NGHIEN CUE ANH HUONG CUA DIEN CHAM LEN LUU HUYET NAO CUA BENH NHAN T A I BIEN THIEU MAU NAO CUC B 0
TS. Vu Thuong Son Benh vien Chum cuu Ti ling uong SUMMARY
Slailv the effect of electro-acupuncture (EA) on rheoencephalography (KEG) of the patients suffered from the cerebral iehemie accident (CIA).
Objective: Evaluation effect of EA the point's regimen and Phong tri (Gil 20) on the change REG of the patients suffered from die cerebral iehemie accident.
Subjects and methods: Research was conducted an REG of 64 patients suffered from die cerebral iehemie accident wild die method of clinical trial and compare. 32 patients treated by EA the point's regimen and Phong tri (GB 20). 32 patients treated by EA the point's regimen without Phong tri (GB 20). Result: After 30 limes EA. die REG on the damage hemiphere ol the re se ached group showed that: The time of a. waves reduced from 0.184-.0.025 see ta 0,160-0.049 see. different ta oilier group (p 0.05). The Index of a T reduced from 0.288+1.83% la 0.265+1,81% no different la other group lp 0.05). The volums at the cerebral circulation increased tram 131.99+31,89 ml miu la 1~H,6-56.01 nil mm. different la oilier group Ip- 0.01) The index of Ri increased from 0.581 i t). 153mm la 0.694±0.185mm. different la aider group Ip- 0.05). The waves from: spike, quick, slaw waves different la other group Ip- 0.05). Conclusion: the eleelra acupuncture the paint's regimen and Phang tri (G20) reducing die lime at a. waves: a T. The index Vm, Ri increasing an rheoencephalography. Reducing loans af die brain blood vessels, increasing die elasticity at brum blood vessels, ameliorating the volums at die cerebral circhral circulation an the damage brain.
TOM TAT
Mae lieu: Danh gid lae dung cua dien eluini phdc dd huyet ed chain them huvet Phong tri hai hen len sir thay ddi cua lint huyet nao dd tren henh nhdn lai hien thieu mdu nao cue ho. Ddi tuang vd phuongphup nghien ciru. nghien ciru duoc lien hanh tren 64 henh nhdn liet nira ngirdi do lai hii'ii illicit mini nao cue hd sau giai doqn cap vdi pinning phiip thir nghiem 1dm sang ed sa sanh. 32 henh nhdn duoc dien chdm phdc dd huyet ed chain them huyet Phong tri hai hen. 32 henh nhdn dime dien chinn phdc dd huyet khdng chain Phong tri. Sa sanh thay ddi ede chi sd liru huyet niia. Ket qua: hai hen hdn edit ldn l/narng cua nhdm nghien ciiu sau lli'ii trinh dieu tri 30 ngdv: Thai gian a giam id 0.1X4-0.025 giciy din
0.160 :0.l)4l) gicix. co sir kluic biet vdi nhdm so sanh lp 0.05). Chi \ii wT giam lit
0.288=1.83% den 0.265=I.8I%i. khdng eo sir khiic biet voi nhom so sanh ip 0.05). Chi s<i Ki Icing lir 0.581=0.153mm den 0.694=0.185mm. eo sir kluic hiel vin nhdm so siinh (/>• (1.05). Lira hrang mini lang ui 131,99±31,89ml phiit den I '8.6=56.1)1 ml phiu cd sir kluic hiel vdi nhom so sanh tp- 0.01). Hinh dang sang: dudng len nhanh. chdm. simg nhon co sir khiic hiel vdi nhdm so sanh (p< 0.05). Ben hdn cdu land co hien did nhirng khdng co sir khiic hiel c ua ede chi so vd hinh dang sdng. Ki't luiin Dien c hdm phdc dii huvet co huvet Phong tri ed trie dung giam dud gian a, a. T %>, lun luang mini tdng. chi sd Ri ning tren liru huvet nao dd. ('di thien lint huyet ado. giam lining lire thanh muc h, king sir dan hdi cua much mini nao. tdng liru lining mdu add o hdn cdu ton thirong.
I. Dat van d£
Luu lugng tuan hoan mau nao giam giiy nen nhieu benh ly khac nhau tir don gian nhu mat ngu. suy nhugc than kinh den tai bien mach mau nao. teo nao. Do vay. tiing cudng luu luong tuan hoan mau nao o ngudi Idn tudi la mot trong nhung muc tieu cua nhieu nha nghien cuu ve y va dugc.
Tang tuan hoan mau nao cho tai bien thieu mau nao cue bd sau giai doan cap la mot chi dinh dieu tri can thiet nham hdi phuc tro lai cac chirc nang hoat dong cua viing nao bi ton thuang cirng sdm cang tdt. Phong tri (GB 20) la mdt huyet cd vi tri dac biet nam sat dot song C1-C2. noi hdi tu ciia hai ddng mach dot song thanh ddng mach than nen di vao da giac Willis. D2 cd mot sd tac gia nghien ciru ve huvet Phong tri tren ngudi hinh thuong va benh ly [1][5][6], De gdp mdt phim tim hieu them ve diic diem cua huvet nay cluing tdi tien hanh: Danh gia tac dung dien cham phac dd huyet cd huyet Phong tri len luu huyet nao cua benh nhan tai bien thieu mau nao cue bo.
I. Ddi tugng nghien ciru:
* Gdm 64 benh nhan liet do thieu mini nao cue bo sau giai doan cap [2]. Chia thanh 2 nhdm. Mdi nhdm 32 benh nhan.
Nhdm nghien cdu (NNC-32 benh nhan):
Phac do huyet [5] (ben liet): Cham ta: Hgp
cdc. Ngoai quan. Kluic tri. Kien ngung. Bat tit. Giap tich C-.-C- Trat bien. Hoan khieu.
Duong king tuyen. Giai khe. Thugng cut hu.
Giap tich Li-Ls Phong tri (2 ben). Cham bd:
Tuc tam ly. Tam am giao. Huyet hai. Than du. Thai xung.
Nhdm nghien ciru cham them huvet Phong tri (2 ben)
Nhdm so sanh (NSS - 32 benh nhan):
Cham ciru nhu phac do huyet ndi tren.
khdng cham them huyet Phong tri hai ben Lieu trinh: 25 phut/lan/ngay. 30 kin cham lien tuc.
2. Phuong phap nghicn ciru: Cluing tdi su dung phuong phap thu nghiem lam simg cd so sanh
3. Phuong tien nghien cdu: May tinh dien chain M7. May do luu huyet:
Rheoscreen compact CP. 01 IX Made in Germany tai benh vien Chiim ciiu.
* Danh gia ve Luu huyet nao: So sanh cac chi tieu cua luu huyet nao dd hinh dang sdng. a (giay). u'T (%). VBc (ml/phut). Ri (mm) cua hai nhom trudc va sau dieu tri [3][4],
4. Xu ly sd lieu nghien cuu: Cac sd lieu nghien ciru dugc xu K theo phuong phap toan thdng ke diing trong y - sinh hgc EPI
IN FO 6.04
TAP CHI CHAM CUV VIETNAM.
III. Ki't qua nghien cuu:
Bang I: Dae diem tudi, gidi d hai nhdm
Tuoi Nh6m nghicn ciru Nhom so sanlu n=32) Tone
(_n= 32j_ | j
Nam Nir Nam Nir
| 35- 50 51-65
> 65
12(18.75%) | ,_32 (50%) j 20(31.25%) Tong 20(62.5', i j2(37_5'Vj 21(<55,6____) 11(34.4%) j 64(100%)
32(100%) 32(100%) 64 Nhan xet: Ty li- nam mac benh nhieu hon nir o ca hai nhom. l ira tuoi mac benh nhom tuong duong nhau. l ai hai nhdm benh nhan chu yeu tap trung vao tuoi 5 I -65.
Bang 2: Ket qua nghien ciiu luu huyet nao trade ed sau dieu tri ctia hai nhdm r Ban ciu ton lliuong I NNC = 32. NSS = 32).'
Chi so
j Nhdm 1 Ti IK K dieu u i
X ± SD Sau dieu tri
X ±_SD P
u(«iav) NNC ~ I (). 184 ± 0,025 0.160 ± 0.049 ~<oisr 1 v — NSS ~r 0.10(1 ± (1.(147 0.186 ± 0.049 >0.05
i _ J2 : >0.05 <0.()5
u/TC i) i _ NNC 0.2S.S ± 1.83 0.265 = 1.81 ^ o o F NSS | 0,280 i 1,80 ', 0.272 = 1.79 >0.05
|~ _ _L> >0.05 >0.05
NNC 131.99x31.89 ! 1 78,60 r 56.01 "" <0.001 (ml/phut i NSS "7 126.10 i 22.4d 1 132.37 ± 25.19 i >0.05 _
P >0.05 | <0.0l I ... .
" Ri NNC 0.581 ± 0,153 0.694 ± 0.185 <0.01 (mm) NSS 0.73 = 0.29 __j 0.N I =0.29 I >0.05
p <0.05 <0.05 1
Ban ciu lanh (NNC = 52. NSS =32).
ct(giay) NNC 0.1801 0.037 0.173 ±0.049 | ~>o"o5 L NSS 0.160 * 0.05 0. [-Ki ± (),049 i <0,05~
i i 1' >0.()5 <0.05
a/T('7 ) ' NNC 0.265 = 2.12 0.261 ± 1.90 1 >0.05 1 NSS' 0.255 ± 1.70 0.251 ± 1.56 ! >0.05
|~~ P . >0.05 >0.05 -1 -
" VTK-- r NNC I02.21) ± 42.51 1NO.S5 x 52,65 >0.O5 (ml/phtil) NSS 140.91 ± 37.97 156.55 i 35.44 1 >0.05
P <0.05 «1.05
i R l L NNC 0.703 ± U.682 0.7S 1 ± 0.199 >0.05 (mm i NSS' 0.86 i 0.05 1.03 ±0.34 >0.()5~
1 ~ _ Jl >0.05 <0.05
Nhan xet: Doi vdi ban can benh. trudc dieu tri cac chi sd a (giay). et/T (%), \'n, (ml/phut) giua hai nhom khdng cd su khac biet. chi cd Ri cd sir kluic biet. Sau dieu trj. chi so n (giay), a/T (%). VBc (ml/phut) giua hai nhdm cd su khiic biet. Cac chi so con lai cd su thay ddi nhung khdng khac biet. Ddi vdi ben lanh. trudc dieu tri luu luong mau nao d nhdm nghien cuu cao hon nhdm so sanh cd su khac biet. Sau dieu tri. luu lugng mau mio cua ca hai nhdm deu tang khdng cd sir khac biet vdi tung nhdm nhirng cd sir khac biet uiua hai nhdm.
Bdng 3: Hinh dung sdng trin luu huyet ndo dd him cdu henh (NNC = 32, NSS = 32) Hinh Dang Nhom 1 luoc dieu tri Sau dieu tri
NO ne So luong Tv le% Sd luong Tv le%
Nhanh NNC 3 T 9.375 11 34,375
Duong len NSS 3 _ T 9,375 7 21,875
P > 0.03 < 0.05
Cham NNC 29 90,62 21 65,625
NSS 29 90,625 25 78.125
P > 0,05 < 0.05 '
Nhon NNC 4 12.50 14 43.75
NSS _ 9.375 10 i 31.25
Dinh song >0.05 < 0.05
Tii NNC 16 50.00 11 34.375
NSS 18 7_ 56,25 14 43.75
P > 0.05 > 0,05
Cao NNC 12 37.50 7 21,875
nguyen NSS _ 11 34.375 8 25.00
P >0,05 > 0.05 1
Cd NNC " 13 40,625 18 56,25
Song phu NSS I (1 31.25 15 46.875
> 0,05 > 0.05 i Khong NNC 19 59.375 14 1 43.75
NSS 22 68.75 17 53,125 1
. _P ~~> 0.05" > 0.05 j
Nhan xet: Trudc dieu tri. ben ban cau benh khdng cd sir khiic biet \e hinh dang song giiia hai nhdm. sau dieu trj dang sdng nhanh ia cham xuat hien o duong len trong ban ghi luu huyet nao do cua nhdm nghien ciru cao bom nhdm so sanh co su khac biet...
TAP CHI CHAM CUV VIETNAM.
Bang 4: Hinh dung song tren liru huyet nao da hdn edit lanh (NNC - 32, NSS - 32) Hinh Dang Ban 1ruoc di cu In Sau dieu tii
song ciiu So lirong_ Ty leC So luong Tv ler;
Nhanh NNC 10 51.25 18 56.25
Duong len NSS 9 28.125 J 13 40.645
P ; > 0.05 , <0,05
Cham NNC 22 68.75 14 43.75
NSS i -> 71.875 19 59.375 1 [ >0.05 ] <0.05
Nhon NNC I JzL " ! 51.25 10 50.00 NSS 8 25.00 4 " 34,375 Dinh Mine I1 T > 0.05 > 0.05
~ Tu" NNC 15 46.87 11 34.375
NSS 14 43.75 13 40.625
l1 1 > 0.05 1 >0.05
Cao NNC 7 21.875 5 "157625 nguyen NSS 10 43.375 ] § 25,00
P i > 0.05 > 0.05
Co NNC '1 18 i 56.25" t ~ 2 0 62.50 Song phu NSS L 1 6 50.00 ! 19 59.375
P r > 0 .05 j >0.05
Khong NNC 14 "43.75 1 12 37.50 NSS 16 50.00 i 13 40.625 . P ' >0.05 t > 0,05
Nhan xet: Trudc dieu tri, ben ban cau lanh khdng cd su khac biet ve hinh dang sdng giua hai nhdm. sau dieu tri dang song nhanh va cham xuat hien d dudng len trong ban ghi REG ctia nhdm nghicn cuu cao hon nhdm so sanh cd su khac biet.
IV. Ban luan
1. Ve cac chi tieu luu huy et nao.
Qua bang I, chung tdi thay ve dac diem gidi. tudi giua hai nhdm tuong ddng nhau.
Qua bang 2. cho thay ket qua nghien cdu cac chi so luu huyet nao cua ban cau tdn thuong. Thdi gian u da rut ngan sau so vdi trudc dieu tri a nhdm nghien cuu (p<0.05) va cd sy khac biet sau dieu tri voi nhdm so sanh (P<0.05). Ddi vdi ban cau lanh thdi gian u cua nhdm nghien cuu khdng cd su khac biet sau so vdi trudc dieu tri nhung cd sy khac biet so vdi nhdm so sanh o thdi
diem sau dieu tri. Thdi gian nhanh len u cua do thi luu huyet nao phan anh do dan hdi.
truong luc cua thanh mach. Do la thdi gian tam thu tdi da can thiet de dua mau vao td chuc. Thai gian nit ngan lai the hien sy luu thdng tuan hoan cua nao tdt hon.
Thai gian ct/T cung the hien dp dan hdi.
truong luc thanh mach. Ben ban cau tdn thuong. thdi gian a/T thu ngan lai sau so v di trudc dieu tri d nhdm nghien cdu (p<0.01).
nhirng khdng cd sy khac biet vdi nhdm so sanh tai thdi diem sau dieu tri. Ben ban cau lanh. thoi gian a/T khdng cd su khac biet sau so vdi trudc dieu tri d tdng nhdm va
giua hai nhom tai thoi diem sau dieu trj.
Nhu vay. su dan hdi cua thanh mach hen ban can lanh khdng thay doi dang ke.
The tich luu thong mau qua ban cau dai nao cung giu vai tro quan trong trong sice- dam hao chuc nang binh thuong cua nao.
Trong qua trinh phat trien cua con ngudi luu krone tuan hoan nao giam theo tudi. trong trudng hop tdn thuong do thieu man nao cue bp luu lupng tuan hoan nao d ban cau ton thuong trudc va sau dieu tri ctia hai nhdm dieu tri giam hon so vdi ban cau lanh [3]. lai nhdm nghien cuu. lun luang mau (V|« ml phut) cua ban cau ton thuong cd sir thay ddi sau so vdi trudc dieu tri (p- 0.001 ) va tang hon cua nhom so sanh (p- 0.01) tai thdi diem sau dieu tri. Nhir vay. thdi gian a va a I rut ngan cho thay dp dan hdi. truong luc thanh much thay ddi nen luu luong mau qua to chuc dii dupe cai thien. Tai ban cau lanh. luu luong mau khong cd sir thay doi sau so voi trudc dieu tri cua tdng nhdm va giira hai nhdm.
Chi so Ri phan anh mire dp nap mau cua viing dong mach thupc thi tiim thu duoc the hien qua tv sd giira bien dp cua sdng vil do chuan cua may. Ciu so nay giam tir tudi thanh nien sang trung nien vii it thay doi tir tuoi trung nien sang tuoi gia [3] Qua bang 2. ciu so Ri tai ban cau tim thuong thap hern ban cau lanh d ca hai nhom. Sau dieu tri chi so nay tiing len d nhom nghien cdu (p<0.01 ). sir thay doi cirng co sau dieu tri tai nhom so sanh nhirng khong cd sir khac biet (p<0.05). Chi so nay khdng cd sir khac biet tai him cau lanh ca hai nhdm sau so vdi trudc dieu tri nhung cd su kluic biet giira hai nhom (p- 0.05) tai thii diem sau dieu tri.
2. Ve hinh dang song
I linh dang do tin va diic diem cua nhirng song phuc tren bang ghi luu huyet mio cd v
nghTa quan trong trong vice danh gia trang thai elide nang cua nao. I rong thdi gian tiim thu. man vao nao time len kim tang dp diin dien va giam dien tra. Tren ban ghi luu huvet mio hien tupng nay duoc bieu llu himg hinh anh thay ddi bien do cua nhanh len. o phia day mini cham moi luong quan giira do dan dien va dien tro lai ngupc lai.
tren ban glu luu huyet mio the hien qua nhanh xudng cua dd thi. Nhu vay. nhanh lim cua do thi the hien kha nang dim cua mach duoi tiie dime cua luu lupng mini chay qua.
nhanh xudng the hien co cua thanh mach de phuc hoi vi tri ban dim do do mach mau co lai se xuat hien cac song phu tren ban elii ciing la the hien dp dim hdi cua thanh much [3], Qua bang 3-4. ben ban cau ton thuong.
nhom nghien ciru cd ty le dirong len nhanh cao hon nhom so sanh (p- 0.05). song chain it hon co cua sir kluic biet sau dieu tri giira hai nhdm. Song phu eii tiing sau so voi trudc dieu tri cua tune nhom nhung khdng co sir kluic biet giiia hai nhom. lai ban cau lanh. tv le dudng len nhanh. chiim cd sir thay ddi sau so voi trudc dieu tri cua tung nhom va giua hai nhdm (p<0.05). Trong khi do song phu cd sir thay doi it sau so vdi trudc dieu tri cua tung nhdm va khdng cd sit kluic biet giiia luu nhom tai thoi diem sau dieu tri.
Qua su so sanh giira hai nhdm cluing tdi thay rang bien doi cac chi tieu cua luu huyet nao do o nhom nghien ciru tdt hon. dupe cai thien nhieu sau dieu tri. dieu do chime to ning tac dung dien chiim huyet Phong tri trong phac do huyet dieu tri tai bien thieu mau nao cue bd. nghien ciru cua chiing toi cho thtiy cd nhung diem tuong ddng vdi ciie nghien ciiu va dii dupe cdng bd cua cue tac gia o hoc viim Trung Y Quang lay ve huyet Phong tri: co tac dung hoat huyet ro. dieu tri ci) hieu qua chung u huyet thudng giip o liet
TAP CHI CHAM CUU WET ISAM.
nua ngirdi. Phong tri la mdt huyet cd tac dung chong co that va co giat manh. dac diet la chong co that mach mau nao |S|
rdc gia Chu Qudc Truong [7] nghicn cdu diiiu tri thieu nang tuan hoan nao man tinh hang phuong phap bam huvet Phong tri. lam du va Cach du. Cac trieu cluing lam sang giam. luu huvet nao cd bien ddi sau dot dieu tri so vdi trudc dieu tri. I heo Doan Van hep [6| nghien ciiu tac dune cua phuang phap bam huvet Phong tri tren lam sang va luu huvet nao o benh nhan thieu nang tuan hoan man tinh. I ren luu huvet nao do. cac thong so cd sir bien ddi rd ret sau dot dieu tri so vdi trudc dieu tri (p- 0.001 ).
V. Kit luan
- Dien chiim phac dd huvet cd Phong tri co tac (.lung giam thdi gian it. a I %. luu luong mau tiing. chi so Ki time tren luu huvet nao do.
- Cai thien luu huvet nao. giam truong lire thanh mach. tang sir dan hdi cua mach mau nao. time luu lupng mail nao o ban cau ton thuong.
Tai lieu tham khao
I. I rim Phuong Ddng (2001 I. Nghien cuu dac diem sinh ly huyet Phone tri va anh hirong cua dien cham huyet nav len dien
nao do va dien tam dd. I nan vim I hue sy i hoc. 1 rudng Dai hoc Y Ha Npi.
2. Hd Huu I.none (1998) Lam sang than kmh. 1.5. NXB Y hpc
5. Dao Phone liin (1993) Liru huyet nao.
Mdt so tham do chuc mine sinh ly.
NXB Y bpc
4. Nguyen Xuim hum (1998) Ghi luu huyet nao. Cae phuong phap chim doan bd trp ve than kmh. Hoc v ien Quan y. Bp mon
I hdn kmh. NXB Y hoc
5. Nguyen lai I hu. I ran I huy ( 1997) ( ham ciru sau dai hoc. NXB Y hoe
6. Doan Van l iep (1999). Nghien ciru tac dune cua phuong phap bam huyet Phong tri len lam sang va luu huyet nao o benh nhan thieu nang tuan hoan nao man tinh.
1 lidn vim thac sy Y hpc. Hoc vien Quan v
". Chu Qudc I rudng. ( 1996) Nghien cuu lam sang thieu nang tuan hoan nao man tinh giai doan dim theo Y hoc ed truyen va dieu tri bang phuong phap bam huyet. Luan an PTS Y duoc. hoe v ien Quan v
8. Zang Quaobao. Xie Quang. Shan Buoxhi ( I 9941. "Wei Jia's experience on the application of I enchi (GB20)"' World .1- Acup-Mo.x.March. (4| I I.P9-I4.
