VIETNAM MEDICAL JOURNAL N°1 - JUNE • 2017
BANH GIA TAC DUNG HO TRg CCTA PLASMA LANH TRONG DIEU TRj
NHIEM KHUAN VET MO THANH BUNG SAU MO LAY THAI
Nguyen Quang Bac*
nghien cffu ciia Chff Quang Op [1] thi ty le nhiem khuan vet mo sau mo lay thai tai Benli vien Phy san Trung LTdng nam 2001 la 18,08%, Tuy nhien, viec sff dung khang khang smh ngay cang gia tang gay ra moi quan ngai ve dieu trt nhiem khuan trong tydng tai. Tren the gidi, ^c biet la eac nyde dang phat trien, van de Ithang thuoc da trd nen bao dpng. Trong do, nghien cffu ffng dung plasma trong diet khuan rat (Jang dypc quan tam, ffng dung nay da phat tnen rat manh trong nhffng nam gan day d cac nyde phat trien tren the gidi [3]. Xuat phat tff thUc tien do, Chung 6 i tien hanh thffc hien de tai: "Banhgiatk dung_ ho trd eua plasma lanh trong dieu tri nhim khuan vet md thanh bung sau mo lay thai".
II. OOI TU'ONG VA PHUONG PHAP NGHIEN CffU 2.1. Doi tu'dng nghiSn c&u: Cae benh nhan dypc chan doan va dieu tn nhilm khuan vet mo tai Benh vien Phu san Trung ydng.
*T7Su ciiuan lu^ chon ddi tu'dng nghien c&t:
- Benh nhan dddc chan doan nhilm khuan vet mo thanh bung nong.
- Benh nhan sau mo lay thai tai vien va cac benh vien tuyen dddi.
- Thdi gian tff khi phau thuat den khi xuat hien nhilm khuan vet mo trong vong 30 ngay.
- Benh nhan dyde cung cap bang thong tin nghien citu, dong y t y nguyen tham gia nghien cffu va ky ten vao bang t y nguyen tham gia nghien eiili.
*TiSu chuan loai tr&:
-Benh nhan bi nhiem HIV/AIDS, mac IM, giang mai.
- Benh nhan co nhilm triing toan than - Benh nhan ed may dieu hoa nhip tim va may khff rung.
- Benh nhan khong dong y tham gia nghien oili 2.2. Ph&dng phap nghiSn ahi: Nghien cuJJ thff nghiem tam sang ehieu tia plasma lanh Itet hdp dieu trj nhiem khuan vet mo thu'dng quy tren tffng benh nhan.
III. KET QUA NGHIEN CCrU
Trong 6 thang cuoi nam 2016, chiing toi diSu trj dyde 33 benh nhan nhilm khuan vet rno thanh bung tai khoa san nhiem khuan Benhvien Phu san Trung ffdng, ket qua thu diidc nhd sau:
TOM TAT
Muc tieu: danh gia hieu ijua ho trO ciia plasma lanh trong dieu trj nhilm khuan vet mo thanh bung sau mo lay thai. PhUdng phap: nghien cifu thir nghiem lam sang chieu tia plasma lanfi ket hop dieu tn nhiem khuan vet mo thu'dng quy tren tirtig benh nlian. Ket gua: Co 28 benh nhan dUdc khau lai vet mo thanh bung chiem 84,8%. Thdi gian len to chffc hat vet mo tff 3-5 ngay chiem 81,8%. Thdi gian trung binh khau lai vet mo la 4,1±0,5 ngay. Thdi gian het sot tff 1-2 ngay chiem 72,7%. Thdi gian nam vien trung binh la 5,2±2,2 ngay. KetluMmDieu tri nhiem khuan vet mo thanh bung sau mo lay thai ket hdp chieu tia plasma lanh giiip vet mo nhanh lien va rut ngan thdi gian dieu tri.
T&khoa: Nhiem khuan vet mo, plasma lanh.
SUMMARY
EVALUATE EFFICIENCY OF MEDICAL PLASMA I N TREATMENT OF POST C-
SECnON WOUND INFECTION Objective: To evaluate efficiency of medical plasma in treatment of post C-section wound infection.
Methods:This is clinical trial using medical plasma in combination with routine protocol in treatment of post C-section wound infection. Result: 28 patients treated with wound resutured (84,8%). Granulabon formation from 3 to 5 days: 81,8%. Average length of resutured was 4,1±0,6 days. Fever tasted for 1-2 days: 72,7%. Average length of hospitalization was 5,2±2,2 days. Conclusion: Combining medical plasma witJi routine protocol in treatment of post C- section wound infection help to reduce length of hospitalization and boost-up healing rate.
Key words: post C-section wound infection, medical plasma.
I. D^T VAN OE
Nhiem khuan vet mo la mot bien chffng nang sau mo, neu khong dffdc chan doan va dieu trj kip thdi se gay nhuTig hau qua nang ne anti hddng ^ kinh te ^ia dinh va xa hoi. Mo lay thai tuy la mpt euoc mo sach nhffng van ed mot ty te bj nhiem khuan vet mo sau mo, theo Bagratee va Moodiey[l], nhiem khuan vet mo chiem 13,3% trong eae nhilm khuan sau mo de. Theo
*Benh vien Phu san Tmng ddng Chju trach nhiem chinh: Nguyen Quang Bac Email: drbacbvpstw@yahoo,com.vn Ngay nhin bai: 9.3.2017 Ngay phan biSn khoa hoc: 26.4.2017 Ngay duyet bai: 9.5.2017
TAP CHi Y HOC VIET NAM TAP 455 - T H A N G 6 - SO 1 - 2017
Bang 1. Khau lai vet mo Khau lai vet mo
Khau Khonq khau
Tong so
Ty le o/o 84,8 15,2 NhSn xet: Co 28 benh nhan dyde khau tai vet mo thanh bung ehiem 84,8%.
Bantf2. Thdi gian len to ch&c hat Thdi gian len t o
chu'c hat
< 3 ngay 3-5 ngay
>5 nqay Tong so
Trung binh 3,7±1,0 3,0
Nhan xet: thdi gian len to ehffe hat vet mo tff 3-5 ngay chiem 81,8%
Bang 3. Thdi gian khau lai vet mo Thdi gian khau lai v e t mo
< 3 nqay 3- 5 nqay
>5 nqay Tong so Trunq binh
n 5 20 3 33 4,1±0,6
Ti le "A 17,9 71,4 10,7 100 Nh^n xet: thdi gian khau lai vet mo tff 3-5 ngay chiem 71,4%
Bang 4. Thdi gian het sot Thdi gian het sot
1-2 nqay 3-4 nqay 5-7 nqav
> 7 nqay Tong so Trung binh
n 24 6 3 0 3 3 1 , 5 ± 0 , 4
Ti le "/o 72,7 18,2 9,1 0 100 Nhan xet: Thdi gian het sot tff 1-2 ngay chiem 72,7%
Bangs. Thdigian nim vien Thdi gian nam vien
< 3 nqay 3-5 nqay 5-7 nqay
> 7 nqay Tong so Trung binh
n 2 7 15 9 3 3 5 , 2 ± 2 , 2
Ti le % 6,1 21,2 45,4 27,3 100
Nhan xet: thdi gian nam vien 5- 7 ngay chiem 45,5%
IV. BAN LU^N
Theo nghien ciTu ciia chiing toi, trong so 33 trydng hdp NKVM co 28 trydng hdp dffdc khau lai vet mo chiem b/ le 84,8%, so edn lai la 5 trydng hdp khong phai khau tai vet mo thanh bung ma de lid ehiem ty lp_ 15,2%. Nhffng trffdng hdp phai khau lai vet mo la do vet mo co toae rpng, khi khau lai vet mo da diidc eat Ipc lay het dich mil, to ehffe hoai tff, gia mac ket hdp
chieu tia plasma lanh va da ten to chffc hat, Vet mo dffdc khau tai bang cae mfii rdi, khau each quang. Theo nghien cffu ciia Nguyin Th| Phydng Thao, trong so 62 trffdng hdp ^NKVi^ cd 20 trffdng hdp dffdc khau lai vet mo chiem ty le 32,3%, so con tai la 42 trydng hdp khong phai khau lai vet mo thanh bung ma de hd chiem b/ le 77,7%*[4].
Trong nghien cffu ciia chung toi, thdi gian ten to ehffe hat vet mo tff 3-5 ngay chiem 81,8%, <
3 ngay chiem 15,2%, tren 5 ngay chiem 3%.
Thdi gian trung binh to chffc hat vet mo 3,7±1,0 ngay. Nghien cffu sff dung khi NO trong dieu tri vet thffdng phan mem nhiem triing cua Lipatov (2002) d 40 benh nhan da chffng minh kha nang tang toe eiia qua trinh lien vet thydng so vdl nhom chffng bang cae xet nghiem vi khuan, te bao hpe va hinh thai hpc. Khao sat bang Laser Doppler flow/metry thay sd eai thien dang ke cae vi tuan hoan trong khu vUc vet ttiypng. Phydng phap nay giiip to chffc hat moc nhanh va giam 3 den 5 ngay thay bang de dong vet thydng [5].
Trong so 28 trUdng hdp co khau lai vet mo thi thdi gian khau tai vet mo sau khi vao benh vien Phu San Trung U'dng dieu tri tff ngay thff 3-5 ehiem t / te 71,4%, ehi ed 5 trffdng hdp la dffdc khau lat vet mo trong vong 3 ngay sau khi vao vien ctiiem b/ le 17,9%. 3 benh nhan diicic khau tai vet md > 5 ngay deu chiem ty te 10,7%. Thdi gian khau lai vet mo sau khi vao vien dieu tn trung binh la 4,1±0,6 ngay. Nhy vay trydc khi khau lai vet mo can dddc lam thudc, cat Ipc, rffa vet mo de loai bd cac to chffc hoai tff, gia mac, vet mo ten to chffc hat thi thdi gian lien ciia vet mo se nhanh hdn, riit ngan thdi gian nam vien.
Isbary (2010) nahien cffu tren 150 benh nhan cd vet thydng nhiem triing man tinh dyde dieu tri vdi plasma argon hang ngay tff 2 den 5 phut, da ket luan dieu tn argon plasma lanh la mot ky thuat dieu tri mdi an toan, khong dau, lam giam tydng vi khuan vet thydng man tinh va thiic day qua trinh lien thUdng [ 6 ] .
Theo bang 4, trong so 33 trffdng hdp NKVNI thi CO 24 trffdng hdp het sdt sau thdi gian dieu trj tff 1-2 ngay, chiem ty te 72,7%, tiep den la het sot sau khi dieu tri trong khoang tff 3-4 ngay chiem ty le 18,2%, chi eo 3 benh nhan la sau khi dieu tri tren 5 ngay mdi het sot va 3 trydng hdp nay deu eo ket qua eay dieh vet mo dUdng tinh vdi E.Coli. Thdi gian trung binh het sdt la 1,5±0,4 ngay. Theo nghien effu ciia Nguyen Thj phydng Thao, trong so 33 trddng hdp NKVM cd sot thi cd 25 trydng hdp het sot sau thdi gian dieu tri tff 1-2 ngay, chiem ty le 75,8%, tiep den
105
VIETNAM MEDICAL JOURNAL N°1 • JUHE - 2017 la het sot sau khi dieu tn trong khoang tff 3-4
ngay chiem ty le 18,2%, nhff vay nghien cffu ciia ehiing toi phii hdp vdi tac gia nay [4]. Co the thay viec sff dung khang sinh phd rpng, phoi hdp 2 hoac'3 loai khang sinh ket hdp vdi viec cham sdc l^m sach vet thffdng tot tam eho thdi gian het sot ciia benh nhan ngan lai.
Benh nhan nam dieu tri NKVM trong vdng 5-7 ngay chiem t / te cao nhat 45,4%, tiep den la thdi gian dieu tri tren 7 ngay chiem ty te 27,3%, trydng hdp benh nhan nam dieu tri tff 3-5 ngay chiem ty ie 21,2%, va chi ed 2 benh nhan cd thdi gian nam dieu tri <3 ngay ehiem ty te 6 , 1 % . Thdi gian nam vien trung binh eua doi tydng nghien cffu la 5,2'±2,3 ngay._ Theo nghien cffu ciia Nguyen Thj phydng Thao, so benh nhan nam dieu tri NKVM trong vdng 5-7 ngay chiem ty te cao nhat 40,3% , tiep den la thdi gian dieu tri tren 7 ngay ehiem ty te 37,2%, trffdng hdp benh nhan nam dieu tri tff 3-5 ngay chiem ty le 17,7%, va chi cd 3 benh nhan ed thdi gian nam dieu trj <3 ngay chiem ty le 4,8%. Thdi gian nam vien trung binh ciia doi tu'dng nghien cffu la 7,5 ± 3,38 ngay [4]. Nhff vay, nghien cffu ciia chiing toi, thdi gian dieu tri trung binh ngan hdn thdi gian dieu trj trung binli la 2 ngay. Sd dT nhy vay bdi nhffng b$nh nhan NKVM vao vien dieu tri trifdc tien se dffde lam thuoc - thay bang vet mo, danh gia tinh trang nang nhe ciia NKVM, neu can thiet vet mo co the se dffde eat tpc, ehay tia plasma lanh, khau lai vet mo khi ten to chffc hat. Theo nghien culi cua Mpogoro FJ, Mshana SE tai Tanzania [7] thi thdi gian nam vien trung binh eiia cac doi tffdng bi NKVM dai hdn nhffng doi tffdng khong co NKVI^ la 12,7±6,9 ngay. Cd sff khae biet giffa 2 nghien cffu, de ly giai cho sff khae khac biet nay do dieu tri vet mo nhilm khuan thffdng quy ket hdp chay tia plasma lanh.
thdi gian bleu rrid hoa vet mo sdm hdn, th6i gian khau lai vet mo thanh bung ngan lai, do vay ^ gian nam vien ngan hdn, do la tinh yu viet khi dieu tri vet mo nhiem_ khuan ket hdp chiiu Qa plasma lanh len vet mo.
V. KET LUjiN
Dieu tri nhiem khuan vet mo thanh bung sau mo lay thai ket hdp chieu tia plasma lanh giiip vet mo nhanh lien va riit ngan thdi gian dieu tri.
TAI U | U T H A M KHAO
1. Bagratee J.S, Moodley 3, Kleinschmidt I ZawJlski W (2001). A randomized contralled tnal of antibiotic prophylaxis in selective cae^rean delivery. BJOG, 108 (2), 143-148. ^ z. Chff Quanh Do (2002). "Gop phan nghien cuii
cac hinh^ thai lam sang va nhOhg yeu to lien_ quan gay nhiem khuan sau mode tai Vien BVBMlis(tif thang 1-2001 den thang 6-2002)", Luan vaiihac sy y hoc, TrUdng Dai hoc Y Ha Noi. ' I f c 3. Tian, Y., et al. (2010), "InacHvatjQriT
Staphylococcus aureus and EntenDCOCCUS raecalis by a direct-current, cold atmospheric-pressiire air plasma xx\icyo]&i", J Biomed Res 24(4), 264-9.
4. Nguyen Thj Phu'dng Thao {2Q\S).Nghi§p nil;
nhiem khuan vet mo thanh bung sau mo liy Hiai dddc dieu tn tai Benh vien Phu san Trung ddng ft)' thang 11/2014 din thing 8/2016, Luan van thac sy y hoc, Trydng Dai hoc Y Ha Noi.
5. Upatov, K. v., et ai. (2002), "[Use of gas flow with nitrogen oxide (NO-therapy) in combined treatment of purulent wounds]" Khirurgiia. 1,41-3.
6. Isbary, G., et al. (2010), "A fiist prospedive randomized oonbolled bial to decrease bacterial load using cold atmospheric argon plasma on dimra.
wounds in patients'! Br 1 Dermatol 163(1), 78-82.
7. Mpogoro FJ, Mshana SE, Mirambo MH, Kidenya BR, Gumodoka B, Imirzaliaglu C, (2014). Incidence and predictors of surgical site infections following caesarean sections at Bugando Medical Centre, Mwanza, Tanzania. AntMatib Resist Infect Control 11,3-15.
NGHIEN Ciru THITC TRANG CONG TAC Y TE TRU'CING HOC TAI CAC TRirONG TRUNG HOC Cff S(y TREN DIA B A N TINH T R A VINH NAM 2015
Pham The Hien', Nguyin Van Lff^TOM TAT Nqhien cffu mo ta cat nqanq tren 95 doi tuWnq la cac trydnq Trunq hoc cd sd tren dia ban tinh Tra Win.
Kgt qua cho thav tv le trydnq hoc co Phonq Ytela 47,37%: Co 48.42% trydnq co ban hanh auvS W Dhan conq can bo ohu trach v te tru'dnq hoc:Tyle trydnq cd thanh lao Ban Chi dao conq tac v te truW hoc la 67,37%: Co 9,47% tru'dnq co can bo vteffl trinh do chuven nqanh v: Tv le trUdnq co lap ke Iww) trien khai conq tac v te trydnq hoc la 87,37%;"
46,32% trydnq co tranq thiet bi phuc vu conq HC so cap effu ban dau, 98,95% b-ydng co tu ttiuoc va 'Tru&ng Dai hgc Tra Vinh
^Trungtam Yteddphong Tra Vinh Chiu trach nhiem chinh: Pham The Hien Email: [email protected] Ngay nhan bai: 10.3.2017 Ngay ph^n bien khoa hoc: 28.4.2017 Ngay duyet bai: 15.5.2017
