TAP CHl NGHllN CCPU Y HQC
Summary
EFFECT OF LINH HOANG DECOCTION ON AQP - 4 IN THE RAT MODEL OF INTRACEREBRAL HAEMORHAGE
Intracerebral hemorrhage (ICH) is one a common cerebrovascular disease with high mortality and severe sequale. The study was conducted to evaluate effects of Linh hoang decoction on AQP - 4 in the rat model of intracerebral haemorrhage. The results showed that in sham-operation group, there was AQP - 4 express. In model group AQP - 4 expresses in uptrend, obviously in Id 3d period Linh hoang deeoefion and Naoxue Kang reduced AQP 4 express area in 3"* day of treatment (p < 0.05). In conclusion, Linh hoang decoction could alleviates brain oedema possibly through reducing AQP - 4.
Key words: linh hoang decoction, Intracerebral hemorrhage, AQP - 4
TAG DgNG OI^U TRj C O A O I E N CHAM VA CHI^U DEN HdNG NGOAI TREN BENH NHAN
OAU VAI GAY DO THOAI HOA COT S 6 N G C6
Ddng True Quynh, Nguyin Thj Thu Hd, Lai Thanh Hien Trwdng Dpi hpc Y Ha Npi Nghidn cuv dwac tidn hdnh nhdm ddnh gid tdc dung diiu trj dau vai gdy do thodi hda cdt sing co (THCSC) eua phwang phdp didn chdm kit hap chiiu den hdng ngopi vd tim hiiu tac dung khdng mong mudn tren Idm sdng. Kit qud nghidn cuv cho thiy dipn chdm kit hpp chiiu ddn hdng ngopi cd tdc di.ing gidm dau tmng dau vai gdy do THCSC vd cd tdc dung han so vdi didn chdm dan thuin: VAS sau diiu tn cua nhdm chung 3.10 ± 1,12 cao han VAS sau diiu trj cua nhdm nghidn cdu id 2.57 ± 0.82 (p < 0,05), dim NDI sau diiu trj cua nhdm nghidn cuv thip han nhdm chung (p < 0,05). Tmng qud trinh <Siu trj khdng c6 tic dung khdng mong mudn trdn Idm sdng. Td dd cd thi kit ludn. didn chdm.kit hpp chiiu den hdng ngopi cd tdc dung diiu trj tdt vd an todn trdn bdnh nhdn dau vai gdy do THCSC.
Tir kh6a: difn chdm, hdng ngo^i, dau vai gdy, thodi h6a eft sdng cd
I. OAT VAN Dt
Thodi hda eft sdng cd (THCSC - Cervical spondylosis) dung hdng thu 2 vd chilm 14%
trong cdc bfnh thodi hda khdp [2, 3]. Y hpc hifn dpi (YHHD) su' dgng cde nhdm thude chdng vidm, giam dau khdng steroid, steroid, thudc gidn ca; k i t hgp vdi chilu tia hdng ngoai, sdng sidu dm...[4] d l dilu trj THCSC.
Trong dd chilu tia hdng ngogi Id phuang phdp thudng dugc su- dung do cd tdc dgng thu gidn
ca, gilm dau, d l sir dgng vd gid thdnh hgp ly.
Y hpc ed truyin (YHCT) x l p dau vai gdy do THCSC vdo Chung Kidn ty, dilu trj bdng nhilu phuang phdp nhu difn chdm, xoa b6p b i m huyft, thudc thang...ed nhilu hifu qua tdt. Chlnh vl vfy, duge tiln hdnh nghidn cii-u ndy vdi mi^c tieu:
1. Ddnh gid tdc dung dilu trj dau vai gdy do thodi hod eft sdng ed bing phuang phap difn chdm k i t hgp chilu ddn hdng ngogi.
2. Theo ddi tdc dung khdng mong mudn ciia phuang phdp difn chdm kit hgp chilu den hdng ngoai trdn Idm sdng.
II. 061 TUgNG VA PHUQNG
P H A P 1. Ddi tugngGdm 60 bfnh nhdn duge chin dodn xdc djnh dau vai gdy do THCSC, dilu trj tu- thdng 9/2010 din thang 4/2011 tgi bfnh vifn Y hpc Co truyin Trung uang.
1.1. Tieu chain chgn bfnh nhin theo y hoc hien dai
Benh nhdn khdng phdn bift lua tiidi, gidi finh, nghi nghifp.
Du-gc chin dodn xdc djnh Id THCSC [3]
(Idm sdng cd hfi chung eft sdng cd vd/hofc hoi Chung r l ; edn Idm sdng cd hinh anh THCSC tren X-quang) trong dd ed trifu chung dau vai gdy.
Tinh nguyfn tham gia nghien cuu vd tudn thii dung quy trinh dilu tri.
1.2. Tieu chain chon benh nhin theo YHCT:
Kien ty thudc mpt trong hai t h i . Phong hdn thap ty.
Phong hdn thlp ty kem can thdn hu.
2. Phuang phdp
2.1. Thiet ke nghien cu'u
Phuang phdp filn cu-u, thii' nghifm Idm sdng md, so sdnh trudc vd sau didu trj, cd doi chung, tuyln chpff.bfnh nhdn theo phuang phdp ghep cap tuang ddng ( v l tudi, gidi, thdi gian mic bfnh vd muc df dau theo thang dilm VAS), chia 2 nhdm:
- Nhdm Chung: 30 bfnh nhdn dilu trj bing difn chdm dan thuin.
C6ng thuc huyft: phong tri XI.20, Dgi chuy X11I.14, Dgitru-VIMI, Kien tinh XI.21, Kidn
TAP CHi NGHllN CCPU Y HQC ngung 11.15, Hgp cdc 11.4, Bdch hfi XIII.20, Tu than thdng, Gidp tich D1/2 - D5/6, A thj huyft. [1].
Nhdm nghidn cuu: 30 bfnh nhdn dieu tn bing difn chdm kit hgp chilu ddn hong ngogi. Cdng thuc huyft.- nhu nhdm chung.
Chilu ddn hdng ngogi: bdng den hdng ngoai cua Cdng ty TNE cdng suit 250W. Lifu trinh: 10 15 phut/lln/ngdy, trong khi difn chdm hofc sau khi rut kim.
2.2. Chi tieu theo doi
Cdc trifu chgng Idm sdng theo y hoc hifn dgi trudc vd sau dilu trj.
+ Trifu Chung ca ndng: muc df dau ddnh gid theo thang dilm VAS.
+ Trifu Chung thgc thi: hfi chung eft sdng cd, Hfi chung re thin kinh.
Muc df han c h l sinh hoat hdng ngdy do dau cd ciia bfnh nhdn trudc vd sau dilu tri:
Bf cdu hdi Neck Disability Index (NDI) [5].
Cdc tdc dgng khdng mong mudn xult hifn trong qua trinh dilu tri.
+ Vgng chdm, gay kim, nhiem trung tai chd chdm.
+ Bdng da vung chieu den hdng ngoai.
2.3. Danh gii ket qua
Ddnh gid muc do dau theo thang dilm VAS:
- Ddnh gid, so sdnh hfi chung eft sdng cd, hfi chung r l thin kinh sau dilu trj cua hai nhdm.
+ Hit tit ca cdc trifu chung cua hfi chung:
0 dilm.
+ Cdn It nhit 1 trifu chgng cua hfi chung:
1 dilm.
2.4. Xu'ly so lieu
Sd dgng chuang trinh xu- ly sd lifu theo phin m i m SPSS 19.0.
TCNCYH 77 (6)-2011 107
TAP CHi NGHllN CLPU Y HQC
+ VAS = 0+ 0 - S 2 + 2 - S 4
Khdng dau Dau nhp Dau vQ-a
Odilm 1 dilm 2 dilm
+ 4 - S 6 + 6 - ^ 8 + 8 - S 1 0
Dau nfng Dau r i t nfng Dau nghidm trpng
3 dilm 4 dilm 5 dilm
Ddnh gid mO-c df eli thifn hgn chl sinh hogt hdng ngdy theo bf cdu hdi Neck Disability Index (NDI):
NDI 0 - 4 = Khdng hgn chl 0 dilm 5 -14 = Hgn chl nhp 1 dilm 15-24= Hgn chl trung binh 2 dilm 25 - 34 = Hgn chl nghidm trpng 3 dilm 35 trd ldn = Hodn todn hgn chl 4 dilm
K^T QUA
1. Kit qud gidm dau sau dilu trj theo thang dilm VAS
Bdng 1. Hifu qud gidm dau theo thang dilm VAS Nhdm Nhdm chii'ng (n = 30) Nhdm NC (n = 30)
Trud'C DT SauDT Trud'C DT SauDT
VAS (dilm)Nhp < 2 dilm Vua 2 - < 4 Ndng 4 - < 6 Rit nfng 6 - < 8 N T 8 - S 1 0
Trudc OT x ± SD Sau DT X ± SD
P
n 0 10 11 9 0
% 0 33,3 36,7 30,0 0 5,50 ±1,46
n 9 19
2 0 0
% 30,0 63,3 6,7
0 0
3,10±1,12
< 0,001
n 0 10
9 11
0
% 0 33,3
30 36,7
0 5,70 ±1,70
< l n 15 15 0 0 0
% 50,0 50,0 0 0 0
2.57 ± 0,82 3,001
>0,05
<0,05
Mu-c df dau sau dilu. trj gilm rd rft so vdi trudc dilu trj d tirng nhdm (p < 0,001). Dilm VAS trung binh sau dilu trj ciia nhdm chung Id 3,10 ± 1,12. eao han dilm VAS.trung binh sau dieu trj ciia nhdm nghidn cu-u Id 2,57 ± 0,82, sg khde bift ndy ed y nghTa thdng kd vdi p < 0,05.
2. Hfi chii'ng eft sdng cd vd hfi chii'ng rl sau dilu trj
Sg khde bift giQ-a hai nhdm sau dilu trj v l sd lugng bfnh nhdn ed hfi ehung eft sdng c6 va
hfi chO-ng r l khdng cd y nghTa thdng kd vdi p > 0,05. Sg khde bift giO-a trudc vd sau dilu trj cua
tgng nhdm ddi vdi sd lugng bfnh nhdn cd hfi chO-ng eft sdng cd Id cd y nghTa thdng kd vdi
p < 0,05. Tuy nhidn, ddi vdi hfi chgng r l , sd lugng bfnh nhdn hit ede trifu ehung eiia hfi chirng
r l sau dilu trj rit thlp (p > 0,05) (bing 2).
Nhdm
HC
H C r l
TAP CHf NGHllN CCPU Y HQC Bang 2. Hdi chii'ng cdt sdng cd va hdi chii'ng r l sau d i l u tri
Nhdm I Nhdm II
Trudc DT Sau DT
% %
Pi
Trudc DT Sau OT
% %
P2
HCCScd 30 100 23 76,7 < 0,05 30 100 18 60,0 < 0,05 > 0,05 28 93,3 27 90,0 > 0,05 29 96,7 28 93,3 > 0,05 > 0,05 3. Hieu qua giam han c h l sinh hoat hang ngdy (bd cdu hdi NDI)
Bang 3. H i f u qua giam hgn c h l sinh hogt hdng ngdy theo bo cdu hdi NDI
Nhom
NDI (dilm)Nhdm chii'ng (n = 30) Trud'C OT Sau OT
Nhdm NC (n = 30) Trudc DT Sau OT
n % % %
KhSng hgn c h l 0 - 4 Hgn c h l nhe 5 -14 Han c h l TB 15-24 Han chl ndng 25 - 34
0 0 17 12
0 0 56,7 40,0
0 18 11 0
0 60,0 36,7 0
0 2 15 12
0 6,7 50,0 40,0
1 22 7 0
3,3 73,3 23,3 0 Han che hodn toan s 35
Trudc OT X ± SD Sau OT X ± SD
1 3,3 24,40 ± 6,53
1 3,3
14,50 ±6,00
1 3,3 23,80 ± 5,20
0 0
11,60 ±3,84
>0,05
<0,05
< 0,001 < 0,001
Dilm bf eau hdi NDI sau dilu trj eua tung nhdm giam rd rft so vdi trudc dilu trj (p < 0,001).
Sau 30 ngdy dilu trj, dilm NDI ciia nhdm nghidn cuu thlp han nhdm chung vdi p < 0,05.
4. Tac dung khdng mong mudn ciia phuang phap dien cham va c h i l u den hdng ngoai Trong 30 ngdy dilu trj, d ca 2 nhdm khdng thiy xult hifn cdc tdc dgng khdng mong mudn nhu- vgng chdm, gay kim, nhiem trung tai chd chdm, bdng da vung chilu ddn hdng ngoai.
IV. BAN LUAN
Hieu qua giam dau theo thang d i l m VAS Chilu fia hdng ngoai cd tdc dgng gidn mgch lam tang cudng tuin hodn, tdng cudng dinh dudng vd chuyin hda tai chd, Idm gidn
ea, tu dd cd tdc dgng giam dau ddi vdi cdc Chung dau man tfnh. Difn chdm cd tdc dgng Idm diu dau, u-e c h l can dau, kich thfch hoat dfng ciia cdc ca, cdc td chuc; tang cudng dinh dudng d td ehge, Idm giam vidm, giam xung huylt, giam phu n l tgi chd.
109
TAP CHl NGHllN CLPU Y HQC
Nhu- vfy, vife dilu trj dau vai gdy do THCSC bing difn chdm dan thuin hay difn chdm kit hgp vdi ddn hdng ngogi d i u mang lgi kit q u i gilm dau rd rft (p < 0,001). So sdnh muc df dau sau dilu trj glQ-a 2 nhdm, Chung tdi nhfn thiy tdc dgng gilm dau eiia vifc kit hgp difn chdm vd chilu ddn hdng ngogi tdt han so vdi difn chdm dan thuin, sg khde bift ndy mang y nghTa thdng kd vdi p < 0,05.
Hfi chii'ng eft sdng cd vd hfi chii'ng r l Cdc trifu Chung cua hfi ehung eft sdng ddp ung vdi dilu trj tdt han, bilu hifn bing hit dau tgi vd cgnh eft sdng cd, h i t co eirng ca, t l m vfn dfng eft sdng cd khdng hgn c h l , khdng cdn tu- t h i chdng dau. Cdc trifu chung cua hfi Chung r l ddp ung chfm vdi dilu trj, ty Id bfnh nhdn cdn dau lan theo dudng di cua r l thin kinh giam It, ddc bift ty If bfnh nhdn cd rdi loan cam gidc (td bl, kiln bd...) giam rit it. Nhu vdy, vifc dilu trj dau vai gdy trong hfi Chung eft sdng ed phin ndo thudn lgi vd kha quan han dilu trj cac trifu chung do chdn dp r l gdy ra.
Kit qua dilu trj theo bf cau hdi NDI Bf cdu hdi NDI do bfnh nhdn tg ddnh gid v l cdc mdt cua ddi sdng sinh hogt hdng ngdy nhu ngu, chdm sdc cd nhdn, ndng dd vdt, Idi xe, dpc sdch... Kit q u i ciia bf cdu hdi cho thiy muc df han c h l md dau cd, vai gdy gdy ra cho bfnh nhdn, cd t h i tu muc nhp d i n hgn c h l hodn todn.
Dilm bf cdu hdi NDI cua nhdm nghidn ciru sau dilu trj thlp han nhdm ehung, sg khde bift ert y nghTa thdng kd vdi p < 0,05.
Nhu vdy, sau dilu trj bdng difn chdm vd chilu ddn hdng ngogi, cdc hogt dfng sinh hogt hdng ngdy cua bfnh nhdn duge cai thifn nhilu han, giam sg hgn c h l gdy ra do dau vai gdy vd ede trifu chung khde ciia THCSC.
Tdc dgng khdng mong mudn cua phuang phdp difn chdm kit hgp chilu d^n hdng ngogi
Quan sdt t i t c l 60 bfnh nhdn trong 30 ngdy dilu trj, khdng thiy xult hifn tdc dung khdng mong mudn ndo ciia difn chdm vd chilu ddn hdng ngogi trdn Idm sdng.
V. K^T LUAN
1. Nhdm bfnh nhdn dilu tri dau vai gdy do THCSC bing difn chdm k i t hgp vdi chidu ddn hdng ngoai cd k i t qud giam dau khd t6t, tdc dgng gidm dau vd giam han c h l sinh ho^t hdng ngdy cao han nhdm difn chdm don thuin. VAS sau dilu trj cua nhdm chung 3,10
±1,12 eao han VAS sau dilu trj ciia nh6m nghidn cuu Id 2,57 ± 0,82 (p < 0.05); dilm NDI sau dilu trj cua nhdm nghidn ciru thlp hon nhdm ehung (p < 0.05).
2. Trong 30 ngdy dilu trj, phuang phdp ket hgp khdng cd tdc dgng khdng mong mu6n trdn Idm sdng.
TAI LIEU THAM KHAO
1. Nguyin Nhugc Kim, Trln Quang Dat (2008). Chdm cuu vd ede phuang phdp ch&a bfnh khdng dung thude. Nhd xuit bin Y hoc, 37, 77, 114-115. 134. 136, 152, 158, 166 174,223-225.
2. Nguyin Thj Phuang Lan (2003).
Nghidn cuu tdc dgng difn chdm trong dilu trj hfi Chung vai tay, Lufn vdn Thgc syr Y hoc.
Trudng Dgi hpc Y Hd Nfi.
3. Hd Huu Luang (2006). Thodi hPa c6t sdng cd vd thodt vj dTa d f m . Nhd xult ban Y hpc, 7-32, 53-59, 60-61, 92-96.
4. Childs JD, Cleland JA, Elliot JM et al (2008). Neck pain: Clinical Practice Guidelines Linked to the Internafional Classification of Functioning, Disability, and Health From the
TAP CHl NGHllN CLPU Y HQC Orthopaedic Secfion of the American Physical 5. Vernon H (1991). The Neck Disability In- Therapy Asociation, Joumal of Orthopaedic & dex: a study of reliability and validity, The Sports Physical therapy, 38 (89): A1-A34. Joumal of Musculoskeletal Pain, 8(2): 155-157.
Summary
EFFECT OF ELECTRICAL ACUPUNCTURE
COMBINED WITH INFRARED LIGHT ON THE PATIENT WITH NECK PAIN CAUSED BY CERVICAL SPONDYLOSIS
Study was to evaluate the treatment effects and side effects of electrical acupuncture com- bined with infrared light in treafing patients with neck pain caused by Cervical spondylosis.
Results showed that electrical acupuncture combined with infrared light has analgesic effect in neck pain treatment better than that simple electric acupuncture: after treatment VAS scale of control group 3.10 ± 1.12 higher than in study group 2.57 ± 0.82 (p < 0.05). NDI scale of study group lower control group (p < 0.05). During the treatment course, there were no the side effects.
In conclusion, electrical acupuncture combined with infrared light has the good effect and safety in treatment for pafients with neck pain caused by Cervical spondylosis.
Keywords: electrical acupuncture, infrared, neck pain, cervical spondylosis
TAG DUNG DIEU TRI HOI CHU'NG
• • •
THAT LU'NG HONG DO THOAT Vj D T A O E M CUA BAI THUOC THAN T H 6 N G TRUC U' THANG
Trdn Thdi Ha\ Nguyin Nhugc Kim^, Nguyin Thj Ngoc Lan^
^Bpnh vipn Yhpc cd tmyen Tmng wang; ^Trwdng Dpi hpc YHa Ndi; ^Bpnh vipn Bpch Mai Hpi chung that lung hdng do thodt vj dia dpm Id mdt bpnh iy rit thwdng gpp tren thi gidi cung nhw d Vipt Nam. Nghidn cdu dwac thuc hipn nhdm ddnh gid tdc dung diiu trj hdi ehung that Iwng hdng do thodt vi dia dem cdt sdng vd tim hieu tdc dung khdng mong mudn cua bai thudc Thdn thdng true w thang. Kit qud cho thay nhdm chdng dpt kit qua mdc dd rit tdt 16,4%; tdt 47,3%; tmng binh 36,4%. Nhdm nghien cwu dpt kit qua tdt han (p < 0,01): muc dd rit tdt 32,7%; tdt 67,3%. Tmng qud trinh diiu trj khdng cd tac dung khdng mong mudn trdn idm sang va cpn Idm sang. Tw dd cd thi kit lupn, bdi thudc Than thdng true w thang cd tac dung tdt vd an toan tmng didu trj hdi chdng that lung hdng do thoat vi dia dpm.
Tir khoa: than thdng true u thang, difn cham, keo gian cpt sdng, hfi chung that lung hong, thoat vj diadem
gidi cQng nhu d Vift Nam, chu yeu xay ra d lua tudi 20 50. Theo thdng kd, thodt vj dTa Hfi Chung thit lung hdng do thodt vj dTa (jem chilm ty If khoang 63% 73% tdng sd
I.OATVANOe
Hfi Chung thit
dfm Id mpt bfnh ly r i t thudng gap tren thd (jau eft sdng thdt lung vd 72% trudng hgp dau
