Tạp chí y học thực hành

TAP CHI Y HOC THtfC HANH • • • JOURNAL OF PRACTICAL MEDICINE KY Nl|M 87 NAM THANH LAP BANG C0N8 SAN VlfT NAM (3/2/1930 - 3/2/2017) JSSN 1859 • 1663 2(1034) JPM 2017 Nam thtr sau hai So 2 (1034) 2017. Bp Y te xuat ban va phat hanh hang thang The 62st year No. 2 (1034) 2017. Ministry of health publishes and releases monthly TAP CHI Y HOC THI/C HANH B O 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. Nguy ln Th'j Kim Tien Pho Tong Bien tap TS. Nguyen Vinh Hung Thu ky Toa soan Ths. Bui Nam Trung Ban Bien tap: GS. TS. Le Ngoc Trpng GS. TS. Ngo Quy Chau GS. TS. Ha Van Quyet GS. TSKH. Nguyen Van Dip GS. TSKH. Ha Huy Khoi GS. TS. Tran O u t Thp GS. TS. Nguy ln Viet Tien GS. TS. Nguy ln Anh Tri PGS. TS. Ngo Van Toan PGS. TS. Nguy ln Qud'c Tuan PGS. TS. Phan Van Tudng PGS. TS. Nguy ln Thi Bich Lien PGS. TS. Luang Ngoc Khue PGS. TS. Tran Quy Tucng PGS. TS. Pham Thuc Hanh TS. Vu Van Du TS. Nguyen Bao Ngoc Trinh bay: Nguy ln Thai, Hai Yen Toa soan: 138A Giang V6 - HN OT: 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 sura doi, bo sung thang ra 2 ky so: 256/GP-SDBS-GPHOBC ngay 7/6/2004 * In tai: Cong ty CP In Sao Viet * In xong va nop luu chieu 2/2017 Gia 50.000d .TRAN DlEP KHOA, DO QUANG HUAN • NGUYEN THI XUYEN • NGUYEN XUAN HUY, TRAN VAN THANH • NGUYEN KHAC MINH, NGUYEN VAN SONG, TRAN OlNH TRUNG •NGUYEN HUNG CU'&NG, NGO QUANG DLCONG, TRAN QUANG CANH, HIROSHI ICHIMURA, PHAM VAN THLFC • NGO QUANG DUONG. NGUYEN VAN KHAI •TAVAN TRAM, PHAM THE HIEN •NGUYEN VAN DUNG, TRjNH BAO NGOC, TRAN TH| THOA, PHAM DUY Tl/ONG • LE DiNH PHAN, NGUYEN TUAN HUNG, OAO VAN DUNG, TRAN VAN HIKING •V0 TH| H6NG, NGUYEN THANH H6l, NGUYEN VAN DO AN •TRAN DIEP KHOA, DO QUANG HUAN • LE THI. HUONG, VO THI THU THUY • NGUYEN OUC MINH • NGO QUANG DUONG, NGUYEN VAN KHAI •TA VAN TRAM, PHAM THE HlEN MUC LUC S6 1034 => Dac diem va cac y l u t l lien quan r l i loan nhip nhl a benh nhan tang huy l t ap Thyc trang va giai phap hieu qua kham chua benh bang y hoc co t ruy l n tinh Thai Binh d i n nam 2020 => Nghien cuu tac dung cua mot so loai khang sinh vdi vi khu l n ducng sinh san a nCr cong nhan khu cong nghiep tinh Hai Duong nam 2016 => Nghien cuu k i l n thuc thai dp hanh vi v l sue khoe sinh san va cac y l u t l lien quan a hoc sinh trung hoc pho thong tai thanh p h i Da N l n g => Ti le nh i lm va phan b l genotype cua Human papillomavirus tren benh nhan ung thu sinh due nu => K i l n thuc, thyc hanh va mot s i y l u t l l i l n quan d i n benh giun ducng ruot cua phu huynh hoc sinh co con hoc tai 4 t rudng tieu hoc o Hai Duong => Oac diem lam sang, can lam sang - k i t qua dieu tri bao ton vo gan trong chan thuong bung kin tai Benh vien Da khoa Trung tarn T i l n Giang => Danh gia tinh trang thai t r u hoa chat bao ve thyc vat qua sua me va nude tieu cua phu nu dang cho con bu dud i 12 thang t u l i tai mot s i quan thanh p h i Ha Npi nam 2013 => Hieu qua can thiep mo hinh tram y t l xa tai 3 huyen, thanh p h i tinh Hda Binh, 2016 => Nghien cuu tinh hinh kiem soat hen p h i quan va mot s i y l u t l nguy co lien quan theo gina 2015 tai Benh vien Dai hoc Y Hai Phong Dac diem va cac y l u t l lien quan r l i loan nhip t h l t d benh nhan tang huy l t ap => Phan ung cd hai tren than kinh trung uong va tarn than lien quan d i n EFV d benh nhan d i l u tri phac d l DF/3TC/EFV => Gdp phan nghien cuu nguyen nhan va co c h l b i n h sinh cua benh viem khdp dang thap theo quan d i l m y hoc c l t ruy ln => K i l n thuc va thyc hanh nudi con bang sua me cua cac ba me cd con dud i 2 t u l i tai mot xa huyen thanh mien, tinh Hai Duong nam 2016 => Cac y l u t l lien quan den loang xuong d ngudi cao t u l i cd benh ph l i t i c nghen man tinh tai Benh vien Da khoa T i l n Giang Y H O C TH lTC H A N H (1034) - SO 2/2017 1 •LE DINH PHAN, NGUYEN TUAN HUNG, OAO VAN DUNG, TRAN VAN HU^NG •NGUYEN TH| THANH HUONG, HOANG TRUNG KlEN, LUU THI ANH TUYET, NGUYEN THU TRANG, NGO TH| TUYET •NGUYEN HUY ANH, LE THj HOAN, TRUONG OINH BAC •NGUYEN THj NGA, KIM BAO GIANG, NGUYEN THANH HA •PHAN QUOC HOI •OAO TH| DUNG, NGUYEN ANH CHI, NGUYEN QUANG TRUNG •TRAN TUAN ANH, LE THI KIM DUNG, DO THAI SON, NGUYEN TH| HA, LY THUY MINH, PHAM TRUNG KlEN, VU VAN DU •OINH NGOC SON, NGUYEN L E BAO TIEN •LE THj HUONG •TRAN NGQC QUE •NGUYEN HOANG LONG, OAO THU THUY •TRAN TH| KIM LIEN •HOANG TRUNG KlEN, NGUYEN TH| THANH HUONG, NGUYEN XUAN TUNG •TA VAN TRAM, PHAM THE HlEN •TRUONG VIET TRUONG, NGUYEN TH| QUYNH HOA •PHAM TUNG LAM, BANG XUAN KET, NGUYEN DUC TAI •PHAM TH| TUYET NGA, HOANG TH| THU TRANG, PHAM THj HANH QUYEN •DO VAN DUNG, BANG TH| NGOC BICH MUC LUC (S6 1034) => So sanh k i t qua tr irdc - sau can thiep mo hinh tram y te xa tai 3 52 huyen, thanh pho tinh Hda Binh, 2016 => Khao sat thai do, k i l n thi>c doi vdi s y co y khoa khdng mong 56 muon cua d i l u d i rdng, hq sinh tai Benh vien Da khoa Trung i r cng Thai Nguyen nam 2016 => Danh gia cua cac ba me co con d i rd i 5 t u l i khi sir dung tiem 59 chung dich vu tai tinh Nghe An nam 2016 => Tinh gia trj va dp tin cay cua mot so cdng cu thu nhan phan h l i t ir 62 giang vien va sinh vien => Thyc trang u l n g mryu, bia cua nam gidi dp tuoi t ir 15 - 60 tai xa 65 Tay Thanh, Yen Thanh, Nghe An nam 2015 => M6 ta thyc trang benh sau rang va viem ly i cua hoc sinh Trung 68 hoc pho thong Chu Van An quan Ba Dinh, thanh pho Ha Ndi => Dac diem benh nhi cd tang ap l yc ddng mach p h l i tai Benh vien 71 Da khoa Trung i r cng Thai Nguyen => Danh gia k i t qua cham sdc benh nhan sau p h i u thuat benh ly 75 tmrp't dot song that lirng, that lumg cung tai Benh vien Hdu nghi Niet Ode => Hieu qua can thiep nham cai thien mot so chi s i danh gia chat 77 l i rgng d i l u tri HIV/AIDS tai Benh vien Da khoa huyen Thuan Chau, tinh Sen La => Thyc trang va giai phap phat then nguon nhan l yc y hoc co 79 t r u y l n tinh Quang Binh den nam 2020 => K i l n thdc va thyc hanh tiem an toan cua d i l u d i rdng vien Benh 82 vien Da lieu Trung i rang nam 2012 => Oanh gia thyc trang sau rang do bu binh d Ida tuoi m i m non 84 => K i l n thdc va hanh vi t y bao ve sdc khde khi sd dung t h u l c bao ve 87 thyc vat cua ngirdi nong dan canh tac che tai Thai Nguyen nam 2016 => Nghien cdu cac yeu t l tien l ireng t d vong b i n h p h l i tac nghen 90 man tinh tai B i nh vien Da khoa Trung tarn Tien Giang => Thyc trang sdc khoe va benh th irdng gap d cdng nhan lao dpng 94 trong mdi tmrdng vi khi hau nong tai Cdng ty Gang thep Thai Nguyen => Nghien cdu dieu kien lao ddng va mdi tmrdng anh hirdng d i n sdc 96 khde va cot s i n g cua ngirdi lao ddng b l c xep tai cac b i n cang nganh Giao thong Van tai, d l xuat giai phap d y phdng => Oac d i l m ton th i rcng md cdng viing c l rang 100 => Cac yeu t l nguy c c trong benh cham tay cua nhan vien y t l 102 2 Y HOC THlTC HANH (1034) - SO 2/2017 •PHAM NHUHUNG, NGUYEN QUANG TUAN •VO THj LAN, DO QUANG HUAN •MAI THj HlEN, D6 GIA TUYEN, DANG THI VIET HA •PHAN QU6C HOI •OAO TH| DUNG, NGUYEN ANH CHI, NGUYEN QUANG TRUNG •LE TH| THANH HUONG, CHU VAN THANG VU DlEN, LE THj THANH XUAN •NGUYEN TH| HOAI, DOAN TH| HUONG, LUU THj ANH TUYET •NGUYEN THAI HUNG DUONG MINH DUC •LE TH| HUONG, VO TH| THU THUY •NGUYEN DUC MINH •HOANG TH| PHUONG •NGUYEN VAN SON •DANG HUNG MINH •PHAM THj THU THUY, DAU XUAN CANH, NGUYEN TH| BACH TUYET •TRAN VAN THANH, NGUYEN VAN LANH •TRAN THj MAI OANH, NGUYEN TH| HUONG, PHAN LE THU HANG •DOAN TH| NGA OAOTlEN TH|NH, LA VAN LUAN •TRAN ANH VU, NGUYEN TH| SON •BINH QUANG HUY, TRjNH HOANG HA, VU NGQC •BUI TH| VAN ANH, NGUYEN XUAN HIEP •BP NGOC SON, NGUYEN VAN CHI, NGUYEN DANG OUC •VU TUAN ANH, NGUYEN DUYANH Tham do dien sinh ly hoc tim tren benh nhan co dien tarn 66 Brugada => Benh dpng mach vanh tren nhdng benh nhan co b#nh van tim dirac p h l u thuat van tim tai Vien Tim thanh pho Ho Chi Minh => Hieu qua dieu trj Corticoid tren mot s6 benh nhan benh than Iga => Xac djnh y l u to lien quan d i n sir dung nrgu, bia cua nam gidi dp tuoi tir 16 - 60 tai xa Tay Thanh, Yen Thanh, Nghe An nam 2015 => M l i lien quan giCra k i l n thdc, thai dp, hanh vi cham sdc rang mieng vdi benh sau rang, viem lei ciia hoc sinh t radng Trung hoc p h i thong Chu Van An, quan Ba Binh thanh p h i Ha Ndi => Sir tham gia cua giao vien tieu hoc trong cdng tac y te tr i rdng hoc tai quan Thanh Xuan, nam 2012 => Khao sat sir tuan thu d i l u trj d benh nhan suy than man giai doan c u l i tai Khoa Ndi Tieu hda - T i l t nieu Benh vien Da khoa Trung i rang Thai Nguyen => Danh gia mdc dp h i l u cua can bp y t l vdi bp cdng cu do l i rdng mdi t r i rdng lam viec (COACH) tai Quang Ninh => Phan dng cd hai tren than lien quan den TDF d benh nhan dieu trj phac dd TDF/3TC/EFV => Vai trd va djnh hirdng phat trien phirang phap dieu trj giam dau ben ngoai d l i vdi benh ly x i rang khdp b l n g t h u l c Y hoc c l t ruy ln => T i l p can c h i n doan benh do Mycobacteria khdng lao Danh gia nguy c c va ty le hien mac benh n h i l m doc hda chat bao ve thirc vat d ngird i lao ddng ndng nghiep 2012 => Nghien cdu dac d i l m lam sang va can lam sang d benh nhan tran khi mang p h l i d i rd i 30 t u l i tai Trung tarn Hd h i p Benh vien Bach Mai => Danh gia m l i lien quan giira trieu chdng lam sang, hinh anh ndi soi, md benh hoc, HP va PH djch vj cua benh ly da day - ta trang tren benh nhan xa gan => Nghien cdu k i l n thCrc, thai dp, thirc hanh va mot s i y l u t l lien quan d i n phdng cum gia e l m tr irdc va sau can thiep cua ngizdi dan tai cac hp cd nudi gia cam huyen Vj Thuy, tinh Hau Giang nam 2014 => K i l n thdc, thai dp ciia hoc sinh p h i thong v l HIV/AIDS tai tinh Hai Dirang => K h l o sat k i t qua thirc hien mot s i can thiep dieu d i rdng tren benh nhan sau m l ndi soi tang sinh lanh tinh t u y l n tien liet tai Khoa Ngoai T i l t nieu, Benh vien Da khoa Trung i rang Thai Nguyen nam 2016 => Cac y l u t l anh hirdng d i n thirc hien hoat ddng the lire tren benh nhan tang huy l t ap tai Benh vien Trung i rang Thai Nguy ln nam 2016 => Tinh trang dinh d i rdng t h l hien qua chi s i BMI va trang thai huyet ap cua sinh vien nam thd n h l t Dai hoc Q u l c gia Ha Npi, nam hoc 2014-2015 => Tr i rdng hgp co rut mi tren sau p h l u thuat cat be => Hieu qua ciia thir nghiem thd tir nhien b l n g may thd cd mode "SBT" cho benh nhan dgt c l p COPD 152 156 158 161 163 Thai dp x d tri vdi thai du thang t h i l u l i tai Benh vien Phu san Ha 165 Ndi •DANG HUNG MINH, TRAN VAN CITONG .PHAM TH! THU THUY OAU XUAN CANH NGUYEN THI BACH TUYET •NGUYEN L E BAO TlEN, DINH NGOC SON, NGUYEN DUY LUAT •D6 THjOlEP, PHAM VIET CUONG, LUONG MAI ANH, TRAN QUANG DUC HA ANH DUC •TO THANH PHUONG, DANG HOANG ANH •LE TH| HUONG, OOAN THUY LINH •NGUYEN THAI HUNG DUONG MINH DUC •NGUYEN DUC MINH •NGO QUANG DUONG, NGUYEN VAN KHAI •NGUYEN L E BAO TlEN, DINH NGOC SON, NGUYEN DUY LUAT •VU XUAN TUYEN, NGUYEN ANH TUAN • NGUYEN VAN VAN. TRAN VAN THANH •NGUYEN XUAN THUC, VU OUC MINH •DO VAN DUNG, DANG THj NGOC BICH •NGUYEN VAN LANH, TRAN VAN THANH •NGUYEN VIET QUANG, CHU VAN THANG, NGUYEN THj QUYNH HOA •NGUYEN XUAN THUC •DANG HUNG MINH, BUI TUONG LAN •PHAM THj THU THUY, DAU XUAN CANH , NGUYEN THj BACH TUYET •TRAN TH! MAI OANH, NGUYEN THI HUONG, PHAN L E THU HANG •CHU TRAM ANH, PHAM THj THU HIEN •NGUYEN MANH CUONG, L E HOANG TUAN •HOANG NGQC SON, NGO HUU HANH => Nghien cCru dot b i l n EGFR va mot so yeu t l lien quan d benh nhan ung thir p h l i the bieu mo t u y l n d i l u tri tai Trung tarn Ho h i p Benh vien Bach Mai => Gia trj npi soi da day trong phat hien sdm ung thir da day => Dac diem r l i loan chdc nang ho h i p tnrdc m l cua benh nhan veo 171 cot s i n g ngyc dirge phau thu|t chinh hinh tai Benh vien HOm nghj Viet Dire => Bao Igc dien tir va mot s i y l u t l lien quan tai Tr i rdng Trung hoc 173 p h i thong Chi rcng My A - Ch i rcng My - Ha Npi => D i l u trj t r i m cam nang co loan t h i n b l n g kich thich tir xuyen so 177 k i t hgp vdi t h u l c an t h i n kinh va c h l n g t r i m cam => T u l n thu d i l u trj d b i n h nhan HIV/AIDS tre em tai Benh vien Nhi 178 Trung i rcng => Danh gia dp tin cay kiem tra lai bp cong cu do l irdng mdi tr irdng 182 lam viec (COACH) tren can bo y t l tai Quang Ninh => Mo hinh gay viem khdp gut cai tien tren ddng vat thgc nghiem 186 => Thgc trang suy dinh d i rdng d tre dird i 5 t u l i tai huyen Thanh Mien 188 - Hai Dircng nam 2016 => Dac diem lam sang, can lam sang cua benh nhan xep than d l t 191 s i n g nggc, t h l t lirng do loang x i rcng tai Benh vien HCru nghj Viet Dire => Nghien ciru cac y l u t l thuan Igi lam x u l t hien com dau nira d l u 194 Migraine =>Tinh trang thieu mau d cac ba me va can nang cua tre so sinh tai 198 Benh vien huyen Tien Phirdc, tinh Quang Nam, nam 2012 =>Tinh trang quanh rang va nhu c l u d i l u trj d cac benh nhan dai thao 201 d i rdng typ 2 tai Benh vien Da khoa tinh Ninh Binh, nam 2014 =>Ti le hien mac thdi khoang 1 nam benh cham tay cua nhan vien y 205 t l => K i l n thirc, thai dp, thgc hanh phdng c h l n g tac hai n g h l nghiep cua 207 cdng nhan tinh Tra Vinh nam 2013 =>Thgc trang sire khoe tarn t h i n cua hoc sinh Tr irdng Trung hoc cc 211 sd Quang Trung, thanh p h i Thai Nguyen, tinh Thai Nguyen =>Ket qua c l djnh rang va xiromg I rang bj sang c h i n bang nep 214 composite => Nghien ciru v l nguyen nhan va cac dac diem lam sang, c|n lam 216 sang cua tran djch da mang djch t i l t => Mot s i nhan xet 65 t r i rdng hgp u vu da d i r c c c h i n doan mo benh 220 hoc =>K i l n thirc, thai dp, thgc hanh ve Iga chpn gidi tinh khi sinh cua 221 cac san phu tai Benh vien Da khoa Q u l c t l Hai Phong => Nghien ciru dac diem lam sang, X quang va hinh thai I n g tuy cua 224 rang ham Idn thir hai ham di rd i =>Banh gia k i t qua sir dung fibrin giau tieu cau trong phau thuat n h l 226 rang ham Idn thd ba ham dirdi => Tr irdng hep dieu trj gay x i rcng got di lech d yee n l n chinh c l djnh 228 bang dinh steinmann (nhan xet cai tien cua f.kermad) 4 Y HOC THlTC HANH (1034) - SO 2/2017 •PHAM TH| THU HlEN •DUONG TRONG TAN, HOANG NGOC SON, NGUYEN THUY QUYNH •NGUYEN OUC NHU, TRAN ANH TUAN •OOAN TH! HUE •TA VAN TRAM, PHAM THE HlEN • NGO THj D'?U MINH, D6 QUANG HUAN •NGUYEN TH! H6NG VAN, HOANG BUI HAl, VIEN VAN DOAN .OINH NGQC SON, NGUYEN LE BAO TIEN .PHAM TH! THU HlEN .HOANG NGQC SON, NGUYEN TRONG TIN, NGUYEN THlilY QUYNH •HOANG THj PHUONG, BACH VAN HO ANH •NGUYEN VAN SON, DINH THUC NGA •LE THj THUY LINH, LUONG MINH HANG TRAN THj MY HANH, NGUYEN THj THU HlEN •DANG HUNG MINH •PHAM THj THU THUY, DAU XUAN CANH, NGUYEN THj BACH TUYET •TRAN THj MAI OANH, NGUYEN THj HUONG, PHAN L E THU HANG •PHAN THj T 6 NHU, NGUYEN THj HUONG GIANG •NGUYEN L E BAO TlEN, OINH NGOC SON •DANG HUNG MINH, BUI THj PHUONG THAO •NGUYEN DUC NHU, TRAN ANH TUAN •NGUYEN THI HUONG GIANG, PHAN TH! T 6 NHU •YHTH =>Banh gia dac diem lam sang, X quang nhom rang phia t ruce co s u 232 dung c h i t soi =>K i ln thuc va thyc hanh ve tiem an toan cua sinh vien dieu duong 235 Trucng Cao d i n g Y te Thai Nguyen tai Benh vien A Thai Nguyen nam 2016 =>Banh gia cac yeu t l lien quan d i n giam dinh t i n thucng c c the c 237 nhung t rucng hep c h i n thucng m l t =>K l t qua can thiep nang cao nang lyc ciia ba me vk cham sdc ve 239 sinh, u Im d tre so sinh non thang d i l u tri tai Trung tarn Nhi khoa, Benh vien Trung u cng Thai Nguyen =>Tinh hinh chua rang tai Benh vien Da khoa T i l n Giang 242 => Nghien cuu r l i loan nhjp t h l t d benh n h l n suy tim man tinh t ruce 248 va sau d i l u tri bang t hu l c uc che beta =>Tinh trang khang insulin va t i n thuong m l t d cac benh nhan r l i 252 loan glucose luc ddi cd tang h u y l t ap => K i t qua cham sdc benh nhan sau m l tao hinh t h i n d l t s i n g ngyc, 253 t h l t lung b l n g bom cement sinh hoc tai Benh vien Huu nghj Viet Due =>Danh gia k i t qua d i l u trj npi nha rang ham Idn thu hai ham dud i tai 255 Benh vien Rang Ham Mat Trung uong Ha Npi =>Thyc hanh va mot s i yeu t l lien quan d i n thyc hanh phdng benh 257 nh i lm xa nghe nghiep cua n h l n vien x-quang tai cac co so y te tren dja ban tinh Quang Ngai nam 2016 => Nghien cuu mot s i y l u t l lien quan d i n mat dp xuong d benh 260 nhan nam m l c benh p h l i tac nghen man tinh tai Benh vien da khoa tinh Thai Binh =>Tinh hinh n h i l m doc mangan n g h l nghiep cua cdng nhan Cdng 262 ty C l p h l n Hop kirn S i t - Gang Thep Thai Nguyen =>Banh gia k i t qua d i l u trj ndi nha rang ham sua 266 => Nghien cuu dac d i l m lam sang, can lam sang cua viem p h l i d 270 benh nhan ung thu phoi =>So sanh tac dung cua t h u l c ampelop va ampelop k i t hop vdi 272 amoxycilline + metronidazole trong d i l u trj loet da day - ta trang =>Mdt s i y l u t l lien quan den viec lya chpn gidi tinh khi sinh cua 274 cac ba me den sinh con tai Benh vien Da khoa Q u l c t l Hai Phdng =>Xac djnh can nguyen va tinh khang khang sinh cua vi k h u l n d 276 benh nhan n h i l m k h u l n huyet duoc d i l u trj tai Benh vien Quan y 103 (2011-2015) =>Dac diem lam sang va can lam sang cua benh nhan t ruo t d l t 279 s i n g t h l t lung, t h l t lung ciing Benh vien Huu nghj Viet Due =>Dac d i l m lam sang, can lam sang, nguyen nhan hoi chung thuy 282 g iua tai Trung t i m Hd h i p Benh vien Bach Mai => Nghien cuu mot s i dac diem c h i n thuong m l t qua giam djnh t i n 285 thuong co t h l =>Cac c h i t uc che SGLT2-nhdm t h u l c mdi trong d i l u trj benh dai 287 thao duong =>Thdng tin y hoc 290 Y HOC TH1/C HANH (1034) - SO 2/2017 5 nhip nhanh t h l t giua ngay va dem. Co s y tuong quan giua t u l i , thai gian THA, dudng kinh nh7 trai, chi s i k h l i ca t h l t trai, EF vdi s i lugng NTT t h l t trong 24 gid. Nguy ca RLN t h l t day hoac phdc tap d benh n h l n THA > 60 t u l i , thai gian THA > 5 nam va cd benh DMV l l n loot la OR = 3,71 (95%CI: 1,54 - 8,92), OR = 6,53 (95%CI: 2,59 - 16,51) va OR = 2,78 (95%CI: 1,16 - 6,65). Nguy ca RLN t h l t day hoac phdc tap d benh nhan THA cd PBTTr va EF < 5 0 % l l n loot la OR = 2,48 (95%CI: 1,18 - 5,20) va OR = 4,89 (95%CI: 2,11 -11,09) . TAI LIEU THAM KHAO 1. Dao Thu Giang (2011), "Nghien ciru biSn thien nhip tim va rdi loan nhip tim d benh nhan tang huyit ap co thieu mau cue bo co tim", Y hoc thirc hanh. 774(7), pp. 119-121. 2. Pham Thai Giang (2012), "Nghien ciru roi loan nhip tim o benh nhan tang huyet ap nguyen phat", Hoi nghj Tim mach toan qudc Idn thCr 13. 3. Acharya T (2015), "Frequent atrial premature complex and their association with risk of atrial fibrillation", Am J Cardiol. 116, pp. 1852 - 1857. 4. Barison A, Vergaro G (2011), "Markers of Arrhythmogenic Risk in Hypertensive Subjects", Curr Pharm Des. 17, pp. 3062 - 3073. PHAN LFNG CO HAI TREN THAN KINH TRUNG LTONG VA TAM THAN LIEN QUAN DEN EFV & BENH NHAN DIEU TRj PHAC DO DF/3TC/EFV L E TH| HUONG, VO THj THU THUY Cue Phong, chong HIV/AIDS, Twang Dai hoc Dope Ha Npi TOM TAT Muc tieu: Mo ta dac diim phan irng cd hai (ADR) tren he than kinh trung irong (TKTW) va tarn thin lien quan din EFV d benh nhan dieu tri phac dd TDF/3TC/EFV va xac dinh mot sd yiu td lien quan din ADR. Phirong phap: Nghien cu>u thuin tap tiin ciru thong qua bao cao tir nguyen cd chu dich tren 841 benh nhan mdi dieu tri tir thang 03/2015. Kit qua: Cd mot ty le dang ke (38,7%) benh nhan gap ADR tren he TKTW & tarn thin lien quan din EFV khi diiu tri phac dd TDF/3TC/EFV. Biiu hien chu yiu la chdng mat (29,5%), tiip din la dau diu va met mdi (19,4%), cam giac ndng bimg (10,7%), budn ndn (9,8%). Cac ADR nang nhw cd y dinh tir tir va trim cam cung da dirge ghi nhan vdi ty le 0,1%. Mot sd yiu to lien quan la: tudi, ndng do hemoglobin va giai doan lam sang. Kit luan: Cd mot ty le dang ki (38,7%) benh nhan gap ADR tren he TKTW & tarn thin liin quan din EFV d benh nhan diiu trj phac dd TDF/3TC/EFV. Tuy nhien, chu yiu ADR d mire do nhe nen dai da sd benh nhan vin duy tri phac dd diiu tri. Vi vay, nhan vien y ti cin tw vin ky lirdng cho benh nhan trirdc va trong qua trinh diiu trj, dac biet la trong thdi gian diu diing thuoc di tranh viec benh nhan tiry bo thubc. Tie khoa: phan irng cd hai, thin kinh trung uvng va tarn thin, EFV SUMMARY EFV- RELATED ADVERSE DRUG REACTION ON CNS AND MENTALOF PATIENT TREATED WITH TDF/3TC/EFV Objective: Describing characteristics and identifying Chiu trach nhiem: Le Thj Hirdng Dja chi: Cue F>hdng, ching HIV/AIDS Email: lehuongvaac@gmail.com Ngay nhan: Ngay phan bien: Ngay duyet bai: Ngay xuit ban: related factors about ADR of EFV on CNS & Metal in patients with TDF/3TC/EFV regiment. Methods: This is a prospective cohort study through targeted spontaneous reporting on 838 new patients from May 03/2015 in An Giang, Dien bien, Lao Cai, Thai Nguyen, Ha Noi, Nghe An, Ho Chi Minh City. Results: There is a significant percentage (38.7%) of patients experiencing the ADR on CNS and Metal related to EFV in patients with TDF/3TC/EFV. Maily is anifested dizziness (29.5%), headache and fatigue (19.4%), feeling hot flushes (10.7%), nausea (9.8%>). The heavy ADR intend to commit suicide and depression have also been recorded at the rate of 0.1%. Some factors related were: age, hemoglobin levels and clinical stage. Conclusion: There is a significant percentage (38.7%) of patients experiencing CNS & Metal ADR related EFV in patients treated with TDF/3TC/EFV but mainly mild so the vast majority of patients still maintenance treatment. Since, we need a thorough consultation for patients before and during treatment, especially during the first period to avoid treatment dropping out. Keywords: ADR, CNS and metal,EFV OAT VAN O E T h u l c ARV da dem lai nhieu loi fch cho benh nhan HIV/AIDS. Tuy nhien, trong qua trinh so dung van thudng xay ra cac v i n d i lien quan den an t o l n thulc, dac biet la cac bien c l b i t loi nghiem trong tac dgng d i n tuan thu dieu trj [1]. Trong khi phac d l chu yeu dang d i l u trj la TDF/3TC/EFV thi phan ung cd hai tren TKTW & tarn than cua EFV duoc khuyen cao giam sat [2]. Tai Viet Nam, s i luong bao cao v l phan dng cd hai cua t h u l c con r l t han c h l va khdng phan anh dung thyc t l d i l u trj [3]. Vi vay, chung tdi t i l n hanh nghien cdu: 'Phan dng cd hai tren than kinh trung uong va tarn t h i n lien quan tdi EFV tren benh nhan dieu trj phac do TDF/3TC/EFV". 40 Y H O C TH lTC H A N H (1034) - SO 2/2017 i D6 l T U Q N G VA PHUONG PHAP NGHIEN C U U 1. Doi tircmg nghien ciru Gom 841 benh nhan mdi dieu tri phac do TDF/3TC/EFV tai 5 tinh/thanh pho trong thai gian tir 16/03/2015 d i n 15/07/2016. Sau khi loai trir 3 benh nhan khdng quay lai tai kham thi con lai 838 benh nhan dupe tham gia nghien cdu. 2. Phuang phap nghien cu i i Nghien cdu thuan tap tien cdu thong qua bao cao to nguyen cd chu dich. Sd lieu thu thap dupe lam sach, nhap b l n g Epidata 3.1, quan ly va phan tich b l n g SPSS 16.0. Sir dung ky thuat phan tich thong ke md ta, kiem dinh X2 va md hinh hoi quy logistic de t im moi lien quan. K E T QUA VA BAN LUAN 1. Thong tin chung ve doi tupng nghien cuu Dac diem cua m i u benh nhan trong nghien cdu khdng cd so khac biet nhieu vdi dac diem benh nhan nhi im HIV/AIDS tai Viet Nam. Trong 838 benh nhan dirge chgn thi nam gidi c h i l m ty le nhieu hon vdi 66,9%. P h l n ddng benh nhan dang d dd tuoi lao ddng, trung binh la 33,9 ± 7,5 tuoi. Benh n h l n lay n h i i m HIV chu yeu qua con d i rdng tinh due (58,1%) va nghien chich ma tuy (37,2%). Tai thdi diem bat dau theo doi, sd benh n h l n dang d giai doan lam sang 1 c h i l m ty le cao n h l t 62,4%. 2. Oac diem ADR tren TKTW va tarn than lien quan den E F V Cd 324 benh nhan (chiem 38,7%) tren tong sd 838 benh nhan dirge nghien ciru gap b i l n cd tren TKTW va tarn t h i n . Ty le nay t h l p hon k i t qua trong nghien cdu cua Ruiz va cong s g ( 54%) [4], Nelsona va cdng sy nam 2010 (46,2%) [5], S y khac biet nay cd the la do th i l t ke nghien ciru khac nhau (co mau, tieu c hu l n lya chpn benh nhan, tieu c hu l n danh gia), c h i t l irgng cua cac phirong phap danh gia, each sir dung cac thuat ngu ("doc tinh tren t h i n kinh trung irang", "tarn th in " , "tarn than, than kinh trung irang"). Tuy nhien, d i l u dang chu y d day la ty le 38,7% trong nghien ciru cua chung tdi v i n cao hon nhieu khi so sanh vdi nghien ciru g i n day tai Viet Nam cua Nguy in Phirong Thuy nam 2013 (12,3%). Nghien ciru cua Nguy in Phirong Thiiy la nghien ciru t i l n ciru theo phirong phap giam sat b i l n cd thuan tap (CEM) theo ddi t i t ca cac loai phac dd sir dung tren benh nh in , t i t ca cac benh nhan d m l u theo ddi dinh ky hang thang d i u dupe giri bao cao v l Trung tarn DI&ADR Qudc gia. Nhir v i y , s y khac biet Idn nay cd the la do cac phan irng tren TKTW & tarn t h i n chu y l u d mire dp nhe, thoang qua, d l bi n h l m l l n vdi cac trieu chirng lam sang cua benh, dac biet tren benh nhan nghien chich ma tuy nen cd the bj bd qua, khdng dupe ghi nhan vao hd so benh an. Trong khi dd, ddi vdi phirong phap TSR d nghien ciru cua chiing tdi, phan Idn cac bieu hien ddc tinh nhe, thoang qua tren t h i n kinh trung irang va tarn than d i u dupe bac si chu y theo ddi, ghi nh ln . 2.1. Tan suit gap ADR tren TKTW va tarn than Bang 1. Cac bieu hien ADR tren TKTW va tarn t h i n STT Bidn c6 co hai n = 838 % 1 Chong mat 248 2 Dau dau 163 19 5 3 Met moi 163 19,5 4 Cam giac nong bung 90 1 n 7 5 Buon non 82 9,3 6 Mo nhieu, gi lc mo rd rang 45 5.4 7 Mlt ngu 43 5,1 8 Ac mong 39 4,7 9 Lo l ing 31 3,7 10 Di cam: dau , ngira , rat, ki ln bo 6 0.7 11 Giam/mat tap trung 5 0,6 12 Co y dinh ty tip 1 0,1 13 Tr im cam 1 0,1 14 Bieu hien khac 6 0,7 Bang 1 cho th l y : Bieu hien ADR dupe ghi nhan nh i l u n h l t la chdng mat (29,5%), t i l p d i n la dau d i u va met mdi (19,4%), cam giac ndng bung (10,7%). Mot sd ADR nang nhu cd y dinh t y tip va t r i m cam cung dupe ghi n h l n vdi ty I I 0 , 1 % . K i t qua nay tuong ddng vdi thong tin dupe ghi nhan trong y van cung nhu nhung nghien ciru tong quan [4], 2.2. Xac suit xuat hien ADR tren TKTW va tarn than Bang 2. Thdi gian t u khi dung thudc d i n khi x u l t hien ADR tren TKTW va tarn than Thai gian n % _ Dudi 1 tuln 136 42,0 1 tuan - <1 thang 170 52,5 1 thang - 3 thang 18 5,5 > 3 thang 0 0,0 Thong so thong ke (ngay) Gia tri trung vi: 7 Tir phan vi 25%: 1 Tu phan vi 75%: 10 Bang 2 cho th l y : Thdi gian trung binh gap ADR tren TKTW va tarn t h i n la 9,3 ± 12,7 ngay va thudng x u l t hien sdm trong vdng 1 t u l n (42,0%) den 1 thang (52,5%), Theo Kenedi va cdng s y (2011), cac ADR thudng b i t d i u x u l t hien trong 1-3 ngay d i u d i l u tri, dat cao n h l t sau 1-2 t u l n dieu trj [8]. K i t qua nay cho th l y , c l n phai chu trong theo ddi ADR tren TKTW va tarn t h i n ngay sau khi d i l u trj de cd bien phap can thiep xir tri kjp thdi, hop ly va hieu qua. 2.3. Mire do nang cua ADR tren TKTW va tarn than va each xCr tri Bang 3. Mire dp nang cua ADR tren TKTW va tarn than Phan loai n % Muc do 1 (nhe) 249 76,9 Muc do 2 (trung binh) 72 22,2 Muc do 3 (nang) 3 0,9 Muc do 4 (tu vong, de doa tinh mang) 0 0,0 Y HOC THlTC HANH (1034) - SO 2/2017 41 Bang 4 Cac bien phap x u tri tren benh nhan co ADR tren TKTW va tarn t h i n Bien phap xir tri n = 324 % Tu van, tiep tuc ulng thuoc 314 96,9 Dung them thulc xi> tri 4 1,2 Giam lieu 0 0,0 Ngimg thuoc 1 0,3 Doi phac do 4 1,2 Chuyen tuyln 1 0_3_ Bang 3 va 4 cho th l y : P h l n Ian cac ADR tren TKTW va tarn t h i n xay ra d mdc dp nhe (76,9%) va mdc dp trung binh (22,2%). Chi cd 3 t rudng hpp b i l n co cd hai xay ra d mdc dp nang (0,9%). Vi vay, p h l n Idn cac benh nhan dupe t u v i n va each u l n g thuoc hpp ly c h i l m 96,9% va sau do benh nhan v i n duy tri phac d l d i l u tri. Cd 4 benh nhan (1,2%) dung them thudc khac x u tri va chi cd 1 t rudng hpp phai tarn ngung t hu l c do bi phat ban do 3 va sau dd su dung lai t hu l c EFV thi phan ung khdng x u l t hien lai. Cd 4 benh nhan phai d l i phac d l ( ch i lm 1,2% trong t i n g s i benh nhan gap ADR) cd 2 t rudng hpp d muc dp nang, 2 t rudng hpp d muc d | trung binh. Theo Ribaudo va cdng su (2004), khoang 4 % benh nhan phai d l i phac d l do ddc tinh tren t h i n kinh trung uang lien quan d i n EFV. Ty le benh nhan d l i phac d l d nghien cuu cua chung tdi t h l p han, cd the do dac diem benh nhan khac nhau, han nua viec xac djnh muc dp nghiem trpng cua cac b i l n c l tren he than kinh trung uang va tarn t h i n la mot v i n de khd d i n g n h l t d l i vdi cac bac si do quan niem/nhan thuc cua bac sy v i muc dp nghiem trpng cua phan ung cd hai khac nhau nen cd quy l t djnh khac nhau. Vi vay, ty le d l i phac do cd the dao ddng giua cac nghien cuu. 3. Cac yeu t l lien quan den ADR tren TKTW va tarn than cua E F V Bang 5. Phan tich don bien cac yeu t l anh hudng tdi t i n s u i t x u l t hien ADR Yeu to HR Khoang tin cay P 95% Cl Tuoi (nam) 1,020 1,006- 1,034 0,005 Gidi (nam/nu) 1,043 0,930- 1,170 0,470 Can nang 0,992 0,980 - 1,005 0,215 Giai doan lam sang 0,135 Giai doan 1 1,460 1,022- 2,089 0,038 Giai doan 2 1,451 0,936 - 2,255 0,096 Giai doan 3 1,136 0,698 - 1,850 0,609 CD4 1,000 1,000- 1,001 0,269 Hemoglobin 1,008 1,003- 1,013 0,004 ALT 0,999 0,996 - 1,002 0,411 eGFR baseline 0,997 0,993 - 1,002 0,215 [Cre) baseline 1,000 0,994 - 1,005 0,928 Bang 5 cho t h l y : K i t qua phan tich don bien da phat hien 3 yeu t l anh hudng tdi tan s u i t x u l t hien ADR tren TKTW va tarn t h i n d benh nhan la t u l i (p = 0,005), giai doan lam sang 1 (p = 0,038) va gia trj hemoglobin huy l t thanh ban d i u (p = 0,004). N l u t u l i benh nhan khi bat dau d i l u trj tang 1 don vj thi nguy co x u l t hien ADR tang them 2% . N l u ndng dp hemoglobin ban d i u tang them 1 don vj thi nguy co x u l t hien ADR tang them 0,8%. Nguy co m l c b i l n c l tren TKTW va tarn t h i n d nhdm benh nhan d giai doan lam sang 1 cao hon g l p 1,46 l l n so vdi benh nhan d giai doan lam sang 4. Bang 6. K i t qua phan tich da b i l n cac y l u t l anh hudng tdi t i n s u i t x u l t hien ADR Yeu to HR Khoang tin P cay 95% Cl Tuoi 1,023 1,008- 1,038 0,002 Can nang 0,981 0,967-0,995 0,008 Giai doan lam sang 0,075 Giai doan 1 1,577 1,088-2,286 0,016 Giai doan 2 1,671 FF1.062-2,627 0,026 Giai doan 3 1,309 0,790-2,167 0,296 Hemoglobin 1,010 1,004- 1,016 0,001 Bang 6 cho th l y : Cac y l u t l t u l i (HR = 1,023; 9 5 % Cl: 1,008 - 1,038; p = 0,002), can nang (HR = 0,981; 9 5 % Cl: 0,967 - 0,995; p = 0,008), ndng dp hemoglobin huyet thanh (HR = 1,010; 9 5 % Cl: 1,004 - 1,016; p = 0,001) va giai doan lam sang 1 (p = 0,016) va giai doan lam sang 2 (p = 0,026) cd lien quan d i n su x u l t hien ADR tren TKTW va tarn t h i n . N l u can nang cua ngudi benh t rudc khi b i t d i u dieu trj tang them 1 don vj thl nguy co gap ADR tren TKTW giam 1,9%. Ngupc lai, n l u t u l i benh nhan tang 1 don vj thi nguy ca gap ADR tren TKTW va tarn t h i n tang 2,3% va n l u gia trj hemoglobin ban d i u tang 1 don vj thi nguy co x u l t hien bien c l tren TKTW va tarn than tang 1,1%. Benh nhan d giai doan lam sang 1 va 2 cd nguy co gap ddc tinh tren TKTW va tarn t h i n cao hon so vdi benh nhan d giai doan lam sang 4. K E T LUAN Tuy co mot ty le khdng nhd benh nhan bao cao cd gap tac dung phu ciia EFV tren TKTW va t i m t h i n nhung p h l n Idn x u l t hien sdm va d muc dp nhe nen da s i benh nhan v i n t i l p tuc dieu trj ma khdng c l n den can thiep y te hay chuyen phac do. Ket qua nay chi ra r i n g nhan vien y te can t u v i n ky ludng cho benh n h l n t rudc va trong qua trinh d i l u trj, dac biet la trong thdi gian d i u dung t h u l c de tranh viec benh nhan t y y bo thu lc . TAi LIEU THAM KHAO 1. World Health Organization (2007), Pharmacovigilance for antiretrovirals in resource-poor countries. 2. World Health Organization (2013), Surveillance of antiretroviral toxicity: HIV/AIDS programme: Surveillance of antiretroviral treatment programmes. 3. Trung tarn Di&ADR Quoc gia (2013), T ing k i t cdng tac bao cao phan ung co hai ciia thuoc (ADR) nam 2013, truy cap ngay 17 thang 11 nam 2016. 4. Ruiz N. M., Bessen L. J . , Manion D. J . , et al., "Potential adverse experiences associated with efavirenz (EFV, sustiva™) in adults", Conf Retroviruses Opportunistic Infect 1999. Chicago, IL, February 1999 [Abstract 655]. Y HOC THlTC HANH (1034) - SO 2/2017 L