VIETNAM MEDICAL JOURNAL N°2 - APRIL - 2018
TAI L i l u THAIVl KHAO
1. Dang Thj Hong Thien (2009), Tinh hinh soi buong tff cung 6 cac benh nhan vo sinh tai benh vien phu san trung u'dng n5m 2008, Luin van tot nghiep bic sy chuyen khoa ci'p II chuyin nginh Sin phu khoa.
i. C. M. March (2011), Asherman's syndrome, Semin Reprod Med, 29(2), tr. 83-94.
3. Nguyen Duy Anh (1993), Gop phan tim hieu nguyen nhan, each dieu tri va phong ngija tai bien dinh buong tff eung do thii thuat, Luin vs/? ft5? nghiep bic sy noi tni benh vien chuyin nganh f^u san.
4. S. R. Soares, M. M. Barbosa dos Reis va A. F.
Camargos (2000), Diagnostic accuracy of sonohysterography, transvaginal sonography, and
hysterosalpingography in patients with uteruig cavity diseases,/fe/*y5fer//, 73(2), tr. 406-11.
5. Dang Thj Minh Nguyet (2006), Soi buong tii cung de chan doan eac bat thudng trong buong t i cung, L uin int'ensyy hgc chuyin nganh San phu khoa, o. Siahbazi S Ahmadi F, Akhbari F, EsIamiB^^
Vosough A. (2013), Hysterosalpingography Finding in Intra Uterine Adhesion (Asheman' s Syndrome): A Pictonal Essay. , Intemam^al Journal of Fertility & Sterility., 7(3), tr. 155 -160.
/ . Rafael F. Erica S., Camran Nezhat (2014), Intrauterine adhesions: hysteroscopic evaluaton and treatment, Laparoendoscopic Suiyic^
Complications, 3rd Edition
LIEN QUAN GIU'A LAM SANG, HINH ANH HOC VCTI MU'C DO HEP TAC DO VITA Xff D O N G MACH CANH DOAN NGOAl SO
6* BENH N H A N NHOI M A U N A O HE CANH
V6 Hong Khoi*, Le Na**, Trirong, Tuan Anh**
T O M TAT
Nhoi mau nao ehiem 80% benh nhan dot quy nao. Mot trong nhffng nguyen nhan la do benh iy vffa xd dong mach canh. Muc tieu: Oanh gia moi lien quan giffa d'3c diem lam sang, hinh anh hoc vdi mffc dp hep tae. Phu'dng phap nghien cii'u: 50 benh nhan dUOc chan doan xac dinh la nhoi mau nao he canh CO viJa xd dong mach canh doan ngoai sp trong giai doan cap (dffdi 1 tiiang) dUcJc kham va dieu tri tai Khoa Than kinh, Benh vien Bach Mai tff thang 7 nam 2016 den thang 7 nam 2017. Ket qua va ket luan: Co sU lien quan eo y nghTa thong ke (p < 0.05) qvSa roi loan lipid mau, lam sang, roi loan y thffc, mffc do liet, d|c diem nhoi mau b^n phim cliup cat Idp vi tinh lioac eong hu'dng tff so nao vdi eac mffc dp hep maeh canh doan ngoai sp.
tit khoa: nhoi mau nao, vife xd mach, dpng mach canh doan ngoai sp.
SUMIVIARY
RELATION BETWEEN CLINICAL, IMAGING FEATURES AND GRADES OF CAROTID STENOSIS OF PATIENTS SUFFERING FROM ANTERIOR CIRCULATION
ISCHEMIC STROKE Ischemic stroke accounted for 80% of stroke patients. One of the common causes of ischemic
*Binh viin Bach Mai
**Binh viin da khoa tinh Nghi An
***Tru^g Dal hoc Dieu du&ng Nam Dinh.
Chm trach nhiem ehinh: Vo Hong Khoi Email: [email protected] Ngay nhan bai: 23.2.2018 Ngay phan bien khoa hpc: 3.4.2018 Ngay duyet bai: 14.4.2018
stroke is due to atherosclerosis of canatid arteries.
Objective: To investigate the relation between dinieal and imaging characteristics and grades of extracranial carotid artery stenosis. Method: 50 acute anterior circulation ischemic stroke patients with carotid atherosclerosis admitted to the Neurology Department of Bach Mai Hospital from July 2016 to July 2017 were enrolled in the study.
Results and Conclusions: Lipid disorders, seventy of clinical eondibons and characteristics of isdiemic stroke on brain CT/MRI correlated statistically with grades of extracranial carotid stenosis.
Key words: ischemic stroke, atherosclerosis, excranial carotid artery.
t. O A T VAN OE
Opt quy nao la benh ly thffdng gap, gay tff vong eao, dffng hang thff ba sau ung thff va cac benh tim mach. Nhoi mau nao chiem 80%
benh nhan dot quy nao. Danh gia tinh trang vda xd cd y nghTa Idn trong dieu trj. Sieu am Doppler la mpt phffdng phap danh gia tinh trang vffa xd rat tot vi eo the tien hanh rong rai, dp chinh xac cao, khong gay bien chffng. Cae de ^1 dot quy nao d benh nhan nhoi mau nao co vii^
hep tae dpng mach eanh doan ngoai so vdi nhutig mffc dp khac nhau chffa dffdc nghien culj nhieu d Viet Nam.
Vi vay, chung tdi thffc hien de tai vdi_ muc tieu: Dinh gla mdi lien guan glu& die diem lain sing, hinh anh hpc vdi mii'c dp hep tie do vSa xd dpng mach canh doan ngoai sp tren sleuarn Doppler dpng mach canh d benh nhan nhoi mau nao he cinh.
TAP CHt Y HOC VIET NAM TAP 465 - THANG 4 - SO 2 - 2018 11.001 T U y N G VA PHl/OfNG PHAP NGHIEN CLTU
1. Ooi lu'cfng nghien cihi: 50 benh nhan du'dc chan^ doan xac dinh la nhoi mau nao he canh CO vu^ xd dpng maeh canh doan ngoai sp trong giai doan cap (dffdi 1 thang) dffdc kham va (Jeu tri tai Khoa Than kinh, Benh vien Bach r4a! tff tiiang 7 nam 2016 den thang 7 nam 2017.
1.1 Tieu chuan lu'a chon:
- Du^ theo dmh nghla dot quy nao cua To chffe Y t e The gidi (1990).
- Dffa vao dac diem lam sang: Khdi dau dot ngpt, cap tinh va nang dan, eo bieu hien ton thffdng than kinh khu tru, cae trieu chffng ton tai tren 24 gid, khong do ehan thu'dng.
- Hinh anh chup cat Idp vi ti'nh (CLVT) hoae cpng hu'dng tff (CHT) sp nao cd ton thu'dng dang niiQl mau nao thupe khu vffc tffdi mau eua dpng mach eanh.
- Sieu am Doppler mach cd mang vffa xd dpng mach canh doan ngoai sp gay hep tac mach v6i cac mffc dp khae nhau.
1.2 Tieu chuan loai tru': Khong thoa man tieu chuan lu^ chpn tren va/ hoac co benh tim gay huyet khoi xae djnh qua tham ktiam lam sang, dien tim, sieu am tim va/ hoac cd cac nguyen nhan khae gay nhoi mau nao. Co nhieu benh ly toan than nang nhff: suy tim, suy than, xdgan...
2. Phu'dng phap nghien cu'u:
2.1 Thiet ke nghien cu'u: mo ta cat ngang.
2.2 Noi dung nghien cu'u:
2.2.1 Chan doin nhoi mau nao:
• Lam sang: Liet nffa ngffdt, roi loan y thffc, roi loan ngon ngff, roi loan cam giac, liet VII trung u'dng , tian manh ciing ten, roi loan cd tron, mat dap, dap yeu hoac tieng thoi dpng maeh eanh, dau dau, CO giat ., cac yeu to nguy ed.
- Danh gia tri giac diia vao thang diem Glasgow.
- Mffc dp liet danh gia qua thang diem Henry.
•:• Hinh anh nhoi mau nao: phai nhin thay 6 ton thu'dng tren CLVT/ CHT so nao.
- Phan tfeh dae diem ton thu'dng tren CLVT/
CHT sp nao: nhoi mau vo nao, nhoi mau du'di vd, nhoi mau vd nao- dffdi vd, nhoi mau nhieu 6' rai rac, nhoi mau vung giap ranh.
2.2.2 Danh gia mang xd vffa tren sieu am dpng maeh canh
- Cd mang vffa xddpng maeh canh (theo Hpi tang huyet ap Chau Au/ Hot tim mach Chau Au nam 2003) khi dp day npi tam mac tren 1,5 mm.
- Xac dinh mffe do hep dong mach canh theo NASCET: % doan hep = [(Dn- Ds)/ Dn ] * 100%
- Danh gia mffe dp hep theo nghien effu eua Zavanone (2012): khong hep hoac hep nhe (du'di 50 % ) , hep vffa (tff 50 den 69 % ) , tiep nang (tff 70 den 99 %) va tac hoan toan (100%).
3. Xu' ly so lieu theo phan mem thong ke y hpc SPSS 16.0.
III. KET QUA VA BAN LUAN
Bang 3 . 1 : Lien quan giu'a tuoi vdi mu'c do liep tac dong macli canh do vii'a xd.
~ ^ ~ ^ ^ _ ^ ^ Tuoi Mii'c do h e p ^ — ^ ^ ^
Khong hep va hep nhe CdifiSi50%) Hep viis va nang ( 50- 99%) Tac hoan toan(100%)
Tong
< 6 0 5 (22,7%) 3 (18,8%) 4 (33,3%) 1 2 ( 2 4 , 0 % )
6 0 - 6 9 7 (31,8%) 9 (56,2%) 5 (41, 7%) 2 1 ( 4 2 , 0 % )
7 0 - 7 9 8 (36,4%) 3 (18,8%) 3 (25,0%) 1 4 ( 2 8 , 0 % )
> 8 0 2 (9,1%) 1 (6,2%) 0 (0,0%) 3 ( 6 , 0 % )
Tong 22 (100%) 16 (100%) 12(100%) 5 0 ( 1 0 0 % ) Nhin xit: Nhom tuot thffdng gap n h a t : 60 -
69 tuoi, chiem ty te 42,0%, sau do la nhdm tuoi 70- 79 (28(0%), nhdm dffdi 60 va tren 80 tuoi it gSp hdn. O nlidm benh nhan cd mang vffa xd Wiong gay hep hoac hep nhe hay gap nhat d dp tuoi 70-79 (36,4%), sau do la dp tuoi 60- 69; j t gap d benh nhan dffdi 60 tuoi hoae tren 80 tuoi.
Nhom hep v u ^ va nang hay gap nhat d dp 60- 69 tuoi (56,2%J, nhdm tac hoan toan cung hay gap d nhom tuoi nay (41,7%).
Ket qua nay eting phu hdp vdi nghien cffu eua M. Fernandes va CS: nhom benh nhan vffa xd
tren 60% cung hay gap d nhom 60- 69 tuoi (50%), ke tiep la nhom 70-79 tuoi (33,3%), nhdm tuoi dffdi 60 va tren 80 tuoi it gap hdn [ 1 ] . Dieu nay cd the dffdc giai thfeh la, nhom dffdi 60 tuo'i CO ft nguy cd dot quy nao hdn, tuoi cang cao thi yeu to nguy cd dot quy nao, vu^ xd mach cang tang, Nhffng nhffng benh nhan tuoi cao tren 70 (dac biet tff 80 tuoi trd ien) thu'dng co nhieu benh ket hdp va tang nguy cd tff vong, ty ie den benh vien cung ft hdn, vi the ty ie gap trong nghien cffu nay khong idn.
VIETNAM MEDICAL JOURNAL N°2 - A P R I L - 2 0 1 8
Bang 3.2: Mii'c do lam sang theo thang diem NIHSS lien quan den mtfc do hep tac.
Mi^cdojiep dong mach canh
Mu'c do lam s^ng — — _ Diem NIHSS
Mu'c do lam sang
Nang va vteCNIHSS >8) Nhe(NIHSS < 8)
Hep nhe 9,05± 4,24 9 (29,0%) 13(68,4%)
Hep vua va nang 11,44 ±3,74
12(38,7%) 4(21,1%)
Tac hoan toan 14,92±6,14
10(32,3%) 6(16,2%)
P P < 0,05 P < 0,05 Nhin xet: Diem NIHSS ban dau d benh nhan tang dan theo mffe dp hep dpng mach canh; hep nhe diem NIHSS la 9,05± 4,24, hep v f f a ' ( l l , 4 4 ±3,74) va hep nang (14,92±6,14). Sy khac blet nay CO y nghTa thong ke (v6l p < 0,05),
l^ffc do lam sang nhe gap chii yeu d benh nhan eo hep nhe dong mach canh (68,4%), hep vti^ co ty le 21,1%, hep nang co ty le thap nhat (16,2%). Mffc do lam sang nang gap chu yeu d nhom hep vffa"trd len (71,0%), nhom hep nhe chi ehiem 29,0%. Mffe do hep vite trd ien (dac biet hep nang va tac hoan toan) se can trd dong mau nuoi duSng hoac mang vffa xd d l bong hdn theo dong mau den tae maeh nho hdn cf xa, gay nhoi mau nao 6 Idn vdi cac trieu chffng lam sang^nang ne hdn.
Bing 3.3: Mot sddac diem lam sang liin quan den /ndc dp hep tac.
MiiiLdgJi^pdpng mach canh
Oac diem lam simg _ _ Roi loan y thu'c
MiJc do liet van dong (Theo Henty & CS)
Diem Glasgow >12 Oiem Glasgow < 12
Nhe (< 3) Nang ( > 3 )
Hep nhe 20(54,1%) 2 (15,4%) 18(72,0%) 4(16,0%)
Hep vu'a va nang 11(29,7%) 5(38,5%) 4(16,0%) 12(48,0%)
Tac hoan toan 6(16,2%) 6(46,2%) 3(12,0%) 9(36,0%)
P P <
0,05 P < 0,05 Nhin xet: Trong nhdm roi loan y thffe nhe hoae khong co roi loan y thffe (diem hon me Glasgow tren 12), ehu yeu gap d mffc dp hep nhe dpng mach canh (54,1%), sau do la mffe dp hep vffa va nang (29,7%), mffc dd tac hoan toan ft gap hdn. Nhdm roi loan y thffe vffa va nang, gap nhieu nhat lai d nhdm tae hoan toan (46,2%), nhom hep vffa va nang (38,5%), ft gap d nhom hep nhe. Vdi liet van dpng, liet nhe gap ehu yeu d mffc dp hep nhe (72,0%), mffc do liet nang gap ehu yeu d nhom hep viia trd ten (84%). Cac moi lien quan nay ed y nghTa thong ke (vdi p < 0,05). Ket qua nay cua cfiung tot cung tffdng dong vdi nghien cffu cua Nguyen Cong Hoan[2].
Bang 3.4: Lien quan gida die diem nhoi miu va mdc dp hep Mu'c do hep Khong hep va hep Hep > 5 0 % va
— " " ' ' - - ' " ' ^ ^ tacCn = 2 8 )
<50<'/o(n = 2 2 )
Nhoi mau vd nao
5 (71,4%)
2 (28,0%) p > 0,05Nhoi mau dffdi vd
13 (72,2%)
5 (27,8%) p < 0,05 Nhoi mau vo- du'di vdNhot mau nhteu d
2 (11,8%)
2 (66,73,2%) p < 0,05 p > 0,05
1 (33,;
Nhoi mau vung giap ranh 0 (0,0%)
5 (100,0%)
p < 0,05 Nhan xet: Co su* khae blet ed y nghTa thong ke (p< 0,05) giffa nhoi mau dffdi vd vdt eae mffe do hep tac, trong do t9 le nhoi mau du'di vd eao hdn d benh nhan co mang v i j ^ xd khong gay hep hoac hep nhe so vdi hep vffa, nang hoac tae.Nhoi mau toan bp vung cap mau dpng mach (vo va dffdi vd) d nhdm hep maeh canh tren 50%
hoac tac cao hdn cd y nghta thdng ke (p < 0,05) so vdi nhdm khdng hep hoac hep dffdi 50%. Nhoi mau vung giap ranh ehi gap d nhdm hep > 50% hoae tac, sii khac blet nay cd y nghTa thong ke (v6i p <
0,05). Sff lien quan co y nghia thong ke vdi nhot mau dffdi vo vdi mffc dp hep nhe va nhoi mau toan bo vung cap mau vdt mffc do hep viia tnJ ten. Theo mpt nghien cffu do Seth va cs, tat ea eae trffdng hdp nhoi mau ddSx vd nao deu co dpng mach eanh khong hep hoac hep du'di 40% [3].
Bing 3.5: Liin quan mdc do hep tac ddng mach vdi cac yeu tdnguy cd.
Yeu to nguy cd
Hep nhe & khong
"hep (Vsoo/o)
Hep vu'a va nang
(50-99 o/o)
( n = 1 6 )
Tac(100o/o) (n = 1 2 ) Nam
17 (77,3%) 15(93,8%) i (66,7%)
p>0,05 Tuoi > 6017 (77,3%) 13(81,2%)
8 (66,7%) p>0,05Tang huyet ap
17(77,3%) 10(62,5'
9 (75,0' p>0,05Roi loan iipid mau 5 (22,7'
10(62,5'
p<0,05TAP CHl Y HOC VI^T NAMTAP465-THANG 4 - SO 2 - 2018 Dai thao du'dnq tvp2
Hut thuoc ia Nghien ru'du Tien SLT ddt quy nao
5(22,7%) 8(36,4%) 7(31,8%) 10(45,5%)
3 (18,8%) 7 (43,8%) 6 (37,5%) 8 (50,0%)
2 (16,7%) 6 (50,0%) 3 (25,0%) 6 (50,0%)
p>0,05 p>0,05 p>0,05 p>0,05 Nhan xit: Nam gidl, tuoi tff 60 trd ten, tang
huyet ap, rot loan lipid mau, hut thudc la la cac ygu t d nguy cd ro ret vdi dot quy nao. Nhan xet nay cung phu hdp vdi nghien effu eua Nguyen Hong Ngpc [4] va Nguyen Van Dang [5]. Tuy nhien, xet moi lien quan giffa cae yeu td nguy cd vdi mffc dp hep tac do v i j ^ xd dpng maeh eanh, diung toi nhan thay chi rot loan chuyen hda lipid CO mdi lien quan co y nghTa tiiong ke (p < 0,05) v&\ cac mffc dp hep dpng mach canh doan ngoai sp. Nhan xet nay cung phu hdp vdi Nguyen C6ng Hoan [2], Salonen [6]. Khac vdi nghien cffu cua Whisnant va cs, hut thudc la la yeu t d lien quan manh nhat vdi vffa xd nang dpng mach eanh doan ngoai sp [7]. Nghien cffu cua chung toi cting phii hdp vdi nghien cffu nu'dc ngoai khi cho rang dai thao dffdng va tang huyet ap la hai yeu t d ddc lap vdi nhoi mau nao COvucixdmach [6].
V. KFT LUAN
Co Sff lien quan cd y nghTa thong ke (p <
0,05) giu^ roi loan chuyen hoa lipid mau, mffc dp lam sang, mffc dp roi loan y thffc, mffc dp liet, dac diem nhoi mau tren hinh anh cat Idp vi b'nh va/ hoac cpng hudng tff sp nao vdi cac mffc dp hep maeh eanh doan ngoai sp do mang vu^ xd.
Khong cd mdi lien quan cd y nghTa thdng ke giij^ tuoi, tang huyet ap, dai thao dffdng, hut thuoc la, uong rffdu, tien sff tai bien mach mau
nao thoang qua va dot quy nao vdi mffc dp hep dpng mach canh do vCici xd d benh nhan nhoi mau nao.
TAI UEU THAIVl KHAO
1. Fernandes M., Keerthiraj B., Mahale A. R. et al (2016), Evaluation of carotid arteries in stroke patients using color Doppler sonography: A prospective study conducted in a tertiary eare hospital in South India. Int J Appl Basic Med Res, 6 (1), 3g.-44.
2. Nguyen Cong Hoan (2008), Nghien cffu dac diem lam sang, hinh anh hoc eua nhoi mau nao do vffa xP he dong mach canh trong. Tap chf Nghien cuu Yhoc. 63f41, 60-65.
3. Seth S. K., Solanki R. 5.. Guota H. f2005).
Color and Duplex DoDDler imaaina evaluation of extracranial carotid arten/ in patients oresentina with transient ischemic attack and stroke: A dinical and radiological correlation. Indian J Radiol Imagiiig ;15:91-8.
4. Nguyen Hoang Ngoc (2002)^ Nghien cuU thUc trang hep dong mach canh d benh nhin nhdi miu nio va heq dgng mach canh khong trieu chiihg bing siiu im Doppler, Luan an Tien sT Y hpc, Hpc vien Qyan Y.
5. Nguyen Van Dang (2003), " Tai bien mach miu nad", Nha xuat ban Y hoc Ha Noi, tr 13-61.
6. Salonen J. T., Seppanen R. (1989): Risk factors for carotid atherosclerosis: the Kuopio ischemic heart disease risk factor study, Ann Med (21), pp 227- 229.
7. Whisnant 1. P., Homer D., Ingall T. J., et al (1990), Duration of cigarette smoking is strongest predictor of severe extracranial carotid artery atherosclerosis. Stroke, 21:707-14.
GIA TRI PHirCXNG PHAP NOI SOI PHONG DAI CO NHUOM MAU INDIGO CARMINE TRONG CHAN D O A N POLYP DAI TRlfc T R A N G
Ph^m Binh Nguyfin', Vu Trirdng Khanh', Dao Van Long^
TOM TAT
Muc tieu: Nghien cffu cjia tn chan doan eiia ky thuat not sol phonq dai nhuom mau (NSPDNM) indigo carmin trong mo ta d§c diem va phan biet polyp dai tn/c trSng tang sinh (neoplastic polyp) - khong t§ng
'iCioa Wu Hda, Binh vlgn Bach Mai 'Trudng Dal hoc YHi Ndi
Chju tr^ch nhiem ehinh: Pham Binh Nguyen Email: [email protected] Ngay nh|n bai:
Ngay ph^n bi^n khoa hoc;
Ngay duy^t bai:
sinh (nonneoplatic polyp). Phu'dng phap: Tong so 200 benh nhan v6i 237 polyps DTT, da dUdc npi soi tff 5/2016 - 12/2017. Polyp phat hien bang ong noi soi thu'dng se du'dc nhupm mau indigo carmin 0,2%, roi sff dyng ong no! soi phong^dai ehup anh vdi dp phong dai xlOO lan. Hinh thai lo mem mac quan sat tren phim NSPDNM du'dc ehia theo phan loai Kudo thanh 5 tuyp: I, I I , III (IIIL va Ills), IV va V. Ooi ehieu ket qua phan loai hinh thai lo niem mac vdi ket qua mo benh hoc sau sinh thiet polyp. Ket qua: 192 polyp tang sinh (167 polyp u tuyen va 25 polyp ung thd). Do nhay, do dae hieu va do chi'nh xac cua ehan doaii polyp tang sinh la 96,4, 88,3% va 94.9%. Ket luan:
Npi sol phong dai eo nhupm mau indigo carmin la mot
