ling ghfip hogt dOng sdng lyc vdi cdc hogt dfing khde nhu tmyin Ihfing gido dye sii'c khod, hogt dfing cua d c Imng tdm chdm sdc sire khoe sinh san...
TAI U $ U THAM K H A O
1. Nguyen Bd Dirc-Ngd Thu Thoa (1999): Kdt qui sing Iqc phdt hidn sdm ung thw vii d cdng dong, O l tdi d p nhd nudc Md sfi KH 11-04.
2. NguySn Chin Hung vd CS (2006): Ginh ndng ung thw tdi TP Hd Chi Minh. Tgp chi y hyc TP Hfi Chi Minh.
S l 4 .
3. Trin Ddng Khoa, Hfi Thj Minh NghTa (1997): Tinh hinh ung thw vO d phq nO- Hd Ndi thdng qua phwang phip tim soit phdt hidn ung thw vO.
A. Bili Difiu (2006): Nghiin cOv dinh gid phwang phdp diiu tti tia xg tiin phdu tmng ung thw cd 10- eung giai dogn la-lla bing ngp ngudn sau Caseim-137. Ludn dn Tiln sT Y hyc. Dgi hgc Y Hd Nfii
5. Trin Ddng Khoa & CS: Kdt qui tim soit ung thw vu vi ung thw co tO- eung cho 10. 014 phq nir nhdm tudi 35-60 tgi Hi Ndi gial dogn 2005-2007. D l tdi d p Thdnh Phd.
6. Nystrom L. Rutqvist L. E et al (1993): Bmast cancer scmenlng with mamogmphy. Overview of Swedish mndomised trials. The lancet Vol 341. N° 8851 Saturday17April, 973, 978.
THUC TRANG N A N G LUC Dl^U TRA NGO OOC THIA; P H £ M CUA H £ THONG Y TE TUYEN 0 0 SOF VA M O T Sd' OAC DIEM CAC VU NGfi OOC THlic PHJM TAI TINH NAM DINH NAM 2010
T6M TAT
Qua hdi cOv vi didu tm dt ngang vi die diim cie vg NDTP vi nSng Iqc <Siu tm NDTP tgl tinh Nam E^nh nSm 2010 cho kit qui: Toin tinh di xiy ra 9 vy A/DTP vdi 436 ngwdi mie 7 ngudi phii nhdp vidn, khdng cd tir vong.
Nguydn nhin ehu yiu li do thuc Sn bidn chit di thiu vd nhi^ hda chiL ThOc Sn gdy NDTP Id mu/qui vd thjt/cdc sin phim tir th'ft. fJDTP xiy ra d bOa Sn gia dmh Id chO yiu. Vd nSrw luc tfeu fra hJDTP: Cdn bd ldm cdng tic ATTP i^u yeu li binh dd y ti, ysp, trinh dd bie sp eh! ed 16.2% ehl tdp tiung d tuyen tinh vd htyin huydn. 100% sd dn bg tuydn xi lim cdng tdc VSATTP Id kidm nhigm vd chwa duqc ddo fgo ehuydn mdn. Vi r^uyen mdn kiim nghidm thuc phim (KNTP): Cdn bg tuyin huydn ehl d trinh dg tmng cip vi fty thudt vien. Tgi tuyen tinh eung c6 3 cin bd tiong ddcd 2 ngwdi c6 trinh dd dgi hqc vi 1 ngwdi cd binh dd trung cip. Cdc cdn dd ti^dn tinh vi tijydn huydn khdng ed kha nSng lam ede xit nghidm phdn tidi hda hqc vd xet nghigm vi sinh vdt Cdn bd ft/j4n xS khdng dim dirong dwqc vide liy mau vi trien khai Arqc eie xdt nghigm nhanh. Tuyen tinh dam bio dO bang tiiiet bj KNTP nhung ddi vdi tuyen huyin till cdn tiiieu hda chit D$e bidt tuydn xa tiii khdng dwqc Uang 6/ dd xfif nghidm nhanh vd tOl ghdp mi de dung miu. Vide deu trj, liy miu xdt nghigm, tim hiiu buB an nguyen nhdn vi td c/iiic dbdn diu fra hidn tnrdng do tuyin tinh vd huygn thqc hidn.
Tir khda: Ngd dgc thwc phim, dOa Sn nguydn nhdn, ning Igc didu tm
SUMMARY
Thmugh a mtmspective study and a cmss sectional study on facts about food poisoning and the food poisoning surveying ability in Nam Dinh pmvince in 2010, we hund : Them wem 9 food positioning cases, with 436 suffemd people including 7 people who had to take medical cam in hospitals all over the pmvince;
luckily them was no death found. Major mason is metamorphosis foods and chemical contamination.
Foods bringing risky poisons am vegetable, hvits, meat and mlated pmduets. Food poisoning cases happen mainly in family meals. About food poisoning surveying ability, most foods safety workem am nurses; them am
NINH TH[ NHUNG, Trwdng dgi hqc Y Thdi Blnh DINH VAN XIM, TT din sd KHHGD TP. Nam Djnh only 16.2% of them am doctom, who work at city genemi hospital 100% vlllage-ofticlals who work at foods hygiene and safety field am holding mom than one office and haven't been tmined pmfesslonally. About technical foods testing ; dlstrict-ofticlals have college degme only and technldans. In city genemi hospital, them am 3 workers Including 2 with university degme and 1 with college degme. City and district officials am not able to do statistic chemical test and bacteria test . Village officials can not take charge In sampling and ddng quick tests. Them am enough infmstmctum for testing foods in city hospital, however, them Is not In districts.
Especially, village health centers are not equipped with quick test kits and seam bags to stom samples.
Tmatment sampling, tinding out causing meals and armnge the survey Is the mission of town hospitats and district hospital
Keywords; Food poisoning, causing meals, surveying ability.
DATVANDfe
& Vifit Nam Iheo thong kfi cua Cue an lodn Ihyc phim lir ndm 2000- 2006 nudc la cd 1616 vu ngg dfic thyc phim vdi 41.898 ngud'i mac vd 436 ngud'i tu* vong.
Cdng tdc dilu tra khic phuc ngd dfic thye phim dd phdn d p cho d c don vj Irong hfi thdng y te. Cde bifin phdp da duyc triln khai tich cyc nhung d n bgc lfi nhiiu b i t d P - Hau hel d c co quan chirc ndng ciia d|a phuong khi triln khai d c bifin phdp dilu Ira ngg dfic xly ra vSn chua tiln hdnh Iheo qui che dieu tra ngfi dfic.
Vific lly mlu bfinh phim, Ihyc phim xfit nghifim nguyfin nhdn ngd dgc Ihyc phim chua duye Ihyc hifin day du, k l l Ihuc vg ngO ddc thud'ng khdng d bdo d o culi ciing. D l cd CO sd khoa hgc xdy dyng d e bifin phdp trong d n g Idc phdng ching ngfi dfic thyc phim vd ddnh gid ndng lyc ciia nhirng don vj tnj'C tiep Ihyc hifin nhifim vu nham de xult nhO'ng gidi phdp phCi hyp vd kjp thdi gdp phin hgn ehl ngd ddc Ihyc phim xdy ra chiing Idi tiln hdnh nghifin d u d l tdi vd'i mgc tieu: Md ta ning Iwc didu tra rm^ dqc thwc plwn ciia h^ thdng y te tuydn ca s&
vi mqt so ^ diem cic vy ngd ^c^W^f^tim tia tinh Nam
£^nh nam 2010.
Y HQC THV'C HANH (815) - SO 4/2012
D 6 I TUVNG, PHU-ONG PHAP NGHIDN cCru 1. D I I t u v n g nghifin ci>u:
Ddi tuyng nghidn ciru Id: Hfi so, sfi sdch lidn quan d i n dilu tra vg NDTP vd d c bdo d o vg NDTP cua dja phuong duyc ghi nhfin trong ndm 2010, Cdn bd quin ly, nhdn vifin y t l tgl d c don vj thufic hfi thdng y l l dy phdng, d c don vj xfil nghifim, d c don vj Ihyc hifin chirc ndng b i o ddm ATTP; Trang Ihill bj dgng eg phuc vg cdng Ide ddm bdo ATTP tgi cdc tuyin.
2. Phuong phdp nghidn ci>u:
Tfi ehii'c dilu Ira hfii ciru, tfing hyp sfi lifiu tCr sd sdch, bdo d o cua d c eo sd y l l cd lifin quan dilu tra, bdo d o vg NDTP tgl Tmng tfim Y l l dy phdng tinh, Chi Cgc An todn vfi sinh Ihyc phim tinh; Trung ldm Y l l huyfin, Trgm Y l l xd; phdn lich vd ddnh gid thyc trgng llnh hinh m i c vu NDTP eua dja phuong nhim md t l mdt sd d$c dilm d j d l6 hyc vd d n g Ide dilu Ira NDTP.
Phdn bd sfi mic. sfi chit, di vifin d a d c vg NDTP theo thdng d l ddnh gid diln biln d a NDTP Iheo thdng trong ndm; bilu hifin ldm sdng vd diln biln ctia d c vg NDTP, nguyfin nhdn d a d c vg NDTP.
Thilt k l nghifin ciru ngang: lfi chirc Ihyc hifin iSlu tra v l chirc ndng, nhifim vg, id chuc, bifin ehl, ndng lyc d n bd, Irang thilt bj lifin quan d i n bdo ddm ATTP d a hfi Ihdng y t l , phdn Uch, ddnh gid thuc Irgng ndng luc ddp ling d a d c don vj d a ngdnh y l l Irang difiu tra vg NDTP d a d c dja phuong.
KtJ QUA
1. D$c d i l m cdc vg NDTP xdy ra tgi Nam Djnh ndm 2010
Bdng 1. Tinh hinh ngfi dOc Ihyc phim Igi llnh Nam Djnh ndm 2010
STT 1 2 3 4
Cfic chi s&
Tdng s6 ca ngd ddc thyc phim Tdnq sd nqudi mdc
Sd ngirdi di vifin Sd nqudi tir vonq
Nam Djnh 9vu 436 nqtrOi
7nqu'yi 0
So vdi cd nudc 6 8%
9 3%
Trong ndm 2010 Igi tinh Nam Djnh dd xdy ra 9 vg ngO dfic Ihyc phim (6.8% d vg NDTP Iron todn qufic) vdi 436 ngud'i m i c nhung chi d 7 ngudi phdi nhfip vifin, khdng d l u vong.
Bdng 2: Ddc dilm v l nguyfin nhdn vd co sd nguyfin nhdn gdy ra d c vg NDTP
STT 1
2
3
Ndi Dung Nguyfin nhdn gdy NDTP
Do vi sinh Do ddc td ty nhifin
Do hda chit Do lhi>c dn blln chit Thi>c dn nguyfin nhdn gdy NDTP
Rau/qud Thit/SP ciia thjt Co sd nguydn nhdn
BQ-a An gia dinh Tific cu-d'i/gi5 Nhd hdng/khdch san
Tyifi%
11.1 11 1 33.3 44,5 55.5 445 66.7 22.2 11.1
2. Ndng Ivc d i l u tra vg NDTP cua h$ thOng y tfi t u y i n c a s d
Bing 3. Trlnh dO chuyfin mdn d a d n bO Iham gia cfing tdc ATTP
Trlnh 60 chuyfin mdn
Bdc 8?
Y 8p, V ti Du'ye, didu du'fi'ng, nO' hd 8lnh, k9 8irTP Tdnq ad
Kdt Qud difiu tra (nguOi) Tuyin xa
(65 xd) 6 56 3 65
Tuyfin huyfin (10 huvfin)
6 15 6 27
Tuyin tinh
5 0 8 13
Chunq n 17 71 17 105
%
16,2 67.6 16.2 100 Todn tinh d 105 d n bd Idm d n g tdc ATTP, chO y i u Id trlnh dfi y Id, y sy c h i l m tdi 67,6%, Irinh dO bdc sy chT d 16,2% nhung ehl tfip tmng d l u y i n tinh vd luyin huyfin. 100% sd d n bd t u y i n xd Idm d n g Idc VSATTP Id klfim nhifim.
B i n g 4. Trlnh dO chuydn mdn d a d n bd ldm cdng tdc k i l m nghifim ATTP
Nguyfin nhdn chO y i u Id do Ihirc dn b i l n c h i t di thiu vd n h i l m hda c h l l . Thuc dn gdy NDTP chu y i u Id rau/
qud c h i l m 55,5% vd t h j l / d c d n p h i m tir Ihjt c h i l m 44,5%.
Ddc b i l l NDTP xdy ra d bu'a dn gia dinh Id chu y i u , c h i l m 66,7% tdng sfi vy.
Trlnh dd chuyfin mOn Dal hoc Trung cdp K9 thudt vifin
Tdng sd
Kdt qud difiu tra (ngirdi)
xa
0 0 0 0Huyfin 0 5 3 8
TTnh 2 1 0 3
Chung 2 1 0 11 8 ngud'i/5 huyfin d chuyfin mdn v l k i l m nghi|m nhung m d i cht d d mi>c dfi trung d p vd ky thu$l vifin.Tgi l u y i n tinh cQng d 3 d n bO d chuyfin mfin v l d n g Ide k i l m nghifim trong d d d 2 ngudri d Irinh dO dgi hoc vd 1 n g u d i c d trinh dfi trung d p .
Bdng 5. T h y c Irgng trang t h i l t bj k i l m nghifim ^ y e phim tgi d c tuyin
STT 1 2 3 4
Trang Ihlfit bj Phich Ignh dyng mdu TOl ghdp ml dynq mdu Panh, kfio, ddn cdn Bfi xdt nghifim nhanh
Tinh dti du du du
Huyfin du dO dO 2bO/
huyfin
xa
dd khdng c6 khdng cdoa
Tgi luyin tinh duyc trang bj du dgng cg, hda chit phgc vg cho d n g tde lly m i u , b i o quan m l u vd ldm cdc xfil nghifim nhanh kilm nghifim Uiyc phim. D l i vdi tuyin huyfin d n Ihilu hda c h l l phgc vy cho xfil nghifim. 0$c b i l l luyin xd Ihl khdng duyc trang bj bO x i t nghifim nhanh vd liii ghfip ml dfi dyng mSu.
Bdng 6. Khd ndng tham gia kilm nghifim Ihyc phim tgi d c luyin
STT 1 2 3 4
Cdc yfiu cdu Khd ndng ldy mdu Ldm cdc xdt nghifim
nhanh XN phdn tich hda hoc
XNvi sinh vfit
Ecoli ColKomi S. aureus
Khd ndno
"Hnh Ldm Idt Ldm Idt GLTI mdu GO-i mSu Gui mdu Gu'i m^u
Huyfin Ldm Idt Ldm tdt GiJNm£u GOi mdu GO-i mdu Girl mdu
l^&ng
xa
dO Khdng GCFI mh' Girimdtl^
Gfli mdi];
GiHnitai Cdc cdn bO t u y i n tinh vd t u y i n huydn d i u d k h i n { ^ I tfit \ri$c l l y mdu vd d c xdt nglufim nhanh nhung khwB^
d khd ndng ldm cdc xdi nghidm phan tich hda hgc vd xdt
Y HQC THVC HANH (815) - S6 4/2012
nghifim vi sinh vfit, md d i u phai gui mlu. Ndng lyc d a edn bd tuyin xd Ihl khfing ddm duong duyc vific lay mlu diing qui djnh d a dilu tra ngO dfic Ihyc phim vd khdng trien khai duyc d c xfil nghifim nhanh.
Bang 7. Gdc nfii dung dd thyc hifin Irong dilu tra ngd dfic thyc phim d a d c tuyin
N(i dung dd thyc hifin trong dilu tra NDTP Tham gia didu trj cho bfinh
nhdn Ghi chdp vdo s6 theo dOi
llnh hinh mdc Ldy mdu xdt nqhifim Tim hi4u vfi bO'a dn
nquyfin nhdn ThOng bdo cho nhdn ddn
tronq xa d l dd phdng Td chi>c doan didu tra tai
hifin tnrdnq Tham gia difiu Ira cCing
tuyin tifin
Ty Id % thu'C hifin tdt Tuyin xd
(n=65) 3,1 100,0
0.0 0,0 100,0
0,0 1,6
Tuydn huyfin (n=10) 90,0 100,0 100,0 100.0 90.0 100.0 100.0
Tuydn tinh 100,0 100,0 100,0 100,0 100,0 100.0 100.0 v l ndng luc id chirc dilu tra ngd ddc Ihuc phim, Cdc nfii dung dd thyc hifin Irong dilu Ira ngfi ddc thyc phim tuyin xd ehu y i u Irlln khai vific ghi chdp, Iheo ddi tinh hinh m i c vd Ihdng bdo cho nhdn ddn b i l l d l d l phdng. Vific dilu trj, l l y m l u xdt nghifim, llm hilu bO'a dn nguyfin nhdn vd tfi chue dodn dilu tra hifin tn/dng chu yiu do tuyin llnh vd huyfin thuc hifin.
K £ T LUAN
Ndm 2010 I d n tinh Nam Djnh dd x l y ra 9 vy NDTP vdi 436 ngudi m i c 7 ngudi phdi nhfip vifin, khdng cd l u vong. Nguyfin nhdn d u y i u Id do Ihirc dn biln c h l l di thiu vd nhiem hda chit. Thirc dn gdy NDTP Id rau/ qua chilm 55,5% vd IhjI/de san phim lir Ihjt chilm 44,5%.
NDTP xly ra d bira dn gia dinh chilm 66,7% tfing sfi vg.
Cdn bfi ldm d n g Idc ATTP chu y i u Id Irinh dO y Id, y sy, trinh dfi bdc sy chi d 16,2% d l tfip tmng d tuyin linh vd tuyin huyfin. 100% sd d n bO tuyin xd ldm d n g tdc VSATTP Id kifim nhifim vd d u a duyc ddo Igo chuyfin mfin. V l chuyfin mdn KNTP: Cdn bfi tuyin huyfin chi d trlnh dfi tmng d p vd ky thufil vifin. Tgi tuyen llnh d n g d 3 d n bfi trong dd d 2 ngud'i d Irinh
dd dgi hoc vd 1 ngudi cd trlnh dO Imng d p . Cdc d n bfi luyin tinh vd luyen huyfin khdng d kha ndng Idm d c xdt nghifim phdn Uch hda hgc vd xfit nghifim vi sinh vdt, diu phdi gCri miu. Cdn bfi tuyin xd khdng dam duong duyc vific lly m i u va Iriln khai duyc d c xfil nghifim nhanh. Tuyin tinh dam bao du dgng cy, hda chit phye vy cho edng tdc lly m i u , bao quin m i u vd ldm d c xdt nghifim nhanh KNTP nhung ddi v<>i tuyin huyfin Ihi cdn Ihilu hda chll. D$c bifit luyin xd Ihi khdng duyc trang bj bd xfit nghifim nhanh vd tui ghfip ml d l dyng mlu.
Vific dilu trj, l l y m i u xdt nghifim, tim hilu b&a dn nguydn nhdn vd l l chirc dodn dilu tra hifin truing do tuyin linh vd huyfin thyc hifin.
KHUYDN NGHI
1. C i n lfi chirc d c ldp ddo Igo chuyfin mdn cho d n bO ldm d n g Idc ATTP dfic bifit Id d luyin xd.
2. Trang bj thfim v l mdy mdc, Irang thill bj eho phdng xfit nghifim d t i l d cdc tuyin nhim ddp ung nhifim vy trong giai dogn hifin Igi.
TAI Ll^U THAM K H A O
1. Ban chi dgo lifin ngdnh v l An lodn thyc phim (2007). Bdo cdo tdng kdt vi Vd sinh an toin thqc phim 2000-2006. Hi Ndi- Hfii nghi lodn qudc ngdy 19 Ihdng 1 ndm 2007.
2. BO Y t l (1998). "Hwdng din thwc hidn quin tp an toin vd sinh thwc phim tmng kinh doanh, dich vu vi phuc vq Sn udng". Thfing l u sd 04/1998/rT-BYT ngdy 23/03/1998.
3. Trin Ddng, Hodng Thuy Tiln, Tm-ong Th| Thuy Thu (2007). Thwe trgng dgi ngu ein bd, cdng chiie tmng quin Ip nhd nwdc ve vg sinh an toin thqe pham. Ky y i u KOi nghj vfi sinh an todn Ihyc pham l i n thir 4. Nhd xult ban Y hge, Ir 39-43.
4. Trin Ddng, Chu Qufic L§p, Truong Thj ThOy Thu (2005). Bd miy td chiie tmnq qudn ly nhi nwdc vd vd sinh an todn thucpham. Ky yeu Hdi nghj vfi sinh an lodn thyc phim l l n thu 3. Nhd xual ban Y hgc, tr 60 - 68.
5. Phan Thj Kim (2003). "Ban ve quan ly vfi sinh an todn Ihyc phim hifin n a / . Tgp ehi Y hgc thqe hdnh, sfi 445.Tr 38-40.
6. Phgm Ouy Tuyin (2009). Ddnh gid hogt dfing cdng tdc qudn ly vfi sinh an lodn thyc phim tinh Hai Duong ndm 2008. Ky y i u Hgi ngh| vfi sinh an lodn thyc pham lan thir 5. Nhd xual ban Y hgc, tr 48 - 53.
mhH xil K£T QUA oiiu TRJ NAM PHSI BANG AMPHOTERICIN B TAI TRUNG TAM Hd HAP- BENH VIEN BACH MAI
NGO QUy C H A U , Trung tam Hd hap- BVBgcb Mai D A N G H O A N G GIANG, BSNT khda 36- D^lhqc YHi Ndi T6M TAT
B§t vin de: Sir dqng Amphoteridn B li mdt tmng nhUng phwang phip didu trj ndm phdi hiin nay. t/fyc diicA; Nh$n x6t hiiu qui diiu trj vi eie tie dqng khdng mong mudn khi sO- dqng Amphotericin B diiu trj nim phdi. Boi twqng vi phwang phip: nghiin cdv hdi eOv md ti trdn 30 bdnh nhin dwqc chin doin nam phdi tqi Tmng tdm Hd Hip- Bdnh vi$n Bgch Mai tir 01/01/2007 din 31/12/2010. Kit qui: Tdng liiu tmng blnh 1,256 ± 0,663 g. thdi gian diiu trj tmng binh 45,97 ±14.3 ngiy.
Kit qui diiu trj: khdi 20 %. dd 46,6 %. thit bgi 33,3 %.
Cic tic dqng khdng mong mudn: Sdt (63,3 %), rit mn (23,3 %), rdi logn tieu hda (26.6 %), vidm tinh mgch (16,6 %). thieu miu (96.7 %). hg kali mdu (80%), ting tmnsaminase (73,3 %), suy thin (56,6 %). Kit lu^n:
Amphotericin B Id thudc didu trj ndm phdi cd kdt qud, tuy nhiin cdn theo doi sit tren lim sing vi xdt nghidm <x phit hidn cdc tie dung khdng mong mudn dd kjp thdi xi>
tri.
Tir khda: Nim phdi. Amphotericin B
Y HQC THV'C HANH (815) - SO 4/2012
