TRNG CAO NG Y T H NI B MN IU DNG NI
TN TI KIN THC, THC HNH V PHNG BIN CHNG CA NGI BNH I THO NG TYP 2
ANG IU TR NGOI TR TI BNH VIN XANH PN, H NI, NM 2012
CNG NGHIN CU Ch nhim ti: Nguyn Th Thy Anh
H NI, 2012
MC LC
MC LC BNG Bng 1: M t c im chung ca i tng nghin
cu..................................36 Bng 2: Tin s
bnh.............................................................................................36
Bng 3: Kin thc v biu hin
bnh....................................................................37
Bng 4: Kin thc v cch tun th iu tr
........................................................37 Bng 5:
Bin chng ca
T................................................................................38
Bng 6: Hu qu ca bin chng bnh
T........................................................38 Bng 7:
Yu t lm trm trng
bnh....................................................................38
Bng 8: Cch phng bin
chng..........................................................................39
Bng 9: c im v hng dn C n, tun th C n, cc thc n cn trnh39 Bng 10: c
im v hng dn CLT, tun th CLT, thi gian LT, tn sut LT
.................................................................................................................................40
Bng 11: c im v dng thuc, tun th dng thuc, t iu tr thuc khc......40
Bng 12: Ngun thng tin truyn thng nhn
c............................................40 Bng 13: Nhng yu cu
v t vn, tuyn truyn phng bnh T..................41 Bng 14: Nhng phng
tin truyn thng mong mun c nhn nht.........41 Bng 15: Nhng kh khn
trong vic tun th iu tr bnh.............................41 Bng 16:
Kt qu phn loi kin
thc..................................................................42
Bng 17: MLQ gia gii tnh vi KT v tun th ch iu tr bnh T....42 Bng 19:
MLQ gia ngh nghip vi KT v tun th CT bnh T..........42 Bng 20: MLQ
gia hc vn vi KT v tun th CT bnh T..................43 Bng 21: MLQ
gia thu nhp vi KT v tun th CT bnh T................43 Bng 22: MLQ
gia thi gian mc bnh vi KT v tun th CT bnh T43 Bng 23: Phn loi kt qu
TH tun th iu tr bnh T..............................43 Bng 24: MLQ
gia gii tnh vi TH v tun th CT bnh T.................44 Bng 25: MLQ
gia nhm tui vi TH v tun th CT bnh T .............44 Bng 26: MLQ gia
ngh nghip vi TH v tun th CT bnh T..........44 Bng 27: MLQ gia hc vn
vi TH v tun th CT bnh T..................44 Bng 28: MLQ gia thu nhp
vi TH v tun th CT bnh T................45 Bng 29: MLQ gia BHYT vi
TH v tun th CT bnh T....................45 Bng 30: MLQ gia thi gian
mc bnh vi TH v tun th CT bnh T45
DANH MC CC CH VIT TT BHYT BN CBYT BC CNVC T TNC KT MLQ NC Q TH
THA THCS THPT TPHCM WHO Bo him y t Bnh nhn Cn b y t Bin chng Cng
nhn vin chc i tho ng i tng nghin cu Kin thc Mi lien quan Nghin cu
Quyt nh Thc hnh Tng huyt p Trung hc c s Trung hc ph thng Thnh ph H
Ch Minh T chc y t Th gii
TM TT BO CO NGHIN CU i tho ng l mt bnh ri lon chuyn ha rt thng
gp cc nc v tr thnh vn y t x hi nghim trng. Hin th gii c khong 180
triu ngi mc bnh i tho ng v con s ny c th tng ln 366 triu ngi vo
nhng nm 2030, trong 90% l T typ 2. Vit Nam, tnh hnh mc bnh T ang c
chiu hng gia tng c bit l ti cc thnh ph ln. Theo kt qu thng k nm
2001 t l T ti khu vc ni thnh ca bn thnh ph ln l 4,0%; t l ri lon
dung np glucose l 5,1% v n nm 2003 t l T ti khu vc thnh ph l 4,4%.
Trong cc typ ca T th typ 2 chim t l cao nht (>90%) v thng din
tin m trong nhiu nm. Khi cc bin chng ln lt xy ra th vic iu tr rt tn
km v hon ton khng khi. V vy, kin thc thc hnh v tun th iu tr ca bnh
nhn T typ 2 rt quan trng. Vit Nam hin nay, trong phm vi nghin cu
kin thc, thc hnh v tun th iu tr bnh T th cha thy c nghin cu no.
Thnh ph H ni l th ca nc Vit nam, l trung tm kinh t, chnh tr, vn ha
v x hi. Vi mt dn s ng, l ni thu ht ngi dn cc tnh v H ni lm n sinh
sng. Chnh v vy, vic kim sot v a kin thc phng chng bnh T n ngi dn gp
rt nhiu kh khn cho nhng ngi lm trong ngnh y t ni chung. Chng trnh
khm v iu tr ngoi tr cho ngi bnh T c cc bnh vin ng trn a bn thnh ph
H ni trin khai trong nhiu nm nay. Nhng n nay, mng li chm sc v qun l
ngi bnh T hu nh ch dng mc ngi bnh n khm nh k theo s v cp pht thuc,
cha p nhu cu chm sc ton din ca ngi bnh v khng gim st c s tun th iu
tr cho ngi bnh T. Chng ti tin hnh nghin cu nh gi kin thc, thc hnh v
tun th iu tr v cc yu t lin quan ca bnh nhn T typ 2 ang iu tr ngoi
tr ti bnh vin Xanh pn H ni, nm 2012. Nghin cu tin hnh trong thi
gian t thng /2012 n thng /2012. Tng s bnh nhn mc T typ 2 ang iu tr
ngoi tr ti bnh vin Xanh pn c chn vo nghin cu v c phng vn bng b cu
hi thit k. Kt qu
nghin cu cho bit: i) Kin thc ca ngi bnh t ..%, khng t ..%. ii)
Thc hnh ca ngi bnh t ..%, khng t %. iii).
T VN i tho ng l mt bnh mn tnh, c yu t di truyn, do hu qu ca tnh
trng thiu insulin tuyt i hoc tng i. Bnh c c trng bi tnh trng tng ng
huyt cng vi cc ri lon v chuyn ha ng, m, m v cht khong [12]. Khng ch
do nhng di chng li v cc kh khn, tn km trong qu trnh iu tr, hin nay
bnh i tho ng cn c coi l mt vn sc khe cng ng ln trn ton th gii do tn
sut lu hnh bnh ngy cng gia tng. Theo thng k mi nht ca T chc y t th
gii (WHO), trn th gii c 10 giy li c mt ngi cht v bnh i tho ng.
Trung bnh, mt ngy c 8.700 ngi v mt nm c 3,2 triu ngi cht do i tho
ng. Hin th gii c khong 180 triu ngi mc bnh i tho ng v con s ny c th
tng ln 366 triu ngi vo nhng nm 2030 [1], [13]. Vit Nam, tnh hnh mc
bnh T ang c chiu hng gia tng c bit l ti cc thnh ph ln. Theo kt qu
thng k nm 1992 ti H Ni: i tho ng chim 1,42%, Hu: chim 0,96% v TPHCM
chim 2,52%. n nm 2001 t l T ti khu vc ni thnh ca bn thnh ph ln l
4,0%, t l ri lon dung np glucose l 5,1% v n nm 2003 t l T ti khu vc
thnh ph l 4,4%. Trong T typ 2 chim >90% ton bnh nhn T. Do , chnh
T typ 2 mi gy vn cho sc khe cng ng, v tn sut n gia tng song hnh vi
s lo ha, th ha, li sng tnh ti v vi s bo ph dn s cc nc cng nghip
[5], [9]. Nhng bin chng ca T chng minh mc trm trng ca bnh cng nh
nhng chi ph v kinh t - x hi. khng ch ng huyt mc bnh thng ngoi vic
dng thuc gim ng huyt nhm khng gy tng hay gim ng huyt qu mc, ng thi
hn ch c tnh trng tng lipit mu lm chm bc tin ca x va ng mch, c bit
nhng ngi bnh T typ 2, th ch n vn ng th lc l phng php iu tr lu di
bnh T [13].
iu tr tt T nhm nng cao cht lng sng, ko di tui th cho bnh nhn v
gim chi ph cho ton x hi. T l bnh mn tnh cha c kh nng iu tr khi hon
ton m phi iu tr sut i, d lm bnh nhn chn nn b cuc, mt s bnh nhn khng
hiu c tm quan trng ca vic dng thuc nht l T typ 2, hoc v l do kinh
t. Vic gio dc, t vn, cung cp nhng kin thc, thc hnh trong vic tun th
iu tr lu di cho bnh nhn khng ch ph thuc vo ngi thy thuc m cn c s hp
tc tt gia bnh nhn gia nh thy thuc t hiu qu cao trong kim sot ng
huyt v phng nga c mt s bin chng do bnh i tho ng gy nn. Bnh vin Xanh
pn nm trn a bn qun Ba nh- H ni. l mt bnh vin a khoa cp 1 ca thnh
ph. Bnh vin tip nhn cha bnh cho cc i tng nhn dn thuc thnh ph H ni.
S lng bnh nhn n khm v iu tr ti bnh vin ng tuyn v vt tuyn ngy mt gia
tng. qun l v gim st v ch tun th iu tr ca nhng ngi bnh T ti cng ng l
mt vn kh khn i vi nhn vin y t. S liu v thc trng bnh i tho ng ti
thnh ph H ni, thng tin v cc yu t lin quan n kin thc, thc hnh tun th
ch iu tr bnh i tho ng l rt cn thit. Nhng s liu ny s gip cho cc nh
hoch nh chnh sch nh gi ng v tnh hnh mc bnh, nguy c pht trin bnh,
hiu qu ca cc bin php phng chng v iu tr xy dng k hoch qun l, phng
chng bin chng ca bnh i tho ng mt cch thit thc nht. Xut pht t mc ch
ny, chng ti tin hnh nghin cu nh gi kin thc, thc hnh v tun th iu tr
v cc yu t lin quan ca ngi bnh i tho ng typ 2 ang iu tr ngoi tr ti
bnh vin Xanh pn, H ni, nm 2012.
MC TIU NGHIN CU1. nh gi kin thc, thc hnh v tun th ch n ung, luyn
tp v dng thuc
ca bnh nhn i tho ng typ 2 ang iu tr ngoi tr ti bnh vin Xanh pn H
ni, nm 2012.2. Xc nh mt s yu t lin quan n kin thc, thc hnh v tun th
ch n ung
luyn tp v dng thuc ca bnh nhn i tho ng typ 2 ang iu tr ngoi tr
ti bnh vin Xanh pn H ni, nm 2012.
CHNG 1: TNG QUAN TI LIU 1.1. Bnh i tho ng 1.1.1. nh ngha: [20],
[16] T l mt bnh mn tnh phc tp, c yu t di truyn, do hu qu ca tnh
trng thiu insulin tng i hoc tuyt i; bnh c c trng bi tnh trng tng ng
huyt cng vi cc ri lon v chuyn ha ng, m, m, cht khong. [20] Bnh i
tho ng nu khng c kim sot tt, sau mt thi gian tin trin ko di c th gy
nhiu bin chng. [16] 1.1.2. Chn on bnh i tho ng: [13], [6] Vic chn
on bnh i tho ng s khng kh khn khi bnh nhn c cc triu chng lm sng c
in nh n nhiu, st cn, i nhiu, ung nhiu, c ng niu v glucose mu tng
cao. Tuy nhin, nhng trng hp c triu chng lm sng rm r thng t gp hoc
glucose mu lc i mc bnh thng th vic chn on hon ton da vo cc xt nghim
ha sinh Theo tiu chun ca T chc Y t Th gii nm 1999, i tho ng c xc nh
chn on khi bnh nhn c bt k mt trong 3 tiu chun sau: - Glucose huyt
trn 11,1 mmol/l (200mg/dl) bt k thi im no. Km theo cc triu chng ung
nhiu, i nhiu, gim cn v c glucose niu, c th c ceton niu. - Glucose
huyt lc i trn 7 mmol/l (>126mg/dl) xt nghim lc bnh nhn nhn i hn
10 gi. - Glucose huyt sau lm nghim php tng glucose huyt vi 75 gam
glucose sau 2 gi trn 11,1 mmol/l (>200mg/dl) theo tiu chun WHO.
1.1.3. Phn loi i tho ng: [13], [16], [7] Bnh i tho ng c phn ra cc
loi sau y: - i tho ng typ 1: (i tho ng ph thuc vo insulin) l bnh t
min c c trng bi s ph hy t bo ca tuyn ty, dn n tuyn ty khng sn xut
insulin
gy nn s thiu ht tuyt i hoc gn nh tuyt i insulin. Bnh c biu hin
bng cc triu chng n nhiu, ung nhiu, i nhiu, st cn, mt mi, thay i th
lc. Bnh xy ra ngi tr, phn ln t 10- 20 tui. T l mi mc cao cc gia nh
c ngi b i tho ng ph thuc vo insulin. C xu hng bin chng hn m toan
huyt. Ngi bnh i tho ng typ 1 d b t vong nu khng c cung cp insulin
hng ngy. - i tho ng typ 2: (i tho ng khng ph thuc vo insulin) l th
i tho ng khng insulin hoc gim kh nng bi tit insulin, chim a s bnh
nhn mc i tho ng ni chung (90%), thng xy ra ngi ln tui, nhng c xu
hng tr ha, ng huyt thng tng cao nhiu nm trc khi c chn on, bnh thng
biu hin c cc triu chng nh, c chn on tnh c hoc khi bnh c cc bin chng
do bnh i tho ng gy nn. a s bnh nhn thuc loi bo (90% cc bnh nhn cc
nc pht trin). Phn ln bnh i tho ng typ 2 l do hu qu ca tnh trng tng
cn v t hot ng th lc. - i tho ng thai k: do ri lon dung np glucose,
xut hin ln u tin khi c thai, v thng mt i sau . Loi i ng ny gp t 1-
2% ngi mang thai c tin s gia nh c i ng, tin s thai nhi cht trc khi
sinh hoc d dng,... 1.1.4. Dch t hc bnh ai thao ng: 1.1.4.1. Tnh hnh
mc bnh i tho ng trn th gii: i tho ng l mt bnh ri lon chuyn ha rt
thng gp cc nc pht trin v ang pht trin, tr thnh vn y t v x hi nghim
trng. Tc pht trin ca bnh rt ln. N l mt trong ba bnh (ung th, tim
mch, i tho ng) pht trin nhanh nht. Theo cng b ca WHO 1985 c 30 triu
ngi trn th gii b i tho ng th nm 1994 l 98,9 triu ngi. Theo c tnh ca
Vin nghin cu i tho ng quc t vo nm 2000 c khong 157,3 triu ngi v nm
2010 c 215,6 triu ngi b T [13]. Bnh c xu hng tng r rt theo thi gian
v s tng trng kinh t. cc nc cng nghip pht trin T type 2 chim 70-90%
tng s bnh nhn b T. Tuy nhin c s khc nhau v t l mc bnh gia cc vng
lnh th.
Theo s liu cng b ti hi ngh T thng 12 nm 1997 ti Singapore cho
thy s bnh nhn b T 10 nc in hnh nh sau: Tn nc S bnh nhn T 1995
(triu) S bnh nhn T 2025 (triu) n 19,4 57,2 Trung Quc 16,0 37,6 M
13,9 21,9 Nga 8,9 12,2 Nht 6,3 8,5 Indonesia 4,5 12,4 Brazil 4,9
11,6 Mexico 3,8 11,7 Pakistan 4,3 14,5 Ukraine 3,6 8,8 Theo thng k
v t l b T Trung Quc cho thy t l ngi mc bnh tng ln r rt: nm 1986 c
trn 1%; nm 1994 c 2,5%. Nh vy bnh T Trung Quc tnh t nm 1986 n 1994
tng 300% [13] Theo P. Zimmet 2001 t l T ngi >25 tui c l 7,5%;
ngi 20% glucid: khng n. - Vitamin v cc vi cht khc
N 25Kcal/kg 30Kcal/kg 40Kcal/kg
i vi ngi bnh T, trong ch n cn c bit ch vic bi ph kali, mt cht in
gii thng c nng thp nhm ny. Kali thng c hm lng cao trong cc thc n nh
c bin. Ngc li, nn hn ch natri. Rau qu ti c nhiu vitamin, l loi thc
phm c sn nc ta. e. Phn b ba n Phn b thc n vo cc ba cho ngi bnh nhm
mc ch duy tr hm lng glucose trong mu tng i n nh, khng xy ra tng
glucose mu t ngt sau n; trnh h glucose ban m, trnh hin tng Somogyi
vo bui sang (tng glucose mu th pht sau h ng mu). Trong thc t, ngi
bnh vn duy tr 3 ba n chnh l ba sng, ba tra, ba ti, cn vic thc hin
cc ba ph vo gia bui sng, gia bui chiu nhiu khi kh thc hin
mt s i tng, ba n nh trc khi i ng l cn thit v trnh c tai bin h
glucose mu ban m v hiu ng Somogyi vo bui sng hm sau. f. Ch luyn tp
Ch luyn tp cn theo nhng nguyn tc c bn: - Phi coi luyn tp l mt bin
php iu tr, phi thc hin nghim tc theo trnh t c hng dn. - C s phn bit
v mc v hnh thc luyn tp gia ngi bnh T typ 1 v T typ 2. - Luyn tp phi
ph hp vi la tui, tnh trng sc khe v s thch c nhn. - Nn tp nhng mn rn
luyn s do dai bn b hn l nhng mn cn s dng nhiu th lc. Nhng vic cn lm
trc khi luyn tp Phi nh gi tnh trng ngi bnh trc khi luyn tp v: - C
ngi bnh T typ 1 v typ 2, c bit ngi bnh T typ 2, u c t l bin chng v
bnh l tim mch cao. Nhng bnh mch vnh ngi bnh T li thng khng c triu
chng lm sng. - Nhng ngi c bnh mch vnh thng tng nguy c b bin c tim
cp tnh hoc ngay sau khi luyn tp. - Tin hnh nghim php luyn tp khng
xm nhp trc khi bt u chng trnh luyn tp c th c s dng ngi bnh nh mt
test nh gi nguy c tim mch, t a ra cc khuyn co luyn tp c th. - Cc yu
t nguy c truyn thng, nh bnh thn kinh t ng, bnh mch mu ngoi vi l cc
yu t d bo quan trng ca nguy c tim mch ca ngi bnh i tho ng. Cc ch s
cn thu thp, nh gi, theo di - nh gi s kim sot glucose mu. - C hay
khng cc bin chng ca T. - Tnh trng tim mch, huyt p, tr nh.
- Tnh trng bn chn v tun hon ngoi vi. - Tnh trng y mt. - Hng dn
ngi bnh t theo di trc v sau khi luyn tp. - Cn lu theo di ngi cao
tui b mc T typ 2 khi luyn tp v nhm i tng ny thng c nhiu bnh tim n i
km. Do vy phi thm khm k thit lp ch luyn tp ph hp. Ngi cao tui thng
ch c tng glucose mu nh, ch cn iu chnh bng ch n v ch luyn tp l a nng
glucose mu tr v bnh thng. Trng hp ny t khi xy ra h glucose mu khi
luyn tp. Ngi T typ 2 luyn tp nhm t c tc dng iu chnh glucose mu thng
qua vic lm gim tnh trng khng insulin nh: + Gim cn nng, nht l nhng i
tng tha cn, bo ph. + Gim khng Insulin. t c mc ch ny hng ngy phi
luyn tp khong 30- 45 pht, mi tun tp t nht l t 4 n 5 ngy. g. Thuc iu
tr trong i tho ng typ 2 Mc ch iu tr bng thuc trong T typ 2 nhm: -
Gim cn nng (vi ngi bo) hoc khng tng cn (vi ngi khng bo). - Duy tr c
lng glucose mu khi i, glucose mu sau n gn nh mc sinh l, t c mc
HbA1c l tng, s gim c cc bin chng c lin quan n T, gim t l t vong do
T. Nguyn tc - Dng thuc phi kt hp vi ch n v luyn tp. - Phi phi hp iu
tr h glucose mu, iu chnh cc ri lon lipid, duy tr s o huyt p hp l,
chng cc ri lon ng mu - Khi cn thit th phi dng insulin. Vic la chn
thuc iu tr i tho ng typ 2 c nu nh sau:Hnh 4
Thuc ung iu tr T g. S dng thuc h glucose mu Ngy nay ngi ta ch nh
thuc theo mc tiu a lng glucose mu nhanh chng v mc sinh l v nhanh
chng t mc HbA1c 6,5. C th l: - Nu mc glucose huyt tng lc i >
13,0mmol/l v mc HbA1c >9,0 c th dng ngay cc thuc vin phi hp. Sau
3 thng kim tra li nu HbA1c vn cao c th xt phi hp vi insulin a HbA1c
v 6,5. - Nu mc glucose huyt tng lc i > 15,0mmo/l v mc HbA1c >
9,0 c th dng ngay insulin n c hoc phi hp vi cc thuc vin h glucose
mu. - Khi lng glucose huyt tng lc i > 10mmol/l, d ngi bnh c pht
hin ln u vn c th ch nh dng phi hp ngay cc thuc vin nhanh chng h mc
glucose mu. 1.1.7. Lch theo di v cc ch tiu cn nh gi ca ngi bnh i
tho ng y l iu c bit quan trng, bi v: - Ngi thy thuc lm sng d c kinh
nghim n bao nhiu i na cng khng th dng kinh nghim thay th cc chn on,
nht l cc bin chng, thng ch pht hin c nh cc thm d bng phng tin k
thut cao. - Bnh cng c pht hin sm cc tn thng, can thip kp thi cng em
li hiu qu tch cc, chi ph s c tit kim. y cng chnh l phng php phng
bnh tch cc, chi ph s c tit kim. y cng chnh l phng php phng bnh tch
cc- phng cc bin chng. Ngc li, ngi bnh cng c bin chng nhiu, bin chng
nng, chi ph cho vic thm d cng tn km nhng hiu qu can thip li hn ch.
y cng chnh l nguyn nhn ngi ta khuyn co nn gi ngi bnh T ln u c pht
hin n nhng trung tm iu tr c kinh nghim nht. - To ra thi quen cn
thit cho c ngi bnh v thy thuc theo di, nh gi cht ch tnh trng ngi
bnh. 1.1.7.1. Theo di thng qui
- Nhng theo di nh k v sinh ha: iu chnh cc ch s v glucose, lipid,
ng mu cho c ngi T typ 1 v typ 2. - Glucose huyt tng lc i: c th lc u
mi thng mt ln. Khi n nh c th 3 thng mt ln. Trng hp c bit (mc bnh cp
tnh hoc sau phu thut,) nh lng glucose mu theo ch nh ca bc s. -
Creatinin, ure huyt tng thng c lm cng vi glucose huyt tng lc i. -
Cc thm d chc nng gan nn c tin hnh trc, trong v sau mt thi gian s
dng thuc mi. - HbA1c: l ch s nh gi kt qu qun l lng glucose mu trung
thnh nht. Buc phi lm 3 thng/ln, nu khng c iu kin th 6 thng/ln. Nhng
c s cha c HbA1c c th thay bng theo di lng glucose huyt tng. Trong
trng hp ny mc glucose huyt tng lc i phi lun bng v/hoc thp hn
6,0mmol/l. - Microalbumin niu: phi c thm d ngay khi mi pht hin bnh
(vi ngi T typ 2) v thng sau 3- 5 nm (vi ngi T typ 1). Sau hng nm
phi c kim tra li ty theo ch nh ca thy thuc. - ngng tp tiu cu: c
theo di khi c ch nh dng cc thuc nh aspirin, asperic v cc thuc chng
ng mu khc. Thng 3 thng mt ln. - Cc ch s v lipid mu thng 3- 6 thng
mt ln. Trng hp c bit ch nh theo tnh trng ngi bnh v nhu cu iu tr.
1.1.7.2. nh gi h thng hormon i lp Thng 1 nm mt ln. 1.1.7.3. Nhng
thm khm nh k khc - Khm bn chn ngi i tho ng Khm lm sng (s dng dng c)
thng nh gi tnh trng chung nh nhit , tnh trng mch mu, tnh trng thn
kinh cm gic, thn kinh vn ng. + Khm ln u tin
+ Sau 3- 6 thng/ln S dng cc k thut thm d khc nh gi tnh trng mch
mu v thn kinh + nh k 1 nm/ ln. - Khm y mt: Ngi T typ 1thng c bin
chng y mt sau 5 nm bnh c pht hin, cn ngi T typ 2 th thng c ngay ti
thi im pht hin. Ngi ta cng chia ra lch khm y mt ty theo mc bnh. y
ch qui nh cho ngi T cha c bin chng vng mc + Khm lm sng 6 thng/ln vi
ngi c pht hin bnh di 5 nm; 3 thng/ln vi ngi t 5 nm tr ln. + Chp y
mt thng t 6 n 12 thng/ ln. Ty theo mc tn thng lm sng. - Thm d nh gi
chc nng h tim mch: + Ty theo tnh trng ngi bnh c th phi lm bt k lc
no nu ngi thy thuc thy cn. + Nhng theo di nh k: . in tim: thng 3
thng/ln . Theo di s o huyt p, phi lm thng xuyn. Nn hng dn ngi bnh
bit cch t theo di s o huyt p v nhng thay i c th cm nhn c do s thay
i ca huyt p gy ra. - Chp xquang tim phi thng 6 thng/ ln cng vi xt
nghim v cng thc mu, tc mu lng. - Kim tra, nh gi ti liu, theo di ch
n ung, ch luyn tp, o ch s khi c th thng 6 thng/ln. 1.2. Tnh hnh
nghin cu trong v ngoi nc: 1.2.1. Nghin cu trn th gii: Rodger W
trung tm T Lawsn London cho rng vic theo di T typ 2 bao gm khm bc
s, tip cn vi vic gio dc cho ngi bnh, t kim tra H, ng niu thng xuyn
v nh lng HbA1C nh k [26].
Nghin cu ca Arfken CL v cng s Missouri (M) cng chng minh Vic iu
tr tng cng c th ngn cn s pht trin v tin trin ca cc bin chng T. Vi
cc chng trnh iu tr tng cng trong 10 nm lm gim HbA1C trung bnh ca
662 bnh nhn T t 11,5% Hb (1979) xung 9% Hb (1989) [21]. Ty Ban Nha,
chng trnh gio dc t kim sot H ti nh gip cho 65% bnh nhn T gim cc ri
lon chuyn ha, gim H v gim HbA1C. Nghin cu UKPDS ti Anh, 4209 bnh
nhn T typ 2 mi c chn on, chia lm 2 nhm nghin cu: nhm iu tr theo ch
iu tr tch cc v nhm iu tr theo ch iu tr thng quy, theo di trong
khong thi gian trung bnh 11 nm. Kt qu nghin cu cho thy: nhm iu tr
tch cc t c kim sot H tt vi nng HbA1C l 7% v nhm iu tr thng quy
HbA1C l 7,9%. Vi vic gim HbA1C l 0,9% so vi nhm iu tr thng quy, th
nhm iu tr tch cc gim c 25% bin chng mch mu nh. Theo nghin cu ca
Dalewitz thc hin ti M nm 2000 khi kho st nhng cn tr kim sot H trn
135 bnh nhn T tm ra: tui, s luyn tp, s hiu bit v bnh v s tun th iu
tr tng quan c ngha thng k vi s kim sot H [22]. 2.2.2. Nghin cu
trong nc: Nghin cu ca H Bch Thy thc hin ti Bnh vin Nhn dn Gia nh vo
nm 2001 vi 327 bnh nhn T ghi nhn t l bnh nhn c H i cha kim sot tt
chim 65% do bnh nhn khng ti khm u n v khng bit cch t theo di bnh
ung thuc tit ch [18]. Nghin cu kin thc, thc hnh phng chng bin chng
v mt s yu t lin quan ca ngi bnh T typ 2 iu tr ngoi tr ti Trung tm y
t Ba nh, H Ni nm 2004 ca on Khc Bo cho bit mi lin quan t l thun gia
hiu bit v thc hnh iu tr. V mc hiu bit t yu cu l 63,4%, vic thc hnh
iu tr ca bnh nhn cng ch t t l l 68,3%. Nh vy mun thc thnh tt trc ht
phi c kin thc tt v kin thc tt mi c nim tin ng v nim tin to sc mnh
cho thc hnh ng [2].
Nm 2003, nghin cu ca Nguyn Th Thanh Nga thc hin ti bnh vin Nguyn
Tri vi 138 bnh nhn T cho thy t l bnh nhn t mc kim sot H i trong gii
hn tt l 11,1% trong khi t l bnh nhn c mc H km chim n 50%. Nguyn nhn
kim sot H km do bnh nhn khng tun th iu tr: khng gi ng tit ch, khng
luyn tp th lc, khng s dng thuc theo y lnh [11]. Nm 2004, nghin cu
ca Nguyn Khoa Diu Vn thc hin ti bnh vin Ni tit Trung ng v khoa Ni
tit T bnh vin Bch Mai vi 338 bnh nhn T typ 2 ang iu tr ngoi tr. nh
gi hiu qu ca phng php iu tr tch cc hn ch cc yu t nguy c i vi bnh l
mch mu bnh nhn T typ 2 mi pht hin, ghi nhn t l THA sau iu tr u gim
r rt so vi trc iu tr c 2 nhm. Tuy nhin nhm tun th iu tr ch c 1,7%
BN T c THA mi xut hin trong khi nhm khng tun th iu tr c ti 7,7% BN
c THA mi xut hin [19]. Nghin cu kin thc, thc hnh phng chng bin chng
ca bnh nhn i tho ng typ 2 ti Thanh Min tnh Hi Dng ca Vn Hinh nm
2007 cho thy nhm c kin thc phng chng bin chng i tho ng khng t th t
l thc hnh t chim 13%, thc hnh khng t chim 87%. Trong khi nhm c kin
thc t t l thc hnh t chim 38% v khng t l 61,4%. T l ngi c kin thc
khng t th thc hnh khng t cao gp 4,2 ln so vi nhm c kin thc t. Qua
cho thy kin thc ca ngi bnh cng tt th thc hnh t cng cao [10]. Khu vc
thnh ph H Ch Minh, nghin cu tnh hnh qun l T phng khm bnh vin Nhn Dn
Gia nh, bnh vin Nguyn Tri Phng cho thy: nu bnh nhn tun th ch iu tr
th kim sot c H v hn ch c nhng yu t nguy c [17].
CHNG 2: PHNG PHP NGHIN CU 2.1. i tng nghin cu: Nhng ngi bnh b
bnh T typ 2 ang iu tr ngoi tr ti bnh vin Xanh pn, H ni, nm 2012.
2.2. Thi gian v a im nghin cu: - Thi gian nghin cu: t ../2012 n ./
2012 - a im nghin cu: Bnh vin Xanh pn, thnh ph H ni 2.3. Phng php
nghin cu: - M t ct ngang. 2.4. Mu v phng php chn mu: 2.4.1 C mu:
Ton b ngi bnh b i tho ng typ 2 ang iu tr ngoi tr ti bnh vin Xanh
pn, H ni. 2.4.2 Phng php chn mu: S dng phng php chn mu ton b ngi
bnh theo danh sch hin ang iu tr ngoi tr ti bnh vin xanh pn, H ni.
2.5. Tiu ch chn mu: -
Tiu ch a vo: Tt c cc ngi bnh T typ 2 ang iu tr ngoi tr ti bnh
vin Xanh pn, H ni, c chn on xc nh T theo tiu chun ca WHO 2001. ng
tham gia phng vn. Tiu ch loi tr: Ngi bnh khng ng tham gia nghin cu.
Ngi bnh c chn on T typ 2 nhng c ri lon tri gic khng ci thin (khng
th tr li cc cu hi thu thp). Ngi bnh qu gi khng th nghe r cu hi tr
li.
-
-
2.6. Phng php thu thp s liu:
K thut thu thp: thu thp s liu bng cch phng vn trc tip bng b cu
hi son sn. Cng c: phiu iu tra c son sn. Ngi thu thp: ch nhim ti v
cc cng s. Qun l d liu: ton b cc phiu sau khi thu thp s c kim tra
ngay v tnh y , logic ca cc thng tin c thu thp.
2.7. Phng php kim sot sai lch thng tin: Sai lch thng tin c th xy
ra do: B cu hi khng r rng, kh hiu. Ngi c chn nghin cu khng nh chnh
xc hay khng hiu cu hi nhng khng hi li. iu tra vin khi phng vn khng
din t ht ca cu hi lm ngi tr li khng tr li ng mc ch ca nghin cu. hn
ch nhng sai lch ny, bin php khc phc l:-
T chc iu tra th 20 b cu hi trn ngi bnh lm sng t b cu hi v pht
hin nhng vn cn sa cha. Gii thch r mc ch nghin cu v ku gi s ng h ca
TNC. Bn thn nghin cu vin tham gia trc tip thu thp thng tin >20%
i tng nghin cu. Nghin cu vin trc tip gim st trong sut thi gian thu
thp s liu. Hng dn tr li c th, chi tit ngay sau khi bt u phng vn.
Trc tip gii thch khi i tng iu tra c yu cu. Lm sch v m ha s liu trc
khi nhp s liu v phn tch. Chun b: kim tra li ton b cc phiu iu tra
thu thp c, loi tr cc phiu in khng y .
-
2.8. X l v phn tch s liu:
Bc 1 Nhp liu: Ton b s liu thu thp c nhp liu bng phn mm EpiData
3.0 Bc 2 Lm sch s liu: Sau khi hon tt nhp liu, cc s liu c lm sch
bng cch xem xt li ton b v hiu chnh cc sai st trong qu trnh nhp liu.
Bc 3 X l v phn tch s liu: Cc s liu sau khi thu thp, c tng hp v x l
bng phn mm SPSS 16.0 Thng k m t: Lp bng phn b tn s ca cc bin s.
Thng k phn tch: xc nh mi lin quan gia vic tun th iu tr vi cc c im
thng tin chung. S dng php kim 2 vi khong tin cy 95%, = 0,05
-
2.9. Cc bin s nghin cu: 1.9.1. nh ngha cc bin s trong nghin cu:
TT Bin s nh ngha bin Phn loi Cc thng tin c nhn ca i tng nghin cu: 1
Tui Thi im nghin cu tr nm sinh 2 3 4 5 Gii tnh Gii tnh ca i tng
tham gia nghin cu Lin tc Nh phn Phn Bng hi Bng hi Bng hi PPTT s
liu
Ngh nghip Cng vic hng ngy v to ra thu nhp chnh Trnh hc vn Thu
nhp
loi Trnh hc vn cao nht ca TNC t c ti Th thi im phng vn Tnh trng
kinh t (Q ca th tng chnh ph nm 2005). - H ngho: thu nhp bnh qun u
ngi < 200 nghn/thng - H khng ngho: thu nhp bnh qun u ngi 200
nghn/ thng hng Nh phn
6
Bo him y
Ngi dn c cha tr bnh khng phi mt
Nh phn Lin tuc
Bng hi Bng hi
t tin vi mc cho php ca bo him y t Cc bin s lin quan n bnh ca TNC
7 Thi gian Tnh theo n v nm t khi c chn on xc c chn on mc 8 bnh Tin
s gia nh v mc 9 bnh T Theo di v kim tra 10 ng mu Biu hin triu chng
bnh T 11 TTCT ang c p dng 12 Cc bin chng chnh ca T Nhng theo di nh
k v sinh ha: - Glucose huyt tng lc i: c th lc u mi thng mt ln. Khi
n nh c th 3 thng/ ln Triu chng lm sng c in: Cc triu chng rm r thng
t gp, tr giai on mt b, c 4 triu chng: n nhiu, st cn, i nhiu, ung
nhiu Ch iu tr ang c p dng nhm lm gim ng mu, bao gm 3 phng php phi
hp vi nhau : ch n ung, luyn tp, dng thuc L hu qu th pht qu trnh tin
trin ca bnh T gy nn, bao gm mt s bin chng chnh sau : - Hn m do tng
ng huyt - Hn m do h ng huyt - Nhim khun - Bnh l mch mu - Bnh l tim
mch Trong gia nh c ai b mc bnh T nh bnh n thi im nghin cu
Nh phn Nh phn Danh mc
Bng hi Bng hi Bng hi
Danh mc
Bng cu hi
Danh mc
Bng cu hi
- Bnh mt - Bnh l thn - Bnh thn kinh 13 Hiu bit yu t nguy c lin
quan 14 n TTT Hu qu bin chng T - Bnh l bn chn L nhng yu t thuc v
hnh vi li sng lm tng nguy c mc bnh cng nh l tng mc trm trng ca bnh
T nh bo ph, t hot ng th lc, ch n, stress... Nhng hu qu ca cc bin
chng T gy nn : - Hn m, t vong - Gim tui th - Suy gim tr tu - Tn tt
do m la, ct ct chi - Hn ch kt qu iu tr 15 Tun th ch iu tr - Tng chi
ph iu tr Bao gm cc bin php : - Khm kim tra bnh theo nh k - Thc hin
y lnh theo li khuyn ca CBYT - Kim sot cn nng - Luyn tp thng xuyn -
Kim sot ch dinh dng - Hn ch, loi b cc thi quen n ung xu (nhiu m,
nhiu ng, ung bia ru, ht 16 Thc phm cn trnh ca ngi thuc) L nhng thc
phm, tri cy c hm lng ga : bnh ko, tri cy ngt, nc ung ngt, ru Danh
Bng hi Danh mc Bng cu hi Danh mc Bng cu hi Danh mc Bng cu hi
ng cao, ung c cht kch thch, ung c mc
17
bnh T Hng dn
bia Ngi bnh c CBYT hng dn ch luyn
Nh phn Th hng
Bng hi Bng hi
ch luyn tp ph hp cho tng i tng bnh 18 tp Thi gian v Thi gian c
cc hot ng th lc nh : i b, i tn sut hot ng th lc do, lm vic ngoi
vn,) khong 20- 30 pht/ ngy. - Thng xuyn (hng ngy) - Thnh thong
(< 3 ln/ tun) 19 Ngun thng tin - Khng tham gia Ngun thng tin m
TNC c c kin thc: - i, bo, ti vi - Sch v, ti liu - Bn b, ngi thn -
Cu lc b i tho ng - CBYT
Danh mc
Bng hi
2.9.2. Bng thang im nh gi tun th ch iu tr ca ngi bnh T 2.9.2.1
nh gi kin thc v tun th iu tr bnh T STT Ni dung 1. Kin thc v tun th
iu tr bnh i tho ng: 1 Bit bnh T c nhng biu hin (triu chng) 2 Bit
bnh T c nguy him 3 Nu c, bnh T nguy him nh th no 4 Bnh T c cha khi
khng? 5 Mun bnh T c iu tr tt th phi tun 6 7 Kin thc ng Tng im 11
Chn 5/7 ng 1 Chn 1 1 Chn 2/2 ng 1 Chn 2 1 Chn 3/3 ng 1 1 1
th Bnh T nu khng kim sot tt s gy cc BC Chn 1 Nu c, bit nhng bin
chng ca T Chn 6/10 ng
8 9 10 11
Bit c hu qu ca bin chng i tho ng Bit cc bin chng ca T s xut hin
nhanh v trm trng hn Bit bin chng i tho ng c phng c Nu c, bit phng c
bin chng i tho ng phi thc hin * Cch nh gi:
Chn 4/6 ng Chn 4/6 ng Chn 1 Chn 5/6 ng
1 1 1 1
t khi 7 im Khng t < 7 im
2.9.2.2 nh gi thc hnh v tun th iu tr bnh T Thc hnh cho ngi bnh
T: Tng im 10 1 Thc hin cc bin php iu tr bnh T 2 Tun th ch n cho ngi
T 3 Ngi bnh T nn trnh n ung nhng loi 4 5 6 7 8 9 10 thc phm Tun th
ch luyn tp cho ngi T Thi gian luyn tp Tn sut luyn tp Dng thuc u Tun
th dng thuc T T iu tr thuc khc so vi n ca bc s Kim tra sc khe tng
qut hng nm * Cch nh gi:
Chn 3/3 ng Chn 1 Chn 1,2,4,8 Chn 1 Chn 2 Chn 1 Chn 1 Chn 1 Chn 2
Chn 2
1 1 1 1 1 1 1 1 1 1
t khi 7 im Khng t < 7 im
2.10. Kha cnh o c trong nghin cu: Nghin cu ny khng vi phm y c v
bo m cc nguyn tc c bn sau: Nghin cu ch tin hnh trn c s t nguyn tham
gia ca TNC. Khng lm tn hi tinh thn, th cht ca cc i tng tham gia
trong nghin cu. Tt c ngi bnh c chn vo mu nghin cu c thng bo trc v
gii thch v mc ch v ni dung nghin cu mt cch r rng. Khng tit l bt c b
mt
no v ngi c iu tra, ch nghin cu vin c php s dng thng tin v ch ph
bin thng tin khi c php ca i tng cung cp thng tin.-
Li ch ca kt qu nghin cu c s dng cho gio dc v cng ng. Nghin cu ch
tin hnh trn phm vi nhng ngi mc bnh T c ng k a bn mt bnh vin nn tnh
i din ca nghin cu b hn ch v mt phm vi ngoi suy kt qu nghin cu.
2.11. Hn ch nghin cu:-
-
Cng c nghin cu ch yu da vo b cu hi phng vn, ph thuc nhiu vo k
nng phng vn ca ngi hi v s tch cc tham gia ca ngi tr li. i tng nghin
cu c th tr li v hnh vi ca h khng nh hot ng thc t ca h. iu dn n nh
gi khng chnh xc mc ca vn .
CHNG 3: KT QU 3.1. c im bnh nhn trong mu nghin cu: 3.1.1. Thng
tin c nhn: Bng 1: M t c im chung ca i tng nghin cu Thng tin chung i
tng nghin cu Nam Gii tnh N 70 C BHYT Khng Tiu hc THCS Trnh hc vn
THPT TH chuyn nghip Cao ng, i hc Lm rung Bun bn CNVC Ngh nghip Hu
tr Ni tr Khc Thu nhp bnh H ngho H khng ngho qun hng thng Hon cnh
gia ang sng vi v/chng hoc con c than nh Ga Nhn xt: 3.1.2 Tin s bnh:
Bng 2: Tin s bnh Tn s T l (%)
Thng tin v tin s bnh
Phn nhm
Tn s
T l (%)
1. Di 1 nm 2. T 1 n 5 nm Thi gian mc bnh 3. T 5 n 10 nm 4. >
10 nm 1. Khm KTSK nh k 2. Khm v mt bnh khc Hon cnh pht hin 3. Ch ng
i khm khi c du bnh hiu nghi ng bnh T 4. Khc 1. 1 thng/1 ln 2. T 1 n
3 thng/1 ln Thi gian kim tra 3. T 3 n 6 thng/1 ln 4. > 6 thng/1
ln ng mu 5. Khng nh Tng Nhn xt: 3.1.3 Hiu bit v bnh:
225
100
3.1.3.1 Cc kin thc (KT) v biu hin bnh, s nguy him, s tun th: Bng
3: Kin thc v biu hin bnh Kin thc v cc biu hin ca T Kin thc v 1. Mt
mi nhiu 2. i nhiu cc biu hin 3. n nhiu ca T 4. Kht nhiu 5. Ung nhiu
6. i nhiu 7. Gy st cn 8. Khng biu hin g 9. Khng bit Nhn xt: Bng 4:
Kin thc v cch tun th iu tr Tn s T l (%)
Kin thc v cch tun th iu tr KT v 1. Thc hin ch n king cho ngi bnh
T 2. Luyn tp th lc tun 3. Dng thuc theo ch dn ca bc s th 4. Khng
bit iu tr 5. Khc Nhn xt: 3.1.3.2 Cc c im v bin chng ca T: Bng 5:
Bin chng ca T Cc bin chng ca bnh T 1. Hn m do tng ng huyt 2. Hn m
do h ng huyt 3. Nhim khun (ngoi da, h hp) 4. Bnh mt 5. Bnh tim 6.
Bnh thn 7. Bnh l bn chn 8. Bnh l mch mu 9. Bnh l gan 10. Bnh l thn
kinh Nhn xt: Bng 6: Hu qu ca bin chng bnh T Hu qu ca bin chng bnh T
1. Hn m, t vong 2. Gim tui th 3. Suy gim tr tu 4. Tn tt do m lo, ct
ct chi 5. Hn ch kt qu iu tr 6. Tng chi ph iu tr Nhn xt: Bng 7: Yu t
lm trm trng bnh Cc yu t lm trng bnh 1. Tui
Tn s
T l (%)
Tn s
T l (%)
Tn s
T l (%)
Tn s
T l (%)
2. C tng huyt p 3. C tng m mu 4. Khng tun th ch n ung 5. Ch luyn
tp khng hp l 6. T thay i ch dng thuc KT ng v cc yu t lm trm trng cc
BC Nhn xt: 3.1.3.3 Cch phng bin chng Bng 8: Cch phng bin chng Tn s
Phng bin chng Cch 1. Khm v kim tra bnh theo nh k 2. Thc hin y lnh
theo li khuyn ca CB y t phng bin 3. Kim sot cn nng chng 4. Luyn tp
thng xuyn 5. Kim sot ch n ung 6. Hn ch, loi b cc thi quen n ung xu
nh ung bia ru, ht thuc, n nhiu m,... Nhn xt: 3.1.4 Ch iu tr bnh
3.1.4.1. c im v hng dn C n, tun th C n, cc thc n cn trnh Bng 9: c
im v hng dn C n, tun th C n, cc thc n cn trnh c im ch n c hng 1. C
2. Khng dn ch n Tun th ch 1. Thng xuyn 2. Khng thng xuyn n Thc n cn
1. Bnh ko ngt 2. Nc ung ngt trnh 3. Tri cy c tnh cht t ngt: i, bi,
thanh long, ... 4. Tri cy ngt: Nho, mt, soi, ma ... Tn s T l (%) 1.
C 2. Khng T l (%)
5. Cc loi rau c qu 6. Go 7. Min 8. Ru bia Nhn xt: 3.1.4.2. c im
v hng dn ch luyn tp, tun th ch luyn tp, thi gian luyn tp, tn sut
luyn tp Bng 10: c im v hng dn CLT, tun th CLT, thi gian LT, tn sut
LT c im v ch luyn tp Hng dn ch luyn 1. C 2. Khng tp Tun th ch luyn
1.Thng xuyn 2. Khng thng xuyn tp 1. 20 pht/ ngy Thi gian luyn tp 2.
> 20 pht/ ngy 1. Hng ngy Tn sut luyn tp 2. 3- 5 ln/ tun 3. <
3 ln/ tun Nhn xt: Tn s T l (%)
3.1.4.3. c im v dng thuc, tun th dng thuc, t iu tr thuc khc Bng
11: c im v dng thuc, tun th dng thuc, t iu tr thuc khc Dng u Tun c
im dng thuc thuc 1. C 2. Khng Tn s T l (%)
1. Dng thuc theo n ca bc s th 2. Dng thuc theo n nhng khng u 3.
T iu tr dng thuc 4. B thuc T iu tr 1. C 2. Khng thuc khc Nhn xt:
3.1.5. Thng tin truyn thng: Bng 12: Ngun thng tin truyn thng nhn
c
Ngun thng tin c c 1. T ngi bnh khc 2. TV, loa, i pht thanh 3.
Sch, ti liu su tm 4. T cu lc b T 5. Cn b t vn, iu tr 6. Khng bit/
khng tr li Nhn xt:
Tn s
T l (%)
Bng 13: Nhng yu cu v t vn, tuyn truyn phng bnh T Nhng yu cu v t
vn, tuyn truyn phng bnh T 1. Tng hnh thc t vn (in thoi, thu, hi tho
nhm...) 2. Thm ti liu (sch nh, t ri, mu thc n...) 3. Tng thi gian t
vn (thi gian/ ln, s ln/ thng, ... 4. Ci tin cht lng thng tin (d nh,
d c, d hiu ...) 5. Khng c nhu cu t vn Nhn xt: Tn s T l (%)
Bng 14: Nhng phng tin truyn thng mong mun c nhn nht Phng tin
truyn thng mong mun c nhn nht 1. T ngi bnh khc 2. TV, loa, i pht
thanh 3. Sch, ti liu su tm 4. T cu lc b T 5. Cn b t vn, iu tr 6.
Khng bit/ khng tr li Nhn xt: Bng 15: Nhng kh khn trong vic tun th
iu tr bnh Nhng kh khn trong vic tun th iu tr bnh 1. iu kin lm vic
2. iu kin kinh t 3. iu kin sinh hot 4. Kh thay i thi quen 5. Tm l
thiu t tinh khi phi c Nhn xt: Tn s T l (%) Tn s T l (%)
3.2. Phn tch mi lin quan gia KT, TH v TTT bnh T vi cc c im ca
bnh nhn: 3.2.1. Mi lin quan gia KT v TTT bnh T vi cc c im ca BN Bng
16: Kt qu phn loi kin thc KT ng v tun th iu tr T Khng t t Tng Nhn
xt: Tn s T l (%)
Bng 17: MLQ gia gii tnh vi KT v tun th ch iu tr bnh T Kin thc v
tun th iu tr T Khng t t N Nam Tng cng Nhn xt: Bng 18: MLQ gia nhm
tui vi KT v tun th CT bnh T Kin thc v tun th iu tr T Khng t t 70
tui Tng cng Nhn xt: Bng 19: MLQ gia ngh nghip vi KT v tun th CT bnh
T KT v tun th iu tr T Khng t t Ngh nghip Lao ng chn tay Lao ng tr c
Hu tr/ni tr/khc Tng cng Nhm Tng cng Tng cng
Tng cng Nhn xt: Bng 20: MLQ gia hc vn vi KT v tun th CT bnh T KT
tun th CT bnh T Khng t t M ch Cp 2 vn > Cp 2 Tng cng Nhn xt: Bng
21: MLQ gia thu nhp vi KT v tun th CT bnh T KT v tun th CT bnh T
Khng t t H khng ngho H ngho Tng cng Nhn xt: Bng 22: MLQ gia thi
gian mc bnh vi KT v tun th CT bnh T KT v tun th CT bnh T Khng t t
Thi gian mc Di 1 nm 1 5 nm 5 10 nm > 10 nm Tng cng Tng cng Hc
Tng cng
bnh Tng cng Nhn xt: 3.2.2. MLQ gia TH v tun th iu tr T vi cc c
im Bng 23: Phn loi kt qu TH tun th iu tr bnh T TH ng v tun th iu tr
T Khng t t Tng Tn s T l (%)
Nhn xt: Bng 24: MLQ gia gii tnh vi TH v tun th CT bnh T TH v tun
th iu tr T Khng t t N Nam Tng cng Nhn xt: Bng 25: MLQ gia nhm tui
vi TH v tun th CT bnh T TH v tun th iu tr T Khng t t 70 tui Tng cng
Nhn xt: Bng 26: MLQ gia ngh nghip vi TH v tun th CT bnh T TH v tun
th iu tr T Tng cng Khng t t Lao ng chn tay Lao ng tr c nghip Hu
tr/Ni tr/Khc Tng cng Nhn xt: Bng 27: MLQ gia hc vn vi TH v tun th
CT bnh T TH v tun th ch iu tr Khng t t Hc vn M ch Cp 2 Cp 2 Tng cng
Ngh Nhm Tng cng Tng cng
Tng cng Nhn xt: Bng 28: MLQ gia thu nhp vi TH v tun th CT bnh T
TH v tun th ch iu tr T Khng t t H khng ngho H ngho Tng cng Nhn xt:
Bng 29: MLQ gia BHYT vi TH v tun th CT bnh T TH v tun th ch iu tr T
Khng t t Khng C Tng cng Nhn xt: Bng 30: MLQ gia thi gian mc bnh vi
TH v tun th CT bnh T TH v tun th ch iu tr T Khng t t Thi gian mc Di
1 nm 1 5 nm 5 10 nm > 10 nm Tng cng Tng cng Tng cng
bnh Tng cng Nhn xt:
CHNG 4: BN LUN 4.1. c im bnh nhn trong mu nghin cu: 4.2. Kin thc
ca ngi bnh v s hiu bit v bnh i tho ng 4.3. Kin thc ng v ch iu tr
bnh 4.4. Ngun thng tin v truyn thng: 4.5. Mi lin quan gia thc hnh v
tun th iu tr bnh i tho ng vi c im bnh
CHNG 5: KT LUN 1. c im chung: 2. S nhn bit v thc hnh ca bnh nhn
v tun th iu tr bnh T: 3. Mi lin quan gia kin thc v thc hnh vi vic
tun th iu tr bnh T
CHNG 6: KHUYN NGH
TI LIU THAM KHO TI LIU TING VIT
PH LC Ph lc 1: Phiu phng vn PHIU PHNG VN NGI BNH I THO NG TYP 2
ANG IU TR NGOI TR V S TUN TH CH IU TR BNH I THO NG M bnh nhn: H v
tn bnh nhn: ............................................... Gii :
1. Nam 2. N
Nm sinh : a ch:
..........................................................................................................................
Cn b iu tra:
.............................................................................................................
Ngy phng vn: ........... thng ...... nm 2009 STT Ni dung cu hi Thng
tin c nhn C1 Ngh nghip Phng n tr li 1. Lm rung 2. Bun bn 3. CNVC 4.
Hu tr 5. Ni tr C2 Hc vn 6. Khc 1. M ch 2. Tiu hc 3. THCS 4. THPT 5.
TH chuyn nghip C3 Thu nhp bnh qun hng thng 6. i hc 1. H ngho 2. H
khng ngho Ghi ch
C4 C5
C BHYT Tnh trng bn thn
1. C 2. Khng 1. ang sng vi v/chng hoc con 2. c thn 3. Ga 4.
Khc.
Tin s bnh C6 Thi gian ng/b c chn on mc bnh vo ngy thng C7 nm no?
ng/b c pht hin bnh T ln u tin trong hon cnh no?
././. (ngy/thng/nm) 1. Khm kim tra sc kho nh k 2. Khm v mt bnh
khc 3. Ch ng i khm khi c th c du hiu nghi ng bnh T 4. Khi c du hiu
khc thng
C8
5. Khc Trong gia nh ng/b c ai b mc 1. C bnh T ging ng/b khng? (b
2. Khng 1. 1 thng/1 ln 2. T 1 n 3 thng/1 ln 3. T 3 n 6 thng/1 ln 4.
> 6 thng/1 ln 5. Khng nh m, anh, ch em rut, cc con,...) Nu c l
ai? ng/b thng kim tra ng mu nh th no? (MT LA CHN)
Khng chuyn C10
C9 C10
Hiu bit v bnh C11 ng/b c bit bnh T c nhng
1. Mt mi nhiu
biu hin g? (NHIU LA CHN)
2. i nhiu 3. n nhiu 4. Kht nhiu 5. Ung nhiu 6. i nhiu 7. Gy st
cn 8. Khng biu hin g 9. Khng bit 1. C 2. Khng 1. C th gy cht ngi 2.
C th gy nhiu bin chng khc 3. Khc: ....................... 1. C 2.
Khng 3. Khng bit 1. Thc hin ch n king cho ngi bnh T 2. Luyn tp th
lc 3. Dng thuc theo ch dn ca bc s 4. Khng bit 5. Khc 1. C 2. Khng
1. Hn m do tng ng huyt 2. Hn m do h ng huyt 3. Nhim khun (ngoi da,
h
C12 C13
Theo ng/b bnh T c nguy him khng? Bnh T nguy him nh th no?
Khng chuyn C14
C14
Theo ng/b bnh T c cha khi c khng?
C15
Theo ng/b mun bnh T c iu tr tt th phi tun th nhng ch g? (NHIU LA
CHN)
C16
ng/b c bit bnh T nu khng kim sot tt s gy cc bin chng khng? ng/b
cho bit nhng bin chng ca T l g? (NHIU LA CHN)
C17
hp) 4. Bnh mt 5. Bnh tim 6. Bnh thn 7. Bnh l bn chn 8. Bnh l mch
mu 9. Bnh l gan 10. Bnh l thn kinh C18 Theo ng/b hu qu ca bin chng
i tho ng l g? (NHIU LA CHN) 11. Khc: ............. 1. Hn m, t vong
2. Gim tui th 3. Suy gim tr tu 4. Tn tt do m lo, ct ct chi 5. Hn ch
kt qu iu tr 6. Tng chi ph iu tr C19 Theo ng/b cc bin chng ca T s
xut hin nhanh v trm trng hn khi no? (NHIU LA CHN) 7. Khc (ghi r):
............... 1. Tui 2. C tng huyt p 3. C tng m mu 4. Khng tun th
ch n ung 5. Ch luyn tp khng hp l 6. T thay i ch dng thuc C20 C21
Theo ng/b bin chng i tho ng c phng c khng? phng c bin chng i tho
ng, theo ng/b cn phi lm g? (NHIU LA CHN) 7. Khc(ghi r):
............. 1. C 2. Khng 1. Khm v kim tra bnh theo nh k 2. Thc
hin y lnh theo li Khng chuyn 22
khuyn ca nhn vin y t 3. Kim sot cn nng 4. Luyn tp thng xuyn 5.
Kim sot ch n ung 6. Hn ch, loi b cc thi quen n ung xu nh ung bia
ru, ht thuc, n nhiu m,... 7. Khc(ghi r):................ Ch iu tr
bnh C22 Hin nay ng/b ang thc hin cc bin php iu tr bnh T no sau y?
C23 C24 C25 1. Dng thuc 2. Ch n 3. Ch luyn tp Khng chuyn C17
(NHIU LA CHN) 4. Khc ng/b c c hng dn ch n 1. C cho ngi bnh T?
ng/b tun th theo ch n cho ngi T nh th no? Theo ng/b ngi bnh T nn
trnh n ung nhng loi thc phm no? (NHIU LA CHN) 2. Khng 1. Thng xuyn
2. Khng thng xuyn 1. Bnh ko ngt 2. Nc ung ngt 3. Tri cy c tnh cht t
ngt: i, bi, thanh long, ... 4. Tri cy ngt: Nho, mt, soi, ma ... 5.
Cc loi rau c qu 6. Go 7. Min 8. Ru bia 1. C 2. Khng 1. C 2.
Khng
C26
ng/b c c hng dn ch luyn tp cho ngi bnh T khng? Theo ng/b ch luyn
tp th lc c cn thit khng?
C27
C chuyn C29
C28
Ti sao ng/b li cho l tp luyn th lc l khng cn thit?
1. Khng c thi gian 2. Cho l cng vic hng ngy lm nhiu ri. 3. Khng
tr li 4. Khc 1.Thng xuyn 2. Khng thng xuyn 1. 20 pht/ ngy 2. >
20 pht/ ngy 1. Hng ngy 2. 3- 5 ln/ tun 3. < 3 ln/ tun 1.
Sulfonylurea 2. Insulin 3. Metflermin 4. c ch - glucosidase 5.
Thiazolidinedione 6. Benfluorex 7. Khc. 1. C 2. Khng 1. Dng thuc
theo n ca bc s 2. Dng thuc theo n nhng khng u 3. T iu tr 4. B thuc
1. Qun khng ung thuc 2. Khng mua c thuc 3. Cho l khi bnh 4. Khng
tin mua thuc 5. Khc : ..
C29 C30 C31
ng/b tun th ch luyn tp cho ngi T nh th no? Thi gian luyn tp ca
ng/b th no? Tn sut luyn tp ca ng/b
C32
Hin ti ng/b iu tr bnh T bng thuc g? (NHIU LA CHN)
C33 C34
ng/b dng thuc c u khng? ng/b tun th dng thuc T nh th no? (MT LA
CHN)
C chuyn C35
C35
L do ng/b b thuc? (MT LA CHN)
C36 C37
ng/b c t iu tr thuc khc so vi n ca bc s khng? L do ng/b dng thuc
khc (MT LA CHN)
1. C 2. Khng 1. Dng thuc theo n khng thy khi 2. Nghe ngi khc mch
bo 3. Dng thm thuc cho nhanh khi 4. Khc 1. C 2. Khng 1. 1 ln/ nm 2.
2 ln/ nm 1. T ngi bnh khc 2. TV, loa, i pht thanh 3. Sch, ti liu su
tm 4. T cu lc b T 5. Cn b t vn, iu tr 6. Khng bit/ khng tr li 1.
Tng hnh thc t vn (in thoi, thu, hi tho nhm...) 2. Thm ti liu (sch
nh, t ri, mu thc n...) 3. Tng thi gian t vn (thi gian/ ln, s ln/
thng, ... 4. Ci tin cht lng thng tin (d nh, d c, d hiu ...) 5. Khng
c nhu cu t vn 1. iu kin lm vic 2. iu kin kinh t 3. iu kin sinh hot
4. Kh thay i thi quen
Khng chuyn C38
C38 C39 C40
ng/b c kim tra sc khe tng qut hng nm khng? Nu c, ng/b kim tra sc
kho my ln trong mt nm Nhng kin thc trn ng/b c c t ngun thng tin no?
(NHIU LA CHN)
Khng chuyn C40
C41
ng/b c yu cu g cho cng tc t vn, tuyn truyn phng bnh T hin nay?
(NHIU LA CHN)
C42
Nhng vn g trong cng vic, sinh hot theo ng/b gy kh khn trong vic
tun th mi ch iu tr
(NHIU LA CHN) C43 ng/b mong mun c nhn nhng thng tin v phng v iu
tr bnh T t ngun thng tin no nht? (MT LA CHN)
5. Tm l thiu t tin khi phi c 1. T ngi bnh khc 2. TV, loa, i pht
thanh 3. Sch, ti liu su tm 4. T cu lc b T 5. Cn b y t t vn, iu tr
6. Khng bit/ khng tr li
XIN TRN TRNG CM N!
Ph lc 2: D tr nghin cu Ph lc 3: K hoch trin khai nghin cu K HOCH
TRIN KHAI NGHIN CU
Phi hp TT Ni dung hot ng Thi gian D kin 10/2011 a im Bnh vin
Thanh nhn Thc hin h tr/gim st 1 - Gp g, lien h vi lnh o v cc khoa,
phng chc nng ca Bnh vin Thanh nhn - To mi quan h vi Phng ban chc
nng. - Thng nht k hoch Ch nhim ti Thy Anh Thng nht c phng php v k
vic. hoch lm u ra/sn phm
lm vic vi lnh o, phng khm. Lin h thu thp cc s liu th cp: - Tm bo
co ti liu 2 v tnh hnh bnh T ca bnh vin Thanh nhn qua cc nm; - Thng
tin v bnh vin Thanh nhn 3 4 Gp g Lnh o cc bn v cc trng khoa ph trch
cc chng 5 trnh y t ang hot ng ti a phng tho lun tm vn y t a phng
Thng nht c - Hp nhm thng nht vn ca a bn thc 6 a, chia x thng tin
chung v phn nhm vn y t s can thip 7 - i kho st thc a, a bn c vn m
nhm thng nht Ngy Phn hin Ngy 22/09/2009 Trng H YTCC Hc vin N. AnhT.
AnhPhng Hu CBYT huyn vn nghin cu, rt ra bi hc kinh nghim v b xung
nhng thng tin CBYT huyn cn thiu Tm hiu thc trng v vn m thng nhm nht
Ngy BVK huyn Thanh 21/09/2009 Min Hc vin N. AnhT. Anh CBYT huyn Xc
nh v 11/2011 Bnh vin Thanh nhn Ch nhim ti Thy Anh Thu thp c cc thng
tin v tnh hnh bnh T v thng tin v bnh vin Thanh nhn
thng nht c vn sc khe u tin cn nghin cu
Hc vin N. AnhT. Anh
23/09/2009 chia thc
nghin cu
v
nhng kh khn, thun li ti a phng khi trin - Tng hp vit bo co - Thu
thp thm thng 8 tin, bng chng b khuyt v vn sc khe. khai nghin cu Hon
thnh c Trng H YTCC Hc vin N. AnhT. Anh CBYT huyn bo co thc a xc nh
vn sc khe u tin Hon thnh c bo co thc a Trng H YTCC Hc vin N. AnhT.
Anh CBYT huyn xc nh vn sc khe u tin trng 10 Gim st vn NC Ngy
8/10/2009 Trng H Hc vin N. AnhCB gim st, phng TSDH Thng qua vn NC
theo ng yu cu ca nh
T 24/09/2009 n 27/09/2009
T 9 -Vit, chnh sa li bn bo co 28/09/2009 n 02/10/2009
YTCC T. Anh 2. XY DNG V BO V CNG NGHIN CU 11 Lp k hoch xy ddng
cng. - Thu thp, nghin cu 12 cc ti liu lin quan. - Vit cng. 13 Hon
chnh cng. Ngy 17/10/2009 T 18/10/2009 H Ni n 21/11/2009 Ngy H Ni
22/11/2009 H Ni Ch nhim ti Thy Anh Hc vin N. AnhT. Anh Hc vin N.
Anh-
GV hng dn
K
hoch
xy
dng cng nghin cus
GV hng Thit k c dn cng cu GV hng Hon chnh dn cng np nghin
14
Np cng.
Ngy 23/11/2009 Ngy 30/11/2009
T. Anh Hc vin H Ni N. AnhT. Anh Hc vin H Ni N. AnhT. Anh CB gim
st, phng TSDH
Np cng ng thi hn
15
Bo v cng. Sa cha, hon thin cng sau bo v
16
