VIETNAM MEDICAL JOURNAL N°1 - MAY - 2017 phap su^ soan ong tuy vcfi tram xoay may va ta^
Niti, Luan an Tien sy Y hoc, Trtfdng Oai hoc Y Ha Npi, tr. 12-38.
. Bane K., Faye B,, et al. (2015), Root Canal Shaping by Single-Rle SySems and Rotaiv Instruments: a Uboratoiy Study, IranBidodJ., 10(2), pp.135-139.
. Burklein S., Hinschitza K., et al. (2012), Shaping ability and cleaning effectiveness of two single-file systems in severely curved root canals of extracted teeth: Reciproc and WaveOne versus Mtwo and ProTaper,//7f f/7rfotf7. 45, pp.449-461.
. Capar I.D., Ertas H., et al. (2014), Comparative study of different novel nickel-titanium rotary systems for root canal preparation in severely curved root canals, JEndc)d,.'\Ci{6), pp.8B2-856.
5. Iqbal M.K., Firic S., et a). (2004), Companson of apical transportation between ProFile and ProTaper NiTi rotary instruments, Int Endod J, 37(6), pp.359-364.
6. Krishna P.P., Beena R.G., et al. (2010). A Comparison of Root Canal Preparations Using Stainless Steel, Ni-Ti Hand, and Ni-Ti Engine- Driven Endodontic Instruments - An In Vitro Study. Bangladesh Journal of Medical Science, 9(4), pp.223-229.
7. You S.Y., Bae K.S., et al. (2010), Lifespan of one nickel-titanium rotary file with reciprocating motion in curved root canals, J Endod, 36(12), pp.1991-1994.
PHAN TICH MOT SO DAC DIEM LAM SANG, HINH ANH HOC GIUP TIEN LU'O'NG BENH NHAN DOT QUY THIEU M A U N A O CAP TINH
DU'O'C DIEU TRI BANG LIEU P H A P TIEU HUYET KHOI ALTEPLASE 6^ BENH VIEN DA KHOA TINH H A NAM
Le Quang Minh*
T O M T A T
B?t vain tfe: Nghien ctfu nay nham phan tich mpt so dac diem lam sang, htnh anh hpc giup ben ItfOng benh nhan dot quy thieu mau nao cap tinh dtfdc dieu tri bang lieu phap tieu huyet khoi Alteplase 6 Benh vien da khoa tinh Ha Nam. Boi tu'dng va phu'dng phap: 35 b§nh nhan dot quy thieu mau nao cap ti'nti dtfdc dieu tri bang lieu phap tieu huyet khdi Alteplase lieu tiiap (0,6mg/kg). Tien ctfu mo ta theo doi dgc, KSt qua: Tuoi trung binh 68,6 ± 11,82, nam gidi chiem 49%. Diem NIHSS trung binh luc nhap vien la 12,9 ± 4,9. KS qua dieu trj danh gia theo l^odified Rankin Scale (mRS) d thdi diem 90 ngay sau nh|p vien thayl4 benh nhan (40%) c6 ket qua tot v6i mRS 0-1 diem. Nhii'ng benh nhan co ket cue khong tot co diem GCS thap hon, NIHSS cao hdn, Uidi gian ttf luc khdi phat den khi vao vien nhieu hdn Idii so vdi cac benh nhan co ket cue tot, khac biet co y nghTa thong ke vdi p<0,05. Nhffng benh nhan ma thdi gian ttf liic khdi phat den khi vao vien tren 90 phiit co nguy cd nhan ket cue khdng tot cao gap 5,9 (95% CI: 1,07- 33,12) lan khi so vdi cac benh nhan nhffng benh nhan ma thdl gian ttf luc khdi phat den khi vao vieri dtfdi 90 phut. Khi ket hpp 4 yeu to GCS liic nhap vien <14 diem, NIHSS luc nhap vien >10, vi tri tac d doan Ml dong m?ch nao giffa hoac dong mach than nen, thdi gian ttf khdi phat den vao vien tren 90 phut nhan thay tren mot benh nhan ma cd k^ hdp 3 va ca 4 yeu to nay thi kha nang benh nhan nhan ket cuc khdng tot la
*B$nh vien da khoa b'nh Ha Nam Chiu trach nhiem chinh: Le Quang Minh Email: [email protected] Ngay nhan bai: 12/1/2017 Ngay phan bien khoa hoc: 15/2/2017 Ngay duyet bai: 10/3/2017
100%. Ket luan: 4 yeu to GCS luc nhap vien <14 diem, NIHSS liic nhap vien >10, vj tri tac d doan Ml dong mach nao glQa hoac dpng mach than nen, thcfi gian tff Ichdi phat den vao vien tren 90 phut la nhOtig yeu to CO kha nang tien Itfdng benh nhan dot quy thieu mau nao cap tinh dffdc dieu tri bang lieu phap tieu huyet khoi Alteplase.
Tii'khoa: Dot quy thieu mau nao, tieu huyet khQ, rt-PA, ben Itfdng.
SUMMARY
ANALYSIS OF CUNICAL CHARACTERISnCS AND IMAGING FEATURES HELP TO PROGNOSIS OF OUTCOME FORACUTE ISCHEMIC STROKE PATIENTS WERE TREATED
WITH ALTEPLASE THROMBOLYTIC THERAPY I N GENERAL HOSPITAL OF HANAMPROVINCE
Background: We conducted this study to analyze of clinical characteristics and imaging features help to prognosis of outcome for acute ischemic stroke patients were treated with Alteplase thrombolytic therapy in general hospital of Hanam province.
Objects and method: 35 acute ischemic stroke patients were treated with low dose Alteplase thrombotic therapy (0,6mg/kg). Cross-sectional study.
Results: The average age was 11.82 ± 68.6, males accounted for 49%. Average NIHSS at admission was 12.9 ± 4.9. Treatment outcomes by modified Rankin Scale assessed (mRS) at the 90 days after admlssionwere 14 patients (40%) had good results with mRS score 0-1. These patients with poor outcomes had lower GCS score, higher NIHSS, the more bme from onset to admission when compared with patients with a good outcome, with statistical significance p <0.05. Patients with time from onset to admissionmore than 90 minutes could have poor
34
TAP CHl Y HOC VIET NAM TAP 454 - THANG 5 • So' 1 - 2017 outcomes higher than 5.9 (95% O: 1.07 to 33.12)
bmes when compared with patients whose had time from onset to admission less than 90 minutes. When combining 4 fectors: on admission GCS <14 points, admission NIHSS> 10, the infarction of the Ml segment of middle cerebral artery or infarction of basilar artery, time from onset to admission more than 90 minutes notice on a patient that had combine 3 and 4 factors, the ability of patients to receive a poor outcome is 100%, Conclusion: 4 factor on admission GCS <14 points, admission NIHSS> 10, the infarction of theMl segment of middle cerebral artery or infarction of basilar artery, time from onset to admission more than 90 minutescouid prognosis poor outcome for acute ischemic stroke patients were treated with Alteplase thrombolytic therapy.
Keywords: Ischemic stroke, thrombosis targets, rt-PA, the prognosis.
I. DAT VAN DE
Xff tri cap ciTu dot quy nao ddi hdi stf khan trtfdng va tinh nhue, phdi hdp da chuyen khoa tff phat hien benh nhan, cap cuXi ban dau tai hien trffdng, van chuyen cap cffu, tiep can chan doan d khoa cap cffu, tiep can chan doan hinh anh, xff ly cac tinh trang cap cuti, dieu trj tai thong mach, phlu thuat, can thiep ndi mach, hoi sffc, cham sdc, dinh dffdng, phuc hoi chffc nang, dieu trj dff phdng. Idem scat cac yeu to nguy cd.
Dieu trj thuoc tieu huyet khdi dffdng tmh mach cho cac benh nhan dot quy thieu mau nao cap tinh khdng ddi hdi trang thiet bj phffc tap, cd the thffc hien d cac benh vien da khoa cd may chup cat idp vi tinh va he thdng xet nghiem huyet hoc, ddng mau va sinh hda cd ban. Tuy nhien lieu phap nay chi thffc sff hieu qua cho khoang tff mot phan ba so benh nhan dffdc dieu trj. Vi vay nghien cii'u mot sd yeu to tien Iffdngkha nang thanh cdng cua lieu phap tieu huyet khoi Alteplase dieu trj benh nhan dot quy thieu mau nao cap tinh la can thiet.
Benh vien da khoa tinh Ha Nam da trien khai irng dung dieu trj tieu huyet khdi alteplase cho benh nhan dot quy thieu mau nao cap tinh.
Chung tdi tien hanh nghien cffu nay nham:
''Phan bch mot so dac diem iam sang, binh anh hgc giiip tien iu'dng benh nhan dot quy thieu mau nao cap b'nh dudc dieu tn bang lieu phap tieu huyet khoi Alteplase d Benh vien da khoa tinh Ha Nani'.
II. DOI TUONG VA PHLraNG PHAP NGHIEN COU 2.1. Doi t&dng nghiin c&u: 35 benh nhan dot quy thieu mau nao cap tinh dffdc dieu tri bingiieu phap tieu huyet khoi Alteplase lieu thap (0,6mg/kg) tai khoa Cap cffu,Benh vien da khoa
tinh Ha Nam tff thang 01/2015 den thang 12/2016
^'Tieu chuan l i / a c h o n :
- Cac bieu chutig khdi phat dot quy rd rang <180 phut ke tff khi OD trieu chutig dot quy dau ten.
- Chan doan nhoi mau nao cap tinh, vdi cac dau hieu thieu hut ve than kinh rd rang va diem NIHSS 4-24 diem.
- CY Scan hoac I^RI so nao khong cd hinh anh tdn thffdng xuat huyet nao.
- Khdng cd cac chdng chi dinh dung thudc tieu sdi huyet.
- Benh nhan va gia dinh dong y diing thudc.
* Tieu chuan loai t r f f :
- Cac trieu chffng khdi phat dot quy >4,5 gid.
- Cac trieu chffng dot quy nhe, ddn thuan va cai thien nhanh chdng (NIHSS<4).
- Khdi phat cd dau hieu co giat.
- Khdng chup CT Scan/MRI sp nao hoac cd bang chiiYig chay mau nao tren CT Scan/MRI so nao.
- Cac frieu chuhg dot quy gdi y xuat huy^ dudi nhen mac dii ket qua cliup MRI so nao binh thffdng.
- Hinh anh CT Scan/MRI so nao cd nhoi mau nao ldn ( > l / 3 ban cau).
- Cd hinh anh ton thffdng nao tren xung T2*
va Flair (Ton thfftfng khdng the phuc hoi neu tai thdng mach nao).
- Diem NIHSS >24.
- Chan thffdng hoac chay mau tien trien.
Tien sff dot quy hoac chan thffdng dau nang, nhdi mau cd tim hoac phau thuat so nao trong 3 thang gan day.
- Cd tien sff xuat huyet nao.
- Cd tien sff da diing thuoc tieu huyet khol.
- Tien sff chay mau dffdng tieu hda, tiet nieu trong vdng 21 ngay.
- Tien sff chan thffdng ldn hoac phau thuat Idn trong vdng 14 ngay.
- Chpc dd tiiy song hoac choc dd dong mach d ndi khdng the ep dffdc trong vdng 7 ngay.
- Cd benh ly noi so (u nao, phinh mach nao).
- Cd bat thtfdng ve dtfdng mau (>46omg/dl = 22,2mmol/l hoac <50mg/dl = 2,8mmol/l).
- Sd Itfdng tieu rau <100.000.
- Dieu tri thuoi: chong ddng gan day vdf INR >1,5.
- Huyet ap khdng kiem soat dudc (HA tam thu
>1 85mmHg hoac HA tam trtfdng > llOmmHg).
2.2. Thiii ici'nghien c&u: Nghien cuti tien cffu md ta.
2.4. X& ly so Heu: Sd lieu dffdc thu thap rieng cho tffng trffdng hdp theo mpt mau benh an thong nhat, dffdc nhap va xff ly bang phan mem Stata 11.0 for Windows vdi cac thuat toan thdng ke thich hdp.
VIETNAM MEDICAL JOURNAL M°1 - MAY - 2017
III. KET QUA NGHIEN CU'U
Bang 1. Dac diem chung nhom nghien c&u So benh nhan
Nam gi6i (n,%)
17 (49%)
Tuoi (nam): Trung bmh Thap nhat Cao nhat
68,6 ± 11,82 45 85
Hep hai la (njT§ng huyet ap (n) Pai thao dffdng (n) GCS danh gia luc nhap vien (diem): Trung bmh
Tliap nhat Cao nhat Diem NIHSS luc nh§p vign (diem): Trung binh Thap nhat
Cao nhat
13,9 ± 0,63 11 15
Thdi gian tit khdi phat den khi nhap vien (phiit) Trung binh
Thap nhat Cao nhat
12,9 ± 4,9 5 22 93,5 ± 31,5
40 150
Thdi gian tuf luc vao vien den khi dung thudc (phut)Trung binh Thap nhat Cao nhat
51 ± 8,6 40 60
mRS danh gia sau 9 0 ngay (n):
8 (22,9%)
6 (17,1%) 8 (22,9%) 6 (17,1%) 4 (11,4%) 2 (5,7%) 1 (2,8%)
Nh$n xet:'Xuo\ trung binh 68,6 ± 11,82, nam gidi chiem 49%. Oiem NIHSS trung binh luc nhap vien la 12,9 ± 4,9. Thdi gian tff luc khdi phat den khi vao vien trung binh la 93,5 ± 31,5phut, thap nliat 40 phiit, cao nhat 150 phut. Thdi gian tff khi nhap vien den khi bat dau dung thudc tieu huyet khdi trung binh la 51 ± 8,6 phiit, nhanh nhat 40 phut, cham nhat 60 phut. Ket qua dieu trj danh gia theo Modified Rankin Scale (mRS) d thdi diem 90 ngay sau nhap vien thayl4 benh nhan (40%) co ket qua tot vdi mRS 0-1 diem.Bang 2. Lien quan giffa kit cyc va mdt sddac dii'm lam sang Dac diem lim sang
Tuoi GCS tuc nhap vien NIHSS luc niiap vien Huyet ap toi da luc vao vien Tlicyi qian tu' kiicJi phat den vao vier
Thdi gian tii" l<hdi phat den dung thuoc Alteplase
Ket cuc tot {n=i4)
66,4+10,16 14,7+ 0,16 9,7+2,67 137,1+21,64
76,7+6,95 124,2+7,69
Ket cuc khong t6t(n=21)
70+12,9 13,4+0,35 14,9+5,09 144,7+24,98
100,9+7,06 142,8+7,19
Nhan xet: Nhffng benh nhan co ket cue khong tot cd diem GCS thgian ti? iijc khdi phat den khi vao vien nhieu hdn khi so vdi cac benh nha y nghla thdng ke vdi p<0,05.
Bang 3. Gia tri tien lu'dng cua mot sddac di^m iam sang hinh Yeu to nguy cd
GCS lijc nhap vien <14 diem NIHSS luc nhap vien >10
So benh nh^n
9
20
Ket cue tot
n=14
1 5
11,11 %
25
P 0,1883 (t-test) 0,0108 (Mann-Whitney test)
0,0007 (t-test) 0,1808 (t-test) 0,0129 (t-test) 0,0477 (t-test) ap hdn, NIHSS cao hdn, thdi n CO ket cue tot, khac biet co
anh vdi icet cuc Ithdng tS't Ket cuekhong tot
n=21
8 15
88,89 %
75
OR (95% CI)
8,0 (0,73-87,99)
4,5 (0,93-21,59)
TAP CHl Y HOC VlgT NAM TAP 454 - THANG 5 - SO -2017 Vj tri tac d doan i^l dong
mach nao giij^ hoac dong mach than nen Thdi gian tii khdi phat den
vao Vien tren 90 phut 11 16
1 3
9,09 18,75
10 13
90,91 81,25
11,8 (0,99-140,62) 5,9 (1,07-33,12) Nhan xet: Nhffng benh nhan ma thdl gian tff luc khdi phat den khi vao vien tren 90 phut cd nguy cd nhan ket cue khdng tdt cao gap 5,9 (95% CI: 1,07-33,12) 13n khi so vdi cac benh nhan nhffng benh nhan ma thdi gian tff liic khdi phat den khi vao vien dffdi 90 phut.
IV. BAN LUAN
Tuoi trung binh cua benh nhan nghien cffu ciia chung tdi la 68,6 ± 11,82. Ket qua cua chung tdi cung tffdng tff Nguyin Huy Thang [1]
la 66,5 ± 12,2 va mdt so tac gia nffdc ngoai nhff Dharmasaroja [2] va Lansberg [3]. Benh nhan tre tudi nhat la 45 va cao tudi nhat la 85. Ket qua cua chung tdi cung tffdng tff ket qua cua Mai Duy Tdn [4] cung cho Uiay tac dpng mach nao giffa gap d benh nhan tre (30 tuoi) tre hdn so vdi nhdm dong mach khac (50 tudi). Chung tdi gap ty ie nam/nff la 0,94. Nam gidi chiem 49%
thap hdn 55% d nghien culi ciia l^ai Duy Tdn [5]. Ty le nay cung thap hdn so vdi tac gia Nakagawara [ 5 ] .
Xac djnh chinh xac thdi diem benh nhan xay ra cdn dot quy nao rat quan trpn, cho phep tinh dffdc thdi gian khdi phat benh den liic vao vien, cung nhff thdi gian tff luc khdi phat den luc dffdc dieu tri. Tff dd dffa ra quyet dinh chup phim CV so nao hay chup MRI sp nao, dieu tri thuoc tieu huyet khoi dffdng ttnh mach hay dpng mach. Khi dieu trj. thudc tieu huyet khoi dffdng tTnh mach thdi gian la yeu t d quyet dinh va quan trpjig nhat. Cho den nay Cd quan Thudc va Thffc pham Hoa Ky chap nhan sff dung thudc tieu sdi huyet trong vdng 180 phut va cu^ so dieu trj cd the md rdng ra 270 phut mdi dtfdc xem la than trpng d nhutig thay thuoc cd kinh nghiem.
Ket qua nghien ciTu cua chiing tdi cho thay thdi gian trung binh tff khi khdi phat den luc b|nh nhan nhap vien la 93,48 ± 31,5 phut, day cung la thdi gian tffdng doi ly tffdng de thtfc hien cac danh gia cung nhff xem xet dieu tri thudc ti^u huyet khdi Alteplase dffdng tTnh mach. Thdi gian trung binh de chiing tdi thffc hien quy trinh tiep can dieu trj tieu huyet khoi la 54,1 ± 15 phut. TTidi gian nay nam trong gidi han cho phep de thffc hien quy trinh cap ctiu va dieu tri tieu huyet khdi, dong thdi cung tffdng tff nghien cffu cua Semplicini [ 7 ] .
Trong nghien cffu ciia chung tdi cd 85,8%
benh nhan tac ddng mach nao giffa trong dd cd 42,9% tac M2, 28,6% tac M l va 14,3% tac M3.
2,9% tac dot sdng than nen va 11,4% tac mach
nhd khac. Khdng cd trffdng hdp nao tac ddng mach canh trong.Ket qua ciia cliung tdi gap bj' le tac ddng mach nao giffa cao hdn Mai Duy Ton [4] la 56,7%.
Ket cue ciia benh nhan d\idc danh gia theo thang diem mRS, dffcfc xem la cd ket cue tdt khi diem mRS sau 90 ngay tff 0-1 diem, trong nghien cffu ciia chiing toi diem mRS sau 90 ngay dat 0-1 diem chiem 40%, tffdng tff nghien cffu NINDS la 39%, nghien ciru CASES tai Canada la 37%, Nguyen Huy Thang la 38,8% [1]. Ket qua ciia chiing tdi thap hdn Mai Duy Tdn [5] la 51,51%. Sau 90 ngay cd 22,9% benh nhan cd mRS=2, 28,5% benh nhan cd mRS (3-4) va 5,7% mRS=5, 1 tru'dng hdp tff vong chiem ty \%
2,8%.Ty le tti vong ciia chiing tdi thap hdn Mai Duy Tdn [4] la 3,03%.Benh nhan nff 53 tuoi vao vien vi tac dpng mach nao giu'a ben trai doan M l vdi NIHSS 21 diem, kem theo nhoi mau cd tim cap vdi dien tim cd hinh anh ST chenh len d cac chuyen dao tff V3 den V6 va men Troponin T 824ng/l. Chi dmh diing thudc tieu huy§t khdi tai thdi diem 140 phut tff khi dot quy. Ket qua benh nhan tai thdng dffdc mach vanh nhffng mach nao thi khong. Benh nhan ngay sau do duWc chuyen tuyen tren xet lay huyet khdi dffdng ddng mach, nhffng khdng can thiep dffdc, benh tien trien nang hdn va tff vong sau 10 ngay dieu trj.
Danh gia mpt sd dac diem lam sang va hinh anh chiing tdi nhan thay nhffng yeu t d GCS luc nhap vien <14 diem, NIHSS luc nhap vien >10, vj tri tac d doan M l ddng mach nao giffa hoac dpng mach than nen cd kha nang dtf bao ket cue klidng tot ciia nhffng benh nhan nhoi mau nao cap tinh dffdc dieu trj bang Alteplase lieu thap vdl OR lan Itfdt la 8,6; 4,5 va 11,8. Tuy nhien khoang tin cay 95% gia trj dtf bao ciia cac yeu to nay van cdn chffa 1, chffa cd y nghTa thong ke, cd the do so Iffdng benh nhan nghien eifu eiia ehimg tdi chffa dii ldn. Dac biet nhffng benh nhan ma thdi gian tff liic kiidi pliat den khi vao vien tren 90 phut cd nguy cd nhan ket cue khdng tot cao gap 5,9 (95% Q : 1,07-33,12) lan khi so vdi cac benh nhan nhffng benh nhan ma thdi gian tff liic khdi phat den khi vao vien dffdi 90 phiit.
VIETNAM MEDICAL JOURNAL N ' l - MAY - 2017 Khi ket hdp 4 yeu to GCS luc nhap vien <14
diem, NIHSS liic nhap vien >10, vj tri tac id doan M l dpng mach nao giffa hoac ddng mach than nen, thdi gian tff khdi phat den vao vien tren 90 phutnhan thay tren mdt bSnh nhan ma cd ket hdp 3 va ca 4 yeu t d nay thi kha nang benh nlian nhan ket cue khdng tot la 100%.
V. KET LUAN
Tudi trung binh 68,6 ± 11,82, nam gidi chiem 49%. Diem NIHSS trung binh liie nhap vien la 12,9 ± 4,9. Thdi gian tff liic khdi phat den khi vao vien trung binh la 93,5 ± 31,5phiit, thap nhat 40 phut, cao nhat 150 phut. Thdi gian tff khi nhap vien den khi bat dau dimg thudc tieu huyet khdi trung binh la 51 ± 8,6 phut, nhanh nhat 40 phut, eham nhat 60 phut. Ket qua dieu trj danh gia theo Modified Rankin Scale (mRS) d thdi diem 90 ngay sau nhap vien thayl4 benh nhan (40%) cd ket qua tdt vdl mRS 0-1 diem.
NhiJtig benh nhan cd ket cue khdng tdt cd diem GCS thSp hdn, NIHSS cao hdn, thdi gian tff luc khdi phat den lihi vao vien nhieu hdn khi so vdi cac bdnh nhan cd ket cue tot, khac biet cd y nghTa thong ke vdi p<0,05. Nhffng benli nhan ma thdi gian tff luc khdi phat den khi vao vien tren 90 phut cd nguy cd nhan ket cuc khdng tdt cao gap 5,9 (95% CI: 1,07-33,12) ISn khi so vdi cac benh nhan nhiJYig benh nhan ma thdi gian tff luc ktidi phat den khi vao vien dffdi 90 phut.l<hl ket hdp 4 yeu to GCS luc niiap vien <14 diem, NIHSS luc nhap vien >10, vj tri tae d doan M l
ddng mach nao giffa hoac ddng maeh than nen, thdi gian tff khdi phat den vao vien tren 90 phiit nhan thay tren mpt benh nhan ma cd ket hdp 3 va ca 4 yeu t d nay thi kha nang benh nhan nhan ket cuc khdng tdt la 100%.
TAI UEU T H A M KHAO
1. Nguyin Huy Thang (2012), Dieu tri thuoc tieu sOi huyet rtPA dffdng tinh mach tren BN nhoi mau nao cap trong 3 gid dau, Luan an tien si y hoc, Trtfdng Dai hpc Y Dtfdc thanh pho Ho Chi I^inh.
2. Dharmasaroja (2011), Outcome ofTliai Patients with acute iscliemic stroke after intravenous thrombolysis, Joural of the Neurological Sdences, 300,pp.74-77.
3. Lansberg (2009), Efficacy and safety of tissue plasminogen activator 3 to 4,5 hours after acute ischemic stroke. Stroke, 40, pp.2438-2441.
4. Mai Duy Ton (2012), Oanh gia hieu qua dieu tri dot quy nhoi mau nao cap trong vong 3 gid dau bang thuoc tieu huyet l<h6i dtfdng tTnh mach Alteplase lieu thap, Luan an tien siy hoc, Trtf6ng Dai hoc Y Ha Noi.
5. Nakagawara (2010), "Thnsmbolysis With 0,6 mg/kg Intravenous Alteplase for Acute Ischemic Stroke in Routine Clinical Practice: The Japan post- l^arketing Alteplase Registration Study (J-MARS)", 5/TOA-e,41,pp.l984-9.
6. Sharma (2010), Intravenous throbolysis is feasible and safe in mutiethenic Asian stroke patients in Singapore, International Joumal of stmke, 19{6), pp.424-430.
/ . Semplicini (2008), Intravenous thromtxilysis in the emergency department for the treatment of acute ischemic stroke, Emerg Med J, 25, pp.403-406.
DAC DIEM CAN LAM SANG HOI CHU'NG TRAO NGirgC
BANG QUANG NIEU QUAN a BENH NHAN TON THU'QNG TUY SONG
TAI BENH VIEN BACH MAI NAM 2014-2015
D6 Dao Vu*
T O M T A r '
Myc tiSu: Mo ta dac diem x-quang va meu dong hoc d benh nhan ton thtfdng tiiy sdng co trao ngtfOc bang quang nieu quan tai benh vien Bach Mai nam 2014-2015. Doi ttfdng va phtfdng phap nghien cifu:
nghien cffu mo th cat ngang 34 benh nhan bang
* Benh vien Bach Mai Ha Noi Chju trach nhiem chinh; Do Oao Vu Email: [email protected] Ngay nhan bai: 15.01.2017 Ngay phan bien khoa hoc: 27.3.2017 Ngay duyet bai: 4.4.2017
quang than kinh cd trao ngtfdc bang quang nieu quan.
Kit qua: Mtfc trao ngtfdc n3ng xay ra d 38,22%
benh nhan va thtfdng kem theo suy than. 9 1 % benh nhan cd sffc chffa bang quang giam; gan 90% trao ngtfOc bang quang meu quan co ap Itfc cd bang quang tren 40 cmH20; 4 1 % so benh nhan cd bang quang co nhd; 50% xay ra hien ttfdng bat dong van bang quang cd th§t. Ket luan: J</ le ldn benh nhan co bien chirtig trao ngtfdc bang quang nieu quan co cac chi so nieu dpng hoc d gidi han khong an toan. Co ty le thuan giDa mtfc do trao ngtfdc va hau qua suy than d nhom benh nhan tdn thffdng tiiy song.
T&khoa: bang quang than kinh, trao ngudc bang quang meu quan
