NGHIEN CUU KHOA HOC
NGHIEN CQU CAN NGUYEN GAY D\ LfNG THUOC TAI BENH VIEN TRUNG UONG Q U A N DOI 108
La Thanh Ha', Ddng Van Em"
T6MTAT
Muc tieu: Xac djnh cic thudc gay dj dng tai Bdnh vidn T U Q D 108 td 7/2012 den 7/2013.
Doi tifong va phUcrng phip: 69 benh nhan dj dng da xae djnh ddpc nguyen nhin la do thudc bSng phuang phip tieu bach cau dac hieu.
Ket qud: Dj dng do khang sinh 26,1 % (eefuroxim 27,7%, amoxilin 22,1 %, biseptol 11,1 %...), giam dau ha sdt 19,2% (paracetamol 23,1%, alphachymo 23,1%, decolgen 15,3%..), nhdm thude tieu hda 17,4%
(cimetidin 66,7%, omeprazol 16,7%..), thude dieu trj goutte 14,5% (allopurinol 60%, colchicin 40%), thuoc bo 14,5% (vitamin 3B 20%, boganic 10%..), thudc dteu trj tim maeh 13,1% (amiorvaeoversyl deu 25%_), than kinh 11,6% (tegretol 25%,...), rdi loan chuyen hda md 7,3%, thudc chong dj dng 7,3%, d6ng y 5,8%, lao 1,5%.
Ket luan: Dj dng hay gap nhat nhdm khing sinh, tiep la nhdm giim dau ha sot khdng steroid, thuiSc tidu hda va ngay ca thudc chdng dj dng van cd the gay dj dng.
Tir khoa; Dj dng, dj dng thudc.
LDATVANDi
Di dng thudc (Drug allergy) la thuit ngdchuydn mdn ndi ve phin dng cOa ca the ddi vdi mdt loai thudc nao dd. Tat c i cic loai thuoc deu cd the cd nhdng phin dng phu khdng mong mudn, trong do cd di dng thudc. Cac loai thuoc thudc khing sinh, thude udng, thudc tidm, thudc dung ngoai, kem my pham... deu cd the giy dj dng. Ty le dj dng thudc trudc day td 2,5 den 3% din sd, den nay ty le tang len 7-8% v i cd xu hudng tang dan [1]. Cd rit nhieu kieu dj dng khic nhau. Cd loai xiy ra trong vdng mpt vai ngay den vai tuan sau khi dung thuoc. Khi dj dng thudng ed cae dau hieu nhu ngda, da dd, noi
*Hgcviin Y Duac hgc Co truyin ViitNam
**BenhvienTUQDI08
Phdn biin khoa hgc: PGS. TS. TRdn Lan Anh
38 I DA L i i u HOC S619 (Thang O6/2015)
mun phdng nudc... Mdt trong nhdng loai hlnh dj dng nguy hiem l i sde phin ve (anaphylaxis).
Phin dng cd hai ndi chung va dj dng thuoc ndi rieng d i ddpc nhidu tie gii trong va ngoSi nudc nghidn edu. Cae nghien edu da de cap nhieu khia eanh khac nhau va deu cho thiy tinh da dang, phdc tap cCia dj dng thudc.Theo Demoly va cpng su d i chi ra rang nhdng phin dng co hai do thuoc ndi chung va dj dng thuoc ndi ridng thi/csii dang cdn la mpt ginh nang la mpt thach thO'c vdi chuydn nganh dj dng [7].
Tai Viet Nam, mot so tie gii da nghidn edu ck khia eanh khae nhau nhu lam sang, thudc gaydj dng. NhUng cac nghidn edu da sd ehua xic djnh chfnh xac thudc gay dj dng ma ehi dupe xac ^nh qua hdi ngUdi benh. Tai Khoa Da lidu - Dj ting,
^MPHMgcOV KHOA HQC
BVTWQD 108 hang nam cd thu dung so luong Idn benh nhin dj dng, trong dd cd di dng thudc va da duac xic dinh bing phan dng tidu bach cau die hidu, mpt phan dng cd dp nhay, dp die hidu 70- 75%. Do vay, chung tdi tien hanh de tai: "Nghien cdu can nguyen gay di dng thuoc tai Benh vien Trung Utfng Quan doi 108" d tren tat c i bdnh nhan da xac djnh dUpc thuoc giy dj dng bang phin dng tidu bach cau die hidu. Vdi muc tieu: 77m hieu cdc thuoc gay di dng duac xac dinh bang phdn dng tieu bgch cau dgc hieu.
11.001 Tl/ONG VA PHl/ONG PHAP 1. Doi tuofng nghien ciTu
- 69 bdnh nhan dj dng do thuoc dieu trj npi tru tai khoa Da lidu - Dj dng Benh vien TL/QD 108 td thing 7/2012 den thing 7/2013.
- Tieu chudn chdn dodn cdc logi hinh di dng t/iudic: Tien sd ed dung thude trudc do; bieu hien lam sang dj dng va xac djnh dupc thudc gay dj dng (p/utieu bach cau -i-).
- Tieu chudn chpn binh nhdn: Tat ei mpi bdnh nhan dj dng xac djnh dupc thuoc gay dj (ing mpi Ida tuoi, mpi gidi va benh nhan dong y nghien cdu.
- Tiiu chuan loai trd: Cac bdnh nhan dj dng I nhdng xet nghidm tieu bach cau dae hidu am tinh I hoac benh nhan khdng dong y hpp tie nghien edu.
- Dia diem vd thc^ gian nghien cdu: Dja diem:
^Khoa da lieu - Dj dng Bdnh vidn TLfQD 108 va thdi igian nghien cdu:Tdthing 7/2012den thing 7/2013.
2. PhiTtfng phap nghien cihi
- Thiet ke nghiin cdu: Md ta eat ngang, tien edu.
- C&mau: mau thuan tidn (tit ci bdnh nhin idj dng la do thude dieu tri npi tru tai khoa Da lieu - Dj dng Benh vienTl/QD 108 t d thing 7/2012 den ithing 7/2013).
- Cdc bddc tiin hdnh:
+ Lip phieu theo mau thdng kd.
+ Kham lam sang, xet nghidm nguyen nhan dj dng.
-I-Tuyen ehpn bdnh nhan, thu thap eic chi s6 cin thiet.
-HThu thap sd lieu can thiet vao phieu nghien cdu.
-I- Xd ly sd lieu theo thdng ke y hpe.
IILK^TQUA
1. Cac nhom thudc benh nhan da suT dung gay dj dng
Bdng 7. Cdc nhom thuoc binh nhdn sddung gdy dj dng (n=69)
Cite nhom thuoc Khang sinh Gi^m dau, ha sot Ti^u hoa Gout Thudc bo Tim mach Than l<inh
Thuoc dieu trj roi loan chuyen hoa m5 (lovac)
Thuoc chong dj Cfng;
mel<ocisin, chlopheniramin, medrol, Itametazin, dofexo.
Thuoc dong y: Thong xoang tan, vien sam, dong y (2) Thuoc dieu tri lao: pyrazynaiid Thuoc nhuom toe Vaccin phong dai
LUOtBN 18 13 12 10 10 9 8 5
5
4
1 1 1
%
26,1 19,2 17,4 14,5 14,5 13,1 11,6 7,3
7,3
5,8
1,5 1,5 1,5 Nhdn xet: Khang sinh gay dj utng 26,1%, ti^p den nhom da day, giam dau, ha sot d^u 19,2%, thuoc goutte 14,5%, tim mach 13,1% va dac biet CO 7,3% nguyen nhan dj ufng lai do chlnh thuoc chong dj uTlg gay n^n.
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. - • - • - •
2.Thudc nhom khang sinh
Bdng 2. Cdc thudc khdng sinh (n=18)
Cac nhom thuoc Cefuroxime Amoxillin Ciprofloxacin Biseptol Ceftriaxone Novamycin Doxycydin Rodogyl Flagyl Tong
LUOtBN 5 4 2 2
18
%
27,7 22,1 11,1 11,1 5,6 5,6 5,6 5,6 5,6 100 Nhpn xet: Khing sinh cefuroxime giy dj dng chiem 27,7%, amoxillin 22,1%, ciprofloxacin va biseptol ddu 11,1%.
3. Cac thuoc gidm dau, ha sot
Bdng 3. Cdc thuoc chSng ho, gidm dau, ha sot fn=J5;
Cac nhom thuoc Paracetamol Alpha-chymotrypsin Decolgen Efferalgan Lidocain Aspegie Nos-pa Atropin Tong
LirotBN 3 3 2
13
%
23,1 23,1 15,3 7,7 7,7 7,7 7,7 7,7 100 W/idnxcf; Paracetamol vaalpha-chymotrypsin la thudc gay dj dng nhidu nhat, deu ehiem 23,1%, tiep den la decolgen chiem 15,3%.
40 I DA Ll£U HOC s6 19 (Th^ng 06/2015)
4. Thuoc dieu tri benh tieu hoa
Bdng 4. Thuoc dieu tri binh tiiu hod (n=12) Cac nhom thuoc
Cimetidin Omeprazol Gastrofulgite Smecta Tong
LUOtBN 8 2 1 1 12
%
66,7 16,7 8,3 8,3 100 Nhpn xet: Cimetidin giy dj dng chiem 66,7%, tiep den la omeprazol 16,7% trong cae thudc dudng tieu hoi.
5. Cac thuoc dieu tri benh gout
BdngS. Cdc thudc diiu tri gout (n^lO) Cac nhom thuoc
Allopurinol Colchicin long P
LUOtBN 6 4 10
<0,05
%
60,0 ] 40,0 ,:|
100 j
1
Nhpn xet: allopurinol chiem 60%, colchicin la 40%, sU thay doi ed y nghTa thdng kd vdi p<0,05.
6. Thuoc dieu tri tim mach
Bieu do 1. T^ li gap cdc thudc tim mach (n=9) Nhan xet: 9/69 benh nhan dj dng vdi thuoc tim mach thi amiodipin va eoversyl giy dj dng nhi^u nhat, ddu ehiem 25%.
i-i-i-J
NGHIEN CUU KHOA HOC7. Thuoc bo
Binge. Cicthu6cboln=10)
Cac n h o m thudc Vitamin 3B Boganic M o r i a m i n Fortex Betex (vitamin) Pharmaton W i n u d i h e p (bo gan) O m e g a Rutin C Tdng
LirotBN 2 1 1 1 1 1 1 1 1 10
%
20,0 10,0 10,0 10,0 10,0 10,0 10,0 10,0 10,0 100 W/idn xef; Vitamin 38 gay dj dng 20% va cae thudc bo khae nhUvitaminC,fotex, boganic...ddu ed the gay di dng chiem 10%.
8. Thuoc dieu trj than kinh
Bdng 7. Cdc thuoc dieu tri thdn kinh (n=8)
cdc n h o m thuoc Tanakan Betaser (tien dinh) N o o t r o p y l (piracetam) Piracetam Stinox
Tegretol (dpng kinh) Seduxen
Tong
LirotBN 1 1 1 1 1 2 1 8
%
12,5 12,5 12,5 12,5 12,5 25,0 12,5 100 Nhin xet: Thuoc dieu trj than kinh deu co th^
gay dj utng nhu tegretol 25%, piracetam, seduxen, stinox, tanakan.. .deu gay dj ufng 12,5%.
9. Thuoc dilu trj chong di Otng
• U P
• Mekocitm {metamethason)• Chlophenii^min
Bleu do 2. Ty li gap cdc thuoc dieu tri di dng (n=5) Nhpn xit: Dj dng vdi thudc chdng dj dng dofexo 40%, mekocitin, chlopheniramin, isametazin ddu 20%.
IV. BAN LUAN
1. Cac nhom thuctc benh nhan da sd dung gay djiimg
Ket qui cda ehung tdi tai bing 1 cho thiy nhdm khing sinh gay dj dng nhieu nhat ehiem 26,1%, giim dau, ha sdt deu 19,2%, thudc dieu tri gout 14,5%, tim mach 13,1% va dac biet cd 7,3% nguydn nhan dj dng lai do chinh thuoc ehdng di dng giy nen.
Theo Nguyen Nang An, bdnh nhan dj dng vdi khang sinh l i 58,55% [ U Nguyen Van Doan la 71 % [3], Pham Cdng Chinh - 2010 la 68,58% [2]. NhU vay, ket qui cua chung tdi thap hon cae tie gii trdn cd y nghla thdng kd vdi p<0,01.
Theo cic nghidn edu cua Caubet va CS [6], Park [8], [55] deu cho thay dj dng vdi khang sinh la nguyen nhan hay gap nhat va trong do ddng hang dau la hp (S-lactam.
2. Thuoc nhom khang sinh
Ket qui cda chung tdi tai bang 2 cho thay thuoc khing sinh cefuroxime gay dj dng nhieu nhat chidm 27,7%, tiep den amoxillin 22,1%, ciprofloxacin v i biseptol deu 11,1%. Theo Nguyen Ning An, dj dng vdi penicillin G l i nhidu nhat [1]. NhUng ket qui ehung tdi khdng gap dj dng vdi penicillin G bdi vi hau nhu loai khing sinh nay hidn nay rat dUpc it
S6 19 (Thing 06/2015) DA Ll£U HQCl 4 1
NGHXgN CU'U KHOA HOC _^ - ^ . ^ ~ j ^
bac sT dung. Theo Nguyen Van Doan, hidn nay ty Id dj dng vdi khang sinh hp (S-lactam hay gap hai bidt dupc la ampicillin v i amoxicillin [3] va kdt qui cua chung tdi ed gap dj dng vdi amoxillin 22,1 %. Theo Pham Cdng Chinh thi f} Id khing sinh hp p-lactam gaydj dng ehiem 52,78% [2].
3. Cac thuoc giam dau, ha sot
Ket qui cua chung tdi tai bing 3 cho thay trong sd 13/69 benh nhin do thude giim dau ha sdt giy dj dng thi paracetamol v i alpha-chymotripsin la thudc gay dj dng nhieu nhat, deu chiem 23,1 %, tiep d^n la teepin codein chiem 15,3%. Vide sddung eac thudc chdng viem ha sot rat duoc thudng dung tai nudc ta, dae biet ngudi bdnh cd thdi quen tU mua thudc nhdm nay dung khdng qua chi dan cCia bic sT. Ngoai vide giy di dng cic mdc dp khic nhau edn gay viem loet da day - t i trang, gay ton thuong gan (tang enzyme gan).
4. Thuoc dl^u tri benh tieu hoa
Ket qui nghien edu cCia ehung toi tai bing 4 cho thay trong sd 12/69 benh nhan dj dng vdi thude he tidu hda thi cimetidin la nguyen nhan giy dj dng nhieu nhat chi^m 66,7%, ti^p ddn la omeprazol 16,7% trong eac thude dudng tieu hoi. Cic t i i lidu chUng toi tham khio dupc chua thay neu nhieu vd dj dng vdi nhdm thudc nay, nen ehung tdi chda cd sd lidu de so sinh v i phin tich.
5. Cdc thuoc dieu tri benh gout
Ket qui nghien cdu ei!ia ehung tdi tai bing 5 cho thay 10/69 bdnh nhan dj dng do thuoc dieu trj benh gout gay ndn thi allopurinol giy dj dng nhieu nhat chiem 60% v i colchicin la 40%. Thuc td lim sang chung tdi thudng gap hai thude nay trong dieu trj rdi loan chuyen hda acid uric gay dj Ung va thudng xuat hien mupn sau 2-3 tuan sddung.
6. Thudc dieu trj tim mach
Ket qui cCia chOng tdi tai bieu do 1 cho thay cd
amiodipin va eoversyl gay di dng nhieu nhat, deu chiem 25%. Day la hai thudc thdng thudng hay dupc cac benh nhan tang huydt ap sd dung ndn ty Id dj dng cung tang. Vdi eae tai lieu chdng tdi tham khio dupe, chUa thay edng bd nao vd t? Id dj dng thuoc tim maeh ndn ehung tdi khdng cd sd lieu de so sanh.
7. Thuoc bo
Ket qui nghidn cdu cua chiding tdi tai bing 6 cho thay cd 8/69 benh nhin (chiem 11,6%) dj dng vdi thuoc bo, trong dd vitamin 38 gay dj dng chidm 20% va cic thudc bo khic nhu vitamin C, fortex, boganic...deu cd the gay dj dng. NhU vay, tat c i eic loai thude ke ei thudc bo vin cd the gay dj dng. Cac tai lieu chung tdi tham khio dUpc ehua thay cdng bd ket qui di dng nhdm thudc bd ndn khdng cd sd lieu de so sanh va phan tich.
8.Thuoc di^u tri than kinh
Ket qui nghidn cdu eua chung tdi tai bing 7 cho thay cd 7/69 benh nhan dj dng vdi cic thudc dieu tri benh than kinh, trong do do tegretol 25%, piracetam, seduxen, stinox, tanakan... ddu gaydj dng 12,5%. Cac bdnh ve than kinh hien nay cd xu hudng gia tang nhu suy nhupc than kinh, ddt quy nao..., vide sd dung cic thude dieu trj benh than kinh eung tang theo va nguy co bj dj dng vdi cac thudc dieu trj bdnh nay eung gia tang. Ket qui cda chung tdi cung chdng minh ddpc phan nao.
9. Thuoc dieu tri chong dj ihig
Moi mdt thude deu la bin khang nguydn khi vao CP t h l duac gin vdi protein van chuyen va trd thanh mot khang nguydn hoan chlnh va lue nay ddu cd the gay di dng. Do vay, eae thudc didu trj dj dng van ed the gay dj dng. Ket qui nghidn cdu cCia chung tdi tai bieu dd 2 cho thay ed 5/69 bdnh nhan di dng do sd dung thudc chdng dj dng gay nen. Trong do, do dofexo (Fexofenadin) l i 40%, mekocitin (metamethason), chlopheniramin, isametazin deu 20%. Cic tai lieu chiing toi tham
4 2 I DA Ll£U HOC S6 19 (Thang 06/2015)
khao dupc, chua thay cd c d n g b d nao ve t h u o c c h d n g d i d n g gay dj d n g . Do vay, c h u n g toi k h d n g cd sd lieu de so sanh va phan tieh.
V. KET LUAN
- Cd 13 n h d m thuoc g a y d j Lftig g d m k h i n g sinh 26,1 %, giam dau ha sot 19,2%, tieu hda 17,4%, gout va thudc b o deu 14,5%, t i m mach 13,1 %, than kinh 11,5%, chuyen hda m d va chong dj dng ddu 7,3%, TAl LIEU T H A M KHAO
1. Nguyen Nang An. Le Van Khang, Phan Quang Doan. (1998), Tinh hinh dj dng do thude va hda chat d Ha Npi; de xuat nhdng bien p h i p ed hieu qua de phat hien sdm va han che h i u qua, De tai Cap Bd y te.
2. Pham Cdng Chinh. (2010), Nghien cdu t o n t h u o n g da, test phat hien t h u d e gay di dng va m d t sd xet n g h i e m trUdc - sau dieu tri benh nhan dj d n g t h u d c , Lugn dn Tien syy hgc, Dal hgc Y Ha Ngi.
3. Nguyen Van D o a n . (2006), IVlpt sd t h e dj d n g t h u o c cd b p n g nUde : Dac d i e m lam sang, xet n g h i d m va m d benh hpc, Tgp chiy hgc thUc hdnh, Ha Noi, 5,542, tr. 21-23.
4. Akiko K., Yamaguchi IVI. (2005), "Drug allergy" Allergy and Rheumatology, 5, pp. 151-55.
d d n g y 5,8%, lao, n h u d m tdc, vaccine dai ddu 1,5%.
- Cu t h l : Thuoc khang sinh: eefuroxim 27,7%, ampicillin 22,1%, cibrofloxacin 11,1%, biseptol 11,1%; thudc ha sot: paracetamol 23,1%, a-choay 23,1 %...;thudet!duhda:cimetidin 66,7%, omeprazol 16,7%,smeaa8,3%...;thu6ethin kinh: tegretol 25%
va tanakan, betaser.. .deu 10% va thudc b d : vitamin 3B 20%, boganic,fotex, piacetam...deu 12,5%.
5. Anne S., Riesman RE. (2001), "Risk o f administering cephalosporin antibiotics o f patients w i t h histories o f penicillin allergy", Ann Allergy Asthma Immunol, Feb, 74,2, pp. 167-70.
6. Caubet JC, Eigenmann AP. (2008), Allergy t o betalactam antibiotics in children. Rev Med Suisse, Apr 23, 154, pp.1014-17.
7. Demoly P., Guglielmi P., Guglielmi L (2006), Drugs allergy and hypersensitivity. Risk factors, Aller. 190 (8). pp.1733-42.
8. Park MA., Li JT (2005), "Diagnosis and management of penicillin allergy". Allergy disease, 99,1, pp.405-10.
SUIVIMARY
THE STUDY OF THE ORIGIN OF DRUG ALLERGY AT 108 MILITARY CENTRAL HOSPITAL Objective:To determine t h e drugs causing allergy in 108 Military Central Hospital from 7/2012 t o 7/2013.
Meterials a n d methods: 69 patients were recognized suffering drug allergy.
Results: Rate of allergy w i t h antibiotic is 26,1 % (eefuroxim 27,7%, amoxilin 22,1%, biseptol 11,1 %...), w i t h analgesic and antipyretic is 19,2% (paracetamol 23,1 %, alphachymo 23,1 %, decolgen 11,1 %...), with digestion medications is 17,4% (cimetidin 66,7%, omeprazol 16,7%...), w i t h goutte medications is 14,5% (allopurinol 60%, colchicin 40%), w i t h restorative medications is 14,5% (vitamin 3B 20%, boganic 10%...), with cardiovas- cular medication is 13,1 % (amior 25%, eoversyl 25%...), w i t h nerve medications is 11,6% (tegretol 25%,..), with antiallergic Is 7,3% (dofexo 40%...), with traditional medicine is 5,8% and tuberculosis medications is 1,5%...
Conclusion: Medications that cause several allergy were antibiotic, analgesic, antipyretic and m e d i - cations for digestion, goutte, restorative and cardiovascular....
Keywords: Allergy, Drug allergy.
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