Nghien cuu bien chung sau dot quy thieu mau nao cue bp
BS. Nguyin Van Thanh*, PGS. TS. Vu Anh Nhj ••
*Benh viin Da khoa Trung tdm Tien Giang
** TrUdng bg mon ngi thdn kinh Dai tigc YDi/ac, TP. Hd CtiiMinti
T6MTAT
Muc tieu: Khao sat cac bi^n chijrng sau dot quy va mS\ li^n quan gida mot s6 bi^n chijmg v6i c^c yeu to nguy co cung nhirton thuong mach mau tuong ijrng.
Phirong phap: Oay la nghien cijru tien ciJu, cat ngang mo t^, dfii tuong la nhiing b6nh nhan dpt quy thieu mau nao cap nhap khoa Noi Thjn kinh Benh vi$n Cha Ray va nhOrng b^nh n^y dU9c kham lai t^i thdi diem 3 thang sau dot quy.
Ket quS: Co 203 trudng hop dot quy thi^u mau nao cap, trong do c6 nam 121(59,6%), nit 82 (40,4%). Tudi thSp nhat la 18 va cao nhat la 91; tudi hay g$p 46 -59 (29,1%) va tudi 60-80 (48,87o);
bien chijmg gom: Dot quy tai phat (19,2%), co giat (3,9%), yeu liet (hoan toan 6%, khdng hoSn toan 80,7%, khdng ygu liet 13,3%); tram cSm (36,9%); sa sijt tri tue (42,4%); co cijtng co (26,1%);
rdi loan tieu ti^n (11,8%); nhiem triing tidu (26,1%); viem phdi (11,3%); l o « ti ik (6,4%); till vong (16,3%); dau khdp (28,1%); rdi loan van ngdn (42,9%), tat ca nghign curu trdn phii h9p nghien cilu Langhorne P va cdng su. Lign quan giiia mdt sd bien chiJrng vdi ydu td nguy CO nhtrsa sut tri tud: tu^i
>80 (52,4%) va < 46 tudi (37,5%); gidi nut (51,2%) va nam (28,9%); tang huyet ap (42,0%), dai thao dudng (69,2%), rdi loan lipid mau (44,8%), udng nhieu ruou (32,5%), hut hudc la (27,4%), xo Vila ddng mach (36,4%), benh tim mach (64,7%), it van ddng the due (45,8%), benh m;ch mau ldn (75,9%) va benh mach mau nhd (38,8%); tram cam: tudi > 80 (36,4 % ) , <46 (12,5%); nam (42,1%), nii(29,3%); tang huyet ap (40,5%); dai thao dudng (18%); rdi loan lipid mau (27,1%);...
Ket luan: Cd rat nhieu bien chijing sau dot quy tai thdi diem 3 thang: bien chQng tam thSn, thin kinh va nhiimg bien chumg khac. Lien quan cua cac bien chumg vdi cac yeu td nguy cc rat rd nhutang huydt ap, dai thao dudng ddng thdi lien quan tdn thuong mach mau ldn va nhd.
TIT khoa: Bien chijrng sau thieu mau nao
I. OAT VAN DE trinh nghien cufu cho thay, bien chumg sau dot Benh nhan (BN) sau dot quy ngay cang duoc ^"« 9'= '^"9 ^°" ""= " " " * " "uan vdi nhifng quan tam d cac nudc tren the gifli bdi co ra't ydut6nguycanhiItanghuyetap(THA),daithao nhieu bien chiing anh hiring chat lirong cuoc i 5 * " g PTB). hut thudc la ... va dich te hpc nhi/
sdng nhu tram cam, sa siit tri tue (SSTT) va dac tudi thp ngay mot tang cao thi sa silt tri tue cung biet la BN con tiep tuc tU vong.Theo mpt so cong ngay cang nhieu.
50 THANKINHHgCWIETNAMI5(3lO/2014 Website; hoithankinhhocvietnam com.vn
BAO CAO KHOA HOC k.
Da CO nhi^u cong trinh nghien cdu trong va ngoai nudc ve dot quy thieu mau nao chung cho mpi Ida tuoi ve cac phuong dien nhuyeu td nguy ca, tien luang, tCf vong... NhUng rat ft cong trinh nghien ciru ve ITnh vdc nay. Cf nUdc ngoai thi cd cong trinh cCia Freddi Segal - Gidan va cpng sU [15], ve su suy giam tam than va the chat; cong trinh cCia Helena C. Chui va cpng su [16] nghien cull suy giam nhan thUc tU nhe den nang cua benh nhan dot quy thieu mau nao nhung cung chi nghien cdu mpt vai bien chdng. Tuy nhien cung da co cdng trinh nghien cdu toan dien hcfn do la cong trinh cua Langhorne P va cpng su [20]
da nghien cuu hang loat cac bien chung sau dot quy d cac thdi diem 1 thang, 3 thang, 6 thang, 1 nam...
6 nUdc ta co vai cong trinh nghien culi ve bien chiJng sau dot quy nhu'ng chi nghien CUXJ vai bien chufng. Chinh vi nhCfng ly do tren chung toi tien hanh de tai "Nghien cUu bien chUng sau ddt quy thieu mau nao cue bp" vdi cac muc tieu sau; Khdo sdt bien chdng sau dot quy va moi Hen quan gido mgt so bien chdng vdi cdc yeu to nguy ca cung nhd ton thddng mach mdu tddng dng.
II. DtfI TUONG VA PHUDNG PHAP NGHIEN COU
1. Thiet ke nghien cuTuCat ngang mo ta, tien cdu.
2. D6\ tucftig nghien cuTu
Ddn so muc tieu: Tat c^ cac trUdng hop dot
quy thieu mau nao cap tai Benh vien Chp Ray.
Ddn so nghiin cufu: Tat c^ cac trudng hop dot
quy thieu mau nao cap tai khoa noi than kinh benh vien Chp Ray trong thdi gian nghien CUXJ th6a tieu chuan chpn vao va tieu chuan loai ra.
2.1.Tieu chudn chgn benh
- Benh nhan dupc chan doan ddt quy thieu mau nao cap, khi thoa man cac tieu chuan chan Website hoithankinhhocvietnam.com.vn
doan dot quy cua To chdc Yte The gidi: Khdi phat dot ngpt vdi cac bieu hien lam sang cua roi loan chirc nang than kinh khu tru hoac toan the cua nao keo dai hdn 24 gid hoac dan den tCf vong ma khong co nguyen nhan rd rang nao ngoai ton thuang mach mau nao.
- Nhap vien trong thdi gian nghien cUu, ddac chpn lien ttep.
- Nhap vien trong vong 3 thang sau dot quy.
- Co hinh anh chup cat Idp ^en toan (CTScan) hoac hinh anh cpng hudng tU{MRI} de chan doan xac dinh.
2.2.Tieu chuan logi trU
- Benh nhan bj huyet khoi ti'nh mach nao.
- Benh nhan bj xuat huyet nao, xuat huyet khoang dudi nhen.
- Benh nhan khong duac theo doi day du trong khi nam vien va sau khi xuat vien.
3. Phan tich sd lieu
So lieu dupc xCr ly va phan tich bang phan mem SPSS 16.0.
BU&C 7; + Dau tien thdng ke mo ta chung cac
bien so nghien cdu.
+ Chia mau ra thanh nhieu nhom thieu mau nao cue bp: Nhom tuoi <46;46 - 59; 60 - 80; > 80.
Chiing toi tim nhCfng bien chLfng sau dot quy tai thdi diem 3 thang.
Bu'(dc2: Tim moi lien quan gida yeu td nguy
CP vdi cac bien chiifng cung nhu lien quan ton thuong mach mau, dung phep kiem chi binh phUPng de thuc hien cac bien so dinh tinh nay.
ill. KET QUA NGHIEN CUTU VA BAN LUAN TCr thang 10 / 2008 den thang 4 nam 2009, tai khoa Npi Than Kinh Benh vien Chp Ray, chiing toi thu thap duac 203 trddng hpp dot quy thieu mau nao cue bo cap thda tieu chi chgn mau.
Sau khi phan tich so lieu chung toi dat dupc
5 0 10/2014 I THAN KINH HOC VIETNAM 51ket qua n h u sau: Trong 203 benh nhan cd nam 121 (59,6%), na 82(40,4%).
1 . Oac diem nhdm BN dot quy thieu mau nao cue bo
1.1. Cdc yeu to dich te 1.1.1.Tuoi
Trong so 203 benh nhan (BN) co 24 BN (11,8%) dudi 46 tuoi va 179 BN (88,2%) tU 46 tuoi t r d len.
Ket qua nay cung gan nghien cUu cua Le Nguyen NhUtTin [5], ty le BN dUdi 45 tuoi (12,8%) va tren 45 tuoi la (83,2%). Bieu nay cung phu hop y van cho rang dot quy hay gap d ngUdi cao tuoi.
112. Gidi
Trong so 203 BN nghien cdu, ty le BN nam la 59,6% (121 BN) nCf la 40,4% (82 BN). Ket qua nay phu hpp vdi nhieu nghien ci^u sau:
• Nghien cuu ve djch t§ hpc dot quy tai 3 tinh thanh phia Nam cua Le Van Thanh va cong su [4]
ghi nhan ty le mac benh d benh nhan nam va nCf lan luat la 54,14% va 45,86%
• Ty le nam, nCf trong nghien cifu ciia Di Carlo va cgng su [14] la 78,8% va 78,3%
1.1.3. Nai cdtru
Ty le BN song d nong t h o n 51,7% va thanh thi la 47,8%, ket qua nay khac nghien cdu sau:
• Nghien cifu Truong van luyen va cong su [3]
ghi nhan t y le BN d nong t h o n va thanh pho theo thif t u la 50,34% va 49,66%
•Theo tac gia BuiThi Lan Vi [7] thi t y le BN sdng 6 nong t h o n 51 % va thanh thi la 49%
Vay nghien cud cua ehung toi eung phu hpp vdi cac tac gia tren.
/. 1.4. Trinh do hgc vdn
Nghien cUu ciia chung toi, trinh dp hpc van:
trinh dp cao 41 BN (20,2%), trinh dp trung binh 144 BN (70,9%), trinh dp thap 18 BN (8,9%).
Theo nghien cdu ciia Nguyen Thi fVlinhTri [6]
trinh dp hpc van: thap 99 BN (42,3%), trung binh 104 (44,4%), eao 31 BN(13,2%).
N h u vay theo nghien cUu ciia chung toi va tac gia Nguyen Thi Tri thi trinh dp hpc van trung binh chiem t y le cao nhat do phan Idn ngUdi dan hoc duac cap 1-il.Theo nghien cdu cua Barba R va cpng sU [11], ty le BN d o t quy m u chijf la 27,1%
(68/251 BN).
1.2 Cdc yeu to nguy cu 1.2.1. Tdng huyet dp
Benh nhan eo tang huyet ap {THA)131 (64,5%).
Nhuvay phan ldn BN dot quy cd THA.
Ty le BN c6 THA trong nghien eUu eiia Le Nguyen Nhut Tin [5], Le Van Thanh [4] lan lUpt la 68,3% va 79,7%.Theo nghien cdu eua Barba R [11]va eong sUthi t y leTHA d BN d o t quy 59,8%.
Nhu vay hau het eac tac gia deu cho thay THA rat t h u d n g gap t r o n g d o t quy.
1.2.2. Bdi thdo dddng
T9 le BN dupc chan doan dai thao dUdng (DTD) 12,8%.
Theo ket qua nghien edu cua Le Van Thanh va epng sU [4], t y le BN dot quy cua dai thao dudng la 3,82%.
Ty le nay trong nghien cUu eiia Bui Thj Lan Vi [7] la 17,2%.
Trong nghien CUXJ A A S A P [8] t y le dai thao dudng thay doi tU 15% den 4 0 % t u y quoc gia.
Qua nhCTng ty le ghi nhan dupc tCf cac nghidn cii'u neu tren cho thay t r o n g d o t quy dai thao dudng it gap han THA.
1.2.3. Lipid mdu (RLLP)
T9 le BN tang Triglyceride la 34,4%. Ket qua nay cao hdn so vdi nghien cifu ciia Bui Thi Lan Vi [7] (12,4%) va thap ban cua Le Nguyen Nhut Tin [5] (70,2%).
Ty le tang Cholesterol t r o n g nghien cdu cCia chung toi la 28,1 %, t u a n g dUPng ket q u ^ nghien cifu ciia BCii Thj Lan Vi [7] (32,8%). Tuy nhien, ty le nay cao hdn khi so vdi nghien cdu cCia PohjasvaaraTva cpng sU[21] (17,5%).
52 I THAN KINH HOC VIET NAM I 5 0 10/2014 Website: hoithankinhhocvietnam.com.vn
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1.2.4. Hut thuoc
Trong203BN hut thuoc chiem (39,4%. Ketqua nay tUdng doi phu h a p vdi nghien ciili AASAP [8]
t y l e BNhCitthu6echiem22,5%-40,6%)va nghien cdu cua Barba R va cpng su [11]ty le la 47,4%.
Tom lai, hut thuoc la yeu t o nguy cd t h u d n g gap trong dot quy. Theo tae gia BUi Thi Lan Vi [7] hut thudc la co lien quan d o t quy. Vi vay nen tranh hut thuoc de g i l m nguy cd dot quy.
1.2.5. Xavda ddng mach
Trong 203 t r u d n g hdp nhoi mau nao (NMN):
50 BN (47,8%) cd mang xd vCfa va 11 BN (10,6%) CO hep d p n g mach.
Ket qua nghien cUu ciia chiing toi cung phu hdp vdi khcio sat Le Nguyen Nhut Tin [5] thay 65 BN (48,5%) CO mang xdvOa va 14 BN (10,4%) cd hep d p n g mach.
2. Tan suat bien chufng sau dot quy vao thai diem 3 thang
Bien chuYig sau d o t quy tai t h d i diem 3 thang chiem t y Id cao dUng hang thUnhi cua bien chUng sau d o t quy d tuan dau, theo tac gia Indredavik B va cpng sU [17] thi cho rang bien chdng sau dot quy d tuan dau la cao nhat ke ke den la bien chUng sau d o t quy tai t h d i diem 3 thang va 6 thang. Nghien ciifu cua chiing toi tai thdi diem 3 thang;
Trong sd 203 BN co cac bien chdng: t i f vong (16%), d o t quy tai phat (19,2%), eo giat (3,9%), eo cdng c d (26,1 %), tram cam (36,9%), sa sut tri tue (42,4%), roi loan tieu tien (11,8%}), nhiem triing dudng tieu (26,1%), viem phoi (11,3%), loet ti de (6,4%).
Cac bien chufng tren tU cae benh ly thieu mau nao cue bp: Benh mach mau nhd 171 BN (84,2%)), benh mach mau Idn 29 BN (14,3%). Cac t d n t h u a n g mach mau t r o n g nghien culi cua chung toi cung phu h o p nghien cdu ciia tac gia nudc ngoai.
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Theo tac gia Langhorne P va cpng sU [20], tan suat bien chUng dot quy thieu mau nao cue bp cap luc 3 thang vdi 311 BN trong d o cd bien chung 256 BN (85%), g o m : dot quy tai phat (9%), CO giat (3%), nhiem trung dudng tieu (24%), viem phoi (22%)), nhiem trung khae (^9%), yeu liet khong tU di lai (25%), liet hoan toan (5%), loet ti de (21 %), thuyen tae tlnh mach sau (2%), thuyen t k phoi (1%), dau vai (9%), dau khac (34%>), tram c^m (16%), lo au (14%), roi loan cam xuc (12%), sa sut t r i tue (56%). Trong d6 nhiem trung, mu thoang qua, dau, tram cam, lo au thUdng t o n tai lau dai.
Theo Indredavik B va cpng su [17] 489 BN dot quy cap dUde danh gia eo 16 BN bien chiitig tUdng t u nghien cdu Langhorne P nhUng bien chUng sdm han sau dot quy.
Nhdng BN dau than kinh (2 den 6 %), day la dau do ton thUdng doi thj, rdi loan chdc nang sinh due (36%)), sao lang thi giac (32 den 55%) ciia tac gia (Freddi Segal - Gidan, Helena C.Chui).
Chiing toi gap kho khan trong hoi BN va ngUdi than nen khong thu thap duac so lieu nay.
6 Viet Nam cd vai nghien cifu bien chdng chung sau dot quy, nghien cdu djch te hpe dot quy eho thay cung co bien chUng sau dot quy thieu mau nao cue bp (75%) ciia Le Van Thanh va cpng sU [4] eac nghien cUu khae ve sa sut t r i tue chiem (40,4%) cua Le Nguyen Nhut Tin [5] tram cam (33,1%)) cua Bao Hung.Trong nghien cUu cua chiing tdi ket qua cho thay tan suat bien chifng sau dot quy thieu mau nao cue bp cap cung tUPng doi phu hpp vdi cac tae gia trong nudc cung n h u nghien ci^u eiia eac tac gia nudc ngoai.
3. Lien quan giufa cac bien chufng sau dot quy vdi cac yeu to nguy ctf tai thdi diem 3 thang sau dot quy
3.7. Lf en quan giCea bien chCtng sa sut tri tue sau dot quy vdi cdc yeu to nguy cU
S6 10/2014 I THJiN KINH HOC VIET NAM 53
3.1.1. Lien quan gida bien chdng SSTT vd nhdm tuoi
Nhom BN < 46 tudi eo ty le SSTT thap nhat (37,5%), nhom BN tren 60 - 80 tuoi co t y le SSTT sau d o t quy cao nhat (46,2%). Su khac biet nay co y nghta thong ke vdi P = 0.001. Ket qua nay phu hop vdi nghien eiiXi Le N g u y i n NhUtTin [5] vdi nhom BN tren 69 tuoi co ty le SSTT sau dot quy cao nhat so vdi cac nhdm con lai, Phan My Hanh [1]{27%). Dieu nay cung phu hpp vdi Y van cho la t y le mac benh tang nhanh theo su gia tang cua tuoi, duac nhan len gap doi sau moi 5 nam trong quan the ngUdi tren 60 tuoi. Ket qua nay cung tuong dong vdi nghien cUu ciia cac tac gia Initari D v a c 6 n g s u [ 1 8 ] . . . N h u v a y c h U n g t o t u o i CO lien quan SSTT sau dot quy
3.1.2. Lien quan gida bien chdng SSTT theo gidi Ty le BN nCTCo SSTT sau dot quy la 51,2% cao hdn BN nam ty le nay la 28,9%. Su khac biet nay CO y nghTa thong ke vdi P = 0,001. Ket q u ^ nay eung phiJ hpp nghien cdu Le Nguyen NhUtTin [5]
vdi SSTT nCf chiem 56%, nam chiem ty Ie29,1%).
Ngupc lai tac gi^ PohjasvaaraTva cong su[21] thi cho rang nam co ty le SSTT eao hdn nCf.
3.1.3Naicdtru
Ty le BN song d nong t h o n 51,7% va thanh thi la 47,8%, ket qua nay khae nghien cdu sau:
• Nghien CUXJ Truong Van Luyen va cpng sU [3]
ghi nhan t y le BN d nong t h o n va thanh pho theo thii'tU la 50,34% va 49,66%
•Theo tac gia Biii Thj Lan Vi [7] thi ty le BN song d nong t h o n 51 % va thanh thj la 49%.
Vay nghien cUu ciia chiing toi cung phCj hpp vdi eac tac gia tren.
Ket qua nghien cUu ciia chung toi, ty le SSTT sau d o t quy eua nhom BN song d nong t h o n va n h o m BN song 6 thanh thj lan lUpt la 42,4% va 38,8%. Khong cb su lien quan giOa ndi cd trii den tinh trang SSTT sau d o t quy vdi P = 0,400.
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Ket q u ^ nay tUdng d o n g vdi nghien cdu cua L4 Nguyen NhUtTin [5].Tuy nhien y van yeu t d noi cd tru khong dUdc nhac den, d o d d t h e d ket quci nghien cUu nay co le ndi eU t r i i it lien quan SSTT sau d o t quy.
3.1.4 Lien quan gida bien chdng SSTT vdi trinh do hgc vdn
Trong nghien cifu ciia chung toi, nhom BN khong khong biet chCf ehiem t y le SSTT cao nhat sau dot quy (71,9%) va hpc van tren c^p III (14,3%). SU khac biet nay eo y nghTa t h d n g ke vdi P <0,001. SU lien quan gida trinh dp hpc van vdi tinh trang SSTT sau d o t quy trong nghien cdu nay chuYigtodayla m p t trong nhdng yeu to nguy cd.
Dieu nay phu hpp vdi y van va eae nghien cii'u sau: Demond D W v a c p n g sU[13]...
3.1.5 Lien quan gida bien chdr)g SSTTvd THA Bdng 1. Lien quan gidaSSTTvd THA
Tang huyet ap
- K h o n g -Co Tong
Khong ( n , % )
41(57) 76(58) 117(57,6)
Co ( n , % ) 31(43.0) 55(42,0) 86(42,4)
Tong
72(100) 131(100) 203(100)
Ty le BN SSTT sau dot quy d nhom BN cdTHA la 42,0%. Tuy nhien su khac biet nay khong cd y nghTa thong ke vdi gia trj P = 0,883. Ket q u i nay phu hop vdi cac tac gia PdhjasvaaraTvacpng su[21]
3.1.6. Lien quan gida bien chdng SSTT vd ddi thdo dddng
Nhom BN cd tien can DTD cd bieu hien SSTT sau d o t quy chiem ty- le 69,2%. Co lien quan ty' le SSTT sau d o t quy BN cd DTD vdi P= 0,003. Ket qua chung toi phan nao chdng m i n h dUpc nhan d m h tren. M p t so nghien edu khac cung cho rang DTD co lien quan SSTT n h u D e m o n d D W v a c p n g sU[13].
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3.1.7. Lien quan gida bien chdiig SSTTva RLLP mdu Bdng 2. Lien quan gida SSTTvd RLLP mdu
RLLP mau
-Khong -Co Tong
Khong (n,%)
24(63,2) 91(55,2) 115(56,7)
Co ( n , % ) 14(36,8) 74(44,8) 88(43,3)
l o n g
38(100) 165(100) 203(100) Ty le SSTT sau dot quy 6 nhdn BN cd RLLP mau 44,8%. Khong co sU Hen quan gida tinh trang RLLP mau den tlnh trang SSTT sau dot quy vdi P= 0,369.
Nghien cdu cCia ciia Pohjasvaara va cpng sU [21] vdi gia t n P lan lupc la 0,038 va 0,04. Tuy nhien theo ghi nhan ciia tac g i i Desmond D W [13] la tang cholesterol khong lien quan SSTT sau ddt quy (P= 0,471). N h u vay chUa co sU t h o n g nhat ve vai tro cua tang cholesterol va SSTT sau dot quy, nhung cd t h e yeu t o nay lien quan SSTT.
3.1.8. Lien quan gid bien chdng SSTT vd xd vda dong mgch cdnh, cot song
Ty le SSTT tren n h o m BN cd mang xd vUa la 49,2%) (32/65 BN) va cd hep d p n g mach la 50,0%) (7/14 BN). Dieu nay co the xem n h u khong co sU lien quan giCfa xa vOa d p n g mach canh ngoai sp vdi tinh trang SSTT sau dot q u y .
3.1.9. Lien quan gid bien chdng SSTT va hut thuoc Id
Trong 203 BN h u t thuoc (ehiem 39,4%). Cd sd khac biet ve t y le SSTT sau d o t quy gida nhdm BN khdng hut thuoc va n h o m BN c6 hut thuoc vdi P= 0,003. Ket q u i nay phu hop vdi nghien cufu cua Le Nguyen NhUtTin [5] BN hut thudc cd SSTT sau d o t quy chiem 40,4% va phu h d p nghien cifu Pdhjasvaara T va cpng sU [21 ].
Theo y van nhCfng ngudi hut thuoc co nguy CP lam nang hdn su suy giam nhan thdc so vdi ngUdi khong hiit thuoc la.
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3.1.10. Lien quan gida bien chdng SSTTvd xa vda dgng mgch
BN CO bien chUng SSTT lien quan xa vCfa dpng mach 24 BN (36,4%) SU khac biet nay khong co y nghia t h o n g ke vdi P = 0,288
3.1.11. Lien quan gida bien chdng SSTTvd benh tim mgch khac
BN bien chufng SSTT lien quan benh tim mach khac 11 BN (64,7%) va khong lien quan 70 BN (37,6%).
SU khac biet nay co y nghta thong ke vdi P = 0,028.
3.1.12. Lien quan gida bien SSTT vd van dgng the due
BN bien chiTng SSTT lien quan van dpng the due, it van the due 65BN (45,8%), khong lien quan 16 BN (26,2%)) Su khac biet nay co y nghTa thong ke vdi P = 0,04.
3.1.13. Lien quan gida bien chdng SSTTvd benh mach mdu
Bdng 3. Lien quan gida SSTTvd benh mgch mdu nhd
Benh mach mau nho -Khong -Co Tong
Khong (n,%) 17(54,5) 105(61,2%)
122(80,1) Co (n,%) 15(45,5%) 66(38,8%) 81(39,9)
Tong
33(100) 170(100) 203(100) BN bien chUng SSTT lien quan benh mach mau nho 66 BN (38,8%) va khong lien quan 15 BN (45,5%). Su khac biet nay khong co y nghTa thong ke vdi P = 0,247.
Bdng 4. Lien quan gida SSTTva benh mgch mdu Idn
Benh mach mau Icrn - Khong -Co
Tong
Khdng (n,
%)
115(66,1
%)
7 (24,1 %) 122(30,1)
Co (n,%) 59( 33,9 %) 22 (75,9%)
31(39,9) T6ng
174(100) 29(100)
203(100)
S 6 10/2014 I THAN KINH HOC VIET NAM 55
BN bien chdng SSTT lien quan benh mach mau ldn 22 BN (75,9%) va khong lien quan 59 BN (33,9%). SU khac biet nay cd y nghia thdng ke vdi P = 0,001
1.2. Liin quan giUa bien chiing trdm cdm va sau dot quy vdi cdc yeu to nguy ca
3.2.1. Lien quan gida bien chdng tram cdm vd nhdm tuoi
Trong nghien cUu ciia chung toi cho thay BN d tuoi <46 chiem 12,5% tram cam sau dot quy, tuoi 46 - 59 (chiem t ^ le 31,4 %) va d dp tudi 60 - 80 (chiem t^ le 42,3%). Nhuvay, theo ket qua tren ty le tram cam d BN sau dot quy dp tuoi tii 60 - 80 cao hdn so vdi dp tuoi 40 - 60 dieu nay cung phu hpp ghi nhan tac gia Bao hung; [2] nhom tuoi <
40 chiem 0,00%, nhdm tuoi t U 4 0 - 60 tuoi tram cam sau dot quy 40,3% va 60-80 tuoi 37,6%>, va ket qua nay cung tUdng tU n h u nghien cUu ciia PohjasvaaraT [21] Dai Hpc Helsinki.
3.2.2. Lien Lien quan gida bien chdng trdm cdm va gidi
Theo ket qua nghien ciifu tren 203 BN ed 51 BN nam (chiem ty le 42,1 %) va 24 BN nCf (chiem ty le 29,3%) bj tram cam sau d p t quy. NhU vay, trong nghien cifu eua ehung toi 6 nhCfng BN d o t quy t y le tram c i m nam gidi cao hdn nijf gidi phij hpp nghien cdu cua tac gia B i o Hung [2] tram c i m sau d o t quy nOf chiem 31,8%), nam chiem 39,08%
Trong nghien ciru cua Anu Berg va cpng su [10] thi nhdm Idn tuoi cua nCf gidi cd t y le tram cam cao hdn, con d n h o m t u o i tre hdn thi nam gidi chiem ty- le cao hdn. Nghien cdu Rdbinson va cpng sU [22] tim thay lien quan giCfa tuoi tre va tram c i m sau dot quy, ket qua nay cung t u a n g tU n h u t r o n g nghienedueCia Anu Berg [10].
56 THAN KINH HOC VIET NAM I S 6 10/2014
3.2.3. Lien quan gida bien chdng trdm cdm vd THA
Bang 5. Lien quan gida trdm cdm vd THA
t i n g huyet ap - Khong -Co Tong
Khong (n,%)
53(73,6) 78(59,5) 131(64,9)
Co ( n , % ) 19(26,4) 53(40,5) 71(35,1)
T6ng
72(100) 131(100) 203(100) Benh nhan bien chiifng tram c i m co lien quan THA chiem t y Id 40,5%). Ket qua nay khdng phii hpp nghien cdu cua tac gia Bao Hung[2] BN tram cam lien quan THA chiem 17,03%. Ket q u i nghien cUu cua chung toi cung phu hdp vdi tac gia Desmond DW [13], BN tram c i m sau dot quy thieu mau nao cd lien quan den THA la 68,1%.
3.2.4. Lien quan gida bien chdng trdm cdm vd DTD
Bdng 6. Lien quan gida trdm cdm vd DTD
Dai thao dudng
- Khong -Co Tong
Khdng (n,%)
105(61,9) 28(82,0) 133(65,5)
Co ( n , % ) 64(38,1)
6(18,0) 70(34,5)
Tong
169(100) 34(100) 203(100) Benh nhan tram c i m cd lien quan tieu dudng 6 BN (18,0%) va khong lien quan 64 BN (38,2%).
Ket qua nay khac vdi nghien cdu ciia tac g i i Desmdnd DW [13] BN tram cam sau dot quy thieu mau nao cd lien quan den DTD la 38,3%. Nghidn cdu cua chung toi khac vdi nghien cdu cua tac gia tren, co le mau nghien cdu cua chCing toi nhd 3.2.5. Lien quan gid bien chdng trdm cdm vd RLLP mdu
Benh nhan tram c i m cd roi loan lipid mau 44 BN (27%) va BN tram c i m khong roi loan lipid mau 17 BN (45,3%). Ket qua nay khac vdi nghien Website: hoithankinhhocvietnam.com.vn
BAO CAO KHOA HOC k.
cUu cCia tie gii Jacque Joubert [19] tram cim (tang Cholesterol la 58,8%), cd le mau nghien cdu cua chung toi nhd hdn tic gii tren.
3.2.6. Lien quan gida bien chdng tram cdm va uong rdgu nhieu
Benh nhan bien ehiifrig tram cam lien quan vdi udng rUdu nhieu (32,5%) va Khdng udng rUdu nhieu (46,0%). Kdt qua nay phu hpp vdi nghien edu ciia tac gii D.W. Desmond [12], BN tram cam lien quan vdi uong rUdu la 30%.
3.2.7. Lien quan gida bien chdng trdm cdm vd hut thudc Id
BN CO bien chiifng tram cim lien quan vdi hut thuoc (22,1 %i) va khong lien quan (38,0%)). Ket qui nghien cdu nay phu hpp vdi nghien cdu eua tic gii Antero Leppavuori [9], BN tram cim lien quan vdi hut thuoc la 20,6%.
IV. KET LUAN
Cic bien chdng sau dot quy gom: - Sa sut tri tue chiem ty le cao, trong nhdm BN 60 - 80 tuoi.
BN nOf gidi chiem Uu the. Nhom BN co tien can DTD cd bieu hien SSTT sau dot quy chiem ty le kha cao cung nhuton thUPng mach mau chi phoi vung chien lupc: nhoi mau dong mach Idn de sa sut trf tue. Ngoai ra trinh dp hpc van, rung nhi, hut thuoc, it van dpng the due... cung inh hUdng den SSTT sau dot quy.
- Tram cam chiem ty- le kha eao, anh hudng nhieu chat lUdng cupc song, tf- le tram cim 6 BN sau dot quy dp tuoi tU 60 - 80 chiem ty' le cao han cac nhom tudi khac, BN nam cd bien chifng
tram cam sau dot quy thieu mau nao cue bp la cao han gidi nO. Yeu to nguy ca nhu THA, DTD, uong nhieu rupu, hut thuoc cung cd lien quan bien chUng tram cam...
- Roi loan ngon, roi loan nuot, roi loan tieu tien, co cdng ca xay ra cung khong ft BN va gay khd khan trong sinh hoat hang ngay...
V. MOT SO KIEN NGHI SAU KHI HOAN THANH NGHIEN Cifu
Qua ket qui khio sat tren cho thay co nhieu bien chUng sau dot quy. Neu dUdc dieu tn tot luc xay ra dot quy va dieu tn du phong day dii thi bien chUng sau dot quy se giim vi the chung toi CO kien nghi nhusau:
1. Dieu tn cie yeu to nguy cd ciia dot quy. Dac biet chu trpng den cac yeu to nguy cd co the dieu chinh dupe nhU: tang huyet ap, dai thao dudng, hut thuoc...
2. Tiep tuc theo doi lau dai sau dot quy de phat hien nhOng bien chUng than kinh (tram cam, sa sut tri tue...) va nhufng bien chutig khae ed the dieu trj dupe nhu (nhiem trung tieu, viem phoi, dau, eo cirng ca. ..).Tu'd6 co ke hoach dieu trj lau dai eho BN, trong do cd ci viec dieu tn du phong tUvong sau dot quy.
3. Chii y dieu trj tich cue luc dot quy vdi phUdng phap hieu qui nhat de lam giim mifc dp nang cua benh cung nhU cham sdc that tot de giam thieu nhdng bien chdng luc dot quy cap thi bien chUng ve sau se it ban, cai thien dU hau dot quy.
Website: hoithankinhhocvietnam.com.vn 50 10/2014 I THAN KINH HOC VIET NAM 57
ABSTRACT
Objective: To investigate medical complications after ischemic stroke and relationship between some complications of stroke and other risk factors corresponding artery dieases.
Method: This is prospective, cross-sectional study in ischemic stroke patients to be hospitalized at Department of Neurology, Cho Ray Hospital and the patients were re-examined at the end of three months after got stroke.
Results: There were 203 patients with a diagnosis of acute ischemic stroke including 121 (59.6%) male and 82(40.4%) female. The patients who are investigated from 18 to 91 years old and often from 46 to 59 years old (29.1 %) and 60 to 80 years old(48.8%).Spedfic complications were as follows: neurological- recurrent stroke ( 19.2%), epileptic seizure (3.9%), paralysis (6% completely, 80,7% uncompletely and 13,3%without paralysis), psychological-depression (36.9%), dementia(42.4%), spasticity (26.1%); urinary incontinence (11.8%),infections - urinary tract infection (26.1% ) . pneumonia (11.3%). pressure sores (21%), mortality (16.8%), joint pain (8.1%), and aphasia (42,9%). These results are quite similar with the results of Langhorne P and his co - researchers. Relationship between some complications of stroke and other risk factors: dementia >80 years old (52,4%), p=0,001},<46years old (37,8%); mole (28,9%), female (21,2%), hypertension (42,0%), diabetes (69,2%),dyslipidemia(44,8%),olchoholsim (32,5%), smoking (27,4%), arteriosclerosis in carotid artery(36,4%). cordivascular(64,7%). not exerclse(45,8%), small artery disease (38,8%) and large artery disease (75,9%,p=0.001). Relationship between psychological- depression and other risk factors : Depression >80 years old (36,4%), <46years old (12,5%); male (42,1 %), female (29,3%); hypertension (42,0%), diabetes (69,2%),dyslipidemla(44,8%)...
Conclusion: There are complications up to 3 month after stroke including : psychology, neurology and others medical complications, the complications are related with risk factors such as hypertention, diabetes. as well as large and small artery disease.
Keywords: Complications after ischemic stroke.
TAI LIEU KHAM KHAO A.TAlLlgUTliNGVI$T:
I. Phan My Hanh, Phan Cong Tan, Vu Anh Nhj (2007), "Sa sut tri tue sau dot quy nhoi mau nao, tan suat va cac yeu to nguy cd', trong: Tap san than kinh hoc, tr. 45 - 47.
* . Bao Hung (2004). "Khao sat tan suat tram c^m sau dot quy bang thang diem Hamilton va thang diem Beck"
Luan van thgcsJyhqc, da bao ve.Dai hpcY DuocTp. Ho Chi Minh.
J . Tri/cmg Van Luyen va cong sU (2004)."Nhufng so lieu ban dau ve Homocystenie huyet thanh 6 benh nhan dot quy dieu tri khoa than kinh Benh vien Cha Ray". TaW/eu bdo cdo fchoa hoc. Hoi than kinhhocTp. HoChi IVIinh,(3),tr:22-26,
4. Le Van Thanh va cong sU (1995). "Nghien cii'u SO bpve dich te hpc tai bien mach mau nao tai 3 tinh thanh phia Nam:Tp. Ho Chi IVlinh,Tien Giang, Kien Gang". Cong trinh nghien cdu khoa hoc 1994-1995, Ba\ hpcY DuocTp.HoChiiVlinh.
58 THAN KINH HOC VIET NAM I S 6 10/2014 Website- hoithankinhhocvietnam com.vn
BAO C A O K H O A H O C ^
5. Le Nguyen Nhut Tin (2006). "Tan suat v^ cac yeu to nguy ccf cua sa sut tri tue sau dot quy". Luan van bdc si ngi tru, da bao ve. Dai hpc Y Dupc Tp. Ho Chi fvlinh, tr: 41 -43.
«. Nguyen Thj MinhTri (2007)."Nghien cdu mot so yeu to nguy co cita dot quy thieu mau nao cue bo cap tren ngudi cao tuoi". Luan dn chuyen khoa cdp II, da bao ve. Dai hoc Y Duoc Tp. Ho Chi Mmh. tr: 54-83.
'- BCii Thi Lan Vi (2003). "Khio sat tan suat cac yeu to nguy cd tai bien mach mau nao" Luan van thac siy hoc.
Bo mon than kinh. Dai hoc Y Dupc Tp. Ho ChiMinh
B. TAI LIEU TI^NG ANH:
8. AASAP (2000). Stroke epidermiological data of nine Asian countries. JMed^lssocT/ia/, pp: 7 - 1 . 9. Antero Leppavuori,et al (2003);'Generali2ed Anxiety Disorders after ischemic stroke",Strajife, pp:257- 2.
10. Anu Berg M et al (2003), "Poststroke Depression an 18 - month follow - up'; stroke (34), pp: 143 - 138.
11. Barba R et al (2000)."Poststroke dementia. Clinical features and risk factors".Strofce, 31: pp: 1501 -1494 12. D.W. Desmond et al (2003)," Ischemic stroke and depression". The enternatial Neuropsychologycal society.
pp: 929-429
13. Desmond D W, Moroney J T, Sano M, Y (2002). "Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA.33"{9):pp 226 - 2 Stroke. 2002 Sep; 33(9), pp: 2261 - z.
14. Di Carlo A et ai (2006), "The European Biomed study of stroke care group, risk factor and outcome of subtypes of ischemic stroke". Journal of the Neurological sciences, 244, pp:143 - 84.
15. Freddi Segal-Gidan (200), "The Chronic Stroke Patient: Management of common ischemic medical proplem" management of ischemic stroke, pp: 189 -181.
16. 16. Helena C. ehui (2000), "The Chronic Stroke Patient: Management of Cognitive Impairment" Monagement of Ischemic Stroke, pp: 195 - 187.
17. Indredavik, Bent et al (2008). Medical Complications in a Comprehensive Stroke Unit and an Early Supported Discharge Service" Chirchill Living Stone, pp: 420 - 414.
18. Inzitari D, Carlo A D et al (1998). "Incidence and determinants of poststroke dementia as defined by an informant interview method in a hosoital - based stroke registry". Stroke, 29: pp: 2087 - 93.
19. Jacque Joubet, chirsreid et al (2005), "Risk Factor management and depresion Post - Stroke: The value of an entergrated model og care" ClinicalNeuroscience, pp: 90 - 84.
20. Langhorne P et al DJ (2000)."Stroke Zmedical complications after stroke: amuj ticenter study". Lancet, 31 (6) p p : 1 2 2 3 - y .
2 1 . PohjasvaaraT, et al (1998}."Ciinical determinnants of poststroke dementia'^fro/ce, 29, pp: 81 - 75.
22. Robison, et al (1984},"Mood disorder in stroke patients, importance of location of lesion" Brain,^07, pp:
9 3 - 8 1 .
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