TAP CHf Y DirqfC HOC CAN T H a - so 13-14/2018
K E T QUA BU^OC DAU CAN THIEP NOI M A C H DIEU T R I PHINH M ^ C H N A O VOf TAI BENH VIEN TRlTCfiVG DAI H Q C Y DlXQC CAN T H O
Nguyen Liru Giang , Nguyen Vd Bang, Nguyen Duy Linh, Trfnh Dinh Thdo Trudng Dgi hoc Y Dugc Cdn Tha
* Email:[email protected] T O M T A T
Bgt van de: xudt huyet dudi nhen Id mgt cdp ciru ngi vd ngogi khoa, cd ty le tdn phi vd tur vong cao neu khdng duge diiu tri kip thdi. Nguyen nhdn gdy xudt huyit nhen phdn ldn la do vd phinh ddng mgch ndo Viic diiu tri va phinh ddng mgch ndo gdm vi phdu kep tui phinh vd can thiep ngi mgch gdy tac bdng coil. Ndm 1991, phdu thugt vien thdn kinh ngudi Y Guido Guglielmi dd cdng bd nhung kinh nghiim ban ddu trong viec sir dgng coil platinum cdt bdng ddng dien. tii do md ra mdt ky nguyen mdi trong dieu trf phinh dgng mgch ndo. Ky thugt dgt coil dugc xem nhu tieu chudn vdng trong can thiep ngi mgch dieu tri phinh dgng mgch ndo, ky thugt ngy dugc dp dgng cho han 800.000 ngirdi tren the gidi Mgc tiiu nghiin euu: ddnh gid kit qud bu&e ddu can thiip "P' mgch dieu tri phinh mgch ndo vd lgi Benh Vien Dgi Hgc Y Dugc Cdn Tha. Boi tugng vd phuang phdp nghiin cd-u: tir thdng 2 nam 2016. chung toi cd 20 BN vd phinh dgng mgch ndo duac dieu trf cdp cuu bdng ky thudt can thiip ndi mgch, chiing tdi tien hdnh ldy sd liiu hdi ciru vd tien cuu Ket qua: tdt cd BN (nam/nir = 9/11; tudi trung binh Id 58,4) deu cd bieu hien trieu chung eua xudt huyit duai nh^n thi nh^ - ndng (Hunt and Hess dg I - do V), trong do cd 1 BN cd hgi chung Terson - .xudt huyit trong d mat lien quan den xudt huyet dudi nhen. Tren hinh dnh chgp mgch mdu ndo cho thdy phdn ldn BNdeu mang tui phinh a tudn hodn trudc - 95% (3 a DM ndo giua. 6 d DM thdng sau. 3 a DM ndo tntde vd 5 a DM thdng tnrac, 2 a DM cdnh trong); 1 BNcd tiii phinh d dgng mgch ndo sau, 35% BN mang tdi phinh cd kich thudc rdt nhd (< 4 mm), 25% BN CO nhiiu tiii phinh (trong do 80% cd 2 tiii phinh). Tat ed BN diu duge tiin hdnh can thiip edp eiru ngay trong ngdy ddu tien khi BN nhdp vien. 90% BN dugc can thiip dgt coil vd 10% BN dugc can thiip dgt stent + coil vdi gdy me ngi khi qudn, thdi gian thu thudt trung binh Id 2,5 gia vd khdng cd tai biin vd biin ehung do thu thugt do thu thudt Kit qud diiu tri sau 3 thdng, ty le tdn phi vd tir vong (mRS > 3 diem) Id 15%: 80% BNphgc hdi hodn todn va 5% cdn de lgi di chung yeu nhe nita ngudi. 1 BN tdi thdng tiii phinh khi chgp lgi kiim tia sau 3 thdng. thdi gian ndm viin trung binh Id 10.85 ngiry. Kit lugn: can thiep ngi mgch dgt coil trong dieu tri phinh dgng mgch ndo da va la mdt phuang phdp it xdm ldn vd eho kit qud khd tdt
Tir khda: phinh mgch, xudt huyet dudi nhin, can thiip ngi mgch, dgt coil ABSTRACT
E N D O V A S C U L A R COILING FOR RUPTURED BRAIN A N E U R Y S M A T C A N T H O UNIVERSITY H O S P I T A L : PRELIMINARY RESULTS
Nguyen Luu Giang, Nguyen Vu Dang, Nguyen Buy Linh, Trinh Dinh Thao Can Tho University of Medicine and Phamarcy Background: subarachnoid hemorrhage is a medical and surgical emergency with high morbidity and mortality rates if not treated promptly. A ruptured intracranial aneurysm is the most common cause of subarachnoid hemorrhage. The primary therapeutic options include microsia-gieal clipping and endovascular coiling. In 1991, the Italian neurosurgeon Guido Guglielmi published his preliminary experience with electrolytically detachable platinum coils (Guglielmi Detachable Coils, GDC), opening a new era in aneurysm treatment. The "coiling"
technique represents the current "gold standard" in endovascular aneurysm therapy with more than 80,000 patients having been tieated worldwide to date. Objectives: evaluate preliminary results of endovascular coiling for ruptured brain aneurysm at Cantho university hospital
TAP CHI Y D U p t HQC C X N THO - SO 13-14/2018
Materials and methods: prospective and retiospeetive clinical data were collected for twenty patients evaluated with a diagnosis of ruptured and tieated with emergency endovascular
intervention from february 2016. Results: all patients (male/female ratio 9/11, mean age 58,4) presented with from mild to severe subarachnoid hemorrhage (Hunt and Hess grade 1-V), one of them had Terson syndrome - intraocular hemorrhage associated with SAH. Angiop-aphy revealed that major of them had aneurysms on anterior circulation - 95% (3 on MCA, 6 on Peom, 3 on ACA, 5 on Acom. 2 on other segments ofICA); 1 on PCA, small aneurysms (size < 7 mm), multiple aneurysms are see in 5 patients (4 patients had 2 aneurysms and 1 patient had 3 aneurysms). All patients underwent emergency endovascular intervention within the first 24 hours when they admitted to the hospital. They were treated with endovascular coiling in 90% and stent assisted coil in 10%, all procedures were performed under general anesthesia; mean time 2.5 hours and no procedure - related complication recorded. 3 months £0er endovascular treatment, morbidity and mortality in 15%, completely recovery in 80%. 1 patient has hemiparesis, recanalization on angio^am after endovascular embolization in 5%, the mean posproeedural length of stay was 10,85 days. Conclusion: it was reported that endovascular coiling for ruptured aneurysm is a minimally invasive treatment and gives exeelent result
Key word; aneurysm, subarachnoid hemorrhage, endovascular, coiling.
I. D ^ T VAN DE
Thu$t ngii phinh ddng mgch "aneurysm" bdt ngudn tu Hy Lap chi s\r dan khu trii dgng tlii hoac dang hinh thoi cua ddng mgch [1],[7]. Phinh mach nao rat thudng gap, trong giai phau tu thi ngudi ta nhgn thdy phinh mach r^o trong ddn sd khodng 0,4 - 10%, nghien ciiu gan day khoar^ 5%. Tan sudt phinh mach nao tang len sau 30 tudinhieu nhat la 60 - 79 vd chi 2% xuat hi?n d tre em, nii/nam = 1,6/1 [1],[9]. Bien chung dang sg nhat cua phinh ddng mgch nao la vd phinh gay xuat huyet dudi nhen, xudt huySt nao, nang ne ban ca la BN cd the ttr vong do tang dp luc noi so [1],[7]. Tdn suat xuat huyet dudi nhen hang ndm Id khodng 6 - 8/100.000 dan, d My khoang 25.000-27.000 tardng hgp/nam.[4],[6]
Viec dieu tri phinh dpng mgch nao da va cd the bang phau thuat clip tui phinh hoac can thiep ndi mgch dgt coil. Da cd cdc nghien cuu ldn nhu ISAT va BRAT ve so sdnh giGa hai phuong nay trong dieu tri cdc phinh ddng mgch nao da vo. Cac nghien curu nay ket luan rdng ddi vdi nhung tui phinh phu hgp cho ca hai phuong phdp 6xhx tri thi can thiep ndi mach ddt coil cd ty le tan phe vd tii vong thdp ban so vdi phau thuat clip tui phuih. Trong khi dd, dat coil lai cd ty le tdi thdng cao ban so voi phdu thudt. Nam 1991, phau thuat vien thdn kinh ngudi Y Guido Guglielmi dd cdng bd nhung kinh nghiem ban ddu trong viec su dung coil platmum diSu chinh dugc cdt bdng ddng dien, tir dd md ra mdt ky nguyen mdi trong di6u tri phinh ddng mach ndo [3], [8], [11]
II. D 6 I Tir(?NG VA PHU'ONG PHAP NGHIEN CtTU
Chung tdi tien hanh hdi cuu va tien cuu 20 trudng hgp cd trieu chiing lam sdng va hinh dnh hoc chan doan xuat huyet dudi nhen ty phdt do vd plunh ddng mach ndo dugc dieu tri bdng can thiep ndi mgch tii thdng 2/2016.
TAP CHi Y Dirgrc HQC CAN THO - s613-14/2018
BN CO bieu hienCT scan co XHDN
CT mach mau nao
Tui phinh can thiep dugc
Tui phinh khong can thiSp dugc
So dd 1 .Quy trinh chpn benh
Phuang phdp can thiep: nhirng BN xudt huydt dudi nhen d giai doan cap, chiing tdi thyc hien can thiep ndi mach dudi gay mS ndi khi quan de tranh cir ddng cua BN vd dam bdo thao tdc chinh xac trong qud trinh can thiep. Sau dd se tien hdnh ddt mot sheath 6F hoac 8F d ddng mach dui phai hoac diii trai, su dung mdt catheter chan doan de chup 4 true mach mau nao, ddi vdi ddng mach mang tiii phinh (da xdc dinh tren CT mach mau) thi chung tdi chup xoay 3D va dyng hinh mach mdu. Tren hmh chup, chiing tdi xdc dinh b'ch cd, cd va chidu thi cua tlii phinh [2], [10], [12].
- Ddi voi tlii phinh cd hep hoac co rdng ma cd the dgt coil dugc thi dua mot guider catheter 6F ddn ddu gdn ciia ddng mgch mang tiii phinh. Mdt microcatheter ddng true dugc dua vdo mach mdu nao vd ludt tren mdt microwire mem cd the dan Idi den Idng cua tui phinh. Sau dd nhe nhdng lui microwire va bdt dau tha coil qua microcatheter vao tiii phinh. Thd coil dugc thyc hi$n lien tuc cho ddn khi khong the dat vao tiii phmh dugc niia thi tiSn hanh cdt coil vd chup lai kidm tra sau moi coil dugc tha.
- Ddi vdi tui phinh cd rOng ma khdng the dat coil don thuan dugc thi sir dyng mdt guider cathater 7F hodc 8F dua ddn ddu gdn cua dgng mach mang tiii phinh. Sir dung ky thuat Jailing vdi mdt microcatheter chpn lpc vao Idng tiii phinh vd thd vdo dd mdt vdi vdng coil, mdt microcathater khdc se choc lpc din ddu xa hoac nhanh ldn ciia ddng mgch mang ttii phinh, sau dd tidn hdnh bung stent ngang qua cd tin phinh vd thd coil qua microcatheter ddu tien, cdc budc cdn lgi thi tuang ty nhu ddi vdi tiii phinh cd hep.
T»p CHi Y Diriyc HPC CAN THO - s613-14/2018
Chung toi se danh gia v6 tai bien, bien chiing xay ra trong va sau thu thuat; danh gia vS cai thiSn triSu chiing Ito sang a thoi dito xuit vien va sau 3 thdng theo thang diem mRS, tren hinh chvp mach m4u va CT scan sau can thiep.
III. KET QUA NGHIEN ClTU
Tit thang 02/2016, chiing toi co t6ng s6 20 BN vo phinh dpng m?ch nSo gSy xuSt huySt duoi nhen va/hoac xuit hiyk hong nao duoc can thiep noi mach d^ coil hoac stent ho tn? coil. Tit ci benh nhan dSu nhap viSn trong tinh trang cip ciiu duoc chup CT scan khong cin quang v4 CT scan m^ch mau nao tiudc Idii can thiep. Trong 20 BN do co 11 BN la nO gidi chiim ty le 55%, tat ca diu tren 40 tu6i (43 - 76 tu5i) vcd d0 hiii trung btah la 58,4.
Biiu hien Ito sang cua BN chii yiu la dau diu d& dOi xuit hijn dot ngot, 6 BN (30%) nhjp vien trong tinh trang tinh tao (GCS = 15 diim); 14 BN (70%) nhap vien trong tinh trang c6 roi lo^n tri giac; trong do co 1 BN h6n me sSu GCS = 6 diem. Hunt and Hess dp 1 vi 11 CO 12 BN (60%); trSn dp m co 8 BN (40%), 1 BN co hpi cliiing Terson.
Tren CT scan khong can quang, 100% BN co biiu hien xuit huyet duoi nhen, 6 BN CO xuit huyit nSo thit di kem, 3 BN co xuit huyit ttong nao di kem. Tren CT scan mach m4u nao 19 BN (95%) thiy duprc phinh dpng mach nao va 1 BN (5%) kh6ng thiy dupe tlii phinh.
v i dac diim tui phinh, phin lon BN diu mang tiii phmh a tuan hoan truoc - 95%
(3 a DM nao giita, 6 a DM thong sau, 3 a DM nSo taroc v4 5 6 DM thong truoc, 2 6 DM canh trong); 1 BN co tiii phinh 6 dpng mach nao sau, 35% BN mang tiii phinh c6 kich thuoc rit nho (< 4 mm); kich c8 tnmg binh 4,2 mm; trd phinh nho nhit c6 kich co 1,5 mm va lon nhit la 7 mm, 25% BN co tiii phmh c6 rpng, 25% BN c6 nhiiu tui phinh (trong do 80% c6 2 hii phinh ya 20% CO 3 tlii phinh).
Tit ca BN diu dupe tiin hanh can thiep cip cuu ngay trong ng4y diu tien khi BN nhap vien. 90% BN dupe can thiep dat coil va 10% BN dupe can thiep dat stent + coil voi gay me npi khi quan, thoi gian thu thuat trung binh 14 2,5 gid, khong cd tai bien va bien chiing do thu thuat do thu thuat.
Kit qua diiu tri sau 3 thang, ty le tan phi v4 tii vong (mRS > 3 diim) la 15%; 80%
BN phuc hoi hoan toan va 5% cdn di lai di chiing yiu nhe nua ngudi, 1 BN tai thong tiii phinh khi chup 1^ kiim tra sau 3 thang, thdi gian nam vien trung binh la 10,85 ng4y.
Bang 1. Kit qua diiu tri.
Dac diem Nam/nir
Tuoi (trung binh) Tri giac
Tinh tao - Roi loan tri giac Hunt and Hess
DO 1,11 - Dp HI, IV, V Kich CO' tiii phinh
<4mm - 4 - 7 mm Vi tri tui phinh
- DM nao trudc
%M 9/11 43-76(58.4)
30(6) 70(14)
60(12) 40(8) 35(7) 65 (13)
15(3)
TAP CHI Y D i r o c HOC CAN THQ - S 6 13-14/2018
Bac diem
%(°)
DM thdng trudc DM nao giita DM thdng sau DM canh trong doan cdn lai DM nao sau
25(5) 15(3) 30(6) 10(2) 5(1) So lirong tui phinh
- Mot tlii phinh Hai tui phinh Ba tlii phinh
75(15) 20(4)
5(1) Mrs
0-2
>3
85 (17) 15(3)
Mnh 1. BN N.P.T vao vien vi dot ngpt dau diu dO dpi. (A); (B) hinh CT scan khong can quang cho thay cd xuit huyit dudi nhen lan toa, BN nay dupe chup CT m ^ h mau nao nhung khong phat hien dupe tiii phinh, sau do BN n4y dirpc dua di chpp DS A. (C) hinh chup DSA mach mau nao CO dung 3D, cho thiy cd hii phinh dpng m^ch nao ttudc doan A1 rit nhd kich CO #1.5 mnL (D); (E) hinh chpn lpc microcatheter v4o tiii phinh, viec chpn lpc tat khd khan. (F) hinh sau can thiep dat coil, cho thiy tic hoan toan tui phiiji v4 bao tin dupe dpng mach mang.
I V . B A N LUAN
TJ^P CHf Y D i r o c HQC CAN THCT - s 6 13-14/2018
Xudt huyet dudi nhen do vd phinh ddng mgch nao cd tdn sudt nhu nhau d ca hai gidi vd thudng gap d nhiing bSnh nhan ldn tudi. Theo tac gia James Vincent Byrne thi nguy CO xudt huydt dudi nhen cd sy uu the d giai nft. 0 ngudi ldn tudi thi ty le xudt huyet dudi nhen do vd tiii phinh ddi vdi nQ gidi la cao gdp 1,5 - 2,5 lan so vdi nam gidi, v% dd tudi tnmg binh cua hai gidi thi d nam cao hon n&. Sy khac nhau ve gidi tinh cua ty le mang tiii phinh vd xudt huydt dudi nhen do vo tiii phinh khdng khac nhau rd rdng d nhftng ngudi tre. Theo Bonita vd cdng sy, ty le nay khdc nhau nhieu d nhftng ngudi > 40 tudi [6].
Theo tdc gid Mark S. Greeberg thi dau ddu id trieu chiing thudng gap nhat, xudt hien trong 97% cdc trudng hgp, thudng dau rdt dft doi va khdi phdt ddt ngdt. Ddu hieu mdng nao thudng xudt biSn trong vdng 6 - 2 4 gid ddu. Ciing theo tdc gid nay, hdi chung Terson xudt hien d nhiing BN vo tiii phinh Id 4 - 27%, thudng o hai ben, tien lugng Idu dai ddi vdi thi luc la tdt trong khoang 80% cd hoac khdng md thdng dich kinh [9].
Trong 20 trudng hgp xuat huydt dudi nh?n, thi hau het do vd tiii phinh nam tren cac ddng mgch d tudn hoan trudc vd cd kich ca khd nhd (trung binh la 4,2 mrri). Theo cdc tac gia trong nghien ciiu BRAT, trong tdng sd 408 BN vd tui phinh dugc dieu tri thi cd 339 (83%) BN mang tiii phinh d tuan hodn trudc va kich cd trung binh ciia nhimg tiii phinh nay la 6 mm [11].
Myc dich di6u tri chinh Id dy phdng vo tiii phinh. Phau thugt chp tiii phinh dugc lya dieu tri cho cd tiii phinh vd vd chua vd. Hon hai thdp ky trudc day, can thiep ndi mach la phuong diSu tri chinh cho nhftng tiii phinh khdng thich hgp de phau thuat clip tiii phinh do vi tri, kich thudc hoac nhihig benh nhdn cd cdc bSnh 1;^ ndi khoa ngng di kem. Khi xuat hien coil detachable cd ki8m soat d6 ldp day tiii phinh, can thiep ndi mgch bat dau dugc lya chpn nhieu ban. Nam 2002 nghien ciiu ddu tien ciia ISAT dugc cdng bd, cdc lgi ich rd rang cua can thiep ndi mgch ldm thay ddi chien luge dieu tri cho cdc tiii phinh ndi sp d nhieu tnmg tdm. Can thiep ndi mgch se trd thdnh phucmg phdp dugc lua chgn dau tien neu noi cd trang bi ddy du. Nghien ciiu ISAT nhu Id mdt ddu mdc quan trpng trong sy phdt trien cdc phuang phap dieu tri tiii phinh. Nghien ciiu da ngimg sdm hon dy dinh sau khi cd ket qua tam thdi dugc jjbdn tich tgi thdi diSm 1 nam: 23,7% benh nhdn dugc dihu tri can thiep npi mach tdn phe hogc tii vong, so vdi 30,6% nhirng b$nh nhan dugc diSu tri phau thudt. V^ lau dai, ket qua dugc ddnh gid la nguy co tuydt ddi giam nhidu 8,7% vd nguy CO tucmg ddi gidm cdn 26,8% ddi vdi nhdm b8nh nhan dugc didu tri npi mach so vdi nhdm benh nhan di^u tri phdu thuat. Hon nfta, nhiing b6nh nhan dat coil s5 it ddng kinh vd ciing it cdn tbiSt dan luu dich ndo tuy. Cac tdc gid phai trd idi rdt nhidu cau hdi vd nghien ciiu ISAT, diem chinh Id miic do dn dinh cua tiii pMnh sau khi ddt coil, thyc su miic dp dn dinh sau ddt coil ve lau ddi vdn cdn dang xdc djnh [3].
V. KET L U ^
Can thi$p ndi mach di6u tri cac phinh dgng mach nao vo Id mpt thii thuat it xdm ldn, an toan vd cho ket qua khd quan. Tuy nhidn, nghien ciiu chi cd 20 BN, sd mdu tuong ddi nhd, can thilt phai nghien ciiu them dk ddnh gid chinh xdc vd hieu qud didu tri ciia phuong phdp nay tai trung tam cua chiing tdi.
T A I LIEU THAM K H A O
1. L, Baert, M. Knauth (2008), "Intracranial aneuiysms", Intracranial vascular malformations and aneurysms, 2°^ editon. Springer, pp 167 - 284.
2. Albert Shuette and Jacques E. Dion (2015), "General techniques of coil embolization", Neurointerventional techniques: tricks of the trade, 1 *' edition, Thieme, pp 52 - 54.
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TifliP CHI Y D i r o c HQC CAN THff - SO 13-14/2018
3. Andrew J. Molyneu and et al. (2002), "International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial". Lancet 360 (9342), pp 1267 - 1274.
4. Alberto Maud and et al. (2014), "Endovascular treatment of intracranial aneurysms by interventional neurologists: first year single-center experience", Journal of vascular and interventional neurology 7(2), pp 13-16.
5. Brad Seibert and et al. (2011), "Intracranial aneurysms: review of current treatment options and outcomes". Frontiers in Neurology (2): 45.
6. James Vincent Byrne (2012), "Intracranial aneurysm". Tutorials in endovascular neurosurgery and interventional neuroradiology. Springer, pp 125 - 167.
7. John B. Weigele, Riyadh N. Alokaili, and Robert W. Hurst (2012), "Endovascular management of brain arteriovenous malformations", Neurointerventional management:
diagnosis and treatment, 2™* edition, Informa, pp 327 - 366.
8. Hae Woong Jeong (2014), "Clinical practice guideline for the management of intracranial aneurysms", Neurointervention 9(2), pp 63 - 71.
9. Mark S. Greenberg (2016), "Subarachnoid hemorrhage". Handbook of neurosurgery, 8""
edition, Tbieme, pp 1191 - 1210.
lO.Mark R. Harrigan, John P. Deveikis (2013), "Intracranial aneurysms and subarachnoid haemorrhage", Handbook of cerebrovascular disease and neurointerventional technique, 2°^ edtion. Springer, pp 483 - 571.
ll.Robert F. Spetzler and et al. (2015), "The barrow ruptured aneurysm trial: 6-year results". Journal of Neurosurgery 123(3), pp 609 - 617.
12.Rufus Corkill (2014), "Basic principles and simple techniques". Interventional neuroradiology. Springer, pp 41 - 52.
(Ngdy nhgn bai: 10/11/2017 - Ngdy duyet ddng: 01/01/2018)
B A N H G I A K E T Q U A U T N G D U N G K Y T H U ^ T © O T S O N G C A O T A N T R O N G D I E U T R I S U Y T I N H M ^ C H C H I DlTOfl T A I B E N H V I E N
D A K H O A T H A N H P H O C A N T H O
Nguyin Hitu Giau, Bdm Van Cwang Trudng Dgi hoc YDugc Cdn Tha
* Email:nguyengiau218(^gmail.com T6M TAT
Bgt vdn di: Suy finh mgch chi dudi la binh ly thudng ggp, gdy nhiing trieu chung dau, te, dj cdm, ... ldm gidm ehdt lugng cugc sdngvd tdn kim chi phi dieu tii. Mgc tiiu nghiin cuu: Ddnh gid kit qud ung dgng ky thudt ddt sdng cao tdn trong diiu trf suy tinh mgch ndng chi dudi tgi Binh viin Ba khoa Thdnhphd Cdn Tha. Boi tugng vd phuang phdp nghiin cuu: Nghien ci^ md td cdt ngang. tiin cuu. Tir thdng 4/2015 din 6/2017, ehung tdi da diiu tri ddt sdng cao tdn diiu trj suy tTnh mgch chi dudi eho 58 binh nhdn (BN) vdi 95 chdn. Ket qud: Tudi trung binh 54,6 ± 13 tudi (tudi nhd nhdt 30. tudi ldn nhdt 80). Cd 22 nam (37.9%), 36 nir (62,1%). Thdi gian BN cd thi sinh hogt binh thuang sau 2-3 ngdy Id 27 BN (46.5%), sinh hogt binh thudng sau 6-7 ngdy la 7 BN (12,1%). Biin chimg di cdm 11 TH (chiim 19%) vd gidm sau 6 thdng chi cdn 2 TH (3,4%). Cdc BNxudt huyet dudi da it, khu tni chiim ti li 51,7% (30 BN) sau 24 gid, bien mdt sau thdm khdm 1 thdng, 6 thdng; khdng xudt huyit sau 24 gia la 48.3%. Triiu ehung dau, mdi chdn gidm tii 82,8%
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