NGHIEN CIJU GIA TRj BACH CAU TRONG 24 GIOT DAU or BENH NHAN CHAN THE/ONG SO NAO NANG
T6M TAT
Dit vin di: Chan thuong so nao giy nen hien tuong viem ngay sau khi chan thuang xay ra. Ca thi dip dng lai phan ung viem niy qua nhieu ca chi thin kinh, thi djch. Ngoii m cdn thiy tang so lugng bach eau ngay sau khi chan thuang. Doi tugng vi phuong phip nghien cuu: 120 benh nhan chan thuong so nao ning diiu tri tai Bdnh vidn Tmng uong Hue, tudi ^18 Kit qua: 120 benh nhin, nam 104, nu 16, 18-39 tuoi cd 82 binh nhan, 40-60 tuoi cd 31 benh nhin, tren 60 tudi ed 7 bdnh nhin Nhdm Glasgow 3-6 diim co 35 bdnh nhin, nhdm benh nhin Glasgow 7-8 diim cd 85 bdnh nhin. Bach ciu a nhdm bdnh nhin Glasgow 3-6 diem li (14,95±1,17)x103 va nhdm Glasgow 6-7 diem la (12.02±1,95)x103. Kit luin: Gia tri bach eau cang cao thang diem Glasgow cing thip, tien luang eang nang.
Td khda: Chin thuang so nao. Glasgow.
SUMMARY
RESEARCH OF WHITE BLOOD CELL VALUE AT FIRST 24 HOURS IN PATIENTS WITH SEVERE TRAUMATIC BRAIN INJURY
Background: Brain injury causing inflammation immediately after the injury. The body msponsed to this inflammation thmugh neumi hormon mechanisms.
Another way. tmumatlc bmin injury patients have elevated white blood cell count immediately. Subjects and methods: 120 patients with severe traumatic bmin injury tmated at Hue Central Hospital, age £ 18. Results: 120 patients, 104 males, 16 females, 18-39 years old: 82 patients. 31 patients 40-60 years old, >60 years old: 7 patients. Gmup Glasgow 3-6 points: 35 patients, Glasgow 7-8 points: 85 patients. I/Wjfe blood cell at Glasgow group 3-6 points: (14.95 ± 117)x103 and Glasgow group 7-8 points: (1202 ± 1.95)x103. Conclusion: In patients with tmumatlc bmin injury, the higher of white blood cells is the low Glasgow Coma Scale. High value of white blood cells IS the worse pnognosis.
Keywords: Brain injury, Glasgow.
DAT V A N Dt
Chin thuang so nao gdy nfin hifin tupng viem ngay sau khi chan thuang xay ra. Ca the dap ung lai phan dng viem nay qua nhieu ca ehe than kinh, thd dieh.
Ngoai su tang tiet Cortisol, glucose, cac cytokine vifim nhu interleukin-6, tumor necrosis factor-o .. eo the cfin phan ung b i n g each tang sd luong bach cau ngay sau khi c h i n thuang.
O nude ngoai da cd nhieu tac gia nghifin edu van de ndy nhung d Viet Nam dang con d mdc khiem tdn
Ctiung tdi nghifin cuu van de nay nham 2 muc tieu Xie dmh gii tri bach cau d cac bdnh nhin chin thuong so nao nang
Tim moi lien quan giua bach cau v&i do ning cda chan thuong so nao qua thang diim Glasgow.
N G U Y I N VIET QUANG, NGUYEN V i e t QUANG HI^N D 6 1 TU'ONG VA PHU'aNG PHAP NGHIEN CLPU 1. Dfii tyang
- 120 benh nhdn bj c h i n thuang sp ndo ndng nhap vifin dieu tn tgi Khoa Gay mg Hdi sdc A va Khoa Hdi sue cap cdu Bfinh vien Tmng uang Hud.
- Thdi gian nghifin edu t u 7/2012 den 12/2013.
1.1. Tieu chuan chgn benh -Tudi t d 18 trd len.
- Bi ehan thuang so n i o ndng khdng hodc chua CO chl dinh phfiu thuat.
- Glasgow <8 diem.
1.2. Tieu ehuan loai trd - Benh nhan < 18 tudi
- Bj thuong tdn nao nhung khdng do chan thuong (u nao, TBMMN).
- Bj c h i n thuang sp nao nhung cd Glasgow td 9 den 15 diem.
- Bi ehan thuang sp nao ndng kfim theo nhung thuang tdn tram trpng khde nhu ddp phdi, vd tang ddc, choang nang.
2. P h u a n g phdp nghien c d u
Mfi ta cdt ngang ed theo doi vd ddnh gid kdt quS dieu tri
K ^ T Q U A
1. Tudi, g i d i , chi s d sdng c d n (mgch, huyfit dp, t i n sfi t h d ) luc nhdp vifin
1.1. Die diem ve tuoi Bang 1 D i e diem vd tudi bfinh nhfin Tu6i
18-39 40-60
>60 n 82 31 07
68,33
%
25,83 5,84
P
<0,05 Nhan xet, Cac benh nhan c h i n thuang sq nao nfing, tudi < 40 chiem da so.
1.2. Dac diem gidi Banq 2, Ddc diem ve qidi Q\a\
Nam Nil'
n 104
16
86,66
%
13,34 P
Nhan xet: Benh nhdn c h i n thuong sp nao ndng, nam gidi chiem 86,66%, nhidu han h i n nu gidi. Sy khac bifit cd ]/ nghTa thdng ke p<0,05.
1.3. Chi so song cdn
Bang 3 Chi sd sdng cdn theo tudi va gidi Mgch
Ian/phut HATB Hg)
TST l^n/phiJI.
Nhdn xfit: Cdc chi sd sdng cdn theo tudi vd gidi khdc nhau khdng ed y nghTa thdng kg, p>0,05
Y HOC THl/C HANH (905) - s 6 2/2014
Bdng 4. Chl sd sdng cdn theo thd loai c h i n ttiugng SQ ndo
M ^ t g NMC
^DMC Miu tu trong nao
Mdutv ph6i h9p (NMCDMC&TN)
P
M^ch linkihlit
84±16 85129 87±21 93±29
>0.05 HATB (mmHg)
70±11 69±17 61it20 58±13
>0,05 TST iSn/phut
27±12 26±13 28±10 29±07
>0,05 Nh$n xfit: Cdc chi sd sdng cdn theo thd loai c h i n thuang sp nao khdc nhau khdng cd y* nghla thdng kg, p>0,05.
Bang 5. Ch? sd sdng cdn theo thang didm Glasgow
Glasgow 3-6 difim Glasgow 7-8 dilm
Mgch HATB TST lan/phOt (mmHg) lin/phCt
>0,05 I >D,05 I >0,05 Nhdn xgt: Cdc chl sd sdng cdn theo thang d i i m Glasgow khac nhau khdng cd 9 nghTa thdng kg, p>0,05.
2. D$c d i i m vd t h u v n g tdn Bing 6. Ddc didm v i thuang tdn
Thuong tdn Mdu tg NMC Mdu tg DMC On'-"' Mdu tg trong nSo Mdu tg phdi hop (NMCDMC &TN)
Nhdn xfiLBgnh nhdn c h i n thuang sp ndo n$ng, mdu tM NMC chidm tl Id cao n h i t , 52,50%.
' i D$c didm vd Glasgow liic nhdp vien Bing 7. Ddc didm vd Glasgow
29,16
Nhdn x6t: Bdnh nhdn c h i n thuang sp ndo cd Glasgovi/ 7-8 didm c h i i m 70,84%, nhidu hon h i n nhdm cfi Glasgow 3-6 ^ e m . Sg khdc bigt cd y nghTa thdng kfi p<o,05.
4. Cdng t h d c bgch c i u liJc nh$p vien 4.1. Cdng thdv b^ch ciu
Bdng 8. Cfing thdc bgch c i u theo tudi, gidi BCfxiOS)
>60tLi6i I 12,33±1,41 Nhdn xdt: Bgch c i u theo tudi vd gidi \ I<li6ng c6 ^ nghla t h i n g ke, p>0,05
Bing 9. Ceng thCpc b?ch cSu theo thmrng so ndo
Miu tu NMC Miu tu OMC MAu tu trong nao MiutuNMC.DMC&TN
BC(X103) 12,02±1,95 12.1211.37 11.9011.10 12.2212.07
t h l ChSn 0
>0.05
Nhin xdt: Bgch c i u theo thd logi c h i n ndo khdc nhau khfing cd y nghla thdng kg,
thuang sp p>0,05.
Bang 10. Cdng thO\: bach cdu theo thang d i l m Giasqow
Glasgow 3 ^ diem Glasgow 7.8 di^m
BC(x103) 14,9511,17 12,0211,95
0 0 , 0 5 Nhdn xet: Bgch c i u nhdm bfinh nhdn cd thang didm Glasgow 3-6 didm cao han h i n nhdm b$nh nhan Glasgow 7-8 didm, p<0,05.
BAN LUAN
Mdi lifin quan gida dp luc ndi sp vdi cong thdc bgch c i u
Trong nghifin cdu cua chung tfii, t i t ca 120 bgnh nhdn c h i n thuang sp nSo ngng ddu dupc kiem tra cfing thdc mdu khi nhdp vign. Sd iug^g hdng c i u cua cac bgnh nhan cd gidm. Nguyen nhfin do mat mdu sau klii c h i n thuong, mfit sd bfinh nhdn m i t mdu r i t nhiiu vl cd thuang tdn phdi hpp nhu kfim theo gay xuang diii hoac v d xuang chdu... Mfit sd bfinh nhdn sau md do m i t mdu trong md nhidu mdc d i u cd chuydn mdu nhung v i n giam hdng c i u .
Di,ra vdo cfing thdc:
Ap luc tudi mdu ndo = Huyet dp tnjng binh - Ap
\up ndi sp
Vdy khi dp luc ndi sp tdng cao thl dp luc tudi mdu ndo gidm xudng se tgo nen mdt vdng l u i n qudn gay phii ndo [3]
Vd ly thuyet khi m i t mdu nhidu thl se gdy hg huydt dp, giam ap li,rc tudi mau nao sg gdy phO ndo vd tdng ap luc nfii sp, da sd b$nh nhdn cd d i u higu thidu mdu thi dugc chuydn mdu ngay [9], Do vdy trfin thye td phu ndo ndng gdy tdng dp lpc nfii sp do gidm hdng c i u trcng nghidn cdu c6a chiing tdi Id khdng cd.
Quan didm cua chung tdi tuong tg nhu cdc tdc gid Dean Chittock Zygun DA, Smith MJ vd cfing sp" Id nfin chuydn mdu sdm dd tdng cudng eung c i p oxy chotdbaondo[1],[4].
Rifing vd bgch c i u , theo cdc tdc gid HartI R, Medary MB, Rovlias vd cdng su, c h i n thuang sp ndo Idm tdng tidt catecholamine vd Cortisol trong mdu, catecholamine gdy phfing thich bgch c i u tmng tinh vd corticosteroids ldm giam s u di ra khoi dfing t u i n hoan cCia bgch c i u trung tinh [7], Dap dng giai dogn c i p tinh bgch c i u tdng cao vd ddy cOng la ydu td c h i n doan vi tifin lupng d cdc bgnh nhdn c h i n thuang sp ndo [6].
Cdc tde gia ndy dd nghifin cdu trfin 624 bdnh nhdn c h i n thuang sp ndo chia ldm 3 nhdm: Ndng, trung blnh vd nhg. K i t qua cho t h i y c h i n thuang sp nao cdng ndng-thi bgch c i u cdng cao, ngodi ra bgch e i u cdn lifin quan d i n thang d i i m Glasgow [8],[10],
Nghifin cdu cua chimg tfii tuong t u vdi cde tdc gia ndy. Bdnh c h i n thuang sp nao cdng ndng, sd lupng bgch e i u cdng tdng.
KtT LUAN
Bgch c i u theo tudi vd gidi khdc nhau khfing cfi y nghTa thdng ke, p>0,05.
Bgch eau theo thd logi c h i n thuang sp ndo khdc nhau khdng cfi y nghTa thdng kg, p>0,05.
Bgch c i u nhdm b§nh nhdn cd thang d i i m
Y Hpc THUC HANH (905) - S6 2/2014
Glasgow 3-6 ffidm cao han han nhdm bgnh nhan Glasgow 7-8 didm, p<0,05.
Nhu vay cd thd ndi d cac benh nhan c h i n thuang sp nao nang, thang didm Glasgow edng t h i p thl bach cau cang cao, tien lupng nang.
T A I U | U THAM KHAO
1. Bednar MM, Gross CE, Hovrard DB, Lynn M:
Neutrophil activation in acute human central nen/ous system injury. Neurol Res 19:588-592, 2007.
2. Boggs DR: The kinetics of neutrophilic leukocytes in health and in disease. Semins Hemat 4:359-386, 2007.
3. Capps JA: Astudy of the blood i " general paralysis. Am J Med, Sci 3:650-682, 2006r
4. Clifton GL, Ziegler MG, Grossman RG: Circulating catecholamines and sympathetic activity after head injury. Neurosurgery 8:10-14,2011, 214.
5. Czigner A, Mihaly A, Farkas 0, Buki A, Krisztin- Peva B, Dobo E, Barzo P: Kinetics of the cellular immune response following dosed head injury. Acta Neurochir (Wien) 149 281-289, 2007.
6. Dale DC: Leukocytosis, leukopenia, and eosinophilia. In: Harrison's, ed. Principles of Intemal Medicine. NewYork: McGraw-Hill, Inc., 1991:359-362.
7. Dietridi WD, Chatzipanteli K, Vitarbo E, Wada K, Kinoshita K: The role of inflammatory processes in the^
pathophysiology and treatment of brain and spinal cord trauma. Acta Neurochir SuppI 89: 69-74, 2004.
8. Fee D, Crumbaugh A, Jacques T, Herdrich B, Seweil D. Auerbach D, Piaskowski S, Hart MN, Sandor M, Fabry Z: Activated/effeetor CD4+ T ceils exacerbate acute damage in the central nervous system following traumatic injury. J Neuroimmunol 136: 54-66, 2003.
9. Gourin CG, Shackford SR.: Production of tumor necrosis factor-alpha and interleukin-l beta by human cerebral microvascular endothelium after percussive trauma. J Trauma 42:1101-1107, 2010.
10. Hallznbeck J, Dutka A, Tanishima T, Kochanek P, Kumaroo K, Thompson C, Obrenovitch T, Contizras T: Polymorphonuclear leucocyte accumulation in brain regions with low blood flow during the early post- ischemic period. Stroke 17: 246-253, 2006.
DANH GIA TAG DUNG GIAM DAU DlT PHONG SAU MD D A N G PHimNG PHAP TIEM MORPHIN TUY SONG
BUI NGOC CHINH, BUI DINH Ll/ONG, N G U Y I N DUY CUdNG Trudng Dai hgc YDugc Thai Binh
TOM T A T
Dinh gii tic dung giim dau sau md ting btjng trdn bing phuong phip tidm morphin tdy sdng theo 2 dch tidm tmdc vi tiem sau mo, cho 60 benh nhin
<^jgc chia thinh 2 nhdm: Nhdm tiim tnr&c (Nhdm T):
Tidm morphin tdy sdng ngay trudc md; Nhdm tiem sau (Nhdm S): Tidm morphin tdy sdng sau mo. Kit qui nhu sau:
- Thdi gian tic dtjng giam dau cda nhdm tiim trudc li 8,07 ± 3,75 kio dai han so vdi nhdm tiem sau li 5,76 ± 0,96 gid.
- Thdi gian yeu cau giim dau diu tiin sau mi cda nhdm tiem trudc li 4,59 ± 3.97 liu hon so v&i nhdm tiem sau la 0,58 ± 0,26 gid
- Lugng morphine dung chuin dd cda nhdm tru&c li 3.27 ± 3,30 thip han so v&i nhdm sau li 7,29 ± 3.38 mg.
- Lugng morphine tidu thu sau 12 gi& vi 24 gid d nhdm tiem tmdc li 4,66 ± 2,24 mg va 9,12 ± 3,21 mg thip han so v&i nhdm tiem sau li 6,67 ± 2,03 mg vi 12,76 ± 2,96 mg
Tukhda: Giam dau sau mo; Morphin; Tdy sing.
SUMMARY
EVALUATING POSTOPERATIVE ANALGESIA IN SPINAL MORPHINE INJECTION METHOD Evaluating postoperative analgesia in abdominal floor with spinal morphine injection method under 2 pmvious injections and injections after surgery, 60 patients wem divided into 2 gmups: Gmup T: Spinal
morphine Injection Immediately befom surgery. Gmup S: Parenteral morphine after spinal surgery. The results am as follows:
- Dumtion of analgesic effect of group was 8.07 ± 3.75 befom injection lasted later than the injection gmup was 5.76 ± 0.96 hours.
- The amount of morphine used previous group titmtion of 3.27 ± 3.30 is lower than the latter group was 7.29 ± 3.38 mg.
- The amount of morphine consumption after 12 h and 24 h before injection group was 4.66 ± 2.24 and 9.12 ± 3.21 mg mg lower than after Injection gmup was 6.67 ± 2.03 mg and 12.76 ± 2.96 mg.
Keywords: Postoperative analgesia; Morphine;
Spinal Cord.
DAT V A N Dt
Dau sau md la mfit trong nhung phien ngn chinh ddi vdi bfinh nhdn, gay ra nhidu bidn loan d cdc co quan nhu hd hdp, t u i n hodn, nfii tidt. Dau gdy dc chi mifin djch, ldm tdng qud trinh vifim, kfio ddi thdi gian n i m vifin. Hdu qua cua dau sau md dnh hudng rit ldn den s u hdi phuc sue khde vd tdm ly cua b$(lh nhdn. Kidm sodt dau sau md Id v i n dd md cdc nhd gay me hoi sde, ngogi khoa vd san khoa ddivd dang quan tdm tdi. Chung tfii tidn hdnh nghifin cuu ndy vdi muc tifiu:
Ddnh gid tdc dyng giam dau sau md t i n g bgng trfin cua phuang phdp tigm morphin tuy sdng theo 2 cdeh tifim trudc vd tigm sau md.
Y HOC THirc HANH (905) - s 6 2/29M