HOI NGHI KHOA HOC BENH VIEN HUfU NGHI VI§T TIEP HAI PHONG LAN THLf 37
J
NHAN XET MOT SO DAC OIEM LAM SANG
VA XET NGHIEM 6 BENH NHAN TAI BIEN MACH MAU NAO CAP
• • •
TAI BENH VIEN OAI HOC Y HAI PHONG
Do Thj Tinh, Ngo Thj Thu Thiiy, Ninh Van Quan Lc Van Thieu, Nguyen Thi Hanh, Nguyen Thj Hien, Nguyen Thj Mai (*
TOM T A T
Muc tieu: Nhan xet mot so dac diem lam sang va xet nghiem d benh nhan tai bien mach mau nao cap tai benh vien DHY Hai Phong n3m 2010-2011. Doi tupng va phu'dng phap: Nghien ciru mo ta Ket qua: nghien ciiU 51 benh nhan tai bien mach mau nao cap, chung toi thay: 74,5% benh nhan d tuoi tren 60.
Ti le nam/nij" la 0,7/1. Trieu chu'ng than kinh hay g3p nhat la liet nira ngu'di (68,6%. Tuoi cang cao ty le THA cang Idn, nguy cd TBMMN cang tang. Ti le dai thao du'dng d benh nhan nhoi mau nao la 36,96%, xuat huyet nao la 40%. Benh nhan roi loan lipid mau chiem ti le cao (84,78%). Kit luan: l^nq huyet ap, dai thao du'dng va roi loan lipid mau la nhu'ng yeu td nguy cd cao ciia tai bien mach mau nao.
ABSTRACT
COMMENT SOME CLINICAL CHARACTERISTICS AND LABOLATORIES IN PATIENTS AT STROKE AT HAI PHONG MEDICAL UNIVERSITY HOSPITAL
Objectives: yci review some clinical features and labolatories in patients at stroke at Hai Phong Medical University hospital in 2010-2011. Subjects and methods: The study describes. Results: study 51 patients at stroke, we found: 74.5% of patients aged over 60. Ratio male/female is 0.7/1. Neurological symptoms is most common hemiplegia (68.6%). Age higher rates of hypertension greater risk of cerebral vascular accident is increasing. The rate of diabetes in patients with cerebral infarction was 36.96%, of blood brain is 40%. Patients dyslipidemia high proportion (84.78%). Conclusions: High blood pressure, diabetes and dyslipidemia are risk factors of stroke.
I.
OAT VAN OETai bien mach mau nao (TBMMN) la hoi chirng thieu sot chirc nang than kinh khu trii hon la lan toa xay ra di)t ngot ton tai qua 24 gio hoac tir vong trong vong 24 gio loai trir nguyen nhan sang chan nao (To chiirc Y te Thi gioi: WHO).
Tai bien mach mau nao gay ra hau qua nghiem trong nhu tan phe. khong nhung anh huong Ion den tinh than ngucri benh ma con doi hoi sir cham soc lau dai, ton kem cho gia dinh \a xa hoi. tham chi gii\ tir vong cho nguoi benh. De gop phan nang cao chan doan cung nhu dieu tri \a phong benh TBMMN. chiing toi ticn hanh nghien ciru nham muc tieu:
Nhan .xet mgt so dgc diem lam sang va xet nghiem & benh nhdn tai bien mach mau nao cap tgi b^nh vien Dgi hgc Y Hdi Phong nam 2010-201 J.
II. 06l TOPNG VA PHlWNG PHAP NGHIEN COU 2.1. Doi tumig nghien ciru
Gom 51 benh nhan dugc chan doan xac dinh TBMMN cSp tai khoa noi benh \ienDai hoc Y Hai Phong tir thang 8/2010-2/2011.
2.2. Phuong phdp nghien ciiu
- Thiet ke nghien cuu: Phuong phap mo ta cat ngang
- Tieu chuan chgn benh nhan: Benh nhan dugc chan doan xac dinh TBMMN cip theo WHO:
Y HOC VIET NAM THANG 10 - SO DAC BIET/2011
Tieu chuan lam sang:
+ Co 3 tieu chuan lam sang do la co trieu chung than kinh khu tru, trieu chinig do xay ra dot nggt tin tai qua 24 gio hoac tir vong trong vong 24 gio va khong co chdn thuang sg nao.
Tieu chuan vl chSn doan hinh anh:
+ Chup CLVT:
Doi vai nhoi mau nao. tren phim chup CLVT nao bieu hien bang \iing giam t\
trong tuong ung \6i \i tri dong mach cap mau.
Doi voi chay mau nao, tren phim chup CLVT nao bieu hien bang hinh anh tang ty trgng cua khoi mau tu trong nhu mo nao hoac tang ty trgng ciia cac khoang dich nhu khoang duai nhen va cac nao that.
2.3. Cdc chi tieu nghien ciru:
Lam sdng:
Tuoi, gioi, dia du, nghe nghiep.
Tien sir ban than: DTD, THA, dieu tri CO thucrng xuyen khong.
- Ly do vao vien: mat, roi loan y thirc,
>cu chi, dau dau,chong mat...
Huyet ap
- Diiu hieu than kinh khu tru: hon me, liet nira ngucri. Met mat trung uong
Can lam sdng:
Xet nghiem mau: glucose mau, cholesterol toan phan, triglycerid, HDL-C, LDL-C.
Nuoc tieu: Amylase nieu.
Phuong phdp xir ly sd lieu
Tat ca cac du' lieu nghien cuu dugc xir ly theo phan mem thong ke y hoc SPSS 13.0 I. KET QUA NGHIEN CCfU
Nhom tuoi N Ty le %
<50 3 5,9
Bang 50-59
10 19,6
.Tuoi 60-69
17 33,3
>70 21 41,2
Tong 51 100
Nhan xet: So benh nhan TBMMN tang theo tuoi, lua tuoi hay gap nhat: tren 60 tuoi chiem ty le 74,5%, tuoi trung binh la 65,7 ± 11,6 tuoi.
Bang 2. Giai Gidi
n Ty le %
Nam 21 41,2
NOT 30 58,8
Tong 51 100
Nhan xet: co 21 benh nhan nam chiem ty le 41,18%, 30 benh nhan nir chiem ty le 8,82%. Ty le nam/nir la 0,7/1.
Bang 3. Dia du Ndid
n Ty le %
Ndng thdn 17 33,3
Thanh thj 34 66,7
Tong 51 100
Nhan xet: Ty le benh nhan nong thon la 33,3% thap hon ty le benh nhan thanh pho (66,7%) Bang 4. Trieu chung than kinh
Trieu chuHig Hon me Liet nira ngu'di
n = 51
35
Ti le % 9,8 68,6
HOI NGHI KHOA HOC BENH VIEN HLfU NGHj VIET TIEP H A I PHONG LAN THLf 37
Liet m§t Roi loan ngon ngu'
Roi loan cO tron
12 11 18
23,5 21,5 35,2
Nhan xct: Trieu chimg Met nira nguiri chiC-m ti Ic cao nhiit (68,6%), tiep den la roi loan cotron (35.2%). liet mat (23.5%). rcii loan ngon ngu'(2l,5%), thap nhat lir hon me (9,8%).
Bang
THA
<50 50-59 60-69
>70 Tong
5. l y IC" tang huyet ap a hcnh nhan TBMMN voi tuoi Co
n 2 8 14 17 41
% 4,8 19,5 34,2 41,5 100
Khong n
1 2 3 4 10
% 10 20 30 40 100
Nhan xct: Tuoi cang cao ty lc THA cang Ion. Chi c6 4,8% benh nhan < 50 tuoi, co 41,5%
benh nhan >70 tuli, lira tuoi 50-59 (19,5%), lira tuli 60-69 (34,2%).
DTD
Co Khong
Tong
Bang 6. Ty le DTD theo the T B M M N Nhoi mau nao
SoBN 17 29 46
Ty le % 36,9 63,1 100
Xuat huyet nao SoBN
2 3 5
Ty 1^ % 40,0 60,0 100
Nhan xet: ty le DTD cao, a benh nhan nhoi mau nao la 36,9%, nhom benh nhan xuat huyet nao CO ty le DTD la 40,0%.
Bang 7. Ty le roi loan Lipid mau 6 benh nhan TBMMN cap
Lipid mau
Co roi loan Khong roi loan
Tong
Nh'oi mau nao SoBN
39 7 46
Ty If % 84,7 15,3 100
Xuat huyet nao SoBN
3 1 4
Tyl#% * 75,0
25,0 100
Nhan xet: b?nh nhan roi loan lipid mau chiem ty le rat cao, nhom nhoi mau nao ty le roi loan lipid mau la 84,78%. Nhom xuat huyet nao ty le roi loan la 75%.
Lipid mau Tang cholesterol
Tang triglycerid Giam HDL - C
Tang LDL-C
Jang 8 . ' fy 1? roi loan than 1 phan lipid mau So bf nh nhan
28 26 19 31
Ty If o/o 66,7 61,9 45,3 73,8
Nhan xet: Trong so benh nhan roi loan lipid mau gap nhieu nhat la rli loan tang LDL - C (73,8%), tilp din la tang triglycerid (61,9%), giam HDL-C (45,3%), thip nhit la rdi loan HDL-C (45,2%).
Y HOC VIET NAM THANG 10 - SO OAC BIET/2011
IV. BAN LUAN
4.1. Trieu chirng lam sang
Tuoi: Ket qua bang 1 cho thay ti le benh nhan TBMMN tang theo tuli, lira tuoi hay gap nhat: tren 60 tuoi chilm ty le 74,5%, tuoi trung binh la 65,7 ± 11,6 tuoi.
Gioi: Ket qua nghien ciru ciia chimg toi CO 21 benh nhan nam chiem ty le 41.2 %, 30 benh nhan niJ chiem ty le 58.8" o. T\ lc nam/nij la 0,7/1. Ket qua nghien ciru ciia chung toi cGng phii hgp \xVi kel qua nghien cuu cua mgt so tac gia khac [2], [3].
Dia du: Chung toi gap phan lan benh nhan a thanh thi (66,7%), benh nhan nong thon chiem ti le thap hon (33.3%). Mot so tac gia khac cung co nlian xet tuong tu [3], [5].
- Trieu chimg than kinli: Trieu chimg liet nira nguoi chiem ti le cao nhat (68,6%), tiep din la rli loan co tron (35,2%), liet mat (23,5%), rli loan ngon ngir (21,5%), thdp nhat la hon me (9,8%).
- Ty le tang huylt ap a benh nhan TBMMN voi tuoi:
Tuli cang cao ty le THA cang Ion. Chi CO 4,88% benh nhan < 50 tuoi, co 41,46%
benh nhan >70 tuli, lira tuli 50-59 (19,5%), lira tuli 60-69 (34,2%). Kit qua nghien cim cua chung toi phii hgp voi kit qua nghien ciiru cua cac tac gia khac, tang huylt ap la nguy CO s i 1 cua TBMMN, tuli cang cao nguy CO TBMMN a benh nhan tang huylt ap cang Ion [3], [4].
4.2. Mgt sd xet nghiem
- Ty leDTD theo thi TBMMN: ty le DTD cao, a benh nhan nhli mau nao la 36,9%, ' nhom benh nhan xuit huylt nao c6 ty le DTD ' la 40,0%. Ti le DTD ctia chung toi cao han
" nhilu so voi cac kit qua nghien cuu o cong 'dlng[4],[5].
^ Ty le roi loan Lipid mau 6 benh nhan
•TBMMN: benh nhan rli loan lipid mau chiem
ty le rat cao, nhom nhoi mau nao ty le roi loan .lipid mau la 84,78%. Nhom xuat huyet nao ly
le roi loan la 75%.
ry le roi loan thiinh phiin lipid mau:
Trong so hcnh nhiin roi loan lipid mau gap nhieu nhiit la roi loan tang LDL - C (73,8%), tiep den la tang triglycerid (61,9%), giam HDL-C (45,3%), thc4p nhSt lii rli loan HDL- (' (45.2%). Kit qua nghien ciru ciia chiing toi cung phii hgp viri ket qua nghien cim cua cac tac gia khac [1].|5].
V. KET LUAN
Tuli: phSn Ion benh nhan TBMMN o tuoi tren 60, chilm ty le 74,5%, tuoi trung binh la 65,7 ± 11,6 tuli.
Ti le nam/nij' la 0,7/1.
Trieu chung th^n kinh hay gap nhit la liet nira ngucri chilm ti le (68,6%), tilp din la rli loan co tron (35,2%), liet mat (23,5%), roi loan ngon ngir (21,5%), t h ^ nhat la hon me (9,8%).
- Tuli cang cao ty le THA cang Ion, nguy CO TBMMN cang tang.
Ty le DTD cao, o benh nhan nhoi mau nao la 36,96%, nhom benh nhan xu4t huyet nao CO tyle DTD la 40,0%.
Ty le benh nhan rli loan lipid mau chilm ty le rdt cao, nhom nhli mau nao ty le roi loan lipid mau la 84,78%. Nhom xu4t huylt nao ty le roi loan la 75%.
- Rli loan lipid mau gap nhilu nhat la roi loan tang LDL - C (73,8%), tilp din la tang triglycerid (61,9%), giam HDL-C (45,3%), thap nhat la rli loan HDL- C (45,2%).
TAI LIEU THAM K H A O
1. Truong Thj Chieu, Dinh Quang Tam, Le Van Tam, Hoang Khanh (2011), "Nghien ciru ti I? rdi loan lipid mdu d henh nhdn hi tai hien mach mdu nao giai doan cdp", Y hoc thirc hanh, si 2 (751), tr: 106 - 108.
HOI NGHI KHOA HOC BENH VIEN HUTU NGHj V I | T TIEP H A I PHONG LAN THLf 37
2. Duong Duih ( h i n h (2005), "Tim liieu mgt sd nguy ea tren h('nh nhdn tai hien mach mdu, nao dieu tri tai h('nh vi('n da khoa Ngh(' .tn Y hoc thuc hanh. so 10.tr. 59-61
.V Le Quang CinVng (2002): "Nghien cuv irinh trang tai hien inaeli mdu nao vd mot so veil td nguy eo' d B('nli vii/n Thanh Nhdn nam 2000- 2001 •• V hoc thuc hanh so 3. ti 76-78.
Pham Thi Thu Ha (2002), "Nhdn xet mqt dgc diem djch le lain sdng, can Idm sdng c.
tai hien mach mdu nao tai Benh vien (2000-2001) , Luan van Bac sT chuyen khi cnp II, Dai hoc Y I la Nyi.
F':i-A(at F, ct al (2005), "Strocke, preventic in diabetic and other hight cardio- va.sculi rick patients" Curr Diab Rep, 5(3), pp: 200-7.
NGHIEN CLTU OAC OIEM THIEU MAU VA HIEU QUA OIEU TRI
• • •
CUA ERYTHROPOIETIN VA SAT 6 CAC BENH NHAN SUY THAN MAN LOC MAU CHU KY
T r a n T h i A n h T u y e t * , T r a n T h a n h Gang
TOM TAT
Thieu mau rat pho bien d cac benh nhan (BN) suy than man - loc mau, nhU mot hau qua ciia thieu hut erythropoietin. Dieu tri thieu mau d cac BN nay chii yeu dUa vao bo sung erythropoietin va sat du'dng tinh mach. Chung toi da tien hanh mot nghien cu'u tren 98 BN loc mau tai Hai Phong thay r§ng, thieu mau gap 6 89.8% BN, chii yeu la thieu mau n3ng & rat n3ng (58.5%). Tien hanh bo sung sSt va epoetin alfa tren mot nhom 26 BN thay co cai thien ro ret dU tru' sat va nong dp hemoglobin (Hb). Sau tiem Ig sSt sucrose dUdng tinh mach, ferritin tang til 162.4 ± 40.08 len 545.8 ± 108.47 ng/ml (p < 0.001). Sau tiem EPO 6000 lU/tuan ket hdp vdi sSt sucrose 25 - 50 mg/tuan, d thdi diem 8 tuan, Hb t§ng tir 87.1 ± 9.8 len 107.5 ± 6.9 g/L (p < 0.001), ferritin duy tri on dinh (657.3 ± 232.79 vs 659.6 ± 165.33, p > 0.05). Khong thay xay ra cac phan iing phu nSng do thuoc. NhU vay, thieu mau d cac BN loc mau van rat tram trong;
phac do bo sung EPO va sat theo khuyen cao ciia NKF cho hieu qua ro ret va an toan.
* Benh vien Hitu nghi Viet Tiep, Hdi Phdng
SUMMARY
Anemia is very common in patients with chron renal failure treated by hemodialysis as a consequenc of erythropoietin deficiency. Correction of anemi associated with this condition mainly relies o supplementation of erythropoietin and intravenoi iron. We performed a study in 98 hemodialys patients in Hai Phong, showed that 89.8% patient have anemia, 58.5% is very severe and sever anemia. In a group of 26 patients with anemii supplementation of iron and epoetin alfa obviousi improved iron status and hemoglobi (hematocrit).Afler receiving Ig intravenous iro sucrose, ferritin increased from 162.4 ± 40.08 to 545.
± 108.47 ng/ml (p<0.001). After 8 weeks treated wrt both subcutaneous epoetin alfa (6000 lU/week) an low-dose intravenous iron sucrose (25 - 50 mg/week Hb increased from 87.1 ± 9.8 to 107.5 ± 6.9 gi (p<0.001), serum ferritin was maintained stab (657.3 ± 232.79 vs 659.6 ± 165.33 ng/ml, p > 0.05 There were no serious drug related adverse event Conclusions: Anemia in hemodialysis patients
