VIETNAM MEDICAL JOURNAL H°2 - JUHE • 2017 chay nu'dc mat giam hdn va bd me tre khdng
dong y dat lai dng. Cac tac gia deu bao cao viec dat dng silicon monoka la kha ddn gian va an toan, it bien chirng [4],[5].
V. KET LU;BkN
Vdi tae dng le mui bam sinh, da that bai bang dieu tri bao tdn va thdng le dao, dat dng silicon monoka la mdt bien phap dieu tri cd hieu qua, ty le het ehay nu'dc mat hoan toan dat 78,9%. Tud'i tre eang eao, tien sir thdng le dao nhieu lan la cae yeu to nguy cd gay that bai. Day la thii thuat kha an toan, cd the thu'c hien du'dc d nhiftig cd sd nhan khoa cd gay me de giup cho tre phuc hoi lai lu'u thdng le dao, tranh bien chuYig va nang cao chat lu'dng sdng cho tre.
TAI UEU THAM KHAO
1. MacEwen C.J.,Young J.D. (1991), "Epiphora dunng the first year of life". Fye (Land) 5 ( Pt 5):
p. 596-600.
. Kakizaki H., Takahashi Y., Kinoshita S., et>l.
(2008), 'The rate of symptomatic improvemerif bf congenital nasolacrimal duct obstruction in Japanese infants treated with conservative management during the 1st year of age", dm
Ophthalmol. 2(2); p. 291-4. ^ . Lim C.S., Martin F., Beckenham T., et al.
(2004), "Nasolacrimal duct obstruction in children- outcome of intubation". JAAPOS. 8(5): p. 466-72 . Memon M.N., Siddiqui S.N., Arshad M., et al.
(2012), "Nasolacrimal duct obstruction in children:
outcome of primary intubation". J Pak M&i Assoc 62(12): p. 1329-32.
. Lee H., Ahn J., Lee J.M., et al. (2012), "Clinical effectiveness of monocanallcular and bicanalicular silicone intubation for congenital nasolacrimal dutt oti^nicXion". J Craniofac Surg. 23(4): p. 1010-4.
. Kaufman L.M.,Guay-Bhatia L.A. (1998),
"Monocanallcular intubabon with Monoka tubes fbr"
the treatment of congenital nasolacrimal duet obstruction". Ophthalmology. 105(2): p. 336-41.
. Miller A.M., Chandler D.L., Repka M.X., et al.
(2014), "Office probing for treatment of nasolacrimal duct obstruction in infants". J AAPOS.
18(1): p, 26-30.
KHAO S A T TiNH HINH CHi DINH CAc XET NGHIEM SINH HOA TRONG CHUYEN HOA Mff DOI V a i MOT SO BENH THU'ffNG GAP
T O M TAT
Ben canh cac xet nghiem chuyen biet, cae xet nghiem lien quan den chuyen hoa m9 (Cliolesterol, H D L " - Cholesterol, LDL - Cholesterol, Lipid mau.
Triglyceride) - thu'dng gpi la xet nghiem bp md, la xet nghiem tUOng ddi thu'dng quy trong sd nhiJng xet nghiem sinh hda trong viee chan doan, dieu trj cac t)enh nhu'tim mach, tieu du'dng,... Nham danh gia sU tt/iSng dong (hoac khac biet) trong viec chi dinh ciia bac si lam sang doi vdl cac xet nghiem thupc bp mB trong viec theo doi dieu trj cac benh tiiu'dng gap, nhdm nghien ciili da tien hanh khao sat tinh hinh chi dinh cua bac si floi vdi cac xet nghiem thuoc bo md la Cholesterol, HDL - Cholesterol, LDL - Cholesterol, Lipid mau, Triglyceride, so sanh vdi cac khuyen cao cua quoc te va Viet Nam, rut ra cac ket luan va cung cap cac sd lieu de giup cho cac nha khoa hgc, nha quan ly va bac sT l§m sang co cai nhin ro hdn ve tinh hinh chi dinh eae xet nghiem thudc bo md doi v6i cac benh thu'dng gSp so vdi cae hu'dng dan dieu tri, qua do xay di/ng cae chfnh sach, ke hoach de chuan hda cdng tac quan ly va nSng cao chat lu'dng xet nghiem, chi dmh phit hdp de tiet kiem chi phi xet nghiem cho benh nhan.
*Tnjng tam Kiem chuan Xet nghiem TP. HCM Ch|U trach nhiem chfnh: Tran HChi Tam Email: [email protected] Ngay nh|n bai: 9.3.2017 Ngay phan bien khoa hoe: 12.5.2017 Ngay duyet bai: 23.5.2017
Tran Huu Tam*
- Cholesterol, LDL - Tu'ArAds; Cholesterol, HDL
Cholesterol, Lipid, Triglyceride.
SUMMARY
SURVEY SITUATION INDICATORS OF BIOCHEMICAL TESTS I N TRANSITION FOR
SOME CONDOMINAL DISEASES Beside the partiicular tests, the tests of lipid metebolism (Cholesterol, HDL - Cholesterol, LDL - Cholesterol, Lipid, Triglyceride) - usually called the lipid metabolism tests, are the routine tests of dinical biochemistry in diagnosis, treatment of canJiac syndrome, diabetes,... With the aim to evaluate 9ie same (or the difference) between physidans's ordering in the test of lipid metabolism tests for treatment or controlling of the usual diseases, we do the study to survey the situation of physidans's test order such as Cholesterol, HDL - Cholesterol, LDL - Cholesterol, Lipid, Triglyceride, and compare with the international guideline or Vietnamese guideline, so that we can give conclusions and data to help the scientists, the policymakers, physicians have a view of the situation in ordenng of lipid metabolism tests for the usual diseases compare to the guidelines, in order to set up policies, plans to standardize the quality management, to improve quality of clinical diagntsi^
to have a better test order, so that ttie patients can save much money for unsuitable diagnosis.
Keywords: Oio\e^ero\, HDL - Cholesterol, LDL- Cholesterol, Lipid, Triglyceride.
180
TAP CHi Y HOC VIET NAM TAP 455 - T H A N G 6 - SO 2 - 2017
I. Bl}J VAN OE
Trong mdt so benh ly thu'dng gap nhu" tim mach, tieu du'dng,... ben canh eae xet nghiem chuyen biet, cae xet nghiem thude bp md (Cholesterol, HDL - cholesterol, LDL - cholesterol. Lipid mau. Triglyceride) thu'dng du'dc bae sT lam sang ehi djnh de bo sung eho viec theo doi, dieu t n , eung nhu* danh gia ket qua hoac de ra mue tieu dieu tri [ 1 U 2 ] , [ 4 ] , [ 5 ] , [ 7 ] .
Tuy nhien, do quan diem va kinh nghiem ciia cae bac sT khac nhau, d i n den cd sii khac nhau trong vlee chi dinh cac chi sd xet nghiem nay [1],[3],[6]. Nham cd du'i^e eac sd lieu thdng ke ve viec chi dinh tren, nhdm nghien cu'u da tien hanh khao sat tinh hinh chi dinh eac ehi so xet nghiem thude bd md ddi vdi eae nhdm benh thu'dng gap la: cao huyet ap; tieu du'dng type 2;
rdi loan chuyen hoa lipid; nhoi mau ed tim; suy maeh vanh tim/thieu mau cd tim cue bd; xd vUa ddng maeh; tai bien maeh mau nao; rdi loan tuan hoan nao/thieu mau nao; gan nhiem md.
So sanh vdi cac tai lieu cua Viet Nam va the gidi ve viec ehi djnh cac xet nghiem nay, tiT dd, cd the phan ticti eu the sy" khac biet hoac tu'dng dong, sy" phii hdp vdi eae khuyen cao cua Viet Nam va the gidi trong viec chi dinh cae xet nghiem theo ddi cae benh ly neu tren, nham giiip cho eac nha quan ly, nha khoa hpc danh gia lai thi/c te, cung nhu" xay du'ng eae ehinh sach de giiip tdi iiii hda viee sir dung eac xet nghiem thudc bp md, phuc vu tdt nhat viec theo doi dieu trj benh, tiet kiem du'dc kinh phi iam xet nghiem clio benh nhan.
II. odi TU'OWG VA PHUONG PHAP NGHIEN CO'U 2.1. Doi tu'dng
-Cae xet nghiem thude bd md bao gdm Cholesterol, HDL - Cholesterol'(HDL-C), LDL - Cholesterol (LDL-C), Lipid mau. Triglyceride.
-43 bac sT lam sang dang cdng tac trong ITnh vu'c kham chu'a benh ngoai tru tai cae quan 4, 6, l O v a P h u Nhuan-TP.HCM.
2.2. Phu'dng phap nghien cu'u -Phu'dng phap nghien ciTu la phu'dng phap cat ngang md ta.
-Cii dieu tra vien den quan sat tinh hinh chi djnh cae xet nghiem thude bd md tren benh nhan thude cae nhdm benii: eao huyet ap ngu'di tre; tieu du'dng type 2; rdi loan chuyen hoa lipid;
nhdi mau cd tim; suy mach vanh tim/thieu mau ed tim cue bd; xd vu'a ddng maeh; tai bien maeh mau nao; rdi loan tuan hoan nao/thieu mau nao;
gan nhilm md.
-Sd lieu thdng ke tinh hinh chi dmh eac xet nghiem thupc bd md lien quan den cac benh ly neu tren du'i^e trich xuat tir phan mem quan ly y khoa va ho sd benh an ciia ddn vi y te du'dc khao sat.
-Phan tich cac sd lieu thu dupe bang phan mem thdng ke Stata 10.0, excel.
-Ket qua thdng ke se du'dc quan sat va bien luan, ket hdp vdi eae tai lieu, hu'dng dan dieu tri eiia Viet Nam va the gidi (cac hiep hdi nhu" Chau Au:ESH/ESC; My: AACE, ADA, NCEP, AHA/NHLBI, ACCF, ASA, AASLD...) [1],[2],[3],[4],[5], [6],[7].
III. KET QUA VA BAN LUAN
3 . 1 . Ty le x e t nghiem bo md du'dc chi djnh tu'dng u'ng vdi cac benh nghien cii'u.
Tien hanh thdng ke de khu trii cac benh thu'dng du'dc ehi dinh xet nghiem bd md trong sd nhD'ng benh khao sat.
Bang 1 . Tv le (%) cac
Cholesterol H D L - C L D L - C Triglyceride
Lipid mau Tong so chl djnh xet nghiem bo mS nam 2016
Ca 34.069 34.466 34.463 37.500 3.700 le tren difO
benh du'dc clii dinti cac xet nqhiem thuoc bo md
Cao huyet ap
57,0
(%)
58,0 58,0 57,1 52,6
; tinh cho cn c .13 N
^ 01 1=
28,2
(%)
28,7 28,9 23,1 nhuhg t
R61 loan chuyen hoa lipid
(%)
55,0 52,2 53,1 u'dng hdNhoi mau cd tim
(%)
0,70,7
benh c Suy mach vanh tim/thieu mau cd tim cue bo 27,4
(%)
D Chi dinh >
XdviTadong mach
(%)
0,5et ngh Tai bien mach mau nao
(%)
0,7em tuo R81 loan tuan hoan nao
(%)
3,22,9
ig Ltng,
Gan nhilm md
(%)
6,27,2 6,8 do do cd the trong benh cao huyet ap, mot so benh nhan co l<em theo tieu dudng type 2 thi van du'dc thong ke.
VIETNAM MEDICAL JOURNAL N°2 - JUNE - 2017 Tir dir' lieu trong Bang 1, cac xet nghiem
thupe bd md du'dc eac bae sT ehi dinh de ehan doan va dieu tri ehu yeu eho bdn loai benh sau:
eao huyet ap; benh tieu du'dng type 2; rdi loan chuyen hoa lipid; va benh suy maeh vanh tim/thieu mau ed tim cue bd. Trong dd, eao huyet ap (chiem tir 52,6% den 58% tong so chi dinh moi xet nghiem bd md) va rdi loan chuyen hoa lipid (ehiem tir 52,2% den 61,9% tdng sd ehi dinh moi xet nghiem bd md) la hai loai benh cd ty le ehi dinh xet nghiem bd md eao nhat.
3.2. Phan tich viec chi ^ n h bg md trong cac benh theo khuyen cao Viet Nam va th§ gidi
Ddi vdl tiit ea eae loai benh trong khao sat, cae tai lieu ciia Viet Nam va qude te deu khuyen eao cd the chi dinh bdn loai xet nghiem cholesterol, HDL-C, LDL-C va triglyceride de chan doan va dieu tri, trong dd LDL-C ludn la mue tieu dieu trj ed ban. Nhu" vay, trong bdn loai xet nghiem nay, xet nghiem LDL-C la xet nghiem du'dc u'u tien chi dinh so vdi ba xet nghiem cdn lai. Ngoai ra, trong tat ca khuyen eao eiia Viet Nam va qude te, khdng cd to chirc nao khuyen eao sir dung xet nghiem lipid de ehan doan va theo ddi dieu tri cac loai benh tren.
Can cir tren ket luan nay, nhdm khao sat tien hanh danh gia viec chi dinh xet nghiem bd md cua eae bae sT theo mdt trong hai tieu chf nhu" sau:
- Tliu ehi 1 (tieu ehi dude khuyen eao): Lfu Wen chi djnh xet nghiem LDL-C (>95% benh nhan du'dc chi dinh bd md ed LDL-C); va khdng ehi djnh hoac chl djnh xet nghiem lipid vdl phan tram khdng dang ke ( < 5 % benh nhan du'dc chi dinh lipid).
- Tieu chi 2 (tieu chi khdng d&dc khuyen cao):
Khdng u'u tien chi dinh xet nghiem LDL-C (<95%
benh nhan du'dc chi djnh bd md cd chi dmh LDL- C) hoae ed ehi djnh xet ngtiiem lipid ( > 5 % benh nhan du'dc ehi djnh lipid).
Chi dinh xet nghiem bo md trong benh cao huyet ap: Ddi vdi benh cao huyet ap, ed 23/43 (53,5%) bac sT chi djnh xet nghiem phii hdp vdi cae khuyen eao eiia Viet Nam va the gidi (tieu ehi 1); ed 20/43 (46,5%) bac si chi djnh xet nghiem khdng phii hdp vdi eac khuyen eao (tieu ehi 2).
Chi dinh xet nghiem bo md trong benh tieu du'dng type 2: Ddi vdi benh tieu du'dng type 2, cd 19/43 (44,2%) bae si ehi dmh xet nghiem phii hdp vdi eae khuyen eao ciia Viet Nam va the gidi (tieu chi 1); ed 24/43 (55,8%) bac sT chi djnh xet nghiem khdng phii hdp vdi cac khuyen cao (tieu ehi 2).
Chi djnh xet nghiem bo md trong rdi loan chuyen hoa lipid: Ddi vdi rdl loan ehuyen hoa lipid, cd 20/43 (46,5%) bac sT ehi dinh xet nghiem phii hdp vdi eac khuyen cao eiia Viet Nam va the gidi (tieu ehi 1); ed 23/43 (53,5%) bac sT chi dinh xet nghiem khdng phii hdp vdi cac khuyen eao (tieu ehi 2).
Chi djnh x e t nghiem bp md doi vdi benh nhdi mau cd t i m : Doi vdl benh nhdi mau cd tim, ed 17/25 (68,0%) bac sT chi djnh xet nghiem phu hdp vdi eac khuyen eao eua Viet Nam va the gidi (tieu ehi 1); ed 8/25 (32,0%) bac sT chi dinh xet nghiem khdng phii hdp vdi cae khuyen eao (tieu ehi 2).
Chi djnh xet nghiem bo md trong benh suy mach vanh t i m / t h i e u mau cd tim cue bp; Ddi vdi benh suy mach vanh tlm/thieu mau ed tim cue bo, cd 21/41 (51,2%) bac sT chi dinh xet nghiem phii hdp vdi cae khuyen eao cua Viet Nam va the gidi (tieu chi 1); cd 20/41 (48,8%) bac sl chi dinh xet nghiem khdng phii hdp vdi cac khuyen eao (tieu ehi 2).
Chi djnh xet nghiem bo md trong benh xd vu'a dpng mach: Ddi vdi benh xd vu'a dpng maeh, ed 19/24 (79,2%) bae sT ehi dinh xet nghiem phii hdp vdi cae khuyen cao ciia Viet Nam va the gidi (tieu chi 1); ed 5/24 (20,8%) bac si chi dinh xet nghiem khdng phii hdp vdi eae khuyen cao (tieu chf 2).
Chi djnh xet nghiem bp md trong benh tai bi§n mach mau nao: Ddi vdi benh tai bien maeh mau nao, ed 20/32 (62,5%) bae si chi djnh xet nghiem phii hdp vdi eae khuyen cao ciia Viet Nam va the gidi (tieu chi 1); cd 12/32 (37,5%) bae si khdng phii hdp vdi eae khuyen eao (tieu chf 2).
Chi djnh x e t nghiem bp md trong benh rdl loan tuan hoan nao/thieu mau nao: Ddi vdi benh rdi loan tuan hoan nao/thieu mau nao, cd 18/29 (62,1%) bae si ehi dinh xet nghiem phii hdp vdi cac khuyen eao cua Viet Nam va the gidi (tieu chi 1); ed 11/29 (37,9%) bae si ehi djnh xet nghiem khdng phii hdp vdi eae khuyen cao (tieu ehi 2).
Chi dinh xet nghiem bp md trong benh gan nhiem md: Doi vdi benh gan nhiem md, cd 16/32 (50,0%) bac si ehi dmh xet nghiem phii hdp vdi eae khuyen eao eua Viet Nam va the gidi (tieu chi 1); ed 16/32 (50,0%) bac sT chi djnh xet nghiem khdng phu hdp vdi cac khuyen eao (tieu ehi 2).
TAP CHi Y HOC VlgT NAM TAP 455 - THAHG 6 • SO 2 - 2017
illlill
Hinh 1 . Bieu do thong ke ty le (%) bae si IV. KET LUAN 1-
• Cac xet nghiem bd md du'dc bac sT chi djnh de chan doan va dieu tri bdn loai benh ehii yeu 2.
sau: benh eao huyet ap, tieu du'dng type 2, rdi loan chuyen hoa lipid va nhoi mau ed tim. Trong dd, benh cao huyet ap va roi loan chuyen hoa lipid la hai loai benh ed ty le chi djnh xet nghiem bd md eao nhat.
• Theo khuyen eao eiia Viet Nam va quoc te, xet nghiem lipid khdng du'dc ehi dinh de chan '*•
doan va dieu trj cae loai benh trong khao sat.
Tuy nhien, qua khao sat nhan thay, xet nghiem lipid van cdn du'dc mdt sd tiac si chi dmh, mac idii vdi ty le tu'dng ddi thap. 5-
• Ty le bac sT chi djnh xet nghiem bd md khdng phii hdp vdi cae khuyen cao (khdng uli tien chi dinh xet nghiem LDL-C hoae ed ehi djnh xet nghiem lipid) eon cao (tir 20,8 - 55,8%).
KIEN NGHj
-Md rpng pham vi nghien ciru them nhieu quan huyen tai TP.HCM hoac nhieu tinh khae de cd so lieu Idn hdn trong danh gia va phan tieh.
-Ccin ban hanh eac phat dd_ chi djnh eae can lam sang va xet nghiem chuan tUdng irng vdi tirng benh, tir dd lam can cii phap ly hoae y chuyen mdn de eae bae si tham khao, ehi dinh thong nhat, phii hdp vdi eac khuyen eao.
TAI u i u T H A M KHAO
ehi dinh phii hdp tieu chi 1 hoac 2 Hoi Tim mach hpc Viet Nam (2011), "Khuyen cao 2010 ve cac benh ly tim mach va chuyen hoa".
NXB Y hpc Chl nhanh TP. HCI^.
American Diabetes Association (2013),
"Stanidands of Medical Care in Diabetes—2013."
Diabetes Care 36.Supplement 1: SU-S56.
Grundy, Scott M., et al. (2005), "Diagnosis and management of the metabolic syndrome an Amencan Heart Association/National Heart, Lung, and Blood Institute scientific statement."
Circulation 112.17: 2735-2752.
Handelsman, Yehuda, et al. (2011), "American Association of Clinical Endocnnologists Medical Guidelines for Clinical Practice for developing a diabetes mellitus comprehensive care plan."
Endocnne Practice 17: 1-53.
Panel, Adult Treatment. " I I I . " Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 285 (2001): 2486-2497.
Smith, Sidney C, et al. (2011), "AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients With Coronary and Other Atherosderotie Vascular Disease: 2011 UpdateA Guideline From the American Heart Associafton and American College of Cardiology Foundation Endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association." Journal of ttie American College of Cardiology5H.2Z\ 2432-2446.
The Task Force for the management of artenal hypertension of the European Sooety of Hypertension (ESH) and of the European Soaety of Cardiology (ESC) (2013), "2013 E5H/ESC Guidelines fbr the management of artenal hypertension". Eunopean HeartJtoumal.
DANH GIA s y BIEN DOI GOC TIEN PHONG SAU LASER MONG MAT CHU BIEN BANG MAY OCT RTVUE 100
Nguyen Dinh NgSn', Pham Thi iVIy Hanh' j S J Muc tieu: Danh gia sU bien ddi goc tien phdng tren dCT RTVue 100 sau cat mdng mat chu bien bang . ptidi hup laser hieu u'ng nhiet va laser quang hiiy dieu tri glocdm goc ddng nguyen phat. Nhan xet sU bien ddl dp md goc tien phong sau laser tren soi goc va ket qua OCT. Bdi tu'dng va phUdng phap nghiin c&u:
Nghien ciTu tien ciTu, khdng ddi ehimg tren 56 mSt cua 53 ngu'di trUdng thanh bi glocdm goc dong nguyen phat dieu tn tai khoa Mat - Benh vien Quan Y
^Benh viin Quan Y103 ^ Chju trach nhiem chinh: Nguyen Dinh Ngan Eniail: [email protected] Ngay nhan bai: 10.2.2017 Ngay phan biSn khoa hpc: 11.5.2017 Ngay duyet bai: 22.5.2017
