Y HOC VIET NAM THANG 1 0 - S O 1/2011 TAI LIEU THAM KHAO.
1. To Vdn Hal, Vu Thdng (2000), "Bidn chUng ciia ngudi hep van hai Id didu tri tai Bfenh vi6n Hai Bd Trung", Ky y^u toin vSn cic d4 tii nghien cifu khoa hoc, Oai h6i Tim mach Qudc gia lan thu VIII, tr. 885-897.
2. Nguyin Phu Khdng (2001), "Lim sing tim mach", Nhd xuat ban Y hpc Ha Npi.
3. Tran Do Trinh (2001), "BSnh van hai Id", Ch^n doin va di4u tri Y hgc hi^n dai tip I, Nhd xud't b^n Y hoc Ha Noi, tr. 485-495.
4. "Cdc rdi loan nhjp tim", Chi^n doin vi di6u tri Y hoc hi^n dai tip /, Nhd xudt b^n Y hpc Ha Noi, tr. 547 - 572.
Bertrand E. (1999), "Evolution epidemiologique des maladies cardiovasculaires dans les pays en developpement". Archives des maladies du coeur et des vaisseau, Neuilly sur Seine, France, 90 (7), pp. 981-985.
Chopra P.. GulwanI H. (2007),"Pathology and pathogenesis of rheumatic heart disease" Indian J Pathol Microbiol, 50 (4), pp. 685- 697.
7. Bassand JP (2002), "Retrecissement mitrale, Etiologie physiopathologie, diagnostic, evolution", cardiologie, Arnette, pp. 153-168.
KET QUA GHEP THAN - THAN GHEP LAY TLf NCaOl CHO CHET NAO TAI BENH VIEN VIET DLTC: NHAN SAU TRJONG HOP OAU TIEN
• • • • •
Oo Tru'dng Thanh*, Nguyen Tien Quyet*
TOM T A T
Muc dich: 6 Viet Nam hien nay ghep than da la mpt phau thuat thudng qui tai mpt sd trung tam phau thuat Idn. Tuy nhien nguon tang ghep la tir ngUdi cho song. Trong thdi gian qua benh vien Viet Dire lan dau tien to chirc phiu thuat lay tang tir ba ngUdi cho chet nao va ghep thanh cong cho 6 benh nhan nhan than.
Tir 6 trUdng hpp ghep nay, chiing toi tong ket ket qua ghep than, than ghep tir ngUdi cho chet nao. Doi tu'dng nghien cu'u: nghien ciru tien cdu tren sau benh nhan dUpc ghep than, than ghep tir ngUdi cho chet nao. Thdi gian tir thang 5/2010 den thang
10/2010. Ket qua: sau benh nhan ghep deu dat dUpc ket qua tot. Khong co bien chu'ng trong va sau md.Ket luan: Vdi ket qua thanh cong ban dau tir 6 trUdng hpp dau tien, chiing toi da khSng dinh dupe ky thuat phau thuat ghep than tir ngUdi cho chet nao cung nhU qui trinh theo doi va dieu tri sau ghep than.
Tu" khoa: ghep than, ngUdi cho than chet nao.
SUMMARY
Kidney transplants from brain dead donor in Viet Due Hospital: The first six cases Purpose: In Viet Nam now kidney transplant is a routine surgery in a large number of surgical centers.
However the source organs from living people. The Viet Due hospital perform first surgery took organs from brain dead of three patients and successful transplants for six patients receiving kidney. From 6 cases of transplantation, we summarize the results of kidney transplants, kidney transplants from brain dead people. Materials and Methods: prospective study
* Benh vien Viet Dij'c 5 6 '
on six patients with renal transplant, kidney transplants from brain dead people. Period from May 2010 to May 10/2010. Results: six transplant patients are achieving good results. No complications during and after operation. Conclusion: With the initial success results from the first six cases, we have confirmed the surgical techniques for kidney transplants from brain dead people as well as process monitoring and treatment after renal transplantation.
Keyword: Kidney transplantation, deceased donor.
I.
OAT VANol
Ghep than la mdt phu'dng phap dieu trj tien tien cho benh nhan suy than man giai doan cudi, giup ngu'di benh cd sire khde va chat lu'dng cupc sdng tdt nhat [1,3]. 6 Viet Nam, ghep than tir ngu'di cho sdng du'dc thi/c hien tir nam 1992, tuy nhien nd chi du'dc thu'c hien mdt each khong thu'dng xuyen tai cac benh vien Idn do nguon than ghep phu thudc vao su" hy sinh cao ca ciia ngu'di hien than.
Benh vien Viet OiTc du'dc Bo Y te cho phep thu'c hien de tai nghien ciru ghep than tir ngu'di cho chet nao. Lan dau tien chung tdi da thu'c hien lay than d 3 benh nhan chet nao va ghep cho 6 benh nhan suy than man giai doan cudi.
Vdi ket qua da dat du'dc chiing tdi thirc hien nghien ciTu nay nham muc dfch: Danh gia kit qua ghep than, than ghep lay td" ngu'di cho chet nao.
Y HOC VIET NAM THANG 1 0 - S O 1/2011 IL OOI TUpNG VA PHUONG P H A P NGHIEN COU
2 J . . Ooi tu'dng nghien cuTu:
Odi tu'dng nghien cu'u la 6 benh nhan ghep than, than ghep du'dc lay tir ba BN chet nao.
2.2. Phu'dng phap nghien cu'u
La nghien ciru tien ciru, moi mdt cap ghep deu du'dc thiTc hien theo mdt qui trinh chuan, ve phau thuat va dieu tn san sdc sau md. Thdi gian thu'c hien nghien ciru tir thang 5/2010 den thang 10/2010.
2.3. Thu'c hien nghien cu'u 2.3.1. Ngu'di cho than
* Tudi, gidi ngu'di cho than: 3 ngu'di cho than gdm: 2 nam, tudi 17 tud'i va 20 tudi. Mdt nii', 40 tudi.
* Nguyen nhan chet nao la tai nan giao thdng va tai nan lao dpng.
* Thdi gian tir khi chan doan chet nao den khi lay tang trung binh la 48h.
2.3.2. Cac chisd ciia ngu'di nhan than
* Tudi, gidi, nguyen nhan suy than ciia ngu'di nhan than
Sott
Bang 3 . 1 : Tud'i, gidi, nguyen nhan suy than ciia ngu'di nhan than Ho ten
Nguyen Thi Thu T Nguyen Huy K Nguyen Thi Thanh H
Pham Dieu L Hoang Dang K Nguyen Minh D
Tuoi 22 38 30 33 _J6_
66
Gidi Nu' Nam
NCr
Ncr
nam Nam
Nguyen nhan suy than Viem cau than man Viem cau than man Viem cau than man Viem cau than man Viem cau than man Viem cau than man
* Nhom m a u va HLA cua ngu'di cho va ngu'di nhan
Ciing nhdm mau giu'a ngu'di cho va ngu'di nhan: 5/6 Bn, 1 tru'dng hdp khdng triing nhdm mau: ngu'di cho nhdm mau O, ngu'di nhan nhdm mau A.
- Hoa hdp ve HLA: 1 tru'dng hdp hoa hdp d mirc 2/6, 2 tru'dng hdp hoa hdp d mirc 1/6, 3 tru'dng hdp khdng hoa hdp.
* Phan UTng cheo: Ty le am ti'nh 100%
(6/6). Thdi gian thu'c hien phan irng cheo: 6h 2.3.3 Ket qua phau thuat ghep than
* Thdi gian phau t h u a t '
Thdi gian mieng ndi tTnh mach trung binh la: 21,33 phut (8-36 phut).
Thdi gian mieng ndi ddng mach trung binh la: 18 phut (9-29 phut).
Thdi gian thieu mau ndng cua than ghep trung binh la : 44 phut (20-75).
* Thdi gian co giot nu'dc t i e u dau t i e n : trung binh 2 phut (15giay - 5 phut) sau khi tha kep ddng mach than ghep.
* Cac bien chu'ng trong mo: 6 benh nhan deu khdng gap cac bien chirng trong md
2.3.4. Theo doidieu tri sau md
* Oieu trj nhiem khuan: Khang sinh sir dung: Sulperazol 2g/24h, tiem tTnh mach, Bactrime 0,48g, 2 vien/24h.
* Oieu trj chong loet da day ta trang:
Losex 40mg/24h
* Oieu trj thai ghep
Sir dung simulect 20mg tru'dc khi tha kep ddng mach than ghep, va ngay thir 4 sau md.
Methylprednisolon: 500mg/24h du'dc sir dung trong md tru'dc khi tha kep ddng mach than ghep va lien tuc 3 ngay sau mo.
Oieu trj prograf 0 , l m g (tacrolimus) 0,07- 0,15mg/kg/ngay udng chia 2 lan de dat ndng dd CO 10-15ng/ml
Sir dung MMP (mucophenolate mofetil) 250mg. Ou'dc sir dung ngay tir ngay dau tien sau md vdi lieu 750mg/24h, sau dd la 1500mg/24h
Bang 3 . 2 : D i l n bien ure va creatinine mau nhij'ng ngay sau md H9 ten b$nh nhan Ure- creatinine mau sau mo (MMoL/L)
Ngay 1 Ngay 7 3 thang
Nguyen Thj Thu Tr 13,5- 788 3,7 - 93 4,9- 108
Nguyen Huy K 9,9- 788 , 3,1- 93 3-119
Nguyen Thj Thanh H 20,9- 760 6,4- 87 5,3 - 80
Pham Dieu L 10,6- 700 3,2- 89 6,1 115
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Y HOC VIET NAM THANG 10 - SO 1/2011 Hoang OSng Kh
Nguyen Minh 0
JMlJ9§4_
30,3-911
15,5- 278 9- 145
9,1 169 8,2 -124
Chirc nang than ghep. Ngay sau tha kep mach mau than ghep, than lam viec ngay va chirc nang than dan dn djnh nhij'ng ngay sau md du'dl sir dieu tri hdp ly cac thudc thai ghep. Chirc nSng than sau md du'dc the hien tdm tat trong bang 3.2.
Sau md ca 6 benh nhan dau khdng sdt.
Mach huyet ap trong gidi han binh thu'dng. Cac dan lu'u d md nhUng ngay dau ra tir 200-lOOml, thu'dng het va du'pc riit sau 5 ngay. Vet md khdng nhiem triing, du'dc cat chi sau 8 ngay.
Benh nhan ra vien vao ngay thir 12 sau md.
Du'pc theo ddi lien tuc kham lai 1 tuan 2ran trong thang dau. 1 tuan 1 lan trong thang thir 2 va thir 3.
III. B A N L U A N
Theo thdng ke ty le sdng sau 1 nam ciia than ghep tir ngu'di cho chet nao la 95%, cdn tang ghep tir ngu'di cho sdng la 98% [6]. Cd sir khac nhau nay la do tang ghep du'dc lay tir ngu'di cho chet nao, chat lu'dng tang kem hdn. Phau thuat ghep du'dc thu'c hien trong cap ciru, tang ghep lai phai bao quan lanh dai hdn, do vay sau ghep cd nhii'ng rdi loan ve chuyen hda d mirc phan tir trong te bao than ghep nen dieu tri sau ghep phirc tap hdn va thu'dng cd nhieu bien chirng.
3 . 1 . Ket qua ghep than tiy ngu'di cho chet nao va qui trinh di'eu trj
Oieu tri thai ghep du'dc thi/c hien tir ngay trong md. Tat ca cac benh nhan deu du'dc sir dung Simulect 20mg ngay trong md, kem vdi methylprednisolon 500mg tru'dc khi md kep mach mau than ghep. Ket qua 6 benh nhan ciia chiing tdi deu khdng cd hien tu'dng thai ghep tdi cap va than hoat ddng ngay sau trung binh 2 phiit.
Than cham hoat ddng chiTc nang (Delayed Graft Function- DGF) cung la mdt bien chirng hay gap ddi vdi ghep than tir ngu'di cho chet nao. Thdng thu'dng bien chirng nay cd the keo dai tir 7-10 ngay. Thdng ke ciia td chirc ghep tang My vdi 107787 [4,5] than ghep tir ngu'di cho chet nao thay; ty le SGF vdi ngu'di cho trong tieu chuan la 23%, vdi tieu chuan md rdng la 34%. Cac benh nhan ciia chung tdi dat ket qua tdt ve mat phau thuat, dieu trj thai ghep, chirc nang than ghep hoat ddng tdt va khdng cd bien chirng nao xay ra trong va sau md.
Trong thdi ky theo ddi va dieu tri ngoai tru, ket qua sau 3 thang cac benh nhan deu khde manh. Chirc nang than ghep hoan toan binh thu'dng. Cac benh nhan d"eu hoat ddng sinh hoat cdng ddng, lao ddng binh thu'dng.
3.2. Ket qua ghep than va cac yeu td lien quan
3.2.1 Hoa hdp vie HLA: Nghien ciru cua Opelz va Dohler phan tich cac sd lieu ciia hiep hdi ghep than qudc te trong hai thap ky 1985 tdi 1994 va 1995 tdi 2004 neu ra anh hu'dng ro ret ciia hda hdp HLA trong ghep. Tuy nhien tren thu'c te, nam 2004 cd 14% ngu'di nhan than d My hoan toan khdng cd hda hdp HLA vdi ngu'di cho so vdi nam 1995 la 12% [6].Trong nhdm benh nhan ghep cua chiing tdi, cd 3 ngu'di nhan hoan toan khdng hda hdp HLA vdi ngu'di cho, 2 benh nhan hda hdp md mirc 1 locus, 1 benh nhan hoa hdp d mirc 2 locus. Ket qua theo ddi sau ghep d ca 6 benh nhan nay deu tdt mac dii phac dd dieu tri deu gidng nhau d ca 6 benh nhan.
3.2.2 Vai tro ciia dieu tri thai ghep: Gan day Butler va ddng nghiep [2] nghien ciru thay rang, dieu tri thai ghep phii hdp lam tang hdn ty le sdng cdn ciia tang ghep tdi 7 lan so vdi dieu trj khdng phii hdp. Thai ghep man va tieu du'dng la hai nguyen nhan chinh gay hdng than ghep. Cac benh nhan ghep ciia chiing tdi khdng gap cac bien chirng ve thai ghep, chirc nang than sau ghep hoat ddng binh thu'dng cd the khang djnh val trd ciia cdng tac dieu trj chdng thai ghep.
IV. KET LUAN
Ghep than la phu'dng phap dieu trj tot nhat cho benh nhan suy than gia doan cudi. 6 Benh Vien Viet Oirc day la lan dau tien chiing tdi thiTc hien ghep than, than ghep tir ngu'di cho chet nao. Sau benh nhan ghep ciia chiing tdi deu dat ket qua tdt. Than sau ghep deu cd chu'c nang binh thu'dng. Theo ddi sau 3 thang, chuTc nang than dn djnh, cac thudc thai ghep da giam lieu d lieu duy tri van dam bao du'dc chiTc nang than.
Ca 6 benh nhan dau khdng gap cac bien chu'ng tru'dc, trong va sau md.
Vdi ket qua tir 6 benh nhan nay, bu'dc dau chiing tdi da khang djnh du'dc cac tieu chuan liTa chpn benh nhan ghep, ky thuat phau thuat va
58
Y HOC VIET NAM THANG 1 0 - S O 1/2011 phac dd san sdc va dieu trj benh nhan sau ghep
than, than ghep du'dc lay tir ngu'di cho chet nao.
TAI UEU THAM KHAO
1. Bo y te (2002), H6i d6ng tu van chuy6n mfin ghep tang, Quy trinh ghep than tir ngudi sdng cho than.
2. Butler 3A, Roderick P, Mullee M, et al (2004), Frequency and impact of nonadherence to immunosuppressants after renal transplantation:
a systematic review. Transplantation 77:769.
3. Gerardo Machnickia, Louiza Seriaib, Mark A.
Schnitzler (2006), Economics of transplantation:
a review of the literature, Transplantation Reviews 20, pp:61-75.
4. Jacqueline M. A. Smitsa, Guido G. Persijna, Hans C. van Houwelingenb, Frans H. J.
Claasc and Ulrich Frei on behalf of all the Eurotransplant Senior Program Centersd (2002), Evaluation of the Eurotransplant Senior Program.
The Results of the First Year, American Journal of Transplantation 2002; 2: 664-670.
5. Isabel Quiroga, Philip McShane, Dicken D.
H. Koo, Derek Gray, Peter J. Friend, Susan Fuggte and Christopher Darby (2006), Major effects of delayed graft function and cold ischaemia time on renal allograft survival, Nephrol Dial Transplant, 21: pp: 1689-1696.
6. Peter J. Morris, Stuart (2008), Kidney transplantation: principles and practice, Chapte
11, PP 657-676.
PHAN LfNG PHAN HUY MASTOCYTE
TRONG CHAN OOAN XAC DjNH HEN PHE QUAN DO BUI NHA
^ Trinh Manh Hung*, Tran Bfch Hanh*TOM T A T
Tien hanh phan img phan huy mastocyte cho 111 ngudi benh HPQ do bui nha va 50 ngudi binh thudng. Ket qua cho thay, phan Ung ph^n huy mastocyte co dp dac hieu v^ dd nhay cao (72% 75,78%), nhung ket qua cdn phu thudc vao nhieu yeu td khach quan. De phu hpp vdi hoan canh nude ta hien nay neu sir dung phan irng phan huy mastocyte trong chan doan xac djnh nguon di nguyen gSy bfnh ddi vdi cac benh dj Ung, can phai phdi hpp 1-2 phUdng phap chan doan dac hi§u khac nhu khai thac ti§n sir di irng, phan img tieu bach cau dac hieu..., thi vi6c chan doan dac hieu se co gia trj hon.
TCf khoa: Phan Ung ph§n huy mastocyte, Chan doan dac higu.
SUMMARY
Execute the mastocyte disintegrate reaction for 111 asthma patients by house dust and 50 normal persons. The result shows that: the mastocyte disintegrate reaction is the method which has the high relative sensitive rate (72%
75,78%), but the result also depends on many objective factors. To suit with our country situation nowadays, if we used the mastocyte disintegrate reaction in diagnosis the allerrgens cause allergy diseases, need to combine with 1
* Benh vien Bach Mai
or 2 other specific diagnosis methods as: exploit allergy prehistory, leucocyte dispel reaction...the specific diagnosis would be more value.
Keywords: The mastocyte disintegrate reaction, Specific diagnosis.
I.
OAT VAN OENgay nay de chan doan dac hi§u cac b§nh di irng, nham xac dinh chinh xac nguyen nhan gay b§nh va danh gia ket qua dieu tri, nhieu tac gia nude ngoai da ap dung cac phucmg phap chan doan dac hieu nhu:
RAST, RIST d^ dinh lupng cac KT IgE, IgG dac higu, hoac cac phuPng phap dd xac dinh dudi nhom te bao lympho (CD3, CD4, CDg) dac hieu vdi dj nguyen (DN) gay b$nh. Day la cac phupng phap chan doan dac hi6u nham chi ra dupe ehinh xac ngu6n DN gSy bfnh.
Ntiung trong thuc t§', cac phupng phap nay van chua dupe sCr dung rpng rai, thudng xuy6n va khong phai lue nao cung ap dung dupe vi gia thanh cao, chi phii hpp vdi nhQ-np nghien ciru Idn va quy mo. Xu hudng cliung de chan doan nguyen nhan gSy benh^, da sd cac tac gia da ke't hpp cac phupng phap chan doan dae hiSu in vivo vdi in vitro nhu: tet lay da, tet kfch
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