TAP CHi Y HOC VIET NAM TAP 459 - THANG 10 • SO 1 - 2017 nghien ciTu ciia Kieu Chi Thanh (2010) tai Vien
Quan y 103 khi lay m l u tiT 8h30-14h30 tai cac phdng md, so lu'dng vi sinh vat dao dpng tiT 234- 312 cfu/m^ [ 2 ] . Nguon nu'de la rat quan trpng doi vdi benh nhan ghep tuy, ciua bang 4 chiing tdi thay, tru'dc khi ghep, cac mau nu'de deu nhiem vi sinh vat ( + ) , cac vi sinh vat gay d nhiem nguon nu'de la E.coli, Klebsiella va Bacillus, sau khi can thiep bang loc RO va lap qua Ipe Nano d dau vdi, lat ca cac mau nu'de deu cd ket qua (-) trong sudt thdi gian benh nhan nam dieu t n .
Oe dam bao mdi tru'dng sieu sach, khdng chi khong khi va nguon nu'de, ket qua d bang 5 va bang 6 cho thay, tat ca cac vat dung cho benh nhan sir dyng^deu du'dc hap tiet khuan tai Trung tam tiet khuan cLia_ Benh vien, trong tlidi gian nam buong benh ke ca thdi gian tru'dc ghep va sau ghep cac benh nhan deu tuan thii chat che eae quy dinh ve kiem soat nhiem khuan trong dieu kien sieu sach. Doi vdi cac nhan vien tham gia dieu tn va cham sdc cho benh nhan, tru'dc va sau khi vao khu ghep tiiy, deu phai tuan thu cae quy dmh ve kiem soat nhiem khuan mot each nghiem ngat.
V. K^T LUielN
- Ty le benh nhan song tren 5 nam sau ghep te bao goc tao mau la 91,0%. Khdng cd benh nhan nao bj nhiem khuan benh vien.
- Dam bao mdi tru'dng sieu sach trong buong
benh nhan ghep tuy bang eae bien phap kiem soat nhiem khuan hieu qua. Sau can thiep, 100% cae mau nu'de cho benh nhan sir dung khdng bi d nhiim.
-Trong thdi gian nam buong benh, cac benh nhan va nhan vien deu phai tuan thii chat che eac quy dinh ve kiem soat nhiem khuan.
TAI LIEU T H A M KHAO
1 - Pham Thj Tuyet Nhung, Nguyen Thi Minh Phtfdnp (2015), "Bao cao ca lam sang': Benh nhan dau tien du'Oc ghep te bao goc tao mau dong loai thanh cong tai Benh vien TWQD108", Tap chi Y hoc Viet Nam, Tap 429, tr 88-94
2- Kieu Chi Thanh (2010), "Oanh gia thu'c trang vi khuan khong khi d benh vien 103", Tap chi Y dUdc hgc Quan su' 9 : 55-50.
3- M.Fleischer et al (2005) "Microbiologycal Control of Airborne Contamination in Hospitals".
Indoor BuidEnviron IS ; 1 : 53-6.
4- Agnieszka Gnladek, Anna B. Macura (2011),
"Air-conditioning vs.presence of pathogenic fungi in hospital operating theatre environmental".
Wiadomosci Paratoiogiczne 57(2), 103-6.
s- ISO 14698-1:2003 (E), Cleanrooms and associated control environment -Biocontamination control, First edition.
6- Merck (2009). Microorganism titers in different environments, care unit: newborns and infants can be contaminated while being fed. Jpn J Infect Dis.
2006 Aug;59(4):213-5.
7- WHO (2002), WHO expert committee on specifications for pharmaceutical preparations, thirty sixth report, 902, 2002.
TINH HINH BENH NHAN CHAN THiraNG DO TAI NAN GIAO THONG TAI BENH VIEN DA KHOA NONG NGHIEP GIAI DOAN 2 0 1 4 - 2 0 1 6
Ha H&u Tung*
T O M TAT
Hang nam, Tai nan giao thong (TNGT) da lam tren 1000 ngu'di chet, Cliu^ day 10% sd nan nhan bi tai n?n giao thdng du'dng bo du'dc cap edu ban dau tai cho. Nghi§n eiru du'dc su' dung trong de tai la phUdng phap hoi CLiU md ti 10126 ho sd benh an cua benh nhan TNOT trong 3 nam tir 2014 den 2016 tai Benh vien Da khoa Nong nghiep nam tren Quoc 15 IA, Ttianh Tri, Ha Ngi. Ket qua nghien ciTu cho thay benh nhan vao cap edu do tai nan giao thong chii yeu la do sir dung phu'dng tien la xe dap va xe may; nhom tuoi bl nh'iieu nhat tiT 16 den 60 tuoi cd 7686 trUdng hdp
*Benh vien Da khoa Nong nghiep Chju trach nhiem chinh: Ha Hffu Tiing Email: [email protected] .vn Ngay nh?n bai: 17.7.2017 Ngciy phan bien khoa hpc: 30.8.2017 Ngay duyet bai: 12.9.2017
(75,9%). Ty le nam bj TNGT gap 2,13 lan so vdi ty le d nu'; Ty le thiVong tat cao nhat la chan thuong sg nao va gay xu'dng chi; BN TNGT dUpc dUa den benh vien cap cull chii yeu do ngUdi di dUdng va ngUdi than dUa den; Ty le benh nhan bj shock tren nhu'ng benh nhan khong dudc sd eiru hoac cd sd ciTu nhu'ng sai cao gap ddi ty le benh nhan bj shock tren nhOtig benh nhan dupe sd edu diing.
SUMMARY
SITUATION OF PATTENT INJURIES IN TRAFnC ACUDENTS AT GENERAL HOSPTTAL OF AGRICULTURE FOR THE PERIOD 2014-2016
Every year, traffic accidents have killed more than 1,000 people, less than 10% of victims of road traffic accidents are inibally on the spot The study used in the study is a retrospective method that describes 10126 patent records of traffic accident patients in three years from 2014 to 2016 at the General Hospital of Agriculture located on Highway IA, Thanh Tri,
VIETNAM MEDICAL JOURNAL N°1 • OCTOBER - 2017 Hanoi. The results of the study show that patients who
get into traffic accident due to traffic accidents are mainly using bicycles and motorbikes; The most aged group aged 16 to 60 years had 7686 cases (75.9%).
The proportion of men with traffic accidents is 2.13 times higher than that of women; The highest incidence is head injury and fractures; Patients with traffic accidents are taken to emergency hospitals mainly by pedestrians and their dependents; The incidence of shock in patients who have not been first aid or first-aid but is higher than twice the rate of shock in patients who receive first aid.
I. D A T VAN DE
Tai nan giao thdng (TNGT) la mdi hiem hpa ciia toan nhan loai, xay ra ngay cang nhieu, anh hu'dng tram trpng den su'c khde, la ganh nang cho gia dinh va xa hdi. Sd lieu ttidng ke eiia Uy ban An toan Giao thdng quoc gia cho thay, 10 nam qua cd hdn 120.000 ngu'di chet vi tai nan giao thdng, binh quan moi nam cd 1.000 nghin ngu'di chet vi tai nan giao thdng, Cu the, moi ngay cd khoang 30 gia dinh mat ngu'di than, 200 gia dinh chiu nhu'ng ton that ve vat chat va tlnh than do tai nan giao thong, ddng thdi nhiihg ngu'di gay tai nan va ngu'di ganh hau qua tai nan se phai chiu nhutig dan vat tinh than sudt eu6c ddi [1].
Chuci day 10% so nan nhan bj tai nan giao thdng du'dng bd du'dc cap ciTu ban dau tai cho.
Chu^ den 10 tinh/thanh pho ed he thong djch vu cap ciTu y te (EMS) chuyen trach trong khi so tinh/thanh edn lai phai phu thude vao nh&ng nguon life ciia benh vien. Chat lu'dng cua edng tac cap ciili ban dsu edn kem vdi 50% sd ea du'dc xu" tri Ididng dung each. Chua day 10% so nan nhan du'dc he thong djcJi vy cap cud y te chi'nh quy chuyen den benh vien vdi da so benh nhan den benh vien bang xe tac-xi hoac xe may [2],
B^nli vien Da khoa Ndng nghiep (BVDKNN) nam tren quoc Id IA ciTa ngo ra vao phia nam Ha Npi, vdi mat dp giao thdng day dac va ^ y du phu'dng tien tham giao giao thong tren ciing mot tuyen du'dng nhu' tau hda, xe tai, xe dau keo, xe may, 6 td, xe dap, ... Moi ngay khoa chan thu'dng eiia Benh vien hep ddn va xd tri trung binh 25 ea chan thuWng/ngay, trong do TNGT khoang 15 ca.
Xuat phat tir thiTc te ndi tren va de cd ke hoach, chien lu'dc tlianh lap Trung tam cap edu chan thu'dng tiiupe mang lu'di cap cii'u TNGT quoc gia, chiing tdi ben hanh nghien ciTu de tai
"Tinh hinh benh nhan chan thu'dng do tai nan giao thong tai Benh vien Da khoa Nong nghiep giai doan 2014-2016" vdi muc tieu:
l.Mo ta thdc trang benh nhan bl tai nan giao thong^ du'dc cap edu tai Benh vien Da Khoa Nong Nghiep giai doan 2014-2016.
2. Cung cap thong tin giup cho cd quan chu'c nang xay di/ng dddc mo hinh mang lu'di cap oft/
chan thu'dng tmn toan qudc.
II. D6\ TUONG VA PHirONG PHAP NGHIEN CUU 2.1. Ddi tWdhg nghien edu: Ho sd benh an ciia nhij'ng benh nhan tai nan giao thdng (BN TNGT) du'dng bp den cap ciili, dieu trj tai Benh vien Da khoa Ndng Nghiep tiT 01/01/2014 den 31/12/2016.
Tieu chuan chon lua chgrr. Tat ca eac ho so benh an ciia BN TNGT du'dng bp den cap cufu, nam dieu tri, chuyen vien, xin ve, tiyvong tai BVDKNN.
77ei; chuan loai trd. Hhdng hd sd benh an ciia BN TNGT du'dng bd da on djnh den dieu tri tiep tuc hoac den phuc hoi chu'c nang dUdc benh vien tuyen tren chuyen ve.
2.2. Dia diem, thdi gian nghiSn cui/
- Dja diem nghien cirtj: Benh vien Oa khoa Ndng nghiep, Thanh Tri, Ha Npi
- Thdi gian; Nghien ciTu tiT thang 02/2017 den thang 05/2017
2.2. Phu'dng phap nghien CIJ'U 2.2.1. ThiSi kenghiSn edu: Nghien ciTu mo ta hdl cii'u.
2.2.2. Cd miu va chon mau nghien cu'u;
Toan bp cac ho sP benh an eae tru'dng hOp TNGT du'dng bd den cap ciTu, dieu tri, chuyen vien, tiT vong tai BVDKNN tiT thang 1/2014 dgn thang 12/2016
2.2.4. Phu'dng phap va ky thu$t thu thap so liSu: Thu thap tiT so ghi chep tai phdng cap ciTu chan thu'dng (phleu ghi chep cac tru'dng help TNGT du'dng bd nhap vien theo Quyet djnh 1356/QD-BYT ngay 18/4/2008 ciia Bp Y te) [3].
- Ho sd benh an ciia Ithoa ngoai chan thu'dng, - So phau thuat tai khoa gay me hoi siTc.
2.2.5. X i y i y s d lieu
Phan tich so lieu TNGT trong 3 nam (01/2014 - 12/2016).
- SiT dung phan m§m SPSS va phan mem phdng chong TNTT de phan tich so lieu, cac dil sd nghien ciTu.
III. KET QUA NGHIEN CLTU
3.1, Thing tin chung ve do! tddng
nghiSncdu %^
Nhom tuoi
<16 16-60
>60 Tong
Tan sCi (n) 1448 7686 992 10126
T* IS °/o«t 14^3 m 75,9 m
9,8 a l
100,00 l l•p
TAP CHi Y HOC V I | T HAM TAP 459 - T H A N G 10 - SO 1 - 2017
Nhan xet: Lda tuoi gap TNGT nhieu nhat d lu^ tuoi 16 - 60 tud'i, chieni den 75,9%.
n a m
68,1%
Bieu do 3.1. Phin bo theo gidi Nhin xet: Ty le TNGT d nam gidi chiem 68,1%'tdng so TNGt, gap 2,13 lan so vdi t / le TNGT dnD'(31,9%).
3.2. Dae diem ve ddi tu'dng nghien edu Bang 3.2: Phan bdtheo sd dung phu'dng tifn giao thong
Phutihg tien SSca
Ty Ci bo
871 8,61
Xe dap
1214 11,98
Xe
may7801 77,04
0 to
240 2,37
Tong 10126 100,00 Nhan xet: Ve phu'dng tien giao thdng, nhieu nhat la xe may vdi 7801 BN (chiem ty le 77,04%)
Bang 3.3: Ty IS ddi tWdng TNGT dddc du'a din Benh vien
Tu'den Ngu'di di du'dng
dUaden Ngu'di nha du'a
den Tuyen txddc chuyen den Cap eihj 115
Tong
T ^ n s o C n ) T y l e C / o )
1579 15,6
42,3
11,3
Nhin xet: Ty le BN bi tai nan giao thdng du'dc ngu'di nha dda den (chiem b/ ie 22,2%) va ngiTdi di dddng dda den (chiem ty le 42,3%). Benh nhan bi TT^GT du'dng bo du'dc van chuyen vao benh vien cap cu'u hau liet bang phu'dng tien xe may va 6 ^ khong chuyen dung vdi ty le 80,1%.
Bang 3.4: Phin bd loai thddng ton cua nan nhan
Loai thiftfnq ton Tray xi/dc Gav xifdnq Chan thUcJnq nqi/c Oian thu'dnq so nao :han thrfflng nhieu
vunq
Tan so ( n ) 1125 2319 536 4627 1478
Ty le { % ) 11,1 22,9 5,3 45,7 14,6
TLT vong sau khi cap cu'u
Tong
41 1 0 1 2 6
0,4 100 Nhin xet: Nhieu nhat la chan thu'dng sp nao 45,7%, tiep den gay xu'dng 22,9%, ty le tu"
vong sau khi cap ciTu khdng thanh la 0,4%. Sd nan nhan bl TNGT den benh vien cd tinh trang stiock la: 587/10126 ea chiem 5,8%.
Bang 3.5. Phin tich sd benh nhan bj shock va sd benh nhin dddc sd edu tru'dc khi dSn BSnh viSn
cihi Siiocl<
Shock Khong shock Tong
SO cu'u dung n 72 1984 2056
3,5
%
96,5 100
Klidng stf cu'u/
sd cu'u sai n 515 7555 8 0 7 0
%
6,4 93,6 100
P
<
0,01
Nhin xet: Cd 8070 ea chan thu'dng khong du'dc sd ciTu hay ed sd ciTu nhu'ng sai (chiem ty ie 80%), 2056 ca la cd sd ciTu va diing (chiem t^
i§ 20%). Cd 72 ca bi shock trong 2056 ca du'dc sd ciTu diing chiem 3,5%. Cd 515 ea bi shock trong 8070 ca khdng du'dc sd edu hoac sd ciTu sai chiem 6,4%. Ty ie khac biet nay cd y nghTa thdng ke (p < 0,05)
Bang 3.6.Phin tich chi phi trung binh cho moi benh nhin
Clii plii (trieu dong) DUdi 01 trieu dong rCr 01 - <03 trieu dong rir 03 - <05 trieu dong Tiros - <10 trieu dong TLT 10 trieu donq trd len
Tong
So lu'dng 1954 3929 1995 1296 952
10126Ty ie C/o)
19,3 38,8 19,7 12,8 9,4
100,0 Nhin xet: Chi phi dieu tri trung binh cho mdt BN TNGT du'dng bp tai BVDKNN la tir 01 den 03 trieu dong chiem t^ le cao nhat 38,8%.IV. BAN L U A N
So tru'dng hdp cap edu do TNGT den cap ctiXi tai BVDKNN trong giai doan 2014-2016 la 10126 BN. Nhu vay trung binh mdi ngay ed hdn 9 BN TNGT den cap ciTu. Dieu nay la do BVDK Ndng nghiep la benh vien idn nhat d phia nam thii dd Ha Npi, nam d vj tri giao thdng huyet mach nen nhtitig tru'dng hdp TNGT trong khu VLTC thu'dng du'dc duS den cap cirU tai Benh vien. I4at khac day la mot Benh vien da khoa ed nhan liTc chuyen sau ve chan thiTdng va trang thiet bi dong bd, dam bao ctiat lu'dng va dieu tri trong viee cap ciTu TNGT la khan tru'dng - khoa hoe - ehinh xac.
Phu'dng tien gay tai nan nhieu nhat la xe may 93,8%, Dl bd chiem 2,7%. Xe dap it nhat chiem 1,4%. Xe may (loai phu'dng tien du'dc siT dung
VIETNAM MEDICAL JOURNAL N''1 - OCTOBER - 2017 rdng ral nhat hien nay d nu'de ta) la phu'dng tien
gSy tai nan nhieu nhat (93,8%). O nong thdn, xe may edn la phu'dng tien du'dc siT dung vao nhieu viec, chd nhieu ngu'di, chd nhieu hang va phan nhieu la da cu, it du'dc bao dudng, tham chi du'dc "cai tien" cho phii hdp vdi chiTc nang mdi.
Ty ie tai nan do xe dap gay ra thap - theo ehiing tdi - cdn do nhDtig sd eo xay ra thu'dng ehi gay thu'dng ton rat nhe nen dai da sd ngu'di bi tai nan khdng can den cd sd y te de cap ciTu va nhij'ng tru'dng hdp nay khdng du'dc thdng ke.
Nhdm tuoi bi TNGT du'dng bp nhieu nhat la tif 16 - 60 tudi (75,9%); nam gidi gap TNGT eao gap 2,13 lan so vdi nu" gidi. Day la dp tud'i hpc tap va lao dpng ehinh ciia xa hdi, tham gia giao thdng nhieu nhat. va gay anh hu'dng Idn den cupe sdng hpc tap, lao ddng ciia ca nhan, gia dinh va gay suy giam den lu'c lu'dng lao ddng, san xuat ciia xa hdi.
Phu'dng tien van chuyen BN bj TNGT chii yeu la xe may va phu'dng tien khdng chuyen dung (chiem t / le 80,1%). Doi tu'dng tham gia van chuyen BN chii yeu la ngiTdi than va ngu'di di du'dng, dieu nay du'dc giai thich la trinh dp dan tri edn thap chu^ y thiTc du'dc sd can thiet trong viec sir dung phu'dng tien chuyen dung de van chuyen Bl^l va cac djch vy van chuyen chuyen dung chu^ du'dc phat trien de phuc vu nhu cau can thiet khi bj TNGT.
Ty le BN bj chan thu'dng sp nao va gay xu'dng rat cao (45,7% va 22,9%), tu'dng tiT vdi ket qua nghien ciTu khac la chan thu'dng tai viing dau, mat va chi chiem hdn mdt nufa (59,8%) eae vu chan thu'dng [4]. Dieu nay diTde giai thi'eh la BVDKNN cd may mdc hien dai (chup cong hu'dng tiT va chup cat Idp vi ti'nh) ho trd chinh xac cho viee chan doan va dieu trj.
Ty le BN tru'dc khi den BV chu'a du'dc sd ciTu hoac sd ciTu nhu'ng khdng dung phu'dng phap cdn rat cao chiem ty le 80%. Qua ket qua nay cho ehiing ta thay du'dc la mac dii da du'dc tuyen truyen rdng rai ve kien thuTc sd cap ciTu nan nhan, nhutig hieu qua cDng ehu:a that siT hai long. Vdi ty le chan thu'dng sp nao cao, gay xu'dng nhieu chu'ng td mot sd cd sd kham chUa benh trong he thong van chu^ dap ifng tot trong cong tac to chiTc kham chu'a benh cho nhdm ngu'di b§nh nay.
V. KET L U A N
- Benh nhan vao cap CLTU do tai nan giao thdng chii yeu la do sir dung phu'dng tien ia xe dap va xe may.
- Lira tudi bi nhieu nhat tir 16 den 60 tuoi
7686 tru'dng hdp (75,9%). Ty le nam bj tai gap 2,13 lan so vdi t^ ie d nu'.
- Ty le thu'dng lat: cao nhat la chan thu'dng sp nao va gay xu'dng chi.
- BN bi TNGT du'dc du'a den benh vien cap ciTu chu yeu do ngu'di di du'dng va ngu'di than du'a den
- Ty le benh nhan bi shock tren nhij'ng benh nhan khdng du'dc sd ciTu hoac sd cii'u sai cao gap ddi ty le benh nhan bi shock tren nhiJng benh nhan du'dc sd ciTu dung.
- Neu du'dc dieu tri ngay tai tuyen dau thi kS qua dieu tri se rat iBt, chong hdi phuc chan thiTdng va kinh phi chi tra la hdp ly (tiT 1-3 trieu dong), KIEN NGHj
- Can tang cu'dng hdn nCTa cong tac truyen thdng de nang cao nhan thiTc eua nhan dan, nhat la nam gidi trong dp tuoi lao dpng ve tinh hieu qua, sir can thiet bao ve ban than trong viec dpi mij bao hiem dung quy each, quy dinh va klidng uong ru'du bia khi tham gia giao thong.
Thu'dng xuyen tuyen truyen, giao due phap luat ve ATGT cho hpc sinh trong tru'dng hoc va tuyen truyen lu'u ddng, tuyen truyen tren eac phu'dng tien thdng tin dai chiing cho edng nhan lao dong va ngu'di dan dja phu'dng
- Xay diTng cac tram cap ciTu chan thu'dng tai nhu'ng Vj trf phii hdp, dac biet la dpc theo chieu cac tuyen giao thdng trpng diem. HiTdng dan cho mpi ngu'di cac bien phap sP ciTu chan thu'dng do tai nan giao thdng (vi du; cd djnh tam thdi gay xu'dng, cam mau ...) d nlia tru'dng, d edng dong.
TAI Ll|U T H A M KHAO
1. Tong cue thong ke (2011), Tinh hinh kinh te- x l hoi Viet Nam mu'di nam 2001 - 2010, Nha Xuat ban Thong ke.
z. Bo Giao thong Van tai (2011), Ket qua ^hfing chong TNGT du'dng bg tai Viet Nam cua nganh Y te va ke hoach trien khai giai doan 2011-2015,1:6 sin tai, http://wv*fw. mt.gov. vn/m/tin- tue/1005/29742/ket-qua-phong-ehong-tngt-duMi^r bo-tai-viet-nam-eua-nganh-y-te-va-ke-hoach-trle&
khai-giai-doan-2011-2015.aspx, truy cap n g l l
20/9/2015. M i. Ministry of Health of Vietnam, World Health
Organization, Hanoi School of Public Health (2009), Report: Evaluation of the Vietnam ro%
traffic injury prevention project (VRTIPP). y 4. Hpc vien canh sat nhan dan (2013), Tong k |
tinli hinh tai nan giao thong nam 2013, ri http ://v™w. hvcsn'd .edu. vn/vn/Acedemy/Tin-An-toan-*
giao-thong/207/3910/Tong-ket-tinh-hmh-tai-nan'*^
giao-thong-nam-2013.aspx "^
5. Luat giao thong du'dng bo 2008.
6. Bo Hang Th?ch (2014), giam TNGT nhin tir cong tac tuyen truyen, NXB giao thong van tai.
