Chung tdi phan biet "ed kfnh" va "khdng ed kinh" vi thffe te cdng ddng khong dii kfnh de sff dung hoac khdng biet rang ed mang kfnh se ed thj lffe tdt hdn. 'Thj lffe ed kfnh" nghia la kfnh ed dd phu hdp do to cdng tac do va thff kinh ehff kiiong phai kinh hp dang sff dung. Sff khac biet nay ndi Ien tam quan trpng cua viec mang kfnh phu hdp.
4.2.2. Thi i&c vdi trinh do van hoa: Ti Ie T I binh thffdng tang dan theo trinh dp van hda, trong do "Mu ehff" cd t i le thap nhat (3,8%) ed le hau het hp thude the he Idn tudi,^ khdng diidc phd cap tieu hpc bat budc nhff tuoi di hpc hien nay. I^gffdi eang Idn tuoi thi ti le TL binh thffdng cang thap vi cae benh ly lien quan den tud'i gia thffcfng gap nhff: due the thuy tinh, thoai hda vdng mac tuoi gia, huyet ap, dai tJiao dffdng [5].
Trong nhieu nghien cuff eho thay TL ed lien quan den trinh do van hda, d day ngoai trff 94%
ed TL binh thffdng, cdn lai hpe sinh PTCS va PTm xap xi ngang nhau (96,7% va 96,8%). Nghien euU nay phu hdp vdi Nguyen Xuan Hiep [3].
V. KETLUiBkN 5 . 1 . Dac d i e m m a u
- Thi Iffc thay doi nhieu theo tudi nhffng khong phu thudc vao eae vung dja ly.
- Mau ngau nhien he thong bao phii nghieu lii^ tudi va trinh dp hpc van khac nhau.
- Ty Ien nam nff xap x! ngang nhau.
5.2. Thi l y c
- Ngffdi mill ehff cd TKL thap hdn.
- Kinh cd tae dung nang TL len rd ret
- Ngffdi miJ cdn ty le kha coa trong cdng d6ng (1,5%)
KIEN NGHj
1. To chffc kham tam soat benh mat dinh '^
phat hien ra cac nguyen nhan ehinh gay mu va giam thj lffe.
2. Tang cffdng giao due tuyen truyen ve %\f dung kfnh deo dung vao hdp ly eho nhan dan, dae biet ia tuoi hpc sinh.
TAI UEU T H A M KHAO M 1. Ky yeu Hoi nghi Phong chdng Mil 16a va Khoa hlf
\^ thuat nganh Nhan khoa toan quoc 2005-Zcfe Kie'm soat cac benh gay mu tai TP Ho Chlfltinh,.^^
48-52^2006.
2. Nguyen Quoc fi^t (1995)_, Ket qua nghiSn cifti tinh hinh mu Ida do due the thuy tmh va due bao sau tai tinh Quang Nam- Da Ning, Ky yeu H&i ngl^
Nhan khoa toan quoc, tr. 24-29.
s. Nguyen Xuan Hi#p (2000), Tat khue xa: mot nguyen nhan chfnh gay giam thj iuc tgi Viet Nam va cac nu'dc trong khu vu'c, Noi san Nhan khoa, so 3 nam^2000, tr. 94-96.
4. Nguyen Xuan Phach (1995)^ Mot so phuUiig phap thong ke toan hoc diing de danh gia cac ket qua nghien cffu trong V sinh dffdc hoc, Tong hoiY hoc Viet Nam, tr.53-57
5. Hoang Thj Phuc (1995), Nhan xet tinh hinh re Mat cong nhan xSng dau khu vdc 1, C6ng binh nghien cffu khoa hgc toan quSc, tr.l99.
6. Ton Thj Kim Thatih, Nguyin Chi DQng (2006J, {)e an tong the ve phong^ chdng mii Ida va cham sdc mSt d Viet Nam hddng tdi muc deu thi giac nam 2020, Ky yeu Hoi nghi phdng chong Mii loa toan quoc , trang 1-16, 2006
7. Alan N. Carison (2004), Whafs New in Qjhthaimokigy, Review of Ophthalmology, pp 21-39
NHAN XET TAC DUNG KHONG MONG MUON CUA PHAC DO HUYET
THANH K H A N G N O C RAN HO MANG B A N H ( N A J A A T R A , NAJAKAOUTHIA) TIEM DU^ai DA KET HOP TRUYEN TINH MACH Pham Due', Ngo fiiic Ngoc"
mach cd the dijng huyet thanh tiem dffdi ^da de lam gi^m cae trieu ehffng phu ne, hoai txf tai cho. Tuy hi?ii qua kha ro rang nhffng lo npai se c6 nhieu tac dung phu khdng mong muon khi sff dung phUdng phap nay.
Muc tieu: Nhan xet tac dung khong monp muon cua phac do ket hcip huyet thanh khang noc ran tiem duai da va truyen tJnh mach. Phudng phap: Tign cOU mo ta. So sanh giij^ nhom phoi hdp tiem huyet thanh^
khang noc dffdi da va tinh mach so vdi nhom chi truyen tlhh mach. Phdi hdp truyen tinh mach veil tiwi HTKNR theo dffdng dffdi da de tao thanh cac vo^
HTKNR ngan chan noc ran lan theo dffdng bach madi.
Lieu HTKNR ti§m dffdi da bang 25- 50% tong so lieu HTKNR ban dau ciia nhdm nghien cifu. Vj tri tiem di^
da: quanh vet ran cSn hoac viing hoai tff, va giSt lui Z- T O M TAT
Bflt van de: R3n hd (Naja atra va Naja kaouthia) c2n thffdng gay tri|u ehffng tgi cho rat ram ro, vi vay ngoai diing Jiuyet thanh Wiang npc rSn (HTKNR) tTnh
^khoa Qjong dgc Benh vien Bach Mai
^BQ mdn HSCC Berih vien Bach Mai
^Khoa CSp cihi Benh vien Bach Mai Chju trach nhiem chi'nh: Pham Dui Email: [email protected] Ngay nhan bai: 13.01.2017 Ngay phan bien khoa hgc: 18.4.2017 Ngay duyet b^i: 27.4.2017
228
TAP CHl Y HOC VIET NAM TAP 454 - THANG 5 - SO 2 - 2017 5 cm, toe dp him cham. Moi vi trf tiim tSi thieu 0,5ml,
tfii da cd the 10ml tai ndi bi can tuy vi tri ton thffdng.
Ketqua: eo 28 benh nhin sff dung phUdng phap phffi hdp va 41 benh nhan chi truyen tTnh mach ddn thuan. Sff khac biet ve ty le eac bien chiing, marker nhiem khuan giij^ hai nhom nghien ciili va nhdm ehimg la khong co </_ nghTa thong ke (p>0,05). Nhom nghien cifu khong co sU khac biet ve enzym CK trUdc va sau tiem (p>0,05). 6 nhom ehffng enzym CK t§ng cao hdn sau tiem, sff khac biet nay cd y nghTa thong ke (p <0,05). Ket luan: Huyet thanh l^ang npc rSn tiem dutii da-Cnh mach khong lam tang ti le cac phan Lilig^dj ffng va Widng lam tang cac marker nhiem khuan so vdi truyen tTnh mach ddn thuan. Tiem dudi da-tTnh mach co mffc tang enzym CK sau tiem thap hdn so vdi nhom truyen tTnh maeh ddn thuan.
T& khoa: tiem dddi da, tac dung khong mong muon, huy& thanh khang noc ran hd.
SUMMARY
EVAUJATION THE ADVERSE DRUG REACnON OF SUBOHANEOUSiraECnON CX)MBINED WITH INTRAVENOUSINFUSION BAPIDAE (NA3A ATR^
NAM KAOUTHIA) AI«n-VB«)M SERUM PROIOCXX Background: Elapidae bites normaly causes paroxysmal local symptoms, thus not only elapidae anti-venom serum used intravenous serum but also can be used subcutaneous injection to reduce subcutaneous edema symptoms and local necrotic.
Objective: Evaluation the adverse dmg reaction of subcutaneous injection combined with intravenous infusion protocol of elapidae anti-venom. Methods:
An prospective observational study. We compared two groups: subcutaneous injection combined with intravenous infusion anti-venous serum group versus only intravenous infusion group. Combination of subcutaneous injection and intravenous infusion to prevent the spread of venom via the lymphatic route.
Anti-venom serum subcutaneous injection dose equalled to 25-50% of the total doses of case group.
The sites of subcutaneous injection: nearby snake-bite site or necrotic area with slow-infusion. The range of injection dose was 0,5 to 10 ml in each snake site.
Results: The sbJdy included 69 patients with 28 patients in case group and 41 patients in control group. The difference of complications, infection marlier rates between the case group and the control group was not statistically significant (p> 0.05). In case group, there was no difference of the CK enzyme before and after injection (p> 0.05). In the subcutaneous-intravenous utilisation group, CK enzyme was higher after injection (p <0.05).
Conclusion: Subcutaneous naja atra anti-venom serum did not Increase the rate of allergic reactions and markers of infection compared to intravenous alone. CK enzym of subcutaneous-intravenous group Increased less than in intravenous group.
Key word. Subcutaneous injection, adverse drug reaction, elapidae anti-venom serum.
I. O^T VAN OE
Ran ean la mpt tai nan thffdng gap tren the gidi va d Viet nam. Khi bj ran ho mang banh can
noc ran se diidc tiem vao dffdi da, trong ed va cd the vao tTnh maeh bang mdc dgc va lan ra toan than theo dffdng bach mach Ja ehii yeu. Tdn thffdng do nhdm ran hd (elapidae) can chii yeu la d tai cho can, gay hoai tff va phii ne tai eho.
Nhieu y kien thffc hanh lam sang dat ra can tiem huyet thanh khang noc ran ho ngay tai cho phdi hdp vdi truyen tTnh mach n h l m tang hieu qua va chong ddi toan dien vdi ed che benh sinh. Thffe hanh lam sang cap ciiu ehong dgc ung hg y kien nay tuy nhien cdn lo ngai rang tiem tai eho huyet thanh khang ngc cd the gay nhieu tac dyng phu khong mong mudn nhff dau ddn hoae sffng ne.
Diing trffdc thffc te tren ehiing tdi tien hanh nghien effu ffng dung phac do tiem huyet thanh khang ngc ran ho phdi hdp dffdi da-tTnh mach nham: "Nhan xet tae dyng khong mong mudn eua phae dd ket hdp huyet thanh khang ngc ran hd mang tiem dffdi da-tTnh mach"
II. DOI TU'QIMG VA PHU'ONG PHAP NGHIEN COU - Phffdng phffdng: Tien cffu mo ta Tiiu chuan lu'a chgn:
- Mang ran den va dffdc ehuy§n gia (bac sT TTCD xac djnh la ran ho mang banh N.astra hoac N. kouthia) hoac ngffdi nha chuTig kien benh nhan bj ran can ia ngffcri ehuyen nudi hoac bat ran, md ta dung sau dd nhan dang dung m l u ran hd mang banh (N.astra hoae N. kouthia).
- Cd tdn thffdng tai cho phii hdp tdn thffdng nhilm ddc ngc ran ho mang banli. Ton thffdng tai cho: gom vet rang (mdc dgc), phii ne, hoai tff tim den den, trang nffde
- Cd chi dinh HTKNR dac hieu khi cac trieu ehffng lam sang dang tien trien nang len: kich thffde phii ne, hoai tff tang len, lan xa hdn; hoac xuat hien liet cd, liet nang them.
Tieu chuan loai tru*: benh nhan di ffng vdi huyet thanh khang ngc ran ho
Tien hanh nghien cu'u: Benh nhan diidc chia lam 2 nhdm:
-I- Nhdm nghien cffu: Phdi hdp truyen tTnh mach vdi tiem huyet thanh khang noc ran theo dffdng dffdi da de tao thanh cac vdng huyet thanh khang ngc ran ngan chan ngc ran lan theo dffdng bach maeh. Lieu huyet thanh khang noc ran tiem dffdi da bang 25- 50% tong so lieu huyet thanh khang ngc ran ban dau eiia nhdm nghien effu.
+ Nhdm ehffng: Truyen huyet thanh khang ngc ran dffdng tTnh maeh 100%.
X& 1^ so lieu: Sd lieu dffdc xff ly bang phan mem SPSS 16.0 vdi eae test thong ke phii hdp.
Chgn a=0.05 dutfc coi la ed y nghTa thong ke, (3=0.
VIETNAM MEDICAL JOURNAL N"2 - MAY - 2017
III. KETQUA
Bang 3.1. Bac diem chung benii nhan luc vao vien Chung (ii,''/o)
Nhom NC ( n , % )
Nhom chu'ng ( n , % )
41
TUOI (nam) 49,9 ± 12,7 50,6 ± 12.3
19 (67,9)
49,3 ± 13,1 0,673
Gldl (n,q 51 (73,9) 32 (78,0) 0,344
Ng
<hi bi can (qid)
18 (26,1) 9 (32,1) 9 (22,0) Thdi qian nhap vien sau 7,00 ± 7,23 6,59 ± 5,22 7,27 ± 8,38
Loai ran (n,%) l^.atra 3 (84%) 24 (85,7 34 (82,9%) 1.00 11 (15,9%) 4 (14,3%) 7 (17,1%) Trong lu'dnq ran (qr) I [ 635.4 ± 400.6 I "673.6 ± 441.5 I 609.3 ± 373.4 I 0 517
Nhin xet: S\^ kiiac biet ve dp tudi, gidi tinh, thdi gian nhap vien, loai ran va trpng ii/dng ran cua hai nhdm khdng cd y nghTa thong ke (p>0,05).
Bang 3.2. Bac diem lam sang benh nhan iuc vao vien Trieu chuiig luc vao C h u n g ( n = 5 9 ) Nhom nghien
cu'u ( n = 2 g )
Nhom chu'ng ( n = 4 1 )
Hon me (n,%) 2C2,9) 2 (7,1)
Liet cd (n,%) 6 (8,7) 2 (7,1) 4 (9,8) 1,000
Mach (lan/ phut) 5,4 ± 13,4 Nhiet do (dp C) 37,2 ± 0.4
Huyet ap (mmHg) 125,1 ± 12,7 123,2 ± 16,5
Nhip thd (lan/phiit) 18,9±3,37 18,9 ± 3,6
Oiem PSS (n,%)
BpO
25 (36,2) 32 (46,3)
3 (28,6) 12(17,4)
17 (60,7)
17 (41,5) 3 (10,7)
15 (36,6) 9 ( 2 2 )
Nhan xet: Sff khac biet ve do nang (theo thang diem PSS) va eac trieu ehimg lam sang cua hai nhdm lue nhap vien khong cd y nghTa thdng ke (p>0,05).
Bang 3.3. Cac chi sdcan lam sang cua binh nhin Mc nhip vi$n.
Thong so xet nghiem ( M ± S D )
Chung f n = 6 9 )
Nhom nghien ciiu ( n = 2 8 )
Nhom ehffng ( n = 4 1 )
Hong cau (T/l) 0,572
Hb (g/l) 144,07 ± 10,37 147,32 ± 13,6 0,289
Bach cau(G/i) 13,3 ± 4,97
Bach cau trunq tinh (%) 79,92 ± 15,24 81,87 ± 12,85 78,59 ± 16,71 0,385 Tieu cau (G/i) 225,75 ± 58,18 221,93 ± 54,43 228,37 ± 61,13 0,655
PT (%)
Fibrlnogen(g/i) 3,17 ± 1,04
APTT b/c 28,27 ± 4,56
Na (mmol/i) 137,15 ± 2,91
Creatinin (umol/l) 79,45 ± 15,75 77,75 ± 12,8 3,61 ± 17,52 0,463 CK (U/l) 1024,71 ± 3099,38 1422,5 ± 4619,22 723,68 ± 926,52 0,372 Procalcitonin(ng/ml) 0,47 ± 1,2 0,8 ± 1,8' 0,27 ± 0,43 0,105 Nhan xet: St/ khac biet ve cac chi sd can iam sang giffa hai nhdm nghien cffu va nhdm chiJTig khong cd y nghTa thdng ke (p > 0,05).
Bang 3.4. Thdi diem dung huyet thanh icbang noc, lieu trung binh va so ngay dieu tri Chung Nghien CIJ'U ChlJng
AL
41Thdi diem diinq (qid) 7,5 ± 7,5 8,2 ± 8,7 >0,05
Lieu trung binh (mi) 153,0±61,0 144,0±52,0
>ao5.
Lieu tiem dffdi da 1 P
TAP CHi Y HCX: VIET NAM TAP 454 - THAHG 5 - SO 2 - 2017 benh nhan (ml) Min-i^ax
Thdi gian dieu tri (ngay)
%
2.32 ± 1.372 5 - 5 0 30,97 2.61 ± 1.32
0 0
2,12 ± 1,38 >0,05 Nhan xet: Hai nhom khong cd sff khac biet ve thdi gian sff dung huyet thanh khang noc ran sau ran can, so Iu'dng huyet thanh khang npc ran trung binh va so ngay dieu tri (p>0,05). Khdng cd sff khac biet ve tong lieu huyet thanh giii^ tiai nhdm nghien cuU va nhdm ehffng (p >0,05).
Bang 3,5. Thay ddi Creatin phosphoklnase (CK) sau tiem HTKNR Nhom nghien c u ^
n = 2 S
Nhom chu'ng n = 4 1 Nong dp CK
mau (to)
Trunq binh
1422,5 ± 4619,2 109,0 T 24854,0
723,7 ± 926,5 91,0 -!- 4454,0
0,372 Nong dd CKmau(Ti)
Trung binh
1685,8 ± 3749,5 1207,8±1599,5
41,0 + 17363,0
0,587Ty ie tang (%) Trung binh Min -fi^ax
41,2 ± 177,1 0,493
PfTi&T;)
0,816 0,009
Nhan xet: Nhom nghien cffu khdng cd sff khac biet ve Iffdng CK trffdc va sau tiem. O nhom ehffng tang cao hdn sau tiem, sff khac biet nay cd <f nghTa thdng ke (p<0,05).
Bang 3.6. Cac phan u'ng dl u'ng khi dung huyet thanh.
Bien chu'ng
Chung Nhom nghien
CUlJ Nhom chu'ng
May day
0,0Phil Quincke 0,0 0,0 0,0
Ngffa
7,1
4,9 0,6451,4 3,6
0,0Soc phan ve 0,0 0,0
Qua man cham
1,000
Nhan xet: Trong cac bleu hien cua phan ffng di ffng do HTKNR ngffa va may day ia trang thai hay gap nhat, khong cd benh nhan bj soc phan ve, qua man cham hay phu Quincke d hai nhdm. Sff khac biet ve ty le cac bien ehffng giij^ hai nhdm nghien effu va nhdm ehffng ia khdng cd <, nghTa thong k4 (p> 0,05). ^
Bang 3.7. Cac marker nhiem khuan Nhom n g h i i n cuXi
n = 2 g
Nhom chu'ng n = 4 1 _ Nhiet d d ( C )
•^tSDd^i'n-rMax)
37,2 ± 0,3 37,0 ^ 38,0
37,3 ± 0,5 37,0 -i- 39,0 jf Bach cau (G/l)
±'SD(Mln-rMax)
10,2 ± 4,6 5,6 ^23,2
11,8 ± 14,5 4,1 -r 15,57
BC trang tinh (%)-' ±%0 (Min -i-Max)
74,0 ± 17,7 7,7 ^91,2
procalcitonin (ng/ml)•^ J: SD (Min ^Max)
76.2 ± 10,7 56.3 ^92,2 1,28 ± 1,96
0,02 -^ 5,66
0,5240,85 ± 1,02
, _,., 0,04 ^3,38 . ^
Nhin xet: Tiem HTKNR dffdi da khdng iam nang them tinh trang nhiem khuan. Tham chiproeaicitonin trung binh cua nhdm nghien cffu cdn thap hdn nhdm ehffng du khdng thffc sff khac biet vdi p>0,05. Tinh trang nhiem khuan ciia nhdm nghien cffu va nhdm ehffng la nhff nhau vdi p>0,05.
IV. BAN LUAN
Thdi diem suf dung va so Iu'dng huyet thanh khang ngc ran: Thdi gian trung binh lienh nhan dffdc sff dung huyet thanh khang noc ran sau khi bl ran can ciia nhdm nghien cffu la (6,4 ± 5,1) gid, ciia nhdm chutig la (8,2 ± 8,7) gid khong cd sff khac blet p=0,304. Thdi gian trung binh benh nhan dffdc sff dung HTKNR sau
khi bj ran can trong nghien cud eua chung tdi mudn hdn so vdi Nualnong Wongtongkam [5] (trung binh la 2 gid), Wong [6] (tnjng binh ia 3 gid).
Theo nghien cffu cua chung tdi so Iffdng huyet thanh khang npc ran ciia nhdm nghien culj la 153,0±61,0ml, cua nhdm ehffng la 144,0±52,0ml, khdng cd sff khae biet p=0,497.
Ket qua nay khac vdi ket qua ciia Nguyen Kim
VIETNAM MEDICAL JOURHAL N"Z - MAY - 2017 Sdn[7] Iffdng HTKNR dijng eho benh nhan trung
binh la 26,5ml. Theakston la 25-75ml [4], ket qua eua Nualnong Wongtongkam [5], Wong [6]
tff 5-lOOm! HTKNR. Sd dl ed sff khac biet nhieu nhff vay vi day la HTKNR ho dat tinh che nen tinh dae hieu vdi ngc ran N.atra khdng eao bang N.kaouthia, dffa tren phan ffng cheo huyet thanh de trung hda doe t d noc ran. Sd Iffdng HTKNR dung cho benh nhan tuy thupc vao Iffdng npc dpe eua ran tiem vao ed the benh nhan, piiu thude vao kieh cd to nhd cua ran va tinh trang cua ran lue can.
Thay dol Creatin phosphoklnase (CK) sau tiim HTKNR: Khi bj ran can doe t d tieu ed se lam tieu cd van. Theo Nguyen Kim Sdn cae benh nhan bj ran ho mang can deu cd tieu cd van.[7] Theo ket qua nghien cffu eua chung tdi enzym CK khi nhap vien cua nhdm nghien effu va nhdm ehffng la nhff nhau (p=0.372). Khi so sanh CK khi nhap vien va sau tiem HTKNR dffdi da cua nhdm ngiiien cffu mac du CK cd tang nhffng khdng cd y nghTa thdng ke (p=0,816). Cd the tang CK la ket qua eua qua trinh nhiem doe ehff khdng phai do tiem HTKNR dffdi da gay nen.
Nhff vay t i e dung phu dang lo ngai nhat cua tiem HTTOJR dffdi da la tieu ed van nhieu hdn da khong dffdc ehffng minh. Day la mot thuan ldi eho md rpng ky thuat tiem HTKN dffdi da trong dieu b-j ran dpe can.
Phan &ng di dng khi dung huyet thanh.
Huyet thanh khang npc ran khdng ehi ed tae dung CO ldi' ma cdn co nhieu tae dung phu.
HTKNR hd dat tai Viet Nam dffde san xuat bdi Vien vac-xin va sinh pham y te Nha Trang la loai immunoglobulin (IgG) lay tff huyet thanh eua ngffa dffdc man cam vdi ngc ran du da dffde tinh ehe nhffng ban ehat la protein la nen van gay cac phan ffng dj ffng. Khi nghien cffu 69 benh nhan chung tdi gap 7/69 benh nhan bj dj ffng ehiem ty le 10,14%, trong dd ty le may day la 02 benh nhan ehiem 2,9%, ngu:a 4 benh nhan ehiem 5,8%, dd da 1 benh nhan chiem 1,4%
khdng cd benh nhan nao bj qua man cham va sde phan ve.
Marker nhiem khuamTrong eac marker ve nhiem khuan nhff nhiet dp, bach eau va procalcitonn thi procalcitonin la yeu td dae hieu nh^t trong chan doan tinh trang nhiem khuan.
Khi sff dung HTKNR tiem dffdi da viec vo khuan viJng tiem dij dung quy trinh nhffng phai tiem nhieu lan nen nguy ed nhiem khuan se tang len nen day eung la dieu lo ngai khi thffe hien nghien cffu bdi vi ban than quan the vi khuan trong mieng ran la rat phong phu. Theo nghien
effuj:ua Shek[l] cd 3 nhdm vi khuan ehinh lavi khuan hieu khi gram dffdng, vi khuan hieu khf gram am va vi khuan ky khi vdi hdn 20 loai vi khuan, trong do vi khuan Morganella morgaiiiiia hay gap nhat. Trong nghien cffu cua chung t&
thi nhdm nghien effu ed PCT trung binh la (0,85
±l,02ng/ml) va nhdm ehffng la (i,28±
l,96ng/ml) khdng ed sff khac biet ve mffc Qo nhiem khuan eiia 2 nhdm (p = 0,524). Trong nghien effu cua chung tdi cd 6 benh nhan cay dich tai cho cd vl khuan va deu nhay vdi khang sinh dCing eho benh nhan. Chung tdi khong gap baih nhan nao ed bien ehffng nhiem khuan huyet.
V. KET LUAN
Bien ehffng ehu yeu la dau tai cho, ngffa, phu Quincke. HTKNR tiem dffdi da-tTnh mach khong lam tang t i le eae phan ffng dj ffng va cung khdng lam tang cae marker nhiem khuan so v&\
truyen tTnh maeh ddn thuan. Tiem dffdi da-tinh maeh edn lam giam mffc dd bien ehffng tieu cd van vdi mffc tang enzym CK thap hdn so wSi nhdm truyen tTnh mach ddn thuan. Nhff vay phae dd tiem huyet thanh khang npc ran ho mang (Naja atra, Naja kaouthia) tai clio ket help truyen tTnh maeh cd the ffng dung kha an toan tren thffc hanh lam sang gidng nhff phac do truyen tTnh mach ddn thuan.
TAI UEU T H A M KHAO
1. K C Shek, KL Tsui, KK Lam et al. (2009). 0^\
bacterial flora of the Chinese cobra (Naja Atra) and bamboo pit viper (Trimeresurus albolabris) in Horg Kong SAR, China, HongKong MedJ;15:lS3-%.
2. Dong - Zong Hung (2002). Multiple thnsmbotic ocdusbon of vessels after Russell's viper envenoming, Pharmacniogy and Toxicology, 91, pp. 106 -110.
3. Ngo Manh Ha (2014). Danh gia hieu qua huy^
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