TCNCYH Phu truung 80 (3A) - 2012
6 NHIEM MAM BENH KY SINH TRUNG TRONG RAU AN SONG TAI MOT SO NHA HANG O THANH PHO NAM DjNH
Le LOT', Hoang Tien Cuxyng\ Nguyin Van De^, Tran Thj Huvng^
^Chi cue Ve sinh An toan Thwc pham tinh Nam Dinh;
^Trwdng Dai hgc Y Ha Noi; ^Trwdng Dai hoc Diiu dwdng Nam Dinh Xet nghiem 120 miu rau gdm 6 loai rau theo phwang phdp Romanenko tim mim bdnh ky smh triing tai mdt s6 nhd hdng thudc thdnh phd Nam Dmh nam 2011 Kit qua cho thiy: Cdc loai rau cd ty Id 6 nhidm mim benh ky smh triing chung id 48,3%. trong do mim benh giun san Id 10,8% gdm giun dua 5%, giun tdc 1,7%; iu trung giun mdc 2,5%; sdn Id nhd 1,7%, mim benh don bao la 45% gdm Entamoeba histolytica 5%; Entamoeba coli 7,5%; Cryptosporidium spp 11,7%, Cyclospora spp 7.5%; GiardIa amblia 1,7%, dan bao khac 11,7%
Tu- khoa: Mam benh ky sinh trung, giun san, dan bao I. DAT V A N Bt
Mim benh ky sinh trung trong mdi trudng cd kha nang lay nhiim cho ngudi ed t h i chii ddng nhu giun mde (ngudi, dgng vat)/m6, san mang, nhung phln ldn thu dpng qua thire an, trong dd cd rau la ngudn thue phim khdng t h i thilu hang ngay. Tai Viet Nam, hlu hit mgi ngudl d i u .nhiem mot hay nhilu loai ky sinh trung truyln lay qua rau bao gdm giun san va dan bao.
Theo thing ke chua d i y du cua Chl cue An tcan Ve sinh Thuc phim tinh Nam Djnh, toan tinh ed g i n 7,000 ca sd nha hang cd SLP dung rau an sing. Tuy nhien ehua cd nghien ciru mim benh-ky sinh trung truyln benh cho ngudi tren rau sdng tai Nam Djnh. Mdi day vao nam 2007, qua nghien ciru cua Trln Thj Hing va es v l khao sat ky sinh trdng tren rau sing ban tal eac sieu thi tren dja ban thanh p h i Ho Chi Minh cho thly ty le nhilm ehung ky sinh trung tren rau r i t cao (ehilm 94,4%) [1] Ngoai ra tai mdt nghien euu tai- Hai Phdng cua nhdm tac gia Dinh Thj Thanh Mai va cpng su cho thly sau 3 l l n n>a rau mua tal chg cLia eac loai rau mill, xa lach, cai canh, cai thia, cai bao, cai eiic, rau mudng van cdn 15,32% nhilm giun san [2]. Trong dd rau xa
lach nhilm cao nhat (26,6%) Vay, viec kilm tra 6 nhilm rau tai ban an d cac nha hang la rit d n thilt Chung tol tlln hanh-nghien cii'u d l tal. O nhilm m i m benh ky sinh trung trong rau an sing tai mdt s l nha hang thdnh p h i Nam Dmh nham muc tieu: Mo ta cac mim benh ky sinh trung con tdn tai trong rau da rua va sw dung an song tai nha hang thanh phi Nam Dinh
II. D6\ TU'gNG VA PHU'aNG P H A P 1. T h i l t k§ nghien ciru: Nghien ciru d t ngang md ta.
2. Chon dia d i l m d i l u tra: Chgn dia dilm cd chu dich chgn 6 nha hang tal thanh p h i Nam Dmh ed su dung rau an sing.
3. Ddi tu'ang nghien cu'u: Cae loai rau thudng dung an sing g i m rau mulng, rau d n , rau ngd, rau eai xanh, rau eai eiie, rau xa lach/dllp.
4. C d mlu; Cd m i u dude tinh theo cdng thirc (WHO 1991)
n = Z^.,/2xP(1-P)/d'
Trong do. n =_ ca miu tdi thieu cin dat dwac, p = Ty le nhiim dw kien = 20%, Z,_
a/2 = he so tin cay 95%, co gia tn 1,96; d = sal 55
TCNCYH Phu truung 80 (3A) - 2012 so tuyet doi = 0,005; ta co s6 m§u n = 120 mau cho 6 loai rau, mdi loai 20 miu/nha hang.
5. Phu'ang phap thu thap mim benh ky sinh trimg va dmh loai
Thu thap mim benh ky sinh triing bang phuang phap Romanenko.
Xac dinh hinh thai hpe theo khoa djnh loai cita Ichiro Miyazaki, Prayong Radomyo va Johannnes Kaufmann.
1. K^T QUA
1. 6 nhilm mim benh ky sinh trung chung tai nha hang Bang 1. Kit qua xet nghiem giun san TT
1 2 3 4 5 6 Tong
Loai rau Rau mudng Rau c i n Rau ngd Rau cai ciic Rau cai xanh Rau xa lach/dllp
n 20 20 20 20 20 20 120
S6(+) 1 1 1 2 4 4 13
Gi lun dua 0 1 1 1 1 2 6
Giuni 0 0 0 0 1 1 2
Loa toe
1 giun A T g
san iun moc
1 0 0 0 1 1 3
SLN 0 0 0 1 1 0 2
SLL
0 •
0 0 0 0 0 0 Ghi chu: SLN = San la ruot nho + San la gan nho; SLL = San la Idn.
Cac loai rau d i u nhilm m i m benh giun san vdi ty le nhilm chung 10,8%, trong do xa lach/
dilp, cal xanh nhilm nhilu nhlt Nhilm trirng giun dQa 5%; giun tdc 1,7%, l u trung giun moc 2,5%, SLN 1.7%; SLL 0%.
Bang 2. Ket qua xet nghiem do'n bao
11 1 2 3 4 5 6
Loai rau Rau mulng Rau ein Rau n g l Rau cai ciic Rau cai xanh Rau xa lach/diep
Ting
n 20 20 20 20 20 20 120
s6 (+) 9 10
5 10 9 11 . 54
Amip 1 0 0 2 1 2 6
E. coli 2 2 0 0 3 2 9
Loai Crypto
3 2 2 3 2 2 14
do'n bao Cycle
0 2 2 2 1 2 9
Giardia 1 0 0 0 0 1 2
Do'n bao Ithac
2 4 1 3 2 2 14 Ghi chil. Amip = Entamoeba histolytica: E.coli = Entamoeba coli. Crypto = Cryptosporidium spp: Cycle = Cyclospora spp: Giardia = Giardia lamblia.
Cac loai rau deu nhilm m i m benh don bao gay benh eho ngu-oi 6 mire do khac nhau, vol ty le nhilm chung la 45%, trong do nhilm bao nang amip la 5%; tiep d i n la Giardia 1,7%; E. coli 7,5%, Cryptosporidium 11,7%; Cyclospora 7,5% va cac loai don bao khac 11,7%.
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TCNCYH Phu tmung 80 (3A) - 2012 IV. BAN LUAN
Tai nha hang, d nhiim m i m benh giun san chung la 10.8%
So vdi nghien ciru eua nhom tac gia Oinh Thj Thanh Mai va cs, 2006, tai Hai Phdng cho thly sau 3 lan rira rau mua tal chg cua cac loai rau xa lach, cai canh, cai thia, cai ciic, rau mudng v i n con 15,3% nhilm m i m benh da bao thi nghien ciru nay cd t h i p han mpt chut, chiem 10,8% nhung v i n tuang dong vi cung d khu vuc dong bang duyen hai Bac Bp [4].
Nghien eiru cua Nguyen Van D l va cong su, 2011 cho thly benh giun san tren rau tai thanh p h i Nam Djnh rau mulng nhilm mim benh giun san 10,9%, rau d n nhiim 3,6%, rau ngo nhilm 3,6%, rau cal xanh nhilm 12,7%, rau diep nhilm 12,7% va rau cai soong nhilm 5,5%. Tal thanh pho Ha Npi rau mulng nhiim mam benh giun san 3,6%, rau d n nhilm 3,6%, rau ngo nhiim 1,8%, rau cai xanh nhiim 5,5%, rau dilp nhilm 3,6%
va rau cal soong nhiirn 1,8%. Tal thanh p h i Hoa Binh, rau mulng nhilm m i m benh giun san 1,8%, rau cai xanh nhiim 3,6% va rau dilp nhilm 1,8% [1]
Tai chg, d nhilm m i m benh dan bao chung la 45%.
So vdi k i t qua nghien cii'u cCia Trln Thj Hdng va cs, 2007 cho thly sau rua rau ty le d nhiim bao nang Entamoeba histolytica la 100% [2].
So sanh vdi k i t qua xet nghiem cua Le Thi Ngoc Kim va es, 2007 cho thly rau sau 3 lln rira v i n cdn 21,1% bao nang Entamoeba coli; bao nang Giardia lamblia la 2,9% [3].
Theo nghien cuu cua Nguyin Van O l va
•cdng su, 2011 [1], kilm tra m i m benh dan bao tren rau xanh tai thanh p h i cho thly d i u d nhiim mam benh dan bao vdi ty le eao va
bao gdm nhilu dan bao gay benh nguy hilm, trong do, tai Nam Oinh ty le nhilm bao nang amip 4,2%; Cryptospondium 29,7%; Cyclo- spora 16,1%; Giardia 13.6% va dan bdo khac 14,8%. Tai Hda Binh ty le nhilm bao nang amip 1,8%; Cryptospondium 5,2%; Cyclospo- ra 6,7%, Giardia 2,7% va dan bao khac 8,2%.
Tai Ha Ndi ty le nhilm bao nang amip 2,7%, Cryptosporidium 11,5%; Cyclospora 7,9%;
Giardia 3% va dan bao khac 7,6% [1].
V. K^T LUAN
Tai mdt s6 nha hang thude thanh p h i Nam Djnh, da tiln hanh xet nghiem kilm tra mim benh ky sinh trung tren 120 mlu rau g i m 6 loai rau an sdng cho kit qua: Cac loai rau d i u cd ty le d nhiim mam benh' ky smh trung, nhilm chung la 48,3%, trong dd d nhiim mim benh giun san la 10,8% va 6 nhiim m i m benh dan bao la 45% g i m cac loai gay benh cho ngudl. Nghien ciru nay canh bao cho khaeh hang d n luu y khi su dung eac loai rau an sing tal cac nha hang
T A I LIEU THAM K H A O 1. Nguyin Van D§ (2011). An Toan thuc phim trong ITnh vue Ky sinh trung tai Viet Nam. Tap chi Thong tin Y Duac (6); 2 - 5
2. T r l n Thj H6ng (2007). Khao sat ky smh triing tren rau sing ban tai cac sieu thj tren dia ban thanh phd Hd Chi Minh. Tap ehi Y +ioc thanh p h i H i Chi Minh. 11 (2); 82 - 86.
3. Le Thj Ngpc Kim, Vu Dinh Phu'ang An, T r l n Thj Hdng (2007)^ Khao sat Ky sinh triing tren rau sdng ban tai chg tren dia ban thanh p h i H i Chi Minh. Bao cao khoa hoc tai Hdi nghj Ky sinh trung toan quic; 34 - 36.
4. Dinh Thj Thanh Mai, Nguyen Dire Thanh, D6 Thj Y i n (2006). Danh gia mirc do d nhiim trirng giun tren mpt s l loai rau xanh sach va chua sach d thanh p h i Hai Phong.
Tap chi Y hgc thue hanh. 537- 66 - 69.
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TCNCYH Phu truung 80 (3A) - 2012 Summary
PARASITIC INFECTION PATHOGENS IN RAW-VEGETABLES AT SOME RESTAURANTS IN NAM DINH CITY
Among 120 samples, including 6 species of raw-vegetables were examined by Romanenko method to detect parasitic Infection pathogens in some restaurants in Nam Dinh City, 2011. The results showes that the rate of parasitic infection was 48.3%, including helminthic infection was 10.8% (Ascaris infection of 5%, Trichuris infection of 1.7%, hookworm larvae infection of 2.5%}, Clonorchis infection 1.7%); protozoan infection was 45%), including Entamoeba histolytica infection of 5%>, Entamoeba coli infection of 7.5%. Cryptosporidium spp infection of 11.7%), Cyclospora spp infection of 7.5%. Giardia lamblia infection 1.7% and other protozoa of 11.7%.
Keywords: Parasitic infection pathogens, helminth, protozoa
KfiT QUA PHAU THUAT TIM MQ TRE SO SINH TAI BENH VIEN NHI TRUNG U'QNG
Tran Mtnh Dien, Nguyin Thanh Liem, Dang Anh Duxmg Pham Hong So'n, Nguyin Ly Thmh Truxyng, Cao Viet Tiing
Benh vien Nhi Trung wang Nghien ciru nhim phan tich kit qud diiu tri, su tiin bd phdu thudt tim md d 38 trd so smh mdc di tat tim bim smh tai bdnh vien Nhi Trung wang giai doan 2006 - 2011. Kit qud cua phdn tich cho thdy vdl 38 tre sa sinh tuSi trung binh ta 16 ngay (3 - 33), can nang trung binh Id 3,2 kg (2,1 - 4.0), cdc dj tdt can thidp ngay giai doan so smh chii ydu Id bdnh chuydn gdc ddng mach (TGA) 22/38 (57.89%), teo van dong mach phdi (PA) 6/38 (15,79%), bit thudng tTnh mach phdi (TAPVC) 3/38 (7.89%), va mdt si di tdt khac 7/38 (18,42). Kit qua diiu tn ty Id sdng Id 81,58%, trong do benh TGA thdnh cdng 77,27%. PA 100%, TAPVC 100%. Giai doan 2010 - 2011 cd 25/38 tre dwac can thi$p phdu thudt tim md trd sa smh, ty Id sing 88%> cao hon so giai doan 2006 ~ 2009 (69,23%). Biin chdng sau phau thudt thwang gap nhit Id vidm phdi 68,42%, suy than 21,05%, nhidm khudn huydt 10,52%, nhidm triing xwang ire 7,89% l\/ldt sd ydu td anh hwdng din tw vong la tudi < 15 ngay (p < 0.05), lactate mau s 4.4 mg/l (p s 0,001), thai gian chay may tuin hodn ngoai ca thd > 160 phiit (p < 0,05), thai gian cap dong mach chu s 110 phOt (p < 0,018) Vdy phdu thuat tim md tre sa sinh tai benh vien Nhi Trung wang cd ty le sdng cao Cd nhiiu swtiin bd vi llnh vwc ndy trong thai gian gin ddy (2010- 2011). Cin chu y ddn cdc vin di biin Chirng sau phdu thuat nhw viem phdi, suy than, nhidm khuin huyit vd mot s6 yiu td anh hwdng ddn tir vong nhw tudi, lactate mau. thai gian chay mdu tudn hodn ngodi co thi va thai gian cap ddng mach chd Tip khoa: dj tat tim bim sinh, phlu thuat su'a chu'a toan b6 giai doan sa sinh, tuin hoan ngoai cathe
I. DAT V A N D E mach nang tre em phat triln song song vdi Trong khoang 3 thap ky g i n day, tiln bg cae tiln bo cua chuyen nganh h l i sire nhi eiia phlu thuat tim maeh va thdng tim tham khoa. So cac trudng hgp dugc dieu tri benh dd eho chin doan va dieu trj cac benh ly tim ly tim b i m sinh trong cac dan vj hoi sire nhi
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