4.
diem dich td hoc lam sang cua benh nhSn glocom dieu tri tai khoa Tong hpp - Viftn mat tCr thang 10/2000 den thang 9/2002, Ludn vdn thgc sy y hoc, Trudng Dai hpc Y Ha Npi.
Nguyin Thi Ha Thanh (2007) "Danh gia ket qiia lau dai cua phiu thuat cfit be ciing giac mac dieu tri glocom nguyen phat tai khoa glocom Btah vien Mat Trung uong" Ludn vdn thgc .s-y y hoc, Tru&ng Dai hoc Y Ha Npi.
Nguyin Thi Hoang Thilo (2007) "Danh gia dp md goc tien phong sau cfit mong mfit chu bien bang laser ND:YAG di^u tri glocom goc dong nguyen phat"; Ludn vdn tdt nghiep bdc .vy ngi trii cdc henh vien, Trucmg Dai hoc y Ha Npi.
Aung J, Ang LP, et al (2001) "Acute primary angle - closure glaucoma: long - term intraocular presure outcome in Asian eyes", Am J Ophthalmol, 131:7-12.
Lai J.S, Tharm G.C, Chua J.K.et al (2002)
"Laser peripheral iridoplasty as initial treatment of acute attack of primary angle - closure glaucoma:
a long - term follow up study". JGIaucoma, 11 (6):
484 - 487.
5. Ng V^'S, Ang GS (2008) "Laser peripheral iridoplasty for angle - cloure glaucoma", Cochran Database of .systematic Reviews, Issue 3.
6. Ritch R (2007) "Argon laser peripheral Iridoplasty: An Update", Survery of Ophthalmology. 52(3): 279 - 287.
7. Ritch R, Tham GG, Larm D.S (2004). "Long - term success of argon laser peripheral iridoplasty in the management of plateau irris syndrome", Ophthalmology. 111 (1): 104 - 108.
8. Tham G.G, Lai J.S (2005) "Immediate argon laser peripheral iridoplasty as initial treatment for acute phacomorphic angle - closure glaucoma before cataract extraction: a preliminary study",.
E K , 19(7): 7 7 8 - 7 8 3 .
KET QUA DIEU TR| QUANG DONG LASER S 6 M BENH VONG MAC DAI THAO DU'dNG
Nguyin Duy Anh*, Hoang Thj Phiic*
TOM TAT
Benh vong mac dai thao dUdng la mpt trong nhu'ng bien chUng nang, hay gap cua benh dai thao dudng, la nguyen nhan gay giam thi lUc va mil loa hang dau d cac nUdc phat trien. Trong khi phiu thuat chi dupc ap dung dieu tn benh vong mac dai thao dudng d giai doan co cac bien chiing tram trpng nhU xuat huyet dich i<inh nang, tang sinh dich kinh vong mac, bong vong mac..thi dieu tri quang dong laser lai to ra CO hieu qua tot, nhat la trUdc khi benh nhan co cac bieu hien ciia BVMDTD tang sinh nguy cd cao.
Chiing toi dang tien hanh mpt nghien ciiu ngau nhien so sanh ket qua dieu trj giu'a hai phUdng phap quang dong laser sdm benh vong mac do dai thao dUdng:
Quang dong laser toan vong mac va Quang dong laser nhdng viing vong mac thieu tUdi mau. Ket qua bUdc
dau tren 35 benh nhan (70 mat) dUpc dieu trj va theo doi toi thieu sau 5 thang nhU sau: 3 mat co tang thi lUc, 61 mat thj lUc dUpc giii nguyen va 6 mat thj lUc tiep tuc giam; chi co 5 mat benh tiep tuc nang len va chUa thay co sU khae nhau ve ket qua dieu trj giu'a hai nhom dieu tn quang dong toan vong mac va
quang dong viing vong mac thieu tUdi mau. ;-,
ABSTRACT j RESULTS OF THE EARLY PHOTOCOAGULATION l
BY USER DIODE THE RETINOPATHY DIABETIC.
Purpose. Evaluation the results of early laser photocoagulation the diabetic retinopathy.
Subject & Methods: 70 eyes of 35 patients w/ith nonproliferative diabetic retinopathy (severe and very severe) and early proliferative diabetic retinopathy ,
' B6 mon mdt Truang Dgi hoc Y Hd Noi isY.iA gnyfa gfiii iruo nsifigo
29
Laser photocoagulation by laser diode with 2 methods: panphotocoagulation and photocoagulation of areas ischemic.
The follow- up times is at least 5 months: the degree of the diabetic retinopathy and visual acuity are analyzed.
Results. Results of laser treatment : 5 eye found bad progression of the disease, 65 eyes stable; gain visual acuity in 3 eye, 61 eyes have visual acuity stable (87%) and 6 eyes with decreased visual acuity. There is no difference in results between two groups.
Conclusion: Early treatment by laser diode can preserve visual acuity in patients with retinopathy diabetic and prevent the disease from the bad progression. No statistic difference in results between two groups received panphotocoagulation and photocoagulation of areas ischemic.
Keywords: diabetic retinopathy, laser photocoagulation. "
I. OAT V A N OE
Benh vong mac dai thao dudng (BVMDTD) la mpt trong nhung bien chung nang, hay gap ciia benh dai thfio dudng (DTD). BVMDTD dang la nguyen nhan gay giam thj luc va mil loa hfing dau d cfic nudc phat trien[l,2,4].
Ciing vdi sir gia tang so lupng benh nhan mac benh DTD la sir gia tang cac bien chiing do DTD, dac biet la BVMDTD. Tai Khoa npi tiet benh vien Bach Mai, qua theo doi tir nam 1984 den 1988, cd tdi 10,92% benh nhan DTD nam vien mic BVMDTD[5]. BVMDTD khdng dugc dilu tri thudng dfin de'n nhiing bie'n chii'ng dich kfnh vdng mac nang nl nhu xuat huye't djch kfnh, tang sinh djch kfnh vdng mac, bong vdng mac, gldcdm tan mach... vfi kfe't thiic bfing mu loa.
Mac dii hien tai chua cd phuang phap nao dieu tri khoi BVMDTD nhung dieu trj quang dong bang laser va cac giai phap phau thuat da ddng gdp rat Idn vao viec lam giam nguy co mat thj lire do BVMDTD, tham chi trong mgt so trudng hgp cdn giup phuc hoi d nhung benh nhan da bj mat thj lire. Trfen thfe' gidi da cd nhilu nghifen cUu iing dung laser trong dilu trj
BVMDTD, trong dd cd nhirng nghifen cthi rfit cd gifi trj nhu Nghifen ciiu bfenh vdng mac dai thao dudng (DRS) (nghien cuu dieu trj quang dong laser BVMDTD tang sinh nguy co cao), Nghifen ciiu dilu trj sdm bfenh vdng mac dfii thao dudng (ETDRS) (dieu trj BVMDTD chua tang sinh nang, rat nang, BVMDTD tang sinh sdni)[6,7], cac nghien ciiu cua cac tac gia Phap, chau A...
Tai Viet nam da cd nhung nghifen ciiu difeu tri quang ddng laser BVMDTD nhu nghifen ciiu cua tfic gifi Biii Minh Nggc (I995)[l,2], Hofing thu Ha (1997)[4], Biii Tife'n Hiing (2002)[3]...va da cho nhirng kfe't qufi budc dfiu vl dilu trj quang dong laser BVMDTD.
De vifec fip dung ky thuat quang ddng laser trong dilu trj BVMDTD ngay cang cd hifeu qua ban, giiip ngan ngUa tife'n trien cua bfenh, han che' va lam gifim ty le mu lofi do bfenh nay gay ra chiing toi tien hanh nghien cuu nay nham muc tieu: Ddnh gid ket qud dieu tri quang dong laser s&m benh vong mac do ddi thdo die&ng bang laser diod
II. 0 6 l TUONG VA PHUONG PHAP NGHIEN COU Nghien ciin dugc thuc hien tren 35 bfenh nhan dai tliao dudng type 11, mac BViytDTB cimg giai doan d ca hai mat, dilu trj ngoai tru tai khoa Day mfit va mang bd dao, Bfenh vifen mfit trung uong trong thdi gian til' thfing 5-2005 den thang 4-2006.
_ Tifeu chufin lira chpn:
-t- Benh nhan cd BVMDTD chua tang sinh nang: khi cd mpt trong nhung dau hieu nang sau:
.Xuat huyet va vi phinh mach nhieu d ca 4 goc phan tu tren so do vong mac.
.Bat thuong tTnh mach gap tren 2 goc phan tu.
.Bfit thudng vi mach sau trong vong mac gap d it nhat 1 goc phan tu.
+ Bfenh nhan cd BVMDID chua tang sinh rfit nang: cd tir 2 dau hieu cua BVMDTD chua tang sinh nang trd len nhung chua cd tan mach.
-I- Bfenh nhfin cd BVMDTD tang sinh sdm:
khi bat dfiu CO tan mach vdng mac kich thudc nhd hon 1/2 dTa thj. (theo phan loai Airiie va House caiti6n(1981)[6,7])
_ Loai trU cfic trudng hgp sau:
-I- Bfenh nhan cd BVMDTD chua tang sinh nhe, vira, BVMDTD tfing sinh nguy ca cao.
-I- Tang sinh td chiic sgi mach nang, de doa lam nang qua trinh co keo dich kfnh vdng mac, xufit hifen bong vong mac.
-I- Vung thife'u tudi mfiu cue sau rdng (han 60% viing hofing diim vfi canh hoang diem), nguy calfim nang BLPHD, mfit vTnh vifen thj luc.
! + Khi vdng mac phu qufi nhilu trfen bfenh nhan cd bfenh ly thfin nang, cao huyet ap nang... hoac benh nhan khdng kiem soat dugc dudng mau.
4- Khdng lam dugc laser do due cfic mdi
trudng trong sud't ciia mfit.'-«^ w<'.i\f« ^W^T :?.,l -I- Bd dilu tri, bd theo ddi.
Phwofng phdp nghien cd-u: cac benh nhan deu dugc dieu trj ngau nhien 1 mat bang quang dong laser toan vong mac vfi mfit kia dugc quang dong laser vimg thieu tudi mau (nhirng viing nay dugc xfic djnh bang chup mach huynh quang).
Mfiy laser dugc sir dung la may laser diod Keeler, budc sdng laser 810 nm. Benh nhan dugc theo doi, kham do thj luc, danh gifi kfet qua dilu trj tren tien trien giai doan benh sau nua thfing, 1 thfing, 3 thang, 5 thfing.
III. KET QUA VA BAN LUAN 1 LTinh hinh chung : <
Trong so 35 benh nhan dugc dieu trj cd 28 benh nhan nu', 7 benh nhan nam; tudi tu 45 den 72.
Benh nhan cd thdi gian phat hien benh dfii thao dudng tir 3 thfing den 15 nam, 13 benh nhan cd cao huyet fip, 6 benh nhan cd suy than do 1 dugc theo doi va dieu trj on djnh, tat ca cac benh nhan deu cd dudng huyet dugc kiem soat tot.
2. Phan bo benh nhan theo giai doan benh vong mac:
So benh nhan Ty le phan tram
Benh vong mac chUa tang sinh nang 6 17,1%
Benh v5ng mac chUa tang sinh rat nang 22 62,9%
Benh vSng mac tang sinh scfm 20%
Tong so 35 100%
3. Ket qua dieu trj: sau tdi thieu 5 thfing theo ddi 3.1. Ket qud ve mat thi lire:
Quang dong toan vong mac Quang dong khu tru vung thieu
tu6i mau Tong so
TL tang 2 (5,7%) 1 (2,9%) 3 (4,3%)
TL giu' nguyen 30 (85,7%) 31 (88,6%) 61 (87,1%)
TL giam 3 (8,6%) 3 (8,6%) 5 (7,1%)
Tong so 35 35 70 3.2. Ket qud tren tien trien giai doan benh vong mac:
Quang dong toan vong mac
Quang dong khu tru vung thieu tUcfi mau
Tong so
Benh thuyen giam
0 0 0
Benh on djnh 33 (94,3%) 32 (91,4%) 65 (92,9%)
Benh nang len 2 (5,7%) 3 (8,6%) 5 (7,1%)
Td'ng so 35 35 70
31
f
r,
1
3.3. Trong nhom dieu tri quang dong todn vong mac, ket qud dieu tri tren cdc giai doan benh nhir saw
fiilr; ftfi^d
Benh vong mac chUa tang sinh nang Benh vong mac chUa
tang sinh rat nang
• Benh vong mac tang
* sinh sdm '-' Tong so
Benh thuyen giam
0 0 0 0
Benh on djnh 6 (100%) 21 (95,5%)
6 (85,7%) 33
Benh nang len
0 1 (4,5%) 1 (14,3%)
2
Tong sd 6 22
7 35 Trong nhdm dieu trj quang ddng viing vdng mac thieu tudi mau, ket qua dieu trj tren cac giai doan benh nhu sau:
Benh vong mac chUa tang sinh nang Benh vong mac chUa
tang sinh rat nang Benh vong mac tang
sinh sdm Tong so
Benh thuyen giam
0 0 0 0
Benh on djnh 6 (100%) 20 (90,9%)
6 (85,7%) 32
Benh nang len
0 2 (9,1%) 1 (14,3%)
3
Tdng sd 6 22
7 - 35
'•
Tir nhung ket qua budc dau neu tren, chung tdi riit ra mpt so nhan xet sau:
_ Khong cd sir tuong xiing giiia ket qua sdm sau dieu trj quang ddng laser ve mat thj lire va tien trien cua benh, cd le de benh vdng mac thoai lui thi can phai cd nhieu thdi gian hon, cdn thj Iuc cd the tang sdm sau dieu trj do tinh trang phii vdng mac cd the cai thipn sd'm sau quang dong laser.
_ Trong vdng 5 thang sau dieu trj chua thay cd sir cai thien ve mat tien trien giai doan benh, cd le thdi gian nay la qua sdm de danh gia ket qua dieu trj. Dieu nay phii hpp vdi nghien cuu cua cac tac gia nudc ngoai, hp chi danh gia ket qua dieu trj quang dong laser sau 1 nam, 5 nam.
Cdn 5 trudng hpp benh nang len trong nghien ciiru cua chiing tdi deu la nhirng trudng hpp cd xuat huyet mdi trong djch kinh d nhiing mat cd benh vdng mac chua tang sinh rat nang hoac tang sinh sdm, dieu nay cd the giai thich la do dieu trj quang dong laser sdm chi tac dpng den vdng mac ngoai cung mach thai duang tren va dudi, mau
van CO the chay ra tir viing vdng mac trung tam hoac tir cac tan mach.
_Giria 2 nhdm dieu trj quang ddng laser toan vong mac va quang ddng laser viing vdng mac thieu tudi mau chua thay cd sir khfic nhau ve ket qua dieu trj. Neu ket qua dieu trj khdng cd sir khfic biet cd y nghTa thdng ke giOa 2 nhdm vdi mpt nghien cuu ngau nhien ddi chimg va vdi so benh nhan dii ldn thi dieu nay het sire cd y nghia vi khi do ta cd the tien hanh quang ddng laser toan vong mac sdm cho cfic benh nhan mac benh vdng mac do dfii thao dudng ma khdng can phai chup mach huynh quang (phuong phfip nay tdn kem, mat thdi gian, riii ro do dj ii^ng thudc, nhieu chdng chi djnh...).
V. KET LUAN
_Thi lire cd the cai thien sdm sau dieu trj quang ddng laser benh vdng mac dai thfio dudng trong mpt sd trudng hgp cd phii vdng mac.
_Chua thfiy cd sir khfic biet ve ket qua thj
lire Cling nhu tiSn trien cua giai doan benh vdng mac dai thao dudng giua dieu trj quang ddng laser toan vdng mac vfi quang ddng laser cfic viing vong mac thieu tudi mau.
TAI LIEU THAM KHAO
1. Biii Minh Ngoc, Su: dung laser trong dieu tri henh vong mgc thie'u tuai mdu, Luan van tdt nghiSp bac sT chuyen khoa ca'p II, Dai hoc Y Ha noi 1994.
2. Biii Minh Ngpc, Sif dung laser trong dieu tri benh vong mgc ddi thdo du'ang, ky yeu cong trinh khoa hpc nganh mSt, 1995, 32.2.
3. Bill Tien Hiing, Nghien cifu cdc hinh thdi tdn thuang vong mgc trong benh ddi thdo difdng, Luto van tdt nghifip bac sT chuyen khoa ca'p II, Dai hoc Y Ha noi, 2002.
4. Hoang Thu Ha, Nhdn xet ton hgi vong mgc trong BVMDTD vd ket qud dieu tri budc ddu hdng Laser diode, Luan van tdt nghiep bac sT npi trii, Dai hpc Y Ha npi 1997.
5. Thai Hong Quang, Gop phdn nghien cicu cdc bien chimg mgn tinh trong benh ddi thdo duang, NXB Y hpc, 1999.
6. Early Treatment Diabetic Retinopathy Study Research Group, Early photocoagulation for diabetic retinopathy. Early treatment diabetic retinopathy .ttiidy number 9, Ophthalmology, 1991,98, 766-78.'5.
7. Early Treatment Diabetic Retinopathy Study Researche Group, Early treatment Diabetic Retinopathy Study design and baselines patient characteristics: ETDRS report number 7, Ophthalmology, 1991, 98, 741 -756.
CAP NHAT VE THlTC TRANG VA MOT SO YEU TO LIEN QUAN DEN TANG HUYET AP or NGirOl CAO
T U O I T A I P H I T O N GPHITONG iVIAl, QUAN DONG DA, HA NOI
Nguyen Thanh Ngoc', Ta Manh Cucrng^
TOM TAT
Dong Oa la mpt quan ciia Ha Npi vdi dien tich 10 km^ gom 21 phUdng, dan sd 365.850 ngUdi trong do CO 32.811 ngUdi cao tuoi. PhUdng Mai la mot trong 21 phudng ciia quan Ddng Oa. Ket qua nghien cu'u cho biet nam 2007 ty le tang huyet ap ciia ngUdi cao tudi la 37,6% trong do nam 48,5% va nu' 32,4%. Ty le tang huyet ap d nhom ngUdi tif 60 - 69 tudi la 31,7%, d nhom 70 - 79 tuoi la 47,1% va tren 80 tuoi la 45,5%. Ty le tien tang huyet ap tam thu la 29,5%
trong do nam gidi la 33,8% va nu' gidi la 27,5%. Tang huyet ap tam thu giai doan 1 la 23,8% va giai doan 2 la 10,0%. Tien tang huyet ap tam trUdng d nam chiem ty le 11,9% va nu" la 21,9%. Tang huyet ap tam trUdng giai doan 1 d nam la 7,14% va nQ" la 13,81%
theo JNC VII. Xem xet nhii'ng yeu to co the lien quan den THA tren cac doi tUpng nghien ciiu thay ngUdi tang huyet ap co tien sir gia dinh benh tim mach cao 1. Cue Dieu tri -Boy te
2. Vien Tim mach Viet Nam
hdn nhu'ng ngUdi I<h6ng tang huyet ap nhUng sU khae biet la chUa co y nghTa thong ke (p>0,05). Ben canh do nghien ciiu CURJ chUa thiet lap dUpc sU lien quan giii'a huyet ap va cac thanh phan lipid mau (CT, TGs, HDL-C, LDL-C), chi so khoi IUdng cd the (BMI) cung nhu cac thoi quen nhU udng bia, rUpu, an man, hut thuoc la va tap the due hang ngay d ngUdi cao tuoi b|
tang huyet ap.
•: : o i . u c >^.uiiii SUMMARY - ' ' =• fq
Update on the realities and some factors j relating to hypertension in the elderly of the >
Phuong Mai Ward, Dong Da District, Ha Noi City Dong Da District of Hanoi City is the area of 10 km 2, including 21 wards, population 365,850 people including 32,811 elderly people. Phuong Mai is one of the 21 wards of Dong Da district. Research results in 2007 showed that the percentage of hypertension in
33
