THUC TRANG TAI NAN THlATNG TICH CUA CAC TRlIftNG HOP NHAP VIEN VA DIEU TRI TAI BENH VIEN Dl)C GIANG NAM 2013
N G U Y E N TH! CHINH - Trung tdm y tiLong Bien, Hd Ndi LA NGOC QUANG - Dai hpc Y tiCong c^ng TOM TAT
Vdi muc tidu "Md ti thuc trang tai nan thuang tieh cOa cdc trudng hgp nhdp vidn vd diiu tri tai bdnh vidn da khoa DUc Giang ndm 2013", nghidn cdu dugc triin khai tren 289 trudng hgp nhap vidn va diiu tri do tai nan thuang tich trong thdi gian tdngdy 01/1/2013 den 31/3/2013.
Kit qui cho thay cd 66.1% Id nam, 33.9%, Id nd bi TNTT. TuSi tmng binh Id 37 tudi. cao nhit Id 92 tudi, thap nhit li 2 tu6i. Cd 5 nhdm nguydn nhdn chinh nhdp vidn diiu tri tai thdi diim nghidn cUu: lai nan giao thdng, tai nan lao ddng, b^o luc/xung ddt, nga. ngd ddc. Trong dd chd yiu Id tai nan giao thdng 139 trudng hgp (48.1%,), sau dd Id ngd 95 trudng hap (32.9%,).
thdi gian nam vien trung binh Id 4.9 ngay, nhiiu nhit la 24 ngay va it nhit Id 1 ngay.
Dua tren kit qui nghidn cdu, viec chuin bi tdt va diy dO trang thiet bi vd nhdn luc dap img vdi vide tiep nhan vd dieu tn TNTT cue berih vien Ddc Giang la hit Stic can thiet tmng thdi gian tdi.
SUMMRAY
With the goal of 'describe the status of the hospitalized injuries at Due Giang hospital in 2013," the study was carried out on 289 cases hospitalized and treated for accidents in the period from 01/1/2013 to 31/03/2013
The results showed that 66.1% were males, 33.9%, females. Mean age was 37 years, 92-year-old is the highest, the lowest was 2 years old. There were 5 main reasons of the injury among the gmup hospitalized:
road traffic accidents, labor accidents, violence/conflict, falls, and poisoning. The road traffic accidents were 139 cases (48.1%,). followed by fails, it was 95 cases (32.9%). The average of hospital stay was 4.9 days, the longest was 24 days.
Based on the results, the well prepared of equipment and manpower to response to treatment of injuries at Due Giang hospital is needed in the coming time.
DAT VAN DE
Tai nan thUdng tieh (TNTT) hien nay dang Id van de ndi cdm cua y te cdng cdng. Tren thd gidi hang nam cd khoang 5 trieu tuf vong do TNTT, chiem 9% cua tong sd tif vong va 12% eda ganh nang bdnh tdt loan cau, 90% tij-vong do TNTT xay ra d cac nudc thu nhap thdp va trung binh Ddng nam a vd Tay Thai binh duOng la khu vUC cd chan thUdng cao nhd't [6. tr7).
Trong cde nguyen nhdn TNTT, tai nan giao thdng dudng bd chiem ty Id eao nhd't, dac biet trong nhdm ttf 19 tudi trd Idn, Theo bao cao todn cau eiia To chife Y tethdgidi ndm 2010, cd 1,24 tneu tnidng hop^tufvong xay ra tren cac con dudng trdn the gidi. Mot nCfa so ca
tUvong do giao thdng dudng bd do nhijng ngudi di bd, di xe dap va xe may. [8],
Theo bao cdo thdng kd TNTT ndm 2012 so ca TNTT den kham va dieu tri Id 4,129 ca (16,1% tong sd kham va dieu tn), trong dd nguyen nhdn chCi yeu do tai nan giao thdng, tai nan lao ddng, ngd. bao luc/xung ddt [2, tr, 10].
Muc tidu eua nghien cdu nham tra Idi cho cau hdi
"Thuc trang tai nan thuang tieh eda cac bdnh nhan din diiu tri tai bdnh vidn nhu the ndo? Tin hai sUc khde cOa benh nhan la nhuthindo?"
001 TUONG, PHL/ONG PHAP NGHIEN CCRJ Ddi tupng nghien cOfu: Td't ca cac tafdng hpp nhap vien va dieu tri do tai nan thUdng tich trong giai doan tnen khai nghien eifu,
Thdi gian, dja diem nghien curu va phuong phap nghien cuu
Thdi gian: tir01/1/2013 den 31/3/2013.
Dia diem Tai Benh vidn Da khoa Diic Giang, Ha Ndi '
Phuong phdp nghien cUu: Nghien cifu md ta cdt ngang eo phdn tich,
Mdu nghien cUu
M l u ciia nghien cifu nay gdm 289 nan nhdn nhdp vidn va iSeu tri do tai nan thuong tieh, nhung ddi tUdng tham gia tra Idi phdng van trong thdi gian dieu tri tai eac khoa Ngoai tdng hpp, Ngoai chan thuong chinh hinh. Hdi sLfccapcifu
PhUdng phap thu thap sd lieu
Phuong phap thu thdp sd lieu dieu tra vien da tien hanh phdng van true tidp doi tUdng nghien eiiU tai budng bdnh.
Phuong phap phan tich so lieu:
Sd lieu duoc phdn tich bang phan mem SPSS 18.0, dp dung cac thudt toan thdng kd md ta cho phep dUa ra kdt qua vd thUc trang tai nan thuOng tich ciia cdc trUdng hop nhdp vien
KET QUA VA BAN LUAN
Thdng tin chung ve ddi tudng nghien cuu Bang 1. Thdng tin chung ve nhdn khau hoc ciia ddi
Gl«
Nhom ludi
Chis6 Nam NO Tonqsd
<151uS 16-301u<Si 31-45 tudi 46-60 ludi
>60 Tdnq sd
Tansd 191
98 289 36 106 60 42 45 289
Tyle%
66,1 33,9 100,0 12,5 36,6 20,7 14,5 15,6 100,0
Y HOC THUC HANH (879) - SO 9/2013
NoiS
Trinh dp hoc v i n
NghS nghi6p
Tham gia bfchifim y i d Phan ioai
lai nan thuong t'chlheo nguydn nhan
Quan Long Bign Dia phiranq khdc Tdnq sd Di/a tidu hoc Toinqhoccosd Phdlhflnqtmnqhoc Tren phd UlOnq Imnq hoc
Tdngsd Hoc smh, smh vidn
Lam mdng Budn bdn Cdng nhan, vifenchCfc
Nfiitro Hirutfi Tdnq sd CO tham gia bdo hidm KhOnq tham qia bdo hidm
Tdng sd Tai nan qiao thOnq
Tai nan iao dOnq Bao luc/xunq ddt Nqdddc
Nga Nquydn nhan lihac
Tdng sd
124 165 289 25 40 141 63 289 59 48 33 75 43 31 289 154 135 289 139 27 20 3 95 5 269
42,9 57,1 100,0 8,7 13,8 48,8 26.7 100,0 20,4 16,6 11,4 26,0 14,9 10,7 100,0 53,3 46,7 100.0 48,1 9,3 6,9 1,0 32.9 1,7 100,0
e h i d m 3 2 , 9 % . C a c n g u y d n n h d n k h a c b a o g d m bong, d d n g v d t c a n , tai n a n d o v d t s a c n h o n la 5 trudng hdp c h i d m 1,7%.
B a n g 2 . P h d n b d t a i n a n t h u o n g t i c h t h e o tudi, oidj Nhdm ludi
<15tudi 1 6 - 3 0 ludi 3 1 - 4 5 tudi 4 6 - 6 0 tudi
> 60 ludi Tdngsd
Gidi Nam
23 85 40 28 15 19)
%
63,9 60,2 66,7 66,7 33.3 66, <
NO 13 21 20 14 30 yu
%
36,1 19,8 33,3 33,3 66,7 33,9
Chunq-^
Tdnsd 36
m
6042 45 289
lOM
%
mu
100,0 100,0 110,0 Bang 2 cho thdy eae tn/dng hpp tai nan thuong tichwo
phai nhdp vidn tdp trung nhdm tuoi 1 6 - 3 0 tudi, ti'ong dd nam cd 85 chidm 80,2% vd nu- cd 21 chidm 19,8%.
Nhdm tudi dudi 15 tudi mac tai nan thuOng tich thap nhdt, trong dd nam cd 23 (63,9%) nd co 13 (36,1%).
Nghien edu eiia Nguydn Ddng Tuan vd md hinh chan thuong vd gdnh ndng bdnh tdt tai mdt sd cd sd y te huydn Dd LUOng ndm 2003 eho thay chan thuong chd ydu tdp trung d nhdm 1 5 - 4 4 tudi chiem ti Id 52,3% [5, tr. 1-33].
Bang 1 cho thay trong 289 ddi tupng nghien cifu cd tudi trung binh Id 37 tudi, tudi cao nhd't la 92, thdp nhat Id 2 tudi Cd 191 nam (ehidm 66.1%) vd 98 nu" (chidm 33,9%). Ty le nay eung tUOng ddng vdi eae nghien eifu trudc day Theo bdo cdo ciia Who, tinh tren todn cau, ty Id tif vong do chan thUdng d nam cao gap 2 lan so vdi nCf [7. tr.14]. Nghien cifu eua Tran Quang Khai tai benh vien Tien Du - Bac Ninh nam 2006 - 2007 trong 125 bdnh nhdn mac TNTT phai nhdp vidn dieu tn cd 87 nam chidm 64, 7% cao hon cd y nghia thdng ke so vdi nCf 35,4%. p< 0.001 [3, tr 1-90]. Sd ddi tuong cd ho khau thudng tnj tai Qudn Long Bien la 124 (chiem 42,9%) va eae trudng hop khde thudng tru tai cae qudn, huyen Idn edn nhU Gia Lam, Ddng Anh, tinh Bac Ninh ehiem 57,1% (165 trudng hpp), Sd trUdng hdp nhap vien la hoc smh tieu hoc trd xudng la 25 (8,7%), THCS la^40 (13,8%), THPT Id 141 (48,8%), trung cap - eao ddng - dai hoc Id 83(chiem 28,7%). Cd 154 trudng hpp cd tham gia bao hiem y td {chiem 53.3%) va 135 trudng hop khdng tham gia bao hiem y te ehie'm 46.7%
Trong 289 eae tnJdng hop nhap vien cd 59 BN dang la hoc sinh, sinh vien ehie'm 20,4%, nhdm edng nhan, vien chifc chiem ty Id cao nhat 75 tn/dng hop (chiem 26,0%); lam rudng cd 48 tnJdng hdp chiem 1.6,6%; Npl trd cd 43 trUdng hdp chidm 14,9%, Huu tri cd 31 tnJdng hop chiem 10,7%, budn ban, kinh doanh 33 ti"Udng hdp chiem 11.4%. Cd 154 trudng hpp nhap vidn cd tham gia bao hiem y te chidm 53,3%, 135 trudng hop khdng tham gia bao hiem chiem 46,7%.
Cd 139 trudng hop do tai nan giao thdng chiem 48,1%, tai nan lao ddng cd 27 t r i i n g hpp ehiem 9,3%, Bao luc/xung dot 20 trUdng hpp chiem 6,9%, ngd ddc cd 3 trudng hpp chiem 1,0%; ngd cd 95 trudng hdp
1D00 9D0 SQO 70 0
«ao UO 40 0 MO 2D0 10 0
727
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1 1
- * -
887
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1
TNLD NgOdJe
1
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Bieu do 1: Phan loai TNTT theo g\cA B i e u d d 1 e h o t h d y , n h i n c h u n g c a e t a i d n g hdp nhap v i d n d o e a c n g u y e n n h d n t a p t m n g d n a m n h i e u hdn nij.
D d i v d i T N G T c d 1 0 1 n a m e h i d m 7 2 , 7 % v d 3 8 niJfchian 2 7 , 3 % , T N L D c d 2 4 n a m c h i e m 8 8 , 9 % v d 3 nQ-chiem 1 1 , 1 % . B a o l u t x u n g d o t c d 1 3 n a m c h i e m 6 5 , 0 % va 7 nu" c h i e m 3 5 , 0 % . N g d d o c e d 1 n a m v d 2 nu". N g a ed 50 n a m e h i e m 5 2 , 6 % v d 4 5 niir c h i e m 4 7 , 4 % .
H o d n c a n h , t h d i g i a n x a y r a T N T T eCia c a c bTjSng h o p n h d p v i d n
Hoan canh xay ra TNTT:
60
50 4 0 1
30
20
10
>
t f 1
rat nan gia S56
T
i i
1
1 'i
a
» »• jjiasii- " T 7fo«-
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1
Ngi 1 a Sang ' I ChiluBieu 66 2. Phan bd TNTT theo thdi gian trong ngay
Y HOC THl/C HANH (879) - SO 9/2013
Bieu dd 2 cho thdy thdi gian xay ra TNTT cCia cac trudng hpp nhap vidn do eac nguyen nhdn. Doi vdi TNGT xay ra vdo budi sdng Id 48 trudng hdp (40,3%), budi chieu la 54 (33,1%) va TN xay ra budi tdi Id 37 tiudng hpp (26.6%). TNLD chCi yeu xay ra vdo budi sang (55,6%). Bao luc/ddnh nhau vd ngd ddc phan bd tUdng duong nhau theo budi. Nga chii yeu xay ra vao budi tdi 41 trudng hop (43,2%).
Bia diim xay ra tai nan thuong tich:
Bleu 66 3. Dja diem xiy ra tai nan thuung tfch Bieu dd 3 eho thay, dia diem xay ra tai nan chd yeu la ngoai dudng (54,7%), tiep theo la tai nan xay ra d nhd (29,8%), noi Idm vide (11,1%) vd thap nhat la d tmdng (4,5%). Kdt qua nay cung phii hpp vdi nguyen nhdn gay tai nan thuong tich. Bao cao giam sdt tai nan thiftlng tich eua Bd Y td tai bdnh vien tren todn qudc cung dio kdt qua tUOng tu: cd 64,1% cdc ca tai nan thUdng ti'ch xay ra tren dudng di, xay ra tai nhd chidm 16,8%, dimg thilf 3 la tai nan xay ra tai noi Idm vide 10,5% [1,tr. 2-4].
Hodn canh xay ra tai nan giao thdng Bang 3. Hoan canh xay ra tai nan giao thdnj Hoan canh x ^ ra
TNGT Bia di^m xay ratal
nan giao thOng Va cham vd loai
l^iMigtlSn
Phuong lien dang si^dung
U6ig nfcai khi diSu khiln xe Si)ckh6eh0mdi6u
khien xe Trang th^i tam l|^
tnjdc liic b; tai nan Ihifcfng tich
C&cy«ut6 Dudng quiic 16 Khu tap thg,_n9fi, l6 dan cu"
~5tt Xem^y Xedap Ngifdi dl bO
Ota Xemeiy Ngifcfi dl bo
ca u6ng njgu Kh6ng j6ng njou
Binh Ihudng Hung phan, kfch dSng
Mua/dLfdng Iron
I Khong mua/diJcmg kha | 59 I 42^t i Bang 3 cho thay trong 139 trudng hdp nhap vidn do tai nan giao thdng chCi yeu xay ra tren dudng qudc Id 133 t'ofdng hdp (95,8%), ehi ed 6 tnJdng hpp xay ra tai
khu tdp the. ngo, td ddn phd. Cd 75 tnJdng hpp nhap vidn cd ddi mu bao hiem (61,9%), khdng ddi mu bao hiem 46 (38,1%). SCf dung mou/bia khi tham gia giao thdng ed 58 trUdng hpp (42,3%), khdng sCf dung niou/bia eo 79 tnJdng hop (57,7%). Cd 39 trUdng hdp sifc khde khdng dupc tdt (28,4%). Trang thai tdm ly trudc lOc bj tai nan khdng dn dinh, lo du, hdng phan, kfch ddng 58 trudng hpp (41,8%). Thdi tiet luc xay ra tai nan cd mua/dudng tron la 80 trudng hpp chidm 57,5%, trdi khdng mite/dudng khd Id 59 tnJdng hpp ehidm 42,4%. Ket qua ndy eung phu hop vdi ket qua ede nghidn eCfu trudc ddy cho rang ed mdi lidn quan ddn tai^nan giao thdng vdi thdi tilt mua/dUdng trdn, anh hudng cCia siit khde, tdm 1;^ cOa ngudi dieu khien xe d td, xe may,..[4, tr. 26 - 31]
Tinh trang nan nhdn sau khi xay ra tai nan thuong tich
Bang 4. Tinh trang nan nhdn sau khi xay ra tai nan thuong tieh:
1 Tdn sd T } i d % Tinh tranq tri qiac sau kni bi TNTT TTnli ISO, binti ttiudnq 1 228
Ma nqay 36 Tinh sau dd me I 23
78,9 13,1 8.0 StJcCru
Cdsocdu Khflnqsomu
281 8
97.2 2.8 Also cap cdu
Niian vien y Id Nqudi niia Nqi/di dan C6nq lac vi6n
NOI didu tn Cliuydn ttidnq tdi t}enti vien Tram y te phudng. phdng l(ham
tunhan..,.
22 162 93 4
7,6 56,1 32,2 1,4 ban ddu
202 87
69,9 30,1 Phuonq hen van chuydn Xe cdu thuonq
X e d t d Xemay
95 52 142
32,9 18,0 49,1 ThOi qian van chuyen ddn tienti vien
< 30 phut 3 1 - 1 h Oidutndcosdytdkhac
Cd Khdng
274 15 87 202 Co sd v te dieu tn tn/dc khi chuvdn nan nhan de
Khdnq didu tri Tram V td phudnq Phonq kham lu nhan
Banh vidn td nhSn Co sdy Id khac SCra chda ptiucnq lidn, tranq
CdsdachOa Khdnq phai sda chda
202 36 22 9 20 thielbihdhdnq
77 212 Bdi thuOnq do qdv tai nan cho nqudi k Cd nhan duoc bdi thddnq
KhOnq nhan duoc b 6 thddnq 7 282
94,8 5,2 30,1 69,9 n benh vidn
69,9 12,5 7,6 3,1 6,9 do tai nan 26,6 73,1 ac
2,4 97,6 Bang 4 eho thay tinh trang nan nhan sau TNTT ed 228 trudng hpp tinh tao, binh thudng (78,9%), 38
Y HOC THirC HANH (879) - S6 9/2013
t r u d n g h p p t r o n g t i n h t r a n g b d t t i n h ( 1 3 , 1 % ) v d 2 3 t r U d n g h o p s a u t a i n a n t i n h s a u d d m d d i . C d 2 8 1 n a n n h d n dUOc s d c i f u s a u t a i n a n ( 9 7 , 2 % ) v d 8 n a n n h d n c h u a d u p c s d c i f u k j p t h d i ( 2 , 8 % ) . N g u d i s d e i f u c h o n a n n h d n s a u t a i n a n c h d y e u Id n g U d i n h d 1 6 2 n a n n h d n ( 5 6 , 1 % ) , 9 3 n a n n h d n d u p c n g u d i d i d u d n g s o c i f u ( 3 2 , 2 % ) , 2 2 n a n n h a n d u p e n h d n v i d n y t d s d e i f u ( 7 , 6 % ) v d 12 n a n n h d n d u p c c a c n h d m d d i t u p n g k h a c s d c d u , C d 2 0 2 n a n n h d n c h u y d n t h S n g d d n b d n h v i d n DifC G i a n g k h d m v d d i d u t r i ( 6 9 , 9 % ) v d 8 7 n a n n h d n d u o c d u a d d n c a c c d s d y t e k h d e . T r a m y t e p h u d n g , b d n h v i e n V i d t D d c , X a n h p o n , . . . ( 3 0 , 1 % ) . C d 9 5 n a n n h d n d u o c v d n c h u y d n d d n b d n h v i S n b S n g x e e d l i t h u o n g ( 3 2 , 9 % ) , 5 2 n a n n h d n d U p e v d n c h u y d n b d n g x e d t d ( 1 8 , 0 % ) v d 1 4 2 n a n n h d n d U d c v d n c h u y d n b a n g x e m a y ( 4 9 , 1 % ) . T h d i g i a n v d n c h u y d n d d n b d n h v i d n t r u d c 3 0 p h i i t Id 2 7 4 n a n n h d n ( 9 4 , 8 % ) v d d u d i 1 h c d 1 5 n a n n h d n ( 5 , 2 % ) .
Vj tri TNTT theo gijii phiu
liQO
1000
eoo
600
20 D 78,2
i ri
1
Bing M, cim mlu Ct 3\nU. bit d^ng 990
10
Tpuykdlch 89fl
-
oKfitng
10 4
KMng lim gl
Bieu d 6 4 , Xir tri trUdc khi nan nhan chuyen den benh vl^n
B i e u d d 4 c h o t h a y t r u d c k h i n h d p v i e n , n a n n h d n d a d u o c c d e c o s d y t d v d n g u d i d d n s d c a p c i f u . T r o n g d d , b d n g b d / c a m m d u l a 2 2 6 l u o t ( 7 8 , 2 % ) ; e d d j n h / b a t d o n g 1 1 4 l u o t ( 3 9 . 4 % ) ; 1 % c d x i f l y t m y e n d j c h .
T i n h t r a n g n a n n h d n k h i ^ n h a p v i e n - L o a i T N T T t r e n c O t h e :
B a n g 5' S d l u p t d d i t U d n g bi t a i n a n t h u o n g t i e h t r e n CO t h e
Loai TNTT Iran CO thd Gayxdonq
Bono qan Tratkhdp Vdt cdi, xudc, vdt Ihuonq hd khdc
Vdt tham lim, bam tim Bdnq Nqdddc Chan thdonq/va dap vunq dau Chan thuonq bdn Ironq nOi tanq
Cd 152 22 9 74 84 1 3 76 13
T y i 6 % 52,6 7,6 3,1 25.6 29.1 0,3 1,0 26,3 4,5
So nflo ' Mdi
NBUC
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Chi dinh 0
b i.i«
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5 10 15 9 7 %
^
20 25
1
30
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Bl^u 66 S. Vj ti-f TNTT theo gl Ji p h i u
B i e u d d 5 v i t r i c h d n t h U O n g t h e o g i a i p h d u t a p trung t a i c a e c h i , t r o n g d d c h i d u d i e h i d m t f Id c a o vdi 122 t r u d n g h d p . e h i t r d n 8 0 t n / d n g h p p , c h a n t h u o n g so ndo c d 6 9 t n / d n g h o p c h i d m 1 9 , 7 % , c h a n t h u o n g c d t sdng c d 1 9 t n J d n g h o p c h i e m 5 , 4 % , c h a n t h U d n g ngUCco 17 t r u d n g h o p c h i d m 4 , 9 % v a c h a n t h u o n g b u n g c d 11 t n J d n g h p p e h i e m 3 , 1 % v d C h a n t h u o n g h d n g c h i CO 04 t n J d n g h d p c h i d m 1 , 1 % .
Loai phiu thuat B a n g 6 : L o a i p h a u t h u a t
Loai phau IhuSI Tidu phau Tmnq phau Dai phau Thu Ihuat rdng
Cd 44 7 128 110 289
T«I8%
152 2,4 44,3 38,1 WO B a n g 6 c h o thd'y t r o n g s d c a c t n / d n g h p p n h a p vien c d 1 2 8 t n / d n g h o p p h a i c a n t h i e p b a n g p h d u thudt g3y m e c h i e m 4 4 , 3 % , 7 tiydng h d p t m n g p h i u (2,4%), 44 t n / d n g h d p tieu p h d u ( 1 5 . 2 % ) v a t h u t h u a t 110 ( 3 8 , 1 % ) . '
- MiJrc d p t r a m t r p n g c u a t a i n a n t h u o n g tich B a n g 7" P h d n b d d i e m m i f C d p ti-am t r p n g c a o nhat ( M A I S )
Mile dO tram trpng MAIS = 1 (nhe nhat) MAlS = 2(Tnjngbinh)
MAIS = 3 (ning)
Tansg T^ax
42,2 23,9
B a n g 5 c h o t h a y l o a i T N T T t r d n c o t h e n h i e u nhd't la g d y x u o n g v d i 1 5 2 t n J d n g h p p e h i d m 5 2 . 6 % . V e t t h d m t i m , b a m t i m ( v e t t h u o n g p h a n m e m ) e d 8 4 t r u d n g h p p c h i d m 2 9 , 4 % , C h a n t h u o n g / v a d a p v i i n g d a u c d 7 6 t a f d n g h d p c h i e m 2 6 , 3 % , V e t e a t , x u d c , v e t t h U d n g h d k h a c c d 7 4 t r u d n g h o p c h i e m 2 5 . 6 % ; C h a n t h U P n g n d i t a n g ( d u n g g i a p b u n g , v d l a c h , g a n , . . , ) c d 1 3 t r u d n g h p p c h i d m 4 , 5 % . J^ l e d u p c n h a c d e n t r o n g b a n g t r d n dLfOC t i n h t r e n s d d d i t u p n g n g h i e n c i f u .
TSHQ I 2B9 VjM^
B a n g 7 e h o t h a y d i e m m i f C d p t r a m t r p n g ei3a chan t h u a n g t h e o t h a n g d i e m A I S c d t h a m k h a o b a e sTdieu t n c h i n h c h o thd'y: C d 6 9 t n / d n g h o p n a n g ( A I S 4 + ) c h i e m 2 3 , 9 % , 1 2 2 t n / d n g h o p n a n g ( A I S = 3 ) chiem 4 2 , 2 % , 9 8 t m d n g h d p 6 m i f c d p t r u n g b i n h v a nhe e h i d m 3 3 , 9 % ( s d l i e u dUOc t r i n h b a y c h i tiet t r o n g bang 9)- , . - h B a n g 8 . S d n g a y d i e u t n t a i b e n h v i d n OJa benn
So nqav nam di6u In tai b6nh vien 1 - 5 nqav 6-10 nqay
>tO nqSy Tdnq s6 nq^y nam vien
Tdnq so 175 89 25
jiiii%L 60,6 3G,8 8,7 1441 nqav
Y HOC THl/C H A N H (879) - SO 9/2013
sg ngay tmng binh Then' gian nam vifen nhigu nhai
Tha gian nam viSn It nhat 24 ng^y
Inggy
1
Bang 8 eho thay^thdi gian nam vien trung binh la 4,9 ngay, sd ngdy nam vidn nhieu nhdt Id 24 ngay vd sd ngay nam vien it nhdt la 1 ngay. Sd ngay nam vien tif 1 - 5 ngdy la 175 trudng hpp chidm 60,6%. sd ngdy nam vien tif 6 - 10 ngay ed 89 tn/dng hop chidm 30,8% va sd ngdy nam vien tren 10 ngay Id 25 tn/dng hdp ehiem 8,7%.
KET LUAN
Vdi 289 ddi tUdng tham gia nghien cifu ed 191 trudng hdp la nam (66,1%) vd 98 trudng hdp la nit (33,9%). Tudi trung binh eCia cdc trudng hpp nhdp ven 37 tuoi, cao nhd't 92, thd'p nhat Id 2, Odi tuOng nghidn ciru nhdp vien dieu trj den tif cae qudn huyen khac cao hdn nhdn ddn tai qudn Long Bien. Nghe nghiep chii ydu la edng nhdn/vien chifc (26,0%), thd'p nhat la eac benh nhan cd nghe nghidp buon bdn/kinh doanh chidm 11,4%. Cdc doi tupng nhap vien ed trinh do hoc van chii yeu da tdt nghiep trung hoc phd thong (48,8%), cap tieu hpc chiem ty le thd'p (8,7%).
Chi cd 53,3 cae trUdng hop nhdp vien cd tham gia bao hiem y td.
Trong 5 nhdm nguyen nhdn ehinh nhap vien dieu tri tai thdi diem nghien eifU, Tai nan giao thdng, tai nan lao ddng, bao luc/xung ddt, ngd, ngo doe. Trong do chO yeu la tai nan giao thong 139 tnJdng hop (48,1%), sau do la nga 95 trUdng hdp (32.9%). Nhom tuoi mac cao nhat la 20 - 60 tudi (72,7%), nhdm tudi 15 - 19 tijoi thap nhd't 14 trudng hdp (4,8%). Nam cao hdn niJ nOfl.gian.
Thdi gian xay ra TNGT ehu yeu tap trung vao ban ngay (73,4%), budi tdi cd 37 tn/dng hpp (26,6%) Tai nan lao dong chii yeu xay ra vdo budi sang (55,6%).
Nga chii ydu xay ra vao buoi tdi (43,2%) vd bao luc/danh nhau, ngo ddc phdn bd tUOng dUdng nhau trong cdc budi.
Ve hoan canh xay ra tai nan giao thdng chii yeu ti'dn cac tuyen dudng quoc Id, lidn xd, lien huyen (95,8%). Trong 139 tnJdng hdp nhap vien do tai nan giao thdng cd 75 trudng hop dpi mu bao hiem (61,9%), 48 tn/dng hpp khdng dpi mu bao hiem (38,1%). Ty le SIJ" dung rUOu/bia cd 58 tnJdng hop ( 42,3%), khdng sir dung rupu/bia cd 79 trudng hdp (57,7%), cd 28,4% cd silt khoe khong duoc tdt, 41,8% eo trang thai tdm ly tnjQc llie xay ra tai nan khdng dn dmh, lo au, hUng phan, kich ddng.
Sau khi xay ra tai nan ed 78,9% nan nhan tinh tao, binh Uiudng; bat tinh cd 38 trUdng hop (13,1%) vd 23 trudng hpp me di sau TNTT (7,9%), 97,2% nan nhdn sau tai nan dupe sd citu kjp thdi vd 2,8% chu^ dupe so cap citu. Ngudi so cdu sau tai nan ehu ydu la ngudi nha 56,1%, ngudi di dudng 32,2%, nhan vien y te 7,6%. Cd 69,9% nan nhan dupc chuyen thing ddn benh vidn Difc Giang, 30,1% nan nhan dupe ehuyen den cac cd sd y te khac sau dd ehuyen de'n benh vien.
Co 32,9% nan nhan dUdc van chuyen bang xe euu thUpng, xe may chiem 49,1%, d td ehie'm 18,0% Thdi
gian chuyen nan nhan den benh vidn trudc 30 phut ehidm 94,8%, dUdi 1 h ehiem 5,2%. Sd lUpt benh nhdn dupe bdng bo/eam mau 222 lUdt, cd dinh/bat ddng 114 lupt.
Cd 52,6% benh nhan nhap vidn bj gay xuong, vet thuong phdn mem chidm 29,4%, chan thUOng/va dap viing ddu chidm 26,3%, chan thUdng d bung chidm 4,5%. Chii yeu bdnh nhdn b\ chan thudng tai ehi dudi chidm 34,8%, chi tren ehiem 22,9%, chan thuong so nao chidm 19,7%. Chan thuong cdt sdng 5,4%, chan thuong d bung chidm 3,1%. Cd 44,3% bdnh nhan phai can thiep mo cap cUU, trung phdu 2,4%, tieu phdu 15,2% vd thCi thuat chiem 38,1%, Nhin chung cac ca nhdp vien vd dieu tn Id nhiing ca cap eifu nen tinh trang nan nhdn rdt nghiem trong neu khdng cap cifu kip thdi anh hudng den tinh mang. Theo thang diem AIS' AIS = 4 + chiem 23.9%, AIS = 3 ehiem 42,2%, AIS = Ihodc 2 ehiem 33,9%. Cao hon ket qua nghien cdu cCia Tran Quang Khai (diem mde dp tram trong cCia Chan thUdng tir 1 de'n 3 diem, AIS 1 c6 47,2%, AIS 2 cd 44,8%, AIS 3 eo 8,0%) [3, tr. 1-90].
J a i thdi diem ra vien, c6 96,9% nan nhdn co bj anh hudng den vide di lai vd sinh hoat. T^ Id mat % sifc khde so vdi trude khi tai nan thUdng tich la khac nhau:
Mat 20% siifc khde Id chu yeu (49,1%), mat 30% sUc khde (17,0%); mat 10% ehiem 31,1%. Tuy nhien, day la nhiing ddnh gia mang tinh chat (Snh tinh, chd quan ciia benh nhdn, nghien citu khdng di sau vao nen thang do danh gid khdng theo quy chuan va mang tinh khoa hoc.
Thdi gian nam vien tnjng binh Id 4,9 ngay, sd ngay nam vien nhleu nhat la 24 ngay va thap nhd't la 1 ngay.
KHUYEN NGHj
Ld benh vien cd trinh do chuyen mon cao nhat tai qudn Long Bien va khu vUc phia Odng Bac Ha Npi.
Thu hilt rat ddng sd benh nhan den kham vd dieu tn, trong dd cd cac trudng hpp nhap vien do TNTT Hang ngay, benh nhan dUde chuyen den tU cac huyen Gia Lam, Ddng Anh, Sdc Son va mdt so huyen ciia tinh Bac Ninh. Vdi sd benh nhan nhap vien va dieu tri tang hdn so vdi mpi nam Nen ydu eau ve nhdn lue, trang thidt bl y te ludn phai s i n sdng dap ifng yeu cau dat ra de cd'p cifu kip thdi. Ben canh do, benh vien de xuat cac giai phap nang cao trinh dd chuyen mdn cho doi ngu y, bdc sTtai khoa ngoai chan thuong
TAI UEU THAM KHAO
1. Bp Y te (2010), Bao cao giam sat tai nan thUOng tich tai 7 benh vidn trdn toan quoc, Cue quan ly Moi trUdng - B o Y t e '
2, Benh vidn da khoa DUc Giang (2012), Bao cao thdng ke tai nan thUOng tich nam 2012
3 Nguyin Quang Khai (2007), Chi phi va tin hai sOC khde do chan thuang khdng chCi dich cOa bdnh nhan didu tn ndi tru tai benh vien da khoa huyen Tien Du tU 05/2006 - 05/2007. Luan vSn Thac sT Y te Cong Cong, TrUdng Gai hoe Y te Cdng epng. Ha Noi-
4 Biii Tu Quyen (2004), Mdt sd dSc diim chan thuong giao thdng khi di xe may cua nan nhan din kham va diiu tn tai Tmng tam y te huydn Luang San - Hda Binh nam 2002. Tap cht Y te Cong Cpng.(Sd 1 ), tr. 26 - 31
Y HOC THl/C HANH (879) - SO 9/2013
5. Nguydn DSng Tuan (2004), Md hinh ehd'n thuang vd gdnh ndng bdnh tdt t^i mdt s6 ca sd y ti huydn Dd Luang ndm 2003 Luan vdn chuydn khoa I - Y td cdng cong -Trudng Dai hpc Y td cdng cdng.
6. Jacobs G, Aeron-Thomas A vd Astrop (2000), Estimating global road fatalities, Crowthorne, Transport Research Laboratory, 2000.
7 World health Organization (2008), Regional report on status of road safety the South - East Asia Region, chapter 3. p. 14.
8. World Health Organization (2013), Global status report on road safety 2013, vww.who.int/entitv/qho/road safetv/mortalitv/en/ access date 05/7/2013.
OAC DIEM L A M S A N G . CAN L A M S A N G VANG DA TRE $ 0 SINH NON THANG TAI BENH VIEN DA KHOA TRUNG lATNG THAI NGUYEN
NGUYEN
NGUYIN NGUYIN
TOM T A T
Bdn canh nhdng hdi chdng Idn nhu Suy hd hip sd sinh, Nhiim trung sa sinh thi Vang da so sinh Id mdt hdi chdng thudng gdp tmng thuc hdnh nhi khoa hdng ngay. Bdnh nhdn can duge chdn dodn vd diiu tn dimg di tranh cho tre bi de doa tinh mang hodc sdng vdi di chdng thdn kmh ndng ni. Di tim hiiu ddc diim Idm sang can Idm sang sa sinh non thdng vang da tdng bilirubin tu do. ChUng tdi tiin hdnh nghidn eifu trdn 310 Ire so smh non thang vdng da dHu tri tai khoa nhi bdnh vien da khoa trung uang Thdi Nguydn theo phuang phdp md ti cit ngang. Kit qua cho thiy da sd vang da xuit hien 49-72 gid sau sinh, vang da dugc phat hien khi tre vang den vung 3, viing 4, van cdn nhdng tri dugc phdt hidn vang da mudn khi da cd biiu hidn tridu chdng tin thuong nao, cd mdi tUOng quan thuan gida mUc do vang da tren Idm sang vd bilimbin mdu tu do.
Vang da chQ yiu xay ra d tre cd me mang nhdm mau 0, con mang nhdm mau B, tri cdng non can ndng cang thip cd mifc bilirubin mdu cang thd'p, tre cd biiu hien ton thuang nao khi bilirubin todn phan tmng binh 261.75 ±100.8. bilimbm GT tmng binh 247.72±95.79.
Co 37.1%o khdng ed yiu td ddi khdng nhdm mau me con hd ABO, 99.6% tre vang da cd suy hd hap sau di, 40.4%o tre vang da ehua tim thay nguydn nhdn, 22.6%, cd yiu Id doi khdng nhdm mau me con hd ABO, 17.1%, me va ndi trdn 6 gid, ch! cd 6.5%, co me dung thuoc kich smh (Oxytocin). Cdn 13.3%, tre vdng da dugc danh gia mdc dd vang da trdn Idm sang khdng tuang xdng vdi mdc bilirubin d cung mdt thdi diim. O nhdm tri dudi 35 tuin cd tin si giim protein mau eung nhU albumin nhiiu han nhdm tri td 35 tuan den dudi 37 tuan.
Tdkhda: vang da so sinh.
SUMMARY
Besides the major syndromes such as neonatal respiratory distress, neonatal infections, the newborn Jaundice is a common syndrome in pediatnc practice daily. Patients should be diagnosed and treated properly to avoid children with life-threatening or life with severe neurological sequelae To explore the clinical charactenstics subclinical premature newborn jaundice hyperbilirubinemia freedom. We conducted a
THj MAI - Bi^nh vi^n da khoa tinh San La V A N S O N - Trudng Dai hpc Y Dupc Thdi Nguyen Vi$7 HUNG - Cyc Quan lyKCB
study on 310 preterm newborn jaundice treated at pediatric hospitals in the state central cmss-sectional descriptive methods. The results showed that the majority of jaundice appear 49-72 hours after birth, jaundice is detected when the golden child 3, the 4, sftf/
young jaundice is detected late when symptoms had damage brain injury, with a positive con-elation bebfl/een the degree of clinical jaundice and hyperbilirubinemia freedom. Jaundice occurs mainly in children whose mothers take 0 blood group, blood type B child bearing, children as young as lower weight, lower blood bilirubin levels, children show signs of brain damage when bilirubin average 261.75 + 100.8, indirect biiimbin average 247.72 ± 95.79. 37.1%
have no countervailing factors mother ABO blood group. 99.6%o of children with jaundice after birth wrf/i respiratory distress, jaundice 40.4% of children had not found the cause. 22.6%, had blood group factor antagonists mother ABO, down 17.1 %o mom amniotic leak in 6 hours, only 6.5% have used drugs fc/rf/i mother (oxytocin). And 13.3% of children were jaundiced assessment of clinical jaundice with a bilimbin is not proportionate at the same time. In infants less than 35 weeks may reduce the frequency of blood proteins albumin and more children aged 35 weeks to less than 37 weeks.
Keywords: newborn Jaundice.
D A T VAN oi
Vang da d tre sO sinh (VDSS) la hien tuong sinh ly xay ra d phan Idn tre sd sinh lien quan tdi ddc diem ve ehuyen hda bilimbin trong cd the tre d nhijng ngdy dau sau sinh. Vang da duoc xem la binh thudng khi d ti'd dO thdng cd bilinjbin <14,8 mg% va d tre thieu thang
<10mg%, vdi dieu kidn' tre bii tdt, nude tieu vdng, ia phan vang 2-3 lan/ngay. Tai Khoa nhi BVDKTUTN trong 5 nam 2001-2005VDTBILTD30% d tre dii thang vd 36.75% tre de non [8] vd Bao Mmh Tuyet nghien cifu ndm 2009 ty le vang da tdng Bilimbin TD d tre 6e non la 67,9% trong tdng sd so sinh vdng da. Theo Nguydn Thi Xuan Huong va cdng sU trong 3 ndm tif 2008 - 2010 tai Khoa nhi BVDKTUTN t j Id tre sd sinh non thang la 53,6% trong do cd 20,3% bi vang da [71,