• TAP C H i NGHl&N CCfU Y HQC
HIEU QUA D A N LU'U NAO T H A T RA NGOAI TRONG VONG 12 GIO SAU TRIEU CHU'NG KH^-I P H A T
CHAY WIAU NAO THAT GO GIAN NAO THAT CAP
L u v n g Q u i c Chinh^; Mai Duy T 6 n \ N g u y i n Dat Anh^; Nguygn Van Lieu^
^Benh vien Bach Mai, ^Tru&ng Dai hQC Y Hi Ndi Nghien cuv duQC thi^ hien tren 42 binh nhan gian nio that cip do chay miu nao that tai khoa Cap cuu
• benh viin Bach Mai tir thing 8/2011 den 8/2014 nhim danh gia hiiu qua din luv nao that ra ngoai tnmv;
12 gid sau trieu chung khai phat B$nh nhan dupc chia 2 nhdm din luu nao that taroc (nham 1, n = 26) vi sau (nhdm 2. n = 16) 12 gia sau tniu chung khai phit. Kit qua tot (khi GCS > 12 diim va mRS > 3) a nhdm 1 (61.5% va 42,3%) cao hon nhdm 2 (31.2% va 0%), vdi p < 0.05 Khdng thiy su khac biet ve cac bien chimg sau dan luv nao that bao gdm tic din luv nao that (7.7% so vdi 18.8%. p > 0.05), chay mau nao xung quanh din luv (7,7% so ven 18.8%, p > 0,05} vi viim nao thit (3,8% so vat 12,5%. p > 0.05). va tyle tif vong (3,8% so v&i 12.5%, p > 0,05) giira hai nhdm. Ket qua niy cho thiy din luv nao that ra ngoai trudc 12 gid sau trieu chung khoi phat khdng lam thay doi ty li cic bien chung va tu vong, nhung cd liin quan tdi cai thien kit qua ngin han (GCS va mRS cai thiin).
Tip khda: d i n l y u nao t h i t ra ngoai, gian nao t h i t c i p the t i c nghen, chay mau nao thit, xuat huylt nao
I. DAT VAN D&
Chay mau nao t h i t lg mdt y l u t l iam tang ty le m i c bgnh vg ty lg t d vong trong vdng 30 ngay, y d c tinh khoang 40 - 80% d bgnh nhan xuat huyet nao [1] Gan day, hai t h y nghigm kiem chdng n g l u nhien Idn da ehdng minh tam quan trpng ciia chay mau nao t h i t nhy mdt yeu t i d y bao k i t qua x l u . T h d nghigm STICH t i l n hanh tren 964 bgnh nhgn xuat huylt nao, 42% cd chay mau ngo t h i t vg trong do ed tdi 55% cd gian nSo t h i t the t i c nghen [2] Khi chay mau nao that va gian nao that cgp phdl hgp, ty lg k i t qua tot giam x u i n g edn 1 1 % . T y o n g t g , chay mgu ngo that c h i l m 49% bgnh nhan trong t h y nghiem Novo Seven - ICH (n = 399). Diem Rankin sda d i i (mRS)
Dia chi lien he: Lucmg Qu6c Chlnh -Khoa Cap cuv • B$nh vi$n Bach Mai
Email. [email protected] Ngiy nh$n: 27/01/2015 Ngiy dugc chap thu^n. 18/5/2015
tai thdi diem sau 3 thang xgu hon d nhdm benh nhgn ngy [3]
Tang ap lyc npi sp thodng lg hgu qua cua hieu dng khoi do mgu tu nhu md ngo, phii nao xung quanh, gian nao t h i t d p do chay mau nao that hoac hidu dng k h l i do mau tu trong n§o that, cho ngn can phai dgt ra van de d i l u trj giam ap, P h i u thugt s d m lay k h i i mau tu va/hoSc iam giam ap cd the han c h l d y o c chen ep eo hoc va nhdng tac hai cua mau tdi nao, nhyng nguy c o p h l u thuat d bgnh nhgn dang chay mgu cd the idn hon. Phyong phap d i l u tn hien nay eho chay mau ngo cd gian ngo that cap the t i c nghen lg d i n lyu ngo t h i t ra ngogi D i n lyu nao t h i t ra ngoai thydng d y g c thyc hign trong giai doan d p tinh d bdnh nhgn chay mgu nao t h i t nhy mdt bien phap dieu tn c i p c d u n h i m k i l m soal ap igc ndi so va cd the iam giam ty lg t d vong n g i n han [5] Vigc dat d i n l y u nao that ra ngoai ed lign quan tdi ty lg t d vong giam vg k i t qua n g i n han eai thign d nhdng bgnh nhan ed
TCNCYH 93 (1) - 2015
TAP CHi NGHIEN C U U Y H p C • chay mgu nao that sau khi d y g c dieu tn eac y l u t i ngng kgm theo. Tuy nhign, giai doan d p tinh ed the kdo dgi t d vgi nggy cho tdi 1 tuan vg d i l u ngy se ed anh h y d n g tdi hidu qua dgn lyu nSo that ra ngoai. Do vay, de ed the lygng hda d y o c thdi gian dat d i n lyu nao t h i t sdm sao cho phii hop vdi dieu kign thye te d phdng d p cdu tgi Vigt Nam, chung toi t i l n hanh nghien edu ngy n h i m muc tieu Dgnh gia higu qua d i n lyu nao that ra ngogi trong vdng 12 gid sau trigu chdng khdi phat trong chay mau nao t h i t cd gian ngo that d p
II. D6\ TU'ONG VA PHU'ONG PHAP
1.Ddi tu'gng
Benh nhan chay mau nao t h i t cd gian nao that d p d y o c nhgp vign d i l u tri tgi Khoa Cap edu, Bgnh vign Bach Mai t d thang 8/2011 d i n thang 8/2014 dap dng du cgc tieu chuan lya chgn vg loai trd-
- Tieu chuin iira chgn benh nhan + TUOI 1 8 - 8 0 tuoi,
+ T h l tich x u l t h u y l t nhu md nao £ 30 ml hogc chay mgu nao t h i t don thuan;
+ Chay mau nao t h i t 3 va/hoac nao t h i l 4 cd gign nao that e l p ;
+ Benh nhan da d y g c dgt d i n l y u nao t h i t ra ngogi;
•^ Tien s d cd thang diem Rankin sda doi (mRS) dat diem 0 hoac 1;
+ Od s y c h i p nhgn tham gia nghign cdu cua bgnh nhan hogc gia dinh benh nhgn.
- Tieu chuan loaii tru- benh nhan + Phinh ddng mgch nao v d , Ihdng ddng ITnh mach ngo v d , hoge u ngo;
+ Dj dang dam r i i mach mgc hogc hpi chdng Moyamoya;
+ Cd cac roi loan ddng mau ( s i lygng tieu c a u < 100.000. I N R > 1,4);
+ Phy ny cdthai;
+ X u l t huyet nao viing d y d i leu.
+ Bat ed tinh trang ngo ma nghidn cdu vidn nhan thay r i n g se tgo ra m i i nguy co aang ke cho d i i t y g n g nghidn c d u n l u viec dieu tri nghign c d u d y g c b i t d i u
2. Phu'O'ng phap
2.1. Thiet Ae: nghign c d u md ta, t i l n cdu 2.2. PhwoTig phap
Benh nhan chay mau nao that cd gign ngo that d p dap dng du cac tieu chuan lya chgn vao nghign c d u se d y g c chup d t Idp vi tinli da dgy (MSCT) sp nao vg mach nao d l xac dinh VI tri cua d i n l y u trong nao t h i t , cae chay mau mdi cung nhy hg mgch mau nao it nhit 6 gid sau khi d y g c dgt d i n lyu nao that ra ngogi. Chia bgnh nhan nghien edu thanh hai nhdm nhdm d y g c d i n l y u nao t h i t ra ngoai tryde 12 gid va nhdm d y g c d i n lyu nao thai ra ngoai sau 12 g i d sau trigu chdng khdi phat Dieh nao tiiy d y g c d i n l y u ra ngoai lign tuc d y d i ap Igc d i n l y u la 10 mmHg. T i t d cac phim chup so nao (CT va MSCT) khi bgnh nhgn nhgp vign, t r y d c khi va sau khi dgt d i i lyu nao t h i t d y o c danh gia bdi bac sT chuyen khoa chan doan hinh anh de xac dinh ben nao that dat dan lyu, vi tri d i u d i n l y u nao ttilt va s y xuat hign cua chay mgu nao xung quanh dan lyu nao t h i t . Diem danh gia mdc dd ngng cua chay mau nao t h i t (diem Graeb) dyoc tinh toan [6]. Tinh trang gian nao that dygc xgc dmh b i n g phgn tich hinh anh phim OTsp nao theo tieu ehuan eua Phan vg cdng sy [7]- Vidm ngo that d y g c xdc dinh khi d y djeh nao tuy d y o n g tinh hogc, d y dich nao tuy gm tinh nhyng so lyong bach d u trong djch nao tuys 50 c h i l e (> 50% lg bach c l u da nhan tmng tinh) hogc nong dd glucose trong dich nao tuy
< 0,83 mmol/l {15 mg/dl) [8] D i l m hdn me Glasgow (GCS) khi nhgp vign |g d i l m hdn mg dau tidn d y g c ghi chep lai khi vgo i -oa d p
32 TCNCYH 93 ( i , -.^5
• TiBlP CHl NGHIEN CUU Y H p C Cdu, vi doi vdi phan ldn benh nhan thi dieu
ngy dai didn cho tinh trang bgnh nhgn liic ban dau de d y a ra q u y l t djnh dat d i n lyu nao t h i t ra ngogi. GCS d y g c phan loai theo cac mdc dp (GCS > 12; GCS 12 - 9; GOS 8 - 7 ; GCS 6 - 5, G = 4, vg GCS = 3). Hoi phyc lam sang t i t d y o c xac djnh khi diem Rankin sda d i i (mRS) t d 0 d i n 3 va h i i phue iam sang kem khi mRS t d 4 d i n 6 sau 1 thgng.
3. Xu' ly s d lieu
s l lieu nghien cdu d y o c thu thgp theo m i u benh an nghien cdu t h i n g nhat, d y o c x d ly va phan tich trgn p h l n m i m t h i n g ke y hoe SPSS 17.0.
4. Dao du'c nghign c i r u
B^nh nhgn vg/hogc thgnh vign gia dinh dgi dign phap ly cho bgnh nhan d y g c giai thieh ve mye dich va p h y o n g phap nghign edu Ohi nhdng bgnh nhgn vg/hoac thgnh vign gia dinh dgi dign phgp ly cho benh nhgn d i n g y t g nguygn tham gia mdi d y o c d y a vgo de tai nghien edu.
Benh nhan vg/hoac thgnh vidn gia dinh dgi dign phap ly cho bgnh nhgn ed quyen khflng tham gia nghign edu t i l p trong bat ky thdi d i l m ngo.
II. K^T QUA
Bang 1. Dac diem lam sang vg can lam sang khi nhap v i e n
Nhdm 1 (n = 26) Nhdm 2 (n = 16) (EVD tru'dc 12 g i d (EVD sau 12 g i d sau trieu chu'ng sau trieu chu'ng GCS {min - max)
Mach (nhip/phCit) (min - max) Huy^t ap tam thu (mmHg) Huy^t ap tam tri^ong (mmHg) Biem Graeb {min • max) T i i u cau (G/l) INR Prothrombin (%) APTT (giay)
7 ( 5 - 1 3 ) 90 (55 -120) 168,1 ± 2 7 , 3 95,8 ± 1 5 , 5 8 ( 5 - 1 1 ) 222,8 + 68,8
1,1 ± 0 , 1 4 89,8 ± 20,1 25,7 ± 3,2
8 (5 - 1 1 ) 9 0 ( 5 5 - 1 2 0 )
173,8 ± 2 9 , 2 96,9 ± 18,2 9 ( 6 - 1 1 ) 263,4 ± 4 8 , 2
1,0 ± 0 , 1 99,8 ± 1 3 , 4
25,4 ± 2 , 1
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
T i t ca dgc diem iam sgng vg cgn lam sgng d hai nhdm nghign c d u khac bigt khdng ed y nghTa t h i n g ke {p > 0,05). Ca hai nhdm deu cd diem hdn mg Glasgow t h i p nhdm 1: 7 (5 - 1 3 ) ; nhdm 2 8 (5 - 1 1 ) , vg d i l m chay mgu ngo Graeb cao nhdm 1 8 (5 - 1 1 ) ; nhdm 2: 9 (6 - 1 1 ) .
TCNCYH 93 (1) - 2015
TAP CHi NGHIfiN CU'U Y H(JC -
Bang 2. Mirc d o hoi phgc y thi>c theo thang diem hon m e G l a s g o w (GCS) Nhom 1 (n = 26) (EVD t r i p l e 12 g i »
sau t r i ^ u ChOng kho^i phdt)
Nhom 2 {n = 16) {EVD sau 12 gio- s a u trieu c h u n g k h a i phat)
> 1 2 9 - 1 2 7 - 8 5 - 6 4 3
Truwc EVD 2 (7,7%) 7 (26,9%) 8 (30,8%) 9 (34,6%)
0 0
Sau EVD 16(61,5%) 4(15,4%)
2 (7,7%) 2 (7,7%)
0 2 (7,7%)
T r u ^ c E V D 0 7 (43,8%) 6 (31,2%) 4 (25,0%)
0 0
Sau EVD 5 (31.2%) p < 0,05
5(31,2%) 1 (6,2%) 2 (12,5%)
0 3 (18,8%)
' GCS thang diSm hon me glasgow; EVD dan Iwu nSo that.
Khong benh nhan nao d ca hai nhdm cd GOS = 3 hogc 4 t r y d c khi d i n l y u ngo t h i t (EVD).
Tuy nhign, sau EVD, nhdm 1 cd 2 (7,7%) vg nhdm 2 cd 3 (18,8%) benh nhgn cd GOS = 3 hogc 4.
Nhom 1 ed 2 (7,7%) va nhdm 2 khdng cd benh nhgn ngo cd GCS > 12 t r y d c khi d i n l y u nao t h i t va sau khi d i n l y u nao t h i t s i benh nhgn cd GOS > 12 d nhdm 1 lg 16 (61,5%) eao hon d nhom 2 lg 5 (31,2%) vdi p < 0,05.
Bang 3. Mi>c do h i i phuc lam sang sau 1 t h a n g Diem Rankin
sLpaddi (mRS)
N h o m l (n = 26) (EVD t r y d x 12 g i d sau trieu chi>ng k h d i phat)
Nhdm 2 (n = 16) (EVD s a u 1 2 g i o ^ s a u trieu chi>ng k h d i phat)
0 1 2 3 4 5 6
Nhap vien 0 0 0 0 0 26(100%)
0
Sau 1 thang 0 0 0 11 (42,3%) 8 (30,8%) 6(23,1%) 1 (3,8%)
Nhap v i e n 0 0 0 0 0 16(100%)
0
Sau 1 t h a n g 0 0 0 0 (0,0%) 8 (50,0%) 6 (37,5%) 2 (12,5%)
<0,05
Tai the»i diem nhSp viSn, fliem Rankin su-a doi (mRS) a ca hai nhOm deu bSng 5. Sau 1 thang:
nhom 1 CO 19 (73,1%) benh nhan co mRS dat 3 va 4 diem; nhOm 2 co 8 (50%) benh nhan CO mRS dat 4 aiem. Hon ni>a, mRS a nhom 1 va nhom 2 l^n lifcrt dat 11 (42,3^- ^ va 0 (0%), p < 0,05.
TCNCYH 93 (^
• TJflkP CHi NGHIEN CUU Y HpC Bang 4. Ty 1^ cdc bign chu'ng sau d i n lu>u nio thit
T i c d§n lu'u nSo thit Chay mSu nSo xung quanh dSn lu'u Viem nSo that
Nhom 1 (n = 26) (EVD tru'd'c 12 gio- sau trieu chQ>ng kh6i phat)
2 (7,7%) 2 (7,7%) 1 (3,8%)
Nhom 2 (n = 16) (EVD sau 12 gid" sau tri§u chu'ng khd*! p h i t )
3 (18,8%) 3 (18,8%) 2 (12,5%)
P
>0,05
>0,05
>0,05
Nhdm 1 cd 2 (7,7%) benh nhan tic din lyu nao thit, 2 (7,7%) bgnh nhgn chay mgu nSo xung quanh din lyu vg 1 (3,8%) benh nhgn vigm nao thit, vg nhdm 2 cd 3 (18,8%) bgnh nhgn tie dan lyu nao that, 3 (18,8%) bgnh nhgn chay mgu n5o xung quanh din lyu va 2 (12,5%) bgnh nhan vigm nao that vdi sg khac bigt cua iln lyot 3 biln chdng ngy gida 2 nhdm khdng cd y nghTa thing kg (p > 0,05).
45 40 35 30 25 20 : 15 10 5 0
-—
25 (96,2%)
1 • 1
H 1 (3,8%)
Nhom 1 (n = 26)
^ *
39 (92,9%)
I Sdng sdt i Ty wng
14 (87,5%)
I 2 (12,5%) -3(7,1%)
Nhdm 2 (n = 16) Ting s l (n = 42) Bilu dd 1. Ty l§ tlf vong sau din lu'u nao thSt
Hai nhdm deu ed bgnh nhgn td vong: nhdm 1 cd 1 (3,8%) va nhdm 2 cd 2 (12,5%) bgnh nhgn vdi sg khac bigt khdng cd y nghTa thong kg (p > 0,05).
IV. BAN LUAN
Phan Idn bgnh nhgn trong nghign cdu dygc din lyu nao thit ra ngogi cd dgc diem lgm sgng vg cgn lgm sgng trong gidi hgn binh thydng vdi sg khgc bigt khdng cd y nghTa
thing kg Tuy nhign, cd hai dgc dilm dgng lyu y (bang 1) la diem hdn mg Glasgow (GCS) thap: nhdm 1 7 (5 - 13); nhdm 2 8 (5 - 11);
p > 0,05, vg diem Graeb eao: nhdm 1: 8 (5 - 11); nhdm 2: 9 {6 -11), p > 0,05 tai thdi diem
TCNCYH 93 (1) - 2015 35
TAP CHi NGHIEN CI>U Y H p C • nhgp vign Diem hdn mg Glasgow t h i p (< 8 dilm) vg diem Graeb cao (> 5 diem) la nhdng y l u t i d g bao d | c lap cho vige dat d§n lyu ngo t h i l ra ngoai d bgnh nhgn c h l y mgu nao that [6]. Bgn cgnh dd, h u y l t gp tgm thu trung binh (bang 1) d ca hai nhdm bgnh nhgn nghidn cdu d i u tgng cao (nhdm 1: 168,1 ± 27,3 mmHg; nhdm 2. 173,8 ± 29,2 mmHg, p > 0,05). Huylt ap tang cao thydng do hogt hda qua mdc hg t h i n g ndi t i l t t h i n kinh vg dgc biet nd lg hgu qua eiia tinh trang tgng ap lyc n i l sp, Huyet ap tgm thu trgn 140 - 150 mmHg trong vdng 12 gid sau x u l t h u y l t nao cd lidn quan tdi viSe tgng hon g i p ddi nguy c d di ehdng va t d vong d bgnh nhgn xuat h u y l t nao [9]
K i t qua cho thay hai nhdm benh nhan nghidn cdu cd s y cai thign rd rgt diem hdn me Glasgow sau khi d i n lyu ngo thit: nhdm 1 cd tdi 61,5% (16) so vdi nhdm 2 cd 31,2% (5) bgnh nhgn cd GOS > 12 diem, vg nhdm 1 vg nhdm 2 i l n lygt cd 7,7% (2) va 18,8% (3) bgnh nhgn cd GCS = 3 diem, tuy nhien vi ca mau chya du Idn cho ngn khdng the so sanh de tim s g khgc biet ve thong ke gida hai nhdm D i l m hdn mg t h i p mdt phan do tang ap lyc ngi sp ggy ra bdi higu dng k h i i eiia mgu tu nhu md ngo hogc gian ngo t h i t do ehay mau nao that hogc higu dng k h i i do mau ty trong nao t h i t Bgt d i n lyu ngo that ra ngogi sdm trong nhyng trydng hgp ngy d y g c coi la bien phgp dieu trj e l p cdu n h i m kiem soat gp lge npi so vg cd the lgm cai thign ket qua vg lam giam ty le t d vong n g i n han [5].
Tgi thdi diem nhgp vign, tat ca benh nhgn d hai nhdm (bang 3) d i u cd mRS = 5 Tuy nhign, thdi diem 1 thgng sau trigu chdng khdi phat thi mdc dd h i i phye iam sgng t i t (mRS = 3) a nhdm 1 (42,3%) eao hon d nhdm 2 (0%) vdi s g khgc bigt ed y nghTa t h i n g kg (p <
0,05). Bgn cgnh dd, mdc dd h i i phuc iam
sang xau (mRS: 4 - 6) tai thdi diem mpt thgng sau tngu chdng khdi phgt a ca hai nhdm d n ehiem khg n h i l u : nhdm 1 57,7% va nhdm 2 100%. Trong mOt nghign c d u v l cac y l u t6 q u y l t dinh tdi vigc dgt d i n l y u nSo t h i t ra ngoai va cgc ket qua liSn quan a bgnh nhan chay mau nao that [5], da danh gig cgc y a j to lidn quan tdi mdc dd h i i phuc lgm sgng tot (mRS: 0 - 3 ) sau 1 thgng cho thay d i n lyu nao t h i t ra ngogi thye s g v i n cdn y nghla (OR 15,7; p = 0,01)
3 bgnh nhgn nghien c d u cd bien chdng vigm nao t h i t , nhdm 1 cd 1 (3,8%) vg nhdm 2 cd 2 (12,5%) bdnh nhan vdi s g khac bigt khdng cd y nghTa t h i n g ke (p > 0,05). Tuy nhign, khdng cd b0nh nhgn vigm nao t h i t nao t y vong hogc cho ket qua x l u Trong m6t nghign c d u [8], cd 82 d i n l y u nao that dugc dat eho 72 bgnh nhgn thi ciing chi cd 3 (3,7%) bgnh nhgn cd bien chdng vigm nao thit khdng cd bgnh nhgn vigm nao that nao li;
vong hogc ed k i t qua x l u vg thdi gian nini vign khdng lau hon so vdi nhdm benh nhan khdng viem nao that. Bien chdng t i e d i n Imi ngo t h i t (bang 4) ggp d 5 bgnh nhan nghien c d u ma trong dd nhdm 1 cd 2 (7,7%) bgnh nhgn vg nhdm 2 cd 3 (18,8%) bgnh nhgn vdi s g khgc bigt khdng cd y nghTa thong ke (p > 0,05) B i l n chyng t i c dan l y u nao thit cung gap a 14 (19,4%) trong s i 72 benh nhan d y g c dat d i n l y u nao t h i t trong mdt nghign cdu [5], bgnh nhgn t i e dan lyu ngo that thydng cd t h l tich mgu trong nao that 11^
(49,2 ± 37,8 ml). Bgc biet cd 5 bgnh nhgn xult hign b i l n chdng chay mgu ngo xung quanh d i n lyu (nhdm 1: 2 bgnh nhan e h i l m 7,7% vi nhdm 2 cd 3 benh nhgn c h i l m 18,8%, s g khac bigt khdng cd y nghTa t h i n g kg vdi p > 0,05) va cd 3 trong s i 5 bgnh nhgn chay mgu xung quanh chan dan l y u t d vor , ( b i l u d l 1):
nhdm 1: 1 (3,8%) benh nhgn vg rj^ 2: 2
TCNCYH 93(1). ,^5
• TAP CHl NGHlfeN cO'U Y HQC (12,5%) bgnh nhan (p > 0,05). Ca 3 bgnh
nhan t y vong deu ed tinh trang y thde rat xau (GCS = 3) va tren phim c l t ldp vi tinh (CT) sg nao thay k h i i mgu tu nhu m l ngo t i l n then rd vg phli nao ngng. Cgc xet nghigm ddng mgu d ca 3 bgnh nhgn t d vong deu cd k i t qua binh t h y d n g
V. K^T LUAN
Qua nghidn cdu 42 benh nhgn gian ngo that cap do chay mgu nao t h i t cd hogc khdng x u l t h u y l t nhu md nao d y g c d i n lyu ngo t h i t ra ngoai chiing tot cd mdt s i ket luan sau:
Od s y cai thign diem GOS (GCS > 12 diem) sau d i n lyu ngo t h i t d ca 2 nhdm nhdm 1 cd 61.5% cao hon nhdm 2 ed 31,2%
vdi p < 0,05.
Thdi diem 1 thgng sau trigu ehdng khdi phat, mdc do h i i phuc lam sgng t i t (mRS = 3) d nhdm 1 dat 42,3% benh nhgn va nhdm 2 cd 0% cai thien.
Bien chdng t i c dan lyu ngo that (nhdm 1 cd 7,7% vg nhdm 2 cd 18,8%), chay mau ngo xung quanh d i n lyu (nhdm 1 cd 7,7% vg nhdm 2 cd 18,8%), vigm ngo that (nhdm 1 cd 3,8% va nhdm 2 cd 12,5%). S y khac biet khdng cd y nghTa t h i n g kg.
Cd 3 benh nhan t d vong nhdm 1 cd 1 benh nhan c h i l m 3,8% va nhdm 2 cd 2 c h i l m 12,5%.
Lai cam an
Nghign edu d y g c hoan thanh nhd s g hop tac cua bgnh nhgn da d i n g •j/ tham gia nghidn cdu, d i n g thdi ed s y ddng gdp cua tap t h l bac sT vg d i l u d y d n g khoa cap c d u benh vign Bach Mai.
TAI LIEU THAM KHAO
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S u m m a r y
EFFECT OF EXTERNAL INTRAVENTRICULAR DRAINAGE WITHIN 12 HOURS FROM ONSET IN INTRAVENTRICULAR HEMORRHAGE WITH
ACUTE HYDROCEPHALUS
The study was conducted on forty-two patients with acute hydrocephalus resulting from intraventricular hemorrhage. Patients were admitted to the Emergency Department of Bach Ma hospital from August 2011 to August 2014. The purpose of this study was to evaluate the effect of external intraventricular drain placement within 12 hours from onset in intraventricular hemorrhage with acute hydrocephalus. Recruited patients were divided into two groups: group one (n = 26), EVD were placed within 12 hours from the onset; and group 2 (n = 16), EVD were placed after 12 hours from the onset. There were better outcomes (GCS > 12 and mRS = 3) in group 1 (61.5%
and 42.3%, respectively) than group 2 (31 2% and 0%, respectively) with p < 0 05. W e found no difference in complications from EVD placement including EVD obstruction (7.7% vs 18 8%, p > 0.05), catheter tract hemonliage (7.7% vs 18 8%, p > 0.05) and bacterial CSF infection (3.8%
vs. 12.5%, p > 0.05) and mortality rate (3.8% vs 12 5%, p > 0.05) between the two groups These results shown that EVD placement within 12 hours from symptom onset did not change the complication rates and the mortality rate, but were associated with improvement of short - terra outcomes (GOS and mRS).
Key words: External intraventricular drainage, acute obstructive hydrocephalus, intraventricular hemorrhage, intracerebral hemorrhage
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