TAP CHi Y HQC VlgT NAM TAP 450 - THANG 1 - S 0 1 - 2017
NGHIEN CthJ DAC DIEM THIEU MAU TREN BENH NHAN SUY TIM MAN TINH DIEU TRI TAI BENH VIEN Q U A N Y 4
T6MTAT
Muc tieu: Tim hieu tan suat va dac diem tiiieu mau; moi lien quan giCJa thieu mau v6l mot so y§u to (nguyen niian, mu'c do suy tim...) d Eisiii nhan suy tim man tinh. 0oi tu'dng va phuVng phap nghien (xni: Mo ta c ^ ngang, tien CUXJ va hoi cutjNghien cult dac diem thiaj mau tren 215 ijenh nhan suy tim man b'nh, dieu tri Benh vien quan y 4. K& qua va ket luin: l a n suat thieu mau gap 6 benh nhan suy tim man b'nh la 48,8%, chii y§u la thieu mau nhu'dC sac (64,8%), thieu mau dp nhe (92,4%) vdi ki'ch thu'dc iiong rau binh thuiSng; benh nhan suy tim co thieu m§u CO lan so bm 94,6 ± 21,4 chu ky/phut, the t'ch
^ m thu thilt b^i 56,6 ± 52,9 ml va the tich lam bu'dng that trai 115,2 ± 71,2 ml deu cao hdn co y nghia thong ke so vdi binh nhan suy tim khong thieu mau {(an li/dt la 86,2 ± 16,6 chu kj'/phut, 48,7 ± 44,8 ml va 103,1 ± 60,6 ml) vdi p < 0,05; suy tim do benh nhSn van tim c6 ti le thieu mau cao nhat, mu'c do thieu mail nang hdn so v ^ benh nhan khong thieu mau; nong do hemoglobin d benh nhan suy tim cd mot lien quan ra ret vdi mdc do suy tim tren lam sang.
Ttykhda: suy tim man b'nh, tan suat ttiieu mau.
SUMMARY
STUDY ON CHARACTERISnCS ANEMIA PATIENTS W I T H CHRONIC HEART FAILURE
AT THE M I L I T A R Y HOSPITAL 4 Objective: i^am the frequency and characteristics of anemia;, the association between anemia with a number of factors (rauses and severity of heart failure...) in patients with chronic heart failure. Subject and Methods Study: Description cut, prospective and recovery characteristics cuuNghlen anemia researdi on 215 pabents with dironic heart failure, treatment of Military Hospital 4.
Results and Conclusions: The frequency of anemia seen in patients with diranic heart failure is 48.8%, mainly anemia hypochromia (64.8%), mild anemia (92.4%) witti normal erythrocyte size; Heart failure patients with ischemic heart frequency 94.6 ± 21.4 cydes/min, left ventricular systolic volume 56.6 ± 52.9 m! and ieft ventricular diastolic volume 115.2 ± 71,2 ml were signifirantiy higher compared with the statistics of heart fBilure patients are not anemic
*Benh viin Quan Y4-Q<4 Chju trach nhiem diinh; Nguyen Trung Kien Eniail: tnjngkienygmiai.mm
Ngay nhan bai: 1.10.2016 Ngay phan bien khoa hpc: 25.11.2016 Ngay duyet b^i: 9.12.2016
Nguyin Trung Kien*
(respectively 86.2 ± 16.6 cycles/min, 48.7 ± 44,8 ml and 103.1± 60.6 ml) with p <0.0S; heart failure due to heart valve patients have the highest prevalence of anemia, severe anemia levels than patients without anemia; hemoglobin levels In patients with heart failure had signifirantiy correlation with the level of diniral heart failure.
/feyw»/5afe Chronic heart failure, Anemia rate.
I. DAT V X N € ) E
Suy tim la hau qua cuoi ciing cua cac benh ly"
tim mach, Mac diJ gan day co nhieu tien bo trong chan doan va dieu t r j , nhutig suy tim man tinh van dang la mot ganh nang doJ vdi toan nhan loai, t l le tu* vong d nhdm benh nhan (BN) nay con d mii'c cao [ 5 ] , [ 6 ] . Ngay cang cd nhieu bang chutig cho thay, thieu mau xay ra pho bi€n d cac BN suy b'm man b'nh [3], Tinh tr^ng thieu mau d cac benh nhan suy tim man tfnh anh hu^fng doc lap tdi d i u t nang tim, dong thdi lam tang nguy cd benh nhan phai nhap vien va tang nguy cd bJ" vong.
Qua thi/c te dieu trj tai Benh vien quan y 4 (Quan khu 4) chung toi thay du'dc cd nhieu BN suy tim kem tiieo thieu mau. Vi vay, chung toi t h u t hien de tai nghien cu'u nay nhamg muc tieu:
Tim hieu lan suat va dac diem thieu mau; moi lien quan giOs thieu mau v ^ mot so yeu to (nguyen nhan, m u t dp suy tim...) d t>§nh nhan suy tim man b'nh dteu tri tai Benh vien 4 (Quan Idiu 4).
IL DOI TUONG VA PHU'ONG PHAP NGHIEN CLTU 2 . 1 . Doi tu'tfng n g h i i n cuTu:
215 benh nhan suy tim man tfnh, dieu tri tai Khoa No! tim mach va Khoa Can bo cao cap va Quoc te (Benh vien Quan y 4, Quan Wiu 4).
Loai trCT cac benh nhan cd benh ly ve mau, benh gay mat mau cap t^'nh hoac man tfnh (xuat huyet tieu hda, x d gan, ung thii"..,), suy tim kem theo suy than man tfnh, viem npi tam mac n h i i m khuan va cac benh b m bam sinli.
2 . 2 . Phu'tfng phap nghien cii'u:
2.2.1. Thiet ke nghien cu'u:
Mo ta cat ngang, tien culj ket hdp hoi cult 2.2.2. Cac bu'de tien hanh:
- Chia benh nhan lam 2 nhdm theo tinh trang thieu mau va khong thieu mau.
- Tim hieu dac diem thieu mau d b^nh nhan suy tim man d u ^ tren lam sang va mpt so d i i so
VIETHAM MEDICAL JOURNAL N°1 • JANUARY - 2017 can lam sang nhu" so lu'dng hong cau (HC), nong
do hemoglobin trong mau (Hb), dun^ tfch hong clu (hematocrit, ky hieu la Het), the tfch trung binh hong cau (MCV), lu'dng hemoglobin b-ung binh b-ong mpt hong cau (MCV), nong do hernoglobin trung binh trong mpt hong cau (MOIC)/ mot so chi so dien tam do va sieu am tim,
Chan doan suy tim theo tieu chuan Framingham [5], danh gia mut dp suy tim theo Hiep hoi Tim mach New York (The New York Heart Association: NYHA) [5].
- Chan doan thieu mau va danh gia mu'c dp thieu mau theo Bach Quoc Tuyen (1984) [4].
Mu'c dd thieu mau Nanq
vas
Hbfq/I)
<59 60-89 Nhe 1 90-119
HC (T/l)
<2,0 2,1-3,0 3,1-3,69
Het ( l / l )
<0,2 0,21-0,3 0,31 - 0,369 - Phan loai thieu mau theo hinh thai l<!'ch thu'dc hong cau [2]:
+ Thieu mau nhu'dC hong sac hong cau nho: MCHC <300g/l; MCH <28pg; MCV<80fl.
* Thieu mau dang sac hong cau binh thu'dng; MCHC > 300 g/l; MCH >27pg; MCV tCr 8 + Thieu mau dang sac hong cau to: MCHC > 300 g/l; MCH >28pg; MCV > 96 fl.
III. KET QUA NGHIEN CU'U VA BAN LUAN 1. Oac diem chung nhom nghien cu'u
Bang 3.1. fin suit va mWc do thii'u miu, mdc do suy tim:
Nhom thieu mau
(n= 105) Nhom l<hong thieu mau (n= 110) Mu'c do suy tim
47 (44,8%)
Cong (n= 215]
64 (58,2%) 111 (51,6%)
NYHA III 41 (39,0%) 38 (35,4%) 79 (36,;
NYHA IV 17 (16,2%) Suy tim CO thieu mau: 105 benh nhan (48,8%); suy tim i<h6ng thieu mau co 110 benh nhan (51,2%). Ti ie benh nhan suy tim c6 thieu mau trong nghien cu'u cija chung toi (48,8%) cao hdn so vdi mot so nghien ciiu i<hac (Chu Thi Giang: 16,2%, De Siiva va cong sU: 32%) [1],[7]. Dieu nay co the do cac nghien cu'u du'dc thi/c hien tren nhij'ng quan the BN i<hac nhau, vdi dac ti'nh iam sang i<hong dong nhat Ti ie BN suy tim cd thieu mau trong nghien cilfu nay (48,8%) cho thay day ia tinh trang pho bien.
3 (7,3%) 25 11,6%)
- Ve mtrc do thieu mau (n= 106): Thieu mau mirc do nhe: 97 benh nhan (92,4%); thieu mau mu'c dp vira: 8 benh nhan (7,6%). Chung toi gap chu yeu ia thieu mau mu'c do nhe (92,4%), ithong cd benh nhan nao thieu mau mu'c do nang. Nghien cu'u cua Chu Thj Giang thay'85,2%
BN suy tim cd thieu mau mirc do nhe [1]. NhlT vay, thieu mau trong suy tim man tfnh chu yeu la mu'c dp nhe.
Bang 3.2.Chiso huyet hoc trung binh theo qidi GiSi BN (n = 215)
150 (69,7%) 65 (30,3%)
HC (T/l) 4,37 ± 5,0 4,14 ± 0,39
Hb (g/l) 130,3 ± 17,8 119,7 ± 1,75 Ham iUdng Hb trung binh cua BN ca hai gidi deu d nguBng bat dau thieu mau'va BN nB co xu liu'dng thieu mau nhieu hdn so vdi BN nam
Bang 3,3. Chi so huvet hoc truna iilnh theo tuoi cua BN ca 2 nhdm BN (n= 25)
4(1,S 30 (14,0' 64 (29,6 68 (31,6 49 (22,8
HC (T/l) 4,50 ± 0,28 4,17 ± 0,52 4,34 ± 0,53 4,28 ± 0,57 4,35 ± 0,48
Hb(g/I) 143,2 ± 11,1 123,4 ± 19.8 128,2 ± 18,4 126,7 ± 19,4 127,0 ± 16,1
Net ( I / I ) 0,415 ± 0,037 0,385 ± 0.044 0,398 ± 0,049 0,396 ± 0,043 J ^ L ^ T ? . ,'n , ,?u'?™A"''-"'^=J' * i ^ " ™ " '= ^1'2 ± 9,5 va nhom benh nhan khong thieu thlnn i / \ n i ^ W " ^ ^^''^}? ""z'™ '^""3 binh cua nliom benh nhan 2 nindm khong co y nghfe ,
h a P j ^ i '^f sf,''7';="?,"5hlen cu'u cua Chu Thi Giang, tuSi trung binh ciia benh nhan suy tim c6N hieu mau la 62j3 ± 18,22 cao hdn co y nghia thong ke so vdi nhdm benh nhSn khong thieu mau \ S n i c ; J i S ™ ' h ! ^ ? ° ^ ° ' ^ ^ - ? i"S:;3 "'^ '™"9 '='"*' '^^ •^ ^ SidI deu tong gidi han binh thu'dng.
KhongcosiTkhacbietvecacchisoHQHb, Het d cac lira tuoi BN s a .
TAP CHi Y HOC VIET NAM TAP 450 - THAHG 1 - S 0 1 - 2017
Bang 3.4. Huyeidd va chi so huyet hoc irung binh Huyet do chi so huyet hpc Chung
(n= 215)
Nhdm thieu mau I Nhom khong thieu p (n= 105) (1) mau (n= 110) (2) Huyet do
Chi so huyet hpc trung binh
P§ng sac 37 (35,2%)
Nhu'dC sac HC(T/i)
78 (64,8'
92 (83,6%)
Hb( q/i)
4,11 ± 0,4
18 (16,4%)
0,394 ± 0,046
112,1± 11,1
4,49 ± 0,5
MCHlESl
91,7 ± 5,9
0,374± 0,038
142,4 ±11,7
<0,05 0,414 ± 0,045
<0,01
MCHC(g/l)
29,4 ± 3,6
91,3 ± 5,9 27,6 ± 3,1
92,0 ± 6,0
>0,01
<qj)S 321,4 ± 34,2 298,5± 30,2
31,1± 4,5 343,6 ± 41,1
<0,01
<0,01 BN nhdm thieu mau co 64,8% ia thieu mau
nhu'dC sac. BN nhdm khong thieu mau van cd ti te nhu'dC sac kha cao (16.4%). Dieu nay du'dc mpt so tac gia cho rang tac gia cho rang, BN suy tim CO ham lu'dng sat va feritin huyet thanh thap.
Tuy nhien, theo mpt so lac gia khac, dir tru' sat trpng tuy xutflig bi can kiet do phan tan tdi cacvj tn' du" trtJ khac thupc vong npi monen khong sin sang cho cac hoat dpng tao Hb cho'hong rau.
Hb trung binh d BN trong nghien ciru nay ia 127,3 ± 18,2g/l, chirtig td cd tinh trang thieu
mau thu'c sir d BN suy Mm man ti'nh. So ii/dng HC va Het trung binh van trong gidi han binh thu'dng, cac chi so MCH, MCHC d gidi han thap.
6 ntidm BN suy tim cd thieu mau, cac chi so Hb, MCH va MCHC giam ro ret; so lu'dng HC va MCV cd xu hu'dng giam nhUng chuS cd y nghTa thdng ke. Ket qua nghien ciru ciia chung tdi cho thay thieu mau trong suy tim man tinh chii yeu la giam Hb, cdn so lu'dng HC va MCV giam it.
2. Mdi lien quan giu'a thi€u mau vdi mdt sdyeu td;
Bing 3.5. Lien quan giSa thiBi miu vdi d'len tim dd vi hinh thai, chdb ning dm tren siiu in T „ ~ . . . - I Chung I Nhom thieu mau I Nhom khdnq thieu I I ~
Tan so tim (chu ky/phiit)
Chung (n= 215)
Nhom thieu mau [n=105)(l)
Nhom khdng thieu mau (n= 110) (2) 94,6±21,4 86,2±16,6 Nhjp xoang
do Runq nhT
66BN (62,i Ngoai tam thu
28 BN (26,7'
71BN (64,5%) >0,05 41 BN (39,0%)
25 BN (22,7%) 34 BN (30,9%)
>0,05
>0,05 Du'dng kinh
tam tru'dng (mm) 46,7±9,0 45,2±9,3 >0,05
DUdng kinh
tam thu (mm) 34,4±9,2 33,4±9,3 >0,05
The tich tam trUdng
that trai (mm) 109,0±65,9 115,2±71,2 103,1± 60,6 The tich tam thu
that trai (mi) 52,7±48,4 56,6±52,0 48,7 ± 44,8 Phan suat
tongmau (%) 57,3±11,9 57,9 ± 11,8 >0,05
26,9±6,3 26,4±6,5 27,3 ± 6,03 >a,05 Tan so tim trung binh ciia Bl^l nghien citu ia
90,1 ± 19,1 chu ky/phut, tan sd tim trung binh d nhdm BN thieu mau (94,6 ± 21,4 chu ky/phut) cao hdn cd )r nghla thong ke so vdi nhdm BN khong thieu mau (86,2 ±15,6 chu ky/phut) Cac roi ioan nhip (nhip xoang, rung nhT), iihong cd str khac biet giu'a 2 nhdm. Trong suy tim, do cung iu'dng tim giam, nhjp tim phai tang ien de bii trir.
Hdn nii^, khi bj thieu mau iam cho kha nang van chuyen oxy bj giam sut cung lam nhjp tim tang len.
The tfch tam thu that trai va the tfch tam tru'dng that trai d BN nhdm thieu mau (56,6 ± 52,0 ml va 115,2 ± 71,2mi) deu tang hdn so vdi BN nhdm khdng thieu mau (48,7 ± 44,8mi va 103,1 ± 60,6ml). SU khac biet cd y nghTa vdi p<
0,05. Khi thieu mau, tim phai chiu ganh nang the tich, lal cdng them kha nang van chuyen oxy giam nen tim bu trCr bang each gian rpng that trai de tang eung iu'dng tim.
Phan tich tong mau ciia cac BN suy tim glarri nhuHg van trong gidi han binh thu'dng (57,3
±11,9%). Chi sd nay d nhdm BN thieu mau (56,8 ±12,2%) cd xu hirdng giam hdn so vdi BN khong thieu mau (57,9 ±11,8%), tuy nhien sir khac biet khong cd y nghTa thong kS (p>0,0S).
Mpt so tac gia cho rang nhiing BN thieu mau ma khong cd suy tim tJii phan suat tong mau khong
VIETNAM MEDICAL JOURNAL N'l - JANUARY • 2017
nhifng khong giam ma cdn tang len de bu trir,'^
con trong suy tim cd thieu mau thi phan suat tong mau van binh thu'dng do cd the phan umg bang each gian mach, lam giam hau ganh va tang chiic nang tam ttiu that trai. iDo vay, Unh ^ trang thieu mau d BN suy tim man tinh kiiong lien j quan den phan suat tSng mau giam hay bao ton. ,; '
Bang 3.6. Liin auan giii'a thieii mau vdi nguyen nhan giy suy tim
rr ^ r n . —I « • I .lUJl—- . h l n n I M U n n . I ^ h n n n f.|.il
Nguydn nhan suy tim Benh van tim Benh mach vanh
Chung (n = 203) 34(16,7%) 57(28,1%)
Nhom thieu mau (n= 99)
23(23,2%) 31(31,3%)
Nhom khong thieu mau (n=: 104)
11(10,6%) 26(25,0%)
Hb trung binh (g/l) 118,2 ± 18,0 123,4 ± 17,3 Benh tang huyet ap
Benh phoi man tinh
52(25,6%) 60(29,6%)
21(21,2%) 24(24,2%)
31(29,8%) 131,5 ± 18,0 36(34,6%) 132,1 ± 17,6 Trong so 215 BN ciia nghidn ciru nay, chung
tdi chi du'dc nguyen nhan gay suy tim d 203 BN (bao gom' 99 BN nhdm thidy mau va 104 BN nhorn khdng thieu mau), vi vay chung tdi danh gia sir iien quan giifa thieu mau vdi nguyen nhan gSy suy tim d 203 BN va cho ket qua nhu' sau: Ti ie va mifc dp thieu mau d BN suy tim do benh van do tim cao nhat, sau dd den BN suy tim do benh m?ch vanh, benh tang huyet ap va benh phoi man tfnh. Ket qua cua chung tdi cd si/ khac bidt so vdi nghien ciiti cQa Chu TTij Giang: ti ie va mii'c dp thieu mau cao nhat d BN suy tim do benh niach vanh (ham iu'dng Hb 108,0 ± 31,1 g/l, ti ie 12,7%)I1]. Oieu nay cd the do BN co bdnh van tim thu'dng mac benh tir sdm, duy tri
Bing 3.7. Liin quan giu'a ihieu mau vdi md'c do suy Um
' Nhnm T "MVHA TT fn= l i n I WVHA TTT fn=
tai nha, khi benh nSng hoac ddt tien trien ciia siiy tim mdi vao vien; con iiiii ed cac benh khac, BN vao Vien da so vi trieu chumg cua benh nguydn neii sd BN suy tim do bdnh ly van tim thu'dng nang va ti Ie thieu mau cao hdn.
Mdt sd nghien cirtj khac cung thay mu'c do va tl ie thieu mau d BN suy tim do benh mach vanh cao nhat. Dieu nay du'dc giai thfch bdi sii tham gia eiia eac yeu td viem, hdn nua BN benh mach-^
vanh thu'dng dung cac tJiuoc chdng ddng, chong,,«
ngirng tap tieu cau va thude u'c che men chuyen 1 se tao tien de cho tinh trang thieu mau. M|t;J khac, nhieu nghien ciiu ciio thay suy tim do ' benh mach vanh cd bieu hien lam sang nang hdn, tien tien nhanh hdn.
NYHA I I (n= 111) NYHA III (n= 79) NYHA IV (n ^ 25)
• Thieu mau Kpong thieu mau
47 (42,3%) 64 (57,7%)
41 (51,9%) 38 (48,1%)
17 (68,0' 8 (32,0%)
0,05 <0^05
Tf id BN suy dm oo tJiieu mau tang dan theo mu'c dp suy Hm (42,3% d i d NYHAU, tang len 51,9% d dp IWHAn va 68% d dp NYHAiy). Oieu nay cho thay mut dp suy Urn eang nang thi ti Id thidu mau cang cao.
Bang 3,8. Cic chi sdhuyii hoc iheo mWc dp suy Um MuTc dd suy tim
NYHA II NYHA III NYHAW Trung binh
Hb (g/l) 130,5 ± 13,8 125,3 ± 18,0 120,6 ± 17,1 127,3 ±18,2
HC (T/l) 4,35 ± 0,53 4,26 ± 0,51 4,21 ± 0,51 4,3 ± 0,5
Het ( I / I ) 0,399 ± 0,046 0,390 ± 0,046 0,387 ± 0,041 0,394 ± 0,046 Mu'c dp suy tim cang nang thi eac chi sd Hb,
HC, Het cang giam nhieu. I^hu' vay, suy tim cang nSng tht mifc dp thieu mau cang cao. Oa cd niiieu nghien culi cho thay thieu mau iam nang hdn tinh trang suy tim, tang nguy cd nhap vien.
Suy tim gdp phan gay thieu mau nhuTig ngiTdc lai, thieu mau cung lam cho suy tim n^ng hdn va nhu'ng BN suy tim cd the thieu mau tlii tien lu'dng xau hdn.
IV. KET LUiBlN
Nghien ciiu tan suat, dSc dfem thieu miu va mdi lien quan giua thieu mau vdi mpt sd yeu tD tren 215 BN suy tim man ti'nh dieu tij tai Benh vien'i quan y 4 (Quan khu 4), chiing toi riit ra ka luan: '
- "Tan suat thieu mau gap d BN suy tim mani tfnh la 48,8%, trong dd chu yeu la thieu maUiJ nhu'dC sac (64,8%), kfch tiiu'dc hdng rau binh.
TAP CHl Y HOC VlgT HAM TAP 450 • THANG 1 - S 0 1 - 2017
thu'dng thieu mau muic do nhe (92,4%) va khong co thieu mau mu'c do nang.
- Tan so t i m , the ti'ch tam thu that trai va the tich tam tru'dng that trai 6 nhom BN suy tim co thieu mau (lan lu'dt la 94,6 ± 21,4 chu ky/phut, 56.6 ± 52,0 ml va 115,2 ± 71,2 ml) cao hdn co y nghTa th6ng ke so vdi nhom BN suy tim khong thieu mau (lan Iu'dt la 86,2 ± 16,6 chu ky/phut, 48.7 ± 44,8 ml va 103,1 ± 60,6 ml); cac roi loan nhip tim, chi so chii'c nang tim tren sieu 3m d nhom BN khong co su" khac biet.
- Suy tim do Ijenli van tim co t i le thieu mau cao nhat, co mii'c do thieu mau nang hdn so v6i (3c nguyen nhan khac. Mu'c do suy tim trong nhom BN thieu mau nang hdn so vdi nhom BN khong thieu mau. Nong dp Hb co moi lien quan ro ret vdi mu'c dp suy tim tren lam sang.
TAI L l | U T H A M KHAO
1. Chu Thi Giang (2009^, flIghiSn cihi ti IS va dac diem thieu mau d benh nhin suy tim man tinh, Luan vSn thgc sT y hpc, tru'cfng Dai hpc Y Ha NQi.
2. Thai Quy ( 2 0 0 6 ) , "Phan loaic thieu mau", Bai gjang huyit hpc va truySn mau sau dai hpc, Nha xuSft ban Y hpc. Ha Npi.
3. Chau Ba Tiiong ( 2 0 0 8 ) , "ThiSu mau lam tang nguy cd hi vong do suy bm", Thong tin y hpc, thang 1/2008.
4. Bach Quoc Tuyen (2002) "Dai cudng ve tfiieu mau" Bach khoa thu' benh hpc, ^ p 1, Nha xuat ban Y hpc Ha N6i, trang 140-142.
a. Ph^m Nguyen Vinh va epng sir (2008),
"Khuyen (so 2008 cOa Hgi dm mach hoc Vi$t Nam ve chan doan va dteu tii suy tim", Khuyen cao cac benh lya tim mach va ciiuyen hoa, Nha xuat ban Y hoc, ha Npi, trang 438-470.
6. Basil S Lewis, Basheer Karkabi, Ronen Jaffe et al ( 2 0 0 5 ) , "Anaemia and heart failure:
^tement of the problem", Nephol Dial Transplant, 20, Supp.7, VII3-VII6.
7. De Silva R, Rigby A.S, W i t t e K.K et al (2006),
"Anemia, renal dyshjnction and dieihnteracHon in patients witii chronic heart failure", American Journal Cardiology, 98 (3), pp. 391-398.
NGHIEN CU'U HINH A N H MRI SO NAO v A CAC TRIEU CHU'NG HOANG TU'd^NG AO GlAC O B^NH NHAN NGHIEN RU-OU
TOIVITAT
Myc tiiu: hinh anh ton thu'dng nao cua ngu'di nghi§n m^u tren phim MRI. \^6\ lien quan giijii t6n thu'dng nao v6i cac trieu chutig hoang tu'dng va ao giac. Boi tiring nghien cHii: 30 b§nh nhan du'dc dian doan xac djnh la nghien ru'du, co hoang ti/6ng va ao giac. PhuVng phap nghien cuU: tien cuU, c5t ngang, mo ta tCmg trufeng hdp benh nhan. Kit qua
va kliuan: - 63,63% so benh nh§n nghien ru'du co ton thu'dng nao tren phim MRI. Vung nao hay bj ton thu'dng nhat la thiiy dinh, chifm 56,56%. Loai ton thu'dng hay gap nhat la gian khe giiJa cu6n nao vung dinh 2 ben, chiem 36,66% va thoai hoa myelin d viing dinh 2 ben vdi 33,33%. - Cac hoang tu'dng va ao giac 6 benh nhSn nghien ru'du khong co moi liin quan den teo nao va thoai hoa myelin d nSo.
*B4nh viin Tam tiian TU'2, Biin Hoa
**Binh vien Quan y 103
***Hgc vien Quin y
Chiu trach nhiim chinh; Biii Quang Huy Email: [email protected] Ngay nhan bai: 16/10/2016 Ngay phan biin khoa hpc: 17/11/2017 Ngay duyet bai: 2/12/2016
Nguyin Hmi ThSng*, Bui Quang Huy**
Nguyin Sinh Phuc***
TCr khoa: Nghten ru'du, ton thu'dng nao, MRI
S U M M A R Y
STUDYING OF THE BRAIN'S M R I IMAGING AND DELUSIONS AND HALLUQNATIONS SYMPTOMS I N PATEENTS W I T H ALCOHOL DEPENDENCE
Objective: Damage of the alcoholic brain on MRI films. The relationship between brain injury v/ith symptoms of delusions and halluanations. Subjects studied: 30 alcoholic patients, who have delusion and hallucinations. Subject and Methods: cross- sectional prospective study, which describes each specific case on 30 patients who are alcoholism.
Result and conclusions. - 63.63% of alcohol- dependent patients have brain lesions on MRI films.
Parietal iobe is the most vulnerable regions of brain, accounting for 56.56%. The most common type of injury is the widaiing gap between the two parietal lobes, accounting fbr 36.66% and myelin degeneration in the parietal tobes with 33.33%. - The delusions and hallucinations in alcoholk: patients cant be associated with brain atrophy and degenffation of myelin in ttie brain.
Key words. Alcohol-dependent, brain lesions, MRI.
