Nghien ciJu - Ky thuat
J Phan tich thyc trang sir dung thuoc trong dieu tri dong ldnh tren benh nhan noi trii
tai Benh vien Tam th^n Nghe An
Dirong Dinh Chinh', Kieu Mai Anh^*
'Benh vien Hihi ngiii Da khoa Nghe An 'Truang Dqi hoc Yichoa Vinh 'E-mail, [email protected]
Summary
This retrospective study involved 136 epilepsy patients of Nghe An Mental Hospital was to reveal the actual drug use features therein. The majority of the prescribed antlepileptlc drugs were of the classical group; the combination of drugs included sedatives, vitamin and mineral supplements, hepatoprotectives, nootropics. The total cost of the anti-epileptic drug group rated lower, but that of the supplement group did significantly higher, reaching 75.75 %. Besides, analysis of the drug use in epilepsy treatment showed 53.04 % of the total 115 cases having been treated before hospitalization used therapeutic doses without dose Increasing. The effectiveness after a longer treatment than 1 month's was 32.17% without seizure and 60.00 % with reduced seizure. Furthermore, the proporiion of inpatient compliance was 96.35 %, against only 53.37 % before hospitalization.
Keywords: Nghe An Mental Hospital, drug use, antlepileptlc drug.
Dat van de
Bpnh ddng kinh hipn dang d y g e xem la v l n d l thai s y vdi ehuydn nganh tam thdn thdn kinh, n l u d i l u trj khdng thanh eong se dk lai nhieu ganh ngng eho ban thdn va gia dlnh bpnh nhdn cung nhy loan xa hdi. Didu In ddng kinh ndi trii ddng mdt vai trd quan lipng vi se q u y l l djnh vdn dd lya ehpn phac dd va lieu dung trong d i l u tri duy tri ngoai tru. Mpt so nghidn cdu v l viee s d dung eae t h u l c khang dpng kinh da d y g c t n l n khai song ehya cd nghien edu nao d l cap day du va hd thong ve v l n dd s d dyng thudc ndi chung trong d i l u tri bpnh ndy. Nghien edu nay d y g c thyc hipn vdi mue tieu: Khao sat tinh hinh sO dung thudc trong dieu trj dong kinh va phan tich tfnh hop ly trong s d dung thudc didu tri dong kinh tren benh nhdn noi tru tai Benh vien Tam thin Nghe An; gdp phan vdo vide s d dyng thudc hidu qua - an todn trong d i l u tn ddng kinh tgi Benh vidn.
Doi tu'O'ng va phircng phap nghien CU'U
Doi t y g n g nghien c d u
Ld benh an cua benh nhan da d y a c chan
doan mde bdnh ddng kinh dieu trj ndi trit tai Benh vidn Tam than tlnh Nghd An trong nam 2012.
Tieu chuan iwa chgn
- O y g c k i t luan chae ehdn mde ddng kinh:
Chan dodn dgng kinh bang lam sang k i t hgp didn nao do cho thay tridu chdng Idm sang d i l n hinh' Bpnh nhan phai ed ft nhdt t d 2 can t r d len each nhau tren 24 g i d , didn nao do d i l n hinh hoge bidn d l i khdng dae hidu '^ ^'.
- Trydng hgp chdng k i l n hoge xae dinh dyge cd can tren Iam sang nhyng khdng ghi dipn nao eung d y g c d y a vao nghien cdu.
- Khdng bj roi logn tam than man lfnh (ngoai can).
- Thdi gian dieu trj npi tru 1 t u i n t r d ldn.
Tieu chuan ioai trip - Phy n y ed thai.
- Lam sang khdng (Sin hinh.
Phyo^ng phap nghien c d u Thiet ke nghien cwu: Mo la hoi edu.
Quy trinh i l y mdu:
1. Lay danh saeh bdnh nhan dpng kinh cd c h i n doan ddng kinh l y u tgi Phdng K l hogch - Tong hgp ciia Bdnh vipn.
TAP CHi D i r a c H Q C - 7/2015 (S6 471 N A M S5)
• Nghien CIFU - Ky thuat
2. Chgn ra eae bpnh nhdn ed thdi d i l m nhgp vidn s d m n h i t Id 1/1/2012. thdi diem xuat vidn mupn nhat Id 31/12/2012, vd thdi gian d i l u tn npi tru t d 1 tuan t r d len.
3. Phan nhdm benh nhdn theo c h d cai d i u ciia ten (An, Anh, Anh... thupe nhdm ma A.)
4. Rut ho sa bdnh dn.
5. Loai cde trydng hap kem theo r l i loan tam t h i n mgn tinh.
6. Ope thdng tin t d bdnh an va logi di cac tardng hgp la phy n d cd thai, hoac cd giai dogn d i l u Iri trgng thai ddng kinh.
Cvmau
Chung tdi lay ed mdu Id bpnh an cua todn b0 bpnh nhdn dap dng du lieu ehuan lya chpn vd tidu c h u i n loai try nhy tren trong nam 2012.
T i n g epng thu d y a c 136 bpnh dn.
Phwong phap danh gid ket qua Odnh gia mdc dp thuyen gidm bpnh d y a vao tripu chdng lam sang vdi 3 mdc dd '^':
- Cat can: khdng edn can tren lam sang;
- Gidm can n h i l u : S l can gidm tren 50%;
- Giam can it: So can giam d y d i 50%.
K i t qua s y tuan thii dieu trj ve van de dung thudc Dya vdo vipe thu thdp Ihdng lin ghi trong bdnh dn ve loan bd qua trinh diing t h u l c , trong do bat ky mpt s y khdng tudn theo ndo vd ehi djnh, dydng diing, l i l u diing, thdi d i l m dung t h u l c d i u d y g c eoi Id khong tuan thu ^.
Ddnh gia chi phi d i l u tri: Dya theo lidu thuoc trong ngdy, so ngay dung thuoc, vd dan gia t h i n g nhat do Khoa D y g c eung cap tgi thdi diem thang 4/2012.
Phwong phap xw ly so lieu
S l lidu thu d y g e x d iy t h i n g kd y hpc tren mdy tinh bdng phan mem Excel, SPSS 15.0.
K e t q u a n g h i e n c u ' u
Dgc diem n h d m benh nhan n g h i e n c d u Tan so con
Bdng 1 • Tan so can dgng kinh trong mau nghidn cCru
M^td^con S i B N T y l S %
Hang ngiy 51 42,50
HSng ( u i n 37 30,83 96,67
Hang thing 28 23,33
Hon 1 thang
4 3,33
Tong so 120 100,0
Nhdn xet Cd 120 trydng hgp ed ghi nhgn tan so can. Bpnh nhdn nhgp vidn didu tn ndi trii phan idn ed c a n ddng kinh xay ra hang ngay, khi bdnh da d i l n b i l n kha ngng, e h i l m 42,5%. Cd tdi 96,67% bpnh nhan ed tan so can d y d i 1 thang, ehi ed 4 trydng hgp ed l l n s l can thya tren 1 thdng, t y l e la 3,33%.
Tien sw dieu trj cua bdnh nhan Bang 2 : Tidn swdung thuoc cua bdnh nhan Tien sir ditng thuoc
Oa dieu tn dong kjnh Chua Sieu tri Ktiongrotiensu' T6ng s6
SoBN S4
31 •' 21 136
Tyle%
6(,76 22,79 15,44 100,00 Nhan xet:
Trong 136 bdnh an nghien edu ed 84 trydng hgp da tdng d i l u tn dpng kinh tryde thdi diem nhap vidn, c h i l m 61,76%; 31 trydng hgp dieu tri npi tru ldn d i u , c h i l m 22,79%; cdn lai 21 bdnh an khdng ghi rd tidn s d dung thuoe. Ndu ehi tinh trong 115 benh nhan ghi rd tien s d d i l u tn thi so da d i l u tri c h i l m 73,04% vd chya d i l u tri Id 26,96%.
Tinh hinh s d d y n g t h u o c
Cac thuoc dieu trf chinh va cdc thuoc bo trcr dwoc sw dung
Nhdm cd tdc dyng dieu tn chinh la nhdm t h u l c khang ddng kinh, trong m i u nghien edu tat ed bpnh nhan d i u d y g c chi djnh thudc khang dpng kinh, ey t h l nhy sau'
Bdng 3: Cdc thudc chong dong kinh gap trong nghien cwu
Ten thuoc Caifeamazepin
Phenobafbital
Valproat
Phenytoin Gabapentin
Biet duvc Carbamazepin, Taver Danotan Gardenal Gardenal, Ganotan Depakin, Encorate Promag Phenytoin Phenytoin, Sodantcn Gabantin
Dang diing Vien Ong Vien Vien Vien Ong Vien Vien
Ham luong 200 nng 0,1 g/ml 10 mg 100 mg 200 mg
100 mg 300 mg
T:^P CHi DlTQC HQC - 7/2015 (SO 471 NAM 55)
Ben cgnh eac thuoe khang ddng kinh vdi mye dieh k i l m sodt can ldu dai, edn s d dyng eae thuoe ed tde dung an than trong thdi gian ngdn nhy diazepam. Thude d y g c dung dgng tiem eho cac
59
Nghien CIJU - Ky thuat
trydng hgp cap tinh, benh nhan len can nang va dung dgng uong vdi muc dieh an t h i n , gay ngu.
Ngoai ra, bdnh nhan trong mau nghien c d u cdn d y g e ehi dinh them thudc ed tac dyng bo t r g va ndng cao the trgng nhy sau:
Bang 4. Ty Id cdc bd tra trong nghien cwu Ten thuoc
Acbso, nghe L-Arqinin PhosptiolipKl dau nanh Vitamin B l Magnesi + vitamin B6 Hon hgp cac vitamin E, B, PP, lysin va calo glycerophospiiat, add glycerophosphonc Ginkgo bihtia Ginkgo £)Ma, vitamin, khoang chat Vinpocebn
Biet duoc (n) Acbsonic (9) Redliver(78) Livolin(32) Vitamin B l (9) Amfemag B6 (62),
MagneB6(14) Tavaad (64) Barokin (19), Giloba (20)
Phamaraton (16) CavintGnfor(18)
Tyle'A 6,62 57,35 23.53 6,62 55,88
47,06 28,68 11.76 12,24
cao t h l trgng: magie, natri, kali, caIci, cac vitamin B, C, PP, A, E.
- Bao ve t h i n kinh, edi thidn t u i n hoan nao- Ginkgo biloba, v i n p o e e t i n .
Mdi bdnh nhdn d y g c dung trung binh 2-3 loai t h u l c ndi tren, ed 17 trydng hgp bpnh nhdn d y g e dung tdi 4 t h u l c bo trg.
Phac d6 dieu tri
Bang 5: Phdc do Iwa chon ldn cuoi theo lo^l can
Lo^iccm C u c t m Toan ttie Ktiong ptian loai
r o n g so
Don tri nl % (nimi 12 57,14 67 68,36 13 76,47 92 67,65 n2
9 31 4 44
Da tri
% ( n 2 f f l | 42,86 31,44 23,53 32,35
Tong
m
21 98 17» 6
Nhdn xet:
Cac thuoe ndy e h i l m ty lp kha cao trong mau nghien cdu, bao gom cac tac dyng:
- Cai thidn ehde ndng gan, tang kha nang gidi dpe gan: arginin, phospholipid t h i l l yeu, aclisonic, eao b i l n sue, nghe.
- Bo sung vitamin vd khoang ehat giup nang
Bang 6; Tien thuoc dieu tri ddng kinh cOa bdnh nhdn trong ca dot
Nhdn xdt C d 92 bpnh nhdn dOng kinh v i n dung d y a e phac do dan tn cho d i n khi xuat vipn, ehilm 67,65%, vd 44 bdnh nhdn dung phde do da tri t r y d c x u l t vidn, c h i l m 32,35%.
Chi phi dieu trf ddng kinh bang thuoc Dya trdn lieu thuoe tinh trong mdt ngdy, so ngay diing tdng loai t h u l c va dan gia eo VAT do Khoa D y g c cung e l p , chung tdi da tinh dygc long chi phi eua 3 nhdm thuoc c a bdn trong d i l u trj dpng kinh eua bpnh nhan.
Nhom thuoc
Ttiuoc khang dong kinh Thufic an than Thuoc t}6 trcr, tang de khang
Tong chi phi
SoBN dung thuoc
136 39 132 M6
Trung binh/1 BN (ngan dong)
52 51 215 276
Tong chi phi (ngin trdng)
7,103 1,967 28,396
37,49
Tjr /9 % chi phi nh6m thuoc 18,95 5,30 75,75 (1)0,0
Tong chi phi thulc khang ddng kinh chi ehilm 18,95% loan bd ehi phi didu tri ddng kinh bang thuoe.
Tong tien ehi eho nhdm thude b l t r g , tang sdc d l khang, tang kha nang giai dpc gan e h i l m ty lp cao nhdt, ldi 75,75% chi phi dieu trj dpng kinh bdng thuoc.
Khi tinh trung binh trdn 1 bpnh nhan, lien thuoe khang ddng kinh gan nhy x l p xi bdng nhdm t h u l c an t h i n . Trong khi dd nhdm thuoe b l trg tang sde d l khang nhieu han gap 4 l l n hai nhdm trdn.
Tinh h g p ly t r o n g s y d y n g t h u o c Sw thay doi iieu AEDs
Bdng 7 ; Ty id thay ddi lieu dung AEDs a nhom ghi nhan tien sw dung thuoc Tien sw dung thuoc (n)
Oieu tri lan aau (31)
Da dieu tri ngoai trii, chuyen phac do khac (33) Da dieu tii ngo^i tnj, ditng lai phac do cu (25) Khong ghi nhan ro t i l n sir dung thuoc (26)
Thay doi lieu 2 1 2
IQmng thay d o i (%) 29 61 32 (53,04;
23 (20,00) 26
Ghi chd
C i n dd lieu theo khuyen c^o C6 t h l Khong phai db l^i l i l u
Khong d i n h gid
TAPCHi Dirpc HQC - 7/2015 (S6 471 NA.M 55)
Nghien cu'u - Ky thuat
Nh$n xet: Chi tinh trong sd 115 trydng hgp ghi nhgn l i l n s d diing thudc t r y d c nhap vien, ed 26 t r y d n g hgp ed md la dge diem dimg thudc ddu, khdng deu hay bd trj, nhyng khdng ghi rd logi thuoe dang diing, chiem 19,13%. Cd 61 benh nhdn d y g c dimg ngay l i l u d i l u trj va khdng ed qud trinh tang l i l u t d t r y d c dd d nhdm dung thuoc mdi, chiem 53,04%. Va cd 20,00% dimg ngay lieu d i l u In d nhdm dung lai thude ngoai tru.
Hidu qua kiem soat con dpng kinh tren lam sang
Trong sd 136 bpnh an nghien edu, cd 16 trydng hgp khdng thay ghi nhan tan sd can liic nhap vidn va ed 4 trydng hgp cd t i n so can thya (thupc nhdm han 1 thdng). Mat khae, qua trinh dieu trj ndi tru dpng kinh keo dai khoang 1 thang ndn chiing ldi khdng danh gia hipu qua k i l m sodt can d 22 bpnh nhdn nay. T i l n hdnh danh gia tren 116 bdnh nhan cdn lai (cdtan s d e a n hang thang cho d i n hang ngay) thu d y a c k i t qua nhy sau :
Hinh 1 : Bleu dd kdt qua dieu tri dong kinh nQl tru trdn Idm sang
Nhan xet: Cd 37 trydng hgp cat d y g c can (trong s u i t qua trinh dieu trj khdng x u l t hien can ddng kinh tren lam sang), ehilm 32,17%.
s l bpnh nhdn cd k i t qua giam can n h i l u (giam can trdn 50%) cd ly Id cao nhat 53,91%. Tong sd bdnh nhan giam d y g e can trong thang dau d i l u trj Id 60,00%. Cd 9 bdnh nhan khdng edi thien v l t i n so can dpng kinh, c h i l m 7,83%.
Van de tuan thu dieu trf cua nhom benh nhdn nghidn cwu
TnftSc nh§p Trong dieu tr
Hinh 2: Ty 1$ tudn thu dieu tri cua nhom benh nhdn nghien cuv
Nhdn xet: Cd 131 benh nhan tuan thu d i l u In vdi ty Id kha cao: 96,35%; ehi 3,65% khdng luan thu d i l u trj. Khao sat vd s y tuan thu eua nhdm bpnh nhan da tdng didu In ddng kinh ngoai tru t r y d c khi nhap vidn thay ed tdi 46,43% bpnh nhan khdng tuan thii didu trj ngogi tru vd 56,57%
dung t h u l c deu nhyng v l n tai phat eon. Nhy vay eho t h i y hidu qua k i l m soal can ngogi tru ehya eao va s y tudn thu ngoai trii chinh la y l u to quan trpng gdp phan lam tang ty lp nhgp vidn.
Ban luan
Dae diem mau nghien ciru
Tan sd can ddng kinh la mdt trcng nhdng dge d i l m quan trpng nhdt ciia benh dpng kmh. Id tidu ehf hang d i u de danh gia hidu qua d i l u trj dpng kinh. Bpnh nhan cd tan so mot hay nhilu can trong ngay n l u khdng d y g c x d ly se ed nguy ea c h u y i n sang trang thai ddng kinh la tinh trgng ddi hdi phai d p cdu. Hau qua ciia trang thai nay Id nhanh ehdng ddn tdi cac nguy ea rdi logn than kinh thyc vat nhy tang than nhidt, lim dap nhanh, khd thd, Iryy tim mgch, cd t h l d i n den t d vong.
Tan sd can ddng kinh logi nay trong nghidn edu eua ehiing tdi kha eao vdi 42,5% (bang 1) phan anh tinh trgng quan ly' va dieu In ngogi tru edn ehya k i l m soal lot eae eon ddng kinh.
Viee khai thac tidn s d d i l u In cua bpnh nhan gdp phdn giiip bae sy ke dan trong vide lya ehpn thudc d i l u trj Trong sd 115 benh an cd ghi nhgn t i l n s d dung thuoc ciia benh nhan, cd tdi 73,04%
trydng hgp da tdng dieu trj ddng kinh tryde thdi diem nhap vipn, va chi 26,96% bpnh nhdn didu tri ngi tru lan dau. K i t qua nghien edu ciia chiing toi cho thay ty lp bdnh nhdn lai phat can dpng kinh trong m i u nghien edu rdt cao.
Tinh hinh s d dung thuoc
Cde thude d y g e s d dyng trong mdu nghidn cdu kha da dgng. Vd thudc khang ddng kinh ehu y l u gap nhdm co d i l n (carbamazepin, valproat, phenytoin, phenobarbilal). Thuoc bo tra d y g c dimg vdi ty le kha cao, bao gdm cae thuoc dan hoae da thanh phan ehda hogt e h l l la cac vitamin, ehdt khoang, chat lam cai thien chdc nang gan va ehdt lam tang hoat ddng l l bao than kmh trung y a n g . Ngoai ra cdn diing thudc diazepam trong thdi gian ngan vdi mye dich an t h i n gdy ngu.
D i l u trj ddng kinh t h y d n g b i t dau b l n g phde do dan trj. Khi benh nhan khdng dap dng
T^P CHI DU'OC HQC - 7/2015 (SO 471 NAM 55)
• Nghien CIFU - Ky thuat
vdi phac dd dan trj se d y g c chuyen sang phac dd phdi hgp thude khang ddng kinh. D a n trj lieu trong nghidn c d u gap 67,65% thap han cac nghien cdu t h y c hidn trong cdng dong tai Ha Tdy (80%), Thai Binh (81%). Ty Id da trj lieu Id 32,35% cao han cac nghidn edu nay (tyang dng la 20% va 19%)'^''i. Theo chung tdi, do ty le bpnh nhan nang trong bpnh vipn eao hon trong cpng ddng ndn ed s y khde biet n h y vay v l lya chpn d i l u In gida hai qudn the.
Vdi dae d i l m cua benh nhan ddng kinh la t h y d n g it cd c a hdi k i l m d y g c vide lam, sdng phy thuge ngydi than vd mgi mat. Hp phdn ddng x u l t thdn t d cae gia dinh ndng dan, d cac viing ndng thdn, m i l n nui, nen dieu kien kinh t l r l i eo hpp. So lieu ehi phi v l t h u l c d bang 3 eho f h l y nhin chung chi phi ve thudc dieu In dpng kinh thap han n h i l u bpnh man tinh khac va kha phii hgp vdi thu nhap cua n h i l u gia dinh benh nhan (trung binh 275 ngan ddng/ngydi). Chyang trinh chong ddng kinh quoe gia ed mdt ea so thudc dgng kinh midn phi lam cho ehi phi didu tn nhdm thuoe khang ddng kinh eua mdu nghien cdu giam di n h i l u . Oieu nay gian t i l p gdp p h l n iam tang ty lp chl phi ede thude bo t r g , song n l u xet vd gid tn thye trung binh chi phi ciia nhdm nay la 215 ngan/ngydi eung Id kha eao, Trong khi dd cd n h i l u thuoc khang ddng kinh mdi ra ddi t y a n g d y a n g v l hipu qua d i l u tri va il tae dyng phy han thi bdnh nhan ddng kinh tai Bpnh vipn eung nhy nhilu nai khae chya ed ea hdi s d dyng, nguyen nhan tryc tiep nhdt d day la gia thudc. Phai chang chi phi d i l u tri ciia nhdm thuoc bo tra nen d y g c can ddi lai eho nhdm eac t h u l c mdi nay.
Tuy nhidn d l thyc hien d y g e didu nay cdn phai cd nhyng nghidn edu sau va toan dipn han v l dp dung thude mdi cho bdnh nhan ddng kinh d n y d e ta nham mye dich dem lgi hidu qua d i l u trj cao han, d l ngydi bdnh cd ea hdi d y g c s d dyng nhD'ng t i l n bd v l thudc trong dieu tn dgng kinh.
Tinh h g p ly t r o n g s d d u n g t h u o c Nghien cdu ch? danh gia hipu qua kiem sodt can d 96,67% benh nhan cd l l n so can d y d i 1 thang, tuy nhien de danh gia hieu qua chinh xde han d n theo ddi dieu tri ddng kinh trong thai gian dai. K i t qua nghidn cdu cua tae gia Phan Viet Nga nam 2002 cho thdy ly id bdnh nhan d l can dgng kinh tren lam sang tang Idn vdi thdi gian d i l u tri keo dai: sau 6 thdng dau ty ie nay la 59,17%, sau
1 nam la 69,09% va sau 2 nam la 83,11% '^. Nhy vay ed the ndi k i t qua dieu tn trong nghien edu ciia ehung tdi vdi thdi gian dieu tii han 1 thang tai vipn phu hgp vdi nghien edu nay.
Ben egnh do, doi vdi nhdng trydng hgp diing thude ldn d i u hoae bdt d i u c h u y i n sang phde do mdi, theo hydng ddn v l lieu diing thude khang ddng kinh, nhdt t h i l l phai thye hien giam dan iieu thudc eij va tang dan lidu thude mdi k i t hgp theo ddi lam sdng ^-^l Trong nghidn c d u nay ed 53,04%
trydng hgp diing ngay i i l u dieu Iri md khdng cd qua trinh dd i i l u trydc do. Day Id each ehi djnh l i l u theo kinh nghiem, chya dp dyng nguyen tae dd l i l u thude khdng ddng kinh. Hgu qua ciJa vipc ngdng thuoe dot ngdt trong d i l u tn ddng kinh Id rdt ngng nd, vi vgy eiing vdi vipe xay dyng phdc do chuan cho d i l u tri ddng kinh lgi Bdnh vidn, c i n ehu y dd l i l u khi s d dyng phde do mdi.
Ve s y tuan thu ^ l u trj, hinh 2 cho thdy ty' le khdng ludn thu d i l u tn ngogi trii kha eao, phan Idn do benh nhdn ngoai tru ed tinh trgng bdnh d mde nhp han, t i n so can thya han, nen nhieu kha nang bdnh nhan cd tdm iy chii quan ve bdnh, hay quen diing thuoc, khdng chu y tai khdm...
K i t qua nay t y a n g t y k i t qua eac tae gia khac nghien cdu trdn ddi l y g n g bdnh nhdn ddng kinh trong cdng ddng E''^'. Day chinh Id nguyen nhan hang ddu gay tdi phat can dgng kinh vd lam tang tinh trang nhap vipn, dong thai lam cho qua trinh d i l u tri dpng kinh ggp nhidu khd khan. So lieu cd d y g e v l s y tuan thii ndi trii kha cao ed the do n h i l u nguyen nhan, trong do quan trpng n h i l Id ngydi bdnh d y a c diing thudc d y d i s y gidm sal tryc t i l p cua nhan vien y t l trong thdi gian ngan (khoang 1 thang). Mac dii khdng trdnh khdi nhdng han c h l cua phyang phap nghidn cdu hoi cdu, k i t qua nay eho thdy bpnh vipn can tang c y d n g giao dye t y v l n cho bdnh nhan ddng kinh v l i l m quan trpng ciia s y tuan thii dieu trj trydc xudt vipn nhdm nang eao hieu qua kiem soal can trong giai dogn duy tri lau dai d ngoai tm
K§t luan
Qua nghien cdu bpnh an cua 136 benh nhdn ddng kinh d y g e dieu trj ngi tru lai Bpnh vidn Tdm than Nghe An, ehiing tdi rut ra mot so k i t ludn sau:
Tinh hinh sw dung thuoc
- Thuoe khang dpng kinh ioai eo dien ehilm phdn Idn trong nghidn cdu.
62 TAP CHI D i r o c HOC - 7/201S (SO 471 NAM 55)
• Nghien CUFU - Ky thuat
- Cde thuoc phoi hgp bao gom thuoe an t h i n , thudc bo sung vitamin, c h i t khodng, thudc eai thipn chdc nang gan va hoat ddng te bdo t h i n kinh trung y a n g .
- T i n g chi phi d i l u tri eua nhdm thuoe khdng ddng kinh ehinh t h i p (18,95%). Nhdm thuoe bo trg, tang giai ddc gan, tang sde d l khang c h i l m ly le trpng y l u (75,75%).
Tinh hgp ly ve sw dyng thuoc trong dieu tn ddng kinh tren benh nhan npi tru
- Cd 53,04% trong s l 115 trydng hgp ghi nhgn l i l n s d dung thuoe, bpnh nhdn d y g c diing ngay lieu dieu trj ma khong qua dd lieu.
- Hipu qua sau thdi gian han 1 thang d i l u tri npi tru: 32,17% edt can, 60,00% giam can.
- Ty 10 tuan thu npi trii 96,35%, ty lp khdng tudn thil t r y d c d i l u tri Id 46,48%.
Tai lieu tham khao
1. Nguyin Van Doanh (2007), "Nghidn cOv mdt so d$c diim djch t§ hgc vd di^u tn d0ng kinh 6 mot cpng d6ng dan cw thupc huyen Gia Binh, tlnh BSc Ninh".
Ludn dn tiln sy Y hpc, HQC vipn Quan Y.
2, Hoang Khanh (2009), Noi thdn kinh, Trydng Dgi hpcY Dygc Hue, tr 153-195.
3. Dyong Huy Hoang (2009), 'Nghien cCni mpt so d$c diim dich te, lam sang dong kmh. tinh hinh quan ly benh nhan dpng kinh t^i tinh Thai Binh', Luan an tiln sy Y hpc, Hpc vien Qudn Y.
4 Nguyin Thuy Hydng (2001), 'Nghien ciru mdt so ffSc diim djch te va tinh hinh dieu tri dpng kinh tai ffnh Ha Tay', Lu|n an tien sy Y hqc, Hpc vi$n Quan Y, Ha Npi.
5. Phan Viet Nga (2002), 'NghiSn cdu chdn doan va theo doi ket qua dieu tn dong kinh todn thi a tre em tw 6 din 15 tudi, Lupn an tiln sy, Hpc vien Qudn Y.
6. Elaine Wyllie, Gregory D„ Cascino, Barry E.
Gidal (2011), "Antiepileptic medications", Wyllie's treatment of Epilepsy: Principles and Practice, fifth edition, p. 229-230, Lippincott Williams & Wilkins, USA.
7. Haynes R. B., McDonald H., Garg A X. &
Montague P. (2002), "Interventions for helping patients to follow prescnptions for medications", Cochrane Database of Systematic Reviews (Online), (2).
8. International League Against Epilepsy (1993), Guiderline for epidemiological study on epilepsy.
Epilepsia, 34(4), pp 592-595.
9. Nathan B., Fountain M. D, (2009), Manual of antlepileptlc drug therapy. Comprehensive Epilepsy Program, University of Virginia.
{Ngdy nhan bdi: 18/05/2015 - Ngay duyet dang: 02/07/2015)
B a h o p c h a t . . . (TlSp theo trang 57)
Tai lieu tham khao
1.V6 van Chi (2012), TO-dien cay thuoc VietNam, WX8yhoc,Tdp2,tr. 667,
2. Vi§n Du'gc lieu (2006), Cay thudc va dong v$t lam thudc & Vi$t Nam. NXB Khoa hgc va Ky thuat, Tdp 2, tr. 693-694.
3. Nie Y. et al. (2013), "Medicinal plants of genus Curculigo: Traditional uses and a phytochemical and eUinopharmacological review", J. Ethnopharmacol.
147(3), 547-563
4. Gupta M. et al. (2005), "Glucosides from Curculi- go orchioides". Phytochemistry, 66(6), 659-663.
5. Zhu CC. et al. (2010), "Chemical constituents from rhizomes of Curculigo breviscapa". Bull. Korean Cftem. Soc, 31(1), 224-226.
6. Li N et al. (2003), "Study on the chemical
constituents of Curculigo orchioides", Nat. Prod. Res.
Dev., 15, 208-211.
7. Peng J et al. (2006), "Optimization suitable conditions for preparative isolation and separation of curculigoside and curculigoside B from Curculigo orchioides by high-speed counter-current chromatography", Separation and Purification Technology 52. 22-28.
8. Da-Xu FD et al. (2004), "Curculigoside C , a new phenolic glucoside from rhizomes of Curculigo orchioides". Acta Botanica Sinica 46(5), 621-624.
9 Wang TM et al, (2009), "A new oligostilbenoid from rhizomes of Curculigo sinensis", Joumal of the Chinese Chemical Society 56, 881-884.
10. Kim SY, Gao JJ., Lee WC, Ryu KS , Lee KR , Kim YC. (1999), "Antioxidative flavonoids from the leaves of Morus alba", Arch. Pharm. Res., 22, 81-85
{Ngay nhan bai: 28/05/2015 - Ngay duydt dang: 02/07/2015)