VIETNAM MEDICAL JOURNAL N°1 - JUNE - 2017 mffc dd di can va nhan thay ty le di can hach ty
le thuan vdi sd Iffdng hach phat hien dffdc treri MSCT, tuy nhien do ed mau nhd nen khdng cd nhieu y nghia. Gia tri cua MSCT trong danh gja di can hach trong nghien cffu cua chiing tdi la 47,3%. Ket qua nay phu hdp vdi nghien cirtJ cua Barros RHO (2015) tff 40,5% den 60,6%r3]. Mac dii cd mdi quan he rd rang giffa kich thffdc hach va hach di can nhffng danh gia hach di can la han che ciia MSCT, nd khdng danh gia dffdc hach viem hay hach di can ung thff, hach cd kich thffdc ldn chffa chac da la hach di can (hach viem, hach phan ffng), ngffdc lai hach cd kfch thffdc nhd cung cd the la hach di can[3].
- Vai trd cua MSCT trong di can xa: MSCT khdng xac dinh trffdng hdp nao trong sd 55 BN cd di can xa. Hien nay han ehe ldn nhat cua CLVT dd la xac dinh tinh trang dl can phiic mac, tuy nhien gan day sff phat trien cua nhieu kT thuat mdi, lat cat mdng hdn, kha nang dffng hinll da lam tang kha nang chan doan di can phuc mac cua CLVT. CLVT van la phffdng thffc dffdc lffa ehpn de chan doan di can phiic mac trffdc phau thuat. Dich co trffdng la mdt trong nhffng dau hieu thffdng gap nhat Bieu hien ciia di can phuc mac bao gdm cac not khu trii tren phuc mac, day len bat thffdng cua phiic mac,mac treo rudt va mac ndi.
Theo tac gia Su Jin Kim va cdng sff (2009) danh gia di can phiie mac sff dung may CLVT 16 day va 64 day thi do nhay cung chi la 28,3% va 50,9%[7], ty le nay theo Hallinan (2013) la 75%, va 92%[4].
NGHIEN CU'U DAC DIEM LAM SANG VA CAN LAM S A N G CUA THAI PHI) GIAM TIEU CAU CHU'A RO NGUYEN N H A N KHI CHUYEN DA
Nguyin Quang B5c*
mau chiem ty le 77,1%. Ket /uan/Tneu chirng lam sang va can lam sang ciiajihai phu giam deu cau chifa rd nguyen nhan khi chuyen da la xuat huyet du'tfi oa bieu hien d dang cham va thieu mau nhe. Benh nhan CO so lu'dng tieu cau 50-80 G/l la hay gap nhat,
T& khoa: Giam tieu eau chda ro nguyen nhan, xuat huyit dddi da.
SUMMARY
RESEARCH THE CLINICAL AND SUBCLINICAL CHARACTERISTICS OF
PREGNANT WOMEN WITH THROMBOCYTOPENIA I N LABOUR Objective: Describe the clinical and subclinical characteristics of thrombocytopenia pregnant wom^
in labour. Methods: this is a descriptive ano retrospective study. Results: 16 patients nao V. KET L U A N
CLVT da day cd gia trj chan doan eao doi vdi tdn thffdng u nguyen phat trong ung thff da day giup danh gia chinh xac giai doan benh Wot phau thuat.
TAI UEU THAIVl KHAO
1. BiJi Dieu (2016J, "Dinh hu'dng cong tac piiong chong uhg thU den nam 2020", Tap Chi Ung thu Hoc VietNam (1), tr. 13-19.
2. 06 Thi Ngoc Hieu (2014J, "Ung thu" bieu mo da day vai tro ciia cat ldp dien toan trcing phSn gia'i doan u tai cho", Y Hoc TP. Ho Chi Minh 18(1), fr 225-229.
3. Barros R. H. et al. (2015), "Multidetector computed tomography in the preoperative staging of gastric adenocaranoma", Radiol Bras, 48(2), pp. 7 4 ^ ^ http://www. ncbi. nlm. nih .gov/pubmed/2598774!3fc' 4. Furukawa K. et al. (2011), "Diagnosis of the invaffln
depth of gastric cancer using MIXTT with viilal gaSroscopy: comparison with staging wiHi en±scDpic ultrasound", AJR Am J Roentgend, 197(4), pp. 857-75, http://www.ncbi.nlm.nih.gov/pubmed/21940574, 5. Hallinan J. T. Venkatesh S. K. (2013), Gastric
carcinoma: imaging diagnosis, staging and assessment of treatment response". Cancer Imaging, 13, pp. 212-27.
6. Kim J. W. et al. (2012), "Diagnostic performance of 64-section CT using CT gasfrograpliy in preoperative T staging of gastric cancer according to 7th edition of WCC cancer staging manual", Eur Radiol, 22(3), pp. 654-62.
/ . Kim S. J. et al. (2009), "Peritoneal metastasis:
detection with 16- or 64-detector row O in patients undergoing surgery for gastnc cancer", Radiology, 253(2), pp. 407-15.
TOM TAT
Muc tieu. \Ab ta dac diem lam sang va can lam sang ciia thai phu giam tieu cau chu^ ro nguyen nhan khi chuyen da. PhUdng phap: Nghien cffu mo ta hpi ciru va tien culi. Ket qua: Co 16 benh nhan co bieu hien xuat huyet chiem b/ Ie 9,6%. Thai phu 6 nhom co so lu'cJng tieu cau 50-80 G/l la hay gap nliat chiem ty le 38,6%, nhom co so lu'cJng tieu cau dffdi 20 G/l chiem tjf le 9,0%. Co 38 benh nhan co thieu mau chiem ty le 22,9%, cd 128 benh nhan khong thieu
*Benh vien Phu san Trung udng Chju trach nhiem chinh: Nguyen Quang BSc Email: [email protected] Ngay nhan bai: 27.3.2017 Ngay phan bien khoa hoc: 3.5.2017 Ngay duyet bai: 15.5.2017
TAP CHl Y HOC VIET NAM TAP 455 - THANG 6 - SO 1-2017 symtomps of bleeding (9.6%). Level of platelet from
50-80 g/l was found in 38.6%, under 20 g/l was 9.0%.
38 patients with anemia (22.9%). 128 patient without agns of anemia (77.1%). Conclusion: Clinical and subclinical symtomps of thrombocytopenia during labour was bleeding under skin and anemia. Patients with a platelet from 50-80 g/l was the most common.
Key words: Unknown thrombocytopenia, bleeding under sldn.
I.
OAT V X N DEQ phu nff mang thai, giam tieu cau la mpt trong nhihig nguyen nhan cd the gay chay mau sau de tham chi tff vong cho me va sd sinh do rdi loan qua trinh ddng cam mau. Tren the gidi, giam tieu cau d phu nff mang thai da dffdc de cap den tff nhffng nam 80 ciia the ky trffdc trong nhieu Hnh vffc ve lam sang, can lam sang, cd che benh sinh cijng nhff theo doi tren tre sd sinh. 6 Viet Nam, chu^ cd nhieu nghien cffu ve giam tie'u c^u d phu nff cd thai va dac biet la giam tieu cau khi chuyen da. Do vay, chung tdi da tien hanh nghien cffu de tai: "Nghien e&U dac diim iam sang va can lam sang cua thai phu giam tieu cau chda ro nguyen nhan khi chuyen da."
II. E>6l TU'ONG VA PHU'ONG PHAP NGHIEN CU'U 2.1. Ddi t&dng nghien c&u: Benh nhan dffdc chan doan la giam tieu cau chu^ rd nguyen nhan dang mang thai va ket thuc thai nghen tai benh vien phu san trung ffdng tff thang 1 nam 2013 den het thang 6 nam 2016 thda man cac tieu chuan sau:
Tieu chuan l&a chgn:
- Phu nff cd thai, xet nghiem mau ngoai vi cd sd Iffdng tieu cau < lOOG/l.
- San phu chi cd 01 thai va ro tuoi thai > 22 tiian.
- Chuyen da de tai benh vien phu san TW.
- Benh nhan dong y tham gia nghien ciTu.
- Ho sd benh an ghi rd rang, day du cac thdng tin can nghien cffu
TiSu chuan loai tr&:
- Cac trffdng hdp giam tieu cau do cac benh ly khac: suy tiiy xffdng, benh ly ae tfnh, benh he thong do virus, do thuoe...
- Cac trffdng hdp giam tieu cau de d ndi khac chuyen den vien
2.2. Ph&dng phap nghien c&u 2.2.1. Thiet ke nghiSn cu'u: Nghien cirli md ta ket hdp cffu hdi citu va tien cffu ed theo ddi doc.
- Hoi effu: Tff 01/01/2013 den 31/12/2015"
- Tien cffu: Tff 01/01/2016 den 30/06/2016.
2.2.2. Cd m l u nghiSn c i ^ : Lay mau toan bo, toan bd cac thai phu dffdc chan doan la giam tieu cau ehffa rd nguyen nhan dffdc theo ddi tai Benh vien Phu san Trung ffdng tff ngay 01 thang o i nam 2013 den_het thang 6 nam 2016.
2.2.3. Dia diem nghiSn cu'u: Tai Benh vien Phu san Trung ffdng
ML K I T QUA NGHIEN CU'U
- Trong nghien cffu cua chung tdi tff thang 1- 2013 den het thang 6-2016 tai Benh vien Phu san Trung ffdng, cd 166 thai phu giam beu cau chffa ro nguyen nhan, du tieu chuan lu^ chpn cd tudi thai khi chuyen da de tff 31 den 42 tuan, ket qua thu dffdc nhff sau:
Bang 1. BSc diem xuat huyii ciia thai phu GTCCRNN Thdi diem
Dac diem XHDD
Cham Not Manq Da hinh thai Xuat huvet niem mac
Xuat huyet noi tanq Khonq xuat huvet
Tong so
Klii vao vien lan ^ u n
10 0 0 5 8 0 143 1 6 6
Tv le % 6,0 0,0 0,0 3,0 4,8 0,0 86,2 100,0
Khi n 9 0 0 5 2 0 150 1 6 6
chuven da Tv ie »/o
5,4 0,0 0,0 3,0 1,2 0,0 90,4 100,0 Nhan xet: Khi vao vien lan dau cd 23 benh nhan co bieu hien xuat huyet chiem ty le 13,8' 143 benh nhan khong cd trieu chutig lam sang chiem ty le 86,2%.
-Khi chuyen da cd 16 benh nhan cd bieu hien xuat huyet chiem ty le 9,6%, cd 150 benh nhan khdng cd trieu chffng lam sang chiem ty le 90,4%.
-Xuat huyet dffdi da bieu hien chu yeu la d dang cham, xuat huyet niem mac bleu hien chu yeu d dang chay mau chan rang.
Thdi diem Thieu mau
Cd
Khi vao vien Tan dau n
1
TV le % 0,6
Khi chu n 1
ten da Ty le o/o
0,6
VIETNAM MEDICAL JOURNAL N''1 - JUNE - 2017
Khdng
99,4 99,4
^ 1Tong so
100,0 100,0
Nhan xet: Da sd benh nhan^ khdng cd bieu hien thieu mau, d thdi diem vao vien lan dau vawii chuyen da ty le benh niian cd bieu hien thieu mau deu la 0,6%.
Bang 3. Bang phan bo m&c do giam tieu €3u Mu'c do giam tieu cau
Vao vien fan dau
Ty le % Khi chuyen da Ty le %
SLTC giam nhe ( : SLTC < 100)
25,9
46 27,7SLTC giam trungbinh (50<SLTC< i
34,9
SLTC giam nang (20<5LTC < 50) 24,7SLTC giam rat nang (SLTC < 20)
14,5
9,0Tong so
100,0
NhSn xet: Trong sd 166 benh nhan nghien ciiu vao vien lan dau thi nhdm cd so Iffdng tieu cau tff 50-BOG/l la hay gap nhat chi^m t / le 34,9%, nhdm cd sd Iffdng tieu cau dffdi 20G/I chiem ty |g 14,5%; Khi chuyen da nhdm ed sd iffdng tieu cau 50-80G/I la hay gap nhat chiem ty le 38,6%, nhom cd sd Iffdng tieu cau dffdi 20G/I chiem t^ le 9,0%.
Bang 4. Bang phan bd'm&c do thieu mau (Hgb)
Khi vao vien lan ^ u Thdi diem
Mffc do thieu mau Ty le %
Khi chuyen dg j|l Ty le %;f Cd
thieu mau
NhedOO < H q b < 1 1 0 ) Trungbinh (70< Hgb<100)
25
15,1
J Nang (Hgb < 70)7,8 Khdng thieu mau (Hgb > 110 g/l) 132
79,5
Tong so
100,0
Nhan xet: Trong sd 166 benh nhan kbi vao vien lan dau lam xet nghiem mau thi cd 34 benh nhan thieu mau chiem ty le 20,5%, ed 132 benh nhan khong cd thieu mau chiem ty le 79,5%; Khi chuyen da cd 38 bSnh nhan cd thieu mau chiem ty le 22,9%, cd 128 benh nhan khdng thieu mau chiem t } le 77,1%.
IV. BAN LU^N
Khi vao vien lan dau ed 23 benh nhan cd bieu hien xuat huyet chiem ty le 13,9%. Trong SQ 23 benh nhan xuat huyet cd 15 benh nhan xuat huyet dffdi da ehlem b/ le 65,2%, cd 8 benh nhan xuat huyet niem mac ehiem t / le 34,8%, khdng co benh nhan nao xuat huyet ndi tang.
Khi ehuyen da so benh nhan xuat huyet giam di, cd 16 benh nhan cdn bieu hien xuat huyet chiem ty le 9,6%, trong sd do cd 2 benh nhan xuat huyet niem mac la cd bieu hien chay mau chan rang, cdn lai 90,4% benh nhan khdng ed bieu hien xuat huyet. Khi so sanh vdi mpt sd tac gia khac, theo nghien effu cua Kieu Thi Thanh (2006-2010) thi t / le benh nhan khdng'cd bleu hifn xuat huyet la 62,6o/o chiem da sd, cdn lai la xuat huyet dffdi da va xuat huyet niem mac chiem t / le 37,4%, khdng cd trffdng hdp n^o xuat huyet npi tang.
Theo nghien CLTU cua W/ebert. Kathryn E (2000) thi cd 65,5% sd benh nhan khdng cd bieu hien xuat huyet, cd 12,9% sd benh nhan cd bieu
hien xuat huyet dffdi da, cd 18,1% sd benh nhan cd bleu hien xuat huyet niem mac va 3,5% so benh nhan la ed bleu hien xuat liuyet ngi tang.
Ty le benh nhan cd bieu hien xuat huySt trong nghien cffu cua tac gia nay la cao hdn eiia chiing tdi, dieu nay cd the dffdc giai thich la d mot so nffdc phat trien nhff Han Qude, Canada nhii'ng benh nhan giam tieu cau chffa ro nguyen nhan thffdng dffdc kham va quan ly thai nghen tdt hcfn d Viet Nam nen viec phat hien cac trieu chifng nay thffdng eao.
Theo ket qua bang 2, ty le benh nhan khi vao vien lan dau va khi chuyen da deu khong co bieu hien thieu mau la 99,4%, tliieu mau nhe la 0,6%, khdng cd trffdng hdp nao thieu mau nang^.
Nhff vay da so thai phu giam tieu cau chffa ro nguyen nhan vao Benh vien Phu san Trung ubng la khdng cd bleu hien thieu mau va neu co thieu mau thi hau het la thieu mau nhe ket qua^nayja phu hdp vi da sd benh nhan khong cd bleu hi§n xuat huyet. Ket qua nay phij hdp vdi ket qua nghien cffu cua tac gia Kieu Thi Thanh (2010) tren nhffng thai phu giam tieu eau.
Tai thdi diem vao vien lan dau sd Iffdng tieu cau trung binh ciia benh nhan la 57,3±27,67G^I, benh nhan khi vao vien lan dau cd so Iffdng tieu eau thap nhat va cao nhat lan Iffdt la 2G/I va lOOG/l, da so benh nhan cd sd Iffdng tieu cau W 50-80G/I ehiem ty le cao nhat 34,9%, sau do la cae benh nhan cd sd Iffdng tieu cau tff 80-lOOG/l
TAP CHi Y Hpc VIET NAM TAP 455 - THANG 6 - SO 1 - 2017 chiem ty le 25,9%, thap nhat la benh nhan cd sd
Iffdng tieu cau dffdi 20G/I chiem bj- le 14,5%. Khi chuyen da th! so Iffdng tieu cau trung binh cua benh nhan la 61,46±26,14G/I, benh nhan cd so Iffdng tieu cau thap nhat va cao nhat khi chuyen da lan Iffdt la 4G/I va lOOG/l, benh nhan cd so Iffdng tieu rau tff 50-80G/I cung chiem ty le cao nhat 38,6%, sau dd la cac benh nhan cd sd Iffdng tieu cau tff 80-lOOG/l chiem t / le 27,7%, thap nhat la cae benh nhan cd so Iffdng tieu cau dffdi 20G/I chiem ty le 9,0%.
Theo ket qua tren cd the nhan thay so Iffdng tieu cau trung binh cua benh nhan khi chuyen da tang so vdi khi vao vien lan dau la cd y nghTa thong ke, dieu nay cd the giai thich la cac benh nhan khi phat hien giam tieu cau d thdi diem vao vien thi se dffdc dieu tn ndi khoa nham nang cao sd Iffdng beu (au tranh gay chay mau khi ehuyen da
Trong sd 166 benh nhan khi vao vien lan dau lam xet nghiem mau thi co 34 benh nhan thieu mau ehiem ty le 20,5%, trong dd cd 25 benh nhan thieu mau nhe la chiem chii yeu, cd 9 benh nhan cd thieu mau trung binh, khdng cd trffdng hdp nao thieu mau nang. Khi chuyen da cd 38 benh nhan co thieu mau chiem ty le 22,9%, trong dd cd 25 benh nhan thieu mau nhe la chiem chu yeu, cd 13 bfnh nhan thieu mau trung binh, khdng cd trffdng hdp nao thieu mau nang. Nhff vay trong nghien cffu ciia ehiing tdi cd nhffng benh nhan khdng ed bleu hien thieu mau tren lam sang nhffng lai cd Iffdng huyet sac td giam nhe dieu nay cd the dffdc giai thich la do trong qua trinh mang thai cac san phu thffdng cd tinh trang thieu mau do thieu sat nen khdng cd bieu hien thieu mau tren lam sang nhffng lai cd
Iffdng huyet sac t d giam nhe. Trong qua trinh nghien cuXi chung tdi thay cd nhffng san phu cd sd ludng tieu cau giam nang, nhuVig Iffdng huyet sac t d lai khdng giam hay chi giam nhe dieu nay chung lBi chu^ thay moi lien quan nao gitfe tinh trang thieu mau vdi tinh trang giam tieu cau nang.
V. KET LUAN
Trieu chirng lam sang va can lam sang cua thai phu giam tieu cau chffa rd nguyen nhan khi chuyen da la xuat huyet dffdi da bleu hien d dang cham va thieu mau nhe. Benh nhan cd sd Iffdng tieu cau 50-80 G/l la hay gap nhat.
TAI UEU T H A M KHAO
1. Beikin A. levy A va Sheiner E (2009). Perinatal outcomes and complications of pregnancy in women with immune thrombocytopenic purpurva. J Matern Fetal Neonatal Med, 22 (11), 1080 -1085.
z. aiver R, Beilcowtz R va Busei 3 (1999).
Thrombocyte^)enia in pregnancy. FiadicB bMdm, No 6.
Chicago: Amencan QJI^ d'OhsiebtsandGyneer^sgy J. Jeffrey Levy, GPT, MC va cong sff (2002).
Thrombocytopenia in pregnancy
4. Kfeu Tn Thanh (2006-2010). Nghien cuU dac diem lam sang, can lam sang va thai do xd tn dot vdi thai phu xuat huyet giam tieu eau chda ro nguyen nhan tai benh vien Bach Mai, Luan van tot ngliiep cao hoc chuyen nghanh san phu khoa Trffdng dai hgc Y Ha Noi.
5. Young - Woong Won va cong sff (2005).
Clinical aspect of pregnancy and Delivery in pabents with Chronic Idiopathic Thrombocytopenic Purpura. The Korean Joumal of Internal Medidne, 20, 129 - 134.
6. E. Webert, R. Mittal, C. Sigouin va cong su"
(2003). A retrospective 11-year analysis df obstetric patients with idiopathic thrombocytopenic purpura. Blood, 102 (13), 4306-4311.
NGHIEN CU'U TINH H I N H BENH TIEU CHAY 6" TRE DUffl 5 TUOI VA MOT SO YEU TO LIEN QUAN TAI TINH T R A VINH NAM 2 0 1 6
T O M TAT
Dat van de: Tai Viet Nam ndi chung va tinh Tra Vinh ndl rieng, viem phdi va tieu chay van la hai nguyen nhan chfnh gay tff vong 6 tre em, trong do tieu chay chiem 10% tong so tff vong d tre dffdi 5 va
"^rung tam phong, chdng HIV/AIDS Tra Vinh
** Trddng Dai hoc Tra Vinh Chju trach nhiem chinh: Pham The Hien Eniail: [email protected] Ngay nhan bai: 24.2.2017 rjgay phln bien khoa hpc: 25.4.2017 Ngay duyet bai: 5.5.2017
Trirffng Van Dung*, Pham The Hien**
van la van de sffc khoe cong dong ran dUOc quan tam. Muc tieu nghien cffu: (1) Xac dinh ty le mac tieu chay d tre du'di 05 tuoi tai tinh Tra Vinh nam 2016.(2) Tim hieu mot so yeu to lien quan den benh tieu chay d tre dUdi 05 tudi tai tinh Tra Vmh nam 2016. Phu'dng phap nghien cuTu: Nahien CLAJ ngan^
tren mau ngau nhien. Ket qua: Ty le tre dddi 5 tuoi mac tieu chay ciia tinh Tra Vinh tai thdi diem nghien ciili la 11,78%. Tre d nhdm 07 den 24 thang tuoi cd t / le mac benh cao. Ty le ba me cd kien thffc diing dat 15,56%. t y le ba me cd thuc hanh dung dat 66,44%.
Cd moi lien quan giife mac benh tieu chay ciia tre vdi cac yeu to: trinh dp hpc van, thu nhap gia dinh, so con, rffa tay, sff dung nha beu hpp ve smh, kien thffc
