V i e t n a m J o u r n a l o f P h y s l o l o g y 2 1 ( 1 ) , 3 / 2 0 1 7 I S S N : 1 8 5 9 - 2 3 7 6
A N H HU'DNG CUA H L I T T H U 6 C L A D i N MOT S 6 C H i S 6 THONG K H i P H 6 I &
NAM G\Cf\ LCCA T U d i 40 ~ 60
N g u y i n Nij' Hal Yen^, Luo'ng Linh Ly^, Le Dinh Tung^'' T 6 M T A T : Ngwai hut thude la thwong ed hai th& ngin han so vai ngwai khdng hut thude la. Hiit thude la la nguydn nhan ehinh anh hwang den chirc nang thdng khi cua phdi. Phwang phap nghien ciru: chOng tdi tidn hdnh thdm dd ehue nang thdng khi phdi cho 40 nam giai khoe manh. tuoi tie 40-60 hut thudc Id (hodc thudc Ido), ty nguydn tham gia nghidn cieu v&i muc tieu: Danh gia mdi lien quan eua hut thudc Id din cdc chi sd TLC, RV, FRC, RV,TLC, Raw, sRaw & nam glal tudi tir 40-60 bing phwang phap the tich k^ thdn (body plethysmography). Kit qua nghidn cO'u: nhO'ng ngw&i hiit thudc la v&i iwgng trdn 20 bao nam ed siec can dw&ng tha (Raw), ty Id RV/TLC cao han e& y nghTa so vai nhdm ngud'i khdng hut NhO'ng ngw&i hut thudc la vdi Iwgng tie 10 din 15 bao ndm cd gid tn Raw, siec can dw&ng thg ridng phin (sRaw) cao han co y nghla so vai nh&m ngw&i khdng hut thude.
* TO- khoa: Phwang phdp the tich ky thdn, thdm dd chiee ndng thdng khi phdi, hdt thudc la.
I . D A T V A N D i
^Tham d d chOc n i n g hd h i p la mdt phuang phap cd g i i trj trong d i n h gia chuc nang thdng khi p h i i , gdp phan quan trpng trong tham k h i m sOc khde, chan doan sdm, theo ddi d i i u trj va tien luang c i c benh hd h i p . N i m 1983, Cdng d i n g than thep chau Au dd xuat v i dugc To chOc Y t i the gldi ijng hd dua ra 18 thdng s i dung eho tham dd chOc n i n g thdng khi phoi trong dd cd dung tich t o i n phoi (TLC), dung tich can chOc nang (FRC), t h i tich can (RV),... c i c thong so n i y rat quan trpng trong e h l n d o i n eac benh hd h i p mgn tinh. Tren t h i gidl cd nam phuang phap tham dd chOc nang thdng khi trong dd phuang phap hd hap k i d u a c sO dung rdng rai tuy nhien khdng the do d u a c mdt s i t h i tich khi nhu TLC, FRC, ... va dgc biet chi s i sOc can dudng t h d (Raw), tuy nhidn c i c chi so n i y cd the do d u a c de
' D^i hpc Y Ha NSi
^ Ogi hgc Dirg'c Ha N6i ' T^c g\i chiu trach nhiem chinh.
LfeDlnh TCing Email: tunaiaihmu edu.vn NgSy nhan bk\. 23/3/2017 NgSy n h | n bki phSn bien: 27/3/2017 NgSy c h i p nh§n dang: 28/3/2017
d i n g va chinh xac b l n g phuang p h i p the tieh ky than [1].
Cf Viet Nam, phuang p h i p the tich ky t h i n dupe trien khai i i n d l u tien tgi Bdnh vien Bgch Mai n i m 1980. TO do den nay da cd nhieu edng trinh nghien cuu v i c i c chl sd TLC, FRC, RV tuy nhien chua d l y du [2]. Nhleu nghien euu cho r i n g c l u tao va chOc n i n g phoi phat tnen v i hoan thien trong 20 d i n 25 nam d l u ddi va duy tri on djnh khoang 15 nam Tren 40 tuoi hogt ddng cua he hd hap ndi ehung va chOc nang thdng khi ndi rieng se suy giam, ty le mac c i c benh hd h i p t i n g len. Ddng thai, n h i i u nghidn cOu g i n day cung cho t h l y ty le hut t h u i c l i , beo phi ngay c i n g tang dgc biet d c i c thanh p h i Idn [3]. C i c y i u td n i y anh hudng d i n chOc nang hd hap trong dd cd chOc n i n g thdng khi phoi [4], [5]. Vi v i y , chung tdi t h y c hien nghien cuu n i y vdi myc tieu: Danh gia mdi Iidn quan eua hilt thudc Id ddn ede chf sd TLC, FRC, RV/ TLC, Raw, sRaw& nam gi&i Iwa tudi 40 - 60 bing phwang phap the tich ky than.
2. D 6 | T U ' g N G V A PHU'ONG P H A P NGHIEN CO'U
2.1. D o i tu'O'ng nghi§n c u u : 40 nam gidl, khde manh, tuoi 40 - 60, hCit thuoc la
V i e t n a m Journal of Physiology 21(1). 3 / 2 0 1 7 I S S N : 1 8 5 9 - 2 3 7 6
(vi/hogc thuoc l i o ) , t y nguyen tham gia nghien cOu. Hut t h u i c l i tinh theo so bao- nam ( s i bao n h i n vdi so nam hCit). N i u hot thudc l i o thi c i c h tinh la: 5 d i i u t h u i c lao bang 1 d i i u thuoc la [6]. Loai t r u ra khdi nghien cOu eac d i i tuang m l c benh mui hpng, bpnh p h i i - p h i quan c l p va m i n tinh, benh v i l i n g ngyc, edt song (gu, vpo, viem cdt s i n g dinh khdp,...), c a hd hap, benh tim mach, sot hay c i c benh k h i c dang d i i u trj v i d i i tugng cd phau thugt trong vdng 6 t h i n g trudc ngay nghien cOu.
2.2. Phuo'ng phap nghien c u u : md t i c i t ngang cd phan tich. C d m i u d u a c tinh theo cdng thuc i p dyng cho md ta cat nang xac djnh mdi tuang quan vdl sai lam logi I (a = 0,05); sai lam logi ll (p = 0,2), dp lech c h u i n cua TLC, RV, FRC tren nam gldl l l n lupt l i 0,44, 0,18 [7].
2.2.1. Phwong tidn nghien CLPU M i y the tieh ky toin thin Med Graphics 1085 Series Piethysmograph (Hoa Ky). M i y hd h i p k i HI 801 Spirometer (Chest - Nhit Bin).
2.2.2. Phwang phap thu thap si lieu:
T i t c i doi t u a n g nghien cuu d u p c phdng
v l n theo m l u p h i i u dieu tra, do chuc nang hd h i p b l n g may phe luu k i d i chgn ra cac d i i tuang d i p Ong d u p c tieu chuan nghien cOu. Sau dd, c i c d i i t u a n g du tieu chuan d u p c do chOc nang hd hap bang m i y t h i tich ky than theo qui trinh t h i n g n h l t cua ATS/ERT.
2.3. Phan t i c h va xO 1^ so lipu: S i lidu nghidn cOu d u a c nhgp va xO ly bang p h l n m i m SPSS 15.0 (Chicago, IL) d i x i c djnh g i i tri Idn n h l t , nhd n h l t , g i i trj trung binh, dp lech c h u i n , ty le p h l n t r i m . SO dung test t - student, Mann - Whitney de so s i n h g i i tri trung binh. X i e djnh moi tuang quan giua cac chi so nghien cOu vdi eac yeu td I n h hudng bang test Pearson, Spearman. K h i c bidt cd y nghTa thong ke khi g i i trj p < 0,05.
2.4. Dao du'c nghien cu>u: Theo qui djnh v i y dOc Trudng Dgi hpc Y Ha Ndi.
3. K^T QUA
3.1. A n h hu'o'ng cua hut t h u o c la den cac c h i so ho h i p
Bang 3.1. Chl s i TLC, RV, FRC, RV/TLC, Raw, sRaw d ngudi khdng hut thuoc v i ngudi hut t h u i c l i
Chisi
K h o n g hut t h u i c (n = 40)
Nhdm hut t h u o c la (bao-nam) (n = 44)
l<5
(n = 4) 5 < t < 1 0
(n = 7)
1 0 S K 1 5 (n = 6)
1 5 < t < 2 0 t > 2 0 (n = 6) (n = 21) TLC (1)
RV(i) FRC (i) RV/TLC %) Raw (cmH20.s/l) sRaw (cmH20.s)
5,23±0,65 1,57±0,55 3,04±0,71 29,8±e,7 1,45±0,66 4,45±1,61
5,85±0,58 1,45±0,27 2,96±0,56 35,3±9 1,77±0,78 5,06+0,92
5,05±0,44 1,44±0,39 3,03±0,5 28,2±6,1 1,24±0,28 3,91±1,5
5,45±1,2 1,61±0,38 3,42±0,76 29,8±3,8 2,36±0,69*
7,03±1,1*
5,03±0,63 1,45±0,68 3,54±0,42 28,9±12,8 1,29±0,29 4,23±1.46
5,08±0,86 1,74±048 3,06±0,9 34,9±9,8*
1,83±0,38*
4,81±2,1
So luang t h u i c l i trung binh nhdm 2 hut la 17,7 ± 9 bao-nam. Ty lp RV/TLC cua nhdm hCit trdn 20 bao-nam eao han ty lp
n i y cOa nhdm 1 (p < 0,05). SOc c i n dudng t h d cua nhdm hut 10 - 1 5 bao-nam va trdn 20 bao-nam cao han chT so n i y 72
V i e t n a m Journal of Physiology 21(1), 3 / 2 0 1 7 I S S N : 1 8 5 9 - 2 3 7 6
3.2. Lien q u a n giOa cac c h i so nghi&n c i r u vd'i cac c h i so nhan trac va t u o i Of n h o m d o i tu'O'ng hut t h u o c ia cua nhdm ngudi khdng hut t h u i c . sRaw
trong nhdm hOt tO 10 d i n 15 bao-nam cao han sRaw cOa nhdm ngudi binh t h u d n g khdng hOt thuoc (p<0,05). C i c ch! s i k h i c khdng cd s y k h i c biet vdl nhdm 1.
Bang 3.2. Moi tuang quan giOa c i c chi so hd h i p vdi chi s i nhan t r i e v i t u i i cua nhdm doi t u a n g hut t h u i c la
C t i i s o Cliieu cao du'ng ClliSu cao ngoi Can nang BIVII Tuoi
TLC (lit) (n = 44) 0,336*
0,18 0,15 -0,18 0,3*
RV (lit) (n = 44) -0,1 -0,18 -0,06 0,005 0,303*
FRC (lit) (n = 44)
0,17 0,04 0,06 -0,12 0,009
Raw (cmHzO.s/l)
(n = 44) -0,2 -0,16 -0,163 -0,03 0,28
sRaw (cmHaO.s)
(n = 44) -0,1 0,094 -0,09 -0,044
0,13
RVn'LC
(%)
(n = 44) -0,28 -0,27 -0,19 0,3 0,537*
*; sy twang quan ed y nghTa thong ke vai p <0,05 Trong nhdm d i i tupng hCit t h u i c chl cd TLC Iidn quan vdi chieu cao dOng (p<0,05).
T u i i cua doi t u p n g hut t h u i c la cd lien quan k h i chgt che d i n c i c chi s i TLC, RV, RV/TLC (p<0,05). T u a n g quan d u a n g n i y chOng td d nhung ngudi hut t h u i c , tuoi c i n g cao thi g i i trj TLC, RV v i RV/TLC
c i n g tang. N h u vgy, khi chieu eao dung tang, TLC cd xu h u d n g tang theo. N g u d l cd c h i i u cao d u d i 160 em, cd TLC d mOc 4 - 4,5 lit. Ddi t u p n g eao 160 - 165 cm cdTLC chu yeu trong k h o i n g 5 - 6 lit.
D O I t u a n g tren 165 cm, g i i trj TLC tO 4,8 - 6,5 liL
150 155 160
Chieu cao dung (cm)
Bieu do 3.1. T u a n g quan giua chi so TLC vdi c h i i u cao dung cua nhdm d i i t u p n g hut t h u i c la
V i e t n a m Journal of Physiology 21(1), 3 / 2 0 1 7 I S S N : 1 8 5 9 - 2 3 7 6
Bang 3 V£
C t i i s o TLC (1) FRC (1) RV(I) RVn'LC (%) Raw (cmH20.s/l) sRaw(cmH20.s)
.3. Cac ctl! s6 tio t i l p cua doi hj/ang i<ti6ng tlut ttiuoc i hut thu6c CO ctileu cao du'ng tu' 160 - 165 cm
K h o n g hut t t i u o c (n = 17) 4,99 ± 0,61 2,83 ± 0,59 1,41 ± 0 , 5 28 ± 8,2 1,27 ± 0 , 4 7 3,66 ± 1 , 5 1
(1) Ntiom liOt t t i u o c (2) (n = 16) 5,27 ± 0,87 3,07 ± 0,81 1,77 ± 0 , 3 9 36,8 ± 7 , 1
1,8 ± 0 , 6 5,6 ± 1 , 7 7
Pi.z p > 0,05 p > 0,05 0,029 0,007 0,027 0,006 Ket qua nghien cuu cho t h i y nam giai
hut thudc l i , IOa tuoi 40 - 60 vdi c h i i u cao trung binh tO 160 - 1 6 5 em cd ehi so RV, ty 1^ RV/TLC, Raw, sRaw cao han hSn so vdi nam gidi khde mgnh cd cOng c h i i u eao, cung dp t u i i nhung khdng hut t h u i c (p<0,05). TLC, FRC d nhung ngudl hCit thuoc v i khdng hut t h u i c khdng khac nhau.
6" nhung ngudi cd c h i i u cao tren 165 cm, khdng cd s y k h i c biet ve c i c chi s i nghidn cuu giua ngudi hut thuoc vdi ngudi binh thudng (p > 0,05).
4. B A N L U A N
Trong nghien cOu n i y chung tdi sO dyng dan vj bao-nim de d i n h g i i mOc dp
hut thuoc cua d i i t u a n g nghien cOu. C i c h tinh nay d u a c s u dung pho b i i n tren lam s i n g , the hien chinh x i c luang thuoc da hut cua ddi t u p n g . Luang t h u i c l i nhdm nam gidi hut trung binh l i 17,7 bao-nam, hut thuoc tren 20 bao-nam c h i i m t^ le Idn n h l t (47.7%) t u a n g t y vai nghien cOu k h i c [6]. K i t q u i nghien cOu cho thay c i c chl s i FRC, RV, RV/TLC, sRaw cao han so vdl nhdm nam khde mgnh, khdng hut t h u i c (bang 3.1) song s y k h i c biet n i y khdng cd y nghTa thong ke. Chl s i Raw cua ngudl hut t h u i c cao han cd y nghTa t h i n g ke so vdl chf so Raw cua ngudl khdng hdt (p<0,05).
Bang 3.4. C i c chl s i hd hap cua doi tup'ng khdng hCit thuoc l i v i hilt thudc cd chieu cao dOng tren 165 cm c t i i s o
TLC (1) FRC (1) RV(I) RV/TLC % Raw (cmHzO.s/l) sRaw (cmH20.s)
Ktiong liOt t t i u o c (n = 16) 5,61 ± 0,45 3,27 ± 0,83 1,71 ± 0 , 6 30,3 ± 1 0 , 1 1,52 ± 0,72 4 , 9 ± 1 , 1 9
(1) Ntiom tiut t t i u o c (n = 19) 5,39 ± 0,73 3,25 ± 0,73 1,5 ± 0 , 5 28,1 ± 9,3 1,66 ± 0 , 6 1 4,46 ± 1 , 5 8
(2) Pl-2 p > 0,05 p > 0,05 p > 0,05 p > 0,05 p > 0,05 p > 0,05
74
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Mgc du nhleu nghien cOu trudc day cho r i n g hut t h u i c la anh hudng d i n chuc nang hd hap [6], song nghien cuu cua chung tdi chua t h i y s y k h i c bi#t d c i c g i i tri TLC, FRC, RV. Tuy nhien, hut thuoc tren 20 b a o - n i m ch! s i RV/TLC. Raw tang Idn cd y nghTa t h i n g ke ( l l n l u p l ta 34.86 ± 9.76%; 1.83 ± 0.38 cmHaO.s/l). RV/TLC tang len chOng td cd hgn c h i dudng t h d ra mac dCi TLC binh thudng. C i c chi s i RV, RV/TLC, FRC tang len chOng td ton thuang s d m d u d n g d i n khi ngogi vl gay ra s y ddng sdm d u d n g t h d v i hinh t h i n h c i c bay khi [8].
D i n h gia tuang quan giua c i c chT sd hd h i p v d i c i c d i e d i i m n h i n t r i e va tuoi.
K i t qua cho t h l y cac gia trj trung binh TLC, FRC, RV, RV/TLC, sRaw cua nhung ngudi hiit t h u i c l i khdng k h i c biet so vdl nhdm ngudi khdng hut nhung nhung ngudi hut thuoc la, cao 160 - 165 em thi cac chi so RV, RV/TLC, Raw, sRaw cao han cd y nghTa so vdl nhi>ng ngudl hut t h u i c vd'i cung c h i i u cao. C i c chi sd TLC, RV v i RV/TLC cung phu thudc v i o tuoi, t u i i c i n g cao thi TLC, RV, RV/TLC c i n g cao. Doi vdl sue c i n dudng thd, chung tdi n h i n t h l y ngudi hCit t h u i c la cd sOc can dudng t h d eao han so vdl ngudi khdng hut (p<0,05). Ngudl hut t h u i c d u d i 10 bao-nim thi c i c chl s i thdng khi, c a hpc p h i i h l u n h u chua bien doi. Nhdm ngudi hut 10 - 15 bao-nam v i nhdm hCit trdn 20 bao-nam cd sOc c i n dud'ng t h d tang len rd r i t . Trong nhdm hut 10 - 15 bao-nam, sOc c l n d u d n g t h d va sOc can d u d n g t h d rieng p h i n t i n g len la b i i u hidn cCia ton thuang dang t i e nghen hd h i p [8]. N h u v i y , t h i n h p h l n ddc hgi trong thuoc la cd anh hud'ng d i n thdng khi phoi, d i e biet d nhdm hut tren 20 bao-nam tren c i c chf s6 RV, RV/TLC, Raw. Day se la c i n h b i o sdm danh cho c i c d i i tupng hut t h u i c l i .
5. KfiT LUAN
- Hut t h u i c l i vdi lugng trdn 20 bao- nam cd Raw, t:^ le RV/TLC cao han so vdl nhdm ngudi khdng hut.
- HOt thuoc l i vdl luang t u 10 - 1 5 bao- nam cd g i i trj Raw, sRaw eao han so vdi nhdm ngudl khdng hut thudc.
TAI LIEU THAM KHAO 1. C. p. Criee, S. Sorichter (2011).
Body plethysmography- Its principles and clinical use", Respir (Vied. 105, p 959-971.
2. Nguyen Thj Chinh, Trjnh Binh Dy (1984). Phuang phap ghi t h i tich t o i n bd than the d i tham dd chOc nang phoi, Y hpc Viet Nam 3(122), tr. 35-39.
3. MD Jean-Paul Janssens (2005).
Aging of the Respiratory System: Impact on Pulmonary Function Tests and Adaptation to Exertion, Clin Chest Med 26, p. 469 - 484.
4. Hoang L o n g Phat (2002). T h u i c l i hay sOc khde, NXB Y hpc.
5. Patll S.M, Patil M J , Aithal M et.
al. (2012). Reduction of splrometric lung function test in habitually smoking healthy young adult: it's correlation with pack years, JKIMSU. 1(1), p. 8 9 - 9 3 .
6. Tran Hoang Thanh, Nguyen Phuo-ng Lan (2009). Tinh hinh hut thuoc la va t h u i c lao cua benh n h i n COPD dieu tri tgi khoa hd hap benh vien Bgch Mai, Tgp chi Y hpc. 7(667), tr. 41-43.
7. B u i Thi T h u Hang (2000). Nghien cOu dung tfch toan phoi, dung tich can chOc n i n g , the tich c i n d ngudi binh thudng v i ngudi hen p h i q u l n IOa t u i i 20 - 40, Lugn van Thge sy y hpc, Trudng Dgl hpe Y H a Npi.
8. Thieny Perez e t Al. (2013). Small ainvay impaimient In mpderate to severe asthamtlcs without significant proximal alnway obstmction, Elsevier Respiratory Mediane 107, p. 1667-1674.
Vietnam Journal of Physiology 2 1 ( 1 ) , 3 / 2 0 1 7 I S S N : 1859 - 2 3 7 6
INFLUENCE OF SMOKING ON SOME LUNG VENTILATION PARAMETERS IN ADULT MALE AGED 40 - 60
Nguyen Nu Hai Yen^, Luong Linh L y \ Le Dinh Tung^
^Hanoi Medical Univerrity.
'Hanoi University of Pharm ^cy Smokers complain of shortness of breath three times more than the non-smokers and it is the major cause of decline in ventilatory functions and physical fitness in terms of both performance and endurance. We conduct this study aim to investigate the effects of smoking on TLC, RV, FRC, RV/ TLC ratio, Raw, sRaw in adult male aged 40 - 60 by body piethysmograph. Plethysmography was performed by Med Graphics 1085 Seles Piethysmograph according to the recommended guidelines of the Amencan Thorucic Society and the European Respiratory Society by highly trained power lab instructor.
Results indicated that smoking more than 20 pack-year had Raw, RV/TLC r3tio significantly higher in comparison with that of non-smoker. Raw and sRaw wers significantly higher among those who smoke 10-15 pack year
Key words: Plethysmography, smoker, Raw
