TAPCHlYDUgCLAMSANGlOS Tap 12-S6 1/2017
Danh gia hieu qua diSu tri benh nhan tam thSn phan liet paranoid dap irng kem vol thuoc bang liy thuat s6c dien mot ben
Evaluate the effectiveness of the treatment of paranoid schizophrenia patients who had a poor response to drugs by electric shock
T6 Thanh Phuvng Benh vien Tam than Trung uong 1
Tom tat
•
/Wye fjeu;Oanh gia h i l u qua vd cac tac dung khdng mong mudn cua sdc di^n mdt ben ^ e u tri benh nhdn tam than phdn l i l t paranoid dap thig kem vdi thudc. Ddituang vd phuang phdp:Tien edu can thiep, m d t d cat ngang tren 15 benh nhdn tdm than phdn l i | t paranoid. Kit qud: 100% benh nhan h i t hoang tUdng do giac va hanh vi dn dinh. Kit ludn: Soc d i l n mdt b&n cd h i l u qua t d t d i l u tri b f nh nhan tam than phan Met paranoid dap ung kem vdi thudc.
rd/c/ida:Oieu tri, tam than phan liet paranoid, soe dien mot ben.
Summary
Objective: To assess t h e effectiveness and undesirable eiTects of the electric shock treatment in paranoid schizophrenia patients who had a poor response to drugs. Subject and method: Interventional, prospective, cross-sectional descriptive study on 15 paranoid schizophrenia patients. Result: 100% of all patients had stable behavior and no longer had paranoia. Conc/us/on; The electric shock treatment had a good effea in the treatment of paranoid schizophrenia patients w h o had poor response to drugs.
Keywords: Treatment paranoid schizophrenia, shocked a party.
I.Datvande vd hay tai p h a t lam mat khd nang lao d d n g va hpc Tam t h a n phan liet OTPL) la benh loan t h a n *^P ^ ^ '^° ^^' 9 ^ " 5 0 % gay ra n h d n g hanh vi p h a m nang. Theo To chdc Y te T h i gidi thi t j le mac chung P^^P" ^^° ^ ^ " "^V ^ ^ " ^ n g u y i n va benh sinh TTPL khoang 1 % dan sd. Hang nam benh t h u d n g gia t a n g ^,^" ^^^^ ^°- ^'^"^ ^ ' ^ " *''! '^^° ^^'^^ "^^^n TTPL dUpc khoang 0,02 - 0,07% dan sd, benh t h u d n g gap d t u o i ° " ^^^ ' ^ " *^^' '^ "'^^ ^^^ ^^^'^ va se cang k h d khan t r i t d 15 - 30 (75%) va t j le cao xung quanh 20 t u o i . ^ ^ " " ^ " "^^""^ ^^^^ *=° "^o^^Q t u d n g , ao giac keo dai Tdm t h a n phan l i l t ed xu hudng tien trien man t i n h ^ ^ "^^P ^ " 9 ^^^ v*^' ^^^ 1°?' t h u d c an t h d n kinh.
Vdi benh nhan dap dng kem vdi t h u d c va k h d n g Ngay nhan bai: 10/11/2016. ngay chap nh9n dang: 05/12/2016 h p p t a c d l l u tri thi SOC d i l n Id phUOnq p h a p lUa Ngudi phan hoi-To Thanh Phuang. . M - \ „ , ,, ' , ^ ^ *" • Bruul:lotharihphuong@^nail.a}m, Binh vien Tam thStTnmguong] '-"9"^ tOI UU. Nam 1938, U g o Cerietti Vd LuciO Binl Ian
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.12-N''1/20i:
dau tien ap d u n g sdc d i l n t r i n ngUdl benh TTPL cd do t h a n h .
Sdc d i l n m d t ben dUpc David Impastato va Bernard Pacella dua ra nam 1954 va phdt t r i l n manh bdi Lancaster (1957). Sdc d i l n 1 b i n cd t h e giam
&isac m o t sd tde d u n g phu ve nhan t h d c sau sdc dien nhu.thdi gian hdi phuc t r i n h d nhanh hon soe hai b i n , it gay rdi loan t r i n h d h o n sdc d i l n 2 b e n . Ban cau chiem uu t h e la jsan cdu cd l i l n quan vdi viJng ngdn n g d v i e t v d l d i ndi. Hon 95% ngUdi t h u d n tay phdi, va t h a m chf phan Idn ngudI thudn tay trai cd vj^.ng Uu t h e Idi ndi va^chCf v i l t d bdn eau trai, d d vdy t d n t h u o n g b i n trai s i gay that ngdn. Khi sdc d i l n rndt ben, ngUdi ta dat dien cUc ben ban cau khdng e h i l m Uu t h e (ban cau phai) [1], [3], [4], [5].
Trong qua t r i n h dieu tri, c h i j n g t d i da gap nhdng benh nhan kfch d d n g m a n h , hoang t u d n g , do giac khdng gldm mac d u dCing phdi h p p cdc loai thudc an than kInh khae nhau, ed t h i he cu vd m d i , cd t i e m vd u d n g , t h u d n g xuyen gay rdi vd khdng h p p tac vdi bac sy d l d i l u t r i . Do vay, de d i l u trj on d j n h benh, chung tdi tien hdnh lieu phap d i l u t r i sdc d i l n m d t b i n han ehe t d i da anh hUdng d i n nao bd ngUdI b i n h Ian d l u tien dupe dp d u n g tai Benh v i l n Tam thdn Trung uong 1, nham muc t i l u Danh gid hiiu qua vd cdc tde dung khdng mong muon cQa soc diin mot bin dieu tri b$nh nhdn tdm thdn phdn Hit paranoid dap Ung kem vdi thuoc.
2. Doi t u a n g va phuong phap 2.1.DSitao^g
Gdm 15 benh nhan (BN) t a m than phan Met paranoid cd do thanh keo dai t d 1 d i n 7 nam, dap dng cac t i l u ehuan chan doan theo ICD -10 muc F20.0 duac dieu trj tai Khoa Cap tfnh n d B i n h vien Tam than Trung UPng 1 ndm 2016.
Vi day la ky thudt nguy hiem n i n chOng tdi chi chpn t u o i t d 16 - 30. Cd hai gidi.
2.2, C&mau
Ap d u n g edng t h d c ed mau n g h i l n cdu m d ta:
Vdi p=1 %, d = 5% va t = 1,96.
Thay sd ta t i n h d u p c n = 15.
2.3. Phdn nh6m binh nhan
N h o m d u n g t h u d c < N h d m N1>: NgUdi b i n h cc d u n g t h u d c an t h a n kinh sau:
Clozapin lOOmg ngdy 2 4 v i l n / n g a y Haloperidol 1,5mg ngay 6 - 1 0 v i l n / n g a y .
N h d m sdc dien m o t b i n < N h d m N2>: Ngudi b e n h khdng d u n g t h u d c an t h a n kinh.
2.4. Phttangphdp
T i l n c d u can t h i e p , m d t a cat n g a n g , phan tfch t d n g t r u d n g h p p t h e o y e u cau cua muc tieu n g h i l n c d u .
Ngudi benh (nhdm N1) diJng t h u d c trong mdt t h d n g ma eae rdi loan t a m t h a n k h d n g o n s i dupe ehuyen sang i ^ l u trj sdc d i l n m o t ben (nhdm N2).
2.5. Cong cu
May sdc d i l n cOa Nhat; CS-1 .AC 2 2 0 v . 5 0 H z . G 7 1 A Y 3 9 2 .
2.6. Cac bif&c tien hanh soc diin mot bin Ithonggaymi
Kiem tra cac xet n g h i e m cdn lam sang: O i l n nao, d i l n t i m , Xquang t i m p h o i , cdc xet nghiem mau, chdc nang t h a n . Neu k i t qud b i n h t h u d n g thi mdi t i l n hdnh soc.
ChuSn bj phuang tien
May tao oxy, b d p b d n g , t h u d c cap cdu.
Giudng edng. Ngang mleng cd d i m bdng gae de BN khdng c^n vat^ludi khi co g i a t
Chuan bi ngudi benh
Loai t r d tat ed eae chdng chi djnh eCia sdc dien (tang dp luc ndi so, nhiem t r u n g cap, cac b i n h tim mach, x o ctftig mach nao, cao huyet dp, suy mach vdnh, lao p h o i t i e n t r i l n , b e n h gan than, cudng gidp, t a n g nhan dp, d i t d t edt song, thai nghen).
K i l m tra hien tai: N l u nhip t i m > 100 Ian/phut t h i eho u d n g Propranolon 4 0 m g 1 v i l n , nhjp tim se x u d n g < 90 I a n / p h u t K i l m tra lai mach, huyet dp dn d i n h se tien hanh soe [2].
Oe n g u d i benh nam t r I n giUdng edng.
Kfp sdc gdm 3 ngUdi:
Bac sy la ngudi ehfnh; Odng ve phfa d I u benh nhan vd cam dien cue.
14
TAP CHI Y DLTdC U M SANG 1 OS Tap 12-S6 1/2017
M 6 t dieu d u 8 n g d i l n g bSn phai (hoac trai) noi d ban cau trai, do vay t d n t h u o n g ben trai se gSy ngUM b e n h , hai tay glCt hai vai theo nhjp giat cQa t h a t n g o n . Khi soc di$n m d t bSn, n g u M ta flat d i e n cdn CO giat. cUc ben ban cau ithong chiem Uu t h e (ban cau phai) M6t dieu duang cam hai gau quSn nhac chSn [ i ] ^ p ] , [4], [5]. M o t cUc dat d d i n h dau va m o t cUc ngudi benh ien khoi mat giifdng luc ngUdi benh a j t ben ban cau I<h6ng Uu t h ^ (thai d u o n g ben phai) CO giat. [1]_[5]
each agtaiin a/cmdtben: Ban cau chiem Uu t h e la ban cSu co lien q u a n vdi v i i n g n g o n n g B viet va IM
Tiin hanh soc
Hieu d i ^ n t h e sU d u n g : TU 70 - 1 lOvol c6 t h i thay doi t u y tUng ngUdi b6nh.
Neu benh nhan nang > 50kg t h i hi&u dien t h e la lOOvoi.
Neu b$nh nhan < 50kg, l l n dau nen d u n g hieu dien t h e 90vol.
So Ian soc: Cach 1 ngay 56c 1 ISn, cac trieu chUng roi loan tSm t h a n on d j n h t h i dUng, toi da soc 10 Ian vl neu soc nhieu se co hai cho su"c khoe benh nhan.
3. Ket q u a
LUa t u 6 i tU 19 - 28 chiem t d i 80%.
3.1. Danh gia biiu qua da soc Sien mdt bin dieu trj tam than phan liet Paranoid Bang 1 . Mii'c &q t h u y e n g i d m cDa r o i loan cSm xuc . ^ ^ ^ Benh nhan nghign cl}u
CSm xiJc ~ ^ Cang thSnghSn hoc
Thd Okho lanh
Vui v§ khong phu hop hoan cSnh TSng
Nhom N1 n 4 7 4
%
40,0 3Q,0 30,0 100,0
Nhom N2 n 0 3 0
%
0,00 30,0 0,00 100,0
p
<0,05
>0,05
<0,05
Cac bieu hien edng thang hdn hpc, d l tde gian ndi cau va vui ve qua mdc t h u y i n giam h i t sau sdc m d t b i n . Bleu hien bang quan khd lanh, t h d o vdi xung quanh van t d n tai sau sdc d i l n m o t b i n .
JOURNAL OF 108 • CLINICAL MEDICINE AND PHARMACY Vol.l2-N"l/20I7
Bang 2 . MiiTc do t h u y e n g f i m cua rdi loan t U d u y
^ ^ ^ . ^ e n h nhan nghien cCHu
C^croiloantU d u y " ^ ^ ^ Tu duy khong lien quan N6I l^m bam mot minh Cudi mdt minh Hoang tudng tu cao Hoang tudng bj theo doi Hoang tudng b| hai Hoang tudng ghen tudng Hoang tudng bi d I u ddc
Nhom N1 (n-15) n 10 4 4 3 3 2 1 1
%
100,00 40,00 40,00 30,00 30,00 20,00 10,00 10,00
Nhom N2 (n-15) n 2 2 0
0
0 0 0 0
%
20,00 20,00 0,0 0,0 0,0 0,0 0,0 0,0
p
<0,05
>0,05
<0,05
>0,05
>0,05
>0,05
>0,05
>0,05 "H
Nhan xet Sau soc mdt ben, bleu hien tU duy khdng lien quan va cUdi mot minh giam nhieu. SU khac biet
cd ^ nghTa so vdi trudc soc di§n 1 ben vdi p<0,05. J Bang 3. Mure Q6 t h u y i n giam cda cac loai Ao giac ^
' .__^^ Benh nhan nghien cUu
Cac roi loan tri giac ^^—•—-..._
Aothanhxui khien Ao thanh dedoa Ao thanh binh pham Ao thanh dam thoai Ao giac noi tang
N h o m N I (n-15) n
3 1 1 1 1
%
30,0 10,0 10,0 10,0 10,0
N h d m N 2 (n-15) n
0 0 0 0 0
%
0,00 0,00 0,00 0,00 0,00
p
>0,05
>0,05
>0,05
>0,05
>0,05 Nhdnxet:Tat ca do thanh vd do giac ndi tang deu thuyen gidm h i t sau soe'dien mdt ben.
Bdng 4 . Mufc do thuyen gidm cua cac roi loan hdnh vi
• B6nh nhdn nghien cUu Cdc roi loan hanh vl - — - - Ph5 phach, dot cac thU trong phdng Ludn giy su vdi benh nhan kh^c GSothet,chutibdi
Danh ngudi
Bilaijung tung, gSy rdi benh phdng Chdng ddi uong thudc
N h o m N I {n-15) n
2 5 3 1 3 1
%
20,00 50,00 30,00 0,00 30,00 10,00
N h 6 m N 2 ( n - 1 S ) n
0 0 0 0 0 0
%
0,0 0,0 0,0 0,0 0,0 0,0
p
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05 Nhan xet: Tat ca cac bleu hien roi loan hanh vi da thuySn giam het.
TAPCHIYDLTOCUMSANGIOS
Tap 12-So 1/2017
B4ng 5. Mtfc do t l i u y i n giam c i a cac trieu clllJng co t h e
— - - . ^ ^ B e n h nhdn nghien cuTu Cac trieu chdng c o t h l " ~ ^ _ _ _ ^ G l i m can
Roi loan kinh nguy&t Gi^m tinh due Rdi loan giac ngCi IVlach nhanh
N h o m N I (n-15) n
10 2 2 10 10
%
00,00 20,00 20,00 100,00 100,00
N h 6 m N 2 (n-15) n
0 2 2 0 0
%
0,0 20,00 20,00 0,0 0,0
P
<0,05
>0,05
>0,05
<0,05
<0,05
Nhdn xet: Cac bieu hien rdi loan kinh nguyet giam tlnh due khdng thuyin gidm, so vdi trUde dieu trj, khdng cd su khac biet vdi p>0,05.
3.2. Danh gid cdc biin co cOa s6c diin mot bin
Bdng 6. Cac bien co cda soc diln mdt ben
^ r Cac bieu hi§n
NgUdI benh nghien cuTu
NgUng tim
Ngtrng ha hSp
Sac ddm dai Gay rang LietBf tieu trong lieu trinh sdc
Sau soc dien (n = 10) n
0 0 0 0 0 0
%
0,0 0,0 0,0 0,0 0,0 0,0 Nhdn xet: Khdng cd biln cd nao xdy ra vdi ngudi binh sau sdc mdt ben.
4. Ban luan
4.1. Danh gia hieu qui cHa soc dien mot bin dieu tri tam than phan Hit paranoid
Cac bieu hiln eang thang han hpc gap d ngudi benh la net mat edng thang khi hdi den la mat nhin bac sy cham cham, mat dd gian dd de tde gian noi eau, ehdi ca bac sy khi kham benh va thdm ehi cdn dpa danh, nhd nUdc bpt do vay khdng ai dam hdi ngUdi benh bat ky mdt van de gi. Biiu hien nay gidm hit sau sdc dien. BIlu hien cdm xue bang quan, thd 0 khd lanh, khdng quan tam din mpl thd xung quanh, khdng mudn tiep xue vdi ai, lam ly...hau nhu ft chuyen bien sau dot sdc dien (Bdng 1).
TU duy khdng liln quan gap d ngudi benh Id khi kham benh, bac sy hdi benh de tim hieu trilu chdng thi ngUdi binh ed tra Idi khdng dung vdi ndi dung edu hdi, hoac ngudi benh ndi cac chO de khdng lien quan gi vdi nhau... eae bieu hien nay khdng giam sau sdc dien. Ndi lam bam mdt minh Id hien tUpng ngudi benh ngdi ndi lam bam dieu gi dd, ndi nhd khdng the nghe duac ngUdi benh ndi gi, sau soe diln cdn 2/4 ngUdI cdn ndi lam bam mot minh.
Cac hoang tudng dIu giam het sau sdc diln mdt ben (Bdng 2).
Ao thanh xui khien la nhdng tieng ndi trong dau
xui ngUdi binh, cd the xul ddnh ngudi, xul tu sat xui
bd nhd di lang thang, xui khdng an...ao thanh de
3URNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.12-N''l/2017
Ipa Id de dpa b d t i j , de dpa g i l t cd nha, de dpa t r i l t tudng sdng...do thanh binh pham Id b i n h luan, ndi au, khen, e h l ngudi b i n h . . . ed m o t benh nhan cd o giac ndi t a n g ludn eho la cd ddi due rong b u n g va n h i t rupt m i n h k h i l n ngudi benh rdt eang t h a n g p hai. Tat cd ede do t h a n h deu h i t sau sdc ^ I n m o t l l n (Bdng 3).
Tat cd 15 ngUdi benh ludn t r o n g t i n h t r a n g gay oi k l o ddi t r o n g khoa, di lai Idn xdn, pha giUdng, ihd t h i l t bj v l sinh, dot chan mdn, k l u gdo dm T, hdi bdi ca nhdn v i l n , danh benh nhdn khac... Sau de d i l n m d t b i n t h i tat cd cdc hanh vi nay d I u dn I n h t d t (Bang 4).
Tat cd benh nhan deu giam cdn, sau d p t dieu t r i , at cd d I u an va ngd t d t hdi phuc cdn nang. Trudc DC dien, hau h i t ngudi benh deu cd mach nhanh >
00 l a n / p h i i t Sau sdc d i l n , mach dd dn d j n h t r I n udi 90 l a n / p h u t R i l n g bieu hien gidm t l n h due vd 5i loan kinh nguyet la khdng giam (Bdng 5).
4.2. Ddnh gid cdc bien c6cua soc diin mot ben Do cd su chuan bj ky mpi p h u o n g tien cap cdu, y t h u a t vien thanh thao do vdy da khdng xay ra bat d bien co nao t r o n g qua trinh soe d i l n m d t b i n Jang 6).
. Ket luan
5.1.Ddnh gid hieu qud cua soc dien mdt ben ieu tri tdm thdn phan Hit paranoid
Rdi loan cdm xuc: Cae bieu hien cang thang han pe, vui v l khdng phu h p p hoan cdnh gidm het sau k dien. Cam xue bdng quan, t h d 0 khd lanh, khdng uan tdm d i n m p i t h d x u n g q u a n h , khdng m u d n ep xijc vdi ai la khdng gidm.
Rdi loan tU duy: Cae hoang t u d n g deu gidm h i t (100%). TU d u y k h d n g lien q u a n k h d n g g i a m sau sdc d i l n m d t ben.
Rdi loan tri gidc: Cae loai do t h a n h vd do gide ndi t a n g g i d m het (100%).
Rdi loan hanh vi: Cac bieu hien gay rdi, pha phach, k l u gdo, ehCW bdi, ddnh ngudi d I u gidm h i t (100%).
Cac trieu c h d n g co t h e : T^t ea deu an ngCi t d t hdi p h u c can nang, mach d n d j n h . R i l n g bieu hien g i d m t l n h due vd rdi loan kinh nguyet la khdng gidm.
5.2. Ddnh gid cdc bien co cua soc diin mot bin Khdng xay ra bien c d nao t r o n g qua trinh sdc d i l n m d t b e n .
Sdc dien m d t b i n cd t h e dp d u n g dieu tri h i l u qua eho cac benh nhdn t a m t h a n phan l i l t paranoid dap dng kem vdi d i l u t n t h u d c .
Tai l i l u t h a m kliSo
1. Cao Tien Ode (1996) Liiu phap soc dien. Mot sd chuyen de t d m t h a n hoc. Hoc vien Quan y, tr.
213-217.
2. Td Thanh PhUong (2003) M d t vdi nhdn xet sd bd trong dieu tri binh nhan tdm thdn phdn Hit (Tram cdm) bdng soc diin co phoi hap vdi thuoc chen bi ta giaocdm. Tap chfY hpc thue hdnh So 8, tr. 40-41.
3. Kaplan HI Sadoek BJ Sismotherapie. Manuel de psychiatrieclinique, Maloine: 101.
4. Nanus M (1998) L'ilectroconvulsivothirapie.
Psychiatrie de I'^tudiant Maloine: 94.
5. Tribolet S- Paradas C (1996) Sectroconvulsivotherapie.
Guide pratique de psychiatre, Heures de France:
73-75.