TINH TRANG DINH DU8NG CUA BENH NHAN NUOI D I A N G B A N G ONG THONG DA DAY TAI CAC KHOA LAM SANG BENH VIEN BACH MAI
T6M TAT
Nghidn cdu tidn hinh trdn 48 bdnh nhin (BN) ed chl djnh chim sdc nudi dudng bing ing thdng dg diy td 01/6/2010 din 31/12/2010 tai Khoa Cip cdu, Diiu W tich cue vi Tmng tim Chdng ddc - B$nh vien Bgch Mai Bing phugng phip nghidn cuu trudng hgp cic BN nudi dudng qua 6ng thdng dg diy, kit qui cho thdy: Dinh dudng sd dijng cho BN phin ldn ii thde in ehi bidn sin (91,7%). Su dung ngp eda BN in qua dng thdng khi cao, chiim 93,7% vi it gip cic tie dgng phij trong qui trinh nudi dudng. Ty le BN sd dgng thdc Sn ti/ niu phii tmyen dlnh dudng dnh mgch cao gdp ban 2 lan so vdi nhdm sd dung thdc in chd biin sin. Tjf 1$ BN sd dung thdc Sn ehe bidn sdn cd ndng dd Protein vi Albumin miu dat ngudng blnh thudng ehldm 68,2% eao han so vCn BN sd dgng thdc in tu niu (25%). BN cd Pmteln vi Albumin miu giim phii ddng dinh dudng dudng tfnh mgch chiim tf Id eao 76,47% so vdi nhdm cd ndng dd dgt d ngudng binh thudng 19,35% vdi p<0,05. O nhdm BN sd dijng thdc Sn tu niu, cdn ning khi ra vidn giim cd ^ nghia so vdi lOc nim vidn (p<0,05).
Ngudi nhi BN su dgng thdc Sn tu ndu ndn dugc tu van bdl ehuyin gia dinh dudng tgi bdnh viin.
Tie khda: Bdnh nhin, nudi du&ig bing dng thdng dg diy, dinh dudng tTnh mgch.
SUMMARY
NUTRITIONAL CONDITION OF PATIENTS WITH GASTRIC TUBE FEEDING AT CLINICAL DEPARTMENTS OF BACH MAI HOSPITAL
The study wes conducted on 48 pgtients who wem fed by gastric tube fmm 01/6/2010 to 31/12/2010 at the Emergency Depariment, Intensive Care Unit and Poison control Centers - Bach Mai Hospital. By the ease study method, tfie results showed that nutrition for patients was mosOy processed food (91.7%). Good hod tolemnee of patient was 93.7% and them wem less unexpected effects in the nutrition pmcess. The percentage of Intmvenous nutrition in the gmup of patients using the home-cooked meals was over 2 times mom than the gmup of patients fed by processed food. The percentage of patients using processed foods having normal pmteln and albumin concentmtlon (68.2%) was higher than the gmup of patients using home-cooked meals (25%). Intmvenous nutriUon of the group of patients with decmased Mtiumin, Protein (76.47%) was higher than the gmup having normal levels of Albumin, Protein (19.35%) with p<0.05. In the gmup of patients using home-cooked meels, weight at the time of leaving hospital significantiy decmased compered with time In the
LE THj H A N G , Benh vi^n B^ch Mai L £ TH! BINH. Hpc Wen YDHCT Viet Nam hospital (p<0.05). The caregivers of patients who use home-crxiked food should be counseled by a dietician at the hospital.
Keywords: patients, fed by gastric tube, intmvenous nutrition.
D A T V A N D £
Chdm sflc dinh du-dng eho bfinh nhdn (BN) Id mdt trong nhdng nhifim vy cua ngu-di difiu dydng d tgi bfinh vifin cQng nhy d cpng dong. Dinh du-dng cfl vai trfl quan trpng ddi vdi c a the con ngudi. Nhd dinh dudng tdt ea the mdi tdn tgi, phdt trien vd ed kha nang chdng dfl' vdi cde yfiu td bat Ip-i xung quanh. Ddi vdi bfinh nhdn hfln mfi, vfin dfi dlnh du-dng Igi edng trd nfin quan trpng han bao gid hfit vt nfl khflng chi dflng vai trfl duy trl ndng lu-gmg eho s y sdng md dfli khi cfln quyfit ^ n h s y thdnh cflng hay thfit bgi cQa difiu trj [1]. Cdc bifin phdp difiu trj nhu- thudc, k? thudt can thifip eOng khdng the thifiu dinh dydng dfi duy trt s y sdng cho c a thfi. VI vdy, dinh du-dng tdt eho ngu-di bfinh dfi ndng eao hifiu qufi chda bfinh, gidm di nhdng bifin chdng vd ty Ifi t d vong, giam ngdy n l m difiu trj tgi bfinh vifin, gidm chi phi tdn kfim cho ngu-di dm Id edng vific thifit yfiu hdng ngdy [2].
Trong cdc khoa ehdm sde ddc bifit, dinh du-dng rfit quan trpng, giup cho bfinh nhdn sdm thodt khdi tinh trgng nguy kjch hodc lofit myc, nhanh bd mdy thd [3]. Do dgc difim cOa nhdng bfinh nhfin nfing khflng Sn dupc du-dng mifing, vific nufli dudng nhy thfi ndo dfi cfl hifiu qud t d ldu nay dd trd thdnh vfin dfi cfip thifit. Nghifin cdu vific nufli du-fi'ng bfinh nhdn dn bfing dng thdng dg ddy tgi cdc Khoa Hdi sdc tieh eye, Khoa Cfip cdu vd Trung tdm Chdng dfie, nai cfl nhifiu bfinh nhfin n$ng cfin dupc hd trp- id rfit quan trpng vd cfin thifit. Chinh vi nhdng ij/ do trfin, chQng tfli tifin hdnh de tdi nghifin cdu vdi myc tifiu: Mfl td tinh trgng dinh d y d n g d b^nh nhdn d i r g v nufli du-dng bdng dng thdng da ddy tai cdc khoa ldm sdng B^nh vifin Bach Mai.
PHUONG P H A P NGHIEN CLTU 1. Ddl tu'ang nghifin c d u 1.1. Tidu chuin chqn benh nhin Tfit ca bfinh nhdn d Khoa Cfip cdu, Khoa Hdi sdc tich eye vd Tmng tdm ehdng dfic - Bfinh vifin Bgch Mai t d 01/6/2010 dfin 31/12/2010 thda mdn ede difiu kifin sau:
- Dyp-c chl dinh nufli dudng bfing dng thflng dg ddy
- Thdi gian nufli dudng bfing dng thflng it nhfit Id 1 tufin.
- Bfinh nhdn hodc ngudi nhd bfinh nhdn ddng y tham gia nghifin cdu
Y Hpc THVC HANH (913) - S6 4/2014
1.2. Tiiu chain loaii b^nh nhin.
- Bfinh nhdn cfl kfim suy thdn, ddi thdo dydng, suy tim, suy gan.
- Bfinh nhdn t d vong trong qud trinh nghifin cdu.
2. Thifit kfi nghifin c d u : Theo phuang phdp nghifin edu trydng hp'p
3. Ky thuat chpn m l u : Chpn m l u todn bfi cdc tm-dng hpp cfl d i i ffinh nufli du-dng bfing dng thdng dg ddy. ChQng tfli lya ehpn d y a c 48 bfinh nhdn thoa mdn cdc dieu kifin vd ddng y tham gia nghifin cdu.
4. Cdc bifin s 6 nghifin c d u
- Dde difim cua ddi typng nghifin cdu: Tudi, gidi, dde difim bfinh ly, thdi gian ndm vifin
- Cdc dgng thde dn: Thde dn che bien s i n , thdc dn t y nfiu vd san phfim dinh dydng tTnh mgch nhy:
Glucose 20%, Aminoplasmal-hepa 10%, Albumin human, Alvesin, Lipofundin 10%. Bac sT dya vdo kfit qua xfit nghifim Protein vd Albumin mdu d i chi c^nh chfi phfim dOng tmyfin thfim vao du-dng tTnh mach.
Bfinh nhdn dn bang dng thdng ea thdc an chfi bien s i n hay t y nau deu cho drf 6 bda/ngay vd ndng lypng du-ac quy ddi ra Id 1900 Kealo/ngdy [4], [5].
- Tinh trang eai thifin sdc khoe du-p-c ddnh gid bfing cdn ndng. Protein vd Albumin mdu, tinh trang phQ. Trong dfl.
Protein £ 65g/l vd Albumin ^ 35g/l : Dat ngydng binh thudng
Protein < 65gfl vd Albumin <35g/i : Chya dgt ngydng blnh thu-dng
5. T h u t h d p s d l i ^ u :
- Bfl Cdu hoi phdng vfin: Phifiu ffieu tra vfi bfinh nhdn; Phifiu difiu tra cflng tdc ghi chep cua difiu dydng vifin.
- Protocol thyc hdnh chdm sflc nufli du-dng bfinh nhdn dn bfing dng thflng
6. Xfr ly s 6 li#u: S y dung test thdng kfi smh hpc, phdn tich s6 lifiu bfing ptifin mfim SPSS 16.0. Cdc b i ^ ^ n h tinh dugc mfl ta d y f l i dgng phfin trdm. Cdc bien dinh t u - ^ g d y p ^ mfi ta du-di dgng tmng btnh ± dfi lfich. So sdnh s y khdc bifit vfi cdc bifin dinh tinh cua 2 hay nhifiu nhflm bfing test x ^ mdc y nghTa Id p<0,05.
7. Dao d d c nghifin c d u : Nghifin cdu tudn thu cac yeu cfiu dgo ddc trong nghifin cdu y sinh hoe.
K t T QUA
1 Dac difim dfii t u w n g nghifin c d u Ddi typ-ng nghien edu cfl dfi tu& > 60 chifim 54.2%, Ida tudi t d 40 - 60 ehi chifim 18,8% vd Ida tudi < 40 tudi Id 27%, trong dd nam gidi ehifim chQ yeu 72,92%. Sd bfinh nhdn cd thdi gian nfim vifin td 8-14 ngdy chifim 31,2%; 15-21 ngdy ehifim 29,2?^>
21 ngdy chifim ty lfi khd cao 39,6%. Dde difim lifinh \y cua bfinh nhdn dn bang dng thdng: xufit huyfit ndo, nhdi mdu ndo, viem nao Id 41,7%; Bj ngfi dfic vd rfin cdn Id 22,9; Bi vifim phdi tfic nghen vd bfinh phfii Id 29,2% vd cdc bfinh khac Id 6,3%.
2. Tinh trang dinh du'fl'ng d bfinh nhan du-^c nufli dU'O'ng bfing dng thong dg ddy s d dung cdc dang t h d c dn khdc nhau
TA c h ^ bi^n sa TA t y nau (6 b n ( 6 L.a-
bu'a = 1900K
" ^ 91.7 900Kcaio)
=alo) BiSu dd 1. Phdn b6 cac d^ng thdc kn du^c sd dvng trong nuoi diro-ng b|nh nhan bing dng thdng d? diy Phfin Idn bfinh nhan dn thde dn chfi bifin sSn ehifim 91,7%, ehi cfl 8,3% dyp-e nufli dudng bfing thde d n t y nfiu.
Bdng 1 • Phan bd cde loai dinh dudng tTnh mach s d dung eho cdc nhdm bfinh nhdn linh du-fi'ng tTnh mgch
Bfinh nhfin ^ an bing fing thong dg
Albumin human 50ml (40 Kcalo)
Aminoplasmal hepa 10%
(400 Kcal/L)
Glucose 20%
(400 Kcal/L)
Lipofundin 10%
(1058 Kcal/L) Alvesin (370 Kcalo/L) Nhfim An TA chfi bifin s§n
(n=44) 8(18.2%) 2(4,5%) 5(11,4%) 3(6,8%)
Nhfim dn TA ty n^u (n=4) 2(50,0%) 1(25%) 1(25%) 1(25%)
Kfit qua nghien cQ-u cho thfiy BN an thdc dn t y nfiu se phai tmyfin dinh du-dng tTnh mgch (TM) vdi tJ Ifi cao gfip han 2 Ifin so vdi s d dung thdc dn chfi bifin san (100% vd 20,5% Albumin human, 50% vd 18,2%
Aminoplasmal hepa, 25,0% vd 4,5% Glucose, 25,0% vd 11,4% Lipofundin, 25,0% vd 6,8% Alvesin).
Bang 2: Su- thay ddl protein vd albumin mdu d cdc nhflm bfinh nhdn Nong ao
Dang thu'c Sn — • — ^ ^ ^ _ _ ^ sit dyng Protein va Albumin mSu — ^ ^ _
Chira dat nqiranq binh thifjrnq Cn=17) Dat nqiro'nq binh thir&nq (n=31)
TA ch6 bi^n s§n (N = 44) 14 30
Tvl«
31,8%
68.2%
TA t i ; nSu ( N = 4) S6 iirgnq
3 1
Tvl«
76.0%
25.0%
P 0.05
<0.05 Trong nhflm s d dyng thde dn chfi bifin sSn, ty Ifi
bfinh nhdn cd ndng dfi Protein vd Albumin mdu dat ngydng binh thudng chiem 68,2% han gfip hai ifin so vdi ty Ifi BN cfl ndng dfi Protein vd Albumin mdu giam (31,8%). Kfit qua cung chi ro ty le Protein vd Albumin giam chiem ty lfi eao d nhflm s d dung thdc
an tu' nfiu (75%).
Bfinh nhdn cfl Protein vd Albumin mdu gidm phfii dCing dinh dudng dydng tTnh mgch ehifim tJ Ifi cao 76,47% (13/17 BN) so vdi nhflm ed ndng dO d9t b ngydng blnh thudng 19,35% (6/31 BN). Sy khdc bifit cfl y nghTa thdng kfi vdi p<0,05.
Y HOC THUC HANH (913) - SO 4/2014
Bdng 3: S y thay ddi cdn ndng cOa cdc nhflm bfinh nhdn
Dgng T A a d dung l TA chfi bifin sSn I TAtyndu Cftnnanfl I ( N = 44) | ( N = 4 )
cnamv can nSng lOc ndm vifin
ttoX X t S D l Cdn n^ngjpcra vifin
tfcfl»X±SDl
55,10 ±4,7
P I >0.05 I < 0 . M , Bfing 3 cho thfiy cdn ndng tmng btnh IQe nfim vifin d nhflm dn thdc dn t y nfiu vd thdc dn chfi bifin s i n Ifin lypt Id 51.6215.09 vd 54,48 ± 7,357 kg. Nhd chfi dd fin hgrp 1^, d nhflm bfinh nhfin dn thdc dn chfi bifin sSn cfl cdn ndng tdng Ifin IQe ra vifin Id 55,10 ± 4,7 kg, tuy nhifin s y khdc bifit khflng cd y nghTa thdng kfi (p>0,05). Tuy nhifin d nhdm bfinh nhdn dn thdc dn t y nfiu, cdn n$ng khi ra vifin gidm cdn 49.76 ± 4,28 kg, 80 vdi IQe nfim vifin, s y khdc bifit cd j/ nghla thdng kfi vdi p<0,05.
Bl^u 66 2. Tinh tr^ng phu cua b^nh nhan du'9'c nuoi du<d>ng bing fing thong d? day Khi vdo vifin xufit hifin phQ chifim tJ ifi 8,3%, Khflng cfl BN ndo khi ra vifin bj phCi.
Sy dung ngp cQa BN dn qua dng thflng Id khd cao, chifim 93,7% khflng bj nhifiu cdc tdc dyng khflng mong mudn trong qud trinh nudi dudng. Tuy nhifin, vfin cfln cfl BN bj rdi logn tifiu hda ehifim t^ lfi thfip nhy tinh trgng chydng byng 1/48 (2,1%), ta long 2/48 (4.1%).
BAN LUAN
1. D$c difim cDa ddi tuvng nghifin cdu Qua nghifin cdu 48 trydng hgp bfinh nhfin dyprc nufli dydng bfing dng thdng dg dgy tgi ede Khoa Idm sdng bfinh vifin Bgch Mai, ty Ifi BN cfl nhflm tudi > 60 tufii chifim trfin 50% vd t^ Ifi thfip nhfit chu-a tdi 20%
thudc nhdm tudi < 40 tudi. Difiu ndy cQng phO hprp vfi mdt sinh ly bdi tudi eao thu-dng mdc nhifiu bfinh mgn tinh, thfi trgng yfiu, bfinh ly ndng vd vific nufli dydng sfi vfit vd khfl khdn han [6]. Kfit qud ndy cOng tuxrng ty nhu trong nghifin cdu cQa Lfi Thj Blnh ndm 2005 trfin 49 bfinh nhdn dn bfing dng thflng eho thfiy cQng g$p nhifiu khd khdn khi nudi dydng nhdm bfinh nhdn tufii cao bdi khd ndng hfip tfiu kfim dfin dfin hdi phyc bfinh chfim han \2]. Nhdng bfinh nhdn ndy do ttnh trgng bfinh I? nfin bj n$ng, s y tifiu hao ndng lyp-ng nhifiu sfi cdng khfl khdn trong ehdm sdc dinh du-dng hon ddi tuvng bfinh ly khdc. Da sd ede bfinh nhdn
wfim phdi t i c nghen dfiu Id nhdng ngydi cd tudi vd cd tifin s d mfic cdc bfinh ly vfi hd hip mgn tinh tnrdc dd hen phfi qudn. vifim phfi quan mdn. Nhdng bfinh nhdn mfic cdc bfinh man tinh trong thflri gian ddi thu-flmg ed van dfi dinh dirflrng do dfl nudi d y d n g hp se khfl khdn hon d nhdng t>finh nhdn chl dom thufin bfinh cfip tinh [7].
2. Tinh trang s d v khde d cdc nhdm b$nh nhdn dtpoc nuoi d i r d n g bfing dng thdng dg ddy s£r dung cdc dgng t h d c an khdc nhau
Cdc nghifin cdu cho thfiy cdc chat dmh dudng cfin s d dyng d i o ngydi binh t h u d r ^ nhu-: protein, lipit, glucid, wtamin vd chfit khodng cdng cfin tdng han khi tH bfinh [8]. Bieu dd 1 cho thfiy, phfin Idn t)finh nhfin dn tilde dn chfi bifin sdn, ehifim 91,7%. Difiu ndy cfl thfi do cdc logi l}pt dinh du'dng duoc phd bien rflng rdi, dfi mua, dfi s d dyng vd dam bdo ndng lyprng cQng nhu- cdc vitamin cho bfinh nhan. Tuy nhifin nhuprc difim cQa cdc logi tilde dn d i d bifin sdn Id dfit tifin nfin bfinh nhan nghfio khfl cfl difiu kifin tifip cdn.
Hai logi dinh du-dng du-dng tinh mgch tiiudng dQng Id Albumin human vd Aminoplasma (bdng 1). TT Ifi bfinh nhdn dQng thdc dn t y nfiu phai s d dgng dinh dudng tTnh mgch dQng kfim cao han so vflri bfinh nhan dung thdc dn ehe bifin sSn do s y hfip tiiy logi thdc dn t y nfiu kfim han.
S y cung cap ndng luprng cQng nhif cdc chfit dinh dudng cOa cdc logi djeh tmyfin tTnh mgeh khflng hfing dinh vd t u } thuflc vdo tinh hinh Ifim sdng cQng nhu- xfit nghifim eg thfi cQa bfinh nhdn d thdi difim dfl. Cdc djeh tnjyfin thudng dflng vai trfl bd sung cdc chfit difin giai, du-dng vd cfl thfi ldm tdng protein mdu.
Bdng 1 cho thfiy d hai nhflm bfinh nhdn dn thde dn t y nfiu vd thdc dn chfi bifin sSn dfiu cfl mfit sd bfinh nhdn duvc tmyfin tTnh mgch cdc chfit nudi dudng nhu- dung djch Albumin, dung djeh dgm hay dung djeh nhQ Lipid. Do nhflm bfinh nhfin s d dgng thde dn t y nfiu cfl cdn nfing khflng ddm bdo, phQ dinh dydng, gidm ndng dfi Albumin mdu nfin ti Ifi bfinh nhdn dupe tmyfin chfit dinh du-dng du-dng tTnh mgeh eao han (100% bfinh nhdn phdi tmyfin thfim dung djch Albumin) (bang 1).
Protein dfic bifit Id Albumin mdu phdn dnh chinh xdc khd ndng eung cfip Protein cua chfi dfi dn.
Protein ddng vai trfl quan trpng trong vific hdi phyc cdc tdn thu'ang vd tdng hp'p cdc men [9]. Kfit qud Bang 2 chi rfl d nhflm dn thdc dn t y nfiu cfl fi Ifi BN giam Protein vd Albumin mdu nhifiu han so vdi nhflm dn thde dn chfi bifin s i n (75% vd 31,8%), s y khdc bifit cfl y nghTa tiidng kfi, vdi p<0,05. Bfinh nhdn cd Protein vd Albumin mdu giam phdi diing dinh dudng dudng tTnh mgch diifim ty Ifi cao so vdi nhdm khflng giam (76.47% so vflri 19,35%).
Nhflm BN dn thdc dn t y chfi bifin cd cdn ndng giam khi ra vifin (p<0,05). Difiu ndy cfl thfi ly gidi do thdc dn t y chfi bifin cfl du vfi \ugng nhyng ed thfi ti Ifi thdnh phfin dinh dudng gida cde chfit cdn chua ehufin chfit lyp'ng vdn khflng dam bao finh hudng khflng tdt dfin ndng dfi Albumin vd Protein trong mdu
Y Hpc THUC HANH (913) - S6 4/2014
vd cdn n$ng lijc ra vifin n h u kfit qua tai bang Tuy nhifin vt sd lucmg BN dn tiidc dn t y nfiu trong nghifin cdu chQng tfli cdn it nfin cfin cd nghifin cdu vflri s6 luvng BN Idn hon dfi cd kfit lufin chinh xdc hon. Bfin cgnh dd. hgn chfi trong nghifin cdu td chi dp dyng d u v c mfit sd ehi tifiu trong ddnh gid tinh trgng dinh dudng todn tiifi (SGA) hogc phuang phdp ddnh gid tdi thifiu (MNA) dang d u v c dp dyng rflng rdi trfin tiifi gidi hifin nay.
K£TLUAN
Bfinh nhdn dupre nudi dudng bfing dng thdng dg ddy tgi cdc Khoa ldm sdng bfinh vifin Bgch Mai phfin Idn trfin 60 tudi vdi tinh trgng bfinh ndng, hfln mfi.
Dinh dudng s d dyng cho bfinh nhan phfin Idn Id thdc dn chfi bifin s i n (91.7%). S y dung nap cQa BN dn qua dng tiidng Id khd cao, chifim 93,7%, khdng bj nhifiu cdc tdc dgng phy trong qud trtnh ngdi dudng.
Nhflm bfinh nhdn s d dyng thdc dn t y nfiu cd nflng dfi Protein vd Albumin mdu dat ngudng blnh thudng chifim ty Ifi thfip, phai fauyfin dinh du-dng tTnh mach gfip han 2 Ifin so vdi nhflm s d dung thdc dn chfi bifin s i n vd cd cdn ndng giam khi ra vifin (p<0,05).
Bfinh nhdn cfl Protein vd Albumin mdu gidm phai dQng dinh dudng dudng tTnh mgeh ehifim ty Ifi eao
76.47% so v d i nhdm cd ndng dd dgt d ngudng btnh thuflrng 19.35% vdi p<0,05.
Ngudi rtfid bfinh nhdn s d dyng thdc dn t y nfiu nfin ducrc tir vfin bdi chuyfin gia dlnh duflrng tai bfinh vifin.
T A I U $ U THAM KHAO
1. Nguyin Dgt Anh, Didu dudng Hdi sdc cap cdu, Bp y tfi, Nhd xufit ban giao dye, Hd Nfli 2010, tr. 210
2. Lfi Tlij Binh, Ddnh gid tinh trgng dinh dudng vd chdm sflc ngudi bfinh an bdng dng thflng dg ddy, Tgp chi Y hpc thyc hdnh, 2005, sd 4, tr. 21
3. Vu Vdn Dinh, Cap cdu ngd ddc, Cam nang dp cuv, Nhd xufit ban Y hpc. Ha Npi 2000, tr. 340-407.
4. Vu Vdn Dinh, Dinh dudng lifiu phap. S^ch cfim nang cfip cdu npi khoa. NXB Y hpe Ha Npi 1996, tr 88 - 102
5. Stanfied.P.S., Nutrition and diet Oiempy, l^redi, USA2005,pg. 1 9 6 - 2 2 6
6. Nguyin Khanh Trgch, Hgi ehdng kem hip thu, Nha xufit ban Y hpc, Hd Nfli 1994, tr. 283 - 288. .
7. Vifin dinh dudng, Chd dd in tmng mdt si b$nh thudng gip. Nha xufit ban Y hpc, Hd Nfli 2007, tr. 192.
8. Phgm Quy Tudng, Dinh duong va an toan ttwfc pham, Nhd xufit ban Gido dye 2008, Hd Nfli, tr. 54-56.
9. G. Reed, Enzyms en food pmcessing, 2"" edi.
New York, Academic press 2003, pp. 347 - 349.
M O T stf KINH NGHIEM KHI PH&U TICH NHANH XUYEN CUA DONG MACH NGl/CLimC
NGO DLTC Higp*, VO ANH MINH
*Kfioa Bdng- PhSu Thuit Tao Hinh, B$nh Vi^n Chiy Riy T6MTAT
Vgt da cin nhinh xuydn (perfomtor flap) dugc su dyng rdng rSl trdn thd gidi tmng thip nidn gdn diy.
Tgi Vidt Nam vgt da ein nhinh xuyen ndi chung vi vgt da cin nhinh xuydn cOa ddng mgch ngi/c lung (Thomcodorsal arterial perfomtor flap)n6i ridng vin chua dugc Ong dqng nhidu. Tmng thdi gian td nSm 2009 - 2013 Chung tdi dS dng dqng 32 vgt da cdn nhinh xuyin cda (^ng mgch ngue lung (NXDMNL) didu trj cho 32 binh nhin bj sgo co kio vdng nich do dl chdng bdng tai Viin Bdng Qudc Gia vi Khoa Bdng - Phiu Thudt Tgo Hinh Bdnh Vidn Chg Riy Kit qui sau md cie vgt da sdng tdt, ed 1 vgt da bj hogi td mdp vgt ddu xa, hogt ddng cOa khdp vai cii thidn tdt Qua qui trinh phiu thu$t chdng tdi mgnh dgn ndu Idn mdt sd kinh nghidm phiu tich vi liy vgt da cinNXDMNL.
Tir khda: Nhinh xuydn, ddng mgch nguc lung SUMMARY
SOME EXPERIENCES WHEN DISSECTION THE PERFORATING OF THORACODORSAL ARTERY
Perforator flap and thomcodorsal arterial perfomtor flap Is widely used in the worid recent years. Neverihelessin Vietnam both of thesehave never beenmore applications. During the period time
2009- 2013 we have 32 applications thomcodorsal arterial perfomtor flap to treat for 32 patients that have mtrat^abte scar caused by sequelae of bum at National Bums Institute and Bums - Plastic surgery department of Cho Ray Hospital. Mostly flaps alive very well post opemtlon, 1 flap was necmsis at the distal end, the activities of the shoulder joint Impmved well. Thmughoursurglcal pmcesswe forclbleraisedsome experiences in opemtlon and havest the ffaps.
Keywords: Thoracodorsal arterial perfomtor flap.
MpT S 6 VAN o e CAN LlfU t KHI P H A U TICH NXDMNL
Nh$n djnh nhinh xuyin trudv mo Nhdn dinh vi tri nhdnh xuyfin (NX) trfin da trudc md Id vific Idm cfin tiiifit vd khdng thfi thifiu, nfl giOp phfiu thufit vifin lya chgn d u v c cudng mgeh tdt, thifit kfi dgng vgt trudc mfi phO hprp vdi kich thudc vd vj trl tiiuang tfin. Hifin nay cd nhifiu phuang phdp khdc nhau dfi xdc dinh vj trl vd kich Uiudc cQa cdc NXtrfin ea thfi n h u sifiu dm Doppler, sifiu dm mdu, chyp mach mdu cfit Idp (computed tomagraphlc angiography) chyp mgch mdu xda nfin (DSA) (digital subtraction angiography), chyp cfing hydng t d mgch mdu (magnetic resonance angiography).
Y HOC THirc HANH (913) - SO 4/2014
