5. Koul RL, et al(19g8), Epidemnlogy and ciinieai profile of diildhood Guillain-Barre Syndrome in Oman.
Middle East Paediatrics, vol 3:41-44
6. Kenwyn James (2005), Plasma Exchange or Intravenous ImmunogliAulins in Treatment of Guillain Barre Syndrome? J NeumI Neumnurg Psychiatry, vol 6:
69-77.
7. Korinthenber, Joachim SchessI, Janbemd Kirschner and JOrgen SshuRe MOnting (2005)^
Inti^venously Administered Immunoglobulin In 9»
Treabnent of Childhood Guillain-Band syndrome: A Randomized Trial, Pediatrics, vol 116:8-14.
8. Owen B, et al (1986), Guillain-Ban-d syndrome in children. Pediatrics in mview, vol 8.3:69-75.
DANH GIA THUC TRANG CHAN THUUNG MAT DO TAI NAN GIAO THONG TAI PHONG TRUC CAP Cl)U DENH VIEN MAT TRONG UUNG
TOM T A T
Muc tiSu: (1) DSnh glS vi thuc trang chin thuxmg mit tgi Bpnh vien Mit Trung irong (2) Tim hiiu mdt s6 yiu t6 lidn quan din tai nan thucmg tich tgi mat.
Doi Urgmg vi phuvng phip nghiSn cOv: NghiSn eiru md tS dt ngang dirge thuc hipn trin 92 bdnh nhSn bj tai ngn giao thdng cd chin thuang mat tai phdng tnj€ dp cOv BPnh vipn Mat Tmng uang tir thing 7 nim 2010 din thSng 10 nam 2010. Kit qui nghiSn ciru: Vi thuc trgng chin thirong mit tgi bdnh vipn Mit Tmng uang: Cd 16,3% bpnh nhSn cd vit thuong nhin du, vS 16,3% bpnh nhSn chin thirong dung dpp tgi mat Cd 66,3% cic tru&ng hgp chin thuong gSy rich da cOa mi ddt Ip quin vS 22.8% cd kdm theo ehin thuong toSn thdn. Anh hudng nghiem trong din thi luc (dim ngdn tay < 3 m chiim ff Id 31,5. Cd sg- khSc bigt rd rpt vS cd 3? nghla thdng kd giO'a s6 tuil vdi bdnh nhSn bj chin thirong mit do tai ngn giao thdng (p < 0,05). Ty lp gpp tai ngn giao thdng d nam IS 79,3% vS d n d li 20,7%. Si/ khic bipt nay cd y nghTa thing kd vdi p <0,05.
TCP khda: Tai nan giao thdng, Tai ngn giao thdng du&ng bd, bdnh nhdn, dim ngdn tay
REVIEW STATUS EYE INJURY TRAFFIC ACCIDENT IN THE EMERGENCY ROOM AT CENTRAL EYE HOSPITAL
SUMMARY
Objective: (1) Assessment of the current state eye injury at the Centml Eye Hospital (2) Learn a number of factors mlated to the eye injury. Subjects and research methods: Cmss-sectional descriptive study was perfonned on 92 patients with tmffie accident ankle in a hospital emergency room dimetly centml eye fmm July 2010 to October 2010. Research results:
On the status of eye injuries in the centml eye hospital:
Them are 16.3% of patients had ocular Injuries, and 16.3% of patients with ocular contusion injury. 66.3%
of all Injuries caused by eyelid skin tom off govemance pmctices and 22.8% am accompanied by full-body injury. Seriously affect vision, such as hand good night
< 3m, accounted for 31.5 percentage. Them is a distinct and meaningful statistics on patients between the age of eye injury due to traffic accidents (p<0.05).
The mte of traffic accidents was 79.3% in males and
N G U Y i N TH! THUY VAN - Bpnh viSn Mat Trung uvng LE THI BINH - Hgc viSn YDHCT Vipt Nam
20.7% females. This diffemnce was statistically signiffcant with p<0.05.
Keywords: Traffic • accidents, mad tmffie accidents, patients, counting ffngers
D^rVANDt
Tai ngn giao thdng Id s y vide bdt ngd xay ra ngodi y mudn chu quan cOa ngudi didu khiln phuang ti$n giao thong, do vi phgm cdc quy tde an todn giao thdng hay do gdp nhdng tinh huong, s y cd ddt xult khdng kjp phdng trdnh. Tai nan giao thdng hdng ndm cudp di sinh mang cua han 1,2 tridu ngudi trdn todn edu, 50 tridu ngudi khdc phai mang thuang tdt su^
ddi [7]. Cling vdi s y phdt tridn cua xd hOi, sd lupng ca chdn thuang ndi chung cung nhu ehdn thuang mdt ndi ridng ngdy edng gia tdng. Tgi phdng tryc c4p cdu Bdnh vien Mdt Trung uang gdp rat nhieu tm-dng hap TNGT md chdn thuang dnh hudng trye tidp t^l mdt. Nhdng tai ngn thuang tich tgi m i t gdy t6n thuang nghiem trpng ddn chdc ndng thj gidc, thdm my vd t d dd gdy dnh hudng nghidm trpng ddn si)c khde, tinh thdn cOng nhu kha ndng lao ddng cOa bdnh nhdn. Cho ddn nay tai bdnh vidn Mdt Trung uang chua cd nghidn edu ndo nghidn edu vd Uivc trgng tai ngn thuang tich tai mdt do TNGT, chlnh vl vdy chCing tdi tidn hdnh nghien cdu dd ^i.'DSnhgiS thgc trang chin thu&ng mit do tai ngn giao thdng (g/
phdng tnrc cip cdu Bpnh vlpn Mit Tmng uong' nhdm mye tidu:
1. DSnh gii vi th^rc trang chan thirong mit ^f bpnh vipn Mat Trung irong
2. Tim hieu mpt so yeu t6 liin quan din fa/
nan thirong tich tai mat
D 6 | T U - O N G VA PHU'ONG PHAP NGHIEN CCW 1. Tidu chudn li^a c h p n : Bdnh nhdn chdn thuong mdt do TNGT ddn khdm tai phdng tryc cdp cii-u b$nti vi$n Mdt Tmng uang.
2. Tidu c h u i n logi trCr: Bdnh nhdn khdng ddng y hodc khdng phdi hap tham gia nghidn edu.
3. P h u v n g phdp nghidn c d u : Nghidn cdu mdti tidn cdu.
Chpn mdu: Chpn mdu thudn tidn, gdm 92 bdnh nhdn ehdn thuang tgi mdt do TNGT ddn khdm
3.1. Dja diim vi th&i gian: Tgi phdng tn/c dp cdu bdnh vi$n Mdt Tmng u a n g t d thdng 7 ndm 2010
Y HOC THirc HANH (922) - s 6 6/2M4
ddn thdng 10 ndm 2010.
3.2. nuong 1^ nghiSn cOu: Phidu didu ba tai ngn Irong cdc budi tryc.
3.3. fiien s&: Hp Tdn, hj6i, gidi, i^a d i l , d\a didm xdy ra tai nan, blnh dd hpc vdn, nghd nghi#p, tinh trgng udng nrgu, bia, cdc chdt kich tfiich, c6 ddi mO bdo hidm hode khdng...
Tlnh b^ng tdn thuang tgi mdt; Vdt thuang da mi, dut Id qudn. Vdt thuang nhdn edu: Rdch gidc mgc, ding gidc mgc, vdt thuang dgng ddp nhdn edu. Tlnh bgng ton tiiuang todn thdn phdi hap.
3.4. Phurmg phip tiin hinli nghiSn cdv: Tdp hudn ede diku dudng b'yc tiiam gia didu tra bdnh nhdn bj tai nan vd didn vdo phidu didu Ira TNGT.
4. Dgo d d c nghidn ci>u: Bdnh nhdn ddng y tham gia, vd cd thd t d chdi tham gia vdi bdt ky ly do ndo.
5. X d ly vd phdn tich s 6 Hdu: Sd lidu duac x d ly bdng phdn mdm EPSS 15.0
KET QUA NGHIEN CI>U 1. Ddc didm Chung cQa b$nh nhdn Bdng 1. Dde didm ehung cua bdnh nhdn bi tai ngn do chdn thuang mdt.
Bi^n s6 nghiSn oitu Gi6i: Nam
NO P NhCmtuii: 0 - 1 5 l u 6 i
16-40 tu6i 41 - 60 tu6i
> 60 tuil Tu6i Irung binh
P
Trtnh d6 v&n h6a: Dai hgc, sau dai hQC Trung hoo Dh6 thOng
Trung tioc ca sd Tiiu hoo Nghi nghiip; Cin b i cing chCrc
Hoo sinh. sinh viin Cing nhin Lao ding t^ do
Ning din Khio
BN chin thuong m i l {n=92) n 73 19
Tv l i % 79.3 207
<0,05 5 52 31 4
5,4 56,6 33.7 4,3 34,4 ±13,9
<0,05 17 57 14 4 18 11 16 39 5 3
18.5 62.0 15.2 4.3 19.6 12 17.4 42.3 5.4 3.3 n Id bdnh nhdn nam g$p nhidu han n d (79,3% so vdi 20,7%). Tudi nhd nhdt ld'5 tudi, ngudi tudi eao nhdt Id 73 tudi. GO tudi thanh nidn t d 16-40 ehidm nhidu nhdt (56,6%), tidp theo Id dd tudi tmng nidn t d 41-60 chidm 33,7%, 0 dp tu6i t d 0 - 15 tudi cd 5 budng hp-p chidm 5,4 %.
SO bdnh nhdn tai ngn giao tiidng cd trinh dd trung hpc phd tiidng chidm ty Id cao nhdt (62%) tidp ddn Id binh dd dgi hpc vd trdn dgi hpc (18,5%), tmng hpc c a sd 15,2%, tidu hpc 4,3%.
Ty Id chdn thuang mdt do tai ngn giao thdng eao nhdt gdp d nhdm lao ddng t y do (42,3%), ty Id tai ngn thdp han d nhdm cdn bd cdng chdc, hpe sinh sinh vidn, cdng nhdn...
2.0$c didm cOa cdc tai ngn xdy ra Bdng 2. Ddc didm ngn nhdn khi xdy ra cdc tai ngn
Biin s i nghiin ci>u Dia diim xiy ra tai nan:
Nii Ihinh Ngoai thinh • Tlnh trang d i l m i : Khing d i l mu bao h i ^
C i dii m i tiao hiim Loai phiKmg Hin giy lai
nan giao thing: O t i Xemiy Phirang tiin t h i so Tlnh Irang su dung ruou
bia' C i Khing
BN chin thirang mit (n=92) n
55 37 68 24 12 75 5 48 44
T y l i % 59,8%
40,2%
74,2%
25,8%
13,0 81.5 5,4 52,2 47,8 Tai ngn giao thdng gdp d ndi thdnh (59,8%) nhidu han ngogi thdnh (40,2%). Tat ngn giao thdng do s d dung xe g i n mdy khdng s d dgng mu bdo hidm cd 74,2% tru-dng hap, chr ed 25,8% tmdng cd s d dung mu bao hidm. Bdng 3.2 cho thdy, xe mdy Id phu-ang tidn gdy tai nan giao tiidng nhidu nhdt chidm 81,5%
tren tdng sd cdc vy tai ngn giao thdng. Trong khi dd ty Id tai ngn do d td ehidm 13% vd phuang tidn thd s a chidm 5,4%. Tlnh trgng cd s d dgng nrau bia chidm han mpt nda (52,2%) so b$nh nhdn tai ngn giao thdng khdng s d dgng ruau bia khi tham gia luu thdng trdn dudng it han (47,8%)
3. Tinh trang tdn t h u v n g do TNGT bj t h u v n g tich tgi mdt
Bdng 3: Bang phdn bd theo tlnh trang tdn thuang.
Tlnh b^ng tdn thuong
Vdt Ihupng nhdn cdu"
Vdt thucrng nh3n cdu/todn than Sang chdn dijng ddp~
Sang ch^n dgng d$p/todn than Sang chdn dung ddp/ddt Id
quan Sang chdn dut Id qudrT
Sang chdn fldt Id quan/todn than
tneo tinn irgng ton m u a n ; BN chdn thu-qng mat (n=92) M TI'/I& T u l A r - h i i n n Ty 1$ Chung
20 (21,7%)
15(16,3
%)
(61,9%) [66,3%
Vdt thuang nhdn cdu ehidm 9,8%. Vdt thuang nhdn cdu ed kdm theo chdn thuang todn thdn chidm 6,5%. Sang chdn dgng ddp chidm 14,1%. Sang chdn dung ddp cd kdm theo ehdn thuang todn thdn chidm 2,2 %. Sang chdn dgng ddp cd kdm theo ddt Id qudn chidm 5,4%. Sang chdn ddt 1$ qudn chidm ty Id cao nhdt 47,8 %. Sang ehdn d d l Id qudn ed kdm theo chdn thuang todn thdn ehidm 14,1%.
4. Phdn loai t h i ^ trgng mflt bj chdn t h u a n g do tai ngn giao thdng
Bdng 4. Phdn bd tlnh trgng ehdn thuang tgi mdt kdm theo ehdn thuang todn thdn.
Biin s i BN chin Ihuong m i l don
thuin Chin Ihuong m i t Kim chin thuong toin thin
BN chin thifong mit (n = 92) N
71 21
T v i i % 77,2 22.8
Y HQC THVC H A N H (922) • S6 6/2014
Ty Id BN chan tiiuong m i t kdm chan thuang toan ttidn chidm ty Id thdp hem BN bj chdn tiiuang mat dan thudn (22,8% so vdi 77,2%).
5. Ttnh trang t h i iirc bdnh nhdn:
Bang 5. Phdn bd tinh trgng thj lyc bdnh nhdn
Bdnh nhdn cd thi luc ddm ngdn tay° < 3m chiem 31,5%, thj lyc "dem ngdn tay*^td 3/10-8/10 Id 35,9%.
TTii luc "ddm ngdn tay" > 8/10 ehiem 27,2%.
BAN LUAN
1. Ddc didm chung cDa ddi t u g n g nghidn c d u Phin bo bpnh nhin theo gi&i: Ket qua nghidn cdu cho thdy ty Id gdp tai nan giao thdng d nam la 79,3% vd d nd Id 20,7%. S y khde biet ndy ed y nghla thong kd vdi p < 0,05. Ddy Id ty Id khd chdnh lech.
Dieu ndy cd tiie ly giai rdng, do nam gidi thudng hay cd thdi quen khi tham gia giao thdng trong tinh trang da udng ruau bia vd y thdc kdm, chii quan didu khien phuang tidn vdi toe dp cao, phdng nhanh vudt au, Igng ldch ddnh vdng. VI le dd BN nam gidi ehiem tdi 79,3% so vdi BN nd Id 20,7%. Ket qua ndy cung phu hpp vdi nghidn cdu ciia nhdng tdc gia khdc ve djeh t i hpc ciia ehan thuang mdt Id so BN nam chiem da sd so vdi BN nu [1]. Ket qua nay cung phO hap vdi thdng kd vd tinh hinh tai nan thuang tich tgi epng ddng 6 thdng dau ndm 2005 eua Tong cyc nghidn cdu thdng kd,
Dpc diem benh nhin theo nhdm tuoi: Qua phdn tich 92 tnj-dng hap bdnh nhdn tai ngn thuang tich mat do TNGT ddn kham tgi phdng t n j c cdp cdu Bdnh vidn Mdt Trung uang chiing tdi ntidn thdy dp tuoi trung binh Id (34,4 ± 13,9) tudi, ddy thudc nhdm tuoi thanh thidu nidn. d dd tudi t d 0-15 tudi cd 5 trudng hap chidm 5,4 % thdp han bdo cdo thdng kd ciia t / Id nan nhdn dudi 14 tudi Id 13% [4]. Dp tudi thanh nidn (td 16-40) vdi 62 trudng hap chiem 56,6% tidp theo Id dd tudi tmng nidn t d 4 1 - 60 cd 21 trudng hap chiem 33,7% Nhu vay dd tudi thanh nidn (td 16-40) cd ty \p cao nhaL Day thye s y la eon so ddng Io ngai vd cdn cd nhdng nghidn edu sdu han nda vd tinh hinh thuang tich mdt do TNGT d dp tudi ndy vi ddy Id Ida tudi phdi hpc tdp vd lao ddng ndn thuang tich mat cQng dd xdy ra han. Hp Id lyc luang lao ddng chinh trong gia dinh vd xd hpi ndn khi b| ehdn thuang mdt khdng ehi thidt hai cho bdn thdn ho, md edn Id ganh nang ddi vdi gia dinh vd xd hdi la rat ndng nd. O dd tudi t d 0 - 15 tuoi ed 5 trudng hap chiem 5,4 %, ket qua ndy eOng phu hap vdi bdo cdo tai bdnh vien Vidt Ddc vd tai ngn giao thdng nhin t d bdnh vidn Vi$t Ddc [3], kdt qud nghien cdu cua chung tdi thdp han ket qud nghidn cuu ve tai nan thuang tich trd em do TNGT ddi vdi tre dudi 6 tudi duac thyc hidn tgi bdnh vidn Nhi Trung. uang thdng 3 ndm 2009 (ty lg nay Id 8,6%) trd em bj chdn thuang do TNGT [1]. Nhung ddy khdng phai la nghidn edu sdu vd tai ngn thuang tich tre em, ndn chi ddn vd sd lidu khdng thd hien d
tidn bdng thdng kd. Ddc bidt cdn cd cdc ydu td kinh td, xd hpi vdi cdc nguydn nhdn gdy tai ngn tiiuang lich do TNGT d tird em. N h u bidn dOi vd e i u tnie gia dinh, tdc ddng cua kinh td thj bordng vd trinh dd vdn hda cDa cdc bdc cha me trd. Kqnc cho thdy cd sy khdc biet vd c6 y nghTa thong kd gida s6 hjdi vdi bn bj chdn thuang mdt do tai ngn giao thdng (p< 0,05).
V4 trinh dp vin hda: CSc tmdng hyp tai ngn tiiuang tich mat do TNGT chl cd khodng 18,5% biidil^' hap bdnh nhdn cd trinh dd hpc vdn t d dgi hpc bd ldn cd s y hidu biet nhdt (^nh vd vdn dd phdng trdnh lal' ngn thuang ti(^ ndn ty id mde tai ngn thuang tich mdt cung it han. Tai ngn thuang tich mdt do TNGT tdp bung d nhdm cd tiinh dp pho thdng tixing h9cJ62%), tmng hpc c a s d (15,2%). Didu ndy cd thd ly gidi ring, tudi tre kdm Iheo Irinh 6p nhdn thdc kdm, nghdnh ngang, coi thudng phdp ludt, khdng ndm duac ludt giao thdng nen chua hieu dung ddn vide tham gia giao thdng mdt cdch an todn ddng thdi chua cd kien thtrc ve ede bien phdp phdng chdng ndn ti Id gdp tai ngn thuang tich cung nhidu han.
Ve phan bo nghi nghiep: Lao ddng t u do d§
mde TNGT nhidu han ca do dac thO cdng vide hp phai lidn tgc di chuydn trdn dudng tham gia giao thdng ndn tai ngn Ihu-ang tich cQng dd xay ra han.
Cd 39 tm-dng hap id lao ddng t y do c h i ^ ti 1$
42,4%. cdng nhdn c6 16 tm-dng hp'p chidm 17,4%, cdn bd edng chdc cd 18 trudng hap chidm 19,6%, tf Id ndy ndi ldn s y hgn chd trong nhdn thde hidu qud cCia vide tham gia giao thdng an todn.
2. Dac didm cda cdc tai ngn:
Dia diem xiy ra tai nan: Khu v y c xay ra tai ngn thuang tich mdt d ndi thdnh chidm nhidu han ngogi thdnh (59,8% so vdi 40,2%), bdi Id ndi Ihdnh cd mdt dd ddn eu ddng diic khidn ngudi tham gia giao thdnii;^
cDng se rdt nhidu, ddy cung Id didu thudn lai ngudi'- ddn tham gia giao thdng rdt de bj cdc va chgm ddn ddn bj TNGT Irong 66 cd chdn thuang mdt. T } 1$
thanh nidn thanh thj bj tai ngn giao thdng cao hon nhidu so vdi thanh nidn ndng thdn, kd cd nam ldn nd d mpi dp tudi. Didu nguyc Igi, mdc dd tai ngn giao thdng d ndi thdnh nhg han d ngogi thdnh. Didu ndy cd thd gidi thich rdng, do cdc vg tai ngn giao thdng trong npi thdnh gdp nhidu do tai ngn xe mdy, ti'ong khi dd tai nan d ngogi Ihdnh Igi hay xdy ra cde vg tai nan dtd va tdc dd di chuydn d ngogi thdnh cao hem ndi Ihdnh, ndn mdc dd c h i n thuang n$ng han. Trong sd nhdng thanh nidn bj lai ngn giao thdng d thdnh tiij, d dd ludi 15-19 chidm ty 10 cao nhdt bdi hdu hdt thanh nidn thdnh thj bidt di xe mdy I d 15 ludl (bdt chdp quy ^ n h cua ludt phdp Id 18 tudi) c^ii ydu Id nam Ihanh nidn. Mdt khdc hp chua cd bdng Idi xe mdto ndn chua dup-c hgc kidn tilde vd ludt giao thdng. Chinh vl Id dd vide vi phgm giao thdng dSn ddn tai nan Id didu khd trdnh khdi [1].
Tinh trang dpi mQ bio hiim cUa n^n nhin bj TNGT: Theo kdt qud nghidn cdu, cd tdi 74,2% sd bdnh nhdn khdng 6pi mO bdo hidm khi luu ttiOng bdn dudng. Tuy nhidn tlnh trgng ddi mQ bdo hidm hay
Y HOC THVC HANH (922) - s6 6/2014
khfing dpi mu khdng hen quan d^n rt 1$ bi tai nan giao thong nhung nd lai Il6n quan rat ch^t ch6 tdi miic d6 tr^m trpng cua chSn thuang ndi chung vd chin thuong tai m i t no! ridng. Theo so li$u tir 54 tinh thdnh cua B6 Y te trong nSm 2008 c6 495.545 vu chin thuong dau, Trong s6 nSy, ty 1$ nan nhan du'd'i 14 tuoi la 13%. Gan 50% s6 trk em bi chan thu'ong nao khdng dpi mu bao hiem Ngudn s6 lieu d6 cung cho biet 2 1 % so ca nhdp vi^n vl tai nan giao thdng IS tre em va vj thanh niSn trong dO tuoi 0-19 [1] T d khi Nghi quyet 32 dupc ban hdnh nSm 2007, tat ca mpi ngud'i deu phai dpi mu bao hi^m khi di xe mSy vi kk tif 15/12/2007, viec doi mu bao hi^m da dupc thyc thl chat che tren to^n quoc vdi hi vpng giam dang ke ty le tu vong va chan thu'ong viing dau, mSt. Ket qua giam sat phan thuong d b$nh vi$n VietDLfc cho thiy trong 6 thang tii' thang 3.6kn t h i n g io/2006, ty le c6 dpi mu bao hiem chi chi6m 5% d tat ca cac tru&ng hpp gap chan thifong dc tai nan giao thong [3], Bang thong ke tren cho t h i y tinh trang dpi mCi bao hiem v i n chua dupc c h i p hanh nghidm chinh.
06 toi 49 trud'ng hpp chiem 74,2% kh6ng dpi mu BH khi tham gia giao thong Dliy that sy \i v i n de nhifc nhli cua xa hpi khi y thuc ngudi d i n cdn kem,
Oac diem cac nhom phiro-ng tlSn giy tai nan:
Hlu het tai nan giao thong duong bp vd tai nan giao thong noi chung d Viet Nam deu liSn quan den xe mdy va oto. So lupng phuang tien nay trong nuoc cung gia tdng nhanh chong So luong xe mdy tang 4 trieu xe tiJ' nam 1996 len g i n 30 tripu xe vdo ndm 2009 vd tro thdnh thj trud'ng xe mdy dung thiF 4 the 9161 sau Trung Quoc, An DO, Indonesia [5]. Trong khi d6 CO sd ha tang nhu dud'ng xd, c l u pha,, vdn chua bit kjp voi nhu cau, Trong nghi&n CLPU cua chiing toi Chan thuong tai mdt do tai ngn giao thdng chu y l u Id tai nan xe mdy voi 75 trudng hpp chi^m 81,5%, ty le nay c6 mli lien quan den hdnh vi khOng an todn nhu Ihli quen uong rupu, bia, Theo thing k§ cua benh vi?n Viet Du'c cd 12% ngud'i Idi xe mdy co uong rupu bia truoc Idi xe mdy vdi gio [5], Mat khac mpt nguyen nhdn khing the bo qua Id do ngud'i ddn su dung xe mdy qud cu khong dam bao an todn, nh&ng xe mdy Trung Quoc khong duoc ki^m tra chat lupng da dupc dua vdo su dyng, do d6 gdy ra nhUng tai nan giao thing ddng tiec.
Tinh trang sir dung ru^u bia: Mdc dii Ludt Giao thing dud'ng bp cp quy dinh chdt che nghiem cam ngul'i dieu khien 6 to, mo 16. xe g i n mdy khi tham gia giao th6ng khong dupc su dung ruou bia nhung tinh trgng nay vdn con xdy ra pho bien vd co xu hudng gia tdng [2], Qua k^t qua nghien cifU tren cho thiy hon mit nua (52,2%) s6 benh nhdn tai nan giao thflng CO su dung rupu bia khi tham gia luu thong Irin du6ng Theo mpt th6ng k l chua day du cua Uy ban ATGT Quoc gia, tii' ndm 2000 d^n n3m 2009, c6 tfri 6% ting s6 vu tai ngn giao thdng xay ra do sd dyng rupu bia [3], Cac vu tai ngn ndy p h i n Id'n xay ra 0 cic thdnh pho Ion nhu Ha nOi, TP H 6 Chi Minh. .Hon 70% nh6m ngudi tham gia giao thdng c6
s d dpng nrgu bia Id ngudi dieu khtSn xe mdy, trong s6 ndy c6 khoang 3,6% bi tai ngn giao thdng sau khi s d dung n/ou, bia. C6 td'i 77,9% nam gidi di^u khiln phuang ti&n giao thdng ngay sau khi vira u6ng Ofp-u, bia [3]. Ddy la mdt thyc trang ddng bao ddng. Cung theo th6ng ke trgn thi dd tu6l b^t dau u6ng njou, bia cua ngud'i dan dang ngdy co xu hudng tre hda, khoang tif 18^25 tuoi.
3. Ddc di&m tai nan thiFomg tich tai mdt:
Qua k i t qua tai bang 3 t h i y ring vet thuang nhdn cau c6 t6ng c6ng 15 trudng hop chilm 16,3%. Day Id loai c h i n thuang m i t rat ndng g6m cac t6n thLfong nhu rdch gidc mac, cung mac, v& nhan c l u , . . K h i ndng bao ton nhdn c l u vd duy tri phyc hoi chiFc ndng thi gidc la rat khd, han the nCra nhung loai chan thuang nay thud'ng phai di^u tri Idu ddi d l i hoi cong sue, t i l n liac r i t Id'n nhung ket qua thud'ng khdng duac nhu mong doi [4]. Sang c h i n dung ddp co 20 bdnh nhdn chiem 21,7%. Dieu ndy c6_the ly giai ring, nhung sang c h i n loai ndy cd the dien bien ngay t d dau hodc ndng d i n \Sn theo thdi gian, r i t khd d l t i l n luang vd dieu tri cung k i o ddi d l lai nhilu b i l n chii'ng ve sau va cung anh hudng d i n chuc ndng thj giac cua BN d i n g thai true t i l p Idm anh hudng d i n lao dpng san xult [6] Sang c h i n dirt le quan c6 62 benh nhan chiem 66,3%, loai ton thuong nay chiem nhieu nhit trong nhom t i n thuang do TNGT, Ly giai eho sang ehin dui Id qudn t r i n BN ndy thud'ng khong anh hudng nhieu den thj lyc nhung anh hudng r i t \&n d i n t h i m my, nP gdy khd khdn r i t ll-n trong smh hogt hdng ngdy cCia BN, Tuy nhidn. hign nay eo r i t nhilu phuang phdp k i t hpp d i l u tri vd tgo hinh dupc ap dyng trong ITnh vyc c h i n thuang mit.
Nhin tren bang 3,4 ta t h i y tinh trgng BN c h i n thuong mdt c6 kfem theo c h i n thuang todn thdn chilm 22,8%. Day Id nhu'ng trud'ng hpp c h i n thuang r i t ndng n l , thd'i gian dilu tri se k i o ddi, phyc hoi ldu, anh hudng r i t Id'n d i n cuOc s i n g sau ndy,
Tlnh trang thj tiPC BN: Nhi/ng tai nan thuang tieh tai mdt thudng gdy ton thuong nghiem trpng d i n chuc ndng thi gide Xir 66 gdy anh hudng ndng n l d i n sifC khoe, tinh t h i n cung nhu kha ndng lao dpng cua benh nhan. Qua NC ndy cho thiy, s6 b§nh nhdn c6 thj lue < DNT 3m ehilm ti le rat cao 31,5%, Theo djnh nghTa eua To chu'c Y t l The gid'i muc thi lye ndy dupe eoi Id mii I l a vi vdy se anh hudng r i t nhilu d i n tinh than, su'c khoe vd kha ndng lao d i n g d l tao ra cua cdi vat chit cho xd hpi, hon t h l nti'a c i n khing t y ehdm soc cho chinh ban thdn minh vd c i n phai e l su giiip do cua nguoi khde. Day Id cde chin thuong ndng, bpnh nhdn phai d i l u tn Idu ddi vd t i n k i m , sy eai thi|n thi lye sau dieu tn Id r i t it, Hp phdi ehiu gdnh ndng do thuong tieh gdy ra va ehit lupng cuOc sdng eua hp se bj dnh hudng r i t nhieu, Cdc chin thuong khdc nhu rdch da mi, dirt le quan e l 62 trudng hpp (66,3%), cac c h i n thuong nay tuy khing anh hudng den thi lyc BN nhung se anh hudng nhilu v l mdt tham my, D i l u ndy c l t h l giai thich rdng, trin khufin mdt c l nhCpng v l t s?o do rdch da mi s l gdy sy chii y
Y HOC T H i ; c H A N H (922) - S 6 6/2014
cua mpi ngudi khi giao t i l p vd d i l u n i y se Idm benh nhdn r i t khd chiu khi c^n phai t i l p xuc, giao tiep trong sinh hoat hang ngdy trorig cupc s i n g .
KfeT LUAN
1. Dinh gia vi tiiuv trang chan thuvng mat tai bSnh ViSn Mat Trung uvng
- C6 16,3% bgnh nhdn cd vet tiiuang nhan cau, vd 16,3% benh nhdn c h i n thuang dung d$p tai mat Cd 66,3% cac tm-dng hg'p c h i n thuang gdy rdch da mi ddt 1$ quan. C6 22,8% c6 kem theo c h i n thuang todn thdn. Anh hudng nghiim trong d i n thi lyc (<
O N T 3 m l c h i e m t i l l 3 1 , § ,
2. Yeu t6 liSn quan din tai nan thirong dch tai mat: C6 sy khdc bi$t rd rdt vd c6 y nghTa thong ke giO'a s6 tuoi vdi benh nhdn bi chan thuang mdt do tai ngn giao thong (p < 0,05). Ty I I gdp tai ngn giao thing d nam Id 79,3% vd d nO- Id 20,7%. Sy khdc biet ndy c6 y nghla t h i n g k6 vdi p < 0,05
TAI U E U THAM K H A O
1. An Suang, Nguy co tai n^n thuxmg tich thu^g tnrc voi tri em. website giao dye va Widi dgi, www.gdtd.vn, 10/01/2010.
3. Bao tin tuc Vipt nam, Tai n^n giao thong do l^m dung nrvu bia gia tang, www.Hanoimoi.com.vn, 3/12/2010.
4. B|nh ViSn Vipt DLPC, Tai n^n giao mong nhin tir benh vien Vl$t D&c, www.vietduchospital.edu vn, 27/06/2010.
5 Hd Huy Tien, Nguyen Due Anh (1994), Bai giing lam sang nhan khoa. NXB Y hpc, tr.88-102.
6. Huy Hodng, Hon da ViSt nam xuat xirdng.
www.tinhte.vn. 15/5/2010.
7. Le Thuy Hgnh (2009), Nhin xit m0t s6 dac diim cua benh nhin bj chin thirong mit vio diiu trj t^i khoa chin thirong Benh vien Mat Tmng irong, Hpi n^hj khoa hpc dieu dudng Bpnh vipn lUlat Trung uong lan ll.Hpi dilu dudng Vipt Nam, tr.21.
8. Thanh tra giao thong v$n tai (201OJ, H01 nghj an toan giao thdng toan quic, http:/rthanh tra.mt.gov.vn, 27/12/2010.
KET QUA DIEU TRj CO DjNH DAY THANH TIT THE KHEP
LE VAN CHfNH, BV YSn Dfnh QUACH TH! CAN. BV Tai Mui Hgng Trung wong N G U Y I N TUAN SON, Khoa Y Dirac - DH Quoc gia Hi Npi T6M TAT
C6 dinh diy thanh tw thi khip li b&nh I'j' c6 thi giy tir vong, inh hu&ng den chit lu^ng cuoc song binh nhin. NghiSn cCru dirac tiin hanh tr&n 30 binh nhin t^l miin BBc Vi$t Nam, vai muc dich d^nh gii kit qui diiu tri binh nhin co dinh diy thanh tir thi kh^p bing phuxyng phip dt 2/3 sau diy thanh mot bin. Kit qui cho thiy, 90% b$nh nhin hit khd thd.
83,33% hit ngu ngiy, 80% bi khan tiing nhe, dO rdng thanh mdn > 5mm (86,67%), 90% cii thiin ro chirc nBng hd hip. Kit lu$n: Diiu tri benh ly c6 djnh day thanh tw thi khip bing phirang phip cit 2/3 sau diy thanh mOt bin dem lai hi$u qua cao.
Ttrlfhda: Thanh quin. co dinh diy thanh. khd thd thanh quin. phiu thuit cit day thanh.
SUMMARY
Bilateral abductor vocal cord paralysis can cause death, affect the quality of life of patients. The study was conducted on 30 patients in northern Vietnam, with the aim ot evaluating the results of treatment patients with bilateral abductor vocal cord paralysis by the method cutting 2/3 of the postehor unilateral vocal corc/s. Results showed that 90% of all patients no breathing difficulties, 83.33% had snonng off, 80% had mild hoarseness, 86.67% patients had glottis width >
5mm, 90% improved respiratory function. Conclusion:
Treatment of patients with bilateral abductor vocal cord paralysis by the method cutting 2/3 of the posterior unilateral vocal cords giving high efficiency.
Keywords: Larynx, vocal cord fixed, laryngeal
dyspnea, surgical removal of vocal cord.
DAT V A N Dt
Thanh quan Id bO phan quan trpng cua dudng hfi h i p , c6 cac chirc ndng Id phdt dm, ddn khfing khi, bao v$ dudng hfi h i p va nuot. NhO'ng chuc ndng ndy, chu y l u do s y vdn dpng cua ddy thanh tao nln, dudi s y d i l u k h i l n cua day t h i n kinh (TK) h l i qui. C6 djnh ddy thanh 2 b i n d t u the kh6p. Id bgnh ly do tin thuang trung uang hay ngoai vi cua 2 ddy TK h l i qui, nhdnh chi p h l i cho ca m d thanh quan Id ca nhin p h l u sau. Benh khfing nhCrng anh hudng tdi chit lupng cupc s i n g cua benh nhdn md cfin c6 t h l din tdi t u vong do suy hfi h i p d p . Cho d i n nay, trin t h l gidi cfi nhilu phuang phdp 6k d i l u tri c6 (Snhddy thanh 2 ben d t u t h l khep. Jackson (1922) dd dt b l ddy thanh mfit ben [1], phuang phdp treo ddy thanh cua Moore (1923) [2], phuang phdp treo sun phlu cua King (1936) [1]. Woodman (1946) vdi phuong phdp c i t bo sun phSu dudng bgn ngodi syn gidp [31 1976 Tucker tdi tgo s y chl p h l i t h i n kinh cho cdc co md thanh quan [4]. Tgi bgnh vign Tai mOi Hpng TW, hign dang dp dyng phdu thuSt King vd Woodman [8], phdu thuat c i t 2/3 sau ddy thanh mOt bgn [5], md khi quan,.., Trong d l , phuang phdp c i t 2/3 sau diy thanh mpt bgn d u p c ung dyng nhilu nhit, do n l bdo t i n duoc mOt p h i n chuc ndng phdt dm, ddm bio chdc ndjig hfl h i p vd nult. Nhung hign tgi d nudc ta, chua cfi nghign cdu ddnh gid higu quS phuang phdp e l t 2/3 sau ddy thanh mflt bgn, trong d i l u trj c6 djnh ddy thanh hai b i n t u t h l kh6p, d i l u dfi dd thdc diy
Y HOC THUC HANH (922) - s6 6/2014