Y HOC VlfT NAM THANG 5 - SO 2/2014 3-4). Day la nhutig dau hieu rat hiJu fch Ithi tam
soat OSA 6 benh nhan COPD. Nhutig dau hieu khac thuSng gap trong OSA d trong dan so chung nhu" map phi, dau dau buoi sang, met moi ban ngay thi lai khong co moi lien quan co y nghTa vcfl chi so AHI d benh nhan COPD. Do vay, do PSG can du'dc thi/c hien d nhiJng benh nhan COPD CO nhOtig dau hieu nghi ngd bj OSA.
V. K f r LU&N
H6i chtrtig ngu'ng t h d khi ngu thu'dng gap tren benh nhan COPD hdn trong dan so chung.
Day la nguyen nhSn lam nang them nhij'ng bien chuTng va ty le tii* vong cua ngu'di benh. Hpi chiJfng ngutig t l i d khi ngu can phai du'dc tam soat m6t each thu'dng qui tr§n benh nhan COPD de co phutfng phap dieu tri thfch hdp.
TAI LI|U THAM KHAO
1. Chaouat A, Weitzenblum E, Kessler R, Schott R, Charpentier C, Levi-Valensi P, Zidinsld 2, Ddaunois L* Comudella R, Moutinho dos Santos
3: OutoDme of COPO padents with miW daytime hypoxaemia wrtti or vwthout steep-related oxygen desaturatjon. &jr Respir J 2001; 17:848-55.
2. Chaouat A., Weitzenblum E., Krieger J„
Ifoundza T., Oswald M., Kessler R. Associaton of dironic obstructive pulmonary disease and sleep apnea syndrome. Am Rev Respir Dis 1995;
151 :82-86.
3. Cully 3.A., Graham D.P., Stanley M.A., Ferguson C.3., Sharafkhaneh A., Souchek]., et al. Quality of life in patients with chronic obstructive pulmonary disease and comortid anxiety or depression. Psychosomatics 2006 ; 47 : 312-319.
4. Duran ] . , Esnaola S., Rubio R., Iztueta A, Obstructive sleep apnea-hypopnea and related dinical features in a population-based sample of subjects aged 30 to 70 years. Am 3 Respir Oit Care l^ed 2 0 0 1 ; 163 : 685-689.
5. FlenleyD.C. Sleep in chronic obstructive lung disease. Clin Chest Med 1985; 6 : 51-61.
6. Vos PJ.E., Folgering H.T.M., Van Herwaarden C.L.A. Predictors for nocturnal hypo}(aemia (mean Sa02 <90 %} in normoxic and mildly hypoxic patients with COPD. Eur Respir J 1995; 8:74-77.
DANH GIA NHU CAU KHAM, CH&A B | N H COA CAC DOI xu'aNG QUAN LY VA GIAM Giir
THUOC BO CONG AN (2009-2010)
T6M TAT
MifC tieu: D^nh gia nhu cau KCB cua cac dol tUiJng QLGG tai BX cac CSGG va tai cac BV nha nu'dc (2009-2010). fidi tuVng vd phu'dng phdp: Cac doi t\im QLGG dUflc KCB tai 31 BX CSGG va 26 BV tCr 2009-2010. Nghien cu\j mo ta d i t ngang ket hop nghien cCTu dinh lu^ng va mo ta hoi cdu diia tr€n c^c sS lj|u thCr clip. Ket qua: Tai BX: nSm 2009 ia 582.583 l u ^ khSm benh, phat thuoc; n3m 2010 la 660.046 l u ' ^ khdm benh, phat thuoc. I a l BV: nSm 2009 la 22.603 lu-<;ft kiidm benh; nSm 2010 la 25.284 l u ^ khdm b^nh. Co cSu benh tat cua cac dol tu^ng QLGG khi KCB tai BV chCi yeu la HIV/AIDS (43,29- 51,20%), Lao (9,10-45,11%), viem gan B, C... Ket lu$n: Nhu cau KCB cho cdc dSl tu'dng QLGG la rat ldn.
Tu'khda:Q6\ tuwng QLGG; nhu cau KCB.
* QK Y te, Tdng cgc H$u cSn-Ky ttiuat, Bp Cdng an
** Tdng cue H$u can-Ky thuat, Bp Cdng an Phan bi$n khoa hgc: P6S.TS Ph^m VSn Thao
Nguyen Khic Thuy*, Ph^m Quang Cu***
S U M M A R Y
RESEARCH T O NEEDS OF TREATMENT FOR PRISONERS, M I N I S T R Y OF P U B U C
SECURITY ( 2 0 0 9 - 2 0 1 0 ) Objective: Evaluate needs medical treatment of Inmates at the prison infirmary and at the state hospital (2009-2010). Subjects and methods;
private medical treatment at the prison's 31 clinics and 26 hospitals from 2009 tp 2010. Cross-sectional descriptive study combined quantitative and qualitative research described in the study based on secondary data. Results: At the Clinic: in 2009 had 582.5S3 respectively examination; in 2010 had 660.046 respectively examination. At tiie hospital: 22.603 respectively examination in 2009; n 12010 had 25.284 respectively examination, Morbidity of prisoners when medical treatment at a hospital mainly HIV/AIOS (43,29 to 51,20%), Lao (9,10 to 45,11%), hepatitis B, C... Conclusions: The need for medical treatment of prisoners is very large.
/feywort/s/Prisoners; needs medical treatment
130
Y HOC VI$T NAM THANG 5 - SO 2/2014
I.BATVANOE
Cong tac quan ly su'c khoe, kham, chiis benh (KCB) cho cac doi tuUng quan ly va giam giu*
(QLGG) la mpt chinh sach nhan dao cua Oang va Nha nu'dc ta. Oieu do the hien tfnh Uu viet cua Nha nu'dc xa hoi chu nghTa, truyen thong dao ly cua ngu'di Viet Nam va dam bao nhan quyen cua ngu'di bl giam gic? [7]. Oang, Nha nudc ta da the chl hoa quan diem fren thong qua he thong van ban ciJa Nha nudc, Chinh phu va cua Bo Cong an [7]. Hi?n nay, y tS Cong an nhan dan (CAND) da trien khai dSn t i t ca cac cd sd giam giff (CSGG), bao gSm; Trai giam (TG), Trsii tam giam (TTG), Cd s4 giao dgc (CSGD), Truftng giao duSng (TGD) trong ca nu'dc vdl 0 1 bSnh vien (BV) va 128 bSnh xa (BX) de KCB cho cac doi tuBng QLGG [2], [7],
Xuat phat tii thut te tren chung toi tien hanh nghien cilu nay nhSm danh gl^ nhu cau KCB cCia c^c dSi tucirng QLGG t^l BX cac CSGG va tai cac BV nhj nu'dc (2009-2010).
II. o d l T\J<fNG VA PHirCTNQ P H A P N G H I E N COXJ
III. K f r Q U A NGHIEN C C u
3 . 1 . Nhu cSu KCB ciia d i e dol t U ^ n g QLGG t^i BX ciia 3 1 CSGG nghidn clhi Bl&i as 3.1. S5 iiiift KCB ngo?i tni cho dol tucjng QLGG tai cac CSGG
491.24
2 . 1 . Ddi tiTtfng, dja diem va thdi gian nghien curu
- Bdt tudng nghien cdu: Cac doi tu'dng QLGG dUdc KCB tai BX CSGG va BV tir 2009-2010.
- Bia diem nghiin cuV: Gom 31 CSGG (15 TG; 13 TTG; 02 CSGD; OITGD) va 26 BV (10 BV da khoa tinh/thanh pho; 5 BV huyen; 5 BV chuyen khoa va 6 BV CAND).
- Thdi gian nghiin cdu: 2009-2010.
2 . 2 . Phu'Ong phap nghien cihi 2.2.1. Thidt ke nghiin aid; Nghien cilu mo ta cSt ngang ket hdp nghien CLi\j dinh luidng va mo ta hoi cilu Sifa tren cac so lieu thu' cap.
2.2.2. Cacphdt/ng phip nghiin cihi
* Phudng phip md ti cSt ngang: Dieu tra ngang tai cac BX CSGG va BV trong ph?m vl nghien citu.
* Phuang phip md ti hdi ciiti: Nghien culi cong tac KCB cho cac dol tu'dng QLGG tai BX CSGG va BV trong 2 nSm 2009-2010.
* Phut/ng phip xdly sSitiu: So ll$u du'dc x * ly bSng cac phan mem thong ke y hpc, excel.
T TT CSGD-
SBIulft K(X ngofi tm cho cac doi tudng QLGG t^lcacBX CSGG deu tang nhieu qua cac nim: KhS TG (nim 2009: 426.310 lupt, nim 2010: 491.244 ludt), khoi TTG (nim 2009:119.922 lupt, nim 2010:
121,483 lupt), khdi CSGD-TGD (nim 2009:36.351 lupt, nim 2010:47.319 ludt).
Y HOC VIET NAM THANG 5 - SO Z/2014
3ieu dS 3.2. So li/cft KCB ngoai tru cho (Joi tuWng QLGG trung binh cho moi CSGG (2009-2010)
350l>l> - : 8 4ai JOOOO -•
25000 f 20000 ^ 15000 -•
lOOOO -^
5000 - 0 -f
32 '-»?
•viii
• NiUn 2009 1060: • N m n 2 0 1 0T T G CSGD
/VAAjxefrSo lUdt KCB tri ngoai tru cho cac doi tu'dng QLGG trung binh/BX: Nam 2009: Dol vdl KhS TG'(28.421 lu'dt ngu'di/BX); TTG (9.225 lum ngu'di/BX); CSGD (12.095 tu'dt ngu'di/BX); TGD (12.162 lu'dt ngu'di/BXV. Nam 2010: Dpi vdS Khoi TG (32.745 lu'dt ngu'di/BX); TTG (9.345 lifdt ngu'di/BX); CSGD (18.359 lu'dt ngu'di/BX); TGD (10.602 lu'dt ngu'di/BX).
Bieu ad 3.2. So lu'dt nam dieu trj tai BX cua cac dpi tu'dng QLGG
mmmm
' " ' J M ' , s .
JM^_,^.
So Iddt ddi tddng QLGG nim dieu bi tai BX cac CSGG: khoi TG (nim 2009: 82.165 Iddt, nim 2010:
78.387 ludt), khdi TTG (nam 2009: 2,840 ludt, nam 2010: 3.037 Iddt), khdi CSGD-TGD (nim 2009:
858 Iddt, nim 2010:911 Iddt).
Bin Chi tieu
KCB So lu'dt kham b|nh
Ngay dieu tri trung
binh So chuyen
vien dieu tri
gr 3.1. Tinh hinh KCB chp cac del tUdnq QLGG tronq 2 nim (2009-2010) Khoi TG
2oog 426.3 10 4,3
1.761 2010 491.2 44 4,7
2.261
Khdi TTG 2009 119.9 22 4,1
868 2010 121.4 83 4,3
834
Khoi CSGD 2009 24.18 9 15,0
12 2010 36.71 7 15,0
7
Khoi TGD 2009 12.16 2 15,0
57 2010 10.60 2 15,0
59
Tdng 2009 582.5 83 9,6
2.698 2010 660.0 46 9,75
3.161 SS lupt KCB cho dc dot tddng QLGG dSu tang (nam 2009: 582.583 Iddt, nim 2010: 660.046 tudt).
Ngiy dieu bf dung binh tai BX cac CSGG thay ddi khdng dang kequa 02 nim (2009-2010). Soludng dS wpng QLGG phii chuyen BV tuyen den deKCB tang (nam 2009:2,698 ludt, nim 2010:3.161 luat).
V HOC VIET NAM THANG 5 - SO a2014
Bang 3.2. Ty le benh nhan Lao va nhiem HIV/AIDS dieu trj tai BX CSGG Khoi CSGG Lao (%) I HIV/AIDS (°/o) Benh khac (%)
2009 I 2010 2009 ] 2010 | 2009 | 2010
AIL
5,32 6,80 87,79 87,88TTG~ I 7,21 I 7,14 I 6 j 9 I 5,98 I 85,9 . . Vdl khdi TG: Ty le benh nhin Lao: Nam 2009: 5,11%, 2010: 5,32%; Ty le benh nhin nhiem HIV/AIDS: Nim 2009: 7,1%, 2010: 6,8%; Cac benh khic: Nam 2009: 87,79%, 2010: 87,88%. Vdi khdi TTG: Ty li binh nhin Lao: Nam 2009: 7,21%, 2010: 7,14%; Ty IS benh nhan nhiem HIV/AIDS:
Nam 2009: 6,89%, 2010:5,98%. Cac benh khac: Nam 2009:85,9%, 2010:86,88%.
Bang 3.3. Ty le sif dung giu'dng BX trunq binli (2009-2010) Chi tieu
Sd giu'dng Tonq so ngciv dISu tri nSI trij
So nqay diSu tri trung binh Conq suat SI/dung (%)
Khoi TG Ke hoach
279
Thu'c ke 756 361.242
2,25 354,7 1 130,9
Khoi TTG Ke hoach
116
Thu'c l<e 230 12.344
4,2 29,15 1 14,70
Khcfi CSGD- TGD Ke hoach
33
Thg'c kS 69 13.275
15,0 110,2 1 52,7 Tylesd dung giudng BX cua cac CSGG rat cao chu yeu d khdi TG vi CSGD-TGD: Khdi TG (Tylesd dutig giudng ki hoach: 354,7%, thdc ke: 130,9%), khdi CSGD-TGD (Ke hoach: 110,2%, Thui ki:
52,7%) Rieng khoi TTG cdng suit siy dung giddng thap: (Ke hoach: 291,5%, Thut ke: 147,0%).
3.2. Nhu cau KCB cua cAc a6fi tu'ang QLGG t^i 26 BV nghign cifu Bing 3.4. Ket qua KCB cho cac doi tu'dng QLGG tai 26 BV nghien curti
Lo^i b$nh vl£n Cong an
Tinh/Thlinh ph5 Chuyen khoa Huyen
c^Pg
Kham benh 2009 22.603 1.317 1.682 687 26.289
2010 25.284 1.346 13.592
626 40.848
Ddn V tmh: Lddtnc, Dieu tri 2009 1.334 1.053 1.295 501 4.183
2010 1.257 1.149 1.352 423 4.181
nim2010(Khim: 40.848 liipt ngudi; dieu bl: 4.181 lupt ngu&i).
Bing 3.5. Nqay dieu tri trung binh va chuyen BV tuyen tren dieu
l^gav dieu t r l t r u n g binh (Ngiy) I So chuyen BV tuygn tren (NgdS)
B$nh vi^n 2010
Cdng an 13,1
Tinh/Thanh pho" 14,2 15,6 17 15 Huyen ~ 10,2 12J 32 35 Chuyen khoa ' 18,7 1?J 2 3
'c$ng I 14,1 I 15,4 I 93 I _ 105 Ngiy dlSu bi trung tiinh: nam 2009 li 14,1 ngay; nim 2010 la 15,4 ngay; Sd ddi tudng chuyen BV tuyen trin didiiu bi li 93 ngudi (nim 2009) vi 105 ngddi (nim 2010).
IV. BAN LUAN
SS lutJt KCB tri ngpal tni chp cac del tu'dng QLGG trung binh/BX: Nam 2009: Dpi vdi Khpi TG (28.421 luvt ngu'di/BX); TTG (9.225 lu'dt ngua/BX); CSGD (12.095 lu'dt ngUdi/BX); TGD (12.162 lu'dt ngu'di/BX). Nim 2010: Dpi vdi Khoi TG (32.745 lifl?t ngu'di/BX); TTG (9.345 lu'dt ngudi/BX); CSGD (18.359 lu'dt ngu'di/BX); TGD (10.602 lirpt nguidl/BX). Qua do cd the thay nhu c3u KCB ciJa cac dcil tuUng QLGG la rSt Idn.
Ngiy dISu tr| tmng binh t^l BX cac CSGG qua 2 t&m thay dpi khpng dang kS, tCr 9,6-9,75 ngay
(2009-2010). Ngay dieu tri trung binh ciJa hai khoi TG, TTG tudng du'dng nhau tif 4,1-4,7 ngay.
Ngay dieu tn trung binh ciia khdi CSGD, TGD (15,0 ngay). tuy nhien, ngay dieu tri trung binh khdi CSGD, TGD cap hdn rat nhieu sp vdi ngjy dieu tr| trung binh cua khdi TG, TTG. Nguyen nhan ciia sif chenh l?ch nay \i dp cac ddi tujng QLGG thupc TG, TTG thu'dng mSc cac b?nh nJng va lay nhilm, theo quy dinh BX chi dupc giif ddu tr! tif 3-5 ngay ma benh ciia cac ddi tuijng khdng thuyen giam se du'dc chuyen di BV de d i u tri, do
Y HOC Vl|T NAM THANG 5 - SO 2g014
vay ngay dieu trj trung binh ciia khdi TG, TTG ngan hdn so vdi khdi CSGD. Ngoai ra,_BX con phai dieu tri nhifng benh mang tinh chuyen khoa:
Lao, HIV/AfDS...Hien tai, co 06 trai tam giam sd 1, 2, 3 Cdng an Th^nh phd Ha Npi, TTG Chi Hoa, TTG Bd La, TTG Cdng an tinh Binh Du'dng, 45 TG da thanh lap td chdng lao tu'dng du'dng vdi to chdng Lao tuyen huyen [1]. Nhu cau KCB cho cac ddi tu'dng QLGG tai BX cac CSGG la rat Idn: Theo khao sat tren 85% can pham nhan co nhu rau ve cham soc su'c khde va lp lang ve siJc khce.
Cd cau benh tat cua cac ddi tu'dng QLGG tai BX la da dang va dac thii la cac benh lay nhiem nguy hiem nhtf: Lap, HIV/AIDS...Tuy nhien v^ec xet nghiem phat hi§n ddi tu'dng QLGG W nhiem HIV/AIDS d cac TTG chu'a thudng xuyen dp dieu kiln cd sd vat chat, kinh phi kho khan, cac TTG plial chil dpng phdi hdp vdi cd quan y te ben ngpal xet nghiSm thep djnh ky va cung chi cp dieu kien lay niiu mau xet nghiem chp mdt sd ddi tiidng QLGG trpng nhdm nguy cd cao nhtf gai mai dam, doi ttfdng nghien chich ma tuy...chtfa the phat hidn hdt dUBc so ddi ttfdng QLGG bj HIV trong TTG [3]. ChuS co kinh phi xet nghiem va thudc dieu tri die hieu cho can ph^m, pham nhin nghidn ma tiiy, HIV/AIDS, thieu phtfdng tl$n y te bao hp phdng djch nhtf iing, ging tay, khau trang...
Thep Ph?m Thj Thai Ha va CS (2011) nghien cilu cho thdy, bdnh Lao tang nhanh tif khi dai djch HIV/AIDS xuat hien. Ngtfdi benh cd HIV, Lao phdl d ngtfdi mic HIV cung cao hdn [5]. Digu nay cung phil hifp vdi ket qua nghien cifu tren ddi ttfdng QLGG, ty le Lao/HIV cung rat cao.
Theo Ld Bifc Quang (2011), ty ie PN xet nghiem ddm AFB(+) la 1,6%, AFB'(-I-)/100.000 la 410,2/100.000, trong do d nhiJng PN co tien sif dieu trj Lao phpl la 1.013,5/100.000 ngtfdi [6].
T?l Tay Ban Nha, ty le nhiim HIV cua cac PN tai TG la 8%, ty le nghien ma tuy la 8,1%. Theo bio cao cdng tic y te TG nim 2008, co 8325 ddi ttfdng nhiem HIV, chuyen AIDS 975 ddi ttfdng;
2075 ddi ttfdng mSc Lao [4]. Nam 2011, cd 866 PN bl mic HIV dtfdc dieu tri bang ARV tai BV.
V. KET LUAN
- Nhu cau KCB cho cac ddi ttfdng QLGG rat ldn, sd Itfdng ddi ttfdng QLGG dtfdc KCB tai BX va BV deu tang qua cac nam;
+ Tai BX: nam 2009 la 582.583 Itfdt kham benh, phat thudc; nam 2010 la 660.046 luOt kham benh, phat thudc.
+ fai BV: nam 2009 la 22.603 Itfdt kham benh; nam 2010 la 25.284 Itfdt khim b?nh.
- Cd cau benh tat ciia cic dol ttfdng quin ly, giam giif khi KCB tai BV chu yeu la HIV/AIDS (43,29- 51,2%), Lao (9,1-45,11%), viem gan B, C...
T A I LI?U THAIVI KHAO
1. B^nh vi$n Lao va bfnh phdl Trung uUng (2008), Cdng vin hudng dan thanh l$p tdclmg Lao, Cdng vin sd 257/BVLBPrU'/DAPLC ngay 03/03/2008 ciia Benh vien Lao vi b$nh phoi Trung udng.
2. Cue elSu tra hinh sv' (2012), Bio do tdm IS cong tac giam gid Bd Qudc phong nim 2012,8io cao cua Cue Oieu tia hinh stf Bp Qudc ph6rig i£
cdng tic giam giif nim 2012.
3. Cvc Hu'dng din t^m giam, t^m giff (2011),
"Bao cao cong tac phong, chdng HIV/AIDS d cac trai tam giam nim 2011", Cdng vin s61139/C84- P3 ngiy S/12/2011 cua Cue Hddng din t^m glrn, tam gid bio cao cdng tic phdng, chdng HIV/AIDS dcic TTG nim 2011.
4. Cyc Y td (2009), Bao cao tdng hgp cdng tacyti bai giam nim 2008 ngay 10/03/2009 cua PhoiigS- Cue Y te, BQ Cdng an.
5. Pham Thi Thii H i , Nguyen Thj Die, Ngd ThS Quin, Tian Van Sang (2011), 'So sanh i]$c diem lam sing, cin lam sing b|rih lao phdi ^ hpF} vdi lao mang phdi, lao mang nio 6 b^h ntiSn nhiem vi khdng nhiim HIV", Tap chl Lao vi b^
phdi, Hgi lao va benh pha Vi$t Nam, (2), tr. 23-27.
6. la Dffc Quang (2011), Nghidn cdU thut tr^ng mic Lao phdl AFB (-I) va mot sd yeu td Mn ijiien d pham nhin t^i 3 trai giam cua tinh Bic Giang, Thanh Hda va Thanh phd Ha Ngi, 2010-2011, Luan vin Thac sy y hoc, Hpc vien Quin Y (2011).
7. Nguyen Khic Thuy (2008), Nghien cdu ttii/C ti^ng cdng tic kham, chda benh cho can ph^
nhan cac trai giam thudc Bd Cdng an tai birih vien din y, Luan vSn Thac sy Y hoc, Hpc vi^n Quin Y.
Dinh chfnh
Trong bai "Buac ddu ddnh gid hi^u qud md hinh Id chuc khu diiu tri danh cho cac ddi tupng qudn ly va giam gluu thuoc Bp Cdng An tgi 6 h^nh vifn da khoa tinh/thanh ph6 , ^ f^0//-^0/2> "dang tren T?p chi Yhoc Vi?t Nam thang lOsd 1/2013 oBang 3.1.,«'i!,|nA * phong vd giudng bfnh tgi 6 BVBK tinh. thanh phd (trang 86), t?i cot Tdng so giirdng
bfnh in la 206 xin dugc sijta Ijii la 246. Thanh thSt xin loi baxi dpc
TAP CHIY HQC VIET NAM
