TAP CHl Y DdCfC LAM SANG 108 Tap 12 - So 5/2017
Nhan xet tac dung phu cua enoxaparin chdng dong mang loc mau hip phu resin trong dilu tri benh nhan ngo doc cap paraquat
Evaluate side effects of enoxaparin in resin hemoperfusion at poison
Bg Hong Thu*,^^ *Benh vien Bach Mai Ngo DiJ-c Ngoc" **TruangDgi hoc YHa Noi Tom tat
Muc tieu: Nhan xet t i c dung phu cua enoxaparin trong Ipc mau hap phu resin tai Trung tam Chdng doe - Benh vien Bach Mai, dieu trj benh nhan ngd ddc d p paraquat. Ddi tuang vd phuang phdp: Nghien cdu md t l tr§n nhdng b f nh nhan ngd ddc paraquat cd loc m l u hap phu resin cd sd dung enoxaparin tai Trung tam Chong ddc - Benh vien Bach Mai. Kit qud: 167 benh nhan dUpc dUa vao nghien cdu. Bien chdng chly mau gap nhieu nhat cd 23 benh n h i n (13,8%), me day 1 benh nhan (0,2%), non nhieu p h l i ngdng Ipc 1 b f nh n h i n (0,2%), dau d I u dd dpi 2 benh nhan (0,4%), ngiitig tim cd 2 benh nhan (0,4%), ha dudng huyet 5 benh nhan (1%). Tieu cau deu g i l m d ca 4 lan loc dau tien (p<0,05). Kef ludn: Sd dung enoxaparin trong Ipc m l u hap phu resin can ldu y den bien chdng chay mau va giam tieu d u .
Tdkhda: Enoxaparin, chdng dong mang, Ipc m l u hap phu resin, tac dung phu.
Summary
Objective: Evaluate side effects of enoxaparin in resin hemoperfusion at Poison Control Center of Bach Mai Hospital. Subject and Method: An obsen/ational study in resin hemoperi'usion patients at Poison Control Center of Bach Mai Hospital. Result 167 patients were included in this study. Hemorrhage was the most common adverse event with 23 patients (13.8%), 1 patient had urticaria (0.2%), 1 patient was over-vomiting lead to stop hemoperfusion (0.2%), 2 patients had acute headache (0.4%), 2 cardiac arrest patients (0.4%), hypoglycemia: 5 patients (1.0%). Platelet count decreased at first four times (p<0.05).
Conclusion: Enoxaparin utilization in resin hemoperfusion should be careful with hemorrhage and platelet count decrease.
Keywords: Enoxaparin, hemodialysis anti-coagulation, resin hemoperfusion, side effect.
I . D a t v a n d e c h i ^ g minh hieu q u i qua n h i l u nghien cdu, dac biet loc mau hap phu resin thddng dddc chi djnh Cd nhieu phuong phap tang thai t r d ddc chat
trong ngd ddc cap paraquat, mdt benh ly ed t y le t d trong CO t h l nhd dung than hoat, rda da d l y . . . Loc „^' \.^ ^.. . ., ' . • , - • . . . . U.
^ ^ ' • , ' , vong rat cao [1]. Khi eo ehl dinh, benh nhan ngo doc mau hap phu resin la mot trong nhyng phuang ^ . ^ ^^ ^.^ ^ . ^^^. ^^„ ^. |^^. ^ . ^.. ^^
phap auoc su dung thuong xuyen gan day trong ^ ^ , ^ ^ . ^ ^^ ^ ^ . , ^ ^ ^^^ ^ , ^^. j ^ ^ . ^.^^ |^^_ ^ ^ dieu t n ngo doc cap. Phdong phap nay da ddoc ^ , .." . , . ^ ^ . u i_- t, u-
• ="• • ^ a M K 7 ^ p yig(- 5J dung chong dong eho benh nhan rat quan trpng. Heparin dugc sd dung nhieu trong Ipc Ngdy nhgn bdi: 7/3/2017, ngdy chdp nhgn ddng: 31/3/2017 mau tuy n h l l n CO nhieu bien chdng [2]. Hien nay tai Nguaiphdn hdi: Ngo Due Ngac Trung t i m Chdng dpc, Benh vien Bach Mai ed dung Email [email protected] - Trudng Dgi hpc YHa Npi
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.12-N=S/20l7
chdng ddng bang enoxaparin trong Ipc mau hap phu resin eho nhdng benh nhan ngd ddc cap.
Enoxaparin cung dugc diing de dU phdng chdng ddng trong Ipc mau [3]. Viec theo ddi benh n h i n sd dung enoxaparin cung ddn g i l n , chi nhdng benh nhan beo phi, suy than, dd thanh t h i l ereatinin dddi 30ml/phut mdi can p h l i theo ddi v l chinh l i l u enoxaparin [4], [5]. Tuy nhien, viec sd dung enoxaparin trong Ipc m l u hap phu tren nhdng benh n h i n ngd ddc d p chua ddpc nghien edu nhieu t r i n t h l gidl, lif u viec sd dung nd ed an toan khdng, vi vay ehung tdi tien h l n h nghien cdu: "Nhan xet mdt so tac dung phu cua enoxaparin trong loc m l u hap phu resin tai Trung tam Chong ddc, Benh vien Bach Mai".
2. Odi t d d n g va phUcmg p h a p Thiit ki nghiin cdu: Nghien edu mo ta.
Tiiu chuan luo chon: Cac benh nhan ngp ddc paraquat cd chi djnh Ipc mau hap phu resin tai Trung tam Chong ddc, Benh vien Bach Mai.
Tiiu chuan logi trd
Bf nh nhan dang ed tinh trang c h l y mau b i t cd ndi tang nao trong co the: Xuat h u y l t nao, xuat huyet tieu hda, d l i m l u . . .
Di dng vdi enoxaparin, heparin hoac mot heparin khong p h l n doan khac.
Dung cu nghien cdu
May Ipc than ngat quang Fresenius 4008S.
Qua Ipc t h i n ngat quang: REXEED 13L va bp d l y Ipc di kem.
Q u i Ipc hap phu HA 230 v l d l y noi kem theo.
May xet nghiem ddng m l u : SYSMEX' CA 1500 eCia hang ^Siemens Medical Solutions USA, Inc Do anti-Xa va d c xet nghiem dong m l u ca ban (tai Khoa Huylt hpc Benh vien Bach Mai).
M I y xet nghiem huyet hpc tU ddng (tai Khoa Huyet hoc, Bf nh vien Bach Mai).
May sinh hoa t u dong (tai Khoa Sinh h o i , Benh v i f n Bach Mai).
Thuoc chdng ddng enoxaparin (biet dupe Lovenox eua hang Sanofi Aventis) ddng bom djnh san 40mg ( I m g tuong dUOng lOOUi khang Xa).
Lieu d i i n g , dUdng dung: 60 - 80UI/kg, t i l m tTnh mach.
Thdi diem dung: Trddc Ipc 5 d i n 10 phut.
Djch rda q u i Ipe: Natrielorid 0,9%, glucose 5%
va heparin diing rda q u i . Cdc xet nghiem trong nghien cdu
Xet nghiem trddc va sau moi l l n loc hap phu gom: Cdng thde mau, ddng mau co ban: PT gily, PT%, INR, APTT giay, APTT b/c, fibrinogen. Hda sinh:
Ure, dudng, ereatinin, AST, ALT, dien g i l i do. Doc chat: Paraquat nieu.
Qui trinh ki thudt
Budc 1: Bat may, test m I y . Bddc 2: Lap bd day qua Ipc HA 230 vao he t h d n g . Bddc 3: L l m day djch va duoi khf trong he thdng. Lam d l y qua loc HA 230:
Dung 500ml glucose 5% khdng pha heparin, detoc do SOml/phut. Duoi khi trong h f thdng: Diing tdng 2500ml natridorua 0,9%, pha 2000UI heparin (0,4ml) trong 500ml vdi di toe dp lOOml/phut de test he thdng d l y qua Ipe (chu y duoi h i t khQ. Budc 4: Lam ngam heparin trong he thdng q u i Ipc HA 230. Diing 500ml natridorua 0,9% pha vdi 12.500UI heparin (2,5ml) de tdc dp 50ml/phut. Budc 5: Lap ndi tiep q u i Ipe than ngat quang (REXEED 13L) vao tiep sau q u i HA 230 trong he thong Ipc. BUdc 6: Lam sach heparin trong he t h d n g . Dung 1000ml natridorua 0,9% (khdng heparin) de duoi h i t dich chda heparin trddc dd va duoi khi trong q u i loc than thudng. Toe do lOOml/phdt. Budc 7: Ndi he thdng Ipc vao benh n h i n . Budc 8 ; Danh gia c l e dac diem ehung cua benh n h i n . Cle dau hieu chay m l u tren l l m sang, c l e thay ddi chi sd cdng thde mau, ddng mau trddc va sau Ipe.
Mpt sd b i i n chdng khIc: Dj (ing, sdc p h l n v^, giam tieu cau, ha dddng huyet...
Xdlysoliiu
Sd dung phan mem STATA 14.0 vdi cae test thong ke phii hop. Chpn a = 0,05 I I mdc ed y nghia thong k l , p = 0,2.
3. Ket q u a
Nghien cdu cCia ehung tdi ddpc tien h l n h tren 167 benh n h i n , trong do cd 91 b l n h nhan nam (54,5%) va 76 benh nhan n d (45,5%). Dp tuoi trung binh cda d c benh nhan I I 29,9 ± 13,06 tuoi, nh6 nhat la 13 tuoi, cao nhat la 71 tudi. Lieu paraquat benh nhan uong trung binh la 180 ± 156,7mg/kg, lieu Idn nhat 870mg/kg.
78
TAP CHI Y Dt/aC LAMSANG108 Tap 12-So 5/2017
Biing 1 . Dac d i e m c h u n g n h o m chcby m a u Dac d i ^ m nhom chSy mau
T6ng sd b&nh nhan co bien chiing chSy mau Tong so lan loc co bien chUng chSy mau Lan Ipc c6 bien chUng chay mau nang LUdng paraquat benh nhan uong (mg/kg) Lieu enoxaparin trong loc mau (Ui/kg)
n 23 27 7
146,1 61 ,S
T ^ l e % 13,8
5,4 1,4
±100,6
±18,1 NhdnxetCo 13,8% benh n h i n cd b i i n chdng c h l y mau khi Ipc mau.
B i n g 2. Vj t r i chay m a u V j t r i c h S y m a u
Chiy mau chan catheter Tu mau chan catheter va viJng ben Dai mau (nUdctieu mau do)
Xuat huy^ttieu hda nang (di ngoai phan cd mau do) Xuat huyet dudi da
So lan loc 15 13 3 1 3
T y l e % 3,0 2,6 0,6 0,2 0,6 Nhdn xit C h l y mau chan catheter la bien chdng hay gap nhat (15/502 lan Ipc). Tiep theo la t u m l u chan catheter v l vung ben (2,6%).
B I n g 3. Thcfi gian gida cac lan loc m a u v ^ so lan chSy mau d cac lan loc
Khoang each (gid)*
Tyle chiy mau (n, %) L a n i 4,6 ±6,42
6
Lan 2 13,5 ±10,05
9 (33,3) Lan 3 16,1 ±8,59
4(14,8) Lan 4 17,2 + 9,55
6(22,2) Lan 5 14,6±7,17
0
L j n 6 21,8 ±12,35
0
Lan 7 45,0 ±28,03
0
*:Th6i gian: Tinh til kit thiic lan loc m^u nay den bat dau iSn loc mau kh^c.
Nhgn xet Lan Ipc mau t h d 2 ed nhieu bien chdng chay mau nhat (33,3%). Khoing each t d l l n Ipc mau 1 den lan 2 I I ngan nhat (4,6 ± 6,42 gid).
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY
B^ng 4 . M o t so dac d i e m giAa n h d m c6 va k h o n g co chSy m a u iSn loc 2
chi so
Khoang each lan 1 - 2 (gid) Anti-Xa lan loc mau 2,2 gid (Ul/ml)
PT(%)
APTT (giay)
INR Fibinogen (g/l)
Tieu cau (G/L)
ChdymaUGrlSnloc2 Cd
n 9
5
9 9
9 9
9
X ± S D 4,2 ±3,10 (1,0-11,50)
1,5 ±0,53 (1,09-2,39) 67,6 ±17,49 (36,0 • 99,0) 91,4 ±42,83 (32,9-154,0) 1,3 ±0,20 (1,01-1,71) 2,6 ±1,03 (1,59-4,28) 152,3 ±73,10
(53 - 279)
Khong n 123
55
121 121
121
121 121
X+SD 4,7 ± 6,61 (0,10-50,40)
1,4 ±0,60 (0,56-2,80) 75,4 ±18,44 (26,0-144,6) 59,8 ±37,58 (22,1-216,4) 1,2 ±0,23 (0,87 - 2,38)
2,2 ± 0,66 (0,60-5,01) 162,0 ±61,82
(29 - 329) P
0,55
0,704
0,197
0,017 0,057
0,132
0,647 Nhgn xet Trong nhdm c h l y mau d lan Ipc hap phu t h d 2 thl APTT cao hon ban nhdm khdng chly mau, khac biet nay la cd -y nghia thdng ke vdi p<0,05.
Bang 5. Cac y e u t o lien q u a n giuTa n h o m c h l y m a u va k h o n g chSy mau
Yeu t o lien quan
Lieu enoxaparin Thdi gian giiTa 2 lan Ipc Tieu cau trudc loc APTT trudc Ipc INR trudc Ipc Creatinin trudc loc AST trudc loc ALT trudc loc
Hoi quy ddn bien OR
1,04 0,71 3,41 2,17 2,06 2,08 2,63 1,90
9 5 % Cl 0,38 - 2,83 0,37-1,36 1,35-8,60 0,94 - 5,01 0,95-4,50 0,92-4,68 1,18-5,86 0,82-4,39
P 0,93 0,30 0,01 0,07 0,07 0,08 0,06 0,13 Nhdn xit Xet rieng tdng yeu to anh hddng den nguy eo e h l y m l u thi: Chi ed tieu c l u thap < 60G/L co nguy co c h l y mau cao hon eac nhom tieu cau con lai.
TAP C H I Y D U O C L A M S A N G I O S TSp 12-56 5/2017
Biing 6. Dac d i e m m o t so chi so d o n g m a u c d ban va t i e u cau giuTa hai n h o m Chi so
PT(%) INR APn(s) Tieu cau (G/l)
ChSy mau n
27 27 27 27
x±so
68,8 ± 22,36 1,5 ±0,93 57,4 ±37,97 162,6 ±87,47
Khong chay mau n
449 449 449 445
X ± S D 78,9 ±16,36
1,2 ±0,24 49,7 ±31,68 196,1 ±80,61
P 0,03 0,001 0,234 0,019 Nhdn xit Tieu cau 6 nhdm chay mau thap hdn nhom khdng c h l y mau cd y nghTa thdng ke vdi p<0,05.
Khdng cd sd khac biet gida APTT.
BSng 7. So sanh t ^ le chSy m a u , k h o n g chay m a u va anti-Xa sau 2 va 4 g i d Anti-Xa sau ti@m
enoxaparin 2 g i d (Ul/ml) DUdi 0,4UI/ml
TilO,4d«nl,2UI/ml TrSn 1,2UI/ml
Anti-Xa sau tiem enoxaparin 4 g i d (Ul/ml) Dudi 0,4UI/ml
TU0,4aenl,2UI/ml
Tren 1,2UI/ml
Chciy mau n
%
n%
n
%
0 0%
8 8%
4 5%
ChSymau n
%
n
%
n
%
0 0%
11 8%
1 3%
Khong chay mau n
%
n%
n
%
3 100%
96 92%
77 95%
Khong chay mau n
%
n
%
n
%
32 100%
134 92%
36 97,3
Tdng 3 100%
104 100%
81 100%
Tong 32 100%
145 100%
37 1
P
0,635"
P
0,231"
Nhdn xit Khong cd sU khac biet gida ty I I e h l y mau d d e nhdm ndng dp anti-Xa 2 gid va khdng e h l y m l u d d c nhdm tren. Khdng cd sd khac biet gida tJ- le e h l y m l u d c l e nhdm nong dp anti-Xa 4 gid va khdng ehly mau d c l e nhdm tren.
Bdng 8. M o t so bien chuTng Ichac Bien chuing
IWeday
Ndn nhieu phSi ngdng Ipc Oau dau d d d d i "
Ngdng tim Ha dudng huyet
Sd lan loc 1 1 2 2 5
T J I e % 0,2 0,2 0,4 0,4 1
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.12-N-s/aoi?
Nhdn xit Cd mdt benh nhan noi me day va 1 benh nhan ndn nhieu p h l i ngdng loc, hai benh n h i n dau d I u d d dpi p h l i ngdng Ipc. Cd 5 b l n h n h i n (1%) cd bien chdng ha dddng huyet.
4. Ban luan
Anh hudng eCia lieu lUpng enoxaparin va bien chdng chay m l u
K i t q u i nghien edu t d B i n g 1 eho thay: Cd 23/167 bgnh nhan ed c h l y m l u trong va sau Ipc (chiem 13,8%), trong dd cd 27/502 lan Ipe (chiem 5,4%) ed b i i n chdng c h l y m l u . Lieu enoxaparin trung binh nhdm e h l y mau I I 61,9 ± 18,10. Phan tich cle vj tri chay mau, k i t q u i t d BIng 2 eho thay: Cd 13/502 l l n Ipc hap phu cd t u m l u chan catheter va vung ben (2,6%), chay m l u chan catheter 15 lan (3,0%), dai mau 3 lan (0,6%), x u l t huyet ti^u hda (di ngoai ra mau) 1 lan (0,2%), xuat huyet dddi da 3 lan (0,6%). Nhu vay c h l y m l u chan catheter la bien chdng hay gap hon d . So vdi Le Khac Duong v l cpng sU, ty le e h l y m l u la 9/21 (42,9%) cao hon trong nghien cdu cda ehung t d i , trong sd benh n h i n nay s6 benh n h i n ed c h l y mau tai c h i n catheter la 7/21 (33%) [6], Vu Dinh Thang: TJ le c h l y m l u la 11,1% (3/27) thap hon t r o n g nghien edu cda ehung t d i , t r o n g do chay mau chan catheter I I 2 trddng hpp (7,4%) [7]. Cung tai Viet Nam, nghien edu cua Pham Due v l Nguyen B a m Chinh [8] cd 4/19 benh nhan (chiem 21,1%) bj c h l y m l u , trong so dd 3/19 (15,8%) d l dCing chong ddng enoxaparin (Lovenox) vdi l i l u 40mg t i l m t i n h mach trUdc ipc 30 phut. Nhd v l y nghien cdu cua chung tdi X^ le bien chdng c h l y mau t h a p hdn so vdi n g h i i n edu eua Pham Due, cd le mdt phan do lieu chong d d n g (enoxaparin) trong nghien cdu cua chdng t d i I I 60 - 80UI/kg, ed dieu chinh l i l u gida d e lan loc cho benh nhan ma khdng dung lieu duy nhat n h d t r o n g n g h i i n cdu cCia Pham Due va Nguyen Dam Chinh [8]. NhU v l y can t i l p tuc cd nhdng nghien edu ve lieu Idpng enoxaparin trong ipc mau hap phu dda theo can nang cda benh nhan, d c nghien cdu tiep theo nen thde hien theo xu hddng g i l m l i l u de gdp phan lam g i l m b i i n chdng e h l y mau.
4.1. Mdt so ddc diem xet nghiem it hai nhom c6 va khong chay mdu
Chung tdi p h l n tich d e X)f le c h l y m l u d cac mde ndng dp anti-Xa sau tiem enoxaparin 2 gid, 4 gid (Bang 8). Ket q u i eho thay, nong dd anti-Xa di/di 0,4Ul/ml thi khdng cd trddng hdp nao cd bien chdng c h l y mau, nong d d anti-Xa t d 0,4 den l,2UI/ml van ed 8/104 b l n h n h i n (chiem 8%) thcS diem sau t i l m 2 g i d v a 11/145 benh n h i n (8%) thcri diem sau ti6m 4 gid cd bien chdng chay mau. Tuong t d vdi nong do anti-Xa tren 1,2UI/ml thi chi cd 4/81 (5%) benh nhan thdi diem sau tiem 2 gid va 1/37 benh nhan (3%) co bien chdng c h l y mau. So sanh 2 t J le c h l y mau d t i t d d e mdc gia t n anti-Xa va khdng e h l y mau d tat c l d e mdc gia trj anti-Xa 1^;
Dddi 0,4UI/ml, t d 0,4 den 1,2UI/ml v l tren 1,2UI/ml 6 d hai thdi diem 2 g i d va 4 gid sau tiem enoxaparin cho thl'y: Khong ed sd khac biet gida 2 ty le nly vdi p>0,05 (Fisher test). Nhd vay, khdng cd sd khac biet v l nong dp anti-Xa gida hai nhdm c h l y mau va khdng chay m l u .
4.2. Anh hudng cua cdc yeu to khac tdi biin chdmg chdy mdu
Trong q u i trinh phan tich dac diem chay mau lien quan tdi t h d t u c l e cupc Ipe, chOng tdi thay sd lln Ipe t h d 2 CO bien chdng c h l y m l u chiem ty le nhieu hdn d 9/27 l l n Ipc (33,3%), d c lan Ipe cd so lan bi^n chdng tiep theo la lan 1 (6/27, 22,2%), lan 4 (6/27, 22,2%), lan 3 (4/27, 14,8%), lan 5 va 8 (1/27, 3,7%) (Bang 3). Vi v l y , p h l n ti'eh tdng yeu t d t i e ddng len nguy cd chay mau ddpc ap dung cho sau lan loc thiJ hai de l l m rd mot sd I n h hddng nhU da n l u t r i n . Ve k h o i n g each gida hai lan Ipc v l nong dp anti-Xa sau 2 gid: Khoing cleh trung binh gida lan Ipc 1 va 2 d nhdm c h l y m l u I I 4,2 ± 3,10 gid, khdng khIc biet so vdi k h o i n g each nay d nhdm khdng chay mau la 4,7 ± 6,61 gid (p=0,55); nong dp anti-Xa 2 gid sau loc lln 2 cung dddc so sanh, ket q u i cho thay d nhdm chay m l u nong dd anti-Xa la 1,5 ± 0,53UI/ml khong khac biet so vdi 1,4 ± 0,60UI/ml d nhdm khdng chay mau (p=0,704). N h U v l y , khdng cd moi lien quan gida bien chdng c h l y m l u (sau Ipc lan 2) vdi khoang each gida hai cudc Ipc 1 - 2 va nong dp anti-Xa 2 gid sau loc lan 2.
TAP CHf Y DLfCfC LAM SANG 108 T^p 12-565/2017
Luong t i l u cau sau Ipc l l n 2 d nhdm c h l y mau la 152,8 + 73,1 OG/L thap hon so vdi nhdm khdng c h l y m l u 162,0 ± 61,82G/L vdi p-0,647 (khdng cd sU khac biet); ty le prothrombin sau Ipe lan 2 d nhdm ehly mau la 67,6 + 17,49% thap hon so vdi nhdm khdng c h l y m l u 75,4 ± 18,44% (p-0,197) va INR d nhdm ehly m l u I I 1,3 ± 0,20 so vdi nhdm khdng chly m l u 1,2 ± 0,23 (p=0,057) (BIng 4). Nhd v l y , khdng ed sU khac biet v l so lupng tieu c l u ty le prothrombin, INR sau Ipc d hai nhdm c h l y m l u va khdng c h l y m l u , hay ndi khac di khdng cd moi lien quan gida nguy eo e h l y mau vdi cac y l u t d t i e ddng tdi prothrombin, INR va sd Idpng tieu cau d lan Ipc 2.
Thdi gian APTT sau Ipc m l u hap phu lan 2, k i t qua t d BIng 4 cho thay: 6 nhdm e h l y m l u thdi gian APTT la 91,4 ± 42,83 (giay) dai hon cd y nghTa so vdi nhdm khdng c h l y m l u I I 59,8 + 37,58 (giay), vdi p=0,017. APTT keo dat sau lan Ipe hap phu 2 rat cd the do Idpng heparin ton d d trong q u i trinh "lam d l y " q u i Ipc va rda q u i Ipe khdng het da lam k l o dai APTTva anh hddng d i n b i i n chdng c h l y mau. Nhu v l y ia can ehd y lam sach luong heparin trong l l n
" l l m day" he thong qua loc bang each tang Idong djch l l m sach heparin trong q u i trinh rda q u i va can nghien cdu them de g i l m l i l u enoxaprin, dac biet I I trudc lan Ipe t h d 2 (vi lan 2 thddng Ipe ngay sau lan 1) de g i l m nguy ca chay mau.
4.3. Cdc bien chCfng khac
K i t q u i nghien cdu t d Bang 9 cho thay ele bien chdng khac gom ed: Me day 1/502 (0,2%), dau dau dd ddi 2/502 (0,4%) phai ngdng Ipe, 1 trddng hpp ndn nhieu phai ngdng Ipc v l 2 trddng hop ngdng tim, hai benh nhan ngdng tim khi vao da cd suy hd hap va ed lieu uong paraquat rat cao lan Idpt la 11 Smg/kg v l 552mg/kg, ngdng tuan hoan d d l y co le do benh d n h ngd dpc paraquat qua nang. Hai benh nhan dau dau d d dpi p h l i ngdng ipc sau dd chung tdi cd chup CT cho mot benh n h i n , ket q u i khdng cd xuat huyet nao hay ton thuong khIe trong nao, benh nhan cdn lai dau dau d d dan, khdng cd dau hieu than kinh khu tru nao va sau dd b l n h nhan dupe ra vien. Chung toi khong gap sde p h l n v l cung nhu khdng gap trddng hpp nao nhiem trung chan catheter. Nhu vay, ed the ndi ngoai bien chdng chay
mau thi cae bien chdng khac trong qua trinh Ipc m l u hap phu resin vdi chdng ddng bang enoxaparin d I u khdng qua nang n l .
5. Ket luan
Bien chdng e h l y m l u la bien chdng t h u d n g gap nhat d nhdng benh n h i n sd d u n g enoxaparin t r o n g Ipe m l u hap phu (13,8%). Mot so t i e d u n g phu va bien chdng khac: 6 a u dau d d dpi (0,4%), me day (0,2%), ha dudng h u y l t (1%), ndn nhieu p h l i ngdng Ipc (0,2%). Ti le bien chdng t d o n g d u o n g h o l e thap hon c l e phdPng phap Ipe mau khac, vi vay t d o n g doi an toan t r o n g d i l u trj benh n h i n ngp ddc cap paraquat.
Tai lieu t h a m k h i o
1. B l Hong Thu, Le Quang Thuan, Pham Due (2013) Ddnh gid hiiu qud loc mdu hdp phu than hogt vd resin trong ngd ddc paraquat. Ky y l u hpi nghj Chong dpc qudc t l Ha Noi, tr, 52-66.
2 Ysis AR, Vikram K (2012) Anticoagulation in haemodialysis. JIMSA 25(2).
3. FDA (2011) Lovenox: Highlights of prescribing information.
4. Nutescu EA, Spinier SA et al (2009) Low-molecular- weight heparins in renal impairment and obesity:
Available evidence and clinical practice recommendations across medical and surgical settings. Ann Pharmacother 43(6): 1064-1083.
5 Clark NP (2008) Low-molecular-weight heparin use in the obese, elderly and in renal insufficiency.
Thromb Res 123(1): 58-61.
6, Le Khac Duong va CS (2013) BUdc ddu ddnh gid hiiu qud loc mdu hdp phu cho 21 binh nhdn ngd dgc paraquat tai Binh vien Viet Tiep Hdi Phdng. Ky yeu hpi nghj Chdng ddc qudc te Ha Ndi.
7 Vu Dinh Thing (2011) Loc mdu hap phu bang cot than hogt tinh trong dieu tri ngo dgc cdp paraquat Hdi thao toan quoc ve cap cdu - Hdi sdc - Chdng dpclanthdXII,tr.142-152.
9. Pham Due, Nguyen Dam Chinh (2013) Loc hdp phu resin vdi qud loc HA230 trong dieu tri ngd dgc cdp paroquaf. Tap chi Y hpc Lam sang, so 71, tr. 182-188.
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