TCNCYH Phu truxyng 80 (3) - 2012
AP DUNG B p CAU H 6 I ST. GEORGE'S DO LU'QNG CHAT LUONG CUOC S 6 N G O BENH NHAN GIAN PH^ Q U A N
Pham Thi Minh Thm\ Ngo Quy Chai^
'Truxyng Cao ding Y ti Di$n Bien, ^Tru^ng Dai hQc Y Ha N^i
Nghiin ci:ru nhim do lug'ng chi s6 chit luxyng cudc sdng - SLK khde (CLCS - SK) d binh nhin dqrt dp giin phi quin diiu tri t^i khoa Hd hip binh vi$n Bach Mai bing bd ciu hdi St Georges phiin bin tiing Vi$t Nh$n xit mdi liin quan giOa mdt s6 tri^u chCrng lim sing vi c$n lim sing vdi CLCS - SK tn/dc vi sau diiu tri d b$nh nhin giin phi quin tai khoa Hd hip binh viin Bach Mai nam 2009 Kit qui cho thiy 70% binh nhin bi giin phi quin ci 2 bin. cdn lai 30% bi giin phi quin mdt ben. Hiu hit cic triiu chi>ng diu cd liin quan v&i diim St.Georges d linh vi/c tin xuit va dd n$ng cCia tridu chO'ng hd tiip trufdc - sau diiu tn. Kit luin: Cic triiu chu-ng lim sing, dn lim sing diu cd liin quan v&i CLCS - SK trudc va sau diiu tn.
Tip khoa: Gian p h i quan, bo cau hdi St. Georges
I. DAT VAN Dt
Gian p h i quan (Brpnchiectasis) la tinh trang gian bit thudng va khdng hoi phuc cua cay p h i quan. Wilson CB va CS [8] da nghien ci>u, ap dung bd cau hoi St. George.s (SGRQ) d i danh gia CLCS- SK cua benh nhan gian p h i quan thiy cd hieu qua tit. Tai Viet Nam, bd cau hoi St. George's da dug-c djch sang tiing vigt [4] va nghien cuu tren bgnh nhan benh phdi tac nghen man tinh [2]
nhung chua cd nghien cuu nao v i v l n d i CLCS- SK d benh nhan gian p h i quan. Vi vay chung tdi t i i n hanh nghien cuu nay nham muc tieu:
Do luxrng chi so CLCS- SK a b$nh nhan dot cap gian phe quan dieu tri tai khoa Ho hap benh vien Bach Mai bing bo cau hoi St.Georges phien ban tieng Vi$t.
Nhan xet moi lien quan giu-a mgt so trieu ChOng lam sang va can lam sang v&i CLCS- SK truuc va sau diiu tn a benh nhan gian phe quan tai khoa Ho hap b$nh vien Bach Mai nam 2009.
II. D6I TLrgNG vA PHi/aNG PHAP
1. Ddi t i r v n g nghien ci>u: 40 benh nhan
(benh nhan) dup'c chin doan xac dinh gian p h i quan bang chup cat Idp vi tinh phoi, diiu trj tai khoa Hd hip - benh vien Bach Mai tu thang 01/2009 d i n thang 8/2009.
2. Phu'O'ng phap nghien cuu Thiit k i nghien cuu thu nghiem lam sang khdng d i i chung. Tiin hanh thu thgp thdng tin v i gian p h i quan bang phuang phap tham kham true tiip va ghi nhan cac k i t qua tham dd can lam sang theo m l u benh an thing nhlt Cac benh nhan t u diin bd cau hdi St. George's [4], nhdm nghien cuu kiim tra lai va giai thich them n i u ngudi benh chua hieu. Danh gia (fiim CLCS - SK d benh nhan gian p h i quan bang each ddi chiiu thdng qua bang diim chuin cua thang do SGRQ ba ITnh vuc:
Danh gia t i n xult va do nang cua trieu chung hd hip, danh gia nhij'ng hoat ddng t h i chit gay ra khd thd, anh hudng cua benh gian p h i quan d i n ddi song va hoat ddng xa hdi D i i m dug'c tinh rieng cho tung ITnh vuc va t i n g diim chung cho ca ba ITnh vuc. D i i m cua mdi ITnh vuc thay doi t u 0 - 100, D i i m cang cao cho thiy tinh trang sue khoe cang kem.
133
TCNCYH Phu truung 80 (3) - 2012 Ml. K£T QUA
1. D i e d i i m lam s i n g
Tuii trung binh 57,1 ± 15,3 n i m . Ty Ip nd gidi chiim 65%, nam gidi chiim 35%.
90% bpnh nhin d i n khim vi ly do ho khpc ddm, 61,9% din kham vl khd thd, 50% din khim vi ho miu, sit 25% v i dau nguc l i 7,5%.
2. D i e d i i m c i n l i m sang
Trong t i n g s i 40 binh nhin dupe chin doin gian p h i qgan trin phim chgp c i t Idp vi tinh dp phin giai cao thi cd 7 1 % binh nhin bj giin p h i qgan ca 2 b i n , 29% bj gian p h i qgan mit b i n .
Cd su cai thipn ro r i t v i dgng tich sing (VC), dgng tich sing thd mpnh (FVC) va c i c luu lupng thd (thi tich thd ra toi da trong giay d i u tien "FEV1", chi s i Tiffeneau "FEV1/
V C ) sau diiu tri so vdi tn/dc dieu tri.
Tri s i FEV1 cai thiin mot each cd y nghTa thing ke: 55,6% SLT tn^dc diiu trj len 63,0%
SLT sau dieu tri v i VC cung cai thien mpt cich cd y nghTa thing ke: tang tu 58,9%
66,9% SLT sau diiu trj.
3. Do ludng cac chi s i CLCS - SK cua b i n h nhan gian p h i quan b i n g SGRQ
3.1. Binh gli tin xuat va dd nang cua trieu Chung hd hap
T i n suit xgit hiin triig chung ho trong
nam qua: Ho nhiig ngiy trong tgan v i ho khi c i nhiim triing hd h i p chiim ty Ip cao nhit (32% va 40% theo thu tu).
T i n suit xgit hipn triig chung ho khac ddm trong nam qua: 40% s i binh nhin tra Idi cd "Khpc ddm nhiig ngiy trong tgin" va 30% tra Idi "chi khpc ddm khi bj nhilm tnJng hd hip"; 17,5% "Ho khpc ddm v i i ngay trong tgin.
T i n suit xuit hiin triig chung kho thd trong n i m qua: hai c i g hdi duac tra Idi nhiiu nhit dd l i "Bj khd thd khi nhilm trung hd hip" v i "Bi khd thd nhiiu ngiy trong tuin"
chiim ty le (35% va 27,5% tuang ung).
S i l i n bpnh n h i n bi nguy hiim hole rat khd chju vi b i n h phii trong nam qua: ciu tra Idi nhiiu nhit l i "khdng bj l i n nao'chiim ty Ip 48%, 29% tra Idi bj nguy hiim 2 lan, 20% tra Idi bj nguy hiim d i n tinh mpng mit lan trong nam.
3.2. Danh gia nhung hoat dong the chat giy khd tha
97,5% y kiin cho ring hp "bj khd thd khi S\
l i n nhung cho die", 82,5% "Khd thd khi leo c i u thang", 7,5% "Khd thd khi di bp trin mpt phing v i 5% "Khd thd khi ngii hole nam yin".
3.3. Anh hudng cua benh gian phi quin din ddi sdng vi hoat ddng xa hdi.
Bang 1. Anh hudng cua benh p h i i d i n sire khoe ngud'i benh trong nam qua
Cau hdi
Ho, khd thd gay x i u h i nai cong cpng
Binh phii g i y nhiiu trd ngai cho gia dinh v i ban b i BN cam thay khong t h i kiim soat bpnh phii BN cam.thay y i u duii, bit luc vi bpnh phii BN cam thiy khdng an toin khi t i p t h i due Mpi vipc d i u trd n i n ngoii t i m tay ngudi bpnh
26 13 16 19 13
65 32,5
40 47,5 32,5
:i
1
4
TCNCYH Phu truung 80 (3) - 2012
65% bpnh nhan thiy "bpnh phoi gay nhiiu trd ngai cho gia dinh v i bpn be", 47,5% cam thiy
"khong an toan khi t i p luyin t h i dgc".
4. Do ludng cac chi s i CLCS- SK cua nhdm binh nhan gian phi quan b i n g SGRQ trudc va sau diiu trj
Bang 2. Diim CLCS - SK cua nhdm benh nhan gian phi quan trudc va sau diiu tri
Trudc diiu trj Sau diiu tri Diim St George's danh gia v i
CLCS-SK
Tin xuit va dp npng cua tripu Chung h i h i p
Cac hopt dpng t h i chit giy ra khd thd
Anh hudng cua bpnh GPQ 40 38,7 ± 20,6 24,7 ± 2,2 43,0 I 18,2 15,4 ±3,7
47,3 ±19,7 35,6 ±4,1
Tong diem CLCS - SK 40 42,1 ± 18,3 26,5 ±1,7
Kit qua cua t i n g diim CLCS - SK chung cho ca 3 ITnh vuc tren cho thiy: Sau diiu tri ting s i diim St. George's danh gia ve CLCS - SK cua tung ITnh vuc tren thap han so vdi trudc diiu trj, chit luong cupc sing cua ngudi benh sau diiu tri dupe cai thiin t i t ban so vdi trudc diiu tri (p < 0,001).
4. Mil lien quan giua mot sd trieu chung lam sang, can lam sang vdi CLCS - SK cua benh nhan GPQ
4.1. Mdi lien quan cua cic trieu chimg lam sang, can lam sing vdi diim St. George's cho linh vuc tan xuat va do nang cua trieu chirng hd hap
Mii liin quan cua cac triiu chung lam sing, c i n lim sang vdi diim St Georges cho ITnh vuc tin xuit v i dp npng cua triiu chung hd h i p
,Bang 3. Lien quan cua cac trieu chung lam sang, can lam sang vdi diim St Georges cho linh vuc t i n xuat va do nang cua triiu chung hd hip trudc - sau diiu trj (n = 40)
Tripu Chung lam sing.
c|n lim sang Ho Khac ddm Khi thd Phii CO ran am, n i FEV1 < 70%
FEV1/VC < 70%
PaOa < 70 mm Hg PaCOz > 45 mm Hg Sa02 < 96%
n
40 36 26 33 28 18 14 28 30
Diim Cho tinh vuc t i n xuit va do nang cua trieu chung hd hip Trudc diiu tri
42,9 ±18,2 42,2 ±18,6 44,2 ±19,0 44,4 + 18,1 44,7 ±18,2 44,3 + 20,0 45,6 ±17,2 40,9 ±17,2 46,3 ±18,6
Sau d i i u tri 15,4 ±13,7 15,2 ±13,3 15,1 ±14,3 16,2 ±14,6 18,8 ± 14,8 16,6 ±15,7 22,2 ±14,2 14,6 ±12,9 22,2 ±14,2
P
<0,05
<0,05
<0,05
<0,05
<0,05
<0,05
<0,05
<0,05
<0,05
TCNCYH Phu tnmng 80 (3) - 2012
H i u h i t c i c triiu chung trin d i u cd lien quan vdi diim St. George's d ITnh vuc t i n xuit v i dp ning cua tripg chung hd h i p trudc sag diiu trj, ngupc Ipi muc d i lan rpng cua t i n thuang trin phim CLVT (GPQ 1 bin) Ipi khong phii l i triiu chung c6 liin quan ciJa ITnh vuc niy, sg khac bipt khdng cd y nghTa thing k i p > 0,05.
4.2. M i l liin quan giua cac triiu chung lam sing, c i n l i m sang vdi diim St.
George's cho ITnh vuc nhung hopt dpng t h i chit g i y ra khd thd: c i c triiu chung lam sang, c i n l i m sing d i u cd liin quan vdi CLCS - SK d ITnh vgc hopt d i n g the chit g i y ra khd thd tpi 2 thdi diim trudc va sau diiu tri. Su khac biit c i y nghTa thing ke vdi p <
0,05
4.3. Mii lien quan cua cac trieu chung lim sing, c i n lam sang vdi diim St George's cho ITnh vuc anh hudng tdi cupc sing hang ngay cua ngudi binh: c i c trieu chung lam sing, c i n lim sang d i u cd anh hudng tdi viic lam, dia vj cua ngudi benh trong gia dinh, x i h i i cung nhu muc dp hpi nhip x i hpi cua ngudi binh. Tuy nhien theo thang do St. George's d tai hai thdi diim trudc va sau diiu tri, GPQ 1 ben khdng phai la trieu chung anh hudng d i n ITnh vgc niy, su khic bipt khing cd y nghTa thing ke p > 0,05.
IV. BAN LUAN
v i cic dac d i i m lam s i n g va can lam sang
Trong nghiin cuu n i y chung toi thiy ty l i nu gidi chiim 65%, nam gidi la 35%, tuang t u k i t qua cua Ly Tuin Hong (2008) ty ip nu l i 58 % [3].
Trong nghien cug ty l i ho khac ddm chiim cao nhit 90%, ho mag l i 50%, kho thd l i 61,9%, tuang t u k i t qga cga Ngd Qgy Chiu (2007): ho mag 43,9%, ho khac ddm
40,5% [1], Ly T g i n Hing: khac ddm 101 ho m i g l i 45,8% [3].
K i t qga nghiin cuu cua chung tdi i thiy ty Ip binh n h i n bj gian p h i quan c b i n chiim ty Ip k h i cao 7 1 % , trong khi giin p h i quan 1 ben: 29%.
K i t qua tham dd chuc nang hd hip: Tt Nguyin Thuy Linh (2008) RLTKTN chi 42,2% [4]. Trong nghien cuu cua chung ty l i RLTKTN trudc d i i u tri chiim 42,9%, ( diim n i y cQng phii hop vdi cac ngh cuu trin.
v i do ludng chi s i CLCS - SK bi SGRQ d bpnh nhan GPQ tai 2 thdi dli trudc va sau diiu trj
Kit qua nghiin cuu cua chiing tdi tr bpnh nhan g i i n p h i quan diig tri npi tru khoa Hd h i p - Binh Vipn Bach mai, cac i s i CLCS - SK l i : 42,8; 47,2; 38,6; 4;
(trudc diiu trj) v i sag diig trj diim ! George's cho tung ITnh vuc la: 15,4; 35 24,6; 26,4. K i t qua nay cung tuang tu ^ qua cua cac nghien cuu trin, nhu viy bp c hdi St George's d i n h g i i v i CLCS - SK o benh nhan gian p h i quan cung cho gia tuang tu nhu danh g i i CLCS - SK cua bpi phii t i c nghin mpn tinh.
Ban lupn v i cac m i l lien quan cua Iii VM'C CLCS - SK theo thang do SGRQ
Cac yiu td duuc ghi nhin li cd lien hi v diem CLCS - SK theo thang do St. Georgt c i c triiu chirng l i m sang: Ho, khac ddm, kl thd, phii cd ran i m , ran n i v i cic chi i CNHH (FEV, , FEV,/ VC), KMDIUI (Pa(
PaCOj), ton thuang (GPQ hai bin) tn CLVT d i u cd m i i lien quan vdi diim i Georges danh gia CLCS- SK d ca 3 ITnh vi t i n xuit v i dp npng cua triiu chung ho h^
nhung hopt dpng t h i chat g i y ra khd th nhung anh hudng cua benh gian p h i qui tdi cuic sing ngudi binh.
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TCNCYH Phu tmxyng 80 (3) - 2012 V. K^T LUAN
Do lud-ng chi sd CLCS- SK d* benh nhSn giSn p h i quan doi: d p blng bo ciu hdi St. George's
Diim tan xult va do nang cua tri^u chung hd hip: giam t u 43; 15,4 sau dieu tri. Diim nhung hoat dgng the chit gay ra khd thd hogc bj gidi han vi khd thd giam t u 47 >
35,8 sau dieu trj. D i i m cho ITnh vuc anh hudng cua bgnh gian p h i quan d i n cupc song hang ngay cua ngudi benh: giam t u 38,7 -^ 24,7 sau dieu trj.
Tong diem chung CLCS - SK cua bgnh nhan gian p h i quan: giam tu 42,1 > 26,5 sau diiu trj.
Mdi lien quan giCra mot sd trieu chung lam sang, can lam sang vd'i CLCS - SK trudc va sau dieu tri d> benh nhan gian phi quan
Cac trieu chung lam sang, can lam sang diu cd lien quan vdi CLCS - SK trudc va sau dieu trj d ca 3 ITnh vuc: t i n suit va dp nang cua trieu chCpng hd hip, cac hoat ddng t h i chat gay khd thd, anh hudng cua benh phii din cupc sdng hang ngay cung nhu muc dg hpi nhap xa hdi cua ngudi benh. Su khac biet cd y nghTa thing ke vdi p < 0,05.
TAI LIEU THAM KHAO 1. Ngd Quy Chau, Phan Thu Phuang (2007). Diiu tn gian phe quan. D i i u tn hgc ngi khoa tap , NXB Y hgc, 119.
2. Ngd Quy Chau, Truo-ng Thj Kim Nga (2006). Nghien cuu ap dung bd cau hdi ST.
GORGES'S danh gia chat lug'ng cudc song b^nh nhan benh phii tac nghen man tinh.
Tgp chi Y hgc lam sang, 65 - 68.
3. Ly Tuin Hdng (2008), Nghien cuu dac diim lam sang, can lam sang, vi khuln hgc d ddm va dich rua p h i quan qua ngi soi phi quan d bgnh nhan gian p h i quan. Lugn van tot nghiep Bac sT chuyen khoa cap II.
4. Le Thj Tuyit Lan, Nguyin Ngpc Phuang Thu, Ngd Quy Chau (2006). Bg cau hdi St.Gorges's danh gia chit lug'ng cupc sing benh nhan bgnh phoi tie nghen man tinh. Tap chi Y hgc Lam sang. So chuyen d i , 106-110.
5. Nguyin Thuy Linh (2008). Dac diim lam sang, can lam sang va vi khuan hgc benh nhan gian p h i quan diiu trj tai khoa Hd hip benh vien Bach Mai. Luan van t i t nghiep bac sT da khoa.
6. Pham Tiin Thjnh (1986). Lam sang va cac tham dd chuc nang benh nhan gian p h i quan. Luan van Bac sT ndi trii chuyen nganh Lao, Trudng Dai hgc Y Ha Ndi
7. Nguyin Van Tudng, Trjnh Binh Di, Nguyin Dinh Hud'ng va CS (1995). Khac biet k i t qua do thdng khi. Ky y i u cdng trinh NCKH Dai hgc y Ha Ndi, 71 - 76.
8. Wilson CB, Jones PW, O'Leary CJ, et al (1997) Validation of the St. George's Res- piratory Questionnaire in Bronchiectasis. Am J Respir Crit care med; 156, 36 - 541.
9. Schunemann HJ, Griffith L, Jaeschke R, et al (2003). Evaluation of the minimal im- portannt difference for the feeling thermome- ter and the St. George's Respiratory Ques- tionnaire in patients with chronic airflow ob- struction. J Clin Epidemiol; 56, 1170 -1176
TCNCYH Phu truung 80 (3) - 2012
Summary
APPLICATION OF ST OF GEORGE'S RESPIRATORY QUESTIONNAIRE FOR MEASURINt QUALITY OF LIFE IN PATIENTS BRONCHIECTASIS
The objective of this study was to measure quality of life in patients with acute exacerbatio of bronchiectasis at respiratory department of Bach Mai Hospital Respiratory by St.George' questionnaires version in Vietnamese. Evaluation the relationship between clinicals and para clinicals with quality of life before and after treatment in 2009. The results showed that 70% c patients with bilateral bronchiectasis and the rest (30%) had bronchiectasis one side. Mos symptoms are associated with the St.George's quetionnaire in the field of frequency and seveii ty of respiratory symptoms before and after treatment. In conclusion, the clinical, paraclinical an involved with qgality of life before and after treatment.
Key words; St. George's Respiratory Questionnaire, bronchiectasis
BIEU HIEN TIM MACH VA R 6 | LOAN CHUYEN HOA O BENH NHAN MAC BENH PHOl T A C NGHEN MAN T I N H
TAI BENH VIEN DA KHOA TINH HAU GIANG
Ooan Van Phuvc', Ngo Quy Chau' ' SdYti tinh Hau Giang, 'Tnmng Dal hoc y Hi Npi
Binh phdi tic nghen man tinh (BPTNMT) mic dU inh hudng chi yiu tai phii song nd cung giy ra nhiiu binh if toin thin. Di tii duac thuc hiin nhim muc tiiu nghiin cUu mpt si biiu hiin tim mach mil si rdi loan chuyin hda d binh nhin BPTNMT. Kit qui cho thiy c<5 3 diu hiiu lim sing cua binh dm gap nhiiu: Tiiu it (90,9%), phii chi dudi (84,8% ) vi rinh mach e6 nil, phin hii gan tinh mach d (*) (55,6%;. Tiin diin tim dd, nh.ip nhanh gip nhiiu nhit (90,9%). Si binh nhin ting ip luc ding mach phii chiim tf ii cao (83,8%), 65,7% si binh nhin glim protein miu vi cd 92.9% giim albumin miu. 71,9% si binh nhin ting ehoiestemi miu: 69,7% ting tngiycend miu: 70,7% sd binh nhin cd ting hing ciu vi 76,8% si binh nhin ting hemoglobin miu.
Tir khoa: bSnh phii tic nghen man tinh, rii loan tim mach va rii loan chuyen hoa
I. BAT VAN B 6 vong v i tan p h i cho binh nhan. Tuy nhien Benh phoi t i c nghen man tinh (BPTNMT) benh ding m i c vdi BPTNMT chua dum thudng la hau qua cua nhiiu benh phii man quan t i m dung muc, diiu n i y t h i hien qua tinh khac nhau, duac biit d i n rpng rai tu han nhung nghiin cuu v i BPTNMT d Viet Nam tram nam nay. Mac du BPTNMT gay anh cd kha nhiig, d i cap d i n nhieu khia canh hudng chu y i u tai phii [1] song nd cung gay cua benh song cdn r i t it d i tai d i cpp ii"
ta nhiiu benh ly toan than. Benh dong mac anh hudng toan thin, benh ding mic ciJa cung vdi BPTNMT k h i p h i biin va la mot BPTNMT [3]. Xuat phat t u thuc t i , tai Benh trong nhung nguyen nhan gay tang ty le tu viin Ba khoa tinh Hau Giang cd mpt ty Ip l*"
138 i
