Áp dụng bảng điểm lanza trong đánh giá tổn thương niêm mạc dạ dày tá tràng ở người cao tuổi có dùng thuốc chống viêm giảm đau non steroid

B GIO DC V O TO B Y T TRNG I HC Y H NI ON VN SANG áP DụNG BảNG ĐIểM LANZA TRONG ĐáNH GIá TổN THƯƠNG NIÊM MạC Dạ DàY Tá TRàNG NGƯờI CAO TUổI Có DùNG THUốC CHốNG VIÊM GIảM ĐAU NON STEROID LUN VN THC S Y HC H NI 2016 B GIO DC V O TO B Y T TRNG I HC Y H NI ON VN SANG áP DụNG BảNG ĐIểM LANZA TRONG ĐáNH GIá TổN THƯƠNG NIÊM MạC Dạ DàY Tá TRàNG NGƯờI CAO TUổI Có DùNG THUốC CHốNG VIÊM GIảM ĐAU NON STEROID Chuyờn ngnh : Ni khoa Mó s: 60720140 LUN VN THC S Y HC Ngi hng dn khoa hc: PGS.TS.V Th Thanh Huyn H NI 2016 LI CM N hon thnh khúa hc v lun tt nghip tụi xin by t lũng bit n sõu sc n: Ban giỏm hiu, Phũng o to sau i hc trng i hc Y H Ni ó quan tõm v giỳp tụi sut quỏ trỡnh hc v lm lun tt nghip Ban lónh o Bnh Vin Lóo Khoa TW ó to mi iu kin thun li cho tụi sut quỏ trỡnh hc v hon thnh lun Tụi xin by t lũng bit n sõu sc ti PGS TS.V Th Thanh Huyn, ngi thy ó trc tip hng dn tụi tn tỡnh sut quỏ trỡnh hc v thc hin lun Tụi xin by t lũng bit n ti cỏc thy cụ hi ng chm lun ó tn tỡnh hng dn v cho tụi nhng ý kin quý bỏu tụi cú th hon thnh tt lun ny Cui cựng tụi xin by t lũng bit n ti nhng ngi thõn gia ỡnh tụi v bn bố tụi, nhng ngi ó luụn ng viờn tụi sut quỏ trỡnh hc v nghiờn cu tụi yờn tõm hc tp, v hon thnh lun ny H Ni, thỏng 10 nm 2016 on Vn Sang LI CAM OAN Tụi l on Vn Sang, hc viờn cao hc khúa XXIII Trng i hc Y H Ni, chuyờn ngnh Ni khoa, xin cam oan: õy l lun bn thõn tụi trc tip thc hin di s hng dn ca PGS TS V Th Thanh Huyn Cụng trỡnh ny khụng trựng lp vi bt k nghiờn cu no khỏc ó c cụng b ti Vit Nam Cỏc s liu v thụng tin nghiờn cu l hon ton chớnh xỏc, trung thc v khỏch quan, ó c xỏc nhn v chp thun ca c s ni nghiờn cu Tụi xin hon ton chu trỏch nhim trc phỏp lut v nhng cam kt ny H Ni, ngy 30 thỏng 10 nm 2016 Ngi vit cam oan on Vn Sang CC CH VIT TT BCDN COX CS CVKS DD : Bch cu a nhõn : Cyclo - Oxygenase : Cng s : Chng viờm khụng Steriod : D dy TT DD - TT HP LZ MBH NS NSAIDs : Tỏ trng : D dy tỏ trng : Helicobacter Pylori : Ch s Lanza : Mụ bnh hc : Ni soi : Non Streroidal Anti Inflammatory Drugs PG TL TS VDD : Prostaglandin : T l : Tin s : Viờm d dy MC LC T VN Chng TNG QUAN 1.1 THUC CHNG VIấM KHễNG STEROID (CVKS) [9] .3 1.1.1 Tỏc dng chớnh v c ch ca cỏc thuc CVKS 1.1.2 Cỏc tỏc dng khụng mong mun ca thuc CVKS 1.1.3 C ch gõy tn thng niờm mc d dy thuc CVKS [11] 1.2 BNH Lí D DY DO THUC CVKS 1.2.1 Triu chng lõm sng bnh DD-TT thuc CVKS 1.2.2 Hỡnh nh ni soi ca bnh DD-TT thuc CVKS 11 1.2.3 Mụ bnh hc bnh d dy thuc CVKS 17 Chng 22 I TNG V PHNG PHP NGHIấN CU 22 2.1 I TNG NGHIấN CU 22 2.1.1 Tiờu chuõn chn bnh nhõn 22 2.1.2 Tiờu chuõn loi tr 22 2.2 PHNG PHP NGHIấN CU 22 2.2.1 Phng phỏp nghiờn cu 22 2.2.2.Phng phỏp chn mu .23 2.2.3 Cỏc ch s nghiờn cu 23 2.2.4 Phng tin v cụng c nghiờn cu 24 2.2.5 Thi gian v a im nghiờn cu 24 2.3 CC BC TIN HNH NGHIấN CU 24 2.3.1 Hi bnh 24 2.3.2 Phng phỏp ni soi v c kt qu 24 2.3.3 ỏnh giỏ tn thng bng thang im Lanza (ó nờu trờn) 25 2.3.4 S nghiờn cu 26 2.3.5 Phng phỏp thu thp x lý s liu 27 2.3.6 o c nghiờn cu 27 Chng 28 KT QU NGHIấN CU 28 3.1 C IM CHUNG CA NHểM I TNG NGHIấN CU 28 3.1.1 c im v gii 28 3.1.2 c im v tui 29 3.1.3 Triu chng lõm sng .29 3.1.4 c im s dng thuc CVKS .29 3.2 C IM TN THNG QUA NI SOI DD-TT V PHN LOI TN THNG THEO LANZA .30 3.2.1 T l v v trớ tn thng ni soi DD-TT cỏc nhúm bnh nhõn nghiờn cu 30 3.2.2 c im tn thng qua ni soi DD-TT ca nhúm bnh nhõn nghiờn cu 30 3.2.3 Mc tn thng ni soi DD-TT nhng nhúm bnh nhõn nghiờn cu theo phõn loi Lanza .32 3.3 I CHIU TN THNG NIấM MC DD-TT THEO THANG IM LANZA VI MT S C IM LM SNG V CN LM SNG 32 3.3.1 Mi liờn quan gia mc ca tn thng vi mt s c im lõm sng 32 3.3.2 Mi liờn quan gia mc nng ca tn thng ni soi DD-TT so vi mt s c im cn lõm sng 36 3.3.3 Mi liờn quan gia mc ca tn thng ni soi DD-TT vi mt s bnh lý37 Chng 38 BN LUN 38 4.1 C IM PHN LOI TN THNG DD-TT THEO LANZA BNH NHN DNG THUC CHNG VIấM KHễNG STEROID 38 4.1.1 Cỏc triu chng lõm sng DD-TT v tn thng DD-TT 38 4.1.2 c im tn thng DD-TT bnh nhõn dựng thuc CVKS 40 4.1.3 V trớ tn thng DD-TT bnh nhõn dựng thuc CVKS .45 4.1.4 Hỡnh nh ni soi DD-TT bnh nhõn dựng thuc CVKS .48 4.2 I CHIU TN THNG NIấM MC DD-TT THEO BNG IM LANZA VI MT S C IM LM SNG V CN LM SNG 50 4.2.1 Mi liờn quan gia nhúm tui, gii tớnh vi tn thng DD-TT nhúm dựng thuc CVKS 50 4.2.2 Mi liờn quan gia mc tn thng ni soi DD-TT vi mt s bnh lý 58 KT LUN 63 TI LIU THAM KHO PH LC DANH MC BNG Bng 1.1 Tiờu chuõn xp loi ni soi Aabakken -1990 [29] 17 Bng 1.2: Xp loi viờm d dy mn tớnh da trờn nguyờn nhõn, nh khu v hỡnh thỏi hc [13] 20 Bng 3.1 Bng v cỏc triu chng lõm sng (n=82) .29 Bng 3.2 c im s dng thuc CVKS (n=82) 29 Bng 3.3 V trớ tn thng ni soi DD-TT (n=82) 30 Bng 3.4 c im v trớ tn thng nhúm bnh nhõn nghiờn cu (n=82) 30 Bng 3.5 c im tn thng v mc tn thng trờn nhúm bnh nhõn cú loột DD-TT 31 Bng 3.6 T l v mc tn thng ni soi DD-TT nhúm bnh nhõn nghiờn cu 32 Bng 3.7 Mi liờn quan v mc tn thng ni soi DD-TT so vi nhúm tui (n=82) .32 35 Bng 3.8 Mi liờn quan gia mc tn thng ni soi DD-TT so vi thi gian dựng thuc (n=82) 35 Bng 3.9 Mi liờn quan gia mc tn thng ni soi DD-TT so vi liu dựng thuc (n=82) 36 Bng 3.10 c im v t l nhim HP so vi v trớ tn thng ni soi DD-TT (n=82) .37 Bng 3.11 Mi liờn quan gia t l nhim HP v nhúm tui (n=82) .37 Bng 3.12 Mi liờn quan gia mc tn thng ni soi DD-TT vi mt s bnh lý (n=82) 37 Bng 4.1 T l cỏc chiu trng lõm sng DD-TT mt s nghiờn cu cú dựng thuc CVKS 39 Bng 4.2: T l tn thng v t l loột DD-TT bnh nhõn dựng thuc CVKS mt s nghiờn cu 43 Bng 4.3: T l tn thng v loột vựng DD-TT bnh nhõn dựng thuc CVKS (T l phn trm trờn tng s bnh nhõn nghiờn cu) 47 Bng 4.4: T l tn thng (T l % trờn tng s bnh nhõn nghiờn cu) ti cỏc phõn vựng DD-TT theo mt s tỏc gi 48 Bng 4.5: Mi liờn quan gia nhúm tui v tn thng DD-TT bnh nhõn dựng thuc CVKS 52 DANH MC BIU Biu 3.1 Phõn b bnh nhõn theo gii (n = 82) 28 Biu 3.2 Phõn b bnh nhõn theo tui (n = 82) 29 Biu 3.3 Phõn b mc tn thng ni soi DD-TT so vi gii (n = 82) 33 Biu 3.4: Mi liờn quan gia mc tn thng ni soi DD-TT so vi nhúm thuc s dngNSAID (n = 82) 35 Biu 3.5 Mi liờn quan gia HP v mc nng ca tn thng (n = 82) .36 64 - Phõn loi tn thng theo Lanza v Lanza nhúm HP (+) v nhúm HP (-) ln lt l: 39,5% v 46,2% - Cha tỡm thy mi liờn quan gia tui, gii tớnh v s xut hin ca HP (+) vi mc tn thng theo phõn loi Lanza (p>0,05) TI LIU THAM KHO Hungin, A.P and W.F Kean (2001), Nonsteroidal anti-inflammatory drugs: overused or underused in osteoarthritis? 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Y T TRNG I HC Y H NI ON VN SANG áP DụNG BảNG ĐIểM LANZA TRONG ĐáNH GIá TổN THƯƠNG NIÊM MạC Dạ DàY Tá TRàNG NGƯờI CAO TUổI Có DùNG THUốC CHốNG VIÊM GIảM ĐAU NON STEROID Chuyờn ngnh : Ni khoa Mó... cu: p dng bng im Lanza ỏnh giỏ tn thng niờm mc d dy tỏ trng ngi cao tui cú dựng thuc chng viờm gim au non steroid ny nhm mc tiờu sau: Phõn loi tn thng niờm mc d dy - tỏ trng theo Lanza bnh nhõn... viờm gim au khụng Steroid ngi cao tui i chiu tn thng niờm mc d dy - hnh tỏ trng theo bng im Lanza vi mt s c im lõm sng v cn lõm sng 3 Chng TNG QUAN 1.1 THUC CHNG VIấM KHễNG STEROID (CVKS) [9]