Y HQC VIET NAM T H A N G 8 - SO 2/2014 nguyen nhan khacli quan do ton thu'dng gay hd
nang, gan khdp co chan thi can phai tich CLTC hu'dng dan cho ngu'di benh tap van dgng sdm khdp goi va co chan, dac biet vdi nhffng tru'dng hdp sd dau, khdng cq^dieu kien den tap tai benh vi^n hoac tap mupn de dan den cdng khdp.
V. KET LUAN
Qua nghien ciru 55 benh n h j n gay h d d a u xa hai xu'dng cSng chan du'dc phau thuat bang cd dinh ngoai tai bdnh vien Viet DiTc chung toi thay:
Ty Ie nam/riff la 2 , 2 / 1 , tuoi trung binh 41,6.
Vj t r i vet thu'dng hay gap nhat d mat trffdc trong (81,9%), chii y§u la loai gay phii'c tap nhieu manh (60,0%) va gay hd dp I I I (85,5%).
Ket qua dieu trj vet thu'dng phan mem dat 70,9% tot va rat tdt, Ket qua lien xu'dng dat 67,3% tot va rat tot. Thdi gian lien xffdng trung binh la 22,8 tuan. Ket qua phuc hoi chffc nang
dat 74,6% tot va rat tot. Bien chimg nhiem trung Chan dinh hay gap nhat chiem 30,9%.
TAI LIEU THAIVI KHAO
1 . Ho Van Binh (2005), "Oanh gia tac dung khung CO (Jinh ngoai Fessa tnang dieu tri gay hd xu'dng cang chan tai benh vien Viet Offc . Luan van bic sy chuyen khoa cap 11,'TriJ'd'ng dai hoc Y Ha noi.
2. Pham D3n^ Ninh (2000), "Ng^hi'en ciili iing dung phu'dng phap co dmh ngoai mot ben bSng coc ep ren ngUdc chieu trong dieu trj gay hd hai xutfng cang qian". jjian an tien si y hoc, Hoc vien Quan y, 3. Nguyen Dinh Phu (2008), "Ket qua bffdc dau Litig dung co dinh ngoai gan khdp cai bien trong dieu tri gay hd 1/3 dUdi hai xu'dng cang chan, Hoi nghi CTCH TP Ho Chi Minh.
4. Olson S (1996), "Open fractures of the tibial shaft. Current treatment", JBJS (Am), 78(9), pp 1428-1437.
5. Zaiavras C (2007), "Management of open fractures and subsequent complications", JBJS (Am), 89(4), pp 884-895.
NGHIEN Ciru DAC DIEM LAM SANG, CAN LAM SANG CUA BENH NHAN VIEM TUY CAP vAO CAP CU'U TAI BENH VIEN BACH MAI
T 6 M TAT
Viem tuy cap la mpt dang benh ly c6 bieu hien da dang va phu'c tap, vi v|y nhieu trffdng h^p chan doan nham, dac bl?t \h cac dau bung do nguyen nhan ngoai khoa khac. M^c tieu: Mo td dac diem lam sang va can lam sang cua benh nhan viem tuy cap vao khoa Cap cu^ benh vien Bach Mai. Doi tu'dng vik phu'dng phdp: mo tci tien cffu, benh nhan viem tgy cap vao khoa Cap ciTu Benh vien Bach Mai trong thdl gian tff thang 02/2013 den tliang 08/2013. Ket qua: Qua nghien cuti 115 trudng hop benh nhan viem tuy cap thi bieu hien thffdng gap la dau bung tiiffpng v|, buon n6n va non, dau diem sffdn lung, s5t nh? va mach nhanh. Tri|u chffng can lam san thffdng g$p la tSng amylase mau,c6 dac mau, tSng bach rau, tSng CRP va roi loan chuyin hoa. Ket tuan: Can ket hop giii^
kham ti mi dSic diem lam sang, phan tfch xet nghiem can lam sang va chan doan hinh anh de du^ ra chan
* B|nh vien Da khoa tinh Phii Thp
* * Bgnh vien B?ch Mai
* * * Trudng Dai hoc Y Ha No!
Chju trach nhi?m diinh: Nguyen Quang An Email: Dt: 0916049258
Phan bien khoa hoc: PGS.TS Nguyen Tung Linh Ngay nhan bhi: 25/5/2014
Nguyen Quang An*, Nguyen Van Chi**, Ngo Difc Ngoc***, Nguyin Huy Ng9c*
doan xac djnh sdm nhat nhSm dffa ra hu'dng dieu tri hieu qua kjp ^ d i .
Tdkiida: Viem tuy cap, dSc diem lam sang, c^n lam sang
S U M M A R Y
RESEARCH C L I N I C A L CHARACTERISnCS AND U B O R A T O R Y FIGURES OF ACUTE
PANCREATITIS I N EMERGENCY DEPARTMENT OF BACH M A I HOSPITAL
Acute pancreatitis have a variety kind of symptoms, then in some cases it makes difficult to take diagnosis or easy to make wrong diagnosis. The Goal: To describe clinical characteristics and laboratory figures of acute pancreatitis In emergency department. Subject and method: prospective descriptive study, all acute pancreatitis patients were admitted in Bach mai hospital from February, 2013 to August, 2013. Results: 115 acute pancreatitis patients were enrolled to the study, the most commai symptoms are epigastric pain, nausea and vomiting, hyperthemia, and tarchycardy. laboratory investigation found elevated semm amylase, increase viscosity, leukocytosis, elevated CRP and metabolic disorder.
Conclusion: rambination careful examination with laboratory investigation is the very important thing to make the diagnosis of acute pancreatitis in time without mistakes.
54
Y HOC VIET NAM THANG 8 - SO 2/2014 Keywords: Acute panaeatitis, clinical
characteristics and laboratory figures I.OATVXNDI
Viem tuy cap la mpt benh ly cap cffu thffdng ga^ trong cac khoa cap cffu. Cung vdi sff phat trien cua kinh te xa hpi, ty le benh ly VTC dang cd xu hffdng ngay cang gia tang. Benh ly viem tuy cap vdi cac trieu chffng lam sang, can lam sang da dang, de nham lan vdi cac benh ly noi ngoai khoa khac nhff viem tui mat, giuri chui dng mat, viem da day ruot... gay khd khan cho viec chan doan va dieu trj sdm, lam tang ty Ie biin chffng cung nhff ty Ie tff vong d benh nhari (BN) viem tuy cap [1], [2], [5], [7].
Viec danh gia trieu chffng lam sang, c$n Iam sang cua VTC d ngffdi Idn gdp phan phan loai sdm, dieu tri kjp thdi, tranh tff vong va bien chffng khdng dang cd cua benh la cap thi€t, dac biet trong giai doan dau nhap vien. Vi vay, chung toi tien hanh nghien cffu nay vdi muc tieu: "Mo ta dac diem lam sang va can lim sang cua binh nhin viem tuy cap vao khoa Ci'p cdu b$nh vlin Bach Mai, sdbd danh gli mdc do n$ng viim tuy cap theo cac bang diem Ranson, Imrie vi Sofd'.
11.06l TUQNG VA PHU'CyNG PHAP NGH|!N CUU 2.1. Doi tu'dng nghfen CIIJXI
Benh nhan chan doan xac djnh viem tuy cap vao cap cffu tai khoa Cap cffu Benh vien Bach Mai 2.2. Phu'dng [riiap nghien cuti: mo ta den ciiU
Thdi gian va dja diem nghien cu^u: Benh nhan VTC vao dieu tri tai khoa Cap cffu benh vien Bach Mai tff thang 02/2013 den thang 08/2013.
- Tieu chuan chon benh nhan:
+ Cac BN dirdc chan doan VTC theo tieu chuan Atlanta nam 2012 [6].
+ Tuoi >16 (nam)
Loai trff cac BN co cac benh man tinh suy gan, suy than... tff trffdc, cac BN khdng dii cac thdng so nghien cffu.
- Cac thong so theo doi:
•^ Lam sang: Dau bung thffdng vj, ndn, buon non, bl trung dai tien, ia Idng, bung chffdng, an dau diem sffdn Iffng, cam ffng phuc mac toan bp, nhiet dp, mach, huyet ap
+ Can lam sang: amylase mau, cdng thffc mau, ure, creatinin, CRP, lipid mau, glucose mau, dien giai do, sieu am d bung, CT scanner o bung.
- Danh gia dp nang theo thang diem Ranson, Apache II, CT scanner bung (diem CTSI).
- Oanh gia mut dp suy da tang theo thang diem SOFA - Oanh gia dap ffng viem he thong: cd dap ffng viem he thdng khi cd 2 trong 4 dac diem sau: 1, Nhiet dp > 38°C hoac <36°C; 2.tan so tim > 90 lan /phut 3. Tan so thd > 20 fan /phut hoac PaC02 < 32mmHg; 4. Bach cau > 12 x 10^9/1 hoac < 4 X 10^9/1 hoac > 10% bach cau non, - Cac so lieu du'dc xii ly theo phffdng phap thong ke y - sinh hoc tren may tinh bang phan mem SPSS 16.0.
III. Kfr QUA NGHIEN CU'U
115 benh nhan du ti§u chuan dffa vao nghien cffu
VTC chu yeu gap d nam gidi, ty Ie nam/nff: 6/1, tap trung d do tudi tff 31 - 60 tudi, trung binh:
45,16 ±13,5 (tudi).
BN nhap vien tn^ng ngay dau tien cua benh chiem so Iffdng Idn nhat, trung binh 2,04±1,3 (ngay).
Bang 1: Phan bo mpt so dac diem tien sff cua BN VTC Tien su'
Soi mat Nghiin riTtfu
RLCH Lipid
So benli nliin (n = 115) 21 76 IS
Ty le (%) 18,2 66,1 15,7 yVAanjre'f; Nguyen nhan gay viem tuy cap chu yeu la do nghien ru'du
Bing 2;Trieu chulig ccf nang Cac dSu hieu Dau bung tren ron
Buon non va non Bi trung (Jai tien
la long
Co 114
3
99,1 89,6 J43_
2,6
Khong
87 112
_ 0 ^ 75,7 97,4
NhSn xit: niau hit cac bSnh nhan VTC deu nhap viin vdi trieu chiHig dau bung va buon non (99,1%
va 89,6%). Dau hieu bf trung dai tien va ia long chiem ty le nlio.
Y HOC VIET NAM THANG 8 . 80 2/2014 Bang 3: Jr'ieu chutia thu'c the
Trieu chil'ng thu'c the Bunq chu'dnq
Diem sudn luliq dau Cam utiq phuc mac toan bo Dap Cmg viem he thong SIRS Huyet ap trung binh <65mmHq
Co n 86 100 4 73 10
74,8
%
87,0 3,5 63,5 8,7
Khong n 29 15 111
42 105
25,2
%
13,0 96,5 36,5 91,3 Nhan xet: BN VTC chu yeu co cac trieu chimg diem sudn lutig dau, chu'dng bung va phan uYig tha bung. Cam utig phuc mac toan bg chiem 3,5%.
Bina 4. Ket qua xet nqhiem huyet hoc _ Chi so huyet hoc
Het (I/I) Bach(^u
Trunq binh
> 44% (nam) va
> 40% (nff) Trung binh
> 12 G/l
A +SD 0,409 ± 0,099
52 (45,2%) 13,8 ± 5,13 73 (63,5%)
nh
NhinxifVtC co tSng hematocrit l<hi vao vien chiem 45,2%, cao nhat la 0,796 I/I. Phan Idn BN VTC vao'vien co tSng BC chiem ty le 63,5%
Bani75. Ket qua xet nqhiem sinh hoa mau. —
Nh^nxet:\- CRP, tang un
Bin
Nl bu
Chi 50 hoa sinh Amylase mau (U/1) < 3 lan binh thu'dng (28-lOOU/l) > 3 lan binh thu'dng
Ure Creatinin
CRP Cholesterol Triglyceride Glucose huyet Trunq binh
> 6,4 mmol/l Natri
Kali Can xi
au het gap BN cd amylase mau tang >3 lan bin 3, creatinin, roi loan md mau, du'dng mau va gian
? 6. Ket qua chup Zt Scanner
A ±SD 31 (27,7%) 81 (72,3%i 7,1 ± 6,47 100,5 ± 95,03
12,8 ± 23,66 7,0 ± 6,63 7,0 ± 11,36
7,7 ± 5,17 51 (45,1%) 134,0 ± 5,56
3,8 ± 0,69 1,8 ± 0,48 1 thu'dng. Ngoai ra, cac BN 1 natri mau
Phan do CT A: Tuy binh thu'dng
B: Tuy to toan bo hoac mot phan
C; Tuy bat thu'dng Item theo phan irng viem nhe xung quanh tuy D: Chi CO mot vi tri co dich (thu'dng phia tru'dc thu'dng than) E: Cd 2 vj trf cd dich nam gan tuy hoac cd l<hi trong tuy hoac phan u'nq viem quanh tuy
T6ng
Diem 0 1 2 3 4
VTC cd tang
N (%) 1 (0,01) 31(0,23) 57 (49,6) 16 (0,14) 10 (0,09) 115 (100%) ian xit: Ket qua viem liiy cap Balthazar C chiem so luBng Idn nhat, chi cd duy nhat 1 ca chup C ng binh thu'dng nhuHg van la viem tuy cap. Chu'ng td Ct scanner cd gia tri cao trong chSn doan VT
Bing 7: Hinh anh sieu am o bunq Hinh anh sieu am
Dich mang phdl Sdi mat Dich 0 bunq Tuy to, phu ne
n=115 56 17 84 69
Ty le (%] - so BN/n 57,4 14,8 73,0 60,0
r6
Y HOC VIET HAM THAHG B - SO 2/2014
Nhan xit: Sieu am cd kha nSng tot phat hien viem tuy cap va cac bien chffng, cd tdi 69 ca chiem 60^0% benh nhan duWc phat hien viem tuy cap bang sieu am 6 bung. Tuy nhien dp chinh xac khdng the bang CT scanner o byng.
Bang 8. Danh qia IMRIE
< 3
> 3 SOFA
< 6
> 6 RANSON
0 - 2 3 - 4 5 - 6 7 - 8
mu'c do nanq theo SoBN 97(100%)
18 95 20 20 75 17 6
cac thanq diem VTC nanq va TU* vong
9 (9,3%) 17 (94,4%)
8 (8,4%) 12 (63,2%)
0 2(2,7%) 12 (70,6%)
6 (100%)
VTC truna binh-nhe 88 (90,7%)
1 (0,6%) 87 (91,6%)
8 (31,6%) 20 (100%) 73 (97,3%) 5 (29,4%)
0 IV. BAN LUJSiN
4.1. D|c diem lam sing ciia viem tiiy cap Nghien CLTU cua chung tdi tren 115 BN thi nam la 86%, nff chiem 14%, ty le nam/nff la 6,1/1 tudng du'dng vdi l<et qua nghien dta cua Bao Xuan Cd (75%) [IJ. Tuoi trung binh BN trong nghien ciJu cua chiing tdl la 45,16 ± 13,5 tuoi cung tudng tu' nhu' ket qua ciia Dao Xuan Cd la 44,75 ± 10,3 [ i ] (p=0,4), nhuHg thap hdn so vdi liet qua nghien culi ciia Chang (2010) la 52,5 (p<0,05) [5].
Ket qua nghien ciiM cua chung toi cho thay ty l | BN VTC cd tien siJ nghien ruau chiSm 53%, Hep den la cac roi loan chuyen hda lipid (15,7%), Hen sit benh 1^ sdi mat chi^m ty le kha thap (14,8%). bau bung la trieu chiing thuSng gap (99,1%), day cung la ly do chfnh khien BN nhap vl|n. Dau bung khdi phat dot ngot, dff doi. Vj tri cdn dau thu&ng dau bunq viing thu'dng vj, viing quanh ron va h^ su'dn trai sau dd lan nhanh ra khSp bung. Mdt so BN dau bung xuat hien sau biia I n thjnh soan nhff trong cac tai lieu kinh dien cung tudng tff nhff cac nghien cffu khac [3], [4].
Sau tri|u chumg dau bung, buon ndn va ndn chiem 89,6%. Ndn thffdng xuat hien ngay sau cdn dau dSu tien va het sau 1- 2 ngay dieu tri.
Ket qua nay cao hdn nghien cuXi Nguyen Thj HSng; 82% [3] va Bill Van Khich: 73,8% [4].
Trieu chiihg ia Idng chiem 2,6%, thap hdn nghien cffu Vu Dffc Dinh: 19,8% [2].
NghiSn cuU ciia chung tdi cho thay cd 74,8%
BN cd dau hieu bung chffdng, do giam nhu ddng rupt hay liet' rupt cd n5ng, thap hdn ket qua nghien ciruciia Bill Vln Khich: 86,8% [4]. Dau hISu diem sffdn lulig dau la mdt tri6u chuTig quan trong ciia VTC (chiem 86,9%) va cao hdn so vdi nghien ciili cua Nguyen Thi HSng: 52%
[3], Bill van Khich: 15,8% [4].
Phan Idn cac BN vao vien dlu sot nhe hoSc khdng sot (70,4%), sot vua chiem 27,8% va sot cao chiem 1,7%. Giam huyet ap cd the do nhieu yeu to phoi hdp gay nen nhffng trong VTC chii yeu la mat d|ch do tang ti'nh tham thanh mach gay thoat djcli va giai phdng cac C)rtokine gay hpi chffng tang ap Iffc 6 bung gSy ra vdng xo3n benh ly cua VTC dan tdi tinh trang sdc.
4.2. Oac diem can ISm sing cua viem tuy cap
Amylase mau la xet nghiem thudng dung nhat trong chan doan VTC, khi nSng dp amylase mau tang gap 3 lan binh thffdng cd gia tri chan doan VTC. Tuy nhien, trong nghien cdij ciia chiing tdi, tang amylase mau tren 3 lan binh thffdng chiem 72,3%, thap hdn nghiSn cull Nguyen Thj Hang: 85% [3].
Ket qua nghien cffu cua chung tdl chp th^y chi so hematocrit trung binh la 0,409 ± 0,099 (I/I), cd 52 trffdng hdp cd tang hematocrit khi nhSp vien. Hematocrit tang cung vdi mach nhanh, huyet ap ha the hien tinh trang thieu djch dang dien bien, nguy cd suy tang va tff vong.
Mot so xet nghiem thffdng quy vdi BN VTC dffdc chiing tdi ghi nhan. Ndng dp ure huyet trung binh la 7,1 ± 6,47 mmol/l. Ket qua nay cao hdn so vdi ket qua nghien cull ciia Jordanov:
trung binh la 4,2 (n=271) [7]. Ting nSng dp ure trong mau lam tang nguy cd tff vong, dieu nay da dffdc chffng minh trong nhieu nghien cffu.
Nghien cii\i ciia chung tdl cho thay ndng dp cholesterol trung binh 7,0 ± 6,53 (mmol/l), nong do triqivcreride trunq binh 7,0 ± 11,36 (mmol/l).
Oieu nay phii hdp vdi tien sff benh lv ciia BN VTC la cd roi loan chuyen hda lipid mau. Khi BN sff dunq rffdu nhieu se lam qia tanq nquy as rol loan chuyen hda lipid dac biet la tang triglycerid. Nong dp dffdng mau trung binh 7,7 ± 6,17 (mmoi/l), trong dd cd 45,1% (n=51) trffdng hdp cd nong dp dffdng > 6,4 mmol/l. Natri mau trung binh l i
Y HOC VigT HAM T H A W G 8 • s 6 2/2014 134,0 ± 5,56 mmol/l. Co mdt so BN cd ha natri
mau thffdng xay ra d trong cac trffdng hdp VTC tang triglyceride do Iffdng lipid mau tang cao.
Mffc canxi mau toan phan trung binh la 1,8 ± 0,48 mmol/l. Dieu nay tffdng tff nghien cffu ciia Bui Van Khich [4] va cao hdn ket qua cua Nguyen Thi Hang [ 3 ] . Ket qua nay Idn hdn cac nghien cffu khac cd the do BN den mudn va ty le BN bj VTC hoai tff nhieu.
Chup CTscanner 6 bung cho cac BN trong vong 24 gid dau nhap vien va thay phan Idn BN VTC cd diem CTSI I^ 3 diem (29,6%), phili hdp vdi k ^ qua nghien diu cua Vu Dffc Djnh [ 2 ] . BN cua chunci toi phan Idn den sdm trffdc 72 gid va chu yeu la VTC tiie nhe, tuy nhien mpt so tac gia cung nh$n djnh rang: trong 72 gid dau mffc dp hoai tff chu^ danh gia day du mffc dd nSng ciia VTC. Si§u am d bung la mpt phffdng pliap can Iam sang^ khdng xam nhap dffdc sff dung nhieu trong chan doan benh cung nhff cac dau hieu khSc, dac biet d nhiitig trffdng hdp cd chong chi dinh doi vdi chup CLVT nhff suy tiian cap, phy nu"
cd thai. Ket qiia nghien culi cua chiing toi thap hdn so vdi nghfen cffu khac cd the do cac BN trong nghien cuff ciia chung ^ 1 chu yeu d pha d i p ti'nh vao vien sdm hdn. Tran dich mang phdi cd the gay tinh trang khd t h d , giam oxy hoa mau, suy hd hap. Day dffdc coi la dau hieu tien lu^ng nang trong VTC.
Nghien cffu 115 benh nhan viem tuy cap thay t y j e nam/nff la 6 , 1 / 1 ; trung binh 45)16 ± 13,5 tuSi. Hau het benh nhan cd trieu chiihg dau bung (99,1%), buon ndn (89,6%), diem sudn Iffng dau (74,8%) va chffdng bung (87,0%).
Ve can Iam sang thay hau het benh nhan co amylase mau tang > 3 I3n binh thffdng (72,3%).
Ngoai ra, cdn cd tang CRP, tang ure, creatinin, rdi loan md mau, dffdng mau va giam natri mau.
Chup CTscanner 6 bung trong vdng 24 gid dau nhap vien va thay 2 9 , 6 % benh nhan cd dian CTSI la 3 diem (29,6%). Tren sieu am thay ed soi mat (14,8%) va dich mang phdi (57,4%)
TAI LIEU T H A M KHAO
1 . Cao^Xuan Cd ( 2 0 1 2 ) , Nghien cilU gia tii ciia ap iiTc 6 bung trong chan doan mffc dd vci theo doi dien bien cua viem tuy cap, Luan dn Ti^n sT y hoc, Tru'dng Oai hoc Y Ha N^i.
2. Vu Dffc Djnh ( 2 0 1 2 ) , Nghien ciili d i e diem lam sang, mpt so chi so can lam sang va hieu qud dieu tri ciia lieu phap Ipc mau lien tuc d b^nh nhan viem tuy cap n^ing, Luan an Tien s9 y hpc, Trff&ng Oai hpc Y Ha Noi.
3. Nguygn Thj H^ng ( 2 0 0 2 ) , Nghien cuff d3c diem lam sdng - can lam sang va hinh dnh sieu am cua viem tgy cap, Lu^n vdn ^ t nghiep bac s9 chuyen khoa cap I I , Tn/dng Oai hoc Y Hd Ndi.
4 . Bui Van Khich (2004),' Nghien cuff d$c di^m lam sdng, c|in lam sang vd ket qua dieu bi viem tuy cap nSng tai khoa Hoi sffc cap dtu - Benh vi^n Bach Mai", Luan vSn tSt nghiep bac si chuyen khoa I I , Trffdng Dai hoc Y Ha Npi.
5. Chang M. C. et a l . ( 2 0 0 3 ) , "Etiology of acute pancreatrtis--a multi-center study in Taiwan.", Hepatogastroenterology. 50(53), tr. 1655 - 7 6. Fabio Cesare Campanile (2013),
"aassification of acute pancreatitis-2012:
revision of the Atlanta classification and definitions by international consensus" Gut. 62, tr. 102 - H I 7. Jordanov P., Grigorov G. ( 2 0 1 2 ) , "Predictors
of Mortality in Acute Pancreatitis: A Retrospective Study", Pancreatology, 3(1), WMC002925.
NGHIEN ClhJ MOT S6 VEU T 6 LIEN QUAN TRONG BfiNH ZONA
T6MTAT
NghiSn cuff 170 benh nhdn zona di€u tri tai Khoa Da lieu-Dj ling Benh vien TL/QO 108 tff 02/2013 den 03/2014 cho ket qud: nam bi benh 67,6%, nff Id 32,4%; 88,8% benh nhan ffeii 50 tuoi, benh nhdn cdng cao tuoi thi cdng hay bj zona mffc dp n$ng
* Khoa Da liSu-Dj img EVn/QO 108 Chju trach nhiem diinh: B u i T h i V a n Email: [email protected] Dt; 0983.661.030 Phdn bien khoa hpc: PGS.TS Ddng VSn Em Ngdy nhdn bdi: 3U.6.2UI4
Biii Thj Van*
(p<0,05);78,2% benh nhan cd tien bieu va co tien trieu khdng dnh hffdng den mffc dp b^nh zona.
Td khoa: zona, ygu to lien quan.
S U M M A R Y
RESEARCH OF FACTORS RELATED SHINGLES The study of 170 shingles patients freated at Department of Dermatology-Allergology Hoaiital 108 from 02/2013 to 03/2014 result: 67.6% male patients, women 32.4%; 88.8% of patiente over 50 years of age, more etderiy patients are more severe (p<0 05), 78.2% in patients with prodromal pain and prodromal pain does not affect the severity of shingles.
58
