Tqp chi THdNG TIN Y DlfQC So 8 ndm 2012
sau gd dinh cao 80,6%, trong do tii6ng cd 2 VTC Id 68 ca (59,6%), thong 1 vdi Id 24 ca (21%).
- Trong so 593 BN nU VS cd 148 ca cd thai sau md (25%). Trong so co thai, aS thai sau can thiip VTC chiem ty le cao nhdt (35,8%).
T A I LIEU T H A M KHAO
1. B$ mdn PhM san - Tru'dng D9I hpc Y Hit N$l:
Ogt cirtJng vS v6 sinh. B^i gidng sdn piifi klioa. Niid XuStbdn Yiigc, 2006, t.219-220.
2 B$nh vl^n Pht^ Sin Trung Udng: ChSin dodn vd dl&u trj v6 sinh. Tdi il$u luV iidnh n0l b$. Ntid XuSt tidn Y hgc Hd N&, 2003.
Nguyin Du'c Hinh: PhSu thu§t n$i soi trong phu khoa. Bdi gidng ph§u thu$t n0l sol 6' bi^ng. Niid Xuit bdn Yhi?c, 2004, tr. 165-179.
Trgn Quae Vl|t: Nghien culi d|ic diSn hlnh dnh tSc voi tnJtig irSn phim chgp tir cung v6i tnihg cb dfit dii& vdi phiu thu^ nOl sol fS bgng. Lij$n vSn t^n^ii^bdcsy diuyinkhoall Tn/^D^iiigcYHd 1^,2004.
Rabaw E. et al: An evaluation of etiologic Actors and therapy In 665 infertile coupes. Fertiity and Sterility, 1981, 28, pp. 718-721.
NakagawB IC, Yamano &: iBpaiuEosp/ shoik] be strongly (xnslcfered fix v\omen with unscplained infertily. J OtBtEt3nci(^Tieco.Rei2C05, vcl33eto5,pp66^€7asi
NGHIBV CliU BAG D i ^ U\M SANG Rfiil LOAN TAM THAN (T BOIH N H A N BENH PHOI TAC NGHBU MAN TINH
Cao Tiin D&c, OoQuySt', Tran Thf Hii", Nguyen Thf Thu Hu'dng*"
T O M T A T
Myc tiSu: nghien cuii bleu hien lam sing roi loan tam than d tienh nhin (BN) benh phoi tic nghen man tfnh (BPTNMT). Doi tu'ang vi phu'dng phap: nghien cuii mo ti dt ngang 39 tru&ng hdp bi BPTNMT dieu tri noi tru tai Benh vien 103 td thing 9/2009-9/2011. Ket qua: roi loan tram cam 56,4%, r& loan chu y 87,17%, roi loan tn nhd 74,35%, roi loan giac ngu 76,92%, roi loan lo iu ddn thuan gip 30,76%, roi loan tram cim - lo au gip 28,2%, roi loan y thdc gip 5,12%. Kei lu$n: r& loan tam than d BN BPTNMT khi cao.
SUMMARY
Research o n m e n t a l d i s o r d e r c l i n i c a l f e a t u r e s i n p a t i e n t s w i t h C h r o n i c o b s t r u c t i v e pulmonary d i s e a s e ( C O P D )
Obejectives: To study mental disorder clinical features in patients with COPD. Methods: a cross descriptive study was conducted on 39 cases diagnosed with COPD in the Military Hospital 103 &om September 2009 to September 2011. Results: Depressive disorder 56.40%, attention deticrt disorder 87.17%, memory disorder 74.35%, sleep disorder 76.92%, anxiety disorder 30.76%, anxiety-depressive disorder 28.20% and consciousness disorder 5.12%. Conclusions:
The rate of mental disorder In patients with COPD Is rather high.
~' " ' ~~ T l i u chudn lu^ chpn: BN dap utig t l u I . DAT VAN DE
BPTNMT la benh ho hap man tinh. Ty le mSc benh tdng dan theo tuoi, diln bien man tinh ngdy cdng ndng them, benh con anh hu'dng den hoat dpng tdm than vd chu'c ndng tdm ly [6].
Tuy nhien, cho tcfi nay d Viet Nam dn\ia cd nghiin ciiU ndo v l van d l rdi lo?n tam than d BN bi BPTNI*1T. Oe gop phan chdm soc ngUdi benh toan diln, ndng cao chat lu'dng cupc song cho hp, Chung toi tien hdnh nghien ciili de tdi nay nham: nghien culi bleu hien lam sang roi loan tdm than d BN BPTWMT.
I I . D O I T U O N G VA P H U O N G PHAP I. Ddi tu'dng nghiin cuti Gom 39 BN bj BPTNMT d i l u tri npi tru tai Benh vien 103 tiT thang 9/2009-9/2011.
chuan chan doan BPTNMT theo GOLD 2001 [6].
- Tieu chuan loai \iif: BN BPTWMT cd tien su* bi roi loan tdm ttidn, 06 benh cd the ndng khdc kem theo, BN khong hdp tac tham gia nghien aili.
2. Phu'dng ph^p nghien cuV 2.1. Thiet ke nghiin cdu: mo td cdt ngang.
2.2. Tien hinh:
Thu thap so lieu (cd benh dn nghien CLTU theo m l u rieng).
- Phu'dng phap chan dodn BPTNMT: ti'eii chuan chan dodn theo khuyen cao cua Vien Tim, Phoi, Huyet hpc My 2001 [6].
Hdi bertfi, kh&n lam sang ho hap va toan ttidn, tim hiSj cac yaj to nguy cd. Chup X-<iuang phoi, do thOng khi phS, ghi dien tim va xet ngWem cong thiit mdu.
'PGS.TS., Benh vien 103; "ThS., Dai hoc Y Thai Binh;""BSCKlI., Benh vign Trung Ucfng Quan doi 108
Tap chi THONG TIN YDlfQC So 8 ndm 2012
PhUdng phap nghien culi roi loan tam than:
Tham kham tam tiian tare tilp tren BN vd tim hieu tien sir, benh sCrva cdc bilu hien roi loan tdm than qua ngUdi than vd ngUcfi xung quanh BN.
Tieu chuan chan dodn cac roi loan tdm than tfieo ICD-10 (1992) [2].
2.3. Xdl}^so lieu: i^ng phan mem ^Di Info 6,04.
I I I . KET QUA
Tufii truig tiih 69,9: nam 35 iS9,7^/o\ nu'4 {lOpSP/o).
- Phdn nhdm BN BPTNMT theo glal doan benh: nhdm IIA 10 (25,64%), nhom IIB i 4 (35,90%) va nhdm I I I 15 (38,46%).
Bang 1: Thdi gian mac benh
——^^^^^^^^^ B^nhnhSn This Qian (nim) — . _ 1-5
6-10 11-15
>15 Tonq
SL 20 12 4 3 39
n %
51,28 30,77 10,26 7,58 100 Thdi gian mdc benh tu" 1-5 ndm chiem 51,28%
Bing 4: Ty le cic rdi loan tarn than theo giai
Bing 2: Thdi gian hut thudc li (Mdc tfnh trung binh: 20 dieu/ngay)
_ _ _ _ ^ B^nhnhSn Thdi gian (nim) - - — ___
Khonq hiJt thuoc Id
<10 11-20 21-30
>30 Tonq
SL 7 2 10 7 13 39
7 Z % 17,94 5,10 25,64 17,94 33,38 100 T y le n g U d l k h d n g h i i t t h u o c Id c h i e m t y le rat thap (17,94%)
Bang 3: Die dii'm lim sang cic RL TT
— _ _ _ _ ^ B4nh nhSn RLTT ~~ -__
Roi logn chii y (RLCY) Roi loan tri nhd (RLTN) ROI loan trSm cam (RLTC) RSi loan lo au (RLLA) Roi loan t r i m cam-lo au (RLTC-LA) RSiloany thLrc(RLYT)
SL 34 29 22 12 11 2
7 1 % 87,17 74,35 56,41 30,76 28,20 5,12 Rdi loan chii y, tri nhd, tram cam chiem ty le cao.
doan benh '~~~~~-~...^idoan
RLTT^~~~^^^
RLCY RLTN RLTC RLLA RLTC-LA RLYT
HA (n=10y SL
5 2 3 0 0 0
TL%
50 20 30 0 0 0
IIB(n=14y SL 14 12 9 3 3 0
71%
100 85,08 64,28 21,42 21,42 0
ni
SL 15 15 10 9 8 2
fn=lS}"' 71%
100 100 66,67 60 53,33 10,33
P' p'"' P '
<0,05
<0,05
<0,05
<0,05
>0,05
>0,05
<0,05
>0,05
Ty le cac roi loan tam than tang dan theo mire dp nang ciia benh.
Bing 5: Rdi loan fam than theo tiidi gian bj benh
6-10 (n=12)" >11 (n=7)"'
<0,05 <0,05 >0,05
<0,05 <0,05 <0,05 57,14 <0,05 <0,05 Ty le rdi loan tri nhd, roi loan chii y, tram cam Ip
Bing 6: Phin tfch cac triiu chutig co lien quan den dam dm
~~~' —,^^^____^ Benh nhan Trieu chutjg
Cam qiac tjuon tronq trai Mat hoac giam thich thu Chonq met moi h o l e cam thay duSi siJc Kho tap trung chii y
Tir ti mac cam, xa lanh xa hoi Cam t h l ^ dian gShg ho3c nghT den cai d i e t Sdchet
Bi quan ve tu'dng lai R£» loan qiac nqO Chanan, 3n kh6ng ngon mieng Met moi
SL 19 16 39 34 18 14 5 17 30 39 39
7 1 % 48,71 41,03 100 87,27 46,15 35,90 12,82 43,59 76,92 100 100 Met moi, duoi su'c, chan an, khd tap trung
y, mat ngu gap ty le cao.
au tang dan theo thdi gian mac benh.
Bang 7: Dac diem trang tiiii cam xuc cua BN
• — — — _ _ _ _ _ _ _ ^ Benh nhan Trieu chihig ~ — - — - ^ _ _ Canq t h i n q
Bon chon Met moi Ac monq
SL 12 11 39 12
7 1 % 30,76 28,20 100 30,76 Met mdi chiem ty 11 cao trong trang thd cdm xuc ciia BN.
Bang 8: Die diem rdi loan giac ngu
"" B^nh nhan Trieu diventi ——__
Ngu it Ngu ga Mqu nqav Nqu nhiSu Ac monq
SL 16 17 23 14 12
7 1 % 41,03 43,59 58,97 35,89 30,76
T^p chi THdNG TIN YDlfQC
••••^ w ,
S3 8 ndm 2012
Cdc kl^u rdi loan giac ngii hay gdp: ngii ngay, ngii it, ngii nhleu, ac mong.
I V . BAN L U A N
- Trong ntidm nghien ciiU: Nam gidi gdp ty 1^ cao gap 9 Idn nQ' gidi, tuoi trung binh 69,9, so ll^u ndy phii hi;fp vdl nghien culi ciia cdc tdc gid khdc. Cdc tdc gid deu cho rSng BPTNMT thu'dng gdp d ngudi cao tu6i. Hau het BN hiit thudc td, ty 11 BN khdng hut thudc Id thdp, dieu ndy phu iidp vdi nh§n djnh cua Td chu'c Y te The gidi cung nhu nhllu tac gia khdc, hut thuoc Id mOt y l u td nguy cd mSc b?nh cao.
- 0$c di§n cdc rSi l o ^ tdm tiidn d BN nghign ouU:
Rdi loan trdm cdm: bi^u hl^n tdm trying buon ba, cdm giac trdng trdi g$p 19/39 BN chiem ty l§ 48,71%. Met mdi, buon ba Id do tinh tr^ng khd thd keo ddl, benh t i l n tri^n m?n tinh ngay cang ndng t h i m vd tinh trang met mdi ndi chung. BN ludn trong tinh trang khd chju, cdm thay dudi su'c, cdu bdn, gdt gdng.
De bi kich thich dii chi la kich thich rat nhd.
Hoat ddng han che, it van dpng, di lai chdm chap hdn. Khdng lam dUdc viec. Neu cd co gdng lam viec tiii hieu qud rang vile, nang suat cdng vile khong cao, chdng met mdi. Khi bat dau cong viec tiiudng phai ed gang rat nhleu mdi lam dUde.
Rdi loan giac ngii: mat ngii gdp 30/39 BN nghiin eiilj. Trong dd bleu hien mat ngu, ngii it, thay khd vao giac ngii ban d i m , ngii khdng sau, de tinh giac, khd ngii trd lai, gap dc mong khi ngu, thirc day sdm.
Mpt so khdc lai phdn dnh tinh trang luon buon ngii, them ngii ca ngay. Odi hdi BN can phdi ngii, n l u khdng dUdc ngii hp cdm thay khdng tinh tao, dd dan.
Mpt so nghiin culj \ ^ roi loan giac ngii d BN BPTNI»4T Oidy rdng eae roi loan \re giac ngii Id do ede rdi loan chut nang cd tiie gdy ra [1,3]. Dac bilt rdi loan giac ngu cd lien quan den mii'c dp khd thd va nong dp dxy trong mau dpng mach.
Cdm giac b/ ti mac cam la txeu hiln chiing toi gap d nhdm BN dii&n tir 43,59-46,15%. Trang tiidi bi quan >« tutfng lai diem 43,59%. BN tiiuflhg od y nghT benh cua minh rat ndng, sap c h ^ vd b'nh ti^ng ndy khdng nhutig khdng khdi ma ngay cang ndng them nen BN rdt bi quan v l tutfng lai oia minh.
Hdi ehuTig fram cdm dien hinh it gdp, do nd thudng bj che lap bdi nhilu trieu chuhg khdc, nhieu roi loan khac. Tuy nhien bang nhieu cdng cu khac nhau ngUdi ta co the phat h i l n ra tram cdm mdt each tUdng doi chinh xac.
Trong cac RLTT thUc t o n , bieu h i l n roi loan tram cam lo au thudng ket hdp di cung nhau rat phd bien [ 1 ] .
Lo ldng ve b^nh t$t cung Id m$t trong nhiJng nguyin nhdn gdy buon chdn. Hdn nu:a, tudi cao thudng k l m gidm vj t h l cung lam cho BN cdm thdy bi quan hdn [4].
Cdc rdi to^n lo du Idm dnh h u t ^ tcfl edm giac ktid thd vd gdp phan lam tdng m i i t dp khd thd, gdp phdn ldm suy gidm chut ndng hd hap. Theo Mishima M., Oku Y., Muro S. vd c^ng sU 2001 [5], tri^u chuhg lo du cung tdng len khi mut d$ khd tiid cung tdng len. BPTWKT ldm tdng nguy ed to au, ddc bilt Id d nhdm BN ndng. Rdi logn ti^m cam-to du ehii y l u xudt h l ^ d nhdm BN BPTNtAT ndng.
BN ddl khi cd y nghT rdng cdi e h ^ se gidi ttiodt eho minh, chiing tdi gdp 35,9% BN da cd y nghT den cdi chSt, ddl liic hp cdm thay chan sdng, tuy nhien chiing tdi khdng gdp trudng hdp ed hdnh vl t i / sdt cung nhu' khdng cd ke hoach chinh xdc d l thut hi^n hdnh vi tiT sat.
Khd tap trung chii y g^p 34/39 BN chiem 87,17%. Cdm thay dudi su'c gdp 100% eae trUdng hdp, mpt so BN phdn ndn rdng nhieu liic hp cdm thay chdn ghet bdn thdn, khdng cdn t u qu^ trpng bdn than.
Rdi loan trf nhd gdp 29/39 BN, chiem 74,35%, BN hay q u l n , khd tiep thu cai mdi, doi khi nhd nham. Roi loan trf nhd xdy ra do sU tap tmng chii y khdng tot.
V. KET LUAN
Nghien cull ddc diem Idm sdng rdi loan tdm than d 39 BN bj BPTNMT, txidi tnjng binh 69,9±6,1, chiing tdi thay BN cd cac roi loan tdm than sau: roi loan tram cdm 56,4%, roi loan chii y 87,17%, rdi loan tri nhd 74,35%, rdi loan giac ngii 76,92%, rdi loan lo du ddn thuan gdp 30,76%, rdi loan tram cam - lo du gdp 28,20%, rcH loan y thii-c gdp 5,12%.
T A I U E U THAM KHAO
1. B$ mdn tSm th^n vi tSm l<^ y hpc: Roi lo^n tam than thyt ton. Wpc vt^ QuSn y, Niia Xuat bdn Quin dgiNtiSn dSn, 2002, tr.13-16.
2 T 8 chiirc Y te Thf gidri: phan lo^i benh quoc ^ lan thif 10 (ICD-10). Geneva, 1992.
3 Bui XuSn Jkm: B#nh h3 hSp. Niid XuSt ban YtHJC, Ha flia, 1998, tr.600-645.
4 Nguygn Vi$t: Tam than hpc. fliha Xuat ban Ytmc, Han&, 1984, tr.115-118.
5. Mishima M., Oku Y., Muro S vd CS.: Relationship between dyspnea in daily life an psydio-physiokigic states in pabens with chronic obslnictive pulmonary disease diiing kxig-lsnn oxygen theraphy. Inter-med.
Jun, 2001,35(6),pp.458-468
6 National Hear^ Lung and Blood Institute:
Global Strategy for the Diagnosis, Management and Prevention (GOLD) of COPD, 2001. Available from:
littp://wvm.gotda^.org/. Updated: Decembs- 2011. Accessed: 7/2012.ff
