Ke'T L U A N
Nghien cifu 258 b l n h nhSn SXHD cd sdc vS khong sdc di/oc dieu tri tai khoa Truyln nhilm BSnh vien 103 nSm 2009. ciiung tfli rut ra m i t sd y l u td tien lUdng so'c sau:
1. CSc yeu to tam sSng c6 y nghTa tien \U<fnQ Trong 5 dS'u hilu TCYTTG (1986) difa ra, chung tfli thS'y: VSt va hoSc li bi. dau bung tSng l l n , lanh d i u chi. da xung huyS't, dSi it; tS't ca p < 0,001. NgoSi ra cbn ghi nhdn t h i m : ha sfl't dflt ngdt. gan to, nfln nhilu. trSn djeh mSng ngoSi tim. trSn djch mSng phdi, tran djch mSng bung, xuS't huyO't nfli tang d i u IS nhiJmg ydu td ed 9 nghTa tien l^dng sde.
2. CSc yeu to can tam sSng: T i l u c l u < 30 G/l, bach c l u < 4 G/l, Het s 48% d i u IS eSc yeu td tien lUdng sdc.
T A I L I $ U THAM K H A O
1. Bfl Y Te (2009), Hudng dSn c h i n doan. d i l u tri sfl't Dengue vS sfl't xua't huyet Dengue, HS Nfli.
2. Bui Dai (2002), Dengue xuat huydt, NXB Y hoc, HS Ndi.
3. TrSn Khac Didn (2007), DSc diem lam sang, xSt nghiSm. d i l u tri sdt Dengue, sdt xuat huyet Dengue tai V i l n cae b l n h truyen nhiem va nhiet ddi qudc gia, LuSn vSn Bac sTCKII, HS Ndi.
4. LS DSng HS vS CS (1998), "Tinh hinh sdt xuat huydt Dengue (sdc vS khdng sdc) tai Vien y hoc lam sSng cSc bSnh nhiet ddi nSm 1998", Tai lieu tap huan c h i n doSn. d i l u trj SD/SXHD. HS Noi.
5. HS VSn Phiic (2006), Nghien cifu mpt sd dac d i l m djeh t l , ISm sSng vS ydu td tien lUdng benh sdt xult huydt Dengue d Huyin VTnh Thuan- Kien Giang, LuSn vSn BSc sTCKII. Hoc V i l n QuSn Y.
6. WHO (1986), Dengue haemorrhagie fever;
diagnosis, treatment and control. Geneva.
7. WHO (2009), Dengue haemorrhagie fever:
diagnosis, treatment and control, Geneva.
NGHIEN CUU MdT Sd DAC D | ! M V£ NHAN THUfC T^NG QUAT TREN B^NH
N H A N D 6 N GKINH NGl/Ol TRUONG THANH
N G U Y I N V A N HUdNG, Lt QUANG CUdNG, N G U Y I N KIM VIET Dgi hgc YHi Ngi
T6M TAT
Mgc tieu: Md ta. dinh gii die dtim nhin thue tdng quit trin binh nhin dgng kinh & ngu&i tnr&ng thinh.
Doi tugng vi phuang phap: 60 bgnh nhin ddng kinh truang thanh dugc khim, ehin doin theo binh in miu vi dinh gii nh$n thtic tdng quit bing test MMSE, tdng diim MMSE 30 vi dinh gii giam kha ning nhgn thue tdng quit tuang ung v&i sd dtim tmng binh MMSE giim din, dinh gii anh hirang cic yiu td nguy ca di/a vio so sinh ty suit chinh OR. Ket qua: dtim tmng binh vi MMSE giua hat gi&i (nam 26,3 ± 3,88; nu 24,9 ±2,91) khdng cd sw khic bigt (p>0,05)). Dtim MMSE giim rd rgt & nhdm dgng kinh cd su dgng Gardenal vi nhdm dgng kinh ed tin suit can diy (p<0,05). Ket iu$n: ed mdi Iiin quan giua su dgng Gardenal tmng diiu trj ddng kinh vi tan suit ean v&i glim khi ning nhin thue tdng quit
Ttf khda: Ddng kinh, nh$n thue tdng quit, Trie nghl$m tim thin tdi thiiu
SUMMARY:
Study some characteristics of general cognitive function on adult patients with epilepsy
Objective: describe and evaluate the genemi cognitive characteristics of the adult patients with epilepsy. Patients and method: MMSE (total scorn of 30 points) used to evaluate the genemi cognitive function, was done to 60 adult patients with epilepsy.
This study was conducted following cmssectlonal descriptive design. Results: them is no statistically diffemnt In tenvs of mean scorn of MMSE between two genders (p>0.05; male 26.3 ± 3.88; female 24.9 ± 2.91).Scorn of MMSE is mart<edly mduced tn patients using Gardenal and having fmquent selzums (p<0.05).
Conclusion: them is no statistically diffemnt in tenms of genemi cognitive function between two genders. Using Gardenal in long term can mduce genemi cognitive function. The mom fmquent the seizum is the more the cognitive function is mduced.
Keywords: Epilepsy, genemi cognition, MMSE DATVANOe
Dflng kinh IS bflnh ly xult phSt tu ton thuang d nao.
ngodi d e can dflng kinh. chue nSng eao d p d a ndo trong db eb chuc ndng nhSn thdc cung eb t h l bj anh hudng [2]. Trin Thi gi&i, dpng kinh IS mflt trong nhung bOnh ly hiOn nay dang dupe nhilu tSe gia nghiOn cuu dudi nhilu gbc dfl khSe nhau, trong db cb ITnh vyc nhgn thue[4;6]. De dSnh gid ve tinh trgng nhgn thue, ngodi thdm khdm Idm sdng ehuyen khoa tSm than kinh, bfl d u hbi trie nghiflm thin kinh tSm ly eua ICD 10 IS d n g cg khdch quan d l ddnh giS tinh chit vS nriirc dfl rli logn nhdn thuc [7]. Trong d c bfl d u hbi. Trie nghipm Tdm thin t i i thilu (Mini Mental State Examination:MMSE|
dupe xem Id mflt cflng cy cb giS tq sSng tpc ban dau de dSnh giS sa bO v l nhung r i i logn trong ITnh vyc nhgn thue gpi IS nhSn thue ting quSt. Vdi dfl nhgy vS dfl dgc hiOu eao, MMSE hiOn nay tren t h l gidi dang dupc sir dyng ring rSi d l nghiOn cuu sSng lpc bpnh nhSn rii logn nhSn thue nbi ehung vS sa sut tri tup nbi riOng. Nhilu nghiOn euu da eho thiy t i n suit can dflng kinh cung nhu su dyng mOt s i thuoc khSng dflng kinh cb anh hudng dSng ke d i n bien d i i nhgn thuc ting quSt, dgc bipt IS khi su dyng nhbm Phenolbacbital (Gardenal) hay Clonazepam (Rivotril) [4;5;6]. Tan suit can d n g ddy nhSn thde ting qudt edng giam da dupe ede tdc gia cbng nhgn[4;6].
Nham ddnh gid mflt so biln doi nhgn thuc ting qudt
68 Y HOC THl/C HANH (787) - S6 10/2011
trOn bOnh nhdn dflng kinh trudng thdnh vd nghiOn cuu anh hudng ciia mflt so y l u to IOn qud trinh nhdn thuc cua ngudi bpnh, chiing tfli tiln hanh "NghiOn cuu mflt s i dgc diem v l nhgn thuc tong qudt trOn bflnh nhdn dflng kinh ngudi trudng thdnh" vdi mgc tieu:
Md ta die diem nhgn thue tdng quit tren binh nhan dgng kinh tru&ng thanh.
Phan tich mdi lien quan gitfa dtim MMSE v&i tin so can dgng kinh vi vigc stf dgng Gamenal tmng diiu trj dgng kinh.
D 6 1 TUQ^NG V A PHU'aNG P H A P NGHIEN CU'U 1. DOi tup'ng nghiOn ciru.
- 60 bOnh nhdn tu 20 tuoi trd IOn, dupc chin dodn Id dpng kinh (theo tiOu chuln ciia ILAE, 1980). Cdc bOnh nhdn dupc khdm Idm sdng, difln nao d i theo bflnh dn rieng thiet k l cho nghiOn cuu. Cdc bOnh nhdn du tiOu chuan Idm sang se dupc tien hdnh Idm trie nghiflm tdm than toi thilu (MMSE) theo mdu.
Logi tru cde trudng hpp can dflng kinh do cde nguyOn nhdn d p tinh (tai biln mgeh mdu ndo giai dogn cap, viOm ndo, dp xe nao, chin thuang sp nao, ngfl dpc), eSc trudng hpp nghi ngd dflng kinh, bflnh nhSn mil chii', khiim thj hogc khiim thinh.
2. Phuang phap nghiOn cii'U.
2.2.f. Thiet ke nghien ctfu
- MO hinh nghiOn cuu mfl ta, d t ngang.
2.2.2. Ca miu nghien ctfu
Vdi nghiOn euu nSy ta Sp dyng cflng thue tinh ed miu udc tinh mflt ty 10 trong quan the:
n = Z i-oc/2
/^(l - P)
iP-sf
Trong db: a." Mdc y nghTa thing kO (dupc quy udc bai ngudi nghiOn euu).
Z c^: GiS trj Z thu dupe tu Bang Z ung vdi gid tq a dupc chpn.
p: ty 10 roi logn nhgn thde tong qudt d bOnh nhdn dflng kinh
s.' dupe ehpn Id mflt ty 10 so vdi ty 10 bflnh p
Ap dyng phan mim stata 8.0 vdi ty 10 rii logn nhgn thu'c cua bOnh nhdn dflng kinh theo phdn logi ty lfl eSc bOnh khflng ISy nhilm d a t h l gidi {CDC)[T\ ta cfl p=0,32, vdi a ta ehpn bang 0,05, e=0,5 tinh dupe n=60.
2.2.3. Quy trinh nghien ctfu
Quy trinh nghiOn cuu eSc d i i tupng se dupe tiln hanh thflng qua eSc giai dogn sau:
Giai dogn 1: Chin doin xic djnh dgng kinh [7].- Chan doan can ddng kinh: Cdn cd vdo thdm khdm lam sdng phoi hpp vdi dipn nao d i (trong db ldm sdng Id chu yeu).
Chan doin ddng kinh: phai eb tu hai can dflng kinh tra IOn cdch nhau trOn 24 gid, khflng IiOn quan d i n cdc ton thuang d p tinh, r i i logn chuyen hba (theo tiOu chuan d a LiOn hfli Quic t l ehing Dflng kinh), dya vdo mo ta ciia ngudi ldm chung hogc quan sdt can dflng kinh ciia bflnh nhdn dpng kinh.
Phin logi ean dgng kinh : theo phan logi 1981 cug Lien hpi Quic t l ching dflng kinh [6].
Giai dogn 2: thye hifln trac nghipm kilm tra trgng thai tdm than t i i thilu eua Folstein (Mini Mental State Examination/ MMSE)[6] cho cde d i i tupng nghiOn cuu.
Dilm toi da 30. Ddnh gid theo muc dfl giam din cua thang dilm tuang duang muc dp giam dan tinh trgng nhgn thuc tong qudt.
ChUng tbi chia nhbm tan suit can dya vdo nghien euu Dodrill CB (2004) [4].
Thbng tin dupc su ly bdng chuang trinh SPSS 15.0. Vdi mflt s i ehi s l so sdnh cdp nhu sau:
+ p i , p2, p3: so sdnh tung d p nhbm bOnh nhdn su dyng Gardenal vdi cdc nhbm tan suit can nham ddnh gid dnh hudng dflc ldp cua t i n suit can IOn nhdn thuc ting qudt
+ p4, p5, p6: so sdnh tung cgp nhbm su dyng thuoc khdng dflng kinh khflng phai Gardelnal vdi cdc nhbm t i n suit can nhim ddnh gid sy anh hudng dflc ldp cua tan suit can len nhdn thdc ting qudt.
+ p7, p8, p9: so sdnh tung d p cdc nhbm t i n suit can vdi 2 nhbm bOnh nhdn su dyng Gardenal vd su dyng nhbm thuic khdc nham danh gid anh hudng dpc ldp ciia thuoc khdng dflng kinh Gardenal din nhdn thuc ting qudt cua bOnh nhdn
KET QUA NGHIEN CU'U
1. LiOn quan giifa MMSE vd gidi. Bang 1 YOu to
Trung binh X DO LQch SD
Nam (n =30) 26,2 3,88
Nu (n = 30) 24,9 2,91
^0,132
Nhin xet diem MMSE trung binh giua hai gidi khflng cb sy khdc biflt cb y nghTa (p>0,05).
Mot iiin quan giua diim tmng binh MMSE vi thi dgng kinh
Dilm trung binh MMSE cua nhbm dflnq kinh cyc bfl thap han so vdi nhbm dflng kinh todn the tuy vgy sy khdc bipt ndy khflng c» y nghTa p =0,618 > 0,05.
2. LiOn quan gida MMSE va thubc d i l u trj dpng kinh
27 26 25 24 23 22 21 20
oe 9
22.7
• • • < - • !
Bfnh nhSn c6 sir di.ing Cic nhdm thu6c khdng Gardenal dpng kinh khac
Nhin xit: nhbm bflnh nhdn dflng kinh cb su dyng Gardenal (n=30) dilm trung binh MMSE la 22,7± 5,84 thip han so vdi dilm trung binh MMSE d bOnh nhdn dilu tq cde nhbm khdng dflng kinh khde (n=30) (26,2±0,52 cb y nghTa vdi p =0,013 <0,05).
3. Mbi IiOn quan giCra MMSE va t i n sb can dpng kinh. Bang 2.
T i n s6 can MMSE DiOm trung
binh DO IQch
>7 can /tudn (nhomi:
n=18) 25,1 1,16
7 can /tuOn-7 can/ thdng (nh6m2: n=22)
25,6 0,98
<7 can/thSng (nh6m3: n=20)
26,9 1,26 p1= 0,035(nh6m1/nh6m2), p2=0,047(nh6m3/nh6m2),
- p3=0,0482(nh6m 1 /nh6m3)
Y HOC THl/C HANH (787) - SO 10/2011 69
Nhin xit t i n suit can dflng kinh cdng nhilu thi dilm trung binh MMSE cdng thip cb y nghTa thing kO khi so sSnh tung cSp vdi P I . P2. P3 <0,05 OR tuang ung 1,2; 1,4; 1,5.
Bang 3. Moi tuang quan giua su dyng thuic khSng dflng kinh vdi t i n suit can dflng kinh den nhdn thuc ting quSt
Tdn sudt can OOi tupng DiOm trung binh
MMSE
>7 can /tuin (nhbml)
NhPm Gardenal n = 10(1) 21,2±1,32
NhPm khde n= 8 (2) 25,8±1,17
7 can /tuln-7 can/
thSng(nhbm2
Nh6m Gardenal n = 12(3) 22,7±0,87
Nh6m khdc n=10(4) 26,1±1,87 p(1)(3)= 0,043 (OR =1,1 95%CI = 0,18-1,43) p(3)(5)= 0,038 ( 0 R = 1,2 95%CI = 0,32 - 2,11) p(1)(5)= 0,021 (OR =1,4 95%CI = 0,88-1,78) p(2)(4)= 0,047 (OR = 1,1 95%CI = 0,33-1,01) p(4)(6)= 0,041 ( 0 R = 1,2 95%CI = 0,12-1,31) p(2)(6)= 0,011 ( 0 R = 1,3 95%CI =0,38 - 1,42) p(1)(2)= 0,007 ( 0 R = 1,4 95%CI = 0,43-1,88) p(3)(4)= 0,009 (OR = 1,3 95%CI = 0,12 - 1,76) p(5)(6)= 0,013 ( 0 R = 1 , 3 95%CI= 0,44-1,56)
<7 can/thSng (nhbmS) NhPm Gardenal
n = 8 (5) 23,6±1,03
Nh6m khde n = 12 (6) 27.7±1,21 P1
P2 P3 P4 P5 P6 P7 P8 P9 Nhdn xOt
Dilm tmng binh MMSE khi so sSnh tung e$p trOn ciing mflt d i i tupng (cb su dyng Gardenal hay thuic khSc) eb xu hudng giSm d i n khi tan suit can tSng d i n (pi, p2, p3 <0,05 vdi OR l l n lupt: 1,1; 1,2; 1,4 vd p4, p5,6 < 0,05 vdi OR l l n lupt: 1,1; 1,2; 1,3).
Trong nhbm bOnh nhdn cb cung t i n suit can, ngudi su dyng Gardenal cb dilm trung binh MMSE thip han nhbm su dyng khSng dflng kinh khSc (p7,p8,p9
<0,05 vdi OR lan lupt IS 1,4;1,3;1,3).
B A N LUAN.
0 Viflt Nam.trong nghiOn euu eua Nguyin Dgi Chiln, Ngfl VSn Dung vS cflng sy su dyng MMSE sSng lpc sa siit tri tup trOn nhung nqudi tu 60 tuii trd IOn [1;
2] dd thiy kit qua biln doi ve nhgn thdc ting qudt d nam gidi t i t han nu gidi. Trong nghiOn cdu eua ehiing tfli, diem trung binh ehung MMSE giua hai gidi khflng eb sy khdc biflt cb y nghTa thing kO (p>0,05) dilu nay cung phii hpp vdi nghiOn cuu cua Dodril vd nhilu tdc gia khdc [4]. LiOn quan giua nhgn thdc ting qudt vdi logi dflng kinh, Dodril vd cflng sy [4] eho thiy nhdn thdc ting qudt gidm rfl rpt han d nhbm dflng kinh thSi duang so vdi cSc nhbm dflng kinh khSc. NghiOn cdu ciia chiing tfli khflng thay rfl sy khSc biflt ndy eb le mflt phin do ed mau cbn nhb nOn chua du d l ddnh gid sy khdc biOt v l bien d i i nhgn thuc ting qudt giua eSc t h l can dflng kinh. Thuoc dilu trj dflng kinh Id mflt phin rlt quan trpng khflng t h l thilu trong dilu tq dflng kinh, tuy nhiOn, mflt s i thuic d anh hudng d i n nhdn thuc. NghiOn cuu chiing tfli eho thiy nhgn thuc ting qudt eua nhbm su dyng d e thuic khdng dflng kinh khbng phai phenobarbital cb xu hudng t i t han so vdi nhbm su dyng Gardenal (phenolbacbital), nhSn xOt ndy cQng triing hpp vdi gia khuyln d o eua nhilu tSe giS trOn t h l gidi. Tuy nhien, do Gardenal IS logi thuic hogt p h i rflng vS giS re, tgi mflt s i nudc nghOo, dSy v l n IS lya chpn hSng d i u phu hpp v l mSt kinh t l . Chinh vi the, d n dypc dSnh giS chSt ehe han ehi phi/hipu quS eua thulc dang IS v l n d l cbn ban d i . Lien quan giua t i n s i can dflng kinh vS nhgn thuc ting quSt: khi tan suit can dflng kinh eSng dSy thi nhgn thuc ting quSt eSng giam, dilu nSy da dupe nhilu nha nghien euu v l nhSn thuc trOn bpnh nhdn dpng kinh tren t h l gidi xSe nhgn. CSc tSc gia cho
ring khi IOn can Idm t i n thuang t l bdo ndo chinh Id ylu t i Idm giSm khS nSng nhdn thuc nbi ehung vS nhgn thuc ting qudt nbi riOng vd kit qud nghiOn cuu ehiing tOi khflng nSm ngoSi nhSn djnh db. Mdt khSe vdi t i t d cdc so sdnh tung d p v l anh hudng v l nhSn thire ting qudt giua su dyng thuic khSng dflng kinh vdi t i n suit can co giS trj cflng hudng nhung Igi IS hai biln d dflc lgp (vdi p<0,05). Chinh vi vSy Snh hudng v l nhSn thuc tong quSt eua thuic khSng dflng kinh eung nhu v l t i n suit can IS dflc ISP-
KtT LUAN
Qua nghiOn cuu 60 bpnh nhSn dflng kinh ngudi trudng thdnh ve nhgn thde ting qudt chiing tfli nhan thiy: khflng d sy khSe bipt v l biln doi nhgn thue tong quSt giua hai gidi. Su dyng Gardenal trong dieu tq dflng kinh ISm giam khS nSng nhgn thirc ting qudt. Tan suit can cang ddy nhgn thde ting qudt cang giam.
TAI LIEU THAM KHAO
1. Nguyin Dgi Chiln (2006). DSnh gid chdc ndng nhgn thue d ngudi Vipt nam tu 60 tuoi trd IOn blng mflt s i trie nghiflm thin kinh tSm ly, LuSn vSn Thge sT Y hpc, trudng Dgi hpc Y HS nfli. Ha nfli.
2. Ngfl Vdn Dung (2005). "Budc dau ddnh gid suy giam nhdn thUe nhe vS mpt sd yeu td IiOn quan I ngdi cao tudi tai huypn Ba Vi. Ha Tdy" Luan vdn Thac sT Y hpe, Trirdng Dai hpc Y Ha Nbi, trang 15-45.
3. American Psychiatric Association (2000), Diagnostic and Statistical manual of Mental Disorders,.
DSM- IV-TR, 4th ed, Washington .
4. Dodrill CB. Neuropsychological effects of seizures. Epilepsy Behav. 2004;5(Suppl. 1):S21-24.
5. Folstein M.F.. Folstein S.E., McHugh P.R., (1975). "Mini- Mental State. A practical method for grading the cognitive state of patients for the clinician".
Joumal of Psychiatric Reseamh, 12: pp 189-198.
6. International League Against Epilepsy (1993), Guideline for epidemiological study on epilepsy.
Epilepsia, pp96-592.
7. Worid Health Organization (1992), The ICD-10 classification of Mental and BehavtomI Disorders, W.H.O. Geneva : 64- 65
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