BAO CAO KHOA HOC k.
oac di^m iam sang, can iam sang nhdi mau nao cap fai Benh vien Da khoa Trung fam Tiln Giang
BS. Hu^h ThI Pliijiing liilinh
SiJyf^77eiTG/artg TdMTjlTm vin a«: Nhdi miu nao ludn IS vSn Si thM sv cia y hgc bdi Hy » can b$nh phd bi6n mang tinh toSn cSu, cd t* \i ti)vong cao, d l l^i nhidu di chlhig n$ng nd cS vd thd xic Idn tinh thdn, thMC sv Id gdnh njing cho gia dinh vd xa hdi.
HMC tidu: Md td ddc didm Idm sdng, cdn Idm sdng d bdnh nhdn nhdi mdu nao cSp flu^c didu tri t?i Bdnh vidn Da khoa Trung tdm Tidn Giang ndm 2014 - 2015.
Phuong phdp: Nghidn cdu md td cdt ngang.
m qud: Khdi phdt bdnh m nghi ngoi chidm 50%, thdi gian vdo vidn a 6 gid Id 54,3%. Bdnh khdi phdt d«t ngdt chidm 89,3%. Huydt dp Um thu trang binh Ific vdo vidn Id 143,9 mmHg, huydt dp tdm truong trung binh id 81,5 mmHg. Didm Glasgow Idc vdo vl?n 13 -15 didm chidm 80%. eidm NIHSS Idc vdo vidn 5 -15 chidm 75%. Tdn thuang ddng m^ch ndo giOa 80%. ASPECTS 8 -10 chidm 77,86%; nhdi mdu ndo tir 2 6 trd Idn 63,6%. Kich thudc 6 nhdi mdu 1 - 3 cm chidm 75%. Dudng huydt trung binh lljc vdo vidn 141,6 2 59,69 mg/dl. hsCRP > 3mg/L 56,4%.
Kdt ludn: Ndm vOng ddc didm Idm vd cdn Idm sdng nhdi mdu ndo cdp gidp gidm t*
Id td: vong, mdc dd tdn phd vd tdi phdt
Tirkhda: Ldm sdng, cdn Idm sdng, nhdi mdu nao cdp.
I. BjT m BE Iu4„ IJ yj„ Oe thif, Sil cda y hoc bdi tfly IJ can whjSi„.s -„.u.c.... b?"hph6 bien, mang tlnh toan cSu, cot* Id Nhai.ndunaolSb6nhlya,/acgayrabc.i tOfvongcao.allainhieudidiCingnangnlcS d S n S n ' « l " , f " • " ' . r * " ^ " " " " " " "^thexSclSntinhthdn.thUcsUISglnhnang dSn tfen tlnh trang suy gdm tiJc thM dong cho gia anh va xa hoi ' triiu nu6l t^vung nho mfl nao, chiem 80 - Tai My, mot n.r6c co nen y hoc hien tfai
85%cdctn«nghopa^,uy.Nhaimau„ao nhangcam6i40gilyccmottL6ngh^tft'^
Weteitei«lthM*ltevtom.com.v„ S(515 QUVl/2O16ilIliHinilHK0CWlfTNAI« ''
^ BAOCAOKHOA HOC
quy, moi 3 phut co mot benh nhari tif vong va moi nam co khoang 185.000 ngUdi bi dot quy tai phat. d Phap, benh ly nay cung la nguyen nhan hang dau gay tii vong d ngu'di gia. Con tai Chau A, nhteu nghien cu'u cho thay so trudng hop mac benh va tCf vong do dot quy ngay cang gia tang nhat la d cac nu'dc dang phat trien, mac du ty le tu' vong co giam dan theo thdi gian [3], [2].
6 Viet Nam, trong khoang thdi gian gan day 6a co nhieu tien bp dat dugc trong chan doan, dieu trj, d y phdng nhoi mau nao nhd hieu ro nhang yeu td nguy co, cd che benh sinh, dac biet tii khi cac don vi dot quy lan lugt ra ddi. Tuy nhien, van cdn nhieu van de ma chung ta can phai quan tam nhU: TCr vong va yeu to lien quan tCf vong, tai phat dot quy, mu'c do tan phe. Gan day da co mpt so nghien cu'u ve vai trd cua cac chat chi diem smh hoc trong nhoi mau nao, nhat la hs-CRP (high sensitivity C - Reactive Protein) mdt chat danh dau viem he thong nhu la mdt yeu to mdi anh hu'dng len tien luong nhoi mau nao.
Hien tai ty le tCf vong chung toan cau khoang 20%, Cl Viet Nam, theo Le Van Thanh va cdng sU thi ty le tiT vong chung cua dot quy nao la 30% [3].
Tai Benh vien Da khoa Trung tam Tien Giang, benh ddt quy nhap vien ngay cang nhieu.dLfngthaetrongso 10 benh nhap vien cao nhat trong nam, ty le nhoi mau nao gap 2,5 (an xuat huyet nao, ty te xii vong chung xH 17 - 25,8%. Ti/ nam 2009, benh vien da thanh lap "Don vi ddt quy" va ap dung cac tien bd trong dieu tn, nhan thay ty le tir vong co giam {nam 2011 ty le tir vong: 15,6%). Tuy nhien, ty le nay cdn cao hon thong ke ve tif vong tai Benh vien Nhan dan 115 la 10%.
Chinh vi nhQng ly do tren, chung toi tien . ^ 4 THAHKINHHOCVIETNAMSOIS QurK2016
hanh nghien CLTU de tai: "Dac diem lam sang, can lam sang nhoi mau nao cap tai Benh vien Da khoa Trung tam Tien Giang" vdi muc tieu:
IV16 ta dac diem lam sang, can lam sang 6 benh nhan nhoi mau nao cap du'pc dteu trj tai Benh vien Da khoa Trung tam Tien Giang nam 2014-2015.
II. DOI TUDNG VA PHIAJNG PHAP NGHIEN CUU
1. D o i tUcing n g h i e n cuTu
Tat ca benh nhan dUdc chan doan xac djnh nhoi mau nao cap nhap vien dieu trj tai Benh vien Da khoa Trung tam Tien Giang trong thdi gian nghien cufu tif thang 08 nam 2 0 1 4 d e n t h a n g 0 2 nam 2015.
2. Tieu chuan c h o n m a u
Benh nhan dUdc chan doan nhoi mau nao cap thoa man tieu chuan chan doan lam sang ciia TCYTTG: Khdi phat dot ngot; thieu sdt chifc nang than kinh khu tru hoac lan toa ciia nao keo dai hon 24 gid hoac dan tdi tif vong; khdng co nguyen nhan rd rang nao ngoai nguyen nhan mach mau nao; hinh anh CT Scan nao co vung giam dam do; nhap vien trong vdng 48 gid sau khdi phat.
3. Tieu chuan loai t r i ^
Con thoang thieu mau nao (TIA), nhoi mau nao do rung nhi, cd benh ly viem nhiem cap tinh hoac dang diing thuoc khang viem.
4. Phaong phap n g h i e n c i h i M d t a cat ngang.
5. XiT ly va p h a n t i c h so lieu Phan mem SPSS 18.0.
IN. KET QUA
Co 140 trudng hop dot quy thieu mau nao cue bd cap thoa tieu chuan chgn mau.
Website hotthankinhhocvieinam com.vn
BAO CAP KHOA HOC k.
1. fide diSn mdu nghien cdu TuSi
Nh6m tudi cd ty le cao nhdt thudc phan nhom 70 - 79 chiem 27,8%; phan nhom tCreo - 79 chiem 50,7%. Tudi trung binh trong mau nghien aJu la 68,6 tfd lech chuin IS 12 55 GUH
Trong mau nghidn cufu co 75 nO chi^m 53m; nam 65 chiem 46,4%; tJ le nO nhieu hon nam.
NghinghUp
IVIat Slic lao tfong chiem t^ le cao 75,7%;
lao tfdng phd thdng chiim 21,4%; cdng chijQ l«nh doanh 2,9%.
NtHattm
Nong thdn chiim tji 1$ 75,7%; thanh thj chiKmtj'1624,3%.
TtSnsirbinh
Rfii loan lipid mau chiem t^ le cao nhat 80%, tang huyet ap chiim 78,6%; Tai bien mach mau nao (TBMiVIN) chiem 19,3%; aS thao tfudng chiim 13,6%.
J.SScdl^m iam sing Bdng I. Bic tiim ldm sdng.
Pic dt€m ISm sdng
Ho^n canii l<l<erlplilt
ThMgian vSovi^n CaciitliiJc i<iidlpl<jt Huy^t^p tam tiiu
Ktii ngiii ngai i<hiiaod6ng Sau itiii ngO d$y Trong iOc ngti Khdng r6 hoan c5nh
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50,0 15,0 15,7 1,4 17,9 45,7 54,3 89,3 10,7 36,4 63,6 Website: hoithankinhhocvietnam.com.vi
Huyetap tSm truong Bi^m GLASGOW vao vien
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71,4 28,6 5,0 15,0 80,0 0 1,4 75,0 23,6 0 3. Trung binh c ^ bi^n cOa dac diem lam sang
Bdng 2. Tmng binb cdc biin cOa dgc diem Idm sdng
Dacdiem Thcri gian vko vi4n Huyet 5p tam thu Huyet ap tam trtftfng Diem GLASGOW i^o vien Dtem NIHSS vao vien
Trung binh
4.03c diem can lam sang Oac ^im hinh inh CT scanner nao Bdng 3. Bdc diim hlnh dnh CT scanner ndo.
Dictfi^m
VjtriDM nSotdn thiAmg
Sod nhoi mJu
OM nao trudc OMnaogiOa OM nao sau OM nao cac niianh sau Viing giap ranh 52vitn 1 6 nhoi mau
TInsi (n)
3 112
2
0 21 51
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(%)
2,1 80 1,4 1,4 0 15 36,4 ,
5(5 15- Quy 1/2016 i niJH KIM HOC mil NAM'^
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-• BAO CAO KHOA HOC
Kich thu'dc 6 nhoi mau
Di lech dUcfng giu'a
Tir I den 3 cm
> 3 d e n 5 cm
> 5 c m Co
Khong 97,9
0,8
9,9 6,8
Phan 0(8-10) 102 nhom 1 (5-7} 27 ASPECTS 2(0-4]
Dudng huyet, hs-CRP Bang 4 Dac diem dadng huyet, hs-CRP.
Oac diem ^ ^ " * ° (n) TangdLJong huyet
Duong (>180mg/d!) ^^
huyet Khong tang duang huyet (< 180mg/ij|] " ' ' l-3mq/L 61 hs-CRP
>3mg/L 79
IV. BAN LUAN
77,86 20,61 1,53
Ty le %
16,4
83,6
43,6 56,4
1 . Dac diem chung mau nghien CUtJ TudV
Tuoi la mot yeu to nguy co cua dot quy noi chung, Nhteu nghien cCfu trong va ngoai ni/dc deu dua den ket luan TBMMN tang dan theo lu'a tuoi va tang vot ten t u liia tuoi 50 trd len Tuoi cang Ion thi benh mach mau cang
36 THANKINHHOCVIETNAM : = _.
nhieu ma trudc het la xa vCra dong mach, theo Hoang Khanh tuoi cang ldn cang tich tu nhieu yeu td nguy ca [3]. Trong nghien cu^j cua chung toi, tuoi trung binh la 68,6; ket qua nay tUdng du'ang vdi nhieu nghien ciiu trong va ngoai nu'dc nhu nghien cUu cua Tei tuoi trung bmh la 67 tuoi [8], cua Vu XuanTan la 65,2 [7], cua Nguyen Van Tuan la 67,2 [tO].
So vdi cac nghien cUu trong nudc, tuoi trung binh trong nghien cUu chung toi cao hdn co the cd nhUng ly do sau; Tuoi tho cua ngu'di Viet Nam ngay cang tang, ty le ngUdi bl cac benh ly tang huyet ap, dai thao dUdng, xo vCa dgng m a c h d n g u d i cao tuoi chiem tyle ngay cang cao.
Chung toi nhan thay nhom tuoi 70 - 79 chiem ty le cao 27,8%; tUong tU cua Nguyen Van Tuan nhdm tuoi 70 - 79 chiem 39% mac nhieu d nU [10], cua TrUdng Van Sdn nhom tuoi 60 - 80 chiem 56%. Cieu nay phu hcfp vdl nhan dinh cua TCYTTG va cac nu'dc la ty le mac benh tap trung d nhdm ngu'di cao tuoi ( 6 0 - 8 0 tuoi).
Gidi
Trong nghien cUu cua chung toi nQchiem 53,57%; nam chiem 46,43%; ty le nCcao hon nam, tUOng tU nghien cUu cua Vu Xuan Tan la nQ chiem 50,88% [7], cua Chau Nam Huan ty l e n U chiem 53,2%.
Nghien cUu cua chung toi nu' chiem ty le cao hon nam, dieu nay khac vdi cac y van.
Theo nhu nghien ciJu cua Nguyen Ba Thang nam cd ty le 54,4% [9]. Oat cau hdi tai sao nam thudng co thoi quen hut thudc la, udng ruou, nhung lai mac benh nhoi mau nao thap hon niJ,cole nUconhieu yeu t d n g u y c o h o n nam nen de mac benh han, ngoai ra sU khac biet nay giUa cac nghien cu'u cd the do each chon mau khac nhau.
Wcbsiti.- hor^.ankinhhocvietnamcomvn
BAO CAo KHOA HQC k.
Nghenghiep
Oiling tdi ghi nh|n nghe nghISp mat siJc lao dong chl^m ty le cao nhat 75,7%; ke den la lao Song phd thdng chiem 21,4%. Ket qua nay phfl hop vdi nhdm tuoi trong nghien cilu chiing tdi da sd la ldm tudi, it van ddng.
tMaltri
Trong nghien cilu chiing tdi benh nhan da sd sdng d ndng thdn chiem 75,7%; thanh thj 24,3%; tJ le nay tuong t u nhu mdt sd nghien cilu duoc thuc hien tai Vitt Nam, chang han nhu cda Chau Nam HuSn d Long An la 74,7%;
cOa LO IVIinh Tam d Ben Tre ty le benh nhan sdng 6 ndng thdn chiem 70,3% [6], dieu nay cung phd hop ve mat dia ly cila Tien Giang.
2. Tiln sdr benh Tang huyit ap
Tang huyet ap (THA) la mot yeu td nguy CO ddt quy nao ddc lap rat manh cho cac bjnh li^ tim mach vJ mach mau nao, dieu nay da duoc chiing minh qua nhieu cdng trlnh nghidn cilu Oing tin cay. Trong nghien ciili cOa Framingham tang huyet 4p tam thu don doc cung lam tang nguy co dot quy len gap 2 - 4 ISn.Theo Hoang Khanh l<hi huyet ap tam truang tang len 7,5 mmHg se lim tang ty le dot quy thieu mau nao cue bd them 46% [3].
Trong nghidn cilu cOa chung toi ghi nhan tiJn SIJTHA chiem tJ Id Icha cao 78,6%; ket qua nJy cung tuong tuciia BSo Duy Khoa la 75% [4], nhung lai cao hon cda Vu Xuan Tan la 64,16%
[10], cda Bravata D. M t^ le nay la 67% [1 ].
OilUldodlllmg
Bai thSo dudng (BTD) da dugc cdng nhan 14 y^u td nguy co ddc lap gay xo vOa ddng m?ch noi chung trong dd cd mach mau nao, nguy CO ddt quy tuong doi la 1,8 d nam va 2,2 d nO [3]. Nghidn cilu cda chdng tdi t^ le benh nhan CO tidn sOr dai thao dudng la 13,6%; cda
Website: hoithanWnhhocvietnam.com.vi SODao Duy Khoa la 16,8% [4], cda Vu Duong Bich Phuong la 22,1 % [5]. Sd benh nhan OTD cd tSn xuat xay ra dot quy cao gap 2,5 - 4 lan ngudi binh thudng va la mot trong nhdng nguyen nhan tilvong.
Tea bien mgch mdu ndo
Trong nghien cdu cua chung tdi cd TBIVIMN cu la 19,3%; tUOng ddng vdi nghien cdu Le Tu Phuong Thao la 16,5%. Nhdng nghien cdu khac trong va ngoai nudc cho mot ty id cao hon nhieu va dao ddng tU 12 den 31%. Cu the nghidn cdu cua Tei [8] la 21,2%.
Rdi loan llpidmdu
Theo y van, mac du da co nhieu nghidn cdu trong ba thap k^ qua nhung vai trd cda roi loan chuyen hda lipid mau trong benh sinh NMN van chua duoc rd rang nhSt la hieu biet ve hau qua cda bdnh nay ddi vdi tang tan sd xo vOa ddng mach vanh [2]. Tuy nhien da cd mdt vai nghidn cdu dd cap den vai trd cda tdng thanh phan lipid mau (tang LDL, tang cholesterol toan bp, tang triglycerid va giam HDL mau) nhu la yeu td nguy co hlnh thanh xovda ddng mach B].
Nghidn cdu cda chung tdi cd 80% bdnh nhan cd roi loan lipid mau, cao hon nhieu so vdi nghidn cdu Hoang Khanh [3], cda Vd Xuan Tan la 71,15% [7]. Hien nay bang cac phuong phap khio sat mach mau qua sieu am, chup ddng mach can quang da cho thay cd mdi lien quan den t3ng ndng dd lipid mau vdi xo vOa ddng mach la nguyen nhSn hang dau cda NMN.
Cim thttang thieu mdu ndo
Can thoang thidu mau nao la yeu to nguy CO chac chan gay nhoi mau nao va ty Id td 0,2 den 2,5% dan sd. Nghien cdu cda chdng tdi,„
con thoang thi& mau nao chiem t^ le 0,7%, *
15 - Quy 1/20161 lUbl HIM HOC niT N TwnirW'j
. i BAOCAOKHOA HQC
tyle nay thap hon nhieu so vdi nghien cdu cda LO Minh Tarn la 5,5% [6], cua Hoang Khanh la 6,7% [3], ciia Tei la 21,2% 18). SU khac bidt nay cd nhieu kha nang la do bdnh nhan khdng nghi do la nhdng trieu chdng cda con thoang thieu nau nao ndn khdng ghi nhan dugc.
Binh ttm thieu mdu cue bg
Chdng tdi ghi nhan bdnh tim thidu mau cue bd chiem 3,6%; ty Id nay hoi thap cd the do da sd bdnh nhan sdng d vung ndng thdn, nen it quan tam den nhdng bieu hien nhe cda benh tim thieu mau cue bd hay it dugc kham sdc khde dinh k^.
^ 3. Dac diem ISm sang Hodn cinh khUphdt
Thdi gian khdi phat ddt quy thudng xay ra Idc nghi ngoi va budi sang sdm do suthay ddi vd nhjp sinh hoc, huyet ap, do k^t tap tilu cau.
f Trong nghien cdu cda chdng tdi da sd xay ra Idc nghi ngoi va sau khi ngd dly la phu hgp
; vdi nhilu nghidn cdu khac vJ cdng phd hgp vdi d$c dilm djch t l hoc cda nhdi mau nao.
Trong nghidn cdu cda chdng tdi, hoan canh khdi phat khi nghi ngoi chidm ty le cao nhat 50%, sau khi ngd day 15,7%; tJ Id nay cao hon cda Ld Minh TSm Ijn lugt la 38,9%; 8,3% [6].
Thdi gian vdo vidn
Trong nghien cdu cda chdng tdi thdi gian v4o vien 2 6 gid chidm ty Id 54,3%; dieu nay rat quan trong vi cd anh hudng den ket quS dllu trj, hidu qua se giam dan theo thdi gian, do vay vide nit ngSn thdi gian nhSp vidn ludn la mgc tieu hang diu, nghien cdu cda chdng tdi thdi gian vao vien trung binh la 10 gid thap hdn cda Vu Duong Bich Phugng la 267 gid [5], cda Nguyen Ba Thjng la 29,63 gid [9], day la con so dang khich id neu biet rang bdnh nhSn chdng tdi deu sinh sdng d ndng thon nhung do dllu kien giao thdng d ndng pBbgjIiiuMmiicwtriiiuiisOis-Quy 1/2016
thdn cd cai thien va cac phutmg, ndn 1 tin, truyen thdng phat tn&i 35 gdp'<j tuydn truyin cho nh|n thuc cda ngi ve TBMMN. Kha nang nhan biet cacd$u{|
cua dot quy nao, he thdng v$n chuyl cdu la eac ylu td gdp phln rut ngSn thi nhap vidn cda bdnh nhSn Cdchthttckhi^phdt
Kit qu5 nghidn cdu eia chung t d i i phat ddt ngdt chilm tJ Ie ^ 3 % , tU tU cl 10,7%; tuong tu vdi nghien cuu cda Vu D Bich Phugng la khdi phat ddt ngot 90,1«
va eda LO Minh TSm la 86,11 % [61 va phu D vdi dac diem eda NMN.
Huyet dp Idc vdo viin
Tang huyet ap la mdt ylu td ngi^
cao ddi vdi benh tim mach d cac nUdCf nghiep va ngay tai nuoc ta tang hu;
dang trd thanh mdt van dd sue fchdi toan cJu do su gia tang tudi tho va tin s clc yeu td nguy CO.
Trong nghien cdu eda chung tdi, HA.tj thu trung binh cda chdng tdi la 143,93mmrt tuong tu cda Dao Duy Khoa 142,94mmH HA t i m truong trung binh cda chung t6ll|
81,57mmHg.
Thang diim Glasgotvldc vdo vidn Ngay cang pho biln va duoe ap dyn rdng rai cho hdn me do eac nguydn nhSi khac, dac biet trong benh dot quy MdCi rdi loan y thdc v l thang dilm Glasgow cdU quan vdi nhau, dilm Glasgow cang t h ^ rdi loan y thdc cang nang
Kit qua cda chung tdi diem Glasgowti binh nhap vidn la 13,69, tUOng duong cda^
Duong Bich Phugng 13^ [51 Vu XuSn 1 13,2[7],diemGlasgow£8diemchilmt^l^^
13 -15 diem chiem t^ Id kha cao 80%, tl cua LO Minh iam lan lugt la 4,6%t 63,9% [Qis
Website: hoithankinhhocvietnam
BAO CAP KHOA HQC k ThanglBimimiSSkicviloviin
Thang dl6n NIHSS dimg de danh gia ciic thieu sdt thin kinh, theo ddi dHu tn, adn lugng kit cue « t quy. DUm cang cao thilu sdt thin kinh cang nang, ddn lugng hoi phuc cing kem.
Trong nghien cflu cua Chung tei, tir 5 - IS dUm diiem nhieu nhat la 75%. NIHSS tmng Hnh la 6.79; tuBng ducdg nghien edu cda Tnang Van Son la 839; thap hon so vdi nghien cdu cda Nguyen Ba Thing NIHSS trang binh la 13,42 [91 cda Vu Xuin Tan la 12J9 [7]. Su khac bidt nay cd t h i la do tieu ehuln chpn mau khac nhau, nghien cdu cda chdng tdi bdnh nhin nhap vidn trong48gidsaukhdi phat, cdn cua Vu Xuan Tan la 72 gid sau khdi phat 4. D|c d i ^ c$n lam sang DgciBSmcrscanndo
VitifMngmgchUtSn thuang Hlnh Inh hge ddng vai trd quan hong trong vide chan doan, dilu tij va Mdn lugng dot quy.
Trong nghidn edu eda chdng tdi, vj tri tdn thuong chiem eao nhat II ddng mach nao gifls 80%; dgng mach nao trade 2,1%; ddng mach nao sau 1,4%. Ket qua nay tuong duong vdi nghien edu eda LO Minh Tam la 82,4% [7];
cda le Ode Hinh va cdng sy la 78% [2J; cda Nguyin VIn Tuan la 70,5%, nao tnJdc 14,4%;
nao sau 3% va sdng nin la 4,7% [10].
Sdonhoimdu
Kit q u i nghidn edu eda ehung tdi ghi nhan da sd tdn thuang td 2 d tid len chiem 63,6%, khac vdi eda LO Minh Tarn va cua Nguyen Van Tuan tdn thuang 1 d chilm 6831% v l 74,2% [71(10].
lOch thudconhdimdu
Chung tdi ghi nhin kich thudc d nhdi mau 1 - 3cm chiem da sd 75%,
Dil^ch dudng gioo
W&bsite:hoithanldnhhocvietnaiTLCom.vn
Nhieu nghien cdu da chdng minh di lech dudng gida ggi y din nhdi mau nao mdc do nang, cd su tuong quan vdi kha nang td vtjng theo sau dot tpjy. Trong nghien cdu cda Chung tdi di lech dudng gida chiem ty Id 2,1 %, nghien edu cda Tian Ngge Tai di lech dudng giua chian 8,8%, tuy nhien d day tac gii da loai trii nhfifng benh nhan hdn me trong nhdm nghien cdu„
JhangdmnASPECr
Be xic djnh do idng cua vdng nhdi mau ddi vdi ton thuong ddng mach nao gifla, chdng tdi l p dimg thang diem ASPECT vi d l sd dung, danh gia nhanh mdt each cd hd thdng vaed do tin cdy, thdng nhat eao gida eac nha danh gii lam sang va chan doan hlnh anh, ASPECT phan anh mdc do tdn thuang sdm, cd gia trj eho vide dilu tn tidu sgi huylt Bdnh nhan cd diem ASPECT cang thap thi nguy co to vong cang caa Nghien cdu cda chdng tdi diem ASPECT = 9 ehUm cao nhat 48,9% phu hgp vdi nhieu nghidn edu trade do.
Ot^mghuyitUcnhdp vien
Tang dudng huyet Idc nhlp vidn tit phd bien d giai doan cap cda NMN va dugc xem la mdt ylu to tien lugng, theo Bravata t^ le tang dudng huyet thay ddi tO 6 - 30% [1 ]. Nghien cdu cda Chung tdi, dudng huyet tmng binh Idc nhap vien la 141,6 mg%, tuong tu cda Vd XuanTan iai41,0mg%.
Nongddhs-CRP
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Nghien cdu cua chung toi, hs-CRP >
3mg/U chiem 56,4%, hs-CRP trung binh la 15,65mg/L, cao hdn cua Dao Duy Khoa la 4,46mg/L [4]. Cd le do thdi diem tay m i u khac nhau, chung toi t h d hs-CRP vao gid t h d 48 sau l<hcii phat, con ciia Dao Duy Khoa t h d 24 gidsau khdi phat.
V. KET LUAN
Hoan canh khdi phat benh khi nghi ngoi chiem 50%, khi lao dong chiem 15%, sau ngu day 15,7%; trong luc ngu 1,4% va khdng ro hoan canh chiem 17,9%. Thdi gian vao vien
< 6 gid la 45,7%; > 6 gid la 54,3%. Benh khdi phat dot ngot chiem 89,3%; khdi phat t d t d chiem 10,7%. Huyet ap tam thu trung binh luc
vao vien la 143,9 mmHg, huyet ap tam truang trung binh la 81,5mmHg. Diem Glasgow lijc vao vien 13-15 diem chiem ty le cao nhat 80%,<8la5%.DiemNIHSSIucvaovien5-1S chiem 75%, 1 - 4 chiem 23,6%.
Tdn thUdng ddng mach nao gida 809t^
dong mach nao trade 2,1%; dpng mach nao sau 1,4%; dong mach nao cac nhanh sau 1,4%; ton thuang t d > 2 dong mach 15%.
ASPECTS 8 - 10 chiem 77,86%; 5 - 7 chiem 27%, 0 - 4 chiem 1,53%. Nhoi mau nao 1 o 36,4%, > 2 6 63,6%. Kl'ch thudc d nhoi mau <
1 cm chiem 2,9%; 1 - 3 cm chiem 75%, > 3 - 5 cm la 16,4%; > 5 cm la 5,75%. Di lech dudng gida chiem 2,1%. D u d n g huyet trung binh lijc vao vien 141,6 ± 59,685. Nong do hsCRP: 1 -3 mg/L chiem 43,6%; > 3mg/L chiem 56,4%.
THE CLINICAL AND PARACLINICAL FEATURES OF ACUTE CEREBRAL INFARCTION IN TIEN GIANG GENERAL CENTRAL HOSPITAL
Huynh Thi Phuong Minh*, Ngo Van Truyen"
Background; Cerebral infarction is always the burning issue of medicine because it is common, worldwide, of high mortality rate, which leaves a lot of severe sequels on both body and spirit, real burden for patients'families and communities
Objective: Describe clinical and paraclinical features of patients with acute cerebral Infarction treated at Tien Giang General Centra! Hospital in 2014-2015.
fUethod: Cross-sectional study
Result: Occurrence of infarction dunng resting periods accounts for 50%. Duration for hospitalization 2 6 hours accounts for 54,3% Sudden occurrence accounts for 89,3o/o.The mean systolic blood pressure atthe time of hospitalization is 143 9 mmHg, and the mean diastolic blood pressure is 81.5 mmHg. Glasgow score at the time of hospitalization of 13-15 points accounts for 80%. MHSS at the time of hospitalization of 5-1S points accounts fo, 75% Middle cerebral artery injury accounts for 80%, ASPECTS 8-10 accounts for 77.86%.
The patients with at least 2 separated areas of cerebral infarction accounts for 63.6o/o. The dimension of the areasofcerebra infarction fr„ml-3cm accounts for 75%The mean blood sugar levelsfrom141.6±596mg/
dlatthetimeofhospitalization, high blood sugar levelsaccountfor164% Level ofhs-CRP^3mg/Lis56.4%
helo , T " " " i * ™ ^ - « - ' " n 9 Clinical and paraclinical features of acute cerebral infarction can help us to reduce mortality rate disability and relapse,
Ke, words: Clinical, paraclinical, acute cerebral infarction . . 4 0 THAN KIHH HDC HET NAM 0 1 5 j i
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B A O C A O KHOA HOC k.
TAI U $ U T H A M i a i % >
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^<>-l9>'yinVin-tuSnmO),-Nghlinciumdtsddgctiimllmsi„g,hlnhinhCTscgnnervgc6nghulngm l>?n/i n M n nhdi miiunoo-ChuySn d l nhiJng ti«n b6 trong Than kinh hoc t i p 2, ttang 19 - 31.
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