mô tả đặc điểm lâm sàng và xét nghiệm của bệnh nhân đái tháo đường được điều trị tại khoa a2 bệnh viện trung ương quân đội 108







HATT

HATTr

THA

TBMMNTHA

: Tai 


TB

TTM
: 
TDD


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 L

 1
C.  3
 3
2 3
1.3.  4
1.3 4
1.3. 4
 5
1.5. âm sàng 5
 6
 6
 6
1.7.2.  8
 9
 9
 9
1.8.2. : 10
 11
1.9. 11
1.9.1.  11

 12
1.9 12
C 2.  15
 15
 15
 15
: 15
 15
 15
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 15

 15
2.3.2. C 15
 16
 16
2.4.2 16
 18
C 3.  19
 19
3.2.  24
.  26

 26

 30
K 33
KHUY  34

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Formatted: Level 1


 xin 
-            
Long         
.
- 

 
 

- 



- 
, khoa A2a- 

- 

-              



2012


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

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 
 
 
       [1],[11].      
 IDF: International Diabetes Federation) 
 


à
           [11].  
  2,5 % tùy
[15].
-  N             

- 

 
200 
 [10].

- là 
  
[11]. 
 
 
030 [11].

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- 

 
[1].  
 

 [3], [12].
-  




 [9].
- 

BV TW Qquân
  

:
1.  lâm 


2. 
sóc.

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3
C


- 



Theo - 




- 
            


 [11].
1.2. 
- 

 
.
-              
        A (Human Leucocyte

              




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4
- 

 65.












1.3. 
 
2004 .
1.3.1. 
-   


- 
         sinh di




1.3.
- 

- ng, c
 
-  cân (<2,5kg)
- 


ng týp 2
Gen



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5
 
           



-            


- 


s
1.4. Tiê

           
2002 [10].  

1. Glucose + Glucose           
             

2. Glucose + Glucose 

3. Glucose + Glucose         

(OGTT).
1.5. âm sàng



Formatted: Condensed by 0.2 pt
Formatted: Vietnamese
Formatted: Vietnamese
Formatted: 222, Left, Line spacing: single,
Widow/Orphan control
Formatted: Vietnamese
Formatted: Vietnamese, Condensed by 0.2 pt
Formatted: Vietnamese
Formatted: Vietnamese, Condensed by 0.2 pt
Formatted: Vietnamese
Formatted: Vietnamese
Formatted: Vietnamese
Formatted: Vietnamese
Formatted: Vietnamese
Formatted: 222, Left, Line spacing: single,
Widow/Orphan control
Formatted: Vietnamese

6
             

- 

-  insulin
- 
        

- 70  75 % 
-

- 
 TBMMN


- 


-  týp 2.
- 
-               

- 
- 
- 
- 
- 

1.7. 
1.7.1. 

Formatted: Vietnamese
Formatted: Condensed by 0.2 pt
Formatted: Vietnamese
Formatted: 222, Left, Line spacing: single,
Widow/Orphan control
Formatted: Condensed by 0.4 pt
Formatted: Vietnamese, Condensed by 0.4 pt
Formatted: Condensed by 0.4 pt
Formatted: Vietnamese, Condensed by 0.4 pt
Formatted: Condensed by 0.4 pt

Formatted: 222, Left, Line spacing: single,
Widow/Orphan control
Formatted: Vietnamese

7

toan ceton.
-    dodo    (HHS: Hyperglycemic
Hyperosmolar State)
c t 


ceton.

+ 

-
n 1,5 g/l.
+ 
+ 

+
)2 + G + Urê >
 [6].
- :
 
       





 [3].
- :


-  (DKA: Diabetic Ketoacidosis):

8
             

-  

       
sàng: glucose  12].
1.7.2. 
- :
+ 
         


+ 


-

+ 



o

 [10].
+ :
             




Formatted: Vietnamese
Formatted: 333, Left, Line spacing: single,
Widow/Orphan control
Formatted: Vietnamese

9
+ 


        
  

1.7.3. 
- :


 [16].
- :
 sau:

                

1.8. 

1.8.1.  týp 1:
- :
+ 



+ 

Formatted: 333, Left, Line spacing: single,
Widow/Orphan control
Formatted: Vietnamese
Formatted: 222, Left, Line spacing: single,
Widow/Orphan control
Formatted: Vietnamese
Formatted: Indent: First line: 0.5"
Formatted: Bb, Left, Indent: First line: 0",
Line spacing: single, Widow/Orphan control

10
 1.1. 



Khá

Go (mmol/l)

4,4  6,1
4,4 - 8
< 7

< 10
> 7
> 10
HbA1c
< 6,2%
6,2 - 8%
> 8%









(mg/dl)

(mg/dl)
< 110
< 120
80 - 120
100 - 140
< 80, > 140
< 100, > 160
HbA1c
< 6%
< 7%
> 8%




Khá

Go (mmol/l)

4,4  6,1
4,4 - 8
< 7
< 10
> 7
> 10
HbA1c
< 6,2%
6,2 - 8%
> 8%



  
   

   

   

< 110
< 120
80 - 120

100 - 140
< 80, > 140
< 100, > 160
Formatted: Font: 6 pt
Formatted: Centered
Formatted Table
Formatted: Centered

11
HbA1c
< 6%
< 7%
> 8%
1.8.2. 
- 

               

- 
+ 
calo hàng ngày.
+         
Theo d
máu.
- 
* 
+     -30
--30
phút.



+ Insulin trung gian 
--5 
+  

-

1.8.3. 
- :
+ 
+ 
Formatted: 333, Left, Line spacing: single,
Widow/Orphan control
Formatted: Vietnamese
Formatted: 333, Left, Line spacing: single,
Widow/Orphan control
Formatted: Vietnamese

12
1.9. 2
1.9.1. 
- 







+ Có sút cân không? Có ho không?

- Quan sát và khám :




- 




1.6.2. 
- 
- 
- 
1.9.3. 
- 
+ 

Formatted: 222, Left, None, Line spacing:
single, Widow/Orphan control
Formatted: 333, Left, Line spacing: single,
Widow/Orphan control, Pattern: Clear
Formatted: Font: Not Italic
Formatted: Font: Not Italic
Formatted: Vietnamese
Formatted: 333, Left, Line spacing: single,
Widow/Orphan control, Pattern: Clear
Formatted: Font: Not Italic
Formatted: Vietnamese
Formatted: Vietnamese

Formatted: Vietnamese
Formatted: 333, Left, Line spacing: Multiple
1.4 li, Widow/Orphan control, Pattern: Clear
Formatted: Line spacing: Multiple 1.4 li
Formatted: Vietnamese

13
+ 
+ 
+ 
+ 

+ 
+ 
-  



 

+            
Diamicron, Glucophage 
  
+ 
- 


+ 




-
 

+ Lenirtal 2,5 mg x 2v/24h.


+ 
Formatted: Vietnamese
Formatted: Vietnamese, Condensed by 0.5 pt
Formatted: Condensed by 0.5 pt
Formatted: Vietnamese
Formatted: Vietnamese
Formatted: Vietnamese
Formatted: Vietnamese
Formatted: Condensed by 0.2 pt
Formatted: Line spacing: Multiple 1.4 li
Formatted: Vietnamese
Formatted: Vietnamese
Formatted: Vietnamese
Formatted: Indent: First line: 0", Line
spacing: Multiple 1.4 li

14
- 
+ 
 
+ 

+ 

+ 
 

- 

+ 
+ 
+ 
+ 
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Formatted: Vietnamese
Formatted: Vietnamese
Formatted: Vietnamese
Formatted: 111, Left, Indent: First line: 0",
Line spacing: single, Widow/Orphan control

15
C 2

2.1. 

- 


- 

2.2. T:
2.2.1. 
Tháng 6/2012 10/2012
2.2.2:

TW Q
2.3. 
2.3.1. Th

2.3.2. C
 

n = (Z1-2)
2
x (1-p)/k
2


- 
- Z
2
1-2 Z
2
1-2 
.
-  

- 
Formatted: Vietnamese
Formatted: Vietnamese
Formatted: 222, Left, Line spacing: single,
Widow/Orphan control
Formatted: 333, Left, Line spacing: single,
Widow/Orphan control
Formatted: 222, Left, Line spacing: single,

Widow/Orphan control
Formatted: Font: Not Italic
Formatted: Font: Not Italic
Formatted: 333, Left, Line spacing: single,
Widow/Orphan control
Formatted: Font: Bold, Not Italic
Formatted: Vietnamese
Formatted: 222, Left, Line spacing: single,
Widow/Orphan control
Formatted: 333, Left, Line spacing: single,
Widow/Orphan control
Formatted: Vietnamese
Formatted: Vietnamese
Formatted: Vietnamese
Formatted: Vietnamese
Formatted: Vietnamese
Formatted: Vietnamese
Formatted: Vietnamese
Formatted: Vietnamese

16
a có:
n = 1,96
2
x (1  0,8)/0,1
2
= 116
 
 165 


2.4.1. 


BMI

-  

- 
 .
2.4.2. 
 
6]
- 2.4.2.1.  :

            


1. Glucose + Glucose 
11,1 mm

2. Glucose + Glucose 

3. Glucose + Glucose 

Formatted: 222, Left, Line spacing: single,
Widow/Orphan control
Formatted: Font: Not Italic
Formatted: 333, Line spacing: single,
Widow/Orphan control
Formatted: Vietnamese

Formatted: Vietnamese
Formatted: Vietnamese
Formatted: 333, Left, Line spacing: single,
Widow/Orphan control
Formatted: Vietnamese
Formatted: Bulleted + Level: 1 + Aligned at:
0.75" + Indent at: 1"
Formatted: Vietnamese
Formatted: Vietnamese
Formatted: Vietnamese
Formatted: Vietnamese
Formatted: Vietnamese, Condensed by 0.3 pt

17
(OGTT).
- 2.4.2.2.  :

-+ 
 . Bình th        
mg/dl)
+

+ . (200  239 mg/dl)
+ 
- + 
+ Bình th
+ -4,5 mmol/l (200-400 mg/dl).
+ 11,3mmol/l (400-1000mg/dl).
+ 
+ - -C (High Density Lipoprotein Cholesterol):

HDL-C  -
-
 Bình th-C trong máu > 0,9 mmol/l.
 Khi HDL-
+ - C (Low Density Lipoprotein Cholesterol)
+ Bình th-C trong máu <3,4 mmol/l (<130 mg/dl)
+  4,1 mmol/l (130-159 mg/dl)
+ 
- 2.4.2.3.  :

- 2.4.2.4.  
+ -  
Formatted: Vietnamese
Formatted: Bulleted + Level: 1 + Aligned at:
0.75" + Indent at: 1"
Formatted: Indent: Left: 0.75"
Formatted: Bulleted + Level: 1 + Aligned at:
0.75" + Tab after: 1" + Indent at: 1"
Formatted: Bullets and Numbering
Formatted: Vietnamese
Formatted: Vietnamese
Formatted: Vietnamese
Formatted: Indent: Left: 0.5", No bullets or
numbering
Formatted: Bulleted + Level: 1 + Aligned at:
0.75" + Indent at: 1"
Formatted: Indent: Left: 0.25", First line:
0.5"
Formatted: Bulleted + Level: 1 + Aligned at:
0.74" + Indent at: 0.99"

Formatted: Bulleted + Level: 1 + Aligned at:
0.74" + Indent at: 0.99"
Formatted: Bulleted + Level: 1 + Aligned at:
0.25" + Indent at: 0.5"
Formatted: Bulleted + Level: 1 + Aligned at:
0.25" + Indent at: 0.5"
Formatted: Bulleted + Level: 1 + Aligned at:
0.5" + Tab after: 0.75" + Indent at: 0.75"
Formatted: Indent: Hanging: 1.7", Bulleted +
Level: 4 + Aligned at: 1.75" + Indent at: 2"
Formatted: Bulleted + Level: 1 + Aligned at:
0.25" + Indent at: 0.5"
Formatted: Bulleted + Level: 1 + Aligned at:
0.75" + Indent at: 1"

18
+ - 
+ -      :  
.
+ - oét bàn

- 2.4.2.5. 

- 2.4.2.6. 
-+  %
-+ Ki  - 7%
-+  8%
-+ .
- 2.4.2.7. 
+ - 

+ - 
+ -            
không
+ - 
+ - 

12



Kém

((((((((((((((mmol/l(mmol/l)
4-6,1
6,2-7
>7
HbA1c (%)
<6,5
 7,5
> 7,5
2.5
-       

- 
Formatted: Bulleted + Level: 1 + Aligned at:
0.75" + Indent at: 1"
Formatted: Bulleted + Level: 1 + Aligned at:
0.75" + Indent at: 1"
Formatted: Bulleted + Level: 1 + Aligned at:
0.25" + Indent at: 0.5"

Formatted: Bulleted + Level: 1 + Aligned at:
0.25" + Indent at: 0.5"
Formatted: Bulleted + Level: 1 + Aligned at:
0.5" + Tab after: 0.75" + Indent at: 0.75"
Formatted: Bulleted + Level: 1 + Aligned at:
0.25" + Indent at: 0.5"
Formatted: Indent: Hanging: 0.01", Bulleted
+ Level: 1 + Aligned at: 0.25" + Indent at:
0.5", Tab stops: 0.79", Left
Formatted: Bb, None, Widow/Orphan control
Formatted: Vietnamese
Formatted: Vietnamese
Formatted: 222, Left, Line spacing: single,
Widow/Orphan control
Formatted: Danish
Formatted: Danish

19

- 
-  

Formatted: Danish
Formatted: Danish
Formatted: 111, None, Indent: Left: 0", First
line: 0", Widow/Orphan control

20
C 3


 
3.


n=165

%


(
X
± SD)
65,3 ± 8,8

94

36


< 40
4
2,43
40  60
60
36,36
> 60
101
61,21
i


97
58,78
Nam
68
41,12
58,78
41,12
 nam
2,43
61,21
36,36
< 40 40 - 60 > 60

 

so               .
C

Formatted: 111, Left, Line spacing: single,
Widow/Orphan control
Formatted: Font: 2 pt
Formatted: Space Before: 12 pt
Formatted: Vietnamese
Formatted: Bb, Left, None, Indent: First line:
0", Line spacing: single, Widow/Orphan control
Formatted: Centered
Formatted: Dd, Left, Line spacing: single,
Widow/Orphan control

21

3.2.
C
ân (n=165)
VM (cm)
93,75  4,75
VB (cm)
96,71  5,99
VB/VM
1,03  0,16

158,18  6,95

57,49  9,07
  cCác 
158,18  6,9557,49  9,07 kg.

1,03  0,16.
3.3.  (Body Mass Index- BMI)


n=165

%

nhân
(n=165)

%

 18,5

Nam
6
3,64
9
5,46

3
1,82
18,6  23

Nam
62
37,57
83
50,30

21
12,73
>23- 24,9
Nam
34
20,61
38
23,03

4
2,42
>25

Nam
32
19,39
35
21,21

3
1,82
BMI (
X
± SD)
22,9 ± 2,7
 ,c
BMI trung bình -23). BMI
165 BN là 22,9 ± 2,7.
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Formatted: English (U.S.)
Formatted: Danish
Formatted: Danish
Formatted: Vietnamese
Formatted: Bb, Left, Indent: First line: 0",
Line spacing: single, Widow/Orphan control
Formatted: Vietnamese
Formatted Table
Formatted: English (U.S.)
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Formatted: English (U.S.)
Formatted: English (U.S.)
Formatted: English (U.S.)

Formatted: English (U.S.)
Formatted: English (U.S.)
Formatted: English (U.S.)
Formatted: Bb, Left, Indent: First line: 0",
Line spacing: single, Widow/Orphan control