TAP CHi Y HOC VIET NAM TAP 465 - THANG 4 - SO 2 - 2018
DANH GIA KET QUA PHAU THUAT BIEU TRI THOAT VI BEN TRE EM TAI KHOA NHI BENH V I £ N VJET DU'C GIAI DOAN 2 0 1 5 - 2 0 1 7
Nguyen Viet Hoa', Vo Ta Chung'"^, VQ Hong Tuan''
TOIVI TATMuc tiiu: Danh gia ket qua phau thuat dteu trj thoat vj ben tre em tai khoa nhi benh vien Viet Dij'c nam 2015 - 2017, PhUdng phap: Nghien cu'u mo ta hoi cii'u 915 benh nhan dUcti 16 tuot du'dc chan doan thoat Vl benva du'dc dieu trj bang phUOng phap mo md hoae mo noi soi tai khoa Nhi benh vien Viet Du'c.
Th6i gian tCr thang 1/2015 den thang 12/2017. Ket qui:Ti le nam/nU la^5/l. Tuoi trung binh cf thcJi diem mo la 4,48 ± 3,52 tuSi (26 ngay-16 tuot). Chi dinh mo phien ehiem 95,74%, mo cap ciru chiem 4,26%.
PhUcJng phap mo md chtem 87,76%, mo not soi chiem 12,24%. Thdi gian trung binh mo md (28 ± 5,5phiit) ngin hdn mo not sol (40 ± 6,5phut). Khong ed tru'dng hdf) nao ghi nhan cac tai bien trong mo. Cd 21/112 tn/dng hdp mo noi soi phat hien dUdc thoat vj ben ben doi dien.Thdi^^ian nam vien trung binh ciia cae benh nhan sau mo phien thap hdn sau mo cap ciru, sau mo md thap hdn sau mo noi soi. /fe^/ua/r/Thoat Vl ben tre em la mot benh khong nang ne, chuan doan khong kho, dieu tfj phlu thuat cho ket qua tot, ti le bien chimg thap.jTuy nhten benh can dUdc hjyeii truyen rong dai de phat hien sdm, giam ti le mo cap cilli do thoat vj nghet va phau thuat can dUdc thi/c hien bdt bac sy chuyen khoa phau thuat nht.
Tiy khoa: Thoat vj ben tre em SUMIVIARY
THE RESULT OF TREATMENT OF INGUINAL HERNIA I N CHILDREN I N VIETDUC HOSPITAL I N THE PERIOD 2 0 1 5 - 2 0 1 7 Objecdves:To evaluate the result of treatment of inguinal hemia in children in VietDuc hospital from January 2015 to June 2017. Material and method:
Retrospective case series, 915 children with inguinal hemia treated at department pediatric in Viet Due hospital from 2015 to 2017. Results: The ratio of male/female is 5/1. The mean age at surgery was 4.48 ± 3.52 years (26 days - 16 years). Plan surgery 95.74%, emergency surgery 4.26%. Open surgery method 87.76%, laparoscopic 12.24%. Mean open incision bme (28 ± 5.5min) was shorter than lapanDSCOpy (40 ± 6.5min). No cases of complications during surgery. There were 21/112 eases of laparoscopic surgery to detect bilateral hernia.
Hospital stay durab'on after surgery was lower in open surgery.Conclusion: Pediatnc inguinal hernia is not a serious disease, diagnosis is not difficult, surgical
'l^oa phau thuit nhi - Benh vien Viet Ddc.
'Bgmdn ngoai - Tru'dng Dal hgc YHi Ngi Chju trach nhiem ehinh: VuHong Tuan Email: [email protected] Ngay nhan bai: 23.2.2018 Ngay phan bien khoa hpe: 3.4.2018 Ngay duyet bai: 12.4.2018
treatment for good results, low rate of complications.
However, the disease diould be widely propagated to detect early, reduce tine rate of emergency surgery and surgery should be done by speaalist paJiatrtc surgery.
Keyword: Pediatnc inguinal hernia.
I. OAT VAN OE
Thoat vt ben la tinh trang benh If do eac tang trong 6 btJng (rupt, mac noi Idn, buong trirng,...) chui qua dng ben hoac qua diem yeu cua thanh bung VLing ben xuong biu hoac moi Idn d nd.
Thoat vi ben co the gap d nhieu IuTa tuoi, nhuYig cd che benh sinh thoat vj ben d tre em va ngu'di Idn cd nhieu diem khac nhau nen each dieu tn cijng khac nhau.
Thoat vi ben tre em la mpt trong eac benh IE nhi khoa do con ton tai ong phiic tmh mac sau khi sinh ciia tre va la benh kha pho bien trong eac benh li ve ngoai nhi [1,2]. Thoat vj ben tre em CO the gay ra nhuhg bien chiTng nguy hiem nhu' tae rupt, hoai tir, viem phuc mac, de lai hau qua nang ne cho benh nhan neu khdng du'dc chan doan va dieu trj kjp thdi.
Ve dieu trj, cac tac gia deu thdng nhat thoat vi ben tre em khong the td khoi ma phai phau thuat. Tuy nhien con nhieu tranh eat trong thdi diem phau thuat, phu'dng phap phau thuat[l,2].
Tai khoa phau thuat nhi va tre sd stnh - benh vien Viet Du'c, chiing toi bat dau diing phu'dng phap mo npi soi thoat vi ben cho tre tii" nam 2015, ben eanh van dimg phu'dng phap mo md ktnh dien. Chfnh vi vay chiing toi tien hanh nghien ciru de tai vdi mue tieu tim hieu cac yeu to anh den ket qua phau thuat thoat vi ben vdi mong muon phau thuat dieu trj thoat vi ben tre em se du'dc thu'c hien tdt hdn nii'a.
IL £)6l TirpNG VA PHLTONG PHAP NGHIEN CUTJ 1. Doi tu'dng:
- Tieu chuan Ida chon: Cac benh nhi du'dc chan doan thoat vj ben du'dc dieu trj bang phu'dng phap mo md hoac mo npi soi va du'dc khang dinh co sii ton tai eiia dng phiic tinh mae trong qua trinh mo.
- Tieu chuan loai trit, Cae iDenh nhi du'dc chan doan thoat vj ben nhutig chu'a du'dc mo vi bat ki li do gi, hoac mo ra lai khong phai thoat vj ben. 915 benh nhan du'di 16 tuoi ddcic ehan doan va dteu trj thoat vj ben tai khoa Nhi benh vien Viet ^dc trong thdi gian td thang 1/2015 den thang 12/2017.
VIETNAM MEDICAL JOURNAL N°2 - APRIL - 2018 2. Phu'dng phap nghien cu'u: Phu'dng phap
mo ta hoi eiiu.
- Chung toi thu thap thong tin benh an du'a theo so ra vao vien eua khoa phau thuat nhi - Benh vien Viet Du'c.
- Chpn cac benh an theo tieu chuan lu^ chpn.
- Vao thong tin theo benh an mau.
- Cac benh an sau khi thu thap deu cd sir xac nhan ciia chii nhiem khoa va phong ke hoaeh tong hdp.
3. Cac chi tieu nghien cu'u:
- Tuoi, gidi, thdi gian mac benh
- Phu'dng phap mo: mo npi soi, mo md, mo phien, mo cap culj.
- Thdi gian cuoc mo, tai bten trong mo - Thdi gian nam vien sau mo - Ket qua dieu trj gan:
-^ Tot; vet mo khd, dau it khong phai diing
giam dau, biu su'ng nhe khong phai dung dioia viem, khong sot hoac sot nhe du'di 38 dp
+ Trung binh: dau nhieu phai dung giam dau sdng biu nhieu phai dung chong viem, sot treii 38 dp, tij mau vimg mo nhung chu'a phai mo lai + Kem: tu mau Idn^viing biu do chay m'au phai mo cam mau, nhiem trung vet mo, viem phuc mae sau mo phai mo lai
- Ket qua dieu trj xa: gpi dien mdi gia dinh du'a benh nhan den kham lai hoae de nghj bSme benh nhan tra ldi theo mau eau hoi. Plian loai ket qua dieu t n :
+ Tot: vet thu'dng lien dep, seo md mjn, khong rdi loan cam giae
+ Trung binh: nhiem triing vet mo keo dai, seo rum xau, co roi loan cam giac vung ben biu.' + Kem: tinh hoan khong xuong biu, teo tirli hoan, thoat vi ben tai phat.
III. KET QUA NGHIEN CLTU 1. Tuoi va gi6i
Bang 1: Gidi va tud'i benh nhin iai thdi diim mo
Tong Du'di 6 thang
6 - 1 2 thang
1 - 3
tud'i
3 - 6 t u o i6 - 1 6
tuoi Tong so
771
Trung binh 4,5 ± 3.6 4,5 ± 2,8 NhMnxet: Ti le nam/ nif lan lu'dt la 84,26% va 15,74%. Tuoi trung binh d thcJ .
± 3,52 tuoi. Tuoi nhd nhat la 26 ngay, tuoi Idn nhat la 16 tuo'i, hay gap nhat la 3 tuoi.
4,48 ± 3,52
2. Chi djnh va phu'dng phap mo
^^ang 2: Chi dinhva phUdng phap md Phu'dng Mo md
phap mo Md noi soi Mo phien
Mo cap euXi
So lu'dng
876
4,26 % Nhan xet: Chi djnh mo phien ehlem da so (95,74%), mo cap cifu it hdn chiem 4,26%.Phu'dng phap mo md chiem 87,76%, mo noi soi chiem 12,24%
3. Thdi gian cuoc mo
Nhin xet: ThiSs gian trung binh mo md{Z8
± 5,5 phut) ngan hdn mo npi soi (40 ± 6,5 phiit]
4. Dien bien cuoc mo
J Khong co tru'dng hdp nao ghi nhan cac tai bien trong mo nhu" rach vao ruot, baiig quang, chay mau, ton thu'dng than kinh,.'..
- Mo md mpt ben khong co kha nang phat hien t h ^ t vi ben ben doi dien. Co 21/112 tru'cfng hdp mo npi soi phat hien du'dc thoat vi ben ben ddi dien.
5. Thdi gian nam vi^n sau mo Bang 3: Thdi gian nam viin sau mo theo phUdng phip vi chi dinh mo
• thdi gian cuoc mo Thcri gian cuoc mS
0 10 20 30 40 Bii'u do 1: Thdi gian cugcmd
Nhan xit: Thdi gian nam vien trung binh ciia cac benh nhan sau mo phien (1,8 ± 1,1) thap hdn cac benh nhan mo cap cu'u (2,8 ± 1,2). Tlic^
gian nam vien trung binh ciia cac benh nhan say mo md (1,78 ± 1,3) thap hdn cac b§nh nhan mo npi soi (2,29 ± 1,5).
TAP CHi Y HOC VIET NAM TAP 465 • T H A N G 4 - SO 2 - 2018 6. Ket qua dieu trj gan
Bing 4: Ket qui dieu tri gan theo PhUi^g phip md
f^^g*^;;""! Mgma I ^ ^ I T6ng
Trung b
Tong
781 (97,3%)
22(2,7%)803
108 (96,4%) 4 (3,6%)
112
. xet! Ket qua mo kem d ca hai phuWng phap deu bang 0. Ket qua tot chiem da so d ca hai phu'Ong phap, va I<h6ng co su" l<hac biet ve ket qua mo giiJa hai phu'dng phap (p > 0,05)Bing 5; Ket qua dieu tn gan theo chi dinhm&
K i t qua liigu tri gan
Tdt Tmnq binh
Kem Tong
Mo phien 858(97,9%) 18(2,1%)
0 8 7 6
Mo cap cu'u 31(79,5%)
Tong 889 8(20,5%) 26
0 39
0 9 1 5 Nhan xet: Cac benh nhan mo phien va mo cap ciJlJ diu^ khong cd k i t qua mo kem. Nhom benh nhan mo phien co ti le tot cao hdnd nhdm mo cap ciJlJ, sd khae blet cd y nghTa thong ke (p <0,05)
7. ket qua dfeu trj xa
Bang 6: Kit qua diiu trfja t/wo dii djnh md Ket qua Mo Mo cap TA'na dieu trj xa phien cu'u ™
Tdt
Trung bmhKem Tong
566 (97,9%) 8(1,^
4(0,7%)
21 3(11,5%)
2 (7,7%)587 (97,2%) 11(1,8%) 6 (1%)
578 26 604 . (100%) I (100%) I (100%) Nh$nxet: . .-6 benh nhan cd ket qua mo kem gom 4 benh nhan c6 thoat vj ben tai phat va 2 b§nh nhan cd tinh hoan ben mo khong xudng biu. Ca 6 j)enh nhan nay deu nho hdn 1 tuoi d thdi diem mo.
-11 benh nhan cd ket qua trung binh la bj seo xau hoac dau te keo dat vdng vet mo
-Nhom benh nhan mo phien cd ti te tot cao hdn d nhdm mo cap cdu, sd khae biet co y nghTa thdng ke (p < 0,05)
IV. BAN L U A N
71 le nam/nO' tan lu'dt la 84,26% va 15,74%.
Benh tuy ft gap nhu'ng ed the xay ra d nii' gidi. Ti le nay tu'dng du'dng vdi t i le eua nhieu tac gia khac nhu* L l o y d D, Rintala (3/1) va Sean Collins (10/l)r3,4]. ^ ^
Tuoi trung binh thdi diem mo la 4,48 ± 3,52 tuSl. Tuoi trung binh thdi diem mo ciia nhdm benh nhan d nong thon cao hdn d thanh thj.
Tuoi trung binh ed chan doan dau tien la 2,9 ± 2,8 nam, va khdng cd SLT khac biet glu^ hai nhdm benh nhan d nong ttion va thanh thj. £)ieu nay chirng minh mot thi/e te la dii d dau thi khi phat hien thay nhu'ng dau hieu bat thu'dng viing ben biu hoac moi Idn, tre deu se du'dc di kham va chan doan ngay I l n dau bdi cae thay thuoc ehuyen khoa. Tuy nhien thdt gian ti!r lue du'dc ehan doan eho den luc quyet djnh di mo chju anh hu'dng bdt dja du" va nghe nghiep eiia bo me benh nhi.
Tat ca cac benh nhan da cd thoat vi ben deu CO chi djnh dieu trj phau thuat. Nhij'ng tru'dng hdp phai tri hoan do cd benh toan than chu'a on dinh bo me benh nhan da du'dc hen kham lai va chi dmh mo khi benh toan than da on dinh. Chi djnh dieu tri phau thuat cua chung toi hoan toan phu hdp vdi quan diem khong nen trong chd vao mpt sir td khdi cita thoat vj ben va khong co mpt lieu pliap npi khoa nao cd tae dung dieu t n thoat vj ben.
Chi dmh mo phien ehiem 95,74%, trong do cd 7 benh nhan den vien vi thoat vj ben nghet da dUdc day khoi thoat vj vao 6 bung an toan. Mo cap cu'u chiem 4,26%, day la cac benh nhan nhap vien trong tinh trang cd thoat vj ben nghet khong day du'dc khoi thoat vi vao 6 bijng hoac cd dau hieu tac ruot ro do thoat vj ben nghet.
Tuy nhien phai co kinh nghiem mdi lam du'iie thu thuat nay va ti le day thanti cong giam hdn neu bi thoat vj ben nghet lan thuf hai. Chinh vi vay ciiung toi hoan toan ung hp quan diem ciJa nhieu tac gia tren the gidi: "trong hoan eanh li tu'dng, tuoi mo chu'a thoat vj ben d tre em la tai thdi diem chan doan du'dc, nham ban ehe ti le
• thoat vj ben nghet"[ 1,2,5,6]
Tat ca cac benh nhan cd thoat vj ben 1 b§n trong nghien eiru deu khong mo tliam do ben dot dien. Chung tot co cd sd ti luan va thu'c tten de thiic hien quyet djnh nay do t i le cdn ton tai dng phuc tinti mac ben doi dien 46 - 63%, khong tu'dng xuhg vdt ti le xuat hien thoat vj ben sau dd d cac benh nhan nay (khoang 15%). Ntiu*
vay khong phai cif con ong phiic tinh mac la bj thoat vj ben. Cd mpt phu'dng phap tot de kiem tra SLT ton tai cua dng phuc tinh mac ben dot dien ia kiem tra bang not soi qua dau tren eua bao thoat vj ben mo. Ldi ich eua phu'dng phap nay da du'dc eac tac gia tdm tat bang mpt cau: "
Kiem tra npi soi qua ong ben da ket thuc sy"
tranh cat trong viec tham dd ben ddi dien trong phau thuat thoat vj ben tre em". Tuy nhien hien nay chung tot chu^ thu'c hien not soi kiem tra ben dot dien khi mo thoat v| ben tre em. Cd mot
VIETHAM MEDICAL JOURNAL N°2 • APRIL • 2D18 phu'dng phap co the giup kiem tra sd ton tai cua
ong phuc tinh mac ben doi dien ma chung toi ap dung do la mo npi soi. Phu'dng phap mo not sot ctiiem 12,24%, da va dang trien khai tai khoa Nhi benh vien Viet Du'c, du'dc ap dijng trong cac tru'dng hdp thoat vj ben tai phat, nghi ngd thoat vj ben 2 tien, hoae cd the la theo nguyen vpng ciia benh nhan va gla dinh.
Thdi gian trung binh mo md d benh nhan eo thoat vj ben mpt ben la 28 ± 5,5 phut. Thdi gian nay tu'dng du'dng vdi thdi gian 27,3 ± 3 phiit trong phau thuat mo that ong phuc tinh mac de diSu tn tran djch mang tinh hoan va nang thirtig tinh cua Nguyen Cong Binh [7]. Cd le vi benh thoat
\fl ben tre em va hai benh tren co ciing mot cd ehe benh sinh va each xd \i cd ban giong nhau.
Thdi gian trung binh mo not soi d benh nhan CO thoat vj ben la^40 ± 6,5 phut. Thdi gian mo npi soi dai hdn mo md do kT thuat can gay me not khi^quan, va thao tac npi soi s i can thdi gian hdn mo md.
Khong cd tru'dng hdp nao ghi nhan cac tai bien trong mo nhu' rach vao rupt, bang quang, chay mau, ton thu'dng than Idnh,... Dieu nay eo the giai thfch do phau thuat mo thoat vt ben tre em khong phai phau tfch nhteu va cung khong can phuc hoi thanh bung nhu" d ngu'di Idn. Dong thdi day la mot phau thuat cd quy tnnh kha ddn gian, du'dc thi/c hien tai ddn vj phau thuat nhi khoa hang dau Viet nam, bdi cac phau that vien CO chuyen mon, kinh nghiem tdt va thc^ gian thu'c hanh lau dai.
Cac benh nhan mo cap cdu bao thoat vj thuftng pliCi ne nen sau mo co su^g biu va phii ne vet mB hdn cac benh nhan mo phien. Dong thdi nhutig benh nhan nay thu'dng du'dc theo doi da| hdn sau mo de phat hi6n cac bieri chii'ng co tiie CO do tang bi nghet. Vi vay thdi gian nam vien trung binh cita eac benh nhan mo cap ciru (2,8 ± 1,2) dai hdn cac benh nhan mo phien (1,8 ± 1,1).
Thdi gian nam vien trung binh cua cae benh nhan sau mo md (1,78 ± 1,3) thap hdn cae b4nh nhan mo not soi (2,29 ± 1,5). Cac benh nhan "mo not soi phai gay me npi khf quan, bdm hdi o bung nen can thdi gian theo doi dai hdn, trong khi eac benh nhan mo md co the gay te ngpai mang aitig ket hdp vdi thudc me boc hdi qua difdng thd, nen cd the tinh tao va di lai ngay sau mo rat ngSn,
Cac benh nhan mo phien va mo cap ciru deu khong co ket qu^ mo kem, tii'e khong cd benh nhan nao^bi tu mau Idn vimg biu do chay mau phai mo cam mau, nhiem trung vet mo hay viem phuc mac sau mo phai mo lai
Nhdm benh^nhan mo phien cd ti' le tot cao hdn d nhdm mo cap cu'u, su" khac biet c6 yligtiia thong^ke (p < 0,05). Dieu nay cd the gti^thfdi do mo cap ciru la cac tru'dng lidp co ^ n # i i i i ^ tang do thoat v[ hoae thoat vj nghet kh6r^ M day ten o bung^vi vay nguy cd bj dau, suhg, phf ne, tu mau, nhiem trung... se cao hdn.
Theo doi benh nhan sau mo la van de nhieu tac gia thu'dng gap kho khan do cac nguyen nhan tir phja gia dinh va benh nhan. Dong thcli ket qua phau thuat tot cung co the la li do Idiien gia dinh ngai du'a benh nhan di kham lai. Chung toi da lien lac vdt gta dinh benh nhan qua dien thoat mdi dua benh nhan^den kham lai, hoac tia Idi qua dien thoai theo mau cau hdi dinh sin. Co 604/915 tru'dng hdp lien lac thanh cdng, eo tiie danh gia ket qua xa cita phau thuat.
97,2% benh nhan cd ket qua mo tdt tiTe vet ttiu'dng lien dep, seo md mm, khong roi loan earn giae. Nhom b§nh nhan mo phien eo ti ietSt cao hdn d nhom mo cap culi, su' khae blet co y nghTa thong ke (p < 0,05). Dieu nay cung'co the giai thich tu'dng tu" nhu" ket qua dieu ti-j gan.
_^ 11 benh nhan cd ket qua trung binh la bi seo xau hole dau te keo dai viing vet m d Dau te vung nay la do than kinh chau t>en, sinh due, eh$u ha vj bj thu'dng ton hay chen ep, Viling chi (Dhoi cam giac ciia 3 than kinh nay cd dan xen tan nhau nen khd nhan blet ton thuttng sau mo, cung chinh vi su' dan xen nay ma roi locin cam giae cd the dan mat di theo ttidi gian.
_Trc3ng nghien cu\i co 6 benh nhan cd kS qua mo kem gom 4 benh nhan cd tiioat vi ben tai phat va 2 benh nhan cd tinh hoan ben nio khSff xuong biu. Tinh hoan bSn mo khong xuong W CO nguyen nhan do sir co rut qua mu'c sau mo ma tac gia Lloyd D da de cap den. Chung A khong gap tru'dng hdp nao bi teo tinh hoan do ton thu'dng mach nuoi, sa tinh hoan hay tran djch mang tinh hoan. Ca 6 ti'u'dng hdp nay dSu gap d tre nho hdn 1 tuoi, dieu nay cho thay mo thoat vj ben d lu^ tuoi nho se kho hdn, de tai phat hdn, dieu nay gial thich do bao thoat vj cl nite tuoi nay d l rach hdn khi phau tich, dteu nay nhieu nghien ciru da chi ra nguy cd bten dn&ns xay ra d nhom tuoi nhd hdn 1 tuoi hdn la cac tre Idn [ 4 ] .
V. KET L U A N
Thoat vi ben tre em la mot benh khong nang ne, chuan doan khong khd, dieu tn phau thuat cho ket qua tdt, thdi gian nam vien ngan, ti I?
bien ctiuTig thap. Nhdm benh nhan mo phienico ket qua gan va xa tot hdn d nhdm mo cap aili,
TAP CHt Y HQC VIET NAM TAP 465 - THAHG 4 - SO 2 - 2018 do do benh can du'dc tuyen truyen rong dai de
phat hien^sdm, giam ti le mo cap CIJIJ do thoat vj nghet. Ho md va mo npi soi eho ket qua tu'dng du'dng tuy nhien mo not sot c6 kha nang phat hien thoat vi ben ben dot dien, vi vay phu'dng phap phau thuat can du'dc can nhac trong tirng tru'dng hdp cu the va du'dc thy'c hien bdi bae sy ehuyen khoa p h l u thuat nhi.
TAI UEU T H A M KHAO
1. Tran Npoc Bich (2002). "CSr di tit bam sinh cua dng phuc bnh mad', Dao tao narig cao ki nanp lam sang cho Bac sT tuyen huyen, BV Viet Dure, Ha Noi, trang 94 - 99
A. Nguyen Thanh Liem (2002). " C & benh do ton
tai dng phuc tmh mad', Phau thuat tiet nieu tre em, NXB Y hoc, Ha Noi, trang 124 - 137.
. Lloyd D. A, Rintala R. J (1998). '"Inguinal Hernia and Hydroceld', Pediatric Surgery, St. Lou*:
Mosby - Year Book, Ine, 5,1071 - 1086.
. Sean Collins (2002) '•^Hydrocele and hemia In Chlldreti' Medicine instant Access to the minds of Medicine.
, Grosfeld J, L (1989). "Current concepts In inguinal hemia in Infants and diildrerl', Vi/orld J Surg 13: 506.
. Grosfeld J. L (1991). '•^Inguinal hernia in children:
factors affecting recurrence In 62 casef, 1 Pediatr Surg 2^:283.
. Nguyen Cong Binh (1995). "Go/' phan nghiin cdu dieu tri trin dich mang tinh hoin vi nang nWdc tilling tinh d di enf, Luan an Thac sT khoa hpc y du'dc, HVQY, trang 7 - 14.
TAC DUNG DIEU TRI ROI LOAN NGON NGU' TREN BENH NHAN DOT Qliy NHOI M A U N A O S A U GIAI D O A N C A P C 6 A DIEN CHAM
Nguyen Dire Minh', Nguyen Vinh Quoc'
JE„2T6MTAT
Muc deu: Danh gia hteu qua dieu tn roi loan ngon ngi? cita dien cham tren benh nhan dot quy nhoi mau nao sau qiai doan can. Bdi tUdnti va nhudnq phip:
50 benh nhan tuoi X.ii 45 - 82 du'cfc chan doan dot quy nhoi mau nao lan dau sau giat doan cap, khong plian bijt gidl tfnh, t^'nh nquyen tham gia nghien ciiu. Nhom dm chutig dieu tri bang Nootropyl 0,8 x 04 vien/ngay ka hgig ngon ngiJ tn lieu co hu'dng dan. Nhom nqhien cuu dieu tri nhu" nhom doi ehuhQ ket hdo dten cham phae dB huyet tai eho va toan than. Phan do roi loan n^on ngu" kefc hdp lu'dng hoa di^m, danh gia mire dp cai thien n^^on ngif sau 30 ngay dieu trj. Theo doi bieii doi mot so ehi tieu huyet hoc va sinh hoa. Kei qui:
sau 30 ngay dieu tri, ty Ie roi loan ngon ngiJ" do IV va V i:^ tang tir 6% tn/dc dieu tT| iln 76,6% sau dieu trj.
Diem trung binh mii'c do roi loan ngon ngif tang tir 2,2
± 0,8 (dilm) tnj'dc dieu tii len 4,0 ± 0,9 (diem) sau dieu tri. 53,3% benh nhaii eo dp ehuyen djch ngon ngif danh gia loai tot sau dieu trj. Kei luan: Dien cham CO tae dung dieu trj phtjc hoi roi loan ngon ngLf sau dot quy nhoi mau nao giai doan cap.
Td khda: roi loan ngon ngi?, dot quy nao, di^n cham
SUMMARY
THE ELECTRIC ACUPUNCTURING EFFECT ON APHASIA TREATMENT APPLIED ON PAnENTS I N THE AFTER STAGE OF STROKE
Objective: To evaluate the achievement in
'Binh viin Chim cuU Trung u'dng
^Vlen Yhgc co truyen Quin dpi Qijii trach nhiem ehinh: Nguyen Du'c Mmh Email: [email protected] Ngay nhan bai: 25.2.2018 Ngay phan bien khoa hpe: 4.4.2018 Ng^y duyet b^i: 12.4.2018
treating aphasia of electric acupuncture on patients who was in the after stage of stroke. Subjects amt Methods: 60 volunteered patients, aging from 45 to 82, being diagnosed with stroke for the first time tn the after stage, regardless of gender. The contral group was treated with Nootropyl 0,8 x 04 tablet per day, combined with guided language therapy, the research group was treated the same but added electrocardiogram on spot and the whole body. Grade of language disorder combines quantitative scoring, evaluating the level of language improvement after 30 days of treatment. Monitor some changes In hematological and biochemical parameters. Results:
after 30 days of medical care, the ratio of language disorder at level IV and V has increased from 6% to 76,6%. Average scores of language disorders increased from 2.2 ± 0.8 (points) before treatment to 4.0 ± 0.9 (points) after treatment. 53.3% of patients had a good quality of post-translational evaluation.
COncluslom Electric acupuncture has achievement in treating aphasia pabents in the after stage of stroke.
Key words: aphasia, stmke, electric acupuncture
I.
OAT VAN BEDot quy nao (OQN) da va dang trd thanh van de dirdc y hpc quan tam doi vdi tat ca cac nu'dc tren ttie gidi trong do eo Viet Nam. OQN du'dc xem la mot trong ba nguyen nhan gay tCr vong hang dau cimg vdi benh ung thu' va tim mach va cung la nguyen nhan hang dau gay tan phe. Ty le de lai di chiltig mu'c dp vii'a va n§ng khoang 50% trong do ty le eo kem theo roi loan ve ngon ngu' ehiem ktioang 40% [1], [2]. Ttieo Le Thj Thanh Hu'dng (2005), trong rdi loan ngdn ngD' (RLNN) sau DQN thi RLNN Broca chiem ti le cao nhat vdi 37,50% [2]. RLNN tam han che kha nang giao tiep, anh hu'dng den tam ly va ddi
