Chỉ số huyết áp và lipid máu ở bệnh nhân đái tháo đường typ 2 điều trị ngoại trú tại bệnh viện kiến an, hải phòng

Y HOC VIET NAM THANG 2 -
SO
2/2014
IV. KET LUAN
Qua nghien
cffli
ve thffc trang ATVSTP tai
eac bep an tap the eua doanh nghiep d Hai
Dffdng ket qua eho thay:
- Dien tich cac bep an :
Chiem
50% cac phdng
che bien cd dien
tich
<iOOm^;
chi cd 12% dien
tich
>200m^;
Dien tich phdng an tff
200-500m^
chiem ty le nhieu nhat (45%).
- Chiem 44% cac BATT chu'a dat yeu eau ve
nhffng qui dmh
thii
tuc hanh chinh .
- Cd tdi 17,5% cae BATT khdng dat yeu cau ve
cd sd ha tang ; 20% cac BATT ed NPV khdng
mang day
dii
bao hd lao ddng khi lam viee ; 20%
BATT ngffdi

phyc
vu khdng sff dung dung cu
sach khi che
bien.
-tren cac mau xet nghiem deu thay cd ty ie
nhiem VSV trong dd ty le nhiem VSV tren ban tay
NPV la cao nhat: Coliform (72,5%);
E.coli
(25,0%);
S.au reus (32,5%).
TAI UEU THAM
KHAO
1.
Cue
An toan thu'c pham - Bp Y te
(2005);
"Mdt so cong trinh nghien cffu ve ve sinh an toan
thu'c pham. Bp Y te. HNKH an toan ve sinh thifc
pham lan thff
ill.
Ha Ndi.
2.
Bui Vi The
(2013),
Tht/c
trang an toan ve smh
thUc
pham,
cdng
tac quan ly va kien thffc,

thi/c
hanh
ciia
nhan vien
tai
cac bep an tap the huyen
Thuy Nguyen,
Hai
Phong nam 2012, Luan van
1^
nghiep bac sT chuyen khoa II,
trUcfng (3ai
hpc Y
khoa Hai Phong,
Hai
Phong.
J.
Pham Duy Tuyen (2010), thUc trang an toan
v^
smh thu'c pham va cong tac quan ly mpt so
cd sd
djch
vu an uong cong cpng tren dja ban thanh
ph6
Hai
DUPng
nam 2010, Luan van thac
sT
y te cong
cpng,

tn/dng dai hpc Y khoa
Hai
Phong, Hal Phong.
4.
Nguyen Thj Van (2012), thifc trang an toan ve
sinh thUc pham,
kien
thffc, thai dp
eiia
ngffdi phyc
vu tai nha hang an udng quan Le Chan, Hal Phong
nam 2012, luan van thac
sT
y te eong cong, tru'dng
dai
hoc Y khoa Hai Phong,
Hai
Phdng.
5. CDC (2000) Foodborne illness,
p.
1-17.
6. WHO (1997) Epidemiological Surveillance of
Foodborne Diseases, Geneva.
CHi
so
HUYET AP VA LIPID MAU
6'
BENH NHAN DAI
THAO
DU'O'NG TYP

2 DIEU TRI NGOAI TRU TAI BENH VIEN KIEN AN
HAI
PHONG
T6M
TAT
Nghien cffu du'dc tien hanh tren 123 benh nhan
dai
thao dudng typ 2 dieu tri ngoai
trii
tai benh vien
kien An
Hai
Phong tff 01/2011 den
06/2011.
Ket qua: Nhdm nghien cffu cd
tuoi
trung binh la
60,4
-I-
9,7; nff chiem 66,7%. Ti le
dai
thao dUdng typ
2
CO
tang huyet ap la
48,8%,
fang huyet ap gd I:
28,5%,
tang huyet ap
giai

doan II: 14,6%, tang huyet
ap giai doan III: 5,7%, Ti le nam
bi
tang huyet ap
nhieu hdn nff (63,4% so
vdi
58,2%).
Tuoi
cang eao ti
le
t§ng
huyet ap cang nhieu; d benh nhan tren 70
tud'i,
t9
le tang huyet ap la 60%. Thdi
gian
mac dai thao
dudng cang dai thi ti le bi THA cang cao; d benh nhan
mac benh tren 10 nam co ty le tang huyet ap la
66,7%.
52,8% dai thao dirdng typ 2 cd tang
Cholesterol; 60,2% cd tang Tryglycerit; 32,5% cd tang
LDL;
39,2% benh nhan cd tang Cholesterol va
Tryglycerit; 25% benh nhan cd tang Cholesterol,
Tryglycerit va LDL. Nhom
dai
thao
dUdng
typ 2 ket

hdp tang huyet ap cd ty le rdi loan chuyen hoa Lipid
mau cao hdn nhom khong cd tang huyet ap.
* SdYte
Hai Phdng
Phan
bi0n
khoa hgc: PGS.TS. Do Thj Tinh
Trinh
Thi Ly* va
cdng
sif
SUMMARY
BLOOD PRESSURE AND
LIPIDEMIA
IN OUTPATIENT WITH TYPE II
DIABETES TREATED IN KIEN AN
HOSPITAL HAI PHONG
The study was conducted on 123 outpatient with
type 2 diabetes treated in Kien An hospital from
01/2011 to
06/2011.
Results: The team has an average age of 50.4 +
9.7; women accounted for 66.7%. The rate of type 2
diabetes have hypertension was 48.8%. Hypertension
stage I: 28.5%, hypertension stage II: 14.6%,
hypertension stage III: 5.7%. Percentage of men with
hypertension is more than women (63.4% versus
58.2%).
As the older patients are, as the rate of
hypertension is higher; in patients over 70 years of

age,
the rate of hypertension
is
60%. As the duration
of diabetes is longer, as the rate of hypertension is
higher; in patients over
10
years of diabetes, the rate
of hypertension
is
66,7%. In patients had type 2
diabetes: 52.8% have Cholesterol increased; 60.2%
have
Triglycent
increased; 32,5% have LDL increased;
39.2%
have Triglycerit and Cholesterol increased; 26%
have cholesterol, Triglycerit and LDL increased. The
Y HQC
VI$T NAM
THANG 2 •
SO
2/2014
type 2 diabetes combined with hypertension have the
rate of blood lipid metabolic disorders is more than the
group without hypertension.
I.
DAT
VAN DE
Tang huyet ap (THA) va dai thao du'dng

(DTD) la hai benh ly phd bien va hay gap phdl
hdp.
Tai Viet
Nam, ty le benh nhan DTD dong
thdi mac
THA khoang 50-70%, Nhieu nghien cffu
cho thay THA va DTD thu'dng song hanh vdi
nhau vi cd cung cac yeu td nguy cP. THA la mpt
yeu td lam tang bien chffng
ciia
DTD, va ngu'de
lai DTD cung lam cho THA khd kiem scat hOn.
O
tienh nhan DTD typ 2, THA cd the xuat hien
trffdc khi DTD dffdc chan doan hoac ca hai dffdc
phat hien dong thdi trong benh eanh
eiia
hpi
chffng chuyen hda. So vdi ngffdi DTD ddn
thuaii,
ngffdi DTD kem THA se tang
60%
nguy ed
benti
than
kinh,
tang gap 2 lan nguy cd benh vdng
m?c,
benh than man va tff vong do mpi nguyen
nhan,

t^ng
gap 3 ian nguy cd benh mach vanh
va
tSng
gap 4 lan nguy cd dot quy, Theo trung
tam phdng ngffa va kiem soat benh tat Hoa Ky
cho thay cd khoang 70%-90% benh nhan dai
thao dffdng tip 2 ed rdi loan lipid mau.
Chinh vi vay, viec kiem soat huyet ap, lipid
mau cung
nhi/
du'dng huyet la nhffng van de
then chdt ddi vdi benh nhan DTD typ 2, giiip lam
cham tien trien
ciia
benh va ngan ngffa nhffng
bien chihig mach mau.
II.
DOI TUONG
VA PHU'OTSJG
PHAP NGHIEN CUD
2.1.
OOI
tu'dng: 123 benh nhan DTD typ 2
dieu tri ngoai tru tai benh vien Kien An tff
01/2011 den
06/2011,
2.2.
Phu'dng
i^ap

nghien
cffu:
Md ta cat ngang
Benh nhan dffdc lay mau tTnh mach luc ddi
de dinh lu'dng: Glucose mau, Cholesterol toan
phan,
triglycerit, HDL, LDL
Oo huyet ap
liie
sang sdm (tff 4-6 gid sang),
liic
cdn dang nam chffa day hoae ban ngay
6if6c
nam
tinh
tff 15-30 phiit. Do huyet ap 3 lan, moi
lan
each
nhau 3 - 5 phiit, lay trung binh eua
huyet ap.
2.3.
Mot so tieu chuan dung trong
nghien
cffu:
- Chan doan dai thao dffdng theo WHO 1999;
- Chan doan THA: theo phan loai eua Uy ban
phdng chdng huyet ap Hoa Ki (JNC VI)-1997
2.4.
Xff ly so lieu nghien cu'u: Xff ly sd
lieu tren phan mem Epi -

info.
III.
KITQUA
NGHIEN CLTU
Bang 1. Phan bd doi tffdng theo nhdm tud'i va gidi
Nhom tuoi
<40
40-49
50-59
60-69
> 70
1
Tuoi trunq binh
So benh nhan
1
13
46
38
25
123
Ti ie %
0.8
10.6
37.4
30.9
20.3
100
60,4
-I-
9,7

Nh$n
x6t:l\iO\
trung binh
eiia
nhdm nghien effu la 60,4
- 49, chu yeu la d tudi tren 50.
Bieu do 1: Phan bd ddi tffdng theo gidi
- 9,7; hiem gap d tud'i < 40, it gap d tuoi 40
Nh$nx4t:r\
le nff (66,7%) gap 2 lan nam (33,3%).
Y HOC VIET
NAM
THANG 2 - SO 2/2014
Bieu do 2:
Chi
so HA theo gidi
Niian xet: Ti le benh nhan cd THA chiem 48,8%. Ti le nam bi THA nhieu hdn nff bj THA (63,4% so
vdi 58,2%, p<0,05).
Bieu tfo 3: Giai doan THA
d ntiom nghiien cCru
28.5
30
-1
C^
25
20
15
10 •
5 •
0 •

^
14.6
—•-
^
P
5.7
I
J-
y
THA gdi THAgdll THAgdlll Giai
doan
Nhan
xet: 0 benh nhan dai thao dffdng typ 2, hay gap nhat la THA giai doan I (28,5%), sau den THA
giai doan II (14,6%), it gap nhat la THA giai doan III
(5,7%).
Bang2.T\
le THA theo
nhdni
tud'i d benh nhan dai thao dffdng typ 2
Nhom tuoi
<49
50-59
60-69
> 70
So benh nhan dai
thao du'dng
(n = 123)
14
46
38

25
Benh nhan
STS
co THA
So BN
(n = 60)
3
22
20
15
Ti ie
»/o
21,4
47,8
52,6
60,0
P
<0,05
<0,05
Nhan xet: Benh nhan dai thao dffdng typ 2, tudi cang cao ti le THA eang nhieu, sff khac biet cd y
nghia thong ke vdi p < 0,05.
a
benh nhan tren 70
tudi,
ty le THA len tdi 60%
Bang
3.
Cn
so HA iien quan den thdi qian
Thdi gian

CTB
So benh nhan bi DTO
• (n =
123)
•
B^nh
nhan bi
OTO CO THA
SoBN
Ti ie
%
<
1
nam
(n = 16)
16
4
25
phat hien dai thao du'dnq tvp 2
1-5
nam
(n = 51)
51
25
49
5-10 nam
(n = 44)
44
23
52,3

> 10 nam
(n = 12)
12
S
66,7
Y HOC VIET NAM THANG 2 - SO
2/2014
(n =
60)
P
1 1 i
<0,05
1
<0,05
Nhan xet: Benh nhan dai thao du'dng typ 2 co thdi gian mac benh cang dai thi ti le bi THA cang cao,
su"
l(hac
biet co y nghia thong
l<e
vdi p < 0,05.
6
benh nhan mac benh tren 10 nam cd ty ie THA len
tdi 66,7%.
Bang 4. Roi loan chuyen hoa Lipid mau d benh nhan dai thao du'dng typ 2
Lipid mau
(mmoi/l)
Cd roi loan chuyen hoa Lipid mau
Khdng roi loan chuyen hoa Lipid mau
Tang Cholesterol.
Tang Tryglycerit

Giam HDL
Tang LDL
Tang ca Cholesterol va Tryglycerit
Tanq ca Cholesterol,
Tryqiycerit
va LDL
So benh nhan
(n
=
123)
90
33
65
74
11
40
49
32
Ti le
«/o
73,2
28,8
52,8
60,2
8,9
32,5
39,2
26%
Nh$n
xet: 52,8% benh nhan dai thao du'dng typ 2 c6 tang Cholesterol; 60,2% benh nhan cd tang

Tryglycerit; 32,5% benh nhan cd tang LDL; 39,2% benh nhan cd tang Cholesterol va Tryglycerit; 26%
benh nhan cd tang Cholesterol, Tryglycerit va LDL.
Bang 5. Roi loan
Lipid mau
(mmoi/l)
Tanq Cholesterol.
Tanq Tryglycerit
Giam HDL
Tanq LDL
chuyen hoa Lipid
Tiau
d benh nhan DTD cd THA
Nhom OTO CO THA
(n = 60)
So benh nhan
35
41
7
22
Ti le
%
58,3
68,3
11,7
36,7
va khdnq THA
Nhom OTO khong THA
(n
= 63)
Sdbenh

nhan
30
33
4
18
Ti ie
»/o
47,6
52,4
6,3
28,6
P
< 0,05
<0,05
< 0,05
<0,05
Nhan xet: Benh nhan dai thao du'dng typ 2 cd THA cd ty le rdi loan chuyen hoa Lipid mau cao hdn
benh nhan khong cd THA.
IV.
KIT
LUAN
Benh nhan dai thao du'dng
typ
2 dieu tri
ngoai tru tai benh vien Kien An cd tuoi trung binh
la 60,4 + 9,7;
niJ
chiem 66,7%, gap 2 ian nam.
Ti le dai thao du'dng typ 2 cd THA chiem
48,8%.

Hay gap nhat la THA giai doan I (28,5%),
sau den THA giai doan II
(14,6%),
it gap nhat la
THA giai doan III (5,7%). Benh nhan nam cd ty le
bi THA nhieu hdn nff (63,4% so vdi 58,2%).
Tuoi cang cao ti le THA cang nhieu; d benh
nhan tren 70
tuoi,
ty le THA ien tdi 60%.
Benh nhan dai thao
difdng
cd thdi gian mac
tj^nh
cang lau thi ti le bi THA cang cao; d benh nhan
mSc
b?nh
tren 10 nam cd ty
leTHA
len tdi 66,7%.
52,8%
dal thao du'dng typ 2 cd tang
Cholesterol; 60,2% cd tang Tryglycerit; 32,5% cd
tSng LDL; 39,2% benh nhan cd tang Cholesterol
va Tryglycerit; 26% benh nhan cd tang
Cholesterol, Tryglycerit va LDL.
Nhdm dai thao dudng typ 2 kem theo THA cd
ty le rdi loan chuyen hoa Lipid mau cao hdn
nhdm khdng cd THA
TAI

LIEU
THAM KHAO
1.
Nguyin Thi Thu Thao (2013), Chuyen tfe roi
loan lipid mau
d
benh nhan
dai
thao dudng - nguy
CO
tCr
vong do dot quy va cac bien co
tim
mach.
2.
Oo Thi Tinh, Tran Thj Mai
(2001),
Bien chirng
thudng gap cua
dai
thao
duOng
tai benh vien Viet
Tiep
- Hal Phong. Ky yeu cac de
tai
nghien
CLTU
khoa hoc.
Dai

hoi
Noi
tiet
- Dai thao dudng Viet
Nam Bn thd nhat, Tr 306 - 316.
3. Nguyin Lan Viet (2007), Tang huyet ap, Benh
tim
mach, Nha xuat ban Y hoc, Tr 135 - 172.
4.
Bottemann
P, Clasen M (1991), Diabetes mellitus
and artenal hypertension. V
46,
p 558 -
562,
5. Sing H - RB (1998), Prevanlence of type diabetes
mellitus and
risk
of hypertension an coronary
artery disease
in
rural and urban population
with
low rate of
obesity.
Cardial, sep, V 1, p 65-72,
6.
Lewington
S et al (2013), standards of medical
carestandards of medical care

in
diabetes