TCYHTH&B SO 5-2014 133
NGHIEN CUTU UfNG DUNG TR! UEU AP LL/C AM TRONG DIEU TR! VET LOET CUNG CUT
Nguydn Van Thanh\ Trdn Van Anh', Nguyln Van Hu§' ' Khoa Phiu thuat tao hinh- thim my,
BV Nhdn ddn 115. Tp Hd Chl Minh
^ Vidn Bong Qudc gia
T6MTAT
Ddnh gid tdc dicing cOa tri Hiu dp luc dm (VAC) tiin hdnh trdn 25 bdnh nhdn lodt cung cut do fy dd duQC diiu tri tai Vidn B&ng Qudc gia tir thdng 06/2011- 04/2012. Kit qui cho thiy: tri lidu VAC cd tdc dijng Idm giim vidm, giam tiit djch, giim nhidm khudn. Idm sach vit thirang, kich thich hinh thdnh md h^t vd co kdo ca hQc Idm thu h^p mdt phin vdt lodt.
ABSTRACT
Vacuum assisted closure (VAC) was evaluated on 25 patients with sacrum sore admitted to National Institute of Burns from 06/2011 to 04/2012. Results showed that VAC stimulated reduced inflammation, fluid exudation, forming healthy granulation tissue and and narrowing chronic wounds.
IDjflkTVANDe
vdt thyang khd Idnh, vdt thuang mgn tinh gdp ngdy cdng phd bidn trong ddi sdng theo cCing vdi sy phdt trien kinh td xd hpi vd tudi thp ddn chung, Cd rat nhidu nguydn nhdn. ca che bdnh sinh gdy vet thuang khd Idnh. vdt thuang mgn tinh, trong dd, lodt do ty dd md didn hinh Id lodt cung cyt chidm ty Id khdng nhd. Ivldi ndm. cd han 2,5 tridu ngydi d- Hoa KJ dupe phdt hidn lodt tj' dd. Trong thdi ky didu trj chdm sdc bdnh cdp tinh, ty Id mdc cua lodt ty dd Id 0,4 - 38%, trong chdm sdc bdnh mgn tinh ddi hgn tgi bdnh vidn Id 2,2 - 23,9% vd chdm sdc tgi nhd tir 0 - 17% sd bdnh nhdn [20]. Cd mdt ty Id Idn bdnh nhan bj lodt ty dd trong cdc dan vj hdl sire cdp cu-u vl tinh trang suy giam midn djch, thieu dmh dudng (8% den 40% benh nhdn ICU gdp loet ty dd) [6] Hidn nay, ndn y hpc tidn tidn trdn thd gidi dd cd nhidu tien bd vypt trcng phu-ang phdp didu trj bdnh, nhung
Phan bi^n khoa hgc: TS. Nguyin ti/finh TSm
vdn di chu-a trj cho vdt thuang khd Idnh. vdt thyang mgn tinh vdn cdn Id thdch thCrc Idn.
Tri lieu dp Iyc dm tinh (Topical negative pressure therapy: TNPT hay Vacuum assisted closure: VAC,...) do nhd phdu thudt tao hinh Loius Argenta (IVly) phat minh ndm 1993. Ndm 1995 dupe FDA cdng nhdn. Theo cdc tdc gia ShaerWD (2001), Votgt P (2003): lidu phdp VAC dd lam tdng hogt ddng nguydn bdo spi vd Idm tdng sgn xudt collagen - ydu to quan trpng trong lien vet thuong,..,
Tgi Vidt Nam, VAC dd dupe irng dung tgi nhidu dan vj y td. IVIai Xudn Thao (2009) dd ii-ng dung trong dieu tn bdng sdu do ddng didn cao the thdy giup cai thien tudi mdu, giam nhidm khuan. tdng tao td chO-c hgt vd ddng ca hpc vdt thypng. Trdn Dodn Dao (2001) bao cdo ket qua budc dau irng dung VAC trong dieu tri vdt lodt do ty de cho ket qua tdt,.. Tuy nhidn, chua cd nghidn ciru ndo ed tinh hd thdng di sdu danh gid tdc dung cua trj lidu VAC trong dieu trj vdt lodt cung cgt do ty dd, chua
134
cd quy trinh thdng nhat i>ng dung VAC trong didu tn vet lodt cCing cyt. Chdng tdi tidn hdnh dd tdi: "Nghien ciru ung dung tri ii^u ip ILK dm trong dieu trj vet loet cdng ci^t vdi myc tidu: Ddnh gid tdc di^ng cOa tri lidu dp luc dm trong didu trj tai chd vit lodt cung cut.
2. D61 TUWNG VA PHUONG PHAP NGHIEN CLFU 2.1. Dd! tu'O'ng nghien cu-u
25 bdnh nhdn ed vdt lodt ciing cyt do ty dd, tCr 16 tudi trd Idn, 6uac didu trj tgi khoa Lidn vet thuang - Vidn Bdng Ld HOu Trdc tir thdng 10/2011 -thdng 9/2012.
Tieu chuin i{Fa chgn BN: BN ed tdn thuang dd III, IV theo phdn logi cua EPUAP nhu sau:
+ Giai dogn I: Xdc djnh cdn cir vdo nhCtng thay ddi so vdi vung da xung quanh: Nhldt dd, dd dm udt; Op mdm cua md (thudng chdc), cam gidc (thudng dau hodc ngu-a), thay ddi vd mdu sdc (thudng dd hodc tim)
+ Giai dogn II. Tdn thuang Idp ndng cua bieu bi hodc trung bl (trdy xudc. ndt phdng).
+ Giai dogn ill: Tdn thuang todn bd Idp da nhung chua tdi cdn (hogi tu udt hodc hogi tu khd).
+ Giai dogn IV: Tdn thuang tdi ca. gdn, xuang (thudng tgo khoang hodc dudng dd).
Tieu chuin loai trir: Bdnh nhdn dang diing cde thudc uc chd midn djch; Vet thuang cd dudng dd chua rd ngudn gdc; Vidm xuang chya dypc didu trj; Cd dau hidu dc tinh tgt vit lodt; Ld mgch mdu hodc tgng, Tdn thuang c6 dudng thdng tdi cdc khoang hodc tgng vd BN khdng ddng y tham gia nghidn ciru.
Nhirng tieu chuin ve d^o dipc trong nghien cO'u: Bgnh nhdn ddng y ty nguy$n tham gia nghien ciru, dupe mien cac chi phi lidn quan nghidn CLFU: vdt tu, xdt nghigm; dirng nghidn ciru ndu xay ra cdc tdc dung khdng mong mudn vd khi bdnh nhdn ydu cau.
2.2. Phu'ang phap nghien c^u
Nghidn cCi-u tidn ciru md, thu ngiiidm ldm sdng theo ddi dpc, so sdnh trydc - sau theo nh&ng tidu chudn da dmh.
- Cdc vdt lodt dup-c cdt Ipc hogi tu. sau dd tidn hdnh ddt VAC theo qui trinh chuan. Thay foarm hut sau mdi 48h. Lidu trinh hiit tCiy theo tinh chat vdt thuang, tir 3 - 7 idn hut
May hiit VAC va Foam hut Cdc chi tidu theo ddi:
- Djch td: lira tudi. gidl tinh, vj tri. nguydn nhdn,...
- Ldm sdng: cam gidc dau, tuc, dp lye hiit, kidu hilt dich hOt (sd lupng, mdu sdc), tinh trgng viem nd. tidt djch, sy hinh thdnh td chirc hgt tinh trgng thu hgp vdt thuang.
- Cdn Idm sdng. Xdt nghidm vi khuan hpe vd md bdnh hpc dupe tien hdnh tgi cdc thdi diem trudc hiit (No), sau hut 7 ngdy (Nl) sau hut 14 ngdy (N2)
+ Xdt nghigm vi khudn vdt thuang. Ldy bdnh phdm theo phuang phdp Ivgnov N.A (1984), chuydn bdnh phdm vd khoa vi sinh vdt xdc djnh lodi vd so luang vi khudn,
+ Sinh thiet md vdt thuang bdng dung eg
sinh thiet (biopsy punch). Nhudm hematoxylin
eosin (HE), nhdn xdt sy bidn ddi te bdo vd c^u
triic md (bgch cau trung tinh, dgi thyc bdo. td
bdo lympho, nguydn bdo sp'i, td bdo spi, mgch
mdu tdn tgo). Xdt nghidm md bdnh hpc dypc
tien hdnh tgi Bd mdn Giai phdu bdnh - Hpc
vidn Qudn y.
TCYHTH&B s6 5-2014 135
3. K ^ QUA NGHIEN c i m
3.1. Mot s d d^c d i l m b^nh nhan nghien civu Bang 3.1. TuSi, gio-i tinh benh nhSn
^ ^ ^ ^ G i a i tinh N h i m t u i l ^ ^
16-60 61-70
>70 C$ng
Nam n, (%)
11 4 1 16(64,0)
Ni>
n, (%) 5 2 2 9 (36,0)
C^ng 16 (64,0)
6 (24.0) 3(12,0) 25(100) Nh$n xet: Bgnh nhdn tir 16-60 tudi chiem ty Id cao nhdt (64%) Ddy Id lira tudi lao ddng chlnh, bdnh nhdn t h u d n g dd phai qua nhidu
4 n / i 3 . f . V e t l o e t d d l l l (BN Luang Van L., SBA: 5615)
tuyen didu tri cung nhu- nhidu bgnh vign do vdy anh hudng rat Idn den didu kidn kinh td, chdm sdc vd didu tn.
Bang 3.2. Phan ioai theo d? logt D^ioet
S6BN
Tfl((%)
Dp III 18 72,0
D^iV 7 28,0
Tfing 25 100,0 Trong nghidn cO'u cua chCing tdi, tat ea edc vdt loet dup'c lya chpn Id lodt dd dn djnh, khdng phai trong giai dogn lodt tien tnen, trong dd, chiem chu yeu Id cdc vet loet dO III (72%), chi cd 7 vdt lodt dp IV (28%).
4nft 3.2. VeDoet dp IV (BN Nguyen THj H., SBA: 6324) Bang 3.3. Tinh trgng toan thSn va tgi chd d loet
TrIf u chiJmg^^-...,,^
s6t
Dau, tu-cDjung
Djcii tiet
Viem n^
TCH
Thu h?p VT
Truo-c hut CO ho$c khdng
Khong Khong Djch tidt nhieu, c6 the kem theo dich mO, miii h6i Viem n^ quanh 6 loet, c6 thS lan ra viing da lanh xung quanh.
Khfing c6
Sau 7 ngay Khong Khong Khong Djch Hit giam, khdng CO djch mil Viem ne het.
Ton thipong sgch. co to chLFC hat.
Thu hgp rat it
Sau 14 ngay Kh6ng Khdng Khdng Djch tilt rat it
Viem ne het, vet thucng sgch, tgo dieu ki#n cho TCH phat trien.
TCH do, sgch. flay 6 loet phu ktn b^ng TCH, nhidu taring hg'p TCH ph^t triln l^p day be m|t 6 loet.
Ria 6 loet co dau higu bilu md. 0 loet thu hgp CO tinh chat co' hpc, t6 chiic hgt che phu co' ban day 6 loet.
136
Nhin xet: sau tri li#u VAC 7 ngSy 6 lo4t hit viSm ni, dich tiet giam nhiiu, nhieu truing h(>p a§ thay xuat hien t6 chLPC hat.
Bang 3.4. Kich thu-6^; vh loet ,.
Lan Kich tliirac
(cm)
NO 5,2 X 6.7 (4,3x6,6-5,6x7,2)
N1 4,5x5,1 (3,8x4,2*4,3x5,6)
N2 3,4x4,1 (3,1x6,3»4,2x4,4)
Nh$n xit: Qua moi lin tn li$u VAC, vet lo« ci5 xu hu'dng thu hep han.
- Thoi gian ap dung tr| li^u VAC: ngin nhat \ii 6 ngSy. dii nhat IS 13 ngSy, lung binh: 13,4 ngSy.
Bang 3.5. Phmyng phap digu trj sau trj ii^u VAC Phipcng phap
Soca Tile
Chuyin vat tai cho 20 80%
Chuyen vat p.hanh xuyen DMMT 5
20%
Nh$n xdt: Sau VAC cd thd phai su- dyng kdt hpp nhidu phupng phdp trdn mdt bdnh nhdn nhu: chuydn vgt, ghep da. ghdp nguyen bdc spi. Cde vet lodt trong nghidn ciru deu lien hodn todn (100%).
Anh 3.7 (a,b,c,d). V l t loet d u y c trj li^u VAC, sau do phau thugt c h u y i n vat tgi chd (BN Nguyln Van D. 19T, SBA: 6078).
Bang 3.S. Xet nghigm vi k h u i n hpc
^ ^ ^ ^ Loai Lan ^ ^ ^ ^
L4n1 L S I I 2 Lan 3 Tffing (%)
P. aeruginosa 9 7 3 19(28,6)
S.aureus 8 8 2 18 (27,3)
E.coli 6 4 1 11(16,7)
P.mirabllis 4 1
5(7,6)
Aci baumanni 5 4 1 10(15,2)
P fluorecens 1 2
3(4,5)
Kh6ng mac VK
0 0 3 3
Nh$n xit: Cde chiing vi khuan tgi vdt lodt rat da dgng, cd chung vi khuan gdn nhu rat It gdp tgi vdt bdng nhu: P.mirabilis hay P.fluorecens.
Bang 3.7. Sd lup-ng vl k h u i n tgi v l t loet Thai dilm
S4 lut»ng VK P
N0(n = 25)(x10') 1993 ±32,5
Nl (n = 22) (x 10') 1385 ±32,7
N2(n = 10)(x10') 198 ±31,2
< 0.05 1
TCYHTH&B 36 5-2014 137
Nhdn xet: Sd lupng vi khuan tgi vdt lodt giam rd ret sau mdi lan cay khuan (khdc bidt cd y nghia vdi p < 0,05).
Bang 3.8. K i t qua xet nghidm mo bgnh hpc
B l mgt \d Idp to- huyet bach cau va chat hoai tu-. Day 6 loet la djch phCi viem, xam nhiim la tran c5c t l bSo vi§m Lympho, dgi thuc bSo, bach cau da nhSn. (hlnh anh viem loet mgn tinh) Nl
(n = 20)
Be mgt Id I6p ta huylt mong, day 6 lo6t la to chirc hgt phd ne. cdn xam nhiem rai rac cac t l b^o viem: dgi thyc bao, bgch cau da nhan, te b^o lympho, rai rac cd it tan mgch.
N2 (n=12)
Chu y l u \h t l chiPc hgt va cac tan mgch phat triln mgnh, ISc dac rlt it cAc te bSo viem.
Nhdn xet: Ldn xet nghidm thu- nhat bidu hidn phan irng vidm tgi chd khd rd rdng, sau dd phan Cmg vidm giam dan thay bdng qud trinh tdng sinh vd tdi tao.
Bang 3.9. Thay d6i sd liPQ-ng td bao viem tai mo v l t thipong Thfri dilm
So Iwng {TBV/BVDT)
1 ''
NO(n ^ 2S) 26.35 ±2,15
Nl (n - 20) 15,53 ±1,27
N2(n = 12) 9,13±1,25
<0.05 Gtti chu: M0t dan vi di$n tich tucfng cJiK/ng 122.400 ijm .
Nhan xet: S6 lu'Q'ng t i bSo vl6m t3ng cao nhat d thai diim tru'd'C hut vS giam dan sau trj Ii6u VAC (l(hac biet V&I p < 0,05).
Bang 9. Thay ddi sd luvng nguyen bao so'i tai mo vet thu'O'ng Thd'i dilm
Sd luffng {NBS/BVDTl P
NO (n = 25) 13.65 ±1,28
N l ( n = 20) 38,63 ± 2,94
N2(n-12) 62,5 ± 3,32
<0,01
Nh$n xet: So lu'Q'ng NBS tSng dan trong qui trinh trj ll#u VAC v4 cao nhit tai th&i diim N2 (l<hScbi#tV(i'ip<0,01).
Bang 10. Thay ddi sd lu'Q'ng tan m^ch t?i md v l t thuong Thdi diem
Sd iLforg (Tanmsc/i/fii/D7)
P
NO(n = 25) 1,49 ±0,37
Nl (n = 20) 6,23 ± 0,46
N 2 | n - 1 2 ) 8,15 + 1,17
< 0,05 1 NhSn xet: S6 li»ong tan m^ch a th&i diem N2 cao hon r6 r#t so vdi Nl v4 NO (i^hSc biftt
vdi p < 0,05).
138
4 . 1 . Tdc d u n g ddn IIFU d j c h tiet, g i a m v i e m nd tai c h d vdt loet
Trj lieu dp li/c dm tinh (VAC) sO dyng dp luc d u d i md'c khi quydn hdng dlnh cd kidm sodt ngang qua vdt t h u o n g Idm djch tidt tir vet thuang, vet lodt d u p e ddn luu ra ngodi ddng thdi dp ly-c d u p e duy tri hdng djnh, kin mdt chidu giOp cho dich khdng bj tham ngupc t r d Igi vdt thucng, hgn che nguy C P ldy chdo giiVa edc bdnh nhdn [8]. Theo Nguydn Trudng Giang (2012): djch, mdu <r dpng tgi vdt thuong Id nguydn nhdn dan den vidm nhidm vd miii hdi tai chd VAC giiip ddn luu djch tidt, djch mu tridt de hon cdc bidn phdp ddn luu thdng thudng khdc, sau 7-12 ngdy (trung binh 11,6 ngdy) sij- dung VAC. vet thuang sgch, hdt djch mO vd gia mgc ddng thdi i d chuc hgt mpc dgp cd thd tidn hdnh phdu thudt che phO tdn thuang dupe [3}. Trdn Dodn Dgo (2010), nghidn c u u trdn 30 bdnh nhdn VTIVIT thay 25/30 trudng hpp s u tidt djch cai thign rd rdt sau 10 ngay VAC, ndn vdt thuang bdt dau cd td chCrc hgt [2]. Nghien c u u eua chiing tdi: sau 7 ngdy VAC djch tidt d VTMT giam nhieu, khdng edn djch mu, hdt vidm ne, ton thuang sgch, bdt dau cd to chirc hgt, sau 14 ngdy dich tiet tgi VTiyiT rdt it. ndn tdn thuang sach tgo dieu kidn cho td chuc hgt phdt tridn, ddy ton thuang phO kin bdng td chuc hat sgch. Nhidu tru'dng hpp sau 14 ngdy VAC ddy vdt t h u a n g da duae lap day bdi Idp td chuc hat dd Id nhirng vet loet dd HI, didn tich nhd (bing 3 3).
Trdn tidu ban md benh hoc, sd lupng te bdo vidm/dan vj dign tich d- thdi diem N l , N2 Idn lupt Id 15,33 ± 1,29 vd 9,33 ± 1,29, giam rd rdt so vdi trudc hot (p < 0,05) (bang 3.9).
Thdi gian s u dung VAC trung binh; Tdc gia Fleischmann (1997) 12.7 ngdy [121; Fleck T (2007) Id 12,2 ngdy [13]; IWuhammad Ahmad (2010) Id 6.9 ngdy [15]. Nghien cu-u cOa chung tdi thdi gian tri lidu VAC trung binh 13.4 ngdy.
Trj lidu VAC vdi dp luc dm tinh hdng dinh qua
vet thuang cd tdc dyng tdng c u d n g ddng mdu ddn md, td chO-c, Idm phyc hdi luu luang mdu trpng Idng bgch mgch, mao mgch, Idm tudn hodn mao mgch d u p e phyc hdi, cai thidn, ldm s y phdn phdi dxy va cdc chat dinh dudng tgi md gia tang. Tdc gia Morykwas vd CS (1991) nghidn cu-u trdn ddng vdt thi nghidm cho thdy vd-i dp luc hilt 125mmHg, kha ndng t u d i mdu ddn tdn t h u a n g tdng gdp 4 lan [14]. Kamols vd CS (2004); De Flazo AJ (2001) nghidn cii'u cQng cho kdt qua tu-ang t y nhu vdy [8], [9].
Chung tdi thdy rdng ti> ngdy thu- 7 cua trj lidu VAC ddy vet lodt da giam dich tidt, cd td chO-c hgt. Ket qud md bgnh hpc cho thdy tai ngdy thir 7 cua VAC bdt ddu rai rdc cd It tdn mgch, cdn It td bdo vidm ddn ngdy thi> 14 thi td chirc hgt do, sgch, hodn todn hdt vidm nd cd thd t6 chirc hat lap day 6 khuyet, trdn kdt qud m6 bgnh hpc cho thay td chu-c hgt, sd lupng nguydn bdo sai vd tdn mgch phdt tnen mgnh {bing 3.9, 3.10). Djch phii, djch tiet Id mdi trudng thudn Ipi cho vi khudn tgi chd phdt tridn mgnh ddng thdi Idm can trd- ddng mdu ddn md, ldm ngipng kha ndng tdng sinh cOa nguydn bdo sal, td bdo sirng vd td bdo ndi md. Djch phO cdn chua nhieu protease do dd phdn cdt cdc prctein ddm md vet t h u a n g trong dd cd ci cdc ydu td kich thich tdng t r u d n g . Do vdy, tn lidu VAC vdi tdc dyng giam djch tiet, djch phd tgi chd vet t h u a n g gdp phan tao dieu kidn thudn Ipi cho qud trinh lien vet thuang. Ndn tdn t h u a n g dd ddng tiep nhdn vgt chuyen giOp che phii dgt kdt qud tdt.
4.2. Tac d v o g g i a m n h i d m khudn tai c h d Vet loet ciing cut ndi ridng vd vdt thuang mgn tfnh ndi chung cd ddc thO: nhidm nhilu loai vi khudn, tgp khudn do vdt thuang tdn tgi Idu ngdy, dieu trj tgi nhieu tuydn bdnh vidn, Chiing tdi thdy cdc logi vl khudn thudng gdp trdn vdt loet cCing cyt tgi Vidn Bong Qudc gia Id P.aeruginosa (28.8%), S.aureus (27,3%), E CO// vd Aci. baumanni. Ngodi ra cdn cd mdt sd lodi vi khuan hiem gdp n h u P.mirabilis hay P.fluorecens (bang 3.6). Tuy nhidn trong
TCYHTH&B s6 5-2014 139
nghidn ciru ndy chung tdi cOng thdy rdng sau mdi tri lidu VAC sd Idn cay khudn vet thuang duang tinh giam rd r g t trudc trj lidu VAC 100% Idn cdy k h u i n d u a n g tinh, lan cdy khuan thd 3 cd 3/10 trudng hp'p khdng mpc vi khudn (30%), dieu ndy chirng td vai tni quan trpng cua tri lidu VAC trong vigc Idm giam tinh trgng nhidm khudn tai chd vdt lodt. Tdc gia Nguydn Trudng Giang thay rdng sau VAC sd vdt thuang cdn mpc vi khuan vd sd lyp'ng vi khudn a vdt thu-ang dd giam ddng kd so vdi trudc didu tn [3]. Tdc gia VO Hti-u Thjnh nhdn thdy VAC Idm giam nhidm triing tgi chd vet lodt ty dd vd giam nguy c a nhiem triing tir ngodi vdo do dupe ndn vdt t h u a n g tdt, it dich tidt [5].
Nghidn cu-u cCta chiing tdi: xdt nghidm md b0nh hpc thay tgi thdi didm trudc VAC sd lupng td bdo vidm: dgi t h y c bdo, te bdo lympho, bgch cdu da nhdn trung tinh xdm nhidm lan trdn tgi d lodt (bdng 7). sd luang td bdo vidm giam nhidu trong nhu-ng ldn xdt nghidm sau, t u a n g Crng trdn ldm sdng dd Id bidu hidn vidm nd mgnh tgi chd, kdm theo bdnh nhdn cd thd cd sdt 38°C den trdn 39''C.
Tdc gig Weed.T (2004) nghien cii'u tren 25 b$nh nhdn vet t h u a n g mgn tinh thdy rdng tri lidu VAC Idm giam xdm nhidm ddng ke vl khudn tgi vdt lodt [19]. Tdc gia Deve AK (2000), Eginton iVIT (2003). nghidn CLPU ea trdn thyc nghidm vd ldm sdng thay rdng vi khudn tgi vdt thuang mgn tinh hay gap do la P.aeruginosa, S.aureus vd mpt sd tgp khudn khdc, ddng thdi cho thdy VAC ed tdc dyng Idm giam nhiem khudn tgi vet loet, sd lupng vi khudn tren mdt gram md td chuc dd giam rd rdt ngay tir ngdy thi> 4 ddn ngdy thir 7 [9]. Trong nghidn ciru cOa chung tdi, sd lypng vi k h u i n tgi chd vdt lodt giam rd rdt tCr lan cdy khuan thir hai tra di (p < 0,05). Thomas DR (2005) thay rdng VAC ldm tdng t u d i mdu tgi vdt lodt do do tdng c u d n g bgch cdu, hdng edu den td chirc, tdng c y d n g oxy ddn md ddn den Idm giam ede vi khuan ky khi d vet lodt [16].
Vi khudn tgi vdt thuang mgn tinh cd kha ndng tidt ra mdng Biofilm bao bpc vi khuan do
dd khdng smh khd cd kha ndng phdt huy tac dung tgi chd. Odng thdi djch tidt. dich vidm tgi chd Id mdi trudng thudn lai cho s y phdt tridn cua vi khuan. Vide Icgi bd td chirc hogi t u cOng vdi trj hdu VAC vdi tdc dyng Idm giam djch tidt, dich phij, giam vidm nd tgi chd gdp p h i n ldm giam nhidm khuan tgi vdt lodt. N h d vdo tdc dung tren ciJa lidu phdp hOt dp Iyc dm md kdt qua chdm sdc sau chuyen vgt dgt ket qua kha quan, trdnh tinh trgng viem dd tgi chd gdy kdo ddi qud trinh didu tri-
4.3. Tac d u n g kich t h i c h h i n h thanh t d chu>c hgt va lam c o hgp vdt lodt c d tfnh c o hpc
Tri lidu VAC vdi dp lye dm tinh hdng djnh tac dyng trdn vdt lodt gdy co kdo Idm hgp vdt lodt mang tinh ea hoc, ddng thd-l ldm dao ngupc s u gian nd cua md ddn ddn ldm kin mpt phan vdt thuang. Theo Nguydn Trudng Giang (2012): VAC Idm thu hgp tdn thuang vd kich thich md hgt phdt tridn, edc td chd-c xung quanh chju tdc dpng cua mpt lye hiit dm tinh nhdt djnh vd lidn tyc se Idm hai mdp vdt thuang kdo Igi gan nhau, thu nhd vdt thuang ca ve the tich vd didn tich be mdt. Bdn cgnh dd, lye hilt dm tinh cung Idm cai thidn t u d i mdu tgt chd, tgo didu kidn eho md hgt phdt trien, Tdc dd thu hep vdt t h y a n g trung binh 4.2
± 0,6cm^/ngdy [3]. Tdc qia Tran Dodn Dgo (2010): VAC ldm dign tich vdt thuang mgn tinh cai thign ddng kd dgc biet ddi vdi lodt cung cyt va lodt bdn chdn do tidu d u d n g [2]. Nghien ciru cua chimg tdi thay kich thudc vdt lodt thu hgp dan sau mdi tn lieu VAC: trung binh tCr 4,3x6.5-5.5x7,2 cm d thdi didm trudc hiit xuong 3,8x4,2-*-4,3x5,6 cm d thdi didm ddnh gid thir hai va 3,1x5,3-*-4,2x4.4 cm d thdi diem ddnh gid t h u 3 (bdng 3.4). Dign tich vdt loet thu hgp tuy khdng nhidu, nhung ed thd thay tinh trgng tai chd vdt lodt cai thidn rd rdt: vet lodt sach, djch tiet giam, het viem, het phii ne, td chirc hat hinh thdnh bdt dau tir thai diem ddnh gia t h u 2, ddn thai didm thir 3 td chirc hgt da dd dgp, nhidu trudng hap to chirc hgt lap day d lodt cd the tidn hdnh chuyen vgt che phu.
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Cdc nghidn ciru deu eho thdy ngodi vide d u a c kiem sodt nhidm khudn, vet loet cdn d u p e t u d i mdu tdt nhd tri lidu VAC. Trdn xdt nghigm md bdnh hpe chiing tdi thdy rdng t u thdi didm xet nghidm thu hai da thdy xuat hidn rai rdc cdc tdn mach vd tgi thdi diem xet nghidm Idn thir ba thi sd luang tdn mach, nguydn bdo sai tdng cao (p <0,05 vd 0,01). ddy chlnh Id nhu'ng thanh phdn chlnh de hlnh thdnh ldn td chLrc hgt. Tdc gia N g u y i n Thj Bich Ddo (2012) nghidn ciru trdn bdnh nhdn lodt bdn chdn tidu dudng t h i y r i n g VAC cd tdc dung hiit djch tiet ra ngodi, giQ- dm vdt thuang, chdng phii nd, cai thidn vi tuan hodn tai chd lam kich thich md hgt, mau chdng Idm day vdt lodt giiip mau Idnh vdt thuang [1]. Nghien ciru cua Deve Brone (2010) trdn ddng vdt thyc nghigm thay r i n g tri lidu VAC Idm phyc hdi luu lupng mdu trong Idng mgch tai vdt lodt, tudn hodn mao mgch dupe cai thign. s y phdn phdi oxy vd cdc chat dinh dudng d md dupe gia tdng [10], 5.KeTLUAN
Qua nghidn cii'u i>ng dung tri ligu hut dp Iyc dm (VAC) trdn 25 bdnh nhdn cd lodt ciing cyt do ty dd tgi Vign Bdng Qudc gia tir thdng 11/2011 - 10/2012, ChQng tdi rut ra kdt ludn sau: Tri lidu hut dp lye dm (VAC) ed hidu qua rd rdt trong didu trj vet lodt cung cut: cd tdc dyng Idm giam tidt djch, giam phCi nd, gidm nhiem khuan. tdng tgo td chirc hgt, co kdo ldm hgp vdt thuang mang tinh c a hpc. Chinh vai trd chudn bj nen vet t h u a n g cCa VAC Id nhdn td quan trpng dam bao cho cdc bidn phdp didu trj tidp theo nhu chuyen vgt da, ghdp da hodc ghdp nguydn bdo spi dgt ket qua tdt, 100% vet lodt trong nghidn ciru khoi hodn todn.
TAI LI|U THAM K H A O
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