Y HOC Vl|T NAM T H A N G 5 - SO 2^014
bien co tir vong trong vong 30 ngay 6 benh nhan NMCT cap di/dc can thiep OMV qua da
- NhiTng benh nhan ma sau can thiep gia trj trung binh cua tong ST con chenh len > 7mm thi tien lu'dng nguy cd tu" vong cao. ^
Nhir vay SLT thay doi cua dien tam do dien bieri theo thdi gian rat co gia tri giup bac sy co the den lu'dng sdm benh nhan va d u ^ ra cac chi djnh thich lidp.
TAI L l | U THAIVI K H A O
X. Nguyen Quang Tuan "Nghien cull phu'dng phap can thiep OMV qua da trong dieu tri NMCT cap".
Cac de tai Ichoa hoc Hoi nghi Tim mach Mien Trung md rong lan I I , 20dl;{40);tr 115-116.
2. Barrabes, JA.^ Figueras 3., e t a l . (2000).
Prognostic significance of ST segment depression
in lateral leads I, aVL, V5 and V6 on the admission electrocardiogram in patients with a first acute myocardial infarction without ST segment elevation, J Am Coll Cardiol, 35:1813-1819.
Bowbrick, S. and Borg AN (2005). Role of ambulatory ECG monitoring. ECG complete:34'35, Crawford MH, Bernstein SJ, et al. (1999)1 ACC/AHA guidelines for ambulataj elecbwardiography. J Am Cbll Cardiol, 34:912-94ff Deedwania PC. and Carbajaf EV (1990). Sila|
ischemra during daily life is an independent predictor of mortality in stable angina. Circulation^
81:748-756.
Drew BJ, Peter MM, et a l . (2002). Frequency, characterristics and clinical significance of ST segment elevation in the patients with acute coronary syndromes. European Heart Joumal^
23:941-947.
MOT SO DAC DIEM LAM SANG VA DICH TE HOC
COA BENH M A Y D A Y MAN TINH DIEU TRI TAI B E N H VIEN 103
T6M TAT
Nghien CLTU 135 b^nh nhan ban may day man tinh den khdm va dieu trj t^i Benh vien 103 tii thang 8/2012 den thang 7/2013, ket qua cho ^S^: Ti le % b<?nh nhan m^y day mgn tfnh trong do tuoi tiy 20-49 la 66,6%. Ti ie benh d nam va nS bang nhau. So benh nhan cd tien siJ di litig chiem 94,1%. B$nh mSy day m^n tfnh co the xuat hien quanh n3m. B|nh gSp nhieu nhat vao mua he (37%). Oa so trudng hdp mac benh trong vong 1 nSm chiem 69,6%. So tru'dng hdp mac tren 5 nam la 11,1%. Mu'c dp benh nang chiem tj le 65,9%, miJfC dO vi!ra chiem 3 i , 9 % va mu'c do nhe la 2,2%. Co 14 yeu to thuan ldi dio viec xuat hien benh, trong do yeu to thdi ti^i: chiem ti l# cao nhat 60,7%.
06 34,8% tru'dng hdp khong tim thay yeu to lien quan.
Tiy khda: B|nh da lieu; Benh may day m^n tinh.
Hoang VSn Manh'^, Ph^m Hoang KhSm**
August, 2012 to July, 2013, the results showed that:
The percentage of the patients with chronic urticaria from 20-49 years old was 66.6%. The rate of males and females was equal. Personal allergic history was:
94.1%. Chronic urticaria occur all year round. The percentage of the patients with chronic urticaria In the summer was the highest (37%). Most of the patients suffer from Chronic urticaria within a year ( 69,6%).
The rate of patients who were ill over 5 years was 11,1%. The level of severity disease was 65,9%, moderate: 31,9% and lighter was 2.2%. There were 14 favorable fectors to occurrence of the disease.
The percentage of the climatic fector was the highest: 60.7%. There were 34.8% cases no find relevant factors.
Keywords: skin diseases. Chronic Urticaria.
SUMIVIARY
SOME C L I N I C A L A N D E P I D E M I O L O G I C A L CHARACTERISTICS W I T H C H R O N I C
U R T I C A R I A WERE TREATED I N 1 0 3 H O S P I T A L
Study of 135 patients with chronic urticaria who were examined and treated in 103 Hospital, from
* B$nh w$n Da lieu Thanh Hda
* * Hgc \^$n Quan y
Phan bi$n khoa hgc: PGS.TS Tr^n OSng Quyet
I. OAT V A N o l
May day (Urticaria) la mpt benh da thudng gap vdi ty le 15 - 2 0 % dan so da tCmg bj cac bl&
hien cua b4nh may day trong cuoc ddi [1]. C6 khoang 8 0 % tru'dng hdp la may day tu" p h ^ 10% cd nguyen nhan va 1 0 % tru'dng hdp 1^ cic dang dSc biet [ 4 ] . May day man tfnh ia si/ tii dien lien tuc hoac hau nhu" hang ngay cOa tk san phu tren da, keo dai t r ^ n 6 tu3n [7]. (J6 khoang 5 0 % tn/dng hdp co kem theo phii macti [ 3 ] . Dieu tri benh may day man tinh khd pliOt
Y HOC V I | T NAM THAHG S - S O 2^2014 tap ma ty le tai phat van cao [5]. Do do, chan
(Joan sdm b#nh va viec tim ra, loai b6 can nguyen gay t)6nh co y nghia rat quan trpng trong diiu t_rj cung nhu' phong tai phat benli [7]. Vi v?y de gop phan hieu ro hcJn dac diem lam sang, djch te hpc benh may day va lam giam ty le ciia binh, chung toi tien hanh nghien dtu Se tai nhSm muc tieu; /Chao sat dac diem lam sang vi djch te hgc cua benh may day man tinh t^l Bgnh vien 103.
II. COI TirpNG vA PHircmG PHAP NGHIEN CIHJ 2.1. Ooi t i r i n g nghign cdti: 135 benh nhan du'dc chan doan xac djnh la b^nh may day man tinh dieu trj tai Vien 103 tir thang 8/2012 den thang 7/2013.
III. K E T Q U A N G H I E N CO'U
flang i/Dl|njich san phu (n= 135) Solu'tfngsan
•slOsanbhianhd
10-50slnphCi nho hojc < 10san phu I5n
>56 sShphiTnho hoac l O j 56 sanjhiLJcin Hfu nhV toan bo ccAh?
Tieu chuan chan doan: Thudng co ngu^ 6 ndi sap sijra xuat hien ton thu'dng. Ton thu&ng od ban: san phu mau hong tu'di hay hong nhat, rai rac hoac tap trung thanh dam, San phij xuat hien nhanh, mat di nhanh va l<hdng de lai dau vet.
Thcfi gian mei san phu xuat hien chp den khi mat
<24h. Benh tien trien tutig ddt lioac lien tiep l<eo dai
>6 tlian den hang nam hoac tai pliat thep mCia [2].
2.2. Phi/cftig phap nghien cuTu: Nghien ciiu tien cijftj, mo ta cat ngang.
C3 mau: Thuan IPi. Tat ca cac faenh nhan Slide chan dpan xac djnh la benh may day m?n b'nh dieu tri tai Benh vien quan y 103 tu' thang 8/2012 den tiiang 7/2013.
2.3. Xijr IV s& lieu: Theo phu'dng ph^p theng ke y hoc phan mem EPI-INFO 6.04.
-&"^
Sd lu'dng 11 52
^ 69 _ 135
Ty m diJn'tKh san phil xuat hien hau nhd toan bp cdthe chiem: 51,1%.
: 8,1 ' 38,5
„_ 51A _
Bim2:Wic d j cua ngiJa (nf 135) MS'cdg ngu'a | So lu'dng
' Khang , 0 Nhe 17 ViiS 38 Nhilu 80 C6ng 135
T y l l V o 12,6 28(1 59,3 100,0
Benh nhan ngu^ mdc dd ning chiim iy le cao nhat la 59,3%.
Bieu dS 1. Mu'c dp benh (n= 135).
Nh5 2,2
./1^
N$ng
A •
6 5 , 9 %
Vtra k 3 1.9 %
1
Bing 3: t.'Trleu chijhg toan thaii(n= 1351
~ffi(|u ChSng to5n thSn 1
• " " Sot I Khpthd I Bau bung j J)au kh(Sp _ _ . _
Muc dp benh ning chiim 65,9%, viii 31,9% vi nhe ti 2,2% phu hdp vdi Hoang Hdu Hao (2007): 77% mdc dp benh nang, 23% dung binh [6].
15
i
11 5
0,7 11,1 8,1 3,7
Y HOC VIET NAM THANG 5 - SO 2/2014
Trieu chdng khd thd: 11,1%, dau bung: 8,1%), dau dau chich'iBn: 0,7%. Kit qua nay tWdng duvnj vdl nghien cdu cua Dang Trin Huyen ThdOng (2009) khd thd chiim 8,3%, dau bung chiem 8,3%, dau khdp 2,8%[S].
Bleu do 2. Ty le phan bp benh theo nhom tuoi va gidi tfnh (n= 135).
25.4%
23.6% 23.8%
9.7% I H 19,4% ^ J ^ " ' " *
T'y ie phan bo benh theo nhdm tudi khdng CO Sd chinh lech gida nam vi nff. Benh gap d nhdm tua 20- 49 chiem ty 1$ cao nhit. Sdkhac biet khdng cd y nghia thdng ke giOd cic nhdm tuoi.
Biiu do 3. Phan bo thdi gian mac benh theo gidi ti'nh (n= 135).
49.2%
<6th 47.2%
6-12th >,.,
19.0%! 9.4% • Nam 15.9%
6.9%
5n >5n
Da sd benh nhin mic benh trong vong 1 nam (chiim 69,6%), trong dd mdi mic benh < 6 thing chlim 48,1%, dac biit cd tdi 11,1% mac benh tren 5 nim.
Thdi gian mic lienh tudng dudng giOi nam va nff(p>0,05).
Biiu do 4. Phan bo theo miia mac benh trong nam (n= 135).
Ha: 38%
Y HOC VlgT NAM THANG 5 - SO 2/2014
Benh may day xuat hien tat ca cac mua trong nam theo ty le khac nhau. Benh xuat hien it nhat vio miia thu (10,4%). Benh xuat hien cao nhat la mua ha (37%) cao hOn mua thu (10,4%) vdip< 0,05.
Benh xuat hien vao mua xuin (30,4%) va miia dong chiim ty te (10,4%) Bieu do 5. Phan bo theo nghe ngh|ep (n= 135).
B a n g 3.5. P h a n bd b^nh theo n g h e n g h i e p
Binh phin bo theo nghe nghiep: Cdng nhan chiim ty ie cao nhat (48,1%). Cac nghe nghiip khac ty li benh: Hinh chinh, sinh vien (14%). Hull tn'(13%). Lam rupng (10%). Budn ban (8%) va Tddo, n$i'tra(7%).
Bing 4. Tien sCr dj u'ng ban than (n= 135).
Tieh SI} ban thin
Hen phe quan Viem ketjTiac d[ utig Vi|m mui dTu'ng^
Viem da Atopy DTii'na tiiuoc
r A .11 .V..,. Ch^i" dj ffng C6diu'ng Ling sue v f i _Thffc Sn: t6m,^ua... ^ Hoa chat: sdn,^my pham...
_Phan hoa Tli<let
long
KhSngJ
10 5 36 19 13 11 12 36 7 8 57
1278
"/o 7,4 3,7 26,7 14,1 9,6 8,1 8,9 26,7
5,2 5,9 42,2 94,1 5,9
82 24 40 19 12 13 10 36 45
Yiu to thdi iScliiim ()> te cao nhSt: 42,2%, viem mui di dng, Sn tom, cua: 26,7%
BingS. Yeu tp thuSn ldi xuat hien benh may day (ri= 135)
Cac y€u toTthuin Idi I Kh6ng i '"C6
Khi thay dei thdi tiet 1 Khi ap da lanh i An tpm cua . ;
_Khl b| nong _ . . __ ! _Ti|p xuc bui nha ______ _ ._ |
Uong bia ru'Ju \ dSn triing dot
Cac nguyen nhan khac I Khong CO nquyen nhan ' . . , _ Ttong sScd fiu token quan tht yiu to thay doi thdi hit cd tyle cao nhat (60,7%). khong thay yeu to /i&jquan chiem 38,4%.
%
38,4
61,6
60,7
17,8
29,6
14,1
8,9
9/6
'7,4
26,6
34,8
Y HOC VIET NAM THANG 5 • SO 2/2014
IV. KET LUAN
Qua ngliien cuU 135 lienli nhan may day man b'nh den kiiam va dieu tri tai Benii vien Quan y 103. Ciiung toi rut ra mpt so ket luan ve dac diem lam sang, y^u to lien quan benh may day man tinii nhu" sau:
- Benh hay gap nhat cf tuoi lao dpng, trong do tuoi tu" 20 - 49 chiem 66.6%. Ty le benh gap d ca hai gidi bang nhau. Tien sCr ban than co 9 4 , 1 % benh nhan mac cac benh dj LTng. Benh xuat hien quanh nam, tuy nhien mua xuan - ha co so benh nhan mac benh nhieu hdn ( 3 0 , 4 % va 3 7 % ) . Da so benh nhan co tuoi benh du'di 1 nam: 6 9 , 6 % , CO l i , l % benh nhan co tuoi benh tren 5 nam.
Mu'c d6 benh chu yeu d mCfc do nang chiem 65,9%, vira 31,9% va nhe 2,2%.
- Co 14 yeu to thuan ldi lam khdi phat benh may day man tfnh. Trong d o , thay doi thdi tiet chiem ty le cao nhat: 6 0 , 7 % va co tdi 34,8% khong tim ra yeu to liSn quan.
TAI UEU THAM KHAO
1 . Nguyen Nang An (2003), '^lay day va pFfi Quincke", Bach Wioa thu* vien hpc tap 3, Nha xua ban tiy dien bach, khoa Ha Ngi, trang 266-269.
£. Bp m o n da lieu Tru'dng dai hpc y Ha Noi (1994), "May day va phiu mach", Benh da lilii, Nha xuat ban y hoc, trang 81-85.
J . Bp m o n Da Lieu Hpc vien Quan y (2001), "(vlay day va phu mach", Giao trinh benh da va hoa lieu dao tao sau dai hoc, Nha xuat ban quan doi nhan dan, trang 225-229.
4 . Bo mon Di u'ng-Tru'dng dai lipc y Hit N^i (2008)," I^ay day va phu Quincke ", Bai giang di utig - mien djch iam sang ( Sach danh cho bac sj va hoc vien sau dai hoc), Nha xuat ban y hgc, trang: 55-70.
5. Dang Tran Huyen ThuVng. (2009), Nghien cuU tinh hinh, dac diem lam sang va anh Mdng aa benh may day man tinh den chat lu'dng cuSc song cda ngu'di benh, luan vBn thacsy yhgc, b-ang47 6. Hoang Huii Hao (2007)," Nghien cuXi tac duiKi cua que chi ttiang gia vj trong dieu trj mSy day di titig man tinh do bui nha', l-uan an tien si y hgc,' Dai hoc y Ha Noi.
7. Asero R..,Riboldi P,.et al (2007), "Chrdit urticaria" A diseasea at a reviews 7 ,pp 71-76. ' j f
NGHIEN Ciru CHAN DOAN KHOI U NAO HO SAU TAI KHOA NGOAI BENH VIEN BACH MAI
T6M TAT
M^c dich: Danh gia dSc diem lam sang va chain doan htnh anh u nao ho sau. Phu'dng phap: Nghiin diu mo ta d t ngang tien cCru 29 binh nhan u nao ho sau tCr 10/2013 den 4/2014 t?i khoa Ngoai Benh vien Bach Mai. Ket qua: Ti le nu'/nam:l,6/l. Tuoi tmng binh 41,5 tuoi. Tlidi gian trudc chan doan trung binh 7,6 thang. Trieu chutig khdi phat la dau d§u, chong m^t 100%. Hpi diutig tSng ap lu'c n6i sp va hpl chutig tieu nao 100%. Giam va mat thinh lu'c 20,6%, oa 17,2% ton thudng day V va 3 1 % ton thu'dng day IX,X,XI. 62,1% u d tieu nao, 17,2% u vung goc c§u, 17,2% u vCing thijy nhpng. Rpng lo tai tnjng d 17,2%.
72,4% giSn nao that tren ieu. 05 chinh xac khi chan doan ban chat khoi u 93,1%. Dp chinh xac cao khi Chan doSn u mang nao, u bao sdi than kinh, u te bao than kinh dem, u nguyen bao mach mau, u nang bieu
* Binh vien d^ch Mai
Phan bi$n khoa hgc: PGS.TS Tran Oinh Ha
Nguyin The H^o*, Dtromg Dii'c Hiing*
bi, va u nguyen bao tuy. Chan doan kho vdi nhiftig k h ^ u tot mang nSo that va u lympho. Ket lu$n: U ho sau chiem 21,8% khdi u nao du'dc phau thu§t t^i B^nli vien Bach l^ai, Bieu hien lam sang khi chin.doin thu'dng ro rang vdi hot chuhg tang ap li/c n$l sg, tigi chutig teu nao. Chan doan hinh anh co th^ chan do^
xac dmh du'dc khoi u, vj tri, kich thudc k h ^ u va co d$
chinh xac cao Wi 93,1% khi chan doan ban chSt khoi u.
S U M M A R Y
S T U D Y I N G D I A G N O S I S OF POSTERIOR FOSSA B R A I N T U M O R S I N SURGICAL DEARTEMENT AT BACH M A I HOSPHAL Objective: To assess the clinical features and imaging diagnosis of the posterior fossa brain tumors.
Method: This prospective study is performed on 29 patients admitted Bach Mai hospital between 10/2013 and 4/2014 for the posterior fossa tumors. Results:
Femaie/Male: 1.6/1. Mean age 41,5. Avarage time before diagnosis was estimated 7,6 months. Initial
