Y Hpc TP. Hb Chi M i n h * T$p 20 * S^ 6 * 2016 Nghien cira Y hoc
DANH GIA HIEU QUA GIAM DAU VAI SAU D O T QUY GIAI DOAN LIET MEM BANG PHLfONG FHAP DIEN CHAM CAC HUY^T:
BiNH PHONG, KIEN NGUNG, KIEN LIEU, TY NHU
Nguyen Le Xudn Trang*, Phan Thi My Suong*, Trinh Thi Diiu Thubng*
TOMTAT
MiJic tieu nghien diu: Dau vai Id mgt biih chieng thiecmg gap sau dot quy, gdy cdn Hb su phuc hoi chiec ndng khap vai vd chi trin, keo ddi then gian nam viin, lam gidm chat lugng cudc song cua binh nhdn sau dot quy.
£Je tfli ndy dugc thuc hiin nham ddnh gid hiiu qud gidm dau vai sau dot quy giai doan liet ni&m khi sit dung phuang phdp dim chdm Hin 2 ca: ca Hin gai vd co mu vai thdng qua cdc huyit Binh phong, Kiin ngung, Kiin liiu, Ty nhu.
Dot tUg^g - phuong phdp nghien dot: Thit nghiem ldm sdng, ngau nhiin co nhom chi^g, tie thdng 12/2014 dzn thdng 06/2015, Hen 60 benh rdidn dot quy giai doqn hit niem, co dau vai bin Hit. Nhom chieng dugc diin chdm a thi huyit, tap cdc dgng tdc ve vqt ly tri lieu sau khi dugc chdm cieu vd nhom can thiip dugc diin chdm cdc huyet: Birih phong, Kiin ngung, Kiin liiu, Ty nhu; tap cdc ddng tdc vi v&t ly Hi lieu sau khi diegc chdm deu. Sau dOu Hi benh nhdn dugc ddnh gid sffdiim dau vai dua vdo thang dirni dau tie 0 dm 10 (Numeric RaHng Scale) sau moi lieu Hirdi.
Kei qud: Phucmg phdp diin ch&m cdc huyit Binh phong, Kiin ngung, Kien liiu, T^ nhu gidp gidm dau vai sau dot quy t^ hem phucmg phdp dien chdm a thi huyit, su khac bmt ndy co y nghia thdng ke (p<O,001). Phuong phdp dien cham cdc huyit Binh phong, Kiin ngung, Kien Liiu, Ty Nhu ldm tang H li binh nhdn ddp ^g Toi vd Khd cao han so vai diin chdm a thi huyit trong viic gidm dau vai cdio binh nhdn sau dot quy.
Ket ludn: Phuong phap diin chdm cdc huyit Binh phong Kiin ngung, Kiin lieu, Ty nhu giup gidm dau vai sau t^t quy giai dgan liet mim.
Tie khoa: Dien chdm, ca Hen gai, ca md vai, dau vai sau dot quy.
ABSTRACT
EFFICIENCY OF ELECTRICAL ACUPUNCTURE ON ACUPUNCTURE POINTS: SI 12, U15, TE 14, LI 14 IN RELIEVING SHOULDER PAIN AFTER STROKE
Nguyen Le Xuan Trang, Phan Thi My Suong, Trinh Thi Dieu Thuong
* Y Hoc TP. Ho Chi Minh * Vol. 20 - No 6 - 2016:57 - 64 Objectives: Shoulder pain is a common complication after sHoke, which hinders motor rdidbilitaHon of the shoulder joint and upper limbs, prolongs inpatient time, reduces patimts' quality of life after stroke. The present study was designed to evaluate the effidmcy of electrical acupuncture on supraspinous jbssa and deltoid muscles, by using 4 acupuncture points: SI 12, LI 15, TE 14, LI 14, in relieving shoulder pain after sHoke.
Method: Randomized conHolled trial, from Decemper 2015 to June 2016. 60 post-sHoke patimts with shoulder pain were treated in 6 weeks. The conHol group recdved traditional electrical acupuncture (by using electrical acupuncture on the pain points) and physical therapy; while the trial group recdved eledrical acupuncture on 4 aojpundure points: SI 12, LI 15, TE 14, LI 14 and physical therapy. After 6 weeks, the paHents were assessed the level of shoulder pain by Numeric Rating Scale.
* Khoa Y hpc co tmyen- Dgi hpc Y Dupe Tp. Ho Chi Minh
Tdc gid lien Iqc: BS. Nguyen L^ Xuan Trang DT 0988863619 Email: [email protected] 57
Nghien cmi Y hoc Y Hoc TP. Hb Chi M i n h * T | p 20 * Sb 6 * 2016
Results: Electrical acupundure on jour acupuncture points SI 12, LI 15, TE 14, LI 14 proved to be more effedive in relieving shoulder pain after sHoke (p<0.001).Moreover, this method also increased the percentage cf patients in "excellent" and "good" rate more than the Haditional method.
Conclusion- Eledricd acupuncture on four acupundure points SI 12, U 15, TE 14, U 14 helps relieve shoulder pain after stroke.
Key ivords: Eledrical acupundure, supraspinous fossa, deltoid muscles, shoulder pain after sHoke.
DAT VAN D I
Dau vai la mot bi&i chiing Ihirong gap sau dot quy, gay can tr6 su phuc hoi chiic nang khop vai va chi tren, keo dai thoi gian nam vien, lam giam chat lucmg cuoc song cua benh nhan sau dot qu3^6'^. Phuang phap kich thich dien than kinh CO tren gai va co mii vai da dugc chiing minh co hieu qua tuong doi trong dieu tri giam dau vai cho benh nhan sau dot quyW-^^iD), Xuy nhien phuong phap nay kho tac dong sau vao co, thai gian kich thich di$n irong ngay kha dai, gay kho khan trong dieu tri(*"^. Phuang phap dien cham CO co che tac dving gan tuong dong voi phuang phap kich thich dien than kinh co, dong thoi day la phtrong phap kim qua da nen tac dong sau vao ca hon. Vi vay, nghien ciiu nay ti&i hanh nham danh gia hieu qua giam dau vai sau dot quy bang dien cham co tren gai va co mii vai, thong qua cac huyet Binh phong, Kien ngung, Kien lieu, Ty nhu.
Muc tieu nghien cuu Mtu: tieu tong qudt
Xac dinh hieu qua giam dau vai sau dot quy giai doan liet mem bang phuang phap dien cham cac huyet: Binh phong, Kien ngung, Ki§n lieu, Ty nhu.
Muc tiiu cu the
Xac dinh hieu qua giam dau vai sau dieu tri d hai nhom nghien ciiu danh gia bang thang do diem dau tii 0 - 10 (Numeric Pain Intensity Scale).
Xac dinh ty le bgnh nhan dap ung dieu tri Kha, Tot 6 nhom can thiep danh gia bang thang do diem dau tii 0 - 10 (Numeric Pain Intensity Scale).
FHUQ^GEHAP-IHdaNG^IENN<^^IENCUtJ Thiet ke nghien cuu
Can thiep Iam sang, co nhom chiing, nglu nhien
Noi nghien cuu
Benh vien Y hoc co truyen Thanh pho Hb ChiMinh.
Mau nghien cuu
[za-a/2)^l2P2 (1 - Pi)i+Zfa-giVlfj q - Pi) + Pzd -Pi)]f
" (P,-P2y Pi = Xdc suat phai nhion trong nhom bath 89,9%
Pl= Ti li ddp ieng dieu tn gidm dau vai khd, tdi d rdiom can tiiiep 80%
P2 = Ti li ddp ihtg dmi tri gidm dau vai khd, tSt b nhom duing 50% (8)
RR = 1,6 Z(i-^m= 1,96 (a = 0,05) Z(l-/i} = 1,28; (!-/}}= 0.9
Ta duac co mau n = 54 doi tuong cho moi nhom nghien ciiu
Ky thu|t phSn nhom
PhSn nhom ngau nhien b3ng phan mem GraphPad.
Tieu chudn chgn benh Du 5 tieu chuan.
Benh nhan dong y tham gia nghien ciiu.
Benh nhan duoc chan doan dot quy dua vao hinh anh hoc hogc trong giay xuat vi&\.
Benh nhan trong giai d o ^ liet m&n V2 ngucri.
Benh nhan co dau vai moi xuat hien sau dpt Khong sii dung cac phuang phap giam dau khac.
Y Hoc TP. Hb Chi M i n h • Tap 20 * Sb 6 * 2016 N g h i e n cufu Y hpc
Tieu chudn loai trie Chi can 1 tieu chua&i.
Benh nhan bi viem nhiem, 16 loet vCing vai ben liet
Benh nhan roi loan tri giac, roi loan ngon ngii, tam than.
Benh nhan co dau vai xuat hien truac dot quy-
Benh nhan co phii chi ben liet.
Benh nhan dau vai khong ciing ben Uet.
Benh trong qua trinh nghien ciiu co dien bioi phiic tap duoc chuy&i sang phuang phap dieu tri khac va so Keu nay se dugc phan tich trong nhom that bai dieu trj.
Liet ke va djnh ng|hia bien s b Bien so doc l^p
La phirong phap dime tien hanh thuc hien tren benh nhan gom 2 phuong phap la phuong phap dien cham A thi huyet voi dien cham fan so cao (nhom chiing) va phuong phap dien cham cac huyet: Binh phong, Kien ngung, Kien lieu, Ty nhu vai dien cham tan so thap va cao (nhom can thiep).
B i ^ so phu thuoc
La ket qua sau khi tien hanh can thiep gom 2 bioi sb.
Diem ntidc do dau
La bi&i so dinh lugng dugc tinh diem Uieo thang diem dau tir 0 Aen 10, di«n so dao dong tir 0 - 1 0 diem, diem cang cao cho thay miic do dau vai cang nhieu.
Xep logi ddp ^g Meu tri
La birai sb dinh tmh co 4 gja tri Tot, Kha, Trung bnih, Kem.
T6t Trung
binh
Giam dau 90% aim 100% so vm so diem ban dau Giam dau 70% gem 89% so voi 56 diem ban dau Giam dau 50% dem 69% so vdi so dilm ban d^u Giam dau < 50% so v6i so diem ban d^u
To chixc thuc hien
Phan bb b ^ nhan: dugc sap xep ngau nhien vao 2 nhom, moi benh nhan dugc bat tham. Trong hop co 60 tham (30 tham danh so 1, 30 tham danh so 2).
Phuong phap can tiiiep Nhom chiing
E)ien cham A thi huyet ket hgp phuc hoi van dgng cho benh nhan bang di&i cham thuong theo kinh Duong Minh va vat ly tri lieu.
Phuong phap chgn huyet: A thi huyet.
Sii dung dien cham: ^n sb 60 Hz, cuong do tli 2-10 mA, thoi gjan 20 phtit.
Cach gan dien cue: khong gan Binh phong va Kien ngung cimg 1 cap dien cue, Kien lieu va Ty Nhu cimg 1 cap dien cue.
Moi ngay cham 1 fan, tir Ihii 2 d a i thii 6, nghi thii 7, Chii nhat, cham dii 30 lan (6 tuan).
Dien cham thuong theo kinh Duang minh:
chpn huyet tren duong kinh Duong minh, ^n sb:
20 Hz, cuang dp: 2 - 1 0 mA, thoi gian: 20 phut.
Moi ngay cham 1 lan, tir thii 2 dSi thii 6, nghi thii 7, Chii nhat, cham dii 30 Ian (6 tuan).
Vat ly tri lieu: dugc thuc hien moi ngay sau qua trinh cham ciiu, khong cho benh nhan tap dgng tac rong roc. Deu dugc ap dung nhu nhau 6 2 nhom nghien ciiu. Ngay tap 1 Ian, Ian 30 phiit (ngoai trir ngay Thii bay va Chii nhat).
Nhom Can thiep
Dien cham cac huyet Binh phong, Kien ngung, Kien heu, Ty nhu ket hgp phuc hoi v | n dpng cac vimg con lai cho benh nhan bang di?n cham thuong theo kinh Duong Minh va vat ly tri heu.
Phuong phap chpn huyet: Binh phong, Ki&i ngung: ca tren gai. Kien lieu, Ty nhu: co mii vai.
Sii dung dien cham: 10 phiit dau: ^ so 20 Hz -10 phut tiep theo: tan sb 60 Hz, cucmg do tir 2-10 mA. Cach mac dien cue: Binh phong, Kien ngung: 1 cgip di|n cue - Kien lieu, Ty nhu: 1 cap dien arc (doi arc cho moi cap huyet moi ngay).
NghiSn ciiu Y hpc Y Hpc TP. Hb Chi Minh * Tgip 20 * Sb 6 * 2016
Dien cham thuang theo kinh Duong minh (kinh Dai tnrang va kinh Vi) 6 tay va chan ben liet (khong cham lai 2 huyet: Kien ngung, Ty nhu). Su dung dien cham: ^ sb 20 Hz, cuang dp 2 - 1 0 mA, thoi gian 20 phiit
Moi ngay cham 1 Ian, tu: thii 2 deh thii 6, nghi thii 7, Chii nhat, cham dii 30 Ian (6 tuan).
V|t ly tri Ueu: dugc th^rc hien moi ngay sau qua trinh cham ciiu, khong cho benh nhan t | p dgng tac rong rpc. Deu dugc ap dung nhu nhau 6 2 nhom nghien ciiu. Ngay tap 1 (an, Jan 30 phiit (ngoai trii ngay Thii bay va Chu nhat).
Tieu chuan theo doi va danh gia Viec Iheo doi va danh gia dugc ghi nhan sau moi Ueu trinh
Chi tieu theo doi
Sinh hieu: mgch, nhiet do, huyet ap.
Diem miic do dau: theo thang diem dau tir 0 d a i 10.
X ^ loai ddp ibig dwu tri Tmng
binh
Giam dau 90% d ^ 100% so vdi so diSm ban dau Giam dau 70% dim 89% so v&i so dilm ban dau Giam dau 50% dim 69% so vcri so dilm ban dau
Giam dau < 50% so voi so diem ban dau
Phuong phap thbng ke
Nhgp va quan ly dii Ueu bang chuong trinh Excell2010.
Phan tich cac sb Ueu qua phSn mem STATA 11.0.
Thong ke mo ta thong tin nen: phep kiem x2 hoac phep kiem Fisher' exact.
Thbng ke phan tich khi so sanh dian dau trung binh trong timg nhom chiing va can thi^p:
phep ki&i T bat cap.
Thbng ke phan tich khi so sanh diem dau tmng binh giiia 2 nhom chiing va can thiep:
phep kiem T dpc lap.
Thbng ke phan tich khi so sanh ty le xep loai dap ling dieu tri giiia 2 nhom chiing va can thiep:
phep kiem chi binh phuang hoac phep kian Fisher" exact
RR, khoang tin c|y 95% dimg de do luong siic mgnh su ket hgp ciia mbi Uen quan giira b i a i sb phu thugc va b i a i dpc lap.
KETQUA So li^u thbng k@
Tong sb 60 benh nhan: nhom chiing 30 benh nhan; Nhom nghien o i u 30 benh nhan.
Dac diran chung cua dbi tupng t ^ ih6i d i ^ truoc nghiSn curu Bdng 1: Dqc di^ chung cua ddi Htgng truac nghiin deu
Ttiong tin ngn va tign si> b#nh d$t quy
Tuoi Gioi Th&i gian tCF tuc dot quy
den dieu tii Hdn mg luc dot quy
S6 l^n bj dot quy ChSn doan luc dot quy Tay y^u l i ^ la tay tiiuan
<50tu6i
>=50tu6i NO Nam
<=1 thdng
> 1 thdng i<hdng
C6 1lin
>=2Ian Niioi mau nao Xuat huyet nao
Khdng C6
Nhom chijng (n=30) n
4 26 16 14 19 11 29 1 28 2 28 2 21 9
13,33
%
86.67 53.33 46,67 63,33 36,67 96.67 3,33 93,33 6,67 93,33 6,67 70,00 30,X
Nhom can thifp (n=30) n
2 28 9 21 17 13 27 3 28 2 25 5 16 14
6,67
%
93,33 30 70 6,67 43,33 90,00 10.00 93,33 6,67 83,33 16.67 63,33 46,67 Nhan xet Khong tim thdy sit khac biit co y nghta thmg ke (p>0,05).
Y Hpc TP. Hb Chi M i n h * Tap 20 * Sb 6 * 2016 Nghien cihi Y hpc
Bdng 2: Dqc diem diung ue thong Hn binh ly cua dm tugng tne&c nghien dhi
Bdng 4: Hiiu qud gidm dau vai dua Hen kei qud xep
U(re d9 dau vai IOc b i t d i u BiSm tnjng binh
(do lech ChuSn)
Nhom chOng (n=54) 5,27 1,31
Nh6m can thiep (n=54) 5,3 1,15 Nhan xefc Khong Hm thmf su khac biit (^ y nghia thong ke (p>0,05)
Ket quS di^u tri Hieu qud gidm dau vai
Bdng 3: Hiiu qud gidm dau vai iheo thang do dimi dautieO-
Thbi gian TO Tl T2 T3 KhacbiOt
T0-T1 Khac biet
T1-T2 Khde biet
T2-T3
10 sau moilo trinh Nhom chijng
Mean 5,27 4.97 4.2 3.9
<0,05
<0,0001 0,1070
SD 1,31 1,13 1.35 1,47
Nhdm can thiep Mean
5,3 3,87
2,7 1,77
<0,0001
<0,0001
<0,0001 SD 1,15 1.17 1,06 1,36
Rvalue 0,9170
<0,001
<0.0001
<0,0001
Nhan xet
Dian dau vai trung binh sau can thiep 6 nhom can thiep fhap han nhom chiing, su khac biet CO y ngMa fhong ke voi P< 0,001
Trong nhom can thiep, dian dau vai trung binh sau moi Ueu trinh tiep tuc giam co y nghia thong ke voi P< 0,0001
Trong nhom chung, diem dau vai trung binh giam CO y nghi thong ke sau Ueu trinh 1, 2 (P<
0,001); Tuy nhien, sau Ueu trinh 3, diem dau vai trung binh gjam khong co y nghua fhong ke (P>0,05).
Hieu qud gidm dau vai sau dot quy di/[a tren ket qud xep loai ddp ibtggidm dau vai
O fhdi diem Tl, su khac biet khong co y nghia thong ke ve xep loai dap iing giam dau vai giiia hai nhom nghien ciiu vol p>0,05.
O thai diem T2, T3, su khac biet co y ngtua thbng ke ve xep loai dap iing giam dau vai gjiia hai nhom nghien ciiu voi p<0,001.
II
T1
T2
T3 Xdp l09i
Kdm Trung binh
Khd Tot Kdm Tnjng binti
Khd T6t Kem Tnjng binh
Klid T6t
Nhdm chijng 30(100)
0 0 0 27(90) 3(10) 0 0 24(80) 5(16,67)
1 (3,33) 0
Nhdm can thl^p 26 (86,67)
4 (13,33) 0 0 13 (43.33) 16(53.33) 1 (3.33)
0 6(20) 12(40) 5 (16.67) 7(23.33)
Rvalue
0.112
0.000
0,000
BIEN LUAN
Nhan xet ve s u dong nhat cua 2 nhom tai thoi diem tru6c nghien cuu
2 nhom dong nhat ve fhong tin hen (tubi, gibi) truoc nghien ciiu (p>0,05).
2 nhom dong nhat ve tien su b&ih (thoi gian dot quy, hon me, so Ian tai biai, ch&i doan, tay yeu Uet cimg ben tay thugn, dian so dau vai) truoc n g ^ e n ciiu ((K>0,05).
Hi^u qua g i ^ dau vai (dua theo thang do dibm dau tu 0-10)
So sdnh m^ do dau vai theo thang do diem dau tit 0 den 10 trong timg nhom chihig vd can thi$p
Ta fhay ca 2 nhom can thiep va nhom chiing deu CO cai thien miic dp dau vai cho benh nhan sau dot quy ngay sau 16 trinh dieu tri 10 ngay dau tien va 10 ngay tiep theo. Co the U giai rang, ca 2 nhom nghien a h i Sea da sir diing mpt each hieu qua tac dung giam dau ciia cham ciiu qua 2 CO che chinh do la ca che t ^ cho va ca che kian soat cong.
Ca chi'tqi chd
Kich thich tiet cac chat adenosine (m6t yeii to tnmg tam fham gia vao tac dung chcmg viem ciia cham ciiu), cac cytokine (thiet lap lai su can bang tii su mat can bang giua cac cytokine kich thich viem va cac cytokine
61
NgJiien cuu Y hpc Y Hpc TP. Hb Chi M i n h * T?p 20 * Sb 6 * 2016
chbng viem). Nitric oxide (vai tro then chot trong CO che cai thien vi tuan hoan, gay gian mach, lam tang tuan hoan tai cho).
Co chekiem sodt c0n^'
Trong nghien ciiu benh nhan dugc cham ctiu va tao dugc cam giac dac khi tot (cang, nang, tlic, moi va khong dau). Khi cam giac dac khi dupe tao ra da lam con duong dan truyen trong Lem (cam giac sau) dupe kich hoat thi con duong dan truyen ngoai Lem (cam giac dau) bi lie die mpt phan hay hoan toan.
Sau 10 ngay dieu tri cubi, nhan thay rang phuong phap cham A thi huyet 6 nhom chiing khong tiep tuc mang lai hieu qua giam dau, trong khi do phuong phap dien diam cac huyet Binh phong, Kien ngung, Kien Ueu, Ty nhu tiep tue mang lai hieu qua giam dau. Co the U giai cho dieu nay rang:
O nhom chiing, phuong phap dien cham A thi huyet chi mang M ^ qua giam dau 6 miic dp nhat djnh, khong tiep tuc keo dai tac dung giam dau them trong Ueu trinh cuoi.
Trong khi do, 6 nhom can thiep tiep tuc eo hieu qua giam dau cho benh nhan vi phuang phap dien cham tac dgng len cac huyet Binh phong, Ki&n ngung, Kien Ueu, Ty nhu da giiip kich thich 2 ca: co tren gai va ca mii vai, giup cai thien siic co gbc chi tren, tir do giiip on dinh khop vai, giam su keo cang bao khap nen tiep tuc cai thien dupe miic dp dau vai cho benh nhan.
Giai thich ciia chiing toi ding phii hgp voi ket qua trong khoa luan tbt nghiep ciia tac gia Nguyen Hong Hanh khi nghien ciiu ve h i ^ qua cai thien siic ca chi tren ciia phirong phap dien cham cac huyet Binh phong, Kien ngung, Kien Ueu, Ty nhu tren benh nhan sau dot quy giai doan Uet m a n . Ket qua nghiai ciiu cua Nguyen Hong H?nh cho thay rang: tai thcri dian TO (bat dau can thiep), va thod dian Tl (sau 10 ngay can thiep): sy khac biet siic ca goc chi tren gjiia nhom chiing va nhom can thiep khong c6 y nglua thbng ke voi p> 0.05. Tuy nhien, bat dau tir
thai diem T2 (sau 20 ngay can thiep), su khac biet siic ca goc chi tren giira 2 nhom nghien ciiu CO y nghia thong ke voi p< 0,05.
So sanh mik do dau vai theo thang do dian dau ta 0 den 10 giUa 2 nhdm chiing vd can thiep
Ket qua tren cho thay giiia 2 nhom chiing va can thiep co su khac biet ve d i a n so dau vai trung binh sau tiing Ip trinh dfeu tri. Nhu vay phuong phap di$n cham cac huyet Binh Phong, Kien Ngung, Kien Lieu, Ty Nhu co hi&u qua hon phuong phap dien cham A thi huy|t trong viec giam dau vai eho benh nhan sau dot quy trong giai doan Uet mem.
Dieu nay ciing phii hop voi ket qua ciia cac de tai dimg phuong phap kich thich dien than kinh CO tac dpng len 2 co mii vai va co tren gai de cai thien finh trang dau vai cho benh nhan sau dot quy:
Yu DT va Chae J (2001), "Kich ttiich dien than kinh co duoi da dieu tri ban trat khop vai va dau vai cho benh nhan sau dot quy" (10):
nghien ciiu thuc hien phuang phap kich thich dien than kinh ca tac ddng len ca mii vai sau va CO tren gai 6 gia mgt ngay trong 6 hian cho thay CO hieu qua cai thien Hnh trang dau dio benh nhan. Dian dau trung binh theo fhang do diem dau Brief Pain Uiventory (BPI) sau 6 tuan dieu tri giam voi p < 0,05 (p = 0,0115).
Chantraine A va cpng su (1999), "Dau vai va mat chiic nang vai trong Uet nira nguoi: hieu qua ciia kich ttiich dien than kinh co" (3): nhom dugc dieu tri bang Ueu phap thong thuang cpng voi kich thich dien than kinh ca da cho thay sir cai thien hon dang ke so voi cac nhom dupe di!&u tri thong ttiuong 6 ti le giam dau (80,7% voi 55.1%) voi p < 0,01.
Ban l u ^ ve s u khac biet cua 2 phuong phap cham cuu
Ca 2 phucmg phap deu cung liic van dung dugc cac yeu to sau trong each chgn huyet
62
Y Hpc TP. Hb Chi Minh * Tap 20 * Sb 6 * 2016 NghiSn cuu Y hpc
Ca 2 nhom deu sii dung tac dung diira benh ciia huyet vi, vira ap dyng tac dung giam dau ciia dien cham.
Nhu vay, ca 2 nhom nghien ciiu deu da su dung mpt each hieu qua tac dung giam dau ciia cham ciiu qua 2 ca che chinh do la co che tai cho va CO che kiem soat cbngf''.
Diem khac biet chii yeu nhat giira 2 phuang phap do chinh la phuang phap chgn huyet:
Phirong phap sir dung trong nhom chiing la phuong phap cham ciiu giam dau tmyen thong tnroc gio da sir dung: phuang phap cham A fhi huyet Trong khi do, phuang phap sii dung trong nhom can thiep la phuong phap dien cham cac huyet Binh phong, Kien ngung, Kien Ueu, Ty nhu. Cae huyet nay dugc chon theo ca sa Iy luan: huyet Binh phong va Kien ngung thuoc CO tren gai, Kien ngung va Ty nhu thugc CO mil vai Cac nghien ciiu da cho thay hai ca diu dibt chiu trach nhiem trong viec gay ra ban trat khap vai 6 benh nhan Uet niia nguoi sau dot quy la co tren gai va co mu vai (bo sau). Hai ea nay binh Ihuong co diiic nang keo xuang eanh tay Ien tren va ep chat ^ u tren xuang canh tay vao 6 chao, gjiip dibng lai trgng lire ciia xuong canh tay. Khi 2 ea nay cai thien tot chiic nang se giiip bn dinh khap vai, tranh viec keo cang bao khop, tir do gjam dau vai cho benh nhan*^'. E>ieu nay ding phu hgp vai cac nghien ciiu t r a i the gioi ve phuang phap kich thich dien than kinh ca khong qua da len 2 ea tren gai va mil vai cho thay hieu qua tuong doi trong viec giam dau vai cho benh nhan sau dgt quyi-3.4.9,io) Xuy nhien, phuong phap kidi thidi dien than kinh co duoc cac tac gia tren the giai sii dung voi ky thuat kha phiic tap va ton nhieu thbi gian. Trong nghien oiu ciia Faghri (1994)w va Chantraine A (1999)<3) fhcri gian kich thich dien trong mgt ngay len toi 6
gio. Trong khi do, phuong phap dien cham ciia chiing toi, thoi gian kich thich trong mpt Kn cham keo dai khoang 20 phiit, moi ngay cham 1 Ian. Dieu nay cho thay phuong phap aia chung toi don gjan va tiet kiem thoi gian cho nhan vien y te va benh nhan hon so vai phuang phap kich thich dien than kinh ca, ma van mang lai hi?u qua giam dau vai cho benh nhan sau dot quy.
Tuy nhien, de tai diung toi khi thirc hi^n da chua thbng ke dugc Ueu cac huyet Binh phong, Kien ngung, Kien Ueu, Ty nhu co phai ciing la A thi huyet trong nhom can thiep hay khong, va diian ti le bao nhieu. Day ciing la diem yeu ciia de tai khi khang dinh rang phuang phap dien diam cac huyet Binh phong, Kien ngung, Kien U^u, Ty nhu giam dau vai tot ban cham A ttij huy#t.
KET LUAN
Phuang phap dien diam cac huyet Binh phong, Kien ngung, Kien Ueu, Ty nhu giiip mang lai hieu qua giam dau vai sau dot quy giai dgan liet mem.
TAI LIEU THAM KHAO
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