A BAO CAO KHOA HOC
Nghien cuu mot so dac diem ve nhan thuc tdng quat tren benh nhan dong kinh cue bo phuc tap 6 nguoi trudng thanh
PGS. TS. Nguyen Cong Hoan*, BS. Ho Bang Muoi**
• Binh vien Bai hoc Y Ha N6i
**Binh viin Nhi Nghe An
T6MTAT
Muc ti^u: Mo t^, danh gici dac diem nti$n thuc tdng qudt tren benh nhan dpng Idnh CMC bd phitc t^p a ngiroi trirong thanh.
Sdi tuong v<i phuong phap: 40 b^nh nhan ddng l<inh trudng thanh diroc l<hani, ch^n doan theo benh dn mau va danh gia nhan thCrc tdng quat bdng test MMSE, tdng diem MMSE 30 Vcl danh gia giam Itha nang nhan thuc tdng quat tuong ling vdi sd diem trung binh MMSE giam dan, danh gia anh hudng cac y^u td nguy co dua vao so sanh ti^ suat chSnh OR.
Kit qua: Diem trung binh ve MMSE giua hai gidi (nam 25,3 ± 3,87; nu 24,8 ± 2,90)
iihdng cd su l(hac biet (p>0,05). Dj^m MMSE giam rd ret d nhdm ddng l<inh cd sCr dung Gardenal va nhdm ddng kinh cue bo phOc tap cd tan suat con day (p<0,05).
Ket luan: Cd mdi lien quan giua su dung Gardenal trong dieu tri ddng kinh cue bo phuc hop va tan suat con vdi giam kha nang nhan thuc tdng quat.
I. DATIfANBE bo kem theo suy giam y thirc trong do ngUcJi benh bj roi loan l<ha nang nhan thiJc va dap ijmg Dpng l(inh la loai benh ly man tinh cua nao, doi vdi cac kich thich ben ngoai. Tren The gi6i, chiem khoang mpt phan tU trong tong so benh dpng kinh cue bp phiJc tap la mot trong nhCrng ly than kinh. Theo Jallon. P (2001) nhan thay dpng benh \^ hien nay dang 6Mc nhieu tae gia nghien kinh cijc bp chiem 60%, trong do mot phan tU la cijxj dudi nhieu goe dp khac nhau, trong do co dpng kinh cue bp dem gian va ba phan tu la dpng ITnh vUc nhan thiJe [5;7].Be danh gia ve tinh trang kinh eijc bp phijrc tap [3]. nhan thufc, ngoai tham kham lam sang chuyen
Dpng kinh cue bp phiJe tap la dpng kinh ciic khoa tSm than kinh, bp cau hoi trSc nghiem than
112 THAN KINH HOC VIET NAMlSfi 14-QUt IV/2015 Website hoithankinhhocvietnam.com.vn
BAO CAO KHOA HOC k.
kinh tam [y cCia ICD 10 la eong cu khaeh quan de danh gia tfnh ehat va mde dp roi loan nhan thCfc [8]. Trong cac bp cau hoi, Trac nghiem Tam than t6i thieu (Mini Mental State Examination:MMSE) dupc xem la m6t cong cu co gia tn sang Ipc ban dau de danh gia sd bp ve nhijfng roi loan trong linh vUc nhan thiJegpi la nhan thtfctdng quat. Vdi dp nhay va dp dac hieu eao, MMSE hien nay tren th^ gidi dang dape sCfdung rpng rai de nghien eiJu sang Ipc benh nhSn roi loan nhan thufc noi ehung va sa sut tri tue noi rieng. Nhi^u nghien eiJu da eho thay tan suat efln dpng kinh cue bo phu'c tap cung nhu' sCf dung mot so thuoe khang dpng kinh eo 5nh hadng dang ke den bien doi nhan thufc tong quat, dae biet la khi SLT dung nhom Phenolbaebital (Gardenal) hay Clonazepam (Rivotril) [5;6]. Tan suat cdn cang day nhan thiifc tong quat cang gicim da dtfpc c^c tae gia cong nhanI4].
Nh^m danh gia mpt so bien doi nhan thufe t6ng quat tren benh nhan dpng kinh cue bp phdc tap 6 ngudi trudng thanh va nghien eUu anh hudng eCia mpt so yeu to len qua trinh nhan thUc eCia ngudi benh, chung toi tien hanh "Nghien cUu mpt so dae diem ve nhan thUc tdng quat tren benh nhan dpng kinh cue bp phUc tap d ngUdi trudng thanh" vdi muc tieu:
- Md ta ddc diim nhdn thdc tong qudt tren benh nhdn dgng kinh cue bg phdc tap d ngddi trddng thdnh.
- Phdn tich moi Hen quan gida diim MMSE vdi tdn sd can ddng kinh cue bo phdc tap vd viec sd dung Gardenal trong dieu tri.
II. DOI TUDNG VA PHUONG PHAP NGHIEN COU 1. Doi tupng nghien cdu
30 benh nhan tU 20 tuoi trd len, dupe ehan doan \i dpng kinh cue bp phUc tap (theo phan V\',M l^lte. hoithanlcinhhocvietnam.com.vn
loai quoe te ve eac cPn dpng kinh (1981). Cac benh nhan dUpc kham lam sang, dien nao do theo benh an rieng thiet ke eho nghien eiJu. Cac benh nhan du tieu ehuan lam sang se dUpc tien hanh lam t r k nghiem tam than toi thieu (MMSE) theo mau.
Loai trC; eae trudng hPp eon dpng kinh cue bp phUc tap do cac nguyen nhan cap ti'nh (tai bien maeh mau nao giai doan cap, viem nao, ap xe nao, chan thuong sp nao, ngo dpe), cac trudng hpp dpng kinh khong phSi 1^ dpng kinh cue bp phUe tap, nghi, benh nh^n mu chU, khiem thj hoae khiem thinh.
2. Phuong phap nghien cufu
Quy trinh nghiin cduQuy trinh nghien cUu cac doi tupng se ddac tien hanh thong qua cac giai doan sau:
Giai doan 1: Chan doan xac dinh dpng kinh [8]:
- Chan doan ePn dgng kinh: Can eU vao tham kham lam sang phoi hpp vdi dien nao do (trong do lam sang la chu yeu).
-Chan doan dpng kinh: Phai cd tCrhai ePn dong kinh trd len each nhau tren 24 gid, khong lien quan den cac ton thUPng cap tinh, roi loan chuyen hda (theo tieu ehuan cua Lien hdi Quoe te chong Odng kinh), dua vao md ta eCia ngudi lam ehUng hoae quan sat cpn dpng kinh cua benh nhan dpng kinh.
- Phan loai eon dpng kinh: Theo phan loai 1981 cua Lien hpi Quoc te ehdng dpng kinh [7].
Giai doan 2: ThUc hien trac nghiem kiem tra trang th^i tam than toi thieu cOa Folstein {Mini Mental State Examination/ MMSE)[7] eho eac doi tUcfng nghien cUu. Oiem tdi da 30. Danh gia theo mUc dp giam dan cua thang diem tUPng dUPng mUc dp gicim dan finh trang nhan thUc tong quat.
- Chung toi ehia nhom tan suat eon dua vao nghien eUu Dodrill CB (2004) [5].
- Thdng tin dupc sCf ly bSng ehuong trinh SPSS 15.0. Vdi mpt so chl sd so sanh cap nhU sau:
S(5l4 QUyiV/2015lTHANKINHHpCVi|THAM 113
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+ p i , p2, p3: So sanh ti/ng eap nhdm benh nhan s d d u n g Gardenal vdi cac nhdm tan suat con nham danh gia anh hUdng ddc lap cua tan suat CPn len nhan thiJfe t o n g quat.
+ p4, p5, p6: So sanh tifng cap nhdm SLf dung thude khang dpng Idnh khdng phai Gardelnal vdi eae nhdm tan suat ccfn nh^m danh gia su anh hUdng ddc lap cua tan suat cdn len nhan thUe tong quat.
+ p7, p8, p9: So sanh tUng eap cac nhom tan suat cPn vdi 2 nhdm benh nhan sddung Gardenal va %d dung nhdm thudc khac nham danh gia anh hudng ddc lap cua thude khang ddng kinh Gardenal den nhan thUc tdng quat CLiabenh nhan.
III. KET QUA NGHIEN COU
Bdng 1. Lien quan gida MMSEvd gidiNhdn xet. Diem MMSE trung binh gtUa hai gidi khdng cd su khac biet ed y nghla (p>0,05).
26.2 27 -
1 Yeuto Trung binh X Do Lech SD p = 0,112
Nam (n =151
3,87
1 Ni>(n = 15)
24,8 2,90
Benhnhan Cacnhom cosLfdung thuockhang
Gardenal dpng kinh khac Hinh i. Liin quan gida MMSE vd thuoc dieu tri dong kinh.
Nhdnxet: Nhdm benh nhan dpng kinh ed sd dung Gardenal (n=15) diem trung binh MMSE la 22,7± 5,84 thap hon so vdi diem trung binh MMSE d benh nhan dieu t n eae nhdm khang dpng kinh khac (n=15) {26,2±0,52 c6 y nghTa vdi p =0,013 <0,05).
Bdng 2. Moi liin quan gida MMSE vd tdn sdcan ddng kinh.
Tan so con MMSE
€)iem trung binh
>7 cofn /tuan (nhom 1:n=8)
7 com/tuan-? con/thang : (nh6m2:n=12)
<7 con/thang (nh6m3:n=10]
25,1
p1 = 0,035 (nhoml/nhdm 2), p2=0,047 (nh6m3/nh6m2), p3=0,0482 {nh6m1/nh6m3)
Nhdn xet. Tan suat eon ddng kinh cang nhieu thi dtem trung binh MMSE cang thap ed y nghTa thdng ke khi so sanh tUng cap vdi PI, P2, P3 <0,05 OR tUPng ufng 1,2; 1,4; 1,5.
114 THAN KINH HOC VIET NAM I Sd 14 - QUV IV/2015 Website: hoithankinhiiocvietnam.com.v
Bdng 3. Moi tuang quan gida sddung thuoc khdng dong kinh vdi tdn sudt cdn ddng kinh den nhdn thdc tong qudt Tjn suat con >7 cOn /tuan
(nhomi)
7 con /tuan-7 con/ thang (nh6m2 Nhdm
Odi tuong i Gardenal n = 5(1) 0iem trung
binh MMSE 21,1+1,31 Nhom khac
n-3{2) Nhom Gardenal
n=7{3) 22,6±0,85 p (1 )(3) = 0,044 (OR = 1,1 95% Cl = 0,18 -1,43) p1 I p (3){5) = 0,037 (OR = 1,2 95% Cl - 0,32 - 2,11) p2 I p(l)(5) = 0,022 (OR = 1,495%Ci-0,88-1,78) p3 I p(2)(4) = 0,046 (OR=1,195%a = 0,33-l,01) p4 I p(4)(6) = 0,042 (OR = 1,295%CI = 0,12-1,31) p5 p{2)(6) = 0,010 (OR =1,3 95% 0=0,38-1,42) p6 p (1 )(2) = 0,008 (OR = 1,4 95% Cl = 0,43 -1,88) p7 p {3)(4) = 0,008 (OR = 1,3 95% Cl = 0,12 -1,76) p8 I p(5}(6) = 0,014 (OR = 1,395%0 = 0,44-1,56) p9
Nhdm khac n=5(4)
<7 con/thang (nh6m3) Nhom Gardenal
n=4(5) 23,5±1,04
Nhom khac n - 6 ( 6 ) , 27,6±1,22
Nhdnxit:
Oiem trung binh MMSE khi so sanh tCitig cap tren eung mpt ddi tUpng (cd sd dung Gardenal hay thude khae) ed xu hudng gi^m dan khi tan suat cdn tang dan ( p i , p2, p3 <0,05 vdi OR lan lupt: 1,1; 1,2; 1,4 v^ p4, p5,6 < 0,05 vdi OR lan lupt; 1,1; 1,2; 1,3).
- Trong n h d m benh nhan cd cung tan suat eon, ngudi sCfdung Gardenal cd diem trung binh MMSE thap hPn nhdm sU dung khang dpng kinh khae (p7,p8,p9 < 0,05 vdi OR lan lupt la 1,4;1,3;1,3).
IV.BANLUAN
Cf Viet Nam, trong nghien cdu cua Nguyen Oai Chien, Ngd Van Dung va cdng su sCf dung MMSE sang Ipc sa sut tri tue tren nhOng ngudi tU60 tudi trd len [1;2] da thay ket qua bien ddi ve nhan thde tdng quat d n a m gidi tdt hon ndgidLTrong nghien edu cua chung tdi, diem trung binh chung benh nhan dpng kinh cue bd phUe tap MMSE giCa hai gidi khdng cd su khae biet ed y nghla thdng ke (p>0,05) dieu nay eung phu hpp vdi nghien cdu cua Dodril va nhieu tae gii khac [4]. Lien quan giCfa nhan thdc tong quat vdi loai dpng kinh, Dodril va Website hoithankinhhocvietnam.com.vn S6 14 - Q u y IV/2015 I THAN KINH HOC VIET N
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cdng sU [4] cho thay nhan thdc tdng quat giSm ro ret hon d nhdm dpng kinh euc bp phdc tap so vdi cac nhdm ddng kinh khac. Thudc dieu trj dpng kinh la mpt phan rat quan trpng khong the thieu trong dieu tn dpng kinh, tuy nhien, mpt sd thudc cd anh hudng den nhan thdc. Nghien cdu chung toi cho thay nhan thdc tdng quat eua nhdm sd dung cac thudc khang dpng kinh khdng phai phenobarto'ital ed xu hudng tot hdn so vdi nhdm sd dung Gardenal (phenolbaebital), nhan xet nay cung trung hdp vdi gia khuyen cao cau nhieu tae gici tren the gidi. Tuy nhien, do Gardenal la loai thude hoat phd rpng va gia r§, tai mpt sd nude ngheo, day van la Ida chpn hang dau phu hdp ve mat kinh te. Chinh vi the, can dUdc danh gia chat che hdn chi phi/hieu qua cua thudc dang la van de con ban cai. Lien quan giOfa tan sd con dpng kinh va nhan thUctdng quat: Khi tan suat eon dpng kinh cSng day thi nhan thde tdng quat cang giam, dieu nay da dupc nhieu nha nghien cdu ve nhan thde tren benh nhan dpng kinh tren the gidi xae nh$n.
Cac tae gia eho rang khi len cdn lam tdn thuong t^
bao nao chinh la yeu t d lam giam Vhi nang nhan thdc ndi ehung va nhan thde tdng quat ndi rieng va ket quci nghien cdu chung toi khdng n^m ngoai nhan dinh dd. Mat khac cung cho thay vdi tat c l cac so sanh tdng cap ve 5nh hUdng ve nhan thde tdng quat gida sd dung thudc khang dpng kinh vdi t^n suat cdn cd gia tri epng hUdng nhung lai la hai bien cd doc lap (vert p<0,05). Chinh vi vay anh hudng ve nhan thdc tdng quat cua thude khang dpng kinh cung n h u v e tan suat edn la dpe lap.
V. KET LUAN
Qua nghien edu 30 benh n h l n dpng kinh cue bp phdc tap ngUdi trudng thanh ve nhan thdc tdng quat chung toi nhan thay: Khong ed su khac biet ve bien ddi nhan thdc t d n g quat gida hai gidi.
Sd dung Gardenal trong dieu tri dpng kinh lam giSmkh^ nang n h a n t h d c t d n g quat. Tan suat cdn cang day nhan thdc t d n g quat eang giam
TAi LIEU T H A M KHAO
1. Nguyen Oai Chien (2006), Danh gia chdc nang nhan thdc d ngUdi Viet Nam t d 6 0 tudi trd len bang mot so trie nghiem than kinh tSm ly, Luan van Thae sTY hoc, TrUdng Dai hoc Y Ha Npi, TP. Ha Npi.
2. Ngd Van Dung (2005), "BUdc dau danh gia suy g i l m nhan thdc nhe va mdt sd y^u td li^n quan d ngUdi cao tudi tai huyen Ba Vi, Ha Tay "Luan van Thae si Y hoc, TrUdng Dai hpe Y Ha Npi, trang 15 - 45.
3. Pierre.jallon (2001), "Dong kinh - dinh nghia, djeh t^ hoc, phan loai, cac yeu td nguy cP va dieu trj", Ngudi djeh: BS. Nguyen Cdng Hoan.
4. American Psychiatric Association (2000), Diagnostic and Statistical manual of Mental Disorders,. D5M- IV-TR, 4 * ed, Washington.
5. Dodrill CB. Neuropsychological effects of seizures. Epilepsy Behav. 2004;5 (Suppl. 1): 521-24.
6. Folstein M.F., Folstein S.E., McHugh P.R. (1975), "Mini- Mental State. A practical method for grading the cognitive state of patients for the clinician". Journal of Psychiatric Research, 12: pp 189 -198.
7. International League Against Epilepsy (1993), Guideline for epidemiological study on epilepsy, Epilepsia, pp96 - 592.
8. World Health Organization (1992), The ICD-10 classification of Mental and Behavioral Disorders, W.H.O.
Geneva: 64 - 65.
1161 THAN KINH HOC VlfT NAM I S6 14-QUy IV/2015 Website: hoithanl^inhhocvietnam.C'
