' TAP CHI KHOA HDCBOTflSc VAN HIEN
STRESS VA CAC YEU TO LIEN QUAN 6 BENH NHAN BI BENH CO THE MAN TINH
Nguyen Sinh PhiicS Pham Phirong Thao^ Trinh Vilt Then^
' ^ Tnrdng Dgi hgc Vdn Hiin
• Tnrdng Dgi hgc YDuoc TP.HCM '[email protected]
Ngdy nhdn bdi: 02/01/2017; Ngdy duyet ddng: 28/02/2017 TOM TAT
Stress a benh nhdn ndi chung, binh man tinh ndi rieng dang ngiiy cimg dirge cdc nhd tdm lyy hoc quan tdm. Nghien ciru dugc Hen hdnh tren nhdm 335 binh nhdn bi benh man tinh gdm cdc benh: tim mgch, tieu duong vd tdng huyet dp. Kit qud cho thdy cd mdt ty le ddng ke binh nhdn bi stress a cdc mdc do khdc nhau. Stress cdng keo theo mdt sd thay ddi a binh nhdn. Bin canh do, nghien ciru cUngxdc dinh mdt sd yeu td bdo ve cOng nhu yeu td nguy ca ddi voi stress a nhdm binh nhdn ndy.
Tit khda: stress, binh man ti'nh, yeu td.
ABSTRACT
Stress and related factors in patiens with chronic ill
Stress in patients in general, in particular chronic diseases are increasingly cared about by medical psychologists. The study was conducted on 335 patients group of chronic diseases including cardio- vascular diseases, diabetes and hypertension. The results show that there is a significant proportion of patients with stress in different levels. Stress also causes some changes inpatients. Besides, the study also identified a number of protective factors and risk factors for stress in this patient group.
Keywords: stress, chronic diseases, factor.
1. Dat van de
Benh man tinh la benh keo ddi bode tdi phat thudng xuyen. Cd nhieu dang benh m^n tinh nhu la benh phdi tdc nghen man tinh, ddi thdo dudng, tim mach, tang huyet ap, ung thu...
Theo Td chde Y te the gidi, nhirng ngudi mac benh man tinh cd nguy co ddi mat vdi stress cao [5], Bat ky benh man tinh nao ciing ed the gay nen trang thdi stress va kbi bi stress tbi stress lai la nguy co 1dm gia tang muc do nghiem trpng cua benh vd lam ddo ldn cudc sdng cua benh nhdn.
Stress cd the dnh hudng true tiep den viec qudn ly cdc tri^u chung benh. Cac hanh \i Hen quan den stress vi du nhu an udng, sd dung rugu, hut thudc la, it boat dgng the luc, quen udng thudc...
ciing anh hudng den viec tu cham sdc va day eiing Id nhung nguy co lam tang muc dp benh.
Nhu vdy cd the thay stress ddng vai trd rat quan trpng ddl vdi sue khoe cua con ngudi. Stress dnh hudng den khdi phat benh ciing nhu dien bidn vd k^t thuc benh [2]. Mat khdc, co nhidu ydu td lien quan den sUess, bao gdm cac yeu td
ben trong cua ed nhan va tu phia mdi trudng ben ngodi. Khdng phdi tdt cd nhiing yeu td nay deu dnh hudng khdng tdt, ma ngugc lai, mang tinh chat bdo ve ddi vdi chii the.
Trong nghien cdu nay, chiing tdi dat ra muc tieu la 77m hieu sdu them ve stress vd cdc yeu td lien quan d binh nhdn bi binh ba binh ca the man tinh. Ket qua se la co sd cho viec xdy dung ke hoach tham vdn, hd tro benh nhan tu quan ly benh, lira chpn each ling phd phu hgp \di stress nham cung cd vd tang cudng ca ve sdc khde the chat va sue khde tdm ly.
2. Khach the ^ a phuong phap nghien cdu Khdch the nghien ciru
Nhdm khach the nghien cdu la 335 benh nbdn benh man tinh gdm ba benh la dai thao dudng, tang huyet ap, tim mach dugc theo doi, dieu tn tai cdc benh vien: Chg Ray, quan Thii Due. quan 2 va qudn 9 TP.HCM trong thdi gian tu thang 02 denthang 7 2014.
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VAN HIEN UNIVERSITY JOURNAL OF SQENCE
Phuongphdp nghien ciru
Phdng vdn true tiep va do tress d nhdm benh nhan nghien cuu. Nghien cdu nay su dung thang do stress d benh nhdn da dugc Pham Phuong Thao xdy dung [3].
Sd lieu dugc xu ly bdng cdc thudt todn thdng ke tren phdn mem R. 3.1. Ddy la phdn mem ma ngudn md [6]. Cd 2 chi sd dugc quan tdm:
- Ty sd nguy co (Relative Risk viet tat PR).
PR Id ty sd cua bai ty le luu hanh (trong nghien cuunayldstress). PR = p I : p 2 . N e u P R > l chiing ta cd thd phdt bieu ring yeu td nguy co tang kha nang bi stress dbenh nhdn benh man tinh. Ngugc lai, n£u PR < 1, chung ta ed bang chiimg de cd thi phat bieu rang yeu td nguy co cd the Idm giam khd nang bi stress. Cdn neu PR =1 thi cd the ndi rang khdng cd mdi lien b? nao giua yeu td nguy CO vd kha ndng hi stress.
Bang 1: Dac diem chung cua nhdm nghien cuu
Gioi tinh Nam (N=133) Na (N=202) Trinh d^ hoc van Tieu hoc (N=56) THCS (N=128) THPT (N=117) DH-ce (N=34) Dan toe Kinh (N=324) Dan tgc khac (N=ll) Ton giao Thien chua giao (N=58) Phat giao (N=153) Cao dai / Hoa hao (N=8) Khong theo dao (N=116) Chung
Co stress so ngirfri (%)
30 (22,6) 45 (22,3)
20 (35,7) 26 (20,3) 21 (19,6) 8 (23,5)
68(21,9) 5(45,5)
7(12,1) 37 (24,2)
4(50) 27 (23,3) 75 (22,4)
Khong tress so ngir61 (%)
103(77,4) 157(77,7)
36 (64,3) 102(79,7) 96 (80,4) 26 (76,5)
254(78,1) 6 (54,5)
51 (87,9) 116(75,8) 4(50) 89 (76,7) 260 (77,6)
P R / KTC 9 5 %
1 0,98/(0,7-1,5)
1 0,57 / (0,3-0,9) 0,50 / (0,3-0,8) 0,66/(0,3-1,3)
1 2,15/(1,1-4,3)
1 2,00 / (0,9-4,2) 4,1 /(1,6-11,1) 1,9/(0,9-4,2)
(*)
P
C 0,95
0,024 0,010 0,24
0,027
0,069 0,005 0,094
_ Ghi chit • THCS: trung hgc co sd. THPT trung hgc phd thdng. DH-CD: dgi hgc - cao dng: (*) KTC cita nhdm co stress Id 18 - 27.2 vd cua nhdm khdng cd stress Id 72 7 — 82
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- Ty sudt ehenh (Odds Ratio, vigt tdt OR).
Neu p Id xac sudt mdc stress, thi 1- p Id xac sudt sir kien khdng mdc stress. Theo dd, OR dugc tinh bdng: OR- p: {1- p). Nhu vay, ndu OR >1, khd nang stress cao hon kha nang khdng stress. Neu OR <1, chdng ta cd the ndi khd nang bi stress thdp hon kha nang khdng bi stress. Cdn OR =1 nghia la kha nang bi stress bang vdi khd nang khdng bj stress.
Vdi khodng tin cay 95% (vi^t tdt KTC 95%);
a = 0,05; gia tri p <0,05 la cd y nghia tbdng ke [6]-
3. Ket qua nghien ciru
3.1. Stress & benh nhan bi b^nh ca the man tinh
Thuc trang ve stress d nhdm benh nhdn nghien cuu dugc chiing tdi trinh bay trong Bang 1. Trong sd 335 benh nhan dugc nghien cdu, benh nhan nii cd 202 ngudi, chiem ty le 60,3%, nhieu bon sd benh nhan nam (133 ngudi, chiem ty le 39,7%).
Tai ddy cd the nhdn thay khdng cd s\r khac biet dang ke ve stress d benh nhdn nam vd benh nhdn nd. O nhdm nam, ty le mac stress la 22,6%), cdn d nhdm nu, ty le ndy la 22,3%.
Xet theo hpc vdn, chung tdi nhdn thdy ty le stress cd xu hudng gidm theo mdc do tdng cua bgc vdn: tu 35,7% d nhdm tieu bpc xudng 20,3% d nhdm cd hgc van THCS va d nhdm THPT la 19,6%. 6 nhdm DH-CD cd cao hon chut it: 23,5%. Trong thuc te, nhdng ngudi cd trinh do hoc van thap thudng cd thu nhap thdp.
Kbi bi benh, tinh trang sdc khde lai cang de tao ra nhiing cang thang trong cugc sdng vdn dl dang cd nhieu khd khan. Tuy nhien, su khac biet gida eae nhdm la khdng dang ke ve thdng ke (p>0,05).
Ve tdn giao ciia benh nhdn, cung khdng cd su khac biet dang ke giiia cac nhdm. Rieng nhdm benh nhan theo dao Cao Dai, Hda Hao, vi sd lugng it nen chua the dua ra nhdn dinh, danh gia.
Bang 2: Phan bo stress theo tirng benh man tinh Bfnh man tmh
Tim mach (N=174) Dai thao duong (N=66) Tang huyet ap (N=193)
So trirtmg hop 56 18 33
Ty If % 32,2 27,3 17.1
Ty le benh nhdn bi stress theo tung benh dugc trinh bay trong Bang 2. Nhieu tdc gid da nhan manh den vai trd ciia stress ddi vdi benh tim mach va tang huyet ap [6]. Ket qua khdo sat cua chiing tdi phan anh ty le stress d benh nhdn sau khi bi benh. Do vay, chinh benh nhdn
khi bi benh, phai udng thudc deu dan, phdi dieu chmh, thay ddi cac che dp sinh hoat, an udng...
cung cd the lai la nhirng yeu td gay stress. Va ty le benh nbdn bi stress d cac benh khac nhau ciing cd su khac biet nhat dinh.
:i3
Bang 3: Stress d benh nhan co nhieu benh man tinh Benh man tinh ket hop
Mpt loai benh (So nguoi ; %) Hai loai benh (S6 nguai ; %) Ca ba benh (S6 nguoi : %)
Co stress 48(19,2) 22 (30,6) 5 (38,5)
Khong stress 202 (80,8)
50 (69,4) 8(61.5)
T6ng 250 (74,6)
72(21,5) 13(3.9)
P 0,046
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Trong ngbidn cuu nay, cac benh nhan cd th6 mdc mpt benh man tinh, hai benh hoac ca ba benh (dai thdo dudng, tdng huyet dp, va tim mach). Ket qud tren Bang 3 cho thdy xu hudng stress gia tdng theo sd benh ma benh nhan mac phai. Td 19,2% vdi nhdm ngudi mdc mgt benh tang len 30,6% ddi vdi nhdm mdc hai b?nh vd nhdm cd ca ba benh len ddn 3 8,5%. Kiem dinh cbi binh phuong khuynh hudng, ket qua cho
thdy gia dip<0,05.
3.2. Mgt so yeu to lien quan lien quan din stress & benh nhdn b\ mac b$nh ca the m^n tinh
3.2.1. Cdc yiu to thupc ve chu the Mdi lien quan giua stresss vdi benh la da chieu va khd phdc tap. Trudc h8t do la nhimg thay ddi cd the lien quan den stress.
Bang 4: Nhihig thay ddi so vdi trirdc day d b^nh nhSn Cam nhan
cua benh nhan
Giam tri nho Nhieu cam xuc tieu cue Co gang thich ung Giam siic khoe Met moi Mat ngu vi lo lang Noi chung sue khoe khong thay doi
Co stress (N=75) SL ngudi / (%)
23/(30,7) 9/(12,0)
18/(24) 37 / (49,3)
3 9 / ( 5 2 ) 38/(50,7) 10/(13,3)
Khdng stress (N=260) SL ngu-M / (%)
61 /(23,5) 17/(6,5) 42/(16,2) 137/(52,7) 93 / (35,8) 77 / (29,6) 67 / (25,8)
T o n g / (KTC 95%)
1,44/(0,8-2,6) 1,95/(0,7-4,8) 1,64/(0,8-3,2) 0,87/(0,5-1,5) 1,95/(1,1-3,4) 2,44/(1,4-4,3) 0,44 / (0,2-0,9)
P
0,20 0,12 0,12 0,61 0,01 0,00 0,02
Ty sudt chenh OR con la chi so dinh lugng dugc yeu td nguy co va ydu td bao ve la bao nhieu. OR>l la yeu td tdm ly nguy eo lam nang tinh trang benh vd nhiing vdn dd tam ly trong cugc sdng, 0R<1 la ydu to bao ve benh nhan.
Mac dii, nhung thay doi so vdi trudc ddy nhu gidm tri nhd. nhiiu cdm xiic tieu cue, cd gang ihich ung a benh nhdn bi stress cao hon d benh nhan khdng bi sUess, 0R>1 nen cdc ydu td nay la ydu to nguy co stress va gidm sue khde a benh nhan bj stress thdp hon benh nhdn khdng bj shess, 0R<1 nen la y^u td bao ve benh nhdn khdi bi stress. Khdng cd sir khac biet rd rang vd cac thay ddi nay d benh nhdn bi stress va benh nhdn khdng bj stress (p>0,05). Tuy nhien, sir khac biet cd y nghia thdng ke giua benh nhan bi stress vd benh nhan khdng bi stress chi thd
hien rd d cdc thay ddi nhu Mel mdi. Mat ngu vi lo tdng va Ndi chung sdc khde khdng thay doi (p<0,05).
Khi hdi ve thuc trang hien tai cua tdm trang benh nhdn, chung tdi nhan thdy nhiing benh nhdn cd tdm trang: budn hon nhieu d benh nhan bi stress cao bon d benh nhdn khdng bi stress 0R= 1,41 va cdm gidc tgi ldi d nhdm benh nhan bi stress thdp hon d nhdm benh nhan khdng bj stress nhung khdng khac biet cd y nghia thdng ke giua hai nhdm benh nhan nay (p>0,05).
Cdc tam trang cdn lai deu cd su khac bi?t r3 rang giua nhdm benh nbdn bi stress vd nhdm benh nhan khdng bj stress (p<0,05). Cac tam trang nhu: gidn bdn thdn. di cdu kinh, boi rdi, lo lang, lo tdc dung phu cita thudc, sg chit. Cac tdm trang nay ddu cd OR>l nen day Id eae y^u
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Bang 5: Cam thiy tam trang trong thdi gian gan dSy Cam nh|n
cua benh nh^n Budn ban nhidu Gidn bdn than De cdu kinh Bdi rdi, lo lang Cdm gidc tdi ldi Lo tac dung phu eiia thudc Sg chet
Binh thudng
C6 stress (N=75) 27 (36) 11 (16,7) 13(17,3) 17(22,7) 2 (2,7) 12(16) 28 (37,3)
18(24)
Khfing stress (N=260) 74 (28,5) 11 (4,2) 21 (8,1) 21 (8,1) 8(3,1) 16(6,2) 29(11,2) 142(54,6)
OR (KTC 95%) 1,41(0,8-2,5) 3,89(1,5- 10,3)
2,39(1,1 -5,3) 3,34(1,5-7,1) 0,86 (0,1 - 4,5) 2,90(1,2-6,9) 4,75 (2,5 - 9,1) 0,26 (0,1 - 0,5)
P
0,21 0,00 0,02 0,00 0,85 0,01 0,00 0,00
td nguy CO stress, gdp phan lam tang nguy co benh tat. Trong do tdm trang sg chet la yeu td nguy CO cao nhdt cd OR=4,75 (KTC 95%
2,5 - 9,1) cd nghia la nhirng benh nhdn bi stress cd tam trang sg chet cao hon gdp 4,75 lan nhirng benh nhan khdng bj stress (k6t qua CU the bieu hien d Bdng 5). Ke den tdm trang gidn bdn thdn lam tang nguy co stress len 3,89 (OR=3,89) ldn, bdi rdi, lo Idng la 3,34 ldn. Cac yen td nguy co thdp nhat cung cao hon gap hai ldn d nhirng benh nhdn bi stress so vdi nhdng benh nhdn khdng bi stress nhu to tdc dung phu cita thudc cao hon 2,90 va di cdu kinh 2,39 vdi OR ldn lugt la OR- 2,90 vd OR=2,39. Phdng van sau benh nhan ve tam trang eua minh gdn day, benh nhdn d Binh Duong, 50 tudi, bi benh tim mach va tang huyet dp ndi rang: "CUng cd hoi ndng linh. At md mdn cdi gi md hoi sdi y cdi Id hai bice riec md khd chiu irong ngudi Idm cd". Khi benh nhdn cho rang tdm trang gan day la Binh thudng, nguy co stress anh hudng d6n benh giam, day la yen td bdo ve benh nhan khdi stress.
Td kfit qua tren, cho thdy benh nhan cd the cung bj benh man tinh nhu nhau nhung cdm
nhan, danh gid eua benh nhdn ve tinh trang sdc khde ciia minh mdi Id yen td gay stress cho benh nhan, nhirng benh nhdn cam nhdn tich cue ve tinh trang sue khde ciia minh se it bi stress hon nen Id yen td bdo ve benh nhdn, cdn nhung benh nhdn cdm nhan tieu cue ve sue khde eua minh thi cd stress cao hon gdp nhieu lan, la yeu td nguy ca stress.
Khi benh nhdn dugc bdc sT dieu tri, each hudng ddn vd chdm sdc cua bac sT cd anh hudng true tiep den ket qua dieu tri benh va muc do stress d benh nhan. Cach giao tiep tdt nhu thdn thien, hdi benh ky, lang nghe cham chii, hudng dan tan tinh se giup benh nhdn hieu dugc benh cua minh, hieu dugc each chdm sdc benh nen benh nhdn an tam, tin tudng, tudn thii dieu tri, dieu ndy gdp phdn lam giam benh man tinh nen lam giam stress. Ngugc lai, each giao tiep khdng tdt se lam cho benh man tinh vd stress nang hen. Cham sdc y te dugc xem la yeu td quyet dinh den sue khde benh nhdn.
Cam nhdn ciia benh nhan sau khi dugc bac sy cham sdc d nhiing benh nhan bi stress va khdng bi stress nhu th^ nao. Chiing tdi so sanh mdt sd cam nhan ciia benh nhdn qua ket qua.
VAN HIEN UNIVERSITY JOURNAL OF SQENCE
Bang Cam nhan cua benh nhan
Hudng dan rd Lo lang
Lo lang ve trieu chdng Khdng tin tudng Hudng dan khdng r5 Khdng hieu ve b8nh
6: Cam nhan sau khi fliryc b i c Cd stress
(N=75) SL ngirM /
(%)
5 1 / ( 6 8 ) 18/(24) 28/(37,3)
8/(10,7) 5/(6,7) 2/(2,7)
Khong stress (N=260) SL ngirdi /
(%)
228 / (87,7) 2 6 / ( 1 0 ) 30/(11,5)
11 /(4,2) 14 / (5,4) 9/(3,5)
I Cham s6c O R / (KTC 95%)
0,30/(0,1 -0,6) 2,84/(1,4-5,8) 4,57/(2,4-8,7) 2,70/(1,0-7,7) 1,26/(0,3-3,8) 0,76/(0,1 -3,8)
P
0,00 0,00 0,00 0,03 0,67 0,73 Sau khi dugc bac sy cham sdc dieu tri,
nhiing benh nhan eho rdng bac sy hudng ddn rd thi it bi stress. Cdm nhdn rang bac sT hudng ddn rd cd OR=0,30<1 nen td yeu td tdm ly bdo ve benh nhdn khdi bi stress (Bang 6). NghTa la nhiing benh nhdn cho rang bac sy hudng din ro se cam nhdn rang bac sy quan tdm nen ed su tin tudng, mdi quan he giao tiep tot vdi bac sy va dugc hudng ddn rd nen tin tudng, bian thu
Bang 7: Chii ddng thay
che do dieu tri nbu thuc hien che dg nghi ngoi, an, udng trong dieu tri benh lam giam stress d benh nhdn (p<0,001). Dieu nay phii hgp vdi vai trd cua giao tiep trong hieu qud dieu tri la giao tiep tdt eiia thay thudc giiip benh nhan hai long, hieu va tuan thu dieu tri, nhiing dieu nay anh hudng den tdm ly, hanh vi cua benh nhdn gop phan lam giam benh man tinh, lam benh nhan an tam nen gdp phan 1dm gidm stress (Bang 6).
ddi tam ly, thdi quen Cam nhan
cua benh nhdn
Thay ddi khdu phdn an Kham sue khde dinh ky Chan ndn, khdng lam viec Tang cudng van dgng the lire Udng ruou. bia
Bd uong rugu, bia Tranh tiep xiic Binh thudng
Cd stress (N=75) SL ngudi /
(%)
3 3 / ( 4 4 ) 48 /(64) 14/(18,7) 7 / (9,3) 2 / (2,7) 4 / ( 5 , 3 ) 6 / (8,0) 18/(24)
Khong stress (N=260) SL ngu-6i /
(%)
110/(42,3) 132/(50,8) 14/(5,4) 50/(19,2)
1 / (0,4) 13/(5,0) 4 / ( 1 , 5 ) 142/(54,6)
O R / (KTC 95%)
l,07/(0,6-,9) 1,72/(1,0-3,1) 4,03/(1,7-9,6) 0,43/(0,2-1.0)
-
1,07/(0,2-3,6) 5,6/(1,3-27,4) 0,26/(0.1 -
0.5) P
0.79 0.04 0,00 0,04
0,91 0,004
0,00
u
TAP CHi KHOA HOC DAI HOC VAN HIEN
Cd su khdc biet cd y nglua thdng ke giua benh nhan bi stress va benh nhan khdng bi stress ve viec chu dgng thay ddi tam ly, thdi quen nhu:
tdng cuong van dgng the luc. kham sue khde dinh ky. chdn ndn, khdng Idm viec, trdnh tiep xiic vdi ngudi khdc.
Chu ddng thay ddi tdm ly, thdi quen nhu tang cudng van dpng the luc la yen td bao ve lam giam stress (OR<l). Nhung benh nhdn thay ddi tdm ly, thdi quen bang cdch tang cudng van ddng the li^c tbi it bi stress ban. Hoat ddng the chdt, bay gid dugc cdng nhan la mdt yeu td quyet dinh quan trpng cua sue khde. Tap the due, van ddng CO the gdp phdn lam giam dudng huyet, huyet dp va giup tim thich iing vdi cdc boat ddng manh.
Chu ddng thay ddi tdm ly, thdi quen nhu kham sue khde dinh ky, chdn ndn, khdng lam viec, trdnh tiep xdc vdi ngudi khde la yeu td nguy CO gia tang stress (OR>l). Trong dd, trdnh dip xiic vdi ngudi khdc Id yeu td nguy co stress cao nhdt, nhiing benh nhdn chu ddng thay ddi tdm ly, thdi quen bang each ne tranh giao tiep vdi ngudi khac ed kha nang bj stress nhieu ban 5,6 lan (OR=5,6). Ke den la chdn ndn, khdng lam
viec cd OR=4,03 (p=0,00). Khi bidt minh benh man tinh, nhung benh nhdn ung phd bang each chdn nan, khdng 1dm viec cd nguy ca bi stress cao hon bdn ldn so vdi benh nbdn khdng cd tam ly nay. Khi biet minh benh man tinh, benh nhdn di kham sdc khde dinh ky, nhung benh nhdn bi stress cdbanh \i nay cao hon 1,7 ldn nhung benh nhdn khdng bi stress, cd sir khac biet cd y nghJa ve hdnh vi nay d nhdm benh nhdn bj stress vd nhdm benh nhdn khdng bi stress (p=0,04<0,05) (Bang 7).
3.2.2. Cdc yeu to ngoai chd the lien quan den stress d benh nhan benh man tinh
Khi xem xet tinh trang hdn nhdn dnh hudng den stress, neu lay tinb trang ddc than de so sanh thi ket qud nghien cuu cho thdy nhiing benh nbdn ket bdn it bi stress hem so \di benh nhan ddc than, nhung benh nbdn ddc than cd kha nang bi stress cao hon benh nbdn ket hdn 26%. Ngugc lai, nhiing benh nbdn cd tinh trang hdn nhdn la dang ly than, ly di lai ed nguy eo bi stress cao ban benh nhan ddc than den 41%. Nhu \ay. tinh trang hdn nbdn cd dnh hudng den stress, trong dd, ly than, ly di la yeu td nguy co stress cao nhdt (Bang 8).
Bang 8:
Sir kien cuoc dtri
Hon nhan Dpc than (N=3I) Ket hon (1M=286) Ly di, ly than (N=18) K i n h t e Kha gia (N=46) Tmng binh (N=230) Ngheo, can ngheo (X=- 59)
l a m thay tam trang trong thon Co stress
SL ngirdi /
(%)
9 / (29,0)
60/(21,0)
6/(33,3)
9/(19,6)
45 (19.6)
21 / (35,6)
Khong stress SL ngiroi /
(%)
2 2 / ( 7 1 , 0 )
226 / (79.0)
12/(66,7)
37/(80,4)
185. (80.4i
38 (64.41
gian gan day O R / (KTC 95%)
1
0,84/(0,4-1.7)
1,41 / (0,6-3.5)
1
1 / (0.5-1.9)
1,82 (1.9-3.6) P
0,163
0,457
1
0.084
VAN HIEN UNIVERSITY JOURNAL OF SQENCE
Didu kien kinh t l kha gia vd dieu kien kinh td trung binh thi khdng khdc nhau khi so sdnh dnh hudng cua cac ydu td nay trong nguySn nhan gdy stress, nhung dieu ki?n kinh td ngheo, can ngheo lai cao hon cac didu kien tren. Vay, nhiing b$nh nbdn ngheo, can ngheo cd nguy co bi stress cao hon nhdm b?nh nhan kha gia hoac trung binh.
4. Ket lu^n
Qua khao sat 335 benh nbdn bi benh man tinh gdm: tim mach, tieu dudng va tang huyet dp tai ba benh vien d TRHCM, kdt qud cho thdy:
- Cd ddn 22,4% sd benh nbdn dugc nghien
cuu ed bieu hien stress,
- Khdng ed su khdc bi?t vd sfress gida 2 gidi tinh va nhiing nhdm ngudi thupc cdc tdn giao khac nhau.
- Mdt ngudi cdng mdc nhidu b$nh, nguy ccr stress cdng cao.
- Stress keo theo hien tugng mdt ngii, met mdi, budn rdu, gidm sue khde d benh nbdn.
- Cdc ydu td: kdt hdn, su quan tdm ch5m soc cua bac sT la nhdng yeu td bdo ve, ngugc lai, tinh trang kinh te thdp la yeu td nguy co gdy stress cr nhdm benh nhdn nghien cuu.
TAI LIEU THAM KHAO
[1] Aldwin C M., 2007. Stress, Coping, and Development - An Integrative Perspective, The Guilford Press
[2] Nguyen Van Nhan, Nguyen Sinh Phiic, 2006. Tdm ly hocy hgc, NXB Y hpc, Hd Ndi.
[3] Pham Phuang Thao, 2014. "Dd tin cdy cua thang do stress d benh nhdn benh man tinh", Tgp chi Y hgc Thuc hdnh - Bd Y td, sd 9, tr. 88-91.
[4] Nguyen Vdn Tudn, 2014. Phdn lich die lieu vdi R, NXB Tdng hop TRHCM, tr. 283-306.
[5] WHO, 2008. "National Institute of Mental Health". Medicine on the Net, 14, (1), pp. 15- 16.
[6] Steptoe, A., Kivimaki M., 2013. "Stress and cardiovascular disease: an update on current knowledge". Annual Review of Public Health, 34, pp. 337-54.
