VIETNAM MEDICAL JOURNAL N°1 • MAY - 2017 dai ciia thude vi thude nghien cffu la thuoc hoan
nen thffdng tac dung cham dong thdi, lieu trinh dieu trj 3 thang (24 ngay/ thang) chu^ dii dai.
Tac dung dieu hda kinh nguyet eiia bai thudc 6ti<Sc danh gia dtfa tren tieu chi rut ngan chu ky kinh nguyet sau dieu tn > 5 ngay. Ket qua eho thay: 69,23% benh ntian dat ket qua tdt va 30,77% benh nhan ed ket qua khdng tot. Theo Y hpe ed truyen, bai thudc cd Thd ty tff, Cau ky tff cd tac dung bo can than, ich tinh, bo huyet;_
Phiic bon tff, Ngu vj tff ed tac dung co tinh, bd than [6], da dieu trj dffdc cai "goc" ciia benh vi the ket qua tot cua ngiiien cffu ttfdng ddi cao.
Ket qua cho thay: ty le benh nhan dat ket qua tot the than htf (77,78%) cd xu hffdng cao hdn the dam thap (50%). Tuy nhien sff khac biet nay chffa cd y nghTa thong ke (p>0,65). Cd the do mau nghien cu\j cdn nhd, pham vi nghien cffu chtfa rgng nen mau chtfa dai dien dMc cho quan the. Ttieo Y hoc co truyen than hff dan tdi tinh htf, huyet thieu gay nen kinh sau ky, Iffdng it.
Nguyen tac chung trong dieu trj la "trj benh tat cau ky ban" cd nghTa la: chffa benh phai ehffa vao gde cua benh. Vi the phap dieu trj ia bd than, ieh tinh, bd huyet [4]. Kinh sau ky trong PCOS CO goc la do than tinh hff ton. Tuy vao eae ehffng trang phoi hdp ma cd the chia thanh the than hff hay dam thap. Tac dung ehinh ciia bai Ngu tff dien tong hoan la bo than ich tinh nen phil hdp dieu trj cho the than hff hdn. Odi vdi the dam thap trd tre cd le nen phdi hdp them cac vj thudc trff dam de dat hieu qua cao hdn.
V. K§t LUAN
Ngu tff dien tong hoan ed tac dung dieu hda
chu ky kinh nguyet do hdi chffng buong trffng da nang. Ty le benh nhan cd ket qua dieu trj tdt la cao (ehiem 69,23%). Chu ky kinh trung binh sau dieu tri 3 thang: 67,44 ± 38,85 (ngay) ngan hdn so vdi trffdc dieu trj 77,05 ± 33,48 (ngay) vdi p
<0,01. Hieu qua giam so ngay ciia chu ky kinh nguyet sau dieu tri 3 thang (64,1%) tang so vdi sau dieu tri 1 thang (12,82%) cd y nghTa thong ke (p<0,05). Ty le chu ky kinh nguyet binh thffdng tang tff 0% len 38,46% sau 3 thang dieu trj. Ty le benh nhan kinh thtfa giam tff 100%
trffdc dieu tri con 61,54% sau dieu tri.
TAI UEU T H A M KHAO
1. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome.
/«rf//5fe/7/2004;81:19-25.
2. Renato Pasquali, Elisabet Stener-Victorin, Bulent O. Yildiz. (2011). Research in Polycystic Ovary Syndrome today and tomorrow. Oin f/70'ocmo/,74C4):424-433.
s. Joshi B, Mukheijee S, Patil A. (2014). A cross- sectional study of polycystic ovarian syndrome among adolescent and young girls in Nlumbai, India. Indian J Endocnnol Metab, 18(3):317-24.
4. Zhang Uy Zhen (2002), Jing hou ql. Duo nang luan chao, zhong yi fu ke xue, Zhong guo zhong yi yao chu ban she, bei. 122-124.
5. Cun Shi Fa (2002), Wu zi yan zong tang wei.
Idling fang pel wu fen xi ying yong, nan jing zhong yi yao da xue, Ren min wei sheng chu ban she, Nanjing. 210-212.
6. 86 Y te (2009), Duac dien Viet Nam IV, Nha xuat ban Y hoc. Ha Ndi.713, 818, 825, 845, 902.
7. Nquyen Khac Lieu (2007^1, Smh lyphu khoa, Bai giang san phu khoa tap I, Trtf6ng Dai hoc Y Ha Ngi, Nha xuat ban Y hpc, 225 - 237.
DANH GIA HIEU QUA SO-A SOAN ONG TCTY BANG T R A M X O A Y P R O T A P E R TRtN THU'C NGHIEM
Nguyen The Hgnh*, Dirffng Thi Phirong Linh*, Ngo Thi Hirimg Lan*
tren da dong kin cuong, dtfdc nho tff cac cd sd nha khoa, ttf 08/2013 den 10/20i5. Tien hanh md tiiy, sir dung tr§m K so 10 de tham dd va thong het chieu _dai ong tiiy, chup phim X-quang can chdp. Su^ soan 6ng tiiy bang tram xoay Protaper theo phtfdng phap bu'dc xuong, cho den file Fl hoac F2, bOm rtfa ong tiiy bang NaOCI 3%. Ou^ cay tram tao hinh cuoi cung vao trang ong tiiy cho den het chieu dai lam viec, sau do chup phim X-quang can chdp. Ghi nhan cac tai bien xay ra trong qua trinh sira soan, th6i gian siTa soan va sjf thay ddi lo chop ciia dng tiiy, Phu'dng phap nghien aHf. Nghien cffu can thiep tien lam sang (Invitro). Ket qua: Tai bien gay dung cu va thiing thanh ong tiiy deu chiem t / le 3,3%. Thdi gian sirs soan trung binh T O M TAT
Muc tieu ciia nghien ctfU nay nhlm danh gia tren thtfc nghiem ve hieu qua sira soan ong tiiy rang ham nho thtf nhat ham tren bang tram xoay Protaper. Doi tu'dng va phffdng phap nghien cffu: Chiing tdi ti§'n hanh nghien cffu d 30 rang ham nhd thff nliat ham
*Benh viin RSng Ham Mat 71/Ha Ndl Chju trach nhiem chinh: Nguyen The H?nh Email: [email protected] Ngay nhan bai; 1/2/2017 Ngay phan bien: 28/2/2017 Ngay duyet bai: 11/3/2017
30
TAP CHi Y HOC VIET HAM TAP 454 - THANG 5 - SO 1 - 2017 mptong tiiy la 167,72 ± 12,23 qiay. Stf dich chuyen lo
chdp ong tiiytrung binh la 0,14 ± 0,03 mm. Ket luan:
Sff dung tram xoay Protaper tao hinh ong tuy giup riit ngin thdi gian lam viec, an toan va hieu qua.
T&khoa: R3ng ham nhd thtf nhat ham tren, sffa soan ong tuy bang Protaper
SUMMARY
EXPERIMENTAL EVALUATION OF THE EFFECTIVENESS OF ROOT CANAL PREPARATION BY PROTAPER ROTARY FILES
Object: This study evaluates the effectiveness of the root canal preparationof the maxillary first premolars by protaper rotary files in experiments.
Subjects and research methods: We researched on 30 closed-apex maxillary first premolars that were extracted from the dental facilities from 08/2013 to 10/2015. We conducted canal access, then used K file No.lO to probe and travel the entire length of the root canal, followed by penapical X-ray. The root canals were prepared by protaper rotary files with step down method to reach to Fl or F2 file, before getting irrigated by NaOCI 3%. We put the final shaping file into the root canal until the end of the working length, followed by periapical X-ray. We recorded the complications that occurred during the preparation process, the bme to prepare and the moving of apical foramen. Method. Preclinical Research (Invitro).
Results: The complications of fractured equipment and punctured root canals'wall together accounted for 3,3% of the cases. The average time to prepare the root canal is 167,72 ± 12,23 seconds. The average moving position of the apex is 0,14 ± 0,03 mm.
Conclusion: Using Protaper rotary files is safe,effective and helps to shorten the working time.
Keywords: Maxillary first premolars, preparing the root canal by Protaper
I. DAT VAN o l
Oieu tr[ ngi nha (OTNN) la mpt giai doan quan trpng trong nha khoa bao ton, nham giff lai chffc nang an nhai va tham my cho mot rang benh ly. Trong do, viec tao hinh ong tiiy (OT) tot dong vai tro quan trpng de dieu tri thanh cong, khong chi nhd loai bo cac mo nhiem triing, ma dong thcrt tao hinh dang ong tiiy thuan ldi cho viec han kin ong tuy theo khong gian ba chieu.
03y la giai doan chiem nhieu thdi gian va doi hoi sff dung nhieu dung cu nhat.
Viec tao hinh ong tity cac rang co he thong Sng tCiy (HTOT) phffc tap luon la mot thach thffc ldn vdi cac bac sT nha khoa. Rang ham nho la mpt trong nhffng nhom rang co dac diem hinh th^i ong tuy phffc tap, kho nhan biet day dii tren phim X quang thong thffdng. Trong do, ti le OT cong, OT dang det va oval ciia nhdm rang nay kha cap [1]. Do vay, viec tao hinh nhffng OT co hinh dang nay cdn cd nhieu khd khan tren lam sang.
Viec sff dung Nickel-Titanium (NiTi) trong san xuat dung cu npi nha vao thap nien 80 ciia the ki 20 la mpt trong nhffng tien bp quan trpng nhat trong iinh vffc tao hinh OT. Nam 2003,Densply duci ra he thong tram xoay Ni-TI Protaper, dffdc thiet ke dac biet cung vdi chuyen dpng xoay lien tuc. Mac dil CO nhieu ffu diem vffdt trpi so vdi tram thep khong gi trong kha nang tao hinh nhff hieu qua cat nga tot, giam chuyen djch chdp rang, riit ngan thdl gian lam viec va tao OT cd dp thudn ly ttfdng... Tuy nhien, he thong tram NFTlProtaper v l n ton tai nhffng ban che nhat dinh, trong dd tinh an toan la mpt trong nhffng yeu to dang de cap nhat [7].
II. OOI TU'OWG VA PHU'CTMG PHAP NGHIEN CUU 2 . 1 . Doi tu'dng nghien cu'u: Chiing toi tien hanh nghien cffu d 30 rang, dffdc nho tff cac cd sd nha khoa, tff 08/2013 den 10/2015. Cac rang dffdc nhan dien la rang ham nhd thff nhat ham tren ngay tff luc nhd, da ddng kin cuong dffdc lffa chpn vao nghien cffu. Tien hanh md tiiy, stf dung tram K so 10 de tham do va thong het chieu dai ong tiiy. Chup phim X-quang can chdp theo chieu gan xa va trong ngoai (cac tram tham dd v l n dtfdc dat trong ong tiiy) de xac djnh vj tri lo chdp. Sira soan ong tiiy bang tram xoay Protaper theo phtfdng phap btfdc xuong, toe dp vdng quay 300 vdng/phut, md men xoan 2,5Ncm cho den file F l hoac F2. Trong qua trinh sffa soan, bdm rffa dng tiiy bang NaOCI 3%. Du^ cay tram tao hinh cuol ciing vao trong ong tiiy cho den het chieu dai lam viec, sau dd chup phim Xquang can chdp theo chieu gan - xa va trong - ngoai de danh gia sff thay doi vj tri lo chdp ciia ong tiiy. Ghi nhan cac trffdng hdp gay dung cu, thiing thanh ong tiiy. Thdi gian sffa soan dng tiiy, dtfdc tinh tff khi bat dau tao hinh OT cho den khi hoan tat qua trinh sffa soan, khdng tinh thdl gian bdm rffa OT, Oanh gia sff thay doi lo chdp ong tuy bang phffdng phap chong phim trtfdc va sau sffa soan ong tiiy. ilTng dyng phan mem Adobe Photoshop va AutoCad 2000 do khoang each giu5 hai dtfdng tiep tuyen tai lo cuong rang ciia dau tram K dffdc dat trong ong tiiy trffdc su^ soan va dau tram hoan tat sau ciing.
2.2. Phu'dng phap nghien cu'u: Nghien cffu can thiep tien lam sang (In vitro).
III.KETQUA
Qua nghien cffu tren thffc nghiem d 30 rang ham nhd thff nhat ham tren chiing toi thu dffdc ketqua nhff sau:
VIETNAM MEDICAL JOURNAL N°1 - MAY - 2017
3 . 1 . Cac tai bien trong qua trinh suTa soan ong tuy Bang 1. Tai biin trong qua trinh sii^ soan dng tiiy
1 Tai bien
So Iffdnq Ty le %
Khong tai bien 28 93,4 Nhan xet: Tai bien gay dung cu chiem ty 1 3,3% (deu g i p d rang cd 2 OT^.
3.2. Thdi gian suTa scan ong tuy Bang 2. Thdigian s&a soan dng tuy Thdi gian siia soan OT (giay)
Thdi qian Dd lech
Gay dung cu 1 3,3
Thung ong tuy 1 3,3 i 3,3% va tai bien thiing thanh ong tiiy chiem ty le
Rang 1 OT 94,96
2,04
Rang 2 OT 176,45
12,60
Trung binh 1 OT 167,72
12,23 Bang tren thay, thdi gian sQ'a soan OT d rang cd 1 OT ngan hdn d rang cd nhieu OT. thdl gian hoan thanh sira soan OT d rang 1 OT va 2 OT lan Iffdt la 94,96 ± 2,04 giay va 176,45 ± 12,60 giay.
Thdi gian sffa soan trung binh 1 OT la 167,72 ± 12,23 giay. • 3.3. Sii dich chuyen Id chop ong tuy: Sff dich chuyen lo chdp OT trung binh la 0,14 ± 0,03 mm(dao ddng tff 0,00 - 0,24 mm). Ket qua dffdc the hien d bang 3.
Bang 3. S& dich chuyen lo chop Ket qua
Kich thffdc (mm)
Khoang dao dong 0,00 - 0,24
Djch chuy€n Id chop trung binh ( m m )
0,14
Od lech chuan 0,03 IV. BAN LUJSLN
4 . 1 . Cac tai bien trong qua trinh siira soan ong tuy
*Tai bien gay dung cu: Trong nghien cffu ciia chung toi, 30 rang vdi 57 ong tiiy dtfdc sffa soan bang tram xoay protaper, chi cd 1 tru'dng hdp bi gay dung cu, chiSm ty le 3,3%. Xay ra d OT ngoai ciia rang cd 2 dng tiiy, vi tri gay la d 1/3 chdp. OT dtfdc xac dmh la kha cong va hep, mac du trtfdc khi sffa soan, chiing toi da sff dung tram K sd 08 de thdng het chieu dai lam viec.
Tuy nhien, khi sffa soan den tram F2, dffdc sff dyng lai lan thff 3 thi xay ra tai bien.
Ket qua cua chung toi phii hdp vdi cac nghien cffu ve kha nang sira soan ong tiiy bang protaper ciia cac tac gia trtfdc day. Trong khi dd, d nhdm sffa soan OT bang Protaper thay cd 2 trffdng hdp dffdc ghi nhan la gay dung cu trong tong s6 40 rang dffdc nghien cffu.
Mdt so nghien cffu trffdc day cho rang, tram protaper dffdc lam tff hdp kim NiTi, cd kha nang khang mdi vat lieu kha cao so vdi cac loai tram dffdc lam bang ttiep khdng gi. You va Cs [7], cho rang tuoi thp cua tram xoay Protaper giam di dang ke sau moi lan sff dung, dac biet la vdi nhffng OT khd. Nghien cffu cua You va Cs thay rang, tuoi thp trung binh ciia mdt tram Protaper la 10,06 ± 4,35 OT, dai nhat la dimg dffdc cho 21 OT, tdt nhat khi dung cho 6 OT cong la gidi han an toan.
*7S/ bien thung thanh ong tuy: Thiing thanh ong tiiy la 1 tai bien trong qua trinh su'a scan
OT, thffdng gap d nhDmg trffdng hdp OT cong va hep hoac tac. Theo Tsesis va Cs (2006), ti le thimg tlianh OT trong dieu tri ndi nha ndi chung tff 2% den 12%, Pham Thi Thu Hien (2012), bao cao 3% cac trffdng hdp thung thanh OT khi stf dung Protaper may. Trong mot nghien cffu danh gia hieu qua sffa soan OT cong bang tram xoay tren thffc nghiem, Nguyen Quoc Trung [1] nhan thay, t^ le thiing thanh OT chiem 6,45% trong tdng so 31 OTdffdc tao hinh bang tram xoay Protaper. Trong nghien cffu ciia chiing tdi, tai bien thimg thanh OT gap 1 trffdng hdp, xay ra d rang cd 2 OT rieng biet tff buong tiiy sau dd chap lai vdl nhau d 1/3 chdp. Tram tao hinh la file F2, sau khi nong OT ngoai den het chieu dai lam viec, chung to\ tien hanh nong dua OT trong. Tuy nhien, Idii den vj tri OT chap lai vdi nhau, txm khdng uon theo chiSu cong ciia OT ma di thing theo true ciia OT, dan den thung thanh OT.
Qua nghien cffu chung tdi thay, sff dung tram protaper de tao hinh ong tuy cd the xay ra cac tai bien, nhffng vdi ty le thap.Tuy nhien, do so Iffdng OT trong nghien cffu nay ciiffa nhieu, hdn nffa chung toi tien hanh nghien cffu tren tat ca cac OT, khdng phan biet OT cong hay thang. Do vay, chffa danh gia het dffdc cactai bien khi sirs soan OT ciia tram xoay Protaper.
4.2. Thdi gian chuan bj dng tuy: Trong nghien cffu nay, thdi gian sffa soan dffdc tinh til' khi bat dau tao hinh cho den khi file tao hinh cuoi di het ciiieu dai ciia OT, khong tinh thdi gian bdm ru^ OT va thay doi dung cy. Thiet ke
TAP CHI Y HOC VIET HAM TAP 454 - THANG 5 - SO 1 - 2017 nay cho phep so sanh vdi ket qua ciia hau het
cac nghien cffu tren thtfc nghiem trtfdc day.
Ket qua ciia chung tdi thay, thdi gian sffa soan d rang cd 1 OT it hdn han so vdi rang cd 2 o f . Thdi gian sffa soan d rang 1 OT Ia94,96 ± 2,04 giay, d rang 2 OT la 176,45 ± 12,60 giay vathdi gian trung binh sifa soan 1 OT bang tram xoay Protaper la 167,72 ± 12,23 giay. Chung tdi thay rang, stis soan OT bang tram xoay protaper giup giam thdi gian dang ke so vdl cac tram thdng thffdng da dffdc minh ehimg bdi cac nghien cffu trffdc day.
You va Cs [7], so sanh thdi gian sffa soan OT bang tram xoay Protaper vdl cae chuyen dpng xoay lien tuc va chuyen "dpng qua lai tren rang da nhd. 60 ong tiiy cong 6ti(ic chia lam 2 nhdm.
Nhdm CM: gom 30 OT 6ii(ic site soan den file F2 vdi chuyen ddng quay lien tuc (theo trinh tff sffa soan bing tram xoay Protaper) cho den het chieu dai lam viec ciia OT. Nhdm RM: gom 30 OT, sff dung mpt file F2 duy nhat de sffa soan OT vdi eiiuyen dpng qua lai cho den het chieu dai lam viee eiia OT. Ket qua cho thay, thdi gian trung binh de site soan 1 OT ciia nhdm CM la 46,42 ± 18,12 giay va ciia nhdm RM la 21,15 ± 6,70 giay. Tac gia ket luan rang, vdi chuyen dpng qua lai, thdi gian sffa soan OT nhanh hdn nliieu so vdi chuyen dpng quay lien tuc va cd sff khac biet ro ret ve mat thong ke giffa cae k9 thuat (p<0,01).
Mdt nghien CUXJ tren thffc nghiem khae eiia Burklein va Cs [3] d 80 OT eong tff 25° den 39°.
Chia lam 4 nhdm, moi nhdm 20 OT, dtfdc site soan bang 1 loai dung cy khae nhau. Ket qua, thdi gian trung binh sffa soan 1 OT bang Mtwo la 181,7 ± 16,5 giay, ProTaper la 188,7 ± 11,5 giay, Reciproc la 73,1 ± 12,2 giay va WaveOne la 82,3 ± 9,8 giay. Tac gia cung dffa ra ket luan, sff dung he thong tram Reciproc va WaveOne glup tao hinh OT nhanh hdn tff 50% den 60% so vdi sff dung he thong tram Protaper va Mtwo, sff khac biet nay cd y nghTa thong ke vdi p < 0,05.
4.3. s y djch chuyen Id chdp dng tuy Tff nhffng nam dau thap ky 70, Schilder da dffa ra 5 nguyen tac c(i, sinh hpc ciia qua trinh tap hinh OT. Trong do, viec giff nguyen v| tri cuong rang sau tao hinh OT la 1^ trong nhffng nguyen tac quan trpng va can thiet nham mang lai ttianh cong trong OTNN. Do vay, sff djch chuyen lo chdp sau tao hinh OT dffdc nhieu tac gia quan tam chu y de danh gia chat Iffdng site soan OT.
Krishna va Cs [6], tien hanh nghien effu d 45
rang ham Idn ham dtfdi da nho. Cac rang dffdc ehla lam 3 nhom, mdi nhdm 15 rang. Tao hinh OT cho nhdm 1 bang tram tay, thep khdng gi, nhdm 2 bang tram Ni-Ti cam tay va nhdm 3 bang tram xoay Ni-Ti ehay may. Ket qua, gia tri djch chuyen lo chdp ciia nhdm 1 dao ddng ttf 0,37 - 0,53 mm (trung binh la 0,43 ± 0,06mm), nhdm 2 dao dong tff 0,20 - 0,50 mm (trung binh la 0,31 ± 0,09mm), nhdm 3 dao dpng tff 0,17 - 0,23 mm (trung binh la 0,21 ± 0,02mm). Tac gia ket luan rang, tao hlnh OT bang tram xoay may it gay dich chuyen lo cudng hdn sff dyng tram tay. Dieu nay cung dffpe minh chiTng bdi Nguyen Quoc Trung [1] khi nghien effu d cac ong tuy cong tren thffc nghiem. Ket qua nghien effu ciia Nguyen Qude Trung thay, gia tn trung binh djeh chuyen lo cudng rang sau tao hinh OT bang tram tay thong thffdng la 0,35 ± 0,02mm, bang Protaper tay la 0,21 ± 0,02mm, bang tram xoay may Ksla 0,23 ± 0,06mm va bang tram xoay Protaper la 0,19 ± 0,06mm.
Ket qua dich chuyen Id chdp sau sffa soan OT bang Protaper ciia chiing tdi thap hdn ciia Nguyen Quoc Trung va Iqbal. Chiing toi cho rang, dieu nay la do cd sff khac biet ve lite chpn ddi ttfdng nghien cffu. Nguyen Quoc Trung va Iqbal tien hanh nghien cffu tren nhu'ng OT cong, cdn trong nghien cii'u ciia chiing tdi, tat ca cac rang ham nhd thff nhat ham tren du tieu ehuan lffa ehpn se dffdc dffa vao nhdm nghien cffU, khdng phan biet OT cong hay thang. Do dd, sff dich chuyen lo chdp trung binh ciia chung tdi thap hdn.
Nam 1988,_ Cimis dffa ra tieu chuan danh gia sff djch chuyen lo chdp sau site soan OT gom 3 mffc dp. Mffc dp nhe la cd sff djeh chuyen lo chdp < 0,25mm, mffc dp trung binh la cd sff dich chuyen lo chdp tff 0,25mm den 0,5mm va mffc dp nang la ed sff djch chuyen lo chdp > 0,5mm.
Nghien cffu cua chung tdi thay, gia tri dich chuyen lo chdp trung binh la 0,14 ± 0,63mm (dao ddng tff 0,00 -^ 0,24 mm). Ddi chieu vdi tieu chuan ciia Cimis, ket qua_ nghien ctiu eiia ehung tdi thay sff djch chuyen 16 chdp sau tao hinh OT d mffe dp nhe.
V. KET LUAN
Sff dung tram xoay Protaper tao hinh dng tiiy giiip rut ngan thdi gian lam viec, an toan va hieu qua.
TAI UEU T H A M KHAO
1. Nguyen Quoc Trung (2007), Nghien ciiU dieu tri tuy nhom rang ham co chan cong bing phugng
VIETNAM MEDICAL JOURNAL N°1 - MAY - 2017 phap su^ soan ong tuy vcfi tram xoay may va ta^
Niti, Luan an Tien sy Y hoc, Trtfdng Oai hoc Y Ha Npi, tr. 12-38.
. Bane K., Faye B,, et al. (2015), Root Canal Shaping by Single-Rle SySems and Rotaiv Instruments: a Uboratoiy Study, IranBidodJ., 10(2), pp.135-139.
. Burklein S., Hinschitza K., et al. (2012), Shaping ability and cleaning effectiveness of two single-file systems in severely curved root canals of extracted teeth: Reciproc and WaveOne versus Mtwo and ProTaper,//7f f/7rfotf7. 45, pp.449-461.
. Capar I.D., Ertas H., et al. (2014), Comparative study of different novel nickel-titanium rotary systems for root canal preparation in severely curved root canals, JEndc)d,.'\Ci{6), pp.8B2-856.
5. Iqbal M.K., Firic S., et a). (2004), Companson of apical transportation between ProFile and ProTaper NiTi rotary instruments, Int Endod J, 37(6), pp.359-364.
6. Krishna P.P., Beena R.G., et al. (2010). A Comparison of Root Canal Preparations Using Stainless Steel, Ni-Ti Hand, and Ni-Ti Engine- Driven Endodontic Instruments - An In Vitro Study. Bangladesh Journal of Medical Science, 9(4), pp.223-229.
7. You S.Y., Bae K.S., et al. (2010), Lifespan of one nickel-titanium rotary file with reciprocating motion in curved root canals, J Endod, 36(12), pp.1991-1994.
PHAN TICH MOT SO DAC DIEM LAM SANG, HINH ANH HOC GIUP TIEN LU'O'NG BENH NHAN DOT QUY THIEU M A U N A O CAP TINH
DU'O'C DIEU TRI BANG LIEU P H A P TIEU HUYET KHOI ALTEPLASE 6^ BENH VIEN DA KHOA TINH H A NAM
Le Quang Minh*
T O M T A T
B?t vain tfe: Nghien ctfu nay nham phan tich mpt so dac diem lam sang, htnh anh hpc giup ben ItfOng benh nhan dot quy thieu mau nao cap tinh dtfdc dieu tri bang lieu phap tieu huyet khoi Alteplase 6 Benh vien da khoa tinh Ha Nam. Boi tu'dng va phu'dng phap: 35 b§nh nhan dot quy thieu mau nao cap ti'nti dtfdc dieu tri bang lieu phap tieu huyet khdi Alteplase lieu tiiap (0,6mg/kg). Tien ctfu mo ta theo doi dgc, KSt qua: Tuoi trung binh 68,6 ± 11,82, nam gidi chiem 49%. Diem NIHSS trung binh luc nhap vien la 12,9 ± 4,9. KS qua dieu trj danh gia theo l^odified Rankin Scale (mRS) d thdi diem 90 ngay sau nh|p vien thayl4 benh nhan (40%) c6 ket qua tot v6i mRS 0-1 diem. Nhii'ng benh nhan co ket cue khong tot co diem GCS thap hon, NIHSS cao hdn, Uidi gian ttf luc khdi phat den khi vao vien nhieu hdn Idii so vdi cac benh nhan co ket cue tot, khac biet co y nghTa thong ke vdi p<0,05. Nhffng benh nhan ma thdi gian ttf liic khdi phat den khi vao vien tren 90 phiit co nguy cd nhan ket cue khdng tot cao gap 5,9 (95% CI: 1,07- 33,12) lan khi so vdi cac benh nhan nhffng benh nhan ma thdl gian ttf luc khdi phat den khi vao vieri dtfdi 90 phut. Khi ket hpp 4 yeu to GCS liic nhap vien <14 diem, NIHSS luc nhap vien >10, vi tri tac d doan Ml dong m?ch nao giffa hoac dong mach than nen, thdi gian ttf khdi phat den vao vien tren 90 phut nhan thay tren mot benh nhan ma cd k^ hdp 3 va ca 4 yeu to nay thi kha nang benh nhan nhan ket cuc khdng tot la
*B$nh vien da khoa b'nh Ha Nam Chiu trach nhiem chinh: Le Quang Minh Email: [email protected] Ngay nhan bai: 12/1/2017 Ngay phan bien khoa hoc: 15/2/2017 Ngay duyet bai: 10/3/2017
100%. Ket luan: 4 yeu to GCS luc nhap vien <14 diem, NIHSS liic nhap vien >10, vj tri tac d doan Ml dong mach nao glQa hoac dpng mach than nen, thcfi gian tff Ichdi phat den vao vien tren 90 phut la nhOtig yeu to CO kha nang tien Itfdng benh nhan dot quy thieu mau nao cap tinh dffdc dieu tri bang lieu phap tieu huyet khoi Alteplase.
Tii'khoa: Dot quy thieu mau nao, tieu huyet khQ, rt-PA, ben Itfdng.
SUMMARY
ANALYSIS OF CUNICAL CHARACTERISnCS AND IMAGING FEATURES HELP TO PROGNOSIS OF OUTCOME FORACUTE ISCHEMIC STROKE PATIENTS WERE TREATED
WITH ALTEPLASE THROMBOLYTIC THERAPY I N GENERAL HOSPITAL OF HANAMPROVINCE
Background: We conducted this study to analyze of clinical characteristics and imaging features help to prognosis of outcome for acute ischemic stroke patients were treated with Alteplase thrombolytic therapy in general hospital of Hanam province.
Objects and method: 35 acute ischemic stroke patients were treated with low dose Alteplase thrombotic therapy (0,6mg/kg). Cross-sectional study.
Results: The average age was 11.82 ± 68.6, males accounted for 49%. Average NIHSS at admission was 12.9 ± 4.9. Treatment outcomes by modified Rankin Scale assessed (mRS) at the 90 days after admlssionwere 14 patients (40%) had good results with mRS score 0-1. These patients with poor outcomes had lower GCS score, higher NIHSS, the more bme from onset to admission when compared with patients with a good outcome, with statistical significance p <0.05. Patients with time from onset to admissionmore than 90 minutes could have poor
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