Sunmary
STUDY ON A PREVALENCE OF NOSOCOMIAL INFECTION AND RISK FACTORS IN INTENSIVE CARE UNIT OF THE NATIONAL HOSPITAL OF PEADIATRIC
Objective: Determine a prevalence and some risk factors for nosocomial Infection. Meteriais: 44 patients were treated in ICU, NHP. Methods: retrospective and prospective description study. Result:
Prevalence of nosocomial infection was 52 %, among them nosocomial pneumoniae: 82.6%, urine infection, nosdcomial bloodstream infection and infection related to catheter. K.pneumoniae: 34.8%, P.aeruginosa: 30.4%, K.pneumoniae sensitive with imipenem 100%, resistant with the third tephalosporin and Aminoglytoside 100%. P.aeruginosa until sensitive with t i p r o p l o x a t i n e , tefepime, cefoperazone, imipenem, ceftazidim, amikacine and tobramycin. Mainly symptome of nosocomial pneumoniae: fever, increasing mucous.crackle, increasing white blood cells, lung invelment on X - ray.
Conlusion: Prevalence of nosocomial infection was 52 %, among them nosocomial pneumoniae: 82.5%.
Longtime mechanical ventilation, reintubate many times, using antaacid, staying in hospital longtime were the fattors intreased nosocomial infections.
Keywords: nosocomial infection, risk factors, nosocomial pneumonia
NGHIEN CL/U L/NG DUNG KHANG SINH AUGMENTIN TRONG DU PHONG NHIEM KHUAN SAU PHAU THUAT COT SONG TAI
• • • •
BENH VIEN VIET DL/C
• • •
Nguyen Thj H u e \ Kieu Dinh Hiing', Nguyin Thj Lien HUdng^
'Trddng Dai hoc Y Ha Nc5i; 'Trddng Dai hoc DdOc Ha Ndi O cac nddc phat trien, ngddi ta co xu hddng khdng sd dung khang sinh hoac chi sd dung dd phdng ddi vdi cac trddng help md sach, ma vSn dai ket qua tdi. Muc tieu: danh gia hieu qua cua Augmentin khi chi dinh dd phdng nhiim khuan Irong phiu thuat cc3( sc5'n^. Do'i tugng va phuang phdp nghien cdu: bay mdai i)enh nhan ddcfc dieu tri khang sinh Augmentin, nhdm nghien cdu cd ba lam benh nhan ddc/c dieu tri dd phong td lue //e/i me va tiem 3 lan trong vong 24 gid sau md, cdn lai ba lam benh nhan ddi chdng tiem khang sinh sau md, khoang each 8 gid mot lan tiem sau md. Ket qua: cac loai benh ly cpf sdng ddde phau Ihuat cua hai nhdm nghien cdu va ddi chdng cd sd tdang dong. Toan bo 100% benh nhan sau md 4 ngay khdng cd dau hieu nhiem khuan. Hieu qua kinh te: Mdi benh nhan da tiet kiem ddac 349.165 dong so vdi nhdm ddi chdng, vdi sd Iddng 35 henh nhan chung tdi da liet kiem 12.220.800 dong tien thudc khang sinh.
Bdn ludn vd ket ludn: nhdm nghien cdu da tiet kiem kinh phi va giam sd lan tiem khang sinh mot each cd hieu qua.
Tu khoa: Augmentin, phlu thuat cpt song, khang sinh dif phong
1. DAT VAN DE
C) tac- nddc phat trien, ngudi ta t d xu hddng khdng sd cking khang sinh (KS) hoat c:hi sd dung eld phdng (KSDP) dd'i vdi cac trddng hdp mo sath, ma van dat k i t c|u,i tc")'t. l a i Viet Nam do thdi i|uen va tam ly lo ngai tua phau thuat vien, |)han Idn bcic s-/ sd dung khang sinh dieu trj sau mo.
D i l u nay lam lang t h i phi d i l u trj, lang nhdng phan dng bai loi tua KS cho benh nhan va nguy hai hdn la tang sd khang thuo'c cua vi khuan. Fai B|nh vien Viet Ddc, mdt so cdng trinh nghien t d u v l KSDP dd'i vdi p h l u thual (\a dddt tic''n hanh va cho kc't c|ua tot |1 - 3]. Iheo sd lieu tua khoa phau thuat t h i n kinh (PI FK) nam 2006 t d 303 trddng hop, nam 2007 t d 537 tnidng hdp dddt phau thuat cdt song (PFCS) |2 - 3|. Day la mdt |)hau ihiial sac h vdi ihdi gian mo thddng dddi 2 gid, nen rai thith hop cho v i e t sd dung KSDP. Ci Viet N,im, t h d n g ldi ehda tha'y nghien cClii nao v l sd dung KSDP ddi vdi lo.ii phau ihuat nay, Augmentin la khang sinh thich hdp clung cle dd phdng sau mc") ph,"ui ihuat c dl sdng vi ngam Idt vao phan mem va xu'dng, hon nda nhay cam vdi cac loai vi khuan hay gap trong nhiem khuan sau mo cdl sc")'ng |6, 7, 8|. Vi nhdng ly do tren, chung ldi lien hanh nghiC'n cdu de tai nay vdi muc tieu:
Ddnh gid hieu qua cua Augmentin trong du phdng nhiem khuan sau phau thuat cgt sdng.
II. DOI TUONG VA PHaONG PHAP NGHIEN CL/U
1 . Doi tu'png nghien cii'u
Cac benh nhan ddflc PFCS tai khoa PI IK BV Viet Due Id 1 1/2006 de'n 1 1/2007. lieu c h u l n Ida chon: benh nhan dddt PIX.S, khdng hi n h i i m khucin Irudc mc"), cd day du ho sO, ddOc: iheo ddi, san sdc, dieu tri tai khoa. lieu chuan lo.d Ird: BN bi di dng vdi Augmenlin hoac trddc md cl.) dung KS, hoac sc")t tren 38"C, bach c l u Iron 10 x I0''g/1.
2. Phuong phap nghien ciiu
2.1. Cd mdu nghien cdu vd thiet ke nghien cdu
Day la nghien cdu md ta cd phan lich hieu c|ua d i l u trj vdi cd man la 70 bc-nh nhan (do ket C|iia ngau nhien Irong ihdi gian lien hanh): 35 benh nhan thudc nhdm nghien cdu (NC) sd clung KSDP, va 35 benh nhan thudc nhdm chdng (NC) sd dung KS d i l u tri. Phfit dd khang sinh dung trong nghien c Clu chdng ldi sd clung phac dd theo:
Robert I . Shiridan, Ronald G. Tomlkin, John F.
Burke |7|.
Nhdm nghic'n cdu: liem 4 mui: Mui I tic':m tinh m.ic h 1,2 g Augmenlin ldc tien me 3 mui con lai tiem vao c a t thdi diem 8, 1 6, 24 gid sau mo.
Nhdm ddi chdng: ddng khang sinh Augmenlin sau md' vdi lieu 1,2 g mdi 8 gid.
Khang sinh Irong nghien cdu: sd dung Aug- mentin 1,2 g dang dng cua hang t]laxoSmith- Kline. \/)dac Bd Y tc" Viet Nam cho phep Idu hanh vdi so Id: Bl 20312 va sc")' dang ky: VN - 8614 - 04. Nd hic^u c|ua Iren cic loai VK O a m M va Gram (-) hieu khi, ky khi
2.2. Mgt so tieu chi ddnh gia
Nhiet dp cd the du'dc lay d iiticli vao 6 gid va 14 gid hang ngay: linh trang vet mo: vet mc") kho, thci'm mail va cljch, lay dd, ri ddt chan chi, cd inii, Chi phi dieu tri
2.3. Phuang phdp thu thap vd xd ly sd lieu
("ac Ihdng lin duOc lim Ihap iheo mau phii"'ii d i l u tra va xd ly theo Microsoft Fxcel 2003,
I - Student va lest yJ2.
III. KET QUA
1. Mo ta dae diem hai nhdm benh nhan
Nhan xcH bang I: tudi va giai cua hai nhdm nghic'n cdu vii ddi chdng cd sd li/ong dong, khac biei khdng cd y nghia tlidng ke.
Bang 1. Dae diem hai nhom benh nhan
Nhom nghien cii'u (n = 35) Nhom doi ehu'ng (n = 35)
Tuoi: < 1 8 - 30 3 1 - 4 0 41 - 5 0 51 - 6 0
> 6 0
Gidi: nam nd Td'ng
n 7 8 9 9 2 42,22 24 11 35
2. Ket qua dieu trj ciia hai nhom benh nhan Bdng 2. Cdc loai benh
Benh mac phai: Hep dng sdng Thoat vj dTa dem
Nep vit - thao nep
(%) (20,00) (22,86) (25,71) (25,71) (5,72)
± 13,92 (68,57) (31,43) (100)
X2 = 0,254 P =
n 7 6 9 8 5
(%) (20,00) (17,14) (25,71) (22,86) (14,29) 44,20 ± 13,30
:
;
: 0,61 5
ly cgt sdng dugc phdu thudt
Trddt, t h a n thddng cot song hoac chen ep tuy Tong
Thdi gian mo ( phut): < 30 30 - 6 0 61 - 9 0 91 - 120
> 120
X2 = 1,609; p = 0,657 Nhom
n 8 23 0 4 35
0 25 7 3 0
22 13 35
nghien cii'u (%) (22,86) (65,71) (0,00) (11,43) (100)
(0,00) (71,43) (20,00) (8,57) (0,00)
(62,86) (37,14) (100)
Nhom doi ehu'ng n (%) 8 (22,86) 20 (57,14) 1 (2,86) 6 (17,14) 35 (100)
0 (0,00) 17 (48,57) 15 (42,86) 3 (8,57) 0 (0,00) X2 = 4 , 4 3 3 ; p = 0,109
Tinh trang vet md' 3 ngay sau md' Kho
Tha'm mau va djeh
34 1
(97,14) (2,86)
30 85,71 5 14,29 Tay dd 0 (0,00) 0 (0,00) Rl ddt chan chi 0 (0,00) 0 (0,00) Co mu 0 (0,00) 0 (0,00) Tong 35 (100) 35 (100)
X 2 = 2 , 9 1 7 ; p = 0,088
Nhan xet: cac loai benh ly cot sdng ddcfc phSu thuat cua hai nhdm nghien cdu va ddi chdng cd sd tdang dong, khac biet khdng cd y nghia thdng ke. Thdi gian md cua hai nhdm nghien cdu va ddi chdng cd sd tdang ddng, khac biet khdng cd y nghia thdng ke. Tinh trang vet md 3 ngay sau mo cua hai nhdm nghien cdu va ddi chdng cd sd tdang ddng, sd khac biet khdng cd y nghia thdng ke.
Bang 3. Than nhiet sau md cua benh nhan
Nhiet do ("O
Ngay thii' 1 Ngay thu' 2 Ngay thiif 3 n (%) n (%) n (%) Nhom nghien cii'u
T ' ' < 3 7 , 5 ° C 32 (91,43 31 (88,57) 33 (94,29) 37,5°C ^cT" < 3 8 , 0 ° C 3 (8,57 4 (11,43) 2 (5,71) 38,0°C < T" < 39,0''C 0 (0,00) 0 (0,00) 0 (0,00) T" > 39,0°C 0 (0,00) 0 (0,00) 0 (0,00) Td'ng 35 (100) 35 (100) 35 (100) Nhom doi ehu'ng
T°<37,5''C 30 (85,71) 29 (82,86) 34 (97,14) 3 7 , 5 ° C < T ° < 3 8 , 0 ' ' C 5 (14,29) 6 (17,14) 1 (2,86) 3 8 , 0 ° C < T ' ' <39,0''C
T ° > 3 9 , 0 " C Td'ng
0 (0,00) 0 (0,00) 35 (100)
0 (0,00) 0 (0,00) 35 (100)
0 (0,00) 0 (0,00) 35 (100) Nhan xet: than nhiet sau md cCia benh nhan cCia hai nhdm nghien cdu va doi chdng cd sd tdang dong, khac biet khdng cd y nghia thdng ke test x2.
3. Chi phi dieu trj
Bang 4. Chi phi khdng sinh Nhom
Nghien cdu Dd'i chdng
Td'ng
Chi phi vat dung tieu hao: 35 benh So
nhan d
lu'ong (lo) 140 444 584
nhdm ngh ien cdu Th
da gi
anh tien (VND) 5.628.000 17.848.800 23.476.800
iam 304 mui tiem khang
% 23,97 76,03 100 sinh.
Nhan xdt: chi phi khang sinh cua nhdm nghien cdu la 5.628.000 d va nhdm chdng la 17.848.800 d IV B A N L U A N ^"-'^ '^'^P '^' '^^ " ' ' ° ' ^ ° ' ^ ° ^ ^ ' ^ m 8 0 % . Day la Ida tud'i lao ddng vi vay neu khdng ddde ehda trj 1 . Danh gia eac dae die'm trUde phlu thuat ^.-^ ^^ , ^^ hddng Idn den ldc Iddng lao ddng chinh Tud'i: Dd tuoi 1 8 - 6 0 chiem ty le cao (nhdm cua xa hdi. Gidi: benh nhan la nam gidi 6 5 , 7 1 % , nghien cClu: 88,56%; nhdm dd'i chdng: 85,71%) nam nhieu gap 1,92 lan nd. Ke't qua cung kha ket q u i nay phu hpp vdi ngien cdu cua N g u y i n phu hop vdi thdng ke cua 1 sd tac gia v l benh ly
cdt sd'ng nhd: Trdong Xuan Mai - 3,2, Vd Xuan Sdnjj) - 1,9. D i l u nay phu hop vdi thdc te do nam gidi thirdng lao ddng nang, cung nhd lao ddng chan lay n h i l u hon nd gidi." Chi djnh md':
Trong c i c benh ly cua t d i song Ihi thoat vj dia dem t h i e m ty le tao nhd't (nhdm nghien t d u : 6 5 , 7 1 % ; nhdm dd'i t h d n g : 57,14%), tie'p den la hep d'ng song (22,86%), trddt, t h a n thddng cdt song hoac chen dp tuy, t a t benh t d n lai chi t h i e m ty le tha'p. Vay man nghien t d u da mang linh dai dien t h o cac benh ly v l cdt sd'ng va phu hop vdi sd' lieu thd'ng ke cac benh ly cdt sd'ng ckrot md' phii^n tai khoa P h l u thuat T h i n kinh - Benh vien Viet D d t td 16/01/06 - 12/10/07. K i t qua nay cung phd hdp vdi t a c nghien cdu tua cac tat gia trong nUdt va nddt ngoai: trong PTCS thi phau thuat dia dem chiem da so.
2. Danh gia eac dae diem lien quan den phlu thuat Thdi gian thdc hien p h l u thuat (do dai cupc mo) ty le thuan vdi NKSM, neu thdi gian thdc hien p h l u thuat eang keo dai thi kha nang NKSM eang tang, do nguy cd phu n l tai chd cao hdn, cung nhd ton tai nguy ca phdi vdng p h l u thuat ra ngoai mdi trddng (thdi gian phdi n h i i m ) lau hon.
Irdng nghien t d u cua chung tdi khdng gap trddng hdp nao bj NKSM. t ^ i l u nay t d the do so Iddng benh nhan trong nghien t d u tua chung tdi ehda clu ldn. 'luy nhien, theo ghi nhan cua n h i l u tac gi.i trong va ngoai nddc thi thdi gian p h l u thuat cd md'i tddng quan ly le thuan vdi NKSM nhd theo ghi nhan cua Van Tan va cdng sd trong p h l u thucit bddu tuye'n giap: vdi p h l u thuat tren 60 phut ty le NKVM la 6,25% trong khi dd p h l u thuat dudi 60 phut thi \y le NKVM chi la 0,42% hoac iheo tat gia Fizan: nguy t d n h i i m khuan tang 1,5 lan mdi 60 phut |5, 6]. Dp dai cupc md' d benh nhan nhdm nghien cdu va nhdm ddi chdng deu tap trung treng khoang 30 - 90 phut (thiem 91,43%), trong dd t h i e m da sd td 30 - 60 phut (nhdm nghien t d u : 71,43%; nhdm dd'i chdng:
48,57%) |4, 6, 8|. Thdi gian mo cua benh nhan khdng keo dai qua 120 phut va eung khdiig dddi 30 phut, day la thdi gian mo thdng thddng dd'i vdi c a t benh ly ve t d t sd'ng. PTCS trong nghien t d u la phau thuat sath vdi thdi gian md' dddi 120 phut, do dd thdi gian ciia cac PTCS phu hdp cho viec sd dung KSDP. Sd khac biet v l thdi gian p h l u thuat cua nhdm nghien cdu so vdi nhdm dd'i chdng KCYNTK (p = 0,109 > 0,05).
Danh gia ty le benh nhan nhiem khuan sau md': danh gia NKSM chung tdi dda tren ke't qua theo ddi lam sang: nhiet dp, tinh trang vet md', dau hieu nhiem khuan d cac ca quan, bo phan khac trong cd the.
Irong thdi gian benh nhan n i m vien: sau md' benh nhan dUdc d i l u tri tai khoa P h l u thuat T h i n kinh - Benh vien Viet Ddc td'i thieu la 3 ngay.
Nhiet dp CO the: ba ngay sau mo d 2 nhdm benh nhan trong nghien cdu khdng cd benh nhan nao sot vCra hoac sot cao, ty le benh nhan sot nhe tha'p (< 18%), da so' benh nhan khdng sot (> 80%). Sot nhe xua't hien d ngay thd nha't, thd 2 hoac thd 3 sau mo'. Benh nhan sd't nhe khdng qua 1 ngay. Vao ngay thd 3 sau md' ty le benh nhan sdt nhe tha'p (nhdm nghien cdu: 5 , 7 1 % ; nhdm dd'i chdng: 2,86%) ke't hdp vdi vet md' khd. Do vay, cac benh nhan nay v i n ddde chuyen vien theo dd kie'n va day khdng phai sot do n h i i m khuan. Cac trddng hdp nay chdng tdi xep vao nhdm sot ddn t h u i n . Sd dT sau md' benh nhan thddng tang than nhiet lei do phan dng tieu mau hoac cac chat djeh ton dong va phan dng cua cd t h i dd'i vdi 1 cha'n thddng (vet md') [5, 61. Mat khac, cac benh nhan trddc khi md' phai nhjn iid'ng nddc lau, sau m l lai thudng met nen n h i l u khi ngai khdng ud'ng nddc hdae Ud'ng ft nddc d i n tdi sd mat nddc sau md', dieu nay cung tae d i l u kien thuan ldi cho viec tang than nhiet d benh nhan sau md' [7, 8].
Tinh trang vet md': benh nhan sau md' (nhdm nghien cdu: 2,86%; nhdm dd'i chdng: 14,29%) vet
mc") t d the tham d j t h va man t d n tdn dong ra bang, t d kem theo tang than nhiet hoac khdng, neu tang Ihan nhiet thi c:ung khdng qua 38'^'C. Qua thc^o ddi khdng tim thay clan hieu nhiem khuan d c a t bd
|)han khcic v.i d ngay tici^p theo Iddng cljch t i l t ra it c\a\\, vc't mo khd, than nhic^t trd ve binh thddng.
Nhd vay 1 00"/u benh nhan d 2 nhdm cd tinh trang vet mc") tcit d ngay thd 4 sau mo.
\^ay\ h i | i i nhiem khuan d cd quan, bd phan khcic trdng ca the: tinh de'n thdi diem thuyen vien: 70 benh nh<in Irong nghien cdu khdng thay xiicl't hien d i l l hieu nhiem khuan d t o c|uan, bd phcin khcit Irong t d t h i .
Dcinh gici hieu (|Uci kinh tc"' tua khdng sinh dd phdng: c:hi phi lien thudt khcing sinh: trong nghien tdu 35 BN da tic"''t kiem dddt 12.220.800 dong l i l n thudc khang sinh. Vay trung binh mdi BN dci tic"''l kiem ddoc 349.165 dong t i l n thuci'c khcing sinh so vdi BN nhdm clci'i chdng. PFC~S, irici vdi tcit thuyc^n ng,inh khcic va trong tocin benh vien, thi being nam se tranh diroc viec lang phi mdt sc')' tien khdng nhd t h o v i e t mua thudt khang sinh. Dcic biet, vdi nhCtng benh nhdn ngheo thu'dng khong cd bao hic'iii y te thi viec liC't kiem chi phi nay r,i't cd y nghia. Cdc chi phi khde:
Ciicim so lan liem KS khdng nhdng tic^'t kiem ddde tien Ihudc ma t d n tiet kiem dddt t a t dung c:ii tieu hao di kem viec tic^m thud'e (vi du: bdm tiem, bdng bang, ton...) va giam bdt t d n g viec tiem truyen va thu don rat thai y te
V. KET LUAN
llieu qua du phdng n h i i m khuan: 100"/.) benh nhdn sau mo 4 ngay khdng t d ddu hic^u nhiem khuan. Hieu qud kinh te: Moi benh nhan da tiet kiem ddde 349.165 dong so vdi nhdm dc")'i chdng.
Vdi 35 benh nhan chdng tdi da tiet kiem 12.220.800 ddng tien thuci'c khang sinh, ngodi ra
cdn t i l t kiem ddde t i l n bdng, b.ing, con sdt khuan, bom tiem cho 304 mui tiem.
TAI LIEU THAM KHAO
1. Nguy£>n Dii'c Hiep (2000), Nghien cdu chan dodn vd d i l u tri p h l u thuat bc}nh Ihodt vj dia dem cdt song , Liicin van tc")'l nghic}p bde si npi tru benh vien, Trddng Dcii hoc Y I la Ndi.
2. Nguyen Vu (2004. Nghien cdu chan dodn va k i t qua phau thudt thodt vj dia dem cot sci'ng thdt ldng, thdt lung t i i n g lai Benh vien VJc?t Ddc (8/1998 - 2/2004). Luan van Ici't nghiejp Bat sT y khoa, Frddng Dai h o t Y Fid Ndi.
3. Nguyen Manh Nham (1998). Khdng sinh va KSDP trong ngOcii khoa, 'lap t h i ngOcti khoa 1/1998, tr. 1 - 7.
4. Ngo Van Toan, Nguyen Trung Sinh (1999).
Nhan xdt l)irdt dau ve sd dung KSDP trong phdu thiicit thci'n thuong c:hinh hinh, Ky ycni t d n g tnnh nghien t d u khoa h o t "Ky niem 95 nam BcJ'nh vicn Viet D d t " .
5.V6 Xuan Sdn, Tran Hung Phong, Tran Minh Tam (1999). Thodt vj dTa dein t d t sd'ng c:o: hdi t d u 64 trddng hop mc") tcji benh vien ("hd Ray, Floi nghj Vic't Lie v l Ngoai Fhan kinh. Thdng 3/1999,
6. Ball P, Geddes A, Rolinson C (1997).
Amoxicillin clavulanate: an assessment after 15 years of clinical application. ]. C'hemother, 9(3), pp: 167 198.
7. Robert L. Shiridan, Ronald C. Tomlkin, John F. Burke. Prophylactic Antibiotics anc\ Their Role in Prevention of Surgic:al Wound Infection.
Advances in Surgery, Vol 27, Cameron J.F Balth Ch. M. Langer B cl al (eds), Mosby 1994: pp. 43 - 59.
8. Dellinger E. F. (1997). Siirgital infettions and thoice of antibiotic Fextbook of Surgery.
Sabiston D.C.
Summary
PREVENTIVE APPLICATION OF AUGMENTIN PROTECT AGAINST INFECTIONS FOR PATIENTS OPERATED ON SPINAL COLUMN AT VIET DUC HOSPITAL
In developed countries, planned operation on spinal column has not been treated by antibiotic because it is a elearn operation. Objective: To examine benefit results of an application of Augmentin at early stage of anaesthetize to prevent infections. Methods: Seventy patients operated on spinal column were randomly devided in two groups: The first group of patients was treated by Augmentin at early stage of anaesthetize and the other group was treated by the same Augmentin after operation. Health index of two groups of operated patients has been well observed. Results and conclusion: All participated patients were well been operated on. After 4 days, all patients of two groups have not been seen with any clirjical signs of infections. Patients in the fisrt group spent lers cost ( 349,165 VND) as compared with patients in the second group, giving total amount of saredmoneyd 2,280,800 VND) for 35 patients in the first group.
Discussion and conclusion: It was significantly reduced a cost of antibiotic treatment and limitted number of antibiotic injection for the first group when compared to the second groups of patients.
Keywords: Augmentin, Spinal column operation, preventive application of Augmentin dose
NGHIEN CL/U ROI LO/\N DONG MAU TRONG L O X E M I CAP TIEN TUY BAO GIAI DOAN HOA TRI LIEU TAN CONG + ATRA
Tran Thj Kieu M y ' , Do Trung Pha'n', Nguyin Anh Tri ^, Bach Quoc Khanh^
'Trddng Dai hoc Y Ha Noi, "Vien Huyet hoc va Truyen mau Trung dang Rdi loan ddng mau dan den xuat huyet nao la nguyen nhan td vong hang dau cua Idxemi cap tien tuy hao. Muc tieu: khao sat tinh trang rdi loan ddng mau d cac benh nhan laxemi cap the tien tuy bao mdi chan doan va giai doan hda tri lieu tan cdng. Dd'i tugng va phuang phdp nghien cdu: nghien cdu tien cdu tren 48 henh nhan laxemi cap tien tuy bao mdi chan doan va sau dieu tri tan cdng bang phac do Daunorubicin -f ATRA. Ket qud: 100% giam sd Iddng tieu cau (trung binh 36,6C/I): 85,4% cd ddng mau ndi mach rai rac;
2,08% cd tieu sai huyei, PT% trung binh la 58,9%; D - dimer trung binh 1297,4ng/ml. 88% dat lui benh va het Ccic rdi loan ddng mau trong dcJt hda tri lieu tan cdng. Thdi gian phue hoi cac yeu td ddng mau huyet tddng sau dieu tri tan cong la 9,2 ngay, phue hoi tieu cau la 14 ngay. Ke't luan: phan'ldn cac benh nhan Idxemi cap tien tuy bao cd rdi loan ddng mau td khi chan doan. Dieu tri tan cdng bang Daunorubicin va ATRA cho ket qua lui benh 88% va cai thien nhanh cac rdi loan ddng mau.
Tii khoa: roi loan dong mau, Idxemi cap, tien tuy bao, hoa trj lieu
I. D A T V A N D E '^^°- ^^'- die'm lam sang nd'i bat cua the benh nay la hdi chdng xua't huye't the hien da dang d Laxemi d p t i l n tuy bad (LXMCTTB) hay the n h i l u vj tri khac nhau, trong dd xud't huyet nao M3 theo phan loai cua FAB 1986 la benh mau dc thddng la nguyen nhan gay td vong eua 10 - 3 0 % tinh trong dd eac te bao ddng tuy bi gian doan benh nhan ngay td nhdng ngay dau tien phat hien trudng thanh mcDt cdch dc tinh d giai docjn tien tuy benh hoac trong qua trinh dieu tri [ 1 , 4 ] . Nguyen