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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

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TAP CHI

Y HOC

THI

/C

HANH

B O Y T E X U A T B A N 
JOURNAL OF PRACTICAL MEDICINE 
PUBLISHED BY MINISTRY OF HEALTH

Bo 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 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. 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 Tucng
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 soan: 138A Giang V 6 - HN

OT: 04.38460728; 04.37368092

Fax:04.38464098;

E-mail:

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 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

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 T H E HIEN

•NGUYEN VAN DUNG, 
TRjNH BAO NGOC, 
TRAN TH| THOA, 
PHAM DUY Tl/ONG 
• 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 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 h u y l t
ap

T h y c trang va giai phap hieu qua
kham chua 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 vdi 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 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 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 sua me 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

Dac 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 ung cd hai tren than kinh trung
u o n g 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 c u u nguyen nhan
va c o 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 r u y l n

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• L E DINH PHAN, 
NGUYEN TUAN HUNG, 
OAO VAN DUNG, 
TRAN VAN H U ^ N G

•NGUYEN TH| THANH HUONG, 
HOANG TRUNG KlEN,

L U U THI ANH TUYET, 
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 QUOC HOI 
•OAO TH| DUNG, 
NGUYEN ANH CHI, 
NGUYEN QUANG TRUNG 
•TRAN TUAN ANH, 
L E 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 D U C 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 trirdc - 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 dirdng, hq sinh tai Benh vien Da khoa Trung i r c n g

Thai Nguyen nam 2016

=> Danh gia cua cac ba me co con dirdi 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 tir 62
giang vien va sinh vien

=> T h y c trang u l n g mryu, bia cua nam gidi dp tuoi tir 15 - 60 tai xa 65
Tay Thanh, Yen Thanh, Nghe An nam 2015

=> M6 ta t h y c trang benh sau rang va viem lyi 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 y c ddng mach p h l i tai Benh vien 71
Da khoa Trung i r c n g 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 H d u nghi Niet

O d e

=> Hieu qua can thiep nham cai thien mot so chi s i danh gia chat 77
lirgng d i l u tri HIV/AIDS tai Benh vien Da khoa huyen Thuan Chau,

tinh Sen La

=> 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

=> K i l n thdc 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 nam 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 sdc 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 sdc khoe va benh thirdng 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 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 thircng 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

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•PHAM NHUHUNG, 
NGUYEN QUANG TUAN 
•VO THj LAN,

DO QUANG HUAN 
•MAI THj HlEN, 
D 6 GIA TUYEN, 
DANG THI VIET HA 
•PHAN Q U 6 C HOI 
•OAO TH| DUNG, 
NGUYEN ANH CHI, 
NGUYEN QUANG TRUNG 
•LE TH| THANH HUONG,

CHU VAN THANG

VU DlEN, L E THj THANH XUAN 
•NGUYEN TH| HOAI,

DOAN TH| HUONG, 
LUU THj ANH T U Y E T 
•NGUYEN THAI HUNG 
DUONG MINH D U C 
•LE TH| HUONG, 
VO TH| THU THUY 
•NGUYEN D U C MINH 
•HOANG TH| P H U O N G 
•NGUYEN VAN SON 
•DANG HUNG MINH

•PHAM THj THU THUY, 
DAU XUAN CANH,

•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

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 r a d n g 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 trirdng 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 r a n g

Thai Nguyen

=> Danh gia m d c dp h i l u cua can bp y t l vdi bp cdng cu do lirdng
mdi trirdng 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 xirang khdp 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

Danh gia nguy c c va ty le hien mac benh n h i l m doc hda chat bao
ve thirc vat d ngirdi 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 dirdi 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 x a gan

=> Nghien c d u 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 trirdc 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 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 hirdng 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

=> Trirdng hgp co rut mi tren sau p h l u thuat cat be

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

152

156

158

161

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•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, 
L U O N G MAI ANH, 
TRAN QUANG D U C 
HA ANH D U C

•TO THANH PHUONG, 
DANG HOANG ANH 
•LE TH| HUONG, 
OOAN THUY LINH

•NGUYEN THAI HUNG 
DUONG 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 
•DANG HUNG MINH, 
BUI T U O N G LAN 
•PHAM THj THU THUY, 
DAU XUAN CANH ,

NGUYEN THj B A C H T U Y E T 
•TRAN TH! MAI OANH, 
NGUYEN THI HUONG, 
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

=> 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 s d m ung thir da day

=> Dac diem r l i loan chdc nang ho h i p t n r d c 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 Trirdng Trung hoc 173
p h i thong C h i r c n g My A - C h i r c n g 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 r c n g

=> Danh 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 khdp gut cai tien tren ddng vat t h g c nghiem 186
=> Thgc trang suy dinh d i r d n g d tre dirdi 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 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 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
dirdng 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 Trirdng Trung hoc c c 211
s d 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 trirdng 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, t h g c 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 dirdi

=>Banh gia k i t qua sir dung fibrin giau tieu cau trong phau thuat n h l 226
rang ham Idn t h d ba ham dirdi

=> Trirdng hep dieu trj gay x i r c n g got di lech d y e e n l n chinh c l djnh 228
bang dinh steinmann (nhan xet cai tien cua f.kermad)

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

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

•NGUYEN TH! H6NG VAN, 
HOANG BUI HAl,

VIEN VAN DOAN 
.OINH NGQC SON, 
NGUYEN L E 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, 
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 BACH T U Y E T 
•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 D U C 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 r u c e co s u 232
dung c h i t soi

= > K i l n thuc va t h y c hanh ve tiem an toan cua sinh vien dieu d u o n g 235
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 237
nhung t r u c n g hep c h i n t h u c n g 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 s o sinh non thang d i l u tri tai Trung tarn Nhi khoa,

Benh vien Trung u c n g Thai Nguyen

=>Tinh hinh chua 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 248
va sau d i l u tri bang t h u l c uc che beta

=>Tinh trang khang insulin va t i n t h u o n g 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 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 255
Benh vien Rang Ham Mat Trung u o n g Ha Npi

=>Thyc hanh va mot s i yeu t l lien quan d i n t h y c hanh phdng benh 257
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

=> 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 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 H o p kirn S i t - Gang Thep Thai Nguyen

=>Banh gia k i t qua d i l u trj ndi nha rang ham s u a 266

=> Nghien c u u dac d i l m lam sang, can lam sang cua viem p h l i d 270
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 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 l y a 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 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 279
s i n g t h l t lung, t h l t lung 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 282

giua 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 285
t h u o n g c o t h l

=>Cac c h i t u c che SGLT2-nhdm t h u l c mdi trong d i l u trj benh dai 287
thao d u o n g

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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 vdi s i lugng NTT t h l t trong 24
gid. Nguy c a 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 c a 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
- 1 1 , 0 9 ) .

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.
1 1 9 - 1 2 1 .

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 THU T H U Y

Cue Phong, chong HIV/AIDS, Twang Dai hoc Dope Ha Npi

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:

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 ARV da dem 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 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 d u o c 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
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 dng cd hai tren than kinh trung u o n g va
tarn t h i n lien quan tdi 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

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D 6 l T U Q N G V A P H U O N G 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 d u p e tham gia nghien cdu.

2. P h u a n g phap nghien c u i i

Nghien c d u thuan tap tien cdu 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 SPSS 16.0. Sir dung ky
thuat phan tich thong ke md ta, kiem dinh X2 va md
hinh hoi quy logistic de tim moi lien quan.

K E T Q U A V A BAN LUAN

1. Thong tin chung ve doi tupng nghien c u u

Dac diem cua m i u benh nhan trong nghien c d u
khdng cd s o khac biet nhieu vdi dac diem benh nhan
nhiim 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 r d n g 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. 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 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 ( 5 4 % ) [4], Nelsona va cdng
sy nam 2010 (46,2%) [5], S y khac biet nay cd the la

do thilt 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 phirong phap danh gia, each sir dung cac
thuat n g u ("doc tinh tren t h i n kinh trung irang", "tarn
thin", "tarn than, than kinh trung irang"). 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 hon nhieu khi so sanh vdi
nghien ciru g i n day tai Viet Nam cua N g u y i n Phirong
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 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 n h i n , 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 d u p e 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 d u p e bac si chu y theo ddi, ghi n h l n .

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, gilc mo rd rang 45 5.4
7 Mlt ngu 43 5,1
8 Ac mong 39 4,7
9 Lo ling 31 3,7
10 Di cam: dau , ngira , rat, kiln bo 6 0.7
11 Giam/mat tap trung 5 0,6
12 Co y dinh t y tip 1 0,1
13 T r i m cam 1 0,1
14 Bieu hien khac 6 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 bung (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 vdi 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. 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 t h l y : Thdi gian trung binh gap ADR
tren TKTW 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 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 T K T W va tarn
than

Phan loai n %

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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 t h 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 trudng hpp 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 trudng hpp phai tarn
ngung 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 ung 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 trudng hpp d muc dp nang, 2
trudng hpp d muc 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, han nua 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 vdi cac bac
si do quan niem/nhan thuc cua bac sy v i m u c dp
nghiem trpng cua phan ung 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 giua cac nghien cuu.

3. C a c yeu t l lien quan den A D R tren T K T W va 
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 ADR

Yeu to HR Khoang tin cay P
9 5 % 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 d o n bien da
phat hien 3 yeu t l anh h u d n g 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 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 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
h u d n g tdi t i n s u i t x u l t hien ADR

Yeu to HR Khoang tin P
cay 9 5 % 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 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 TKTW 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 TKTW va tarn than tang
1,1%. Benh nhan d giai doan lam sang 1 va 2 cd nguy
c o 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 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 ludng cho
benh n h l n trudc 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 .

TAi LIEU 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., 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].

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