TAP CHi Y HOC VIET NAM TAP 464 - THANG 3 - Sd 1 - 2018 palsy April 2006. Dev Med Child Neurol Suppl.
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2. Gration J. Epidemiology and Disease Prevention: A Global Approach. Occupational Medicine. 2014;64(5):396-
3. Chahine NH, Wehbe TW, Hilal RA, et al.
Treabnent of Cerebral Palsy with Stem Cells: A Report of 17 Cases. Int J Stem Cells. 2016;9 (l):90-5.
4. Wang X, Cheng H, Hua R, et al. Effects of bone marrow mesencnymal stroma! cells on gross motor function measure scores of children with cerebral palsy: a preliminary clinical study. Cytotherapy.
2013;15 (12): 1549-62.
J. Vu Duy Chinh. Ap dung thang do lu'dng chut nang van dong tho danh gia hieu qua cac ky thuat tao thuan van dojig trong phuc hoi chiTc nang tre bai nao'du'di 5 tuoi: Dai hoc y Ha Noi; 2005 6. Chen G, Wang Y, Xu Z, et al. Neural stem ceil-
iike cells derived from autologous bone mesenchymal stem cells for the treatment of patients with cerebral palsy. 3 TransI Med. 2013;11 (21): 1479-5876.
7. Sharma A, Sane H, Gokulchandran N, et al. A clinical study of autologous bone marrow mononuclear cells for cerebral palsy pabents: a new frontier. Stem Cells Int. 2015;905874(10):18.
KET QUA P H A U THUAT DIEU TRI M A U TU NGOAl M A N G CITNG DO CHAN THU-aNG TAI BENH VI$N DA KHOA TJNH BAC GIANG
Nguyen Van SOTI\ Dinh Thai Son^,
Nguyen Huy Nggc', D6 Thi Thanh Toan^
TOM TAT
Mau tu ngoai mang cijhg (NMC) la khoi mau tu hinh tiianh giu^ mat trong xu'ang so va mat ngoai mang cirng, la mot bien chirng nguy hiem thu'dng gap trong chan thuUng sp nao (CTSN). Nghien ciru du'dc tien hanh vdi muc tieu danh pia ket qua phau thuat dieu tri mau tu ngoai mang eUng do ehan thu'dng tai B^nh ViSn da khoa tinh Bac Giang giai doan 2 0 l i - 2017. Doi tu'dng nghien ciili gSm 62 benh nhan du'dc chan doan va mo mau tu NMC do chan thUOng tai Idioa Ngoai than Idnh - So nao BSnh vien da khoa tinh Bac Giang tir 01/2013 - 06/2017. Sau Jchi phau thuat, phan I6n BN da dUdc ciili sdng v&i mu'c do hdi phuc ia hoan toan hoac la chi mang cac di chdng nhe la 44 BN chiem 71%. bii khong c6 tru'dng hop nao tir vong song van con 03 BN bi rdi vao tinh trang sdng thUc vat. Bien chiihg pho^bien nhat ma BN gap trong thdi gian nam vien ia nhiem trung vet mo (15 BN, 24,2%).
Uet nira ngu'di (8BN, 12,9%) roi loan n^on ngu" (2BN, 4,3%), tinh trang suy ho hap, viem mang nao va roi loan tam than gap d 3 BN chiem 4,8%.
Tu'khda:Tu mau ngoai mang cirng, chan thUdng, l(et qua phau thuat
SUMMARY
SURGICAL RESULT OF EPIDURAL HEMATOMA DUE TO INJURY I N BAC GIANG
PROVINCE GENERAL HOSPITAL Epidural blood is the hematoma that forms between the inside of the skull and the epidermis, a common complicahon of traumatic brain injury. The 'Binh vien Da khoa Phu Tho
^VienDiotao Y hoc Dd phong vi Ytecongcgng, Trifdng Dai hoc YHi Noi
ChjU b^ch nhiem chinh: Dmh Thai Sdn Eniail: [email protected] Ngay nhan bai: 14.12.2017 Ngay phan bien khoa hoc; 2.2.2018 Ngay duyet bai: 21.2.2018
study was conducted with the aim of evaluating the results of surgical treatment of epidural blood at Bac Giang General Hospital for the penod of 2013-2017.
The study recruited of 62 patients who were diagnosed and treated for epidural ectasia. After surgery, the majority of the disease was recovered or only mild sequelae of 44 patients accounting for 71%.
Although no cases of death, but still three patients fall into the state of plant life. The most common complication of hospitalization was wound infection (15 patients, 24.2%). Half of the people (8 people, 12.9%) of language disorders (2 people, 4.3%), respiratory distress, menmgibs and mental disorders in 3 patients accounted for 4.8%.
Key words: Epidural hematoma, injury, surgical result.
I. OAT VAN BE
Mau tu ngoai mang cirng (NI^C) la khdi mau tu hinh thanh giu'a mat trong xu'dng sp va mat ngoai mang eirng, la mpt bien chu'ng nguy hiem thddng gap trong chan thu'dng sp nao (CTSN) [1]. Chan thu'dng sp nao ia mot cap ciiu thu'dng gap. Tai I^y, moi nam eo khoang 1,4 trieu ngu'di CTSN, trong do 52.000 ngu'di chet,_90.o6o ngu'di de iai di chirng sudt ddi. Tai Chau Au, ty ie ehan thu'dng so nao dao dong vao khoang 100-700 ngu'di tren 100.000 dan [ 2 ] , [ 3 ] . 0 Viet Nam, CTSN cung gia tang den mdc bao dpng trong nhij'ng nam gan day. Trong do mau tu ngoai mang cirng la mpt trong nhutig loai thu'dng tieh gay ra hau qua het sire nang ne, de iai nhieu di ehirng cho ngu'di benh, ia ganh nang cho ca gia dinh va xa hpi neu khong du'dc chan doan va dieu tri kjp thdi. [viau tu NMC chiem 6,5% theo Carlson, 11,5% theo Baiik va eong sd, 2 6 , 1 % theo Dong Van He va Vu Ngpc Tii trong tong so benh nhan CTSN, va ehiem xap xi 10% benh
163
VIETNAM MEDICAL JOURNAL N°1 • MARCH - 2018 nhan cd CTSN nang [ 4 ] , [ 5 ] , [ 6 ] .
Da CO nhieu cong trinh nghien cud cho thay nguyen nhan hinh thanh mau tu NMC ia do tdn thu'dng dpng mach mang nao giu^ va cac nhanh eiia no sau mpt tae nhan ehan thu'dng vao dau dot ngpt. Dieu do chirtig to co sd lien quan gida \dc ehan thudng va vi tri giai phau ciia dpng maeh
mang nao giOci. Neu mau tu NMC du'dc phat hien sdm, md kjp thdi ket qua dieu tn se tdt nhat va ft de lai di ehirng [7]. Vdi muc dich gop phan dieu tri thanh eong hdn benh iy ehan thu'dng nay nham ha thap ty ie t d vong giam thieu thiet hai ngudi va cua cho ca nhan va xa hpi, ciing vdi mong muon trien khai phau thuat dieu tri mau tu NMC tai benh vien huyen nang cao chat lu'dng dieu tri phyc ngirdi benh, toi tien hanh nghien ciru de tai: "Ket qua phau thuat dieu tri mau tu ngoai mang cdng do chan thu'dng tai Benh vien da khoa b'nh Bac Giang" vdi hai muc tieu:
l.Mo ti ket gua phau thuat dieu trf miu tu ngoii ming cung do chan thu'dng tai Benh vien da khoa tinh Bac Giang glal doan 2013-2017.
2. Phan tidi mdt so yeu tD anh hddng den ket qui phau tiiuat miu tu ngoai ming cdng do cMn thudng tai Benh viin da khoa tinh Bac Giang.
II. DOI TUQNG VA PHU'ONG PHAP NGHIEN CUU 061 tu'dng: Ddi tu'dng nghien eiru gom 62 benh nhan du'dc ehan doan va mo mau tu NMC do chan ttiu'dng tai khoa Ngoai than kinli - Sp nao Benh vien da khoa tinh Bac Giang tir 01/2013 - 06/2017.
Phu'dng phap
Thiet ke nghien culi: mo ta loat benh pho bien Cac bddcjtien hanh nghien ciru; Benh nhan vao vien, chan doan I3m sang, ehup cat idp vi tmh so nao, thu thap thong tin trddc, phau that va thu thap thong tin sau.
Cae thong tin thu thap t d benh nhan gdm:
thong tin hanh chmh va nhan khau hpe, ket qua phau thuat mau tu NMC, cac yeu t d lien quan tdi ket qua phau thuat.
Phu'dng phap phan tich xuT ly so lieu: Sir dung phan mem SPSS de phan tfeh so lieu. Cac bien sd (Knh tinh dddc mo ta bang tan so va ty le phan tram.
Dao du'c trong nghien cu'u: Cac thdng tin rieng cua benh nhan trong ho sd hoan toan bao mat, Cac thong tin nghien ciru dude sd dong y cua benh nhan va dirng tham gla nghien eiru khi
benh nhan khong hdp tac hoac khong ddng y.
T i t ca thong tin ciia benh nhan chi phue vu cho nghien etid ma khong t d mue tieu nao khae. Oe eddng nghien cdu diidc thong qua hpi dong nghien cdu khoa hpc Trddng dai hpc Y- Du'dc Thai Nguyen xet duyet va eho phep trien khai nghien ciru. Ket qua nghien ciru dam bao tinh trung thdc.
III. KET QUA
Tir thang 01/2013 den thang 06/2017 da eo 62 benh nhan dii tieu ehuan dddc ehpn lu'a de thu thap sd lieu, thdi diem nhap vien ciia benh nhan tral deu trong cae nam. Benh nhan eo dp tudi nam trong khoang tir 3 den 75 tuoi, do tuoi trung binh ia 28,9 ±15,9 tudi.
Bang 1. Dac diem chuitg Oac diem
chung
Tuoi
Gidi
Nguygn nlian gay tai
nan Cac bien
pliap stf cu'u Diem Glasgow cua benli nhan khi vao vien
<10 1 1 - 2 0 2 1 - 3 0 3 1 - 4 0 4 1 - 5 0 5 1 - 6 0
>60 Nam Nif Tai nan giao
thSng Tai nan lao
dong Tai nan sinh
hoat Tai nan nga
cao Co Khong
< 8 9 - 1 2 1 3 - 1 5
So li/dng { n j
8 13 15 10 13 1 2 54 8 42 4 12 4 43 19 3 32 27
T y i e
•/o 12,9 21,0 24,2 16,1 21,0 1,6 3,2 87,1 12,9 67,7 6,5 19,3
6,5 69,4 30,6 4,8 51,6 43,5 Nhom tuoi thudng gap nhat la tir 21-30 eo 15 BN chiem 24,2%. Ty Ie nam gidi cd MTNMC eao hdn ntj", nam gidl ehlem t i le 8 7 , 1 % . Tai nan giao thong chiem ti le 67,7%, Tai nan lao dfing va nga eao chiem 6,5%. Ty le BN du'dc sd cihj trudc khi chuyen vao vien ehiem 69,4% (43 BN).
Nhom GCS td 13-15 diem ehiem t l le 43,2%.
Nhom GCS < 8 diem diem chiem ti le 4,8%.
Bang 2. Kei qua phau Ket qua phau thuat Cac ton thu'dng phoi
tiiuat dieu tii mau tu NMC Co
So lu'dng ( n ) 14
Ty |g o/o 22,5 1
TAP CHl Y HOC VIET NAM TAP 464 - T H A N G 3 - SO 1 - 2016
hdp Ket qua khi ra vi$n
(theo thang diS'iin GOS)
Bien chij'n^va di ehufng sau phau thuat
Sau kiii phau thuat, phar
Khonq Hoi phuc hoan toan Di cfiLrng than Itinii nhe Di ctiu^q than kinii nanq Dcfi sonq tiiu'c vat
J\l vong Viem mang nao
Suy tiid Niiiem kiiuan vet mo
Donq kinh Sup mi Uet nu'a nqu'cii Roi ioan ngon ngi?
Roi loan tam tiian
48 12 32 15 3 0 3 3 15 1 0 8 2 3
77,5 19,4 51,6 24,2 4,8 0 4,8 4,8 24,2 1,6
0 12,9 4,3 4,8 Idn BN da du'dc cu'u song vdi mu'c do iioi piiuc la iioan toan iioac la chi mang cac di chirtig nhe la 44 BN chiem 7 1 % . Dii khong ed tru'dng hdp nao tir vong song van^con 03 BN bi rdi vao tinh trarw sdng thu'c vat. Bien chdng phd bien nhat ma BN gap trong thdi gian nam vien la nhiem triing vet rno (15 BN, 24,2%). Liet nira ngu'di (8BN, 12,9%) roi loan ngdn ngd (2BN, 4,3%), tinh trang suy ho hap, viem mang nao va rdi loan tam than gap d 3 BN chiem 4,8%.
Bang 3: Cac yiu to anh hddng den kei qua phau thuat Yeu to l i i n quan
Lien quan ket qua va tri giac theo GOS
Lien guan ket qua vdi miJc do de day du'dng giu'a tiieo GOS Lien quan ket qua sau mo vdi
khoi IUdng mau tu
< 8 9 - 1 2 1 3 - 1 5
< 5 mm 5 - 10 mm
> 10 mm
< 50 c m ' 51 - 1 0 0 cm'
> 100 cm'
I + 11 1(33,3%) 18(56,3%) 25(92,6%) 30(85,7%) 7(46,7%) 7(58,3%) 11(73,3%) 31(77,5%) 2(28,6%)
I I I + I V 2(66,7%) 14(43,8%) 2(7,4%) 5(14,3%) 8(53,3%) 5(41,7%) 4(26,7%) 9(22,5%) 5(71,4%)
Tong 3 32 27 35 15 12 15 40 7
Odi vdi GCS < 8 diem ket qua sau mo do I+II
(33,3%), dp III+IV (66,7%).
Doi vdi 9 -12 diem ket qua sau mo do I+II (56,3%), dp III+IV (43,8%).
Ddi vdi 13 -15 diem ket qua sau mo do I+II (92,6%), dp III+IV (7,4%).
Trong 35 BN co mire de day du'dng giu'a nhe, chi CO 5 BN, ehiem 14,3% bi cac di chirng than kinh vira va nang (GOS=Ili, IV), ty le nay d nhdm co de day du'dng giu'a d mdc trung binh va nang lan Iddt la 53,3% va 41,7%.
Khdi mau tu Idn >100 cm^ thi ty le BN cd GOS a mdc I I I va IV la rat eao. Co 5BN (71,4%) cd khdi mau tu tir >100 cm cd GOS d mdc I I I va IV, trong khi do ty le nay chi la 26,7% (4BN) ddi vdi nhom CO the tich khoi mau tu <50 c m ^ IV. BAN LUie^N
Nhom tuoi thddng gap TMNMC nhat ia tir 2 1 - 30 tudi vdi 15BN chiem 24,2%. Khi nhin nhan them dac diem ve gidi eo t h ^ thay ngay rang gidi tinh nam cd tan suat xuat hien Idn hdn han nu'.
Mau tu ngoai mang cirng d nam gidi la 54/62
chiem 8 7 , 1 % , d nd gid 8/62 chiem 12,9%. Dieu nay co the du'dc ly giai bdi nguyen nhan chinh gay TMNMC ia do chan thu'dng, va chan thu'dng CO xu hu'dng xay ra d nam gidi nhieu hdn nu' gidi do hp thu'dng tham gia cac hoat dpng co mire dp nguy cd cao hdn va tudi thu'dng gap tai nan thupc cac nhom tuoi iao dpng ehinh va sir dung phu'dng tien giao thong nhieu nhat. Trong 62 benh nhan tham gia nghien cdu, co den 42 BN bi Tl^JGT, chiem den 67,7%, tiep sau do la TNSH 12 BN chiem 19,3% va mot sd nguyen nhan khac.
Cd 43/62 BN du'dc sd ciru d tuyen tru'dc khi chuyen vao benh vien, cho thay mot io hong khac trong xir ly tai nan ddi vdi nhDTig tru'dng hdp ehan thu'dng. Dieu nay ed the anh hu'dng nliat dmh den chat lu'dng dieu tri eho BN. Phan Idn benh nhan du'dc d u ^ vao Benh vien trong khoang thdi gian it hdn 2 gid (30BN, 48,4%), va trong khoang tir 2-6 gid (19BN, 30,6%). Day la mpt dieu kha tdt bdi viec sdm tiep can vdi ed sd dieu tri se mang lai nhieu ed hpi sdng sot va hoi phyc cho nan nhan. Ve can ban phan idn BN co mii'c dp hdi phuc kha sau phau thuat. Ngay tai
VIETNAM MEDICAL JOURNAL N°1 - MARCH - 2018 thdi diem ra vien, cd 12BN (19,4%) hoi phuc
hoan toan, 32BN (51,6%) cdn di chirtig than kinh nhe. Dieu nay khang dinh hieu qua rat Idn eiia phu'dng phap phau thuat ddi vdi TMNMC.
Tuy nhien van eon 15BN (24,2%) eon di chu'ng than kinh nang va 3BN (4,8%) phai ra vien trong tinh trang sdng thu'c vat. Ve eae bien chirtig gap phai sau khi phau thuat, nhom bien chiTng lien quan den nhilm triing co 18BN chiem 29%, trong do nhiem triing vet md la 15BN va viem mang nao la 3BN. Day la dieu eo the giai thieh du'dc bdi khi bj chan thu'dng, tinh trang ton thu'dng tai dau de dang bj nhiem ban kem vdi viec chi co 43BN (69,4%) benh nhan du'dc sd cirtj, ddng thdi eo den 13BN (20,9%) BN du'dc dda vao vien sau 6 gid khien viee dam bao vo khuan eho BN gap nhieu khd khan. Viec con tdn tai nhieu di chirng cung cap them bang chu'ng ve viec dii phau thuat eo the cirtj du'dc mot ty le Idn BN bj TMNMC nhu'ng viec phong ngda tai nan van CO vai tro chu dao, dong thdi Uep tuc md rong nghien eiru nham nang cao hieu qua phau thuat ia rat quan trong. Cac BN co tri giac xau luc vao CO xu hu'dng dat diem GOS cao, tiic ket qua kem hdn. Cac BN vao vien trong tinh trang hon me hoac diem Glasgow du'di 12 diem eo ty le b| sdng thu'c vat va con nhieu di ehudg than kinh nang tai thdi diem xuat vien la 16/35BN (chiem 45,7%). Trong khi do ehi ro 2/27BN (ehiem 7,4%) ed diem Glasgow/ tir 13-15 diem eon di ehirng than kinh nang luc ra vien. Dieu nay mpt lan nu'a khang djnh lai rang danh gia mire dp nguy cd bang diem Glasgow trong phau thuat than kinh noi chung va trong phau thuat MTNMC CO y nghTa vo eung quan trpng. Mire do de day du'dng giu^ thu'dng lien quan den kich thu'dc ciia khdi mau tu va do do ed lien quan chat che vdi ket qua sau md. Trong 62BN dddc phau thuat d nghien cdu nay neu mire dp de day nhe <5mm thi cht eo 5/35BN (14,3%) eo ket qua lue ra vien la cdn di chu'ng than kinh nang, trong khi do ty le BN eo ket qua xau va song thiTe vat d nhom ed de day 5mm trd len ia 13/27BN (48,1%). The tieh khdi mau tu tren hinh anh CLVT dddl 50 cm^ cd the la dau hieu khien tien lu'dng phau thuat tdt hdn han so vdi nhom co khdi lu'dng idn hdn. Co 4/15BN (26,7%) BN ed ket qua phlu thuat nhu'ng khong cd BN nao t d vong, trong khi do neu khdi lu'dng nay ia 51-100 em^ thi CO 9/40BN (22,5%) cd ket qua phue hoi cham va ty le nay d nhom co khdi mau tu
>100cm^ la 71,4% (5/9BN). Ket qua eho thay
mpt xu hu'dng tu'dng ddi rd rang rang neu khdi lu'dng mau tu Idn thu'dng kem theo mot tien lu'dng xau hdn ddi vdi phau thuat va khi khdi lu'dng mau tu la tir 100 cm^ trd len mdc dp xau trd nen rd rang hdn.
V. KET LUAN
Phau thuat mang iai nhUng hieu qua tii'e thi rat dang khieh ie, song can phai thdc hien theo doi lau dai hdn doi vdi benh nhan b[ mau tu ngoai mang cdng da du'dc p h i u thuat bcfi eae theo doi tiep tuc trong dai han cho thay eac di chdng than kinh tiep tuc phat sinh trong khoang thdi gian sau khi benh nhan ra vien. Khi tiep nhan benh nhan nghi eo khdi mau tu ngoai mang cirng thi can theo doi rat sat, bat cd khi nao co bang ehirng ve viec khdi mau tu ngoai mang eirtig idn nhii gay de day du'dng glQ^ va co dau hieu ciia tri giac xau dan thi can thy'c hien phlu thuat dieu t n sdm, cang de muon thi hieu qua dieu tri hoi piiuc eham.
LCn CAM ON
Toi xin ehan thanh cam dn Dang Uy, Ban giam ddc Benh vien Da khoa tinh Bae Giang, Khoa Ngoai Than Kinh-Sp Nao, Phong Ke hoaeh tong hdp va eae khoa phong Benh vien Da klioa tinh Bae Giang da tao dieu kien tdt nhat cho toi thu'c hien nghien cirtJ.
TAI L l | U T H A M KHAO
1. Jacobson, W. H. (1886), "A Case of Supra-pubic Lithotomy, with Remarks on the Operation'; Med Chlr Trans. 69, pp. 377-83.
z. Langlois, Jean A, Rutland-Brown, Wesley, and Thomas, Karen E (2006), 'Traumatic brain injury in the United States; emergency department visits, hospitalizations, and deaths".
3. Markogiannakis, Haridimos, et al. (2006),
"Motor vehicle trauma: analysis of injury pnDfiles by road-user category" Emergency medidne journal.
23(1), pp. 27-31.
-t. Ddng Van He, Vu Ngpc Tu (2010), "Lam sang, hinh anh chup cat Idp vi tinh chan thu'dng so nao nang'; Tap chi Y hoc thut hinh. 709 (So 3/2010), tr.47-15d.
5. Balik, V., et al. (2010), "Posterior fossa extradural haematomas'; Cent Eur Neurosurg.
71(4), pp. 167-72.
6. Carlson, A. P., et al. (2010), "Low rate of delayed deterioration requiring surgical treatment m patients transferred to a tertiary care center for mild traumatic brain injury", Neurosurg ficus.
29(5), p. E3.
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