Sử dụng thang đo VAS trong đánh giá mức độ đau sau phẫu thuật kết hợp xương đùi tại bệnh viện việt đức

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
0 — 12 gia, 12 — 24 gia, ngay ther hai, ngay 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 trong thai diem 24 gia dau sau
mO, cho yeu /à dau vela tai dau Ong, VAS 4 — 9 cfiem.
Cac you to hen quan den tinh trang dau sau and bao
gOm tool gay xuung, vi tri, tinh chat 6 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 . 0 - 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 do 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, trong s6 nhCrng
BN nay 86% la dau vCra va dau nang.
Gay xuang dui la mdt char) thuang thLranggap, CO
the xay ra
moi hoan canh vai nhieu
tu6i khac
nhau. Theo Janos P S thi hang ngay 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 con
BN.Va van de dau sau PTKHX dOi la mdt trona ,Thrr,,3
io lang hang dau cita nhieu BN, tra thanh An a can
quan tam cho nhan vien y te. Do 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 ra
la quan trong. Vi nhung li do ten chUng tdi tien hanh
ngnien cL:ru de tai val hai muc tieu la m6 to min 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 6 tu6i.
Tieu chuAn lc* trck
KhOng CO chi dinh hoar co chOng chi dinh PTKHX,
BN s 6 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 ngay 15/11/2014 den ngay 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 ra
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 con 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 thanh 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 0 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: 0 - 12 gide, 12 - 24 gia, ngay thin hai, ngay
thin ba va Nay ra vien.
- Diem dau VAS dt.rac phan loaf theo Salley

L.Collens:
• VAS - KhOng
• VAS 1 - 2: Cam giac khO chiu
• VAS 3 -4: Dau nhe
• VAS 5 - Rt Dal, virs
• VAS z 7 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

7 - 85 tu6i
2,8/1
Gay kin: 43 BN (86%)
Gay her 7 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: 9 BN (18%)
: dung nep vit 37 BN (74%)
Si
Dinh nc)i tuy Kuntscher: 7 BN (14%)
Dinh SIGN co ma 6 gay:, 3 BN (6%)
billi. 11(,)1 it.iy Kt long m& o Tay @inn
RUSH): 3 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 do 3: Phan bo In CPC de dau cua benh nhan
vao than diem ngay thu, nal sau mo

Nhan xet. Tai ngay thir hai sau mo: phan Ion BN
they dau viva (chiem 62%), dau nang con 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-

0

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 ngay 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%),
8 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 do

......

10%6 Oau .t Oeu ()au
visa flans
eau chiu

Tan so
40
30

.0
Iwo.

0 Khonu

[--

10

(16 5: Phan 136 min dc;) dau cua benh nhan
vao thai diem ra vien
NW xet: Den ngay ra vien, 60% BN de khOng con
dau (n = 30), co 12 BN yen con cam giac kho chiu va 8
Bi6U

BN con dau it.
KhOng Kho Dau at Dau Dau PAtit as
n3ng
Vv.
dau Oita

8 VAS , 3:
46

6

;3
3.82

Biku d61: Phan b6 min de dau CCM benh nhan

vao thai diem 0 -12 gia sau m6
xet:
Tai thai diem 0 - 12 gia sau m6, diem
Nhon
VAS phan bo tir 4 - 9 diem. Phan Ian cac BN a MCYC
dO dau neng, chiem 68%.

78

0 84

2

0 12 it.0 12 24 Nitay tht‘Nguy II, t Noy ra
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.
ra 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 ha deu
cao han so v6i cac BN gay kin. Si,, khac biet co
nghia thong ke tai thai diem 0 — 12 gibs sau pheu thuat
(p < 0,05).

2.4 3 3

10

15 1
4
0

S

12 - 24 Ngny Ngny Noy t a
Mil hat thu b a vier)
Sub

0- 12
CA0

-•

4

Morphia
Faicicetainui
dang truyen
Paracetamol

5

0

0

0

0

50

50

49

29

0

0

0

1

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 5
BN can dung them Morphin giam dau trong 12 gia deu
sau mo. SO luvng BN can dung thu6c giam dau giam
den theo thai gian. Ngay thir ba con 29 BN, ngay ra
vien khong BN nao can sip dung.

Cac yeti to lien quan tai tinh trang dau sau m6
5 - 15

4

3

—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 0 — 12 giO sau pheu
thuat vai p < 0,05 (p= 0,015).
14 ,

(Jay II,.

8 29
9

14
5 86

6 35
443

5.0 -

1

3 -2

0
0- 1Z
2I

hai gi:ut

12 - 24 NI.L.1 ilatil5L4a) that Nsca■
2141

Itas

La

I .1

% tett

Bieu do 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 4 (57

5
3 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 ra
Om dau
gia
gia thi", hai thir ba
vien

VAS
10

£1iiitt

•Zi

gian

--MB-- TltAtt xi 44,444,t

7 3 -{

BiAu d6 7: Phan b6 tinh chAt dau cua benh nhan
theo thai gian

ti

j)34, treat
7C/P0111,14t11

10

.12

1 11
0 68

- 2
.4I• •

12 - 24
44144

1.31:eny
11114 14.14

/51s4c1r,..11441 1...

Nutty a.n
5 . 1.61

BiAu do 10: Lien quan giCi,a 6 gay xtrolig dui va tinh wog
dau sau m6.

Nhan xet: Tai cac the?' diem nghien city, diem dau
trung binh cua nhom gay dau dual xuang dui deu cao

han hai nhom doi twang con lai. Min chart tech diem
trung binh cao nhat la 1,26 diem tai theyi diem 0 — 12
gia sau phAu thuat. Sir khac bietConghia
coy
thong ke
hau het cac thai diem (p< 0,05), trir ngay ra vien
V.

:pan

J

--Phirc tap
6 6 n
4 -

4 75

3 9"

76
0

0 - 12 gio 12 - 24

11;x1

gian

Ngay Hai Nay thir Ngay ra

hai
ba
vletl

BiAti d6 11: Lien quan girra tinh chit gay wang
va tinh trang dau
Nhan xet: Diem dau trung binh tai cac thai diem

cua cac BN bi gay xuang phirc tap deu cao han nhom
BN gay xtfung don gian. Thai diem chenh lech !an
nhat le 0 — 12 giO• sau mo (0,97 diem), su, khac Wet co
\"/ nghia th6ng ke vai p < 0105 (p= 0,028).
Bang 3: Lien quan giCya phvang phap PTKHX vhi
tinh trang dau sau mo
Prayong
Diem VAS trur9 binh
p1-1,:ip Ki-IX
0-12
12-24
Ngay
Ngay Ngay ra
gig"
gia
thCr hai thir ba
vien
Nap '.dt
7.52
1
5,65
5,32

3,35
Dinh nti ttly
Kuntscher
r Dinh SIGN
co ma 6 gay
Dinh nOi tuy
khong mar 6

6,29

5,71

4,57

3,14

0,57

7,5

6,67

5,25

3,5

0

5,67

5,1

4,67

3,67

0

gay (RUSH)
Nhan xet: Tai cac thai diem nghien ciru, diem VAS
trung binh cua nh6m BN duvc PTKHX bang nep vit
cao han ba nhom can lai.
khac biet CO y nghia
thong ke tai thai diem 0 — 12 gia sau ma vOi p < 0,05
(p= 0,009).
BAN LUAN
£au la mat cam nhan chu quan cua ban than
nglEA bent) do do cam nhan dau cang kho dinh Itiong

79


va phu thuec vao scr danh gia cua BN cung nhu, kinh a Min de dau nang co 6 BN (12%) va 13 BN (26%) &
nghiem cua nhan vien y te. Dau sau mO la dau cap mirc de dau it.
Nhu' vay, ngay thin hai sau PTKHX, mirc de dau
.tinh, hien nay van de giam dau sau m6 Clang duac
cua
BN d5 Om hart hOn so vai hai theri diem tuft.
quan tam nhieu. Tuy nhien each danh gia ph6 bien van
Tai

theri
diem nay co 01 BN da sir dung giam dau bang
la hoi BN dau nhieu hay dau it ma van chua ap dung
paracetamol
duang uOng, cac BN con lai van can
.he thong thang diem de danh gia cuang de dau cua
giam
dau
bang
truyen Paracetamol tinh mach_ Tuy
BN sau PTKHX dui. Trong nghien ciru len nay, chiing
nhien
s6
luang
da
gi5m han thai diem truck.
tei Op dung thang diem VAS de danh gia dau. hang
de
dau
theo VAS a ngay th& ba sau
Min
diem VAS co Liu diem la the tao va sir dung de dang,
PTKHX
khach quan hoe cam giac dau cua BN, ph5n anh duac
0' ngay thin ba sau ph5u thuat, diem dau cua 50
sir thay d6i min de dau sat han (10 mire de) giCip
BN
phan b6 tap trung tir 1 - 6 diem tren thang phan
quan- ly dau tot han. Nhu'ng VAS co nhirac diem la BN
bpi

VAS.
Gia tn ph6 bien nhat la 4 diem (n = 19). Diem
phai khOng co riOi loan nhan thirc hay khuyet tat ye thi
VAS
trung
binh & thai diem ngay thir ba sau m6 la
glad, y thtrc tinh tao va kheng thich hap cho tre em
3,82
±
1,19
diem, & mirc de dau it. Kheng co BN nao
duti 6 tuoi. Do de trong nghien ciru nay chUng tOi chi
dau
nang,
14
BN dau vim (28%), 38 BN dau It (76%),
chon nhCyng BN co de tu6i tir 7 - 85 tu6i co y third tinh
co
8
BN
chi
con
they kh6 chiu.
tao, chin nang thi giac binh thuang.
Nhu
vay,
sau
ba ngay duac dieu to diem dau cua
Sau phau thuat ket hap xuang dui, chUng tOi
BN

da
clam
h6n
Vi vav da co 21 BN khena can su.
huVno dhn BN tu, nhan xet tinh traria dau cua minh
dung giam dau. Con lai 29 BN dau & mirc de viva van
theo thang diem VAS.
duac cham sac giam dau bang Paracetamol hap
CO 5 min de dau theo VAS: Kheng dau (VAS = 0
Mire de dau theo VAS vao ngay benh nhan ra
diem), cam g:ac khe chiu (VAS: 1-2), dau it (VAS: 3vign
4), dau viva (VAS: 5-6) va dau nang (VAS z 7).
Vao that diem ngay ra vien, 50 BN &An danh gia
Muc d6 dau theo VAS a 0 - 12 gia sau PTKHX
min
de dau met len nCra Diem VAS trunq binh & thai
Trong so 50 BN duac nhan xet dau trong 12 gib'
deu sau ph5u thuat. diem VAS phan 66 tap trung tCy 4 diem ngay ra vien la 0.84 ± 1,01diem. Diem VAS cao
nhat tai thai diem nay la 4 diem. Da s6 cac BN deu da
- 9 diem tren thang phan loai VAS. Gia tri phe bien
het dau (60%), co 8 BN con dau it va 12 BN cam they
nhat la 8 diem (n = 15). Diem VAS trung binh a thai
diem 0 12 gia sau m6 la 7,32 ± 1,35 diem, & mirc con kh6 chiu vai vet mO.
Nhu vay qua 50 BN duac danh gia dau tir ngay
dau nang. Trong d6 co tai 34 BN dau nang (78%), 14
thin
nhat sau PTKHX den ngay ra vien, chung toi nhan
BN dau viva (28%), chi co 2 BN (4%) dau it. Nhu vay,
they
rang phan b6 diem dau theo VAS Om den theo

trong 12 gia elk sau PTKHX mire de dau chu yeu tir
thai
gian.
dau viva den nang. Tai then diem nay, co 9 BN dau
Bleu d6 cho they sO BN dau lien tuc Om den theo
Min nang diem ,VAS tir 8 - 9 diem can sir dung
thai
gian, va sO BN dau ngat quang tang len theo thai
Morphin tiem bap de giam dau va ket hop vai
gian
tit' 0-72 gia sau mO. Sy khac biet giCra cac thin
Paracetamol truyen tinh mach. Nhiyng BN con at deu
diem
coy nghia thong ke vai p < 0,05. Dieu nay cho
phai SCI' dung Paracetamol truyen tinh mach vai s6
they
mire
de dau gi6m den theo theri gian tiv 0 - 72 gib
luang tir 2 - 3 gam /24 gia.
sau
mO.
Mire d6 dau theo VAS a 12 - 24 gia sau PTKHX
Cac yeu tO lien quan tai tinh trang dau sau mo:
Trong so 50 BN duac nhan xet Min de dau trong
Diem VAS :rung binh tang cac hen O. nhorn EN co,
12-24 giu. dau sau NI Ou thut, diem dau phan b6 tap
do
tuOi
tren 60 tai cac theri diem nghien ciru. Sty khac
trung tir 4-8 diem tren thang ph5n loai VAS Gia tri phO

biet
coy
nghia thong ke tai theyi diem tir 0-12 gib sau
bien nhat la 7 diem (n=14). Diem VAS trung binh &
m6
vai
p
= 0,015.
thai diem 12 - 24 gia sau m6 la 6,46 ± 1,18 diem,
O'
nhOrn
BN gay ha xuang dui, ton thuang xuang
mu c dau viva. Trong d6 co tai 24 BN dau nang (48%),
phiyc
tap
diem
VAS trung binh cung cao han nhorn BN
23 BN dau viva (46%), chi co 3 BN (4%) dau it. Ty le
Min
da ton thuang xuang Clan gian.
gay
kin
va
co
BN co mire de dau nang va dau viva xap xi ngang
khac
biet
coy
nghia
thong. ke vai p < 0,05 tai theri diem

nhau. Nhu'ng s6 luong BN a mirc de dau nang van
0-12
gia
deu
sau
mO.
Dieu nay cung la hap ly bai vi
con nhieu. Nhu vay, sau 12 - 24 gia PTKHX tY le BN
gay
ha,
gay
xuang
phirc
tap thuang kern theo sang
dau nang da giam di re ret. Tai theri diem nay kh6ng co
chan
phan
mem
nang
ne
han
so veri gay kin va gay
BN nao can sir dung morphin de giam dau. Tat ea BN
xuang don gian.
deu s& dung Paracetamol truyen tinh mach.
Phtrang phap PTKHX di-mg la yeu to anh twang
Min de dau theo VAS a ngay thin hai sau
tai
ML:n
de dau cua BN. NhOm BN duac PTKHX bang

PTKHX
nap
vit,
do
vet m6 dal, bac tech phan mem va mang
Trong ngay thin hal sau phAu thuat, 50 BN co diem
xuang
nhieu
han nen diem VAS trung binh cao han
dau phan le6 tap trung tir 3 - 7 diem tren thang phan
thong ke tai
khac biet COnghia
coy
cac
nhem
den
lai.
loai VAS. Gia tri pho bien nhat la 5 diem (n = 16). Diem
thai
diem
tir
0
12
gib
deu
sau
m6
vai
p<0,05.
VAS trung binh a thdri diem ngay thti hai sau m6 la 5,2

KET LUAN
± 1,09 diem & mire dau viva. Tai thai diem nay, da s6
Dau
sau ph5u thuat ket hop xuang dui c6 the duvc
BN they dau a Min d¢ dau viva, chiem 62% (n = 31),

80

Y HQC THVC HANH (971) - S6 7/2015


quart li bang thang diem VAS. Dau sau phau thuat ket
hap xu'ang dbi nang nhat vac) ngay dau tien sau m6 va
giam dan theo thai gian. Trong d6 thai diem 0-12gia
dau sau m6 BN cam nhan dau nang ne nhat. Diem
VAS tiy 4-9 diem (trung binh la 7,32±1,5 diem).
Trong thai diem 0-12 gia dau, tinh trang dau sau
m6 co lien quan vai tu6i, loci gay xuang dui, tinh chat
gay xuang, vi tri gay xuang va phuang phap ket hap
xuang.
KHUYEN NGHI
De nang cao chat luting cham soc BN sau phau
thuat ket hap xuang dui nen huang dan dOi ng0 dieu
dua. ng vien by dung mot cach co he thong thang diem
VAS de quan ly dau sau PTKHX (bao gom danh gia va
theo doi mtk do dau) cho BN gay xuang dui Nen tip
dung mot so phtyang phap giam dau sau m6 chu dOng
trong 48 gia dau sau n16 cno BN nhu' dat Catheter
giam dau ngoai mang
Chu y dac bet han

nhCing BN cao tuOi, the trang yeu, gay xu'ang hey, ton
thuang xu'ang phuc tap. gay dau xuang, PTKHX
bang nep vit de giup BN giam dau tot, nhat la trong
thai diem 12 gice dau sau m6.
TAI LIEU TRAM KHAO
1. ThOilid riddjtudvlupuUlOS & Nennern u. Craig
(2004), Pain Psychological Perspectives, Lawrence
Ertbaumm Associates, Inc, publishers 10 industrial
Avenue Mahwah, New Jersey, USA.
2. Jeffry Lapfelbaum, Connie Chen, Shilpa S, Mehta

and Tong J.Gan (2003), Postoperative pain experience:
Results from a National survey suggest postoperative
pain continues to be undermanaged, Anesth Analg, 97:
534-540.
3. Pham Gia Curing (2005), Dau, Nha xuat ban Y
hoc.
4. Trinh HON Ctyang (2011), Sinh ii hd than kinh
cam giac, Sinh li hoc, tnyang Dai hoc Y Ha Ni,
O Nha xuat
ban Y hoc.
5. Mai Trung Dung (2006), Dieu tri dau, Google
Books,
gle com.vn/books?id=JLkZec63H4UC.
6. Trinh Binh Di va cac tac gia (2000), Cam giac
Sinh li hoc tap II, Nha xuat ban Y hoc.
7. An Thi Thanh Van (2009), Nghien cua anh hating
:am ti nguoi benh den cani giac dau trong va sau pnau
thuat. Benh vier) Mat Trung wring.
8. Pham Thi Van Anh, Nguyen Van Gal, DO Gia

Phirc, , Pham Dirt Muc Danh gia hidu qua giam dau sau
me3 bang phuong phap dUng thudc
day theo
Et(E„.hh vien Btyu dien, KY yeu Nghien clru khoa hoc toan
dirk Ian thtY III.
9. United States department of veterans affairs
(2000), Pain as the 5 vital toolkit, Health care.
IL.. Nguyen Tien El lit C2UU/),.Vann gia bleu qua wain
dau sau ma ung thu, truc trang bang hOn hop Buoivacain Fentanyl qua catheter nqoai nang cUng do henh nhan
dieu khien va truyen lien Luc, Luan van Thac si Y hoc,
Truang Dal hoc Y Ha N'Oi.

DANH GIA WET QUA DIED TRI PHUC HINH RANG BANG PHUTIN PHAP
CAY GHEP IMPLANT NHA KHOA VII Slc HO TRU at PHAN MEM 3D
TAI BENH VIEN RANG HAM MAT TRUNG RING HA NOI
TRINH DINH HAI, PHAM THANH HA, DAM VAN VIET
BOnh vien Rang Ham Mat Trung uting Ha NOi
TOM TAT
Myr; heti caa nghien ctiu nay la nharn danh gia ket
qua dieu phuc hinh rang bang phuong phap cay
gliep inipiant nria knoa voi sit n6 tro ctia phan mem
3D. D6i luting va phirong pnap - so lieu di roc Thu (hap
tit 30 bent) nhan lien 18 tudi dutc cay ghat) Implant vat
tong s6 Implant duce cay thanh cOng /à 49. Cac heti
chi dutc danh gra bat.; g6m 1;1e thaiiii Gang. kik; tidny
khdi phuc than my va chdt nang cua rang gia tier)
Implant, cac Bien cluing xay ra trong va sau qua trinh
dieu tri. Kat qua: Ty le thanh cOng coa nghien citu la
98%. Sau khi lap phuc hinh 6 thang stir; nhai cCia rang
gia tren Implant &roc khdi phuc tot chiem 83,7% va

trung binh chiem /6,3%. TY/10 nay tuOng ring la 85,7%
va 14,3% sau 12 (hang con sau 18 (hang tuong Ong /à
83,7 va 16,3%. Sau khi lap phuc hinh 6 (hang thdm my
du'oc khdi phuc tot chiem 91,8% va trung binh chiem
8,2%. Ty re nay tilling Ling la 89,8% va 10,2% sau 12
(hang con sau 18 thang mitt tot là 87,8%, mut kha la
10.2% va intro kern la 2%. Trong va ngay sau khi ph5u
thuat CO 1 trutng hop bi chay mac' (chiem 2%) va 3
trutng hop bi ha vet throng (chiem 6,1%), 2 truOng
hop sung n4 (chiem 4,1%) va 1 trutng hop dau keo dal

Y HOC THIIC HANI-1 (971) - SO 7/2015

(chidm 2%). Sau khi phuc hinh 18 thang co 2 truOng
hop bi long 6c lien kdt abutment lchidm 4.1%1, 4
truOng hop bi vd sri (chidm 8.2%) va 6 trutng hop hi ha
tiep xuc vci rang kd ben (chiem 12,2%). Sau 18 thang
ke tti khi phuc hinh, tj't 10 vien and mem quanh Implant
la 14,3% va ty 10 vien quanh Implant /à 4,1%.
tcet ivan: Ky thuat phuc hinh rang gia fro n Implant
co tj't 10 thanh cOng rat cao, kha nang khei phuc chrfc
nang an nhai va thdm iny rat tot. Cac bien chCmg xay
ra chiem tY 10 rat nho va deu trong pham vi co the' seta
cht-ta
Takhba: Implant, pilaf.) mem 3D.
SUMMARY
PROSTHETIC OUTCOMES ASSESSMENT OF
PATIENT TREATED WITH OSSEOINTEGRATED
DENTAL IMPLANTS USING 3D SOFTWARE
PLANNING AT THE NATIONAL HOSPITAL OF

ODONTO-STOMATOLOGY HANOI
The goal of this study was to evaluate prosthetic
outcomes of 49 dental implants, successfully placed
for 30 patients at National hospital of Odontostomatology Hanoi. Materials and methods: Data were

81