Professional Documents
Culture Documents
Roi Loan Tien Dinh
Roi Loan Tien Dinh
Chng I
V no thy trn
V no thy
chm
Nhn dy III
Di di sau
Nhn dy VI
Nhn tin
nh
11
13
Chng II
14
4.1. c im BN
Khi BN vo vin iu dng vin ly cc ch s ca BN nh: Tui,
gii, mc chng mt, tnh trng BN, du hiu sinh tn, chn on
nh gi cc c im BN:
- Tui : phn ra cc nhm ( di 15 tui, 16-30 tui, 31-45 tui v
trn 45 tui)
- Gii tnh.
- Nguyn nhn (sau phu thut, Meniere, ic t ngt, hoc nguyn
nhn khc)
16
4.2. c im lm sng:
- Bnh cnh xut hin ri lon tin nh
- c im lm sng thi im vo vin chia theo tng nhm bnh
4.3. Kt qu iu tr:
- Kt qu iu tr tng nhm bnh
- Tnh trng bnh nhn khi ra vin.
5. O C TRONG NGHIN CU
17
Chng 3
KT QU NGHIN CU
1. C IM BN
1.1. Tui
Bng 3.1: phn b tui ca bnh nhn
Tui
T 0 n
15 tui
T 16 n T 31 n
45 tui
30 tui
S BN
T l %
24,1
Trn 45
tui
Tng s
14
29
48,3
27,6
100
Tu
Tui
48,3%
14
12
10
8
27,6%
24,1%
2
6
4
2
0
16 n 30 tui
31 n 45 tui
trn 45 tui
18
%, Nam,
17.2%
Nam
Nu
%, Nu,
82.8%
Mnire
ic t
ngt
Bnh cnh
khc
Sau phu
thut
Tng s
S BN
16
29
T l %
20,7
13,8
10,3
55,2
100
Nguyn nhn
Biu 3.3: Phn b theo bnh cnh xut hin ri lon tin nh
Nhn xt:
- Trong nghin cu ny chng ti gp BN c ri lon tin nh t
pht trong 2 nhm bnh cnh ch yu l Mnire, ic t ngt.
- Ri lon tin nh gp nhiu sau phu thut tai, y ch yu l
sau phu thut thay th xng bn p.
2.2. Mc ri lon tin nh bnh nhn c hi chng Mnire khi
nhp vin
Bng 3.3. Mc ri lon tin nh bnh nhn c hi chng Mnire
khi nhp vin
S bnh nhn
T l %
Chng mt d di + bun nn + nn
16,7
Chng mt d di + bun nn +
33,3
33,3
16,7
100
khng nn
Chng mt quay nh + khng bun
nn + khng nn
Cm gic chnh chong + khng
bun nn + khng nn
Tng s BN
20
25
75
100
khng nn
Cm gic chnh chong + khng bun nn +
khng nn
Tng s BN
T l %
Chng mt d di + bun nn + nn
33,3
33,3
33,3
100
khng nn
Cm gic chnh chong + khng bun nn
+ khng nn
Tng s BN
21
T l %
18,7
25
31,3
16
100
25
20,7
20,7
10
34,5
24,1
16
29
100
22
3. KT QU IU TR
Nm bt
Tp vn
Tp i c
ng tng
Tp t i
ng
ngi
i
BN %
BN %
BN %
BN %
15,4
2
15,4 3 23,1 6 46,2 2
Tng s
BN
13
Ngy 02
23,1
30,8
46,2
13
Ngy 03
7,7
23,1
69,2
13
Ngy 04
7,7
12
92,3
13
Ngy 05
13
100
13
Nm bt
Tp vn
Tp i c
ng
Tp t i
ng
ngi
tng i
BN %
BN %
BN %
BN %
7 43,8 7 43,8 2 12,5 0
Ngy 02
Ngy 03
18,8
Tng s
BN
16
37,5
43,8
16
25
31,2
43,8
16
Ngy 04
25
12
75
16
Ngy 05
6,3
15
93,7
16
ic t
ngt
0
Bnh
khc
0
Sau phu
thut
0
Tng
s BN
0
T
l %
0
3,4
16
28
96,6
16
29
100
Mnire
Chng mt
quay nh
cm gic
chnh
chong
Bnh
thng
Tng s
BN
Nhn xt: Tnh trng bnh nhn tr li bnh thng khi ra vin l 28
trng hp chim t l 96,6% . Mt trng hp cn cm gic chnh
chong chim t l 3,4%.
3.4. Thi gian dng thuc iu tr chng mt
Bng 3.11. Thi gian dng thuc iu tr chng mt phi hp chm sc
iu dng
01 ngy
ic t
ngt
1
02 ngy
03 ngy
04 ngy
05 ngy
Tng s
BN
Mnire
Bnh
khc
2
Sau phu
thut
3
S BN T l %
9
31,0
20,7
27,6
10,3
10,3
16
29
100
24
Chng 4
BN LUN
1. C IM BNH NHN
1.1. c im v tui
Biu 3.1 cho thy la tui t 31-45 chim t l cao nht 48,3%
Nhm tui di 15 khng gp trng hp no. Nh vy tui hay gp
thng t 16 tui tr ln v c xu hng gim dn theo tui. BN gp
ch yu tui lao ng, rt him gp tui cn tr <15 .
1.2. c im v gii
Biu 3.2 cho thy t l nam/n rt chnh lch, nam 17%, n
83%. . iu ny phn nh m hnh bnh tt ca ri lon tin nh gp
nhiu n hn l nam gii. Tuy nhin do c mu nghin cu qu nh do
t l ny l khng c ngha thng k.
2. C IM LM SNG
2.1. Yu t cn nguyn
Biu 3.3 cho thy t l phn b cn nguyn gy ri lon tin
nh trong nghin cu ny gp ch yu trn i tng sau phu thut
chim t l 55 %. S d c hin tng ny l do khoa Tai - Thn kinh l
mt khoa c s lng bnh nhn phu thut tai nhiu, c bit c nhiu
trng hp c m thay th xng bn p. y l phu thut c tc
ng trc tip ti vng ca s bu dc, t tc ng vo c quan tin
nh tai trong, do vy sau phu thut nhiu bnh nhn c cm gic
chng mt, bun nn. Hin tng ny l do c quan tin nh b kch
thch v gy ri lon tin nh ngoi vi vi cc biu hin bnh tng i
r rt: chng mt quay d di c bit l khi thay i t th, km theo c
bun nn v nn [1].
Nhm nguyn nhn th hai l hi chng Mnire vi 20,7%. y
l dng bnh l nc tai trong gy ri lon tin nh km tai, nghe
25
26
27
28
3. KT QU IU TR
32
KT LUN
Do t trc n thi im chng ti nghin cu cha c nh gi
no ca iu dng v chm sc bnh nhn ri lon tin nh nn chng
ti cha tm c kt qu so snh. V vy qua nghin cu 29 trng hp
BN c ri lon tin nh ti khoa Tai - Thn Kinh Bnh vin Tai Mi Hng Trung ng t thng 6 n ht thng 12 nm 2011 chng ti rt ra
cc kt lun sau:
1. c im BN:
- Hay gp tui lao ng, him gp tui di 15. Nhm tui
t 131-45 chim t l cao nht ( 48,3%). T l ny c xu hng gim dn
t l nghch vi tui .
- N chim t l cao hn nam gii ( 82,8%). Tuy nhin do c mu
nghin cu cn nh nn con s ny cha thc s c ngha.
- T l BN c ri lon tin nh sau phu thut thay th xng bn
p chim a s(55,2 %). S d c hin tng ny l do khoa Tai - Thn
kinh c s lng bnh nhn phu thut tai nhiu, c bit phu thut thay
th xng bn p v ri lon tin nh l mt trong nhng bin chng
hay gp giai on hu phu.
- T l BN c ri lon tin nh cao th hai gp trong nhm bnh
nhn c hi chng Mnire vi 20,7%, v cao th 3 trong bnh cnh ic
t ngt (13,8%).
2. Chm sc BN ri lon tin nh:
- Cng tc chm sc iu dng ng mt phn rt ln vo kt qu
iu tr, thuc khng th thay th c cc bi tp vn ng.
- Phn ln bnh nhn ch iu tr thuc n ngy th 4 chim t l
89,7%
- BN c ri lon tin nh d do nguyn nhn g th s chm sc
33
cng gn ging nhau khng c s khc bit gia cc nhm nguyn nhn
m ph thuc vo mc ri lon tin nh. Quy trnh chm sc theo 4
mc ph thuc vo c im lm sng: mc chng mt, c km
theo bun nn v nn hay khng?
+ Chng mt d di km theo bun nn v nn: Nm bt ng tng
i .
+ Chng mt nhiu km bun nn nhng khng nn: tp vn ng
th ng tp vn ng ch ng.
+ Chng mt nh, khng bun nn: tp i c ngi tr gip.
+ Cm gic chnh chong: tp t phc v bn thn.
- Phn ln bnh nhn c th t tp i ngy th 4 v 5 ca t iu tr.
- Ring v bnh nhn sau m thay th xng bn p cn cn chm
sc, theo di vt m ti ch.
KIN NGH
1. Cn nhn rng cc bi tp vn ng ti cc khoa phng
2. Chun ha cc bi tp sau khi BN xut vin c th t tp ti nh.
34
MC LC
T VN ..........................................................................................1
35
1.1. Tui................................................................................................ 18
1.2 Gii tnh .......................................................................................... 19
2. C IM LM SNG ................................................................... 19
2.1. Bnh cnh xut hin ri lon tin nh.......................................... 19
2.2. Mc ri lon tin nh bnh nhn c hi chng Mnire khi
nhp vin ....................................................................................... 20
2.3. Mc ri lon tin nh bnh nhn ic t ngt khi nhp vin
....................................................................................................... 21
2.4. Mc ri lon tin nh nhm bnh nhn khng r cn nguyn
khi nhp vin ................................................................................. 21
2.5. Mc ri lon tin nh nhm BN sau phu thut thay th
xng bn p ngy u tin ........................................................ 22
2.6. Tng hp mc ri lon tin nh ca nhm BN trong nghin
cu ngy iu tr u tin:.......................................................... 22
3. KT QU IU TR .......................................................................... 23
3.1. Chm sc iu dng nhm ri lon tin nh trong bnh cnh
Mnire, ic t ngt v nhm cha r nguyn nhn................. 23
3.2. Chm sc iu dng nhm ri lon tin nh sau phu thut
thay th xng bn p: ................................................................ 23
3.3. Tnh trng bnh nhn khi ra vin................................................... 24
3.4. Thi gian dng thuc iu tr chng mt ...................................... 24
Chng 4: BN LUN........................................................................ 25
1. C IM BNH NHN ................................................................. 25
1.1. c im v tui............................................................................ 25
1.2. c im v gii............................................................................ 25
2. C IM LM SNG ................................................................... 25
2.1. Yu t cn nguyn ......................................................................... 25
2.2. Mc ri lon tin nh BN c hi chng Mnire khi nhp
vin ................................................................................................ 26
36
37
DANH MC BNG
Bng 3.1: Phn b tui ca bnh nhn.................................................. 18
Bng 3.2.: Cc bnh cnh xut hin ri lon tin nh............................ 19
Bng 3.3. Mc ri lon tin nh bnh nhn c hi chng
Mnire khi nhp vin.......................................................... 20
Bng 3.4. Mc ri lon tin nh bnh nhn ic t ngt khi
nhp vin.............................................................................. 21
Bng 3.5. Mc ri lon tin nh nhm bnh nhn khng r
cn nguyn khi nhp vin ..................................................... 21
Bng 3.6. Mc ri lon tin nh nhm BN sau phu thut
thay th xng bn p ngy u tin................................... 22
Bng 3.7.: Tng hp mc ri lon tin nh ca nhm BN trong
nghin cu ngy iu tr u tin....................................... 22
Bng 3.8. Ch chm sc iu dng nhm ri lon tin nh
trong bnh cnh Mnire, ic t ngt v nhm cha r
nguyn nhn ......................................................................... 23
Bng 3.9. Ch chm sc iu dng nhm ri lon tin nh
sau phu thut thay th xng bn p. ................................ 23
Bng 3.10. Tnh trng bnh nhn khi ra vin.......................................... 24
Bng 3.11. Thi gian dng thuc iu tr chng mt phi hp chm
sc iu dng ..................................................................... 24
38
DANH MC BIU
DANH MC HNH
39