Y HQC VI6T NAM THANG 6 - S6 OAC BllTttd 2
KHAO SAT DAC mim CUA PHAN UMG STRESS CI BENH NHAN LOXini CAP
TAI VliN HUYlT HQC - TRUYIN MAU TW NAM 2012
Tri^u Th| Blln", Bfch Qu6c Khdnh", Nguyin Hi Thanh*, Ng6 M?nh Qufin*, NguySn Anh Trf*, Nguyin Sinh Ph4c**
T6MT&T
Muc tKu: Khiio s^t c^c d^c dlSm ciia phin ihig stress d b^nh nhSn LXMC. Phutmg phip:
nghiSn ciiti m6 ta cSt ngang i<St help nghiSn ciJu ajnh tinh va djnh luljng, sir dung thang do DASS 21 it 72 b?nh nhan. Ket qui: 41,7% b^nh nhan LXMC CO stress 4 cac mijc dp i<h4c nhau (nh?, vCiS, n3ng va rat nSng); phan uhg stress 6 b?nh nhan rSt phiit tap, thuttng « kkn vcli cac bleu hi$n dia lo l u (73,3%) va film cim (65,7%), 66,7% o6 ca sbess, lo au va tram cam; dSc biet, mot so benh nhan CO y dinh hf hj'de tu giai thoat.
ABSTRACT
CHARACTERISTICS OF THE STRESS RESPONSE IN PATIENTS WITH ACUTE LEUKEUMIA IN NATIONAL INSTITUTE OF HEMATOLOGY AND BILOOD TRANSFUSION
2012
Objective: To investigate the characteristics of the stress response in patients with Acute leui<emia. Methods: cross-sectional descriptive study combined qualitative research and quantitaHve, using DASS21 scale among 72 patients. Results: 41.7% of patients with stress in different degrees (mild, moderate, severe and very severe); stress response In patients is very complex, along with other manifestations of anxiety (73, 3%) and depression (66.7%).
66.7% of pafents includes stress, anxiety and depression; in particular, some patients have attempted suicide to free himself.
I. DifiT V £ N o f
Stress li h ^ g thii cSng thing tim \f xuit hi^n nhu li svr dip iing v6i cic kich thich qui miic; d-ong di^u kijn b§nh \f, sttess giy n6n r6i lofui tim thin vi cic r6i lo?n ca thi [3]. C6 nhieu nguySn nhin din ikt sfress ttong d6 vi?c biet minh bj benh, nhit li b?nh ung thu c6 thi li mgt tic nhin dan din sttess a ngu6d b?nh. M5i nim ttSn thi gicri c6 220,000 ngu6i chet vi ung thu miu, ty 1? mic benh LXMC 14 4 truong hop/100.000 nguoi [2], Trong khi do, ITnh vyc chim soc tim \f ciia benh nhin chua dugfc quan tim mpt cich phu hpp. Chiing toi thuc hifn nghiSn cilu niy vol muc tieu: khao sit cdc ddc diim cua phan img stress a bfnh nhdn LXMC, tir do dira ra met sl kiln nghi nham trien khai, ip dyng cic phuong phip ho ttg tim ly cho benh nhan trong qui hinh diiu tri benh.
n. OdI TUPNG VA PHlKING PHAP NGHIEN CClU 2.1. Boi tirgug va ph^m v i nghien cthi:
• Ddi tuong: benh nhan LXMC dang diiu tri noi tri tai Vien Huyit hgc - Truyin miu TW, dugc chin doin LXMC, dang diiu tri npi tni, di diiu hi hoa chit (DTHC) it nhit 1 dgt, giao tiip tit, sin sing tham gia nghien ciiu.
• CS miu: Trong nghien cvra, chiing toi uac tinh ty 1$ co stress la 0,7. (NghiSn ciiu cua Nguyen Thj Mai a benh nhan ung thu liia tuii vi thanh nito la 0,79)[ 4],
* Vifn Huyet hoc - Truyen mau TW; • * Hgc vien Quan y 103 Phan bifn khoa hoc: Ths. Bach Qu6c Khinh
131
CHUYEN Bg: HQI NOHI KHOA HQC HUYgf HQC • TRUYJN MAU TOAN QU6C 2012
Sir dvng cflng thiic tinh cO miu nglu nhiin dom vdi cic tham sl gli djnh:
n: CO miu;
p: Tin suit b^nh nhin c6 stress (gii
thilt nghien Cliu li 0,7). n-z=i-„/j:
Z^.on - h$ s6 tin c(ly, vdi a = 0,05, Z - 1,96;
E: Sai sl tucmg dii (e = 0,15).
Udc tinh ti-1? hfl cuflc hoic khflng hoin thinh nghiSn cuu li 10%.
Vdi cic tham sl neu ttSn, cd miu cin cho nghien ciiu li: n = 80
P ( i - p
• Thdi gian nghien cuu: TCr thing 2/2012 din thing 5/2012.
2.2. Phinmg phip nghien cihi:
•:• mil ki nghien cuu: nghiin ciiu mfl ti cit ngang cd so sinh, kit hgp nghiin ciiu dinh tinh vi djnh lugng.
• Phuang phip thu thfp dCt llfu:
- Thu thip thdng tin djnh lugng: Sir dyng thang do Trim cim - Lo iu - Stress (DASS 21) dugc su dyng rpng rii tien the gidi vi tgi Viet Nam [8]. Thang do gim 21 ciu hdi, dinh gii vl 3 npi dung: trim cim, lo au vi stress, moi npi dung cd 7 ciu hdi. Moi ciu hdi cd 4 phuong in
d:i Idi Wong iing vdi sl diim:
0: Khdng dung vdi tdi
I: Diing v&t tdi phin nio, hofc thinli thoing mdi dung
2: Dung vdi tdi phin nhiiu, hofc phin Idn thdi gian li dung
3: Hoin toan dung vdi tdi, hofc hiu hit thai gian la dung
Benh nhin dugc yiu ciu dpc ciu hii vS khoanh trdn vio cic ciu tii Idi tuong iing vdi tinh tr?ng mi hg cim thiy trong suit 1 tuan qua. Cich tinh diem: Cdng ting diim ciia 21 cau rii nhin hi s6 2.
Bing 1: Cich tinh diem Thang do DASS 21 [10]
Mij'c dd Binh thudnq Nhe Viia NSnq Rat ninq
TrSm cim 0 - 9 10-13 14-20 21-27
>2S
Loiu 0 - 7 8 - 9 10-14 15-19
>20
Stress 0 - 1 4 15-18 19-25 26-33
>34 Thu thap thong tin djnh tinh: Phong van sdu 10 b?nh nhan.
• Xu ly so li^u: bSng phan mem SPSS 18.0 vai lest thong ke thong dyng
Ml. KET QUA NGHIEN CCTU
Trong so 80 phieu co 72 phieu h^p 1$, dira v^o nghien curu.
3.1.D9C diem nhan khau h9c cua doi tvQUg nghien cihi Bang 2: B&c diem nhan khau hpc cua d6i tucmg nghien cuu
„
Tuoi <35
>35
Nam (n=34) n 14 20
%
41,2 58,8
NB(n=38) n 18 20
»/o 47,4 52,7
Tong(n=72L n 32 48
%
_44,4_
ssi.
Y HQC VigT NAM THANG 8 • S6 BAC BlgT/2012 Trinh dp
Thdi gian dieu tri SodgtOTHC
DUdi THIT TNTHPT
< 1 nim
> 1 nim
< i d o t i l d O t
10 24 22 12 14 20
29,4 70,6 64,7 35,3 41,2 58,8
18 20 23 15 10 28
47,4 52,6 60,6 39,5 26,3 73,7
28 44 45 27 24 48
38,9 61,1 62,5 37,5 33,3 66,7 Phin Idn benh nhin > 35 tuii (55,6%), 61,1% da tit nghiip THPT. Da sl binh nhin di diiu tii dudi 1 nim (62,5%) vi dugc DTHC ti^n 1 dgt (63,9%).
3.2. T h ^ trang phan ihig stress Bang 3: B i i u hien ciia phin img stress
Ciu hdi T6I thay Kho ma thoai mai dul?c
Toi cd xu hudnq phin linq thai qua vdi moi tinh hudnq T6i thay minh danq suy nqhT qui nhieu
Toi thay bin than de bi kich donq T6i thay khd thu gian duWc
Toi khong chap nhan dUdc viec cd cai gi dd xen vao cin trd viic toi dang iam
Toi thay minh khi d l phat y, tU ai
T r i Idl (c6) n 72 39 48 42 45 50 45
%
100 54,2 66,7 58,3 62,5 69,4 62,5 Tin xuit xuit hien cic biiu hien ciia phin ung stress rit cao, 100% benh nhan thay khd mi thoii mii dugc, cic biiu hiin khic diu xuit hien d benh nhan vdi ty li trin 50%.
Qua cich cho diim (md ti d phin 2.3) cho thiy 41,7% binh nhan cd biiu hiin cua sttess.
Trong dd, phin Idn benh nhin cd sttess d miic dp vira (46,7%):
Bieu do 1: Miic dp stress ciia binh nhan 3.3. S^c diim ciia phan limg stress
Bang 4: Phin Stress Loau
Co Khonq
dng stress di kim vdi lo au Co (n=30)
n 22 8
°/o 73,3 26,7
Khonq (n=42) n 26 16
%
61,9 38,1
Tonq ( n = 7 2 ) n 48 24
»/o 66,7 33,3
P
>0,05
CHUYgN Bi: HOI NOHI KHOA HQC HUYgT HQC - TRUYJN MAU TOAN QU6C 2012
73,3% binh nhin stress cd kim biiu hiin lo iu (d nhiiu miic dfl khic nhau); ty li trong nhdm khdng Stress li 66,7%, sg khic biit khflng cd y nghTa thing ke.
Stress TrBni cim C6 Khdnq
C6(n=30) n 20 10
"/o 66,7 33,3
Kh6ng n 19 23
( n - 4 2 ) o/o 45,2 54,8
Ttfna (n=72) n 39 33
"/o 54,2 45,8
P
>0,05
54,2% binh nhin LXMC cd biiu hiin trim cim. Trong dd, cd tdi 66,7% binh nhin bi sti^ss cd kim theo phin ling trim cim, ly li niy trong nhdm khdng stress li 45,2%. Trim eta d binh nhin dugc the hiin qua tim trjng bi quan, cam xiic tiiu eye. Thim chi cd binh nhin cdn cd y dinh ty tCi. Benh nhin Ph?m Quang N (32 tuii). di 4 lin DTHC, cho biit: "Did luc tdi muin kit thuc cufc sing vi cim thiy minh li'i ginh nfng cho nhiing ngudi mug quanh ".
Bing 6: Phin ling stress di kim vdi lo au - trim cim D^c dl£m
Stress di kem lo au Stress di kem tram cam Ca stress, lo au va tram cam
Tdng n 22 20 20
»/o 73,3 66,7 66,7 Phin img stress cua binh nhin khi phiic tjp, cd tdi 66,7% binh nhan cd dan xen ca stress, lo iu vi trim cim, 66,7% benh nhin stress vi ttim cim, 73,3% binh nhin cd stress vii loiu.
Bang 7: Mpt sd yeu to lien quan den
"^ Stress YSi tS liin quan ^ - ~ _ _
Gidi tfnh Tudi Trinh do Thdi gian dieu tri
Nam
m
<35
>35 DUdiTHPT Tot nqhiep THPT
< 1 nim
> 1 nim
shan ling stiess d hpnh nhin LXMC Cd
36,7 63,3 6,7 93,3 43,3 56,7 43,3 56,7
Khdng
54,8 45,2 11,9 88,1 35,7 64,3 42,9 57,1
0R(9S<yi>CI)
2,091 (0,801 - 5,458)
1,892 (0,24-10,478)
0,726 (0,278-1,896)
0,981 (0,381-2,526)
P 0,101 0,376 0,341 0,579 Ty Ii CO stress d nhung benh nhin nO, tren 35 tuoi, da tit nghiip THPT va da diiu tii tren 1 nim cao hon so vdi nhdm nhOmg dii tugng cdn lai nhung sy khac biet niy khdng cd y nghii thdng ke vdi p>0,05.
Y HQC VigT NAM T H A N G 8 - S6 B A C Br$T/2012
IV. BAN LUAN
4.1. T h i ^ tr^ng stress & b^nh nhan LXMC
Kit qua nghien cuu cho thdy, 41,7% b^nh nhan LXMC c6 stress. Ty If n^y th^p hem so voi gia thuyet ban dau (70%) [4]. Ket qud niy CO thi dupe ly giai nhu sau: Nghien ciru dugrc tien hanh tai th6i diem hau het b?nh nhSn da tr^i qua it nhit mpt d(?t DTHC (66,7%); Theo bdc sT Kubler - Ross - chuyen gia nghien cuu tam ly b§nh nhan mdc b?nh nan y, ngucri b?nh thu6ng tiii qua 5 giai dogn tam ly ph6 bien; Phu nhan (Denial), gj§n dii (Anger), m3c ci (Bargaining), tram cam (Depression) va chap nhein (Acceptance). Chung t6i nhgn thdy phan 16n b?nh nhan d3 trai qua giai doan co nhOng cu soc v6 tam ly (thcri diem mcd phat hi?n b?nh) va dang d giai doan chap nhan. ^'Li'ic mai vao vien toi cam thay rdt cdng thdng nhung qua nhiing dot DTHC toi thdy rdng benh tat Id mot thu thdch cdn phai vugt qua nen toi cam thdy tinh thdn rdt thodi mdr - benh nhan Hoang Thi H (30 tu6i) cho hik. Ben canh do, theo Tri?u Thi Biin va cs nghien cuu nSm 2010 [1] cho thdy 78% benh nhan LXNC co thai dp lac quan trong qua trinh diiu tri. "Rieng vai benh ung thu mdu thi giii duac tdm ly 6n dinh, tinh thdn lac quan la da chiin thdng duac 50% benh tdt rdi" - b?nh nhan Phan Van M. (58 tu6i) cho biit. Chit lupng diiu tri va cham soc cung la yeu to giiip giam nhe ganh nang tam ly cho b?nh nhan;
Benh nhan Lucmg Van X. (22 tudi) cho biet:
"Khi biit minh bi ung thu mdu toi suy sup va dd muSn chit. Nhung gia thi tdm trang toi da on hem. Duac diiu trj tgi b^nh vien hien dai, nhdn vien y ti thdn thien, toi rdt yen tdm vd tin tuong".
Ty le benh nhan co tress khong cao co thi do chung toi chua du diiu kien tiin hanh
nghien curu tren dja bdn rpng vk c& mau Idn, ket qud thu dupe chua th^rc sy phong phii.
Chiing t6i cho rSng vi?c tiin hdnh cdc nghien cuu trong ITnh v\rc ndy trfin phgm vi rpng Idn hom la rat c4n thiit, c ^ c6 s\r d^u tu ciia cdc b?nh vi?n tuyen Trung uomg nhu Vi^n Huyit hpc - Truyen mdu Trung ucmg d i ddn tiin t6i hodn thi^n djch v\i cham s6c sue kh6e mpt cdch bdi bdn, chuyen nghi$p. Mpt s6 b?nh nhdn de xuat: ''Cdn cd cdn bg lam cong tdc tu tuong, tro chuyen vai b^nh nhdn trong qud trinh diiu tri". D6 thyc sy Id viec lam rat cdn thiet.
Tuy nhien, ty 1? b?nh nhdn co stress trong nghien cim nay cung cao hem so voi nghien cuu cua Nguyen Thi Doan Trang (11%) [6].
Diiu ndy c6 thi ly giai boi doi tuong nghien Cliu a de tai U-en la benh nhan ung thu tre em, CO nhiing ddc diem tam ly, nhan thuc khac vcri benh nhan LXMC. Hem nua, tac nhan gay ra stress a b?nh nhan LXMC ciing mang dac trung rieng, khong chi gay ra nhfing cang thdng v i mat tam ly md con true tiep de dpa din tinh mang nguoi b?nh. Benh nhan Trdn Thi Thanh T. (45 tu6i) cho biit: "^/ biit minh CO benh cung dd cdng thdng lam roi hudng chi Id biet minh bi benh ung thu!".
4.2. D^c diem cua phan ung stress Phan ung stress a b?nh nhan LXMC dien ra tuong doi phiic tap. Ty le cao co stress di kem voi lo au (73,3%), stress di kem voi trdm cam (66,7%) vd co din 66,7% benh nhan co cd trdm cdm, lo au vd stress. Theo Nguyen Sinh Phuc [5] lo au vd trdm cam la phan ling thuong hay gap nhat o benh nhan diiu tri npi tru do vipc cdch xa voi cupc song binh thudng, phai doi mat vol van de ve tdi chinh, cdc phdn iing phu khong mong muon xay ra ... Dac biet, benh nhan LXMC phdi
CHUYfeN B^: H^l NOHI KHOA HOC HUYgl HQC • TRUYJN M A U T O A N QUgC 2012
tuin thi m^t phic dl diiu trj nghiim ngit cimg vdi vi|c n5 lyc diu tranh dl glinh sy sing timg ngiy. M«t sl b|nh nhin cd j djnh ty Ut do cim thiy cu^c sing ciia minh khdng ci lii thoit. B|nh nhin Trin Thanh D. (24 hiii) chia si; "fld cd lie tdi khdng muiij sing naa. Nhiiu nguM nhin tdi vdi inh mil Unh ngpc vl trin diu khdng mft spi tdc".
Trong sl 10 b|nh nhin dugc phdng vin siu cd 2 b^nh nhin cd ^ djnh ty til. Diy li con si ding bio d^ng dl cic bic s^ diiu trj cihi xem xit cd nhttng bi|n phip hi tig tim 1^ kip thdi cho b|nh nhin. Dii mit vdi mgi khd khin dl glinh 1^ sy sing, nhiiu b|nh nhin di tim din cic ho«t d|ng tim linh dl dugc giii thoit. 7/10 b?nh nhin dugc hdi di timg xem bdi. Cling bii, giii h^, th$m chi cdn dii hudng bin thd dl ciu mong kio dii sy sing.
B|nh nhin PhCmg Vin T. (60 tuii) cho biit:
"Trudc mdi lin vio vifn DTHC gia dinh tdi diu lim li cing Id tiln, ciu xin lin niy vio vifn si khde han. Cd nhitng hdm dau nhiiu qui va con tdi d nhi lam le giii hgrT. Nhflng flidng tm niy cho thiy ting vi$c xem xit thinh l$p bd phin hi tig tim 1;^ cho benh nhin li nhu cau biic thilt vi cin dugc d^ ling.
Ty le lo iu, trim cim d nhdm b^nh nhin cd stress cao hon so vdi nhdm khdng cd stress, tuy nhien sy khic biet niy khdng cd i nghia thing ke. Mit khic, khdng tim thiy moi lien h$ nio gitta cic yiu tl gidi tinh, dd tuii, trlnh dg hgc vin... vdi phin ling stress d b|nh nhin. Cd thi li do nghiin ciiu dugc tiln hinh trong m$t thdi gian ngin, cd mau chua dii Idn nen chua tim ra dugc sy tuong quan gitta phin dng stress, lo iu vi trim cim d benh nhan. Ciing cd thi do cic b|nh nhan deu nh?n dugc sy hi ttg nhu nhau ttt ngudi nhi, y bic sj; die biet, tat ci cic benh nhan dugc nghien ciiu deu chira nhin dugc bit ky
sy tic d$ng nio tii cic bi^n phip tim|i Chiing tdi mong muin si cd nhttng nghih Cliu ling dyng vl Hnh vyc niy dugc triln khai siu hon, ring hon ti£n nhiiu nhdm b ^ nhin khic nhau vdi cd miu Idn hon.
V. K^T L U A N
Qua nghiin cdu d 72 b|nh nhin LXMC, kit qui cho thiy:
- 41,7% b|nh nhin LXMC cd phin ing stress d cic mdc d$ khic nhau tii nb« din li ning, chd yiu li d mCtc dd vita (46,7%).
- Phin dng stress d b^nh nhin LXMC khi phdc Hip, 73,3% cd stress di kim lo in, 66,7% cd stress di ktai tilm cim, 66,7% ci ci stress, lo iu vi trim cim; ding luu j , m$t si benh nhin cd y djnh ty tii dl ty giii thoit.
VI. KI^N NOHI
Bic s^ diiu tri quan tam vi dinh them thdi gian cho vi?c tim hiiu tam ly benh nhiii, chia s4 khd khin tam ly ben c?iiih viec thim khim lim sing vi chim sdc y tl. Xem x6l thinh lip bd phin nghiin cdu vi ho tig Hm
\i cho b$nh nhin ung thu miu tiong qui trlnh diiu tri.
TAI U|U THAM KHAO
1. Trifu Thi Biin vi cs (2010), Thtc tm thil df ipc quan vi cic yiu tiinh huing da thil dp Ipc quan cua b4nh nhdn ung thu mit nim 2009, Tjp chi Y hoc Viet Nam tl sl 2/2010, NXB Y hgc, 31 - 36.
2. Nguyin Thj Lan Hinnig (2010), Dihi tn Laxemicap ddng tuy a ngudi lin turn Ai^
nay vi triin vpng, K^ yiu cic cdng trinh nghiin cdu khoa hgc chuyin nganh Huyet hpc - Truyin miu Tip 373 Thing 9 - Si 2, NXB Y hgc.
3. Ding Phuvng Kift (2004), Stress va 0
Y HQC Vl|T NAM THANG 8 • Stf BJiC 8161/21112 song, NXB Khoa hgc X ! hgi vi Nhan vSn.
Nguyin Th| Mai (2011), Luin in Tiln st Y hgc, Nghiin dot rii lopn trim .cam to dud tre em bf ung thu vi ing phd cua cha me. Dji hgc Y Hi Ndi.
Nguyin Sinh Phic (2007), Tim thin hpc vi (am 1^ Apc^ AtK, NXB Quin dOi nhin din.
Nguyin Thj Doan Tnmg (2008), Khda lu|n tit nghiep, Bute diu nghiin ciu rii nhiiu dm xic
(loiu- trim cam) a tre em bi bfnh ung thu tpl khoa Ung budu -BVNhi Trung uang, Tnidng DH Khoa hpc Xi hdi vi Nhin vSn.
A.VXavaxeilc6, Iu.G.Dubarep, (I991X Tim ly hpc binh nhdn,YiXBYi«>c.
Lovibond, S. H., & Lovibond, P. F, (199S), Manual for the Depression Anxiety Swess Scales, Psychology Foundation of Australia.
IJMG DUNG Kf THUAT FISH KHAO SAT CHUYEN DOAN T(1;19) TRONG BfNH BACH cAu cAP BONG LYMPHO
TOM TAT
Chuyen doan t(l;19)(q23;pl3) l i y£u td hin ludng xau, gap trong 3 - 5 % benh b^ch c3u cip ddng lympho B. Cd 2 kleu chuyen doan t(l;19) gom chuyen doan can bing va chuyen doan khdng can bang, trong dd nhdm chuyen doan khdng cin bing chl€m ti le d€n 75% v i dugc cho li cd den lUdng tot hdn. Tir thing 1/2011 den thing 4/2012, chung toi sif dung ky thuat RSH de khio sit kigu chuyen do?n t(l;19) frSn 9 binh nhin cd bleu hien E2A/PBX1 bing ky thuat PCR tai Benh vien TruySn miu Huyet hgc.
Ket qua ciia nghien cdu cho thay 44,4% benh nhin cd chuyen doan t(l;19) cin liSng v i 55,6%
benh nhan cd chuyen do?n t(l;19) khdng cin bang, trong do 1 benh nhan cd chuyin doan t(l;19) cin bing nhuhg cd them 1 tin hieu NST 1. Ky thuat FISH la ky thuat ddn giin, cho ket
Le Nguyen Kim Dung*, Pban Th) Xinh*
qui nhanh v i vdi doan dd die hieu gliip xic djnh chinh xic cic kilu bat thudng cila t(l;19).
SUMMARY
DETECTION OF t(l;19) TRANSLOCATION IN ACUTE LYMPHOBLASnC LEUKEMIA USING FISH
TECHNIQUE
The translocation of t(l;19)(q23;pl3) Is a poor prognostic factor, occurs in 3 - 5% of patients with B-cell acute lymphoblastic leukemia.
There are two fomis of t(l;19) translocation Including balanced t(l;19) and unbalanced der(19)t(l;19), in there the unbalanced rates up to 75% and expected to be a better prognostic.
From January 2011 to April 2012, fluorescent in situ hybridization (FISH) technique was used to detect t(l;19) b-anslocatlon of 9 patients with
• Khoa Dl truyen hgc Phan Tu; Binh vien TruySn mau-Huy&hpc TP.HCM.
Phan Ufn khoa hpc: TS. Phan Thj Xinh
