Vietnam Journal of Physiology 19(2), 6/2015 ISSN: 1 8 5 9 - 2 3 7 6 MOT S 6 Bl^N D 6 | CAN LAM SANG & BENH NHAN NGHIEN RU'OU M A C VIEM
P H d l C p N G D 6 N G
Tran Thj Hu-cng G i a n g \ Ha Tran Hu-ng^'*' T 6 M T A T : Nghiin cO'U dirge tien hanh nhdm xdc dinh mpt so bien ddi edn idm sdng a bpnh nhan nghipn rwgu mdc viem phdi cpng ddng. Nghiin c&u md td hoi ciru trin 36 benh nhdn nam dugc chin doan nghipn rwau theo tieu ehuan chan doan ICD.10, dugc chdn doan xae djnh viim phdi cdng dong. Kit qua cho thiy trong tdng sd 36 binh nhdn nam nghipn rwgu bj viim phdi edng ddng cd dd tuoi trung binh la 48,3 ± 9,2. th&i gian udng rwgu trung binh la 13,6 ± 6.2 ndm, Iwgng rugu udng hdng ngay a mirc dw&i IL/ngay. Bpnh nhdn cd thiiu mdu hdng cau to a mirc nhe, MCV trung Id 98 ± 8,1. 39%
bpnh nhan cd tiiu edu gidm < 50 G/l, tl Id tu- vong & nhdm tieu cau giam ndng cao hon cdc nhdm khdc (p<0,01). Ty li binh nhin ed biin ddi ve men SGOT vd SGPT Id 91,6%
vd 54%. 100% bpnh nhdn cd tang GGT, GGT trung binh id 386 ± 344. Hdm lugng albumin la 23,9 ± 5,4 g/L va protein la 53,2 ± 9,6 g/IL. Cd 84% bpnh nhdn cd tang creatinin mau >120 f/imoi/L, 58% bpnh nhdn cd ha Natri mdu. Kali mau trung binh Id 3,8
± 0,6 mmol/L, trong dd 6/36 BN cd K" < 3,5mmol/L va 3/36 BN ed K" >4,5mmol/L. Kit luan mpt sd dac diem can Idm sdng a bpnh nhdn nghiin rugu mdc viim phoi cpng ddng liin guan din tang ty Ip iCr vong Id: suy dinh dwang, giam tiiu cdu nang, rdi loan dipn giai.
Vi vdy cin cd chiin Iwgc can thiep s&m ddi v&i bpnh nhdn nghiin rwgu mac viem phdi cpng ddng.
Tip khoa: nghipn rwgu, viim phdi cdng ddng.
I.DATVANOe
Viem p h l i mac phai ttr cpng dong (VPCD) l i benh ly thufi'ng gap, co tl le di chipng va tir vong cao, nhat l i & b i n h nhan n i m vien. Tinh ty l i m i e chung cfi khoang 8-15 tren mot nghin ngufi'i. Cf My, VPCD anh hufi'ng 4 trieu ngufi'i mfii nam, trong s l dfi cfi 20% phii nhap vien d l d i l u trj Chi phi dieu trj VPCD t i n kem da trfi' thinh ganh nang cho bgnh nhin v i xd hpi.
Theo ufi'c tinh tgi Hoa Ky chl phi hang nam cho dieu trj VPCD khoing 9,7 ty USD.
Tgi khoa hfi h i p benh vien Bgch Mai tir 1996-2000, viem phli chilm 9,57% benh nhin n i m vien [1],
'' Benh vi|n da khoa DUc Giang
^ Truong Dai hpc Y Ha N6i
^ Bgnh vien Bach Mai
* Tac ^ia chju trach nhiSm chinh:
Ha Tran Hipng
Email, [email protected] Ngay nhan bai: 14/5/2015 Ngay nhgn bai phSn bien: 1/6/2015 Ngay chap nh^n dang 8/6/2015
Mirc dp nang cOa VPCD lien quan den t u l i , tinh trang miln dich v i thfii quen efi hai nhu hiit thulc, nghien rugu. Nhtrng y l u t l nguy ca cao d i n d i n VPCD bao g i m ' nghien rugu, hen p h i quan, giim mien djch va t u l i tren 70. Nhtrng ngufi'i nghiin rugu nang (vi du, mirc t i i u thu khoang tren lOOg ethanol mot ngay trong 2 nim), cfi t;/ l i mac viem p h l i do vi khuan Gram (-) cao han, tneu ehirng lam s i n g nang han va ty l i tir vong eao tren 60%, v i d i d i n d i n ARDS [2],[3].
Sir dyng rugu tren t h l gifi'i tang cao trong vai t h i p k } g i n day, t i c hai b i n h ly cua rugu da dugc to ehtre y t l t h l gifi'i xep sau eae benh tim mach, ung thu. Cf Viet Nam, g i n day rugu dugc sir dyng rpng rai va da tro' thinh v i n nan cho xa hpi v i y te [2]. Rugu i n h hufi'ng ien he mien djch, bao g i m h i m i l n djch tai phli, lam giam chirc nang cda dai thge bao p h i nang, cae bgch cau da n h i n , e i c eytokin [4],[5]. Do v i y viec xac dinh sfi'm c i c
Vietnam Journal of Physiology 19(2), 6/2015 ISSN: 1 8 5 9 - 2 3 7 6 b i n h n h i n cfi nguy ea cao bj viem phoi
m i c p h i i a cpng d i n g ngng l i rat quan trpng, de c i c b i c sT eo t h l dua ra chien lugc d i l u tri phti hgp vfi'i benh nhan, vi dy n h i p dan vj H l i sire tich cue sfi'm.
Tren t h l gio'i da co mpt so nghien ciru danh gia ve s u anh hufi'ng eua vige lam dung rugu vai e i c nguyen nhan gay v i i m p h l i v i dp nang ciia v i i m phli. Tuy nhien, Viet nam eo it nghien euu v l v i n de niy, Gan day ty le benh n i y ngay cang tang v i vlee d i l u trj van cfin kho khan, nen v i i c nghien cu'u mot so b i l n doi egn l i m s i n g nham XLP tri viem phoi 6' benh n h i n nghign rugu dang Irfi' thanh van d l cfi tinh thai sg va c i n thilt. Vi ly do tren, chung toi tien hanh.dl t i l nham myc tieu xac djnh mpt so d i e d i l m cgn l i m s i n g ciia viem p h l i cpng dfing a benh nhan nghien rugu.
2. D 6 | TU'ONG VA PHU'ONG PHAP 2.1. D l i t u v n g nghien CLFU
2.1.1. Tieu chuan chon benh nhan: C i c b i n h nhan vao d i l u trj tai khoa Cap ciru va Hoi sire tieh euc Binh vien Bach Mai dugc lua chpn v i o nghien ciru efi du tieu ehuan dufi'i day:
D u g c chan doan nghien ru'O'u: (theo tieu chuin chan doan ICD.10). Cfi 3 trong 6 bleu hien sau:
- Them m u l n manh me hoac c i m t h i y bupc phai uong rugu.
- Khfi khan k i l m tra v l thfi'i gian bat d i u u l n g va k l l thiic uong cung nhu muc dfi u l n g hang ngay.
- Khi ngirng rugu Ihi xuat hien hfii chO'ng eai (lo au, t r i m cam, dau moi, r l i loan nhjp tim, cau b i n , tho bgo ...) v i b i n h nhin cfi
"y djnh u l n g rugu trfi' lai d l ne tranh hogc giam trieu chtrng cai.
- Co bang chung ve s l lugng rugu uong ngay cang gia tang.
- Sao nhang nhO'ng Ihu vui trufi'c d i y , d i n h nhilu thai gian d l tim k i l m va u l n g rugu.
- V i n t i l p tue u l n g mae du da hilu ro t i c hai ciia rugu.
DiFO'c chan doan la viem phoi cgng dong:
C h i n doan xae djnh dua vao:
- Benh khfi'i phit dfit ngpt, efi t h l thay eae y l u t l thugn Igi cho viem phoi p h i eau nhu cat lich, suy giam miln djch, nghign rugu mgn tinh,
- Cfi can ret run, s i t cao 39-40^0. Dau nguc, ho va khac dfi'm m i u gi s i t hogc dfi'm m i u xanh, dam mii. Moi khfi lufi'i ban, bgch e i u mau tang eao. Hpi chu'ng dong dge phli: ri r i o p h i nang giam, go dye, rung thanh t i n g , cfi t h l cfi tiing thoi I n g .
- Bilu hign trin phim X-quang: cfi hinh anh dfing dac phli, cfi t h l cfi hinh i n h tran djch ming phoi, hogc ranh hen thtiy day. Cac t i n thuang dang lufi'i not. hinh kinh ma ggi y viem phoi do vi khuan khong dien hinh.
2.1.2. Tieu chuan loai tn>:
- Benh nhan nhiim HIV
- Benh nhan co c i y ghep tang hogc cay ghep tuy xuang.
- Benh nhin lao phoi ttln triln 2.2. Phu'O'ng phap nghien ciPu: mo ta h l l ciru. H l i eiru b i n h an dugc chin doan viem p h l i cpng dong fi* nhung benh nhan nghiin rugu d i n c i p cuu tgi khoa c i p ciru benh vien Bgeh Mai ttr 01/01/2009 d i n 31/10/2010, dua v i o t i i u chuan chin d o i n nghien rugu (theo tieu ehuan chin doan ICD.10), dga vao djnh nghTa v i tieu chuan chan doan viem p h l i cpng d i n g
Cach thu thap so lieu: Theo m i u bgnh an nghien ciru dugc lam khi h l i ciru benh an.
Thu t h i p c i c thfing tin ehung: Tuoi, gifi'i, thfi'i gian tir khi xuit h i i n trieu ehirng dau t i i n den khi nhgp khoa.
Tim eae b i n g ehirng ve nghiin rugu: s l lugng rugu u l n g mfii ngay, thai gian u l n g rugu
Tien sir benh: Cac b i n h ly k i m theo co hay khfing, c i c thuoc da dilu tn trufi'c dfi.
61
Vietnam Journal of Physiology 19(2), 6/2015 ISSN; 1 8 5 9 - 2 3 7 6 Co bgnh ly gan, than kinh, tim mgeh,
THA,,, da dugc ehin doan trufi'c dfi khong
C i c thay doi v l huyet hgc: s l lugng h i n g c i u , djnh iugng Hemoglobin, Hematocrit, t h l tich trung binh hong e i u , s l lugng bach c i u , s l lugng t i l u cau 6' thdi d i l m benh nhan nhap vien.
Cae thay d l i v l sinh hfia: SGOT, SGPT, eac thay doi dong m i u PT,creatinin, d i i n giai do: natri, kali, elo, CK, GGT, pro BNP, 2.3. Xu> ly so lieu. C i c s l hgu dugc xir ly va phan tich bang phin m i m thing ke y hpc SPSS 16,0, C i c thuat toan dugc su dung: Tinh trung binh va dp leeh ehuin (mean ± SD), tinh ty le %, so sanh trung binh sir dung t test, so s i n h ty le % sir dung test x^ (gii trj p < 0,05 dugc coi la efi
</ nghTa thong ke).
3. K^T QUA NGHIEN CLKU 3.1. Dgc d i l m chung
Nghiin ctru tren 36 bgnh nhan nghiin rugu bj viem p h l i cfing d i n g v i o c i p ciru tgi benh v i i n Bach Mai tir 01/01/2009 den 31/10/2010, tuoi tir 33 d i n 72 co 36/36 l i nam gifi'i, nu' 0/36, Tuoi trung binh cua c i c bgnh nhan nghien ctru la 48,3 ±9,2.
T u l i t h i p n h i t l i 33, cao nhat l i 72 t u l i . Ggp chii y l u o' nhfim t u l i < 65 ehilm 94%, tuoi tren 65 chilm it chl cfi 5,6%.
Khong cfi sg khac bigt v l ti le lir vong gitra eae nhfim t u l i .
Thfi'i gian ttr khi xult hiin trigu chung dau tien d i n khi v i o vien Bgch Mai c i p ciru la 5,0 ± 3,7 ngay, sfi'm nhat la 1 n g i y v i mupn nhat l i 14 ngay.
Bang 1. Lugng rugu benh nhan u l n g h i n g ngay
N
%
< 500ml 15 41,3
500-1000 ml 20 56
>1000ml 1 2,7
Thfi'i gian u l n g rugu trung binh la 13,6 3.2. Mot so b i l n doi ve chi so c i n lam + 6,2 nam, khong efi su khac biet giu'a sang 6- b i n h nhan nghien r u g u m i c nhfim s i n g va tir vong. Lugng rugu BN viem phoi cgng d i n g
ulng hang ngay o' mtre dufi'i IL/ngay,
khfing cfi sg khae biet giu'a 2 nhom BN Dac diem huyet hpc s i n g v i tir vong.
Bang 2. Dgc dilm ve h i n g c l u
HC(T/1-) HB(g/L) HCT(L/L)
Chung n = 36 3,57 ± 0,69
113 ±12,4 0,34 ±0,5
Nhom sOng n = 13 3,69 ± 0,81 118,0 ±14,1 0,34 ± 0,64
Nhom to vong n = 23 3,50 ±0,63 112±13,4 0,33 ± 0,48
P
>0,05
Vietnam Journal of Physiology 19(2), 6/2015 ISSN: 1 8 5 9 - 2 3 7 6 Benh nhan nghien ciru cfi thilu m i u Khong cfi sg khic biit gitra nhom s i n g va HC to fi' mirc nhg, MCV Irung l i 98±8,1, nhfim lir vong.
Bang 3. M l i lien quan gitra t i l u cau va ti le tii' vong
T i l u cau (G/L)
>150.000 5150.000
<50.000 n 1 12 0
Nhom s6n£ 1
%
8 92 0
Nhom ti>
n 0 9 14
vong
%
0 39 61
P
<0,01
Han 90% benh n h i n v i o vign cfi tinh vong a nhfim tieu e i u giam nang nay la trang giam tieu cau, trong do. 14/36 b i n h eao han cac nhfim khae (p<0,01), nhan eo tieu c i u giam < 50 G/l v i ti lg tir
Dac d i l m v l sinh hoa mau
Chl so
SGOT (U/L)
SGPT (U/L)
Bang 4. Thay a6i ve enzym gan
Binh thu'ong N(%) 3 (8,4)
16(46)
Tang gap 2 \hn N(%) 8 (22,4)
12(31,6)
Tang > 3 ian N(%) 25 (69,2)
8(22,4)
BSnh nh3n nghien cO'U vao vien phan ldn l^n so vdi binh thudng). Khong co sy CO bien doi ve men SGOT (91,6%), tang 6 khac biet v l tang cac men nay gi&a nhom mi>c cao > 3 ian binh thudng chiem > 60% benh nhSn song va benh nhan tfl' vong benh nhan. Tl le tang SGPT thi it hon (p>0,05).
(54%), va thu'dng tang i<h6ng cao (gap 2 Bang 5, Thay doi ve PT
<10%
N(%)
10-70%
N(%)
>70%
N(%)
1(2,8) 20(55,5) 15(41,7)
Trong nhom benh nhan nghien cdu cd gan 60% cd giam PT chu y l u giam d mdc trung binh.
63
Vietnam Journal of Physiology 1 Bang 6. Thay doi mgt so chi
GGT (U/L) Albumin (g/L)
Protein (g/L) Giucose (mmol/L) BilirubinTP (^moi/L)
Chung n = 36 386 ± 344 23,9 ± 5,4 63,2 ± 9,6 8,4 ±4,3 38,4 ± 3,9
9(2), 6/2015 ISSN: : 1 8 5 9 - 2 3 7 6 so sinh hda d b§nh nhSn nghiin nrgu
Nhdm sdng n = 13 3 1 0 ± 3 1 9 25,2 ± 3,8 58,6 ±6,9 9,6 ± 6,1 39,5 ± 9,9
Nhdm tfl- vong n = 23 422 ± 357
22 ± 6,0*
50 ± 9,6*
7,7 ± 2,8 37,8 ± 4,1
* sg k h i c biet cfi j - nghTa thing k i (p<d,05) BN NC cfi 100% cfi t i n g GGT, GGT trung binh la 386 ± 34,4, khong khac nhau giO'a nhom s i n g v i nhfim ttr vong. Giam Albumin v i Protein o- 2 nhfim la k h i c nhau CO y nghTa thing ke. H i u h l l benh nhin efi tang Bilirubin t o i n phln, khong khae biet giO'a 2 nhfim.
Mfit s l chi so khic: Trong nhfim nghiin ctru cfi 29/36 bgnh nhan cfi CK tang > 200 dan vj/L, khong co trufi'ng hgp nao tang 6' mtre >1000 dan vj/L. Cfi 84%
binh nhan co tang creatinin mau >120 (iflmol/L. Cfi 21/36 (58%) b i n h nhan cfi ha Natri mau. Kali m i u trung binh la 3,8 ± 0,6 trong do 6/36 BN cfi K"^ < 3,5mmol/L va 3/36 BN cfi K* >4,5mmol/L.
4. BAN L U A N
T u l i trung binh cua c i c b i n h nhan nghien eiru eiia chiing tfii l i 48,3 ± 9,18, tre nhit la 33 tuoi v i nhilu nhit la 72 t u l i . nhfim benh n h i n cfi dp t u l i tren 65 chi cfi 2/36 bgnh nhan (ehiem 5,6%) cfin lgi la du6i 65 t u l i , tgp trung chii y l u fi- dp tuoi 44-64.
Trong nghien ciru ciia Ngfi Thanh Hoi nam 2002, nghiin cO-u tren 28 binh nhin bj viem phli m i c phai tO' cfing dong thi dp t u l i trung binh ciia nhfim binh n h i n nghiin ciru l i 59,3 ± 20,63, cac bgnh n h i n CO t u l i Iren 70 chilm ti l i cao 42,1% [1].
Trong khi dfi. Carles nghien ciru tren 343
thufi'ng gap a 66 t u l i trung blnh l i 64,4 (lir 18 d i n 102 tuoi) [6]. Tuoi tmng binh eua b i n h n h i n nhfim nghien ciru ciia chting tfii cOng luang t g vfi'i t u l i gap dugc 6' eac bgnh nhan nghign rugu bj viem phoi cpng d i n g qua nghiin ciru cua Jong G.M-1995 [7]. Nghien eiru lien hanh trong 3 nam cfi 28 b i n h n h i n nghien rugu bj v i i m phoi m i c phai ttr cfing d i n g trong dfi dp t u l i trung binh la 48,9±2,2 nam (tre nhat l i 28 l u l l v i nhieu nhat la 78 tuoi).
Trong nghien ciru eiia chiing toi khong cfi b i n h nhin nO" n i o , tat c i d i u l i nam giai. nghien ciru cua ehiing tfii cung tuang t g nhu nghien eiru eiia Jong G.M- 1995 [7]. trong 28 bgnh nhan nghien ciru t o i n la nam. Trong mpt nghien ciru khae fi' MT cho t h i y nghiin ciru v l i n h hufi'ng ciia nghign rugu d i n nguyen n h i n v i mire do nang eiia viem phoi m i e phai ttr cfing d i n g cho t h i y ti le nam chilm 86%
bgnh nhan nghiin ciru. S g uu t h l nay efi t h l g i i i thich do Ihfii quen uong rugu fi' nam gifi'i nhilu han ntr. Trong s l 38 benh nhan m i c v i i m p h l i cfing d i n g dilut trj tai khoa Hfi h i p benh v i i n Bgeh mai ttr thing 11/2001 d i n thing 10/2002 benh nhan nam ehilm 6 1 % va binh nhan ntr ehilm 39% [1]. Cavaneanti M - 2006 [8]
Vietnam Joumal of Physiology 19(2), 6/2015 ISSN: 1859-2376 cao han fi' nhfim khong nghign rugu cfi y
nghTa t h i n g ke.
Thfi'i gian tir khi xuit hign trigu ehirng d i u t i i n d i n khi benh nhan dugc nhgp khoa e i p ctru la 5 ± 3,7 ngay (sfi'm n h i l la 1 ngay v i chgm n h i t l i 14 ngiy). Binh n h i n thufi'ng cap ciru qua tuyen ea so* sau dfi mfi'i duge ehuyin len luyln trung uang nen thfi'i gian den v i i n d i i . o- tuyen co sa benh nhan da dugc dieu tri nhilu logi khang sinh. So vfi'i nghien eiru eiia Jong v i cpng su-1995 thi thfi'i gian tir khi bj benh den khi vao vien l i 53±7,1 gio (sfi'm n h i l la 12 gia va eham n h i t la 7 ngay)[0].
B i n h n h i n nghien ctru cua chiing tfii fi' thfi'i diem nhap vign efi 6 1 % benh nhan eo b i l u hien o j a hpi chtrng cai rugu o' nhieu mtre dp, cac trigu ehirng cfi the gap l i run, va mo hoi, sang hoac co giat. Cfi 27%
benh nhan co b i l n d l i y thirc fi' thai d i l m vao v i i n .
Cac thay doi ve can l i m sang tren bgnh n h i n nghien ciru eua chting tfii thay h i u h i t bgnh n h i n vao vien d i u efi llnh trang thilu m i u hong c i u to o' mO'c do nhg, MCV tmng binh l i 98. Kem theo b i n h nhan co giam tieu cau mau a nhieu mirc dp va tr le tir vong 6' nhfim giam tieu cau mirc dp nang < 50 giga/lit cao han han eac nhom khac (p<0,05). Trong cac nghiin CLPU v l cac d l i tugng viem phoi cfing dong ehung ca Irong nuac va nufi'c ngoai khfing t h i y noi d i n gia tri cua tieu c i u . Theo tac gia Jong va cs (1995) [9], khi nghien ctru tren 11 benh n h i n bj viem phoi do Klebsiella peumoniae thi t i l u giam o- mirc trung binh l i 45 G/l.
Trong nghiin ctru ciia chting tfii b i n h nhan v i o vien co tang cac enzym gan, chu y l u l i tang SGOT, thucfng tang & mire han gap 3 lan so v6i binh thufi'ng. Trong khi dfi s g tang SGPT chi ehilm han nira s l benh nhan nghien ctru. s g thay d l i v l enzym gan khong eo lien quan vfi'i ti lg ttr vong hay ti le tir vong giO'a eac nhom tang va khfing tang khong co s u k h i c nhau vfi'i
p>0.05. Tuang t u nhu mot so nghien ciru k h i c [10], bgnh nhan cfi thay d l i mpt so thong s l sinh hfia khac o' thfi'i diem nhgp v i i n nhu tang GGT fi" muc tang l i 386 ± 344, giam nabi m i u . Trong nghien ciru ciia ehung tfii benh n h i n co giam protein va g i i m albumin v i d i l u n i y co i n h hufi'ng den ti lg tir vong cua benh nhan, sg khac nhau nay cfi y nghTa thing ke vai p<0,05. Bgnh nhan nghien rugu thufi'ng kem theo tinh trang suy dinh duang ning.
Trong nhfim nghien cuu cfi 29/36 bgnh nhan co CK tang > 200 dan vj/L, khfing co trufi'ng hgp n i o t i i u ca van e i p (ting a mirc >1000 dan vj/L). Cfi 84% benh n h i n efi tdng creatinin m i u >120 pmol/L. Co 21/36 (58%) b i n h n h i n eo hg natri m i u . Kali mau tmng binh la 3,8±0,6 trong dfi 6/36 BN efi K* < 3,5mmol/L v i 3/36 BN efi K* >4,5mmol/L.
5. K t T L U A N
C i c y l u t l suy dinh du5ng, giam t i l u e i u n i n g , roi loan dign giai tren bgnh nhan nghign rugu m i e viem p h l i cfing dong CO lien quan d i n tang ty lg tir vong la. Vi v i y e i n eo chiln lugc can thiep sam dfii vfi'i benh nhan nghiin rugu m i c viem phoi epng ding.
TAI LIEU THAM K H A O 1. Ngo Thanh Hoi (2002)," Dac d i l m lam s i n g va nhu-ng b i l n d l i vi sinh gay v i i m phoi mac phai tir cpng dong ", ludn van tdt nghiep bdc sT npi tru truong Dai hgc YHd npi
2. Marc A.Schuckit (1998),
"Alcoholism and Dmg Dependency", Harrisons Principles of internal Medicine, 64, 386.
3. Shellito JE, Zeng MQ,Ye P, Ruan S, Shean MK, Koils J . (2001) "Effect of alcohol consumption on host release of interleukin-17 during pulmonary infection with Klebsiella pneumoniae". Alcohol Clin Exp Res 2001 ;25872-81
Vietnam Journal of Physiology 19(2), 6/2015 ISSN: 1859-2376 4. Sofya M. Rubinchik (2002),
"Alcoholic ketoacidosis". Endocrinology, 1- 12.
5. Thomas o. Marry," community- acquired Pneumonia", Harison Principles of Internal Medicine 16'\823, 1528-1541.
6. Carlos M, Luna ,MD,FCCP; Angela Famigiettti, PhD (2000) " eommunity- Aquired Pneumonia: etiology, epidemiology, and outcome at a teaching hospital In Argentina" Chest : 118; 1344- 1354.
7. Jong GM. Hsiue TR, Chen CR et al.
(1995) "Rapidly fantal outcome of bacteremic Klebsiella pneumonie in alcoholics". Chesf ;107:214-217.
8. Cavaneanti M, marcos MA, Garcia .£, Ewig S, Mensa J, Torres A. (2006)
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SUMMARY
LABORATORY ABNORMALUTIES IN ALCOHOL ADDICTION PATIENT WITH COMMUNITY ACQUIRED PNEUMONIA
Tran Thi Huong Giang^, Ha Tran Hung^'^
^Duc Giang Hospital, ^Hanoi Medical University, ^Bach Mai Hospital The study aimed to examine some laboratory changes in alcoholism patients suffering from community acquired pneumonia. Retrospective descriptive study included 36 alcoholism patients with community pneumonia diagnosed alcohol dependence according to ICD. 10 and diagnosed community acquired pneumonia. The results showed that all patients were male, mean age was 9.2 ± 48.3, average alcoholism duration was 13.6 ± 6.2 years, daily alcohol consumption less than lUday. Patients had mild anemia, medium MCV was 98 ± 8.1. 39% of patients had platelet decrease <50 G/l, the mortality rate among severely thrombocytopenia was higher than that in other groups (p <0.01). The percentage of patients with changes in SGOT and SGPT enzymes was 91.6% and 54%, respectively 100% of patients had increased GGT, average GGT level was 386 ± 34.4.
84% of the patients had increased blood creatinine > 120 pAmol/L, 58% of patients with hyponatremia. The average serum potassium was 3.8 ± 0.6 mmol/L, 6/36 patients had K-f-
< 3,5 mmol/L and 3/36 patients had K-*- > 4,5 mmol/L. Some laboratory charactenstics related to increased mortality as malnutrition, severe thrombocytopenia, electrolyte disorders should have early intervention strategy for patients with alcoholism community pneumonia.
Keywords: alcoholism, community acquired pneumonia.
