MOT SO YEU TO LIEN QUAN DEN BENH ME DAY TAI BENH VIEN DA LlIu CAN THO NAM 2009
TOM T A T
Dwa tren quan sit 158 b$nh nhan may day t^i Benh V/pn Da Lieu Can Tha, chiem ti le 8,6 %, tren tong so benh da trong nam 2009, cd mpt so van di dwac ghi nhin:
Nhirng benh nhan miy day thwong de nhin thay d nir (54%), vi chiem ti Id mac b$nh cao nhat trong so nhirng b$nh nhan cd dp tuoi dwdi 10 (72,2 %>).
89,9 % khdng phit hien co benh di img di kem va 10,1% benh nhan cd mdt so b$nh di img kem theo nhw:
Cham, hen suyen, va viem mui di img.
Benh xay ra pho bien tw thing 4 den thing 6 (38%,) va cd 95,6% b$nh nhin khdng tim thay cac yeu to di img nghi ngd.
. Cd 94,6% benh nhan may day mac benh tir 2 lan trd len khdng dap img vdi dieu tn thdng thwdng.
Tir khda: b$nh nhan may day SUMMARY
SOME RELATIVE FACTORS TO URTICARIA PATIENTS AT CAN THO HOSPITAL OF DERMATO - VENEREOLOGY IN 2009
According to the observation of 158 patients of urticaria seen at Can Tho hospital of dermato - venereology, of the 8,6 percent of the patients who had skin diseases in 2009. There are several noticeable problems.
The patients who have urticaria follow specific trends, prevalence in women (54 percent), and the highest incidence rate is in those who are under the age of 10 (72,2 percent).
There were 89,9 percent of patients without other allergic diseases, with 10,1 percent of patients having some allergic diseases such as eczema, asthma and allergic rhinitis.
The disease occurs most frequently from April to June (38 percent), and no suspect allergic factor was found in 95,6 percent of patients. There were 94,6 percent of patients suffering from a second or third occurrence of urticaria with no response to common treatment.
Keywords: patients of urticaria OAT V A N D £
M l day IS mpt bpnh ngoSi da khS phd biln, ggp d mpi lUa tudi. Bpnh rat de tai di tSi Igi do nguyen nhan phue tap va thu'dng khong du'pe phSt hipn ro rang. Chinh vi thi, vipe dilu trj thu'dng chi mang lgi kit qug tgm thoi, khong hing djnh. Trong thyc te, mpt sd bpnh nhan co lien quan din tinh trgng nhiem ky sinh tnjng duong rupt, dj ung vol thudc, thdi tilt,...Thiy thudc co the dya vSo eSc yeu td tren de dua ra eSc bipn phSp dilu tri vS phong ngUa thich hpp. Nhu'ng trong thyc t l , kit qua mang lgi vin khong dupc nhir mong mudn. Cd the con rit nhieu eSc yeu td khSe, tu nhirng thgy ddi v l mgt chuyen hda ben trong da ISm cho ca thi trong tinh trgng d l man cam.
KHlAl BACH X U Y § ' N - Benh Vien Da Lieu Can tha HUYNH V A N B A - Trutfng DHYD Cin Tho
va nhirng ylu td tSe dpng tU ben ngoSi, dupc xem nhu' la eSc dj ung nguyen, cd kha nang gay nen tinh trgng dj Ung ddi vol eo thi. Cac dgc dilm ve khi hgu, thai tilt, moi trirang lao dpng sinh hogt, hay nhUng thdi quen trong an udng rit co t h i IS nhirng ylu td dSng dirpc quan tam trong sy hinh thSnh eSc bpnh ly co lien quan den ngudn gde dj ung noi chung vS benh m l day noi rieng. Chinh vi thi, vipe tim hilu mpt sd ylu td lien quan din bpnh me day tgi Bpnh Vien Da Lilu Can Tha IS that sy cin thilt, nhim tim ra nhirng dgc dilm cd lien quan, giiip hinh thSnh mpt sd gia thuyet cd y nghTa tich eye trong vipe phong trj bpnh m l day hipn nay.
De tai nham muc tieu
- Xac djnh ti Ip bpnh me day nim vipn tgi Bpnh Vipn Da Lilu Cin Tha
- Mo ta mpt sd yeu td lien quan den bpnh me day T6NG QUAN
Ti Ip mie mSy day, phii Quincke IS 6,42%. Trong do, nguyen nhan gay nen bao gdm: Thgy ddi thai tilt 73,5%, thUe Sn 5,8%, long siic vgt 6,1%, thudc 2,7%, hoa my phim 13,6%, con trimg ddt 30,4%, khong rd nguyen nhSn 14,1% [ 2 ].C6 din 15- 23% dSn sd da tung bj may day trong doi sdng, mSy day man tinh ehilm 25% trong sd mSy day, chung da ve noi eo ngudn gde vgt ly ehilm ti Ip 4,2% dan sd. MSy day mgn tinh ty phSt co can nguyen khong ro, ehilm tl Ip 80-90%, thu'dng ggp d lira tudi tu 20- 50, nir nhilu ban nam [1]. MSy day co the xay ra d mpi lua tudi, cd den 20% dan sd ed it nhit mpt lin mac mSy day trong dai sdng cua hp. May day mgn tinh keo dSi tren 6 tuin, ehilm ti Ip tu 5% den 20%
tru'dng hpp [4]. Bpnh mSy day ehilm tl Ip 15- 20% d nguoi trudng thanh, thirong ggp nhilu d nU. Trong mpt nghien cuu 554 bpnh nhan d lUa tudi tru'dng thanh eo 50% bpnh nhSn vua cd mSy day vS phii mgch, trong do ed 10% phii mgch don thuin, 40% may day don thuan.
Cae tdn thu'ang bien mit trong vong 1 nam, nhung co din 20% tilp tyc diln tiln tren 20 nam. O tre con, may day khong kem phii mgch ed tinh phd bien ehilm ti I?
80%, vUa mSy day vua phii mach ehilm ti Ip 10%, phii mgch dan thuin 5%. C6 khoang 50% mSy day co dien tien tren 1 nam. Co it nhit 70% trudng hpp mSy day man tinh khong tim dupc nguyen nhan [3]
Ti Ip bpnh mSy day tgi Bpnh Vipn Da Lieu Cin Tho:
Nam 2006 (4,53%), nam 2007 (9%), nam 2008 (8%), nam 2009 (8,6%). Bpnh thu'dng ggp tu thSng 4 den thSng 9.
D 6 I TU'O'NG, PHLPONG P H A P N G H I E N CLCU
1. D6i tirp'ng nghien cii'u
Cac bpnh nhan mSy day nam vipn tgi Bpnh Vipn Da Lilu TP. Cin Tha trong nam 2009.
2. Phu'ang phap nghien cu'u
2.1. Thilt ke nghien ciru: Cat ngang mo ta hdi cuu 2.2. Ca m i u nghien ciru: Tit ca eSc bpnh nhan mSy day nim vipn trong nam 2009
44 Y HOC THVC HANH (729) - SO 8/2010
2.3. Phu'ang phap XCP ly vS phan tich s6 lipu P h i n mem SPSS 16.0
NhUng so thdng ke c i n tinh IS t i n sd va ti Ip % eSc dgc tinh cua m i u nghien cuu, mdi lien quan vS muc dp lien quan giira nhUng nhom bien sd djnh tinh dupc xSc djnh bang phep k i l m y^ a mire y nghTa 0,05; ti sd sd chenh OR vS khoang tin eay 95% cua OR (eho nhUng bien sd nhi gia)
K^TQUA Bang 1: Giai
G\(/\
NO' Nam Tong
T i n so 86 72 158
Tl 1$ % 54,4 45,6 100 Nh§n xet Nir ehiem ti Ip uu the (54,4%), trong khi nam (45,6%)
Bang 2: Lua tudi Lira tuoi
<10 10-18 19-24
>25 Tong
Tan so 114
10 11 23 158
Ti le % 72,2
6,2 7 14,6 100 Nhin xet Du'di 10 tuoi IS lua tuoi thu'dng ggp trong nghien cUu (72,2%)
Bang 3: Noi d Noi a ThSnh thi N6ng thon
Tong
'S
Tin s6 38 120 158
TI 1$ % 24 76 100 Nhin xet Ti Ip bpnh nhan song d nong thon chiem U'U t h i (76%)
Bang 4: Sd l i n m i c bpnh So lin mic b$nh
L i n l
> 2 l a n Tdng
T^n s6 65 93 158
TI 1$ % 40,9 59,1 100 Nh$n xet Cd 5 9 , 1 % bpnh nhan mSe bpnh > 2 lan, trong khi c6 40,9% bpnh nhSn mac bpnh l i n d i u
Bang 5: Bpnh ly dj Ung kem theo B$nh ly dj img k6m theo
Kh6ng C6 Tong
T i n s6 142
16 158
Ti Ip % 89,9 10,1 100 Nhin xet Co 89,9% bpnh nhan khong phSt hipn bpnh ly dj ung kem theo, trong khi chi e6 10,1% bpnh nhan du'pe phSt hipn mpt sd bpnh ly di Ung kem theo nhu': ehSm, hen, viem mui dj Ung
Bang 6: Thdi diem m i c bpnh trong nam ThSng trong nSm
1-3 4-6 7-9 10-12 Tdng
T i n s d 34 60 36 28 158
TI le % 21,5
38 22,8 17,7 100 Nh$n xet T u thSng 4 - 6 IS khoang thdi gian bpnh thu'dng ggp (38%)
Bgng 7: Y l u td dj uncj nghi ngo Yeu to dj irng
Khong C6 Tdng
Tan s6 151 158
TI l9 % 95,6
4,4 100
Nhin xit P h i n Ion bpnh nhSn khong phSt hipn dupc y l u td dj ung nghi nga (95,6%)
Bang 8: T i l n can d| Ung Tien can dj irng
Khong C6 Tong
Tan so 76 82 158
TI le % 47,8 52,2 100 Nh$n xet Co 52,2% bpnh nhan dupc phSt hipn co t i l n can dj Ung vS 47,8% bpnh nhSn khong eo t i l n can dj ung
Bang 9: DSp Ung vdi dieu trj khSng dj Ung thong thirong
Dip Ung vol dieu trj Khong
C6 Tong
T i n so 90 60 158
TI le % 60 40 100 Nhin xet Chi cd 40% bpnh nhan dSp Ung vol dieu trj vS con lgi .60% khong dSp ung voi d i l u trj khang dj ung thong thudng
Bang 10: S y lien quan giira sd l i n mac bpnh vS tien can dj ung (n = 158)
So lan m i c b§nh L4n dau
2 2lSn
Tong
Tien e§n di Ung Khong
57 (75%) 19 (25%) 76 (100%)
C6 8 (9,8%)
74 (90,2%)
82 (100%)
Tong 65 (41,1%)
93 (58,9%)
158 (100%)
P <
0,01
Nhin xet Co 90,2% bpnh nhan mSy day eo tien can dj ung mac bpnh > 2 l i n , eao ban eo y nghTa thdng ke so vdi 25% bpnh nhan khong ed tien can di ung m i c bpnh > 2 l i n ( P < 0 , 0 1 )
Bang 11: S y lien quan giUa sd l i n mac bpnh vS dSp Ung dieu trj (n = 158)
DSp LPng dieu tri Kh6ng C6 Tdng
So l i n maeb§nh Lan dau
2 (3,5%) 55 (96,5%)
57 (100%)
> 2 l a n 88 (94,6%)
5 (5,4%)
93 (100%)
Tong 90 (60%) 60 (40%) 150 (100%)
P <
0,01
Nhin xet Co 94,6% bpnh nhSn mSy day mSc bpnh i 2 l i n , khdng dSp Ung voi dieu trj thong thirong, eao hon ed y nghTa thdng ke so voi 3,5% bpnh nhSn mac bpnh l i n d i u ( P < 0,01)
BAN LUAN
Trong 158 trudng hpp nghien cuu, tl Ip bpnh mSy day tren tdng sd bpnh da 1921 (8,6%), tuong t y vdi mpt sd ghi nhgn tru'dc day eua Phan Van DoSn, Nguyin Van Dinh trong nghien cuu tinh hinh m i c bpnh mSy day, phii Quincke trong cpng ddng dSn cu' Ha Npi nam 2008 (6,42%) [2], nU ehilm tl Ip uu t h i (54%), phu hpp vai ghi nhgn cua l^itzpatrick [1], [3].
Du'di 10 tudi IS lua tudi thu'dng ggp trong nghien cUu (72,2%). Tu'ong t y vdi mpt sd ghi nhgn khac: Cl tre con, mSy dey khong kem phu mgch co tinh phd b i l n (80%) [3]. Trong khi theo mpt sd ghi nhgn tru'dc dSy, mSy day mgn tinh t y phSt cd can nguyen khong r5, ehilm tl Ip 80- 90%, thu'dng gap d lUa tudi 20- 50 [1]. Mpt tSi lieu khSc, bpnh mSy day ehilm tl Ip 15- 20% d ngu'oi tru'dng thSnh [3]
Y HOC THl/C HANH (729) - SO 8/2010 45
Co 59,1% bpnh nhan mie bpnh > 2 lin. Trong khi, mpt sd nghien cuu khac cho thiy mSy day mgn tinh keo dai tren 6 tuin, tai di tai Igi nhilu l i n ehiem ti le tu 5% - 20% tru'dng hpp [4]. Rit co t h i tinh trang tai di tSi Igi nhilu lin, cP lien quan din phin Ion bpnh nhSn trong nghien eUu khong phat hien du'pe ylu td dj Ung dupe nghi ngo (95,6%).
Benh thu'dng gap tU thSng 4 den thSng 6 (38%), tirong ty vdi nhQ'ng ghi nhgn trirdc day tgi Bpnh Vipn Da Lieu Cin Tho (2006, 2007, 2008): Bpnh mSy day thu'ang gap tu thang 4 din thSng 9.
K^T LUAN
TI le benh mSy day nam vien tgi Benh Vien Da Lieu c i n Tho nam 2009 la 8,6%; nU ehilm tl Ip U'U the (54%); duoi 10 tudi IS lUa tudi thu'dng gap (72,2%); tl Ip benh nhan sdng d nong thon ehilm ti Ip uu t h i (76%);e6 59,1% benh nhan mic bpnh > 2 lin.
Co 89,9% benh nhan khong phSt hipn bpnh ly dj Ung kem theo, trong khi ehi co 10,1% benh nhan du'pe phSt hien mpt sd bpnh ly dj Ung kem theo nhu": ChSm, hen, viem mui dj Ung. Tu thang 4 din thSng 6 IS khoang thdi gian benh thudng ggp (38%). Phin Ion bpnh nhan
khong phat hipn du'pe y l u td dj Ung dupc nghi n^o (95,6%); c6 52,2% bpnh nhan dupe phSt hipn cojien can dj Ung. Chi cd 40% benh nhan dap ung vol dilu trj vS con lai 60% khong dSp Ung vol dilu trj khSng dj Ung thong thu'dng. 90,2% benh nhan mSy day co tiln can dj Ung mic bpnh > 2 lin, cao ban co y nghTa thdng ke so voi 25% bpnh nhan khong co tiln can dj Ung. Cd 94,6%
bpnh nhan may day mie bpnh > 2 lin, khong dap ung vol dilu trj thong thirang, cao ban eo y nghTa thdng ke so vol 3,5% bpnh nhan mie bpnh lin dau.
T A I L I E U THAM K H A O
1. Nguyen Canh Ciu, Nguyen Khie Vien (2001).
MSy day vS phii mgch. Giio trinh benh ngoii da va hoa liiu. NhS xuit ban quan dpi nhan dan. tr.226-229
2. Phan Quang DoSn, Nguyen Van Dinh, Le Anh Tuin (2008). Tinh hinh mac bpnh mSy day, phii Quincke trong cpng ddng dSn eu Ha Npi
3. Fitzpathek's (1999). Urticaria and angioma.
Dennatology In medicine, volume 1. pp. 1409-1415 4. Thomas p. Habif (1985). Urticaria. Clinical Dermatology. Mosby. USA. pp. 86-100
TIM HIEU SO LUUC VE KIM, CHI
VA NHAN MAC DONG
G 6 ICHI TBONG
P H A UTHUAT
TRINH HONG SON, NGUYEN HAM HQI, N G U Y I N T H A I MINH
DAT VAN DE
Mpt phiu thuat vien difng trUde mpt eupe phau thuat dii md npi soi hay md md cung can phai ed nhi/ng hieu biet co ban tdi thieu ve kim, chi, ddng gdi kim chi ma minh s§ sir dung trong cupc phiu thuat.
BSi viet nay nham trinh bay sd lUPe ve kim, chi va ddng gdi ehi trong phiu thuat.
VE N H A N M A C DONG GOI CHJ
De chuan bi trUde cupc md, phiu thuat vien thudng cd ke hoach IS md phUdng phap nao, nhuTig tang thi nao trong eupe md va mdi tang thi can SLf dung loai ehi gi. Ngay nay, SLf dung chi ddng gdi da dUde diing tren toan the gidi trif mpt sd nUde ngheo.
Tren ehi ddng gdi, dii hang nao san xua't cung thudng ed eSc thdng tin ghi tren dd:
1. Ld san xuat, han diing
2. Cd chi (1-0, 2-0,3-0,4-0,... sd eSng Idn thi chi eang nhd)
3. Ten ch? ( Vicryl, Chromic gut, Dexon plus. Pain gut, Flexoerin, Ereedex, IVIaxon, Cat gut, Premio, Prolene, Safil...).
4. Thanh phan cau tao (Polyglyeolie acid, Polyglactine, Polypropylene...) ddn sdi hay da sdi (chi ben), mau sac (xanh, tfm, trang).
5. Tinh nang chi: ehi khdng tieu, chi tieu ( tieu nhanh, tieu cham)
6. Do dai chi: 90em, 0.75 m, 70cm, 67cm, 45cm...
7. Dae tfnh kim: thudng dUdc bieu hien bang hinh ve kim tren vd chi vS ky hieu qudc te: cd kim, hinh dang, cau tao dau mui kim vS thSn kim, dp dai kim.
8. Ma so chi.
9. Ky hieu chiimg chi cha't ludng, phUdng phap tiet trung
10. Ten nha san xuat chi
Tiiy nhS san xua't, nhuTig tfnh nang mdi cua chi mS ed nhOrng ky hieu khac.
Mdi goi ehi thudng ed 2 Idp bpc, boc thif 1 thUdng bang nilon ed the nhin ro Idp thif 2 ben trong, bpc thif 2 v6 triing tuyet ddi.
MOT SO DAC TINH C O A KIM P H A U THUAT Dae tinh kim phiu thuat ed 4 S la chCf cSi dau tien cua 4 tif tieng Anh: Sharp (sac de d§ xuyen qua td chife); Stay sharp (dp sac ben, lau eiin); Strong (khde); Stability(chac, kim khdng bi xoay khi khSu).
Su sac ben eiia kim phu thupc vSo ty le vudt nhpn eiia kim ( 12:1, 10:1, 8:1). Ty le vudt nhpn ciia kim cung IS mot trong nhufng yeu to de ISm giam tdn thUdng td chife. Ngoai ra each gan ket giiira ehi vS kim eung cd vai tro quan trpng.
De kim chae khde, eac hang san xuS't canh tranh nhau dua vao eSch luyen thep ISm kim, cau tao than kim, dudng kinh cua kim.
Tuy nhien de kim dUdc ben vCfng ngoai cac yeu td tren, sU hieu biet ve kim chi cua phiu thuat vien cd vai tro quan trpng, vi du tiiy tifng mui khau, td chife
46 Y HOC THVC HANH (729) - SO 8/2010
