Phản ứng có hại trên thần kinh trung ương và tâm thần liên quan đến EFV ở bệnh nhân điều trị phác đồ DF/3TC/EFV

JSSN 1859 • 1663
JPM

2(1034)
2017

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)

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


MUC LUC

TAP CHI

Y HOC

THI/C HANH
BO Y T E XUAT BAN
JOURNAL OF PRACTICAL MEDICINE
PUBLISHED BY MINISTRY OF HEALTH
B o trudng B o Y te

Tong Bien tap
PGS. TS. N g u y l n Th'j Kim Tien
Pho Tong Bien tap
TS. Nguyen Vinh Hung
T h u ky T o a s o a n
Ths. Bui Nam Trung
B a n 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. N g u y l n Viet Tien
GS. TS. N g u y l n Anh Tri
PGS. TS. Ngo Van Toan
PGS. TS. N g u y l n Qud'c Tuan
PGS. TS. Phan Van Tudng
PGS. TS. N g u y l n Thi Bich Lien
PGS. TS. Luang Ngoc Khue
PGS. TS. Tran Quy T u c n g
PGS. TS. Pham Thuc Hanh
TS. Vu Van Du
TS. Nguyen Bao Ngoc
Trinh bay:
N g u y l n Thai, Hai Yen
Toa s o a n : 138A G i a n g V 6 - HN
OT: 04.38460728; 04.37368092
Fax:04.38464098;
E-mail:

Website: www.yhth.vn
V a n phong dai dien phia Nam
109A P a s t e u r - Q u a ' n 1, TP. H C M
* Giay phep s o : 108/GP-BVHTT
Cap ngay 29-3-2001
ISSN 1859-1663
* Giay phep sura doi, bo s u n g
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

S6
.TRAN DlEP KHOA,
DO QUANG HUAN
• NGUYEN THI X U Y E N

• NGUYEN XUAN HUY,
TRAN VAN THANH

• NGUYEN KHAC MINH,
NGUYEN VAN SONG,
TRAN OlNH T R U N G
•NGUYEN HUNG CU'&NG,
NGO QUANG DLCONG,
TRAN Q U A N G CANH,
HIROSHI ICHIMURA,
PHAM VAN THLFC

• NGO Q U A N G DUONG.
NGUYEN VAN KHAI

• T A V A N TRAM,
PHAM T H E HIEN

•NGUYEN VAN DUNG,
TRjNH BAO NGOC,
TRAN TH| THOA,
PHAM DUY T l / O N G
• L E DiNH PHAN, NGUYEN
TUAN HUNG, OAO VAN
DUNG, TRAN VAN H I K I N G
•V0 TH| H6NG,
NGUYEN THANH H6l,
NGUYEN VAN DO AN
•TRAN DIEP KHOA,
DO QUANG HUAN
• L E THI. HUONG,
VO THI THU THUY

• NGUYEN O U C MINH

• NGO QUANG DUONG,
NGUYEN VAN KHAI

•TA VAN TRAM,
PHAM T H E HlEN

Gia 50.000d

Y H O C T H l T C H A N H (1034) - SO 2/2017

1034

=> D a c diem va cac y l u t l lien quan r l i
loan nhip nhl a benh nhan tang h u y l t
ap
T h y c trang va giai phap hieu qua
kham c h u a benh bang y hoc co t r u y l n
tinh Thai Binh d i n nam 2020
=> Nghien c u u tac dung cua mot so
loai khang sinh v d i vi k h u l n d u c n g sinh
san a nCr cong nhan khu cong nghiep
tinh Hai D u o n g nam 2016
=> Nghien c u u k i l n t h u c thai dp hanh
vi v l s u e khoe sinh san va cac y l u t l
lien quan a hoc sinh trung hoc pho
thong tai thanh p h i D a N l n g
=> Ti le n h i l m va phan b l genotype
cua Human papillomavirus
tren benh
nhan ung t h u sinh due n u

=> K i l n thuc, t h y c hanh va mot s i y l u
t l l i l n quan d i n benh giun d u c n g ruot
cua phu huynh hoc sinh co con hoc tai
4 t r u d n g tieu hoc o Hai D u o n g
=> Oac diem lam sang, can lam sang k i t qua dieu tri bao ton v o gan trong
chan t h u o n g 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 t h y c vat qua s u a m e va n u d e
tieu cua phu n u dang cho con bu d u d 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 c u u tinh hinh kiem soat hen
p h i quan va mot s i y l u t l nguy c o lien
quan theo gina 2015 tai Benh vien Dai
hoc Y Hai Phong
D a c diem va cac y l u t l lien quan r l i
loan nhip t h l t d benh nhan tang h u y l t
ap
=> Phan u n g cd hai tren than kinh trung
u o n g va tarn than lien quan d i n EFV d
benh
nhan
dilu
tri
phac
dl
DF/3TC/EFV
=> Gdp phan nghien c u u nguyen nhan
va c o c h l b i n h sinh cua benh viem
k h d p dang thap theo quan d i l m y hoc
c l truyln
=> K i l n thuc va t h y c hanh nudi con
bang sua m e cua cac ba me cd con

d u d i 2 t u l i tai mot xa huyen thanh
mien, tinh Hai D u o n g nam 2016
=> Cac y l u t l lien quan den loang
x u o n g d n g u d i cao t u l i cd benh p h l i
t i c nghen man tinh tai Benh vien Da
khoa T i l n Giang
1


MUC LUC (S6 1034)
• L E DINH PHAN,
NGUYEN TUAN HUNG,
OAO VAN DUNG,
TRAN VAN H U ^ N G
•NGUYEN TH| THANH HUONG,
HOANG T R U N G KlEN,
L U U THI ANH T U Y E T ,
NGUYEN THU TRANG,
NGO TH| T U Y E T
•NGUYEN HUY ANH,
L E THj HOAN,
T R U O N G OINH B A C
•NGUYEN THj NGA,
KIM BAO GIANG,
NGUYEN THANH HA
•PHAN Q U O C HOI

=> So sanh k i t qua trirdc - sau can thiep mo hinh tram y te xa tai 3
huyen, thanh pho tinh Hda Binh, 2016

52

=> Khao sat thai do, k i l n thi>c doi v d i s y co y khoa khdng mong
muon cua d i l u d i r d n g , hq sinh tai Benh vien Da khoa Trung i r c n g
Thai Nguyen nam 2016

56

=> D a n h gia cua cac ba me co con d i r d i 5 t u l i khi sir dung tiem
chung dich vu tai tinh Nghe An nam 2016

59

=> T i n h gia trj va dp tin cay cua mot so cdng cu thu nhan phan h l i t i r

62

=> T h y c trang u l n g mryu, bia cua nam gidi dp tuoi t i r 15 - 60 tai xa
Tay Thanh, Yen Thanh, Nghe A n nam 2015

65

•OAO TH| DUNG,
NGUYEN ANH CHI,
NGUYEN QUANG TRUNG
•TRAN TUAN ANH,
L E THI KIM DUNG,
DO THAI SON,
NGUYEN TH| HA,
L Y THUY MINH,

PHAM TRUNG KlEN,
VU VAN DU
•OINH NGOC SON,
NGUYEN L E BAO TIEN

=> M6 ta t h y c trang benh sau rang va viem l y i cua hoc sinh Trung
hoc pho thong Chu Van An quan Ba D i n h , thanh pho Ha Ndi

68

=> D a c diem benh nhi cd tang ap l y c ddng mach p h l i tai Benh vien
Da khoa Trung i r c n g Thai Nguyen

71

=> D a n h gia k i t qua c h a m sdc benh nhan sau p h i u thuat benh ly

75

giang vien va sinh vien

tmrp't dot song that lirng, that lumg cung tai Benh vien H d u nghi Niet
Ode

• L E THj H U O N G

=> Hieu qua can thiep n h a m cai thien mot so chi s i danh gia chat

77

l i r g n g d i l u tri HIV/AIDS tai Benh vien Da khoa huyen T h u a n Chau,
tinh S e n La
•TRAN NGQC Q U E

=> T h y c trang va giai phap phat then nguon nhan l y c y hoc co

79

t r u y l n tinh Quang Binh den nam 2020
•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 T R U O N G ,
NGUYEN TH| QUYNH HOA
•PHAM TUNG LAM,
BANG XUAN KET,
NGUYEN D U C TAI
•PHAM TH| T U Y E T NGA,
HOANG TH| THU TRANG,
PHAM THj HANH QUYEN
•DO VAN DUNG,
BANG TH| NGOC BICH

2

=> K i l n t h d c va t h y c hanh tiem an toan cua d i l u d i r d n g vien Benh

82

vien Da lieu Trung i r a n g n a m 2012
=> Oanh gia t h y c 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 s d c khde khi s d dung t h u l c bao ve

87

t h y c vat cua ngirdi nong dan canh tac che tai Thai Nguyen nam 2016
=> Nghien c d u cac yeu t l tien lireng t d vong b i n h p h l i tac nghen

90

man tinh tai B i n h vien Da khoa Trung tarn Tien Giang
=> T h y c trang s d c khoe va benh t h i r d n g gap d cdng nhan lao dpng

94

trong mdi tmrdng vi khi hau nong tai Cdng ty Gang thep Thai Nguyen
=> Nghien c d u dieu kien lao ddng va mdi tmrdng anh h i r d n g d i n s d c

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 t h i r c n g md c d n g viing c l rang

100

=> Cac yeu t l nguy c c trong benh cham tay cua nhan vien y t l

102

Y H O C THlTC HANH (1034) - SO 2/2017


•PHAM NHUHUNG,
NGUYEN QUANG TUAN

T h a m do dien sinh ly hoc tim tren benh nhan co dien tarn 66
Brugada

•VO THj LAN,
DO QUANG HUAN
•MAI THj HlEN,
D 6 GIA TUYEN,
DANG THI VIET HA
•PHAN Q U 6 C HOI

=> Benh dpng mach vanh tren n h d n g benh nhan co b#nh van tim
d i r a c p h l u thuat van tim tai Vien Tim thanh pho Ho Chi Minh

•OAO TH| DUNG,
NGUYEN ANH CHI,

NGUYEN QUANG TRUNG

=> 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 n r g u , 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 c h a m sdc rang mieng
vdi benh sau rang, viem lei ciia hoc sinh t r a d n g Trung hoc p h i thong
Chu Van An, quan Ba B i n h thanh p h i Ha Ndi

• L E TH| THANH HUONG,
CHU VAN THANG
VU DlEN, L E THj THANH XUAN
•NGUYEN TH| HOAI,
DOAN TH| HUONG,
L U U THj ANH T U Y E T

=> Sir tham gia cua giao vien tieu hoc trong cdng tac y te t r i r d n g hoc
tai quan Thanh Xuan, nam 2012

•NGUYEN THAI HUNG
D U O N G MINH D U C

=> D a n h gia m d c dp h i l u cua can bp y t l v d i bp cdng cu do l i r d n g
mdi t r i r d n g lam viec ( C O A C H ) tai Quang Ninh
=> Phan d n g cd hai tren than lien quan den T D F d benh nhan dieu trj
phac dd TDF/3TC/EFV

• L E TH| HUONG,
VO TH| THU THUY

•NGUYEN D U C MINH
•HOANG TH| P H U O N G
•NGUYEN VAN S O N

=> 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 r a n g
Thai Nguyen

=> Vai trd va djnh h i r d n g phat trien p h i r a n g phap dieu trj giam dau
ben ngoai d l i v d i benh ly x i r a n g k h d p b l n g t h u l c Y hoc c l t r u y l n
=> T i l p can c h i n doan benh do Mycobacteria khdng lao

•DANG HUNG MINH

D a n h gia nguy c c va ty le hien mac benh n h i l m doc hda chat bao
ve thirc vat d n g i r d i lao ddng ndng nghiep 2012
=> Nghien c d u dac d i l m lam sang va can lam sang d benh nhan
tran khi mang p h l i d i r d i 30 t u l i tai Trung tarn Hd h i p Benh vien
Bach Mai

•PHAM THj THU THUY,
DAU XUAN CANH,
NGUYEN TH| B A C H T U Y E T

=> Danh gia m l i lien quan giira trieu c h d n g lam sang, hinh anh ndi
soi, md benh hoc, HP va PH djch vj cua benh ly da day - ta trang tren
benh nhan x a gan

•TRAN VAN THANH,
NGUYEN VAN LANH

=> Nghien c d u k i l n thCrc, thai dp, thirc hanh va mot s i y l u t l lien

•TRAN THj MAI OANH,
NGUYEN TH| HUONG,
PHAN L E THU HANG
•DOAN TH| N G A
O A O T l E N TH|NH,
LA VAN LUAN
•TRAN ANH VU,
NGUYEN TH| S O N
•BINH QUANG HUY,
TRjNH HOANG HA,
VU NGQC
•BUI TH| VAN ANH,
NGUYEN XUAN HIEP
•BP NGOC SON,
NGUYEN VAN CHI,
NGUYEN DANG O U C
•VU TUAN ANH,
NGUYEN D U Y A N H

quan d i n phdng cum gia e l m trirdc va sau can thiep cua ngizdi dan
tai cac hp cd nudi gia c a m 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 r d n g 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 r a n g Thai Nguyen nam 2016
=> Cac y l u t l anh h i r d n g d i n thirc hien hoat ddng the lire tren benh

nhan tang h u y l t ap tai Benh vien Trung i r a n g Thai N g u y l n nam 2016
=> Tinh trang dinh d i r d n g t h l hien qua chi s i BMI va trang thai huyet
ap cua sinh vien nam t h d n h l t Dai hoc Q u l c gia Ha Npi, nam hoc
2014-2015

152

=> T r i r d n g h g p co rut mi tren sau p h l u thuat cat be

161

=> Hieu qua ciia thir nghiem t h d tir nhien b l n g may t h d cd mode
"SBT" cho benh nhan d g t c l p C O P D

163

Thai dp x d tri v d i thai du thang t h i l u l i tai Benh vien Phu san Ha

165

Ndi

156
158


•DANG HUNG MINH,
TRAN VAN CITONG

=> Nghien cCru dot b i l n E G F R 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

.PHAM TH! THU THUY
OAU XUAN CANH
NGUYEN THI B A C H T U Y E T
•NGUYEN L E BAO TlEN,
DINH NGOC SON,
NGUYEN DUY LUAT
•D6 THjOlEP,
PHAM VIET C U O N G ,
L U O N G MAI ANH,
TRAN QUANG D U C
HA ANH D U C
•TO THANH P H U O N G ,
DANG HOANG ANH
• L E TH| HUONG,
OOAN THUY LINH
•NGUYEN THAI HUNG
D U O N G MINH D U C
•NGUYEN D U C 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 O U C 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 T H U C

=> Gia trj npi soi da day trong phat hien s d m ung thir da day

•DANG HUNG MINH,
BUI T U O N G LAN
•PHAM THj THU THUY,
DAU XUAN CANH ,
N G U Y E N THj B A C H T U Y E T
•TRAN TH! MAI OANH,
N G U Y E N THI H U O N G ,
PHAN L E THU HANG
•CHU TRAM ANH,
PHAM THj THU HIEN
•NGUYEN MANH C U O N G ,
L E HOANG TUAN
•HOANG NGQC SON,
NGO HUU HANH

4

=> Dac diem r l i loan c h d c nang ho h i p t n r d c m l cua benh nhan veo
cot s i n g n g y c d i r g e phau thu|t chinh hinh tai Benh vien HOm nghj Viet
Dire

171

=> Bao Igc dien tir va mot s i y l u t l lien quan tai T r i r d n g Trung hoc
p h i thong C h i r c n g My A - C h i r c n g My - Ha Npi

173

=> 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 h g p v d i 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 e m tai Benh vien Nhi

178

Trung i r c n g
=> D a n h gia dp tin cay kiem tra lai bp cong cu do lirdng mdi trirdng

182

lam viec (COACH) tren can bo y t l tai Quang Ninh
=> Mo hinh gay viem k h d p gut cai tien tren ddng vat t h g c nghiem

186

=> T h g c trang suy dinh d i r d n g d tre d i r d i 5 t u l i tai huyen Thanh Mien

188

- Hai D i r c n g 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 r c n g 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 s o sinh tai
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
d i r d n g 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
tl
=> K i l n thirc, thai dp, t h g c hanh phdng c h l n g tac hai n g h l nghiep cua
cdng nhan tinh Tra Vinh nam 2013

198
201
205
207

= > T h g c trang sire khoe tarn t h i n cua hoc sinh T r i r d n g Trung hoc c c

s d Quang Trung, thanh p h i Thai Nguyen, tinh Thai Nguyen

211

=>Ket qua c l djnh rang va xiromg I rang bj sang c h i n bang nep
composite
=> Nghien ciru v l nguyen nhan va cac dac diem lam sang, c|n lam
sang cua tran djch da mang djch t i l t
=> Mot s i nhan xet 65 t r i r d n g h g p u vu da d i r c c c h i n doan mo benh
hoc

214

= > K i l n thirc, thai dp, t h g c hanh ve Iga chpn gidi tinh khi sinh cua
cac san phu tai Benh vien Da khoa Q u l c t l Hai Phong

221

=> Nghien ciru dac diem lam sang, X quang va hinh thai I n g tuy cua
rang ham Idn thir hai h a m d i r d i
=>Banh gia k i t qua sir dung fibrin giau tieu cau trong phau thuat n h l
rang ham Idn t h d ba ham d i r d i
=> T r i r d n g h e p dieu trj gay x i r c n g got di lech d y e e n l n chinh c l djnh
bang dinh steinmann (nhan xet cai tien cua f.kermad)

224

216
220

226
228

Y H O C THlTC HANH (1034) - SO 2/2017


•PHAM TH| THU HlEN
•DUONG TRONG TAN,
HOANG NGOC SON,
NGUYEN THUY QUYNH
•NGUYEN O U C NHU,
TRAN ANH TUAN
•OOAN TH! HUE

=>Banh gia dac diem lam sang, X quang nhom rang phia t r u c e co s u
dung c h i t soi
= > K i l n t h u c va t h y c hanh ve tiem an toan cua sinh vien dieu d u o n g
T r u c n g 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 t h u c n g c c the c
n h u n g t r u c n g hep c h i n t h u c n g m l t

232
235

237

= > K l t qua can thiep nang cao nang l y c ciia ba me vk cham sdc ve
sinh, u Im d tre s o sinh non thang d i l u tri tai Trung tarn Nhi khoa,
Benh vien Trung u c n g Thai Nguyen

239

•TA VAN TRAM,
PHAM THE HlEN
• NGO THj D'?U MINH,
D 6 QUANG HUAN

=>Tinh hinh c h u a rang tai Benh vien Da khoa T i l n Giang

242

=> Nghien c u u r l i loan nhjp t h l t d benh n h l n suy tim man tinh t r u c e
va sau d i l u tri bang t h u l c u c che beta

248

•NGUYEN TH! H 6 N G VAN,
HOANG BUI HAl,
VIEN VAN DOAN
.OINH NGQC SON,
NGUYEN L E BAO TIEN

=>Tinh trang khang insulin va t i n t h u o n g m l t d cac benh nhan r l i
loan glucose luc ddi cd tang h u y l t ap

252

=> 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,
t h l t lung b l n g b o m cement sinh hoc tai Benh vien H u u nghj Viet D u e

=>Danh gia k i t qua d i l u trj npi nha rang ham Idn t h u hai ham d u d i tai
Benh vien Rang Ham Mat Trung u o n g Ha Npi

253

.HOANG NGQC SON,
NGUYEN TRONG TIN,
NGUYEN THlilY QUYNH

= > T h y c hanh va mot s i yeu t l lien quan d i n t h y c hanh phdng benh
n h i l m xa nghe nghiep cua n h l n vien x-quang tai cac c o s o y te tren
dja ban tinh Quang Ngai nam 2016

257

•HOANG THj PHUONG,
B A C H VAN HO ANH

=> Nghien c u u mot s i y l u t l lien quan d i n mat dp x u o n g d benh
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
ty C l p h l n H o p kirn S i t - Gang Thep Thai Nguyen
= > B a n h gia k i t qua d i l u trj ndi nha rang ham s u a

260

.PHAM TH! THU HlEN

•NGUYEN VAN SON,

DINH THUC NGA
• L E THj THUY LINH,
L U O N G MINH HANG
TRAN THj MY HANH,
NGUYEN THj THU HlEN
•DANG HUNG MINH
•PHAM THj THU THUY,
DAU XUAN CANH,
NGUYEN THj B A C H T U Y E T
•TRAN THj MAI OANH,
NGUYEN THj HUONG,
PHAN L E THU HANG
•PHAN THj T 6 NHU,
NGUYEN THj H U O N G GIANG
•NGUYEN L E BAO TlEN,
OINH NGOC S O N
•DANG HUNG MINH,
BUI THj P H U O N G THAO
•NGUYEN D U C NHU,
TRAN ANH TUAN
•NGUYEN THI H U O N G GIANG,
PHAN TH! T 6 NHU
•YHTH

255

262
266

=> Nghien c u u dac d i l m lam sang, can lam sang cua viem p h l i d

benh nhan ung t h u phoi
=>So sanh tac dung cua t h u l c ampelop va ampelop k i t h o p v d i
amoxycilline + metronidazole trong d i l u trj loet da day - ta trang

270

=>Mdt s i y l u t l lien quan den viec l y a chpn gidi tinh khi sinh cua
cac ba me den sinh con tai Benh vien Da khoa Q u l c t l Hai Phdng

274

=>Xac djnh can nguyen va tinh khang khang sinh cua vi k h u l n d
benh nhan n h i l m k h u l n huyet d u o c 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 r u o t d l t
s i n g t h l t lung, t h l t l u n g ciing Benh vien H u u nghj Viet D u e
=>Dac d i l m lam sang, can lam sang, nguyen nhan hoi c h u n g thuy
g i u a tai Trung t i m Hd h i p Benh vien Bach Mai
=> Nghien c u u mot s i dac diem c h i n t h u o n g m l t qua giam djnh t i n
thuong co t h l
=>Cac c h i t u c che SGLT2-nhdm t h u l c m d i trong d i l u trj benh dai
thao d u o n g
=>Thdng tin y hoc

276

Y H O C TH1/C HANH (1034) - SO 2/2017

272

279
282
285
287
290

5


nhip nhanh t h l t giua ngay va dem. Co s y t u o n g quan
giua t u l i , thai gian THA, d u d n g kinh nh7 trai, chi s i
k h l i c a t h l t trai, EF v d i s i l u g n g NTT t h l t trong 24
gid. Nguy c a RLN t h l t day hoac p h d c tap d benh
n h l n THA > 60 t u l i , thai gian THA > 5 nam va cd benh
D M V l l n l o o t la OR = 3,71 ( 9 5 % C I : 1,54 - 8,92), OR =
6,53 ( 9 5 % C I : 2,59 - 16,51) va OR = 2,78 ( 9 5 % C I : 1,16
- 6,65). Nguy c a RLN t h l t day hoac p h d c tap d benh
nhan THA cd PBTTr va EF < 5 0 % l l n l o o t la OR =
2,48 ( 9 5 % C I : 1,18 - 5,20) va OR = 4,89 ( 9 5 % C I : 2,11
-11,09).

TAI L I E U THAM K H A O
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| H U O N G , V O THj T H U T H U Y
Cue Phong, chong HIV/AIDS, Twang Dai hoc Dope
TOM T A T
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:

Ngay nhan:
Ngay phan bien:
Ngay duyet bai:

Ngay xuit ban:

40

Ha Npi

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

O A T VAN O E
T h u l c A R V da d e m lai nhieu loi fch cho benh nhan
HIV/AIDS. Tuy nhien, trong qua trinh s o dung van
t h u d n g xay ra cac v i n d i lien quan den an t o l n t h u l c ,
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 d u o c khuyen cao giam sat [2].
Tai Viet Nam, s i l u o n g bao cao v l phan d n g cd
hai cua t h u l c con r l t han c h l va khdng phan anh dung
t h y c t l d i l u trj [3]. Vi vay, chung tdi t i l n hanh nghien
c d u : 'Phan d n g cd hai tren than kinh trung u o n g va
tarn t h i n lien quan t d i EFV tren benh nhan dieu trj
phac do
TDF/3TC/EFV".

Y H O C T H l T C H A N H (1034) - SO 2/2017

i


D 6 l T U Q N G VA P H U O N G PHAP NGHIEN C U U
1. Doi tircmg nghien ciru
Gom 841 benh nhan m d i dieu tri phac do
TDF/3TC/EFV tai 5 tinh/thanh pho trong t h a i 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 d u p e tham gia nghien c d u .
2. P h u a n g phap nghien c u i i
Nghien c d u thuan tap tien c d u thong qua bao cao

to nguyen cd chu dich.
Sd lieu thu thap d u p e lam sach, nhap b l n g Epidata
3.1, quan ly va phan tich b l n g S P S S 16.0. Sir dung ky
thuat phan tich thong ke md ta, kiem dinh X2 va md
hinh hoi quy logistic de t i m moi lien quan.
K E T Q U A VA BAN LUAN
1. T h o n g tin c h u n g ve doi t u p n g nghien c u u
Dac diem cua m i u benh nhan trong nghien c d u
khdng cd s o khac biet nhieu v d i dac diem benh nhan
n h i i m HIV/AIDS tai Viet Nam. Trong 838 benh nhan
dirge chgn thi nam gidi c h i l m ty le nhieu h o n 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 r d n g tinh due ( 5 8 , 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 6 2 , 4 % .
2. O a c diem A D R tren T K T W va tarn than lien
quan den E F V
Cd 324 benh nhan (chiem 3 8 , 7 % ) tren tong sd 838
benh nhan d i r g e nghien ciru gap b i l n cd tren T K T W
va tarn t h i n . Ty le nay t h l p h o n k i t qua trong nghien
cdu cua Ruiz va cong s g ( 5 4 % ) [4], Nelsona va cdng
sy nam 2010 (46,2%) [5], S y khac biet nay cd the la
do t h i l t ke nghien ciru khac nhau (co mau, tieu c h u l n
lya chpn benh nhan, tieu c h u l n danh gia), c h i t lirgng
cua cac p h i r o n g phap danh gia, each sir dung cac
thuat n g u ("doc tinh tren t h i n kinh trung i r a n g " , "tarn
t h i n " , "tarn than, than kinh trung i r a n g " ) . Tuy nhien,
d i l u dang chu y d day la ty le 3 8 , 7 % trong nghien ciru

cua chung tdi v i n cao h o n nhieu khi so sanh v d i
nghien ciru g i n day tai Viet Nam cua N g u y i n P h i r o n g
Thuy nam 2013 (12,3%). Nghien ciru cua N g u y i n
Phirong Thiiy la nghien ciru t i l n ciru theo p h i r o n g
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 n h i n , t i t ca cac
benh nhan d m l u theo ddi dinh ky hang thang d i u
d u p e 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 d u p e ghi nhan vao
hd s o 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 i r a n g va tarn
than d i u d u p e bac s i chu y theo ddi, ghi n h l n .

Y HOC THlTC HANH (1034) - SO 2/2017

2.1. Tan suit gap ADR tren TKTW va tarn than
Bang 1. Cac bieu hien ADR tren T K T W va tarn t h i n
STT
1
2
3
4
5
6
7

8
9
10
11
12
13
14

Bidn c6 co hai
Chong mat
Dau dau
Met moi
Cam giac nong bung
Buon non
Mo nhieu, g i l c mo rd rang
M l t ngu
Ac mong
Lo ling
Di cam: dau , ngira , rat, kiln bo
Giam/mat tap trung
Co y dinh t y tip
T r i m cam
Bieu hien khac

n = 838
248
163
163
90
82

45
43
39
31
6
5
1
1
6

%
19 5
19,5
1n 7
9,3
5.4
5,1
4,7
3,7
0.7
0,6
0,1
0,1
0,7

Bang 1 cho t h l y : Bieu hien ADR d u p e ghi nhan
n h 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 b u n g (10,7%). Mot
sd ADR nang n h u cd y dinh t y tip va t r i m cam cung
d u p e ghi n h l n v d i ty I I 0 , 1 % . K i t qua nay t u o n g ddng

vdi thong tin d u p e ghi nhan trong y van cung n h u
nhung nghien ciru tong quan [4],
2.2. Xac suit xuat hien ADR tren TKTW va tarn
than
Bang 2. T h d i gian t u khi dung thudc d i n khi x u l t
hien ADR tren T K T W va tarn than
Thai gian
n
Dudi 1 t u l n
136
1 tuan - <1 thang
170
1 thang - 3 thang
18
> 3 thang
0
Thong so thong ke (ngay)
Gia tri trung vi: 7 Tir phan vi 25%: 1
Tu phan vi 75%: 10

%_
42,0
52,5
5,5
0,0

Bang 2 cho t h l y : T h d i gian trung binh gap ADR
tren T K T W va tarn t h i n la 9,3 ± 12,7 ngay va t h u d n g
x u l t hien s d m trong vdng 1 t u l n (42,0%) den 1 thang
(52,5%), Theo Kenedi va cdng s y (2011), cac ADR

t h u d n g 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
t h l y , c l n phai chu trong theo ddi ADR tren T K T W va
tarn t h i n ngay sau khi d i l u trj de cd bien phap can
thiep xir tri kjp thdi, h o p 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 T K T W va tarn
than
Phan loai
Muc do 1 (nhe)
Muc do 2 (trung binh)
Muc do 3 (nang)
Muc do 4 (tu vong, de doa tinh mang)

n
249
72
3
0

%
76,9
22,2
0,9
0,0

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
Tu van, tiep tuc ulng thuoc
Dung them thulc xi> tri
Giam lieu
Ngimg thuoc
Doi phac do
Chuyen tuyln

n = 324
314
4
0
1
4
1

%
96,9
1,2
0,0
0,3
1,2
0_3_

Bang 3 va 4 cho t h l y : P h l n Ian cac ADR tren
T K T W va tarn t h i n xay ra d m d c dp nhe (76,9%) va
m d c dp trung binh (22,2%). Chi cd 3 t r u d n g h p p b i l n
co cd hai xay ra d m d c dp nang (0,9%). Vi vay, p h l n

Idn cac benh nhan d u p e t u v i n va each u l n g thuoc
hpp ly c h i l m 9 6 , 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 r u d n g h p p phai tarn
n g u n g t h u l c do bi phat ban do 3 va sau dd s u dung lai
t h u l c EFV thi phan u n g khdng x u l t hien lai. Cd 4 benh
nhan phai d l i phac d l ( c h i l m 1,2% trong t i n g s i benh
nhan gap ADR) cd 2 t r u d n g h p p d m u c dp nang, 2
t r u d n g h p p d m u c d | trung binh. Theo Ribaudo va
cdng s u (2004), khoang 4 % benh nhan phai d l i phac
d l do ddc tinh tren t h i n kinh trung u a n g lien quan d i n
EFV. Ty le benh nhan d l i phac d l d nghien c u u cua
chung tdi t h l p han, cd the do dac diem benh nhan
khac nhau, h a n n u a viec xac djnh m u c dp nghiem
trpng cua cac b i l n c l tren he than kinh trung u a n g va
tarn t h i n la mot v i n de khd d i n g n h l t d l i v d i cac bac
s i do quan niem/nhan thuc cua bac sy v i m u c dp
nghiem trpng cua phan u n g cd hai khac nhau nen cd
q u y l t djnh khac nhau. Vi vay, ty le d l i phac do cd the
dao ddng g i u a cac nghien c u u .
3. C a c y e u t l lien quan den A D R tren T K T W v a
tarn than c u a E F V
Bang 5. Phan tich d o n bien cac yeu t l anh h u d n g
tdi t i n s u i t x u l t hien A D R
Yeu to

HR

Tuoi (nam)
Gidi (nam/nu)

Can nang
Giai doan lam sang
Giai doan 1
Giai doan 2
Giai doan 3
CD4
Hemoglobin
ALT
eGFR baseline
[Cre) baseline

1,020
1,043
0,992

Khoang tin cay
9 5 % Cl
1,006- 1,034
0,930- 1,170
0,980 - 1,005

1,460
1,451
1,136
1,000
1,008
0,999
0,997
1,000

1,022- 2,089
0,936 - 2,255
0,698 - 1,850
1,000- 1,001
1,003- 1,013
0,996 - 1,002
0,993 - 1,002
0,994 - 1,005

P
0,005
0,470
0,215
0,135
0,038
0,096
0,609
0,269
0,004
0,411
0,215
0,928

Bang 5 cho t h l y : K i t qua phan tich d o n bien da
phat hien 3 yeu t l anh h u d n g t d i tan s u i t x u l t hien
ADR tren T K T W 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 h u y 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 d o n vj thi nguy

c o x u l t hien ADR tang them 2 % . N l u ndng dp
hemoglobin ban d i u tang them 1 d o n vj thi nguy c o
x u l t hien ADR tang them 0,8%. Nguy c o m l c b i l n c l
tren T K T W va tarn t h i n d nhdm benh nhan d giai doan
lam sang 1 cao h o n 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
h u d n g tdi t i n s u i t x u l t hien ADR
Yeu to

HR

Khoang tin
cay 9 5 % Cl
1,008- 1,038
0,967-0,995

1,023
Tuoi
Can nang
0,981
Giai doan lam sang
1,577
1,088-2,286
Giai doan 1
1,671 FF1.062-2,627
Giai doan 2
1,309
0,790-2,167
Giai doan 3

Hemoglobin
1,010
1,004- 1,016

P
0,002
0,008
0,075
0,016
0,026
0,296
0,001

Bang 6 cho t h 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
s u x u l t hien ADR tren T K T W va tarn t h i n . N l u can
nang cua n g u d i benh t r u d c khi b i t d i u dieu trj tang
them 1 d o n vj thl nguy c o gap ADR tren T K T W giam
1,9%. N g u p c lai, n l u t u l i benh nhan tang 1 d o n vj thi
nguy c a gap ADR tren T K T W va tarn t h i n tang 2 , 3 %
va n l u gia trj hemoglobin ban d i u tang 1 d o n vj thi
nguy c o x u l t hien bien c l tren T K T W va tarn than tang
1,1%. Benh nhan d giai doan lam sang 1 va 2 cd nguy
c o gap ddc tinh tren T K T W va tarn t h i n cao h o n so
vdi benh nhan d giai doan lam sang 4.
KET LUAN
Tuy co mot ty le khdng nhd benh nhan bao cao cd

gap tac dung phu ciia EFV tren T K T W va t i m t h i n
nhung p h l n Idn x u l t hien s d m va d m u c 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 l u d n g cho
benh n h l n t r u d c 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 t h u l c .
T A i L I E U THAM K H A O
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 i n g 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., B e s s e n 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].

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