TAP CHi V - DU9C HOC QUnNSy SO 6-2014
DANH GIA HlfU QUA cCiA PHlJONG PHAP THAM TACH SIEU LOG MAU BU DjCH TRI/C J\iP TRONG CAI THI$N MOT SO CHi SO BIEN D A N TRUYEN THAN KINH 6 BENH NHAN SUY THAN MAN TINH LQC MAU CHU KY
Nguyen Thi Thu Hat; Nguyen Thanh Binh"
Nguyin Thj Thanh Binh"; L i Viet Thing***; Le Quang Cimng""
TOM TAT
Muc tiSu: So s4nh biln doi mpt sd chl so dipn din truyin (DTTK) d bdnh nhan (BN) suy than man tinh (STMT) dugc dieu tr| blng tham tach siSu loc bii dich tryc tiep vdi thjn nhSn tao sd dung qua ioc he so sldu lpc thlp. Bdi tuong va phygng phap nghidn cyu: 92 BN STMT loc mau ehu ky (LMCK) tai Khoa Than nhan tao, B$nh vi#n Bach Mai dugc thSm d6 dien sinh if 6 day than kinh (TK) ngoji vi: mac, chay, tru vjn ddng va cam giao, giUa vjn ddng va cam giac. 31/92 BN dugc tham tach sieu ipc bCi d|ch tryc tiep xen ke 1 lln/2 tu^n trong 12 thang, 61 BN cdn lai dugc coi la nhdm chung benh, tilp tuc ipc vdi chl dd th6ng thudng va theo ddi dpc trong 12 thang. Tham dd dien sinh i'j TK dugc tiln hanh vao 3 thii diem: bat dlu nghidn cyu, sau 6 va 12 thang theo doi doc. Kit qua: sau 12 thang, d nhdm BN tham tach sieu ioc bu dich tryc tilp, tdc dd din truyen cac day TK chay, tru cam giac, gi&a cam giac tang (p < 0,05), bien dd dap Crng cae day TK chay va giya cam giac tang (p < 0,05), thdi gian tilm ngpn chi cac day TK giOa van ddng va cam giac giam (p < 0,05) so vdi thirl diem bit dau nghidn cyu; so sanh vdi nhdm Ipc mau sir dung qua ipc cd he s6 sidu Ipc th^p, bian dg dap yng cac day TK chay, try cam giac, gitra van ddng va cam giac tang (p < 0,05), thdi gian tilm tang ngon chi dSy giya van ddng giam (p < 0,05). Kit Iuan: ipc mau bSng phuong phap thIm tach sl§u loc bU dich tryc tilp cai thidn va ngan su tien triln cua Ion thuong TK ngoai vi a BN-STMT LMCK.
* Ty khda: Suy than man tinh; Loc mau chu kji; BSnh thin kinh ngoai vi; Tham tach siau lee bu d|ch tryc tiep.
' Benh vien B^ch Mai
*' Binh vlin Lao khoa Trung uong
**' Benh vlin Quin y 103
— Bai hoc Y Hi Ndi
Ngu^ phin hoi (Corresponding): NguySn Thi Thu Hai (thuhaimma@yahoo,com) Ngiy nh$n bii: 24/01/2014; Ngiy phin bi^n dinh gii bii bio: 26/02/2014
Ngiy bii bio dwgK ding: 28/07/2014
TQP CHi V - Diroc Hpc OUflN Sy so 6-2014
EFFECTIVENESS OF ON-LINE HEMODIAFILTRATION IN IMPROVEMENT OF NERVE CONDUCTION INDEX
IN PATIENTS WITH CHRONIC RENAL FAILURE TREATED WITH HEMODIALYSIS
SUMMARY
Objective: To compare the effect of 1-year hemodialysis and on-line hemodiafiltration treatment on peripheral neuropathy. Patients and methods: 92 chronic dialysis patients were assigned randomly to on-line hemodiafiltration (HDF) group and hemodialysis (HD) group. 31 patierits of on-line HDF group received regular hemodialysis and on-line HDF once per two weeks, while 61 remaining patients received hemodialysis twice a week and were considered as a control group. Nen/e conduction studies of peroneal, tibial, ulnar and median nen/es were perfomed In each group and comparison of electroneurographic parameters were made after 6 and 12 month's treatment. Results: After the 1-year treatment, the motor nerve conduction velocity of tibial, the sensory nen/e conduction velocities of ulnar and median nen/es, the action potential amplitudes of tibial, median nen/es in on-line hemodiafiltration group increased, while the distal motor and sensory latencies of median nerves decreased significantly: in comparison with that in hemodialysis group the action potential amplitudes of tibial and median nerves increased, the distal motor and sensory latencies of median nen/es decreased signifiOantly. Conclusion: The present study suggests that on-line hemodiafiltration might improve electmeurographic parameters in patients with chronic renal failure treated with hemodialysis.
' Key words: Chronic renal failure; Maintenance hemodialysis; Peripheral neuropathy; On-line hemodiafiltration.
BAT VAN OE ^^"^ ^9^Q ^^70 cai thi#n khi chuyin BN ti>
ch4 do Ihim tach mau sang che dO tham T6n thu-ang da day TK 6" BN STMT, d|c tach sieu lpc mau [2, 3, 5, 6]. Tgi Vl?t Nam, bi$t, BN LMCK chi^m ty 10 rat cao Co chu-a co nghidn cu-u 6ky du nao danh gia c h l benh sinh chu'a ro r^ng, tuy nhien hieu qua phu'ang ph^p t h l m t^ch sidu loc nhieu nghien cteu cho rang t6n thu-cng TK mau tren cac chT so di^n TK. Vi vgy, chung 0- nhom BN STMT la do cSc doc t6 uremic toi nghien CLTU de t^i nay vo-i muc tIeu' So tiCh ty, dac biet cac chat dOc c6 ph^n tu' sanh biSn doi mgt so chl so di$n d§n lu'p'ng trung binh. Lpc mau toi u'u ph^n truyen TK a BN STMT diegc dieu tri bang n^o cai thien du'p'c tinh trang benh v^ ng3n phwang ph^p tham tach sieu loc mau bu chgn sy tiln triln cua benh [4]. Mpt so nh^ djch tnic tiep (on-line hemodiafiltration) nghien cu-u nu'dc ngoai cho rang ngu-dng v&i than nhan tao sCr dung qua IQC CO he cam giac rung Vci toe dp dan truyen TK s6 si§u loc thap.
103
TAP CHl V - DUOC HOC OUfiN Sysg 6-8014 DOI Tl/pNG VA PHl/ONG P H A P
NGHliN C i n j 1. s a i typing nghien c(ni.
- 92 BN STMT khdng phan biet nam, nO', hien dang dilu trj thay t h i than tai Khoa Than nhan tao, Benh vl^n Bach Mai.
Chia BN thanh 2 nhdm: 31 BN LMCK sir dung qua lpc ed he s l sieu lpc t h l p xen ke 2 tuln/iln tham tdch slSu ipc bij djch tn,re tilp (nhdm HDF) va 61 BN LMCK SU' dyng qua Ipc cd he s l sieu ipc t h l p (nhdm HD).
- BN ^ 18 tudi, nguyen nhan suy than gdm viem c l u than man va vidm than b l than man, cd thdi gian Ipe mdu a 3 thang, dang dilu trj blng qua Ige cd he s l sieu loc thlp, tai sO dung qua Ipc 6 l l n , ding y tham gia nghian cO'u.
- Leal trCr cao BN STMT do dai thao dydng, benh he thong, nhu'ng BN ed b$nh ly TK tardc khi loc mau, BN nghi ngd mac b^nh ngoai khoa, BN sdt, BN khdng ding •) tham gia nghidn cyu.
2. Phu'O'ng phap nghien ciru.
- Md ta c i t ngang, theo ddi doc cd can thiep dieu tri.
- BN dyye tham kham iam sdng va tham dd dien sinh ij bang may ghi dien ea NEUROPACK- 81 (Hang NHON KOHDEN, Nhat ban) tai Khoa Tam Thin kinh, Benh vien Lao khoa TW theo m l u benh an thing nhlt. Cae day TK nghiSn eCru gdm:
day TK mac, chay, try v l n d|ng va e l m giac, giO'a van ddng va cam giac. Moi day TK ngoai vi d l u dyye do 3 ehi so: t i c dd d i n truyin, bien dp dien t h i hoat ddng va thdi gian tilm tang ngpn chi. Bo d i n truyen cam giac theo kJ thuat do thuan chilu.
- cac xdt nghi$m: Mb, ure, ereatinlr albumin, CRP, p2-microglobulin mau, ure creatinin nieu iam tai Khoa Huylt hpc vi Sinh hda, Benh vien Baeh Mai.
- Cdng thyc tinh mCrc loc c l u thji (MLCT) tdn dy:
MLCT tdn d y (ml/philt) = (Cl ure + C ereatinln)/2.
Cl = Qu X Cu/T X (P, + P2)/2, trong 4 Cl: clearance; Qu: the tich nydc tilu thi dyye giO'a hai ky lpc; Cu la ning dd ure creatinin nude t i l u ; T la khoang thdi giai giO'a hai ky ipc; Pi la ndng dp ure, creatinii mau sau ipc cua ky Ipc trydc; P2 la non;
dd ure, creatinin mau trydc ipc eua kJ Igi sau.
ThIm tach sieu ipe bu djch tnj'c ti^[
siy dung qua ipc ed he so sieu Ipc 5£
ml/gid/mmHg.
- Lpc mdu thydng quy vdi qua Ipc ci he s l sieu Ipc 11,5 ml/gid/mmHg.
- Thdi d i l m do d i n truyin TK: To: bl d l u vao can thiep; Tg: sau 6 thang cai thiep va T12: sau 12 thang can thiap. Toi dd d i n truyin, bien dp dap yng eua nhor thIm tach sieu lpc bu djch tnj'c tilp tang thdi gian t i l m tang ngpn ehi giam c6 ) nghTa thing ke so vdi thdi dilm bit all nghien ciiu (To) va so vdi nhdm lpc niSi blng qua loc cd he s l sieu loc thlp duiji col cd cai thi$n tot.
- BN cua ca 2 nhdm nghidn cyu d^i dyp'c dilu tri thilu mau, t i n g huylt ap, si dyng thulc tang d i n truyin TK, vltamii nhdm B, giam dau TK theo khuyin cSi eiJa Hpi Than hpc Quoc t l .
- Xi ij s6 lieu bang phan mIm SPSS 16.0.
T9P CHf V - Diroc HOC OUflN sir sd' 6-2014
K^T QUA NGHIEN C(J\1 VA BAN L U A N
Sang 1: Bae dilm BN nhdm thIm tdoh sidu Ipc (HDF) va nhdm tham tdch mau (HD).
BACDI^M Tuoi
Th&i gian Igc (thang) MLCT tSndu (ml/phut) Ure (mmol/l) Creatinin (Mmol/l) Hb (g/l) Albumin (g/l) CRP (mg/1) IJ2-M (mg/1)
HDF (n = 31) 42,2 ±13,0 48,8 ± 32,8 0,8 ±1,3 25,5 ± 6,6 880,9 ±176,8
107,6 ±23,9 39,9 ± 4,3
0,3 ± 0,4 53,5 ± 20,8
HD (n = 61) 42,7 ± 12,3 45,5 ±31,4 0,6 ± 0,8 23,4 ± 6,3 843,2 ±188,1
98,4 ±21,8 40,2 ± 3,3 0,3 ± 0,4 61,2 ±20,8
P
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05 Nhdm BN thIm tach siSu ipe mau va thIm tach mau cd dac dilm v l tuli, thdi gian lpc, MLCT tdn d y va cac chi so sinh hda khae khdng khac nhau cd y nghTa thing ke (p > 0,05).
Bing 2: So sanh eac chi sd di^n sinh 1^ (BSL) day TK mac eua 2 nhdm BN sau 8 va 12 thang.
CHI s o BSL
u
A
t X ± S D
X ± S D
X ± S D
HDF(n = 31) To
43,9 ±7,4 Te 44,7 ±6,7
T,2 45,7 ±7,7 p ANOVA > 0,05 3,5 ±2,3 3,6 ±1,9 3,2 ±1,4
p ANOVA > 0,05 4,0 ±1,7 3,8 ±0,8 3,8 ±1,2
p ANOVA > 0,05
HD(n = 61) To
45,0 ±5,1 Te 43,5 ±6,2
Ti2 45,8 ±6,1 p ANOVA > 0,05 3,7 ±1,9 3,5 ±1,5 3,3 ±1,6
p ANOVA > 0,05 3,8 ±1,1 3,9 ±0,9 3,7 ±0,8
p ANOVA > 0,05
^
To> 0,05 To > 0,05 1,2 > 0,05 To > 0,05 Te > 0,05 T,2>0,05 To > 0,05 Te > 0,05 T,2>0,05 (V; t6c dd din truyin (m/giiy); A: bien dd dap ring (mV); t: thai gian tiem ngon chl (miligiiy)).
Sau 12 thang, cae chi s6 di^n d i n truyin TK day rhac cua ea 2 nhdm BN nghien cCru d l u chya biln a l l cd J nghTa thing ke so vdi thdi d i l m bat d l u nghien ciiu (p ANOVA > 0,05).
105
TBP CHI ¥ - Diroc HOC QUflN Slf s g 6-2014
Bang 3: So sanh cac chi so DSL day TK chay cua 2 nhom BN
CHf S 6 DSL
V
A
t X ± S D
X ± S D
X ± S D
HDF(n = 31) Ta
42,2 ± 4 , 0
PTO-Ta.Tfl- Ta 42,4 ±4,5
T,2 43,7 ± 3,6
Ti2>0,05, pTo-Tia<0,05 5,2 ± 2 , 3
PT0-T6, TG-
6,2 ±4,2 6,3 ± 3,5
Ti2>0,05; pro.Ti2<0,05 4,3 ± 0,9 4,9 ± 0,9 4,6 ±0,9
p ANOVA > 0,05
sau 6 va 12
H D ( n = 61) To
43,0 ±4,2 Tf, 41.8 ± 5 , 0
Tl2 43,6 ± 5 , 4
p ANOVA > 0,05 5,7 ±3,3 5,8 ± 3 , 8 4,6 ±2,7
PTO-T«,TS-TI2> 0.05; PT0-T12 < 0,05 5,0 ± 1 , 0 5,2 ± 1 , 1 4,9 ± 1 , 0
p A N O V A > 0 , 0 5
th^ng.
PHWCF
T(i>0,05 T6>0,05 Ti2> 0,01 To>0,05 T8>0,OS T,2<0,05 To> 0,05 Ts>0,05 Ti2> 0,05
(V: tdc do din truyin (m/giay); A: bien do dip irng (mV); t: thai gian tiem ngon cW (mill giay)).
Sau 12 thdng dilu tri, tdc dp d i n truyin day TK chay cua nhdm HDF tang (p < 0,05) so vdi thdi dilm bat d l u nghien cu'u, bien dp dap irng tang so vdi thdi dilm bat dau nghien cu'u va so vdi nhdm HD (p < 0,05).
Sang 4: So sanh cac chi so BSL day TK try van ddng vd try cam giac cua 2 nhdm BN sau 6 vai2thang.
O A Y T K
Try y^n (3$ng
Try cam giSc
V
A
t
V
A
t X ± S D
X ± S D
X ± S D
X ± S D
X ± S D
X ± S D
HDF(n = 31) To
58,0 ±5,8 Te 56,1 ±6,2
Tl2 56,5 ±5,1
p ANOVA > 0,05 6,2 ±2,2 6,8 ± 1 , 6 6,5 ±1,9
p ANOVA > 0,05 2,5 ±0,4 2,6 ± 0,5 2,5 ± 0,4
p ANOVA > 0,05 57,8 ±7,6 60,1 ±6,3 61,8 ±7,3
PTO-T5,TS-TI2>0,05; PTQ-TU < 0,05
41,4 ±24,8 42,9 ±24,9 48,8 ±41,8
p ANOVA > 0,05 2,3 ± 0,3 2,2 ±0,2 2,1 ± 0 , 3
p ANOVA > 0,05
H D ( n = 61) To
57,6 ± 5,3 TB 56,4 ± 5,3
T l 2 59,1 ±6,6
p ANOVA > 0,05 7,2 ± 1 , 9 7,8 ± 1 , 7 6,4 ±1,9
PTD-T9.Ta-Ti2> 0,05; pTOn2 < 0,05 2,6 ± 0,4 2,7 ± 0 , 4 2,6 ±0,5
p ANOVA > 0,05 58,8 ± 8,0 56,7 ± 8 , 2 59,3 ±7,6
p ANOVA > 0,05 36,1 ±25,2 30,2 ±15,7 32,2*15,3
p ANOVA > 0,05 2,2 ± 0,3 2,3 ± 0 , 4 2,2 ± 0,3
p ANOVA > 0,05
p„»
To>0,p5 • Te > 0,05 Ti2>0,05 Tg<0,C^
Te>0,05 Ti2>0,05 Tci> 0,05 T B > 0 , 0 5 Ti2>0,01 To> 0,05 T9<0,05 T,2> 0,05 To > 0,05 Ta < 0,05 Ti2<0,05 To>0,05 Ta > 0,05 T,2> 0,01
vai c
(V: toe do dan tnjyen (m/giay); A: biin dg dap (mg (pV doi vai day tru cam giac; mVdii 1 day tru van ddng); t: thai gian tiim ngon chi (mill qiiy)).
T^P CHi V - Diroc HOC OURN Sl^' s6 6-2014 Tai thdi diem bat d l u nghien ciru, bien dp dap Crng day try van dOng cua nhdm HDF thap hyn so vdl nhdm HD (p < 0,05), sau 12 thang dilu tri, bien dp dap irng da tang len khdng khac biat so vdi nhdm HD.
Sau 12 thang d i l u tri, t i c dp dan truyin ciia day tru cam giac a nhdm HDF tang so vdi thdi d i l m bat d l u nghien ciru (p < 0,05), bien dd ddp irng tang so vdi nhdm HD (p
< 0,05), rieng bidn dp dap irng day try van ddng cua nhdm HD giam so vdi thdi dilm bit d l u nghien ciru (p < 0,05).
Sang 5; So sanh eac ehi so DSL day TK giOa van dpng va giCra cam giac cua 2 nhdm BNsauBva 12 thang.
DAY TK
GiO'a aOng
GiO'a cam giac
V
"
t
\/
"
t X ± S D
X ± S D
X ± S D
X ± S D
X ± S D
X ± S D
HDF(n = 31}
To 56,7 ± 5 , 7
Ta 54,3 ± 4 , 6
T I 2 54,8 ±4,6
p ANOVA >0,05 7,2 ± 2,9 7,3 ± 2 , 3 7,5 ± 2,4
p ANOVA > 0,05 3,3 ± 0,4 3,4 ± 0 , 5 3,1 ± 0 , 5
PTO-T6,TB-TI:> 0,05; PTO-TI3 < 0,05
56,0 ± 7,0 59,3 ± 7,7 60,0 ± 6,0
PTO-T9.TB-TI2> 0,05; pro-m < 0,01 32,8 ± 1 7 , 0 41,2 ±22,4 50,5 ±23,1
pT0-Te,T^T12> 0,05, pTO-TI! < 0,01 2,5 ± 0 , 3 2,4 ± 0,3 2,3 ± 0,3
PTO-T6.T6-TI2> 0,05; PTO-TO < 0.01
HD(n = 61) To
55,7 ±5,1 Ta 53,5 ± 4,4
T,2 54,8 ±5,1
p ANOVA >0,05 6,8 ± 1 , 8 7 , 5 ± 2 , 1 5,9 ± 1 , 9
PTO.Ta.T0.T13< 0,05, PTB-T12 < 0,01 3,3 ± 0 , 4 3 , 5 ± 1 , 1 3,4 ± 0,5
p ANOVA > 0,05 57,6 ± 7,7 55,0 ± 6,5 57,6 ± 7,2
p ANOVA > 0,05 31,2 ±19,1 32,0 ± 20,8 30,4 ±13,7
p ANOVA > 0,05 2.5 ± 0,3 2,6 ± 0,3 2,5 ± 0 , 3
p ANOVA > 0,05
PHIWCF
To > 0,05 Ta > 0,05 T i 2 > 0 , 0 1 To > 0,05 Ta > 0,05 T i 2 < 0 , 0 1 To > 0,05 Ta > 0,05 Ti2 < 0,05 To > 0,05 To < 0,05 T i 2 > 0 , 0 5 To > 0,05 Ta > 0,05 T,2<0,01 To > 0,05 Ta < 0,05 T,2>0,05
V: toe do din truyen (m/giiy); A: bien do dip ung (pV ddi vdi day giOa cam giac; mV ddi vol day git/a van ddng); t: thdi gian tiim ngon chi (mill giay).
Sau 12 thang d i l u trj, d nhdm HDF, cae chi so OSL day giii'a cam giac cai thien tdt ho'n so vdi day gi&a van ddng; so sanh, vdi nhdm HD, bien dd dap irng day giira van ddng va cam giac tang (p < 0,01), thdi gian t i l m tang ngpn ehi cua day giO'a van ddng giam (p < 0,05).
Bang phyyng phap so sanh gia tri trung binh, chi so OSL cac day TK mac, chay, tru van dpng va cam giac, giya van dgng va cam giac a 3 thdi dilm (bat d l u nghien ciru, sau 6 vd 12 thang dilu tri), Chung tdi thly a nhdm 31 BN dy(?e dilu tri xen ke thIm tach sidu ipc mau bii dich 107
Ti)p CHi V - piroc HOC OUfiN sir sa" 6-2014 tryc tilp, tdc do d i n truyen day TK chay va day TK cam giac, bien dp dap irng ciia day TK chay va day giCra cam giac tang len ed y nghTa thong ke sau 12 thang dilu tri. Thdi gian tilm tang ngpn chi eua day TK trong nghien ciru it biln ddi, chi cd thdi gian tilm tang ngon chi cua day TK giira van dpng va can\ giac giam cd y nghTa ngay sau 12 thang d i l u trj. cae chi so dien d i n truyin TK khac hoac cd cai thipn nhyng chya cd y nghTa thong ke hoac duy tri dn djnh nhy thdi diem b i t day nghien eiru. Trai ial, d nhdm 61 BN tham tach mau, khdng ed chl sd didn TK nao dyye cai thien cd y nghTa thong ke sau 12 thdng theo ddi doc, da sd eac chi s l nay cung khdng biln ddi theo thdi gian.
Tuy nhien, chiing tdi nhan thly, bian dd dap irng eua cae day TK van dpng (day chay, day tru van ddng vd giya van ddng) giam ed y nghTa thing ke (p < 0,05). Cd le dilu nay phan anh sy t i l n triln cua ton thyang syi true cue cac day TK ngoai bien d nhdm BN loc mau bang qua lpc cd he so sieu ipe thlp. Khi so sanh eac chi sd BSL giCra 2 nhdm HDF va HD: tai thdi diem bat dau nghien eiru, eac chl s l nay khdng khac biet ed y nghTa thong ke trCr bien dp dap irng cua day try van ddng.
Sau 12 thang, bien dp dap irng cua h l u hit eac day TK nghien ciru eua nhdm HDF tang hon so vdi nhdm HD (p < 0,05), Bi6n dp dap irng day tru van ddng cua nhdm BN HDF khi bat d l u nghien eiru thlp hon nhdm HD (p < 0,05), nhyng sau 12 thang, da tang Idn khdng khde biet ed y nghTa so vdi nhdm HD. K i t qua eua chiing tdi ed nhyng dilm phu hp'p vdi nghidn eiru eua mpt sd tac gia trong va
ngoai nydc. Nguyin Trpng Hung (2008) theo ddi dpc 20 BN t h l m tach mau thdng thydng trdng 3 nam thly: cac chi s l DSL khong thay ddi theo thdi gian ipe mau mi cdn cd xu hudng t i l n triln nang len, a?c biet, bien dp dap irng day TK mac, hiln ngoai va h l u h i t cac chi sd BSL ciia dSy TK chi tren [1]. Nam 1991, Malbetti nghien ciru so sanh sy biln doi cae chi so BSL eua day TK ngoai bldn 4 2 nhdm BN t h l m tach sieu loc mau va tham tach mau (n = 21). Sau 12 thang dilu trj, cac chis6 BSL nhdm HD cd xu hydng tiln triln nang ien, trong khi a nhdm HDF khong biln d l i va dng rut ra k i t Iuan: phyang phap thlm tach siSu Ipe mau ed t h i ngan chan ton thyyng TK ngoai vi tiln triln nang ISn a ngydi STIVIT [5], Nhy v|y, nghien eiru eua chung tdi cho thly phuong phap thlm tach sieu ipc mau bii dich tryc tilp cd t h i cai thien cac ehi s l dan truyin TK d BN LIVICK. U'u dilm eua phyong phap doi vdi t i n thyang TK ngoai vi co le do kha nang dao thai hieu qua ban cac cac phan t l i cd trpng iyang trung binh va Idn so vdi phyang phap thlm tacli mau thydng quy. Nhin chung, cac day TK cam giac trong nghien eiru phgc hoi t i t han so vdi day TK van dgng. Bel vdi BN Ipc mau than nhan tao bang qua loc ed he sd sieu ipe thlp, ton thyang sgi true ed xu t h i nang len, dac biet, d day TK van ddng.
KfiT LUAN
Sau 12 thang theo ddi dpc, nhdm BN LMCK dygc d i l u tri xen ke thlm tacli sieu ipc mau bu dich tryc tilp, toe dp din
TQP CHi V - DVOC HOC OUAN SV S6'6-2014
truyen d a y T K c h a y , tru c a m g i ^ c , giO'a c a m g i a c t a n g (p < 0,05), bien d p d a p u-ng cua d a y T K c h a y va giCra c a m g i a c t a n g (p < 0,05), thd'i g i a n t i e m ngpn" chi c6c d§y T K giCfa v a n d p n g v ^ c a m g i a c g i a m (p < 0,05) s o v d i thd'i d i l m bat d a u n g h i e n CCPU; SO s a n h vo'i n h 6 m Ipc m a u s u ' d y n g qua lpc CO h$ s 6 sieu ipc t h a p , bi§n dp dcip Crng c a c d a y T K c h a y , try c a m giac, giO'a v l n d p n g v ^ c a m giac t a n g (p < 0,05), t h a i g i a n t i e m t a n g n g p n chi dSy giOa v a n d p n g g i a m ( p < 0 , 0 5 ) .
T A I L I E U T H A M K H A O 1 Nguy§n Trgng Hwng. Nghien cu'u b i l n (36i tr6n DSL t6n thu'cng TK ngogi vi a ngu'6'i dang iJieu tn th$n nh&n tao chu kJ, Tgp chl Y hpc Vi6t nam. 2012, t | p 39; tr-30-33.
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