JOURNAL OF COMMUNITY MEDICINE
YHOC
CX>NG DONG 2018
DANH GIA KIEN THUTC, THAI DO, THlTC HANH DU PHONG BIEN C H Q N G 6 BENH NHAN TANG HUYET AP DIEU TRj NGOAI TRU TAI TRUNG TAM Y TE HUYEN AN THI, T I N H HUNG YEN N A M 2017
T 6 M TAT:
Bgt vdn di: De gdp phdn vdo cdng tdc quan ly va dilu tri benh nhdn THA, chung ldi tiSn hdnh danh gia kiin thdc, thai dp, thuc hanh dg phdng biSn chdng d benh nhan dang diSu trj ngoai tru tai Tmng tdm Y tl huyen An Thi.
Muc tieu: Danh gid kiln thdc, thai dp, thgc hanh dg phdng biln chdng d benh nhan THA dang dieu tri ngoai trd tgi Tmng ldm Y tl huyin An Thi, tinh Hung Yin nam 2017.
Bii tugtng vd phuffng phdp nghien ctru: Nghien cdu md la cat ngang tien hanh tren 276 benh nhdn THA dang diiu tirj ngogi trd tgi Trung tam Y tl huyen An Thi, tinh Hung Yen, chua bi bien chdng cda THA, tinh than binh thudng.
Ket qud vd kit lugn: Ty IS benh nhdn THA diSu trj ngogi trd tgi Trung tam Y ti huyen An Thi, tinh Hung Yen cd kiSn thuc, thdi dp, thuc hanh dat vS dg phdng biln chdng trong bpnh THA Idn lugt Id 56,2%, 42,8%i vd 29,3%. KiSn thuc, thai dp, thgc hanh d benh nhan THA dieu tri ngoai trd lai Tmng lam Y te huyen An Thi, tmh Himg Yin nhin chimg edn thdp.
Tu khda: KiSn thuc - thai dp - thgc hanh, benh nhan tang huylt dp, du phdng bien chdng. An Thi.
SUMMARY:
KNOWLEDGE, ATTITUDE, PRACTICE FOR THE PREVENTIVE OF COMPLICATIONS IN OUTPATIENTS WITH HYPERTENSION WERE TREATED AT AN THI DISTRICT HELTH CENTRER IN HUNG YEN PROVINCE IN 2017
Introduction: To contribute to the management and treatment of hypertensive patients, we conducted an
Phqm Hirdng Lan', Trjnh Van Hdng) assessment of KAP for the prevention of complications in patients were treated at An Thi District Health Center Objective; To evaluate KAP for the prevention of complications in outpatients with hypertension were treated at An Thi District Health Center in Hung Yen province in 2017.
Subjects and method: A cross-sectional descriptive study was conducted on 276 hypertensive outpatients without complications were treated at An Thi District Health Center, Hung Yen province.
Results and conclusion: The proportion of outpatients with hypertension treated at An Thi District Health Center in Hung Yen province with KAP for the prevention of complications of hypertension was 56.2%, 42.8% and 29.3% respectively. In general, KAP for the prevention of complications of hypertension in outpatients at An Thi District Health Center in Hung Yen province was stil low.
Key words: Knowledge attitude practice, hypertension patients, prevention of complications,AnThi.
I. D^T VAN DE
Tang huylt dp la mdt benh mgn tinh phd bien nhat trln Ihl gidl gay ra khoang 4,5% gaitii ndng benh t|t ehung todn cau [5] va la benh thudng gap d cdc nude phit triin ciing nhu cdc nude dang phat ttiln [1],[3].
Cdc biin chdng cda THA cung rat da dgng gay anh hudng nghiim trpng den toan bd cac co quan, nfii tang dgc biet la tim, nao, than, phdi, mdt, mgch ngo^i vi. Tang huyit ap Id nguySn nhdn chinh ddn den c4c bSnh tim mach, dpt quy [2]. Theo udc linh cua WHO, cac biin chdng trong benh THA lien quan tdi 9,4 trieu ca td vong mdi nam, THA gdy nin 45%. ca td vong do 1. Trung tam Y te diJr phong Hung Yin,
2. Trudng Dai hoc Y- Dirge Thdi NguySn SDT: 0915209940
» Ngay nhdn bdi 28/12/2017 | f> Ngdy phan bi|n: 01/02/2018 | » Ngay duyet dang: 30/02/2018
82
S 6 3 (44) - Thing 05-06/2018 Website: yhoccongdong.vn\ j ^ cufu KHOA HOC
cdc benh tim mgch vd il nhat 51% sd ca td vong do dot quy [4].
Dl gdp phan vdo cdng tdc qudn I;/ vd diSu trj benh nhan THA, chung tdi thgc hipn nghiSn cdu vl kiln thdc, thai dp, thgc hanh dg phdng biin chdng d benh nhan dang diiu tri ngoai tru tai Trung tam Y ti huypn An Thi.
Muc tieu nghien cdu: Danh gia kien thdc, thdi dd, thgc hanh du phdng biln chung d bfnh nhan THA dang diiu trj ngogi tea tgi Tmng tam Y ti huypn An Thi, tinh Himg Yin ndm 2017.
n. PHU'ONG PHAP NGHlfiN C t t J 2.1. Doi hrpfng nghiin cihi: Bpnh nhan THA dang dieu tri ngoai tru tgi Trung tam Y ti huypn An Thi, tinh Hung Yin, chua cd biin chung cua b§nh THA, tinh tiiin bkih thudng.
2.2. Thdi gian vk dia diim nghiSn cihi: Nghiin cdu dupe tiigc hipn hi 3/2017 - 10/2017 tgi Tmng tam Y tB huyen An Thi, tinh Himg Yin.
2.3. Thiit ki nghiin cdn: Nghiin cdu md td cdt ngang.
Ca miu: Ap dgng cd mlu diiu tra cho nghiin cdu mo ta cat ngang:
n = Zt P<i
Trong dd; n: ca mau tdi thilu cho nghien cdu, p = 0,6: Ty lp thuc hanh dgt cda ngudi bj THA vi phdng biin chdng theo cdc nghien cuu trudc. d: Dp chinh xdc tuang ddi, chpn d= 0,06
Z| _^^ J =1,96 vdi a = 0,05 tuomg ung vdi dp tin cay la 95%. Ca man nghiin cdu theo tinh todn Id: 256. Co mdu nghiin cdu thuc ti la 276.
Phuang phdp chgn mdu nghien ciiu: Chpn tdt cd cdc benh nhan din khdm lai phdng kham binh THA cua TTYT huyen An Thi cd du tiiu chudn lua chpn vao nghiin Clhi cho dSn khi du cd mdu.
2.4. PhiroTig phap thu th^p si lieu: Phdng vdn trgc tilp benh nhan theo bd cau hdi da thiit ki sdn.
2.5 Phirorng phap xd ly si lilu: Nhap lilu bdng phdn mlm Epidata 3.1. Xd Iy sd Ueu bdng phdn mim SPSS 20.0 va sd dung cdc thuat loan thdng kl dng dung ttong y sinh hoc.
III. KET QUA NGHlfiN CtJtJ
3.1. Kien thdc dg phdng biin chung trong benh THA ciia DTNC
Bdng I. Kien thite vi th&i gian do huyit dp cua ddi tuang nghiin c Bien si
Cdch theo doi tdng huyet dp
Ddnh gid kien thdrc vk cdch theo doi THA
Lira chpn Hang ngay Hang tuan Hing thdng Bat Khdng dat
Tdng
Sh llTQUg 92 46 138 139 138 276
Tyl6(%) 33,3 16,7 50,3 540,7
50 100
t Nhdn xSt: Cd 50,3 % DTNC cho ring can do HA kiin thdc cua DTNC vl each theo doi tang huylt ap du hang tiidng, 16,7% DTNC cho rdng cin do HA hdng radn, phdng biin chdng ttong benh THA: cd 50,3% DTNC cd 33,3% DTNC cho rdng edn do HA hdng ngdy. Danh gid kiin tiidc dat vd 40,7%. DTNC cd kiin thuc khdng dgt.
L
S 6 3 (44) - Thang 05-06/20181
83
JOURNAL OF COMMUNITY MEDICINE
CONGDONG 2018 ^
Bang 2. Kiin thiic cua doi tugng nghiin cAu ve nguyen tac diiu tri vd nguyen tdc diing thuic Bien so
Nguyen t^c diku tri THA
Nguyen tdc dung thuoc A(i dp
hwachon Chi can dung thudc
Dung thuoc Icet h(?p thay doi loi song Khong biet
Tdng Lau dai, lien tuc Chi dung khi thiy huyet ap cao Khong biet
Ting
Soliiflfng 10 252
14 267 266 6 4 276
T y l e ( % ) 3,6 93,1 5,1 100 96,4 2,2 1,4 100
Nhgn xet: Cd 93,1%. DTNC cd kiln thuc dgt vl DTNC cd kiln thuc d^t vl nguyln tdc ddng thuic ha nguyen lac dilu trj THA la phdi ddng thudc ket hgp dp la ddng lau ddi, liSn tuc theo chi djnh cda bac si thay dii ldi sdng, cdn lai 6,9%. DTNC cd kiln thdc vd 3,6%j DTNC cd kiin thdc khdng dat vi nguySn tdc khdng dat vl nguyln ldc dilu tri THA. Cd 96,4% diing thudc ha ap THA.
Bdng 3. Kien thdic cua doi tuging nghien cieu ve chi so tdng huyet dp Bien so
Klh thiec v i chl s6 THA
P h a n loai
HATT > 140 rnniHg vd/hodc HATTr > 90 mmHg Khong dimg/ Kh6ng bilt
Tdng
T ^ n s d 147 129 276
Tyie{%) 53,3 46,7 100
Nhgn xet: Cd 53,3% DTNC cd kiin tiiuc dgt vi chi sd THA, cdn lai 46,7% DTNC cd kiin thdc khdng dat vi chi si THA.
Bdng 4. Kien thiec cua doi tugng nghien cdv ve cdc yiu to nguy cff Biln s l
Cdc yeu lo nguy CO
Bdnh gid kien thtrc ve cdc YTNC
L y ^ cbQD Tuoi cao An man Uong nhieu lugu, bia Beo phi ft van dong Hut thuoc la, thuoc lao Gia dinh c6 ngutri bi THA Ciing thang, streess KhSng biet Bat Khong dqt
Tdng
T i i n s I 255 231 239 189 189 236 141 210 10 187 9S 27
T y l e ( % ) 92,4 83,7 86,6 68,5 68.5 85,5 51,1 76,1
3,6 J 67,8
32,2 100
84
SO 3 (44) - Thang 05-06/2018 Website: yhoccongdong.vn| , VJUfHIEN cufu KHOA HOC
Nhdn xet: Cd 67,8% DTNC cd kiin thdc dgt vd 32,2% DTNC co kiin thdc khdng dat vi cac yiu td nguy ca.
Bdng 5. Kiin thAc cua doi tugng nghiin cieu vi cdc biin chung trong benh THA Biln sl
Cdc biin chiing cua THA
Ddnh gid kien thiec ve biin chimg
Lira chon BiSn chirng ve nao Biln chiing vl tim Bi€n chiing ve than Bidn chiing ve mat, ma mat Bien chiing ve mach man Khong biet Dat Khdng dat
Tdng
Tan so 227 208 164 141 102 47 164 112 276
TylS(%) 82,2 75,4 59,4 51,1 37 17 59,4 40,6 100 Nhan xel: Ty le cac biSn chdng md DTNC biSt din 17%. DTNC khdng biet vl cdc bien chdng. Danh gia kiln nhieu nhat lan lugt la: biln chdng nao (82,2%), bien thuc cda DTNC vl cdc bien chdng ttong b^nh THA, cd chung tim (75,4%), biin chung tiian (59,4%), biln chdng 59,4% DTNC cd kiin ihdc dat va 40,6% DTNC cd kiin vl mat (83,7%.), biin chdng vi mach mdu (37%.) vd cd thue khdng dat.
Biiu do 1. Bdnh gid chung kiin thiec cda BTNC ve du phdng biin chung trong benh THA
Nhan xet: Danh gia chung kiln thdc cua DTNC khong dat.
vi du phdng biin chdng trong benh THA, cd 56,2% 3.2. Thai dp dg phong bien chung trong binh DTNC c6 kiin thuc dgt va 43,8% DTNC cd kiin thdc THA cda DTNC
S 6 3 (44) - Thang 05-06/20181
Website' yhocconedane.vn I
85 B
JOURNAl OF COMMUNITY MEDICINE
YHOC
CONGDONG 2018
Bang 6. Thdi d^ cda dii tugng nghien cAu ve du phdng bien chung
Danh gia thdi do dtr phong bien chirng ciia DTNC
PhSn lo^i T6t (40 - 50 dilm) Tnmg binh (30 - 39 dilm) Kem (< 29 dilm)
Ting
Tin so 118 153 5 276
Tyie(%) 42,8 55,4 1,8 100 Nhgn xet: Cd 42,8% DTNC cd thai dp tdt vl dg phdng ttong benh THA.
biin chdng cua THA, 55,5%. DTNC cd thai dd tmng binh 3.3. Thyc hanh dg phdng biin chdng trong benh va 1,8% DTNC c6 tiidi dp kIra vi dg phdng biin chdng THA cua DTNC
Bdng 7. Thyc hdnh tuan thd diiu trj tdng huyet dp cda doi tuffng nghien cuu Biln sl
NguySntdc dieu tri Ngiedi do
HA
Thdiglan theo ddi HA
Thdiglan diing thuoc
Quen udng thuoc
Lira chon Chi dimg thuoc
Diing thuoc ket hop v6i thay doi loi song Nhan vien y te
Tir do/ngitoi than Hang ngiy Hang tuan Hang thang Lien tuc, ISu d^i Chi dung nhihig liic HA cao Thinh thoang Hiem khi/khong bao gi6
). s l lu^ng 40 236 248 28 29 13 234 263 13 182 94
Tyin%) 14,5 85,5 89,9 10,1 10,5 4,7 84,8 95,3 4,7 65,9 34,1 Nhdn xet: Cd 85,5%. DTNC thuc hien dung nguySn
tdc dilu trj la dung thuic vdi thay ddi ldi sdng va 14,5%.
DTNC chi dung thudc, khdng cd DTNC nao chi thgc hanh Id thay ddi Idi sdng. Cd 89,9% DTNC thudng do huyit ap bdi nhan vien y ti vd 10,1% DTNC thudng tg do hoac nhd ngudi than do. Phan Idn DTNC do huyit ap hdng thang (84,8%), cd 4,7% DTNC do hang tudn
va 10,5% DTNC do hang ngay. Da sd DTNC tiigc hiUih dung thuoc hg ap lien tuc, ldu dai theo hudng ddn cda CBYT (95,3%), ehi cd 4,7% DTNC chi ddng nhdng liic huyit dp cao. Cd 65,9%. DTNC thinh thodng quen uing thuoc va 34,1% DTNC hiim khi hoac khdng bao giii quin udng thudc, khdng cd DTNC nao thudng xuySn quen udng thudc.
a 86 S 6 3 (44) - Thdng 05-06/2018 Websile. yhoccongdong vn
>*
UGHIEN cufu KHOA HOC
Bdng 8. Thuc hdnh loi song tich cue dirphdng biin chung cua ddi tugng nghiin cuu Bi£n sl
Che d^ gidm dn man Chi dg dn tdng cudng rau,
hoa qud ChS dp dn han che m&
dpng vqt Khdng hut/bd thudc Id, ldo
Hpn chS udng ruau, but Thi difC, lao ddng ^muc
vira phdi Kiem tra vd kiem sodt
cdn n^ng KiSm tra vd IdSm sodt
vdng bung
Lira ch^n Dat
Khong dat Dat Khong dat Dat Khong dat Dat Khong dat Dat Khdng dat Dat Khdng dat Dat Khong dat Dat Khong dat
s l lirong 147 129 114 162 115 161 236 40 208 68 71 205 32 224 12 264
TJ1?(%) 53,3 46,7 41,3 58,7 41,7 58,3 85,5 14,5 75,4 24,6 25,7 74,3 11,6 88,4 4,3 95,7 Mdn xet: Cd 53,3% DTNC tiigc hien chi dp giam an thgc hien ban chi udng mgu, bia; 25,7%. DTNC thgc hien j ^ ; 41,3% DTNC an tang cudng rau, hoa qua tuai; 41,7% tiii due, lao ddng d mdc vda phdi, cd tdi 74,3% DTNC chua DTNC fligc hi|n an hgn chi md ddng vgt; 85,5% DTNC tiigc hi|n vipc tiiS due, lao ddng hgp IJ'; chi cd 11,6% DTNC I khong hut hogc bd hiit tiiudc Id, tiiuoc lao; 75,4% DTNC kiim can nang vd 4,3% DTNC kiim sodt vdng bung hgp ly.
Biiu do 2. Bdnh gid ehung thifc hdnh cua BTNC vi dif phong biin chung trong bfnh THA
s o 3 (44) - Thang 05-06/20181
87 I
JOURNAl OF COMMUNITY MEOICINE
YHOC
O0NGE3ONG 2018
Nhan xet: Ddnh gid chung ve thgc hdnh dg phdng biin chdng trong benh THA cda DTNC, cd 29,3%
DTNC tiigc hdnh dat va cd tdi 70,7% DTNC thuc hanh khdng dat.
IV. BAN LU^iN
v i kiin thdc dg phdng biin chdng cda DTNC cho thdy, cd 56,2% DTNC c6 kiin thdc dgt va 43,8% DTNC khdng cd kiin thdc dat. Kit qua ciia chdng tdi tuang ding vdi kit qua nghiSn cdu cua Bui Thj Thanh Hda dugc tiSn hdnh ttIn 170 benh nhan THA dang dugc qudn ly ngogi tru tgi BSnh vien E Ha Npi (2012) vdi 51,7% DTNC cd kiin tilde dgt ve phdng biSn chdng cua THA vd thap hon kit qua cua Trinh Thi Huong Giang (2013) vdi 82,2%
ngudi binh c6 kiln thuc dgt. Tu ket qua ttSn cho thdy, kiin thdc cda ngudi b^nh vi dg phdng biin chdng ttong b|nh THA cdn han chS, ddi hdi nganh Y IS dia phuang ndi chung va cdc BCYT ndi riing cdn tang cudng cdng tac tmyen thdng va tu van cho ngudi benh ve nhiing van dS lien quan din benh THA vd phdng trdnh biin chdng cda benh THA nhieu han nua.
VS thdi dp du phdng biln chdng ttong benh THA cua DTNC, c6 42,8% DTNC cd tiiai dp tit vi dg phdng biin chdng va 57,2%. DTNC cd thdi dp chua tdt vi dg phdng biln chdng trong b$nh THA. Kit qua nghien cdu cua chdng tdi cao hon ket vdi nghien cdu ciia Siraj Ahmad va cpng su ttIn 354 b|nh nhdn THA lai An Dd, cho thdy cd tdi 77.7% DTNC cd thai dp chua dgt ve dg phdng biln
chdng cda benh tang huyit ap. Td kit qud ttln cho thdy, thai d§ cda ngudi bpnh vi dg phdng biin chdng trong bpnh THA cdn hgn chi, benh nhdn chua nhgn thuc dky du vS muc dp nguy hiim cua cac biin chdng din din s\(
chd quan, thd a trong viec tuan thu diiu tri va thay dii 1^1 song tich cgc. Do vdy, can phdi cd nhung chucmg trinh truySn thdng phd hpp, djnh ky dk ndng cao thdi dp ciia ngudi binh THA ndi rieng va cua ngudi cd nguy co noi chung vl bpnh THA, biln chdng cda benh THA va each phdng trdnh.
VI thgc hanh dg phdng biin chdng ciia DTNC, trong nghiSn cdu cda chung tdi chi cd 29,3% DTNC cd thgc hanh dat. Kit qud nghien cdu cda chung tdi tuang dong vdi kit qua nghien ciiu cda Tnnh Thj Thdy Hdng vdi 29,4% DTNC cd thgc hdnh dat. NghiSn cdu cua chung tdi cho thdy con mpt ty 11 khd cao STNC vdn chua c6 thuc hdnh vi phong biSn chung cda THA dat (70,7%). Day la mdt moi nguy co cd thi ddn tdi biin chdng d nhtrng ngudi bi THA, lam gia tang cdc trudng hpp tu vong hoac tan phS vi benh THA, gay ra gdnh ngng b|nh tdt cho gia dinh vd xa hpi.
K E T L U ^
Ty 11 benh nhdn THA tgi Trung tam Y ti huyen An Thi, tinh Hung Yin cd kien thdc dat vS du phdng bien chdng trong bpnh THA d rode dd trung binh (56,2%). Ty IS benh nhan THA cd thai dp tdt vi du phdng biin chtog d muc dp thdp (42,8%). Ty lp benh nhdn cd thgc hanh ve dg phdng bien chung d mdc dp rat thap (29,3%).
TAI LJ|U THAM KHAO
1. Dao Duy An (2005). Cai thi^n tinh trgng n h ^ bilt, dieu tti vd kilm sodt tang huyet dp: Thach thdc va vai tro cda tmyen thdng giao dgc sue khde. Tgp chi Tim mgch hgc Viil Nam, 41,65-72.
2. Nguyln Van Dang (1998). Tai biin mgch mdu nao, Nxb Y hpc. Ha Ndi, 20-21.
3. Mmh, H, v., Byass, P., Huong, D. L., Chuc, N. T., Wall, S. (2007). Risk Factors for Chronic Disease Among Rural Vietnamese Adults and the Association of These Factors With Sociodemographic Variables. Findings From the WHO STEPS Survey m Rural Vietnam, 2005. Prev Chronic Dis, 4(2), 1-10.
4. W., Joffres, M., et al (2003). Hypertension prevalence and blood pressure levels in 6 European countries, Canada and United States. JAMA, 289(18), 2363-2369.
5. WHO/ISH (2003). Worid Health Organization (WHO)/ Intemational Society of Hypertension (ISH) statement on management of hypertension. JHypertens, 21, 1938-1992.
S 6 3 (44) - Th^ng 05-06/2018 Website' yhoccongdong.vn
