Y HOC VI^T NAM THANG 8 - SO 1f2014
SO LiraNG TIEU CAU VA MOI LIEN QUAN T a i MU'C DO XUAT HUYET 6' BENH NHAN LffXEMI CAP
Nguyen Trieu Van*, Nguyen H a Thanh**
T O M TAT
f)at van de: Mii'c do xuat huyet thu'dng hen quan tdi mu'c do giam tieu cau trong LXM cap. Muc t i e u : Nghien cu\j mot so chi tieu tieu cau va moi lien quan den tinh trang xuat huyet. 061 tu'dng va phucfng phap: Nghien cu\j du'cfc tien thanh tren 110 benh nhan (BN) da du'cfc chan doan xac dinh la Idxemi cap duWc dieu trj tai Vien Huyet hpc - Truyen mau TW.
Ket qua: So lu'dng TC trung binh la 47,6±43,1. Gam s6 luang ti^'u cau mau ngoai vi chiem 92,7%; giam mau tiiu rau trong tuy chiem 91,8%. So lu'dng tieu cau lien quan den tinh trang xuat huyet, khi SLTC giam, tinh tr^ng xuat huyet tang len va mu'c dp xuat huyet nSng len. Ket lu^n: SLTC giam trong LXM cap, mii'c dp giam tiiu rau lien quan den tinh trang xuat huy6t.
SUMMARY
P U T E L E T VOLUME A N D R E L A T I O N S H I P W I T H BLEEDING RATE I N PATIENTS
W I T H ACUTE LEUKEMIA Background: Severity of bleeding symptom in acute leukemia patiens may related to level of platelet count reduction. Purpose: To investigate some platelet indicators and relationship to bleeding symptom in acute leukemia patients. Patients and methods; The research has been taken on 110 patients to be diagnosed acute leukemia at National InstitiJte of Hematology and Blood Transfusion (NIHBT). Results: average platelet count of 47.6±43.1; Peripheral platelet count reduction of 92.7%, Marrow platelet reduction of 91.8%. Platelet volume relates to bleeding situation. Platelet reducing increases bleeding situation and degree. Conclusion;
Platelet count is reduced significantly in acute leukemia patients, severity of bleeding symptom is related to level of platelet count reduction.
Keywords: LXM c3p, tieu cau, xuat huyet
* Vien Huyet hpc - Truyen mau Trung u'dng
** Truftng Dai hpc Y Ha Noi Chiu b-ach nhiem chinh: Nguyen Thanh Ha Emaihha tiianh nouven vhhtmOyahoo.com Dt: 0913.086.463
Phan bien khoa hpc: PGS.TS Bach Khanh Hoa Ngay nhan bai: 11.6.2014
t. OAT V A N DE
LcJxemi (LXM) cap la mot nhom benh ac tinh cua ccf quan tao mau, gom LXM cap dong tii^
(AML) va LXI^ trap dong lympho (ALL). Dac tnmg cua benh la s i / tang sinh qua mii'c, khong kiem scat du'dc dan den viec tich luy trong tiiy xu'dng va mau ngoai vi nhu'ng t e bao ac ti'nh (te bac blast). Nhii'ng t e bao nay se dan thay the, iic che qua trinh sinh tru'dng va phat trien cua cac dong te bao binh thu'dng trong^ tiiy xu'dng, bao gom hong cau, bach cau va tieu cau. Tieu cau diTcfc sinh ra trong tuy xu'cing tii te bao goc sinh m^u van nang du'di tac dpng cua cac yeu t o ki'ch thicti sinh tieu cau. So lu'dng tieu cau trong m^u ngo?i vl binh thu'dng la 150-450G/I. Trong IdXemi cap, so lu'dng tieu cau thu'dng ^ i a m do bj te bao ac tfnh lan at qua trinh sinh tieu cau [3;4;5],
Viec nghien cii'u mii'c do giam so lu'dng tieu rau va moi lien quan den mu'c do xuat Kuyet do giam tieu cau d benh nhan Idxemi cap nham phat hien cac bieu hien^ trieu chutig, mii'c dp ciia xuat huyet do giam tieu cau trong Idxemi cap, tu* dd CO cac dU lieu trong viec tien lu'dng b§nh va du phong dieu trj do cac hau qua cua viec xuat huyet do giam tieu cau. ^
Vi&: truyen khoi tieu cau giiip gi cho benli nhan trong viec han che xuat huyet? xuat phat tu* thyc te d d , chting toi nghien cii'u de tai na^
vdi myc tieu sau: "^Ngtiiin cihi mot sd'dti si tieu cau va moi iien quan Sen tinii tr^n^
xuat huyet d cac benii nhan idxemi dp ".
II. DO! T U p N G V A P H y O W G PHAP NGHIEN COXJ 2 . 1 . D o i t u ' d n g n g h i e n cuXi
Gom 110 b i n h nhan (BN) du'dc chan doar Idxemi cap, dieu tri tai Vien Huyet hoc - Truyer mau TW tii njl^Xl den 4/2013. Tat ca cac B^
tren du'dc lam xet nghiem dong mau huyel tu'dng, ket qua la khong co gi dac biet.
2.2. Phu'dng phap nghien cu'u 2.2.1. Ttiiet ke ngiiien cut!
Nghien ciili mo ta cat ngang, tien o i l i va hoi CLjli Cd m a u : Ap dung viec thu thap c5 mai thuan tien.
2.2.2. Cac tieu ciiuinsii'dung
a. Chan doan xac djnh va xep loai Idxemi ca|du'a va xet nghiem t e bao hpc tiiy xudng, si luidng t e bao non ac ti'nh ( t e bao blast) tren 20'!' tong so t e bao cd nhan trong tiiy. Xep toai Idxerr cap theo FAB 1986 bo sung,
Y HQC VIET NAM THAHG 8 - SO 1/2014
b. Giam so Wang tieu rau (SLTC): Khi SLTC
trong mau ngoai vi du'cli 150G/L Giam SLTC iitsSc cilia lam 4 mCrc: < lOG/l: 11-50 G/l; 51-lOOG/i;
101-150 G/l.
c. Chan doan xuat huyet va miJTc do xuat huyet: BN co hieu hien xuat huyet khi co it nhat
mpt trong cac trieu chu'ng: xuat huyet dydi da, xuat huyet niem mac, xuat huyet noi tang. Mu'c dp xuat huyet: du'dc chia thanh xuat huyet nhe, vita, nang.
Ili. KET QUA NGHIEN cCfU
3.1. Cac digm Chung cua nhom benh nhan nghien cii'u 3,1,1. Phin Isdtudi
Trong 110 BN nghien cufu, BN nho nhat la IS tuoi va Idn nhat la 85 tuoi.
Bieu do 3.1. Phan bo tuoi trong nhom benh nhan nghien ciTu
Nhin xit: Tuoi trung binh cua nhdm nghien ciru la 39,9 ± 16,8. Nhdm tuoi 17 - 34,5%. LiJa tuoi 17 - 60 chiem 83,7%. Nhdm > 61 chiem ti le 13,6%.
3.1.2 Bac diem ve gidi cua nhdm nghiin cut/
Bieu'do 3.2. Ti le gidi tfnh trong nhdm benh nhan nghien ciJu
30 chiem ti le
Nh^n xifTi le benh nhan nam cao hdn ti le benh nhan nii'. Khong cd sir l<hac biet ve gidi tinh trong nhdm nghien citu vdi p > 0,05.
3.1.3. Ty 1$ cic theb$nh theo FAB 1986
BanO ^ '* '''' ' ^ " ' ' *'^^ K a n k l-kan CAD 1 OQC
Nhdm benh
AML
ALL
The benh MO Ml M2 M3 M4 MS M6 M7 Ll
a L3 n 2 1 25 5 18 6 4 0 2 47 0
Ty le % 3,3 1,6 41,0
8,2 29,5 9,8 6,6 0 4,1 95,9 0
long n
61
49
T v l 6 %
55,5%
44,5%
Nhin xitiTy I? nhdm AML (55,5%) cao hdn so vdi nhdm ALL (44,5%). Trong nhdm AML, the M2
chiem ty IS cao nhat (41%)^tlep theo la the M4 (29,5%), khong gap the M7. Trong nhom ALL g5p
95 9% theL2, khong gap the L3.
Y HQC VlgT HAM THAHG 8 - s6 1/2014
3.2. Mot so chi so ve so lu'dng tieu cau
3.2.1. Xet nghiem solWdng ti^u cau (SL TC) ^ Bieu d& 3.3. Phan bo benh nhan theo mii'c tieu cau
JL
Nhin xit: SLTC trung binh : 47,63 ± 43,14 G/l. Mu'c do giam TC 11-50 G/l chiem ty le cao nhat 49,i%. 18 tri/dng hdp cd SLTC giam nang du'di 10 G/l chiem 16,4%.
3.2.2. Ty 1$ giim solu'fing tieu cau Bang 3.2. Ty le qiam so lu'dng TC
Giam (<150r SLTC (G/l) Binh thu'dng (> 150)
Ty le "/o
92,7Tonq I 110 I iqcT Nh$nxit:Jy le BN cd SLTC giam (92,7%) cao hdn rat nhieu so vdi BN cd SLTC binh thu'dng (7,3%).
3.2,3, So sinh solWdng TCTB dnhdm AML vi ALL Bang 3.3. SLTC d nhdm AML va ALL The benh~
AML
61SLTCTB (G/TT
49,79 ± 45,9544,94 ± 39,66
>0,05
|_ ^*-*-.. I . .. . ^^ .. . ~ I 44,^4 ± .iy,13b [ . . . r ' " " .1 Nhin xet: Trong nhdm nghien ciru, sd lu'dng TCTB ciia 2 nhdm AML v^ ALL khdng cd s^ khac biet vdi p<0,05.
3.2.4. Mau tliu (Su tiiy xu'dng
Tinh trang mau tieu rau trong tiiy xu'dng du'dc trinh bay trong bleu dS du'di day:
Bleu do 3.4. Mau tieu cau tiiy xu'dng
jmrnmrnvvH
/VA^/ijrefcMau tieu cau giam sinh la chii yeu chiem 91,8%. Mau tieu rau binh thu'dng chiem 8,2%.
"liii. Moi lien quan giCa so lu'dng tieu <Sa va tinh trang xuat huyet d benh nhan idxemi cap 3.3.1, Liin quan giita solWdng tieu cau vi mifc dd xuat huyit
Bing 3.4. Tv le xuat huygt lien quan vdi SLTC SLTC (G/i)
< 10 (n = 18) 11 - 50 (n=54) 51-100 (n=21)
> 100(n=17) X±SE
Xuat huyet n 14 30 1 0
77,8 %
55,6 4,8
0 18,5 ± 14,4
Khdng xuat huyet n
4 24 20 17
22,2 %
44,4 95,2 100 67,8 ± 44,9
P
<0,05
<0,05 .
<0,05
<0,05
<0,01
Y HOC VIET NAM THAHG 8 - S6 1/2014
Nhin xet: SLTC ciia nhdm cd XH (18,5±14,4 G/l)
thap han so vdi nhdm khong XH (67,8 ± 44,9 G/l).
Khi TC > 50 G/l thi ty le xuat huyet rat thap (4,8%), khi TC > lOOG/l thi khong cd XH. Si/ khac biet nay co y nghia thong ke vdi p<0,05. Khi STTC
giam < 50G/I thi ty le benh nhan d nhdm xuat huyet rao hdn nhdm khong xuat huyet. Dac biet khi tieu cau < 10 G/l thi ty le xuat huyet la 77,8%, ty le khong xuat huyet la 22^2%. SiT khac biet nay CO y nghTa thong ke vdi p<0,05.
3.3.2. So sinh SL TC vdi cic mifc dp xuat huyet Bii'u do 3.5. SLTC lien quan vdi mu'c dp xuat huyet
• Khoni; \ [9 Nh«
S Vira a Ning
^.huy^l
Nh$n xit: SLTC cang giam thi mire do nSng ciia xuat huyet cang tang. Sit khac biet nay cd y nghia thong ke vdi p<0,01.
IV.
BAN L U ^ N4.1. Mot so d|c diem nhdm nghien cii'u 4.1.1. Bac diim ve tuoi vigidi Tuoi trung binh ciia cac benh nhan la 38,9 tuoi, tu'dng du'dng vdi cac tac gia trong nUdc nghien ciru tren ciing loai doi tu'dng [1,2]. Benh nhan nhd nhat trong nghien ciiu la 15 tuoi, Idn nhat la 85 tuoi. Dp tuoi hay gSp nhat la 17-30 tuoi. Ty Ie benh nhan tren 60 tuoi chiem 13,6%.
Ty le Nam trong nghien ciTu chiem 51,8% va t / le Nff la 48,2%, tUdng du'dng vdi tac gia Nguyen frl$u Van va Pham Quang Vinh khi nghien ciJu cung ioai ddi tu'dng [4;5].
4.1.2. ryl4cic the binh theo xip loai FAB Trong nghien ciru, ty le AML chiem 55,5%
va ty I? ALL chiem 45,5%. KSt qua nay tu'dng du'dng vdi tac gia Nguyen Trieu Van khi nghien cull ciing loai doi tu'dng [4;8]. Trong nhdm AML, so benh nhan the M2 chiem rao nhat vdi 41%, sau dd la M4, it gip Ml va MO, khong gap Vii, ket qiia nay tu'dng tit mpt so tac gia khac trong nitiSc khi nghien ciru ciing loai doi tu'dng.
4.2. eae di€m chi sS tieu cSu
4.2.1. Mifc d$ giim so lu'dng tii'u tau trong miu ngo^l vi
Giam so lu'dng tieu^cau gap 92,7% cac h'U'dng hdp. So lu'dng tieu cau trung binh ciia nghien cu'u la 47,6± 43,1. Nguyen nhan giam deu rau la do ire che sinh san te bao mau trong tuy do te bao ac tinh lan at hoac do diing hda
chat dieu tri gay suy tuy. Nhdm gap nhieu nhat la so lu'dng ieu cau trong khoang 11-50G/I.
4.2.3. Mau tiiu cau tuy xu'dng Trong nghien ciru cd gap 91,8% mau tieu cau giam sinh, khong gap mau tieu cau tang sinh. Cd gap 8,2% mau tieu cau binh thu'dng.
4.3. Moi lien quan giifa SLTC va tinh trang xuat huyet 6 BN Idxemi cap
So lu'dng tieu cau d nhdm cd xuat huyet thap hdn nhdm khong xuat huyet cd y nghia thong ke.
Ket qua nay phij hdp vdi nghien cu'u ciia Vu Minh Phu'dng [2;6;7]. Theo nghien cu'u, s6 IUdng tieu cau cang giam, mire dp xuat huyet cang nang.
V. KET LUAN
Qua nghien cffu 110 BN Idxemi cap tai Vien Huyet hpc - Truyen mau TW, xin duS ra mpt so ket luan sau: So lu'dng TC trung binh la 47,6±43,1. Giam so lu'dng tieu cau mau ngoai vi chiem 92,7%, giam mau tieu cau trong tiiy chiem 91,8%. So lu'dng tieu cau lien quan den tinh trang xuat huyet, khi SLTC giam, tinh trang xuat huyet tang len va mffc dp xuat huyet nang len.
VI. KIEN NGH!
Khi so lu'dng tieu cSu giam < lOG/l, can theo
doi chat che tinh trang xuat huyet npi tang, dac
biet la xuat huyet nap. Khi benh nhan cd tieu cau
giam, ed tinh trang xuat huyet npi tang ran
nang mffc truyen tieu cau dff phdng den 20G/I de
tranh bien chuTig xuat huyet nao.
Y HOC VIET HAM THAHG 8 • SO 1/2014
TAI LI^U T H A M KHAO
1. Nguyen Thj Lan Hu'dng (2001): "Nghien culi cac roi io?n dong cam mau tren mot so benh nhan mac benh mau ac ti'nh tai l<hoa lam sang cac benh mau vien Huyet hpc - Tmyen mau", Luan van tot nghiep bac sy noi tru binh vien, Tn/dng Dai hgc Y Ha NOI.
2. Vu Minh Phu'dng, Pham CJuang Vinh va cong su* (2007); "Mpt so dac diem huyet hpc va mien dich d b6nh nhan Id xe mi cap dong tuy tai Vien Huyet hpc - Truyen mau Trung u'dng". Tap chi Y hgc so 4 -5, trang 37 - 41.
3. Nguyen Anh Tri (2010): Tien Idxemi va Idxemi cap, Niia xuat ban Yiigc.
4. Nguyin Trieu Vdn (2009): "Nghien ciitJ gia ]bi m$t so dau an bi^t hoa t@ bao mau trong chan dodn phan loai va tien lu^ng benh idxSmi cap
ngu'di idn tai Vien Huyet hoc - Truyen mau", Lu$n an Tieh si Yiioc, Tru'dng DH YHa Ngi Ph?in Quang Vinh (2003): "Nghien cuXi bSt thu'dng nhiem sSc the trong cac the benh IcJxemi cap d ngu'di Idn tai Vien Huyet hpc - Truyen mau", Luan an Tien sy Y hoc, Trudng Oai Iioc Y Ha Ngi
Tomebonhm E, l.odcner D, Paul C (1993). M retropecbve analysis of bleeding complication In 438 patients wrth acute leucemia dunng ttie years 1972 - 1991", Eur J Haematol, 50 (3), pp. 160 - 167.
Navarro y\, Hernandez JA, Ribera JM, et al (1998). "Prophylactic platelet transfusion threshold during therapy for adult acute myeloid leukemia:
10,000/|JL versus 20,000/|JL". Haematc^oglca, 83:998-1.000.
NGHIEN CfrU THai DIEM MO VA KET QUA DIEU TRI VIEM TUI MAT CAP DO S 6 I BANG PHAU THUAT CAT Tlii MAT NOI SOI
Phan Khanh Vi?t*, Le Trung Hai**, Ph^m Nhir Hiep***
T 6 M TAT
- Phau thuSt cSt tiii m|t npi soi dieu trj viem tui mat cap do soi neu thu'c hi?n sdm trong vong 72 gid, die biet la 24 gid d3u trl^u chutig thdi gian mo se ng^n hdn, (t dau hdn, sdm co trung tien hdn, it tal bien trong mS va bien diiitig sdm sau mo hdn, tong ttidi glan n3m vien se ngSn hdn dang ke.
- Phau thuat c3t tui mat nol sol trong viem tui mat cap do sol la phlu thuat kh6 nhutig an toan vdi ty 1$ thanh cong \h 95,1%, tai bien trong mo la 18,2%, bien dii5hg sdm sau mo la 14,3% chu yeu la cac bien chutig nhe. Thdi gian mo tnjng binh la 67,06 ± 16,18 phut, tong thdl gian nSm vien la 10,48 ± 4,50 ngay.
Ty le ket qua tot khi ra vien ia 84,6 % va khong co tu"
vong sau m6
Titldtda: viem bii mat cap do sol, phau thuat c5t bii m^t noi soi
S U M M A R Y
STUDY ON THE H M I N G OF SURGERY
* Benh vien tinh Quang Tri
* * Cyc Quan y - Bo QuSc phong
* * * B?nh vien Trung u'dng Hue Oiiu trach nhiem chfnh; Phan K h a n h V i ? t Email: khanhviet7Q(aQmaii.cQm Dt: 0914.059.623 Phan bl?n khoa hpc: PGS.TS Nguyen VSn XuySn Ngay nhan bai: 9.6.2014
A N D RESULTS OF U P A R O S C O P I C CHOLECYSTECTOMY FOR ACUTE
CALCULOUS C H O L E C Y S T i n S - Laparoscopic cholecystectomy for treatment of acute calculous cholecystitis wittiin 72 hours, espectially within 24 hours from the first symptom of disease, it resulted in shorter operating time, less pain, sooner breaking wind, fewer intra-operatve accidents and eariy postoperative complications, shorter total hospital stay
- LapanDscopic cholecystectomy for treatment of acute calculous cholecystitis is difficult, but safe. Tfie sucessful rate was 95,1%, the accident rate was 18,2%,. The postoperative complication rate was 14,3%, mainly minimal complications.The mean operative time was 67,06 ± 16,18 minutes. The mean total hospital slay was 10,48 ± 4,50 days. The good result when discharge from hospital was 84,6 % and no mortality.
Keywords: acute calculous cholecystitis, Laparoscopic cholecystectomy
I. O A T V A N OE
Viem tui mat cap la benh ly viem nhiem cS^
tinh cua tiii mat ma 9 0 % cac tru'dng hdp c6 nguyen nhan la soi tui mat [ 2 ] Nam 1987 tai Lyon (Phap), Philip^ Mouret da tien hanh thanh cong tru'dng htfp cat t u i m a t noi soi dBu tien va phau thuat nay da nhanh chong du'tfc chap nhan va t r d thanh tieu chuan v a n g trong d i i u t r i befih ly soi tui mat vcTr^cac uti diem hdn so vdi pliau thuat m d kinh dien nhu* it dau sau m o , ft nhilm
