6. Wimo A, Winblad B, Aguero - Torres H, occurrence in the w o r l d " , Alzheimer Dis Assoc von Strauss E (2003), "The magnitude of dementia Disord, (1 7): 63 - 67.
Summary
STUDY ON CLINICAL AND NEUROPSYCHOLOGICAL TESTS CHARACTERISTICS IN PATIENTS SUFFERING ALZHEIMER DISEASE
Objective: To study and analyze some clinical and neuropsychological tests characteristics of Alz- heimer disease. Method: 81 patients were diagnosed as Alzheimer disease based on the criteria of DSM IV TR, All the subjects in the study were examined thoroughly and carefully. Necessary neuropsychological tests as well as paraelinicai exams have been done. Result: The main group age is dver 60. Memory disorder is common (100%) and is key reason for healtheheek. Psycholdgical disorder such as hallucination and illusion are quite popular in Alzheimer patients. Conclusion: All Alzheimer's patients have memory disorders, mainly near and memory disorders that affect daily activities with tools and means. Psychosis is common feature including delusions and hallucinations of different types.
Keywords: Alzheimer, neuropsychological test
CHAN DOAN VA DIEU TRj
TRAO NGLfOC DA DAY THL/C QUAN (GERD)
Nguyen Duy Thing Benh vien Ndng nghiep Ddnh gid trieu chdng lam sdng vd ndi soi cd do tin cay cao trong chan dodn vd dieu tri CERD. Muc tieu:
nghien cdu cdc tneu chdng lam sang, ndi soi trddc vd sau dieu tri. Dd'i tugng va phuang phap nghien cdu:
58 benh nhdn cd tneu chdng Idm sdng, ddac ndi soi vd dieu tri vdi esomeprazole trong 4 tuan. Ke't qua: cac trieu chdng lam sdng dien hinh trddc va sau dieu tn: ndng rdt (87,9 % va 25,5%), dau ngdc (84,5 % vd 26,5
%), ho (81,0 % va 36,2 %), a chua 72,4 % va 26,2 %). Viem thdc quan trdc'lc vd sau dieu tri: do A (67.4% va 18,9%) do B (28,2% vd 8,6%), do C (4,4% vd 1,7%). Ke't luan: tneu chdng lam sang chu yeu Id ndng rat sau xddng dc, dau ngdc, e3 ndng, cf hai. Viem thdc quan do A chiem da sd. Sau dieu tri trieu chdng Idm sang va viem thdc qudn deu giam .
Jii khoa: trao ngUdc da day thUc quan
I. DAT VAN DE
va ung thd thdc q u i n . Trdde day do ehda cd noi soi, ty le phat hien benh cdn tha'p. Ngay nay ty le Trao ngdoc da day thdc q u i n (GERD) la benh benh nhdn trao ngdde da day thdc q u i n ddoc phd bien tren t h i gidi eung n h d d Viet Nam. Trao phdt hien tang len do chan dodn qua lam sang ngdde da ddy thdc quan Id tinh trang trao ngdoc k i t hdp ndi soi ed n h i l u tien bd. Mae du GERD la bat thddng eae cha't trong da day. Day la benh ly phd bie'n nhdng viee dieu tri eho de'n nay v i n thddng gap va ed I n h hddng den cha't Idpng eude ehda dat ddde mong mudn tdi du. De gdp p h i n sdng eua ngddi benh, Neu khdng ddde dieu trj, tim hieu them v l van de tren, ehung tdi tien hdnh benh ed the gay nen ede bien chdng nguy hiem d l tdi n h l i n muc tieu:Md ta ve trieu chdng lam sang, hinh anh ndi soi va ket qua dieu tri trao ngUac da day thUc quan.
II. DOI TUONG vA PHUONG P H A P NGHIEN cUu
1. Ddi tuong nghien cii^
a.Tieu chuan chon benh nhan nghien cdu:
- Tudi td 20 - 70, khong phan biet gidi tinh, nghe nghiep.
- Ddde npi soi tai Benh vien Ndng nghiep, td thdng 2/2007 den thang 8/2009.
- Cd eae trieu chdng lam sang eua trao ngdde da day thdc quan nhd: ndng rat sau xddng de (d ndng ), dau ngdc, d hdi, d ehua, ho. Cd hay khong ed viem thdc quan tren npi soi.
- Td nguyen dieu tri theo phac dd nghien edu.
b. Tieu chuan loai trd
- Loet thdc q u i n do hda cha't va eae nguyen nhan khde.
- Viem thdc q u i n khdng do trao ngdde.
2. Phuong phap nghien cu'u
- Tham kham lam sang, khai thac tien sd, benh sd.
- Npi soi thdc q u i n da day bang may npi soi dng mem video eua hang Pentac.
- Md t l tdn thddng thdc quan qua npi sci theo phan loai Los Angeles 1999.
- D i l u trj: benh nhan ddde hddng d i n dieu trj theo phac dd sau: Esomeprazole (Nexium) 40 mg X 1 l l n / ngay x 4 t u i n .
- Sau 1 thang kiem tra lai de danh gia ket q u i d i l u tri so vdi trdde dieu tri ve: eac trieu chdng lam sang, eac mde dd viem thdc quan.
- Nghien edu tien edu.
- Xd ly sd lieu theo phddng phap thdng ke y hpe.
III. KETQUA
Bang 1. Dae diem nhdm benh nhin nghien cufu
Nhom tuoi 2 0 - 2 9 3 0 - 39 4 0 - 4 9 5 0 - 5 9 6 0 - 7 0
Tdng sd
Nam n 4 7 11 5 4 31
(%)
(12,9) (22,6) (35,5) (16,1) (12,9) (53,5)
NCf n 2 7 9 5 4 27
{%) (7,4) (26,0) (33,3) (18,5) (14,8) (46,5)
Ton n 6 14 20 10 8 58
gsd (%)
(10,3) (24,1) (34,5) (17,3) (13,8) (100)
Nhdn xet bang 1: nhdm tudi bi benh nhieu nha't td 30 - 49 (58,6%).
Nhan xet bang 2: ndng rdt sau xdang dc, dau ngdc va ho la cdc trieu chdng noi bat nha't.
Nhdn xet bang 3: cd 79,3% benh nhdn bi viem thdc quan, trong dd viem thdc quan do A chie'm
da sd.
Nhan xet bang 4: ndng rat, cl chua, dau ngdc vd nudt khd cd ty le bet han cao nhat.
Trieu chiifng
Ndng rat sau xddng dc Dau ngdc
Ho 0 ndng 0 ehua
Khan tieng Nudt khd
Bang 3. Hinh
Miifc dp viem thUc quan
Bang 2. Trieu chdng lam
Nam n = .31
29 27 26 21 19 20 7
(%)
(93,5) (87,1) (83,9) (67,7) (61,3) (64,5) (22,6)
sang trudc dieu tri
Na
n = 27 (%) 22 (81,4) 22 (81,4) 21 (77,7) 23 (85,2) 23 (85,2) 19 (70,3) 4 (14,8)
Tong so' n = 58
51 49 47 44 42 39 11
anh ndi soi thUc quan trUdc dieu tri theo phan loai LA 1999
Tdng
n = 58 so
(%)
(%)
(87,9) (84,5) (81,0) (75,8) (72,4) (67,2) (18,9)
Khdng viem TQ Dp A
Dp B D d C Do D
12 (20,7) 31 (53,5) 13 (22,4) 2 (3,4) 0 (0) Bang 4. Ke't qua tren lam sang sau dieu tri
Trieu chiifng
Het trieu chUng
(%)
Con tri?u ehu'ng
(%)
Ndng rat n =51 0 ehua n = 42 0 ndng n =44 Dau ngUe n = 49 H o n = 47 Khan tieng n = 39 Nudt khd n = 11
38 31 31 36 30 25 8
(74,5) (73,8) (70,5) (73,5) (63,8) (64,1) (72,7)
13 11 13 13 17 14 3
(25,5) (26,2) (29,5) (26,5) (36,2) (35,9) (27,3)
Bang 5. So sanh ket qua ndi soi thUc quan trUdc va sau dieu tri
Miifc dp viem TQ
TrUdc dieu tri Sau dieu tri
Khdng viem TQ Dp A
DdB DdC
n = 58 12 31 13 2
(%) (20,7) (53,5) (22,4) (3,4)
n = 58 12 11 5 1
(%) (20,7) (18,9) (8,6) (1,7)
IV. BAN LUAN
1. Dae diem benh nhan nghien cii'u
Cd 58 benh nhan ddde ehan doan va dieu tri, trong dd ed 31 nam va 27 nd. Ty le nam va nd khac biet khdng ed y nghTa thdng ke vdi p > 0,05.
Dp tudi thddng gap nha't td 30 - 49 (58,6%). Day la dd tudi lao ddng sung sdc eua xa hdi. Tudi tha'p nha't la 20 va eao nha't la 70. Ket q u i cua ehung tdi eung tddng td nghien cdu eua N g u y i n Thi Hda Binh I 2] va Ta Long [3 ] .
2. Trifu ehu'ng lam sang thudng gap
Trong nghien edu nay ehung tdi gap eae trieu chdng lam sang dien hinh la ndng rat sau xddng Crc (87,9%). Da sd benh nhan phan nan ve trieu chdng ndng rat va den khdm benh, xin td van eua bae sy.
Ndng rat xay ra ed the lien tue hoac khdng lien tue trong ngay. Benh nhan khdng md ta trieu chdng nay met each eu the ddde. Cd ngddi bi ndng rat td phia bung len nhdng eung cc ngddi cam giac ndng rat ngay dddi xddng de. Ndng rdt v l ban dem hay gap hdn. Day eung la trieu chdng dien hinh nha't eua trac ngdde da day thdc q u i n [5]. Ty le ndng rat theo Nguyen Thj Hda Binh la 7 8 , 1 % [2], eua Mai Hdng Bang la 27,8% [ I j . Nghien edu da trung tam eua Ta Long va cpng sd [41 eho tha'y l.y le benh nhan ed trieu chdng ndng rat la 94%, a ehua 9 0 % vd dau ngdc 72%. Trong nhien cdu nay ehung tdi gap 72,4% trieu chdng d chua, eao hdn cua Mai
ehiem ty le 84,5%, ho la 81,0%. Ty le benh nhan ed ho va khan tieng trong nghien edu eua ehung toi eao hdn Ta Long [2].
Ngddi ta thddng phan tich lam hai nhdm dd la nhdm ed eae trieu chdng o ndng rat, trao ngdde, dau hdae ndng bdng thddng vj va nhdm trieu chdng ngcai thdc q u i n bao gdm: rdi loan giac ngu, dau ngdc, ho ban ngay, ho ban dem, khan tieng, khd khe, khd nudt va budn ndn. Theo Ho June Song [7 ] va cpng sd. ed mpt ty le Idn benh nhan trinh bay trieu chdng khd tieu, dae biet la dau. Theo quan die'm eua GERD, dau, khd tieu ehu yeu e i n ddde dieu tra va q u i n ly mpt each khac nhau.
3. Hinh anh npi soi
Chung toi tien hanh npi soi da day thdc quan eho 58 benh nhan nghien eCru. Ket qua eho tha'y: 46/58 benh nhan trong nhdm nghien eCili ehiem 79,3% ed hinh anh viem thdc quan d eae mCre dd khac nhau tren ndi soi. Cd 12 benh nhan (20,7%) khdng ed bieu hien viem thdc quan trong khi trieu chiifng tren lam sang rd hdn. T'/ le mi're dd viem thdc quan theo phan loai Los Angeles [6] eho thay dp A cd 31/58 benh nhan (53,5%); dp B ed 13/53 benh nhan (22,4%); dd C ed 2/53 benh nhan (3,4%).
Nhd vay, ty le viem thdc quan dp A eua ehung tdi eao hdn nhdng dd B va C lai tha'p hdn eua N g u y i n Thj Hda Binh [2] va Mai Hong Bang [1].
Chdng tdi khdng gap viem thdc quan dd D. Tren
Theo nghien edu eua Mai Hdng Bang, Vu Van Khien va edng sd ( 2006), ty le nay la 66,7%.
4. Ke't qua dieu tri
4.1. Trieu chdng lam sang: sau d i l u trj nhin ehung eae trieu chdng lam sang deu g i i m rd ret.
Ndng rat trdde dieu tri 87,9%, sau d i l u tri ehi edn 25,5%. Dau ngdc trdde dieu trj 84,5%, sau dieu trj ehi edn 26,5%. Ho ed t'/ le tddng dng la 8 1 , 0 % va 36,2%. 0 ndng 75,8% va 29,5%. 0 ehua 7 2 , 4 % va 26,2%. Mai Hdng Bang va cpng sd nghien edu dieu trj viem trddt thdc quan do trao ngdde b i n g Nexium vd Prevaeid eho ke't q u i la Nexium lam mat h i n trieu chdng d ndng 65,8%, mat h i n d chua 6 9 , 1 % , tha'p hdn k i t qua eua ehung toi. Cae trieu chdng khan tieng va nudt khd khdi ban tha'p chut It sc vdi cde trieu chdng khac ( 6 4 , 1 % va 72,7%). Theo Ri - Nan Zheng [8] Esomeprazole ed the hieu q u i hon Omeprazdle, Lansoprazole, Pantoprazole va de g i i m nhanh ede trieu chdng d ndng va trieu chdng trac ngdde axit 6 benh nhan viem thdc quan trad ngdde
4.2. Hinh anh ndi soi
TAI LIEU THAM KHAO
Sau 4 t u i n dieu trj, kiem tra lai tren ndi soi chdng tdi thdy viem thdc q u i n dp A g i i m td 53,5%
xudng edn 18,9 %, dd B g i i m td 22,4% xudng edn 8,6% vd dp C td 3,4% xudng edn 1,7%.
Nhd vdy nhin ehung viem thdc q u i n d ta't e l eac mde dp d i u giam td 50 - 65 % so vdi trdde dieu trj. Theo Ta Long [3] thi benh nhan thddng dap dng td't, g i i m trieu chdng nhanh. Trong eae the viem loet hay tai phdt , thudc PPI cd hieu qua lam lien seo trong da sd trddng hdp.
V . K E T L U A N
Trieu chdng lam sang ehu yeu la ndng rat sau xddng de, dau ngdc, a ndng, d hdi. Viem thdc quan dp A chiem da sd. Sau d i l u trj eae tneu chdng lam sang va mCre dp viem thdc q u i n deu g i i m .
1. Mai Hdng Bang, ViJ Van Khien, (2006), Dae diem lam sang, hinh anh npi soi eua benh nhan trao ngdde da day d thdc quan, tap ehi khoa hpe tieu hda Viet Nam, tap 1, sd 3.
2. Nguyen Thj Hoa Binh (2005), Mdt sd nhan xet bddc dau ve hpi chdng trao ngdoc da day thifc quan tai benh vien Ddng da, Cdng trinh nghien edu khoa hpe, Hdi nghj khoa hpe tieu hda Ha Ndi, 15 - 12 - 2005, tr.9.
3. Ta Long (2005), djeh te hpe, cha'n doan va xd tri benh trao ngdde da day - thdc q u i n , Dae san tieu hda Viet Nam, sd 3, thang 12, tr.5.
4. Ta Long, Dao Van Long, Tran Kieu Mien (2008), Khao sat djeh te hpe ve trieu chdng va mo hinh cha'n d o i n - d i e u tri benh trao ngdde da day thdc quan. Tap ehi khca hpe tieu hda Viet nam, tap III, s d i 3, tr.818.
5. Advances in the management of acid - related disorders in ASIA, Astra Zeneca Asia - Pacific Gi Summit Symposium 24 September 2005, Seoul , Korea.
7. 6. Dent J et al: An evidence - based appraisal of reflux disease management - the Genval Workshop report. Gut, 1999, vol 44, suppl 2, pp. 1 - 1 6 .
8. Ho June Song; Kee Don Choi; Hwoon - Yong Jung, (2007). Endoscopic Reflux Esophagitis in Patients W i t h Upper Abdominal Pain - Predominant Dyspepsia, J Gastroenterol Hepatol.
22(12): pp. 2 2 1 7 - 2 2 2 1 ,
9. Ri - Nan Zheng, (2009). Comparative study of omeprazole, lansoprazole, pantoprazole and esomeprazole for symptom relief in patients with reflux esdphagitis. World J Gastroenterol. February 28; 1 5 (8): pp. 990 - 995
Summary
DIAGNOSIS A N D TREATMENT OF GASTRIC ESOPHAGEAL
REFLUX (GERD)
Assessing clinical symptoms and endoscopy is highly reliable in diagnosis and treatment of GERD.
Objective: study of clinieai symptoms, endoscopy before and after treatment. Methods: 58 patients with clinical symptoms, endoscopy and was treated with Esomeprazole in 4 weeks. Results: The typical clinical symptoms before and after treatment: hot burning (87.9% and 25.5%), in tomato (72,4 % and 26.2%), chest pain (84.5 % and 26.5%), cough (81.0% and 36.2%). Oesophagitis before and after treatment: grade A (67.4% and 1 8.9%), grad B (28.2% and 8.6%), grad C (4.4% and 1.7%) . Conclusion:
The main clinical symptom is hot burning after sternum, chest pain, heartburn, in the steam. Esophagitis grad A is the majority. After treatment, clinical symptoms and inflammation are reduced.
Keywords: gastric esophageal reflux
HINH THAI LAM SANG VIEM XOANG TRAN MAN TINH VA CHI DINH PHAU THUAT
Phan Ngpc M i n h ' , Nguyen Tan Phong'' 'Benh vien Viet Tri - Phu Tho; 'Trddng Dai hoc Y Eld Noi Mac du phdu thudt noi soi xoang trdn dd thay the gan nhd hodn todn phdu thuat xoang trdn qua dddng ngoai nhdng ty le tai phdt viem xoang tran do loai phau thudt nay van cdn kha cao. Muc tieu: nghien cdu cdc hinh thdi viem xoang trdn man tinh qua neii soi vd chup cdt lap vi tinh dd'i chieu vdi ket qua phau thudt nhdm tim ra nguyen nhan that bai cua phdu thudt de de xudt bien phdp can thiep thich help. Ddi tugng va phuang phap nghien cdu: (1) Nghien cdu cdc hinh thdi lam sang cua viem xoang trdn mdn tinh qua ndi soi vd chyp est Idp vi tinh. (2) Ddi chieu hinh thai lam sdng viem xoang trdn vd chup cat Idp vi tinh vdi ke't qud phau thudt. Ke't qua: 3 hinh thdi viem xoang trdn ddac phat hien: viem xoang trdn dan thuan mot ben, viem xoang trdn mot t)en phdi hap vdi viem xoang sang ~ hdm vd viem xoang trdn ddi xdng. Viem xoang trdn dan thuan mot ben lien quan chu yeu den cdc di hinh cua chinh xoang trdn vd quanh Id thdng xoang. Viem xoang tran mot ben phdi hap vdi viem xoang sang-hdm thi nguyen nhdn chinh Id td viem xoang sdng hdm.
Viem xoang trdn ddi xdng lien quan den nhieu nguyen nhan todn than. Ke't luan: (1) Viem xoang trdn dan thuan (17%) thi phdu thudt phdi trong tdm xd ly di hinh quanh Id thdng xoang. (2) Loai viem xoang trdn mot ben phoi hgp vdi viem xoang sang - hdm (59%) thi phau thudt phai triet de ddi vdi xoang sdng - hdm. (3) Loai viem xoang trdn ddi xdng (27%) phdi tim vd dieu tri phd'i hap nguyen nhan todn than.
Tii khoa: phiifc hpp Id ngach, ngach xoang tran
1. D A T V A N D E can trd dddng dan lull xoang trdn sau p h l u thuat.
Viem xoang tran man tinh Id loai benh ly khd Mdt trong nhiTng ly do can b i n la khdng d i n h gia dieu tri ke e l phau thuat eung tdi phdt vdi ty le rat h i t ddde benh tich, nhifng hinh thai va eau true eao. Theo Zhou Bing [6| nguyen nhan gay tha't g i l i phau bd't thddng d vung Id thdng xoang
