Y HOC VIET NAM THANG 12 - SO 2/2010
NGHIEN Cl)U c a CAU BENH TAI KHOA DA LIEU BENH VIEN 103 (2000-2009)
Pham Hoang Kham*
TOM TAT
Nghien ciru 5695 benh nhan npi tru tai khoa Da ligu, benh vien 103 tir 2000-2009. Ke't qua cho thay:
1. Su phan bd theo nhom benh:
- Nhom cac benh di irng do thudc chiem ty le cao nha't 14.87%. Tiep do la nhom benh da do Virus chiem 13,78%. Nhom benh Eczema: 12,91%. Nhom benh co san vay, do vay: 8,73%. Nhom cac benh nam: 7,66.
Benh tuyen ba: 6,95%. Nhom benh da do Vi khuan:
5,44%. Nhom benh long, toe, mong: 4,57%. Nhom benh lay truyen qua dudng tinh duo: 4,11%. Nhom bgnh da do KST,Con triing: 4,02%. Nhom cac benh he thdng (benh tu mien): 3,56%. Nhom benh niem mac mieng: 1,74%. Cac u da lanh tinh, tien ung thu da, ung thu da: 1,15%. Nhom benh rdi loan sac td da: 0,97%.
Cac benh Da khac: 9,54%.
2. Iv- le 10 benh Da li§u thudng gap la: Di irng thudc: 14,87%; Eczema: 12,91%; Nam da: 7,66%; Vay nen: 6,57%; Trirng ca: 5,65%; Zona than kinh:5,37%;
Viem da mu: 3,83%; Ghe: 3,56%; Hat cam: 2,32%;
Ban may day: 2,14%.
3. Co nhu'ng thay ddi dang ke ciia su phan bd benh nay theo su phat trien chung cua toan xa hoi.
* Tit khda: Benh da li§u, Cd cau benh.
SUMMARY
Distribution of disease in Dermatovenereology department of 103 hospital (from 2000 to 2009)
Studying 5695 inpatients of Dermatovenereology department of 103 hospital (from 2000 to 2009).
Results showed that:
1. The most common is the allergy diseases group: 14.87%. Next is the skin diseases are caused
by viruses: 13,78%. Group of eczema : 12.91%, Group of psoriasis and papules: 8.73%. Group of fungal infection diseases: 7.66%. Sebaceous hyperplasia disease: 6.95%. Skin infections disease : 5.44%, Groups hair, nail diseases: 4.57%, Group of diseases transmitted sexually: 4,11%, Group of the skin disease caused by parasites and insects: 4,02%, Group of Oral mucosa disease: 1,74%, Skin tumors, cancer: 1,15%, Pigmentation disorder: 0,97%, Other Skin Diseases: 9.54%,
2, Ratio of 10 kinds of Dermatological common diseases at dermatology department, 103 hospital as follows: Toxidermie: 14,87%; Eczema: 12,91%;
Demiatophytes: 7,66%; Psoriasis: 6,57 %; Acne: 5,65%;
Herpes zoster: 5,37%; Impetigo: 3.83%; Scabies: 3.56%;
Common warts: 2,32%; Urticaria: 2,14 %,
3, There are significant changes of this distribution disease under the general development of society
* Key word : Skin diseases. Distribution of
disease. - . . . , . : ,
I. OATVXNOE
Benh Da lilu kha phd bien tren the gidi.
Benh gap nhieu d cac nude dang phat triln, dac biet la cac nude nhiet ddi. Tuy chi cd it loai benh gay tit vong nhu: Luput dd, Xa Cling bi, Hdi chirng Lyell, Pemphigus, nhung sir tien triln ciia nhilu benh Da lilu thudng dai ddng va hay tai phat. Nhilu benh Da lilu da thuc sir anh hudng tdi sire lao dpng ciia xa hdi va lam giam chat luong sd'ng ciia ngudi benh. Nhirng nam gan day, su phat trien manh ciia cac nghanh cdng nghiep va dieu kien sd'ng ciia con ngudi dupc cai thien dang
* Binh viC-n 103 - I IQC vifn Qudny
ke. Siic khde con ngudi td't len va md hinh benh tat cung thay ddi nhilu. De gdp phan hilu rd them ve tinh hinh benh Da lilu ndi chung va dac dilm benh Da lilu trong quan dpi noi rieng, chiing tdi tien hanh nghien ciiu dl tai nhdm muc tieu:
Xdc dinh ca cdu cdc benh Da lieu tgi khoa Da lieu benh vien 103 tit ndm 2000 de'n 2009.
II. o6l TUONG VA PHUONG PHAP NGHIEN COU
2.1. Ddi tuang nghien ciiru \ Benh an ciia 5695 benh nhan bi benh D^
lilu, dilu tri npi trii tai khoa Da lilu tai Vifnj
103 tir 2000 den 2009. i
' I
2.2. Phuang phap nghien curu j Hdi ciru, md ta, phan tich. | Sd lieu xir ly theo phuang phap thdng kd
Yhoc. J
III. KET QUA VA BAN LUAN
Bang 1. Sd benh nhan theo cac che dp dieu tri n = 5695 Nam
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Tdng Ty le %
Quan 262 238 301 312 402 423 468 496 532 620 4054 71,19
Bhyt 27 38 66 84 82 70 80 88 105 182 822 14,43
Dan 25 36 52 63 97 80 60 68 43 48 572 10,04
c/s 23 15 27 33 28 24 23 31 30 13 247 4,34
Tong 337 327 446 492 609 597 631 683 710 863 5695 100 Benh nhan Da lilu dilu tri ndi tni tai khoa Da lilu vien 103 tir nam 2000 -2009 chii yeu la chfi'j dp Quan: 71,19%. BHYT: 14,43%, Dan: 10,04% va ddi tuong chinh sach: 4,34%. Ty le benh ngoai!
da rat cao d bd dpi chirng td viec luyen tap sdn sang chien dau va cac hinh thai cdng tac, sinh boat:
ciia bd dpi la mdt hinh thai dac biet nen ty le benh Da lieu cdn cao: 71,19%. ;|
Tliem vao dd sd lupng benh nhan Da lieu dilu tri npi tru tai khoa Da lilu vien 103 ciing tang lenS lien tuc tir nam 2000 — 2009. Viec giam ty le benh Da lilu la mdt thach thiic khdng chi dd'i vdii
nghanh quan Y ndi rieng, ma cdn ddi vdi tat ca cac nganh trong quan dpi ndi chung. j
Bang 2. Ca cau benh theo nhdm benh d khoa Da l i l u benh vien STT
1 2 3 4 5
Ten benh Nhom cac benh dj iing thudc Nhom benh da do Virus Nhom benh Eczema,
Nhom benh co san vay, do vay.
Nhom cac benh nam.
103.n = 5695 SdBN
847 785 735 497 436
Ty le % 14,87 13,78 12,91 8,73 7,66
Y HOC VIET NAM THANG 12 - SO 2/2010 6
7 8 9 10 11 12 13 14 15
Benh tuyen ba
Nhom benh da do Vi khuan Nhom benh long, toe, mong
Nhom benh lay truyen qua dudng tinh due Nhom benh da do KST,C6n triing Nhom cac benh he thdng (benh tu mien) Nhom benh niem mac mieng
Cac u da lanh tfnh, tien ung thu, ung thu da Nhom benh rdi loan sac td da
Cac benh da khac Tdng
396 310 260 234 229 203 99 66 55 543 5695
6.95 5.44 4,57 4,11 4,02 3.56 1.74 1,15 0,97 9,54 100.00
Ca ca'u benh Da lilu ciia 10 nam gan day (2000 - 2009) : Cao nhat la nhdm cac benh di iing thudc: 14.87%. Tiep dd la nhdm benh da do Virus: 13,78%. Nhdm benh Eczema: 12,91%. Nhdm benh cd sdn vay, dd vdy: 8,73%. Nhdm cac benh nam: 7,66. Benh tuyl^n ba: 6,95%. Nhdm benh da do Vi khu^n: 5,44%. Nhdm benh Idng, tdc, mdng:
4,57%. Nhdm benh lay truyin qua dudng tinh due: 4,11%. Nhdm benh da do Ky sinh triing, Cdn triing: 4,02%. Nhdm cac benh he thd'ng (benh tu miln): 3,56%. Nhdm benh niem mac mieng: 1,74%. Cac u da lanh tinh, tiln ung thu da, ung thu da: 1,15%. Nhdm benh rdi loan sdc td da: 0,97%. Cac benh Da khac:
9,54%. ./- r ....
Ca ca'u cac benh Da lilu thudng gap, cao nha't la nhdm benh Di ling thudc: 14,87%
chiing td ngay nay cd rat nhilu loai thudc biet dupc mdi dupc sit dung. Cung vdi viec cac thudc nay dem lai nhilu lai ich trong dilu tri benh, chiing cung gdp phan lam tang cao sd benh nhan bj nhilm ddc da di litig thudc.
Them vao dd, nghien cihi cdn cho thay cd nhimg benh nhan bi di iing nhilu lan vdi cung 1 loai thudc chiing td cdng tac phdng benh di iing thudc cung chua dupc quan tam diing mirc. Dl ban che bi di iing nhilu lan ngudi thay thudc can phai dan dd benh nhan
va ghi vao giay ra vien cua ngudi benh ca ten thudc va ten cac biet dupc cd chiia thudc dd.
Ngudi benh can phai ludn nhd xuat trinh gia'y ra vien hoac giay kham benh ma ca sd Y te' da ghi ten cac thudc benh nhan bi dj ling de cac bac sy biet, tranh dung lai cac thudc dd dl bj dj ling lai, rat nguy hiem.
Nhdm benh Da do virus ciing chiem ty le cao: 13,78%. Nhdm benh Da nay gdm rat nhilu benh nhu: Zona, Thiiy dau. Hat cam, U mIm lay...Ty le cac benh da do Vi rus cdn cao cung phii hpp vdi sir tang len cua nhilu benh do virus trong nhiing nam gan day, ddi hdi su nd lire Idn ciia cac thay thudc chuyen khoa Da lilu ndi rieng va cua toan nganh Y te ndi chung.
Nhdm benh Eczema cung chie'm ty le tuang dd'i cao: 12,91%. Dilu nay cung dl nhan tha'y vi benh Eczema la benh cd ca dja dj ling, nen dilu trj dai dang va dl tai phat, nen ty le benh cao. Them vao dd, nhirng nam gan day cd su phat trien ciia nhilu nghanh cdng nghiep ndi chung va nghanh cdng nghiep hda chat ndi rieng, gdp phan dang kl lam tang nhdm benh Eczema trong ca ca'u chung ciia cac benh Da lilu.[1],[5]. Mat khac, Dieu trj benh Eczema hien nay tuy da cd nhilu tien bd, nhung ca dja dj iing vdn cdn la thach thiic dd'i vdi nIn Y hoc toan the gidi.
Ty le nhdm benh da do Na'm chie'm 7,66%. Benh da do nam diing thir 5 trong 10 nhdm benh Da lilu thudng gap. So sanh vdi ca ca'u benh Da lilu cua 10 nam trudc dd da cd su khac biet. Ty le nhdm benh Da do Nam dilu trj tai vien 103 tir 1987 - 1996 chiem ty le cao nhat: 21,10% (Nguyin Thj Hai Yen.
1997).[4]. Ty le nhdm benh Na'm cao nha't phii hop vdi ca ca'u ciia benh ngoai da d cac dan vj tuyen trudc thdi ky dd. Nguyin Canh
Cau va CS. 1992 da kham 2102 benh nhan bj;
benh ngoai da d 13 dan vj quan dpi nhan thay benh Nam da chiem ty le cao nhat: 40,72%;
[2]. Ty le benh Nam da cao la do dilu kienj luyen tap va sinh boat thdi ky dd cdn nhieu i khd khan, nen benh lay lan nhanh trong cac dan vj.[3]. Nhimg trudng hop benh nang, dilu trj dai dang dupc chuyen de'n benh vien dieu i trj nen ty le benh n&n da d benh vien ciing | cao.
Bang 3. Phan bd 10 Benh Da lilu STT
1 2 3 4 5 7 6 8 9 10
Ten benh Di irng thudc.
Eczema Nam da Vay nen.
Trirng ca.
Zona than kinh.
Viem da mu Ghe Hat cam Ban may day.
gap nhilu nhat d SdBN
847 735 436 374 322 306 218 203 132 122
khoa Da lilu b6nh vien 103. n = 5695 Ty le %
14.87 12,91 7,66 6,57 5,65 5,37 3,83 3,56 2,32 2,14
Hal Yen - Ty le % 15,04
6.61 21,10
4,88 3,43 1,94 8,49 10,01
0,51 0,91
Ca ca'u 10 benh Da lilu thudng gap hien nay d khoa Da lilu benh vien 103 nhu sau: Dj j ling thudc: 14,87%; Eczema: 12,91%; Nam da: 7,66%; Vay nen: 6,57%; Triing ca: 5,65%; j Zona: 5,37%; Viem da mii: 3,83%; Ghe: 3,56%; Hat cam: 2,32%; Ban may day: 2,14%. ^
Bang 4. Ty le 4 benh Da lilu thudng gap dilu trj d khoa Da lilu vien 103 va d cac dan vj.
STT 1 2 3 4
Ten benh
Eczema Nam da Viem da mii
Ghe
SoBN
735 436 218 203
Vien 103 (2000-2009)
(Ty le %) 12,91
7,66 3,83 3,56
Vien 103 (1987-1996)
(Ty le %) 6,61 21,10
8,49 10,01
Ddn vj (1992) (Ty le%)
5,89 40,72
3,39 9,07
Tii trudc tdi nay, cd 4 benh Da lilu thudng gap trong quan dpi. Dd la cac benh:
Na'm da, Ghe, Eczema va benh Viem da mu.
Kit qua nghien ciiu nay cho tha'y da cd su khac nhau giii'a ty le 4 benh Da lilu thudng
gap trong quan dpi ndm dilu tri ndi tni tai khoa Da lilu tir 2000 de'n 2009 va 10 nam trudc dd.
Ty le benh Eczema chie'm ty 16 cao nhd't:' 12,91%, sau den benh Nam da: 7,66, Viem'
Y HOC VIET NAM THANG 12 - SO 2/2010
da mu: 3,83 va it nha't la benh Ghe: 3,56.
Nguyin Thi Hai Yen (1997) nghien cuu ca cau benh ngoai da dilu trj npi trii tai khoa Da lilu vien 103 tir 1987-1996 nhan thay:
Benh Nam da chiem ty le cao nha't: 21,10%.
Tiep dd den benh Ghe: 10.01%, Viem da mii:
8,49%, va ty le benh Eczema it nhat:
6.61%.[4]. . ••;, : ,;, ; ,
Ca cau benh ngoai da ciia Nguyin Thi Hai Yen cung phii hop vdi ca ca'u ciia benh ngoai da d cac dan vj tuyen trudc thdi ky dd.
Nguyin canh cau va CS. 1992: Benh Na'm da chiem ty le cao nhat: 40,72%, benh Ghe:
9,07%, Eczema: 5,89%, va Viem da mii:
3,99%. [2].
Dilu nay cho thay, benh ngoai da d cac dan vj bd dpi thdi ky dd chii yeu la benh Nam da va benh Ghe. Cac benh nay dl lay lan trong tap the, nhat la nhung dpi huan luyen. dti ngoai. Benh cang lay lan nhanh a cac dan vi ddng quan d rirng niii, dilu kien \e .sinh ban che, thieu ngudn nudc sach| 11. 12|, Ccic benh nhan Nam da va Ghe cdng dupc dilu trj chii ye'u d cac dan vj, nhung trudng hpp benh nang mdi chuyin den benh \'ien dilu trj. Do dd ca cau benh nhan dilu tri tai benh vien liic dd ciing cd ty le benh Nam da
\a benh Ghe cao, nhung nam giin day, dilu kien luyen tap va sinh boat ciia bp dpi cd nhilu cai thien nen ty le cac benh Nam da \a Ghe giam nhieu. J fi~.->a -^ -ir:,-^; ( ; v_ ,
Ty le benh Eczema hien nay cao nha't trong ca cau ciia 4 benh Da lilu thudng gap chimg td benh Eczema la benh cd ca dja dj img. dai dang, khd dilu trj. Tliem \'ao dd, sir thay ddi ciia dilu kien sd'ng va tinh chat ciia cdng viec trong sir phat triln ciia xa hdi nga\' n:iy chinh la nhung nguyen nhan ca ban da lam thay ddi ca cau ciia benh trong 10 nam srin da\ . Hilu rd ban chat ciia sir thay ddi na\
se giup cho nganh Da lieu, nhat la cac chuyen vien Da lieu Quan dpi cd phuang an chii dpng cho cdng tac phdng \'a dilu tri benh Dalieu hien nay, kl ca tap huan kiln thirc, va ca phuang tien, thudc men giiip cho cdng tac phdng va dilu tri cac benh Da lilu dat ket qua tdt han.
!V. KET LUAN
Nghien ciru benh an 5695 benh nhan dilu tri npi tiii tai klioa Da lilu, benh \ien 103 tir 2000- 2009. Chiing tdi alt ra nliung dac dilm sau:
* Su phan bd theo nhdm benh:
- Nhdm cac benh dj irng do thudc chiem ty le cao nha't 14.87%. Tiep dd la nhdm benh da do Virus chiem 13,78%. Nhdm benh Eczema: 12,91%. Nhdm benh cd san vay, dd vdy: 8,73%'. Nhdm cac benh nam: 7,66. Benh tu)'en ba: 6,95%. Nhdm benh da do Vi khudn: 5,44%. Nhdm benh long, tdc, mdng:
4,57%. Nhdm benh lay truyin qua dudng tinh due: 4,11%. Nhdm benh da do KST.Cdn triing: 4,02%'. Nhdm cac benh he thdng (benh tu miln): 3,56%. Nlidm benh niem mac mieng:
1,74%. Cac u da liuih tinh, tiln ung thu da, ung thu da: 1,15%. NTidm benh rdi loan sdc td da:
0,97%. Cac benh Da khac: 9,54%.
* Ty le 10 benh Da lilu thudng gap la: Dj ling thudc: 14,87%; Eczema: 12,91%; Nam da: 7,66%; Vay nen: 6,57%: Triing ca:
5,65%; Zona than kinh:5,37%; Viem da mii:
3.83%; Ghe: 3,56%; Hat cam: 2,32%; Ban may day: 2,14%.
* Su phan bd ty le 4 benh Da lieu thudng gap trong quan dpi ndm dilu trj ndi trii tai khoa Da lilu tir 2000 den 2009 la: Benh Eczema chiem ty le cao nha't: 12,91%, sau den benh Nam da: 7,66, Viem da mii: 3,83 va ft nhat la benh Ghe: 3,56. Nhung thay ddi
dang k l ciia su phan bd benh nay phii hop vdi su phat trien ciia xa hdi hien nay d nude ta.
TAI LIEU THAM KHAO
1. Nguyin Canh Cau, Nguyin Khdc Vien (2001), Giao trinh benh Da va Hoa lidu, NXB Quan dpi nhan dan. tr 17- 20.
2, Nguyin Canh Cau.(1992), Co cau benh ngoai da va cac bien phap phong chdng trong quan dpi, Dl tai cap bp, tr 1-9.
3. Bid Khanh Duy(2008), Benh da va hoa lilu.
NXB Quan dpi nhan dan, tr 62- 104.
4. Nguyin Thi Hai Yen (1997), Nhan xet ve co cau, yeu td dich tl benh da khac va benh lay \ tru\'en qua duong tinh due dilu tii tai vien 103 I va vien 108. Luan an thac .sy y hpc, tr 26-31. | 5. Thomas B. Fitzpatrick.(2003), Color atlas j
and synopsis of clinical dermatology. Mc j Graw - companies. ' ;
NGHIEN CUfU HIEU QUA CUA DIEU TR! THOAT Vj DfA DEM COT SONG THAT LONG BANG PHl/ONG PHAP KET HOP DIEN CHAM VOfI KEO DAN COT SONG
- / . . • - ' •' . . . , , J
Bui Thanh Ha*, Tran Quoc Bao*, -^ ' Do Viet Phuong*
TOMTAT
Nghien citu dieu tri cho 30 BN bi thoat vi dia dem cot sdng that lu'ng bang phu'dng phap dien cham va dien cham ket hpp vdi keo dan cot sdng, cho thay: phUPng phap dieu trj bang dien cham ket hpp vdi keo dan cot sdng cho ket qua tot hdn phUdng phap dieu tri bang dien cham ddn thuan:
Ket qua dieu tri: tdt dat 80%; kha dat 13,33%. Tac dung giam dau nhanh: Ngu'dng dau sau dieu tri tang 445,7g/s ± 89,8g/s (K=l,41) cao hPn so vdi nhdm dien cham ddn thuan. Tam van dpng ciia cot sdng du'pc cai thien tdt: dat 93,33%.
TLT KHOA: Y hpc CO truyen; thoat vi dTa dem; dien cham; keo dan cot sdng.
* Bi>nh vien 103 - Hoc vien Qudn y
SUMMARY I A study on the effectiveness of the \
treatment of hernniated disc lumbar spine 1 by the combination of electric magnets and ;
spinal stretch
A studying on 30 patients with herniation [ disc lumbar spine treated by the combination of \ electric magnet and the combination of electric \ magnet and spine stretch shows: the treatment j using combination of electric magnet and spine stretch bring about move positive results then treatment with pure electric magnets:
Treatment results: good 80%; fair 13.33%. Pain Is ; fast velieved: pain threshold after the treatment 1 Increases 445.7 g / s ± 89.8 g / s (K = 1.41) higher than I In those patients with purely electric magnets. Spine!
range of nnotion Improve greatly: 93.33%. j