Tap chl Tai Mui Hpng Vigt Nam - Volume (58-16). N°4-June. 2013
NGHIEN CXfU MQT SO DAC DIEM LAM SANG HQI CHITNG CAI NGHIEN HEROIN
Dam Due Thdng*, Pham Vdn Manh *, Nguyin Xuan Bdi*
T 6 M TAT
Bat van di: Nghian ma tuy noi chung, dac biet nghien heroin la mgt te ngn xd hoi dnh huong sdu sac den benh nhdn, gia dinh vd xd hgi So lugng ngudi nghien ma tuy cd chiiu hudng ngdy cdng gia tdng. Muc tiiu: Nghien cim ddc diem Idm sdng hoi chimg cai nghien heroin. Doi tuong vd phuong phap nghiin ciru: Gdm 59 benh nhdn nam. theo tieu chudn chdn dodn nghien heroin cua hgi tdm than hoc My nam 1994 (DSM-IV), diiu tri noi trii tgi benh vien Tdm thdn Hdi Phong, tudi tic 18 ^ 58 tudi. Tiin hdnh theo phuong phdp tiin cuu, cat ngang, cd tien hdnh phan tich timg truang hgp dien hinh. Kit qud: nghien heroin chu yiu muc do vica 64,40%, roi logn lo du Id 88,14%, roi loan cdm xiic 55,9%, rSi logn vi tri gidc: 27,12%, rSi logn y thirc 32,20%, rSi logn hdnh vi tdc phong 89,83%. Ket luan:
nghien ciru cdc ddc diem lam sdng hoi chirng nghien heroin Id rdt cdn thiet trong dieu trj cai nghien ma tuy.
Tir khoa: Hoi chirng cai nghien heroin SUMMARY
Introduction: Drug addiction, particularly heroin addiction is a social evil. It has deeply affect to patients, families and society. Numbers person drug addicts has trends increasing. Objective: To study clinical features of heroin addiction syndrome. Patients and Method: including 59 male patients, according lo the heroin addict diagnosis standard of American psychiatry Assembly in 1994 (DSM-IV), inpatient treatment at a mental hospital in Hai Phong, aged from 18 to 58 years old. it is prospective study, cross, analyze each of the typical case. Results: heroin addiction mainly moderate 64.40%.
anxiety disorders was 88.14%. 55.9% emotional disorders, disorders of consciousness was: 27.12%, consciousness disorder was 32,20%, behavioral disorder was 89.83%
Conclusion: The study of clinical features of heroin addiction syndrome is essential in the treatment of drug addiction.
Key words: clinical features of heroin addiction syndrome
I. BAT VAN DE sir dung ma tuy tro lai. Do do, viec dieu tri hoi chiing cai la viec khong the thieu trong KM sue khoe gidm siit hay vi mot ly do cdc lieu trinh cai ma tuy noi chung cai nao day nguoi nghien phai ngimg sir dung nghien heroin noi rieng. Diiu tri hpi chiing heroin se thay xuat hien hpi chiing cai vol ^ai, giiip nguoi nghien vot qua hpi chiing nhihig bieu hien sau: nguoi nghien rat kho ^ai mot each, nhe nhang vd nhanh chong chiu, bieu hien bang cac roi loan tam than ^61 phuc sire khoe vln luon la vdn dl dupe va roi l o ^ co the tir nhe den nang, thuong uj^jl^ ng^^ quan tam nghien cim khong xay ra cap tmh da bupc nguoi nghien phai ^j^j^g ^ viet Nam ma cd tren thi gioi.
Chinh vi vay chiing toi tien hanh nghien
* DEII hoc Y Thai Binh Nhan bii 23/5. Duyet in 5/6/2013
Tgp chi Tai Mui Hpng Vi^t Nam - Volume (58-16). N°4 - June, 2013 ciiu vai muc tieu sau: Nghien ciiu ddc diem
lam sdng hpi chimg cai nghi?n heroin.
2. BOI TU'gfNG VA PHl/ONG PHAP NGHIEN CUU
2.1. Boi tvpng nghien cihi
Gom 59 benh nhan nam nghien heroin dupe dieu tri npi tni tai benh vien Tam than Hdi Phong vd Iiia tuoi tir 18 -^ 58 tuoi, tuoi trung binh Id 33,05 ±8,09.
2.1.1. Tiiu chudn chpn binh nhdn nghien ciru.
Tat cd cac doi tuong da vao nghien ciiu phai dap img day du cac tieu chuan chin dodn nghien heroin ciia hpi tam than hpc My nam 1994 (DSM-IV) [4].
- Co bang chimg da sii dung heroin (thir test morphin dong tinh trong noc tiiu)
- Benh nhan dap ling dupe nhu cdu kham benh va lam cac xet nghiem.
Tat cd cac benh nhan dpc dieu tri bang levomepromazin va diazepam theo phac do ciia Bp Y tl(1995) dl cat con nghien
2.1.2. Tieu chudn loai trir.
Benh nhan co benh co thi nang: tim mach, hen, gan, than...
Benh nhan dung thu6c cit con khdc voi quy trinh nghien ciiu.
Benh nhan co tien sir mpt benh tam than khac.
Benh nhan dong thoi nghien rgu hoac loai ma tuy khac.
2.2. Phirong phap nghien cihi.
Tien hanh theo phuong phap tiin cuu, cat ngang, co tiin hanh phan tich timg tr- uong hpp diln hinh.
2.2.2. Phuong phdp khdm Idm sdng chung
- Sir dung mau b?nh dn nghien ciiu.
2.2.3. Cdc chi tiiu Idm sdng d6 danh gia ket qud:
Dien biln trieu chiing trong 10 ngay dieu tri tir ngay thir 01 den thii 10.
2.2.3.1. Ddnh gid cdc roi logn ve ca thi.
Danh gia cac roi loan co the theo DSM- IV the hien qua 9 tri?u chiing: Lo^n khi sac, non, bon non, dau co, chay nude bpt - nu6c mat, gian dong tii hodc ra nhilu mo hoi, ia chay, ngap, sot, mat ngu.
Ddnh gia hpi chiing cai theo bang diim cua Himmelsbach 1982.
Bang 2.1 Bang diem cua Htmmelsbach.
Tri$u chiing Met moi r5 roi Ng^p chay nu'6'c mat Chay nuoc mui va mo h6i [a chay Dau lung Nhuc xuong N6i da gd
Diem 1 1 1 1 2 1 1 2
Tn0u chijng Dan d6ng tii N6ng ngyc kh6c6 Mat ngu Nhuc dau N6n mira, CO gi^t H6nm6 TSng huyet ap Xuat huy^t
Diem 3 1 2 2 3 3 3 3 Tong s6: 30 diim
Danh gia miic dp:
+ Ducri 10 diem la nghien nhe.
+ Tir 10 •!• 20 diSm la nghien vira.
+ Tir 21 -7- 30 dijm la nghien njng.
T9P chl Tai MOi Hpng Vljt Nam - Volume (58-16). N°4 - June, 2013
2.2.3.2. Ddnh gid ve rdi loan tdm thdn.
2.3. Phmmg ph^p xit ly s6 li^u: xii ly bing chuomg trinh SPSS 15.0.
3. KET QUA NGHIEN ClTU Bang 3.1Tu6i cua nhdm b^nh nhSn nghjgn
STT 1 2 3 4 5
\ B ^ n h N i h S n Tuoi \
< 2 0 2 1 - 3 0 3 1 - 4 0 4 1 - 5 0
>50 Tong cdng
n=59
1 21 27 8 2 59
T y l S
%
1,70 35,59 45,76 13,56 3,39 100.00
P P3-1 <0.001 Pt-2<0,001 P2.3>0,06 Pw <0,001 PJ-5 < 0 , 0 0 1
Tmng binh ( X ± SD) = 33,05 ± 8,09
Nhan xet: nhom tuoi nghien ma tiiy 31 - 40 chiem ty le cao nhat 45,76%, tiep den 21-30 chiim 35,59%. Tu6i trung bmh nghien ma tiiy 33,05 ± 8,09.
Bang 3.2 Dud-ng dung heroin
STT
1 2
3
\ BSnh
\ n h a n Du'6'ng\
diJnq \ HUt, hit dan thu^n Tiem TM dan thuan Hut, hlt+
tiSm TM Tong cdnq
n 69
11
8
40 59
T y l e
%
18,64 13,56
67,80 100,00
P
P3.,<0,001 p,.2>0,05 P2.3<0,001
Nhein xet: Hiit, hit, tiem tinh mach chiim ty 1? cao nhdt 67,8%; Hiit, hit don thudn chiim 18,64%, tilp den Id tiem don thudn 13,56%.
3.3. Ddc diem lam sdng h^i chung cai heroin.
3.3.1. D^c diim cdc rSi hgn tdm than d binh nhdn cai nghian heroin.
Bang 3.3. TSm trgng cua b6nh nhan.
STT
1 2
3
\ B$nh
\ nhan Tri§u \ chijnq \ L o d u Hoang hot vO CO' Bon chOn
n = 6 2
52 32
40 Ty le %
100,00 61,54
76,92 P
P3.2
>
0,05
Nhan xet: 100% benh nhan co bieu hien lo au, tiep din bon chon 76,54%, hoang hot vo co 61,54%.
Bang 3.4. Dac diem ve cac tri^u chijng r6i loan y thirc.
STT
1
2 3
\ Benh
\ nhan Trieu \ chLrnq \ RL nSng lu'C dinh hu'ang Me sang LU l3n
n = 1 9
12
5 2
Ty le %
63,15
25,31 10,53
P
P3.1 <0,05
p,.2>0,05 P2-3>0,05
Nhan xet: Benh nhan c6 roi loan nang lire dinh huong 63,16%, me sang chiem 26,31%, liil&i 10,53%.
Tap chi Tai MQi Hong Vi&t Nam - Volume (58-16). N°4 - June. 2013
Bang 3,5 Roi loan ciim xuc
STT
1
2
3
\ B$nh
\ n h a n Tri&u \ chiinq \
Lo sp khSng c3t du'pc con Cam xuc d§ bunq n6
Cam xuc kh6ng on dinh
n
=51
41
7
3 T y l «
%
80,39
13,73
6,88 P
P2-1
<0,001 P3.2
>0,05 P,.3<
0,001
Nh^in xet: 100% b?nh nhan mdt ngu, gidm tap trung chii y 92,59%, tilp theo la bi quan ve tuong lai 81,48%, co y tudng va hdnh vity sat 7,41%.
Bang 3 7 D$c di^m v^ cSc 3o giSc d b$nh nhSn cai nghian heroin.
Nhan xet: co den 80,39% benh nhan lo sg khong cat dugc con, cam xiic de biing no 13.73%, cam xuc khong on dinh 5,88%.
Bang 3 6 DSc diem ve c^c tn6u chung cua r6i loan tr&m cam.
STT 1 2
3 4 5
6 7 8
9 10
\ . BSnh
\ ^ h a n Trieu chOrfgs.^
Giam khi s i c Mat moi quan tam thich thil Tang m^t moi Giam tap trung chu y Giam tir trpng va iong tLf tin Y tu'ong bi t6i BI quan ve tu'ong lai Co y tuong va hanh vi tu' s4t Mat ngu An khong ngon mi&ng
n = 6 4 28 19
43 50
12 2 44
4 54 42
T y l 6
%
51,85 35,18
79,53 92,59
22,22 3,70 81,48
7,41 100,00 77,78
P P s . , > 0 , 0 5
Pi-z>0,05
P2.3 < 0,001 P i n < 0,001
P;-s>0,05 P 3-6 < 0,001 p 10.7 > 0,05
P7.B<0,001
P4.10 > 0 , 0 5 STT
1
2 3 4
Phan loai Tri^u chi>ng Ao thinh giSc A o t h i qiac A o x u c giac Ao giac khac Tong cpnq
Ao giac thd s o n
=13
3 4
)
2
13 Ty \i%
23,08
30,77 30.77
15,38
100,00 Ao giac phCrctap n
=3 2
1 0
0
3 Ty 16%
66,67
33.33 0
0
100,00
Nhdn xet: Benh nhan ao giac tho so chiim 22,03%. do giac phuc tap 5,08%
Bang 3,8. 0 5 c (3iem ve roi loan t u duy a bSnh nhSn cai nghian heroin.
STT
1 2 3 4 5 6 7 8 9
^ ^ B6nh
Tn6u c h i > n q \ Y tLTong bat hanh Y tu'ong hoai nghi Y tu'ong bi tdi Y tu'ong ghen tudnq Am anh so c h i t Am anh sa ma quy am anh sp"
cdn trijnq am anh so khac Hoang tird'ng nh$n nh^m
n = 2 9
7 6 2 3 3 1 4 2 1
Ty 1$ %
24,14 20,69 6,89 10,35 10,35 3,45 13,79 6,89 3,45
P
>0,05
1':
Tgp chl Tai MQi Hpng Vi$t Nam - Volume (58-16). N°4- June. 2013
Nhdn xet: roi loan tu duy, co toi 24,14% y tuong bit h?mh, y tuong hoai nghi chiem 20,69%, am anh sg c6n trung
13,79%.
Bang 3.9. R6i logn hdnh vi tdc phong
STT
1 2 3 4 5
" \ ^ B^nh
^ \ n h a n Trifeu c h i > n g \ VHt va kich thich Kich ddng tram cam.
Chan an Giam ham mu6n tinh due Hanh vi hi sat
n = 54 53 5 37 47 1
Ty i$ % 98,15
9,26 68,52 87,04 1,85
P P M <
0,001 P 3 - 2
<0,001 P4-3>
0,05 P 5 - 4 <
0,001 Pl.5<
0,001
Nhan xet: ve roi loan hanh vi tdc phong CO 98,15% vat va kich thich, giam ham mu6n tmh due 87,04%, chdn an 68,52%.
3.3.2. Cdc trieu chirng roi logn co thi d b$nh nhdn cai nghian heroin.
Bang 3.-10. Cdc r6i loan c o the thuong gap.
STT 1 2 3 4 5 6 7 8 9 10 11 13 12
^ ^ ^ . . ^ ^ B ^ n h nhan Trifeu chi>ng~~—-.^
Ngap Chay nu'dc mat,
nude bot
€)au moi c o khd-p Thdm heroin Toat md hdi. noi da
ga N6n, buon ndn
Mach nhanh Dj cam (gidi bd
trong xu'ang) Dong ti> gian la chay
Sdt Mat ngu Si)t can
n = 59 59 40 59 55 45 18 59 55 45 11 24 54 59
Ty l« % 100,00
67,80 100,00 93,22 76,27 30,51 100,00 93,22 76,27 18,64 40,68 91,52 100,00
Nhdn xet: Trong cac roi l o ^ ve co the:
100% benh nhan co ngdp, dau moi co the, mach nhanh, siit can.
Bdng 3 11. D$c iJi^m vfe muc dO nghian heroin theo Himmelsbach 1982.
STT
1 2 3
\ BSnh X ^ n h a n Mdc dd \
Nhe V d a Nang Cdnq
n=69
5 38 16 59
Ty le%
8,48 64,40 27,12 100,00
P P2.1 < 0,001
P3.2<0.01 P i . 3 > 0 , 0 5
Nhan xet: muc dp nghien heroin, 64,4% benh nhan nghien heroin 6 miic dp vira, 27,12% muc dp nang va 8,48% a muc dp nhe.
4. BAN LUAN
4.1. Ve tudi va gi^ cua nhom benh nhan nghien cihi.
March J.C va cs (2006) nghien cuu 1879 benh nhan nghien heroin o 9 thdnh phd Ion thugc EU chi ra rang benh nhan nam chiim 69,7%[6]. Lu .B va cs (2001) nhan thay benh nhan nghien heroin o Trung Qu6c CO 82% la nam va 18% la nil [5].
Nhu vay, voi cof mdu (n = 59), chpn benh nhan bi gioi han tai khoa dieu tri va nghien heroin chu yeu o nam nen trong nghien cuu cua chiing toi khong gap benh nhan nii la dieu de hieu. Ve tuoi ciia nhom benh nhan nghien cuu, ket qua ciia chiing toi (bdng 3.1) cho thdy, tu6i trung binh ciia nh6m benh nhan nghien cuu la 33,05 ± 8,09 tu6i, nhom tu6i tir 21 -7-40 tuoi chiim ty 1? cao nhat 81,35%, tudi thdp nhat Id 13 tuoi va cao nhdt Id 58 tudi. Theo Chawarski M.C va cs (2006), tu6i trung binh cua ngucri nghien heroin tai Malaysia la 37,2 ± 9,1 tu6i. Ciing chung nhan dinh vl vdn dl nay.
Tap chl Tai MOi Hong Vijt Nam -Volume (58-16). N°4-June, 2013 March J.C va cs (2006) cho ring tuoi chung
binh cua ngudi nghi$n heroin 14 39,19 tu6i[6]. Nguyen Viet vi cs (1995), khi nghien ciiu tren 100 b$nh nhan nghian heroin cho thay co 29% so b?nh nhan dudi 20 tudi va 82% s6 benh nhan dudi 30 tuoi [3]. Nhu v$y, ket qua nghien cihi cua chiing toi phii hgp vcri hau het ket qu4 ciia cac tac gia tren. Chung ta co the nh^n dinh rang, nghien heroin hay gSp d lira tuoi tre, dieu nay phan nao ndi nen anh hudng cua nghien heroin doi vdi doi tuijmg cd the cdng hien cho xa hpi nhieu nhat.
4.2. Ve durcmg diing heroin.
Qua bang 3.11. cho thay duong dung heroin hiit don thuan la 18,64%, tiem chich don thuan chi chiim 13,56%. Dudng dung heroin chu ySu la tir hit, hut thudc rdi chuyen sang tiem chich chiim 67,80%) va ty le sit dung heroin tai thdi diim nghien cim la 81,36%.
Ket qua nghien cuu cua chiing toi phii hgp vol da s6 cac tac gia nhu March J.C (2006) nhan thSy 60,2% benh nhan nghien heroin su dung dudng tiem chich [6] va De la Fuente de Hoz L va cs (2005) nghien ciiu 991 benh nh&i nghien heroin cd 42,4%
diing dudng tiem chich.
Nhu vay, de cd dugc cam giac sang khoai nhu lin trudc, lugng heroin dua vao CO thi lin sau phai cao han. Va cii nhu thi, CO the ngudi nghien dugc tap dugt dl din dan dung nap nhung lilu heroin ngay cang tang va tang rat cao. Mat khac duong hiit thi lugng heroin dua vao co thi thip hon nhieu so vdi duong tiem chich, nen dl cd cam giac sang khoai nhu mong mudn nguoi nghien phai mit rit nhilu tiin mua heroin neu tiep tuc duy tri dudng hiit. Vi vay dudng tiein chich la sir lira chgn cudi cung cua hiu hit ngudi nghien mac dii hau qua no dem lai rat nang nl.
4.3. Ve lam sang h^i chirng cai heroin.
4.3.1. B^c diem cdc roi loffn ctf the ci b^nh nhdn cai nghian heroin,
4.3.1.1. Ve ddc diem hoi chimg heroin theo DMS-IV nam 1994.
Chiing tdi tien hanh theo doi dien biln hgi chiing cai trong 10 ngay lien tiep. Tit ca cac b$nh nhan nghien ciiu deu xuat hi^
cac rdi loan co the vk tam than sau 6 -rlSh ngimg sir dung heroin, nghia 14 cac b^nh nhan deu dugc chan doan xac dinh cd hoi chiing cai heroin.
* Ve thin gian: ket qua bang 3.15 cho thay g^p d tat ca c4c trieu chung cua hpi chiing cai trong 4 ngay diu dieu tri vdi ty 1?
trieu chiing moi loai khac nhau va biln doi theo timg ngay. Ngay thii 2 cua dgt diiu tii hoi chiing cai xuat hi?n ram rg nhat, din ngay thii 7 cac tri$u chiing thoai lui rd rIt, ngay thil 10 chi cdn 3/59 benh nhan mit ngu..
Nhieu tac gia cho rang thdi gian xual hien hgi chirng cai heroin tir 4 -f 8 gid, hgi chiing cai a dinh diem vao tir ngay thii I den ngay thii 3 va kit thiic sau 7 -f 10 ngay [4].
Theo Aleksandrov S.G (2004) nghien ciru 82 benh nhan nghien heroin dugc dieu tri cit can thiy trong hai ngay diu ciia h$i chiing cai heroin xuit hi$n nang ne nhat, trong vdng 15 -f 16 ngay hgi chiing cai het hoan toan.
Gekht A.B va cs (2003) cho ring hpi chiing cai heroin trung binh 12,3 ± 8,1 ngay.
Trin Van Cuong (1995) nh|n thiy tit ngay thir 5 cua dgt diiu tri cit con h^i chiing cai cd xu hudng giam dan, binh nhSn thiy dl chiu hon va an ngon mi$ng hon. tir ngay thii 7 cac trieu chiing chi cdn
Tgp chi Tai MQi Hgng Vi$t Nam - Volume (58-16). N°4 - June. 2013
le te, an uong khd hon va bat dau len can.
Sau 10 ngay dieu tri chi c6 mot vai b?nh nhan con mot so bieu hien nhu: mat ngu, vd ngap vdi Idn trong ngay [2].
Nhu vay, ket qua nghien ciim cua chiing toi vl m^t diln bien hpi chung cai theo thoi gian phu hop voi hau het cdc tdc gid trong va ngodi nuoc.
* Ve lo^n khi sic: kit qua bang 3.15 cho thdy r6i loan khi sSc xuat hien ngay tir ngay ddu tien va dao dpng it (49, IH- 55,9%), trong do khi s k giam la 28/59 benh nhan (47,45%), khi sac han hpc bdt man Id 5/59 benh nhdn (8,47%).
Theo Rodriguez-Llera MC va cs (2006) nghien cuu 149 benh nhdn nghien heroin cho thdy ty le chong doi xa hoi va roi loan khi sic Idn luot la 33% vd 26% [7].
* Dau cor: theo ket qua nghien ciiu (bang 3.15) chiing toi thdy dau co gap 6 59/59 benh nhan 6 ngdy thii 2, sau do gidm ddn din ngay thu 5 chi con 37,3% ngay thii 8 chi con 3/59 benh nhan con co cam giac dau CO. Da so benh nhdn co cdm giac dau CO lan tod vung co, cdnh tay vd viing mong, con dau khong lien tuc thudng hay xuat Men vao thoi diem ma hang ngay benh nhdn sit dung heroin. Mpt so co bieu hien dau kilu phdn ly chiing toi phai dung phuong phdp dm thi moi het dau.
* Ngdp: theo kit qua cua chiing toi (bang 3.15) bilu hien ngai? gap cr 100% s6 benh nhan trong 2 ngdy ddu, cdc ngdy sau ty le gidm din den ngay thii 7 khong con benh nhan nao c6 bieu hien ngap.
* Mat ngu: Kit qua bang (3.15) cho thdy mdt ngii cao nhat trong ngay thir 2 vd 3 chiim 91,5%, benh nhdn thuong thuc su6t dem ngdy trong 2 ngdy nay kem theo r6i loan hdnh vi khdc nhu di lai Ipn xpn do mdt dinh huong vd ao giac chi ph6i. Cac
ngay sau trieu chung mdt ngu gidm di (27,1% ngdy thir 5) nhung benh nhan thuong CO nhiJng ac mong voi npi dung ghe sp ky qudi. Sau 10 ngay van con 3/59 benh nhan mdt ngii.
Ket qud nghien ciiu ciia chiing toi phu hop voi Abott P.J (1994) khi nhan thdy 87% benh nhdn co roi loan gidc ngii. So sanh voi ket qua cua Nguyin Thanh Binh (2001) chiing toi khong thdy su khac biet voi p < 0,05.
* Cac roi loan cor the khac.
Kit qua nghien cim cua chiing toi cho thdy cac trieu chiing co the thay doi tirng gio, timg ngdy. Cac roi loan co the bieu hien ram ro vao 3 ngay dau voi 30,5% non vd bu6n non, 67,8% chay nuoc bpt nuoc mat, 76,3% gian d6ng tir, 18,6% ia chdy va 40,7% CO than nhiet cao.
Theo Stuart(2002) dua vao cdc roi loan CO thi trong hpi chiing cai chia ra cac miic dp nghien:
Mirc dp 0 : bao gom them va lo du.
- Muc dp 1 : Ngap chay nuoc mat, so miii vd va mo hoi.
Miic dp 2 : Cac trieu chiing truoc do kem theo gian ddng tu, run, chan an, cac con nong lanh kem theo dau lan tod.
Muc dp 3 va 4 : Cac trieu chiing tren kem theo tang than nhiet, tang huyet dp, mach nhanh, tho nhanh sau.
Da s6 cac tdc gid diu nhan dinh cac rdi CO thi trong hpi chimg cai bao gom yeu met, non, buin non, nhip tim nhanh, tang phan xa, tang tilt ml hoi, ngap, an kem ngon mieng... song rdt it tac gia dua ra ty le cu the moi loai [4],
Tom lai cdc rli loan co thi trong hpi chimg cai diln biln rdt phirc tap, phdn Ion cac cac roi loan xay ra trong 3 ngay ddu sau
Tgp chi Tai Mui Hpng Vi$t Nam - Volume (58-16). N°4- June. 2013 khi ngimg su dung heroin va thuyen gidm
sau 1 dSn 2 tuan. Cdc roi loan ndy c6 the khien cho benh nhan nghi?n von co sue chiu dung kem muon n^ tranh, tim mpi each de sir dung lai heroin.
5. KET LUAN
Bdng phuong phap tien ciru tren 59 benh nhdn cai heroin dupe chdn doan xac dinh theo DSM -IV vd dieu trj bdng levomepromazin vd diazepam trong 10 ngdy, chiing toi nit ra mot so ket luan sau.
1. Dac diem lam sang hpi chung cai heroin
Roi loan lo au Id 88,14% trong do hodng hot vo co Id 61,54%, bon ch6n chiim 76,92%
- Roi loan cam xiic g6m 55,9% loan khi sac, khi sac giam la 69,81%.
Roi loan ve tri giac: 16/59 benh nhan (27,12%) co do giac, trong do do gidc tho so cdc loai 13/16 benh nhdn.
- Roi loan y thiic: 19/59 benh nhdn (32,20%) CO roi loan y thiic trong do r6i loan dinh huong la 12/19 benh nhan (63,16), sang cung gap 6 5/19 BN.
Roi loan hdnh vi tac phong: vat va kich thich gap 53/59 benh nhdn, giam ham muon tinh due la 67,04%, chan an Id 68,25%.
Hpi chiing cai dupe dac trung bdng cac trieu chung co the ro ret trong do dau CO ngdp, mach nhanh la n6i bat nhdt chiim 100%, them heroin vd di cam moi loai chiim 93,22%, mdt ngu gap 91,5%.
Nghien heroin chu yeu mirc do vira 64,40%.
TAI LI?:U THAM KHAO 1. Nguyen Thanh Binh (2001) '•Nghien
ciru ddc diem lam sdng rdi logn tdm thdn a b$nh nhdn dang dieu tri cat con nghian ma tuy (opioid ) " . Luan van thac sT y hpc, Hpc vien Qudn Y.
2. Trdn Vdn Cuong (1995) "Nhgn xet kit qud nghien ciru buac ddu md thinh to chuc dieu tri nghien ma tuy tgi CQng dong". Tap san ky yeu cac cong trinh nghien curu khoa hpc. Bp y te - Chuyen nganh Tdm than. Trang 132 - 139.
3. Nguyen Viet, Tran Viet Nghi, Nguyen Minh Tuan (1995) "Ddnh gid diiu tri cat can nghien ma tuy bdng cdc thuoc hudng thdn theo hudng ddn cua bg y ti ban hdnh" Tap san ky yeu cac cong trinh nghien cuu khoa hoc. Bp y tl - Chuyen nganh Tdm thdn. Trang 120- 131.
4. Kaplan H. L, Sadock B. J., Grebb J. A.
(1994) "Synopsis of psychiatry.
Seventh edition". Wasington D.C.
Pages 278-318, 1014.
5. Lu B., Mai L., Zhou L et al. (2001)
"An epidemiological stucfy of spongiform leucoencaephalopatl^
among heroin abusers ". Zhonghua Nei Ke Za Zhi. Dec; 40(12). Pages 802 - 805.
6. March J.C, Oviedo Joekes E., Romero M (2006) "Drugs angd social exclusion in ten eurpean cities". Eur addict ;12(1). Pages 33-41.
7. Rodriguez- Llera M.C.Domingo- Salvany A et al (2006) "Psychiatric comorbidity in young heroin users".
Drug Alcohol Depend.Sep; 84(1).
Pages 48-55.
