VIETNAM MEDICAL JOURNAL N°1 - OCTOBER - 2017
DANH GIA MOT SO CHITC NANG THI GlAC TREN BENH NHAN ^ D i r g e PHAU THUAT DUC THUY TINH THE
BANG PHUaNG P H A P P H A C O TAI BENH VIEN QUAN Y 3 5 4 Ha Thu-a Lanh*, Hoang T i i n Thanh^*
Keyword: Phacoemulsification, Cataract surgerv Visual acuity, VF-14.
I. O^T VAN OE
Phiu thuat tan nhuyen the thuy tinh bang nang lu'dng sieu am (Phacoemulsification gpi t^t la phau thuat Phaco) la phu'dng phap dieu trj due the thuy tinh tien tien va hien nay dang du'dc ip dung rdng rai [1]. Viec eai thien chiTc nang thi giac va han che bien chu'ng xa chiu anh hu'dng bdi nhieu yeu t d trong do viee kham theo doi djnh ky cac benh nhan sau phlu thuat ddng gop vai trd quanj:rpng. TiT nam 2012 benh vien quin y 354 da trien khai phau thuat phaco trong dieu tri due the thuy tinh^ hang nam ed hang tram benh nhan du'dc phau thuat phaco tai benh vien, eho den nay chu'a cd nghien eutj nao danh gia ket qua cua kT thuat dieu trj nay tai benh vien 354. Chinh vi vay, ciiung tdi tien hanh nghien ciTu de tai vdi myc tieu sau: Danh chdc nang th/
giac trin binh nhan da dddc phau thuat due the thuy tinh bang phu'dng phap Phaco dat kinh n&;
nhan tai Benh vien Quan Y354 va mdt so yeu id' lien quan den elide nang thi giac sau phiu thuat II. €>6l TU'ONG VA PHLrCTNG PHAP NGHIEN COU Doi tuidng n g h i e n cii'u: la 158 benh nhan vdi 195 mat da du'dc phau thuat Phaco dat lOL tai vien 354 tiT nam 2012 den 2015.
Phu'dng p h a p nghien cu'u: mo ta, cat ngang cd sir dung du" lieu hoi ciiXi.
Sd lieu du'dc thu thap trong thdi gian tif thang 9/2016 den thang 5/2017 vdi bp cong cu thu thap sd lieu kham benh va cae du" lieu tiT kho hd sd cua Benh vien. Ben canh viee thu thap cac dac diem ciiung cua doi tu'dng nhu"; tuoi, gi6i, benh tai mat, benh toan than lien quan den mat;
ngu'di nghien ciTu se kham thu'c te chiTc nang thj giac tai thdi diem hien tai va sau dd trich xuat di?
lieu ve cupe phau thuat tiT kho benh an ciia benh vien. Cac phu'dng phap do lu'dng chiTc nang ftj giac va nang lu'c hoan thanh cdng viec ciia benh nhan deu su" dung cdng cu chuan nhu" bang ^
\de nhin xa (Snellen 6m), do nhay cam tuting phan Colenbrander, sd dyng sinh hien vl, den sol day de kiem tra tinh trang bao the thiiy tin va ban phan sau eiia nhan cau.
XuT ly so l i e u : Dii' lieu du'dc nhap va phan tieh vdl phan mem SPSS 21.0.
T O M TAT
Gidi thieu: Phacoemulsification (phaco) la mot trong nhutig 'kT thuat thudng dUOe si^ dung nhat trong dieu tri due the thiiy tmh (TTT). Trong vai nam qua benh vien quan y 354 da sir dung kl thuat nay de phuc vu benh nhan. Muc tieu: danh g]a chiTc nang thj giac ciia benh nhan due thiiy tmh the da du'cJc phau thuat phaco tai BV QY 354, va tim hieu mot sd yeu td lien quan. Phu'dng phap: Nghien cu'u mo ta du'dc sir dung tren 158 BN (195 mat) cd thi lu'c ban dau
<20/100 dUcJc \^ phaco tai BV QY 354^ Ket 903:
ChiTe nang thi giac du'dc cai thien dang ke, 21 mat eo thi lUc 20/200 - <20/60; 70 niat co thi lUc 20/60 -
<20/40; 36 mat c6 thi lUe 20/40 - <20/30; va 68 mat CO thi lUc >20/30. '-Diem VF14 trung binh la 87,49±12,04, vdi diem nho nhat la 42,5 diem. Sd mat can can thiep do due bao sau la 29 (14,9%), va cd 19 mat (9,7%) hien da ro chi dmh can thiep. Mot so yeu to CO the anh hu'dng den thi liTe sau PT phaco gom:
benh toan than va tinh trang thi lUc tru'dc md.
Tdkhoa: Phau thuat Phaco, Phlu tliuat due thiiy tinh the, Thj lUc, VF-14
SUIVIIVIARY
EVALUATION OF VISUAL ACUITY OUTCOMES AMONG CATARACT PATIENTS
UNDERGOING PHACOEMULSIFICATION SURGERY AT 3 5 4 MILITARY HOSPITAL Introduction: Phacoemulsification (phaco) is the most common technique that use to treat cataract patients. In last few year, the 354 Military Hospital has applied this technique to serve patients. Purposes: to evaluate patients' visual acuity outcomes among cataract patients undergoing phacoemulsification surgery at 354 Military Hospital, and explore some related factors. Methods: Descriptive study has been used on 158 cataract patients (195 eyes) with visual acuity <20/100 had been undergone phaco surgery from 2012 to 2015 at 354 Military hospital. Results:
The visual acuity has improved, 21 eyes (10.8%) with VA: 20/200-<20/60; 70 eyes (35.9%) had VA; 20/60 -
< 20/40, 36 eyes (18.5%); 68 eyes (34.9%) had VA;
>/=20/30. The VF-14 score was 87,49±12,04 with min score was 42,5. There were 29 eyes (14.9%) had been gone laser capsulotomy, 19 eyes (9.7%) had required for laser capsulotomy. Some factor that affect on postoperative VA were systemic diseases and preoperative VA.
*Benh vien Quan Y354
**'Benh vien Mat Trung Udng Chiu traeh nhiem ehinh: Ha ThiTa Lanh Email: [email protected] Ngay nhan bai; 25.7.2017 Ngay phan bien khoa hgc: 20.9.2017 Ngay duyet bai; 26.9.2C)17
TAP CHl Y HOC VigT NAM TAP 459 - T H A N G 10 - S 6 1 • 2017
' 111. KET QUA VA BAN LU^N 3 . 1 . Dac diem nhom nghien cu'u Bac diem diung: Nghien cuU bao gom 158 benh nhan, tuoi trung binh la 68,48±6,47 tuoi,
\ trong dd cd 72 benh nhan (45,6%) nam gidl, 86 . benh nhan (54,4%) nO' gidi. Tong sd mat du'dc
theo ddi la 195 mat, trong dd 12_1 benh nhan duWe phau thuat 1 mat va 37 du'dc phlu thuat 2 mat, tkt ca deu du'dc phau thuat bang phu'dng phap phaco dat kinh ndi nhan tai vien Quan y 354.
Bang 1: Bac diem sdc khoe chung eda ' bjnh nhin (n=lS8).
Trong tdng sd 158 benh nhan ed thdng tin ve tien sir benh toan than va benh tai mat da hd sd hdi cii'u. So benh nhan cd benh toan than la 41,7% CO benh ve matja 15,5%.
Hinh thai due the thuy tinh.
Bing 2. Phin loai theo hinh thii due thi' thiiy tinh (n=195)
Phan loai Due the thiiy tinh tudi qia
Dye the thiiy tinh tinh chat benh ly
Tdng
Sd lu'dng
177 18 195
Phin tram 90,76%
9,24%
100%
Ngi dung Benh
toan than
Cd Khong Tong
Benh tai mat 7 (10,6%)
16 (19,3%)
23 (15,5%)
Khdng 59 (89,4'
135 (84,5%)
Tong 66 (41,7%)
92 (56,1%)
158 (100%)
Hinh thai due the thCiy tinh chu yeu la due the thuy tinh tuoi gia vdi 177 mat (90,76%), due the thuy tinh tinh chat bgnh [y chi co 18 iriat (9,24%).
Ty le nay phu lidp vdi dac diem chung cua due the thuy tmh tren benli nhan eao tuoi va dae thu eua benh vien, phan idn benh nhan trong nhom nghien diu la bo doi nghi hu'u, tien su" it cd benh toan than, tai mat va du'dc kham tu' van ciiam su'c l<h6e dinh ky day du [ 2 ] . Chu'c nang thi giac tru'dc o l i l u t l i u a t .
Bang 3. Thi tde tru'dc phau thuat ('n=195) Thdi diem
Thllttcnhlif
2012 nC/o)
2013 2014
n('A>) 2015 nf'/a)
Tdng nC/o) ST(+)- < BNT I m . 16 (32,7) 20 (40,0) 13 (28,8) 20 (39,2) 69(35,4) BWTlm-< 20/200 22 (44,9) 19 (38,0) 16 (35,6) 14 (27,5) 71 (36,4) 20/200 -<20/100. 11 (22,4) 11 (22,0) 16 (35,6) 17 (33,3) 55(28,2)
Tdng 491 VlOO'/o) 50(100'/o) 45(100'/o) 51 (100%) 195(1000/0)
"nii ly'c nhin X3 tru'dc phau thuat cua nhdm l)§nh nhan trong 4 nam ve can ban ia tu'dng du'dng nhau. Tuy vay, theo khuyen eao thi lire phij hdp nhat cho p h l u thuat nay la khoang 20/200 den 20/60.
Bien chu'ng trong va sau phau thuat. ^ Bang 4. Bi&n chulig trong va sau phau thuat (n=195).
Bien chu'ng Rach bao tru'dc
Rach bao sau Dong til meo Lech lOL Viem manq bo dao
Sdlitdng 8 6 9 14 2
(%)
4,13,1 4,6 7,2 1,0 Trong liic phau thuat van cdn mdt ty le kha Idn benh nhan gap phai nhu'ng bien chu'ng, tuy
vay trir bien ehiTng rach bao la dang quan tam, eac bien ehdng khac deu la bien chiTng kha nhe nhang. Trong dd, rach bao la 72%. Ty nay khac biet vdi nghien ciTu ciia Sheludehenko va edng sy (2014) cd 7 mat tren 2556 mat du'dc phau thuat (0,27%) benh nhan bj rach bao sau. Mdt sd bien chirng khac eung du'dc phat hien vdi t / le cao: dong tiT meo khi ra vien (9/195 mat), lech lOL 14/195 mat; viem mang bd dao 2/195 mat.
Theo ehiing tdi cd sy" khac biet nay do ky thuat ciia phau thuat vien, trang bj may phaco va miTc dp due the thiiy tlnh [3],[4].
3.2. Chu'c nang tlij giac cua cac nhom benh nhan tai thdi diem kham ( 2 0 1 7 ) .
Thi lu'c nhin xa
^ ZjThdl gian ThllUc~~-~~^
i m ^ - < 20/60 20/60 - <20/40 20/40 - <20/30
> 20/30 Tdng
Sau 4 nam nC/o) 8 (16,3) 26 (53,1) 10 (20,4) 5 (10,2) 49 (100"/.)
Sau 3 nam nC/o) 7 (14,0) 23 (46,0) 11 (22,0) 9 ( 18,0) 50(100'/.)
Sau 2 nam nC/o) 3 (6,7) 13 (28,9) 8 (17,8) 21 (46,7) 45(100%)
Sau 1 nam nC/o) 3 (5,9) 8 (15,7) 7 (13,7) 33 (64,7) 51(100%)
Tong n(%) 21 (10,8) 70 (35,8) 36(18,5) 68 (34,9) 195(100%)
VIETNAM MEDICAL JOURNAL N°1 - OCTOBER - 2017 Tai thdi diem nghien edu, cd 21 mat (10,5%)
ed thj lye trong khoang 20/200 - < 20/60; 70 mat (35,8%) cd thj luC phan cdn lai la cac mat ed thi ILTC la tiT 20/40 hoac hdn.
Ty Id mat du'dc mo sau 4 nam cd thj Idc tir 20/60 den <20/40 la 5 3 , 1 % , trong khi do sau 3 nam, 2 nam va 1 nam thi ty le nay tu'dng iTng la
46,0%; 28,9% va 15,7%. Oieu nay cho thay thj ly'c ciia benh nhan se suy giam dan theo th6J gian sau md, nhuYig ty le > 20/30 tang dan is nhij'ng nam md gan day. Dieu nay cho thay vdi phau thuat phaco, thdi gian sau phau thuat la mdt trong nhiTng yeu t d anh hu'dng den thi luc.
Thj lu'c tu'dng phan
Bang 6: Bd nhay cam tu'dng phin (n=195) (Thj lu'c do khoang each 63em d do nh$y cam tu'dng phan thap lO^/o)
Thi IWe d BNCTP10% Thi Idc glim < 3 dong Thi lite glim > 3 (BNCTP binh thwdng) ddng (BNCTP giam) Td'ng
87,2
12,£ 100%
^ 1,65±1,25
Tron^ nghien cu'u nay, sd mat du'dc phat hien cd giam dp nhay cam tu'dng phan giam tren 3 dong ia _25 mat (12,8%). Day la mdt ket qua can ldu tam bdi nhu'ng benh nhan nay kha nang nhin d trong mdi tru'dng anh sang yeu se khdng tdt. Ty le nay khdng khac biet vdi bao eao cua Tran Ngpc Khanh (2015) khi bao cao rang 12,8% benh nhan ed giam thi lu'c tu'dng phan [ 5 ] .Thang diem VF14
Bang 7: Bang didm danh gii kha nang thife hi0n cdng viee So diem VF-14 Sdbenh nhan Ty le %
0,6
75-100 diem~ 137
12,7 87,49± 12,04 42,5 - 100
Tong 158 100%
Diem VF trung binh 87,49±12,04, vdi diem nhd nhat la 42,5 diem eho thay miTc giam nang lu'c thdc hien cac hoat dpng hang ngay eiia benh nhan la khdng qua nhieu. Chi ed 1 benh nhan cd diem 42,5 va 20 benh nhan (12,7%) cd diem trong khoang 50 - <75 diem, sd benh nhan cd diem tir 75 - 100 diem la 137 benh nhan (86,7%) cho thay hieu qua rat tdt ciia p h l u thuat phaco tren nhdm benh nhan nghien ciTu.
Bang 8: Thi lu'c hien tai va b$nh toan than
Ket qua nay khdng khac biet vdi nghien cfiU eiia Do Minh Himg (2007): trung binh 78,35±18,28 [6]. Them vao dd, Chiang (2011) da ed nghien eiiu chiTng minh rang diem VF l^i mdt thang do dang tin cay do dd rat nen si^
dung thang diem nay de danh gia chiTc nang thj giac sau phau thuat phaco [7].
3.3. Mot SO yeu t o lien quan den thj lu'c sau mo phaco
Lien quan thi lu'c vdi benh toan than.
(n=19S) Npi dung
Thildenhmxa
* 20/30 20/40 - <
20/30 20/60-
<20/40 20/200 - <
20/60 Tong
Binh toin thin 1 Khdng
34 (29,8)
28 (34,6) 21 (18,4) 18 (22,2)
42 (36,8) 30 (37,0)
17 (14,9)
5(6,2)114 (58,5) 81 (41,5)
Tong 62(31,8) 39(20,0) 72(36,9) 22 (11,3) 195
Nhdm thi lye thap (20/200 - <20/60) tap trung nhieu hdn ro ret (15,4% so vdi 4,8%) d nhdm co va khdng cd benh toan than kem theo. Dieu nay gdi y rang viee khao sat ki tinh trang benh toan th3n la quan trpng bdi ngoal viec gay khd khan trong phau thuat cdn anh hu'dng den chirc nang thi giac sau nay. Nhd vay, viec phdi hdp vdl cac chuyen khoa khac de dieu tr; la thu'c su" can thl§t de giam thieu cae bien chii'ng do benh toan than gay ra.
Chdc nang thi giac va bao sau
Bang 9: Lien he gida thi lu'c tru'dc phau thuit va tinh trang bao sau (n=19S) Bao sau
Thildc ST(+)-<DNTlm
Khong due bao sau 24 (34,3)
Co due bao sau Bamd
bang laser 1 (10,0)
Canmd 12 (17,1)
Chita can md 27 (38,6)
Tdng sd
1
70 (35,9) 1
TAP CHl Y HOC VIET NAM TAP 459 - THANG 1 0 - s o 1 -2017
BUTlm - <20/200 20/200-20/100
Tong
29 (41,4) 24 (43,6) 77 ( 3 9 , 5 )
13 (18,6) 9 (16,4) 29 ( 1 4 , 9 )
4 (5,7) 3 (5,5) 19 ( 9 , 7 )
24 (34,3) 19 (34,5) 70 ( 3 5 , 9 )
70 (35,9) 55 (28,2) 195 ( 1 0 0 ) Ket qua cho thay sau mdt khoang thdi gian tiT
1-4 nam, tinh trang due bao sau la kha phd bien, chi ed 77 mat (39,5%) la chu'a xuat hien tinh trang due bao sau. Phan cdn lai, cd 29 mat da du'dc md bang laser, 19 mat khac da ed chi dinh mdj va 70 mat chu'a can phai md bao sau. Khi xem xet kt hdn mdi lien quan vdi thi ly'c tru'dc phlu thuat, thay ty le mat chu'a bi due bao sau tdt hdn vdi cae mat ed thi iiTc tot hdn, neu thi lu'c tru'dc phau thuat kem (<DNT I m ) thi nguy ed bi due len den 65,7%.
Theo ket qua nghien ciTu nay ty le due bao sau tang phu thupc vao tinh trang thi lu'c tru'dc mo, phii hdp vdi nghien ciTu tru'dc dd va phu hdp vdi cac khuyen cao hien tai ve viee chi dinh phau thuat phaco sdm cho cac benh nhan ed thi liTc con chu^ kem qua.
V. KET LUAN
- Thi lu'c nhin xa du'dc cai thien rd ret: 21 mat CO thi i'u'c 20/200 - <20/60; 70 mat ed thj lu'c 20/60 - <20/40; 36 mat ed thi liTc 20/40 -
<20/3O; va 68 mat cd thi lu'c > 20/30 - Diem VF14 trung binh la 87,49±12,04, vdi diem nhd nhat la 42,5 diem
- So mat can can thiep do due bao sau la 29 (14,9%), va cd 19 mat (9,7%) hien da ro chi
djnh can thiep
- Mdt sd yeu t d ed the anh hu'dng den thj lu'c sau phau thuat phaco gom; benh toan than va tinh trang thj lu'c trddc md.
TAI U i U T H A M KHAO
1. Unlu M., Hondur A. M., Korkmaz S. et al. (2016).
Pharmacologic Management of Pressure-Induced StromgJ Keratopathy after LASIK. Optom VisSa^
2. Nguyen Trong Khai (2012). Danh gia ket qua phau thuat PHACO tren mat due the thuy tinh chin trang tai tinh Ha Nam. K hoc thdc hanh, 825 (6/2012), 101-103.
3. Sheludehenko V. M., Sheludehenko N. V., Eksarenko O. V. et al. (2014). [Results of intraocular lens implantation on top of the anterior capsule in cases of phaco complications]. Vestn Oftalmol, 130 (5), 42-46.
4. Vu Anh Tuan and TniWng Tuyet Trinh (2003).
Nghien ajU thu'c hien ky thuat Phacoemulsification viS the thiiytinhductrang. Yhoc TP.Ho ChiMinh,7{2,),21.
a. Tran Ngoc Khanh (2015). Khao sat chuC nang thj giac cua benh nhan sau mo Phaco dat kinh noi nhin da tieu +2,5D, Thac sy, Bai hpc Y Ha Npi.
6. Do Minh Hung (2007)^banh gia ket qua lau dai ciia phUOnq phap tan nhuyen the thiiy tinh,dat the thiiy tinh nhan tao tai khoa glocom. Daihocyha noi, 7. Chiang 9. P.', Fenwick E., Marella M. et al.
(2011). Validation and reliability of the VF-14 questionnaire in a German population. Invest Ophthalmol Vis Sd, 52 (12), 8919-8926.
GlA TRI CUA THANG DIEM GLASGOW BLATCHFORT S O A DOI TRONG TIEN LirgNG BENH NHAN XUAT HUYET TIEU HOA TREN
TOM TAT
Muc dich: So sanh gia tri tien lu'dng eua thang diem Glasgow Blatehfdrd siVa doi so vdi thang diem Rockall va Glasgow Blatchford day dii d benh nhan xuat huyet tieu hoa tren. Doi tu'dng va phu'dng phap: 104 benh nhan xuat huyet tieu hoa tren, 78 nam, 26 nu' tuoi frung binh 56,5 ± 16,0: Tat ca dUOc kham lam sang, danh gia bang thang diem Rockall, Glassgow Blatchford day dii, Glasgow Blatchford siTa doi; Tat ea dude lam cae xet nghiem cong thirc mau;
Ure, creatinin mau, men gan (SGOT, SGPT), Protid mau, Albumin mau, chiTc nang ddng mau toan bo, bilirubin mau, dien tim, sieu §m tim, sieu am byng;
*Daihoc Ykhoa Vinh
Chju trach nhiem ehinh: Cao Tru'dng Sinh Email: [email protected] NgSy nhan bai: 1.8.2017 Ngay phan bien khoa hoe: 19.9.2017 Ng^y duyet b^i: 26.9.2017
Cao Tru-oiig Sinh*, Hoang Thi Cue*
ndi soi da day- ta trang de xac dinh vj tri cliay mau, phan do nguy ai theo Forrest. Ket qua: Diem trung binh ciia thang diem Rockall la 3,34 ± 1,69; Glasgow Blatchford day du la 8,65 ± 3,49; Glasgow Blatchford siTa doi la 7,38 ± 3,22. Do nhay, do dac hieu dien b'eh dudi dudng cong ciia thang diem Glasgow blatchford sira doi tUOng du'dng vdi thang diem Glasgow blatchford day dii va c6 gi tri cao hdn thang diem Rockall trong dU bao can thiep y khoa (AUC: 0,854 so vdi 0,675); trong du' bao tai xuat huyet (AUC: 0,706 so vdl 0,586); trong dy bao tiT vong (AUC: 0^,902 so vdi 0,650) d benh nhan xuat huyet tieu hoa tren. Ket luan: Thang diem Glasgow Blatchfort siTa doi cd gia tri'trong dU bao can thiep y khoa, diT bao tai xuat hiiyet, du bao nguy cd tif vong vdi do nhay, do dae hieu cao,'deap dung tai cac cd sd y te tuyen huyen.
SUIVIMARY
THE VALUES OF THE MODIFIED GLASGOW BLATCHFORT SCALE I N THE PREDICTION
OF PATIENTS W I T H UPER
