TAP CHi Y HOC VIET NAM TAP 465 - THANG 4 - SO 2 - 2018
HIEU QUA CAN THIEP TU* VAN DINH DU-aNG VA CUNG CAP CHE DO A N CHO NGU'6'1 BENH THAN N H A N TAO CHU KY
TAI BENH VIEN DA KHOA T I N H T H A I BINH
T r a n Khanh Thu', Le Bach M a i ^ Pham Thi Dung^ Pham Thi TTnh^
tdt trong sudt ca cude ddi eon ngu'di. Oac biet, ddi vdi ngu'di benh, dinh du'dng la mot phan khdng the thieu du'dc trong cae bien phap dieu tn tdng hdp va cham sdc toan dien. Khi che do an cho ngu'di benh ithdng dap u'ng dtJ nhu cau eac chat dinh du'dng can thiet va l<hdng phtj hdp vdi tinh trang benh iy thi hau qua lam gia tang ti le suy dinh du'dng d ngu'di benh nam vien.
Giai doan tu" 1995-2013, Bd Y te da ban hanh nhieu van ban ve day manh hoat ddng dinh du'dng benh vien [1],[2],[3]. Tat benh vien da khoa tinh Thai Btnh, khoa Dmh duSng du'dc tai thanh lap ttr' dau nam 2014 nhu'ng chu'a ed eac hoat ddng day dii theo thdng tii 08/2011/TT- BYT ciJa Bo Y te. Hoat ddng cham sdc dinh du'dng chu'a ddng bd, nhat la sii phdi hdp vdi eac khoa dieu tri. Trong khi dd, vdi quy md hdn 1.000 giu'dng benh vdi tong sd ngu'di benh nam vten trung binh tren 50.000 ngu'di/nam, van de can thiep phdng chdng suy dtnh dUdng cho ngu'di benh nam vien la vd cung can thiet. Odi vdi mdt sd benh man tinh nhu" dai thao du'dng, suy than man... dinh du'dng ed anh hu'dng idn tdi qua trinh dteu tr; va dien bten ctJa benh. Oac biet doi vdi ngu'di benh than man tfnh cd lpc mau chu ky thu'dng cd tinh trang dmh du'dng kem, siJt can do chan an, an kieng nen giam lu'dng thu'c an, cdng vdi tinh trang tang di hda nen de dan den hdi chu'ng suy mon protein nang lu'dng (protein energy v/asting-PEW). Khi ngu'di tienh bi hdi chu'ng nay se lam tang nguy cd mac cac bien chu'ng, giam thdi gian sdng cua ngu'di benh.
Chung tdi tien hanh nghien cu'u de tai nay vdi cae mue tieu: Danh gii hieu qua can thiep tu' van dinh du'dng vi cung cap che dp an cho ngu'di benh chay than nhan tao chu k} tai benh vien da khoa tinh Thii Binh.
II. €>dl TLTpWG VA PHLTOTJC PHAP NGHIEN COU 061 tu'dng va dia ban nghien cii'u: Ngu'di benh, ngu'di nha ngu'di benh suy than man ipc mau chu ky nhap vien dieu tri ndi tru tai benh vien da khoa tinh That Binh.
Thdi gian nghien cii'u; TCr thang 7/2015 den thang 6/2016
Thiet ke nghien cii'u: Tien hanh nghien cu'u can thiep lam sang.
TOM TAT
Mac tieu: Oanh gia hieu qua can thiep tU van dinh dUSng va cung cap che do an cho ngu'di benh chay than nhan tao chu ky tat benh vien da khoa tinh That Binh. PhUdng phap: Tien hanh nghien cifu can thiep lam sang. Ket luan: Xay dUng dUcJc quy trinh trong cham soc dmh dU6ng cho ngu'di benh than nhan tao. Ty le ngUdi benh thieu nang IUdng trUcJng dien tru'dc can thiep la 37,1% , sau can thiep tU van dinh duSng la 35%, sau can thiep cung cap khau phan la 30,7%. Ty le ngUdi benh ty le ngu'di benh co mii'c albumin huyet tFianh thap giam co y nghla thdng ke vdi p<0,05 sau can thiep cung cap khau phan. Ty le ngUdi benh co mu'c Prealbumin thap sau can thtep t i / vail dtnh duQng la 81,4%, sau khi can thiep cung cap khau phan la 8,6%. ty le sat huyet thanh thap la 27,1%, sau can thiep tU van dinh dUdng la 21,4%
TO"khda: Ngu'di benh chay than nhan tao chu ky;
TUvan dinh dudng; Che do an SUIVIMARY
EFFECTIVELY INTERVENE NUTRITIONAL COUNSELING AND PROVIDE DIET FOR HEMODIALYSIS PATIENTS AT THAI BINH
GENERAL HOSPITAL
Objectives: Evaluate itie effectiveness of nutritional intervenbon counseling and provide diet for hemodialysis patients at Thai Binh General Hospital.
Methods: Conduct a clinical intervention study.
Conclusion: Building a process in nutritional care for patients with renal disease. The prevalence of chronic energy deficiency was 37,1%, 35% after nutrition Intervention, and 30,7% after intervention. Proportion of patients with low serum albumin level decreased significantly with p <0,05 after diet intervention. The prevalence of low prevalence was 81,4%, after a dietary intervention of 8,6%. Low serum iron was 27,1%, after nutrition counseling was 21,4%.
Key words: Hemodialysis patients; Nutrition consulting; Diet
I. D;CiT V ^ N OE
Che do an va dinh du'dng hdp ly la yeu to quan trong de tang cu'dng va duy tri siTc khde
'Binh vien da khoa tinh Thai Binh
^Viin Dmh duQng Quoc gia
^Tru'dng Dai hgc Y Du'dc Thai Binh ChjU traeh nhiem chfnh: Tran Khanh Thu Email: [email protected] Ngay nhan bai: 14.01.2018 Ngay phan bien khoa hoc: 19.3.2018 Ngay duyet bai: 28.4.2018
VIETNAM MEDICAL JOURNAL N°2 - APRIL - 2018 Cd mau nghien citu: C8 mau toi thieu theo
tinh toan la 127 ddt tu'dng. Tren thiTc te chiing tdi can thiep 140 ddi tu'dng. ^
Phu'dng phap chon mau: Chpn nhdm can thiep la toan bd ngu'di benh chay than nhan tao chii ky nhap vidn dieu trj tai khoa than nhan tpo benh vien da khoa tinh Thai Binh. Day la nhdm dSi tiidng ddc lap vdi nhdm 400 doi tu'dng chpn trong dieu tra ban dau. Bdi vi day la nhdm benh nhan nam vien, cdn nhdm doi tu'dng dieu tra ban dau du'dc lu'a ehpn tu" danh sach benh nhan nhap vien.
*Thlet kecac quy trinh cham sdc dinh du'dng - Xay duYig quy trinh cham sdc dinh duSng cho ngu'di benh
+ Quy trinh sang Ipc, danh gia tinh trang dinh du'dng
+ Quy trinh td van dtnh dddng + Quy trinh bao an va cung cap suat an - Xay du'ng bang md ta cong viee lien qua^
den eham sdc dinh du0ng cho bac sy dteu t i f dieu du'dng vien (bang cdng viec nay du'dc moll long ghep vao cung cac npi dung quy trinh cham sdc dinh dudng
- Xay duhg bang kiem danh gia cong tac diam sdc dinli duSng tae sy dteu trj, d^u du9ng vien.
- Xay ddng mdt so khau phan an mau ctio ngu'di benh
- Thiet ke eac ndi dung tu* van dinh du8ng cho ngu'di benh tai benh vien
Phu'dng phap xit ly so l i | u : So lieu du'dc lam sach va nhap may. Sir dung phan mem SPSS 13.0 de phan tieh.
III. KET QUA NGHIEN CLTU
Bang 3.1. Kit qui ap dung nhdm biin phip in/yen ihong Noi dung hoat dong Thdi diem
tiiu'c hien
- Cac quy trinh du'dc xay duVig va ap dung - Phieu sang Ipc va danh gia diidc ap dung cho 100% ngu'di benh
Ket qua thu'c hien Xay dt/ng cac quy trinh cham soc
dinh du0ng, lap phieu sang loc, danh gia TTDD
Sau dieu tra eat ngang nam
2014 Xay dt/ng tai lieu tu" van dinh dudng. Tap huan cho bae sy, dieu duQng khoa than nhan tao va khoa Dinh dudng ve quy frinh cham sdc dinh duQng, hu'dng dan danh gia TTDD, tu" van dinh duQng.
Sau dieu tra cat ngang nam
2015
Tai lieu truyen thdng du'dc xay dirtig la mot quyen bang anh lu^ ehpn thi/c phair chuyen doi
- To chirc 1 ddt tap huan rieng eho can bo y te
Tu" van dinh duSng cho ngu'di benh, ngu'di nha ngu'di benh
Thi/c hien khi bat dau can thiep truyen thdng
- Thyc hien tu* van ca the 2 ddt khi bat dau can thiep truyen thdng va tihi thi/c hien cung cap xuat an.
- Tu" van dinh duQng theo nhdm dutfc nhac tai 1 thang/lan trong cae budi hpp hdi dong ngu'di benh
To chirc bO^ an thi pham
•Tht/e hien khi bat dau cung
cap suat 5n
- 10 budi che bien biJa an mau eho 10 nhdm ngu'di benh.
Bang tren trinh bay cac ndi dung hoat ddng truyen thdng. Nghien ciru da thdc hien ca phu'dng phap truyen thdng tri/c tiep va gian tiep. Nhdm can bd y te du'dc t d chdc tap huan cac kien thiJt ve eham sdc dinh dudng, dac blet la kien thirc, ky nang tii" van dinti du'dng. Ddi vdi nhdm ngu'di benli va ngu'di nha ngu'di benh, nghien ciTu thi/c hien ca phu'dng phap truyen thdng trdc tiep bang ti/vanca the va truyen thdng gian tiep Idng ghep thdng qua cac buoi hpp hdi dong ngu'di benh.
Bang 3.2. Kei qui di thien iinh trang dinh dUdng ngu'di benh theo dii sd khdi cd thi'BMI Chi so BMI
Tru'dc can thiep ( l ) ( n = 1 4 0 ) '
Sau can thiep T U v a n ( 2 ) ( n = 1 4 0 ) SL o/o
Sau can thiep cung cap KP ( 3 )
( n = 1 4 0 )
SL o/o
Thieu can Binh thu'dng
Thifa can
49 35,0 43 30,7 p(l,2)>0,0|
p(l,3)<0,05l
TAP CHi Y HOC VIET NAM TAP 465 - THANG 4 - SO 2 - 2018
Ket qua bang 3.2 cho thay ty le ngu'di benh ed BMI d miTc dp binh thu'dng tru'dc can thiep la 57,1%, sau thiep tii van khau phan la 62,9%, sau can thiep cung cap khau phan la 6 7 , 1 % . Ty le ngu'di benh thieu can tru'dc can thiep la 3 7 , 1 % , sau can thiep tu' van dinh du'dng la 35%, sau can thiep eung cap khau phan la 30,7%. Ty le thira can tru'dc can thiep la 5,7%, sau can thiep tu' van dinh dudng va cung cap khau phan la 2,2%, tinh trang dinh du'dng ciia ngu'di benh tru'dc can thiep va sau can thiep cung cap khau phan cd su' khae biet eo y nghTa thdng ke vdi p<0,05.
^^ 39.8 ^Q 7
30 20 10
0 ^^
Khona C d Bleu do 3.3. Ty le thieu nang IUdng trUdng dien cua ngddi binh
theo nhdm cd vi khdng an them bda phu
Qua bieu dd 3.4 cho thay nhdm ed an them bu'a phu cd ty le thieu nang lu'dng tru'dng diln la 29,7% thap hdn so vdi nhdm khdng an la 39,8%. St/ khae blet cd y nghla thdng ke vdi p <0,05.
Bing 3.4. Kit qui cii thien tinh trang dinh dUdng trddc sau can thiep danh gia qua cdng cu SGA/MNA
» » * * * « « « * » 4
Tinh trang dinh du'dng Binh thu'dng SDD nhe, trung binh
SDD nanq
Tri/dc can thiep ( l ) ( n = 1 4 0 )
SL 71 60 9
»/o 50,7 42,8 6,4
Sau can thiep Tu' van (2J
( n = 1 4 0 ) SL 71 62 7
»/o 50,7 44,3 5,0
Sau can thiep cung cap KP ( 3 )
( n = 1 4 0 ) SL 95 39 6
67,9
%
27,9 4,3
P
p(l,2)>0,05 p(l,3)<0,05 Ket qua bang 3.4 cho thay ty le ngu'di benh khdng cd nguy cd suy dinh duSng tru'dc va sau can thiep tu" van dinh dudng la 50,7%, sau can thiep cung cap khau phan ty le nay la 67,9%. Ty le ngu'di benh cd nguy cd suy dinh du'dng mdc dp nang giam td 6,4% tru'dc can tliiep xudng cdn 5% sau can thiep va 4,3% sau can thiep cung cap khau phan. Tinh trang dinh du'dng theo thang phan loai SGA tru'dc va sau can thiep tu' van dinh duQng khdng co si/ khac biet vdi p>0,05, khac biet cd y nghTa thdng ke sau can thiep cung cap khau phan vdi p<0,05.
Bang 3.5. Ket qui cai thien iinh trang dinh dUdng trUdc, sau can thiep qua mdi sdchi sdhda sinh
Chi so hoa sinh
Albumin huyet thanh thap Sat huyet thanh thap
Huyet sac to thap PreAlbumin thap
Tru'dc can thiep ( 1 ) Cn=140) SL 19 38 97
o/o 13,5 27,1 71,3
Sau can thiep t u van ( 2 )
( n = 1 4 0 ) SL 21 30 101 114
15,0
%
21,4 72,1 81,4
Sau can thiep cung cap KP ( 3 ) ( n = 1 4 0 )
SL 10 46 97 12
%
7,1 32,9 71,3 8,6
P p(l,2)>0,05 p(l,3)<0,05 p(l,2)>0,05 p(l,3)<0,05 p(l,2)>0,05 p(l,3)>0,05 p(l,3)<0,05 Ket qua bang 3.5 cho thay ty le ngu'di benh cd mu'c albumin huyet thanh thap la 13,5% tang len 15% sau can thiep tu' van dinh du'dng, giam cd y nghTa thdng ke vdi p<0,05 sau can thiep cung cap khau phan. Ty le ngu'di benh bj thieu mau dmh dudng la 71,3%, sau can thiep tu' van dinh du'dng la 72,1%, sau can thiep cung cap khau phan ty le nay la 71,3%, vdi, ty le sat huyet thanh thap la 27,1%, sau can thiep td van dinh du'dng la 21,4%, sau can thiep eung cap khau phan la 32,9%. Ty le ngu'di benh cd vndc Prealbumin thap sau can thiep tu' van dinh dudng la 81,4%, sau khi can thiep eung cap khau phan la 8,6%, st/ khac biet cd y nghTa thdng ke vdt p<0,05.
121
VIETNAM MEDICAL JOURNAL N°2 - APRIL - 2018 Bang 3.6. Tylen
Noi dung
Co thu'c hien boi du'Qnq them
Them siJa Them dam uong,
tiem truven Bo sung da vi chat
Khac TrUdc can thiep ch
qitdi benh co thwc hien bdi du'dnq bo sung Tru'dc can thiep
( 1 ) ( n = 1 4 0 ) SL 37 29 11 12 18 CO 26,4°/
o/o 26,4 20,7 7,9 8,6 12,6
Sau can thiep TU van ( 2 )
( n = 1 4 0 ) SL 79 64 42 71 46
o/o 56,4 45,7 30,0 50,7 32,9
Sau can thiep cung cap KP ( 3 )
( n = 1 4 0 ) SL 140 140 47 80 44
100,0
%
100,0 33,6 57,1 31,4
P
P(l,2)<0,05 P(l,2)<0,05 P(l,3)<0,05 p(l,2)<0,05"
P(l,3)<0,05 p(l,2)<0,0S p(l,3)<0,05 p(l,2)<0,05 P(l,3)<0,05 so ngu'di benh cd thu'c hien boi du8ng an them, trong dd 20,7% bi sung them su^, 7,9% them eac acid amin du'dng udng hoac tiem truyen, 8,6% bd sung da vi cliat, Sau can thiep tu' van, ty le cd thi/e hien bdi du'dng them la 56,4%, trong dd them su^ la 45,7%, them acid amin la 30,0%, i5ac biet la bd sung them da vi chat ehlem 50,7%. Sir khac biet ed y nghia thdng ke vdi p<0,05. Sau tu' van khau phan, 100% ngu'di benh du'ide eung cap them su^ va ty ie bo sung da vi chat tang len du'dc 57,1%.
Bang 3.7. Kei qui cii thien gii in vi iinh dn ddi dc chii sinh nang IUdng irong kliw , 7han ciia ngUdi binh
Chat sinh nang lu'dng
T r U d c r a n thtep C 1 ) ( . V ± S D )
Sau can thiep tu*
v a t i D D ( 2 K - y ± S D )
Sau can thiep cung-cap KP'(3)
( X ± S D )
Nang lu'dng (Kcal) p(l,2)>0,05
p(l,3)<0,05
Protein (g) 56,3±9,4 p(l,2)>0,05
p(l,3)<Q,05 Lipid Cg) 20,9±14,1 21,1 ±14,1 26,6±3,9 p(l,2)>0,05 p(l,3)<0,05 TyleP:L;G 12,1:13,4:74.4 12,8:13,8:73,4 14,7:15,1:70,2
Ket qua bang 3.7 eho thay nang lu'dng khau phan ngu'di benh la 1398Keal, Protein la 42,3g, Lipid la 20,9g. Sau can thiep tu' van dinh du'dng cac chi sd protein, lipid tang, su" khae blet khdng co f nghTa thdng ke.
Bang 3.8. Kei qua cai thien mdc dap dng nhu du khuyin nghf ve nang IUdng Mu'c dat ve
nang lu'dng
Tru'dc can thiep (1) ( n = 1 4 0 )
Sau can thiep T u ' v a n ( 2 )
( n = 1 4 0 )
Sau can thiep cung cap KP (3}
( n = 1 4 0 ) SL
50-75% 16
61
> 75% 31 43,6 62 44,3 33
11,4
22,1 91
23,5 64,9
P(1,2)>0,OS p(l,3)<0,05 Ket qua bang 3.8 cho thay, tru'dc can thiep ty
le ngu'di benh chi dat du'di 50% nhu cau khuyen nghi ve nang lu'dng ia 34,3%, sau can thiep khau phan ty le nay giam cdn 11,4%, ty ie ngu'di benh dat tren 75% nhu cau nang lu'dng tru'dc can thiep la 20% va tang den 64,9% sau can thiep.
Su" khac blet cd y nghTa thdng ke vdi p<0,05.
IV. BAN LUAN
^ Nghien ciru da xay di/ng du'dc sd dd cham sdc dinh dudng chung vdi cac quy trinh ky thuat eho timg bu'dc va sd dd can thiep dinh du'dng.
Ndi dung sd dd can thiep dinh du'dng gom ^ bu'dc nhi/ng trong nghien ciTu eua ehung toi khdng ed ngu'di benh nang cd chi dinh nuoi 3n qua dng thong va nudi an qua du'dng ttnh mach.
Cae hoat ddng truyen thdng va ket qua^tioat dpng truyen thdng cho ngu'di benh than nhan tao chu ky du'dc md ta ehi tiet trong bang 3.1 vdi cac no!
dung tac dpng den ca nhdm bac sy, dieu duQng khoa than nhan tao va ddi ngu khoa Dinh dudng.
Ddi vdi nhdm benh nhan, nghien cii'u cua ehiing tdi tien hanh can thiep tren 140 do! tu'dng suy than man toe mau chu ky, khi danh gla tinh
122
TAP CHl Y HOC VIET NAM TAP 465 - THANG 4 - SO 2 • 2018 trang dinh du'dng theo BMI ed 3 7 , 1 % ngu'di
binh thieu nang lu'dng tru'dng dien {BMI< 18,5) (tiang 3.2). Trong dd, nhdm ngu'di benh cd thi/c hien cac biJa an ptiu ed tinh trang suy dinh diidng thap hdn cd y nghta thdng ke so vdi nhom khdng an them hda phu (p<0,05) (Bieu do 3.1). Day la mot ty le tu'dng ddi cao so vdi quan the binh thu'dng Ichong bi benh d Viet Nam do hau qua eiia giam khdi cd va khdi md cd the". Ty le suy dinh du'dng cd the len tdi gan 100% d ngu'di benh benh phoi tac nghen man tinh nhu' trong nghien ciTu cua Le Thj Diem Tuyet d benh vien Bach Mai. Suy dinh dirdng gap kha cao d ngu'di benh ung ttiu', ngu'di benh mac cac benh ly ngoai khoa nhu'ng gap thap hdn d ngu'di benh dieu tn ndi khoa [ 5 ] .
Phu'dng phap danh gia tinh trang dinh dudng theo cdng cu SGA/MNA du'dc hdi than hge khuyen cao sir dtjng de danh gia ngt/di benh trong sudt qua trinh mae benh [7]. Ket qua nghien CLTU cita chiing tdi sir dung phu'dng phap danh gia nay eho thay ty ie ngu'di benh suy dinh dudng la 49,3% (bang^3.3J.
Thieu mau, thieu sat la dau hieu thu'dng gap d ngu'di tjenh suy than. Trong nghien eiru eiia chiing tdi, nong dp sat huyet thanh du'di mifc binh thu'dng cua ngu'idi benh la 2 7 , 1 % va ty le ngu'di benh cd huyet sac to thap la 71,3% (bang 3.4).
Creatinin bai tiet trong nu'dc tieu phan anh khdi ed. Chi sd nay thap d nhu'ng ngu'di benh bi mat dich. Ngu'di ta cd the diing chi so creatinin so vdi chieu cao de danh gia tinh trang mat djch va the hien khdi cd bi mat. Cac xet nghiem khac:
cac xet nghiem nhu' dien giai do, ure, hemoglobin, sat, kem huyet thanh, protetin C- Reaetlve de danh gia gian tiep cae dau hieu lien quan tdi tinh trang dinh du'dng, kha nang tieu hda, hap thu, chuyen hda va tinh trang viem cap tinh, man tinh. Chi sd ure la mdt thdng sd hu'u ich the hien qua trinh di hda protein. Khi ngu'di benh bi ddi, tdc dp quay vdng cua protein thap va du'dc dae tru'ng bang ndng dp ure huyet thap neu ngu'di benh du'dc bii nu'dc tdt.
Nghien ciTu ciia chiing tdi eho thay thang danh gia tinh trang dinh dudng theo cdng ctJ SGA/MNA cd ty le suy dinh duSng cao nhat, tiep den la danh gia theo chi sd BMI. Mac diJ ty le suy dinh dudng theo cac thang phan ioai khac nhau deu kha cao, nhu'ng so vdi mdt sd nghien ciru khac, ty le nay trong nghien CUIJ ciia chung tdi lai thap hdn.
Chinh vi vay, de xay dt/ng hoat ddng dinh dudng dieu trj trong benh vien, chung tdi chpn trpng diem nhdm ngu'di benh than nhan tao de
xay dt/ng quy trinh cham sdc va can thtep dinh du'dng. Dd la quy trinh sang loc, danh gia tinh trang dinh dudng, quy trinh tu" van dinh du'dng, quy trinh dieu tri dmh du'dng va quy trinh eung cap djch vu tht/c pham. Cac quy trinh nay sau khi dieu chinh ed the ap dung du'dc cho eae nhdm ngu'di benh khac nhau tai cac khoa dteu tri trong benh vien.
Tru'dc can thtep chi cd 26,4% sd ngu'di benh cd thu'c hien bdi du'dng an them, trong dd 20,7%
bd sung them sffa, 7,9% them cac acid amin du'dng udng hoac tiem truyen, 8,6% bd sung da vi chat, Sau can thiep tu" van, ty le cd thi/e hien bdi du'dng them la 56,4%, trong dd them sda la 45,7%, them acid amm la 30,0%, dac biet la bo sung them da vi ehat chiem 50,7%. Si/ kliae biet ed y nghTa thdng ke vdi p<0,05. Sau tu' van khau phan, 100% ngu'di benh dffdc cung cap them su'a va ty le bd sung da vi chat tang len dffdc 5 7 , 1 % (bang 3^5).
Nhff vay, bang sff tff van dinh dffdng etj the vdi trt/e quan sinh ddng la bd tat lieu truyen thdng hffdng dan each Iffa chon thffc pham, cung vdi hoat ddng hffdng dan eti the each nau che do an benh ly cho ngffdi benh, chiing tdi da ho trd cai ttiien dang ke tinh trang dinh dffdng cho ngffdi benh suy than man cd lpc mau chu ky.
Ddng thdi, giiip ngffdi benh nang cao dffi3c kien thffe de duy tri dffdc khau phan can ddi hdp ly trong sudt qua trinh dieu tri benh, giup cai tiiien chat Iffdng eudc sdng ciia ngffdi benh.
V. KET LUAN
• Xay dt/ng dffdc quy trinh trong cham sdc dinh dffdng cho ngffdi benh than nhan tao. Thiet ke dffdc tai lieu truyen thdng va thffc hten viee cung cap kien thffc dinh dffdng hdp ly, each It/a ehpn, thay the thffc pham cho ngffdi benh thdng qua tai lieu phat tay. To chffe hffdng dan CIJ the each che bien che dp an benh iy de ngffdi benh va ngffdi nha ngffdi benh tff thffe hien tai gia dinh.
- Ty ie ngffdi benh thieu nang Iffdng trffdng dien trffdc can thiep la 3 7 , 1 % , sau can thiep tff van dinh dffdng la 35%, sau can thiep cung cap khau phan la 30,7%.
Ty le ngffdi bienh ty ie ngffdi tienh cd mu'c albumin huyet thanh thap la 13,5% tang ten 15%
sau can thiep tff van dmh dudng, giam ed y nghTa thdng ke vdi p<0,05 sau can thiep eung cap khau phan. Ty le ngffdi benh bi thieu mau dmh dudng la 71,3%, sau can thiep tff van dinh dudng la 72,1%, sau can thiep cung cap khau phan ty le nay la 71,3%, vdi, ty le sat huyet thanh thap la 27,1%, sau can thiep tff van dinh dudng la
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VIETNAM MEDICAL JOURNAL N°2 - APRIL - 2018 21,4%, sau can thiep eung cap khau phan la
32,9%. Ty le ngffdi benh cd mffc Prealbumin thap sau can thiep tff van dinh dffdng la 81,4%, sau khi can thiep cung cap khau phan la 8,6%, sff khac biet cd y nghTa thdng ke vdi p<0,05.
KIEN NGH!
- To ehffc cac Idp tap huan ve cham sdc dinh dffdng cho cac bae sy, dieu dffdng benh vi|n theo cac ehuyen khoa, chit trong cung cap kien thu'c lien quan den tff van, chan doan, dieu tri dinh dudng, tao mdt mdi trffdng tich ct/e trong viec nhin nhan, danh gia vai trd cita dinh dffdng ddi vdi ngffdi benh.
- Can xay dffng va ap dung quy trinh cham sdc dinh dffdng theo tu'ng nhdm benh cu the.
- Xay dffng cac tai lieu truyen thdng dinh dudng cho cac nhdm benh de lam cd sd cho cae can bp y te thffc hien eac ndi dung lien quan den eham sde dinh dffdng ngffdi benh. De nhan rdng md hinh tff van va thffc hanh dinh dffdng cho ea the, can xay dffng cac video hffdng dan thffc hanh
cac che dp an benh ly de lam tai lieu cung cap c{io ngffdi benh, ngffdi nha ngffdi benh thffc hien.
TAI UEU T H A M KHAO
1. E^Yte'(2011).Th6ngtUso08/2011/rr-BYThijem dan conq tsc dmh du8nq, tet che trong benh vien, 2. Bo Y t e ^ Z O l l ) . Thong tU so 07/20il/rr - Bn
hffdng dan cong tac dteu dUSng ve ch3m soc ngudi benh trong benh vien,
3. Bo Y te (2013). Chu'dng trinh^dao tao Cham soc ngVdi benh toan dien
4. Lu'dng Ngoc Khue (2016). Tht/c trang hoat dpng dtnh duSng lam sang, Bao cao Hoi nghi klioa hoc Dtnh dySng iam sang cac tinh phia Bac nam 2016.,' 3. Nguyen Thj Lam (2016). Vai tro cita dinh dii3rK|
dieu tri va cac giai phap cai thien eong tac diSm soc dtiih dudng trong benh vien. Tap chi Dmh DU3ng & Tht/c Pham, 12 (3), 1-4.'
b. Doan Thj Tu'dng Vi, Cao Thj Thu, Du'dng Mai Phu'dng va cong s^i (2016). Hieu qua cita ho ttii dinh dudng trong benh dat thao dUdng tat h^\\
vien 19.8 Bo cdng cart. Tap chi Dinh DuQng & Ttwt Phim, 12 (3), 4-10.
7. P. M. Vegine, A. C. Fernandes, M. R. Torres, et al (2011). Assessment of methods to identify protein-energy wasting in patients on hemodialysis, JBrasNefrol, 33 (1), 55-51.
NGHIEN Ciru MOT SO TAC DONG CO hOl CUA CHE PHAM TRA T H A O MOC TU* LA CHE VA QUA CO
Nguyen Tran Hoang Anh*, Kieu Thanh Hang*
TOIVI TAT
Muc dinh: Xem xet mot so tae dpng c6 ldi den sffc khoe nhu giam beo phi, chong oxy hoa va kha n3ng tieu diet te bao ung thU ciia che pham tra thao mpc tff la, che va qua co. PhUdng phap. So sanh quang pho cua cae dung dich vdt DPPH de danh gia kha n3ng ehong oxy hoa cua CT3. Danh gia kha nang giam beo tren chuot nuoi. Tien hanh phan tich tai phong thi nghiem Khoa Sinh hpc dai hoc SU pham Ha Not. Xac djnh kha tiang khang khuan cita tra thao mgc tren 2 loai vi khuan la Escherichia coli va Salmonella typhimurium. Xac dinh kha nang khang nam M.
cirdnelloides vdt chiing gay benh R7B. Ket qua: La ehe gta co cac vong ffe che la 19,2mm (S.
typhimurium) va 21,3mm ( £ coli), Idn nhat trong cac loaMa, tUcJng dUtJng che pham CT3. La che gta va che pham CT3 co kha nang ffe che sinh tru'dng cita bao tff nam M. araneiloides. Kei luan: Djch chiet ciia tra thao mpc co kha nang khang Escherichia coli va Salmoneiia typhimurium, ffe che manh toe dp stnh trUdng bao tU nam M. cirdnelloides qa^ benh.
^Tru'dng THPT Chuyen Hiing Vu'dng Phu Thg Chiu trach nhiem ehinh: Nguyen Tran Hoang Anh Email: [email protected] Ngay nhan bai: 23.2.2018 Ngay phan bien khoa hpc: 30.3.2018 Ngay duyet bat: 12.4.2018
Tdkhda: khang khuan, khang nam, tra thao moc, la che, qua co
SUMIVIARY
STUDY OF SOME HEALTH BENEFIT OF HERB TEA FROM CAMELLIA SINENSIS AND
LIVISTONA SARIBUS Objective. To evaluate the antibacterial, antifungal properties of herb tea preparations from Camellia sinensis leaves and Livistona saribus fruit.
Companson of antibacterial and fungicidal pnaperties of CT3 formula with old tea leaves and young tea leaves. Method. We had proceeded analytical atthe Biology department of Ha Noi national university of education. Determine the antibacterial of the herbal teas on Escherichia coii and Salmonella typhimun'uffi.
Determine the antifungal on pathogen R78 of M.
ciranelloides Results: The zone of inhibition of old tea leaves were 19.2 mm (S. typhimurium) and 21.3 mm ( £ coli), which was the largest equal CT3. Tlie old tea leaves and CT3 formula could inhibited the growth of M. circinelioides spores. Conclusion: Ttie extracts of herbal teas could resistant to Eschenchia coll and Salmonella typhimurium, which could strongly inhibit the growth of M. circinelioides scores.
Key words: Antibacterial, antifungal, herb tea, camellia sinensis, livistona saribus
