Tap chl Tai MUI Hgng Vidt Nam - Volume (58-15). N°3 - May, 2013
NHAN XET fflEU QUA DIEU TRI CAT COfN NGHIEN HEROIN BANG LEVOMEPROMAZIN VA DIAZEPAM
Ddm Dire Thdng*, Phgm Vdn Mgnh *, Nguyin Xudn Bdi*
TOM T A T
Bgt van dh Nghiin ma tuy noi chung, ddc biet nghiin heroin Id mot ti nan xd hgi dnh hudng sdu sdc din b?nh nhdn, gia dinh vd xd hgi So lugng n^udi nghien ma tuy co chiiu kldng ngdy cdng gia tdng. Mgc tieu: Nhdn xet hieu qud dieu tri cdt can, nghiin heroin bang levomepromazin vd diazepam. Doi tugng vd phirong phdp nghiin cuu: Gom 59 herth nhdn nam, theo tiiu chudn chdn dodn nghiin heroin ciia hgi tdm thdn hgc My ndm 1994 (DSM-IV), diiu tri ngi tru tgi binh viin Tdm thdn Hdi Phong, tuoi tir 18 -^ 58 tuoi Tiin hanh theo phuong phdp tiin cuu, cat ngang, co liin hdnh phdn tich timg trudng^ hop diin hinh. Ket qud: Cdc roi logn tdm thdn vd co the xudt hien chii yeu trong 3 ngdy ddu, tit ngdy thir 5 ciia dgt dieu tri cdc roi logn co xu hucmg gidm ddn. Sau 10 ngdy diiu tri chi co mot vai benh nhdn con mgt s6 bieu hien nhu: gidm khi sdc mdt ngu, lo du, them heroin.
Thu6c levomepromazin liiu trung binh Id 127,5 ± 78,5mg/BN/ngdy, diazepam Id 28,75 ± l6,Smg/BN/ngdy. Ket ludn: nghien cm hiiu qud cua cdc thudc cdt can nghiin Heroin trin lam sdng la hit sue cdn thiet vd hiru ich.
Tirkhda: Biiu tri cdt can nghien heroin SUMMARY
Introduction: Drug addiction, particularly heroin addiction is a social evil . It has deeply affect to patients, families and society. Numbers person drug addicts has trends increasing Objective: Reviews the effectiveness of treatment cutting heroin addiction by levomepromazin and diazepam. Patients and Method: including 59 male patients, according lo the heroin addict diagnosis standard of American psychiatry Assembly in 1994 (DSM-IV), inpatient treatment at a mental hospital in Hai Phong, aged fi-om 18 to 58 years old. it is prospective study, cross, analyze each of the typical case Results: The mental disorders and body appear mainly in three days, from days 5 of treatment the disorder tends to decrease. After 10 days of treatment only a few patients are still some signs such as decrease insomnia mood, anxiety, craving for heroin. The drug dose levomepromazin average 127.5 ± 78,5mg/patient/day, diazepam was 28,75 ± 16,5mg/
patient / day. Conclusion: The study of the drug effectively cut heroin addiction is clinically necessary and very useful.
Key words: cut heroin addiction
1 tlAT VJlM ' * ' " • '''^" '''™ '^^ '^^'^ '™ ' ° ™ ' ^ * ™ 1-BAr VAN DE y^j.! j igjj^ (,„ j y t(, nhe dSn nang, thuong
Hri siic khoe giam siit hay vi mpt ly do xay ra cip tinh da huge nguoi nghien^phai
"W diy nguoi nghien phai ngimg su dung su dung ma tuy tra lai. Do do, viec^dieu tri iKtoin se thiy xuit Men hgi chiing cai vdi hpi chiing cai la viec khong the thieu trong nhiing bilu hien sau: ngucri nghien rit kho cac lieu trinh cai ma tuy n6i chung cai
nghien heroin noi rieng. Dieu tri hgi chiing
•Bsi hoc Y Thii Btah
I'lSn Mi 25/5. Duyet m 5/6/2013
Tgp chl Tai Mui Hpng Vl^t Nam - Volume (58-15). N°3 - May. 2013
cai, giup nguoi nghi?n vgt qua hpi chiing cai mpt cich, nhp nh^g v^ nhanh ch6ng hoi ph\ic sue khoe van luon 1^ van de dupe nhilu nguiri quan tam nghien cuu khong nhihig 6 Vi?t Nam mil cd tren the gidi. 6 nu6c ta phuang phdp cit ccm nghi?n heroin diing levomepromazin ket hpp v6i diazepam dupe Bp y te Vi?t Nam cho ph^p (1995) la thong dyng trong cdc b?nh vien Jam thSn, song cdc cong trinh nghien cuu vdn dk n6i tren e6n chua nhieu. Chinh vi vay chung toi tien hanh nghien curu v6i muc tieu sau: Nhdn xet hieu qud dieu tri cdt ccm nghien heroin bdng levomepromazin vd diazepam.
2. D 6 I TlTONG VA PHUONG PHAP NGHIEN CUtJ
2.1. Doi tirong nghien cihi
Gom 59 benh nhan nam nghien heroin dupe di8u tri npi tni tai benh vien Tam than Hai Phong va liia tuoi tir 18 -^ 58 tuoi, tuoi trung binh la 33,05 ± 8,09.
2.1.1. Tieu chudn chgn benh nhdn nghien ciru.
Tat cd cac doi tupng da vdo nghien ciiu phai ddp ling day du cdc tieu chudn chan doan nghien heroin cua hpi tam thdn hpc My nam 1994 (DSM-IV) [5].
Co bang chung dd su dung heroin (thu test morphin dong tinh trong noc tieu)
Benh nhdn dap ung dupe nhu cau kham b?nh va lam cac xet nghi?m.
Tdt cd cdc benh nhan dpc dieu tri bang levomepromazin va diazepam theo phdc do cua Bo Y te(1995) de cat con nghiSn
2.1.2. Tieu chuan logi trir.
B?nh nhan co benh co the nang: tim mach, hen, gan, than...
Benh nhan dung thuoc cdt con khdc
v6i quy trinh nghien ciiu.
B?nh nhdn c6 tien su mpt b?nh tdm thdn khdc.
B?nh nhan ddng thai nghien rem hodc loai ma tuy khdc.
2.2. Pbaomg phap nghien cihi.
Tiln hdnh theo phuang phdp tien ciiu, cat ngang, co tien hdnh phan tich timg tr- uong hpp dien hinh.
2.2.2. Phu-gng phdp khdm Idm sdng chung
- Su dung mau benh an nghien ciiu.
2.2.3. Cdc chi tieu lam sdng de ddnh gid ket qud:
Dien biin trieu chiing trong 10 ngdy diiu tri (tir ngdy thii 01 den thii 10.
2.2 3.1. Bdnh gid cdc roi logn ve ca the.
Ddnh gid cac roi loan co the theo DSM- IV thi hien qua 9 trieu chiing: Loan khi sdc, non, hhn. non, dau co, chdy nuoc bpt - nuac mat, gian dong tii hoac ra nhieu mo hoi, ia chdy, ngap, sot, mat ngu.
Ddnh gid hpi chiing cai theo bang diem cua Himmelsbach 1982.
Bang 2.1 Bang diem cua Himmelsbach.
Tri^u chunq Met moi ra Ttr\
Ngap chay nug-c mat
Chay nud-c mui Va mo hdi la chay Dau lung Nhiic xuD-ng Noi da gd
Diim 1 1 1 1 2 1 1 2
Trieu chiinq Dan d6nq tu Ndng ngvc kh6c6 Mat nqu Nhuc diu Ndn mua, co giSt Hdn me Tang huyet ap Xuat huyet
Dllm 3 1 2 2 3 3 3 3
Tap chl Tai MQi Hong Vi^t Nam - Volume (58-15). N°3 - May, 2013
Tong so: 30 diem
Danh gid miic dp: + Duoi 10 diim Id i ^ e n nhe.
+ Tii 10 -^ 20 diim la nghien vira.
3. KET QUA NGHIEN ClTU
3.3. Hieu qua dieu tri cat con nghien heroin.
Bang 3.1 Diin bi^n tSm trgng trong d\eu trj cat can
+ Tir 21 -^ 30 diem Id nghien ndng.
2.2.3.2. Ddnh gid ve rdi logn tdm thdn.
2.3. Phvong phap xir ly so lieu: xu ly bdng chuong trinh SPSS 15.0.'
B$nh nhan Trifeu chiing
Loau
Hoang Ii6t
Ban chdn
n
%
P n
%
P n
%
P
N g i y 1
52 88,14 Pi-!<0,01
2 3,39 Pi-i<0,01
0 0
2 37 62,71 P2j>0,05
32 54,24 P!.3>0,05
12 20,34 P2-3>0,05
3 26 44,07 P3.s> 0,05
26 44,07 P3-5< 0,01
9 15,25 P3-5< 0,01
5 16 27,12 P5-7> 0,05
4 6,78 P5-7> 0,05
3 5,08 Pi -5<0,05
7 5 8,47 P7-io>0,05
1 1,69 P7-io>0,05
0 0
10 3 6,08 p,o.,<0,001
0 0
0 0
Mv. '. r - ' ;»- L - khong con benh nhan nao. Bon chon ngay Nhan xet: Lo au ngay dau chiem .x , , , . • , . , , . - *; - Ti - 1 izio/ „„.. IA • i-J » • • c noo/ u-^^. dau khong co benh nhan nao, den ngay thu s,14%saulOngay dieu tri con 5,08%, hot & . - & j lang ngay ddu 3,39% sau 10 ngdy diiu tri 2 CO 20,34%.
Bang 3.2 V4 r6i loan y thijc trong dieu tri cit con.
B0nh nhan Tri^u chCpng RL nang luc flinh hudng
M& sang
Llllln n
%
P n
%
P n
%
P
NgSy 1
3 5,08 p,.2>0,06
0 0
0 0
2 8 13,56 P!.3>0,05
3 6,08
P2.3=
2 3,39
3 6 10,17 P3-5> 0,05
2 3,39 0,06
2 3,39
6 1 1,69 P2.s<0,05
0 0
1 1,69
7 0 0
0 0
0 0
10 0 0
0 0
0 0
Tap chl Tai MGI Hpng Vl^t Nam -Volume (58-15). N°3- May, 2013
Nhan x^t: ngiy dau r6i loan ntag l^c dinh hu6ng co 5,08% den ng4y thu 2 14 13,56%, ngay thu 7 trd di khong con b^nh
khong c6 b?nh nhan nao den ngay thu: 2 cd 2 b?nh nhan, ngiy thii 7 tro di khong cdn b^nh nhan nao.
nhan nao roi loan. Me sing, lu lan ngiy dau
BSng 3.3 R6I loan cSm xdc chung trong dl^u trj c^t con.
B$nh nhdn Tri$u chung Lo so- khdng c^t duQ-c c o n
Cam xdc d§ bCjng nd
Cam xOc khdng on dinh
n
%
P n
%
P n
%
P
Nqav 1
37 62,71 Pi.2>0,05
0 0
0 0
2 32 64,24 P2.3<0,06
4 6,78
P2-3=
3 3,39
3 11 18,64 P3.5< 0,05
3 5,08 0,05
2 1,69
5 2 3,39 Pi-s< 0,01
0 0
1 1 6 9 p > 0.05
7 0 0
0 0
0 0
10 0 0
0 0
0 0
, „ • '* • .»- -4. £1 -710/ 1 Cam xuc de bung no, cam xuc khong on Nhan xet: ngay dau cat can 62,71% lo ^. , , , i , . . , . . . ^ ^ . f I L - ' -* J • *u' -7 . • >• dinh chl xuat men vao ngay thu 2,3 va 4.
sp khong cat dupe con, ngay thu 7 tra di • • ^ •' khong con benh nhan nao co cam giac nay.
B ^ n h r Tridu chdng
Loan khi Scic
Giam khi sdc
Kh( s i c h i n hoc, bat man
han
n
%
P n
%
P n
%
P
Bang 3 4. V ^ rdi loan khi sac trong dl^u trj c^t c a n . Nc
1 29 49,15 Pi.2>0,05
8 13,56 Pi.2<0,06
0 0
2 33 55,93 P2.7>0,05
28 47,47 P2.3>0,05
3 5,08
3 33 55,93 P3-5> 0,05
25 42,37 P3-s> 0,05
2 3,39 P J . , > 0 , 0 5
ay 6 27 45,76 P5-7> 0,05
21 36,59 Ps-7>0,05
0 0
7 13 22,03 P2.7<0,05
17 28,81 P7-n)>0,06
0 0
10 3 5,08 Piin<0,01
5 8,47 Pj-iii<0,01
0 0
Tap chl Tai MOI Hpng Viet Nam - Volume (58-15). N°3 - May, 2013
>4han xet: Loan khi sjc ngay diu '•J''"?'"' ^^" "8?y "ni '0 con 8,47%. Khi 49,15% ngay thii 10 con 5,08%. Giam khi ^^'^ ''*" '"?c, bat man chi xult hien vao sSc 13,56% ngay dfiu, ngay thii 2 tang len "^ay thii 2 va 3.
B«
fri^u chung
do thanh
So thi
ao xQc giac
Bang 3.5. V ^ rdi loan tri giac trong dieu tn cdt con.
nh nhan
n
%
P n
%
P n
%
P
Ngay 1
0 0
0 C
2 4 6,78 P2.3>0,05
5 8,47
3 3 5,08 P3-5> 0,05
3 5,08
5 2 3,39 P5.2> 0,06
2 3,39 p > 0,05
0 0
4 6,78
3 5,08 p >0,05
0 0
7 0 0
0 0
0 0
10 0 0
0 0
0 0
Nhan xet: ao thanh, ao thi, ao xiic giac "^iy thii 2 xuSt hien mot sd truong hop, tii nhang ngay dSu khong co benh nhan nao, "^ay thu 7 trd di khong cdn benh nhan nao.
Bang 3 6. Dien bien
1 B^nh
Tri^u chi>ng
vat va kich thich
Kich dOng tram cam
Hanh vl t u sat
Chan an
.
nhan
n
%
P n
%
P n
%
P n
%
P
roi loan hanh vl trong didu trj cat con.
Ngay 1
7 11,86 Pi-2<0,01
0 0
0 0
4 6,78 Pi.2<0,01
2 53 89,83 P2-3>0,05
5 8,47 P2-3>0,05
0 0
31 52,54 P2.3>0,05
3 49 83,05 P3-5< 0,01
2 3,39 P3.5>0,05
0 0
27 45,76 P.w< 0,01
5 5 8,47 Ps_2<0,001
1 1,69 P5.2> 0,05
0 0
2 3,39 Ps.,< 0,001
7 0 0
0 0
1 1,69
0 0
10 0 0
0 0
0 0
0 0
105
Tap chl Tai MOI Hpng Vl$t Nam - Volume (58-15). N°3 - May, 2013
nhihi]
X1U- ^ w . » 1, 1, .KI u » 11 oM/ c*n bfnh nh&i nao tir ngdy thii 7 trd- di.
Nhan xdt: Vat vS kfch thich gjp 11,86% ^ ^ ^. ^^^ ^^. j j , ^ mg ngiy dau, ngdy thu 7 trd len khong
cdn b^nh nhan nao. Kich dpng trim ctoi ngay thii 2 c6 8,47%, giim dan vk khong
Bdng 3.7. Dl6n bl4n rdi loan co thi trong diiu tn cat con.
TT
1 2
3
4 5
6 7 8
9 10 11 12 13 14
Bdnh nhan Tridu chung Ngap Chay nude mat, nude bpt Qau mdi CO khop Them heroin Toat mo hdi, noi da ga Non, budn ndn Mach nhanh Di cam (gidi bd trong xuang) Bdng tu gian ia chay Sot Mat ngu Sdt can TSng can
Ngay 1
n 42 31
44 12 28 5 8 3 13
4 9 13
0 0
%
71,19
52,54
74,58 20,34
47,46 8,475 13,66
5,085 22,03 6,78 15,25 22,03 0 0
2 n 59 40
69 55 45 18 30 27 45 7 24 54 59 0
%
100,00
67,80
100,00 93,22
76,27 30,51 50,85
46,76 76,27 11,86 40,68 91,53 100,00
3 n 43 25
40 51 23 17 59 55 20 11 11 54 69 0
%
72,88
42,37
67,80 86.44
38,98 28,81 100,00
93,22 33,90 18,64 18,64 91,63 100,00
-
^ 5 n 17 14
22 32 0 0 16
8 0 0 0 28 0 4
%
28,81
23,73
37,29 54,23
- -
27,12
13,66
- - -
47,46
-
6,78 7 n 2 3
4 14 0 0 6 0 0 0 0 11 0 51
%
3,39
5,08
6,78 23,72
- -
10,17
- - - -
18,64
86,44 10 n 0 0
0 6 0 0 0 0 0 0 0 3 0 59
% - - -
10,17
- - - -
5,08
100,0
106
Tap chl Tai MQi Hpng Vidt Nam - Volume (58-15). N°3- May, 2013
Nhan xet: them heroin ngay ddu 20,34%, f^ ^^P "^l"" ^f! "^^^ ^ ""^'^"^ ^^'22°^"' sau do tang len 93,22% ngdy thu 2 sau do ^^" "^ay thu 10 khong con truong hpp ndo.
giam ddn din ngdy thu 10 con 10,17%. Di
Bdng 3.8. Li^u, lupng thu6c si> dyng Loai thudc
NgSy 1 2 3 4 5 6 7 8 9 10 T6ng cdng Trung binh
Levomepromazin 25mg mg
182,75(162,5 +212,5) 233,25(150,0 + 325.0)
227,5(137,5+312,5) 178,25(87,5 + 262,5) 143,25 (625 + 237,5) 106,75(60,0 + 175,0) 122,25(37,6+162,5) 5 4 , 2 6 ( 2 5 , 0 + 1 0 0 , 0 ) 34,25(0,0 + 8 7 5 ) 1 3 , 2 5 ( 0 , 0 + 75,0)
1.299,75 127,5±78,5
%
14,06 18,33 17,50 13,71 11,02 8,14 9,41 4,17 2,64 1,02
100,00
Diazepam 5mg mg 36,75 (20,0 - 55,0) 46,85(27,5 + 60,0) 45,15(30,0^57,5) 34,15(17,6+52,5) 2 1 , 5 ( 7 5 + 42,5) 15,05(2,5 + 32,5) 1 , 7 5 ( 0 , 0 + 1 7 5 )
0,00 0,00 0,00 201,20 28,75±16,5
%
18,27 23,29 22,44 16,97 10,69 7,48 0,87 0,00 0,00 0,00
100,00
Nhan xet: hiti trung bmh cua Cac rdi loan lo au cung dugc xem nhu levomepromazin la 127,5±78,5 , Idu trung la bidu hien chinh cua benh nhan nghien binh ciia Diazepam la 28,75±16,5.
4. BAN LOAN
4.1. Ve roi loan tam than 6" benh nhan
!>SUcn heroin.
4'U. Ve tdm trgng cua benh nhdn.
heroin trong giai doan cat ccm nghien.
Trong nghien ciiu ciia chiing toi gap 52/59 benh nhan (88,13%) cd biiu hien lam sang rdi loan lo au, trong dd hoang hot vo cd la 61,54%, bdn chdn chiSm 76,92% va ac mong la 32,73%. Kdt qua cua chung toi phu hop vol nghien ciiu cua Nguyen
107
Tgp chi Tai MQi Hpng Vi$t Nam - Volume (58-15). N ° 3 - May, 2013
Thanh Binh (2001) thdy 88,3% b^nh nhan CO r6i loEin lo au vd 38,3% c6 dc mpng [1].
Nhilu tdc gid deu nh|n dinh rdng lo du c6 tii rdt s6m, mu'c dp nghien cdng n$ng thi tinh tr^ng lo du cdng tdng, chi khi cdt dupe con nghien vd gid quyet tri?t de trang thdi Ip thupc vk tam than thi tinh trang lo du sB dupe cdi thien ro ret.
4.1.2. Ve roi logn cdm xuc.
Quan sat b?nh nhdn cai nghi?n heroin, nguoi ta thudng de dang nhan thay cdc bieu hien kich thich hung phdn hon Id Id trang thdi tram cam, nhung su that an chiia ben trong trang thdi kich thich hung phdn do la trang thai npi tdm rat phuc tap do la roi loan tram cam va lo au. Trong nghien cuu cho thdy roi loan cam xiic gap o 53/59 benh nhdn (89,83%) trong do benh nhan co roi loan tram cam la 69,81%, cam xiic de bung no la 13,21% va khi sac han hpc bat man la 7,55%. Bieu hien nang ne nhdt ciia benh nhdn roi loan tram cdm Id nhiJng y tuong vd hanh vi tu sdt. Theo Sadock B.J (2003) 90% benh nhan nghien heroin co roi loan tdm than va gdn 15% nguoi nghien opioid CO I Idn tu sdt trong doi [6]. Theo Susan J.
Blumenthal (1990) nghien ciiu 533 ca di6u tri cai nghien opioid, tac gid nhdn thay 17,3% so hp CO hanh vi tu sdt [7]. Trong nghien ciru ciia chung toi co 3/59 benh nhan co y tuong tu sdt vd 1/59 benh nhan CO hanh vi tu sat nhung dupe ngan chan kip thoi. Nhung y tuong nay hdu hk xudt phdt tir nhihig cdng thdng, nhung xung dot truong dien ma benh nhdn gap phdi trong gia dinh va xd hpi. Tuy nhien n^u dupe dieu tri tot (cat con nghien, lieu phdp tam ly phu hpp, su dong vien khich le cua
ngu6i thdn..) thi y tuong bdt lai se tan bien.
4. J. 3. vi do gidc.
Trong nghien ciiru cho thdy 16/59 b$nh nhan (27,12%) c6 do gidc, trong do do giac th6 so cac logi chilm 81,25% (13/16BN) va do gidc phiic tap Id 3/16BN, do gidc th6 so g6m 30,77% gidc thi giac , 30,77% do gidc xuc gidc vd 33,08% do thinh gidc, cdc gidc ndy xuat hien khong thuong xuyen, chu yeu vdo liic benh nhdn sdp di vdo giac ngu, sap thiic day hay trang thai qua met moi. do gidc phiic tgp chiing toi chi gap do thinh giac (2/3 benh nhdn), do thi giac (1/3 benh nhdn), ca 3 benh nhan ndy deu nghien heroin a miic dp nang vd thoi gian nghien
>10 ndm. Ket qua nghien cuu cda chiing toi phu hpp voi Nguyen Thanh Binh (2001) khi cho rang 30% benh nhdn cat con nghien heroin co do gidc tho so vd 3,33% co do giac phuc tap [1].
4.1.4. Ve roi logn hdnh vi
* Hoat dpng co y chi: da so benh nhan CO bi^u hien vdt va kich thich 53 benh nhan (chiem 98,15% s6 benh nhan co roi loan hanh vi), co 5 benh nhdn c6 bieu hien kich dpng do Id kich dpng trong pham vi giuong benh da dupe cham dut khi dupe gidi thich hpp ly vd dm thi.
* Hoat dpng bdn ndng : nghien cuu ciia chiing toi cho thdy 37/54 benh nhdn co r6i loan hdnh vi (68,25%) co bieu hien chan an. Chung toi khong gap truong hgp nao an nhieu. Di8u nay c6 thi gidi thich do trang thai met moi, lo au, mdt ngu... keo dm, cung vai cac bilu hien r6i loan ca thi nhu dau CO, non vd bu6n non, va m6 hoi... lam
Tap chl Tai Mui Hpng Viet Nam - Volume (58-15) N°3- May, 2013 anh hudng tdi viec an udng ciia ngudi
benh. Theo Sadock B.J (2003) hoi chiing r6i loan hanh vi lien quan chat che vdi tram cam va lo Eiu do la cac xxmg dpng , cac tinh hudng tin cong co the c h ^ diit bang sir drnlg thudc giai lo au [6]. Nhu vay, kdt qud nghien cmx cua chiing tdi phu h^p vol cic tac gia tren, didu nay rdt hop ly khi hdu hdt cac benh nhan ddu phan nan do ydu td met moi, suy nhupc lo au ve benh tat, va sy: xa lanh ciia ngudi than... md mdt di hiing thu vd tinh due.
4.1.5. vi rSi logn y thu-c.
Rdi loan y thiic gap 19/59 benh nhan (32,20%) trong dd roi loan nang luc dinh hudng don thuan chidm 63,16% va me sang la 5/19 benh nhan. Kdt qua nghien ciiu cua chiing tdi va Abott P.J (1994) khong thdy sir khac biet vdi p >0,05. Cac rdi loan dinh hudng chii ySu rdi loan vd mdi tmdng, thai gian va khdng gian kdt hgp, chi gap 3 benh nhan c6 roi loan dinh hudng ban than, cac roi loan nay xuit hien khong lien tuc trong 2 ngay dau. Chiing tdi chi gap bidu hien me sang trong ngay thii 1 + 2 cua dot didu tri, ngudi benh cd nhOng hanh dpng bjt con v3t tren da va tim cac dd la trong phdng benh, cam xiic thuong cang thing va hoang h6t...
O.6. Vi rdi logn tu duy d benh nhdn cai nghiin heroin.
Cdl9/59 benh nhan( 32,20%) cd cac tnlu chiing cua rdi loan tu duy, trong do 36,84% cd y tudng bit hanh, 31,58% cd y '•ciig hoai nghi, 3/19 benh nhdn cd y tudng
"Slien tudng va 2/19 cd y tuong hi tdi bi
•Si, chi cd 1/19 benh nhan cd hoang tuong
"Ijn nhim da nghien heroin 13 nam benh
nhan cho rang ngudi benh cung phdng la bd de cua minh va trieu chiing ndy xuit hien khdng lien tuc. Kdt qua nghien ciiu cua chung tdi phu hpp vdi Nguyen Thanh Binh (2001) khi nhan xet ring cd 20% benh nhan cd rdi loan ndi dung tu duy, trong do da SP cac rdi Ipan nay chi dimg lai d miic la cac y tudng am anh 83,3% va 16,7% la hoang tudng nhan nhim[l].
4.1.7. Vi roi logn chu y-tri nhd.
* vi rdi loan chu y: cd 84,75% benh nhan cd bieu hien giam chu y. Benh nhan khdng tap trung chii y hoac chi tap trung chu y trong khoang thdi gian ngin. Cac tac dpng ngoai canh de lam benh nhan phan tan. Benh nhan khd duy tri dpc sach bao va xem vd tuyen.
* Ve rdi loan tri nhd: cd 38/59 benh nhan (64,41%) phan nan ve giam tri nhd, hau het cac benh nhan nay giam tri nhd gan don thuan, giam tri nhd toan bd gap 5/38 benh nhan, ngudi benh tu than phi8n hay nhan vien y te danh gia benh nhan hay quen nhiing sir viec dang lam hay dang suy nghi dinh lam gi tu nhien quen di.
4.2. Ve hieu qua dieu tri cat con bang diazepam, levomepromazin.
Levomepromazin la thudc an than em diu chdng lo au va chdng kich thich. Tac dung giam dau gap 4 lan aminazin va ha than nhiet manh ban aminazin 3 lan . Dac biet nd lam tang tac dimg cua thudc ngu.
Nen trong lam sang ngudi ta hay phoi hpp vdi diazepam lam tang hieu quii dieu tri [2].
* Ve lieu l u ^ g va thdi gian - Vdi levomepromazin: ket qua bang
109
Tap chl Tai MQI Hpng Vidt Nam - Volume (58-15). N ° 3 - May, 2013
3.27 cho thiy thuoc dupe sil d^ng lien tyc trong 10 ngdy dudi dang vien ndn, lieu trung binh Id 5,10 ± 3,14 vien/ngdy/BN, Hdu tnmg binh cao nhit vdo ngdy thii 2 Id 238,25mg/BN/ngdy, thap nhit ngay thii 10 la 13,25mg/Bn/ngay vd lieu cao that md mpt bpnh nhan sii dung Id 325mg/24h.
Chung toi nhan thay trong 3 ngdy dau sd lupng levomerpromazin chiem 50,87%.
- Vdi diazepam: ket qud cua chung tdi (bang 3.27) cho thiy thoc chi sii dung trong 7 ngay dudi dan vien nen, lidu trung binh la 5.75 ± 3,3vien/BN/ngay, lidu trung binh cao nhit vdo ngay thd 2 Id 46,85mg/ngay/BN, va thip nhit ngay thii 7 la 1,75 mg/ngay/BN. Chung tdi nhan thiy lieu cao nhat ma mpt b?nh nhan dupe dung la 55mg/ngay. Trong 3 ngdy d i u so lupng diazepam chidm 63,99%.
Theo Nguyen Viet (1995) lidu dung tisercin trong 5 ngay dau lidu tir 5,38 + 9,48 vien, va seduxen dung trong 5 ngay d i u lieu tCr 2,14 + 10,88 vien, hiu cap nhit vao ngay thii 2. De gay ngu cho b$nh nhan cai heroin trong nhirng ngay cudi lidu tisercin trung binh 1,7 den 2,3 vien [4]. Ngo Ngpc Tan, Nguyen Vdn Ngan, (2003) lidu seduxen trong su dyng phoi hpip thoc trung binh 20 - 30mg/BN/ngay va tdi da 40 - 60mg/BN/ngay, vai lidu tisercin (levomerpromazin) trung binh Id 40 lOOmg/BN/ ngay lidu lAi da la 300mg/BN/
ngdy [3]. Ket qua nghien ciiu cua chung toi phu hpp vol vdi tdc gia tren.
* V l h i | u q u a d i i u trj
Vdi nhdm trieu Chung rdi logn ca thi- qua tham kham, theo dai berf, „han chdng
110
toi nhan thay: sau uong thudc khoang 30 phut ddn 1 gidr hau het cac benh nhan ddu thay h^t hodc giam cdc trieu chung chdy nude bpt, nude mdt, giam bdt va md hoi...
Tdc dung vdi nhirng trt?u chiing khac nhu ngdp, dau mdi khdp... sau udng thuoc cdc benh nhan ddu t h i y giam ro ret. Mpt s6 it b?nh nhan phdi sii dyng them paracetamol cho het cam giac dau mdi co.
Vdi nhom trifu chiing rdi logn tdm thdn:
Doi vcri gidc ngii, sau khi udng thudc lidu dau tien sau 30 phut ddn 1 gid tit cS cd benh nhan deu di vao giic ngii. Trong 3 ngay d i u tien, moi dem bfnh nhan chi ngu dupe 2 * 3 tidng, giic ngu ch|p chdn khdng sau. Nhirng ngdy sau bjnh nhan ngd dai hon khoang 4-5 tieng moi dem, ddn cudi dot didu tri giic ngu da tra lai gin nhu binh thuong. Tuy nhien ngjy thii 4, thii 5 benh nhan vin cdn m$t nhidu, mpt sd it cd ac mpng. Ddi vdi rdi loan lo au va trim cam sau khi udng thudc 30 phut ddn Ih do cac b?nh nhan ngii dupe nen tam tiang sau khi tinh ngu bdt lo lau hon va trieu chiing tram cam cai thien rd r?t sau 3 ngay diiu trj. Doi vdi rdi loan hanh vi: sau udng thudc khoang 20 den 30 phut cac benh nhan dSu giam con vat va, ndm yen duoc khdng con khd chju nhu trudc. Cac bjnh nhan kich dpng ngoai l i | u phap hanh vi chung tdi con sii dung seduxen lOmg dang tiem tinh mach sau 5 phiit benh nhan di vao giic ngii.
Ddi vdi cac r6i loan tdm thin khdc thudc' deu cd tac dung lam giam bdt va thuyln giam rd ret, dac biet la y tudng va hanh vi tv sat kiem soat dupe nhd lidu thudc cao hon. Sau 10 ngay di^u tr, 100% bdnh nhan
Tap Chl Tai MQi Hpng Vi^t Nam -Volume (58-15). N°3- May, 2013
khong con hoi chiing cai, cdc b?nh nhan a^u hop tdc dieu tri mac dii liic ddu con ch6ng ddi nhung do tdc dung tot ciia thuoc di6u tri ma benh nhdn vugt qua hgi chiing cai mgt each nhe nhang vd hoi phuc siic khoe nhanh chong.
5.KfeTLUAN
- Cac roi lo^n tam than va co* the xudt hien chu y6u trong 3 ngdy ddu tu ngdy thii 5 ciia dot dieu tri cac roi loan co xu huong gidm dan. Den ngdy thu 7 cdc trieu chiing chi con le te, benh nhan an uong khd hon va bit ddu len can. Sau 10 ngay dieu tri chi CO mSt vai benh nhan con mot so bieu hien nhu: gidm khi sdc mat ngii, lo au, them heroin.
Ve thuoc dieu tri cat ccm:
|,evoniepromazin lieu trung binh la 127,5 ± 78,5mg/BN/ngay; Diazepam lieu trung binh la 28,75 ± 16,5mg/BN/ngdy.
TAllIEU THAM KHAO Nguyin Thanh Binh (2001) "Nghien cuu dgc diim Idm sdng rdi logn tdm than a benh nhdn dang diiu tri cdt con nghien ma tuy (opioid ) " . Ludn van th^c SI y hpc. Hoc vien Quan Y.
Ngo Ngoc Tdn, Nguyen Van Ngan vd Cs (2005 ) "Phv thuQc vd Igm dung
thudc phien - B^nh hoc tdm thdn".
Nha xudt bdn Qudn Doi Nhan Ddn.
Trang 1 6 2 - 1 6 8 .
3. Ngo Ngpc Tdn, Nguyin Vdn Ngan va Cs (2005 ) "Tdc dung chung cua thuoc hucmg Tdm (hdn - Tdm thdn hoc dgi cuong vd dieu tri cdc binh Tdm thdn".
Nha xuat ban Quan Dgi Nhan Dan.
Trang 2 2 3 - 2 5 1 .
4. Nguyen Viet, Tran Viet Nghi, Nguyen Minh Tuan (1995) "Ddnh gid dieu tri cdt can nghien ma tuy bdng cdc thuoc huong thdn theo hudng ddn cua bo y te ban hdnh". Tap san ky yeu cdc cong trinh nghien cuu khoa hgc Bg y te - Chuyen ngdnh Tdm than. Trang 120 - 131.
5. Kaplan H. I., Sadock B. J., Grebb J. A.
(1994) "Synopsis of psychiatry.
Seventh edition" Wasington D.C.
Pages 2 7 8 - 3 1 8 , 1014.
6. Sadock B. J., Sadock V.A (2005)
"Concise textbook of clinical psychiatry 9th edition". Lippincott Williams & Wiikins.USA. Pages 1 1 7 - 122.
7. Susan J. Blumenthal., Davis J. Kupfer (1990) "Suicide over the life cycle"
American psychiatric Press, Inc, Washinton DC. Pages 1 8 4 - 1 8 6 .
i:ii
