NHAN XET LAM SANG, HJNH ANH XQUANG VA DANH GIA KET QUA DIEU TRI NOI NHA LAI
TOM TAT
Nghien ciru tren 50 rang da dUdc dieu tri noi nha that bai dUdc danh gia b^ng lam sang dau.
sung ngach ldi 58%, do ngach ldi; 8%. Khong c6 bieu hien dau 34%. Xquang Han bo sot ong tuy 54%, chat han thieu 30%, chat han khong dong nhat, gay dung cu trong ong tuy 8% va 4%,
Sau dieu tn tiiy lai 1 tu^n ket qua tot 84%, trung binh 16%. Sau 6 thang dieu trj lai. Ty le thanh cdng 82,2%; nghi ngd 11,1% va that bai 6,7%.
ABSTRACT:
Research on 50 faillure treatmant endodontic, base on clinical symptomer; pain, vestibuler swollen 58%, vestibular fistula 8%, painless 34%. X-ray;
signs missing not cannal detection 54%, mising root canal obturation root 30%, root canal instreatmant faillure 8% and 4%.
One week after; Root canal retreatmant give a good rerult with 84% and a medium rerult 16%. 6 moths After root canal retreatmant give a good rerult with 82,2%, faillure 6,7%, not certain 11,1%.
I.
OAT VANof
Dieu tri benh tuy rang ludn gap khd khan do dng tuy cd cau tao tUdng ddi phUc tap, nhat la cac rang nhieu chan. Hien nay viec dieu tri ndi nha van gap rat nhieu khd khan va ty le thanh edng d lan dieu trj dau dao ddng kha Idn.
Hadi Antoun, Pien-e Cherfane el.all (2005) cho rang, ty le thanh cdng lan dau la 33-60%; Sjogren U, Hagglun (1990) dUa ra t/ le la 62-96%.
Tai Viet Nam, viec ap dung cae ky thuat va phUdng phap dieu tri ndi nha tien tien mdi ehi dUdc ap dung chu yeu tai cac trung tam Idn nhu Ha Ndi, TP Hd Chi Minh. Su thieu hut ve phUdng tien cdng vdi han che ve phUdng phap dieu tri lam cho viec chUa tuy lan dau dat hieu qua khdng cao.
Oe gdp phan dieu trj ndi nha hieu qua ngay tU lan dau cung nhu phUdng phap chan doan, giai phap khac phuc that bai trong cac trudng hdp phai dieu trj lai, ehiing tdi chpn de tai nay vdi muc tieu:
* Benh vien Viet Nam Cu Ba Ha Noi
Nguyen Thuy Nga*, Oac Thj Dung*
1. Nhan xet dae diem lam sang, hinh anh XQ cua cac trUdng hdp dieu trj ndi nha that bai.
2. Oanh gia ke't qua dieu tri ndi nha lai, de xuat ehi djnh va ky thuat ap dung.
II. o 6 l TUpNG VA PHUONG P H A P NGHIEN CCfU 2.1. Odi tUdng nghien ciiru
Cae rang da dUdc dieu trj ndi nha khdng ke't qua dUdc danh gia bang Xquang va lam Scing hoae ed bien ehUng sung dau. viem quanh cudng cd dudng kinh tdn thUdng
<10mm. Nhung rang dieu trj lai cd the phuc hdi lai than rang, chan rang binh thudng, khdng dj dang hay nirt gay, td chUc quanh rang tdt.
Dia diSm khoa Rang ham mat benh vien Viet Nam-Cu Ba Ha Ndi
Oieu trj tuy lai eho 50 benh nhan vdi 50 rang phan bd deu tren eung ham
2.2. PhUdng phap nghien cuu: Md ta, cd can thiep
Mo ta: Ly do den kham, vj trf rang tdn thUdng tren eung ham. tinh trang phuc hinh, ndi va thdi gian dieu tri tuy lan dau.
Trl^u chiing lam sang: Oau am i lien tuc hoac khdng dau. cam giac chdi rang, dau khi go rang: doe. ngang. tinh trang tdn thUdng than rang, tinh trang niem mac. phdng ngach ldi, lo ro VLing cudng rang, rang lung lay: cd, khdng.
Hinh anh Xquang trudc han:
Tinh trang han dng tuy; Han thid'u, han thUa. bd sdt dng tuy.
Ton thUdng vung cudng: Binh thudng, gian day ehang, u hat<1cm.
Tinh trang dng tuy: Hinh dang, sd lUdng, chieu dai, dung cu gay trong dng tuy.
Tinh trang td chUe vung quanh rang: Co hoac khdng tieu xUdng d rang.
Phuang phap tien hanh dieu trj lai Dieu tri triet dS 1 lan: cho cac rang can dieu tri lai chua ed bieu hien phan img cudng, do ddng dae cua khdi han dng tu^ kem, cd the thao bd ehat han cu va lam saeh he thdng dng tuy trong mdt lan dieu trj.
Y HOC VIET NAM THANG 1 - SO 2/2012
Dieu trj nhieu lan: Ddi vdi eac rang can dieu trj lai ed tdn thUdng man tinh va cap tinh ed phan Ung cudng. viee thao bo ehat han cu khd khan, he thdng dng tuy khd lam saeh va tao hinh, ehiing tdi dieu trj tuy vdi nhieu lan hen.
Phuang phap dieu tn lai
- Dijng eu: Bd sifa soan ldi vao dng tuy. may lay eao rang ed dau sieu am diing trong npi nha, bd tram xoay Protaper diing eho dieu trj lai.
•I- Dung dieh lam mem Eugenate Desobturator, Resin Remover, dung dich H2O2
(5 -10 V), NaOCI 2,5%, dung dieh Clyde.
Dung eu tao hinh va lam saeh dng tuy:
Tram K, tram H. K-Reamer. tram Protaper diing tay, diing may. Thudc do ehieu dai dng tiiy Endo-Ring.
Vat lieu han dng tuy: Ciment gan cudng AH^R Gutta-perreha Protaper.
2.3. Cac budc tien hanh dieu trj: Thao bo ehat han eu, thao gutta-pereha, md rdng dng tiiy, lam saeh dng tuy, han kin he thdng dng tuy.
2.4. Oanh gia ke't qua sau dieu trj: DUa vao lam sang va Xquang.
Tdt
Han kin khit, day du cac ong tuy den du'dng ranh gidi xu'dng nga
Trung binh Han each 16 cuong
<1mm
Kem
Han each 16 cu6'ng>1mm; ra ngoai cudng.
sang sau han dng tuy 1 tuan
~~~~~~~—-->^MUc do Trieu chUng^~^-—- Oau
Ngach ldi Go rang doc Go rang ngang
Tot
Khdng dau hoan toan ke ca khi an nhai Kh6ng suTig Khong dau Khdng dau
Trung binh
Dau nhe khi an nhai Kh6ng suTig, an dau nhe Dau nhe (-•-)
Khong dau
Kem
Oau tii nhien, c6 cam giac choi rang
SuTig. ap xe, lung lay rang Dau nhieu (++)
Oau nhe
2.4.2. Danh gia ket qua dieu trj sau 6 thang: Theo Bender va Seltgen
Thanh edng:
+ Benh nhan an nhai binh thudng.
-•- Tdn thUdng viing cuong giam hoae phuc hdi hoan toan.
- Nghi ngd:
-t- Benh nhan an nhai binh thudng
+ Khdng danh gia 6\Jac tien trien eiia tdn thUdng tren film xquang.
That bai:
-1- Sung dau tai phat hoae dau am i viing cudng rang
+ Tdn thUdng nang them, xuat hien tdn thUdng mdi, rang phai nhd.
III. KET QUA VA B A N LUAN 1.0ac diem chung
1.1. Phan bdrang dieu tri lai tren cung ham theo vitri rang
Sd rang can dieu tri lai gap d ham dudi:
60%, ham tren: 40%. Nhdm rang ham ldn (78%), trong dd rang ham ldn dudi (54%).
Nhdm rang cufa (12%), thap nhat la nhdm rang ham nhd. Ty le nay cung tUdng tu nhu eae
nghien eUu eiia Biii Thi Thanh Tam (72%). Le Thi Hong Van (67.9%). Cd the tha'y rang, nhdm rang ham Idn hay bi sau nhat va khi dieu trj tuy thi ty le that bai eung eao nhat. Oieu nay ed the ly giai bdi eau triie giai phau eiia eae rang ham Idn rat phUe tap va vi trf d phia sau eung ham nen khd khan trong viee tie'p can dieu trj.
1.2. Tinh trang phuc hinh cua cac rang dieu trj lai
Trong eae rang can dieu trj tuy lai cd 26/50 rang (52%) bi bong hoae vd ehat han eu, ehiem ty le eao nhat. Tiep theo la 18/50 (36%) rang edn ehat han cu. So rang da dUdc lam ehup, cau chiem ty le tha'p nhat (12%).
1.3. Ly do den kham va thdi gian tirlan dieu trj dau tien
Cd 54% sd benh nhan den kham lai vdi ly do dau, 34% benh nhan can lam phuc hinh mdi va ke't hdp ea hai ly do tren la 12% sd benh nhan.
1.4. Nal dieu trj tuy lan dau: Trong nghien cUu nay eae trudng hdp dieu trj tuy lan dau that bai do eae phdng kiiam tU thuc hien cao hdn so vdi ty le dieu trj that bai tai eae benh vien cdng (62% so vdi 38%).
2. oac diem lam sang va xquang
2.1. Trieu chiing Idm sdng cua cdc benh nhin didu trj tuy lai
t u i K . i l.tni -..iinf !/<'•'• -.'I Ix-nfi f f i . i r t
So tfuonc] \)o\) (l<iii S.HI \,\\\ (liiMi 111 'I,ill l i d i l,i ]'}!')() {'W/'>}. \\(:\) 'lew In hf'.'nh nh;^jn c6 tneu chirnq ( i u j v.i SU'IK] IKJ-K h ldi ( IIKMII yiy\^ So hf.'iili nli.ni tn do \](]<\(,\\ Uu r^]\ r;6 8%. Co 34% so ht:^nli iih.iii khon(i co c.oc. tiioii ( hinu] h i n soiif) Sii kh.io hiot v*,' rj/iu liioij l/un ^,anrj cua cac benh nhJiii tion du'ni tii Ln oo v fHihi.i Ihoiu] k<^ 701 [t- O.OS
2.2 /-//n// fifih XqiJcUiq one] tuy truoc dicti tri Ini
H.111 \)o sot oiu] tuv 1.1 I'^i lliiuiiK] (i-i[) nliot tio'fi filfn '/(]\\:\\](] '")4%, nhom rang so 6 chiem tdi 6 4 , 2 ^ ^ tiop don lo tinh I M I K J ( h,i( hon thio-u (:^.()';n), f,hot hon khoiuj riong nhat (8%). Co 4% c6 gay dung co trong ong tuy
t . A t
i,.\i I . .1 M t r > IA , , .. M.M i i .10 •- <n A "
l o -. <-.! A M U ' « ' /
"..Tv (f iJ " V) • "
£ 3 / e ( / r / o .J G. f^li,^ifi ty<\ fiirth ,irtlt X C? trtf<>-c cTitfn tri f.u thr'<^ •:<> f,tfi<f
2.3. Muc do tdn thuang vung cudng tren Xquang
Tdn thUdng gian day ehang thudng gap nhat. sau den tdn thUdng u hat <1em (38% va 36%.
khdng thay hinh anh tdn thUdng viing cudng 26%.
2.4. Sd luong dng tuy tung loai rang
Nhdm Rang sd 6 cd tU 3 den 4 dng tuy. Trong dd. da sd rang sd 6 ham dudi cd 4 dng tuy' (15/18). Nhdm rang eCra va ham nhd ed tU 1-2 dng tuy.
2.5. Nguyen nhan that bai do lai ky thuit
Bang 2.5. Phan bd nguyen nhan that bai theo sd lUdng rang Nguyen nhan
Md dng tuy Tao hinh ong tuy Han dng tuy
Phuc hinh than r3ng Tong cpng
So lu'dng rdng 15 18 12 5 50
dieu tri lai
Ty le % 30,0 36,0 24.0 10,0 100,0
Nhijfng nguyen nhan dan den viec tao hinh tuy chiem 30% nguyen nhan, de gay dung cu
khdng tdt la:, Nha sy khdng tuan thu theo cac trong dng tuy thUdng gap do dung dung cu qua
nguyen tac cua Schilder; chUa danh gia ehinh han, cu, cong veo, lap di lap lai, li/a chon diing
xac tinh trang dng tuy tren Xquang de lUa chon ciJ khdng phu hdp vdi tUng loai dng tuy va sif
dung cu tao hinh thi'ch hdp vdi tUng loai dng tu;y' dung lUc cudng trong khi tao hinh. Mat khac,
dan den loi do tao hinh dng tuy (36%). Ldi md
Y HOC VIET NAM THANG 1 - SO 2/2012 viee tao ldi vao dng tuy khdng diing eung la
nguyen nhan lam gay dung eu.
Nguyen nhan nCa dan den dieu trj tuy khdng thanh edng la do yeu td phue hinh 10%.
Trong sd dd, ed 2 trudng hdp ehan rang bj xuyen thiing khi dat ehd't, gay viem nhiem keo dai. 3 trudng hdp edn lai bj vd, gay chat han.
Cudi Cling, ehiing tdi eho rang nguyen nhan gay dieu trj ndi nha lan dau that bai edn do ehan doan kem, lUa chpn dung eu va eae phUdng phap dieu trj ehUa phii hdp, tien lUdng khdng diing. Oieu kien thUe hien, ehuyen mdn eiia nha sy va su hdp tae eua benh nhan.
3. Ket qua loai bo chat tram bit cu va han lai dng tuy
3.1. Phuang phap loai bo chat tram bit cu Oe loai bd chat han cu trong dng tuy.
phUdng phap ke't hdp giua nong tay hoae nong may vdi sir dung dung mdi la phUdng phap dUdc thuc hien nhieu nhat 58%. Nong may ddn thuan dUdc sir dung it nhat 8%.
Hau het cac vat lieu tram bit trong dng tuy deu ed the loai bd hoan toan bang cac phUdng phap neu tren. Tuy nhien. vdi vat lieu la gutta- percha, van cdn 7 1 % rang khdng loai bd dUde hdan toan.
3.2. Solan hen trong dot dieu trj lai Da sd cae rang ham Idn can tdi 3 lan hen de thi/e hien dieu trj lai (62%). Nhdm rang ham nhd thdng thudng chi can den 1 hoae 2 lan dieu trj. Sd dT nhu vay vi viee thao bd ehat han d nhdm rang nay thudng phUe tap hdn rat nhieu so vdi 6 nhdm rang cUa. Thdi gian tao hinh dng tuy ciia eac rang nay eung lau hdn dd eau triie giai phau phUe tap va phai chia lam
nhieu lan de tranh met moi. nham ehan eho benh nhan eung nhU thay thude.
4. Oanh gia ket qua:
Sau 1 tuan han dng tuy, ed 84% benh nhan khdng ed trieu ehUng dau, edn 16%
trudng hdp van cd earn giae dau nhe sau han.
Tuy nhien, trieu ehUng sUng phdng ngach ldi va earn giae ehdi rang khdng edn nUa. Day la 2% ehat han thUa. 8% AH26 ra ngoai cudng.
6% han thieu.
Theo nghien eUu eua Erausquin (1966) va Barkhordar (1985). AH26 cd kha nang gay phan Ung di Ung eho md cudng. TrUdng hdp han thUa gay dau do kieh thich viing cudng do AH26 d dau edn chinh tiep xiic vdi md cudng.
Ve hinh anh Xquang sau han: Cac trieu chUng lam sang rat tUdng thich vdi bieu hien hinh anh tren Xquang. Ty le eae rang 6^0c han tdi cudng tren Xquang (84%) diing bang ty le benh nhan khdng ed trieu chUng dau tren lam sang. TUdng tu nhU vay, eac trUdng hdp edn cam giae dau phu hdp vdi hinh anh han thUa.
AH26 qua cudng. han thieu.
Cdn 3 trudng hdp han thieu d nhirng benh nhan cd thdi gian dieu trj tuy lan dau da qua lau, benh nhan eae tudi, ed hien tUdng canxi hoa viing chdp nen khdng tao hinh dUdc het ehieu dai. Tuy vay, sau han benh nhan v i n dn djnh.
Danh gia ket qua sau 6 thang dieu trj: sd benh goi lai dUde la 45 (90%).
Sau 6 thang ke't qua dat 6\Jcic d mUe dd thanh cdng la 82,2%, d mUe dp nghi ngd ehiem
11,1 % va 7% dUdc coi la that bai.
Ty le thanh edng d nhung ngudi tre tudi cao hdn d nhung ngUdi Idn tudi (91,7% so vdi 62,6%), va nU nhieu hdn nam (87.5% so vdi 76.2%).
6,7% a T h a n h cc
a N g h i n g o I J ThAt b a i
Bieu cJo 3.9. Ket qua lam sang sau 6 thang (Sieu tri
Cac tnidng hdp that bai gap d cae rang sau: ngach ldi, tai phat nhieu lan. Cd the do rang cd + Rang 47 dieu tri tuy lai, dng tuy da dUdc dng tu:y' phu hoac benh \</ tuy- ket hdp vdi benh han kin nhung tren Xquang hinh anh viem d nha ehu.
mat ben d chan ngoai gan. Rang cd dd mO + Rang 26 da dUde dieu trj tu;}' nhung dng
tuy ngoai gan va ngoai xa bi khae, va benh nhan da dUde dieu trj lai nhieu lan tai trung tam y te quan.
5. Ky thuat ap dung
Tuan thu diing qui trinh dieu trj npi nha, trudng hdp khd ap dung ky thuat sau:
Khi dng tuy nhd, ehat han cirng ehae khd lay; diing dung mdi Eugenat Desobturator (hoac Resin Remover) lam tan trUde sau dd sir dung tram K, H de thao bo, diing tram xoay Protaper de tao hinh dng tuy.
Can ket hdp giua dung eu cam tay ed dien, tram xoay Protaper, sdng sieu am va dung mdi lam tan trong qua trinh dieu tri.
V. KET LUAN
1 Oac diem lam sang, hinh anh Xquang Ly do benh nhan den kham va dieu trj lai: Do dau, ehiem 54%; can phuc hinh mdi:
34%; ea hai ly do tren: 12%.
Trieu ehimg lam sang: dau, sung ngach ldi 58%; dd ngach ldi: 8%. Khdng cd bieu hien dau 34%.
Hinh anh Xquang: Han bd sdt dng tuy 54%. chat han thieu 30%. ehat han khdng ddng nhat. gay dung eu trong dng tuy 8% va 4%. Tdn thUdng gian giay ehang va u hat chiem 38% va 36, khdng ed tdn thUdng la 24%.
2. O^nh gid ket qua dieu trj ndi nha lai 2.1. Sau 1 tu^n dieu trj lai
Sau 1 tuan kham lai, ke't qua dat dUde d mUc do Tot: 84%; Trung binh: 16%
2.2. Sau 6 thang dieu trj lai
Ty le thanh cong 82,2%; Nghi ngd:
11,1%va Thi't bai: 6,7%.
T A I LIEU THAM K H A O
1. Biii Que DiTdng (1998) Nhang phuang phap sCra snnn dng tuy. Cap nhat nha khoa. thang 4/1998, tr.125-126
2. Bui Que DUdng (2000) Nhurng trudng hap nqi nha khd Cach xif tri. Bao cao khoa hpc, hpi nghj nha khoa quoc te. thang 6/2000.
3. Nguyin Manh Ha (2005); Nghi&n cdu d$c diom Icim sang va diSu tri viem quanh cuong man tinh bSng phuang phap ndi nha. Luan an tien sy y hoc,
4. Mai Dinh Hung (2001) Cac phuang phap chuSn bi ong tuy. Bai giang danh cho cao hoc RHM. Bp mon RHM, trUdng dai hoc Y Ha Npi.
5. Nguyen Kim Ngpc (2000) Dieu tn ngi nha lai: Mot so nhan xet lam sang. Ky yeu cong trinh khoa hpc trudng dai hpc Y DUdc Tp. Ho Chi Minh
6. Nguyin Thanh Nguyen (1994); Tram bit ong tu^
chan rdng. Tai lieu djch. Trudng dai hpc Y Ha Noi.
7. Bill Thj Thanh Tam ( 2004) Nhan xet hieu qua dieu tri tuy vdi NiTi Protaper cim tay. Luan van thac sy y hpc.
OANH GIA TiNH TRANG ROi LOAN NUOT 0 BENH NHAN TAI BIEN MACH NAO GAP CHITA OAT NOI KHJ QUAN TAI KHOA CAP CUU
B A N GBANG DIEM GUSS
. - . — 2
Nguyen Oat AnhS Mai Duy TonS Nguyen The Dung
TOM TAT
Muc tieu. Danh gia tinh trang rdi loan nuot d benh nhan tai bien mach nao cap chUa dat npi khi quan. Do/ tu'dng: 42 benh nhan dii tieu chuan tai bien mach nao giai doan cap chUa dat npi khi quan vao khoa Cap ciru tU 4/2009 den 9/2009! Kit qua. Ty le rdi loan nudt d ngay thir nhat la 64,3%, d ngay thU ba la 54,8%. 12/26 benh nhan cd Glasgow 15 diem va 15/16 benh nhan cd Glasgow 10-14 diem bj liet hau-hpng.
100% benh nhan liet hau-hpng cd rdi loan nudt. Rdi loan nudt 6 benh nhan nhdi mau nao la 16/27 va d
benh nhan chay mau nao la 11/27. Kit luan: Roi loan nudt rat hay gSp d benh nhan tai bien mach nao giai doan cap. Rdi loan nudt cd lien quan den tinh trang y thUc (p<0,05) va liet hau-hpng (p<0,001). Khong co siT lien quan giUa rdi loan nudt va loai tai bien mach nao,
SUMMARY
Evaluation of dysphagia in acute stroke patients without intubation in Emergency Department by
The Gugging Swallowing Screen
Objective: To evaluate dysphagia in acute 1. Khoa Cap cu'u, Benh vien Bach mai; 2. Khoa Hoi site Cap cu'u Binh vien da khoa tinh Dien Biin
