NGHIEN Cl/U LAM SANG i.
Nghien ciili bieh doi dien tam do trong quan he tmh due d nam gidi trong do tuoi 45 - 50
*Tran Tat 0?t, *Luu Hung An, **Kieu Kim Giung 'Benh vien 19-8, Bd Cong An
" B e n h vien 105, long cue Hau can Quoi ddi
TOMTAT
N ^ e n cflu bien ddi nhip tim vi doan ST tren 100 nam gidi troi^ (]uan he tinh due bang HcJto: dien tim dd dfltfc ket qui:
Tan so tim cao nhit khi dat cnic kholi l i 141 t h i p n h i t ll 96, trung binh 118.54 ± 9 3 6 7 Thdi gian nhip tim trd ve binh thticftig sau khi dat dinh i^ln nhit 3 phut, dai nhit 20 phut,tiui^lMib 8.82 ±3.73 phut
ST chenh xuong thap nhat d kenh A -0.07 mm, chinh lin cao nhit li 030nim, mflc ehinh trung binh 0.0817 ± 0.08918 mm
s r chinh xudng thip nhat d kenh B -0.10 mm, chenh Iin cao nhit 110.30mm, mflc chenh trung binh 0.0315 ± 0.07709 mm
DAT VAN BE
WHO da dfla ra tilu chi chat Itidng cupc sdng de do mpt sd tilu chi 11:
Mflc dp sing kholi ve d i l chat gdm: Sflc khde, tinh than, an udng, ngu, nghi, di lai (giao thdng, van tai), thude men (y ti, cham sdc sflc khde).
Mflc dp sing kholi vi tim than: Yeu td tam Iy, yen td tam linh (tin ngtidng, tdn giao).
Mflc dp sang khoii ve xi hdi gpm: Cie mdi (]uan he xi hdi ke d cjuan he tinh due, Mdi trtidng sdng (bao gdm d mdi trtidng xi hdi: an toan, an ninh, Mnh te, van hda, chinh tri... vamdi trtidiig thiln nhien)
Trong quan diem nay, nghi n ^ ve sti an toan eua hoat ddng tinh dye rat phd bien d nhiiiig benh nhin vi bic si nhti nhau vl thtidng bi bd c^en trong thim kham dinh ky hole khi xuat vien. Dtide coi la mdt "dilu d m 1^" bdi hiu hit d e bic a va benh nhin, boat dpng tinh dac cudi eiingbi ky thi
va dtitfc dat sang mdt bin bdi d c chuyen gia vi khich hang oia hp. Benh nhin khdng ylu d u va d e bic a khdng tra Icri, nhti mpt thda hiep i^lm.
N g ^ l n cflu bien ddi dien tam dd trong khi quan he tinh due la mdt van d l khi mdi me vi nhay cim. Tuy nhiln nd lai rit cd gii tri ddi vdi vdi viec tti van cho benh nhin tim mach. Vi vly chiing tdi tien hanh nghiin cda nay vdi hai myc tieu:
• Nghien cda sti thay dot nhip tim v i
• Bien ddi doan ST - T tren dien tam do trong qoan h^ tinh due d nam gidi t r o i ^ do tuoi 4 5 - 5 0 .
TONG (HUN Holter dien tam do
\^ec tfaeo ddi Holter dtitfc dat ten theo tiln si Norman J. Holter (bic sy ngfldi My) - ngtidi phat minh ra tiieo ddi dien tim vao nam 1949 [9]. Lam sang sfl dingbat dau vao diu diap niln 1960.
Holter dien tim do la mdt phfltftig phip do TAPCHITIMMACH HOC\ IET NAM-SO 68.20141123
a NGHIEN CLfU LAM SANG
dien tim dd trong mdt thdi gian hin tuc va dai hing gid, hang ngay nham phit hien d e biln ddi dien tim ma vdi phticftig phip do dien tim dd binh thtidng khdng the phat hien dtide.
La mpt phflcJng phip thim do khdng ehay m i a Ngtidi deo holter cd the ve nha va vin sinh hoat, lim viec nhti binh thtidng.
Nghiin cuTu dien t i m dd trong qnan he tinh due
Nghien ctiu thflc hien tfl nhflng nam 1960 [4]
kiem tra nhiing thay ddi trong hai ehi sd (nhip tim so vdi huyet ap tam thu) trong quan he tinh dye trong hdn nhan d nam gidi khde manh vi xae dinh rang, d d e vi tri dtitfc danh gia ging sflc trong qui trinh (juan he tinh due tticAig iing vdi mtic tieu hao ning Ititfng nhe din trung binh. Cf dinh eao eua ciic khoii, nhip bm tdi da Ii 114 nhip/phut (SD 14), va huyet ip tdi da 163/81 mmHg [8]
Bohlen [ l ] giln tilp do tilu hao ning Ititfng trong bdn hinh thflc tinh dye khie nhau va tim thay mdt sfl hap thu oxy dinh 3,3 Mets; d e phtidng difle khac (ngticri php nti d phi'a tren, tti kieh thieh, va kieh thieh ddi tie) cho thay thim chi thap htfn (ttitfng ling 2,5,1,8 vl 1,7 Mets).
Hoat dpng tinh due nen dtitfc xem nhti ll bit k^ boat dpng the chat khae, chit liln quan den hogit dpng tinh due 11 mdt sti kiln hiem hoi, ehilm 0,6 Clia tat d d c trtidng htfp cua tat ea d e dot tfl [6], [7]. Da sd la nam gidi trong nhdm 60-66 tudi, va nhdi mlu ctf tim Ii nguyen nhan chinh gly tfl vong . Mau nfl la rat nhd, va cai chet da dtitfc chu yeu li do sti kiln maeh miu nao. Biy mticfl lam phan tram cfla nhiing ngtidi din ong da chet trong mdi quan h | ngoai hdn nhin, chu yeu 11 vdi gii mai dam tre (dtidi 30 tuoi). [5]
Nhin ehung, nguy ctf nhdi mau ctf tim gly ra bdi ho?t ddng tinh due eiing dtitfc cho 11 thip.
Khoing 3% sd benh nhan cd boat ddng tinh due bio d o nhdi miu ed tim d p tinh trong hai gid trtidc khi cd trieu chi&ig, nhitog ehi trong 0,9 % de trticftig hdp hoat ddng tinh due cd thi dtitfc eoi
la mdt ylu td gay ra. Nguy ctf ttitfng ddi cfla nhdi mau ctf tim xay ra trong 2 gid sau khi cjuan he tinh dye Ii 2,5, d ngticfl ed hole khdng co tien sfl benh tim. Nguy ed nay thap hcfti ding ke d nhitog ngtidi thtidng xuyen tap luyen the Itic [2] [3]
Bdi TUDNG VA PHUDNG PHAP NGHIEN COU
D6i ttitfng n^iien oahi
> 100 nam gidittinguyen tham gia n^iien Cliu
• Dp tudi tfl 45 den 50 tudi
• Khdng mac d e benh tim match . Thdi gian tien hanh 2007-2014 Phtitfng phap n^iien cflu . Md t i d t ngang va tiln cflu .Xfllysdiilu: SPSS 11.0 Phfltfng tiln
• Holter CardioTens ghi 2 kenh dien tim - Phan mem xfl IyIVlB138
KET QUA VA BAN LUAN Md ta citing.
Thdigian quan hi tihh due Thdigian
< IS phiit 15-30 30-45
>45 phut Tons; so
N 15 80 4 1 100
%
15.0 SO.O 4.0 1.0 100.0 Thdi gian quan he ehu ylu tfl 15-30 phiit, chilm 80% so nghien cda. Thdi gian quan he nhanh nhat la 12phutvallunhatla65phut.
Thdi diim quan hi tinh due I h M d i i m
Dem Ngay Tongso
N 69 31 100
%
69.0 31.0 100.0 124ITAP CHiTIM MACH HOC VIET NAM-SO 68.2014
NGHIEN CLfU LAM SANG k.
Thdi diem quan he tinh diic thfldng II ban dim, ehiem 69% so vdi 31% li ban ngay.
Md t l nhip tim, mflc chenh ST kinh A, B trong luc dat ctic khoai va khi hdi phuc nhip tim, thdi gian phyc hdi nhip tim
N H I P J N STAJN STBJN STA_END STB_END Th6i gian phyc hoi
N 100 100 100 100 100 100
Thiptihat 96 -.07 -.10 -.07 -.07 3.00
Cao nhat 141 .30 .30 .90 .50 20.00
Tning binh 118.54 .0817 .0315 .1024 .0433 8.8200
SD 9.367 .08918 .07709 .13333 .06733 3.73120 Tan sd tim khi dat cflc khoii tang tfl 25% den 120% so vdi nhip tim trung binh, dat tfl 52% din 82%
tin sd tim ly thuylt. Phfl hdp vdi nghiin ctiu cfla tie gia W.A.Litder nhip tim tang khi dat cflc khoii tfl 25 -120% so vdi nhip tim trung binh [8]. Dieu nay la an toan ddi vdi Iiia tudi nay khi gIng sflc.
Mflc chenh xudng cua doan ST d kenh B nhieu htfn d kinh A, nhiilig chtia dat tieu ehuan thilu mlu ctf tim.
Bien ddi nhip tim Nhip tim 24h cua 2 nhdm
Thdi diem Dem
Ngay
Tongso
Trung binh N SD Trung binh
N SD Trung binh
N SD P Loan nhip
Tmng binh 72.93
69 6.369 7465 .
31 4.680 73.46 100 5.928
<0.05
Cao nhat 118.20
69 9.522 121.90 31 8.773 119.35 100 9410
<0.05
Ihapnh^t 54.52
69 4.792 57.39 31 5.451 5541 100 5.152
<0.05 Khong
Nhip tim ctia nhdm C ^ T D ban ngay cao hcfti nhdm QHTDB ban dem, sti khae nhau cd y nghia thdng ke vdi p < 0,05. Dilu nay cd the giai thich phii chang la quan he tinh due ban ngly cd sti hdi hpp hdn, hiing phan htfn do bin chat ngtidi Vilt Nam vin ll kin dao, quan he tinh dye truyen thong vin 11 trong bdng tdi va dien ra mot d e h Im thim.
TAP CHI TIM MACH HOCVIET NAM - SO 68.20141125
A NGHIEN CLfU LAM SANG
Nhip tiro trtidc, trong va quan he tinh diic gifla 2 nhdm Thdi diem
Dem
Ngay
T6ngs6
Trung binh N SD Tmng binh
N SD Tning binh
N SD P Loan nhip
Bat dau 72.42
69 8.222 77.26 31 8.782 73.92 100 8.652
<0.05
Ctfc khoai 117J2
69 9.169 121.26 31 9.377 118J4 100 9.367
<0.05
Hdiphi^c 73.67
69 8.725 79.00 31 8.132 75.32 100 8.858
<0.05 Khong
Nhip tim ldc khdi diu, dat ctic khoai va sau khi hdi phyc cua QHTD ban ngay cao htfn nhdm QHTDB ban dim, sti khic nhau ed y nghia thdng ke. Viec quan he tinh dye ban ngay ed le la mpt yeu td gdp phan Iim tang st;( hiing phin trong ddi ttitfng nghiin cniu. Dilu do gdp phin lam nhip tim tang eao htfn.
Ihdi gian hoi ph^c nhip tim, ty 1^ gifia nhip tim cao nhat va He bat dau giifa 2 nhom Ihotidilm
Dem
Ngay
T6ngs6
Trung binh N SD Trung binh
N SD Trung binh
N SD P
Thdi gian phi^c hdi 8.6449
69 3.59647 9.2097
31 404923
8.8200 100 3.73120
<0.05
Ty le cUc khoai/ bat dSu 1.6336
69 .16834 1.5788 31 .11015 1.6166 100 .15424
<0.5
Thdi gian hdi phuc nhip tim trd vl nhti trtidc khi quan h i tinh due tinh tfl thdi diem dat ctic khoai ngan nhit 3 phut, dii nhat 20 phut, hamgbinh 8.82 phut (SD3.73). Kit qui niy cao htfn rat nhilu so vdi tie gii W. A.Litder va cdng sfl la tii 20 giiy din 120 giiy
Thdi gian hdi phuc sau khi dat cflc kholi vl ty II gifla nhip luc dat ctic khoai vdi nhip lue bat diu nhdm QHTD ban ngay cao htfn nhdm QHTDB ban dim, sti khic nhau cd y n ^ a thdng ke.
126ITAP CHi TIM MACH HOC VIET NAM-SO 68.2014
NGHIEN CL/U LAM SANG <
thdi gian b6i phyc nh|p tim, t^ le n h ^ cao nhat vdi tdiip trung binh va nhip diap nhat dieo thdi gian quan
Thdigian qnan he
< 15 phut
>lS-30
>30-45
>4S
T6ngs6
Tnmg binh N SD Trung binh
N SD Trung binh
N SD Trung binh
N SD Trung binh
N SD P
Thdi gian h6i phuc 7.3333
15 2.39543
9.0000 80 3.81867 11.0000 4 5.49242
8.0000 I 8.8200
100 3.73120
<0.5
1^ 1^ nhip cao nMt/
thSpnhSt 2.1219
IS .24429 2.1575 80 .22425 2.2050 4 .20468 2.0441 1 2.1529
100 .22412
>0.5
Ty le nhjp cao nhat/
tmng binh 1.6243
15 .14365 1.6131 80 .12336 1.6966 4 .13719 1.6548 1 1.6186
100 .12618
>0.5 Thdi gian hdi phyc sau khi dgtt cdc kholi khac nhau ed y nghia thdng kl gifla d e nhdm ed thdi gian quan he: thdi gian quan he tiai htfn - thdi gian hdi phyc cham hcfti
Ty I | gifla nhip khi dat ctic khoai vdi nhip thip nhat va nhip trung binh khdng khae ed y nghia thdng ke gifla cac nhdm ed thdi gian quan he.
Bien ddi doan ST-T s r A, STB giiia 2 nhom Thdidi^m
Dem
Ngay
T3ngs6
Trung binh N SD Trung binh
N SD Trung binh
N SD P
SIA trung binh .1380 69 .10548
.1190 31 .07044
.1321 100 .09604
<0.05
STB trung binh .0755 69 .04310
.0645 31 .04456
.0721 100 .04363
<0.05 STAcao
nhft .2370 69 .07421 .2313 31 .06490 .2352 lOO .07117
<0.0S STB cao
nhat .2070 69 .08028
.2000 31 .05967
.2048 100 .07427
<0.05 STAthip
nhit -.0177
69 .16041 -.0719 31 .22591 -.0345 100 .18378
<0.05 STB thip
nhit -.0499
69 .15090 -.0968 31 .21723 -.0644 100 .1-440
<0.05 TAPCHiTIMMACH HOC VIET NAM-SO 68.20141127
i NGHIEN CLfU LAM SANG
ST A & B d nhdm CLHTD ban ngay chinh xudng nhieu hdn STA & STB htfn nhdm QHTDB ban dim, sti khie nhau cd y nghia thdng ke., nhting chtia den ngtidng benh ly. Dieu niy cd thi thay rang vi|c quan he tinh chic ban i ^ y lam nhip tim tarig rihieu len cung la lira tang ngiiy ctf thieu miu ed tim hcJn (bieu hien bang doan ST trin dien tim do ehinh xudng nhilu hcfti ban dim. Bdi vay nin chang hie sy se khuyin nhiing bliih nhan tim mach cua minh nen quan he tirih due vao ban dim hcfti la ban ngiy mpt d e h nhe nhang, tranh gang sdc qua
So sanh mtic chinh STA va STB luc bat dao (BEGIN) vdi luc dat dinh (IN) va luc khdi phuc (END) dien tun
C a p l
Cap 2
Cap 3 Cap 4
STABEGIN STAIN STB_BEGIN
S T B J N STA_BEGIN
STA_END STBBEGIN
STB_END Mean .1258 .0817 .0703 .0315 .1258 .1024 .0703 .0433
N 100 100 100 100 100 100 100 100
Std. Deviation .08382 .08918 .08747 .07709 .08382 .13333 .08747 .06733
Std. Error Mean .00838 .00892 .00875 .00771 .00838 .01333 .00875 .00673 STA va STB Ifle dat cflc khoai va lue hdi phuc
diu chinh xudng so vdi lue bat diu , nhulig STA Ifle hdi phyc chenh xudng so vdi STA bit dau khdng cd y ng^a thdng kl.
KETLUAN Biln doi nhip tim
Tan sd tim cao nhat khi dat ctic khoii la 141 diap nhit la 96, tiimg binh 118.54 (SD 9.367)
Nhip tim khi dat ctic kholi trong quan he tinh dye tang tfl 25%-120% so vdi nhip tim trung bmh, dat tii 52% - 82% tin sd tim tdi da ly thuylt
Thdi gian nhip tim trd ve binh tiitidng sau
khi dat ctic khoii ngan nhit 3 phut, dii nhit 20 phut,himg binh 8.82 phut (SD3.73).
Khdng cd trtidlig hdp nio xiy ra rdi loan nhip tim trong qua tiinh cjuan he tinh dye
Bien doi ST
ST chenh xudng trung binh d kinh A -0.07 mm chenh lin cao nhit Ii 0.30mm mflc chinh hTmg binh 0.0817mm (SD.08918).
ST chinh xudng trung binh d kenh B -0.10 mm chinh lin cao nhit la 0.30mm mflc chinh trung binh .0315mm (SD0.07709)
Khdng ed bieu hien thilu miu cue bd d 2 kenh trong qui trinh quan he tinh due.
128ITAP CHI TIM MACH HCX: VIET NAM - SO 68.2014
NGHIEN CLTU LAM SANG t.
SUMMARY:
Research Heart rate and ST segment on 100 men in sex:
Maximum heart rate is 141 to orgasm wMe the lowest is 9d, average 118.54 (SD 9,367). Time heart rate returns to normal after peak shortest 3 minutes, longest 20 minutes, average 8.82 minutes (SD3.73) ST segment depression lowest in chaimel A -0.07 mm, the highest elevation is 0.30nim, the average difference 0.0817mm (SD.08918)
ST segment depression lowest m chaimel B -0.10 mm, the highest elevation is 0.30mm, the average difference .0315 mm (SDO.07709).
TAI LIEU THAM KHAO
1. Bohlen JG, HeldJP, Sanderson O, Patterson PR. Heart rate, rate-pressure product, and oxygen uptake during foursexuaIactivities,Areh Intern Med 1984; 144:1745-8.
2. Muller JE, Mitlleman MA, Maclure M, et aL Triggering myocardial inferction by sexual activity. Low absolute risk and prevention by regular physical exertion. J Am Med Assoc 1996; 275:1405-9.
3. MulIerJE.MD. Triggering ofcardiac events by sexual activity: Findings from a case-crossover analysis.
AmJ Cardiol 2000; 86 (suppl): 14F-18P.
4. Nemec ED, Mansfield L, Kennedy JW. Heart rate and blood pressure responses during sexual activity in normal males. Am HeartJ 1964; 92:274-7.
5. Parzeller M, Raschka C, Bratzke H. Sudden cardiovascular death in correlation with sexual activity - results ofa medicolegal posbnortem study from 1972-1998. Eur HeartJ 2001; 22:610-6.
6. Thorson AI. Sexual activity and die cardiac patient AmJ Genatr Cardiol 2003; 12:38-40.
7. UenoM The so-called coition death. Jpn J Leg Med 1963; 17: 333-40.
8. W^Xitder, AJ.Honour and P.Sleight Direct arterial pressure, heart rate and eleetiocardiogram during human coitus. J. Reprod. Pert (1974) 40,321-331.
TAPCHiTIMMACH HOCVIET NAM-SO 68.20141129
