nhan sau dot quy nao cap bang thang diem danh gia tam than toi thieu MMSE Nghien cuu tinh trang suy giam nhan thuc 6 b$nh

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Nghien cuu tinh trang suy giam nhan thuc 6 b$nh nhan sau dot quy nao cap bang thang diem danh gia tam than toi thieu MMSE

TS. Nguyen Hoang Ngoc, BS. L€ Dinh Toan Benh vien Trung uang Qudn ddi i 08

rtM

TAT

Nghidn cuu d<inh gici tinh trang suy gi^m nh^n thuc being thang di^m MMSE trin 107 b$nh nhan d$t quy nao dieu tri t^i Trung t<ini dot quy nao tCr thcing 4/2012 den 10/2012, ic^t qui cho thSy ti \i benh nhan bi suy giim nhan thuc sau dot quy nao cip l i 53% trong d6 sau nhii miu nao la 56%; sau chiy miu nio l i 46,8%. Tinh trang suy giim nhin thCrc mire dO vCia v i ning ti nh6m b$nh nhan nh6i m i u nao cao hon nhom chiy miu nao (46,6% so vol 15,7% voi p<0,05). Sic diem suy giim nh|n th<K v(ra v i ning ti nhom nhdi miu nio cao hon chiy m i u nio ihii yiu 6 chCrc ning ghi nhin, tri nh6 gin v i suchii y khi ning tfnh toin.

Mot so yeu td Win quan den suy giim nhin thlic 6 benh nhan sau ddt quy nio l i tudi cao, trinh dd hoc vin thip, rSi loan ngdn ngCr, tdn thuang thuoc cic vung chien luoc thudc bin cau uu thi v i rdi loan Hpide m i u .

Tir khda: Suy giim nhin thuc; dot quy nio, MMSE

LDATVANDE

Roi loan nhan thiJc do mach mau la thuat ngOf chi nhCfng thay doi mach mau co the dan dgn tinh trang suy giam nhan thutc hoac sa sut trf tue. Day

\i mot tap hpp cac tri^u chijrng li^n quan den co che mach mau khac nhau, hay gap nhat la cac b^nh ly dot quy nao. 0 mpt mOfc dp nao do tinh trang suy giam nhan thufc nay co the d u phong dupc khi chung ta phat hien sdm va chan doan 102 TH£N KINH HOC VIETNAM I s d

chfnh xac benh ciing vPi cac bien phap dieu trj, kiem soat cac y^u t d nguy cp cua dot quy.

fie tim hieu mtJc dp va bieu hi^n cua tinh trang roi loan nhan thCfc sau dpt quy nao chOng toi tien hanh de tai nay nhSm muc dich:

Khao sat mifc dp suy gi^m nhan thijfc cac benh nhan sau dot quy nao cap lan dau tien bang thang d i l m danh gia tam thSn toi thieu (MMSE).

Nghien cufu dac diem iam sang cOa tinh trang suy giam nhan thilc sau dpt quy nao cap.

14 - QU"? IV/2015 Website hoithankinhhocvietnam com.vn

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BAO CAO KHOA HOC k.

II. 601TUVNG VA PHU0NB PHAP NGHIEN COU

1. Ddi ti/tfng nghien cihi

Gom 107 benh nhan dot quy nao dieu trj noi tru tai Trung tam Dot quy nao Benh vien Trung ucfng Quan dpi 108 ttrthang 4/2012 den thang 10/2012 dddc chan doan xac dinh dot quy nao bang llm sang va chup cat Icfp vi tfnh so nao (trong d6 75 b§nh nhan nhoi miu nao va 32 b$nh nhan chay mau nao).

Ti§u chuan chon benh nhan:

Cac benh nhan tham gia nghien cuu deu tinh l<hi ra vien, biet chuf va hpp xic trong qua trinh tham kham va thUc hien cac tr^c nghiem tam ly trong Test tam than toi thieu MIWSE (Mini - Mental State Examination) cua Folstein.

Tat ci cac benh nhan deu bj dot quy nao lan diu tien

Cac b^nh nhSn deu th6a man tieu chuin chan doan sa sut trf tue (SSTO can nguyen mach m^u cOa NINDS - AREN va thang diem thieu mau Hachinskl.

TestMMSE

Tong diem binh thudng 30 diem

Muc

1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 2.1 2.2 2.3 3.1 3.2

Ndi dung Thijf may ? NgSy may ? Th^ng mIy ? Miia gi ? Nam may ? Bu6ng hay khoa nao?

B&nh vien niio ? QuSn (huyen nao) ? Tinh (thanh pho nao) ? Hddcnao ?

Ope ten do vat thuf 1 Bpctend6vatthu'2 Bpc ten do v3t thil 3 100trLrdl7c6nmay?

93trirdi7c6nmay?

Dilm Muc

3.3 3.4 3.5 4.1 4.2 4.3 5.1 5.2 5.3 6.1 6.2 6.3 6.4 6.5 7

Noi dung 86trLrdi7c6nmay?

79trLfdi7c6nmay?

72trL/di7c6nmay?

NhactendovatthiJI Nhactend6vatthu'2 NhactendovatthaS Xem do vat 1 h i ! cai gi day?

Xem do vit 2 hd\ cai gi dSy?

Yeu cau nhac lai 1 cau Cam td giay bSng tay phk\

Gap dditP giay lai Dat tP giay xuong ban Yeu cau doc va lam theo yeu cau viet mpt cau bat l<y Yeu c l u ve lai mPt hinh

D i l m

Wel~ '<-^ hoithanlcinhhocvietnamcom.vn S614 - QUV IV/2015 I TH&N KINH HOC V|£T NAM 103

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Muc 1.1 -1.10:Danh gia k h i nang djnh hudng khong gian va thdi gian (toi da benh nhan lam t o t dUpclOdiem).

Muc 2.1 - 23:Banh gia sU ghi nhan (3 diem).

Muc 3.1 - 3.5: Oanh gia sd chu y va kha nang tinh toan (5 diem).

Muc 4.1 - 4.3: Danh gta tri nhd gan (3 diem).

Muc 5.1 - 5.3: Danh gia ngon nguf (3 diem).

Muc 6.1 - 6.5: Danh gia chu'c nang thUc hien cac hoat dpng ket hpp {5 diem).

Muc 7:Danh gia chufc nang thj giac (1 diem).

Tieu chudn loai trd

Cac benh nhan t h i e u mau nao t h o a n g qua da hoi phuc hoan t o a n , benh nhan t r a m cim nang hay co t a m t h a n phan liet Xrddc khi d o t quy. Cac benh nhan g i i m t h f n h luc nang hay t h j lUc nang i n h hUdng den cac test kiem tra. Cac b e n h nhan t i e n sCf co b f n h ly t h a n kinh t r u n g dang kem t h e o khac nhU u nao, Parkinson, chan thUPng sp nao, nao ung t h u y .

2. Phddng phap nghien cuti: Mo ta cat ngang Cac benh nhan dCi dieu kien tham gia nghien cUu dupc danh gia tinh trang nhan thUc bang Test tam than toi thieu MMSE khi ra vien.

Vdi Test MMSE danh gia nhU sau:

Khong co suy giam nhan thUc: > 24 diem Suy g i i m nhan thUc nhe: 20 - 23 diem Suy g i i m nhan thirc vUa: 1 4 - 1 9 diem Suy g i i m nhan thifc nang: 0 - 1 3 diem 3. Phapng phap t h o n g ke va xd ly s6 lieu

Theo chuong trinh SPSS 11.5

III. KET QUA NGHIEN CUU

1. Dac diem chung n h o m n g h i e n cdu Bang 1. Tuoi gidi vd trinh do hoc vdn

Tuoi - Gidi Tuoi £ 65 Tuoi trung binh Nam Nu:

Tieu hoc Trung hoccdsp Trung hoc pho thpng Cao dang - Dai hoc

Chay mau nao N= 32 11(34,4%) 62 (±13,7) 23 (72%) 9 (29%) 2 (6,3%) 4(12,5%) 10(31,3%) 16(50%)

Nhoi mau n i o N = 75 48 (64%) 69 (±18,6) 51 (68%) 24 (32%) 6(8%) 3(10,6%) 25 (33,4%) 36 (48%)

P

<0,05

<0,05

>0,05

Tu6i trung binh nhom c h i y mau nao thap hPn nhom nhoi mau nao. Khong cd sU khac biet ve gidi giCfa hai nhdm chay mau nao va nhoi mau nao.

Khong cd sp khac biet ve trinh dp hoc van giCfa hai nhdm chay mau nao va nhoi mau nao.

C i hai nhdm nghien cdu deu cd trinh dp tC/trung hpe pho thong t r d len chiem 81,3%- Bang 2. Mot sdyeu to nguy cd hay gap.

Cac yeu t ^ nguy ctf Tang huyet ap Dai thao dudng Roi loan chuyen hoa iipide Nghien thuoc la Nghien rUdu

Chdy mau nao N = 32 23 (72%) 3 (9,4%) 12(37,5%)

2 (6,3%) 2 (6,3%)

Nh6i mau nao N = 75 52 (69,4%)

8(10,7%) 49 (65,4%)

6 (8%) 3(4%)

P

>0,05

<0,05

>0,05

>0,05 Cac yeu t6 nguy co hay gap nhSt vSn la tang huyet ap, roi loan chuyen hoa Iipide va dai thao 104 IHAN KINH HOC VIET NAM I S(3 14 - QUV IV/2015 Website'hoithankinhhocvietnam.com.vn

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BAO CAO KHOA HOC k.

dudng. Trong d d roi loan chuyen hda Iipide gap d nhdm nhoi mau nao cao hcffi chiy mau nao.

Bdng 3. Cdc trieu ehdng Idm sdng dnh hddng tdi tinh trang nhdn thdc vd thdc hiin nghiem phdp MMSE.

TriSu chihig ISm sang Liet nda ngudi Roi loan ngon ngu' Roi loan thi luc

Chiy mau nao N = 32 25 (78,2%)

Nhoi m i u nao N = 75 60 (80%) >0,05 10(31,3%) I 22(29,4%) i >0,05

3(8,6%) I 2(2,7%) Cac t r i e u chUng lam sang hay g a p van 1^

liet nCra n g u d i . Dac biet c i hai n h d m cd t y le roi loan n g d n ngU t U d n g d U d n g nhau 31,3%

d n h d m c h i y mau nao, 29,4% d n h o m n h o i mau nao. Ty 1^ b e n h n h 3 n Met k h u t r u nCfa

ngUdi d hai n h d m la 78,2% n h d m chay m a u nao, 8 0 % n h o m n h o i mau nao.

Bdng 4. Vi tri ton thdang tren bdn cdu.

Vj t r i ton thuong tren ban cau Ban cau Uu the

Jtrai)_

Ban cau khdng uu the Tieu nao, than nao Ci hai ben

Chaymau nao N = 32 16(50%)

Nhoi mau nao N = 75 39 (52%)

110(31,2%) 22(29,4%) i

6(18,8%) 4(5,4%) ' 10(13,2%)1

Cac benh nhan dot quy ty le gap chu yeu d ban cau dai nao 81,3%; trong dd ban cau uu the ca hai nhdm deu tren 50%.

Bang 5. Vi tri ton thUOng vung chien lUOc.

Vj t r i theo vung chien lifOc

Vung vd nao -Vung tran -Vung dinh -VCing thai duong -VCing cham Vung dudi v6 -06i thj, bao trong -Nhan xam Vung dudi leu -Tieu nao -Than nao T6n thuong nao nhieu 6

f

-

Nhoi m^u nao N = 75

17 2 3 i n 2 20 5 15 4 2 2 34

T y i i %

22,70%

26,70%

5,30%

45,30%

Chdy mau nao N = 32

9 1 1 4 3 17 8 9 6 4 2

T y l e %

28,2

55

18,8

Hai nhom

24,30%

34,60%

9,40%

1

• hoitiiankinhhocvietnam com vn S6 14- QUY iV/2015 I THAN KINH HOC V I | T NAM 105

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Cac vj t r i chien lUdc lien quan t d i m d t so chdc nang n h u n g d n ngO, thUc d u n g d d n g t i e la nhUng vung se anh hudng t d i viec thuc hien cac nghiem phap t h a m d o chUc nang nhan thifc, 24,3% cac benh nhan t o n thUdng v u n g v d nao; 34,6% ton t h u a n g viJng dUdi vd; 9,4% t d n thUpng dudi leu. LUU y hdn ca la n h d m nhoi mau nao t h u d n g t o n t h u o n g nhieu vj t r i tren mpt b^n cau hoac ca hai ban cau chiem 45,3%-

2. Ket quS t r i e nghiem tam ly (MMSE)

Bang 6. Ket qud ddnh gid tri nhd, tfnh todn vd mot so linh vdc nhdn thdc.

Noi dung trlic nghiem

Banh gia sU ghi nhan

Danh g i i suchu y va khi nang tinh toan

BanhgiatrinhPgan

Danh gia ngon ngU

Danh gia chUc nang thi/c hien cac dpng tae ket hpp

Danh gia chufc nang thj giac

Djnh hudng khong gian thdi gran

Diem 0 1 2 3 0 1 2 3 4 5 0 1 2 3 0 1 2 3 0 1 2 3 4 5 0 1 0-5 06-ThglO

Chay mau nao N 10

0 6 16 1 6 2 7 6 10 11 2 7 12 12 1 1

4 15 18 7 0 0 2 5 6 26 15 17

= 32 10 31,20%

18,80%

50%

9 28,20%

21,90%

18,70%

31,30%

13 40,70%

21,90%

37,40%

17 53,20%

46,80%

25 78,20%

7 21,80%

18,70%

81,30%

47%

53%

Nhoi mau nao N!=75 28 12 3 32 7 13 14 10 16 15 30 16 7 22 30 4 6 35 45 15 0 1 2 12 10 65 36 39

40 53,40%

4%

42,60%

34 45,40%

13,30%

21,30%

20%

46 61,40%

9,40%

29,20%

40 53,40%

46,60%

60 80%

15 20%

13,40%

86,60%~

48%

52%

<o,os

<0,05

<0,0S

>0,05

>0,05 106 THANKIMHHOCVIETNAIW!5(3 14-QU?IV/2015 Website: horthankinhhocvietnam.com.v

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B A O C A O K H O A H p ^ k

Danh gii cic chdc nang trong bing danh gia MIVISE, chung tdi nhan thay, sU ghi nhan, khi nang tri nhdg^n, danh gia suchu y va kha nang tfnh toan cua nhdm benh nhan nhoi mau nao thap hdn nhdm chiy mau nao. Theo thUtu la 31,2% benh nhan chay mau nao so vdi 53,2% benh nhan nhdi mau nao cd roi loan su ghi nhan; 28,2% so vdi 45,4% cd giim su chu y va kha nang inh toan; 40,7% nhdm chay miu nao so vdi 61,4% nhdm nhoi mau nao cd rdi loan tri nhd gan. Su khac biet nay co y nghla thong ke vdi p<0,05

Bdng 7. Tong diem trdc nghiem MMSE

T£ng tfiem IHMSE Khdng suy gi^m nhan thijfc l«ll«ISE>24diem Suy giam nhan thijrc nhe MMSE 20-23 diem Suy gi^m nhan thiJrc vCra MMSE 14-19 diem Suy giam nhan thiic nang MMSE0-13diem

Chay mau nao N = 32

17 53,2%

10 31,3%

3 9,4%

2 6,3%

Nhoi mau nao N = 75

33 44%

7 9,4%

13 17,3%

22 29,3%

P

>0,05

<0,05

Ty le benh nhan bi suy giim nhan thu'c mUc dp vij^ va nang d nhdm benh nhan nhoi mau nao cao han nhdm benh nhan chiy miu nao. (15,7% nhdm chay mau nao so vdi 46,6% nhdm nhoi mau nao).

SU khic biet nay cd y nghTa thdng ke vdi p< 0,05

Bdng 8. Moi liin quan gida mot sdyeu to Idm sdng tinh trang suy giam nhdn thdc (5GNT).

Ci hai nhdm cd 107 doi tUdng nghien cUu. Sau khi bj dot quy lan dau, tai thdi diem ra vien cd 57 benh nhan bi suy giim nhan thdc tCf nhe den nang. Thdng ke cic yeu to lien quan trong bing sau:

Cic yeu to lien quan Tuoi trung binh Tu6i tren 65 Trinh do tieu hoc Rdi loan ngon ngCr Tang huy^t ap B^i thao dudng Roi loan chuyen hoa Iipide T6n thudng ban cSu uu the Ton thudng vung chien iuoc

C6 SGNT N = 57 73 ±10,4 42 (73,7%)

6(10,6%) 31(54,4%) 40 (70,2%) 7 02,3%) 38 (66,7%) 40 (70,2%) 43 (76%)

Khong SGNT N = 50 58 ±11,2 17(34%) 2(4%) 1(2%) 35(70%)

4(8%) 23 (46%) 15(30%) 20 (40%)

P

<0,05

<0,05

>0,05

<0,05

<0,05

Website" hoithankinhhocvietnam com.vn S6 14 - QUV IV/2015 I THAN KINH HOC VI|T NAM 107

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Cac yeu t d nhU tuoi trung binh cao; trinh dp hoc van cang thap; ton thUdng ban cau uu the; ton thUPng vung chien luoc (lien quan chdc nang ngdn ngif va nhan thut-.) cung nhu roi loan chuyen hda Iipide la nhijfng yeu t d lien quan den tinh trang suy giam nhan thdc cua cac benh nhan sau dot quy nao cap (vdi p< 0,05).

IV.BANLUAN

1. Dac diem chung n h d m nghien cuti Tuoi vd gidi

Tuoi taing binh trong nhdm nhdi mau nao cao han nhdm chay mau nao 69 (± 18,6) so vdi 62 (±

13,7). Tuoi tren 65 d nhdm nhoi m i u nao cao hdn cd y nghTa thong ke so vdi nhdm chay m i u nao.

Day la sU thong ke ngau nhien trong thdi gian lay so lieu. Thuc te chung tdi thay cic benh nhan chay mau nao ngay cang gap d Ida tuoi tre hon do anh hudng cua sinh boat, loi song, ap luc cdng viec nen cac benh nhan nay khdng kiem soat tdt cic yeu to nguy ca dac biet tang huyet ap, nhieu benh nhan khi bj dot quy rdi mdi biet bi tang huyet ap. Tong hdp ca hai nhdm chung tdi cung nhan thay tuoi tren 65 chiem da sd 56%.

Cac yeu to nguy ca hay gap quan trpng nhat van la tang huyet ap 69,4% nhdm nhdi mau nao 72% nhdm c h i y mau nao, tiep den la rdi loan chuyen hda Iipide 65,4% nhdm nhoi mau nao, cao hdn nhdm c h i y m i u nao 37,5%. Nhan xet nay cung phu hpp vdi nhieu thdng ke khac ve rdi loan chuyen hda Iipide dudng nhu lien quan nhieu tdi cd che cua dot quy nhdi mau nao, trong khi dd yeu t o nay it anh hudng tdi c h i y mau nao. Ty le cac yeu t d nguy ca trong nhdm nghien cdu nay cung tuang tU n h u ty le chung cua cac nghien cdu ve dich te dot quy nao trong nudc trong thdi gian gan day.

Trinh dp hoc van cua cac benh nhan nghien

cdu d hai nhdm chay mau nao va nhdi mau nao theo t h d t u la mUc tieu hoc va dUdi tieu hoc chi chiem 6,3% - 8%. Cd 31,3% - 33,4% trinh d d trung hoc pho thdng va 50% - 48% benh nhan cd trinh d d cao dang va dai hoc. Dieu nay rat thuan loi cho chUng tdi khi thUc hien cac test tam ly nhu MMSE trong dd cd phan t i n h toan.

Vj trf ton thuang theo cac vUng chien lupc n h u thijy thai duang, thuy dinh, nhan xam trung Udng va ddi thj bao trong phia ban cau Uu the 6 hai nhdm nghien cdu chiem 50%-52%.Tuy thupc vao vj trf tdn t h u a n g se cd nhdng trieu chUng than kinh khu tru tuang dng, dac biet mpt s6 trieu ehdng se i n h hudng nhieu tdi viec thUc hien cac test t i m ly n h u roi loan ngdn ngd, liet van dpng gay thuc hien cac dpng tae ban che. Chinh vi viy danh g i i cac chdc nang qua thang diem MMSE, chung tdi thay tinh trang suy giam nhan thdc chi!i yeu g i i m diem d phan thuc hi^n thdng qua ngon ngCr nhu nhac ten cac do vat, g i i m di^m trong phan danh gia chdc nang thuc hien cac ddng tic do tinh trang thieu hut van ddng.

2. Ket qua ve t i n h t r a n g suy gidm nhan thufc sau d o t q u y nao cap d a n h gia bling t h a n g d i e m MMSE

107 benh nhan ra vien du dieu ki^n thuc hien cac t r i e nghiem tam ly nhU MMSE, ket q u i cho thSy cd 56% benh nhan sau nhoi m i u nao cap co tinh trang suy giam nhan thdc tU nhe den nang, so vdi nhdm c h i y mau nao cd 46,8%. SU khic bi§t nay khdng cd y nghTa thdng ke. Tuy nhien sd benh nhan suy giam nhan thdc mUc dd vUa va nang co su khac biet rd ret gida hai nhdm c h i y m i u nao va nhdi m i u nao, vdi t y le cao han hSn dcac b$nh nhan sau dot quy nhdi mau nao 46,6% so vdi 15,7%. Ly giai dieu nay chung tdi cho r5ng b i n than nhdm nhdi mau nao tudi trung binh cao hdn nhdm benh nhan chay mau nao, them vao d d cac benh nhan nhdi m i u nao thudng nhi^u y^u to 108 THAN KINH HOC VIET NAM 15(5 14- QUV IV/2015 Website: hoithankinhhocvi 'ietnam.com,vn

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BAO CAO KHOA HOC k.

nguy co han dac biet ty le rdi loan Iipide mau gay vda xa ddng mach, lam gia tang cac ton thuong mach mau nhd, gay benh ly ci hai ben ban cau cung nhu tdn thuang da 6. Cic yeu to nay lam gia tang nguy co rdi loan nhan thdc. Ket qui nay cua chung toi so vdi tic gii Dinh Van Thang (2006) khio sit 40 benh nhan nhdi mau nao cap khi ra vien cd 55% benh nhan cd bieu hien sa sut tri tue, trong dd sa sut trf tue mde dp nhe va trung binh chiem 50%; mde dp nang 50%. Trong nghien edu cCia tic gii Phan My Hanh (2006) nghien cdu tren 74 benh nhan dot quy nhdi mau nao cd den 50%

sd benh nhan cd bieu hien sa sut trf tue ngay sau ddt quy lan dau. Nhu vay t^ 1$ eie benh nhin sa Slit trf tu# sau dot quy nao qua nghien cdu cua chung tdi tUdng dUdng vdi cac ket qua nghien cdu khic trong nude.

Dinh gii eie ehde nang trong bing dinh gia MMSE, chung tdi nhan thay, sU ghi nhan, khi nang trf nhd gan, danh gia sU chu y va kha nang tfnh toin eUa nhdm benh nhan nhoi mau nao thap hdn nhdm chiy mau nao. Theo thd tu la 31,2% benh nhan chay mau nao so vdi 53,2%

benh nhan nhoi mau nao cd roi loan sughi nhan;

28,2% so vdi 45,4% cd giim su chu y va khi nang tinh toan; 40,7% nhdm chay miu nao so vdi 61,4% nhdm nhdi miu nao cd rdi loan tri nhd gan.

Su khac biet nay cd y nghTa thong ke vdi p<0,05.

Dieu nay hoan toan phu hpp khi nhdm benh nhan nhdi miu nao tudi cao hon nen chdc nang nhan thdc tfnh toin kem hdn nhdm benh nhan tr^ tudi. Th^m vao dd nhdi mau nao la mdt benh ti^n tri^n theo thdi gian, gay tdn thuong eae te bao nao man tinh, trong khi dd tdn thuong chay miu nao qua giai doan cap tfnh het phu nao, mau tu hSp thu, eac te bao nao phuc hdi nhanh hon, do vay tdi thdi diem ra vien mde dp hdi phuc cua cae benh nhan ehiy mau nao tren lim sang thudng nhanh ban eie benh nhSn nhdi mau nao.

Website: hoirhankinhhocvietnam.com vn

Nhu chung ta da biet sa sut trf tue sau dot quy la mdt bien ehdng thudng gap va trong nhieu nghien cdu ty le mac phii dao dpng khoang 30%

(td 13,6% den 31,8%) [3,4,5,6,8].

Nghien cdu cua chung tdi so vdi eie tae gia khac tren the gidi ty le chung cd cao hon cd the do ehung tdi thong ke ci eac benh nhan suy giim nhan thdc nhe va vua, neu chi tfnh rieng suy giam nhan thdc nang trong nghien cdu cua chung tdi cung chl cd 29,3% d nhdm nhdi miu nao; 6,3%

nhdm chay miu nao.Trong nghien cdu eCia David H va epng sd (2004) tren benh nhan thieu mau nao cap tren 55 tudi tan sd sa sut tri tue 3 thang sau dot quy la 27,2%, sau dot quy lan dau la 22,7%

[5]. Trong nghien cdu doan he cua 337 benh nhan tuoi tren 55, Pohjavaara nhan thay tj* le sa sut tri tue sau 3 thing dot quy la 31,8%, sa sut trf tue sau ddt quy tan dau la 28,9%. [6]

Mdt sd y^u td inh hudng den tinh trang sa sut tri tue cua cie benh nhin sau dot quy nao cap trong nghien cdu nay chiing tdi nhan thay: Tuoi cao; trinh dp hpe van cang thap; tdn thUdng ban eau uu the; tdn thuang eae vCing chien lUdc (lien quan chdc nang ngdn ngd va nhan thdc.) cung nhu nhoi mau nao da d la nhdng yeu td lien quan den tinh trang suy giam nhin thde cOa cac benh nhan sau dot quy nao cap (vdi p< 0,05). Nhan xet nay cua chung tdi cOng phu hpp vdi cac tae gii trong va ngoai nudc.

Tuoi cao li yeu td hSng dinh nhat va la yeu td nguy cd cua sa sut trf tue (SSTT) ndi chung, trong nghien cdu nay 81,4% benh nhan SSTT tren 65 tudi, trong dd nhdm khdng SSTT ehi cd 40,7% (p<0,05). Rdi loan ngdn ngd van ddng khd ndi hoac khdng hieu Idi la yeu td lam sang inh hudng rat nhieu den tinh trang sa sut tri tue.

Ket qui cua chung tdi cd 30% (ca hai nhdm) cac

benh nhan suy giim nhan thde cd rdi loan ngdn

ngd. Nhan xet nay cua chung tdi eung phu hop

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vdi nhdng nghien edu khac [3,4]. Ween va edng su nhan thay nhCfng benh nhan bj mat van ddng ngdn ngd deu giam trf nhd gan va t r i nhd xa, dieu nay cung lien quan tdi tdn thuong ban eau nao Uu the cung gta tang ty le sa sut tri tue, giai thich dieu nay vi trung khu ngdn ngd d b i n cau Uu the.

[10] Mpt sd nghien edu khae cung thay rang tdn thddng ban cau uu the cd anh hudng cung lue rdi loan ngon ngdva tri nhd[8]. Tdn thuong cac vung chien lupc thudc t u i n hoan nao trudc, nhoi mau nao nhieu 6 cOng la yeu t d anh hudng khdng kem phan quan trpng trong suy giam nhan thUc sau dot quy, ket q u i ehung tdi nhan thay hai nhdm cd suy giam n h i n thdc va khdng suy g i i m nhan thde ty le ton thuong vung ehien lupe lan lupt la 76%

va 40%. Nhan xet nay cua chung tdi cung tUdng t u c i c tae gia tren the gidi nhan thay rang vj trf tdn thuong nam 6 hdi gdc, ddi thi, bao trong thuy thai duong hay gap d cac benh nhan suy g i i m n h i n thdc sau dot quy [8].

V.K^TLUAN

Qua nghien cdu danh g i i tinh trang suy g i i m nhan thdc bang thang diem MMSE tren 107 benh nhan dot quy nao dieu t n tai Trung tam Dot quy nao t d t h i n g 4/2012 den 10/2012 chiing toi nhan thay ty le benh nhan bj suy g i i m n h i n thdc sau ddt quy nao cap la 53% trong do sau nhdi m i u nao la 56%; sau ehiy mau nao la 46,8%. Tinh trang suy g i i m nhan thdc mde dp vda va nang 6 nhdm benh nhan nhoi mau nao eao hdn nhdm c h i y m i u nao (46,6%sovdi15,7%vdip<0,05).Dac diem suy giam nhan thdc vda va nang b nhdm nhdi mau nao cao hon c h i y mau nao chu yeu d chdc nang ghi nhan, tri nhd gan va su chu y kha nang tinh t o i n .

Mot sd yeu t d lien quan den suy g l i m nhan thdc d benh nhan sau dot quy nao la tudi eao, trinh dp hoc van thap, rdi loan ngdn ngd, ton thUdng thudc cac vung chi^n lupc thudc b i n cau uu the va roi loan Iipide mau.

STUDY THE COGNITIVE IMPAIRMENT IN PATIENTS AFTER ACUTE CEREBRAL STROKE BY ( M I N I MENTAL STATE EXAMINATION) MMSE SCALE.

SUMMARY

Background and Purpose: Cognitive impairment may significantly worsenthe quality of life after stroke. Our aim was to determine the frequency of cognitive impairment by MMSE scale and the clinical features of the state of cognitive disorders in poststroke patients.

Methods: 107 patients with cerebral stroke for the first time, includes 32 brain hemorrhage and 75 cerebral infarction have been tested by MMSE at the time after the acute phase. Cognitive decline when MMSE less than 24 points.

Results and conclusions: The proportion of patients with cognitive impairment after the first cerebral stroke is 53%, (group cerebral infaraion was 56%;and group brain hemorrhage was 46.8%. Status moderate and severe cognitive impairment in patients with cerebral inferction are higher than cerebral hemorrhage (46.6%

vs. 15.7%, p <0.05). Characteristics of the cognitive impairment in cerebral inferaion group higher cerebral hemorrhage group; mainly in the registration's function, the memory and attention, calculation capabilities.

The feaors related to cognitive impairment in patients after cerebral stroke are high age, low education level, language disorders, lesions of the strategic areas in the dominant hemisphere and dislipidemie.

Keywords: cognitive impairment; cerebral stroke; MMSE.

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BAOCAOJCHOA tHQC k

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