Y HOC VI|T NAM THANG 1 - s 6 1/2013
DAC DIEM BENH NHAN CAP COU TROAC BENH VIEN TAI HA Ndi
D S n g T h a n h K h S n S M a i D u y T o n ^
T6M TAT
Mgc t i g u : Khao sat dSc diem dich te benh nhSn cap ciru tru'dc benh vi§n tai Ha Noi. PhiTcrng p h i p : Nghien ciiU mo ta hoi ciru, thUc hien tren 22.764 benh nhan du'dc cac kip dip ciru 115 x(t tri trong thdi gian tir 01/01/ 2010 den 31/12/2010. Ket qua:Yeu cau cifp cull gSp nhieu nhat vao thang 12 (9,42%) va thang 6 (8,99%); va vao khoang 8 - 1 0 gid va 20 - 01 gid. Do tuoi by 20 - 60 chiem 44,8%. Benh cap ciru noi khoa chiem da so (71,3%). 72,20% so benh nhan da duttc chuyen den benh vien de tiep tuc dieu tn. Ket l u | n : Ket qua tren giitp cho viec to chiTc hoat dong cap ciru, s3p xep nhan lUc, trang thiet bi phii hop tai Trung tam cap cuU 115 Ha Npi.
Tu" khoa: cap cu^i, 115, trUdc benh vien ABSTRACT
Survey of epidermiological characteristic of pre- hospital emergency patients in Ha Noi Objective: To survey the characteristic of pre- hospital emergency pabents in Ha Noi. Methods: a retrospective, observabve research on 22,764 patients who were managed by 115 sift from 01 January 2010 to 31 December 2010. Results: The most common months of emergency requirement were on December (9.42%) and June (8.99%); the most common time of emergency requirement in day were 8-10 hours and 20-01 hours. Age from 20 to 60 years accounted for 44.8%. Medical emergency patients was 71,3%;
72.20% of patients were tranfered to hospital.
Conclusions: Those results help to organize emergency activities, personal arrangement, appropriate equipment in Emergency Center 115 Ha Noi
/fey words'; emergency, 115, pre-hospital Ml. KET Q U A
Khao sat 22.764 benh nhan du'dc Trung tam cap ciru 115 Ha Npi cap CUIJ va van chuyen cap ciiti trong nam 2010, ehiing toi duia ra mot so eac dac diem sau:
3 . 1 . Phan b o b e n h n h a n t h e o t u o i Bang 1. Phan bo benh nhan theo tuoi
I.
OAT VAN OETrung tam cap ciTu 115 Ha Noi la ddn vi chuyen lam nhiem vu cap cu'u ngu'di benh tai nha, ngu'di bj tai nan tai cdna dong (cap ctJfU tru'dc benh vien), dSng thdi san sang dap (fng cap cu'u khi co tham hoa xay ra, van ehuyen ngu'di benh cap ciru den cac benh vien. Be dap irng nhanh nhat yeu cau cap ciTu tru'dc benh vien eiia ngu'di benh, thi viec phat trien va hoan thien he thong mang tu'di cac tram cap cutJ ve bnh la rat can thiet, cac kip cap ciiU se gan ngudi dan hdn, thdi gian h'ep can ngu'di benh nhanh hdn, do do cong tac cap eiili ban dau se hieu qua hdn. De tao od sd cho viec phat bien he thong mang lu'dt cap aiU va van chuyen cap CUIJ Thu do, dong thdi giiip cho viec sap xep nhan ly'c, to chiTc hoat dong cap cuU 115, cung nhu' chuan bj thuoc men, trang thiet bj sin sang dap irng cap culi tru'dc b4nh vien khi co yeu cau, chiing toi ben hanh de tai nay vdi muc tieu:
Khao sat cac dac diem djch te tenh nhan cap aiV, tru'dc benh vien tai Ha Ngi.
II. o 6 l Tl/ONG VA PHUONG P H A P NGHIEN CCfU 2 . 1 . S o i t u ' d n g : Tat ca benh nhan du'dc tiep nhan bdi Trung tam cap cihj 115 Ha Npi trong thdi gian tir 1/1/2010 den 31/12/2010.
2.2. Phu'dng p h a p n g h i e n cu'u: Mo ta, hoi eiru.
Phan ti'eh ve mat djch te hpc tong so luUt yeu rau cap ciru goi den Trung tam cap ciru 115 va tong so benh nhan du'dc cac kip cap ciru 115 giai quyet trong thdi gian mpt nam.
Cac so lieu thu thap du'dc "Asi ly theo thuat toan thong ke.
Do tuoi Benh nhan
n Tv le %
< = 10 1002
4,4 1 1 - 20 1115
4,9 2 1 -
30 2800
12,3
31 - 1 41 - 40 50 1935 2276
8,5 10,0 5 1 -
60 3187 14,0
6 1 - 70 2937 12,9
> 7 0 7512 33,0 Tu6i trung binh 54,72 - Nho nhat ia 1 tuoi, Idn nhat la 112 tuoi
Cong 22764 too
N h a n x e t : Benh nhan d do tuoi > 70 ehiem phan Idn so benh nhan: 3 3 %
* Trung tam cap cuU 115 - Ha Ngi; ** Benh vien Bach Mai Phan bien khoa hoc: GS.TS. Nguyin Thj Du
Y HQC VigT NAM THAHG 1 • SO 1/2013 3,2. Phan loai benii nhan cap cu'u tiieo cliuyen i<Iioa Bang 2. Phan loai benh nhan cap cull theo chuyen khoa
B^nli nlian Chuv^n iclioa " " — NOI
Ngoai Nhl San Khac
Tonq so benli nlian
n 16 231
3 961 1 138 387 1047 22 764
%
71,3 17,4 5,0 1,7 4,6 100 Nhan xet: Benh nhan cap culi ngi khoa ehiem da so (71,3%); it nhat la cap ciru san phu khoa (1,7%).
3.3. Phan bo benh nhan theo cac thang trong nSm Bang 3. Phan bo benh nhan theo cac thanq tronq nam
\ j h a n g nhin ^ N
n T v l | %
1 1887 8,29
2 1760 7.73
3 1792 7,67
4 1748 7,68
5 1912 8,40
6 2046 8,99
7 1983 8,71
8 1778 7,81
9 1821 8,00
1 0 1965 8,63
1 1 1928 8,47
1 2 2144 9,42
Tfing so 22764
100 Nhan x e t : Benh nhan cap ciTu gap nhieu vao cae thang 10, 1 1 , 12 va thang 6. Nhieu nhat la vao thang 12 (9,42%) va thang 6 (8,99%).
3.4. Phan bo benh nhan cap cu'u theo gid trong n g a y Bang 4. Phari bo benh nhan cap cilTu theo gid trong ngay
III
II xet: S5 luHt benh nhan yeu rau cap eiili tap b-ung nhieu vao khoang 8-10 gid va 20 - 01 gid.
3,5. TV le benh nhan cap cu'u du'dc chuyen den benh vien Bang 3.5, Ty le benh nhan cap cu'u du'dc chuyen den benh vien
^— _ _ _ ^ Benh nhan Cacli giai quyet
Chuyen den benh vien Khonq chuyen vien
Tong so
N 16 436 6 328 22764
%
72.20 27.80 100.00 Nhan xet: 72.20% benh nhan da du'dc kip cap ciru ehuyen den benh vien de tiep tyc dieu t n , con lai 27.80% tong so benh nhan khong chuyen den benh vien.
IV. B A N LUiBiN
4.1. Ve phan bo benh nhan theo tuoi
•• Ket qua nghien ciru chung toi thay chii yeu benh nhan dUdc cap ciru cd do tuoi > 70, chiem den 33%. Benh nhan d dp tuoi du'di 10 tuoi chi chiem 4,4%. Ket qua nghien euXi ciia chiing toi cung tu'dng tu" tac gia B o Quoc Huy [2], va cua
tac gia Ario [3], vdi phan Idn benh nhan can sii ho trd ciia cap ciru 115 cd do tuoi > 70 chiem 46,9%. Cd the thay, nhu'ng ngu'di Idn tuoi, thu'dng mac benh man tinh, ben canh dd viec di lai, van chuyen kho khan hdn, vi vay khi cd benh cap ciru thu'dng hay gpi cap ciru 115. Doi vdi ngu'di tre va tre em thu'dng du'dc du'a triTc tiep
Y HQC VigT NAM THANG 1 - SO 1/2013 den benh vien, khong yeu eau 115. Oieu nay
phan anh he thong cap cu'u 115 chu'a dUdc mpi tang Idp dan chiing quan tam va sir dyng.
4.2. Ve phan bo benh nhan theo chuyen khoa: Cap ciTu npi khoa chiem da so 71,3%, sau do den ngoai khoa (17,4%). It nhat la cap cirtj san khoa: 1,7%. Cac benh cap ciiU npi khoa chiem da sd, cung phii hdp vdi tac gia Do Quoc Huy [2]. Tir ket qua nghien ciiU nay, cho phep chiing ta xay dytig mang lu'di thong tin ket noi vdi eac khoa cap ciilj ciia eac benh vien trong dia ban Ha Npi de ket ndi tru'dc khi van chuyen benh nhan den cae ed sd y te phii hdp theo tuyen chuyen khoa.
4.3. Ve phan bo b^nh nhan theo thdi gian So lu'dt benh nhan yeu cau cap eiru tap trung nhieu vao cac thang 10 (8,63%), thang 11 (8,47%), thang 12 (9,42%) va thang 6 (8,99%), thang 7 (8,71%), dd la cac thang nong va lanh nhat trong nam, ket qua nghien eiru eiia chiing toi ciing tu'dng ty* ciia tac gia Dang Van Chi'nh [1]. Tre em va ngudi gia, dac biet ngu'di cd benh man tinh nhu' tim mach, ho hap rat de phat benh.
Ve phan bo benh nhan theo gid trong ngay, nghien ciTu cho thay so lu'dt benh nhan yeu cau cap ciru tap trung nhieu vao khoang 8 - 1 0 gid va 20 - 01 gid trong ngay. Nhieu nhat la khoang 8 - 9 gid; it vao khoang 3 - 6 gid.
Tir ket qua nghien ciTu nay, se giiip nhii'ng nha quan ly bo tn' sap xep nhan ly'c y te, cung nhu' trang thiet bi phii hdp theo thdi gian trong ngay, cung nhu" trong nam de phue vu tot nhat nhu eau goi cap ciru va van chuyen cap ciru cua benh nhan, riit ngan thdi gian ehd ddi van chuyen, giiip benh nhan nhanh chong du'dc tiep can vdi eac cd sd y te chuyen khoa.
4 . 4 . V e t y 1$ b # n h n h a n cap c i h i du'dc chuyen d e n benh v i e n
Ty le benh nhan'du'dc Trung tam cap ciJti 115 chuyen den benh vien de tiep tuc dieu tri la 72,20%. So cdn lai khong ehuyen den benh vien la do benh qua nSng, tien lu'dng t i r vong, tir vong ho3c benh nhe co the ke ddn dieu tri tai nha.
V. KET lUfikH
Qua nghien eiru tinh hinh djch te ciia nhii'ng benh nhan cap eiru du'dc Trung tam cap ciiU 115 tiep nhan, chiing toi riit ra mpt so ket luan sau:
- Chii yeu benh nhan cap ciiXi 6 do tuoi tren 70.
Benh nhan bi eac benh cap ciTu npi khoa ehiem da so vdi 7 1 , 3 % ,
- Yeu cau cap ciiU nhieu nhat vao thang 12 va thang 6, vdi so lu'dt yeu rau cap cutJ tap tmng nhieu vao khoang 8 - 10 gid va 20 - 01 gid.
- Chi CO 72,20% benh nhan da duWc chuyen den t)enh vien de tiep tue dieu tri.
TAI LIEU T H A M K H A O
1, -Dang Van Chinh (2006), "Nghien ciTu tinh hinll cap ciru trUdc benh vien tai Nghe An". Ky y&i cong trinh nghien cuU khoa hoc nganh y teNghe An nam 2006, ir. 31-3^.
2, D6 Quoc Huy va cong s\i (2011), "Khao sat dac diem djch te, su* phan bo t)lnh cua cac tn/dng hdp cap ciru dUOc tiep nhan, xii tri qua he thong clip cinj 115 tai Thanh pho Ho Chi Minh. Yhgc Thanh pho Ho Chi Minh, 15(4), tr.105-111.
3, Ario Kiusura (2007), "Most Impoftan Rote Emergency Physicians", Resusdtadon. 55, p 92-96.
DANH GIA KET QUA DIEU TRf MONG THIT BANG PHOffNG PHAP GHEP KET MAC TI/THAN TAI BENH VIEN CHanAY
T6M TAT
Muc deu nghien cuU:
• Phan loai lam sang va chi djnh phau thuat dieu tn mwig thjt bang phi/ong phap ghep kS: mac \ii than,
- Oanh gia ket qua ciia phau thuat ghep ket mac t y than trong dieu tri mong thjt.
* Khoa Mat - Benh vien Cho Ray,
Phan bien khoa hoc: PGS.TS.TrIn Minh Trirang
N g u y i n HOtu Chu'c
Doi hygng va phu'dng phap nghien dhi:
Doi tu'dng nghien cuti: Benh nhan bj m6ng thit
> do 11, den kham va dieu trj tai benh vien Chd Ray tir 01 thang 6 nam 2009 den 01 thang 6 nam 2011
Phu'dng phap nghien cuti:
Thiet ke nghien cutr. Tien cu'u, thy'c nghiem 15m
