TAP CHi Y HOC VIET NAM TAP 463 • THANG 2 - SO 1 . 201 a Danh gia kit qua chung sau phau thuat:
Nghien cyu ciia ehung toi, sau 3 thang ket qua tdt chiem nhieu nhat ehlem 88,6%, ket qua trung binh chiem 8,6% va 4/140 benh chiem 2,8% dat ket qua xau.
Ket qua eiia chung tdi so vdi ket qua cua tac gia Hoang Lu'dng [4] tren 462 tru'dng hdp ed ket qua tot la 86%, trung binh la 14%. Sy khac biet tren cd the la do mau nghien cyu ciia chiing tdi nho hdn nhieu so vdi tae gia.
Ket qua sau mo phu thupc vao rat nhieu yeu td nhu" qua trinh dieu tr| ndi khoa tfch eye trUde va sau md, vi polyp mui de tai phat nen van de eham sdc sau mo ed vai trd rat quan trpng giup cho sy lanh vet mo va phuc hoi ciia he thong mang nhay - long chuyen nhanh hdn. Mat khae, chi dinh p h l u thuat cung rat quan trpng phu thudc vao riit nhieu yeu t d nhu' trieu ehyng ed nang, hinh imh npi soi va CY scan tru'dc phau thuat. Cae thao tae trong lue phau thuat cung la mpt yeu to chfnh quyet dinh thanh cdng trong dieu tri.
V. KET LUAN
Phau thuat noi soi mui xoang vai trd quan trpng trong dieu tri mui vi nhffng u'u diem no'i bat la toan, ft bien chyng, khong cd trpng, cai thien ro ret cac trieu
>75% (khong cdn trieu chimg tru'dc phau thuat chiem 84,3%)
ngay cang ddng VI^XMT CO polyp phu'dng phap an tai bien nghiem chirng lam sang chay mui so vdi va hinh anh noi
soi sau p h l u thuat (90% nhdm nghien cyu khdng eon polyp). Sau phau thuat 3 thang, tot (88,6%), trung binh (8,6%) va ehi cd 2,8% dat ket qua xau.
TAI UEU T H A M KHAO
1. D6 Hong Diep (2011), Nghien cuV hinh thai polyp mui gua npi soi, cat Idp vi tinh va doi chieu vdi mo benh hoc, Luan van Bac sT Noi tru, Tru'dng Oai hgc Y Ha Npi, Ha Noi.
i . Tran Giam (2013), "Nghien cihj dac diem lam sang, can lam sang va ket qua dieu tn yiem m_ui xoang man tinh co polyp 6 ngirdi Idn ban^ phau thuat noi soi ", Tap chf Tai Mui Hong Viet Nam, 58(17), i:r. 331-346.
3. Tran Thj Thuy Hang (2013), Khao sat dac diem lam sang va mo benh hoc cua polyp mui, Luan van Bac sT Noi trii, Trydng Dai hoc Y DUdc Thanh pho Ho Chi Minh, TP. Ho Chi Minh.
4. Hoang Lu'dng (2015), "Dieu tn benh viem xoang polyp mui tai Benh vien Tai Mui Hong Sai Gdn", Ky yeu Hoi nghi khoa hoc Tai Mui Hong toan quoc lan thu-XVIII, tr. 88-95.
5. Vu Kim Ngan (2017), "Khao sat SLT hien dien ciia bach cau ai toan trong mo giai phau benh polyp mui xoang ya sy dap ung dieu trj thuoc sterciid xit miji sau phau thuat"^ Chuyen de Tai Mui Hong va Phau thuat Dau - Co, tr. 56-62.
6. DeConde A.S, Mace J.C et al (2016), "Prevalence of polyp recun-ence after endoscopic sinus surgery for chronic minosinusitis with nasal polyposis". The l^ryngosojpe, 127(3), pp. 550-555.
7. Kim BG., Kang JM. et al (2015), "Do sinus computed tomography findings predict olfactory dysfunction and its postoperative recovery in chronic rhinosinusitis pabenis",Am J Phinol Allergy, 29, pp. 69-76.
NGHIEN Ciru DAC DIEM LAM SANG, CAN LAM SANG BENH NHAN DAI T H A O DUaNG TYPE 2 DIEU TRI NGOAI TRU TAI BENH VIEN DA KHOA
TINH HAI DU'aNG TIT T H A N G 10 DEN T H A N G 11 N A M 2 0 1 7 Le Van Them*, Tran Minh Tan*
TOM TAT
MIJC tieu: Md ta dac diem tam sang, can lam sang phan tfch mot so yeil to lien quan den kiem soat glucose mau 'd benh nhan DTD lype 2 dieu tn ngoai trii tai Benh vien Da khoa tinh Hai DUdng tir thang 10 den thang 11 nam 2017. Phu'dng phap: Nghien eiiu mo ta eat ngang 150 benh nhan dai thao du'dng tuy 2 dang dieu tri ngoai tru. Ket qua: Tudi trung binh la 65,33±10,35', tren 50 tuoi chiem 94,68%, nhieu nhat la nhdm tuoi 60-69 (39,33%), f f thyc (39,33%). The
*Trudng dai hoc ky thuat Y teHai Dudng Chju trach nhiem chinh; Le Van Them Email: [email protected] Ngay nhan bai: 1.11.2017 Ngay phan bien khoa hgc: 27.12.2017 Ngay duyet bii: 4.01.2018
trang thift can, beo phi chiem 46,0%. Thdi gian mac benh >5 nam chiem 60,7%. Tneu chiing lam sang thu'dng gap bao gom an nhieu (60%), uong nhiiSu (73,3%), dai nhieu (75,3%), gay sut can (70,7%), met mdi (78,0%) va te bi roi loan cam giac (58,7%).
Kiem soat glucose mau d miTc tot chiem 37,3%, myc chap nhan 28,0%, myc kem 34,7%; myc kiem soat kem cao d doi tu'dng eo dp tuoi 60-69 chiem 37,2%, tri_^thyc chiem 40,7%. Mgt so yeu to lien quan den kiem soat glucose mau nhu" moi Hen quan giD^ mye dp kiem soat glucose mau va kiem soat HbAlc ciia benh nhan.
SUMMARY
STUDY OF CLINICAL, PRE-CLINICAL FEATURES OF DIABETIC PATIENTS TYPE 2 UNDER THE OUT- PATIENT TREATMENT AT
VIETNAM MEDICAL JOURNAL N°1 - FEBRUARY • 2018
HAI DUONG PROVINCIAL GENERAL HOSPITAL FROM OCTOBER TO NOVEMBER, 2017
Purposes: To describe clinical, pre-dinical features, evaluate related factor of blood glucose control in the diabetic patients type 2 under the out-patent treatment from October to November, 2017. Methods:
Descriptive cross- sectional study on 150 patients with diabetes type 2 who was under the out-patient treatment. Results: mean age was 65.33±10.35, over 50 at 94.68%, group 60-90 achieved the highest rate at 39.33%. Scholar was 39.33%. Over weight and obesity accounted for 46%. Disease duration over 5 years accounted for 60.7%. The common clinical symptoms were eating much (60%), dnnk much (73.3%), unne much (75.3%), lose weight (70.7%), tired (78%), feeling disonder (58.7). Glucose control at good level accounted for 37.3%, acceptable level at 28%, poor level at 34.7%, patients in group 60-69 years old with poor level accounted for 37.2% while scholar at 40.7%.
Some related factor of blood glucose control such as correlation of blood glucose control and HbAlc control in patients.
I. D A T VAN BE
"The ky 21 la the ky ciia cae benh npi tiet va roi loan ehuyen hoa" d y bao eiia cae ehuyen gia y te t y nhffng nam 90 cua the ky XX da va dang trd thanh hien thyc. Trong dd, dai thao du'dng (DTD) la benh khdng lay nhiem du'dc To chye y te the gidi (WHO) quan tam hang dau trong chien lu'dc cham sdc sye khoe eong dong. Dnh trang tang du'dng huyet man tfnh eiia benh dai thao du'dng gay cac roi loan chyc nang va tdn thu'dng nhieu cd quan, dae biet la mat, than, than kinh va tim mach. DTO typ 2 cdn gpi la DTD khdng phu thupc Insulin, chiem 90-95%
tong so ca OTD, dac tru'ng bdi sy de khang Insulin kem theo sy giam bai tiet Insulin tu'dng doi [1]. Theo Hiep hpi Dai thao dddng Quoc te (IDF) 2015, so ngu'di mac DTD tren the gidi la 415 trieu ngu'di (9,1%), eon sd nay d y bao vao nam 2040 se la 642 trieu ngu'di (10% dan so the gidi). Viet Nam la nu'dc ed toe dp gia tang DTD nhanh, theo dieu tra ciia benh vien Npi tiet Trung u'dng nam 2002 ty le mac DTD toan qudc la 2,7%, nam 2015 theo dieu tra ciia Bp Y te, ty le nay la 4 , 1 % , ty le tien DTD la 3,6%), trong dd ed tdi 65% ngu'di benh khong biet minh mac benh [1].
Hai Du'dng la tinh dang tren da phat trien ve cong nghiep va djeh vu, ciing vdi sy phat trien ve kinh te, xa hpi, cimg vdi sy thay doi cua loi sdng thi le mac benh DTD t)'pe 2 ngay cang gia tang. Bien phap hffu hieu de lam giam tien trien va bien chiing cua benh, chi phi cho chya benh la phat hien sdm va quan ly, dieu tri ngu'di b$nh kjp thdi. Benh vien Da khoa tinh Hai Du'dng da
sdm da trien khai eong tac quan ly va dieu tri ngoai trii DTD type 2 tai phdng kham Ndi tiet cua benh vien. Tuy nhien, chu'a cd nhieu nghien ciru ve viec danh gia dae diem lam sang, can lam sang ciia benh nhan DTD type 2 dieu trj ngoai trii tai day chfnh vi vay chiing tdi nghien cdu ciia de tai nay nham myc tieu:
l.Mo ta dac diem lam sang, can Iam sang cua benti nhan DTD type 2 dieu tri ngoai tru tai Benh vien Da khoa tinh Hai Du'dng td thang 10 den thang 11 nam 2017.
2.Phan tich mpt sd yeu to lien quan den kiem soat glucose mau d benh nhan DTD type 2 dieu tri ngoai tru tai Benh vien Da khoa tinh Hai Du'dng td thang 10 din thang 11 nam 2017.
II. DOI TUONG VA PHU'ONG PHAP NGHIEN CUU 2.1. Bdi tu'dng nghiSn cdu. Benh nhan DTD type 2 da diTdc chan doan DTD type 2 theo tieu chuan ciia ADA 2010 va dieu tr| ngoai trii tai benh vien Oa khoa tfnh Hai Du'dng.
- Niyc glucose huyet tu'dng luc ddi >
7,0mmol/l (>126mg/dl).
- lAiic glucose huyet tu'dng > l l , l m m o l / l (200mg/dl) d thdi diem 2 gid sau nghiem phap dung nap glucose bing du'dng uong.
- HbAle > 6,5% (48mmol/mol theo Uen doan Sinh hda Lam sang Quoc te - IFCC).
- Cd cac trieu chiing lam sang dien hinh ciia DTD va myc glucose huyet tu'dng d thdi diem bat ky > l l , l m m o l / l (200mg/dl),
Thdi gian: T y 01/10/2017 den 30/11/2017.
Dja diem: Phdng kham Npi tiet, benh vien Oa khoa tinh Hai Du'dng.
2.2. Phu'dng phap nghien cdu 2.2.1 Thiit ki' nghien cdu: Nghien cyu ngang ed phan tich.
2.2.2 Cd mau, chpn mau: Toan bp benh nhan DTD type 2 da du'dc chan doan DTD type 2 theo tieu chuan ciia ADA 2010 va dieu tri ngoai trii tai benh vien Oa khoa tinh Hal Du'dng trong thdi gian nghien cyu
2.2.3. Ky thuat thu thap sd/iSu: Tat ca doi tu'dng nghien eyu khi di "kham dinh ky du'dc kham lam sang, lam cac xet nghiem can thiet va phdng van khai thac ky cae yeu td lien quan den benh theo mau benh an nghien cyu da dddc chuan b\ tru'dc.
2.2.4. Xdlysd'iiiu.'B^ng phan mem SPSS 19.0.
III. KET QUA NGHIEN CO'U
3 . 1 . Oac diem cua do! tiTdng nghien cyu:
So lu'dng benh nhan nam la 7 1 , so benh nhan nu*
la 79. Ty le nam/nU la 0,90.
TAP CHi Y HOC VIET NAM TAP 463 - THANG 2 - SO 1 . 2018 Bang 3.1. Phan bdddi tu'dng nghien cdu
Uieo nhom tud'i.
Nhom t u o i
<40 40-49 50-59 60-69
>70 Tonq so Tuoi trunq binh
So lUOnq 2 6 34 59 49 150
Ty le % 1,33 3,99 22,67 39,33 32,68 100 65,33 ± 10,35 Nhan xet: Tudi trung binh eiia doi tu'dng nghien cyu la 65,33 ± 10,35. Ty le doi tu'dng nghien ciiu tren 50 tuoi chiem 94,68%. Nhdm tudi 60 - 69 cd ty le cao nhat 39,33%.
Bang 3.2. Phan bo doi tu'dng nghiin cu'u theo thdi gian mac benh.
Thdi g i a n mac b e n h 1 So lu'dng I Ty le %
< 1 nam
T o n g so Thdi gian mac benh
trung binh
39,3
7,87±6,32
Nh$n xet:l\\b\ gian mac benh trung binh la 7,87±6,32 nam. Thdi gian mae benh tren 5 nam chiem phan Idn 60,7%.Bang 3.3. Thi' trang cua doi tu'dng nghien cud.
T h e t r a n g Gay Binh thu'dnq Beo
"Vniia can Beo do 1 Beo do 2
B M I
<18,5 18,5 - 22,9
23 - 24,9 25 - 29,9
> 3 0 Tong so
So lu'dng
14 67 33 35 1 ISO
T y l e 9,3 47,4 22,0 23,3 0,7 100 Nhan xet: Odi tu'dng ed the trang binh thu'dng' chiem da sd (47,4%). Ddi tu'dng thiia can, beo phi chiem 46%.
3.2. Dac d i e m l a m s a n g , can lam sang cua doi t i f d n g n g h i e n cu'u.
Bang 3.4. Bac diem lam sang d dSi tu'dng nghien cu'u.
Trieu chu'nq An nhieu Udnq nhieu
Oai nhieu Gay sut can
Met moi
So lu'dng 90 110 113 106 117
Ty le »/o 60,0 73,3 75,3 70,7 78,0
Te bi roi loan cam giac Dau nqi/c Giam thi li/c Trieu d i i j ^ ban chan DTD
Khonq co trieu chijtiq 88 59 53 15 7
58,7 39,3 35,3 10,0 4,7 Nhan xet: Cac trieu chutig lam sang ehu yeu la; an nhieu (60%), udng nhieu (73,3%), dai nhieu (75,3%), gay sut can (70,7%), met mdi (78,0%) va te bi roi loan cam giac (58,7%)! 4,7%
ddi tu'dng khong bieu hien trieu ehiing lam sang.
Ban^ 3.5. Mdc dp kiem soat glucose mau cua doi tu'dng nghie/i cui/
Mu'c dp
Tdt (4,4-6, I T
Chap nhan (6,2 -7,0)K e m ( > 7 , 0 ) ~ Tong so Glucose mau trung binh
So lu'dng Ty le %
56
42
6,98±1,86
37,3 28,0Nhan xet: Mu'c do kiem soat du'dng huyet tot la 37,3%. Mye dp kiem soat du'dng huyet kem la 34,7%. Chi s6 glucose mau trung bmh eua ddi, tu'dng nghien cyu la 6,98±1,86 nam d myc kiem soat chap nhan.
Bang 3.6. Mdc dp kiem soat HbAlC cua ddi tddng nghien cih/. (Theo tieu chuan cua WHO nam 20021
Mu'c do Tot (< 7,0) Chap nhan (7,1-7,5)
Kem ( > 7,5) Tong so HbAlC trunq binh
So lu'dng 87 25 38 ISO
Ty le % 58,0 16,7 25,3 100 7,25±1,34 Nhan xet: Doi tu'dng kiem soat HbAlC d myc dp tot chiem 58,0%. Ddi tu'dng kiem soat HbAlC d myc dp kem chiem 25,3%. Chi so HbAlC trunq^ binh cua dpi tu'dng nphien eiiu la 7,25±1,34 nam d mye kiem scat chap nhan.
Bang 3.7. Ty li roi loan thanh phan lipid mau d doi tif dng nghiin cdu.
T h a n h phan Triglycerid
Gidi han b e n h I So I T y l e lv(mmol/"l) lu'dng % "
>3.5 43
18,0
28,7 Co roi ban It nhat mot thanh phan^^ | 98 | 65,33 ,Nhan xet: Co 20,7% doi tu'dng co tang cholesterol mau, ed 18,0% doi tu'dng cd giam HDL—C mau, ed 65,33% doi tu'dng cd rdi loan ft nhat mgt thanh phan md mau.
3.3. M o t so y e u t d lien q u a n den k i e m s o a t glucose m a u ciia doi tu'dng n g h i e n c i t u . Bang 3.8. Mdc dp kiem soat glucose mau theo gidi tinh.
Kiem soat G mau
Gidi tinh
Nam Nff
Tot SolUdnq
25 31
Ty le % 35,2 39,1
Chap nhin So iLfdnq
20 22
Ty le % 28,2 27,0
Kem So lu'dng
26 26
Ty le % 36,6 32,9 p>0,05
VIETNAM MEDICAL JOURNAL N°1 - FEBRUARY - 2018
Nhan xet: Ty le i<iem soat glucose mau d mu'c do chap nhan trd len d nam va nff ian lu'dt ia 63,6%'va 67,1%. Mfe do kiem soat glucose mau d nani va nC tu'dng du'dng nhau Cp>0,05).
Bang 3.9. Mi^c do kiem soat glucose mau theo nhdm tud'i.
Kiem soat G mau Kem Nhom tuoi
Tot Soli/dng Tyle",
Chap nhan
SolLidnq 'TYle% So lu'dng Tyle
50 1
16,7
37,2
>70 17 34,7 17 34,7 19 30,6
p>0,05
Nhan xet: Du'dng huyet kiem soat tot nhat d nhom tuoi <40 (100%). Du'dng h^yet kiem soat kem niiat d nhom tuoi 40-49 (33,3%). V[iiz do kiem soat glucose mau d cac nhom tuoi tu'dng du'dng nhau (p>0,05).
Bang 3.10. Mu'c do itiem soat glucose mau theo nghe nghiep.
Kiem soat G mau Nghe nghiep
[^ong dan Cong nhan Tri thiJc
Khac
Tot Sollfdnq
18 20 17 1
Tyle%
53,0 39,2 28,8 16,7
Chap nhan Sollfdnq
8 14 18 2
Tyle%
23,5 27,5 30,5 33,3
Kem Sollfdnq
8 17 24 3
Tyle%
23,5 33,3 40,7 50,0 p>0,05
Nhan xet: Du'dng hujet kiem soat tdt nhat d ddi tu'dng la ndng dan (53,0%) va kem nhat d ddi tu'dng khac (16,7%). Myc dp kiem soat glucose mau d cac nhdm nghe nghiep tu'dng dudng nhau (p>0,05).
Bang 3.11. Mdc dp kiem soatdddng huyet theo chi'do an.
Kiem soat G mau
So I Ty le lu'dng I %
Chap nhan So I Ty [e lu'dng I % "
So Ty le lu'dng 1 p/o Che dp an DTD theo tu' vifn
Che dp an binh thu'dng khong kieng
27,9 35,9
Che dp an nhieu du'dng/md/muoi 25,0 p>0,05
Nhan xet: Nhdm cd che dp an DTD t d van co myc dp kiem soat glucose mau d mye dp tot eao nhat 41,9%. Myc dp kiem soat du'dng huyet ciia cac nhdm doi tu'dng cd che dd an khac nhau tu'dng du'dng nhau (p>0,05).
Bang 3.12. Mdc dp kiim soat ddd/ig huyet va tap the due thi'thao.
Kiem soat Thoi quen G mau
tap th€ due the thao Khonq tap the due Tap the due < 3 ian/tuan Ttiudnq xuyen tap the due
Tot So lu'dng
11 13 32
T y l e 40,7 43,3 34,4
Chap nhan So lu'dng
6 8 28
T y l e
"/o 22,3 26,7 30,0
Kem So lu'dng
10 9 33
T y l e 33,0 30,0 35,6 p>0,05
Nhan xet: Miic do kiem soat du'dng huyet ciia eac nhom doi tu'dng cd thdi quen tap the due thi thao khac nhau khdng cd sy khac biet (p>0,05)
IV. BAN LUAN
4.1. Bac diem lam sang, can lam sang ciia dSi tddng nghiSn cdu
4.1.1 .TriSu chu'ng lam sang. Trieu chiing lam sang d benh nhan OTD rat da dang. Cac trieu chu'ng co dien an nhieu, gay nhieu, dai nhieu, uong nhieu cd the gap day dii hoac khdng day du tren mot benh nhan. Tan xuat xuat hien cac trieu chyng lan lu'dt la uong nhieu 73,3%,
dai nhieu 75,3%, an nhieu 60,0%, gay silt can 70_,7%. Benh nhan cd dii bon trieu chyng eS dien la 43,3%. Ket qua nghien eifu cua chung toi cd tan suat xuat hien cac trieu ehyng ed dien il hdn so vdi eac tac gia khac. Nghien eiiu cua Nguyen Ba Tri ed 98,6% benh nhan gay sut can, uong nhieu 87,8%, dai nhieu 83,7% [7]. Tac gia Be Thu Ha cho thay gay siit can 81,7%, udng nhieu 84%, dai nhieu 86,7% [4].
TAP CHI Y HOC VIET NAM TAP 463 - THANG 2 - SO 1 - 2018 4.1.2. Bac diem can lam sang. Ket qua
nghien ciiu eiia chiing tdi cho thay, chi so glucose mau trung binh eiia cac nhdm tuoi t y 3,8 den 16,3 mmol/1, trung binh la 6,98±l,86mmol/l.
So sanh vdi tieu chf kiem soat glucose mau ciia WHO (2002) thi glucose mau trung binh nam d mye kiem soat chap nhan. Trong tong sd benh nhan nghien eyu, kiem soat glucose mau d mde tdt ehi cd 37,3%, myc chap nhan 28,0% va eon lai 34,7% d mye kiem soat kem.
Nhdm benh nhan kiem soat glucose mau tdt nhat thupc nhom tuoi <40, chiem 100%. Nhdm benh nhan d nhdm tuoi 60-69 kiem soat d myc dp kem chiem 37,2%. Benh nhan cd nghe nghiep ndng dan cd myc kiem soat tot nhat (53,0%) trong khi dd benh nhan co nghe nghiep khae kiem soat glucose mau 6 myc chap nhan va myc kem lan lu'dt la 33,3% va 50,0%.
Theo Nguyin Thj Ngpc Lan va cdng su', glucose trung binh ciia doi tu'dng nghien eyu la 7,96±2,43, mye kiem soat tdt la 14,4%, kem la 67,8% [5]. Dao Thi oya nghien cyu tai Benh vien Trung u'dng Hue cho ket qua kiem soat glucose mau luc ddi dat myc tdt 7,6%, myc ehifp nhan 17,7%, mdc kem 74,7% [3]. Pham Van Thiiy nghien cyu tai benh vien tuyen huyen, tinh Thai Binh thay kiem scat glucose mau d myc tot chiem 31,8%, myc chifp nhan 27,9%, myc kem 40,3% [6]. Nghien cyu ciia ehung toi va mpt sd nghien cyu tren phii hdp vdi ket luan ciia cae tac gia tren.
Theo ket qua nghien cyu ciia chiing toi, chi sd HbAlc trung binh ciia doi tu'dng nghien eyu la 7,25±1,34, thupc xniSz dp kiem soat chap nhan theo tieu chuan eiia WHO 2002. Ty le benh nhan cd myc do HbAlc kiem soat tot, ctiap nhan va kem lan lu'dt la 58,0%, 16,7% va 25,3%. ^
Theo nghien cyu cua tac gia Nguyen Thi Nggc Lan va eong sy, ham lu'dng HbAle trung binh ciia cac benh nhan tai benh vien A TTiai Nguyen la 6,93±0,98, ty le benh nhan dat mye kiem soat tot va chap nhan la 70% [5]. Nhu" vay nghien culj ciia chiing toi cd ket qua tu'dng du'dng vdi euat tac gia nay.
Nghien cyu ciia ehiing toi ed 150 benh nhan, chiem ty le 65,33% cd rdi loan mpt hoac nhieu thanh ph3n lipid mau. Trong do, roi loan cholesterol mau la 20,7% (cholesterol toan phan trung binh la 4,49±l,78mmol), tang triglycerid 40,0% (triglycerid trung binh la 2,49±2,26mmol), tang LDL - C chiem ty le 28,7% va giam HDL - C chiem b/ le 18,0%.
Theo Be Thu Ha, benh nhan co roi loan triglycerid la 38,4%, it gap roi loan HDL-C
(11,9%), 76,7% benh nhan cd rdi loan it nhat 1 thanh phan lipid mau. Theo Le Thi Cam va cpng sy, ket qua ty le rdi loan lipid mau la 65,3%, trong do tang cholesterol mau toan phan chiem 53%t, tang triglycerid ehlem 40%), tang LDL - C ehiem 42,9% va giam HDL - C chiem 20% [2]. So vdi mdt sd nghien eiiu tren, ket qua nghien eiiu ciia chung tdi tu'dng du'dng vdi cac nghien ciiu tren.
4.2 Mot SO yeu to lien quan den kiem soat glucose mau cua doi tu'dng nghien cu'u
Ket qua nghien cyu ciia ehung toi cho thay ty le kiem soat glucose mau d mdc dp chap nhan trd len d nam va ny lan lu'dt la 63,6% va 6 7 , 1 % (p>0,05). Du'dng huyet kiem soat tdt nhat d nhom tuoi <40 (100%i) Du'dng huyet kiem soat kem nhat d nhom tuoi 40-49 (33,3%i), tuy nhien sy khae biet khdng cd y nghTa thdng ke (p>0,05). Du'dng huyet kiem soat tdt nhat d ddi tu'dng la ndng dan (53,0%) va kem nhat d ddi tu'dng khae (16,7%), (p>0,05). Nhdm ed che dp an OTD tu' vifn ed mye dp kiem soat glucose mau d myc do tot cao nhat 41,9%, Myc dd kiem soat du'dng huyet ciia cae nhdm doi tu'dng cd thdi quen tap the due the thao khae nhau khong cd sy khac biet. (p>0,05)
IV. KET L U A N
1 , 0 a c diem lam sang va can l i m sang cua benh nhan.
- Thdi gian mae benh phan Idn > 5 nam (60,7%).
- Trieu chyng lam sang thu'dng gap bao gom an nhieu (60%), uong nhieu (73,3%), dai nhieu (75,3%i), gay silt can (70,7%), met mdi (78,0%) va te bi rdi loan cam giac (58,7%).
- Kiem soat glucose mau d myc tdt chiem 37,3%, myc chap nhan 28,0%, myc kem 34,7%
- 65,33%i benh nhan cd roi loan lipid mau, 20,7% tang cholesteron mau toan phan, 40,0%
tang triglycerid, 28,7% tang LDL-C, 18,0% giam HDL-C.
2. Mot SO yeu to lien quan den kiem soat glucose mau ciia benh nh3n.
- Myc dp kiem soat glucose mau d nam va nff tu'dng du'dng nhau.
- Du'dng huyet kiem soat tot nhat d nhdm tudi <40 (100%). Du'dng huyet kiem soat kem nhat d nhdm tuoi 40-49 (33,3.%), tuy nhien sy khac biet khong cd y nghTa thdng ke (p>0,05)
- Nhdm ed che dp an DTD t i / van cd myc dp kiem soat glucose mau d mye dp tdt cao nhat 41,9%, Myc do kiem soat du'dng huyet ciia cae nhom ddi tu'dng cd thdi quen tap the due the thao khac nhau khong ed sd khac biet. (p>0,05).
39
VIETNAM MEDICAL JOURNAL N°1 - FEBRUARY - 2016
TAI LI^U THAM KHAO
1. Bo Y Te (2014), Hu'dng dan chan doan va dieu tri benh noi ti& - chuyen hoa, NxbYhoc, Ha Noi, 2015.
2. Le Thj Cam va cong sy (2015), "Kiem soat mpt so chf so lam sang, can lam sang d benh nhan dai thao du'dng typ 2 dieu tn ngoai tru tai benh vien noi tiet Ngfie An", Hoi nghj Y te tinh Nghe An.
3. Oao Thi^ DiTa (2010), "Kiem soat chuyen hoa benh nhan dai thao du'dng kem beo phi dieu tn ngoai trii tai benh vien Trung Udng Hue", Tap cfii
YhocthWchanh, (723).
4. Be Thu Ha (2003J, Nghien cdu thu'c trang benh dai thao dWdng dieu tri tai benh vien da khoa tinh Bac Kan, Luan an Thac st Y hoc, trydng Dai Hpc Y Du'CcThai Nguyen.
5. Nguyen Thi Ngoc Lan, Biii Nguyen Kiem, Trjnh Xuan Trang, ^ 0 1 0 ) , "Nhan xet dac diem lam sang, can iam sang cua benh nhan dai thao dudng typ 2'dieu tn ngoai trii tai benh vien A Thai Nguyen", Tap chi khoa hoc va cong nghe, tru'dng Dai Hoc Y DUdc Thai Ng^uyen^
6. Pham Van Thuy, Nguyen Do Huy, Ninh Thj Dung (2013)^ "Ket qua quan i^, dieu tn ngoai tm b&ih nhan dai thao dUdng tai benh vien tuyen huyen, tinh Thai Binh", Tap chi Yhoc thi/c hanh, (874).
7. Nguyen Ba t r i (2016), " f hu'c trang benh dai ttiao dLidng d ngUdi 45-69 tuo'i va mot so yeu to lien quan tai thi tran Sa Tha^, huyen Sa Thay, tinh Kon Turn nam 2016", Sd Y te tinh Kon Turn.
KHAO SAT sir HAI LONG COA DIEU DirffNG TAI CAC KHOA N O I - NGOAI - SAN - NHI BENH VIEN VIET NAM - THUY DIEN UONG Bl
TIT T H A N G 4 / 2 0 1 7 DEN T H A N G 6 / 2 0 1 7
Dao Thi Phuong*, L6 Thi Dung*
T O M TAT
Muc tieu: nghien cyu nay md ta sy hai long trong cong viec eiia dieu dudng (DD) va so sanh sy hai long chung ciia DD trong tyng yeu to ca nhan.
Phu'dng phSp: nghien ciTu mo ta cat ngang tien hanh tren 126 OD. Ket qua: t / le OD hai long vdi cong viec dat 55,6%, ve moi tru'dng lam viec la 61.9%, lanh dao, dong nghiep la 32.5%, quy che noi bo, tien lu'cfng, phue lOi la 63.5%, cong viee, ctJ hgi hoc tap, thang tien la 68.3% va ve benh vien la 77.8%. Cd y nghTa khac nhau ve sU hai long ciia OD trong yeu td ca nhan la gidi va nguon thu nhap ehinh trong gia dinh (p < 0.05). Tuy nhien sU hai long ciia OD trong yeu to (dieu kien sdng, bang cap, so nam cong tac, vi tri^ loai cdng chyc, so cong viee kiem nhiem va so buoi trUc) la nhu' nhau (p > 0.05) tai cac khoa Npi - Ngoai - San - Nhi benh vien Viet Nam - Thuy Oien Dong Bi. Ket luan: kit qua nghien ciru nay da gdi y cho cac nha quan ly mudn nang cao chat lu'cfng nguon nhan lye va cai thien sy hai Idng ciia OD thi ban lanh dao benh vien can ti'eh cu'c eai thien moi quan he lanh dao- dong nghiep, nang cao dieu kien va moi tru'dng lam viec, tang che do tien lu'dng, phu cap, tao cd hoi cho OD hoc tap, phat trien.
Tii'khoa:su!ha\ Idng, dieu du'dng, benh vien.
SUMMARY
SURVEY SATISFACTION OF NURSING I N INTERNAL - SURGERY - OBSTETRICS -
PEDIATRIC WARD I N VIETNAM - SWENDEN GENERRAL HOSPITAL UONG BI
FROM 4 / 2 0 1 7 TO 6 / 2 0 1 7
*Tru&ng Dai hoc ky thuat y teHai Du'dng Chju trach nhiem chfnh: Dao Thi Phu'Ong Email: [email protected] Ngay nhan bai: 1.11.2017 Ngay ph^n bien khoa hoc: 5.12.2017 Ngay duyet bai: 4.01.2018
Purposes: To describe the satisfaction of the nurse's work and to compare the overall satisfaction of the nurse in each individual factor. Methods: cross- sectional descriptive sbidy conducted on 126 nurses.
Results: job satisfaction of nurses was 55.6%; the working environment was 61.9%; the leader and colleague were 32.5%; the interna! regulations, salary and welfare were 63.5%, work, study opportunities, promobon were 68.3% and the hospital was 77.8%.
There were significant differences of the nuse's satisfaction In gender and mam income in the family (p < 0.05). However, the nuse's satisfaction In the factors (living conditions, degrees, years of employment, positions, types of civil servants, number of year for works and number of night shift) were the same (p> 0.05) at the Internal - Surgery - Obsterics - Pediatric wards in Vietnam - Swenden General Hospital LJong Bi. Conclusion: these results suggest that leaders want to raise the quality of their staffs resources and improve nuses' satisfaction. Leaders of hospital needs to positively improve relationships beetween learderships and nurses, to raise working conditions and environment, to increase salary and allowances, and to advance opportiinihes for education and development.
/Ceyivo/icfe; satisfaction, nursing, hospital.
I. DAT V A N O E
Chat lu'dng nguon nhan lyc la mot yeu to vo ciing quan trgng anh hu'dng den chat lu'dng c8n^
viee eiia moi nganh nghe, va nen kinh te moi quoc gia. Nhieu nghien ciiu tren the gidi da chi ra rang sy hai long ddi vdi cdng viec eiia nhan vien y te se dam bao duy tri dii nguon nhan li/c va nang cao chat lu'dng eae dich vu y te [1]. I^at khac viee lam hai long nhan vien y te eung la mot chi so quan trong trong danh gia hieu qua hoat dgng va hieu qua eua djch vu y te. 6 Viet Nam hien nay, nang cao chat lu'dng cham soc
