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v 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 sn 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 su 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 t§p 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
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nu ngan. gan h^u mon nen 6k nhtcm khuan ucl ni£u. 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.
1
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).
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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
•*
•
r
«.
'
■
»
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 xu§t
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.
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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 b£nh 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.
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- 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
nhiC‘1 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.
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