(8,4%) cd mdc nang lifdng bj coi la thieu nn (<1500 KCal). Ty le ngifdi trUdng thanh cd mdc nang lupng coi la du an va cao hdn nhu cau (id nghj deu cao hdn so vdi nam 2003 (b.'iiK! 4). Rd rang khau phan cua nhan dan Bac Can hien nay dang phan hda vdi gan 5 0 % sd hd no dii va (;an ed hudng dan dmh dUdng hdp ly, tranh tinh trang thira can beo phi do dU thifa nang lUdnq
V. KET LUAN
1. Bae Can da ed thay dni Idn ve an ninh thuc pham hd gia dinh:
Sife mua eua cac ho gia dinh trunc) binh hang thang da tang len, ket qua eho Ihay tdng thu nhap. tdng chi phi va ehi phi cho an udng deu tang tir 2-3 lan so vdi 2003. Rieng ehi cho an udng 540.000 d/hd, cao gap gan 2 lan so vdi 2003, ehiem 7 0 , 7 % tdng ehi phi vd 5 3 , 3 % thu nhap trong thang. Qua ehin da dUa vao bifa an tuy ty le mua thap ( 2 7 % hang ngay, 2 2 % mua 3-5 lan/tuan).
2. Mirc tieu thu eae thife an ngudn gdc ddng vat va dau md deu tang so vdi 7 nam trUde: Tuy nhien v i n edn 8,4% ngUdi trUdng thanh ed mifc nang lUdng < 1500 Kcal trong khi ty le NTT cd mifc nang lUdng coi la du an
vd eao hdn nhu cau de nghj deu cao hdn so vdi nam 2003.
TAI UEU THAM KHAO
1 Bd Y te, Vien Dinh Dudng (1995). Ke hoach hanh ddng quoc gia v6 dinh dddng 1995 - 2000.
Nh^ xuat ban Y hpc Ha npi.
2. Bd Y te, Vien Dinh Dudng (2001). Chien luoc qudc gia dinh dddng 2001-2010. NXB Y hpc 3. Hoan, Pham Van va cs (1996). Budc dau
nghien cifu an ninh lUdng thuc thuc pham va dinh dU(U)(j d cac hd gia dinh tai 5 xa ndng thdn miSn Bac nam 1993 va 1994. Oe tai nghien cifU cap bp, Bd Y te, da nghiem thu ngay 21/5/1996 theo quyet dinh sd 796/BYT ngay 11/5/1996.
4. Khdi, Ha Huy Phuong phap dich te hoc dinh dudng. NXB Y hoc Ha ndi -1997. Trg 28
5. Vien Dinh dudng. Tdng diSu tra dinh dudng nSm 2010. Nha xuat ban Y hoc Ha noi -2012.
6. Deaton A (1997). The analysis of household surveys: A micro-economethc approach to development policy. Baltimore, Md.: Johns Hopkins University Press, pp. 24 - 38.
7. Gillespie S; Martorell R (1996). How Nutrition Improves. ACC/SCN State of the Art. Series Nutrition Policy Discussion Paper 15, Geneva:
United Nations, pp. 104 - 117
NHAN XET KET QUA CUA PHAU THUAT CAT BE CUNG GIAC MAC DIEU TRI GLOCOM
Khuc Thi Nhun*
TOM T A T
Chiing tdi nghien cifu ket qua ciia 434 mSt (355 benh nhan) md eat be dieu trj gldcdm tien phat trong hai nam 1988-1989 tai Khoa Mat Benh vien Viet Tiep Hai Phdng.
Ket qua nhU sau: tudi benh nhan tir tren 50 ehiem 67,07%, nij" chiem 67,61%, 84,79% m§t d vao nhij'ng giai doan nang ne eiia benh, ket qua sau md nhan ap dieu ehinh d 97,00% sd mSt, thi life sau md dn djnh va tang d 91,29%; bien chifng trong md: xuat huye't tien phdng d 35 mat (8,1%), thoat djch kinh d 2 mat (0,47%); bien chifng sau md: xua't huyet tien phung d 47 mat (11,05%), tien phong ndng d 25 mit (5,89%), viem mang bo dao d 21 m5t (4,83%), due the
* Bo mdn mSt DH Y Hai Phdng
Phan bien khoa hqc: GS.TS. Tdn Kim Thanh
thiiy tinh (TTT) nhanh sau md d 3 mat (0,69%). Nhin chung cac bien chifng khdng nang va dieu trj npi khoa ket qua tdt, rieng 3 ca due TTT nhanh sau md chiing tdi phai lay TTT toan bd ngay trong thdi ky hau phau.
RESUME
Nous avons etudies les resultats de 434 yeux operes de la trabeculectomie au service ophtalmologie de i'hopital VietTiep Hai Phong
pendant 2 ans 1 9 8 8 - 1 9 8 9 .
Les resultats sont suivants: I'age de malades de plus de 50 est de 67,07%; les femmes 67,61%;
84,81% sont des glauedmes avances, les resultats post-operatoires: le tonus oculaire est bien eontrole
Y HOC VIET NAM THANG 2 - SO 1/2012 dans 97,00%; l'acuite visuelle sans correction (AVSC)
post-operatoire restent stable et augmentent dans 91,29%. Les complications pero-operatoires: hyphema dans 35 yeux (8,10%), perte de vitre dans 2 yeux (0,47%). Les complications post-operatoires: hyphema dans 47 yeux (11,05%), petite chambre anterieure dans 25 yeux (5,89%), uveite anterieure (4,83%), cataracte rapide post-operatoireschez 3 yeux (0,69%).
En generalement, les complications pero et post- operatoires ne sont pas baucoups et passe vite avec le traitement mais 3 yeux cataractes rapides post- operatoires nous devont fait une extraction intra- capsulaire (EIC) pendant le temps post-operatoires.
I. OAT VA'N OE
Gldcdm tien phat la mdt benh mat nguy hie'm, gay ty le mil Ida cao d nude ta. 6 Hai Phdng hang nam benh gldcdm tien phat ehiem 13,09% tong sd benh nhan dieu trj ndi trii, sd phdu thuat dieu trj gldcdm tien phat ehiem 57,88% trong tong so cac phau thuat mat (566/976) ehUa ke de'n cae gldcdm thif phat.
Chung tdi da diing nhieu phUdng phap phau thuat de dieu trj benh gldcdm tif nhufng phUdng
phap ed dien den nhCfng phUdng phap cd hieu qua eao hien nay nhU phdu thuat cat be ciing mac va phau thuat ket ciing mac dUdi vat eiing mae.
De danh gia dUdc ke't qua trude mat va lau dai cua phau thuat cat be ciing mac, chiing tdi nghien cdu de tai nay nham muc tieu: Danh gia kit qua cua phau thuat cat be cung giac mac dieu tri gldcdm tren benh nhan gldcdm tien phat dieu tri tai Khoa Miit BV Viet Tiep Hai Phdng trong hai nam 1988-1989.
II. o 6 l TUpNG VA PHUONG P H A P NGHIEN CCfU 2.1. Ddi tirdng nghien ciiru: tat ca nhtfng benh nhan gldcdm tien phat dUdc dieu trj phau thuat tai khoa mat BV Viet Tiep tif thang 12/1987 den^ het thang 11/1989 (khdng ed chpn Ipe). Tdng sd benh nhan: 355. Tdng sd mat; 434. Theo ddi lau dai tir 1 den 3 nam tren 78 benh nhan (109 mat).
2.2. Phu'dng phap nghien cufu: nghien cirli tien cifu cd theo doi lau dai tif 1 den 3 nam.
KET QUA
3.1. Tinh hinh benh nhan:
Sd lUdng benh nlian: 355 (434 mat).
Nam: 115 (32,39%), nir: 240 (67,61%).
Tudi: dudi 55: 112 (34,93%), tren 55: 231 (65,07%).
Gloeom gdc ddng: 368 (84,79%), gldcdm gdc md: 66 mat (15,21%).
3.1.1. Phan loai theo tuoi:
Tuoi Sob/ nhan
Ty le %
35-40 11
41-45 23
46-50 56 34,93
51-55 34
56-60 84
61-65 72
>65 75 65,07
Tong so 355 100 Nhu'vay da sd benh nhan la tir tren 50 tudi (chiem 67,07%)
3.1.2. Phan loai theo gidi:
Nhu vay sd lieu cua chung tdi cung phii hdp vdi tai lieu kinh dien. Ty le mac benh cua nu"
nhieu hdn nam gap 2 lan. So vdi sd lieu cCia Le Ba Van (1985 - Khoa Mat Hue) sd benh nhan nU chiem 72,7%.
Gidi
Sd lUdng benh nhan Ty le %
Nam 115 32,39%
Nur 240 67,61%
Tdng sd 355 100%
3.2. Phan loai theo g i a i doan Bang 3.1. Phan loai theo giai c
Cac giai doan gldcdm Sd phat
Tien trien Tram trong Gan mil
phat trien cua benh:
oan phat trien ciia benh So mat
66 116 179 47
Ty le%
15,20 26,72 41,24 10,82
Mil _ Tong sd
26 434
5,99 100
3.3. Tmh trang nhan ap sau mo cua 434 mit: trong sd 434 mat gldcdm, cd 39 mat due thuy tinh hoan toan, nhCfng mat nay hnt budc ehiing tdi phai md lay thijy tinh phdi hdp eat be eung mac. Ket qua nhUsau:
^ang 3^2. Nhan ap sau mo cun 4,'^4 maUno cat be N.A sau md
So mat T y l e
Khdng d/ chinh ^ 13
3,00% J
Tdng sd 434 100%
Dieu chinh 421 97,007n
Trong sd 13 mdt tang N.A sau md, cn 2 ITUII Gldcdm ac tinh hau phau, chiing tdi dieu trj ndi khoa nhan ap trd lai binh thudng cdn 11 iii.it tang nhan ap sau mo khae (phan nhieu la nhi/ng mat d giai doan gan mu) chung tdi phai md cnl (»! ian hai nhan ap mdi dieu chinh.
3.4. Tinh trang thj lire sau md cua 434 mat:
Bang 3.3^ TinMrang thi luc sau mo eua 434 mat Giu nguyen va tcing
396 j 91,29%
N.A sau^md So mat
_T^]e% ^ _J_
Giam 38
Tdng^q^
8,70%
434 100%
3.5. Bien chu'ng trong mo: viec ha nhan ap trUde md thUdng khdng td't d nhu'ng mat tram trpng, gan mil va mil nen trong thdi gian phau thuat thudng hay gap bien chifng: xuat huyet tien phOng: 35 mat (8,1%) thoat djch kinh d 2 mat (0,47%). Xuat huyet tien phdng trong liic md thudng khdng nhieu sau khi gat mau va tifdi nude tren giac mac mau thUdng ra het.
3.6. Bien chiimg sau md d 434 mat:
Bang 3.4. Bien chifng sau md d 434 mat
Cac bien chu'ng Sd mat Ty le %
XHTP(l) 47 11,08%
Xep TP(2) 25 5,89%
Viem MB0(3)
21 4,94%
Due TTT(4) 3 0,7%
Phil hoang diem
5 1,17%
(1) XHTP (xuat huyet tien phdng): gap trong 47 mat vdi ty le 11,05% thUdng tren nhCfng mat d trong nhCfng giai doan nang cua benh. Xua't huyet tien phdng thu'dng xuat hien vao ngay thir hai hoae thif ba cua phau thuat vdi sd lupng it va sau dieu trj ndi khoa ke't qua tdt, ehi ed 1 ca sau md lay thuy tinh phd'i hdp xuat huyet nhieu trong budng djch kinh. Oieu tri ndi khoa khdng tieu het thj life luc ra vien chi cdn anh sang.
(2) Xep TP (tien phdng): gap tren 25 mat chiem 5,89%, trong dd cd 6 mat la do bong the mi mach mac. Dieu tri ndi khoa bang truyen tinh mach dung dich Uu trUdng, udng diuramit, kaliclorua va tra atropin ket qua rat kha quan.
(3) Viem (MBD) mang bd dao: gap trong 21 mat thudng la nhUng phan ifng nhe, dap
ifng tdt vdi dieu trj ndi khoa.
(4) Chung tdi cd gap 3 ca due thuy tinh (TTT) nhanh sau md cd le do phau thuat vien cham vao mang bao trong khi md, phai xCf ly bang lay thiiy tinh ngay trong thdi gian ky hau phau.
3.7. Moi lien he giCRa nhan ap trudc mo va ty le bien chimg trong, sau mo:
Cac phau thuat vien thudng rat ngai mo tren nhCfng mat nhan ap ha khdng td't trudc md vi thudng cd ty le bien chifng cao. Oe thay rd dupe mdi lien he nay chiing tdi da lap bang so sanh va cung nhan thay rd rang ty le bien chifng rat cao d nhCfng mat nhan ap ha khdng tdt trudc md: gan gap 3 lan so vdi nhu'ng mat ha tdt nhan ap trudc md.
Y HOC VIET NAM THANG 2 - SO 1/2012
Bang 3.5. Md'i lien he giira nhan ap tn/de md va ty le bie'n chung trong, sau md Bien churng
Xuat huyet tien phong Xep tien phong Viem mang bo dao Thoat dich kinh Due the thiiy tinh
Phil hoang diem Tong so
Ha td't (<25mmHg) 12
28 (27,33%)
Nhan ap trUdc md
Ha khdng tdt (>25mmHg) 35
10 13 2 3 4 73 (72.44%) 3.8. Ket qua lau dai cua phau thuat:
3.8.1. Dac diem benh nhan: sd lupng benh nhan: 78 (nam 19; nCf 59), sd mat: 109, gldcdm gdc ddng: 94 mat, gldcdm md: 15 mat, thdi gian theo ddi 1-3 nam.
Bang 3.6. Tae dung dieu chinh nhan ap lau dai ciia 109 mat eat be ciing mae Thdi gian theo
ddi 1-3 nam
Tyle
NA khdng dieu chinh
4 3,66%
Oieu chinh bang Pilocacpin
2 1,83%
NA dieu chinh 103 94,49%
So mat 109 100%
Nhu'vay ty le nhan ap dieu ehinh khong can diing thude sau md eat be eiing mac td 1-3 nam theo nghien cirtj cua chiing tdi la 94,49%, vdi thudc pilocacpin ddn thuan la 1,83% nang tong sd nhan ap dieu chinh sau mo cua chiing tdi len la 96,31%.
3.8.2. Moi lien he gida tinh trang seo ket mac va ty IS dieu chinh nhan ap iren 109 mat:
Bmg 3.7. Md'i lien he giua tinh trang seo ket mac va ty le dieu ehinh nhan ap tren 109 mat
Seo ket mac Bong nhieu Bong vifa Khong bong
So mat 39 42 -28
Nhan ap Khdng DC
0 1 (2,38%) 3(10,71%)
DC bang pile 0 0 2(7,14%)
Dieu chinh 39(100%) 41(97,61%)
23(82,14) Chiing tdi nhan tha'y seo ke't mac sau md
cat bd cung mac neu cd bpng tda lan deu tren ket mac eUc tren vi bpng nhieu hoae bong vifa thi deu cho t^ le ha NA cao tu" 97,61 %-i 00%, neu seo ket mac khong cd bong thi ty le nhan ap dieu ehinh chi gap d 82,14% cac ca (bang 3.7).
3.8.3. Tinh trang thj life lau dai sau md a 109 mat: Theo ddi tif 1 3 nam tren 109 mat chung tdi thay cd 29 mat thj life tang hdn liic ra vien (26,6%), thj lUc khdng ddi d 66 mat (60,55%) va thj lire giam d 14 mat (12,84%).
Thj lUc giam ia do due the thuy tinh tien trie'n them sau mo.
IV. B A N LUAN VA KET LUAN
4.1. Tinh trang nhan ap sau mo: qua thd'ng ke tren 434 mat md cat be cung mac.
ehiing tdi nhan tha'y phau thuat eat bd eho ty le dieu chinh nhan ap cao (97,00%) (bang 3.2).
So vdi sd lieu cua B.s Le Ba Van (1985) md mat be cUc du'dl cho 230 mat, ty le dieu chinh nhan ap la 94,8% thi ket qua eua chung tdi tUdng ddi eao. Tuy nhien trong nghien cifu nay chiing tdi chi thdng ke tren nhung mat gldcdm tien phat ma khdng thd'ng ke tren nhu'ng mat gldcdm thif phat hoac tai phat, cd le vi the ma ty le dieu ehinh nhan ap ciia chiing tdi cao hdn ciia BS Le Ba Van.
Theo nghien cifu nay ty le dieu ehinh nhan ap lau dai eung rat cao: nhan ap dieu ehinh vdi thudc pilocacpin ddn thuan d 2/109 mat (1,83%) hoac khdng can diing thude d 103/109 mat (94,49%) (bang 3.6). So sanh vdi ke't qua lau dai cua cac nghien cifu khac (bang 3.8):
Bang 3.8. Tae dung di^u^hinh nhan ap lau ddi cua phau thuat cat be cung mac theo cac tac gia Tac gia
Vien Mat
LeBa Van (1985) Khiic Thi Nhun
T h ^ ^ i a n theo ddi 2-7 nam lO^thang- 4 nam
1-3 nam
Sd mat 9 4 ' 50"[
109
NA khdng OC^
4 (3,66%)
DC bang Pilo
2(1,89%)
NA d. chinh 91,5%
92,0%
103(94,49%)
4.2. T i n h trang t h i lu'c s a u mo: theo nghien cifu ciia chung tdi thi life dn djnh va tang sau md d 91,29%, giam d 8 , 7 1 % (bang 3.3). Thj Il/c tang sau mo la do ket qua ciia viec ha nhan ap tdt sau mo lam eho giac mac trong hdn va cac phan dng viem tieu het, cdn nhu'ng mat thj lUe giam chii yeu la do due the thuy tinh va phu hoang diem sau mo.
So vdi s d lieu B.s Le Ba Van (1985) m d cat be cue dudi, ty le thj lUe giir nguyen va tang chiem 8 3 % .
Theo ddi tif 1 3 nam tren 109 mat ehiing tdi thay cd 29 mat thj lUe tang hdn liic ra vien (26,6%), thi life khdng ddi d 66 mat (60,55%) va thi life giam d 14 mat (12,84%). Thj lUe giam la do due the thuy tinh tien trien them sau mo.
4.3. Bien chufng trong va sau md cua phau thuat cat be cung mac: theo nghien cifu eiia ehiing tdi bien chifng sau md la khdng nhieu (bang 3.4) va cho ket qua tdt sau dieu trj. So vdi ket qua nghien cifu eiia BS Le Ba Van thi nhU sau:
Bang 3.9: So sanh Tac gia\ Bien chiJmg LeBa Van CBCD (1985) Khiic Thj Nhun (1989)
ty le bien chifng sau phau 1 XHTP
26(12,2%) 47(11,08%)
XepTP 23 (10%) 25 (5,89%)
:hat cat be vdi cac tae Viem MBD
7 (3%) 21 (4,94%)
XHVM 1 0
qia khae Due TTT
3 (0,7%)
Phil H. diem 5(1,17%) Nhu' vay ta thay ty le bien chifng sau mo
cat be cung mac la it va thudng dien bie'n td't neu dupe dieu tri ndi khoa sdm va tich eUc.
Viec ha td't nhan ap trudc m d cd mdt tam quan trpng dae biet trong viee ha thap ty le bien chirng.
Seo ke't mac sau m d thudng bpng, tda lan deu, lam cho benh nhan it cd cam giae vUdng viu va it cd nguy c d bj v 6 seo bpng.
IV. KET LUAN
Phau thuat cat be cung mac ngay nay la
mdt phau thuat pho bie'n rdng rai den cac tuye'n tinh de dieu trj gldcdm. Phau thuat cd tac dung dieu chinh nhan ap tdt va bao tdn chifc nang thj giac, tuy nhien can phai tien hanh p h i u thuat dudi kinh hien vi md.
T A I LIEU T H A M K H A O
1.' Le Ba Van (1985), "Nhan xet ket qua mo eat be cUe dudi d 50 mSt gldcdm dieu tri tai benh vien Trung Udng Hue" Ky yeu Hoi nghi khoa hoc ky thuat
nganh mSt 1985, tap 2, tr 76-80.
NGHIEN CljrU BIEU HIEN HUYET HOC 0 BENH NHAN VIEIVI CAU THAN LUPUS
TOM
TATD$t van der. Rdi loan ve huyet hpe la bieu hien thudng gap trong benh lupus ban dd, trong do ehii yeu la thieu mau d cac mifc dp khae nhau, viem eau than (VGT) Lupus rdi loan huyet hpc cd the n§ng hdn.
Muc tiiu. (1) Nhan xet mdt sd rdi loan vie huyet hpc
* Dai hqc Y Ha noi
Phan bien khoa hoc: PGS.TS. 0 6 Thi Lieu
Ngo Phan Thanh T h u y * , D o Gia Tuyen*
viem eau than (VGT) Lupus (2) Tim hieu mdi lien quan giiJa tinh trang thieu mau va mirc Ipc eau than (MLCT).
Phu'dng phap nghien cutr Benh nhan viem cau than lupus nam dieu trj ndi trii tai khoa Than Tiet nliu Benh vien Bach mai. Kit qua: BN thieu mau ehiem ty le eao 93,3%. Trong dd thieu mau mifc dp
