Y HOC VIET NAM THANG 10 - S6 1/2014
DAC DIEM CUA BENH NHAN TRI VONG DlTCrC DIEU TRI BANG PHUaNG PHAP LONGO TAI BENH VIEN 1 9 - 8 , BO CONG AN
Tran Trpng Dircrag', Tran Minh D90 , Nguyen Tuan Binh\ Ta Quang Minh'*
- Subjects and Methods: Included were patients diagnosed witti hemorrhoids round (level I I I or level IV hemon+ioids accompanied by rectal mucosa sa) were treated surgically at the Department of Foreign Longo synthetic Hospital 19-8, from 01/2011 to 07/2012.
- Results: The youngest patient was 19 years old, the highest 75, average age 40.49; Men (77%), female (23%). The percentage of time the symptoms begin to appear until patients hospitalized between two groups of less than 6 months and 6-12 months was 44.26%
and 45.90%. Groups have symptoms lasting> 12 months (78.8%). Reasons for patient viat and hospitalization is usually only one reason; Group of patients with bloody diarrhea accompanied by mass lay out the anus (16.4%); Group of patients with bloody diarrhea accompanied by pain, burning, itching anus (18.03%); Group of patients with anal blocks laid out accompanied by pain, burning, itching anus (13.11%);
The patient group included 03 reasons (19.67%).
- Conclusions: The age disease: Minimum age is 19 years old, the highest 75, average 40.49 years old, male (77%), female (23%). Reason to hospital, mainly due to bloody diarrhea (75.40%), bun laid out anal hemorrhoids (52.4%). Duration of hospitalization, fashioned mostly over 12 months (78.8%). On the history of hemorrhoids, in this study, 11 cases (18.03%) had hemorrhoids medical treatment and only 02 cases (3.27%) had been treated hemorrhoids surgical, surgery.
Keywords: Hemorrhoids round; Hospital 19-8;
Longo.
I. OAT V A N DE
Benh trf la benh thu'dng gap d cac nu'dc tren the gidi. Nhieu thong ke d nu'dc ngoai cho thay ty le benh d ngu'di tren 50 tuoi la 5 0 % va co khoang 5 % dan so mac benh tri. Trong nhutig tru'dng hdp t r i sa nhieu thi cat t r i la mot trong nhu'ng phu'dng phap du'dc chi dinh de dieu trj, Tuy nhien, cac phuUng phap cat t r i kinh dien thu'dng gay dau nhieu va cac bien chu'ng trong giai doan hau phau. Ngoai ra, cac thanh phan trung lap cua hau mon dong vai tro quan trpng trong v i « : hinh thanh cac bui trT. l3o do^ nhieu 1^
thuat pjiau thuat mdi du'dc ap dung de thay the cho phau thuat cat tri.
O Viet Nam, chung ta c h u ^ co thong ke ve djch te hoc cua benh t r i mot each day d u . Nhung qua so b i n h nhan du'dc dieu tri t^i cac bSnh vien va cac benh ly nhu" viem dai trang, ly, thi benh t r i cung rat pho bien trong cpng dong. Sach y hpc T b M TAT
- Muc t i e u : Danh gia dac diem chung cua benh nhan tri vong i,\S^ dieu b i bSng phu'dng phap Longo tai B§nh vien 19-8 tCr 2011-2012.
- 051 t i l i n g j r a phtftfug phSp: Bao gSm c^c t>inh nhSn duUc chan doSn la tri vong (tri dp I I I hoac dp IV k6m theo sa niem mac tri/c trang) du'dc dieu trj bSng phlu thuSt Longo tai Khoa Ngoai tong hdp Benh vien 19-8, tCr thang 01/2011 den thang 07/2012.
- KSi qua nghi@n d h i ^ B$nh nhan ft tuoi nhat la 19 tudl, cao nhat la 75 tuoi, trung binh la 40,49 tuoi;
Nam (77%), n\i (23%). Ty \% thdi gian bat dau xuat hi^n tri^u chOtig den khi benh nhan nhap vl^n giii^ hai nh6m du'di 6 thang v^ tiT 6-12 thing la 44,26% va 45,90%. Nhdm c6 triiu chuhg xuat hien keo dai >12 thang (78,8%). Ly do benh nhan dSn kh^m va nhap vi^n thu'dng chi c6 1 1^ do; Nhom benh nhan co di ngodi ra mau kem theo kh5i sa ra ngoai hau mon (16,4%); Nhdm benh nh§n cd di ngoai ra mau kem theo dau, xit, ngiJa h?u mon (18,03%); Nhom benh nhan c6 khdi sa ra ngoai hau mon k^m theo dau, xht, ngiia hau mon (13,11%); Nhdm benh nhan co ca 03 ly dotrgn(19,67%).
- Ket luan: Do tuoi mSc b^nh: Tu€i thap nhat la 19 tu6i, cao nhat la 75 tuoi, trung binh la 40,49 tuoi, nam (77%), nO' (23%). L'^ do vao vien, chu yeu lei do di ngoSi ra m^u (75,40%), bui tri sa ra ngoSi hau mdn (52,4%). Thdi gian nh^p vien, hu yeu ta b^n 12 thang (78,8%). Ve tiSn SLT b^nh tri, trong nghien cCrli nay co 11 trudng h^p (18,03%) da tiiTig dieu trj ngi khoa b^nh t i i va chi CO 02 tru'dng hdp (3,27%) da tijrig dieu til b§nh tn bSng thCi thuat, phau thugt.
7i)'ifcftda.'Tri vdng; Benh vien 19-8; Longo.
SUIVIMARY
CHARACTERISTICS OF HEMORRHOIDS ROUND TO BE TREATED W I T H LONGO SURGERY I N 1 9 - 8 HOSPITAL, M I N I S T R Y
PUBLIC OF SECURITY
• Objectives; Evaluate the general characteristics of the patients were treated with hemorrhoids loop method Longo at 19-8 Hospital from 2011 to 2012.
' CMC Y ^ , T5ng cMC H§u dn-Ky thuat, Bo C5ng an
^ B ^ h viSn 19-8, Bp Cong an ' B|nh vt§n Y hpc 06 t r u ^ n , Bp Cong an
^ T n j ^ g D^i hpc An ninh nhan dan Chiu tTcich nhl|m chinh: Tran Trpng DUPng Email: [email protected] Ot: 0167.686.789 Phan bioi l^oa hoc: TS Le Quang Minh Ng&ynh^nb^l: 22.7.2014
V HOC VIET NAM THANG 10 • SO 1/2014
dan tgc cua chung ta ghi nhan "TTiap nhan cifu tri" CO nghTa la "Mu'di ngu'di chin ngu'di bi benh tri". Theo Pham Khue (1980) cho biS benh tri chiem ty le 2,3% trong cac benh ngoai khoa 6 nhu'ng ngu'di tren 60 tuoi.
Benh vien 19-8 la benh vien hang I, la tuyen dieu tri cuoi cung cua nganh Cong an. Hang nam benh vien thu dung va dieu tri cho hang van lu'dt binh nhan trong va ngoai lu'c lu'dng Cong an nlian dan vdi day du cac chuyen nganh: Npi khoa, ngoai khoa, cac chuyen khoa khac. Phlu thuat cat tri bang phuHng phap Longo da dUdc trieii khai trong he thong y te Vie_t Nam. Tuy nhien, phuSng phap nay mdi duac trien khai va ap dung tai Benh vien 19-8. Xuat phat til' tinh hinh thVc te tren, chiing toi tien hanh nghien ctru de tai nay nhSm muc tieu danh gia dac diem chung cua benh nhan tri vong du'dc dieu trj bang phu'dng pliap Longo tai Benh vien 19-8 tir 2011-2012.
II. Odi TU'(?NG VA PHirONG PHAP NGHIEN COtI 2.1. Bol t i r i n g , d[a diem va thdi gian nghiln cCiti: Bao gom cac benh nhan du'dc chan doan la tri vong (tri do III hoac do IV kem theo sa nim mac trUc trang) du'dc dieu trj bang phau thuat Longo tai Khoa Ngoai tong hdp Benh vien 19-8, tir thang 01/2011 den thang 07/2012.
• Tieu chuan benh nhan lua choniBenh nhan du'dc Chan doan la tri vong (Tn do III, IV kem theo sa niem mac triTc trang) duS vao:
- Lam sang: Oai Men ra mau; Cau, rat, ngte viing hau mon; Sa bui tri khong tif co vao dUdc;
Sa niem mac trUc trang
- Can lam sang: Soi hau mon-tryc trang chan doan xac djnh: mire dp bui tri dp III, IV kem theo sa niem mac true trang, tri vong; Cac xet nghiem thu'dng quy khac cho phep phau thuat.
- Cac tieu chuan khac: DUdc dieu tri ngoai khoa bang phau thuat Longo; Cd du ho sd nghien ciili;
Khong phan biet gidi ti'nh nam hay nS; Khong phan biet tuoi.
* Tieu chuan benh nhan loai trir: Benh nhan mac benh tri vong du'dc phau thuat bSng cac phu'dng phap khac; Cac loai benh tri khac; Co chong chi djnh phau thuat bSng phu'dng phap Longo.
2.2. Phu'dng p h i p nghien du Thiet ke nghien culi: Nghien cihi h3i ciJu va nghidn cull tien culi.
+ Nghien ciru hoi ciru: tir thing 01/2011- 09/2011
+ Nghien ciru tien culi: tir thang 10/2011- 07/2012.
- Phu'dng phap nghien ciru; Cac benh nhan du'dc kham benh, lam xet nghiem, soi hau m6n-tm'c trang cac ket qua du'dc ghi vao mot mau bSnh an thong nhat.
- Xu' ly so lieu: So lieu thu duUc si xu' 1^ bang chu'dng trinh thong ke y hpc.
27.87 III. KET QuA NGHIEN CO'U
Bleu do 3.1. Ty le cac nhom tuoi Tyle
30 25 20 15 10
< 20 tuoi 21-30 tuoi 3140 tuoi 41-50 tuoi 51-60 tuoi > 60 tuoi Nhom tu6i
HhfnxdbTmng nghien cuU nay, chung toi thay benh nhan it tuoi nhat la 19 tuoi va benh nhan cao tuoi nhat la 75 tuoi, tuoi trung binh cija nhom benh nhan tham gia nghien ciru la 40,49 tuoi; Tir 21-30 tuoi (27,87%), tir 51-60 tuoi (24,60%); Ba nhom tuoi cd ty le tu'dng du'dng nhau trong nghien cull la 31-40 tuoi, 41-50 tuoi va tren 60 tuoi (13,11%).
Y HOC VI$T NAM T H A N G 10 • SO 1/2014 Bieu do 3.2. Bieu do gidi tinh t^enh nhan nghien culj
Nh$nx4t:y<f \QbQX\Y\ nhan nam gidi gap hdn 3 lan so vdi nifgidi: Nam (77%), nu'(23%).
Bang 3.1. TTidi gian t\S xuat hien trieu chu'ng den nhap vien Thdi gian
< 6 thanq 6-12 thang
> 12 thang Tong cong
n=61 6 7 48 61
Ty le (%) 9,8 11,4 78,8 100
iVhanxet'Ty le thdi gian bat dau xuat hien trieu chu'ng den khi benh nhan nhap vien g\\Jta hai nhdm du'di 6 thang va tii 6-12 thang la tu'dng du'dng nhau (44,26% va 45,90%). Nhom cd trieu chuVig xuat hien l^eo dat (>12 thang) chiem ty le cao (78,8%).
Bang 3.2. Ly do vao vien LV do vao vi$n Di ngoai ra mau
Khoi tr? sa ra ngoai hau mon Dau, rat, n^isa hau mon
Cac ly do khac (phat hien benh tri kem theo)
n=61 46 32 20 2
Ty le (%) 75,40 52,46 32,78 3,27 Nhan xet: Trong tong so 61 benh nhan nghien
cull thi Chii yeu ly do khien benh nhan phai vao vien l(ham benh la di ngoai ra mau la 46/71 benh nhan chiem ty le 75,40%; Ly do di kham benh do thify khoi, bui trT sa ra ngoai hau mon la 32/61 b^nh nhan chiem ty' le 52,46%. Ngoai ra con do
nguyen nhan la dau, rat, ngLTa hau mon khien benh nhan phai di kham benh la 20/61 benh nlian chiem ty le 32,78%. I^pt nhdm benh nhan rat nho (2/61 benh nhan) di benh vien kham vi cac ly do khac dong thdi phat hien benh tri cd cht djnh phau thuat Longo chiem ty le 3,27%.
Bang 3.3. Ty le nhom benh nhan co tir hai ly do vao vien trd len Ly do vao vien
DI ngoai ra mau+Khoi sa ra ngoai hau mon DI ngoai ra mau+Oau, rat, ngira hau mon Khoi sa ra ngoai hau mon+Dau, rat, nqii^ hau mon DI ngo^l ra mau+Dau, rat, ngu^+Khoi sa ra ngoai hau mon
Tong cpng
n=61 10 11 OS 12 41
Ty le (%) 16,40 18,03 13,11 19,67 68,3 Hh$n x4t! Qua ket qua d bang tren ta thay, ly do benh nhan den kham va nhap vien thu'dng chi cd 1 ly do. Viec phoi hdp nhieu ly do thu'dng chiem ty le thap; Nhdm benh nhan cd di ngoai ra mau kem theo khoi sa ra ngoai hau mon cd 10/61 benh nhan chiem ty le 16,4%; Nhom benh nhan co di ngoai ra mau kem theo dau, rat, ngiTa hau mon cd 11/61 benh nhan chiem t^ le 18,03%; Nhom benh nhan cd khoi sa ra ngoai hau mon kem theo dau, rat, ngus hau mon co 8/61 benh nhan chiSm ty 1$
13,11%; Nhom b^nh nhan cd ca 03 ly do tren cd 12/61 benh nhan chiem ty le 19,67%.
Y HOC Vl|T NAM THAHG 10 • S 6 1/2014 Bieu dd 3.5. Ty le cac nhdm tien sir benh
3,27%
Nh$n xet: Hau nhu' benh nhan trong nhdm benh nghien ciru deu cd tien sir khde manh cd 40/61 b|nh nhan chiem ty le 65,57%. Nhdm benh nhan cd tien sir benh tri i ^ dUdc dieu trj ndi khoa cd 11/61 b?nh nhan chiem ty l§
18,03%, nguac lai nhdm benh nhan cd den sir bj
• Khoe m^nh
• Da diSu tri npi trT , Da dieu tri ban thuat, phau thu
• Betih Ichac
benh tri du'dc dieu trj bang thii thuSt, phau thu^it cliiem ty le khong dang ke chi cd 2/61 benh nh3n chiem ty le 3,27%. Trong nghien cuU nay, cii 8/61 benh nhin cd tien siT benh khac nhu cao huyet ap, phau thuat tii mau ngoai mang ciiTig, thieu mau... chiem t^ le 13,13%.
Bang 3.4. Cac yeu to nguy cd do thdi quen sinh hoat cd the gay benh tri Y§u to nguy cd
An cay Uong rUdu^ bia Hiit thuoc la, thuoc lao Nqdi lau
Van donq manh Tong cong
n=61 46 35 26 23 14 61
Ty le (%) 75,40 58,61 42,62 37,70 22,95 100 Nh$n xet; Trong nhdm cac yeu to nguy cd do
thdi' quen sinh hoat thi nhdm benh nhan cd thdi quen an cay (dt, hat tieu) cd 46/61 benh nhan chiem ty le cao nhat 75,40%. Nhom benh nhan cd thdi quen udng rUdu, bia cd 35/61 benh nhan chi€m ty le 58,61%. Nhdm benh nhan cd thdi quen hut thuoc la, thuoc lao va ngdi lau lUdt la
26/61 va 23/61 benh nhan chiem ty I? tu'dng diTdng nhau (42,62 % & 37,70%). Thdi quen trong nhdm yeu to nguy cd do thdi quen sinh hoat gay nen benh tri chiem ty le thSp nhat la nhdm cd thu'dng xuyen van dong manh chi co 14/61 benh nhan chiem ty ie 22,95%.
Bang 3,5. Benh npi khoa kem theo benh tri vong B$nh noi i<hoa kim theo
Cao huyet ap Roi loan tuan hoan nao Viem dai-tru'c trang Thi€u mau man tfnh
Tong so:
n=61 1 2 4 1 8
Ty le (o/o) 1,64 3,28 6,56 1,64 13,12
Nhan xet: Cd 8/61 benh nhan du'dc phau thuat Longo dieu trj benh tri cd mac cac benh npi khoa kem theo (ciing dieu trj phoi hdp trong nghien ciTu) chiem ty le 13,12%. Ty le cac benh trong nhdm chenh lech nhau khong dang ke thu'dng tir 1-2 benh nhan. Dac b i ^ cd 01 bgnh nhan cd tinh trang thieu mau man tfnh phai tien hanh truyen 1500 ml sau khi phau thuat trong 48 gid dau.
IV. BAN LU$N
- V£ do tuoi mic b^nh: Theo ket qua nghien cull, trong nhdm nghien ciJu ciia chiing toi, binh nhan cd tuoi thap nhSt la 19 tuoi, cao nhat la 75
tuoi, tuoi trung binh la 40,49 tu6i. Tuoi trung binh trong nghien ciru ciJa chijng toi thap hdn ciia mot so tac gia; Theo Nguyen Thanh Xuan •A cong sir (2007) nghien^ ciru thay dp tuoi trung binh la 43±1,4 tuoi, tuoi nhd nhat la 16 tuoi va
Y Hpc VlgT NAM THAMG 10 - S01/2014 benh nhan cd tuoi Idn nhat la 83 tuoi; Nguyin
Phuc Minh (2002) benh nhanjaS tuoi trung binh la 46,06, benh nhan nhd tuoi nhat la 15 tuoi, benh nhan idn tuoi nhat la 86 tuoi; Theo Trieu Trieu Du'dng (2008), tuoi trung binh cua nhdm benh nhan nghien ciru la 46,2, benh nhan it tuoi nhSt la 26, benh nhan nhieu tuoi nhat la 72 tuoi;
Theo Lg Van Diem (2007) va cpng su tuoi mac b#nh trung binh ciia nhdm^benh nhan nghien cull la 50, tre nhat la 24 tuoi, gia nhat 76 tuoi;
Tac gia Papillon M (1999) va cpng sir tuoi mac b|nh trung binh trong nhdm bSnh nlian nghien cUU la 47 tuoi; Tac gia Sven Petersen (2004) va c$ng SI/, tuSi mSc benh trun§ binh la 54 tuoi.
Tuy nhien, ket qua nghien culi cua chung toi ciing tUdng duOng ket qua nghien ciru ciia mot so tac gia: jTac gia Le Manh CUdng va cpng sU (1996): Tuoi trung binh ciia nhdm nghien culi la 42,3 tuSi, nhd nhSt la 21 tuoi va Idn nhat 80 tuoj;
TTieoTrieu Trieu DUdng va cpng sU (2004), tuoi trung binh ciia nhdm benh nhan nghien cull la 41,2 (tuoi tre nhat 38 v j tuoi cao nhat 65); Tac gia Trjnh Hong Sdn va cong sU (2011), tuoi trung binh ciia nhdm benh nhan nghl§n cUu la 40,6*12,1, benh nhin it tuSi nhat la 22, benh nhan nhieu ttiol nhat la 68 tuoi. Theo Nguyen ' Thanh Xuan (2007), do tuoi trung binh ciia nhdm binh nhin la 41,69±12,81.
Ve nhdm tuSi mac benh: TuSi mac b|nh tap trung cao nhat d hai nhdm tuoi 21-30 tuoi (27,87%) va nhdm ftioi 51-60 tuoi (24,6%), cd le day la hai nhdm tuoi dac thil: Nhdm 21-30 tuoi thudng cd sire khde rat tot, lao dpng va v$n dong manh thUdng xuyen kem theo cd thdi quen uong niiieu rUdu, bia. Nhdm tuoi 51-60 tuoi thudng cd nhiitig benh ve roi loan chuyen hda, diing nhieu bia, ru^u va ngol lau. It v;n dpng.
Ket qua nay khac vdi mot so ket qua nghien culi:
Theo Giamundo P (2011), tuoi mac lienh trung binh ciia nhdm benh nhan nghien culi la 46 tuoi.
- V& gl6i: Theo ket qua nghien ciili cua chung tdi, b?nh nhan la nam gidi chiem ty le 77%, benii nhan la nii' gidi chiem 23%, ty le nam/niia > 3/1.
Day cung la mpt dac thii ciia Benh vien 19-8 la b^nh viln thuoc luc lu'dng vu trarig,can bp, chien sy Cdng an phan Idn la nam gidi nen benh nh3n nam gidi duUC kh^m va dieu trj tai bi|nh vien chiem ty le cao. Nhu vay, ty le benh nhaii la nam gidi chi&ii da s6, ty le nay kliac vdi ket qua nghien ciili cua mot so iic gia: Theo tac gia Nguyin Thanh Xuan va cpng sU (2007), ty le nam bj benh tri trong nghien oili chiem t^ le 53,1% va nu' chiem ty le 46,9%; Ttheo Nguyen Phiic Minh (2002), ty le nam bi b?nh trf la 58,6%
va nii'la 41,4%.
Ket qua nghien culi cua chung toi phii hdp vdi ket qua nghien cull cua mot so tac gia: Tic
gia Trieu Trieu DUdng (2004), ty le nam/nii' mac benh tn dUdc phau tiiuat Longo la 146/78; Theo L§ Manh CUdng va cpng sU (1996), ket qua nghien cuU tren 594 binh nhan trong dd nam gidi chiem ty le 74,25%, nu' gidi chiem ty le 25,75%. Theo Le Van Diem va cpng sir (2007), ty le nam/nii' bj mac benh tri la 2 / i ;
- V I ly do vao vien: Trong nghien cijru cua chiing toi, ly do vao vien chu yeu la do di ngoai ra mau (75,40%), bui tri sa ra ngoai hau mon (52,4%). Ket qua nay cung tUdng dUdng vdi ket qua nghien ciru ciia mot sd tac gia: Theo Nguyin Duy Thanh (2011), trieu chiiiig cd nang: sa bui tri (85%), di ngoai ra mau (72,2%), dau rat hau mon (73,7%) [6]. Ngoai ra cdn cd cac ly do khac khien benh nhan nhap vien nhu dau, rat, ngUa hau mon (32,78%), cd tU 2 ly do phoi hdp trd len nhu di ngoai ra mau kem theo bui trf sa ra ngoai hau mdn (16,4%), di ngoai ra mau kem theo dau, rat, ngila hau mdn (18,03%), bui tri sa ra ngoai kem theo dau, rat, ngii^ hau mdn (13,11%) va ca ba ly do tren (19,67%).
- V I thdi gian nhap vien: Theo ket qua nghien ciru, thdi gian tir liic cd trieu chuhg bat thudng den khi benh nhan den benh vien kham va nhap vien dieu trj chii yeu la tren 12 thang chiem ty le 78,8%. Kit qua nay cung phii hdp vdi thdi quen cua ngUdi Viet Nam trong viec phdng chdng benh tat, thong thirdng khi bj benii hp se tU dieu trj vh neu benh khong thuyen giam, liic dd hp mdi nhap vien de kham va dieu trj. Ket qua cung phii hdp vdi ket qua nghien cu'u ciia mot so tac gia kliac: Theo Trieu^ Trieu DUdng va cpng sir (2008), thdi gian ke tU khi mac benh trf ciia benii nhan tU 01-12 nam, thdi gian mac benh trung binh la 5 nam.
- Ve t i l n su' benh tri; Trong nghiln cUu nay cd 11 trudng hdp chiem ty II 18,03% da timg dilu trj npi khoa benh trf va chi cd 02 trUdng hdp chiem ty le 3,27% da timg dieu trj benh tri b5hg thil thuat, phau thuat. Ket qua nghien cull ciia Trieu Trieu DUdng va cpng sU (2004), nghien ciilj cho thay cd 49% trUdng hdp benh nhan da dUdc dieu trj not khoa bang thuoc ting su'c ben thanh mach nhu Cycio 3 Fort...
V. Kfr LU^N
- Dp tuoi mac benh: Tuoi thap nhat la 19 tuoi, cao nhatja 75 tuoi, trung binh la 40,49 tu6l. Ve nhdm tuoi mac benh: Tud'i mac benh tap trung cao nhat d hai nhdm tuoi 21-30 tuoi (27,87%) va nhdm tuoi 51-60 tuoi (24,6%).
- Gidi: Nam gidi chiem ti II 77%, benh nhan la nff gidi chiem 23%.
- Ly do vao vien: Chu yeu la do di ngoai ra mau (75,40%), biii trf sa ra ngoai hau mon (52,4%).
Y HOC VigT NAM THAHG 10 • SO 1/2014 - Ve thdi gian nhap vien: Chu yeu la tren 12
thang chiem ty le 78,8%.
- Ve tien sir benti t r i : Trong nghien culi nay cd 11 trudng hdp ( i 8 , 0 3 % ) da txing dieu tri npi khoa benh trT va chi cd 02 tru'dng hpp (3,27%) da trai qua dieu trj benh trT bSng thu thuat, phau thuat.
TAI LIIU THAM KHAO
1. Le M^nh Cu'dng, Nguyin M^nh Nham (1996), "Nghien culi bu'dc dau qua 800 tru'dng hop dieu tn. benh tri ngi bang may WD - 11", Tap dii Ngoai ldioa,so'\,\x. 18-23.
2. Trieu trieu DuVng (2008), "Nghien cuU dieu trj phau thuat bSng phu'dng phap Longo tai Benh vi?n 108"^ Tap chi Y hoc Wipf Nam, so 4, t$p 345, tr. 19-23.
3. L3 van Diem, Ddo Quang Minh, Vu Trung Tn/c va cpng of (2007), "Ket qua ban dSu djeu trj benh tri theo phuUng ph^p Longo tai B?nh vien da Wioa Xanh Pon Ha Noi", Tap chi Thdng hn Y Z?uMr,s64,tr. 23-26.
4. Nguyen Thanh Xuan, To V3n Tanfi, Ph^m Nhu" Hiep, Phan Hai Thanh, Ho Hull Thien,
Ph^m Anh Vu, Dao Le Minh Oiau (2007),
"Oanh gia Itet qua dieu tri bu^c dau bang song cao tan tai benh vien Trung uWng Hue", Tap chiY hoc thu'c hanh, so i , tr. 8-10.
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THU'C TRANG VA HIEU QUA MO HINH CAl THIEN TANG HUYET AP TAI TINH BAC GIANG
D i n h v a n T h ^ n h * , Nguyen V a n S o n * * , N g u y S n T i e n D u n g * * T6M TAT
Myc tieu: Mo tS thyic trang quan I'y' (QL) t^ng huy€t ap (THA) tai tuyen y te co sd d tinh Bac Giang va danh gia hieu qua ho?t dong mo hinh QL THA d huy^n Tan Yen, tinh BSC Giang sau can thiep. Phu'dng phSp: Mo ta cat ngang va can thiep cong dong tru'dc sau CO doi chiVng. Ket qua: Ty le 42,9% du'pc dieu tri (OT). C6 22,8% ngufii THA du'dc QL, co 14,6% du'dc QL dung, co 56,7% ngu'di THA du'dc tu' van ve bao hiem y te (BHYT). Ket qua viec phong chong THA d tinh Bac Giang chu^ dat muc tieu cua tinh BSC Giang.
Tram y te (TYT) )ra, Nhan vien y te thon ban ( NVYYTB) diuS duWc giao qua ly THA. Sau can thiep cSc h^nh vi nguy cd d ngu'di THA glam ro r^t; Ty le ngu'di THA du'pc QL dung 66,4%, ty le ngu'di du'dc QL dung dat huy^ ap muc tieu (HAMT) ting tilf 4,9% len 63,7% (CSHQ 1200). Ty le bj bien chutig, tii vong giSm, Ngu'di duttc QL tai TTYT xa on dinh, Mo hinh de tiii^ hien, kha n^ng duy tri va nlian rpng cao..
* Sd y te BSC Giang
* * Trudng dat hoc Y DuUc Thai Nguyen Chju trach nhiem chinh: Nguyen TiSn Dung Email: [email protected] Ot: 0913.516.863 Phdn bi?n khoa hpc: PGS.TS Duttng HQng Th^i NgSy nh|in bar: 30.8.2014
Khuyen nghj: Giao nhiem vy QL THA cho TYT x3, tang cu^ng nang cao nang liic can bd, ho trd trang tiiiet bj y te cho cac BV huyen, TYT xa va NVYTTB.Nen nhan rong mo hinh nghien cu'u ra toan tinh Bac Giang.
Tu'kh6a:l\\\ic trang, quan Iy,t3ng huyet ap, mo hinh nghl&n CUXJ, Bac Giang.
SUIVIIVIARY
CURRENT S I T U A T I O N A N D EFFECTIVITY OF HYPERTENSION I M P R O V E M E N T MODEL
I N BAC G I A N G PROVINCE Objective: To describe management current state of hypertension at grassroots level healtti faalities in Bac Giang province and evaluate tfie effectivity of hypertension management model after interventiwi In Tan Yen district, Bac Giang Province. Methods: Cross- sectional descnption and post- and pre-controlled community intervention. Results: 42.9% of p e c ^ with hypertension were treated. Among 22.8% of pecqile with hypertension have been ajntrolled 14.6% were conecOy contitilled. 56.7% of hypertensive recdved counseling on health insurance (MI).
The study results showed that the deployment of hypertension prevention program In Bac Giang province has not reached the objective planned. CHCs, village health woriters have not been assigned to
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