VIETNAM MEPICAL JOURHAL N°1 - APRIL - 2017 binh thu'dng, trong ciing dp tudi so sanh, thay
khong cd sff khac blet. Tac gia Biji Van Han (1990) cho rang lay cao rang va hffdng dan VSRM ed tae dung lam giam ty le CPl 2 va CPl 3, ket qua dat yeu cau duy tri diidc tdi sau thang thff 3. Ket qua so sanh nay la kha ngoan muc, nd khong chl ehffng minh cho quan di&n dieu tri khdi dau la bffdc dieu trj can ban nhat trong dieu trj benh QR, ma con chiing minh can thiep benh QR d ngudi OTD typ 2 cung dat dffdc ket qua tffdng tff nhff d ngu'di khong mae DTD.
Bang 3.6 eho thay tru'dc can thiep sd trung binh viJng lue phan lanh manh (CPl 0) va vung luc phan khdng cd cao rang (CPl 1) rat thap. Tuy nhien sau ean thiep, trung binh moi benh nhan cd gan 1 vung luc phan CPl 0 (tff 0 vung tang len 0,8 viJng), ed hdn 3 vung luc phan GPI 1 (tff 0,2 vung tang len 3,3 vung). Trung binh vung luc phan CPl 2 va CPl 3 cung giam manh. Sau ean thiep, trung" binh mdi benh nhan ed gan 2 viJng iuc phan CPl 2 (tff 4,1 vung giam xuong cdn 2,7 vung), trung binh vijng luc phan CPl 3 gan nhff khdng ed (giam tff 1,6 vimg edn 0,1 vung), dong thdi khdng xuat hien vimg luc phan CPl 4.
Nhff vay sau can thiep, mac dau khong co benh nhan nao cd ma sd CPl 0 (ldi hoan toan lanh manh) va GPI 1 (chay mau ldi ddn thuan) chi chiem 23,3%; nhuYig xet ve trung binh vung luc phan thi sau can thiep binh quan moi benh nhan tdi 4 viing eo CPl 6 va CPl 1 va cd gan 2 viing CPl 2 (1,7 viing), sd trung binh viing lue phan CPl 3 giam rat manh va gan nhff bang 0 (tff 1,6 vung giam xudng 0,1 viing). Vdi thdi gian tai kham sau 3 thang ma trung binh vimg lue phan cd eao rang (CPl 2) van xap xi 2 viing ehffng td eao rang tai tao kha nhanh, chu yeu d vimg rang ham va rang cffa dffdi. Day eung la mpt dac diem ran lffu y de cd nhffng khuyen cao va dan dd benh nhan tai kham vdi thdi gian phii hdp. Mat khac, nghien cffu eung cho thay lay eao
rang va lam nhan mat ehan rang cd tae dung tot trong viec tai tao va hinh thanh bam di'nh mdi, Trung binh vimg luc phan cd tui ndng (CPl 3) cung vi the ma giam di dang ke.
V. KET LUAN
Sau khi nghien effu can thiep quanh rang tren 30 benh nhan mac OTO typ 2 tai khoa Ring Ham Mat benh vien Bach Mai, chung toi rut ra ket luan sau: Dieu tri khdi dau benh quanh rang d eae benh nhan DTO typ 2 giup cai thien dang ke mpt so chi sd quanh rang nhu' OHIS, GI va CPITN vdi mffe y nghTa thdng ke p < 0,01.
TAI UEU T H A M KHAO
1. International Diabetes Federation (2Q09),
"Guideline on oral health for people with diabetes", B-1170 Brussels - Belgium.
2. Ainamo 3A, Seppala B (1994), "site-by-site follow-up study on the effect of controlled versus poorly controlled insulin-dependent diabetes mellitus", J Periodontal, 21(3): 161-5.
3. Iwamoto Y, Nishimura F, Nakagawa M, Sugimoto H, Shikata K, Makino H, et al (2001), "The effect of antimicrobial periodontal treatment on circulating tumor necrosis fartor- alpha and glycated hemoglobin level in patients with type 2 diabetes", J Periodontot, 72: 774-778.
4. Lechleitner M, Herold M, Dzien-Bischinger C, Hoppichler F, Dzien A (2002), "Tumour necrasis factor-alpha plasma levels in elderly patients with type 2 diabetes mellitus-observations over 2 years". Diabetes Medicine, 19: 949 - 953.
5. Ta Van Binh (2006), "Benh dai thao du'dng - tang glucose mau", Nha xuat ban Yhoc, tr. 24 - 35.
6. Brochut PF, Marin I , Baehni P, Mombelli A (2005), "Predictive value of dinicai and microbiological parameters for the treatment outcome of scaling and root planing", J Clin Periodontot, 32(7): 695-701.
7. Cugini MA, Haffajee AD, Smith C, Kent RL ]r, Socransky SS (2000), "The effect of scaling and root planing on the clinical and microbiological parameters of periodontal diseases: 12-month results",.; C//>? Periodontal, 27(1): 30-6.
MO TA Y Tird-NG vA HANH VI T V SAT
(y BENH NHAN ROI LOAN TRAM CAM NANGT O M TAT
*Vi§n sdc khoe Tim than, Benh vien Bach Mai Chju trach nhiem ehinh: Nguyen Van Dung Email: [email protected],vn Ngay nhan bai: 9.01.2017 Ngay phan bien khoa hoc: 8.3.2017 Ngay duyet bai: 14.3.2017
Nguyen Van Dung* va cong sy TU sat la mpt cap cffu thu'dng gap trong lam sang tam th3n hoc, dac biet la tram cam. Muc tieu: Mota dac diem lam sang y tu'dng va hanh vi tU sat va nhSn xet mpt so yeu to lien quan den y tu'dng va hanh vi ti/
sat d benh nhan tram cam. Phu'dng phap:_^Ngliien cffu mo ta cat ngang, dUa theo tieu chuan chan doan ICD-10, tff thang 10 nam 2014 den thang 8 nam 2015. Ket qua: TU sat gap nhieu nhat d giai doanTC nang ed loan than (chiem ty le 100%) tiep tiieo la
54
TAP CHi Y HOC VIET NAM TAP 453 • THANG 4 • SO 1 - 2017 RLTCTD CO loan than (88,9%). Cac trieu ehffng dac
trutig cho tram cam nSng c6 vai tro tfiuc day tii sat nhu cam xuc buon rau, bi quan, ehan nan, mi't hy vpng gap d 100% cac BN. Nguy cO ciia tU sat lien quan den cae yeu to nhu benh tram cam, yeu to ve tam ly xa hpi va cac yeu td ngSn ngffa tU sat. Ket luan: y tu'dng va hanh vi tii sat thu'dng gap trong tram cam nang eo loan than (100% trong roi loan cam xuc iuBng ci/c, 88,9% treing tram cam tai dieii), lien quan chu yeu tram cam tai phat va cac yeu to tam ly
>S hpi.
SUMMARY
DESCRIPTION OF IDEAS AND ACTS SUICIDE DISORDERS IN PATIENTS
SEVERE DEPRESSION Suicide is a common emergency in dinical psychiatry, especially depression. Objective: Describe clinical characteristics and behavior idea of suicide and review a number of factors related to the ideas and behaviors of suicide in depressed patients. Methods:
cross-sectional descriptive study, based on diagnostic critena for ICD-10, from October 2014 to August 2015. Results: Suicide meets the most severe stage of psychosis TC (accounting 100%) followed by RLTCTD with psychosis (88.9%). The symptoms characteristic of major depression with suicidal role of promoting feelings as sadness, pessimism, depression, loss of hope found in 100% of patients. The risk of suicide- related factors such as depression, psychological factors and social factors prevent suicide. Conclusion:
ideas and suicidal behavior is common in severe depression with psychosis (100% of bipolar disorder, 88.9% in recurrent depression), relabng mainly recurrent depression and the psychosocial factors I. DAT VAN OE
Tff sat la mpt cap effu trong lam sang tam than hpc. Cd nhieu nguyen nhan khae nhau dan den tff sat: do tram cam, do cac stress tam ly, do hoang tffdng va ao giac chi phoi, do doa tff sat dan den tff sat thffe sff. Tram cam la nguyen
nhan hang dau dan den tii sat, nhieu nghien cuXi cho thay cd tdi 75% so tru'dng hdp tff sat cd lien quan den roi loan tram earn, trong dd 2/3 la tram cam cd loan than va 10-15% benh nhan tff sat thanh edng. TLT sat ed the xay ra d mpi loai tram cam nhffng pho bien hdn ca (nguy cd cao) d benh nhan cd roi loan tram cam nang. Mpt so benh nhan tff sat dffdc phat hien va cffu song, song nguy cd tai tii sat la rat eao. O Viet Nam da cd mpt so nghien cffu ve tff sat tren cac benh tam than ndi chung nhuPg cho tdi nay chu^ cd eong trinh nao nghien cffu ve y tu'dng va hanh vi tff sat d benh nhan roi loan tram cam nang, do vay ehung toi tien hanh nghien effu de tai vdi cac muc tieu nghien effu sau:
1. Mo ta dac diem iam sang y tudng va hanh vi tu'sat dbenh nhan rdi loan tram earn nang.
2. Nhan xet mot sd yeu td lien quan den y t&dng va hanh vi tu'sat.
II. D 6 | TU'ONG VA PHU'OTMG PHAP NGHIEN CLTU Gom 56 benh nhan dffdc ehan doan roi loan tram cam nang co y tffdng va hanh vi tff sat theo ICD-10, dieu tn noi tru tai Vien Sffc khde Tam than Benh vien Bach Mai va Benh vien Tam than Trung Udng I, tff thang 10 nam 2014 den thang 8 nam 2015. Nghien efflj mo ta cat ngang. 56 lieu du'dc xff ly theo phffdng phap thong ke y hpe, ed sff dung chffdng trinh SPSS 16.0.
III. KET QUA NGHIEN cCrU
1 . Dac diem chung ciia nhom benh nhan nghien cu'u
Trong 56 benh nhan, nam chiem 30 va nff la 26. Tudi trung binh 32,71 ± 12,82. Ngu'di dpe than gap cao nhat vdi 34 BN (chiem 60,7%).
Bang.l; Phan ijobenh ntian co hanh vi tu'sat al cac theijenh The benh
F32.2 = 8 F32.3 = 16 F33.2 = 12 F33.3 = 9 F31.4 = 4 F31.5 = 7 Cong = 56
Nam So lu'dnq
1 7 3 6 5 22
12,5
%
43,8 25,0 66,7 0,0 71,4 39,3
NO' So li/tfng
4 3 4 2 1 2 16
»/o 50,0 18,8 33,3 22,2 25,0 28,6 28,6
Tone So liftfng
5 10 7 8 1 7 38
so
»/o 62,5 62,5 58,3 88,9 25,0 100,0 67,9 2. Cac yeu to lien quan den y tu'dng va hanh vl tu* sat
Bang .2: Cac yeu to iam sang iien quan den lianh vi tu'sat Khong CO hanh
v l T S
Co hanh vl TS OR
( 9 5 % C I )
Tai phat TC 26 (46,2%)
12 (21,4%)
7 (12,5%) 11 (19,6'
3,4
0,92<OR<13,02 <0,05
Hoang tu'dng bi toi
Lam dung chat
Co Khonq
Co Khong Tram cam nanq - Becic
Mirc ae Y T T S - ["liller
27 (48,1%) 11 (19,6%) 20 (35,7%) 18 (32,1%) 28,13±7,01 33,95±5,89
7 (12,5%) 11 (19,6%) 4 (7,1%) 14 (25,0%) 23,94±5,74 22,78±4,26
3,86 1,03<OR<14,98
3,89 0,94<OR< 17,25
u ' = 4,9243 ii" = 23,3594
<0,05
<0,05
<0,05
<0,01 Trong sd cac benh nhan tram cam tai phat, so BN ed hanh vi TS nhieu gap 3,4 lan so benh nhan khdng cd hanh vi b/ sat. Sff khae biet nay cd y nghTa thong ke vdi p<0,05. 6 benh nhan co lam dung ehat so BN ed hanh vi tff sat nhieu gap 3,89 so benh nhan khong cd hanh vi tff sat. Sff khac biet nay ed y nghTa thong ke vdi p < 0,05. Mffc dp tram cam bieu hien bang test Beck va mffc dp y tffdng TS bang thang Miller d nhdm benh nhan c6 hanh vl tff sat nang ne hdn nhdm khong cd hanh vi tff sat.
Sff khae biet nay ed y nghTa thong ke vdi p < 0,05.
Bang 3: Cac yeu to'tam lyxa hdi lien quan den t&sat
— _ l 1 a n h vl TS Yeu to lien quan _
Gicli Tinh trang
hon nhan Sang chan tam ly
Nam NiS Co qia dinh Ly hon, doc tiian
05 Kiiong
Cb hanh vi TS 22 16 10 28 18 20
Khong co
Hvrs
8 10 11 7 3 15
OR
(95% cn
1,72 0,48<OR<6,21
4,4 1,16<0R<17,41
4,5 0,98<OR<23,49
P
>0,05
<0,05
<0,05 Nhdm dpe than d nhiJPg BN cd HVTS nhieu gap 4,4 lan so BN co gia dinh khong cd HVTS. Sff khac biet nay cd y nghTa thdng ke vdi < 0,05. Nhdm BN cd sang chan tam ly cd HVTS nguy eao gap 4,5 lan so BN khong cd sang chan tam ly. Sff khac biet nay co y nghTa thong ke vdi < 0,05.
Bang 4: Cac yeu to ngan ng&a tu'sat
Sff tuan thu OT eiia ngffdi benh Khong
Ho trd eua gia dinh Dffde dieu tri day
du
Khong
0,16 0,Q4<OR<0,63
" C o Khong
Nhffng benh nhan tuan thu dieu trj tot thi cd ty le tff sat ft hdn 0,23 lan so vdi nhutig benh nhan khong tuan thu. Sff khac biet nay cd y nghia thong ke vdi p < 0,05. Sff khae biet nay cd y nghTa thong ke vdi p < 0,05. Trong so cac BN tram cam nang dffdc dieu trj kjp thdi thi so cd hanh vi tff sat it hdn 0,23 lan so vdi ngffdi khong cd hanh vi tff sat. Sff khae biet nay ed y nghTa thong ke vdi p < 0,05.
IV. BAN LU^N
4 . 1 . D i e diem lam sang YT va HVTS d cdc b | n h nhan nghien cu'u: Benh nhan rdi loan cam xuc lffdng effc, hien tai giai doan tram cam nang cd loan than chiem ty le tff sat cao gap d nam. Tiep theo la RLTCTD hien tai giai doan n3ng co LT chiem 88,9%. Ket qua nghien cuU cua chung toi cung phu hdp vdl nghien culJ cua Rihmer A (2008) vdi 1/3 so benh nhan b-am earn ddn cut va 2/3 so benh nhan roi loan cam xue luQng cut hien tai tram cam ed hanh vi tff sat.
4.2. Cac y§u t o lien quan den y tu'dng va hanh vi tu* sat
0,23
0,05<OR<0,91 <0,05 M&c dp y t&dng t& sat: Khi sff dyng thang Miller de danh gia mffc dp YTTS eho thay diem trung binh cua thang Miller d nhdm cd HVTS cao hdn hSn so vdi nhdm khdng ed HVTS. Sff khac biet nay ed y nghTa thong ke cao vdi p<0,01. Y tffdng tff sat la thffdng xuyen cd trong tram cam, trong da so cac tru'dng hdp ngffdi benh ndi YTTS cua minh trffdc Wii chuyen qua hanli dpng. YTTS cang manh Net thi nguy cdTS eang cao. Ketqua nay eiia chung toi cung phu hdp vdi Kaplan H.I.
(1994) khi nhan dinh la y tu'dng t y sat eang tram trpng thi eang de dan den HVTS.
Cac yeu td tam iy xa hdi iien quan den hanh vi t&sat: Gidi tinh it ed lien quan den hanh vUi/
sat. Sff khac biet ve gidi khong cd y nghTa thong ke vdi p>0,05. Theo Dao Hong Thai (2007), khao sat hoi cffu tai Trung tam sffc khoe Tam than Thanh pho Ho Chi Minh: vdi 205 benh ntian loan than ed y tffdng va hanh vi tff sat thay nam ch'iem 59,5%, nff chiem 40,5%. Ket qua^ nay eung tPdng tff nhu' nghien cffu cua chung toi vfli ty le nam va nff chenh lech khdng dang ke. Tac
TAP CHi Y HOC VIET NAM TAP 453 - THANG 4 - SO 1 - 2017 gia Oyama H (2010) khi nghien cffu nguy cd TS
d benh nhan TC da eho rang, benh nhan TC nam cd nguy cdTS cao hdn benh nhan nff.
Tinh trang hdn /7/?a/j: _ phan tfch cac yeu to tam ly xa hpi cd lien quan den hanh vi tff sat d benh nhan roi loan tram cam nang cho chung tdi thay nhdm dpc than d nhffng BN ed HVTS nhieu gap 4,4 lan so BN ed gia dinh khdng cd HVTS. Sff khac biet nay co y nghTa thdng ke vdi p < 0,05.
Dao Hong Thai thay nhffng ngu'di dpe than ehiem 74%, ed gia dinh 26%, trong so lieu nay khong phan biet du'dc y tffdng va hanh vi iii sat.
Cac sang ehan tam iy: nhdm benh nhan ed sang chan tam ly cd hanh vi tff sat cao gap 4,5 lan sd benh nhan khdng ed sang ehan tam ly. Sff khae biet nay cd y nghia thong ke vdi p < 0,05.
Nguyen Hffu Ky (1996) cho rang mau thuan gia dinh gap trong 80,7% sd tru'dng hdp tff sat, mau thuan tai cd quan chi chiem 3,6%, mau thuan xa hpi chiem 2,2%, benh man tfnh gap d 1,2%, cd thai ngoai y muon gap d 0,5% so tru'dng hdp.
Tac gia cho rang chi mpt ty le nhd (11,8%) benh nhan la khong ed ehan thu'dng tam ly.
4 . 3 . Cac y e u t o n g a n ngufa h a n h v i t u ' sat S& tuan thu dieu tri cua ng&di benh: Theo Pompili. M. (2008) sff hdp tac dieu tri eua benh nhan co lien quan den van de nhan thffc ve benh va vai tro cua dieu trj gop phan lam giam nguy cd tff sat. Benh nhan cang ed y thffc hdp tae dieu trj tot thi y tffdng tff sat cang it va nguy ed thu'c hien hanh vi tff sat cang giam.
Ho trd cua gia dinh va xa hdi: Tac gia Au AC (2009) khi nghien ciiu ve vai trd cua gia dinh va xa hpi doi vdl tff sat da ket luan rang eac benh nhan CO sff giup dd tot tff gia dinh va xa hpi thi nguy cd tff sat se giam nhieu. Freitas G.V. va epng sff (2002) Iffii nghien citu tram cam va Ur sat d nhffng co gai tre ed thai thay nhuPg eo khdng cd ban fral va fl: nhan dutfc sff quan tam cham sdc ciia gia dinh va )a hpi thi ty le tff sat cao.
Benh nhan d&dc dieu tri hdp ly: Nghien cffu cua t . W. Haywood (1995) khi cho rang nhii'ng benh nhan khong duldc dieu tri duy tri day dii cd nguy cd tai phat cao dan den tang ty le tff sat.
Gaudiano BA. (2005) eho rang viec theo doi va dieu tri tiep tue eho eae benh nhan nay la rat can thiet tranh tai phat. Gonda X. va cdng sff (2007) cho thay c6 rat nhieu benh nhan tff sat vi hp khong diicic dieu tn day dii. Tac gia k§t luan rang de t^ng cffdng cong tac phdng ehong tff sat, dieu quan trpng la tang cffdng cong tac dao tao cho cac bae sy tam than, nhat la cac bac sy da khoa trong viec chan doan va dieu trj rdi loan
tram cam, dac biet nhffng ngu'di ed y tffdng va hanh vi tff sat. BNTC nang neu khong dffdc DT day du bdi cac thanh to tren, kha nang xuat hien YT va HVTS nhieu hdn. Ket qua nghien ciTu eiia chung tdi phii hdp vdi nhieu nghien cuXi khae, trong cong tae quan ly dieu trj benh nhan roi loan tram cam nang, rat can phai giai thfch eho mpi thanh vien trong gia dinh cua benh nhan ed roi loan tram earn ve nguy cd tff sat cao eiia benh nhan da cd HVTS de hp blet each cham sde, quan ly va phat hien sdm YT va HVTS ciia ngu'di benh.
V. KET LUjOkN
1. Tff sat gap nhieu nhat d RLCXLC hien tai giai doan TC nang eo loan than (chiem ty le 100%), tiep theo la RLTCTD ed loan than (88,9%). Cae trieu chirtig dac tru'ng cho tram cam nang cd vai trd thuc day tii sat nhU cam xiie buon rau, bl quan, ehan nan, mat hy vpng gap d 100% cac trffdng hdp.
2. Cac yeu to lien quan den YT va HV tii sat:
Binh tram cam: Tram cam tai phat cd ty le tu' sat eao gap 3,4 lan. Tram cam cd loan than nguy cd t y sat cao hdn tram cam khong cd loan than 3,68 lan. C^e yeu td ve tim iy xa hdi: Nhiipg ngffdi doc than, ly hdn cd nguy cd tff sat cao gap 4,4 lan. Nhffng benh nhan cd sang chan tam ly nguy cd TS cao gap 4,5 tan so vdi benh nhan khong cd sang chan tam ly. Cac yeu td ngan ng&a t&sat: Nguy ed tff sat thap hdn d benh nhan tuan thii dieu tn tdt, cd s y quan tam, giiip dd ciia gia dinh va dffdc dieu tri hdp ly.
TAI UEU T H A M KHAO
1 . Nguyen Hihi Ky (1996), Nghien aid sd iien guan giua yeu td ngoai lai, nhan td tam ly va nhan to benh tam than d'nhuhg ngddi toan tu'sat, Luan an tien sy y hoc, Tru'dng Dai hoc Y Ha Noi, tr 45-70.
2. Au AC, ' Lau S, Lee M.T. (2009), "Suicide ideation and depression: the moderation effects of family cohesion and social self-concept".
Adolescence. Winter press;44(176):851-868.
3. Gelder M., Gath D., Mayor R. (1988). "Affective disorders", Oxford texbook of Psychiatry, (Second edition), p. 268-323.
4. Guillaume S, Jaussent X, Jollant F, et al.
(2010), "Suicide attempt characteristics may orientate toward a bipolar disorder in attempters with recurrent depression", 3 Affective Disorders . Apr;122(l-2):53-59.
5. Pompili M, Innamorati M, Raja M, et al.
(2008), "Suicide risk in depression and bipolar disorder: Do impulsiveness-aggressiveness and pharmacotherapy predict suicidal intent", Neuropsychiatr Dis Treat, (Feb;4(l)), pp. 247-255.
6. Yoshimura R. (2007). "Treatment of depression from the point of view of suicide prevention", Seishin Shinkeigaku Zasshi.l09{9):B22.
