TCNCYH Phu tnmng 80 (3) - 2012 4. Quach Van Ngu' (1999). D i e diim lam alcohol withdrawal Canadian Medical Asso- sang v i diiu kipn phit sinh sang rupu d elation Journal, 160 (5), 675-680.
7. Hall W, Andor D (1997). The alcohol ngudi nghiin ruau man tinh. Lgin an thpc sy
v hpc, Trudng Oai hpc Y H i Noi. -^uj i j • ' . ' „ . « ' ^ ' a • V withdrawal syndrome. Lancet. 349
5. Anne H. Powell (1999). Alcohol with- 1897 -1900.
drawal in critical care. Dimensions of Critical „ . . . „ , . - . , , ... ..
8. http;//apps.who.mt/classifications/
Care Nursing, 18 (6), 24 - 28. . ...,. , „ „ . „ , , . .. , „ . . . .
" ^ ' icd10/browse/2010;en. International Statisti- 6. Anne M. Holbrook, Pharm 0, et al cai Classification of Diseases and Related (1999). Diagnosis and management of acnte Health Problems 10th Revision.
Summary
CLINICAL AND PARACLINICAL CHARACTERISTICS OF PATIENTS SUFFERING FROM PNEUMONIA WITH ALCOHOLISM IN RESPIRATORY DEPARTMENT
BACH MAI HOSPITAL
The study was to describe clinical, paraclinical characteristics in patients suffering from pneu- monia and chronic alcoholism The resglts indicated that 47.4% of patients used alcohol over 20 years; 61.7% of patients used alcohol over 500 ml/day. Clinicals: alcohol withdrawal syn- drome (65.9%), dyspnea (73.2%), cough (53.7%), chest pain (48.8%), fever (92.7%), convul- sions 7.3%. Paraclinical: WBC average was 15.02 ± 22.01 (G/l), AST avarage was 194.03 ± 343.66 (U/L - 37°), 61.5% of patients had increased serum CK level. Klebsiella pneumoniae was found in 33.3% of patients. In conclusions, pneumonia in patients with alcoholism were more severe and more complications, escpecially hepatic than usual.
Key word: pneumonia, alcoholism
SINH THIET MANG PHOl BANG KIM CASTELAIN TRONG C H A N D O A N TRAN DjCH MANG PHPl IT TAI TRUNG TAM
HO H A P B E N H VIEN BACH MAI
Ngo Quy Chau, Nguyen Thj Thanh Ha Trudng Dai hoc Y Hi Ndi Sinh thiit ming phdi bing kim Casteiain cd nhiiu uu diim trong chin doin nguyin nhin trin dich ming phdi nhung khi thuc hiin niu trin dich It Nghiin ciru tiin hinh nhim nhin xit die diim lim sing, dn lim sing vi kit qui sinh thiit ming phii kin bing kim Casteiain trin binh nhin trin dich ming phii dich It. Kit qui cho thiy triiu ch&ng hay gip: dau nguc 84,6%: ho 78,1%: khd thd 65,6%; sSt 43,8%: hdi chirng ba glim 78,1%. Ty ii liy duac binh phim thinh cdng 100% sau khi di bom thim NaCI 0,9% vio khoang ming phii. Xic dinh duoc nguyin nhin trin dich ming phdi nha sinh thiit ming phdi bing kim Casteiain li 34,4%. Ty li tai biin nhe do sinh thiit li 15,6%. Tu cic kit qui trin ci thi kit luin dii vdi trin dich ming phdi si luong tt, sinh thiit ming phii bang kim Casteiain cd thi thuc hiin duac niu bam thim NaCI 0,9%. Ky thuit vi cd gii tri chin doin cao vi an toin ngay ci khi trin dieh ming phii si luang it.
Tir khoa: sinh thiit mang phii, tran djch mang phoi djch it
TCNCYH Phu truung 80 (3) - 2012
I. DAT V A N D ^
Ngiy nay cd nhiiu phuang phip hipn dpi dupe ung dgng d i chin d o i n nguyin nhin trin dich mang phii. Tuy nhiin vdi tinh chit can thipp it nguy hiim Ipi cd hiiu qua chin doin cao n i n sinh thiit ming phii kin v i n la phuang phap dupe tin diing, dpc bipt khi cd sy h i trp t d c i c phuang tiin chin doin hinh anh nhu siiu i m , CT scan.
Trong thyc t i , vipc chin d o i n nggyin nhin d nhung binh nhin trin djch ming phii djch it thi thudng khd khan ban ca. Ky thupt sinh thiit mang phii bing kim Caste- lain c i n phai c6 mpt khoang cich dich du d i i p kim s i t v i o thanh nguc cat bpnh phim an toin nen khi dich mang phii it thi nguy ca xay ra tai biin cao.
Vdi mong muin chin d o i n binh k|p thdi, Chung toi da thuc hipn ky thuit nay dydi hudng d i n cua siiu i m , cd bom them dung d|ch nude muii sinh ly 0,9% vao khoang ming phii l i m tang khoang cich giua la thinh va la tang dam bao sinh thiit thanh cdng va an t o i n trong c i c trudng hop trin dich ming phii djch it.
Xuit phat t u thuc t i dd, chung tdi tiin hanh nghien cuu n i y nham muc tieu:
Md ti dac diem lam sang, can lim sing cua binh nhan trin dich ming phoi dieh it tai Tmng tam Hd hap binh vien Bach Mai.
Xic dinh gii tri chin doan cua ky thuat sinh thiit mang phdi bing kim Casteiain d benh nhan trin dich ming phdi dich it II. D6\ TU'O'NG VA PHLCaNG PHAP
1. Ddi tup'ng nghien cdu
32 binh nhan dupe chin d o i n t r i n dich mang phii djch It, djch tiet duac dieu trj noi trii tpi khoa Hd Hap, dap ung tieu chuan chpn bpnh nhan.
T i i u chuin chpn bpnh nhan:
* bpnh n h i n duac c h i n d o i n tran djc ming phii djch it t u khi nhip viin d i n thi diim STming phii:
XQ phii thing: cd hinh anh dam md d i viing d i y phii, l i m m i t gdc sudn hoinh.
Siiu i m m i n g phii khi v i o viin va tpi thd diim sinh thiit mang phii do dupe khoan cich Idp djch m i n g phii < 3cm.
* Tieu chuin t r i n d|ch m i n g phii djch i dupe x i y dyng dya tren:
Nghien cdu cua Klemens L Eibenberge (1994) udc tinh khi khoang cich Idp diet mang phii la 2cm thi t h i tich djch tmng binl la 380 ±130 ml.
Nghiin cdu ciJa Truang Hgy Hung (2004]
thiy binh nhin duac sinh thiit mang phii an toan CO lupng dich trong khoang mang phoi t h i p nhit la 330 ml (3).
* Benh n h i n duac chin d o i n trin djch mang phii dich tiit chua rd nggyin nhan
Chan doan xac c^nh dya v i o : Lim sang, c i c xet nghipm c i n lam sing, t i bao hpc djch mang phii, PCR - BK v i MGIT djch ming phii, md bpnh hpc sinh thiit mang phoi, sinh thiit p h i quan qua npi soi phe quan, sinh thiit hpch, sinh thiit xgyen thanh nguc n i g cd t i n thuang.
2. P h u c n g p h i p n g h i i n cii'u Nghien cuu m i ta cat ngang.
Phuang phap chpn m i u khdng xic xuSI, theo muc dich nghien cuu.
Ky thuat thuc hien trong nghiin cuu: Sinh thiet m i n g phii kin bang kim Casteiain sau.
khi bam t h i m nude muii sinh ly 0,9% vao khoang ming phii, d i sinh thiit ming I an t o i n , hipu qua.
K i t qua xet nghipm md binh hpc dtf?*
128
TCNCYH Phu truxyng 80 (3) - 2012 dpc tai trung tam Giai p h l u bdnh Benh vien
Bach Mai trong vdng 24h.
lILKeTQUA
1. Dac diim chung cua ddi tup'ng nghien cu>u
Benh nhan tran djch mang phii it chu yeu gap d dp tuii lao dgng (< 50 tuoi) chiim 62,4%. Tuii trung binh la 47 ± 22,8. Ty le benh nhan namlnir la 59,4%/40,6%.
Da s i cac bgnh nhan d i n vi$n sau khi xult hien trieu chung lam sang d l u tien dudi 1 thang (71,9%). Thdi gian trung binh la 24 ± 21,7 ngay.
2. Kit qua chin doan lam sang cudi cung
- 65% cac trudng hp'p tran dich mang phoi djch it la do lao ;
- 9% cac tnjdng hg'p do ung thu;
-13% do vidm phdi mang phoi;
13% la tran djch mang phdi dich it chua rd nguyen nhan;
3. Dac diim lam sang va can lam sang cua tran dich mang phdi djch it
3.1. Dac diem lam sang Bang 1. Dac diim lam sang Triiu chdng
Dau ngyc Khd thd Ho Sot Giy sut can Hpi chung ba giam
n 27 21 25 14 7 25
%
84,6 65,6 78,1 41,8 21,9 78,1 Bau nguc la trigu chung lam sang thudng gap nhlt {84,6%), ho 78,1%, khd thd 65,6%.
hgi chung ba giam chi phat hien dug'c 78,1%
cac trudng hgp tran djch mang phoi.
3.2. Xet nghiem mau
s i lug'ng bach cau nam trong gidi han binh thudng chiem 78,1%. Chi cd 21,9%
benh nhan cd tang bgch clu
29/32 (90,6%) benh nhan cd xet nghigm CRP duang tinh
Ty le duang tinh tren 5mg/dl la 21,9%.
trong do chu y i u gap tran djch mang phii do lao 19/29 trudng hap.
94.4 % benh nhan cd VSS sau 1h.
100% cd tang VSS sau 2 gid, tang manh tren 40mm gap 88,9%.
3 3. Xet nghi§m djch mang phoi Ty le gap djch mang phoi mau vang chanh trong nghien cuu la 81,2%, trong dd cua nhdm tran djch mang phdi do lao cao nhlt (90,5%)
Luang Protein dich mang phoi trung binh cua nhdm nghien cuu la 45,5 ± 11,56 va cua nhdm tran djch mang phii do lao la: 47,6 ± 11,29.
Trong nhom tran djch mang phoi do lao k i t qua t i bao hgc cho dich mang phii chu yiu la lympho bao chiim tdi 76,5%.
3.4. Xet nghiem vi sinh dich mang phoi T i t ca 32 trudng hep dug'c xet nghigm AFB true tiep trong djch mang phii d i u cho k i t qua am tinh.
Cd 3/31 (9,7%) trudng hp'p PCR-BK djch mang phdi duang tinh, ty le duang tinh d nhdm tran djch mang phdi do lao la 3/21 (14,3%).
4. Kit qua sinh thiit mang phdi cua tran djch mang phdi djch it
Lug'ng dich trung binh bam vao khoang mang phii de chuin bj cho sinh thiet mang phii la: 261,8 ± 61,58ml Trong dd bam vao
129
TCNCYH Phu tnmng 80 (3) - 2012
it nhit l i 200ml, nhiiu nhit l i 400ml, Kit qua ky thupt: 37/37 l i n sinh thiit (cd 5 trudng hpp dupe sinh thiit 2 lin) l i y dupe m l u bpnh phim an tpan gui lam xit nghlim md binh hpc.
Kit q u i chin doin bing sinh thiit ming phii.
C i 11/32 trudng hpp cho kit q u i duong tinh, d i g l i hinh anh t i n thuang ming phii do lao, khdng phit hiin trudng hpp n i o gng thu ming phii.
Ty l i chin doin duang tinh cua sinh thiit mang phii trong nhdm trin djch ming phii djch it do lao l i 52,4%.
Cic binh nhin cdn Ipi cd 10 binh nhin tran djch mang phii do lao dupe chin doan nhd phuang phap khac (lam sing, PCR - BK, IVIGIT cua djch mang phii va djch p h i quan, v i diiu tri thy lao).
Trong 3 binh nhan tran d|ch ming phii do gng thu cd 1 ca dupe chin doin dya vao soi p h i qgan, 1 ca sinh thiit hach thypng ddn va cd 1 ca chin doin dya v i o l i m sing vdi chin doan hinh anh.
Sinh thiit ming phii cho kit qga duang tinh g i p nhiiu nhit l i nhdm cd kich thudc Idp dich tu 1,5 - 2 cm vdi 6 trudng hpp.
Tf le tai bien sau sinh thiit:
Cd 5/32 trudng hpp (chiim 15,6%) cd tai biin sau sinh thiit.
C6 2 trudng hpp (chiim 6,2%) trin khi mang phii.
3 trudng hpp (chiim 9,4%) bj choang sag khi sinh thiit.
IV. BAN LUAN
Hieg qua sinh thiit ming phii trong chin dean nguyin nhin trin djch ming phoi it djch.
Hiiu qga k; thgit
O i thyc h i i n sinh t h i i t t h i n h cdng, cOni nhu d i hpn c h i tai b i i n xay ra khi sini thiit m i n g p h i i d b i n h n h i n t r i n djcl ming p h i i djch it, chung tdi bam thin huyit thanh m i n d i n g truang (Natriclorui 0,9%) v i o khoang mang p h i i tCiy theo bi d i y cua Idp djch m i chung tdi do dupi t r i n s i i u i m va tCiy v i o cam giic cui ngudi b i n h , n i g ngudi bpnh khd chju hoic t h i y cd cam g i i c gpp sue can th chung tdi dung bom.
Trong nghiin cuu n i y , chung tdi ghi nhir dupe lupng djch trung binh bam v i o khoang ming phii 6^ chuin bj cho sinh thiit mang phii la: 261,8 ± 61,58 ml. Trong do bam vao it nhit la 200ml, nhiiu nhit l i 400ml.
Theo Truang Huy Hung (2004), binh nhin cd lypng djch it nhit d i sinh thiit mang phii an t o i n l i 330ml [3].
Chung tdi d i thyc hipn 37 l i n sinh thiit mang phii trin 32 bpnh nhin Tdjch mang phii djch it, trong dd cd 27 ngydi dupe sinh thiit ming phii 1 l i n , 5 ngudi dupe sinh thiit ming phii 2 l i n . Vdi 37/37 l i n liy dupe m i u bpnh phim an toin, khong cd tn/dng hpp n i o t h i t bpi.
B i n g Hiing Minh (2002) cung c i ty I?
thinh cdng cua ky thgpt tuang duong vdi Chung tdi 98%. Sd dT cd thinh cdng viy la do Chung t i i thuc hipn ky thupt sinh thiit ming phii kin cd hudng d i n cua siiu i m . Trudc day Bill X u i n T i m (1980 - 1986) thyc hiin sinh thiit ming phii mg gpp 9% thit bpi k?
thgit, L i NghTa Trpng (1994) cDng that biii 18,7%trydnghpp[6, 7, 9].
Hiiu qua c h i n doin cua sinh thiit mai phii trong tran djch ming phii djch it.
Sinh thiit ming phoi giup c h i n doin i ^
130
TCNCYH Phu truung 80 (3) - 2012 djnh dupe nguyen n h i n t r i n djch ming phoi
djch it la 34,3% benh nhan, trong dd chin doan duac nggyin n h i n do lao l i 52,4%.
65,7% khdng xac djnh dupe nggyin nhan Tdjch ming phii, md bpnh hpc cua cac trudng hpp n i y d i g cho k i t qga l i viim mpn tinh. Trong nhung binh nhin n i y bang phii hpp cic phuang phip chin dean: lam sing, chin doan hinh anh, mantoux, PCR-BK, MGIT, n i l soi p h i quan, sinh thiit hpch, diig trj thu lao, chung tdi da chin doan dypc them cd 10 trudng hpp tran djch ming phii nggyin nhin do lao v i 3 ca do gng thu phii dicin.
Xem xet kit qga sinh thiit ming phii theo kich thudc Idp djch cho thiy, cd 2 trudng hop thupc nhdm cd kich thudc Idp dich tu 1 - 1,5 cm va 3 tnrdng hop thupc nhom cd kich thudc Idp djch tu 2,1 - 2,5 cm cho k i t qua duang tinh.
Gip nhiiu nhit l i nhdm cd kich thudc Idp djch tu 1,5 - 2 cm vdi 6 trudng hap.
So sanh ty le duong tinh cua sinh thiit mang phii giua hai nhdm dupe bam vao £ 250ml v i > 250ml cho thiy cd su khac biet nhung chua cd y nghTa thong k i vdi p > 0,05.
D i an t o i n cua ky thuit.
Trong nghiin cuu n i y gap 5/32 (15,6%) ca cd tai biin sau sinh thiit. Nhin chung thi ty Ip tai biin cua t h i p cung phii hap vdi nhin xit cua cac t i c gia khac. Do dd nghien cuu mpt lin nua khang dinh tinh an toin cua sinh thiit ming phoi kin bang kim Casteiain, cung nhu viec bam t h i m djch v i o khoang mang phii [6],
V. K i r LUAN
Nghiin cuu 32 bpnh n h i n t r i n djch mang phii djch it, chung tdi rut ra m i t s i k i t luan sau:
Die diim lam sing v i c i n l i m sing cua trin djch ming phoi djch it.
Tripu Chung hay gpp: dau nguc chiim ty Ip 84,6%, ho cung vdi 78,1%; khd thd gap d 65,6%; s i t c6 43,8%; hii chung ba giam l i 78,1%.
Phan dng Mantoux: 30,8% (+).
IVIiu s i c djch: Djch mau ving chanh 81,2%.
Luang lupng Protein djch ming phii trung binh la 45,5 ±11,56
100% khong thiy AFB trong djch mang phii khi soi true tiip.
Ty Ip duang tinh cua PCR - BK trong dich ming phii l i 9,6%
Gia tri chin doan cua sinh thiit mang phii bing kim Casteiain d bpnh nhin tran djch ming phii it:
100% cac l i n sinh thiet, sau khi da bam them NaCI 0.9%, liy duac md mang phii.
Ty le xac dinh dupe nguyin nhan Tdjch ming phii nhd sinh thiit ming phii bing kim Casteiain l i 34,4%.
Ty l i chin doan duang tinh cua sinh thiit mang phoi trong nhdm nguyen nhan do Lao la 52,4%.
Ty le tai biin nhe do sinh thiit l i 15,6%;
khdng cd tai biin npng.
TAI LIEU THAM K H A O 1. L i Khic Bao (2003). Gia trj sinh thiit mang phii bang kim xuyin da trong chin doan nguyen nhin lao, ung thu gay trin djch, day, u mang phoi. Tap chi Y hoc TP. Ho Chi H/linh, 7 ( 1 ) : 9 3 - 9 6 .
2. Nguyin Huy Diin, L i Huy Chinh, Trin Quang Phuc, Vu Thj Hanh. (2009).
Nghien cuu die diim lam sang va cpn lam sang d bpnh nhin tran djch mang phii do lao tpi Hai Phdng t u 2005 - 2008. Ky y i u hdi nghj khoa hpc binh phii toan quic lin thu 131
TCNCYH Phu tnmng 80 (3) - 2012
111,323-331.
3. Truang Huy Hung (2004). Nghiin cuu dpc diim lim sang va hinh anh sieu am cua tran djch ming phii do lao. Luin van l i t nghiip bac sy chgyin khoa c i p II, trudng Dpi hpc Y H i Npi.
4. Trjnh Thj Huang (2003). Nhin xit die diim l i m sing, c i n l i m sing v i k i t qga diiu trj binh nhin trin djch ming phii diig trj nil tru tpi khca Hd H i p binh vipn Bpch Mai n i m 2001 Luin van t i t nghiip bac sy da khoa, tm'dng Dpi Hpc Y H i N i l
5. Nguyin Thj Bich Ngpc, Trin Thj Dung, Nguyin Xuin Triiu (2010). Dpc diim l i m sing trin djch ming phii do iao.Y Hpc thuc hinh 708 (3): 78 - 80.
6. Dpng Hiing Minh (2002). Hieu qua cua sinh thiit ming phii bang kim Casteiain dudi djnh vj cua sieu i m trong chin dean nguyen nhin trin djch mang phii. Luan van thpc sy y khoa, Dai hpc Y Ha Npi.
7. Biii Xuin Tam (1999). Chin doin nggyin n h i n tran djch ming phii thanh ta va mag. Bpnh hpc hd h i p , Nha xgit ban Y hpc, 9 0 4 - 9 4 1 .
8. Nguyin Dinh Tiin, Pham Thi Anh (2009). So sanh mit s i dpc diim lam sang, cpn lam sing d binh nhin trin djch mang phii do lao v i i c tinh. Ky y i u hoi nghj khoa hpc binh phii toan quic lin thu III, 372 - 378.
9. Le NghTa Trong, L i Van Tam, Trin Thanh Hung (1994). Nhin x i t 80 trudng hpp tran dich ming phoi thanh ta dupe chin doin nggyin nhin b i n g phuang phip sinh thiit ming phii kin vdi kim Casteiain tai BV Da khoa C i n Tha. Ndi san Lao v i Binh Phii, Ting hdi Y Dupe Vipt Nam, (15): 33 - 46.
10. Gopi A, Madhavan SM, Sharnia SK, Sahn SA. (2007). Diagnosis and Treatment of Tuberculous Pleural Effusion in 2006, Chest; 131:880-889.
Summary
BIOPSY PLEURAL WITH CASTELAIN NEEDLE FOR SMALL VOLUME PLEURAL EFFUSION IN RESPIRATORY CENTER- BACH MAI HOSPITAL Objective of the study was to evaluate clinical, paraclinical characteristics and results of biop- sy pleural with Casteiain needle for pleural effusion with small volume. The result showed that chest pain (84.6%), cough (78.1%), dyspnea (65.6%), fever (43.8%). Biopsy was success in all of cases. Identify the cause ef pleural effusion in 34.4% of cases. In conclusion, biopsy pleural with Casteiain needle allowed etiological diagnosis for small volume pleural effusion This tech- nique is safe in trained medical doctors even in small volume pleural effusion.
Key words: biopsy pleural with Casteiain needle, pleural effusion with small volume
