TAP CHi Y HOC VIET HAM TAP 456 - THANG 7 - SO 1 - 2017 thang tinh mach bj tac hoan toan, khong co pho
dong chay, sau 3 thang kfch thu'dc tTnh mach nho hdn so vdi trffdc, sau 1 nam tTnh mach teo nhd.
V. KET LUiSkN
Phu'dng phap dieu t n laser npi mach la mot thii thuat ft xam lan, an toan, chi can gay te cue bp, thdi gian dieu tri nhanh, tf le thanh cong cao, hoi phuc nhanh, rat hiem co bien chiTng, tfnh tham my cao, nen du'dc ap dung rpng rai trong dieu trj suy tTnh mach chi du'di man tinh.
TAI LIEU THAIVI KHAO
1. Beebe-Dimmer J.L. (2005). "The epidemiology of chronic venous insufficiency and varicose veins".
Ann Epidemiol, 15, 84-175
2. Cang Hanh De (2011). "Suy tfnh mach man tinh chi dUdi. Benh ly mach mau cd ban". hlXB Giao due Viet Nam. 112-116.'
. Adam Howard, Dominic P.]. Howard, Alun H.
Davies, (2009). "Surgical treatment of the incompetent saphenous vein". Handbook of venous disorders, p. 400 - 406.
. Mark H, Meissner, Pannier F (2007}. "Primary chronic venous disorders". 3 Vasesur, 46, 54-65.
. Ho Khanh Du'c, Nguygn Van VJ|t Thanh*, Phan Thanh Hai (2008-2009). "Oieu tri suy tTnh mach nong chi dUdi bang phu'dng phap laser npi tinh mach vdi laser diode bu'dc song BlOnn".
YhocTP.HoOiiMinh, 14, 168-173
. Min R,Zimmet S, Isaacs M, Forrestal M (2001^, "Endovenous lasertreatment of the incompetent greater saphenous vein". JVase Interv Radiol, 12: 1167-71
. Gerard 3L, Desgranges P, Becquemine J (2002). "Feasibilty ofendovenous laser fort the treatmentof greater saphemousvarieose veins: one month outcome in a series of 20 outpatients". J l^ai Vase, 27, 5- 222
CONG TAC CHAM SOC, PHONG CHONG ROI LOAN DINH DlTaNG LIPID vA CAC BENH MAN TINH KHONG LAY TAI HUYEN TiraNG DlfaNG
TINH NGHE AN N A M 2 0 1 4
LuoTig Van Phung*, Vu Minh Hai**
TOM TAT
Muc tieu. Danh gia cdng tac cham sdc, phong chong roi loan dinh duBng lipid va eac benh man tinh khong lay tai huyen Tu'dng Du'dng tinh Nghe An nam 2014. Phu'dng phap. mo ta co phan tfch qua cupc dieu tra cat ngang. Kit qua: Hau het ngu'di dan khong biet ve hau qua ciia roi loan lipid mau.100%
can bp y t? va c^n bp ban nganh tuyen huyen va xa deu co nhu cau dddc tap huan ve quan ly va cham soc benh nhan roi loan lipid mau. Dia phUdng chUa co ban ctii dao hay van ban ve phong benh roi loan lipid mau. Kei luan: Cac cap y_ te va chfnh quyen huyen Tu'dng Du'dng can long ghep, phdi hdp cac hoat dong phong chong roi loan dinh du'dng lipid va eac benh khong lay nhilm vao cac ke hoach trien khai cong tae Ytetaidia phu'dng.
SUMMARY
CARE, PREVENTION OF L I P I D DISORDERS AND CHRONIC NON-CONTAGIOUS DISEASES I N TUONG DUONG DISTRICT,
NGHE AN I N 2 0 1 4
*Benh viSn Tddng Du'dng, Nghe An
*Waihgc Y Dutfc Thai Binh Oiju trach nhiem chinh: Vu Minh Hai Email: [email protected] Ngay nhan bai: 17.2.2017 Ngay phan bien khoa hpc: 15.5.2017 Ngay duyet bai: 30.5.2017
Objective: Evaluating the care, prevention of lipid disorders and chronic non-contagious diseases of in Tuong Duong distnct, Nghe An province in 2014.
Methods, cross sectional survey. Results. Most of the people did not know the consequences of blood lipid disorders. 100% of distnct health care staff were in need of training in management of patients with lipid disorders. Local authonties had no steering committe or document concerning blood lipid disorder prevention. Conclusion: The medical professionals and local government need to integrate and coordinate activities of lipid disorder and chronic non- contagious disease prevention into local medical plans Keyword: blood lipid disorders, hyperlipidemia, hypercholesteremia
I. OAT VAN OE
Vdi nen kinh te md cira, phat trien theo cd che thi tru'dng, ddi song ciia nhan dan ta da dddc cai thien ro ret, ty le thieu dinh duSng da giam xuong dang ke. Tuy nhien ty le cac benh man tfnh nhd thiTa can beo phi, dai thao du'dng, tang huyet ap, benh tim mach... xu hu'dng ngay cang gia tang [1]. Cac benh man tfnh lien quan chat che tdi tinh trang dinh du'Sng - lipid do la dai thao du'dng typ 2, benh tim mach, tang huyet ap. Roi loan chuyen hoa lipid mau la nguyen nhan dan tdi vUa xd dpng mach [ 2 ] .
Cf Viet Nam chu'a co so lieu day dii ve tinh trang dinh du'dng - lipid d ngu'di tru'dng thanh.
VIETNAM MEDICAL JOURNAL N°1 - JULY- 2017 mdi chi eo cac nghien ciTu le te ve tinh trang roi
loan lipid mau, chii yeu la cac nghien ciru tren benh nhan trong benh vien. Dac biet chu^ cd cac nghien ciTu mot each he thong tren cong dong.
Trong giai doan hien nay, Viet Nam co nhij'ng thay doi ve kinh te - xa hpi, che dp an, loi song CO nhieu thay doi. Dieu do da tac dpng tdi mo hinh benh tat va "nhuhg van de siTc khoe mdi nay sinh" can dddc theo doi, danh gia kjp thdi. Chfnh vi vay chiing toi da tien hanh nghien cud "Co/Tg- tac phong, diong rdi loan dinh dudng Lipid va cac benh man tfnh khong lay tai 2 xa cua huyen Tddng Dudng tinh Nghe An nam 2014'
II. 061 TUpNG VA PHl/aNG PHAP NGHIEN CCTU 1 . Oja ban, thdi gian nghien cu'u: Nghien cull du'dc thdc hien tai hai xa eiia huyen Tu'dng Du'dng ia xa Yen Na va xa Thach Giam tir thang 3 den thang 6 nam 2014.
- Xa Thach Giam dai dien cho viing ngoai la viing CO dieu kien dddng xa giao thong di lai thuan tien. Nghe nghiep chu yeu la lao dpng ILT do (lam ne, lam thue, lam vddn buon ban nho le..).
- Xa Yen Na dai dien cho viing trong la viing sau, xa, dieu kien du'dng xa giao thong di lai klio khan. Dieu kien kinh te kho khan, Jac hau, cong viec chinh cua ngu'di dan la lam r I y xa nha 3-7 km di bp du'dng doi nui.
2. Dol tu'cfng nghien cCtw. Ngu'di tru'dng thanh tiT 25-64 tuoi chia lam 4 nhom tuoi: 25-34 tuoi, 35 - 44 tuoi, 45-54 tuol, 55-64 tuoi va moi nhom tuoi chia thanh 2 gidi, co thdi gian cdtnj tai dja phu'dng ft nhat 5 nam.
3. Phu'dng phap nghien cuTu: Nghien cihi djch t l hpc md ta co phan tich qua cuoc dieu tra cat ngang nham xac dmh t / le roi loan dinli dddng lipid mau va cac benh man tfnh khong lay
111. KET QUA NGHIEN CU'U
Bing3,l. Cich thdc xd tri cua ngddi dan khi bi benh Vung trong ( n = 6 4 )
s[ T % "
Vung ngoai ( n = 6 4 ) Chung ( n = 1 2 8 ) SL ] % I SL " % Y te den nha
20,3
0,0 0,0
Den tram y te xa 23,4 37,5 <0,05
Den benh vien 18 :8,1 36 56,2 54 42,2 <0,05
Den Y te t d nhan 0 0,0 3,9 <0,05
Ty le ngu'di dan den benh vien khi bj benh la cao nhat ehiem 42,2%; tiep theo la den tram y te ehiem 37,5%. Ty le ngu'di dan tai viing ngoai den benh vien la 56,2% trong khi ty le nay d viing trong la 28,1%. Ngu'dc lai, ty le ngddi dan tai vimg trong den tram y te la 51,6% trong khi ty le nayd viing ngoai la 23,4%. Sii khac biet la rat co y nghTa thong ke vdi p<0,05.
Vimg ngoai Vimg trong Chung
Bieu do 3 . 1 . Ty le ngu'di dan da tiTng du'dc x e t nghiem lipid mau Ty le ngu'di dan da tiTng du'dc xet nghiem lipid mau la 5,5%. Ty le nay d vung ngoai la 7,8% cao hdn d viing trong ehi chiem 3 , 1 % .
Bang 3.2. Thdc trang ddi ngd can bd quan ly tham dd tap huin ve cac benh liSn quan den rdi loan lipid miu theo tuyen
Cac benh lien quan den RLLP Oai thao du'dnq Tang huyet ap
Tim mach Unq thu'
Can bp y te tuyen huyen (n = 20)
ChuS Chu'a Chu'a ChuS
Can bg ban nganh tuyen xa (n = 18)
ChuB Chu^
Chua Chua
Can bo y t e tuyen xa (n = 36) _
Chua Chua Chua Chua
TAP CHl Y HOC VIET NAM TAP 456 - THANG 7 - SO 1 - 2017
Bang tren cho thay chda co can bp y te hay can bo lanh dao ban nganh nao du'dc tham dd tap huan ve quan ly, cham soc cac benh co lien quan den roi loan lipid mau.
Bing 3.3. Thdc trang ddi ngd cin bd quin ly tham gia truyen thdng ve cic benh lien quan den roi loan lipid miu theo tuyen
Cac benh lien quan den Can bo y t e tuyen 1 Can bo ban nganh tuyen I Can bo y te tuyen xa RLLP I huyen ( n ^ 20) | xa (n = 18) (n = 36) Dai thao du'dng
Tang huyet ap Chu'a Chu:a
Chua
Bang tren cho thay chu'a co can bg y te hay can bp lanh dao ban nganh nao tham gia truyen thong ve quan ly, cham soc benh nhan roi loan lipid mau, dai thao du'dng, cao huyet ap.
Bing 3.4. Nhu cau tap huan cua cin bd quan ly ve cic benh liSn quan den rdi loan lipid mau
Cac benh lien quan den RLLP Dai thao du'dnq
Tang huyet ap Tim mach
Can bp y te tuyen huyen (n = 20)
20/20 20/20 20/20
Can bo ban nganh tuyen xa (n = 18)
18/18 18/18 18/18
Can bp y te tuyen xa (n = 36)
36/36 36/36 36/36 Qua bang tren ta thay 100% can bo y te hay can bo lanh dao ban nganh deu eo nhu cau tap huan ve quan ly, cham soc benh nhan roi loan lipid mau, dai thao du'dng, cao huyet ap, tim mach.
Bang 3.5. Thdc trang ve ban chi dao phdng chdng benh lien quan dSh rdi loan lipid miu *_
Thanh lap ban chi dao Chu'dng trinh phong chong RLLM
Chu'dng trinh phonq chong DTD Chu'dng trinh phonq chonq THA Chu'dng trinh phonq chonq benh tim mach
Tuyen huyen ChUa ChUa ChUa Chua
Xa vLing trong Chda Chda Chda Chua
Xa vung ngoai Chda Chda Chda Chua Bang tren cho thay ca tuyen tuyen va 2 xa viing trong, vijng ngoai deu chu'a co ban chi dao phong chong benh lien quan den roi loan lipid mau.
Bing 3.6. Thdc trang ve cic van ban chi dao phong chdng benh lien quan dSn rdi loan lipid miu
Van ban chi dao Tuyen huyen Xa viinq tronq Xa viing ngoai Van ban chinh quyen
Phonq chonq RLLM Phdnq chonq DTD Phonq chong THA Phonq chonq benh tim mach
Khonq Khong Khong Khonq
Khong Khong Khong Khonq
Khong Khong Khong Khonq Van ban ng^nh y te
Phonq chonq RLLM Phong chong DTD Phong chong THA Phonq chonq benh tim mach
Khonq Cd Co Khong
Khong Khonq Khong Khong
Khonq Khonq Khong Khong Ket qua bang tren cho thay ca chfnh quyen tuyen huyen va 2 xa viing trong, viing ngoai deu khong ed van ban chi dao phdng chong benh lien quan den roi loan lipid mau. Chi eo y te tuyen huyen co cac van ban ehi dao phong chong benh dai thao du'dng va tang huyet ap.
Bing 3.7. Thdc trang vS boat ddng khim benh lien quan den rdi lo^n lipid mau To chu'c kham Tuyen huyen Xa vung trong Xa viing ngoai
Phat hien RLLM Khong Khong
Co Khong Khong
Phat hien THA Co Khong Khong
Phat hien benh tim mach Co Khong Khong
Qua bang tren ta thay y te tuyen huyen da co cac hoat dpng to chiTc kham benh lien quan den roi loan lipid mau nhu" phat hien RLLM, phat hien dai thao du'dng, phat hien tang huyet ap va benh tim mach. Y te tuyen xa d ea 2 viing deu chda co cac hoat dpng nay.
VIETNAM MEDICAL JOURNAL N°1 - JULY- 2017
Bing 3.8. Thdc trang ve ke hoach vi boat dong cham sdc cac benh liSn quan den roi loan lipid mau
Thonq tin Tuyen huyen Xa vunq tronq Xa vunq nqoai Ke hoach
Ke hoach quan ly benh RLLM Ke hoach quan ly benh DTD Ke hoach quan ly benh THA Ke hoach quan ly benh tim mach
Khonq Co Cd Khonq
Khonq Khonq Khonq Khonq
Khdnq Khdnq Khonq Khdng Hoat dong cham soc
Benh RLLM Benh DTD Benh THA Benti tim mach
Cd Co Co Co
Khonq Khdnq Khonq Khong
Khdnq Khonq Co Khonq
1 \
1
Qua bang tren ta thay y te tuyen huyen da co eac hoat dong quan ly, ke hoach cham soc benh hen quan den roi loan lipid mau. Y te tuyen xa d ca 2 vung deu chu^ eo cac hoat dpng nay. tuy nhien xa vimg ngoai da eo hoat dong cham soc benh tang huyet ap.
IV BAN LUAN
4.1. Cdng tic phdng, chdng roi loan dinh dddng lipid d ngddi tritdng thinh: Nghien cdu each xi^ trf ciia ngu'di dan khi bj benh ehiing toi thay rang ty le ngu'di dan den benh vien khi bj benh la cao nhat chiem 42,2%; tiep theo la den tram y te chiem 37,5%. Dieu nay chiTng to phan Idn ngu'di dan da nhan thiTc du'dc SLT can thiet eiia viec kham benh dong thdi cung cho thay ngu'cfi dan co sd quan tam kha Idn den sire khde eua hp tuy nhien van cdn 20,3% ngu'di dan khong di ktiam benh, day la 1 son so khong he nho can thiet phai nghien ciTu sau hdn tim ra nguyen nhan cu the bdl da so cac tru'dng hdp xuat hien bien chu'ng nang khi tdi kham tap trung d nhdm nay. Bang 3.1 cung cho thay ty le ngu'di dan tai vung ngoai den benh vien la 56,2% trong khi ty le nay d viing trong la 28,1%. Ngu'dc lai, ty le ngu'di dan tai viing trong den tram y te la 51,6% trong khi ty le nay d viing ngoai la 23,4%. SiT khac biet la rat co y nghTa thong ke vdi p<0,05. Tren thiTc te vimg ngoai co dieu kien diTdng xa giao thong di lai thuan tien, kinh te ciia ngu'di dan kha gia hdn nen ngu'di dan vimg ngoai Ida chpn tdi benh vien cao hdn viing trong. Vimg trong la vimg sau, xa, dieu kien du'dng xa giao thong di lai kho khan, dieu kien kinh te kho khan, lac hau, cong viec chfnh la lam nddng ray nen thu nhap thap do do ma ngu'di dan viing trong Ida chpn tdi tram y te khi CO benh de tiet kiem kinh phi.
Ket qua bang 3.1 cho thay ty le ngu'di dan da tiTng dddc xet nghiem lipid mau la 5,5%. Dieu nay cho thay ty le ngu'di dan da tiTng dddc xet nghiem lipid mau rat thap trong khi day la 1 benh gay ra nhieu bien chiTng nguy hiem co the dan den tu" vong rat nhanh. Ty le nay d viing ngoai la 7,8% cao hdn d vimg trong ehi ehiem
3,1%, Ty le ngudi dan viing ngoai da tiihg dude xet nghiem cao hdn vung trong rat nhieu, day la mot sd chenh lech kha Idn ddi hdi cac lanh dao dia phu'dng can quan tam hdn den khu vdc viing sau, xa trong viec truyen thong giao due siTc khoe va cung cap cac dich vy can thiet den khu vdc nay.
Mot thi/c trang dang qan tam ve cong tac quan ly phong, chong roi loan dinh du'dng lipid la chi/a CO can bo y te hay can bp lanh dao ban nganh nao dddc tham diT tap huan ve quan ly, cham sdc cac benh co lien quan den roi loan lipid mau. Day chfnh la 1 trong nhu'ng nguyen nhan hang dau dan den SLT thieu hieu biet ciia ngu'di dan ve roi loan lipid mau cung nhd viec tham gia eac xet nghiem chuan doan benh. Neu khong cai thien dddc tinh trang nay thi cong tae phong, chong roi loan dinh dddng lipid cho ngu'di dan gap rat nhieu kho khan tham chf ton kinh phf ma lai khong hieu qua. Ben canh thdc trang tren nghien ciTu eiia chimg toi cung cho thay rang chua cd can bo y te hay can bp lanh dao ban nganh nao tham gia truyen thong ve quan ly, cham soc benh nhan roi loan lipid mau, dai thao du'dng, cao huyet ap. Dieu nay chu'ng to benh roi loan lipid mau chda du'dc cac cd quan ban nganh va lanh dao y te 5\a. phu'dng quan tam, day chinh la nguyen nhan quan trpng gay ty le mac benh cao.
Tuy ket qua bang tren chi ra chu^ cd can bp y te hay can bo lanh dao ban nganh nao dddc tham d d tap huan ve quan ly, cham soc cac benh cd lien quan den roi loan lipid mau nhuTig k i t qua bang 3.4 cho thay 100% can bo y te hay can bp lanh dao ban nganh deu cd nhu cau tap huan ve quan ly, cham sdc benh nhan roi loan lipid mau, dai thao du'dng, cao huyet ap, tim mach. Dieu nay chiTng to cac can bp lanh dao dia phu'dng rat mong muon du'dc hpc tap de
TAP CHl Y HOC VIET NAM TAP 456 - THANG 7 • SO 1 - 2017 nang cao va bo sung kien thu'c tir dd gdp phan
cho cong tac quan ly va dieu tn roi loan lipid mau va cac benh man tfnh khong lay khac.
4.2. Cdng tic phdng, chdng cic benh man tinh khdng lay, Roi loan lipid mau noi rieng ma benh man tfnh khong lay ndi chung deu la nhu'ng benh dang quan tam hien nay the nhiTng khi tim hieu ve viec thanh lap ban ehi dao phong chong benh lien quan den roi loan lipid mau cho ket qua rang ca tuyen tuyen va 2 xa vimg trong, viing ngoai deu chda cd ban chi dao phdng chong benh lien quan den roi loan lipid mau. Mot thu'c trang dang quan tam khac ia ea chfnh quyen tuyen huyen va 2 xa vimg trong, viing ngoai deu khong ed van ban chi dao phong chong benh lien quan den roi loan lipid mau. Chi CO y te tuyen huyen ed eac van ban chi dao phong chong benh dai thao du'dng va tang huyet ap. Dieu nay cho thay tuyen trung u'dng va tuyen tinh cdn chda quan tam den benh nay.
Day cung la lo hong Idn trong cong tac quan ly cua cac cap, ban nganh lien quan.
Bang 3.8 cho thay rang y te tuyen huyen da CO cae boat dpng quan ly, ke hoach cham sdc benh lien quan den roi loan lipid mau. Y te tuyen xa d ea 2 viing deu chu'a eo cac hoat dpng nay.
Tuy nhien xa viing ngoai da cd hoat ddng cham soc benh tang huyet ap. Sd dT cd thdc trang tren theo chimg toi cd le la do Tu'dng Du'dng la mot huyen mien niii cua tinh Nghe An cho nen cijng khong nam ngoai tinh trang chung ciia ca nddc.
Chu'dng trinh phdng chong benh khong lay nhiem tai Viet Nam da dddc thanh lap tiT nam
2002 vdi cac cau phan dai dien cho tiTng nhdm benh khong lay nhiem nhu' tang huyet ap, dai thao du'dng, ung thd, benh du'dng hd hap man tfnh va roi loan tam than. Mdi cau phan eua chu'dng trinh tiTng bu'dc dddc chuyen thanh cac diT an/tieu dd an ciia Chudng trinh Muc tieu quoc gia. Tuy vay, cho tdi nay hoat dpng phdng chong benh khdng lay nhiem v I n chda dap uTig dddc nhu cau. Nhin chung khi benh nhan mac benh va di kham thi cac ndi tiep nhan mdi cd dap ij'ng chiT eac lanh dao ban nganh chda chii dpng trong cdng tac quan ly va phong chong roi loan lipid mau.
V KET LUAN
- Ty le ngu'di dan den benh vi§n khi bi benh ia cao nhat ehiem 42,2%.
- Ty le ngu'di dan da tiTng du'dc xet nghiem lipid mau rat thap (5,5%).
- Cac lanh dao ban nganh chu^ cd siT chu dong trong cdng tac quan ly va phdng chong roi loan lipid mau.
TAI LIEU T H A M KHAO
1. Nguyen Cong Khan (2010), "Nghien culi tinh trang roi loan dmh du^ng lipid d ngu'di tru'dng thanh tai cong dong va mot so giai phap can thiep dU phong", ChuUng trinh KHCN cap nha ni/dc kc 10.05- Bao cao tong hap Idi qua khoa hgc cong nghe de tai.
2. Le t h e Trung (2009), Danh gia tinh trang rdi loan lipid mau va mot so yeu to anh hwdngd ngUdi tren 40 tuoi tai mot so xa phUdng tinh Nam Dinh va Ha Nam nam 2007, Luan van thac sy Y hoc, Thai Binh, Dai hoc Y Thai Binh, 90.
TAC DUNG HO TRQ PHUC HOI CHU'C NANG VAN DONG BENH NHAN N H 5 I M A U NAO SAU GIAI DOAN CAP CUA LASER TREN HUYET
Dang Kim Thanh*, Nguyen Thj Ngoc Linh*
TOM TAT
Muc tieu nghien cihi: Danh gia tae dung ho trO phyc hoi chiTc nang van dong d benh nhan nhoi mau nSo sau giai doan cap bang laser tren huyet. Phu'dng phap nghien cu'u lam sang, co nhom doi chu'ng, so sinh tru'dc va sau dieu tn. Ddi tu'dng nghien cu'u gom 60 benh nhan chia 2 nhom, moi nhom 30 benh nhan: nhom dieu tn laser tren huyet va nhom doi
*Khoa Y hgc cd truyen, Trddng Dai hgc YHa Noi Chju trach nhiem ehi'nh: DSng Kim Thanh Email; [email protected].
Ngay nhan bai: 12.4.2017 Ngay phan bien khoa hoc: 25.5.2017 Ngay duyet bai: 2.63.2017
chimg, trong thdi gian 30 ngay. Ket qua: nhom nghien ciTu miTc chenh diem Barthel la 46,46 ± 20,29, cao hon nhom chiTng 37,33 ± 13,81 {p<0,05). Ket luan: Laser tren huyet eo tac dung tdt trong viec ho trd phuc hoi van dong 6 benh nhan nhoi mau nao sau giai doan cap.
Td khda: Laser tren huyet, nhoi mau nao, phuc hoi chiTc nang.
SUMMARY
THE EFFECTS OF LASER ACUPUNCTURE I N RECOVERING OF MOTOR FUNCTION I N PATIENTS W I T H CEREBRAL INFARCTION
AFTER ACUTE PHASE Purpose: Elevating the effects of laser acupuncture in recovering of motor lijnction on cerebral infanSion
