Y HOC VlgT NAM THANG 6 - s t i 1/2013
DIEU TRj PHAU THUAT VET THlTONG BUNG
T n n h v a n T u a n * , Tran Binh Giang*»
T6M TAT
Muc tieu ciia de tai la danh gia ket qua dieu tn phau thuat vet thirong bung. Td 1/2010 den 8/2012 tai benh vien Viet DUc Ha noi, 62 tru'dng hdp vet thuong bung da diTOC phau thuat, trong do nam 60 (96.8%), niJ 2 (3.2%); tuoi tmng binh 29.3 ± 11.5 (dao dong tir 13-61 tuoi), nguyen nhan do vet thu'dng bach khi 47 (75.8%), hoa khi 4 (6.4%), lao dong 4 (6.4%), smh hoat 7 (11.3%); thai gian t d khi tai nan den liic nhap vien trung binh 5.8 ± 1.3 gid. Lam sang CO SDC 18 (29%), phan irng thanh bung 40 (64%), binh thudng 4 (6.-1"/u) vi tri vet thu'dng d thanh bung trUdc 62.9%, phan thap (ong ngUc 19.4%, thanh bung sau ben 12.9%, tanq smh mon 4.8%; xet nghiem hong cau 4.1 ± O ' l ' l O ^ m m ^ hematocrit 0.37 ± 0.9%, Hb 12.2 ± 2.6 g/l, chan doan hinh anh: X quang co hem hdi du'di hoanh 13 (21%), sieu am va chup cat Idp thay co ton thUdng tang 63.5% va 81.5%. Chi dmh mo md 42 (67.7%), phau thuat noi SOI 20 (32,3%). Thdi gian nam vien trung binh cua nhdm md md 8.2 ± 3.6 ngay, cua nhom mo noi soi trung binh la 6 ± 2.7 ngay. Ket qua. bien chu'ng sau mo 8 (12.9%), td vong 3 (4.8%), ty le khoi ra vien dat 95.2%.
Tir khoa: Vet thu'dng bung, Phau thuat vet thu'dng bung
SUMMARY
SURGICAL TREATMENT FOR PENETRATING ABDOMINAL TRAUMA Study carred on with the aim of evaluating the result of the surgical treatment of penetrating abdomen. From January 2010 to August 2012 at Viet Due hospital in Ha noi, 62 cases of penetrating abdomen was treated with surgery, in which was male 60 (96.8%), female 2 (3.2%), the median age of 29.3
± 11.5 (ranged 13 to 61 years old), the cause of injuries* stab wounds were 47 cases (75.8%), gunshot wounds were 4 (6 -1%), labor accidents were 4 (6.4%), living accidents were 7 (11.3%); the time from the accident to tho admission averaged 5 8 ± 1.3 hours (ranged from 5 minute to 72 hours). Physical examination shock 18 (29%), abdominal wall reaction 40 (64%), normal wall abdomen 4 (6.4%). Paraclinics.
red cells averaged 4 1± 0.9'109/mm3, hematocrit 0.37 ± 0.9%, hemoglobin 12.2 ± 2.6 g/l, imaging diagnostic- X ray showed 13 cases (21%) having the gas under diaphragm, ultrasound found 63.5% of organ damage, computed tomography (CT) showed 81.5% significant injuries in all cases. Management:
laparotomy group was 42 cases (67.7%), laparoscopic
* TrUdng Dai hoc Y Hi noi, * * Benh vien Viet - Ddc Phan bien khoa hoc PGS.TS. Nguyin Du'c Tien
surgery was 20 cases (32.3%). The hospitalization time of laparotomy group averaged 8.2 ± 3.6 days, of laparoscopic surgical group averaged 6 ± 2.7 days.
Results: complications of 8 cases (12.9%), mortality of 3 cases (4,8%), 95.2% of patients cured out of hospital.
Key words: Penetrating abdominal trauma, Surgical treatment.
I.
DAT VANof
Vet thddng bung la mdt cap ciru ngoai khoa g§p nhieu trong thdi chien cung nhd thdi binh.
Tac nhan gay thu'dng tfch xuyen thung phuc mac lam thdng thddng d bung vdi mdi trddng ben ngoai. Trong cac loai nguyen nhan gay vet thddng bung thi vet thddng do hda khf la loai gay thddng ton phdc tap hdn so vdi cac loai thddng ton do vet thddng khac. Tai nan sinh hoat, tai nan lao ddng va tai nan giao thdng cung la nhu'ng nguyen nhan gay nen vet thddng bung.
Hien nay, cung vdi sd gia tang cua cac phddng tien giao thdng va tdc dp dd thj hda nhanh chdng, vet thddng bung dang cd xu hddng tang cao cung vdi nhu'ng tdn thddng da dang, phiTc tap va nang ne.
Oieu t n vet thddng bung trddc kia thddng la md md sau khi kiem tra thay cd thung phuc mac, vi vay nhieu trddng hdp chi dinh mo md nhuTig khdng cd ton thddng hoac tdn thddng khong dang mo. T d nhu'ng nam 90 cua the ky trddc [1], phau thuat ndi soi da trd thanh sd lu^ chon ciia cac phau thuat vien cho nhieu benh ly 6 bung, trong dd cd vet thddng bung. Ldi the cua phau thuat npi SOI trddc het la kha nang chan doan nhu'ng thddng ton trong o bung ma cac tham do khac khong phat hien dddc. Ldi the thd hai la dieu trj, x d ly nhiTng thddng ton ma khdng can thiet md bung n h d cam mau, khau ton thddng...
Tai Viet nam, nhti'ng nam gan day cung da cd mdt sd nghien cdu ve chan doan va dieu tri vet thu'dng bung [2,3] nhutig ft cd nghien cdU di sau vao chi dmh va each Ida chon phddng phap phau thuat de dieu t n cac ton thddng do vet thddng bung gay ra. Do dd, chung tdi thdc hien de tai vdi muc tieu: Danh gia ket qua dieu tri phau thuat vet thudng bung tai t>enh vien Viet Ddc.
Y HOC V|£T HAM THANG 6 - SO 1/2013 II. OOI TUONG VA PHaONG PHAP NGHIEN COU
2 . 1 . Odl tu'dng nghien cu'u: Nhdng benh nhan chan doan vet thddng bung dddc chi djnh p h l u thuat tai benh vien Viet Ddc t d thang 1/2010 den thang 8/2012!
2.1.1. Tieu chuan Ida chgn
- Benh nhan d mpi Ida tudi, khdng phan biet gidi tinh.
Bao gom cac trddng hdp vet thddng bung do hda khf, bach khi, tai nan lao ddng, slnh hoat, giao thdng...
- Bddc chi djnh phau thuat.
2.1.2. Tieu chuan loai trd Khdng dat tieu chuan tren.
- Nhij'ng trddng hdp md vi chan thddng bung kfn.
2.2. PhuUng phap nghien ciili: tien ciili md ta.
Cac chf tieu nghien cdu: tuoi, gidi, nguyen nhan chan thddng, thdi gian tdi vien sau tai nan, tinh trang luc nhap vien, cac tham dd trddc md, chi dinh phau thuat, danh gia thddng ton va cac can thiep trong md, ket qua dieu tr; sdm sau mo.
Thu thap va sd ly sd lieu bang cac phan mem thdng ke Y hpc.
III. KET QUA
T d 01/2010 den 8/2012 tai benh vien Viet
Ddc Ha ndi, 62 trddng hdp vet thddng bung da dddc dieu trj phau thuat, trong dd nam 60 (96.8%), nii'; 2 (3.2%); tudi trung binh 29.3 ± 11.5 (dao dpng t d 13 - 61 tud'i); nguyen nhan:
do bach khf 47 (75.8%), hda khi 4 (6.4%), tai nan lao ddng 4 (6.4%), tai nan sinh hoat 7 (11.3%); thdi gian t d luc tai nan tdi khi vao vien trung binh 5.8 ± 1.3 gid (tir 5 phut - 72 gid).
Lam sang: cd sdc 18 (29%), dau hieu bat thddng thanh bung 40 (64%), binh thddng 4 (6.4%). Vi tri vet thddng: d thanh bung trddc 62.9%, phan thap long ngdc 19.4%, thanh bung sau ben 12.9%, tang sinh mdn 4.8%. Tham dd vet thddng thay; ldi tang 12 trddng hdp (19.4%), cd thung phuc mac 10 (16.1%), khdng ro thiing phuc mac 3 (4.8%), khdng tham dd 37 (59.7%).
Xet nghiem: hong cau 4.1 ± 0.9*10Vmm^
hematocrit 0.37 ± 0.9%, Hb 12.2 ± 2.6 g/l. Chan doan hinh anh: X quang cd liem hdi dddi hoanh 13 (21%), sieu am va chup cat Idp (CT) thay cd thddng ton trong d byng 63.5% va 81.5%. 26 trddng hdp (41.9%) cd tdn thddng phdi hdp di kem nhd: vet thddng ngdc, vet thddng phan mem, vd xddng chau, vet thddng tang sinh mdn...
Chi dinh phau thuat: mo md 42 trddng hdp (67.7%), mo npi soi 20 trddng hdp (32.3%). Xd ly cac tang bi tdn thddng trong mo xem trong bang 1.
Bang 1. Tanq ton Tang ton thu'dng Ruot non Gan CcJ hoanh Da dav Dai tru'c tranq Mach mau Lich Mac treo Than Mac noi Idn Tuy Bang quang Ta trang
thu'dng va cac phu'dng phap dieu tn Mo md (n=42) Khau
11 2 5 8 6 10 9 1 1 2 2 1
Cat 5 1
4
2 2 1
Bao ton 5
Mo noi soi (n = 20) Khau
6 3
3 Cat
1 Bao ton
7
Cpng (n, % ) 16 (16.7%) 16 (16 7%) 11 (11.5%) 11 (11.5%) 10 (10.4%) 10 (10.4%) 3(3.1%) 9 (9.4%) 3 (3.1%) 3 (3.1%) 3(3.1%) 2(2.1%) 1 (1.04%) Mo md 42 trddng hdp, trong dd cat va lam hau mdn nhan tao 4 vet thddng dai trdc trang, 5 trddng hdp vet thddng gan da cam mau khdng lam gi them. Mo ndi sol 20 trddng hdp, trong dd ndi sol de chan doan 9 ( 4 5 % ) , ndi soi dieu trj 7 (35%), ndi soi dieu tri ket hdp md bung tdi thieu 3 (15%), chuyen md m d 1 ( 5 % ) . Thu'dng ton phoi hdp trong vet thu'dng bung xem trong bang 2.
Banq 2. Thddnq td'n phoi he Tang ton thu'dng Tran mau mang phdi Vet thirdnq phan mem
^p va each x d trf XLT tri ton thu'dnq Dan Idu mang phdi Khau vet thdcfng
So benh nhan 18
3
Tv le % 69.2 11.5
Y HOC VIET NAM THANG 6 - SO 1/2013 Vet thirdng tang sinh mon
Vet thu'dnq tim Vd xu'dnq chau
CSt loc, hau mon nhan tao Khau, dan lu'u mang phoi ThSt mach chau tronq, bat donq Conq
2 1 2 26
7.7 3.8 7.7 100 Thdi gian md cua nhdm md m d trung binh la 196.6 ± 1 1 0 phut, cua nhdm m d npi soi trung binh 74.4 ± 32.2 phut. Bien chu'ng sau md 11 trddng hdp (17.7%), trong dd 8 trddng hdp (12.9%) bien chirng chi can dieu trj ndi khoa khdi ra vien, 3 trddng hdp (4.8%) t d vong. Bien chu'ng va td' vong xem trong bang 3.
Bang 3. Bien chirnc Bien chijrng Chay mau sau mo Ap xe ton dd Nhiem triinq vet md Tir vong sau md
va tir vonq sau md Nguyen nhan Bd sdt ton thddnq T3C dan Idu d bunq Khdng xac dmh 2 sdc mat mau 1 viem phuc mac
Phu'dng phap mo Noi soi Mo md Mo md Mdmd
Thdi gian mo Nqay 2 Ngay 4 Nqay 4-8 Ngay 2,3,12
C$ng f n, % ) 1 (1.6%) 1 (1.6%) 6 (9.7%) 3 (4.8%) Thdi gian nam vien trung binh cua nhdm mo md 8,2 ± 3.6 ngay, cua nhdm mo npi soi 6 ± 2.7 ngay. Ty le benh nhan khdi ra vien 95.2%.
IV. BAN LUAN
Vet thddng bung hien van la nguyen nhan chfnh phai nhap vien do chan thddng tai nhieu qud'c gia tren the gidi. Trong vet thddng bung, vet thddng do bach khf thddng gap nhieu hdn gap 3 lan vet thddng hda khf nhdng ty le tir vong cua vet thddng bach khf thap hdn nhieu so vdi vet thddng hda khi vi nang Iddng xuyen thau cua nd thap hdn. Cd khoang 90% cac ca t d v o n g ciia vet thddng bung deu den t d vet thddng do hda khf.
Oieu tri vet thddng bung, trddc the ky 19 chii yeu la theo ddi bao ton khdng mo [ 1 ] . Nam 1887, sau cupc ndi chien d My, Hiep hdi phau thuat chan thddng Hoa ky d^ khuyen cao s d c a n thiet phai md bung tham dd vi nhu'ng tru'dng hdp dieu tr; bao ton khdng md vet thddng bung cd ty le t d vong rat cao. Khuyen cao nay da t r d thanh tieu chuan bat budc cho viec x d trf vet thddng bung sudt qua hai cudc chien tranh The gidi trong the ky 20. Tuy nhien x d trf vet thddng bung bang phau thuat khdng tranh khdi nhieu trddng hdp md bung khdng cd ton thddng hoac ton thddng da t d lien khdng can thiet phai phau thuat. T d 30 nam trd lai day, khuynh hddng dieu tri vet thddng bung bang phau thuat da cd nhieu thay doi nhd s d tien bp cua cac phddng tien chan doan hinh anh n h d sieu am, chup cat Idp, npi soi d bung.,, do dd ty le md bung tham dd da giam di ro ret.
Ve tudi va gidi trong vet thddng bung:
nghien cdu cua Monzon-Torres (2003) [ 3 ] , nam gidi chiem 79.7%, nhdm tud'i hay gap vet thddng bung t d 16-30 tud'i; Nguyen Chanh (1995) [ 2 ] ,
nam gidi 95%, tudi trung binh 28.4; nghien cdUcua Chung tdi, nam gidi 96.8%, tuoi trung binh 29.3, tu'dng dddng vdi nghien cird ciia Nguyen Chanh.
Ve nguyen nhan gay nen vet thu'dng bung;
theo nhieu tac gia [1,2,4,6], chu yeu la vet thddng bach khf. Monzon Torres [3] nghien cu'u 89 vet thddng bung t d 1999-2000 thay vet thddng do bach khf chiem 66.3%, vet thu'dng hda khi 3 3 . 7 % ; McCarthy (1991) [4] nghien din 311 trddng hdp vet thddng bung trong thdi gian 5 nam thay 7 5 . 9 % la vet thddng bach khi, vet thddng hda khf chi chiem 2 4 % ; Nguyen Chanh [2], trong 60 trddng hdp vet thddng bung thi vet thddng bach khf chiem den 87.8%. Nghien cuti cua chung tdi, vet thddng do bach khi chiem 75.8%, vet thddng do hda khf chi cd 6.4%.
Odi vdi vi trf cua vet thddng tren thanh bung, nghien cdu cua Monzon Torres [3] thay vet thddng d thanh byng trddc 34.8%, ha siTdn phai 16.8%, ha sddn trai 23.5%, thanh bung sau 16.8%; McCarthy [4] thay vet thddng d thanh bung trddc 4 5 % , mang sddn 16.4%, thanh bung sau 19.2%. Nghien cull cua chung tdi, vet thddng thanh bung trddc 62.9%, phan thap long ngdc 19.4%, thanh bung sau ben 12.9%. theo Demetriades (1987) [ 6 ] , doi vdi vet thddng do bach khf d thanh bung trddc cd the dieu trj bao tdn khdng mo ngay ca khi cd thung phuc mac nhdng khong cd cac dau hieu bat thddng cua thanh bung va huyet dpng on djnh. Tuy nhien ddi vdi nhUng vet thu'dng d thanh bung sau thi thai dp x d ly lai khac so vdi vet thu'dng d thanh byng trddc. Sd dl n h d vay la vi mot so tang trong d byng nam dinh sat vao phuc mac thanh sau nhu"
Y HOC VlgT NAM THANG 6 - SO 1/2013 ta trang, tuy, dai trang nen khi bi ton thddng thi
khong cd bleu hien cac trieu chutig thanh bung do do kho phat hien dan tdi x d trf mupn.
Ve Chan doan: chup CT cd the phat hien dddc hau het ton thddng d tang dac. Tuy nhien vdi tang rong thi dp nhay cua CT thap hdn. Vi le dd nen nhieu tac gia [1,3] de nghj khi da chup CT ma van nghi ngd cd thddng tdn tang rong thi nen chi djnh phau thuat npi soi 6 bung de chan doan va ket hdp dieu tn trong mdt so tn/dng hpp. Nghien ciTu cua chung tdi, chyp CT de chan doan trddc md phat hien dddc thddng ton 81.5%, chi dmh md ndi soi de chan doan va dieu tn 32.2%.
Nghien cdu cua Villavicencio (1999) [6] tren 37 trddng hpp cd chan thddng bung da neu ra 3 vai trd CLia mo ndi soi la: sang Ipc, chan doan va dieu trj. Neu phau thuat npi soi de sang ipc xem cd tdn thddng trong o byng hay khdng thi hau het cac nghien ciTu cho thay mire dd chinh xac gan nhd tuyet ddi vdi dp nhay va do dac hieu dat 100%. Neu sir dyng phau thuat npi soi nhd cdng cu de chan doan va danh gia ton thddng thi cd nhieu tranh luan, ket qua rat khac nhau. Nghien cdu ciia cac tac gia [7] cho thay: phau thuat npi soi trong chan thddng bung cho ket qua chfnh xac cao vdi dp nhay 100%, dp dac hieu 9 1 % , dp chfnh xac 96%. Nghien cdu cua Cino Bendinelli lai cho thay p h l u thuat ndi soi de de sdt ton thddng d rudt non, mac treo, cac tang sau phuc mac (tyy, ta trang, than, thdpng than...), ty le bd sdt ton thddng t d 4 1 % den 77%. Nghien ciru cua chung tdi, phau thuat ndi soi cho ty le chan doan chfnh xac 98.4%, cd 1 trddng hpp (1.6%) bd sdt ton thddng (xem bang 3).
Ve dieu tri vet thddng bung: Mocap cducH dinh khi benh nhan cd viem phiic mac va tinh trang huyet dpng khdng on dinh ca tren lam sang va xet nghiem hoac khdng the danh gia dddc tinh trang byng. f^d c6 tri hoan khi huyet dpng chda dn djnh, khdng cd viem phiic mac nhdng chup CT thay cd thung tang rdng. i^o noi 50/khi nghi ngd cd thddng ton tang rong hoac cd thddng ton ngdc bung ben trai tren chup CT.
Theo roi khong /77o'khi chup CT khdng cd thddng ton tang rong, huyet ddng dn djnh. Mo ndi soi cd the can thiep cam mau trong vd gan, vd lach, rach mac treo rupt hoac khau vd rudt non, bang quang, cd hoanh... Ddi vdi vd rudt non phiTc tap hoac vd dai trang phai cat doan thi can thiet phai ho trd bang mpt dddng m d bung tdi thieu de dda quai rudt ra ngoai thanh byng x d ly (cat, noi, md thdng hoac lam hau mdn nhan tao...).
Trong trddng hdp thddng tdn Idn, phiTc tap, nhieu ton thddng khdng the tiep tuc thdc hien phau thuat npi sol thi can phai quyet djnh chuyen md md sdm de giai quyet dut diem tdn thddng.
Nghien cdu cua Zantut (1997) tren 510 trddng hdp vet thddng byng, trong dd cd 316 vet thddng bach khi va 194 vet thddng hda khi.
Chi djnh md md 207 trddng hpp (40.6%) trong dd cd 52 tru'dng hPp (10,2%) mo md bat budc vi vet thddng hda khf. Mo npi soi 303 trddng hdp (59.4%), trong dd 277 trddng hpp (54.3%) khi ndi soi khdng thay ton thddng hoac ton thddng khdng can x d ly; 26 trddng hdp (5.1%) ndi soi dieu trj gom khau cd hoanh: 16, cat till mat: 1, khau gan: 6, khau thiing da day: 3. Bien chu'ng sau mo trong toan bp nghien cdu la 10.2%, bien chdng trong nhdm mo ndi soi la 2 % . Khdng cd t d vong trong nghien cdu. Thdi gian nam vien trung binh la 1.7 ngay,
Chung tdi cd 62 trddng hdp vet thddng bung, trong dd do bach khf 47 (75.8%), do hda khf 4 (6.4%), do tai nan lao dpng 4 (6.4%), do tai nan sinh hoat 7 (11.3%). Chi dmh md md 42 (67.7%); md ndi soi 20 (32.3%) trong do ndi sol chan doan 9 (45%), ndi soi dieu tri 7 (35%), npi soi ket hpp md nhd thanh bung 3 (15%), chuyen md md 1 (5%). Bien chdng sau mo 11 trddng hdp (17.7%), t d vong 3 (4.8%). Thdi gian nam vien trung binh ciia nhdm mo md 8.2 ± 3.6 ngay, cua nhdm mo npi soi 6 ± 2.7 ngay. Ty le benh nhan khdi ra vien dat 95.2%.
V. KIT LUAN
Vet thddng bung la cap ciTu ngoai khoa thddng gap. Mac du da cd nhieu tien bd trong chan doan, phau thuat, gay me hoi sdc nhdng ty le bien chdng (17.7%) va ty le t d vong (4.8%) trong vet thddng bung cdn cao. Ket qua khdi ra vien chi dat 95.2%.
Phau thuat npi soi trong chan doan va dieu trj vet thddng bung td ra an toan, hieu qua, kliong cd bien chdng phai chi dinh mo lai, thdi gian mo va ngay nam vien ngan, ty le khdi benh ra vien cao. Tuy nhien phau thuat ndi soi chi nen ap dung vdi nhu'ng thddng ton mdc do nhe, trung binh. Vdi nhu'ng tdn thddng Idn, nhieu ton thddng ddi hdi phai x d trf phdc tap nhd vd ta trang, vd Idn tang dac, td'n thddng nhieu tang, nhieu vi trf... thi chda nen chi djnh x d trf bang phau thuat ndi soi.
Y HOC VlgT NAM THANG 6 - SO 1/2013 TAI LIEU T H A M K H A O
1. Stawicki SP (2007). Trends in nonoperative management of traumatic injuries: A synopsis.
OPUS 12 Scientist; 1 (1): 19-35.
2. Nguyen Chanh (1995). Vet thddng thau bung nhan xd tri 60 trddng hdp. Ngoai khoa sd 9, tong.
hpi Y Dddc hgc Viet nam, 187-190.
3. Monzon Torres B I , Maria Ortega Gonzalez (2004). Penetrating abdominal trauma. SAJS, Vol 42(l)february, 11-13.
t . McCarthy MC, Lowdermilk GA, David FC, Thomas AB (1991). Prediction of injury caused
by penetrating wounds to the abdomen, flank, and back Arch Surg. 126 (8): 926-966.
Francis ON, Martin HW, Lester WJ, James a , Isidore C ( 1 9 7 4 ) . Surgical judgment in the management of penetrating wounds ofatxiomen:
experience with 2232 patients. Ann Surg, Vol 179, No 5, May, 639-645.
Demetriades D, Rabinowitz B (1987), Indication for operation In abdominal 5fei wounds. A prospective study of 651 pahents. Ann Surg, 205: 129-32.
Villavicencio RT, Aucar JA (1999). Analysis of laparoscopy in trauma. J Am QJII Surg, 189:11-20.
CAC HiNH THAI TON THlATNG DONG MACH THAN QUA
SIEU A M DOPPLER a B E N H N H A N DAI THAO OOffNG TYP 2
V u B i c h N g a * , D a u Ly Na**
T O M T A T
Muc tieu. mo ta cac hinh thai ton thddng dong mach than qua sieu am dopller mau d benh nhan dai thao du'dng typ 2 va mot sd yeu td lien quan. Phu'dng phap nghien cdu. Sieu am Doppier mach than cho cac benh nhan dai thao dddng typ 2, mo ta ton thu'dng dong mach than tren sieu am vdi cac mdc do khac nhau. tang sdc can, mire do xcf viJa, hep dong mach than. So sanh mdc do ton thUdng dong mach than vdJ mot so yeu to hen quan khac nhd; tuoi, gidi, va tinh trang hiit thudc la. Ket qua: 11/92 benh nhan dai thao dddng typ 2 cd tdn thddng dong mach than:
trong dd co 6 trddng hdp hep dong mach than, 3 tru'dng hdp xd \i\ia dong mach than, 2 trudng hdp tang sdc can ddng mach than. Tuoi trung binh ciia nhdm cd ton thu'dng ddng mach than la 71,63 ± 7,173 (nam) cao hdn han so vdi nhdm khong cd ton thddng dong mach than (60,17 ± 8,814 (nam) (p
<0,05). Ty ie ton thddng dong mach than trong nhdm
> 70 tuoi la 38,1% cao hdn han so vdi nhdm < 70 tuoi (p < 0,05). Ty le ton thu'dng ddng mach than trong nhdm nam la 11,36%, va trong nhdm nd la 12,5%
(p>0,05). Khong cd sd khac biet cd y nghfa thong ke ve ty le hiit thuoc la trong 2 nhdm co ton thUOng dong mach than va khdng cd ton thu'dng ddng mach than.
Ketluan:Tm thu'dng dong mach than hay gap nhat ia hep dpng mach than(6/lltru'dng hdp), tiep den la xd viJa mach than (3/11), va tang sdc can dong mach than (2/11), TUOI cang cao thi nguy cd ton thddng mach than tang cao. Khong cd sd khac biet ve gidi va
* Bo mon Noi tong hdp, Tru'dng Dai hgc Y Ha Noi, * * Dai Phan bien khoa hoc: PGS.TS. Biii Van Lenh 108
hilt thudc vdi tdn thu'dng ddng mach than d benh nhan dai thao dddng typ 2.
Tu'khoa: dai thao dddng typ 2, hep dpng mach than S U M M A R Y
THE TYPES OF RENAL ARTERY LESIONS ON ECHODOPPLER AMONG TYPE 2 DIABETES
Objective :. Our study aimed to assess renal artery lesion forms on echo Doppier in type 2 diabetes patients, it relations with some clinical indexes, contnbuted to the source of literature about renal artery lesions in type 2 diabetes patients. Method.
The cross-sectional study, involved 92 type 2 diabetes patients. Assessment of renal artery lesions based principally on echo Doppier. Companng dinical indexes between the subgroup with renal artery lesions and the one without renal artery lesions with Pearson's chl- squared test and Student's t-test. Results: 11 patients (n=92) diagnosed renal artery lesions on echo Doppier: 2 cases: two-sided elevated arterial resistance (18.18%); 3 cases: renal artery atherosclerosis (27,27%); 6 cases: renal artery stenosis (54,55%). We compared the 2 sub - gnDups:
the sub - group with renal artery lesions vesus the one without renal artery lesions. Average age: 71,63 ± 7,173 VS 60,17 ± 8,814 year - p <0,05. Smoking (9,09% VS 16,05%, p>0,05). Compare the percentage of patients with renal artery lesions in the male sub- group to the female sub - group: 11,36% vs 12,5 %, p>0,05. Conclusions: 11 patients (n=92) diagnosed hoc YHa NOI
