TCNCYHphu trWdng 71 (6) - 2010
NGHIEN CLfu TINH HINH NGO DOC CAP TAI BENH VIEN DA
• • « • •
KHOA KHU VL/C THAP MliCfl NAM 2006 - 2009
Doan Thj H l e n \ Ho Thj Hien^, Nguydn Phffdng Hoa' 'Benh vien da khoa khu vdc Thap Mddi; 'Trddng Dai hoc Y te Cdng cdng, -'Trddng Dai hoc Y Ha Noi Sd lieu thdng ke gin diy tai Viet Nam cho thay sd gia tang ve sd trddng hap ngd ddc cap (NDC) Hen quan den hda chi't ndng nghiep (HCNN) ngay cang ting. Muc tieu: md ta mdt sd dac diem cua bdnh nhin bi NDC tai benh vien da khoa khu vUc Thip Mddi td nam 2006 - 2009. Doi tugng va phuang phap nghien ciiu: tat ca cac trddng hap NDC nhip vien ddac chon de hoi cdu bdnh an, thu thap sd lieu theo phieu ddac thiet ke sin. Ke't qua: ty le NDC cd xu hddng tang dan qua cic nam, td 0,59%, nam 2006, den l,82%o nam 2008. Cic benh nhin bi NDC phan Idn cdn rat tre, tuoi td 16 - 35 (72%o). Ngd ddc do HCNN chiem ty le cao, 74%o, trong dd chu yeu la do Phospho hdu ca (chiem 50%A 75,7%o cic trddng hap bj NDC la do td tif, ty le nay d nd gidi cao han nam gidi (p < 0,01). Paracetamol la loai thudc giy ra NDC d nd cao han d nam gidi (7,9%o so vdi 3,2%o, p = 0,016). Ket luan: can tang cddng truyen thdng ve dd phdng ngd ddc cap, ting cddng quan ly hICNN, dac biet vdi Phospho hdu ca.
TO khoa: ngo doc cap, hoa chat nong nghiep, dff phdng I. D A T V A N D E
Tai nan thifdng tich (TNTT) la mpt trong nhflng nguyen nhan hang dau v l benh tat va tfl vong tai nhieu qudc gia tren the gidi. Tai Viet Nam, sau khi trien khai chfnh sleh qudc gia phdng chdng tai nan thUPng tfch, tinh hinh TNTT tuy cd n h i l u ehuyen b i l n tieh cifc, song cac trfldng hpp TNTT van cdn phd bien, dang ehu y la m i c va tfl vong do ngd dpc cap, dac biet la ngd dpc hoa chat dung trong ndng nghiep ngay cang tang [2]. Cac hda c h i t dung trong ndng nghiep dfldc hap thu d l dang qua da, niem mac, difdng tieu hoa va hd hap, ngo dpc cap cd the do sfl dung khdng dung hda chat trong ndng nghiep, tai nan hoae do tfl tfl.
Hien nay, tren the gidi dac biet la d d e nflde dang phat t r i l n , sd Iflpng d c loai hoa chat dung trong ndng nghiep (HCDTNN) tang hang nam vdi muc dfch de b i o ve Ida va hoa mau. Theo Td chdc Y t l The gidi, hang nam tren the gidi fldc tinh cd 3.000.000 ngfldi n h i l m dpc cap tfnh nghiem trpng va td vong 22000 ngfldi va 772000 ngifdi tdn thifdng man tfnh. Trong dd ed den 45.000 trifdng hdp td vong do ngo dpc cap tfnh d tre em va nhflng ngfldi dfldi 20 tudi tren tcan t h i gidi [7].
Viet Nam la mdt nifdc san xuat ndng nghiep, vi vay ngd dpc cap do d e loai hoa chat dung trong ndng nghiep (HCDTNN) la het sflc phd b i l n . Tinh hinh sd dpng H C D T N N d Viet Nam ngay eang difpc nhan rdng mpt each nhanh chdng. Nam 1957 khi s i n x u i t ndng nghiep cdn d quy md nhd, H C D T N N chfla tdi 100 tan/nam.
Den nay, lifpng H C D T N N hang nam tang nhanh, hien tai mfle trung binh khoang 15.000 ta'n/nam. Dien tfch da't canh t i c cd dung H C D T N N tfl 0,48% (1960), tang len 50% vao nam 1980 va tren 9 0 % nam 1990 [1]. Viec sd dung, H C D T N N d nifdc ta tang nhanh ca sd lifpng va ehung loai. Cac H C D T N N dung de diet sau hai, la mpt yeu to' quan trpng gdp phan lam tang s i n lUdng cay trdng. Ben canh dd, H C D T N N ft hay nhieu d I u gay dpc hai dd'i vdi sflc khde con ngfldi [ 1 , 5 ] .
Thdng ke cua Trung tam y t l dfl phdng tinh Ddng Thap, trong 27 thang tfl q u y . I nam 2007 d i n quy I nam 2009 ed tdng sd trifdng hpp ngd dpc ca'p ehung trpng tinh Ddng Thap la 4772 trifdng hpp va ed 47 trfldng hpp td vong [6]. Theo sd lieu cua Trung tam chdng dpc benh vien Bach
TCNCYH phu trWdng 71 (6) - 2010
Mai sd benh nhan ngd ddc cap d i l u trj'tang theo tflng nam. Nam 1998, ed 11 8 trfldng hpp ngd dpc cap, 2000 ed 740 trifdng hpp ngd dpc cap, 2002 ed 1817 trfldng hpp ngo dpc cap 2003 cd 1669 trifdng hdp ngd dpc cap va 2004 cd 1 846 trfldng hpp ngd doe cap [3]. Chung tdi t i l n hanh d l tai nay vdi muc tieu: Mo ta mgt sd dac diem cua benh nhan bi NDC tai benh vien Da khoa Khu vdc Thap MUdi td nam 2006 - 2009.
II. DOI TUONG vA PHUONG
PHAPNGHIEN CLfu
1. Doi tffdng nghien cffu: tat e l nhflng benh nhan bi ngd dpc cap den nhap vien va dieu tri tai benh vien da khoa khu vfle T h i p Mfldi giai doan 2006 - 2009.
2. Dja diem: nghien cflu dflpc thflc hien tai benh vien da khoa khu vfle Thap Mifdi.
3. Thie't ke nghien cffu: nghien cflu md ta hdi edu eac trfldng hpp benh nhan ngd dpc cap vao vien, tai benh vien da khoa khu vfle T h i p Mfldi.
hidi cflu dfla vao sd "ra vao v i e n " va ta't d d e benh an ngd dpc cap tfl nam 2006 - 2009.
Bang 1. Ty le benh nhan mac ngo
4. Thu thap so' lieu: thu thap so' lieu thfl cap dfla vao: sd "ra vao v i e n " eua benh vien da khoa khu vfle Thap Mfldi, cac trifdng hpp ngd dpc cap giai doan 2006 - 2009. Benh an nhap vien vi ngd dpc cap giai doan 2006 - 2009.
Thdng tin tfl eae benh an ngd dpc dflpc ghi chep lai sfl dung mpt bieu mau thu thap so' lieu da dflpc thie't ke s i n .
5. Phan tich sd lieu: nhap sd lieu bang phan mem Epi Data. Phan tich sd lieu bang phan m l m SPSS 15.0. Thuat t o l n Khi binh phflpng (x") difdc sfl dung nham so s i n h sO khac biet gifla cac nhdm. Nghien cdu sd dung mde y nghia a = 0,05.
in.KETQUA
Trong 27 thang (tfl quy 1/ 2006 - qui 11/ 2009), tdng sd benh nhan npi trd cua benh vien da khoa khu Vifc Thap Mifdi la 51.142 trifdng hpp, trong dd cd 526 trfldng hdp ngd dpc cap. Ty le ehung bi NDC la 1,03%, tfnh trung binh cfl 100 benh nhan nhap vien thi ed mpt trifdng hdp NDC. Nam 2006, ty le NDC la 0,59% va ed xu hfldng tang d i n qua e l c nam, cao nhat la nam 2008 vdi tl le la 1,82% ( b i n g 1).
dgc cap nhap vien theo thdi gian So benh nhan
Tdng sdbenh nhan npi trd Sdbenh nhan bi NDC Ty le (%)
2006 10.320
61 0,59
2007 13.034
81 0,62
2008 13.101
238 1,82
2009 14.687
146 0,99
Tdng 51.142
526 1,03 Trong tdng sd 526 trifdng hdp nhap vien do NDC, nam gidi (59,1 %o) nhieu han nd gidi. Hau het cac benh nhan la ndng dan, chiem 89,9%o. Nhdm tudi 76 - 25 chiem ty le NDC cao nhit, tiep den la nhdm 26 - 35 tudi (bieu do 1).
Bang 2 cho thay 89,9%o cac trddng hap NDC Ta ndng dan. Ty le nay d nhdm hoc sinh va sinh vien la 5,9%o.
Ket qua nghien cdu cho thiy difdng xam nhip vao ca the cila cac trifdng hap NFJC chu yeu la difdng tieu hoa (chiem ty le 94,1 %o), cdn lai la qua da va niem mac (chiem ty le 5,9%o).
Phin Idn cac trifdng hdp NDC la do cd y (td td), chiem ty le la 75,7%o (bang 3). Trong dd, d nam gidi cd 215 trddng hap (chiem ty le 69,1 %o); d nd gidi la 187 trddng hap (chiem ty le 87,0%o). Ty le td td d ndgidi cao hdn so vdi nam gidi (87,9%o so vdi 75,7%o, p < 0,01).
TCNCYHphu trWdng 71 (6) - 2010
140 120 100 80 60 40
20
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1
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DGlai Nam oGib'i NO'
>55 0-15 16-25 26-35 36-45 46-55
Bieu do 1. Phan bd ddi tUgng bi ngo dgc cap theo tudi va gidi Bang 2. Phan loai cac trUdng hgp ngo dgc cap theo nghe nghiep va gidi tinh
Cidi Nghe nghiep
Nam n (%) Nff n (%)
Tong
Tre em
Hpe sinh, sinh vien Can bp
Ndng dan Khac Tdng
Bang 3.
Nhom tuoi
< 1 5 tudi 1 6 - 2 5 tudi 2 6 - 3 5 tudi 36 - 45 tudi 46 - 55 tudi
> 55 tudi
5(1,6) 14 (4,5)
3(1,0) 285 (91,6)
4(1,3) 311 (100,0)
Phin bd giUa nhom tudi vdi tha
C o y (n = 398) r 14(3,5) 192 (48,2) 113 (28,4) 46 (11,6)
29 (7,3) 4(1,0)
4 (1,9) 17 (7,9)
1 (0,5) 188 (87,4)
5(2,3) 215 (100,0) / do cua ddi tugng
Thai do (%,) V o y
9(1,7) 31 (5,9)
4 (0,8) 473 (89,9)
9(1,7) 526(100,0)
(n = 128) n(%o) 18(14,1) 35 (27,3) 30 (23,4) 18(14,1) 15 (11,7)
12 (9,4)
Bang 3 cung cho thiy NDC do cd y d nhdm tudi 16 - 25 la cao nha't, tiep theo la nhdm tudi 26 - 35.
Ket qua nghien cifu chi ra ring d nhdm NDC la tre em (< 15 tudi) va ngddi cd tudi (> 55 tudi) thi ty le bj NDC do vd y chiem ty le cao hdn.
Ket qua d bang 4 cho thay ty le NDC do cac hda chit dung trong ndng nghiep chiem han hai phin ba nguyen nhan. Trong cac chit thudc ve nhdm ndng nghiep (thudc trd sau, diet chuot...) thi NDC do Phospho hCfu ca chiem ty le cao nhit (50%o trong tdng sd cac nguyen nhan gay NDC).
TCNCYJH phu trWdng 71 (d) - 2010
NDC do cac chit phi ndng nghiep chi chiem cd 26%o va d nd cao hdn d nam gidi (37,2%o so vdi 18,3%o, p < 0,001). Dac biet NDC do Paracetamol d nd cao hdn d nam gidi (7,9%o so vdi 3,2%o, p = 0,016).
Bang 4. Phan bd nguyen nhan ngo dgc cap theo gidi Nguyei
Phi ndng nghiep
Ndng nghiep
1 nhan
Thflc an Paracetamol
An than Khac
Phospho hOu ed Thudc diet chudt H o i chat khac
Nam 57 (18,3)
19 (6,1) 10(3,2)
9 (2,9) 19 (6,1) 254 (81,7) 162 (52,1) 1 (0,3) 91 (29,3)
Nff 80(37,2)
9 (4,2) 17(7,9) 9 (4,2) 45 (20,9) 135 (62,8) 101 (47,0)
3(1,4) 31 (14,4)
Tong 137(26,0)
28 (5,3) 27(5,1) 18(3,4) 64(12,2) 389 (74,0) 263 (50,0) 4 (0,8) 122 (23,2)
IV. BAN LUAN
Nghien cflu cua chdng tdi cho thay ty le NDC tang d i n theo thdi gian. Nhdm tudi thudng gap NDC nhat la tO 1 6 - 25 va d nam cao hdn nfl gidi.
Kit q u i eua mpt sd nghien edu eho tha'y, hoa chat dung trong ndng nghiep va thudc tan dflpe la nhflng chat thfldng difpc eac benh nhan dung de to tfl. Y l u td gidi, mdi trfldng sdng, tudi, d c van d l tinh d m , cang thang... la nhflng y l u to lien quan den hanh vi tfl tfl [ 1 , 3]. Ty le NDC do td tfl trong nghien cflu cua chdng tdi c h i l m ty le kha cao (75,7%), va gap n h i l u d nfl gidi hdn nam gidi ( p < 0 , 0 1 ) .
Theo d c ket qua thdng ke, nam 2004, tai thanh phd D l Nang ed 487 ea ghi nhan la tfl td, tang gap 4 lan so vdi nam 2003. Phan Idn tap trung chu y l u d Ida tudi thanh nien d dp tudi tO 1 5 - 24. Sfl phan bd cae trfldng hdp tfl tfl theo dja ban gdm 63,7% sinh sdng tai thanh thj va 36,3%
sinh sdng tai ndng thdn. Tuy vay, neu so sanh tren 100.000 dan thi ty le ngfldi dan ndng thdn tfl tfl tang gap ddi so vdi dan thanh thj (ndng thdn 25 ca/100.000 dan, thanh thj 12 ca/100.000 dan).
Phfldng tien sd dung eho mue dich tfl tfl la thudc trO sau, thudc diet chudt, thude ngd, eac loai dupe
pham [4, 5]. Cung cd k i t q u i tUPng tfl, tai benh vien Chp R i y nam 2002 chi ed 1039 ca ngd dpc cap d i l u tri npi trd nhifng d i n nam 2009 sd ca ngd dpc cap d i l u trj npi trd da tang tren 2 l l n (2.449 ca). D i n g lUu y la mpt trong nhflng nguyen nhan ngd dpc cap cd d i n 6 0 % benh nhan la tfl tfl [4].
v l nguyen nhan gay NDC, ket qua nghien cflu eho thay cd 7 4 % la do d e hda chat dung trong ndng nghiep. D i l u nay dflpc li giai la do e l c hda chat n l y hien nay rat phd bien, d l dang mua dupc, viee quan ly khdng dUpe thflc hien dung theo quy dinh. Thap Mfldi la mpt huyen sdng bang n g h i ndng I I ehinh, cd tdi 8 0 % dan so' sdng bang ndng nghiep. Dien tich dat ndng nghiep ngay cang dflde md rpng, vi vay viec sfl dung H C D T N N ngay mpt n h i l u . Dp dd, va'n d l ngd dpc cap H C D T N N la khdng the tranh khdi.
Cd 24,3% sd d e benh nhan (128 trfldng hpp) NDC trong nghien edu nay la do vd y va gap d tre em va ngfldi gia vdi ty le kha eao. D i l u nay ehi ra rang can cd cae ehfldng trinh can thiep phdng chdng tai nan thfldng tich do NDC d cpng ddng nhfl viee sfl dung va bao quan cac hda chat (dac biet la Phospho hflg cd), thudc tan dflpc va ve sinh an toan thflc pham vdi mue dich g i l m thieu td'i da
TCNCYH phu trWdng 71 (6) - 2010
d e tai nan dang t i l e cd the xay ra. Vdi nhdm dd'i tflpng thanh nien tudi tfl 16 - 35 e i n md rpng eac chifOng trinh hd trp ky nang sdng, tfl van de gdp phan lam giam ty le NDC do tfl tfl.
V. KET LUAN
fy le NDC ed xu hifdng tang qua cae nam.
Nhdm tudi thifdng gap NDC la 1 6 - 2 5 tudi, va d nam gidi cao hdn nfl gidi. NDC ed chu dich (td tfl) ehiem ty le kha cao (75,7%), gap n h i l u d nfl gidi hdn nam gidi (p < 0,01). 74% cae benh nhan bj NDC la do eac hda chat dung trong ndng nghiep.
Can cd cae ehfldng trinh can thiep phdng chdng tai nan thfldng tieh do NDC eae hda chat, thudc tan difpc va ve sinh an toan thife pham tai cpng ddng.
T A I LIEU THAM KHAO
1. Le Vu Anh, Tran HOu Bich (1997). Djch t l hpe chan thifdng d Viet Nam va tren T h i Gidi, c h i l n Iflpc phdng ngfla va kiem solt. Trfldng Dai hpe y te Cdng cpng.
2. Bo Y te - Cue Y te dff phong Viet Nam (2007). Thdng ke tfl vong do tai nan thflpng tich 2005 - 2006, Ha N p i .
3. Nguyin Thj Du, Dang Thj Ngoc Ha (2006).
Nghien eflu tinh hinh ngd ddc cap trong sinh vien va hpe sinh trung hpe ehuyen nghiep va cac trfldng tai Ha Npi, d i l u trj tai trung tam chdng dpc benh vien Bach M a i .
4. Le Cff Linh, Pham Viet Cffdng (2003). Dieu tra lien trifdng v l chan thifpng d Viet Nam. TrUdng
Dai hpe Y t l Cdng Cpng.
5. Le Ngoc Trong (2005). Chifdng trinh phong chdng tai nan thfldng tich, xay dflng cpng ddng an toan d Viet Nam.
6. Trung tam Y te Dff phong tinh Dong Thap (2009). Bao d o thdng ke tai nan thflong tich 2006 - 6 / 2 0 0 9 . Ddng T h i p .
7. World Health Organization (2008). Global Burden of disease. Geneva.
Summary
STUDY ON ACUTE POISONING AT THAP MUOI GENERAL HOSPITAL IN 2006 - 2009
In Vietnam, there were data that showed up increasing number of acute poisoning which related to agriculture chemicals. Objectives: to describe some characteristics of acute poisoning patients at Thap Muoi general hospital in 2005 - 2009. Methods: a retrospective study of all acute poisoning patients in the general hospital. The cheek lists were used for collecting data. Results: the rates of acute poisoning were increasing trend by years, from 0.59% in 2006 to 1.82% in 2008. Most of the patients were still so young, 1 6 - 3 5 years (72%). The rate of poisoning by agriculture chemicals was high, 74%, among them 50% by Phosphor organic. 75.7% of the patients were intentional - self - poisoning. It was higher among women than among men (p < 0.01). Paracetamol was drug that caused for acute poisoning, particularly among women (7.9% vs. 3.2%, p = 0.016). Conclusions: health education about acute poisoning prevention.
Management agriculture chemicals, special Phosphor organic were needed to pay more attention.
Keywords: acute poisoning, agriculture chemicals, prevention