- Lidn quan mire (JO b iiu hidn Her-2 vdi giai (Joan bdnh

Khdng c6 su khde bidt v i b iiu hidn Her-2 d cdc giai (Joan bdnh TNM khde nhau <Jd dupe chung minh d nh iiu nghidn cuu. K it qud cua cdc tdc gia cGng d iu cho thdy khdng cd su khde nhau v i b iiu hidn Her-2 d nhdm di cdn xa vd khdng cd di cdn xa; nhdm di cdn hach vd khdng cd di cdn hach; nhdm u dd ra thanh mac vd chua ra thanh mac [4], [6], [7], [8], [9] Nghidn cuu cua chung tdi cOng cho k it qua tuong tu.

k £t l u AnTy 1$ b iiu hidn Her-2 3+, 2+, 1+ vd 0 Idn lupt Id

12,8, 10,5 vd 76,7%. T u ii gidi, kich thudc u vd giai doan bdnh Id cdc y iu t6 khdng lidn quan d in b iiu hidn cua Her-2. Cd nh iiu y iu t6 lidn quan d in muc dd b iiu hidn cua Her-2 nhu th i md bdnh hpc, muc dd bidt hda cua kh ii u tuy nhidn d iiu ndy chua dupe Idm rd trong nghidn cuu cua chung tdi vl cd m iu cdn hgn ch i. Cdn tudn thu chdt che cdc budc trong quy trinh nhudm Her-2 d i cd k it qua chinh xdc.

TAl LIEU THAM KHAO1. Parkin DM, Bray F, Ferlay J, et al. Global cancer

statistics, 2002. CA Cancer J Clin. 2005; 55:74-108.2. Bang YJ, Van Cutsem E, Feyereislova A, et al.

Trial Investigators. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro- oesophageal junction cancer (ToGA): a phase 3, open- label, randomised controlled trial. Lancet. 2010; 376: 687-697.

3. Ld V iit Nho, Trdn Vdn Huy, Ddng Cdng Thugn, Ta Vdn Td. Nghien cuu su b iiu Ip Her2 d benh nhdn ung thu da ddy. Y hpc TP. Ho Chi Minh, tap 15, phg ban cua s i 2, 2011 .trang 47-53.

4. Ling Shan, Jianming Ying, Ning Lu. HER2 expression and relevant clinicopathological features in gastric and gastroesophageal junction adenocarcinoma in a Chinese population. Diagnostic Pathology 2013, 8:76.

5. Nguyen Vdn Thdnh, Ldm Thanh Cim. Ddc diem biiu hien Her2 tren carcinom tuyen da ddy. Y hoc TP. Ho Chi Minh, tdp 15, phu ban cua so 2, 2011, trang 43-46.

6. Park Dl, Yun JW, Park JH et al (2006). Her2/neu amplification is independent prognostic factor in gastric cancer. Dig Dis Sci 51: 1371-79.

7. Raziee HR, Kermani A T, Ghaffarzadegan K, Shakeri MT, Ghavamnasiri MR (2007) Her2/neu expression in resectable gastric cancer and its relationship with histopathologic subtype, grade and stage. Iranian Journal of basic medical sciences. 10(2): 139-145

8 S.D. Xie, C.Y. Xu, J.g Shen, Z.N. Jiang, J.Y. Shen, B. Wang. HER 2/neu protein expression in gastric cancer is associated with poor survival Molecular Medicine reports 2: 943-946, 2009

9. Gravalos C, Mdrquez A, Garcia- Carbonero et al (2007). Correlation between Her-2 overexpression/amplification and clinicopathological parameters in advanced gastric cancer patients: s prospective study. Gastrointestinal cancers symposium 130 (Abstr 89)

10. Tanner M, Hollmen M, Junttila TT et al (2005). Amplification of Her-2 in gastric carcinoma: association with toipoisomerase lia gen amplification, intestinal type, poor prognosis and sensitivity to trantuzumab. Ann Oncol 16: 273-278.

11. Hdi giai phiu benh - T i bdo hpc Viet Nam. Hudng d in xdt nghidm Her2 trong ung thu vu vd ung thu da day (2013). Nhd xu it ban Y hpc.

DANH GIA KET QUA BlfftC DAU GAY TE DAM R0I THAN KINH CANH TAY Dllft HtftifNG DAN CUA SIEU AM

t 6 m t AtMuc tidu: Ddnh gid hidu qud bis&c d iu thuc hidn

gdy td ddm r6i th in kinh cdnh tay dudi h ir in g ddn cua sidu dm.

0 6 i tirgng vd phuong phdp nghidn ciru: Vdi 30 bdnh nhdn p h iu thudt chi trdn tu cdnh tay ddn bdn tay, khdng c6 chdng chi dinh cua gdy td ddm rdi th in kinh cdnh tay, ASA 1,11. Tudi tu 16 d4n 81 t$i Bdnh vi$n Trung uong Hud tu 8/2011 ddn 2/2012. B$nh nhdn duyc gdy td ddm r6i th in kinh dudng lidn co b$c thang dudi hudng d in cua sidu dm. Mdi bdnh nhdn du<?c tidm 20 ml lidocain 1% vd 150mcg adrenaline, sau dd ddnh gid uc chd cdm gidc vd v$n ddng theo thang d iim Hollmen, ghi nh$n d iu di cdm, thdi gian ch i/ tdc dung uc chd cdm gidc, v$n ddng, thdi gian ire chd cdm gidc, v$n ddng, t i Id thdnh cdng vd bidn chimg xdy ra.

NGUYiN VIET QUANG Khoa Gdy md Hdi sue A bdnh vidn Trung uomg Hue

Ket qud: Thdi gian chd tdc dung uc chd cdm gidc trung binh 5,30±1,53 phut, thdi gian chd tdc dung ire chd vdn dong vdn ddng trung binh Id 17,76±3,58 phut, thdi gian ire chd cdm gidc trung binh Id 123,46±12,64 phut, thdi gian ire chd vdn dong trung binh la 152,33±15,41 phiit, ti Id thdnh cdng: 96,70% tdt, 3,30% khd, khdng cd trudng hop ndo phdi chuydn phuc/ng phdp vd cdm. Khdng c6 bien chimg ddng tide ndo xdy ra, chi c6 mdt trudng hyp vd bao th in kinh vi bom dp lt/c qud m^nh.

K it ludn: Gdy td ddm rdi th in kinh dudng co bac thang dudi hudng d in cua sidu dm ti Id thdnh cong cao chidm 96,70% tdt, 3,30% khd. Ti Id ndy cao hon ky thudt kich thich th in kinh co, gidm thdi gian chd tdc dung ire chd cdm gidc vd vdn ddng, tdng thdi gian uc chd cdm gidc vd vdn ddng, lidu lupng thudc td c in dungth ip .

Y HOC THI/C HANH (902) - S6 1/2014 21

SUMMARYObjective: To evaluate the effectiveness o f initial

implementation of untrasound-guided brachial plexus blockage.

Subjects and methods: In 30 patients undergoing upper limb surgery from arm to hand with ASA I, II, aged from 16 to 81 at Hue central hospital from 8/2011 to 2/2012. The untrasound-guided interscalene brachial plexus was performed with 20 ml of 1% lidocaine mixed with adrenaline 150mcg. The sensory and motor evaluated by Hollmen score, including paresthesia, the onset and duration of sesorry, motor blockage, the success rate and and complications were noted.

Result: The mean onset o f sensory and motor blockage were 5.30±1.53mins, 17.76±3.58mins. Mean duration of sensory and motor blockage were 123.46±12.64, 152.33±15.41. The success rate was 96.70% good, 3.30% quite good, no failures and major complication occurred in the study group. One cas has broken nerve sheath because of too strong pump.

Conclusion: The untrasound-guided interscalene brachial plexus blockage lead to a high success rate (96.70% good, 3.30% qiute good), a short onset and a long duration of sensory and motor blockage with the use of low volume of local anesthetic.

DAT VAN 0 £G3y td vung dudi hudng d in cua sidu dm Id m0t

phuang phdp tuang d li mdi. Tuy nhidn do tim quan trong cua n6 ndn da phat tr iln nhanh chdng. Phuang phap nay duac m6 ta nam 1978 nhung mai cho d in n3m 1990 mdi duac thuc hien. C6 nh iiu nghien cuu ve gay td vung dudi hudng d in cua sidu am, trong d6 gay td dam r6i th in kinh canh tay dudng lidn ca bdc thang, trdn xuang d6n, dudi xuang ddn hay dudng nach de phiu thuat chi trdn dudi hudng d in cua sieu am ia kha ph6 biln. G in day m0t so nghidn cuu v l hidu qua cua sidu am doi vdi l ly dudng chuyin tinh mach trung tam hay te th in kinh ngoai bien nhu th in kinh dui, th in kinh hdng...[4],[9], Vdi nhO’ng uu d iim cua sidu am va gidi han cua ky thuat kich thich th in kinh ca, tai Bdnh vien Trung uang H u l chung tdi ap dyng phuang phap nay nhim tang ti Id thanh cdng, hieu qua, an toan va giam tai biln. Chung tdi nghien cuu de tai nay nhim 2 muc tidu:

- Ddnh gid hidu qud cua gdy te ddm rdi than kinh cdnh tay du&ng lidn ca b$c thang du&i hu&ng dan cua sidu dm.

- Ddnh gid cdc b iin chirng cua gdy td ddm roi th in kinh cdnh tay du’&ng lidn ca bdc thang durOi huting d in cua sidu dm.

oOi Ti/aN G , PHU’cyNG phAp n g h ien cCru30 b£nh nhan phiu thuat chi trdn tu canh tay d in

ban tay duac gay td dam r6i th in kinh canh tay dudng lidn ca b$c thang dudi hudng d in cua sidu am, thuc hi$n tgi khoa Gay md H ii sue va khoa C hin doan hinh anh b£nh vi£n Trung uang H u l tu 8/2011 d in 2/2012.

1. Ddi tuang nghidn cuu1.1. Tidu chu^n li/a chQn bdnh nhdn Cdc bdnh

nhan phiu thudt chi trdn tu canh tay d in bdn tay. tuAi tu 15 trd Idn, ASA I,II, khdng cd ch lng chi dinh ciia gdy td ddm r6i th in kinh cdnh tay, ddng y gdy td vd hap tac vdi th ly thudc.

1.2. Tidu chuin loai t r ir Bdnh nhdn da chin thuang, chin thuang so ndo, tran dich. trdn khi mang phli, tiin su c lt phAi, s ic m it mdu. chin thuana nguc bgng kdm theo, bdnh nhan khd khdn v l giao tiep

2. Phuang phdp nghidn cuu2.1. Th iit k i nghidn ciru: Md td cdt ngang2.2. Cdc tidu chi ddnh gid- Trong luang ca th i, tudi, gidi, ch ilu cao, ASA.- Cdc loai ph iu thudt- D iu hidu dj cam- Danh gia thdi gian chd dai tac dgng ire c h i cdm

giac, vdn d0ng theo thang d iim Hollmen [1],* LTc ch i cam giac:+ Muc 1: Cham kim c6 cdm giac binh thudng + Muc 2: Cham kim c6 cdm gidc rO rdng tai mOt

d iim nhung y iu han bdn d6i di$n+ Muc 3: Chdm kim c6 cdm gidc nhu sd m6 + Muc 4: Chdm kim nhung cdm gidc khdng b ilt gi* l /c c h i vdn d0ng+ Mire 1: Vdn dOng ca binh thudng + Muc 2: Vdn ddng ca y iu nhe + Muc 3: Vdn d0ng ca y iu + Muc 4: M it vdn ddng ca Sau khi bam thu lc bdnh nhdn duac test uc chi

cam gidc b lng cdch cham kim d iu tu Idn tay phiu thudt. Test uc c h i vdn d0ng dua vdo su vdn d0ng cua ngdn cdi: dang, dudi, d6i ngdn cdi, g ip khuyu, g ip vd ngua cdng tay.

Danh gia thdi gian chd tac dung uc c h i vdn ddng, cam giac duac thuc hidn mdi phut sau khi bam thulc. Thdi gian b it d iu uc c h i cam gidc vd vdn ddng duac tinh d muc 2 cua thang d iim Hollmen [1],

Ddnh gia thdi gian ph iu thudt tinh tu luc rach da d in may da

Ddnh gid thdi gian uc c h i cam giac tinh tir luc bam thu lc td xong d in khi bdnh nhdn dau trd lai

Danh gia thdi gian uc c h i van ddng tinh tir luc sau khi bam thu lc td xong d in khi bdnh nhdn co ca trd lai

C h it luang giam dau: Cdn cu vdo cam gidc chu quan cua bdnh nhan qua tung thi ph iu thudt trdn ca sd ddnh gid muc d0 vd cam cua Bromage:

- T6t: bdnh nhdn hodn todn khdng cd c im gidc dau trong cdc thi ph iu thudt

- Khd. b£nh nhdn c6 cam gidc dau nhe d mdt sA thi ph iu thudt nhung chju dung duac do td chua hodn todn

- Trung binh. td khdng hodn todn, ph& dung thu lc giam dau

- Kdm: b$nh nhdn dau nh iiu khdng chiu dung duac phai chuyin d l i phuang phdp khde

Theo ddi mgeh, huy it dp, hd h ip trudc trong vd

22 Y HOC THI/C HANH (902) - S<5 1/2014

sau khi gdy tdL iy y k iin ddnh gid cua b inh nhdn: r i t hdi I6ng,

hdi Idng, khdng hdi Idng.Theo ddi cdc b iln chirng xdy ra trong m i vd 24

gid sau m i.2.3. Cdch tiSn hdnh nghi§n ciru- B$nh nhdn c6 chi djnh ph iu thudt chi trdn tir

cdnh tay d in bdn tay, bao g im ca m i chuang trinh vd c ip ciru.

- Bdnh nhdn n im ngua, quay d iu v i bdn d ii d iin 45 d i, sdt trung da vd chuin bj d iu d6.

Cdch t iin hdnh:+ Budc 1: O iu d6 sau khi duac bQC bdi bao d iu

d6 vd khuin, d iu dd duac d$t ngay bd trdn xuang ddn d i xdc djnh d ing mach dudi ddn theo mdt c lt ngang, luc ndy ddm r i i cdnh tay ndm trdn ngodi ciia d ing mach

+ Budc 2: Di chuyin d iu dd Idn trdn v i hudng sgn gidp theo dudng di cua ddm r i i th in kinh cho d in rdnh lidn ca bdc thang, ddm r i i du’ac xdc dinh bdi gidi hgn phla trudc Id ca ire ddn chQm vd ca bdc thang bd trudc, phla sau Id ca bdc thang bd giua.

+ Budc 3: Dua kim vdo trung tdm cua ddm r i i sau khi xuydn qua bao th in kinh

+ Budc 4: Bam thu ic td vd theo ddi qud trinh thu ic td di vdo bao Idm gidn ring bao th in kinh.

2.4. XCr ly s6 li$u: cdc s i liiu duac xu ly bdng phin m im MedCalc

k £t q u a n g h ie n clpu1. Ddc d iim cua bdnh nhdn nghidn cu>uBdng 1. Tu ii, ch iiu cao, cdn ndng cua bdnh nhdn

Ddc diim Trung binh T ii thidu T6idaTu6i 39,53 ± 20,01 16 81

Chidu cao 161,63 ± 10,46

140 178

Cdn ndng 60,36 ± 12,35 40 80

Bdng 2. Gidi tinh, ASA cua bdnh nhdnDdc didm S6 lu’Q’ng %Nam/NO 18/12 60/40ASA I/ll 8/22 26/74

2. Phdn loai phdu thudt

Loai PT S i luang bdnh nhdn %Gdy xuang cdnh tay 6 20,00

Gdy lidn li i ciu 5 16,50Gdy xuong quay 4 13,50

Gdy 2 xu’O’ng cdnh tay 3 10,00Seo co rut bdn ngdn 3 10,00Thdo phuang tidn 3 10,00

Gdy Gelaezi 2 6,70Gdy xuang try 2 6,70

Gdy xuang bdn ngdn 1 3,30Di>t gdn du5i 1 3,30

Ting 30 100Nhdn xdt: Trong nghidn cuu chung tdi cd nhiiu

loai phdu thudt, nh iiu n h it Id gdy xuang cdnh tay ch iim 20,00%, th ip n h it Id gdy xuang bdn ngdn vd dirt gdn dudi 3,30%.

3. Ddu dj cdmBang 4. TI Id dj cam cua bdnh nhdn

0<Jc didm S6 lirang bdnh nhdn

%

Di cam 09 30%Khftng di cam 21 70%

Nhdn xdt: 70% bdnh nhdn khdng cd di cam 4. Thdn gian chfr tdc dung uc chd cdm gidc vd

v̂ n ding

Thai gian (phut) Trung binh T6i thidu T6i daThdi gian chd tdc dyng

ire chd cam gidc5,30 ± 1,53 3 8

Thdi gian chd tdc dgng urc chd v$n dOng

17,76 ±3,58 12 26

Nhdn xdt: Trong n tdc dyng uc c h i cam

hdm nghidn ciru thdi gian chd gidc trung binh Id 5,30 ± 1,53

phut, th ip n h it Id 3 phut, cao n h it Id 8 phiit. Thdi gian chd tdc dyng ire c h i vdn d ing trung binh Id 17,76 ± 3,58 phiit, th ip n h it Id 12 phiit, cao n h it Id 26 phiit.

5. Thdi gian uc chd cdm gidc vd v$n dingBang 6. Thdi gian uc c h i cdm gidc, vdn ddngThdi gian (phut) Trung binh Min Max

Thdi gian ire chd cam giac

123,46 ± 12,64

90 145

Thdi gian i>c chd v£n ddng

152,33 ± 15,41

120 175

Nhdn xdt: Trong nhdm nghidn cuu cua chiing tdithdi gian uc c h i cam gidc th ip n h it Id 90 phut, cao n h it Id 145 phiit, trung binh Id 123,46 ± 12,64 phiit. Thdi gian uc c h i vdn d ing th ip n h it Id 120 phiit, cao nh it Id 175 phiit, trung binh Id 152,33 ± 15,41 phut.

6. Thdi gian phdu thu$t Bang 7. Thdi gian phdu thudt

Thdi gian _ (phut)

Trung binh T6i thiiu T6i da

Thdi gian PT 83,00 ± 39,03 30 150lian

ngdn, trung binh Id 83,00 ± 39,03 phut, ngdn n h it Id 30 phiit, ddi n h it Id 150 phiit.

7. Tai bidn

Loai tai bidn S6 luang %Tin thuong than kinh 0 0Chpc vdo mach mdu 0 0

H0i chirng Claude-Bemard-Horner 0 0Trdn khi mdng phdi 0 0

Chpc vdo khoang NMC, DN 0 0Vd bao thdn kinh 1 3,30

‘ ...... .................. J ’ ■ ’ — ■ ■ w * * w W U U W l I U I IV j I U I

khdng cd tai b iin ndo ddng t i ic xay ra, chi cd mot trudng hap vd bao th in kinh ch iim ty le 3,30%.

8. C h it luang gidm dau Bang 9. C h it luang giam dauDdc diim S6 luang bdnh nhdn %

Tit 29 96,70Khd 1 3,30

Trung binh 0 0Kdm 0 0

Y HOC THVC HANH (902) - S 6 1/2014 23

Nhan xdt: Trong nghien cuu cua chung tdi khdng c6 ca nao c6 ch it luang giam dau trung binh vd kdm, <3a s6 Id dat ch it luang t6t, chi c6 mot trudng hop dat ch it luang kha.

BAN LUAN1. Thd>i gian chd- tac dung i>c ch i cdm giac vd

vdn ddngTrong nhdm nghidn cuu 30 bdnh nhan cua chung

tdi thi thdi gian chd tac dung uc chd cam giac trung binh ia 5,30 ± 1,53 phut, thdi gian nay tuong duang vdi Vincent W.S. Chan, Anahi Perlas va cs ia 5,40 ± 1,80 phut (su dyng may sidu am de gdy te dam rdi th4n kinh canh tay), th ip han so vdi cac tac gia su dgng phuang phap gdy td dam rdi th in kinh canh tay bang may kich thich th in kinh ca nhu: tac gia Ali Movafegh, Mehran Razazian vd cs ia: 11 ± 4 phut [3],I. H. Mir va A. Hamid Id 10 ± 5 phut, Ali Movafegh, Behrang Nouralishahi va cs ia 10 ± 3 phut [2], A. Casati, F. Vinciguerra va cs Id 7,5 phut [8], Michael Felfernig, Marion Weintraud va cs 8,2 phut. B iiu nay ia r i t ly tudng vi rut ngdn thdi gian chd phiu thudt ma vdn dam bao uc che cam gidc dau.

Vdi thdi gian chd tdc dung uc chd vdn ddng trung binh trong nghidn cuu cua chung tdi Id 17,76 ± 3,58 phut gdn tuang duang vdi Vincent W. S. Chan, Anahi Perlas vd cs ia 16,70±5,50 phut. Nhung th ip han Ali Movafegh, Mehran Razarian va cs ia 22±8 phut [3],

Nhu vdy so vdi cac tac gia khac thi phuang phap gay td dam rdi th in kinh cdnh tay dudi hudng d in cua sidu dm trong nhdm nghidn cuu cua chung tdi cd thdi gian chd tdc dgng uc chd cdm giac va van ddng tuang duang.

2. Thd>i gian u>c chd cdm gidc vd vdn dpngThiri gian uc chd cam giac trong nhdm nghidn

cuu chung tdi Id 123,46±12,64 phut ddi han so vdi tdc gia I.H.Mir, A.Hamid vd cs ia 101 ±35 phut, Ali Movafegh, Mehran Razazian va cs ia 98±33 phut[3], Ali Movafegh, Behrang Nouralishahi va cs 68±7 phut[2],

Thdi gian uc chd vdn ddng ia 152,33±15,41 phut cao han so vdi tac gia I.H.Mir, A.Hamid va cs ia 125±30 phut, Ali Movafegh, Mehran Razazian va cdng su 130±31 phut[3], Ali Movafegh, Behrang Nouralishahi vd cs 89±79 phut[2],

Nhu vdy thdri gian uc chd cam giac va van ddng trong nhdm chung tdi cao han cdc tac gia tren. Cd le do mdu nghidn cuu cua chung tdi cdn it (30 benh nhdn) ndn cd su khde bidt ndy. Chung tdi se t iip tuc nghidn cuu thdm d i k it qua nghidn ciru cd gid tri han.

3. Ty 1$ thdnh cdngHidu qua giam dau trong nhdm nghien cuu cua

chung tdi ddnh gid theo Bromage thi muc dd tdt 96,70%, khd 3,30%. So sdnh vdi cac tdc gia khac nhu Kapral S, Greher M vd cs ia 99%, Hopkin P.M 95%[9], Stephan R.Williams, Philipe Chouina vd cs 95%, Bru R, Lupu M vd cs 92%[7]

Nhu vdy k it qua nghidn cuu cua chung tdi thdnh cdng tuang duang mdt s6 tdc gia nude ngodi. O ilu

ndy chung td gay td ddm rdi th in kinh cdnh tay dudi sidu am ia phuang phap khd ly tudng

4. T h i tich thudc tdTi Id thdnh cdng han 96,70% trong nhdm nghidn

clpu cua chung tdi vdi th i tich 20ml, tuong tu Arthur Atchabahian[5],

Mdt sd tdc gid khac dung th i tich th ip nhu Bnan D O Donnell, Gabrielle lohom vd cs Id 1ml/1 th in kinh[6], Hugh M.Smith, Christipher M Duncan vd cdng su Id 5ml (dudi hudng d in cua sidu dm) Chung tdi se nghidn cuu phuang phdp gdy td su dung liiu th ip trong nhung nghidn cuu t iip theo.

5. Ti Id tai biinTrong nghidn cuu cua chung tdi vdn 30 bdnh nhdn

khdng cd tai b iin ndo dang t i ic xdy ra, chi cd 1 trudng hap bj vd bao th in kinh do bam vdi dp luc qud manh. Vdi Brull R, Luppu M vd cs[7], Stephane R. William, Philipe Chouinard vd cs, Kapral S, Greher M, Huber G, Willschke H va cs h iu nhu khdng cd b iin chung, Vincent W. S. Chan, Anahi Perlas vd cs cd mdt trudng hap bj hdi chirng Homer trong 40 bdnh nhdn ch iim 2,5%. Nhu v iy vdi g iy td ddm rdi th in kinh cdnh tay dudi hudng d in sidu dm ti 1$ tai b iin r i t th ip.

K£T LUANQua nghidn cuu ddnh gia budc d iu gdy td ddm

rdi th in kinh canh tay dudi hudng d in cua sidu dm chung tdi nhdn th iy:

- Ti Id thdnh cdng cao- Giam thdi gian chd tdc dgng uc c h i c im gidc

vd vdn ddng- Tdng thdi gian uc c h i c im gidc, vdn ddng- Giam th i tlch thudc td- R it it b iin chung- Tuy nhidn cd han c h i Id ky thudt phai dupe

tiin hdnh d ca sd cd mdy sidu dm cd d iu dd ddc chung d i phdt hidn duac bd mgeh, th in kinh cOng nhu c ln cd bdc sT sidu dm cd kinh nghidm.

TAI LIEU THAM KHAO1. A. Jadon, M.R.Panigrahi, S.S. Parida,

S.Chakraboty, P.S.Agrawal & A Panda (2009), “Buprenorphine improves the efficacy of Bupivacaine in nerve plexus block", J Anaesth Clin Pharmacol. 25(2) 207-210.

2. Ali Movafegh, Behrang Nouralishahi, Mustafa Sadeghi, Omid Navabian (2009), “An Ultra-Low dose of Naloxone added to lidocaine or Lidocaine-Fentanyl mixtured prolongs Axilary Brachial Plexus blockade’ . A&A, 109(5)pp1679-1683

3. Ali Movafegh, Mehran Razazian, Fatemeh Hajimaohamadi and Alipasha Meyamie (2006). “Dexamethasone added to Lidocaine prolongs axillary brachial plexus blockade’ , A&A, 102(1): p263-267

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d Ac d ie n i l A m s a n g , c a n l Am s An g , k e t q u a DIEU TR! VA YEU TO T liN LUUNG BENH SOT XuAt HUYET DENGUE NGUU1 LON

t 6 m t AtB$t v in de: Sdt x u it h u y it Dengue Id mQt trong

nhCrng b$nh truyin nh iim quan trqng 6/ Vidt Nam. Tim h iiu nhCrng ddc d iim Idm sdng, c$n Idm sdng vd cdc y iu td tidn luxyng giup cho vi$c ch in dodn, d iiu trj sdm Idm gidm tl I$ tir vong cho bdnh nhdn.

Muc tidu: Xdc djnh ddc d iim Idm sdng, c$n Idm sdng, ddnh gid k i t qud d iiu tri theo phdc dd B0 Y t i vd tim h iiu cdc y iu t6 lidn quan d in tidn luxyng b$nh S6t x u it h uy it Dengue 6 ngu&i Idn.

Phuxyng ph ip nghidn ciru: M6 td cdt ngang, s ir di^ng bd KIT SD Bioline NS1, IgG/IgM rapid test d i xdc dmh nh iim virut Dengue, xdt nghi$m Hct, BC, TC, AST, ALT, Bilirubin mdu, PT, aPTT vd Fibrinogen, sidu dm.

K it qud: Nghidn ciru 146 bdnh nhdn SXHD: SXHD 45,2%, SXHD cd d iu hi$u cdnh bdo 48,6% vd SXHD ndng 6,1%, 100% bdnh nhdn SXHD cd sdt vd sdt cao dOt ngOt, s6 ngay sdt trung binh 5,9 ± 1,2 ngdy, tir 3-10 ngdy, C h im x u it h u y it ch iim 89,7%, xu it huy it nQi 1,3%, Gan to 13%, C6 ddc mdu 34,4%, TDMP 21,9%, TDMB 28%, PNTTM 28,7%, TC <10G/L ngdy 6-7 90,8%, BC gidm 64,71%. Khdi bdnh 99,3%, t ir vong 0,7%. D iu hidu t iin s6c: vdt vd- li b i 100%, dau bung nh iiu 11,1%, Ignh d iu chi 100%, nhidt d6 gidm ddt ngdt 88,8%, mi?ch >100 l in / phut 100%, gan to 33,3%, TDMP 66,6%, TDMB 77,7%, x u it h u y it tdng 33,3%, ndn nh iiu 22,2%. Yiu td tidn luxyng ndng: dau bung nh iiu 9,7%, vdt va- li bi 100%, lanh d iu chi 100%, mach > 100Uphut 41,1%, x u it h uy it gia tdng 100%, PNTTM 14,2%, TDMP 18,7%, TDMB 17%.

K it ludn: D$c d iim Idm sdng, c$n Idm sdng vd y iu t6 tidn luxyng giup cho vide ch in dodn, d iiu trj sdm Idm gidm ti I$ tu- vong cho bdnh nhdn vd d iiu tri SXHD theo phdc dd Bd Y T i dat k i t qud cao.

SUMMARYCLINICAL, PARACLINICAL FEATURES, RESULT OF

TREATMENT AND PROGNOSTIC FACTORS IN DENGUE HEMORRHAGIC FEVER IN ADULTS

Background: Dengue haemorrhagic fever is one of the important infectious diseases in Vietnam.

DOAN VAN QUYEN, NGO VAN TRUYIN

Studying the paraclinical, clinical characteristics and prognostic factors to diagnose and treat early reducing the mortality o f DHF.

Ojective: Determine the paraclinical, clinical characteristics and find out prognostic related factors to Dengue hemorrhagic fever in adults.

Method: Description, cross-sectional study, using the SD Bioline KIT NS1, IgG / IgM rapid test for determining dengue virus infection, testing Hct, leukocyte, platelet, AST, ALT, bilimbin, PT, aPTT and Fibrinogen, ECHO.

Result: Research 146 DHF patients: DHF 45.2%, DHF warning sign 48.6% and severe DHF 6.1%, 100% of DHF patients have fever and a sudden high fever, days of averaged fever 5.9 ± 1.2 days from 3-10 days, petechiae 89.7%, internal bleeding 1.3%, hepatomegaly 13%, high Hct 34.4%, pleural effusion 21.9%, peritoneal effusion 28%, edema of gallbladder 28,7%, platelet <10G / L the 6-7day 90.8%, Leukopenia 64.71%. Recovery 99.3%, mortality 0.7%. Signs before the shock: discomfort 100%, abdominal pain 11.1%, cold extremities 100%, sudden temperature drops 88.8%, pulse> 100 beats / minute 100%, hepatomegaly 33, 3%, pleural effusion 66.6%, peritoneal effusion 77.7%, increased bleeding 33.3%, vomiting 22.2%t. Severe prognosis factors: abdominal pain 9.7%, discomfort 100%, cold extremities 100%, pulse> 100 beats / minute 41.1%, increased bleeding 100%, edema of gallbladder 14.2%, pleural effusion 18.7%, peritoneal effusion 17%.

Conclusion: Understanding clearly the paraclinical, clinical characteristics and prognostic factors to diagnose and treat early reducing the mortality and treating DHF with guideline of Ministry of Health is good result.

DAT VAN OfcS6t xu£t huy£t Dengue (SXHD) Id bfenh do virut

Dengue gSy ra, di/g-c truy&n chu y6u do mu6i Aedes aegypti, xay ra nhi&u nai trfin th6 gidi, b$nh canh 6a dang, tir nhe <J6n n$ng, c6 th£ g£y tu- vong cao n£u khdng du’O'C ch in <Jo£n va <Ji&u tri s&m [5], [3],

V lToC THI/C HANH (902) - S6 1/2014 25