4. Lua TT, Hop LT va CS, 2001. Danh ()i'i tinh lr;ing dinh dudng, xac dinh tudi dciy thi (tre em g;.ii)lir,T tudi vi thanh nien (11-17 tuoi) dong tlufi tim hi(>u mot so yeu to lien qunn tai lun viing th.mh pho v^
nong thon. Bao cao hoi nghi khoa hoc Vien Dinh duang. 12/2001.
5. Millward DJ, Jackson AA. Protein/energy ratios of current diets in developed and developing countries compared with a safe protein/energy ratio: implications for recommended protein and
amino acid intakes. Public Health Nutr 2004;7:387-405.
6. PCD (1998) (Partnership for Child Development).
The anthropometric status of school children in five countries in the Partnership for Child Development. Proceedings of the Nutrition Society 57: 149-158.
7. Spear BA. (2002). Adolescent growth and development. ] Am Diet Assoc. 2002 Mar; 102 (3 suppl): S23-9.
PHAN TJCH VIEC SI/DUNG THUOC DIEU TR| ROI LOAN LIPID MAU TAI VIEN TIM MACH VIET NAM
Ta Manh Cu'dng ^^\ Nguyen Phu'dng Dung^^^
TOM TAT
Muc tieu: 1) Khao sat tinh hinh sir dung thudc dieu trj rdi loan lipid mau tai Vien Tim Mach Viet Nam;
2) Danh gia ti'nh hpp ly ciia viee sir dung nhdm thudc dieu trj rdi loan lipid mau tren eae benh nhan nghien ciru. Ooi tu'dng - Phu'c^ng phap: Nghien ciru hoi eiru 293 benh nhan du'dc dieu tri phdi hdp bang thude ehdng rdi loan lipid mau di/a tren cac ehi tieu v'e dac diem lam sang, dae diem nguy ed tim maeh, dae diem rdi loan lipid mau, thudc dieu tri rdi loan lipid mau, phan tich loai thude sif dijng, lieu lu'dng va tu'dng tac thudc. Ket qua: 293 benh nhan trong dd ed 176 benh nhan nam (60,1%) va 117 benh nhan nu' (39,9%), tudi trung binh 63,9 ± 9,1. 274 benh nhan ed nguy ed tim mach eao va rat eao (93,5%). Ve dae diem benh ly: 140 benh nhan mac hdi chirng ddng mach vanh cap (47,8%), 47 benh nhan nhdi mau ed tim cap (16,0%), 87 benh nhan tSng huyet ap (29,7%), 19 benh nhan benh tim thieu mau cue bd (6,5%) trong do ed phdi hqJp vdi cac benh ly va tinh trang lam sang khac nhu' tieu du'dng, suy tim, dot quy, benh dong mach ehi du'dl do vu'a xd ddng mach. Gan 50% sd benh nhan cd nong dp HDL thap du'dl Immol/I. 216 benh nhan thuoc nhu'ng benh nhan nguy cd cao va rat eao ed LDL-C > l,8mmol/l. Thudc dieu trj rdi loan lipid mau ehii yeu la statin (50,3% la Rosuvastatin, 43,8% la Aton/astatin) vdi lieu quy u'dc. Tu'dng tae thudc dang lull y la Atorvastatin - Omeprazol (45,5%) trong chi djnh nhu'ng khdng gap cac bien ed tren lam sang, ket luan: ehi djnh diing thude la hdp ly, an toan, phii hdp vdi nhii'ng quy djnh, khuyen eao trong nu'dc cung nhu' tren the gidi.
TCr khoa: rdi loan lipid mau, yeu td nguy ed, statin.
SUMMARY
AnalysisusingdrugsdyslipidemiainVietnamHeart Institute
Objectives: 1) Survey on theuse ofdrugtreatmentof dyslipidemiain Vietnam Heart Institute; 2) Assessing the reasonableness ofthe use ofdrugtreatmentof dyslipidemiain studiedpatients.
Objects Methods: retrospective study 293 patients received combination treatment with anti-dyslipidemia based onthe eriteriaofthe clinical characteristics, cardiovascular riskeharaeteristies, the characteristics of dyslipidemia, treatment of dyslipidemia, analyze druguse, dosage and drug interactions. Results: 293 patients, of which 176 male patients (60.1%) and 117 female patients (39.9%), mean age 63.9±9.1; 274 patients athigh cardiovascular riskand veryhigh (93.5%) were included in the study. Pathological characteristics: 140 patients with acute coronary syndrome (47.8%), 47patients with acute myocardial infarction (16.0%), 87 patients with hypertension (29.7%), 19 patients with is ehemieheart disease (6.5%) of which coordinating with medicaland other clinical conditions such as diabetes, heart failure, stroke, lower limbarterial diseasedue toatherosclerosis artery. Nearly 50% of patients with low HDL levelsless than Immol/l. 216 patients inpatientsat high risk and very highLDL-C>1.8mmol/l. Treatment of dyslipidemiais mainlystatin (rosuvastatinis 50.3%, 43.8% of atorvastatin) with conventional doses. The commondrug interactions should be noted that atorvastatin-omeprazole (45.5%) butdid not showed eliniealevents. Conclusion: Thedrugisusedto speeifya reasonable, safe, in accordance with the regulations, as well asreeommendations inthe world.
Keywords: dyslipidemia, cardiovascular riskfaetors, statin.
(IJ: Vien Tim Mach Viet Nam; (2) Hoc vien Y Du'dc hoc Co truyen Viet Nam Phan bien khoa hoc.GS.TS.Pham Gia Khai
Y HOC VIET NAM THANG 2 - SO 2/2012 I. OAT V A N O E
Rdi loan lipid mau da dUpe chifng minh la mdt trong nhifng yeu td nguy eP quan trpng ciia eae benh tim maeh, dae biet khi nguy cd nay xay ra ddng thdi vdi cac yeu td nguy cP quan trpng khae nhU tang huyet ap, tieu du'dng, benh ddng maeh chi dUdi do vu'a xP ddng maeh... tren eiing mpt ngu'di benh, ma dieu nay khdng hiem xay ra tren thifc te lam sang. Oieu trj rdi loan lipid mau (RLLM) trong benh ly tim maeh giiip lam giam bien ed va ty le tir vong do benh tim mach cung da dviOc nhieu thir nghiem lam sang Idn ehi ra va da dUde khuyen cao sir dung mot each khac chi tiet trong cae tinh hudng lam sang, trong dd thudc dieu trj RLLM loai statin dUPe dae biet nhan manh trong nhieu nam gan day [1;2;3].
Vien Tim Mach Viet Nam (VTMVN) la eP sd dau nganh ve dieu trj cae benh ly tim maeh, tai day ed sd lUPng benh nhan Idn, hinh thai benh ly da dang, benh nhan nhap vien trong tinh trang nang va cd nhieu yeu td nguy eP phdi hpp, dpi ngu thay thude giau kinh nghiem, thu'dng xuyen cap nhat cac khuyen cao trong nUdc cung nhU tren tlie gidi ve chi djnh dieu tri RLLM. Oe tim hieu ve tinh hinh sif dung thudc cung nhU tinh hdp ly ciia ehi dinh dieu tri bing cac thuoc chdng RLLM, chiing tdi tien hanh nghien culi nham mue tieu:
1. Khao sat tinh hinh sif dung thude dieu trj roi loan lipid mau tai Vien Tim Maeh Viet Nam.
2. Oanh gia tinh hdp ly ciia viee sif dung nhdm thudc dieu trj rdi loan lipid mau tren cae benh nhan nghien cifu.
II. odl TUpNG VA PHUONG P H A P NGHIEN CCfU 1. odi tu'dng nghien cu'u
Ooi tu'dng nghien cifu ciia ehiing tdi la nhu'ng benh an ciia benh nhan dieu tri ndi trii tai VTMVN thdi gian tif 01/06/2009 - 31/03/2011 cd sif dung phoi hdp thudc dieu tri RLLM.
2. Phu'dng phap nghien cu'u 2.1. Thiet ke nghien cdu
Cach thufc chon cd mau nghien cuTu:
Oe tinh toan sd lu'dng benh an can lay, chung tdi ap dung cdng thifc tinh ed mau eho
viec u'dc tinh ty le trong quan the benh nhan nam dieu trj ndi trii tai VTMVN: N > Z^(i-„/2)/
[P(l-P)/d^, trong dd n = ed mau nghien cifu can cd; P: ty le u'dc tinh tir nghien cifu tru'dc; d: u'dc lu'png khoang sai lech cho phep giu'a tham sd thu du'pc tir mau nghien cifu va tham sd quan the;
a: mifc dp tin cay ; Z {i-u/iy he sd tin cay. Chpn (/
= 0,05, ta ed Z (i.„/2)=l,96 , d=0,05. Tren quan the benh an eiia benh nhan nam dieu trj npi trii tai VTMVN tir 01/06/2009-31/03/2011, riit ngau nhien 100 benh an. Trong sd nay ed 39 benh an benh nhan ed sif dung thude dieu tri RLLM.
Trong dd sd benh nhan khdng thiTe si/ RLLM la 8, sd benh nhan ed RLLM la 31. P = sd benh nhan khdng thifc sif RLLM/sd BN ed RLLM = 8/31=
0,25. Nhu' vay sd benh an tdi thieu can lay se la 288. Oe ed 288 du'dc benh an ed sif dung thude dieu trj RLLM mang tinh dai dien thi sd benh an can nghien cifu la 288 x 100/39 = 738 benh an.
Tiep tue riit ngau nhien cd each 3 benh an lay 2 benh an trong sd 738 du'pc 293 benh an dii tieu ehuan ngau nhien.
Npi dung nghien cdu:
Oac diem benh nhan nghien cifu: tudi, gidi, loai benh ly tim mach, chi sd lipid mau khi nhap vien, phan loai mifc dp RLLM, danh gia nguy eP tim mach, SGOT, SGPT, creatinin ciia benh nhan nghien cifu.
Khao sat tinh hinh sif dijng thudc dieu trj RLLM: eae thudc dieu trj RLLM du'dc sif dung, mue dich sif dung thudc dieu trj RLLM ddi vdi nhii'ng benh nhan nam dieu tri ndi tru tai Vien difa theo eae khuyen eao dieu tn dang ap dung...
Oanh gia tinh hpp ly eiia viee sir dung nhdm thudc Statin: benh ly ciia benh nhan du'dc sif dung Statin, quyet dinh diing thudc, quyet djnh du'a lieu diing cho benh nhan, cac tu'dng tac thudc thudc bat ldi, cae tae dung khdng mong mudn gap phai, danh gia sif thay ddi chifc nang gan tru'dc va sau dieu tri.
3. Xu' ly so lieu
Sd lieu thu thap du'dc xif ly bang cac phu'dng phap thdng ke y hpc.
III.KET QUA
1. Oac diem chung cua benh nhan nghien cii'u
Chung tdi da li/a chon du'dc 293 benh nhan nghien cifu thdi gian tif 01/06/2009 - 31/03/2011, trong dd cd 176 benh nhSn nam, chiem ti le 60,1% va 117 benh nhan nu' chiem ti le 39,9%, tudi tif 34-88, trung binh 63,9±9,1, trong dd dp tudi tif 60-69 chiem ti le 37,5%. Oac diem benh ly ciia cac benh nhan nhap vien du'dc trinh bay tdm t^t trong bang 1.
Bang 1 - Phan bd benh ly mae kem eiia benh nhan nghien_CLfij Benh ly chinh
Hdi chirng DMV cap (n=140)
Nhdi mau cd tim cap (n=47)
Tang huyet ap (n=87)
Benh tim thieu mau cue bd (n=19)
Benh ly hoac tinh trang lam sang di kem Hoi chu'ng DMV cap
Hoi^hifn^ OMV^cap d benh nhan THA
Hpi chu'ng DMV cap kem theo cae tinh trang lam sang khac nhu' tieu du'dng, dot quy
NMCT cap
JMMCr cap 6 benh nhan THA
NMCT cap kem theo ticu du'dng hoSe e^c bien cd nhu' suy tim.
dotj]u^
THA ddn thuan
THA kem theo cac tinh trang b|nh ly khac nhu' tieu du'dng, benh dong mach chi dirdi
Benh tim thieu mau cue bo
Benh tim thicu mau cue bp kem theo cae tinh trang lam sang nhu'suy tim, RLLM
66 53 21 23 15
35 52
10
Ti le (%) 22,5 18,1 7,2
2A. AL
3,1
AIA.
17,7
JJ,
3,5DMV: dpng mach vanh, THA: tang huyit ap, RLLM: roi loan lipid mau, NMCT: nhoi mau cdtim.
Tien hanh danh gia nguy ed tim maeh eiia benh nhan theo thang diem Framingham chiing toi nhan thay phan Idn benh nhan cd yeu td nguy cd tim mach cao va rat cao. Ket qua du'dc trinh bay theo bang 2.
Bang 2 - Phan loai nguy ed tim maeh ciia benh nhan nghien cifu Nguy cd
Nguy cd cao va rat cao Nguy ed cao - trung binh
Nguy cd trung binh Nguy ed thap
So benh nhan (n) 274
11 6 2
Ty le C%)
93,5 3,8 2,1 0,6 2. Oac diem lipid mau 6 benh nhan nghien cufu
Thanh phan lipid mau du'pc nghien cifu bao gdm cholesterol toan phan (CT), LDL-C, HDL-C, tryglycerides (TG). Ket qua nghien cifu cho thay cd tdi tren 70% benh nhan cd nong dp cholesterol mau trong gidi han ciia ngu'di binh thu'dng, chi ed 10,2% benh nhan cd lu'png cholesterol toan phan Idn hdn 6,2mmol/. Tuy nhien 59,4% benh nhan nghien cifu cd nong dp LDL < 2,6mmol/l, 6,5% benh nhan cd nong dp LDL eao va rat eao. Oieu dang ndi la gan 50% sd benh nhan cd ndng dp HDL thap du'dl Immol/l va tren 50% benh nhan cd ndng dp TG cao hdn binh thu'dng. O nhu'ng benh nhan eo nguy cd eao va rat cao (274 benh nhan) thi ed tdi 216 benh nhan (73,7%) cd LDL > l,8mmol/l; cd 58 benh nhan (19,8%) cd LDL < l,8mmol/l. Ket qua chi tiet du'dc trinh bay theo bang 3.
Bang 3 - Oac diem chi sd lipid mau d benh nhan nghien cifu
Chi sd lipids m^u LDL-C (mmol/l)
< 2 , 6 ) 2,6-3,4 3,4-4,1 4,1-4,9
>4,9
Tdi uti Gan td1 uli Cao gidi han
Cao Rat cao CT toan phan (mmol/l)
<5,2 5,2-6,2
^6,2
Binh thu'dng Cao gidi han
Cao HDL-C (mmol/l)
< 1
>1,6
Thap Cao Triglycerides (mmol/l)
<1,7 1,7-2,3
Binh thu'dng Cao gidi han
n 174
61 39 13 7 206
57 30 136 157 140 56
Ti le (%)
59,4 20,8 13,3 4,4 2,1.
70,3 19,5 10,2 46,4 53,6 47,8 19.1
Y HOC VIET NAM THANG 2 - SO 2/2012 2,3 - 5,64
>5,65
Cao Rat cao
89 8
30,4 2,7 3. Khao sat ve sir dung thudc dieu tn roi loan lipid mau
Cd 2 nhdm hoat chat du'dc sir dung la nhdm Statin va nhdm Fibrate. Trong dd nhdm statin du'dc sif dung chii yeu vdi 348 lu'pt diing (98,3%), nhdm Fibrate vdi 6 lu'pt diing (1,7%), thdi gian dieu trj trung binh la 9,2 ± 4,3 ngay. Chi tiet du'pc trinh bay trong bang 4.
Bang 4
STT 1 2 3 4 5
- Cae thude dieu tri rdi loan lipid mau Thuoc
Ten quoc te Rosuvastatin Atorvastatin Simvastatin Fluvastatin Fenofibate
Ten biet du'dc Crestor
Lipitor Zocor Lescol XL Lipanthyl
du'pc sif dung Nhom thudc
Statin Statin Statin Statin Fibrat Tong so lu'cft dung:
Lu'dt dung (n) 178 155 14
1 6 354
Ty le (»/o) 50,3 43,8 3,9 0,3 1,7 100 Cae thude phdi hdp ciing vdi thudc dieu tri
RLLM thu'dng la thudc ehdng ngu'ng tap tieu eau (88,9%), thudc ifc che men chuyen dang angiotensin II (66,7%) va thude thude chen bdm proton (61,1%).
4. Oanh gia tinh hdp ly cua chi djnh dieu trj phd1 hdp bang thuoc chdng rd1 loan lipid mau
4.1. Quyet djnh suf dung thudc
Trong 293 benh nhan nghien cu'u, ehiing tdi thay cd 173 benh nhan cd RLLM va 120 benh nhan mac dll chu^ bj RLLM nhuTig van du'dc chi djnh s'i dung statin. Ly do: day la nhUng benh nhan nari trong nhdm ddi tu'dng cd nguy cd eao va rat cao vdi benh ly chi'nh la hpi chifng ddng mach vanh cap va nhoi mau ed tim du'dc chi djnh thudc vdi muc dich lam giam bien cd tim mach va lam dn djnh mang viJa xd ddng mach vanh do tae diing eiia thudc mang lai. Trong sd 120 benh nhan nay cd cd 22 benh nhan mac dii LDL-C < 1,8 mmol/l van du'dc chi djnh dung statin ngay khi nhap vien.
4.2. Quyet dmh chpn liieu Iddng thudc Cd 120 benli nhan du'dc chi djnh dung Rosuvastatin vdi lieu lOmg/ngay, chi cd 57 benh nhan du'dc sif dung vdi lieu 5mg/ngay, 1 benh nhan du'dc sif dung vdi lieu 40mg/ngay (day la benh nhan nhap vien du'dc chan doan la hdi chifng ddng mach vanh cap).
Cd 119 benh nhan du'dc chi dinh diing Atorvastatin vdi lieu lOmg/ngay, 35 benh nhan sif dung vdi lieu 5mg/ngay va duy nhat 1 benh nhan du'dc chan doan nhoi mau cd tim cap sif dung vdi lieu 40mg/ngay. Mpt sd hoat chat khac
nhu' simvastatin, fluvastatin va fenofibrat du'dc chj djnh it nen mdi gap d 1 mifc lieu diing.
4.3. Cac tdcfng tac thudc - thudc bat ldi Trong 293 benh nhan nghien cifu ehiing tdi thay ed 66 benh nhan cd tu'dng tae thude - thudc bat Ipi (giUa thude dieu trj RLLM va thudc khac ) chiem ti le 22,5%. Trong dd ed 5 benh nhan gap tu'dng tae bat iPi mifc dp nang (cd cap tu'dng tae xay ra d mifc dp 3) ehiem ti le 1,7%, 2 benh nhan gap tu'dng tae mifc nhe (ed cap tu'dng tac xay ra d mifc dp 1) ehiem ti le 0,7%, 59 benh nhan gap tu'dng tae mifc trung binh (cd cac cap tu'dng tae d mifc dp 2) chiem ti le 20,1%.
Sd cap tu'dng tae xay ra la 77 cap,trong dd cap tu'dng tae hay gap nhat la tu'dng tae xay ra giii'a Atorvastatin (Lipitor) - Omeprazol ehiem ti le cao 45,5% (vdi 35 lan gap).
Cd 62 cap tu'dng tac (20,8%) lam tang tac dijng ciia statin, 1 cap tu'dng tac (0,3%) lam giam tac dung eiia statin, 10 cap tu'dng tae (3,4%) lam tang tae dijng ciia thudc phdi hdp eiing thudc dieu trj RLLM, 4 cap tu'dng tae lam tang nguy cd xuat hien ddc tinh ciia nhau (0,7%).
4.4. Cac tac dung khong mong mudn Tae dung khdng mong muon cd the gap khi sif dung statin la ddc tinh tren gan, ddc tinh tren cP, ddc tinh tren tieu hoa. Khi sif dung Fibrate tac dung khdng mong mudn cd the gap la tang men gan, su'ng phii mat, dau bung, budn ndn, man ngifa, dau dau,.... Tuy nhien nghien cifu tren 293 benh nhan ciia chiing tdi khdng cd tru'dng hdp nao xuat hien cac tac dijng khdng mong mudn nhu'the tren lam sang.
4.5. SLT thay ddi chdc nang gan trddc dieu tri va sau dieu tri
Cd 50 benh nhan dude lam xet nghiem ALAT, ASAT tru'dc khi ra vien. Odi chieu vdi ket qua xet nghiem khi nhap vien ehiing tdi nhan thay ndng dp ASAT tSng len khdng ed y nghia thdng ke so vdi khi nhap vien (33,52 ± 41,83 U/l so vdi 47,52 ± 46,67 U/l; p ^0,05). Mde dp tang eiia ALAT la ed y nghia vdi p < 0,05 (26,76 ± 18,14 U/l so vdi ndng dp ALAT khi ra vien la 51,00 ± 51,89 U/l), tuy nhien mifc dp tang chu'a vu'pt qua 3 lan so vdi gia trj binh thu'dng.
IV. BAN LUAN
1. Oac diem benh nhan nghien cuTu Qua nghien cifu 293 BN ed sif dung thude dieu trj RLLM tai VTMVN Benh vien Bach Mai, ehiing tdi nhan thay ddi tu'png nghien cifu ciia chiing tdi la nhtfng benh nhan du'pc dieu trj phd'i hdp vdi cae thude ha lipid mau, chii yeu trong sd dd la benh nhan tang huyet ap cd hdi chifng dpng maeh vanh cap va/hoac nhdi mau cd tim cd sdng Q hay doan ST chenh len. Oang lu'u y la ed tdi 54,7% benh nhan cd da yeu td nguy cd, nghia la nhap vien trong tinh trang cd 2 3 benh ly. Nhu' vay, chi dinh dieu trj phdi hdp vdi statin la chi djnh hau nhu* khdng the khdng thifc hien ddi vdi nhii'ng ddi tu'dng nay theo nhii'ng khuyen cao gan day tren the gidi. Ben canh dd, chiing tdi cung nhan thay rang RLLM hau nhu" ludn song hanh vdi nhu'ng tinh trang benh ly tim mach cap tinh va nguy hiem, thu'dng lien quan den vCi'a xd ddng mach, trong dd chii yeu la ddng mach vanh. Tang huyet ap la mdt trong nhu'ng benh ly thu'dng gap nhat trong cae benh ly tim maeh.
Nhan xet nay ciia ehiing tdi ciing phii hdp vdi cac y kien ciia cac tac gia trong nu'dc cung nhu' tren the gidi [1;2].
Ve dac diem thanh phan lipid mau, chiing tdi nhan thay diem quan trpng nhat ma nghien cifu chi ra la cd tdi gan 50% benh nhan nhap vien vdi cac tinh trang benh ly tim mach cap tinh cd nong dp LDL-C du'dl 1 mmol/l. Cd the ndi day la mpt nhan xet het sifc quan trpng trong thifc hanh lam sang vi tif tru'dc den nay chiing ta it chu y tdi thanh phan nay. Thanh phan nay giam d nhii'ng benh nhan da benh ly tim mach, thudc nhdm benh nhan cd nguy cd cao va rat cao mdt lan nUa chifng td, dieu chinh thanh phan nay tru'dc khi xuat hien cac bien cd tim mach la mdt dieu khdng du'dc bd qua.
Ben canh dd phan Idn nhu'ng benh nhan can dieu ehinh ndng dp LDL-C ve du'dl 1,8 mmol/l (hdi chirng ddng maeh vanh cap, nhdi mau cd tim, ed nhii'ng benh ly tu'dng du'dng benh dpng maeh vanh nhu' tieu du'dng, benh ddng maeh ehi du'dl...) van cd ndng dp LDL-C > 1,8 mmol/l (gan 60% benh nhan ed ndng dp LDL < 2,6 mmol/l).
Nhirng benh nhan nay van thudc ddi tu'dng phai diing statin theo khuyen eao ciia NCEP- ATP III [2].
2. Cac thudc dieu trj RLLM du'dc suf dung
Trong nghien cifu ciia ehiing tdi ed 2 nhdm thude dieu tri RLLM du'dc sif dijng dd la nhdm Statin va nhdm Fibrate, trong dd nhdm Statin du'pc lu'a chpn ehii yeu ehiem ti le 98,3%. Trong dd hoat chat Rosuvasatin vdi biet du'dc Crestor du'pc sir dung nhieu hdn ea (50,3%), tiep dd la Atorvastatin (43,8%), Simvastatin (3,9%), Fluvastatin (0,3%). Nhdm Fibrat du'dc li/a chpn it hdn vdi ti le 1,7%. Lieu diing phd bien ciia Rosuvastatin la 10 mg/ngay, lieu thap nhat la 5mg/ngay, lieu cao nhat la 40mg/ngay. Lieu diing phd bien ciia Atorvastatin la lOmg/ ngay, lieu thap nhat la 5mg/ngay, lieu cao nhat la 40mg/ngay. Simvastatin, Fluvastatin du'dc dung vdi ti le thap,lieu diing 6a gap deu la 20mg/ngay.
Quan sat tren 293 benh nhan chiing tdi nhan thay cae benh nhan deu du'dc sif dung lieu diing phii hdp vdi cac hu'dng dan, khdng cd tru'dng hdp nao sir dung qua lieu so vdi lieu cho phep.
Viee tuan thii theo lieu hu'dng dan la chat che va nghiem tue.
3. Tu'dng tac thudc
Trong 293 benh nhan cd 66 benh nhan gap phai tu'dng tae thuoc thudc bat ldi (giO'a thuoc dieu trj RLLM va thudc khac) chiem ti le 22,5%.
Sd cap tu'dng tae xay ra la 77 cap, trong dd cap tu'dng tae hay gap nhat la tu'dng tac xay ra giu'a Atorvastatin (Lipitor) - Omeprazol ehiem ti le cao 45,5% (vdi 35 lan gap). Sd dT cap tu'dng tac nay chiem t^ le cao vi tat ca nhu'ng benh nhan mac hpi chifng dpng mach vanh cap va nhoi mau cd tim, khi nhap vien deu dung cac thudc chong ngu'ng tap tieu cau lieu cao (Aspirin va Clopidogrel). Li/a chpn sd dung dieu tn phoi hdp vdi Omeprazol vdi hy vpng lam giam bien co doi vdi da day-rudt cho benh nhan nen sif phdi hdp nay gan day da trd thanh mdt thdi quen ciia ngu'di thay thude. Tuy nhien cung nen nhin nhan rang, thoi quen nay cung chu^ ban la tdt, nhat la khi cd mpt sd khuyen cao gan day cho thay, bien cd tim mach co the gia tang khi sif dung phdi hdp vdi thuoc (ic che
bdm proton d nhu'ng benh nhan du'pc can thiep va dat Stent ddng mach vanh [3].
V. KET LUAN
Qua nghien cifu tren 293 benh nhan mac benh tim maeh dieu trj tai Vien Tim Maeh Viet Nam, cd sif dung thude dieu trj RLLM, ehiing tdi nhan thay:
1. Phan Idn la nhu'ng benh nhan da yeu td nguy eP tim maeh, nhap vien trong tinh trang mac nhu'ng bien cd tim maeh nang nhu' dau that ngiTc khdng dn dinh hoac nhdi mau eP tim, edn tang huyet ap nang, suy tim... ed LDL-C > 1,8 mmol/l va/hoac HDL-C < 1,0 mmol/l va deu ed ehi djnh diing thudc chdng rdi loan lipid mau loai statin. Nhij'ng statin thu'dng difpc ehi djnh la Rosuvastatin, Atorvastatin vdi lieu lu'png quy u'dc trong thdi gian dieu tri ndi trii.
Y HOC VIET NAM THANG 2 - SO 2/2012
2. Chi dinh thude la hdp ly, phii hpp vdi nhii'ng quy dinh, khuyen eao trong nu'dc eung nhu' tren the gidi. Trong qua trinh sif dijng, thude khdng gay nhu'ng tae ddng khdng mong mudn hay nhii'ng bien ed, bien chifng ddi vdi ngu'di benh.
TAI UEU THAM KHAO
1. Baigent C, et al (2010), "Cholesterol Treatment Trialists' (CTT) Collaborators. Efficacy and safety of more intensive lowering of LDL cholesterol : a metat-analysis of data from 170,000 participants in 26 randomised trials ",Lancet; 376: 1670-81.
2. Grundy SM, Cleeman J l , Merz CNB, et al (2004).Implications of recent dinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Qrculation 110 : 227- 239.
3. Sean C Seefanen (2009), "The Martindale: Tlie complete dnjg reference,Thirty-six edition", 1119 -1430.
NGHIEN CQU LAM SANG VA PHAU THUAT DIEU TRj UNG THI/THANH QUAN TAI BENH VIEN TAI M O I HONG TW
Le Minh Ky*
TOM TAT
Ung thu' thanh quan la khdi u ac tfnh xuat phat tif te bao bieu mo viing thanh quan. Muc tieu nghien cufu.' nghien cuV cac dac diem lam sang, phu'dng phap dieu tri phau thuat va ket qua ung thU thanh quan.
061 tu'dng nghien cu'u.' 224 benh nhan dWdc tham kham, chan doan xac dinh ung thU thanh quan va difdc phau thuat lay u tai khoa Khoi u (Bl) benh vien
Tai Mui Hong TW tCf nam 2000 den 2004. Phu'dng phap nghien cu'u.- hoi cifu mo ta. Ket qua.- do tuoi trung binh cua benh nhan la 56,5 ±9,4 tuoi, gidi nam chiim 96,9%. Phan bd ve khdi u: Tl 13,4%, T2 28,6%, T3 45,1%, T4 12,9%. Phan bd ve hach cd: NO 85,3%, Nl 9,4%, N2 4,5%, N3 0,9%. Ve each thifc phau thuat: co 181 benh nhan du'dc cat thanh quan-ha hong toan phan (80,7%), 43 benh nhan du'dc cat tiianh quan ban phan (23 benh nhan cat thanh quan tran ben, 12 benh nhan cat day tiianh, 8 benh nhan cat thanh quan tren sun nhan kieu co dinh nhan-mong-thanh thiit). (36169/224 benh nhan dWdc nao vet hach c6(8 nao vit tiet can 1 ben, 14 nao vet chut nang 1 ben, 24 nao vet tiet can 1 ben va chdc nang ben kia, 127 nao vet chifc nang 2 ben). Ket luan: Hien tai phau tiiuat van la phu'dng phap chon li/a trong dieu ti ung tiiu' tiianh quan d Viet Nam, mang lai k&: qua tot
* BV Tai MQi Hong Trung WOng
Phan bien khoa rtoc/PGS.TS.Nguydn Hoang Sdn
SUMMARY
Clinical presentations and surgical treatment of laryngeal cancer
Laryngeal cancer was common in Vietnam.
Objectives: study on clinical presentations and surgical treatment. Patients and methods: 224 patients were operated in ENT hospital from 2000 to 2004 and follow up to 2008. With retrospective descriptive study.
Results:The mean age was 56,5±9,4. 96,9% was males. Staging: T l 13,4%, T2 28,6%, T3 45,1%, T4 12,9%. NO 85,3%, Nl 9,4%, N2 4,5%, N3 0,9%.
Surgical managements: Toatal larygeetomy in 181 patients (80,7%), partial larygeetomy in 43 pts (23 frotal lateral laryngectomy, 12 cordeetomy, and 8 supracricoid laryngectomy. Conclusions: Surgical treatment for laryngeal cancer in Vietnam was the treatment of choice, it had the good results.
I.
OAT VAN OEUng thu' thanh quan la khdi u ac tinh xuat phat tif te bao bieu md viing thanh quan. Benh ed ty le gap eao thif 2 trong eae ung thu' viing dau mat ed sau ung thu'vdm. Benh nhan chii yeu thupc gidi nam vi benh lien quan den hai yeu t d
