NGHIEN CQU ANH HUlOrNG CUA VIEN NANG NAO THONG LAC DOI von CHUfD NANG GAN VA THAN TREN DONG VAT THUC NGHIEM
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N G U Y I N MINH HA, N G U Y I N CONG THL/C Vien Y hgc CO truyen Quin dpi
TOM TAT
Vien nang Nao thdng lac dugc dimg danh gia anh hudng chUc ning gan vi than tren tho thuc nghiem . Ket qua nghien ciru cho tha'y tren ca hai id thd, mgt Id uong vien nang Nao thdng lac 0,28g/kg/ngay (tuang duang vdi lieu dung cho ngudi, tinh theo he so 4) vi mdt Id uong lieu cao gap 3 lan ( 0,84g/kg/ngiy) lien tgc trong 4 tuan: Khdng iam thay doi ke't qua cac xet nghiem dinh gia chUc ning gan (SGPT, SGOT, bilirubin toin phan, protein) va chUc ning than (urea vi creatinin) cCia tho.
TU khda: Vien nang Nao thdng lac, chUc ning gan va than
SUMMARY
The capsule of Nao thong lac was used to evaluate the rabbits' liver and kidney function, it was shown in the result that after 4 weeks of using Duong Tam Dan capsule no changes were seen in the results of experiments evaluating liver function (SGPT, SGOT, total bilirubin, and protein) and kidney function (urea and creatinin) in the both two groups (one used dose of 0.28g/kg/ per day, equivalent to human dose and one used dose of 0.84g/kg/ per day).
Keywords: capsule of Nao thong lac, liver and kidney function
OAT VAN OE
Vien nang Nao thdng lac dUde nghien culi bao ehe tu bai thudc "Bo dUdng hoan ngu thang" gdm eae vj thudc: Hoang ky, OUdng quy, Xich thUde, Dia long, Xuyen khung, Hdng hoa, Dao nhan de dieu trj chUng benh ban than bat toai, khau nhan oa ta, trd ngai ngdn ngU... sau triing phong (di ehUng liet nCra ngudi, mieng meo mat seeh, ndi ngpng...do dot quj nao) cua y hoc cd truyen ...[2][3]. Chiing tdi da tien hanh nghien cCfu doc tinh cap va anh hudng eua vien nang Nao thdng lac ddi vdi trang thai chung va chi sd huye't hpe tren dpng vat thue nghiem. De ed ed sd khoa hpe chae chan ve dp an toan cua vien nang Nao thdng lac, trude khi tien hanh nghien cUu va danh gia hieu qua eua thudc tren lam sang[1]. Chiing tdi tien hanh nghien cifu de tdi vdi muc tieu: Nghien cUu anh hudng cua thuoc den chUc nang gan va than tren ddng vat thuc nghiem.
DOI TUONG VA PHUONG PHAP NGHIEN CLfU 1. Nguyen lieu va ddi tUdng nghien ciJu
* Nguyen lieu: eae vi thudc: Hoang ky, OUdng quy, Xich thUdc, Dja long, Xuyen khung, Hdng hoa, Dao nhan dUdc bao ehe, chief suat, cd cao, sa'y khd...
theo qui trinh thdng nha't tai khoa dUde Vien Y hpe cd truyen Quan dpi vd dUdc ddng dUdi dang vien nang, trUde khi dung hda vdi nude am de'n dang Idng thich hdp eho thi nghiem.
* Dgng vit thuc nghiem:
- Thd ea hai gidng, khoe manh, trpng lUdng tU 2,0 - 2,5kg do Trung tam Chan nudi Vien Kiem nghiem Bp Y te eung cap. Dong vat thue nghiem dUdc nudi tai phdng thi nghiem Vien kiem nghiem thudc trung Udng, bang thUe an chuan ddnh eho mdi loai, udng nude tu do.
- Hda chat va thie't bi: Kit dinh lUdng eac enzym va chat chuyen hoa trong mau: ALT, AST, bilirubin toan phan, protein toan phan, cholesterol vd creatinin cua hang Hospitex Diagnostics (Italy) vd hang DIALAB GmbH (do), djnh lUdng tren may Screen master cua hang Hospitex Diagnostics (Italy).
2. Phutifng phap nghien cuv
Thd dUde chia thanh 3 Id, mdi Id 7 eon, mdi eon nhd't rieng mdt chudng.
Ld chUng (n = 7): udng dung dich NaCI 0,9% lieu 5ml/kg/ngay;
Ld thLf 1 (n = 7): udng thudc thCf Nao thdng lac lieu 0,28g/kg/ngay;
Ld thCf 2 (n = 7): udng thudc thCf Nao thdng lac lieu 0,84g/kg/ngay (gap 3 lan lieu 16 thCr 1).
Thd d ca 3 Id dUdc udng dung dich NaCI 0,9%
hoac thudc nghien cUu trong 4 tuan lien, mdi ngdy mdt lan vao 8 gid sang vdi the tich 5ml/kg.
Thd dUde theo doi cac ehi sd danh gia ehUe ndng gan: Djnh lUdng hoat dp cac transaminase (SGPT, SGOT), ndng dp Bilirubin toan phan, protein; danh gia ehUe nang than thdng qua dinh lUdng creatinin va urea. Cae chi sd tren dUde theo ddi tai 2 thdi diem trude dung thudc va sau 28 ngay udng thudc lien tue.
So sanh ke't qua cua nhdm thCf va nhdm chifng theo phUdng phap thdng ke.
3. PhUdng phap xur ly so' lieu
Cae sd lieu nghien eUu dUde XLf 1^ thdng ke theo phUdng phap t-test Student vd test trudc sau (Avant- Apres). Su khac biet cd y nghia khi p < 0,05.
KET QUA NGHIEN CLfU
1. Ve chdc nang gan: di ddnh gid anh hudng cua thudc tdi chUe nang gan ehung tdi dinh lUdng hoat dp SGPT, SGOT, ham lUdng Bilirubin toan phan, protein.
Bang 1: Anh hudng cua vien nang Nao thdng lac de'n hoat dd SGPT trong mau thd
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Thdi gian Trudc udng
thuoc Sau 4 tuan uong thuoc P (sau 4
tuan)
Hoat do SGPT (Ul/L) Lo chimg
( X ± SD) 82,1 ±
15,8 94,0 +
22,3
Lo thLf 1 ( X± SD)
82,0 ± 17,3 98,1 ±
41,1 P C . T , > 0 , 0 5
L 6 t h L f 2 ( X± SD)
82,3 + 17,6 79,3 ±
20,7 Pc.T2>0,05
P (trudc thi nghiem) P T , . C > 0 , 0 5 P T 2 . C > 0 , 0 5
dinh lUdng urea va creatinin trong huyet thanh Bang 5: Anh hudng eua vien nang Nao thdng lac
Ke't qua d bang 1 cho tha'y: hoat do SGPT d Id thCf 1 vd Id thLf 2 deu khdng ed sU khac biet cd ^ nghTa so vdi Id chifng ea thdi diem trUdc va sau 4 tuan udng vien nang vien nang Nao thdng lac (p > 0,05).
Bang 2: Anh hUdng cua vien nang Nao thdng lac den hoat dd SGOT trong mau thd
Thdi gian Trudc udng
thudc Sau 4 tuan udng thuoc P (sau 4
tuan)
Hoat do S G O T (Ul/L) Lo chifng
( X± SD) 66,7 ±
15,5 71,4 ±
27,2
Lo thCr 1 ( X+ SD)
60,6 f 15,8 71,3 ±
33,5 Pc-Ti>0,05
Lo thCf 2 ( X ± SD)
64,3 ± 18,5 68,9 +
3 1 , 1 Pc.T2>0,05
' P (trudc thi nghiem) P T I . C > 0 , 0 5 PT2.C;>0,05
Ke't qua d bang 2 eho tha'y: hoat dp SGOT d Id thCr 1 vd Id thu" 2 deu khdng cd su khac biet c d y nghTa so vdi Id ehUng ca thdi diem trUde va sau 4 tuan udng vien nang Nao thdng lac (p>0,05).
Bang 3: Anh hudng cua vien nang Nao thdng lac de'n hdm lUdng bilirubin toan phan trong mau thd
Thdi gian Trudc uong
thudc Sau 4 tuan udng thuo'c P (sau 4
tuan)
Bilirubin toan phan (nmol/L) Lo chimg
( X± SD) 2,43 ±
0,58 3,57 +
1,33
Lo thLf 1 ( X ± SD)
3,29 + 1,18 2,57 ±
0,58 Pc.T,>0,05
Lo thLf 2 ( X± SD)
2,29 + 0,56 2,71 ±
0,56 Pc.T2>0,05
P (trudc thi nghiem) P T , . C > 0 , 0 5 P T 2 - C > 0 , 0 5
Ke't qua d bang 3 cho tha'y: ham lUdng Bilirubin todn phan d Id thCf 1 vd Id thu" 2 deu khdng ed sU khde biet ed y nghTa so vdi Id chifng ca thdi diem trUdc va sau 4 tuan udng thudc Nao thdng lac (p > 0,05).
Bang 4: Anh hudng eua vien nang Nao thdng lac de'n ham luqng protein todn phan trong mau thd
Thdi gian TrUdc udng
thuo'c Sau 4 tuan udng thudc P (sau 4
tuan)
Protein toan phan (g/L) Lo chimg
( X+ SD) 72,1 +
6,4 64,7 ±
6,4
Lo thLf 1 ( X+ SD)
66,6 ± 8,3 64,7 ±
9,5 P C . T , > 0 , 0 5
L 6 t h L r 2 ( X± SD)
71,1 ± 6,9 62,6 + 3,2 Pc-T2>0,05
P (trude thi nghiem) P T I . C > 0 , 0 5 P T 2 . C > 0 , 0 5
Ke't qua d bang 4 eho tha'y: ham lUdng protein d Id thilf 1 vd Id thCr 2 deu khdng ed sU khac biet ed y nghTa so vdi Id chifng ea trUdc va sau 4 tuan udng thudc Nao thdng lac (p > 0,05).
3.2. Ve chiirc nang than: De theo ddi anh hudng cua thudc tdi chUe nang loc eua eau than chung tdi
Thdi gian
TrUdc udng thuoc Sau 4 tuan uong thudc P (sau 4
tuan)
Lo ehUng ( X± SD) 4,71 ±
0,81.
5,57 ± 1,02
(mmol/L) Lo thCr 1 ( X+ SD)
4,44 + 0,68 4,89 +
0,65 Pc.T,>0,05
Urea L 6 t h L r 2 ( X+ SD)
4,76 ± 0,29 4,37 ±
0,57 Pc.T2>0,05
P (trudc thi nghiem) P T , . C > 0 . 0 5 P T 2 - C > 0 , 0 5
^--.
Ke't qua d bang 5 eho tha'y: hdm lUdng urea d Id thCr 1 vd Id thLf 2 deu khdng ed su khac biet cd </ nghTa so vdi Id chUng ca trUdc va sau 4 tuan udng thudc Nao thdng lac (p > 0,05).
Bang 6: Anh hudng eua vien nang Nao thdng lac de'n ham lugng creatinin trong mau thd
Thdi gian Trudc uong
thudc Sau 2 tuan udng thudc P (sau 4
tuan)
Creatinin (nmol/dL) Lo chimg
( X+ SD) 113,0 +
18,2 125,0 ±
16,5
Lo thU 1 ( X ± SD)
135,0 + 21,1 140,1 +
14,2 Pc.T,>0,05
Lo thU 2 ( X+ SD)
118,4 ± 10,9 132,9 ±
21,4 PcNT2>0,05
P (trudc thi nghiem) P T I . C > 0 , 0 5 P T 2 . C > 0 . 0 5
Ke't qua d bang 6 cho tha'y: ham lUdng Creatinin b 16 thCi' Ivd Id thCf 2 deu khdng cd sU khac biet ed y -nghTa so vdi Id chUng ca trudc va sau 4 tuan udng
thudc Nao thdng lac (p > 0,05).
BAN LUAN *' 1. Anh hifdng cua vien nang Nao thong lac den
chdt nang gan
Trong cd the, gan la cd quan dam nhan nhieu chUe nang ra't quan trong. Khi dua thudc vao ed the ed the gay doe vdi gan, lam anh hUdng de'n chUe nang gan. Vi vay, khi danh gia doc tinh eija thudc, nghien eifu anh hudng eua thudc ddi vdi chUe nang gan la rat can thie't.
Ke't qua nghien cUu d eac bang tU 1 de'n 4 cho tha'y: Tren ea hai Id thd, mot Id udng vien nang Nao thdng lac 0,28g/kg/ngay (tUdng dUdng vdi lieu dung eho ngudi, tinh theo he sd 4) va mot 16 udng lieu cao gap 3 lan (0,84g/kg/ngay) lien tue trong 4 tuan: Khdng lam thay ddi ke't qua cae xet nghiem danh gia ehUc nang gan (SGPT, SGOT, Bilirubin toan phan. Protein toan phan) dieu dd chUng td vien nang Nao thdng lac khong lam anh hudng tdi chUe nang gan.
2. Anh hudng cua vien nang Nao thong lac de'n chdt nang thin
Than Id cd quan bai tiet cua cd the. Nhu md than rat d l bi tdn thUdng bdi eac chat ndi sinh va ngoai sinh. Vi vay, khi dUa thudc vao ed the ed the gay ddc, lam tdn thUdng than, tU dd anh hudng de'n chUe nang than, danh gia chUe nang than sau khi diing thudc thudng djnh lUdng creatinin mau. Creatinin la thanh phan dam trong mau dn dinh nha't, hau nhu khong
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phu thudc vao che do an hoac nhCfng thay ddi sinh ly ma ehi phu thupc vao kha nang dao thai cua than. Khi cau than bi tdn thUdng, ndng dp creatinin mau tang sdm hdn ure.
Trong nghien cifu cua chiing tdi, urea va creatinin trong mau thd sau 4 tuan udng vien nang Nao thong lac d ca 2 lieu 0,28g/kg va 0,84g/kg khdng cd sU thay ddi so vdi trUde khi dung thudc vd so vdi 16 chUng, chifng td vien nang Nao thong lac vdi cae lieu tren khong anh hudng tdi chUe nang Ipc eua cau than.
KET LUAN
Vien nang Nao thdng lac vdi lieu 0,28g/kg/ngay (lieu tUdng dUdng vdi lieu dung tren ngUdi) va 0,84g/kg/ngay (gap 3 lan lieu dung tren ngudi) udng lien tue 4 tuan: Ta't ca cac chi sd theo ddi ve chUc
nang gan (hoat dp SGPT, SGOT, ndng dp Bilirubin todn phan. Protein toan phan) vd chUe nang than (Urea vd Creatinin huye't thanh) deu nam trong gidi han binh thudng, khdng cd sU khde biet rd ret so vdi 16 chifng.
TAI LIEU THAM KHAO
1. Bo y te (1996), Hudng din kem theo quyet djnh sd 371/BYT-QD ngay 12/3/1996 ve xdc djnh dp an toan eho thudc ed truyen Bo Y te.
2. Giang Khac Minh, Bao Minh Hue. Gian minh phUdng te tU dien (Tai ban lan 2). NXB Khoa hoe ky thudt Thupng Hai, 2002: 649 (tilng Trung).
3. Cau Bdi Nhien. Tuyen tap phUdng thudc Tmng y ndi tieng cdc trieu dai. NXB TU thu ThUdng Hai, 1998:
483 (tieng Trung).
CHAN DOAN VA DIEU TRj PHAU THUAT UNG THlTDAI TRlA; TRANG TAI BENH VIEN HOU NGHj (GIAI DOAN 2008 - 2000)
HOANG VIET D O N G , N G U Y I N QUOC DUNG Benh Vien HQu Nghi
TOM TAT:
Dat van de: UTDTT dUng hang dau trong ung thu dudng tieu hda. Trieu chifng khdng rd ring trif khi cd bien chifng. Chan doan bing ndi soi dai trang va sinh thiet. Dieu trj phau thuat la chij ye'u, hda xa trj cai thien thdi gian song sau mo. NC rut ra mdt so kinh nghiem trong chan doin vi dieu trj phiu thuat UTDTT. Doi tupng va phuang phap: NC tien cifu tat ca cic trudng hgp phiu thuat UTDTT tit 1/2008 de'n
12/2009 tai Benh vien Hutu Nghi. Kei qua: 114 trudng hgp UTDTT duac phiu thuat: nam 78,9Vo, nO 21,1%o;
t^ le nCf/nam: 1/3,75. Tuoi trung binh 65,75 ±12,53, nho nhat 22, Idn nhat 88. Ye'u to nguy ca: hiit thuoc li 23,7%,, viem dai tring 12,3%,. Phoi hgp: ting huyet ip 37,7%,, benh phoi man tinh 14%,, u xa tien liet tuye'n 14%,, dii dudng 9,6%,, benh ly tim mach 7%,...Lam sing: dau bung va RLTH 48,2%,, la miu 42,1%%, tic rudt 12,3% %,, thieu miu 34,7%o, CEA va CAI9-9 tang 55,7%o. Ndi soi dai trang 86,8%o. Md benh hgc: UTBM tuyen 85,9%o, ung thu tuyen nhay
12,3%,, u lympho 0,9%, di cin khdng biet hda tU dudng tieu hda 0,9%. Giai doan benh: Dukes A
15,8%o, Dukes B 29,8%o, Dukes C vi D 54,4%,. Mo cap cifu 13, •?%, md' cd chuan bj 86,9%o, cd hd trg ngi soi 7,9%,. Vj tri u: dai trang phai 14,9%,, dai tring ngang 11,4%, dai trang trii 32,5%o, true tring 37,7%o, u dong thdi 3,5%. Phau thuat cit u noi ngay thi dau 63,•/%, caf u iam HMNT 16,7%,, phiu thuat Hartmann 14,9%o, khdng cit u chi lam HMNT4,4%o, noi tat 0,9%,.
Bien chifng sau mo 12,3%o, t^ le tCf vong 1,7yo. Phoi hgp hda xa tri sau mo 52,6%o. Kit luan: UTDTT vin la mdt thach thUc trong chan doin sdm va dieu tri.
Dieu tri phau thuat phu thudc vao giai doan benh vi tinh trang toin than. Phiu thuat ket hgp vdi hda chat sau mo la md hinh phii hgp tai Benh vien HOu Nghj.
Tif khda: UTDTT, Benh vien HCfu Nghj.
SUMMARY:
Background and aims: colorectal cancer is the most common malignancy in the gastrointestinal tract. It does not have any eariy signs. Unless a patient presents with a tumor complication. Diagnosis is typically made by colonoscopy and biopsy. Surgery is the most common fonv of colorectal cancer treatment.
Postoperative chemoradiotherapy was shown to improve survival rates. The aim of this study was to report our experience in diagnosis and management Material and Method: A prospective study of all surgical cases due to colorectal cancer in our institution from 1/2008 to 12/2009. Results: 114 patients who have been surgery for colorectal cancer, males 78.9%, and females 21.1%o, female/male ratio: 1/3.75. These patients, aged from 22 to 88 years, mean age: 65.75
±12.53. Risk factors included: smoking history 23.7Vo, ulcerative colitis 12.3%,. Associated with: hypertension 37.7%,, chronic obstructive pulmonary disease 14%,, benign prostatic hypertension 14%o, diabetes 9.6%,, cardiovascular diseases 7%... Signs and symptoms:
abdominal pain and bowel habits is highest rate (48.2%o), lower gastrointestinal bleeding 42.1%, obstructive signs 12.3%,, anemia 34.7%,, increased CEA and CA19-9 level
55.7%,. Colonoscopy with biopsy 86.8%o.
Histologic classification: adenocarcinoma 85.9%o, mucinous carcinoma 12.3%,;' lynphoma 0.9%o, undifferentiated metastasis from gastrointestinal tract 0.9%,. Stage I (Dukes A) 15.8%o, stage II (Dukes B) 29.8%, stage lll-IV (Dukes C & D) 54.4%o. Urgent surgery was performed in 13.1%,; selective surgery:
86.9%<,, iaparoscopy-assisted colectomy 7.9%o. Side tumor: the right colon 14.9%o, the transverse colon
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