JOURNAL OF COMMUNITY MEDICINE
Y H O C
CX>NGE)ONG2015
TINH HINH HUT THUOC LA, THUOC LAO VA MOT SO BIEU HIEN VIEM DUbNG HO HAP CUA NGUbl DAN XA THUY LAM HUYEN DONG ANH, HANOI
Hoang Trung Kien'
TOM T A T
Thudc li li nguy co Idn nhat d6i vdi con ngudi va la nguyfn nhan tir vong hang dau dan dfn tii vong sdm trfn toin the gidi. Nghifn cuu nay nham tira hifu tinh hinh hiit thudc li, thudc lio vi mgt sd bieu hifn viem dudng hd hap cua ngudi ndng dan xa Thyy Lam, huyfn Ddng Anh, Ha Ngi. Kft qui cho thiy, ty If hut thudc li, thudc lao ciia ngudi ndng din khi cao (48,5%), Irong dd ty le nara ndng dan hiit thuoc la 70,6%, 100% nii gidi khdng hiit thudc.
Ty If mic cic trieu tning dudng hd hip nhu ho, dau hgng, nggt mQi, khgc ddm, khd thd d nhdm hiit thudc cao hon gap 3 lan so vdi nhdm khdng hiit thudc. 100% cic trudng hgp ho, dau hgng, khac ddm keo dai la nhiing ngudi hiit Ihudc la, thudc Iao tren 5 nam.
Tir khda: Hiit thudc la, thudc lio (HTL/TL), vifm nhiem dudng hd hap, ndng dan, trifu chimg.
SUMMARY:
Smoking is the biggest risk to humans and the cause of death leading to premature death all over the world. This study aimed to find out the situation of smokers, tobacco and some respiratory manifestations of farmers at Thuy
Lam social, Dong Anh District, Hanoi. Results showed that the percentage smokers, waterpipe tobacco of farmers is high (48.5%), while the proportion of male farmers was 70.6% smokers, 100% women non-smoking. The prevalence of resphatory symptoms such as cough, sore throat, stuffy nose, sputum, shortoess of breath in smoking group higher 3 times than non-smoking group. 100% of cases, cough, sore throat, sputura lasting are smokers, tobacco over 5 years.
Keywords; Smoking cigarettes, waterpipe tobacco, respiratory tract infection, farmers, symptoms.
I. D^T VAN DE
Hiit Ihudc la gay tic hgi ldn dfn sue khde con ngudi.
Theo Td chiic Y If thf gidi (WHO) [ 1 ], [2], Vift Nara hifn cd 15 trieu ngudi tnrdng thanh dang hiit thuoc li, trong sd dd cd dfn 2/3 phy nil vi trf em thudng xuyfn hit phii khdi Ihudc tai nha va trfn 8 trifu ngudi Viet Nam hit phai khdi thudc tai noi lam vifc, 47 trifu ngudi tifp xiic thy dgng vdi khdi thuoc, trung binh ra§i nira ude tinh cd khoing 40.000 ngudi tii vong do cic benh lien quan den thudc li.
Nhu viy, sd ngudi tii vong do thudc li gay ra gap ba lin sd
I. Ban l^yf n giao Th&nh uy Ha N$i, DT: 0904965795, Email: [email protected]
» Ngiy nhgn bai: 14/10/2015 | » Ngay phin bien: 21/10/2015 | » Ngiy duyet dang: 27/10/2015
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f'i, Visf IEN CUfU KHOA HOC
ngudi chft vi tai nan giao thdng vi HTV/AIDS. Day li mgt ganh nang cho nganh Y If cua Viet Nam bdi nhimg hf lyy do bfnh tat gay ra nhu qua tai cho he Ihdng y tf, tang cao sy lay nhifm cheo cic loai bfnh...
Nghifn Cliu nay nham myc tifu tim hifu tinh hinh hut thudc la, Ihudc lio vi mgt sd bifu hifn vifm nhiem dudng hd hip cua ngudi ndng dan tai xa Thuy Lim, huyfn Ddng Anh, Hi Ngi.
IL PHlTONG PHAP NGHIEN ClTU 2.1. Doi tv^rng nghien ciru
Nghifn Cliu dugc tifn hinh tren nhirng ngudi ndng dan tir 18 tuoi trd Ifn tgi cac hg gia dinh Ihudc xa Thyy Lara, huyfn Ddng Anh, Hi Ngi.
2.2. Thdi gian nghien cihi
Nghifn cuu dugc tien hinh tir thing 3/2015 d6n thing 8/2015.
3. Phirong phip nghifn ciru
3.1. Thiet ke nghiin cuu: Nghien ciiu md ta cit ngang.
3.2. C&mdu vd chgn mdu vd phuffng phdp thu thgp thdng tin:
„=7= pii-p:>
Trong dd; n: Co man cin dieu tra; Z ^ ^ : Li he s6 tin ciy = 1,96 vdi do tin cay 95% (nguong xic suit a = 0,05);
p= 0,4: La ty If ngudi ndng din hiit thudc la; d: Sai sd chip nhin dugc = 0,06.
Thay sd vao cdng thiic ta cd: n = (1,96)2 = 255 (nguoi).
Liy n X he sd anh hudng thift kf (Design effect) = 2, dugc mau li 510 ngudi. Trfn Ihyc tf da tien hinh phdng vSn 550 ngudi df bd sung eho nhirng trudng hgp bd Iham gia nghifn Cliu,
Dieu tra vifn tifn hanh phdng van (theo bg ciu hdi thiet ke san) 550 ngudi ndng dan tir 18 tudi trd Ifn Igi cic h$
gia dinh ciia xa Thyy Lam, huyen Ddng Anh, Ha Ngi. Chia 550 ngudi cho 8 Ihdn theo ty le dan sd cua mdi thdn, dirge sd ngudi can difu tra d lung thdn. 6 mdi thdn chgn ngSu nhien gia dinh diu lien df difu tra. Nhung gia dmh tifp theo dugc chgn Iheo ky thuit "cong lifn cdng" vi tifp tue cho den khi dii sd ngudi can dieu tra cua tung thdn.
Sd lieu dieu tra duge raa hda va xir ly bing phin mfm SPSS 22.0.
UI. KET QUA
Hinh 1: Ty If hut thudc chung (%)
Kft qui d Hinh I cho Ihay, trong 550 ngudi difu ha cd hut thudc Ii 44,2% (243 ngudi), chi cd 7,3% li di cai i,5% li dang hut thudc (267 ngudi), ty If ngudi khdng thudc (40 ngudi).
Ar I S6 25-Thang 11/2015 I Websile: yhoccongdong.vi
JOURNAL OF COMMUNITY MEDICINE
Y H O C
CONGDONG2015
Bdng 1: Ty Ip hut Ihudc theo gi&i vd trinh dp vdn hoa (n=550)
^"^"-...^^ Nhom Dac trung""...^^
Gi*i:
Nam Nu Vao h6a:
Muchu TH, THCS THPT
Hut thuoc (n=267) SL
267 0 6 238
32
%
70,6 0 31,5 53,4 37,3
Cai thuoc (n=40) SL 40 0 0 28 12
%
10,5 0 0 6,4 13,9
Khong hut thuoc (n=243) SL
71 172 13 179 42
%
18,8 100 68,5 40,2 48,8 Ket qui Bing 1 cho thiy, ty If nam gidi hut thudc
tuong ddi eao (70,6%) trong khi 100% nii gidi khong hiit
Ihudc. Sd ngudi hut Ihudc cd trinh do van hda lieu hgc va trung hgc co sd chiem ty le cao nhat (53,4%.).
Bdng 2. Cdc trieu chung hul thuoc & nhdm HTL/TL vd nhdm khong HTL/TL (n=510)
Trieu chung dircmg ho hap
Ho Dau hong Ngat mui Chay nuoc miii Khac dam Kh6thcf
Nhdm hiit thuSc (0=267) SL 176 146 126 113 103 56
%
65,9 54,7 47,2 42,3 38,5 20,9
Nhom khfing hiit thuSc (0-243) SL 55 37 32 29 23 21
%
22,6 15,2 13,1 11,9 9,4 8,6
PrR
2,9 3,6 3,6 3,5 4,1 2,4
95% Cl
%
2.31-3,72 2,68 - 4,66 2,53 - 5,24 2,47 - 5,22 3,12-6,25 1,96-3,88
P
<0,001
<0,00l
<0,001
<0,001
<0,001
<0,001 Bing 2 cho thiy, ty If cic trieu chung dudng hd hip d ho (65,9%) chiem ty tf cao nhit, tifp dfn la dau hgng nhdm HTL/TL cao hon so vdi nhdm khdng HTL/TL vdi (54,7%) vi nggt mui (47,2%), hifu chiing khd thd chifm PrR tir 2,4 - 4,1. Trong dd, nhdm HTL/TL cd trifu chung ty le thip nhit (20.9%).
Bdng 3. Trieu chimg du&ng ho hdp & hai nhom hut thudc < 5 ndm vd >5 ndm (n = 267)
"" ^..^^^ Nh6m Trieu chung ' -~~-.__^_^^
duong h6 h^p ~~~—__
Ho Dau hong Ngat mui Chay nuac mui Kh^cdom Kho tho
Hiit thu6c (n=267) SL
16 17 13 14 11 7
%
37,2 39,5 30,2 32,5 25,6 16,3
Cai thuoc (n=40) SL
140 103 88 75 101 54
%
62,5 46,0 39,2 33,5 45,1 24,1
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HIEN CUU KHOA HOC
l±j. '-
Qua bang 3 ta thay, nhdm hiit thudc > 5 nam cd ty If mac cac trifu chiing dudng hd hl^ cao hon nhdm hut thudc < 5 nim. Trong do trieu chung ho, dau hgng, khgc ddm, ngat mui d nhdm hiit thudc > 5 nam cao hon nhdm hiit thudc < 5 nam mgt cich ro ret (p < 0,05).
IV. BAN L U - ^
Ket qua dieu tra cho thiy, Irong sd 550 ngudi ndng din d xl Thyy Lam, huyfn Ddng Anh, Hi Ndi, ty If hut thudc la, thudc lao li tuong ddi cao (chiem 48,5%). Ket qui niy tuong duong nghifn ciiu cua Nguyen Thi Thu va cdng sy (2005) vdi ty If ngudi ndng dan but fliudc li, thudc lio li 46,8% [3], fliip hon nghifn ciiu ciia Bg Y16 (2010) la 56%
[1]. Ty If hut thudc ciia nam ndng dan la 70,6%, 100%i nii gidi khdng hut thudc. Kft qui nay cao hon nghifn cuu ciia Trin Thu Thuy (63%) [4] va Le Nggc Trgng (50,0%) [5].
Cd the ly giii tinh trang hut thudc Ii, thudc lio cua ngudi nam ndng dan xa Thyy Lam cao la do trong thdi gian rinh rdi, mgi ngudi thudng chi Iy tip d nhi ndi chuyen nen df bj ldi cudn hiit thudc. Mat khie, do phong tyc, tap quin vi thdi quen hiit thudc, mdi thudc trong cac dam hifu, hy, hgi he... Ngudi nii khdng hiit thudc li do quan nifm ve hinh inh ciia ngudi phy nir Vift Nam ndi chung va nhat Ii phu nii ndng thdn ndi rifng. Ben canh dd, raiic thu nhgp thap vi ngudi phy nir ndng thdn edn phii ban rdn vdi cic cong vifc gia dinh, ddng ang. Yeu to ve trinh do van hda it anh hudng den Ihdi quen hiit thudc ciia ngudi ndng dan. Trong nghien cuu nay, idiimg ngudi hiit thudc cd trinh do van hoa tieu hgc vi trung hgc co sd chifm ty If cao nhit (53,4%), ket qui niy cimg phu hgp vdi nghien ciru cua Bg Y If, Lf Nggc Trgng vi ragt so tic gia khac.
Qua phdng van bing cau hdi ve mgt s6 trifu chiing viem nhiem duong hd hap, chiing Idi nhgn thay hiu hft cic yifu chiing vf dudng hd hap d ngudi hiit thuoc chifm ty If cao. Trong nghien ciiu nay, cic Irieu chiing viera nhifm dudng hd hip d nhdm hiit thudc deu cao hon nhdm khdng hut thudc (p<0,001). Cic trifu chiing difn hmh thudng gap d nhdm hiit thudc nhu ho (65,9%), dau hgng (54,7%), ngat mui (47,2%), khac ddm (38,5%). Kft qui niy tuong duong nghifn ciiu cua Nguyen Cy Ddng vi cgng sy vdi
cic tdn thuang niem m ^ phe quan d nhirng ngudi hut Ihudc cao ban ro rft so vdi ngudi khdng hiit thudc li, thudc lio [6].
Ty le ho, dau hgng, nggt miii, khac ddm keo dii cQng lang theo sd nam hut thudc. 6 nhiing ngudi hut fliudc tn ho, dau hgng, ngat mui va khac ddm keo dai. 100% ca;
trudng hgp dfu la rdiihig ngiroi hiit fliudc tir 5 nam trd IOL Kft qua niy cimg phu hgp vdi n ^ i f n cuu ciia Bd Y tf, TrSn Thu Thiiy va Lf Ngoc Trgng. Nhu vgy, sy phit iri^n bfnh tat do hiit thudc li, Ihudc Iao ting din flieo Ihdi gian hilt thudc, cang hiit thudc lau nam thi nguy co bi booh cang cao va tinh trang benh ngay cang trd nen trim trgng.
Cd the nhin thiy trong nghien ciiu nay, mac dii chung tdi chua cd difu kifn kham lam sang va lam cic xft nghifm dinh gii chiic nang hd h ^ df cd kft luan diy du vf tic hgi ciia Ihudc la, thudc Iao tdi co quan hd h ^ ndi rifng va sue khde ngudi ndng din ndi chung. Tuy nhifn, qua kft qui phdng vin ve tinh trang mac mdt sd Irieu chiii^ vion nhifm dudng hd h ^ d 550 ngudi ndng dan xa Thuy Lam, huyfn Ddng Anh, Hi Ngi cho thay hiit thudc li, thude lio cd inh hudng xau den siic khde ciia ngudi hiit Ihudc. Ty If ngudi biit thudc cd cac tneu chimg ho, dau hgng, khac ddm khi cao. Day la nhirng dau hifu ciia mdt sd bfnh ve dudng hd hip nhu viera phe quin man, Iao phdi, ung thir phdi... Vi vay, can chu y den viec quin iy siic khde cua cic ddi tugng hiit thudc la, thudc lio liu rmn de phat hien va dieu tri sdm cic benh phd, phe quin cd hfn quan dai hiit thudc li, thuoc lio.
V. KET LUAN
Qua difu tra tinh hinh hut thudc li, thudc lio va mgt so bieu hien vifm nhiem dirong hd h ^ ciia n^idi ndng dan xa Thyy Lira, huyen Ddng Anh, Hi Ngi chiing toi thiy.
Ty If hut ihudc la, thudc lio cua ngudi ndng din kbi cao (48,5%), Irong dd Iy if nam ndng dan hiit thudc la 70,6%, 100%i nii gidi khdng hut thudc. Ty le mac cac trifu thing dudng ho hap nhu ho, dau hgng, nggt mui, khae ddm, kho thd d nhdm hut thudc cao hon gip 3 iin so vdi nhdm Ididng hiit thudc. 100% cic inrdng hgp ho, dau hgng, khac ddm keo dai li nhiing ngudi hut thudc li, thudc Iao tren 5 nam.
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JOURNAL OF COMMUNITY MEDICINE U U N ^ w O l M O ^ U I O
1. Bg Y If, Tong cyc Thdng ke, WHO, Difu tra toin ciu vf hiit thudc la d ngudi trudng thanh tgi Viet Nam (GATS), nam 2010.
2. World Health Organization, Geneva, Who report on Ihe global tobacco epidemic, 2008: the MPOWER package, 2008 (Bio cao cua WHO vf dai dich thudc la toan ciu, 2008: flie MPOWER package, 2008) trang 26-27.
3. Nguyfn Thi Thu va cs. Bio eio kft qua: Nghien ciiu vf kien thiic, thai do, thuc hanh vf thudc li d Viet Nam, Chuong trinh hgp tic y Id Vift Nam - Thuy Difn, Bd Y tf, 2005.
4. Trin Thu Thuy vi cs, Thye hang nghifn hiit thuoc d ndng dan Viet Nam, Bd Y tf - Ban chi dgo phdng chdng tic hai Ihudc la, 1999, tr 26-30.
5. Le Nggc Trgng, Dio Nggc Phong va cs, Danh gii tbyc trang Iinh hinh hut thudc li d Vift Nam nam 1997, Bp Y rf - Ban chi dgo phdng, chdng tic hai thudc li, 1999, tr 1-24.
6. Nguyfn Cy Dong vi cs, Anh hudng ciia hut thudc den nifm mgc phf quin, Bd Y te - Ban chi dgo phdng chdng tic hai thuoc li, 1999, h 47-50.
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