ANH H I ; 6 N G C U A HUYET PHONG TRI LEN LU^U HUYET N A O CUA BENH N H A N TAI BIEN THIEU M A U NAO CUC BO
Vij Thudng Sdn Vien Chim cdu Trung Udng Muc tiSu: nghiSn edu sU thay ddi len luu huyit nao ciia benh nhan tai bien thieu miu nao cue bd sau giai doan cap bing sd dung phic dd dien chim cua vien cham cdu TW cd ke't hgp thSin huyet Phong tn.
Dd'i tugng va pbuang pbap ngbien cdu: thd nghiem lam sang cd so sinh ddi chdng. Hen hinh tren 64 benh nhan tai bien thiiu mau nao cue bd sau glal dgan ci'p, chia 2 nhdm trong dd nhdm chdng dimg phic do huyet dien cham thudng quy va nhdm nghien cifu diing phic do niy chim thSin huyet Phong tn hai bSn.
Kit qua: sau lieu tnnh dieu trj 30 ngiy, mdt sd chi so tren huye't nao do bSn bin cau tdn thuang ciia nhdm NC cd cat thien rd so vdi trUdc diiu trj vi so vdi nhdm ehdng: thdi gian a giim td 0,184 ± 0,025 giay den 0,160 ± 0,049 giay; chi sd Ri tang td 0,581 ± 0,153 mm din 0,694 ± 0,185 mm; lUu lUgng miu tang td 131,99 ± 31,89 ml/phiit den 178,6 ± 56,01 ml/phut; Hinh dang sdng: dUdng ISn nhanh, chim, sdng nhon cung cd Sif khic biet rd vdi nhdm chdng trong khi bSn bin cau linh su biin doi khdng rd net. Kit luan: dien cham phic dd huyet cd huyet Phong tn cd tic dung giam thdi gian a, luu lugng miu tang, chi sd Ri tang tren luu huySi nao do. Cai thien lUu huyit nao, giam trUong life thinh mach, tang sU dan hoi cda mach miu nao, tang luu lugng miu nao d bin ciu tdn thuang.
Tii khoa: Dien cham, luU huyet nao, tai bien thieu mau nao cue bo
L D A T V A N D E
Lflu Ifldng tuan hdan nfilu nao g i l m gay nen nhieu benh ly k h l c nhau tfl ddn ^ i a n nhfl mat ngu, suy nhflpc than kinh den tai bidn mach m l u nan, ted nad. Do vay, tang cfldng Itfu Ifldng tuan hdan m l u nao d ngfldi Idn tudi la mdt trong nhflng muc tieu cua nhieu nha nghien cflu v l y va dflpc. Tang tuan hoan mau ngo.cho tai bie'n thieu m l u nao cue bp sau giai doan cap la mpt chl djnh dieu trj e l n thiet nham hdi phuc trd lai d c chflc nang hoat dpng cua vung nao bi tdn thflpng d n g sdm cang tdt. Phong tri (GB20) la mpt huyet cd vj tri dac biet nam sit ddt sd'ng Cl - C2, noi hdi tu cua hai dpng mach ddt sdng thanh dpng mach than nen di vao da giae Willis. Da cd mpt sd tac gia nghien cflu ve huyet Phong tri tren ngfldi binh thfldng v l benh ly n , 5, 6]. De gdp mpt phan tim hieu them v l tac dung eua huyet nay nham muc tieu:
Danb gia tac dung dien cham phac dd huyet CO huyet Phong tri len lUu huyit nao ciia benh nhan tai bie'n thiiu mau nao cue bo.
II. DOI TUONG vA PHUONG
P H A PNGHIEN CL/U
1 . Ddi tUOhg nghien cii'u
Gdm 64 benh n h i n liet dfldc cha'n doan x l e djnh la thieu m l u nao cue bp sau giai doan cap [2] v l dtfpc ehia t h i n h 2 nhdm. Mdi nhdm 32 benh nhan.
Nhdm chflng (nhdm C): dung p h i c dd huyet thfldng quy d i l u trj thieu m l u nao cue bp tai vien cham cflu T W 15]: dien chain ben liet d c huyet cham t l c l e huyet Hpp cd'c, Ngoai quan, Khue tri.
Kien ngung. Bat ta, Giap tfch C3 - C7, Trat bien.
Hoan khieu, Dfldng lang t u y i n , Giai khe, Thfldng cfl hfl, Giap tich L2 - L-5, Phdng tri (2 ben) v l cham bd: Tuc tam ly, Tam am giao, hluyet hai.
Than du, Thai xung.
Nhdm nghien cflu (Nhdm NC): dung phac dd huyet thfldng quy dieu trj thieu mau nao cue bp tai vien Cham cflu Trung fldng I5] cham ben liet v l cham them huyet Phong tri (2 ben).
Lieu trinh: 30 ngay chain lien tuc, mdi ngay cham 1 lan, 25 phut/ lan . " " ' ' '^ '' ' ' ' 2. Phuong tien nghien cii'u
May dien chain M 7 . May do lflu huyet:
Rheoscreen compact CE 0118 Made in Germany tai benh vien Cham cflu Trung tfdng.
3. PhUdng phap nghien cii'u
Thfl nghiem lam sang cd so s i n h dd'i chflng .
IILKETQUA
Theo ddi va d i n h g i l b l n g d c h so s i n h thay ddi trtfdc va sau d i l u trj trong mdi nhdm v l so s i n h vdi nhdm cht'fng d e chl sd v l lifu huyet nao dd gdm: hinh dang sdng, afgiay), a/T (%),Vec(ml/
phut), Ri(mm) [3, 4 ] . 4. Xuf ly so lieu nghien cii'u
C l e sd lieu nghien cflu dfldc xfl ly theo phflpng p h i p t o l n thd'ng ke dung trong Y - Sinh hpc tren p h l n m i m EPI INFO 6.04.
Tudi
35 - 5 0 51 - 6 5
> 6 5 Tdng
Bang 1.
N h d m N C ( r Nam
3 11
6 20(62,5%)
Dac diim i 1 = 32)
Ni?
3 5 4 12(37,5%) 32(100%)
fuo';. gidi d hai nbdm Nhdm C ( n Nam
3 13
5 21(65,6%)
= 32) Ni?
3 3 5 11 (34,4%) 32(100%)
Tdng
12(18,75%) 32 (50%) 20(31,25%)
64(100%) 64
Nhin xet bangl: ty le nam mic benh nhiiu ban nd d ca hai nhdm. Lda tudi mic benh hai nhdm tuang duang nhau. Tai bai nhdm benh nhin cbu yeu tap trung vao tudi 51 - 65.
Nhin xet bang 2: ddi vdi bin cau benh, tnfdc diiu tri cac chl so a (giay), a/T (%o), Vecdnl/pbut) d hai nhdm ttfang dtfang ngoai trd chi sd Ri. Sau diiu trj, chi sd a (giay) va Vgcdnl/pbut) giifa bai nhdm cd st,t khic biet. Cic chi sd cdn lal khdng cd sd thay ddi rd net (p > 0,05). Ddi vdi ben lanh, tnfdc diiu trj lifu ktang miu nao d nhdm NC vi nhdm ehifng khdng cd sU khac biet trif chf sd VBC- Sau diiu trj, cic chl sd niy d mdi nhdm cd eai thien so vdi tntdc dieu trj nhtfng khdng cd y nghia thd'ng kS.
Nhin xet bang 3: tnfdc diiu trj, bSn bin cau benh khdng cd stf khic biet vi hinh dang sdng giifa hai nhdm, sau diiu trj hai dang sdng nhanh va chain xuai hien d dtfdng len trong ban ghi kfu huye't nao do ciia nhdm NC cao han nhdm chitng d mifc cd y nghia thdng ke.
Nhin xet bang 4: sau diiu trj khdng cd cd thay ddi trif dang sdng nhanh va chim xua't hien d difdng len trong bin ghi REG cua nhdm nghien cdu cao han nhdm chdng (p < 0,05).
IV. BAN LUAN
B l n g 2 cho thay d c ket q u i nghien cflu d c chl sd lflu huyet nao cua ban cau tdn thtfdng: sau d i l u trj, d nhdm NC thdi gian a da rut ngan rd so vdi trtfdc dieu tri (p < 0,05) va cd sfl khae biet rd so vdi nhdm chflng (p < 0,05). Thdi gian n h l n h len a eua dd thj Itfu huyet nao p h l n I n h dp dan
hdi, trtfpng kfe eua thanh maeh. Dd I I thdi gian t i m thu tdi da can thiet de dfla m l u v i o td chflc.
Thdi gian rut ngan lai the hien sfl Itfu thdng t u l n hoan cua nao td't hdn. Thdi gian a/T cung the hien dp dan hdi, trfldng Iflc t h i n h mach. Ben b i n cau tdn thfldng, d nhdm NC, thdi gian a/T thu n g l n lai rd ret so vdi trfldc d i l u trj (p < 0,01), nhflng khong
Bang 2. Kit qua nghidn cdu luu huyit nao trudc va sau diiu tri d bai ban ciu nao (bSn tdn thuang va lanh) cda hai nhom Tai ben ban cau tdn thfldng
TrUdc dieu tri Saudieu tri Chiso Nhom — „ ^ — '
X ± SD X ± SD
P
Nhdm NC
or (gily) Nhdm C
0,184 ± 0 , 0 2 5 0,160 ± 0,049 0,190 ± 0 , 0 4 7 0,186 ± 0 , 0 4 9
> 0 , 0 5 < 0,05
< 0 , 0 5
> 0 , 0 5
Nhdm NC
a/T (%) Nhdm C
0,288 ± 1,83 0,265 ± 1,81 0,280 ± 1,80 0,272 ± 1,79
> 0 , 0 5 > 0 , 0 5
< 0 , 0 1
> 0 , 0 5
Nhdm NC VBC (ml/phut) Nhdm C
131,99 ± 3 1 , 8 9 1 78,60 ± 56,01 126,10 ± 2 2 , 4 0 1 3 2 , 3 7 ± 2 5 , 1 9
> 0 , 0 5 < 0 , 0 1
< 0,001
> 0 , 0 5
Nhdm NC
Ri (mm) Nhdm C
0,581 ± 0 , 1 5 3 0,694 ± 0 , 1 8 5 0,73 ± 0 , 2 9 0,81 ±0,29
< 0,05 < 0 , 0 5
< 0 , 0 1
> 0 , 0 5
Tai ben ban cau lanh Nhdm NC
a'.(giay) Nhdm C
0,180 ± 0 , 0 3 7 0,173 ± 0 , 0 4 9 0,1 60 ± 0 , 0 5 0,140 ± 0 , 0 4 9
> 0 , 0 5 < 0 , 0 5
> 0 , 0 5
< 0 , 0 5
Nhdm NC
a/T (%) Nhdm C
0,265 ± 2 , 1 2 0,261 ± 1,90 0,255 ± 1,70 0,251 ± 1,56
> 0 , 0 5 > 0 , 0 5
> 0 , 0 5
•>0,05
Nhdm NC VBC (ml/phut) Nhdm C
162,29 ± 4 2 , 5 1 180,85 ± 52,65 140,91 ± 37,97 156,53 ± 35,44
< 0 , 0 5 < 0 , 0 5
> 0 , 0 5
> 0 , 0 5
Nhdm N C .
Ri (mm) Nhdm C
0,703 ± 0 , 6 8 2 0,781 ± 0,199 0,86 ± 0,03 1,03 ± 0 , 3 4
> 0 , 0 5 < 0 , 0 5
> 0 , 0 5
> 0 , 0 5
cd sfl k h l c biet vdi nhdm chflng Nhfl vay, sfl dan hdi cua thanh mach ben b i n cau lanh khdng thay ddi d i n g ke. The tfch lflu thdng m l u qua b i n cau dai nao cung gifl vai trd quan trpng trong viec d i m b l o cht'fc nang binh thfldng cua nao. Trong q u i trinh phat trien cua con ngfldi lflu Ifldng t u l n hoan nao g i l m theo tudi, trong trfldng hpp tdn thtfdng do thieu m l u nao cue bd Itfu ltfdng t u l n
hoan nao d ban cau tdn thtfdng trtfdc va sau d i l u trj cua hai nhdm d i u g i l m hdn so vdi b i n cau lanh 13]. Nhfl vay, thdi gian a, a/T rut ngan cho thl'y dd dan hdi, trfldng life thanh mach thay ddi nen lflu Ifldng m l u qua td chflc da dfldc e l i thien Chl sd Ri p h l n I n h mflc dp nap mau cua vung dpng mach thupc thi tam thu dtfpc the hien qua ty sd gifla bien dp cua sdng va dp chua'n cua m i y .
Hinh
Bang 3. Hinh dang song trdn luu huyit nao'dd ban ciu benb cda bai nhdm
TrUdc dieu tri Sau dieu tri Dang sdng Nhom
n (%) n (%)
Dtfdng len
Nhdm NC 3 (9,375) 11 (34,375)
Nhanh Nhdm C 3 (9,375) 7 (21,875)
> 0 , 0 5 < 0 , 0 5
Nhdm NC 29 (90,62) 21 (65,625)
Cham Nhdm C 29 (90,625) 25 (78,125)
> 0 , 0 5 < 0 , 0 5
Dinh sdng
Nhdm NC 4 (12,50) 14 (43,75)
Nhpn Nhdm C 3 (9,375) 10 (31,25)
> 0 , 0 5 < 0 , 0 5
Nhdm NC 16 (50,00) 11 (34,375)
Tu Nhdm C 18 (56,25) 14 (43,75)
> 0 , 0 5 > 0 , 0 5
Nhdm NC 12 (37,50) 7 (21,875)
Cad nguyen Nhdm C 11 (34,375) 8 (25,00)
> 0 , 0 5 > 0 , 0 5
Sdng phu
Nhdm NC 13 (40,625) 18 (56,25)
Cd Nhdm C 10 (31,25) 15 (46,875)
> 0 , 0 5 > 0 , 0 5
Nhdm NC 19 (59,375 14 (43,75)
Khdng Nhdm C 22 (68,75 17 (53,125)
> 0 , 0 5 > 0 , 0 5 Chl so' nay g i l m tfl tudi thanh nien sang trung
nien va ft thay ddi tfl tudi trung nien sang tudi gia [3]. Qua b l n g 2, chl sd Ri tai b i n cau tdn thifdng tha'p hpn b i n cau I l n h d c l hai nhdm. Sau d i l u trj chl so' n l y tang len d nhdm nghien ctfu (p < 0,01), sfl thay ddi cung cd sau d i l u tri tai nhdm so s i n h nhflng khdng cd sfl k h l c biet (p > 0,05). Ch! sd nay khdng cd sfl khac biet tai b i n cau I l n h d hai nhdm sau so vdi trifdc d i l u trj nhtfng cd sfl k h l c biet gifla hai nhdm (p < 0,05) tai thdi diem sau dieu tri.
Hinh dang dd thj va dae die'm cua nhflng sdng phu tren b i n ghi Itfu huye't nao ed y nghfa quan trpng trong viee danh g i l trang t h l i chflc nang cua nao. Trong thdi gian t i m thu, m l u v i o nao tang len lam tang dp d i n dieh va g i l m dien trd. Tren ban ghi lflu huyet nao hien ttfpng n l y dflpc bieu thj bang h i n h , I n h thay ddi bien dp cua nhanh len, d pha day m l u cham md'i ttfdng quan g i l dp d i n dien va dien trd lai ngfldc lai, tren b i n ghi lflu huyet nao the hien qua n h l n h xuo'ng cua dd thj. Nhfl vay, n h l n h len cua dd thj the hien
Bang 4. Hinh dang sdng trSn lUu huyit nao do bon cau l#nh cua bai nhom
Hinh
TrUdc dieu t r i Sau dieu t r i Ddiig sung B i l l d u
n (%) N (%)
Dtfdng len
Nhdm NC 10 (31,25)
Nhanh Nhdm C 9 (28,125)
> 0 , 0 5
Nhdm NC 22 (68,75)
C h i m Nhdm C 23 (71,875)
P > 0 , 0 5
18 (56,25) 13 (40,645)
< 0 , 0 5
14 (43,75) 19 (59,375)
< 0 , 0 5
Dinh sdng
Nhdm NC 10 (31,25)
Nhpn Nhdm C 8 (25,00)
> 0 , 0 5
Nhdm NC 15 (46,87)
Tu Nhdm C 14 (43,75)
> 0 , 0 5
Nhdm NC 7 (21,875)
Cad nguyen Nhdm C 10 (43,375)
P > 0 , 0 5
10 (50,00) 11 (34,375)
> 0 , 0 5
1 (34,375) 13 (40,625)
> 0 , 0 5
5 (15,625) 8 (25,00)
> 0 , 0 5
Sdng phu
Nhdm NC 18 (56,25)
Cd Nhdm C 16 (50,00)
> 0 , 0 5
Nhdm NC 14 (43,75)
Khdng Nhdm C 16 (50,00)
> 0 , 0 5
20 (62,50) 19 (59,375)
> 0 , 0 5
12 (37,50) 13 (40,625)
> 0 , 0 5 k h i nang dan cua maeh dfldi t i e dung cua lflu
Iflpng m l u chay qua, n h l n h xuo'ng the hien co cua thanh maeh de phue hdi vi tri ban dau do dd mach mau co lai se xua't hien d c sdng php tren b i n ghi cung la the hien dp d i n hdi cua thanh mach [3]. Ket q u i b l n g 3 - 4, cho tha'y nhdm nghien cflu ed ty le dfldng len nhanh cao hdn nhdm chflng (p < 0,05), sdng cham ft hdn cd sfl k h l c biet sau d i l u tri gifla hai nhdm. Ket qua nay eho tha'y r i n g bien ddi d e chl tieu cua Itfu huyet nao dd d nhdm nghien cflu dfldc d i thien nhieu
sau d i l u trj. Ket q u i n l y ed nhflng diem tfldng ddng vdi nghien cflu cua D o l n Van Tiep 16] v l Chu Qud'c Trtfdng [7] dung phflpng p h i p bl'm huyet Phong tri, Tam du va C i c h du d i l u trj thieu nang tuan h o l n nao man tinh tha'y cac trieu chflng l l m sang va lflu huyet nao cd c l i thien.
V. KET LUAN
Ket q u i ket hdp them huyet Pheng tri trong p h i c dd dien cham thtfdng quy tai vien chain cflu Trung fldng dflng d i l u trj thieu mau nao cue bp cd
tac dung c l i thien td't hdn mdt so' thdng so' cua Itfu huyet nad sd vdi dung phac dd tren den thuan thdng qua: 1) G i l m thdi gian a, a/T %, lflu Ifldng m l u tang, chl sd Ri tang tren Itfu huyet nao dd va 2) C l i thien lflu huyet nao, g i l m trfldng Iflc thanh mach, tang sfl dan hdi cua mach mau nao, tang Itfu ltfdng mau nao d ban cau tdn thifdng.
T A I L I E U T H A M
KHAO
1. Tran PhUOng Dong (2001). Nghien cflu dac diem sinh ly huyet Phong tri va I n h htfdng eua dien chain huyet nay len dien nao dd va dien t i m dd. Luan van Thae sy Y hpc. Trfldng Dai hpc Y Ha N p i .
2. Ho Hifu LUdng (1998). L l m sang t h i n kinh.
T3. Nha xua't b i n Y hpc.
3. Dao Phong Tan (1993). Lifu huyet nad. Mdt Sd tham dd chflc nang sinh ly. Nha xua't b i n Y hpc.
4. Nguyen Xuan Than (1998). Ghi Itfu huye't
nan.Cac phifdng p h i p cha'n d o l n bd trp ve t h i n kinh. Hpc vien Q u i n y, bp mdn Than kinh. Nha xul't b i n Y hpc.
5. Nguyin Tai Thu, Tran Thiiy (1997). Cham cflu sau dai hpc. N h l xuat b i n Y hoc.
6. Doan Van Tie'p (1999). Nghien cflu t i e dung cua phflong phap bam huyet Phong tri len lam s i n g v l Itfu huyet nao d benh nhan thieu nang t u l n h o l n nao man tfnh. Luan van Thae sy Y hpc. Hpc vien Q u i n Y. ; • ,• ,,^.
7. Chu Qudc TrUdng (1996). Nghien ct'fu lam s i n g thieu nang t u l n h o l n nao man tfnh giai doan dau theo Y hpc cd t r u y i n va dieu trj bang phfldng p h i p bl'm huyet. Luan I n Phd tien sT Y - Dflpc.
Hpc vien Quan Y.
8. Zang Qiaobao, Xie Quang, Shan Baoxhi (1994). "Wei Jia's experience on the application of Fenchi (GB20)". World J - Acup - Mox. March.
4(1). P 9 - 14.
Summary
THE EFFECT OF ELECTRO - ACUPUNCTURE (EA) ON
RHEOENCEPHALOGRAPHY(REG)OFTHE PATIENTS SUFFERED • ^ FROM THE CEREBRAL ICHEMIC ACCIDENT (CIA)
Objective: Evaluation effect of EA the points regimen and Phong tri (GB 20) on the change REG of the patients suffered from the cerebral ichemic accident. Methods: Research was conducted on REG of 64 patients suffered from the cerebral ichemic accident with the method of clinical trial and compare. 32 patients treated by EA the points regimen and Phong tri (GB 20), 32 patients treated by EA the points regimen without Phong tri (GB 20). Result: After 30 times EA, the REG on the damage hemiphere of the, study group showed that: The time of a waves reduced from 0.184± 0.025 sec to 0.160 ± 0.049 sec, different to other group (p < 0.05). The Index of a/T reduced from 0.288 ± 1,83% to 0.265 ± 1.81% nd different to other group (p > 0,05). The volumes of the cerebral circulation increased from 1 31.99 ± 31.89 ml/min to 178.6 ± 56.01 ml/min, were different to other group (p < 0,01). The indices of Ri increased from 0.581 ± 0.153mm to 0.694 ± 0.185mm, were different to other group (p < 0.05). The wave forms:
spike, quick, slow waves different to other group (p < 0.05). Conclusion: the electro - acupuncture the points regimen and Phong tri (G20) reducing the time of a waves, a/T. The index VBC, Ri increasing on rheoencephalography. Reducing tonus of the brain bidod vessels, increasing the elasticity of brain blood vessels, ameliorating the volumes of the cerebral circulation on the damage brain.
Keywords: The electro - acupuncture (EA), the rheoencephalography(REG), the cerebral ichemic accident (AlC)