TAP CHi Y HOC VlfeT NAM TAP 453 • THANG 4 - SO 2 - 2017 Ndl soi 6 byng de chan doan va dieu trj trong
ehan thffdng bung kfn cung da co nhieu b^o cao, vdi dp nhay 95% va dp chuyen doi vdi ruot non la 100%, dai trang 9 7 % [ 7 ] . Tl le xff trf t6n thffdng thanh eong khi phat hien ton thffdng tang bang phau thuat noi soi cua Tran Hieu Nhan la 7,2%. Tuy nhien trong nghign cffu ciia chung toi cho thay cac phau thuat vien chUci manh dang ap dung npi soi o bung de chan doan va dieu trj dol vdl chan thffdng byng kin.
V. KET LUiiN
Chan thffdng byng kfn gay ton thffdng tang dac nhieu hdn tang rong, ti le chan thffdng phdl hdp cao. Ti le dieu tri bao ton d benh nhan chan thffdng gan cao hdn chan thffdng lach. Sieu am bung; xquang byng dffng giup chan doan nhanh va chinh xac. Phau thuat dung va kip thdi giup giamti le tff vong.
TAI UEU T H A M KHAO
1. Russian MX et al (2009), Operative managament of liver trauma. A 10-year experience in Riyadh, Saudi Arabia, Saudi Med J, King Saud Medical Complex, University Unit (C), pp 942-946.
2. Lesy A.Dossett, Bryan ACotton (2010), Abdominal trauma: evaluation and decision making. Emergency Surgery, Blackwell Plublishing Ldt, po 139-144.
3. Nguyen Van Hai, Do Hai Ky (2007), Ket qua dieu tri v3 gan chan thu'dng, Y hoc TP.HCM, tap 14, phu ban so 2, tr 101 - 105.
4. Nguyen Vin Long (2003), Dieu tii bao ^ v d l a d i dian thuiang, Y hoc TP.HCM, tap 7, phu bah so 1, tr 60^7.
D. Phillip J. Stephan, et ai (2002): 23-hour observation solely for identification of missed injuries after trauma: is it justified? Joumal of trauma, fulltext
6. Tnin Chanh linh vacs (2003), Chan doan chanftiu^ng bung kfn, Y hpcTP.HCW, tap 7, phu ban so 1, tr 122-126.
7. TrSn Chanh Tin, Nguyen Tan Cffdng, Bui Van Ninh (2003), Noi soi chan doan trong chan thffdng - v^t thu'ong bung, Y hoe TP.HCM, tap 7, phu ban so 1, tr 113-118.
DAC DIEM GIAC NGU CUA CAC BENH NHAN SAU MO TRUgT DOT SONG THAT LU'NG TAI BENH VIEN VIET DUC NAM 2 0 1 5
Nguyin L6 Bao Tiin*, Dinh Ngoc Som*, Vo VSn Thanh*
TOM TAT
Myc tieu: Mo ta dac diSm g|ac ngCi cCia cac bfnh nhan sau mo trffdt dot song that Iffng tai benh vien Viet Qifc n3m 2015. Phutfng phap: nghiin cffu mo ta. KSt qua: Theo thang diem PSQI, 86% benh nhin CO CLGN kem. Trong do; b|nh nhan gu dffde trung binh 5,27 gid moi ngay va can khoang 30 phut de di vao giac ngu; 84% benh nhan eo hieu suat giae ngu kem. 92% benh nhan tff danh gia rang ho co CLGN kem hole rat k^m so vdi trffdc do; c6 46% benh nhan ran sff ho trcf ciia thuoc ngu. Ket lu$n: Nhin chung, hau het cac benh nhan sau mo tnfOt dot song that lUng ^ u CO bieu hien kho ngu trong khi dieu tri tai benh vifn.
T&khda: dae diem giac ngu, trffdt dot song thSt
\\ing, benh vien Viet Dffc.
SUMMARY
THE CHARACTERISTICS OF SLEEP OF THE PATIENTS AFTER LUMBAR SPONDYLOLISTHESIS SURGERY I N VIETNAM - GERMANY HOSPITAL I N 2 0 1 5
*Binh vien HOV nghj Viet D&c Chju trach nhiem chinh: Nguyin Le Bao Tien Email: [email protected] Ngay nhan bai: 8.01.2017 Ng^y phan bien khoa hoc: 29.3.2017 Ngay duyet bai: 5.4.2017
Objectives: To describe the characteristics of sleep of the patients after lumbar spondylolisthesis surgery in Viemam - Germany hospital in 2015.
Methods: descriptive study. Results: According to PSQI scale, 86% of patients had poor sleep quality.
Among them: Patients spent 5.27 hours sleeping every day and took about 30 minutes to fall asleep;
84% of patients had poor sleep efficiency. 92% of patients self-assessment that they had poor sleep quality or very poor compared to the previous; 46% of patients needed sleeping pills. Conclusion: In general, most pataents with postperative lumbar spondylolisthesis had expressed difficulty sleeping during treating at the hospital.
Keywords: characterises of sleep, lumbar spondylolisthesis, Vietnam-Germany Hospital
I.DATVANDI
Ngu la mpt nhu eau tffdng doi cd ban cua con ngffdi. Khi ngu cd the tiet ra nhffng hormone quan trpng cho qua trinh chuyen hoa, tfch luy nang Iffdng, glup cd ttie phat trien thidi nghi vdi moi trffdng song. Mat ngii khong chi tac dpng den chffc nang nhan thffc ma con tac dpng den sffc khoe tinh thBn va the chat con ngffdi. Thieu ngu gay ffe che he pho giao cam, lam tang nguy cd mae benh ly tim mach, beo phi, dai thao du6ng[l].
Dol vdi mpt ngffdi benh, giac ngu vo cung quan trpng. Ngu eo anh hffdng tfch cu'c trong viec giam dau, giam cang thang lo au, nang cao
137
VIETNAM MEDICAL JOURNAL N°2 - APRIL • 2017 the trang va thuc day qua trinh phuc hoi sffc
khoe cua ngffdi benh. Tren the gidi da co nhieu cdng trinh nghien cffu ve giac ngu d benh nhan noi tru bang nhieu phffdng phap khae nhau. Tuy nhien d Viet Nam, van de nay lai chffa dffde quan tam dung mffc. Viec cham soe va nang cao ehat Iffdng giae ngu cho benh nhan la mpt trong nhffng yeu to nham muc tieu eham sdc toan dien ma ngffdi dieu dffdng can nghT tdi. De giup hieu sau hdn ve van de nay, ehung toi thffc hien nghien cffu de tai nham muc tieu: "A/d ta dac diem giac ngu cua binh nhan sau phau thuat mo tr&dt dot sdng that lung tai khoa phau thuat cot sdng, benh vien Viet D&c".
II. DOI TU'ONG VA PHU'CFNG PHAP NGHIEN CIJXJ 1.1. Doi tu'dng nghien cu'u: 100 benh nhan trudt dot song that Iffng dffdc dieu tri tai khoa phau thuat ept song, benh vien Viit Dffc nam 2015.
1.2. Phu'dng phap n g h i i n cihi: Nghien cffu mo ta tien cffu.
Cac chi so danh gia ve giac ngu trong tharig diem PSQI (Pittsburgh Sleep Quality Inde^ ^ PSQI): Thdi gian ngu, tinh glae giffa dem, f^ilt dp kho ngu, mffc anh hffdng den hoat dgng ban ngay do thieu ngu, hieu suat giac ngu, tff (Janh gia ehat Iffdng giac ngu, sff dyng thuoe ngu.
- Tong diem PSQI < 5 lien quan den chat Iffdng giae ngii tot.
- Tong diemm PSQI >5 lien quan den ciiat Iffdng giac ngu kem, trong do diem PSQI > 13 lien quan den chat Iffdng giac ngu rat kem.
1.3. Xiir ly va phan b'ch sff lieu: So lieu du'cfe nhap va xff ly so bang phan mem SPSS 20.6.
III. KET QUA
3.1 Thdi gian ngii trung binh mdi ngay Biiu do 1 . Thdi gian ngii trung binh moi ngay
-^ ^ § M
• ^ ^H ^H ^H ^H
• i HI Hi HI WM
Ng^V 1 Ngay 2 Ngay 3 Ng^y 4 Ngay 5
So gid ngu trung bmh tang dan qua tffng ngay, thap nhat la ngay thff nhat sau mo (2,35 gi6)va cao nhat vao ngay thff 5 (6,96 gid). Thcfi gian ngu trung binh nam 5 ngay 5,27 gid.
3.2 Mu'c do kho ngu Bang 1 . Mu'c do kho nc
Dl/cli l ^ h u t Tir 15 - 30 phut
Tren 30 phut Tong
u n 18 60 22 100
»/o IS 60 22 100 Phan ldn benh nhan (82/100) cam thay kho di vao giac ngu trong moi trffdng benh vien, trong do CO 22% benh nhan ran tren 30 phut de dl vao giac ngu.
3.3 Hi$u suat giac ngu
Nghien cffu hieu qua cua giac ngu (HQGN) cua 100 benh nhan dffa tren cong thffc HQGN %
= so gid ngu/tong thdi gian nam ngu x 100%.
Hau het eae benh nhan eo hieu xuat giac ngu thupc loai trung binh va kem dffdi 85% (82 benh nhan), chi ed 16 benh nhan co hieu suat giac ngu tot > 85%. Hieu suat giac ngu trung binh la 72,7 ± 12,7 (%).
Bioi do 2. Hieu xuat giac ngii dia benh rt Khi dffdc hoi ve tff danh gia chat Iffdng giac ngu (CLGN), da so cac benh nhan tff danh.^
CLGN giam hdn khi nam vien (72%), trong 33, 48% benh nhan tff thay CLGN rat kem, tiic la kho vao giac ngu, hay tinh giac, kho ngu l?l, hoac thffc trang dem. Gan V2 so benh nhan khong can tdi sff txd giup cua thuoc ngu (48/100), edn lai trong so cac benh nhan ran den thuoc ngu a5 8 benh nhan (8%) sff dung thuoc ngu 3 ^n trcl len trong vong 5 ngay sau mo.
3.4 Chat lu'dng giac ngO theo PSQI
TAP CHi Y HOC V l i T NAM TAP 453 - THANG 4 • SO 2 - 2017
Bang 2. Chat lu'dnq qiac nqu ciia benh nhan theo PSOI C h i t lu'dnq qiac ngu
Giac ngu t o t ( P S Q I < 5 ) Giac ngu k e m (PSQI > 5 )
Trong do: CLGN kem
CLGN rat kem (>13)
n 14 86 66 20
»/o 14 86 66 20 Chi cd 14/100 benh nhan (14%) eo diidc CLGN tot trong 5 ngay dau hau phau, phan Idn benh nhan (86%) co CLGN kem, trong so do co den 20/100 benh nhan cd CLGN d mffc rat kem.
IV. BAN LUAN
4.1 Thdi gian ngu mdi ngay: Thdi gian giac ngu ngan nhat 6 ngay dau sau mo, trung binh 2,35 gid moi ngay va dffdc cai thien dan qua tffng ngay. Nghien cffu ciia Ly Duy Hffng tren eac benh nhan co lien quan den stress la 3,6 gid/
dem [2]. Dieu nay cho thay rang phau thuat cung la mpt stress Idn va anh hffdng nhieu den giac ngu ciia benh nhan.
4.2 Mu'c do kho ngii: Mffc dp kho ngu la mpt trong nhffng van de dang quan tam d benh nhan. Trong nghien cffu, benh nhan can trung binh 15 -30 phut mdi co the ngii dffdc, nhieu benh nhan can thdi gian nhieu hdn. Dieu nay eo the lien he tdi viec benh nhan kho thich nghi dffde vdi moi trffdng benh vien hoac mpt phan do qua dau dan tdi viec hp mat nhieu thdi gian dedi vao giac ngii.
Geisler P va cong sff [3] khi sff dung test MSLT - 30 (Multiple Sleep Latency Test - 30) de tim hieu thdi gian vao giac ngii tren 100 doi tffdng ngffdi binh thffdng, cho ket qua thdi gian trung binh tff liic di ngii cho tdi khi ngu dffdc j a 13,9 ± 6,9 phut va co lien quan ro rang vdi tuoi, tuoi eang cao thi thdi gian nay cang dai.
4.3 Hieu suat giac ngii: Thdi gian ngii dffdc qua it so vdi thdi gian nam tren giffdng danh eho viec ngii la dau hieu cho mot giac ngu kem. Hieu suat giac ngii cang thap chffng to giac ngii cang kem. Trong nghien cffu ciia chung toi, hieu suat giac ngii trung binh dat dffdc la 72,7 ± 12,7 (%), tffdng tff ket qua 62,60 ± 21,26 ciia tac gia Nguyen Thanh Binh [ 4 ] , ket qua nay co the dffdc ly gial do benh nhan trong nghien cffu ciia Nguyen Thanh Binh cd ehffng ngffng thd khi ngii nen hieu qua giac ngii se kem hdn.
Trong nghien cffu, ty le benh nhan co hieu suat giae ngii kem la 8 4 % , rao hdn nghien effu khae cua Fetvelt A va cong sff [5] khi tien hanh
nhan phai phau tiiuat, sau mo benh nhau dau nhieu nen anh hffdng Idn den hieu suat giac ngii.
4.4 T\i danh gia chSit lu'dng giac ngii va sif dung'thuoc ngii: CLGN dffdc danh gia dffa tren nhan xet ehii quan ciia ngffdi benh. Ket qua nghien cffu eho thay, da so benh nhan than phien rang giae ngii cua minh thupc mffc rat kem va tffdng doi kem. Dieu do hoan toan phu hdp vdi thffc te chung ciia hau het cae benh nhan.
Khi dieu trj tai vien, dae biet sau mot cupe phau thuat, benli nhan phai doi mat vdi nhieu thay doi nhff moi trffdng, thdi quen giac ngii...dan den ngu kem va hay tinh giac giu^ dem, the trang met moi. Mae dii danh gia CLGN d mffe kem nhffng ty le benh nhan sff dung thuoe ngii khong cao, 8/100 benh nhan diing thuoc >3 Ian/5 dem.
Benh nhan dii mat ngii nhffng van co gang khong sff dung den thuoc vi sd tac dung phu, sd phu thupc v^o thuoc... Qua day co the thay rang, kien thu'c chung ve y hpe eiia ngffdi benh ngay cang dffdc nang rao. Hdn nffa, benh nhan chii yeu mat ngii la do dau, vi vay, khi dau giam.
benh nhan se de ngii hdn. Tuy nhien ciJng nen cin nhac viec sff dung thuoe ngii trong trffdng hdp benh niian khong the tff dieu chinh dffdc va anh hffdng den tinh trang sffe khoe.
4.5 Ch3t lu'dng giac nqii theo thang PSQI: Diem PSQI cang cao, the hipn CLGN cang kem. Sau khi tong hdp va tfnh diem tff nhan to cau thanh bp cau hoi, ehiing toi dffa ra ket qua da so benh nhan co CLGN kem (diem PSQI >5) ehiem 86%. Mpt nghien eirtj ve moi lien quan giffa giae ngu, dau va khuyet tat tren 121 benh nhan co benh ly cot song eho thay 87% benh nhan eo CLGN kem [ 6 ] .
V. KET LUiSkN
Theo thang diem PSQI, 86% benh nhan cd CLGN kem. Trong do: benh nhan gii dffdc trung binh 5,27 gid moi ngay va can khoang 30 phut nghien cuU rol loan giac ngu tren toan bp aoi ^ g j | ^^^ ^^^ j , g ^ , 540/^ !,§„(, „f,i,„ ^ higu jygt tuBng is trai an du8ng, ket qua hieu suat giac ,.^ ^^^ ^^^ g2o/„ bgnii nhan tti danh gia rang ngu trung binh la 75% va so doi tu'dng co hi^u ^^ ^^ j-^g,^ 1^^^ f^^^ i-gt f^^ ^„ ^,31 tr^.^^ j ^ . qua giac ngu khong tot (<8S%) la 72%. Co the ^ ^^^^ j j ^ ^ l , ,,[,§1, can sy ho trd ciia thuoc ngii.
glai thich si/ chenh lech nay la do doi tu'cfng lua ^^^^^ ^^^j„„ ^ 5 „ l,gt ^^ i^„f^ n h j n j g ^ ^ g ( r , , ^ chpn trong nghien ciru cua chung toi la tren benh
VIETNAM MEDICAL JOURNAL N°2 - APRIL - 2017 dot song that Iffng deu eo bleu hien kho ngu
trong khi dieu tn tai benh vien.
TAI UEU T H A M KHAO
1. J.S. Young, et al (2008), "Sleep in hospitalizied medical patients, part 1: factor affecting sleep", J Hosp Med.3(6),p. 473-82.
2. Ly Duy Hu'ng (200&), Nghien cud cac dSc diem_^
lim sang binh nhan rol loan giac ngii trong eae roi loan liin guan den stress, Luan van tot nghiep Thac sy Y hoc, trffdng Dai hpc Y Ha Ngi, Ha Npi.
3. Gei'sler P et al (2006), "The Influence of age and
sex on sleep latency in the MSLT-30-a normative study", Sleep.29, p. 678-92.
4. Nguyen Thanh Bmh (2011), "Nghien cirtJ flSc diem lam sang,giac ngu dd da kf va hieu qua ciia CPAP trong dieu tn hoi chffng ngung thd do tSc nglien kiii ngii", Luan an 'tien sj^ Trudng Dai hgc YHN.
5. Feiveitaetal(2002), Sleep detufbances among nuaig home residert", IrtJGEri^PBydii^. 17,p. 604^.
o. M.M. Zarrabian, M. Johnson, and D. Krlellaars (2014), "The relationship between sleep, pain and disability in patients wwith spinal pathology", Ardi Phys Med Rehabil.
TAC DUNG KHONG MONG MUON CUA D-PENICILLAMINE TRONG DIEU TRI NGO DOC CHI 6^ TRE EM
Ngfl Ditc Ngoc''^, Pham Du£^ Nguyin Anh Tudn' T 6 M
TAT
0at van dS: Theo dffpc thff, khi diing D- penicillamin dieu tri ngp doe ehi co the gay ra hien tffdng t3ng nguHe chi mau, lam tang nguy ed ngp dpc nSng ten. Ngoai ra, cdn co mpt, so tac dung phu nhff:
thieu mau, giam b|ch cau...6 Viet nam chffa co nghien diu ve van de nay, thffc hanh 13m sang can c6 th&m thong tin. Myc tieu: Nhan xet mot so tac dung khong mong muon D-penicil!amin trong dieu trj ngo dfic chi d tre em. Ddi tddng va phUdng phap: 52 benh nhSn ngo d6c chi cap, dieu tri tai Trung tam Chong Doc - Benh vien Bach Mai, du'dc dieu tri binci D-penidllamin. Ketqua: j\ ie nam/nff la^l,2:i; tuoi trung binh Ia21,6 ± 19,9^thang). Nhom tuoi 1-6 nhieu nhlt (53,9%). Nguon ngo doe chii yeu: do dung thuoc cam gia. Co 7,7% benh nhan tang ngu'dc chi mau trong qua trinh dieu trj, tuy nhien khong anh hu'dng tdi cae chffc nang ctJ quan tron_3 ed the. Vdi lieu 15mg/kg/ngay, D-peniciliamin eo rat ft tac dung khong mong muon. Ket luamMdi lieu dieu tri D-genicillamin ISmg/k^/ngay, tac dung khong mong muon la tffdng doi ft va khong co tiiih trsing nang. Ty le tSng ngffdc chi mau thap va khong anh hffdng tdi cd the benh nhi, so benh nhi phai chuyen diiu trj phu'cfng phap khac khong dang ke.
T& khda: D-penicillcmin, ngp dgc chi cap, tac dung khong mong muon
SUIVIMARY
THE ADVERSE DRUG REACnON OF D- PENICILLAMINE I N LEAD POISONING
CHILDREN TREATMENT
'B^ man HSCC, D^i hgc Y Ha Ngi 'Khoa CSp aiVA9, Binh vi4n Bach Mai
^Trung tam Chdng dgc Benh viin Bach Mai Chju trach nhiem ehfnh: Ph?m Due Email: [email protected] Ngay nhan bai: 27.12.2016 Ngay phan bien khoa hoc: 6.3.2017 Ngay duyet bai: 20.3.2017
Background: Using D-Pecicillamine as a antidote for children with lead poisoning can cause ino-eased blood lead rebound, which is lead to more severe lead poisoning. In addition, many medicine textbook argued that D-Penieillamine have some adverse drug reactions such as anemia, leukopenia. There is no research in Vietnam deal with this issue while clinical practice needs more information. Objective; Reviews some adverse reactions of i>Penieillamine in treameat lead poisoning in children. Subjects and Methods:
Restrospedive study, 52 patients diagnosed acute lead poisoning and treatmented at Poison Oan'm Center - Bach Mai Hospital. Results: male/female ratio were 1.2:1; mean age of 19.9 ± 21.6 (monHis), Age group 1-6 years old is the highest, accounted for 53.9%. The cause of lead poisoning: using feke medicines. There was 7,7% patients with increasing blood lead rebound in the treatment process, but no harmful effect for the organ function was reconled.
Increasing blood lead rebound in patients who M.
treatmented fiDr >2 years is higher than patients v*o had treamented for <2 years (p=0,002). There iSiro adverse effects threatened the lives and kidneys^of patents. Conclusion: With the therapeutk: dose of ISmg D-Peniclllamlne/kg/day, adverse effects is relativeV few and no serious condition. The rebound increasing semm lead level was quite hight 30th day treatment (28%), but it did not have significant effects on patients.
Keyword: D-penicillamine, acute lead poisoing, adverse drug reaction
I . D / I T V A N D E
6 Viet Nam co thoi quen sff dung thuoc cam, thuoc te de dieu tri mot so benh thffdng gSp { tre: tu^ l&di, loet mieng, bieng Sn... Mot so thufic nay bj lam gia, trong thanh phan co nhiBu kim loai nang nhff chi, ehinh dieu nay tao ramSt van nan dac biet nghiem trpng.Nhieu tre phai sif dung phac do D-penicilamin dffdng uong[ll- Trong dffdc thff de cap nhieu tac dung phu cOa thuoc nay nhff hien tffdng tang ngffdc chi mau
