5. Trin Van Tang, (1999). Y i u to djch te v i die diim lim sing cua ung thu da gip d Vien K Hi Ndi v i Vien Bdng Quoe gia trong thdi gian tCr thing 1/1997 den 6/1999; Luin i n thae sy; Hpe vien Quin Y, 37.
6. Amado-J at al, (Jun 1998). Skin cancer.
ACTA-Med-Port.,11(6), 529-532).
7. Geller AC, Annas GD, (2003 Feb).
Epidemiology of melanoma and nonmelanoma skin cancer. Semin Oncol Nurs.;19(1):2-11.
8. Marks R, (Jun 1997). Epidemiology of
non-melanoma skin cancer and solar keratoses in Australia: a tale of self-immolation in Elysian fields.
Australas J Dermatol.;38 SuppI 1;S26-9. Review.
9. Rogers HW, Weinstock MA, Harris AR, Hinckley MR, Feldman SR, Fleischer AB, Coldiron BM, (Mar 2010). Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch Dermatol.,146(3):283-7.
10. Stern RS, (Mar 2010). Prevalence of a his- tory of skin cancer in 2007: results of an incidence- based model. Arch Dermatol.;146(3):279-82.
Summary
DISTRIBUTION OF SKIN CANCER AT THE NATIONAL DERMATOLOGY HOSPITAL 2007 2010
Objective: To study the skin cancers at the National Dermatology Hospital. Study subjects and method:
The cross sectional study design was applied based on the data of 856 patients with skin cancers who were checked up and treated at the National Dermatology Hospital. Results: During preriod "of January, 2007- December, 2010 there were 856 patients with skin cancers, in which 58.8% of patients suffering from basal cell carcinoma, 32.2% patents with squamous cell carcinoma, 4.8% of patients with malignant melanoma and 4.2% patients with other skin cancers. Number of patients in 2010 was 2.6 times higher than that in 2007. Male/ female ratio was 1.2. There was 64.25% patients with skin cancer over 60 years old and 61 % of them lives in rural areas. Conclusion: The number of patients with skin cancers at the National Hospital of Dermatology was increased in recent years. The basal cell carcinoma was the most common skin cancer. Neariy 2/3 of patients with skin cancers, was over 60 years old. The pathology was more frequent in men than among female and most of patients live in rural areas.
Keywords: Skin cancer,basal cell carcinoma, Squamous cell carcinoma, malignant melanoma
T A C D U N G C O A BAI
ICH KHI DIEU VINH THANG
TRONG DIEU TRj THIEU
N A N G T U A N H O A N N A OMAN TJNH
T r i n Qudc Binh Benh vipn Y hpc Cd tmyin Tmng wang
Mpc tieu: Dinh gii tic dung cua bai thude cd phwong "Ich khi aiu vinh thang" trong aiu tri thiiu nang tuin hoin nao. Ddi twpng vi phwang phap: 35 bpnh nhin duvc diiu tri ndi trii trong 1 thing bang bai thude Ich khi aiu vinh.
Oinh gii kit qua lim sing bang aim theo bang chin doin TNTHNMT ciia Khadjev. Kit qua cpn lim sing dwa tren biin ddi tren Iwu huyit nao dd vi dipn nap dd. Kit qua: Sau 1 thing diiu tri, diim tmng binh ciia bpnh nhan giim tir 29,26 ± 2,68 xudng 12,86 ± 3,8. Cie chi sd Iwu huyit nao dd vi dipn nap dd diu duvc cai thipn rd rpt Khdng thiy tic dvng khdng mong mudn tren lam sing. Kit luin: Bii thude tren cd tic dung tdt tmng aiu tri thieu ning tuin hoin nao.
Tir khoa: thieu nang t u i n hoan nao, ich khi di4u vinh thang
TCNCYH Phu trwong 74 (3) - 2011
I. OAT
V A N 0 &Thiiu nang tuin hoin nao man tinh (TNTHNMT) l i mdt benh hay gap d ngudi ed tudi.
Chan doin v i dieu trj benh sdm, kjp thdi v i tich eye khdng ehf ed y nghTa mang lai cho benh nhan cupc sdng khde manh, m i cdn mang lai hieu qua cao trong diiu trj. Trong YHCT, TNTHNMT vdi cie tridu ehCrng ehu yiu l i : hoa mat, chdng mat, mat ngu, giam tri nhd duge md ta trong eae chCrng
"huyen vyng" "diu thong", "that mien",... v i d i diiu trj ehCrng benh niy bang eic phuang phip khac nhau. De md rdng kha nang lya chpn thude trong diiu trj ehCrng benh nay, ehung tdi tiin hinh nghien eCru bii thude eo phuang "ieh khi diiu vinh thang" d i dieu trj eae the bdnh TNTHNMT theo YHCT vdi muc tieu: 1. Dinh g i i t i c dung eua bii thuoc CO phuang "ieh khi dieu vinh thang" trong diiu trj TNTHNMT dua trdn mdt so ehf tidu lam sang va can lam sing. 2. Tim hieu mdt so tie dung khdng mong mudn eua bii thude (niu ed).
II.
D 6 |TU'QNG VA PHU'QNG
P H A P1. Chit lieu
Bai thude cd phuang "ich khi dieu vinh thang"
cd nguon goc tCr sach "ChCrng trj chuin thing" cua Vuang Khang Dudng gdm cie vi: Hoang ky 16g, Nhan sim (Cit lim) 6g, Bach truit 12g, Thuc dja 12g, Bach thugc 12g, Mach mdn 8g, Tran bi 8g, Bin ha (chi) 12g, Cam thao 4g, Thing ma lOg, Sii h i 8g. Cie vj thude duge kiem djnh tai khoa duge cua Benh vien dat tieu chuan duge diin Viet Nam IV.
Thuoc uong 1 thang / ngay sic chia lam 2 lin udng 2. Ddi tu'gng: 35 benh nhan duge diiu trj ndi tru trong 1 thing tai khoa Ndi va khoa Ngudi cd tuoi benh vien Y hpe Co truyen Trung uang.
2.1. Tieu chuin lam sang: chpn benh nhin dya theo hudng dan chin doan TNTHNMT cua Pham Khue (1993)[1]. Chpn nhu-ng benh nhan ed tong so diim tCr 23,9 diem trd len.
2.2. Tieu chuin can lam sang: Chpn nhung
miu nao, HA > 145/90 mmHg, rdi loan tim thin, ed eic bdnh cap tinh khic.
3. Phu'ang phip
Phuang phap thu- nghiem lam sing, so sinh ty ghep cap trude v i sau diiu trj.
3.1. Cac chi tieu theo doi 3.1.1. Chf tieu theo ddi lam sang:
Cac tridu chCrng ehu quan: duge danh gia bing diem theo bang chin doin TNTHNMT cua Khadjev [1].
3.1.2 Chf tieu theo ddi can lim sing:
* Luu huyit nao do: thdi gian nhinh len a, ty le a/T (X%), ehf sd luu huyit A/C, he so mit doi xCrng giii-a hai ban eiu, the tich miu qua bin ciu nao trong mdt phut (Vml/ phut/ ban eiu).
* Didn nao do: bien dp, tan sd, ehf so % eua eic sdng.
* Sinh hoi miu: Ure, creatinin, SGOT, SGPT
* Cdng thu-e miu: so lugng hong cau, bach eiu, tieu eiu, huyet s i c to...
3.2. Theo YHCT: Dya theo tCr chin de quy nap benh nhan theo 3 the:
* The ty hu dam tre: diu ludn cing dau, choing vang, toi sim, hoac diu ning m i nhCrc, ngudi met mdi ning n i m i nguc bung budn diy, buon ndn, chin an, chat ludi beu, reu ludi tring, mach trim hoat hoac nhu hoat
* The khi huyet ludng hu: vang diu hoac co cam giic diu nhu trong rong, chdng mat, hoa mit, lam vide qui sCrc dau d i u , chdng mit tang len, hdi hop hay quen, mit ngu, met mdi, hai thd ngin, i n kem, diy bung, s i c mat nhgt, reu ludi tring mdng, chit ludi nhgt, mach te nhuge.
* The ean than am hu: chdng mat, ving diu, tai Ci, hpng khd, bCrt rCrt it ngu, ngu hay me, lung goi nhCre mdi, chat ludi dd khd, reu ludi ving mdng, mach t i sic.
3.3. Phwong phap danh gia kit qua 3.3.1. Dinh gia k i t qua lim sing theo YHHO
- Dya v i o bang diim cua Khadjev so sinh kit qua diem sau OT va so vdi trude OT d i dinh gii:
biin doi cie thdng sd trdn luu huyit nio do, dien nio do, sinh hda, huyit hpe trude v i sau diiu trj.
3.3.3. Dinh g i i k i t qua theo YHCT: phin loai kit qua A, B, C, 0 theo thang diim Khadjev doi vdi cie thi benh eua YHCT.
3.4. Xwlyso lieu: theo phuang phip thing kd y sinh hpc Epi infp 6.04
III. K^T QUA
I.Dac diim chung cua nhdm nghien cu'u -Gidi: Nam 19/35 bdnh nhan (54.3 %). Nu-16/35
Bang 2. Mii'c do phuc hdi lam sing ddi vd'i tipng t h i benh theo YHCT benh nhin (45,7%)
Tuoi trung binh: 59.9 ± 12
Die diem v i hin, nhidt; hin: 12/35, nhidt:
10/35, hin nhiet thic tap: 13/35.
Bang 1. Sy biin ddi diim lam sang theo tieu chuin cua Khadjev
Diim trung binh
TOT (n = 35) 29,26 ± 2,68
SDT (n = 35) 12,86 ±3,8 p<0,01
Cie thi theo YHCT So BN
Tdt (A) Kha (B) Trung binh(C)
N Ty If % Ty le % Ty le %
Khi huyit hu Ty hu dim trd Can than hu
Cdng
13 10 12 35
1 0 1 2
7,7%
0%
8,3%
5,7 %
8 6 7 21
61,5%
60%
58,3%
6 0 %
4 4 4 12
30,8%
40%
33,3%
34,3 %
Bang 2 cho thiy sau q u i trinh diiu trj, mCre dp benh tren lim sing duge cai thien rd ret, trong dd kit qua khi chiem ty Id cao nhit (60%). Thude ed tic dung vdi t i t ca benh nhin nhung vdi mCre dp khie nhau, trong dd mCre dp phuc hoi cua the ty hu dim tre khdng cao bing hai t h i kia.
3. Kit qua can lam sang
Bang 3. Sy biin ddi cac thdng sd cua lu'u huyit nao dd Dao trinh
Chi tieu
Thdi gian nhinh len a
Chfsomaeha/T(X%) Vml/phut/bin eiu
H* cA 1^
F TOT(n 0,221 ±
28,798 ±
161,69 ± 34,41 ±
- M (Tran - Chum)
=35) 0,022
P<
2,127 P<
19,89 4,72
P<
SDT (n=35) 0,197 ±0,024 0,05
25,738± 2,082 0,01
188,7± 23,59 13,76 ±3,92 0,05
M TDT(n 0,222 ±
28,722 :
35,93 ± - 0 ( C h
=35) 0,023
P<
1:2,15 P<
4,58 P<
um - Chim) SOT (n:
1
=35) 0,201± 0,025 0,05
26,029 ± 0,05
12,97 ± 0,05
2,074
3,82
Kit qua d bang tren eho thiy thdi gian nhinh len a, ehf sd mach a/T(X%) giam vdi p < 0,05; The tich Vml/phut/bin eiu ting vdi p < 0,01; He so bit ddi xCrng K giam vdi p < 0,05.
TCNCYH Phu trwong 74 (3) - 2011
T i n so (CK/gy) Bien dp (^v) Chf so (%)
Bang 4. Sy b
TDT 9,83±1,11 28,96±13,95
31,18±11,2
iin ddi sdng Alpha, Theta tren dien nao Alpha
SDT 9,89 ±0,8 34,13± 15,83
39,3± 11,94
P p > 0,05 p<0,01 p < 0,01
TOT 5,74± 0,62 17,52±11,64
14,26±7,71
dd nin Theta
SDT 5,75± 0,72 15,26±8,77 11,8717,45
P p>0,05 p < 0,05 p < 0,01 Kit qua bang tren eho thiy bii thuoc ed tic dung lim tang bien dp v i chf so sdng Alpha vdi p < 0,01;
lam giam bien dp v i ehf sd sdng ehim Theta vai P<0,05.
Cie chf sd sinh hoi: Ure, Creatinin, SGOT, SGPT trude va sau diiu tri thay doi khdng ding ke (P >
0,05) v i diu d trong gidi han binh thudng.
4. Tic dung khdng mong mudn: trong suit q u i trinh diiu tri, ehung tdi khdng thiy xuit hien nhCrng tic dung phu nhu: diy bung, sdi bung, dai tien Idng, min ngCra ngoai da, HA tang q u i 145/90 mmHg.
IV. BAN LUAN
Nhin chung cie vj thuoc trong bai cd tic dung bo khi huyet, dudng am, kien ty, trCr dam nen d i oil thien dugc cie trieu ehCrng eua TNTHNMT nhu:
dau diu, chdng mat, met mdi, mit ngu, Ci tai [3 4]...
do khi huyit hu, i m hu, ty hu dim tre giy ra.
- Sau 1 thing diiu trj, kit qua d bang 1 eho thiy:
diim trung binh eua benh nhin trude dieu trj la 29,26 ± 2,68, diem sau diiu tri l i 12,86 ± 3,8 (p <
0,01). Kit qua bang 2 eho thiy t i t ca 35 benh nhin thude tit ea cac t h i lim sing theo Y hpc co truyin diu cd kit qua cai thien ve lam sing d cie mu-c dp khic nhau.
- Cie vj thude Nhin sim, Hoing ky cd tic dung lam giin mach vinh v i mach nio, chdng ngung tip tiiu ciu, ha md miu [5], do dd lim cai thien tuin hoin nao. Kit qua d bang 3 eho thiy bii thude ed tic dung lim giam truang lye mach miu nio, ting dp din hdi eua thinh mach, ting luu lugng tuin hoin nao v i diiu ehfnh sy tudi miu giii-a eic viing cua nio [6].
Kit qua trdn dien nio do eho thay bii thuoc
"ieh khi dieu vinh thang" ed tic dung lam tang bidn dp v i chf so nhjp sdng Alpha v i giam bien dp eung nhu ehf sd Theta. Diiu dd ehCrng td bii thude ed tie dung phuc hdi trang thii hoat hoa eua vd nio d nhii-ng benh nhin TNTHNMT.
V. KiT LUAN
Bii thude "ieh khi diiu vinh thang" cd tie dung cai thien cie trieu ehCrng eua thiiu ning tuin hoin nao man tinh trdn lam sang:
- So diim lim sing theo Khadjev giam xuong ro ret tir 29,26 ± 2,68 xudng 12,86 ± 3,8
- Bii thude ed t i c dung tot doi vdi ea 3 the theo y hpc ed truyin.
Bii thuoc cd cai thien tuin hoin nio tren mdt sd chf tidu can lam sing:
Tren luu huyet nao dd: giam truang lye mach miu nio, tang chf sd luu huyit, ting luu lugng mau nio Vml/phCit/ban ciu, he so mit doi xCrng hai bin ciu giam.
Trdn dien nao dd: tang bien dp v i chf sd phin tram sdng Alpha. Giam bien dp v i chf sd phan trim sdng ehim Theta.
Sau 1 thing diiu trj khdng thiy xuit hien tie dung phu tren lim sing cung nhu khdng thiy biin ddi cie ehu-e nang sinh hda cua gan v i thin.
TAI LIEU
THAM
KHAQ1. Pham Khue (1987). Thiiu ning tuin hoin nio, Y hpe thye hinh, sd 4, 25 - 32.
2. Dao Phong Tin, Trin Le Minh, Pham Khue, Doan Yen (1987). Gii trj chin doin cua dien nio do va luu huyit nao do trong thiiu ning
4. Chu Qudc Tru'd'ng (1996). Nghien cCru lim monograph on selected medicinal plants, Volum 1, sang thiiu ning tuan hoin nio man tinh giai doan 50-58, 67-76, 168-194.
dau theo y hpc co truyen va dieu trj bing phuang 6. Joseph Donald Easton, Stephen L.Hauser, phap bim huyet, Luin i n phd tiin sy khoa hpc y Joseph B. Martin (1998). Cerebrovascular dugc, Hpc vien quan y. diseases, Harrison's principles of internal
5. World Heath Organisation (1994). WHO medicine, 14th edition, 2325 - 339.
Summary
EVALUATION ON TREATMENT EFFECT OF THE REMEDY
"ICH KHI DIEU VINH THANG" IN CHRONIC CEREBROVASCULAR INSUFFICIENCY TREATMENT
Objective: To evaluate the remedy "Ieh khi dieu vinh thang" in the treatment of chronic cerebrovascular insufficiency. Subject and methods: 35 patients sufered from chronic cerebrovascular insufficiency were treated in 1 month by Ich khi dieu vinh thang. Evaluation of clinical results was based on Khadjev table of chronic cerebrovascular insufficiency. Paraclinical results were evaluated by cerebral rheography and electroencephalography. Result: After one month treatment, clinical degree based on Khadjev table was reduced from 29.26 ± 2.68 to 12.86 ± 3.8. Laboratory tidings of cerebral rheography and electroencephalo- graphy were improved. There were no side effects observed. Conclusion: The remedy has good effect in treating cerebrovascular insufficient patients.
Keywords: chronic cerebrovascular insufficiency, ich khi dieu vinh thang