CHUYgN Bi: Hpl NOH| KHOA HQC HUYgT HQC • TRUYGN M A U T O A N Q U 6 C 2012
Sir DUNG KHOI Tifu cAu TRONG Ol£u TRj NGOAI KHOA TAI OiNHVl|NVl|T Diic
Linmg T u i n Anh, Nguyen Thj H u l , Ph^m Die Tndijig, Qui&ch Chinh NghTa vd C9ng9ir(*) T 6 M TAT
NghiSn cStu vS nhu c3u si^ di^ng cliS ptiSm tieu c9u trong dlSu tr| ngoal khoa t^l b^nh vl$n Vl^t Out
K€t q u i : nam 2011 c6 362 b^nh nhin du^c taiySn tieu (SM, C4 2 g l * , (67,4% nam v4 32,6%
niJ), tuol tnmg binh 46,S± 21,2, nh6 tuSi nhSt l i 3, cao tu5l nhSt l i 80. Ty le b|nh nhin chin thuOng: 31,5%, nlHSm b$nh ly tliu h6a v i gan m i t (27,3%), mS tim 12,2%, 8(2,2%) truing h(^p n p , leukemia, suy tuy, 3 trUdng h^p ghip tang (0,8%). 12,7% b?nh nhin c6 SLTC glim ning <20G/I. So lu^ng tieu cSu sir dgng c i n i m l i 709 don v|, trong dd 188 dOn vj Ueu cSu m i y (26,5%), c6n lai 73,5% la khoi tieu cau t i p h9p, vdi ty le nhom 0 : 4 2 % , nhom B: 2 9 % , nh6m A:
25% va AB: 3,9%, 61,5% tiT ngufll hien tinh nguyen, 21,4% tu* n g u ^ cho chuyen nghifp. Nhu (Su ve,ch€ pham tieu au trong dieu trj ngo^l khoa ngay cang ting, chii yeu trong tinh tr^ng khong co ke hoach (79,3%). Vl?c cung cap che phSm beu c i u m6l chi dap irng duljc 83,2% so vdi nhu c3u.
Van de tuyen mg v i phit trien dpi ngu hien Heu rau diT b| la thuc sU can thiet.
S U M M A R Y
Platelets using for t r e a t m e n t s o f surgical patients In V i e t due Hospital.
Subjects and methods: Cross- sectional descriptive study
Results: In 2011, there are 362 patients received platelets concentrate In their
hospitalization, indude 67.4% male and 32.6%
female, age from 3 to 80, (average; 46,5± 21,2 years old), trauma: 3 1 , 5 % and non-trauma:
68,5% (27,5% cases with liver deseases, 3 cases with organ transplantation ( 0 . 8 % ) , opened heart surgery with cardk>pulmonaiy bypass: 12.2%, 8 cases with H P , leukemia and aplastic anemia ( 2 . 2 % ) . The number of platelets conoenbates is 709 units, including 188 units of p^telet apheresis (26.5%), the rate of group 0: 42%, group B: 2 9 % , group A: 2 5 . 1 % and group AB:
3.9%. Among them, there is only 20.3% supplied In plan. The source of platelets comes from volunteers (61.5%) and paid-donors (21.4%).
I. Oi^iT V X N oi
Trong nhiing nim g4n diy truyen mSu timg phin di du^c ip dvmg pho bien trong chi djnh truyen miu. B^nh vi?n Vi^t Diic- trung tam ngo^i khoa 16n, cd vi^n cti^
thuong chinh hinh, cd cic trung tam ptiau thuit, trung tam ghdp t^g...hing nim thuc hi^n tdi 38000 ca mo Idn vi trung binh, d3 si) dyng tdi tren 31000 dan vi miu va che phSm.
Truyen miu Kmg p^in da du(?c b^nh vi^ap dyng tir 1996 vdi s6 lu^ng ban diu rat it, nhung hi^n nay di th\rc iii^n tdi gan 100%
cac Uirdng hgp truyfin mau, vdi cac che p h ^ chii yeu la khoi hong cau, huyet tuong tuoi ddng lanh, tua ignh va tieu ciu. NSm 2012, viec cung cap chi pham tieu ciu cho diiu trj duac coi la mpt muc tieu quan trpng trong cung cip mau, tuy nhien viec cung cip van chua th\rc sir dap tag du va kip thdi. Be
(*) Benh vlfn Viet But
Y HQC VigT NAM T H A N G 8 - s 6 e A C B I 6 T / 2 0 1 2
cd kl hoach phit triln trong cung cip che phim tilu cau cho diiu trj, chiing tdi tiln lianh nghiSn cuu nhim myc tiiu:
- Nghien ciru nhu cdu su dpng khii tiiu ciu trong diiu tri bfnh nhdn ngopi khoa tpl b^nh viin Vift Due.
• Danh gii hifu qua cua truyin tiiu cdu trong diiu tri & nhiing bfnh nhdn nay
II. 0611tJI)N6 VA PHlfONG PHAP NGHIEN COU
2.1 Bii lupng:
- Cic bfnh nhan nim diiu trj t^i bfnh vifn Viet Bite du<;»c chi djnh miyln tilu ciu trongthdi gian tit 01/1/2011 - 31/12/2011.
- Khdi tieu ciu (KTC) tinh theo dem vj [1], gdm:
+ KTC tip hgrp: dugc sin xuat tir 04 don
III. K I T Q U A
3.1 Dac diem benh nhan Bing 1: Die diim ve tuoi vi gidi
vj miu toin phan citag nhdm miu (tuang duang 1000ml)
•^ KTC miy (TCM): dugc sin xuit bing miy tich tl bio tp dgng (apheresis).
2.2 Phuvng phip
Nghien ota md ti cit ngang. Cic tifu chi nghien ciru:
- Die diem ciia bfnh nhin nghifn cijru:
lim sing, xdt nghifm.
- S6 lu(7ng, chiing lofii KTC dugc chi djnh cho tiing bfnh nhin trfn phiiu ding ky truyin tilu ciu cua lim sing.
- s l lu<;mg, chiing io^ii, nguon gic KTC cung cip cho timg bfnh nhin.
- Dinh gii sa bg vl hifu qui truyin TC:
SLTC tmdc truyin vi sau truyen 8 gid 2.3. Xu-1^ sl lifu: Phin mim SPSS
Tuoi (nim) Gldl
X ± S D (thiip nhat- cao nhat) Nam
NO' Tonq
46,5 ± 21,2 (3 - 80) 244 (67,4%)
118 (32,6%) 362
>0,05
Nhdn xet: tuoi trung binh: 46,5 ± 21,2 (thap nhat 3 tuoi, cao nhat 80 tuoi) Bang 2: Phan bo benh nhkn theo nh6m phau thuat
N
%
Chan thu'dng
114 31,5
Khonq chan thu'dng Tim
mach 44 12,2
Tieu hda gan mat
99 27,3
Ghep tang 3 0,8
Benh mau 8*
2,2
Khic 94 26
Tong 248 68,5
*Cd 5 BN cd bfnh ly xuat huyet giim tifu cau, 2 loxemi, 1 suy tiiy Nhfn xit: chin thucmg: 31,5%, ghip tang: 0,8%, ml tim 12,2%...
Bang 3: Phan bd BN theo muc dg giim sd lugng tifu cau (SLTC)
SLTC 20G/I 21-49 G/I >5 0G/ I Tong
Bfnh nhin (n) Tv le %
46 12,7
175 48,4
Nhfnxel: 12,7% benh nhan cd giam SLTC ning {<20G/1) 141 38,9
362 100
315
CHUYEN Bi: HOI NOHI KHOA HQC HUY£'T HQC - TRUY£N MAU TOAN au6c 2012
3.2 B$c diim v l nhu ciu ai dyng ehi phim tilu ciu Bing 4: Sit dvng khii tilu ciu diln biin theo nim (2009- 2011)
Nim S« bdnh nhin SSdOn
v| tidu ciu
T»phl?p (s8 KTC/I bdnh nhin)
Miy ts6 KTC/I bdnh nhin)
Tdna
2009 179 173 (65,8%)
(1-5) 90 (1-4)
263
2010 238 356 (68,6%)
(1-8) 149 (1-5) 505
2011 362 521 (73,5%)
(1-11) 188 (26,5%)
(1-8) 709 Nhfn xil: S6 bfnh nhin sir dting tilu ciu nim sau ting hon nim trudc tit 32- 52%, KTC sit dimg 2010 eao hon 2009: 92%, 2011 cao hon so vdi 2010: 40.3%.
Bl^uddl: KTC sur dyng phin btfthto nhim miu 3,90%
(25,10%
Nhfn xil: Ty if KTC nhdm 0 eao nhat. sau den nhdm B. nhdm A, thip nhit AB Bing 5: Ty If KTC dugc chi djnh sir dun^ theo k l hoach
So luanq KTC Tyle%
06 Ice hoach TCM
55 29,3
TC tap hgp 89 17,1
Tong 144 20,3
Khong kS hoach TCM
133 70,7
TC tap h^p 432 82,9
Tong 565 79,7 Nhgn xit: Chi c6 20,3% \u<yn% tieu cau sOr dyng \k dugc d^r tru co ke ho^h Bdng 6: Ty 1^ cung cap so v6i nhu cau
KTC Ty If %
TCmiv Nhu ciu
236
Cunq ciip 188 79,6%
T C t Nhu diu
616 Sphdp
Cung cSp 521 84,6%
long Nhu ciu
852
Cunq cip 709 83.2% . Nhfn xit: Ty If dap tag dugc so vdi nhu ciu: TCM: 79,6%, TC tip hgp: 84,6%
Bang 7: Nguon cung cap khoi tifu ciu
Tieu cau tip hdp Tieu cau may Tdng sd
Tinh nquyen 351 (67,4%)
85 (45,2%)
436 (61,5%)
Chuyen nqhiep 100 (19,2%)
52 (27,7%)
152 (21,4%)
Khac*
70 (13,4)
51 (27,1%)
121 (17.1%)
T$na 521 188 709
_
Y HQC VI$T NAM THANG 8 - s6 CAC BlgTf2Q12
* Til vifn HH-TM TLT cung cip vi tit ngudi thin bfnh nhin hiin tilu ciu Nhfn xit: 61,5% tir ngudi hiin tinh nguyfn, 21,4% tit ngudi cho chuyf n nghifp 3.3 Hifu qua cua truyin KTC
Bang 8: Sy thay dii SL'TC sau truyin KTC
Tieu cau tip hop (n=41) Tieu cau mdy (n=44))
Cliunq
Tru'dc truyBn X ±SD 40,6 ± 11,3 37,7,2 ± 12,9
39,4 ± 12,2
Sau truyiSn X ± S D 73,2 ± 22,6 95,2 ± 39,6 86,8 ±35,7
P
<0,01
< 0,001
<0,01 Nhpn xdt: 100% b?nh nhfin c6 so lugmg tieu cku tSng len sau truyen
IV. BAN LUAN
4.1 D$c diim b^nh nhfin
Dac diem tuoi v^ gidi: B^gl cho thay tir 1-20U den 12-2011 c6 t6ng so 362 b^nh nhan ngoai khoa dirge truyen che pham tieu ciu trong qud trinh di^u tri, g$p ck 2 gi6i, nam chiim da s6 (67,4%), niJ 32,6%, c6 dO tuoi trung binh 46 8 ± 20,7 thap nhat 3 tuoi, cao nhat 80 tuoi.
Ph§n b6 benh nhfin theo benh ly: Bang 2 cho thay co 31,5% la benh nhan chan thuang, trong s6 68,5% benh nhfin khong chfin thucmg CO 12,2% la phau thu^t tim va mach mau, 27,4% la b?nh ly lien quan den tieu hoa va gan mat, 0,8% tnidmg h^p la phau thu^t ghep tang, c6 8 benh nhan c6 benh mau (xuat huyet giam tiiu cfiu, laxemi va suy tuy (2,2%).
Dac diem ve xet nghi?m so luong tieu cau truoc truyin: 100% benh nhan co so lupng tiiu cfiu giam, trong d6 12,7% SLTC giam n^g <20G/1 (bang 3). Tuy nhien, khong trucmg hgp nao co xuat huyet duoi da, bao gom ca nhihig bSnh nhan xufit huyet giam tieu cfiu. Co 4 benh nhan da chan thuong CO kem theo giam cac chi so dong mau khac: PT, fibrinogen, keo dai APTT.
Nghign ctjru cua Biii Minh Dire c6 79,1%
b^nh nhfin dugc chi dinh truyen tiiu c^u c6 SLTC gidm nfing <10G/1 [2].Theo Ishide A, Hande M: chi dinh truyin tiiu c^u khi SLTC
<50G/1 hofic khi SLTC 50-lOOG/l ma Ifim sang c6 chay mdu hofic thoi gian mdu chay
>12phut[5].
4.2 Nhu c^u sit dung va kha nang cung cap tieu c^u cho dieu tri
Nhu cau ngdy cdng tdng: Bang 4 cho thfiy nhu cfiu sir dung khoi tieu cfiu trong dieu tri ngoai khoa tang len ro ret hang nfim (2009: 179 benh nhfin, 263 kh6i tiiu cfiu, 2010: 238 bfnh nhan, 505 kh6i tiiu cfiu;
2011: 362 benh nhfin, 709 kh6i tiiu cfiu). So sanh giita cdc nam cho thay: so lugng benh nhan can diing tieu cfiu nfim sau cao han nfim truoc liin lugt ia: 32% vd 52%, s6 lugmg khoi tiiu cfiu tieu thu cung cao hon: 2010 cao han 2009: 92%, 2011 cao han 2011: 40,3%. Diiu nay co thi gifii thich Id do tir nfim 2010 benh vien dd tiin hdnh chd dgng san xufit che phfim tiiu cfiu de dap ung nhu cfiu sfin co cho diiu tn, do vay, s6 lugng KTC dugc sii dung cho diiu tri 2010 tang gfin gap doi 2009.
Tniac 2010, benh vien chi sdn xufit che phfim tiiu cfiu khi co chi dinh tu phia lam sdng, nen
317
CHUYEN Bi: Hpl NOH| KHOA HQC HUYe't HQC - TRUYgN MAU TOAN QU6C 2012 vifc cung cip thudng bj d$ng, khdng dip ml. Do dd, nfn cd phuong in d\r phdng cliiy tag dd vi kip thdi so vdi nhu ciu.
Phin bi nhu ciu theo nhim miu: Biiu dl 1 cho thiy t^ If nhdm miu cda chi phim tilu ciu dugrc chi djnh sir dvng tuong tvi ly If nhdm miu cOa ngirdi Vift Nam binh thudng:
nhdm O cd tJ- If eao nhit (42%), sau din nhdm B (29%), nhdm A (25,1%) vi thip nhit li AB (3,9%). Diy cflng li mOt die diim thuin Igti trong vifc l\ra chgn ngudi hiin tilu ciu vi xiy dtag <)di ngfl ngudi hiin tilu ciu d\i bj.
Phin bi nhu ciu theo ki hopch: Trfn th^rc tl, chi djnh truyin khii tilu ciu trong ngo^i khoa chu yiu thudng d trong tinh huong khdng cd kl ho^ch. Kit qui d bing 5 cho thiy: chi cd 20,3% \ugng tilu ciu sir dung li dugc d\r trii cd ke ho^ch, 79,7% cdn l^i li khdng cd kl ho^ch. Dieu niy cd thi dugc ly giii do nhieu bfnh nhin cd dien biin sd lugng tilu cau giim ngoii du kiln trong qui trinh dieu tri sau mo. Cic trutag hgp cd ke ho^ch chu yf u li nhtag ml Ita nhu ghdp tgng, md tim phoi nhin tgo, hoic bfnh nhin cd bfnh ly die bift (ITP, loxfmi, suy tuy), hoic bfnh nhin cd SLTC giim ning ngay tir khi vio vifn. Tifu cau cd vai trd rit quan trgng trong ddng cam miu die bift li khi cd can thifp phau thuit. Theo sd lifu nghien eta tai bfnh vifn Vift Diic cd 5,7% bfnh nhin vio cip eta tgi phdng khim bfnh cd so lugng tilu ciu giim <100G/L, trong dd cd 2,3% cic trudng hgp giim <50G/1 cin can thifp phiu thuit [3J. Tgi bfnh vifn Chg Ray sd bfnh nhin da chin thuoong ed SLTC giim ning trudc mo li 18,8% [4]. Vifc theo ddi so lugng tilu ciu trudc md vi sau md khdng nen xem nhe. Sd lugng tilu ciu giim trudc md cd thf sS li nguyen nhin chiy mau sau
miu sau ml bing cic chi pham miu trong do cd chi phim tilu ciu.
ly If dip img so vdi nhu ciu: Bisii i eho thiy nim 2011 vifc cung cip tieu cjta mdi chi dip tag dugc 83,2% so vdi nhu db ciia chi dinh diiu tri, trong dd t^ if dip ung dugc ciia tilu ciu miy li 79,6%, tilu ciut^
hgrp: 86,7%. Nguyfn nhin din din khdng M dip tag: diu tifn li nguin ngudi hiin tilu ciu cdn thiiu, tilu ciu cd thdi gian bio quin ngin, tilu ciu miy chi phi cao nfn thudng khdng sin cd, sau din li vifc theo dii diln biin cua SLTC ci trudc vi sau ml cliua dirge nhiiu nhi ngogi khoa thyc s^r quan tim.din din chi dinh thutag bi dgng, khi co khi ning dip tag dii theo so lugng yeu ciu.
Nguin cung cip: ty If ngudi cho tieu cau tinh nguyfn chiim ty If khi cao 614%, ngudi cho chuyfn nghifp chi cd 21,4% (bdng 7). Tuyin mg vi phit trifn dpi ngfi nguoi hien tilu ciu du bi tgi cho li rit ein thilt, dong thdri phii phoi hgp tot giiia cic trung tim truyin miu trong vifc cung cip tieu db cflng nhu cic chi phim miu khic. C6 nliit viy thi vifc cung cap du miu vi chi pham miu cho dieu tri bfnh nhin mdi thyc su du^c cai thifn.
4.3 Hifu qua cua truyen khoi tieu cau trong diiu trj
Trong so 362 benh nhin dugc trayin tieu ciu trong nghifn eta, l\ra chgn 85 b?nli nhin cd so lugng tieu cau giam trong kho^
20- 50G/I, khdng mic cic bfnh vl man, khdng cd biiu hifn bit thudng ldn vl cic chf so ddng miu khic, khdng cd kdm theo trayfin miu khdi lugng ldn, trong dd gdm 44 b£nh nhin chi truyfn 01 khoi tilu ciu miy va41 bfnh nhin ehi truyen 03 khdi tilu ciu #
Y HQC VigT NAM T H A N G 8 - S6'gAC BlgT/2012
hgp, phfin tich svr bien d6i s6 lugng tiiu cku sau truyen, Chiing tdi nh^n thay 100% b$nh nhfin CO so lugng tieu cku tfing 16n r5 r^t 8 gift sau truyin. SLTC trung binh trudc Ifi 39,4±12,2G/1, tfing len 86,78±35,7G/1, s\r khac biet co ^ nghia th6ng k& v6i p<0,01 {bdng 8). Tuy nhi6n, d i ddnh gid hi$u qud th|t s\r cdn phdi c6 nghien curu bdi bdn vdi nhieu tieu chf nghien curu, s6 mSu 16n vd ihn% nhat hcm.
V. KET L U A N
Nhu cfiu ve che p h ^ tiiu c^u diing trong diiu trj n g o ^ khoa ngdy cdng tfing, nam 2011 Id 362 bfnh nhfin va 709 dan vj tiiu cfiu (188 tieu cfiu mfiy, 521 don vj tieu , cfiu t|ip hgp), chi c6 20,3% la c6 ke hogeh, , dap ftng dugc 82,3% so vcri nhu cau, 61,5%
I ngu6n cung cap chii yeu den tCr ngudi cho I tinh nguyen. Vi$c xay dung dgi ngu ngudi hiin ti6u cfiu du bi luon sfin sdng Id cfin thiet.
I TAI UEU THAM K H A O
[ 1. Pham Tuan Dinmg, Cac chi phfim mau va
sit dyng Ifim sdng, Bdi gidng Huyet hpc Truyin mdu, Nhd xuit bdn Y hpc 2004, tr 302 -308.
Bill Minh Dure, Nguyin Duy Thfing NguySn Ng9c Minh.. .NghiSn curu chit lugng vd hi^u qud truyin khoi tiiu c4u sfin xu4t tr£n mdy Hemonetics trong diiu trj b^nh nhfin gidm tiiu c4u nfing. Y hgc Vi^t Nam thdng 9 - S i 2/2010, tr5I2-517.
Nguyin Thi HuS, Qudch Chfnh nghTa vd c^ng sy, NghiSn curu m$t s6 chi so ddng c4m mdu d b^nh nhan mS ckp ciJru t^i b$nh vi^n Vi?t Dire. Y hpc Vi|t Nam thdng 5- So dJc bi?t/2011,tr3-7.
Nguyin Trvfmg Stfn, Le Hoang Oanh, I d P h u ^ Hai, Tran Quy Phuvng Linh, Mgt so nh^n xet truyen mdu trong 24 gid dau tien trSn b|nh nhan da chan thuang t&i bfnh vi?n Chg Ray. Y hpc Thanh ph6 Ho Chi Minh Phy bdn t§p 15* so 4* 2011, trang 239-244.
Ishide A, Hande M (2005), Examination and treatment for dilutional thrombocytopenia, Rinsho Byory Jul, 53(7):
654-657.
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