Y Hpc VlgT NAM THANG 5 - SO 2/2013
V. KET LUAN
Benh nhan TBMMN tai Khoa Than kinh Benh vien Oa khoa Hai Du'dng cd ty le nam cao hdn nU. Sd lu'dng benh nhan ty le thuan vdi tud'i.
Tang huyet ap la yeu t d nguy cao nhat va dai thao du'dng la thap nhat.
Can thiep bang ky thuat PHCN trong 3 ddt x 10 ngay/ddt, BN tien bp rd ret qua 3 lan danh gia ve cac Ikha nang: Ode lap trong sinh hoat, td ngoi day, van dpng chi ben Net, di chuyen va giao tiep. Trong dd kha nang giao tiep ciia BN tien bp nhat.
TAI LIEU THAM KHAO
1. Lam Van Che,'Ta/ bien mach mau nao" Qsi giang than kinh Tru'dng Oai hpc y Ha Npi.
Tran Van ChUtfng," Cac phudng phap tap vk dong tmng PHCN''Nha xuat ban y hpc Ha Npi. ,^
Ti'Sn Van Chu'dng, Nguyen Xuan Nghfa vS cOng su", "PHCN di chung sau Tai bien mach mk nao".
Tran Vdn Chu'dng, Cao Minh Chau va c$ng SM" (1996): " Oanh gia ket qua PHCN van ( % cua ngddi benh TBMMN" Hhh, xuat ban y hoc Ha Npi.
Du'dng Xuan Dam ( 2 0 0 2 ) , "Nghien cuV motso bien phap PHCN van dgng doi vdi benh nhan TBMMN"\de tai khoa hpc cap bo Quoc Phong, Nguyen Van DSng (1997), " Tai biS) mach rrm_
nao"Nha xuat ban Yhgc
Bai giang VLTL benh he than kinh cd (2012)- Tru'dng DHKT Y te Hai Du'dng
NHAN XET c a CAU KY SINH TRUNG SOT RET TAI NGH| AN GIAI DOAN NAM 2 0 0 3 - 2 0 1 0
Nguyen Canh PhuS Pham Van Han^
T O M TAT
Muc tieu: Oanh gia thUc trang va xu hudng thay doi ve so lu'dng va cd cau KSTSR 6 tinh Nghe An, mot sd huyen trpng diem sot ret giai doan nam 2003 - 2010. Phu'dng phap nghien ciTu: Nghien ciru hoi ciru. Ket qua: Giai doan 2003-2010, d Nghe An da phat hien 2 loai KSTSR gay benli cho ngu'cJi la P.falciparum (43,30 'yo)va P.vivax (54,36 % ), nhiem phoi hop ca 2 loai la P.falciparum + P.vivax (2.34 % ) ; Ty le KSTSR/dan so chung ca tinh giaj doan 2003-2010 la 0,73; Ty le KSTSR/lam phat hien giai doan 2003- 2010 la 0,62%; KSTSR dUpc phat hien quanh nam.
Trong giai doan 2003-2010, sU thay doi theo chieu hU6ng co Ipi: giam dan ty le P.falciparum va P.vivax, SUMMARY
Objectives: Assessment of the status and trends of changes in the number and distribution of malana parasites Nghe An province and some key districts that is about malana in period from 2003 to 2010.Method: Retrospective study.Results: In the penod 2003-2010, in Nghe An has discovered two types of the malana parasite which are P. falciparum (43.30%) and vivax (54.36%), combined infection of ' Dai hgc Y khoa Vinh; ^Dai hoc Y Hai Phong.
Phan bien khoa hgc: TS.BS. Nguyin Van Hu-o-ng 72
two types of P. falciparum and P.vivax is 2.34%; The rate of malana parasite/general population of Nghe An province in the period 2003-2010 is 0.73; The rate of maiaria parasite/ blood slide in the period 2003-2010 is 0.62%; Malaria parasites are found throughout the year. In the penod 2003-2010, the change is Bie direction of benefit: reducing rate of falcipanjm and
I. O A T V A N OE
Nghe An la tinh trpng diem sdt ret ciia Mien Bac tru'dc kia va ca nu'dc hien nay. Dan so hdn 3 trieu ngu'di, trong do dan so nam trong viing sot ret 1,4 trieu ngu'di trong dd cd hdn 800 ngan dan so nam trong viing sdt ret vira va nang. Nghe An la tinh trpng diem sot ret ciia Mien Bac tru'dc kia va ca nu'dc hien nay. Sot ret npi dja tuy di/dc khdng che nhu'ng d nhij'ng viing sau vung xa, viing dan tpc it ngddi, viing cd di bien dpng dan cu': di lam an tu' do, cac cdng tru'dng xay di/ng mdi, ky sinh triing sdt ret du'dc khuech tan tren mdt dia ban cd dieu kien de sot ret lull hanh quanh nam lam cho sdt ret cd the xay ra batciJ'
Y HOC VlgT NAM THANG 5 - SO 2/2013
luc nao neu mat canh giac va ludn la SLT quan
tam ciia ca tinh.
sy thay ddi ciia KSTSR ( tang giam ve sd lu'dng, cd cau chiing loal ), keo theo SLT thay ddi ve dien bien sdt ret d pham vl ca tinh, ngay ca mdt huyen hay mdt viing dia ly. Vi vay chung tdi tien hanh de tai nay muc tieu: Danh gia thu'c
trang va xu hu'dng thay doi ve so lu'dng va cd cau KSTSR d tinh Nghe An, mot sd huyen trgng diem sot ret giai doan 2003 - 2010.II. DOI TUONG VA PHUONG PHAP NGHIEN CCTU 2.1. Doi tu'dng nghien cu'u:
+ Nhu'ng benh sot ret du'dc xac djnh cd mang KSTSR.
-I- Cac chimg loai KSTSR trong cd the ngu'di.
2.2. Pham vt nghien cii'u: 19 huyen thanh tinh Nghe An.
2.3. Phu'dng phap nghien cu'u: Hdi ci?u so lieu bao cao sdt ret hang nam tir 2003 - 2010 tirng huyen, thanh, thi xa va ca tinh.
III. KET QUA
1. Tinh hinh KSTSR theo huyen, thi xa d Nghe An, giai doan 2003 - 2010
Bang l:?hh:n bd chiing loai KSTSR giai doan 2003- 2010 dcac huyen, thj.Ten huyen, thj Tu'dng Du'dng
Que Phong Con Cuonq KySdn Anh Sdn Nghia Dan TanKy Hutig Nguyen
Dien Chau Quy Hdp Quy Chau Quynh LUu Thanh Chifdng
Nghi LOG Yen Thanh Nam Dan Do LUOnq CteLo TP. Vinh Cong
KSTSR 332
26 98 190
30 126 38 58 235 42 60 273 100 120 235 84 70 11 177 2305
P. falciparum SL 197 17 21 6 12 58 12 25 140 25 47 124 35 41 109 36 32 4 56 997
Ty le »/o 59.34 65.38 21.43 3.16 40.00 46.03 31.58 43.10 59.57 59.52 78.33 45.42 35.00 34.17 46.38 42.86 45.71 36.36 31.64 43.25
P.vivax SL 124 9 72 184
18 66 26 31 93 14 12 145 62 77 120 45 38 5 113 1254
Ty le % 37.35 34,62 73.47 96.84 60.00 52.38 68.42 53.45 39.57 33.33 20.00 53.11 62.00 64.17 51,06 53 57 54,29 45.45 63.84 54.40
Phoi hdp (P.f + P.v) SL
11 0 5 0 0 2 0 2 2 3 1 4 3 2 6 3 0 2 8 54
Ty IS % 3.31
0 5.10
0 0 1.59
0 3.45 0.85 7.14 167 1.47 3.00 167 2.55 3.57 0 18.18
4.52 2.34 2. Phan bo ty le KSTSR / 1 0 0 0 dan so toan tinh
Bang2: Phan bo ty le KSTSR / 1000 dan theo khu viTc huyen, thi:
T f 1 2 3 4 5 6 7 8 9 10 11 12
Khu vu'c Tlfdnq DUdng
Que Phonq Con Cuonq KySdn Anh Sdn NqhTa Dan Tan Ky Himq Nquven
Dien Chau Ouv Hdp Ouy Chau Ouynh LUu
DS 74576 62611 68262 68599 111097 199677 140036 123112 293464 121824 55252 377494
KSTSR 332
26 98 190
30 126 38 58 235 42 60 273
KSTSR/lOOOdan 4,45 0,42 1,44 2.77 0.27 0.63 0.27 0.47 0.80 0.34 1,09 0,72
Y HQC VIET NAM THANG 5 - S6' 2/2013 13
14 15 16 17 18 19
Thanh Chu'dng Nqhi Loc Yen Thanh Nam Dan Do Lu'dnq CCft L6 TP. Vinh Cong
241822 222664 280400 192510 197227 49633 277203 3.157.463
100 120 235 84 70 11 177 2305
0.41 0.54 0.84 0.44 0.35 0.22 0.64 0.73 3. Ph3n bo ty le K S T S R / l a m mdu t o a n t i n h
Bang J / T v le KSTSR/lam XN nam 2003-2010 6 cac huyen va toan tinh TT
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Huyen TUdng DUdng
Que Phong Con Cuonq KySdn Anh Sdn NqhTa Dan Tan Ky Hung Nguyen
Dien Chau Quy Hop Quy Chau Quynh LL/U Thanh ChUdng
Nghi Loc Yen Thanh Nam Dan Do Lu'dnq
CiraLo
TP. Vinh CongLamXN 52042 28920 36336 30705 13119 23265 21676 1553 11669 31147 26941 20269 17822 20455 12967 10731 9354 1307 1226 371531
KSTSR 332
26 98 190 30 126 38 58 235 42 60 273 100 120 235 84 70 11 177 2305
Ty le "/o 0.64 0.09 0.27 0.62 0.23 0.54 0.18 3.73 2.01 0.13 0.22 1.35 0.56 0.59 1.81 0.78 0.75 0.84 14.14 0.62 4 . Cd cau Chung loai KSTSR A Nghe An tir n a m 2 0 0 3 - 2 0 1 0
Bang 4: OS cau chiinq loai KSTSR tCr 2003 - 2010 ciia tinh Nahe An
NSm Nam 2003 Nam 2004 NSm 2005 Nam 2006 Nam 2007 Nam 2008 Nam 2009 Nam 2010 Cong
So lam XN 44224 37145 44599 42334 54179 52709 46809 49532 371531
So lam COKST 554 259 448 197 281 241 242 93 2305
Chung loai kv sinh trim P. falciparum
SL 223 100 241 72 120 134 69 39 998
"/o 40.99 36.81 53.79 36.55 42.70 55,60 28,51 41.94 43.30
P. vivax SL 306 155 186 120 160 104 168 54 1253
•/o 56,25 59,85 41,52 60,91 56,94 43.15 69.42 58.06 54.36
9 Pho SL 15 4 21 5 1 3 5 0 54
hfp i
^
% 1 2.76 • 1.54 i 4.69-11 2.54 i 0.36 1 1.24 ' 2.07
0 2.34
S. CO cau KSTSR noi dja va ngoai lai tir 2003-2010
Bangs-. Ky sinh triing noi dia va nqoai lai tCf 2003 - 2010
Ty \i % KSTSR ngoai lai
451Ty le °/o 82.90 80.69 ! 61.83
Y HOC Vl|T NAM THANG 5 - 3 0 2/2013 Nam 2006
NSm 2007 Nam 2008 Nam 2009 NSm 2010
C6ng Trung binh
197 281 241 242 93 2305 288.13
50 163 25 112 8 672 84.00
25.38 58.01 10.37 46.28 8.60 29.15 27.90
147 118 216 130 85 1633 204.13
74.62 41.99 89.63 53.72 91.40 70.85 72.10 6. Phan bo KSTSR no! dja 6 Nghe An tu' n i m 2 0 0 3 - 2 0 1 0
I _ Ky sinh trung sot ret npi dia
I • 90! / . \ m -,a _ t _ K y SO'n
•-Tu'ffngDu'O'ng
<-' Con Cuong Que Phong Quy Chau Nam Nam Nam N3m N3m N3m Nam Nam , 2003 2004 2005 2006 2007 2008 2009 2 0 - | 0 ^ ' ^ ^ ^
Bieu do 1: KSTSR tai mot so huyen dai dien giai doan 2003 - 2010 IV. BAN LUAN
1 . Ve Chung loai KSTSR d Nghe An - Qua phat hien KSTSR bang phu'dng phap giem sa, Nghe An cijng chi mi5i phat hien 2 loai KST, do la P.falciparum va P.vivax. Sit phoi hdp cung chi gap giu'a la P.falciparum va P.vivax.
- Do Trung tam PCSR tinh chu'a co trang bi ky thuat de thi/c hien phu'dng phap PCSR nen chu'a the ket luan co hay khong 2 loai KST con lai la P.malariae va P.ovale.
2. Ve phan bo chung loai KSTSR 6 Nghe An Cung nhu' giai doan tru'dc l<ia, tii 2003-2010 tai Nghe An bang phu'dng phap nhupm giem sa soi du'di ki'nh hien vi vat kinh dau cung chi mdi phat hien co 2 loai KSTSR. Do la P.falciparum va P.vivax. Sd phoi hdp cung chi phat hien 2 loai P.falciparum va P.vivax. Si/ xuat hien KSTSR ca P.falciparum va P.vivax d tat ca cac huyen, thanh, thj trong tinh cd so lu'dng va ty le khac nhau theo hang nam.
3. Ky sinh trung SR noi dia toan tinh la
; 27.90 %, KSTSR ngoai lai chiem iy le 72.10%. 6 nhij'ng huyen mien nui cao bien gidi , vung sau viing xa nhu" Ky Sdn, Tu'dng Du'dng, Con Cuong CO sot ret lu'u hanh nang thi KST sot ret noi dia chiem uXi the. Cac huyen trung d u , vung sot ret lu'u hanh nhe, hoac khong co sot ret thi KST sot ret ngoai lai chiem uli the.
4 . Cd cau KSTSR
Cd cau KST thay doi hang nam theo chieu hu'dng giam dan ty Ie P.falciparum va tang dan ty le P.vivax. Sii thay doi nay ty le thuan vdi hieu qua tac dpng cua cac bien phap can thiep dang du'dc thi/c hien tren cac dia ban tiing huyen cung nhu' ca tinh. Ty le P.falciparum giai doan 2003 - 2010 tai Nghe An la 43,30__% va P.vivax la 54.36
%, trong dd 2.34 % la nhiem phoi hdp ca hai loai KSTSR tren.
5. Ty le K S T S R / 1 0 0 0 dan so chung Ty le KSTSR/IOOO dan so chung d Nghe An giai doan 2003-2010 la 0.73. Day la mot chi so thap va thap nhat la nam 2010 (0,03) chitng td sot ret d Nghe An giai doan nay dang on dmh tren phu'dng dien tong the nhu'ng chu'a loai tru"
nhu'ng 6 nguy cd dang ton tai d cac vung sau, viing xa, vung dan tpc dang ton tai nhiJng kho khan ve kinh te van hda xa hpi, Neu khong canh giac va tiep tuc thu'c hien nhiJng bien phap PCSR quy dinh thi benh sot ret rat cd the quay trd lai pha vd nhiJng thanh qua ma nhieu nam toan tinh gianh du'dc.
6. T y le KST/ lam mau
Ty le KST/lam phat hien toan tinh giai doan 2003-2010 d miJc thap 0.62 %. Ty le nay it co gia trj danh gia tinh hinh sot ret trong giai doan thu'c hien chien lu'dc PCSR va day lui sdt ret.
Y Hpc VlgT NAM THANG S •• SO 2/2013
V. KET LUAN
- Giai doan 2003-2010 (bang phu'dng phap nhupm Giem sa) 6 Nghe An da phat hien 2 loai KSTSR gay benh cho ngu'di la P.falciparum (43.30 %)va P.vivax (54.36 % ), nhiem phoi hdp ca 2 loai la P.falciparum + P.vivax (2.34 % ) .
- Ty le KSTSR/dan so chung ca tinh giai doan 2003-2010 la 0.73 cao nhat la huyen Tu'dng Du'dng, Ky Sdn, Con Cuong do cac huyen nay nam trong vung sot ret lu'u hanh nSng, la nhiJng huyen sot ret trong diem sot ret ciia ca nu'cfc tru'dc kia va ciia ca tinh Nghe An hien nay. Sinh dja canh phirc tap, nhiet dp, lu'dng mu'a rat thuan ldi cho sot ret lu'u truyen quanh nam cong them nhu'ng kho khan trong ddi song kinh te, van hda xa hoi. Nguy cd sot ret dang ton tai lau dai can cd siJ quan tam va tiep tuc dau tu'.
- Ty le KSTSR/lam phat hien giai doan 2003- 2010 la 0.62%.
- KSTSR du'dc phat hien quanh nam. Trong giai doan 2003-2010, cd cau KSTSR thay doi theo chieu hu'dng cd ldi do hieu qua tfch luy cua cac bien phap PCSR ciia nhieu nam: giam dan ty le P.falciparum va P.vivax.
- Nghe An la tinh trong diem sot ret cua Mien Bac, qua nhieu nSm thu'c hien phong chong sot ret da thu du'dc nhutig thanh qua: dat dutt:
cac muc tieu cd ban cua DiJ an Quoc gia PCSR
€% ra la giam chet, giam djch va giam mac, tulig bu'dc xay di/ng cac yeu to ben vO'ng.
TAI UEU T H A M K H A O
1. BQ Y t € (2000), Benh sdt ret, benh hgc. Lam sing va dieu di, Nha xuat ban Y hpc. Ha Npi 2. Le Binh Cong ( 1 9 9 2 ) , Tinh hinh sot ret bin M
gidi va chien lifdc phong chong. Thong dn flCSfc va cac benh KST, Vien Sot ret KST-CT TW,^Ha Ngi.
3. Le Dufc Dao, Le Dinh Cong^ Nguyen Vln Tuan, Bui Quang Phuc vS cong SM* (1996]^
Chan doan phan biet 4 loai KSTSR bang kp tfi^
PCR - Thong tin PCSR va cac benh KST So 4, Vi|n Sot ret KST-CT TW, Ha Npi.
4. Vien Sot ret KST-CT TW (3-2006), Danh gii kit qua thu'c hien ke hoach phong chdng s& ri nam 2005 va phdong hu'dng ke hoach nSm 2006, Ha Noi.
5. Vu Thj Phan ( 1 9 9 6 ) , Dich te hgc benh s^ret \^
phong chdng sdt ret d Viet Nam, Nha xuat ban f hpc, Ha Noi.
NGHIEN COU TINH AN TOAN
CUA BAI THUOC DIEU TRI VIEM GAN B TREN THUC NGHIEM
Hoang Anh Tuan *, Vu Xuan Nghia TOM
TATDe danh gia tinh an toan cua bai thuoc dieu tri viem gan B, chiing toi danh gia lieu dpc cap (LD50) va doc tinh ban cap ciia 5 vi thuoc Y hpc Co truyen (YHCT) 6 dang cao long tren 60 chupt nhat trang dong Swiss va 16 tho. Ket qua cho thay, vdi lieu 1 ml cao long/chupt (gap 300 fan lieu diing tren ngu'di) khong gay chet cho chugt nhSt tr^ng qua theo doi 7 ngay, khong xac dmh du'dc LD50 qua dUdng tieu hoa. Khi sif dung lieu 3ml cao long/kg the trpng, trong 30 ngay lien tuc, khong gay chet cho thd sau 30 ngay udng thuoc. Cac chi tieu sinh hoa danh gia chiic nang gan, chii'c nang than va cac chi tieu hong cau, bach cau, huyet sac to ciia tho cJ cac nhom nghien cirtj khong thay doi so v6i nhom chirtig.
* Tit khoa: \i\erc\ gan B; Bai thuoc dieu trj viem gan B; dpc tfnh, Tfnh an toan.
* Hgc vien Quan y
S U M M A R Y
STUDYING THE SAFTY OF VIETNAMESE HERB FOR HBV TREATMENT I N EXPERIMENTAL
MODELV
In order to assess the safety of treatment for hepatitis B by Vietnamese herb, we evaluated the acute dose (LD50) and subacute toxicity of five herbs in traditonal medicine (traditional medicine) in the form of liquid on 60 Swiss white mices and 16 rabbits, The results showed that, at the doses of 1 ml per mouse (250 times the human dose) did not lethal for, white mice monitored for 7 days, can not te determined LD50 orally. When use liquid doses 3ml/lq body weight, for 30 consecutive days, not lethal to rabbits after 30 days of medication. Biochemical indicators assess the function of liver, kidney and blood cells of rabbits in the study groups which were