TAP CHi Y HC3C VigT KAM TAP 451 - THANG 2 - SO 2 • 2017 Al LigU T H A M KHAO
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k Tran Thj trieu Nhien ( 2 0 0 6 ) , Vnh trang viem nha chu cua benh nhan tieu du'dng type 2 tai
benh vien Trung l/dng Hue, Luan van Thac sJ Y hoc, Oai hoc Y Du'dc thanh pho Ho Cht Minh.
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MirC DO SUY GIAM CHITC NANG THAN KINH THEO THANG DIEM NIHSS C C A BENH NHAN NHOI M A U NAO
TAI BfeNH VIEN LAO KHOA TRUNG U'O'NG
rdwiTAT
Myc tieu: Tim hieu m6t so dac diem va yeu to len quan cCia thang diem NIHSS t r i n benh nhan nhoi nau nao t?i Benh vi?n Lao khoa Trung U'dng.
Phu'dng phap: nghien di\i mo ^ cat ngang tren 60 aenh nhan nhoi mau nao^gom 31 nam, 29 nu". Su"
Jung tJiang diem NIHSS de danh gia benh nhan. Ket qiia: diem NIHSS trung binh la 6,9±4,74, ty le benh nhan suy giam mu'c do nhe la 75%, vCte la 13,3% va nang \h, 11,7%. Suy gilm chiit nSng van dpng tay gap S 86,7%, suy giam chii'c nang van dpng chan gap 6 B5% so benh nhan. Ty le benh nhan suy giam n|ng tSng dan 6ieo tuoi. Oiem NIHSS trung binh cua nam cao hdn niJ (7,1±4,89 so vdi 6,7±4,65).
Td Idioa: nhoi mau nao, thang diem NIHSS, suy giam diiitnSng than Mnh, Beih wen Lao khoa Trung U'dng.
S U M M M A R Y
EVALUATE THE NEUROLOGICAL FUNCTION I M P A I R M E N T BY N I H S S I N CEREBRAL
INFARCTION PATIENT AT NATIONAL GERIATRIC HOSPITAL Objective: To describe some characteristics and related factors of NIHSS in inlarction patients at the National Geriatric Hospital. Methods: Cross-secdonal descriptive study was conducted dn 60 patients, 31 male, 29 female, who had been diagnosed with cerebral infarction. Using the NIHSS to evaluate the neurological function impairment. Results: This study showed that: The mean NIHSS score is
*QfihgeYHaNgi
Chju tr^ch nhiem chinh: Nguyen Thanh Binh
&nail: [email protected] Ngay nhan bai: 20.11.2016 Ngay phan bien khoa hpc: 9.11.2016 Ngay duyet b^i: 23.01.2017
Nguyin Thanh Binh*, Pham Thi Binh*
6,9±4,74, the rate of mild impairment was 75%, moderate 13,3 and severe 11,7%. I^otor function deficit in upper limb was 86,7%, lower limb 85%. The rate of severe impairment inaeased by age, mean NIHSS score was higher in male than female.
Keywords: cerebral infarction, NIHSS scale, tfie neurological function impairment, National Geriatric Hospital.
L O A T V A N D E
Tren the gio^ co nhieu thang diem du'dc stf dung de danh gia mii'c do suy giam c h i i t nang than kinh cua benh nhan nhQi mau nao. Ngay nay thang diem NIHSS du'dc su" dung nhieu nhat, Thang diem NIHSS (National Institutes of Health Stroke Scale) do Vien nghien cifu sii'c khoe dot quy xay di/ng [1,2]. TTiay thuoc chi can 5-10 phiit dil de danh gia cac chi so cd ban cua benh nhan. Ket qua thang diem NIHSS gop phan danh gia du'dc mii'c dp nang, kha nang hoi phuc trdn Ism sang, chl djnh sif dung tieu sc^ h u y ^ cung nhu" viec lap ke hoach phuc hoi chiifc nang sdm cho benh nhan [1,3,4]. Chinh vi nhiJng li do do, chiing toi da tien hanh nghien culi^Mu'c do suy giam chii'c nang than kinh theo thang diem NIHSS cua benh nhan nhoi mau nao tai Benh vien Lao khoa Trung Lfdng" vcfi muc tieu tiim hieu cac dac diem va yeu to lien quan cua thang diem NIHSSJ:ren nhom benh nhan tai bien mach mau nao the nhoi mau nao.
11. OOI n r O N G VA P H U ' C T N G P H A P NGHIEN CUXJ 1.\. Ooi tu'tfng nghien cu'u: Benh nhan td 50 tuoi t r d len, du'dc chan doan tai bien mach mau nao theo tieu chuan cua To chii'c y te the gidi, xac djnh nhoi mau nao dsia vao hinh anh
VIETNAM MEDJCAL JOURNAL WZ • FEBRUARY • 2017
tren phim chup cat Idp vi tinh hoac cong hUcfng
tLrsonac.
2.2. Phu'dng phap nghiSn cij'u: Nghien CUU mo ta cat ngang tren 60 benh nhan dieu tri tai Khoa Tam Than l(inh, BSnh vien Lao l<hoa
Trung LTcJng trong thdi gian tir thang 12 n 2015 den thang 3 nam 2016. Benh nhan tfi itham iam sang noi i<hoa va than itinh, danh thang diem NIHSS va i<et qua can iam sang tt benh an danh rieng cho nghien cu'u.
III.KfT QUA NGHIEN CU'U
Nghien cijti thUc hien tren 60 benh nhan, gom 31 benh nhan nam va 29 benh nhan nif, tuoi tru binh ia 72,4*11,22.
3.1.Phan bS benh nhan theo diem NIHSS , Bang 3.1: Phan bo benh nhan theo diSm NIHSS.
eiem NIHSS" sa lu'dng B T T Ty le (%) (N=601 TB Suv qiam nhe (0-9 diem )
Suv qiam yUa( 10-14 diem) Suy qiarri nanq (15-20 diem Suv qiam rat nanq (Tren 20 diem)~
45 75
13,3
11,7 6,9±4,74
Nhan xet: ly ie benh nhan giam dan theo mu'c dp nang cua suy giam chii'c nang than idnhi^
benh nhan co suy giam nhe chiem t/ le cao nhat ia 75%.
3.2. Mu'c do thu'dng gap cua ton thi/dng cac chu'e nang than kinh theo thang diem NIHSS Bang 32: MuC do thudng gap cda tSn thudng cac chd'c nang than idnh tlKO ttiang diem fiHI^S.
Cftiic nSng th^n i<inh ton thu'dng Chu'e nanq van donq tay Chtrc nanq van donq chan
CU donq .cua mat Nqon ngii' Cam qiac Phan tan hoac thd d
Y thirc Cau hdi dinh hu'dnq
Bap LTnq vdi lenh Phat am That dieu chi Ouy tu hai mat vao vat
Thi tru'dng
So lu'dng BN 52 51 27 26 19 16 13 12 11 10 3 2 1
Ty IS (°/o) (N=60) 86,7 J
85 - ^ 45
43,3 31,7 26,7 21,7 20 18,3 16,7 5 3,3
1,7 J flihan xSt: Chdc nang than kinh hay bj suy giam nhat la chii'c nang van dpng tay (86,67%)^^
chii'c nang van dong chan (85%), it bi suy giam nhat la ton thu'dng thi tru'dng (1,67%) va quy tui
mat (3,33%), that dieu chl (5%). ' '_
I Suy giSm viia » Suy giam n^ng
• * " ^ ^ ^ » ^ w ^^•TT™^ ^ B M i ^ ^
Bleu dS 3.1: Phan bddiSm NIHSS theo nhdm tudi ciia benh nhan.
NhSnxetiT)/ le benh nhan suy giam nhe cao nhat d nhom < 60 tuoi (92,3%). Ty ie benh nh suy giam nang tang dan theo tuoi. Su ichac biet nay i<h6ng co y nghla thong ke (p=0,616>a,b5).l
Bang 3.3: Phan bo diem NIHSS theo qidi tinh bSnh nhSn. M Diem NIHSS
Suv qiam nhe Suy qiam yUa Suy qiam nanq
ry ie (%)
J2A
SL BN 16,1
TV le (%)
( N = 2 9 )72,4 20,7
6,9TSng so Jig^
45
^?^^-,5f^'^'','? J l " " !?'^^" suy giam nlie va ty le benh nhan suy giam nang d narri deu cao'lgi
nu; 77,4% va 72,4%, 16,1% va 6,9%. SU khac biet nay khong cd y nghia thong ke (p=0,181>(),l
TAP CHl Y HQC VIET HAM T^P 451 - THANG 2 - SO 2 - 2017 IV. BAN LUAN
4 . 1 . Phan bS benh nhan theo diem NIHSS Nghien cdu cho thay: diem NIHSS trung binh la 6,9±4,74, ty le benh nhan giam dan theo mdc do nang suy giam chii'c nang than kinh, cu the suy giam chu'e n§ng than kinh nhe,vLfe va nang lan lu'dt la 7 5 % , 13,3% va 11,7%. Khong'co b|nh nhan nao bj suy giam chu'e nang than kinh mii'c dp rat nang.
Nghien cuij cua Nguyen Minh Hien va cong su"
tren 119 benh rihan NMN ban cau dai riao tai Benh vien Quari doi 103 cung thay rang suy giam cang nang;thl t y Ie benh nhan cang thap:
suy giam mu'c d6 nhe la 57,9%, mu'c dp vij:a la 3 1 , 1 % , mu'c dp nang la 9,2%, mii'c dp rat nang la 1,7% [ 3 ] . rjghien cu'u ciia Tran t h j Thanh tren 55 benh nhan nhoi mau nao mdi vao vien thi benh nhan co mdc diem NIHSS 5-15 chiem ty le cao nhat la 52,7%, nhdm co diem NIHSS 16- 21^ chiem 25,5%, nhom co diem NIHSS trgn 2 1 diern^hiem 14,5%, thap nhat la nhom co diem NiHSi 1-4 diem chiem 7,3% [ 4 ] ,
4.2.2. Mili'c do thu'dng gap t 6 n thu'tfng cua cac chu'e nang t h a n kinh t h e o thang diem NIHSS
Nghien ciili ciia chiing toi cho thay chii'c nang van dpng chi tren va chii'c nang van dpng chi du'di la chii'c nang tJian kinh thu'dng bi ton thu'dng nhieu nhat; thj tru'dng, quy tu hai mat va thang bang-phoi hdp dpng tac la chii'c nang than kinh k khi b| ton thu'dng nhat.
Ket qua cCia chiing toi phu hdp vdi nhieu nghien cult ve dac diem lam sang cua benh nhan NMN cua cac tac gia trong va ngoai nUdc.
Nghien cdu cua Pham Thi Kim Dung va cong su*
tren 133 benh nhan NMN tren leu dieu trj tai B^nh vien Oa khoa Trung Lfdng Thai Nguyen cho thay cac trieu chu'ng lam sang hay gap trong glai doan toan phat la liet nu'a ngu'di (94,7%), roi loan ngon ngu" (51,2%) va roi loan cam giac (30,1%) [ 5 ] . Nghien cu'u ciia Nguyen ehu'dng va cong sd thi ty le iiet nda ngddi la 100%, roi loan y thirc 32,7%, roi loan tam than khac nhu" thd d , chSm chap, phan u'ng cham vdi cac kich thich, roi loan cam xuc..la 2 9 % , that ngon la 35,5%
[6], Mpt nghien cu'u khac vdi quy m6 Idn cua Thomas Heinsius va cong sd thay t y le Iiet van dpng la 99%, roi loan cam giac la 9 2 % , rSi loan y thifc ta 58%, 5 5 % co that ngon, trong do co 9 1 % la that ngon hoan toan [ 7 ] .
4.2.3. Phan bo diem N I H S S theo nhom tuoi v^ gidi
Trong nghien cu'u nay nhom tuoi 61-70 co diem NIHSS cao nhat roi giam dan ve hai cdc. Ty
Ie benh nhan suy giam nhe cao nhat d nhom <
60 tupi con ty le benh nhan suy giam nang thi tang dan tiieo dp tuoi. Tu'dng quan gid^ tuoi benh nhan va cac yeu t o nguy cd ciia tai bien mach mau nao da du'dc chifng minh [ 1 , 2 ] . Hdn nda tuoi cang cao thi the trang, kha nang thich irtip va hoi phuc cang kem. Ket qua cho thay diem NIHSS trung binh cua nam cao hdn nQ'. Ty le benh nhan suy giam nhe va ty le benh nhan suy giam nang d nam deu cao hdn d nu*. Theo chiing toi, co le do nam gidi cd nhieu yeu to nguy cd hdn han nff gidi vi vay tDn thu'dng nhoi mau nao d nam gidi hay gap va nang ne hdn, V. KET LUAN
Thang diem NIHSS la mot thang diem ddn gian, thuan tien su" dung trong lam sang than kinh, Di/a vao ket qua thang diem NIHSS giup cho bac sy danh gia va theo doi du'dc tinh trang benh nhan, tir do du'a ra cac bien phap can thiep hdp ly. Nen sir dung thang diem NIHSS thu'dng qui trong danh gia miTc dp suy giam c h u t nang than kinh cac benh nhan nhoi mau nao trong thdc hanh lam sang hang ngay.
TAI LIEU T H A M KHAO
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3. Nguyen Minh Hi^n, D|ng Phuc Du'c va Hoang Cao Xa ( 2 0 1 5 ) , Danh gia edng tae dieu du&ng benh nhin 6gt quy nhdi mau nao diiu tii tieu huyet khdi tai Binh viin 103, Tap chf Y du'dc hoc quan sir so 3-20i5,95-102.
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