TAP CHi Y HOC VIET NAM TAP 456 • THANG 7 - SO 1 - 2017 Bach Mai nam 2013', luan an tien si, vien ve sinh
dich t£.
4. Bozzetti F, Braga M, Gianotti L, Gavazzi C, Mariani L (2001). Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trial. Lancet. 2001;358:1487-92. doi: 10.1016/50140- 6736(01)06578-3.[PubMed][CrassRef]
5. Braga M.,Gianotti L.,Gentlllni 0.,et al (2001), Early postoperative enteral nutrition improves gut oxygennation and reduces costs compared with
total parenteral nutrition
. Braga M, Gianotti L, Gentilini S, Liotta S, Di Carlo V. Feeding the gut early after digestive surgery: results of a nine-year experience. Clinical Nutrition. 2002;21:59-65. doi:
10.1054/clnu.2001.0504. [PubMed] [Cross Ref]
. Lewis SJ Early enteral feeding versus "ml by ,EFiouth" after gastrointestinal surgery: systematic review and meta-analysis of controlled trials . 2001 Oct 6; 323(7316): 773. [PubMed]
NGHIEN Ciru HIEU ^UA CUA PHiraNG PHAP AN THAN DO BENH NHAN Tir DIEU KHIEN B A N G P R O P O F O L TRONG HUT THAI D i r a i 12 TUAN
Hoang Ngpc Vinh*, Nguyen Dire Lam**
Objectives: To compare die sedation effects of propofol by Patient Controlled Sedation - PCS with propofol intravenous anesthesia in abortion under 12 weeks of gestation. Subjects and methods:
Randomized clinical tnal companng 100 patients with gestational age 10-12 weeks, divided into two groups:
Patient Controlled Sedation (PCS): self-controlled sedation by bolus injection of 20 mg propofol, block time IS 50 seconds, anesthesia group (GM):
intravenous anesthesia with propofol 2 mg/kg. Both groups were given analgesia by the cervix with 80 mg lidocaine. Results: The PCS group had a patient satisfaction score similar to the anesthetic group (94%
vs 90%); the incidence of move of patienr in abortion procedure was lower than that of the anesthetic group (2% vs. 8%), less to deep sedation (OAA/S > 5).
Compared to. the anesthetist group, the PCS group used less propofol (49.7 ± 11.2 mg versus 105.4 ± 21.6 mg, p <0.05); shorter recovery time (1.5 ± 0,5 minutes vs. 6.8 ± 1.9 minutes, p <0.05) and discharge time (55.6 ± 15.4 minutes vs. 125.5 ± 35.4 minutes, p <0.05}. Conclusions: Patient Controlled Sedation with a higher OAA/S sedation score, less use of narcotic anesthetics, shorter recovery time and and discharge time, less move of patienr in abortion procedure, while the patient satisfaction rate is equivalent to the anesthesia group.
Key words: Patient Controlled Sedation, abortion, propofol
I. O^e^T VAN OE
Nao hilt thai la mdt thii thuat san phu khoa ngan, nhu'ng viec vd cam cho ngu'di benh chUa du'dc quan tam dung miTc nen thu'dng de lai cho hp nhu'ng an tu'dng xau mdi khi phai chap nhan lam thii thuat nay. Thii thuat nay la khong gay dau ddn nhieu nini/ng gay lo lang va sd hai rat nhieu, dac biet d phu niJ tre nen can phai an than tdt cho benh nhan. Muc tieu eiia an than trong hut thai la lam cho benh nhan het lo sd, cdng tac tdt nhu'ng khong bj bien loan ve hd hap va tuan hoan. Cd 3 miTc an than la: an than benh nhan van tinh; an than sau va gay me toan TOM TAT
Muc tieu: 50 sanh hieu qua an than bang propofol do benh nhan tu" dieu khien vdi phu'dng phap gay me tfnh mach bang propofol trong hut thai dUdi 12 tuan._Doi tu'dng, phu'dng phap: thiT nghiem lam sang ngau nhien co so sanh tren 100 benh nhan hiit tliai cd tuoi thai 10 - 12 tuan, chia hai nhom: nhom an than do benh nhan tiT dieu khien (nhom PCS), benh nhan tu dieu khien bdm tiem dien bolus 20 mg propofoi, thdi gian trd la 60 giay; nhom gay me (GM):
gay me tTnh mach bang propofol 2 mg/kp. Ca hai nhom deu du'dc ^ay te canh eo tu* cung bang BOmg jidocain. Ket qua: nhom PCS co ty le hai long ciia benh nhan tu'dng du'dng nhdm gay me (94% so vdi 90%), ty le benh nhan co ciT dong can trd thu thuat thap hdn lihom gay me (2% so vdi 8%), it chuyen sang miTc an than sau (diem an than trong suot thdi gian lam thu thuat la 4 - 5 theo OAA/S). So vdi nhom gay me, nhom PCS sii* dung lu'dng thuoc propofol it hdn (49,7 ± 14,2 mg so vdi 105,4 ± 21,6 mg, p <
0,05); thdi gian hoi tinh ngan hdn (1,5 ± 0,5 phiit so vdi 6,8 ± 1,9 phut, p < 0,05) va thdi gian xuat vien ngan hdn (55,6 ± 15,4 phut so vdi 125,5 ± 35,4 phiit, p < 0,05). Ket luan: phu'dng phap an than do benh nhan tiT dieu khien co diem an than OAA/S cao hdn, sir dung it thuoc me hdn, thdi gian hoi tinh va xuat vien sdm hdn, it gap benh nhan cd dong can trd thu thuat hdn trong khi t9 le hai long ciia benh nhan tu'dng du'dng vdi nhdm gay me.
Td khoa: an than do benh nhan tiT dieu khien, hiit thai, propofol
SUMMARY
RESEARCH THE PATIENT CONTROLLED SEDATION METHODE W I T H PROPOFOL FOR ABORHON UNDER 12 WEEKS OF GESTATION
*Benh vien Da khoa Dong Anh
**Tnfdng Dai hoe y Ha Ngi Chju trach nhiem chfnh: Hoang Ngoc Vinh Email; [email protected] Ngay nhan bai; 7.4.2017 Ngay phan bien khoa hpc: 25.5.2017 Ngay duyet bai: 12.6.2017
VIETNAM MEDICAL JOURNAL N°1 - JULY- 2017 the. Mii'c do an than cang cao thi benh nhan
cang bdt lo lang va thuan Idi cho viec tien hanh thii thuat nhdng cang lam tang bien chiTng ve hd hap va tuan hoan cijng nhu' cham tinh va lau dddc xuat vien. Phu'dng phap an than do benh nhSn t d dieu khien (Patient Controlled Sedation - PCS) bang propofol la phu'dng phap mdi cd nhieu iiu diem do benh nhan van tinh va ed the tham gia ti'ch ciTc vao viec kiem soat miTc do an than ciia minh, phu'dng phap nay chda du'dc nghien cud nhieu d ndde ta. Vi vay, chung tdi tien hanh nghien ciTu de tai nay muc tieu: so sanh hieu qua an than bang propofol do benh nhan t d dieu khien vdi phu'dng phap gay me tTnh mach bang propofol trong hiit thai dddi 12 tuan.
II. DOI TUpNG VA PHLTONG PHAP NGHIEN CLTU 2 . 1 . Qoi tu'dng nghien cu'u: Cac phu nu' ed thai, tuoi thai 10 - 12 tuan, cd yeu cau dinh chi thai nghen tai Benh vien Phu san Ha Ndi.
*77eu chuan luB chpn: tudi 16 - 50, ASA I, I I , khdng cd chdng chi djnh vdi propofol, lldoeain, tinh nguyen tham gia nghien ciTu.
*Tieu chuan loai trd: cd cac benh ly ndi khoa kem theo (benh tim, phoi, gan than...), benh III. KET QUA NGHIEN CCrU
Bing 3.1. Die diem chung cua ddi tddng nghien cuti
nhan dang say thai, chay mau nhieu, tut huyet ap, thieu khoi lu'dng tuan hoan...
2.2. Phu'dng ghap nghien cuTu: Tlii^
nghiem lam sang, ngau nhien, cd so sanh.
"'Thdi gian, dia diem nghien c&u: nghien cij\j du'dc tien hanh tiT thang 12/2015 den thang 6 nam 2016 tai khoa Ke hoach hda gia dinh, benh vien Phu san Ha Npi.
*Cach thdc tien hanh: Benh nhan du'dc kham, lam cac xet nghiem huyet hpe, du'dc ^iai thich ve phu'dng phap vd cam va hu'dng dan siT dung bdm tiem dien t d ddng (PCS). Du'dc boc tham chia thanh 2 nhdm, moi nhdm 30 benh nhan:
- Nhdm PCS; an than do benh nhan tiTdieu khien, benh nhan t d bam niit dieu khien bdm tiem tiT ddng de may bdm vao tTnh mach moi i n 20mg propofol, thdi gian khoa la 60 giay.
Nhdm gay me: gay me tTnh mach bang propofol lieu 2mg/kg.
Ca hai nhdm deu du'dc gay te canh eo tif cung bang 80mg lldoeain tru'dc khi tien hanh iam thii thuat. Cac benh nhan dddc theo ddi lien tuc trong qua trinh lam thii thuat: dp an than, thdi gian hdi tinh, eac chi sd hd hap va tuan hoan, sd hai Idng cua benh nhan va phau thuat vien.
Tuoi (nam) Chieu cao fcm)
Can nanq Ckq) Clli so BMI ASA: 0 6 1
S o i l
77/7/7 trang hon nhan: Cliu'a co gia dinh Oa CO gia dinh Wn su'hut thai: Cliu'a tiut thai
Da hut thai
Nhom PCS (n = 5 0 ) 26,7 ± 7,3 (17 - 45) 158,1 ± 5,4 (145 - 167)
47,8 ± 6,3 (39 -65) 18,8 ± 3,5 (17 - 23)
425 (84%) 8 (16%) 11 (22%) 39 (78%) 31 (62%) 19 (38%)
Nhom GM (n = 5 0 ) 27,2 ± 6,7 (18 - 47) 157,8 ± 6 , 2 ( 1 4 4 - 1 6 5 )
48,3 ± 7 , 1 ( 3 8 - 6 3 ) 19,4 ± 4,3 (18 -24)
45 (90%) 5 (10%) 9 (18%) 41 (82%) 29 (58%) 21 (42%)
P
>0,05
>0,OS
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
Bieu do 3 . 1 . 0 6 an thBn theo OAA/S Bing 3.2. So sinh hai phu'dng phip an than
Nhom PCS (n = 5 0 ) I Nhom GM (n = 5 0 ) Tong lieu propofol su'dung (mg) 1 lieu proporoi suaung [mg
Thdi gian hoi tinh (phut) T h r i i n i a n viiSl- v/ian ^ r \ k n f \
49,7 ± 14,2 (20 - 105,4 ± 21,6 (70 - 130) 1,5 ±0,5 (0,5-4) 6,8 ±1,9 (5-12) c c X ic /I /An _ om | 35 5 j - 25,4 (60 - 120)
> 0,05 .
55,6 ± 15,4 (40 - 90)
Thdi qian xuat vien (phut)
TAP CHi Y HOC V l i T NAM TAP 456 - THANG 7 - SO 1 - 2017 Ty le cua benh nhan c6 cu' dong
can trd thu thuat Sir hai long cua benh nhan: Hai long
Khdnq hai lonq Si/ hai long cua bs lam tiiu thuat
Hai iong Khonq hai lonq
1(2%) 47 (94%)
3 (6%) 48 (96%)
2 (4%)
4 (8%) 45 (90%)
5 (10%) 47 (94%) 3 (6%)
< 0 , 0 5
>0,05
>0,05
IV. BAN LUAN
Cac benh nhan d hai nhdm trong nghien cu'u ciia chiing toi kha tu'dng dong ve cac dac diem Chung nhd: tuoi, chieu cao, can nang, chi so BMI, phan loai siTc khde theo ASA. Chiing tdi chpn vao nghien ciTu eac benh nhan ed tuo'i thai tiT 10 - 12 tuan vi dp tuoi nay van ed chi djnh hilt thai bang phu'dng phap hiit chan khdng vdi bdm tiem Karman, tuy nhien, thdi gian hut thai thu'dng keo dai hdn va can phai vd cam tot hdn de dam bao thuan Idi cho thii thuat va giam thieu cac tai bien. Cd the vi ly do nay ma ty le benh nhan cd gia dinh trong nghien ciTu ciia etiung toi chiem ty ie kha cao (78% d nhdm PCS va 82% d nhdm gay me), da sd cac benh nhan nay co thai ngoai y muon, da dit con, dieu kien kinh te khd khan nen benh nhan quyet dinh dinh chi thai nghen khi thai d dp tudi 10 - 12 tuan.
Khi so sanh miTc an than eiia cac benh nhan d hai nhdm nghien cifu (bleu do 3.1), chiing toi thay; diem an than ciia nhdm PCS ehi dao dpng tir 4 ± 0,7 theo bang diem dd an than lam sang OAA/S, trong thdi gian tien hanh thii thuat, chiing tdi khdng gap tru'dng hdp nao an than sau (OAA/S <3). Ket qua eiia chung tdi phii hdp vdi ket qua cua Tao Ngpc Sdn [2] trong nghien ciTu an than bang propofol do benh nhan tiT dieu khien cho thii thuat npi soi dai trang va ciia Nguyin Quang Binh nghien ciTu an than bang propofol do benh nhan t d dieu khien cho nho rang khdn [1]. Oieu nay cho thay phae do siT dung propofol ciia chiing tdi va cac tac gia nay la hdp ly (lieu ban dau 20mg, lieu bolus 20mg thdi gian khda la 1 phut va khdng kem theo duy tri truyen tinh mach lien tuc). Trong nghien cifli eiia Thorpe, nghien cu'u PCS lieu bolus 3mg va khdng dat thdi gian trd nen tac gia cd gap 5 benh nhan bj an than sau va 2 benh nhan bj an than qua mu'c [3]. Diem an than OAA/S ciia nhdm gay me thap hdn nhdm PCS mot each cd y nghTa thdng ke (p<0,05) d cac thdi diem T l , T2, T4 va T6, lu'dng propofol tieu thu 6 nhdm gay me (trung binh la 105,4 mg) cao hdn han so vdi nhdm PCS (49,7mg) vdi p < 0,05.
Trong gay me ngoai tru, thdi gian hdi tinh va xuat vien la cac tieu chf dddc quan tam nhat.
Thdi gian hdi tinh trung binh d nhdm PCS va nhdm gay me khac nhau cd y nghTa thdng ke vdi p<0,05 (1,5 ± 0,5 phiit d nhdm PCS va 6,8 ±1,9 phut d nhom gay me). 6 nhdm PCS, benh nhan t d dieu khien viec siT dung thuoc an than khi lo sd nen viec dung thude se giam hdn d cudi ky thii thuat, dieu nay cung thay ro vi benh nhan chi an than chiT khdng gay me nen benh nhan gan nhd tinh ngay sau khi iam thu thuat. Ket qua ciia chung toi d nhdm PCS phii hdp vdi Tao Ngpc Sdn (1,56±1,93 phut)[2] va Nguyen Quang Binh (2,89+0,53 phiit) [1]. Thdi gian xuat vien trung binh d 2 nhom khac nhau cd y nghTa thong ke (55,6±15,4 phut d nhdm PCS va 125,5±35,4 phiit d nhdm gay me). Day cijng la diem chii yeu ciia phu'dng phap an than do benh nhan t d dieu khien, benh nhan chi phai theo doi thdi gian ngan sau thii thuat va co the dddc xuat vien sdm hdn, giam chi phi dieu t n , iam tang sd hai long ciia benh nhan.
Ty le benh nhan co ciT dpng can trd thu thuat eiia hai nlidm ciJng ed sd khac biet ed y nghTa thdng ke ( 2 % d nhdm PCS va 8% d nhdm 2 vdi p>0,05). Benh nhan ciT ddng chii yeu la do dau nhu'ng dddi tae dung an than eiia propofol benh nhan khdng ciT dong do giam lo sd, thoai mai, trong khi d nhdm gay me, ed the do lieu thuoc me chda dii vdi mdt sd tru'dng hdp nen benh nhan cd ciT ddng nhieu hdn. Chiing tdi danh gia siT hai Idng eiia bac sy san khoa khi tien hanh tiiu thuat hilt thai, ty le hai Idng kha cao: 96% d nhdm PCS va 94% d nhdm gay me, siT khac biet khdng cd y nghTa thdng ke giu'a hai nhdm. Dieu nay cho thay ca hai phu'dng phap deu dam bao vd cam tdt, thuan Idi cho thii thuat. SiT hai Idng ciia benh nhan d hai nhdm cung khac nhau khdng cd y nghTa thdng ke (94% d nhdm PCS va 90% d nhdm gay me vdi p>0,05). Cac benh nhan khdng hai Idng eiia chimg tdi chu yeu do benh nhan cam giac khd chiu khi phai dinh chi thai nghen do dd cd the lam cho viec danh gia ket qua vd cam khat khe hdn.
V. KET LUAN
Phu'dng phap an than do benh nhan t d dieu khien (PCS - patient controlled sedation) cd hieu qua an than tdt, dii de an than cho thu thuat hiit
VIETNAM MEDICAL JOURNAL N°1 • JULY- 2017 thai vdi tudi thai tiT 10 -12 tuan (ty le hai Idng
eiia benh nhan la 94%, ty le benh nhan khdng CO cir' dpng bat thu'dng can trd thii' thuat la 98%), It chuyen sang mu'c an than sau (diem an than trong sudt thdi gian lam thii thuat la 4 - 5 theo OAA/S). So vdi phu'dng phap gay me tTnh mach, phu'dng phap an than do benh nhan td digu khien sir dung lu'dng thuoc propofol it hdn (49,7 ± 14,2mg so vdi 105,4 ± 21,6mg, p <
0,05); thdi gian hdi tinh ngan hdn (1,5 ± 0,5 phut so vdi 6,8 ± 1,9 phut, p < 0,05) va thdi
gian xuat vien ngan hdn (55,6 ± 15,4 phiit so vdi 125,5 ± 35,4 phut, p < 0,05).
TAI LIEU T H A M KHAO
1. Nguyen Quang Binh (2010), "Nghien cifu phu'dng phap an than bang Propofol do tienh nhan tu dieu khien trong phau thuat rSng", Luan van Tien syyhoc, Oai hoe Y Ha Noi.
£. Tao Npoc Sdn' (2006), "Danh gia tac dung an than bang propofol do benh nhan tU dieu loiien trong thii thuat npi soi dai trang", Luan vSn Thacsi y hoc, Dai hoc Y Ha Noi.
3. Thorpe S. J, Balakrishnan V.R, Coo L. B. (1996),,
"Observations on patient controlled administradon of propofol", BrJAnaesdi, 76, pp. 576-594.
THITC TRANG TIEP CAN DICH VU Y TE TRITQC SINH VA MOT SO YEU TO ANH HU'DNG CUA B A ME CO CON DUOT 1 TUOI TAI HAI HUYEN LUC YEN vA TRAM TAU T I N H YEN BAI NAM 2016
Nguyin Tra My', Ngo Van Toan^, Nhir Thanh Hirng^
TOM TAT
Oat van de: Mang thai va sinh nd la giai doan chiTa 'ddng nhieu nguy ed ve su'c khoe, benh tat va tan phe, la nguyen nhan gay ra it nhat 18% ganh nang benh tat toan cau d phu nu' trong do tuoi sinh dk. Tiep can dich vu cham soc y te tru'dc sinh giiip giam ty le tif vong d ba me va tre sd sinh mot each hieu qua trong cham soc sinh san. Muc tieu: 1. Mo ta thuc trang sd dung dich vu y te trddc sinh cua cac ba me cd con dddi 1 tuoi tai hai huyen Luc Yen va Tram Tau tinh Yen Bai nam 2016; 2. Phan ii'ch mot so yeu to anh hu'dng den thi/c trang su'dung dich vu y te cham soc trude sinh cua cac ba me tren. Doi tu'dng va phu'dng phap nghien COTU; Nghien ciTu dUdc ben hanh tren 509 ba me co con dddi 1 tuoi tai hai huyen Luc Yen va Tram TSu tinh Yen Bai. Nghien ciTu sd dung phu'dng phap mo ta cat ngang. Ket qua:
8i,34% cac ba me da siT dung dich vy kham thai tir 3 lan bd len. Hdn 86% ba me da di tiem phdng uon van trong do co den hdn 54% eac ba me di tiem dii 2 mui va 76,97% ba me siT dung vien sat trong thai ky. Yeu to dan toe va ngtie nghiep ba me anh hudng den viec tiep c|n dich vu y te triTdc sinh ciia cac ba me. Ket lu|n: ThiTc trang tiep can dich vu y te trddc sinheiia cac ba me co con diTdi 1 tuoi la tu'dng doi tot tai 2 huyen thuoc tinh Yen Bai.
Tdkhoa: Tiep can dich vu y te, dich vu y te tru'dc sinh, yeu to anh hu'dng
'Vien dao tao rang ham mat
^Trudng Dai hoc Y Ha ngi Chiu trach nhiem chinh: Nguyen Tra My Email: [email protected] Ngay nhan bai: 6.4.2017 Ngay phan bien khoa hoc: 29.5.2017 Ngay duyet bai: 9.6.2017
SUMMARY
THE REALITY OF ANTENATAL HEALTH SERVICES AND INFLUENCING FACTORS OF MOTHERS WHO HAD THE CHILDREN UNDER ONE YEAR OF AGE I N LUC YEN AND TRAM TAU DISTRICT, YEN BAI PROVINCE 2016 Background: Pregnancy and childbirtii is the stage contains many healdi risks, morbidity and disability, is the cause of at least 46% of the global burden of disease among women of reproductive age. Access health sen/ices prenatal care reduces mortality in mothers and infants effectively in reproductive care, Objective: 1. Describe of status use of health sen/ices before born of mothers who have children under age 1 in two district Instrumentals Station yen and Yen Bai province 2016; 2. Analysis of some factors affecting the status of medical sen/ice use care before birth of the mother. Subject and methodology: The study was conducted on 509 mothers who had the children under 1 years old in Luc Yen and Tram Tau districts, Yen Bai province. The study uses cross-sectional study. Result 81.34% of mothers used antenatal care sen/ices three or more times. More than 86% of mothers who received tetanus vaccination included over 54% of mothers who received 2 doses and 76.97% of mother^
who received iron during pregnancy. Ethnic and occupational factors affecting mothers' access to antenatal health services me. Conclusion: The situation of access to antenatal services of mothers who had children under 1 year old is relatively good m Z districts of Yen Bai pnDVince.
Keyword: Access to health sen/ices, antenatal health services, influencing factors
I. OAT VAN OE
l^'ang thai va sinh nd la giai doan chiTa dLfng nhieu nguy cd ve siTc khde, benh tat va tan phe, la nguyen nhan gay ra it nhat 18% ganh nang
58
