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2 0 1 7

tap cA l

DtfOC HOC

SO 495 * NAM THl> 57 * THANG RA 1 KY * ISSN 0866 - 7861

Momordica charantia L.

rA Ho Bau bi - Cucurbitaceae

CAY KHO QUA RIJNG

BO Y XUAT BAN

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TAP CHI D U g C HOC

ISSN 0866 - 7861

7/2017 (So 495 NAM 57)

MUC LUC

NGHIEN CCfU - KY THUAT

0A0 NGUYET SUONG HUYEN, NGUYEN VAN HAl, BUI THj HONG
NHUNG, NGUYEN DlNH LUYEN: Nghien CLHU tong hgp mesna tir

1,2-dicloroethan qua trung gian muoi Bunte 2
NGUYEN THI KIM THU, DANG KIM THU, BUI THANH TUNG:_Tac dyng

quet goc ty do DPPH va ire che AchE cua cac phan do?n tir re dan sam

(Salvia miltiorrhiza Bunge) a Viet Nam 5

TRAN ANH VU, HOANG THAI PHUONG CAC: Nghien ciru tic dung ha
glucose huyet va doc tinh cap ciia che pham com hon djch tir cao que va

kho qua loai qua nho 9
NGUYEN CAO TOAN, TRUONG TH| DEP LE NGQC KiNH: Nghien ciru

dac diem hinh thai va cau tao vi hpc cua cay xirong chua - Hibiscus

surattensis L, hp Bong - Malvaceae 12

VU VAN DUY, NGUYEN TH| HU&NG, NGUYEN THACH TUNG: Nghien
ciru xay dpng cong thirc bao che vi nhu tuang betamethason dipropionat 17
! T6NG TH| THANH VUQNG, TRAN THj HANG, TRAN CAO SON, 1_E

TH| HONG HAO, LE DlNH CHI: Xay dpng phaang phap djnh lirgng
dong thai ba doc t6 acid okadaic, dinophysistoxin-1 va dinophysistoxin-2
a dpng tp do trong nhuyen the hai manh vo bang sic ky long sieu hieu

nang ket noi khoi pho hai Ian (UPLC-MS/MS) 21
i HUYNH TH| MY DUYEN, BUI TH| VAN KHANH, HUYNH VAN H6A,

D O TH| HONG TUOk Khao sat hoat tinh doc te bao ung thu- da day cua
vien nen noi chua curcumin tren dong te bao ung thu da day ngudi N87 24
i D 6 HOU XUAN, PHAM VAN HIEN, CAO VAN ANH, NGUYEN TH|

THANH PHU'ONG, NGUYEN THj TUYET, DAO VAN DON: Nghien ciru
djnh lupng S-allyl-L-cystein trong toi den bing phuang phap tao dan chat

phat huynh quang vdi Dansyl clorid 28

- HA VAN THUY, NGUYEN ANH PHU'ONG, LE THU THUY: Phan tich ca

cau thuoc sir dung tai Benh vien Phu San Ha Noi nam 2014 30
. NGUYEN VIET TAN, NGUYEN VAN TAN MINH, TRUONG NGOC

TUYEN, NGUYEN DUC TUAN: Tong hpp va tieu chuan hoa tap chat

L-cystin va A/,N-diacetyl-L-cystin cua W-acetylcystein 35
» NGUYEN THj TRANG OAl, HUYNH NGOC THMY HUYNH KY: Nghien

ci>u thpc vat hpc va da dang di truyen cua Clinacanthus nutans tai Vipt

Nam 40
• NGUYEN VAN LlNH, DUONG THj HAl YEN, HOANG LE TUAN ANH,

VU MANH HUNG, PHAM THANH KY: Hai flavanonol-glucosid phan lap
ti> phan tren mat dat cay tien hac thao {Aghmonia pilosa Ledeb. var.

pilosa) 46

» TRAN VIET HUNG, LE OiNH CHI, NGUYEN TlEN OAT: Nghien ciru
chiet, phan lap va tinh chi apigenin ti> flavonoid toan phan chiet tir cue
hoa vang (Chrysanthemum indicum L.) lam nguyen lieu thiet lap chat

chuan 50
• NGUYEN TlEN VUNG, VO DUC Lai: Mot so hpp chat phan lap tir la cay

gan heo (Dicliptera chinensis (L.) Nees) 54
• HA VAN OANH, VO VAN DiEN: Nghien ciru dpc tinh cip va tic dung Ipi

mat ciia bai thuoc BG 57
• LE THANH LONG, NGUYEN TRAN VAN ANH, CHUONG NGOC NAI,

HOANG DiNH HUU HANH, NGUYEN OliC TUAN: Tong hpp va xac dinh
dp tinh khiet tip chat lien quan 2-azaspiro[4.5]decan-3-on cua gabapentin 60

» NGUYEN T H U MINH, NGUYEN THI TUYEN, TRAN NHAN THANG,

DUONG OUC HUNG, CAN TUYET NGA, NGUYEN TlEN PHUONG,
NGUYEN MAI HOA, NGUYEN HOANG ANH: Khao sat tinh hinh tieu thu
khang sinh carbapenem tii Bpnh vien Bach Mai trong giai doan tu nam

2012 den nam 2016 63
» TRAN HUU TAM: Xay dung thanh phan moi trudng chua P. aeruginosa

gop phan tio mau kiem chuan xet nghipm 67
• NGUYEN THj MAI: Cac hpp chat lignan glycosid tu qua cay lien kieu

(Forsythia suspensa (Thunb.) Vahl.) 70

» TRAN ANH VO, HUYNH THANH HAU: Nghien cuu dieu che cao giau
hpp chat saponin tir qua kho qua (Momordica charantia L. var. abbreviata

Ser.) 73

• PHAN OiNH CHAU, TRAN THj VAN, TRAN THI HANG, NGUYEN VAN

THINH, VO BiNH DUONG: Nghien cuu ve cac dan chat cua adamantan.
Phan X: Nghien cuu tong hpp 1-amino-adamantan hydroclorid di tir

1-bromo-adamantan va acetonitril tren ca sd phan ung kieu Ritter 77

PHARMACEUTICAL JOURNAL

ISSN 0866 • 7861

7/2017 (N° 495 Vol. 57)

CONTENTS

RESEARCH - TECHNIQUES

»OAO NGUYET SUONG HUYEN, NGUYEN VAN HAl, BUI TH|
HONG NHUNG, NGUYEN OINH LUYEN: Synthesis of mesna from

1,2-dichloroethane using Bunte salt approach 2
» NGUYEN TH| KIM THU, OANG KIM THU, BUI THANH TUNG: DPPH

radical scavenging and acetylcholinesterase inhibitory activities of

fractions from the roots of Salvia miltiorrhiza Bunge in Vietnam 5
• TRAN ANH VU, HOANG THAl PHUONG CAC: Hypoglycemic property

and acute toxicity of granules of condensed combined extracts of

Cinamomum (Cinnamomum obtusifolium Nees.) and wild bitter melon

(Momordica charantia L. var. abbreviata Ser.) 9

• NGUYEN CAO TOAN, TRUONG THIDEP LE NGOC KINH: Macroscopic
morphology and microscopic anatomy of the plant Hibiscus surattensis L.

(Malvaceae) 12
• VO VAN DUY, NGUYEN THj HUftNG, NGUYEN THACH TUNG: Study

on preparation of dosage form containing betamethasone dipropionate in

nano-sized micro-emulsion 17
• T6NG THI THANH VUONG, TRAN THj HANG, TRAN CAO SON, LE

THj H6NG HAO, LE DiNH CHI: Simultaneous determination of the toxic
residues of okadaic, dinophysistoxin-1 and dinophysistoxin-2 in bivalve

mollusk by UPLC-MS/MS 21
• HUYNH THj MY DUYEN, BUI THI VAN KHANH, HUYNH VAN H6A, DO

TH| H6NG TUOI: Cytotoxicity of the gastric floating tablets of curcumin

on the human gastric cancer line N87 24
• 0 0 HUU XUAN. PHAM VAN HlEN, CAO VAN ANH, NGUYEN THI

THANH PHUONG, NGUYEN THj TUYET, DAO VAN DON: Preparation
of the fluorescent derivative of S-allyl-L-cysteine with Dansyl chroride for
subsequent quantitative determination of S-allyl-L-cysteine in black garlic

by HPLC-FLD 28
• HA VAN THUY, NGUYEN ANH PHUONG, LE THU THUY: Analysis of

the structure of drug use at Hanoi Obstetrics and Gynecology Hospital

in 2014 30
• NGUYEN VIET TAN, NGUYEN VAN TAN MINH, TRUONG NGOC

TUYEN, NGUYEN DUC TUAN: Synthesis and standardization of L-cystin

and N,N'-diacetyl-L-cystin as related N-acetylcystein impurities 35
• NGUYEN THj TRANG OAl, HUYNH NGOC THUY, HUYNH KY: Study on

botany and genetic diversity of Clinacanthus nutans in Vietnam 40
• NGUYEN VAN LlNH, DUONG THj HAl YEN, HOANG LE TUAN ANH,

VO MANH HUNG, PHAM THANH KY: Two flavononol glucosides isolated

from the aerial parts of Agrimonia pilosa Ledeb. var. pilosa 46
• TRAN VIET HUNG, LE DINH CHI, NGUYEN TlEN OAT: Isolation of

apigenin from the extracts of total flavonoids from Chrysanthemum 
indicum L. and its purification for establishment of its reference standard 50
• NGUYEN TlEN VUNG, VU DUC LOI: Some phytochemical compounds

from Dicliptera chinensis (L.) Nees 54

• HA VAN OANH, VO VAN OlEN: Choleretic activity and acute toxicity of

the herbal remedy BG 57
• LE THANH LONG, NGUYEN TRAN VAN ANH, CHUONG NGOC

NAI, HOANG DiNH HUU HANH, NGUYEN DUC TUAN: Synthesis
of 2-azaspiro[4.5]decan-3-on and determination of its purity for use in

impurity control of gabapentin 60

• NGUYEN T H U MINH, NGUYEN THj TUYEN, TRAN NHAN THANG,

DUONG DUC HUNG, CAN TUYET NGA, NGUYEN TlEN PHUONG,
NGUYEN MAI HOA, NGUYEN HOANG ANH: Actual use of carbapenem
antibiotics in the Central Hospital of Bach Mai in the period of 2012 - 2016 63
• TRAN HUU TAM: Formulation of the medium for laboratory microscopic

examination samples of P. aeruginosa 67
• NGUYEN THj MAI: Lignan glycosides from the Fmctus forsythiae of

Forsythia suspensa (Thunb.) Vahl. 70

• TRAN ANH VO, HUYNH THANH HAU: Preparation of saponin-rich

extracts from the fruits of Momordica charantia L. var. abbreviata Ser. 73
• PHAN DiNH CHAU, TRAN THj VAN, TRAN THj HANG, NGUYEN

VAN THjNH, VU BiNH DUONG: Study on adamantine derivatives.
Part X: Synthesis of 1-amino-adamantane hydrochroride from

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• Nghien

cveu

- Ky thuat

Khao sat tinh hinh tieu thu khang sinh carbapenem

tai Benh vien Bach Mai trong giai (loan

r

tir nam 2012 den nam 2016

Nguyen Thu Minh

2

, Nguyen Thj Tuyen

1

, Tran Nhan ThSng

2

Diromg Dire Hung

2

, Can Tuyet Nga

2

, Nguyen Tien Phiromg

2

Nguyen Mai Hoa

1

, Nguyen Hoang Anh'*

'Trung tarn DI va ADR Quoc gia, Tru&ng Dai hoc Dupe Ha Noi

2Benh vien Bach Mai 
* E-mail:

Summary

The consumption of carbapenem antibiotics in Bach Mai Hospital was characterized, analysing the trend from 2012 
to 2016. Dispensing data of all carbapenem prescriptions and relevant population data were collected to measure the 
defined daily doses (DDDs) per 100 patient-days. The level of carbapenem consumption was so high in 2012 (1385 
DDD/100 patient-days) continuouly increased almost two-fold in 2016 (2475 DDD/100 patient-days). The Intensive 
care unit, Respiratory Center and Department of Infectious Diseases were responsible for the highest carbapenem 
utilisation of all, especially the proportion of ICU accounting for one-third of the total hospital. A significant increase 
in meropenem and ertapenem consumption was observed but no such trend was seen for imipenem/cilastatin. In 
conclusion, this study may be a contribution to strict antibiotic management, and the carbapenem use in particular, in 
order to reduce antimicrobial resistance.

K e y w o r d s : Carbapenem, DDD/100 patient-days, antibiotic consumption.

O a t v a n de

Carbapenem la nhom khang sinh co pho khang
khuan rat rong nen chi d u g c u u tien sir dung trong
t r u d n g hop nhiem khuan nang khi cac khang sinh khac
khong co hieu qua. Tuy nhien, ty le vi khuan khang
carbapenem tai Viet Nam hien nay dang tang nhanh va
6 mice dang bao dong. Bao cao ve tinh hinh sir dung

khang sinh va khang khang sinh tai 15 benh vien trong
ca n u d e t u giai doan 2008 - 2009 da chi ra ty le so
chung Acinetobacter sp. khang carbapenem d mot so
benh vien khu v u c phia Bac v u g t qua 5 0 % m. Gan day,
trong mot nghien c u u tren 3287 benh nhan dieu tri tai

15 d a n vi dieu tri tich cue, ty le khang carbapnenem
cua A. baumannii phan lap d u g c t u nhung t r u d n g hgp
nhi§m khuan benh vien da len den 89,2%, con doi vdi

P. aeruginosa, ty le nay la 55,7% ( 9 ]. Mot so nghien c u u
tren the gidi da cho thay m u c do tieu thu khang sinh
carbapenem co anh h u d n g ro ret d£n ty le de khang
cac thuoc nay [ 3 6 ]. Benh vien Bach Mai la benh vien
da khoa tuyen cuoi, tiep nhan l u g n g Idn benh nhan co
benh canh nang va p h u c tap t u cac tuyen d u d i chuyen
len. Nghien c u u nay d u g c thuc hien nham khao sat
l u g n g tieu thu khang sinh carbapenem tai Benh vien
Bach Mai trong giai doan t u nam 2012 den nam 2016;
t u do, dinh h u d n g cho c h u a n g trinh quan ly khang sinh
trong Benh vien.

O o i t i r o n g v a p h y e n g p h a p n g h i e n c i k i 
D o i t u g n g n g h i e n c u u

D u lieu thong ke ve so ngay nam vien cua

benh nhan noi tru (luu tai Phong Ke hoach Tong hgp) va
so lieu s u dung khang sinh carbapenem cua cac khoa
lam sang, Trung tarn hoac Vien true thuoc BV. Bach Mai

(luu tai Khoa D u g c ) d u g c truy xuat theo tung thang t u
nam 2012 den nam 2016 de khao sat dac diem tieu thu
khang sinh carbapenem theo thai gian.

Phuxyng p h a p n g h i e n cu>u

Nghien cuu hoi ciru ket h g p phan tich dinh l u g n g
theo chi so DDD/100 ngay nam vien theo tung thang
(DDD - Defined Daily Dose: lieu xac dinh hang ngay).
Chi so nay d u g c s u dung de danh gia cac m u c do va
xu h u d n g s u dung khang sinh nhom carbapenem theo
quy mo toan benh vien va theo tung khoa, phong.

r»r-.i-./^nr, - 1 Tong so gram su dung x 100

DDD/100 ngay nam vien = ^—2

DDD x so ngay nam vien
Chi so DDD/100 ngay g i u d n g tinh theo cong t h u c
tren. Trong do, gia tn D D D cua cac thuoc khang sinh
d u g c tham khao tir c a s d d u lieu cua Trung tarn H g p
tac ve p h u a n g phap thong ke d u g c , To c h u c Y te The
gidi ( W H O Collaborating Centre for Drug Statistics
Methodology - W H O C C ) . Gia tri D D D s u dung trong
nghien c u u vdi cac thuoc Meropenem: 2 g; Imipenem:
2 g ; Doripenem: 1,5 g; Ertapenem: 1 gt 1 0 ).

Xir ly ket q u a

So lieu d u g c x u ly theo p h u a n g phap thong ke

y hpc b l n g phan m e m R3.2.2 va Microsolf Excel
2010. S u dung kiem dinh M a n n - Kendall de phan
tich xu h u d n g tieu thu khang sinh c a r b a p e n e m cua
toan Benh vien cung n h u cua t u n g khoa lam sang.

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• Nghien cCru - Ky thuat

Xu h u d n g d u p e ket luan tang neu cac chi s o phan tich
S > 0 va p < 0,05, x u h u d n g d u p e ket luan giam neu S
< 0 va p < 0,05. Cac t r u d n g h g p c h o ket qua phan tich
co p > 0,05 d u p e ket luan khong co xu h u d n g .

K e t q u a n g h i e n cu u

T i n h h i n h tieu t h u c a r b a p e n e m t r o n g t o a n 
B e n h vien t r o n g giai d o a n 2012-2016

Tinh hinh tieu thy khang sinh carbapenem c u a
toan Benh vien theo tung n a m thong qua so gram va
DDD/100 ngay n 3 m vien d u p e bieu dien trong bang 1
va hinh 1 .

Bang 1. Tinh hinh tieu thu carbapenem trong toan Benh vien trong giai doan 2012-2016 (dv: gram) 
~~~~~~ - ^ ^ ^ Nam

Hoatchat 2012 2013 2014 2015 2016 Tong

Meropenem 46.370,50 42.630,00 64.867,00 84.244,50 111.522,50 349.634,50

Imipenem 39.617,50 50.829,00 74.255,50 68.520,50 59.496,50 292.719,00

Ertapenem 1.906,00 3.328,00 4.992,00 7.606,00 10.026,00 27.858,00

Doripenem 170,50 3.798,00 3.968,50 
Tong 88.064,50 96.787,00 144.114,50 160.371,00 184.843,00 674.180,00

» meropenem imipenem ertapenem • doripenem

Hinh 1. Tinh hinh tieu thu khang sinh carbapenem 
cua toan Benh vien trong giai doan 2012-2016

Tong l u p n g khang sinh carbapenm s u dung trong
toan Benh vien d m d c cao va tang dan trong 5 n a m ,
trong d o , n a m 2016 c d l u p n g tieu thu gap ddi n a m
2012, khi tinh theo so gram tieu thu va DDD/100 ngay
nam vien, so lieu DDD/100 ngay n £ m vien t u a n g d n g
trong hai nam nay la 2475,68 va 1385,33 DDD/100 ngay
n^m vipn. So lieu DDD/100 ngay n d m vien cua tung
Khoa lam sang, Trung tarn hoac Vien thuoc Benh vien
Bach Mai d u p e trinh bay trong bang 2.

Ket q u a d j n h lu p n g t h e o tCrng d e n vj

Ket qua dinh l u p n g theo t u n g d a n vi trong vien
cho thay, nhom khang sinh n a y d u p e s u dung rong
rai d tat ca cac Khoa lam sang, Trung tarn hoac Vien.
Tuy nhien, nhom khang sinh nay c h u y e u d u p e tieu
thu b d i ba d a n vj co l u a n g s u dung nhdm khang sinh
nay v u p t tren 800 D D D / 1 0 0 ngay n £ m vien la Khoa
Hoi s u e tich c u e (ICU), Trung tarn H o h a p va Khoa

Truyen nhiem. D a c biet, Khoa ICU co tong D D D / 1 0 0
ngay n a m vien c u a khang sinh c a r b a p e n e m len d e n
h a n 3000 lieu, g i n bang 1/3 tong l u p n g s u dung cua
toan Benh vien. Dieu nay cung d u p e the hien ro ret
qua x u h u d n g s u d u n g khang sinh c a r b a p e n e m theo
t u n g n a m c u a ba d a n vi n a y so v d i trung binh toan
vien, the hien trong hinh 2.

Bang 2. Tong lieu DDD/100 ngay nkm vien cua 
ung Khoa lam sang, Trung tarn hoac Vien true thuoc

Benh vien Bach Mai trong 5 ndm

77 Don vj Tong DDD/100 ngay nim vien

1 Khoa Hoi sire tich eye 3253,24
2 TT. Ho hap 945,10
3 Khoa Truyen nhiem 854,57
4 Khoa Gay me hoi sire 590,60
5 TT. Chong doc 529,71
6 Khoa Huyet hoc 517,45
7 Khoa Than kinh 407,34
8 Khoa Than - Tiet nipu 400,72
9 Khoa Ngoai 389,74
10 Vien Tim mach 368,97
11 Khoa Tieu hoa 334,88
12 Khoa Cap cu u 248,74
13 Khoa Noi tiet & DTD 187,72
14 TT. Di i>ng & MDLS 182,46
15 TT. Phuc hoi chiic nang 154,46

16 Khoa Co - Xuong - Khop 59,38
17 Khoa Dong y 41,61
18 Khoa Da lieu 39,10
19 Khoa PT- TK 29,66
20 Khoa CT- CH 25,39
21 Khoa San 14,58
22 Vien SK tarn than 5,60
23 TT. YHHN & Ung birou 4,94
24 Khoa Tai Mui Hong 4,59
25 Khoa Mat 2,94
26 Khoa Rang ham mat 0,19

Chu thich: TT: Tmng tSm: DTD: Dai thao duvng; MDLS: Mien dich 
lam sang: PT TK: Phiu thuat Thin kinh; CT CH: Chan thuvng

-Chinh hinh: SK: Sue khoe: YHHN: Yhoc hat nhan.

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• Nghien

CIFU

- Ky thuat

A/'

» i , i > « * \ \\ i

Khoa Hii sire tiehci/c

2015 2016 
KhoaTrvyinnhiim — • • TBto*nvi*n

Hinh 2. Xiv hirong sti dung cac hoat chit carbapenem giai 
doan 2012-2016

Co cau si> dung cac hoat chat carbapenem cua 3

d a n vi co l u g n g tieu thu nhom khang sinh nay nhieu
nhat trong 5 n a m d u g c bieu di§n trong hinh 3. Ket qua
cho thay, d ca ba d a n vi cd l u g n g sir dung carbapenem
nhieu nhat trong toan vien, meropenem deu la thuoc
d u g c s d dung pho bien nhat, tiep theo la imipenem/

cilastatin (viet tdt la imipenem). D a y cung la c a cau SIP

dung chung cua nhom khang sinh carbapenem trong
toan vien khi bieu d i l n ket qua theo t u n g nam trong hinh
1. Hinh 4 the hien ro h a n xu hirdng SIP dung cac hoat
chat carbapenem trong n a m t u 2 0 1 2 den 2 0 1 6 d u g c
phan tich bdi kiem dinh Man - Kendall.

3500

c 
'5 3000

E 
= 2500 
> 
?2000 
9 
° 1500

a 1000

0

I

500

•o

co o Khoa Hoi sue tich CLTC TT.HohSp Khoa Truyen nhiism Trung binh toan vi$n

Hinh 3. Co ciu sCr dung cua 3 don vi co luung tieu thu 
khang sinh carbapenem Ion nhat giai doan 2012-2016

X u h u d n g su> d u n g c a c hoat chat c a r b a p e n e m

S = 1182, p < 0,05

Xu hirdng tang S = 30, p > 0,05 Khong thay doi S = 1224, p < 0,05 Xu hudng tang

Hinh 4. Xu hudng so dung cac hoat chat

Kiem dinh thong ke da khang djnh xu hirdng tang SIP

dung dang ke cua meropenem va ertapenem; trong khi
do, imipenem khong the hien dirge xu hirdng thay doi
trong giai doan 2012 - 2016. Doripenem bit dau d u g c
dira vao di§u tri tir nam 2016 nhirng chi chiem ty le nho
va chu yeu dirge dung d Khoa Hoi sire tich c u e nen
khong the hien d u g c xu h u d n g khi ap dung kiem djnh
nay.

Ban luan

Nhom carbapenem ngay cang d u g c s u dung pho

bien tai BV. Bach Mai khi cac khang sinh sir dung d
tuyen d u d i da khong the dem lai hieu qua cho benh
nhan. T i r nam 2012, lugng khang sinh va gia trj
DDD/100 ngay n^m vien cua khang sinh carbapenem
cua toan vien da v u g t qua 1300 lieu va tang gan gap
ddi vao n a m 2016. Nghien c u u nay khong khao sat ve
chi phi dieu trj nhung no cho thay a p lire kinh te rat Idn
cua cac khang sinh d l t tien n h u carbapenem cho ngan
sach y te quoc gia noi chung cung n h u cho BV. Bach
Mai noi rieng. V d i vai tro la benh vien tuyen cuoi, l u g n g
tieu thu khang sinh carbapenem cua BV. Bach Mai tang
len theo tung nam con phan anh xu h u d n g lira chon
cac thuoc nay dau tien do m u c do phuc tap cua nhiem

carbapenem theo phan tich Mann - Kendall

trung. Theo nghien c u u cua Nguyen Thj Le Minh n a m
2013, tai cac Khoa Hoi s u e tich c u e (ICU), Truyen nhiem
va Huyet hoc cd gan 5 0 % so benh nhan d u g c chi djnh
carbapenem trong phac do ban dau, trong do 5 9 , 1 %
vdi imipenem va 4 1 , 9 % v d i meropenem. Carbapenem
d u g c sir dung cho 9 0 % cac t r u d n g h g p nhiem khuan
hoac cd dau hieu nhiem khuan Viec s u dung rang
rai cac hoat chat nay tiem tang nguy c a nghiem trpng
ve d e khang khang sinh, dac biet v d i cac khang sinh
" d u tru" trong C h u a n g trinh Quan ly Khang sinh Quoc
gia. Khao sat ve A. baumannii va Enterobacteriaceae

khang carbapenem d cac n u d e N a m A va D o n g N a m

A cho thay day la khu v u c co ty le d e khang cac khang
sinh nay cao nhat tren the gidi. Trong do, Viet N a m la
mot trong ba n u d e co cac chung Enterobacteriaceae

khang carbapenem l u u hanh trong moi t r u d n g va ngoai
cong dong va ti le khang carbapenem d cac khoa ICU
cua 14 benh vien tai Viet N a m la 8 9 % m. Day t h y c sir

la moi nguy hiem vdi s u e khoe cong dong, can d u g c
kiem soat b§ng mot c h u a n g trinh quan ly khang sinh
phu h g p de gidi han viec s u dung nhom khang sinh nay,
qua do cai thien do nhay cam cua vi khuan vdi thudc.

Nghien ciru da ghi nhan l u g n g tieu thu khang sinh

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• Nghien cu»u - Ky thuat

carbapenem tap trung chu y l u d ba d a n vi la Khoa
H6i s u e tich c u e (ICU), Trung tarn Ho h i p va Khoa
Truyen n h i l m . Dae biet, Khoa ICU co tong DDD/100
ngay nam vien cua khang sinh chiem gan 1/3 tong
l u g n g s u dung cua toan BV, vdi chi so nay m6i nam
deu trong khoang 500 - 700 lieu. Day la d a n vi dieu tri
cac benh nhan nang, nhiem trung phuc tap nen viec
s u dung carbapenem chiem ty trong Idn khong kho ly
giai. Tuy nhien, khi so sanh vdi cac d a n vi dieu tri tich
c u e khac tren th§ gidi, Khoa ICU cua BV. Bach Mai co
l u g n g s u dung carbapenem cao han dang ke mac du
co s u khac biet ve thai gian truy xuat d u lieu. Khao sat
tren 530 benh vien tai Phap nam 2007 cho thay gia

tri DDD/100 ngay n l m vien cua cac Khoa ICU chi dat
146,6 lieu | 2 ]. Ben canh do, nhiem trung benh vien va
khang thuoc cung la mot van de quan trgng tai cac Khoa
ICU. V d i cac n u d e co thu nhap trung binh - thap n h u
Viet Nam, ty le nhiem trung benh vien ghi nhan tai cac
Khoa ICU len den 35,2% [9). Cung theo nghien c u u cua
N T . L. Minh nam 2013, ti le khang cua cac chung vi
khuan tai cac Khoa ICU, Truyen Nhiem va Huyet hoc
cua Benh vien Bach Mai da dat m u c 6 4 % vdi imipenem
va 6 2 % vdi meropenem [ 1 1 J. Da s6 cac trudng hgp
nhiem trung nay gay ra bdi vi khuan Gram a m , vdi ty
le d§ khang carbapenem rat dang luu y. Ty le de khang
carbapenem cua A. baumannii, P. aeruginosa va K. 
pneumoniae l l n lugt la 89,2%; 55,7% va 14,9% n. Day
t h u c s u thach thuc Idn doi vdi cac nha lam sang trong
lua chon khang sinh t r u d c boi canh khang khang sinh
ngay cang Ian tran hien nay.

Ve c a cau s u dung, trong giai doan 2012 - 2016,
meropenem va ertapenem cd xu h u d n g tang s u
dung trong khi viec s u dung imipenem lai kha on dinh.
Meropenem la hoat chat chiem u u the khong chi d ba
d a n vi cd l u g n g s u dung nhieu nhat ma day con la xu
h u d n g chung cua toan BV. Dieu nay co the xuat phat
t u dac diem ve d u g c ly cung n h u dp an toan cua cac
thuoc nay tren lam sang. Trong khi imipenem co nguy
c a gay doc tinh tren than kinh cao nhat trong nhom
va khong hieu qua tren tu cau vang khang meuiicilin
thi meropenem lai mang nhieu u u diem n h u co nguy
c a dpc tinh tren t h i n kinh thap h a n va la hoat chat

carbapenem duy n h l t d u g c s u dung trong dieu tri viem
mang n a o[ 6 ]. Ben canh do, t u nam 2016, hoat chat mdi
cua nhom carbapenem la doripenem bat d l u d u g c d u a
vao dieu tri tai BV. Bach Mai. Vdi Igi the han so vdi
meropenem tren P. aeruginosa va vi khuan Gram (+)( 8',
doripenem hua hen la mot lua chpn khang sinh hieu qua
trong cac t r u d n g hgp n h i i m khuan nang da khang cac
carbapnenem khac. Tuy nhien, viec then khai c h u a n g
trinh quan ly khang sinh chat che trong benh vien la c l n
thiet de bao ton d u g c cac khang sinh dang s u dung,
dac biet la cac thuoc mdi n h u doripenem.

Ket luan

Nghien c u u da cho thay hinh anh tong the ve tinh
hinh tieu thu khang sinh carbapenem tai BV. Bach Mai
trong giai doan 2012 - 2016, vdi m u c l i l u DDD/100
ngay n l m vien d m u c rat cao (tren 1000 lieu) va tang
dan theo thai gian. Khoa ICU, Trung tarn Ho hap va
Khoa Truyen nhiem la ba d a n vj co l u g n g tieu thu
carbapenem Idn nhat trong toan BV, trong do chi
rieng Khoa ICU da co tong DDD/100 ngay n l m vien
cua khang sinh carbapenem gan bang 1/3 tong l u g n g
s u dung nhom thuoc nay cua toan BV. Ve c a cau,
meropenem va ertapenem co xu h u d n g tang len trong
khi viec s u dung imipenem lai kha on djnh trong thai
gian khao sat. Nghien c u u la c a s d de then khai cac
nghien c u u danh gia s u dung thuoc cung n h u c h u a n g
trinh quan ly khang sinh trong benh vien n h l m nang
cao hieu qua s u dung thuoc khang sinh.

Tai lieu tham khao

1. GARP Viet Nam (2009), Bao cao st> dung khang sinh 
va khang khang sinh tai 15 benh vien Viet Nam nam 
2008-2009, Du an Hgp tac toan cau ve khang khang sinh GARP
Viet Nam va Don vj Nghien cuu Lam sang Dai hoc Oxford.

2. Dumartin C , L'Heriteau F. et al. (2010), "Antibiotic use
in 530 French hospitals: results from a surveillance network at
hospital and ward levels in 2007", J. Antimicrob. Chemother.,

65(9), pp. 2028-36.

3. Guclu E., Ogutlu A. etal. (2017), "Antibiotic consumption
in Turkish hospitals; a multi-centre point prevalence study", J. 
Chemother., 29(1), pp. 19-24.

4. Hsu L.Y.,ApisarnthanarakA., etal. (2017),
"Carbapenem-resistant acinetobacter baumannii and enterobacteriaceae in
South and Southeast Asia", Clin. Microbiol. Rev, 30(1), pp.
1-22.

5. Lai Chih-Cheng, Wang Cheng-Yi (2011), "Correlation
between antibiotic consumption and resistance of
Gram-negative bacteria causing healthcare-associated infections
at a university hospital in Taiwan from 2000 to 2009", J. of 
Antimicrobial Chemotherapy, doi:10.1093/jac/dkr103.

6. Melanie Cupp. (2007), "Comparison of carbapenem

antibiotics", Pharmacist's Letter/Prescriber's Letter, 23(12),
pp. 231205.

7. Phu V. D„ Wertheim H. F. etal. (2016), "Burden of hospital
acquired infections and antimicrobial use in Vietnamese adult
intensive care units", PLoS One, 11(1), pp. e0147544.

8. Restrepo M. I. (2009), "Efficacy of intravenous infusion
of doripenem", Clin. Infect. Dis., 49 Suppl 1, pp. S17-27.

9. WHO (2011), Report on the Burden of Endemic Health 
Care-Associated Infection Worldwide:a system review of the 
literature.

10. WHO Collaborating Centre for Drug Statistics 
Methodology, Retrieved 11/06/2017, from cc.
no.

11. Nguyln Thj Le Minh (2013), "Danh gia tinh hinh su
dung khang sinh nhom carbapenem tai Benh vien Bach Mai",

Luan van Thac sTDuyc hoc, Trudng Dai hoc Dugc Ha Ngi.

{Ngay nhan bai: 16/05/2017- Ngay phan bien: 06/06/2017 - Ngay duyet dang: 29/06/2017)

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