Tifp chi THONG TIN YDUffC Sd 11 nam 2012
NGHIEN CUU MOT SO DAC DIEM ROI LOAN T A M T H A N 0 BENH NHAN HEN PHE QUAN
Cao Tien Du'c*, BoQuyif, Trlnh VSn Anh"
T O M T A T
M^lc tieu: tim hieu m0t sd' ddc dii'm rdi lo^n tdm thdn (RL TT) d b^nh nhdn (BN) hen phe qudn (HPQ). Ddi tWdng vd phutmg phdp: md td cdt ngang 76 BN HPQ diiu bingltivd Khoa Ho hap, Benh vien 103 (BV103) tCftiidng 8/2010 den thang 7/2012. Ket qud: ty le hgi chuhg tram cdm vdi mat quan tdm thth tiiu ctii&n 64,5%, khd t$p tivng chu y chi&n 59,2%, budn rau chiem 53,9%, bi quan chiem 51,3%. Lo du, hodng sd chl§m 59,2%, rdi io^n ti-igidc chiem 15,8%. 38,5%sdBNc6 cdc yeu td'stress. Ket lu^n: tiidm cdm, lo Su, suy nhudc d BN HPQ cotyie cao.
SUMMARY
Research on clinical features of m e n t a l disorder in patients w i t h a s t h m a
Obejectives: to investigate some clinical features of mental disorder In patients with asthma.
Methods: A descriptive, cross-sectional study was conducted on 76 inpatients with asthma treated In Hospital 103 from August 2010 to July 2012. Results: The rate of depression syndrome with interest lost was 64.5%, attention disorder 59.2%, sadness 53.9%, pessimistic 51.3%, anxiety/panic 59,2%, perceptual disorder 15.8%. 38.5% had stress-related astiima.
Cktnduslons: The rates of depression, anxiety and weaitenlng were high in patients with astiima.
I . DAT VAN DE
HPQ Id mdt benh thudng gSp, ty le 3-12% dan sd [1]. Benh oo bleu hien lam sang da dang, phong phu, ngoai cac trieu chuhg \ffi HPQ, b|nh con od the kem theo cac RLTT vd bi&i doi chiit nang tam ly.
Cac roi loan ndy cung rat phiit tap, dd la cac hoang tudng do giac, tram cam, to au va y tudng chan song,... lam cho cudc sdng vd anh hoat eiia BN tw anh hudng nhieu. Tren the gidi cd nhieu nghien cirtJ ve van de nay nhuhg d Viet Nam chua od, w vay, chung tdi tiai hanh nghien ciiU nay nhSm muc tieu:
tim hieu mdt sd dac diem RLTT d BN HPQ.
I I . OOI TU'QNG VA PHl/ONG PHAP 1. Ddi tu'dng nghidn cuti 76 BN HPQ' dieu tri ndi trii d Khoa Hd hap - BV103, tir 8/2010-7/2012.
* Tieu chuan chon BN:
- Tat cd BN dUtfc Chan doan HPQ dtft theo tieu chuan chan doan cua Hlep hdi Lao va Benh phoi nam 1996 [ 3 ] .
* Tieu chuan loai trif:
- C ^ BN cd RLTT trudi: khi khdi phat HPQ, benh HPQ od laen chutig hode cac b|nh phS ket hdp.
2. Phu'dng phap nghien cut/
2.1, Thiet l(e nghiin cuU. nghien ciru md ta e3t ngang.
2.2. Tien hdnh:
- Cd mau: lay theo thdi gian, cac ddi tUdng dii tieu chuan nghien ciru.
- Cach chon mau: chon mau thuan tien ddi vdi BN HPQ.
- TTiu thap thdng tin; lap phlaj nghien cuU, ghi chep Sn luOt Iwt qua tiiam khdm lam sdng loan than, hd h§p, tam than, lam cac )ffit nghiem can lam sang.
'PGS.TS, Benh vl§n 103;
"ThS., Benh vien Tam than Thanh Hoa
- Phan loai miit dp HPQ (ndng, vua, nhe) [8].
- Cdc bien sd nghien aiti: tua, gidi, thdi gian mSc benh, phan nhdm BN theo miit dp benh HPQ, y§u to stiiess, roi loan ao giac; dm dnh, tram cdm,...
2.3. X&lysdlieu: bdng phan mem Epi Info 6.0.
I I I . KET QUA 1. Ddc diem chung
Tuoi 20-40 41-60 61-70 Tfing
Nam SL 20 18 9 47
TL%
26,3 23,7 11,8 61,8
Nit SL 13 11 5 29
71%
17,1 14,5 6,6 38,2
Chung SL 33 29 14 76
71%
43,4 38,2 18,4 100 Op tuoi 20-40 dii&Ti ty le cao nhat (43,4%).
Nam m k benh nhieu htfn nu" (61,8% va 38,2%), sU khac biet ve gidi d nhdm BN nghien ciilj cd y nghla thdng ke vdi /?«:0,01.
2. D0C diem lam sang
Bang 2: Thdi plan mdc benh HPQ (n=76) Thdi gian
<5 n3m
>5 n3m
SL 40 36
7Z%
52,6 47,4 Ty le BN tt HPQ <5 ndm va >5 nam Id tuOng dudhg nhau, sU khac biet khdng cd y nghia thong ke.
Bdng 3: Phan nhom BN theo m&c do binh HP0(n=76)
MOtag Nh^
vera N3nq
SL 26 34 16
7 1 % 34,2 44,7 21,1 Oa SO BN HPQ miit dp vua * i S n tJ le cao n h t (44,7%), SI/ khac biet 00 y nghia thong ke vii ;xD,05.
Tap cM THONG TIN YDlfQC So 11 nam 2012
Bdng 4: Cdc yeu tS stress (n=76) dc nhdm stress Mau thuan, xung dot nghiSm trpng (d gia dinh, cd quan va xa h^)
h>jn nhan: Yi than, Iv h6n, nocei tinh, Dhu bac Rui rOi tai nan cua ngu^i than Kho kh3n klnh te (vd nd, mat ciia) Tonq
SL 15 8 .3
? 28
7 1 % 19,7 10,5 3,9 2,6 36,8 36,8% sd BN cd cac van de stress.
Bdng 5: M^sotmj Nin tdm trang BN fn=76) Tri$uch&nQ
LoSu Hoang sd vo cd Bon chon Ac monq khi nqii
SL 45 29 18 11
7 1 % 59,2 38,1 23,7 14,5 Trieu chiTng lo du xudt hien d da so cdc BN (45 BN) chiem ty le cao nhat (59,2%).
Bdng 6: Cdc roi loan tri gidc (n=76) Ao gi^c n6l tanp Lo^iiogiic
Ag xung gljic
Tong 12
Ao giac chiem 15,8%, trong dd do giac ndi tang chiem ty le eao nhat (10,5%).
Bdng 7: Cdc y tudng qud ddng (n=76)
"Meuchvenq Y tudnq bat hanh Y tudnq chan sonq Y tudnq hoai nqhi Y tudnq qhen tuonq
SL 10 4 1 1
7 1 % 13,1 5,3 1,3 1,3 Y tudng bat hanh cd t^
Bdng 8: Noi dung dm Qtu ^ dm anh Am anh sd benh nSnq Am anh sd ch€t Am anh sd con trunq Am anh sd x l hoi
e cao nhat (13,1%).
anh (n=76) SL 24 9 1 1
7 1 % 31,6 11,8 1,3 1,3 Am anh sd benh nang cd ty le rat cao (31,6%).
Bang 9: l<4dtsdtiiiu chuhg tiam cam (n=76) Tr^uehihui
Cam thSv du5i sut Giam quan tam thich thu Kho tap trung chil •i Cam thay buon Bi quan, ch^n nan Cam thSv bi Icim l6i G\hm khf sSc Ckm thav chan sonq
SL 63 49 45 41 39 24 25 4
7 1 % 82,9 64,5 59,2 53,9 51,3 31,6 32,9 5,3
\7* Mot so tTi$u chAig: cdm thay dudi sut (82,9%), giam quan tam thich thu (64,5%) cd ty le rat cao.
Bdng 10: Cdc roi l<mn hoat dong (n=76) Tiiiudtihta
Roi loan giac ngu Giam hoat dong Giam ham mudn tinh dgc Ch^n Jn, 2n khong ngon
^ M " i 1 giSc ngii chiem t SL 59 43 43 19
|g cao (77 7 1 % 77,6 56,6 56,6 25 6%).
I V . BAN LUAN
Tuoi cua BN nghien cuU tir 20-70, trong dd 20- 40 t i d l chiem 43,4%, ket qua nay phii hdp y&i nhan xet ciia Biii Xuan Tam [3], HFQ chu ygu gSp d Ida tudi 20-40, TO gicfi, nam chiem 61,9%. Theo cac tac gia khac nhu Bui Xuan Tam, Nguyen Ndng An [1], Nguyen Thanh Hai [2] cd ket qud tudng tU.
05c diem lam sdng ciia BN, thdi gian mang benh <5 ndm (HPQ mdi) va >5 ndm (HPQ cu), ket qud eho tiiay ty le BN d 2 nhdm tuWng dUdng nhau. Ve miit dp benh, ty le mac benh mut dp VLft eao nhat, 44,7%, cd sU khdc bi§t ve t / le giua mut dp viia vd ndng vdi /7<0,05. Ket qua nay phu hdp vdi Nguyen Thanh Hdi (1999) [2].
Trong nhdm nghien euU od 36,8% so BN cd cac yaj td stress tam ly, stress xdy ra tnjdt hodc trong ddt biing phat (HPQ). Cac stress md BN gdp la nhijhg chan tfiutfng manh lam dian dong, dao Ion ddi song tinh tiian, tinh cam BN. Theo Ho S.F. va cdng sU [&1, sbess cd vai tro quan trpng, dnh hudng Idn d&i dien bien bat tiiudng ciia BN .
Lo au gap d 59,2% sd BN, day la mdt t / l i cao, no cho thay benh HPQ anh hudng lat Idn den tam 1^
BN, lo du thudng xuat hiai sdm va trd nai nang hdn khi dien bien ciia HPQ xau di. Lo au cung lam cho BN cam thay eupe song buon rau va tiiat vong hdn.
Ao giac gap d nhom nghien cuU la 15,8% - chii yeu la do giac thd sd, cac ao giac ndy Id nhOhg cam giac bat thudng nhU dau that trong long ngut, tac nghen, ndng lattrong bung,...
Cdc rdi toan tam than d HPQ ft: gap, thudng chi xual hien d BN od khd tiid nang va od stress tam ly (cdc rcH toan ndi dung tU duy nhu" am dnh sd benh nang, sp diet chiem 31,6% va 11,8%). Mpt sd cd y tudng bat hanh, chan sdng, hoai nghi, ghen tudng,...
chung toi khdng gap rdi toan hoang tudhg, cd tiie vi ddi tudng nghien aiU la BN d Khoa Hd hap.
Mdt sd rdt toan hoat ddng d BN nghien cuU: rcS toan giac ngii 77,6%, giam ham mudn tinh dye 56,6%, giam hoat ddng 56,6%, dian an, an khdng ngon 25%. Cac t / le nay phu hdp vdi nghien cuU eiia nhieu tac gia khac Cac rdi ban tren deu chii yeu do met ma, suy nhutt; khd thd, to au, benh tat Phu hop vdi nghien culi ciia Can" R.E (1998) [5].
Hdi diLtig suy nhuU: gap d nhdm nghien euU vdi t / le rat cao, dd la tinh ti^ng met mdi. Met mdi lam BN de kidn thidi, cau gat; khd chiu,... Khdng chi BN ma ngudl xung quanh cung cd the nhan tiiay su"
thay da tinh tinh cua hp. Cd tiie ke ra ca ra loan giac ngii cua BN, khd vao giac ngu, ti^n t r a ; ngu khdng sau, hodng sd vd cd, dc moig,... cd liic cam tiiay bon chon ngpt ngat phai thiit day. Kha nang Idm viec ciia H^ giam sut Cac so lieu cua chiing toi cung phii hdp vdi ket qud ciia Campbell D A , Lennan G.L, Coates J.R. [4] vd Lewris D.A. {7\. Theo
Tgp chi THdNG TIN YDUQC So 11 nam 2012
c ^ tac gia ndy cdc trieu chutig trong h$ chuhg suy nhubt vua la nguyen nhSn viia la ket qud cua nhau.
V. KET L U A N
Nghien ciru 76 BN HPQ bjdi trung binh 44,9±13,4, gom 47 nam, 29 nu", cd 26 BN HPQ milt dd nhe, 34 viia va 16 ndng, chiing ^ 1 thSy.
hpi chuhg trSm cdm vdi gidm quan tdm thfch thii chi§m 64,5%, khd t§p tmng chu y (59,2%), buon rSu (53,9%), bi quan (51,3%). Lo Su (59,2%), hodng sd (38,1%), rSi loan do gidc (15,8%). 36,8% s5 BN ed cdc ygu td stress.
T A I LIEU T H A M KHAO
1. Nguyin NSng An v i cs: ChSn dodn dSc hl$u vh diSu tri HPQ theo C6ng utic qu6c t§ t^i Khoa D| utig v i MiSn dich ISm sing B^nh vl^n B^ch Mai. Tdm t^t bdo cdo khoa hqc, Hd N0i. 1997, t.2'8.
NguySn Thanh M i : Birdc dSu dinh g i i hl|u qui diiu tri kh6 thd bing khi dung trong phS quSn COPD. Lu$ndn Th^ a y hgc Hd N$i, 1999, tr.68.
Bui XuSn T i m : B^nh hfi h?p. Nh^XuStbdn yhpc Hd N^l, 1999, tr.Sll-649.
Campbell D.A., Lennan G., Coates ].R. et al:
Near fatal asthma attacks: the reliability of diseriptlvee information collected from close acqurlntances. Thorax, 1993, 43, f^. 1099-1104.
Carr R.E.: Panic disorder and asthma: Cause, Effect and Research implications. J Psychosom Res, 1998, 44 (1), pp.43-52
Ho S.F., Jones D.: Morbklty In older people with self- Refiarted asthma. Age- Agehg, 1999,28 (5), pp.457-48a Leuds D.A.: Sleep in patients with Resp^atory disease.
Re^Care Oln NAm, 1999,5(3), pp.447-460.
Shetfer A.L: For the Intematkxial asthma management project. Intematxxial consensus rqxyt on dlagno^ and management of asthma. CSn. Bip.
Allergy, 1992, 22, pp.l-72.S>
DANH GIA DO PHU HOP THUONG TON SUN CHEM DO CHAN THUONG TREN CONG HUONG TUVA NOI SOI
Vo Thanh Toan' T O M T A T
Muc tieu: ddnh gia dp p^u hdp hinh dnh tiiudr^ ton sun dmm do dian thut^ tren diup cpng hudng tit hat nhan (fIRI) va noi scx(NS). Doi tutmg vd phuiAig phdp: nghen cuti ti&i cut/, tham Ididm vd dian dodn theo benh dn mau, IW sun diim tx rddi do dian thut^ dudc dim dodn va phau tiiuat NS tai Binh vien Thdng Nhat- Thanh pho Ho Chi Minh, tir 1/2007-1/2012. Kit qua: tivng chan doan vj tn ben sun diem bf rnch tren hinh anh MRI vdi hinh dnh fllS dat sdphu iidp cao dpv& hisd Kappa (K)=0,8. Si/phii h0 trong chan dodn rdch sun chim theo suhg tiin MRI vdi hinh dnh fi/S tiy/thd tiX t&:(K=0,6). Ddc bi^trc^ Chan dodn rdch suhg sau sun chem cd SI/nham lan, bo s^30/68 tiv(^
h0 chi&n ty le 44,2%. KM luan: MR! cho gid tii phu hep (30 dp ve \H tii, tuy r^On dii dat mut dd tii"
i<ha d&i t^ da V&I dian dodn vi tii'sjhg rdch tivng tiiuOhg t^ sun diim do chan tfKMig.
SUMMARY
To assess the relevance of meniscal lesion d u e t o t r a u m a o n magnetic resonance imaging ( M R I ) and arthroscopy
Otgecth/es: to assess tiie relevance of meniscal leaon due to tiauma on magnetic reson^ice ima0ng (MRI) and arthroscr^T/. Methods: f^v^xctive ^jdy, dhical cSagnosis of prntixol, 180 meniscal teais eAie to tiauma wens diagnosed and underwent adtirosoofxc surgery at Thong A^t Hcepff^ - Ho Ov MM CSy Horn January 2007 to January 2012. Results: The result ofdiagncsis oflocstior^ where mervscus torn on tiie MRI mage is highly appropriated !Mtii arthmsocfry (Kappa ffid&( K=0.8). ConfbmtykitiiecSagnosscf torn meniscus hom on t4RI witii the internal image is fhxn far to 5000' (K=0.6). However, there is a conHskxi in the dorsal hom of the menisajs tears dia^Ktstic and missed cases are 3Q/68, acooimtUig for 44.2%. Conchisions: MRI gives af^jropnatedreajlts about tiiepcxitiori, however, itor^r^^fiomf^to goodjev^fyrdiagnoashom tearintiiemenscaH^ionsdue to tiauma.
I . DAT VAN DE
Nhuhg nam gan day, cung vdi su" gia tang cac p h u t ^ tien giao thdng va phong trao tap luyen the due the ttiao ngay cang phdt trien sau rang, lam dio sd lutfng chan thutJng khdp gSi ndi chung va thu'dng ton sun chem ndi ri§ng ngay cang tang [2].
Nhd sU xuat hien 1^ thuat MFU od the cho hinh anh tdn thudng sun chem tudhg dS diinh xag qua
"ThS., Benh vien Thong Nh3t - Thanh pho Ho Chi Minh
dd giiip phau thuat vien du& ra chan doan va phudng phap dieu tri thich hcfp va kjp thdi, dieu ndy cd y ngha r k Idn trong viec tranh dudc nhuhg hau qud khdng dang od i^idtsinh tirthudng tdn ndy nhU han che van dpng aJa khdp goi, teo od, thoai hda ktidp cung nhu" viec phuc hoi van ddng ktidp g6i.
Tuy nhien tren ttii/c 1^ lam sang cd nhu'ng trudng hdp hinh dnh tdn thu'dng fren MRI vd
