Tjp chl Tai MOI Hong Vi$t Nam - Volume (58-15). N°3 - May, 2013
T H V C TR^JVG D I N H DlTOING CUA BENH NHAN
T ^ HAI BfNH VIEN CUA TINH QUANG NINH NAM 2012
Nguyen Bd Huy*, VuMinh Thuc **
TOM TAT
Nghien cuu ddnh gid tinh trgng dinh duong (TTDD) cita ngudi benh trudng thdnh (tit 17 din 75 tudi) trong benh vien bdng phucmg phdp nhdn trdc vd phuong phdp ddnh gid Todn dien ddi tuong chii quan (Subjective Global Assessment)(SGA). Nghien cuu cdt ngang md td tren 268 benh nhdn tai bfnh vien Da khoa Cam Phd (Qudng Ninh)vd Benh vi?n Lao tinh Qudng Ninh tic thdng 10-12/2012. Ket qua cho thdy ty le benh nhdn thieu dinh dudng trong benh vien Da Khoa Cam Phd vd benh vien Lao Qudng Ninh la d mite trung binh dii ddnh gid bdng phuong phdp nhdn trdc (BMl) hay bdng phuong phdp SGA:
Ty l^ ndng luang trudng diin (CED) Id 29,8% (theo nhdn trdc) vd ty le cd nguy co SDD m SDD Id 14,1% (theo SGA). Ty le benh nhdn cd nguy co vi SDD deu cd xu huong tdng len theo thdi gian ndm vien khi ddnh gid TTDD bdng nhdn trdc hay ddnh gid bdng SGA V&i cdch ddnh gid bdng BMl thi xu hudng ndy rdt rd ret, su khdc biet cd y nghia thdng ke vmp<0,05.
Tirkhda: Phuang phdp nhdn trie, SGA. nguy caSDD. SDD ngudi benh.
SUMMARY
NUTRITION STATUS OF HOSPITALISED PATIENTS AT TWO HOSPITALS OF QUANG NINH PROVINCE IN 2012
The research evaluated nutrition status of hospitalized adult patients (from 17 to 75 year old) by anthropometrical and by SGA tool. A cross sectional study was conducted with involvement of 268 hospitalized patients at Cam Pha hospital and tuberculosis hospital of Quang Ninh province from October to December, 2012. The results show that the prevalence of malnutrition of hospitalised patients at Cam Pha hospital and tuberculosis hospital of Quang Ninh province was average level by both anthropometric or SGA methods: CED prevalence was 29.8% (by anthropomestric method) and prevalences of at risk malnutrition and malnutrition was 14.1% (by SGA tool). The prevalence of malnutrition (by BMl or SGA) have trend to increase by hospital length of stay, and by BMItool, the trend of reduction was signiflcally withp<0.05.
Key words: Anthropometric, SGA methods, at risk and malnutrition status of hospitalised patients
I . B ^ T V A N D E vien. SDD khong chl la mot benh dcii c J- u J - /„T^^^^ . ..- 1. t - thu&l ma Hen quan toi nhidu vSn de trong Suy dmh duong (SDD) cua benh nhan ^enh vlSn, bJng chung la nhiju benh nhan trong benh vien lien quan tm tang nguy co . ^^^. ^^^ ^^^ ^^ ^ . „ ^ig„
mac benh, tu vong vakfe da. thoi gian nam ^.^^^^^ ^ ^^^.^^ ^^ ^ . „ , y ^-^ ^4 ^
; „.. ,,. , cac benh a Viet Nam nhu Bach Mai, benh
• Vi5n Dmh Dirong,DT: 0913558179 cav. i;c
* * Vi^n Tai Mui hong Trung uong
Tgp chl Tai Mui Hpng Vi^t Nam - Volume (58-15). N°3- May, 2013
vien 198, Benh vien Cho Rdy.... da sir dung cdng cu ddnh gid ddi tugng todn dipn chu quan (Subjective Global Assessment) (SGA) trong danh gid TTDD cua bpnh nhan va cho thdy ddy Id cdng cy ddnh gia TTDD dac hi?u vd tin cay, do vdy duoc khuyen nghi dp dung cdng cu nay de ho trp, bd sung cho cdc phuong phdp nhdn trac trong ddnh gid TTDD trong benh vidn [2],[3].
Trong ndm 2012, chung tdi tien hanh nghien cuu "Thuc trang suy dmh duong cua benh nhdn tai benh vi?n Da Khoa Cam Phd vd benh vien Lao Quang Nmh" vdi muc tieu xdc dinh thuc trang tinh hinh SDD cua benh nhan trudng thdnh tai cdc khoa Ndi vd khoa Ngoai vd benh nhdn lao de tir dd dua ra nhimg du lieu giup nang cao nhdn thuc cua cpng ddng vd xa hoi ve boat ddng dinh duong trong benh vien trong thdi gian tdi.
2. PHl/OfNG PHAP NGHIEN ClTU 2.1. Ddi tugng nghien cuu: benh nhdn mdi nhap vien, dang ndm vien, chudn bi ra vien cd tudi tu 17 den 75 tudi (trir benh nhdn mac cdc benh cdp tinh, cdp cuu).
2.2. Thiet ke nghien cuu: Phuang phdp nghien cuu md td, tien hanh tit thdng 10 den thdng 12 nam 2012 tai benh vien Da Khoa Cam Pha va benh vien Lao Quang Nmh.
2.2.1. C&mdu [4].
n Id so lugng cdn dieu tra; Z (i^2)- Do tin cay 95%, 2^1,96.
p Id ti le thieu ndng luptig trudng dien trong benh vien trung binh la
25%[\\\did sai so cho phep Id 5%, n = 268 doi tugng.
2.2.2. Cdch chgn m&u: Ldy cdc benh nhdn cd dii tieu chudn lien tiep den khi du co mau.
2.3. Phu-<rag phap nghien cihi va ky thuat thu th^p so lifu:
Tinh trang dinh dudng cua bpnh nhdn dupe danh gid trong thoi gian it nhdt 48 gio sau khi nhap vien bang 2 phuong phdp nhdn trdc (chi sd BMl) vd SGA dp dung cho benh nhdn 17-75 tudi.
* Thu thgp, ddnh gid TTDD bdng so do nhdn trac (cdn ndng, chieu cao): bang dung cu tieu chudn. Can ndng: cdn SECA dien tir dp chinh xdc 0,1 kg, can duoc didu chinh, kiem tra trudc khi su dung. Chieu cao: do bang thudc g5 UNICEF vdi dp chinh xac 0,1 cm. Danh gid tinh trang dinh duong bang chi sd khdi co the BMl theo tieu chudn cua To chuc Y te The gioi ddi vdi ngudi Chdu A: Nguoi thieu nang lupng trudng dien khi BMl < 18,5 kg/m^, thira cdn khi BMl > 23 kg/m^ vd beo phi khi BMI>25kg/m^[l], [4].
* Thu thgp, ddnh gid TTDD bang cdng cu SGA: Ddnh gid SDD dua vao thay ddi can n$ng, thay ddi khdu phdn dn, cac trieu chung da ddy nipt keo ddi tren 2 tudn, thay ddi chiic ndng van ddng, cdc benh mac phai vd dnh huong cua cdc sang chdn chuyin hda do benh kem theo,. cac ddu hieu SDD lam sdng (mdt lop mo dudi da, phii, c6 trudng). TTDD dupe ddnh gid theo 3 muc:
A: tinh trang dinh duong tdt; B: Nguy co SDD;C:SDDndng[l].
Phdn tich thong ke: Cdc bidn dinh lugng dugc kiem tra phan bd chudn trudfc
56
Tgp chl Tai MQi Hpng Vi$t Nam - Volume (58-15). N°3 - May. 2013
khi phdn tich vd sii dung kiem dinh tham so hoac phi tham so. So sanh cdc ty le bdng kiim dinh Chisquare test. Cac phan tich thdng k6 dugc thuc hien tren phein mdm SPSS 16.0. Y nghia thdng ke dupe xdc dinh vdi gid fri p < 0,05 theo 2 phia.
Dao dire nghien CUTI: Trudc khi tien hanh nghien cuu, cdc cdn bd nghien ciiu lam vi?c chi tiet ve n0i dung, m\ic dich nghien ciiu voi lanh dao cdc Bfnh vipn, cung vdi can bd cua cdc Khoa lam sang, 3. KET QUA
BDng 1 : T9nh trOng dinh dDDng (HDD) theo giDi t6nh
trinh bay vd gidi thich n^i dung, miic dich nghien ciiu vdi ngudi b$nh. Cdc ddi tupng tham gia phdng van mpt cdch tu nguyen, khdng bdt bupc vd cd quyen tir bd khdng tham gia nghien ciiu md khdng can bdt cii ly do ndo. Vdi benh nhan suy dinh duong se dupe tu van dinh duong, tu van sue khoe. Cdc thdng tin ve doi tugng dupe giir bi mat vd chi dupe sir dung vdi muc dich nghien ciiu, dem lai Igi ich cho cdng ddng.
TTDD theo nhon trDc (BMl) Nam giDi (n= 149}
ND giDi {n= 99}
Chung (n=248) CED,n(%)
B8nli«lDtlng,n(%) ThOa™,n(%) B8ophJ,n(%)
46(30,9) 87(58,4) 13(8,7)
3(2,0)
28(28.3) 56(56.6) 9(9,1) 6(6,1)
74(29,8) 143(57,7) 22(8,9)
9(3,6)
HDD Iheo SGA Nam glDi
(n= 165)
NDgiDi (n= 103)
Chung (n=268) Bftih thDDng, n(%)
Nguy cD SDD, n(%) SDD, n(%)
144(87,3) 20(12,1) 1(0,6)
86(83,5) 16(15,5) 1(1.0)
230(85,8) 36(13,4) 2(0,7)
Theo cdch ddnh gid TTDD bdng chi sd nhdn trdc: Ty le benh nhan thiSu nang lucmg trucmg diin (CED) la 29,8%, Ty le thira cSn la 8,9% va ty le beo phi la 3,6%.
Ty le CED (30,9 %) cua nam gicti cao hem cac ty le nay o nu gioi (28,3%) nhihig sir khac bi$t chua co y nghia th6ng ke vi vcri p>0,05. Ty le thira can va beo phi (8,7% va 2,0%) cua nam gioi thip hon cac ty le nay
biet chua co y nghia thong ke ve voi p>0,05.
Theo cdch ddnh gid TTDD bdng SGA:
Co toi 85,8% benh nhan co TTDD binh thuang, CO 13,4 % benh nhan co nguy co suy dinh duong va chi co 0,7%i benh nhan bi suy dinh dudng. Ty le nguy co suy dinh duong (12,1%) cua nam gioi thip hem ty le nay 6 nil gioi (15,5%), sir khac biet chua co
Tgp chi Tai MQi Hpng Vi$t Nam -Volume (58-15). N°3- May, 2013
Bang 2 : Tinh trgng dinh du&ng (TTDD) theo Khoa Idm sdng
CEDlheoBMI
Ung bu'6u Tim mach
Theo ddnh gid TTDD bdng nhdn trdc: Ty le benh nhdn CED rat khdc nhau theo benh:
Ung buou Id 50,0%, Ho hdp (22,6%),Thdn kinh (16,8%), Lao (12,3%), ty le CED d benh nhdn khoa Ngoai Id 15,8%(p<0,05).
Theo ddnh gid TTDD bdng SGA: Ty le nguy CO suy dmh duong vd suy dinh dudng
cao nhdt vdi benh nhan Ung budru (50,0%), Lao (41,2%), Hd hdp (36,7%), Thdn kinh Id 28,0%, ty le CED d benh nhan khoa Ngoai Id 26,0%, sir khdc biet cd y nghta thdng ke ve vdi p<0,05.
Bdng 3: Tinh trgng dinh du'd'ng (TTDD) theo thdi gian nam vi$n TTDD theo
nhan trac (BMl) CED, n(%) Binh thub-ng, n(%)
Thu-a can, n(%) B6o phi, n(%)
TTDD theo SGA Binh thi/i-ng, n(%) Nguy CO SDD, n(%)
SDD, n(%)
M&[ nh^p vi§n (n= 66) 13(19,7) 44(66,7) 7(10,6)
2(3,0) M6\ nh^p vi$n
( n = 7 1 ) 61(86,8) 10(14,1) 0(0,0)
Tir 3-7 ngay (n= 79) 16(20,3) 52(66,8) 9(11,4)
2(2,5) Tir 3-7 ngay
(n= 89) 79(88,8) 8(9.0) 2(2,2)
7 ngay (n=103) 46(43,7) 47(45,6) 6(5,8) 5(4,9) 7 ngay (n=109) 90(83,3) 18(16,7) 0(0,0)
<0,05
>0,05
Theo ddnh gid TTDD bdng nhdn trdc:
Ty le CED cua benh nhdn cd xu hudng tang len theo thdi gian nam vien: moi nhap vien
Id 19,7%, ndm vidn trong vdng 1 tudn la 20,3% vd nam vien > 1 tu4n la 43,7%(p<0,05). Ngugc lai, xu th6 thira cdn,
58
Tgp chl Tai MQi Hong Vi$t Nam - Volume (58-15). N°3 - May, 2013
beo phi cua bdnh nhan lai gidm di theo thai gian ndm vi6n: moi nhap vien Id 10,6% vd 3,0%, ndm vi^n trong vdng 1 tudn la 11,4%
va 2,5% vd nam vien > 1 tudn la 5,8% vd 4,9% (p>0,05).
Theo ddnh gid TTDD bdng SGA: Ty le nguy CO SDD va SDD cd xu hudng tang len theo thdi gian nam vi?n: mdi nhap vien Id 14,1% va 0,0%, nam vien trong vdng 1 tudn Id 9,0% vd 2,2 % vd ndm vien > 1 tudn la 16,7% vd 0,0% (p>0,05).
Bang 4 LiSn quan giira chl s6 Albumin vdi tinh trgng dinh du'd'ng Albumin/mau
DuOi 32 g/l, n(%)
>=32 g/l, n{%)
Du&\ 32 g/l, n(%)
>=32 g/l, n(%)
TTDD theo nhan trSc CED
(n=51) 3(5,9) 48(94,1)
TTDD theo SGA Nguy CO SDD/SDD
(n= 97) 6(6,2) 91(93,8)
(BMl) Kh6ng CED
(n= 68) 6(8,8) 62(91,2) Binh thwirng
(n= 28) 3(10,7) 25(89,3)
P
>0,05
P
>0,05
Vdi ddnh gid TTDD bdng nhdn trdc:
Chi s6 Albumin mau duoi 32 g/l ciia nhom CED la 5,9%, thSp hem ty le nay o nhom binh thuong (8,8%) (p>0,05).
Vdi ddnh gid TTDD bdng SGA: Chi s6 Albumin mau < 32 g/l cua nhom nguy ca SDD va SDD la 6,2%, thjp hon ty le nay 6 nhom binh thuong (10,7%),(p>0,05).
4.BANLU^
Voi each danh gia bang cac chi so nhan trSc (BMl), thuc trang van de vira xuat hien thi6u dinh duong vira thira can-beo phi 6 d6i tui^ng benh nhan. Ty le thieu nang lugng tnrdng diin (BMl < 18,5) chiSm toi 29,8% cao hon so voi ty le 9 % ttong nghien cuu tai cpng ddng [6]. Ty le benh nhan CED r4t khac nhau theo benh, cao nhdt tai khoa Ung buou la 50,0%i, Ho hap la 22,6%, Thin kinh la 16,8%, Lao la 12,3%, ty le CED a benh nhan khoa Ngoai la 15,8%(p<0,05).
Kft qua danh gid bang SGA ttong nghien ciiu nay cho thiy ty le SDD va nguy
CO SDD ciia benh nhan la a mire tnmg binh (14,1%), ty le nay cua nam gioi la 12,7%, thdp hon ty le nay 6 nii gioi (16,5%)(p>0,05). Ty le SDD va nguy co SDD theo SGA la rdt khac nhau theo khoa lam sang, nhimg nhin chung deu cao hon so tuong d6i so vol ty le CED theo danh gia bSng nhan trac(BMI). t y le SDD va nguy co SDD theo SGA cao nhdt o khoa Ung buou (50,0%), Lao (41,2%), Ho hdp (36,7%), Thdn kinh (28,0%), Tim mach (14,7%), Tieu hoa (21,4%), ty le CED a benh nhan khoa Ngoai la 26,0%>. Kk qua nay la tuong ddi cao, cao hon ty le SDD Of Khoa noi tiet (14,3%) va thdp hon ty le nay a Khoa tieu hoa (58,5%>) hong nghien ciiu tai Benh vien BachMai(2006)[l].
Kit qua nghien ciiu nay cho thay voi ca hai each danh gia TTDD blng nhan trdc (BMl) hay danh gia bdng SGA, ty le benh nhan co nguy co vi SDD iiu co xu huong tang len theo thai gian nim vien. Voi each danh gia bSng BMl thi xu huong nay rdt ro ret, sir khac biet co y nghia thdng ke voi
Tgp chl Tai Mui Hpng Vi$t Nam - Volume (58-15) N°3 - May. 2013
p<0,05. Ndi cdch khac, thdi gian ndm vi?n cang Idu thi nguy co suy dinh du6ng cdng cao, ket qud ndy phu hcfp vdi nghien cuu tim hieu mdi lien quan ghJa thoi gian ndm vien, tinh trang suy dinh duong 6 Tay Ban Nha cua Lobo Tamer vd nghien cuu cua Riccardo Caccialanza nam 2009 [5],[ 6].
Bdng phuQjig phdp SGA co the thay mgt ty le ngudi benh cd nguy co SDD khi nhap vien va trong qua trinh dieu tri trong benh vien. Do vdy, cdc phuong phdp ddnh gid tinh trang dinh duong ndy khdng chi nen duoc ap dung giup phdt hien som ngudi benh can quan tdm ve dinh duong ddng thdi xdc dinh du(?c nguy co suy dinh duong trong thoi gian ndm vi?n dd co bien phdp phdng chong som vd kip thdi,gdp phan nang cao hieu qua dieu tri, gidm sd ngdy nam vien, tiet kiem chi phi cho nguoi benh vd xa hoi.
5. KET LUi^N
Ty le benh nhdn thieu dinh dudng trong benh vien Da Khoa Cdm Pha va benh vien Lao Qudng Ninh la o muc trung binh dii ddnh gid bang phuong phdp nhdn trdc (BMl) hay bdng phuong phdp SGA: Ty le ndng lugng trucmg diin (CED) Id 29.8%
(theo nhdn trdc) vd ty li co nguy ca SDD vd SDD Id 14,1% (theo SGA).
Ty le benh nhan cd nguy co ve SDD dhx cd xu hudng tdng len theo thdi gian ndm vien khi ddnh gia TTDD bang nhdn trdc hay ddnh gia bang SGA. Vdi each danh gid bdng BMl thi xu huong ndy rdt ro ret, su khdc biet cd y nghia thdng ke vdi p<0,05.
6. KIEN NGHI
Danh gid tmh trang dinh duong bdng SGA cho benh nhdn nen trd thanh mot boat ddng thuong quy trong benh vien. Tiep tuc cd nhiing nghien curu vdi cd mau Idn hon ve tinh trang suy dinh duong vd cdc yeu td
nguy CO dinh duong cua ngudi benh trong b?nh vi?n.
Lai cdm on: Cdc bdc sy yd diiu duong ciia b$nh vi^n Da Khoa Cdm Phd vd binh vi?n Lao Qudng Ninh da tgo diiu kien cho nghien cuu ndy dugc trien khai thudn Igi vd hi4u qud.
TAI LIpU THAM KHAO 1. Pham Thu Huong, Nguyen Thi Lam,
Nguyen Bich Ngpc, Trdn Chdu Quyen, Nghiem Nguyet Thu, Ph^im Thang (2006). Tinh trang dinh dudng cua benh nhan nhdp vien khoa tieu hda vd ndi tiet tai benh vien Bach Mai. Tap chi dinh dudng va thuc pham, Sd 3+4, 85-91.
2. Briony Thomas, Jacki Bishop (2007).
Manual of Dietetic Practice, 4th ed., Oxford, UK.
3. Jane A,Read et al(2005). Nutritional Assessment in Cancer: Comparing the Mini-Nutritional Assessment (MNA) with the Scored Patient-Generated Subjective Global Assessment (PG- SGA., Nutrition and Cancer, Vol.53, issue 1 September 2005, 51-56.
4. Hd Huy Khdi, Le Thi Hgp (2012).
Phuong phap dich te hpc dinh dudng.
NhdXudtbdnY hpc, 57-61.
5. Lobo Tamer G, Ruiz Ldpez MD, Perez de la Cruz AJ (2010). Hospital malnutrition: relation between the hospital length of stay and the rate of early readmissions. Med Clin (Bare).
Mar21;132(10):377-84.
6. Riccardo Caccialanza, Catherine Klersy, Emanueie Cereda, et al (2010).
Nutritional parameters associated with prolonged hospital stay among ambulatory adult patients. CMAJ November 23, 2010 vol. 182 no 17
60
