T A P C H CMAM cilLi VICT NAM So 3/201 1
NGHIEN ClfU SlJ THAY DOI MQT SO CHI TIEU SINH LY, SINH HOA TREN BENH NHAN BENH LY CQT SONG THAT L I J N G
DlJOC DIEU TRI DAU BANG DIEN CHAM
PGS.TS. NGHIEM HgU THANH (Bdnh vien ChSm cihi Trung lAAig)
Tom tdt
Nghien ctfti si^ thay ddi mpt sd chi sd' sinh ly, sinh hoa trdn 300 benh nhdn dau thit Itftig dtfdc dilu tri dau b^ng didn chdm. Ngtfdng dau tdng dtftfi tac dung cua di$n chdm, hd sd K sau didn chdm (lOHz) l^n 1 la 1^1, sau d^t dieu tri la 1,34. Cac chi s6 didn nao khdng thay ddi sau didn chdm°. Chd't din truyin th^n kinh (Adrenalin, Noradrenalin) va chdt tham gia trong h$ thdng giam dau (p-Endorphin) tSng Idn sau d<^t dilu tri. H$
so' giam dau K tf nhom di^n chdm lOHz kdt hdp thuy chdm sau dieu tri tdng hdn so vtfi nhdm didn chdm tin s6 lOHz va nhdm di$n cham tSn sd4Hz ddn thuSn.
Summary
Study the changes of some physiological and biochemical indicators of 300 patients who suiter from low - back pain syndrom and are treated by the Electro Acupuncture (EA). The pain threshol has been increased hy the EA effect, K index after the 1st of EA (iOHz) is 1,21, after treatment period is 1,34. The Electro Encephalogram Indicators haven't changed after EA. The nervous transmitted substances (Adrenalin, Noradren- alin) and internal anti pain substances (^-Endorphin) have been increased after treat- ment period with EA. The K index of group which has been combined EA wich frequency of lOHz and Pharmaco Puncture is higher to the group has been used EA with frequency of lOHz and 4Hz singularly.
¥ A r c H C H I M c i / t V I | T N A M _._J s e e 3 / 2 0 1 1
I - DAT VA'N Di
Dau thdt Itfng Id hidn ttfdng dau cdp tfnh hoac man tSnh 6 vting ttf ngang ddt sdng LI ddn ngang dia ddm L5 - S1 (bao gdm cdt sdng thJit Itfng vk c^c td chtfc xung quanh) do nhi^u nguyen nhfin (b$nh IJ dia d^m, c^l sdng, thSn kinh. ndi tang...). T? Id b^nh tSng theo tudi. 6 Vidt Nam, dau xtfdng khdp (chu yd'u 1^ thodi hoi) chidm 20% sd bdnh nhSn, cdc vi tri thodi ho5 theo thtf ttf ttf cao ddn thdp: cdt sdng tb^t itfng 31%. cdt sdng cd 14%, gdi 13% (4],[5].
Y hoc phtfdng Ddng da md td chtfng ydu thdng rdt rd ling trong c5c y van cd v& cd nhidu phtfdng phfip didu tri hidu qui: chim ctfu, thudc ddng y, xoa b6p bS'm huydt... trong dd cham ctfu da khing dinh dtfdc hidu qui cua minh trong didu tri dau thiit limg. Cic tic gii dIu cho ring chSm ctfu cd tic dung rat td't ddi vdi dau thit Itfng khdng nhffng lam giam dau nhanh mi con nhanh chdng kbdi phuc lai van dong CSTL [2],[3].
Nham lam phong phtf thdm phtfdng phip dieu tri dau th^t lung vi gdp phan tim cic cd sd khoa hoc dd chtfng minh gii tri gidm dau c6a didn chim, chijng tdi tidn hanh: Dinh gii stf thay ddi mot sd chl tidu sinh 1^, sinh hoi trdn bdnh nhin dau th£t Itfng dtfdc dilu tri dau bKng didn chSm.
II - D 6 I TU0NG VA PHlTONG PHAP NGHIEN CirU
1/ Ddi ttf<^ng nghidn cl^u: 300 bdnh nhin dtfdc Itfa chpn theo tidu chu^n cOa y hoc hidn dai va y hpc cd truydn. Chia lam 3 nhdm:
Nhdm 1:100 bdnh nhan dilu tri bang phtfdng phip didn chim cic huyet vdi tan sd kich thfch 4H2.
Nhom 11: 100 benh nhin dieu tri bJing phtfdng phap dien cham cac huyet vdi t^n sd kich thich lOHz.
ZOl
Nhdm III: 100 bdnh nhin didu tri b k g phtfdng phip di?n cham cic huydt vdi tan sd kfch thich lOHz kdt h(?p vdi thiiy cham Vitamin BI2, Becozyme 2ml vi Novocain 3%.
2/ Phtfdng phdp dilu tr}:
Phic dd huy^t dilu trj dau do thoii hoi cdt sdng thit Itfng: Dilu tri giim dau bing di^n chim.
- Cdng thtfc huydt:
+ Chim t i cic huy^t: Dai Trtfdng du, Giip Tfch LI - L5, Uy Trung, Thtf Lidu.
+ Chim bd huyet: Thin du.
- Kim chim: DQng kim the chim d4i 5-8cm tuj huydt.
- Miy didn chim M7 do Benh vidn Chim ctfu san xuat.
- Lieu trinh: Mdi ngay I lln 30 phut x 10 ngiy lien tuc.
3/ Phtfdng phip nghidn cihi: TbOr nghidm lam sing so sinh trtfdc sau dieu tri.
4/ Chi tidu theo doi:
Ngtfdng dau dtf^c xic dinh bing may Analgesy metter (Italia): dtfdc xic dinh trdn thang do vi tinh bing gam/giay (g/s). * Hd sd giim dau K dtfdc tinh bing mtfc cam giic dau sau dieu tri chia cho mtfc cam giic dau trtfdc didu tri.
5/ Theo doi chi sd sinh 1^, sinh hoa: Didn nio. Xic dinh ham Itfdng catechotamin (Adren- alin, Noradrenalin) bing bd ELISA canh tranh si^ dung mlu dia vi dinh ItfCfng. Ldy man miu ba thdi didm: Trtfdc vi sau didn chim l^n 1, sau ddt didu tri. Xic dinh ham Itfdng P-Endorphio bing phtfdng phip midn dich.
6/ Phtftfng p h i p xiS" ly s6' lidu:
Cic sd lieu deu dtfdc lap bang, x& IJ theo thuat toin thdng kd y hoc chtfdng SPSS 15.0.
T A P c u i CHAM cCli V I C T N A M
S6' 3/201 1
III - K E T QUA NGHIEN CtfU:
Bang 1 : So sanh s i l blSh doi ngU3ng dau (g/s) t^l cac thdi diem nghien o l u
Nhom ~~—.—..^^^^
Dien cham f=4Hz (n=100) Di§nchamf=10Hz
(n=100) Ot^n chSm + ThuJ Cham
(n=100)
Tniac dISu tri (1) 339,21±91,0 K2-1=1,15 341,16±85,71 K2-1=1,21 336,35±84,85 K2-1=1,22
Sau diSu tri 30phlJt(2) 392,35±79,16 K3-1=1,25 412,51±82,16 K3-1=1,34 409,68±81,85 K3-1=1,34
Sau 7 ngdy dlSu tri (3) 425,27±81,35 K3-2=1,08 456,23±84,58 K3-2=1,06 452,68±82,89 K3-2=1,11
P p2-1=' p3-1="
p2-1=' p3-1="
p2-1=*
p3-1="
GhichO:*=0,01, "=0.001
Cic kdt qui trdn bing 1 cho thdy: dieu tri giim dau bang dien chim tan sd lOHz kdt hdp thiuy chim dat hidu qui giim dau ttfdng dtfdng vdi dien chim tan so lOHz ddn thuan.
Bang 2 . S u bien tfdi cua ni$t so nh|p cd ban t r l n <5i$n nao dS tai cac thdi d l l m nghien cCTu
Ian so (Hz)
Bien a t i V )
Chl so %
Nhip alpha beta theta delta alpha t}eta theta delta alpha beta theta delta
Thdi diem nghien cl3u (n=300) Trudc dieu trj
10,5010,79 17,35±3,12 5.76±0,83 3,45±1,14 56,08±20,73
13,13±8,54 11,6S±4,53 5,23±1,86 45,21±16,69 32,37±12,68 8,46±3,03 2,64±1.96
Sau dieu tr|
10,65+1,14 17,97±3,66 5,61+0,96 3,41±0,64 62,83±20,17
12,2416,90 8,4714,24 5,1511,87 64,25117,69 29,94111,06 5,1812,96 2,32+1,24
P
>0,05
>0,05
>0,05
>0,05
<0,05
>0,05
>0,05
>0,05
<0,05 . >0,05
>0,05
>0,05 C i c sd lidu trdn bang cho thay sau ? ngiy dilu tri, bien dd v i chi sd (%) nhip alpha ting cd y nghia thdng ke. Didn chim khdng lim tang t^ Id tin sd sdng alpha d nhdm benh nhan. Bidn dd va chi sd (%) nhip beta, theta, delta trdn didn nao cua nhdm bdnh nhan nghidnctfu deu giim nhtfng khdng cd stf khac bidt vdi p>0,05.
la
T A P cui cHiM ci/li VI(T NAM
SS' 3/201 1Bing 3. KSt quH nghl6n cilu sv thay del nn$t s£i chl so hoa sinh llSn quan d^n tac di^ng giam dau cua difn cham tr§n lam sdng t^l dc thdi dljm nghien cClu (pg/ml) (n=SO)
" ^ ^ TheidiSm
Nhom N C ^ \ ^
Adrenalin Noradrenalin p-EndorphIn Cortisol (ng/ml)
Tn/dcdiSutri(1)
45,3018.09 274,81157,97 45,85112,94 386,161130,23
SaudlSutn30phut(2)
58,81116,46 333,54158.40
54,51112,69 547,711162,84
Sau7ngiydi8utr|(3)
67,57113,54 341,76159,62 55,41113,86 560.451145,64
P
<0,01
<0,01
<0,05
<0,01 Sau ddt dilu u-i bing di?n chim, him Itfdng cic chi tidu sinh hda trong miu ting Idn rd rdt. Stf bidn ddi him Itfdng ^-Endorphin, Adrenalin, Noradrenalin, Cortisol trtfdc vi sau ddt didu tri bing dien chim cd y nghTa thdng kd vdi p<0,05-0,01.
IV - BAN LUAN 1/ Ngtf9ng dau:
Gia tri trung binh cua ngtfdng dau d benh nhin nghien ctfu sau dien chim 30 phiit vi sau 7 ngay dilu tri dIu tSng so vdi trtfdc khi didn cham, stf tang nay co y nghia thdng ke vdi p<0,01 vap<0,001.
- Nhdm bdnh nhin dtfdc kich thich cic huydt vdi tan sd I OHz cd stf bien ddi gii trj trung binh ngtfdng dau cao hdn so vdi nhdm didn chim vdi tan sd4Hz vi ttfdng dtfdng vdi nhdm didn chim vdi tan sd lOHz ke't hdp vdi thuy chim, stf khic bidt niy c6 J nghTa thdng kd vdi p<0,001.
Stf kdt hdp giffa didn chim vi thuy cham trong dilu tri giim dau khdng nhffng cd tic dung giim dau nhanh mi cdn rut ngin dtfdc thdi gian dieu tri cho cic bdnh nhan. Trong nghidn ctfu c5a Doin Hai Nam [4] sau 20 ngiy dilu tri mtfc dp khdng dau cua nhdm nghidn ctfu la 73,3%, mtfc dd dau nhe li 20% dau vffa 6,7%. Nghidn ctfu ciia Ltfdng Thi Dung [1] cung sau 20 ngiy dieu tri cho kd't qui khdng dau va dau nhe li 85,8%. Nghien ctfu cua Tarasenko Lidiya [5]
Z2|
trdn 30 bdnh nhin hdi chtfng thit Itfng hdng do thoii hda cdt sdng cho thdy sau 20 ngay kdt qua tdt li 60%, khi l i 40%. Kdt qui nghidn ctfu cua chung tdi cung dat ty Id cao so vdi mdt sd nghidn ctfu trdn, nhtfng thdi gian dieu tri ciia nhdm didn chim tan sd lOHz kdt hdp thuy cham cua chung tdi dtfdc rut ngin hdn (6 ngay). Dieu dd cho thay i^ng stf kdt hdp giffa didn chim vi thuy chim iion$ dilu tri bdnh dau that Itfng do thoii hda cdt sdng khdng nhffng cd tic dung giim dau nhanh ma c6n rut ngin dtfdc thdi gian dieu tri cho cic bdnh nhin.
2/ Kdt qua nghidn cihi si/ thay ddi chi tidu sinh 1^:
Cic kdt qui nghidn ctfu (Bang 2) cho thay sau didn chim, bidn dO va chi sd sdng alpha, cic sdng dang theta vi delta d nhdm nghien ctfu dIu thay ddi ting Idn hoac giam di nhtfng stf thay ddi nay khdng cd y nghia thdng kd vdi p>0,05. Dieu niy chtfng to didn cham cd tic dung dieu hda chtfc ning sinh ly cua cd thd.
Cd chd cua dien cham li tao ra cac phin xa thtfc vat, tuy nhieii hoat tinh cda he giao cam
T A P cui CHAH ci/t VICT HAH '- S ^ 3 / 2 0 1 1 hay phd giao cim chi xiy ra cue bd ndn khdng lam inh htfdng tdi cic chi sd sinh 1^ dtfdc nghidn ctfu. Mat khic dieu hda boat ddng h^
thin kinh thtfc vat cdn cd vai trd cda cic trung tim d thin nao va viing dtfdi ddi. Chi khi toin bo hay phan Idn hd tbSn kinh giao cim htfng phan d6ng thdi thi mdi giy ra phin tfng bio ddng hay dip tfng vdi stress cOa he giao cim, lam cho cd thd hoat ddng manh hdn hdn so vdi luc binh thtfdng.
3/ Kdt qua nghidn cthi si/ thay ddi chi tidu sinh hda:
Bing 3 - Tai nhdm bdnh nhin dau thit Itfng, Adrenahn ting ttf 45,30 pg/ml Idn 67,57 pg/ml, Noradrenalin tang ttf 274,81 pg/ml Idn 341.76 pg/ml.
Ham Itfdng Adrenahn vi Noradrenalin tang 16n sau dilu tri 30 phut va sau dilu di 7 ngay, theo chung tdi li do khi dieu tri bang didn cham cac huydt da lim boat hda he th^n kinh nr chu (he thin kinh thtfc vSt).
Cung vdi stf ting ham Itfdng Cathecholamin, him Itfdng P-Endorpbin trong miu cung tang Idn cd y nghia thdng kd vdi p<0,05 sau dien chim lln 1 vi sau 7 ngiy dilu tri.
Dien chim lim ting ham Itfdng Cathe- cholamin trong miu da dtfdc nhilu tic gia d l c§p tdi nhat l i nhffng nghien ctfu cham te tuy kdt qua cd khic nhau do phtfdng phip dinh itfdng khic nhau. Cd chd tic dung ciia dien chim theo hpc thuyet thin kinh the dich tao ra ba loai phan tfng: tai cho, tidt doan, toin than.
Kich thich cOa dien chim dtfdc din truyin theo thin kinh tao ra cic cung phan xa tfc chd phin xa bdnh ly. Vide tang cic cbdt din truyin than kinh sau dien chim chffng td ring bd thin kinh, he thin kinh giao cam da dtfdc hoat hda [7].
Cung vdi ham Itfdng Cathecholamin tang, ham Itfdng p-Endorphin trong mau cung tang len sau
didn chim. Theo ke't qui d Bang 3, him Itfdng p-Endorphin trtfdc didn chim li 45,85 pg/ml, sau didn chim li 54,51 pg/ml vi sau ddt dilu tri li 55,41 pg/ml (p<0,05). p-Endorphin la mdt trong nhffng chat sinh hpc tham gia trong he thdng giam dau ctia cd thd. Xung didn dtfdc tao ra ttf cic huydt bi kich thich bing didn chim truyin tdi cic vttng cd khi ning lim mit cam giic dau d trdn nao. Tin hi^u nay dtfdc truyen tdi stfng sau tiiy sdng kich thich cic ndron bai tidt enkephalin va endorphin. Hai chdt niy tfc chd bii tidt chdt P vi giy ra tfc chd trtfdc synap do dd chan dtfdng dan tmyin cim giic dau qua sdi A5 va sdi C [6]. Nhtf vSy, vide tidn hinh dinh Itfdng Adrenalin, Noradrenalin, Cortisol va P- Endorphin trong miu cd y nghia quan trpng trong vide Itfdng hda tic dung giam dau cua dien chim thinh cic clii sddanh gia cd tinh chat thuyet phuc trong nghidn ctfu, cac ke't qua sinh hda gdp phan chtfng minh gia thuyet ciia nhffng nhi sinh IJ hoc ve cd chd chdng dau cfia cham ctfu li stf kdt hdp cua hai cd chd, dd li tfc chd din truyen cam giic dau cua tin hidu xuc giic va stf hoat hda hd thdng giim dau ciia cd the din tdi bai tidt cac opiate ndi sinh. Dilu niy d nhdm chi dtfng thudc giam dau khdng the cd dtfdc.
V - KET LUAN
Qua nghidn ctfu trdn 300 bdnh nhin dau cot sdng that Itfng dilu tri bing dien chim cic huydt vdi tin sd lOHz, didn chim cic huyet vdi tan sd 4Hz vi didn chim cic huydt vdi tan sd lOHz kdt hdp vdi thiiy chim, chiing tdi rilt ra nhffng kdt luan sau:
1/ Stf thay ddi cua mdt sd chi sd sinh I^, hda sinh btfdc dau da chtfng minh dtfdc cd sd khoa hoc ciia didn cham trong dilu tri chtfng dau:
Trdn lim sang, sau 7 ngiy dilu tri ngtfdng dau
T A P cui CHAM cCli vifT NAM
s e f 3 / 2 0 1 1 — (vdi tin so xung didn lOHz) d nhtSm b^nh nhan dau cOt s5ng thSt limg \i 456,23184,58 g/s cao hdn ro so vdi ngifdng dau sau di^n chSm iSn mOt I 30 phtit 412,5I±82,16 g/s vj ngudng dau ttudc ' di$n cham 341,16±85,7I g/s. H$ s^ gidm dau I K=l,34. Sir kh^c bi^t theo ngirdng dau giffa cdc I lln dl$n cham ndi trSn dIu cd ^ nghia th^ng kt
(p<0,OI-0,001).
2/ Hilm lUdng P-Endorphin sau 7 ng^y di^u tri 6 h$nh nhSn dau c$t s^Tng thIt liTng II 55,4I±I3,86 pg/ml, tang cao hdn so vdi sau di$n chSm lln 111 54,5I±I2,69 pg/ml v4 him liTdng
P-Endorphin trudc di6n chSm II 45,85±12,94 pg/ml. Him lltdng Cortisol, Adrenalin vl Nora- drenalin d nhdm bSnh nhSn nghi6n citu sau 7 ngiy di$n chim cung ting cd ^ nghia th^ng k€
so vdi sau di$n chim lln 1 vl trUdc di6n cham vdi p<0,OOI. Di^n chim khdng lim c i c chi s^
di6n nIo thay d^i cd ^ nghia th^ng k6 so vdi tnrdc di$n chim.
3/ H$ s^ giim dau K d nhdm di^n chim IOHz k^t hdp thiiy chim sau di^u tri ting cao hdn so vdi nhdm di6n chim tin s^ IOHz vl ditn cham tin s6 4Hz ddn thuln.
TAI LIEU THAM KHAO
1. Lddng Thi Dung (2008). Dinh gii tic dung cOa phiTdng phip di^n chSm k^t hdp xoa bop bim huyet dieu tri dau thIt lirng do thoai hda cot song. Khda luan tot nghiep.
2. Tran ThIi HI (2007). Dinh gii tic dung dilu tri tholt vi dia dem cdt sdng thIt lung bing phiTdng phip didn chim, xoa bdp k^t hdp vlt 1^ tri lieu. Luan vin thac sT y hpc, Tnrdng Dai hoc Y HI Ndi.
3. Lai Doin Hanh (2008). Dinh gii tic diing dilu tri hdi chifng thIt lutlg bdng bing phudng phip thuy chim. Luin vin chuyen khoa cap II, Tnrdng Dai hoc Y HI NOi.
4. Doin HIi Nam (2003). Dinh gii tic dung cda didn cham huySt Uy trung v l Gilp tich that limg (LI - L5) trong dieu tri chd'ng ydu thdng th^ hin thi'p. Lugin vin thac sT y hoc, TrUdng Dai hoc Y HI Ndi.
5. Tarasenko Lidiya (2003). Nghidn clhi dilu tri hdi chihig dau thIt lUhg hdng do thoii hda cdt sdng LI - SI bang di^n mang chim. Lu$n vin th^c sT, TrUdng D^i hoc Y HI Ndi.
6. Pham Thi Minh Ddc, Hoing Khinh HSng (2000). Nghien ciJu sU thay ddi ndng do hormdn true tuyen yen - vd thUdng than vl mdt sd chlTt truyen d?t thin kinh dudi t i c dung cija dien cham huyet Hdp Cdc. Tap chl Y hoc Viet Nam (tip 247 sd 5), tr. 24-28.
7. Nghidm Hiiu Thinh (2004). Nghidn cdu mdt sd chi sd sinh 1^ - hda sinh 6 cac bdnh nhan dUdc phlu thuat da dly dUdi dilu kidn chim te k^t hdp Uiudc h6 trd. Tap chi Y hpc thUc hinh (10), tr. 6- 9.
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