim ngan hoa, Nguu bang tu. Lien kieu, Phong phong deu 8 - 12g, Bac ha 6
- 8g (cho sau) Hoat thach 12 - 20g (boc sac trudc) Moc thong 6 - 8g. Cam thao 4
- 6g.
2. Thap nhi^t thinh: Tre sot cao, but rut hoac quay khoc, mom kho, mat
moi do, tieu vang it. not dau day, sac tim tham, nude sac due, hoac thuy dau.
Niem mac mom co not du loet, ludi do, reu vang day kho, mach hong dai
sac.
- Phep trj: Thanh nhiet giai doc tham thap
- Ngan kieu tan hop hoang liem giai doc thang gia giam.
Kim ngan hoa, Nguu bang tu. Lien kieu, Sinh dia. Hoang cam, Hoang ba deu

8 - I2g. Bac ha, Chi tu 6 - 8g, Ha kho thao 8 - 12g, La diep ca. La tre deu 16g.
Hoat thach 16 - 20g (boc sac trudc) Moc thong 8 - 12g. Dang lam 3g. Xac ve 3g.
Cam thao 2 - 4g.
Gia giam: Sot cao gia: Thach cao 20 - 30g, Tri mau 8

12g, Not dau to gia

Tru linh, Bach linh, Y di deu 12 - 16g.

3. B a i thuoc kinh nghiem :
1) Kim ngan hoa 30g hoac day Kim ngan 50g, Cam thao day 20g sac
uong.
2) Rau diep ca. La tre deu 20 - 30g sac uong
3) Sinh dja. Bo cong anh deu 20 - 30g sac uong

75

4)

Truong hop not dau day to de v a dune hoi Thdnh

>Thanh dai 8<>g.

Thach cao I60g. Hoang ba XOg. Hoat thach IftOg tan hot min tron Jeti) rac van
not dau da va hoac tron dau mu u boi vao r*eu dau chua va.
Phong benh:
1 . Cach ly benh nhi 5 ngay sau khi da ht not phong thuy dau
2

Doi voi cac chau co tiep xuc cach ly kiem dich I ngay ke tir ngay phat

hien benh va cho uong cac bai thuoc kinh nghiem tren.

VIEM NAO B
(Encephalitis B)
Benh viem nao B cung goi la viem nao Nhat ban B. vi la benh duoc phat bien
d Nhat ban tir nam 1871 va ngudi ta da ghi lai d Nhat tu nam 1924 dfen nam
1937, co dn 21.355 benh nhan trong do co 12.159 ngudi tu vong (ty le 60**).
Va tir do benh cung dupe phat hien d nhifiu nude uong do co Trieu Tiin, Trung
Quoc va nude ta. Benh co ten goi la viem nao B de phan biet vdi viem nao A
(Encephalitis Lethargica) do Von Econome mota diu tien nim 1917 dchau Au
Viem nao B la mot benh lay cap tinh do mot loai virut (Arbor virus) ua than
kinh truyen vao ngudi qua muoi dot. Dac diem lam sang la sot can. met moi. co
giat, hoi chung kich thich mang nao. Benh phat nhieu ve mua he thu. ty le phat
benh cao d tre tir 2 den 6 tuoi Benh thuoc pham tru chimg thu on, thvquvet cua
Y hpc co truyen.
N G U YEN NHAN VA BEN H LY:
Ngudi va cac loai gia gia sue. gia cam nhir Lon. ngira. trau. de. ga. vit.
ngan... dSu co the trd thanh nguon benh. Loai muoi van culicines. aedes chemul
poensis. Culex japoni

co the vira la trung gian chu vira la moi gidi truyen

benh. Muoi dot truyen virut vao mau, neu co the khde (chinh khi t6t) virus bi
tieu diet, nen bj nhiem virus ma khong mac benh (viem nao the an). Nguoc I91
neu ca the yeu. lupng virut lam. doc luc manh, virus theo mau vao nao gay viem
nao.
T R IE U C H U N G L A M S A N G :

- Thai ky nung benh. 11-21 ngay, trung binh 14 ngay.

76

- Thai ky phat benh: Phai benh dot ngot, bai dau sol, dau dau. non. linh than
lo mo, met moi, sau 3 - 5 ngay benh tang sot cao, co giat. hon me hoac ban hon
me, nang co the dan den suy ho hap suy tuan hoan, benh nhi kho thd. dam kho
khe, luoi do thEm it reu hoac kho den, benh nguy kich. Sau 5 - 1 0 ngay, sot ha
dan, het co giat, tre tinh dan va chuyen sang thdi ky hoi phuc.
- Thai ky hoi phuc: Thudng sau 2 tuan bnh khoi. Mpt so benh nhi co bieu
hi^n roi loan than kinh tinh than va van dong nhir: Dan dpn. ngd ngan. khong noi
dupe, chan lay liet, co quap, nuot kho, run giat ... Phan Idn dupe hoi phuc trong 6
thang. Nhirng roi loan tren d Ire benh nang (hon me, sot cao. keo dai, co giat
nhieu) co the keo dai lau horn hoac de lai di chung nhimg neu tich cut dieu tri ,
cac hau chdng va di chimg deu co the dupe cai thien.
X E T N G H IE M :
- Mau: T %bao bach cau tang tir 10.000 den 20.000/mm' hoac hon chu yeu
tang bach cau da nhan trung tinh.
- Djch nao tuy: trong hoac hcri due, tong so te bao bach cau tang nhimg
thudng khong qua 500tb/mm\ ca bi?t co the len tdi tren 1.000tb/mm' bit dau te
bao da nhan tang nhung sau do tiep theo la te bao lam ba tang, dudng va protein
binh thudng hoac hoi tang, color binh thudng.
- Phan ung ket hpp bd the huyet thanh co the giup xac djnh vu dich. Nhung
khong giup chan doan sdm.
- Neu co dieu kien, nen lay dich nao tuy, mau, phan dich hong gdi xet
nghiem virut.
C H A N D O A N V A P H A N B IE T :
- Chan doan chu yeu dua vao:
Dac diem lam sang, phat benh cap, sot cao, co giai, hon me), dac diem nude
nao tuy (trong, dudng, protein binh thudng hoac tang nhe, bach cau tang nhe, co
the vai tram, it khi qua 500tb/mm\
Tinh hinh djch b^nh.
- Chan doan phan bi$t vai:
1.

Viem mang nao mu: The nang cung sot cao, dau dau, non nhung da

niem mac co diem u huyet vung bung ngyc nhieu. Lay mau diem tu huyet lam
phidn dd xem se phat hi$n nao md cau. Te bao bach cau mau tang rat nhieu, dac
bi?l la tfi bao da nhan trung tinh, ap lyc nuoc nao tuy tang (tren 200mmH,0) mau
due vang mu, so bach cSu tang rat nhieu len tdi hang ngin/mm' 90** da nhan

77

irung linh protein lang ro. duong va coto giam. i<m pn*en J> xcrt* rac cat *1
khuan deu duong unh
2

Lao mane nao: Lich sir tier *uc lao. nunc nao tuy dm. mau co to. it

bao bach cau tang cao phan Ion la lam ha. pruein tans ro. djrm t \a 00(0 r u n
3.

L> nhiem doc: Trong 1 - 2 ngay dau soi cao co giat thuong keo theo

suy tuan boan ho h ip (6 viem nao it coi. Ngoay hau mon xet nghteoi phai teea
phan co nhieu te bao mu
T IE N L U O N G :
- Tu&i cang be tien lupng cang xau
- Benh cang nang. s6t cao. co giat keo dai. di chung cang nang ne.
- Dieu tri som va tich cuc. ket bop tot v hoc hien dai voi co truven. bcafc
phuc boi t6<bon.
- Theo tai lieu cac nuoc. ty le tu vong cua benh la 70** trong tuan diu 20**
trong tuin thu hai va chi con duoi !OT trong tuan thu 3. cho nen cap cuu 161
trong tuan diu la bt sue quan trong de giam tu vong v i di chong.
D lfeU T R I:
A . Che do cham soc an uong:
Cue ky quan trong trong khau dieu tri benh ire em v iem nao de gum ty e tu
vong v a di chung
- Tuy theo tinh hinh benh ma cho an che do long, ban long, cho du nuoc va
ch it dinh duong. du chit sinh to. cho uong cac loai nuoc mat nhu nuoc sac d6
xanh. bot san day. dua hau (dua doi... Benh nhi hon me cho an baag ong thong
da day va truy en dich
- Then kv cap dien benh nhi bon me phai Jjt k d>eu tn cap cuu tai phong cap
cuu trang bi diy du thuoc men va trang b: cb6 ng suy bo hip va tuan hoar Car
co dieu duong hoac neim nha thuong m*. theo doi dien b*n hie enso thay thuoc
de ducv cap cuu kip then D 61 voi benh nhi non roe Leo dai. phai thay dci tu the
benh nhan. de cnong loet, ve sinh rang kn cho benh nhi hang gac vo truns tam
nude muoi sinh ly lau sach nguoi cbo benh nhi ngay 1 - 2 Lan bang khan nuoc
nong. ao quan La lot tftay hang ngay. neu mai tre khong rmam lun. dap bang ga:
lam nuoc muoi sinh ly hoac md tni sinh. nho thuoc chdng nhiem khuan _
B . D iiti tri b in g dong v:

Dung ihuoc Jong y ihco Nen c/wing luan tn:

78

1. The nhe: Co trieu chung chu yeu cua phan ve va phan khi: Sol ^8 39"c, dau dau, non, met moi, buon ngu, dau Iutti do reu trang, mach nhu sac dau
chung kich thich mang nao nhe, thuirng trong I tuan co the hoi phuc
Thircrng co 2 the: Thap thang hoac nhiet thang.
a) Thap thang ngoai nhirng trieu chung chung them bung ngm: day, met moi.
buon ngu khong khat, reu trang day hoac vang day, mach nhu sac.
- Phep chira: Thanh nhiet giai doc trir thap.
- Bai thuoc: Ngan kieu tan hop luc nhat tan gia giam.
Kim ngan hoa, Lien kieu, Nguu bang tir, True diep, Kinh gidi, Bac ha deu
12g, Hoac huong lOg, Hoat thach 20g (hoc sac) Cam thao 3g. Tao 3 qua. Gimg 2
lat, Khuong ban ha 6g sac uong.
b) Nhiet thang: Sot cao, blit rut, khat nude, tieu vang it tieu bon, luoi do reu
vang, mach hong sac.
- Phep chua: Thanh nhi^t giai doc chi khat sinh tan
- Bai thuoc: Ngan kieu tan hop Bach ho thang gia giam
Kim ngan hoa, Lien kieu, Nguu bang tu, True diep deu 12g, Sinh dia tuoi, Lo
can, Tri mau deu 12g, Thach cao 40g (goi sac trudc) Dai hoang 8g (cho sau).
Trudng hop co giat: Gia Thuyen thoi 2g, Cau dang lOg, Dia long lOg, buon ngu
gia Thach xuong bo turn 12g hoac vien An cung Nguu hoang hoan 1 - 2g hoa
thuoc uong.
2. The nang: Co trieu chimg chu yeu cua phan dinh va huyet nhu: sot
cao tren 40 do, hon me, co giat lien tuc, ludi do it reu hoac reu den kho. Neu
benh dien tien rat nang co the xuat hien hoi chung khi am hu thoat. tre sac mat
tai nhot, quanh moi urn tai, kho thd, thd khong deu chan tay con am, huyet ap
hoi ha hoac binh thudng, ludi do mach te sac vo luc. Neu la tam duong hu thoat
thi chan tay lanh, than nhiet va huyet ap deu tut, ra mo hoi, sac mat tai xam, moi
va mong chan tay tim tia, ludi tim tham, mach vi te kho bat.
- Phep chua: Thanh nhi^t giai dpc luong huyet khai khiiki
- Bai thuoc: Thanh on bai dpc am gia giam.
Sinh thach cao 40g, Sinh dja tuoi, Dai thanh diep, Ngu tinh thao deu 12 20g, Sung trau (bot) (sac trudc) 40g, Tri mau, Hoang cam, Don bi, Xich thuoc.
Huyen sam deu 12g, Lien kieu lOg, Dja long lOg.
- Doi vdi the nang benh nhan thudng la hon me phai cho uong thuoc bang
song va nen k6t hop dung cac loai thudc hoan dim nhu: Tir tuyfet don, Chi bao

79

d<rn. An cung nguu hoan hoang do tang hieu lUv thanh nhiei giai J'*.. Iran kinh
khai khiGu. Truong hirp xuat hien khi am hu thoat dung Sinh mach lan de ich khi
phuc mach. nt;u lam duirng hu thoat. dung hai Sam phu Long mau lhang de hoi
duang ciru thoat
- D 6 i vai the-nang. can ket hirp dong lay y dieu tri irieu chung

I . Sot cao:
(1) Cho benh nhi nam phong lanh dudi 30c. hoac dat da d giuong henh
chudm da d tran dau. lau ngudi henh bang khan am, xat con 30 . lot la sen cho
benh nhi nam.
(2) Cham huyet Dai chuy, Khuc tri, mo hoi nhieu them Phuc luu. hoac chich
nan mau cac huyet Thieu thmrng, Thuong duang, Thap tuyeh.
(3) Dung bot sung trau (tre dudi va 3 tuoi 30g/mdi ngay, tren 3 tuoi 60g moi
ngay) sac trong 3 gid lay nude cho uong hoac cho qua song dudng mui
(4) Trudng hop nang cho Dexamethason 0,5mg/kg/24 gid chich hip, hoac
Hydrocortison 4 - 8 mg/kg/llan, cho vao djch glucoza ID% - 250ml nho gipt linh
mach, ngay 1 lan, diing lien 3 ngay. Hoac dung Prednison I - 2mg/kg/ngay chia
3 - 4 lan udng hoac cho vao song qua mui. Neu benh con nang dung irong 5 - 7
ngay, roi giam lieu

2. Co giat:
(1) Cham nhan (rung. Hap coc, Thai xung, Hau khe kich thich manh. dung
An cung Nguu hoang hoan. Chi bao dom 1 - 2g.
(2) Phenobarbital 5 - 8mg/kg/24 gid chich bap hoac Diazepam 0.1 0,2mg/kg chich tinh mach cham trong 3 phut.

3. Suy ho hap:
(1) Chu y hut ddm rai. cho thd oxy
(2) Chong phu nao: Mannitol

20%, lieu 1,5 - 2g/kg truyen nho giot tinh

mach trong 30 - 60 phut, co the nhac lai sau 12 gid. Trudng hap hon me sau co
the cho cac loai thuoc dong y nhir To hap huang hoan 1 - 2g/moi lan

4. Suy tuan hoan (Trieu chung cua tam duong suy): Chan lay lanh. huyet
ap tut, mach kho bat ... Tuy tinh hinh cu the ngoai vi^c dung cac loai ihuoc
cudng tim. nang ap. loi tieu. co the ket hap cuu dong tuyen. Tuc tam ly. chain
noi quan. Nhan trung co tac dung nhat djnh.

Thai ky phuc hoi:

80

Do henh sol cao keo dai keo dai gay ton thuong tan dich. khi huyet su> ton
lam cho chan am cua 3 kinh tam can than hao ton nang gay nen dan don. ngo
ngan, sot chieu. mo hoi trom, long ban chan tay nong, noi kho ngong hoac cam.
chan tay liet ciing, co giat, luai do tham it reu hoac kho loet. moi kho do mach te
sac nhugrc hoac huyen sac.
- Phep chua: Tu duang can than, hoat huyet khu phong
- Bai thuoc: Dai djnh phong chau gia giam
Qui ban, Mifet giap, Sinh dia deu I5g, M lu le 30g, Mach dong, Bach thuac,
A giao (hoa uong) deu 12g, Cau ky tii lOg, Hoai son. La dau, Dan sam deu lOg,
Chich thao 4g. Ngudi met mdi, an kem gia Nhan sam, Hoang ky deu I2g. Co
giat nhifiu gia Chu sa Ig, tan bot mjn hoa uong, Toan yet 4g.
Cham cuu: Chu yeu dung tri cac hpi chiing roi loan than kinh, roi loan ngon
ngu va van dpng. Chpn huyet tuy chiing nhu sau:
- Nuot kho: Thien d<jt, Liem tuyen, Hop coc, Nh3n nghenh.
- Lipt mat: Dja thuong, Giap xa, Duong bach, Ngu yeu, Hqp cdc.
- Non di: Npi quan, Noi dinh, Trung quan, Tuc tam ly.
- Cam, noi kho: A mon, Lien tuyen, Thong ly, Hap cdc.
- Mu: Tinh minh. Toan true, Ngu yeu, Dong tu lieu, Can du, Hanh gia,
Quang minh.
- Dan don, ngd ngan: Bach hpi, Npi quan, Than mon.
- Thao cuong, mua may: Hop coc, Thai xung, Tam am giao.
- Nuot kho: Liem tuyen. Hop cdc, Kim tan ngoc djch.
- Chan liet hoac co cung: Hoan khieu, Phong thi, Duang lang tuyen, Tam am
giao, Tuy$t cot, Con Ion, G iai khe
- Tay liet hoac co ciing: Kien tinh, Kien lieu, Dai chuy, Khuc tri, Kien
ngung, Thu tam ly. Hap coc.
- Co lung mem nhun: Phong tri, Than try, Thn du, Kien tinh.
- Diec: Thinh cung, Thinh h0i, Nhi mon.
Ngoai ra dung cac phuong phap xoa bop, veo cQt song, bam huyet ket hop
giup cho tre m ic bfnh phyc hdi tdt hon.
Phong benh:
- Cach ly bnh nhi cho d&n luc hfet sdt 1 - 2 tu&n.
- Di$t mudi va nhn man la bn phap chdng b?nh tich eye.

81

Chich vacxin phong henh viem nao B.

BENH BAI LIET TRE EM

(Paralysis infantile)
Benh bai lit tre em cung goi la viem cap tuy xam sung trudc (acute
poliomyelitis) la mot benh lay cap tinh do mot loai virut duang rupt (Entero
virus) tra than kinh gay benh. Dac diem lam sang la sot kem theo irieu chimg '.icu
hoa va ho hap va lt^t mem cac chi. Ty le mac benh cao d tre tu 1 -5 tuoi. ( I nuoc
ta da co thuoc uong phong bai liet nen ty I? mac bnh giam di rat nhieu tuy chua
het. M ic b?nh mpt lan thudng duac mien djch sudt ddi.
N G U YfeN N H A N V A B E N H L Y :
Nguon lay la benh nhi thdi ky cap tinh va ngudi mang virut. Virut co nhieu
trong chat xuat tiet dudng ho hap va trong phan. Thdi ky trudc va sau khi phat
benh 5 ngay la thdi ky lay Ian manh nhat. Virut ton tai trong chat xuat tiet dudng
ho hap tuong d6 i ngan nhung duong phfin thudng keo dai. Trudc khi phat b^nh
2 -3 tuan da co virut trong ngudi benh va sau khi phat bSnh 6 tuan hiu hit ngudi
benh da khong con mang virut. Trong mot vu dich. ngudi mang mam benh
chiem khoang 50%, con so ngudi mac benh the an gap 1(X) lan so benh nhan co
trieu chung va day la nguon lay rat nguy hiem. Thudng qui dmh thdi gian cach
ly la 40 ngay.
Virut truyen benh chu yeu qua dudng tieu hoa va ho hap, do thuc an nguon
nude o nhiem virut truyen qua dudng mieng, do bui bam, khong khi o nhiem
truyen qua mui nhung truyen qua dudng tieu hoa la nhieu han. Tre em dudi 6
thang con dupe hudng kha nang mien dich cua me nen it mac benh. con tre tren
5 tuoi phan ldn mac benh nhe hoac mac benh the an ma dupe mien dich benh
b^i li?t tre em co the phat vao bat ky mua nao trong nam nhung thuong tap trung
vao cac thang 6 , 7, 8 , 9.
Virut bai li 6t xam nhap vao ca the co the gay ton thuong toan bp he thin
kinh, vo nao, trung nao, hanh tuy, tieu nao v.v... nhung d tuy song la nang hem
ca, nhit la vung co va vung that lung. Virut true tiep lam tdn hai tfc bao thin kinh
v|n dpng cua chat xam sung trudc tuy song gay nen li?t cac chi, tuy theo muc do
va vj tri tdn that ma tinh chat va vi tri liet khac nhau, tinh hinh hdi phuc cung

82

khac nhau. Nhimg gan ca liet lau ngay se teo dan va khong van dong duoc, kho
hoi phuc. Co khi kem theo viem co tim hoac viem phoi.
Theo Y hpc co truyen, benh doc (virut) thuoc loai phong thap nhiet ta do
mdm mui xam nhap ca the pham vao phe vi nen co trieu chifng sot, hpng do.
hoac non, tieu chay ... Chuc nang phe vi (ty) suy giam gay nen khi huyet mat
didu hoa (phe chu khi vi la nguon goc cua sinh hoa) gan ca mat dinh duang ma
sinh bai liet. benh lau ngau khi huyet cang bj ton thuong, tinh huyet khong du thi
can than cung hu tdn ma sinh chimg nuy (gan ca teo liet).
T R IE U C H U N G L A M S A N G :
- Thdi ky nung benh: Thudng tir 5 - 14 ngay (co the 3 - 35 ngay).
- Benh phat dot ngot nang nhe rat khac nhau. Co the chia qua trinh benh lam
5 thdi ky:
/. Thai ky b it dau (sa khai): Trieu chimg nhiem khu&n nhe nhu sot 38 39"c, dau dau, md hdi nhieu, an kem kem theo non hoac buon non, tieu chay
hoac tao bon, tre kho chiu quay khoc, hoac dau hpng, so mui ho... Sau 1 - 4 ngay
sot ha, ngudi trd lai binh thudng.

2. Thai ky truoc liet: Sau khi ha sdt 1 - 6 ngay, benh nhi lai sot, ra mo hoi
dau dau tinh than la ma, dau hpng tiep heo la toan than ca bap dau, lung gay
cimg. Tre nho khong thich be, tre Idn muon ngoi phai chong tay dua sau lung, co
dau chung kich thich mang nao. Benh co the dung lai d day, hoac chuyen sang
liet.

3. Thai ky liet: Thudng sau khi sot lai 3 - 4 ngay thi xuat hien liet dac
diem cua liet la liet timg nhom ca, khong dong deu, liet mem khong doi xung
Thudng liet d tu chi, chan nhieu hon tay, phan xa gan xuong mat. neu te bao than
kinh tuy vung co nguc bi nhiem se liet co hoanh ca sudn gay kho thd. Hanh tuy
bi benh gay suy ho hap, suy tuan hoan. Ca thanh bung liet thi phan xa da bung
mat, byng loi timg cho. Neu liet ruot thi tre khong chu dpng di tieu dupe. Cac ca
liet thudng cimg luc vdi sdt. Neu het sot dp 2 ngay thi liet khong phat trien nua.

4. Thai ky hoi phuc: Sau khi phat benh 1 - 2 tuan, benh chuyen sang hdi
phuc. Do ton thuong than kinh nang nhe khac nhau, nen qua trinh hdi phuc
nhanh cham khac nhau, nhe khoang 1 - 3 thang, nng phai 6 dfen 18 thang hoac
chuyen sang giai do^n di chung.

R3

Thm ky di chiing: Mot so

5.

cct

do than kinh ion ihuong qua nang khong

hoi phuc sinh teo ca. chan tay. than hinh di dang 'I'huong sau khi phai henh IK
thang, kha nang hoi phuc ral kho.
X E T N G H IE M :
1

Mau: Thcri ky bat dau va truoc liet, so luong te hao hach cau ting nh?:

10.000 - 15.000/mm', te bao da nhan trung tinh tang nhe Toe do lihg mau tang
2. Nuoc nao tuy: Thai ky truoc liet te bao thudng ting: 50 - 500/mm . then
ky dau te bao da nhan trung tinh tang sau do chu yeu la te bao lam ba. protein
thcri ky dau binh thudng sau tang dan, dudng hai tang.
3. Xet nghiem virut: L iy djch hau hpng, phan, nude nao tuy trong cac tuan
diu de cay phan lip virut co y nghia ve djch te hpc.
C H A N D O A N V A PH A N B lfe T :
- C hin doan chu yeu dtra vao tinh hinh dich te va Ijch sir tifep xuc cua tre,
nuoc nao tuy luc chua xuit hien lift.
- Luc da xuit hi^n liet chu yu dya vao die diem liet (liet m&n. timg nhom
co khong doi xung...). can phan biet vdi:
(1) Viem nhi&u re thin kinh: Khong sdt, liet tang din keo diu hang tuin,
liet chi doi xung kem roi loan cam giac. Protein nude nao tuy ting ro. t bao it.
(2) Bai liet thd hanh tuy chu y phan biet viem nao B .
T IE N LU O N G :
- Sot con keo dai la liet con phat trien.
- Sot cao hay thap. trieu chung nang hay nhe khong lien quan dfcn muc d0
liet va co liet hay khong.
- C hin doan sdm de dieu tri va nghi ngoi co the tranh dupe lie* phat tridn.
Dieu tri sdm va tich cuc co the tranh dupe liet hoic liet cung hdi phuc nhanh.
- Tien lupng benh tuy thuoc vao cong tac dieu trj, vi tri bnh ly cua co qaun
than kinh va muc do ton thuong sau nong cua te bao thin kinh. Tfc b io thin kinh
ton thuong sau kho hoi phuc. C a liet sau cung hoi phyc trudc. 6 thing diu h6 i
phuc nhanh, thdi gian sau cham dan.
- Diing thu6c dong y kfet hpp cham cuu xoa bop giup hdi phuc t6t hon.
khoang nua so benh nhi liet trong thdi gian dudi 1 nim co thS hdi phuc boan

toan.
D lfeU T R I:

84

A . Che do cham soc fin uong:

- Tuyet doi nghi ngoi trong thcri gian bnh nhi con sot va sau khi liet it nhat
t

tuan. Dap am cac chi liet de cct hoi phuc tot hem.
- Che do an uong du chat dinh duirng va sinh to. Che do long, ban long then

ky bftih cap diin, che do thudng then ky hoi phuc. Benh nhi khong an duoc phai
cho 2n hang song.
- Tre bi dai phai thong bang quang, khong tieu dupe phai thut neu cham
khong ket qua.
- Ddi vdi the hanh tuy suy ho h ip va tuin hoan can dupe chuyen dieu tri tai
mpt co so y t i co trang bi cap cuu d iy du.
R . Dieu tri t o g liw g y :

t Bien chung luan trj:

1) Thdi ky bdt dao va trade Het: Sdt, buon non hoac non, nhieu mo
hdi, but nit, la mo- ho$c quay khde, Jim. loan than (cham vk> ngudi tie khoc,
khong cho h i). Reu ludi vang dSab mach hoat sac.
- Phep chua: Khu phong thanh nhiet thong l^c
- Bai thuoc: Doc hoat ky sinh thang gia giam
Doc hoat 8g, Tang ky sinh- 12g, Tan giao 12g, Xuyen nguu tit 12g, Duong
qui I2g. Bach thupc 12g, Cat can 16g, Hoang cam 12g, Bach linh I2g, Hoang ba
I2g, Don bi I2g, Sinh hoang ky I2g, Cam thao4g, Gung tuoi 12g.
+ Non, tieu chay: H o ic huong chinh khi tfin 4- 8g uong vdi nude gimg.
+ Mo hoi nhifiu gia: Mau le (boc sactfuoc) I 6g, La dau 8g.
+ Dau oo nhifeu: Rupu que hoac gung 10% xoa co dau.
2) Thdi ky lift: T rifti chung chu y&uJa lift chi, liet co mSt (meo mom)
hoac lift co bung (loi d bung) L ift ho hip (kho thd, kho khe) L ift co bang quang
(bi dai hoac dai khong tu chu), but rut, mom khat, ludi do, reu vang, mach hoat
sac.
- Phep chua: Thanh nhiet Ipi thap thong l*c, bo khi hoat huyet.
- Bai thudc: Bo duong hoan ngu thang gia giam
Sinh hoang ky 30g. X ich thupc 8g, Duong qui 12g, Xuyen khung 8g, Sinh
dja 12g:, Dao nhin 4 - 8g, Dja long lOg, Th^ch cao 30 - 40g, Y di 16g, Dang tam
2 - 3g. Cam thao 4g.

3)

Thai ky hoi phuc va di chimg: Do benh lam ion ihuvmg can thar

khi huyet kem gay ca leo va liet

- Phep chira: Bo ich can lhan. on thong kinh lac. dung thuoc ket hop chani
CLTU.

- Bai thuoc. That bao my nhiem don gia giam.

Hoang ky. Ha thu o, Thuc dia. Duong qui, Tuc doan, Xuyen nguu tat, Ba
kich thien, B 6 c6 t chi dSu 10 - 12g, Nhyc thung dung 8g. Nhan sam 8g. Hat sen
12g, Cam thao 4g.

2. D iiu trj bang cham cuu. xoa bop, van Jong chi Cham ciru va xoa bop.
van dong chi chu y&u dung cho chiing liet va chong teo ca hoi phuc chuc nang
van dong. Tuy theo bo phan ma chQn huyet cham cun:
1) Chi tren: Kien ngung, Khuc tri. Ngoai quan, Hap coc.
2) Chi duoi: Hoan khieu, Tuc tam ly, Phong thi, Duong ling tuyen. Tuyet cot
3) Liet mjit: Giap xa, Dja thuong, Hap coc.
4) L ift ca hoanh: Cuu vT, Cach du, Ky mon.
5) Liet ca bung: Ttiihg quan, Luong mon, Khi hai.

6 ) Liet ca bang quang: Than du. Bang quang du, Trung eye.
7) Tao bon: Quan nguyen, Tuc tam ly, Dai trang du.
Co the ket hap phuong phap dien cham hoac chon chi.

3. Xoa bop va van Jong lieu phap la rat co gia tn de chong teo ca va phuc
hoi chuc nang chi liet.

4. K et hop thuoc tay: Tay y chua co phuong phap va thuoc dieu tn dac
hieu nhung ket hap tay y trong dieu tri trieu chung va cap cuu la rat can ihiet.
- Tre dau co nhieu cho Aspirin hay Paracetamol 0,05g/kg/ngay.
- The hanh tuv suy ho hap va tuan hoan can chuyen den co so y te co trang
tam cap cuu.
- Co boi nhiem viem phoi cho tru sinh nhir Penicilin, Ampicilin ...
- Tre bi dai va bi tieu tien truong hop cham cuu khong dat k it qua dung thut
dai trang hoac thong duong tieu.
- Trudng hop thdi ky cap dien sot cao, cho u6 ng nhieu Vitam inC ngay 1 - 2g
hoac truyen dich glucoz 50% - 40 - 60ml gia I - 2g Vitam inC chich unh mach
ngay 1 - 2 lan de giam bot phii ne to chuc than kinh co Igri cho hdi phoc benh.

86

Phong benh: La vo cung quan trong can duac moi gia dinh quan triefde tieu
diet chung bai liet.
1. Chu y tuyen truyen phong benh, tap quan ve sinh, an uong. Xu ly tot phan
nude rac. Trong thdi gian co dich benh khong cho tre den cac nen dong nhu rap
hat, cho..., khong cho tre chai dua qua sue.
2. Tre mac benh phai cach ly tieu hoa 40 ngay va cach ly ho hap trong tuan
dau phat benh. Cac chat bai tiet ddm phan phai tiel trung. Ao quan chan man tre
benh dung phai duac giat ky, lupc nude soi. Cac do chai, do dung cua tre mac
benh phai de rieng, thudng xuyen phai nang.
3. Qui dinh che dp bat bupc uong vacin bai liet cho tre tu 2 thang - 7 tuoi

BENH LAO
(Tuberculosis)
Lao la mpt benh lay man tinh thudng gap a tre em va anh hiromg nhifeu den sy
phat trien cua tre. Nhimg ySu t6 thuan Ipi de benh lao phat triSn d tre em la: tuoi
nho (tuoi cang nho ty le m5c benh cang cao) tinh trang dinh duong kem, tap
quan ve sinh khong tot, tre em hay mac nhieu benh (nhir sai, ho ga, tieu chay
man tinh ...)
Benh lao thuoc pham tru chimg lao trai hoac hu lao theo Y tioc co truyen.
Nhieu tre nhiem khuan lao nhung chi mpt so tre mac benh lao.
N G U YEN NHAN V A B EN H L Y :
Nguyen nhan benh la vi khuan lao Mycobacterium tuberculosis. Nguon lao
truyen cho tre em thudng la nhung trudng hpp lao hd d ngudi ldn nhu lao
hang, lao xa hang a phoi, do tre tiep xuc, hit phai nhung giot xuit tiet nho co
chua vi khuan lao tung vao khong khi. O lao dau tien thudng la a phoi. Hien nay
tuy da co thuoc chung lao, thudc dac hieu ch6ng lao nhir Streptomycin, P.A.S,
Rimifon. Rifampicin, nhung a nude ta hien nay benh lao van con la mpt moi de
doa cho sue khoe cua tre va thuoc dong,y van la thuoc ket hpp rat quan trpng
trong dieu trj bnh lao.
Do vi khuin lao co trong bui bSm ma benh co thg lay qua dudng ho hip (do
thd) va dudng tieu hoa (do nuoc u6 ng. thuc an bj nhilm khuin)

T R IE L C H L N G L X M SA N G :
Bieu hien trieu chimg lam vang cua benh lan la kh-i pnir. '.jt

thav Joi tii)

theo vi tri ton thurmg va giai Joan tien irien

! Lao so nhiem
Lao so nhiem pho bien la d phoi Tre hu phai vi khuan lao gay mot o ton
thircmg diu tien d phoi. mot so vi khuan lao theo duong lam ba ten hach lam ha cr
canh phe quan chinh lam hach to len tao hinh din trong thudng La hinh anh tre hi
so nhiem lao. Tre sot nhe. sut can it. neu tre khoe co the hoi phuc hrnh thudng
- Then gian u henh: Tir khi nhiem khuan dfen khi nghiem phap Tuberculin da
duong tinh khoang tir 2 tin 10 tuan

2. Lao cac bo phan khac

Neu tre yeu. dac biet la cac tre nho. vi khuan d l lan tran trong co the ga> lao
cac bo phan.
- V i khuan theo dudng lam ba ja y lao phoi. tao mang phoi. tan hach ...
- V i khuan theo duong mau gay: Lao ke loan the. chu yeu gap d tre duoi 2
tuoi. tie suy dinh dudng. lao mang nao, lao xuong khdp (nhat la Lao cot song) lao
than...
C H AN DOANr
Chan doan benh Lao khong the dua vao tneu chung lam vang hoac ket qua
chieu chup X quang ma phai dua vao nhung tu lieu tone hop nhu sau:
1 Lich sir tiep xuc co gia tn Idn nhat la doi vdi tre nho
2 Tneu chung lam sang:
- Tneu chung chung cua mot benh man linh: S 6 t nhe hoac trung binh keo dai
met moi. mo hoi trom. an kem, ho lau ngay. sut can hoac khong tang can. hoi
phuc rat cham sau khi mac benh nhiem khuan nhat la son. ho ga.
- Tneu chung neng:
+ Hach to va nhieu, lau ngay khong nho, co cai khong di dong (lao hach)
+ Viem phoi dieu tri lau khong khoi (lao phoi)
+ S d t dau nguc tran dich mang phoi nude vang (lao mang phoi i
+ Viem mang nao nude trong hay vang co ua (lao mang nao)
+ Bung to co hach va co trudng (viem mang bung lao)
+ Dau lung, bien dang cot sdng. dau khdp btag (fan cot sdng. lao xuong)
+ Dai mau timg dot vo khuan (lao th ja)

3. Xet nghK*m:
- Phan ling Mantoux. van 0,1ml Tuberculin loang 1/2000 (5dim v; TU ) hoac
pha loang 1/1000 ( lOdom vi T U ) doc ktM qua sau 48 - 72 gid. Duong kinh not san
dudi 10mm la am linh. Iren 10mm la duong linh. Thu nghiem Mantoux am linh
cung khong loai trirdupc lao neu tre suy yeu hoac suy dinh duong.
- Soi dom hoac dich bao tii tim vi khuan lao
- X quang phoi tim ton thuong lao, hoac chup cot song, khdp, than neu nghi
co ton thuong lao.
- Soi day mat tim cu lao d vong mac.
- Xet nghiem cac djch va to chuc neu co nghi ngd.
- Toe dp ling hong cau tang cao.
- N 6u co dieu kien phat hin tryc tiep vi khuan Mycobacteria d cac chat dich
bang nhuom Auramin 0, soi kinh hien vi huynh quang.
- Sinh thifct hach lam ba.
Phong benh:
Tre em rSt de nhiem lao nen khau phong b?nh-la cue ky quan trpng. Chu y
cac m$t sau:
1. Giao due tap quan ve sinh trong sinh hoat hoc tap vui choi cho tre, tap the
due thudng xuyen, an uong ve sinh, dieu do, du chat dinh dudng. Thuc hien tot
chircmg trinh xoa doi giam ngheo, nang cao muc song toan dan. Chong cac te
nan xa hoi la anh hudng den sue khde cua tre.
2. To chuc kham sue khde dinh ky cho tre tai cac nha tre, Idp mau giao,
trudng hoc, khu pho de phat hien benh, cach ly sdm va dieu tri kip thdi.
3. De khong che nguon lay, nhung ngudi mac benh lao trong ddm co vi
khuan lao nen cach ly dieu tri tai benh vien hoac khu dieu dudng benh lao.
4. Tiem chung B C G cho moi tre luc mdi sanh va tre dudi 1 tuoi. Thudng kha
nang mien dich sau khi chung lao duy tri dupe 4 - 5 nam nen cach 3 -4 nam lam
let Mantoux am tinh nen chung lai, thurdng tre em nen dupe chung lai vao cac
tuoi 1,4,7, 10, 14, 17.
5. Vdi tre con bu ma me bi lao, van co the tiep tuc cho bu neu tinh trang me
khong qua yeu va trj dir phong bang cach cho tre udng Isoniazid lOmg/kg/ngay,
trong 3 thang, kifem tra djnh ky 3 thang 1 lan.

89

LAO PHOI
(Tuberculosis pulmonalis)
Lao phoi thudng chia ra lao sa nhiem va lao tliir phat Tre em thudng mac lao
so nhiem. thuong gap co 3 the: hoi chung so nhiem, lao hach lam ha va lao ke,
thuong gap d tre nho dudi 1 . 2 tuoi.
N G U YEN NHAN VA BEN H LY :
Tre nhifem khuan lao qua dudng ho hdp. Khuan lao sinh soi nay no tai mach
lam ba vao hach, gap luc tre yeu sue chong do kem ma gay henh nhe thi co cac
trieu chung nhu sdt chieu, mo hoi trom, moi kho khat nude, an kem met moi,
nang thi tre sot cao, me man, co giat kho thd (the lao ke).
T R IE U C H U N G L A M S A N G :

1. Lao sa nhiem va lao hach lim ha phe quan: Hai the henh nay kho phan
biet tren lam sang.
- Trieu chung: Nhe thi tre chi met moi, kem an (thd) hoi nang co sot nhe keo
dai. ho, mo hoi trpm, gay, kem an... Thudng gap d tre Idn tuoi. Tre nho dudi 2, 3
tuoi thudng sot cao dot ngot, trieu chung nhu cum hoac viem phoi, neu hach lam
ba to gay chen ep phe quan thi co trieu chung ho con, kho thd tuc nguc tieng
khan.
- Xet nghiem: Thu nghiem Mantoux duong tinh, do lang hong cau tang
- X quang phoi: Phoi co dam md nho va cung ben phoi co hach lam ba to
hinh thanh anh dui trong hoac qua ta. Neu ron phoi dam, dam md lan ra dinh lien
vdi trung that la hinh anh lao hach lam ba phe quan.

2. Lao ke cap tinh: Thudng gap d tre dudi 1 - 2 tuoi.

- Trieu chung: Sot cao dot ngot, kho thd, ho, an it, ra mo hoi, quanh moi tim
tai. Co trudng hop gan lach to. Nghe phoi khong phat hien benh ly hoac co it ran
am nho.
- Xet ngiem: Tong so bach cau co luc tang rat cao. Tet Mantoux duong linh.
Kiem tra dich vj co the phat hien khuin lao.
- X quang phoi: Luc dau chi thay nhanh phe quan d|m , sau 2 - 3 tuin phat
hien 2 phe trudng phan bd deu lam tim hat ke.
C H A N D O A N V A C H A N D O A N P H A N B lf T :

90

- Chan doan (nhi/ phan dau da neu) chu yeu dua vao trieu chung lam sang,
can lam sang va lich su tiep xiic.
- Can phan biet von

1. Thuvmg han: Co thi s6t keo dai nhung bach cau giam 3()00 4000/mm', ty le lam ba cao, toe do lang mau khong tang, huyet thanh chan doan
*Widal duong tinh... X quang khong co dam ma a phoi.

2. Viem phoi: Phat benh dot ngot sot cao. Tong so bach cau va ty le bach
ciu da nhan trung tinh tang ro. Kiem tra X quang phoi va vi trung hoc giup xac
djnh chan doan.
D IE U T R I:
1) Che do cham soc an uong:
- B 6nh nhi phai duac nghi ngai tai giuong hoac ho?t dng nhe tuy theo tinh
hinh benh. Can duoc ngu nhieu Va co nhieu thoi gian hoat dong ngoai tron. dua
tre di choi nhung noi thoang mat, noi ngu va sinh hoat thoang mat.
- Ch 6 dp an long, ban long hoac che do cam thuong tuy tinh hinh benh
nhung yeu cSu du chat dinh duong va cac sinh to A, B, C, D.
- Can giu khong de benh nhi cam lanh va mac cac benh nhiem khuan khac vi
neu boi nhiem se lam cho benh lao nang them.
- Phai cho benh nhi uong thuoc dung Ion dan cua thay thuoc.
- Benh nhi phai duoc cach ly it nhat sau khi khoi benh 6 thang men duoc di
nha tre hoac di hpc.
2) Dieu tri bang dong y:
Tuy hien co nhieu ihuoc lay dc hi$u chong lao va dung thuoc tay la chu yeu
nhung ket hpp dieu tr; bang dong y la rat quan trpng de giup bnh hoi phuc
nhanh hon, giam nhe cac bien chung do thuoc tay (nhu Rimifon, Rifamycin h?ii
gan. Streptomycin hai than kinh thinh...) va doi vai nhung trudng hpp nhan
thuoc tay thi thuoc dong cang co gia tri.
- Phep chua: Thanh nhiet tu am, nhu(in phS sinh tan
- Bai thu6c: Luc vi dja hoang hoan hpp Sa sam, M ?ch dong thang gia giam.
Sinh dja 10 - I2g, Hoai son lOg, Som thu 8 - lOg, Don bi JOg, Dia cot bi lOg, Tri
mau 8 - lOg, Sa sam lOg, Mach mon lOg, Tang b^ch bi lOg, Hoang cam lOg.
Trudng hpp am hu nang gia: Mifet giap (d|p vun sic nuoc)l0g, Hoang tinh lOg,
nu khi hu (m$t moi chan in , noi nho) gia Bach truflt 8 - lOg, Nhan sam 6 - 8g.
neu ho nbieu gia Bach bo 8 - lOg, TrSn^bi 6g, dam kho kh^c gia Qlia lau bi 8 -

91

lOg. Xuyen hoi mau (tan hot hoa ihuoc uong) H - l()g. mo hoi trom gi<i Mau l<
20g (sac trudc). La dau lOg. Hoang ky song I2g.
- Gidi thieu bai thuoc kinh nghiem:
( 1) Bach bo 20g. Hoang cam lOg. Dom bi IOg sac uong ngay I thang. thuoc
che thanh hoan goi la Cam bo dom" ngay uong 4 - 6 g chia 2 lan.
(2) Ha kho thao, Ngu tinh thao. Cam thao bac moi thu lOg sac uong moi
ngay.
(3) Toi vo tim 3g. bo vao nuoc soi I - l,5phui, vdt ra cho vao 30g gao nau
chao an, tron them bot Bach cap 3 - 4g an ngay 2 lan
(4) Mat de say kho lam thanh vien boc, moi vien Ig hot kho. ngay uong 3
vien chia 3 lan.
(5) Ga mai den con (ga to) hoac ga ac. lam thjt bo nipt gir tim gan cho vao
50g nip, 20g d6 xanh, |0 dQt la dau. chung cach thuy n moi tuan 2 con.
( 6 ) Huyen mach Bach bp thang (Trieu Truong Vinh) benh vi?n Long Hoa
Thupng hai: Bach bp I5g. Mach mon. Huyen sam, Don sam. Hoang cam, Ha
kh6 thao, Nam, Bac Sa sam deu 9g, ngay uong I thang chia 3 lan. Lieu tren cho
tre 7 tuoi tro lai, tre lorn hon hoac nho co gia giam. Trudng hpp am hu gia Hoang
tinh, Ha thu o do, Nu trtnh tu deu 9g. neu khi hu (hon tho ngan. met moi. it noi)
them Hoang ky (hoac Dang sam) Bach truat 9g. Da dung tn 24 ca. tneu chiing
lam sang duoc cai thien.
Dieu trj bang thuoc tay: (Gim thieu cach dieu tri benh lao theo Vien ba>)
ve sue khoe tre em - Sach cam nang dieu tri Nhi khoa 1991)
(1) Lao khong co tneu chimg (Mantoux dinrng tinh, X quang phoi am tinh):
Isomazid lOmg/kg/ngay (toi da 300mg). trong I nam uong
- Theo doi X Q phoi 3 thang - 6 thang mot lan
(2) Lao phoi. tran djch mang phoi. Lao hach co:
- Isomazid lOmg/kg/ngay. uong vdi Rifampicin lOmg/kg/ngay hay
PA S

(Para-aminosalicylique)

0,2

0.3g/ngay,

hoac

Ethambutol

15mg/kg/nga>, thay the cho PA S a tre tren 13 tuoi. Tac dung phM cua
Ethambutol la viem than kinh mat (nhin md. mu mau sac, thi trudng kem) do do
khong dung cho tre nho. Thdi gian 18-24 thang tuy sudien bien benh.
(3) Lao mang nao, lao ke:
- Isomazid 20mg/kg/ngay. Rifampicin lOmg/kg/ngay, trong 14 - 24 iuch
thang, cung vdi Streptomycin 20 - 40mg/kg/ngay trong 4 tu la diu.

92

(4) Lao xuong. Lao thn, dining liet mpu:

- Dieu trj nhu lao phoi, Iran d|ch mang phot trong 12-24 thang Cac thuoc
khac:
- Pyridoxin 25 - 50mg/kg/ngay. khong can thiet voi tre dum 10 tuoi. Tru khi
tre kem dinh duong.
- Corticoid: Co the lam giam qua trinh viem mang phoi, mang ngoai tim. Co
thfi cho khi hach ron phoi qua to lam tro ngai ho hap. Trong lao mang nao,
Corticoid co the lam giam tinh trang tang ap lye npi so.

SOT RET
(Malaria)
Sot ret la mpt lo?i benh lay cho tre do muoi Anopheles co mang ky sinh
trung sot ret Plasmodium dot.
Dac diem cua benh la nhung con sot ret co dinh ky, benh nhi mic benh
thuong bi thieu mau va lach to co anh hudng xau den su phat tien cua tre ve the
lire va tri luc, nhung com sot ret ac tinh co the uy hiep tinh mang. O nuoc ta soi
ret con la mot benh can dupe toan dan tich cue phong va tri bmh nhat la doi voi
tre em la doi tupng de mac benh nhat.
N G UYEN NHAN VA BEN H LY :
Nguon lay la nguoi benh co mang ky sinh trung sot ret Plasmodium. Co 4
loai Plasmodium gay sot ret cho ngudi la: P. Falciparum, P Vivax. P. Ovale, P
Malariae.
Cach lay truyen:
- Chu yeu do muoi Anopheles cai (chu yeu la lo?ti A. minimus (tru an ngoai
trdi) vira la vat chu trung gian. vua la moi giai truyen benh.
- Chich truyen mau nguoi benh sang ngudi lanh, chich ma tuy khong pho
bien.
- Do mau me co Plasmodium truyen cho con qua rau thai.
Thoa trung xam nhp vao hong cau, mpt m|t sinh truong lam vo hong cau
(gay ret run va sot), mt khac tiet chat d0c cung lam cho dp b6 n cua hong cau
giam nen de va. Thoa trung cung hong cau bi nhiem ket tu a thanh m?ch lam

93

cho tat nghen. mau luu thong cham gay hoai lu. xuat huyet noi ian Hong cau
vor nhieu sinh thieu mau. doc to cua (hoa trung gay phan img tang ^inh cua le hao
vong nen gan. lach to. a tre em lach to la thuung gap a the sot ret a<- tinh. do t5c
mach gay hoai tiro nao ma bieu hien the nao tren lam sang (sot. co giai. ho. hon
me), rfghiem trong hon co the gay ton thinmg cu tun, tuyen thuong than xual
huyet, hoai tu sinh choang.
Theo Y hpc co truyen, nguoc tat la do nguoc ta, chudng khi (Son lam chuong
khi) phong han thu thap xam nhap co the, phuc tai phan ban bieu ban ly, chinh
khi cung ta khi giao tranh sinh ra sot ret run, ta khi nam phuc thi khong com
Benh lau ngay ty vj ton thuong sinh met moi, khi huyet hu. huyet u dam tr? sinh
ngupc mau (gan lach to). Con co luan diem "vo dam bat thanh ngucc" v noi do
5n uong that thudng, lao luc qua sue lam ton thuong ty vi, vn hoa kem sinh dam
tich, hoc vo hu bat thanh nguoc la do co the yeu de mac benh sot ret, deu noi
Idn co che sinh benh sot ret theo Y hoc co truyen.
T R lf U C H U N G L A M SA N G :
- Thai ky nung benh: Dai ngan tuy thupc nhiem loai Plasmodium khac nhau:
P. Falciparum tu 7 dfen 15 ngay, P. Vivax tu 12 - 20 ngay (co chung co thdi gian
keo dai 6 - 9 thang), P. Ovale tu 11 ngay den 10 thang, P. Malariae tir 20 ngay

d i n 10 thang.
- Thai ky phat benh:
Bat dau benh nhi sot 38 - 39C lien may ngay. O tre 1cm, benh canh giong
ngudi Ion: Nhuc dau, buon non, co khi dau bung de nham vdi thuong han Ve
sau com sot ro rft, con dien hinh thudng co 3 giai doan:
(1) Giai do^ui ret run: Benh nhi on lauih, song lung, met moi roi tiep tuc ret
run l^uih toan thin, sic mit xanh tai, mach nhanh nho yu, keo dai 30 phut den
vai gid, tre nho thudng co giat it ret run.
(2) G iai doan sot nong: Than nhiet tang dpt ngpt 39 - 4l"c, mat do. mach
nhanh, khat nude, dau diu va toan than, non hoac buon non, keo dai 1 - 6 gid, co
khi 2 - 3 ngay.
(3) Giai doan toat mo hoi: Sot ha, va mo hoi, co khi than, nhiet ha <ftn duoi
muc binh thudng mpt it roi tro lai binh thudng, ngudi mt moi. Chu ky len con
sdt ret tuy thupc nhi&m loai Plasmodium. Sdt 1 ho&c 2 ngay I con thuong do P.
Falciparum, s6t cach nh|t do P. Vivax.sOt 3 ngay 1 con do P. Malariae. Sau
nhung con sdt ret, benh nhi thu mau, da xanh xam ving bung. 6 vung co st
ret luu hanh, b$nh nhi tai nhm rfhu lin co in ita dich nn cac con sAt ret

94

khong dien hinh 3 giai doan ma co khi chi on rel, nhuc dau, ngap vat va buon
ngu.
Ngoai the dien hinh sot ret con, thuong gap cac the sau:
1. Sot ret o tre duoi 3 tuoi: Com khong dinh hinh, thudng khong co ret run
hoac chi lanh co chan tay, than nhiei (hau mon) co the rat cao 40 - 41c, mo hoi
ra nhieu hoac chi co trieu chung roi loan lieu hoa nhu non buon non, tieu long,
co khi la mot trang thai tieu chay nhiem dpc. Lach to rat nhanh va nho lai cung
nhanh sau khi dieu trj. Co khi bung an dau ro, gan lach to, thanh bung cirng de
nham voi viem phuc mac, viem ruot thua.
2. Sot ret ac tinh: Giai doan ret run ra mo hoi khong ro ret, sot cao, keo dai
40 - 4l"C, phan nhieu sot giao dpng, moi ngay 1 - 2 lan, co luc sot lien tuc tren
36 gia, thirong gap cac the chinh sau:
(1) The than kinh: Sot cao, cuong hoang hon me co gift, trieu chung kich
thich mang nao.
(2) The tieu hoa: Non va buon non, tieu chay.
(3) The tim mach: Than nhiet ha xu6 ng duoi muc binh thuong, m?u:h nho
kho bit, huyet ap ha, chan tay lanh dan den tryy tim m^ch.
(4) The than: Tieu mau. lieu huyet sac to, protein nieu, vo nieu...
3. S 6 t rel do truyen mau: Then ky nung benh thuong tir 7 din 10 ngay. Tneu
chimg nhu con sot ret thuong nhung it con hon va co xu huong tp khoi. It tai
phat.
4. Sot ret do me truyen cho con qua rau thai: Con gpi la sot ret bam sinh.
Benh phat o tre so sinh khong qua 5 - 6 ngay tuoi, Kham lam sang benh nhi co
trieu chirng thieu mau va lach to trpng lupng giam.
X E T N G H IE M :
H 6 ng cau, huyet sac to, bach cau deu giam, benh man tinh keo dai, bach cau
giam nhifiu, co khi xuong den 1000 - 2000c/mm', bach cau don nhan tang, co khi
len toi 20 %.
Tim ky sinh trung sot ret trong mau giup xac djnh chin doan va phan biet cac
lofli mim benh khac nhau.
B IE N C H U N G B E N H S O T R E T :
1.

Bien chung phoi gay viem phe quan, tu mau phoi, viem phoi thuy (co khi

d6 ng thai vai cac con sot ret).

9*5

2 Bien eh ung gan Gun sung ilfin idi viem gan. \ugan. su> g.'n
3. Lach sung do lu mau
4. Bien chung than sinh viem than d tre sot ret lau nga\ rtuix tieu co protein
nieu. hong cau. tru nieu.
5. Huyet sac to nieu: Benh nhi dot ngot sol cao 39 - 40 c. tinh than suy
nhuCTC. bung dau that, vang da. mach nhanh yeu. Trong I - 2 nga>. hong cau co
the giam xudng con horn 1.000 000 mm', nunc lieu it mau nau den hoac v6 nieu
Benh nhe khoi trong vai ngay. benh nang dan den suy tim. ure huyet cao gay tir
vong.

6 . Bien chung tinh than kinh: Thudng gap d the ac tinh Sot ret co khi gay lipt
nua nguoi, dong kinh co giat ... Gay roi loan tam than, khddai. dan don sau con
sot ret.
7. Thieu mau. suy dinh during, suy mon Otachexia).
C H A N D O A N P H A N B IE T C H A N D O A N :

1. Chan doan chu yeu dua vao:

1) Trieu chung lam sang: Sot timg dot kich phat, com sot co kem ret run,
sot lien mien hay timg com, sot theo chu ky 1 hay 2 ngay 1 lan a tre em nho tu6i
thudng sot khong co chu ky dien hinh.
- Kem theo sot tre bi thieu mau, vang da nhe. lach to, dau dau. dau co the,
kem an. tieu chay, nuoc tieu sam mau
- Benh dien tien man tinh, thai gian giua cac com, tre cam iha\ khoe, chcn
binh thuong. thmrng lach to dan len
- Nhung cun sot ret ac tinh do P. Falciparum: Me sang, co giat. hon me. tan
mau manh, choang. dong mau trong mach lan toa, suy than, phu phoi. truy tim
mach.
2) Ket qua xet nghiem mau: Ky sinh trung sot rel duong tinh
3) Yeu to djch te hoc: Benh nhT dang hoac da song d vung luu hanh benh.
4) Dung dieu tri de chan doan: Trudng hap khong tim tha\ k\ sinh trimg
sot ret. dung cac loai thuoc chong sot ret trong 3 ngay ma khong ha soc. co the
loai trir benh sot ret.

2. Chan doan phan biet:

0 tre nho va d6i vdi nhung thd bfnh khOng dtfn hinh. chu y phan bifct:

96

1) Thm ky cap tinh The sol ret ac linh can phan bici un:. Viem nao. viem
m ang nao,

thwrng han. viem be than. viem phoi nang. Lao kc. L ) nhiem doc. la

ch a y nhiem

dpc. benh xoan khuan Leptospira.

2) Thcri ky man tinh chu y phan biet vori: Benh lao. benh suy dinh duong
nang.
DlfeU T R I:
I. Nguyen tic dieu tri benh sot ret:
- Tri kip thoi, dung thuoc du lieu.
- Phai duoc theo doi trong qua trinh dieu tri va tiep tuc dung thuoc chong tai
phat tir 3 dSn 6 thang. Khi xet nghiem mau khong thay ky sinh trung it nhat 3 lan
moi ngumg thuoc dac hiSu.
- Trong then gian mac benh cho benh nhi an che do de tieu hoa va du nunc
ch5t dinh dudng va chat sinh to. Doi voi tre thieu mau cho thuoc tro gan va
thu6c co chat sat, truong hop nang cho truyen mau.
- Dung thu6c dong hay tay y tuy theo dieu kien cu the cua benh nhi va thuoc
men. Nen dung I, 2 loai thuoc die hieu tay y chong ky sinh trting sot ret kem
theo thudc dong y co tac dung dieu chinh co the nang cao sue chong do, giam
duoc tinh khang thuoc cua tan duoc.phong corn sot ret tai phat.
- Nen dung thuoc uong. neu co ket qua khong can dung thuoc chich.
- Doi voi tre sot ret ac tinh. nen ket hop dong tay y. theo doi benh chat che
va xu tri cap ciru kip then Truong hop benh khang thuoc tay co the nghien ciru
dung thuoc nam, thuoc bac.
- Dung phuong phap Y hpc co truyen: Uong thuoc hoac cham cuu nen tien
hanh truoc luc benh nhi len con I - 2 gid moi phat huy hieu qua tot.
II. Dieu trj bang dong y:

I) Dung ihuoc theo bien chung luan tri: Tuy theo the benh dimg thu6c nhu
sau:
(1)

The benh chung thieu duong: Sot ret lanh tinh, truoc khi s6 t gai ret

hoac luc sdt luc ret (han nhiet vang lai) nguc sudn day tuc, bu6 n non, kem an.
mom dang, reu ludi trang.
- Phep chua: Hoa giai thieu duong

- Bai thuoc: Tieu sai ho thang gia Thudng son, Thao qua.

Q7

Sill ho 12 - I6g. Bun ha ft - 8g. Hoang cam 8 - I 2;j. Dung sum 8 I2g.
Thmrng son 4 - lOg. Thao qua 4 - 6g. Dai lao 6 - IOg. Cam ih.m 2 - 4g. Ciimg
iiriri 2 lai Neu rel run nhieu. il mo hoi gia Que chi 2 - 4g khinmg hoat 4 - 8g._
nguc lire hung day gia Thanh b'l (hoac Tran hi) 4 - ftg. Hau phu^ b - 8g
(2) The lhap nhiet. The on nguoc sol nhieu ret it hoac cht sot khong ret.
mo hoi it, nang dau. cac khcrp va than minh dau. khat ninK. tieu it do, tieu tao
bon. Chat ludi do reu day vang, mach huyen sac hay hoat sac.
- Phep chua: Thanh nhiet tao thap
- Bai thuoc: Thmrng truat bach ho thang gia giam
Thach cao song (sac truoc) 20 - 30g. Tri mau 8 - I2g, Cam thao 4g, Thanh
hao 10 - 12g, Hoang cam, Thirong son deu 8 - 12g, Thuong truat 4 - 8g, Tan
giao 8 - IOg.
Neu sot cao tan dich ton thuong (moi kho, ludi do tham) gia Sinh dja, Huyen
sam, Thach hoc deu 8 - 12g, thap nhiet n^ng gia Hoang liem 3 - 6g, Hoang ba,
X a tien tudeu 8 - 12g, dam nhieu gia Boi mau, Chi thuc, Tran bi deu 6 - 8g.
(3) The hu nhiet: Benh nhi sot cao keo dai lau ngay gay ton thuong chan
am co trieu chung sot nhieu ve dem, nguoi nong, long ban chan tay nong da kho
khat nuoc, tre but rut it ngu, moi kho ludi thon do m?ch te sac.
- Phep chua: Dudng am thanh nhiet
- Bai thuoc. Thanh hao Miet giap thang gia giam
Thanh hao, Miet giap, Sinh dia, Thien hoa phan, Sai ho 12g. Tri mau. Don
bi. Dia cot bi deu d - 12g. Thudng son 12g. Dai tao 3 qua.
(4) The han thap: Thuoc loai han thap nguoc, ret nhieu sot it, sudn nguc
day tuc, bung day an kem kho tieu, ngudi met moi, reu ludi day, minh may dau,
mach tram hoat hoac huyen hoat, nhu hoat.
- Phep tri: Tao thap trir han
- Bai thuoc: Sai binh thang (Tieu sai ho hop Binh vi tan gia giam)
Sai ho, Thuong truat deu I2g, Thao qua. Binh lang, Hau phk: <fi*u 8 - I2g,
Tran bi 6 - 8g, Cam thao 2 - 4g. Gudng tuoi 2 - 3lat.
(5) Sot ret lach to: Tre sot ret kem lach to, bung truong. ngudi met moi,
sac da xam, ngudi tim nhat tram nhuoc hoac tram sap.
- Phep chua: Tru nguoc hoa tich
- Bai thuoc: Miet giap am tii gia giam.

98

Thimrng scm, Sai ho, Miet giap. Hoang ky deu I2g. O mai. Binh lang. Xuyen
khung, Thao qua, Hau phac deu 8 - IOg, Gimg tuai 2 - 3 lat.
Tat ca hai thuoc deu sac uong va truoc luc len can I - 2 gid

2) Dung cham cuv. cac phuong phap khong dung thuoc:

- Cham cat can trudc luc len can 1 - 2 gia
Huyet chinh: Chon I trong 2 cong thuc:
( I)

Dai chuy, Dao dao, Gian su. (2) Noi quan, Tuc tam ly, Khuc tri. Cham ta

ve manh, luu kim 15-20 phut, ngay cham I - 2 lan tiiy tinh hinh len con.
Huyet gia giam:
- Ret nhieu: Cuu ngoai quan, Hop coc.
- S 6 t cao, co giat: Cham Nhan trung, chich nan mau Thap tuyen, Thieu
thuong.
- Hon me: Nhan trung, Hop coc, Thai xung.
- Dau dau nhieu: Bach hpi, Liet khuyet, Dau duy, Thai duong.
- Non, buon non: Thuong tinh, Noi dinh.
- Duong thoat (chan tay lanh, huyet ap ha, ra nhieu mo hoi, mach kho bat):
Cuu Khi hai. Dong tuyen. Lao cung.
- Phirung phap niet tich (veo dpc 2 ben cot song dpc cac huyet giap tich tir
huyei Phe du den Dai trang du.
- Giac cac huyet Dai chuy va Dao dao trudc luc len can 2 gid

V Ket herp dieu tr/ hang thuoc tay dac hieu:

( I ) Sot ret do P. Falciparum:
- Tai vung chua co khang thuoc cho:
Cloroquin, Delagil lOmg/kg uong (hoac chich bap neu can) tiep theo 6g gid
sau 5mg/kg/ngay trong 2 ng^y tiep theo. Uong cung co moi thing 1 lieu nhu tren
trong 3 thang.
- Tai vung co khang thuoc cho:
Quinin

sulfat

25mg/kg/ngay, chia

3 lan,

trong

3 ng&y, cimg

vdi

Pyrimethamin: Tre dudi 10kg cho 6,25mg cho moi ngay, trong 3 ngay.
- Tre tir 10 - 20kg, cho 12,5mg/ngay, trong 3 ngay.
- Tre 20 - 40kg. cho 25mg/ngay, trong 3 ngay, cung vdi Sulfadiazin
(Sulfonamide) 100 - 200mg/kg/ngay, chia 4 15n trong 5 ngay (toi da 2g/ngay).

99

Neu henh nhan nang khong uong dinre. dung Qumin dihydn*.lorid chich linh
mach lieu 25mg/kg/ngiiv. cho nira lieu tmng I gitrdau. con nira lieu chu trong ft
- 8 gid sau. hoa loang ihuoc irong dung djch muoi sinh ly 'tn nong dp 0.5 I.Omg/ml. nho gipl 0.5 I.Omg/phui. ihco doi huyei ap va Jten nm
(2) Sol rel do P. Vivax va P. Malariae:
Cloroquin photphal lOmg/kg (hay chich bap sau). Hep ihco 6 gid sau:
5mg/kg, roi 5mg/kg/ngay irong 2 ngay licp ihco. cimg

%cn Primaquin

0,3nig/kg/ngay, trong 14 ngay (toi da 15mg/ngay).

- Trudng hgrp nghi sot ret nhung chua tim duoc ky sinh trung. co the dung
Cloroquin, Delagyl va Primaquin.
- Trudng hgrp sot ret nang can dieu tri ho trp tich cuc vdi:
+ Hoi phuc can bang nude, dien giai bang uong hoac chich truyen tinh
mach.
+ Truyen hong cau neu lan mau nang gay thieu mau

+ Manitol chong phii nao, suy than.

+ Thuoc chong co giat trong the nao.
(Phac d6 dieu tri Vin Nhi trung uong)
Phong benh:
- Tang cudng phong irao ve sinh phong djch. Phat dong cao trao quan chung
thudng xuyen diet muoi. bo gay va no: muoi de (bui ram. ao tu. ir nude dong).
- Ca nhan triet de nam man. dung nhang chong muoi. thuoc boi chong muoi
cung nhung bien phap dan gian diet muoi
- Dieu tr| dir phong neu trong gia dinh co ngudi mac benh xot ret hay d viing
co lim hanh sot ret.

VIEM D U O N G HO HAP TREN CAP TINH

(Acute infection of the upper respiratory tract)
Viem duirng ho hap tren la chung benh viem nhiem chung cua cac bo phan
dudng ho hap nhu mui, hau hong ke ca viem amidan (neu viem khong khu tru
noi bat d amidan), thuat ngu dong y thudng gpi la chung ihuong phong" ho$c
"cam mao" la mot chung benh thuirng gap a ire em. Neu viem co linh khu tru d

100

moi bo phan nao nhieu horn thi co the chan doan la viem mui. \iem hong hoac
viem amidan.
Viem dudng ho hap tren co the la giai doan bat dau cua nhieu benh nhiem
nhu soi, ho ga, viem phoi. viem nao v.v... Cung co khi la benh cum. co tinh chat
lay lan, can chu y phan bipt.
N G UYEN NHAN BEN H LY:
Mam gay benh co rat nhieu: Cac loai virrut (chiem tren 90%) va vi khuan
virut thuong gap co: Rhinovirus. virut dudng rupt ECHO, virut dung hgrp dudng
ho h&p, Adenovirus... Vi khuan gay benh co: Lien cau khau nhom A (nhieu nhat)
phS cau khuan, tu cau khuan... Mam benh lay qua bui hoac true tiep tiep xuc, co
khi lay qua dudng rupt (it). Tre em de mac bnh vi co the tang phu con non yeu,
sue d khang con yeu. Mot dua tre co the mac benh viem dudng ho hap trung
binh 10 lan trong I nam, thudng mic vao luc thdi tiet thay doi, cam lanh dot
ngpt, luc tre suy yeu do benh tat, do an uong thieu thon, do sir cham soc gia dinh
yu kem, tre sinh hoat trong moi trudng am thap thieu ve sinh.
Theo Y hQC co truyen, viem dudng ho hap tren thupc chung cam mao, ta khi
xam nhap vao phe lam cho phe khi mat tuyen thong (phe chu bi mao, khai khieu
d mui) gay nen sot, chay nude mui hoac tac mui kho thd ho ... Tre von ty thudng
bat tuc nen cam phai ngoai ta cung anh hirdng chuc nang ty, sinh ra chan an. met
moi. non. bung day, tieu chay. Tre than chi yeu (bo may than kinh chua phat
trien hoan thien) nen khi mac benh tre kho ngu but rut, sot cao cung gay me man
co giat.
T R IE U C H U N G L A M S A N G :
Benh nang nhe rat khac nhau.
- The nhe: Chi co hat hoi, tac mui. so mui nude trong, ho nhe, hong do, Tre
Urn co the keu dau hpng, do 3 - 4 ngay khoi hoac co the keo dai 1 tuan. Tre nho
de co non va tieu long.
- The nang: Tre sot cao 39 - 40C hoac hon, met moi, ludi an. ngu khong yen
giic, tit'p theo la ho nhieu co ddm viing, hpng do loet dau. Trieu chung toan than
nang nhu s6 t cao co giat thudng gap d tre dudi 2. 3 tuoi, keu dau bung quanh
r6 n. An khong dau (do nhu dong rupt tang hoc viem hach lam ba mang bgng).
- Viem amidam cap: La nipt the benh co chan doan rieng khi triu chung cuc
bp ro: Amidan sung tav to. dau co mu (thudng do lien cau khuan) kem trieu

101

chung loan lhan Sot cao chan an met moi. dau Jau. benh ihu'fng keo dai 5, ft
ngay hoac lau hon
X E T N G H IE M :
Mau: Tong so bach cau giam. binh thmrng hoac tang nhieu it tuy ihuoc mam
gay benh. neu do virut, bach cau ihinrng giam hoac binh ihinrng, neu la vi khuan
thi bach cau tang va da nhan trung tinh tang cao.
BlfeN C H U N G :
Benh viem duong ho hap tren cap tinh thuong la nhe, tien luong toi, nhung
neu la ca the cua tre suy yeu, benh nang ma cham soc kem. chua tri khong kjp
then de co bien chimg. Co the co may loai bien chung can chu y sau:
1. Bien chung tir viem mui hong lan ra: Vtem mang uep hop cap, viem xoang
mui, viem mom, viem thanh quan. viem tai giua, viem hach lam ba d co (co the
hach to do phan ung viem). ap xe sau yet hau, viem mu quanh amidan, viem phe
quan va viem phoi.
2. Nhiem khuan qua duong mau nhu: Nhiem khuan huyet, ap xe sung tay
duoi da, viem co tim, viem phuc mac, viem khdp, viem mang nao, nhiem khuan
duong nieu.
3. Nhiem khuan dj ung gay cac benh viem cau th^n cap, viem co tim cap,
benh thap. viem gan, ban di ung, hen phe quan.
C H A N D O A N V A P H A N B IE T :
Chan doan chu yeu dua vao trieu chung lam sang, chu y cac mat sau:

1 . Tinh hinh dich benh: Canh giac voi cac benh lay cap tinh nhu son, ho ga,
viem gan cap, bai liet tre em (thai ky sa khai)..
2. Benh cum: Co djch va tneu chung toan than nang hon.
3. Viem ruot cap: Luc co tneu chung dau bung non, tieu chay.
4. Cac benh viem nao mang nao. luc co trieu chung sot cao giat. Noi chung
viem dudng ho hap la trieu chung bat dau cua nhieu benh nhiem cho nen phai
theo doi ky tinh hinh dich benh tai d;a phuong.
D lfeU T R I:
I. Dieu tri bang dong y: Doi voi the nhe co thS don thuln dung dong y.

I) Bien chung luan tri: Thudng chia lam 2 thS bfcnh.

(1) The phong han:

102

- Tneu chimg chu yeu: Sol so lanh khong ra mo hoi. tac mui. chay nuoc nun
trong, hiit hoi. ho it, dau dau, ngira hoac dau hong. Reu luoi mong (rang, mach
phu.
- Phep tri: Tan on giai cam
- Bai thuoc: Kinh phong bai doc am (tan) gia giam
Kinh gim, Phong phong, Khuung hoat, Chi xac deu 6 - IOg. Tien ho 8 - 12g.
Cat canh 4 - 6g, Cam thao 3g. Tran bi 4 - 6g, Gimg tuoi 4 - 6 g
Gia giam: Dau dau nhieu gia: Bach chi 6 - 8g, ho nhieu gia: Bach bo 6 - 8g,
an kem gia: Mach nha. Than khuc deu 6 g, reu ludi day, buon non hoac non gia:
Bach linh IOg, Ban ha 6 g, co mo hoi bo khuong hoat gia Bach thuoc IOg, Que
chi 4g.
(2) The phong nhiet:
- Trieu chung chu yeu: Sot hoi co mo hoi. dau dau, tac mui, hat hoi. chay
nuoc mui dac, ho dam vang nhe, h<?ng do dau, reu luoi mong vang, mach phu
sac.
- Phep trj: Tan luong giai cam.
- Bai thuoc: Ngan kieu tan gia giam.
Kim ngan hoa, Lien kieu. True diep, Nguu bang tu deu 10 - I2g, Cat canh,
Kinh gim deu 6 g, Thach cao song 16 - 20g, Cam thao.
- Gia giam: Sot cao gia Hoang cam. Sinh dia, Dia long deu 8 - IOg, hoac cho
An cung Nguu hoang hoan 0,5 - lg (neu co). Sot kem non gia Huong nhu 8g.
True nhu 8 - lOg, Hoa do van 12g, Quay khoc, co giat gia: Bot simg trau 12 20g, Xac ve, Dang tam deu 2g. Sot tieu chay gia Cat can 12g, Hoang liem 4g
- An kem gia Mach nha. Than khuc deu 8g. Ho nhieu gia Khoan dong hoa.
Bach b<? deu 12g.

2) B a i thuoc kinh nghiem:

(1) Tia to IOg, Bo cong anh I2g. Gimg tuoi 3 lat sac uong ngay 1 thang chia
3 - 4 lan.
(2) La ngai ciru tuoi 1 nam vira du, gia nat rit 2 ben thai duong, ket hop nau
chao gao voi hanh tam (cu) an luc nong cho ra mo hoi.
(3) Hanh cu tuoi ca re rua sach 3 - 7 cu, Gimg tuoi 3 - 5 lat, gia nat nau nuoc
sic dac, them duong mia vira du uong luc nong cho ra mo hoi.

103

(4) La sen. Bi dao

l j

v o

vu

hai. hai bo h<>. (Jira J o linnj;

>

lt. i

J u s. nmn.

uong nhieu lan irong ngay

(5) Boi sdn day s6ng 20 40g khuav vcn 100m I

2X>nil nmv gung uong

irong ngay.

.1) Cham cuu: Dung cac huyei chinh: Phong tri. Dai chuy. Khuc tri. Hirp
coc.
- Dau dau nang gia : Dau duy, Thai dmmg. The phong han dung them dau
nong.
- S 6 t cao: Nhan trung, Thieu thuong (nan ra mau) Hop coc
- Tieu long. Thien xu, Tuc tam ly.
- Non, buon non: Thuong tinh. Tuc tam ly, Noi dinh
- Co giat: Nhan trung, Hgrp coc, Thai xung.

4) Ket hyp thuoc lay:

- Truong hop viem

duong ho hap trfen sot cao, tai hpng va amidan vifim

sung do dau ro ret nen ket hpp, cho benh nhi uong thuoc tru sinh kem cac loai
sinh to B I, C.
Phong benh:
1. Chu y tang sue khoe cho ire bang cach: Bao dam che do an du chit dinh
dudng va sinh to, khong nen cho tre cai bu qua som.
2. Chu y ve sinh trong cham soc sinh hoat doi voi tre: Ve sinh ve an mac lam
rua thay quan ao hang ngay. mua lanh mac du am. mua he mac du mai. phong
ngu thoang. co thoi gian dua tre choi ngoai tren...Khong dua tre den noi dong
ngudi nhu raj) nat, cha, pho xa dong due. Dac biet chu y doi vm ire so sinh. Ire
de non. suy dinh dudng.

T U A MIENG (thurush)
Tua mieng la mot loai viem mieng thudng gap 6 tre so sinh. tre de non suy
dinh dudng do sue chong do cua co the kem. D$c diem cua benh la khip mieng
co mang trang nen Y hpc co truyen gpi benh nay la nga khau sang hay tuyet
khau .

104

N G L ?Y E N N H A N B E N H L Y :
Benh do mot loai nam (Candida alhicans) song ky sinh trnne mieng co the
gap d tre lanh. Nam gay benh do:
- Tre dudi 2 thang it nuoc bot. can sua me len men. pH mem mac co tinh
chat acid.
- Tre de non. co the yeu. suy dmh dudng. roi loai tieu hoa va sau khi mac
henh sue chong do giam sut. ve sinh rang mom kem.
- Dung cac loai tru sinh tinh khang khuan rong vdi lieu cao keo dai gay loan
khuan dudng tieu hoa, nam phat trien gay benh.
Benh lay truyen chu yeu do tay sd mo vao cac dung cu cho an bu nhu cdc,
tach, thia, birth sua, hoac tre sa sinh luc sanh nhiem nam d cua minh ciia me.
Berth co the gay cac vu dich nho trong cac phong dudng nhi.
Theo Y hpc co truyen thi nguyen nhan cua benh nga khau sang la do tre mac
benh lau ngay, ty hu thap thang hoac vi nhiet xong len ket hpp doc ta xam nhap
ma sinh benh.
T R IE U C H U N G L A M S A N G :
B it dau d niem mac ludi va niem mac mom mpc nhung vay trang to dan, ket
hpp vdi nhau thanh mot mang trang kho troc. dung dung cu lam troc vay de gay
chay mau. Quanh vay trang co vien do, nude mieng tang, tre quay khoc. bo an
bu, 6 the n$ng. benh co the lan khap mom hoac lan len vao niem mac mui.
/

<

'

xuong vao hau hpng va phe quan co the gay kho tho, an bu nuot kho
C H A N D O A N V A P H A N B IE T :
- Chan doan chu yeu dua vao: Dac diem lam sang. Mom ludi co mang trang
Boc mOt manh mang trang cho vao dung djch 1% NaOH hoac KOH bo len phien
kinh xem kinh hien vi phat hien spi nam va nha bao.
- C5n phan biet vdi can sua (de bong) va mang gia benh bach hau (trieu
chung lam sang n$nj; va manh dinh chat kho boc).
D lf e u T R I:

I. Dieu trj b ing dong y:

I ) Bien chung luan tn: Thudng chia 2 the benh.
(I)T h e vi nhiet:

105

f.'cu chim;: ciru yiru: Quanh manh irantr

*.0

vien do Jam. mot lirai do. l*cu

. -tne. mum hoi chay nhieu ninn. hoi. ire quay khoc. ecu rx*n. r.u luoi vang. chi
v an do !;u i Ua
Phep u .. Thanh nhiet giai doc.
- Bai thu.v Hoang lien giai dpc lhang gia \i
Hoang liem 4g, Chi tu 4g. Hoang cam. Hoang ha. Sinh dia deu Kg. Sinh
thach cao IOg. Dang lam 2g
(2) The ly hu lhap ihmh:
- Trieu chimg chu yeu Manh trang day day mom, vien do nhal. sac mat lai
nhot, tre mt moi chan an. nude tieu trong, lieu phan long, chat luoi hong nhal.
chi van hong nhat.
- Phep tri: Kien ty ich khi hoa vi lai thap
- Bai thuoc: Sam linh Bach truat tan gia giam.
Dang sam, Y di deu IOg. Bach linh, Lien nhuc. Bach bien dau deu 8g, Hau
phac, Thuong truat, Tran bi deu 6 g. Cam thao 3g.

2) Thuoc dung ngoai: Co the chon mot trong cac bai thuoc sau :
(1) Bang sa (phi), La rau ngot 20g gia lay nuoc c 6 t tron bot bang sa 2g hoa
them mat ong boi vao tua. ngay 3 - 4 lan sairkhi an bu.
(2) Phen phi 8 g. Hoang ha I2g. O tac c5l 20g deu lan boi min iron mat ong
boi sau khi dung canh dau cao sach tua, ngay 3 - 4 lan.
(3) Co kinh nghiem dung I vj han the (bang sa. borax) phi hoac tan hot min
iron mat ong hoac sira me boi vao hoac dung them bot gach cua dong tron chung
vai bot han the phi de boi.
(4) Nga khau tan (Khoa Nhi Vien Dong Y Ha Noi): Hoang liem. Hoat thach.
Bang phien deu lOOg. Thanh dai 80g. Bang sa 40g. tat ca tan bot mm trpn lan
deu boi hoac tron mat ong boi sau luc an bu ngay 3 - 4 lan.

3) Dung ihuoc lay ket herp

(1) Boi mieng bang dung dich Natri bicarbonat 5% hay Xanh Melhylen 1%,
Glycerin iot nhe (luc khong co hoac boi cac loai tren khdng giam )
(2) Cho tre them sinh to B I va C.
(3) Cho thuoc chong nam: Mycostatin 100.000 - 150.000dv/kg/24 gid chia 4
lan uong. trong thdi gian 4 - 8 ngay. Chi dung khi dung dong y khong kfet qua.

106

Ph o n g benh:

- Chu y vc sinh cho tre luc cho an hoac hu, cac dung cu cho an hao dam \o
khuan.
- Chu y vc sinh rang mom cho Ire luc mac henh keo dai. co the suy nhuoc.
- Tranh xudung tru sinh lieu cao keo dai mot cach tuy tien
- Theo doi cac ba me co nam d cua minh can phai dieu tri trudc luc sanh

VIEM PHfi Q UAN CAP

(acute bronchitis)
Viem phe quan dip la mpt chung b$nh thudng gap d tre em (it gap d tre so
sinh duoi 3 thang) do virut hoac vi khuan gay vi&m niem mac cac phe quan Ion
va vira. Nhung it khi don thuan viem cac phe quan ma thudng kem theo nhung
bieu hin cua viem mui hpng, viem khi quan hoac viem cac phe quan nho (viem
khi phe quan). Benh nguyen phat hoac thu phat sau cac bnh viem dudng hd hap
tren, sdi, ho ga hoac cac benh lay khac.
Theo Y hpc co truyen, benh thuoc pham tru chung ngoai cam, khai thlu do
cam thu ngoai ta phong him hoac phong nhiet.
N G U YEN N H AN B EN H L Y :
1. Nguyen nhan thudng gap: Virut (cum , Adenovirus, sdi) vi khuan (phe
cau, Lien cau khuan, True khuan ho ga, Bach hau micrococcus catarralis v.v...
2. Nguyen nhan it gap: Di ung, cac chat doc, khoi, chat dau, ky sinh vat
(Pneumocysti dc Carim)
3. Yeu to thuan len: Thay doi thdi tiet, Lanh, am, mua dong xuan khi hau
thay doi thSt thudng. tre mac benh man tinh: Tieu chay, suy dinh dudng, coi
xuong, viem mui hong keo dai. Tre co ca dia dj ung. Che do dinh dudng kem.
moi trudng song thieu ve sinh, sinh hoat khong dieu do nhu hoc tap cang thang.
choi boi qua sue...Nhirng yeu to nay deu lam cho sire chong do cua co the y6u di.
virut va vi khuan xam nhap co the de gay benh.
Theo Y hpc co truyen. phong ta nhap phe, phe khi mat tuyen thong sinh ra ho
kho thd, phong him hoa nhiet b phe gay hpng dau sot cao, ddm vang. Phe khi
r6i loan anh hudng ty khi sinh met moi, an kem, bung day, dau bung, buon non,
non. Ph nhi?t nhap dai trang sinh tao bon hoac tieu chay.

107

T R IE U C H U N G L A M S A N G :
Benh nang nhe rat khac nhau Thudng hat dau co irieu chimg \iem dudng ho
hap iron, co luc bat dau bang ho khan sau do ho it dam roi nhieu dam Nghe 2
ben day phoi co ran kho. ran am to va vira nhung thua va it Tre nho khong biet
khac dom nen 6 hpng nghe co tieng kho khe. Trieu chung toan than n$ng nhe
khac nhau. Benh nang tre sot cao 39"C - 40"C co khi kem co giau. Tre met moi
but rut khong choi, quay khoc, an ngu kem, co khi non, tieu long hoac tao bon.
Tre Idm keu dau dau hoc dau nguc. Ho thudng la 7 - 10 ngay roi bdt dan, cung
co khi keo dai 2 - 3 tuan hoac ho di ho lai nhieu lan. mpt so tre co dja dj ung co
con ho kho thd nhu hen.
T IE N L U O N G V A B IE N C H U N G :
Tien lirpng benh tuy thupc vao co the cua tre va ke hoach dieu tn Neu co
the' cua tre khoe va dieu trj kip thdi tien lupng t<fc. D6i vdi tre coi xuong suy dinh
dudng, nhieu lan viem mui hpng hoac trj benh khong kip thoi co th& chuyen
thanh viem phoi hoac vi8m phe quan keo dai.
C H A N D O A N V A PH A N B lfe T :
- Chan doan chu yeu dua vao: Trieu chung lam sang: Ho la chu ye* va nghe
phoi co ran kho, ran m to, vua.
- Can phan biet vdi:

1. Viem duong ho hap tren: Co ho nhieu nhung khong co ran d phdi.

2. Viem p h i quan phoi (phe quan phe viem ): Viem phe quan nang kho
phan biet. Trieu chung lam sang thudng nan^ hon. Chup X quang phoi giup xac
dinh chan doan.

Viem phe quan the hen va hen phe quan: Viem phe quan the hen Ia mpt
the benh cua viem phe quan. Hen phe quan dupe xac djnh d nhung benh nhi co
tien su hen nhieu lan, gia dinh npi ngoai co ngudi mac benh ben, nghe ph6i co
nhieu ran rit ran ngay day 2 phe trudng, tet di ung duong tinh. bach d u ai toan
tang ro.

4. Lao so nhiem: Tien trien tir tir va keo dai: Co trieu chung lao so nhiem
nhu: Sut can. sot nhe mo hoi, tet Mantoux duong tinh, hinh anh X quang ph6i,
tien su ISy benh.

5. D j vat duong tho: Tre ho dpt ngpl kho thd. Soi phi quan phai hin dj
vat.
D lfeU T R I :

108

I. Che dp cham soc an uong:

Benh nSng phai nghi tai giudng, theo doi chu dao de phat hien hien chung. xir
ly kip thcri. Not nam phai thoang. Doi voi tre nho, thudng xuyen thay doi lu the
Che dp an long, nua long hay 5n thuong tuy tinh hinh benh ly nhung can du chat
dinh duong va sinh to.
I I . Dieu trj bang ddng y:

I.

Bi$n chung luan tri: Theo chung khai thau do ngoai cam. thmrng gap

cac the' benh sau:

1) Phong han:
- Tri?u chimg chu ygu: S6t nhe, khong co m6 hdi, on lanh, ho nhieu dam
tring, mui tac hoac chay nuoc mui trong, chan tay mat, tre Ion keu dau dau, reu
ludi triing mong, m?ch phu hoan ho$c phu sac.
- Phep trj: Tan 6n giai bieu tan han chi khai
- Bai thudc: Tam ao thang gia vj
M a hoang 6g, Hanh nhan, To ng^nh, Ban h& Kinh gidi, Tran bi deu 8g, Tien
hd 10 - 12g, D |u xj IOg, Cam thao 4g, Gimg 2 lat sic uong.
Ddm nhi&u gia: To tu. La b$c tir deu 6g, An kem gia: Thn khuc 6g.

2 ) Phong nhiet:
- Trieu chimg chu yeu: Sot ho dam vang hoac ho it dam kho khac. hpng do
dau, khat nuoc, tieu vang, ludi do reu vang, m^ch phu sac.
- Phep trj: Tan luong giai bieu, thanh phe chi khai
- Bai thuoc: Tang cuc am gia giam
Tang diep I2g, Kim ngan hoa I2g, Cue hoa IOg, Hanh nhan 8g. Lien kieu
IOgT Tifen hd IOg, Hoang cam IOg, Qua lau bi 8g, Tho bdi mau IOg, Cam thao
4g, Gimg tuoi 2 lat.
Ho nhieu gia: Bach bp, Khoan dong hoa deu IOg, non, buon non gia: True
nhy IOg, Khuong ban ha 8g. Sdt cao gia: Thach cao 20g, Tri mau IOg. Bot sung
trau 20g (sic trudc). Trudng hpp sot cao co giat cho thudc thanh pham nhu Chi
bao don, Tu tuySt don hoac An cung nguu hoang hoan dS thanh nhiet trin kinh.
N6u khong co ket hpp dung thudc tay an than chdng co giat. Viem phe quan the
phong nhiet co the dung bai Cao ma hanh. Viem phe quan the hen dieu tri nhu
hen ph quan (xem bai hen phe quan)
3) Phfi am hir

109

- Trieu chiing chu \eu Benh nhi von co the veu mac henh %lem phe quan to
tneu chung sol nhe. mo hoi trom. ho Mum il dam. ionj han ehan :> nong. moi
kho, luon ihon do. il reu. mach le sae.
- Phep tri. Duong am thanh phe hoa dam ehi khai
- Bai thuoc: Sa sam mach dong thang gia giam
Sa sam, Mach mon. Thien hoa phan. Tang diep. Ngoe true deu 10 - I2g.
Bach bien dau IOg, Tang diep IOg. Dia cot bi IOg, Tran bi 8g. Boi mau 8g. Cam
thao 3g. Dai tao lOg.
- Khi hu gia Nhan sam 4 - 6g. Sinh hoang ky 12g. an kem gia: Bach truat
IOg, quay khoc it ngu gia Thuyen thoi (xac ve) 2g, Mau le 20g (sac innk).

2. B ai thuoc kinh nghiem:

(1) Cao ma hanh (Tran Van Ky, Khoa nhi Vien Dong y Ha Noil: Ma hoang
8g. Hanh rthan 8g. Thach cao I2g, Tien h6. Cat earth deu IOg, Tran bi. Tho boi
mau deu 8g. Cam thao 4g Theo ty le lieu luong tren nau thanh cao long (ty le
I ml cao co 1 gam thuoc song). Hoac lam thuoc sac con 100ml ihuoc nutrc chia
3 - 4 lan uong trong ngay. Tre nho duoi 1 tuoi giam lieu.
(2) Tuyen giang thang (Ton Lam, Khoa nhi Benh Vien Trung y Tir Lgn, Ho
Nam): M a hoang 2 - 4g. Hanh nhan 6 - 8g, Tien ho 6 - 8g. Cat canh 3 - 6g, To tu
4 - 7g. Dinh 1ich tii 4 - 6g sac uong. Da dieu tri

87 ca. dat ty !c co ket qua

97,7%.
(3) Mao trac thuyen y thang (Ha tu xuyen): Mao can 6 - 12g. Trac ba diep 6
IOg. Xuyen boi 2 - 4g. Hanh nhan 3 - 5g, Thuyen y 4 - 8g,Cam thao I - 4g, To
diep 3 - 6g. sac uong Da dieu tn 80 ca uong 3 thang ket qua tot
(4) Tieu nhi phe bao phucmg (Trinh Trieu An, Hoc Vien Trung y Truong
Xuan, Cat Lam): Nhan sam, Bach truat. Miet giap, Mach dong. Ke noi kim
lucmg bang nhau che thanh thuoc bot dong goi 3g. ltuoi tro lai: 0.5 - 0,75g/lin, 1
- 3tuoi: 0,75 - 1.Og/lan. 3 - 6tuoi: 1.0-1,25g/lan, 6 - 9luoi: 1,25 - 1,5g/lin.
(5) Bai thuoc nam.
- La chanh. La tao moi thu 1 nam sac uong tri ho.
- Rau diep ca hoac co Nho noi 40 - lOOg sic u6ng.

3. Dieu tri hang thuoc tay: Doi voi nhung trircmg hop nang kit h<?p dung
tru sinh Penicilin 20.000 - 50.000dv/kg/ngay chia 3 - 4lin tbip hoic uong,
Ampicilin 100 - 2(K)mg/kg/ngay chia 3 - 41an u6ng, Kanamycin 15 - 20mg

110

/kg/ngaytb chia 3 - 4lan, Tetracyclin 25 - 5<)mg/kg/ngay chia 3 4 lan

uong...Hoac dung cac loai sulfamid.
Phong benh: Chu yeu tang sire khoe cho tre, an du dinh duirng. chong lanh.
dieu tri cac benh ve tai mui hong.

BA N X U A T HUYfiT DI UNG
(vascularite hemorragique)
Ban xuat huyet di ung con goi la viem mao mach chay mau (vascularite
hemorragique) hay benh Schoenlein Henoch la mot loai benh do phan ung khac
thuong cua thanh mao mach gap d moi lira tuoi tre em nhieu nhat la tre Ion va
tuoi day thi. Dac diem cua benh la noi ban xuSt huyet, chay mau cam, mau chan
rang hoac dau bung, tieu ra mau hoac sung dau cac khdp. Theo dong y, benh
thuoc huyet chiing.
N G U YfcN N H A N BfeNH L Y :
Hin chua ro. Nhieu tac gia Y hoc hien dai cho day 1& m$t hoi chung benh ly
khong dac hiu, xay ra do phan irng qua man cua thinh mach doi voi nhieu yeu
to khac nhau nhu nhiem khuan, nhiem doc hoac thuc pham, thuoc, ky sinh trung
gay mot phan ung mien dich di img trong co the, nhat la d thanh mach lam tang
tinh tham thau cua mao mach gay xuat huyet.
Theo Y hoc co truyen thi neu nhiet ta xam nhap co the, nhiet gap khi huyet,
nhit birc huyet hanh. ir tich d c o bi sinh ban xuat huyet, huyet u thuong tieu xuat
huyet d rang, mui, khi huyet ir tre tai khdp gay sung dau. khi huyet u tre tai
trudng vj gay non roi loan chuc nang ty vi sinh ra buon non, non, dau bung, tieu
ra mau, trudng herp khi huyet ir tre tai ha tieu Lac mach ton thuong sinh huyet
nieu. Mac khac co the von hir, chinh khi hu, ty khi yeu khong nhiep duoc huySt
nen cac trieu chung xuat huyet tren day tai hi?n nhieu lan. Con neu co the am hu
sinh noi nhiet cung de dan den huyet chung.

T R IE U C H U N G L A M S A N G :
Benh bat dau thudng dot ngot, benh nhi cam thay kho chiu, s6t. chan an,
b^nh canh nhieu ve, ban xuat huyet la thudng gap nhat, hinh dang co the la
ch5m, ban xuSt huyfet, not xuat huyet hoac nhu m l day, mau sic khac nhau, to
nho khac nhau phat ra timg dot. hay gap d 2 chi dudi, 2 mong ben ngoai nhifeu

111

roi 2 cang tay. doi xung Ban xual liuvet ihinrng irong I

- n^J > '^ L lhanh Mm

nhal roi mai khong de dau vol. Tu\ \i iri \a min. do xual huvcl. vii the co cac
trieu chung sau:
- Trieu chiing dudng ruot: Buon non. non. dau hung, lieu ra mau
- Dau cac khdp: Goi. co chan, co lay nhe chi dau nhuc. nang co the kem theo
sung dau nhieu hoac kem sot nhe.
- Nhung tneu chiing khac nhir. Chay mau cam. mau rang. phu. neu it. lieu co
mau. dam nieu, huyet ap cao, co giat
X E T N G H IE M :
So luong tieu cau, thdi gian mau chay, mau dong, proirombin deu binh
thudng, kiem tra phan mau (+), tieu mau (+) dam mu ( +) Huyei tram thudng
tang. Tifen trien noi chung nhe nhung de tai phat. Bien chiing thudng thay la
viem cau than, hoi chung than hur.
C H A N D O AN V A PH A N B IE T :
- Chin doan benh khong kho, chu yeu dua vao trieu chung lam sang va ket
qua xet nghiem (nhu tren).
- Chan doan phan biet vdi:
I. Ban xuat do giam lieu cau: Sd lupng tieu cau giam dudi 100.000/mm'
thdi gian xuat h uyet k eo dai.

thdi g ian co cuc mau keo dai.

Trudng hpp chua xuat hien ban xuat huyet ma co dau bung chu y chan

doan phan biet chung dau bung cap nhu viem ruot thira. dau bung giun...Tieu co
mau chu y phan biet long ruot, sung dau khdp, kem sot nhe. chu y phan biet vdi
thap khdp cap.
D lfeU T R I :
I. Bien chung luan tri: Thudng gap cac the benh va luan in nhu sau:

I ) Huyet nhiet:
- Tneu chung chu yeu: Phat benh dot ngot, ngoai da co diem va ban xuat
huyet sac tia tham. chan co nhieu, kem theo chay mau cam hoac dau bung tieu
tieu co mau. khdp sung dau. tao bon. Chat lum do. reu vang mong. mach sac.
- Phep trj: Thanh nhiet luong huyet, chi huyt.
- Bai thuoc: Te giac. Dia hoang thang gia giam.
Bot sung trau (sac trudc) 20g, Sinh dja 20g, Bach thupc IOg. Don bi lOg.
Huyen sam I2g, Hoang cam IOg, A giao (hoa uong) I2g. T ii thao I2g.

112

Gia giam: Sot so lanh. nguai ngua gia Kim ngan hoa. Lien kieu Chay mau
mui gia: Mao can tuai 30g. khdp sung dau gia: Han phong ky, Nhu huang, Moc
ducjc deu 3 - 6g, Xuyen nguu tat 12g. Bung dau lieu co mau gia: Bo hoang than
IOg, Quang moc hucmg 2 - 4g, Dja du than IOg. Kinh giai than 6g. Tao 5 qua.
lieu co mau gia: Dai tieu ke moi thu IOg, Han lien thao IOg, tao bon gia: Sinh
dai hoang 3g.

2) Khi hu:
- Tri^u chung chu yeu: Ban xuat huyet tai phat nhieu lan, ban mau do nhat,
b?nh keo dai, ngudi. met moi sac mat kem tuui nhuan, dau dau tim hoi hop hoac
byng dau tieu co mau, moi luoi hong, mach te hu.
- Phep trj: Bo khi nhiep huyet.
- Bai thuoc: Qui ly thang gia giam
Dang sam, Sao bach truat, Thuc dja, Chich hoang ky, Duong qui deu IOg,
Sao b?ch thugrc 8g, Han lien thao I2g, chich thao 4g
Gia giam:
- Chay mau cam: Trac ba diep (than) IOg, Bach mao can IOg (than)
- Huyet nieu gia: A giao IOg (hoa u6ng) O mai (than) 6g.
- Tieu mau: Bot sam lam that 2g hoa thuoc uong, Moc huong sao 3g, Hoa
hoe 6g, Tao 5 qua. Dau khdp gia: Dan sam 12g.

3) Am huhoa vutmg:
- Trieu chung chu yeu: Ban xuat huyet ngoai da, 2 chan nhieu. kem theo
vang dau sot nhe, mo hoi trom, sac mat hong nhat, long ban chan tay nong, luoi
thon do, reu it mach te sac.
- Phep trj: Dudng am thanh nhiet hoat huyet chi huyet.
- Bai thuoc: Dai bd am hoan gia vi.
Sinh thuc dja moi thu 12g, Tri mau, A giao (hoa uong) Thuyen thao than,
Qui ban deu 8g, Hoang ba, Mach mon du 12g.
Gia giam: Mo hdi trom gia: Mau 1? (sic trudc) 20g, Chich hoang ky 16g, sdt
nhe, long ban chan tay nong gia: Dja cot bi 12g, Hd hoang lien 6g, Vang dau
gia: Tran chau mau I5g (bot mjn hoa uong), Thuc nu trinh tu, Han lien thao du
12g-

113

II . Bai thuoc kinh nghiem:

( 1) Song dem ihany: O'tii sam. Dai lhanh diep deu 15g. Dni hi. Sinh dia. lu
thao deu IOg. sac uong Ir e duoi 6 tuoi giam lieu (Khoa Nhi So Nghien Cuu
Trung y Giang To).
(2) Phong phong. O mai. Sinh cam hao deu Mg. Dai tao 15g sac uong (Dao
VTnh Phmmg, Benh Vien Thuy Kim. Thuong Hai).
(3) Tu xich thang: Dem sam. Dai lhanh diep deu I5g, Tu thao. Xich thuoc.
Can dia hoang, Dan bi IOg. sac uong
(4) Re Iranh turn 500g sac uong thay tra (nuoc che)
(5) Hong tao 10qua, Tuthao I6g sac uong.
(6) Xich lieu dau 40g Sinh me nhan (y di) 40g. Hong tao 5 qua. M lu 1$ 40g,
sinh Cam thao 4g sac uong.
III. Cham cuu an h u yft:
(1) Chu huyet: Tuc tam ly. Khuc tri. phoi herp: Hop coc. Huyet hai.
(2) Trat bien, Hgrp coc, Phong long. Tat nhan. Tuc tam ly. Thu tam ly. Tam
am giao, Con Ion, Chieu hai, chon huyet thay d*i dung.
(3) Huyet bam cam mau mui: Bam huyet tren dudng chinh giua cac bd toe
tran 1 - 2 thon
IV . Phoi hap thuoc tay: Luc dung thuoc va cham khong ket qua. co the
chon dung cac loai thuoc tay sau day:
(1) Thuoc chong dj ung: Benadryl 2 - 4mg/kg/ngay chia 3 - 4 lan uong.
Phenergan 0,5 - Img/kg/ngay chia 2 lan uong
(2) Thuoc Corticoid, Prednison 2mg/kg/ trong 2 tuan.
(3) Cac loai vitamin chu yeu la Vitamin C 0,5 - 2g/moi ngav chia 2 lan uong.

DAI DAM
(enuresis)
Dai dam la hien tucmg benh ly khi dua tre tren 3 - 4 tuoi dem nam ngu con
dai trong quan.
N G U Y EN N H A N :
Phin Idn la do roi loan su dieu tifet cua thin kinh trang uong. M ot sd yu t6
nhu tap quan sinh hoat khong tdc choi nghich qua dQ. an ngu khong didu

114

dp...Hoac tre mac benh cot song ho tien thien. nao phat due cham. tre mac benh
giun kirn Y Iiqc co truyen cho la do than khi kem khong lam chu duac tieu tien
hoac do bang quang hu lanh. chuc nang khi hoa kem sinh dai dam.
C H AN D O AN V A PH A N B IE T :
Chu yeu la loai tru cac benh mac phai gay dai dam, chu y tap quan sinh hoat
cua tre. Chi chan doan dai dam khi khong phat hien benh gay nen
D IE U T R I:
1. Chu y trong dieu tri :
- Chu y dieu chinh sinh hoat dieu do. Khong la mang tre ma thudng xuyen
dpng vien moi khi co tien bo.
- N hic di tieu trudc luc ngu va khong uong nude va an canh nhieu vao bua
com tdi. Khong nen an cac chit mat l?nh.
2. Nhung bai thuoc co the dung:
(1) Bong bong lpn 1 cai, Ich tri nhan IOg, Ngu vj tu IOg. Bong bong Ion mo
bo nude dai rura sach, cac vi thuoc bo vao dun chin bo ba ly nude uong. Ngay 1
tin, uong lien tuc trong 5 - 7 ngay.
(2) Bo cot chi IOg, Ich tri nhan, Tang phieu tieu mdi thd IOg, Hoai son 12 I6g, Chich thao 3g sac uong.
(3) Tho ti tir IOg, Ich tri nhan IOg sac nude uong trong ngay lien tuc 5 ngay.
(4) Ich tri nhan 10 - I2g tam dam sao tan bpt min chia 3 lan uong vdi nude
nong trong ngay.
(5) Ngu boi tu, Ha thu o tan bpt mpi thu 3 - 4g tron dam ha nong goi vao gac
dap vao ron moi dem 1 lan trong 3 - 5 dem lien.
3. Dieu tri bang cham cuu:
(1) Cham kim: Huyet chinh: Quan nguyen, Khi hai, Tam am giap, Tuc tam
ly, neu ty hugia Ty du. than hugia Than du. Kich thich nhe va vua 15 lan cham
la mpt lieu trinh. Tuan dau cham hang ngay sau do cham each nhat. Nen cham
gia cuu hoac chi cuu va day an huyet.
(2) G6 kim mai hoa giua 2 dudng kinh bang quang tir phe du d$n bang quang
du moi ngay trudc luc ngu, kich thich nhe cho dn luc sic da do ung la dat.
(3) Veo cpt song (nhu vdi hen phfi quan).

115

HEN P U t QUAN TRE EM

(Brochial asthma, asthmatic bronchitis)
Hen ph quan tre em la mot benh d( ling dudng ho hap hay gap 6 tre em
Theo tai lieu cua Trung Quoc. ty le mac benh la 0.5 - 2.0#. Tuoi bat dau mac
b?nh phin Icm dudi 6 tuoi. Bao cao cua Tran Van Ky khoa nhi vien Dong y Ha
Npi nam 1970 theo doi trong 1262 ca tre em hen phe quan co 77.9# bSt dau
duoi 6 tuoi. Bao cao cua nhieu tac gia khac cung neu len ty le tuong tir Kaganov
(Lien X o ) cho rang benh nhi hen tuoi tCr 2 - 7 tuoi chiem ty le 71%. Charpin,
Boutin. J. Aubert (Phap) ghi tuoi bat dau tir 1 - 6 tuoi chiem 73,8%. Theo Y hoc
co truySn, cach day hem 2000 nam trong sach N<?i kinh da co ghi nhung tneu
chung benh hen voi ten Hong benh , Suyen tuc, Ap khai , cho ddn thoi Kim
Nguyen moi co ten la hao suyen.
N G U Y EN NHAN VA BEN H L Y :
Nguyen nhan benh la kha phuc t?p co the qui n?p vao cac m il sau:
1. Car dia di ung: Tre co tieii su benh cham, me day. viem mui dj ung.
Khoang tir 20 - 30% trong gia dinh benh nhi co nguoi mac benh hen ho|c cac
benh dj ung khac khoang tu 50 - 70% benh nhi.
2. D i ung nguyen: Co the phan lam cac loai sau:
1) V i khuan va doc to: Tre em thuong viem dudng ho hap tren nhieu lan,
nhung o nhiem trung tai mui hong nhu viem amidan man, viem xoang mui...Co
the sinh ra di img nguyen Loai hen nhiem khuan thudng hay len con theo mua
va len con nhieu luc thay doi then tiet.
2) Chat hit vao phoi nhu: Phan hoa, bui nha, khoi, long da dong vat. chat
doc hoa hoc va nhieu loai chat bay hcri khac. Loai hen nay len con luc co tiep
xuc. Conn hen co lien quan den mua, noi d va hoan canh sinh hoat.
3) Thuc an: Chu yeu la cac loai protid (trung, sua, tom, cua, ca, nhpng),
loai co huong thorm, lua mach, mot sd hoa qua.
3. R o i loan chuc nang than kinh va noi tiet:
Chuc nang than kinh thuc vat bj roi loan, nhung kich thich thin kinh do Ion
noi, nhung cang thang ve tinh than. Khoang 30 50% benh nhi hen giam nhe
benh hoac m it han vao tuoi day thi. Theo dong y, chung hao suyen do ben uong
co the ty thin b it tuc nen dam thip thinh, them b in ngoai l i khi hpc dam xam
nh|p vao co the' truoc hfet vao p K lam tic p h i l*c,ph m ik tro y alltfn g . phi khi
nghich g iy suyen tuc kho tho. h it khdng tu trong tb w in lam lAn thuong ty

116

vi. van hoa roi loan, Thuy dich sinh derm lam lac phe dao gay kho thd. Benh lau
ngay anh hudng d6n chuc nilng than, than nap khi kem, kho thd tang them.
T R IE U C H U N G L A M SA N G :
Benh hat dau tir tii hoac cap dien. Trong I - 2 ngay dau thuong co trieu chung
viem duong ho hap tren. viem phe quan, con hen phat nhieu ve dem, ( khi hau
thay d<i, do benh nhi tiep xuc nhieu voi dj ung nguyen, do tiet to vo thugmg than
giam ve dem). Con hen keo dai vai gid co khi may ngay lien tuc.
- Luc len con: Benh nhi quay khoc but rut kho thd chu yeu thi thd ra phai
ngoi day, mat tai nhot, canh mui phap phong, mdi va mong tay tim tai, co khi
toat mo hdi lanh hoac ho nhieu co ddm dac.
Kham: Go nguc th iy vung dap tim nho l?i, nghe 2 phoi d&y ran rit ran ngay,
tieng kh^ khe ca 2 ben phdi, ho va khac ddm (khac ra ddm thi de chju). Con hen
keo dai co the' gay suy tim. Do dj ung nguyen khac nhau ma trieu chung co khac
nhau: Ngu viem duovg bd h ip tren hoac viem phe qpan, con hen kem ho nhi&u,
phdi co ran 3m, sdt, td'ng sd b^ch c iu tang trong mau. Nu do ch it hit thi co cam
giac ngua mui, h it hoi, chay nuoc mui ho khan tifep theo la con hen, neu do thuc
Sn thi sau khi in vao m iy phut ho$c vai gid lin cam hen, kkdng sdt co the co ndn
dau byng, tieu long, ndi m l day ngoai da.
Chuc nang phdi roi loan: Giam thong Rhu giam dung rich song, tang dung
tich can dir chuc nang va the tich can du. Hinh anh chup chieu phdi: Ngyc phdng
u khi 2 ben phoi hoac co hinh anh phe quan dam (thudng kem viem phe quan).
Xuong sudn long nguc ngang, khoang lien sudn rong.
- Luc khong nen com: Benh nhi hoac cam thay binh thudng hoac tuc nguc,
hoi thd ngan. ngudi met moi, phoi nghe binh thudng hoac con tieng kho khe, ran
rit ran ngay. Benh keo dai nhieu nam lam cho tre gay yeu, giam sut ve tri luc, dj
dang nong nguc kem bien chung phe khi thung.
X E T N G H IE M :
Ddm co tinh the Charcot Leyden, mau hong cau va huyet sac to, tong sd bach
cau ndi chung khong thay doi (tru trudng herp nhiem khuan thi b^ch cau tang) ty
Ifc b?ch cau ai toan tang thudng tir 5 - 20% hoac hon, con sd tuyet doi t6 bao ai
toan co the 300 - 1000/mm hoac hon.
T IE N LU Q fN G :
Tuy thudc lo?i dj ung nguyen va co dja dj img. Nhung benh nhi hen do thuc
in h o ?c chat hit luc tranh cac thu ay thi khoi. Luc tiep xuc vdi chat hit hoac an

117

lai Ihirc fin ihi ccm hen tai phai va co the nang him Nhiem khuan duong ho hap
iren la yeu to gay com hen thuong gap d tre Do co lien quan Jen noi net nen den
tuoi day thi nhieu henh nhi khoi am hen.
Chung loi da theo doi 384 henh nhi hen trong thai gian tu 3 den 1 nam co
nhan xet: 38,595- khoi 40.6# am hen giam nhe 8.4# ccm hen that thixmg va
12,5# ccm hen nang him. Benh hen lau ngay lam cho tre ca the phat trien long
nguc di dang, bien chimg phe khi thung. tam phe man. Benh nhi co lien su gia
dinh hen thuong kho chua.
C H A N D O A N V A PH A N B IE T C H A N D O A N :
+ Chan doan hen phe quan chu yeu dua vao:
- Trieu chung lam sang luc len con: Kho thd, kho khe, ren rit ren ngay luc
nghe phoi.
- Tien suco can hen nhieu lan lai phat. benh di ung. tien siigia dinh.
+ Chu y phan biet voi:
1) Viem phe quan the hen: Trieu chung y hl com hen nhung thudng co s6l,
ho nhieu. tien six khong co con hen. Doi voi len con dau lien kho phan biet.
2) Lao hach lam ba phe quan: Ho nhieu va kho thd kieu hen nhung khong len
can timg dot. Phan ung Mantoux duong tinh, chup chieu phoi phat hien co dom
mdcua hach lam ba.
3) Dan phe quan: Luc hoi nhiem cung co can hen kho thd, Benh nhi co tien
su dan phe quan. ho ddm nhieu va khong co tien su hen. Chup phoi co hinh anh
dan phe quan.
4) Di vat dudng ho hap: Di vat vao dudng ho hap gay kho thd kieu hen keo
dai. Benh nhi khong co lien su hen. luc thay doi tu the con kho thd nang han hay
nhe di. nghe phoi chi ben bi benh co ran rit. Soi phe quan va chup phoi giup xac
djnh.
5) Hoi chung Loelfler: Di img giun dua gay can kho thd dot ngot nhung chi I
lan roi het. Xet nghiem mau. bach cau ai toan tang rat cao 60 - 80#. Chup phoi 2
ben phe trudng co nhung dom md mat di nhanh trong khoang 3 -7 ngay.
D lfeU T R I:

1. Nhung d iiu can chu y irong dttu tri bfnh hen:

- Tim hieu di img nguyen de chu y tranh.

118

- Tranh cho benh nhi nhung chan thuung vc tinh than khong la mang hat
hui. tranh gay cho benh nhi tam ly cho rang henh hen kho chira hoac phai mac
b^nli suot ddi.
- GiCr am cho benh nhi nhung luc thdi tiet thay doi. cho henh nhi song noi
thoang mat, chu y phong benh nhiem dudng ho hap.
- Cho an che do du chat dinh duang. du nude va chat sinh to, iranh nhung
thuc an de gay dj ling nhu: Mam tom. cua, ca bien. khong hut thuoc (doi vdi tre
Ion)
- Day tre co chd dp hpc tap lao dpng dieu do khong suy nghi nhieu khong
lao dpng qua sue gay met.
- Day tre t$p luyen ca the ket hpp thd xoa bop tam ngam nuoc nong
- Luc len con hen nang va lien tyc can nam vien dieu trj .
2 . Dieu tri b&ng dong y:

1) Bien chimg luan trj:

Nguyen tac dieu trj benh hen theo dong y la: Luc len con chu yfeu la khu ta
(lam ha con hen), luc khong len con chu yfiu la pho chinh (nang cao the trang,
dieu chinh co thfe). Luc khu ta chu y phan biet han nhiet dam de di3u tri <luc pho
chinh can chu y dieu chinh. nang cao chuc nang cua ty phe than.

A. Dieu trj luc len con hen: Thudng chia 3 the benh.
( 1) The phong nhiet: Benh nhi thudng kem theo viem dudng ho hap tren hoac
viem phe quan, co trieu chung sot nong co mo hoi hoac khong, mat do. thich
uong nude lanh, nude tieu vang, dai tien tao bon, ludi do. reu vang, mach hoat
sac.
- Phep chua: Thanh nhiet hoa dam chi khai binh suyen.
- Bai thuoc: M a hoang thang hoac Dinh suyen thang gia giam
Ma hoang 4 - IOg. Hanh nhan 6 -IOg, Hoang cam 6 - 12g, Thach cao 20 40g, Khoan dong hoa 6 - IOg. Tang bach bi 6 - IOg. To tu (bao) 6 - 8g. Tran bi 4
- 8g, Cam thao 2 - 4g sic uong, ngay 1 thang sac chia 3 - 4 lan uong. Hoac dung
bai: cao ma h^nh: (xem bai viem phe quan).
(2) The phong han: Phan lorn len corn nhieu ve dem, gap lanh len com benh
nhi ngudi mat, khong sdt, nuoc tieu trong, reu ludi trang mong. mach tram hoan
ho$c trim hoat.
- Phep tri: On p h i hoa dam, Chi khai binh suyen.

119

- Bai thuoc: Tieu thanh long thang gia guim

Ma hoang 6 - IOg. Te tan 4g. Khinrng han ha 4

Kg. Ngu i ur '

thurrc 8-12g. Mach mon K - 12g. Quv chi 2 - 4g, To iir(ho>.i-l

f>g. Bach

f>g. Carr thao 3

4g, Gimg tirai 4 - 8g, Tran hi 4 - 6g. sac uong ngay 1 thang
(3)

The phong dam Phan Ion henh nhi the chat hu bam. hen nhieu derm kho

khe. reu lirm day nhot. mach hoat co lire.

- Phep chua: Giang khi hoa dam hinh suyen
- To tu giang khi thang hgrp nhi tran thang gia giam
Dang sam 8 - I2g. Bach linh 8 - I2g, Tran hi 6 - 8g. Ban ha tgung che) 6 8g. To tu (boc) 6 - 8g, La bac tu (boc) 6 - 8g. Hoang cam 6 - 8g. Cam thao 4 6g, Gimg tuai 6 - IOg sac nude uong ngay I thang chia 2 - 4 lan

B. Dieu trj luc khong len can (thcri ky on dinh): Tuy theo co the benh nhi
can uong thuoc de cung co. Truong hgrp biet truoc mua len con cua tre thi cho
uong thuoc truoc 3 - 4 thang co the lam giam nhe hoac ngan chan con hen.
Thuong g$p cac the va cach dieu trj nhu sau:
(1) The phe hir Thuong gap la phe am hir. Benh nhi ngudi gay hay ra mo hoi
trom, da nong long ban chan tay nong, luoi thon do reu it hoac vang, mach t
sac.
- Phep chua: Duong am thanh phe.
- Bai thuoc: Sa sam mach mon dong thang gia giam.
Sa sam 8 - I2g. Mach dong 8 - 12g, Tang diep 8 - 12g (hoac dung tang bach
bi) Sinh bien dau 8 - 12g. Thach hoc 8 - 12g, Hanh nhan 6 - 8g. B6t miu 8 - IOg,
Cat canh 8 - IOg, Cam thao 2 - 4g. Sac uong ngay 1 thang.
G ia giam: Nguoi met moi gia: Dang sam, Hoang ky m6i thu 8 - I2g. an kem
gia: Mach nha. Son tra. Than khuc moi thu 6 - 8g, mo hoi trpm gia: La dau 8 12g, Mau le 12 - 16g.
(2) The ty hu (ty phe hu): Tre gay xanh xao, an kem tho ngan hen. day byng
hoac tieu long, ngudi met moi ho co nhieu dom trang, than luoi hong nhat. reu
day hoat, mach tram nho vo luc.
- Phep tri: Ich khi kien ty hoa dom
- B a i thudc: Luc quan tu thang hop nhi trin thang gia giam.
Dang sam 8 - I2g, Bach truat 8 - I2g, Bach lin frS -T2g. Lien nhuc 8 - I2g,
Hoai som 8 - 12g, Tran bi 6 - 8g, Khuomg ban ha 6 % Cam thao 3 - 6g.

120

(3)

The than hir Thutmg gap a benh nhi hen lau ngay nguc nho, bieu hien

lam sang than am hu hoac than duong hu.

a) Than am hu. Thudng gap a tre hay s6t nong viem nhiem dudng ho hap,
nguoi gay da nong ra m6 hoi trom, moi ludi do, it reu, mach te sk: vo lire.
- Phep chua: Tu bo than am.
- Bai thuoc: Mach vi Dia hoang hoan gia giam.
Thuc dja 10 - 16g, Hoai som 8 - I2g. Son thu 6 - IOg, Don bi 8 - 12g, Mach
mon 8 - 12g, Sa sam 8 - 12g, Tang bach bi 8 - 12g, Ngu v lu 4 - 6g, Ha thu o 8 12g, Mau I? 12 - 16g, La dau 8 - 12g, Cam thao 3 - 6g.
b) Than ducmg hir Bieu hien hoi tho ngan, chan tay lanh, co luc dai'dam,
hen lau ngay ngudi met moi, than ludi beu, mach tram nho vo luc.
- Phep chua: On than trang duong.
- Bai thuoc: Bat vi hoan gia giam.
Thuc dja 12 - 16g, Hoai son 8 - 12g, Son thu 8 - 12g, Don bi 6 - IOg, B^ch
linh 8 - 12g, Tho ti tu 8 - 12g, Cau ky tu8 - 12g, Che phu tu4 - 6g, Nhyc que 4 6g, Cap gicri 8 - 12g sac uong ho$c tan bt mjn che mat lam hoan, moi lan uong
4 - 8g ngay 2 ISn.

2) Gioi thieu bai thuoc kinh nghiem:

Bai thuoc kinh nghiem chua hen co rat nhieu, sau day chi gicn thieu mot so
bai dom gian.
( 1) Giun dat mo bung rua sach sao kho tin bot min, moi lan uong 3 - 6g ngay
3 lan, co the dung luc dang len com, hoac truoc con 1 gicr.
(2) Vien mat Ion (vien M P cua Vien Dong y Ha Noi): Dung mat Ion say kho
them ta duoc dap thanh vien 0,5g, ngay uong 6 -10 vien chia 2 lan uong truce
luc len com I gio hoac sau bua an.
(3) Trung ga ngam dong tien: Ngam trong 1 tuan thay nude tieu hang ngay.
sau 1 tuan luoc cho tre an, moi ngay 1 qua trong 15 ngav lien.
(4) Cu sa phoi kho tan bot min lam muoi cho benh nhi an voi com ngay 20 40g.
(5) Rau thai (nhau dan ba de khong benh tat) luoc chin cho tre an, hoac phoi
hay say kho tan hot min, moi lan uong 5 - IOg ngay 3 lan.
(6) La ngau tuoi 1 nam khoang 20 - 40g sac nude cho benh nhi uong luc len
con non ra ddm rai lam nhe com.

121

3) Dieu tr i bang ch;im ciru va cac phinm g phap khong dung I hum :
( 1) Cham cuu:
+ Cham kim: Chon huyet:
- Luc len ccm: Dinh suyen. Thien dot. Chien (rung. Tuc tam l> Hvrp coc.
Phong long, moi lan co the chon 3 - 5 huyet
- Luc khong len ccm Phe du. Ty du. Than du
Thu phap: Hen nhiet chain ta. hen han: on cham hoac ciru C o the dung ham
day huyet, Luc len ccm cham luc co com va truoc luc ccm (neu biet dui*c then gian
len ccm theo thutmg le). neu len ccm khong co nhat dmh thi cham nga\ 2 lan
sang va toi truoc luc ngu va luc co ccm.
+ Cham loa tai: Vung Phe ty than, giao cam. cham kim luu 10 - 20 phut hoac
gai kim 3 - 4 ngay. moi ngay dung ngon tay day huyet.
+ Thuy cham: Dung nunc cat hoac Vitamin B, moi lan 0.5 - 1ml thuy cham
cac huyet Phe du, Suyen tuc. Than try. Thuy cham h3hg ngay hoSc cach nhat. 10
lan cham la mQt lieu trinh.
+ Go kim hoa mai: Go vung giua hai duong kinh bang quang tir huyet Suyen
tuc den huyet Than du. luc len con go ngay 1 lan hoac 2 lan. mdi lan 10 lupt den
luc mau da hong la dat.
(2) Veo cot song tir huyet Than tru den huyet Truong cuong. moi ngay 2 lan
moi lan 20 luot (nhu go hoa mai).
(3) Giac cac huyet Phe du, Cao hoang, Ty du. Than du doi voi con hen keo
dai va co bien chung viem phe quan co ket qua giam nhe con hen. benh nhi de
chiu.
(4) Tap tho. xoa long nguc, thu gian can luyen tap.

4) Ket herp thudc tay:

Phep chua bang dong y co ket qua tot doi voi con hen nhe va vira Nhung
truong hop hen nang va keo dai can ket hop phuong phap tay y Thuong dung
co:
- Thd oxy: Trudng hop kho thd nang, benh nhi tim tai.
- Con hen keo dai. dung cac phuong phap dong y khong giam dung:
Adrenalin 1 % . 0.1 - 0.3ml tiem dudi da ho^c tiem b&p (lidu ining binh
0,01ml/kg/15n, co the nhic lai sau 20 phut nhung kh6ng dung qua 3 lieu. Khi
dimg Ventolin (Salbutamol) co thg 4 gid 1 lan (tranh l^m dung, nen han chd

12

dung). Aminophilin. Theophilin (Coledin) liem tinh mach 4 - (Smg/kg/lan. 4 - ft

gid liem lai 1 l4n hoac (ron vdi Glucoza 25^ liem tTnh mach chain Neu dung
thudc vien Aminophilin 0,1 - 0.2/vien vdi lieu 4 - 6ing/kg/lan. 6 gid I lan. hoac
dung thudc dan nhei hau mon vdi lieu 4 - 6mg/kg/lan, 6 gid 1 lan (khong nen
diing cho ire dudi 5 tuoi).
- Tru sinh: Chi dung khi co viem dudng hd hap sdt cao.
- Corticoid: Luc cap dung Hydrocortison 50 - 200mg tiem hap, co the 4- 6
gid tiem I lan nhung sau do giam lieu sang dung thudc Prednison I - 2mg/ngay
chia 3 - 4 lan uong va giam dan lieu. Nhirng loai thudc tay tren day cung chi
dung trong dieu tri cap cuu cat con, thudc dong y van can tiep tuc dung trong
dieu t r i.

TIEU CHAY TRE EM

(Infantile diarrhea)
Bnh tieu chay la khi dua be di tieu nhieu lan hon binh thudng va phan long,
khong thanh khuon va co nhieu chat khong tieu. Tre em ty vi con non yeu (bp
may lieu hoa chua phai trien day du) nen de mac benh lieu chay.

NGUYEN NHAN:
Nhirng nguyen nhan ihudng gap co:
1. Sai lam ve che do an bu cua tre: Cai sira qua sdm, thuc an bo sung khong
thich hop nhu cho an bot qua sdm hoac nhieu qua, gid giac tiiy tien
2. Nhiem khuan dudng ruot va ngoai dirdng ruot: Nhiem khuan dudng rupt
nhu do tryc khuan Coli, cau khuan rupt, virrut, nam, ky sinh trimg ... Nhiem
khuan ngoai dudng rupt nhu tre mac benh viem tai giua, viem dudng ho hap tren,
viem xuong chum ...
3. Nhiem doc thuc an nhu an thit ca di thiu, nhiem doc thudc chua benh nhu
Cloramphenicol, Am picilin ...
4. The tang tiet djch d nhung tre hay mac benh cham, di img ndi man ngoai
da. Ngoai ra co nhi&u yeu td thu|n kjri lam cho tre de mc benh tieu chay nhu tre
coi xuong suy dinh dudng, nori d am thlp, thdi tiSt nong lanh thay doi that
thudng.

12^

V c n g u y e n n h a n h e n h tie t ta (tu c la b^nh tie u c h a y d o n g > c h o la d< n g o ^ i

c a m ly e d a m h o a c n p i th u o n g am th u c d eu la m c h o c h u c n an g c u a ly v i ro i ln ? n
m a sin h b e n h .

T R IE U C H U N G L A M S A N G :
Theo Y hpc hien dai, thuong phan biel tieu chay lam 3 loai: Tieu chay
thuong (chi co roi loan so lan va tinh chat phan, toan trang benh nhi binh thutmg.
khong co irieu chung mat nuoc) tieu chay nhiem dpc hay lieu chay mat nuoc
(benh nhi co bieu hien trieu chung than kinh va m il nude) lieu chay keo dai (thdi
gian tieu chay keo dai tren 2 tuan. tre thudng sut can kem theo suy dinh dudng).
Theo Y hpc co truyen, tieu chay tre em tren lam sang thudng gap co 4 thd
bgnh chinh:
1. Thiromg thuc (thutm g nhu): Thudng thuoc loai tieu chay thudng. neu
benh nhan keo dai gay nen ty vi hu yeu co the chuyen thanh tieu chay keo dai.
2. Phong han: Do cam lanh hoac viem dudng ho hap iren, thupc loai lieu
chay thudng, neu khong chua kip thdi benh co the chuyen thanh lieu chay m il
nude.
3. Thap nhiet: Chu yeu do nhiem khuan thudng thupc loai tieu chay mat
nude (nhiem doc).
4. T y h ir Do noi thuong am thuc hoac ngoai cam luc dam gay nen chuc nang
ty vi hu yeu hoac do benh noi thuong anh hudng lam cho ly duong hu lau ngay
lam ton thuong th^n gay nen ty than duunj! hu. thupc loai lieu chay keo dai. Ty
hu ta de dan den chung cam tich (suy dinh dudng)
Tren lam sang, doi vdi tre em tieu chay can chu y theo doi cac tneu chung
sau d3y:
(1) Mat nude: Tuy nang nhe thudng chia 3 dp:
- Nhe: Tre tinh than kem lanh Ipi, sac mt hoi tai, mat trung nhe. can nang
giam dudi 5%.
- Vira: Sac mat xanh tai. tinh than met moi hoac quay khoc. tinh dan hoi da
giam, thop lom, m il trung, dai it. can nang giam 6 - 10%. M<ich nhanh nho.
- Nang: Da xam, chan tay lanh, tre lanh nhat mat phan ung vdi xung quanh,
mai kho trung, thop lom sau, da mat dan hoi khong dai, din n$ng giam 10 - 15%.
Mach nhanh nho kho bit.
( 2 ) N h ie m d p c lo a n : T in h th a n l a m a th d sa u
k ie m m a u g ia m .

124

dai,

n ju ig th i

hon me. D y

tru

(3) Kali mau ha: Thutmg gap sau khi mat nuoc duoc hoi phuc, lieu dupe
nhieu. hieu hin chan lay la. hyng day. tieng nhu dong ruot giam hoac mai tieng
lim tram nho, phan x? g6i m il. Neu khong dieu trj kip thoi se dan den lift co ho
hip, lift rupt, lift bang quang. tim dap chm, lo<in nhip dan den tu vong. Mau
Kali lhap hon 3,5mEq/lit.
(4) Canxi mau h?: Thudng gap d tre em suy dinh duong sau khi truyen dich
giai quydt dupe nhiem dpc toan, co trifu chung tre quay khoc but rut. chan tay
run giat ho$c co gi^t.
X E T N G H IE M :
- Mau: Hematocrit tng vi mau co d?c, b?ch cau da nhan tang trong nhilm
khuan, roi lo?n cac ch it di|n giai nhir Na, K, Ca...
- Phan: Soi tuoi co chat khong tieu, h?t mo, it hong bach cau co the' co.
- Cay phan tim vi khuin gay bnh.
C H AN D O AN V A PH A N B Ig T :
- Chin doan xac djnh chu yfeu dua vao triu chung lam sang, chu y xac dinh
nguyfin nh2n, cac the benh theo dong y, muc dp mat nuoc, r6i loan dien giai va
cac bien chung.
- Chu y phan biet voi:
1. Ly true khuan: 6 tre nho trieu chung mot ran khong ro, chu y phan co
mau mu. djch te hpc, lich su tiep xuc va xet nghiem phan, cay phan.
2. Viem ruot xuat huyet tre nho: Tieu chay thdi gian dai, sot cao, bung
day non nhieu. phan luc dau long sau chuyen thanh nhu tuong qua mau hong
xam, trieu chung nhiem dpc nang de truy tim mach.
3. Cac benh ngoai dudng rupt gay tieu chay nhu viem dudng ho hap tren,
viem phe quan, viem phoi, viem tai giua, viem xuong chum... dfiu co nhimg trieu
chung rieng, neu can kham chuyen khoa tai mui hpng.
4. Tieu chay sinh ly: Thudng g$p d tre the tang tiet dich (the t$ng xuat
tiet) sau sanh khong lau tieu chay nhieu lan phan xanh vang long khong non, tre
by bam vin len can, in bu binh thudng, hay kem theo cham.
B IE N C H U N G :
I.

Nhilm trung ngoai dudng rupt: Nhir viem dudng ho hap, nhiem trung

ngoai da, viem dudng liet nieu, ham Id dit... CSn dupe luu y k;p thdi.

125

2. Tira mieng: Do ca the yeu. sure de khang kem. cung co the du Jung nhieu
tru sinh.
3. Benh suy dinh durrng va ihieu cac loai sinh to: Thutmg do lieu chay keo
dai, ru6t hap thu dam va cac chat sinh id kem ga> nen
4. Viem gan nhiem J5c: Xuat hien da mat vang do nhiem trung huyei thudng
gap d tre em suy dinh duong.
5. Nhimg hien chung khac nhu suy tim cap. suy than cap cimg nhimg hien
chimg liet ruot, thung rupt... Co the gap, can hot sire canh giac doi vdi tre em tieu
chay.
D IE U T R I:
1) Nhung dieu can chu y trong dieu tri tieu chay tre em:
- Trudng hop tieu chay cap do nguyen nhan an bu, can dan ba me sua sai vc
che do an bu. Neu tre dang bu me nen tiep tuc cho tre hu, trurmg hop dang nuoi
bang sua bo thi pha loang mot nira de cho bu va khi het tieu chay cho an sua nhu
truoc. Neu con tieu chay nhieu lan cho uong dung dich O R E S O L ( I goi gom:
Glucoz 20g, Clorua natri 3.5g, Clorua kali l,5g, Bicarbonat nain 2.5g) I goi pha
vao 1 lit nuoc cho benh nhi uong.
- Trudng hop tieu chay do nhiem trung dudng ruot hoac ngoai dudng ruot
benh nhi co sol cao can cho tru sinh Ampicilin l()Omg/kg/ngay chia 4 lan hoac
Erythromycin 30mg/kg/ngay trong 3 ngay.
- Trudng hop benh nhi tieu chay the thap nhiet sot cao co mat nude hay
khong deu phai dieu trj tai benh vien .
- Tieu chay keo dai (the ty hu hay cam tich) ngoai viec dung thuoc dong y,
can hel sure coi trong che do an bu du chat dinh dudng va du calo, du sinh to
- Can phat hien bien chung va dieu trj kip thdi.
2) D ieu tri bang dong y:

a)

Bien chimg luan tri: Tuy theo the benh ma chon phep chua va bai thuoc

nhu sau:
( I) Thutmg thuc. (tieu chay thudng hoac keo dai do 2n bu).
- Trieu chung: Bung day dau bung tieu xong giam dau, m6i ngay di tidu 5 6 lan hoac nhieu hon. phan thoi kham, nhidu ch it khong t&u, mom hdi an kem.
hoac buon non, non. reu ludi day vang. mgeh ho^t.
- Phep chua: Tieu thuc dao tre.

126

- Bai thuoc: Bao hoa hoan gia giam.

San tra, Than khuc. La bac tir. Khuong ban ha. Bach linh moi ihir 8 - I2g,
Chi thuc 6 - 8g, Tran bi 4 - 6g.

(2 ) Phong han: Do cam lanh sinh tieu chay thuoc tieu chay cap
thudng.
- Trieu chimg: Tieu nhieu lan phan co hot, mau nhal it tanh hoi, soi bung,
dau bung, co luc sdt nhe chay nirdc mui trong. hoac nghet mui, ho it, chan an
khong khat nude, reu ludi tr&ng nhdt, mach nhu hoan.
- Phep chira: Sa phong tan han hoa thap.
- Bai thuoc: Hoac huong chinh khi tan gia giam.
Hoic huong, Tia to, Khuong ban ha, Phuc linh, Bach truat moi thu 8 - 12g,
Trln bi, Bao khuong moi thir 4 - 6g.

(3 ) Thip nhipt: Thudng do nhiem khuan (nhiet dpc) gay b?nh.

- Trifu chung: Tieu chay nhieu nude hoa ca hoa cai, phan vang tanh sot^po,
hoac sdt nh<?, khat nude, da kho thop lom, reu ludi vang nhdt mach ho?t sac.
- Phep chua: Thanh nhift Ipi thap
- Bai thudc: Cat can cam lien thang gia vj.
Cat can, Hoang cam, Kim ngan hoa mdi thir 8 - 12g. Hoang lien 3 - 4g, Luc
nhal tan, Xa tien tu mdi thu 12 - 16g (bao sac). Neu khat nude nhieu gia Thach
hoc I2g, O mai 4g sac uong, ngay I thang chia 3 - 4 lan uong, doi vdi tre dudi 6
thang chia nhieu lan.

(4 ) Ty hir: (tieu chay keo dai thudng kem suy dinh dudng) tieu chay 5
- 6 lan mpt ngay phan song lien tuc tren 2 tuan khong khoi hoac uong thudc khoi
2 - 3 ngay lai tai phat, hoac bung day phan thdi kham (the cam tich), ngudi gay
sac mat vang bung, tinh than mt moi, chan tay lanh, chat ludi hong nhat, reu
trang mong. mach te nho, hoac tram vo luc.
- Phep chua: On trung kien ty chi la.
- Bai thudc: Co the chpn 1 trong 2 bai sau tuy dieu kien thudc.
(a) That vi bach truat tan gia vi.
Cat can. Bach truat. Bach linh, Hosic huong, mdi thu 8 - 12g, Bach bien dau
12 - I6g, Mpc huong, Cam thao mdi thu 3 - 6g, Bao khuong 3-4g.
(b) Cdm bo ty (TrSn Van K y)

127

d7. Hoai son. Lien nhuc. Bach hien dau (deu saoi Dang ..im moi thu lOOg.

Nhuc khau, Coc nha moi ihir 3()g, Sa nhan. Tran hi moi thu 20t:
Cach che va dung: Nhuc khau. Sa nhan. Tran hi sac la> nin^c. cac vi khac sao
don tan bot mm cho duang vira du tron lam thanh dang com. moi lan uong 5 IOg, ngay 2 lan vdi nude com.
Trudng hop ty hu kiem than duong hu tieu chay keo dai. phan long nude
nhieu khong mui, tinh than u ru, sac mat tai nhot. chan tay mat lanh, lung goi
lanh, chat ludi sac nhat reu trang mong, mach tram te nhuoc. dung bai: Phu tu ly
trung hop tu than hoan gia giam:
- Phu tu 3 - 6g (sac trudc) Bao khuong, Ngu vi tu. O mai. Ngo thu du moi
thu 4 - 6g, Dang sam, Bach truat. Bo cot chi, Nhuc dau khau. Kha tii nhuc moi
thu 8 - 12g.

b)

Gion (hieu mpt so bai thuoc kinh nghiem dung nhung v/ thuoc don gian

(nhung bai thudc sau day da dupe xu dung co ket qua tai khoa nhi Vi('n Dong y
Ha N o i 1962-1976).
- Viem ia chay nhi:
Cong thuc: Hoang ba 125g, Ngu vi tu 45g, Ngu boi 35g, Phen phi 25g. Tat
ca tan bot mjn dap vien 0,5 - 1,0/1 vien. M oi ngay uong 2 - 4g chia 4 lan. Dung
cho tre ia chay thudng the thap nhiet hoac thuong thuc.
- Bot binh vi:
Cong thuc: Thuong truat 8g, Hau phac 5g, Tran bi 5g. Mach nha, San tra,
Than khuc. Cam thao moi thur 4g. Tat ca say gion nghien nho cat dung. Moi lan
uong 2 - 4g, ngay uong 3 lan vdi nude gao rang. Dung cho the thuong thuc va
the ty hu kiem thuc tich (tieu chay keo dai co nhung dot tai phat).
- Bpt tieu thuc:
Cong thuc: MOng ma 2 phan, Son tra 2 phan, Chi thuc, Hat cau. Tran bi m6i
thir 1 phan. Theo ty le, cac vj thuoc deu tan bot mjn, tron deu dong goi 10g/lgoi,
moi lan uong 2 - 3g, ngay uong 2 - 3 lan. Dung cho the thuong thuc.
- Bot tieu chay han:
Cong thuc: Cu gau 40g, Bup oi 40g, Cu sa (sao thorn) 30g, V o quyt (sao)
20g, Cu rieng 20g. Cac vi sao gion tan mjn trn diu d t dung. M di lin u6ng 2 4g, ngay 3 lan dung cho the han.

128

- M ot so vj thuoc trj tieu chay dung theo kinh nghiem dan gian:
(1) Vo thach luu 40g gia dudng do vira du sac nunc chia nhieu lan uong
(2) Bot hoai son moi lan 12 - 20g cho nude tron lhanh ho, ngay uong I - 2
lan.
(3) Som tra ddt lhanh lhan, Ke noi kim, Gung luong bang nhau dot chay
thanh than deu tan bot min moi lan uong 1 - 2g vdi nude soi de nguoi, moi ngay
4 lan.
(4) Rau sam 40g sac nude uong.
(5) Ng sim, Bup oi moi thir mpt nam sao len sac nude uong.
(6) La hoac bup che tuoi sac dc uong.
(7) La voi. La thach luu sac dac uong.

c ) Dieu trj bang cham cuu:

Thudng dung cuu doi vdi cac the thuong thyc, the phong han, the ty hu thupc
lo?i tieu chay thudng khong bien chung.
ChQn cac huy$t: Thien xu, Khi hai, Tuc tam ly, Huyet chi ta (tren huyet quan
nguyen 5 phan), Ty du, Dai trang du.
- Tre co giun, suy dinh dudng: Cham Tir phung, co non: Cham ho$c cuu cac
huyet: Trung quan, Noi quan, Noi dinh.
- Xoa am vung bung dudi, veo da cot song lung (met tich) deu co tac dung
trj tieu chay do thuc tich, do han va do ty than duong hu.
K et hop tay y:
Chi dinh chinh cua cac phuong phap dong y la tieu chay thudng the thuc
tich, thucmg nhu thirong thuc ta, the phong han va thap nhiet ta khong co bien
chung, mat nude hoac kem suy dinh dudng nang. Can ket hpp tay y trong cac
trudng hpp:
- M a t nude vua va nang, sot cao co giat: Dung try sinh, thuoc an than chong
co giat ha sot.
- Nhiem doc toan, ha kali, calci: Dieu chinh kiem toan, can bang dien giai.
- Trudng hpp tre mat nude hon me, boi md tetracyclin hoac dap gac tam
nude muoi sinh ly vao mat de chong viem giac mac, thay ta lot thudng xuyen
chong viem quanh h$u mon ...
- Trudng hgrp tre suy dinh dudng nang can truyen huyet tuong hoac mau.

129

Phong benh:
1. Chu y che do an bu cua tre du chat dinh durmg. hirp \e sinh dung che do.
Khuyen cac ba me khong nen cai sua qua som, de chong coi xurnig va suy dmh
dudng.
2. Tich cuc phong va chira tich cuc benh nhiem khuan
3. Chu y ve sinh moi trircmg song cua tre. khong de tre bi cam lanh. chu y giu
bung am.

SUY DINH DU O N G
(infantile malnutrition)
Suy dmh dudng la mot trang thai benh ly cua tre do an doi khong du chat
dinh dudng nhu dam dudng. md va cac sinh to, cac yeu to vi luong ho|k co quan
tieu hoa cua tre (chu yeu la ty vi) khong hap thu chuyen hoa dupe ch it dinh
dudng. ket qua la co the tre khong du chat lieu de hoat dong va phat trien nen ccr
bap teo dan. ldp md giam sut, tri luc va the lyc deu phat trien cham. chinh khi
kem ve khi (sue de khang cua ca the) cung kem nen tre de mac b?nh ngoai cam
(nhiem khuan) va chuc nang cac tang phu cung de hu yeu. Thuat ngu suy dinh
dudng chi dung cho tre dudi 3 tuoi (theo qui dinh quoc te). Dong y goi suy dinh
dudng la chung cam tich va cho rang nguyen nhan chu yeu la do an bu that
thudng (bao g( m chat lucrng. so luong thuc an va cach nudi tre) lam ton thuong
ty vj. chuc nang b ip thu van hoa cua ty vi giam sut. thuc an khong tieu u dpng
lai gay nen tich tre va sinh ra chung cam nen co cau: Vo tich bat thanh cam" noi
len co che va benh ly theo Y hpc co truyen. Suy dinh dudng la mot benh chiem
ty le rat cao d tre em nude ta. CJ cac nude dang phat trien benh chiem ty If tir 30 60% d tre dudi 3 tuoi, tai cac nude chau A la 54%, d Viet Nam tre suy dinh
dudng dudi 3 tuoi tir nhe den nang chiem 51% (tai lieu cua Vien bao v f sue khoe
tre em trung uong 1991).
N G U Y EN N H AN V A BEN H L Y N G U Y EN N H AN TH U O N G G A P C O :
1. Sai lam trong che do an bu: Thieu sua m? hoac cai sua qua sdm. an bpt qua
sdm. thieu dam va md keo dai, tom lai thuc an thieu ca ch it va lupitg.
2. Tre om dau nhieu lan va keo dai; Thudng la hjUi qua cua cac benh lieu
chay. viem phdi. lao, ho ga v.v...

130

3. Dieu kien sinh hoat nuoi dudng kem: Niri achat am thap. thieu anh sanj;.
thieu khong khi, tre it duac cham soc.
4. Di tat ham sinh, tre de non, de yeu: Thuirng la nhieu nguyen nhan ket herp.
Suy dinh duang nhe chu ydu ia giam sut lap md. dudi da va ca teo, trudng
hgrp n$ng thi thanh ruot mong. nep nhan niem mac ruot mat dan, sai ca tim phu
ne, to chuc te bao gan thoai md, tuyen uc teo, den luc to chuc md mat di 90% thi
cac tang phu, cac tuyen noi tiet deu teo nho.
T R IE U C H U N G L A M SA N G :
Y hpc co truyen chia benh cam lam 5 chung:
1. Ty cam (phi cam, thuc cam) ca the xanh gay. sac mat vang, sdt chieu, an
bu kem, co luc bung dau. dau to. co luc non, mom kho, dai tien tanh hoi
2. Can cam (Can cam, phong cam) toe thira dung nguoc, mat nhieu ri co
mpng trang, hay lac dau, bung to ndi gan xanh, tre but rut tieu phan xanh.
3. Tam cam (kinh cam) ngudi nong hay giat minh, moi do, mom ludi loet,
long ban chan tay nong, md hdi trom, nhien rang the ludi ...
4. Phe cam (khi cam): Sac mat trang bech, da toe kho nhu chay, ho suyen, sa
l?nh, thudng chay nuoc mui trong.
5. Than cam (cot cam): Sac mat den xam. lai rang chay mau. mom hdi bung
dau, tieu long, chan tay lanh. hay quay khoc. Ngoai ra Y hpc cd truyen con chia
benh theo trieu chimg nhu cam nhiet (am hu sdt chieu) Cam ta (tieu long bung
sdi) Cam thung (phu) hdi cam (cd giun dua) cam lao (sdt chieu), md hoi trom,
long ban tay nong) nhan cam (mat loet, sa anh sang, cd mong trang) nha cam
(mom hdi, lai loet, chay mau rang) ty cam (khde mui Id loet) v.v... deu md ta
nhirng trieu chiing va bien chung cua benh.
De giup cho tien luong va dieu tri benh, cac hpc gia Y hpc hien dai cd nhieu
cach phan loai theo Gomez (1956) chia theo 3 dp suy dinh dudng theo ty le giam
trpng luong. cach phan loai theo Wellcome (1969) cung dua vao trong luong
nhu: Neu trpng luong cua tre chi con 80 - 60% so vdi trpng luong chuan thi coi
la suy dinh dudng, neu thap han la 60% la the nang con goi la Marasmus, co phu
kem theo goi la Kwashiorkor trpng luong dudi 60% them phii thi goi la
Kwashiorkor marasmus. Vaterlow (1974) phan loai can cu theo ca chieu cao va
trpng luong.giam so vdi chuin. Phuong phap nay thi chinh xac nhung phuc tap.
Theo khuyen nghj cua O M S thi: Chan doan la suy dinh dudng khi trpng lupng
dudi 80%. gpi la teo del khi trpng luong dudi 60%, neu cd phu la Kwashiorkor,

131

CO phii va teo d e l thi goi la K w ashiorko r-m arasm us

M o t cach phan loai kinh

dien m a co y nghia thuc dung la:

1. The teo det:

- Dp I: Can nang giam 10 - 15%. lop mdda hung giam ngoai ra binh thudng
- Do II: Can nang giam 15 - 30%. lop mdda hung mong teo. mat gay. truong
luc cogiam. khoc tieng nho ngudi yeu. an ngu deu kem.
- Do III: Can nang giam tren 30%. mat ong gia. sic mat tai nhot, tran co
nhieu nep nhan, kem theo la cac roi loan linh than (Id do, cau kinh, lanh nh^t) roi
loan tim mach (nhip tim khong deu, huyet ap h?o roi loan tieu hoa ( tieu chay
keo dai, nhac an, day bung. . ) Da kho loet giac mac.
2. The phu suy dinh dudng: Phu mem trang chu yeu la d vung mat lay chan.
3. The K w ash iorkor: la the suy dinh dudng nang phu kem theo roi lo?m sic
to da thanh mang nau rai rac khap co the, roi loan tinh than va tim mach nhu suy
dinh dudng dp 3.
X E T N G H lfeM :
Protid va Lipid mau giam ro, ty le A/G giam, cac chat dien giai trong mau
nhu Na, Ca... Cac men tieu hoa deu giam, huyet sac to dudi 5g la thieu mau njng
can truyen mau. Hematocrit tang tren 40% la co dac mau can truyen dich. Ngoai
ra can thu phan tim trung giun, thu nude tieu.
Bien chung:
Thudng gap la thieu mau do dinh dudng. Dam toan phan qua thap gay phu,
thieu cac sinh to A, B, C... Tre phat due cham, roi loan tieu hoa keo dai.
Benh nhiem trung nhu tua, viem tai giua, viem dudng ho hap. viem loet da,
viem dudng tiet nieu... Benh nhi co the tu vong dpt ngpt do ha dudng huy&t.
CHAN DO AN:
- Dua vao lam sang de xac djnh the benh va dp suy dinh dudng.
- Tim hieu nguyen nhan de phoi hpp trong dieu trj .
- Xet nghiem va kiem tra X quang phoi de xac dinh bien chung.
D IE U T R I:
1) Nhung dieu can chu y trong d ilu tri benh suy d n h < M ag tre cm :
- Dieu trj nguyen nhan gay suy dinh dudng: C h i dQ in sai lim , nhilm khuan,
tieu chay keo dai.

132

- Co ch i do cham soc h<j ly lot: Ve sinh ca nhan. benh nhi duoc nam n<n
(hoang sach. doi voi suy dinh duong nang. co che do cach ly bao v (chu y
chong nhiem khuan, da duong ho hap va tieu hoa).
- Ch<i dQ an bu phai bao dam 2 yeu cau: Du chai dmh duirng, sinh to va benh
nhi hap thy dupe. Theo che dQ tang dan ty I? d^m trong khau phan so luong calo
cho vao co the tang dan tir 40 - 70 calo/kg/ngay len 120 - 150calo/kg/ngay.
- D6i voi benh nhi suy dinh duong nang can truyen huyet luong hoac truyen
mau, co nhiem khuan ket hop tru sinh.
2) Dieu tri b in g dong y:

a)

Bi$n chiing lu$n trj: Tren lam sang dong y thuong gap 3 the chinh: The

cam tich, the ty hu va the' khi huyet hir va luan trj nhir sau:
(1) Th6 cam tich:
- Triu chung: Nguoi gSy, byng to hoac dau bung tieu xong het dau, tao bon
hoac tiSu phan thoi kh&m, met moi da nong ngu khong yen g ilc, chat luoi do reu
day, chi vin tia tre, mach hoat sac.
- Phep chua: Tieu thuc kien ty.
- Bai thuoc: Chi trufrt hoan gia vj.
Bach truat 4 - 8g, Chi thuc 4 - 6g, Mach nha 4 - 6g. Than khuc 4 - 6g, Tran bi
4 - 6g, Chich thao 2 - 3g.
Hoac dung bai:
- Tieu thuc hoan: Hoai son 8 - 12g, Son tra. Than khuc. Lien kieu, Khuong
ban ha, Tran bi. La bac tu moi thir 4 - 6g.
2

bai thuoc deu co the sac nuoc uong ngay 1 thang hoac tan bot mjn de uong

ngay 2 lan, moi lan 2 - 4g voi nuoc com hoac nuoc chao.
Gia giam: bung dau gia: Mpc huong 2 - 4g, Binh lang 4 - 6g.
- Non gia: True nhu 2 - 4g, Gimg tuoi 4 - 6g
- Tieu long gia: Hau phac 4 - 6g, Hoang lien 2 - 3g.
- Tao bon gia; Chi xac 4 - 6g, D?ii hoang 1 - 2g.
(2) The ty hu:
- Trieu chung: Sac m it vang xpn, tinh than met moi, it ngu, luc ngu nham
khong kin mat, kem an. tieng khoc nho, phan nhieu chat khdng tieu, khong thoi
ngay 4 - 5 lan, chat ludi nhqrt, reu triing giua day dinh, chi van h6ng nhat, m^ch
trim nho vo lye.

133

- Phep chira B ' tv khi kiem t:cu ii^h

- Ba; thuoc
- Corn tv tv

\cm ha: neu chay '

- Viem cam coc iLuomg \ Nguven Trong Caui

Boi coc lOOg. chuoi ta> sa> kho 150g. Bot Ions Jo inmg ga 25g
- Cach chc va Jung Chon Ctx; map khong co ha dui. bo Jau da ^a ruot inmg.
chi lav thu VL.nTng ho van r.jee none nira sach cho nen chao gang nau khong do
nuv'C. \ong cho

kho lan 'hot. chuoi lav va hot long do tnrng ga deu say kho

tror deu gia nhuven dar \:en nang 2g/vien Tre 1 - 3 tuoi moi lan uong 2 - 4
vien. ngav ? lan Neu tieu chav phai diing hinh vi irong 3 ngav het tieu chav imii
dung \ ten cam coc
i ' i The khi huvet hir
- Tneu chung Sac mat tai nhat. chan tav lanh. toe kho thira tinh than met
moi. tieng khoc nho. tieu phan luc tao luc long, moi Iikti nhot. chi van hong nhat.
mach le sac hoac tram te nhurv
- Phep chua: Ich khi ducmg huyet kien ty
- Bai ihuoc Dang sam 'hoac nhan sdmt 8 - 12s (neu diing nhan sam luong
K i n n n i n i H . \ i n o V, \

fi - 1 2 ?

[ V j n m j o*jf 8 - j %

Y d*

1??

L tf f l

i saoi s _ ]2g. Thuc Jia Tin'm g1s - | 2c Ha thu 6 S - I2g Lons nhan 8 I2g.
Ngu vi in-i - Pg Sac uong chia nhieu lan irong ngay Bai thucx nay co the gia
boi rau tr.ai lam hoan. moi lan uong 4 - 6g. ngay uong 2 lan. Neu hjnh nhi lieu
chav, dung com ho t> gia Binh vi inrcv. khi het ueu chav moi Ju r s hai nav.
- Gia giam:
- Truong nop co xuat huvei duoi da. cho uong sam lam that bot moi ngav 2 4g chia 2 lan
- Trircmg hop am hu huyei nhiet (sdi chieu. mo hoi irom. long han chan lav
nong i lhay Thuc dia hang Sinh dia. gia Dia cot bi 8 - 12g. Tn mlu 6 - 8g. Dim hi
8 - 12g. Miet gtap S - 12g de ducmg am lhanh nhiet.

* Chu > trung coc rat doc phai bo b it.

- TnJcmg hop phu. dung Wien ty l<Ji thap, cho uong mfdc r tranh. rau ngo. 4n
chao bo bo ho3c cho uong bai : Dang sam 8 12g. Y d ? !

I2g, H oai sdn 8

12g.

Xa tiSn ni 6 - 8g. La bac ni 6 - IOg. Moc th6ng 8 - IOg, D in g tflm 2g, Tang bach

bi 8 - 12 g, Gtfrig tudi 6 - I2g.

134

- Truong herp bien chung loci mom. tua: Dun}! boi luu lam vao mieng gac
boi vao cho loci (hot lira gom: Bang sa. Phen phi. Thanh dui linrng bang nhau lan
bpt mjn tron deu).

h) G id i thieu hai thuoc kinh nghiem:

- Cam tich tan: Ke noi kim 4()g. Mach nha. San tra. Than khuc moi ihir
I20g, lan bot min trpn deu, moi lan uong 2 - 4g. ngay 2 - 4lan. ire nho sac bo
c?n.
- Khien nguu tu40g. Binh lang 40g, Hung hoang I2g, lan bot min. Moi lan
uong 3 - 6g, ngay 2 lan tri Ire suy dmh duong tao bon (Trung y hoc vien Bac
kinh)
- Con coc bo dau rupt da say kho tan bpt min, moi lan uong 2 - 4g voi nuoc
duong, ngay 3 lan.

c) Cac phuong phap khong dung thudc:

- Veo cpt lung (niet tich) ngay 2 lan ngu day va truoc luc ngu co tac dung
ting cuong khi huyei luu thong. Co the ket hpp bam mpt so huyet nhu .Ty du,
Thjrn du, Tuc tam ly.
- Cham tir phung co tac dung tang khau vj, tay giun, ket hpp cham loa tai
vung da day tang them an, ciru Thien khu. Than khuyet chua tieu chay.
3) K et hop thuoc tay:
Chu yeu doi voi the suy dinh duong nang va co bien chung.
Phong benh:
- Giao due pho cap cach nuoi day tre: Nuoi tre tir trong bung me, cho tre an
bu dung phuong phap, du chat dinh duong, phong benh nhiem. giao due tap
quan ve sinh cho tre. Phat hien benh chua kip thoi.

135

VIEM CAU THAN CAP

( A cu te n ep h ritis)
DAI CUONG:
Viem cau than cap (cung goi la viem cau than \uat huyet ^ap. viem lhan cap)
la mot benh tiet nieu thircmg gap o tre em Ty le mac henh cao 6 lira tuoi 3 - 8
tuoi, ire duoi 2 tuoi it mac benh benh co lien quan nhieu Jen cac benh 16 ngua
ngoai da. benh viem duong ho hap tren Dat diem lam sang cua benh la; Phu
toan than, nunc tieu it. dai mau (dai the hoac vi the) va huyet ap cao.
Theo Y hoc co truyen. benh thuoc pham tru chimg thuy thung the duong
thuy Tru mot so it benh nhi kem suy tin . suy than cap. phu nao cap. da so benh
nhi duoc dieu tri kip then, tien luong benh la tot.
N G U Y EN NHAN VA BEN H LY :
Viem cau than cap la mot benh nhiem khuan di img do lien

'

^an lan

huyet beta nhom A (beta hemolytic sueptococcus A ) gay nen khi xam nhap co
the. Benh thuong phat sinh sau khi mac benh nhiem khuan ngoai da, benh tai
mui hpng, viem duong ho hap tren khoang 1 - 4 tuan. phan ung giua khang
nguyen va khang the tu sinh xay ra trong toan co the nhung noi bat la 6 cac
mach mao quan cau than. Mach mao quan co that lam cho tinh tham thau cua
thanh mach tang, niroc. chat keo va chat dien giai trong huyet tucmg thoat ra
ngoai to chirc gian bao sinh phu. Co that cung lam cho mao quan cau than hep.
luu lupng mau qua it. lirrmg nuoc tieu loc qua cau than cung it. Mat khac, mau
qua it cau te bao than thieu mau cung thieu oxy va net ra nhieu chat than to
(renin) la chat co kha nang lam cho mach mau toan than co that \a ket qua la
huyet ap tang. Tinh tham thau cuo mau quan cau than tang, huyet tucmg, hong
cau. bach cau thoat ra ngoai. gay nen protein nieu. hong cau va bach cau nhieu
trong nuoc tieu
Y

hoc co truyen cho rang: Do cam nhiem ngoai ta (phong. han. thap, nhiet

chuc nang thong dieu thuy dao cua phe va khi hoa cua bang quang bi tro ngai.
phe khi mat tuyen thong, chuc nang khi hoa roi loan, nuoc khong theo thuy dao
vao bang quang ma ir dong o co bi sinh phu. Benh lau ngay se anh huong den

136

than khi, than khong chu dune thuy, chuc nang van hoa cua tv do thap tre ma su\
giam, nunc tieu cang it phu keo dai. Mat khac, thap nhiet u- tre a hang quang,
nhiet lam ton thuong huyet lac sinh dai mau. Thuy thap dinh luu trong ca the anh
buong ddn lam phe (thuy thap phiem lam) sinh ra suyen tuc kho tho. thuy thap
xam phan len nao sinh ra cac chung dau dau, hoa mat, chong mat. co giai
T R IE U C H U N G L A M S A N G :
Trieu chiing lam sang nang nhe rat khac nhau. Nhe co the chi co thay doi
benh ly nuoc tieu (luc xet nghiem mai phat hien) nang thi gay bien chting suy
tim, phu nao, cao huySt ap co the uy hiep tinh mang. Nhirng trieu chiing chinh
thuong gap la: Phu loan than, protein nieu dai mau, huyet ap cao.
- Phu: Bat dau a mi mat (tir mat dau lan ra toan than) sang nang chieu nhe,
co In lom nhe. Sau dieu tri 3 - 7 ngay, nuoc tieu tang, phu giam.
- Nuoc tieu giam ro trong may ngay dau tang dan thirong sau 1 tuan.
- Suy than cap: Tinh trang thiSu nieu hoac vo nieu keo dai qua 3 ngay. Xet
nghi$m ure, creatinin mau tang, co tinh trang nhiem toan chuyen hoa va roi loan
dien giai. Benh nhi k&u dau d iu Chong mat, buon non, non, nang dan den hon
me co giat. Nhung bien chiing tren day neu xu tri dung va kjp thoi, tien lugrng la
tfo .

T IE N L U O N G B E N H :
- Phan Ion benh nhi hoi phuc trong 6 thang, mot so benh nhi benh keo dai
tren I nam van khoi. Tieu chuan khoi benh la: Trong 6 thang sue khoe binh
thtrcmg, chuc nang than binh thuong, protein nieu (-) can nuoc tieu hinh thirong
- Neu sau 6 thang, toe do huyet tram van cao, ty trpng nuoc tieu thap, benh
co the chuyen thanh man tinh. Ty le khong qua 2%.
- Nfeu sau 6 thang chuc nang than binh thudng ma can Addis chua binh
thjong la benh viem than keo dai.
- Benh nhi thuorg tu vong do bien chting nang xu tri khong kip then.
Dlfeu T R I:
A . Che dp cham soc an uong:
- Tuy$t doi nghi tai giuorng trong 2 tuan dau, neu con dai mau can han che
v$n dpng. B^nh nhe co the dieu trj tai nha nhung can dupe nghi ngoi it nhat la 1
thang tir khi phat hien benh.

137

Benh nhi can duoc chain sir. x;t dinn: ihio dui dial che irons 2 luan dau vinlaVc tien. huyei ap v j irang lhai chung de duoc phai hien cac hien chimg s(rm va
xu in' kip ihai
- Benh nhi can duac hao ve chong cac henh nhiem khuan khac Sau 2 thang
henh hoi phuc loi. henh nhi co the Hep xuc hoc lap nhung sinh hoai dieu do
khorg lao dong hoc lap qua sue.
- Che do an nhal va han che muoi luc henh nhi con phu va protein njcu
duang linh. Luc con dai it va huyei ap cao. han che nunc uong. luong nuoi: uong
irong co the linh hang luong nuac lieu horn truoc cong them 200ml. Luang dam
an vao can han che khong qua Igam/kg/ngay. Che do an tuy theo khau vj, nen
cho an nhieu trai cay co sinh to B. C va nhieu duang. hao dam nhu cau nang
luong.
B. Dieu tri bang Y hoc co truyen dan toe:

I . Bien chimg luan irr Theo cac the benh sau:

1) The phong nhiet: Thuong kem theo viem hQng. sot vua ra mo hoi,
phu. dai it mom kho khat, Reu ludi vang mong, mach hoai sat hoac phu sac.
- Phep trj: Thanh nhiet loi thuy.
- Bai thuoc: Ngan kieu tan hap tu linh tan gia giam, hoac diing bai:
Kim ngan hoa 2()g. Bo cong anh 12g. Cue hoa I2g. Ha kho thao I2g, Dan hi
12g, Bach mao can 12g. Tho phuc linh I2g. Tho nguu til I2g. Cam thao nam
12g, Gimg tuai 3 lat, sac uong ngay I thang.
2) The phong thuy: Phii. tieu it. chan tay cac khop dau moi so gio, dau
dau, reu luai trang mong, mach phii hoan.
- Phep trj: Tuyen phe lai thuy.
- Bai thuoc: M a hoang. Lien kieu xich tieu dau lhang gia giam. Ho5c diing
hai: Kinh giai 8g. Ma hoang 6 - 8g. Tang hach bi 12g. Lien kieu 8g, Xich tieu
dau 12g, Xa tien thao I2g. Bach mao can I2g, Hanh nhan 6g. Cam hao 4g, Gimg
tuai 3 lat. Sac uong ngay I thang.
3) The thap nhiet: Phii. nguai nong but rut, lieu tien it mau nuoc tra
dam. reu luai vang day, mach tram sac.
- Phep trj: L a i thap nhiet luong huyet giai doc.
- Bai thuoc: Tieu ke am tu gia giam.

138

Kim ngan hoa 20g. Cue hoa I2g. Bo cong anh I2g. I icu ke Ibg. Han lien
thao I6g, Mao can luoi 20 - 40g, Don hi I2g. Sinh ho hoang (bao sac) IOg. Hoat
thach 20g (bao sac). Sac uong ngay i thang.
4)

The han ihip: Phu loan lhan. lieu it, nguoi va chan tay nang nc.

nguoi mat. Reu ludi irang day. mach tram hoan.

- Phep tri: Thong duong loi thuy.
- Bai thuoc: Ngu linh tan hop Ngu bi am gia giam.
Bach truat, Thuong truat, Trach la. Bach linh, Ngu gia bi deu I2g, Que chi
6g, Tran bi 6g, Sinh khuong bi 4g.
- D6i voi cac the benh tren day, neu bnh nhi co dau vang dau, mach huyen.
huyfet apcao gia: Hoang cam, Ha kho thao, Cau dang (cho sau) 12 - 16g.
*
- Bpnh nhi vao thoi ky hoi phuc ma con huyet ni?u va protein nieu tire than
khi suy giam. bnh chua dut dimg Luc vj dia hoang hoan hop Duong qui xich
dau tan: Gia vi:
Sinh dia 12g, Hoai son I6g, Don bi I2g, Trach ta, Son thu, toan Duong qui,
Phyc linh, Han lien thao deu I2g, Xich lieu dau 30g s5c uong.
- Trudng hop khi hu, tinh than mpt moi, sac mat xam, an kem, tieu long, sac
lum nhot mach yeu, dung bai Bo trung ich khi gia giam:
Hoang ky 12 - 20g, Dang sam, sao Bach truat, Duong qui. Hoai son. Bach
hien dau, Kim anh tudeu !2g. Sac uong.

2. Diing bai ihuoc kinh nghiem: Chu yeu diing cho the benh nhe khong co
hien chung.
- Bai thuoc co nhieu, d day chi giai thieu mot so bai de kiem thudng duoc xu
dung:
( 1) Re co tranh tuoi 80 - 160g sac uong.
(2) Hoa la ma de tuoi (ca re). Rau ngo moi thir 150g sac uong.
(3) Ich mau thao 150g sac lay nude chia 4 lan trong ngay.
(4) La ngai cuu. Thuong truat. Cam thao day moi thir 20g sac nude uong
trong ngay hoac doc vi La ngai cuu 40 - b()g moi ngay sac uong.
3. Dieu tri thudc lay phoi hirp:
Thuoc nam co truyen chi diing don thuan doi voi viem cau than cap the
thong thudng co ket qua tot. Doi vdi nhung the co bien chung. rat can phoi hop
ihuoc lay.

139

!) Doi van viem cau than cap co hien chung urn mach
- Thuoc Ion nieu: Furosemid 3mg/kg/24gid. tiem tmh mach
- Thuoc ha huyet ap: Diazoxit 3 - 5mg/kg tiem nhanh tinh mach Sau 30 phut
chua k6t qua co the tiem nhac lai Hoac Reserpin tiem hap 0.02 - 0.07mg/kg/lan.
sau 6 - 8 gid co the tiem nhac lai.
Hydralazin (Apresolin) 0.1 - 0.2mg/kg/lan (1,7 - 3.5mg/kg/24gid) tiem tinh
mach, cach 6 gid 1 lan. Co the phoi hgrp Reserpin va Hydralazin
Sau ccm huyet ap cao cap dien nen cho uong:
- Propranolon 1mg/kg/1 lan x 3lan/ngay
- Hoac Hydralazin Img/kg/lan x 3lan/ngay.
- Hoac Reserpin 0,04mg/kg/Ingay chia 2 lan.
- Thuoc tra tim: Digoxin 0,04mg/kg/ngay. tiem tinh mach 1/2 lifeu. tiem lan
luot sau 8 gicr tiem l/41ieu.
- Tho oxy (neu kho thd)
Neu co phu phoi cap: X u tri theo phu phoi cap.
2) Doi vdi viem cau than cap co bien chung pho nao cap:
- Thuoc ha ap nhu doi vdi the tim mach. Thuoc loi lieu nhu tren.
- Chong phu nao va co giat: Magie sunfat 15% - 0,3ml/lcg. tiem tioh mach
cham hoac tiem hap. Diazepam 0.2 - 0,3mg/kg, tiem tinh mach cham (ling/phut
doi vdi tre em lieu toi da la lOmg/lan.
3) Doi vdi viem cau than cap co hien chung suy than vo meu: Cac
bien phap xu tri theo nhu suy than cap.

140

N H lfiM KHUAN DUONG TIEU

(Infections o f the urinary tract)
DAI CUONG:
Nhiem khuan duong tieu la danh tir chung chi chung viem nhiem dudng tieu
bao g6m be thn, nieu dao, bang quang... V i benh it khu tru a mpt bo phan nao.
Tuy nhien tuy theo vj tri ton thuong nang hon ma co benh danh rieng nhu viem
be than (pyelonephritis) viem bang quang (cystitis) viem m?u dao (urethritis).
Dac trung chu yeu cua benh la su tang so luong cua vi khuan va bach cau khac
thuong trong nuoc tieu. Benh nay khong bao gom viem duong nieu ^o cac b?nh
hoa liiu (lau, giang mai...).
N G U YEN NHAN BEN H :
V i khuan gay benh chu yeu la vi khudn duong ruot, nhieu nhat la do E. Coli,
Proteus, Klebsiella, cu khuan duong rupt, hi6m gap co Salmonells true khuin
thuong han, tryc khuin mu xanh, virut, nam ,...
- Yeu to thuan loi: Tre duoi 3 tuoi, gai, tre suy dinh duong, dj dang ducmg
tieu.
- Theo Y hpc co truyen, benh thuoc pham tru chimg lam va nguyen nhan chu
yeu la do thap nhiet uat ket tai bang quang.
T R IE U C H U N G L A M SA N G :
Tuy theo tuoi va co dja ma trieu chung lam sang rat khac nhau, co the khong
co tri^u chung ro ret ma cung co the co trieu chung nhiem khuan nhiem doc toan
than.
- Tre so sinh: Sot hoac than nhiet giam, kem an, cham tang can, vang da, co
the co cac bieu hien nhiem khuan huyet.
- Tre bu me: S6t non tieu chay, luoi an bu.
- Tre Ion va ngudi Ion co trieu chimg dien hinh nhu sot, ret run, dau bgng
hoac vung sudn lung, dai buot, dai dat, dai dam ...

141

K IE M T R A CAN L A M SA N G :

Xet nghiem nurrc tieu: Co gia tr) xac dinh chan doan Phai la> nunc lieu

giCra dong.
- Ket qua nuoi cav vi khuan nieu: So luong khuan lac/ml nuoc tieu co tren
100.000 la duong tinh. it hon 1000 la am linh. neu giua hai so luong tren la nghi
ngdcan kiem tra nhieu lan
- Ket qua soi tuoi bach cau nieu: Soi can sau ly tam. ket qua duong tinh neu
so luong bach cau tren 10 cai/vi trudng. Soi tuoi theo Webbs-Stansfeld, ket qua
duong tinh neu so luong bach cau tren 30 cai/mm3
- Cong thuc mau ngoai vi va toe dp lang mau.
- Ure, creatinm khi nghi ngdeo viem than be than.

3.

Chup than: Trudng hpp benh keo dai, nghi ngdeo di dang tiet nieu, soi tiet

nieu.
C H A N D O AN V A P H A N B IE T :
- Xac dinh chan doan chu yeu dua vao ket qua xet nghiem nuoc tieu. Chi
can mot trong 2 ket qua xet nghiem nude tieu duong linh.
- Chu y xac dmh nguyen nhan: Nho ket qua chup than, bang quang, nieu
quan de phat hien di dang dudng nieu, soi nieu. Kiem tra ky cac bo phan khac de
phat hien viem am dao, viem bao qui dau, viem ruot ...
- Luc co than suy chu y phan biet vdi viem cau than man. Neu viem be than
thi chuc nang co dac cua than b| ton that la chinh chuc nang loc it anh hudng,
con viem than man thi ca 2 chuc nang deu kem.
- Trudng hpp benh keo dai nhieu thang den nhieu nam la nhiem khuan
dudng nieu man tinh, benh nang nhe khac nhau, sot giao dong keo dai gay nen
tre thieu mau, suy dinh dudng. phat due cham. Can chu y co di dang dudng nieu.
T IE N L U O N G :
Nhiem khuan dudng nieu cap dupe dilu tri kip thdi phiin lorn la khoi. Sdt keo
dai khoang 7 - 1 0 ngay ha. nude tieu trd lai binh thudng sau 2 - 3 tuan. Trudng
hpp co bien chung suy than (hay gap d tu6i d$y thi) tien lupng thuong khong tdt.
D lfeU T R I:
I. Che do an uong cham soc:

142

- Luc sol va co nhiem doc toan than, henh nhi phai duac nglu ngoi tai
giudng. cham soc theo doi chu dao de xu tri cac bien chiing kip thai
- Cho an che do long ban long hoac thuong tuy tinh hinh benh nhimg can itu
chat dinh duang va sinh to. Chu y cho uong du nude nhat la tre nho knong cho
an cac chat cay nong.
II. Di^u tri bang Y hoc co truyen dan toe:

I) Bien chung luan trj:

Nhiem khuan duong tieu cap thuong gap cac the benh sau:
(1) Can dom uat nhiet:
- Tripu chung lam sang: Luc sot luc ret an kem mom dang, non, but rut. nguc
sudn dau tiic, reu luoi vang, mach huyen sac.
- Phep trj: Thanh loi dom hoa giai thi&u duong.
- Bai thuoc: Long dom ta can thang gia giam.
Long dom thao 2 - 6g, San chi 8 - 16g, Hoang cam 8g, Sai ho 8g, Sinh d;a
12g, Tr?ch ta 12g, X a tien ti> I2g, M qc thong 6g, Cam thao 2 - 4g.
(2) Trudng vj thuc nhipt:
- Trieu chung lam sang: Sot cao lien tuc, ra mo hoi, mom hoi khat nude uong
nhieu, byng dau tao bon, tieu it do, reu ludi vang nhat mach hong sac.
- Phep tri: Thanh nhiet lai nieu thong lam.
- Bai thuoc: Dao xich thua khi thang gia giam.
Sinh dja 12 - 20g. Hoang lien 2 - 4g. Hoang ba 12g, Dai hoang 2 - 4g. (cho
sau) Moc thong 6g. Cam thao 4g, sac uong. (Bai nay do 2 bai Dao xich tan va
bai Dieu vj thua khi thang hop lai gia giam).
(3) Bang quang thap nhiet:
- Trieu chumg lam sang: Tieu nhieu lan, tieu gat va dau, bung dudi va lung
dau, reu ludi vang nhdt hoac trang nhdt, mach nhu sac.
- Phep trj: Thanh ntyet ta hoa, loi thuy thong lam.
- Bai thuoc: Bat chinh tan gia giam.
Bien sue, Cu mach, Chi tu, Ngan hoa, Lien kieu, O duoc deu I2g. Moc thong
6g, Xa tien tu 20g. Hoat thach 20g, Cam thao 4g. Tieu dau nhieu gia'*Ho phach 3
-4gN hilm khuan dudng tieu man tinh thudng gip cac the benh sau:

143

( I ) Than am hat tuc kiem lhap nhiei

- Trieu chung lam sang: Sot nhe vany dau Jan luris: r.i nu-' hr>i trom. moi
hong kho. Iirfri do khong hoac it reu. mach huven le sac
- Phep tri: Tir am lhanh nhiet
- Bai thuoc: Ngan kieu thach hoc lan gia giam
Ngan hoa. Lien kieu. Thach hoc. Dim hi. Phuc linh. Trach ta. S<m duoc. Tri
mau deu 10 - 12g. Sinh dia 20g. Hoiing ha 8g Sac uong trong nga>
(2) Ty than Itrfmg hir:
- Tneu chiing lam sang: Ngoai nhimg trieu chimg tren. henh nhan mat chan
phii. an kem. hung day. dai tien phan nhao, nguoi met moi. Lufn nhot reu trang
mong, mach tram te vo luc.
- Phep trj: Kien ty tu than.
- Bai thuoc: Kien ty hoa vi thang hop Tri ba hat vi hoan gia giam
Dang sam, Bach truat, Bach linh. Che Cau tich, Trach ta dfeu 12g, Cam thao
4g, Moc huomg 4g, Tran bi 6g, sac uong cimg voi vien Tri ba bat vi hoan

2 ) B a i thudc kinh nghiem: Diing doi voi cac benh nhe hoac xen ke dung
cung cac bai thuoc tren.
- Hai kim sa. X a tien thao. Bo cong anh, Rau ma moi thu 30 - 50g sac uong
- Thach vy. Xa tien thao, Bach mao can moi thu 30 - 50g sac uong thay nuoc
che.
- Kim tien thao, Kim ngan hoa, Xa tien thao moi thu 30 - 50g sac uong.

3) Cham cuu chon cac huyet sau:

- Sot cao: Dai chuy, Khuc tri.
- Co giat: Nhan trung, Thieu thuong (chich mau) Hop coc.
- Dai rat, dai dau: Quan nguyen, Khuc tuyen, Tam am giao.

4) Ket hop thudc lay:

Doi voi nhung trudng hop nang hoac da diing thuoc co truyen khong thuySn
giam nen ket hop diing tru sinh, hoac sulfamit. co the chpn dung cac loai sau:
- Sulfathiazolum 0,1 - 0,2g/kg/ngay chia 3 - 4 lan uong, lieu d iu luong gap
doi.
- Amoxilin 30 - 50mg/kg/ngay uong chia 2 -3 lin .

144

- Bactrim (Biscptol. Trimason) 36 - 48mg/kg/ngay uong chia 2 lan thai

gian dieu trj 7-10 ngay.
Trudng hop benh nhi sot cao va co dau hieu viem than be than nen dung phoi
hop 2 loai tru sinh:
- Ampicilin 1OOmg/kg/ngay hoac Bactrim.
- Gentamicin 5 - 7mg/kg/ngay tiem tinh mach hoac nhom tru sinh
- Cephalosporin (nhir Keforan. Keflex, Claforan) 25 - 50mg/kg/ngay trong 7
ngay (doi vai tre tren I tuoi).
Neu co ket qua cay vi khuan nen chon tru sinh theo khang sinh do.
Phong benh:
- Chu y giao ducve sinh ca nhan cho tre, va gia dinh.
- Phat hien sam va dieu trj kjp thoi cac tre mac dj tat tiet nieu.
- Dieu trj tich cuc cac benh de lay viem nhiem duong tiet nieu nhu viem cua
minh, viem am dao d be gai, bao qui dau (be trai) benh tieu chay, viem phoi ...

HOI CHUNG THAN H U

(nephrosis)
Hoi chung than hu cung goi la than hu nhiem mo la mot hQi chung benh
thudng gap d tre em 3 den 8 tuoi, nam mac benh gap nhieu lan so voi nu. Dac
diem lam sang ciia benh la: Protein nieu cao, protein mau ha, nhat la anbuymin
rat ha, cholesterol mau tang cao, phu toan than nhung huyet ap binh thudng.
Hoi chung than hu thuoc pham tru chung thuy thung trong Y hoc co truyen
va phan nhieu thuoc am thuy.
N G U YEN NHAN B EN H L Y :
Cho den nay nguyen nhan van chua ro. Nhieu tac gia cho la benh thuoc loai
tu mien. Benh thudng nang len luc co nhiem khuan. va benh giam nhe luc dung
cac loai thuoc corticoid va cac thuoc uc che mien djch khac. cung co tac gia cho
day la benh cua su roi loan chuyen hoa dam va ma. C a che cua phu trong benh
than hu la do mat nhieu protit qua nude tieu lam cho protit mau ha. ap luc thlm
thau cua mau ha va nude thoat ra ngoai mach sinh phu.
Benh ly d than: Qua than thudng phu ne va su thay doi ve to chuc hpc la da
dang. (7 phan Idn benh nhi. diu than thay doi rat it, chi co te bao ting ngoai

145

mang da. phu ne duns hap. te bao giua cac mat' mach tans

t 1 m<n ' it. te

bao ciua cac r: . r-.ach tana 'inh nhimg mane da. kh/ nc da\ ter <1 m.H v> khat
irat iti manti dav va thanh r..a<> x.a^h deu da> ien Co khi wa ; ;oj. :nay Jot henh
K tren cung ton tai va thuong chi thav mot m it c.m than ^or Ja so van hinh
[hums Benh ly d ong than thuong tiep theo hen:-. i> o ^ac O',jr. \c rao phu ne v j
nhiem mo. giira one than co tru protein Trieu churg iam '_"lg r.he nang ket qua
dieu tn u tien luong tot hay \au deu co lien quan mat 'h;ct Jen s ' 'j'm g va nm
do benh ly cua ciu than
Theo V hoc co truyen. henh phu phat sinh do ty .han d irrrg hu thuy thar :
tre trong ca the. Sach Chu benh nguyen hau luan da neu Thuy henh ch jr.. r!.u
khong co chung nao la khong do ty than hu. ty than hu thi t;.uy long hanh Han
day ra bi phu khien cho co the thung man Ty hu khong van hoa duoc thuy. than
duong hu khong chu duoc thuy. nuoc tran ra ca bi sinh phu. chuc nang khi hoa
cua than bi roi loan, nuoc khong xuong bang quang nen dai it
T R IE U C H U N G L A M S A N G :
- Phu la tneu chung noi bat Phu toan than, phii lom va tang din. thi*>ng
kem theo tran dich mang bung, phii biu dai. am ho. neu phu phan tren co the
sinh tran dich mang phoi. kho thd mat hip. ma phinh. co phi to Phii an lom sau.
co khi da cang nut. chay nuoc Cung co it benh nhi phii khong ro truong hop co
hoi nhiem phu ting, pha c ' khi tu giam nhung rat de i; phi: Neu Vh*r,g coK*.
nhiem khong co sot hoac co khi than nhiet ha thap Truong hop phii keo dai. do
phii d ruot ma sinh non tieu chay. chan an. benh nhi suy dinh duong. co the gay.
phii to ninx tieu giam
- Huyet ap thudng khong cao Co it trudng hop huyet ap co tang nhe nhung
chi tam thdi. Trudng hop huyet ap cao lien tuc phai nghi den benh chuyen thanh
viem than man tinh hoac hoi chung than hu the than man. tien lurmg xau
- Nude tieu it va tieu cang it. phii cang tang
- Nhung tneu chimg khac co the gap tren lam sang la: Gan to. coi xuong. run
giat chan tay ...
X E T N G H IE M :
- Nude tieu: Protein nieu cao hon hoac bing .V5g/1, ty trpng gum

Neu

protein nieu giam. ty trong nude lieu lang la benh thuyen giam. T y trong nunc
ueu dudi 1,010 keo dai la xu huong chuc nang than suy. hoac co xu huong
chuyen thanh viem than man tinh. Ngoai ra. trong nine b h i con co c ic loai tru
trong tru hat. cac tieu the mo. hach dm . M ag dto co k b afc khong co h5ag ciu

146

- Mau: Protein loan phan giam. ihurmg ii hern 3 - 4g'/f- nhal la albumin giam
ro. globulin lang (rong do alpha-globulin tang cao nhat va gamma-globulin lhap
hon binh thuong.
- Cholesterol tang cao nhieu thutmg 3(H) - 700mg%, co khi len ten I000mg9?
va hoi phuc cham.
- N.P.N.: O giai doan dau cua benh la binh thudng nhung tang cao d thcri ky
cuoi hoac co xu huong chuyen thanh viem than man tinh.
- Tdc do huyet tram: Tang cao luc benh nang va giam luc benh hoi phuc.
BlfeN C H U N G :
1. Bpi nhiem: Do sue dc khang cua co the suy giam (chinh khi suy) nen benh
nhi de mac bnh duong ho hap va benh ngoai da. Neu tran djch mang bung tang
dpt ngpt kem sot va dau bung phai nghi den viem phuc mac (an bung dau) co the
chpc nude mang bung kifem tra. Boi nhiem da thudng gap cd viem tay, dinh
nhpt, ap xe dudi da.
2. Roi loan dien giai: Do an nhat keo dai va dung thudc lpi tieu nen mau
Natri ha (nhpt nhat, met moi, phu nang len, chan an ...). Dieu trj bkng thuoc
corticoid ma khong cho Kali kip thdi gay Kali mau ha, dung corticoid keo dai
trong luc chuc nang than kem. do chuyen hoa phot pho bj roi loan, canci se bai
liet theo nude tieu nhieu lam cho canci mau ha.
T IE N L U O N G :
Co lien quan den ton thuong benh ly. tuoi mac benh va phuong phap dieu tri .
Neu to chuc than ton thuong nhe, tuoi mac benh dudi 10 tuoi dung corticoid.
benh khoi nhanh, tien lupng tot. Neu to chuc than ton thuong nang, to chuc tang
sinh phat trien, tuoi mac benh Idn, dieu tri bang corticoid khong ket qua ro ret,
tai phat nhieu lan, tien lupng kem, de tien trien thanh viem than man tinh. Tre
dudi 1 tuoi benh thudng nang do to chuc than chua phat trien hoan chinh.
C H AN D O A N V A P H A N B IE T :
- Chan doan than hu nhiem mo chu yeu can cu:
1. Phu la trieu chung lam sang chu yeu, co dac diem la phu to, co trudng, de
tai phat.
2. Protein nieu cao hon b3ng 3,5g/l hoac cao hon bang 50mg/kg/24gid.
3. Giam va thay doi thanh phan protein mau: Protit toan phan dudi hoac b^ng
56g/lit trong do albumin dudi ho|c bing 25g/l, ty le A/G rit thip. alphaglobulin tang cao va gamma-globulin giam.

147

4 Tang lipil va cholesterol mau. cholesterol tang tren VX)

7(X)mg*X. Con

cac trieu chimg khac nhu ure tang luc chuc nang than suy. henh nen trien thanh
man tinh Huyet tram tang cao la benh dang tien trien Huyet ap thuong khong
cao va ure cao keo dai la xu hirdng cua viem than man Benh nhan dai mau it,
nhung neu co dai mau can chu y the viem cau than cap (nephrose. nephrite).
- Benh nhan phu to can phan biet voi phu suy tim va phu suy dmh duong.
viem cau than cap (kem dai mau nhieu). Muon phan bit von hoi chimg than hu
thir phat cln tim benh chinh (hoi ky tiSn su b^nh. kiem tra mau toan dien ...)
D lfcU T R I:
A. Che do cham soc va an uong: La rat quan trong de phat huy ket qua dieu
tri . han che tai phat va tien trien xau cua benh.
- Benh nhi dupe hoat dpng tuy sue khong nen qua han che Bao v? b^nh nhi
chong benh nhiem khuan (thuoc dong y co gia tri nang cao chinh khi). Khong
nen dira benh nhi den nhimg noi dong nguoi nhir rap hat. cho pho xa dong nguoi
va nhieu xe co qua lai.
- Luc vao dieu trj, benh nhi phai cay dich hpng va nuoc lieu: Hang ngay theo
doi lupng nuoc tieu va lupng nuoc uong vao.
- Chi nen dung try sinh.khi co nhiem khuan. Lam dung tru sinh qua nhieu co
the dan den hien tuong nhan thuoc cua vi khuan va co the gay loan khuan.
- Rat han che chich thuoc luc benh nhi phii nang vi de gay ap xe va thuoc
kho hap thu.
- Khong chich cac loai vacin phong benh vi vacin de gay benh tai phat
- D phong benh lao tien trien nen cho benh nhi chup chieu phoi moi nam
mot lan. Chu y ve sinh da cho tre mac benh.
- Cho che do an hpp khau vi benh nhi, du chat dinh dudng va sinh to, cho
them protit co muc do. Luc cho thuoc lpi tieu can chu y bo xung kali, canci,
natri... Theo doi trieu chung roi loan dien giai de bo xung kip thoi. Chi han che
nuoc trong giai doan phii to va dai it.
B . D ieu trj bang dong y:

I. Bien chimg luan tri: Chung phii trong hoi chung tham hu chu yeu ta do
ty than dirong hu hoac ty hu cho nen phep difcu trj chu yu la dieu ly ty th|m.
Nhung luc phu to, co the' ket hpp phep true thuy hanh khi lpi thip.

148

(1) The ty hir

- Trieu chimg chu yeu: S ic mat tai nhpt, tinh than met moi, toan than phu.
byng day nuoc. tieu it, hoac them chan an, tieu long, buon non hoac non. ludi
beu sac nhpt, reu trang mong hoac tring day, mach nhu te
- Phep iri: Ich khi kien ty Ipi thuy.
- Bai thuoc: Bd trung ich khi hgrp Ngu linh tan gia giam.
Hoang ky 12 - 20g, Nham sam 8 - IOg, Bach truat 12g, Phuc linh, Tru linh,
Tr?ch ta, Hau phac dfeu 12g, Rau ngo 30 - 40g, Trim bi 8g, Chich thao 3g.
- Truong hpp bong day, tiu rt gia: Dai phuc bi, X a tien tur, Bach mao can
dfeu I2g, nguc dky chan an gia: Y di 12g, Chi xac, Mpc huong dfeu 6g, non gia:
Ban ha IOg, Gung 4g.
- Neu phu to, dung Tieu thuy hoan (H ie Bach suu lupng binh nhau lOOg
mdi thu, sao vang tan bpt min, cho nuoc duong va gung vua du lam thanh dang
ho (dp 300g) chung cach thuy 4 gid, chung 2 lan chia lam 5 - 7 ngay uong. Hoac
dung vien Tam vat bi cap hoan (B a dau Suang, Dai hoang lupng bang nhau say
kho tan bpt trpn nuoc gungvua du lam vien nho b5ng h^t me) mdi lan uong 0,5 Ig hoc it hom tuy tre Ion nho, thudc rat dpc dung phai can th$n, phai cho uong
bSt dSu tu lieu nho. v i theo doi phan irng cua thuoc. Phu giam phai uong thudc
ki?n ty. De phong mat nude co the truyen dich trong luc dung thuoc true ha.
(2)

Ty than duong hir Trieu chung chu yeu: Sac mat tai nhpt hoac da

xam, tinh than met moi. phii nang cd tran dich mang bung hoac mang phoi. tieu
it, bung day. chan an, non; buon non hoSc kho thd. Chat ludi trang nhpt, reu
tring mong, mach tram te.
- Phep tri: On duong Ipi thuy.
- Bai thudc: Chan vu thang hpp Phong ky hoang ky thang gia giam.
Che phu tu (sac trudc), Bach tru|t, Bach linh, Bach thupc, Phong ky. Son
dupe, Ba kich thien. Nhuc thung dung, Tien linh ty deu 10 - 12g, Gimg tuoi 6 g.
Tao 12g, Chich thao 4g.
- Trudng hpp tieu long gia: Y d7, Tran bi. Th|n duong hu nang gia: Loc giac
giao 13g chung uong vdi thudc. Huyet kem gia: Thuc dja, Ha thu o do, Cao qui
ban du 12g. Ngoai ra cd the' uong them cac lo^i thudc thanh pham nhu Bat vi
hoan (neu thn duong hu) 12 - 16g/moi ngay chia 2 lan, Huong sa luc quan (neu
ty duong hu) 12 - 16g/ mdi ngay.

149

Truong hirp hoi chimg than hir inii hoi nhiem co mm ;hi

ihimg dur :

thuoc nhu viem cau than cap

2 Bai thudc kinh nghiem tri phu ihuna

(1) Ich mau (hao. Rau ngo. Ma do. Bach mao can. chon I -2 m. moi vi HX)
2(M)g sac uong nga\ 1 lan

(2) Ca qua 1 con. nau vai 200 - 4(X)g do do. an moi ngay
(3) Rau ma, Ma de, Rau can. moi thu I(X)g sac uong irong ngay.
(4) Kinh nghiem tri thuy thung cua Tue Tinh (Nam duoc than hieu (sach tai
ban nam 1982 cua Vien TD H D T - TP. Ho Chi Minh) tr. 118. I 19. 122)
- Xich tieu dau 5 cap, Toi to I cu. Gimg song 5 dong. Re Thuong luc I cai
deu dap nat. bo vao noi do nuoc nau chin, ho cac thuoc. chi dung dau do an \ao
khi doi va uong het nuac. Rua chan bang nuoc dau do.
- La canh dau huong dong dot thanh tro ngam vao nuoc. dung nuoc nau chin

1 thang dau do, moi lan an dau cho no. khong uong nuoc dau.
- B i dao. Hanh cu nau canh vai ca chep cho an
- Huang phu sao gia bo vo den. Sa nhan sao vira luong bang nhau. sac uong
- Ruot oc buou. Hot ma de. Toi cu to deu bang nhau gia nat dap len ron.
- Cu hanh gia nat uong nuire
- Gao te. Dau xanh 1 nam. Gan hco I cai thai nho cung nau chao an
- Hot dinh lich 3 lang. Nhuc qui- bo vo I lang deu tun nho luyen mat lam
vien bang hot ngo dong, moi lan uong 10 vien vai nuac nong.
- Vo bau con mai sao tan bot. moi ngay uong luc doi 2 dong vai nuac sac
Tran bi.
.1 Thudc tay phoi hop:
1) Dieu tn bang corticoid: Trong dm mac benh dau tien tai phat lan 2 diing
2mg/kg/ngay. uong lien tuc 4 tuan hoac cho den het protein nieu (thuoc chia 3 4 lan uong trong ngay). Neu kei qua tot (het phii. protein nieu am linh) diing
thuoc cach nhat hoac trong 1 tuan dung 3 ngay nghi thuoc 4 ngay. thuong phai
diing tiep trong 6 - 8 thang, hoac lau han.
2) Dieu tri bang thuoc giam mien dich: Chi dmh irong cac truong hap khang
corticoid hoac hay tai phat.
- Thuoc chon

la nhom Ankin

nhu: Cloram buctl (Lru keran ) 0.2

0,3mg/kg/ngay hoac Cyclophosphamid (Endoxan) 2,5 - 3mg/Vg/ngay. Then gian

150

dieu li i (rung hinh } lhang. I rong qua trinh dieu trj phai theo doi cac bien chung
dac hiei cong thuc mau ngoai bien. Co the phoi herp vai Levamisol iloai thuoc co
tac dung dieu hoa mien dich

v it i

lieu 2 ,5 mg/kg/lan. moi tuan 2 lan trong vong 6

9 thang.)
3) Thuoc lai nieu: Cho luc benh nhi phu nhieu, thuoc dong > a ket qua. va
luc cho corticoid lieu cao. Thuirng dung Furosemid (I.axixi I - 2mg/kg/ngay
Furosemid co the chich tinh mach neu cho uong khong to hieu qua.
4) Chi djnh tiem truyen albumin khu muoi hoac Plasma kho: Khi nong do
albumin mau lOg/lit va thuoc lai nieu khong co hieu qua. Lieu lupng albumin
lg/kg hoac Plasma kho lOml/kg, chich nho giot tinh mach (khong duac chich
nhanh vi co the gay phu phoi va suy tim.

BENH KY SINH TRUNG

DUONG R U 0 T
(Parasitosis)
Benh ky sinh trung duang ruot hien con la m6t benh xa hoi ph6 bin d nuoc
ta. Ty le phat benh kha cao d tre em do dieu kien an d thieu ve sinh va cac bien
phap quan ly rac phan ninVc cong cong chua tot.
Tac hai ciia cac kv sinh trung song trong ca the tre em la:
- Hut het cac chat dmh duang nuoi tre lam tre cham Idn.
- Thai nhung chat doc lam cho ca the nhiem doc gay roi loan tieu hoa. than
kinh. ho hap ...
- Gay nhung bien chung co nguy hiem den tinh mang nhu giun dua gav ap
xe gan. tac ong dan mat. tac ruot thua, giun moc cau gay thieu mau nang

BENH GIUN D U A
(ascariosis, ascaridosis, round worm disease)
Benh giun dua la mpt benh ky sinh ti'ung pho bien nhat d tre em . ty le nhiem
giun co tdi 80 - 9GrA ho^c han. Giun ky sinh d rupt non. chu yeu gay roi loan

151

lieu hoa va blit chai dinh duong Guir con co the gav nhijme Vien chung nguv
hiem nhu giun chui one dan mai lam lac mat hav gas \icm ru

'hira

N G U Y E N N H A N V A Y E L t 6 T H I AN L O I:
Trunc 2 iun vao duonc tieu hoa do lav va thin an han vai iieu irang -.inh au
trung Au trung choc thung niem mac ruot qua mach mau va mach lam ha tinh
mach cua. vao gan (khoang 18 gia den vai ngav. theo mach mau va<> irm phai.
len phoi (khoang 4. 5 ngav i. d phoi au irung lot vac lan thu 2 va V chui vao phe
nang theo phe quan. khi quan len hong, duoc nuot qua thuc quan vao lai da dav
va neu trang. phat due trudng thanh giao phoi va de trung Tu luc nhiem trung
giun den luc giun cai de mat khoang 2 thang ruoi Thoi gian au trung du hanh
trong co the khoang 10 ngay. Trong qua trinh do mot so bi tieu diet Au trung
cung co the vao cac to chuc khac nhu nao. tuy song. tim. than. lach. tuyen giap
v.v. . Co khi tim thay au triing trong nude tieu. Khi vao cac co quan nay. au
trung thuong hi tieu diet. So luong giun trong ruot tuy thuoc vao so trung giun
nhiem phai nhieu hay it va sue chong do cua co the manh hay yeu So luong co
the tu vai con den hang tram con Den song ciia gum dua trong rudt tu I - 2 nam
Yeu to thuan loi lam cho treco de nhiem giun:
I . Hoan canh ve sinh kem. quin ty phan nuoc rat khong tot.
2 Ve sinh phone benh kem nhir Tre choi dat. mong tay dai. can mong tay.
mut tay. ia hav. trudc luc an va sau khi ia khong ora tay. an rau song, uong nuw
la. v v
3 Dieu kien khi hau: Khi hau am thap va nong a nuac ta la dieu kien thich
hap de giun dua phat tnen. khi hau kho (do am < 50'< i va nhiet do qua cao o
45 C i hoac qua thap (< 12 C ) deu la dieu kien khong ihich h(Tp cho trung giun
phat due
4 Siic chong dd cua co the C a the khoe it mac benh giun hem ca the yeu
Sau khi nhiem giun. co the co sue chong do nhit dinh nhung ve sinh kem cung
de nhiem lai
T R IE U C H U N G L A M SA N G
I Trieu chung tieu hoa:
Dau bung (thudng khong nang lam), quanh ron hoac vung bung tren dau that
thudng va dau di dau lai nhieu lan. luc dau thich am. luoi in h o ic in nhieu. co
tre thich an dat. an chua. Co luc buon non, non, ia long h oic tao hoa M6< sd non
ra hoac ia ra giun.

152

2. Tneu chiing loan than:

Giun ky sinh nhieu. hip thu hit chit dinh duong lam cho tre gay com. thieu
mau. tri luc va phat due deu cham.
3. Trieu chiing tinh thin th&n kinh:
Do nhiem doc ginn. benh nhi hay blit rut quay khoc. hoac lor do it chcn,
nghien rang, de cau git, dau dSu. ngu it hay giat minh, co khi co giat.
4. Triu chiing dj img:
Thuong gap la noi m day, ngiia ngoai da, mat phu Tre hay moc mui (do
ngua) can mong tay, da m$t co nhung dom trang, cung mac mat co nhirng diem
xanh, moi duoi co lam tim tring.
Hoac co hpi chung ho kho tho nhur suyen (hpi chung Loeffler) chup chieu
phoi thay nhanh phe quan d^Lm, hinh anh co luc nhir la mpt viem phe quan phdi
ho$c lao ke nhung se mat di nhanh, trong dom co nhieu t bao bach cau ai toan;
b?ch cau ai toan trong mau tang rat cao co khi 80 - 90%. Nhung trieu chung tren
thuong hfet sau 2 tuan.

XET NGHI$M:
- Phan co trung giun dua.
- Bach cau ai toan trong mau tang ro.
B IE N C H U N G :
Giun dua co dac tinh sp oxy, sp chua, thich chui, quan thanh chum. Luc giun
qua nhieu hoac moi truong trong ruot thay doi (sot cao, thuoc so giun uong
khong dung lieu, hoc do kich thich cua thuoc, thuc an) co the gay bien chiing.
Thudng gap co:
1. Tac ruot do giun;
Bui giun gay nen tic ruot (hoan toan hay khong hoan loan). Trieu chung chu
yeu la dau bung tung con du dpi, non ra thuc an, chat m$t hoac giun, bi dai tien
(neu vung tac cao; tic khong hoan loan co the ia ra phan). Kham bung so thay
bui giun mem, luc nan lam cho bui giun thay doi hinh dang va vi tri. Trudng hpp
nang co kem mat nuoc, nhiem doc toan. co khi choang.
2. Giun chui ong mat:
Dau quan dudpi d viing bung tren ben phai, dau timg con xuyen len vai phai
ra sau lung, benh nhi keu la. cong lung. ch6 ng mong dm bung, buon non, non.

153

loai mo hoi lanh. co the non ra mat hoac giun. kham suns:

mom lk sa Mini;

hung tren hen phai co an dau ro nhimg khong co phan imt' lhanh bung

3. Viem ruot lima do giun:

Benh nhi bai dau dau ihal loan hung hoac quanh ron sau khu iru o vung ho
chau phai Diem ruot ihira Mac-Buot-nay co an dau Co ihe so thay bui giun
benh phat iricn nhanh. co khi ihung ruot gay viem phuc mac
4 Viem phuc mac do giun:
Thuong gap tren nhimg benh nhi von da co viem ruot. kiet ly. Bieu hien chu
yeu la benh nhi nhiem doc. suy nhuoc nang. Bung dau nhimg khong nang Kham
bung co khi co phan img thanh bung (so cimg), co khi mem nhu bong nhu la
viem phuc mac do lao, kho chan doan. Neu khong dupe dieu tn dung, co the tir
vong, phai canh giac.
Ngoai ra giun dua co the chui vao khi quan (luc benh nhi hon me. hoac dung
thuoc an than) gay ngat tho. giun chui vao ong mat gay viem ong mat, viem ong
gan, gay ap xe gan. v.v...
CHAN DOAN:
Chu yeu dua vao:
1. Tien su phan co giun hoac non ra giun.
2. Nhimg tneu chimg lam sang de chan doan va phai hien bien chimg.
3. Tim thay trimg giun trong phan. Nhung neu khong co trung cung khong
loai trirdupc benh vi ruot chi co giun due. So trimg giun trong phan rat it.
4. Doi vcn hoi chung Loeffler, tim bach cau ai toan trong dom va chup X
quang phoi de xac dinh.
D lfeU T R I:
A. D l u T R I B A N G Y HOC C 6 T R U Y E N D A N TOC:
1. Dung thuoc chu y : Xo giun va lam giun yen.

a) X o giun
Bai 1: Su quan tu, Nhuc sao qua, Binh lang. O mai mdi thu 12g. Kho luyen
can bi 16g. sac uong chia sang va chieu uong 3 ngay lien.
Bai 2: Bot giun (Bo t Suquan tu 8 phan, bpt Dai hoang sdng 1 phin iron du).
Cach dung va lieu lupng: Lmpng moi lan bing so tudi + Ig ihuoc (v i du tre 3
tuoi dung lupng la: 3 + 1 = 4g moi lan) ngay udng 2 lan (long luong mpt ngay la

154

8g). Luang loi da mot ngay khong qua I5g m6i lieu trinh 3 ngay Neu co nac
cham Cini vi. Cach du
Bai 3:
Six quan tu I2()g (sao)

Hat him him l(X)g

Hat cau gia 160

Moc huong 8()g

Cac vi tan hot nho luyen h6 lam vien nho Ngay uong I lan vao sang luc doi

6 - 12g, 3 ngay lien.

Bai 4: Co nu ao phcn kho tan nho luyen mat lam hoan bang hat Ngo dong.
Uong luc doi, moi lan 20 - 40 vien (N D TH - Tue Tinh).
Bai 5: San kho sao chay tan nho luyen mat lam vien nho bang hat Ngo dong.
Moi lan uong 10 vien vai nuac nong, ngay 3 lan (N D TH - Tue Tinh)
Bai 6 : Sir quan tu sao qua chay vo lua. Cu moi tuan uong 1 - 2 hat trong mot
ngay chia 2 lan. Uong 6 ngay lien.
Cach dung khac: Sao tan bot luong moi ngay (gam) bang so tuoi + I. Tong
luong khong qua IOg uong vao sang luc doi 1 lan hoac chia 2 - 3 lan trong 24
gia uong het. uong lien 2 ngay.
Bai 7: Phi tu (diing song cang^ot) 10 - 15 qua thai nho, sac nuac uong.
Bai 8 : Bach bo sao nghien thanh boi. luong Ig/luoi/ngav Toi da khong qua

8g. Cach dung nhu Su quan tu.

b) Lum giun yen:
Diing trong truong hap ca the tro yeu suy nehuac, gap cac bien chung: Tac
ruot, giun chui ong mat, dau bung du doi, non ra giun. chan lay ra mo hoi lanh
(hoi quyet).
Bai I : () mai hoan: (Dung thuoc theo nhan thuc cua y hoc co truyen cho rang
giun dua gap chua thi tinh. gap dang thi ha. gap cay thi phuc) dung thuoc hoan
hoac thuoc thang:
O

mai 12g. Hoang ba 12g, Te tan 4g, Que chi 4g. Phu lu 4g. Dang sam 12g.

Hoang lien 8g. hat tieu 4g. Duang quy 12g, gung 4g. sac uong.
2. Dieu trj bang cham cuu:
Co tac dung giam dau va xo giun.
-

Cham Tir phiing: Co tac dung xo giun. chich ra nuac vang doi von tre suy

dinh duang the cam tich (trung tich). Cham mot ngay mot lan trong 3 nga> lien
hoac cach nhat.

155

- Dau bung nhieu: Cham thien khu, Trung quan. Tuc tam l>. Dmmg lang
luyen.
- Non, buon non: Cham Noi quan. Nc)i dinh. Hop coc
3 . Phuong phap tong hop dieu trj cap cuu cac bien chung:

a) Tac ruot do giun:

- Nhjn an, truydn dung dich bang duong tinh m?ch giam ap luc d? day va
ruot.
- Cham: Chpn huyet nhu tren.
- Uong O mai hoan ho&c it dam n nong.
- X6 giun: Co the dung oxy hoc cac lo<u thudc xo giun.
Ngu khong k it qua, chuyen ngoai khoa.

b) Giun chui ong m$t.

Cham Nghinh huong xuyen. Tu bach, Dom nang sau do cham Nhan trung,
Trung quan, Npi quan, Tuc lam ly. Ho|ic cham huyet D 31 hoanh, Thidn khu,
Quan nguyen.
O mai hoan sac uong hoac uong dam an de lam yen giun hoac cho uong bai
thuoc:
Binh lang

12g

Mpc huong

Kho luySn can hi

I2g

0 mai

12g

Su quan tir

12g

Uat kim

I2g

Chi xac

8g

Chi tii

8g

8 - 1 2g

Sac uong ngay I thang luc doi trong 3 ngay lien.

c) Viem ruot thua do giun:

Cham Tuc tam ly, Lan vT.
Thuoc uong dung bai:
Dai hoang

4 - 8g

Bo cong. anh

12g

Dan bi

12g

Xuyen luyen tu

4 - 6g

H |u phat

12g

Su quan tu

12g

Dong qua nhan

12g

Kho luyen can bi

12g

Hoac dung D ai hoang - Mang tifcu - Cu toi g ii nat trOn g iim (hanh dip len
diem dau lan vl. (X u dyng trong du kien khdng co ngoai khoa).

156

BENH GIUN KIM

(O x y u ria s is )
La bnh giun dudng ruot thudng g$p d tre em . Nhiim giun do an cac thuc an
co trung giun, tay ban lay nhau hoac tir nhilm. Tri?u chimg chu yeu la bnh nhi
ngiia vung h|iu mon, vung hdi am va ngu khong yen giac.
N GUYfeN N H A N V A B E N H L Y
Do giun de trung d hau mon nen trung giun de dinh vao ao quan chan man,
dd choi, bui bam, tay tre (do gai hau mon) o nhiem vao ca thuc an va qua thuc an
> hoac mut tay ma truyen vao dudng tieu hoa. Cd khi trung no con ngay d h$u
mon va giun con bd nguoc vao ruot.
Giun kim ky sinh d manh trang, phan dudi tieu trang va phan tren dai trang
Giun due chet ngay sau khi giao hop. Giun cai mang day trung bd ra vung nep
nhan quanh hau mon va hdi am de trung. Giun cai de xong khong bao lau cung
se chet. Trung de duoc 6 gid da cd au trung. Trung mang au trung nay se theo
thuc an. byi b$m, tay bin ma vao co the theo dudng tieu hoa. 6 da day va hanh
ta trang, trung nd ra giun con phat due thanh giun Idn d tieu trang va dai trang.
Thdi gian tu luc nhiem giun den luc giun de trung khoang 4 - 8 tuan.Do benh nhi
(ir nhiem va lay nhau. nen mac benh giun kim lau khoi.
Giun cai de trimg d hau mon va hoi am vao ban dem. gay kich thich ngira
lain cho tre kho ngu hay quay, hay giat m'inh. co khi sinh dai ral, dai dam. Cnun
ky sinh d ruot cung hut het chat dinh dudng lam tre gay xanh, an kem. tuoi tho
cua giun kim la 20 - 30 ngay.
T R IE U C H U N G L A M SA N G :
Benh nhi hay gai hau mon, vung hoi am, ngu it hay giat m'inh. quay khoc. Do
gai nhieu gay Id d da hoac cham. Co khi benh nhi ludi an, non, buon non. bung
dau, thich can mong tay, dai rat, dai dam, chau gai ngua am dao. ham do, xuat
tiet nhieu gay viem am dao, viem ong dan trung, tham chi cd the gay viem phuc
mac.
X E T N G H IE M :
Phan: Dung kinh soi phan tuoi it thay duoc trung giun.
Dung tam bong ngoay chui cac nep nhan quanh hau mon. dem run \ ao nude
muoi bao hd. bd tam di, do day nude. d|y bang lam kinh. sau 5 - 2d phui lay
lam kinh dem soi: K Sl qua duong tinh cao.

157

Dung '-Mas ko ' trung dan \.n> '.ung nep nhan r hau tr^n. h- ' !:it ia> r.>ep 'j"
lam kinh Je m

soi

C H A N D O AN D U A V VO
- Trieu chung lam sang
- Kel qua dinmg linh cuu xel nghiem iren
- Tim duoc giun kim (hinh irang nho nhi/ cai kimi irong phan Ban Jem , luc
ire ngira gai. hai duoc giun kim it hau mon \a ke mong ta)
D I^ L T R I B A N G V H O C C 6 T R I Y E N DAN TO C
Chu yeu la xo giun. giam ngira
Bai 1: Bot giun (Suquun tir S phan - Dai hoang 1 phan). Cach dung nhir vcn
giun dua Uong 6 ngay lien
Bai 2: Bach bo song 40g. do 2<)Oml nuin sac con 40ml. moi tin truc khi ngu
thut dai irang I lan trong 5 ngay lien Hoac dung cu Bach b'> sat) tan boi cu moi
tuoi uong Ig trong 1 ngay (luimg toi da khong qua 8gt. Long 6 ngay lien.
Bai 3: La loc at. Hat chua ngui linmg bang nhau. say kho tan nho ray min
luyen ho lam vien Moi lan uong 8 - I2g ngay uong 2 lan luc bung doi. 5 ngay
lien
Bai 4: Hat xoan (Kho kuyen tir) ngam nuoc nong boc vo ngoai nhei vao hau
mon I - 2 hat I ijn I ng:;y. >ang h-'<m 'au da: tien ra r.het lan k h a . . ir .ng ?

ngay.
Bai 5: Dam an boi hau mon

BENH GIUN MOC CAU

(u n k U o sto m ia ^ is)
Benh do giun moc cau ky sinh a hanh ta trang. hut mau ca the. ann huong
Ion den sut khoe ire em. la mot benh ky sinh trung can diruc chu y phong \a
chua kip then.
N G U Y E N N H A N v A B E N H LS :
Nguoi nhiem giun \a mac benh giun la nguon lay chinh. Giun Icy sinh trong
ngudi co tu I den hang nghin con Giun cat hang ngay de tu 1 dfen 2 van trung
Trung giun iheo phan ra ngoai. 0 moi truong am thip thieu anh sang, nhiet do tii
15 - 38 C irong khoang 5 - 8 ngay. trung o trong d it no thanh au trung. Khi hau
vung on doi va nhiei dm la dieu kien ihich hop cho au thing song lau tir 6 lu i

158

den 6 thang. I re em va ngudi Idn di chan dal, au trung se chui qua da vao mau
qua tim phoi len khi quan, hpng qua thyc quan, da day vao hanh ta trang, tai day
au trung phat due va trudng thanh. Thai gian nay khoang 4 - 5 tuan. Giun song
trong nguai 5 - 8 nam. Au trung co the o nhidm thuc an, tre an vao mac phai. Au
trung co the qua rau thai nhilm vao thai nhi gay benh giun moc tien thien do me
truyen (it gap). Benh luu hanh rit rong, phin nhieu a nong thon co lien quan den
tap quan ve sinh va vung trong trot, vung mo.
Benh ly chu yeu la thieu mau do giun khi can vao niem mac rupt, tiet ra chat
chong dong de hut mau va lam chay mau thuong xuyen. co the gay thieu mau
nang da vang nen y hpc co truyen goi la hoang benh (do da vang) hoac tang
diep hoang (do ty I? mSc benh cao 6 vung trong dau). Giun con gay roi loan
tieu hoa. Do thieu mau, huyfet sic to giam, sue tai oxy cua hong ciu thp, tim
phai lam viec nhieu dd bu tru nen tim to va co the suy tim.
T R IE U C H U N G L A M S A N G :
Benh n$ng nhe rat khac nhau. Co the lam sang khong co trieu chung ro ret.
Da ch6 au trung chui vao co the noi sin ngua; au trung vao mau gay sdt, ho, tfe
bao ai toan tang; giun hut mau va lam chay mau gay sac mat xanh vang, mdi tai
nhpt, da kho, toe thua d l ryng, benh nhi kem an, r6i loan tieu hoa, nguoi g iy
com, co luc quay khoc, tre lan keu chong mat, hoa mat, u tai, ngu khong yen
giac, co khi tim dap, hoi hop, kho tho. Co tre thich an dat. bung keu dau. Kham
phat hien thay tim to, co tieng thoi tam thu a mom tim. Mat va chan co the phii.
X E T N G H IE M :
1. Mau: Te bao hong cau nho, huyet s5c to thap. Bach cau ai toan tang luc
mai mac benh, thdi ky cuoi thudng an-bu-min trong mau ha.
2. Phan: Soi tuoi tim thay trimg giun. Phan ung Mayer duong tinh.
C H A N D O A N V A P H A N B IE T :
Chu yeu dua vao tinh hinh luu hanh benh, tap quan ve sinh (di chan dat, ia
by). Trieu chung lam sang thieu mau nhuoc sic. Xet nghiem phan trung giun
duong tinh. Tet khang nguySn giun moc.
Chu y phan bit vdi: Cac loai benh thiu mau do cac nguyen nhan khac, benh
viem da do nuoc n chan, neu co ho cin phan bi$t vdi viem duong ho h ip (viem
ph quan, lao ph6i), co r6i loan tieu hoa phin bi$t vdi viem rupt, loet da day la
irang v.v...
D lfeU T R I:

Chu y hai mai: Xo giun va dieu Iri loan than hoi phuc mjc k.-c
A D IE U T R I B ANG Y HOC CO T R U Y EN DAN T( K
I. Bien chung luan tri:
La phurrng phap dieu tri loan lhan hoi phuc co ihe. nang , j i ' ' ia khoc. Dung
ihuoc tuy theo the henh.
1) Ty hu tich tre: Sac mat vang. chan lay hoi phu an kem. an vao day
bung, thich an dat, an gao, la che v.v... Dai lien long hoac tao hon. mui thoi,
nguai met moi, chat luoi nhcrt nhat, reu mong hoac day nhat. mach tram te hoac
huyen hoat.
- Phep chua: Kien ly lieu tich.
- Bai thuoc:
Dang sam

I2g

Hau phac

8g

Hoai son

12g

Tran hi

8g

Y di

12g

Mach nha

8g

Thuong truat

12g

Chich thao

4g

Sac uong ngay 1 thang.

- Neu ia chay bung day dung them bot Binh vi 8 - 12g/lngay.
- Neu ty hu nang dung them com Bo ty ngay 15 - 20g.
2) Khi huyet hu: Da mat xanh vang hung, loan than met moi. vang dau, u
tai, it ngu, tinh than lanh nhat, dai lien that ihuang, ehal luoi nhal. reu mong,
mach tram nho vo luc.
- Phep chua: Bo khi huyei.
- Bai thuoc: Bat chan thang gia giam.
Dang sam

12g

Ha thu o

Lien nhuc

12g

Thuc dia (nirong)12g

Ydl

Hoai son

12g

Bach ihuac

Tran bi

Chich thao

4g

Xuyen khung

12g

12g

Sa nhan

8g
12g
8g

4g

2. Thuoc xo giun:
Nhimg loai thuoc nhir Phi tu, Binh lang, Loi hoan, Bach bp, Quan chiing,
Ma xi hien v.v... deu co tac dung xo giun.
Bai I : Kho luyen hi 20g. Binh lang 20g. do nuoc cd thanh 60ml cho duong
uong truoc luc ngu. Uong 2 ngay lien. Tre duoi 3 tudi giam nua.

160

Bai 2: Phi ii> 10 - 15 qua thir nho sac nude uong luc doi
Bai 3: Loi hoan (Omphalia) tan hoi min moi lan uong 10 2()g. ngay 2 lan.
uong 2 ngay lien.
Bai 4.
Thanh phan

80g

Binh lang

20g

Phi lu

80g

Hacsuu(sao)

20g

Thutmg truat

80g

Tan bpt luyen mat lam hoan bang dau ngon tay ut, sang toi moi lan uong mot
hoan.
3. Che dp an va nhung thuoc phdi hop:
Tre em mac benh giun moc thuong ca the suy nhuoc thieu mau cho nen rat
din mpt che dp an du chat dinh dudng nhieu d?m, nhieu sinh to co the dung
thuoc tay ket hpp.
Phong benh:
1. Tuyen truyen giao dye rpng rai cho moi ngudi biet tac hai cua benh giun,
cach lay truyen cua benh va cach phong benh.
2. Giao due tap quan ve sinh phong benh cho tre em trong sinh hoat hang
ngay: Khong choi dat. khong ia bay, khong uong nude la, khong an rau qua
song, phai rira tay trudc luc an va sau luc ia. Ngudi Idn phai lam guomg cho tre
em .
3. Quan li tot phan nude rac: Khong tudi phan tuoi, khong phong ue bira bai
xuong ao ra dudng, dao gieng uong nude, bao ve nguon nude an khong bi o
nhiem, khong do rac bira bai ra dudng.
4. Dieu tra co ban tinh hinh nhiem giun d timg dja phuong de co bien phap cu
the tien hanh phong benh.
5. Cac hpc sinh cac trudng hpc, cac tre em d nha tre, mau giao phai dupe
djnh ky kiem tra phan (theo dpt kiem tra sue khoe) de cd bien phap tay giun kip
thdi, dam bao sue khde cho tre.

K E T LU A N
Benh ky sinh trung dudng rupt con la mot benh xa hoi kha pho bien d nude
ta, da anh hudng nhieu den sue khde cua tre em cho nen c.in phat dong mot
phong trao loan dan tich cuc phong bc'nh.

161

hoc hien Jai Ja che Jinn: nhieu loai ihuoc tas giun manh tjv dung toi Mins:

doc tinh con cao \a lovmg ihuoc cung han che

lim irong khv lang > tuv co

trusen nhun hai ihuoc. nhung si ihuoc las giun has Je ngnicn ciru img dung sa
pho cap la rat can thiet

c h 6 c lo

(Impetigo)
Benh choc ha\ choc lo la benh ngoai da thuong gap o ire dum 6 - 7 tuoi. phai
sinh nhiu sc- mua he Benh ihuoc pham tru chimg tie t" hoac thien bao sang"
theo y van co truyen
N G U Y E N N H A N V A BfcN H L Y :
Benh ngoai da thudng do tre bj nhiem lien cau khuan hoac ca lien cau va tu
diu khuan ket hop Benh co the lay lan thanh dich trong mot gia dinh hoac a
trudng hoc. Lay truyen do tre true tiep tiep xuc voi nguoi Theo Y hoc co truyen.
benh do ngoai cam then ta thu thap nhiet ket hop vcn ben trong co the tam hoa va
ty thap thinh ma sinh benh.
T R IE U C H U N G L A M SA N G :
O

da hai dau not nhung san do nhanh chong hinh thanh bong nuoc (thuy bao)

hinh hat d~^ anh. hat ngo hoac 1cm hem chua chat dich luc dau mau vang trong.
rat nhanh chi_. 2 i lhanh \ang due hoa mu Bong nuoc de vo. thao mu dong vay
mau vang. Vay troc de lai da mau hong nhat. dan dan tro lai binh thuong. Benh
co the nang hem. cac bong nuoc lien ket lai thanh mang vo ra dong vav dudng
kinh 4 - 5cm. an loet sau vao trung bi (Impetigo ecthyma) thuong ga^> d ch i dudi.
Co khi choc keo dai noi len lung dot thanh man tinh Benh nauig co the gay sot
nhe va vira, tre ludi an. chat ludTdo. mach te sac.
Choc thudng moc 6 nhung vung co the Ip ra ngoai nhu m jt, hai m i chung
quanh cac Id tu nhien. da diu va chan tay. Niem mac khong cd. O tre a n do gai.
vi khuan co the lay lan gay benh khap co the.
Cac bien chung co the xay ra nhu chdc cham boa, viem bach lam ba bin
thanh ap xe, bien chung viem cau lh$n, nhiem trung buyd.

DIEU TR|:
L Dieu tri b i^ d o ^ y :

162

I) Thuoc uong [rong Dung phep lhanh nine! giai doc co [he dung cac h.n
thuoc sau:
(1) Hoang lien giai doc (hang gia vi: Hoang cam, Hoang ba deu IOg. Hoang
lien 8g. Chi tir IOg. Kim ngan hoa. Don hi. Dia col hi deu I2g. Vo dau xanh IOg.
am hir gia Thien hoa phan. Sinh dia. Thach hoc deu I 2g de lu am thanh nhiet
(2) Thanh thir thang. Kim ngan hoa I6g. Lien kieu 8g. Thien hoa phan 12 .
Xich thtngrc IOg, Hoat thach 30g (sac trudc), Xa tien thao. Trach ta deu IOg.
2) Thuoc boi ngoai: Tuy dieu kien co the chon dung cac bai thuoc sau:
(1) Bpt Thanh dai (Thanh dai 80g. Hoat thach. Thach cao moi thu I60g.
Hoang ba 80g, tat ca tan bot min tron deu voi dau me boi, hoac che thanh mo
Thanh d?i (Bpt thuoc lOOg gia vaselin) boi ngay 2 - 3 lan.
(2) Hoang lien, Hoang ba, Phen phi, Hong don deu 20g, O tac cot 40g, Thach
cao nung 80g, deu tan bot mjn hoa voi dau me tron deu boi hoac rac va cho lo
sau khi da rixa sach bang nuoc la trau khong va kinh gidi dun soi de nguoi.
(3) Hong don song 40g, Phen phi 8g, O long vi (mo hong bp) 20g, Hung
hoang song 4g, Tao giac 5 qua dot thanh than. Tat ca tan bot min tron deu hoa
md Ipn boi choc sau khi nia sach b&ng nude bo ket dun soi de nguoi.
(4) Cay Ke d&u ngya (ca hoa la canh) Beo da, V oi voi mdi thu mpt nim tuoi
(100 - 200g) do nude khoang 5 - 6 lit dun soi de goi dau hoac rua ngam d chan
DiSu trj bang dong y cang sdm ket qua cang sdm khoi.
II. Ket hop thuoc tay:
Trudng hop benh nang (benh nhi sot cao, choc loet nhieu lan rpng hoac lau
khong khoi) clin ket hpp dieu trj bng khang sinh nhu: Penicilin, Am picilin,
Erythromycin, Gentamycin ...Cac loai Vitamin A, B, C va chu y an du ch it dinh
dudng, ve sinh da.
Phu luc: M U N L O D O M O H O I
Thudng hay phat sirth vS mua he tre em ra nhieu mo hoi ngua gai bi nhiim
khuan sinh Id.
- Phep trj chu yeu la: Thanh thu ta hoa
- Luc chua co mu, dung bai: Kim ngan hoa. Bo cong anh. Cue hoa dai. Cam
thao nam m6i thu 12 - 20g sac uong (tuy tre Ion be) hoac dung tuoi nau nude
t5m.

163

Luc da co mu. dung hai: Ngan kieu lan hirp l uc nhai 'an yij giam Moj*.

hai Thanh ihu lhang: Lien kieu. Thien hoa phan. Xich thin*, kim ngjn hoa. Xa
lien. Trach ta. Cam thao. Hoat thach. Hoac hinmg. Boi lan. La sen linn moi ihir
12 - I6g sac uong

BENH NHOT
(Furunculosis)
Benh nhpt hay dinh nhot la henh nhiem khuan ngoai da thinmg gap <Vnhirng
tre em sinh hoat trong dieu kien ve sinh kem hoac suy dinh dunng. cho nen h^nh
de tai phat. Nhot la henh viem nhiem nang long thuong lan ra cac to chuc (rung
hi lan can, gay sung lay lam mu. Theo y van co trUyen. rthot thuoc ph?m tru
chung tiet, ung (nhieu nang long cung nhiem khuan). Tuy vj tri 6 co the con goi
la dinh rau (mpc tren moi, duoi cam) chin me (nhpt 6 canh mong lay. chan) dmh
hoi (nhot cir lirng). Dinh rau mpc quanh mom la viing tam giac nguy hiem de gay
nhiem trung huyet phai het sire canh giac khong duoc tuy tien chich nan.
N G U Y EN NHAN BEN H L Y :
Nhot phan Ion do tu cau khuan nhimg cung co the do lien cau khuan hoac
trirc khuan mu xanh gay viem nhiem nang long va lan ra cac to chuc trung hi
xung quanh gay sung nong do dau. Nhpt co ngoi a giua. hoa mu, va mu. lanh
mieng thmrng de lai \ct seo to nho tuy theo muc do cua nhot Theo Y hoc co
truyen. nhot la do ngoai cam ta khi thuong la thu. thap. hoa Nhiet doc uat ket <V
hi phu dan den dmh ve hat hoa. khi huyet ngung tre gay sung tay dau (thong tac
hat thong). Dinh nhpt gay nhiem khuan huyet la tiet ung tau hoang hay dinh doc
tau hoang (co trieu chung tre sot cao, hon me, co giat).
T R IE U C H U N G L A M S A N G :
Vung nang long viem nhiem sung do nong dau. dinh cua nhot co mun mu
nho. luc bat dau nhpt cung sau hoa mu mem dan hot dau roi vo mu mau vang
nhat. het mu thanh seo. Benh nhe, tre an ngu choi binh thuong. Truong hop nang
(viem nhiem lan toa hoac tram trpng gay viem tac tinh mach xoang mat. nhim
khuan huyet) tre sot cao. me man li bi hoac hon me, co giat. Benh nhpt co the tai
phat nhieu lan, thudng gap a ire ve sinh kem. Ire suy dinh duong an u6ng thiiu
thon hoac tre mac benh tieu dudng.
D IE U T R I :
Benh nhot nhe, ve sinh dinh duong tot bnh co the' tv khoi.

164

Benh nang co the gay nhilm khuan huy( (Sep(icemte) hoac gay lac linh
mach xoang nao (Thrombophlebite des sinus) co (he gay (1/ vong
1. Dieu tri bang dong y:
/ Bien chung'lufin trj theo .? thdi ky benh:
1) Thdi ky sung tiy (nhiet doc thinh): Nhpt do sung dau nhidu ngudi
nong sot, tieu vang, tieu bon, luai do, reu vang mach hong sac.
- Phep trj: Thanh nhiet luong huyet giai dpc
- Bai thudc uong: Truong hop benh nhe co the chon dung cac bai.
(1) Kim ngan hoa 16 - 20g, Bd cong anh 20 - 40g, Lien kidu 10 - 16g, Hoang
cim, Sinh dja, Don bi. Cue hoa dai diu 12 - 16g sic chia 2 - 4 lin udng trong
ngay.
(2) Tho phyc linh, Sai dit, Bd cong anh, Kim ngan hoa deu 12 - 20g, Cam
thao nam 10- I6g.
- Thudc boi dip ngoai: Bdi dap ngoai la thudc dieu tri phdi hop tai cho rat
din thiet. Co the chpn dung cac loai sau day:
( 1) Cao phu dung: Hoang lien, Hoang elm, Hoang ba, Dai hoang, La phu
dung, Trach lan diep mdi thu 80g tan bt min, Bang phien 2g, vaselin vua du
trpn thanh cao mem boi ngoai.
(2) Chon 1 uong cac loai sau: Cue hoa dai tuoi. Bo cong anh. La V oi voi, hoa
la Phu dung. La dam but. La Bdi leri hoac la Diep ca (deu dung tuoi) gia nat tron
ti muoi dap len nhpt co tac dung sat trung hut mu hoac tieu sung (neu chua co
mu).

2)

Thai ky co mu: Nhpt hda mu toan bp, thanh cua nang long va to

chuc vung lan can hoat tu, nhpt mem bot dau, cuoi cung vo mu mau vang co
ngoi. Neu co sot thi vao thai ky nay sdt ha.
- Phep tri: Thac doc bai nung
- Bai thudc: Kim ngan hoa, Bd cong anh deu 20g, Lien kifiu, Hoang cim ,
Boi mau. Xuyen son giap, Tao giac thich deu 12g, Tran bi 8g, Sinh hoang ky
20g. sic udng ngay 1 thang. Co the tilp tuc dung cac loai thudc dip tren day,
hoac truong hgrp nhpt to co mu da chin, dung dao vo trung rach thao mu.
Trong 2 thoi ky tren neu nhpt cd bien chung nhiem khuan lan rong, benh nhi
sdt cao keo dai hofc hon me co gi$t can cho thudc luong huyet giai doc khai
khieu nhu Tu tuydt don, Chi bao don. Yen cung nguu hoang hoan lieu lupng 0,5

165

 Ig hoac kei hirp ia> \ dung cac lojii iru sinh manh \j lieu t j " ^hiuh I'-1!' *11lv11cin iruycn linh mach kei

hirp

dune sinh to B I. C

1) Thai Av hoi phuc Mu ra gan sach. sunc nhoi len da non chuan hi

lien mieng. doi vdi ini henh lau ngay cir ihe su> nhuin: can ucp ilk dune
- Phep iri: Khir hu sinh cu dieu hoa khi huyei
- Bai ihuoc: Tieu dao hirp luc vi gia giam
Duirng quy. Bach thuoc. Sai ho, Sinh dia. Dim hi Bach linh Bach truat deu
10 - 12g. Sinh hoang ky, Dang sam deu IOg, Tran hi. Hat sen. Hau phac deu 6 IOg. Tai cho boi cao Phu dung hoac cao nghe.
II. Ket hop thuoc tav:
Trircmg hirp nhot Ion, to hoac nhieu. dinh rau. hau boi. tre suy dinh dirfmg
hoac sot cao nen ket hop dung khang sinh. Vitamin C lieu cao de tranh bien
chiing nang. Chu y ve sinh dinh duirng tot. cho tre an nhieu rau. trai cay. kteng
an nhirng chat cay nong, mo thuc an chien. ran, khong an duong, loai trai cay
qua ngot nhu mit. sau rieng, cam ngot.

BENH GHE
(Scabies)
Ghe la mot benh ngoai da do ky sinh trimg ghe Scacoptes Scahcci gay nen,
tinh lay lan rat manh. thudng gap d tre em nhung vung \e sinh an a kem Due
diem cua benh la gay ngua du doi khien tre mai an mai ngu dan den suy dinh
duong. co the dan den bien chung viem cau lhan cap. can het sire chu y phong
benh va tri benh som.
N G U Y EN NHAN BEN H L Y :
Thu pham gay benh la con ghe cai (vi ghe due thuirng chet sau khi giao herp)
sinh soi nay no rat nhanh. Lay lan do tre mac benh ngua gai nhieu lam cho con
ghe vuong vai ra quan ao, giudng chieu cua be nam. va do do henh ghe lay chu
yeu vao ban dem luc nam chung chan chung giudng von nguoi Ion hoac tre mac
benh. Benh cung co the lay qua do choi. dung cu sinh hoat dung chung trong cac
nha tre truong hoc. cung co the lay benh do true tiep. tiC;p xuc nhung it hon
Theo Y hoc co truyen benh ghe goi la gim sang, gay ngua la do luc ghe xam
nhap vao da hien tuong phong thap nhiet u tre 6 bi phu sinh ngua Id chay nude
T R IE U C H U N G L A M SA N G :

166

- Xhcri gian u benh thuong tir 10 din 15 ngay.

- Benh bai dau ngua la trieu chung chu yeu. ngua (hutmg hai dau khu iru a
cac ke ngon (ay, ngon chan, nach, ke mong, qui diu (tre flam) hen. am ho (tre
nu), ve sau co (he Ian loan than. Ngua nhieu ve dem luc dap chan lam cho tre
kho ngu. Thuong ion chinh a da Ia cac Iu6ng ghe va mun nude. Luong ghe la
mpt duong go cao hon mat da, hoi vong veo 2 - 3mm, mau trang due khong
khdp voi Jan da, a dau co myn nuoc nho bang bang danh ghim. Duong hang la
con ghe dao d lop sung va mun nude la noi khu tru cua con ghe Ton thuong ghe
hiem co d mt.
Chan doan benh ghe chu yeu dua vao: Trieu chung lam sang, lich su tiep xuc,
con ghe tim thay d luong ghe. Chu y phan biet vdi viem da, thuy dau tre gai
nhiSu co the ghe cham hoa hoc b$i nhiem.
D IEU T R I:
1. Dieu trj bing dong y:
- Phep tri chinh: So phong thanh nhipt hoa thip.
- Bai thuoc: Tieu phong tan: Kinh gidi, Phong phong, Thuong trufU dSu 6 IOg, Kho sam, Duong qui, Sinh dja, Nguu bang deu 12g, Tri miu, Mqc thong
dSu IOg, Thach cao song 20 - 40g (sac trudc), Thuyen thoi 2 - 3g, Cam thao 3g.
- Thuoc dung ngoai: Chon mot trong cac bai sau de dung:
(1) Luu hoang 50g, Hung hoang 20g, Kho phan IOg, tan bot min tron md Ion
song boi vao cho ghe sau khi tim s$ch bing nude la khe hoac la xoan.
(2) Co the dung cac loai la sau nau nude tam: La kho sam, L a xoan. La khi,
La ca doc duoc. La trau khong. La diep ca hoac La chuoi tu o i...
(3) H^t mau cho gia ep nude nau co dac boi.
(4) Kho phan (phen phi) 20g, Cam thao 40g, tan bot min tron deu boi.
(5) Thuoc lao lOOg, ruou trang 100ml, tron lan cho vao bat dun ky liy nude
dac bdi. Chu y khay not ghe len cho chay nude, tam bang cac thu la tren day, lau
kho roi bdi thudc.
(6) Dau hat
mau cho, dau hat mu u boi len mun ghe sau khi tim
sach lau kho.
'
r
(7) Diem sinh IOg, Ht mau cho tan bot 30g, Cu nghe gia tan bQt 30g, tron
diu, chung voi diu l*c, diu vung ho$c md Iqm boi mdi ngay 1 tin trudc khi di
ngu.

- r.

2. Nhung dieu can chu j Idki dieu tri hfnh g h i:

167

1 Can phai hien semi Je dieu in lui. henh cun ii Ik . j:ian d n

< hi .in iluni}.'

thuoc nam lam \a hoi la co ket qua khoi nhanh

2 Trong moi gia Jinh hay lap the nha tre truong ho<. neu phai hien io nhieu
nginri mac. phai Jieu tri tap the de tranh lay lan
3. Dieu tri lien tuc triet de it nhat 10 - 15 ngay. sau do ihco doi uii phat trong
2 tuan (de phong co dirt trung mai no)
4. Ket harp dieu tri vai phong benh ca nhan tot nhu cat mong tay. giat luoc
thay quan ao hang ngay. long ve sinh giudng chieu. cach I n tre va ngudt trong
gia dinh va tap the bi ghe.

HAM KE (Intertrigo)
Ham ke (Intertrigo) la benh ngoai da thuong gap 6 tre em bn '

.iirdng

khu tru 6 nhung vung do co xal giua hai mat da cac nep ke nhu co, sau tai, ke
mong, ke ben. nep da giua cac ngon tay chan.
N G U Y EN N H A N :
Nguyen nhan ham ke chu y6u do nhiem cac loai cau khuan. vi khuin dudng
ruot, nam.
Yeu to thuan lai cho vi khuan gay benh la sinh hoat. cham soc tre it chu y vc
sinh, da nhiem ban. mua he nong nuc, song noi am uot. tre dai vao ta lot khong
duoc thay ngay. mo hoi nhieu
Theo y hoc co trj yen, benh ham ke la do ngoai ta thap nhiet tich tu dda.
T R lfc L C U U N G L A M SA N G :
Vung de sinh benh la sau tai. co, nach, ben, biu dai, vung quanh hau mon,
vung hoi am. mong. Ban do ranh gtoi khong ro, nang co the phu, xual tifet. chay
nuoc la loet. sinh mu. Co the ngua
D lfeU T R | B A N G D O N G Y :
- Phep tri chu yeu la thanh nhiet tru thSp kifem khu phong Thudng ket hop
uong thuoc va song rua boi thuoc tai cho.
- Bat thuoc uong: Tam dieu hoan (Thuong truat, Hoang ba, Nguu t il) gia vj.
Thuong truat. Hoang ba. Nguu t5t deu 12g, Kho sam. Cam thao nam ddu
16g. Kim ngan hoa 16 - 20g. Kinh gidi. Phong phong <u 8 - I2g. Thuydn thAi 2
- 4g sic nude uong (dong thdi co ihe dung n&u nw ic xftng rib h o ic tim .

168

- Thu6c rua boi ngoai: Co the chon mot trong cai. hai sau
(1) Minh phan. La chc moi (hu l(X)g. cho nude 3 In sac con I Ml loc qua vai
gac rua viing ham ngay 3 - 4 lan
(2) Vo va la xoan. La voi. La choi xe. sac nude rua ngay 2 - 3 lan
(3) Ngu boi tir, Xa sang tir, moi thir 30 - 40g sac nuot rua
(4) Bo cong anh, Hoa cuc dai deu HX) - 200g sac nuoc rua
(5) Phen phi 8g, Hoang ba 12g, 6 tac cot I2g. tan min tron deu hoa dau me
boi.
(6) Bot Thanh dai, Hoang lien, Hoat thach. Bang phien moi thu lOOg, Thanh
dai 80g, Bang sa 40g, tan bot min tron deu boi. Cung co the dung cac loai bot
bdi cham.
M fO N G B E N H : Chu y giu ve sinh da cho tre. Luc tim cho tre, chu y tim
sach xac vung co nep nhan tiep xuc cua hai lan da nhu nrch. ben, co. hau mon.
am hp... Va luc tim xong cunh nhu nhung luc trdi nong ra md hoi nhieu chu y
lau kho.
Trj ham ke chi can giu ve sinh tot cho tre, uong thuoc va rua. boi thuoc nam
lai cho la khoi.

CHAM TRE EM
(Eczema du nourisson)
Cham la mot benh viem da di ung co the gap a tai ca cac lua tuoi nhung
thudng gap d ire cm tren 2 (hang va thudng den ^ tuoi lu khoi tea biet cung co
khi dai dang den kh Ion tuoi) nen goi la chain ire em
N G U Y EN NHAN BEN H LY :
Theo y hoc hien dai thi eczema la mot benh di ung. phat sinh henh co lien
quan den 2 yeu to:
(1) The trang lit mot ca dia di img. co su roi loan ve than kinh. noi tiel
chuyen hoa v.v... Co lien quan den di (ruyen.
(2) Dj ung nguyln (Khang nguyen gay dj ung) co Ihe la sua me (co tre ngung
sua me thai cham lan) sua bo. trung. vi khuan. ihuc an. thuoc uong. phan hoa.
long thu, tiep xuc hoa chat ... Phan Ion cung rat kho xac dinh (heo y hoc co
truyen do dac diem cua benh la ngua chay nude, san do nen cho nguy en nhan la
do tre cam nhiem ngoai ta phong lhap nhiet ket (u o da sinh henh. Benh cham ire

169

em con do yeu to lliai di*c. benh thinnig gap u tre map map thuiv. ihe lang dam
lhap linnh
T R IE U (.H U N G L A M SA N G :
Ton thuirng cu han la mun nuoc d da kem theo ngira thu<mg tien men i|ua >
giai doan
I I ) Do da.
(2) Nhieu mun nuoc xuat hien lam tam.
(3) Mun nude vo chay nude viing da lom xuong.
(4) Huyet tinmg dong thanh vay mau vang roi tham dan, vai ngay sau hong
vay.
(5) Vay bong de lai da non mau do, khong de lai seo. O tre em nhung mun
nude thudng khu tru 2 ben ma va tran, tru mui va mom tao lhanh vanh mong
ngua, gidi han khong ro ret, doi khi lan len dau. lan xuong cac chi, ngua
nhieu.b^nh luc lang luc giam. doi khi kem theo sot cao. Benh dien bien co the la
cap tinh (ton thuong da chu yeu la sung do. chay nude ngua nhieu co sot) hoac la
man tinh (vay day kho, ngira nhieu da vang).
D IE U T R I:
I.

Dieu trj bang dong y: Bien chung luan tri theo 2 the henh cap va man

linh. The cap tinh thuoc phong lhap nhiet. the man tinh thuoc huyet tao

I Phong thap nhiet:

- Trieu chung chu yeu: Cham nong do chay nunc vang. benh nhi da nong.
sot. ngua nhieu. luoi do reu vang. mach phu sac (hoac chi van phi) do).
- Phep in: Khu phong lhanh nhiet trir thap.
- Bin thuoc: Kinh gim. Phong phong deu 8

I2g. Kim ngan hoa, Ha kho

thao. Tho phuc linh deu 16g. Thuyen thoi 3g, Kho sam. Sinh dia. Hoang ba dOu
12g. Thach cao 30 - 40g (sac trudc). Cam thao giay 16g. Thuung truat IOg sac
uong ngay I thang.
Gia giam: Nhiet ihinh gia Chi lu, Hoang cam. Thap thinh gia Mpc thong.
Dang tam. Phong ihinh gia Bach chi, Xa sang tu.

2.

The huyet tao: Cham dong vay day kho, ngua nhieu, da kho. ludi kho.

reu vang. mach nho sac.

- Phep tri: Dudng huyet khu phong. thanh nhiet trir thap
- Bai thuoc: Co the chon nipt trong cac bai sau:

170

( I ) Sinh dja. Kim ngan hoa, Huyen sam, Dia phu tir deu 12

I6g. Xac ve 3 -

6g, Phong phong, Kinh giai, Bach tai le. Thuxmg (ruai Jcu 8 - l2g. Duong qui
I2g, Xich thirprc IOg, Dai tao 5 qua.
(2; Sinh dja, Duong qui. Xa sang tu. Bach tien bi, Kho sam. Dja col bi. Bach
thuoc, Ha thu o du I2g. Kinh giai, Phong phong du IOg, Xac ve 3g. sac uong.
- Thuoc boi ngoai: Tuy the henh co the dung cac bai sau:
( 1) Nga khau tin (xem bai tua mieng).
(2) Bpt Thanh dai tron voi dau vung vi>a du boi
(3) Long do trung ga nau thanh cao boi.
(4) Tam dieu tan phuong (Han thuy thach 40g, Hoang ba 20g, Thanh dai 4g)
tron dau vung boi.
(5) Ngu thach tan: Han thuy thach, Thach cao, Bang phien, Xich thach chi,
Lo cam thach luong bing nhau tan hot mjn tron deu hoa voi dau vung vua du boi
ngay 2 - 3 lan dung cho the man tinh.
- Chu y luc dieu trj cham tre em:
(1) Cin kfet hpp thuoc Uong va boi ngoai, trudng hqrp cham ngoai da da khoi
cung can uong thuoc trong it nhat la 2 thang de ch6ng tai phat.
(2) Trudng hop cham boi nhiem keo dai, tre sot, bach cau tang, can ket h<^p
dung tru sinh trong 7 - 10 ngay.
(3) Chu y ve sinh cham soc tre tot, khong de tre chcri ban, thay ao quan hang
n g a y . g ia t

deo b a o

ky b'&ng xa b6ng, Iu q c nuoc soi (ch6ng bO'i nhilm ) tre nho dudi

la y

tuoi

(tranh ue gai gay lor loet).

(4) Ban dem tre ngua nhifeu khoc la khong ngu duac nen kfet hop cho thu6c
an than.
(5) Khong cho tre an cac loai thuc 5n tanh nong nhu ca bin, tSm, cua, tep,
thit bo, thjt ga, cac loai trai cay qua ngQt nhu mit, oi, sau riftng, cam ngot, keo,
banh ngot (theo dong y. cac chat co vj ngot la nong). N6u tre mcbnh dang con
bu me phai kieng cac thuc an tren.
Cham la mot benh dj ung rat de tai phat cho nen trong dieu tri phai kifen tri va
loan dien.

171

TAI LIEU THAM KHAO CHINH

Tieng viet:
1. Bo mon Nhi truong dai hoc Y khoa Ha Noi: Nhi khoa dap 2)
Nha xuat ban Y hoc Ha Noi X B . nam 1974.
2. Triin Van Ky: Thin; hanh cham ciru Nhi khoa
Nha X B Y H - TP. H6 Chi Minh X B . nam 1985
3. Bo mon Nhi trircmg dai hpc Y khoa TP.H CM : Dieu iri nhi khoa (tp I, II):
Tai lieu d;ch, (luu hanh noi bo) X B . nam 1986
4. Vien bao ve sue khoe tre em: Cam nang dieu tri nhi khoa.
Nha X B Y H Ha Npi X B . nam 1991.
5. Benh vien nhi dong I: Cap cuu nhi khoa.
Vien thong tin Thu vien Y hpc X B . nam 1993.
6. Nguyen Duy Thanh: Benh truyen nhiem.
Benh vien Da khoa D6ng thap X B . nam 1990.
7. Nguyen Xuan Hien va C S: Benh ngoai da va hoa lieu.
Nha X B Y H chi nhanh TP. Ho Chi Minh X B . nam 1991
8. Tran Van Ky . Trieu chung va dieu tri hpc dong y.
Nha X B Y H - X B . nam 1991.
9. Tran Van Ky: 250 bai thuoc dong y co truyen chpn loc.
Nha X B T H . D6ng thap X B . nam 1992.
10. Tran Van K y: Duoc hpc co truyen. (tap I, II)
Nha X B TP. H C M X B . nam 1995, 1997.
11. Bo Y l: Huong din thyc hanh dieu ui.
Nha X B Y H . X B . nam 1995.
Ting H oa:
12. Bo mon ngoai khoa Hpc vien Trung y Thuong hai: Bai giang ngoai khoa
Trung y.
N H A X B . Ve Sinh Nhan Dan X B . nam 1960.
13. Trung y hpc vien Quang Chau: Bai giang Nhi khoa Trung y.
Nha X B . K H H T Thuong Hai X B . nim 1964

172

14. Cue v sinh linh Quang Dong ...: Tan bien Trung y hoc khai yeu
Nha X B Ve Sinh Nhan Dan X B. nam 1974.
15. Bo mon Nhi khoa Hoc vien Quang Chau: Trung y Nhi khoa.
Nha X B. Ve Sinh Nhan Dan X B. nam 1972.
16. Hpc vien Trung y Thircmg hai: Nhi khoa hpc.
Nha X B. Nhan Dan Thircmg Hai X B . nam 1974.
17. Ho Di Minh: Trung Quoc trung y bi phucmg dai toan.
Nha Xuat Ban Van Hoi X B . nam 1991.

173

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