T/\l BENH VIEN TAI MUI HONG TRUNG UONG

TCNCYH 68 (3) - 2010

Summary

INVESTIGATION ON ADVERSE DRUG REACTIONS OF ANTI - TUBERCULOSIS MEDICATIONS IN TWO TUBERCULOSIS HOSPITALS

Objectives: To determine the frequency and type adverse drug reactions (ADR) of anti - tuberculosis medications in the two tuberculosis hospitals. Methods: Retrospective method was used to collect information from 1060 medical charts of in - patient who was treated in the two tuberculosis hospitals during 2005 - 2006. The nature of ADR, symptoms and the timing of their onset, as well as subsequent modifications in the treatment regimen, were investigated. Results: The proportions of patients had side effects were 16.32%. The most common reactions were those involving the skin (58.96%), the gastrointestinal tract (24.85%). Adverse reaction was common in the first week of the treatments (56.07%). Modification regimen was neseessary in 41 cases (23.7%) and stop tuberculosis treatment was 1 8.5%. Conclusions: In 1060 tuberculosis patients, the frequency of adverse reaction related to medication treatment was 16.32%. However, 23.7% of the cases were neseessary to modify the treatment regimen due to side effects and 1 8.5% of the cases had to stop treatment by antituberculosis medications.

Keywords: tuberculosis, adverse drug reactions, anti - tuberculosis medications

CAC BIEU HIEN LAM SANG VA DANH GIA KET QUA

DIEU TRI CUA VIEM TAY VA AP - XE QUANH AMIDAN TRONG T/\l BENH VIEN TAI MUI HONG TRUNG UONG

* Pham Tran Anh, Pham Khanh Hoa Trddng Dai hoc Y Ha Ndi

Muc tieu: md ta ddc diem lam sdng cua viem tay vd dp - xe quanh amidan. Dd'i tugng va phuang phap nghien cdu: nghien cdu tien cdu theo phddng phdp phan tich thdng ke md ta 30 benh nhan VTQA vd AQA da duqc chan dodn lam sang vd dieu tri bdng thudc khdng sinh tai khoa cap cdu Benh vien Tai Mui Hong Trung dang td thdng 10/2006 den thdng 10/2007. Ke't qua: nhdm tudi td 15 - 30 tudi chiem 34,78%). Trieu chdng lam sang: bieu hien toan than nhiim triing todn than 66,67%. Trieu chdng ca nang: Trieu chdng dau cd 83,33%.Tneu chdng nudt dau va quay cd ban che 75,00%. Trieu chdng thdc the: Sdng tay vung cd gap 100% Trieu chdng can lam sang: X Quang cd nghieng: day phan mem CS cd 56,55% trddng hap. Bien chdng 69,56%; (2) Phau thudt chiem 95,65%. Ket qua dieu tri: khdi benh 86,95%. Ke't luan: (1) Viem tay mil ben co cd the gap d moi Ida tudi, tudi trung binh Id 34,57. Viem tay mu ben cd cd ty le bien chdng khd cao. Can thiep phau thuat Id chu ye'u. Dieu tri khdng sinh phdi hap gida mot Cephalosphorine the he 3 vdi Metronidazole cho ket qua tdt chie'm tl le cao. Ty le khoi cao, chiem 86,95%.

Tii khoa: viem tuy, ap xe quanh amidan, diing khang sinh

I. DAT

V A N D E

Hpng-amidan la vung ddc biet d l bj nhiem trung. Thdc an va khdng khi vao hpng mieng deu p h l i di ngang qua amidan. Nhiem vu chinh eua amidan la nhiem vu m i l n djeh vdi nhdng chdc nang sinh ly quan trpng bao ve hpng va toan ed the. Khi amidan bi n h i i m trung va qua phat gay n h i l u trieu chdng nhd viem amidan cap, viem amidan man va mdt sd bien chdng. Vi vay nhdng benh v l hpng - amidan ludn ddde coi la mot trong nhdng chdong muc quan trpng va cd b i n eua benh hpng ve Tai Mui Hpng. Ap - xe quanh amydan la giai doan mdng mu eua td chdc lien ket quanh amidan, nhdng neu mu lan rpng ra eac md long leo xung quanh theo Cae khoang giai p h l u tu nhien eua hpng se lan len mat hoac xud'ng ngdc gay nen benh e I n h nhiem trung n h i i m dpc rat nang ne. Viem tay va ap-xe quanh amidan la mdt benh ly khdng thddng gap, tuy nhien lai la mpt ca'p cdu Tai Mui Hpng. G i n day do tinh trang sd dung khang sinh bda bai, khong dung ehi djnh trong mpt bp phan dan sd eung lam tinh trang nay ngay eang tang [8]. Neu benh nay khdng ddde xd tri kip thdi, cd the gay nen nhdng bien chdng nguy hiem va gay nen hau qua toan than (tim, than, khdp) [2]. Ngdde lai neu phat hien benh sdm va xd tri kip thdi cd nghTa rat quan trpng rut n g l n thdi gian d i l u trj va trdnh nhdng bien chdng khdng ddng cd. Mat khde viee dung khang sinh ddng each, dung l i l u lUdng theo ehi dinh cua bde sy chuyen khoa cung gdp p h i n dang ke de benh nhan rdt n g l n ddde thdi gian d i l u tri va dUa lai ket q u i tdt hdn.Vdi nhdng ly do tren, chung tdi tien hdnh nghien cdu de tdi: "Cdc bieu hien Idm sang va ddnh gia k i t q u i dieu tri eua viem tay va ap-xe quanh amidan trong thdi dai dung khdng sinh tai benh vien Tai Mdi Hpng Trung Udng" vdi muc tieu:

/. Mo ta dae diem lam sang cua viem tay va ap-xe quanh amidan.

2. Danh gia ke't qua dieu tri vdi cac khang sinh phd rdng hien nay.

II. DOI TUONG vA PHUONG

PHAP

NGHIEN CUu

1 . odi tuong nghien ciifu

Dja diem nghien edu: khoa ca'p edu Benh vien Tai mui hpng Trung ddng

Ddi tddng nghien cdu: khoang 30 benh nhan VTQA va A Q A da ddde ehan doan lam sang va dieu trj b i n g thudc KS tai khoa cap edu Benh vien Tai Mui Hpng Trung Udng td thang 10/2006 den thang 10/2007.

Tieu chuan Ida chon:

- Nhdng benh nhan ddde ehan ddan xae djnh VTQA va AQA.

- Khong gidi han tudi, gidi, n g h i nghiep, noi sdng.

- Cd d l y du ho sd BA, eae xet nghiem ed ban, ed phim X Quang phdi t h i n g , X Quang co nghieng hoac CT.Seaner vung d

- Ddde chpc hut lay mu, nudi cay VK ddi vdi benh nhan AQA.

- Ddde dieu tri tai Benh vien Tai Mui Hpng Trung ddng.

Tieu chuan loai trd:

- Nhdng benh nhan ed kem thed benh npi khna khac.

Benh nhan khdng ddng y tham gia nghien edu.

2. PhUdng phap nghien cufu

Nghien edu tie'n edu thee phddng phap phan tich thdng ke md ta.

2.1. Quy trinh nghien cdu

- True tie'p tham kham benh nhan va thu thap sd lieu theo mau BA nghien cdu.

78

TCNCYH 68 (3) - 2010

- Tudi va Gidi- Nghe nghiep - Dja phUdng- Tinh cha't theo thdng trong nam- Nguyen nhdn- Thdi gian m i e benh va dung khang sinh trddc khi vdo vien - Giai doan eua benh khi de'n benh vien - Ben tdn thddng - Tien sd m i c benh

Nghien cdu trieu chdng lam sang chung ciia viem tay va ap xe quanh amidan: trieu chdng toan than - Trieu chdng cd nang - Trieu chdng thdc the - Trieu chdng can lam sang: (XQ ed nghieng, XQ tim phdi t h i n g , Cdng thdc bach eau ) bie'n chdng.

Nghien cdu ket qua dieu tri viem tay va ap xe quanh amidan: phddng thdc d i l u tri - Hinh thdc sd dung khdng sinh phd'i hdp - Ket q u i d i l u trj - Thdi gian dieu trj.

Thu thap ke't qua xet nghiem nuoi cay vi khuan

- Cde Icai vi khuan trong viem tay mu vung hpng mieng.

- Ten loai vi khuan va sd chung cua mdi loai phan lap ddde

2.2. Phuang tien nghien cdu

Vat lieu nghien cdu: bp dung eu khdm Tai 30.43

Mui Hpng :Den clar, Panh de lUdi, Bdm kim tiem nhUa 5inl, Lp dUng benh pham vd trung.

Thuoc khang sinh: KS tdc dung phd rpng- KS chdng ky khi.

2.3. Xd ly so lieu

Cdc sd lieu thu dUpe se xd ly b i n g phddng phap todn thdng ke vdi chddng trinh Epi Infd 6.0 theo thuat toan thdng ke thdng thddng.

III. KETQuA

1 . Dae diem lam sang va phan bd benh nhan 1.1. Tinh hinh chung

1.1.1. Tudi va gidi

- Tudi: Benh ed the gap d mpi nhdm tudi.

Chung tdi gap tudi thap nha't la 4 tudi, eao nha't la 71 tudi.Nhdm tudi td 15-30 tudi (ehiem 34,78%), nhdm td 3 1 - 5 0 tudi (ehiem 26,09%) va td 51 - 70 tudi (ehiem 26,09%) la hay gap nha't trong nghien edu eua chdng tdi.

- Gidi: trong nghien edu eua ehung tdi ed 18 nam, 05 nd .

• 1.1.2. Nguyen nhan gay benh Ket q u i ddde minh hpa:

35 n 30 - 25 - 20 - 15 - 10 - 5 - 0 -

30.43

•SSf

^4.35

04

^&J1

| | | | 4

Khong Sau ap Sau viem Sau Do di vat Vet xac dinh xe duo'ng t a y , a p nhi^m thuc thuong

ro ro xe quanh trung do quan viing cd amidan rang va

khu vuc quanh

rang

H Khong xac dinh ro

• Sau ap xe duong ro H Sau viem tay, ap xe quanh

amidan

D Sau nhi^m trung do rang va khu vuc quanh rang

Dl Do di vat thuc quan

• Vet thuong vung cd

Bieu dd 1. Hoan canh xua't hien benh

Nhan xet: benh xay ra sau cha'n thdang cua hong - thdc quan chiem ty le Idn (43,47%), trong dd nguyen nhan do di vat thdc quan Id da sd (chie'm 70,00% trong tdng sd cdc trddng hap chan thdang

TCNCYH 68 (3) - 2010

hong - thdc qudn). Hoan canh xua't hien benh do di vat thdc quan cd ty le cao han han cdc hoan canh xua't hien benh khac, sd khac biet nay cd y ngbla thdng ke vdi p < 0,05.

1.2. Cac ye'u to thuan lgi cd lien quan: trong 23 trddng hdp ddde nghien edu ed 86,95% khdng tha'y cd t i l n sd m i c benh ed lien quan.

1.3. Thdi gian mac benh va dung thud'e KS:

khdng ed BN nao vao vien ngay trong ngay dau tien. Thdi gian m i e benh td 2 - 7 ngay, ehiem 69,57%. sd BN den vien sau 07 ngay ehiem 30,43%. Ty le ddng KS trdde khi vao vien chiem 91,29% ehi cd 2 BN ehda dung KS trddc khi vao vien ehiem 8 , 7 1 % .

1.4. Trieu chdng

1.4.1. Trieu chdng lam sang

a. Bieu hien toan than eae the lam sang eua viem tdy mu ( VTM) ben ed:

- The VFM ben ed ddn t h u i n : bieu hien nhiem trdng toan than gap 8/1 2 trddng hdp chiem 66,67%.

- The VTM ben cc - ngdc: BN cd bieu hien sdt chiem 57,14%. Bieu hien nhiem triing toan than ehiem 85,71 %. Bieu hien nhiem doe ehiem 57,14%.

b. Trieu chdng ed ndng

- VTM ben cd ddn thuan: trieu chdng dau ed gdp 1 0/1 2 trddng hdp ehiem ty le 83,33%.

- VTM c d mat: trieu chdng nudt dau gap 4/4 trddng hop c h i i m ty le 100%.

- VTM ed ngdc: trieu chdng nudt dau va quay ed han ehe gap d 100% trddng hdp.Trieu chdng dau ed gap 6/7 trddng hdp ehiem f/ le 85,71 %.

c. Tneu chdng thdc the

Sdng tdy vung ed gap d 1 0 0 % trddng hdp.

1.4.2. Trieu chdng can lam sang a. Fiinh anh XQ cd nghieng

D l y trddc khi q u i n ehi gap d benh nhan VTM ben cd don t h u i n . D l y p h i n m i m CS ed va CS ed

mat c h i l u eong sinh ly gap 13/23 BN chiem 56,55% trddng hdp.

Hinh anh khi l l n md m i m g i p 23/23 BN chiem 100% trddng hdp.Hinh I n h dj vat e i n quang gap 7/23 BN chiem 30,43% trddng hdp.

b. Hinh anh X Quang phdi t h i n g : hinh I n h trung that tren gian rpng la bat thddng chu yeu tren hinh XQ phdi t h i n g gap 6/7 trddng hdp ehiem 8 5 , 7 1 % .

e. Cdng thdc bach c l u : tat ea eae benh nhan VTM ben ed deu tang ddng bach eau da nhan trung tinh tren edng thdc bach e l u .

3.1.5. Bie'n chdng: trong 23 trUdng hop ed 69,56% khong xay ra bien chdng, sd trddng hdp bi bie'n chCrng ehiem 30,44%. Trcng dd viem trung that ehiem ly le cac nha't (26,09% tdng sd BN).

7.6. Dieu trj

1.6.1. Phdang thdc dieu tri: eae trUdng hdp ddde dieu trj ed can thiep phau thuat ehiem 95,65%.

1.6.2. Sd dung KS: dieu trj phdi hdp gida mpt Cephalosphorine the he 3 vdi Metronidazole cho ket qua tdt trong dieu tri eung ldc c l VK ky khi va ai khi ddde ap dung trong 34,79% sd trddng hdp.

1.6.3. Ke't qua dieu tri: trdng nghien cdu cua ehung tdi ed 20/23 trddng hdp (ehiem 86,95%) khdi benh.

2. Ke't qua xet nghiem vi khuan:

2.1. Phan bd vi khuan trong viem tay mii vung CO

Bang 1. Phan bd vi khuan trong viem tay mu vung c6

Vi khuan VKAK VKKK VKAK va Khdng th.

Tong sd VKKK a'y vi khuan

So benh pham

9 2 10

2 23

%

39,12 8,70 43,48

8,70 100,00

80

TCNCYH 68 (3)-2010

2.2. Ten loai VK va sd chung cua mdi loai phan lap dUgc

Bang 2. Ten loai VK va sd chung cua mdi loai phan lap duac

Loai VK

Streptococcus spp TrUc khuan gram (-I-) E. coli

K. Pneumoniae E.Cloaceae

Streptococcus nhdm P. cepacia

P.pseudomallei 8 loai

V K a i

A

khi

30 N 14 5 3 3 2 1 1 1 chung

V K k y Loai VK

Prevotella spp

Peptostreptoeoeeus spp Porphyrouionas spp Baeteroides

Fusobaeterium Trdc khuan grain (-I-) khdng ed nha bao

6 loai

khi

22 N 6 5 5 3 2 1

ehung 2.3. So loai VK phan lap dugc d mdi benh

pham: ed 19/21 benh pha'm nghien edu dddng tinh cd td 2 loai VK trd len ehiem ly le 90,48%.

Dae biet d 1 benh pham ed de'n 6 loai VK cd mat:

gdm 1 VKAK va 5 VKKK , 1 benh pham khde cd 5 loai VK gdm 2 VKAK va 3 VKKK.

2.4. Do nhay cam khang sinh cua vi khuan va nhdm khang sinh thudng gap

2.4.1. Ket qua KSD vdi 30 chung VKAK Ampieilline/sulbaetam la KS nhay e l m nha't, chiem ty le 93,33%.

Cephotaxime va Chloramphenicol la KS nhay e l m , chiem ty le 86,67%.

Clandamyeine la KS ed ty le khang eao nha't gap 46,67%.

2.4.2. Ke't qua KSD vdi 22 chung VKKK Ampieilline/sulbaetam la KS nhay e l m nha't ehiem ty le 100%. Chloramphenicol la KS nhay e l m d 19/22 ehung chiem ly le 86,36%. Metroni- dazolela KS nhay e l m d 18/22 ehung ehiem ty le 81,82%. Cephotaxime va Clandamyeine la KS nhay e l m ehiem ty le 77,27%. Penicilline la KS ed t'y le khang eao nha't ehiem ty le 27,73%.

2.4.3. Ket qua KSD cua 52 chung VK phdn lap: ampieilline/sulbaetam la KS nhay cam nha't 6 50/52 chung (96,15%). Chloramphenicol la KS nhay cam d 45/52 ehung ehiem t'y" le 86,56%.

Cephotaxime la KS nhay e l m d 43/52 ehung ehiem t'y le 82,69%. Metronidazole la KS nhay e l m d 18/22 ehung VKKK ehiem ty le 81,82%.

Penicilline la KS ed ty le khang eao nha't gap d 1 8/52 chung ehiem ty le 34,62%.

3. Doi chieu bieu hi^n lam sang vdi ket qua xet nghiem VK .

Khi dd'i chieu eae trieu chdng ed nang , thdc the, XQ vdi eae loai VK gap trong VTM ben ed ehung tdi ehi tha'y mdi lien quan gida tinh chat mu vdi VK.

3.1. Dd'i chieu do dae cua md vdi nhdm VK:

mu loang ehi tha'y d nhdng trddng hdp ed VKAK.

Mu nhay ehi tha'y d nhdng trddng hdp ed VKAK.

Hai trddng hdp ed VKKK va eae trddng hdp hdn hdp VKKK va VKAK deu dae. Hai trUdng hdp khcng tim tha'y VK deu ed mu dae.

3.2. Dd'i chieu mau sac cua mu vdi nhdm vi khuan: mu tring, vang ehi tha'y d nhdng trUdng hep ed VKAK.Mu xanh gap 10/23 trddng hdp gdm nhdng

trddng hdp ed hdn hdp VKKK - VKAK va 2 trddng hdp khdng tim tha'y VK. Mu Choeola tha'y d nhdng trudng hdp ed VKKK va hdn hdp VKKK - VKAK.

3.3. Ddi chieu mui cua mu vdi nhdm vi khuan: khdng mui chi tha'y d nhdng trddng hdp cd VKAK.Mui hdi chi tha'y d 5 trddng hdp ed VKAK.

Hai trddng hdp cd VKKK va c l e trddng hdp hdn hdp VKKK va VKAK d i u ed mui thdi va rat thdi.

Hai trddng hdp khdng tim tha'y VK deu cd mui thdi.

3.4. Cdc tinh chat mu cua nhdm vi khuan ki khi: cdc trUdng hdp ed VKKK vd hdn hdp VKKK vdi VKAK d i u dae, mui thdi va rat thdi ehiem 100%. cd mdu xanh vd choeola 91,67%.

IV. B A N LUAN

1. Dae diem lam sang va phan bd benh nhan 1.1. Tinh hinh chung

- Tudi vd gidi: trong nghien cdu eua ehung tdi VTM ben cd cd the gap d moi nhdm tudi, song gap n h i l u nhd't Id nhdm tudi td 1 5 - 3 0 (34,78%), rdi d i n nhdm tudi 3 1 - 5 0 (26,09%) va 51 - 70 (26,09%). K i t q u i nghien edu cua ehung tdi cdng tddng td cua cdc tdc g i i khde. Bruce, Weber nhan xet rang VTM ben ed cd t h i gap d mpi Ida tudi [6]

- Nguyen nhdn gay benh: trong nghien edu cua chdng tdi VTM ben cd xud't hien sau mpt ehan thddng cua hdng - thdc q u i n Id hay gap nha't (43,47%), nhdng trddng hdp khdng xdc djnh ddde hoan canh xua't hien benh ehiem 30,43%.

TrUdng hdp khdng xde djnh ddde nguyen nhan gdy benh, Bruce vd cpng sd cdng gap ty le 2 0 %

16], theo Linh The Cddng la 28,6% [2]. Trong nghien cdu eua chdng tdi khdng xde djnh nguyen nhdn gay benh chie'm 30,43%.

- Cde yeu td thuan ldi lien quan: cd tdi 86,95% BN khdng ed i n l e benh lien quan.

1.2. Thdi gian mac benh va dung thud'e khang sinh: chiem ty le cao nha't la sd den trong vdng 2 - 7 ngdy 69,57%.

1.3. Trieu chdng

1.3.1. Trieu chdng lam sang

B i l u hien nhiem trung toan than ed d toan bo BN. Trirdng hdp sd't gap 1 3/23 BN chiem 56,52%.

D i l u nay dupc ly giai do ty le dung KS trdde khi vao vien ehiem tdi 91,29% sd BN.

- VTM ben ed don t h u i n : trieu chdng ed nang va tai chd la dau cd gap 10/12 trUdng hop ehiem ty le 83,33% k i t q u i nghien edu eua chung toi tddng td nhd k i t q u i cua Linh The Cddng (85,70%) sdng vdng cd gap 12/12 trUCng hop chiem ty le 100% .

- Viem tay mu ben ed mat VTM ben ed - mat ludn ed bieu hien nhiem trung. Bieu hien nhiem ddc toan than edng thddng gap. Bleu hien sdt va nhiem trung toan than gap d 100% trddng hdp.

- Viem tay inu ben cd ngUc: quay ed han ehe, nudt dau va sUng n l vung ed gap d ta't e l ede trddng hpp. Dau cd, lpc epe thanh q u i n - CS eung la trieu chCrng thddng gap ehiem 85,71%.. Thed Bruce 16]

vd Kevin 15] khd thd chu yeu do dddng thd bj chen ep lai hode khi benh da lan vdo trung that.

1.3.2. Trieu chtfng can lam sdng

- Hinh anh XQ ed nghieng: trong nghien eClLi cua ehung tdi, d l y trdde khi q u i n ehi gap d the VTM eanh ed ddn thudn. Mat chieu cong sinh ly CS ed vd day phan mem trddc CS ed gap d ta't ca cae the lam sang. Theo Greiwald |4], Mathieu [51 sd ed mat eua nhieu loai VK da khi va ki khi gay benh e I n h lam sang hoai td va sinh hdi, lam tdn thddng nhanh chdng lan rdng, de dda tdi nhieu bien chdng hiem ngheo.

- XQ phdi t h i n g : chung tdi gap chu yeu la hinh I n h trung tha't gian rpng.Theo Bruce, Corsten, va nhieu tdc gid khde: XQ phdi t h i n g ed gid trj ldn trong phdt hien bie'n chdng vdo trung tha't cua VTM ben ed.

1.4. Bien chdng: theo nghien cdu eua ehung tdi ty le khdng xdy ra bien chdng la 69,56%, ty le

82

TCNCYH 68 (3)-2010

ed bien chdng la 30,44%, thd'p hdn Linh The Cddng ty le bien chdng vao trung that la 31,4%

[2], theo Kantu va Har ty le bie'n chdng vao trung that ed the tdi 5 0 % [6j.

1.5. Dieu tri

- D i l u tri p h l u thuat: theo nghien edu cua ehung tdi 95,65% trddng hdp phai can thiep p h l u thuat. Thee Gillis [5] p h l u thuat edn tao dieu kien vet thddng chdng phue hdi, do vet thddng trong can thiep phau thuat nhd va gpn hdn vet thddng khi khdi dp xe vd td nhien (spontan abruption).

- Ket q u i d i l u trj: trong nghien cdu cua ehung tdi t'y- le khdi ehiem 86,95% ty le khdng khdi la 13,05%. Nhan xet nay edng gidng eua Chen vd cdng sd [4].

2. Vi khuan

Trong ket q u i nghien cdu eua chung tdi Streptococcus spp la nhdm VK thddng gap nhd't trong cde benh phd'm (14/23 = 60,87%) phdng xet nghiem ehung tdi ehda ed dieu kien de djnh danh nhdm nay nen trd Strepotocoecus nhdm A, cdc loai khac deu ddoc tinh vao nhdm nay.

3. Khang sinh dd

3.1. Khang sinh do vdi 30 chung vi khuan ai khi VKAK chju tae dung tdt vdi Ampicilline/

sulbactam, Cephotaxime va Chloramphenicol.

Peuieilline G vdn la KS bj eae VK dddng rupt de khang tU nhien ed ty le de khang eao.

Theo Brook, Chen eac ehung VK ed kha nang s i n xua't men (3 - laetamze lam tang ty le that bai eCia KS Penicilline [5].

3.2. Khang sinh do vdi 22 ehung vi khuan ki khi: VKKK cdn nhay e l m tUong ddi tdt vdi eae KS phan lap ddde trong cdng trinh.

3.3. Khang sinh do vdi 52 chung vi khuan:

Ampieilline/sulbaetam la KS tae dung tdt nha't.

Chloramphenicol la KS thdng dpng re t i l n nhdng

edn tae dung tdt. Ddi vdi VKKK nen d i l u trj b i n g Metronidazole.Theo ke't q u i nghien edu cua ehung tdi viee phdi hdp gida ede nhdm KS gdm Cephaldsphorine the he 111 vdi Metronidazole ddde sd dung n h i l u nha't ehiem 56,67% BN vd chd ket q u i dieu tri tdt. Thed Helmy, Mailsel viee phd'i hdp gida mdt Cephalosphorine the he HI vdi Metronidazole eho ket qua tdt trong d i l u trj eung lue ea VKKK va VKAK [5],[4]. Cdn viec phd'i hdp Metronidazdie vdi cae KS khde ehiem 43,33%

trddng hdp.

4. Mdi lien quan giCra tinh chat mii vdi vi khuan Tuy sd Iddng benh pha'm khdng n h i l u nhdng ehung tdi edng manh dan dda ra nhdng nhan xet eua ehung tdi. Trong 2 benh pha'm ed VKKK va 10 benh pham ed VKKK va VKAK mu d i u dae, mui thdi va rd't thdi cd mau xanh va choeola .

V. KET LUAN

Qua nghien edu 23 trddng hdp viem ta'y mu ben cd tai Benh Vien T M H T W , chdng toi rut ra ddde mdt sd nhan djnh nhd sau:

Ve dae diem lam sang va can lam sang cua viem tay mij ben cd:

Dae diem ehung: viem ta'y mu ben ed ed the gap d moi Ida tudi, tudi trung binh la 34,57. Mac dd ddde dieu tri tich cde, benh v i n cd ty le that bai cao chiem 13,05%.

Dae diem lam sang: viem ta'y mu ben ed ed the bieu hien ddde n h i l u the lam sang:

- Viem ta'y mu ddn t h u i n ehiem 52,17%

trddng hdp.

- Viem ta'y mu ed mat ehiem 1 7,39% trddng hdp.

- Viem ta'y mu cd ngdc chiem 30,44% tardng hop.

Viem ta'y mu ben ed ed ty le bie'n chdng khd eao, ehiem 30,43% trddng hdp trong dd bie'n ehi'rng vao trung that la thddng gap nha't ehiem 8 5 , 7 1 % cac trddng hdp bie'n chdng.

Dae diem XQ:

- Co nghieng: hinh anh day phan m i m cpt sdng cd va cpt sdng ed mat chieu eong sinh ly e h i l m 56,52% trddng hdp. Hinh anh khi l l n td ehdc m i m vung ed ehiem 1 0 0 % trddng hdp.

- Phdi t h i n g : bieu hien bat thudng ehu yeu la hinh I n h trung that gian rdng ehiem 8 5 , 7 1 % trddng hdp. Ket qua phim XQ phdi t h i n g rat ed gid tri trong phat hien bien chdng vao trung that.

Vi khuan va van de khang KS trong nghien ciifu - Vi khuan: trong cae viem ta'y mu ben ed thddng la cdc n h i l i n trung hdn hdp VKAK - VKKK, cd n h i l u loai vi khuan phdi hdp. Ty le vi khuan phan lap dUde chiem 9 1 , 3 0 % trong dd:

- T y le VKKK chiem 52,17%;

- Ty le VKAK ehiem 90,48%;

- Hdn hdp VKKK - VKAK ehiem 47,62%;

Dd phan lap ddde 14 loai vi khuan gdm 52 ehung. Vi khuan trong viem tdy mu ben eo ed the la cdc nhiem khuan ndi sinh hoac ngoai sinh tuy theo ngd ednh gdy benh. Nhin ehung eae vi khuan cd ngudn gde npi sinh nhieu hdn. Trdc khuan Gram (-I-) cd vai trd gdy benh trong viem tdy mu ben ed.

- Khang sinh dd

Trong nghien edu toan bd ehung vi khuan ddde lam khdng sinh dd chdng tdi thu ddde ket qua sau:Ampieilline/sulbaetain ed tde dung tdt nhay e l m nha't ehiem ty le 96,1 5%; khdng 3,85%.

Chloramphenicol la khdng sinh thdng dung re t i l n nhdng tde dung tUOng ddi tdt nhay e l m 86,56% khdng 13,46%. Cephotaxime la khang sinh nhay cam 82,69%; khang 17,31%.

Metronidazole la khdng sinh nhay e l m d 18/22 ehung VKKK ehiem ty le 8 1 , 8 2 % , dae biet la VKKK Gram (-).

T A I LIEU THAM KHAO

1 . Luong Sy Can, Pham Khanh Hoa, Le Van Ldi (2001), Cap edu T M H , Nxb Y hoe. - ,

2. Linh The CUdng (2001), Nghien edu dae diem lam sang va dieu tri viem ta'y lan tda vung ed gap tai Benh vien Tai Mui Hpng, Luan van thac sy Y khoa.

3. Le Thj Thieu Hoa (1996), "Ke't q u i nudi eay va phan lap 632 benh pham tim vi khuan ky khi tai khoa vi sinh benh vien Viet Ddc td 30/12/1992 de'n 05/10/1995", tap chi Y hoe thdc hanh, tr. 1 7 - 1 9 .

4. Bartllet J.G, Gorbach SL (1976) Anaerobic infections of the head and neck, Otolaryngol, Clin north Amygdale. pp 703.

5. Bruce Ascott and Charles M, Stienberg (1993) "Deep Neck Space - infection" Head and Neck Surgery - Otolaryngology Vol 1, Philadelphia, pp 735 - 53.

6. Corsten M.J Chamjj F.M, Odell P.F, and al (1997) "Optimal treatment of descending necrotizing mediastinitis" Thorax, pp 702 - 70

Summary '

CLINICAL PARAMETER AND RESULTS OF THE TREATMENT OF PARATONSILLAR ABSCESS IN THE NATIONAL ENT - HOSPITAL HANOI

Objective: Peritonsillar abscess is the most common deep neck infection and still provides a challenge to care givers in terms of diagnosis and treatment in Vietnam. This study has 2 objectives : (1) clinical parameter of peritonsillar abscess and (2) Assesment of treatments by patients with peritonsillar abscess.

Methods: We performed a prospective study of 23 patients diagnosed and proved to have a peritonsillar

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TCNCYH 68 (3) - 2010

abscess. Data regarding: age, sex, ethnicity, number of patients per year, seasonality, prior history of tonsillar infection, prior antibiotic treatment, length of hospitalization, surgical treatment, bacterial results and in hospital antibiotic treatment was collected the patients. Results: 34.78% of the patients were from 1 5 - 3 0 years of age. 66.67 % have a general infection. 69.56 % of the patients have complication.

95.65% have surgerieal treatments. The bacterial culture was negative in 2 (8.7%) patients. In 23 patients we have 14 typs of bacterias, 6 typs were positive for anaerobes. 96.1 5% of the patients were treated with Ampeillin/ Sulbactam. Conclusion: Peritonsillar abscess, a potentially life threatening infection, is in every ages, has many complications and need to do surgery. Based on our review we conclude that peritonsillar abscess in can be effectively treated byAmpeillin/Sulbactam.

Keywords: paratonsillar abscess, high dose antibiotics

DANH GIA MAT DO XUONG, T I N H TRANG LOANG X U O N G

VA M O T SO Y E U TO ANH H U 6 N G 6 BENH NHAN SUY THAN M/\N TL/ 50 TUOI T R 6 LEN

N g u y i n M i n h T h u y \ D6 Thj Khanh H y ^ Pham Thang' 'Benh vien E Trung dang, '^Trddng dai hoe Y Ha Noi; ^Benh vien Lao khoa Trung dang

Ciing vdi sd tien tnen cua suy than man, nhdng rdi loan ve chuyen hda chat khodng cung se xay ra ddn den cdc rdi loan vd chu chuyen xddng, lam giam mat do xddng. Muc tieu: (1) Md ta ty le giam mat do xdang va loang xddng d benh nhan suy than man giai doan 4 vd 5 td 50 tudi trd len. (2) Xdc dinh mdt sd yeu to anh hddng de'n mat do xdang d nhdm benh nhan nay. Ddi tUgng va phuang phap nghien cdu: 66 benh nhdn suy than man td 50 tudi trd len ddac do mat do xddng theo phdang phdp hap thu tia X nang Idang kep d hai vi td cd xdang dui va cot sd'ng thdt Idng. Ke't qud: ty le gidm mat do xdang, lodng xdang theo vi tn:

45,5%; 28,8% tai cd xdang dui; 34,8%; 36,4% tai cot sdng that Idng. Ndng do PTH huyet thanh cd mdi lien quan nghich vdi mat do xdang tai ca hai vi tn. Ndng do calci ion hda cd mdi lien quan thuan vdi MDX tai cd xddng dui. Benh nhan nd cd ty le lodng xddng cao han so vdi benh nhdn nam. Cd mdi tdang quan thudn gida mdc loc cau than vdi mat do xdang d ca hai vi td. Ke't luan: giam mdt do xddng thddng gap d benh nhan suy than man. Nhdng benh nhdn cd mdc loc cau than cdng giam, ndng do PTH > 20U/L vd ndng do calci ion hda tha'p cd mat do xdang thap han so vdi benh nhdn cd ndng do PTH < 19,9 U/L, nong do calci ion hda binh thddng.

Tii khoa: suy than man, mat dp xUdng, loang xUdng

I. D A T V A N D E ra cddng can giap thd phdt va eae benh ly v l Khi than bj suy man tinh, td ehdc nhu md than xddng. Ta't ea nhdng rdi loan nay ed the dan den bj xd hda d i n , mde lpc e l u than giam sdt, than tde dp huy xUOng manh hdn tao xddng va k i t qua khdng edn du k h i nang duy tri can b i n g chuyen la gay nen tinh trang thda xUdng, loang xddng va hda calci va phospho trong huye't thanh d i n den tang nguy cd gay xUdng d nhdng benh nhan STM hang loat cde bien logn x l y ra ma hau q u i la gay [9]. Nghien edu eua Rix M va cpng sd eho tha'y