A BAO CAO KHOA HOC
Dac diem lam sang, can lam sang nlioi mau nao cap tai Benh vien Da khoa Trung tam Tien Giang
BS. CK2. Huynh Thj Phuong Minh
SdyteTienGangT6MTAT
Dat v£n &i: Nhoi niciu nao ludn la van de thai sir cda y hoc b6i day la can benh phd
\nin, mang ttnh to<in cflu, co t$ le tir vong cao, d^ lai nhieu di chung nang ne ca ve th^
x<ic lan tinh VtAn, thuc su la ganh nSng cho gia dinh vi xa hpi.
Muc ti£u: M6 tci dele diem Mm sdng, c$n lam sdng b b^nh nhcin nhoi mdu nao cUp dugc di^u tri tai B^nh vien Ba khoa Trung tam Tien Giang ndm 2014 - 2015.
Phuong phdp: Nghien ciJru m6 td cdt ngang.
Kft qud: Kh6i phdt benh khi nghi ngoi chi^m 50%, thdi gian vdo vien 2 6 gio Id 54,3%. Benh khdi phdt d6t ngot chiem 89,3%. Huyet dp tdm thu trung binh IQc vdo vi^n Id 143,9 mmHg, huyet dp tam truong trung binh Id 81,5 mmHg. fii^m Glasgow luc vao vi^n 13 -15 eMm chiem 80%. Diem NIH5S luc vdo vi#n 5 -15 chiem 75%. Tdn thuong dOng mach nao giua 80%. ASPECTS 8 - 1 0 chiem 77,86%; nhdi mdu ndo tir 2 d trd \in 63,6%. Kich thude d nhdi mdu 1 • 3 cm chidm 75%. Dudng huy^t trung binh liic vdo vien 141,6 ± 59,69 mg/dl. hsCRP > 3mg/L 56,4%.
Ket ludn: Ndm viing ddc diem Idm va cdn lam sdng nhoi mdu ndo cap giup gidm t^
1^ tir vong, mire dd tdn phe vd tai phdt.
Tir khda: Ldm sdng, cdn Idm sang, nhdi mau nao cdp.
I. OAI VAN DE ttnh toan cau, co ty le tCfvong cao, de lai nhieu di chutng nang n l cS ve thixic lan tinh than, thirc sU Nhoi mau nao id benh ly dupc gay ra bdi tinh la ganh nang cho gia dinh va xa hpi.
trang t3c nghen dpng mach nao cap tinh dan TaiMy,mptnUdcc6nenyhpchiendainhUng den tinh trang suy gidm tijrc thdi dong mau nuoi cLi" moi 40 giay co mpt trapng hpp dot quy, moi tai vung nhu mo nao, chiem 80 - 85% cac trUPng 3 phut c6 mpt benh nhan tCf vong vd moi nam hpp dot quy. Nhoi mau nao luon la van de thpi co i<hodng 185.000 nguPi bj dot quy tai phat. d su cOa y hoc bdi ddy la can benh pho bien, mang Phdp, benh ly ndy cung la nguyen nhan hang dau
54 THAN KINH HOC n i l NAM l sO M - QUV IV/2015 W^site hoithanl<inhhocvietnam,com.vn
BAO CAO KHOA HOC k
gay tuf vong d ngddi gia. Con tai Chau A, nhieu nghien cijfu eho thIy so trJdng hop mac benh va tilf vong do dot quy ngay eang gia tang nhat la d e^c nddc dang phat trlen, mac du ty le xd vong co giam din theo thdi gian [3], [2].
0 Viet Nam, trong khocing thdi gian gan day
da CO nhieu tien bp dat dupe trong ehan doan, dieu trj, dd phong nhoi mau nao nhd hieu ro nhiJng yeu to nguy co, co che benh sinh, dac biet
Xd khi e^e don vj ddtquy \$n iddX ra ddi.Tuy nhien,van con nhieu van de ma chung ta can phii quan tSm nhU: Ti!f vong va yeu to lien quan xd vong, tai phat ddt quy, mufc do tan phe. Gan day da CO mpt so nghien cu'u ve vai tro cCia cac chat chi di^m sinh hoc trong nhoi mau nao, nhat la hs-CRP (high sensitivity C - Reactive Protein) mpt ehat danh dciu viem h$ thong nhu la mpt yeu to mdi einh hudng len tidn lupng nhoi mau nao.
Hien tai ty le tCrvong ehung toan eau khoing 20%. 6 Viet Nam, theo Le Van Thanh va epng su thi ty le tCfvong chung cua dot quy nao la 30% [3].
Tai Benh vien Da khoa Trung xim Tien Giang, benh dot quy nhap vien ngay cang nhieu, dufng thOf 6 trong so 10 b#nh nh$p vien cao nhat trong nam, ty le nhoi mau nao gap 2,5 lan xuat huyet nao, ty" 1^ tCr vong chung tCr 17 - 25,8%. Ti^ nam 2009, benh vien da thanh lip "Odn vj dot quy" va ap dung cac tien bd trong dieu tn, nhan thay t / le
xd vong ed giam (nam 20111^ le tCf vong: 15,6%).Tuy nhien, t^ le nSy edn cao hon thong k^ ve tuf vong tai Benh vien NhSn dan 115 la 10%.
Chinh vl nhOfng ly do tren, chung tdi tien hanh nghien edu d^ tai: "Dac diem lam sang, can JSmsang nhdi mau nao cap tai Benh vien 0a khoa Trung tam Tien Giang" vdi muc ti§u:
Md xi dac di^m lam sang, e$n lam sang cf benh nhin nhoi mau nao cap dupe dieu tn tai B§nh vi^n Da khoa Trung tam Tien Giang nam 2014-2015.
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II. Bdi TUONG VA PHiniNG PHAP NGHIEN CllfU
1. Ooi ti/ofng nghien cufu
Tat ca benh nhan dUpc ehan doan xac dinh nhoi mau nao cap nhap vien dieu trj tai Benh vien Oa khoa Trung tam TTen Giang trong thdi gian nghien cCfu td thang 08 nam 2014 den thing 02 nam 2015.
2. Tieu chuan chon mau
Benh nhan dUde chan doan nhoi mau nao cap thoa man tieu ehuan chan doan lim sang cCia TCYTTG: Khdi phat dot ngdt; thilu sol chdc ning than kinh khu trO hoae lan tda cua nio keo dii hon 24 gid hoae dan tdi Xd vong; khdng ed nguyen nhin rd ring nao ngoai nguyen nhan mach miu nao; hinh anh CT Scan nao cd vung giam dam dp;
nhap vien trong vdng 48 gid sau khdi phat.
3. Tieu chuan loai trif
Cdn thoang thieu mau nao (TIA), nhdi mau nao do rung nhT, cd benh 1^ viem nhiem cap tinh hoac dang dung thude khing viem.
4. PhUdng phap nghien cihi Md ta cat ngang.
5. XLf ly va phan tich so ll^u Phan mem SPSS 18.0.
III. KET QUA
Cd 140 trudng hpp ddt quy thieu mau nao cue bd cap thda tieu chuan ehpn mau.
1. Oae di^m mlu nghien cufu
TuoiNhdm tuoi cd ty le cao nhat thude phin nhdm 70 - 79 chiem 27,8%; phin nhom tUeO - 79 chiem 50,7%. Tuoi trung binh trong mau nghien cuu la 68,6 dp lech chuan la 12,55.
Cidi
Trong mau nghien cdu ed 75 nd chiem 53,6%;
65 nam ehiem 46,4%; ty le nd nhi^u hdn nam.
sd 14 - QWf iV/2015 I THAN KINH HOC Vl|T NAM 55
A BAO CAO KHOA HOC
Nghe nghiep
Mat sufc lao dpng chiem ty le cao 75,7%; lao ddng pho thdng chiem 21,4%; cdng ehde, kinh doanh 2,9%.
Afof'cu'tru
Ndng thdn chiem ty ie 75,7%; thanh thj chiem ty le 24,3%.
Tiin sd benh
Roi loan lipid m i u chiem ty le cao nhat 80%, tang huyet ap ehiem 78,6%; Tai bien maeh mau nao CTBMMN) ehiem 19,3%; d i i thao dUdng chiem 13,6%.
2.Dacdiem l i m sang Bang 1. Dac diim Idm sang.
Dac diem lam s^ng 1 Tan so (n)
Hoan cdnh khdi phat
Thdi gian vao vien
Cach thae ithdi phdt
Huy^t dp tam thu
Huy^taptamtri/ang
Diem GUVSGOW vao vi&n
Diem NIHSS vao
Khi nghi ngdi 1 70 Khi lao dong
Sau khi ngCI day Trong luc ngu Khong ro hoan canh
< 6 g i p
£ 6 gip Dot ngpt Tii tii
<140
>140
<90 a 90
< 8 9-12 13-15 21-42 (ndng) 16-20 {nang VLfa) 5-15 {trung binh) M(nhe) 0 (tot)
21 22 02 25 64 76 125
15 51 89 100 40
7 21 112 0 2 105 33
0
TJ l | (%) 50,0 15,0 15,7 1,4 17,9 45,7 54,3 89,3 10,7 36,4 63,6 71,4 28,6 5,0 15,0 80,0 0 1.4 75,0 23,6 0 3. Trung binh cac bien cixa dac diem lam sang
Bang 2. Trung binh cdc bien cua ddc diem Idm sdng.
Dac diem ThPi gian vao vien Huy^taptamthu Huyet dp tdm truong Biem GLASGOW vdo vien Biem NIHSS vao vien
Trung binh 9,99 143,93
81,57 13,69 6,79
Bollchchuin 11,732 23,921 11,397 2,149 3,180
56 THAN KINH HOC WIET NAM I 56 14 - QU^ IV/2015 Website: hoithankinhhocvietnam.com.vn
BAO CAO KHOA HOC k.
4 . Dac diem can lam sang Dac diem hinh dnh CT scanner nao Bdng 3. Dac diim hinh dnh CT scanner nao.
Dac diem
Vj triBM ndo ton thuong
S66nh6imau
Kfch thupc 6 nh6i mdu
Di lech dudng giijfa
ASPECTS
Phan nhPm ASPEaS
DM ndo trupc DM nao giOa BM ndo sau DM nao cac nhanh sdu Vung gidp ranh
> 2 vi tri 1 6 nhoi mdu
> 2 6
<1 cm TCr 1 den 3 cm
>3 den 5 cm
>5cm Cd Khong 3 4 5 6 7 8 9 0(8-10) 1 (5-7) 2(0^)
Tan so (n) 3 112
2 2 0 21 51 89 4 105 23
8 3 137
1 1 5 13 9 38 64 102 27 2
TyK(%i 2,1 80 1,4 1,4 0 15 36,4 63,6 2,9 75 16,4 5,7 2,1 97,9
0,8 0,8 3,8 9,9 6,8 29 48,9 77,86 20,61 1,53
Ddc/ng huy&, hs-CRP
Bdng 4. Dac diem dUdng huyet, hs-CRP.
L Dac diem
Tdng dudng huyet (>180mg/dl) Khdng tdng dudng huyet (< 180mg/di) l-3mg/L
>3mg/L
TlnsSln) 23 117
61 79
Tyie%
16,4 83,6 43,6
56,4 [
Website: hollhankinhhoevielnam.com.vn s d 14 - QUY IV/2015 I THAN KINH HOC VIET NAM I 57
A BAO CAO K H O A HOC
IV. BAN LUAN
1 .Oae d i e m chung m a u nghien cufu Tuoi
Tuoi la mpt yeu t o nguy cd eua dot quy not chung. Nhieu nghien cdu trong va n g o i i nddc deu dua den ket luan TBMMN t i n g dan theo Ida tuoi va tang vpt len t d Ida tuoi 50 t r d len. Tuoi cang Idn thi benh maeh m i u c i n g nhieu ma trdde het la xo vda ddng maeh, theo H o i n g Khanh tuoi cang Idn cang tieh t u nhieu yeu t d nguy ca [3]. Trong nghien cdu eua chung tdi, tuoi trung binh l i 68,6;
ket q u i nay tddng dUdng vdi nhieu nghien edu trong v i n g o i i nudc nhu nghien cdu cua Tei tuoi trung binh l i 67 tuoi [8], ci^a Vu Xuan Tan la 65,2 [7], eua Nguyen Van Tuan l i 67,2 [10]. So vdi cic nghien cdu trong nddc, tudi trung binh trong nghien cdu ehung tdi cao hdn ed the cd nhdng ly do sau: Tuoi thp cua ngddi Viet Nam ngay cang t i n g , ty le ngddi bi cie benh ly tang huyet ap, dai t h i o dddng, xo vda ddng mach 6 ngddi cao tuoi ehiem ty le ngay eang eao.
Chung tdi nhan thay nhdm tuoi 70 - 79 ehiem ty le cao 27,8%; tdong t d cua Nguyen Van Tuan nhdm tuoi 70 - 79 ehiem 39% mac nhieu d n d [10], cua Truong V i n Sdn nhom tuoi 60 - 80 ehiem 56%. Dieu nay phiJ hpp vdi nhan dinh eua TCYTTG va eie ndde la ty le m i c benh tap trung d nhdm ngddi cao tuoi (60 - 80 tuoi).
Gidi
Trong nghien edu cua chung tdi nO chiem 53,57%; nam ehiem 46,43%; ty le n d eao hdn nam, tddng t d nghien cdu cCia Vij Xuan T i n la n d chiem 50,88% [7], cCia Chau Nam Huan t y le n d chiem 53,2%.
Nghien cOfu cua ehung tdi n d ehiem ty le cao hon nam, dieu nay khae vdi cac y v i n . Theo nhu nghien edu cCia Nguyen Ba Thang, nam co ty le 54,4% [9]. Dat c i u hdi tai sao nam thddng
58 THAN KINH HOC VIET NAM I S(5 14 - QUV IV/2015
ed thdi quen hut thude la, uong rUdu, nhdng lai mic benh nhdi m i u n i o t h i p hdn nd, cd le n d c d nhieu yeu to nguy co hem nam nen de m i c benh hdn, n g o i i ra sd khae biet nay gida c i c nghien edu ed the do each chpn mau khac nhau.
Hghe nghiep
Chung tdi ghi nhan nghe nghiep mat sde lao ddng e h i l m ty le eao nhat 75,7%; ke d^n 1^ lao dpng pho thdng ehiem 21,4%. Ket q u i nay phu hpp vdi nhdm tudl trong nghien cdu chOng tdi da s6 l i Idn tudi, it v i n ddng.
Hdi cd tru
Trong nghien cdu chung tdi benh n h i n da so sdng 6 ndng t h d n chiem 75,7%; thanh thi 24,3%;
t y le n i y tUdng t d n h d mpt so nghien cdu ddcic thdc hien tai Viet Nam, chang han nhdeOa Chau Nam Huan d Long An l i 74,7%; eua Ld Minh Tam d B^n Tre ty le benh nhan song 6 ndng thdn ehiem 70,3% [6], dieu nay cung phu hop v l mat dia lycCia Tien Giang.
2.TiensCrb@nh Tdnghuyetdp
Tang huyet i p (THA) la mdt yeu to nguy cd dot quy n i o ddc l i p rat manh eho cac benh ly tim maeh va mach mau nao, dieu nay da dddc chufng minh qua nhieu cdng trinh nghien eOli d i n g tin cay. Trong nghien cufu eua Framingham t i n g huyet ap tam thu ddn ddc cung lam tang nguy CO dot quy l^n gap 2 - 4 lan. Theo H o i n g Khanh khi huyet ap tam trddng tang l^n 7,5 mmHg se lam tang ty 10 dot quy thieu mau n i o cue bpthem 46% [3].
Trong nghien cdu cCia ehung tdi ghi n h i n tien sd THA ehiem ty te kha eao 78,6%; ket q u i nay eung tddng t d eua D i o Duy Khoa la 75% [4], nhdng lai cao hon cCia Vu Xuan T i n la 64,16%
[10], cua Bravata D. M t y le n i y l i 67% [1 ].
Ddi thdo dddng
Dai thao dddng (DTD) da ddpc cdng n h i n la
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BAO CAO KHOA HOC k.
yeu t d nguy ca ddc lap gay xd vda ddng mach ndi chung trong do cd mach mau n i o , nguy cd dot quy t u o n g ddi l i 1,8 d nam va 2,2 d n d [3]. Nghien edu cOa chOng tdi ty le benh n h i n cd tien sCf dai t h i o dddng la 13,6%; cua D i o Duy Khoa la 16,8%
[4], cOa Vu Ddong Bi'ch Phdpng la 22,1% [5]. Sd benh nhan DTD cd tan xu^t x i y ra dot quy eao g i p 2,5 - 4 lan ngudi binh thddng va la mpt trong nhdng nguyen nhan t d v o n g .
Tai bien maeh mdu nao
Trong nghien cdu cCia chung tdi cd "TOMMN cu la 19,3%; tddng ddng vdi nghien cdu Le Td Phdong T h i o la 16,5%. Nhdng nghien edu khae trong va ngoai nddc cho mdt ty le eao hdn nhieu va dao ddng t d 12 den 3 1 % . Cu the nghien cdu cuaTei[8]la21,2%.
Roi loan lipid mdu
Theo y v i n , m i e du da co nhieu nghien cdu trong ba thap ky qua nhdng vai trd cOa rdi loan chuyen hda lipid m i u trong b§nh sinh NMN van chua ddpc rd rang nhat la hieu biet ve hau qua cua benh nay doi vdi tang tan sd xd vda dpng mach vanh [2]. Tuy nhien da cd mot vai nghien cdu de cap den vai trd cua tCftig thanh phan lipid m i u (tang LDL, tang cholesterol toan bp, tang trlglycerid v i g i i m HDL mau) nhd la yeu t o nguy CO hinh thanh xo vda ddng mach [3].
Nghien cdu eua ehung tdi ed 80% benh nhan cd rdi loan lipid mau, cao hon nhieu so vdi nghien cdu Hoang Khanh [3], eua Vu Xuan Tan la 71,15%
[7]. Hien nay bang eie phddng phap k h i o sat maeh m i u qua sieu i m , chup dpng mach c i n quang da cho thay ed moi li^n quan den t i n g ndng dp lipid mau vdi xo vda ddng mach l i nguyen n h i n hang dau cCia NMN.
Cow thodng thiiu mdu ndo
Cdn t h o i n g thieu m i u nao la yeu t d nguy eo c h i c c h i n g i y nhdi m i u n i o v i ty le t d 0,2 den 2,5% dSn so. Nghien cdu cCia chOng tdi cdn
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t h o i n g thieu m i u n i o chiem ty le 0,7%, ty le nay thap hdn nhieu so vdi nghien edu cCia Ld Minh T i m la 5,5% [6], eua Hoang Khanh la 6,7% [3], cCia Tei la 21,2% [8]. Sd khie bi^t nay cd nhieu kha n i n g la do benh n h i n khdng nghi d d la nhufng trieu ehdng cua eon thoang thieu nau nao nen khdng ghi nhan ddpc.
Binh tim thieu mdu cue bg
Chung tdi ghi nhan benh tim thieu mau cue bp chiem 3,6%; ty' le nay hdi thap cd the do da so benh nhan sdng d vung ndng thdn, nen it quan tam den nhdng bieu hien nhe cCia b^nh tim thieu m i u cue bd hay it dddc k h i m sde khde dinh ky.
3. Dac diem lam sdng Hoan ednh khdi phdt
Thdi gian khdi p h i t dot quy thddng xay ra luc nghi ngcri v i budi sang sdm do sd thay doi ve nhjp sinh hpe, huyetip,dp ket tap tieu eau. Trong nghien edu eua ehung tdi da sd xay ra luc nghi ngdi va sau khi ngu day la phu hpp vdi nhieu nghien cUu khac va cung phii hpp vdi dac diem djeh te hoc cCia nhoi m i u nao. Trong nghien cdu ciia chung tdi, hoan c i n h khdi p h i t khi nghi ngoi chiem t^ le cao nhat 50%, sau khi ngu d i y 15,7%; tj' le n i y cao hon cCia Ld Minh T i m lan lupt la 38,9%; 8,3% [6].
Thdi gian vdo vien
Trong nghien cufu cua chung tdi thdi gian v i o vidn > 6 gid ehiem t^ le 54,3%; dieu nay rat quan trpng vi ed i n h hddng den ket q u i dieu trj, hieu q u i se g i i m dan theo thdi gian, do vay viec rut n g i n thdi gian nhap vien ludn l i muc tieu hang dau, nghien cdu cCia chung tdi thdi gian v i o vien trung binh la 10 g i d t h a p hon cCiaVu DUdng Bfeh PhUcftig la 26,7 gid [5], cua Nguyen B i T h i n g la 29,63 gid [9], d i y l i eon sd d i n g khieh le neu biet rang benh nhan ehung tdi deu sinh sdng d ndng thdn nhdng do dieu kien giao thdng 6 nong thdn ed cai thien v i cac phdong tien thdng tin, truyen thdng phat trien da gdp phan tuyen truyen cho
S6 14 - QUY IV/2015 I THJIN KINH HOC V l | l NAM 59
A BAO CAO KHOA HOC
n h i n thdc eua ngddi d i n ve TBMMN. Kha n i n g nhan biet c i c dau hieu cua dot quy nao, he thdng v i n chuyen cap cdu la eie yeu t d gop phan rut n g i n thdi gian n h i p vien cua benh nhan.
Cdch thdc Ifhcfi phdt
Ket qua nghien cdu eua ehung tdi khdi p h i t dot ngdt chiem ty le 89,3%; t d t d chiem 10,7%;
tddng t d vdi nghien edu cCia Vu Ddong Bieh Phdpng la khdi p h i t dot ngdt 90,1 % [5], va eua Ld Minh Tam la 86,11% [6] va phu hpp vdi dae diem cCia NMN.
Huyet dp luc vdo viin
Tang huyet ap la mdt yeu t d nguy eo eao ddi vdi benh tim maeh d eie ndde cdng nghiep v i ngay tai nddc ta tang huyet i p dang t r d thanh mdt van de sdc khde tren toan eau do sd gia t i n g tuoi thp va tan suat cac yeu t d nguy cd.
Trong nghien cdu cCia chung tdi, HA t i m thu trung binh cua chung tdi la 143,93mmHg, tddng t d cua D i o Duy Khoa 142,94mmHg [4], HA tam trdong trung binh eua chOng tdi l i 81,57mmHg.
Thang diem Glasgow iuc vdo viin N g i y eang phd bien v i dddc i p dung rdng rai eho hdn me do eac nguyen nhan khae, dae biet trong benh dot quy. Mde dd rdi loan y thdc va thang diem Glasgow cd lien quan vdi nhau, diem Glasgow cang thap thi roi loan y thde eang nang.
Ket qua cCia chiing tdi diem Glasgow trung binh n h i p vien l i 13,69, tuong ddong eua Vu Dddng Bfeh Phdpng 13,8 [5], Vu X u i n Tan la 13,2 [7], diem Glasgow < 8 diem ehiem ty le 5%, 13 -15 diem chiem ty' le k h i eao 80%, tdong t d eua Ld Minh T i m lan Iddt la 4,6%, 63,9% [6].
Thang diem NIHSS Idc vdo vien
Thang diem NIHSS dung de danh gia cae thieu sdt than kinh, theo doi dieu trj, tien lupng ket cue dot quy. Diem c i n g eao thieu sdt than kinh eang nang, tien luong hoi phue cang kem.
Trong nghien cdu cua chung tdi, t d 5 - 15
60 THAN KINH HOC VIET NAM IS6 14 QUV IV/2015
diem chiem nhieu n h i t la 75%. NIHSS t n j n g binh la 6,79; tUong ddcmg nghien cdu ciia Trddng Van Son la 8,39; thap hon so vdi nghien cdu cua Nguyen B i Thang NIHSS trung binh la 13,42 [9], CLia Vu X u i n Tan la 12,39 [7]. Sd k h i c biet nay eo the la do tieu ehuan chpn mau khac nhau, nghien cdu cua chung tdi benh n h i n n h i p vien trong 48 gid sau khdi phat, con cua Vu X u i n T i n la 72 gid sau khdi p h i t .
4 . Dac d i e m can lam sang Ddc 3iim CTSean ndo
Vi tri ddng mach bi ton thdang Hinh anh hpe ddng vai trd quan trpng trong viec chan d o i n , dieu tri va tien Iddng dot quy.
Trong nghien edu cCia chung tdi, vi trf ton thUdng ehiem eao nhat l i ddng maeh nao giij^
80%; ddng mach nao trdde 2,1 %; ddng mach nao sau 1,4%. Ket qua nay tuong duong vdi nghien edu eua Ld Minh T i m l i 82,4% [7]; cCia Le Biic Hinh va edng sd l i 78% [2]; eua Nguyen Van Tuan la 70,5%, nao trdde 14,4%; nao sau 3% v i song nen l i 4,7% [10].
So 6 nhoi mdu
Ket qua nghien cufu cua chung tdi ghi nhan da sd ton thddng t d 2 6 t r d len ehiem 63,6%, khac vdi eua LdMinh T i m va cCia Nguyen Van Tuan ton thuong 1 6 chiem 68,51% v i 74,2% [7],[10].
Kich thddc 6 nhoi mdu
Chung tdi ghi n h i n kich thudc 6 nhdi mau 1 - 3cm chiem da sd 75%.
Di lech dddng gida
Nhieu nghien edu da ehdng minh di lech dudng gida gdi y den nhdi m i u nao mde dp nang, cd sd tddng quan vdi k h i nang t d v o n g theo sau dot quy. Trong nghien cdu cua chiing tdi di lech dudng gida chiem ty le 2,1%, nghien cdu ciia Tran Ngoc Tai di leeh dudng gida chiem 8,8%, tuy nhien d d i y t i c g i i d i loai t r d nhdng benh nhan hdn me trong nhdm nghien edu...
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BAO CAO KHOA HOC k.
Thang diem ASPECT
Oe x i c dinh dp rdng cua vung nhdi mau ddi vdi tdn t h d d n g ddng maeh nao gida, chiing tdi i p d u n g thang diem ASPECT vi de sd dung, danh gia nhanh mpt c i c h cd he thdng v i ed dp tin cay, thdng nhat cao gifla c i c nha danh gia lam sang v i chan doan hinh anh, ASPECT p h i n i n h mde dp tdn thdong sdm, cd gia t n cho viec dieu t n tieu spi huyet. Benh n h i n ed diem ASPECT cang thap thi nguy cd t d v o n g cang cao. Nghien cdu eua ehung tdi diem ASPECT = 9 ehiem cao nhat 48,9% phu hpp vdi nhieu nghien cufu trdde do.
Dddng huyit lOc nhdp viin
Tang dUdng huyet liic nhap vien rat phd bien d giai doan cap cua NMN va ddpc xem la mpt yeu td tien iddng, theo Bravata ty le tang dddng huy^t thay doi t d 6 - 30% [1 ]. Nghien cdu eua chung tdi, dudng huy^t trung binh luc n h i p vien la 141,6 mg%, tdong t d eua Vu X u i n T i n l i 141,0 mg%.
Nong do hs-CRP
hs-CRP l i chat d i n h dau sinh hpe chi diem cho sd viem, n g i y nay ddpc chii y va dddc xem nhu la 1 yeu t d nguy co doc lap cho ddt quy n i o . Cic nghien edu hs-CRP trong dot quy eho thay ed lien quan den dp n i n g va ket cue dot quy, dot quy t i i p h i t , dU phdng dot quy tien phat va t h d p h i t . T i n g hs-CRP l i yeu t d tien lupng xau ddi vdl benh nhan NMN.
Nghien cdu cua chiing tdi, hs-CRP > 3mg/L, ehiem 56,4%, hs-CRP trung binh la 15,65mg/L,
cao hdn eua Dao Duy Khoa la 4,46mg/L [4]. Cd le do thdi diem lay mau khie nhau, chung tdi t h d hs<RP v i o gid t h d 4 8 sau khdi phat, edn cua Dao Duy Khoa t h d 24 gid sau khdi phat.
V. KET LUAN
H o i n canh khdi p h i t benh khi nghi ngdi chiem 50%, khi lao ddng ehiem 15%, sau ngu day 15,7%; trong lue ngu 1,4% va khdng rd hoan canh chiem 17,9%. Thdi gian vao vien < 6 gid la 45,7%;
> 6 gid la 54,3%. Benh khdi phat ddt ngdt chiem 89,3%; khdi p h a t t d t d c h i ^ m 10,7%. H u y ^ t i p tam thu trung binh liic v i o vien l i 143,9 mmHg, huyet ap t i m trdOng trung binh la 81,5mmHg. Diem Glasgow lue v i o vi§n 13-15 diem ehiem t^ le cao nhat 80%, < 8 la 5%. Diem NIHSS liic v i o vi$n 5 - 15 chiem 75%, 1 - 4 chiem 23,6%.
Tdn t h d d n g dpng mach nao gida 80%, d d n g mach nao trdde 2,1%; d d n g mach n i o sau 1,4%; d d n g mach nao cac n h i n h s i u 1,4%;
t d n t h d d n g t d 5 2 ddng mach 15%. ASPECTS 8 - 1 0 chiem 77,86%; 5 - 7 chiem 27%, 0 - 4 chiem 1,53%. Nhdi mau n i o 1 d 36,4%, > 2 d 63,6%.
Kich thddc o nhdi m i u < 1cm chiem 2,9%; 1 - 3 cm chiem 75%, > 3 - 5 em la 16,4%; > 5 em la 5,75%. Di lech dUdng gida ehiem 2,1%. D d d n g huyet t r u n g binh liic vao vien 141,6 ± 59,685.
Ndng dp hsCRP: 1 - 3 mg/L chiem 43,6%; >
3mg/L chiem 56,4%.
ABSTRACT
THE CLINICAL A N D PARACLINICAL FEATURES OF ACUTE CEREBRAL INFARCTION IN TIEN G I A N G GENERAL CENTRAL HOSPITAL
Huynh Thi Phuong Minh*, Ngo Van Truyen**
Background: Cerebral infarction is always the burning issue of medicine because it is common, world- wide, of high mortality rate, which leaves a lot of severe sequels on both body and spirit, real burden for patients' families and communities.
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Objective: Describe dinical and paraciinical features of patients witti acute cerebral inferrtion treated at Tien Giang General Central Hospital in 2014-2015.
Method: Cross-sectional study.
Result: Occurrence of infarction during resting periods accounts for 50%. Duration for hospitalization >
6 hours accounts for 543%. Sudden occurrence accounts for 89.3%. The mean systolic blood pressure at tfffi time of hospitalization is 143.9 mmHg, and the mean diastolic blood pressure is 815 mmHg. Glasgow score at the time of hospitalization of 13-15 points accounts for 80%. NIHSS at the time of hospitalization of 5-15 points accounts for 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 inferction accounts for 63.6%. The dimension of the areas of cerebral infarction from 1-3 cm accounts for 75%. The mean blood sugar levels from 141.6±59.6 mg/
dl at the time of hospitalization, high blood sugar levels account for 16.4%. Level of hs-CRP > 3 mg/L is 56.4%.
Conclusion: Thorough understanding clinical and paraciinical features of acute cerebral in^retion can help us to reduce mortality rate, disability and relapse.
Key words: Clinical, paraciinical, acute cerebral infarction.
TAI LIEU T H A M KHAO
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how often do we sreen for undiagnosed d/abefes",QJM,(96),pp 491 - 497.
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62 THAN KINH HOC VKT NAM : S6 14- QUV' IV/2015 Website: hoithankinhhocvietnam.com.vn
