Y HOC VIET NAM THANG 1 0 - S O 1/2011 IV. KET LUAN
1- Ap dung eae phuong phap cha'n doan dac hidu trong qua trinh tuydn chpn 46 chdu dupe cha'n dodn xac djnh HPQ do bui nha tham gia diiu tri GMCDH.
Chiing tdi nhan thay: day Id nhffng phuang phap cd gia tri trong viec chan doan xdc djnh ngudn di nguydn gdy benh, ed dp nhay vd dd dac hieu cao.
2- Budc dau diiu trj cho 46 tre HPQ do bui nhd gay ra, chiing tdi nhan thay:
Cd kit q u i rat tdt 24/46 chdu (52,17%) vd tdt 9/46 chdu (19,57%)= 71,74%
- Khdng cd kit qui la 5/46 chau, vdi ty Id Id 10,87%.
- Cd thd ndi ddy Id phupng phap diiu trj an toan, hidu qui vd nhiiu tridn vpng.
TAI LIEU THAM K H A O
1. Phan Quang Doan, Nguyin Nang An, L/ng dung dt nguyen bui nha trong chan docin va dieu tri dac hieu
hen phe quan. Cdng trinh nghifin ciru khoa hoc, 1995- 1996, Bv Bach Mai, t$p II, 215-222.
Pham Thifc, Phimg Minh Sdn, Pham Van Linh va cong sir, irng dung di nguyen bui nha trong chan do^n dcic hieu hen phe quin tai Hii Phong. Bao cao khoa hoc-Hpcvi6nQuanY, 1996, 64.
U. Muller, Immunotherapy of allergic disease: Present and future. Shweiz Med Wochenschr, 12-1993, 31- 113(50), 1988-1993.
J.M. Olaguibe, A.I. Tabar, C. Cortoos, et al.
Immunotherapy with standardized extract of D.pteronyssinus in bronchial asthma: a dose titration study Allergy -1997, 52(2), 168 -178.
CE. PIchler, A. Marquardsen, S. Sparholt, et al.
Specific immunotherapy with D.pteronyssinus and D.farinae results in decreased bronchial hyperreactivity. Allergy 1997, 52(3), 274 283.
VAI TRO CUA THAY HUYET TUONG TRONG DIEU TRj HOI
C H Q N GGUILLAIN BARRE' TAI KHOA HOI SLfC TfCH Cl/C BENH VIEN BACH MAI
Nguyen cong Tan*, Nguyen gia Binh*
TOM T A T
Muc tieu: 1-Nghien ciru hieu qua ciia phUdng phap thay huyet tUdng trong cap ciTu benh nhan bj hpi chirng Guillain-Barre'. 2-Oanh gia cac bien chu'ng ciia phUdng phap thay huyet tUdng. Doi tu'dng: Tir 1/2008 den 9/2010 chiing tdi tien hanh thay huyet tUdng cho 36 benh nhan nam dieu tri tai khoa Hoi sire b'ch cUc Benh vien Bach mai vdi chiin doan Hpi chirng Guillain-Barre' dUa theo tieu chuan ciia /\sbury va comblath nam 1990. Phu'dng phap: nghien ciru tien ciru cd can thiep, Cac benh nhan dUpc danh gia cd lUc va xet nghiem theo protocol nghien ciru, chiing toi sir dung huyet tUdng tUPi ddng lanh. Ke't qua: cd 36 benh nhan (22 nam, 14 nu'), tudi trung binh 39,8 ± 15,8 (15-72), cd 16 benh nhan can phai thong khf nhan tao, lUdng huyet tUdng moi lan thay 35,6 ± 5,43 (25,9 - 50,5 ml/kg), sd lan thay huyet tu'dng trung binh 4,9 ± 1,3 (2 7). Cac benh nhan cd cai thien tinh trang liet cP sau moi lan thay huyet tUPng tuy nhien mii'c dp cham hPn so vdi benh nhan nhUpc cP, cd mpt sd benh nhan hdi phuc gan nhU hoan toan cac cd bi Het khi ra vien, cac bien chiTng nhU phan irng di irng
*Khoa Hoi sdc tich cdc, Benh vien Bach Mai
(noi man, ngira, do da) chiem 38/176 (21,6%) tdng so ihn thay huyet tUdng, co mpt benh nhan phai dirng thay huyet tUdng khi con 1/2 thdi gian vi ndi ban dj irng nhieu Khong cd benh nhan nao bi sdc phan ve, nhiem khuan mau hoac tai cho. Thdi gian nam vien trung binh 16,3 ± 11,1 (4 - 52 ngay). Ke't luan Thay huyet tUdng cai thien cd lUc d benh nhan bj hpi chu'ng Guillain-Barre', do do riit ngan thdi gian thd may va nam vien, han che dUpc cac bien chu'ng do nam lau gay ra, bien chu'ng hay gap nhat la phan img di irng.
SUMMARY
ROLE OF PLASMA EXCHANGE IN THE TREATMENT OF GUILLAIN-BARRE' SYNDROME
AT THE I N T E N S I V E CARE DEPARTMENT AT BACH MAI HOSPITAL
Objectives: 1-studying effectively of Plasma exchange in severe Guillain-Barre' syndrome. 2- Evaluation of complications of the Plasma exchange method. Subjects: From 1/2008 to 9/2010 we performed plasma exchange for 36 patients with severe Guillain-Barre' syndrome were treated at the
intensive care department at Bach Mai Hospital with diagnosis of Guillain-Barre syndrome based on the standards of Asbury and comtjiath in 1990. Method:
research progress with intervention studies, patients were evaluated according to the research protocol, we use fresh frozen plasma. Results: 36 patients (22 male, 14 female), average age 39,8 ± 15,8 (15-72), 16 patients required artificial ventilation, plasma volume changes each time 35,6 ± 5,43 (25,9 - 50,5 ml/kg), number of times for each patient was 4,9 ± 1,3 on average (2-7 times). The patient's condition improved after each change plasma, but more slowly than patients with myasthenia gravis, some patients have recovered almost completely paralyzed muscles when the discharge, complications such as allergic reactions (rash, itching, red skin) accounted for 38/176 (21,6%) of the total number of episodes, there is a patient must stop plasma exchange as 1/2 times because of severe allergic rash No patient with anaphylactic
shock, blood infection or local. The average hospitalization time is 16,3 ± 11,1 (4 52 days). Conclusion: plasma exchange improved weak muscles condition of patients with Guillain-Barre' syndrome, thereby shortening the time mechanical ventilation and hospitalization, limiting the complicabons caused by long lying. The most common complication is allergic reaction.
I.
OAT VANof
Trong hdi chirng gulllain-barre, cd the sinh ra khang the chdng lai cac nguyen nhan nhiem triing, ddng thdi cung chfnh cac khang the dd cung tan cdng va lam tdn thu'dng myeline va sdi true cua day va re than kinh. Bieu hien lam sang chii yeu la yeu cd tien trien nhieu nPi, dac biet nang khi cd liet cd hd hap va rdi loan than kinh tirddng.CS]
Khi benh nhan bi liet nhieu nhdm cd, dac biet cd hd hap, benh nhan phai dieu tri dai ngay, nam lau se cd nhieu bien chirng nhu': loet do ty de, nhiem khuan phoi lien quan den thd may, tac mach nhieu nPi do nam bat ddng.
Cac bien phap dieu tri tfch cdc lam giam lu'dng khang the tu" mien trong mau de cai thien du'dc tinh trang lam sang bao gdm: diing thudc u'c che mien dich lam giam san sinh ra khang the, Ipc huyet tu'dng de loai bd khang the td mien ra khdi cd the [4][5].
Thay huyet tu'dng (Plasma exchange) la bien phap lay bd huyet tu'dng ciia ngu'di bj benh cd chu'a khang the tu" mien, sau dd bii lai the tfch bang plasma tu'di ddng lanh hoac aliDumin5%,
giiip cho kha nang van ddng ciia cd du'dc hdi phuc nhanh chdng.
6 Viet Nam bu'dc dau da tien hanh thay huyet tu'dng cho benh nhan bi hdi chu'ng Guillain-Barre' va nhu'dc cd. Vi vay chiing tdi tien hanh nghien ciTu de tai nay nham muc dfch:
1- Nghien cii'u hieu qua ciia phu'dng phap thay huyet tu'dng trong dieu trj cap cufu b$nh nhan bj hgi chu'ng Guillain-Barre'.
2- Danh gia cac bien chu'ng ciia phu'dng phap thay huyet tu'dng.
II. o 6 l TU<?NG VA PHUONG P H A P NGHIEN COU 2.1. Doi tu'dng nghien cuTu:
Tir 1/2008 den 9/2010 chiing tdi tien hanh thay huyet tu'dng cho 36 benh nhan nam dieu tri tai khoa Hdi sire tfch cdc Benh vien Bach mai vdi chan doan Hdi chirng Guillain-Barre' di/a Theo tieu chuan ciia Ashbury va comblath nam 1990: [3]
Cac dac diem can nghi den hdi chu'ng Guilain-Barre
-I- Cd su" yeu cd tien trien dan dan cua ca chan va tay.
+ Cd giam hoac mat phan xa
Cac dac diem lam sang ho trd them cho chan doan:
-I- Tien trien nhieu ngay den 4 tuan -I- Cd tfnh chat ddi xirng ciia cac dau hieu -I- Cac trieu chirng hay dau hieu cam giac thu'dng la nhe
-I- Ton thudng day than kinh so (b'nh chat hai ben) -I- Bat dau phuc hoi sau 2 4 tuan sau khi ngirng tien trien
-I- Rdi loan chu'c nang td ddng -t- Khdng cd sdt luc khdi benh
- Cac dac dien xet nghiem ho bdcho dian ddan + Dich nao tiiy: Protein tang, te bao
<10/mm^
+ Dien cd: dan truyen than kinh cham hoac mat 2.2. Phu'dng phap nghien cu'u.
Nghien CU\J can thiep tien ciTu
Sd lieu du'dc thu thap va ghi chep can than theo mau benh an nghien ciTu.
Benh nhan du'dc danh gia tinh trang liet cd theo tirng nhdm cd tru'dc va sau moi lan thay huyet tu'dng va sau ket thuc ddt thay huyet tu'dng theo thang diem cang cd tren lam sang cua Hdi ddng nghien cufu y hoc (Medical research council Scale for Muscle Strength) dang du'dc ap dung tai khoa dieu bi tich ci/c benh vien Bach Mai:
0: Khdng cd bieu hien co cd.
Y HOC VIET NAM THANG 1 0 - S O 1/2011 1: Co cd quan sat du'dc nhu'ng khdng cd van
ddng.
2: Cd van ddng cd nhu'ng khdng thang du'dc trpng lu'c.
3: Van dpng cd thang du'dc trpng lu'c nhu'ng khdng thang du'dc ddi khang.
4: Van ddng cd thang du'pc trpng lu'c va ddi khang.
5: Cd li/c hoay ddng binh thu'dng.
Benh nhan liet cd hd hap du'pc do NIP, Vt tiT thd tru'dc va sau khi thay huyet tu'png.
Benh nhan du'pc lam cac xet nghiem mau tru'dc va sau moi lan Ipc huyet tu'dng: Cdng thirc mau, Ddng mau cd ban, Dien giai dd.
- Benh nhan duOC lam dien od khi cd dieu kien.
Sd lan thay huyet tu'dng cho moi benh nhan: tuy thudc vao tinh trang lam sang va dap irng ciia benh nhan.
Khoang each giO'a cac lan thay huyet tu'dng: thay huyet tu'dng hang ngay each ngay.
* Cac bien cd khi thay huyet tu'dng (cd the phai dirng cupc Ipc) [2][7].
-1- Ddng mang va bau bay khf.
+ Tac hay tuot dng thdng tTnh mach.
-I- Dirt day, vd mang.
+ Khf lot vao tuan hoan ngoai cd the.
+ Sdc phan ve
2.3. Phu'dng tien nghien cu'u.
May Ipc mau: Diapact ciia hang B/Braun, Prisma ciia hang Gambro.
Djch thay the: huyet tddi ddng lanh du'dc tfnh theo cdng thirc [5][6].
Vplasma = (1-Ht)x(0,065 x Wkg)
Hoac u'dc tfnh 30 40ml/Kg/lan. Ca dpt khoang 200 250ml/kg.
Them 2 gram canxidorua (tiem tmh mach Igram sau 30 phiit chay va ngay tru'dc khi ket thiic 30 phiit).
- Ong thdng 2 ndng cd 12F Thudc chdng ddng: heparin.
- Cac thiet bi cap ciru: bdng ambu, may thd, dng ndi khf quan, adrenalinlmg, dimedron, methylpresnisolon 40mg, monitoring, bdm tiem dien.
Dung cu do NIP, Vt.
2.4. XuT ly va phan tich so lieu: theo thuat toan thdng ke y hpc SPSS 17.0.
III. KET QuA
Bang 3 . 1 . dac diem chung
Thong so
Tudi Gidi
Thdi gian nam vien Thdi gian nam HSTC Thdi gian bj den khi thay huyet tUdng (ngay)
Sd lupng huyet tUdng/lan (ml/kg) Sd lan thay huyet tu'png
Heparin bolus (Ul/lan) Heparin duy tri (Ul/gid)
Chung (n = 36) 39,8 ± 15,8
(15-72) 22 nam - 14 nii'
16,3 ± 11,1 (4 52) 13,0 ± 10,6
(2 50) 14,2 ± 28,21
(2 170) 35,6 ± 5,43 (25,9 - 50,5)
4,9 ± 1,3 ( 2 - 7 ) 850,0 ± 300,1
(0 - 1000) 468,4 ±200,
(0 - 1000)
Khong TKNT (n = 20) 39,2 ± 13,6
(16 - 65) 9 nam - l l n C
13,1 ± 8,3 (4 33) 8,1 ± 3,2 (2 14) 19,3 ± 37,4
(3 170) 35,4 ± 6,5 (26,8- 48,7) 4,8 ± 1,4
( 2 - 7 ) 800 ± 278,1 (200 1000) 537,5 ± 221,7 (200 - 1000)
Co TKNT (n = 16) 40,8 ± 18,6
(15-72) 13 nam 3 ni?
19,6 ± 12,8 (6 - 52) 17,9 ± 13,1
(4 - 50) 8,2 ± 7,25
(2 - 30) 31,9 ± 4 , 1 1
(27,3 - 40) 5,1 ± 1,18
(2 7) 892,9 ± 289,5
(0 - 1000) 457,1 ± 145,3
(0 - 600) Thdi gian xuat hien trieu chu'ng dau tien den khi thay huyet tu'ong dao ddng
Thdi gian nam vien tai khoa hdl sire tfch ciTc dao ddng nhieu.
Sd lan thay huyet tu'dng trung binh 5 Ian/1 benh nhan
nhieu.
Bang 3 . 2 . Nhom cd
Nhdm cd dau m3t
CO
Cdho hap
- Cac
Gap dau lai Quay dau 2 ben Nham mat Ha mieng Nhai c3n
Danh gia cd li/c nhdm cd dau mat co va hd hap.
Vt (ml/kg) NIP (mmHg)
nhdm cd dau mat co va cd
Tru'dc PEX 2,76 ± 1,46 2,91 ± 1,47 3,15 ± 1,42 3,33 ± 1,38 3,30 ± 1,36 2,17 ± 1,17 3,67 ± 2,88
tru'dc khi ra vien 4,24 ± 0,97 4,39 ± 0,87 4,45 ± 0,79 4,64 ± 0,60 4,64 ± 0,60 8,17 ± 3,92 14,50 ± 2,80 hd hap cai thien rd ret cd y nghia thdng ke tru'dc
P P < 0.001 P < 0.001 P < 0.001 P < 0.001 P < 0.001 P < 0.01 P < 0.01 va sau khi thay huyet tu'ong (vdi P < 0,01).
Bang 3 . 3 . Danh gia cd lu'c nhdm cd tir chi.
Nhom cd
Nhom cd chi tren
vai
DUa vai ra trUdc Nang canh tay Gap cSng tay Quay sap c§ng tay Gap/dudi co tay Cam bilt
V/ddng ngon tay
Tru'dc PEX 2,35 ± 1,25 2,32 ± 1,28 2,21 ± 1,43 2,61 ± 1,37 2,61 ± 1,32 3,00 ± 1,35 3 , 0 0 ^ J ^ 3 5 _ 2,82 ± 1,38
Tru'dc khi ra vien 4,06 ± 0,81 4,06 ± 0,81 4,09 ± 0,88 4,27 ± 0,72 4,39 ± 0,70 4,39 ± 0,75 4,39 ± 0,75 4,48 ± 0,67
P < 0.001 P < 0.001 P < 0.001 P < 0.001 P < 0.001 P < 0.001 P < 0.001 P < 0.001 Nang 8t giiJ' 2 chan 1,82 ± 1,40 3,79 ± 0,93 P < 0.001 Nhdm cP
chi dudi
Gap dili vao bung Gap/duoi cang chan
1,88 ± 1,39 3,88 ± 0,93 P < 0.001 2,037 ± 1,40 4,12 ± 0,96 P < 0.001
Gap duoi ban chan 2,12 ± 1,41 4,33 ± 0,85 P < 0.001
V/d ngdn chan 2,30 ± 1,49 4,42 ± 0,79 P < 0.001
Cac nhdm cd chi tren va chi du'dl cai thien rd ret cd y nghia thdng ke tru'dc va sau khi thay huyet tu'ong (vdi P < 0,001).
Bang 3.4. Thay dd'i ve cdng thiTc mau
Thong sd Tru'dc PEX Sau PEX Sau PEX 6h
Hong cau 4,32 ± 0,66 4,29 ± 0,73 4,35 ± 0,73
Hemoglobin 123,9 ± 17,3 121,1 ± 17,5 123,8 ± 17,5
Hematocrit 35,6 ± 6,93 35,4 ± 6,32 36,4 ± 4,86
Bach cau 13,1 ±4,46 16,0 ± 5,46 13,9 ± 4,78
Tieu cau 246,2 ± 102,66 228,0 ± 96,77 237,6 ± 103,85
Khdng cd sir thay ddi nhieu ve cdng thirc mau tai cac thdi diem tru'dc, sau va sau 6 gid khi thay huyet tu'dng cho benh nhan.
Bang 3.5. Thay dd'i ve dien giai do mau
Thong so Tru'dc PEX Sau PEX Sau PEX 6h
Natri 136,8 ± 4,99 137,3 ± 4,87 136,5 ± 4,37
Kali 3,65 ± 0,440 3,59 ± 0,339 3,86 ± 0,307
Canxi 2,163 ± 0,2693 2,714 ± 0,3689 2,299 ± 0,2111
Clo 100,9 ±4,62 I 100,8 ±4,55 | 100,6 ± 4,09
nhieu ve dien giai do mau tai cac thdi diem tru'dc, sau va sau 6 gid khi nhan, cac gia tri nay van d trong gidi han binh thu'dng.
Khdng cd sir thay do thay huyet tu'dng cho benh
Thong so Protein
Albumin PT%
aPTT Benh/chirng Fibrinogen
Bang 3.6. Thay dd'i ve ddnq mau:
Tru'dc PEX 65,57 ± 8,009 35,74 ± 5,734 92,68 ± 22,52 33,52 ± 19,13 1,257 ± 1,0555 3,213 ± 1,0647
Sau PEX 61,24 ± 7,501 35,70 ± 9,406 79,24 ± 19,65 53,05 ± 28,790
2,047 ± 1,675 2,850 ± 0,8937
Sau PEX 6h 64,93 ± 6,315 37,33 ± 5,361 94,79 ± 16,53 27,90 ± 5,841 0,997 ± 0,255 3,037 ± 0,9265
Y HOC VIET NAM THANG 1 0 - S O 1/2011
Cd sir thay ddi ciia PT% va aPTT tai thdi diem ngay sau khi thay huyet tu'dng, nhu'ng tai thdi diem sau 6 gid cac gia trj nay tru'd ve binh thu'dng nhu' tru'dc khi thay huyet tu'dng.
Bang 3.7. Thay dd'i ve mach, huyet ap Thong so
Mach
Huyet ap tam thu Huyet ap tam trUPng
Tru'dc PEX 94,5 ± 11,4 117,6 ± 13,5
72,1 ± 8,9
Sau PEX 93,8 ± 12,6 118,3 ± 14,9
72,7 ± 10,2
P P > 0,05 P > 0,05 P > 0,05 Sir thay ddi nhe ciia mach, huyet ap tru'dc
va ngay sau khi thay huyet tu'dng khdng cd y nghTa thdng ke (vdl P > 0,05)
Cac bien chirng:
Do thay huyet tu'dng: dj iTng: 38/176 (21,6%) lan thay huyet tu'dng
Do benh ly: xep phdi 5/36 (13,9%) benh nhan, Viem phdi 7/36 (19,4%) benh nhan.
IV. BAN LUAN
Trong sd 36 benh nhan cd 16 (44,4%) benh nhan bj liet cd hd hap kem theo can phai thdng khf nhan tao, sau khi thay huyet tu'dng cd 1 benh nhan khdng bd du'dc may thd, tinh trang liet cai thien rat cham, chiing tdi chuyen benh nhan ve tuyen dddi dieu trj tiep.
Cac benh nhan cd cai thien tinh trang liet cd sau moi lan thay, dac biet benh nhan cd cam giac dd te bi. Khi ra vien cac cd bi liet du'dc hdi phuc so vdi tru'dc khi thay huyet tu'dng, su" khac biet nay cd y nghia thdng ke (vdi P < 0,001). Tuy nhien cd 9 benh nhan cd tinh trang liet cd hdi phuc cham so vdi cac benh nhan khac (15%).
cung tu'dng du'dng vdi ket qua nghien ciTu ciia cac tac gia khac nhu' Mohammed Atiq cd 8/10 (80%) benh nhan cai thien tinh trang Het.[6].
Sd IBn thay huyet tu'dng d benh nhan (2 7 lan), da sd benh nhan cd sd lan thay huyet tu'dng 4 6 lan (4^9 ± 1,3), tu'dng du'dng vdi tac gia Mohammed Atiq [6] va Nikolina [7].
Cac benh nhan du'dc thay huyet tu'dng vdi sd lu'dng moi lan thay (35,6 ± 5,43 ml) tu'dng du'dng vdi lu'dng huyet tu'dng u'dc tfnh du'dc khuyen cao [5][7]. Chiing tdi sir dung huyet tu'dng tu'di ddng lanh cho benh nhan, cd siT giam cac yeu td ddng mau ngay sau khi thay huyet tu'dng so vdi tru'dc va sau 6 tieng cd the lien quan den lieu dung heparin. Tuy nhien cac gia tri nay van d trong gidi han cho phep, khdng cd hien tu'dng chay mau tren lam sang va tai chan catheter loc mau.
Cac thay ddi ve cong thuTc mau, dien giai mau tai cac thdi diem xet nghiem tru'dc, ngay
sau va sau 6 tieng thay huyet tu'dng khdng thay khac biet nhieu, cac gia tri nay van nam trong gidi han binh thu'dng.
Trong nghien ciru ciia chiing tdi cd gap cac bien chiTng nhu' phan iTng dj iTng (ndi man, ngiTa, dd da) chiem 38/176 (21,6%) tdng sd lan thay huyet tu'dng, bien chiTng nay xuat hien mudn sau khi ket thiic hoac sap ket thiic thay huyet tu'dng. Cd mdt benh nhan phai diTng thay huyet tu'dng khi cdn 1/2 thdi gian vi ndi ban dj irng nhieu. Cac benh nhan nay du'dc dieu tn diphenhydramin hydroclorid lOmg va methylprednisolon 40mg tiem tTnh mach, sau 30 phiit thi het tinh trang di iTng. Tuy nhien khdng cd benh nhan nao bi sdc phan ve, nhiem khuan mau hoac tai cho dng thdng tTnh mach Ipc mau do qua trinh thay huyet tu'dng gay ra.
Cac bien chirng khac do benh ly gay ra nhu' xep phdi 5/36 (13,9%) benh nhan, tinh trang xep phdi cd tru'dc khi vao vien va Hen quan den giam thdng khf phe nang do liet cd hd hap, cac benh nhan nay deu du'dc thdng khf nhan tao va soi hut phe quan. Viem phoi chiem 7/36 (19,4%) b?nh nhan lien quan den xep phdi va viem phdi do thd may.
Thdi gian nam khoa hdi siTc d nhdm khdng cd thdng khf nhan tao 8,1 ± 3,2 (2 14) ngan ngay hdn so vdi nhdm cd thdng khf nhan tao 17,9 ± 13,1 (4 50), so vdi nhdm benh nhan Guillain-Barre' (15 benh nhan) khdng du'dc thay huyet tu'dng tru'dc day phai thd may 34,4 ± 23,8 (9 -108) thay cd cai thien rd thdi gian nam tai khoa hdi siTc [1].
Thdi gian thdng khf nhan tao d nhdm du'dc thay huyet tu'dng 11,9 ± 11,15 (3 - 45 ngay) ngan hdn so vdi nhdm khdng du'dc thay huyet tu'dng tru'dc day 24.9 ± 23.7 (6 - 100 ngay) [1].
V. KET LUAN
Thay huyet tu'dng cai thien tinh trang yeu cd d benh nhan Guillain-Barre', do dd riit ngan thdi gian nam vien, thdi gian nam hoi siTc va thdi gian thdng khf nhan tao, han che du'dc cac bien chiTng do nam lau gay ra.
Thay huyet tu'dng cd tfnh an toan cao, bien chiTng hay gap nhat la phan iTng dj iTng va tinh trang giam ddng mau ngay sau khi thay huyet tu'dng, tuy nhien cac bien chiTng nay khdng gay nguy hiem den tinh mang benh nhan va trd ve binh thu'dng sau vai tieng khi ket thiic.
T A I UEU T H A M K H A O
1. Nguyen cong Tan. "Danh gia dU phong xep phoi d benh nhan liet cd hd hap dUpc thong khi nhan tao vdi ap lUc duong cudi thi thd ra" Luan van thac si. 2002
2 Andre A Kaplan, Joy L Fridey. "Complications of therapeutic plasma exchange", UpToDate CD (2009) version 17.3
3. Asbury, AK, Comblath, DR. "Assessment of current diagnostic criteria for Guillain-Barre syndrome" Ann Neurol 1990; 27 Suppl:21-24
4. Haupt W.F. "Recent Advances of Therapeutic Apheresis in Guillain-Barre Syndrome" Ther Apher, Vol 4, No 4, 2000: 271- 274
5. Lehmann M.C; Hartung H.P; Hetzel H.Z;
Stuve. O; Kieseir B.C. "Plasma exchange in neuroimmunological disorders" Arch Neurol.
(2008) 63: 1066-1071
6 Mohammed Atiq Dada and AndrD A Kaplan.
"Plasmapheresis treatment in Guillain-Barre' syndrome" Ther Apher Dial, Vol 8, No 5, 2004:
409-412
7. Nikolina Basic-Jukic, Petar Kes, Snjezana Glavas-Boras. "Complications of therapeutic plasma exchange: Experience with 4857 treatments" Ther Apher Dial, Vol 9, No 5, 2005:
391-395 7
NGHIEN CLfU MOI LIEN QUAN
G I Q A D ODAY
L 6 PNOI TRUNG MAC
• • •
DONG MACH CANH V6l MOT SO YEU TO NGUY CO TIM MACH
• • • - •
d NGUdl CAO TUOI
Le Thj Ve*, Nguyin Thi Kim Thuy*
T O M T A T
Cd sd: Tudi cao, tang huyfe'f ap, rdi loan lipid mau, beo phi, hut thudc la la nhumg y^u \6 gSy vaa xd ddng mach.
Cac y^u to nay li§n quan den dp day Idp ndi trung mac thanh ddng mach canh lei yfe'u td nguy co ddc lap du b^o cac bidn cd tim mach. Muc dich: Tim hieu md'i lien quan giua mpt sd yeu td nguy co tim mach vdi dd day Idp ndi trung mac ddng mach canh d ngudi cao tudi Odi tUdng: Gdm 90 benh nhan ddn kham va didu tri tai Benh vien 108 tU 7/2007 4/2008. Trong do 52 nam, 38 nOr, Tudi trung binh (68,3
±8,3), dao ddng (60-82 tudi). Phuong phap nghien cifu:
Nghien ciru tidn ciru, md ta cat ngang. Cac b6nh nhan dupe kham iam sang, xet nghifem mau, difin tam dd. Su dung phudng phap sifeu am B- mode do Idp ndi - trung mac ddng mach canh. Sd lifiu thdng k6 dupe M ly tr6n phan mdm SPSS 15.0. Ket luan: Dp day Idp ndi frung mac va ty 16 dp day Idp nOi tmg mac tr6n dudng kinli Idng ddng mach canh Chung d cac bfenh nhan cao tudi cd tang huydt ap, rdi loan lipid mau, thira can, hut thudc la cao hon so vdi nhdm bfenh nhan khdng cd ydu td nguy cd (p <0,05).
Tir khoa: Tudi cao, tang huydt ^p, rdi loan lipid mau, beo phi, hilt thudc la, dd day Idp ndi trung mac ddng mach canh
* Benh vien 108
PBKH: PGS.TS. Nguyin Van Quynh
SUMMARY
STUDY THE RELATIONSHIP BETWEEN INTIMA- MEDIA THICKNESS CAROTID ARTERY WITH SOME CARDIOVASCULAR RISK FACTORS IN ELDERLY Background: Old age. hypertension, dyslipidemia, obesity, smoking are factors that cause atherosclerosis.
These factors are related to the high desert thickness internal carotid artery are independent risk factors predicting cardiovascular events Purpose: Understanding the relationship between some cardiovascular risk factors witti intima media thickness carotid artery in the elderly.
Subjects and Method: Sun/ey 90 patients examined and treated at 108 Hospital from January 7/2007- 4/2008, including 52 males and 38 females; the mean age (68.3 + 8.3), range: 60-82 years. Research Methodology:
prospective, descriptive, cross-sectional. Patients received clinical examination, blood tests, ECG. Using the method of B-mode ultrasonic measuring internal carotid artery high desert. Statistics are processed on SPSS 15.0 software Conclusion: The high desert inner layer thickness and thickness ratio on the content and opening kinhlong common carotid artery in elderly patients with hypertension,
