ITtNeQUAIItllCHItHCttUI
Nhan xet hieu qua di^u tri cat cdn nghien heroin bang Levomepromazin va Diazepam
Nguyfin Thi Xuyen(*), Dam Dffc Thang (**)
Nghien ma tuy ndi chung, ddc biet nghiin heroin Id mot ti ngn xd hoi dnh hudng sdu sde ddn binh nhdn, gia dinh vd xd h^i. So luang ngUdi nghien ma tuy co chiiu hudng ngdy cdng gia ldng. Nghiin Clhi ndy dUa ra nhdn xel hiiu qud dieu tri cdt ccm nghien heroin bdng levomepromazin vd diazepam.
Mdu nghien cdu gdm 59 binh nhdn nam, theo tiiu chudn chdn dodn nghien heroin cua hoi tdm thdn hoc Hoa Ky ndm 1994 (DSM-IV). dieu tri noi trii tgi binh vien Tdm thdn Hdi Phong, tudi tit 18 58 tudi. Tie'n hdnh theo phuang phdp tie'n ciiu, cat ngang, cd tii'n hdnh phdn tich tUmg trUdng hdp diin hinh. Ket qud cho thdy cdc rdi logn tdm thdn vd ca the xudt hien chd ye'u trong 3 ngdy ddu, tit ngdy thd 5 cua dot dieu tri cdc rdi logn cd xu hudng gidm ddn. Sau 10 ngdy dieu tri chi co mgt vdi benh nhdn con mot sdbieu hiin nhU: gidm khi sac mdl ngu, lo du, them heroin. Thudc levomepromazin lieu trung binh Id 127.5 78,5mg/BN/ngdy, diazepam Id 28,75 16,5mg/BN/ngdy. Tdm lgi, nghiin cdu hiiu qud cua cdc thud'e cdt can nghiin Heroin tren ldm sdng Id hit siic cdn thie't vd hdu ich.
An evaluation of the effectiveness of levomepromazin and diazepam used
for heroin detoxification
Nguyen Thi Xuyen (*), Dam Due Thang (**)
Introduction: Drug addiction, particularly heroin addiction, is considered as a social evd profoundly affecting patients, families and the society. The number of drug addicts is on an increasing trend.
Objective: To reviews the effectiveness of heroin detoxification by the use of levomepromazin and diazepam. Subjects and Method: 59 male patients were selected according to the heroin addict diagnosis standard of American Psychiatry Assembly in 1994 (DSM-IV). They were on inpatient treatment in Hai Phong Mental hospital, aged from 18 to 58 years. This is a prospective, cross- sectional study wilh analysis of each typical case. Results: The mental and physical disorders were mainly found within ihefirst three days, but they tended to decrease from day 5 of treatment. After 10 days of treatment, only signs such as insomnia mood, anxiety, craving for heroin were observed.
The average levomepromazin dose was 127.5 78.5mg/paiient/day while diazepam dose was 28.75 I6.5mg/patient/day. Conclusion: The study on effectiveness of drugs usedfor heroin detoxification is clinically necessary and very useful.
46 Tap chi Y td Cdng cdng, 7.2010, Sd 15 (15)
I TiNG I B M & NGHIEN CBBj
Tac 0i
(*) TS. Nguyen Thi Xuyfin - Thtf mrSng B$ Y te
(**) Ths. BS. Dim Dtfc ThSfng • TrdSng ph6ng KHTH, kifim Tnrdng khoa dilu tri nfl,
Gidng vifin kiem nhi^m Bg m3n TSm ib&a Tnrdng Dai hgc Y Hai Hi6ng. Di^n thoai: 0912043562.
E.mail: [email protected]
1. Dat vS'n de
Khi sffc khoe giam srfl hay vi mfit ly do nao dd'y phai ngffng sff dung heroin ngffdi nghifin sfi tha'y xua't hifin hpi ehffng cai vdi nhiJng bieu hien sau:
ngffdi nghifin rd't khd chiu, bieu hien bang ede rdi lo^n lam than vd rd'i loan cd thd tff nhe ddn nang, thffdng xay ra cap tinh vd bupe ngffdi nghifin phai siJ dung ma tuy trd Iai. Do dd, vifie dieu iri hpi ehffng eai la vipc khdng the thidu trong cdc lifiu Irlnh eai ma tiiy ndi ehung, cai nghifin heroin ndi rifing. Dieu tri hfii ehffng eai, gidp ngrfdi nghipn vffpl qua bpi chrfng cai mfit edeh, nhe nhang va nhanh ehdng boi phuc sffc khde van luon Id vd'n de dffde nhidu ngffdi quan tam nghifin cffrf khdng nhffng d Vifil Nam raa ca irfin thd gidi. O nffdc ta phrfdng phdp cat cdn nghipn heroin dung levomepromazin kfi't hdp vdi diazepam dffde Bd Y tfi' Vifit Nam eho phfip (1995) Id thdng dung trong cdc bfinh vifin Tdm thin, song cdc cong irinh nghifin crfu va'n dl ndi trfin edn chffa nhieu. Chinh vl vay chiing ldi tid'n hanh nghifin effu vdi muc tieu sau:
Nhdn xel hipu qua dieu Iri c^t cdn nghien heroin bang levomepromazin vd diazepam.
2. Ddi ttfdng va phiftfng phap nghifin citu 2.1. Ddi tUifng nghien cdu
Gdm 59 bfinh nhan nam nghien heroin dffde dieu tri npi tru tai Bfinh vipn Tam than Hai Phong vd Iffa ludi tff 18 58 mdi, mdi trung binh Id 33,05 8,09.
2.1.1. Tiiu chudn chgn benh nhdn nghien cdu Td't ca ede ddi tffdng da vao nghi6n cffrf phai dap ffng dly du ede tifiu ehuan chan doan nghien heroin cua Hfii Tam ihin hpe My ndm 1994 (DSM-IV) [5].
- Cd bang ehffng da sff dung heroin (Ihff test morphin ddng tinh trong nffdc tidu)
- Bfinh nhan ddp ffng dffde nhu elu kham bfinh va Iam ede xet nghiem.
Ta'l ea cdc bpnh nhan ddc dieu tri bang levomepromazin vd diazepam theo phdc dd effa Bfi Y tfi'( 1995) dd eat edn nghifin
2.7.2. Tiiu chuan logi trit
Bfinh nhan ed bfinh ed the nang: tim mach, hen, gan, than...
Bfinh nhan dffng Ihude cat cdn khac vdi quy trinh nghien cffu.
Bfinh nhan ed tien sff mdl bfinh tdm thin khae.
Bfinh nhdn ddng Ihdi nghifin rffdu hode Ioai ma niy khdc.
2.2. Phuangphdp nghien ctht
Tifi'n hdnh theo phrfdng phdp tifi'n cffu, cat ngang, ed lien hanh phan lieh tffng Irffdng hdp dien hinh.
2.2.2. Phuang phdp khdm ldm sdng chung - Sff dung man bfinh an nghifin effu.
2.2.3. Cdc chl liiu ldm sdng deddnh gid kit qud Difin bifi'n Irifiu ehffng trong 10 ngay dieu iri (tiif ngay thff 01 den tiiff 10).
2.2.3.1. Ddnh gid cdc rdi logn ve cathi Ddnh gid cdc rdi loan cd the iheo DSM- IV the hifin qua 9 trifiu ehffng: Loan khi s^c, ndn, bdn ndn, dau cd, ehay nffdc bpt - nffdc mat. gian ddng tff hoac ra nhieu md hdi, ia chay, ngap, sdt, mai ngti.
Ddnh gia hpi ehffng eai tbeo bang diem ciia Himmelsbaeh 1982.
Tap chi Y te Cdng cdng, 7.2010, Sd 15 (15) 47
jTfi'NGQBAN& NGHIEN ctiu I
Bdng 2.1. Bdng diim cua Himmelsbaeh
T r i ( i i c h i t o g M e t m o i T 3 rdi tigip c h a y nifOc m i t G i a y ninjc mQi V a ToS h d i l a c h a y D a u lUtag N h i f c Xlf d u g Mi d a g l
D i & n I 1 1 1 2 1 1 2
T r i ^ D c M n g D i n d o n g [ 6 N 6 a g ngiTc k h o c ^ M f f t n g a N h l t c d a a NOn m ^ CO g i J I HOn m e T i n g I m y e l a p X u f i huyg't
D l ^ 3 1 2 2
3 3 3 3
Tong sd: 30 diem Ddnh gid mrfc dp:
+ Dffdi 10 diem Id nghifin nhe.
-H Tff 10 - 20 didm Id nghifin vffa.
-1- Tff 21 - 30 didm Id nghifin nang.
2.2.3.2. Danh gia ve rdi loan tam than 2.3. PhUdng phdp xd IS sdlieu: xvl l^ bang chuang trinh SPSS 15.0.
3. Kfi't qua nghidn cifu
3.3. Hi$u qud dieu trf cat can nghidn heroin
Bdng 3.1. Diin biin tdm trgng trong diiu tri edi can
B f n l i i i h l a T r i f u c b < S (
u...
Hsiiightfi
BindiAii D
%
rB
*
Pn
«
PN s l T 1
S2 S S . l l t„<O.Ol 2 339 Pl i<0.01
Q 0
1 37 62,71 p^3^^).DS
32 54.24 pn>O.0S
!2 20.34 Pi.3M).0S
3 16 44,07 p n > O J B
16 44,07 P M < 0 . 0 1
9 15,2:
pM<Ofll 5 16 27,12 f,--f>0OS 4 6.78 P).i> 0,05
3 5,0B p,.j«o,as
7 5 B.47 pi io>a.05
1 1*9 P7.,c^0,D]
D 0
10 3 5,0S p,n<0.001
0 0
0 0
Nhdn xfit: Lo du ngay dau ehiem 88,14% sau 10 ngdy dilu tri cdn 5,08%, hfi't hoang ngay dau 3,39%
sau 10 ngdy dieu iri khdng con benh nhdn nao. Bdn ehon ngay dau khong cd bpnh nhdn nao, ddn ngay Ihff 2 cd 20,34%.
Nhan xfil: ngay dau rdi loan ndng Iffe dinh hffdng ed 5,08% dfi'n ngay thff 2 Id 13,56%, ngay thrf 7 trd di khdng edn bfinh nhan ndo rdi loan. Me sang, Iu Ian ngdy Mu khong ed bpnh nhan nao den ngay ihff 2 cd 2 bfinh nhan, ngay thrf 7 trd di khfing con benh nhdn ndo. (Bdng 3.2)
Bdng 3.2. 'e rdi logn
B f n h n h i n Tri^D c h A i g
RL n i n g life dinh hitflng
M c s i n g
L i S l I n
%
„p n
%
P n%
Py thdc trong dieu tri cat can
N g i y 1
3 5.08 pi-;>0,05
0 0
0
n
1 8 1 3 . 5 6 P3-s>0.05
3 5 . 0 8
3 6 10.17 p v i > 0 , 0 5
2 3 , 3 9 P:.j>0,05 1 3 . 3 9
2 3 , 3 9
S 1 1.69 P : 5 < 0 . 0 S
0 0
1 1.69
7 0 0
0 0
0 0
I D 0 0
0 0
0 0
Bang 3.3. Rdi logn can
B g n h n l i f l a T r l f n c h d u g
L o i ^ k h S o g d l aibfc CCta
e i m Kic d l bang nd
k M o g ^ l ^ a h D
%
P D%
PD
%
PI xiic chung trong dieu trj cat can
N g i y 1
3 7 62.71 p,.i>O.OS
0 0
0 0
2 3 2 5 4 . 2 4 K-rcO.OS
4 6.78
3 II 18,64 P i . j < 0 . 0 5
3 S.08 pi.p'O.OS 3 3.39
2 1.69
5 2 3 3 9 P i . ^ a , o i
0 0
1 1,69 p > 0,05
7 0 0
0 0
0 0
10 0 0
0 0
0 0
Nhan xdi: ngay dluc^t cdn 62,71% Io sd khdng cat 6MC cdn, ngay thff 7 Ird di khdng cdn bpnh nhdn nao ed cam gide nay. Cam xrfc de bung nd, cam xrfc khfing dn dinh cfu xud't hifin vao ngay thff 2, 3 vd 4.
Bdng 3.4.
TrKucbitng
L o u khi tdc
Oi i DiU l s dc
Kllii<[;Uii n
*
Pn
*
P« »
P
^e roi logn khi sac trong diiu trf cdt can
N | » / 1
29 49.15 pi.i>o.a5
i
i 3 j e PL i<0.05
D 0
I 3J S5.93 Pi;>0A3
28 47,47 pi.pfl.Oi 3 SM
3 33 55.93 PM>tWB
2J
•12J7 P M X W I S
2 J J 9 Pi-fMsa
S 27 4S,76 P9.,>0.QS
21 35 J 9 Pl.7>0J}S
0 0
7 13 22.03 PiKO.0i
17 2B,S1 Piiii>0J]5
0 0
10 3 S.08 PlB.I<DJ)l
5 8,47 PMIf^Jll
0 0
Nhan xfit: Loan khi sac ngdy diu 49,15% ngay Ihff 10 cdn 5,08%. Giam khi sic 13,56% ngay dau,
•gay ihff 2 tdng Ifin 47,47%, den ngay thff 10 cdn 8,47%. Khi sac ban hoc, ba't man chi xuat hi^n vdo ngay Ihff 2 va 3,
48 Tap chi Y td Cdng cdng, 7.2010, Sd 15 (15)
ITl'llGIIUIIIIGIIItHCIigi
Bang 3.5. Ve roi logn tri gidc trong dieu tri cat can
BfnhnhSn Tr^DchdoE AoihaDh
Aodd
Ao Ilic Eiic D
•i
P
n t
%
P0 0 0 0
4 6.7B I h o * 0 5
5 B.47
3
5,08 g
,
3 J 9 0
0
4 I 3 6.78 1 S.OR
p>0,05
.,
n
in
0
Nh§n xet: ao thanh, ao thi, ao xrfc gide nhffng ngay dau khong cd bpnh nhdn nao, ngay thrf 2 xuat hifin mpt sd trffdng hdp, iff ngdy ibff 7 trd di khdng cdn benh nhan nao,
Bdng 3.6. Diin bien rdi logn hdnh vi trong dieu trf cdtcdn
Bfnh Oban TrKuckdi^
— • >
KliHideD^irfnicim
„....„.,
d u n a n n
«
p
f p
»
p•S
"
N B * . 1
7 J 1.86 P. r<0,OI n 0
<i 0
4 f.1S
2 S3 89.8}
pj.>0,n5 5 8 47 P--.XKI5
0 0
11 5Z.14
3 49 83,U5 P l « 0.01
2 3,39 P.j>0,OS
0 0
27 4S,76
5 s 8 47 Pi -ell DOI
1 1.69 r$.,> 0 OS
0 n
3 39
o w l 7 n 0
n 0
J 1,69
0 0 i n n II
0 0
n n
0 n
Nhdn xel: Vat va kich tiu'eh gap 11,86% nhffng ngdy diu, ngdy thff 7 trd Ifin khdng con bfinh nhan ndo. Kieh dpng trim cdm ngay thff 2 ed 8,47%, giam din va khdng edn bpnh nban nao Iff ngay thrf 7 trd di. Hdnh vi iff sat chi gap I irffdng bdp d ngay ihrf 7, Bdng 3.7. Dien bien roi logn cd the trong dieu trf cdt cim
Hutctiai t liX W SUi » l"l.l« It 1712 _6_ ill'7 B_ -
M u n i Cii 1' :2j^; « ^in :ti ; ) w o o - _o_ ^
f t - i2. ^ ' i i 'I J' j ^ ^ u ' _^ " « II I'M _2_ !»
T i M = . II 0 n 0 . 4 6T! -y » . U .'^ IOC
Nban xet: them heroin ngay dau 20,34%, sau dd Idng 16n 93,22% ngdy thrf 2 sau dd giam dan dd'n ngay thff 10 con 10,17%. Di cam gdp nhilu nha'l ngay 3 chiem 93,22%, de'n ngay thff 10 khdng edn trffdng hdp ndo.
Bdng 3.8. Lieu, lUffng thuoc sH dgng
L09I thntfc
1 2 3 4 5 6 7 8 9 ID Tl(iigc4iig TrmgUob
LetameprDinttila 25mg mg 182.75(162.5 *212j) 238.25(1500*325 0) 227.5(137,5+312.5) 178.25(87.5* 262 j ) 143.25 (625 • 237 J ) 105.75 (50.0 • 175,0) 122,25(37,5+162,5) 54,25 (25,0 + 100.0) 34,25(0,0*87.5) 13.25(0,0*75,0) 1J9»,7S 127^:78,5
14,06
«
1833 17,50 13,71 11,02 8,14 9,41 4,17 Z.64 1,02
10t.O
niMepam Smg mg 36,75 (20.0 * 55.0) 46,85 (273 * 60.0) 45,15 (30.0 * 57.5) 34,15 (173 *523) 21,5(73*423) 15,05(23*32.5) 1,75(0,0*17.5)
0,00 0.00 O.DO 201,20 1 8 , 7 5 ± 1 « 3
18.27
%
23 J 9 22,44 16.97 10.69 7.48 0,87 000 000 0,00
IOO,!
Nhdn xet: lieu trung binh eiia Levomepromazin la 127,5±78,5, lilu tmng binh eua Diazepam la 28,75 16,5.
4. Ban luSn
4.1. Verdi logn tdm thdn dbfnh nhdn nghifn heroin
4.1.1. Ve tdm trang cda bfnh nhdn Cdc rd'i loan lo du cung dffde xem nhff la bieu hifin chinh eua bpnh nhan nghien heroin Irong giai doan cat cdn nghifin. Trong nghifin effu eiia chiing Ioi gap 52/59 benhnhan (88,13%) ed bieu hien Idm sdng rdi loan Io du, Trong dd hoang hfi't vd ed Id 61,54%. bdn ehdn chifi'm 76,92% vd dc mdng Id 32,73%. Kfi'l qua ciia chung ldi phQ hdp vdi nghifin crfu cua Nguyfin Thanh Blnb (2001) thd'y 88,3%
b6nh nhan ed ro'i loan Io au va 38,3% cd ac mdng [1], Nhieu lae gia diu nhan dinh rang loaned tff rat sdm, mffe dd nghidn cdng ndng thi tinh trang lo au eang tang, chi khi cai dffde edn nghien va giai quydt irifil de trang thdi Ip thupe ve Iam thin thi tinh trang Io au sfi dffde cai ihifin rd ret.
4.1.2. Vi rdi logn cdm xiic
Quan sal benh nhdn cai nghien heroin, ngffdi ta ihffdng dl dang nhan thay ede bieu hifin kich thich hffng pha'n hdn la la trang Ihdi tram cam, nhimg sff lhat an chffa ben irong Irang Ihdi kich thich hffng Tap chi Y te Cdng cong, 7.2010, Sd 15 (15) 49
ITBNGmN&HGHIENCBBI phan dd Id trang thai npi tam r^l phrfc tap dd la rdi
loan tram cam va lo au. Trong nghifin erfu cho thay rdi loan cam xrfc gap d 53/59 bfinh nhan (89,83%) trong dd benh nhdn cd rdi loan tram cam la 69,81%, cam xrfc de biing nd la 13,21% va khi sac ban hoc bait man la 7,55%. Bieu hifin ndng nl nhl't cua benh nhdn rdi loan trim cam Id nhihig y tffdng vd hanh vi Iff sdt. Theo Sadock B.J (2003) 90% bfinh nhdn ngbien heroin cd rdi loan tdm thin vd gin 15%
ngffdi nghifin opioid co 1 Ian tff sal trong ddi [6].
Theo Susan J. Blumenthal (1990) nghifin erfu 533 ca dieu tri eai nghifin opioid, tae gia nhdn thay 17,3%
so hp cd hdnh vi tff sat [7]. Trong ngbien cffu ciia chiing tdi cd 3/59 benh nhdn cd y tffdng iff sat va 1/59 bpnh nhan cd hanh vi trf sdt nhffUg dffde ngan chdn icip thdi. Nhffng y tffdng nay blu hdt xud't phdt tff nhffng cdng thing, nhiJng xung dfit trffdng difin md bfinh nhdn gap phai irong gia dinh va xa hpi.
Tuy nhifin ndu dffde dieu tri idt (cat cdn oghien.
hfiu phap tam ly phii hdp, sff dpng vifin khieh le cua ngffdi than..) thi y tffdng bat Idi se tan bidn.
4.1.3. Ve do gidc
Trong nghifin cffu eho tha'y 16/59 bfinh nhan (27,12%) cd ao giae, trong do ao gidc thd sd cac Ioai ehiem 81,25% (13/I6BN) va ao gidc phrfc lap la 3/16BN, ao gidc tho sdgdm 30,77% ao gidc ihi giac, 30,77% ao giac xrfc gidc va 33,08% ao thinh gidc, cde giae nay xua'i hien khdng Ihrfdng xuyfin, chu yeu vdo Irfe benh nhan s^p di vdo giac ngu, sap thrfc day hay trang thai qud met moi. Ao giae phrfc tap chiing tdi chi gap ao thinh giae (2/3 benh nhan), ao Ihi gidc (1/3 bfinh nhan), ca 3 bpnh nhdn nay deu nghipn heroin d mrfc dp nang va thdi gian nghien
>10 nam. Kfi't qua nghien crfu cua chrfng ldi phu hdp vdi Nguyfin Thanh Binh (2001) khi cho rang 30%
bfinh nhan eat cdn nghifin heroin cd ao gide tho sd vd 3,33% ed ao giac phrfc tap [I].
4.1.4. Ve rdi logn hdnh vi
* Hoat ddng cd y chi: da sd bfinh nhan cd bidu hipn vdt vd kich thieh 53 benh nhdn (ehiem 98,15%
so' bfinh nhdn cd rdi loan hdnh vi), cd 5 bfinh nhan cd bieu hifin kieh dpng dd Id kich dpng trong pham vi giffdng benh da dffde cha'm dfft khi drfdc giai thieh hdp Iy vd dm tbi.
* Hoat ddng ban nang: nghien cffrf eua chrfng tdi cbo thay 37/54 bfinh nhan co rdi loan hanh vi (68,25%) cd bieu hifin chdn an. Chiiog tfii khdng gap trffdng hdp nao an nhieu. Dieu nay cd the giai Ihich do trang thdi mfil moi, Io au. mat ngiJ... keo
ddi. cffng vdl cde bieu hieo rdi loan cd the nhff dau ed. ndn va budn non, vd mo hdi... Idm anh hffdng tdi vifie an udng ciia ngffdi beoh. Theo Sadock B.J (2003) hdi chrfbg rdi loan hanh vi lifin quan chdt che vdi tram cam vd lo au do la cdc xung ddng, cdc tinh hud'ng td'n cdng cd the ehd'm ditt bang sff dung thudc giai lo au [6]. Nhff vay, kdt qua nghifin crfu cua ehffng ldi phii hdp vdi cac tdc gia trfin, dieu ndy rat hdp Iy khi hlu hdt cdc bfinh nhan diu phan nan do yfi'u id met mdi, suy nhffde lo au v | bfinh tat, va sff xa Idnh ciia ngrfdi thdn... ma mat di hffng ihii ve tinh due.
4.1.5. Ve rdi logn y ihdc
Rdi loan y thrfc gap 19/59 bpnh nhdn (32,20%) Irong dd rdi loan nang Iffc dinh hffdng ddn ihuin ehie'm 63,16% va mfi sang Id 5/19 bfinh nban. Ket qua nghifin erfu cua chung tdi va Abon P.J (1994) khdng tha'y sff khac bifil vdi p >0,05. Cac roi loan dinh hffdng ehii ydu rdi loan ve mdi trffdng, thdi gian va khdng gian kel hdp, chi gap 3 bfinb nhdn cd rdi loan dinh hrfdng ban than, cdc rdi loan nay xuat Iiifin khdng lien tuc trong 2 ngay dau. Chrfng tdi chi gap bieu hifin mfi sang irong ngdy thff 1 x^ c"^ ddt dilu Iri, ngffdi bfinh cd nhifng hdnh ddng bat con vat trfin da va tim cde dd la trong phong benh, cam xiie thffdng cdng thang vd hoang hd't..
4.1.6. Ve rdi logn lu duy d benh nhdn cai nghien heroin
Col9/59 bfinh nhan( 32,20%) cd eac trifiu ehffng ciia rdi loan m duy, trong dd 36,84% cd y tffdng bd't banh, 31,58% cd y trfdng hoai nghi, 3/19 bpnh nhdn ed y mdng nghen tudng va 2/19 cd y tffdng cd tpi, chi cd 1/19 bfinh nhdn cd hoang mdng nban nhim da nghien heroin 13 ndm benh nhan cho r^ng ngffdi benh ciing phdng Id bd'de ciia minh va trieu chrfog nay xuat hien khdng lifin tuc. Ket qua nghien crfu cua ehung ldi phff hdp vdi Nguyfin Thanh Binh (2001) khi nhdn xet rang cd 20% benh nhan cd rdi loan ndi dung tff duy, trong dd da sdcac rdi loan ndy ehi dffng lai d mffe la cdc y tffdng am anh 83,3% vd 16,7% la hoang tffdng nhdn nham[l].
4.1.7. Ve rdi logn chu y • tri nhd
* Vl rdi loan chti J: ed 84,75% bfinh nhdn cd bieu hipn giam chu y. Benh nban khdng tap tmng chu y hoac chi tap irung chd y trong khoang thdi gian ngan. Cac tac dpng ngoai caoh dfi Iam bfinh nhan phan tan. Bfinh nhan khd duy ni doc sdch bao va xem vd myen.
* Vl rdi loan tri nhd: cd 38/59 bfinh nhan 50 Tap chi Y te Cdng cpng, 7.2010, Sd 15 (15)
I TGNG QUJIN & HGHIEN eiiu I
(64,41%) phan nan vl giam tri nhd, hlu het cdc bfinh nhan nay giam iri nhd gan ddn tiiuan, giam tti nhd^toan bfi gdp 5/38 bfinh nhan, ngffdi bfinh tff than phien hay nhdn vifin y id ddnh gid bfinh nhan hay quen nhffng sff vipc dang Iam hay dang suy nglii dinh Idm gi tff nhifin qufin di.
4.2. Ve hifu qud diiu tri cat can bdng diazepam, levomepromazin
Levomepromazin Id thudc an than em diu chdng lo au vd chdng kich tiuch. Tae dung giam dau gap 4 Iln aminazin va ha than nhifit manh hdn aminazin 3 Ian. Dae biet nd Idm tang tdc dung ciia tiiudc ngu. Nfin trong iam sang ngffdi la hay phdi hdp vdi diazepam ldm tdng hieu qua dieu tri [2].
* Vi lieu lUdng vd thdi gian:
- Vdi levomepromazin: ket qua bang 3.27 cho thd'y thudc dffde sff dung lien mc trong 10 ngay dffdi dang vien ndn, lieu trung binh la 5,10 ± 3,14 vifin/ngdy/BN, lilu trung binh cao nha'l vdo ngay thff 2 la 238,25mg/BN/ngdy, tha'p nhd't ngay tiiff 10 la 13,25mg/BN/ngay va lieu cao that md mfit bfinh nhan sff dung la 325mg/24h, Chrfng Ioi nhdn thd'y Irong 3 ngdy diu sd Iffdng levomerpromazin ehie'm 50,87%,
- Vdi diazepam: ket qua cda chung tdi (bang 3.27) cho thd'y thd'c chi sff dung trong 7 ngay dffdi dan vifin nfin, lieu trung binh la 5,75 ± 3,3vi6n/BN/ngdy, lilu trung binh cao nhat vao ngay thff 2 Id 46,85mg/ngay/BN, va thd'p nha't ngay thff 7 Id 1.75 mg/ngdy/BN. Chiing tdi nhdn ihdy lilu cao nhat ma mpt bpnh nhdn 6.\l(ic dung la 55mg/ngdy. Trong 3 ngay dau sd'Iffdng diazepam ehie'm 63,99%.
Theo Nguyen Viet (1995) lieu diing tisercin trong 5 ngdy diu Hlu iff 5,38 -^ 9,48 vien, va seduxen diing trong 5 ngdy diu lilu tff 2,14 ^10,88 vifin, lieu cao nhd't vdo ngdy thff 2. Dd gdy ngii cho bfinh nhan cai heroin trong nhffng ngdy cudi lilu tisercin irung binh 1,7 d6'n 2,3 vi6n [4]. Ngd Ngpc Tan, Nguyfin Vdn Ngdn, (2003) Ulu seduxen trong sff dung phdi hdp thdc trung binh 20 30mg/BN/ngay vd td'i da 40 - 60mg/BN/ngay, vdi
heu tisercin (levomerpromazin) trung binh la 40 - lOOmg/BN/ngay Ueu tdi da la 300mg/BN/ngdy [3].
Kel qua nghifin effu cua chiing ldi phii hdp vdi vdi tae gia tten.
* Ve hiiu qud dieu tri:
Vdi nhdm trieu ehffng rd'i loan ed the: qua thdm kham, theo doi benh nhdn ehiing ldi nhan tha'y: sau udng thude khoang 30 phut ddn I gid hlu hdt edc benh nhan diu thd'y bdi hoae giam eac trifiu chfftag chay nffde bpt, nffde mat, giam bdt va md hdL„
Tac dung vdi nhffng trifiu ehffng khac nhff ngdp, dau mdi khdp... sau ud'ng thud'e eae bfinh nban diu thdy giam rd ret. Mpl sd' it bfinh nban phai srf dung ihfim paracetamol cho hfi'l cam giac dau mdi cd.
Vdi nhdm trieu chiing rdi logn tdm thdn:
Ddi vdi giac ngu, sau khi udng ibude hlu diu tien sau 30 phut dfi'n 1 gid td't ca eac benh nhdn deu di vao gia'c ngii. Trong 3 ngay diu tifin, mdi dfim bfinh nhan ehi ngii dffde 2 -H 3 tifi'ng, giac ngu ehdp ehdn khdng sau. Nhffng ngdy sau bpnh nhdn ngu dai hdn khoang 4-5 tidng mdi dfim, de'n eud'i ddt dieu tri gia'c ngu da trd Iai gin nhff binh ihffdng. Tuy nhifin ngay thff 4, thrf 5 benh nhdn vdn cdn mfil nhieu, mpl so it ed dc mdng. Dd'i vdi rfii loan Io du va trim cam sau khi uo'ng thufi'c 30 phiit dfi'n Ih do cde bfinh nhan ngu dffde nfin lam trang sau khi tinh ngii bdi Io lau hdn vd Irifiu ehffng trim cam eai thipn rd rfit sau 3 ngay dieu tri. Ddi vdi rd'i loan hanh vi:
sau uo'ng thud'e Ichoang 20 de'n 30 phut cac bfinh nhan deu giam cdn vdl va, nam yen dffde khong cdn khd ehiu nhff irrfdc. Cdc bfinh nhan kich dfing ngoai Ueu phap hanh vi chung tfii cdn sff dung seduxen lOmg dang tifim finh maeh sau 5 phiit bfinh nhdn di vdo gia'c ngu. Dd'i vdi eae rdi loan tdm than khdc thudc diu cd idc dung lam giam bdt vd thuyfin giam rd ret, ddc biel Id y tffdng va hanh vi trf sdt kiem sodt drfdc nhd Ueu thudc cao h(Jn. Sau 10 ngay dilu iri 100% benh nhan khdng cdn hdi chrfng eai, cdc benh nhdn diu hdp lac dieu tri mac du Iffc dau eon chdng dd'i nhimg do tdc dung Id'l cua thudc dieu tri md bfinh nhdn vrfdl qua hdi chrfng cai mot cdch nhe nhang va hdi phuc sffc khde nhanh chdng.
Tap chl Y fd Cdng cong, 7.2010, Sd 15 (15) 51
ITtNGIIANaNGHIENCgBI
Tai Upatham khao Tidng Vl$t
1. Ngo Ngpc Tan, Nguyen Vin Ngan va Cs (2005 ). "Phu tfanpc v^ lam dung diode [rfii^n - Benh hoc tSm tfain". Nha xuat ban Quin dgi NMn ddn. 162 -168.
2. Ngo Ngpc Tdn, Nguyin VSn Ng3n va Cs (2005 ). "Tac dung chung ciia thudc hudng Tam diln - TSm than hoc dai cUUog va di^u tli cac b^nh Tarn than'. Nha xoat ban Quan doi NhSn dSn. 223-25L
3. Nguyin Thanh Binh (2001). "Nghifin c*] die dilm lim sing rdi lo^n lam than d b^nh nhin dang dilu tri d t cdn oghien ma tuy (opioid)'. Luin van tliac si y boc, Hoc vi|n Quiny.
4. Nguyin Vigt, Tran Vidt Nghi, Nguyin Mmh TuSii (1995).
"Dinh gia di^n tri cat ctta nghidn ma tdy b^ng cdc thudc hirdng thin theo hirdng din cda BO Y tcbaa hinh". T i p san ky ydu cac cong trmh ngtiien cffu khoa hoc B$ Y te - Chuyen nganh Tam Aln. 120-131.
Tidng Anh
5. Kaplan H. I., Sadock B. I., Grebb J. A. (1994). "Synopsis of psychiatry. Seventh edition". Wasingion D.C. 278 -318, 1014.
6. Sadock B. I., Sadock V.A (2005). "Concise textbook of chnical psychiatry 9tb edition". Lippineott WiUiams &
Wilkins.USA. 117-122.
7. Susan J. Blumenthal., Davis J. Kupfer (1990). "Suicide over the life cycle". American psychiatnc Press, Inc, Washinton DC. 184- 186.
52 T a p chi Y te C d n g cpng, 7.2010, Sd 15 (15)
