CONG TRINH NGHIEN ClfU
NGHIBI CUU HiNH THAI HOC LAM SANG CUA 106 DBUH NHAN SEO HB^
THANH KHi QUAN TAI DBVH VIBV TAI MUI HONG TRUNG UONG
Quich Thi Can' TOM T A T
Muc tiiu: nghien cdu die diem lam sang va hinh thai tdn thUdng cua seo hep thanh khf quin (SHTKQ) mic phai DaS titdng va phUdng phip: mo ta hoi cdu va tiin cdu, 106 benh nhan (BN) SHTKQ dddc chan doin va dieu tri tai BV Tal Mul Hgng trung Udng td thing 01/2002 din 12/2006. Kit qua: nam gidl chiim 68,9%, ndgidl chiim 31,1%. Tuol b-ung binh 31,81 ± 8,95 tuol Trieu ehuhg lam sang ndi tiat eua BN luc vao vien la: khd rut ong 50,9%, khd thd 28,3%. Vi tri ton thUdng hay gip d thanh quan: thanh mon 37,2%, ha thanh mon 31,4%, toan bg thanh mon 27,5%. Vi trf ton thuang gap d khf quan ddn thuan 73,2%, thanh khf quan 16,2%. Hinh thil ton thUdng hay gap: xa seo 45,3%, sap sun 25,5%, mang 11,3%.
Ton thUdng theo Cotton: Cotton I (1,9%), Cotton li (32,1%), Cotton III (43,4%), Cotton IV (22,6%). Chieu dil cua seo hep: < 1cm (37,8%), l-2em (43,4%), 2-3em (17,9%). Kit luan:
SHTKQ thudng gap d nam gidl, trieu ehuhg lam sang ndi bat la khd rut ong va khd thd, tdn thUdng tal khf quan la hay gip nhat, tdn thUdng mdc do II va III theo phan do Cotton ehlim ty IS eao nhat Chieu dai cua tdn thUdng thudng gap nhat la <lcm va >l-2em.
SUMMARY
Study on clinical features and morphological lesions of 106 cases of laryngotracheal stenosis a t National ENT Hospital
Objective: study clinical features and morphological lesion of acquired laryngotracheal stenosis. Method: a retrospective study was performed on 106 patients with laryngotracheal stenosis from 01/2002 to 12/2006. Results: Male made up 68,9% and female made up 31,1%.
Average age was 31,81 ± 8,95. Clinical features: deeannulatlon failure occurred In 50,9%, dyspnea In 28,3%. Lesions mostly found In larynx Included glottic (37,2%), followed by subglottic (31,4%) and whole laryngeal (27,5%). Tracheal stenosis (73,2%), laryngotracheal (16,2%). Most common leslpns were: fibrosis (45,3%), cartilage disruption (25,5%), Cotton grade classification: Cotton I (1,9%), Cotton II (32,1%), Cotton III (43,4%), Cotton IV (22,6%). Stenosis length: <lcm (37,8%), l-2cm (43,4%), 2-3em (17,9%). Conclusion:
laryngotracheal stenosis are more common In men, clinical features are deeannulatlon failure and dyspnea, tracheal stenosis is the most common. Cotton grade II and III make up the majority. Stenosis lengths are mostiy found to be <lem and >l-2em.
I . OAT VAN DE
SHTKQ do nhieu nguyen nhan khac nhau gay nen. Cac nguyen nhin nay thay ddi theo thdi gian va ed sif khac biet giifa cie nUde phit trien vdi cic nu'dc dang phit frien. Hien nay, tren the gidl dieu tri SHTK^ vin la 1 van de rat khd khin va phifc tap. Y van the gidi da de cap nhieu phUdng phip diiai frj SHTKQ, song chua cd phUdng phap nao hoan thien eho t i t c l d e BN. Vi vay, SHTKQ ludn I I de tai duWC franh luan d hau het eac hdi nghj chuyen nganh trong khu vifc va qudc te. SU da dang ve h'nh tiili lam sang va each thifc dieu trj dUde ghi nhan trong y v i n cho thay: viee nghien ciili die diem lam sang va hinh thai hpe ciia SHTKQ la rat can thiet de tim ra mdt phu'dng phip dieu trj phii hdp eho tiitig loal tdn thudng do. Do dd, chiing tdi tien hanh
'TS., Benh yilnjrai Mui Hgng Trung uWng 1 5
nghien cifu vdi eae mue tieu: nghien ciili die diem lam sang va die diem hinh thai tdn thudng ciia SHTKQ mic phai.
I I . D O I TUONG VA PHU'ONG PHAP 1, Doi tUdng nghien cudi
106 BN SHTKQ dUdc chan doan va dieu tri tai BV Tal Mul Hpng frung Udng hj': 01/2002 dien 12/2006 va dUdc chia lam 2 nhdm:
- Nhdm hoi euU (9 BN): la nhiitig BN dUdc dian doan SFfTXQ tif thing 1 den tiiang 12 nim 2002.
Nhdm tien cifu (97 BN): la nhifng BN dUde chan doan SHTKQ tif thing 1/2003 den ttiang 12/2006.
* Tieu chuan lUa chgn:
- Nhdm hoi cifu: hd sd ghi chep rd rang, ed ket qua: ndi soi, cd nghieng, ehup eat ldp vi ti'nh (CLVT). Tie gia tham gia phau thuat va theo ddi BN.
- Nhdm tien ailj: benh an xay dutig theo miu, cd ket qua: ndi soi, cd nghieng, ehup CLVT (coronal va axial l i t d t 3mm).
* Tieu chuan loai trd:
BN dUde chan doin la hep thanh khf quin (TKQ) bam sinh hole chen ep tif ngoai vl vao.
2. PhUdng phip nghien cUu
2.1. Thiit ki nghien cdU: md ta hdi cifu va tien cifu.
2.2. Cic budc tiin hanh:
Odi vdi nhdm hoi aili: thu thap d c sd lieu tif hd sd dil tieu chuan lift chpn va miu benh an nghien cifu
- Ddi vdi nhdm tien eifU:
+ Hdl benh sif va tien sif
+ Thim khim phit hien d c trieu chifng lim sang nhu" khd thd, khan tieng,...
+ Ndi soi thanh khi phe quan bang dng ndi soi eifng hole mem de dlnh gia va phan loai tdn thUdng theo Cotton
+ Chup d t Idp vi tfnh viing cd va tien hanh do chieu dai doan hep tren phim chup
+ Tat d d e sd lieu thu thap dUde deu dUdc ghi vao miu benh I n nghidn cifu
- Phan loai SHTKQ eiia Cotton [5]:
•I- Cotton I: Seo hep duidi 50% khau kfnh du'dng thd
+ Cotton I I : Seo hep tii' 51-70% khau kfnh dudng thd
+ Cotton III: Seo hep tii' 71-99% khau kfnh du'dng thd, vin nhan thay Idng dUdng thd
+ Cotton IV: Seo hep 100% khau kfnh dUdng thd, khdng edn nhan thay Idng du'dng thd
2.3. Xdlysoleu:dirq phai man Epi Info 6.04.
I I I . KET QUA ^
1. B$c diem lam sang cua SHTKQ micphai
1.1. Die diim vegldi:
Phan tid theo gidi: trong 106 BN du'dc dieu tii SHTKQ, thi nam gap nhieu hdn nif, tu'dng litig la 73 BN nam (68,9%) va 33 BN nif (31,1%).
1.2. Die diem ve tuol:
Phan bd theo tudi: tudi trung binh 31,81±8,95 tiJOi. Hay gap nhat tif 16 den 30 tudi (37,7%), tuoi nhd nhat la 18 thing va Idn tudi nhat la 76 tudi.
13. Trieu ehutig Hm sang cua SHTKQ mac phii:
Bang 1: Trieu chdhg lam sang oia SHTKQ micphai
Trieu chdng Kho nit ong (1) Khd ttid (2) Khothd, khanti0ig(3) Khan tieng (4) Tdng
SL 54 30 18 4 106
7 Z % 50,9 28,3 17,0 3,8 100
P Pl,2<0,01 Pl,3 <0,01
Khd nit dng I I trieu chifng chiem ty le cao nhat (50,9%), trieu chiilig khd thd eung hay gap chiem ty le 28,3% v l sif khie biet glQci t^
le khd riit dng v l khd thd cd y nghTa thdng ke vdi p<0,01. Trieu chifng khd thd kem theo khan tieng gap nhieu hdn so vdi trieu chifng khd thd ddn ttiuan (17,0% so vdi 3,8%) va sif khie biet nay cd y nghTa thdng ke vdi p<0,01.
1.4. Ty le SHTKQ cd benh nang kem theo:
Bang 2: Ty le SHTKQ co benh ning kem theo Cac benh ning kem theo
Suy gan Suy than Dai thao du'dng Tai bien maeh nao Chan thu'dng so nao {)ong kinh
Di chifng than kinh trung Udng sau tu'tif
Benh ho hap dudi San khoa Hen phe quan
Benh khac (liet tuy, viem nao,...) Khong a5 benh toan than nang Tong
SL 2 1 4 10 19 2 5 3 2 2 16 40 106
n %
1,9 0,9 3,8 9,4 17,9
1,9 4,7 2,8 1,9 1,9 15,1 37,8 100 SHTKQ thudng cd benh nang kem theo.
Trong do nhdm benh chan thudng sp nio kem theo SHTKQ chiem ty le cao nhat 17,9%. Ty le SHTKQ khdng ed benh toan than nang kem theo chi chiem 37,8% sd BN nghien cifu.
2. Die diem hinh thil hoc lam sing cua SHTKQ
2.1. Vl til ton OiUdng cua SHTKQ:
- Vi frf eiia eiia seo hep thanh quan ddn ttiuan: 35 trUdng hdp SHTQ cd 2 trUdng hdp seo hep fren ttianh mdn, 13 tru'dng hdp seo hep thanh mdn (10 trUdng hdp dfnh mep frifdc, 3 trudng hdp dfnh mep sau) va 11 trUdng hdp seo hep ha thanh mdn, 9 tru'dng hdp seo hep toan thanh mdn.
- Vj frf ciia SHTKQ.
Bang 3: Vi tri cua SHTKQ Vi tri ton thuVng Khf quan ddn thuan:
-Cao - Trung binh - Trung b'nh thap -Thap
Thanh khf quan Thanh quan+khf quan Tong
SL 52 31 7 4 10 12 7 71
7 1 % 73,2 59,6 13,5 Tfl 19,2 16,9 9,9 100 Vi fri ton thu'dng ciia SHTKQ tai khi quan ddn thuan chiem ty le cao nhat (73,2%). Tiep tiieo la tai ttianh khf quan (16,9%). Ty le phit hien thay tdn thUdng rieng re d 2 vi tri (thanh quan va khi quan) la ttiap nhat (9,9%).
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2.2. Hinh ffiii tdn tiiUOng thUe tiie:
Xd seo 45,3%, sap sun 25,5%, mang 11,3%, tieu khung sun 9,4%, siii 8,5%.
2.3. Phan loal theo Cotton:
Tdn thUdng Cotton III hay gip nhat 43,4%, Cottan I I 32,1%, Coti:on IV 22,6% va it gip nhat la Cotton 11,9%.
2.4. Chieu dai dia seo hep tien CL VT:
Bang 4: Chieu dai see hep tien CL VT Chieu dii
<lcm (1)
>l-2cm(2)
> 2-3 cm (3)
>3 cm (4) Tdng
n 40 46 19 1 106
TL<yo 37,8 43,4 17,9 0,9 100,0
P Pi,2>0,05 P2,3<0,01 Chieu dai eiia tdn thUdng hay gap nhat la
>l-2cm chiem ty le 43,4%, tdn thUdng <lcm cung thudng gip diiem ty le 37,8% ft gap hdn la tdn tiiUdng cd chieu dai >2-3em (17,9%).
Ton thUdng seo hep >3cm chiem ty le thap nhat (0,9%).
IV. BAN LUAN
1. D$c diem lam sing cua SHTKQ micphai
- Vetuol:
Trong ket qua nghien ciili ciia chung tdi, SHTKQ ed the gip d BN thude mpi lifa tiidi nhutig chu yeu gip tif 16 den 30 tiidi (chiem 37,7%). Day la life lUdng chfnh trong dd tudi lao ddng cho gia dinh va xa hdi. Do vay lifa tudi nay cd the gip riii ro cao hdn. Ket qui nghien cifu nay eung phii hdp vdi cdng bd ciia Grillo [7] va mdt sd nghien eifU frong nUde ciia Pham Khinh Hda [3], Quach Thj Can [1].
- Vegldi:
Theo ket qui nghien culi, ty le SHTKQ d nam gip 68,9%, nif 31,1%. Sif khac biet d dly od y nghia thdng ke (p<0,001). Cd le sif khac biet la do nam gidi thudng phai dam nhan nhiitig odng viec ning nhpc trong gia dnh va xa hdi.
M|t khIc, trong chifng mifc nao do, nam gidi d d d i sdng phdng tiing hdn so vdi'^nif gidi. Cd the vi nhiitig ly do nay ma nam gidi ro nguy cd bj SHTKQ cao hdn so vdi nif gidl. Ket qua nghien aiu oia chung tdi tu'dng tif vdi ket qui nghien ailj eiia Grillo [8] nam: 73,17%, nif: 26,83%.
Nghien ailj oia Pham Khinh Hda va Pham Thanh Sdn cung eho thay ty le SHTKQ gap nhieu d nam gidl hdn [3,4].
Tri^u ehutig lim sang ndi bat
Cd 50,9% BN vao vien vdi ly do khd nit dng sau d i t ndi khf quan (NKQ) hole md khf quan (MKQ). BN chan ttiu'dng viing dau mit ed, dutfc xii ly rap ciili d|t NKQ hole MKQ sau do khdng
nit dUde dng thd hole nit mdt vai ngay ra phai dat lai. Sau sif cd nay, BN i\i(ic girt ve BV Tai mul hpng de dieu tri tiep. Cd 45,3% BN vao vien vi khd thd frong dd khd thd ddn thuan la 28,3% cdn lai khd tiid, khan tieng la 17,0%.
Khan tieng ddn thuan khdng ed khd tiid gap 3,8%. Nguyen nhan chii yeu la do tdn thUdng dat NKQ va chan thUdng TKQ. Trieu chifng lam sang oia BN SHTKQ rat d l phit hien. Bleu hien ram rd bing d e hdi ehutig khd thd do ehft hep dudng hd hap tren hole khan tieng neu d tdn thUdng tai cd quan phit Im. Tren thifc te lam sang nhifng BN nhap vien vi khd thd, khan tieng, chiing tdi thudng khai tiiie tien sif chan thUdng hole d can thiep dUdng thd tif frUde, bude dau nghT tdi SHTKQ.
- Ty le SHTKQ cd benh nang kem theo.
Theo ket qua nghien cifu, 62,2% sd BN SHTKQ den vdi chiing tdi sau khi 6\i(ic dieu trj tif d c chuyen khoa: hoi sifc d p cifu ndi khoa, ngoai khoa, san khoa, nhi khoa,... hole chan thUdng chinh hinh. Sd BN niy cdn rat nhieu di chifng cua benh toin thin: liet nift ngUdi, tinh than tri tre, ddng kinh, dai dUdng, hd hap phu thudc hoin toan vao dng. Theo Wiafrak [10], d c benh ly toan thin cung la nguyen nhan din tdi tdn thUdng SHTKQ nang hdn nhutig cung la trieu chifng lam eho viee yiii ly SHTKQ phai &{i(3c can nhlc. Chung tdi khdng the xif ly SHTKQ tren BN cdn nguy cd phu thudc vao dng thd. Sau hdn me, d nhifng BN d tdn thUdng nao, sU xuat tiet, \i tre ddm rai, hdi chifng trao ngUdc la van de rat nang ne, lam cho phiu thuat chinh hinh TKQ bj that bai.
2. Die diem hinh thii hgc lam sing cua SHTKQ
- Qua ndi soi chiing tdi thay: ed 10/35 BN (28,6%) seo dfnh mep frUdc, 11/35 BN (31,4%) seo hep d ha thanh mdn, 9/35 BN (25,7%) tdn thUdng toan TQ. NhU vly, vai frd cua ndi soi TKQ bang dng eifng, mem de dlnh gia vj trf va mdc. dp tdn thUdng la rat quan frong trUde khi lap ke hoach chinh hinh TKQ.
Nhdm SHKQ gap 52/106 BN, frong dd 31BN SHKQ cao. Ton thUdng nay do d hai nguyen nhan dat NKQ va MKQ giy nen.
Nguyen nhan d i t NKQ thUdng do cd ehe I p life eiia bdng khf qua rang, chen ep gay hoai tif niem mac, mang sun va sun KQ. Nguyen nhan do MKQ du'dc giai thfch nhd mdt thieu hut khung sun tai lo MKQ, nhiem triing ket hdp lai gay hoai tif them khung sun. SHKQ hung b'nh va tmng binh thap tUdng dUdng vdi ddt sun 2, 3, 4 ciia KQ, day la vj tri xung quanh lo 17
MKQ. Grillo [8] edng bd sd lieu 178/503 BN cd seo hep tai lo md KQ trong nhdm BN rat ndi KQ, diiem 35% tUdng dUdng vdi sd lieu eiia ehiing tdi. SHKQ ttiap (KQ ngifc) gap 10/106 BN (9,4%). Dly la tdn ttiUdng do Ip life bdng khf oia dng thd hole dau dng thd ep sit vao thanh frUde KQ ngUe gay nen.
- Hinh ttiai ton tiiUdng tiiUc ttie: ehiing tdi phan chia hhh thai tdn ttiUdng ttiUe the cua SHTKQ ttianh d e ton ttiutJng siii (td chifc hat, polyp hole qui san tuyen), mIng mdng, xd seo day, sap thanh sun, tieu khung sun. Viee phan chia nay dift vio hinh Inh ndi soi TKQ eiing nhU phUdng tien chan doin hinh anh (phim X-quang cd nghieng, CT Sran). Ton thUdng gap nhieu nhat la xd seo 48/106 BN (45,3%) va d sif khac biet vdi d c h'nh thii khac d y nghia thdng ke (p<0,01). Qua fr'nh viem gay hoai tif td chifc nhd niem mac, mang sun, sau dd la SLf tai sinh d c sdi xd dudi niem mac, tao md xd giy ro keo lap Idng dUdng tiid. Day l l tdn tiiUdng ma Robert: [9] da nghien oili va rong bd rdng rai tif tiiap ky 80 d a tiie ky XX. Sap sun gip 27/106 BN (25,5%), khung sun thanh frifdc KQ sap vao Idng dudng thd. Theo nghien cifu ciia Govidan [6] thi qui fr'nh viem nhiem tif niem mac, mang sun, khung sun, gay nhuyen sun va lam sap khung sun la nguyen nhin chi'nh gay hep dUdng thd. Tdn thUdng la to chifc siii (u hat, polyp, qua san tuyen) va mang mdng la hai ton thUdng gap it nhat 8,5% va 11,3%. Cic ton tiiUdng nay rat phii hdp de lift chpn phUdng phip bao ton nhU ndi soi d t sui, rat mang dfnh. Tieu khung sun II tdn tiiUdng ning gip 10/106 BN (9,4%). Day la nhdm tdn thUdng m l Cotton [5], Grillo [7] md ta, lift chpn phUdng phip phiu thuat rat ndi mang lai hieu qua eao.
- Phan loai theo Cotton: theo ket qua nghien ciiu tdn ttiUdng Cotton III (bft lap tij' 71% den 99% Idng dUdng thd) gap 46/106 BN (chiem 43,4%) rao nhat Mifc dp tdn ttiu'dng Cottxsn I (mat 50% Idng d u ^ tiid) gap ft nhat: 2 BN (1,9%). SU khac biet giiici rac mifc dp tdn thu'dng ro y nghTa thdng ke. Mifc dp tdn ttiUdng theo Cotton dii rd dp tie dUdng thd tif tren 50% trd len. Oieu nay ro the giai tiifch du'dc mijfc dp khd thd tren lam sang. NhUng trong thifc te, ehu^ dii de danh gll mifc dp ning nhe d a tiJtig BN cu tiie. Viec tien lu'dng BN SHTKQ ron phu thudc vao h'nh tiili lim sang, chieu dai d a ton thuWng va ra vi tri d a tdn thUdng. Viee phan chia mifc dp ton thu'dng theo Cotton [5]
giiip rac nha phiu thuat tao h'nh TKQ lift chpn
mdt phUdng phip phiu thuat dung va tien lUdng dUdc ty le thanh rong trong tiitig nhdm tdn thUdng eu the. Dong thdi rac phiu thuat ve dudng thd ndi chung va tai thanh khf quan ndi rieng tn/dc hay sau phiu thuat ngoai viec danh gll h'nh thai tdn thUdng d n g can phii dUde tham dd ky ludng ve d e chifc ning hd hap va ttianh phan khf mlu [2].
- Chieu dai eua seo hep fren CLVT: chiing tdi chia chieu dai d a doan seo hep thanh 4 mifc dp khIc nhau: = 1cm, >l-2em, >2-3em,
>3cm. Chieu dii nay dUdc dlnh gia tren d e lat rat dpe va mdt sd tru'dng hdp dUde do tiifc tiep frong soi TKQ bang dng soi eifng. Nhdm tdn thUdng cd chieu dai >l-2cm chiem ty le rao nhat: 46/106 BN (43,4%). Nhdm cd chiSu dai tdn tiiUdng >2-3em ro 19/106 BN (17,9%). Sif khIc biet giifa hai nhdm nay ed y nghTa thdng ke (p=d,001). Trong dieu trj SHTKQ, sU tiianh d n g phu thudc vao d mifc dp tdn thUdng va chieu dai tdn thUdng. Neu mifc dp tdn thudng nang ma qua dai thi dd II yeu td tien lUdng xau va ngUde lai. Rat may man trong nghien dfu d a chung tdi, dp dai (dn thUdng >l-2cm chiem t / le rao nhat. Dly II dieu kien de cho ket qua nghien aili kha quan hdn.
Ket qua nghien cifu eiia Grillo [8], dp dai
>l-2cm d 73/503 BN, chiem 14,5%. NgUdc lai, d dp dai doan hep >2-3em gap 195/503 BN, chiem 38,8%. Ket qua nay khac vdi chiing tdi, d le do tic gia chpn ddi tUdng nghien cifu la nhutig BN nang frong seo hep KQ va phUdng phap j i h i u thuat chfnh la rat doan TKQ.
V. KET LUiBiN
1. Die diem lam sang
- Seo hep thanh khi quan gap d nam nhieu hdn nif. Lifa tudi gap nhieu nhat la tif 20-29 tudi.
- BN vio vien vdi d e trieu chifng khd thd, khan tieng va khd nit dng thd sau md khf quan.
- 62,2% sd BN seo hep thanh khf quan den BV Tai Mul Hpng dieu frj edn mang nhieu di chifng ciia benh toan thin nang nhu' dai thao dudng, tai bien maeh mau nao, chan ttiUdng sp nao,...
2. Die diem hinh thil ton thUdng cua SHTKQ
- Seo hep khf quan ddn thuan gip nhieu nhat (71/106 frifdng hdp).
H'nh thai tdn ttiUdng hay gip nhat la dang sd seo lap Idng du'dng thd (46/106 tnfdng hdp).
H'nh thai tdn thu'dng phan loai tiieo Cotton g|p nhieu la Cottan I I (43,4%).
- Chieu dai ton ttiu'dng >l-2cm chiem da sd.
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TAI UEU THAM KHAO
1. Quich Thj Can: Tm hieu nguyen nhan va danh gia ySL qua dieu tii s ^ hep TKQ giip tai Benh vien Tai Mui Hong Trung Udng. Luan vSn t^ nghiep Bac sy chuyen khoa dp n, Trudng Bai hoc YHa Ngi, 2001.^
2. Ngd Quy Chau: ThJm do thong khi phoi, cac hoi c h u ^ roi loan thong khi phoi va c^c ttianh phan khi m^u. T^iiieu dao tao mgt so chuyen deho hap, Benh vien Bach Mai, 2001, tr.247-255
3. Phfm Khdnh H6a: Tinh hinh seo hep thanh khi qucin, ifng dung va danh gia c^c phu'dng phap dieu tri. De till NCKH cap BQ, 2003
4. Ph^m Thanh Sdn: Phiu thu|t c3t noi sun nhan - khi quan v3 khi quan - khf quan trong dieu tn seo h?p ha thanh mon, khi quan. Luin an tot nghiep Bic sy chuyin khoa cap II, Trudng DH Y Dutfc Thinh pho Hd Chi Minh, 2000.
5. Cotton R.T.: Management of subglottic stenosis in infancy and childhood. Ann Otorhinol laryngotracheal,1978, 87, pp.649-657.
6. Govindan R.: Is tracheal stenosis caused by percutaneous tracheostomy different from that by surgical tracheostomy. The American college of chest physicians, 2005,127(3), pp.879-885.
Grillo H.C: Surgical approach to the trachea.
Thorax, 1972,28, pp. 667.
Grillo H.C: Tracheal replacement: a critical review. Ann thoracsurg, pp.73.
9. Robert E.W.: A prospective study of laryngotracheal sequelae in long-term intubation.
The Laryngoscope, 1994, 3, pp.367-375.
10. Wiatrak BJ. et aL: Laryngotracheal reconstruction.
American academy of otolaryngolory - Head and neck surgery. 1992. s
7.
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TiM HIEU TAC DUNG CUA CAC THUOC GIAN PHE QUAN THEO DUONG TlNH MACH TRONG DIEU TRj CON HBV PHE QUAN NANG
Trinh Manh Hung' TOM T A T
Muc tieu: tim hiiu mgt sd die diim lam sang d benh nhan (BN) hen phi quan (HPQ) nang^
va dinh gii tie dung, lieu thfeh hdp cua dc thudc glan phi quan trong cat edn HPQ nang. Dii tUdng vi lOiUdng phip: mo ta hdi cud, tiin cud, den 54 BN HPQ nang dddc dung salbutamol hoic diaphylllne bing bdm tiem dlin hoae tivyen tinh maeh, tU thing 8/2008-8/2011. Kit qui:
binh ehu yiu gip d nhdm tuol >60 din <70 (68,52%). Phoi ed nhieu ran rft va ran ngiy hoae phdi Im ning (100%); ed ti'm moi va dau chl (83,33%); tan sd thd ting nhanh (>30 Ian/phut);
nhip tim>120 Ian/phut va eo theco maeh dio; BN khd ndi hoae ndi ngit quang. Do bao hda oxy tiong mau (SpOi) glim chi edn khoang 65%; lull lUdng dinh giam cdn khoang 2,481/phut SoBN dt can eao nhat la khi dung salbutamol vdi lieu 15mg/24h hoae diaphylllne vdi lieu td 480mg- 960mg/24h. Tic dijng phu hay gap la ha kail miu (70,37%), ha eanxl miu (37,04%), m^eh nhanh (75,93%). Kit luan: tneu ehuhg hay gap nhat la phdi ed ran rit va ran ngiy hoae phoi Im ning. Dimg salbutamol lieu 15mg/24h hoic diaphylllne lieu 960mg/24h cho hieu qua eao nhat SUMMARY
To evaluate the effect of intravenously used bronchodilator drugs in treatment of severe bronchial asthma
Objective: to evaluate the dinical features In patients with severe bronchial asthma and effects, dosage of bmnchodilatiyr drugs to prevent severe bronchial asthma attacks. Methods: a retrospective study was conducted on 54 severe bronchial asthma patients provided with salbutamol or diaphylllne Intiavenously or through a syringe pump from 8/2008-8/2011 Results:
the most common age: >60-<70 (68.52%). Breathing sounds can be heard whooping ran, ran snoring or silent lung (100%); with blue lips and extiemltles (83.33%); Increased breatiiing frequency (>30 times/minute); heart rate> 120 beats/minute with commutation; difficult or intenvpted talking. Blood oxygen saturation (SpOz) level decreased to about 65%, peak espiratory flow to about 2.481/mlnute. The prevention ofastiima ati:aeks get the highest rate for patients who took salbutamol witii dosage ofl5mg/24h or diaphylllne with dosage of480mg/24h- 960mg/24h. Conclusions: the common symptoms are whooping ran, ran snoring or silent lung.
Dosage of salbutamol 15mg/24h or dlaphyllne 480mg-960mg/24h give highest efflelency.
LOATVANDE
Theo dinh nghTa ve HPQ, d 3 ed die chi'nh lam xuSt hien odn khd ttid la: qua fr'nh viem d|c hifu, ting ti'nh phin utig phe quin, die
*TS, Benh_yien HDuNahi
biet la sif ro that da cd frdn phe quin [1]. Vi vay, de itleu tri d n khd thd da HPQ, ngUdi ta thu'dng sif dung de loai thude gian phe quin:
nhdm kfch thi'di p2 (giao ram) hole nhdm 19
