Xác định mối tương quan giữa các test in vitro và in vitro trong chẩn đoán nguyên nhân viêm mũi dị ứng

BAN LUAN

Benh nhan trpng nghien ciru ciia chung tdi phan Idnja

cd tuci cao (tuoi trung binh la 61 tuoi, cac nhat la 96 tuPi),

vd chu yeu la eae trudng hop suy hd hap cap trung binh yd

nang. Chung tdi khdng lay nhdm benh nhan suy- hd hap

nguy kjch hoac cd ehi dinh dat ndi khi quan va thdng khi

xdhi nhap ngay tCr dau.

Nghien ciru eua ehung tdi chp thay CPAP giup cai thien

-ddng ke ve lam sang va khi mau a benh nhan phii phoi cap

huyet ddng. Sau khi thd CPAP 30 phiit, tan so thd va nhip

tim da cai thien dang ke (nhip thd giam tu 35,7 ± 3,78

xucng 26,7 ± 3.76 vdi p< 0,01 - nhip tim giam tir 139 ± 15,2

xupng 116,2 ± 13,63 vdi p < 0,01). Nhip thd nhanh va nhip

tim nhanh trcng phu phoi cap thudng la phan ung dap ung

de bCi lai tinh trang thieu cxy. Khi benh nhan thd qua nhanh

lai ed tac dung khdng tct len thdng khi phe nang. Trpng suy

hd hap cap, do met co hd hap nen benh nhan thudng thd

ndng vdi the tich luu thdng thap dp vay thudng chi cd tdc

dung tang thdng khi khoang chet, edn thdng khi phe nang it

cai thien hoac tham ehi cdn bi giam khi benh nhan thd qua

nhanh [6]. Tac dung cai thien nhip thd nhanh va nhip tim

nhanh da gian tiep phan anh tac dung cai thien mirc dp suy

hd hap cCing nhu cai thipn thdng khi phe nang khi thd

CPAP. Ket qua phan tich khi mau thuc su eho thay pxy

trcng mau ddng maeh da dupc cai thien dang ke sau khi

thd CPAP 30 pliut (Pa02 tang tir 68,7 ± 21,7 len 127 + 55,1

vdi p < 0,01). Ap lye rieng phan eua CO2 trcng mdu dpng

mach (PaC02) phan anh tinh trang thdng khi phe nang,

PaC02 giam la bieu hien eiia tinh trang tang thdng khi phe

nang va ngupe lai [7]. Benh nhan phu phoi cap nang, met

CP he hap, giam thdng khi phe nang thudng ed PaC02 binh

thudng heae tang [1,6], Khi thd CPAP, PaC02 da giam

dang ke tu 36,8 ± 8,7 xucng 32,2 ±7,1 (p = 0,024). PaC02

giam lam tang pH mau, tuy nhien pH mau khi thd CPAP vin

d trpng gidi han an tpan ehe phep (7,45 ± 0,07) [6].

Huyet ap eua benh nhan dupc giCr cn dinh trpng khi thd

CPAP. Thuc su Id tinh trang tang huyet dp phan irng cua

benh nhan cd xu hudng dupc cai thien khi thd CPAP tuy

chua du cd y nghTa thong ke (huyet ap giam tu 162.5 ± 29.2

xucng 148,9 ± 22,54 vdi p> 0,05). Chiing tdi khdng gap

trudng hop nac bi tut huyet dp khi thd CPAP. Tac dung phu

gay tut huyet dp dp giam tuan hpan trd ve khi thdng khi

nhan tao dp lue duong thudng hay gap d benh nhan bi

giam the tich ldng maeh [1]. Benh nlian phii phci cap huyet

dpng thudng ed the tich Idng mgch binh thudng hoge tang.

Han nCra, tae dung giam tuan hedn trd ve eua CPAP Igi ed

tac dyng Idm giam bdt phu phci.

Trpng SP 31 bpnh nhdn nghien cuu, ehiing tdi ehi gdp

duy nhit mpt trudng hpp thd CPAP that bai do khdng hpp

tac va cd suy than phai dat ndi khi quan va chay than nhan

tao. 30 benh nhan cdn lai (96.7% sc benh nhdn nghien ciru)

tuy phan Idn bi suy hd hap cap mire dp trung binh hpac

nang deu thedt phu phdi cap va tranh phai dat ndi khi quan.

Thdi gian thd.CPAP trung binh la 5,0 ± 1,68gid. Hau het

benh nhdn deu thedt phu phdi va che phep ehuyin khdi

khea cap ciru sau 10,4 ± 1,91 gid. Chiing tdi chi gap mdt

vdi bien ehirng nhp nhu dd da mat (5 trudng hap), xung

huyet kit mac (2 trudng hop), chudng hoi da day (3 trudng

hap) va khdng cd anh hudng dang ke den qua trinh thd

CPAP.

Han che cua nghien ciru la khdng cd nhdm chirng, dp

vay nghien euu chi md ta va sc sanh trudc va sau thd

CPAP. Tuy nhien cac kit qua ve cai thien lam sang va khi

mau trong nghien ciru eiia ehung tdi kha tuang ddng vdi

nhdm benh nhan thd CPAP trong cae nghien ciru ngiu

nhien va cd nhdm chirng cua cac tac gia Au My (2,3,7).

K^T LUAN

Thd CPAP hd tra trong dieu tri phu phci cap giiip cai

thien nhanh ve lam sang va khi mau, gdp phan han che

phai dat npi khi quan .

Ky thuat thd CPAP dan gian, d i ap dung vd khdng gap

eae tac dung phg hay bien chirng dang ke.

TAI LIEU THAM KHAO

I.VLI Van Dinh, Nguyin Thj Dy: nguyen ly thuc hanh

TKNT. Nha xuat ban y hpe nam 1995.

2.Bersten AD, Helt AW va cs: Treatment of severe

cardipgennie pulmenary edema with centinupus ppsitive

airway pressure delivered by face mask. N Engl J Med.

1991; 325: 1825-1830 (medline)

3.L'Her E, Duquesne F va cs: npninvasive cpntinpus

positive airway pressure in elderiy cardiogenic pulmonary

edema patients. IntensCare Med 2004;30(5):882-888

4.Giaeomini M, lapiehinp G vd cs: shert-term

npninvasive pressure suppprt ventilatipn prevents ICU

admittance in patients with acute eardicgenic pulmenary

edema. Chest. 2003:123: 2057-2061

5.Liesching T, Kwck H va es: acute application pf

noninvasive pcsitive pressure ventilation. Chest 2003;

124:699-713.

6.Lprraine B .Ware Michael A. Matthay: Acute

hyppxemic respiratory failure: pulmenary edema and acute

lung injury. Critical Care;576-587.

7. Rasanen J, Heikkila J vd cs: continuous positive

airway pressure by face mask in acute cardigenie

pulmenary edema. Am J Cardiol. 1985; 55 (4): 296-300

(medline)

XAC DjNH MOI TUONG QUAN GIUA CAC TEST IN VIVO VA IN VITRO

TRONG CHAN DOAN NGUYEN NHAN VIEM MO I Dj llfNG

TRAN THAI SON, PHAM QUANG HOAI,

PHAM VAN THLTC, PHUNG CHf THIE N

TOM TAT :

Dat van di: Xac djnh dwgc nguyen nhan gay Viem

mui dj irng (VMDU), nhat la tim dwgc di nguyen gay

benh, de dwa ra cac bien phip diiu trj la rat cap thiit.

Cic test in vivo va in vitro thwdng dwoc ap dung de

chuan doin VMDU. Muc tieu: Xie djnh moi twang quan

giu'a cic test in vivo va in vitro trong chan doan nguyen

nhan VMDLf. Doi twang vi phwang phap nghien ciru:

Gdm 100 benh nhan dwgc chan doin xac dinh VMDU

khim vi diiu trj tai Benh vign Trwdng Dai Hoc Y Hal

Phdng va Khoa khim benh Vien Y Hgc Bien Viet Nam

va 100 ngwdi khde manh, khdng cd tiin sir dj img.

Nghien ciru md ta cdt ngang, ddi chimg. Kit qua: Test

lay da cd do nhay (73%o), test ndi bi (82%,), phan irng

Y HOC THl/C HANH (727) - SO 7/2010 45