- Cd su cdch bigt KTC cua cdc thfing s i xdt nghigm giira cdc PXN Irong cCing luyin vd giOa cdc tuyin vdi nhau.
KI£N NGHI
- c i n ed vdn bdn quy djnh thing nhit vigc sd dgng hg dan vj do ludng trong cdc PXN y khoa Id hg dan vj SI theo cdc khuyin cdo cua quic t l .
- Cin cd khuyin cdo hogc quy djnh nhdng Idi ligu (nguin tdi ligu) ddng tin cgy d l PXN su' dgng Idm KTC, nham Ihing nhit gid trj KTC dang su dgng Igi cdc PXN.
- C i n cd bign phdp de gidm thilu su cdch bigt KTC giua cdc bgnh vign eung tuyin hogc khde tuyin, nhit Id tuyin 2 vd luyin 3, ddy Id mgl trong nhdng nguydn nhdn cde bgnh vign chua tin tudng k i t qud cua nhau, phdi lam xdt nghigm igi khi bgnh nhdn chuyin vign cdng tuyin hogc tuyen dudi Ign luyin trdn.
- Qua nghidn cCfu d l Idt cho Ihly KTC ddnh eho ngudi Vigt Nam chua dup'c nghidn cdu cgn ke. Do dd, chtjng Ifii d l nghj nghign euu sdu hon v l su tuang ding cua KTC danh cho ngudi Vigt Nam vdi KTC cua quic l l , tung budc xdy dyng KTC ddnh ridng cho ngudi Vigt Nam,
T A I L1$U T H A M K H A O :
1. Bfi Y l l , Quylt dinh 23/2005/QD-BYT ngdy 30/8/2005 v l vigc phdn tuyin k9 thugt vd danh mgc k?
thugt trong khdm chOa bgnh,
2. Bg Y t l , Thdng tu s i 23/2005/TT-BYT ngdy 25/8/2005 v l hudng ddn x l p hgng cdc dan vj su nghigp y t l ,
3. Trin HlJu Tdm vd cs. Kiyoshi Ichihara, "Nghidn ciru tinh dja phuang trong ehi s i xdt nghigm vd khoang tham chilu khu vuc Chdu A", Dd til NCKH mS sd CS/KCA}9/01 h&p tdc vdl DH Yamaguchi Nhdt (2009).
4. Bland M. (2003), An introduction to Medical Statistics, 3rd Edition, New York.
5. Burtis, C, A., E. R. Ashwood, D. E. Bruris (2005), Tiefz textbook of clinical chemistry and molecular diagnostics, A^ Edition, WB Saunders Co. Ltd., Germany.
6. Westgard, J. 0., P, L Batry (2008), Refemnce Interval tmnsfemnce. Basic method validation, Third edition.
DIEU KIEN c a s a VA THUt; TRANG fi NHllM HfiA CHJT BAO VE THOC VAT, VI KHUAN TRONG THUC P H £ M TAI CAC CO SOT KINH DOANH THQC A N DirfTNG PHO THUfiC THI XA U l CH&U
T6M TAT
Qua diiu tm dt ngang thwc trgng d nhiim hod chit BVTV. vi khuin vd didu kign ca sd cua cdc ca s& kinh doanh thue Sn dwdng phd tgi thj xd Lal Chdu. Kit qud:
Ve ty Ig d nhiem do E eoli tren thOe an: Ty Ig nhiem Chung li 38%, tren cd vd cdc sdn phim tie ci Id 40%, trdn tiijt vd cdc sdn phim tir thjt ii 34,3%, trin mu ludc la 40,0%. vi mue nhiim E cr^l eao nhat: trdn cd li 165 con trdn thjt li 28 con. trdn mu ludc 21 con. Vd d nhiim hdachitBVTV: T^ 1$ d nhiim chung tren mu Id 16,6%.
Tmng dd, d nhidm do hda chit trdn rau Sn li li 15%;
tren rau dn qud li 25% vi rau an sdng la 10%. Vi diiu kign ciia cic ca sd: Cdc ca sd kinh doanh thue dn dudng phd da diip hdnh cdc quy dinh vd diiu kidn VSATTP theo quy dtnh nhw: Cd che ddy tO kinh 84%;
bdn cao dung qui d/nh 92%; ddc bidt li 100% cdc ca sd da sir dqng tdi nilon vi hdp xop di gdi thwc phim, khdng sw dgng giay bio dd gdi thuc phim.
Tir khda; An todn thwc phim, E coli, hda chit bio vg thwc vgt
SUMMARY;
By applying the descriptive cmss-sectional study on chemical contamination, bacteria, and the basic condition of the business establishment of stmet food In Lal Chau distric. Result: The pementage of E.coli contamination on food: the general infection was 38%.
On tish and tish pmduct was 40%. On meat and pork meat was 34.3%. On vegetable was 40%. The highest level contamination E coli: 28/165 on the tish, on vegetable was 21 E coli. The mte of chemical contamination of pesticide: the genami vegetable infection was 16.6%. On vegetable leaves 15%. On Root vegetables was 25% and raw vegetable was 100%.
NINH TH| NHUNG, D^i hqc Y Thdt Blnh DUONG NGQC HUONG, Chi cifc ATTP tinh Lai Chiu
N G U Y I N X U A N T H I ; C , Bgnh vign B^ch IVIal The basis of food safety in accordance, such as: cover- up. 84% cupboard; table's tall as mquim 92%, especially
100% of the facility used plastic bags and box to packagetixxi, do not use newspaper to wmp food.
Keyswords: safty food, E. coll. pesticide DAT VAN Dt
Hign nay tinh trgng thuc phim bj d nhilm vi khuan, l i n du HCBVTV dang Id van d l xa hpi. Id noi lo ldng Ihudng true eua cde ca quan chue ndng eung nhu ngudi tidu dCing. Theo s i ligu cda Cgc ATTP, tCr ndm 1999 den Ihdng 6/2004 nude ta dd xay ra 1.282 vg ngg dgc thuc phim vdi 27,731 ngudi mac, 336 ngudi tu vong. Trong dd, nguyen nhdn do t i n du hod chat BVTV trong rau, cu. qud chilm tdi 25%. Ndm 2006, nghien eCru eua Trin Huy Quang, ty Ig d nhiem vi khuan ehung d cdc m i u thuc dn dudng p h i Id 57.74%, d nem chua Id 76,7%, thjt vd cdc sdn phim tCr thjt Id 51,7%, ed vd cdc SP td cd Id 43,3%, Djch vg thCrc dn dudng phi tilm I n nhieu nguy ca gdy ra ngfi dgc thu'c phim cap llnh do tinh trgng vg sinh mdi trudng, vg sinh nguin nudc, trang thilt bj, dgng eg ehl biln, bao qudn nguygn ligu, Irang thilt bj bdn hdng cdn thd sa, ngudi true tilp san xuat c h i bien thuc phim cd hilu b i l l v l VSATTP chua day dtj, ngu'di Ueu dung do thieu kiln Ihuc VSATTP ndn chua b i l l chpn lua nhdng thuc pham bdo dam c h l l lupng VSATTP hogc Id do chu quan, ham re, ham Ipi md mua nhdng thuc phim bdn via hd, ldng, l l dudng, thg'C phim khdng rd nguin gic, khdng dam bdo chat lupng, chua cd y thuc d i u tranh khi su dgng nhung Ihuc phim khdng dam bao chit lup'ng Id nhirng yeu to nguy ca cao Idm cho ngfi dfic thg'C phim gia tdng. Xult phdt td thg'C te dd ehung t i i tien hdnh nghidn ciru de tai nhim mge tidu: Xic i^nh (hyc trgng d nhiim hd chat
J Y H p c THV'C HANH (815) - SO 4/2012
BVTV, vl khuin thwc phim vi diiu kidn ea sd cOa cic ca sd kinh doanh UiCic Sn dudng phd (gt thj xS Lai Chdu.
D(^i Tyg^NG, PHuaNG PHAP NGHI£N cCru 1. Dja d i l m vd d i l tup'ng nghidn ci>u:
Nghidn cuu dup'c thg'C hign Igl cdc ca sd kinh doanh thdc dn dudng p h i tgi thj xd Lai Chdu. Thdi gian nghidn cuu Id Ihdng 5/2010 d i n thdng 7/2010.
D i i lup'ng nghign cdu td: Cdc logi rau; cd vd sdn phim cua cd; thjt vd s i n phim cua thjl vd cdc ca sd kinh doanh thuc Sn dudng p h i
2. Phu'ang phdp nghidn ciJu:
a.Thilt kg n g h i i n CCFU: Ld nghidn ci>u djch tS hpc m i td elt ngang cd phdn tich
b. Cfr m l u vd phuang phdp chpn m l u Cd' miu:
Cd miu cho xit nghidm vl khudn dirge tinh theo cdng thuc: s '
n = Z\^) —•--- A*
Dua vdo cfing thuc trgn linh dudC cd m l u xdt nghigm nhu sau:
+ Vdi XN E.coli n=30 x 3 logi TP = 90 (mlu) + Vdi XN fi nhilm HCBVTV: n=20 x 3 logi TP = 60 (mlu)
Cd miu khdo sit didu ki$n ca s&: 15 ca sd/phudng, xd X 5 phudng, xd = 75 (ca sd)
Phwang phdp chgn miu
Tgi m i l phudng/xS, Igp danh sdch todn bg cdc ca sd kinh doanh thirc dn dudng p h i , b i c thdm nglu nhidn 1 s i ca sd sao cho dO cd m l u dd tinh(75 ca sd). Chpn nglu nhidn 30 ca sd , tgi m i l ca s d l l y 3 logi thuc phim (Thit vd cdc sdn phim tu Ihjl, cd vd ede sdn phim tup ed, cde logi rau lufic). Tuang t u cQng chpn nglu nhidn 20 ca sd, tgi m i i ca sd l l y 3 logt rau (rau dn Id, rau dn cij vd rau dn sing).
c. Cdc ky tiiu$t ip dyng trong nghiin cwu:
•:• Kp thudt liy miu TP xdt nghidm: Theo quy djnh cua FAO -1988
•:• Kf thudt xdt nghidm dw&c sOf dgng:
> Nuii c i y vi khuin: xdc djnh SLvi khuin/ I g TP:
theo thudng quy FAO.
> Xde djnh E. coli trong thg'C p h i m (theo PP Vincent)
> Test nhanh HCBVTV nhfim Ldn hdu ca vd Carbmale trong rau, hoa qud tuai.
d. Xw If so li^u: S l ligu dup'c Idm sgch trudc khi nhgp vdo mdy tinh, st> dyng EPI DATA d l nhgp s i ligu. Phdn tich s i ligu b i n g SPSS 16.0 vdi cdc test thing kg y hpc.
K£T QUA
% 30.
K i t qud Bldu dfi 1 cno may ly i? mau idu u iiiiietri Chung Id 16,6%; 1;^ Ig m l u rau dn Id i nhilm hda chll BVTV Id 15%; rau dn qud Id 25% vd rau dn sing Id 10%;
su khde bigt ty Ig fi nhilm ciJa 3 logi rau ndy Mcd^
nghTa thing kd p < 0,05. ,„
Bdng 2: Dfi nhilm E.coll trong cdc loai thg'C phim tjjj}^
cdc ca sd kinh doanh IhifC dn dudng pho Thvc ph^m
Cd vd SP tCr cd ThllvSSPW
Ihit Rau luOc
Tidu chudn {46/QD-BYT)
3 10 0
D( nhidm khudn Min
0 0 0
X
2 1 0
Max 17 13 9 Bdng 3: Ty Ig m l u Ihuc phim khdng dgt tidu ehuin yi khuin E.coli tgi cdc ca sd thdc dri dudng phi.
Cd va sdn phdrr tdcd Th|t vd sdn phdm
tdthjt Rau luge
Sdmdu khAng I T$l(
dgi I (%)
Tdng I 90 I 38 \ ~ ^ . K i t q u i Bdng 2 vd bdng 3 cho Ihly: Dg nhiem E.coli trong cdc logi thuc phim tgi cdc ca sd kinh doanh tfiOc dn dudng p h i d i u vupl qud gidi hgn cho phdp theo quy djnh (46/QD-BYT), Ty Ig d nhilm vi khuin E.coli trdn trdn cdc m l u dilu tra Id 42,2%; cd vd sdn phim ti> cd l i 46,7%. thjt vd sdn phim ti> thit 40,0% vd rau luge Id 40%.
Bdng 4: Thue trgng nai bdn Ihuc phim chin tgi c^c sd Thuc dn dudng p h i (n=75).
Chi ti6u ddnh gid Cd che ddy, tu kinh 8dn cao dunq qui iSjnh
KhAnq theo quy djnh
S6 luong 63 69 6
T*I6% •:!
B4 -i 92 -
8 A
Bdng 5: Thuc trgng s u dgng bao gdi thuc phim t^ica sd Thdc dn dudnq p h i •»
Chi tiAu ddnh qid Gily bdo Tui nilon HAp xAp
Sdlt/ong 0 75 75
T * » % . 0 ^-^
100 .-.
too Jfi
Rau 9n l i Rau in cu Rau ftn s^g Chung Bilu d i 1: TJ Ig m l u rau cd hod c h i t BVTV
K i t qud bdng 4 cho thiy: Cdc ca sd kinh doanJif thuc dn dudng p h i dd c h i p hdnh cdc quy djnh v l di4u kign VSATTP theo quy djnh nhu: Cd che dgy. tii ^ 64%; bdn cao dCing qui dinh 92%; dgc bigt Id 100% cdc ca sd da st> dgng tui nilon vd bfip x i p d l gdi thg'C phim, khfing sti' dgng gily bdo d l gdi thg'C phim.
KET LUAN
Ty Id 6 nhiim do E coll trin thwc Sn: Ty Ig nh'tim Chung Id 38%. trdn cd vd cdc san phim tir cd Id 40%, trfin thjl vd cde sdn phim td thjl Id 34,3%. trfin rau luge Id 40,0%. V l muc nhiem E coli cao nhit: trdn cd Id 165 con trdn thjt Id 28 eon. trdn rau luge 21 eon.
7y /$ d nhiim bda chit BVTV: Ty Ig fi nhilm Chung trdn rau Id 16,6%. Trong dfi, 5 nhilm do hda chat trdn rau dn Id Id 15%; trgn rau dn qua Id 25% vd rau in sing Id 10%.
Didu kl^n cua cic cv sir. Cdc ca sd kinh doanh thdc dn dudng p h i dd c h i p hdnh cdc quy t^nh v l diSu kign VSATTP theo quy djnh nhu: Cd che dgy. tiJ kinh 84%; bdn cao dung qui dinh 92%; dgc bigt Id 100% cdc
y HQC THVC HANH (815) - S6 4/Mi2
ca sd dd sd dyng ICii nilon vd hgp x i p d l gfii thuc phim, khdng su dgng gily bdo d l gdi thuc phim.
KHUYDN NGHI
T i chdc cdc Idp tgp huin v l chuyfin mfin nghigp vg cho cdc thdnh vidn ban ch! dgo vg sinh an tdan Ihuc phim cdc d p nhim tung budc nfing cao nhgn thdc cua ngudi qudn ly trong cdng tdc truyin thfing tgi dia phuang cho phCi hpp tinh hinh.
Ndng cao kiln thdc cho cdc d i i tup'ng Iham gia sdn xult, ehe biln, kinh doanh thuc phim, Dgc bigt d i i vdi dii tup'ng kinh doanh thuc dn dudng p h i d l ddm bdo an tdan vg sinh thuc phim theo quy dinh cua phdp lugt.
T A I L I $ U T H A M K H A O
1. Bg Alfing nghidp vd phit triin Ndng thdn, Cgc bio vi thuc vdt (1998), Tdi ligu tgp huin phdn tleh du lupng bdo vg thuc vdt. Hd Ngi - Ihdng 6/1998. tr 2-54,
2, Bfi Ndng nghidp vd phit triin Ndng thdn - Cue bio vd thi/c vdt (2002), Khdo sdt ddnh gid thgc trgng si> dgng vd du- lupng hda chll bdo vg thgc vgt trong nAng sin tgi
hat vCing sdn xult rau Hd Ngi vd thdnh phi H i Chi Minh, tr 1-20.
3 Bd Ndng nghiip vd phdt tridn Ndng thdn - Cgc bdo vd thue vdt (2004), Bdo cdo thuc trgng sdn xult rau, qud, ehd an lodn vd d l xudt gidl phdp phdt Iriln rau, qud, ehd an todn trong giai dogn 2006-2010, Tdi ligu Hgt Ihdo v l sdn xult rau an todn. Hd Nfii, thdng 12/2004, tr.1-18
4, Trin VSn Chi vd CS (2005} Khdo sdt ban diu d|Ch vg thgc phim thdc dn dudng phfi cd d|a dilm e i dinh trdn die bdn tinh Qudng Tri.
5, Phan Thj Kim vd cdng sw (1998) Tinh hinh thiic dn c h i biln sin trdn thi tm-dng Hd Ngi 1998. Bdo cdo khoa hpc tgi Hgi nghj khoa hpc Y t l du phdng todn quic 1998
6, Trin Huy Quang (2006). Khdo sdl llnh hinh d nhilm thdc dn dudng phi vd ede ydu t i lidn quan tgi thdnh phi Thanh Hda, tr 32,
7, Hi Blnh Ngw. Trin Huy Quang (2006-2007). Dilu tra thuc Irgng su dgng vd du lupng thuic bdo vg thgc vgt trdn rau tgi thdnh phi Thanh Hda vd vCing phg cgn, tr 42-43
NGHIEN CUlU DAC DIEM LAM S A N G , C A N L A M S A N G Cd GlA TRj TIEN LimNG NANG TREN BENH N H A N XUAT HUYET NAO CO T A N G HUYET AP TAI B £ N H VIEN DA KHOA TRUNG UtTNG CAN THff
TOM T A T ;
Qua nghidn citu dt ngang 56 trudng hap xuit huyit nio a bdnh nhin tSng huyit ip diiu tq tgi Bdnh vidn da khoa bung wang C^n Tha, tim hiiu cdc yiu td Idm sdng vd cdn Idm sdng Idii vdo )ri$n vi theo ddi den ngiy tiiir 30 cua bgnh chiing t& nhdn tiiiy sd bdnh nhin tiin triin xiu cd 20 bdnh nhin chidm ty /g 35,796. Cic yeu td ed gii bj tidn Iwgng da vdi tidn triin a tjdnh nhdn xuit huyit nSo cd tSng huyet ip li: Kich thwdc kha miu tu trdn idu £ 5cm; Diem Glasgow S 8 aim; Thd tich khdi mdu tv trdn liu £ 60cm'; Miu vio ndo tiiit IV; Ugt hodn todn; Mdu vdo nSo thit; Thin nhigt £ 3£fC; Diu hidu co gidt.
Tir khda : xuit huyet ndo. ting huyit ip SUMMARY:
A cmss-sectional study of 56 cases of cembml hemorrhage in hyper tensive patients tmated at the I Centml Hospital of Can Tho, To learn the elements of clinical and subclinical when the hospital and follow-up today 30 of patients we found negative evolution of ) patientsmth 20 patients accounting for 35.7%. These
factors have pmgnostic value forprogmssion in patients with cembml hemorrhage is hypertension: the size of the tenthematoma £ 5cm; Glasgow scam s 8 points;
, on hematoma volume £ 6i}cm^ tent, bloodon the fourth '. ventricle: Lit enOmly; blood into the ventricles; body
temperatum a 3^C; Signs seizums.
Keywords: cembml hemorrhage, hyper tensive
oATvANoe
Tai biln mgch mdu ndo, xult huylt nao Id nhdm .; bgnh khd pho biln vd lufin Id v i n de cdp thiet cOa y hpc nu'dc trgn I h l gidi. Bgnh cd xu hudng gia tang theo t u i i vd nhip dg phdt triln cua xd hfii. Theo thong kg cua T i J chirc y t l t h i gidi, d cdc nudc phdt triln tai biln mgch ' mdu nao Id nguyfin nhdn t d vong dung Ihu' hai sau bgnh
ttm mgeh.
' Tang huyet dp tdng nhanh trdn the gidi, Vigt Nam cd
NGUYEN QUANG KHA, D A N G QUANG T A M nhilu gidi phdp cho v i n d l ndy, nhung dp dgng, su ludn thu r i t khd khdn cho bgnh nhdn, ngudi tang huyet dp dupe kllm sodt t i t v i n bj tai blln mgch mdu ndo vd tu vong nhilu han so vdt ngudi cd huyet dp binh thu'dng[2]. Xult huyel ndo Id t h i Idm sdng eiJa tai biln mgch mdu ndo, bgnh thudng ngng, ty Ig t^ vong cao vd n l u khfing t u vong cd d l Igi di chCrng, gidm chdt lup'ng cufic sing, tdng thfim gdnh ngng cho gia dinh vd xa hgi.
Trong thuc hdnh Idm sdng, vtgc tign lup'ng bgnh cd vat trd quan trpng d i i vdi ngudi Ihly thuic. Tidn lupng dtJng giCtp Ihly thuic cd thdi dfi xu Iri ddng, theo doi sdt vd cd lua chpn dilu tri hgp ly. Bdn cgnh do, vige tign luang dtJng giup ngudi Ihly thuic chu d$ng han trong vigc tu v i n giai thieh eho ngu'di nha bgnh nhdn nang cao kha ndng phii hpp l i t vdi Ihly thuic trong qud trinh c^dm sde vd i:nlu trj.
Vdi su tien bfi phuang tign ehin dodn hign dgi, edng tde chdm sdc dilu trj, cd lam cho vigc tidn lupng logi bgnh ly ndy cd thay doi khing, vd cdc y i u t i lifin lup'ng trudc ddy cd phCi hep hay khdng? ed nhilu edng trinh d trong vd ngodi nude nghien cuu ve cde yeu t i ttdn lupng xult huylt ndo dd gdp phin tich cue trong cing tde chdm sdc vd dilu trj bgnh nhdn xult huylt ndo, Idm hg thip t j Ig tu vong trong bgnh vign. 0 Vtgt Nam mgl s i cdng trinh nghifin cuu ve cdc yeu t i lien lupng xult huylt nao nhung k i t qua nghign cuu v i n cdn nhieu bdn edi, mgt khde hign nay d vimg ding bing sfing Cuu Long chua cd nghidn cdu ndo lidn quan d i n v i n de ndy.
Xult phdt t d nhung v i n d l neu trdn chung Idi l i l n hdnh d l tdi: "Nghidn cO'u d | c diem lim sdng, c$n lim sing cd gii trj tidn Iwgng n$ng tren b|n/> nhin xuat huyet nio cd tdng huydt ip tgi bgnh vi^n da khoa trung wong Cin Tha"nhkm hai mgc tidu sau:
1. Khdo sdt cde dgc dilm iam sdng, cgn lam sdng cd gid trj tidn lupng d i i vdi tiln triln trfin bgnh nhdn xuat huyll nao ed tang huyel dp.
