TAP CHl NGHllN CCPU Y HQC
TiNH TRANG DINH DU'DNG C O A BENH NHAN OAI THAO OU'CXNG VA THU'C
H A N HNUOI DU'&NG, TU"
V A NDINH DU'O'NG
TAI BENH VIEN BACH MAI
• • • «
T r l n Thj Phiie Nguyft, Phgm Vdn Khdi Tmdng Dpi hpc Y Hd N^i Nghien cOv du^ thuc hidn nhim ddnh gid tinh trpng dinh dudng, md td thwc hdnh nudi dwdng vd thi/c hdnh tw vin dinh dwdng bdnh nhdn ddi thdo dwdng tpi Bdnh vidn Bpch Mai. Kit qud cho thiy: Bdnh nhdn giy chiim 23.6%, bdnh nhdn thda cdn, bdo phi 10,7%. Ty Id bdnh nhdn dn tpi bdnh vidn Id 94,3%. cd 69%
bdnh nhdn hdi Idng vi suit dn d bdnh vidn. Bdnh nhdn dwp/c tw vin dinh dwdng chiim 75,7%. Tmng Oi, bdnh nhdn dwac tw vin rit ky vd hiiu dwac ndi dung tw vin chiim ty 97,2%. Hlnh thdc tw vin dinh dudng chu yiu Id tw vin theo nhdm chiim 84.0%. ndi dung tw vin cho bdnh nhdn tdp tmng vdo vai trd cua chi cf(?
dn. nhung thwc dn ngwdi bdnh ndn dung vd ehi dd luydn tdp Ty Id bdnh nhdn tdp thi due thwdng xuydn chiim 55.7%. Tw dd cd thi kit ludn. bdnh nhdn ddi thdo dwdng dd cd y thdc tudn thu chi dd dn vd tw vin dinh dudng tai bdnh vidn. tuy nhidn ehwa thwc hidn rdn luydn thi Iwc thwdng xuydn di ndng cao tinh trpng dinh dwdng.
Td khod: ddi thdo dud'ng, nu6i duang, tu vln dinh dud-ng, tinh tr^ng dinh dircyng
I. DAT V A N Dt
Td chuc Y t l T h i gidi ude lugng sd ngudi mdc ddi thdo dudng trdn todn t h i gidi ndm 2006 la han 180 fi-ifu ngudi, con sd ndy ed t h i tdng len gip ddi vdo ndm 2030 (vd chilm 5,4% ddn sd todn eau) [10]. Theo Hifp hfi Ddi thdo dudng T h i gidi thi ty If mic ddi thdo dudng ciia ngudi trudng thdnh tai Vift Nam ndm 2010 Id 2,9% [8].
Ddi vdi bfnh ddi thdo dudng, c h l d f dn udng, c h l df luyfn tfp Id r i t quan trpng nd khdng nhung kilm sodt dWQfc dudng huylt md edn phdng ngua cde biln chung. Tu v l n cho bfnh nhdn trong bfnh vifn thft sg ein thilt vl se giup bfnh nhdn hilu dwqfc v l bfnh, thu-c dn vd luyfn tfp nhu t h i ndo Id tdt nhit. D l ndng cao hifu qua dilu trj cho bfnh nhdn ddi thdo dudng, chung tdi tiln hdnh nghidn cu-u d l tdi ndy vdi muc tieu: Ddnh gid finh trgng dlnh dudng, md t l thgc hdnh nudi dudng vd thgc hdnh tu v l n dinh dudng bfnh nhdn ddi thdo dudng tgi bfnh vifn Bach Mai.
II. D 6 I TUONG VA PHUONG PHAP
Nghidn cu-u dugc tiln hdnh tai Khoa noi tilt - Ddi thdo dudng, bfnh vifn Bgch Mai Hd Nfi. Ddi tugng Id cde bfnh nhdn ndm dieu trj trong bfnh vifn it nhit 3 ngdy d l cd du thdi gian Iga chpn djch vu dn udng va khi bfnh nhdn sir dgng dich vg dn udng cua bfnh vifn trong 1 thdi gian sd ed khd ndng ddnh gid v l djch vg dn udng trong bfnh vifn. Thdi gian filn hdnh tu- thdng 12/2010 d i n thdng 5/ 2011.
Thilt k l theo nghidn ciru md td e l t ngang vdi cd m i u Id 140 bfnh nhdn bdng cdch lly todn bf bfnh nhdn n i m dilu trj d bfnh phdng de ddnh gid finh trgng dinh dudng cua bfnh nhdn theo chl sd khdi ea t h i (BMI) eiia phdn loai ciia WHO 2000. Cde y l u td lidn quan din thgc trgng nudi dudng vd tu v l n dinh du-dng bao gdm: kiln thgc vd thgc hdnh dn udng cua bfnh nhdn, ly do khdng thgc hifn theo hu-dng d i n c h l d f dn, bfnh nhdn ed dn hit suat khdng, sd bO-a dn mft ngdy, nfi dung vd hinh thO-c tu vln,dn kidng vd luyfn tdp. Xii- 1;^ s6 lifu bing phin m i m EPI INFO 6.04 vd su- dgng mft sd test thdng kd y hpc.
118 TCNCYH 77 (6)-2011
' —^^ TAP CHl NGHllN CLPU Y HQC
I. K^T QUA
1. Tinh trang dinh dud-ng ciia bfnh nhdn ddi thdo dudng
Bang 1. Tinh trang dinh dudng ciia bfnh nhan theo chi sd khdi ca t h i (BMI)
Tinh trang dlnh dud-ng theo BMI n % Gay (< 18,5) 33 23,6 Binh thudng (18,5-24,9) 92 65,7 Thu-a can (25,0 - 29,9) 13 9,3 Beo phi ( > 30,0) 2 1 4
Tdng 140 100 BMI trung binh 21,3 ± 3,4 kg/m^
Bang 1 cho thiy cd 23,6% ddi tugng nghidn cuu thufc mge giy (vdi BMI < 18,5), 65,7% ddi tu-gng cd muc BMI binh thudng, 9,3% sd ddi tugng ed BMI d muc thua cdn vd 1,4% bdo phi.
Trung binh BMI eua ede bfnh nhdn Id 21,3 ± 3,4 kg/m^
2. Thuc hdnh nudi dud'ng benh nhan tai bfnh vifn
Bang 2. Thuc hanh nudi duang bfnh nhdn tai bfnh vifn (n=140) Thuc hanh
Thgc hdnh tudh thii che df an tai benh vifn Ly do bfnh nhdn khdng dn tai bfnh vifn
nudi dud'ng bfnh nhdn Bfnh nhdn dn tai BV Bfnh nhdn khdng an tgi BV Sg thuc dn khdng sach Khdng thich dn d vifn
n 132
8 2 6
% 94,3
5,7 25,0 75,0
An h i t 85 64,4 Bfnh nhdn an het suat
Khdng dn h i t 47 35,6 23 16,4 Sd bQ-a dn mdt ngay
74 52,9 27 19,3 16 11,4 Trong sd 140 bfnh nhan ed 132 bfnh nhdn dn theo suit dn cua bfnh vifn chiem ty If 94,3%
vd 8 bfnh nhdn chilm ty If 5,7% khdng dn theo suit dn cua bfnh vifn md an d qudn an hoac an thuc dn ngudi nhd n l u mang d i n . Bfnh nhdn khdng an thgc dn cua bfnh vifn vl sg thuc an khong sgch hodc khdng thich dn d bfnh vifn.
Trong 132 bfnh nhan an tai vifn cd 85 benh nhan an hit suit dn chilm 64,4% va 47 bfnh nhan chilm ty If 35,6% khdng dn h i t suit.
TAP CHl NGHllN CO'U Y HQC
Trung binh bfnh vifn cung c l p 4 bO-a /ngdy. sd bfnh nhdn dn 4 b&a Id 74 bfnh nhdn chilm 52,9% vd 23 bfnh nhdn dn 3 bQ-a chilm 16,4%. Bfnh nhdn tg y dn thdm cde bO-a phg, nghidn cdu cho thiy sd bfnh nhdn dn 6 bO-a Id 23 bfnh nhdn chilm 11,4% vd 27 bfnh nhdn dn 5 bOa chilm 19,3%,
3. Thgc hdnh tu vln dinh dudng tgi bfnh vifn
Bdng 3. Thgc hdnh t u v l n dlnh dudng tgi bfnh vifn (n = 140) Thgc hdnh tu
Bfnh nhdn dugc tu v l n DD
Hinh thuc tu v l n dinh dudng
vln dlnh dudng
Cd dugc tu v l n DD Khdng dugc tu v l n DD Tu v l n DD theo nhdm Tu v l n DD theo cd nhdn
n 106
34 89 17
% 75,7 24,3 84,0 16,0 Bdnh kpo
Thgc phim bfnh nhdn dn kidng Md Khoai tdy Cdc mdn xdo
136 130 55 37
97,1 92,9 39,3 26,4 Ddnh gid cua bfnh nhdn v l tu
vln dinh dudng
Rit ky vd hilu Rit ky khdng hilu Nhanh qud khdng hilu
103 97.2
2,8
Thudng xuydn Thgc hdnh rdn luyfn thi lgc Thinh thoang
Khdng tfp t h i dge
78 13 49
55,7 9.3 35,0
Trong sd 140 bfnh nhdn. cd 106 bfnh nhdn dugc tu v l n dinh dudng chilm 75.7%
trong dd cd 103 bfnh nhdn ddnh gid bdc sT tu vln dinh dudng r i t ky vd bfnh nhdn hilu dugc nfi dung tu v l n chilm 97,2%. Cd 3 bfnh nhdn chilm ty If 2,8% aho ring bdc sT tu v l n mdc du ky xong bfnh nhdn v i n khdng hilu, v l hlnh thuc tu v l n dinh dudng theo nhdm cd 89 bfnh nhdn chilm 84,0%, ehi ed 16,0% bfnh nhdn dwQc tu v l n dinh dudng theo hlnh thuc tu v l n cd nhdn. Nghidn cu-u cQng cho thiy 136 bfnh nhdn dn kidng bdnh kpo chilm 97,1%, md dfng v f t chilm 92,9%.
Ngodi ra bfnh nhdn dn kidng khoai tdy vdi ty
If 39,3% vd cdc mdn xdo rdn Id 26,4%. Bfnh nhdn tfp thi dge thudng xuydn Id 78 chilm ty Id 55,7%, thinh thoang tdp Id 13 bfnh nhdn chilm 9,3% vd ed 49 bfnh nhdn chilm 35% khdng tdp t h i due.
IV. BAN LUAN
Tinh trgng dinh dud'ng cua bfnh nhdn ddi thdo dud-ng
Trdn thgc t l bfnh nhdn ddi thdo dudng it ed finh trgng dinh dudng thay ddi, tuy nhidn ed mft sd bfnh nhdn g i y hodc bdo. T9 If thii-a edn bdo phi cQng Id m f t v l n d l sO-c khoe hidn
120 TCNCYH 77 (6) - 2011
TAP CHI NGHllN CCPU Y HQC nay d nudc ta: mft bf phdn xd hfi cd dilu
kifn kinh t l , dn udng tdt thi trd ldn thga cdn bdo phi kdm theo cdc bfnh mdn tinh khdng Idy, trong khi dd dai da sd ngudi ddn lao dfng sdng d vung ndng thdn lai bj suy dinh dudng, mdc cdc bfnh nhilm trung. Kit qua nghidn cuu cua Chung tdi ty If bfnh nhdn ddi thdo du-dng cd chi sd BMI thua cdn bdo phi Id 10,7%. Mpt nghidn cuu cua Hoa Ky trong sd 15-20 trifu bfnh nhdn ddi thdo du-dng typ 2 thi 90% Id thua cdn bdo phi [5], trong nghidn CU'U ndy ty If bfnh nhdn ddi thdo dudng typ 2 thua cdn bdo phi Id 15 bfnh nhdn chilm 11,8%, thlp han r i t nhilu so vdi nghidn cuu ciia My.
Qua nghidn cgu cua chung tdi thi BMI trung binh cua bfnh nhdn ddi thdo dudng typ 2 Id 21,3 ± 3,4 kg/m. K i t qua ciia ehung tdi thap han nghien cuu cua Ddc San tai dja bdn thdnh phd Hd Chl Minh ndm 2001 cho thay BMI trung binh cua ngudi ddi thao dudng Id 22,7±3,8kg/m d nam gidi va 23,3 ±4,1 kg/m d nd gidi [7].
Thgc hdnh nudi duang benh nhan tai bfnh vien
Bfnh nhdn duge nudi dudng tgi bfnh vifn chilm ty If 94,3%. cao han nghidn cuu cua Lai Thj Minh Hing ndm 2007 la 74,7% va ddc biet cao han r i t nhilu so vdi khoa Dinh duang bfnh vifn Nhi Trung uang vd mft sd benh vifn tinh nhu Thanh Hod, Hai Duang, Nam Djnh, Thdi Binh... la 20 50% [2]. Ty If bfnh nhdn an h i t suit dn la 64,4%, cQng cao han nghien cuu cua Trln Le Giang ndm 2007.
ty If benh nhdn an h i t suit dn cua vifn Id 46% [3]. Kit q u i chung tdi cd dugc sau dilu ira 4 nam k l tu nghien. cuu eua Trln Lf Slang, nhu vdy la ty If bfnh nhan an h i t suit :ao han cd hai hudng tdt, thu nhit Id bfnh /ifn nlu an tdt han, ngon vd phu hgp vdi chiu vj bfnh nhdn han, thu- hai Id kiln thuc v l
c h l df dn ddi thdo dudng cua ngudi bfnh dugc cai thifn ndn hp khdng kidng khem qud muc. Nhu vfy thi tdc dung cua tu van dinh dudng sau nhilu ndm cQng dd gdp phan vdo thay ddi thgc hdnh dn udng cua bfnh nhdn.
Theo suit dn cua bfnh vifn Id 4 bQ-a/ngdy, tuy nhidn tdm ly cua bfnh nhdn thudng Id han c h l dn udng vi sg du-dng huylt tdng cao.
Theo khuyin cdo cua Hfi ddi du-dng thi ndn chia nhd cdc bQ'a trong ngdy c6 t h i chia 5 6 bQ-a/ngdy. Ndn chia nhilu bO-a dn d l dudng huylt cd t h i dn dinh vd cd mft bQ'a dn nhd vdo budi tdi dk trdnh ha dudng huylt. Kit qua cua Chung tdi cho thiy thi ty If bfnh nhdn dn 4 bQ'a mft ngdy chilm 52,9%, bfnh nhdn dn 6 bQ'a mft ngdy chilm ty If 11,4%.
Thuc hanh t u v l n dinh dudng tai benh vien Van de tu van dn udng cho benh nhdn cQng la mot yeu td qudn trpng, giup cho bfnh nhdn bilt cdch an udng hgp ly vd tu do cai thien du-gc finh trang dinh duang cua bfnh nhdn gop phan lam tdng hifu qua dilu trj bfnh. Tuy nhien, van d l tu van an udng cho bfnh nhdn d bfnh vien v i n chua dugc thgc hifn rfng rai [2, 4].
Tu vln dinh dudng Id mft qud trinh lien tgc, thudng xuyen tao mdi quan hf thdn thifn glQ'a nhdn vien y t l vd benh nhdn. Tu vln dinh dudng tai benh vifn thudng do cac bdc sT dieu trj tai bfnh phdng cQng cd t h i do Trung tdm Dinh dudng lam sdng bfnh vifn Bach Mai dam nhifm. Nfi dung tu van cho bfnh nhdn Id c h l df dn udng, luyfn tdp, vai trd quan trong cua c h l df dn, Iga chon thgc phim vd chdm sdc sire khde khi nim vifn. Do bfnh vifn ddng bfnh nhdn ndn khdng phai ai cQng dugc cac bdc sT di budng tu v l n dinh dudng, ddng thdi cd nhilu bfnh nhdn ndng khdng di Igi dugc ndn khdng di nghe tu v l n tap trung va do vfy ty If bfnh nhdn dugc tu vln dinh dudng trong qud trinh nghien cuu la 75,7%
TAP CHl NGHllN CCPU Y HQC
hlu hit bfnh nhdn du-gc tu v l n Id trong qud trinh dilu trj tgi vifn. Ty If ndy tuang duang vdi nghidn cu-u cua Nguyin Thj Vdn Anh cho thiy cd 76% sd bfnh nhdn suy thfn mgn tinh Ipc mdu cd chu kl dwQfC tu v l n v l c h l df dn udng [1] trong khi bfnh vifn HQ-u Nghj Vift Nam - Cu Ba Ddng Hdi mdi eh? thgc hifn tu vln cho mft sd It bfnh nhdn nfng tgi mft sd khoa nhu Hdi su-c clp cuu, Nfi chuydn khoa [2],
v l hlnh thuc tu v l n , phin Idn Id tu v l n theo nhdm nhd Id 84,0% vd ed 97,2% bfnh nhdn cho ring cdc bdc sT tu v l n rit ky, bfnh nhdn hilu dugc nfi dung tu v l n vd hdi ldng v l cdch thuc tu v l n dinh dudng cua bdc sT cQng nhu- vifc tu v l n dinh dudng tai vifn Id thudng xuydn. Ndm 2007, Lgi Thj Minh Hing chi ra ring bfnh nhdn dugc tu v l n chu y l u tgi bfnh phdng bing hinh thuc ndi chuyfn trge tilp (98,4%) cdn cdc hinh thuc khde chilm ty If rit thap nhu hlnh thuc bdn tdi lifu hudng din v l c h l df dn eho bfnh nhdn (3,2%) vd trao ddi nhdm (1,6%) [4]. Cd khd nhilu nghidn cuu cho thay tdng hogt dfng t h i Igc Idm giam nguy ea phdt triln ddi thdo dudng typ 2 vd ldm tdng tinh nhay cam cua insulin [9]. Nghidn cuu cua Chung tdi cd 55,7% bfnh nhdn tfp t h i due thudng xuydn, tuy nhien khi bfnh nhdn nhdp vifn dd ed ede biln chung d bdn chdn, thfn, tdng huylt dp, nhin md thi vifc tfp t h i dge cua bfnh nhdn Igi bj hgn c h l . Mft sd nghidn cuu chi ra ring hifu qua cua tu v l n dinh dudng cho bfnh nhdn ddi thdo dudng se Id sg phdi hgp chft ehe cua bfnh nhdn trong vifc thgc hifn c h l df dn udng hgp ly vd thdi quen rdn luyfn ca t h i [9].
v l n d l dn kieng d' bfnh nhan ddi thdo dud-ng
Trong qud trinh nghidn cuu cho thiy bfnh nhdn ddi thdo dudng hay dn kidng mft sd logi thgc phim, 97,1% bfnh nhdn dn kidng bdnh keo ngpt; 92,9% bfnh nhdn kidng md dfng
vft. Md dfng vdt thua trong ca t h i Id ngu6n cung c l p chit bdo bdo hda, Idm tdng hdm lugng cholesterol x l u eho ca t h i do dd se Idm tdng tdc df xult hifn cdc biln ehung cua ddi thdo dudng trdn hf thdng fim mgch. Vi$c bfnh nhdn dn kidng md dfng vft cd thi cho thiy bfnh nhdn ddi thdo dudng dd nhfn thu-c dugc hgn c h l dn udng Id c i n thilt. Do vdy, bfnh nhdn ddi thdo dudng ndn kidng hay han c h l tdi da ddi vdi cdc loai dudng hip thu nhanh, tuy nhidn ngudi bfnh cd t h i su- dung cdc chit tgo vj ngpt khdng cung clp hodc cung c l p r i t It ndng lugng [6].
V. K^T LUAN
1. TInh trang dinh duang cua benh nhdn ddi thdo dud'ng
Ddnh gia tinh trgng dinh dudng cua 140 bfnh nhdn cho thiy bfnh nhdn gay chilm ty If 23,6%, bfnh nhdn thua cdn. beo phi chiem t y l f 10,7%.
2. Thuc hdnh nudi duang bfnh nhan tai bfnh vien
Kit qua nghidn cuu thgc hdnh nudi du-dng bfnh nhdn cho thiy ty If bfnh nhdn dn theo suit dn d bfnh vifn Id 94.3%. trong dd 64 4%
bfnh nhdn dn h i t suit. 69% bfnh nhdn hai Idng v l suit dn d bfnh vifn. Ty Id bfnh nhdn duge nudi dn 4 bua chilm ty If 52,9%, 5 bO-a Id 19,3%, 3 bO-a Id 16,4%, 6 bQ'a Id 11,4%.
3. Thuc hdnh t u vln dinh du'dng tai bfnh vifn
- Bfnh nhdn dwtyc tu v l n dinh du-6-ng chilm ty If 75,7%. Trong dd h l u hit bdnh nhdn dugc tu v i n r i t ky vd hilu chilm ty le 97,2%, h l u h i t bfnh nhdn dugc tu vln dinh dudng trong qud trinh dieu trj tai bfnh vifn.
Hlnh thuc tu v l n dinh dudng chii ylu la tu v l n theo nhdm chilm 84,0%, nfi dung tu- v l n cho bfnh nhdn tdp trung vdo vai trP cua
122 TCNCYH 77 (6) - 2011
chl df dn, nhQ-ng thuc dn ngudi bfnh ndn dung vd c h l df luyfn tdp.
Ty If bfnh nhdn tdp t h i dge thudng xuydn chilm 55,7%.
TAI
LIEU THAM
K H A O1. Nguyin Thj Van Anh, Trln Thj Phiic Nguyet (2009). Nghidn cuu khiu phin dn thgc t l cua bfnh nhdn suy thfn man tinh cd lpc mdu chu ki tgi Bfnh vifn Bgch Mai ndm 2008, Y hpc thgc hdnh, 643,45-49.
2. Bf Y t l (2005). Hfi nghj trao ddi kinh nghifm td chuc cdc hogt dfng chdm sdc dinh du-dng tgi bfnh vifn, H u l 22/12/2005, 37-69.
3. Trln Le Giang (2007). Nghidn cuu thgc trgng nudi dudng bfnh nhdn ddi thdo dudng tai bfnh vifn Bgch Mai, khda ludn tdt nghifp cii- nhdn y t l cdng cfng, Trudng Dai hpc Y Ha Npi, 22 - 42.
4. Lai Thj Minh Hdng (2007). Thgc trang sir dgng djch vg an udng tgi bfnh vifn Bgch
i TAP CHl NGHllN CCPU Y HQC Mai - thdnh phd Hd Nfi, Khod lufn tdt nghifp cu- nhdn Y t l edng cfng, 40-48.
5. Ha Huy Khdi (2002). Dinh dudng dg phdng cdc bfnh man tinh. Nhd xult ban y hpc, 117-178.
6. Nguyin Thj Ldm vd Cs (2004). Tdi lieu tu v l n dinh dudng cho bfnh nhdn DTD typ 2, Bf Y t l - Vifn Dinh dudng, 16-34.
7. Due Son LN, Kusama K, Hung NT et al (2004). Prevalence and risk factors for diabetes in Ho Chi Minh City, Vietnam. Diabet Med 21:371-376.
8. Nguyin Khoa Difu Van (2010). Cdp nhdt dilu trj ddi thdo dudng typ 2. Ky ylu hfi nghj chuydn d l ddi thdo dudng vd rdi loan chuyin hda lln thu nhit, Hd Nfi thdng 10 2010,19-46.
9. WHO/ FAO (2004). C h l df an, dinh duang vd dg phdpg cdc bfnh man tinh, Vifn Dinh dudng, 83 - 92.
10. WHO (2006). Diabetes fact sheet No.
312, September 2006, WHO Media Centre.
Summary
NUTRITIONAL STATUS OF DIABETES PATIENTS AND FEEDING PRACTICE NUTRITIONAL COUNSELING IN BACH MAI HOSPITAL
The study was carried out in order to assesses nutrition status, describe feeding and nutritional counseling pracfice of diabetes patients in Bach Mai hospital. The results showed that prevalence of underweight pafients was 23.6%, overweight and obesity was 10.7%. The pafients who used eafing services in hospital were 94.3%, among of them 69.0% pafients very satisfied with their meals. The percentage patients having dietary counseling was 75.7%. Almost of them were received counseling carefully (accounted 97.2%). Focus group discussion was used with highest rate for nutrifional counseling in hospital (84.0%), the counseling contents consisted of dietary role, foods should be used and physical excersices. The patients known to control themselves using wine, beer and smoking. The propotion daily excersices in patients was 55.7%.
In general, diabete patients were follow dietary and nutrifional counselling in hospital, however they still uncomplete daily excersices to improve nutrifional status.
Key words: diabete, feeding, nutritional counselling, nutritional status