QUYẾT ĐỊNH số 2470 qđ BYT HƯỚNG dẫn KHÁM SÀNG lọc TRƯỚC TIÊM CHỦNG đối với TRẺ EM

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CONG HoA xi\. HOI CHU NGHiA VIET NAM
DQc l~p - T\f do - H~nh phuc

BOYTE

Ha N(Ji, ngay

S6:.2~10/QD-BYT

44

thong

6

nam 2019

QUYETDINH

V~ vi~c ban hanh Huong d§n
Kham sang lQc trmrc tiem cluing

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oBi vrri tre

em

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BO TRUONG BO Y TE
Can ctr Nghi dinh s6 75/2017/ND-CP ngay 22 thang 6 nam 2017 cua
Chinh phu quy dinh clnrc nang, nhiem vu, quyen han va co d.u t6 clurc BQ Y tS;
Theo dS nghi cua C\lCtnrong C\lCQuan ly Kham, chua benh - BQ Y tS,
QUYETDINH:
Di~u 1. Ban hanh kern thea Quyet dinh nay Huang d~n kham sang loc
tnroc tiem chung d6i voi tre em.
Di~u 2. Quyet dinh nay co hieu hrc kS tir ngay ky ban hanh. Bai bo Quyet
dinh s6 2301lQD-BYT ngay 12 thang 6 nam 2015 cua BQ tnrong BQ Y tS vS
viec ban hanh Huang d~n kham sang loc tnroc tiem chung d6i voi tre em.
Di~u 3. Cac ong, ba: Chanh Van phong BQ, C\lC tnrong C\lC Qmin ly
Kham, chua b~nh, Chanh Thanh tra BQ, cac V\l truOng, C\lC truang cua cac
V\l/C\lC thuQc BQ Y tS; Giam d6c cac co sa kham b~nh, chua b~nh trvc thuQc BQ
Y tS; Giam d6c Sa Y ts cac tinh, thanh ph6 tn)'c thuQc Trung uang; Thu tnrOng
y tS cac BQ, nganh; Thti truang cac dan vi co lien quan chiu trach nhi~m thi
hanh QuySt dinh nay./.

Noi nhtin:
- Nlm Di~u 3;
- BQ truang (de b/c);
- C5ng TTDTBYT, Website Cl,lCQLKCB;
- Luu: YT, KCB.


BOYTE

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eONG HoA xA HOI eHU NGHiA VIET NAM
DQc l~p - Tl}'do - H~nh phuc

HUONGDAN
Kham sang IQctrmrc tiem chung d8i v6'i tre em
(Ban hanh. kern thea Quyet dinh

s6 1.-!t1.0/QD-BYT

ngay4.4thimg .6.narn 2019)

I. Muc dich cua kham sang IQc:
Nh~m phat hien tnrong hop bfit thuong c~n hru y dS quyet dinh cho tre tiem
chung, khong tiem chung, hoan tiem chung hoac chuyen kham sang loc tai benh
vien.

II. Kham sang IQctrurrc tiem chiing cho tre em ~ 1 thang tuAi:
1. Cac tnrong hop chong chi dinh:
a) Co tiSn sir s6c hoac phan irng nang sau tiem chung vAcxin l~n tnroc (co cung
thanh phan): s6t cao tren 39°C kern co giat hoac dfiu hieu nao/rnang nao, tim tai,
kh6 tho.
b) Suy giam miSn dich (benh suy giam miSn dich bam sinh, tre nhiem HIV giai
doan lam sang IV hoac co biSu hien suy giam miSn dich n~ng) ch6ng chi dinh

tiem chung cac v~c xin s6ng giam dQc h.rc.
c) Cac trucmg hqp ch6ng chi dinh khac thea huang d~n cua nha san xufit d6i vai
tUng lo~i v~c xin.
2. Cac trucmg hgp t~m hoan:
a) U6i v6i co sa tiem chung ngoai b~nh vi~n:
- Co tinh tr~ng suy chuc nang cac co quan (nhu suy ho hfip, suy tu~n hoan, suy
tim, suy th~n, suy gan, hon me ... ). Tiem chung khi suc khoe cua tre 6n dinh.
- M~c cac b~nh cfip Hnh, cac b~nh nhiSm trung. Tiem chung khi suc khoe cua tre
6n dinh.
- S6t ~ 37,SoC ho~c h~ than nhi~t:S 3S,SoC (do nhi~t dQt~i nach).
- Tre m6i dung cac san ph&m globulin miSn dich trong yang 3 thang (tru khang
huy~t thanh viem gan B): t~m hoan tiem chung v~c xin s6ng giam dQc h.rc.
- Tre dang ho~c m6i k~t thuc dgt diSu tri corticoid (u6ng, tiem) liSu cao (tuang
duong prednison ~ 2mg/kg/ngay), hoa tri, x~ tri trong yang 14 ngay: t~m hoan
tiem chung vAc xin s6ng giam dQc h.rc.
- Tre co can n~ng du6i 2000g: chuySn kham sang lQc va tiem chung t~i b~nh
vi~n.


- Co tiSn su phan irng tang d~n sau cac l~n tiem chung tnroc cua cung Ioai v~c
xin (vi du: l~n d~u khong s6t, l~n sau s6t cao tren 390C ...): chuyen kham sang
19C va tiem chung tai benh vien.
- M~c cac benh b~m sinh hoac benh man tinh a tim, phoi, h~ thong tieu hoa, tiSt
nieu, mau, ung thu chua 6n dinh: chuyen kham sang 19C va tiem chung tai benh
vien.
- Cac tnrong hop tam hoan tiem chung khac thea huang d~n cua nha san xuAt
d6i voi tung loai v~c xin.
b) D6i voi co

sa tiem chung tai benh vien:

- Co tinh trang suy chirc nang cac co quan (nhu suy ho hAp, suy tuan hoan, suy
tim, suy th~~, suy gan, hon me ... ). Tiem chung khi sire khoe cua tre 6n dinh.
- Tre mac cac benh cAp tinh, cac b~nh nhiSm trung. Tiem chung khi suc khoe
cua tre 6n dinh.
- Tre s6t 2: 38°C ho~c h~ than nhi~t ::;35,5 °c (do nhi~t dQ t~i nach).
- Tre moi dung cac san ph~m globulin miSn dich trong vong 3 thang (trir khang
huySt thanh viem gan B): t~m hoan tiem chung v~c xin s6ng giam dQc l\lc.
- Tre dang ho~c moi kSt thuc dqt diSu tri corticoid (u6ng, tiem) liSu cao (tuong
duong prednison 2:2mg/kg/ngay), hoa tri, x~ tri trong vong 14 ngay: t~m hoan
tiem chung v~c xin s6ng giam dQc l\lc.
- Tre m~c cac b~nh tim b~m sinh ho~c m~n tinh kern thea tang ap l\lc dQng m~ch
ph6i (2:40mmHg).
- Cac truemg hqp t~m hoan tiem chung khac thea huang d~n cua nha san xuAt
d6i voi tUng lo~i v~c xin.
3. Cac truemg hqp c~n kham sang 19C va tiem chung t~i b~nh vi~n:

sa

Cac truemg hqp t~m hoan tiem chung t~i cac ca
tiem chung ngoai b~nh vi~n
c~n chuy@ntuySn d@du<)'ckham sang 19C, tiem chung t~i b~nh vi~n:
a) Tre co can n~ng < 2000g.
b~ Tre co tiSn su phan Ung tang d~n sau cac l~n tiem chung truoc cua cung lo~i
vac xin.
c) Tre m~c cac b~nh b~m sinh ho~c b~nh m~n tinh
hoa, tiSt ni~u, mau, ung thu chua 6n dinh.

a tim,

ph6i, h~ th6ng tieu

III. Kham sang IQc tnr&c tiem chung cho tre sO'sinh
1. Cac truemg hqp ch6ng chi dinh:
a) Khong tiem v&c xin BCG cho tre sinh ra tir m~ nhi@m HIV rna m~ khong
du<)'cdiSu tri d\l phong t6t lay truySn tir m~ sang con.
b) Cac truemg hqp ch6ng chi dinh khac thea huang d~n cua nha san xuAt d6i voi
tirng lo~i v~c xin.
2


2. Cac tnrong hop tam hoan:
a) D6i voi co sa tiem chung ngoai benh vien:
- Co tinh trang suy chirc nang cac co quan (nhir suy ho h~p, suy tu~n hoan, suy
tim, suy than, suy gan, hon me ... ). Tiem chung khi sire khoe cua tre on dinh.
I"

f'OW

- Tre mac cac benh cap tinh, cac benh nhiem trung. Tiern chung khi sire khoe
cua tre 6n dinh,
- Tre s6t ~ 37,SoC hoac ha than nhiet ::; 3S,SoC (do nhiet dQ tai nach). Tiem
chung khi than nhiet cua tre 6n dinh.
- Tre co can nang duoi 2000g: chuyen kham sang loc va tiem chung tai benh
vien,
- Tre sinh non co tuoi thai < 34 tuan: N@ume co HBsAg (-) tam hoan tiem v~c
xin viem gan B so sinh, tiem chung khi tre du 34 tufrn tu6i (tinh ca tu6i thai).
N@ume co HBsAg (+) hoac me khong xet nghiem chuyen kham sang lQc va
tiem chung t?i b~nh vi~n.
- Tre sinh non co tu6i thai < 34 tufrn t?m hoan tiem v~c xin BCG. Tiem chung

khi tre du 34 tuk tu6i (tinh ca tu6i thai).

a

- M~c cac b~nh bAm sinh ho~c b~nh m?n tinh tim, ph6i, h~ th6ng tieu hoa, ti@t
ni~u, mau, thfrn kinh, ung thu chua 6n dinh: chuySn kham sang lQc va tiem
chung t?i b~nh vi~n.
- Cac truOng hqp t?m hoan tiem chung khac theo huang d~n cua nha san xu~t
d6i v6i timg lo?i v~c xin.
b) D6i v6i co sa tiem chung t?i b~nh vi~n:
- Tre co.chi dinh c~p cUu. Tiem chung khi suc khoe cua tre 6n dinh.
- Tre s6t 2: 37,SoC ho~c h? than nhi~t ::; 3S,S
chung khi than nhi~t cua tre 6n dinh.

°c (do

nhi~t dQ t?i nach), tiem

- Tre co tu6i thai < 28 tufrn. Tiem chung v~c xin viem gan B khi tre du 28 tufrn
tu6i (tinh ca tu6i thai).
- Tre co tu6i thai < 34 tuAn t?m hoan tiem v~c xin BCG. Tiem chung khi'tre du
34 tufrn tu6i (tinh ca tu6i thai).
- Tre co can n~ng < 2000g rna m~ co HbsAg (-). TruOng hqp m~ co HbsAg (+)
ho~c khong xet nghi~m cho m~ thi cfrn tiem v~c xin viem gan B cho tre.
- Tre m~c cac b~nh tim bAm sinh co tang ap Ivc dQng m?ch ph6i (2:40mmHg).
- Cac truOng hqp t?m hoan tiem chung khac theo huang d~n cua nha san xu~t
d6i v6i timg lo?i v~c xin.
3. Cac truOng hqp cfrn kham sang lQc va tiem chung t?i b~nh vi~n:
Cac truOng hqp t?m hoan tiem chung t?i cac co sa tiem chung ngoai b~nh vi~n
cAnchuySn tuy@ndS duQ'ckham sang lQc, tiem chung t?i b~nh vi~n:

3


a) Tre co din nang < 2000g va my co HBsAg (+) hoac my kh6ng xet nghiem,
b) Tre co tu6i thai < 34 tuan va my co HBsAg (+) hoac my kh6ng xet nghiem,

a

c) Tre mac cac benh b~m sinh tim, phoi, h~ thong tieu hoa, gan, than, mau,
than kinh, ung thu, chua 6n dinh.

IV. M<)t s8 hru

y khi

kham sang loc trmrc tiem chung t~i b~nh vi~n

1. Tre co ti@nsir di irng voi v~c xin hoac nghi ngo di irng voi v~c xin:
a) NSu tre co bang clnrng di img voi loai v~c xin tiem l~n tnroc: kh6ng tiem
chung cho tre.
b) Tre co ti@nsir nghi ngo di ung voi v~c xin: Kham, danh gia nguyen nhan va
rmrc dQ di img,
2. Tre co yang da sa sinh:
a) Kh6ng chong chi djnh va kh6ng tarn hoan tiem chung d6i voi tnrong hop
yang da sinh ly co n6ng dQ bilirubin huySt thanh :S 7mg/dL. Trong truang hgp
kh6ng thvc hi~n xet nghi~m thi dVa vao phan vung yang da Krammer.
b) T~m hoan tiem chung vai truang hgp yang da b~nh ly ho~c yang da sinh ly co
n6ng dQ bilirubin mau > 7mg/dL.
3. Tre de non ho~c nhy can so vai tu6i, suy dinh duOng, m6 de:
a) Kh6ng co ch6ng chi dinh va kh6ng t~m hoan tiem chung d6i vai tre co can

n~ng ~ 2.000g ho~c m6 de. Thvc hi~n tiem chung dung lich cho tre.
b) Kh6ng co ch6ng chi dinh va kh6ng t~m hoan tiem chung v~c xin viem gan B
d6i vai tre sinh non co tU6i thai 28-36 tu~n.
c) Kh6ng co ch6ng chi dinh va kh6ng t~m hoan tiem chung v~c xin BeG d6i vai
tre sinh non co tU6i thai 34-36 tu~n. Tinh tU6i cua tre dS xac dinh ngay tiem
chung thea ngay thang nam sinh cua tre.
4. Tre dang di@utri khang sinh: Kham, danh gia ly tinh tr~ng b~nh ly, nSu tre
khong co ch6ng chi dinh ho~c t~m hoan: Thvc hi~n tiem chung cho tre thea Iich.

a

5. Tre nhiSm ho~c nghi nhiSm HIV nhung chua trong giai do~ AIDS: NSu tre
khong co cac ch6ng chi dinh ho~c t~m hoan, tiem chung cho tre thea lich kS ca
v~c xin s6ng giam dQc Ivc.
6. Tre co b~nh b~m sinh ho~c b~nh m~n tinh
th~n, mau, ung thu, th~n kinh

a tim, ph6i, h~ th6ng tieu hoa, gan,

a) NSu tinh tr~ng b~nh cua tre dang a giai do~n 6n dinh, tre kh6ng a trong tinh
tr~ng c~p tinh, kh6ng co chi dinh can thi~p di@utri c~p CUu: Kh6ng ch6ng chi
dinh ho~c t~m hoan W~mchung. Thvc hi~n tiem chung cho tre thea Iich.
b) NSu tre thiSu ySu t6 dong mau: truy@n ySu t6 dong mau bi thiSu truac khi
tiem chung.

4


v. T8 clnrc tlnrc

hi~n:

1. D6i voi co sa tiem chung ngoai benh vien
a) Ngtroi thuc hien
- Bac sy, y SI: true tiSp tham kham cho tre va ghi cac thong tin cua tre, tnrc tiSp
do va ghi kSt qua nhiet dQ cua tre khi khong co diSu duong vien, hQ sinh vien.
Can bQ y tS kham sang loc tnroc tiem chung phai diroc t~p huan chuyen mon vS
tiem chung thea quy dinh tai Nghi dinh s6 155/2018/NI)-CP ngay 12 thang 11
nam 2018.
- DiSu duong vien, hQ sinh vien: Ghi cac thong tin cua tre, tnrc tiSp can tre, do
va ghi kSt qua nhiet dQ cua tre.
b) Phuong tien
- Nhiet kS, 6ng nghe.
- Bang kiem truce tiem chung cho d6i nrong tir 1 thang tu6i tro len (phu luc I)
- Bang kiem tnroc tiem chung cho tre sa sinh (ph\ll\lc II)
c) Cac buac thvc hi~n kham sang lQctruac tiem chung
Cac buac thvc hi~n va diSn thea bang kiSm truac tiem chung bao g6m:
- Hoi tiSn sir va cac thong tin co lien quan
- Danh gia tinh trC;lngsuc khoe hi~n tC;li
- KSt lu~n
d) Ghi chep vi~c kham sang IQcva luu bang kiSm
Toan bQ nQi dung kham sang lQc duQ'c ghi thea bang kiSm, luu tC;licac diSm tiem
chung. Thai gian luu: 15 ngay.
2. D6i vai ca sa tiem chung tC;lib~nh vi~n:
a) Nguo'i thvc hi~n
- Bac sy, y SI kham sang lQc truac tiem chung: kham, danh gia, ph6i hQ'Pvai cac
th~y thu6c chuyen khoa (nSu c~n), dua ra nh~n xet va kSt lu~n vS chi dinh tiem
chung cho tre.
- Bac sy chuyen khoa: kham, danh gia tinh trC;lngb~nh ly cua tre thea chuyen
khoa; ph6i hQ'Pvai bac sy tu vftn tiem chung dS dua ra kSt lu~n vS chi dinh tiem

chung cho tre.
- Can bQ y tS co lien quan dSn tu vftn, tiem chung v~c xin va thea d5i phan ll'ng
sau tiem chung.
b) PhU011gti~n
- Co du phuang ti~n dS thvc hi~n vi~c kham sang IQcva kham chuyen khoa.

5


- PhiSu kham sang 19C tnroc tiem chung cho d6i nrong tir 1 thang tu6i tro len
(phu luc III) va phieu kham sang IQc tnroc tiem chung cho tre sa sinh (phu luc
IV).

c) Cac buoc thuc hien
- Bac sy tu van, kham sang IQc tiem chung: kham danh gia toan dien cac diSu
kien tiem chung cho tre; tham v~n thay thuoc chuyen khoa vS tinh trang benh ly
theo chuyen khoa (neu cftn). Dira ra kSt luan vS diSu kien tiem chung cho tre.

- Bac sy chuyen khoa: khi duoc yeu cftu, danh gia dfty du vS tinh trang benh ly
theo chuyen khoa cftn tham van; dua ra nhan xet, dS nghi lien quan dSn tiem
chung vS tinh trang benh ly cua tre, Ph6i hQ'P voi can bQ tiem chung thirc hien
tiem chung va theo d6i sau tiem chung cho tre khi cftn.
d) Ghi chep vi~c kham sang IQcva luu hi) sa
- Thvc hi~n vi~c ghi chep, luu gifr ca sa dfr li~u tiem chung theo quy dinh hi~n
hanh va cac quy dinh vS ghi chep s6 kham b~nh, hi) sa b~nh an nhu d6i vai tre
dSn kham, diSu tri ngo~i tru, nQi tru t~i b~nh vi~n.
- Truang hQ'Pco hi) sa b~nh an t~i b~nh vi~n: toan bQ nQi dung kham sang IQc
trong bang kiSm va y l~nh chi dinh tiem phai duQ'c ghi trong hi) sa b~nh an ho~c
phiSu kham sang IQc truac tiem chung duQ'c luu cung hi) sa b~nh an theo qui
dinh.

TrU'ftng SO'n

6


PHULUCI
(Ban hanh kern thea Quyet atnh s6 ..~... iQD-BYTngay ...thang.... ndm 2019)

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CONG HoA xA HOI
. CHU NGHiA VIET NAM
DQc l~p - TV do - H~nh phuc

TTYTDP /TYT IPKlNHS

BANG KIEM TRUdc TIEM CHUNG DOl v6'I DOl TUQNG 2: 1THANG TUOI
TAl
. cAc CO TIEM CHUNG NGoAI BENH VIEN

Sa

.

HQ va ten tre:

.

Nam

Tu6i:

sinh ngay

thang

0

NfrD

nam

..

Dia chi:

.

HQ ten bo/me:

Dien thoai:

Can nang:

I.

kg

..

°c

Than nhiet:

Kham sang loc:
CoO

Khong

0
0

Co

0

3. Dang hoac moi k~t thuc dot dieu tri corticoid li~u cao (tuong
duong prednison >Zmg/kg/ngay), hoa tri, xa tri, gammaglobulin **

Khong

0

Co

0

4. S6t/H~ than nhiet ( S6t: nhiet d9 2: 37,5 o,
::;35,50C )

Khong

0

CoO

5. Nghe tim bfrt thuOng***

Khong

CoO

6. Nhip tho, nghe phoi bfrt thuong

Khong

7. iii giac bfrt thuong (li bi hoac kich thich)

Khong
ong

0
0
0
0

Khong

0

l. S6c, phan img nang sau l~n tiem chung tnroc

Khong

2. Dang mac benh cfrPtinh hoac benh man tinh ti~n trien"

H~ than nhiet: nhiet d9

8. Can nang < 2000g

...........................................................................................................................................................................................................................................~
......,......

. ........................ _

9. Cac chong chi dinh/tam hoan khac, neu co ghi ra:

...............................................................................

I CoO
CoO
CoO
CoO

.......... ....................................................................................................................................
_........

*: Khong hoiin tiem v6c xin a6i voi tre co benh nhe (ho, .'1'6mUi, lieu chay muc ap nhr;:... va khOng s6t),
bu t6t, {m t6t
**: Tru khang huydt thanh viem gan B. Tieu chudn nay chi ap d1:lngv6'i v6c xin s6ng giam ape hrc.

II.

K~t lu~n:

- Du di~u ki~n tiem chung ngay (Tfrt cft d~u KHONG co di€m bftt thuOng)
. :, xm
. t'lem c h'ung 1~
,
L O~lvac
an nay:
.
A

- Ch6ng chi dinh tiern chung (Khi CO di€rn bfrt thuOng t~i m\lc 1,9)
- T~m hoan tiem chung (Khi CO bfrt kY m(>tdi€m bfrtthuOng t~i cac m\lc 2,3,4,5,6,7,8)
D~ nghi kharn sang lQc t~i b~nh vi~n:
+ Ly do:

Khong

0

Co

D
D

GJ

0
.

•,
' ngay....
,
thang
'
~
gUY
p hut,
nam
Nguai th\fc hi~n sang lQc
(k)', ghi ra hQ va ten)

lJ).·

n01

7

.


. .

PHULUCII
(Ban hanh kern thea Quyit dinh s6

IQfJ-BYT ngay
TTYTDP ITYT IPKlNHS

.........................

.

.)

.

.

CONG HoA xA HOI CHU NGHiA VIET NAM
DQc l~p - T1}.'do - H~nh phuc

BANG KIEM TRUaC TIEM CHUNG DOl VOl TRE SO SINH
TAl cAc CO Sa TIEM CHUNG NGoAI BENH VIEN

.

.

HQ va ten tre:

Nam

gio

Sinh:

.

ngay

thang

nam

D

NfrD

Tu6i thai khi sinh:

..

Dia chi:

.

HQ ten bo/me:
Can nang:

Di~n thoai:
g

M~ da xet nghiem HbsAg: Kh6ng

.

°c

Than nhiet:

D

C6

0

K€t qua: Duong tinh

D Am tinh 0

I. KhalD sang IQc:
Kh6ng 0

C60

Kh6ng 0

C60

Kh6ng 0

C60

4. Da, m6i kh6ng hong

Kh6ng 0

C60

5. Bu kern hoac bo bu

Kh6ng 0

C60

6. Tu6i thai < 34 tu~n

Kh6ng 0

C60

7. Tre < 2000 g

Kh6ng 0

C60

Kh6ng 0

C60

l. Tinh trang sire khoe chua 6n dinh
2. S6t/H~ than nhiet (S6t: nhiet d<) ~
nhiet: nhiet d<)::;35,50C)

,5°C; H~ than

6c be hoac kh6ng kh6c duoc

8. Cac chong chi dinh khac, neu c6 ghi ra:

...................................................................
II. K~tlu~n:

- Du di~u

D

ki~n tiem chung ngay (Titt ca d~u KHONG co diem bitt thuong)

Loai~I Va:'c xi n ti eITI
~ ch ung
' 1"
,
an nay:
- Chong chi dinh tiem chung (Khi

.

Co diem bitt thuong

tai muc 8)

- Tarn hoan tiem chung (Khi CO bitt icy m<)tdi6m bitt thuang t~i cac mvc 1,2,3,4,5,6,7)
- D€ nghi kham sang iQc t~i b~nh vi~n:

Kh6ng

D

Co

D

D

D

+ IJY do:

.
lJ).·

nOl ........

•,
h ' ngay....
,
thang
' .....nam.....
~
glO'
..... put,

Nguai th\fC hi~n sang iQC

(ky, ghi ra hQ va ten)
8


PHULUC III
(Ban hanh kern thea Quyet dinh

s6 .......";QD-BYT ngay

... thang .... ndm 2019)

CONG HoA xA HOI CHU NGHiA vrsr
DQc l~p - T1}.'do - Hanh phuc

BV

NAM

BANG KIEM TRUaC TIEM CHUNG DOl VOl DOl TU<}NG ~ 1THANG TUOI
TAl cAc CO
TIEM CHUNG THUOC BENH VIEN

sa

.

.

..

HQ va ten tre:

Nam 0
. h ngay.............
'
sln

z.
T UOl:

Dia chi:
HQ ten b6/m~:

thaang..

nam .

Dien thoai:

Can nang:

kg

°c

Than nhiet:

I. Kham
1. S6c, phan img nang sau Ifin tiem chung truce

.
.
.

ng 0

C60

Khong 0

C60

Khong 0

C60

:s 35,50C)

Khong 0

C60

Nghe tim bfrt thuong"?"

Khong 0

C60

Nhip tho, nghe phoi bfrt thuemg***

Khong 0

C6

Tri giac bfrt thuong (li bi hoac kich thich)

Khong 0

C60

Khong 0

C60

........
. ... ...... ............................... ~
............ ...............................~

~

-.....

....................................

ng mac benh cfrPtinh hoac benh man tinh tien trien"
Dang hoac moi kSt thuc dot di€u tri corticoid li€u cao (nrong
dirong prednison >2mg/kg/ngay), h6a tri, xa tri, gammagiobulin**

S6t/H;;t than nhiet ( S6t: nhiet d{)~ 3soC; Ha than nhiet: nhiet d{)

s. Cac chong chi dinh khac, neu co ghi ra:

...............................................................................

*: Chi dinh tiem
tre co b?nh nh? (ho,
mui, lieu chily muc d(5nh? ... va khOng
**: Tn} khtmg huyit thanh viem gan B
***: Niu khCtmchuyen khoa khOng cdn xu trEclip cUu thi chi dinh liem chimg

- Kham sang IQctheo chuyen khoa:

Khong 0

C6 0,

chuyen khoa:

..

+ Ly do:

.

+ Ket qua:

.

+ KSt lu~n:

.

II. K~t lu~n:
-Du di~u ki~n tiem chung ngay CTfrtca d€u KHONG c6 di~m bfrt thuemg)
.,:_
. t'lem ch'ung I~
,
vac Xln
an nay:
LO;;tl

.

A

- Ch6ng chi dinh tiem chung (Khi CO di~m bfrt thuemg t;;tim\1c 1,S)
- T;;tmhoan tiem chung (Khi CO b~t ky m{)tdi~m b~t thuemg t;;ticac m\1C2,3,4,5,6,7)
,

lJ~ •
110l
.........

D

•,
h " ngay ... ..... thang
' ..... nam
~ .....
guy

..... put,
Nguai tht;rchi~n sang IQc
(k'), ghi ra hQ va ten)

9

D
D


PHVLVCIV
(Ban hanh kern thea Quyit dinh s6
IQD-BYT ngay

.)

CONG HoA xA HOI CHU NGHiA VI~T NAM

BV

DQc l~p - Tl}' do - H~nh phuc

BANG KIEM TRUaC TIEM CHUNG DOl VOl TRE SO SINH
T~I cAc CO
TIEM CHUNG THUOC B~NH VI~N

sa

HQ va ten tre:
Sinh

gio
Dia chi:
HQ ten bo/rn«:
Can nang:

Nam 0
ngay

thang

nam

M~ da xet nghiern HbsAg: Khong 0
I. Kham sang lee:
Cac dĐ.uhieu hien tai:
ÃÃÃÃÃÃl.ÃÃÃTiriliÃÃt;~ng sire kh6~'

C6

0

-

-

ÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃ_ÃÃ1ÃÃÃÃÃÃ

ÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃuÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃ

,

....ã...ãããããã.ãããããããããããããããããããããããããããããããããã

--_

Kh6~~ÃÃÃÃÃÃDÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃ(:6-0
!

,

2. SotlH~ than nhiet (Sot: nhiet dQ ~ 37,5 C; H~ than

!3~~i~~9~~~~

-

_...............................................................................................................................................................................................................................................................

I

0

j' .••. _ ••• _ ••••••••••••• _ ••••.•••.•••.•.....•..•

c6D
_ .•.•.•.•••••••••••••••

i

Khong_ 0

5. Btl kern hoac bo btl

I

Khong 0

6. Tu6i thai < 28 tu~n

Khong

*

Khong

8. Tre < 2000 g, me c6 HBsAg (-)
9. Cac chong chi dinh khac, neu c6 ghi r5

C6 0

f~-D

4. Da, moi khong hong

7. Tre < 34 tuan tu6i

.
.
..

°c
Am tinh 0

K~t qua: Duong tinh 0

~h~~6~···di~···
_........ .

..................................,

0

Tu6i thai khi sinh:
Dien thoai:
Than nhiet:

g

Nit

+ _..___
..___

+

o
o

.

C60
_

1

C60
C60
C60

Khong 0

C60

Khong 0

C60

* Chi ap dung voi vdc xin song giam d(jc luc
- Kham sang loc theo chuyen khoa:

Khong 0

C60,

chuyen khoa:

..

+ Ly do:

.

+ Ket qua:

..

+ .K~tluan:

.

II. K~t lu~n:
- Du di~,uki~n tiem chung, ngay (T§.tca d~u KHONG c6 di8m b§.tthuang)
. ~ xm
. t'lem
~ ch'ung l~
,
- L O~lvac
an nay:
.
- Ch6ng chi dinh tiem chung (Khi
di8m b§.tthuang t~i m\lc 9)
- T~m hoan tiem chung (Khi CO b§.tky mot di8m b§.tthuang t~i mvc 1,2,3,4,5,6,7,8)

Co

H6i..

gia

phiLt,ngay

thang

Nguai thlJc hi~n sang lQc
(ky, ghi r5 hQ va ten)
10

D
D
D

nam


. .

PHULUCV

(Ban hanh kern thea QuyJt dinh s6

TAn

sB thO' binh

IQIJ-BYT ngay

.)

thuimg hie nghi 0' tre theo cac nhom tu8i

Tu8i (nam)

Nhjp thO' (tAn sB thO' theo phut)

So sinh

40 -50

<1

30 - 40

1-2

25 -35

2-5

25 - 30

5 -12

20 -25

>12

15 - 20

(Hirong dfin dieu tri - Tap III -

11

Xu tri c§.pciru nhi khoa)


PHl) Ll)C VI
(B ~n hanh kern thea Quyet dinh s6 ....... IQD-BYT ngay .......... )

Nhjp tim binh thuong theo tu3i
Nhjp tim (tin

Tu3i (nam)

sa tim/phut)

So sinh

140 -160

<1

110 - 160

1-2

100 - 150

2-5

95 -140

5 -12

80 -120

>12

60 - 100

I

(Hu6ng d~n diSu tri - Tap III -

12

Xu tri e&pelm nhi khoa)