- Ldm sdng dien biln ch^m
^ - Dau higu c i t Idp vi tinh quan trgng Id hinh anh cae mang xa hod cd ty trgng phin mem it ngam thudc can quang bao bgc cac mgch Idn, thuc quan va khi quan.
Thdnh mgch bj vdi hod hay xa vQ-a. Khdng thIy xam lan vao Idp niem mge thue quan vd khi quan. Luu thdng cua thuc quan chi bj can trd nhg nhdng. Khdng ed hgeh vd di cdn cdc ca quan lan c i n (phdi, mdng phdi...)
v l chin dodn phdn bi#t chung tdi mudn dgt ra d day Id vdi cdc tdn thuang dc tinh:
- Cdc u trung that hay di can hgch trung that thudng cd tinh chat hgeh hay cdc mang cd dgng td chuc mIm vdi cdc dgc diem nhilu thujr miii bao bgc cdc mgch Idn, chdn dp vdo thuc quan, khi quan...Cd gidi hgn khdng rd xdm l l n cdc ea quan. Han nua chung ta cd t h i bilt trudc u nguyen phdt [4].
- Cdc bit thudng bam sinh nhu gian thue quan bam sinh, thue quan ddi, eo that tam vj...Cae bgnh ly ndy dii ed mgt sd dau higu tuang tu nhu nudt nghgn, hgi chung u trung that... nhung cd t h i chan dodn de nhd cdc ky thu|t thdng thudng [4,5].
K^T LUAN
Mgt can bgnh lanh tinh nhung dilu tri cdn nhieu khd khan chiing tdi mudn d l cgp trong khudn khd bdi ndy, nham thdng bdo vd dua ra mgt sd dIu higu ggi y gdp phin tim hieu thdm v l bgnh ly viing Idng ngue- trung that ed lien quan d i n mach mdu, thue quan vd bg mdy hd hap...
TAI LIEU THAM K H A O
1. Brooks AP. Computed tomography of idiopathic retroperitoneal fibrosis "periaortitis ": variant, variations, patterns and pitfalls.Clinical Radiology 1990; 42: 75-79.
2. Buthiau D et coll. Fibrose r§troperiton6ale. TDM et IRM clinique 1992; 697-698.
3. Degesys GE, Dunnick NR, Siivemnan PM, Cohan RH, lllecas FF, Castagno A. Retrop6riton6al fibrosis: use of CT in distinguishing among poosible causes.
4. Joffre F, Cinqualbre A, Rousseau H. Imagdrie des fibroses rdtroperiton6ales benignes. Edictions techniques EMC 1993; 34-290 A10:1-13.
5. Smith SJ, Bosniak MA, Megibow AJ, Hulnick DH, Smiles S and coll. CT demonstration of rapid improvement of retroperitoneal fibrosis in response to steroid therapy.
Urol. Radiol 1986 ; 8:104-107.
TiNH HINH VIEM NIEM MAC TU CUNG SAU DE DIEU TRj TAI BENH VIEN PHU SAN TRUNG UONG TRONG 2 NAM TUT 2008-2009
T6M TAT
Mgc tiiu nghien cCru: xic djnh t} Ig viem niem mgc tu cung (VNMTC) tgi Bgnh vi$n Phg san Tmng uang (BVPSTW) vi niu dgc diim lam sing, c$n lam sing cua VNMTC cua 2 nhdm sau de du&ng im dgo vi mi liy thai Phuang phip nghidn cuv: Hoi ciru hd sa VNMTC diiu trj tgi BVPSTW bao gom ci tnrang hgp de tgi vi$n vi di tgi cic bgnh vign khic. Kit qui nghiin edit: T91$ VNMTC tgi BVPS7V\/ tmng 2 nam 2008-2009 li 0,55% trong toin bg nhimg tru&ng hgp de, hay gip han trong Uudng hgp mi liy thai (0,75%), cao han de du&ng im dgo li 1,94 lin (p<0,05). Nam 2009 ty' Ig VNMTC giim han 2008(p<0,05). D$c diem lim sing cua VNMTC: Tu6i tmng binh 27± 4,3, lira tuoi sinh di nhiiu. 50,5% a sin phg de lin diu tien. Th&i gian xuat hi^n b$nh chu yiu li sau 1 tuin (84,8%), v&i trigu chung chu yiu id sit trin 3ff'C (94,6%), tu- cung co hoi chgm (94,6%), sin djch nhiiu, kio dii (70,9%). Xit nghigm c$n lim sing biiu hign nhiem trung qua cdng thuc bgch ciu ting trin 11000/mm3, CRP tang cao tmng binh 73±50,1 mg/l. Khi ciy sin djch vi khuin hay ggp nhat li E coll chiim 47,4%. Kit iu$n: Vin di vd khuin tmng khi cd thai vi di rit quan trgng. dgc bi^t tmng mi liy thai cin nghiin cCru them vi yiu to nguy ca giy VNMTC tmng dd di dua ra hu&ng phdng bgnh cd higu qua cao.
TCf khda: viim niim mgc tCrcung SUMMARY
Objective: Endometritis in the National Hospital of Gynecology-Obstetrics - nosometry and characterization of clinical, paraclinical symptoms of postpartum endometritis in the transvaginal delivery and abdominal delivery (partus caesareus) gmups. Methods:
Retmrespective documentation fmm the medical mcords
NGUYfiN SY THjNH, LE THj THANH V A N Bgnh vign Phg sin Trung Wong
in the National Hospital of Gynecology-Obstetrics.
including deliveries both in the hosptal and other ones.
Results: In the two years of 2008-2009. the endometritis incidence was 0.55% of the total devivery cases, higher in abdominal delivery (0.75%) which was greater than transvaginal delivery by 1.94 times (p<0.05). in 2009, the incidence was less prevalent than 2008 (p<0.05).
Clinical charaterization: Age averege: 27 ± 0.43, falling in the pmlific lifetime. Noticible prevalence was in primipamus puerperal women - 50.5%. The remari^able majority of occurences were a week after the dilivery (84.8) with the following symptoms: fever over 38PC (94.6%), slow uterine involution (94.6%); pmfused and prolonged lochiorrhagia (70.9%). Paraclinical tests revealed infections thmugh blood counts with increases in leucocyte (over 11.000/mm^) and CRP (73 ± 50.1mg/l) with infection of E coli was the commonest (47.4%).
Conclusion: Sterility is essential during the pregnanccy.
especially in abdominal parturation. Further investigation on the risk factors of the postpartum endometritis is needed to pmpose effective measures for prevention.
Keywords: Endometritis DAT V A N D 6
Viem niem mgc tir cung (NMTC) sau de Id mdt trong nhung hinh thdi sdm vd hay ggp nhlt ciia nhilm khuin hdu san. Nlu khdng dugc chan dodn vd dieu tq kjp thdi viem NMTC ed the tien triln thdnh nhirng hinh thdi nhiem khuan ngng sau de nhu viem tu* cung todn bg, viem phin phg, viem quanh tu* cung d i n d i n viem phiic mge tilu khung hay vidm phiic mge todn t h i , cudi ciing la nhiem khuan huylt Id nguyen nhdn gdy tir vong hang dau, dgc bigt d nude dang phdt trien.
Su tien bg v l hdi sue, phiu thugt, khdng sinh mdi dd
Y HOC THUC HANH (767) - S6 6/2011 11
lam thay ddi mgt phan dgc diem lam sdng cua nhilm khuan san khoa, dgc bigt la viem NMTC sau de. Ngdy nay VNMTC hilm ggp d nhirng nude ed nIn kinh te phat triln, dieu kign sdng vd cham sdc y te cao nhu cac nude d Tay Bac Au, Bae My. Nhung d Vigt Nam hinh thai VNMTC sau de v i n chiem mgt ty Ig khdng nhd trong cdc hinh thai cua nhiem khuan hgu san. Neu chung ta khdng phdt hign sdm vd dieu tr] kjp thdi thi ed t h i dan d i n nhirng bien chUng ngng ne, gay vd sinh, viem phdn phg, cudi ciing cd the gay tir vong mg. Mge tieu nghien cuu:
1. Xac djnh ty Ig viem niem mac tu cung de tgi bgnh vign phg san trung uang trong 2 nam 2008-2009.
2. Md ta dgc dilm lam sang vd cgn lam sang ciia Viem NMTC sau de tai BVPSTU" trong 2 nam 2008-2009.
PHU'ONG P H A P NGHIEN CLTU
- Ddi tugng nghien cuu: tat ea bgnh nhan sau de tgi BVPSTLf bj vidm NMTC, nhdm de tgi nai khac de so sanh vd nhgn xet. Sau khi da logi trir nhii'ng trudng hgp sdt khdng phai do nhiem khuan ligu san.
- Cd miu: chgn miu khdng xdc suit lay t i t ca bgnh nhan trong 2 nam
- Phuang phap thu thgp thdng tin: lay Igi hd sa cu de tgi BVPSTLf. Tim hilu nhiing trigu chii'ng va y l u td lien quan din VNMTC. Ddnh gia k i t qua dieu tn tgi vign
- Dgo dire trong nghien eii-u: bgnh nhan dugc hdi thdng tin vd trigu chirng ed lien quan den chan doan vd dilu tri. Kit qua vd ddnh gid dugc giir bi mgt khdng lam anh hudng din kit qua dilu tri vd uy tin cua bgnh vi^n chi dugc thdng bao cho phdng k l hogch tdng hgp d l rut kinh nghigm trong cdng tdc dieu tri bgnh nhan.
KET QUA V A B A N LUAN 1. Ty Ig viem NMTC sau de
Trong 2 nam nghidn ciru cd 279 san phg viem NMTC, trong dd cd 209 ea de tgi BVPSTW, dugc chia Idm 2 nhdm de dudng A D vd md lly thai
Bang 1. Ty Ig VNMTC tgi BVPSTW CSch de
Be dyd'ng AB Md lly thai
Tdngsd
Tdng sd de 21006 17078 38084
VNMTC 81 128 209
%
0,39 0,75 0,55
OR (95%CI) 1,94 (1,07-2,06) P< 0,05
Ty Ig VNMTC sau de tgi BVPSTW trong thdi gian 2 nam 2008-2009 la 0,55%. Sau md de chilm ty Ig cao han 0,75% cao gap 1,94 lan so vdi de dudng A D ed y nghTa thdng ke vdi p <0,05
Bang 2. Ty Ig viem NMTC trong tung nam Ndm
2008 2009 TS
Vigm NMTC BAB
n 59 60 119
%
49,6 50,4 100
MLT n 101
59 160
%
63,1 36,9 100
Tdng sd n 160 119 279
%
57,3 42,7 100 P<0,05
Nam 2009 sd VNMTC sau de nhilu han, chilm 57,3%. Ty Ig sau md lay thai hay de thudng cua 2 nam khde nhau ed y nghTa thdng ke, vdi p<0,05, nam 2009 ty 10 viem NMTC sau md lay thai thap han nam 2008, mge dii ty Ig md lay thai chung todn vign cao han, phai chdng ky thugt md lay thai tdt han nen ty Ig VNMTC giam di.
Khi sg sdnh vdi cac kit qua nghien cuu ciia cae tdc gia khac t y Ig VNMTC sau de cung nhu sau md thIp han nhilu, do thdi gian nghien cuu trudc nghien cuu nay han 10 nam.
Bang 3. Ty Ig VNMTC theo mdt s d tac gia Tdn tac gia
Sweet va Ledger GIbbs vd CS Chii' Quang Bd Nguyin Thj Phuong Lien
Tdc gia
Ndm 1973 1983 19991
2002 2005 2008 2009
MLT 20,8 13,5 38,5 1,2 1,3 0,75
BAD 2,6 1,3 . 1,2
-
0,3 0,39 Cae tdc gia deu thdng nhat nhgn djnh rang: Ty 1$
VNMTC sau md lay thai cao han rd rgt so vdi de dudng AO, cung gidng vdi nhirng nghien ciru khac. Nhu v|y MLT Id mgt trong nhirng y l u td nguy ca cua VNMTC sau de.
So sanh vdi nhii'ng nghien cuu tgi bgnh vign PSTW, ty Ig VNMTC giam rd rgt tir 1,2-1,3% xudng 0,75%.
Tudi tmng binh ciia 279 san phg VNMTC sau de la 27±4,3 tudi, thap nhat la 17 tudi va cao tudi nhat Id 44 tudi.
Bang 4. Tudi ddi tugng nghien cuu Tudi
<20 20-24 25-29 30-34 S35 TS Trung binh
n 18 52 129
66 14 279
%
6,5 18,6 46,2 24,7 3,9 100 27 ±4,3
Lua tudi mac bgnh cao nhat tu 25-29 tuoi (46,2%), phii hgp vdi tudi sinh de nhilu nhat. Cdng tdc vg sinh trong sinh de, hgu san chua tdt, de cang nhieu ty l§
nhilm triing cang cao.
Bang 5. Nghe nghigp ddi tugng nghidn cuu Nghi
nghidp Canbd Cdng nhdn
Ndng dan Nhan ddn
TS
Viem NMTC BAB
N 52 20 9 38 119
%
43,7 16,8 7,6 31,9
100
MLT n 75 24 5 56 160
%
46,9 15 3,1 35 100
Tdng sd n 127
44 14 94 279
%
45,5 15,8 5 33,7
100 P > 0,05
Nghi nghigp ddi tugng nghien cuu khdng cd sy khac nhau giira nhdm de dudng A D hay nhdm md lay thai. Do bgnh vign d Ha, Ngi, so bgnh nhan thanh pho HN cao (64,5%), ndn ty Ig can bg cung cao nhat (45,5%), sd bgnh nhan la ndng ddn thap nhlt chi cd 5%.Theo nghien cuu cua Nguyen Thj Phuang Lien, phdn bd nghe nghigp giO'a cdc nhdm Id tuang duang nhau. Ly giai cho su khac nhau nay la do doi tugng nghidn cuu cua chung tdi Id VNMTC, mgt hinh thdi nhg cua NKHS nen hg dugc dieu trj tgi ca sd, chi Idn vi$n khi bgnh ngng han, nhu viem todn bg ca tir cung, vidm phiic mge.
Bang 6. So lan cd thai vd sinh con So lan
sinh L i n l Lln 2 Lln 3 Lln 4 Lln 5 TS
Vidm MNTC sau de DAB
n 63 26 13 10 7 119
%
52,9 21,8 10,9 8,4 5,9 100
MLT n 78 34 25 14 9 160
%
48,8 21,3 15,6 8,8 5,6 100
Tdng sd n 141
60 38 24 16 279
%
50,5 21,5 13,6 8,6 5,7 100
\jv icii I II lai ly II lai u UI ly uii III id <:.,u IX I ,o;j, Ixiu i ii lai la
nhdm cd thai lan 1, chilm 50,5%. lan 2 Id 21,5%. Giira 2
12 Y HOC THV'C HANH (767)-Sd6/20l4j
nhdm khdng cd su khac bigt.
Hi#n nay chinh sdch dan sd moi gia dinh chi ed 1-2 con ndn ty Ig de cao d 2 nhdm 1-2 con nen VNMTC cDng tSp trung cao d 2 nhdm day.
Thdi gian (ngdy)
1-2 3-7 8-15
TS
Viem NMTC BAB
n 6 13 100 119
%
5 10,9 84,1 100
MLT n 6 9 145 160
%
3,8 5,6 90,6
100
Tdng sd n 12 22 245 279
%
4,5 7,7 87,8
100 P>0,05
Thdi gian phdt hign b^nh thudng sau 1 tuan chilm ty 1$ 87,8%.
Thdi gian xult hign nhiem khuan sdm 1-2 ngdy sau de 4,5%. Nhung trudng hgp ndy thudng lien quan tdi nhiem khuin trudc va trong chuyen dg vi vgy sau de 1-2 ngdy dd xuat hign dau higu sdt, san djch hdi ggi Id VNMTC sdm, thudng trigu chii'ng ngng vd xuat hign trong vdng 24 h dIu.
Bang 8. Trigu chung sdt sau de Thdi gian
(ngdy) 1-3 4-7 8-10
>10 TS
Vidm NMTC BAB
n 11 21 25 62 119
%
9,2 17,6
21 52,2
100
MLT n 10 33 46 71 160
%
6,3 20,6 28,7 44,4 100
Tdng sd n 21 54 71 133 279
%
7,4 19,3 25,4 47,9 100 sdt thudng Id trigu chung dau tien, bdo higu ed nhilm khuin sau de. Mudn ddnh gid dung tinh trgng sdt, phdi theo ddi nhigt dg nhilu l l n trong ngdy.
Nhigt dg trung binh Id 38,8° ± 0,7. Kdt qua ndy phii hgp vdi cdc nghidn ciru khac cua Alan Deeherney (1990), Beckmann (2002). Tat ea dIu cho rang sdt Id dIu hi^u rlt cd gid tq trong chan dodn VNMTC, d$e bidt khi cdc san phg cd kdm theo cdc yeu td nguy ca. Tuy nhidn c i n phai logi trir ede trudng hgp sdt do nhirng nguydn nhdn khde nhu vidm phdi, viem dudng tilt nigu, cdng vii sau de. 64,9% cd nhigt dd 38° C - 39° C, 27,9%
cao trdn 40° C. Thdi gian sdt sau de 10 ngdy chiim ty Ig cao nhlt 47,9%. Tridu ehUng sdt khdng cd su khde bigt giO'a 2 nhdm vdi p> 0,05
Bang 9. Tridu chii'ng Idm sdng Tri$u chii'ng Idm
sdng Sdt >38 °C Tu'
cung
Sdn djch
Co hdi ch|m Di ddng
dau nhilu
hdi lln mil
Vidm NMTC BAB
n 111 114 73 86 69 0
%
93,2 95,7 61,3 72,3 57,9 0
MLT n 153 150 92 112
91 5
%
95,6 93,8 57,5 70 56,8
3.1
Tdng sd n 264 264 165 198 160 5
%
94,6 94,6 59,1 70,9 57,3 1,8 Tri$u chii'ng VNMTC diln hinh khi sau de cd sdt (94,6%), tii' cung co hdi ch$m (94,6%), di dgng tir cung dau (59,1%), sdn djch ra nhilu, kdo ddi (70,9%) ed miii hdi (57,3%).
Tif cung co hdi ch$m Id tri$u chirng rlt diln hinh, chilm ty 1$ rlt cao. Khi bj vidm NMTC thudng hay ggp trong nhO^ng trudng hgp sdt rau, sdt mdng, be san djch (d$c bi$t trong md lly thai chii ddng). Tir dd d i n d i n
dgc diem cua san djch nhilu, keo ddi, n l u lau nira se ed miii hdi vd tu" cung viem lau se dau khi khdm. Tiiy tung trigu chimg cd t h i ddnh gid muc dd b§nh ngng hay nhg, chiing ta phdt hign mudn hay sdm. Khi san djch ed mii id nhirng^ trudng hgp nhiem triing ngng va keo ddi vd d nhdm md lly thai Id chii y l u . Neu nhirng san phg ndy khdng dugc dilu tq tich cue bgnh se tiln trien n|ing han. Cuningham (1993) cung ed nhgn xet tuang tu ve trigu Chung san djch ban.
Bang 10. Xet ng Ket qua x^t nghiem
SLBach c l u (X 10'3/mm3)
<11 11-<20
S20 Sd lygng Hb(g/I)
<70 70-110
>110 Ndng dd CRP(mg/l)
6-48 49-96 97-192
>192 Trung binh
higm mau BAB n 119
37 78 4 119
3 42 74 119
61 30 22 6
%
100 31,1 65,5 3,4 100 2,5 35,3 62,2 100 51,2 25,2 18,5 5,1 70±54,7
MLT n 160
52 99 9 160
3 47 110 160 66 57 27 10
%
100 32,5 61,8 5,7 100 2,2 29,4 68,7 100 41,2 35,6 16,9 6,3 77±55,2
Tdng sd n 279
89 177
13 279 6 89 184 279 127 87 49 16
%
100 31,9 63,5 4,6 100 2,2 31,9 65,9 100 45,5 31,2 17,5 5,8 73,5±50,1 Xdt nghigm mdu bieu hign nhiem khuan rd rgt. Cdng thue bgch c l u tang cao trem 11000/mm', CRP duang tinh 100%, ham lugng trung binh Id 73,5±50,1mg/l.
Bgnh rlt ngng khi CRP >97mg/l chilm 23,3%. Thuc t l CRP ed gid tq trong theo ddi dieu tn bgnh.
VNMTC chi Id t h i nhg trong NKHS, it anh hudng d i n tinh trgng thilu mdu, chi cd 2,2 % ed Hb< 70g/l.
Bang 11. Kit qua GPBL GPBL
Vidm NMTC Mdng rgng thodi
hda Hoai ty huylt
Hoai to md Khdng Idm
TS
^ ji . . .
BAB n 8 9 11
0 91 119
%
6,7 7,6 9,2 0 76,5
100
MLT n 9 10
6 2 133 160
%
5,6 6,3 3,8 1,3 83,1
100
Tdng sd n 17 19 17 2 224 279
%
6,1 6,8 6,1 0,7 80,3
100 Trong so bgnh nhan nghien ciru chi cd 55 trudng hgp cd kit qua GPBL, trong dd ed 17 ea VNMTC (30,8%), cdn Igi ehl Id hogi tu" huylt hay mdng n,ing thodi hda
Bang 12. Xet nghidm vi khuin Vi khuan gdy
bdnh Cly san djch
Am tinh Dyo'ng tinh
Chlamydia Am tinh Dyong tinh Cly mau dm tinh
Vidm NMTC DAB
n 49 23 26 78 26 52 17
%
100 46,9 51,3 100 33,3 66,7 100
MLT n 64 22 42 110
60 50 21
%
100 34,4 65,6 100 54,5 45,5 100
Tdng sd n 113
45 68 188
86 102
38
%
100 39,8 60,2 100 45,7 54,3 100 Khdng ed trudng hgp ndo cly mau duang tinh, nlu cay mdu duang tinh Id bgnh dd rlt n|ing. Id t h i nhilm khuan huylt.
Cly san djch 113 ca chilm 40,5%, ed vi khuin gdy b^nh 68 ea chiem ty Ig 60,2%. Xdc djnh dugc vi khuan gdy bgnh hay g|p Id E coli (47,4%), Chlamydia duang tinh 102 ca (54,3%). Cly san djch Id mdt xdt nghi$m ein
Y HOC THVrC HANH (767) - S 6 6/2011 13
thilt, cin phai lam trudc khi dieu tq khdng sinh.
K^T LUAN
Viem niem mge tir cung sau de tgi Bgnh vign Phg san Trung uang trong 2 nam 2008-2009 chiem ty Ig 0,55%, hay ggp han d nhdm md lay thai cao han nhdm de dudng am dgo 1,94 lan cd y nghTa thdng ke vdi p<0,05. Ty Ig bgnh giam kha nhieu so vdi thgp nien trudc, nhung v i n chu y vi ggp nhieu han d nhdm md lay thai vi ty Ig md lay thai tgi cac bgnh vign ngay cang tang, ggp d nhung san phg de l l n dau (50,5%). Trigu chung lam sang khd diln hinh vdi cac dgc diem
Thdi gian xult hign chii yeu sau 1 tuan (84,8%) Nhirng trigu chung diln hinh: Sdt tren 38dg C (94,6%), Tu" cung eo hdi chgm (94,6%) va san djch nhieu, keo dai (70,9%).
Khi xet nghigm mdu cho thIy:
CRP cao trong t i t ca ede trudng hgp, trung binh 73,5±50,1mg/l.
Bgch c l u da nhan trung tinh tren 11 nghin d 68,1%
Thilu mdu trung binh vdi Hg < l l g / l gap trong 31,9%.
Trong 55 trudng hgp ngo NMTC ed kit qua giai phiu chi thay VNMTC d 30,8% trudng hgp.
Khi cay san djch E. coli id vi khuan hay ggp cao nhlt (47,4%), sau dd la tg c l u vang 26,6%.
Vin de vd khuan trong khi cd thai vd de v i n la y l u td quan trgng, eIn chii y de giam ty Ig VNMTC dac bigt d nhung ngudi de eon so, d l phdng nhirng viem nhiem ngng n l va gay vd sinh sau de.
TAI LIEU THAM K H A O
1. Nguyin Tuln Anh (2000), Nghidn cii'u lam sdng
nhu'ng tnrdng hgp nhiem khuin hdu sdn dilu tn tgi Vi^n BVBM&TSS trong 3 nam 6/1999-6/2000. Ludn vdn thgc si.
Tnrdng BHY Hd Ndi.
2. Phan Kim Anh (1986, MOt vdi nhdn xdt v l vi khuin gdy nhilm khuin huylt trong sdn phg khoa. Hdi nghj tdng kit nghidn eUu khoa hgc vd dilu tq nam 1986. VBVBMTSS- tr 76-77.
3. Bd Y t l (2005)Sdt sau de hirng din chuIn qudc gia v l cdc djch vg ehdm sdc sue khde sinh san, tr 202-211
4. TrIn Nggc Can (1978). Nhilm khuin hdu sdn - san phg khoa. Nhd xult ban y hgc tr 295-302.
5. Nguyin Canh Chuang (1999)Tinh hinh nhilm khuin san phg khoa tgi khoa san 3 VBVBMTSS ndm 1996.
Tgp chi thdng tin Y dugc chuydn d l san phg khoa 12/1999 tr 203-206.
6. Chii' Quang Dg (2002). Gdp phin nghidn cuu cdc hinh thdi Idm sdng vd nhirng ylu td iidn quan gdy nhilm khuin sau md de tgi VBVBMTSS tir 1/2000- 6/2002. ludn vdn tdt nghidp thgc sT y khoa, trudng DHY HN.
7. Nguyin Thj Phuang Lien (2005). Tinh hinh vidm ndi mgc tu" cunp sau de tgi BV PSTW tU thdng 6/2004- 5/2005.
Ludn van tot nghigp bdc sT chuydn khoa cip II Trudng d^i hgc YHd Ndi
8. Nguyen Viet Tien (1986) Nhgn xdt 68 trudng hgp vidm phuc mgc San khoa tgi VBVBMTSS. Ludn vdn t6t nghidp bdc sy ngi tni trudng DHYHN.
9. Le Thanh Tting (2001) xdc djnh gid tn CRP trong chin dodn nhiem khuan di d di vd non. Ludn vdn thgc s9 Y
khoa trudng DHY HN. ^ 10. Charles R.B Backmann (2002), Postpartul
infection. Obstetrics and gynecology, fourth edition. Lipisci}.
William & Willkins New York, pp 182-190.
NGHIEN CUU DAC DIEM LAM SANG, NONG DO IMMUNOGLOBULIN G VA CHUfC NANG HANG RAO MAU NAO cr BENH NHAN DOT QUY CHAY MAU NAO TREN LEU TIEU NAO GIAI DOAN CAP
DAT V A N Dfe
Dgt quy nao la nhdm bgnh ly chilm ty Ig cao trong lam sang than kinh va la mgt trong nhu'ng nguyen nhan gdy tii' vong hang dau d nhilu qudc gia. Theo Td chuc Y te t h i gidi, nam 1990 ty Ig tu" vong do dgt quy nao chilm hang thu ba sau bgnh ung thu vd cac bgnh tim mgch.
Chay mau nao la mgt the cua dgt quy nao chilm ty Ig tu 18-35% tdng sd bgnh nhan dgt quy nao. Ty Ig hign mdc d Trung qudc la 259,93/100.000 dan; d Vigt nam dao dgng trong khoang tir 117- 425,5/100.000. Ty Ig tir vong trong 30 ngay dau tu 30-40%, ty Ig chay mdu tdi phat tu 4-10%; 50%, bgnh nhan sdng sdt la ganh ngng cho gia dinh vd xa hgi. Hg thdng hang rao mau nao vua Id rao can vgt ly vua la hg thdng vgn chuyen t l bao. Khi hang rdo mau nao bi tdn thuang, te bdo ngi md bj long leo th$m chi bj pha vd. Cac ion. Protein va thanh phan hii-u hinh xam nhgp te bao nao gay phti td chuc nao la y l u td tien lugng ngng cho bgnh nhan dgt quy nao. Vi vgy vigc nghien cuu danh gia chuc nang hang rao mau nao la rat quan trgng. Chung tdi thuc hign d l tai nham mge tieu:
1. Nghien cuu mgt sd dgc dilm lam sang va hinh anh chgp cat Idp vi tinh d bgnh nhan dgt quy chay mdu
TRUONG TUAN ANH, Dgi hgc DDND N G U Y I N V A N CHUONG, PHAN VI$T NGA.
Hgc Vien Quan y-103
nao tren leu tilu nao giai dogn d p .
2. Xdc (!Onh ndng dg ImmunoglobulinG trong djch nao tuy, huylt thanh; ddnh gia chuc nang hang rao mdu nao d bgnh nhan dgt quy chay mdu nao trdn leu tilu ndo giai dogn cap.
D 6 I TU'Q'NG V A PHU'ONG PHAP NGHIEN Cl/U 1. Ddi tug'ng nghien ciru
Gdm 32 bgnh nhdn dgt quy nao giai dogn cap dilu trj tgi khoa dgt quy nao Bgnh vign 103 tir thang 4/2009 din 5/2010.
2. Phu-ang phap nghien ciru: Tien ciru, cat ngang, md ta ed phan tich. Can cu* vao tieu chuIn lam sdng, chgp cat Idp vi tinh sg nao, lam cae xdt nghidm phgc vg nghien cuu. Xet nghigm huylt thanh vd djch ndo tuy' ciing thdi dilm vdi nhau.
3. Phuang phap thdng ke vd xO 1;^ s6 lifu.
Cae kit qua dugc thdng ke vd xu ly blng cdc thullt toan thich hgp phgc vg cho mgc dich nghidn ciru. Xu ly sd ligu tren phan mem SPSS 16.0 vd EPI-INFO 6.04.
K^T QUA NGHIEN CLTU
Bang 1. Phan bd theo tudi cua bgnh nhan trong nghien cii'u.
