TAP CHi Y HOC VlgT NAM TAP 459 - T H A N G 10 - SO 2 - 2017
NGHIEN Ciru CAC TAC DUNG KHONG MONG MUON CUA OXYTOCIN TRONG MO LAY THAI KHI TIEM TINH MACH TRITC TIEP CO HAY
KHONG PHA LOANG HOAC TRUYEN TINH MACH
TOM TAT
Muc tieu: Danh gia cae tac dung khdng mong muon cua oxytocin trong mo lay thai khi sir dung bang ba phu'dng phap: tiem tinh mach tri/c tiep khong pha bang, ti6m tTnh cd pha loang hoac truyen tinh mach.
Ofifi tu'dng, phu'dng phap: Thir^ nghiem lam sang ngau nhien eo so sanh, 90 benh mo lay thai du'dc chia thanh 3 nhom, sir dung 10 ddn vi oxytocin sau khi lay thai bang ba each, nhom 1: Tiem tinh mach tru'c tiep khong gha loang, nhom 2: Pha loang trong 10 ml NaCI 0,9% roi tiem tinh mach cham trong 1 phiit; nhom 3:
pha trong 50 ml NaCi 0,9% va truyen tTnh mach trong 5 phiit. Ket qua: Ty le dau tiTc ngy'c va danh trong ngu'c ciia ba nhom 1, 2, 3 tu'dng inig la: 0%; 6,6%;
6,6% va 73,3%; 53,3%; 30%. Ty le bi dd da va man ngira ciia ba nhom tu'dng iTng la: 16,7%; 10%; 6,6%
va 10%; 6,6%; 3,3%. Ty le non, buon non ciia ba nhom tu'dng irng la: 10%; 3,3%; 3,3%. Ket luan:
Tmyen tTnh macFi 10 ddn vj oxytocin pha trong 50 ml NaCI 0,9%, sau khi lay thai it gay dau tiTc ngi/c va danh trong ngi/c hdn so vdi tiem tinh mach triic bep khong pha loang hoac tem 6nh mach tn/c bep c6 pha Ireing, trong khi cac tac dung khong mong muon khac Wiong CO su" l-^ac biet (dd da, man ngirS, non, buon non).
Tu' khoa: Oxytodn, mo lay thai, tac dung khong mong muon
SUMMARY
RESEARCH THE SIDE EFFECTS OF OXYTOCIN I N CEASAREAN SECTION WHEN
ADMINISTERED BY TREE METHODS:
INTRAVENOUS INJECTION NON DILUTED OR DILUTED OR INFUSION Objectives: To evaluate the side effects of oxytocin on caesarean section when administered by three methods: direct intravenous injection undiluted, direct intravenous injection diluted or infusion.
Subjects, methods: Randomized comparative dinical trial, 90 cesarean sections divided into 3 groups, 10 units of oxytocin after delivery in three groups, group 1: Direct intravenous injection undiluted, group 2: Diluted in 10 ml of NaCI 0.9% and slowly intravenously injected for 1 minute; Group 3:
Diluted in 50 ml of NaCI 0.9% and infused intravenously for 5 minutes. Results: The rate of chest pain and palpitabons of the three groups 1, 2, 3
*Dai hoc Y Ha Noi
Chju trach nhiem ehinh: Nguyen Dire Lam Email: [email protected] Ngay nhan bai: 20.8.2017 Ngay phan bien khoa hgc: 4.10.2017 Ngay duyet bai: 17.10.2017
Nguyen Dire Lam*
were: 0%; 6.6%; 6.6% and 73.3%; 53.3%; 30%.
Skin redness and rash of the three groups were 16.7%; ten%; 6.6% and 10%; 6.6%; 3.3%, The nausea and vomiting rate of the three groups were 10%; 3.3%; 3.3%. Conclusion: Intravenously infusion of 10 units of oxytocin diluted in 50 mi of NaCI 0.9%, after delivery had less chest pain and palpitation than intravenous direct undiluted or diluted, while other side effects were not different (Skin redness, rash, vomiting, nausea).
Keywords: oxytocin, caesarean section, side effects
I. OAT VAN DE
Oxytocin la thuoc du'dc diing phd bien trong san khoa, thuoc cd tac dung eo hdi tiT eung giiip han che mat mau trong md lay thai, chdng dd tiT cung. Vi vay, trong mo lay thai, sau khi lay thai xong, ngu'di ta ludn sir dung 5 - 1 0 ddn vj oxytocin tiem tTnh mach hoac truyen tTnh mach.
Tuy nhien, ngoai tac dung gay co tir eung, oxytocin cdn cd nhij'ng t^e dung khdng mong mudn khac dac biet tren tim mach, tren huyet ap, gay do da, dau ngiTc, man ngira...cae tac dung khdng mong mudn nay khdng chi gay khd chiu eho benh nhan ma tham ehi anh hu'dng den tinh mang eiia benh nhan khi hp dang du'Oe gay te tiiy sdng de md lay thai. Theo bao cao cae tru'dng hop tir vong ngu'di me d Anh, cd mot tru'dng hpp san phu thieu khdi lu'Ong tuan hoan da tir vong sau khi tiem tTnh mach nhanh 10 ddn vj oxytocin. 6 nu'dc ta, oxytocin van ehii yeu du'dc tiem tTnh mach triTc tiep va it du'dc quan tam den cac tae dung khdng mong mudn cua thudc nay. TiT thdc te dd, ehung tdi tien hanh nghien ciru nay nham mue tieu: Oanh gia cac tac dung khdng mong mudn eua oxytocin trong md lay thai khi sir dung bang ba phu'dng phap: tiem tTnh mach triTc tiep khdng pha loang, tiem tTnh cd pha loang hoac truyen tTnh mach.
II. E>6l TyQNG VA PHU'aNG PHAP NGHIEN CU'U 2 . 1 . Dol tu'dng nghien cii'u
*Tieu chuan lu'a chon: Cac san phu cd ehi djnh md lay thai cd siTc khde tot, ASA dp I, I I . Thai dii thang, khdng ed dj tat bam sinh. Khdng sir dung oxytocin tru'dc mo.
* t i e u chuan loai triT: Benh nhan tir chol tham gia nghien ciTu. Cac tru'dng hdp chong chi djnh gay te tiiy sdng. Cae tru'dng hpp bj chay
VIETNAM MEDICAL JOURNAL N°2 - OCTOBER • 2017 mau nhieu hoac cd nguy cP d d tu' cung sau mo
(da thai, da di,,.). Cd benh ly ndi khoa dac biet benh ly tim mach kem theo.
2.2. Phu'dng phap nghien cihi: Thir nghiem lam sang, ngau nhien cd so sanh. Nghienciru du'dc tien hanh tren cac benh nhan ddric md lay thai tiong thdi gian tir thang 7 - 1 2 nam 2007, tai khoa Gay me hdi su'c, Benh vien Phu san TW.
Cd mau: 90 benh nhan diTdc phan loai ngiu nhien thanh 3 nhdm bang nhau:
-Nhdm 1: Tiem tTnh mach triTc tiep 10 ddn vi oxytocin sau khi lay thai.
-Nhdm 2: Pha loang 10 dPn vj oxytocin ciing vdi NaCI 0,9% thanh 10ml, tiem tTnh mach trong 1 phiit sau khi lay thai.
-Nhdm 3: Pha 10 dPn vl oxytocin trong 50 ml dung djch NaCI 0,9%, truyen tinh mach nhanh trong 5 phut.
Thudc va phu'dng tien nghien ciTu: Thudc oxytocin dng 1ml chiTa 5 ddn vj oxytocin cua
hang Gedeon Riehter, Hungari. May theo doi trong gay me hoi su'c ciia hang Nihon Konden Nhat Ban. Cac thudc dimg trong hdi siTc va cac loai djch truyen.
2.3. Cach thii'c ti§n hanh: Lira chon benh nhan theo tieu ehuan nghien eiru, kham trirdc md, giai thfch eho benh nhan ve cuge mo phu'dng phap vd cam va ve nghien eiru.
Gay te tiiy song d L3 - 4 bang kim 27G. Lieu thudc te bupivacain (Mareaine) 8mg phdi hdp vdi 25mcg fentanyl. Tien hanh phau thuat khi ire che cam giac dau den T6. Khi lay thai xong thi bat dau sir dung oxytocin theo cac phac do ciia moi nhdm nghien ciru.
Theo ddi lien tuc cac chi sd sinh tdn, miTc do u'e che cam giac, van ddng, cac tac dung khong mong mudn gap phai trong mo va sau mo 6 gid.
2.4. Xu* ly so lieu: Sd lieu nghien cufu diTdc ghi vao phieu nghien culi va du'dc xir ly theo chu'dng trinh SPSS 12.0.
III. KET QUA NGHIEN CLTU
Bing 1. Bac dli'm chung ciia sin phu vi thai nhi
Nhom l ( n = 3 0 ) Nhdm 2(n = 3 0 ) Nhom 3 ( n = 301 Tudi (nam) 29 ± 4,3(22 - 41) 30,7 ± 4,3(23 - 42) 28,3 ± 3,9(21 - 39) Chieu eao (cm) 156,3 ± 4,4(150 -165: 155,2 ± 4,6(150 -164) 155,9 ± 5,3(148 - 163) Can nang (kg) 62,8 ± 6,9(47 - 81) 61,8 ± 8,4(50 - 82) 64,7± 7,0(53 - 79) Tuoi thai (tuan) 39,8 ± 1,2(38-41) 39,3 ± 1,4(38 - 40) 39,5 ± 1,6(38 - 41)
Can nang sd 3128,3 ± 275,4 3212,5 ± 296,6 sinh (g) | (2500 - 4100) | (2650 - 4050}
3095,7 ± 301,4 (2450 - 4250)
Nhin xet: Cac dac diem chung eiia san phu va thai nhi khdng cd siT khac biet cd y nghTa thong ke giii'a ba nhdm.
Bang 2. Oac diem ciia gay te tuy song vi thdi gian phau thuit N h o m l
f" = 3 0 )
Nhom 2 (n = 3 0 )
Nhom 3 Cn = 3 0 ) P
ToiM
>0.05
>0.Q5
>0.05
Lieu bupivacain (mg) 8,1 ± 0,34 7,9 ± 0,5
Thdi gian khdi te den T6 (phut)
MiTc dc che tdi da > T4 n(%) 4,7 ± 1,5 5,1 ± 1,2 Lfe che van ddng Bromage do 3
sau gay te 10 phiit n(%)
1 (3,3%) 2(6,€
23 (76,6%) 25 (83,3%) 26 (86,7%) Thdi gian phau thuat (phiit) 31,7 ± 7,5 29,8 ± 8,0 30,5 ± 6,9 Nhan xet: Khdng ed SLT khac biet ed y nghTa thdng ke ve cae dac diem gay te tuy sdng gian phau thuat ciia ba nhdm nghien ciiu.
Bang 3. Thay ddi dc xet nghiem huyei hoc tru'dc va sau md
>Q.Q5 va thcJi
So lu'dng hong cau (G/l)
Hb(g/I) Ht {%) So lu'dng bach
cau (G/l) Tieu cau (G/l)
Tru'dc Sau TrMc
Sau TrUdc
Sau Trifdc
Sau TrWdc
Sau
Nhom l ( n = 60) 4,22 ± 0,3 4,9 ± 0,31 120,3 ± 11,6 111,7 ± 12,3 0,391 ± 0,041 0,345 ± 0,032 9,15 ± 1,78 10,69 ± 1,65 220,7 ± 37,0 187,7 ± 36,
Nhom 2(n= 60) 4,31 ± 0,41 4,09 ± 0,37 126,3 ± 12,1
114,8 ± 9,8 0,387 ± 0,029 0,362 ± 0,043 9,35 ± 1,61 11,2 ± 1,93 237,6 ± 44,8 197,3 ± 39,9
Nhom 3Cn=60) 4,27 ± 0,35 3,96 ± 0,39 124,5 ± 10,9 110,6 ± 10,1 0,375± 0,037 0,332 ± 0,028 8,95 ± 1,57
11,7 ± 1,8 217,3 ±41,1 178,8 ± 35,5
P
>0.05
>0.05
>0.05
>0.05
>0.05
>0.05
>0.05
>0.05
>M5_
jL?i25-
TAP CHl Y HOC VIET NAM TAP 459 - THANG 10 - SO 2 2017
Nhan xet: Hb va Ht sau mo d ca ba nhom nghien cu'u deu giam co y nghTa thong ke so vdi tru'dc mo (p '< 0,05).
Bang 4. Thay doi tren dien tim khi sti' dung oxytocin Nqoai tam thu that nhip dol
Nqoai tam thu that < 10%
Loan nhip xoanq ST chenh ien
Nhom l ( n = 3 0 ) 1 (3,3%)
0 2 (6,6%) 1 (3,3%)
Nhom 2 ( n = 3 0 ) 0 1 (3,3%) 1 (3,3%) 1 (3,3%)
Nhom 3 ( n = 3 a ) 0 2 (6,6%)
0 0
P
>0.05
>0.05
>0.05
>0.05 Nhin xet: Nhdm 1 va nhdm 2 cd ty ie rdi idan nhip tim nhieu hdn so vdi nhdm 3, tuy nhien sif khac biet ithong cd y nghTa thdng ke (p > 6,05).
Bang 5. Cac tac dung ithong mong muon
£>dda Man nqiya Ndn, buon ndn
Dau ttfc ngu'c Danh trcnq nqi/c
Nhom l ( n = 3 0 ) 5 (16,7%)
3 (10%) 3 ( 1 0 ) 2 (6,6%) 22 (73,3%)
Nhom 2Cn = 3 0 ] 3 (10%) 2 (6,6%) 1 (3,3%) 2 (6,6%) 16 (53,3%
Nhom 3 ( n = 3 0 ) 2 (6,6%) 1 (3,3%) 1 (3,3%)
0*
9 (30%)*
P
>0.05
>0.05
>0.05
<0.05
<0.05 p < 0,05 so vdi nhdm 1 va nhdm 2 Nhin xet Nhdm 3 cd ty le dau tii'c ngiTc va danh trdng ngi/c thap hdn ed y nghTa thdng ke so vdi nhdm 1 va nhdm 2 (p < 0,05).
IV. BAN LUAN
Ket qua d bang 1 cho thay: Cac dac diem Chung eiia san phu va thai nhi d hai nhdm khdng cd sir khac biet va deu trong gidi han binh thu'dng. Thai nhi dii thang, khdng ed cae di tat bam sinh du'dc chan doan tru'dc hoac sau sinh.
TnDng nghien cu'u nay, chiing tdi tap trung danh gia cac tac dung khdng mong mudn eiia oxytocin tren san phu du'dc gay te tuy sdng de md liiy thai. Do ed mdt sd tae dung khdng mong mudn ciia oxytocin eiing giong tae dyng khdng mong mudn ciia gay te tiiy sdng (vi du: ndn, buon ndn...) nen phai dam bao ba nhdm nghien ClTu deu du'dc gay te tiiy song theo eiing mot phac dd giong nhau. Ket qua bang 2 cho thay cae benh nhan d ca ba nhdm deu du'dc vd cam tdt trong md, thdi gian mo cung khdng ed sir khac biet cd y nghTa thdng ke.
Oanii gia mat mau trong md lay thai rat khd vi cd lan nu'dc oi. Vi vay, ehimg tdi danh gia lu'dng mau mat qua xet nghiem tai cdng thud m k sau khi md va so vdi gia trj tru'dc md.
Chung tdi thay: Sd lu'dng hong cau, bach cau, deu cau, Hb, Ht khong cd sir khac biet giite^eae nhdm nghien cu'u d ca thdi diem tru'dc md va sau mo. Dieu nay cung giiip han che cac sai so trong nghien cii'u do mat mau nhieu ciing ed the gay cac tac dung khdng mong muon chong lan tac dung khdrig mong mudn ciia oxytocin. Sau md lay thai, hai chi so Hb va Ht eiia cac benh nhan d ca ba nhdm nghien eirli deu giam ed y nghTa thdng ke so vdi tru'dc md (p < 0,05). Cac nghien ciru ciia Thomas J.S va Pinder A deu ehi ra rang: Lu'dng mau mat trong mo lay thai khdng
ed SlT khac biet khi tiem tTnh mach triTc tiep oxytocin hay truyen tTnh mach [2], [3]. Ket qua Hb va Ht ciia cac benh nhan sau md lay thai d ba nhdm nghien ciTu khdng ed siT khac biet cting gian tiep cho thay tac dung cua oxytocin sir dung theo ba each khac nhau nhu'ng deu ed tae dung tu'dng du'dng nhau. Theo y van, cd the cae yeu td nhu' gian mach sau gay te tiiy song, mat mau trong mo lay thai gdp phan lam tang cae tac dung khdng mong mudn cua oxytocin len san phu va ddi khi gay cae bien chiTng nguy hiem den tinh mang benh nhan.
Tac dung khdng mong mudn cua oxytotcin la ed the gay cac roi loan nhip tim. Trong nghien eiru eiia chiing tdi, cd gap cac thay ddi nhjp tim sau khi sir dung oxytocin bang ba each khac nhau. Dae biet, d nhdm tiem tTnh mach triTc tiep oxytocin khdng pha loang (nhdm 1), cd gap mdt benh nhan xuat hien ngoai tam thu that nhjp ddi phai dieu tri. Nhdm truyen oxytocin (nhdm 3) it gap cae rdi loan nhip tim khac nhiT loan nhjp xoang hoac ST chenh len, tuy nhien, cd the do c6 mau nghien ciTu ciia ehung tdi chiTa du Idn nen chu'a cd siT khac biet ed y nghTa thdng ke (p
< 0,05). Thomas T.A da bao eao mot tru'dng hdp benh nhan tut huyet ap, mach cham sau gay te tiiy sdng de md lay thai, sau khi lay thai chay mau nhieu, benh nhan ngirng tim sau khi tiem tinh mach nhanh khdng pha loang 10 ddn vi oxytocin [1].
Cac tae dung khdng mong mudn khac ma ehung tdi gap trong nghien ciTu du'dc the hien trong bang 5. 06 da, dac biet la da viing mat, do oxytocin gay gian macti ngoai da. Ty le dd da d nhdm tiem tTnh mach tri/c tiep cao hdn so vdi
VIETNAM MEDICAL JOURNAL N°2 - OCTOBER - 2017 hai nhdm cdn lai tuy nhien khdng ed su" khac biet
ed y nghTa tdng ke ed the do ed mau trong nghien cdu eiia chiing tdi chu'a du Idn. Ndn ya buon ndn la tae dung khdng mong mudn ga^
nhieu khd chju cho benh nhan. Non trong mid con gay can trd qua trinh phau thuat. Ty le ndn va buon ndn d ba nhdm nghien ciTu eiia chiing tdi khdng ed siT khac biet ed y nghTa thdng ke va ty le ndn va budn ndn eiia chiing toi thap hdn so vdi Sartain J.B (32,5% khi tiem tTnh mach triTc tiep 5 ddn vi oxytocin sau dd truyen tTnh mach 10 ddn V! oxytocin). Trong nghien ciTu cua Wedisinghe L, t^ ie benh nhan buon ndn d nhdm tiem tinh maeh oxytocin eao hdn cd y nghTa thdng ke so vdi nhdm truyen tTnh mach oxytocin (20% so vdi 7%) [5]. -Dae biet trong nghien ciTu eua ehung toi thay ty le dau tdc ngiTc va danh trdng ngiTc d nhdm truyen oxytocin tTnh mach thap hdn cd y nghTa thdng ke so vdi hai nhdm tiem tTnh mach oxyotein. Dau tiTc ngiTe cd Hen quan den nhjp tim nhanh, vi vay, khdng du'dc tiem tTnh mach oxytocin cho cae benh nhan cd benh ly tim mach nhu' thieu mau cd dm, hep van hai la hoac hep van ddng maeh chu..,Ty le dau tire ngiTc trong nghien euii eiia chiing toi d nhdm 1 va nhdm 2 tiTdng du'dng vdi eiia Carvalho CA (5%) [3].
V. KET LUAN
Truyen tTnh maeh 10 ddn vl oxytocin pha trong 50ml NaCI 0,9%, bat dau sau khi lay thai It gay dau tiTc ngy'c va danh trdng ngu'c hdn so vcli tiem tTnh mach triTc tiep hoac tiem tTnh macli tru'c tiep sau khi pha loang (khong gap triring hdp nao dau tdc ngu'c so vdi 6,6% d nhom 1 va nhdm 2; ty le danh trdng ngiTc la 30% so v^
73,3% d nhdm 1 va 53,3% d nhdm 2), trong khi eac tac dung khdng mong mudn khac khong co sir khac biet (dd da, man ngira, ndn, buon non).
TAI LIEU T H A M KHAO
1. Thomas T.A. (2002), "Maternal deaths from anaesthesia. An extract from Why mothers die 1997 - 1999, The Confidential Enquiries into Maternal Deaths in the United Kindom", British Journal of anaesthesia, vol 89, No3, 499-508.
2. Thomas J.S (2007), "Heamodynamic effects of oxytocin give as I.V bolus or infusion on women undergoing Ceasarean section", , Br 3 Anaesth 98 (l):116-9.
3. Pinder A. "Heamodynamic changes caused by oxytocin dunng ceaserean section under spinal anesthesia". International Journal of Obstetric aneshtesia. Voium 11, issue3, p.156-159.
4. Wedisinghe L. "Use of oxytodn to prevent haemorrhage of practice in United Kindom"., Eur J Obstetrics gynecology repro 2007, June 1.
CHAT LirffNG SONG LIEN QUAN SITC KHOE CUA TRE MAC DAI T H A O DU-ffNG TYP 1 sO* DUNG THANG DO PedsQL 4.0
Can Huyen Han*, Le Trong Tu*, Nguy6n Phu fiat*
T O M TAT
Hue tieu: Danh gia chat lu'Ong song (CIS) hen quan sii'c khoe ciia tre em mac dai thao du'dng typ 1 (DTDl). Dol tu'dng va phu'dng phap: Si^ dung thang do CIS lien quari sire khde tre em PedsQL 4.0 danh gia 129 tre mac DT£)1 da du'dc dieu tri va^theo doi vdi thdi gian tmng binh 33,5 ± 20,0 thang; tuoi trung binh 10,3
± 4,0. Ket qua: Diem CIS do ban than tre DTDl danh gia trong linh vu'c the chat, cam xuc, quan he ban be - x l hoi, hoc tap va CIS chung lan lu'dt la: 84,2 ± 8,4;
64,9 ± 9,9; 77,3 ± 10,1; 75,2 ± 9,0; 76,5 ± 6,1. Diem CLS khi cha/me tre danh gia tu'dng dng la: 77,8 ± 9,9;
70,9 ± 9,3; 75,3 ± 8,6; 71,3 ± 7,8; 74,3 ± 5,7. Ket luan: CLS ciia tre DTDl giam so vdi tre khoe manh binhthudng. CLS do cha/me tre mac benh danh gia tti3P:hdn so vdi tre tiT danh gia.
-Tiy khoa: Chat lu'dng sdng, tre em, dai thao dudng typ 1
Tru'dng dai hgc Y Ha Noi Chiu trach nhiem chinh: Can Huyen Han Email: [email protected] Ngay rihan bai: 19.8.2017 Ngay phan bien khoa hoc: 5.10.2017 Ngay duyet bai: 16.10.2017
SUMMARY
HEALT>1-RELATED QUALITY OF LIFE IN CHILDREN WITH TYPE 1 DIABETES MELLITUS
BY PedsQL 4.0 GENERIC CORE SCALES Aim: To evaluate the health related quality of life (HRQOL) of children with type 1 diabetes mellitus (TIDM). Patients and Method: Health related quality of life were evaluated in 129 TIDM chitdren with mean age: 10,3 ± 4,0 and treated for 33,5 ± 20,0 months. All children were assessed through a cross - sectional appnaach using the Pediatric Quality of Life Inventory 4.0 generic core scales (PedsQL 4.0).
Results: The TIDM children reported HRQOL in physical, emotional, social, school areas and the total HRQOL is: 84,2 ± 8,4; 64,9 ± 9,9; 77,3 ± 10,1; 75,2
± 9,0; 76,5 ± 6,1. According to the parent proxy- report, the result of HRQOL in correlative areas is:
77,8 ± 9,9; 70,9 ± 9,3; 76,3 ± 8,6; 71,3 ± 7,8; 74,3
± S,7. Conclusions: The TIDM children reported significantly lower HRQOL than those of healthy children. According to the child self-report, the HRQOL was significantly higher than their parent proxy-report.
Keywords: Quality of life, children, type 1 diabetes mellitus.
