VIETNAM MEDICAL JOURHAL N°1 • JUNE - 2017 nghen cd 77,0% sd benh nhan khdng cd bleu hi|n
xuat huyet, cd 13% benh nhan cd bieu hien xuat huyet dffdi da, cd 10,0% benh nhan bj chay mau cam, ra mau am dao hoac chay mau da day.
Theo nghien cffu cua Webert. Kathryn ^E (2000) thi cd 65,5% sd benh nhan khdng cd bleu hien xuat huyet, cd 12,9% so benh nhan cd bieu hidn xuat huyet dffdi da, cd 18,1% sd benh nhan CO bieu hien xuat huyet niem mac va 3,5% sd benh nhan la co bleu hien xuat huyet ndi tang.
Ty le benh nhan cd bleu hien xuat huyet trong nghien cffu cua tac gia nay la cao hdn cua chung tdi, dieu nay cd the diidc giai thfch la d mot sd nffdc phat trien nhff Han Quoc, Canada nhffng benh nhan giam tieu cau chffa rd nguyen nhan thffdng dffdc kham va quan ly thai nghen tdt hdn d Viet Nam nen viec phat hien cac trieu chffng nay thffdng cao. Tuy nhien trong nghien cffu nay thi t / le benh nhan cd xuat huyet niem mac va xuat huyet npi tang (la nhffng bleu hien ciia xuiit huyet nang) lai cao hdn so vdi nghien cuU cua Chung tdi dieu nay cd the giai thfch la do thdi diem nghien cffu khac nhau, thdi gian gan day kien thffc ve benh giam tieu rau ngay cang dffdc nang cao chfnh vi vay benh thffdng dffdc phat hien sdm hdn, neu dffdc phat hien sdm thi dffdc kiem soat dieu tri theo doi chat che hdn chinh vi vay ma tinh trang benh nang ngay cang ft di nen chung ta ft thay bieu hien cua tinh trang xuat huyet nang nhff xuat huyet npi tang.
Theo ket qua bang 4, ty le benh nhan khi vao vien lan dau va khi chuyen da deu khong cd bieu hien thieu mau la 99,4%, thieu mau nhe la 0,6%, khdng cd trffdng hdp nao thieu mau nang.
Nhff vay da sd thai phu giam beu cau chffa rd nguyen nhan vao Benh vien Phu san TW la khdng cd bieu hien thieu mau va neu cd thieu
mau thi hau het la thieu mau nhe ket qui nay la phu hdp vi da so benh nhan khdng cd bieu Wn xuat huyet. Ket qua nay phu hdp vdi ket qiia nghien cffu cua tac gia Kieu Thi Thanh (2010) tren nhihig thai phu giam tieu cau.
V. KET UJfyN
Trieu chffng lam sang cua thai phu giam Beu cau ciiffa rd nguyen nhan khi chuyen da la xuat huyet dffdi da bieu hien d dang cham va thieu mau nhe.
TAI U | U T H A M KHAO
1. Belkin A. levy A va Sheiner E (2009). Peiinatal outcomes and complications of pregnan^ m women with Immune thrombocytopenic purpiiffva J Matem Fetal Neonatal Med, 22 (11), 1080 - Ms.
2. Pham Quang Vinh (2007). Bai giang benh Iwc ndl khoa - tap I, Tru'dng Dai hoc Y Ha Npi, \U
xuat ban Y hgc, 25- 29. '!
i. Bui Thj Hu'dng Thu (2007). Nhan xet mot so thay doi lam sang va xet nghiem d benh nhan xuat huyet glamr tieu eau ehu3 ro nguyen nhan sau dieu tn corticoid dddng dnh mach, Khoa luan tot nghiep bac si y khoa Tru'dng Oai hoc Y Ha Noi, khoa 2001-2007.
^. Kieu Trj Thanh (2006-2010). Nghien cuti ^ diem lam sang, can lam sang va thai dgxiybim vdi thai phu xuat huyet giam tieu cau chda iS nguyen nhan tai benh viin Bach Mai, , Luan van tot nghiep cao hgc chuyen nghanh san phg Ithta Tru'dng dai hoc Y Ha Ngi.
5. K. E. Webert, R. Mittal, C. Sigouin va cong sii (2003). A retrospective 11-year analysis of obstetric patients with idiopathic thrombocytopenic purpura. Blood, 102 (13), 4306-4311.
6. Young - Woong Won va cong sff (2005).
Clinical aspect of pregnancy and Delivery in pabents with Chnanic Idiopathic Thrombocytopenic Purpura. The Korean Journal of Internal Medidne, 20,129 -134.
KET QUA DIEU TRI BO TRCX UNG THU* DAI T R A N G GIAI DOAN IMII BANG P H A C DO FOLFOX 4
TOM TAT
_ Nghien cffu tien cffu 194 benh nhan ung thu" dai trang giai doan II co yeu to nguy cd cao va giai doan
*Benh vien Tl/QD 108 Chju trach nhiem chinh: La Van Tru'dng Email: [email protected] Ngay nhan bai: 15.3.2017 Ngay phan bien khoa hoc: 3.5.2017 Ngay duyet bai: 16.5.2017
La Van Triroug*
III da phau thuat triet can dUpc dieu tr; hoa diat 1:^
tro phac do FOLFOX 4, cac tac gia rut ra mot so Idt luan sau:
- So benh nhan nam nhieu hOn so benh nhan nD (nam/nff = 1,34). Nhom tuoi co sd benh nhan nhieu nhat la 40 - 60 (69,5%). Vi trf ung thU hay gap nhat la dai trang Sigma (28,9%). Da so benh nhan cd Qnii trang toan than 0 diem (88,2%). Benh nhan giaido?n I I chiem 36,1%, giai doan III chiem 63,9%, co mo benh hpc the kem biet hda chiem 13,9%.
TAP CHi Y HOC VlfeT NAM TAP 455 • THAHG 6 - S01 - 2017 - Thdi gian sdng them khong benh 3 n3m u'dc tfnh
la 76,3%. Cac V| tri tai phat hay gap la: gan (32,1%), hach (20,7%), tai cho (18,9%). Thdi gian song them toan the 3 nam Udc tfnh la 84%.
SUMMARY
THE RESULT OF ADJUVANT CHEMOTHERAPY USING THE FOLFOX 4 REGIMEN I N STAGE I I
AND STAGE I I I COLON CANCER From a prospective study on 194 patients had undergone curative resection for stage I I with high risk and stage III colon cancer to receive adjuvant FOLFOX 4 treatment, the authors come to the following conclusions:
- Male patients outnumber female ones (males/females = 1.34). Patients aged 40-60 outnumber other age groups (69,5%). The most frequent site is Sigma (28,9%). Most patients have perfomance status of 0 score (88,2%). Patients in stage I I account for 36,1%, stage III for 63,9%, patients with histological poorly diffirentiated account for 13,9%.
- Free disease sun/ival of 3 years is estimated at 76,3%. Frequent sites of relapse are: liver (32,1%), lymphatic node (20,7%), regional recurrence (18,9%).
Overal survival of 3 years is estimated at 84%.
I. DAT VAN DE
Ung thff dai trang (UTDT) la mpt trong nhffng benh ung thff hay gap tren the gidl cung nhff d Viet Nam. Theo ghi nhan tinh hinh mac ung thff tai Ha Noi va thanh phd Ho Chi Minh nam 2000, UTOT xep cao thff 4 d nam va cao thff 3 d nff [1]. Nhieu thff nghiem lam sang cho thay dieu trj hda chat bd trd keo dai thdi gian sdng them khdng benh va thdi gian song them toan the cho benh nhan UTDT da phau thuat triet can [5], [6],[7]. Chung tdi thffc hien nghien cffu nay nham tim hieu mot sd dac diem lam sang, xet nghiem va hieu qua dieu trj hda chat bd trd phac do FOLFOX 4 ddi vdi nhffng benh nhan ung thff dai trang da phau thuat triet can tai Benh vien TlfQD 108 tff nam 2011 den nam 2016.
II. 001 TU'ONG VA PHU'ONG PHAP NGHIEN CUU 2.1. Doi t&dng nghien c&u:
- La nhffng benh nhan UTOT giai doan I I cd nguy cd cao va giai doan I l l d a phau thuat triet can dffdc dieu tri hda chat bd trd sau phau thuat bang phac do F 6 L F O X 4 tai BV 108 tff thang 1- 2011 den thang 12-2016.
- Loai ra khdi nghien cffu nhffng benh nhan:
+ Khdng phau thuat hoac khdng phau thuat triet can.
+ UTDT giai doan I, giai doan I I khdng cd hoac khdng ro yeu Ixi nguy cd cao va giai doan IV.
+ Khdng chap hanh dung phac do dieu trj.
+ Khdng cd day du ho sd nghien cffu.
+ Khdng danh gia dffdc tinh trang khi ket thuc nghien cffu.
2.1. Ph&dng phap nghien c&u: nghien c&u tiin c&Uf tiieo ddi dgc
- Ndi dung nghien cffu:
+ Oac diem benh nhan: tudi, gidl, vi tri ung thff, tinh trang toan than (theo ECOG - Eastern Cooperative Oncology Group), giai doan lam sang, cac yeu td nguy cd cao (theo NCCN - National Comprehensive Cancer Network), mffc dp biet hda cua te bao ung thff.
+Hieu qua dieu trj: thdi gian song them khdng benh, thdi gian song them toan the.
- Cac bffdc nghien cffu -1- Xay dffng mau nghien cffu.
+ Thu thap sd lieu theo mau nghien cffu.
-H Xff ly sd lieu bang phan mem SPSS 22.0.
Thdi gian sdng them khdng benh va thdi gian sdng them toan the ffde Iffdng bang phffdng phap Kapplan - Meier.
III. KET QUA NGHIEN CCrU
3.1. Dac diem benh nhan nghien c&u Tdng cdng cd 194 benh nhan du tieu chuan nghien cffu. Oac diem cac benh nhan nghien cffu the hien d bang 3.1
Bang 3.1: dac diem benh nhan nghien cij^u Chi tieu
Gidi: Nam NiJ Tuoi: < 40
40-60
> 60 - 70 Vi tri ung thu': Manh trang
Dai trang phai Dai trang ngang
Dai trang trai Dai trang Sigma Unq thu" c( nhieu vi tri Tinh trang toan than: 0 diem
So benli nhan (%)
i l l (57,2)
83 (42,8) 27 (13,9)
135 (69,5)
32 (16,6) 19 (09,8) 49 (25,3) 17 (08,8) 43 (22,1) 56 (28,9) 10 (05,1)170 (88,2)
VIETNAM MEDICAL JOURNAL N°1 - JUNE - 2017 1 cfiem
2 diem Giai doan benh: IIA
IIB IIIA
nc
IIIB IIIC YTNC cua giai doan I I *
Tac ruot Danh gia < 12 hach Xam lan mach mau Xam lan bach huyet Kem biet hoa
Thunq ruot The mo benh hoc: Biet hoa cao Biet hoa vu'a Kem biet hoa
19 (09,8) 04 (02,0) 42 (21,7) 15 (07,7) 13 (06,7) 36 (18,5) 53 (27,3) 35 (18,1) n = 42 (%)
6 (14,3) 20 (47,6) 10 (23,8) 9 (21,5) 8 (19,0) 2 (02,4) 76 (39,2) 91 (46,9) 27 (13,9)
^~<jS|
*YTNC: yiu tonguycdcdo 3.2.Thdigian sdng them khong bSnh:T6ng cong cd 53 benh nhan tai phat. Thdi gian song them khdng benh cua 194 benh nhan nghien cffu the hien d bleu do 3.1
Thdi gian sdng cdng don
=..<-) — _ Thang W Bieu do 3.1: thdigian sdng them khong benh
*Thdi gian sdng them khong benh 3 nam ffde ti'nh la 76,3%.
3.4. Thdi gian song thSm toan the
^ Cd 33 benh nhan tff vong. Cac benh nhan tff vong deu do tai phat ung thff. Thdi gian sdng them toan the cua 194 benh nhan nghien cffu the hien d bieu do 3.2
Thdi gian sdng cong don
'-,_
ThangBiS'u dS 3.2: thdigian sdng thSm toan the
*Thdi gian sdng them toan the 3 nam ffde tinh la 84%.
3.3. Vitri tai phat VI tri tai phat
Hach Gan Tai cho Phuc mac Thanh bunq
So lu'dt benh nhan 11 17 10 9 3
Tv le f % ) 20,7 18,9 17,0
05,7
.
TAP CHi Y HOC VlgT NAM TAP 455 - THANG 6 - SO 1 - 2017 Phoi
Xu'dnq Buonq triinq
6 5 4
11,3 09,4 07,6 IV. BAN LUAN
4.1. Bac diem ijenh nhan tru'dc diieu tii - Gidi, tudi: cac nghien cffu dich te hgc cho thay ty le mac ung thff dai trang d nam cao hdn nff, Iffa tudi mac benh cao nhat la 40-60. 6 nhdm benh nhan giai doan I I cd nguy cd cao va giai doan I I I ma chung tdi nghien cffu cung cd ty le nam caojidn nff (Nam/ Nff = 111/83 = 1,34) va nhdm tuoi 40 - 60 chiem tdi 69,5%.
- Vj tri ung thff: ung thff d dai trang Sigma chiem ty le cao nhat (28,9%), tiep theo la d dai trang phai (25,3%) va dai trang trai (22,1%).
Mdt nghien culi tai Benh vien K Trung ffdng giai doan 1983-1993 cung cho thay: ung thff d dai trang Sigma chiem 29,67%, d dai trang phai chiem 20,88%, d manh trang chiem 15,48%, d dai trang ngang chiem 14,2%, d dai trang trai chiem 16,48% va khdng ro vi tri la 2,2% [2].
- Tinh trang toan than: dai da sd cac benh nhan cd tinh trang toan than 0 diem (88,2%).
Nhff vay trffdc dieu trj hda chat bd trd cac benh nhan nghien cffu deu cd tinh trang toan than tdt, cd the dam bao lieu va ke hoach dieu trj. Tuy nhien dieu nay co the dffdc ly giai do 2 nguyen nhan. Mdt la cac benh nhan ung thff dai trang thffdng d Iffa tudi 40-60 va da diidc phau thuat triet can nen cd tinh trang toan than tot. Hal la trffdc dieu trj hda chat cac benh nhan ludn dffdc danh gia tinli trang toan than, cac benh ket hdp, xet nghiem cdng thffc mau, chffc nang gan than, xet nghiem chan doan hinh anh (sieu am, CT scanner, xa hinh xffdng...). Chi nhffng benh nhan cd tinh trang toan than < 2diem, cac xet nghiem sinh hda huyet hoc trong gidi han binh thffdng, xet nghiem hinh anh khdng con u ton dff mdi dffdc dieu trj hda chat bd trd. Nghien cffu thffc hien d nhdm benh nhan da dffdc chi djnh dieu tri hda chat nen da phan cac benh nhan cd tinh trang toan than tdt va khong cd benh nhan cd tinh trang toan than 3; 4 diem.
- Giai doan benh: gial doan I I chiem 3 6 , 1 % (IIA: 21,7%; I I B ' : 7,7%; IIC: 6,7%), giai doan I I I chiem 63,9% (IIIA: 18,5%; IIIB: 27,3%;
IIIC: 18,1%). Hffdng dan thffc hanh cua NCCN an ban nam 2016 khong khuyen cao sff dung FOLFOX cho cac benh nhan giai doan IIA (pT3N0M0) ma khdng cd yeu t d nguy cd cao [ 7 ] . Do vay, 42 benh nhan giai doan IIA trong nghien cffu cua chung tdi deu cd mpt hoac nhieu yeu to
nguy cd cao. Cac yeu t d nguy cd cao hay gap trong nghien cffu cua chung tdi la: danh gia <
12 hach (47,6%), xam lan mach mau (23,8%), xam lan bach huyet (21,5%). Hyeong ~ Joon Jeon (2011) hoi cffu 82 benh nhan ung thff dai trang giai doan I I - I I I dffdc dieu tri bd trd FOLFOX, cd 13 benh nhan giai doan I I (15,8%) [5]. Ty le benh nhan giai doan I I cua chung tdi cao hdn. Xem xet cu the chung tdi thay d nghien cffu cua chung tdi gan mot nffa sd benh nhan giai doan IIA cd yeu t d nguy cd cao lien quan den danh gia < 12 hach. Oieu nay cho thay can cd sff phdi hdp chat che giu^ cac phau thuat vien va cac nha md benh hpc de khao sat du 12 hach nham giam so benh nhan giai doan IIA phai dieu tri hda chat bd trd khdng can thiet.
- Mffc dd biet hda: mffc do biet hda kem cd tien Iffdng xau. Ty le benh nhan cd md benh hpc biet hda kem trong nghien cffu cua chung tdi chiem 13,9%. O nghien cffu MOSAIC ty le nay la 10,4% d nhdm FOLFOX 4 va 9,4% d nhdm FU-FA.
4.2. Hieu qua dieu trj
- Td'ng cdng cd 53 benh nhan tai phat. Thdi gian sdng them khdng benh 3 nam ffde tfnh la 76,3%. Trong nghien effu cua chung tdi d 136 benh nhan ung thff dai trang dffdc dieu trj bd trd gial doan 2008 - 2013, thdi gian song them khdng benh 3 nam ffde tinh la 73% [3]. Ty le nay d nghien effu cua Hyeong - Joon Jeon, Jin - Hee Woo va cdng sff (2011) la 82,9% [5], d nghien cffu MOSAIC (2004) la 78,2% d nhom dieu tri FOLFOX 4 va 72,9% d nhdm FU-FA [6].
- Cac vi tri tai phat hay gap la: gan (32,1%), hach (20,7%), tai cho 18,9%. Tai phat d thanh bung la 5,7%. Cac vj tri tai phat hay gap d nghien cffu cua chung tdi giai doan 2008 - 2013 la: hach (23%), gan (23%), tai chd (19,2%). Tai phat d thanh bung la 19% [3]. Ket qua nay cho thay cd sff tien bo trong vet hach qua phau thuat ndi sol ya tranh lay nhiem te bao ac tinh qua thanh byng. 6 nghien ciili cua Hyeong - Joon Jeon, Jin - Hee Woo va cdng sff (2011) 3 vj tri ^ 1 phat hay gap (an Iffdt la xffdng, gan va hach [5].
- Tong edng cd 33 benh nhan tff vong. Thdi gian song them toan the 3 nam ffde tinh la 84%.
Ty le nay d nghien cffu cua Hyeong - Joon Jeon, Jin - Hee Woo va cdng sff (2011) la 87,5% [5], d nghien cffu MOSAIC (2004) la 87,7% d nhdm dieu tri FOLFOX 4 va 86,6% d nhdm FU-FA [6].
VIETNAM MEDICAL JOURNAL N't - JUNE - 2017
V. KET LUAN
- Sd benh nhan nam nhieu j i d n sd benh nhan nff (nam/nff = 1,34). Nhdm tudi cd so benh nhan nhieu nhat la 40 - 60 (69,5%). Vj tri ung thff hay gap nhat la dai trang Sigma (28,9%). Da ^s6 binh nhan cd tinh trang toan than 0 diem (88,2%). Benh nhan gial doan I I chiem 36,1%, giai doan I I I chiem 63,9%, cd md benh hpc the kem biet hda chiem 13,9%.
- Thdi gian sdng them khdng benh 3 nam ffde tinh la 76,3%. Cae vi tri tai phat hay gap la: gan (32,1%), hach (20,7%), tai cho (18,9%). Thdi gian song them toan the 3 nam ffde tfnh la 84%.
TAI U | U THAM KHAO
1. Nguyen Ba Du'c, Nguyen Thj Hoai Nga (2007).
Did! te hoc benh ung thu". Chan doan va dieu tri benh ung thu". Nha xuat ban y hoc: 9-19.
2. Bai giang ung thu' hpc Nha xuat ban Y hoc 1997 3. La Van Tru'dng, Nguyen Thi Minh Phwna
Nghien cUu dieu tri hoa chat bo trcJ ung thir fla trang tai Benh vien Trung u'dng Quan doi ing S nam 2008 - 2013. Tap chf Thong tin Y duWc ^-
3/2013.29-33. ^'^
t. Lisa Baddi. Adjuvant therapy in stage n (ska Cancaer: current Approaches. The OncolooKj
2005, 10: 325-331. ^^
5. Hyeong - Joon Jeon, Jin - Hee Woo et all Adjuvant chemotherapy Using the FOFOX 4 regimen in Colon Cancer. Juornal of the Kerean Society of Coloproctology 2011; 27 (3): 140-145 6. Thierry Andre', MD, Corrado Boni et all Oxaliplatin, Fluorouraeil, and LeucovorinM Adjuvant Treatment for Colon Cancer. The.lw England Journal of Medicine 2004; 350; 2343-51 7. NCCN - National Comprehensive Cancer
Network. Vesion 2.2016.
GIA TRI TIEN LITONG BIEN CO TIM MACH NOI VIEN CCA RUNG NHI TRONG NHOI M A U C a TIM CAP
T6MTAT
Md ^ u : Rung nhT (RN) la mot roi loan nhip thffdng gSp d BN (BN) nhoi mau cd bm (NMCT) cap, ty IS tu 5% den 23%. RN lien quan den tSng cac bien CO tim mach, tang tff vong npi vien. Viet Nam chu'a co nhieu NC chuyen biet ve RN d BN NMCT cap. Muc tieu: Danh gia gia tri tien IffOng noi vien ciia RN trong NMCT cap. PhiAKng phap NC: NC tien cuff md ta tff 08/2015 den 06/2016 tren 560 BN NMCT cap dieu trj tai cac khoa hoi sffc va tim mach BV Nhan dan 115.
Danh gia lien quan giij^ RN va bien cdbm mach cung nhu" tff vong npi vien dUa tren b/ so chenh du'pc tinh theo phffdng trinh hoi quy logistic ddn bien vdi khoang dn cay 95%. Sff dung phan mem SPSS 22.
Ket qua: Giai doan noi vien: ty so chenh suy tim surra huyet cua RN la 5,0[2,1-12,0], ty so chenh phu phoi cap 2,4[l,3-4,3]; ty so chenh sdc tim 2,5[1,3- 4j7]; ty so chenh tff vong noi vien l,7[0,8-3,2]; va t / so chenh bien co tim mach chinh 2,5[l,3-4,5]. Ket luSni^RN b-ong NMCT cap cd y nghia tien doan dff hau xau noi vien. Ty so chenh bien co tim mach chfnh npi vien cua RN la 2,5 [1,3 - 4,5].
*Benh w$n ChdRay
** Benh vien Nhan dan 115
*** Bg Mon Noi Dai hgc Y Pham Nggc Thach Chju trach nhiem chinh: Huynh Kim Phffdng Email: [email protected] Ngay nhan bai: 8.3.2017 Ngay phan bien khoa hpc: 3.5.2017 Ngay duyet bai: 16.5.2017
Huynh Kim Phu-cmg*, Pham Tu QuJ'nh**
Nguyen Thanh Hien**, Le Cong Tan***
SUMMARY
SHORT-TERM PRONOSHC VALUE OF ACUTE MYOCARDIAL INFARCHON- ASSOCIATED ATRIAL FIBRILLATION Background: Atrial fibrillation (AF) is a commDn significant arrhythmia complication of acute myocardial infarction (AMI), the incidence of AMI- caused AF is around 5%-23%. AF is recognized in the relation to cardiovascular outcomes; increasing in- hospital mortality. In Viet Nam cunently, there are not too many professional researches about AF related to AMC. Objective: Assessing short-term risk value of atrial fibrillation related to AMI. Method! The prospective descriptive study from Aug. 2015 to June 2016 of 560 AMI patients at Intensive Care Department and Cardiology Department of People's hospital 115. Diagnosis of AF is based on symptoms and ECG. The odd ratio will be calculated by logisft:
recurrent equation with p value <0.0S. Using software SPSS 22. Results: For the AMI population, the incidence of AF in AMI group is 8.6%. Durwg hospitalized time: the odd ratio of congestive heart failure in AF is 5.0 [2.1-12.0], the odd rabo of acute pulmonary edema is 2.4 [1.3-4.7]; the odd rabotf cardiac shock is 2,5 [1,3-4,7]; the odd ratio of deatti IS 1.7 [0.8-3.2]; the odd ratio of main cardiovasoW outcomes is 2.5 [1.3-4]. Conclusion: AMI-assoaatefl AF is bad significant prognosis in hospitalized tme.
The odd ratio of main canJIovascular outcomes m hospitalized time of AF is 2.5 [1.3-4.5]. ,
Key words. Acute myocardial infercBon, atnai fibrillation, main canjiovascular outcome.
