Phan Hùng Việt

1. TRUONG £)~I HOC Y DUQC HUE
HUE UNIVERSITYOF MEDICINE AND PHARMACY

2. TRVONG £)~I HOC V DVQC HUE
HUE UNIVERSITY OF MEDICINE AND PHARMACY
,
TAP CHI•
Y DU'dc IIOC• •JOURNAL OF MEDICINE AND PHARMACY
S608
2012
Hue, 04 - 2012

3. MUCLUC• •
5C?P nhat v~ di~u tri n(>isoi xuat huyet tieu h6a do loet da day ta trang
Update on endoscopic therapy of peptic ulcer bleeding
Dang Ngoc Quy Hue, Trim Van Huy
2 12Nghien ciru SlJ bien d6i nong d(>CK, CK-MB va Troponin T trong mau 0 tre
giai dean sa sinh som c6 ngat
The serum concentrations level of CK, CK-MB and cardiac Troponin Tin
early neonates with asphyxia
Nguyen Ngoc Minh Chdu, Phan Hung Vi?t
3 18K~t qua di~u tri glocom g6c dong nguyen phat bang dt mong m~t chu bien
laser Nd: YAG tai Khoa M~t B~nh vien C Da NAng
The outcome of Nd: fAG laser peripheral iridotom in patients with primary "
angle closure glaucoma
Nguyen Hiiu Quoc Nguyen, Nguyen Nam Trung
4 25C~t tui mat n(>isoi mot cong (single port) tai Benh vien Trung irong Hu~
Single port laparoscopic cholecystectomy in Hue Central Hospital
Pham Xudn Dong, Pham Nhir Hiep, H6 Hiiu Thien, Pham Anh Vii,
Phan Hili Thanh, Nguyen Thanh Xuiin, Trim Nghiem Trung,
Pham Trung Vy, Van tu« Nhdn, t-s« Van Nghia
5 31Xay dung Module tra ket qua sang loc tnroc sinh va sa sinh true tuyen tren
Website Ditatbamsinh.vn
Design modules for sending prenatal and neonatal screening results online
on website ditatbamsinh. vn
Doan Htru Nh(lt Binh, Nguyln Hoang Bach, is Tudn Linh,
Ha Th; Minh Thi, Nguyen Vi~tNhan
6 44Nghien ciru r6i loan phosphat, parathyroid hormon 0 benh nhan cao tu6i lQC
mau dinh ky
Study of dysturbances of phosphate and parathyroid hormon in the elderly
chronic hemodialysis patients
Nguyln Bach, Nguyln Th; L?, Vu Dinh Hung
7 51Nghien ciru nghiem phap gang sire d6i chieu voi k~t qua chup mach vanh 0
benh nhan co can dau that ngirc
Research on the exercise testing compare to the result of coronarygraphy in
patients with chest pain
Mang Thanh Chung, ts Th; Blch Thu(ln
8 58Nghien ciru d~c diem lam sang va k~t qua ph~u thuat u lanh tinh day thanh
bang noi soi treo
Study on clinical characteristics and treatment result for benign vocal cord
tumor with suspensive endoscopic laryngeal surgery
Truong Duy Thai, Phan Van Dung, Nguyen Tu Thd
Tap chi Y DU'Q'c hoc - Trutrng Dai hoc Y DU'Q'c Hu~ - S6 8 3

4. NGHIEN C(rU 51! BIEN DOl NONG DC) CK, CK-MB
vA TROPONIN T TRONG MAu (y TRE GIAI DO~N
so SINH SOM CO NG~T
Nguyin Ngoc Minh csa«, Phan Hung Viff
(1) Benh vien Trung uong Hu€
(2) so man Nhi, Truong Dgi h9C Y Duac Hu€
Tom dt
Ml}c tieu: Khao sat SlJ bi~n d6i nong d(>CK, CK-MB va Troponin T trong mau a tre giai dean
sa sinh som co ngat. Tim hieu moi lien quan giira sir thay d6i nong d(>CK, CK-MB va Troponin
T voi mire d(>ngat, D~i tU'Q1lg va phuong phap: Bao gom 27 tre giai doan sa sinh sorn co ngat
voi apgar Sph nr 0-7 di~m di~u tri tai Nhi sa sinh- Khoa Nhi BVTW Hu~. T~t ca benh nhan
d~u diroc lam xet nghiern CK, CK-MB va Troponin T ngay tir khi vao vien. K~t qua: Nong d(>
CK trung binh a nhom tre ngat la 1146,7±711,7U/L cao hon so voi nhom chirng (14S,6±26,4)
voi p<O,Ol. Nong d(>CK-MB trung binh a nhorn tre ngat la 22,lS±13,78ng/ml cao hon h~n so
voi nhorn chirng (2,77±1,08) voi p<O,Ol. Ncng d(>Troponin T trung binh a nhorn tre ngat la
0,099±0,08ng/ml cao hon so voi nhom chirng (SO,OI) voi p<O,OS.Nong d(>CK, CK-MB va
Troponin T tang co y nghia thong ke voi mire d(>nang ngat. K~t lu~n: Co SlJ gia tang nong d(>
CK, CK-MB va Troponin T a tre sa sinh bi ngat. Co m6i lien quan co y nghia thong ke giira
.nong d(>CK, CK-MB va Troponin T voi mire d(>nang cua ngat.
Abstract
THE SERUM CONCENTRATIONS LEVEL OF CK, CK-MB AND CARDIAC
TROPONIN T IN EARLY NEONATES WITH ASPHYXIA
Nguyen Ngoc Minh Chau', Phan Hung Viet'
(1) Hue Central Hospital
(2) Department of Pediatrics, Hue University of Medicine and Pharmacy
Objective: Investigate the change of serum Creatine kinase (CK), CK-MB and cardiac troponin T
concentrations in early neonates with asphyxia. The relation between the change of serum Creatine
kinase (CK), CK-MB and cardiac troponin T concentrations and degree of asphyxia. The serum
CK, CK-MB and cardiac troponin T concentrations of asphyxiated newborn were measured in the
first 24 hours after admission. Material and methods: Patients: 27 early asphyxiated neonates
with apgar mark at S minutes from 0-7. Study site: Neonatal of Pediatric department, Hue central
hospital. Methods: Prospective, description study. Results: Asphyxiated neonates had significantly
higher concentration of CK, CK-MB and Troponin T than controls: mean CK 1146.7±711.7UIL
vs 14S.6±26.4, p<O.OI;mean CK-MB 22.1S±13.78ng/ml vs 2.77±1.08, p<O.Ol; mean Troponin T
0.099±0.08ng/ml vs SO.OI,p<O.OS.The serum CK, CK-MB and cardiac troponin T concentrations
increased significantly with severity of asphyxia. Conclusion: There is an increase in CK, CK-MB
and Troponin T levels in neonates with asphyxia. Correlation with statistical significance between
the concentration ofCK, CK-MB and troponin T with severity of asphyxia.
12 Tap chi Y.Du·Q·choc - Truong D~i hoc Y DlfQ'CHu~ - S6 8

5. '0
lei
ei
(>
a
II
1. D~TVAN DE
Ngat sa sinh la mot trong nhirng
nguyen nhan quan trong gay nr vong va
di chirng than kinh nang n~ cho tre sa sinh
dac biet la giai dean sa sinh som. 15-20%
tre c6 benh nao thieu khi sau ngat nr vong
a giai dean sa sinh. N gat c6 the xay ra
truce trong hay sau de gay ra giam oxy
d~n thai va tre sa sinh, lam bien loan SI
trao d6i khi (tang khi carbonic) va giam
tuoi mau d~n cac co quan (thieu mau CI,lC
bQ) d~c biet la tim va nao rnac du duoc
uu tien cap mau va oxy. Tuy vay khi ngat
nang, hai co quan nay v~n bi anh huang
nang n~ dira d~n t6n thuong thieu mau
khong h6i phuc [1], [2].
Tren th~ gioi thai gian g~n day da c6
nhi~u nghien ciru cho thay co nhirng t6n
thuang tim rnach khi tre sa sinh ngat. 0
Vi~t Nam thi chira th~y nghien CUll nhi~u.
Sir thay d6i r~t sorn cua cac men tim nhir
CK, CK-MB, Troponin T a tre ngat nang
thuorig c6 lien quan d~n mire d(> nang cua
t6n thuong tim va cling co gia tri Ian
trong tien IUQ'ng benh [5], [6]. Day chinh
leiIy do d~ chung toi thuc hien d~ tai nay voi
2 muc tieu:
1. Khiw sat su bidn a6i nong a6 CK, CK-
ME va Troponin T Irong mau aIre giai doan
sa sinh som co ngat.
2. Tim hidu mbi lien quan giiia S,! {hay
abi n6ng a6 CK, CK-MB va Troponin T vai
muc a6 ngat.
2. DOl TUQNG vA PHUONG PHA.P
NGHIEN CUU
2.1.D8i tU'Cfngnghien ciru
- Nh6m benh: g6m 27 tre giai doan sa
sinh sorn (0-6 ngay tuoi) duoc chfin do an
ngat sau sinh co chi s6 apgar 5 phut tir 0- 7
diem, khong mac cac di t?t b~m sinh, tai
Phong Nhi sa sinh- Khoa Nhi BVTW Hu~
tir OS/2009- 07/2010.
- Nh6m chirng: (D~ tim nong d(> CK,
CK-MB va Troponin T binh thuong a tre
sa sinh) chung toi da chon nhimg tre giai
dean sa sinh sorn khong bi ngat hay suy ho
hap, mac cac benh nhe da di~u tri 6n nhung
khong lam anh huang d~n nong d(>CK, CK-
MB va Troponin T, tai Phong Nhi sa sinh-
Khoa Nhi BVTW Hu~. G6m 30 tre.
2.2.PhU'o·ng phap nghien ctru
- Thi~t k~ nghien ciru: nghien ciru ti~n
ciru, mo ta cat ngang
- Cach ti~n hanh: m6·i benh nhan c6 mot
phieu nghien ciru trong do ghi d~y du cac
phan hanh chinh, benh sir, ti~n sir, trieu
chimg lam sang, apgar 1 phut va 5 phut,
I~y xet nghiern CK, CK-MB va Troponin T
trong 24 gio d~u vao vien.
- Xu I;' s6 lieu: sir dung phan m~m
Medcalc 10.0.
3.KETQUA.
3.1.f)~e di~rn nhorn nghien ciru
Bang 1. Dac diem chung nh6m nghien ciru
TuBi thai (tu~n) Can n~ng (gr)
Gio'i
Narn Nfr
2420±841
Nh~n xet: Tu6i thai trung binh cua nh6m benh la 36,3±3,9 tuan, din nang ' trung binh
2420±84I gam va ty I~ nam nir g~n tirong dirong nhau.
36,3±3,9
Tap chi Y DU"Q"choc - Truong D~i hoc Y DU'Q'cHu~ - sa 8
12 15
13

6. Bang 2. Tinh trang ngat sau sinh thee thang di~m Apgar 5 phut
De}ngat n 0/0
Ngat nhe (6-7d) 8 29,6
Ngat vira (4-5d) 14 51,9
Ngat nang (0-3d) 5 18,5
Tong 27 100
Nh~n xet: Trong 27 tre sa sinh ngat chu yeu la ngat vira chiem 51,9%, sau d6 la ngat nhe
(29,6%). Ngat nang it g~p hon chiem 18,5%.
3.2. S,! bi~n d&inang de}CK, CK-MB va troponin T trong mau 0' tre giai doan SO'sinh SOm co ngat
Bang 3. Nong dQ CK, CK-MB va Troponin T & nh6m benh va nh6m chirng
Nang de} Nhom b~nh Nhom clnmg p
- -
(X ± SD) (X ± SD)
CK(U/L) 1146,7±711,7 145,6 ± 26,4 <0,01
CK-MB(ng/ml) 22,15±13,78 2,77±1,08 <0,01
Troponin T(ng/ml) 0,099±0,08 ::;0,01 <0,05
Nh~n xet: N6ng dQ CK, CK-MB va Troponin T & nh6m tre ngat tang cao so voi nh6m chirng,
sir khac biet c6 y nghia thong ke voi mire p<0,05.
3.3. M6i lien quan gifra s,! thay d&i nang de} CK, CK-MB va Troponin T vOl rmrc de} ngat
Bang 4. M6i lien quan gifra sir thay d6i nong dQ CK voi mire dQ ngat sau sinh theo Apgar 5 phut
De}ngat
Nang de}CK
n - p
(X ± SD)
Ngat nhe 8 544,25±388,64
Ngat vira 14 1187,71±653,55 <0,05
Ngat nang 5 1995,6±86,96
Nh~n xet: Nong dQ CK tang lien quan c6 y nghTa thong ke veri mire dQ nang cua ngat (p<0,05).
Bang 5. M6i lien quan gitra sir thay d6i nong dQ CK-MB voi mire dQ ngat sau sinh theo
Apgar 5 phut
De} ngat
Nang de}CK-MB
n - p
(X ± SD)
Ngat nhe 8 9,65±6,9
Ngat vira 14 24,53±11,04 <0,05
Ngat nang 5 36,5±9,15
Nh~n xet: Nong dQ CK-MB tang lien quan c6 y nghia thong ke voi mire dQ nang cua ngat
(p<O,Ol).
14 Tap chi Y DU·Q·C hoc - Truong f>l.li hoc Y DU·Q"c Hu~- sa 8 T

7. Bang 6. M6i lien quan gitra su thay d6i nong dQ Troponin T voi mire dQ ngat sau sinh theo
Apgar 5 phut
DQ ngat
Nang de}Troponin T
TAng
~O,Olng/mi >O,Olng/mi
Ngat nhe 3 5 8
Ng?t vita
° 14 14
It;
Ngat nang
° 5 5
~t
TBng 3 24 27
8,01 <0,05
Nh~n xet: Nong dQ Troponin T tang lien quan co y nghia thong ke voi mire dQ nang cua ngat
(p<O,05).
4.BANLU~N
4.1.D~c di~rn nhom nghien ciru
Trong nhorn nghien ciru chung toi gom
27 tre sa sinh ngat co tuoi thai trung binh
36,3±3,9 tuan, can nang trung binh 2420±841
gam, nam/nir (12/15) la g~n tU011g dU011g
nhau. Mire dQ ngat theo chi s6 apgar 5 phut
chuy€u la ngat vita (51,9%), ngat nang chiem
th§pnhfrt co 5 tnrong hop (18,5%).
4.2. S'! bi~n dAi nang de} CK, CK-MB va
Troponin T trong mall iYtre giai doan so
sinh som co ngat:
Trang nghien ciru.cua chung toi tai bang 3
cho thfry nong dQ CK, CK-MB va Troponin T
trong mau cua nhom tre ngat d~u tang len rfrt
cao so v61 nhorn chirng voi sir khac biet co y
nghia thong ke p<0,05.
Nong dQ CK toan phan va CK-MB
tang cao hful 0 nhorn tre ngat tU011g irng la
1146,7±711,7U/L, 22,15±13,78ng/ml so voi
chirng Ia 145,6 ± 26,4YU/L, 2,77±1 ,08ng/mI,
p<O,O1. K~t qua nay ciing tU011g W 0 nghien
ciru Nguyen Tfrn Phu cho thay nong dQ CK
roan phan va CK-MB tang cao 0 nhorn ngat
cotonthuong tim cling nhu nhom ngat khong
t6n thuong tim so voi nhorn chirng [3].
Nghien ciru chung toi ghi nhan nong
d(> Troponin T 0 nhorn tre ngat tang cao
(O,099±O,08ng/ml) so voi nhorn chirng
(:::O,OIng/mI)voi mire p<0,05. Di~u nay phu
hopvoi k€t qua Costa S va cong su nghien ciru
Tap chi Y DU'Q'c hoc - Truong D~i hoc Y DU"Q"c Hu~ - S6 8
cho thay nong dQ Troponin T tang cao 0 29
tre ngat la 0,15 (0,1-0,23) so voi 30 tre nhom
chirng la 0,05 (0,02-0,23) voi p<O,OI va tang
cao co y nghia thong ke 0 nhorn co dfru hieu
t6n thU011gco tim [8].
Theo Adcock L. M, 'n6ng dQ CK - MB va
Troponin T tang cao trong ngat [4]. Boo N.
Y da ghi nhan nong dQ CK-MB va Troponin
T tang cao 0 50 tre du thang co kho tho do
ngat trong 24 gio d~u sau sinh [5]. Correale M
[7], Tarkowska A [14] d~u chi ra rang nong dQ
troponin T tang cao 0 tre co tinh trang ho hfrp
nang do ngat, va lien quan d~n bieu hien thieu
mau co tim tren.dien Him d6. Fonseca E nghien
ciru thay rang nong dQ CK cung voi CK-MB
tang cao 0 nhorn tre kho tho do ngat so voi
nhom tre khong ngat va dien Him d6 co bieu
hien thieu mau co tim trong nhom co CK-MB
tang [9].
Theo nghien ciru cua Rajakumar P. S,
nong dQ CK-MB tang rfrt cao 0 nhorn tre
ngat (I21±77,4U/L) so voi nhorn chirng
(28,2±20,2U/L), tuong tu Troponin T la
0,22±0,28 so voi 0,03±0,0 18 [11].
Szymankiewicz M nam 2005 nghien
ciru cho thay nong dQ troponin T trong
24 gio tuoi tang cao 0 nhorn 39 tre ngat
(0,141 ±0,226 ng/ml) so voi 44 tre du thang
khoe rnanh (0,087±0, Ill) va chi ra rang voi
mire TnT>O,l ng/ml la co t6n thU011g co tim
[12]. MQt nghien ciru khac cua ong nam
15

8. 2006 tren 21 tre de non va 22 tre d6i clurng
ciing cho k~t qua nrong nr khi th~y nong dQ
CK-MB va Troponin T tang cao a nh6m ngat
so voi chimg: CK-MB 18,35±14,8Ing/ml so v61
II ,09±5, 17 voi p<0,05; TnT 0,287±0,190ng/ml
so voi 0,II2±0,099 v61 p<O,OI [13].
Nhir vay, clnrng to nong dQ CK, CK-MB
va troponin T tang cang cao cang c6 y nghia v~
mat t6n thirong co tim v~ vi th~ cling nhtr Him
sang do h?u qua v~ thi~u khi lau trong ngat.
4.3.M5i lien quan gifra Sl}' thay d&i nAng d{)
CK, CK-MB va Troponin T vo; mire d{)ngat
Qua nghien ciru, chung toi thay rang c6
moi lien quan c6 y nghia thong ke giira SlJ gia
tang nong dQ CK, CK-MB va troponin T voi
dQ nang cua ngat (bang 5, 6, 7).
K~t qua nghien ciru chung toi cling phu
hop voi Nguyen T~n Phu khi nghien ciru r6i
loan tim rnach atre sa sinh ngat cling cho thay
c6 m6i lien quan c6 y nghia thong ke giira mire
dQ tang CK va CK-MB voi mire dQ nang cua
ngat tinh theo apgar [3].
Theo nghien ciru cua Boo N. Y nong dQ
Troponin T tang cao a tre c6 tinh trang ngat
nang da chet hem nhirng tre da song s6t [5].
Clark S. J cling thay rang nong dQ CK va
troponin T tang cao a nh6m tre ngat nang [6].
Tarkowska A [14] chi ra rang nong dQ
Troponin T tang cao a tre c6 tinh trang h6
hap nang do ngat, va lien quan d~n bieu
hien thi~u rnau co tim tren dien tam d6.
Rajakumar P. S cling thay rang nong dQ
CK-MB va Troponin T tang r~t cao a nh6m
tre ngat so voi nh6m chirng va lien quan d~n
mire dQ nang ngat [II].
Nhir V?y qua nghien CUll chung toi cho
thay nong dQ CK, CK-MB va Troponin T
tang c6 mci lien quan voi mire dQ nang cua
ngat luc sinh. Gonzales da nghien ciru lam
sang va gia tri tien do an nhirng r6i loan tim
mach a tre ngat cho thay c6 SlJ suy giam
chirc nang tim mach va than kinh do thieu
khi [10]. Khi tre ngat nang, SlJ thi~u khi dira
den t6n tlurong da co quan va cac r6i loan
chuyen h6a, oxy kh6ng du cung cap cho tim
va nao dira db thi~u mau cc tim nen nong
dQ cac chat nay tang cao d~c biet la CK- MB
va troponin T neu mire dQ t6n thuong co tim
nhieu se tang cao hon. Viec dinh hrong cac
men nay giup phat hien som tinh trang thieu
rnau co tim nharn tien hrong va dir phong
sorn [6], [7].
5. KtT LU~N
1. Nong dQ CK trung binh a nh6m tre ngat
la 1I46,7±711,7U/L cao hem h~n so voi nh6m
chirng (I 45,6±26,4) voi p<O,Ol.
Nong dQ CK-MB trung binh a nh6m tre
ngat la 22,15±13,78ng/ml cao hem h~n so voi
nh6m chirng (2,77± 1,08) voi p<O,O I.
Nong dQ Troponin T trung binh a nh6m
tre ngat la 0,099±0,08ng/mI cao hem so voi
nh6m chirng (SO,O I) voi p<0,05.
·2. Nong dQ CK, CK-MB va Troponin T
tang lien quan c6 y nghia thong ke voi mire dQ
nang cua ngat.
TAl LIt::UTHAM KHAo
1. Kattwinkel J (2006), T6ng quan va nguyen Iy
h6i sire, H6i SL!'C cdp ctru sa sinh, ban djch,
nha xuat ban Y hoc, tr. 1-9. 4.
2~ Ngat o' tre so sinh, H6i .nrc va cham sac so',
sinh ndng cao, nha xuat ban Dai hoc Hu~, tr.
51-56.
3. Nguyen T~n PhJ (2005), Nghien ctru 11191 sc5 5.
rc5iloan tim much a Ire sinh ngat, Luan an
16
chuyen khoa dp " chuyen nganh nhi tirn
mach, Truong f)~i hoc Y Hu~.
Adcock L. M, Papile L. A (2008), Perinatal
asphyxia, Manual of neonatal care,
Lippincott Williams & Wilkins, a Wolters
Kluwer, Philadelphia, pp. 518-528.
Boo N. Y, Hafidz H, Nawawi H. M,
Cheah F. C, Fadzil Y. J, Abdul-Aziz B. B,
Tap chi Y DU'Q'choc - Truong D~i hoc Y Dune Hu~ - sa 8
6.
7.
8.
9.

9. uan den
toi cho
ponin T
~ng cua
iru lam
giarn
thieu
hidua
'i loan
o tim
I nong
-MB
otim
g cac
thi€u
hong
ngat
om
tn~
veri
om
veri
T
d<)
rn
al
s
Ismail Z (2005), Comparision of serum
cardiac troponin T and creatinine kinase
MB Isoenzyme mass concentrations In
asphyxiated term infant during the first 48h of
life, Journal of pediatrics and Child health,
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6. Clark S. J (2006), Understanding cardiac
troponin T in the newborn period, American
journal of respiratory and critical care
medicine, 173, pp. 816-817.
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GianFranco Maffei G. F, Magaldi Rand
Biase M. D (2009), Troponin in Newborns
and Pediatric Patients, Cardiovascular
& Hematological Agents in Medicinal
Chemistry, 7, pp. 270-278.
8. Costa S, Zecca E, De Rosa G, De Luca D,
Barbato G, Pardeo M, Romagnoli C (2007),
Is serum troponin T a useful marker of
myocardial damage in newborn infants with
perinatal asphyxia?, Acta Paediatr, 96(2),
pp.181-184.
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Ochoa R, Galvan R. E, Jimenez-Solis G (1995),
Elevation of activity of creatine phosphokinase
(CK) and its isoenzymes in the newborn is
associated with fetal asphyxia and risk at birth,
ClinBiochem, 28(1), pp. 91-95.
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10. Gonzalez de Dios J, Moya Benavent M,
Castano Iglesias C, Herranz Sanchez Y
(1997), Clinical and prognostic value of
cardiovascular symptoms In perinatal
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II. Rajakumar P. S, Vishnu Bhat B, Sridhar M.
G, Balachander J, Konar B. C, Narayanan P
and Chetan G (2008), Cardiac enzyme levels
In myocardial dysfunction In newborns
with perinatal asphyxia, Indian Journal of
Pediatrics, 75(12), pp. 1223-1225.
12. Szymankiewicz M, Matuszczak- Wleklak
M, Hodgman J. E, Gadzinowski J (2005),
Usefulness of cardiac troponin T and
echocardiography in the diagnosis of hypoxic
myocardial injury of full-term neonates, Bioi
Neonate, 88(1), pp. 19-23.
13. Szymankiewicz M, Matuszczak-Wleklak
M, Hodgman 1. E, Gadzinowski J' (2006),
Retrospective diagnosis of hypoxic myocardial
injury in premature newborn, J Perin at Med,
34(3), pp. 220-225.
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