4.3.2. Mdi lien quan tdi s& thay doi ciia cdng sudt giac mac
Trong nghien cffu cua ehung tdi, ket qua cdng suat khuc xa giac mac trung binh cua nhdm can rat nang mac dii giam nhleunhffng ciing nam trong gidi han an toan sau phau thuat la > 35D.
Vi neu sau p h l u thuat LASIK, giac mac phang qua ( < 35D), thi se xuat hien hien tffdng giam chat luWng thi giae sau md [5]. Vi vay can dffa ra mpt chi djnh gidi han ye dp can va cong suat khuc xa giac mac trffde khi ptiau thuat. Quan trpng la trffdc Idii phau thuat phai dff doan dffdc gia trj cdng suat khuc xa giac mac sau phau thuat. Nhff vay mac dij edng suat khue xa giae mac trung binh sau p h l u thuat 1 thang ed tang hdn so vdi 1 tuan, nhffng sff thay doi nay eung khdng lam thay ddi khiie xa eua benh nhan sau phau thuat. Trong nghien effu cua chung tdi, thay doi cdng suat Wiuc xa giac mac cho moi Diop khiic xa dieu chinh khdng phai la mdt hang sd ma thay ddi tu*/ vao Iffdng khiic xa dieu chinh. Ket qua nay tffdng tff ket qua eua Cheri Leng [3],[4].
4.33. Mdi liSn quan tdi s& thay doi cua bin kinh do cong giac maic
Khong cd sff khac blet ve ban kfnh dp cong giac mac trung binh giffa cac nhdm can thj ton dff vdi p > 0,05. Nhff vay mae du ban kinh dp cong giac mac trung binh sau phau thuat 1 thang cd giam hdn so vdi 1 tuSn, nghTa la giac mac cong hdn, nhffng sff thay doi nay khdng lam thay ddi khiic xa cua benh nhan sau p h l u thuat.
V. KET L U A N
- Op day giac mac trung ^ m . cdng suat khiic xa giac mac giam rd ret sau khi phau thuat LASIK. Ngffdc Iai ban kfnli do cong giac mac mac tang ro ret tai thdi diem 1 tuan sau phau thuat
so vdt trffdc phau thuat. Chi sd nay giam di sau 1 thang so vdi 1 tuan sau phau
- Sff thay dot dp day giac rnac sau phlu thuat tten quan den dp can trffdc p h l u thuat.
- Cd moi tffdng quan tuyen tfnh giffa sff thay ddi dp day giac mac trung tam trffde va sau phau thuat 1 tuan vdi do can diidc dieu chinh sau phau thuat.
- Cd mdi tffdng quan giD^ sff thay doi cua dp day giac mac va sff thay ddi cdng suat khiic xa giac mac sau mo 1 tuan so vdi trffde mo.
- Sff thay ddi edng suift khue xa giac mac trung binh lien quan den dp can trffdc phau thuat, dd can eang eao thi edng suat khuc xa giac mac cang giam nhieu.
- Sff thay ddi edng suit khue xa giac mae cho moi Diop khuc xa dieu chinh khdng phai ia mpt hang sd ma nd tuy thupc vao Iffdng khue xa dieu chinh.
TAI UEU T H A M KHAO
1. Nguyen Xuan Hiep (2008). Nghien cffu hieu qua dieu tn TKX bang laser excimer. Luan van tien sy yhoc, TrUdng D?i Hoc Y Ha Ndi
2. Tdn Thj Kim Thanh, Cung Hong Sdn, Vu Tea Thai (2002). Ket qua dieu trj can thj viici va nang bang laser Excimer. Noi san nhan khoa. 7: p. 78-83.
3. Tran Thi Hai Yen, Phan TTij Hong Mai (2002). Danh gia dieu tri can thi nang bang laser in situ keratomileusis (LASIK). i^ol'san nhan khoa, (8): p. 77-88.
4. Fiander, D. C.,Tayfour, F. (1995). Excimer laser in situ l<eratomileusis in 124 myopic eyes. J Re&act Surg. 11(3 Suppl): p. S234-8.
5. Salah, T., Waring G. O., el al. (1996). Excimer laser in situ keratomileusis under a corneal flap for myopia of 2 to 20 diopters. Am J Ophthalmol 121(2): p. 143-55.
D. Condon, P. I., Mulhem, et al (1997). L^ser intrastromal keratomileusis for high myopia and myopic astigmatism. ^JOf^thaimd. 81(3): p. 199-206.
DANH GlA MU'C DO HAI LONG COA PHAU THUAT VIEN Sfr DUNG PHU'CrNG P H A P PCS BANG MIDAZOLAM
vA PROPOFOL TRONG PHAU THUAT R A N G
Nguyen Quang Binh*, Ngo Thanh Nam**
T O M TAT thuat vien sff dyng phUdng phap PCS bang midazolam
^ va propofol trong phau thuat rang. Bdi tuyi^
phudng phap: 105 benh nhan eo ehi dinh phau thuat, tuoi 18 - 60, ASA I - II ehia lam 3 nhdm ngau nhien. Nhom 1 (gay te ddn thuan = GTDT) bang lidoeaine 2% (n = 35); nhdm 2 (PCS midazolam): gay te ket hdp vdi an than bang midazolam do benh nhan tff dieu khien (n = 35); nhom 3 (PCS propofol): gay te ket hdp vdi an than bang propofol do benh nhan tff diiu khien (n = 35). Kel qua: thdi gian phau thuat d
*Benh viin RSng ham mat Trung ddng HN
**Tmng lam nhlgt ddi Yiit - N^a Chju trach nhiem chfnh: Nguyen Quang Binh Email: [email protected] Ng^y nh^n bai: 19.01.2017 Ngay phan bien Wioa hpc: 24.3.2017 Ngay duyet b^i: 4.4.2017
nhom midazolam va propofol (p > 0,05) n^an hdn ^p
< 0,01) so vdl nhom GTDT; sU hdp tac tot vdi phau thuat d nhom midazolam 91,43% va propofol 85,71%
(p > 0,05) cao hdn (p < 0,01) so vdi nhom GTDT 31,43%; ti le khong cff dong trong phau thuat d nhom midazolam 97,14% va propofol 97,14% (p > 0,05) cao hdn (p < 0,01) so vdi nhdm GTDT 54,29%; mffc hai long ciia phau thuat vien 6 nhom midazolam 8,23+0,88 diem va propofol 8,34+0,54 diem (p >
0,05) cao hdn (p < 0,01) so vdi nhom GTDT 6,74±0,95 diem. Ket luan: PCS sir dung midazolam va propofol co thdi gian, sff hdp tac, mffc khong cff dong trong phau thuat va hai long ciia ph|u thuat vien la gan nhff nhau nhUng thdi gian phau thuat ngan, hdp tac tot, mffc khong cff dgng va hai long cua phau thiiat vien eao hdn so vdi phubng phap GTDT.
T&kii6a:An than, PCS, midazolam, propoM SUMMARY
SURGEON SATISFACTION ASESSMENT USING PCS BY MIDAZOLAM AND PROPOFOL IN DENTAL SURGERY
Objective: To asess the level of surgeon satisfaction using PCS by midazolam and propofol in dental surgery. Subjects of Methods: 105 patients w i ^ surgical indications, ages 18-60, ASA I - I I randomly divided into 3 groups. Group 1 (general anesthesia = GA) with lidoeaine 2% (n = 35); Group 2 (PCS midazolam): anesthesia in combination with patient-controlled sedation using midazolam (n = 35);Group 3 (PCS propofol) anesthesia in combination witti patient-controlled sedation using propofol (n = 35).
Results: Surgical Ome in midazolam and propofol group (p > 0.05) is shorter (p < 0.01) than GA group;
better surgical cooperation in midazolam group witti 91.43% and propofol group with 85.71% (p > 0.05), higher (p < 0.01) than GA group with 31.43%;
immobilization rate during surgery at midazolam group is 97.14% and 97.14% for propofol group (p> 0.05), higher (p < 0.01) than GA group with 54.29%;
surgeon satisfaction level at midazolam group is 8.23
± 0.88 points and 8.34 ± 0.54 points for propofol group (p > 0.05), higher (p < 0.01) than GA group with 6.74 ± 0.95 points. Conclusion: PCS using midazolam and propofol have almost the same at surgical time, cooperation, immobilization level during surgical and surgeon satisfaction but shorter surgical time, better cooperation, higher level of immobilization during surgery and surgeon satisfaction than GA method.
Keywords: Sedation, PCS, midazolam, pmpofol.
I.BATV^NDI
Sff dung phffdng phap an than do benh nhan tff kiem soat (PCS = patient controlled sedation) ket hdp vdi gay te tai cho trong phau thuat rang ngay cang trd nSn pho bien va ap dung kha rdng rai d cac rnicSc tien tien tren the gidi. Viec sff dung PCS bang midazolam va propofol cd tac dung an than, gay quen, lam diu, chong lo au trong khi can thiep phau thuat va anh hffdng den thai dp hai Idng cua phau thuat vien la do
benh nhan giam cff ddng trong mo, hdp tac tot va giam thdi gian phau thuat hdn so vdi nhom chi gay te ddn thuan (GTBT) trong phlu thuat rang khdn ham dffdi. O Viet Nam, viec sff duiig phffdng phap PCS bang midazolam hay propofcl ket hdp vdi gay te tai eho v l n la van de mft va chffa thffc sff phd bien dffdc eac phau thuat viSn ap dung trong cac can thiep nha khoa. Vi vay, chiing tdi nghien cffu: "daiib gia sif hai long ^ phau thuat vien s& dung phudng phap PCS bSag midazolam va propofol trong phau thuat ring khon ham dudi".
II. t>6l TU'ONG VA PHU'CrNG PHAP NGHIEN CUU 2.1. Boi t&dng: Benh nhan cd ctii dinh ptiaii thuat mpt rang khdn ham dffdi 38 hoae 48, vo cam dffdi gay te tai chd ddn thuan hoac gayte tai eho ket hdp vdi an than. Tudi tff 18 - 50, tinti trang toan than khde manh theo ASA I, I I . Benh nlian thffc hien phau thuat tren ghe niia khoa- tal khoa Phau thuat Rang Mieng, Benh vien Rang ham mat Trung ffdng Ha Ndi bdi mdt phau ttiuat vien cd kinh nghiem va bac sT gay me hoi siit.
2.2. Ph&dng phap
2.2.1. Thiet ke nghien c&u: thff nghiem tam sang ngau nhien, so sanh dot chffng. Chia ngau nhien lam 3 nhdm:
- Nhdm 1 (GTDT = gay te tai cho ddn thuan]
n = 35 benh nhan
- Nhdm 2 (PCS sff dun^ midazolam) n = 35 benh nhan: gay te tai cho ket hdp vdi an than bang midazolam theo phffdng phap PCS.
- Nhdm 3 (PCS sff dung propofol) n = 35 b|nh nhan: gay te tai cho ket hdp vdi an ttian bang propofol theo phffdng phap PCS.
2.2.2. Ph&dng phap ben hanh:
Chuan bj benh nhan, dung cu, ph&dng tien:
Theo quy trinh chuan benh vien.
2.2.3. Ph&dng phap danh gia
*Tieu ehi danh gia:
- Dac diem chung benh nhan: tudi, gidi, can nang, ASA, mffe an than OAA/S.
- I^ffc dp khd phau thuat rang khon ham duflt theo Pedersen: khd ft (1 -5diem), khd vij^ (6- 10 diem), rat khd m -15 diem) [5].
- Thdi gian phau thuat (phut): bat dau racti niem mac den khi khau ddng.
- Mffc dp hai Idng aia phau thuat vien theo VAS, hoi trffdc khi xuat vien ( 0 - 3 : Ididng hai&ng, 4 - 5;
hai long f^ 6 - 7: hai long, 8 - 1 0 : rathalldn^.
*Thdi diem danh gia: To: 5 phut trudc an than; T i : 1 phut sau an than; T j : 5 phiit, Ta'. 10 phut, T4: 15 phut phau thuat; T5: ket thuc ptiau thuat; Tx: xuat vien.
VIETNAM MEDICAL JOURNAL N°2 - APRIL - 2017 (2005) tien hanh d 83 benh nhan phau thuat
rang khdn ham dUdi bang GTDT cho biet thdi gian phau thuat 27,68 + 12,7 phut [2], ket qua nay dai hdn ciia ehung tdi. Zacharias (1998) sff dung PCS bang propofol d benh nhan phau thuat rang khdn ham dffdi cho talet, thdi gian phau thuat la 20,6 (17,6 - 23,5) phiit, ket qua nay gan gidng nhff cua ehung tdi. Nhff vay, viee sff dung PCS bang midazolam hay prcipofol giiip cho qua trinh hdp tac giffa phau thuat vien va benh nhan dien ra thuan tdi do dd lam giam thdi gian phau thuat, ehi ptii va tac dpng tdt den mffc dd hai Idng cua benh nhan va phau thuat vien sau phau thuat.
4.3. S& hdp tac cua benh nhan vdl phau thuat: d bang 3.2 eho thay mffc hdp tac tot cua benh nhan vdi phau thuat d nhdm midazolam va propofol khac nhau khdng y nghTa thdng ke (p >
0,05) nhffng khac nhau cd y nghTa (p < 0,01) so vdi nhdm chffng GTOT. Khi sff dung an than dii la midazolam hay propofol ket hdp vdi gay te tai cho trong phau thuat giup cho benh nhan tinh than em dju, giam lo sd, giam ngu9ng dau, ft cff ddng, ehinh vi vay sff hdp tae vdi phau thuat ciia benh nhan tdt hdn nhdm GTOT (mffc hdp tac trung binh 57,14% va hdp tac kem 11,43%) la do benh nhan qua tinh tao, tang lo sd, ngudng dau tang va cff ddng nhieu hdn trong phau thuat. Sff hdp tac tdt vdi phau thuat ta ffu diem ciia phffdng phap PCS sff dung midazolam hoac propofol hdn han phffdng phap chi gay te ddn thuan trong phau thuat rang khdn ham dffdi.
Leitch (2004) so sanh ngau nhien an than sff dung propofol va midazolam ket hdp vdi gay te tai cho trong phau thuat rang khdn.
4.4. S&c&dgng cua benh nhan: bang 3.3 cho thay ti le sd benh nhan khdng cff ddng trong phau thuat d hai nhdm PCS sff dung midazolam (97,14%) va propofol (97,14%) khac nhau khong y nghla (p > 0,05) nhffng cao hdn cd y nghia (p < 0,01) so vdl nhdm chffng GTOT (54,29%). Nhff vay, d hai nhdm PCS sff dung an than bang midazolam va propofol benh nhan nam yen, ft cff dpng nen hdp tac tdt, dung ft thuoc gay te va thdi gian phau thuat ngan hdn, trong khi dd d nhdm GTOT benh nhan to tang, bon chon, khd chju va cff ddng nhieu nen kem hdp tae, diing nhieu thuoc gay te va thdi gian pliau thuat dai hdn hdn. Ellis (1996) danh gia moi lien he giffa lo sd trffdc md va mffc cff dpng trong md d benh nhan sff dyng an than trong phau thuat rang khdn. Tac gia cho rang nhffng benh nhan cang Io sd cang cff ddng nhieu va ft
hdp tac trong qua trinh phau thuat [ 3 ] . Nhff v|y, sff dung an than pnDpofol hay midazolam eo tac dung lam giam eang thang than kinh, lo sd va ci' ddng trong phau thuat, tao dieu kien thuan tdi va nang cao chat lUdng cude mo hdn so vdl nhdm khdng sff dung an than. Mffc dp cff dpng ciia benh nhan se tac dpng manh den mffc do hai Idng ciia benh nhan va phau thuat vien trong phau thuat sau phau t h u a t
4.5. M&C do hai long cua phau thuat vien: Mffe dd hai ldng eiia phau thuat vien d bang 3.4 cho thay d hai nhdm sff dung PCS bang midazolam va propofol khae nhau khong y ngtiia (p > 0,05) nhffng cao hdn ed y nghla (p < 0,01) so vdi nhdm GTBT. De tf giai cho van de nay la do d hai nhdm sff dung an than midazolam va propofol benh nhan nam yen, phdi hdp tot, ftcu' dpng, diing ft thudc gay te va dau hieu sinh ^n on dinh hdn so vdi nhdm GTDT. Vi vay, d hai nhdm midazolam va propofol lam cho ptiau thuat vien hai Idng hdn nhdm GTOT trong phau thu|t rang khdn ham dffdi. Sff hai tdng ciia phau thuit vien gian tiep phan anh ffu diem eua phu'dng phap. Tao Ngpc Sdn (2006) nghien cffu PCS bang propofol cho thay diem hai long ciia phlu thuat vien cao hdn cd y nghTa (p < 0,05) so viS GTOT [1]. Oei - Lim (1998) nghien cuff PCS bang propofol d benh nhan dieu trj rang cho biet mii'c dp hai Idng ciia phau thuat vien la 8 (7 - 10) diem [ 7 ] . Ket qua nay giong nhff cua nghien ciJu ehiing tdi.
V. KET LUJjkN
PCS sff dung midazolam va propofol co thcfi gian, sff hdp tae, mffc khdng cff ddng trong phau thuat va hai Idng cua phau thuat vien la gan ntiif nhau nhffng thdi gian p h l u thuat ngan, hdp tac tot, mffc khdng cff dpng va hai tdng cua ptiai thuat vien cao hdn so vdi phffdng phap GTDT.
TAI LIEU T H A M KHAO
1. Tao Ngoc Sdn (2006), Danh gia tae dung an ttii bing propofol do benh nhan td dieu khien trong thu thuat noi soi dai trang, Luan van Thac si y hoc, Dai hoc YHa Noi.
2. Le Ngoc Thanh (2005), Nhan xet dac diim ^ sang x-quang va danh gia ketqua phau thuStrang ham dddi moc lich ,moc ngam, Luan van Ttiac a y hoc, Oai hoc YHa Noi.
J . Ellis S. (1996), "Response to intravenous midazolam sedation in general dental practice", S' Dent J, 180(11), pp. 417-20.
4. Leitch J. A., Anderson K., Gambhir S., Millar K./«
al (2004), "A partially blinded randomised controlled trial of fatient-maintained propofol sedation and
TAP CHl Y HOC VIET NAM TAP 453 - THAHG 4 - SO 2 - 2017 Curator contn^lted midazolam sedation in third molar
extractions", Anaesthesia, 59(9), pp. 853-60.
5. Pedersen G.W. (1988), "Surgical removal of teeth", Oral^ig&y, WB Saunders, Philadelphia, pp. 60-81.
6. Rodrigo C , Irwin M. G., Yan B. S., Wong M. H.
(2004), "Patient-controlled sedation with propofol
in minor oral surgery", J Oral Maxillofyc Surg, 62(1), pp. 52-6.
. Oet-Lim V. L., Kalkman C. J., Makkes P. C , Ooms W. G. (1998), "Patient-controlled versus anesthesiologist-controlled conscious sedation with propofol for dentel treatment in anxious patients", Ane^h Analg, 86(5), pp. 967-72.
NHU CAU DIEU TR! QUANH RANG 6" CAC BENH NHAN E»Al T H A O DU'CTNG TYP 2 DU'aC DIEU TRI NGOAI TRU TAI BENH VIEN BACH MAI
Nguyin Xuan Thirc*, Tir Manh Son*
them; 80.7% needed to have oral hygiene guidance and scaling, 19.3% needed complex treatment. Time detection of diabetes was not related to periodontal treatment needs. Periodontal treatment needs were higher in the group of over 65 years old, male, and poor control of HbAlc with statisticcal significance level p < 0.05; Poor oral hygiene increased the periodontal treatment needs at a statistically significant p < 0.01. Conclusions: Periodontal treatment needs of type 2 diabebc patients was high, required oral health care strategies and coordination between doctor specialized in Endocrinology-Diabetes and doctor specialized in OdontoStomatology to imprcive the quality of life for patients with type 2 diatietes.
Key words: type 2 diabetes mellitus, periodontal treatment needs, oral hygiene.
T6MTAT
Muc tieu: xac djnh nhu cau dieu tri quanh rang ciia eac benh nhan DTD typ 2.
Dol tu'dng va Phu'dng phap: Ap dung phffdng phap nghien cffu mo ta c3t ngang tren 400 benh nhan mac DTD typ 2 theo tieu chuan ciia IDF 2005 tai khoa Rang Ham Mat benh vien Bach l^lai tff 6/2010 den 6/2011. Cac benh nhan dffdc tien hanh l<ham rang mieng de ghi nhan chi so nghien cffu CPITN. Ket qua: 100% ddi tffdng nghien ciiff can dffdc dieu tri QR. Trong do; 100% cSn dffdc hUdng dan VSRM;
80,7% can dffdc hffdng dan VSRI^ va ISy cao rang;
19,3% can dffdc dieu tri phffc hdp. Thdi gian phat hien mSc DTD khong lien quan tdi nhu c^u dieu trj QR. Nhu cau dieu tn quanh rang t3ng cao 6 nhom tuoi tren 65, nam gidi v l HbAlc kiem soat kem vdi mffc <j nghTa thong ke p < 0,05; VSRM kem lam tSng nhu eau diSu tri QR vdi mifc y nghTa thong ke p < 0,01. Ket luan: Nhu cau dieu tr| quanh rSng eiia cac benh nhan DTD typ 2 la rat idn, can phai co chien luHc cham soc sut khde rang mieng, cung nhff ran co sff phffl hdp dieu tri giLJ^ cac bac sy ngi bet DTD va eac bac sy nha khoa, de nang cao chat luwhg song cho ngffdi OTD t/p 2.
T&khoa: dai thao dffdng typ 2, nhu cau dieu tr|
quanh rang, ve smh rang mieng.
SUMMARY
PERIODONTAL TREATMENT NEEDS I N OUTPATIENTS W I T H TYPE 2 DIABETES AT
BACHMAI HOSPITAL Objectives: To deserible the periodontal status in patients with type 2 diabetes mellitus. Subjects and Methods: Using a cross-sectional study on 400 outpatients with type 2 diabetes mellitus according to diagnostic criteria of IDF 2005, at the department of OdontoStomatology Bachmai hospital from 6/2010 to 6/2011. The patients received oral exam directly to take index as CPITN. Results: 100% of study subjects had periodontal treatment needs. Among
*Benh viin Bach Mai
Ch|u trach nhiem chfnh; Nguyen Xuan Thffc Email: [email protected] Ngay nhan bai; 5.01.2017 Ngay phan bl|n khoa hoe: 20.3.2017 Ngay duyet bai: 30.3.2017
I. DAT VAN OE
Oen dau nhffng nam 90 eua the ky XX, khi nghien cffu djch te hoc tren quy mo t6n ve benh DTD cf bang Arizona - My, ndi eo ty le mac DTD typ 2 cao nhift the gidi, sau khi da dieu chinh eac yeu to nhieu chang han nhff tuoi, gidi, tinh trang VSRI^, trinh dp hgc van va dieu kien KTXH ..., cac nha nghien effu da di den ket luan rang DTD typ 2 la mpt yeu to nguy cd cua benh QR [1].
Gan day hdn, cac chuyen gia trong tTnh vffc noi tiet - dai thao dffdng con cho rang viem quanh rang la bien chffng thff 6 cua DTD, quan diem nay cung dffdc cac nha nha chu hpc dong tinh Ling hp. Bien chffng rang mieng cua ngffcfi mac OTO t^p 2 se anh hffdng rat Idn den chat Iffdng song cua cac floi tffdng nay, dong thdi chi phi Y te de giai quyet van de nay cung rat Idn, Do dd, viec nghien ciTu benh QR d benh nhan DTD, ma dac biet la OTO typ 2 la rat can thiet. Tong hdp cac nghien cffu nay se lam sang td moi lien quan, cac tac dong hai chieu giirla benh QR va OTO t^p 2.
Tff dd giiip cho rang tac dieu trj va dff phong hai benh nay dat ket qua tot hdn, giup cai thien ctiat tffdng song cho cac benh nhan DTD.
Hien nay, d Viet Nam, van de benh quanh rang d ngffdi DTO con chffa dffdc chii y nghien
