sy KHAC NHAU wt CAC CHl S6 LIEN QUAN TCf\ DINH DU'O'NG XAC DINH THEO PHU'aNG PHAP SGA CUA BENH NHAN < 65 TU6l TAI BENH VIEN 198
Nguyin Do Huy' , Doan Thj Ttfdng Vi^
' Vipn Dinh dir&ng Qudc gia, Hd Ndi
^Bpnh vipn 198-Bp Cdng An, Hd Ndi
TOM TAT
Ngtiien CLPU ntilm m6 tS cac ctii s6 lien quan ti!n dmh du'd'ng cua cac ntiom benti nlian suy dmh du'ang (SDD) va nhom benh ntian dinh duang tot theo c^ch d^nh gia bang cong eg dSnh gia doi tupng toan dien chu quan (Subjective Global Assessment)(SGA) Thiel ke nghien cu'u c^t ngang tien hanh tu' thang 2 den ttiang 4 nam 2012 Iren 411 can bp v^ chien sy nganh cong an (a benh nhan nhap vien di^u tri trong vong 48 gid d£lu tgi Benh vien 198 cho thiiy Ccic chi so lien quan toi nguy co dmh duong khac cua nhom benh nhan SDD d^u cao ho'n so v&\ nhdim benh nhan dinh duong tot: Ty le giam can >5 % trong 6 thang cua nhom SDD (25,4%) cao hon gip 8 lan so voi ty le nay 6 nh6m dinh duong tot (3,3%)(p<0,001) Ty le giam khau phin an o nhom SDD (68,3%) cao gap 5 lan so voi nhom dinh du&ng tot (13,1%)(p<0,001) Ty Ie giam chiJc nang van dong cua nhom SDD (76,8%) cao hon gap 3 lan so voi nhom dmh du&ng tot (26,4%)(p<0,001). Ty le cd dau hieu sang chan chuyen hoa cua nhom SDD (89 %) cao hon so v6i ly le nay a nhom dmh duong tot (65.0%)(p<0,001) Ty le xuat hien cac tneu chifng da day-rugt cua nhom SDD (50,0%) cao ban gap 2 lan so voi ty le nay o nhom dmh duong tot (24,5%){p<0,001),
Til" khoa: Chi so lien quan dinh du&ng, phu'ong phap SGA, benh nhan < 65 tuoi.
L DAT VAN DE
Che dp dinh dudng day du d ngudi trudng thanh giiip dam bao cau true va chuc nang cua cac CO quan trong ca the, he thdng mien djch duoc tang cudng de chdng lai benh tat, co the duy tri duac trang thai sue khde tdl [ I ].
Khi hi mac benh, nhirng ngudi cd tinh trang dinh dudng ca the tdt se cd sue de khang vdi benh tat tdt hon va mau chdng Ianh benh; trong khi nhihig ngudi cd ca the kem dinh dudng, dac biet la suy dinh dudng keo dai, khi mac benh se lau khdi [2]. Suy dinh dudng d benh nhan nam vien dan den tang bien chimg ddi vdi benh, keo dai thdi gian nam vien, tang ly le tii vong, tang chl phi y te [2], [3]. Dinh dudng tdt trong benh
vien sc giiip benh nhan tang cudng kha nang de khang vdi benh tat, sdm lanh benh va mau chdng hdi phue stic khde[2],[3]. Do dd, viec xac dinh tinh trang dinli dudng d benh nhan nhap vien la rat can thiet, dac biet la nhung benh nhan cd nguy co cao can hd tra dinh dudng tich cue. Viec danh gia tinh trang dinh dudng ctia benh nlian trong benh vien chua dugc coi trong, nSu ed thi chi danh gia tinh trang dinh dudng qua eae ehi sd nhan trac (ehieu cao, can nang va chi sd BMI). Trong khi eac cdng cu danh gia tinh trang dinh duong nhu edng cu danh gia ddi tugng toan dien chu quan (Subjective Global Assessment) (SGA) cho ngudi benh tir 16 den
< 65 tudi dugc su dung rdng rai trong benh vien cua cac nudc tren the gidi thi viee su dung cac
* Tac gia: Nguyen Dd Huy Dia chi: Vi?n Dinh Dudng Email: nguyendohuyl965(^yahoo.com
Ngaynhanbai: 16/2/2013 Ngay gui phan bien: 28/2/2013 Ngay dang bai: 5/5/2013
Tap chi Y hpc du phdng. Tap XXIII, sd 2 (138) PHU BAN
cdng cu nay cdn r^t xa la vdi hku hdt cac b?nh vien d nudc ta [2],[3].
Hicn nay van dc dinh dudng trong b$nh vien vkn chua dugc quan tam dung mue. Thdng tin vd tinh hinh dinh dudng ciia benh nhan mdi nhap vien ndi chung va theo tung khoa phdng ndi rieng cdn rkt han che Do dd, nghien cuu nay dugc thuc hicn vdi muc tieu md la cac chi so Iicn quan tdi dinh dudng ctia cac nhdm benh nhan SDD va nhdm benh nhan dinh dirdng tdt theo danh gia b^ng cdng cu SGA cua benh nhan mdi nhap vicn tai Benh vicn 198.
n . P H U O N G P H A P N G H I E N CU'U 2.1. Thiet ke nghien cuu: nghien cuu md ta cat ngang
2.2. Doi tu'OTig nghien cii'u: Toan bg benh nhan la can bd, chien sy nganh cdng an hr 18 den <
65 tudi mdi nhap vien dieu tri ngi trii trong 48 gid dau tai Benh vien 198 tu thang 2 den thang 4 nam 2012 duae dua vao nghien ciiu.
2.3. Thi^t ke nghien cuu: nghien cuu dich te hge md ta cat ngang
2.3.1. Cff mdu
2P(1-P)
- n la sd lugng ckn di6u tra; Z^ (i-u/z): Dp tin c&y95%thiZ=l,96
- p la ti 1? SDD trong benh vien uac tinh la lay p = 36,9 % trong mpt nghien curu trudc [2].
- d i a sai sd eho phep la 5%. =>Ca mSu tinh duge la 398.
2.3.2. Cdeh chgn mdu: Lay cac benh nhan cd dli tieu chuSn lien tidp den khi dii cd mau.
2.4. Cac phu-oTig phap thu thap so lifu Cac didu tra vien la bac sy va dieu dudng cua Khoa Dmh Dudng Benh vien 198 va Trung tam dao tao ciia Vien Dinh Dudng cd nhieu kinh nghiem danh gia tinh trang dinh dudng tren benh nhan va dugc tap huan chu dao.
Phucmg phap danh gia dinh dudng toan the SGA (Subjective Global Assessment - SGA) duac xay dung bdi Detsky va cdng su nam 1980 va duoc Hiep hdi dinh dudng dudng mieng va dudng tTnh mach ciia My (ASPEN) khuyen cao sir dung [3], [4], [5].
Oanh gia theo phucng phap SGA (diem)
Giam can trong vong 6 Khong thang
Thay doi che do an Khong Trieu chung da day, ruot Khdng Giam kha nang di lai Binh thudng Stress chuyen hoa Khong Kham lam sang Binh thuang
5-10% >10%
Chao dgc/dich du nang lugng Dich nang lugng thap Chan an Buon ndn, ndn Giam vu'a NAm tai giudng
VCi'a Nang Giam Idp md dudi da, khoi co Phii, co chudng
Cac mirc dp dinh dudng gdm: i) Dinh dudng chudn trudc khi phan tich va su dung kiSm dinh tdt(9'-12dicm), ii) Nguyca suy dinh du5ng(4-8 tham sd hoac phi tham sd. So sanh cac ty le diam) va iii) Suy dinh dudng (0-3 digm)[3],[5]. ^^"^ ^'^"^ "^'.^ ^' ^^^'^ ^'^^^' ^'^^'^^ ^^'^- ^f^
2.5. Xii- ly so Heu
Cac bien dinh luong dugc kigm tra phan bd
phan tich thdng ke dugc thuc hien tren phan mSm SPSS 16.0. Y nghia thdng ke dugc xac dinh vdi gia tri p < 0,05 theo 2 phia.
110 Tap ehi Y hge du phdng. Tap XXIII, sd 2 (138) PHU BAN
2.6. t>^o dih: nghien cuu:
Cac can bg nghien ciiu lam vi?e chi tiet ve ngi dung, muc dich nghien curu vdi lanh dao Benhvi^n, cac Khoa lam sang, trinh bay va giai thich npi dung, myc dich nghien cuu vai ngudi benh. Cac ddi tuong tham gia phdng van mpt each tu nguyen, khdng bat bugc va cd quyen tir
bd khdng tham gia nghien ciru ma khdng cin bat cu ly do nao. Vdi b?nh nhan suy dinh dudng se duge tu van dinh dudng, tu van siic khoe.
Cac thdng tin ve ddi tugng dugc giu- bi mat va chi dugc sii d\ing vdi muc dich nghien eiiu, dem l^i Igi ich cho epng ddng.
IH. KET QUA
Biing 1. D$c diem can n^ng cua do! t u v n g theo tlnh tr^ng dinh du'ong (SGA)
Thay doi cSn n|ng
Gldm c3n trong 6 thang qua. n(%) DiKji 5%
TCI 5-10%
>10%
Thay doi can trong 2 tu^n qua, n(%) Tang can Giam can Khong thay doi
Tinh tr^ng dinh dirong theo SGA Binh third'ng
(n = 329)
318(96.7) 11(3,3)
0(0.0)
9(2,7) 74(22,5) 246(74.8)
Suy dinh dtrong (n = 82)
61(74,4) 16(19,5) 5(6.1)
0(0.0) 48(58.5) 34(41,5)
Chung (n = 411)
379(92,2) 27(6,6)
5(1,2)
9(2,2) 122(29,7) 280(68,1)
Gia trj p, Kiem dinh
0,001
0,001
Ty le giam can tir 5-10% trong 6 thang qua "horn SDD chiem 6,1% (p < 0,001). Di sau tim 6 nhom SDD la 19,5% cao hon ro ret so voi a hiSu vS tinh trang dtnh dtrong trong 2 man httac nhom dinh duimg t6t (3,3%, p < 0,001). Ty le ^''' " ' ' ' P " « " "-^y- "^y I? 8""" c™ 'rang 2 tuan giamcan>10%cannangtrong6thanganh6m ° nh6ra SDD la 58,5% cao hon nhom dmh dinh duiing t6t Ichong co d6i tuong nao, con d ^"^i '°> ' ^ 22,5% (p < 0,001).
Bang 2. Oac diem thay ddi khau phan cua doi tuo-ng theo tinh trang DD (SGA) Tinh trang DD theo SGA Thay doi Ithau phan an g i n ^ t h y o n g
Thay doi ichau ph^n. n(%) Kh6ng thay do!
Thay do!
Trang thdi thay do! khiu phin, n(%) Chao dac Djch, du nang luong Dich, nang lu'ong thap Nhm doi Khong thay d6i
|n = 329)
286(86,9) 43(13,1)
27(8,2) 10(3.0) 1(0.3) 5(1.5) 286(86.9)
Suy dinh dirong (n = 82)
26(31.7) 56(68.3)
23(28,0) 11(13,4) 5(6,1) 18(22,0) 25(30,5)
Chung (n = 411)
312(75,9) 99(24,1)
50(12,2) 21(5,1) 6(1.5) 23(5,6) 311(75,7)
Cia trip.
Kiem dinh
0,001
0.001
Tap chi Y hoc du phong, Tap XXIII, so 2 (13 8) PHU BAN
Ty le ngudi benh nliap vi?n khdng an dugc binh thudng, phai ehuyen sang cae dang dinh dudng nhu chao, dich ldng hoae tham chi phai nliin ddi (trir nhung trudng hgp bpnh ly dac bi?t) la difiu can chu y, Danh gia su thay ddi (gi^m) kliau phan an khi nliap vifin d nhdm SDD chicm tdi 68,3% ddi tugng cao hon so vdi nhdm dinh dudng tdt la 13,1% (p < 0,001). D^c bi?t nhifiu benh nhan nhap vicn khdng an dupc binh
thudng, ma phai chuySn sang c^c dang dinh dudng khac nhu chao, dich long hoac tham chi nhjn ddi (hit nhiing trudng hgp benh ly dac biet).
Nhdm SDD phai chuydn sang an chao dac la 28,0%», an dieh Idng dii nang lugng nhu udng sua eao nang lupng, bao siip tai benh vien la 13,4%, an dich Idng nang lugng thap nhu udng nudc chdo, tu chg an la 6,1 % va nhin ddi la 22% deu cao ban nhdm dinh dudng tdt (p < 0,001).
Bdng 3. Tri^u chung d? ddy-rupt theo tinh trang DD (SGA)
Tinh tr?ng DD theo SGA Tri^u chd'ng d^ d^y-rupt Binh thud'ng Suy dinh du'd'ng
{n = 329) (n = 82)
Chung (n = 411)
Gid trj p, Kiem djnh x^
Khdng co trieu chicng, n(%) 281 (85,4)
Buon non, n(%) 5(1,5) Non, n{%) 1(0,3) Chanan, n(%) 34(10,3) Tieu chay, n(%) 8(2,4)
41(50.0) 9(11,0) 4(4,9) 25(30,5)
3(3,7)
322(78,3) 14(3,4) 5(1,2) 59(14,4)
11(2,7)
Cac trieu chiing vfi da day - rugt ciang anh nhdm dinh dudng tdt ty le nay chi la 24,5%.
hudng dfin qua trinh dinh dudng ciia benh nhan. Nhdm SDD ty le chan an la 30,5%, budn ndn la Cd tdl 50%> benh nhan d nhdm SDD xuat hien 1 l,0%j, ndn la 4,9% va tieu chay la 3,1%, su cac trieu chiing da day - rudt, trgng khi do d khac bifit cd y nghia thong ke vdi p<0,001.
Bang 4. Thay doi chuc nang van dpng theo tinh trang DD (SGA)
Thay doi chuc nang van dong
Tinh trang DD theo SGA Binh thuang Suy dinh duo'ng Chung
(n = 329) (n = 82) (n = 411) - Gia trj p,
Kiem djnh z ^
Thay doi cac chuc nang van dong, n(%)
Ktiong thay doJ 242(73,6) Giam 87(26,4) Trang thai thay doi chuc nang van dong, n(%)
Dl lai dugc 130(66,3) Giam chuc nang 50% 58(29,6) Nam tai giudng 8(4,1)
19(23,2) 63(76,8)
24(33.3) 12(16.7) 36(50.0)
261(63.5) 150(36.5)
154(57.5)
70(26.1) 44(16.4)
^ Cac thay doi vg chile nang van dpng la nhiing SDD co ty le di lai dupc la 33,3%, thip hon ty le yeu to iinh huong true tigp d^n qua trinh dinh nay 6 nhom dinh duong binh thucmg. Mpt dieu duong ciia benh nhan. Nhom SDD c6 ty le giam dang quan tam la a nhom SDD co ttW 50% benh chiic nang van dpng len ttji 76,8%, trong khi do nhan phai njm tai giucmg, su khac biet co y nghta ty 16 nay it nhom dinh duong t6t la 26,4%. Nhom th6ng ke voi p<b,001.
1'2 Tap chi Y hpc du phong. Tap XXIII, s6 2 (138) PHU BAN
Bang 5. Muc do sang chan c h u y i n hda do b^nh t^t k^m theo vci dau hi^u thirc the ve dinh du6>ng theo tlnh tr^ng DD (SGA)
Tlnh tr^ng DD theo SGA Sang chan chuyen hda
vi dau hi^u SDD ^ linh thtP6'ng (n = 329) Sang chan chuyin hia do b$nh l(6m theo. n(%)
Khong c6 tneu chung Nhe Vira Nang Dau hieu thtrc t h i ve dinh duong. n(%;
Khong co dlu hieu gi Giam lop mij duoi da Phil, giu nudc Giam khoi co
115(35.0) 139(42.2) 73(22.2) 2(0.6) 1
306(93.0) 18(5.5) 0(0,0) 5(1,5)
Suy dinh dirvng (n = 82)
9(11,0) 32(39.0) 35(42.7) 6(7.3)
55(67.1) 16(19.5) 2(2.4) 9(11,0)
Chung (n = 411l
124(30,2) 171(41,6) 108(26,3) 8(1,9)
361(87,8) 34(8.3)
2(0.5) 14(3,4)
Gfa tfl p, Kiem djnh / ^
0,001
0,001
Cd tdl 89% nhdm SDD cd dau hifiu sang chan chuyen hda do benh kem theo d eac mirc do khac nhau, trong khi dd vdi nhdm dinh dudng tdt, ty le nay chi la 65,0 %. Ty lfi sang chan chuyen hda d muc dp nang eiia nhdm SDD la 7,3% cao hgn nhieu so vdi ty le nay d nhdm dinh dudng tdt {0,6%)(p<0,001). Cac d^u hieu thuc the ve giam mg dudi da, giam eg d nhom thifiu dinh dudng la 19,5% va 11,0% deu cao hon nhdm dinh dudng tdt vdi cac gia tri hrong ung la 5,5% va 1,5%>.
IV. BAN LUAN
Phuang phap danh gia dinh dudng toan thfi chu quan (Subjective Global Assessment - SGA) cho benh nhan < 65 tudi la edng cu sang lgc dugc sir dung rdng rai tren the gidi va budc dau da dugc ap dung d Viet Nam, trong dd cd benh vifin 198 Bg cdng an [2],[3],[4],[5],[6].
Ket qua trong nghien euu nay cho thay ty le giam can >5 %, trong 6 thang ciia benh nhan
SDD la 25,4%, cao han gap 8 lan so vdi ty le nay d benh nhan dinh dudng tdt (3.3%) (p<0,001). Ty lfi benh nhan giam khau phan an khi nhap vien d nhdm bfinh nhan SDD la 68,3%), cao gap 5 lan so vdi nhdm benh nhan dinh dudng tot (13,l%>)(p<0,001). Nhdm benh nhan SDD phai nhin ddi lit 22,0 %, cao hem ty le phai nhjn ddi cua benh nhan dinh dudng tdt Ifin tdi han 14 ISn (l,5%)(p<0,001). Nhdm benhnhan SDD cd ty le chan an la 30,5%i, cao han gkn 3 lan so vdi benh nhan dinh duong t6t(10,3%) (p<0,001). Nhu \ay, nfiu khdng ed che do ean thiep dinh dudng kip thdi dae bifit cac doi hrgng chan an d nhdm benh nhan SDD thi muc do tram trpng ciia bfinli nhan SDD se ngay cang xSu han va anh hudng khdng tdt tdi hieu qua difiu tri va keo dai thdi gian nam vifin.
Ty le bfinh nhan giam chuc nang van dgng cua nhdm benh nhan SDD la 76,8%, cao hon gap 3 ikn so vdi ty le nay d nhdm bfinh nhan dinh dudng tot (26,4%)(p<0,00l). Dae biet d nhdm SDD ed tdi 50%i benh nhan phai nam tai
Tap chi Y hge du phdng. Tap XXIII, sd 2(138) PHU BAN
giudng, vdi nhdm benh nhan dinli dudng tdt, ty lfi nay chi la 4,1 % (p<0,001). Do vay, c5n cd ke hoach cham sdc dinh dudng dae hieu cho nhiing bfinh nhan cd giam kha nang ty eham sdc do mac b?nh va lai cd SDD
V. KET LUAN
Dieu tra tren 411 ddi tupng nhap vipn trong vdng 48 gid dau tai benh vicn 198 thay cac chi sd Ilfin quan tdi nguy ea dinh dudng khac cua nhdm bfinh nhan SDD deu cao hem so vdi nhdm benh nhan dinh dudng tdt' Ty le giam can >5
% trong 6 thang ctia nhdm SDD (25,4%) cao han gap 8 lan so vdi ty lc nay d nhdm dinh dudng tdt (3,3%)(p<0,001), Ty le giam khau phan an d nhdm SDD {68,3"/o) cao gap 5 lan so vdi nhdm dinh dudng tdt (13,1 %)(p<0,001). Ty lfi giam chire nang van dgng ciia nhdm SDD (76,8%) cao hon gap 3 lan so vdi nhdm dinh dugng tdt (26,4%)(p<0,001). Ty le cd dau hieu sang chan chuyen hda ctia nhdm SDD (89 %) cao hon so vdi ty lfi nay d nhdm dinh dudng tdt (65,0%>)(p<0,001) Ty le xuit hien cac trieu chung da day-rudt ciia nhdm SDD(50,0%)) eao han gap 2 lan so vdi ty lfi nay d nhdm dinh dudng tot {24,5%)(p<0,001).
KHUYEN NGHI
Can ap dung eac phuang phap danh gia tinh trang dinh dudng bang chi sd nhan trac BMI.
dac bifit bang phuang phap danh gia toan difin (SGA) cho benh nhan nhap vien dfi phat hien sdm nhung bfinh nhan cd nguy ea thieu dinh dudng dfi ed bifin phap can thiep kip thdi
L&i cdm ffn:
Xin tran thanh cam an cac bac sy, can bg dicu dudng, dinh dudng va ky thuat vi?n ciia Khoa Dinh dudng va cac Khoa lam sang ciia bgnh vi?n 198 da tham gia va ddng gdp quan trgng cho Ihanh cdng ciia nghien cini nay.
TAII.IEU THAM KHAO
1. Ha Huy Khdi (2002). Dinh dudng lam sang.
Nha xuSt ban Y hgc.
2. Pham Thu Huong va egng su (2006). Tinh trang dinh dudng ciia benh nhan nh^p vien khoa tieu hda va ngi tiet tai B?nh vi?n Bach Mai. Tap chi Dinh Dudng va Thuc pham, sd 3+4, trang 85.
3. M.Shirodkar, K.Mohandas (2005). Subjec- tive Global Assessment: a simple and reli- able screening tool for malnutrition among Indian. Indian Joumai of Gastroenterology, 24:246-250.
4. Jane A.Read et al. (2005). Nutrirional Assess- ment in cancer Comparing the Mini Nuttitional Assessment (MNA) with the Scored Patient - Generated Subjecrive Global Assessment (PG- SGA). Nutrition and Cancer, 53(1): 51-56.
5. Dona J.Secker et al. (2007). Subjective Global Assessment for children. Am J Clin Butr 85:
1083-1089.
6. Woong Sub Koom, Seung Do Ahn, et al (2012). Nutritional status of patients treated with radiotherapy as determined by subjective global assessment. Radiat. Oncol. J. 2012; 30 (3): 132-139.
Tap chl Y hgc du phdng. Tap XXIII, s6 2 (138) PHU BAN
THE DIFFERENT OF NUTRITION RELATED INDICATORS OF NUTRITIONAL STATUS OF UNDER 65 YEARS OLD PATIENTS BY SGA TOOL IN
HOSPITAL 198
Nguyen Do Huy', Doan Thi Tiiong Vi^, 'National Institute of Nutrition, Hanoi
^Hospital 198, Hanoi The purpose of the study was to describe the nutiition-related factors of hospitalised patients in hospital among malnutrition group and well- nourished group by SGA tool. A cross sectional shidy conducted from February to April 2012 in 411 patients hospitalized within 48 hours in 198 hospitai showed that all nutrition related in- dicators in malnourished patients were higher than that in well noiuished patients: Percentage of unintentional weight loss > 5 %o of malnour- ished patients was 25,4%, and 8 times higher than that of v/elhiourished patients (3.3%o)(p<0.001).
Percentage of dietary intake change of malnour- ished patients was 68,3%), and 5 times higher
than that of weilnourished patients (13.1%i) (p<0.001) Percentage of reduction of func- tional capacity of malnourished patients was 76,8%, and 3 times higher than that of well- nourished patients (26.4%) (p<0.001). Percent- age of metabolic stress in malnourished patients (89yo) was higher than that of weilnourished pa- tients (65,0%o)(p<0.001). Percentage of gastroin- testinal symptoms in malnourished patients (50,0%o) vi'as two times higher than that of well- nourished patients (24,5%.)(p<0.001).
Key words: Nutation related indicator, SGA tool, malnutrition status, patient under 65.
Tap chi Y hge du phdng. Tap XXIII, sd 2 (138) PHU BAN