VIETHAM MEDICAL JOURNAL N°2 - APRIL - 2018 bien, mdt sd yeu t d cd gia trj tien IUdng d benh
nhan ntidt mau than nao giai doan cap ta; tudi tren 60; diem Glasgow tU 3 den 8; diem NIHSS tren 20; rdi loan hd hap, roi loan nudt; kich thudc 6 nhdi mau tren 20mm d vj tri hanh nao;
kieh thude 6 nhoi mau tren 20mm d cac vj tri ket hdp; tren xung mach TOF cd hep tac ddng maeh than nen.
TAI UEU THAM KHAO
1. Lg Van Binh (2012), "Nghien cuU dac di&n ling sing, hinh inh chup cit Idp vi b'nh vi cong hu'dng tiy cua nhoi miu tian nad', Luan van Thac ST, Dai Hpc Y Ha Npi.
. Le Thi My (2015), "Nghien cuU dSc diem lam sang vi hinh inh mach miu cua nhdi mau r^
thuoc he ddng mach sdng - neri' Luan van Bac 3 Nditrii, baiHocYHa Noi.
. Kiiker W., Weise 3. (2002), 'MRI characteristics of acute and subacute brainstan and thalamic infarctions: value of T2- diffusion-Weighted sequences".
, Etgen T., Von Einsiedel H. G. (2004),' of acute brain Sem inferdion by uang DVW/MRT' , . Tru'dng Tuan Anli(2003): "Ughlen cub dac mT
lim sing vi can lim sing cua tai bien mach i^
vung ho sad. Luan van TTiae Si, Dai Hoc Y HB m . Nquyen Huy Nppc (2011), "Nghien cuUmm dac diem lam sang, can lim sing vi den li^m tienh nhin nhoi mau nao tai Benh vien da m^
ti'nh Phu Thd', Luan an Tien sT Y hpc, Hoc vieri Q|
TY LE MAT NGU vA NHU'NG YEU TO LIEN QUAN 6* PHU NU- QUANH TUdl MAN KINH DEN KHAM TAI BENH VIEN TIT DU
Huynh Minh ThSng', Vo Minh Tuln^
T6MTAT
Mdi lien he giij^ mat ngu va tinh trang kinh nguyet da dupe ghi nFian trong cac nghien ciiu. Muc deu:
Yic dinh ty le mat ngii d nhOYig phu nu' quanh tuoi man kinh va cac yeu to lien quan. PhUdng phap va ddi tuang nghien cdu: NghiSn edu eat ngang thUe hi^n ti? 10/2017-12/2017 d phu nu' tU 45-52 den kham phu khoa djnh ky tai Benh vien Tii* DO. Ket qui: 386 trUcfng hpp dUdc thu nhan vao nghien cdu, ty le mat ngii la 11.IT^. Mat ngu lien quan vdi tuoi tac khi so giita nhom tudi 45-49 va 50-52 (PR = 1.9;
KTC 95% = 1.1 - 3.5), kinh te (PR = 2.99; KTC 95%
= 1,2 - 7.6), eon bdc hoa (PR = 3.65; KTC 95% = 2 - 6.6). NhijUg phu nU quanh tuoi man kinh nen dupe tam soat mat ngii de co hudngJjj' van va dieu tri sdm.
Tdkhda: phy nU quanh tuoi man Idnh, mat ngii SUMIVIARY
PREVALENCE OF INSOMNIA AND RISK FACTORS AMONG WOMEN AROUND
MENOPAUSE AGE COMING FOR E)CAMINATION AT TUDU HOSPITAL The relationship between insomnia and the menopause status lias been documented in a number of studies. Objective: The aim of this study was to determine the incidence of insomnia in women around menopause age and related factors. Methods and study participants: A cross - sectional study was conducted from October 2017 to December 2017 among women around menopause age who came for periodic gynecological examination in Tu Du Hospital.
Results: 386 subjects were recmited, the prevalence
'Dal hgc Y DudC Thanh pho Ho OiiMlnh Chju trach nhiem cJifnh: Huynh Mmh Thang Email: [email protected] Ngay nhan bai: 18.2.2018 Ngay ph^n bien khoa hoe: 30.3.2018 Ngay duyet bai: 11.4.2018
of insomnia was 27.72%. Insomnia related to age when comparing age group 45-49 with age group 50- 52 (PR = 1.9; CI 95% = 1.1 - 3.5), economical status (PR = 2.99; CI 95% = 1.2 - 7.6), hot flush (PR = 3.65; CI 95% = 2 - 6.6). Women around menopause age should be screened for insomnia in order to be counseled and treated early.
Key words: women around menopause age, insomnia
I.OATVXNBE
Mat ngii tang nguy ed tU vong, tang sd dung djch vu y te va tang nguy ccf mac nhiJlig rdi loan t^m than khac dac biet la tram cam. I^di lien lie giij'a mat ngii va tinh trang kinh nguyet cija ngUdi phu nd cd khac biet giij'a cac nghien ciili vi tinh trang nay xay ra con do tac ddng ciia tuoi tac va eac yeu t d tU xa hdi [4].
Tteu chuan vang de chan doan mat ngii la do Ba mien ky. Tuy nhien, phUdng phap nay kho dUde ap dung d nhiitig cd sd khdng ehuyen ve tam than. Hten nay, tteu chuan ehan doan mat ngu ciia DSM-5 cd the dddc sd dung bdi^eae bac sT khdng chuyen ve tam than ntiam chan doan mat ngu cho benh nhan [2],
Ty le mat ngii rat dao ddng tiiy thude vao dSn sd nghiSn cuXi va cdng cu sii dung. Theo mpt s5 nghien cUu, t / le mat ngu d phu nii' quanh tuoi man ktnh dao ddng tif 19.7% den 62.5%
[1],[3],[4J,[6],[_7]. Chinh vi vay, viec sir dung tteu chuan chan doan mat ngii ciia DSI^-5 se giup phan biet ro rang hdn giiJa t / le mat ngii va ty le gtam chat IUdng gtac ngii.
Bdi vi cd nhieu yeu t d tac dong ten chat IUdng giac ngii nhu nen can thiet phai cd sU phan tfch t / le that sU ciia nhD'ng yeu t d nay trong dan so.
76
TAP CHl Y HQC VigT NAM TAP 465 • THANG 4 • SO 2 - 2018 Tat Viet Nam, van chUa cd nhieu nghien eiiu ve
mat ngii, nhift la mat ngii d phu nd quanh tuoi man kinh. Chfnh vi vay, chiing tdi tien hanh nghien cu\j "Ty le mat ngu va nhuYig yeu t d tten quan d phu nif quanh tudi man kinh den kham tai benh vien TU Du" vdi mong mudn tra tdt dUde eau hdi nghien cUu: "Ty le mat ngii d phu nfj"
quanh tudi man kinh den kham tai benh vien TU Du la bao nhieu?" r'luc tidu nghien cuii
l.Muc tieu chinh: Xac dinh ty IS mat ngu gua chin doan sang loc d nhihig phy nit den khim phu khoa dinh ky tai Benh vien Tiy DO trong khoing thdi'glan td 10/2017 den 12/2017.
2. Khio sat nhiihg yeu i^ Hen quan vdi mat ngu d phu niy den kham phu khoa dinh ky tai Benh vien TdDu.
IL DOI TUONG VA PHU'ONG PHAP NGHIEN CUU Thiet ke nghien cihi: Nghien euXi eat ngang.
Din so dich: Whdng phu nff quanh tuoi man kinh den kham djnh ky tai benh vien TU DiJ
Din so chon mau: NhiJYig phu nff tU 45-52 tudi den kham dinh ky tai phdng Icham phu khoa benh vien TU Du tif 10/2017 den 12/2017, edn t i i cung va > 1 buong triing, khdng cd tien can dteu trj not tiet to trong 3 thang trUde dd va dong y tham^ia nghien cifu.
Tieu chuan ioai triy. phu nff mang thai, tinh trang sUc khde va ttnh than khdng cd kha nang tra Idi dUdc bang phdng van
^ z f - ^ ^ P^{\- p)
d^ Cd miu: Ti'nh ed mau theo cdng thffc Udc tinh mdt ty te trong quan the vdt dp chi'nh xac tuyet ddi
Z= 1.96; p = ty le mat ngii tren nhiilig trUdng hdp phu nff quanh tudt man kinh. Theo cae nghien cull nude ngoai [1],[3],[6],[7], t / le mat ngii tff 19.7%-62.5%^ do vay chung tdt ehpn p = 0.50 de CO duUc ed mau tdn nhat -> n = 386.
PhUcftig phap nhan benh va thu thap so lieu Thu thap sd lieu cho den khi dii mau theo thiet ke nghien cUu. Vao ngay iam viec, tat phdng lulj hd sd khu l^am Phu khoa, ehiing tdt se mdi nhiitig phu nff den kham phu khoa dinh ky thoa tieu chuan chpn mau tham gia nghien cUU.
Tac gta la ngu'di trUc tiep phdng van ngUdt tham gta. Cac bu'dc tien hanh:
Bddc 1: Tien hanh phdng van thU bang cau hot (Pilot study)
Bddc 2: Sang Ipc va thu nhan ddi tUdng nghien cffu
Bddc 3: Td van ve nghien cffu va de ngffdi tham gia ky cam ket dong thuan tham gia nghien cifu.
Budc4:Tien hanh phdng van, thu thap sd lieu Bddc 5: Nhap, lam sach va phan tfch sd lieu.
Xdly sdlieu bang phan mem thdng ke Stata 10.0
Dao d^c nghien cihi: Hot ddng £)ao dUc trong nghien cffu Y sinh hoe (IRB) da phe duyet dao dUc ciia nghien effu. So 293/OHYD-l-lB.
Ngay chap thuan: 15/09/2017 III. KET QUA NGHIEN CLTU
Bing 1 00c dle'm din so- xa hdi ciia ddi iddng nghien cdu
O^c diem Tuoi 45-49 50-52 Nqiie nqliiep Conq nhan vien Nonq dan Buon ban Conq niian Tiiat nqliiep, noi trd
Trinii Co tioc van
< C a o l Cap I I Cap I I I Bai hoc Tinli t r a n ^ kinh t e
Du sonq Kho l<han
Tong so ( N = 3 8 6 ) 275 111 75 94 116 25 76 80 151 102 53 354
32 T y l e 71.24 28.76 19.43 24.35 30.05 6.48 19.69 20.73 59.84 86.27 13.73 91.71 8.29 Trong nghien euli eua chung toi, dp tuoi trung binh la 48,1 ±2,27. Ve nghe nghiep, nhom cd cdng viec budn ban tU do chiem t / le cao nhat (30.05%), thap nhiit la cdng nhan (6.48%). Nhdm cd trinh dd hoc van cap 2 chiem ty ie Idn nhat (39.12%), thap nhat la dai hpc (13.73%). Da sdcd tinh trang kinh te dii song (9i.71%).
Bang 2: Die diem nhdng tiiiu chdttg kinh nguyet cua ddi tUdng tham ^ia nghien cdu
0 | c diem Tinh trang kinh nguy
Seu Chu l<y dai > 7 nqay
>2 chu Icy vo Icinh
>12 thang vo Itinh Ctfn boc hoa: Khong
Co Do mo hoi dem
Khonq Co Dau khdp: Khong
Co Khd a m dao; Khonq
Co
Tong so (N=:386)
T y l # (O/o) St
140 38 137 71 233 153 293 93 198 188 217 169 Giam ham muon tinh due
36.27 9.84 35.49 18.39 60.36 39.64 75.91 24.09 51.3 48.7 56.22 49.78
VIETNAM MEDICAL JOURNAL N°2 - APRIL - 2013
Khdng
Tong so Ty Ie
CN=386) I (%)
Nhdm ddi tUdng kinh nguyet deu ehiem ty le cao nhat vdi 36.27%. Ty ie ed trieu chffng edn bde hda la 39.64% va trieu ehffng do md hdi chiem t / le 24.09%. Ty le dot tUdng cd van de dau khdp la 48.7%. Cae trUdng lidp b\ khd am dao ehiem t / ie 49.78%. Va eudi eiing, ty ie cd giam ham mudn tinh due la 58.55%.
Bing 3 Ty IS mii ngu theo tieu chuan chin doin DSM-5
Mat ngu Khonq
Co Tong so
Tong s 6 ( N ) 279 107 3 8 6
T y l e C/o) 72.28 27.72 100
KTC gsvo 67.53 - 43.69 23.31 - 32.47
Bang 4. Phan bdloai mat ngu
Muc danh gta Dac diem mat ngu Khd bat dau qiac ngii ThUe giac giffa dem va
khd nqii iai Thffc day sdm va khong nqii iai dUde
Tdng so Thdi qian mat ngu
3 thanq - 6 thanq 6 thang - 12 thang
>12 thang Tdng sd
Khong thoa n i l i u ve thdi gian va 1 chat lu'tfnq nqili .
62 29 16 1 0 7 74 28 5 107
1 57.94% J 27.1% ; 14.96 \
loo«^
69.16%':
26.17%
4.67%
lOOO/o
Theo tieu ehuan ehan doan DSM-5, cd 107 trUdng hdp dUde ehan doan mat ngu chiem ty ie 27.72% [KTC 95% = 23.31 - 32.47], tUdng dUdng 107/386 trUdng hpp.
Da sd nhiitig phu nff dii tieu chuan chan doan mat ngii theo DSM-5 than phien ve viee kho bat dau giac ngii (57.94%). Phan Idn, nhifng trufln'g' hdp thda tieu chuan chan doan deu da trat qua mift ngii trong khoang thdi gian tff 3-6 thang.
Bang 5. Phan tich da bien giO'a cac dac diem fiac diem
Tuoi: 45-49 50-52 Nghe nghiep: Cong nhan vien
Nonq dan Buon ban Cong nhan That nghiep, noi trd Trinh do hoc van: < Cap 1
Cap 2 Cap 3 Dai hoc Tinh trang kinh te: Du song
Kho l(han Chu ky kinh: Deu
> 7 nqay
> 2 thang vo kinh
> 12 thanq vo km\\
Tien can: Chu'a phau thuat Cat 1 buonq trirnq Cdn boc hoa: Khonq
Co 0 6 mo hoi dem: Khong
Co Oau khdp: Khonq
Cd Kho am dao: Khonq
Co
Giam ham muon tinh duc:Kh6ng Cb
Khong mat ngu (N = 279) 212 (75.99) 67 (24.01) 59 (21.15) 64 (22.94) 90 (32.26) 14 (5.02) 52 (18.63) 55(19.71) 99 (35.48) 82 (29.39) 43 (15.41) 263 (94.27) 16 (5.73) 115 (41.22)
27 (9.68) 90 (32.26) 47 (16.85) 276 (98.92)
3 (1.08) 199 (71.33)
80 (28.67) 230 (82.44) 49(17.56) 151 (54.12) 128 (45.88) 173 (62.01) 106 (37.99) 128 (45.88) 151 (54.12)
va mat ngii.
Mat ngu (N = 107) 63 (58.88) 44 (41.12) 16(14.95) 30 (28.04) 26 (24.30) 11 (10.28) 24 (22.43) 25 (23.36) 52 (48.6) 20 (18.69)
10 (9.35) 91 (85.05) 16 (14.95) 25 (23.36) 11 (10.28) 47(16.85) 24 (22.43) 100 (93.46)
7 (6.54) 34 (31.78) 73 (68.22) 63 (58.88) 44 (41.12) 47 (43.93) 60 (56.07) 44(41.12) 63 (58.88) 32 (29.91) 75 (70.09)
*Muitivanate Logistic regression PR
1 1.92
1 1.18 1.06 3.67 1.12 1 1.72 1.01 1.38 1 2.99
1 1.47 1.65 1.99 1 2.96
1 3.65
1 1.56
1 1.16
1 1.49
1 1.03
KTC 95»/o
1.05 -3.5 0.31-4.5 0.3 -3.76 0.8-16.58 0,29-4.22 0.79-3.73 0.38-2.65 0.27-7.09 1.17-7.64 0.56-3.85 0.84-3.22 0.87-4.59 0,61-14,5 2 . 0 1 - 6.6 0.83- 2.9 0.6 -2.02 0.68 -3.3 0.45-2.4
P« 0.034 0.804 0,925 0.091 0,858 0.168 0.988 0.7 0.023 0.436 0.144 0.103 0,179
<0.01 0.166 0.603 0.316 0.939
TAP CHt Y HOC VIET NAM TAP 465 • THAHG 4 - SO 2 - 2018 Qua phan tfeh hdi quy da bien, chiing tdt
nhan thay cd 3 yeu t d tac ddng ten mat ngii d nhffng phu nff quanh tudi man kinh gdm tudi tac, tinh trang kinh te, trieu chimg cdn bdc hda IV. BAN LUAN
Nghien culi dffdc thUe hten nham phan tfeh ty le mat ngii va yeu t d lien quan d nhffng phu nff quanh tudi man ktnh. Sd lieu nghien eiiu eho thay lien quan ed y nghla thdng ke giffa tinh trang mat ngii va mot sd yeu t d sau: nhdm cd tudi tff 50-52 lam tang nguy ed mat ngii len 1.92 lan so vdi nhdm cd tudi tff 45-49; nhdm cd tinh trang kinh te khd khan iam tang nguy ed mat ngii ten 2.99 lan so vdi nhdm cd tinh trang kinh te du sdng; nhom cd trieu chiing cdn bdc hda lam tang nguy cd mat ngii len 3.65 lan so vdi nhdm khdng cd trieu chiing cdn bdc hda.
Ty le mat ngii thap hdn nghien culi ciia Ciano [1] tat My. Tuy cung sff dung tieu chuan DSM-5 nhUng nghien ciiXi tat My cd han che la phai dUa tren thdng tin da dUdc thu thap tff trUde nen khdng loai dUde nhutig trUdng hdp mat ngii do sff dung thuoc, chat kfch thich.
Xet ve yeu t d tudi tac, mot sd nghien eUu [5],[7] ddng thuan vdi chiing tdi khi ket luan rang ra rang ty le mat ngii cang cao hdn khi tdn tudi nhUng Simin Taavoni [6] lat khdng dong thuan ve dieu nay. Xet ve yeu t d tinh trang kinh te, ehiing tdt tim thay cd mdi lien quan gtu^ mat ngii tinh trang ktnh te khd khan. Ket qua nay dong thuan vdi Slmtn Taavoni [6] va Choi Sin [5]
nhUng lai khdng ddng thuan vdi Zohreh Yazdi [7]. I^hten cifli ciia chiing tdi ket tuan cd mdi lien quan tri&j chuhg cdn bdc hda, va tinh trang mat ngii. Dteu nay dong thuan vdi Zohreh Yazdi [7].
TU 50 tudt trd di da phan ngUdi phu nff se budc vao giai doan quanh man kinh va sU sut giam ndng dd ndi tiet to sinh due trong ed the gay ra nhieu trieu chffng dan tdi tang nguy cd mat ngii. Tuy nhten, Simin Taavoni [6] eho rang khdng ed mdi lien quan ^iffa mat ngu va tudi tac.
SU khac blet nay cd the do sU khac nhau trong viec \da chpn dot tffdng nghien cffu. Simin Taavoni [6] chi chon trong dp tudi tU 50-60.
Trong khi do, sff da dang hdn ve nhdm tudi dUdc thay d nhffng nghien ciiu khac. Ve mdi lien quan giu^ tinh trang kinh te va mat ngii, day la mpt yeu t d phu thude vao danh gia chii quan ciia ddi tUdng tham gia. SU khac nhau giffa nhffng nghien cffu cd the do mffc dp khd khan hay dii sdng cua mot nen ktnh ti la ktiong gidng nhau.
Ket qua trong cac nghien cffu cdn ed mdt sd mat han che. TrUdc het, cdng cu chan doan mat
ngii khdng cd sU thdng nhiit. Them vao do, sd tffdng ciia nhffng bien sd ddc tap eung edn han ehe, khdng eho phep phan tfeh rd rang, can ke each thffc ma nhiitig yeu t d dd dan den tinh trang mat ngii. Cudi cimg, ta khdng the loai trU hoan toan nhutig phUdng phap thu thap sd lieu khac nhau d nhffng mau quan the khac nhau cd the d i n den sat iech trong ket qua.
Nghien ciilj eiia chiing tdi cdn nhffng han che dd la chffa ed nghien cffu tffdng tU dffdc thffc hien tai Viet Nam. Tuy nhien, nghien cffu nay da dat dddc mue tieu dac ra la phan tich ty le mUt ngii d phu nff quanti tudi man kinh den kham dmh ky tai benh vien Tff Du va danh gia mdt sd yeu t d lien quan.
V. K^T LUAN
Ket qua nghien cUu cho thay cd sff Hen he ciia nhutig yeu to nguy cd va mat ngu d phu nd quanh tudi man kinh. Vay nen d nhiitig phu nff quanh tudi man kinh nen dffdc tam soat mat ngii khi hp tiep xuc vdi nhan vien y te, tff dd ed hffdng dieu tri nham giiip nang eao chat iffdng sdng. Ngoai ra, viec tam soat mift ngii cd the dddc thffc hien ddn gian tai cac cd sd y te vdi ngUdi phdng van chi can la nhffng can bd y te da diidc tap huan. Ngoai ra, nghien ciiu nay eung eung cap dff lieu va la mdt ngudn tai lieu tham khao cho nhutig nghien cii'u trong tffdng tai.
Ldi cam tin: Tac gia cam ket khdng xung dot ldi feh tff ket qua nghien ciiu.
TAi LIEU THAIVl KHAO
1. Ciano C , King T. 5., Wright R. R., et al.
(2017), "Longitudinal Study of Insomnia Symptoms Among Women During Perimenopause", Journal of Obstetric, Gynecologic & Neonatal Nursing, 46 (6), pp. 804-813.
z. Khurshid K. A. (2015), "A review of changes in DSM-5 sleep-wake disorders". Psychiatric Times, 32 (9), pp. 16-16.
3. Kravitz H. M., Joffe H. (2011), "Sleep during the perimenopause: a SWAN story", Obstet Gynecol Clin North Am, 38 (3), pp. 567-86.
4. Kuh D., Hardy R., Rodgers B., et al. (2002),
"Lifetime risk fectors for women's psychological disfress in midlife", Soc Sd Med, 55 (11), pp. 1957-73.
d. Shin C, Lee 5., Lee T., et al. (2005), "Prevalence of insomnia and its relationship ta menopausal status in middle-aged Korean women". Psychiatry Clin Neurosd, 59 (4), pp. 395-402.
6. Taavoni S., Ekbatani N. N., Haghani H.
(2015), "Postmenopausal Women's Quality of Sleep and its Related Factors", J Midlife Health, 6 (1), pp. 21-5.
7. Yazdi Z., Sadeghniiat-Haghighi K., Ziaee A., et al. (2013), "Influence of Sleep Disturbances on Quality of Life of Iranian Menopausal Women", Psychiatry Journal, 2013, pp. 5.