NGHIEN CliU HIEN TUffNG DAP UfNG TANG HUYET AP CAP TiNH or RENH NHAN XUAT HUYET NAO GIAI DOAN CAP
CAO TRl/ONG SINH - Dai hoc Ykhoa Vinh
N G U Y I N T A DONG, PHAN THANH BJNH, LE THj YEN, TRAN THLfA NGUYEN Bgnh vien Trung uang Hue
L i ANH T U A N - Benh vien HQu nghiBa khoa Nghe An
TOM T A T
Muc dich: Danh gid subiin dii huyit ip va xic dinh hi$n tugng dip dng ting huyit ap (THA) dp tinh d bdnh nhan xuit huyit nao giai doan dp
Bii tugng vi phuang phap: 48 bdnh nhan duac chin doan xuit huyit nio cd ting huyit ip, tuii tmng binh 64,9±12,7. mCfc huyit ap <180/105mmHg, khdng diing thuic ha huyit dp, giai doan dp, nim diiu tri tai khoa Ndi-fim mach Bdnh vien Trung uang Hui. Tit ci dugc do huyit dp lOc vdo, sau 12 gid, sau 36 gid va mang may do huyit dp luu ddng 24 gid vao ngdy thU 2 vd ngdy thU 7 sau khi nhdp vidn vdi khoing cdch 30 phOt/lin vdo ban ngay vd 60 pfiut/lin vao ban ddm.
Kit qui: Huyit ip giim tu nhidn ma khdng dn diing thuic, sau 12 gid huyit Ap giim 5/1.4 mmHg, sau 24 gid giim 15,3/3,9 mmHg vi giim nhiiu nhat sau 36 gid giim 25,4/11,3 mmHg so vdi lOc vao. Sau 5 ngay vio vidn huyit dp giim ti/ nhien khi do bing huyit ip luu ddng 24 gid lin lugt 6.8/4,0 mmHg;
7,6/5,2 mmHg vi 6,7/4,2 mmHg cho chu kp ban ngay.
ban ddm vi 24 gid.
Tp Id bdnh nhdn cd dip Ung THA dp tinh khi do bing huyit dp ki thdy ngin li 35% (17/48) trdn ABPMIi 23% (11/48)
Kit lugn: Khi bi xuit huyit hao c6 ddp Ong ting huyit ip cip tinh. sau dd giim mdt dch tu nhidn khdng dn diiu tri irong giai doan cip, giim ro nfiit sau 36 gid.
TCr khda: TSng huyit ip, bdnh nhan.
SUMMARY
STUDY ACUTE HYPERTENSIVE RESPONSE IN PATIENTS WITH HEMORRHAGE STROKE IN ACUTE PHASE
Aim: To evaluate the change in blood pressure and determinate phenomenon of acute hypertensive response in patients with cerebral hemorrhage in acute phase.
Subjects and Methods: 48 patients were diagnosed a cerebrate haemorrhage with hypertension, mean age 64.9±12.7, blood pressure
<180/105mmHg, not using antihypertensive drugs, in acute phase, are treated at the medical cardiovascular department of Hue Central Hospitai Ail patients was measured blood pressure at the entry, after 12 hours, after 36 hours and brought 24 hours ABPM on day 2 and day 7 after admission with the interval of evry 30 minutes for daytime and evry 60 minute at nightime.
Result: Dei^eased blood pressure naturally without medication, blood pressure decreased after 12 hours 5/1.4 mmHg, after 24 hours of 15.3/3.9 mmHg and the largest decline after 36 hours decreased 25.4/11.3 mmHg compared to the admission. After 5 days admission blood pressure reduced naturally as measured by 24-hour ABPM respectively 6.8/4.0 mmHg; 7.6/5.2 mmHg and 6.7/4.2 mmHg for the daytime, nighttime and 24 hours.
The proportion of patients with acute hypertensive response as measured by mercury sphygmomanometer was 35% (17/48) on ABPM was 23% (11/48).
Conclusion: When a cerebral hemorrhage meet acute hypertension, then reduce spontaneously without treatment during the acute phase, the most obvious decrease after 36 hours.
Keywords: Ambulatory blood pressure monitoring (ABPM), acute hypertensive response.
DAT VAN DE
Tai bien maeh mau nao la mdt trong 10 nguyen nhan gay ti!r vong hang dau, chi dUng sau benh tim mach va ung thu [3]. 6 Hoa Kf mdi nam co khoang 500.000-750.000 benh nhdn tai bien mach mau nao mdi va tai phat [2]. 6 Phap mdi ndm ed 130.000 trudng hop tai bien mach mdu nao va dd la nguyen nhdn ciia 40.000 ngUdi tir vong va 30.000 ngudi bj tdn phe nang ne. Nguy co tai phat trong 5 ndm Udc tfnh trong khoang 30-43%. Tai bien mach mdu ndo cap thudng do nhdi mau nao (khoang 85% so trUdng hop) [7].
Phan Idn benh nhdn tai bien mach mdu nao (trong dd cd xuat huyet nao) c6 huyet ap tang song da sd tnidng hdp huyet ap se giam t u nhien trong 3- 5 ngay [1] den 10 ngay dau ma khdng can diing thude chdng tdng huylt dp [4]. Do dd viec diing thuoc dieu trj tdng huyet dp trong tai bien mach mau nao giai doan cap ed anh hudng den d i l n b i l n vd tien lUdng bdnh, ddi khi lai gay bat Idi eho benh nhdn, nhung tren thUe te lam sang, phan Idn nhdng bdnh nhdn nhdi mau nao vao vidn ed tang huylt ap deu dupc diing thudc ngay trong giai doan cap khong ke miJlC dp huylt dp nhu the nao. Do vay, nhieu f kien cho rang, de chpn thdi diem dung thude ha huyet ap hdp If, dat hidu qua, giam bien chUhg tut huylt ap do tae dung eiia thude can thiet phai theo ddi huyet ap thudng xuydn trong giai doan cap de danh gia biln ddi huylt ap va phan
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biet dUde benh nhan ed tang huyet dp tU trude hay la dap Ung tang huyet ap khi bj x u l t huyet nao.
De theo doi bien doi huyet ap vd xae djnh hien tUdng dap Cmg tang huylt ap cap tinh trong giai doan cap ciia xuat huyet nao chiing tdi t i l n hanh d l tai nham myc dich: Danh gia subiin doi huyit dp va xic dinh hidn tugng dap dng fang huyit ap cip tinh d bdnh nhan xuat huyet nao giai doan cap.
DOI TUONG v A PHl/ONG P H A P NGHIEN cCfU I . D d i t U d n g
48 bdnh nhan dUdc ehan dodn xuat huylt nao ed tang huylt dp, mifc liuyet ap <180/105mmHg, khdng dung thude ha huyet dp, giai doan cap, nam dieu tn' tai khoa Ndi- Tim mach Benh vidn Trung Udng Hue thdi gian tilf'thdng 7/2013 den thdng 6/2014.
Loai tri^ nhQfng benh nhdn xuat huyet nao khdng cd tdng huyet ap hoac huyet ap tang eao > 180/110 mmHg va cae trudng hpp c6 chi djnh ha huylt ap cap cdu.
2. PhUdng phdp nghien ciiru:
Md ta eat ngang, chpn mdu ngau nhidn thuan tien Tat ea bdnh nhdn dUdc do huyet ap Itic vdo vien, sau 12 gid, sau 24 gid vd sau 36 gid bang huyet dp ke thCiy ngan va do huylt dp luu dpng 24 gid vdo ngay thd 2 vd ngdy thiJf 7 sau khi nhap vien vdi khoang each do 30 phiit/lan vao ban ngay va 60phCit/lan vdo ban dem bang may Gears 2 ciia My,
Dap Ung tdng huyet dp cap tfnh duoc xac dinh khi huylt ap tang len 20/10 mmHg giCfa ngdy d i u va ngay cudi trong trong giai doan cap khi do bang may thOy ngan [4] hodc 15/10 mmHg khi do bang may luu dpng 24 gid,
Sd lidu duoe xt^ If bang phan mem Excel 2010 vd Medcal 2007.'
K f r QUA NGHIENjjCfU
1. Danh gia bien doi huyet ap bang huyet ap ke thuy ngdn
mmHg), sau 24 gid huyet ap giam xuong con 150,6/87,4 mmHg (giam 15,3/3.9 mmHg) va giam nhilu nhat sau 36 gid xudng cdn 140,5/83 mmHg (giam 25,4/11,3^mmHg) so vdi luc vdo. S u k h a c M giij^ cac thdi diem do so vdi lue vao Id ed f ngh^|\^
p<0,05. ^ -' 2. Danh gia bien doi huye't dp bling theo doi
luu dong 24 gid
2.1. Huyet ap do th^ thudc do bing miy luu ding
Bleu do 1. SU bien doi huyet ap ti^luc vao den sau 36 gid Trong giai doan e l p eiia xuat huylt nao, huylt ap giam dan mdt each t u nhien ma khdng ddng thudc tU Iiie vdo d i n sau 36 gid. Sau 12 gid huylt ap giam tU 165,9/91,3 xudng con 160,0/89,9 mmHg (giam 5/1,4
Bleu do 2. Huyet ip do thay thu^c do bing miy luu dong ngay 2 vk ngay 7 Sau 5 ngdy trong giai doan cap huylt dp giam tiJ' nhien khong can diing thude 17,7/10,4 mmHg nghra la giam tU 150,6/97,6 mmHg xudng cdn 132,9/87,2 mmHg.
2.2. Huyit apdoluu ddng 24 gid ngiy thCrl vi ngiy thift trong giai doan cap
B a n g 1 . H u y e t d p t d m t h u n g a y t h U 2 v d n g a y thii 7 t r o n g g i a i d o a n c a p :
HATT(mmHg) TB ban ngdy TB ban ddm
Ngay 2 139,8*14,2 141,8 ±16,6 T B 2 4 g i d 1 139,9 ±13,9
Ngay 7 133,0*12,9 134,2 ±15,3 133,3 ±12,6
A 6,8 ± 1 0 7,6*15,1 6,7*9,4
P
<0,05
<0,05
<0,05 H A T T T B b a n n g a y , H A T T T B b a n d e m , H A T T T B 24 g i d n g d y t h U 7 t h a p h d n e d f nghTa s o v d i huyet ap n g d y t h U 2 ( p < 0 , 0 5 ) .
H u y e t a p t a m t h u g i a m m p t e a c h t u n h i d n khong c a n d i i n g t h u d e l a n luttt 6 , 8 ± i 0 ; 7 , 6 ± 1 5 , 1 ; 6,7 ± 9,4 m m H g e h o e h u k y b a n n g a y , b a n d e m v d 2 4 g i d . , ^ , j
B a n g 2 . H u y e t a p t a m t r U d n g n g a y fhijf 2 v a n g ^ j C ihCr 7 t r o n g g i a i d o a n c a p :
HATTr(mmHg) TB ban ngay TB ban ddm T B 2 4 g i i I
Ngdy 2 93,4 ±13,4 9 5 , 3 * 1 5 , 2 93,5 ±13,3
Ngdy 7 89,4 ±11,2 90,1 ±11,9 89,2 * 10,9
A 4,0 ±6,7 5,2*11.9 4,2 ±6,8
P
_
<0,05,
<0,OS,
<0,05 H A T T r t m n g b i n h b a n n g d y , H A T T r t m n g b i n h ban d e m , H A T T r h u n g b i n h 2 4 g i d n g d y t h U 7 ttiap h d n c d f nghTa s o v d i h u y l t a p n g d y t h d 2 (p < 0 , 0 5 ) .
H u y e t a p l d m t r u d n g g i a m m d t e a c h t u n h i e n khong e l n d i i n g t h u d e i a n l u o t 4 , 0 ± 6 , 7 ; 5 , 2 , 6 ± 1 1 . 9 ; 4 , 2 ± 6 , 8 m m H g e h o c h u k f b a n n g d y , b a n d d m v a 2 4 g i d .
S a u 5 n g a y v a o v i d n h u y e t a p g i a m t u n h i d n khi d o b a n g h u y e t d p l u u d p n g 2 4 g i d l a n lUpt 6,8/4,0
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mmHg; 7,6/5,2 mmHg vd 6,7/4,2 mmHg eho ehu ky ban ngdy, ban dem va 24 gid.
^ 3. Ty le benh nhan cd ddp dug tang huyet ap cap tinh ta-ong giai doan cap
T f le benh nhan ed dap Ung THA cap tfnh hay t f Id ed huyet ap giam tU nhien trong giai doan cap tren ABPM: 11/48=23%.
T f 1^ bdnh nhdn ed dap ijfng THA cap tfnh hay t f Id cd giam huylt dp t u nhien khi do bang huylt ap ke thOy ngan: 17/48 = 35%.
BAN L U A N
Bien ddi HA va dap Ung THA cap tfnh trong giai doan cap cOa TBMMN ndi chung va xuat huyet nao ndi ridng hien nay oQng chua dUde h i l u biet mdt each d l y dO va dang dUde mdt sd nghien eijfu de cap,
Theo Adnan I. Qureshi, Tnjng tdm Nghien cUu £)pt quy ciia TnJdng Dai hpc Minnesota Hoa Kf, dap Uhg THA e l p tinh la khi HA tang hdn gidi han binh thudng va gid trj tnJdc do xay ra sdm trong vdng 24 gid dau sau khi khdi phat dot quy. Hien tUdng nay dUdc ghi nhan > 60% sd bdnh nhan ddt quy tU mdt nghien cUu qudc gia ciia Hoa Kf. Tuy nhidn t f Id ndy phu thupc vao benh nhdn dUde chpn, thilt ke nghidn ciiii, mdu tham chieu vd dinh nghTa duoc sCr dung. Trong bao cao ciia 18 nghien cdu thi cd 52% sd bdnh nhdn dot quy cd dap Ung THA d p liie nhap vidn. HA mdi khdi phat cao d nhuTig benh nhdn ktidng ed tien sU THA dUdc ghi nhdn d 20% bdnh nhan ddt quy va 8% trong ddn sd [4].
HA cd xu hudng giam t y phat so vdi liic vao 20mmHg cho huyet ap tdm thu vd lOmmHg cho HATTr (20/10 mmHg) trong vdng 10 ngdy dau sau dot quy d p dii khdng diing bat kf thudc dieu trj nao.
Nghien cUu Glycine Antagonist in Neuroprotection International Trial [4] tren 1455 BN dot quy d p nhdp vien sau 6 gid khdi phat trieu ehUhg, HA dudc do bang may thuf ngdn d ede thdi diem ngay khi nhap vien, sau 30 phtit 4, 12, 12.25, 60 va 60.25 gid, ket qua cho thay HATB giam dan trong vdng 60 gid, bat chip gid tri HATB ban d i u , vdi ehii y l u giam trong vdng 10 gid sau l l n do d i u tien ngay khi nhdp vidn [4].
Thilr nghiem lam sdng SCAST (Scandinavian Candesartan Acute Stroke Trial) da trung tdm d Na- uy va VUdng qude Anh trdn 2029 BN dot quy cdp trong 30 gid dau ed HATT >140 mmHg. D i l u tri candesartan dUdc t i l n hdnh trong 7 ngay. Suthay doi HA dupe xae djnh la sU khae biet HATT ban dau vdi HATT ngay 2 va dUdc suT dyng de ehia benh nhan thdnh nhdm tdng/khdng thay ddi, nhdm giam it giam vita hodc giam nhieu. Ddnh gia hdu qua ban dau Id nh(?ng bien cd cd hai sdm (dot quy tdi phat, dot quy tien trien vd giam HA trieu chdng keo dai trong 7 ngay diu). Danh gia hdu qua thd phat la tinh trang t h i n kinh vdo ngdy thU 7 va hau qua chdc ndng sau 6 thang. K i t qua cho thay BN ed giam manh hodc tdng/khdng thay ddi HATT lam tdng cd f nghTa nguy cd bien cd x l u x u l t hidn sdm hdn Id bdnh nhan cd giam HA it (OR, 2,08; 95% Cl, 1,19-3,65 va OR 1.96;
95%CI. 1.13-3.38). BN cd tang/khong thay ddi HATT se tang cd f nghTa nguy cd bien chUhg TK xau hdn la cac nhdm khde. Ket qua tU nghien eiiU nay gdi f rang HA giam cd t h i gdy hai vd rang thdi quen dieu trj giam HA ed le nen tranh trong GD d p [5].
MUc dp HA trong giai doan d p ciia nhdi mdu nao cung anh hudng tdi qua trinh tdn hai than kinh. nghien eUu eOa Toyoda va cs tai Nhat Ban, do HA 6 gid mpt lan trong 36 gid dau sau khi nhdp vidn e l p eijfu tren 565 benh nhdn (347 nam, tudi TB 70+11) bi nhdi mau nao d p trong vdng 24 gid. Ton hai TK dupe xac djnh tdng > 2 diem cOa thang d i l m NIHSS vdo t u l n thU 3 so vdi liic vdo vien. Ket qua cho thay vdo tuan thU 3 ed 64 BN (11,3%) ed tdn hai TK. Vdo thdi d i l m 24 gid t f s u i t tdn hai TK tang Idn 20% khi HATT tang 10 mmHg [6].
Mpt sd tac gia trong nudc cung nhan thay rang HA giam mdt each t u nhidn, eo mdt sd benh nhan cd the trd ve binh thudng sau 3-5 ngay trong giai doan d p ma khong phai dung thudc dieu trj [1].
Ket qua d bleu do 1, 2 bang 1, 2 trong nghien edu ciia chiing toi cho thay. trong giai doan d p cQa x u l t huyet nao, huylt dp giam dan mot each t u nhidn md khdng dung thude ti^ liie vdo den sau 36 gid. Sau 12 gid huydt dp giam tU 165,9/91,3 xudng edn 160,0/89,9 mmHg (giam 5/1,4 mmHg), sau 24 gid huydt dp giam xudng con 150,6/87,4 mmHg (giam 15,3/3,9 mmHg) va giam nhieu nhat sau 36 gid xudng cdn 140,5/83 mmHg (giam 25,4/11,3 mmHg) so vdi liic vao. SU khde biet giiia dc thdi diem do so vdi liic vdo Id CO f nghTa vdi p<0,05.
Khi theo ddi huyet ap luu dpng 24 gid vao ngay 2 va ngay 7 d l xdc djnh hien tupng huylt dp giam tu nhien chiing tdi nhan thay:
Khi do bang may luu dpng liic khdi ddng may: Sau 5 ngdy trong giai doan cap huyet dp giam tU nhien khdng e l n dung thude 17,7/10,4 mmHg nghTa la giam tu 150,6/97,6 mmHg xudng cdn 132,9/87,2 mmHg
K i t qua do luu dpng 24 gid' Huylt dp tdm thu trung binh ban ngdy, HATT trung blnh ban ddm, HATT tmng binh 24 gid ngay thU 7 thap hdn eo f nghTa so vdi huyet ap ngay fhU 2 (p < 0,05).
Huyet dp tam thu giam mdt d c h tu nhien khdng d n diing thudc lan ludt 6,8±10;7,6±15,1; 6,7+9,4 mmHg cho chu ky ban ngdy, ban dem va 24 gid.
HATTr tmng binh ban ngay, HATTr tmng binh ban dem, HATTr tmng binh 24 gid ngay thU 7 thap hon cd f nghTa so vdi huyet ap ngay thU2 (p < 0,05).
Huylt dp tdm trUdng giam mot each t u nhien khong can dling thude lan lUdt 4,0±6,7: 5.2,6±11.9; 4.2+6,8 mmHg cho chu ky ban ngay, ban dem va 24 gid.
Sau 5 ngay vdo vien huyet dp giam t u nhien khi do bang huyet dp lUu dpng 24 gid lan lUpt 6,8/4,0 mmHg; 7,6/5,2 mmHg va 6,7/4,2 mmHg cho chu k f ban ngay, ban ddm va 24 gid.
KET LUAN
Huylt ap giam mdt d c h t u nhien khdng can dung thude ha huyet dp trong tuan dau (giai doan d p ) sau
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khi bj xult huylt nao, giam nhieu nhat sau 36 gid.
T f le benh nhan ed dap i:fng THA d p tfnh j i a y t f Id ed huyet dp giam t u nhien trong giai doan d p tren ABPM: 11/48 =23%. '
T f le benh nhdn ed dap Ung THA d p tinh hay t f te cd giam huyet ap tU nhidn khi do bang huyet dp ke tiitlyngan: 17/48 = 35%.
T A I L I E U T H A M KHAO
1. Nguyen Vdn ChUdng va cs (2003)," Dac diem lam sang dot quy, nhUng sd lieu qua 150 benh nhan". Tap chi Yhgc thuc hinh. 10: tr 7 5 - 7 7 .
2. Hoang Khanh (2009), Tai bien mach mau nao- TU ydu td nguycO tdi du phong, NXB Dai hoc Hue.
3. Nguyen Ldn Viet, Le Quang C i ^ g (2008), Khuyin
do vd chin tftan vi dieu tri nhdi mau nao dp, Hpi "Rl madi Viet Nam, NXB Y hpc. Ha Noi, tr 40-51. '>'
4. Adnan i. Qureshi, MD (2008), Acute Hypertensive Response In Patients With Stroke: Pathophysiology anttt"
Management, Cardiovascular Medicine. ' ^ 5. Sandset et al (2012), Relation between change in blood pressure in acute stroke and risk of eariy adverse event and poor outcome. Stroke, 43(8):2108-14. -^
6. Kazunori Toyoda et al (2009), Acute Blood Pressijiib|
Levels and Neurological Deterioration in Different Sub^p^:
of Ischemic Stroke, Sfroke, 40:2585-2588. S'' 7. Thomas Tmelsen et al (2006), Global burden of cerebrovascular disease. Cerebrovascular diseases, p 1-67.
NGHIEN CUU THO& TRANG VE SINH Nidi TROANG, DIEU KIEN AN TOAN THUC PHAM, DANH GIA MOT SO BENH TRUYEN NHllM DU0NG TIEU HOA
TAI MOT S6 CHU DO THj TINH PHU THO
TRAN QUANG TRUNG, N G U Y I N MINH T U A N Cyc an toin thyc pham
N G U Y I N ANH VU, LUONG TA'T THANG, N G U Y I N X U A N T H D Y Trudng Cao dSng y tiPhu Thg
L £ K H A C DCTC - Hgc vidn QuSn y
TOM TAT
Qua nghidn cdu md ti dt ngang kit hap phdn tich v4 mdt si yiu ti ve sinh mdi trudng (nguin nudc, cdng trinh vd sinh nha tidu, rac thii) vd kien thdc.
tht^ hdnh an toan thuc phim cda 464 ngudi kinh doanh thuc phim tai 10 chg dd thi tinh Phd Thg, ndm 2014. Kit qui cho thiy: Thuc trang vi mdt si yiu to vd sinh mdi trudng trong kinh doanh thuc phim tai cdc chg dd thj tinh PhO Thg ii chua dip Ung day dd ydu du theo Luat ATTP quy djnh: chua dim bio dd ngudn nudc sach, nha tidu hgp vd sinh va thu gom rac; khdng dat ydu du v4 cdch xa khu vuc, dudng giao thdng giy 6 nhidm vi dch biet nhi tieu bi d nhidm. NgUdi kinh doanh thuc phim tai dc cha dd thi cd kiin thdc ATTP dOng dat tp Id thip (44.5%), thUC hanh dOng vi cac didu kidn dim bao vd sinh mdi trudng dat tp id thip (21.5 - 33%) vi thuc hinh dOng ve dc dieu kidn dam bao vd sinh an toin thuc phim dat tp Id thip (17,1 - 24.7%).
Tirkhda: vd sinh mdi trudng, an toan thuc phim.
SUMMARY
Through a descriptive cross-sectional study combined with analyse of some environmental hygiene fectors (water, latrine, garbage) and knowledge, practice in food safety of 464 food holders at 10 urban markets in Phu Tho province in 2014, the results were: The current status of some environmental hygiene factors in food trading at urban marfcets in Phu Tho province did not fully meet the requirements of the Food Safety Law: did not
ensure enough clean water, hygienic latrines and garbage collection; did not meet the requirements on the distance between food premises and polluted areas/roads, contaminated latrines. The percentage of food traders at urban markets having predse knowledge on food safety Is low (44.5%), having good practices on ensuring environmental hygiene conditions is low (21.5-33%) and ha\ring good practices on ensuring food safety conditions is low (17.1-24.7%).
Keywords: environmental, food safety.
DAT VAN oi.
An toan thuc pham ddng mdt vai trd rat quan trpng trong chien lUdc bao ve sUe khde con ngudi va tac dpng den sU phat trien kinh t l , vdn hda xa hpi, nip sdng vdn minh cQa mot qude gia. Khi thUc phim bj 6 nhidm ede loai vi sinh vat gdy benh nhU vi khuin, kf sinh trung, vi nit...do dieu kidn vd sinh mdi tordng (phan, nude, rdc thai) khdng dam bao se gay nguy cd mac cae benh truyen nhilm anh hUdng tdi sUc kh6e edng ddng.To chdc Y t l T h i gidi (WHO) Udc tfnh mdi nam ed khoang 10 tridu lupt ngudi bi ngd dde, trong dd d 85% do thdc dn bj nhiem khuan [1],[2]. 6 Vidt Nam, theo Cue an todn thue phim (ATTP), Bd Y t l [3]: bao cao f d n g k i t chuong trinh mue tidu qudc gia v l Ve sinh an toan thUc phim ndm 2012 eho thiy:
cdn nguydn gay ngd ddc thuc phim cd 30,1% sd vu do vi sinh vdt; Vi ptiani iSeu kidn vd sinh moi truflng cd sd khdng dat 17 - 30%. Vi pham dieu kidn v l trang thilt bi, dung cy 15 - 30%. Vi pham dilu kidn ve eon
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