Journal of research in viet nam traditional medicine and pharmacy No 45 - 2015
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A N H GIA T A C D U N G CUA CAO MO QUA T R E N B E N H N H A N ZONA Evaluation on the effects of "Cao mo qua" in herpeszoster* Nguyen Th} Tam Thuan, * Dirung Minh Sun Benh vien Yhpc co truyen Trung ucmg Tom tat
M^ic tieu: Ddnh gid tdc dung cua Cao Mo Qup tren benh nhdn Zona. Dot tupng vd phinmg phdp nghien citu: Nghien cuu tien cuu thit nghidm ldm sdng ma, so sanh truac - sau diiu trf tren 30 binh nhdn Zona, thai gian diiu trj 14 ngdy. Kit qud: 1. "Cao mo qud " co tdc dmg tSt trong diiu trf zona: sau 7 ngdy dieu trf 90,0% binh nhdn zona da lanh tdn thucmg vd 100% b?nh nhdn lanh tdn thuang sau 14 ngdy diiu tri. 2. Trong qud trinh nghien ciru chua thdy tdc dung khong mong mudn tren ldm sdng. Ket lugn: "Cao mo qua " co tdc dyng tot vd an todn trong dieu tri ton thuang da do zona.
Tir kh6a: Cao M6 Qu?, Zona.
Summary
E V A L U A T I O N ON THE EFFECTS OF "CAO M O QUA"
IN HERPESZOSTER
Objective: To evaluate the effects of "Cao Mo Qua " in Herpes Zoster patients. Subjects and methods: A prospective clinical trials, comparing the result before and after treatment in 30 Herpes Zoster patients, the period of treatment was 14 days. Results: I. "Cao Mo Qua " had good effects in the treatment of Herpes Zoster. After 7 days of treatment, skin lesion has healed at 90.0% of patients and at 100% of patient after 14 days of treatment. 2. During the study, there are no undesirable effects in clinical practice. Conclusion: " Cao Mo Qua " had good effects and was safe in the treatment of skin lesion caused by Herpes Zoster.
Key words: Cao Mo Qua, Herpes Zoster.
Dja chi lien h?: Nguyen Thi Tam ThuSn - B|nh vi|n YHCT TW Ngay nhSn b&i: 24/4/2015 Dja chi email: [email protected] Ngay phSn biln: 06/S/201S Phin bi^n khoa h(?c: PGS.TS. Nguyin VSn To^i Ng^y dang b4o: 26/6/2015
•TS.BS
Nghien cim YDHCT Viet Nam So 45-2015
I
L DAT VAN DE
Benh Zona gay ra do su tai boat virus Varicella zoster (VZV) tilm 4n a re than kinh cam giac canh cot song.
Benh eo bieu hien lam sang la ban do, mun nuac, mun mu lorn giiJa tap trung thanh dam dpc theo duang di cua day than kinh ngoai bien. Neu benh Zona khong dugc ehan doan va dieu tri kip thai se de lai di chung dau sau Zona, benh dieu tri dai dang, gay anh huang nhieu den chat luang eupe song eua benh nhan. Benh Zona gap a mpi lua tuoi, thuang gap han a nguai gia, nguoi suy giam mien djch, dae biet a ngucri nhiim HIV/AIDS [1].
Zona theo YHCT gpi la Dai trang bao ehan , Hoa dai sang, Xa xuyen sang, Tri thu sang, Xa dan . Nguyen nhan do Kinh can uat nhiet hoac Ty hu thap tre hoac Khi tre huyet li.
Tir lau benh vien Y hpe co truySn Trung uong da nghien cuu va ung dung "Cao mo qu^" di^u tri vit thuang lau lien dat hieu qua tfit. Vi vay, chung toi thuc hien de tai: "Danh gia tac dimg eua Cao Mo Qua tren benh nhan Zona" nham muc dieh:
1. Ddnh gid tdc dung cua Cao Mo Qua tren benh nhdn Zona
2. Theo doi tdc dung khong mong muon cua bdi thuoc (niu co).
IL CHAT LIEU, DOI T U O W G VA PHU'OfNG PHAP NGHIEN ClTU
2.1.Chat lieu nghien cihi
"Cao mo qua" c6 thanh phan:
dieh chiet xuat tu la Mo qua + ta duoc vua du vai ham am 30%.
"Cao mo qua'' do khoa Dugc ciia Benh vien Y hoc c6 truydn TW bao che theo tieu ehuan Dugc dien Viet Nam IV.
2.2. Doi tirgng nghien cuu Benh n h ^ dugc ehan doan Zona theo YHHD dieu tri npi tru tai khoa Da lieu, Benh vien YHCT Trung U'ang
2.2.1. Tieu chuan chpn benh nhan - Benh nhan dugc ehan doan xac dinh Zona theo huang ehan doan cua AmoldvaHabif[2], [3].
-Benhnhan>18 tuoi.
- Thai gian bi benh < 7 ngay - Chua dieu tri gi.
- Dong y tham gia nghien curu.
2.2.2. Tieu chudn logi trie binh nhdn
- Mae benh gan, thgn, tSng mo mau, HIV/AIDS, benh thdn kinh, co thai, cho con bii.
- Khong dong y tham gia nghien cuu hoac khong tuan thu lieu trinh didu tri, bo da hoac diing them cac thuoc khac.
J
' " Journal of research in viet nam traditional medicine and pharmacy No 45 - 2015
2.3. Phirong phap nghien cuu 2.3.1. Thiit ke nghien ciru:
- nghien cuu thur nghiem lam sang so s^ih truac sau dieu tri
- CO mlu: 30 benh nhan 2.3.2. Phiectngphdp dimg thudc:
- u6ng Acyclovir 800mg x 5 vien chia 5 l4n trong ngay (cti 4 gia u6ng 1 vien) x7 ngay
- Boi "Cao mo qua" ham am 30%
- Cach diing: Boi "Cao mo qua"
1 i W ngay+ dap gac sau khi boi.
- Thai gian dieu tri 14 ngay lien tiep.
2.3.3. Cdc chi tiiu theo doi:
- Dau rat vimg t6n thuang, miic do lanh ton thuang
Tac dung khong mong muon:
ban do, phii ne sau dieu tri
2.3.4. Cdc phmrng phdp ddnh gid ket qud:
Cach xae dinh muc dp t6n thuang: Ap dung theo quy tae ban tay eua Blokine va Glumov: 1 long ban tay ciia benh nhan tuang ling voi 1%
dien tieh co thd (DTCT). Cu thd nhu sau
+ Miic dp ton thuang nhe: < 1%
DTCT.
+ Muc dp ton thuong viia: 1-2%
DTCT.
+ Muc dp ton thuong nang: >2%
DTCT.
- Phan miic dp dau: Dua vao chi s6 Likert : dugc phan ra 11 dp (0-10) va dugc phan 3 miic dp nhu sau:
+ Dau nhe: Benh nhan hoi kho chiu/ nhan mat ( Likert 1-4)
+ Dau vira: Benh nhan ren ri (Likert 5-6).
+ Dau nang: Benh nhan keu la hoac CO thd bi choang ( Likert >7)
- Mue do lanh ton thuang + Tot: Toan bp ton thuang lanh seo.
+ Kha: ton thuong co eho lanh seo xen lan vay tiet, vdt trgt.
+ Trung binh: Ton thuong vay tiet, con it mun nuoc.
+ Kem: Van con mun nuoc/ bong nuoc, ehua eo dau hidu lanh seo.
2.3.5. Thoti gian vd dfa diem nghiin ciru
- Thai gian thue hidn de tai tijr thang 03/2014 ddn thang 11/2014.
- Dia didm: Khoa Da lieu - Benh vidn Y hpe cd truydn Trung uong.
2.3.6. Phu€fngphdp xu ly so lieu So lieu thu dugc trong nghien curu dugc phan tich, xii ly theo phuang phap xac suat thong kd y sirih hoc. Cac so lieu duge xii ly trdn may vi tinh qua phan mdm SPSS 16.0
Nghien ciu YDHCT Viet Nam Sd 45-2015
i n . KET QUA NGHIEN CUtJ
3.1. Dac diem chung ciia doi tirmig nghien cmi
Bang 3.1. Bac diem chung ciia doi tutfng nghien <
I
Gidi tinh
Nhom tuoi
Thai gian mac benh
Miic do dau
Mirc dp ton thuonng
ThS YHCT
Nam NO
<50
< 50, >60
< 60, >70
<70, <80
>80 Tir 1-3 ngay Tu 4-5 ngay Tir 6-7 ngay
Nhe Vira Nang Nhe Vira Nang Kinh can uat nhiet
Ty hu dam thap Huyet u
n = 3D n
18 12 2 6 8 10 4 2 13 15 5 14 11 3 9 18 19 8 3
%
60.0%
40,0%
6,7%
20%
26,7%
33,3%
13,3%
6,7%
43,3%
50,0%
16,7%
46,7%
36,6%
10,0%
30,0%
60,0%
63,3%
26,7%
10,0%
Nhan xet: Da phan benh nhan den kham tir ngay thii 4 den ngay thii 7; miic do dau va miic dp tdn thuong chii ydu tir miic do vua ddn nang chidm 83,3% va 90%;
Cac bdnh nhan co a ca 3 thd, the Can kinh uat nhiet chidm 63,33%.
Journal of research in viet nam traditional medicine and pharmacy No 45 - 2015
3.2. Ket qua lam lanh tdn thuonag
Bang 3.2. Ty le mirc dp lanh ton thuang sau 7ngay va 14 ngay dieu tri Ket qua dieu tri
T6t Kha Trung binh
Kem Tdng
D7 n 27
2 1 0 30
%
90,0 6,7 0,3 0 100
D14 n 30
0 0 0 30
%
100 0 0 0 100
Pt-s
<0,05
Nhan xet: miie dp lanh ton thuang sau 7 ngay dieu trj va sau 14 ngay dieu trj khac biet co y nghia thong kd (p<0,05). Dieu tri lam tang ty Id benh
3.3 Muc dp dau
Bang 3.3. Thay doi muc do dau sau 7 ngay va sau 14 ngay dieutri nhan dat hieu qua "Tot" tir 90% (D7) len 100% (D14) va giam ty Id benh nhan "Kha" -t- "Trung Binh" tii 7%
xuong 0%
Ket qua dieu trj Dau nhe Dau vira Dau nang
T6ng
DO n 5 14 11 30
%
16,7 46,7 36,6 100
D7 n 16 9 5 30
%
53,3 30,0 16,7 100
D14 n 23
5 2 30
%
76,6 16,7 6,7 100
Pt-.
<0,05
Nhan xet: Miic dp dau sau 7ngay va sau 14 ngay didu tri co su khae biet CO y nghia thong kd (p<0,05). Didu tri lam giam ty benh nhan "Dau nang" tir 36,6% (D0)xu6ng 16,7%(D7) xudng 6,7% (D14) va tang ty Id benh nhan
^•Dau nh? " tu 16,7% (DO) len 53,3%
(D7)ldn76,6%(Dl4).
3.3. Tac dpng khong mong
Trong suot qua trinh dieu tri khong thay tac dung khong mong muon nhu ban do, phu nd tren lam sang . IV. BAN LUAN
4.1 Dac diem doi tuong nghien cuu.
Ve tuoi, gioi: gap a ca 2 gioi va mpi Ilia tuoi (Do nghien cuu cua chiing toi chi co 30 Benh nhan ndn khong CO nhan xet cu the)
Nghien citu YDHCT Viet Nam So 45' 2015
Vd miie dp dau, miic dp ton thuong da: Qua bang 3.1 cho th4y:Trong nghidn ciiu nay ca hai nhom benh nhan co miic dp ton thuong a miie dp nang va vua la chu ydu chidm 83,3% va 90%; Cac bdnh nhan co a ea 3 the, thd Can kinh u4t nhiet chidm 63,33%. Kdt qua nay tuong ling voi kdt qua nghien ciiu cua Dang Van Em [4], [5].
4.2. Ket qua dieu tri
4.2.1. Bdnh gid mirc do lanh ton thirang:
Tir ket qua nghien ciiu Bang 3.2 cho thiy co su khac biet co y nghia thong ke voi p<0,05giiia mtic dp lanh ton thuong sau 7 ngay dieu tri va sau 14 ngay dieu tri. Boi "Cao mo qua"
sau 7 ngay ton thuang zona lanh vai ty Id kha cao 90,0% va sau 14 ngay didu tri 100% benh nhan lanh tdn thuang da hoan toan khong con hinh anh mun nuoc, vay tiet, loet, chi con lai dat tham tren da. Ket qua nghidn ciiu cua chiing toi tuong ling vai nghidn cuu ciia Dd Thi Phuang, Lai Lan Phuang [6].
Can cii vao kdt qua nghien cuu cua Giao su Tran Van Hidn [7] thi trong dich chiet cua la mo qua co thanh phSn Polyphenolic la chat eo tac dung chong oxy boa cua gde tu do (la thanh phan chinh gay phan ling vidm tai to chiic bi ton thuang), chinh vi thd "Cao mo qua" co tac dung chong vidm
manh. Ngoai ra flavonoid cua la Mo qua con co tac dung khang khuan manh voi cac loai vi khuan,vims, nam....Didu nay ly giai tac dung chong vidm, lanh vet thuong nhanh chong ciia "Cao mo qua" sau 7 ngay didu tri. Tuy nhien chiing tdi chua tim thiy tai lieu nao nghidn ciiu vd tac dung dc chd sir phat trien eiia virus cua
"Cao mo qua" mot each diy du.Day ciing la huang ma cho cac nghidn ciiu sau han vd "Cao mo qua" trong tuong lai.
4.2.2. Bdnh gid mite dp dau Tir kdt qua nghien eiiu Baig 3.3 eho thiy: co su khae bidt eo y nghia thdng kd (p<0,05) giiia miic dp dau sau 7ngay va sau 14 ngay didu tri cua nhom nghidn ciiu. Didu trj lam giam ty bdnh nhan "Dau nang" tii 36,6% (DO) xudng 16,7%(D7) xudng 6,7% (D14) va ty Id bdnh nhan "Dau nhe" tir 16,7% (DO) tang len 53,3% (D7) len 76,6% (D14).
Dau trong zona la do virus Varicella zoster pha buy bao myelin ciia day than kinh cam giac, do do bdnh nhan zona rat nhay cam voi kich thieh ngoai da viing ton thuang: cp xat cua quan ao, gio, nhiet dp....Do d6 khi boi "Cao mo qua" tranh dugc nhung tidp xiie trdn ndn co tae dung giam dau. Ngoai ra chinh tac dung ehdnj viem, giam phu nd, lie chd vi khuin lam tdn thuang zona nhanh chong
Journal of research in viet nam traditional medicine and pharmacy No 45 - 2015
lanh, dong vai tro chinh trong co chd . ^ giam dau cua "Cao mo qua". Kit qua nghien cuu eua chung toi tuong ung
• vol ket qua nghien cuu cua Nguyen
"""'' Van Thong [8], Dang Van Em [4], D6 Thi Phuong [6], Nguydn Thi lai [9]
m] V. KET LU^N
' " 1. "Cao mo qua" eo tac dung tdt i^virs, trong didu tri zona : sau 7 ngay didu tri lay dii 90,0% bdnh nhSn zona da lanh tdn
•ailii :
thuong va 100% benh nh§n lanh ton thuong sau 14 ngay didu tri. Bdi "Cao mo qua" lam giam ty bdnh nhan "Dau nang" tir 36,6% (DO) xudng 16,7%
(D7) xu6ng 6,7% (D14)va tang tyl?
benhnhan "Dau nhe" tir 16,7% (DO) len 53,3% (D7) Idn 76,6% (D14).
2. Khdng thay tae dung khong mong mudn trdn lam sang khi bdi
"Cao mo qua"
TAI LIEU THAM KHAO
1. Thiboutot D.M., Strauss J.S (2003), Varicella and Herpes Zoster, Fitzpatric 's Dematobogyin general medicine- 6th edition, McGraw- Hill, p.
1885.
2. Arnold HL, odom R.B, Jannes.WD , Herpes zoster, Andrew's disease of the skin 1990, 446-451.
3. Habif T.P, Herpes zoster, Clinical Dermatology Mosby, 1996, 351-359.
4. Daing Van Em, Ngo Xuan Nguyet (2005), Nghien cuu mpt so tmh hinh, dac diem ldm sdng benh Zona dieu tri >^Qi tru tpi khoa Da lieu Benh viin Trung ucmg qudn dpi 108, Y hpe thuc hanh, 2005.3,27-29.
5. Dang Van Em, Ngd XuSn Nguyet (2005), Kinh nghiem dieu tri b^nh Zona bdng Acyclovir tai khoa Da lieu Benh vien Trung uang qudn dpi 108, Y hoc thuc hanh, 2005,3,23-26.
6. Do Thi Phuong, L^i Lan Phuong (2006), Budc ddu ddnh gid hieu qud ldm sdng cua thuoc uong BSP2A vd kem bdi tai cho Atzi ddi vdi benh zona, Y hoc thuc hanh, 2006, 5, 542, 42-45.
7. Tran Van Hien, Mai^eret, G.
Chery (1999), Tdc dung bdo ve cua dich chiet Polyphenolic tie Id mo qug doi vdi mpt so loai te bdo bi tdn thuang bdi goc tu do Xanthineoxydase , Ky ydu cac cdng trinh nghien ciiu khoa hpe, tr 331.
8. NguySn Van Thfing (1997), Mpt so nhdn xet qua 60 ca zona diiu tri vi$n 110 tit 1/1990-4/1997, Npi san Da lieu, 1997, 2, U51-53.
9. Nguyen Thj Lai (2005), Nghien cuu mpt so dpc diem zona a nguoi cao tuoi vd hi$u qud cua Acyclovir trong diiu tri Zona, Y hpe th\rc hanh,
10/2005, 20-26.
