Đánh giá ưu và nhược điểm của phẫu thuật sọ não không cạo tóc

xuong cot.

Tam am giao: la huyet giao nhau cua 3 kinh am d

chan, ed tae dung tru thip do dd ed tac dyng giam dau

rit tdt.

Phac dd huyet nay la phii hgp vdi chCrng dau lung

do the phong han thip.

2.2.Chl do kich thich huyet

* Trong cham eCru eung nliu trong cham giam dau va

cham te, mudn kich thich huyet dugc tdt trudc hit phai

cham dugc " Dac khi". Nlu nhu khi cham khdng dat

dugc dac khi thi khi tang cudng dp kich thich bpnh

nhan khong thl chiu dung dugc vi qua dau. Mgt khac

khi mudn kieh thich huypt de nang cao hieu qua dilu tri

cung nhu nang cao ngudng dau trudc tien la phai tang

tin sd. Mpt sd tac gia eho rang khi dung xung dipn d tan

sd thip 2- 5 Hz chi cd tae dyng hogt hda vung dudi ddi

va tuyen yen tilt ra p-endorphin, trong khi dd kieh thich

vdi tin sd cao tren 10 Hz khdng chi cd tac dyng hoat

hda hp Opiat, ma cdn hoat hda ca cac he thdng chdng

day khac, Nham tao ra su canh tranh dudng din truyin

giO'a cac xung dpng phat ra tu cac huyet kich thich va

cac xung dpng truyen cam giac dau do dau lung gay ra

d cac mu'c khac nhau trong hp thin kinh trung uong. Su

bien dpng chuc nang trong he thin kinh trung uong

(thdng qua biln ddi dipn the) va keo theo la su tang tilt

cac chit cd tac dyng ngan chan cam giac dau nhu (3-

endorphin, dynorphin, serotonin, cateeholamin (ehu ylu

la adrenalin) va aminobutyric axit dugc xem la can cu'

d l giai thich co che giam dau do dipn cham theo con

dudng than kinh - the djch. Trong cdng trinh nghien cu'u,

chung toi da dung chi dp kich thich huyet vdi tin sd 10

Hz la theo kinh nghipm cua Giao su Nguyin Tai Thu va

kinh nghipm cua chung tdi trong qua trinh dilu tri vi khi

kich thich vdi tin sd cao qua cd tac dyng giam dau rit

tdt nhung trong trudng hgp dieu tri chung dau lung nlu

kich thich vdi tin sd qua eao se gay hien tugng co cu'ng

CO va benh nhan se bi met sau khi cham. Theo chung tdi

day la vin dl rit dang duge cac nha cham cuu, cham te

quan tam ap dung vac thuc tien tren lam sang. Vi thdi

gian cd han nen chung tdi ehua tiln hanh nghien eCru

cac chi dp kich thich d tin sd khac nhau dugc, nlu cd

dilu kien thi dl tai se du'gc tilp tyc nghien cCru them d l

lam sang td vin d l nay hon.

v l SU' dyng cudng dp kich thich huyet tuy theo tieng

huypt va tirng bpnh nhan chung tdi su dyng cudng dp d

mCrctdi da ma bpnh nhan chiu dugc thudng la 15-30|iA.

Viec SU' dung cudng dp nay cung gidng nhu cac tac gia

da sCr dung.

K^T LUAN

1. Dac diem lam sang:

^ Trong 52 bpnh nhan bi dau lung do the phong han

thip Chung tdi thay:

- Ty le bpnh nhan nam vS nti' la tuong duong nhau

gap d mpi lira tudi, nhilu nhat la ICra tuoi > 60 chiem

25%) va ICra tudi 20 - 29 tudi chiim 25%.

- Bpnh nhan lao dpng chan tay ehilm 70.8% cao hon

so vdi benh nhanjao dpng tri dc (29,2%).

2. Ket qua dilu tri:

Trong 52 bpnh nhan dau lung thl phong han thap

dugc dieu tn bang dipn cham cac huyet: Giap tich Li -

Si, Trat bien xuyen Hoan khieu, Uy trung, Than du, Tam

am giao cho kit qua: logi A la 80,77%; logi B la 13,46%>;

loai C la 5,77%); khdng cd kit qua logi D.

- Theo thang dilm Schober: 84,61%) benh nhan trd

v l muc binh thudng (0 dilm).

- Theo thang dilm Neri: 65,38%) bpnh nhan trd ve

mu'c binh thudng (0 dilm).

- Dp ngCra cpt sdng tang 15° so vdi trudc dieu trj,

trong dd cd 85% bpnh nhan trd ve muc binh thudng.

- Dp nghieng phai cpt sdng tang 18° so vdi trudc

dieu tri, trong dd cd 88%) bpnh nhan trd v l mii'c binh

thudng.

- Dp nghieng trai cpt sdng tang 20,1° so vdi trudc

dilu tri, trong dd cd 95% bpnh nhan trd v l mCrc binh

thudng.

TAI LIEU THAM KHAO:

1. Vu Quang Bich (1997). Phdng va chO'a cac chirng

bpnh dau lung, Nha xuat ban Y hpc Ha Npi, tr. 137-139.

2. Ngd Thanh Hdi (1995). Nghien cii'u gia tri cac tripu

chung va tieu chuan lam sang thoat vj dTa dpm cpt song

thit lung, Lugn an PTS khoa hpc Y - Dugc, Dgi hpc Y

Ha Npi.

3. Pham Khue (1988).Dung thudc Nam chO'a mpt so

benh thdng thudng: Dau xuong khdp, cpt sdng, Tgp chi

y hpc quan sg, sd 02 Cyc Quan Y, tr. 35-57.

4. Nguyin Tai Thu (1984). Cham ciru chO'a bpnh,

nha xuit ban Y hoc Ha Npi.

5. Nguyen Tai Thu, Tran Thuy,(1997). Cham ciru

sau dgi hpe, nha xuat ban Y hpc Ha Npi.

6. Anton Hayasuriya. (1989).The scientific basis of

acupuncture, Second enlarged edition, Srilanka.

7. Bures J., Petran M., Zachar J.(1960).

Electrophysyological methods in biological research.

Prague.

8. Chen R.S,(1977). Enkephalin, drug addiction and

acupuncture.Amer, J. Chin.med. Vol. 5, p. 25- 30.

DANH GIA UU VA NHlTUC DIEM CUA PHA U THUAT SO NAO KHONG CAO TOC

DONG VA N H E

Khoa PTTK, Benh vien Viet Diit

TOM TAT

Muc dich: Danh gia Uu nhuge diem cua viec khdng

cao dau trong phau thuat sg nao va t^ le nhiim khuan

sau md.

Phuang phap nghien cdu: Md ta tie'n cdu 100 benh

nhan dugc phau thuat sg nao bdi mdt phiu thuat vien,

tai Khoa Phiu thuat Than kinh, Benh vien Viet DUc, Ha

Ndi tu thang 11/2006 tdi thang 7/2007. Tat ca benh nhan

deu dugc gdi dau bing xa phdng trudc khi mo va khdng

phai cao dau. Phiu thuat vien phi cit tdc theo dUdng

rach da ngay trong phdng md, rCra sach bing nudc va

sat trung bang povidine. Phiu tquat, dieu tri khang sinh

va thay bSng, cit chi dugc tien hanh theo phac do

thudng qui cOa Khoa PTTK. Danh gia tinh trang nhiim

16 Y HOC THirC HANH (667) - SO 7/2009