Tgp chi THONG TIN YDlfOC S6 7 ndm 2012
7. Van D. D., Binn CW., Lee A.W.: Breastfeeding innitiation and exdusive breastfeeding in rural Vietnam. Public Health nutr 2004, 7(6), pp.795-799.
8. Tanant M , Dodgson ].E.: Knowledge, attitudes, exposure, and future intentions of Hong Kong university
students toward irtant feeding. J Obstet Gynecol NeonstalNtMS. 2007May-Mi, 36(3), pp.243-254.
Tjiang L, Binns C: Indonesian students' knowledge of breastfeedin. Breastfeed Rev, 2001 Jul, 9 (2), pp.5-9.iS'
NGHIBV CUU HIEU QUA CUA UEU PHAP INSUUN TJCH CUC THONG QUA CHI SO FRUCTOSAMIN MAU 0 DENH NHAN DAI THAO DUONG TYP 2
Nguyen Thu Hien', Nguyin Hdng Tnfdng", Dang Thi Mai Trang', Nguyen Qudc Viet', Doan Thai HWng', Pham Thdy HWdng' TOM TAT
Muc tieu: danh gia hieu qua ciia lieu phap insulin tich cut t)ang chi sd fructosamin mau d benh nhan dai thao dWdng (BN DTD) typ 2 sau 2 tuan dieu til noi tru tai Benh vien Noi Tiit
Trung Wdng (BVNTTW). Ddi tWdng va phWdng phap: mo ta tiin euU, tien 89 BN DTD dude dieu tri tai BVNT td2/2008-8/2008. BN dWde chia ngau nhien thanh 2 nhdm: nhdm 1 dWdc dieu tri bang lieu phap insulin quy Wde 2 lan/ngay, nhdm 2 dWdc dieu tri bang lieu phap insulin tich eWe 3-4 lan/ngay. Ket qua: d nhom 1, ndng do fructosamin mau giam td 565,79±134,505 pmol/l xudng cdn 440,08±91,623 pmol/l; d nhdm 2, ndng do fructosamin mau giam tW 629,87±164,619 pmol/l xudng cdn 392,34±70,381 pmol/l. Ket luan: lieu phap insulin tich eWe ed hieu qua tiong lam giam glucose mau, fructosamin.
SUMMARY
Studying the effectiveness of Intensive Insulin therapy based on fructosamine concentration in patients w i t h type 2 diabetes
Objectives: to assess the effectiveness of intensive insulin therapy based on fructosamine concentration in patients with type 2 diabetes after a two-week tieatment at National Hospital of Endocrinology. Methods: A prosixetive study was conducted on 89 patients with diabetes being treated at National Hospital of Endocrinology dom February 2008 to April 2008. Patients were randomly divided into two groups: group 1: tieated with conventional insulin therapy 2 times per day, group 2: tieated with intensive insulin therapy 3-4 times per day. Resuls: applying conventional insulin therapy, ductosamine concentrations decreased dom 565.79±134.505pmol/l to 440.08±91.623 pmol/l In intensive insulin therapy group, ductosamine concentrations deaeased from 629.87±164.619pmol/l to 392.34±70.381 pmol/L Conclusions: Intensive insulin therapy are elective in reducing blood glucose level and fructosamine concentration.
I . Di^T VAN DE
Co 2 each sir dung insulin trong dieu trj DTD, dd la lieu phap insulin quy Udc (tiem 1-2 lan/ngay) va lieu phap insulin tich cUc (tiem
>3 lan/ngay hoSc truyen lien tuc). Lieu phap insulin quy Udc thudng dUdc diing khi bat dBu chuyen sang diing insulin dieu trj cho BN DTD typ 2. l/u diem ciia lieu phap nay la sd dung it mui tiem, nen thuan ben hdn cho BN. Tuy nhien, lieu phap insulin tiem 2 lan/ngay khdng cd b'nh linh boat can thiet de thich nghi vdi cac thay ddi trong thdi quen Sn uong, sinh hoat ciia BN [7]. Lieu phap insulin tich cUc (tiem >3 lan/ngay ho3c tmyen lien tuc) cung cap ndng do insulin phii hpp sinh ly hdn bSng each bd
sung insulin nen va insulin tac dung nhanh hoac ngan trUdc biia an. Lieu phap insulin b'ch cUc cd kha nSng kiem soat chat che glucose mau va o6 tac dung tich cUc tren lipid mau giiip lam giam nguy cd dai han m3c cac bien chifng mach mau [4].
Mac dii CO nhuhg UU diem tren, nhUhg d Viet Nam hien nay vin chua co nghien cdU nao dUdc cong bd iing hd viec sif dung lieu phap insulin tich cifc trong dieu trj DTD typ 2. Do vay, de chifng minh hieu qua ciia lieu phap insulin ti'ch cut, chiing toi tien hanh nghien ciiU nay nhSm danh gia hieu qua ciia lieu phap insulin ti'ch cut bang chi sd fructosamin mau d BN OTO typ 2 sau 2 tuan dieu tii ndi tid tai BVI^TTW.
"ThS., Benh vien Npi Het Trung UOng; "ThS., Benh vien 115 Thanh pho Ho Clii Minh
26
Tgp chi THdNG TIN YDlfOC So 7 ndm 2012
I I . D O I TU'DNG VA PHUONG PHAP 1. Dot tWdng nghien cut/
89 BN OTO dUdc dieu trj ndi tni tai BVNTTW tii 2/2008-8/2008.
* Tieu ehuan IWa chon: BN dUdc chan doan DTD typ 2 theo tieu ehuan ciia WHO (1999), hJOi >30, HbAic >9%.
* Tieu ehuan loai trd:
- Mcic cac benh cap tinh nhU nhiem khuan, tai bien mach mau nao, nhoi mau cd tim,...
Dj ifng insulin, nghien rUdu, thieu mau, benh huyet sSc td.
- Dang diing cac thudc anh hudng len ndng do glucose mau.
- Nong dp albumin mau <30 g/l.
Phu nd mang thai, cho con bu ho3c dU dinh mang thai.
2. PhWdng phip nghien cuti 2.1. Thiit ki nghien cdu: md ta tien cifu
* Tien hanh:
Cac ddi tUdng nghien cifu dUdc chia ngau nhien thanh 2 nhom dieu tri:
Nhom 1 (nhom insulin quy Udc): dieu trj bSng lieu phap insulin quy Udc 2 lan/ngay theo 1 trong 2 phac do:
+ Tiem dudi da insulin ban cham vao luc S^SO va 16''30.
-I- Tiem dudi da insulin hon hdp vao luc S^SO va 15*'30.
Nhom 2 (nhom insulin tich cue): dieu tri bSng lieu phap insulin tich cUc 3-4 lan ngay theo 1 trong 2 phac do:
+ Tiem dudi da insulin nhanh vao luc S^SO va lO^SO va insulin hon hdp vao liic le^SO.
+ Ti§m dudi da insulin nhanh vao luc 5^30 va 10^30,16''30 va insulin ban cham vao luc 20^00.
BN dUdc do glucose mau it nhat 2 (an/ngay, cac thdi diem lay mau dUdc luan phlen thay ddi. Chi dieu chinh lieu insulin tai mot thdi diem tiong ngay.
BN tuan theo che dp 3n, sinh boat ciia Khoa DTB.
Khong diing thudc ha glucose mau udng tix)ng sudt thdi gian nghien cifU.
* Cac chiso danh gia:
Oanh gia hieu qua ciia lieu phap insulin ti'ch cut bSng each so sanh giiia nhdm 2 vdi nhdm 1.
- Cac d3c diem gidi ti'nh, nhan trSc va thdi gian mSc bdnh.
Ndng dp glucose mau, HbAm fructosamin, C-peptid luc nhap vien.
Mut dp giam glucose mau khi diing insulin d ckc thdi diem (trudc Sn sang, sau an trua vei niia dem) tir ngay thd nhat den ngay ttiuT 7 va t d ngay thd 7 den ngay ttiuT 14.
- SU thay doi ndng do fructosamin mau ciia 2 nhom sau dieu trj.
2.3. Xdlysdlieu:\x\n3 phan mem SPSS 15.0.
I I I . KET QUA VA BAN LUAN 1. Dac diem chung
Ket qua cho thay, nhom 1 co 42 BN (15 BN nam, 27 BN nu), nhom 2 cd 47 BN (19 BN nam, 28 BN nOO (p>0,05).
Bang 1: dc dac diem gidi tinh, nhan trie va thdi gian mac benh giita 2 nhdm
Tuoi (nSm) Chiso
Chieu cao (cm) Can nang (kg) BMI
Vong bung (cm) Thdi gian m3c benh (nSm)
NMml ('X±SD) 60,71±12,Z8 154,07±6,20 49,57±9,06 20,89±3,64 79,05±9,16 4,29±4,30
Nhdm 2 (X±SD) 57,55±10,75 156;36±8,30 50,64±11,21 20,66±3,93 7834±n,18 4,23±5,18
>0,05
Khong co sU khac biet ve cac dac diem chung giOa 2 nhom (p>0,05). Tudi trung binh ciia nhom 1 va nhom 2 khong khac biet nhieu so vdi nghien cifu d Nhat Ban (lan lUdt la 58,5±11,3 tudi va 57,9±11,9 tudi) va d Y (60,7±7,9 tudi) [3,5]. Tuy vay, tiidi gian mac benh ciia nhom 1 va nhom 2 lai it hdn nhieu so vdi nghien cifu d Nhat Ban (lan lUdt la 9,5±10,7 nam va 10,7±2,1 nam) va d Y (16,2±9,1 nam).
Co the do tudi xuat hien OTO ciia ngUdi Viet Nam cao hdn, nhuhg cung co the nghT do y thifc kham benh djnh ky ciia ngUdi Viet Nam thap, thudng ddi cho den khi cac trieu chiitig xuat hien ro mdi tim kiem sU ho trd ciia y khoa.
Cac chi sd nhan trac nhu can nang, chieu cao, BMI, vong bung deu thap hdn so vdi cac nghien cifu d Nhat Ban (can nang va BMI lan lUdt cho nhom 1 va nhom 2 la 62,5±12,9 kg va 62,1±12,2 kg; 23,7±4,1 va 23,7±4,2) va d Y (can nang 75,4±10,4 kg; BMI 27,1±3,1) [3,5].
R5 rang, the tang ciia ngUdi Viet Nam nhd be hdn so vdi cac nUdc tren. Ngoai ra, che dp an ciia ngUdi Viet Nam thudng nhieu chat bdt va rau qua, it chat dam, chat beo, nen ciing giup ly giai cho dac diem tren.
Bang 2: Nong do glucose mau, HbAia fhjclosamin, C-peptid luc nhap vien giu^ 2 nhdm
Chiso GlucEeemBu(mmD|fl) HbAic (%) FnidDsamin (pmol/I) C-peptid (nmol/l)
Nhoml (X±SD) 17,96±4,61 12,55±2,48 565,79*134,51 1,51±1,16
Nhdm 2 (1(±SD) 18,88±4,94 12,93±2,53 6B,87±1M,62 1,14±0,79
P
>OfE
Khong co sU khac biet ve ndng dp glucose mau, HbAic, fructosamin, C-peptid luc nhap vien giDa 2 nhom (p>0,05).
27
Tgp chi THONG TIN YDlfOC So 7 ndm 2012
Ndng dp glucose mau, HbAic luc nhap vien ciia ca nhdm 1 va 2 dSu cao hdn so vdi nghien cull d Nhat Ban, Y va Canada [3,5]. Nghien dm is Nhat B^n va Y deu tiiUc hien tren BN dieu tri ngoai tnj, nen HbAic ttiap hdn la dieu de hieu.
Z nieu qua cua deu phap msMidch cut Bang 3: SW thay ddi ndng do glucose mau khi diing insulin
Gkgnsemiu (nmol/0 TiudcSnsang
Sau an t r u ^
Nifa dem Thin diem N I N7 N14
NI N7 N14
N I N7 N14
Nhoml X±SD 8,75±3,15 8,07±2,43 6,72±1,94 15,83±5,45 12,97±3,01 11,76±2,10 12,92±3,42 10,83±1,79 7,97±1,65
Nhom 2 lt±SD 9,60±4,52 7,42±2,32 6,01±1,27 14,57±6,22
9,74±2,29 8,91±0,74 12,74±4,72 9,50±1,71 6,82±1,11
P
>0,05
>0,05
<0,05
>0,05
<0,01
<0,01
>0,05
<0,01
<0,01 (NI: ngay thd nhat, N7: ngay thd 7, N14:
ngay thd 14)
d ngay dieu trj thd nhat, khong cd sU khac biet ndng dp glucose mau tai cac thdi diem trong ngay glQa 2 nhdm. O ngay dieu tri thd 7, ndng dp glucose mau sau 3n trUa va niia dem ciia nhdm 2 thap hdn nhom 1, sU khac biet cd y nghTa thdng ke (p<0,01). 6 ngay dieu trj thd 14, ndng do glucose mau tai cac thdi diem trong ngay ciia nhom 2 deu thap hdn nhom 1, sif khac biet co y nghTa thdng ke (p<0,01). Mut dp dao dpng glucose mau (dp lech ciia glucose mau trung binh) tai thdi diem trUdc an sang, sau an trua va nifa dem ciia nhdm 2 thap hdn nhdm 1.
Bang 5: SWthay ddi nong do fructosamin mau
Bang 4: Mdc do giam glucose mau khi dung insulin
TniiCansang Sau antrum Nifa dem
Hhdml N1,N7
^±SD Oieai345
^99±5,24 231±3,55
NI, N14 lc±SD 2,02±3,10 4,10*5,78 4,93±3,24
Nhdm 2 N1,N7 1(±SD 2 , I 9 t 4 / E 5,21±691 234±433
NI, N14 X±SD
ill
Ndng dp glucose mau tai cac thdi diem trong ngay lay d ngay dieu tri thif 1 khong co sU khac biet giOa nhdm 1 va nhdm 2. 6 ngay dieu tri thif 7, ndng dp glucose mau d nhom 2 thap hdn niidm 1 tai thdi diem sau an trua va nifa dem. O ngay dieu trj thd 14, ndng do glucose mau d nhdm 2 thap hdn nhom 1 tai tat ca thdi diem trong ngay.Lieu phap insulin tich cUc mo phong gan gidng vdi kieu bai tiet insulin hang ngay [6].
Lieu insulin tac dung ngan trUdc moi bOa i n giiip lam giam glucose mau sau i n [3], nen glucose mau sau i n , nhat la sau i n trua d nhom 2 thap hdn dang ke so vdi nhom 1 (p<0,001). BN DTD thudng cho rang xet nghiem glucose mau luc doi mdi co gia trj, vi vay, bat ke la trUdng hdp mdi phat hien lan dau hoac tai kham, hp thudng nhjn i n , tham chi khong diing thudc ha glucose mau trUdc khi kham. Tuy nhien, cac khuyen cao hien nay cho rang tang glucose mau sau an lam ting nguy cd bj cac bien chdng dai mach, benh ly vdng mac, thuc day cac phan ifng oxy hoa [2].
Vi vay, t u van cho BN va sd dung lieu phap insulin tich cut se kiem soat tdt glucose mau sau an va lam giam dUdc cac bien chifng tren.
eiia 2 nhdm sau dieu tii
Nhom 1 Nhdm 2
Pl.2
nu6tdfBulri
~X±SDOtnol/0 565,79*134,51 629,87*164,62
>0,05
SauSeutn lCiSDOMnol/0
440X»i91,62 392,34*70,38
<0,05
Bien d$ giam (iimol/l) 'X±SD
125,71*146,80 23733*140,57
71%
2^2 377
<0,01
P
<0,01
<0,01
So vdi tiUdc dieu trj, ndng do fructosamin sau dieu tri d ca nhdm 1 va 2 deu giam dang ke (p<0,001). Oieu dd cho thay, ca 2 lieu phap insulin quy Udc va ti'ch cut deu co hieu qua lam giam glucose mau rd ret. Bien do giam fructosamin d nhdm 2 cao hdn so vdi nhdm 1.
Fmctosamin la san pham glycat hda giOa dudng va albumin, the hien glucose mau trung binh trong vdng 14-17 ngay, chju anh hUdng ciia glucose mau liic ddi, glucose mau trUdc an va glucose mau sau i n . Lieu phap Insulin tich cut cung cap insulin trUdc moi bOa i n giiip lam giam glucose mau sau i n va lieu insulin nen kiem soat glucose mau liic doi, do do lieu phap insulin tich cut cd kha nang dn dinh
glucose mau sudt ca ngay, nen ket qua fructosamin cai thien tdt hdn [8].
Fmctosamin phan anh gia tri glucose mau trung binh trong khoang thdi gian 2 tuan.
Ndng dp glucose mau tai cac thdi diem tiong ngay khi diing lieu phap insulin tich cUc deu thap hdn lieu phap insulin quy Udc, nen ndng dp fructosamin sau 14 ngay dieu tri cung thap hdn dang ke.
Ngoai ra, mdc do giam fructosamin d nhom 1 cung nhieu hdn nhdm 2, nghia la diing lieu phap insulin ti'ch cut se sdm dua ndng dp glucose mau ve gia trj binh thudng, nhanh chdng phuc hdi cac rdi loan chuyen hda va tao dieu kien cho viec chuyen sang cac bien phap 28
Tgp chi THdNG TIN Y DlfQC So 7 ndm 2012
dieu trj ddn gian hdn, nhat la ddi vdi cac BN mdi phat hien lan dau hoac chdc ning cua te bao p cdn tdt.
V. KET LUAN
Lieu phap insulin tich cut hieu qua trong lam giam glucose mau, fructosamin. Ndng dp fructosamin mau giam t d 629,87±164,62 pmol/l xudng con 392,34±70,38 pmol/l.
TAI LIEU THAM KHAO
1. Capaldi B.: Optimising Glycemic Control for Patient Staring Insulin Therapy. Nursing Standard, 2007, 21 (44), pp.49-57
2. Ceriello A.: Postprandial Hyperglycemia and Diabetes Cijmpiications. Diabetes, 2005, 54, pp.1-7.
3. Ceriello A.., Prate S.D.: Premeai insulin lispro plus bedtime NPH or twice-daily NPH in patients with type 2 diabetes: acute postprandial and chronic effects on glycemic control and
cardiovascular risk factors. Journal of Diabetes and Its Complications, 2007, 21, pp.20-27.
Geltner C , Lechleitner M., Foger: Insulin improves fasting and postprandial lipemia in type 2 diabetes. European Journal of Internal Medidne, 2006,13, pp.256-263
Hirao K., Aral K.: Six-month multicentric, open- iabei, randomized trial of twice-daily injections of biphasic insulin aspart 30 versus multiple daily injections of insulin aspart in Japanese type 2 diabetic patients (JDDM 11). Diabetes Research and Clinical Practice, 2007, pp. 1-6.
Leahy J.L: Basai-Prandiai Insulin Therapy: Scientific Concept Review and Application. The American Journal of The Medical Sciences, 2009,332, pp.24-31.
Meneghini LB.: Why and How to Use InsuBn Therapy Earlier in the Management of Type 2 Diabetes. Southern I'ledkal Association, 2007,100, pp.164-174.
Zachary: Achieving Glycemic (Boals in Type 2 Diabetes. Diabetes Care, 2007,30, pp.l74-181.s
THUC TRANG CHAN THUONG MAT DIEU TRI TAI KHDA MAT DBVH VIBV DA KHDA TRUNG UDNG THAI NGDYEN TU 2DDD - 2011
Vu Thi Kim Lien, Hoang Thanh Nga"
TOM TAT
Muc deu: md ta thut tiang chan thudng mSt tai Khoa Mat - Benh vien Da khoa Tmng udng Thai Nguyen. Dot tWdng va phWdng phap: md ta cat ngang, hoi cuii tien 325 mat bj chan thudng cua 310 benh nhan (BN) dude dieu tri tai khoa Mat - Benh vien Da khoa Trung udng Thai Nguyen td 1/2009-11/2011. Ket qua: chan thudng mat gap chu yiu d tudi lao dong (56,1 %); nam (69,7%) nhieu hdn nd (30,3%). Nguyen nhan do tai nan lao dong chiim 56,8%. Cd 81,3% BN khdng dutfc sd cuV ban dau. Cac hinh thai chan thWdng: dung dap nhan cau: (46,2%); dian thudng xuyen: (12,9%); vdnhan cau: (5,2%). 84,6% sd mat luc vao vien ed thi lut dWdi mdc binh thudng, 44,9% thi lut d mdc mil Ida. Sau dieu tri van con 54,2% BN ed thi lut dWdi mut binh thudng. Kit luan: chan thWdng mat delai hau qua nang ne, anh hWdng Idn tdi chdc nang thi giac.
SUMMARY
Situation of eye trauma a t Ophthalmology Department of Thai Nguyen Central General Hospital f r o m 2009 t o 2 0 1 1
Objective: to investigate the situation of eye tiauma at Ophthalmology Department of Thai Nguyen Central General Hospital Methods: a cross-sectional, retrospective shidy was conducted on 310 patients with 325 eyes trauma being hospitalized at Ophthalmology Department of Thai Nguyen Central General Hospital dom January 2009 to November 2011. Results: eye trauma found mosOyat woridng age (56.1%) with 69.7% in males and 30.3% in females. 56.8% of eye injuries was due to accident at work. 81.3% of patients were not provided with first aid. 46.2% of eye injuries were blunt tiauma, 12.9% were penetrating ocular trauma and 5.2% were broken eyeball 84.6% of patients had subnormal visual acuity, in which 44.9% of them were blindness when hospitalized. After the tieatment, visual acuity of 54.2% were still subnormal Conclusions: eye trauma brings serious consequences and is a common cause of visual loss in people.
I. DAT VAN DE
(3ian thUdng mit la cap cuU thUdng gip tiong Nhan khoa do cac tai nan xay ra trong sinh
"ThS.; "as., 0?i hgc Y-Du«c Thai Nguyen
boat hang ngay ciia con ngUdi. Cac tdn thUOng tai mat do chan thUdng gay ra co mdc dp tir ddn gian den phut tap de lai di ehuhg ning ne lam
29
