HIEU QUA DI^U TR! LIET DAY THAN KINH VII NGOAI BIEN DO LANH BANG PHUONG PHAP
ON CHAM KfiT HOP THU6C C6 TRUYEN
Duffng Thf Mai Huyen', Nguyin TM T6r^
(1) Sinh vien l&p YHCT6, Trudng Dgi hgc Y Diegc Hui (2) Khoa Y hgc co truyin. Tru&ng Dgi hgc YDugc Hue Tdm tat
D^t van de: Lift dly than kinh VII ngoai bien la bpnh khi phd bien, inh hudng nhieu den sinh hogt, thim my,^iao tilp xa hdi cua ngudi bpnh. On chim 11 phuang phip didu tri thudng dugc de c|ip nhieu ttong cac y van, tuy nhidn d nude ta vin chua cd mgt nghien cdu nio ve phuang phip nly. Muc tidu:
Dinh gia hidu qui dieu trj tipt dly than kinh VII ngogi bien do Ignh bing phuang phip dn cham ket hgp thudc cd truydn va tic dyng Ichdng mong muon (TDKMM) cfia phuang phip dn chim. Phuong phip nghien cihi: Gom 40 bpnh nhin vio dieu tij tgi khoa Y hgc cd truyen - Bpnh vipn Trung uong Hue vi Bpnh vipn Y hgc cd truyen tinh Thua Thien Hue dugc chan doan xic djnh lidt day than kinh VII ngogi bien do Ignh, didu tri bing phuang phap on cham vl thudc thang. Nghidn cfiru dugc thiit kd theo phucmg phap nghidn cuu tiln cdu, dinh gii kit qui trudc vi sau dilu tij. Kit qui: Ty tp khdi holn toin tl 85%, ty Ip dd 1112,5%, khdng hdi phuc 2,5%. Cd 22,5% benh nhin xiy ra tic dgng khdng mong mudn, trong dd chiy miu vi dau do cham li thudng ggp nhat. Ket luain: Dieu ttj liet dly thin kinh VII ngogi bien do Ignh bing phuang phip dn cham kit hgp vdi thudc cd truyen cho t^ tp khdi vi do cao (97,5%). Phuong phap dn chim khdng gly ra tic d ^ g tdidng mong mudn ding ke tren tam sing.
T& khda: Liil ddy thdn kinh VII ngogi biin do Ignh. on chdm, diiu tri Abstract
THE TREATMENT EFFECTS OF WARM - NEEDLING COMBINED WTTH TRADITIONAL MEDICINE IN THE TREATMENT OF PERIPHERAL FACIAL PARALYSIS CAUSED BY COLD
Duong Thi Mai Huyen'. Nguyen Thi Tan' (1) d'* Traditional Medicine Student. Hue University of Medicine cmd Pharmacy (2) Faculty ofTraditional Medicine, Hue University of Medicine and Pharmacy Background: Peripheral facial paralysis caused by cold is a common disease. It affect daily life, aesthetic, social communication of the patient. Warm - needling is often mentioned in the ancient documents, but there is no research on this method in our country. Objectives: evaluate the tteatment effects of warm - needling with traditional medicine in the tieatment of peripheral facial paralysis caused by cold. Methods: 40 patients of peripherally facial paralysis caused by cold, were examined and tieated by method ofwarm - needling and remedy at Thua Thien Hue Traditional Medicine Hospital and Traditional Medicme department of Hue Cential Hospital. The study was designed by the method of prospective studies, assess the resuhs before and after freatinent. Results: completely recovering rate is 85%, the improved rate is 12.5%, not recovery is 2.5%. 22.5% of patients had happened side effects.
- Dia chl lien hi: Nguyin Thf Tdn, email: [email protected] • ' = ' . " " ^ ^ ^ - Ngc^ nhgn bdi: 25/3/2016^* Ngdy dingy dang: 19/04/2016 *^Ngdy xudt bdn: 29/04/2016 " ^ ^ ^ S - ' l 6 Tgp chf Y Dugc hpc - Truimg Dgi hpc Y Dugc Hui - Sd D|c bipt
tiie most common is bleeding and needle pain. Conciusioas: The tteatment of peripheral facial paralysis caused by cold with warm - needlmg and ttaditional medicinal showed that the completely recovering and improved rate is 97.5%. Warm - needling does not cause significantly side - effects in clinical.
Key words: Peripheral facial paralysis caused by cold, warm - needling, treament.
L D ^ T V A N D i
Lipt day than kinh VII ngogi bien do Ignh y hgc CO ttuyen ggi l l "Khiu nhin oa t l " the phong hin ti mgt bdnh tuong ddi phd bien tren tim sang vdi ty Id mic bdnh hlng nlm trdn thi gidi khoing 30/100.000 ngudi [9]. Bpnh tuy khong nguy hilm den tinh mgng nhung inh hudng nhieu den sinh hogt, tim If, thim m5^ cfia ngudi bpnh. Vi vay, vipc phat hipn va dieu trj sdm cin bdnh niy, hgn che tf tp de tgi di chung ti vin de quan trgng va can thiet.
Y hgc cd truyen od nhieu phuang phip dieu ttj lipt day than kinh VII ngogi bien do Ignh nhu: uong thuoc, cao din, curu, dn chim, dipn cham, thuy chim, din thudc lenhuypt,xoa hdp bim huypt...[5].
dn cham 11 mdt phuang phip dilu ttj ket hgp gida chim vl cdu, li mdt phuang phap dieu tij li^t day thin kinh VII ngogi bidn ngi^dn nhan do Ignh dugc de cgp nhieu nhat trong cac y vin [1], [5].
Tuy nhien, cho den nay vin chua cd mdt nghien cdu nao danh gii hipu qui dieu trj cung nhu elc tic dvng khdng mong mudn cua phuang phip niy, do dd chfing tdi tidn hinh nghien cita: "Ddnh gid hlfu qud diiu trf lift ddy thdn kinh VII ngogi biin do Ignh bdng phuffng phdp on chdm ket hgp vdi thudc cd truyin" vdi cic myc tieu sau:
/. Ddnh gid hifu qud diiu tri li§t ddy ihdn kinh VII ngogi bien do Ignh hdng phuang phdp on chdm kit hgp v&i thudc co truyin.
2. Khdo sdt cdc Idc dgng khdng mong mudn cua phuong phdp dn chdm.
2. DOI TirgiNG VA PHU'ONG PHAP NGHIEN CUtJ
2.1, Doi tu-gng nghien ciru
Gom 40 bpnh nhan dugc chin doin lipt dly than kinh VII ngogi bidn do ignh, didu ttj tgi khoa Y hgc cd truyin, Bdnh vidn Trung uang Hue vl Bpnh vipn Y hgc cd truyen tinh Thda Thien Hue tu tiiang 4/2015 din thing 3/2016.
2.1.1. Tieu chudn chgn bfnh nhdn Tit ca cic bpnh nhin nam v l nu: mgi tda
tuoi dugc chan doin lipt day thin kinh VII ngoai bien do Ignh - chdng "Khiu nhan oa ti" the phong hin.
Tieu chuan chan doan theo y hgc hifn dai - Ve lam sing: Dya theo tidu chuin chin doin lim sang Hdt dly than kinh VII ngoai bidn do lanh cfia Nguydn Van Ding [2] vl cfia Hd Huu Luang [6]:
+ Mit nip nhin tiin, mat ranh mui ml, Ipch nhan trung, m^o mipng, diu hidu Souques (+), diu hipu Charles Belt (+).
+ Cd thd c6 rdi loan than kinh thyc vgt, cam giic nhu: khd mit, chiy nude mit, giim tilt nude bgt, cim giac dau vung sau tai, nghe vang dau.
+ Nguyen nhan do Ignh thudng xuat hipn dgt nggt, hay g|p vio mfia Ignh hay sing sdm vl thudng khdng tim thiy nguydn nhan khic.
- Vl cgn lam sing: Cic x^t nghifm hdng ciu, bgch ciu, tieu ciu, tdc dg ting mlu... deu cho ket qui buih thudng.
Tieu chuin chin doan theo y hpc co truyen:
Ngoai cac bilu hifn tgi chd vung m|t nhu trdn cdn cd cic bieu hipn nhu: sg lanh, sg gio, gai r^t, khdng sdt, reu ludi tring, mdng, mgch phfi, khan [5].
2.1.2. Tiiu chudn logi tr& b$nh nhdn - Tdn thuang cic day thin kinh sg nao khac, hgi chung thin kinh khic kem theo.
- Bdnh nhan dang mic cac bpnh cip tinh, bpnh toln thin khac.
- Tien sd chan thuang ho|c phiu thugt vfing dudng di cfia dly thin kinh VII.
- Kham tai mui hgng cd bilu hipn viem tai giiia, viem tai xuang chum, zona tai...
- Bpnh nhan khdng ty nguypn tham gia nghien cdu, khdng tuln thu nguydn tic dieu trj, bd didu trj qui 3 ngiy ho§c dfing them cic phuang phip didu trj khic.
2.2. Phutfng phip nghien cihi
2.2.1. Thiit ki nghien c&u: Theo phuang phap tien cdu, danh gia ket qui trudc, sau dieu frj.
2.2.2. Cdc bu&c tiin hdnh nghiin c&u Khim thyc the bing y hgc hipn dgi, danh gii Tgp chf Y Dugc hpc - Tnrdng Dpi hpc Y Dugc Hui - Sd D^c bift 77
mdc dg bfnh theo thang didm tam sing cfia Le VIn Thinh [7].
Tiln hinh dilu tij bing y hgc cd truyin: dn cham vi thudc thang.
Trong qui tiinh dieu tij, theo ddi, ghi nh|n cac tic dyng khdng mong mudn cfia 6n chim.
Fhac dd dieu tri
- On cham cic huyet: Toan trfic, Tinh minh, Duong bgch, Thii duang, E phong, Gilp xa, Nghinh huang, Dja tiiuang, Thua tirang, Nhan tmng, Ngu yeu, Hgp cdc, Ty ti^c khdng, Dong td lieu.
Sau khi chim kim dat die khi tien hanh tmi kim, sau do ha dieu ngii (da dot chiy dau) vio ddc kim sao cho bpnh nhin cd cim giic ndng im dd chju (khdng ndng rat gay bdng). Moi huypt cuu lien tyc frong 5 phfit. Mdi lln cuu 20 phfit (4 Bing 2.1. Tieu chuin
huydt), ngay 1 lin. Mgt lidu tiinh 10 ngiy. Sau 1 lipu tiinh bfnh nhin chua khdi thi nghi 7 ngay, sau dd tidp tyc didu trj lidu tiinh thd hai, tdi da 3 lipu ttinh [1].
- Thudc thang: dung bii thudc cd phuang
"Dgi tin giao thang" [3].
Tin giao 12g, Phong phong 04g, Te tin 02g, Khuang hogt 04g, Xuyen khung 08g, Hoang cim 04g, Bgch tiiigt 04g, Thyc dja 04g, Bgch thugc 08g, Bgch chi 04g, Sinh dja 04g, Bgch phyc linh 04g, Thgch cao 08g, Dgc hogt 08g, Duong quy 08g, Cam thio 08g. (Sic uong ngiy 1 thang, udng 2 lin sing vl chidu).
2.2.3. Phuangphap ddnh gid
Dya vio tripu chfing dg hd Idie mi mit vl sue CO CO khi cudi theo Ld VIn Tiilnh [7].
danh gii dilm tim sing Trif u chdng
D$ hd khe mi khi nham mat Hd khe mi > 3 mm Hd khe ml < 3 mm Dau hipu Souques duang tinh Nhim mit binh thudng Sue co CO khi cudi
Hoan toin tdidng cd bieu hien co ca Cd sdc CO ca nhung Ipch nhieu Cd sue CO ca rd nhung yeu ban ben lanh Sdc CO ca binh thudng
Tdng sd diem
Diem chuan
3 2 1 0 3 2 1 0 6
Tnrdc khi dieu tri
Sau khi dieu tri
Ket qua dieu trj Diem
Bang 2.2. Tieu chuan dinh gii ket q Khdi
Odilm
Dd
< 2 diem so vdi ttudc dieu tij
ua dilu ttj [7]
KhSng boi phyc Khong thay ddi 2.2.4. X& ly sd li$u: Xd ly theo phin mem thdng ke SPSS 16.0.
3. KET QUA VA BAN L U ^
3.1. D^c diem chung cua b^nh nhan trong nhdm nghien ciru
Bang 3.1. Dgc diem chtmg cfia bfnh nhan trong nhdm nghidn cdu D^c diem chung
Nhom tudi
GiM
<18tu6i 18-49tu6i
> SO tu6i Ting Nam NS TSng
sd b^nh nhan 9 22 9 40 15 25 40
Ty le % 22,5
55 22,5 100 37,5 62,5 100
78 Tjp chl YDuyc h?c - Tnrftng D»i hpc Y Duyc Hui - So D}c bift
p 1118-49 Bdnh mic phii d mgi Ida tudi, thip nhit li 6 tudi, cao nhit li 68 tudi, Ida tudi thudng ggp la tudi (chidm 55%), ty- Ip mic bdnh d nfi cao han d nam. Kit qui nly phfi hgp vdi nghidn cdu cfia Le VIn Thinh (2007) [7].
3.2. Ket qua dilu t n
3.2.1. Kit qud diiu trf cdc tri$u ch&ng chinh
Bing 3.2. Kit qui dieu trj cic tiipu chdng chinh Tri^u chirng
Roi lo^n vSn d$ng
Rdi loan thifc v^t
Mat nep nlian tr^n Charles-Bell (+) Souques (+) Mat rSnh mui md L^ch nhan trung - m^o mif ng Kh6ng CO ca cuoi Ch4y nu6c mat Khdm4t Giam vi giac Giim tiet nude bpt Nghe vang dau Cam giac dau sau tai
Trirorc di^u
«ri n 40 40 40 40 40 40 20 7 13 3 4 14
%
100 100 100 100 100 100 50 17,5 32,5 7,5 10 35,5
Sau dilu trj C6n
n 3 3 3 3 3 3 0 0 0 0 0 0
%
7,5 7,5 7,5 7,5 7,5 7,5 0 0 0 0 . 0 0
Het n 37 37 37 37 37 37 20 7 13 3 4 14
%
92,5 92,5 92,5 92,5 92,5 92,5 100 100 100 100 100 100 Sau dieu ttj, da sd bpnh nhan diu hdi phyc cac ttipu chdng rdi logn vin ddng (92,5%), chi cd 7,5%
bpnh nhin khdng hdi phyc. CIc ttipu chfing rdi logn thyc v§t deu hdt (100%). Ket qui nly tuang duong vdi kit qui nghien cdu cua Le Thj Dipu Hlng (2012) [4].
3.2.2. Kit qud diiu tri chung
Bing 3.3. Kit qua dieu tij chung K^t qua
Khoi Do- Khdng hdi phyc
Tdng
So b|nh nhan 34
5 1 40
Tf 1? % 85,0 12,5 2,5 100,0 Ket qui nghien cdu cho thiy ty tp khdi hoin toan (85%), cao han nghien cdu cfia Nguydn Hoing Trung (2013) II80% [8].
3.2.3. Kit qud dieu tri ldm sdng theo th&i gian tit khi phdt bfnh din khi vdo vi^n Bang 3.4. Ket qua dJeU ttj theo tiidi gian mJc bpnh Th&i gian
<10 ngay 10 - 30 ngay
> 30 ngay
Khoi n 32 2 0
%
100 50
0 B»
n 0 2 3
%
0 50 75
Kh8ng hdi phyc n 0 0 1
%
0 0 25
Tdng n 32 4 4
%
100 100 100 p<0,OS
Tgp chi Y Dugc hpc - Trudng Dgi hpc Y Dugc Hue - Sd D$c b
Cd sy lien quan gitia thdi gian td khi phit bfnh bfnh nhin din sdm thi t i khi mdi xlm nhap d din khi vio vipn vdi dip dng didu tij: bpnh nhan ndng, chinh khi ca thi chua bj suy giim nhidu sg vio vipn cing sdm thi dip dng vdi dieu tij iiing tdt gifip cho vipc didu trj mau khdi bfnh.
(p<0,05). Bpnh nhin vao vipn sdm han 10 ngiy 33. Cac tic dyng khdng mong mudn cua cd dip iJmgvdi dieu trj tdt nhit (100% khdi). Kit phinrag phap on cham
qui niy cao han kit qui nghidn cuu cfia Le Vin 3.3.1. Ty 1$ bfnh nhan xdy ra cdc tdc dung Thanh (2007) [7]. Theo Y hgc cd truydn, nhihig khdng nwng muon
Bang 3.5. l y 1? benh nhan xay Tdc dyng khong mong muon Co tac dung khong mong muon Khong CO tac dung kh5ng mong muon
Tdng
ra tac dyng khong mong muon So b|nh nhan
9 31 40
Ty 1? % 22,5 77,5 100,0 Ty If bfnh nhin xiy ra tic dyng khdng mong mudn trong qui tiinh didu trj thip (chiim 22,5%).
3.3.2. Cdc idc dfuig khdng mong muon
Bing 3.6. CIc tic dyng khdng mong mudn Tac dyng khong mong muon
Chay mau Bam mau Gay, cong kim Dau sau khi kim qua da Dau sau khi rut kim, sat trung Nhiem trung vet chSm Vung cham ChSm trung thSn kinh Kim kho rut Bong
Chay chan man, quan ao Tong CQng
B^nh nhan n2=40 n 3 2 0 3 1 0 0 0 0 0 0 9
%
7,5 , 5,0
0 7,5 2,5 0- 0 ,0 0 0 0 22,5
So lan cham n = 599 n 5 ' 2 0 7 2 0 0 0 0 0 0 16
%
0,83 0,33 0 1,17 0,33 0 0 0 0 0 0 2,66 Theo Bing 3.6, chfing tdi nhgn thay ring
chiy mau la tic dyng khdng mong mudn hay gap nhit, tilp ddn la dau sau khi kim qua da;
bim mlu; dau sau khi rut kim, sit trfing. CIc tic dyng khdng mong mudn khic nhu gly, cong kim; nhilm trfing vdt chim; vyng chim; chim ttung thin kinh; kim khd rfit; bdng, chiy chin min quin lo deu khdng xiy ra. Tripu chdng
"dau" dugc ghi nhan nhidu lin trong qui ttinh nghien cuu, tuy nhidn "dau" li loai clm giic chu quan, phy thudc vao ngudng chju dyng
cua mdi ngudi nen cd gii frj khdng cao. Chfing tdi khdng ghi nh|n trudng hgp nio bj bdng do dn cham trong qua ttinh dieu ttj. On cham ta phucmg phap cuu giln tiep, dieu ngii dugc ho cich da 3 - 4 cm qua kim chim cdu. Khdng cd tnrdng hgp cip cfin nio dugc ghi nhgn. Dilu dd cho thay phuang phip dn cham cd cic tic dyng khdng mong mudn khong ding kl tren lam sing.
4 . K E T L U ^
Qua nghien cdu dieu trj bfnh lift day tiiin kinh Tgp chf Y Dugc hpc - Trudng Dgi hpc Y Duprc Hue - Sd Djc bift
VII ngogi bien do Ignh bing on cham kit hgp tiiudc CO truyen chfing tdi rfit ra mdt sd ket lugn sau:
- T^ If khdi bfnh holn toin 11 85%, ty If d9 12,5%, chi cd 2,5 % khdng hdi phyc do bfnh nhan
TAI L i f u 1. Bd Y tl (2007), Y hpc cd truyin sdch dao tgo bdc si
da khoa, Nhi xuit ban Y hpc, HI Npi, ttang 65 - 84, trang 167-172.
"^ NguySn VIn Ding (2003), Thuc hdnh thdn kinh cdc bfnh vd h0i chung thu&ng gdp, Nhi xuit bin Y hpc, HI Ndi, ttang 355-377.
3. Trin Nhu Hii, Lf Gia Canh (2011), Thmg Qudc danh phucmg todn tgp, Nhi xuit bin Y hgc, Hi Ndi, trang 853 - 854.
4. Le Thj Dipu Hlng, NguySn Thj Tin, Hoing Dfic DOng (2012), "Dinh gii hifu qui dilu trj lift dly Vll ngogi bi€n do Igiih bing difn eye din kit hgp bii thudc Dai tin giao thang", Tgp chi Y dugc hgc (sd 10), ttang 70-75.
5. Khoa Y hpc cd tmyin, tnrdng Dgi hpc Y HI Ndi (2003), Ngi khoa Y hgc cd truyin, Nhi xuit bin Y hpc, HINdi, ttang 243-246.
tdi mudn. Bpnh nhan vio vidn cing sdm thi dip dng vdi dieu trj cing tdt.
- Phuang phip dn chim khdng gly ra tic dyng khdng mong mudn ding kl ttdn lim sing.
THAMKHAO
6. Ho Hdu Luong (2005), Bfnh than kinh ngogi vi, Nhi xuit bin Y hpc, HI Npi, trang 303 - 341.
7. Le VIn Thinh (2007), Ddnh gid tdc dyng diiu trj lift day thdn kinh VII ngogi bien do Ignh bdng phuongphdp xoa bop bdm huyit kit hgp v&i difn cham, Lu^n vin tdt nghifp BIc sT chuyen khoa cap 11, trudng Dgi hpc Y Hi Ndi-
8. Nguyin Hoing Trung (2013), Ddnh gid tdc dung diiu tri vaphdn tich chi phi cua phuang phdp c^
chi Catgut vdo huyit trong dieu trf lift VII ngogi bien do Ignh, Lu§n vin tdt nghifp Thgc si Y hpc, Trudng Dgi hpc Y HI Npi.
9. Li Y, Wu X, Hu KM, Chen XM (2010), "Current situation and evaluation of clinical studies on acupuncture and moxibustion treatment of peripheral facial paralysis at selected stages", J.
Tiadit. Chin. Med30 (2), p.p 153 -159.
Tgp chi Y Dirge hpc - Trudng Dgi hpc Y Dugc Hui - Sd D^c bift
