ISSN 1859 • 1663

8(1054) JPM 2017

TAP CHI Y HOC THI/C HANH • • •

JOURNAL O F PRACTICAL MEDICINE

KY NitM 72 NAM CACH MANG THANG TAM THANH CONG • m

Nam thur sau hai So 8 (1054) 2017. Bp Y te xuat ban Va Phat hanh hang thang

The 62nd year No. 8 (1054) 2017. Ministry of health publishes and releases monthly

T A P C H I

Y H O C THITC HANH

BO Y T E X U A T BAN JOURNAL OF PRACTICAL MEDICINE PUBLISHED BY MINISTRY OF HEALTH

Bo trudng Bo Y te Tong Bien tap

PGS. TS. Nguyen Th'j Kim Tien

Pho Tong Bien tap TS. Nguyen VTnh Hung

Thu ky Toa soan Ths. Bui Nam Trung

Ban Bien tap: GS. TS. Le Ngoc Trong GS. TS. Ngo Quy Chau GS. TS. Ha Van Quyet GS. TSKH. Nguyin Van Djp GS. TSKH. Ha Huy Khoi GS. TS. Trln Due Tho GS. TS. Nguyen Viet Ti ln GS. TS. Nguyen Anh Tri PGS. TS. Ngo Van Toan PGS. TS. Nguyin Quoc Tuan PGS. TS. Phan Van Tudng PGS. TS. Nguyin Thj Bich Lien PGS. TS. Luang Ngoc Khue PGS. TS. Trln Quy f udng PGS. TS. Pham Thuc Hanh TS. Vu Van Du TS. Nguyin Bao Nggc

Trinh bay: Nguyin Thai, Hai Yen

Toa soan: 138A Giang V6 - HN DT: 04.38460728; 04.37368092

Fax:04.38464098; E-mail: info@yhth.vn Banbientap@yhth.vn

Website: www.yhth.vn

Van phong dai dien phia Nam 109A Pasteur- Qua'n 1, TP. HCM

* Giay phep so: 108/GP-BVHTT Cap ngay 29-3-2001

ISSN 1859-1663

* Giay phep sua doi, bo sung thang ra 2 ky

s i : 256/GP-SDBS-GPHDBC ngay 7/6/2004

* In tai: Cong ty TNHH Thuang mai Djch vu In va Quang cao Phong Linh * In xong va nop luu chieu 8/2017

Gia 50.000d

• L E TH| CHlEN HA VAN NHLT

•HA TH| LIEN, DUONG HdNG THAI, HOANG TRUNG KIEN •PHAM VAN THANG, NGUYEN TH| HOAl THU, NGUYEN HONG SON

•PHAM QU6C BINH, NGUYEN TH| TRANG

•NGUYEN DiNH TAP, D U O N G T R Q N G NGHIA, NGUYEN TH| THU HA •NGUYEN THANH BINH

• L E MINH D U G DAM THI T U Y E T

•CHU HUYEN XIEM HUYNH THANH HUYNH

•DLPONG TH| NGAN, BUI TH| MY HANH, LE TRUNG THO, TA VAN TO •NGUYEN KHANH CHI, PHAM VAN MINH

•NGUY&N TH| PHOONG, NGUYEN NGOC CHAU

•TRAN TH| HAU, v u HGNG THANG, D6 THj THANH MAI, TROONG VAN HOP, NGUYiN CONG HUY, PHAN THANH DUONG, LE VAN QUANG •HA TH| THU TRANG, THAI DANH TUYEN, VU DUC DINH, VU HONG ANH •TO TH| MINH HANG, VO DUC DjNH, VU H6NG ANH •NGUYEN VAN THANG, NGUYEN THI VAN HdNG

M U C L U C S6 1054

=> Thuc trang va mot so yeu t i anh 6 huang d in quan ly chit thai ran y t ! tai Binh vien da khoa tinh Binh Phudc nam 2017 => K i t qua dieu tri benh viem gan virus B 9 man tinh blng Tenofovir tai Binh vien gang thep Thai Nguyen ^> Mo ta thuc trang thuc hien cac nhiim 12 vu, ky thuat dieu dudng ca ban va nhu cau dao tao lien tuc cua cac dieu duang lam sang tai Binh vi in Nhi Hai Duang nam 2016 => Tac dung cua bai thuic "Luc vi dja 16 hoang hoan gia vi" trong di iu tri rang kinh ca nang => Tac dung cua bai thuoc Sinh tan cam 19 lo am k i t hap Metformin trong dieu trj binh nhan dai thao dudng typ 2 => Dac diem lam sang binh nhan 22 Alzheimer giai doan cuoi => Thuc trang nguon nhan luc Binh v i in 26 da khoa huyin Quan Ba, tinh Ha Giang => Thuc trang va mot so yeu td anh 29 hudng den cong tac quan ly su dung thiet bi y te tai Binh v i in da khoa huyin D l k Glong, tinh B i k Nong nam 2016 => Nghien cuu ty l i cac typ ung thu bieu 32 mo tuyln vu theo phan loai cua To chuc Yte The gidi nam 2012

=> Nghien cuu dac diem lam sang roi 35 loan nuot d tre bai nao the co cung tai Binh vi in Phuc h l i chuc nang Ha Noi => Tien lugng gay xuang trong mudi 38 nam tdi blng mo hinh FRAX d binh nhan nu thoai hoa khdp goi => Dac diem lam sang va can lam sang 41 cua binh nhan ung thu dai trang ngang dugc dieu trj phau thuat tai Binh v i in K

=> Nghien cuu nong dp Protein C d binh 43 nhan xa gan

=> Gia tri cua bang diem SOFA trong 45 danh gia muc do nang cua v i im tuy cap

=> Danh gia mat dp xuang a b inh nhan 48 viem loet dai true trang chay mau

Y HOC THIJC HANH (1054) - SO 8/2017

•NGUYEN THI THUY, CAO THI THU HUYEN, NGUYEN H6NG DUONG, NGUYEN HOANG ANH, NGUYEN VIET NHUNG •NGUYEN THANH BIEN, PHAM THj QUYNH HOA •NGUYEN THI KlEU ANH, NGUYEN NHAT CAM •NGUYEN VAN HUU HAC VAN VINH •TA THU HUONG, TRjNH XUAN TRANG •NGUYEN THUY NGA TRUONG MANH DUNG • L E VAN KY, NGUYEN VAN HUNG, NGUYEN THI KHUYEN, NGUYEN CONG TRUNG • L E TRONG TU, NGUYEN PHU DAT, LUONG THI THU HlEN, LE THANH CHUONG •NGUYEN THI CAM VAN, NGUYEN THI THU PHUONG •LE TlEN CUONG, NGUYEN THj QUYNH HOA •Dd THI KIM TAO, NGUYEN D U C CHINH •NGUYEN P H U O N G SINH, NGUYEN THJ THANH MAI

.TRAN TU ANH, TRAN TRUNG KIEN •TRAN KHANH TO AN, NGUYEN THI VAN ANH, NGUYEN TRAN KIEN •HOANG NGOC HA, NGUYEN TIEN Q U Y E T , Dd MANH HUNG •NGUYEN VAN HONG, LE NGOC HUNG, PHAM HUU THUONG •VU THI KIM HAl, LUU THI BiNH, HOANG TRUNG KIEN •NGUYEN MINH NGUYET, NGUYEN DUC CHINH •TRAN CAO BINH, VO VAN TlEN

•TRAN THI MINH TAM, TRAN VAN VIET

•NGUYEN VAN HUNG, DOAN THU HA •NGUYEN THI THAM, TRAN CHIEN THANG

=> Phln tfch phan ung co hai cua thuoc trong dieu trj lao da khang ghi nhan tu he thing bao cao tu nguyen cua Viet Nam giai doan 2009 -2015

=> Ki t qua c l t tu cung hoan toan do u xa bang phiu thuat ndi soi tai Benh vien C Thai Nguyen

=> Thyc trang ki ln thuc ve tang huylt ap cua ngudi dan td 18-69 tuoi tai Ha Noi, nam 2016

=> Dac diem djch te hoc benh due thuy tinh the d ngudi tren 50 tuoi tai tinh Thai Nguyen

=> Ket qua dieu trj ngoai tru dai thao dudng typ 2 tai Benh vien C Thai Nguyen

=> Ket qua phuc hinh thao l ip tdng phln nen nhya tren ngudi cao tuoi dang co benh toan than tai Thanh pho Ha Noi nam 2016-2017

=> Moi lien quan giua bde Id hoa md mi ln djch d l u I n Ki67 vdi diem Gleason va khang nguyen dac hieu tuyen tien Met trong ung thu bi lu md tuyln tien Met

=> Can nguyen gay benh viem tuyen giap d p mu d tre em

=>Oac diem lam sang va ket qua lanh thuang sau nho rang ham d 75 benh nhan dai thao dudng type 2 tai khoa Rang Ham Mat Benh vien Bach Mai nam 2016- 2017

=> Thuc trang benh can thj hoc dudng va mot so yeu to lien quan d 78 hoc sinh tieu hoc tai thanh pho B lc Giang

=> Thuc trang phan loai chi t thai r ln y te tai Benh vien Xanh Pdn Ha 80 Ndi nam 2017

=> Ket qua phuc hoi chdc nang ban tay blng dieu trj ndi khoa k i t hop 84 tap van ddng theo chrrang trinh GRASP d benh nhan Met nda ngirdi sau nhoi mau nao

=> Danh gia tac dung dir phdng dau sau phau thuat cot song th l t lumg 87 cua Pregabalin phoi hgp celecoxib

=> Mot so dac diem lam sang va can lam sang cua benh nhan dai thao 91 dirdng typ 2 dieu trj tai phdng kham bac si gia dinh Mai Huong, Ha Ndi nam 2017

=> Nghien cdu lya chon ky thuat va k i t qua phau thuat qua 37 trirdng 93 hgp u Klatskin

=> Nhan xet mot so tac dung khdng mong muon cua thuoc lao phac do 97 IV (a) d i lu trj benh lao phoi khang da thudc

=> Nghien cdu m|t dd xuang blng phuang phap DEXA d benh nhan 99 viem khdp dang th lp tai Benh vien Trung uomg Thai Nguyen

=> Thuc trang tuan thu quy trinh thay bang thudng quy cua dieu dudng khoi ngoai tai Benh vien Da khoa Xanh Pdn nam 2017

=> Mot so y lu to l i ln quan tren binh nhan dai thao dudng typ 2 dang dieu tri ngoai tru tai Phdng kham Ndi t i l t, Benh vien Da khoa Dong Nai 2017

=>Dac di lm hinh anh ch in thiromg cot sing thl t lung tren phim chup 109 c l t Idp vi tinh tai Benh vien Da khoa tinh Hai Duang tu 4/2017 d i n 5/2017

=> Acinetobacter baumannii da khang phan lap tai Benh vien Phoi 112 Trung uang trong 3 nam tu 2014 d in 2016

=> Nghien cuu cac y lu to lien quan d i n k i ln thuc, thuc hanh phdng 114 bi ln chung cua ngudi b inh dai thao dudng type 2 d i lu trj tai Benh vien Da khoa thanh ph i Ha TTnh nam 2017

2 Y HQC T H V C HANH (1054) - SO 8/2017

•NGUYEN THANH TAM, BUI THI NGOC ANH, NGUYEN TH| VIET HA •NGUYEN THI THANH THUY, NGUYEN TH| VIET HA •DC T U Y E T MAI, NGUYEN KIM VIET •NGUYEN THI HOA, D U O N G MINH TAM •VU T H U Y D U O N G , HA HAI BANG, PHAM MY HOAl, PHAM MINH HUE, NGUYEN f H| HIEP TUYET •CHU TH\ THU HUONG, H6 S Y HUNG •VU NGOC VUONG, HOANG VAN LY, H6 VlET LONG •NGUYEN THI PHUONG, NGUYEN THj THUY •NGUYEN HOAl LINH, DUONG TRONG NGHI A, NGUYEN TH| THU HA •VUONG OiNH THUY, DUONG MINH TAM •NGUYEN HAI LAM, L E THE TRUNG •NGO VlET LOC, NGUYEN TH| HONG L Y •NGUYEN THI HUONG, TRAN CHIEN THANG

.TRAN TH| MINH TAM, TRAN VAN VIET •TRjNH VAN DU, H6 SY HUNG •PHAM HUNG TIEN, HA VAN NHU, PHAM THj THANH BiNH •NGUYEN THj THUY, NGUYEN KHAC DlEN •CAO THI ANH T U Y E T , NGUYEN VAN TUAN •PHAM HOANG TUAN, HUYNH THANH T R U N G • NGUYEN HOA NGAN, D U O N G N G O C ANH, HOANG TH| THU HOAI, T R U O N G MANH HA •NGUYEN TH| HONG NHAN. NGUYEN THI Y E N , NGUYEN PHAM Y NHI

•PHAM VU, D U O N G T R O N G NGHTA •NGUYEN VAN HAI, PHAM MANH HUNG, LE OiNHTUNG

=> Tim hieu mot so yeu to lien quan den tieu chay keo dai nhiem khuan 117 d tre em 6 - 2 4 thang tai Benh vien Nhi Trung aang

=> Dac diem djch te hoc va md hinh dj tat bam sinh dng tieu hda d tre 120 em tai Benh vien Nhi Trung ircmg

=> Dac diem mire do giai doan tram cam d benh nhan dieu trj ndi tru tai 122 Vien Sdc khde Tarn than

=> Dac diem loan than d benh nhan rdi loan phan Met cam xuc loai tram 124 cam dieu trj ndi tru tai Vien Sdc khde Tarn than

=> Ket qua va mot so yeu td anh hadng den ky thuat bam tinh trung 127 vao budng td cung tai Benh vien A Thai Nguyen

=> So sanh ket qua gay trirdng thanh noan bang GnRH agonist va 129 hCG tren benh nhan kich thich budng trdng blng GnRH antagonist

=>Danh gia tac dung phuc hoi chdc nang cot song trong didu trj hoi 131 chdng th l t limg do thoai hda d ngadi cao tuoi blng bai thudc Ddc hoat tang ky sinh ket hap vdi dien cham

=> Vai trd didu dadng trong cham sdc benh nhan loet da day ta trang 134 tai Benh vien Tue Tinh

=>Tac dung cai thien tarn van dpng cot song cua lieu phap kinh can 136 ket hap quyen ty thang tren benh nhan dau vai gay do thoai hda cot song cd

=> Dac diem roi loan cam xuc d giai doan khdi phat cua roi loan loan 139 than cap va nhat thai

=> Nhan thdc ve can thj hoc dirdng cua hoc sinh trung hoc ca sd tai 141 thanh phd Nam Djnh nam 2016

=> Nghien cdu tinh hinh sd dung djch vu kham chda benh tai tram y te 143 cua ngadi dan thj tran Phu Da, huyen Phu Vang, tinh Thda Thien Hue

=> Nghien cdu mot sd yeu td lien quan den chat lirang cupc song 148 ngadi benh dai thao dadng typ 2 tai thanh phd Ha TTnh nam 2017

=> Nhan xet hinh anh thoat vj dia dem cot song th l t lirng tren may 151 cpng hadng td 1.5Tesla tai Benh vien Da khoa Hai Daang

=> Dac diem chu ky kich thich budng trdng va ket qua chuyen phoi trd 154 lanh cac trirdng hap chuyen phdi taai khdng thanh cdng

=> Thyc trang quan ly benh nhan dai thao dadng ngoai tru va mot sd 156 yeu td anh hadng tai Benh vien Da khoa tinh Tuyen Quang nam 2016

=> Tac dung cua bai thudc "Y dT chi thong sda" trong dieu trj thieu sda 159 sau sinh

=> Mdc do t r im cam theo thang diem HAM - D d benh nhan rdi loan ca 161 the hda dieu trj tai Vien Sdc khde Tam than

=> Danh gia ket qua phlu thuat gay phdc hap go ma - cung tiep blng 163 he thong nep vit nhd

=> Danh gia ket qua dieu trj thoai hda cot song cd blng may keo gian 166 TM400 tai Phdng kham Da khoa Tradng Cao ding Y td Thai Nguyen

=> Oanh gia ndng dp dc che tdi thieu cua vi khuan phe cau, Hemophilus Influenzae, tu cau gay viem phdi nang d tre em tai khoa Nhi Benh vien Xanh Pdn

=> Tac dung phuc hdi van dpng d benh nhan nhdi mau nao sau giai doan cap cua bai thudc "Huydt phu true d thang"

=> Nghien cdu phan suit da tra lau lagng ddng mau dpng mach than trade dat stent d benh nhan hep ddng mach than dc xa vaa tai Vien Tim Mach Viet Nam

Y HOC T H U C HANH (1054) - SO 8/2017 3

•HOANG THj THU HUONG, PHAM Q U A N G C U

•BUI L E V I CHINH, DINH VAN

T H U C , D U O N G THJ H U O N G •NGUYEN TH| THANH HUYEN, TRAN CHIEN THANG

•TRAN CAO BINH, VU VAN TlEN

•PHAM Q U O C BlNH, NGUYEN VINH THANH

•TRAN THI DlEP HA, N G U Y E N f HI tAM, TRAN LE H6NG GIANG, NGUYEN THI MY DUYEN, PHAN THI HA DUYEN, T R U O N G ANH KIET, TRAN THI KHANH NGOC, BUI TH| MY HANH • L E HOANG LONG, BUI VAN GIANG, PHAM H6NG OUC •NGUYEN OUC TOAN, NGUYEN THj QUYNH HOA

•NGUYEN THj THU HANG, NGUYEN H6NG HA

•TRAN D U C QUAN, DAM THj BAO HOA

•NGO THj TRANG, DAM TH| BAO HOA, LE HAi Y E N , KHUC THI T U Y E T H U O N G •DANG THJ HOANG T U Y E N , NGHIEM HUU THANH, NGUYEN VAN C H U O N G

•NGUYEN DUY KHANH, NGUYEN QUANG T R U N G

•NGUYEN DiNH THUY, VO NHAT DINH, PHAM TLEN THANH, NGUYEN ANH DUONG, PHAN T R U N G DO • NGUYEN HOANG NGAN, TRAN HUY HOANG

•PHAN THANH NAM, VU MINH HAI, NGO VAN TOAN

.TRAN TH| THU VAN, NGUYEN f R U O N G NAM

•PHAM VAN TUY, NGO' QUANG D U O N G

=> Nghien cdu tac dung dieu tri cua dirge lieu sdi rang tren benh nhan thoai hoa khdp gdi

=> Thgc trang va mot so yeu to lien quan den mic, td vong do dudi nadc a tre em dadi 15 tuoi tai huyen Tuy Phadc - tinh Binh Binh

=> Danh gia sg thay doi nhan thdc cua ba me ve che do an cho con dadi 24 thang tuoi sau can thiep giao due tai huyen Thach Ha tinh Ha Tinh nam 2017

=> Thgc trang tuan thu dieu tri benh nhan dai thao dadng typ 2 dang dieu tri ngoai tru tai Phdng kham Ngi tiet, Benh vien Da khoa Dong Nai 2017

=> Tac dung cua bai thuoc "Tieu thgc hanh khi trd thap thang" trong didu tri hoi chdng roi loan lipid mau qua cac chi tieu lam sang

=> Tarn soat va danh gia tinh trang dinh dadng d benh nhan mdi nhap vien khoa Npi tieu hda - gan mat Benh vien Da Nang

=> Ket qua bade dau tidm tham phan id lien hgp dadi hadng dan C-arm trong didu tri dau r l than kinh cot song that lang

=> Mot sd yeu td lien quan tdi ngudn nadc gieng dao d ho gia dinh tai La Hien, huyen Vo Nhai, tinh Thai Nguyen

=> Ca lam sang: Ket qua bade ddu dng dung ndi soi trong phlu thuat bde tach idy ca lang rpng

=> Thgc trang hoat ddng quan ly ngadi benh tarn than phan liet dga vao cpng ddng tai tinh Yen Bai

=> Thgc trang stress d hoc sinh Tradng Trung hoc Phd thong Laang Phu - Phu Binh - Thai Nguyen

=> Oanh gia tac dung phuc hdi chdc nang van dpng cua phaang phap dai tradng cham va phaang phap hao cham tren benh nhan thoai hda cot song cd

=> Nghien cdu dac diem lam sang ung tha bieu md vay vung hong mieng

Danh gia ket qua dieu trj gay dau dadi xaang chay blng nep khda

=> Nghien cdu tac dung giam can, dieu chinh rdi loan lipid mau cua cao khd dai hoa bup giam (Hibiscus sabdariffa L.) tren thgc nghiem

=> K i t qua phau thuat chuyen gan chay sau dieu trj liet than kinh mac chung

=> Tac dung ha ap cua bai thudc "Bo than giang ap thang" theo quan diem hien dai hda y hoc cd truyen

=> Danh gia hieu qua phat hien ung tha trong djch mang phdi cua phaang phap due khdi te bao (Cell block) tai Benh vien Hdu nghj Viet Tiep Hai Phdng

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4 Y HOC T H U C HANH (1054) - SO 8/2017

.DINH SY MANH, TRAN SINH WONG, NGO XUAN KHOA •CHU THj PHUQNG MAI, NGUYEN THj VIET HA •NGUYEN THU HA, NGUYEN THI VIET HA, BUI VAN VIEN •VU THI TUE KHANH, DANG DUC KHANH TIEN, HOANG THI HAi HA, THAI THANH NAM •BUI VAN THANH, DAM TH| T U Y E T •NGUYEN THj THUY, TRINH XUAN TRANG, NGUYEN NHUOC KIM .TRAN TH| MINH TAM

•TRUONG NHUT KHUE, NGUYEN THANH Q U A N G

•BUI VAN KHANH, HOANG ANH TUAN, DUONG TH| T6 ANH .TRAN THI MINH TAM, NGUYEN THj NGOC LAN

•TRAN TH| THU VAN

.TRAN TH| THU VAN

.TRAN TH| THU VAN

•TRAN TH| THU VAN

•HOANG MINH D U C , L E T U HOANG •VU TRONG HANH, 0 6 T R U O N G THANH, L E TAN PHAT •NGUYEN THI HUONG, 0 6 GIA T U Y E N •NGUYEN VU THAI LIEN, L E THI HUONG, DAO THj HANG NGA •VU THI LOI, BUI THj TU QUYEN

• HOANG MINH DUC, LE TU HOANG •NGUYEN NHAT CAM, CHU THANH BACH •NGO VlET LOC, NGUYEN VAN TAM

=> Mot so dac diem nhan tr ie dau mat ngirdi Kinh 18-25 tuoi qua 226 nghien cdu tren anh ky thuat so chuan hoa

=> Dac diem lam sang, can lam sang viem tuy cap d tre em tai Benh 229 vien Nhi Trung irang

=> Nghien cdu dac diem lam sang, can lam sang va phan loai benh 232 nhan Thalassemia tai khoa Huyet hoc Benh vien Nhi Trung irong

=> Ghep giac mac xuyen tai Benh vien Ml t Sai Gdn: Thj lye sau mo 234 va sir toan ven cua manh ghep

=> Thyc trang ngudn nhan lye Benh vien A Thai Nguyen 237

=> Thyc trang kien thdc, ky nang kham chda benh blng y hoc co 241 truyen tai cac tram y te xa mien nui tinh Thai Nguyen

=> Thyc trang kien thdc, thai do ve phdng chong HIV/AIDS cua sinh 245 vien nam I Trirdng Dai hoc Ky thuat Y te Hai Dirang

=> Nghien cdu dac diem lam sang, can lam sang d benh nhan viem 248 nhiem vung ham mat do rang tai Benh vien Ml t - Rang Ham Mat Can The nam 2015-2017

==>Danh gia dau d ngirdi benh sau phau thuat md birdu giap dan 252 thuan tai khoa Ngoai tong hap Benh vien A Thai Nguyen nam 2017

=> Thyc trang hai long cua ngirdi benh ve ky nang giao tiep cua sinh 254 vien tai khoa Ngoai Benh vien Hdu nghj td thang 5 den thang 6 nam 2017

=> Dac diem thyc vat va dac tinh lam thuoc cua cay mot la (Thanh 259 thien quy)

=> Dac diem thyc vat, cdng nang chu trj, tac dung dirac ly va v l n de 260 bao ton cay thuoc giao co lam

=> Dac diem thyc vat, tac dung dirge ly va dng dung tren lam sang 262 cua cay ba kich

=> Dac diem sinh trirdng phat then va tac dung lam thuoc cua cay 263 dang sam

=> So sanh ket qua sdm gida phau thuat ngi soi va mo md dieu trj 265 ung thir tryc trang giai doan sdm

=> Ket qua phau thuat noi soi sau phuc mac lay sdi nieu quan 1/3 tren 267 tai khoa Phau thuat tiet nieu Benh vien Hdu nghj Viet Ddc giai doan 2014-2016

=> Nghien cdu mat do xirang va mot so yeu to lien quan d benh nhan 270 loc mang bung lien tuc ngoai tru

=> Danh gia mdc dp lo l ing cua tre td 6 den 11 tuoi trong kham - dieu 272 trj rang mieng va mot so yeu to lien quan

=> Thyc trang s in sang chi tra mot so djch vu ke hoach hda gia dinh 275 cua phu nd 18- 49 tuoi cd chdng tai huyen Viet Yen tinh B lc Giang nam 2017 va mot so yeu to lien quan

=> Danh gia ket qua sdm c l t cut tryc trang dieu trj ung thir tryc trang 278 blng phau thuat npi soi tai Benh vien Viet Ddc

=> Thyc trang kien thdc ve dai thao dirdng cua ngirdi dan td 18-69 281 tuoi tai Ha Npi, nam 2016

=> Nghien cdu nhiem vi rut viem gan B d phu nd ngirdi dan tpc H're 284 td 15 den 49 tuoi tai huyen Tir Nghla, tinh Quang Ngai

Y HQC T H U C HANH (1054) - S O 8/2017 5

do nang benh nhimg khdng co y nghTa thong ke vdi p 0,05. Con tai CXD thi su hirdng giam nay co y

ghia thdng ke vdi p < 0,05. Mot so nghien cdu cua ~c tac gia nirdc ngoai chang han nha Bundela va ;ng sy cung co ket luan tircrng ty vd sy lien quan

gi&a UC va giam MOX hay cua De silva va cong sy. Mac du van con nhidu nhdng quan diem chira thong nhat vd sy lien quan nay doc lap hay khong doc lap nhimg torn lai sy giam MDX la thirdng gap d nhdng benh nhan UC.

K E T LUAN Ty le mat do xacrng th lp pho bidn d benh nhan

viem loet dai trang chay mau tai Viet Nam. Do vay can toan dien hern trong qua trinh cham sdc va dieu trj benh nhan VLOTT chay mau de dy phdng loang xirang va cac bidn chdng.

TAI L I E U THAM K H A O 1. Thomas A. Judge and Gary R. Lichtenstein

(2003), Inflammatory bowel disease. Current diagnostic & treament in gastroenterology,. 2 n d Edition. McGraw-Hill, p. 108-130.

2. Krela-Kazmierczak, I., et al. (2015), The importance of vitamin D in the pathology of bone metabolism in inflammatory bowel diseases. Arch Med Sci, 11(5): p. 1028-32.

3. Nguyen Thj Thu Hien (2008), Nghien cu-u dac diim lam sang va can lam sang benh viem loet dai trang chay mau. Luan van thac sy y hoc Dai hoc Y Ha Npi.

4. Loftus E.V., et al. (2000), Ulcerative colitis in Olmstead county, Minnesota, 1940 - 1993. Incidence, prevalence and survival. Gut, 46: p. 336 - 43.

5. Aghazadeh, R., et al. (2005), Inflammatory bowel disease in Iran: a review of 457 cases. J Gastroenterol Hepatol, 20(11): p. 1691-5.

PHAN TICH PHAN 1>NG CO HAI CUA THU6C TRONG OIEU TR| LAO OA KHANG GHI NHAN Tl> HE THdNG BAO CAO T U NGUYEN

CUA VIET NAM GIAI DOAN 2009 - 2015

N G U Y E N THI T H U Y 1 , C A O THI T H U H U Y E N 2 , N G U Y E N H O N G D U O N G 2 , N G U Y E N H O A N G ANH 2 , N G U Y E N VlET N H U N G 1

1Benh vien Phoi Trung wang 2Trung tarn Dl & ADR Quoc gia, Truxyng Dai hoc Dirge Ha Ndi

TOM TAT Phan tich phan Cmg co hai cua thudc (ADR) sCr

dung trong diiu tri lao da khang (MDR-TB) tir he thing bao cao ti/ nguyen cua Viet Nam giai doan 2009-2015 da ghi nhan 144 bao cao tCr 15 don vi trong tdng sd 48 tinh, thanh phd dirge quan ly dieu tri MDR-TB trong ca node. Kit qua cho thiy cac ADR cua thuoc diiu tri lao da khang anh huong din hiu hit cac he co quan trong co thi. Cac biiu hiin ADR dirge ghi nhan nhiiu nhat bao gdm rii loan tieu hda (46,5%), rii loan da va to choc dodi da (21,5%), roi loan hi co xoong khdp (15,3%). Da so cac phan dng co hai doge xCr tri bing each tarn thdi ngdng thuic nghi ngo gay ADR (69,4%) hoac giam liiu thudc nghi ngd (5,5%). Phan Ion cac trodng hgp phan dng cd hai doge cai thien sau xd tri. Khdng ghi nhan doge trodng hgp nao to vong lien quan din ADR.

Td khoa: ADR, bao cao to nguyin, thudc khang lao, MDR-TB.

SUMMARY The aim of this study was to analyze the adverse

reactions of MDR-TB drugs recorded in the national spontaneous reporting system in the period of 2009 -

Chiu trach nhiem: Nguyin Thi Thuy Email: thuy_vl77@yahoo.com Ngay nhan: 23/6/2017 Ngay phan bien: 20/7/2017 Ngay duyet bai: 08/8/2017 Ngay xuit ban: 25/8/2017

2015. There were 144 reports from 15 healthcare units in 48 provinces where MDR-TB treatment system was set up. The results showed that ADRs of MDR-TB drugs affected almost body organ systems. The most frequently reported ADRs were gastrointestinal disturbances (46.5%), skin and subcutaneous disorders (21.5%) and musculoskeletal disorders (15.3%). Most adverse reactions were managed by temporarily discontinuing suspected drugs (69.4%) or dosage reduction (5.5%). Majority of adverse reactions have been improved after treatment. No ADR-related deaths has been identified.

Keywords: ADR, spontaneous reporting, anti-tubercular drugs, MDR-TB

O A T VAN O E Viet Nam n lm trong nhdm 27 quoc gia cd ganh

nang lao da khang thuoc cao nhat the gidi, xep thd 11/20 quoc gia cd so lirprig benh nhan MDR-TB nhieu nhat, chiem 1,7% so benh nhan tren toan cau. Phac do dieu trj lao da khang can phoi hyp nhieu thuoc cd dbc tinh cao, thdi gian dieu trj keo dai, lam tang kha nang xuat hien phan dng cd hai cua thuoc, bao gdm ca cac phan dng nghiem trpng, anh hirdng den tien liryng, giam tuan thu dieu trj, tang ty le that bai dieu trj va tir vong cho ngadi benh. Viec phat hien, danh gia, quan ly va truyen thdng nguy ccr lien quan den thudc ddng vai trd quan trpng trong thyc hanh lam sang. Bao cao ty nguyen phan dng cd hai cua thudc chu yeu diryc thyc hien bdi nhan vien y te la mot kenh bao cao d i thyc hien, it ton kern, cd kha

Y HQC THy'C HANH (1054) - SO 8/2017 51

nang phat hien nhdng ADR hilm gap va nghiem trpng, gop phan cung cap thong tin ve an toan cua thuoc. Tuy nhien, he thdng bao cao ty nguyen ton tai nhidu han che bao gdm bao cao thieu "under­reporting" ca vd sd liryng va chat liryng thong tin, do dd chira ho try hieu qua danh gia anh hirdng cua ADR den qua trinh dieu trj tren benh nhan. Ddn thdi diem hien tai, da lieu ve ADR cua thudc khang lao dayc ghi nhan td he thdng bao cao ty nguyen cua Viet Nam da dayc thdng ke trong mot sd nghien cdu nhang chaa cd nghien cdu tdng ket ve ADR cua thudc didu trj MDR-TB [1]. De tim hieu thyc trang phan dng cd hai cua thudc didu trj lao da khang tai Viet Nam, lam co sd cho viec tiep can cac phaang phap giam sat toan dien ADR cua thudc didu trj lao da khang, nghien cdu da dayc thac hien vdi muc tieu phan tich dac diem phan dng cd hai cua thudc didu trj lao da khang dayc ghi nhan td he thdng bao cao ADR giai doan 2009-2015.

0 6 l TUgNG VA PHUONG PHAP NGHIEN CUU 1. Doi tayng nghien cau Cac bao cao ty nguyen vd phan dng cd hai cua

thudc (bao cao ADR) cua thudc didu trj lao da khang da dayc tiep nhan, tham djnh va lau trd tai Trung tarn Dl & ADR Qudc gia td thang 1/2009 den 12/2015.

Tieu chuan lya chpn: dap dng 1 trong 2 tieu chuan sau:

+ Cd ly do sd dung thudc la: "lao da khang" hoac cac each dien dat khac cua cum td "lao da khang".

+ Cd mot trong cac thudc nghi ngd va/hoac thudc dung ddng thdi la: kanamycin, capreomycin, ethionamid, cycloserin, prothionamid va acid para-aminosalicylic (PAS).

Tieu chuan loai trd + Trong nhdng thudc benh nhan sd dung cd bao

gdm: isoniazid va/hoac rifampicin + Benh nhan cd chi djnh sd dung thudc vdi ly do

khac vdi "lao da khang". 2. Phaang phap nghien cdu Md ta hdi cdu dd lieu td cac bao cao ADR cua

thudc dieu trj lao da khang tai Trung tarn Dl & ADR Qudc gia.

Cac tieu chi dayc md ta bao gdm: + Thdng tin ve sd layng bao cao ADR So layng bao cao, ty le bao cao Dan vi. gai bao cao + Thdng tin ve ADR va thudc nghi ngd gay ADR Thudc lao nghi ngd daac ghi nhan trong bao cao

ADR Cac loai ADR dayc ghi nhan ADR phan loai theo he ca quan chju anh hadng Xa tri ADR va ket qua sau xd tri 3. X d ly so lieu Xd ly da lieu bdng chaang trinh Microsoft Excel

2010. Bieu hien ADR daac ma hda theo cap dp thuat ngd chuan cap cao (High-level terms) trong bp td dien thuat ngd ve phan dng cd hai cua thudc WHO-

ART. Cac thuat ngd md ta cac ADR xay ra tren cung mot he ca quan cua ca the daac xep vao mot nhdm Idn gpi la nhdm ca quan bj anh hadng (SOC), dya theo sy phan loai cua bp td dien thuat ngd WHO-ART. Cac bieu hien ADR dayc thdng ke theo ca hai cdp dp ma hda nay. Thdng ke cac bidn khdng lien tuc theo tan suat va ty le phan tram. Cac bien lien tuc daac trinh bay theo gia tri trung binh hoac trung vi.

K E T Q U A Sd layng bao cao ADR cua thudc dieu trj lao da

khang thu nhan doyc So layng bao cao ADR cua thudc dieu trj lao da

khang va ty le bao cao ADR/100 benh nhan dieu trj MDR-TB qua tdng nam trong giai doan 2009 - 2015 dayc trinh bay trong hinh 1. Cd the thay, sd layng bao cao ve ADR cua thudc trong dieu trj lao da khang tang len trong giai doan td nam 2013 - 2015 so vai giai doan 2009 - 2011. Khi xet tdi ty le bao cao tren tdng sd benh nhan dieu trj MDR-TB, ket qua cho thay dd lieu tang dot bidn trong nam 2010 taang dng vdi 23,7 bao cao/100 benh nhan; trong khi ty le nay taang ddi thap trong cac nam khac va trung binh deu dadi 3 bao cao ADR/100 benh nhan dieu trj MDR-TB.

Tinh den het nam 2015, mac du viec tiep nhan va dieu trj lao da khang da dayc thac hien tai 48 tinh, thanh phd tren khap ca nadc, Trung tarn DI&ADR Qudc gia chi nhan dayc bao cao ADR lien quan den thudc dieu trj lao da khang td 14 dja phaang (Ha Npi co 2 dan vj gdi bao cao la Benh vien Phdi Trung aang va Benh vien Phdi Ha Npi). Hinh 2 bieu dien sd layng gai bao cao ADR cua thudc dieu trj lao da khang td cac dan vj va ty le sd bao cao ADR/100 benh nhan dieu trj MDR-TB tai dan vj taang dng. Phan Idn cac bao cao lien quan den thudc dieu trj lao da khang dayc gai td Benh vien Pham Ngpc Thach (TP Ho Chi Minh) vdi 85 bao cao, chidm ty le 59% tdng sd bao cao. Tuy nhien, xet ve ty le bao cao trung binh/100 benh nhan, cac Benh vien Lao va benh Phdi Binh Djnh va Blc Giang la cac dan vj cd ty le cao nhlt.

2009 2010 2011 2012 2013 2014

56 luong bao cao A D R Dong dieu lao da khang thuoc

A Ty le sd bao cao A D R 100 benh nhan dieu tri lao da khane

Hinh 1. So laang bao cao ADR va ty le bao cao ADR/100 benh nhan dieu tri MDR-TB theo nam

52 Y HOC T H U C HANH (1054) - SO 8/2017

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oo TP. Binh C in Thanh p i Sot Bi t Tiy Ha Noi Ben Khanh As Thai Tien

HCM Dinh Tho Hoa Ning Trang Giang Ninh Tre Hoa Giasg Binh Giang

Solum? BC ADR — T y le sc bao cao ADR lOObenhnhan dieu tn lao da khang

Hinh 2. So lirang bao cao ADR va ty le bao cao ADR/100 benh nhan dieu trj MDR-TB theo dja phu'ong gm bao cao

Thong tin td cac bao cao ADR ciia thudc dieu tri lao da khang thu nhan dupe

Mot sd thong tin chung cua benh nhan gap ADR (tudi, gidi tinh) bao gdm: Do tudi trung binh cua benh nhan la 44,5 ± 14,7 (nam), benh nhan tre nhat trong nghien cdu la 16 tudi va cao tudi nhat la 87 tudi. Benh nhan nam chiem ty le 72,9%, ty le phan bd gidi la 2,7 Nam: 1 Nu.

Cac thudc nghi ngd gay ra ADR va ty le bao cao cua tung thudc dupe trinh bay trong bang 1. Prothionamid la thudc nghi ngd dupe bao cao nhieu nhdt vdi tuong ung 51 bao cao (35,4%). Cac thudc khac co ty le bao cao kha cao bao gdm pyrazinamid (30,6%), kanamycin (27,8%), levofloxacin (25,7%), cycloserin (23,6%) va ethambutol (18,8%).

Bang 1. Thong tin bao cao vd thudc dieu tri lao nghi ngd gay ADR

Thuoc nghi nga So lugng BC Ty le (%)(n = 144) Prothionamid 51 35,4 Pyrazinamid 44 30,6 Kanamycin 40 27,8

Levofloxacin 37 25,7 Cycloserin 34 23,6 Ethambutol 27 18,8

PAS 13 9,0 Ethionamid 8 5,6

Capreomycin 6 JA

Streptomycin 1 0,7 Amikacin 1 0 7 Ofloxacin 1 0 7

Moxifloxacin 1 0,7 Clofazimin 1 0,7

Thong tin ve dac diem ADR cua thudc dieu tri lao da khang thu nhan dupe

Cd 29 bieu hien ADR khac nhau dupe thu nhan. Tai bang 2 trinh bay ve 10 ADR dupe ghi nhan nhieu nhat trong m lu nghien cuu. ADR dupe thu nhan cao nhat la budn non, non (42 bao cao, chiem 29,2%). ADR dupe thu nhan nhieu thu hai la cac rdi loan ve da va td chuc dudi da (di ung da, ngua, ndi man), chiem 21,5% vdi 31 bao cao. Mot sd ADR cd ty le kha cao khac do la dau khdp (15,3%), viem gan (13,9%) va hoa mit , chong mat (12,5%).

Cac ADR ghi nhan dupe tir bao cao thuoc dieu tri lao da khang anh hudng den hau het cac he co quan trong co the, dupe trinh bay tai bang 3. Trong do, ty le bieu hien ADR dupe ghi nhan nhieu nhat la cac rdi loan he tieu hda (67 bao cao, chiem 46,5%), rdi loan da va td chuc dudi da (21,5%), rdi loan he co xuang khdp (15,3%), rdi loan gan mat (13,9%), rdi loan thinh giac va tien dinh (12,5%).

Bang 2. Thong tin vd cac ADR dupe ghi nhan nhieu nhat trong mau nghien cuu

Phan ung co hai So lugng BN Ty le (%) xuat hien ADR (n = 144)

Bubn non, non 42 29,2 Dj irng da, ngua, noi man 31 21,5

Dau khdp 22 15,3 Viem gan 20 13,9

Hoa mat, chdng mat 18 12,5 An kem/chan an 17 11,8

Tang creatinin huyet thanh 12 8,3 Tang acid uric huydt thanh 12 8,3

Roi loan tarn than 11 7,6 Tang bilirubin huyet thanh 9 6,2

Bang 3. Thong tin ADR xuat hien tren cac he ca quan

He co quan chiu anh hudng (SOC) Sd lugng Ty le (%) bao cao (n = 144)

Roi loan tieu hoa 67 46,5 Rdi loan da va to chuc dudi da 31 21,5

Roi loan gan-mat 23 16,0 Roi loan ca xuang khdp 22 15,3

Roi loan chung 22 15,3 Roi loan than kinh trung uong va 21 14,6

than kinh ngoai vi Roi loan thinh giac va tidn dinh 18 12,5

Roi loan he tiet nieu 13 9,0 Roi loan chuyen hda va dinh dudng 12 8,3

Roi loan tarn than 11 7,6 Roi loan ho hap 4 2,8 Roi loan thi giac 4 2,8

Rdi loan tieu hda dupe ghi nhan co lien quan nhieu nhat den cac thudc prothionamid 43,3% (29/67), pyrazinamid 20,9% (14/67), levofloxacin 14,9% (10/67), PAS 13,4% (9/67). Rdi loan he ca xuang khdp dupe ghi nhan co lien quan den cac thudc pyrazinamid 77,3% (17/22), ethambutol 13,6% (3/22), levofloxacin 9,1% (2/22).

Cd 77,8% (14/18) trudng hpp rdi loan thinh giac va tien dinh dupe danh gia co lien quan den kanamycin va 81,8% (9/11) trudng hpp gap rdi loan tarn than dupe ghi nhan cd lien quan den cycloserin.

Thong tin ve bien phap xu tri khi ADR xay ra va ket qua xu tri dupe trinh bay trong bang 4. Cach xu tri ADR phd bien nhat la tarn ngung thudc nghi ngd dupe ghi nhan d 100 trudng hop (69,4%), trong do cd 33 trudng hpp bd sung them thudc dieu trj trieu chung. Viec giam lieu dupe thuc hien trong 8 trudng hpp (5,5%), trong do co 2 trudng hpp phdi hpp vdi dieu trj trieu chung. Tuy nhien, v in con mot ty le khong nhd (6,9%) bao cao chua co thong tin ve viec xu tri phan ung.

Y HOC T H l / C HANH (1054) - SO 8/2017 53

Bang 4. Cach xi> tri ADR va ket qua xu tri ADR f^or^h vi'u t r ! A P l D

uacn xu in m u k So lipong bao Ket qua sau xir tri ADR

cao Hoi phuc (%) Dang hoi Chua hoi Knong co

Ngi>ng thuoc nghi nga {/o) phuc (%) phuc(%) thong tin (%)

Ngi>ng thuoc nghi nga 67 59 3 3 2 Ngi>ng thuoc nghi nga + dieu trj trieu churng 33 25 4 3 4 1

Giam lieu 0 3 2 0 4 u i d m lieu + aieu iri irieu cnuTig £ n u 2 0 n u

Dieu trj trieu chung 22 6 1 2 13 Them thuoc dieu tri ho tro 3 0 2 1 0

Theo ddi them 1 0 0 0 1 Khong co thong tin 10 0 0 0 10

Tong 144 (100,0%) 93 (64,6%) 14 (9,7%) 9 (6,3%) 28 (19.4%)

Phan Idn cac trudng hop phan dng cd cai thien sau xi> tr:: khong cd benh nhan tut vong lien quan den ADR, benh nhan hoi phuc chiem 64,6% va dang hoi phuc chidm 9,7%. Ngoai ra, co 19,4% so bao cao con bo trong trudng thong tin nay.

B A N L U A N Nghien cdu nay dupe thuc hien tren du lieu bao

cao ADR tu nguyen trong vong 7 nam (tu nam 2009 d in 2015) nham cung c lp mot hinh anh toan dien ve tinh hinh bao cao ADR lien quan den cac thudc dieu tri lao da khang, nhung thuoc cd ddc tinh cao nhung khdng cd nhidu lua chpn thay thd trong didu tri. Trong giai doan tren, Trung tarn Dl & ADR Qudc gia da ghi nhan tong so 144 bao cao ADR ve thuoc dieu trj lao da khang, tuang ung vdi 2,4 bao cao ADR/100 benh nhan MDR-TB. Ty Id bao cao co xu hudng tang d i n trong nhung nam gan day nhung van con d muc thlp. Khi so sanh con so nay vdi ket qua thu dupe trong cac nghien cuu khac, ty Id ADR ghi nhan theo phuang phap bao cao tu nguydn con rat khidm tdn. Trong tong quan he thdng va phan tich gdp vd phan ung cd hai lien quan den dieu tri lao da khang cua chung tdi dupe cdng bd trudc do, ty Id xult hidn it nhat 1 bien co b i t Ipi la 68,2%, nghTa la cu 10 bdnh nhan didu tri MDR-TB cd it nhlt 7 ngudi gap bien co [2], Nghidn cuu cua Nguyen Binh Hoa tien hanh nam 2015 tai Bdnh vidn Pham Ngpc Thach thdng qua khao sat thdng tin tu bdnh an cung da ghi nhan dupe 226 bidn co bat Ipi vdi ty Id xay ra d 50,7% bdnh nhan dieu trj [3]. Tu dd phan anh rd net han che cua he thong bao cao tu nguydn la tinh trang bao cao thidu hut so vdi thuc te xay ra. Kdt qua cung chi ra ty Id bao cao ADR trdn tong so bdnh nhan dieu trj MDR-TB cd su chenh lech kha Idn giua cac dan vj bao cao, cd the do van de nhan luc hoac do su quan tam/nhan thuc ve tarn quan trpng cua vide bao cao ADR la khdng dong deu giua cac dan vj. Dieu nay giup khang djnh su can thiet phai thuc day hoat ddng bao cao tu nguydn thdng qua cdng tac tuydn truyen, dao tao, tap huln Canh giac Dupe cho can bp y te trong Chuang trinh chong Lao Quoc gia.

Cac thuoc khang lao dupe nghi ngd nhieu nhat bao gdm prothionamid (35,4%), pyrazinamid (30,6%), kanamycin (27,8%), levofloxacin (25,7%) va ethambutol (18,8%), phu hpp vdi vide su dung thuoc theo phac do dieu trj lao da khang dupe ap dung pho

bidn trong Chuang trinh Chong lao Qudc gia. Phac do dieu trj cd chi djnh dong thdi nhieu thuoc, so bao cao vdi It nhat 2 thuoc lao nghi ngd gay ra phan ung chiem 45,1%. Bao cao tap trung vao cac tridu chung tuang doi de phat hidn, cac phan ung cd hai dupe bao cao nhieu nhat ddi vdi thudc khang lao bao gdm rdi loan tidu hda (46,5%) vdi phan ung chu ydu la ndn, buon ndn (29,2%), roi loan da va to chuc dudi da (21,5%), roi loan he ca xuang khdp (15,3%), roi loan gan mat (13,9%), roi loan thinh giac va tien dinh (12,5%). Cac ADR lien quan den xet nghidm can lam sang nhu tang creatinin, tang bilirubin, tang acid uric huyet thanh it dupe ghi nhan han (6,3% - 9,0%) cho du day la cac phan ung cd hai thudng gap cua thudc da dupe ghi nhan trong y van. Tu dd, cho thay vai trd cua viec tang cudng theo ddi, phat hien ADR theo quy trinh dupe Bp Y te ban hanh de phat hien, xu tri kjp thdi nhung bat thudng tu cac xet nghidm thudng quy, phuc vu cho cdng tac phat hien sdm nguy ca ve ADR va theo ddi chat che benh nhan, giup kiem soat va xu tri ADR tdt han.

Vdi dac diem cua nghien cuu hoi cuu mang tinh chat tham dd budc dau thdng qua viec tong ket bao cao tu nguyen lien quan den cac thuoc dieu tri lao da khang, du lieu da dupe phan tich hoan toan dua tren thdng tin thu dupe tu bao cao ADR nen khd tranh khdi nhung han ch§ vd kha nang tidp can cac thdng tin goc. Mac du cac so lieu tu nghien cuu nay chua phuc vu cho viec xac djnh tan sui t va muc dp nghiem trpng, thdi gian tidm tang cung nhu tac ddng cua ADR den phac do lao da khang tai Viet Nam nhung kdt qua nghidn cuu da phln nao phan anh dupe thuc trang ve bao cao tu nguydn lien quan den cac thuoc dieu tri MDR-TB. Dong thdi, kdt qua nghidn cuu con cho thay nhung han che cua he thong bao cao tu nguydn, bao gdm tinh hinh bao cao thap han so luang thuc te, yeu td chu quan cua ngudi bao cao trong vide chi tap trung bao cao mot so ADR dien hinh, de quan sat, chat lupng bao cao chua cao the hidn d vide con thieu nhieu trudng thdng tin trong bao cao, chua phan anh dupe muc dp nghidm trpng va hau qua cua ADR trong dieu trj MDR-TB. Qua dd, nhan manh su can thiet cua vide then khai cac phuang phap djch te dupe hoc khac nhlm theo ddi tich cue ADR mot each he thong va toan dien de khlc phuc nhung han che trdn va gdp phan nang cao

54 Y HQC T H U C HANH (1054) - SO 8/2017

thuc hanh lam sang, tang hieu qua dieu tri tren benh nhan MDR-TB.

KET L U A N Thong qua viec ra soat he thong bao cao tu

nguyen cua Viet Nam trong giai doan tir nam 2009 den nam 2015, nghien cuu da thu dupe 144 bao cao lien quan den cac thuoc dieu trj MDR-TB vdi tong s6 262 ADR. Cac phan ung theo he ca quan chiu anh hudng dupe bao cao nhieu nhat gom roi loan tieu hoa, rdi loan da va to chuc dudi da, roi loan gan mat, roi loan he ca xuang khdp... Trong dd, hai loai ADR chiem ty le cao nhlt la budn ndn, ndn va di ung da, ngua, noi man. Mot sd ADR nghiem trpng cung da dupe ghi nhan nhu viem gan, diec, roi loan tarn than... Bao cao ADR lien quan den thuoc dieu trj MDR-TB con thieu ca ve so lupng va chat lupng cho thly c l n t i lp tuc tang cudng hoat ddng Canh giac Dupe trong cac ca sd kham chua benh cua Chuang trinh Chong lao Quoc gia thdng qua he thong bao cao tu nguyen, k i t hop vdi cac phuang phap giam sat

tich cue de thu thap thdng tin triet de, hudng tdi kip thdi phat hien, xu tri va du phdng ADR, gdp phan nang cao chat lupng va hieu qua dieu tri lao da khang.

TAI LIEU THAM KHAO 1. Le Thi Thuy Linh, Tran Thu Thuy, Nguyen Thi

Thuy, Nguyen Hoang Anh (2014), "Phan ung cd hai cua thudc khang lao ghi nhan tu he thong bao cao tu nguyen cua Viet Nam giai doan 2009-2011", Y hoc thuc hanh (908)-So 3/2014: p.16-19.

2. Nguyen Thj Thuy, Nguyen Hong Duong va cong s y (2017), "Tong quan he thdng va phan tich gdp cac nghien cuu quan sat v l biln co bat Ipi cua thuoc trong dieu tri lao da khang/ lao sieu khang", Nghien cuu dupe va thdng tin thudc 8(1): p. 2-9.

3. Hoa et al. (2015), "Adverse events in the treatment of MDR-TB patients within and outside the NTP in Pham Ngoc Thach hospital, Ho Chi Minh city Vietnam", BMC Res Notes, 8:809.

KET QUA CAT TIT CUNG HOAN TOAN DO U XO BANG PHAU THUAT NOI SOI TAI BENH VIEN C THAI NGUYEN

NGUYEN THANH BIEN1 , PHAM THj QUYNH HOA 1Benh vien C Thai Nguyen

2Truxyng Dai hoc V Dirge Thai Nguyei

TOM TAT Dat vin di: Phiu thuat noi soi (PTNS) di cit tu>

cung mang tai nhiiu wu diim cho benh nhan nhw: riit ngin thdi gian nim vien, nhanh chong phuc hii sau phau thuat, giam ti le biin chirng... Muc tieu nghien ciru: Danh gia kit qua diiu tri cat tir cung hoan toan do u xo bing phiu thuat noi soi.

Ddi tirgng va phircrng phap nghien ciru: Nghien ciru mo ta cat ngang tren 80 benh nhan dirge chi dinh mo cit tir cung hoan toan do u xo bing PTNS tai Binh vien C Thai Nguyin.

Kit qua: Ti le PTNS thanh cdng la 98,8%, thdi gian phiu thuat trung binh la 98,50 ± 19,99 phut, ti le mit 50 - 100 ml mau trong phiu thuat la 48,8%. Ti le benh nhan cd sot d ngay thir 2 sau phiu thuat la 6,3% va sot d ngay thir 3 la 5,0%. Ti le benh nhan xuit hien trung tien sau phiu thuat 1 ngay la 58,8%; 2 ngay chiim 40,0% va > 3 ngay chiim 1,3%. Ti le binh nhin ngoi day va di lai sau phiu thuat d ngay thir 2 la 82,5% va 16,2% (theo thir tir). Ti le ngdi day va di lai d ngay thir 3 sau phiu thuat la 11,2% va 88,8% (theo thir tir). Ti le benh nhan cd thdi gian nim

Chiu trach nhiem: Nguyin Thanh Bien Email: nguyenbien8822@gmail. com Ngay nhan: 14/6/2017 Ngay phan bien: 24/7/2017 Ngay duyet bai: 03/8/2017 Ngay xuit ban: 25/8/2017

vien sau phiu thuat tir 3 - 5 ngay la 78,8%; £ 6 nga} chiim 21,2%. Ti le tai biin tran khi dirdi da va cha_ mau trong phiu thuit lin lirgt la 3,7% va 2,5%; ti It wem mom am dao gap trong 1,2% trirdng hgp ts biin sau phiu thuit.

Kit luan: PTNS cit tir cung hoan toan do UXTC tai Benh vien C Thai Nguyen dat kit qua cao va ti It biin chirng thip.

TCr khoa: kit qua, phiu thuat ndi soi, cit tir cung u xo tir cung

SUMMARY THE RESULT OF TOTAL LAPAROSCOPIC

HYSTERECTOMY DUE TO UTERINE FIBROMA A" C HOSPITAL IN THAI NGUYEN

Background: Laparoscopic surgery fo hysterectomy bring many advantages for patient such as shortening hospital time, rapidly recovering after surgery, reducing the rate of complications.. Study objective: to evaluate the results of tots laparoscopic hysterectomy due to uterine fibroma.

Subjects and methods of study: A cross-sectiona study was conducted on 80 patients assigned to dt total laparoscopic hysterectomy due to uterim fibroma at C Hospital in Thai Nguyen.

Results: The rate of success laparoscopic hysterectomy was 98.8%, the average operative timi was 98.50 ± 19.99 minutes, the rate of 50-100 ml o blood loss during surgery was 48.8%. The rate c patients with fever 2 days after surgery was 6.3% ant

Y HOC T H U C HANH (1054) - SO 8/2017 5: