Nhu v$y. dya vdo cS 3 chi tifiu theo doi, chufit dugc d i l u trj vdi bfio t d DD1.1 vd A T M , hodc ph6i hgp giOa A T M hodc DD1.1 vdi BS02 cd khfi ndng dilu trj tifiu (^ay vfl^ l i l u bdo t u vi khuin s u dung Id 106 bdo tu/lOg TTC, 2 lln/ngdy, l i l u ndy tuang dLrang vdi l i l u 108 bdo tu/1 kg the trpng, 2 lln/ngdy, tuong irng vdi l i l u cDa cdc san p h i m probiotic chua Bacillus ciia WHO. Ddi vdi l i l u probiotic ttilp han 2.105 bdo td/10g TTC, c6 t h l ldm giam mde dfi gdy tifiu chay so vdi Id ddi chdng, tuy nhifin khflng d i l u trj hit tifiu chay hofin tofin, do vdy l i l u probiotic tdi thilu giOp phflng ngCra vfi d i l u trj tifiu chay ciJa hai chOng vl khuin nghien cdu Id 106 bdo tu/1 Og TTC d ca mdu thd ehi chda mflt vi khuin vfi mdu thir phdi hgp vdi BS02. Trong nghifin cuu ndy, chiing tfli t h i y rang cdc chiing Bacillus sinh carotenoid Id A T M vd DD1.1, tuy khdng cd kha ndng ddl khdng vdi cdc chung gdy bfinh, nhung cd kha nang d i l u tri ADD khi su- dgng dflc ldp hodc sir dung k i t hgp vdi chung vi khuin cd tilm ndng Idm probiotic khdc la BS02 trong ^ e u tri
KfiT LUAN
Bdo t u ciia Bacillus marisflavl DD1.1 vd Bacillus infantis A T M cfl kha nang d i l u trj tifiu chfiy lifin quan din khdng sinh khi s u dgng ddc lfip hofic phdi hgp vdi Bacillus subtilis BS02 vdi l i l u su dung Ifi 108 bfio td/g t h l trpng, ngfiy 2 i l n .
TAI LI^U THAM K H A O
1 Basu S , Paul D K , et al (2009) Efficacy of high- dose Lactobacillus rhamnosus GG in controlling acute watery diarrhea in Indian children: a randomized controlled trial. J Clin Gastroenterol, 43(3): 208-13.
2. Czenvionka S. M., Murawska S., et al. (2009) Evaluation of influence of oral treatment with probiotic and/or oral rehydration solution on course of acute
dianhoea in ctiSdren. Gastnaenterologkzny 4{3): 166-172.
3. Elmer G. W. (2001). ProbioScs: living drugs'. Am J Health Syst Pharm, 58(12): 1101-9.
4. Friedman G. (2012). The role of protnotics in the prevention and treatment of antibiotic-associated diarrhea and Clostridium difficile colitis. Gastroenterol Clin North Am, 41(4): 763-79.
5. Graul T.. Cain A. M., et al. (2009) Lactobacillus and bifidobacteria combinations: a strategy to reduce hospital-acquired Clostridium difficile dianhea incidence andmortality. Med Hypotheses, 73(2): 194-8.
6. Hempel S., Newbeny S. J., et al. (2012) Probiotics for the prevention and treatment of antibiotic- associated dianhea: a systematic review and meta- analysis. JAMA, 307(18): 1959-69.
7. Hickson M, D'Souza A., et ai. (2007). Use of problem Lactobacillus preparation to prevent diarrhoea associated mth antibhtics: randomised dout^ blind placebo controlled trial British Medical Joumal, 335' 80-83.
8. Kotowska M., Albrecht P., et al. (2005).
Sacchammyces boulardll in the prevention of antibiotic- associated diarrhoea in children: a randomized double- blind placebo-controlled trial Aliment Pharmacol Ther, 21(5): 583-90.
9. McFarland L. V. (2006). Meta-analysis of pmbiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. Am J Gastroenterol, 101(4): 812-22.
10 Misra S.. Sabui T. K., et al. (2009). A randomized controlled trial to evaluate the efficacy of lactobacillus GG in infantile dianhea. J Pediatr, 155(1). 129-32.
11 Qamar A., Aboudola S., et al. (2001).
Saccharomyces boulardll stimulates intestinal immunoglobulin A immune response to Clostridium difficile toxin A in mice. Infect Immun. 69(4): 2762-5.
DANH GlA KIEN THIJfC HIEU BllT VE CHE DO AN CUA BENH NHAN TANG HUYET AP Cd ROI LOAN UPID MAU VA CAC YEU T 6 LIEN QUAN
D 6 T H O Y NGOC - B$nh vl$n Trung uang QuSn dgi 108 Lt THj BiNH - Hgc vign YDHCT Viet Nam
T 6 M TAT
Muc tidu: (1) D^nh glA duoc kiin th&c hiiu biit vi chi dddnd bdnh nhSn tBng huyit ip rii loan lipid mdu tgi Bdnh vidn Tmng uong Quin ddi 108.(2) Xdc dinh dugc cdc yiu ti Hdn quan din tlnh tr^ng rii lo^n lipid mdu d bdnh nhdn tSng huyit Sp. Ddi twang va phuang phdp nghidn c&u. Nghidn c&u md td cit ngang dupc thwc hl$n trdn 115 bdnh nhSn tdng huyit dp cd roi loan lipid mdu dugc (Xiu tq ngoai tni t^i Khoa khdm binh, Bdnh vidn Tmng uong Qudn ddl 108. TO- thdng 6 nim 2012 din thing 10 nim 2012. Kit qua: Kiin th&c hiiu biit nhw: binh nhin khdng biit minh bj tdng huyit dp rit cao (33,04%). biit vi b$nh nhwng khdng diiu tn bdnh (12.04%). c6 diiu tri nhwng khdng kiim soit dupc HA (33.04%). Sw hHu biit vi chi dd sinh ho^t: Cd kiin ihirc vi phdi in ting rau vi hoa qud (73%), cin di bd
(67.8%), h^n chi mo ddng vat (55,6%). ridng cd kiin thuc vi tic hai cua thudc /d vd nrgu nhung vin khdng thuc hdnh tdt, do viy ngimg hiit thudc chl cd 4,3% vi h$n chi mau li 13%. Cdc yiu ti lidn quan din tlnh trang ting huyit ip: Cd sw lidn quan gi&a benh nhin ting cholesterol ting tnglycerid miu vdi bdnh nhin cd s& thich in nhidu chit bdo (p<0,05), giWa bi ting huyit ip V&I c6 thoi quen in min, in nhieu chit bdo (p
<0.05), gi&a benh nhin ting huyit ip cd rii loan lipid miu v&i "hiiu biit vi chi dg in" (p<0,01), giO'a bdnh nhin ting huyit ip cd roi lo?n lipid miu v&i thiy thudc cd tw vin" (p<0.001), gi&a bdnh nhin ting huyet ip cd rdi lo^n lipid miu vdi tw dgc tai lidu tim hiiu chi <3d Sn udng, sinh ho^t" v&ip < 0,(X}1.
TO- khda: Bdnh nhin ting huyit ip, huyit ip.
nghidn cihi, kit qui nghidn cOv.
Y HOC THVC HANH (916) - S6 5/2014
SUMMARY
ASSESSING KNOWLEDGE UNDERSTANDING OF THE DIETS OF HYPERTENSIVE PATIENTS WITH
DYSLIPIDEMIA AND FACTORS RELATED Objective: (1) Assess the knowledge of diet in patients with hypertension dyslipidemia in the Central li^illtary Hospital 108 (2) Identify the factors related to the state of confusion hyperiipldemla In patients with hypertension. Subjects and research methods: Cross- sectional descriptive study was pertormed on 115 hyperiensive patients with dyslipidemia treated in outpatient clinics, the Army Centml Hospital 108. From June 2012 to October 2012. Results: knowledge, such as patients do not know they have high blood pressure IS very high (33.04%), but did not know about disease treatment (12.04%). be treated but uncontrolled BP (33.04%). Understanding of the mode of living: to have no knowledge of eating fmits and vegetables Increased (73%), on foot (67.8%), limited animal fat (55.6%), no pnvate finv knowledge about the harmful effects of tobacco and alcohol but still not good practice, so only stop smoking and limit alcohol 4.3% to 13%. Factors associated with hyperiension status: an association between increased cholesterol patients, hyperinglyceridemia in patients with a high-fat diet preference (p<0 05), between hyperiension with no habit of eating salt, high-fat diet (p<0.05), between patients with hyperiension disorder lipid quickly with
"understanding of diet" (p < 0.01), between patients increased blood pressure, lipid disoaSer with
"consulting physicians" (p < 0.001), between patients with hypertension disorder lipid quickly with "self-leam reading diet and living" with p < 0.001.
Keywords: Patients with hypertension, blood pressure, researchers, research results
DAT V A N Bt
Tfing huylt dp nguyen phdt la mflt trong nhung v i n de quan trpng ddi vdi s&c khoe cflng ddng, ddy id benh hay gap nhit trong sd cdc benh tim mach o- h l u het cac nudc trfin t h l gidi. Ty le mac THA cfl xu hudng tang d i n theo tuoi, nhit la trong d i l u kien hien nay khi tudi tho trung binh ngay cang cao [4] To chii'c Y te t h l gidi (WHO) udc tinh ty Ifi THA tren the gidi ndm 2000 la 26,4%, tuang duang vdi 972 tneu ngudi, rifing cac nudc dang phdt tnen chiem 639 tneu ngudi.
Dy kiln ty le THA se tang len 29,2% vdo nam 2025, tuo-ng duang vdi 1,56 ty ngudi Tai Viet Nam, ket qua dieu tra djch t l hoc eho thay sd benh nhan THA dang gia tang nhanh chdng [1]. Y l u td nguy c a xuat hifin nhieu nhat, dong thdi cung tdng nhanh nhat, nhat Id khi ddi song xfi hdi nang cao, an udng d u thda, dfic biet d cdc nudc dang phat then, chuang trinh giao due tfing huylt dp chua dugc manh me va pho cap, h i l u biet ciia ngudi dan thi cd han do la roi loan lipid mdu hay benh xa vua dpng mach Id mot thdch thipc quan trpng vdi cac benh ly tim mach cung nhu vdi ganh nfing chi phi y te toan xfi hfli, Che dp fin cd vai trfl h i t sue quan trpng trong tang lipid mdu ndi chung va tren benh nhan tfing huyet dp nfli rieng, Vi cfic ly do trfin.
d l tdi 'Dinh gii kiin thOv hiiu biit vi chi dd Sn oia bdnh nhin ting huyit ip c& rii lo^n lipid miu vi cfic yiu to lien quan' diFOC thyc hifin n h l m muc tifiu:
1. Dinh gii duoc kiin th&c hiiu biit vi chi d? Sn
& benh nhin tang huyit ip roi loan lipid miu t^l Bdnh vien Tmng uxmg Quin ddl 108.
2. Xdc (Snh diroc cdc yiu td Hdn quan t^n tlnh tmng roi logn lipid miu & bdnh nhin tSng huyit Sp.
D d l TUXTNG VA PHLTONG P H A P NGHIEN CCPU 1. Tieu chudn lu-a c h o n : Benh nhdn THA nguyfin phdt dirac c h i n dodn theo tieu c h u i n cua WHO/ISH - 2003 den khdm, ^ e u trj ngoai tru tgi BV Tiung u'ong Qudn ddi 108.
2. Tifiu ehufin logi trip: THA t h d phdt nhu suy than, hep dflng mach than, u ndo, u tuy thugng thfin..., bfinh nhan dang cd cac bfinh d p tinh.
Dja d i l m nghifin cdu: Khoa khdm benh vfi dilu tri ngoai tru tai Bfinh vifin Tnjng u a n g Qufin dfli 108, tO thdng 6 nfim 2012 d i n thdng 10 ndm 2012.
3. P h u a n g phdp nghien cu>u: Tien edu, mfl I I cdt ngang.
- C d m l u l u a e h p n : n = (Z21-a/2)2 x (1-p)/k2.
Trong dd, n: C d mdu nghifin cdu.
Z21-a/2: Gia trj gidi han tuang ung vdi dd tin cfiy (Z21-a/2 = 1,96 n l u dd tin cdy Id 95%).
Vdi p Id ty le u d c luang roi loan lipid mdu d bfinh nhfin THA (udc tinh 70% qua cac k i t qua nghifin cdu trudc).
k Dp chinh xac mong mudn (k = 0.1) Thay vfio cdng thde tren ta cd: n = 1,962 x (1 - 0,75)/0,12 = 96.
Trfin thyc te chiing tdi lay thfim 10% d l phdng s l BN t u chdi, vdy tien hdnh chpn 115 benh nhdn bi THA nguyfin phat. _
- Cach chpn mau' Chon ngdu nhien benh nhSn bj tang HA__cfl tdng m d mdu trong sd NB d i n khSm, chon n g l u nhien theo sd chan cua tdng sd NB din khfim trong ngay.
4. Cfic bifin s d nghien cu'u
^ Bien so nen: T u l i , gidi, n g h i nghiep, trinh dd hpc van, dja du.
Bien s6 lam sang: BMI, chi sd huylt dp, tiln si>
ngudi benh huylt dp, tien a& cd tang Lipid mfiu, triglyceride, cholesterol, s y hieu b i l t v l c h l dfl Sn cLia ngudi cao huyet dp, thfli quen dn udng.
5. Chi s d danh gia (djnh nghTa)
- Chi tidu quan sit: Cdc chi sd Idm sdng difgc ddnh gifi 1 ngay mdt i l n do huylt dp vfi nhfin djnh cdc d i u hieu trifiu chdng cua tang h u y l t dp, theo dfii cdc b i l n chdng cua BN den khdm benh tgi khoa kham bfinh BVTUQD108.
- Tidu chuan chan doan tang huyit ip: Phfin dO tdng huyet dp theo WHO/ISH 2003.
Tang huyet ap.
DO 1 (Nhe) Phan nhflm qidi hgn
OO II (trung binh) DO 111 (n^ng) THA tam thu don dflc
HA tam thu (mmHg)/HA tfim trucnq (mmHq) 140- 159 vfi/hoac 9 0 - 9 9
140- 149va<90 160-179 vfi/hoac100-109
>i80va/hoac>iio
> 140 va < 90
Y HOC THVC HANH (916)-S6 5/2014
- Tidu chuin chin doAn ting Cholesterol huyit tuong:
a. Binh tiiudng: Cholesterol trong mdu < 5,2 mmoI/l(< 200 mg/dl).
b. Tdng gidi hgn. Cholesterol trong mdu t u 5,2 din 6,2 mmol/l (200 - 239 mg/dl).
c. Tdng cholesterol mdu khi >6,2mmol/l (>240mg/dl).
- Tidu chuin chin doin ting Triglycerid trong miu:
a. Blnh thudng. TG mdu<2,26mmol/l (<200mg/dl), b. Tfing gidi hgn: TG t d 2,26-4,5 mmol/l (200-400 mg/dl).
c. Tdng TG: TG t d 4,5-11,3mmol/l (400- lOOOmg/dl).
d. Rat tfing: TG mdu >11,3 mmol/l (> 1000 mg/dl).
- Tieu chuin chin doin BN thich Sn man: Lfi thdc dn eua BN thudng che bien mdn han nhieu so vdi ngudi dn binh thudng (cfl nghta Id ngudi khde khd fin vi qufi mfin)
- Tieu chuin chin doin BN thich Sn beo: BN dn lugng md hodc d i u dn > so vdi mdc quy iSnh eua ngu'dl binh thudng, thich dn thdc dn xdo, quay rdn...
6. Thu thap s d lieu
Thu thip thdng tin: T d hd sa bfinh dn tai phflng khfim luu ma benh, thong tin qua nhdn tSnh BN, k i t qufi phdng v i n v l sd thich, l6i sdng, ve fin, uong, qua cdc kit qufi xfit nghiem.
Tat ci so ll^u dwgK ghi chdp vio bing theo ddi b^nh nhin: Theo dung mau thilt k l dfi thilt lfip s i n (theo protocol).
Do chiiu cao, cin n^ng: Tinh chf sd khdi ca thl (Body Mass Index. BMI) theo cflng thiPc. BMI = trpng lu-gng ca t h l (kg) / [chilu cao(m)]2.
Ky thu$t do huyit ip: Mdy do huyet dp, dng nghe, biit ghi, bang theo ddi-
Phdng van b^nh nhSn vS ghi nhSn cic thdng s6: Tiln sd bfinh, h i l u b i l t ve ehe dd dn udng, tdp luyfin, bfinh ly kfim theo,
7. X d ly s d li^u: B i n g p h i n mem SPSS 16 0 de tlnh hfi sd tuang quan giua cham sdc ngudi benh vdi m0t sd cfic y l u td dnh hudng. S y khdc biet dugc coi Ifi cfl y nghTa thdng kfi d cfic mue khi. p < 0,05, p <
0,01, p< 0,001.
8. Ogo diPC trong nghifin c d u : Cde ddi tugng NC dugc gill thich cy the, rfl rfing mue dich qui trinh nghifin cdu. Ddm bdo bl mfit cac thdng tin nghien cuu,
K £ T QUA NGHIEN CLTU
1. D$c d i l m Chung cua dfli t u g n g nghifin c d u Bdng 1. Cdc dfic d i l m ehung vd k i l n thuc hilu bilt v l bfinh d bfinh nhfin tdng huylt dp
Tu6i
<40 4 0 - 6 0
>60
N 9 40 66
Tvie 8 35 57
E)$c d i l m bfinh nhfin tang h u y l t d p Chifiu cao trung blnh
(cm) c a n nang (kg)
BMI (ka/m2) Gidi
Bfinh nhan tang huyfet ap (n = 115) Nam 1 5 9 + / - 0 , 6 9 57,3 +/- 0,75
22,65 58 (50,4%)
N u 147+/-0,87 47.7+/- 0,69
22,89 57 (49,6%)
Chi sd BMI cua nam vd n u tuang duang nhau <
23 (22,65 so vdi 22,89). Ddi tugng trong nghien cuu s u ehfinh Ifich it ve gidi (nam 50,4%, n u 49,6%), Ida tudi > 60 chilm ty le cao n h i t vd t h i p n h i t Id Ida tudi
< 40 tudi (57% so vdi 8%).
Bang 2 K i t qud k i l n thuc hieu bilt eiia BN v l bfinh vd cdc tudn thO khfic d BN tfing huylt dp
€>3c d i l m bfinh nhfin tang huyet a p
Benh nhan tang huy^t ap ( n = 1 1 5 ) n 1 Tv la Hieu bi&t v& b#nh va tuan thu dieu tri lanq huyet ap
Kh6nq biet bi T H A Biet, khonq dieu tn CO aieu tri nhu-ng khong kifem
soSt duo-c HA Kiem sodt difo-c huyet a p
(<140/90 mmHq) 38 14 38 25
33,04 12,04 33,04 21,74 Su- hi6u biet ve ch6 do sinh hoat A n nhat
D i b O Tanq rau, hoa qua Han che ma dOng vat
Giam can Nqu'nq hiit thuOc
Han che r u g u
29 78 84 64 49 5 15
25,2 67,8 73 55,6 42,6 4,3 13 Ty le BN khdng biet minh bj tfing huyet dp r i t cao (33,04%), nhung ty le BN dfi bilt nhung khflng d i l u tri thudc cQng cao (12,04%), BN cfl dieu trj nhung khflng kiem soat dugc HA (33,04%). Sy hilu biet v l c h l dp sinh hoat chilm ty Ifi cao n h i t Ifi phai dn tfing rau vfi hoa qua (73%), tifip den Id c i n di bfl (67,8%), han che md dflng vfit (55,6%), ty Ifi ngung hut thude Chi4,3%, hgn chfi rugu 13%,
2. Cdc y l u t d lifin quan d i n rdi loan lipit mfiu d BNtang h u y l t fip
Bang 3 Mdi lifin quan giua tfing huylt dp vdi cde chl sd cdn Idm sdng
Bien s6 ng ien CU'U
BN tang huySt ap (n=115) C6 1 KhOnq
P MOI lien quan giira tSng huyet ^p vdi cac chl sd
cholesteron mSu Tang
cholesteron Tanq Binh thu'dng
46(40) 35(30,43)
17(14,78) 9(78,27) <0,05 MOI lien quan giira tSnq huySt 3p va tSnq tnglyceride miu
TSng triglycerid
TSnq Binh thu'dng
44(38,25) 35(30,43)
19(16,52) 17(14,78) <0,05 S v lien quan giua tifen sir tang huy^t ap v 6 i rOi loan Itpit
C h i s 6 n g h , 4 n c u . u 1 BN cb nen s i a n g hu,«t j Sw lien quan qiira tiSn s(> tSnq huySt Ap vd/i cholesteron
Tang cholesteron
Tang Binh thu'dng
24(20,86) 25(21,73)
39(33.91) 27(23,47) >0,05
Y Hor THirr H A N H (916) - s O 5/2014
Su' li&n quan giira tiSn sir tSna huvdt ap vdi triglycerid TSng
Tnglycerid Tanq Binh thiffi-ng
20(17,39) 29(25,21)
30(26,08) 36(31,3) >0,05 Khi bj tdng huyet dp thi ty Ifi cholesterol tdng cao han khdng bi tang HA, cfl s u lifin quan gida BN bj tang huyet dp vdi tang cholesterol mau, s y khdc bifit cfl y nghla thdng ke vdi p <0,05.
Khi bj tang huylt dp thi ty Ifi triglyceride mdu tang cao han khdng bj tang HA, cd s y lien quan giua BN bj tang huylt dp vdi tang triglyceride mau, s y khdc biet cfl y nghTa thong ke vdi p <0,05.
Chua tim thay sy khac biet giua BN cd t i l n s u tdng HA vdi tang cholesterol mdu vdi p > 0,05.
Chua tim thay s y khdc bifit giua BN cd tien s u tang HA vdi tang tnglycerid mdu vdi p > 0,05.
Bang 4, S u lifin quan giua thdi quen dn udng vdi roi loan lipit mdu d BN tang huyet dp
ThOi quen Si/lien quan giira 16
Loi sonq
Hut thuoc la D i b O Stress
Si/lien quan giira tt ThOi quen an man Thoi quen an beo Sw lien quan giira ThOi quen Sn man Thoi quen an b6o Sw lien quan giO-a Thoi quen an m a n Thoi quen an beo
Benh nhan tanq huyet a p T a n q | Binh t h u d n q P song vdi roi loan lipit m§u d BN tang
huyet^p Cholesterol 8 { 6 ^ 44(38,26)
5(4,34) 5(4,34) 35(30,43)
2(1,74) T n q l y c e n d 5(4,34) 34(29,56)
4(3,47) 8(6,95) 45(39,13)
3 ( 2 ^ 01 quen an uong vdi tSng choi
14(12,17) 66(57,39)
1 4 ( 1 2 , 1 7 ) 21(18,26) hdi quen an uong vdi tang trig!
15(13) 63(54,78}
13(11,3) 24(20,86) hoi quen Sn uong vdi tang hu^
25(21,73) 65 (56,52)
3(2,6) 22(19,13)
>0,05
>0,05 ssterol
>0,05
<0,05 ycerid
>0,05
<0,05 etap
<0,05
<0,05 Chua tim thay sy khac biet giua BN cd loi song hilt thuoc la, di bp, co stress vdi tdng cholesterol vd tang triglyceride mau vdi p>0,05. Chua tim thay s u khac biet giua thfli quen an man vdi tdng cholesterol mau Tuy nhien BN cfl sd thich an chat beo nhilu lai gay nen tang cholesterol mau (p <0,05), Chua tim t h i y su khac biet giua thfli quen an mfin vdi tang tnglycerid mdu (p>0,05). Tuy nhien BN cd lifin quan giu-a tang triglycend mau vdi sd thich dn chdt beo nhidu (p<0,05), Cd s u khdc biet va co y nghTa thong ke giij-a BN tdng huyet ap vdi cd thdi quen an man, fin nhieu chat beo vdi (p<0,05)
Bang 5, Ket qua sau khi dugc t u van ve che dfl
Bien so ngh en c u u
Hieu biet che dO an
C o biet KhOng
biet P
Tang huyet ap c 6 roi loan lipid m a u T o n q 44(38,2) 71(61,8)
<0,01 N a m 2 0 ( 3 4 , 5 ) 38(65,5)
<0,001 N u 24(42,1) 33(57,9)
<0,01
T u v i n bdi thay thuoc Tlf doc tai lieu tim hieu
ve bfinh, che do dn udng, smh
ho^t C o KhOng
P CO KhOnq
P 7 2 (62,6) 4 3 ( 3 6 , 5 )
< 0,001 4 1 ( 3 5 , 6 ) 74(64,3)
< 0,001 35(60.3) 23(39,7)
< 0,001 19(32,7) 3 9 (67,3)
<0,001 37(64,9) 20 (35,1)
< 0,001 22(38.5J 35 (61,5)
<0,001
vdi khdng h i l u b i l t ve ehe dp dn la 61,8%, p< 0,01).
Ty Ifi "thay thudc cd t u v l n ° cho BN tdng cao tfli 62,6% vdi p<0,001. Ty lfi BN "tu doc tai lifiu tim hilu v l bfinh, c h l dfl an udng, sinh hoat" khi bj bfinh c6n t h i p 35,6%, vdi p <0,001
BAN LUAN
Ket qua NC cho thdy, chi sd BMI ciia nam vd n&
tuang duang nhau < 23. Giam cdn ngng n l u thda cdn/beo phi, gid chi so khdi ca t h l (BMI) d mirc il tudng (BMI t u 19 - 23) vd vdng bung khdng qua 90 a nam gidi vd 80 d n d gidi, trdnh loi song tTnh tai, tranh cdng thang. Tudi trfin 60 c h i l m han mfit nda (57%), tudi dudi 40 chiem 8%, Theo cdc nghien cdu djch te d Vifit Nam cung nhu trfin t h l gidi, ty Ifi THA tang nhanh theo tudi, tuoi cdng cao, ty lfi THA cdng cao.
Theo Pham Gia Khai (2000) cho t h i y d Ida tufii 16 - 24 ty Ifi THA trong edng ddng Id 2,78% den tudi 35 - 44: 11,88%, t d 55 - 64 tudi: 38,21%; 65 - 74 tuoi' 46,99% va d Ida tudi eao tren 75 ty Ifi THA Ifi 65,46%
vd eung phti hgp vdi KQNC eua ehung tfli [2]. v i gioi tinh, nghifin cuu cua chOng tdi cfl ty Ifi nam, nO' tuang duang nhau theo Phgm Gia Khai [2], [3] v^
T r i n Dd Tnnh thi nam eao han n u [5]. Sy khfic nhau ve ty lfi THA cd ^ nghTa giua nam vd n u cd t h l lien quan ve gen, v l sinh 1^ hpc cua gidi tinh, cfl t h l bfinh nhdn nu d tudi man kinh cfl rdi loan ndi tilt nhieu nfin huylt dp tang han.
Ty le bfinh nhdn khflng biet minh bi tdng huylt ap rat cao (33,04%), nhung ty le nhung ngudi da biet nhung khdng dieu tri gi cung cao (33,04%). THA Id mdt benh ly keo dai, cd ty lfi bien ehung lifin quan d i n ty le chet do bfinh tim mgch va dot quy nfio cao.
Da cd nhieu t i l n t^d trong hudng dan, c h i n dofin, dieu trj, kiem sofit huylt fip d Viet Nam cQng nhu trfin the gidi- Tuy nhifin ty le hieu biet ve d i l u trj, nhltjfi kiem sodt dwgc huyet dp tdi uu (<140/90 mmHg) vin edn la van de nan giai can duac quan tdm. KQNC chi ra ty le benh nhdn khflng b i l t minh bi THA Ifi 33,04%, bilt bj THA nhung khdng d i l u tri gi la 12,4%, bilt bj THA nhung dieu tn khdng thudng xuyfin, th^t thudng, khdng k i l m sodt duac huyet dp chilm da so la 33,04% vd chl cfl mflt ty Ifi nhd bfinh nhfin THA duac d i l u tri thudng xuyfin, hifiu qua, kilm soSt huyet dp tdt d muc huylt dp < 140/90 mmHg 1^
21,7%. Sy hieu b i l t ve c h l dfl sinh hogt, nhin chung khi bi tang HA kien thuc v l han c h l md ddng v$t (55,6%) va d n phai fin tfing rau vd hoa q u i (73%), c i n di bd 30 - Ih/ngdy c h i l m ty lfi khd cao (67,8%).
Tuy nhien, ddi vdi nam gidi mac dCt cd h i l u bilt v&
bfinh nhung ty Ifi ngung hut thudc r i t t h i p (4,3%),
Y HOC THITC HANH (916) - s 6 5/20M
hgn c h l rugu 13%. D i l u ndy cfl tiie ly giai r i n g , do nghifin qud ndng mdc dii biet Id c6 hgi v l sdc khoe nhung r i t khd bd, dd Id ly do ty Ifi r i t t h i p . Nhu vfiy vdi ty lfi t r ^ till myc tifiu k i l m sodt huylt dp, ngfin chfin bien chung, gidm ty Ifi t u vong do THA gdy nfin cfln Ifi mdt chdng dudng dfii ddi hdi s y nfl lyc, trdch nhifim a i a ngfinh Y te cOng nhu tofin xd hdi. Nghifin cuu cua Phgm Gia Khdt ndm 2000, cho t h i y ty Ifi nhfin bilt vd thdi dd d i l u tri THA r i t t h i p (21,3%) [2].
Khi bi tfing huylt dp thi ty Ifi cholesterol tdng cao han khdng bj tdng HA, cd s y tifin quan giua BN b|
tdng huylt dp vdi tfing cholesterol mdu, s y khdc bifit cd y nghTa thdng kfi vdi p <0,05. Khi bi tdng huydt dp thl ty Ifi triglyceride mdu tfing cao han khflng bi tang HA, cfl sy lifin quan gida NB bj tfing huylt dp vdi tfing triglycende mdu, s y khdc bifit cd y nghTa thdng kfi vdi p <0,05 KQNC eua chiing tdi t h i p hon KQNC cDa Bill Ddc Long 2007 tai tinh Hai Duang ve cdc y l u t l nguy ca cOa tfing huylt dp, trong dd rdi loan lipid mdu Ifi 77% vfi chil y l u Ifi vua va nhe chiem 86,27% [4].
Ldi sdng, thdi quen dn udng d BN tang huylt dp cfl rli logn lipit mfiu nhu hOt thudc Ifi, di bfl, cfl stress chua tim t h i y s y khdc bifit vdi tang cholesterol mdu, tdng triglyceride mfiu. Tuy nhifin, thfli quen fin mfin, thfli quen thich dn chat bdo mdc du chua bj tdng HA thi nguy ca cao gfiy tfing huylt dp. K i t qua nghifin cuu cho thiy, ngudi bfinh cd sd thich fin c h i t bdo nhilu Igi gdy nfin tfing cholesterol mdu va cd sy khdc bifit cfl y nghTa thing kfi vdi p <0,05, Cd sy khdc bifit cd y nghTa thdng kfi gida cde thfli quen trfin vdi bfinh nhfin cao huylt fip cd rdi loan lipid mfiu vdi p <0,05
KQNC cho thiy, ty Ifi h i l u bilt v l ehe dfl dn r i t thip 61,8% trong dfl 38,2% lfi khflng biet vd cOng khdng Ou^gc nghe nfli bao gid, so sdnh ty Ifi cd vfi khdng bilt khfic bifit cd y nghTa thdng kfi. T i l p theo Id ty lfi dugc t u v i n cOa t h i y thudc chiem ty le eao, d i l u ndy cho thiy cdc t h i y thudc dfi cd y thde han trong vific xdc (^nh vai trfl ciia c h l dd sinh hogt, Vd cudi ciing Id nhfin thdng tin v l sdc khde, c h l dd qua tdi lifiu r i t thip chi chilm 35,6% edn Igi 64,3% Id khdng dpc tfii lifiu, khdng t u tim hieu, nhu vfiy ve phin benh nhfin d i n thdi d i l m hifin tai vfin ehua nfing cao y thdc thay d l i ldi sdng, tfic phong sinh hogt vfi che dd dn udng vd t y tim h i l u , cfip nhfit k i l n thdc v l bfinh ly cua minh. Chiing ta Id cdc d i l u dudng vien c i n phai hilu thiu dfio t i m quan trong cua v i n d l , phdt huy
han nua trdch nhifim cOa minh, tir v i n , tiiuylt phgc bfinh nhdn vd gia dinh d l hp cd mdt phuang dn d i i u fai bfinh tdng huylt dp cd rdi logn lipid mfiu tiM nhit.
K t T LUAN
Ddnh gid du>pv kifin thi>c h i l u b i l t vfi chfi d$
an d benh nhan tdng huyfit fip
Benh nhdn khdng bilt minh bj tdng huylt dp r i t cao, chiem 33,04%. Hp b i l t v l bfinh nhung khdng d i l u fai bfinh (12,04%), cfl dieu tri nhung khflng kiem sofit dugc HA (33,04%).
Sy hieu biet v i c h l dd sinh hogt: Cd k i l n thdc v l phai an tdng rau vd hoa qua (73%), d n di bfl (67,8%), hgn c h l md dflng vdt (55,6%). Rifing cd k i l n thuc v l tdc hgi cua thudc lfi vd rugu nhung van khflng thyc hdnh tdt, do vdy ngdng hOt tiiudc ehi cd 4,3% vd han che rugu Id 13%.
Cdc y l u t d lifin quan d i n tinh trang tang huyfit dp
Cd sy lifin quan giua BN tfing cholesterol, tang triglycend mdu vdi cd s d thich fin nhilu chat beo (p
<0,05).
Cfl sy hfin quan giua BN tdng huylt dp vdi cd thdi quen an man, fin nhilu c h i t bfio (p <0,05).
Cfl sy lifin quan giua BN tdng huylt dp cd rdi loan lipd mdu vdi "hieu bilt ve che dd dn° (p < 0,01).
Cfl su lifin quan giua BN tfing huylt dp cd rdi loan lipd mau vdi "thay thudc cd t u v i n " (p < 0,001).
Cfl sy lifin quan giua BN tfing huylt fip cfl rdi loan lipd mfiu vdi "ty dpe tai lifiu tim hieu c h l dfl fin udng, sinh hoat" vdi p < 0,001.
T A I L I $ U THAM K H A O
1. To Van Hai va CS (2002), Dieu tra THA dpng m^ch & cdng dong Ha Ngi. Ky y l u toan vfin cdc de tdi NCKH, dgi hfli tim mgch tofin qudc 2002, tr, 105-11.
2. Phgm Gia Khai (2000), Ofic dl^em d/ch ti hgc bdnh THA t^i HS N0i, Ky yeu toan vdn cac de tfii nghifin cdu khoa hoc dgi hfli tim mgch toan qudc 2000, tr, 258 - 81.
3. Phgm Gia Khai, Nguyen Ldn Vifit vfi cs (2003), Tan suit THA va cSc yeu td nguy ca a cSc tlnh mien bic Vidt Nam nam 2001- 2002, Tgp chi tim mgch hpc Vifit Nam, tr. 9 - 3 4 .
4. Bui Ddc Long (2007), Nghien cim ty 1$ vS cic yiu to nguy ca cua tSng huyet ap tai tinh Hii Dwang, Lufin an tien sy y hpc, Hpc vifin Quan y 2007
5. Tran DO Trinh (1992), Tom tat bao cao tdng kit cOng trinh dieu tra dich te hpc bfinh tang huyet fip d Vifit Nam, Y hpc Vifit Nam. sd 2, tgp 162, tr. 12 - 14.
KET QUA DIEU TRj BENH RO HAU MON
PHAM VAN N A N G - Truang Bai hqc YDupc CSn Tha
T 6 M T A T
BfiT VAN B£: Rd hiu min ii mil b$nli luvng Mi ph6 biin Imng c&c b$nti cua h$u mdn tnjc tring. Tai Khoa Ngoai long quit, B^nh viin Da fcrtoa C^n Tiia, inii nSm c6 khoing 20 tnidng hvp m hiu mdn duvc
phSu thuit PHI/ONG PHAP: Nghiin ciiv h6i ciiu vi miri tM ci bint) nhin duvc phiu thuit diiu Irj rd hiu mdn til' nim 1997-2001 dSn tii lihim dS tJinh gii Idt qui diSu In. KtT QUA: Nghiin cuv bao gdm 78 binh nhin, tmng dd 63 binh nhin nam (80,8%) vi 15
Y HOC THUC HANH (916) - S6 5/2014
