HIEU QUA DIEU TRI THOAT VI DIA DEM COT SONG CO MU'C DO NHE VA VU'A BANG DIEN CHAM KET HO'P THUOC HOAN

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TAP CHl Y HOC VigT NAM TAP 465 • THANG 4 - SO 2 • 2018

HIEU QUA DIEU TRI THOAT VI DIA DEM COT SONG CO MU'C DO NHE VA VU'A BANG DIEN CHAM KET HO'P THUOC H O A N CHJ THdNG

TOM TAT

^ Mifc deu: danh gia hieu qua dieu tr[ thoat vj dia dem cot song co mffc do nhe va vii^ bang dien cham ket hop thuoc Ho&n chi thong. Bdi iUUng va I^Udng^ phap: 60 benh nhan tuoi tff 24 - 68 dUpc chan doan thoat vi dia dem cot song eo mffc do nhe va vifii, khong phSn biet gidi tinh, nghe nghiep) tinh nguyen tham gia nghien cuU. Nhom nghien ciiu diing difn cham ket hop thuoc Hoan ehi thong, nhom doi chffng diBu tn bang dien eham dOn thuan. So sanh ket qua tnidc va sau 15 ngay dieu trj. Ket qua: d nhom benh nhan nghien cuU, tJ' le dat hieu qua tot va kha chiem 83,3%. Bien dpjioat dpng cpt song eo va sffc cd rflu cai ^ttiien, diem VAS trung binh giam tff 6,5±0,7 (diem) trUdc _ dieu tn xuong con 3,2±0,8 (diem) sau dieu tri, diem NPQ trung binh da giam tff 16,1±3,2 (diem) tru'dc dieu tr| xuong eon 5,8±1,4 (diem) sau dieu trj, khae biet cay nghTa thong ke. Kei lufn: dien cham ket hpp thuoc Hoan chi thong co hieu ciua tot trong dieu tn thoat vj dTa dem cpt song CO mffc dp nhe va vffa.

Tvt khda: thoat vi dTa dem cpt song co, dien cham, hoan chi thong.

SUMMARY

THE EFFECT ON TREATING HERNIATED I N THE NECK AT MILD AND MODERATE LEVEL OF ELECTRIC ACUPUNCTURE COMBINED

W I T H "HOAN CHI THONG"

Ohjecdver. to evaluate aftereffed: of cevical herniated disc at mild and moderate level's therapy by the combination of electric acupuncture and "Hoan chi thong" on patients. Subjects and methods. 60 volunteered patients aged from 24 to 68 diagnosed with cervical disc hemiation, regardless of gender or occupation, were participated in the study.

Researchers combined electric acupuncture using with "Hoan chi thong", while the control group was treated with electric acupuncture only. Comparing the results before and after 15 days treatment. Result tiie treating method by using the combination of electric acupuncture with "Hoan ehi tfiong" worked efficiency, indicated by the 83.3% rate of good and effective results. The VAS score reduced from 6.5±0.7 (points) before the treatment to 3.2±0.8 (points) after the study; the average NPQ score decreased from 16.1±3.2 (points) pre-ti^bnent to 5.8±1.4 (points) post-treabnent. Conclusion: the treating method

^Viin Yhoccdtru^n Quin dgi,

^Binh vien Chim cdu Trung udng Oliu trach nhiem chinh: Nguyen Vinh Quoc Email: quocnguyenvinh@gmail.com Ngiy nhan bai: 25.2.2018 Ngay ph^n biln khoa hpc: 5.4.2018 Ngay duyet b^i: 13.4.2018

Nguyin Vinh Qu6c\ Nguyen Dwc Minh^

using electric acupuncture combined with "Hoan ehi thong" show pleasing outcome during treatment for cevieal herniated disc.

Keyword: cervical disc herniation, electric acupuncture, hoan chi thong.

I. O^T VAN €)E

Thoat vj dia dem (TVDD) cot song co la mpt benh ly kha pho tiien d Viet Nam eiJng nhff tren the gidl, ty le mae benh cao dffng hang thff hat sau TVDD cpt song that lUng [1]. Benh thffdng gap d doi tu'dng dang trong dp tuoi lao dpng, gay anh hudng khong tot tdt nang suat lao dpng cung nhff chat IUdng cuoc song eiia ngu'di benh.

Neu khong dUde dieu trj hoac khong dieii tri dung cd the dan tdi cae di chffng nang ne, tao

* ganh nang cho ban than ngffdi benh, cho gia dinh va xa hoi [1]. Theo Y hoc co truyen (YHCT), TVDD cpt song co dffdc dffdc xep vao pham vi Chffng ty. Oieu tri benh ly nay ed rat nhieu phffdng phap mang lai hieu qua tot trong dd cd phUdng phap dung thuoe ket hdp eham culi, xoa bdp bam huyet...-[2], [3].

Hoan ehi thong la thuoe YHCT dffdc san xuat tai Vien YHCT Quan dpi thupc de tai nghien eiru cap Bp Quoc phdng "Nghien cdu xiy dung quy trinh bio chi va danh gia tic dung chdng viem giam dau a/a thua: Hoan chi thdng trong dieu tri mpt so benh iy xu'dng khdp". Nghien cilli dffdc tien hanh vdi mue tieu danh gia hieu qua dieu trj TVDD cpt sdng co mffc dp nhe va viici bang dien cham ket hdp thuoc Hoan chi thdng.

II. DOI TU'ONG VA PHUWIG PHAP NGHIEN COXJ 2 . 1 . Chat lieu

- Thudc Hoan chi thdng bao che dang vien hoan mem 8,5g/vien do Khoa DUdc/Vien YHCT Quan dpi san xuat, gom cae vj thuoe: [5ay gam, Day dau xUdng, Bach chi, Nguii tat, ^ue ehi, Ke huyet dang. Thudc da dffdc Vien kiem nghiem thuoc Trung ffdng - Bp Y te tham djnh dat tieu chuan ed sd.

- May dien cham KWD - TN09 - T06; Thffde do thaiig diem VAS (Visual analogue scale).

- Kim cham ciTu 1 tan eae c3 phii hdp vdi yeu cau ky thuat, pince, bong, con 70°.

2.2. Doi tu'dng nghien cu'u: 60 benh nhan (BN) tuoi tff 24-68, khong phan biet gidi tinh, nghe nghiep, dffdc ehan doan TVDD cpt song co mffc dp nhe va vira, cd chi djnh dieu in bao ton

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VIETNAM MEDICAL JOURNAL W<^ - APRIL - 2018 [1]. Dieu tri tai Khoa Lao khoa/Benh vien Cham

cffu Trung ffdng tff 08/2016 tcli 6/2017. Khong dffa vao nghien culj cac BN co dau viing vai gay khdng do TVDD cpt song co, TVDD mffe dp nang cd chi dinh can thi^p phau thuat, tang huyet ap, suy gan, suy than, suy tim, dai thao dudng, BN.

m i c cac-benh ve than kinh, tam than, rdi loan cam giac, ung thff, phu nff cd thai, loang xu'dng, nhilm khuan tai cho.

2.3. Phu'dng phap nghi&n cu'u Nghien culi tien cffu, thff nghiem lam sang md. So sanh ket qua tru'dc va sau dieu tri va ed nhdm ddi chu'ng. Chpn mau ed chii dich theo phffdng phap ghep cap tffdng dong ve mffc dp dau theo thang dtem VAS. Cac BN dffdc chia thanh 2 nhdm, moi nhdm 30 BN:

- Nhdm dot chirng (NDC): dteu trj ddn thuan tsang dien cham theo phae do cham bo cac huyet Pliong tri, Dai ehuy, Dai trff, Kien tinh, Giap ti'eh, Hdp coc, A thj huyet tien dau.

- Nhdm nghien culi (ISINC): dteu tri nhu' NDC ket hdp uong Hoan ehi thong ngay 04 vten, ehia 2 tan, moi tan 02 vien, sau khi an sang va an tdi 1 gid.

III. KFT QUA NGHIEN CCrU

Lieu trinh dieu tri: 15 ngay, moi ngay 1 lan x 30 ptiiit (thd 7, chu nhat va ngiy lenghi).

Chi tieu theo doi va danh gla:

- Dac diem chung cac BN nghien cuti (tuoi, gidl, nghe nghiep, thdi gian mac benh, v| tri ton thu'dng tren phim chup cpng hu'dng tff cpt sdng co). Cac chi beu theo doi lam sang dutfc danh gia tai thdi dtem ti-udc dieu tri (Do), khi ket thuc^dteu tii (bis).

- Danh gia ket qua: so sanh diem cac chi tieu theo doi lam sang trffdc va sau dieu tri, phan thanh loai tot (tong so diem sau dteu trj giam

>80% so vdi tru'dc dieu tri); Kha (tong so diem sau dieu trj giam 61-80% so vdi trffdc dieu hi);

Trung binh (tong sd dtem sau dieu tri giam 40- 60% so vdi trffdc dieu tri); Kem (tong so diem sau dieu tri giam < 4 0 % so vdi tn/dc dieu tri) [2], 2.4. XO" ly so l i i u : Cac so tieu dffdc xff ly theo phUdng phap thong ke y sinh hpc bang phan mem SPSS 16.0 for Windows. C^c thuat toan du'dc ap dung: tinh ty le phan tram, ti'nh so trung binh, dp lech chuan, so sanh so trung binh theo thuat toan T-Student.

3 . 1 . file diem chung cac doi tu'dng ngliien curu Bang 1. Bac diem chung cac doi ttfOnq nqhien cu'u

Clii tieu

Tuoi

Gidi tinli

Nghe nghiep

Ttidi gian mac iD^nh V j t r i thoat vj ti-enMRIcot

song CO

< 3 0 3 1 - 4 0 4 1 - 5 0 5 1 - 6 0

> 6 0 ( X ±SD)

Nam Nu- Nonq dan Conq nhan Lai xe Van phonq

Khac

< 6 thanq 6 - 1 2 thanq

> 12 thanq a - C 4 C 4 - C 5 C 5 - C 6 C 6 - C 7

N N C " ( n = 3 0 ) So IUdng

02 05 08 11 04

Ty le % 6,7 16,7 26,7 36,7 13,3 48,3 ± 11,3 16 14 02 06 07 U 04 04 15 11 13 18 23 04

53,3 46,7 6,7 20,0 23,3 36,7 13,3 13,3 50,0 36,7 22,4 31,0 39,7 6,9

N O C " 1 So lu'dng

01 07 07 10 05

n = 3 0 ] Ty le o/o

3,3 23,3 23,3 33,3 16,7 49,2 ± 9,7 17 13 03 07 05 12 03 05 13 12 10 17 21 07

56,7 43,3 10,0 23,3 16,7 40,0 10,0 16,7 43,3 40,0 18,2 30,9 38,2 12,7

Pi-i

>0,05

>0,05 Tuoi thap nhat la 24, cao nhat ia 68. Tuoi

trung binh cac BN NNC ia 48,3±11,3 (nam), NBC ia 49,2±9,7 (nSm). Bo tuoi mac benh tir 4 1 - 68 chiem ty le cao d ca 2 nhom m nghien cuU (63,4% d NNC va 56,6% d NBC), tuoi mac benh

trung binh cung nhu' phan bo BN theo nhom tuoi cua NNC va NBC la tu'dng du'dng (p>0,05). Ty ie BN mac benh ia nam gidi chiem tren 50% d ca 2 nhom, khong khac biet ve t i ie nam/nu' d NNC va NBC (p>0,05).

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TAP CHl Y HOC VIET NAM TAP 465 - THANG 4 • SO 2 - 2018 Ty le BN bi benh co dac thii cong viec thffdng

joiyen ngoi eo djnh mot tff the (lai xe, can bo van phong) chiem b/ le eao, 60% d NNC vk 56,7% d NDC. Phan Idn cac dot tffdng tdi dieu trj c6 thdi gian mac benh tff 6 thang trd ten, trong d6 36,7% BN d NNC va 4 0 % BN d NDC cd thdi gian mSc benh tren l nam. Chffa nhan thay khae

blet giuci nghe nghiep, thdi gian mac benh giij^

hai nhom BN nghien cffu (p>0,05).

Ve vi trf TVDD cpt song co nhan thay, vi tri C4-C5 va C5-C6 chiem ty le cao (70,7% d NNC va 6 9 , 1 % d NDC), khdng khac biet ve vj trf ton thffdng tren phim cpng hUdng tff cpt song co giffa hai nhom BN nghien ciru (p>0,05).

3.2. Ket q u a d i e u t r i Bing 2. M&c da daii (VAS) sau

VAS Khonq dau

Nhe Trunq binh

Nanq X ±SD Sau dieu tr

dieu tri NNC ( n = 3 a ) D

n 0 08 16 06

»'"

%

0 26,7 53,3 20,0 6,5±0,7 mire Jo dau

D n 18 09 03 0

,'''

60,0

%

30,0 10,0 0 3,2±0,8 heo tl anq die

Pl-2

<0,05

>0,05

<0,05

<0,05 m VAS d

N O C f n = 3 0 ) D„'"

n 0 07 18 05

%

₀

23,3 60,0 16,7 6,6±0,8 hai nl dm BN

D n 09 17 03 01

,14) 30,0

%

56,7 10,0 3,3 4,6±1,1

P M

<0,05

<0,05 P2-4

<0,05

>0,05

<0,05 Diem VAS trung bmh d NNC da giam tff 6,S±0,7 (diem) tru'dc dieu tri xudng con 3,2±0,8 (diem) sau dieu tii, d NDC diem VAS giam tff 6,6±0,8 (diem) xuong 4,6±1,1 (diem) sau dieu tri, khac biet trUde va sau dieu tri ed y nghTa thdng ke (p<0,05). Hieu qua giam dau sau 15 ngay dieii tri cua NNC tot hdn NDC (p<0,05).

Bang 3. T h a y doi su'c c d sau d i e u trj Sii'c c d

Binh thu'dnq Giam nhe Giam trung binh

Giam nanq

N N C ( n = 3 0 ) D„>"

n 15 13 02 0

%

50,0 43,3 6,7 0

Dis'^' n 24 6 0 0

80,0

%

20,0 0 0

Pl-2

<0,05

N e C ( n = 3 0 ) D„l''

n 14 12 04 0

46,7

%

40,0 13,3 0

D n 22 7 1 0

,14) 73,3

%

23,3 3,3

0 P3-4

<0,05

<0,05 P2-4

>0,05

>0,05 Tinh trang eiia sffc cd ciia ca hai nhdm BN nghien ciiu deu eai thien kha tot sau dieu tri, khong con BN nao d NNC ed tinh trang sffc cd giam mffe dp trung binh hoac giam nang, trong khi do d NOC chi eon 1 BN co tinh trang sffc ed giam mffe dp trung binh, khae biet tru'dc va sau dieu tri co y nghia thong ke (p<0,05). Sffc cd sau dieu tri d NNC va NDC khong khac biet (p>0,05).

Bing 4. Tiiay doi biin dp hoat dpng cpt singed sau dieu tri Ddng t a c

Qii Nqu^

Nghieng Ouav

N N C { n = 3 0 ) D„'"

28,1± 8,9 28,3±9,7 32,8±7,0 33,7±6,2

Dis'^' 35,8±3,9 37,2±2,5 43,3±3,0 42,2±3,4

Pi-i

<0,05

N e C ( n = 3 0 ) Do<"

27,5±9,5 28,5±8,5 30,2±8,S 33,2±6,9

33,3±3,5

D„™

35,2±2,7 41,7±4,9 41,2±3,8

P3-4

<0,05

<0,05 P2-4

>0,05

>0,05 til d ea hai ntidm BN nghien cffu (p<0,05). Thay doi bien do hoat dong cot song eo sau NNC va NDC khong khac biet (p>0,05).

Bing 5. Cii thiin chdc nang s/'nh hoat theo thang diem NPQ sau d/eu tri

trffdc dieu dieu tri d

Mu'c d o anh hu'dng

6 6 1 0 6 I I 66111 0 6 I V

0 6 V X ± S D

N N C ( n = 3 0 ) D„"'

n 0 0 11 13 06

%

0 0 36,7 43,3 20,0 16,1 ± 3,2

D n 16 08 05 01 0

,'"'

53,3

%

26,7 16,7 3,3

0 5,8 ± 1,4

Pl-2

<0,05

N B C ( n = 3 0 ) D„<^'

n 0 0 12 1 4 j 04

%

0 0 40,0 46,7 13,3 15,5 ± 3,4

D n 10 10 07 03 0

, , ' • "

%

33,3 33,3 23,3 10,0 0 10,8 ± 3,7

P3-4

<0,05

<0,05 P2-4

<0,05

>0,05

<0,05

>0,05

<0,05

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VIETNAM MEDICAL JOURNAL N°2 • APRIL • 2018

Trffdc dieu tri, 100% BN bi anh hffdng tcS'i ehffc nang sinh hoat do dau, diem NPQ trung binh tru'dc dieu ti-j la 16,1±3,2 (diem) d NNC va 15,5±3,4 (diem) d NDC. Sau dieu tri, chffe nang sinh hoat d ca 2 nhom BN nghien effu deu cai thien, chi edn^3,3% BN d NNC va 10% BN d NDC chffe nang sinh hoat bi anh hffdng mffe do nhieu va rat nhieu. Diem NPQ trung binh sau dteu tri giam cdn 5,8±1,4 (^eni) dNNC va 10,8±3,7 (diem) d NDC, khac biet trUde va sau dieu tri cd y nghTa thong ke (p<0,05). I^ffe dp cat thien chffe nang sinh hoat sau dieu tri d NNC tot hdn NDC (p<0,05).

Bang 6. Hieu Qui dieu tri chung Ket qua

Tot Kha Trunq binh

Kem Cong Sau dieu trj, so B

NNC>"

n 19 6 5 0 30 N dat ket

»/o 63,3

20 16,7

0 100

N O C "

n 10 12 7 1 30 :iua tot va kha chiem 83,3% d NNC

%

33,3 40 23,3

3,3 100 va 60% d NNC

Pl-2

<0,05

>0,05

>0,05 , khac blet co y nghla thong ke vdt p<0,05.

IV. BAN LUAN

4 . 1 . Cac diem chung cac doi tu'dng nghien cihi: Tuoi trung binh cac BN NNC ia 48^3 ± 11,3 (nam), NDC la 49,2 ± 9,7 (nam). Dp tuoi mac benh tff 4 1 - 68 chiem ty le eao, 63,4%

d NNC va 56,6% d NDC, day la nhffng ngUdi dang trong dp tuoi lao dpng do vay gay anh hffdng nhieu ehat Iffdng lao dpng va stnh hoat ciia ngffdi benh. Ket qua nay phii hdp vdi nhan dtnh ciia Ho Hffu Lffdng (2006), Nguyin Quoc Dung (2005^,... [1], [ 2 ] , H ] . Theojy luan YHCT, vao lii^ tuoi nay chinh khf cd the bat dau suy gtam, cdng nang tang phu, khf huyet hu suy, dtnh v i , tau ly sd hd... ta khi d ben ngoai de xam pham vao ma gay benh [ 5 ] , [ 6 ] .

Ty le BN mac benh la nam gidi chiem tren 50% d ca 2 nhdm, mpt so tac gia khi nghien eiTu benh ly TV£>D cpt song eo cung cho rang benh gap nhieu d nam gidi [2],[4]. Chung toi eliffa thay ly do dac biet nao de giai thfch khac biet nay, day co the do dac diem thu dung dieu trj BN tqii Benh vien Cham ciiXi Trung ffdng.

Ve tfnh chat nghe nghiep, ket qua nghien ciru cho thay TVDD cpt song co cd the gap d tat ca cac nghe, nhffng nhdm BN mac benh cd dac thu cong viec yeu cau thffdng xuyen ngoi lau eo djnh mpt tff the (lai xe, can bp van phong) chiem t^ le cao. Day la nhuTig ddi tu'dng dot hdi dau va co phai chiu dUng^mpt tff the bat buoc keo dai, khong sinh^iy dan den eac bien dot benh ly ciia cpt song CO, nhan xet nay cijng phii hdp ket qua theo dot cua mpt so tac gia khac (Nguyen Qudc Dung - 2005, Nguyen Thj Tam - 2001...) [2],[4].

Do vay, tap mot trffdng lam viec thoai mat, thdi gian lam viec khoa hpc hdp ly, tff the lam vtec dung cho nliom dot tffdng cd nguy cd cao la het sffc can thtet, gdp phan han che ty le mac benh va nang cao chat Iffdng eupe song eho ngffdi

Ve thdi gian mac benh, phan Idn eae do!

tffdng tdi dieu tri ed thdi gian mSe benh tff 6 thang trd ten, trong dd cd tdi 36,7% BN d NNC va 40% BN d NDC cd thdi gian mac benh tren 1 nam. Nhff vay ed the thay TVDD cot song eo la mpt benh man tfnh dai dang, gay anh hudng nhieu tdi chat iffdng eupe song cung nhff anh hffdng tdi hieu suat lao dpng cua ngffdi benh [1], [2]. Dieu nay cung cho thay mffc dp quan tam ciia ngffdi benh doi vdi benh ly n^y ran ehffa thuc su sau sac, can co cac giai phap tuyen truyen nham nang cao y thffc phdng va dieu tri benh not chung va TVDD cpt song co ndi rieng trong eong dong.

\ ^ vj trf TVDD cpt song eo, ket qua chup eong hu'dng tff cho thay vi tri C4-C5 va C5-C6 chiem ty le cao (70,7% d NNC va 6 9 , 1 % d NDC), ket qua nay eung phii hdp vdi Ho Hffu Lffdng (71,4%), Nguyen Thi Tam (67,7%), Nguyen Quoc Dung (63,4%) [1],[2],[4]. Cac tac gia deu cho rang ty le TVDD cpt song co cao tai cac vi tri nay la do tae dpng ciia trpng lu'c len vimg dTa dem nay Idn va vj trf nay ddng mpt vai tro nhff mpt diem tffa trong sff van dpng d^u co.

4.2. K i t qua dieu tri

*Ve eai thien mffc dp dau tiieo thang diem VAS sau dieu trj: Trong TVDD cpt song co, dau la trieu ehffng ehi'nh khien ngffdi benh phai tdi benh vien kham va dieu trj [ 1 ] . De danh gia hteu qua dieu tri, can phat danti gia mffc dp gtam dau eiia BN.^ Thang diem VAS la thang diem thong dung de danh gia mffc dp dau dffdc iffa chpn trong nghien cut; nay. Ket qua nghien cffu clio thay mffe dp dau theo thang diem VAS d hai nhdm BN nghien ciiu deu dddc cai thiSn sau dieu trj, diem VAS trung binh trffdc va sau dieu tri khac biet ed y nghTa thong ke. Hieu qua giam

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TAP CHi Y HOC VIET NAM TAP 465 - THAHG 4 - S6 2 - 2018 dau sau 15 ngay dieu tri eiia NNC (3,2±0,8

diem) tot hdn co y nghta so vdi NDC (4,6±1,1 diem). Ket qua nay chffng td phffdng phap dieu bj bang d i | n cham ddn thuan hoae thuoc YHCT ItSt hdp dien cham da co hieu qua giam dau. Ve

^ luan, dien cham co the thong qua tac dpng tai cliS, phan irng tiet doan va phan utig toan than kicti thich phan ffng ed the lam giam ham Iffdng Catheeholamin, tang ham lu'dng Achetyleholin va lam san stnh Endorphin npi sinh, tff do dat du'dc hieu qua giam dau [ 6 ] . Mat khac, thuoe Hoan ehi thong dffdc xay dutig tff nhffng vi dffdc lieu ed tac dung hoat huyet hda ff, giam dau chong viem manh, ket qua nghien culi thu'c nghiem cung da chutig minh tac dung giam dau cua Hoan chi thong [ 7 ] . Nhu vay, ed the nhan dinh dien cham ket hdp thudc Hoan ch! thdng co tac dung giam dau rd ret.

*\^ cai thien bien dp hoat dpng cpt sdng cd va sii'c cd: Cpt song eo ed tam van dpng rong va linh hoat, ban che van dpng trong TVDD cpt sSng CO chil yeu nguyen ntian do tae nhan viem gay phan xa co rut he day chang, eae ed canh s3ng, ngoai ra dTa dem bi thoai hda hoac thoat vj se lam giam chieu cao khoang gian dot... [1] [3].

Trffde dieu tri, cac dpng tae van dpng vung eo cia cac BN dBu ban che. Bien dp hoat dpng ept s5ng CO d cac dpng tae cut, ngffa, nghieng, quay sau dteu tri deu tang so vdi tru'dc dieu tri d ea hai nhom BN nghien ciru, chu^ nhan thay khac biet ve thay dot bten dp hoat dpng cot sdng co sau dieu trj d NNC va NDC. Ket qua nay phii hdp vdi nhan djnh cua nhieu tac gia [3]. Theo nhan dinh cua cliung toi, do tac dung giam dau, gian cd cua dien eham ket hdp thuoc Hoan ehi thdng da giiip eho bien do boat dpng cpt song co cac tiT the dffdc cai thien dang ke sau dieu trj. Mffe dp cat thien bien dp boat dpng cpt song co sau diSu trj eung la minh chffng thuyet phue cho tinh trang cat thien sffc cd d cac BN nghien eirtj sau diSu tri.

*[fe cii thien chdc nang sinh hoat theo thang diim NPQ: Bo eau hoi NPQ thu'dng dffdc sff dyng de danh gia mffc dp dau va anh hudng ciia dau viing co ien cac chffe nang sinh hoat hang ngay ciia ngffdi benh. Day la phffdng phap ddn gian, de sff dung va la cong cu do dac khach quan. Sau dieu tri, chffe nang sinh boat theo tliang diem NPQ d ca 2 nhdm BN nghien cffu deu cai ttiien, chi con 3,3% BN d NNC va 10%

BN d NDC chffe nang sinh hoat bi anh hffdng mffc dp nhieu va rat nhieu. Diem NPQ trung binh sau d i i u tri giam con 5,8±1,4 (diem) d NNC va 10,8±3,7 (diem) d NOC, khac biet tru'dc va sau

dieu trj CO y nghTa thdng ke. Mffe dp cai thien chffe nang sinh hoat sau dieu tri d NNC tot hdn NOC. Nhff vay, dien cham ket lidp thudc Hoan ehi thong da gop phan nang cao chat iffdng sinh hoat va chat Iffdng lao dpng cho ngffdi benh. Day cijng la nhan djnh ciia nhieu tac gia - Ket hdp dien eham vcfi thuoc YHCT dat dffdc hieu qua tot trong dieu tri cae chuhg dau man tinh [2],[3].

*V§ hieu qui dieu trj chung: Tff ket qua thay doi dtem NPQ, sy thay dot cae trieu ehffng lam sang trffde va sau dieu tri, ehiing tdi nhan thay t / ie BN dat ket qua tot va kha chiem 83,3% d NNC va 60% d NNC sau 15 ngay dieu tri, khac biet cd y nghla thdng ke. NhU vay, dten cham ket hdp thuoc Hoan chi thong co tac dung tot doi vdi cac BN TVDD ept sdng co, ket qua nay cung phil hdp vdi ly luan YHCT ve cd ehe tac dung eiia thuoc Hoan chi thong cung nhu phUdng, phap diem cham la thong kinh lac, hoat huyet, lihff ff, lykhiehithong...[5], [6],[7].

V. KET LUiBkN

Dien cham ket hdp thuoe Hoan chi thdng eo hi|u qua tdt trong dieu tri thoat vj dTa dem cpt song CO mffe dp nhe va vffa va tot hdn cd y nghTa so vdi phffdng phap dien eham ddn thuan.

Ty ie ket qua tot va kha sau 15 ngay dieu tri cliiem 83,3%. Oiem VAS trung binh giam tii"

6,5±0,7 (diem) trffdc dieu tri xuong cdn 3,2±0,8 (diem) sau dieu trj. Bien dp hoat dpng cpt song CO va sffc cd deu cat thien eo y nghTa sau dieu trj. Chffe nang sinh boat theo thang diem NPQ dffde cai thien, diem NPQ trung bJnh da giam tff 16,1±3,2 (diem) trffdc dieu tri xuong con 5,8±1,4 (diem) sau dieu tri.

TAI Ll|U T H A M KHAO

1. H 3 Hihi Luting (2006). Thoii hoa cot sdng cova thoityi dia dim, NXB Y hpc, Ha Noi.

2. Nguyen Thi Tam (2001). Nhan xet bUdc dSu ve ket qua dieu tri noi khoa thoat vi dTa dem cot song cd Tao chf Yh'gc'thu'chanh, 9 (3^-38), s. Nguyen Van Chu'dng va Do Danh Thang

(2012). Thoat v[ dTa dem cgt song co va nhffng dinh hudng nghien cuU mdi.* Tap chf Y hoc thut hanh, SZQ, 46-49.

4. Nguyen Quoc Dung (2005). Mot so nhan xet ve hinh anh eong hU6ng tff thoat vi dTa dem e6t song CO. Tap chi Y hoc thWc hanh^ 503 (2), 65-68.

5. Vi?n Y hoc co truyen Quan dpi (2013). Mdt sd chuyin de npi khoa Y hgc Q5 tmyen, NXB Quan dpi nhan dan, Ha Npi._

6. Bo mon Y hoc co truyen - Tru'dng dai hpc V Ha Noi (2005). Chim cuU, NXB Y hpc. Ha Npi.

7. Nguyen Vinh Quoc va Tran Thj Tuyet Nhung (2017). Oanh gia tae dung giam dau ciia thuoc Hoan chi thong tren thUc nghiem. Tap chf Y hoc thuc hinh, 325, 49-52.

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