SUDUNG THANG DO VAS THONG DANH CIA MU DO DAU SAU PHAU THUAT KET HOP XUUNG DUI TAI DOH VIEN VIET Bit NGUYEN THI NGOC MAI, NGUYEN HUY PHUONG, IRAN TRUNG DUNG TOM TAT Muc tieu: MO te tinh trang dau sau phau thuat kat xuong a benh nhan gay xuceng theo thang di m VAS Nhan xet cac yeti t6 lien quan tai tinh trang dau sau phau thuat Doi tuong va phuong phap nghien ciru: Gam 50 benh nhan duor chin (loan gay xikyng va /for pilau thuat ket hop xuung tai benh vien Viet Dix Diem dau VAS duoc phan loai mUc CIO theo Salley L.Collens Xcy ly s6 lieu bang phan mem SPSS 16.0 Ket qua nghien cthi: Diem dau cc:La benh nhan duoc danh qia bang Mang diem VAS tai cac thdei diem — 12 gia, 12 — 24 gia, ther hai, thin ba sau phau thuat MUc dO dau giam den theo thai gian Ket luan: Tinh trang dau ctia benh nhan sau phau thuat Aei livp Awing Jul co tne itiong gia va theo dal bang thang diem VAS Dau sau pilau thuat ket hop xuonq crOi nang nhat thai diem 24 gia dau sau mO, cho yeu /à dau vela tai dau Ong, VAS — cfiem Cac you to hen quan den tinh trang dau sau and bao gOm tool gay xuung, vi tri, tinh chat gay, phuong phap ket hop xuong va tu6i benh nhan Tir khda: Phau thuat ket hop xuong dui, thang diem VAS, muc da dau SUMMARY USING VAS PAIN CLASSIFICATION SCALE TO ASSESS LEVEL OF PAIN AFTER FEMUR FRACTURE SURGERY AT VIET DUC HOSPITAL Objectives: Assessing the level of pain after femur fracture surgery by using VAS scale Assessment the factors that related with pain postoperative Methods: 50 patients with femur fracture were operated atVict ho.3pital VAS pal Jwies categorized according to Salley processing using SPSS 16.0 software Results: Distribution on the pain VAS scale at the ()nit), of timp - 12 hours, 12-24 hoc -2 scccnd and third postoperative day Pain postoperative decreases along the time Conclusions: Level of pain after femur fracture sugery can fully assessed and followed up by VAS scale Pain level in the first 24 hours postoperative were the most severe, mainly moderate and severe pain, VAS at 4-9 points The factors that is related with pain postoperative include: type of fracture, local of fracture, level of fracture, fixated method and patient's years old Keywords: Femur fracture surgery, VAS scale, level of pain DAT VAN DE Dau la mot li ph6 bien nhat khien nguai benh tim den sir cham sac cua y te tinh cd khoang Y HOC THLIC HANN (971) - SO 7/2015 Dai hoc Y Ha NOi 80% benh nhan (BN) den kham lien quan tai yeu to dau Dua theo ket qua dia mdt cudc dieu tra ve dau sau ph5u thuat tai M9 Lrac tinh c6 khoang 80% BN trai qua can dau cap tinh sau ph5u thuat, s6 nhCrng BN 86% la dau vCra va dau nang Gay xuang dui la mdt char) thuang thLranggap, CO the xay moi hoan canh vai nhieu tu6i khac Theo Janos P S thi hang a M9 co trung binh 01 ngLyai gay xuang dui Van 100.000 dan Dieu tri thin thu gay wang dui thuteng sir dung bien phap phau thuat ket hop xuong (PTKHX) Tuy nhien PTKHX dOi la mdt ph5u thuat Ian, doi hdi st,r chuan bi ki ludeng khOng chi & nhan vien y te ma BN.Va van de dau sau PTKHX dOi la mdt trona ,Thrr,,3 io lang hang dau cita nhieu BN, tra An a can quan tam cho nhan vien y te Do vied danh gia va giarn dau cho BN sau phau thuat, giup rut ngan qua trinh phuc hdi va tranh nhirng ben chirng c6 the xay la quan Vi nhung li ten chUng tdi tien hanh ngnien cL:ru de tai val hai muc tieu la m6 to dd dau sau PTKHX dOi theo thang phan loai dau VAS va nhan xet cac yeu t6 lien quan tai tinh trang dau sau md DOI TU'O'NG VA PHU'O'NG PHAP NGHIEN D6i ttran9 nghien Tieu chuan lua chop: BN gay xuang dui &roc PTKHX tai Vien Chan thiyang Chinh hinh — Benh vien Viet Dire, tren tu6i Tieu chuAn lc* trck KhOng CO chi dinh hoar co chOng chi dinh PTKHX, BN s tu6i, CO da char) thuang va cac rOi loan then k iii/ rigoai vi Vi a du n , iir en6i [ham gia ngnien cu'u 50 Bri phu hop tieu chuan Iva chon Phiyang phap nghien ciru Ngher cth: rrid td, tier khong nhom chi.mg Dia di4m Khoa Chan thuang Chinh hinh I va khoa Chan thuang Chinh hinh II - Vien Chan thLiang Chinh hinh Benh vien Viet DC/c Thai gian Tir 15/11/2014 den 28/2/2015 Bi6n s6 nghien ciru Tudi, giai tinh, nghe nghiep, nguyen nhan chan thuang, loai gay Arcing, tinh chat gay xuang, phiyang phap PTKHX, thai gian: vac) vien, phAu thuat va vien, tinh trang dau truck m6, tinh trang dau sau m6 Cong cy va phwang phap thu thap sO lieu COng cu ihu Chap Thuac phan loai dau VAS: Cu i too: La mdt thirac dai 10cm co hai mat: 77 MOt mat kh6ng s6 danh cho BN bieu thi cac dau ttr khOng dau tai dau tot Binh nhat, khong the chiu dog Cuvc Mt lai quay ye phia they thu6c du'oc chia 11 vach vai 10 MCYC d6 dau, krang Ong vai mat quay ye phia BN tir khOng dau tai kh6ng the chiu dog &roc d6 dau Thanh truvt co the di chuyen de chon so sanh va nhan xet rnt:rc De BN tu, Cach ser dung: 60 dau sau CIO di chuyen truvt_tir dau khOng dau tai vi tri tulang Ong dau cua minh They thu6c se biet duvc diem dau cua BN qua mat so, diem VAS la khoang cach tir den diem BN danh dau PhtFong phap thu thOp so Ho: theo mot m5u benh an nghien ci:ru thong nhat Diem dau VAS tai cac thai diem: - 12 gide, 12 - 24 gia, thin hai, thin ba va Nay vien - Diem dau VAS dt.rac phan loaf theo Salley L.Collens: • VAS - KhOng • VAS - 2: Cam giac khO chiu • VAS -4: Dau nhe • VAS - Rt Dal, virs • VAS z Oat, neng Xt/ Li SO LIEU Bang phan mem SPSS 16.0 KET QUA NGHIEN D4c diem chung cua mAu nghien ctru Tan so 25 20 15 10 Khong dau Tinh chat gay xuang dui Vi tri gay xaang CIO Phan b6 phaang phap ph5u thuat ket hp.p xirang - 85 tu6i 2,8/1 Gay kin: 43 BN (86%) Gay her BN (14%) Phirc tap: 38 BN (76%) Dan gian: 12 BN (24%) Dau tren xtrang dui 13 BN (26%) Than xuang dui: 28 BN (56%) Dau dirtri nrcmg dui: BN (18%) : dung nep vit 37 BN (74%) Si Dinh nc)i Kuntscher: BN (14%) Dinh SIGN co ma gay:, BN (6%) billi 11(,)1 it.iy Kt long m& o Tay @inn RUSH): BN Kho ()au it chiu Dau Mire dO Dau VIJJ naafi Bieu dO 2: Phan bO mu'c 6) dau cua benh nhan vao thai diem 12 - 24 gio, sau mo Nhan xet: Tai thai diem 12 - 24 gib, sau m6: 48% sO BN dau Ong, 46% s6 BN dau viva, 06% s6 be nhan dau it Tin 46 „ 35 30 25 70 15 10 r LL.1111 -Mur dQ /Chong dau chiu Dau it Dau Vva Dau navy Bleu 3: Phan bo In CPC de dau cua benh nhan vao than diem thu, nal sau mo Nhan xet Tai thir hai sau mo: phan Ion BN they dau viva (chiem 62%), dau nang 12% va 26% BN dau it Tin:4 30 , Bang 1: flac diem Chung cua mau nghien ciru so Penh nhancn = 50) Tuoi Ti le nam/ nir Loai gay xtrang (110i -:iatair- 25" , 20 15 r 10 1", Khanga Kta6 Dau it Dau Dau Mirc dij viva nava dau chiu Bi4u des 4: Phan b6 mt"pc de dau cua benh nhan vao thol diem thu ba sau mo Nhan xet: Ngay thin ba sau m6, khOng co BN nao dau nang, 14 BN dau vira (28%) 28 BN dau it (56%), BN chi they kho chiu Tan so 20 10 Mirc dO dau cua benh nhan sau phSu thuOt ket Iwo mpan 20 e M arc 10%6 Oau t Oeu ()au visa flans eau chiu Tan so 40 30 Iwo Khonu [ 10 (16 5: Phan 136 dc;) dau cua benh nhan vao thai diem vien NW xet: Den vien, 60% BN de khOng dau (n = 30), co 12 BN yen cam giac kho chiu va Bi6U BN dau it KhOng Kho Dau at Dau Dau PAtit as n3ng Vv dau Oita VAS , 3: 46 ;3 3.82 Biku d61: Phan b6 de dau CCM benh nhan vao thai diem -12 gia sau m6 xet: Tai thai diem - 12 gia sau m6, diem Nhon VAS phan bo tir - diem Phan Ian cac BN a MCYC dO dau neng, chiem 68% 78 84 12 it.0 12 24 Nitay tht‘Nguy II, t Noy KIC'Theiht;a11 Bi6U I" v'i'n di 6: Phan b6 diem VAS trung binh tai cac thai diem sau phau thuat Y HOC THUG HANH (971) - SO 7/2015 Nhan xet: Diem VAS trung binh giam den theo thai gian Lien tuc Tan 50 45 40 35 30 Ng:1t 34 It 14c WAS 17 20 Nhan xet: Tai cac thai diem nghien cVu thi diem dau trung binh sau pheu thuat cua cac BN gay deu cao han so v6i cac BN gay kin Si,, khac biet co nghia thong ke tai thai diem — 12 gibs sau pheu thuat (p < 0,05) 2.4 3 10 15 S 12 - 24 Ngny Ngny Noy t a Mil hat thu b a vier) Sub 0- 12 CA0 -• Morphia Faicicetainui dang truyen Paracetamol 0 0 50 50 49 29 0 0 Bang uong Kh.on_g sat dung ,, 21 50 Nhan xet: Phan Ion cac BN deu duvc sir dyng Paracetamol clang truy4n de Om dau sau m6, co BN can dung them Morphin giam dau 12 gia deu sau mo SO luvng BN can dung thu6c giam dau giam den theo thai gian Ngay thir ba 29 BN, vien khong BN nao can sip dung Cac yeti to lien quan tai tinh trang dau sau m6 - 15 —4M1— ent4i 16 - 60 tudi - - ein enAs 4.14 15 A 0.25 (I - 12 nib 12 - 24 NstAy thir Ngay Mit Noy to r.nc, hat ba vitt' Bleu d6 Lien quan giipa tuig va tinh trang dau sau phiu thuat Nhan xet Tai cac (nal diem nghien cu'u, diem VAS trung binh tai cac th6i diem cua nhom BN > 60 tu6i deu cao han cac nhom tu6i khac Sir khac biet co nghia thong ice tai theri diem tt:r — 12 giO sau pheu thuat vai p < 0,05 (p= 0,015) 14 , (Jay II, 29 14 86 35 443 5.0 - -2 0- 1Z 2I hai gi:ut 12 - 24 NI.L.1 ilatil5L4a) that Nsca■ 2141 Itas La I % tett Bieu 9: Lien quan giCra loci gayxu,ceng dui va tinh trang dau sau ma Y HOC TH1VC HANH (971) - S6 7/2015 at roi :50 ten q4 AYri AL (57 68 • Nhan xet: S6 BN dau ngat quang tang len theo thtri gian va s6 BN dau lien tuc thi piam den theo thai gian khac biet gitla cac tho'i diem c6 y nghia thong ke veti p < 0,05 Thu6c giam dau sau m6 da thing Bang 2: Thu6c giarn dau benh nhan da SO' dung sau m6 n=50 Thu6c 0-12 12-24 Ngay Ngay Ngay Om dau gia gia thi", hai thir ba vien VAS 10