Nghien cifuikhoa hoc
Nghien cifu dac diem lam sang, hinh anh hoc than kinh va tien iu'dng cua nhoi mau nao
khu vUc dong mach nao giiJa
Doan Thi Huy6n*, Lg Van Thinh*
TOM TAT
Muc tieu: 1) Nghien cLfu dac diim lam sang, hinh anh hoc thin kinh cua nhii mau nao khu vuc ddng
mach nao giira. 2) Nghien ciiu mpt sd yiu td tien lugng cda nhdi mau nao khu vuc ddng mach nao gida. Boi tirang va phirang phap.- nghien ciiu tiin ciiu 112 benh nhan nhdi mau nao khu vuc dpng mach nao giua tai Khoa Thin kinh, Benh vien Bach Mai tu 01/11/2007 din 31/10/2008, md ta trieu ehiing lam sang, hinh anh hoc thin kinh. Dua vao hinh anh hoc chia nhdm benh nhan thanh hai nhdm benh nhan nhii mau nao dien rpng va nhdi mau nao gidi han, danh gia tinh trang benh nhan sau mpt thang diiu tri va phan tich cac yiu td tien lugng. Ke't qua va i<e't luan: tudi bi benh tren 45 tudi chiim 87,5%, nam/nO = 1,55/1. Cac trieu chiing hay gap la: liet niia ngudi (93,75%), rdi loan cam giac (82,14%), thit ngdn (58,93%), rii loan cd trdn (45,54%) va rdi loan y thiic (36,61%). Ty le di chiing la 91,98%, ty le td vong la 15,18%. Benh nhan nhdi mau nao dien rpng chiim ty le 56,25%, nhdi mau nao gidi han chiim ty le 43,75%, ty le nhdi mau - chay mau la 11,61%. Cd 13,39% benh nhan vdi diy du hinh anh phu nao gian tiip. Su khac biet vi cac trieu chiing lam sang, hinh anh hoc than kinh eua nhdm benh nhan nhii mau nao dien rpng so vdi nhdm benh nhan nhdi mau nao gidi han la cd y nghla thdng ke, vdip < 0,05. Cac yeu tddpc lap tien lugng xiu bao gim: nhii mau nao toan bp dpng mach nao giUa, rdi loan thin kinh thuc vat, rdi loan y thiic va hdn me giai doan toan phat. Cac yiu tddpc lap tien lugng tii vong la nhdi mau nao toan bp dpng mach nao giira, hdn me.
LDATVANDE
Tai bien mach mau nao (TBMMN) la benh cd vj tri quan trgng trong chuyen nganh thin kinb cung nhu trong y hgc. Tai bien mach nao gdm nhdi mlu nao, chay mau nao va chay mlu dudi nhen. Tuy theo ket qui ciia timg nghien ciru, ty le benb nhan nhdi mlu nao chiem khoang 80% trong
* Khoa Than kinh - Benh vien Bach Mai
tdng sd benb nban bi tai bien mach nao.
Dgng mach nao giira la nhanh tan Idn eua dgng mach cInh trong. Dgng mach nao giira cap mlu cho nhieu viing chirc nang quan trgng nhu van ddng, cam gilc va ele chiic nang cao cap ciia vd nao. Theo nhieu nghien ciiu trong nudc ciing nbu tren the gidi, nhdi mlu dgng mach nao giiia chiim
Nghien ciiu khoa hoc
ty le cao nhat trong ele the lam sang va nhdi mlu nao dien rgng do tdn thuong ddng mach nao giira ddng vai trd quan trong trong tii vong sdm va di chimg do TBMN.
O Viet Nam, vdi su tien bg ciia chan doln hinh anb nhdi mlu nao do tdn thucmg dgng mach nao giira da dugc nghien ciiu d nhieu khia canh ca lam sing, can lam sing, chan doln benh va dieu trj nhtmg chua di sau phan tich tdi tirng the lam sang v l hinh anh bgc than kinh cung nhu ele yeu td tien lugng. De thiet thuc hon trong cdng tic dieu tri, ngan ngiia cic bien chiing, eai thien mii-c do hdi phuc ebo benb nban, ehiing tdi tien hanh nghien ciiu de tii: "Nghien ciiu dac diem lam sang, hinh Inh hgc than kinb vl tien lugng cua nhdi mlu nao khu vuc ddng mach nao giiia" nham muc tieu:
1. Nghien cihi dac diem Idm sdng, hinh dnh hgc thdn kinh cua nhdi mdu nao khu viec dong mach nao giita.
2. Nghien cim mot sd yeu td tien luong cua nhdi mdu nao khu vuc dong mach nao giiia.
11. DOI T i r p G VA PHIiaNG PHAP NGHIEN CUU 1. Ddi tirong nghien cuu
Bao gdm 112 benh nban nhdi mlu nao do tdn thuang dgng mach nao giira tir 16 tudi trd len da dugc chan doln va dieu tri ndi trii tai Khoa Than kinh, Benh vien Bach Mai tii 1/11/2007 din 31/10/2008.
Tieu chudn lua chgn
- Cae benh nhan cd dau hieu than kinh khu trii do tdn thuang khu vuc cap mlu ciia ddng mach nao giira, tinh chat khdi pblt benh dot nggt, tdn tai qui 24 gid hoac gay tii vong trong vdng 24 gid.
- Chup eat ldp vi tinh sg nao va/hoac chup cdng hudng tir nao thay hinh Inh nhdi mlu nao d khu vuc tudi mlu eiia ddng mach nao giira.
Tieu chuan can lam sang la tieu chuin quyit dinh.
Tieu chudn loai tru
- Nhdi mau nao do chan thuong.
- Nhdi mlu nao cua ele ddng mach khlc khdng phai la ddng mach nao giira.
- Nhdi mau d khuyet.
2. Phirong phap nghien cuu
Phuong phap nghien cuu md ta cat ngang, tien ciiu.
Phuong phdp thu nhap sd lieu.
Chiing tdi sir dung mdt mau benh In nghien cuu thdng nhat.
Md ta cac dac diem cbung va trieu chirng llm sang, trieu chirng binh anb hgc.
Dua vIo hinh anh hgc, chia nhdm benh nhan thanh hai nhdm ddi tugng:
- Nhdm ele benb nhan nhdi mlu nao dien rdng: nhdi mau nao toan bg tii hai den ba khu vue nhanh mach ciia ddng mach nao giira (nhlnh ndng trudc, nhlnh ndng sau v l ele dgng mach sau).
- Nhdm cac benb nban nhdi mlu nao gidi ban:
nhoi mlu nao ttr dudi hai khu vuc nhlnh mach trd xudng. So sinh ele trieu chirng lam sing va hinh
anh hgc cua bai nhdm. [52]. ,,s:
Theo ddi dien bien benh va danh gia tinh trang benh nhan sau mdt thing, cd hai miic do can dinh gil: benb nhan tir vong hay khdng tir vong va benh nban tien trien nang hay tien trien tdt.
Phan tich sd lieu de tim ra ele yeu td tien lugng.
Phuong phdp xu ly sd lieu
- Lap bang, ve bieu dd de the hien ele ket qua nghien cuu.
- Xii ly sd lieu theo phuong pblp thing ke y hgc SPSS 16.0, STATA 10.0
- Tinh ty le phan tram, gil tri trung binh, dp lech chuan, so sanh hai gil tn tmng binh.
- Thuat toan khi binh phuong, Fisher de so sanh hai ty sd quan sit, tinb mirc y nghla p.
- Dung tbuat toln bdi quy logistic dan bien de phan tich tung yeu td tien lugng v l da bien de tim ele yeu td don dgc v l ele yeu td phdi hgp tie ddng den tien triin xau, tien trien tir vong ciia benh nhan. , ;.- , , -.
8 IY HOC LAM SANG So 42 (Thang 07/2009)
Nghien cii'u khoa hpc
III. KET QUA NGHIEN CUU 1. Dac diem lam sang
Bdng 1. Phdn bd benh nhdn theo tudi vd gidi
^^"--^-^^^^ Giffi Tuoi ^~~-~-^^^
Dual 25 25-34 35-44 45 - .54 55-64 65 - 74 Tren 74 Tong Tuoi trung binh
Nam So benh
nhan 1 2 7 13 16 17 12 68
Ty le % 1,47 2,94 10,29 19,12 23,53 25,00 17,65 100
Nir So benh
nhan 0 0 4 5 6 18 11 44
Ty le % 0 0 9,09 11,36 13,64 40,91 25 100
Tong So benh
nhdn 1 2 11 18 22 35 23 112
Tyle%
0,89 1,79 9,82 16,07 19,64 31,25 20,54 100 62,24 ± 13,66
Nhdn xet: phan Idn benb nhin duge nghien cuu tu tren 45 tudi (85,3%). Nhdm tuoi bay gap nhlt la 65-74 tudi (chiim 25,00%).
Bdng 2. Cdc trieu chiing lam sdng giai doan todn phdt cila hai nhdm benh nhdn .__^The nhoi mdu nao
Trieu chimg -^——____^^
Y thuc (Diem Glasgow)
Mirc do liet van dpng (theo Franklis)
Roi loan ngon ngir
Tren 12 diem Tir 8 den 12 diem Duoi 8 diem
0 1 2 3 4 5 That ngon Broca That ngon Wernicke That ngon toan bo Roi loan cam giac
Ban manh Roi loan ca tron
Con CO giat kieu dong kinh Roi loan tam than
Roi loan than kinh thuc vat
NMN dien rong n = 63(100%)
16 (25,4) 34 (53,97) 13 (20,63) 49 (77,78) 4 (6,35) 6 (9,52) 1 (1,59) 1 (1,59) 2 (3,17) 8(12,7) 5 (7,94) 30 (47,62) 59 (93,65)
13 (20,63) 42 (66,67) 2 (3,17) 10(15,87) 22 (34,92)
NMN giffi han n = 49(100%)
58 (51,79) 41 (36,61) 13 (11,61) 15 (30,61) 8 (16,33) 5 (10,20) 11 (22,45) 5 (10,20) 5 (10,20) 20 (17,86) 13 (11,61) 33 (29,47) 33 (67,35) 10 (20,41) 9 (18,37) 1 (2,04) 8(16,32)
2 (4,08)
Tong so n=112(100%) 42 (85,71) 7 (14,29) 0 (0,00)
64 (57,14) 12 (10,71) 11 (9,81) 12 (10,71)
6 (5,36)
93,75
%
7 (6,25) 12 (24,49)
8(16,33) 3(6,12)
58,93
% 92 (82,14) 23 (20,54) 51 (45,54) 3 (2,68) 18(16,07) 24 (21,43)
P
0,001
0,001
0,005 0,001 0,97 0,001
1,0 1,0
0,001 Nhdn xet: so sanh vdi giai doan khdi pblt,
benb nban ed bdn me giai doan toan phIt chiem ty le 11,61% v l tat ca cac benb nban hdn me deu bi nhoi mau nao dien rgng. Benh nban cd liet van dgng 93,75%. Ty le benh nhan liet
hoan toln (muc do 0) chiem ty le cao nhat (57,14%). Benh nhan ed rdi loan ngdn ngir chiem ty le 58,93%. Trong do, benh nhan ed trieu chu-ng that ngdn toan bg chiim ty le cao nhat (29,47%).
Nghien cii'u khoa hpc
Tyl#?
Miic do 1 Mflc do 2 Miic do 3 Miic dp 4 Miic do 5
Bieu do I. Miie do hoi phuc cua cdc benh nhan sau mot thdng dieu tri
Nhdn xet: ele benh nhan nhdi mlu nao do tdn thuang dgng mach nao giiia cd ty le hdi phuc holn toan (miic do 1) chiim ty le la 8,02%. Trong khi dd ty le benh nhan cd di chirng (mirc do 2 den mirc do 4) chiim ty le 76,78% vl ty le tir vong la 15,18%. CIc benh nhan nhdi mlu nao dien rdng ed ty le tu vong la 22,22%.
2. Dac diem hinh anh hoc than kinh ciia nhdm benh nhan nghien cuu
Bdng 3. Ty le nhdi mdu nao dien rang vd nhdi mdu gidi han khu vuc ddng mach nao giiia
Phdn loai cdc the nhoi mdu nao Nhoi mau nao dien rong
dong mach nao giira
N M N toan bo dong mach nao giira N M N hai nhanh mach dong mach
nao giCra
N M N giai han dong mach nao giira (duoi hai nhanh mach) Tong
So luong benh nhdn 30
33
4 9 112
Ty le % 26,79 29,46
43,75 100
Bdng 4. Ty le benh nhdn nhdi mdu nao chay mdu
^ ^ ^ The nhoi
^^^Hflw nao Nhoi mdu ^ ^ ^
chdy mdu ^ ^ ^ C6
Khong Tong
NMN dien rgng So benh nhan
9 54 63
Tyle%
14,29 85,71 100,00
NMN gidi han So benh nhdn
4 45 49
Tyle%
8,16 91,84 100,00
Ty le ehung So benh nhdn
13 99 112
Tyle%
11,61 88,39 100,00
Nhdn xet: ty le nhdi mlu chay mau d nhdm benh nhan nhdi mlu nao dien rgng ddng mach nao giira cao hon so vdi nhdm nhdi mlu nao gidi han (14,29% so vdi 8,16%).
Bdng 5. Hinh dnh phu nao gidn tiep
^^-^^ The nhoi
^^-^mdu nao Hinh dnh ^ ~ ^ ^ ^ phii nao gidn dep ^^^~^^^^
Ma hay mat ranh cuon nao Chen ep nao that ben Di lech duang giiia
Co tat ca cac dau hieu phii nao
NMN dien rong (n= 63) So benh
nhdn 33 23 13 13
Tyle%
52,38 36,51 20,63 20,63
NMN giffi han (n=49) So benh
nhdn 10
5 2 2
Ty le % 20,41
10,2 4,08 4,08
Tdng (11=112) So benh
nhdn 43 28 15 15
Tyle%
38,39 5,0 13,39 13,39
P
0,001 0,001 0,012 0,012
Nhdn xet: ty le benh nhin nhdi mlu nao dien rdng cd hinh Inh phii nao giln tiep tren phim chup eSt Idp vi tinh va/hoac cdng hudng tii cao ban ban nhdm nhdi mlu nao gidi ban.
1 0 IY HOC LAM SANG So 42 (Thang 07/2009)
Nghien cii'u khoa hoc ^
3. Phan tich m o t so yeu to tien lurnig nhoi m a u nao dong mach nao giCra
Bang 6. Phan tich hdi quy logistic da bien cac yiu to lien quan din tien lugng xiu sau mpt thang diiu tri
Bien phu thugc (tien lugng xau) Hon me (loan phat) Rdi loan y thirc (loan phat) Rdi loan than kinh thuc vat
Nhoi mau toan bo dong mach nao giira
Ty sudi chenh (OR) 8,1
6,2 4,9 7,2
Khoang tin cay CI (95%) Gidi han du6i
1,64 1,14 1,11 1,79
Giai han tren 35,2
24,15 22,17 29,1
P 0,002 0,003 0,012 0,005
Nhdn xet: nhoi mlu nao toan bd dgng mach nao giira, rdi loan than kinh thuc vat, rdi loan y thire va hdn me (giai doan toln pblt) II nhirng yeu td dde lap tien lugng xiu cho benb nban.
Bdng 7. Phdn tich hdi quy logistic da bien cdc yeu td lien quan den tien lugng tii vong sau mot thdng dieu tri
Bien phu thuoc (tien lumtg td vong) Nhoi mau toan bo dpng mach nao giira Hon me giai doan toan phat
Ty sudt chenh (OR) 34,1 21,8
Khoang tin cay Cl (95%) Giai han duoi
3,2 1,54
Giai han tren 364,0 308,4
P 0,003 0,023
Nhdn xet: nhdi mlu nao toln bg dgng mach nao giira va hdn me giai doan loan pblt II bai biin dgc lap doi vdi tien lugng tir vong.
IV. BAN LUAN
Trong mau nghien ciru ciia ehiing tdi, tudi benh nhan tii dudi 25 tudi den tren 75 tudi. Lira tudi hay gap nhat II tii 65 den 74 tudi chiem 33,93%. Benh nhan nam (61 %) chiem ty le cao ban benh nhan nii (39%), ty le nam/nir la 1,55. Ket qui nghien ciru nay phii hgp vdi ket qui nghien ciru ve nhoi mlu nao va nhdi mlu nao ddng mach nao giiia trudc day.
Trong giai doan toln pblt, ty le benb nhin ed diem Glasgow tren 12 diim la 51,79%, tii 8 diem tdi 12 diem la 36,61%, benh nhan hdn me sau, Glasgow dudi 8 diem la 11,61%. Ty le benh nhan ed rdi loan y thiie gan lien vdi muc do rdng ciia tdn thuang nao, dieu nay da dugc ehiing minh qua cac nghien ciru nhdi mlu nao dien rgng. Theo Hensius va edng sir, rdi loan y thire tren benh nhin nhdi mlu nao dien rdng ddng mach nao giiia 11 46%, hdn me la 12%. Ddng mach nao gitra ed nhieu nhanh, khdng phai liic nIo cung gap tdn thuang toan bg ddng mach nao giira, khong ed benb nhan nao bdn me trong nhoi mlu nao gidi ban II trieu chirng quan trgng de tien lugng benb nhan nhlt la khi chup phim chua thay ro tdn thuong.
Chiing tdi chia mirc do liet van ddng ra thInh nam mire do liet van ddng (theo Franklin), benb nhan cd liet van ddng tu miie do nhe den nang chiem ty le 93,75%, 7 benb nban khdng liet van ddng, chiem ty le 6,25%. Day la ket qua khlc vdi ele nghien eiiu trong nudc trudc day ve nhdi mlu nao do tdn thuong dgng mach nao gitra cung nhd ddi vdi he dgng mach canh trong, e l e nghien ciiu etia Le Van Thinh, Nguyin Hoang Hii, Nguyen Bac Son , Nguyen HoIng Nggc va cdng su idiu ed ket qua II 100% benb nban ed liet van ddng, ket qua nghien cuu eiia Vu Thi Nggc Lien la 97%. Ddi vdi nhirng tie gil nude ngoli, vdi sd lugng benb nhan Idn, nhdi mlu nao dien rgng cd 99% benh nhan liet van ddng, nhdi mau nao gidi ban cd 8 1 % benh nhan liet van ddng. Miie do liet van dgng giiia hai nhdm benh nhan la khlc biet c6 y nghia thdng ke nnung dti kicb thude nhd nhung tdn thuang holn toan khu vue bao trong se llm benh nhan liet hoan toln. Nhu vay, tren mdt benh nhan, liet hoan toan hay khdng hoan toln khdng t h i ndi len miic do Idn hay gidi ban ciia tdn thuong,
Nghien cii'u khoa hpc
nhung da sd benh nhin nhdi mlu nao dien rdng ed liet van dgng 96,83% v l liet d miic do nang 84,13%.
Benh nhan that ngdn chiem ty le 58,93%, mdt ty le kha cao, trong dd benb nban that ngdn toln bo 29,47%, thit ngdn Broca la 17,86%, that ngdn Wernicke la 11,61%. That ngdn bao gdm nhieu mirc do tir khdng hoan toln den holn toan. Nhdm benh nhan nhdi mau nao dien rdng ty le that ngdn cao ban rd ret vdi p < 0,05, trong dd that ngdn toan bg cd tdi 30 benb nhan vdi 47,62%. Ty le rdi loan ngdn ngir ehung ciia ca nhdm benb nhan phii hgp vdi ele nghien ciiu khlc. Tuy nhien vdi ele nghien eiiu nude ngoai, ty le benb nhan rdi loan ngdn ngii rat cao, nghien eiiu cua Hensius v l cong su cho ket qua tii tren 80% benb nhan vdi nhdi mlu nao ddng mach nao giira. Nghien ciiu nhdi mlu nao dien rgng cdn cd ty le cao ban nhieu, ciia Nguyen HoIng Nggc va cdng sir II 93,8%, ciia Hensius v l cdng sir la 100%.
Tdm lai, trong giai doan toan phIt, benh nhan nhdi mlu nao do tdn thuang ddng mach nao giira cd rat nhieu cic trieu chiing vdi ele mire do khlc nhau. CIc trieu chiing nay khdng die tnmg ebo ban than dgng mach nao giira cung nhu cho vdng tdn thuang nhu trieu ehiing ly thuyet. Tdn thuang Idn thi y thirc ciia benh nhan xau ban vl ty le gap ele trieu ehiing khae biet ro ret so vdi tdn thuong gidi ban vdi p < 0,05. Hensius va edng sir da tinh mdi lien quan giira ele trieu chiing lam sang va nhdi mlu nao dgng mach nao gitra, ket qua la liet nua ngudi, mat cam gilc tay mat, bin manh va that ngdn toan bg du doln dugc 3/4 trudng hgp nhdi mlu nao dien rdng ddng mach nao giiia.
Bieu dd 1 eho thay hai xu hudng rd rang: nhdi mlu nao dien rdng tien trien xau ban, ty le tii vong cao ban. Day la ket qua da dugc thi hien qua nhiiu nghien ciiu. Theo nghien cuu cua Hensius, ty le tii vong tren benh nhan nhdi mlu nao dien rdng la 17%, benh nhan nhdi mau nao toan bg ddng mach nao giiia la 22%. Trong nghien eiiu ciia ehiing tdi.
ty le tii vong tren benb nhan nhdi mlu nao dien rdng la 22,22%. Nhu vay, vdi day dii phuong tien cap cuu, phan loai dieu tri tdt, ty le benb nhan tii vong tai khoa tuong duong vdi trung tam Idn tren the gidi.-Dinh gil miie do hdi phuc ciia benb nhan dua vao tieu chi benh nhan dd cd trd lai sinh boat dugc binh thud'ng khdng nen phu thugc nhieu vao mue do hdi phuc liet v l y thire. Nhdi mlu nao dien rdng van cd benh nhan bdi phuc holn toln vl nhdi mlu nao gidi han van c6 benh nhan ttr vong va muc tieu ma ehiing tdi hudng tdi ehinh 11 di tim yeu td tien lugng.
Ty le nhdi mlu nao dien rgng dgng mach nao giiia la 56,25%, nhdi mlu nao gidi ban la 43,75%, trong dd nhdi mau nao loan bg ddng mach nao giira chiem ty le 26,79%. Theo nghien eiiu ciia Hensius, Donnan va Levi, 9% benb nhan nhap vien do TBMMN la nhdi mau nao dien rdng dong mach nao giira, mdt phan ba trong sd nay la nhdi mlu nao toln bd ddng mach nao giiia, 27% benh nhan nhdi mlu nao gidi ban. Nhu vay, trong mdt nam, ty le benh nban nhdi mlu nao dien rgng va nhdi mlu toan bg dgng mach nao giira den Bach Mai rat cao, Idn ban nhieu so vdi ele nghien cuu thdng ke.
Chung tdi cd 11,61% benh nhan nhdi mlu chay mlu trong nghien ciru. Ty le nay phii hgp vdi nghien ciru ciia Moulin T v l cong su, 209/1776 (11,77%) benb nhan nhdi mlu nao cap ehuyen dang thInh nhdi mlu chay mlu. Sir khlc biet giiia ty le benh nban nhdi mlu chay mlu trong nhdm benb nban nhdi mlu nao dien rdng va trong nhdm benb nban nhdi mlu nao gidi ban II cd y nghia thdng ke, ket qua nay minh chirng them nhdi mlu nao dien rgng la mot trong nhiing nguyen nhin gay nhdi mlu chay mau. Nhdi mlu chay mlu ed mot ty le nhat djnh (17,00%) bieu hien trieu ehiing lam sang nang len nbu mat y tbiic, nhtre diu, co giat kiiu ddng kinh. Nhu vay, nhdi mlu chay mlu gdp phan tang them tinh trang nang cua benb nhan.
1 2 I YHOC LAM SANG Sd 42 (Thang 07/2009)
Nghien cii'u khoa hoc
Tren phim chup elt ldp vi tinh va/ hoac phim edng hudng tii cd 38,39% md hay mat ele ranh cudn nao, 25% de ep nao that, 13,39% de day dudng giiia ddng thai ed dly du ele dau hieu phu nao tren. Benb nhan dugc chup phim sdm, khdng chup lai kiem tra cd the khdng thay dau hieu giln tiep pbii nao, hoac chup phim q u i mudn, giai doan chuyen sang di chirng. Phu nao lam eho tinb trang lam sang ciia benh nhan nang len. Ty le benh nhan nhdi mlu nao dien rgng phii nao cao ban nhdi mlu nao gidi ban, day la mot ly do de benh nhan nang len va benh nhan nhdi mlu nao dien rdng nang ban nhdi mlu nao gidi ban. Benb nban phii nao nhieu thudng xuat hien tren benh nhan tac mach nao dot nggt nhat la do nguyen nhan tir'tim, tien trien cap tinh v l trieu chirng llm sang nang ne. Nhan xet nay ciia ehung tdi tuong tu nhu nban xet eiia Nguyen Van Dang va HoIng Dire Kiel.
Nhirng yeu td dde lap tien lugng xau ebo benh nban II nhdi mlu nao toln bd ddng mach nao gitra, rdi loan than kinh thue vat, rdi loan y thuc, hdn me (giai doan toln phIt). Hai yeu td dde lap gay tii vong cho benh nhan la nhdi mlu loan bg ddng mach nao gitra va hdn me giai doan toln pblt.
Nghien eihi tren benh nhan nhdi mlu nao dien rgng ddng mach nao gitra, Hensius v l edng sir da thay cac yeu td doc lap gay tien lugng xau la nhdi mlu hoan toan dgng mach nao giiia, bin manh, rdi loan y thiic va hdn me. Ket qua nly ciing tuong tu nghien ciru eiia Henon H, Steiger. Ciing trong nghien eihi ciia Hensius, Henon H, Steiger, hdn me la yeu td dge lap gay tii vong. Tdm lai, nhdi mlu nao toan bd ddng mach nao giira va bdn me la nhirng yeu td tien lugng xlu v l tu vong.
V. KET LUAN
1. Dac diem lam sang va hinh anh hoc than kinh
Tud'i bi benh tren 45 tudi chiim 85,3%, nam/nii
= 1,55/1.
Trong giai doan toan pblt, ele trieu cbung hay gap la: liet niia ngudi (93,75%), rdi loan cam gilc (82,14%), that ngdn (58,93%), trong dd that ngdn toln bd la 29,47%, rdi loan co trdn (45,54%) va rdi loan y thire (36,61%).
Ty le di ehiing la 91,98%, ty le tir vong II 15,18%.
Sir khlc biet ve cic trieu cbung lam sang, ty le di chirng va ty le ttr vong eiia nhdm benh nhan nhdi mlu nao dien rgng so vdi nhdm benh nhan nhdi mau nao gidi han la cd y nghia thdng ke, vdi p < 0,05.
Tren hinh anh chup cat ldp vi tinh va/hoac chup edng hudng tir ebo thay nhdi mlu nao dien rdng chiem ty le 56,25%, nhdi mlu nao gidi han chiim ty le 43,75%.
Ty le nhdi mlu - chay mau la 11,61%, trong dd nhdm nhoi mlu nao dien rdng cd ty le la 14,9%
cao hon nhdi mlu nao gidi ban 8,16% vdi mirc y nghia p < 0,05.
13,39% benh nhan ed day dii binh anh phii nao giln tiep.
2. Cac yen to tien luong
Cic yeu td dgc lap tien lugng xau bao gdm:
nhdi mau nao loan bd dgng mach nao giiia, rdi loan than kinh thuc vat, rdi loan y thue va hdn me giai doan toan phat.
CIc yeu td dgc lap tien lugng tii vong II nhdi mlu nao toan bg dgng mach nao giiia, hdn me.
TAI LIEU THAM KHAO
1. Nguyen Hoang Hdi (2001), Nghien cuu chan dodn nhoi mdu nao dong mach nao giiia dieu tri tai Khoa Than Kinh, Benh vien Bach Mai, Luan vdn Tliac si y hoc. Dgi hgc Y Hd Noi.
2. Le Vdn Thuih (2004), "Nhoi mdu nao dien rong do ton thuang dong mach nao giira: dgc diem lam sdng vd nguyen nhdn", Hoi thao Khoa hoc Thdn kinh, Benh vien Bgch Mai, 2/12/2004, 158-165.
3. Nguyen Bdc San (1999), Doi chieu lam sdng vd hinh dnh chup cdt lap vi tinh ciia nhoi mdu nao dong mach nao gida, Luan vdn Thgc sJ y hgc, Dgi hoc Y Hd Ndi.
Nghien cii'u khoa hpc
4. Adams H.P, Zoppo CD, et al. (2007), "Guidelines for tiie early management of adult with ischemic
stroke", Stroke, 38: 1655-1711.
5. Heinsius T, Bogousslavsky J., Van Melle G. (1998),
"Large Infarcts in the Middle cerebral artery territory", Neurology 50:314-350
6. Warlow CP, Dennis M.S, Van Gijn J., Hankey G.J, Sandercock P.A.G., Bamford J.M, Wardlaw J.M.
(2001), "Stroke - A practical guide to management".
Second Edition, Blackwell Science Ltd,11-13, 118- 123, 301-324, 659-660.
SUMMARY
CLINICAL CHARACTERISTICS, NEUROLOGICAL IMAGING FEATURES AND PROGNOSIS OF THE MIDDLE CEREBRAL ARTERY TERRITORY INFARCTIONS.
Background and purpose: In stroke patients, middle cerebral artery (MCA) territory infarctions have a highest proportion (80%) and large MCA territory infarctions play an important role in early mortality and severe disability. The purpose of this study is determining clinical characteristics, neurological imaging and predictive factors of MCA territory infarctions.
Method: Studying 112 patients with MCA territory infarctions in the neurological department of Bach Mai hospital from 01/11/2007 to 31/10/2008. With clinical characteristics, neurological imaging, outcome at 1 month and analyzed predictive factors. Basing on neurological imaging, infarcts in the territory of the middle cerebral artery were assigned to two groups: large middle cerebral artery compared with limited middle cerebral artery.
Result: The proporatlon of age above 45: 87.25%; male/female: 1.55/1; hemiplegia: 93.75%;
hemisensory loss: 82.14%, global aphasia: 58.93%, incontinence: 45.54%; reduced consciousness:
36.61%. The proporatlon of disability: 91.98%, mortality: 15.18%, large MCA territory infarctions:
56.25%, limited MCA territory infarctions: 43.75%, hemorrhagic infarctions: 11.61%, cerebral edema: 13.39%. The difference of clinical symptoms and neurological Imaging of two groups was statistically significant (p < 0.05). Independent predictors of bad out come were complete MCA, automatic disorders, reduced conciousness and coma, independent predictors of death were com- plete MCA and coma.
Conclusion: MCA territory infarctions have a various clinical characteristics, neurological imaging and major predictive factors are complete MCA and coma.
1 4 IY HOC LAM SANG So 42 (Thang 07/2009)
