Tgp chf Tai MQi Hpng Vigt Nam - Volume (60-27). N°3- June. 2015
NGHIEN CUtJ UWG DVNG BANG RSI VA RFS TRONG CHAN DOAN VA DIEU TRI TRAO N G U Q C HQNG TIIANH QUAN
Lirang Thf Minh Huang", Ha Phuang Thdo
TOM T A T
Mftc tiiu: 1. Chdn dodn trdo ngu^c hQng thanh qudn dua vdo bdng chi so RSI vd RFS. 2. Ddnh gid kit qud bu&c ddu diiu tri noi khoa trdo nguac hgng thanh qudn. Boi tu^g: 38 b4nh nhdn duac chdn dodn trdo ngugc hgng thanh qudn vd dugc diiu trf ngogi tru, thdi gian tic 4/2014 -10/2014. Phuang phdp nghien citu: Nghiin ciru mo ta timg truang hgp co can thi$p. B$nh nhdn co chi so RS1>13 & RFS>7 dugc dieu tri Esomeprazole 20mg, 2 Idn/ngdy trong 2 thdng, cdc binh nhdn diu dugc hu&ng ddn thay doi loi song va dugc theo doi dieu trj sau 1 thdng, 2 thdng, kiem tra ddnh gid lgi sau kit thuc diiu tri 1 thdng. Ket qua: Ddu hiiu ca ndng hay gap nhdt & binh nhdn Id cdm gidc c6 df vgt trong hong (94.7%), tiip theo la a hai, a chua (86.8%), ddng hdng (84.2%),dich nhdy nhieu trong hQng(84.2%), khdn tiing (78.9%). Cdc ddu hiiu thuang thdy trin ngi soi gdm:phi dgi mep sau (100%), ni ddy thanh(97.4%), ni thanh qudn toa lan (94.7%), sung huyit (89.5%).Ddu hiiu day thanh gid gap a 5/38 BN(13.2%). Chi sd RSI trung binh tru&c diiu tri la 16.6±2.8, sau dieu tri Id 4.8±2.6. RSI gidm cd y nghTa thong ke. Tuang tu, RFS cung gidm tic 12.9±3.1 xudng 7.0±3.0 (p<0.001). Kit qud ndy dugc diry tri sau dungdieu tri 1 thdng. Ket lucin: RSI, RFS co gid tri trong chdn dodn vd theo doi hiiu qud diiu tri LPR. Qua icng dung 2 chi sd trin cho thdy diiu tri LPR bdng PPl 20mg 2 Idn/ngdy keo dm 2 thdng vd thay doi loi sdng cdi thiin ddng ki binh li hgng thanh qudn do trdo ngugc.
Tvr khoa: Trdo ngugc hgng thanh qudn, thuoc uc chi bam proton. RSI. RFS.
S U M M A R Y
APPLICATION OF SCORING SYSTEMS: RSI, RFS IN DL\GNOSIS AND MANAGEMENT OF LARYNGOPHARYNGEAL REFLUX
Luang Thi Minh Huang, Hd Phuang Thdo Objective: To diagnose and determine the efficacy of medical therapy for laryngopharyngeal reflux according to RSI and RFS . Study design: Prospective study with intervention was designed for 38 patients Methods: Patients with RSI >13 and RFS> 7 were enrolled and received esomeprazole 20mg twice daily in addition to lifestyle modification. The RSI and RFS were assessed at baseline, at the end of the Imonth, 2 month of treatment period and at week 4 of follow up period. Results: Among RSI items.
the most common symptom was a globus sense in the throat (94.7%). Next, heartburn (86.8%), throat clearing (84.2%). excess throat mucus (84.2%), hoarseness (78.9%) were frequently reported. In RFS evaluation, the signs commonly detected were posterior
•B0m6nTaiMuiHp„g-DHYH4Npi commissure ^Oper^ophy (100%), vocal W i n dirt,: GS.TS. Nguyin Dinh Phuc-Tmimg '""''' ^'^""' ^^^•*^°^' '''^'^ '"^^ed Dai h(?c Y Ha Noi
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Tgp chl Tai MOi Hpng Vi$t Nam - Volume (60-27). N°3- June, 2015 edema (94.7%), erythema (89.5%). We observed pseudosulcus in 13.2% of patients. Initial RSI of the patients were ranging between 14 and 25 with a mean of 16.6±2.8.
Posttreatment RSI were ranging between 1 and 11 with a mean of 4.8±2.6. The decrease in RSI was found to be highly statistically significant (p<0.001). Similarly, total RFS decreased from 12.9±3.1 to 7.0±3.0 (p<0.001). Conclusion: RSI, RFS are valuable tools in diagnosis and monitoring of LPR treatment. Thereby, PPl treatment (20mg, twice daily in 2 months) with lifestyle modification improve significantly laryngopharyngeal symptoms and signs due to reflux.
Keywords: Laryngopharyngeal reflux, proton pump inhibitor, RSI, RFS
1. DAT VAN DE
Trao ngupc hpng thanh qudn (Laryngopharyngeal reflux - LPR) la benh ly ngay cang phd bien, do dich da day trao ngupc ISn viing hpng thanh quan, gay ra nhiing tdn thuong tai vimg nay va cac trieu chiing khd chiu cho benh nhan. Tri$u chiing lien quan dSn benh: khdn tiSng, ding hing, cam gidc cd di vat tiong hong...chiem den 10% trong sd nhiing than phiSn ma benh nhdn dSn kham chuyen khoa TMH.
Hi|n nay, chan doan LPR chu yeu dua vao: khai thac trieu chiing, kham npi soi, do pH 24h. Do pH 24h vdi nhiSu n h u ^ diSm khdng dupc khuyen cao trong thuc hanh lam sang thudng quy. Theo hdi TMH
— phau thuat ddu cd Hoa Ky, chin doan LPR cd thS dua vao khai thde trieu chiing CO nang va diu hieu tren khdm ndi soi TMH. Thdng qua dd, benh nhan nghi ngd LPR se dupc diSu tri bang thudc iic che bom proton (PPl) vd danh gia s\r cdi thi?n trieu chiing. Do pH 24h chi dupc chi dinh khi thit bai diSu tri hoac ldm sdng cd nhiing diu hieu nang.
De chudn hda tiong ddnh gia trifu chiing, Belafsky cung cdng sir da xay dung
2 cdng cu: chi so trieu chiing trao ngupc (Reflux Symptom Index - RSI) va diSm sd ttao ngupc tten kham ndi soi (Reflux Fmdmg Score - RFS).
Cac phucmg phdp diSu tri LPR bao gom: thay ddi l6i sdng, diSu tri ndi khoa, phau thuat. Trong dd, diSu tri ndi khoa bang PPl dupc coi la lua chpn diu tay. Do su khac biet ttong co che bSnh sinh, dieu tri PPl ttong LPR cdn liSu ldn hon, thdi gian keo ddi hon tiong trao ngupc da ddy tiiuc qudn (GERD).
DS tai "Nghien cuu ung dung bdng RSI vd RFS trong chin dodn vd ^iu trf trdo ngirgc hpng thanh qudn" dupc tien hdnh vdi 2 muc tiSu:
- Chdn dodn trdo ngugc hgng thanh qudn dtfa vdo bdng chi sd RSI, RFS.
- Ddnh gid kit qud bu&c dau dieu tri ndi khoa trdo ngugc hgng thanh qudn dua vdo chi sd RSI, RFS.
2. D 6 I n r p N G VA PHU'OfNG PHAP NGHIEN Ciru
Doi tu-grng nghien cihi: 38 BN dupc chin dodn ttao ngupc hpng thanh qudn d\ra vao 2 bang chi sd RSI, RFS vd dupc diSu
T^p chl Tai Mui Hpng VI6t Nam - Volume (60-27). N°3- June, 2016 trj ngoEii tru tai b?nh vien TMH TW tu
04/1014 d6n 10/2014.
Tieu chu^n lira chon:
+ Tu6i> 18.
+ BN CO nhung tri?u chung trao ngugc hong thanh quan trong 1 thang tra 1^ day, CO 2 chi s5: RSI >13 va RFS >7.
+ Dong y tham gia nghien cuu.
Tieu chuan lo^i trir:
+ BN da dung PPl trong vong 1 thang tra lgi.
- Co tijn su ung thu hpng thanh quan hole phau thu|t ducmg tieu hoa
- Dj ling voi thuoc. BN phai di^u tri keo dai wafarin, coumarin, acetyl salicylic acid, clopidogrel
- Phu nu CO thai, cho con bu. BN suy gaa - Khong dong y tham gia nghien cuu Thiet kl nghiSn ciru: m6 ta timg truong hop co can thiep
Phinmg tifn nghiSn cuii: bang RSI, RFS da viet hoa Bg kham npi soi TMH.
Qui trinh nghien ciru:
- BN nghi ngo LPR: khai thac tri$u chung-> tinh dilm RSI. Kham n§i soi TMH-> tinh dilm RFS
BN CO ca 2 chi s6: RSI>13 va RFS>7 dugc chin doan LPR va nhan vao nghien cuu.
- BN dugc dieu tri: huang din thay doi loi s6ng va u6ng Esomeprazole 20mg, n^ay 2 vien, chia 2 ISn, tnrdc an sang va toi 30 phiit. Thai gian dilu tri la 2 thing (trong nghien cilu nay diing nexium mups 20 mg cua hang Astra Zeneca)
- BN dugc danh gia lai dilm RSI, RFS
sau 1 thing, sau 2 thang dilu trj va sau kit thiic dilu tri 1 thing.
- Danh gii hi$u qua dieu tri; dua vao svr thay doi tdng dilm, mirc d0 nang, tin suit cic trieu chiing co nang, thvrc till.
3. Ktr QUA NGHIEN ClTU 3.1. tTng diing RSI, RFS trong chan doin trao ngirg'c hf ng thanh quan
3.1.1 Mdt so Mc ^m vi tudi. gi^
ySu to nguy cff
- BN it tuoi nhat la 28 tuoi, nhilu tuli nhit la 58. Tuli trung bmh la 43.
NO bi benh chilm 68.4%. Nam:
31.6%. Sir khic biet co y nghia thing ke.
- Yeu to nguy co: ti le lam dvmg gigng 42.1%; CO 2/38 BN thira cin.
3.1.2. Triiu chiing cff nang: Bang mim RSI
Bang 1; Trieu chCpng ca nSng trSo ngugc hong thanh quSn
Trigu Chung 1. Khin tiing ho3c c6 vSn
de v^ gipng ndi 2. Cing hing 3. Nhiiu djch nhiy hgng
ho^c chiy mOi sau 4. Nuot thuc an, dich,
thuoc kh6
5. Ho sau khi Sn hoSc sau khi nim
6. Kh6 th*
7. Ho kh6 chiu 8. Cam giic c6 dj v$t trong
hgng
9. NOng rit, dau ngyc, g hoi, g chua Bilm s l RSI trung blnh
S6BN (n) 30 32 32 6 25
8 11 36 33
Tyle 78.9
(%)
84.2 84.2 15.8 65.8 21.1 28.9 94.7 86.8 16.6±2.8 24
Tgp chl Tai MOi Hpng Vi^t Nam - Volume (60-27). N°3- June. 2015
- Trieu chung co ndng hay gdp nhdt la cam giac co di vat trong hpng, chiem 94.7%
- Durng thli 2 Id triSu chumg ndng rdt, dau nguc, p hoi, g chua, chiem 86.8%.
TiSp theo Id ddng hdng ( 84.2%). nhiSu dich nhay trong hpng (84.2%)
- Co 30/38 BN khan tiSng, chiem ti 1?
78.9%. Ho sau khi an hodc sau khi ndm (65.8%).
- Cdc trieu chung khdc it gdp hon: Ho kho chiu (28.9%), Kho tho (21.1%), Nu6t thijrc dn, dich, thu6c kho (15.8%)
- Diem RSI trung binh trong ldn tham kham ddu Id 16.6±2.8
3.1.3. Trieu chitng thuc thi:
Bang 2: Tri$u chi>ng thi/c thl trdo ngui^c hpng thanh quan RFS
Hinh anh trfin ngi soi Diy thanh gia xga bu6ng thanh thit Sung huyit Ne diy thanh PhCi n i thanh quan toa lan Phi d^i mip sau To chi>c hat Djch nhiy nhieu trong thanh quan Olim RFS trung blnh
S6BN (n)
5 30 34 37 36 38 7 23
T } l *
(%)
13.2 78.9 89.5 97.4 94.7 100 18.4 60.5
12.9±3.1 - Diu hieu phi d^ mep sau gip a ca 38/38 BN.
- Tilp theo l i diu hieu ne day thanh , gap a 37/38 BN (chilm ti 14 97.4%), diu hieu phu nl thanh quin toa lan gap a 36/38 BN (94.7%), diu hieu sung huylt
gjp or 34/38 BN (chilm ti Ie 89.5%), diu hieu xoa buIng thanh thit gap 6 30/38 (chilm ti le 78.9%).
- Co 5/38 BN CO dau hieu day thanh gii, chilm ti le 13.2%
- Dilm RFS trung binh trong lin tham khamdiulal2.9±3.1
m^.Ju.
Hinh 1: Phi dai mep sau cac mu>c dd 3.2. Danh gia hieu qua dieu trj npi khoa dua vao RSI, RFS
3.2.1. Su thay d&i tri$u chung ca nang sau ^u tri
3.2.1.1. Su thay ddi chi sd RSI
Khim Sau DT Sau DT Sau difng ldn d^u 1 thang 2 thang DT
1thang
Bieu 66 1: Thay doi chi s6 RSI
Tap chl Tai Mui Hgng Vigt Nam - Volume (60-27). N°3- June, 2015
- Chi s6 RSI sau 1 thing dilu tri giam - Chi s6 nay khong co sir khac bift so voi truac dilu tri, sau 2 thing dieu trj giiia khi hoan thinh qui trinh dieu tri vi tilp tuc giim so vdi sau 1 thing dilu tri khi ngimg dilu t4 1 thing.
(p<0.001)
3.2.1.2. Su thay ddi muc do nang cua trieu chung ca nang Bang 3; Si/ thay doi mi>c dO njng trieu chi>ng ca ning
RSI
1. Khan tieng hoic c6 v i n de ve gigng noi
2. Ding hing
3. Nhieu dich nhiy hpng hoic chay mOi sau
4. Nuot thu-c i n , d|ch, thuic kh6 5. Ho sau khi i n hoic sau khi n i m
6. Kho tha 7. Ho kh6 chiu
8. Cam giic cd di v i t trong hpng 9. Ndng r i t dau nguc, a hai, a chua
TruOc BT
2.3±1.7
2.5±1.5 2.2±1.3
0.2±0.6
1.7±1.7
0.310.6 0.7±1.4
3.7±1.5
3.0±1.8
Trung blnh S a u B T 1 thing 1.3±1.3
1.5±1.3 1.3+1.0
0.1 ±0.2
0.510.9
0.010.2 0.2±0.5
2.611.6
1.611.3 S a u B T 2 thing 0.811.0
0.710.9 0.610.7
0.110.2
0.3±0.6
O.OlO.O
0.010.2 1.611.4
0.710.9
Sau k i t thuc BT 1 thing
0.811.0
0.811.0 0.610.6
O.OlO.O
0.110.3
O.OlO.O O.OlO.O
1.611.4
0.710.8
- Mlic dp nSng tit ca cac tri$u chiing Tong hpng, a hai g chua co su giim mOrc deu khong co su khac biet khi kit thiic DT "IO nSng sau dilu tri 1 thang,vi tilp tyc 1 thing so vol ngay sau hoan thinh dilu tri. giani sau dilu tri 2 thing (p<0.05)
- Phin Ion cac trieu chiing, gim; khan - Cic tri?u chiing con Iai: co giim miic tiing, ding hing, dich nhiy nhilu trong <10 nang sau dilu tri 1 thing, sau do khong hpng, ho sau khi nam, cim giac cd di vat ^ y ^o*-
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Tap chf Tai MGi Hpng Vi^t Nam - Volume (60-27) N°3- June, 2015
3.2.1.3. Su thay ddi tdn sudt gap cdc triiu chung ca ndng
Bang 4: S\f thay dSi tdn suat g^p cdc bi$u chi>ng ccr ndng
RSI Khin tling Bing hing
Nhieu dich nhiy hong hoac chay mQi sau Nuot thCpc i n , d|ch, thuoc khd Ho sau khi i n hoic sau khi nim Khd tha
Ho khd chiu
Cam giic cd d| v$t trong hpng Ndng rit, dau nguc, a hal, a chua
Trudc BT n 30 32 32 6 26
8 11 36 33
%
78.9 84.2 84.2 15.8 65.8 21.1 28.9 94.7 86.8
Sau DT 1 thing n 24 26 28 2 13
1 4 33 28
%
63.2 68.4 73.7 5.3 34.2 2.6 10.5 86.8 73.7
Sau DT 2 thing n 19 20 20 2 7 0 1 29 18
%
50 52.6 62.6 53 18.4
0.0 2.6 76.3 47.4
Sau kit thOc BT 1 thing
N 18 21 20 0 5 0 0 29 20
%
47.4 55.3 52.6 0.0 13.2 0.0 0.0 76.3 52.6
- Tdn suat gap cac trieu chung Id nhu nhau giiia sau khi ngiing dieu tri 1 thang va sau khi hodn thdnh dieu tri.
- Ti le khdn tiing, ddng hdng, kho tho, ho nhilu giam ngay sau 1 thdng dilu tri (p<0.05), va khong &ay d6i khi dilu tri tilp.
- Ti 1? dich nhdy trong hpng, p hoi g chua, cam gidc co di vat trong hpng sau 2 thdng dieu tri moi co sir gidm so vdi truoc dilu tri CO y nghla thong ke
- Trieu chiing ho: ti le g|p gidm ngay sau 1 thang dilu tri va tiep tiic giam sau 2 thdng dilu tri.
- Trieu chiing: nuot thiic an, dich kho khong CO s^r thay doi tl le gdp trong qua trinh dieu tri va theo doi.
3.2.2. Sv thay doi trieu chirog thyc the sau dieu tri
3.2.2.1. Stf thay ddi chi si RFS
Khim SauDT SauDT SaudUng ldn ddu 1 thang 2 thang DT 1thang
Bieu d6 2: Su thay doi chT s6 RFS - Chi s6 RFS sau dilu tri 1 thang giam so voi truoc DT. Sau 2 thdng tilp tuc gidm
Tjp chi Tai MOi Hpng Vi$t Nam - Volume (60-27). N°3- June, 2015
so vdi sau 1 thing DT co y nghia thing kl 3.3.2.2. Stf thay Si miic d? nang cua (p<0.001) trifu chiing th^ thi
• Sau ngimg DT 1 thing, chi so RFS khong khac biet so vdi ngay sau ket thiic DT
Bing 5: Su thay dii mi>c dd n^ng cua tri$u chCrng thuc thi
RFS
B i y thanh gia
Xda b u i n g thanh t h i t
Sung h u y i t
N i d i y thanh
Phil n i thanh quan toa lan
Ph) dai mdp sau
T 6 chiJc hat
Djch n h i y n h i i u trong thanh q u i n
Trung binh T n / d c D T
0.310.7
2.111.4
2.911.4
1.610.6
2.010.9
2.510.6
0.410.8
1.211.0
Sau B T 1 t h i n g 0.210.6
1.511.4
2.111.3
1.110.7
1.610.8
2.310.6
0.410.8
0.610.9
S a u B T 2 t h i n g 0.210 6
0.911.4
1.111.1
0.910.8
1.410.7
2.110.5
0.410.8
0.210.5
Sau k i t thuc DT 1 t h i n g 0.210.6
0.811.2
1.211.2
1.010.8
1.410.7
2.210.5
0.410.8
0.410.8
- Ddu hieu: xoa buong thanh that, sung huyet, ne day thanh, ne thanh quan toa lan, dich nhdy nhiSu trong thanh qudn:
+ Co su giam ve muc dp ndng giiia sau 1 thang DT va truoc DT, sau 2 thang so vdi sau 1 thang DT co y nghia thli^ ke.
+ Khong CO su khdc biet miic dp ndng triSu chiing sau ngiing DT 1 thdng
-Ddu hieu phi dai mep sau : + Khong CO su thay doi sau 1 thdng DT + Sau 2 thdng DT, co giam miic dp pW d^ mep sau so truoc DT (p<0.05)
- Cdc dau hieu: day thanh gid, t6 chiic hat khong co su thay d6i giiia tru6c va sau DT
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Tap chl Tai MQi Hpng Vigt Nam - Volume (60-27). N°3- June, 2015
3.2.2.3. Sur thay dii tin suit g^p cdc dau hi^u thtfc the Bdng 6: Si/ Uiay doi tan suit gdp cdc ddu hi$u thi/c the RFS
Biy thanh gia Xda budng thanh thit Sung huyit N i diy thanh Phu n i thanh quan tda lan
Phi dai mdp sau To chuc hgt Djch nhiy nhieu trong thanh quan
Trudc BT n 5 30 34 37 36 38 7 23
%
13.2 78.9 89.5 97.4 94.7 100 18.4 60.5
Sau BT 1 thing n 4 23 31 32 36 38 7 12
%
10.5 60.5 81.6 84.2 94.7 100 18.4 31.6
Sau DT 2 thing n 4 13 19 26 35 38 7 3
%
10.5 34.2 60 68.4 92.1 100 18.4 7.9
Sau kit thde BT 1 thing n 4 14 21 26 35 38 7 7
%
105 36.8 55.3 73.7 92.1 100 18.4 18.4
- Ti IS cdc ddu hieu day thanh gia,phi dai mep sau, to chiic hat, ne toa lan thanh qudn khong co sir khdc biet truoc va sauDT
- Ti le gap cac ddu hi?u: xoa buong thanh thdt, sung huyet, ne ddy thanh
+ Khong CO sir thay d6i sau 1 thang DT voi trudc DT
+ Co su gidm ti I? sau 2 thdng DT voi truoc DT
+ Ti le nay khong co su khac biet giiia sau DT 2 thang va sau ngiing DT 1 thang.
- Ti Ie gap ddu hi|u: dich nhdy nhieu trong tiianh quan
+ Co sv giam sau 1 thdng DT so voi truoc DT, sau 2 thang so voi sau I thdng DT (p<0.05)
4. BAN LU^^N
4.1. f n g dung chi so RSI, RFS trong chan dodn trao ngvoc hong thanh quan
4.1.1. Mpt si d^c diiem ve tuoi, gi&i, yeu ti nguy ca
- Benh chiem uu the o nu gioi, tuoi trung nien.
- Lam dyng gipng Id yeu to nguy co cOa LPR
- Khdc voi GERD, khong nhdn thay m6i lien quan gifia beo phi va LPR.
4.1.2. Tripu ehirng ca nang - Cdm gidc co di vat trong hpng Id than philn nhilu nhdt, g^p 6 36/38 BN (94.7%).
Mot so nghien curu khac cho kit qua tuong tu. Ngupc lai, theo nghien ciiu cua cac tdc
Tgp chl Tai Mui Hpng Vigt Nam - Volume (60-27). N°3- June, 2015
gia Koufinan, Vaezi, khan tiing moi la dau hi^u diing dau.
Khan tiing ciing la tri?u chiing thucmg gdp cua LPR. Trong nghien cihi cua chiing toi, BN din kham than philn ve khan tiing voi nhieu miic dp khdc nhau.
6/9 trieu chiing thucmg thiy trong nghien ciiu ciia chiing toi deu nam trong top ddu nhom trieu chiing thucmg thdy cua trao ngupc hpng thanh qudn giong cac nghien ciiu khdc, trii nong rat sau xuong iic, g hoi, g chua.Tri6u chftng nay chiem ti le kha cao (86.8%), dilu nay trdi ngugc voi cdc phan tich ve CO che benh sinh khi chi ra rdng phdn Ion benh nhan LPR it kem theo ddu hieu dien hinh cua GERD la g nong, g tro.
4.1.3. Tripu chung thuc the:
Phi dai mep sau la dau hifu g|.p nhieu nhdt (100%). Dieu nay triing voi nhieu nghien ciiu truoc d6 cho rdng phdn sau thanh quan Id vung tilp xiic som, thudng xuyen Idii dich da day trao ngugc Ien, nen de bi t6n thuong. Cac trieu chiing khac cung hay g^p nhu: n6 day thanh, sung huyet, phu ne thanh qudn toa lan.
- Diu hiSu day thanh gia trong nghien cuu cua chung toi chi gap 6 5/38BN (13.2%), trai ngugc voi kit qua ciia Belafsky va Ylitalo cho rdng day thanh gid Id dau hieu chi diem ddc hieu trong LPR, vdi dp nhay 70%, dp ddc hieu 77%.
4.2. Danh gia hieu qua dieu tri n6i khoa trdo nguffc hong thanh quan
- Khi sii dung chi s6 RSI, RFS dl ddnh gia hieu qua diSu tri trao ngugc hpng thanh quan bang PPl, chiing toi nhdn thay cd 2
chi so ndy deu giam ro r?t sau 1 thdng dieu tri vd sau 2 thang dilu trj co ;^ nghia thong ke. Chi so nay van dugc duy tri sau khi dimg dilu tri 1 thdng.
- Trieu chiing co ndng cdi thien nhanh chong, dang ke hon so voi dau hieu thuc thl, voi dilm RSI trung bmh tir 16.6±2.8 xuong con 4.8±2.6. Diem RFS trung binh gidm CO y nghia thong ke, tuy nhien miic dilm sau dilu tri con cao 7.0±3.0. Dilu nay cirng phu hgp voi 1 so nghiSn ciiu khi cho rdng dl niem mac hpng, thanh qudn ton thuong do trao ngugc phuc hoi lai can thoi gian it nhdt 6 thdng.
- Cu thl vl timg trieu chiing Iam sang:
+ v l miic do ndng: tdt cd cdc tri?u chiing CO ndng deu cai thien. Cac ddu hi?u thi^c the deu giam trii 2 dau hieu: day thanh gid, th chiic hgt khong thay doi trong qud trinh diSu tri. Nguyen nhan: cac ton thuong nay hinh thanh do qua trinh benh ly keo dai, can thdi gian dai hon de dieu tri. Trong cdc ldn tdi khdm, chiing toi nhan thay 2 dau hieu nay cung kh6ng tien trien nang Ien, khong tang kich thudc u hat.
+ Ve ti Ie gap: so vdi trudc dieu tri, 8/9 cdc triSu chumg co ndng deu giam co y nghia thdng ke. Trong khi do, chi co 4/8 tri?u chiing thuc thS gidm.Ly gjai cdc trieu chiing gidm sau khi dilu tri nhung khong het hodn toan, cd thl do: 2 thdng Id thoi gian chua du. Thii 2 la rdt khd cd thl ngSn chan hoan toan dich da day trao ngupc.
Dong thdi, khdng chi acid, md cdc yeu t6 khac nhu dich mat cung gdp phan vdo benh sinh gdy t6n thuong niem mac.
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Tgp chl Tai MQi Hpng Vigt Nam - Volume (60-27). N^S- June, 2015 5. KET L U ^
- 2 chi s6 RSI, RFS cd gia tri trong thirc tiln ldm sdng de chdn doan b?nh Iy trao ngugc hpng thanh quan :
+ Cong cu phap ly, thdng nhat trong danh gia tri$u chiing.
+ Uu viet trong lua chpn benh nhdn vao dieu tri.
- Danh gia ket qua qua dieu tri 2 thdng bdng PPl, img dung RSI, RFS dl theo d6i vd danh gid, nhan thdy:
+ Dilu tri LPR bdng PPl 20mg 2 Idn/ngdy keo ddi 2 thdng vd thay doi loi song cai thien dang ke benh Ii hpng thanh quan do trdo ngugc.
+ Tiiy trudng hgp, cd the keo ddi thdi gian di^u tri dS dat kiem soat benh toi uu.
+ Cdn nghiSn ciru tiep tuc vdi thdi gian dai hon de dua ra mpt quy trinh dieu tri chuan benh trdo ngugc hpng thanh qudn.
TAI LI|:U THAM KHAO
1. Belafsky, P.C, G.N. Postma, and J.A.
Koufinan, Validity and reliability of
the reflux symptom index (RSI). J Voice, 2002.16(2): p. 274-7 2. Belafsky, P.C, G.N. Postma, and J.A.
Koufinan, The validity and reliability of the reflux finding score (RFS).
Laryngoscope, 2001.111(8): p. 1313-7.
3. Vaezi, M.F., Laryngeal manifestations of gastroesophageal reflux disease.
Current gastroenterology reports, 2008.10(3): p. 271-7
4. Ylitalo, R., P.A. Lmdestad, and S.
Hertegard, Is pseudosulcus alone a reliable sign of gastroesophago- pharyngeal reflux? Clin Otolaryngol Allied Sci, 2004. 29(1): p. 47-50.
5. Same, M., et al.. Risk factors for laryngopharyngeal reflux. European archives of oto-rhino-laryngology, 2012. 269(4): p. 1189-94.
6. Wan, v., et dl., LPR: how different diagnostic tools shape the outcomes of treatment. J Voice, 2014. 28(3):
p. 362-8.
