feed the habv .In group who have used formula milk (192 cases), 72% were given the formula when they were in the first month, 25% in the age of 1 -4 months old. In group who have had com- plementary liiod: 32",, were introduced at the early age (<4 months old), only 2 % at the right dmc (>=6 months old). 62. l'!'o were fed with poor complementary food .Conclusions: 75% ofthe in- fants have been breastfed but only 17.9% have been exclusively breastfed until 6 months because ofthe constrains of mother's knowledge, maternal diseases, large nipples, and social reasons; over 70% were given formula milk when they were in the first month, 32% were given complementary foods at the early ago (<4 months old), 62.1 % were fed with poor complementary food. All these reasons lead to the condition that the malnutrition rate in group who was not exclusively breastfed is higher than the others.
Keywords: nutrition care, infant under 6 mo. pediatric hospital
>? A ' 9.
DANH GIA HIEU QUA KIEM SOAT DA YEU^TO Cf BENH NHAN DAI THAO^DI/ClNG TYPE II DIEU TRI
TAI TRUNG TAM Y TE DU PHONG THAI BtNH
Nguyen Thi Ngpc Hdn', Ddng Bich Thuy \ Vii Dinh Trien- vii cpng su'
Qua nghien ciru 165 benh nhan dai thiio duong Typ II dieu tri tai Tmng tam y te du phong Thai Binh, ket qua cho thay ty le mac benh d nam cao hon nu vdi p<0,05, co su khac biet ve ty lc mac benh giiia cac nhom tuoi va tap trung cao hon d nhom tuoi 60-70. Hieu qua kiem soat da yeu to d cac benh nhan dai thao duong duoe theo doi cho thay: Ty le benh nhan chap hanh tot dieu tri la (62,4%), d nliom benh nhan nay c6 mot so chi so nhu Glucose, HbAjC, Cholesterol, LDL-C...
giam ro ret so vdi nhom khong chap hanh dieu tri vdi p<0,05. Cac chi so dugc kiem soat toi uu do la BMI (65,5%), huyet ap (40,0%), cholesterol (32,1%), triglycerid (33,3%o); chi s6 Glucose du-gc kicm soat t6t la 30,3%, HbAlC la 31,5%.
Tii- khoa; Ddi thdo dirdng: Glueosse: HbAlC: Cholesterol, LDL-C: BMI: Thira cdn beo phi
I - D A T V A N D E
Til- nhung nam cudi thap ky 80, Dai thao duirng (DTD) da trd thanh mpt van de Idn ciia y hgc hien dai. Theo thong kS ciia hiep hoi DTD qudc tS (IDF) nam 1994 ca thS gidi cd khoang 110 trieu ngudi mac benh DTD, niini 2000 cd 15 1 trieu ngudi va dSn nam 2006 cd 246 trieu
I SVY6 - Truong DH Y Thai Binh - ThS. - Tmng tam YTDl' Thai Binh ' TliS - Tm-ang DH Y Thai Binh
ngudi. D T D typ 11 d u g e coi la benh da ySu td. KiSm soat Glucose mau va cac chi sd khac la myc tiSu quan trgng ciia cac biSn phap diSu tri d benh nhan D T D . KiSm soat tot Glucose mau va cac ySu td nguy c a khac se cai thien va keo dai cuge sdng cd chat lugng cua ngudi benh. Cac yeu to nguy ca di kem d benh nhan D T D
typ II thudng la tang huySt ap, thiia can beo phi, tang Lipid mau... Do dd trong diSu tri, ngoai viSc kiSm soat Glucose mau cdn phai dieu chinh cac ySu td nguy ca, tao thanh mgt tinh trang kiSm soat da yeu td. Chi cd kiSm soat da ySu td d benh nhan DTD typ II mdi dam bao dugc ban che cac biSn chung cac ca quan dich. Tii- nhiing ly do tren chung tdi tiSn hanh nghien ciiu de tai nay vdi 2 myc tiSu:
1. Tim hiSu mdt sd dac diSm ciia benh nhan DTD typ II dSn kliam va diSu tri tai Trung tam Y tS dy phdng tinh Thai Binh
2. Danh gia hieu qua kiSm soat da yeu td d benh nhan
II- DOI Tl/ONG VA PHUOTVG PHAP NGHIEN c t r u
l.Doi tuoTig:
-I- Benh nhan DTD typ II dSn kham va diSu tri tai Trung tam Y tS dy phdng tinh Thai Binh
+ Thai gian: Tu thang 5-12/2008 2. Phuong phap nghien cuu:
+ Thiet ke nghien cim: NghiSn ciiu dich te hgc md ta cd phan tich
+ Ca mdu: Ap dyng cdng thiic
n = Z\_a/2 .p.q/d- ->Vdi p=0,l; d = 0,05 -> Theo tinh toan cd mSu tdi thieu la 140 ngdi, thuc te dieu tra dgc 165 ngdi -I- Cdc ky thudt dp dung trong nghien cim:
- Xac dinh can nang, chiSu cao dung, vdng eo, vdng mdng. Tinh BMI, phan loai BMI theo WHO, 2000 ap dung cho ngudi trudng thanh chau A.
- Do huyet ap, phan loai huySt ap theo J N C - V I 1997
- Dinh lugng cac thanh phan Lipid huySt thanh; Cholesterol toan phan. Triglyc- erides, Cholesterol-HDL; dudng mau.
Xac dinh Lipid mau d muc ngoai gidi han binh thudng: Theo tiSu chuan ciia Trinder 1969: Cholesterol TP > 5,2mmol/l;
Triglycerides > 2,3 mmol/1; Cholesterol- 66
HDL < 0,9 mmol/l. Dirdng mau binh thudng khi d miic 3,9-6,4inniol/l
* TiSu chuan chan doan DTD: theo IDF va WHO -1999: gdm 1 trong 3 tiSu chi:
-I- Cd cac trieu chung ciia DTD lam sang:
mirc glucose huySt tuang d thdi diSm bat k y > 11,1 mmol/l (>200mg/dl)
+ Muc glucose luc ddi > 7,0 mmol/l (>
126mg/dl)
-I- Muc glucose huySt tuong >
11,1 mmol/l (> 200mg/dl) d thdi diem sau 2 gid lam nghiSm phap dung nap glucose
* Tat ca cac ddi tugng dugc chan doan, phan loai miic do va dugc diSu tri (tuy theo tirng benh nhan) bang cac phuang phap nh sau:
-I- Cac bien phap khdng diing thudc:
Giao due siic khoe ve DTD
Can thiep bang che do an, luyen tap the due Giiim can nang ca the
-I- DiSu tri bang thudc:
- Thudc udng ha glucose mau:
* Lam tang tiet insuline; sulfonylurea, meglitnid.
. Han che tang giai phdng glucose cua gan: biguani
. Cai thien sy nhay cam ciia insuline:
thiazolidinedione - Dieu tri bang insuline
* Danh gia mu-c do chap hanh chS do diSu tri cua benh nhan theo quy dinh ciia Hiep hgi DTD va chuySn hoa qudc tS:
- Nhdm diSu tri thudng xuySn - Chap hanh tdt: Chap hanh tdt, day dii thudng xuySn cac bien phap diSu trj da dugc hudng dan, khdng ty y bd thudc. Cd so theo ddi cac chi sd huyet ap, can nang, Glucose mau; kham benh theo djnh ky - Nhdm dieu tn khdng thudng xuySn - Chap hanh chua tdt: Chap hanh khdng thudng xuySn cac bien phap diSu tn, cd thS ty thay ddi hoac bd thudc. Theo ddi
cac chi sd khdng thuong xuySn
* Danh gia mirc do kiSm soat cac chi sd theo khuySn cao ciia Hgi ndi tiSt DTD Viet Nam [2]
Miic kiem soat mot so chi so 6- benh nhan dai thao du-ong typ II Chii so theo doi Tot Chap nhan duffc Kem
Chi so theo doi Glucose (mmol/l) H b A l C ( % )
Cholesterol (mmol/l) LDL-C (mmol/1) HDL-C (mmol/1) Triglycerid (mmol/1) BMI (kg/m2) HA (mmHg)
T6t 4,4-6,1
<6,5%
<4,5
<2,5
< l , l
<1,5
<18,5
< 130/80
Chapnhan 7,0 6,5-7,5 4 , 5 - 6 , 3 2,5 - 4,0
1,1 -0,9 l , 5 - < 2 , 2 18,5-22,9 130/80-140/90
Kem
> 7 , 0
>7,5
> 6 , 0
> 4 , 0
< 0 , 9
>2,2
> 2 , 3
> 140/90
+ Xd: ly so lieu: Sd lieu thu thap dugc xir ly trSn may vi tinh theo chuong trinh EPI info 6.0, theo phuong phap thdng kS y hgc.
Ill- KET QUA VA BINH LUAN
1. Mot so dac diem ciia benh nhan dai thao dudng tham gia nghien ciiu Bang 1. Phan bo benh nhan theo gioi
'V'ling Thanh thi Nong thon Ven bien Tong*
Gioi
So sdnh nam, nir:
Nam n 45 28 24 97
Nir
% 46,4 28,9 24,7 58,8
Chung n 30 20 18 68
r =
% 44,1 29,4 26,5 41,2 8,3 p*
n 75 48 42 165
< 0.05
% 45,5 29,1 25,4 100,0
Qua bang 1 cho thay: Tdng sd benh nhan dugc nghiSn cim la 165 ngudi benh DTD, trong dd nam la 97 ngudi, chiem 58,8%), cao hon so vdi nir la 68 ngudi chiem 41,2%). Su khac biet nay cd y nghTa thdng kS vdi p<0,05. Cac ddi tugng dugc diSu tra sdng tai viing thanh thi chiem ty IS cao nhat (45,5%o), viing ndng thdn la 29,1% va thap nhat la -vung ven biSn(25,4%).
SD 1
« •
m • 3D ' JS }|| ' 15 - ID -
S • D •
247 25.5
47.4 412
HNam
32.3
DNff
S0-S3 ED-B >--n
Bleu do 1. Phan bo benh nhan theo tu6i va gioi
Qua biSu do 1 cho thay ty lc benh nhan d nhdm tudi 60-69 chiSm ty IS cao nhat a c a 2 gidi (41,2%, va 47,4%,). Nhdm tudi tir 70 trd ISn chiem ty IS 27,8%, a nam, 32,3 d nii- va thap nhat la nhom tudi
Bang 2. Chi so vong bung/vong mong ciia doi tuong nghien ciiu
50-59 (24,7; 26,5%). Sy khac biet ve ty IS mac guia nhdm tuoi 60-69 vii tren 70 so vdi nhom 50-59 ki ed y ngliTa thdng ke vdi p<0,()5.
Gioi VB/VM
Binh thuong Khong binh thuang
N n 52 45
am (n= =97)
%
53.6 46,4
NiT n 37 31
{n= =68)
'/o
54,4 45,6
Chung(n=165) n "A 89 53.9 76 46,1 Gliicln'i: VB/VM > 0.9 (nam): > fl,H (uu) Id klwnif tnnli llurcm;.^ (WI'H().2(Hltl)
Qua kSt qua d bang 2 cho thay chi sd vdng bung/vdng mdng a mire khdng binh thudng d nam la 46,4%, cao hon so vdi nir la 45,6%,. Tuy nhiSn, sy khac bict nay khdng cd y nghla thdng kS vdi p > 0,05.
ED SD 4D 3D iD H
51 4
46.3
^'
iNim UHU
4.? 5
-1.2 5 3
42.6
B.Thueng Giy TCBP Bleu do 2. Tinh trang dinh duong ctia benh nhan nghien ciiu
Qua bieu do 2 cho thay cd 48,5%, sd benh nhan thira can beo phi la nam va cao han so vdi nii ( 42,6%,), biy nhiSn sy kliac bict nay khdng cd y ngliTa thdng ke vdi p>0,05.
Bang 3. Ty le hien mac benh tang huyet ap ctia benh nhan theo gioi Gioi
Huyet ap Binh thuo-ng Tang HA
Nam n 35 62
(n = 97)
•'() 36,1 63,9
P
.Nii- n 22 46
> 0,05
(n = = 68)
"/o
32,4 67.6
Chung (n = n
57 108
= 165)
• 0
34,5 65.5
Qua kSt qua d bang 3 cho thdy cd 65,5%, sd benh nhan bi tang huySt ap, trong dd nir la 67,6%, cao han so vdi nam la 63,9%,. Sy khae biet nay khong cd y nghia thdng kS vdi p>0,05.
68
Baiiii 4. Hiim Chl so (mniol/l)
Glucose Cholesterol I P Triglycerid Cholesterol - HDL
lirong trung Nam
n 97 97 97 97
binh mot so chi Nu .X ± SD 6,9 '- 2,5 5,2 ± 0,8 2,9 ± 2,2 1,5 ±0,5
so sinh hoa
n 68 68 68 68
mau ciia benh
X ± SD 6.4 + 2,3 4,9 ± 1,7 2.5 ± 1,9 1,3 ±0,5
nhiin DTD theo gioi t
0,5 0,5 0,6 1,2
P
> 0,05
>0,05
>0,05
>0,05
KSt qua nghien cim ham lugng trung binh cua mdt so chi sd sinh hda mau d bang 4 cho thay: a nam cd ham lugng glucose, cholesterol TP, triglycerid, cho- lesterol - HDL trung binh cao hon so vdi nu, nhung sy khac biet chua cd y nghla thdng kS vdi p > 0,05.
2. Hieu qua kiem soat da yen td d cac benh nhan duoe theo doi
Bang 5. Ty le benh nhan chiip hanh che do dieu trj (n= 165)
Noi dung 1. Chap hanh tot 2. Chap hanh chua tot
n 103 62
% 62,4 37,6
Qua ket qua bang 5 cho thay ty IS benh nhan chap hanh tdt chiSm ty IS tuang ddi cao (62,4%), cao ban so vdi benh nhan chap hanh chua tdt la 37,6%
Bung 6. Hieu quii kiem soiit da yeu to ff benh nhan duoe theo doi (n=165)
s n
1 2 3 4 5 6 7 8
Chi so theo doi Glucose (mmol 1) HbAlC ("«)
Cholesterol (mmol/1) LDL-C (mmol/1) HDL-C (mmoLI) Triglycerid (mmol/l) BMl(kgm2) llA(iTimHi;)
n 50 52 53 41 20 55 108
66
T6t
<)/
30.3 31.5 32,1 24,8 12,1 33,3 65,5 40,0
Ch3p n 58 52 68 67 59 60 40 65
nhan duoe
% 35,1 31,5 41,2 40,6 35,8 36,4 24,2 39,4
n 57 61 44 57 86 50 17 34
Kem
•/«
34,5 36,9 26,7 34,5 52,1 30,3 10,3 20,6
Qua ket qua bang tren cho thay: Cac chi sd dugc kiem soat toi uu do la BMI (65,5%), huyet ap (40,0%), cholesterol (32,1%), triglycerid (33,3%); chi sd Glu- cose dugc kiSm soat tdt la 30,3%,, HbAlC lil 31,5%o. Trong cac yeu td tren thi kiSm soat chi sd HDL-C d mirc kem
chiem cao nhat (52,1%,). KSt qua nghiSn ciiu nay cua chimg tdi cd cao ban so vdi mdt so nghien eiru khac nhu ciia Ta Van Binh (chi cd 16,46%, trudng hgp diSu trj dat ndng do Glucose mau d muc chap nhan duac)
Bang 7. So sanh gia tri trung bi
Chi s6
Glucose (mmol/l) HbAlC (%)
Cholesterol (mmol/l) LDL-C (mmol/1) HDL-C (mmol/1) Triglycerid (mmol/1) BMI (kg/m2) HA tam thu (mmHg) HA tam truang (mmHg)
Nhom
inh cac chi so du-ffc 1 BN chap hanh tot
(n= 103) 14,2 ±6,1 9,4 ± 5,0 4,7 ± 1,3 2,9 ± 1,4 1,1 ± 0 , 7 2,1 ± 0 , 7 22,2 ± 3 , 2 125,8 ± 18,5
86,5 ± 12,5
kiem soiit Nhom
ciia 2 nhom benh nhar BN chap hanh khong
(n=62) 16,1 ± 6 , 1 11,5 ± 6 , 0 6,1 ± 1 , 2 3,8 ± 1,6
1,1 ± 0 , 8 2,1 ±0,7 25,2 ± 3 , 0 130,1 ± 18,4
88,7 ± 12,3
1 du-oc t6t
theo doi P
<0,05
<0,05
<0,05
<0,05
>0,05
>0,05
<0,05
>0,05
>0,05
Qua ket qua bang 7 cho thay: d nhdm benh nhan chap hanh tdt theo hudng dan ciia bac sT diSu tri cd mdt sd chi sd: Glucose, HbA|C, Cholesterol, LDL-C... thap ban so vdi nhdm khdng chap hanh theo hudng dan. Sy khac biet nay cd y nghTa thdng kS vdi p<0,05.
IV. KET LUAN
/. Mpt so dgc diem cua benh nhdn ddi thdo diro'ng tham gia nghien cim - Ty IS mac DTD d nam cao ban nir ( 58,8%, 41,2%) vdi p<0,05, tap trung cao d nhdm tudi 60-69, cd sy khac biet giira cac nhdm tudi vdi p<0,05.
- Ty IS thira can beo phi chung la 46,0%o, d nam cao ban nii- ( 48,5%o, 42,6%o) vdi p>0,05.
- Ty IS tang huySt ap la 65,5%, nir la 67,6%) cao ban nam (63,9%) vdi p>0,05.
- Ham lugng trung binh ciia glucose, cholesterol TP, triglycerid, cholesterol - HDL d nam cao ban so vdi nii vdi p >
0,05.
2. Hieu qud kiem sodt da yeu td ff cdc benh nhdn DTD dug'c theo doi
- Ty IS benh nhan chap hanh tdt dieu tn la (62,4%o), d nhdm benh nhan nay chi sd Glucose, HbA jC, Cholesterol, LDL-C...
giam rd ret so vdi nhdm khdng chap hanh
diSu tri vdi p<0,05.
- Cac chi sd dugc kiSm soat tdi un do ia BMI (65,5%), huyet ap (40,0%), choles- terol (32,1%), triglycerid (33,3%o); chi s6 Glucose dugc kiem soat tdt la 30,3%,, HbAlCla31,5%o.
V. KHUYEN NGHI
Can cd nhiing nghiSn cim sau, rong hon nira vS hieu qua kiSm soat cac ySu to ciia benh dai thao dudng nham gdp phan dy phdng sdm cac bien chung ciia benh TAI LIEU THAIVI KHAO
1. Ta Van Binh (2005). Diic diim benh nhdn ddi thdo dudng den khdm lim ddu tgi Benh vien Noi tiet. Ky yeu cac de tai khoa hoc - Dai hoi Noi tiet- Dai thao dudng Viet Nam lan thir 3: 759 64 2. Nguyen Huy Cudng (2002), Benh din
thdo dudng nhirng quan diem hien dgi, Nha xuat ban y hoc. Ha Noi.
3. Tran Van Huy, Truong Tan Minh (2005), Tdn sudt hoi chirng chuyen hod d ngudi ldn Khdnh Hod Viet Nam.
Nhung tieu chuan nao phii hgp vdi ngudi Vict Nam chau a, tap chi tim mach hpc Vict Nam, s6 40, tr9-22 4. Duong Dinh Thien, Pham Ngoe Khai
va CS (1999), Dich te vd thong ke irng dung trong nghien cim khoa hoc, Nha xuSt ban Y hoc. Ha Noi.
70
5. Tran Dinh Toan, Nguyen Thi Phuong Ngpc va CS (2003), "Tinh trgng chole- sterol, triglycerid. glucoza, acid uric huyet thanh, benh tieu dudng, tdng huyet dp vd moi lien quan den thira cdn - beo phi d cdn bo vien chirc den khdm benh, kiem tra sire khoe tgi benh vien Hiru Nghi", Sinh hoat khoa hpc danh gia mpt sd yeu to dinh dudng co nguy CO anh hudng den sire khoe cpng dong va cac giai phap can thiep. Vien Dinh Dudng, Ha Npi, t r i 0 6 - 113.
6. INC VI (1997), High blood pressure 7. Kaplan .N.M (1998), Clinical hyperlen-
10.
slon, 1 Edition, William - Wilkin.
Jaya Rao K.S, Mukerjee S, Rao U.K (1972), A survery of diabetes mellitus in a rural population of India, Diabetes, 21,p. 1192- 1196.
Levine G.N, Keaney J.A (1995), Cho- lesterol reducation in cardiovascular disease. New Eng L. J, Med, 332, (8), p 5 1 2 - 5 2 1 .
WHO/FAO (2003), Diet Nutrition and the prevention of chronic diseases.
WHO technical report series 916, Geneva.
Summary
EFFICACY ASSESSMENT OF MULTI-FACTOR CONTROL IN TYPE II DIABETIS PATIENTS ADMITTED TO THAI BINH PREVENTIVE HEALTH CENTER The study was conducted in 165 type II diabetes patients who have been treated in Thai Binh Pre- ventive Health Center The results showed that the prevalence of diabetes was higher in males than in females with p<0.05. There was a difference between the rates of different age groups and it is highest in 60-70 years old. The efficacy of multi-factor control in those patients showed that:
the proportion of compliance was 62.4%, in this group a number of indicators such as blood Glu- cose, HbAjC, Cholesterol, LDL-C... have reduced significantly compared to un-compliance group (p<0.05). The indicators that were optimally controlled are BMI (65.5%,); blood pressure (40.0%), cholesterol (32.1%), triglyceride (33.3%); Blood glucose and HbAlC were well controlled (30.3%, and 31.5%, respectively)
Keywords.- Diabetes, Blood glucose, HbAlC: Cholesterol, LDL-C: BMI; Overweight/obese
THptl TI-ANG AN T O A N VE SINH THlTC PHAM CH$
BIEN SAN TAI CAC CHd TRUNG TAM T H A N H PHO THAI NGUYEN
Phgm Tien Thp', Do Hdm^
vdi muc tieu nghien cim thuc trang an toan ve sinh thuc pham che bien san tai cac chg trung tam thanh pho Thai nguyen, mot nghien ciru mo ta cat ngang tai hai chg Dong Quang va chg tmng tam ciia thanh pho Thai nguyen. Ket qua: Ty le kem hieu bict cua ngudi che bien va kinh doanh thuc pham ve an toan vc sinh thuc pham con cao (20-67%). Ty le thuc hanh tot ciia ngudi che bien va kinh doanh thuc pham ve an toan ve sinh thuc pham chua cao (28%). Chi so nguy ca 6 nhiem ciia ngudi che bien va kinh doanh thirc pham ve an toan ve sinh thuc pham cao (64% - 81%). Ty le han the trong cac thuc pham che bien san con cao (nhu gid, cha...tir 15,4% den 22,8%).
Tir khoa: An todn ve sinh thuc phdm, kien thirc, thuc hdnh, ngudi che biin/kinh doanh thuc phdm SV - DH Y Du-gc Thai Nguyen
PGS.TS - DH Y - Dugc Thai Nguyen
