TAP CHf Y Dl/OC LAM SANG 108 Tip 12 - Sd 6/2017
Nhan xet mot s6 dac diim lam sang va mot s6 ylu t6 nguy ca 6^ benh nhan dot quy nao giai doan cap tinh theo y hoc CO truyen
Reviews some clinical characteristics and risk factors in patients with brain stroke acute phase according to traditional medicine
TrSn Van Chiin, Vu Van Dai Benh vien Trung uang Qudn dpi 108
Muc tiiu: Nghien cdu ve dae diem lam sang va cae yeu t d nguy co d benh nhan dot quy nao cap theo y hpc cd truyen. Ddi tugng vd phUOng phdp: Nghien cdu tien edu, mo ta eat ngang tren 157 benh nhan dot quy nao cap dupe dieu trj tai Trung tam Dot quy nao Benh vien Trung UOng Quan dpi 108 t d 01/2014 -12/2014. Kit qud: Tuoi trung binh mac benh 63 ± 13 tuoi; t;/ le nam/nd la 3,1; 1; ty le benh nhan nhdi mau nao chiem 63,1%, xuat huyet nao chiem 36,9%, t i n g huyet l p la yeu td nguy co hang dau ehiem 66,9%. Theo y hoc cd truyen chdng phong dam d tr^, khi hd huyet d la hai chdng hau hay gap nhat tren lam sang d d hai the nhdi m l u nao va xuat huyet nao. CJ benh nhan dot quy nao ed tien sd huyet l p thi ehdng hay gap nhat la phong dam d t r e 27,6%, khi hU huyet d 19,1%; tien sd rdi loan chuyen hda lipid chdng phong dam d tre 26,5%, dam nhiet phu thUc 17,6%; tien sd dai t h I o duPng chdng phong dam d t r e 47%, phong hda thupng nhieu 17,6%... /Cef/udn: Chung ta can nhan biet sPm eacy^u to nguy cO va d i e diem lam sang d benh nhan dot quy nao cap theo y hoc co truyen de cd chien lupc tdt hon trong edng t i e dieu trj v l d u phdng ed hieu q u i hdn.
Tdfc/70o;Dptquynao,tai bien mach m l u n l o , yeu t d nguyco, trung phong.
Summary
Objective: Study on the clinical characteristics and risk factors in patients with acute ischemic stroke, according to traditional medicine. Subject and method: Prospeaive study, described cross over 157 acute ischemic stroke patients treated at the Center Cerebral Stroke 108 Military Central Hospital from January 2014 toDecember 2014. Re5u/f;The mean age 63 ± 13 years old disease; the proportion of male/female of 3.1; 1; proportion of patients with cerebral infarction accounted for 63.1%, accounting for 36.9% of cerebral hemorrhage, hypertension was the leading risk factors accounted for 66.9%. According to traditional medicine stock room stasis phlegm, blood stasis discharge was the most common post two certified clinical in both cerebral infarction and possible brain hemorrhage. In patients with a history of cerebral stroke having hypertension, the most common symptoms was customary phlegm stasis 27.6%, 19.1% discharge blood stasis; history of lipid metabolism disorders stock style stasis phlegm 26.5%,
Ngdy nhdn bdi: 10/10/2016, ngdy chdp nhdn ddng: 11/4/2017
Ngudi phdn hoi- Trdn Vdn Chien. Email: vudail08@gmail com - Benh vien TiVQD 108
JOURNAL OF 108-CLINICAL MEDICINE AND PHARMACY VoM2-N''6/2017 17.6% real government talks heat; history of diabetes stock style stasis phlegm 47%, 17.6% noise style rooftop fire... Conclusion: VJe need to recognize early risk factors and clinical characteristics in patients with acute ischemic stroke according to traditional medicine for the better strategy in the treatment and prevention more effective.
Keywords: Stroke brain, stroke, risk factors, winning style.
1 . Dat van de
Dot quy nao da va dang la nguyen nhan t d v o n g ddng hang t h d 3 sau benh ung t h d v l tim mach, la nguyen nhan hang dau g l y t i n tat v l la nguyen n h i n t h d 2 gay sa sut t r i tue. Dot quy nao khdng chi la van de sde khde, y te ma eon ta van de y te v l x l hpi tren tat c l d c qudc gia tren the gidi khong p h l n bidt tudi, gidi, qudc gia giau hay ngheo, p h l t trien va dang phat trien. Viec didu tri sdm cle yeu t d nguy eo n h l m d u phdng x l y ra dot quy nao la rat c l n thiet. Vi v l y , nghien cdu cle yeu t d nguy eo dpt quy nao gidp ich nhieu trong viec dleu tri va d d phdng.
Hidn nay viee ket hpp y hpe hien dai (YHHD) va y hpc cd truyen (YHC7) da va dang dupc chdng minh co hieu q u i rat tdt. Tuy nhien, hien nay d nddc ta chua cd nghien edu nao vd the lam sang theo y hpc cd truyen va mdi tdong quan vdi cic yeu to nguy eo, chinh v) the chung toi tidn hanh nghien cdu de tai: "Nhan xet d i e diem t i m sang va mdt sd yeu t d nguy eo theo y hpc cd truyen d benh dot quy nao giai doan cap tfnh" n h l m mue tieu:
Nhdn xit mot so ddc diem Idm sdng dot quy ndo cdp theo y hgc co truyin. Ddnh gid mdi liin quan gida Idm sdng vd mot sd yiu td nguy ca cua dot quy ndo cdp theo yhoc co truyen.
2. Doi tupng va phUOng phap 2.1. Doi tugng
Ddi tdpng nghien edu bao gdm 157 benh nhan dupe chan doan dot quy nao giai doan cap tfnh nam dieu trj tai Trung tam Dpt quy nao A21 Benh vien Trung uong Q u I n dpi 108. Thdi gian t d thang 01/2014 den thang 12/2014.
2.1.1. Tiiu chudn lua chgn binh nhdn Benh nhan dupc c h i n doan dot quy nao cap eua YHHD.
Chup MRI hoac CT seaner cd hlnh anh nhdi mau nao hoac xuat huyet nao.
Benh n h i n vao vien trong 48 gid dau ke td khi bj benh.
CIc benh nhan h o l e ngUdi nha ddng y tham gia nghien edu.
2.1.2. Tiiu chudn logi trdbinh nhdn Khdng phu hop vdi tieu chuan Ida chon.
Dpt quy n l o kem theo d c benh nhd ung thu.
Benh phdi tac nghen man ti'nh, suy gan, suy thin.
2.2. Phuang phdp 2.2.1. Thietke nghiin cdu
Dung phuong p h i p nghien cdu:Tidn edu, mo t i cat ngang cd phan tieh.
2.2.2. Tieu chudn chdn dodn Tiiu chudn chdn dodn YHHD
Benh d n h lam sang phu hop vdi dot quy nao:
Xle djnh dot quy khi x l y ra dot ngpt cle thieu sot chdc nang than kinh khu trd hoac lan tda, tdn tai qua 24 gid h o l e g l y t d vong trong 24 gid, loai trtf nguyen nhan ehan t h u o n g (theo WHO 1990).
Chup MRI h o l e CT seaner cd tdn thUOng xuft huydt nao hoac nhdi m l u nao tren phim.
Tiiu chudn chdn dodn YHCT
Tieu chuan ehan doan va phan the theo YHCT: DLO theo tieu chuan cda Cue y dupc qude gia Trung Qudc
Tieu ehuan chan doan mdc dd benh YHCT:
TAP CHl Y DdOC LAM SANG 108 Tap 12-566/2017
Binh thudng Ngu ga Me man Bat tinh Honmg
Khdng liet Liet nhe Liet hoan toan
Blnh thupng khong liet Y^u nhe
Nang dupe qua vai Khong nang dupe qua Chi lay ddng dupc nhe Liet hoan t o l n
Blnh thudng Nang cao tren 45°
Nang eao dudi 45°
Khdng nang ddoc Chi cd dpng nhe 1 Liet hoan t o l n
L T h ^ n t r i Odiem 3 d i ^ 5 diem 7cRem 9 diem 3. Liet mat
Odiem 1 diem 2 diem 5. Tay
Odiem 1 diem 2 diem /ai 4 diem 5 d l l m 6 diem 7. Chan
Odiem 1 diem 2 diem 4 d i ^ m 5 diem 6 diem
1 : _ _ 9. Bieu hf^n khac
B i t thudng ddng t d Co giat
7 diem 7 diem Non ra m l u , dai tidn ra m l u 8 diem Rdi loan dai tieu tien
Mat nham, mieng md HOi thd yeu Maeh vi mudn tuyet Tay ehan lanh
8 diem 8 diem 9 diem 9 diem 9 diem
2. Ngon nguT Binh thudng Ndi ngpng Tra Idi khong phu hpp Phat ngon khong ro That ngon
4. Mat Blnh thudng Mat phan dng c h l m Mat khdng phan dng 6. Ngon tay Binh thudng Yeu nhe Cam nam khd k h l n Chi van dpng nhe Lipt hoan toan
8. Ngon chin Blnh thUPng Yeu nhe
Van dpng kho khan Chi ed dpng nhe Liet h o l n toan
Odiem 1 diem 3 diem 4 diem 6 diem
Odiem 2 diem 4 diem
Odiem 1 diem 2 diem 4 diem 5 diem
Odiem 1 diem 2 diem 4 diem 5 diem
Ddnh gid: Tdng diem T d 1 - 1 3 diem: Benh mdc dp nhe.
T d 14 - 26 diem: Mde dp trung binh.
T d 27 - 39 diem: Mde dp n l n g . T d > 40 diem: Mde d d r l t nang.
Tieu chuan ehan doan the lam sang:
Phong dam hda cang:
Chu chdng: Ban than bat toai, mieng meo lUdi lech, ndi khd hoae that ngdn, m i t h o l e giam e l m g i l c , phat benh bat thinh finh.
JOURNAL OF 108 - CLINICAL MEDICINE A N D PHARMACY VoLn-N^e/IOl?
Thd chdng: Chdng mat hoa mat, tam phien hay d u gat, ddm nhieu va s i n h , ludi dd, reu lUdi vang dinh, maeh huyen.
Phong hda thupng nhieu:
Chd ehdng: Ban t h i n bat toai, mieng meo ludi lech, ndi khd ndi ngpng, phat benh dot ngdt, t h i n t r i me man.
Thd chdng: Co gay cdng, t h d thd, dai tien khd tao, tieu tien ngan do, ludi dd giang, reu lUdi vang dinh khd, maeh huyen sac.
Dam nhiet phd thUe:
Chu chdng: B i n than bat toai, mieng meo lUdi lech, ndi khd ndi ngpng, g i l m h o l e mat d m giac.
Thd ehdng: Dau dau chong mat, ddm nhieu, bung chUdng dai tien khd bi, ehat lUdi dd tia, rdu vang dfnh, mach huyen hoat.
Phong dam d t r e :
Chd chdng: B i n than b i t toai, mieng meo Iddi lech, ndi khd ndi ngpng, g i l m hoae mat d m giac.
Thd chdng; Chdng mat hoa m i t , ddm nhieu dinh, ehat lUdi tia nhpt, reu ludi trang mdng hoac trang dinh, mach huyen hoat.
Dam thap mdng than:
Chd chdng: B i n than bat toai, mieng meo Iddi lech, ndi khd ndi ngpng, giam h o l e m i t d m giae, lo mo t h d khd khe.
Thd ehdng: Dai tieu tien khdng t u chu, toan t h i n ra md hdi lanh, chat ludi tim, reu t r l n g dinh, mach t r i m hoan.
Khi h u huyet d:
Chu ehdng: Ban than bat toai, mieng meo Iu61 teeh, ndi khd ndi ngpng, giam hoac m i t d m gilc.
Thd chihig: Sic mat trang nhpt, hoi t h d ndng, ra m d hdi, chat Iddi tia nhpt, reu Iddi trang dfnh hoac cd han rang, mach tram te.
Am h d phong ddng:
ChCi ehdng: B i n than bat toai, midng meo Iddl lech, ndi ngpng h o l e that ngdn, g i l m hoac mat d m giae.
Thd ehdng: Chdng mat u tai, Idng ban tay ban chan ndng, mieng khd tao, lUdi hdng gay, it reu hoac khdng reu, maeh huyen te sac.
Tiiu chudn chdn dodn cdcyeu to nguy ca Tang huyet ap: (JNC VII - 2003) HA tdi da >
MOmmHg va hoae HA tdi thieu > 90mmHg.
D l i thao dudng: Theo tieu ehuan hidp hpi DTB My (American Diabetes Assocelation - ADA - 2007).
Dudng huyet khi ddi > 7,0mmol/L h o l e dddng huyet thdi diem bat k>' > 11,1 mmol/L hoae HbAlc s 6,5%.
Tang mP m l u : Cholesterol > 5,4mmol/L, Triglycerid > 2,3mmol/l, HDL-C < l,Ommol/L, LDL-C
> 3,4 mmol/L.
Nghien thude la: (WHO -1999): Hut thudc la tren 10 dieu/ngay, thdi gian hdt tren 3 nam.
2.2.3. Xdly sdliiu
DCing p h l n mem SPSS! 7.0 de xd ly sd lieu, diing kiem nghiem x' ^^ danh g i l mdi tdOng quan gida the lam sang YHCTvl eac yeu t d nguy CO.
3. Ket qud
3.1. Dgc diem chung cda nhom nghiin cdu
Bang 1 . Tuoi va gidi d6\ tdpng nghien cuTu
~ ^ Tudi Giofi ^ - — ^ . . ^
Dadi 40 40-49 50-59 6 0 - 6 9 7 0 - 7 9 Tren 80 Tdng
Nam So iuong (n)
3 9 47 25 18 17 119
Tyie%
1,91 5,73 29,93 15,92 11,46 10,82 75,8
NO Sd iUtfng (n)
0 3 7 11 14 3 3S
TJi#%
0 1,91
4,5 7,0 8,91 1,91 24,2
TAP CHl Y Dl/OC LAM SANG 108 Tap 12-So 6/2017
Nhdn xit BIng tren cho thay tudi gap nhieu nhat 50 - 59, nam mae benh chiem t;^ le 75,8%, n d mac benh chlem t y Id 24,2%, ty le mac benh d nam gap 3 lan n d gidl, tudi trung binh mac benh 1163 ± 13 tuoi.
3.2. Dgc diem lam sang theo YHHD 3.2.1 .The Idm sdng
Bieu do 1 . Dac diem the lam sang
NhdnxetTy le benh nhan nhdi mau n l o ehiem 63,1% eao hon ty le benh n h i n x u l t huyet nao chiem 36,9%.
3.2.2. Cdcyeu td nguyco
• %
80 -
60 -
40 -
20 • 66,9
It
huyit dp l a n g D i i thio 10,8 Stitmg21,7
RLCH Lipid
10,2
B^nh m^di vinli
t
TiSnsO TBMMN
5,1
Nghiin O i u i c i i
8,3
Nghi$n rupu
B i ^ u d o 2 . T y le c a e y e u t d n g u y c o
Nhdn xetTy \i BNtang h u y e t a p c h i e m t y l e eao nhat vdi 66,9% tiep theo 11 rdi loan chuyen hda lipid vdi 21,7%. Ty ie BN bl dpt quy lan t h d 2 t r d len cd tdi 19,7%. Cle yeu t d nguy cO cdn lai chiem ty le thap.
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.l2-N°5/2017
3.3. Dgc diem Idm sang thea YHCT 3.3.1. Phdn bd chdng hdu
Phong dSm Khihu Phong dam Phong iJam DSmnhi^t Amhtf Bamthip LPtrl huylt iJ thuang nhilu hoa cang phuthi/c phong i3png mong than
Bieu do 3. Ty le p h l n bd chdng hau
Nhdn xet Ket qua cho thay the ehiem ty le cao nhat la phong dam d tre (chlem tdi 30,6%), ddng thd hai la the khi hd huyet d (20,4%)...
3.3.2. Phdn bd mdc dd binh
Bieu do 4. Ty le eac mdc dp benh theo YHCT
Nhdn xet Trong nghien cdu benh nhan bj benh mdc 66 nhe chiem X)f le eao nhat vdi 43,3%, mdc db trung blnh chlem 33,8%, mde 66 nang 19,7%, mdc dp rat nang thap nhat vdi 3,2%.
TAP CHi Y DLTOC L A M S A N G 108 Tap12-S6 6/2017
3.4. Moi liin quan giCta the Idm sang YHCTvd yeu tdnguy ctf YHHB trong BQN cdp 3.4.1. Chang hau YHCTva the ldm sang YHHD
%
35 30 25 20 15 10 5 0
^
^ ~ j | ^/,„ H • fljij ^1
''_Hi£__BH_
Phong dam Phong hoa hoa cang thifong nhilu
10,1
__B52
Dam nhiat phu thuc
Phong dam aw
• Nh6lmaunao
• Xuat huylt n§o
22,4 13.8 -
— 3_B-
Dam thap mong thin
Kliihu huylt ip
^ 6 . 9
Amhu phong dgng
Bieu d o 5. Lien quan gida t h e l l m sang va chdng h l u
Nhdnxet: Ket q u a t r e n c h o t h a y d c l hai t h e chCfrig p h o n g d a m d t r e e h i e m t y le eao n h l t (p>0,05).
3.4.2. Tdng huyit dp vdi chdng hdu YHCT
Trong nghien edu ed 105 benh nhan tang huyet ap chiem 66,9%. Ty le phan bd ehdng hau n h d sau:
30 25 20 15- 10 5
0 •
/ 1 27.6
1 1 19,1
/ i'^'* i"'" i"'" 1
1 ^ 9 . 5 Phong dam Phong hoa Dam nhiet Phong d^m OSm thiphoa cang thuvng nhilu phuftyc i>tr§ m6ngthln
Khi hu' Am hif huyet LP phong dpng
Bieu d o 6. Tang huyet ap v l chdng hau
Nhgn xet Ket q u a eho t h a y c h d n g p h o n g d a m d t r e c h i e m ty' le cao n h a t 27,6%, t h d hai la c h d n g k h i h d h u y e t d 1 9 , 1 % (p>0,05).
JOURNALOF 108 - CLiNiCAL MEDICINE A N D PHARMACY Vol.l2-N'6/2017
3.4.3. fiof loan chuyen hoa lipid vdi chiing hdu YHCT
Trong nghien cilu CO 34 benh nhan roi loan chuyen hoa lipid chiem 21,7%. TJ le phan bd v6i chiing hlu
• % 30-1 2 5 - 2 0 - 15 10 5
/ ^ 26,5
X 17,6 1
Phong d^m hda cang
11,8
Phong hoa thifdng nhilu
Ddm nhilt phu thi/c
Phong ddm trlre
Ddm thIp mfing thin
11,8
Khlhu- huylt d
A m h u phong dQng
B i e u d o 7 . Rdi l o a n e h u y e n h d a l i p i d v l c h d n g h a u
Nhdn xet K e t q u a e h o t h a y t y l e c h d n g p h o n g d a m d t r e e h i e m t y le c a o n h a t v d i 2 6 , 5 % , d a m n h i f t phi) t h d e d d n g t h d 2 c h i e m 1 7 , 6 ( p > 0 , 0 5 ) .
3.4.4. Ddi thdo dddng vdi chdng hdu YHCT
Trong nghien cdu cd 17 bdnh n h i n mac dai thao dudng ehlem 10,8%. Ty le phan bd vdi cle chdng hau nhusau:
• % 50 40 - 30 - 20 - 10
/
47/ i / i
/ 17.6
Phong ddm Phong hoa hoa cang thiifng nhiSu
11,8
Ddm nhiCt phu th^c
-4- •
, Phong ddm i U r l
5,8
^ k
Ddm thip mOng thin
5.9
^ k
Khihif huylt Cr
5.9
^k y
Amhif phong (I$ng
Bieu do 8. €)ll thao dUPng va ehdng h l u § Nhdn xet Trong sd benh n h i n dai thao dddng cd tdi 47% la chdng phong dam d tre, t h d hai la chiing
phong hda thupng nhieu chiem 17,6% (p>0,05).
TAP CHf Y Daoc LAM SANG 108 Tap12-S66/2017
3.4.5. Mdt soyiu td nguy co khde
BSng 2 . Cac y e u t d n g u y ca Chihig hSu
Phong dam hoa cang
Phong hoa thuong nhieu
Dam nhiet phil thuc
Phong dam l i t r e
Dam thap mong than
K h i h u h u y ^ t i l
A m h u p h o n g d o n g Tdng
Benh m.
n 2
0
0
5
0
8
1 16
ch vanh TJIc%
12,5
0
0
31,3
0
50,0
6,3 100
Nghien thuoc la n
1
2
2
1
1
1
0 8
T y l e % 12,5
25,0
25,0
12,5
12,5
12,5
0 100
Nghien rUtfu n 2
4
1
4
0
2
0 13
T > i e % 15,4
30,8
7,7
30,8
0
15,4
0 100
Nhdn xit: Nghien edu ed 16 benh n h i n bj benh mach vanh (ehiem 10,2%) trong dd chdng khf h d huyet d ehiem 50%, ddng t h d 2 I I ehdng phong dam d t r e vdi 31,3%.
4. Ban luan
4.1. Dgc diim ldm sdng ddi tugng nghien cdu 4.1.1. Ddc diim vigidi
Trong ket q u i nghien cdu cua chung tdi d BIng 1 cho thay ty le bj benh d nam (75,8%) cao hOn nd gidi (24,2%), ty le nam n d la 3,1:1. Ty le n l y cung gan tdong dong vdi ty le theo nghien edu eua Nguyen V I n Thdng t^ le nam 69,95%, n d 30,05%.
4.1.2. Ddc diem ve tudi
Theo ket qua BIng 1 cho thay benh nhan d dd tudi t d 50 den 59 cd ty le mac benh eao nhat vdi
• 34,4%, tiep theo la dp tudi t d 60 den 69 ehiem 22,9%.
Tudi trung blnh m I e benh trung blnh la 63 ± 13 tudi.
Ket qua nghien cdu cua Nguyen Van Chuong dd tudi i'70 - 79 tudi chiem 41,9%, nhU vay nghidn edu eua
ehung tdi dp tudi mac benh trd hon).
4.2. Ddc diem the Idm sang theo YHHD 4.2.1. Ddc diem the Idm sdng
Kix q u i nghien cdu theo Bleu do 1 cho thay ty le benh nhan nhdi mau nao ehiem 63,1% eao hon so vdi ty' le benh nhan bi xuat huyet nao 36,9%. Ket q u i nay phu hpp vdi ket qua nghien cdu cCia Nguyen Van Thdng nhdi m l u n l o chlem 60,5%, xuat huyet nao ehlem 39,5%. Ket q u i dleu tra toan qudc nam 2008 cua Le V I n Thinh ty le nhdi m l u nao 59,2%
xuat huyet n l o I I 40,8%.
4.2.2. Ddc diim cdc yeu td nguy co
Theo Bleu dd 2, ket q u i nghien cdu cho thay benh nhan bj dot quy cd tien sd t i n g huyet I p ehiem t>^ le eao len tdi 66,9% ket q u i nay phu hpp vdi ket q u i cda cae t i e g i l Pham Hdng V I n (Thai Nguyen) 78,5%, Ph?m Gia KhIi 77,25%. T i n g huyet 15
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY VoLl2-N%/2017
l p de lam tdn thddng npi mac t h l n h mach do I p lde ddng mau manh hon, lam tang tfnh tham cda thanh mach ddi vdi cic lipoprotein mau dan den vda xo ddng mach de p h l t trien va de dan 6en dot quy.
Bdng t h d hai 11 rol loan ehuyen hda lipid vdi 21,7%, ket q u i cda chung tdi thap hon so vdi nghien edu eCia Pham Thi Hdng V I n CThli Nguydn 2004) 53,9%.
Pham Gia Khai 40,8%, Vdong Kim Lan (Ha Nam - Trung Qudc 2009) 75%, cd the do sd Idpng benh n h i n nghien edu eua ehung tdi it hon va tap q u I n sinh hoat an udng cua benh nhan khlc nhau gida cac nhdm nghien cdu. CIc nghien cdu cho thay rdi loan ehuydn hda lipid mau va tang huyet I p hay phdi hpp va thuc day manh sU phat trien eua nhau va lam t i n g nguy eo bj dot quy.
4.3. Dgc diem Idm sang theo YHCT 4.3.1. Dgc diem phdn bd the Idm sdng Ket q u i nghien edu theo Bieu dd 3 cho thay the phong dam d tre chiem ty le cao nhat vPi 30,6%, t h d hai la the khi h d huyet d vdi 20,4%, thap nhat la the d i m thap mdng than vdi 7%.
Ket q u i nghien cdu cua mdt sd t i e gia ben Trung Qudc nhd N h l m Boan Hpe thl ehdng phong d i m hda cang chiem ty le eao nhat 28,47% t h d hai la ehdng phong hda thupng n h i i u 24,3%. Ket qua nghien edu eua ehung tdi cd sd khlc biet, ed the la do eac nghien cdu 6dgc tien hanh tren c l e ddi tdpng benh nhan sinh sdng tai cac dja diem khac nhau, ed su khae nhau ve the ehat, thdi quen sinh boat va an uong.
4.3.2. Ddc diem phdn bdmdcdd binh theo YHCT Ket q u i p h l n mdc dp benh theo YHCT tai Bieu do 4 cho thay: Benh nhan bi benh d mdc 66 nhe (td 1 den 13 diem, theo thang didm phan dp eua YHCT) diem ehiem 43,3%, mdc dp trung blnh (td 14 - 26 diem) chlem 33,8%, mde do nang (td 27 - 39 diim) ehiem 19,7% va mdc dp n l n g (td40 trd len) chiem 3,2%.
4.4. Moi lien quan giSfa cdc chdng hau YHCT vd cdc yeu t6 nguy ca YHHD
4.4.1. Chdng hdu vd thi Idm sdng YHHD Kix q u i theo Bleu do 5 eho thl'y d c l hai the xul't huyet nao v l nhdi mau n l o chdng phong dam d tre
deu chiem ty le cao nhat ty le tdong ddOng I I 32,8% va 29,3%. Bdng t h d hai la chdng khi hu huydt d t y le dthe xuat nao 22,9% d the nhdi mau nao la 19,2%.
Cae chdng phong dam hda cang, phong hoa thdpng nhieu, dam nhiet phu thde, am hu phong ddng chiem ty le thap hon va d the nhdi mau nao cao hon the xuat huyet nao. Sd khac bidt khong co J nghTa thdng ke (p>0,05).
4.4.2. Tdng huyit dp vdi chijffig hdu YHCT Trong nghien cdu ed 157 benh n h i n thl ed tdi IOS bdnh n h i n ed tang huyet I p (66,9%), theo kdt qui Bleu 66 6 ta thay trong nhdng benh n h i n t i n g huyetap gap nhieu nhat la chdng phong dam d tre chlem 27,6%, t h d hai la ehdng khi h d huyet d ehiem 19,1%. Si(
khlc biet khdng cd y nghTa thdng ke (p>0,05).
Theo nghien cdu cda Thai Nghiep Phong (Triing Qudc) tren 739 benh nhan bj dpt quy glal doan cap tinh thi ty le ele chdng hau tren benh nhan ed THA nhd sau: Chdng phong dam d tre chlem tdi 47,3%, chdng phong hda t h u p n g nhieu chiem 20,6%. So vdi ket q u i nghien edu cua ehdng tdi ed sd tdong dong, n h u v l y du cle nghien cdu ddpc tien hanh tren cac nhdm ddi tdpng k h l c nhau, cd tap q u I n sinh hoat khie nhau th) benh nguyen benh sinh dot quy nao 6 benh nhan cd tang huyet ap khdng khae nhau.
4.4.3. Rdi logn chuyen hda lipid vdi chdng hdu YHG Trong nghien cdu cd 34 benh n h i n ed roi loan chuyen hda lipid ehiem 21,7%, ket q u i phan tichty le ehdng hau theo Bieu do 7 cho thay chiem ty le cao nhat la ehdng phong dam d t r e (26,5%).ThiJhai la chdng dam nhiet phu thuc (17,6%), tldp theo la chdng phong dam hda cang (14,7%), cac chdng con lai chiem ty le thap hon. Tuy nhien sU khlc biet khdng ed y nghia thdng ke p>0,05.
4.4.4. Ddi thdo dudng vdi chdng hdu YHCT Trong nghien cdu cd 17 benh nhan bj benh i!ai thao dudng ehiem 10,8%, ket q u i phan tich theo Bleu dd 8 cho thay t J le chdng phong dam d tre chiem ty le cao nhat (47%), ddng t h d hai la chumg phong hda thdpng nhieu (17,6%) t h d ba la dam nhiet phd thde (11,8%), sd k h l c biet khdng c6 y nghTa thdng ke.
TAP CHf Y DdCJC LAM SANG 108 Tip 12-566/2017
4.4.5. fi/ldt sdyeu tdnguycokhdc
Trong 157 benh nhan nghidn edu thi cd 16 benh nhan bi benh maeh vanh (ehldm 10,2%) trong dd chdng khi h u huyet d chldm 50%, ddng t h d 2 la chdng phong dam d t r e vdi 31,3%. Nghien thude la cd 8 benh n h i n ehiem (5,1%) trong dd ehdng phong dam phu thuc va phong hda thupng nhieu dieu ehiem ty- Id cao vdi 25%, eae chdng khae ehiem ty le thap hon. Nghien rdpu ed 13 benh nhan ehiem 8,3%, trong d d ehdng phong hda thdpng nhieu ehiem t y le cao n h l t vdi 30,8%.
5. Ket l u d n
Qua nghien cdu tren 157 benh nhan ve lam sang va m d t sd yeu t d nguy co chung tdi dUa ra mdt sd ket luan sau:
5.7. Dgc diem Idm sang
Ty Ie bj bdnh d nam gidi cao hon d n d gidi vdi ty le 3,1:1. Nam gidi bj benh sdm hon n d gidi, d nam t^' le mae benh nhieu nhat la t d 50 - 59 tuoi, n d gidi I I 70 - 79 tudi, tudi trung binh tuong dng la 62 ± 13 v l 6 7 ± 1 2 t u 6 L
T'} le bdnh n h i n bl nhdi m l u n l o (63,1%) eao hon xuat huydt n l o (36,9%).
Tang huyet I p la yeu t d hay gap va ddng hang dau trong cac yeu t d nguy co cda benh dot quy nao (66,9%), d d n g t h d hai la rdi loan ehuyen hda lipid vdi 21,7%, ty le benh nhan bj dot quy lan 2 t r d len ed tdi 19,7%, cac yeu t d cdn lai chiem ty le thap hon.
5.2. Moi lien quan giSfa YHHD vd YHCT Phong dam d tre, khi h d huyet d, la hai chdng
>iau hay gap nhat tren l l m sang d c l hai the nhoi Tiau nao va xuat huyet nao vdi tJ" le lan Idpt la 30,6%
/a 20,4%.
Ty le ehdng phong dam d tre, khf h d huyet d.
Jam thap mdng th^n d the xuat huyet nao eao hon
;henh6i mau nao.
Benh nhan bj dot quy cd THA ele chdng hay gap a: Phong dam d t r e (27,6%), khf h d huyet d(19,l%).
Benh nhan bi dot quy cd rdi loan chuyen hda ipid ba chdng hay gap la: Phong dam d tre (265%), Jam nhidt phu thUe (17,6%).
Bdnh nhan bi dpt quy ed BTB hay gap chdng phong d i m d t r e (47%).
Tai lieu tham khao Tidng Viet
1 Nguyen Van Dang (2008) Dgi cUOng ve tai bien mgch mdu ndo, nhdng kiin thde ca bdn trong thUc hdnh, tai biin mgch mdu ndo hudng chdn dodn vd xdtrf. N h i Xuat ban Y hoc, tr. 19-28.
2. Li Ddc Hmh va cdng sU (2009) Tai biin mgch mdu ndo. Nha Xuat ban Y hpe.
3. Le Quang CuPng (2008) Cdc yeu td nguy ca tai biin mach mdu ndo. Trong Tai bien mach nao - Cap cdu - Dieu trj - DU Phong, Nha Xuat b i n Y hpc, tr. 27-36.
4. Le Thi Hda Blnh (2010) Ddc diim Idm sdng va cdn Idm sdng cda thieu mdu cue bg d ngUdi cao tudi tgi Binh viin Thdng Nhdt. Luan I n Tien sT Y hpe, Dai hpe Y dupe HCM.
5 Hoang KhInh (2003) Yiu td nguy ca gdy TBMMN. Y hoe thuc hanh, sd 438, tr. 33-36.
6 Hoang Khanh (2007) Cdc yiu td nguy cO gdy tai biin mgch mdu ndo. Tai bien mach mau nao - Hudng dan chan d o l n va xd trf, N h i Xuat b i n Y hpc, tr.
84-108.
7. Hd Hdu Luong (1998) Tai biin mach mdu ndo. Llm sang y hoc, tap 111, N h i Xuat b i n Y hpe.
8. Pham Khue (1991) Tai biin mgch mdu ndo. Bich khoa thu b§nh hoc, tr. 245-248.
9. Phan Thanh HIi va cpng sU (2010) Nghiin cdu ddc diem Idm sdng, can ldm sdng vd cdc yeu td tiin lugng d binh nhdn ddt quy ndo tgi Benh viin Qudn y 107. Tap ehi y hpe Viet Nam, (374), tr. 43-48.
10. Nguyen Van Thong (2009) Dan vi ddt quy ndo, Tai biin mgch mdu ndo. Nha Xuat b i n Y hpc, tr. 393-402.
11. Nguyin Van Thong, Nguyen HoIng Ngpc, Do Mai Huyen, Dinh Hlo Ha (2007) Nghiin cdu dgc diim ldm sdng, can Idm sdng vd mot sd yiu td nguy ca cua 1378 binh nhdn dot quy tgi Benh viin Trung UOng Qudn ddi 108. Tap chi Y Dupc Lam sang 108, (2),tr.5-11.
12. Vu Van Dinh (2011) Hdi sdc cdp cdu binh nhdn ddt quy. Tap chi dpt quy Bp y te, tr. 89-102.
17
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.12-N-6/20
T i e n g T r u n g
5 « * . 446 « B i l 6 L t t B Z f ' f > f f i t t H * » W [ J I ' P # ' > f H E ' ! ^ S f e S , 2007,5(10) : 27-28.
±W , fKitM, #ms.. 56
r j S B f l - : ^ * ^ S , 2008,25(5): 765-766.
* « : t H E B W S t H I S a , 2000.144-150.
« * « * , ffiiaBt. « « . 739 0 * T , t H f E S l g , 2005,14(10):974-976
i S , ! K « * L , * > • » , B a * , I * i « . , 2002,25 (5): 47-52.
i S a t S ' , 3KtelL.
> f = E t > M J S : » H « S 5 t * g W ? C * ^ 9 ' « t - , t p B
>fEB1f.i.*i6, 2002, 9 (3): 71-73.
s t t a i t L t t i f MifeiaH«-ij-cpEffi«ft« • t t » W, )Stt't'HE@-g-3SS, 2010, 20(10); 637 - 638.
fl5*!i?, 2011.
ftttajiLt|3«.ffis#ffi-ij-fiSH*mffi • ttw.
i I ± * < S a 3 : . r t H " f E * * . " f B .
ISfaliffi, 2010.
ra±*fi:v6s:.rffltfiE** 'pm.
IU. I^Bp, 20' ttJiitt*M*ttM#iiEgiJ3-jkJgKi« • «5E.
11. » = . 20(
tf>Mai|fiftSJ»l(6KH*-%-K«; • JB^EiJEfe
• * • m±!kmm- t » B * E f 4 ¥ P . S B a E | i S .
12. a ^ t e , 2005. 'p^mMttmmmM'^n •'
»±*mts.?5»>t'E*is. •I'B.
13. B S , 201
<t> J i « : » H « 6 f j i I ( S » « i | t ^ , a H : S = F H S S i
a s . =f'E^-t¥i!iiM±¥fS:ifc 14. * ! ] , * * . " f M S m S W 6(
1995,15(3): 16-19.
15. s ^ l B f f , 2012.
mmw.mvE»&^ikmcRP, UA, LDL-
16. liM.aHttB^fft^HJSSffaaff.
c t J H * ¥ ' * a * . , 2 0 1 0 , 30(11): 1587-1588.
17 { £ » ¥ . •I'H.JS.ftttaW^ERSffiilJSffW 16:
mts^mm. • f H t p E a s , 1995, 4 (2) -.e.
64
18. sfl-, 2011. misntf^mmmi&mm^wi
