Y HQC VI$T NAM THANG 8 - s 6 1/2014 Trong cac tru'dng hdp khe hd mdi toan bp
mdt hay hai ben, xu'dng o rang va vom mieiig bj tach lam 2 hoac 3 doan xu'dng. Khe hd j 6 dp rpng t5ng dan tir trUdc ra sau (tir xu'dng d rang tdi iuSI ga). Day la mot t r d ngai trong khi phau thuat vi khe hd cang rong thi hai manh xu'dng ham tren va xu'dng khau cai bi keo ra ngoai, du'dng glD'a bj di lech, trong tru'dng hdp khe hd mdi mpt ben du'dng giiTa se bj di chuyen ve ben lanh va canh mui cung bien dang theo. SU di lech ciia xu'dng ham tren va xu'dng khau cai la dc sir keo ra ngoai va ra sau cua cac cd chan bu'dm khong ddi xutig (thu'dng gap d tre em tren 10 tudi). Ngoai ra cdn cd sir bien dang glal phau ve cun^ ham, nen mui, mdi, canh mui, lech lac rang, thieu s^n cd vdng mdi, tat ca se lam tSng them sir khd khan va phii'c tap khi phau thuat tao hinh mdi.
H§ sd tu'dng quan glQ^ cac loai bien dang vdi khe hd mdi cho thay day la mdi tu'dng quan thuan va kha chSt che (r = 0,82, p = 0,04) nghia la khe hd mdi cang nang thi mu'c dp bien dang giai phau ve cung ham, rSng va canh mui cang nhieu.
V. KET L U A N
Qua nghien ciJu dieu trj 306 frudng hdp khe hd mdi tai benh vien da khoa b'nh Khanh Hda chp thay;
- Trong phan Ioal khe hd mdi; Khe hd mdi mot ben khdng toan bd chiem 22,54%, hai ben khdng toan bd chiem 2,30%. Khe hd mdi tpan bd mot ben chiem 2 8 , 8 1 % , toan bp hai ben chiem 5,60%.
Khe hd mdi kem khe hd ham ech chiem 43,79%, trong dd khe hd mdi toan bd mdt ben kem khe hcl ham ech chiem 38,20%, khe hd mdi toan bp hai ben kem khe hd ham ech chiem 5,60%.
- Ket qua dieu t n phau thuat tao hinh khe hd moi phu thudc vao tirng phu'dng phap phau thuat va sit phu thudc nay cd y nghia thdng ke.
T A I L i f U T H A M K H A O
1. Nguyin Hoanh Dii'c (1999). Mot (Se nghj i ^ mo Slit mol va khe hd ham edi. Tuyen tap cong trinh nghien ciAj khoa hpc Rang ham mat, trang 117-118.
2. Mai Oinh Hulig (1979). Phau ijiuat tao hinh sut moi. Tai lieu nghien ciTu R3ng ham mSt, so 01, trang 25-31.
3. Tran VSn Trtfclna ri999). Tao hinh khe hd moi mot ben va hai ben. Tap chi V hoc Vilt Nam, so 10, trang 81-88. . T , 4. Converse J.M.. The bilateral deft lip.
Reconstructive plastic. Surg. W.B Saunders Comp, Philadelphia London. Pp. 1389-1413.
5. Millard D.R.. Rotation advancement In the repair of Bilateral deft lip. In cleft lip and palate. Little Brown Company Boston. Pp. 305-310,1971./.
NGHIEN CU'U MOT SO CHI SO LIPID MAU 6- BENH NHAN DOT QUy NAO TAI BENH VIEN HVV NGHI DA KHOA NGHE AN
T 6 M TAT
Qua nghiSn dtu 168 benh nhan dot quy nao dieu tr! tai khoa Than kinh Benh vien HDU nghi Oa khoa Nghe An tir thang 8/2011 den thang 11/2012 chung toi xin du^ ra mot so nhan xet sau:
Opt quy nao gSp nhieu nhat d nhom tuoi > 55, nam mac nhieu hdn nil.
Ti le roi loan lipid miu d benh nhan dot quy nao noi Chung la 58,6%, trong do nhoi mau nao la 65,7%
cao hon chay mau nao \i 48,5% (p<0,05).
Nong dO cholesterol toan phan vJ triglycerid d b^nh nhan nhoi mau n5o cao hdn chay mau nap.
• BSnh vien HOu Nghj Ba Khoa Nghe An Chju trach nhiem chinh: DUdng Oinh Chinh Email: chinhuehoangegmail.com Dt; 09133513809 Phan bi?n khoa hpc: TS.BS.CWI Cao Tnrdng Sinh Ngay nhSn bai: 26/5/2014
Duong Dinh Chinh*
Khong cd si/ khac bl?t ve nong dp HDL-C vJ LDL-C glu:a 2 nhom.
Cholesterol toan phBn d mu'c dp thap (<3,9 mmol/l) thi ti le chay mSu nao cao hdn nhoi mau nao.
Cholesterol toan phan d mire cao (>5,2 mmol/l), triglycerid cao (>2,3 mmol/l), LDL-C cao (>3,4 m_mol/l), HDL-C thap (<0,9 mmol/l) thi ti 1^ nhdl mau nao cao hdn chay mau nap.
SUIVIIVIARY
STUDY O N LEVELS OF BLOOD L I P I D S IN STROKE PATIENTS AT NGHE AN GENERAL
F R I E N D S H I P HOSPITAL By studying 168 patients with sfroke treated at neurology deparftnent at Nghe An Hospitai from May 8 * 2011 to December 1 1 * 2012 we would like to present following results:
- Most of stroke patients are at age >55 years old, occurred predominantly in males.
Y HOC Vt$T NAM THAHG B - S01/2014 - Percentage of dyslipidemia in stroke patients was
58.6 % overall, including ischemic stroke was 65.7%
higher than hemorrhage stroke with 48.5 % (p<0.05).
- The concentration of total cholesterol and triglycendes in patients with ischemic stroke are higher than hemorrhage stroke patients. No significant difference in HDL - C and LDL - C levels between 2 groups
- Patients with total cholesterol at low levels (<3.9 mmol/l) have the rate of hemorrhage stroke higher than ischemic stroke. Ischemic stroke is higher than hemorrhage stroke in conditions of hypercholesterolemia (>5.2 mmol/l), hypertriglyceridemia (>2.3 mmol/l), high LDL - C (>3.4 mmol/l) and low HDL - C (<0.9 mmol/l).
I. OAT
V X No l
Ddt quy nao (DON) ludn la mdt van de thdi su' cua v hoc bdi day la mdt benh thu'dnq qap, cd ty le tir vonq cao, thdl qian nSm vien keo dai, chi phi dieu tri tdn kem, di chutiq nSnq ne, de lal qanh nanq cho qia dinh va xa hdi. Tronq nhiTnq nam qan day, mac dii y hoc da cd nhuliq tien bd danq ke tronq linh vu'c chan doan, dieu tri DON nhutiq van chu^ cd bien phap nap du'dc coi la dac hieu. Theo chien lu'dc cua To chu'c Y te the qldi th) DON cd kha nanq du' phonq va quan ly tdt cac veu to nquy cd. Nhieu nqhien cuti tronq va nqoai ni/dc da cho thay t3nq lipid mau la mdt tronq nhijtiq vdu td nquy cd quan tronq cua benh ly mach mau ndi chunq va DON ndi rienq (11, (21, (71. Tuy nhien mdt sd nqhien cutj mdi dSy Iai cho thay co mdi lien quan qiD^ ndnq do Cholesterol va cac lipo-protein khac vdi tirng the BQN (31, (61.
Xuat phit tir nhii'nq thu'c te neu tren chung tdl tien hanh nghien ciJu nay nham muc tieu:
- Dinh gli sd bien doi mot so chi sd lipid miu d binh nhin DQN.
• Tim hliu mol Uin quan glifa sif bien doi cic chi so llpkl miu vdi ty le hai the, nhdl miu nao vi chay miu nao.
IL 001 TirpNG VA PHUOfNG PHAP NGHIEN CUTJ 2.1. Del tu'dng nghien CtJ'U
Cac benh nhan du'dc chan doan xac dinh la Dot quy nao dieu tri tai Khoa Than kinh - Benh vien HDU nqhl da khoa Nqhe An.
Tieu chuan chon benh nhan dita vao;
+ Dinh nqhia Bdt quy nao ciia Td chirc .Y te the qldi nam 1990.
+ Xac dinh the nhoi mau nao hay chay mau nao du'a vao lam sang va chup cat Idp vi tinh sp nao.
Loai trir khdi nqhien ciiti nhutiq benh nhSn khdnq xac dinh du'dc the ddt quy, benh nhan nhdl mau nao, chay mau nao, benh nhan da va dang diing thudc ha Lipid mau.
2.2. Thdi gian va dia di£m nghien clhi Thdi qian nghien ciiti; Tir thang 8/2011 den thanq 11/2012
Dia diem nqhien ciru; Tai benh vien hDti nghj da khoa Nqhe An
Thiet ke nghien cu'u; Tien ciitj, cSt ngang, mdta
2.3. Kf thuat thu thap so lieu Chon benh nhan, kham lam sang theo chi tieu nqhien cuti.
Chup cSt Idp vl tinh so nao du'dc tien hanh tren may Scaner Emotion hanq Siemens.
Xet nqhiem Lipid mau; Benh nhan du'dc lay mau tinh mach buoi sanq, luc chuci an. TIdn hanh dinh lu'dnq cac chi sd lipid mau tren may AV400 Olympus (Nhat Ban).
Danh gia rdi loan Lipid mau dira theo tidu chuan;
Tanq Cholesterol toan phan; Cholesterol TP>5,2 mmol/l.
T3nq Triqiycerid >2,3 mmol/l Tanq LDL-C; LDL-C>3,4mmol/l Giam HDL-C; HDL-C<0,9mmo!/1 2.4. Xir li so lieu
Theo phu'dnq phap thdng ke Y hpc, tren phan mem Epiinfo 6.04
IILKfTQUANGHl!NCO'U
Tuoi
<35 35-44 45-54 55-64 65-74
>75
Nam(n N 1 7 25 36 35 14
= 118) 0,8 %
5,9 21,2 30,5 29,7 11,9
NffCn
N 0 0 7 14 17 12
= 50)
% 0
0 14 28 34 24
l o n g (n
n 1 7 32 50 52 26
= 168)
0,6 %
4,2 19,0 29,8 31,0 15,4
- Nam gap nhieu hdn, ty le nam/nif = 2,3
Y HOC VlgT NAM THANG 8 - S O 1^014
ing 2: Phan bd the ddt quy nao theo tudi Tuoi
<35 35-44 45-54 55-64 65-74
>75
Nhoi mau (n N 0 4 12 25 38 19
= 98)
% 0
4,1 12,2 25,2 38,8
. 19,4
Chay mau (n = 70) N
1 3 20 25 14 7
1,4 %
4,3 28,6 35,7 20 10 - 6 nhdm tudi >65 tudi t^ le nhdl mau nao cao hdn chay mau nao.
Bing 3: So benh nhan cp rdi loan Lipid mau Tuoi
Cd rdi loan Lipid
Nhoi mau N=98
65
Chay mau N=7a
34
Tong N = 168
99
58,9Tyle% I ' 65,7 r ] 4'5,5
Nhin xet:-Ty le benh nhan DQN co rdi loan Lipid mau la 58.9%
- Nhdm benh nhan nhdl mau cd ty le rdi lean Lipid la 65,7%, cao hdn nhdm chay mau nao 48,5% (P<0,5'%)
Bing 4: Ndng dp trung binh ciia mpt sd chi so Lipid rnau theo gidi
Nongdp^
Triglycerid
Nam n = 118 5,0 ± 1,3 (2,3 -
10) 2,1 ± 1,5 (0,5-
12,5)
1,3 ± 0,9 (0,5 -
10) 3 ± 0 , 9 (1,5- 6,5)
Nu' n = 50 5,7 ± 1,5 (2,5 -
10,3)
2,1 ±2,0 (0,8 -
12,5)
1,4 ±0,5 (0,6 -
3,2) 3,3 ± 1,2 (0,5 -
1,7)
Chung n = 168 5,2 ± 1,4 (2,3 -
10,3)
2,1 ± 1,7 (0,5-
12,5)
1,3 ±0,8 (0,5 -
10) 3,1 ± 1 (0,5 - 6,5)
>0,05
>0,05
Nhin xit: - NSng do trung binh cua Cholesterol d niT cao hdn nam.
- Khdng cd sir khac biet ve ndng dp Triglycerid, HDL-C, LDL-C giiJa nam va nH.
Bing S: NBng dp mdt sd chi sd Lipid mau thed the lam sang
~~--~~...^ Thg NSng dp^~~~-^^^
Cholesterol Triglycerid HDL-C LDL-C
Al-. '
Nhidl mau n = 9S 5,4 ± 1,4 (3,1 -10,3) 2,3 ± 1,8 (0,8 -12,5) 1,3 ± 1,0 (0,5 -10) 3,1 ± 1,0 (0,5-7,1)
Chay mau n = 70 5,0 ± 1,4 (2,3 - 8,8) 1,7 ± 1,3 (0,5 - 9,5) 1,3 ± 0,5 (0,6 - 3,2) 3,0 ± 0,9 (0,9-6,5)
(Ddnvi:
P
<0,05
<0,01
>0,05
>0,05 Nhinxiti
- Nonq ddtninq binh cua Cholesterol va Triglycerid d nhdm nhdl mau cao hdn nhdm chay mau (P<0,05)
• Khong CO sir khac biet ve nong do HDL-C, LDL-C glD^ nhdm nhoi mau va nhdm chay miu (P>0,05),
Y HOC Vt$T NAM THANG 8 - s 6 1A2014
Bina 6: Lien quan oitra ndna dd Cholesterol va the ddt ouv nao Nong do
mmol/i
<3,9 3,9 - 5,2
>5,2
Nhoi mau n (o/o) 7 (29,2) 49 (62,8) 42 (63,6)
Chay mau n (o/o) 17(70,8) 29 (37,2) 24 (36,4)
Tong n (»/o) 24 (100) 78(100) 66(100)
P
<0,001
<0,001 - Q nono do Cholesterol thao (<3.9mmol/l) tv le chav mau nao la 70.8%. cao hdn nhdl mau nao 29.2%.
- a nong dp Cholesterol cao (> 5,2mmol/l) ty le nhoi mau nao la 63,6%, cao hdn chay mau nao 36,4%
Bang 7: Lien quan qlija ndnq dd Triqiycerid va the ddt quy nao Nong do
mmol/i Nhoi mau
n (%) Chay mau
n (%) Tong
n (%)
<2,3 7(54,3) 59 (45,7) 129(100) >0,05
>2,3_ 28(71,8) 11(28,2) 39(100) <0,001 Nhin xet-O nong dp Triglycerid cao (> 2,3mmol/l) ty le nhdl mau nao la 71,8%, cao hdn chay mau nao 28,2%. i , / / r .
Bing 8: Lien quan glD'a ndnq dd HDL-C va the ddt quy nao Nong do
mmol/l
<0,9
Nh'di mau n (%) 20 (66,7)
Chay mau n(°/o) 10(33,3)
Tong n (%)
30(100) <0,001
^ > 0 , 9 78(56,5) 60(43,5) 138(100) >0,05 Nhin xit: d ndng dp HDL-C <0,9 mmol/l ty le nhdl mau nao la 66,7%, cao hdn chay mau nao 33,
Bing 9: Lien ouan qiiia ndnq dd LDL-C va the ddt quy nao Ndng do
mmol/l
NhBi miu n (%) 65 (55,6)
Chay mau n (%) 52 (44,4)
Tong n (%)
117(100) >0,05
^ . > 3 , 4 33(64,7) \ 18(35,3) 51(100) <0,001 Nhan xet; cs nong dd LDL-C cao >3,4 mmol/l ty le nhdl mau nao la 64,7%, cao hdn chay mau nad (35,3%)
IV. BAN LU4N
Oua nghien cuti 168 bSnh nhan DON chunq tdi nhan thav ranq: DON qap nhieu nhat d nhdm tudi sau 55 tudi, nam mac benh nhieu hdn nii'.
Nhdl mau nao thu'dnq qap d lu'a tudi sau 65 tudi.
Ket qua nay cunq phu hdp vdi nqhien cuti ciia cac tac qia tronq nu'dc (21, (31. Ket qua nqhien cut! mdt sd chi sd Lipid mau cho thay cd 99 benh nhan cd rdi loan Lipid tronq tonq sd 168 benh nhan DON (chiem ty le 58,9%), tronq do cd su' khac bidt ve tv le rdi loan Lipid va ndnq dd cac chi SP Lipid qiiTa nhdm nhdl mau nap va chay mau nao. Nhdm benh nhan nhdl mau cd ty le rdi loan Lipid la 65,7% cao hdn nhdm chav mau nao 48,5% (bang 3). Ndnq dd trunq binh cua Cholesterol toan phan va Triqiycerid is nhdm nhdl mau cunq cao hdn nhdm chay mau (bang 5).
Oleu nay cd le phan anh mdt tinh tranq vOa xd adnq mach, mdt tronq nhOtiq yeu to nquy cO cua DON ndi chunq, die biet la nhoi mau nao.
Tran Thi Thuy Nqan (2004) khao sat cac yeu td nguy cd tren 545 benh nhan DQN ciing cho thay
rdi loan Lipid mau la veu td nquy cd danq ke ciia DON. Cac the lam sanq cua DON deu bi anh hu'dng bdi yeu td nquy cd nay 6 cac miTc dd khac nhau, tronq dd nhdl mau nap bi anh hu'dng nhieu hdn ca (21.
Lien quan qiiiB ndnq dd cac chi sd Lipid vdi
tv le cac the DON, chunq tdi thay d miTc
Cholesterol toan phan thap (<3,9mmmol/l) thi tv
le chav mau nao cao hdn nhoi mau nao. Nqu'dc
Iai d mii'c Cholesterol toan phan cao
(>5,2mmol/l) thi ty le nhdl mau nap cao hdn
chav mau nao.Vdi mire Triqiycerid cao, LDL-C
cao, HDL-C thao thi rt le nhdl mau nao deu cao
hdn chay mau nao. Zhaos (1999) so sanh mii'c
Cholesterol va LDL-C ciia 90 benh nhan nhdl
mau nao, 90 benh nhan chay mau nao vdi 107
nqu'di khoe manh cd ciinq tudi, qldi cunq cho
thay nhdm chay mau nao co mihc Cholesterol
toan phan thap, LDL-C thap tronq khi nhdm nhoi
mau nao cd mire Cholesterol toan phan cao,
LDL-C cao hdn so vdi nhdm chutiq (61. Nqhien
ciiti qan day ciia cac tic qia Nhat Ban va Hoa Ky
cho thay khi ndng dp Cholesterol toan phan <
Y HOC VlgT NAM T H A N G 8 - SO 1/2014
4,62 mmcl/1 se lam tanq nquy cd chay mau nao len qap 2,7 lan.Vlec ket hdp QiiJta tanq huvet ap va qiam Cholesterol mau khonq lam qia tSnq them ty le chay mau nao. Cac tac qia qiai thfch ranq Cholesterol donq vai tro tao nen siT toan ven cua thanh mach, khi Cholesterol qiam dan tdi roi loan manq te bao lam cho lop noi mac donq mach bi suy veu de qay chay mau nao JSl.
Tuv nhien mot so tac qia khac Iai cho thay co s qiam Cholesterol tronq mot qiai doan cap cua chay mau nao tronq khi Triqiycerid khonq thay thay doi, va dieu nay chua du'dc gial thich ro rang [41,
Nqu'dc Iai, cac nqhien culJ ve tinh tranq tanq Lipid mau vdi DON va benh mach vanh da cho thay khi nonq do Cholesterol tanq >5,7mmol/l den tren 7,28mmol/l se lam tanq ty le nhoi mau nao len 1,31 den 2,57 lan [31. Nqhien cull cua Jane D (2001) cunq cho thay nquy cd nhoi mau nao t5nq len 1,27 lan lien quan vcfi Triqiycerid >
200mq/dl va tac qia khSnq dinh Triqiycerid cao la yeu to nquy cd doc lap cua nhoi mau nao va thieu mau nao thoanq qua [51. Nhu" vSy viec dunq thuoc ha Lipid mau se lam qiam nquy cd nhoi mau nao nhuTiq co lam tanq nquy cd chay mau nao khonq? Oieu nay ran du'dc nghien ciiu nhieu hdn trong tu'dng lal
V. Kfr lUfyN
- DON qap nhieu nhat d nhom tuoi > 55 tuoi.
Nam m3c benh nhieu hdn nu". Chay mau nao thudnq qap tru'dc tuoi 65, nhoi mau nao thu'dng g^D sau 65 tuoi.
- Ty le rol loan Lipid mau d cac benh nhan DQN ndi chunq la 58,6%, tronq d d d the nhoi mau nao la 65,7%, rao hdn chay mau nao 48,5%, -^Nonq do Cholesterol toan phan va Triqiycerid d benh nhan nhoi mau nao cao hdn chay mau nao.
Khonq cd su" khac biet ve nonq do HDL-C, LDL-C giiJa nhdm nhoi mau va nhdm chay mau.
- Cholesterol d mu'c do thap ( < 3,9mmol/l) ttit t / le chay mau nao cao hdn nhoi mau nao, d miic Cholesterol rao f>5,2mmo!/l), Triqiycerid cao C2,3mmol/l), LDL-C cao (>3,4mmol/n, HDL-C thap (<0,9mmol/n thi ty le nhoi mau nao cao hdn ty le chay mau nao.
T A ! LIEU T H A M KHAO
1 . Bach VQng Hai, Lai Phu Thu'dng, Hoang Klial U P / Ph^m Thj Honci Van (1997), Cac chuyen de hoa sinh va dich te hoc ISm sing - Nha xuat ban y hoc Ha Noi, Tr 26-42.
2. I r a n Thj Thuy Ngan (2004), Nqhien cuU (JSc diem dich te hoc lam sinq, c3n lam sang ciia benh nhan tai bien mach m^u nSo tai Benh vign da khoa Trunq Lfdnq Thai NquySn, LuSn van tot nqhiep Thac sy Y hoc, Dai hoc Y Ha Noi.
3. Nguyen Nang Tan, L i Quang Cudng (2004)
"Nghien cub mc^ quan he qiu^ roi loan Lipid mau voi cac the tai bien mach mau nao", T^p d i i Y hoc Viet Nam, tap 301, tr 70-72.
4. Cheng Y.C, Wang L.z, Zhaos S.P (2000),
"Dynamic changes of serum lipid in patiens witti acute stroke", Unan Yike Daxue xue Bao, Vol 25:
489- 491.
5. Jane,D; Koren-r^orag, I V et al (2001), "Blood lipids and first-ever ischemic stroke/Transient isichemic attack in tiie Bezefibrate infadjon Provention (BIP) Registry: hiqht Triglycerides constitude an independent risk fector", Circulation, Vol 104: 2892-2897.
6. Peng.D; Zao,S (1999), "Serum Lipids, Lipproteln and Stroke", Unan Yike Da xue xue Bao, vol 24;
167-170.
7. Simons, LA, Simons, j e t al (2000) "Cholester(ri and other lipids predit coronary heart disease and ischaemic stroke In tiie elderly but only in those below 70 years", athero5clerosis,vol 159:201-208
DAC DIEM UNG THIT DA! T R A N G CO THIEU M A U DU'gC DIEU TRI PHAU THUAT TRIET CAN TAI BENH VIEN DA KHOA TRUNG U^aNG CAN THQ
T 6 M TAT
* B^nh vien Oa khoa Trung uUng CSn TTio
** B^nh vien 103, Hoc vi?n Quan Y
* * * 0 ? i h 9 c Y Du'dc TP.HCM Chiu b^ch nhi?m chinh: Nguyen Minh Hiep Email: [email protected] Dt: 0913737376 Phin bi?n khoa hoc: GS.TS LS VSn Cu'dng Ngiy nhan bSl: 14/6/2014
Nguyin Minh Hi^p*", Nguyen VSn Xuyen**, Triin Van Phffi***
Ung thu" d?! trang thu'dng g^p d nhutig ngi/di tren 50_^tu6i. Thieu m^u la trieu chiing l i triSu chdhg tnidc mo chiem 56%, thu'dng la yeu to nguy cd, inh hu'dng den ket qua phau thuat. Ung thu* cd thtSu mau d d^i trang phai chiem 36,5% va cho thay h|nh d giai doan tram trong. Myc dich cua nghien cull nay nham khio sat cac dSc diem lam sang, can lam sing va giii phau benh ly cua nhdm nghien ciiu gom 93 benh nhan b|
ung thu" dai trang cd thieu mdu du^c dieu tn phau thuat triet c3n tai Benh vi^n Da khoa Tmng u'dng CSn
24
