djch vg thi thyc td hidn nay edc BV ngodi cdng lap ddu t y ddnh gid Id hp chua duge coi trpng dOng muc vd ddi xO- binh dang nhu mpt dan vj cung i>ng djch vy KCB trong mdt hd thdng y t l thong nhit,
K £ T LUAN
1. Mang ludi bdnh vidn ngodi cdng Idp da t h i hidn duge vai trd rd ret trong cung e l p cdc djch vy chan dodn ky thudt cao, ddt tien nhu CT-Sean, MRI vd mdt sd djch vg 1dm sdng chuydn khoa sdu nhu can thidp tim m?ch, sinh san nhan tao t h i hidn t i l m ndng phdt triln v l mdt ky thudt vd cung Q-ng djch vu d khu vuc ngodi cdng lap. Ty trpng thu dung bdnh nhdn ea ngoai tru vd ndi trO d cdc BV ngodi cdng Idp chi chiem mdt ti trpng nhd trong tdng sd thu dung benh vidn tren todn qudc nhung da t h i hidn t i l m ndng trong tham gia vdo KCB cho cdc bdnh nhdn cd BHYT cQng vdi hd thdng y t l cdng Idp n l u cd mdt ca c h i ehi tra phCi hap
2. Vide tudn thu cdc quy djnh v l quy chd benh vidn vd hogt ddng chuydn mdn theo quy dinh cua cdc BV ngodi cdng lap cdn thilu thudng xuyen vd chua ddnh gid duac c h i t lugng thyc hidn quy che benh vien vd qudn ly hopt ddng chuydn mdn,
3 Vide qudn ly cdc bdnh vien ngodi cdng Idp ve thyc hidn hoat ddng chuydn mdn, ddm bdo chat lugng djch vu vd an todn bdnh nhdn rat han c h i Thieu cdng cu vd co che gidm sat viec thuc hien cdc c h i dd chuydn mdn tai cdc bdnh vipn ngodi cdng lap mdt cdch cd hieu qua.
KHUYEN NGHj
1. Xdy dyng cac vdn ban quy djnh lai vj tri vai trd cua y t l ngodi cdng lap trong he thdng y te trong dd eIn ey t h i hda cdc quy dinh, ca che phdi hgp giQa edc ea sd' y te ngoai cdng lap vd ca sd y t l cdng Idp mdt cdch binh ddng trong hoat ddng cung ung djch vy va phdt huy duac uu the cua tu'ng bdn trong hd
trg chuydn mdn ky thudt, chia se cung u'ng dich vu l l n nhau.
2, Tdng cudng cdc gidi phdp nhdm kilm soat chdt lugng djch vy d cdc bdnh vidn ngodi cdng Idp bdng cdch tdng cudng thyc hidn chdt che edc quy dinh ciing vdi vide hd tra ddo tao ndng cao nang lye chuydn mdn eho y t l ngodi cdng Idp, chu y cdc bi$n phdp tuydn truyin ndng cao h i l u biit cua ngudi su' dyng djch vu v l c h i t lugng djch vu cung nhu tao dieu kidn cho hp gidm sdt vd phdn hdi v l c h i t lugng dich vy,
3. Xdc dmh ey t h i trdeh nhi$m hodc d i l u kidn cho cdc bdnh vidn ngodi cdng Idp trong cung e l p cdc djch vy cdng hen quan tdi phdng bdnh, gidm sdt dich bdnh vd ndng cao sue khde cdng ddng vdi cdc quy dinh cy t h i vd ca che khuyin khich phu hgp.
T A I L I E U THAM K H A O
1. Bdo cao ddnh gid hogt dpng y t l tu nhan - Vy Dieu trj - BO Y te 2007.
2. Bdo cao dieu tra y t l qudc gia-2002; Bao cdo he thong y te Viet Nam 2006
3. Tdng quan he thong benh vien Viet Nam, NXB Y hpc, 2005,
4. Quyet djnh sd 1895/1997/QD-BYT ngdy 19 thang 09 nam 1997 cua Bp trudng Bd Y te ve Quy che benh vien
5 Quylt dmh 266/1988/QD-BYT v l quan ly benh vien 1988,
6, Quyet dinh so 24/2008/Qe-BYT ngay 11/07/2008 cua Bp Y t l ban hanh quy dmh ve to chuc va hoat dgng cua nha thudc benh vien,
7. Thdng tu- tien tich sd 11/2007/TTLT-BYT-BTC- BCT ngdy 31 thang 8 nam 2007 cua Lien Bg Y t l - Bp Tai chinh - Bp Cdng Thucng hudng d i n thyc hien quan ly nhd nudc ve gia thuoc du-ng cho ngudi va khdng duge ban cao han gid mem y i t
OANH GIA HIEU QUA LOG BETA2-MICRDGL0BULIN CUA PHI/imG PHAP THAM TACH SIEU LOC
NGUYeN HJJTU DUNG - Benh vien Bach Mai H O A N G TRUNG VINH, LE VI^T THANG - Benh vien 103.
TOM T A T
Nghien c&u hiiu qua loc beta2-microglobulin cOa 32 benh nhAn suy than man tinh loc mAu chu ky sw dung xen ke 2 tuan 1 lan thim tach sieu loc (qua loc cd h$ s6 IQC 55 ml/mmHg.h), so sAnh v&i 46 benh nhAn xen ke 2 tuan 1 lin sO dung quA loc cd he sd sidu loc cao (25,6 ml/mmHg.h) va 64 benh nhdn sw dung qua IQC C6 h$ sd sieu IQC thap (8,6 ml/mmHg.h), kh qua cho thiy nhdm tham tAch sidu IQC sau 1 cuoc loc ndng dd beta2-microgiobulin giam cd y nghTa so v&itnj^cloc (69,2 ± 17,3 mgA so v&i 21,8 ±6,9 mg/l), p< 0,001. Beta2-microglobulin nhdm nAy giAm nhiiu han cd y nghTa so v&i mOxi giam cua nhdm loc mAu
sw dung quA IQC hd sd sidu loc cao, p< 0,01. Sau 6 thAng beta2-microglobulin & nh&m thim tdch sieu IQC cung giAm nhiiu han so v&i nh&m bdnh nhan sw dung qui IQC cd he sd sidu loc cao (tw 69.2 ± 17,3 mg/l xudng cdn 32,4 ± 9,1 mg/l so v&i tir 64,8 ± 19,4 mg/lxudng 46,7± 12,8 mg/l), p<0,01
TCP khda: suy than man tinh. beta2-microglobulin, thim tdch sieu IQC.
SUMMARY
Studying on effects of beta2-microglobulin filtration of 32 chronic renal failure patients treating with maintenance hemodialysis using hemodiafiitration online with once per 2 weeks
Y HQC THV"C HANH (868) - SO 5/2013
(dialyzer with Kuf: 55ml/mmHg.h), compared with those of 46 hemodialysis patients using high-flux dialyzer once per 2 weeks (Kuf: 25.6 ml/mmHg.h) and of 64 patients using low-flux dialyzer (Kuf: 8.6 ml/mmHg.h), the result shows that after dialysis secsion serum beta2-microglobulin of hemodiafiitration online is significantly decreased compared with time before dialysis secsion (69.2 ± 17.3 mg/l versus 21.8 ± 6.9 mg/l), p< 0.001 Reduce level of beta2-microglobuiin of hemodiafiitration is much than that of hemodialysis using high-flux dialyzer, p< 0.01 After 6 months, reduce level of beta2-microglobulin of hemodiafiitration is also much than that of hemodialysis using high-flux dialyzer (from 69.2 ± 17.3 mgA down to 32.4 ± 9.1 mg/l compared with from 64 8 ± 19 4 mgA down to 46.7± 12.8mgA). p< 0 01
Keywords chronic renal failure, beta2- microglobulin, hemodiafiitration
DAT V A N D E
Thodi hod dang tmh bpt do tdng ndng dd beta2- microglobulin (B2M) Id bien chu-ng thud'ng gdp d' benh nhdn suy thdn man tinh giai doan cudi Ipc mdu chu ky Tuy idng dpng B2M khdng gdy tU' vong, nhung id nguydn nhdn dau khdp, dnh hudng d i n chuc ndng he vdn ddng. Hidn nay Ipc mdu bdng qud loc cd he so sieu Ipc thap vdn dang phd biln, Vdi sy phat then cua khoa hoe cdng nghe gan ddy da cd nhQ-ng mdng Ipc vdi hieu so sieu ipc cao cd the Ipc duac cdc chat cd trpng lupng phdn t u trung binh trong do cd B2M NhO'ng ndm gan ddy, phuang phdp tham tach sieu Ipc mau bu djch true t i l p tu' dich Ipc (Hemodiafiitration online) da duac dp dung, dat hieu qua tdt, cd tdc dung loai bd duge edc chat ed trong lugng phdn tiJ ca nhd, trung binh vd mdt sd cytokine, Tren the gidi cd nhieu de tdi nghien cii'u khdng djnh n l u su- dung qua loc cd mang tuang hap sinh hoe vdi he sd sieu loc cao kem tham tach sidu loc mdu se cd tdc dung giam ddng ke ndng dd B2M huyet thanh, Tuy nhien, cac de tdi nghien cuu trong nudc khao sdt bien ddi ndng dd B2M vd hieu qud cua phuang phdp tham tach sieu loc online de giam B2M chua duge d l cdp day du Vi vay chung tdi thyc hien de tdi nhdm muc tieu ddnh gid hieu qua loc B2M khi su' dyng xen ke t h i m tdeh sieu loc online sau mdt cudc Ipc vd sau 6 thdng
D 6 | T U ' P ' N G V A PHU'aNG P H A P NGHIEN CU'U 1. Ddi tugng nghien cuu
+ Ddi tuang nghidn ciru gdm 142 bdnh nhdn suy than man tinh dupe Ipe mdu bdng phuang phdp than nhdn tao chu ky tai Khoa Thdn nhdn tao, Bdnh vien Bach mai chia 1dm 3 nhdm cd thdi gian loc mdu, tudi, gidi, lieu Ipc mdu tuang duang nhau,
- Nhdm 1 (N1 )• 64 benh nhan Ipe mdu t u l n 3 idn thudng su dyng qua loc cd hd sd sidu loc thap vdi he so loc- 8,6 ml/mmHg h
- Nhdm 2 (N2): 46 benh nhan Ipc mau su dyng qua Ipc nhu nhdm 1, cd xen ke 2 tuan 1 lan su dung qua loc cd he sd Ipc 25,6ml/mmHg,h.
- Nhdm 3 (N3): 32 bdnh nhdn Ipc mdu si> dyng qud Ipc nhu nhdm 1, cd xen ke 2 t u l n 1 l l n thim tdeh sidu Ipc mdu vd'i qud Ipc ed hd sd Ipc:
55ml/mmHg,h.
+ Tidu chuIn lya chpn bdnh nhdn:
- Bdnh nhdn suy thdn mgn tinh giai doan cudi Ipc mdu chu k j .
- Thdi gian Ipc mdu chu ky & 3 thdng, - Nguydn nhdn gdy suy thdn mgn gdm : vidm clu thdn mgn, vidm thdn b l thdn man tinh, tdng huylt dp, ddi thdo dud'ng, lupus ban dd hd thdng,,.
- Tudi eua bdnh nhdn a 18,
- B$nh nhdn hgp tde, tham gia nghidn ei>u.
+ Tidu chuIn logi trd':
- Suy tim mdn tinh ndng - Suy gan ndng
- Mdc ung thu giai do^n cudi kdm theo.
- Dang mdc cdc benh cdp tinh nhu , nhidm khuin, nhdi mdu ea tim, suy tim cdp, ddt qui ndo, ,
- Khd khdn trong thuc hidn dud'ng vdo mgch mdu Idm anh hud'ng d i n chdt luang Ipe mdu
- Bdnh nhdn nghi ngd m l c bdnh ngoai khoa, hoac bdnh nhdn da ed can thidp phdu thudt trong 1 thdng,
- Khdng hgp tdc nghidn cu'u,
2. Npi dung vd phiro'ng phdp nghidn ciPU.
+ T i l n cuu, cdt ngang, md ta, so sdnh giOa cdc nhdm,
+ Benh nhan duoc khdm lam sdng. Idm cdc x6t nghiem can lam sdng ve huyet hoc vd sinh hda mau thudng qui
_+ Djnh lugng ndng dd B2M b i n g phuang phap midn dieh men vi hat
+ Thdi gian can thiep 6 thdng + L l y mdu djnh luang B2M, mdi thdng 1 lln + Tinh ty Id giam B2M sau mdi cudc Ipc (PR-B2M-
%) va he sd thanh thai B2M tung phIn sau mdi cudc Ipc (Kd-B2M- ml/phut),
+ X u ly sd lieu bdng phdn m I m SPSS xdc i^nh, gid tn trung binh, so sdnh gid trj trung binh, ty Id phln trdm
K^T QUA v A B A N L U A N
1. Hidu qud Ipc B2M sau m^t cudc Ipc cua p h u c n g phdp thdm tdeh sidu loc
Bang 1 So sdnh hieu qua Ipc B2M d cdc nhdm sau SU' dyng qua Ipe lan d I u
B2M (mg/l) Tru'oc IQC Sau Ipc
P N1(1).
{n=64) 66,04 ± 18,1 66.7 ±
16,5
>0,05 N2 (2), (n=46) 64,8 ± 19,4 47.8 ±
12,4
<0,01 N3 (3), (n=32) 69.2 ± 17.3 21.8 ±6,9
< 0,001 P pANOVA>
0,05 2&V<0,05 3&1,3&2<
0.01
- Sir dyng cdc loai mdng Ipc trong cdc phuffng phdp Ipc khdc nhau cho hidu qua Ipc B2M khdc nhau.
- Nhdm s u dyng qua Ipe thud'ng ndng dd B2M tdng nhp sau ipc, tuy nhidn so vd'i tnj'd'c Ipc khdng c6 s y khac bidt p> 0,05,
Y HQC THV'C HANH (868) - s 6 5/2013
- Nhdm si> dyng qua Ipc high-flux ndng dd B2M giam sau cudc Ipc ed J nghTa p< 0,01, so vdi nhdm qua Ipc thudng hidu qua loc B2M giam nhieu cd ^ nghTa p< 0,05.
- Nhdm su- dyng phuang phdp tham tdeh sidu Ipc online gidm B2M tdt nhit so vd'i trudc Ipe vd so vdi cdc nhdm khdc, p< 0,01.
Bdng 2: So sdnh hieu qud Ipc B2M d cdc nhdm sau su dyng edc qud loc lan d I u dua vdo chi sd PR- B2M
PR- B2M X±SD
(%)
Cao nhM Thap nhSt
N1.
(n=64) -9+12,2
5,12 -23,6
N2, (n=46) 37,3 ±8,8
53,2 14,8
N3, (n=32) 66,6 ±7,9
85,6 37,8
p ANOVA
<0,01
- Lugng B2M Idy ra khdi ca the sau mdi l l n Ipc mdu d nhdm dOng qua Ipc cd hd sd sidu Ipc thip Id khdng cd
- Nhdm Ipe theo phuang phdp t h i m tdeh sieu Ipc mau online cd muc l l y B2M ra khdi co t h i sau mdi cudc Ipe Id hidu qua nhit, p< 0,01
Bang 3: So sdnh hidu qua Ipe B2M d cae nhdm sau su- dung cdc qua loc l l n d I u dua vdo hd sd thanh thai B2M (Kd)
Kd- B2M (ml/phut) X±SD Cao nhat Thap nhdt
N1.
{n=64) 6,2 + 4,2
15,8 -3,7
N2, (n=46) 32,5 ±5,7 45,4 17,8
N3, (n=32) 52,4 ± 6.8 81.2 32,6
ANOVA P
<0.01
- He sd thanh thai B2M d' edc nhdm Id khac nhau, nhdm bdnh nhdn su dung phuang phdp tham tdeh sidu Ipc mdu cd he so thanh thai B2M cao nhat khde biet ed y nghTa thdng ke so vdi cdc nhdm khdc, p<
0,01,
2. B i l n ddi ndng dp B2M sau 6 thang can thiep didu trj d- nhdm nghien ciVu
Bang 4: Biln d l i ndng dd B2M sau 6 thdng d i l u tri Tho'i di^m
Trudc Ipc (TO) Sau 1 thanq Sau 2 thanq Sau 3 thanq (T3)
Sau 4 thanq Sau 5 thanq Sau 6 thanq (T6)
P N1(1).
(n=64) 66,04 ± 18,1 65.9 ±
12,3 66,5 ±
19,8 66,9 ±
16,7 67,6 ±
19.1 68,5 ±
18,2 68,5 ±
16,6 ANOVA
>0,05 N2 (2), (n=46) 64,8 ± 19,4 57,8 ±
17,8 56,3 ±
19,1 54,9 ±
16,4 52,1 ±
15.8 48,7 ±
16,2 46,7 ±
12,8 T6 &T3, T6&T0:
<0,05 N3, (3) (n=32) 69,2 ± 17,3 46.1 ±
16.3 44,6 ±
14,8 42,7 ±
12,4 40,8 ±
11,6 36,6 ±
10,0 32,4 ±9,1
T6&T3, T6&T0:
<0,01 p ANOVA
>0,05
<0.05
<0,05
<0,05
<0,05
<0,01
<0.01
Th{rigian(Th^ng) Bi^u ab 1: Bi^n thien ndng dp B2M trong 6 thang di^u trj
if cac nhdm b^nh nhan nghien cu'u - Nhdm benh nhan su dyng qua Ipc hd sd mdng sidu Ipc thap, ndng dd B2M tdng ttieo thdi gian.
- Nhdm bdnh nhdn su' dyng qua cd hd sd sidu Ipc thip xen ke vdi qua ed hd so sieu Ipc cao ndng dd B2M giam, sau 6 thdng gidm cd y nghTa p< 0,05,
- Nhdm bdnh nhdn thdm tdeh sidu loc mdu ndng dp B2M giam manh, d i n thdng thu' sdu ndng dd chi cdn 32,4 mg/l, p< 0,01.
- GiO'a cdc phdn nhdm tu'ng thdng deu ed sy giam khdc bidt giO'a nhdm tham tdeh sidu Ipc vd Ipc thudng sir dung qua loc he sd Ipc cao vd nhdm qua loc he so loc thip, p<0,05
B A N LUAN
Hieu qua loc B2M khi sw dung qua loc lin dau.
Chung tdi dmh luang ndng dp B2M trudc vd sau cudc loc d 142 benh nhan nghien ciju trong 3 nhdm can thidp vdi loai mang loc cd hd sd Ipc khde nhau.
Nhdm benh nhdn su" dung qua Ipc thudng eho thay ndng do B2M khdng giam tham chi cdn tang nhe sau eudc Ipc (66.04 ± 18.1 mg/l so vdi 66,7 ± 16.5 mg/l).
Su- dung qua loc ed he sd sieu loc cao giam duge ndng dp B2M sau cudc Ipc cd y nghTa vdi p< 0,01 (trudc Ipc la 64,8 ± 19,4 mg/l, sau loc la 47,8 ± 12,4 mg/l), Su dung phuang phdp tham tdeh sidu loc mdu vdi mdng loc ddc bidt giam ndng dd B2M nhilu nhat trudc vd sau cudc loc cd y nghTa vd'i p < 0,001 (69,2
± 17,3 mg/l so vdi 21,8 ± 6,9 mg/l). So sdnh muc giam B2M cua 3 loai qua Ipc chung tdi nhan t h i y ring SU" dyng phuang phdp t h i m tdeh sidu loc mdu mO-c dd giam B2M sau eudc loc tdt nhat, giam khdc biet so vdi nhdm benh nhan dung qua Ipc cd hd sd sidu Ipe cao, p< 0,05 vd duang nhidn so vdi qua loc he so sieu Ipc thdp mO-c giam B2M khdc biet rat Idn p <
0,001, Nhdm bdnh nhdn su' dung qua loc cd he so sidu Ipc thap sau cudc loc ndng dd B2M thdm chi cdn tdng mdt chut, dieu ndy Id hgp ly bdi sau cudc Ipc qua Ipe dd khdng lo_e dupe B2M ndn ndng dd cdn nguydn, mat khde mdi bdnh nhdn d I u thyc hien sidu Ipc vd'i khoi luang trung binh 2,7 kg nudc, nhu vay Idm t h i tich t u l n hodn se giam di, vd ndng dd B2IV1 ehi Id tdng tuang ddi sau cudc loc. Cung nhu ure vd ereatinin, chung tdi s u dung hidu qua Ipe B2M danh gid qua 2 thdng so ty Id giam B2M sau cudc loc PR- B2M vd he sd thanh thai B2M-Kd, Chung tdi nhdn thdy ty Id giam B2M sau cudc Ipc cQng nhu he s6
Y HQC THV'C HANH (868) - SO 5/2013
thanh thdi B2M sau cudc Ipc d nhdm bdnh nhdn s u dyng phuang phdp t h i m tdeh sidu Ipc mdu Id tdt nhit, cao han nhidu so vd'i nhdm s u dyng qud Ipe ed hp sd sidu Ipe cao, Nghidn cuu cua T r i n Kim Cuong ve mu-c dd giam B2M su- dyng qud Ipc ed hd sd sidu Ipc cao cOng trung vdi k i t qud d nhdm bdnh nhdn ehCing tdi su' dyng qua Ipc cd hd sd sidu Ipc cao.
Bang 5. Mdi lidn quan giO'a h§ sd sidu Ipc vdi khd ndng Ipc cdc c h i t
Piiucng thu'c IQC- Qua igc LQC mdu- qua Iqc cd he sd sieu IQC
th^p (Kuf. 8.6 mmHq.h) Lpc mdu-qua Ipc cd he s6 siSu Ipc
cap (Kuf 25.6 mmHg h) Thdm tdeh sifeu
Ipc m d u - SLP dgng qua Ipccd
he so sieu Ipc cao (Kuf 55
mmHg.h)
Co chd Ic^i bo chit tan Khudch tan, khdng ho^c cd
It ddi lu-u Khufech tdn kfet
hgp it ddi iu-u
D6I iuu v^
khulch t^n
Cdc chSt cd thd qua mdnq Ipc Thanh that hifiu qua cdc phdn ti> nho nhu' ure. ereatinin, axit
uric.
Thanh thai hieu qua cdc phdn \ir nhd nhu- ure, ereatinin, axit uric va phan li> trung
binh nhu B2M Thanh thai hieu qua cac phan tii nhd nhu
ure, ereatinin, axit uric va cac phan lij
trung binh. idn nhu' B2M. CRP, mOtsd
Cytokine Nhieu nghidn cuu nuOc ngodi d I u ddnh gid hidu qua loc B2M cua phuong phdp t h i m tdeh sidu Ipe mdu Lonnemann G vd cdng sy dd nghien cuu hieu qua Ipc B2M sii dyng qua Ipc cd hd sd sieu Ipe cao trong phuang phdp Ipc mdu thudng d 14 bdnh nhdn suy thdn man tinh lpc mdu chu ky, k i t qua cho thay su' dyng qu_a loc ndy se gidm dupe 30% ndng dd B2M sau mdi lan Ipe, ty Id ndy trong nghien cu'u eua Chung tdi Id 37,3% vd cua Trdn Kim Cuang id 31,2%.
Cdc nghien ciru deu khang dinh vai trd cua phuang phdp t h i m tach sidu Ipc mdu trong qud trinh Ipe sach B2M Penne EL vd cpng s y nghien cu'u bien ddi ndng dd B2M trudc vd sau su dung tham tach sidu loc mdu so sdnh vdi Ipc mdu su' dung qua Ipc cd he sd sieu Ipc cao a 230 bdnh nhan trong do cd 176 bdnh nhdn khdng cdn chuc ndng than tdn d u . K i t qua cho thiy sau 6 thdng can thidp ndng dd B2M giam t u 29,5
± 0.8 mg/i xudng cdn 24,3 ± 0.6 mg/l. ddc biet tdt eho nhung bdnh nhan khdng cd chu'c ndng thdn tdn du.
Biin ddi ndng dp B2f\A sau 6 thAng diiu tri: Chung tdi tien hdnh djnh lupng lai ndng dp B2M sau mdi thdng. K i t qua cho thdy ndng dd B2M mdu sau 6 thang can thiep giam so vd'i luc bdt d I u nghien cu'u d nhdm benh nhan Ipc mdu qua Ipe cd hd sd lpc cao vd nhdm benh nhan thdm tdeh sidu Ipe (p< 0,01 vd p<
0,001), mii'c giam B2M huylt thanh d nhdm t h i m tach sieu loc cung nhieu han cd y nghTa so vdi nhdm loc mau su dung qua loc he sd sieu Ipc cao, p< 0,01.
Dieu nay cho thay phuang phap tham tdeh sidu loc mang lai hieu qua Ipc B2M sau mdi lan Ipc vd ca Idu ddi, Nhin vao cac bieu do bien doi ndng dp B2M sau mdi thdng can thipp chiing ta thay rd mu'c dp giam B2M rd ret nhat d nhdm benh nhdn tham tdeh sidu Ipc sau mdi thdng. Danh gia hieu qua Ipc B2M eua
qud lpc cd hd s6 sidu lpc thdp trong nghidn cO-u ndy Id khdng cd. Bdnh nhdn ed tdng ndng dd B2M ti> khi b i t d I u vdo can thidp qua tCrng thdng vd ddn hit 6 thdng can thidp v I n khdng c6 s y cai thidn v l ndng s^
B2M, D i l u ndy ggi 9 cho cdc nhd Ipc mdu cdn sis dyng lo^i qud Ipc khdc d l Ipc B2M cho bdnh nhdn, Phdn nhdm cd dCing qud Ipe cd hd sd sidu Ipc cao loc mdu bdng phuong phdp binh thud'ng cd khd ndng IQC duge B2M. Ndng dd B2M huylt thanh d nhD-ng bdnfi nhdn trong phdn nhdm ndy gidm rd sau l l n Ipc d^u tidn vd ddc bi$t sau mdi 3 thdng. D i n h i t 6 thdng ndng dd B2M dd gidm ddng k l khdc bidt cd y nghTa so vdi trud'c can thidp, p < 0,05. Phdn nhdm bSnh nhdn dung thdm tdeh sidu Ipc vd'i qud Ipc cd hd s6 sidu Ipc cao thdy rd hidu qud Ipc B2M, sau 6 thdng*
ndng dd B2M dd gidm dupe khodng 50% so vdi ban ddu can thidp. Nhidu nghidn cQ-u trdn thd gidi cDng cho k i t qua tuong t y nghidn cO-u cua chung tdi, M$c dO ddnh gid Ipe sau mdi cudc Ipe phuang phdp thim tdeh sidu Ipc cho hieu qua Ipe B2M r i t cao, tuy nhlfin cQng nhu ure, ereatinin B2M vdn duge sdn sinh ra hdng ngdy trong ea t h i vd nd tdng san khi bdnh nhSn cd vidm, suy dinh dud'ng,..Chinh vi t h i sau 6 thdng can thidp, ndng dd B2M d* bdnh nhdn suy thdn mgn tinh Ipe mdu chu ky v I n khdng trd- lai binh thudng K i t qua nghidn ci>u cua ehiing tdi ggi y cdn su dyng phuang phdp thdm tdeh sidu Ipe xen kd vdi Ipc mdu thdng thudng d l giam ndng dd B2M huylt thanh cho bdnh nhdn,
K t T LUAN
Nghien cu'u hidu qua lpc B2M cua 32 bdnh nhdn suy thdn man tinh loc mdu chu ky si> dyng xen ke2 t u l n 1 l l n t h i m tdeh sieu Ipc mdu, so vdi 46 b$nh nhdn xen ke 2 t u l n 1 l l n dunq qua Ipc ed hd sd sifiu Ipc cao, chOng tdi rut ra mdt so nhdn xet sau:
+ Hipu qua sau 1 cudc lpc Nong dd B2M nhdm t h i m tdeh sidu Ipc mdu online Id 21,8 ± 6,9 mg/l, thip han cd y nghTa so tn/dc Ipc Id 69,2 ± 17,3 mg/l. p <
0,001. MO'C giam B2M khdc bidt so vd'i nhdm b$nh nhdn su' dyng Ipc thud'ng vd'i qua Ipe cd hd sd Ipc cao, p< 0,01.
+ Hidu qud Ipc sau 6 thdng: Ndng dd B2M gilm nhilu han so vd'i nhdm bdnh nhdn dung Ipc mdu sir dyng qua Ipc cd hd sd sidu Ipe cao (nhdm thim tdeh sidu Ipc tu' 69,2 ± 17,3 mg/l xudng cdn 32.4 ± 9,1 mg/l; nhdm Ipc mdu thud'ng qua Ipc h$ sd sidu Ipc cao t u 64.8 ± 19.4 mg/l xudng 46,7 ± 12,8 mg/l), p<0,01.
TAI LIEU THAM KHAO
1, TrIn Kim Cuang (2008), "Ddnh gid hidu qua lpc Beta2-Microglobulin vd hidu qua budi Ipc vdi mdng sidu Ipc cao d' bdnh nhdn suy than mgn chay th$n nhdn tao chu ky", Luan vdn cao hoc,
2, Amato A, et al. (2005), "Sequential hemofiftration hemodiafiftration technique: all in one", Contrib Nephrol, 149:115-20
3, Chun LL el al (2000), "On-line hemodiafiitration reduces prediaiysis p2 IWieroglobulin levels in chonic hemodialeysis patients", The 8th Asian pacific
Y H p c THV'C HANH (868) - SO 5/20)3
congress of Nephrology March, 26-30, p. 313, 4. Fry AC et al. (2007), "Relative importance of residual renal function and convection in determining beta-2-microglobulln levels in high-flux haemodialysis and on-line haemodiafiltration". Blood Purif, 25(3):295-302
5, Roumelioti Lonnemann G, Noviek D, Rubinstein M et al (2003), "A switch to high-flux helixone membranes reverses suppressed interferon-gamma production in patients on low-flux dialysis". Blood
Purif. 21(3):225-31.
6 Penne EL, van der Weerd NC, Blankestijn PJ et al (2010), "Role of residual kidney function and convective volume on change in beta2-mieroglobulin levels in hemodiafiitration patients", Clin J Am Soc Nephrol. 5(1):80-6.
7, Tiranathagul K et al. (2007), "Companson of middle-molecule clearance between convective control double high-flux hemodiafiitration and on-line hemodiafiitration", Int J Artif Organs, 30(12):1090-7
THUC TRANG DAI THAO DUT^G, ROI LOAN LIPID MAU 0 NGU0I CAO TUOI TAI HAI XA HUYEN VU BAN TINH NAM DjNH NAM 2011
NINH THj NHUNG - Bai hgc Y ThAi Binh MAI ANH DAO - Dai hoc Dieu dip&ng Nam Djnh
TOM T A T
Vidt Nam hidn dang la mdt qudc gia nghdo, trong khi cAc bdnh nhiem trung vd bdnh Idy nhiim cdn dang IA phd biin thi nay cdc b$nh cua mdt xA hdi cdng nghidp - bdnh khdng lay nhidm l^i cd xu hw&ng tBng cao v&i mdt tdc dd dAng lo ngai NgAy nay ty Id ngwai cao tudi tAng, tudi tho trung binh tAng kdo theo ty Id mic bdnh cDng tSng dAc biet la benh khdng nhidm trOng. I\^dt sd nghien cwu cho thiy & dd tudi trdn 60 thi (^ Id mic bdnh rit cao dAc bidt IA cAc bdnh man tinh. Tren mdt ngw&i cao tudi cd thi mic nhiiu bdnh khAc nhau nhw vOa dAi thAo dwang vu-a rdi loan lipid mAu vira cao huyit Ap...
Muc tidu: XAc djnh ty Id dAi thAo dw&ng va rdi loan lipid mau & ngwai cao tudi tai hai xa huyen Vu Ban, l^am Dinh nam 2011.
Phuxyng phAp nghien cu-u: thiit ki theo nghien CU'U dich td hoc md ta cd phAn tich qua mdt cudc diiu tra cit ngang.
Kit qua: Ty 1$ ngw&i cao tudi bi dAi thAo dw&ng la 7,1%. Ty Id ngw&i cao tuoi bi tang cholesterol la 16,4%. Ty Id ngwai cao tudi giam HDL-C la 11,7%.
TO khoa: thAo dw&ng, roi loan lipid mdu, ngw&i cao tudi
SUMMARY
Background: Vietnam is a poor country, while infections and infectious diseases are still popular, but now the disease of industrial society - non- communicable diseases tend to increasewith an alanning speed. Today proportion of elderly increases, the average life expectancy increases entail incidence also increased especially non- infectious diseases. Some studies show that at the age of 60, the incidence is very high especially chronic diseases. On an elderly person may have many different diseases such as diabetes has both dyslipidemia and hypertension...
To: Determine the rate of diabetes and dyslipidemia in the elderly in two communes Vu Ban
distnct. Nam Dinh province in 2011.
Materials and Methods design descriptive epidemiological study analyzed a cross-sectional survey.
Results: The rate of elderly people with diabetes IS 7.1%. Proportion of elderly people suffer from high cholesterol is 16.4%. Rate of the elderly decreased HDL-C was 11 7%.
Keywords: diabetes, dyslipidemia, elderly DAT VAN Dt
Viet Nam hidn dang Id mdt qudc gia ngheo, trong khi edc bdnh nhilm trung vd benh Idy nhidm cdn dang Id pho b i l n thi nay cac benh cua mdt xd hdi cdng nghiep - bdnh khdng idy nhidm lai ed xu hudng tdng cao vdi mdt toe dp dang lo ngai Trong khi dd, d nhieu dia phuang trong cd nudc khdng cd bac sy chuydn khoa ve ndi tiet vd rdi loan chuyin hda. Ve mat d y phdng, chung ta cung chua cd he thdng de phat hidn sdm vd ngdn ngu-a kha nang tien tdi benh dai thdo dudng d nhdm ngudi cd yeu td nguy ea cao.
Rdi loan lipid mdu cQng la mdt v I n de dang duac quan tam dac bidt hidn nay, Rdi loan lipid mdu la nguyen nhan hodc hau qua cua mdt sd bdnh man tinh nhu dai thao dudng, tdng huylt dp,
Ngdy nay ty Id ngudi cao tuoi tang, tuoi tho trung binh tang keo theo ty le mdc benh cung tdng dac biet Id benh khdng nhidm trung. Mdt sd nghidn cu'u cho thay d do tudi trdn 60 thi ty le mdc benh r i t cao ddc biet la cdc bdnh mdn tinh, Tren mdt ngudi cao tuoi ed t h i mac nhieu benh khdc nhau nhu vQ'a dai thdo dudng vira rdi loan lipid mdu vQ'a cao huylt dp.,,
D l ddnh gid ty Id mdc benh ddi thdo dudng vd tdng lipid mdu d ngudi cao tudi d- khu vue ndng thdn tinh Nam Djnh, ddng thdi tim hieu ve nhdn thuc cua ngudi ddn ve bpnh ddi thdo dudng d khu vyc ndy ehCing tdi t i l n hdnh nghidn cu'u de tdi ndy vdi myc tidu Xdc djnh ty' IS dAi thAo dieiyng vA roi loan lipid mau & ngwai cao tuoi tai hai xd huyen Vu Ban, Nam Dmh nam 2011.
Y H p c THUC HANH (868) - SO 5/2013
