VIETNAM MEDICAL JOURNAL N'l - FEBRUARY - 2017
IV. K I T LUAN
Oieu trj nhoi mau nao cap co sir dung Cytoflavin ap dung tai benh vi$n Hthi nghj Da khoa Nghe An bu'de dau cho nhuhg ket qua kha quan vdi mu'c dp cai thien ve lam sang tot va cd dp an toan cao vdi t i tac dung khong mong muon thap va it gay bien dpng cac thong sd can lam sang.
TAI LIEU THAM KHAO
1 . Nguyen Van Thong va cong su* (2012). Nhan xet dac diem tfnh chat cd cau benh tai trung tam dot quy vien 108 td thang 1/2003 den 6/2012.
Tap chf Y dutfc iam sang 108, tap 7, so dac biet thang 10/2012, tr. 10-22.
2. Phan V i | t Nga va Nguyen T h | Thanh Nhan (2012). Nghien cirtj dac diem lam sang, can l§m sang va yeu to tien lu'dng d benh nhan dot quy nhoi mau nao co hoi chiihg chuyen hoa. Tap dil Y dddc lam sang 108, tap 7, so d3c biet thang 10/2012, tr. 221-226.
3. Nguyen Minh H i | n va cong su" (2012). Nghigti cuU hieu qua phac d6 dieu trj kS: hdp Thi/ huygt ninh v ^ y hoc hiai dai d benh nhan dot quy nha'Mi ban rau dai nao. De ^1 cap cdsd, Binh v^lOS, V 4. Rumyantseva SA e t al (2011). Effects of Early
Correcb'on of Energy and Free Radial Homeostasis on the Clinical and Morphological Picture of Cerebral Infarction. Neurosdenoefand Behavioral Ph^oiogy, 41 (8), pp. 843.
5. Fedin AX, Rumyantseva SA and PJradov MA (2006). Mutti-centered piacebo-controled clinical trial of cytoflavin solution for intravenous use In patients with consequences of acute ischemic cerebrovascular accident in the early recovery period. Vrach, 13 (8), pp. 52-58.
o. Shestakov W e t al (2011). Qinical efficacy of cytoflavin in the combined treatment of patients during acute phase of ischemic stroke. Klin Med (Mask), 89 (1), pp. 38-40.
7. R(Hnantsov MG and Kovalenko AL (2005). Double- blinded placdxHxvitrolled multi<£nb9ed dinial trial of cyteflavin In patients with acute cerebrovasailar acdderft (brain infatction] in the fir^ 3 wed<s c^ the disease. Basecffnkslt^ls, 5, pp. 29-33.
DANH GIA HIEU QUA DIEU TRI VIEM LOET GIAC MAC NANG DO NAM BANG PHOI HCTP TIEM AMPHOTERICIN B v A o
TIEN PHONG VA N H 6 MAT NATAMYCIN 5 %
T 6 M TAT
M^c tieu. Danh gia hieu qua ciia viec liem amphotericin B tien phdng phoi hdp vdi nho tai chS Natamycin 5% trong dieu trj nhuhg trudng hdp viem lo6t giac mac nSng khong dap ijfng vdi dilu t i i khong can thiep. Phu'dng phSp nghien cihr. 28 mat viim loet giac mac do nam khong dap uYig vdi thuoc nho tai cho natamycin 5% va thuoc uong itraconazole duWc chi djnh dem tien phong amphotericin B lieu 5ug/0,lml. Kit guar. 20 mSt dap dnq vdi lieu phap diSu tn cua diiing toi. Thdi gian het mil tieii phong trung binh la 10 ±7.3 ngay. Thdi gian bi^u mo hoa o loet trung binh la 22,7± 9,3 ngay. Tinh trang thi lu'c duWc cai thien ro ret sau thdi gian dilu trj. Co 8 mat that bai phai thay doi lieu phap i^eu trj la muc noi nhan. Ket lu$n: Tiem tien phong amphoteridn B di/dc xem nhU la mot lieu phap dieu tri bo sung cd hi$u qua cho nhOhg truing hop viem loet giac mae nSng da de khang vdi li$u phdp dieu bi bvyen tiidng khdng can ffiiep.
Tit Idioa: viem loet giac mac do nam ning, tiem tien phdng amphotericin B, natarhycin S%.
* Binh viin MSt Da Ning
Chju trach nhiem chinh: Nguyen QuocDat Email; [email protected] Ngay nh|n bai: 28.11.2016 Ngay phan bien khoa hoc: 4.01.2017 Ngay duyet bii: 16.01.2017
Nguyen Quoc Dat*
S U M M A R Y
EVALUAHNG THE EFFECT OF INTRACAMERAL A M P H O T E R i a N B COMBINED WTTH TOPICAL N A T A M Y Q N 5 % I N MANAGEMEm-OF DEEP
FUNGAL KERATTTIS
Purpose: to evaluate the efficacy and safety rf.
intracameral amphotericin B in the management rf severe fungal keratitis not responding to conventional, antifungal therapy. Method: 28 eyes with fungal keratitis that did not respond to initial treatment with topical Natamydn 5 % and oral Itraconazole were treated with up to 5 intracameral injections of 5ug of amphoteridn B. Result: 20/28 eyes (71,43%) responded to amphoteridn B therapy. The mean time for disappearance of hypopyon is 10 ±7.3 days and for re epith^ialization of ulcer is 22,7± 9,3 days. The visual acuity is improved deariy. Bghts eyes progressetl?
to evisceration. Condi^on: intracameral amphcter^
B may be an effective adjunctive of fungal keratitis unresponsive to convemtional antifugal tiierapy.
Key words: fungal keratitis, intracameral amphoteridn B, topical natamydn 5%
I.OATVXNOI
Viem loet giac mac (VLGM) la mpt benh nhiem trung thu^cfrig gap d nu^c ta^ trong do, viem loet giac mac do nam chiem ty le eao nhat (50,8% theo nghien eil\j cua vien Mat trung
154
TAP CHl Y HOC Vlgr NAM TAP 451 - THANG 2 - S01 - 2017
ddng trong vong 10 nam tif 1998-2007) [7], [2].
Viem loet giac mac do nam thu'cing tien trien nang, gay nhieu bien chuhg nang ne, anh hu&ng dang ke den cupe song cua ngu'cfi benh. I^ong giong vi khuan, nam la tac nhan duy nhat eo kha nang di xuyen qua I6p mang Deseemet con nguyen ven, va di vao tien phong gay ra mil tien phong. bo do, mu tien phong trong nhihig tru'cfng hdp viem loet do nam thu'dng bao gom ca tac nhan nam gay benh. Mac du hien nay da CO nhieu ioai thuoc chong nam khac nhau tren thj trudng nhuhg van de dieu trj viem loet giac mac do nam van la mpt thach thut, nhat la khi
\riem loet giae mac da co kem theo mu bBi phong, do pho khang nam hep, tinh tiiam qua giae mac thap, va doc b'nh cao. Vi vay, thdi gian dieu trj viem loet giac mae do nam thu'dng keo dai [2].
Natemyein 5% du'dc xem nhu* la lu^ chpn dau tay de dieu trj nam spi. Tuy nhien, van de de khang vdi thuoc va kha nang tham kem qua giac mac i ^ lam cho van de d i u tn gap nhieu kho khan, dac biet ia nhuhg trudng hpp nhiem nam nhu mo sau va cd mu tien phdng. Ben canh do, nguon cung cap thuoc khong on djnh, co nhij'ng thdi diem thuoc khong co d thj tru'dng. Do do, amphotericin 6 la 1 lieu phap thay the day hiJa hen [4].
Amphoteridn B la nhdm thuoc polyene co hieu qua den vdi nhieu chiing loai nam. No co the diJng theo du'dng toan than, nho tai cho. Nd cijng du'dc xem nhu' la an toan de tiem vao npi nhan neu ehi djnh vdi lieu lu'dng thidi hpp.
Vi vay, de cd them ida chpn thuoc dieu trj viem loet giac mac do nam trong dieu kien thu'c te aJa nu'dc ta hien nay, chung toi tien hanh nghien cil\j de tai vdi muc dich danh gia hieu qua cOa phuting phap tiem amphoteridn 5 vao tien phdng de dieu trj nhuhg tru'dng hcfp nhiem nam da de khang vdi phu'dng phap ^ u trj biiyen thong la nhd thuoc tai mat.
11. D 6 | T U V N G vk PHU'CTNG PHAP NGHIEN COU
Nghien cu\j du^e thifc hien tren 28 benh nhan dutfc chan doan viem loet giac mac sau dutic dieu tri tai khoa ket giac mac Benh vien Mat Da Nang'tCT thang 2/2015 den thang 6/2016
2.1. Tieu chuan chon benh:
- Du'dc ehan doan xac djnh la viem loet giae mac do nam bang soi tuoi chat nao 6 toet.
- 0 loet sau, cd mu fen phdng
- Da dieu trj bang nhd tai cho Natamycin 5%, kem vdi thudc udng itraconazole 0,lg x 2 viai/l ngay trong 1-2 tuan, tiiy mii'c dp lam sang, nhuhg ttnh Uang mu tien phdng khong
giam va 6 loet co xu hu'dng lan rpng hoac tham nhiem sau hdn.
2.2. Phu'<Aig phap nghien cuti: nghien culi du'dc tien hanh theo phuUng phap nghien cu\j tien cdu. Benh nhan vao vien du'dc kham theo qui trinh thu'dng qui, t)ao gdm hdi benh sd, tien sir, do thj life va Idiam du'di sinh hien vi.
- Nhupm Fluoureseeln de danh gia mu'c dp ton thu'dng be mat bieu mo
- Banh gia mifc dp tham nhiem nhu mo - Danh gia mifc dp mu ti@n phdng - Danh gia cac yeu to khac nhu' mong mat, thuy tinh the...
Tif do, danh gia mifc dp lam sang nhe, vii^
hoac nang
Sau khi da xac dinh nguyen nhan \nem loet giac mac do nam, tien hanh dieu trj theo lieu trinh nhu" sau:
- Itraconazole 0,lg x 2 vien/ngay udng 1 lan sau an no sang
- Natamycin 5% x 01 Ip, nhd 6-8 lan/ngay - Atropin 1% nhd 1 lan/ngay
Sau 1 tuan se ghi nhan Iai tinh trang lam sang, neu khong dap ufng dieu trj, loet cd nguy cd lan rpng, tham nhiem sau, mu tien phdng khdng ed dau hieu thuyen giam, benh nhan se du'de chi djnh thao mu tien phdng pha hpp vdi tiem amphoteridn B vao b'en phong. Quy trinh tiem Amphotericin B vao tien phong nhu' sau:
- Pha thuoc Amphoteridn B Smicrog/0,lml:
- Gay te c^nh nhan rau - Sat trimg bang povidin 5%
- Dat vanh mi
- Md hen phdng tai vj tn thai dudng - Hiit mil tien phdng
- Btfm hdi tai tao tien phdng
- Bdm 0,1m! dung djch pha bang thif 3 vao tien phdng
- Bdm phD tai vj tri md tien phong. Ket thiic phau thuat
2.3. Xiir \^ so lieu : ket qua du'de xd ly theo ehu'dng trinh SPSS 16.0
III.Kfr QUA
3.1. Dac di^m cua benh nhan nghien dhi:
Trong thdi gian nghien cutj td 2/2015 den 6/2016, chiing toi d^ tien hanh kham va dieu tn cho 28 benh nhan VLGM do nam cd mil tien phdng, kh6ng_^dap ifng vdi dieu h-j Natamydn 5% nhd tai eho, trong dd:
- NanichioTi 42,86% (12), nadiiaii 57,14% (17) - Dp tuo^ trung binh la 55+/-12,7, tuoi nhd nhat la 30 tuoi, tuoi Idn nhat la 79 tuoi
VIETNAM MEDICAL JOURNAL N°1 - FEBRUARY - 2017 - Phan Idn benh nhan la nong dan (19),
chiem 67,86%.
- Ve yeu to thuan ldi gay benh, cd den 13 benh nhan (46,43%) tim thay yeu to thuan ldi gay benh,
Bang 3.1: Aftfe do lam sang cua benh nhan trorig nghien cuVi
ehii yeu la do chan timing vc& tac nhan la dj vat thut vat Khoang 28,57% (8 mat) khong t6 tiai sd, Widng tim thay yeu to thuan ldi gay benh.
- Mu'c dp lam sang:
Mu'c do lim sang Nhe vera Nanq Tiinq
So bgnh nhan 0 10 18 28
Vo 0 35,71 64,29 100
Trong 28 benh nhan trong nghien diu cua chung tfii, da so la benh nhan nang chiem tdi 64,29%, mu'c do vira chiem 35,71%, I<h6ng co benh nhan nhe.
- 100% benh nhan deu co mu tien phong vao th&i diem bat ^ u iieu trinh dieu tri.
3.2. Ket qiia dieu til
3.2.1. Banh gia ket qua dieu til Chung Bang 3.2: Ket tjui dieu trj diung
Ketqua So benh nhan
Tot 17,86
Trunc^ bmh 15 53,57
Xau 28,57
, Tong I 28 I 100 , Trong so 28 bgnh nnan du'dc tiem Amphotericin B, co 20 mat (71,43%) dap utig vdi dieu tri, trong do CO 5 b4nh nhan cho Icet qua tot, 15 benh nhan dat l<et qua trung bmh. Co 8 mat dat Icet qua xau v^ phai chuyen phac do dieu tri la miic npi nhan. NhiiYig tru'dng hdp do dudc xem nhu' la that bai trong dieu trj.
3.2.2. Thdi gian het mu t^n f^ng Bing 3.3: Thdi gian het mu tien phonq
Thdi gian 1-3 ni !gas_ So benh nhan
%
10>2 tuan 25
Tong 20
Thdi gian het mu tien phong trung binh trong nghien cull cua chung toi la 10 +-7.3 ngay. Thcfi gian nay dudc tmh tu* thdi diem mui tiem cuoi cung den khi mu tien phong bien mSt.
3.2.3. Thdiglan bleu mo hoa oloet
Bing 3.4: Thdiglan bi&i md hda o loet hoin toin Thdi gian~
<1 tuan 1-2 tuan
;°"g..
So benh nhan Vo
TWi gian trung bmh bieu mo hoa o loet hoan toan trong nghien cUU cua chung toi la 22,7+/- 9,3. Thcli gian nay dUdc h'nh tir Ichl benh nhan vao vien cho den Ichi o loet da duBc bieu mo hoa hoan toan.
3.2.4. So mui tiem tien phong du'dc thifc hien Bing 3.4: So mSi dim tfin phdng
S6 miii tiem
K a qua dieu tri 1-3 mui Tong Trun^ bmh
Xau
c P ^
Trong so benh nhan du'dc diSu tri Ichoi theo phac do cijia chiing toi, hau het deu chi nhan <3 miii Hem flen ghong (chiem 90%). Con vdi nhthig benh nhan du'dc tiem >3 mui, chi co 2 benh nhan dip ftig vdi dieu bi, cdn tdi 6 ben nhan dUdc coi nhir la that bai dieu tri.
TAP CHi Y HOC VigT HAM TAP 451 - THANG 2 - SO 1 - 2017 3.2.5. Danh gia ket qua dieu tri sau 1 thang
Tai thdi diem danh gia sau 1 thang, trong so 0 b4nh nhan khdi han, ed 9 benh nhan tao seo au gom: seo rong tdi vimg ciiu bien, seo day, 6 tan mach, chiSm 60%. Chi khoang 5 benh tian tao seo mdng tai vj trf trung tam, con 3 enh nhan cd seo dinh rhSng mat. Cd 3 benh ilian khong quay lai tai kham, nhuhg l^t qua tai ham ciia 3 benh nhan nay tai thdi diem 1 tuan leu tot, 1 ea bieu mo hda lioan toan, tao seo ung trung tam, seo day, 2 mat dang dan diftfe lieu mo hda, dang tao seo mdng vung ehu bien.
3.2:6. Bien chu'ng sau tiem tien phong Nghien cuXi eua ehiing tdi ghi nhan hau het lenh nhan deu cd cam giac dau tifc mat sau iem va 7 tru'dng hdp cd phan tfng tien phdng hoang qua nhuhg ca 2 trieu chifng tren deu tif lieu chinh sau 24h. Khdng cd tru'dng hdp nhiem rung tiitf phat hay viem mii noi nhan sau tiem ien phong trong vdng 3 ngay sau tiem.
L T J I thdi diem tham kham sau 1 thang, ghi
^ ^ trudng hdp due thuy tinh the.
IV. BAN LUJSkN
Viem loet giac mac la nguyen nhan chinh 3ay nen mil mat d nhffng vijng ndng thdn, ndi na khi hau ludn nang ndng va am u'dt. Mac dii i c tiiuoc dieu trj nam da du'dc cai tien rat nhieu /dl SLf phat trien eiia nhffng loai thudc khang iam pho rpng, nhuhg ty le cac tru'dng htfp ihiem nam nang do nhffng Ioai nam khang thuoc cung gia tang gan day. Do dd, viec lifa chon loai thuoc dieu tn nam thich htfp van cdn la upt thach thffc. Hieu qua lam sang ciia thuoc khang nam phu thuoc phan Idn vao ndng do tap trung cua thuoe tai md dich, pho hoat dong va miit dp an toan.
Natamycin tff lau da dffde xem nhff la lu^
dipn dau tay de dteu trj viem loet giac mac do nam sdi. Tuy nhien, tren thj tru'dng hien nay chi CO che pham natemyein dung nhd mat tai chS, va nhutfc diem eiia thuoe la tham qua giac m?c rat kem sau khi dfftfc nhd tai cho.
Ngu^c Iai vdi Natamycin, Amphotericin B cd the du'dc ehi djnh dung theo nhilu dffdng khae nhau bao gom: dffdng toan than, tiem dffdi ket mac, nhd tai cho, tiSm vao buong djeh kinh va hem nhu mo va tiem tien phdng. Dffdng tiem Bnh madi ft dfftfc chi djnh vi nong do tap trung tai mat thap va nhieu tdic dung phu, dac biet la doc than kinh. Tiem dffdi ket mac cd the gay ra tinh b^ng viem keo dai quanh nhan (^u, loet bieu mo, va hoai tff tai vj tri tiem. Dffdng dimg
tai cho vdi nong do 0,15 % cho ket qua dieu trj khang nam tot tren be mat nhffng tham kem qua Iffdp bieu mo nguyen ven.
Amphoterincin B cdn ed the dffdc chi djnh tiem tien phdng. Kaushik va cong sff la nhffng ngffdi dau tien danh gia hieu qua tiem thudc khang nam tien phdng de dieu trj viem loet giac mac sau do nam. Trong nghien cifu ciia chiing tdi, chung .toi dting thudc amphotericin B tiSm tien phdng vdi nong dp 5ug/0,lml, giong vdi nong dp cua nhieu nghien cffu trffdc dd nhff eiia Kuriakose va cdng sff, hay ctia Namarata Sharma va epng sff[2],[43. Lieu dimg tff 5ug den lOug dffdc cho la an toan va hieu qua de tiem tien phdng hay tiem vao buong djch kinh theo nhieu nghien cifu trffdc dd.
Trong 28 benh nhan dfftfc dieu trj theo phac do nghien culi, ty le tien trien khdi benh la 71,43%, va cd 8 mat (chiem 28,57%) that bai phai chuyen phac do dlBu trj qua muc npi nhan.
Ty le khdi nay cua chiing tdi tffdng dffdng vdi nghien cifu eua tae gia Sharma va epng sff (73,3% d nhdm tiem amphotericin B tien phdng phdi hdp vdi rifa mii tien phdng va nhd natamycin 5 % tai cho) [4]. Nhffng Iai thap hdn hau het cac nghien cifu cua cac tac gia trffde dd cung nghien cifu ve hieu qua dieu trj eiia amphotericin B tiem tiSn phdng nhff Yoon va epng sff (2007), hay lac gia Salfiye Yilmaz va cdng sff (2005) [3], [5]. Oieu nay cd the la do ty le benh nhan nang trong nghien cifu ciia chung toi chlem ty' le cao, hau het benh nhan den kham va dieu tri khi tinh trang benh da nang hoac da dffdc dieu trj bang cac phac dd dieu trj khac trffdc dd nhffng khdng dap ffng. Mot nhffdc diem nffa trong nghien cffu cua chung tdi eung einh hffdng den ket qua dieu trj la chiing toi khong phan lap dfftfc danh tinh ciia tae nhan nam gay viem loet.
Neu so v ^ cae ket qua nghien eihj hieu qua dieu tri vi§m lo^t giae mae eOa Amphotericin B theo nhffng dffdng dung khae nhau nhff tac gia Thai Le Na (2006) nghien cifu ve amphotericin B 0,15% tra mat phoi htfp vdi Itraconazole toan than (81,6%) hay nghien cifu ciia tae gia Doan Thiiy Hda (2010) nghien cifu ve tiem Amphotericin B nhu md giae mac phoi hdp vdi Itraconazole toan than thi ket qua cua chiing tdi cung thap htfn[3], [5]. Dieu nay cung ed th^ la do trong mau nghien cifu ciia chiing tdi khong cd trffdng htfp benh nhan nhe, cdn benh nhan nang chiem ty le cao.
157
VIETNAM MEDICAL JOURHAL N*^ -FEBRUARY-2017 Thdi gian mii tien phdng bien mat trong
nghien cifu ciia chung tdi khd cd the so sanh vdi cac nghien effu khae tren the gidi vi chiing tdi ti'nh thdi gian mu tien phdng bien mat tff thdi diem mui tiem eucu ding ma chiing toi thffc hien tren benh nhan, cdn nhffng tac gia khae nhff Yoon hay Shamar lai ti'nh ke tff thdi gian bat dau xuat hien mii tien phdng. Cdn vdi thdi gian bleu md hda hoan toan, thdi gian trong nghien cffu cua chdng tdi dai hdn cac nghien cffu khae nhff nghien cffli ciia Yoon va rang sff la 19,8 ngay+/- 10,4; hay tae gia Yishao va cong sff (2010) la 20,2 +/-10,6 [2], [6]. Dieu nay ngoai ly do cd den 64,29% benh nhan trong nghien ciili ciia chung tdi ia benh nhan nang, khdng cd benh nhan nhe tht them ly do khach quan ia benh nhan nam thffdng nam dieu trj lau dai vdi ganh nang chi phi rat Idn, cho nSn khi diung tdi nhan thay benh nhan da dap ifng dieu tri, h ^ mii tien phdng va dang trong qua trinh bieu md hda vet loet, chung tdi thffdng cho benh nhan xuat vien va tai kham theo hen, vi vay, nhieu luc khdng danh gia dutfc chmh xac thdi gian bleu md hda hoan toan vit loet. Tuy nhien, theo nhiSu nghien cifu trddc dd cd sff so sanh giffa nhdm a5 tiem tien phdng amphotericin B va nhdm khdng dung amphoteridn B deu cho ket luan la am photeridn B tiSm tien phdng cd hieu qua trong viec lam giam thdi gian xuat hien mCi tien phdng va rut ngan thdi gian bieu md hda vet loet [3], [5], [6].
Theo nhieu nghien eihj, lieu 5ug ma chiing tdi diing trong nghien cffu la an toan va hieu qua trong dieu trj viem loet giac mac do nam cd kem mu tien phdng t3],[6],[7]. Tuy nhien,ro rang trong nghien eulJ cua chiing tdi, lieu 5ug td ra ed hieu qua ve mat Iam sang, bdi vi cd 4 mat lanh sau 1 mui tiem, va 14 mit dap uhg dieu tri sau 3 mui tiem. Trong sd 8 mat can >3 mui tiem, chi ed 2 mat cd cai thien. Cdn 6 mat phai chuyen phae do dieu tri. Do do, chiing tdi khuyen eao i^ng chi tan 3 mui tiem amphotericin B lieu 5ug la du de kiem soat viem loet giac mac do nam va tranh dddc cac bien chiitig lien quan den dde b'nh cua thuoc dung. Nhan djnh nay cua chuiig tdi cung phii hdp vdi nhan djnh cua tac gia Salfiye Yilmaz va cdng sff[7].
Nhin chung, thj life eua nhffng benh nhan trong nghien cifu cua chiing tdi dfftfc cai thien rd r$t, ty le tang tiij Iffc chung cua chiing tdi la 17/20 benh nhan, va eai thien dan sau thdi gian
1 tuan, 1 thang sau ra vien. Tuy nhien, mirt do eai thi$n khdng cao, hau het chi tdi dfftfc miit 3/10. Dieu nay cd the la do trong nghien cifu cua chiing tdi, ty le benh nang chiem ty le eao, viem loet dien rdng va vj tri 6 trung tam. Vdi nhiitig viem loet d vi tri trung tam thi dii ed dieu tri khoi cung gay giam thj Iffc nhieu.
V. K ^ LUAN
Nghien cffu cua chiing tdi ghi nhan trong 28 mat dutfc tiem Miphoteriein B, cd 7 mat cd phan uhg tien phdng thoang qua ngay dau sau tiem nhuhg tff cai thien sau 24h. Mac dii trong nghien ofu khdng cd trffdng htfp nao nhiem trung thiJ phat hoae viem mu npi nhan nhffng dd eung la 1 nguy ed dang Iffu y, can phai thffc hien viec ti^m tien phdng trong dieu kien vd trting. Sau 1 thang, ghi nhan 4 trffdng htfp due thuy tinh the.
Ket qua tff nghien culi ciia chung tdi die thay rang tiem tien phdng Amphotericin B la mot phffdng phap dieu tri bo sung hffu ich cho nhDhg trffdng hdp viem loet giac mac nang.
TAI UEU THAM KHAO
1 . Hodng Minh C h i u , Pham Ngoc Dong, (2007), ''DSc diem viem loet giac mac nhilm khuan ^ i benh vien mSt trung ffdng" Tap clil Nghien cifu y hoc (tap 50) so 4, ti- 92-97 2. Phgm Thu Lan, Tran Anh Thu" (2008), "Tim
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