KHOA HOC, CdNG NGHE VA MOI TRUONG
U i qua (tISu trj ulem quanh rang bang bai tbuOc Dong nam dirdc DMT-09
60 NAM NGAY TRUYI (20 /10 /1950
Trung tudng Luang Cudng, Bi thu Dang uy, Chinh uy Quan khu 3 trao Huan chuang Quan cdng hang Nhat cho Benh vien 7
B
ENH rang mieng ndi chung va benh viem quanh rang noi rieng la nhii'ng benh rat phd bien trong cong dong. Nam 1986, To chirc Y te the gidi da xep benh rang mieng la tai hoa thir 3 cua loai ngudi sau benh ung thu va benh tim mach. O Viet Nam sd ngudi mac benh viem quanh rang tuang ddi cao, d tre em tudi tir 6- 8 chie'm 42,7%, lira tudi 12-14 chiem 71,4%, d ngudi Idn ty le nay chie'm de'n 96,7%. Viem quanh rang la benh pha huy td chirc viing quanh rang, cac cau triic nang dd va giii' rang tren cung ham. Neu khdng dupc dieu trj kjp thdi se dan tdi tinh trang mat rang, anh hudng den tam ly chirc nang nhai, phat am, thammy sire khoe cua con ngudi.
Hien nay viec dieu trj viem quanh rang chu ye'u la dung thudc tan dupe nhu Rodogyl (thudc udng), GelMrtrogyl Denta (thudc bdi), Givalex (nudc xiic mieng)... da sd cac thudc nay chi phii hpp vdi giai doan viem cap tinh, khdng the diing keo dai, lai cd tac dung phu, chdng chi djnh nen can dupc kham, ke don, theo ddi cua bac sT. Trong nhan dan cd kha nhieu bai thudc chira viem quanh rang, it ddc hai, gia thanh tha'p song cac bai thudc nay chua dupc danh gia mpt each khoa hpc, thudc cdn d dang tu pha che, san pham chua tien Ipi cho ngudi diing nen chua dupc phd bie'n rong rai. Tir thuc te neu tren nam
Ths. TRAN THI LOAN
2009 UBND tinh Hai Duong cho phep Benh vien 7 tie'n hanh thuc hien de tai "Nghien ciru danh gia ke't qua dieu trj benh viem quanh rang bing bai thudc Dong nam dupc DMT-09 (ke thira va phat trien tir bai thudc cd Co xi cao va Sat nha cao)", vdi muc tieu:
Nghien ciru hoan thien bai thudc nam dupc DMT-09 tir bai thudc cd phuong de dieu trj benh viem quanh rang; danh gia ke't qua dieu trj benh viem quanh rang cua bai thudc nam dupc DMT-09, so sanh vdi nhom dieu trj thudc tan dupc; danh gia hieu qua kinh te cija de tai.
Ket qua nghien ciru:
Benh vien 7 da ky hop dong vdi Cdng ty cd phan dupc, vat tuy te Hai Duong tie'n hanh san xuat thii nghiem vao thang 8 nam 2009, quy mo san xua't 3.000ml thudc cao long va 3.000ml nudc xuc mieng, san pham da dupc Trudng Dai hpc Dupc Ha Noi kiem nghiem dp an toan thong qua viec thii dpc tinh cap LD50 va ddc tinh an toan ban trudng dien, ke't qua cao long va nudc xuc mieng cho dp an toan cao. Don vj tien hanh xay dung tieu chuan bai thudc DMT-09 de san xua't thudc tren co sd dd Cong ty cd phan dupc vat tu y te Hai Duong tie'n hanh san xua't thudc tren quy mo cong nghiep, thdi gian san xua't vao thang 10 nam 2009, quy mo san xuat 800 Ip thudc cao long loai 15ml va 450 chai nudc xiic mieng loai 240ml, cac loai thudc
1 A TAP CHi KHOA HOC, CONG NGHE & MOI TRUONG HAI DUONG So 5 MO/2010
KHOA HOC, CONG NGHE VA MOI TRUING
C/ dupc san xua't dam bao dp an toan, du sd lupng, chat lupng, dat tieu chuan co sd, ddng gdi theo dung quy each de ra.
- Ap dung thudc cao long va nudc xiic mieng OMT-09 dieu trj cho 50 benh nhan bi benh viem quanh rang (nhdm 1), trong do benh nhan nam chie'm 50% va nu chiem 50% va 10 benh nhan ddi chirng chira bing thudc tan dupc (nhom 2), trong dd benh nhan nam chie'm 40%, nu chie'm 60%, benh nhan dieu trj deu cd lira tudi tir 20-45, lira tudi bj benh viem quanh rang cao nha't tir 40-45 tudi chie'm 68,3%, thdi gian mac benh cua benh nhan chie'm cao nha't tir 3-5 nam chie'm 51,7%.
Lp trinh dieu trj cho mdi benh nhan la 15 ngay, benh nhan dupc lay sach cao rang, lam ve sinh tiiJ Ipi bing may lay cao sieu am sau do mdi dung thudc, thudc cao long dupc bam vao tiii Ipi bj viem sau khi da lay sach cao rang, ngay bom 1 lan lien tuc trong vdng 15 ngay. Nudc xuc mieng dupc diing ngay sau khi ve sinh rang mieng, ngam thudc trong vong 2-3 phut rdi nhd di, sau do de thudc ngam vao td chirc Ipi viem 20-30 phut sau mdi dupc an udng hoac xiic mieng bang nudc sach, mpt ngay xuc mieng 3 lan va lien tuc trong 15 ngay.
Sau 15 ngay cho thay:
+ Chi sd the hien mire dp viem Ipi cua benh nhan ca 2 nhom deu giam sau 2 tuan dieu trj va tai kham sau 3 thang, ty le dp 0 (khoi benh) va dp 1 (giam benh) cua 2 nhdm deu tang, ty le viem quanh rang nang (dp 2 va dp 3) deu giam. Trong dd ket qua cua nhom 1 benh nhan khoi chiem 74%, nhdm 2 khoi chi chiem 50%.
+ Mire dp cai thien dp lung lay rang cija 2 nhdm nghien ciru deu giam, trong dd dp 0 (khdi benh) tang len, dp 1 dp 2 (benh vira va nang) deu giam di (nhom 1 dp 0 la 78%, nhdm 2 dp 0 la 60%) . Nhu vay, cao long va nudc xuc mieng BMT-09 c6 tac dung lam tang dp vung chac cua rang, thong qua viec lam giam viem Ipi, giiip td chirc Ipi lanh manh hon, rang chic hon va giiip benh nhan an nhai dupc tdt hon.
+ Mire dp giam dp sau tui Ipi:
dp sau till Ipi cang Idn the hien mire dp viem nhiem viing quanh rang cang nang, no the hien su pha huy td chirc Ipi quanh rang, lam dirt cac day ching quanh rang, lam tut Ipi, rang lung lay va ne'u khdng dupc dieu trj kjp thdi se dan tdi tinh trang mat rang sdm. Sau 15 ngay dieu tn bing bai thudc DMT-09 benh nhan d nhom 1 dp sau tui loi da giam la 1,29mm ro ret hon nhdm 2 la 0,89mm, dp sau tui Ipi giam, da phuc hdi dupc cac td chirc mo quanh rang.
+ Chay mau Ipi la bieu hien mire dp xung huye't, pha vo mao mach Ipj quanh rang, lam chay mau ra viing chan rang, tuy mire dp viem Ipj ma mau chay khi tham kham vao tiii Ipi hay chay mau tu nhien. Mire dp cai thien chi sd chay mau Ipi sau dieu trj 15 ngay da cd bien chuyen tdt cua benh nhan nhom 1 la 74%, trung binh 18%, kem la 8%;
nhom 2 tdt la 50%, trung binh 30% va kem 20%. Mire dp xung huyet, phii ne Ipi va chay mau Ipi cua benh nhan dupc dieu trj bing bai thudc DMT-09 da giam rd ret.
+ Mire dp tieu xuong d rang CLia benh nhan nhom 1 bieu hien
it bj tieu xuong hon d nhdm 2 thdng qua hinh anh chup Xquang danh gia mire dp tieu xuong d d rang va mire lam day huyet hdng xuong sau dieu trj, ket qua sau dieu trj cho tha'y benh nhan d nhdm 1 c6 bieu hien phuc hoi su tieu xuong d rang tdt la 72%, trung binh la 20%, kem la 8%;
nhdm 2 tdt la 50%, trung binh 40%, kem la 10%; dac biet viec phuc hdi cac mao xuong d rang, viing day chIng quanh rang dupc phuc hoi ro ret.
+ Mire dp bie'n ddi mo benh hpc d nhom 1 tdt la 74%, trung binh 20% va kem la 10%; nhom 2 tdt la 50%, trung binh 30% va kem la 20%. Thudc DMT-09 da kich thich cac te bao bieu mo tai tao, lam tang sinh te bao IpJ, giam te bao viem.
Ke't qua dieu trj dupc danh gia day du tren ke't qua lam sang va can lam sang, 50 benh nhan cua nhdm 1 sau 15 ngay dieu trj benh nhan khdi 76%, dd la 18% va khdng khdi la 6%, trong khi do nhom 2 benh nhan khdi chi c6 50%, benh nhan dd 40% va benh nhan khdng khdi la 10%. Nhu vay ket qua dieu tri cua nhom diing thudc nam dupc DMT-09 tdt hon nhom benh nhan ddi chirng diing thudc tan dupc the hien qua su cai thien chi sd Ipi, chi sd chay mau Ipi, dp lung lay rang, giam dp sau tui Ipi, sutieu xuong d rang va cai thien ve ke't qua mo benh hpc.
Dac biet trong sudt qua trinh dieu trj va theo doi" ket qua sau dieu trj khdng thay cd phan irng phu nao xay ra vdi benh nhan.
Bai thudc DMT-09 da ke thira dupc nhung tinh hoa eua bai thudc cd, bd sung them cac vi
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TAP CHI KHOA HOC, CONG NGHE & MOI TRUONG HAI DUONG So 5 MO/2010 <15
KHOA HOC, CONG NGHE VA MOI TRUONG
C ) thudng luon tren 90mmHg va ICP luon dudi 20mmHg (neu do dupc ICP) de sao cho ap luc tudi mau nao luon tren 70mmHg. Boi phu the tich neu benh nhan c6 da'u hieu giam the tich tuan hoan bing cac che pham ciia mau (dam bao Mb > 100g/L), albumin, djch keo, djch tinh the... Noi chung khong dupc sir dung cac dung djch nhupc truang.
+ An than giam dau bing mpt thudc nhom morphin (Fentanyl, Morphine) ke't hop vdi benzodi- azepine (Midazolam) hoac Thiopental (lieu khdi dau:
10mg/kg truyen TM trong 30; lieu tiep theo: Smg/kg trong 3h tiep theo; lieu duy tri: 1mg/kg/h).
+ Sir dung Manitol chdng phii nao: Manitol se dupc diing vdi lieu 0,5-1 g/kg khi ICP > 20 mmHg keo dai tren 15 phut. Ngoai ra, Manitol 20% dupc su dung thudng qui 6h/ lan vdi lieu noi tren. Khong sir dung khi huye't ap tam thu dudi 90 mmHg.
- Dieu tn cac rdi loan trung tam va toan than c6 anh hudng den tdn thuang nao thir phat:
+ Chdng co giat, kich thich: co giat hoac kich thich se gay tang ap luc noi sp.
+ Kiem soat huye't ap dn djnh
+ Chdng tang than nhiet:
khong dupc de sdt 39C hoac hon:
Paracetamol, lau mat...
+ Duy tri Hb > 100g/L: Truyen mau (ne'u can)
+ Chdng rdi loan nudc dien giai (Na+)
+ Kiem seat dudng mau:
Khong nen de dudng mau cao tren 7 mmol/L.
+ Hut ddm dai... (luu y hiit nhe nhang va han che kich thieh khi hut ddm)
Phong ngira va dieu tri cac bie'n chirng: Nhiim khuan benh vien (viem phdi, viem dudng tiet nieu, nhiim trimg mau, nhiem triing catheter), xuat huye't tieu hoa, rdi loan dong mau, rdi loan noi tie't, loet do ty de...
- Nuoi dudng tich cue: (qua sonde da day va dinh dudng tmh mach).
- Cac bien chung:
+ Bien chirng chung: nhiem triing benh vien, xuat huye't tieu hoa...
+ Bie'n chimg tdn thuang nao thir phat gay phii nao nang, tut ket va tii vong.
Danh gia ket qua.
Thang diem GOB (Glasgow Outcome Scale): la thang diem hay dupc dung de danh gia ke't
qua dieu tri benh nhan CTSN nang vao cac thdi diem: khi chuyen khoi khoa hoi sire, khi ra vien, 6 thang va 1 nam sau...
Thang diem dupc chia thanh 5 muc dp vdi ke't qua dieu trj tir tdt tdi xau:
- Dp 1; hoi phuc tdt (khong c6 hoac CO di chimg nhe)
- Dp 2: CO di chirng trung binh nhung v l n heat dpng dec lap dupc
- Dp 3: CO di chirng nang tinh tao nhung phai c6 ngudi phuc vu
- Op 4; trang thai sdng thuc vat - Dp 5: td vong
Chan thuang sp nao nang la mpt benh ly nang, c6 tinh dac thii rieng, diln bie'n phirc tap va c6 nguy ca dan den nhung tdn thuang khong hoi phuc, tham chi gay tu" vong. Viec cap ciru, dieu tri va hoi sire tich cue can phai dupc thuc hien bdi cac co sd y te c6 du dieu kien, co dpi ngu thay thudc da dupc huan luyen ve chuyen nganh. Dieu tn CTSN doi hoi tinh toan dien, su kien tri bam sat ngudi benh va thuc hien qui trinh ky thuat mpt each nghiem tiic mdi CO CO hpi curu sdng benh nhan va giam thieu tdi da di chirng sau chan thuong!
1 % V I I J U d 111 (Tii^ theo trang 15) thudc mdi so vdi bai cd phuong lam tang hieu qua dieu tri benh viem quanh rang, bai thudc da eo su phat trien hien dai hoa ve each bao che san xuat, thudc da dupc san xuat bing he thdng thiet bj hien dai va cho san pham dong Ip, ddng chai dam bao su dong deu ve chat lupng, bao quan dupc lau dai, tien Ipi cho ngudi sir dung. Bai thudc da dupc kiem nghiem dp an toan thong qua viec thir dec tinh cap LD50 va dpc tinh an toan ban trudng tai Trudng Oai
hpc Dupc Ha Ndi cho ket qua an toan. Phuong phap diing thudc da dupc cai tien thay vi bdi thudc vao Ipi, phuong phap mdi cua bai thudc tien hanh bom thudc dudi dang cao Idng vao tiii Ipi, viec nay da giup thudc luu giu trong mieng dupc lau hon nang cao hieu qua ciia bai thudc, Bai thudc OMT-09 dupc san xuat tir nam dupc, neu phat trien se md rdng dien tich trong cay thudc nam trong ca nudc, giam nhu cau thudc tan dupc nhap ngoai, gia thanh ciia bai thudc cung re hon thudc tan dupc va de sii dung cho ngudi b e n h " * •
18> TAP CHI KHOA HOC, CONG NGHE & MOI TRUONG HAI DUONG So 5 M 0/2010