1409 nghiên cứu đặc điiểm lâm sàng cận lâm sàng các mức độ nặng và kết quả điều trị nội khoa của bệnh viêm tụy cấp

BO Y T~ BO GI~O DUC V~ D~O TAO TRU'~NG DAI HQC Y DU'QC CAN THO MAC PHU~C TO~N NGHI~N C~U DAC DIEM LAM S~NG, CAN L~M S~NG, C~C M~C DO NANG A VA KET QUA DIEU TRI NQI KHOA C~A BENH VI~M TUY CAP Chuy~n n g ~ n h : NQI KHOA Ma s6: 62.72.20.40.CK Ngu~i d~n khoa h o e : PGS.TS.TR~N D~ H~NG BS.CKII.KHA H~'U NH~N , CAN THO-2015 r I L~I CAM DOAN Toi xin cam doan day l~ c~ng trinh nghi~n c u c~a ring t~i C~c s~ li~u, k~t qu~ n~u lu@n ~n l~ trung thuc v~ chua tung duo c~ng b~ b~t ky c~ng trinh nghi~n c u n~o kh~c (Ji, )_ Mac Phu~c Toan I Loi c~m on Ti x i n ch~n th~nh c m on: Ban gi~m hi~u, phong d~o tao sau dai hoc v~ c~c quy th~y c~ b~ m~n ni truong dai hoc Y Duoc C~n Tho d~ tao di~u hoe v~ ho~n th~nh lu~n ~n kin cho t~i tham du kh~a Ban gi~m doc, phong k~ hoach tong hop v~ to~n th~ nh~n vi~n khoa n@i ti~u h~a huyet hoc lam sang b~nh vi~n Da Khoa Trung Uong C~n Tho d~ tao di~u ki~n thu~n loi cho t~i su~t qu trinh hoc t~p v~ nghi~n c~ru X i n b~y t long bi~t on ti PGS-TS.Tr~n D~ Hing v~ BSCKII Kha H~u Nh n d~ t~n tinh d~n t~i qu~ trinh hoc t@p, nghi~n c~ru v~ ho~n th~nh lu~n ~n C~n Tho, thing n~m Mac Phuc To~n t t f MUCLUC • • Trang Trang phu bia L~I CAM DOAN L~i cam on MUC LUC DANH MUC CAC CH~ VI~T TAT DANH MUC CAC B~NG E>AT VAN E>E · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · " · · · · · · · · · · · · · · · · · · · Chuong : TONG QUAN TI L I E U ; ; 5nh Dai cuong v~ tuy~n ty v~ b~ vi~m c a p L l Giai ph�u tuy�n t\ly 1.1.2 E>jnh nghia viem t\ly cil.p 1 Djch tS h9c viem t\lY cil.p S A nh~n Nguy~n ; vi~m c a p D~c di~m l~m sang v~ c~n l~m s~ng ca b~nh vi~m c~p E>?C di!Sm lil.m sang · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 1.2.2 E>?C di!Sm c�n lil.m s an g • ' 't � � t� · ' M'u ' c d' IQ nang va mo' so yeu o [1en q u a n 8 1:- · � · teu 1.5 M@t Chuong ' u1 s~ 2: ' va cac nghi~n DI 2.1 E>6 2.2 Phuong b.� Men cu h ' cl un g TUONG V~ 2.2.1 Thi�t k� huong P nh er , vIem t 'uy : 16 cap n u ~ c 19 PHUONG PH~P N G HI N C U 3 cu .24 nghien cuu 2.2.2 Ca m�u 2 ' v~ ngo~i i tugng nghien cuu php nghi~n ' b cua 4 hap ch9n p m�u ; (V 2.2.4 N6i dung nghien cuu 24 2.2.5 Phuong php thu th~p s6 l i ~ u 34 2.2.6 K thu~t han ch~ sai s ~ 2.2.7 Phuong php x~ ly s~ l i ~ u 2.3 Dao huong C dc 3: KET nghi~n D~c di~m chung 3.2 D~c di~m v~ c u a 36 QUA lam 36 37 ca m~u s~ng v~ nghi~n c@n l~m c u 37 s~ng c~a b~nh vi~m c ~ p ' c a' c mu 'cdo' nang ' mot 'tso'y' 'l" , l.e Ty va 'eu to a1en quaI 50 K~t qu~ di~u trj ca b~nh vi~m ty c ~ p 55 huong 4: BAN LUJ,.N 58 C D~c di~m chung c~a m~u nghi~n c u 58 4.2 Dc di~m v~ lam sang v~ c@n l~m sang D~c di~m v& n~ng c a b~nh vi~m c ~ p 60 d CRP va PCT m~u c~c mc d@ b ~ nh 70 4.4 D~c di~m v~ k~t qu~ di~u t r j a 74 KET LUAN KJENNGHJ 80 T~I LI~U THAM KH~O PHU LUC V DANH MUC C C CH~' VI~T TAT AST: Aspartat aminotransferase ALT: Alanine transaminase BN: B~nh nh~n CRP: C-reactive protein (protein ph~n (ng C) Cs: Cong su CT: Computer Tomography (chup ct Ip vi tinh) HCO, Bicarbonate Hct: Hematocrite (dung tich hng c~u) HDL: High density lipoprotein (lipoprotein lung ph~n t~ ca0) LDH: Lactatedehydrogenase LDL: Low density lipoprotein (lipoprotein lugng ph~n PaO, pressure of oxygen in arterial blood (Ap luc ri~ng ph~n mu d~ng mach) PCT: Procalcitonin TB: T~ b~o VTC: Vi~m ty c~p t th~p) c a oxy r v1 DANH MUC • C C B~NG Trang B~ng He thng di~m Marshall cho r~i loan ch~c n~ng co quan 1 B~ng 1.2 Uc tinh FiO, theo mc th~ x y 1 Bang Ph~n b~ theo trinh d~ hoc v ~ n B~ng 3.2 Ph~n b~ theo ngh~ n g h i ~ p B~ng 3.3 Ph~n b~ theo tu~i 39 B~ng 3.4 Ph~n b~ theo ly 39 B~ng 3.5 Ph~n b~ theo ho~n Bang 3.6 S6 luong bach v~o vi~n canh khoi p h ~ t c~u 40 a s a s o a a 42 Bang 3.7 N6ng d~ H e m a t o c r i t e 42 Bang N~ng d~ ure m u 43 B~ng 3.9 N6ng d~ creatinin m u 43 B~ng 3.10 N~ng du~ng B~ng 3.11 N~ng d ~ AST mu • .• • .• 44 B~ng 3.12 N~ng d~ ALT m u 45 B~ng 3.13 N6ng d~ albumin mu 45 Bang 3.14 N n g d~ amylase m~u 46 B~ng 3.15 N~ng d~ LDH m~u 46 B~ng 3.16 Nng d~ Triglyceride m ~ u 47 Bang 3.17 N~ng d@ Calci m~u 47 B~ng 3.18 Gi~ Pa0 m ~ u 48 Bang 3.19 N6ng dHCO, B~ng 3.20 N~ng d~ CRP mu • 49 Bang 3.21 N6ng d PCT m~u 49 Bing 3.22 N~ng d6 CRP ~ 50 trj c a m u m~u c~c m c d@ n~ng c~a b~nh VTC 44 48 Bing N~ng d@ PCT ~ cc mc B~ng 3.24 Phan b~ theo tu6i Bng 3.25 S6 long bach ~ c~c md n~ng cu ~ c~c mc d@ Bang 3.26 Nng d@ du~ng m~u ~ c~c m~c B~ng 3.28 N~ng d@ ALT ~ cc Bang N~ng n~ng ca b&nh VTC 52 52 d@ nng ca bnh VTC 53 mc d~ n~ng ca b~nh VTC 53 ~ c~c mc d@ n~ng c~a b~nh VTC 54 ~ cc m~c B~ng N~ng d~ calci m~u c~a bnh V T C ~ c~c m~c d@ n~ng c~a b&nh VTC Bing 3.27 N~ng d6 AST B~ng 3.29 N~ng d@ ure m~u d@ n~ng c~a b&nh V T C d~ n~ng c~a b@nh VTC 54 d LDH m~u c~c m~c d n~ng ca b~nh VTC 55 B~ng 3.32 K~t qu~ di~u trj c a bnh VTC 55 Bang 3 K~t qu~ di~u tri theo mc d@ b~nh • 56 B~ng 3.34 S6 ng~y n~m v i ~ n 56 B~ng 3.35 Lien quan B~ng 3.36 Th~i gian gi~a th~i h~t tri~u gian truc chng lam 57 57 nh@p sang vi~n v~i di~u trj it DANH MUC CAC BI~U • DO Trang Bi~u d6 Ph~n b~ theo gi~i t i nh Bi~u d6 Ph~n b~ theo dia d u 37 Bi~u d6 Tri~u chng co n ~ n g 40 Bi~u d 3.4 Tri&u Bi~u d6 3.5 D~c Bi~u d~ 3.6 T y chng thuc dim l¢ c~c hinh mc th~ ~nh d@ si~u n~ng ~m c~a bung bnh V T C 41 41 50 DAT VAN D~ • Viem ty c~p l~ m t b~nh l thuong g~p ~ khoa c~p cru c~c b~nh vi~n, b~nh nh~n thuong nh~p vi~n v~i b~nh c~nh dau bung c~p B~nh c6 nhi~u bi~u tr l c hi~n l~m sang kh~c ty v~o mc d~ n~ng nhe c~ng nhu th~i gian kh i ph~t den nh~p vi~n; dau bung x~y 85%, s~t g~p 95% c~c tru~ng hop, non ~i 60% tu~ng hop, mach nhanh, huy~t ~p, xu~t huy~t du6i da, c~m ng v~ d~ kh~ng th~nh bung, vang da, tr~n dich m~ng p h ~ i Kho~ng % - % trubng hop vi~m cp di~n ti~n n~ng c6 th~ nh~n thuong g~p l~ soi m@t (chi~m 40%) v~ t vong Nguyen rurou (chi~m 30%) [4] Ty I~ mac vi~m c~p d~ t~ng l~n ding k~ th@p ky qua Nim 2009, tai My vim c~p chi~m hon 200.000 truong hop nh@p vin m i n~m Trong d6 80% c~c trut~ng hop l~ nhe, 20% lai l~ n~ng lien quan ti bi~n ch'ng Ty le t vong c a vi~m cap n~ng 10-30%, chi phi di~u tri l~ 2,6 ti d6 la [48],[63] Di~n bi~n c a vi~m ty c~p r~t phc tap, kh~ ti~n lugng 80% vi~m ty c~p l~ th~ nhe, c~n lai 20% l~ vi~m cp hoai tr [47],[48] Viem c~p c6 nhi~u bi~n chng s~m v~ mu~n, c~c bi~n chng n~y nguy hi~m c th~ g~y t vong ph thu~c v~o mc d@ chinh x~c ca ch~n don v~ di~u trij c~ dung, kip th~i hay kh~ng D~ng th~i, x~c dinh mc d n~ng nhe ca b~nh c~ng sm v~ chinh x~c thi kh~ n~ng di~u trj c~ hi~u qu~ c~ng ca0 C~ nhi~u chu~n Ranson, ti~u ti~u chun ch~n do~n mc chu~n APACHE II, d ti~u n~ng vi~m chu~n cap nhu ti~u Balthazar, ti~u chu~n Imrie Tuy nhi~n, tr~n thc t~, c~c ti~u chu~n n~y it duoc sir dpng thuong qui tr~n lam sang gom nhi~u thong s~ v~ c~n 48 gi~ sau nh@p vi~n mdi d d~ d nh gi~ d~ c~c bi~n chimng cd th~ d~ x~y Ti~u chu~n Balthazar c~ han 44 Dulce M Cruz-Santamaria, "Update on Carlos pathogenesis and Taxonera, clinical Manuel Giner (2012), management of acute pancreatitis", World Journal o f Gastrointestinal Pathophysiology, 3(3), 60-70 Fisic E, Poropat G, Bilic-Zulle L (2013), The role o f IL-6,8, sTNFr, CRP, complication and pancrestic elastase in the prediction and 10, of systemic in patients with acute pancreatitis, Hindawi publishing corporation, Croatia 46 Giedrius Barauskas, "C-reactive protein Saulius in Svagzdys, early Almantas prediction of Maleckas pancreatic (2004), necrosis", Medicina, 40(2), - 47 Ibrahim A AI Mofleh (2008), "Severe acute pancreatitis: Pathogenetic aspects and prognostic factors", World Journal o f Gastroenterology, 14(5), 675-694 48 Izakson A, Ezri T, Dana Weiner understanding of pathophysiology, (2012), diagnosis "New development in and treatment of severe acute pancreatitis", J Rom Anest Terap Int, ( ) , 39-50 49 Jennifer K pancreatitis: Carroll, Brian diagnosis, Herrick, Prognosis, Teresa and Gipson treatment, (2007), Acute University of Rochester school of medicine, New York, - 50 Ji Young Park, Tae Joo Jeon, Tae Hwan Ha (2013), Hepatobiliary Pancreat Dis Int, 12(6), 645-650 Jitin Yadav, Sanjay Kumar Yadav, Satis Kumar (2015), Predicting morbidity and mortality in acute pancretitis in an indian population: a comparative study o f the BISAP score, Ranson's score and CT severity index, Oxford, India tY 52 Liliana Simon, Procalcitonin France and Gauvin, C-Reactive Devendra K Protein levels Amre as (2004), markers "Serum of bacterial infection: a systematic review and meta-analysis", CID, 39, 206-217 53 Marco acute Simoes, Patricia pancreatitis Alves, severity: Helder Esperto companson of (2011), "Predicting prognostic score", Gastroenterology Research, 4(5), 216-222 54 Maruna P, Nedenikova K, Gurlich R (2000), "Physiology and genetics of Procalcitonin", Physiological research, 49(1), 57-61 5 Michael K Digalakis, Iraklis E Katsoulis, Serum profiles o f C-reactive protein, Kalliopi Biliri (2009), interleukin-8, and tumor necrosis factor a in patients with acute pancreatitis, HPB Surgery 56 Mihailo Bezmarevic, ·Procalcitonin and Zoran BISAP Kostic, score Miodrag versus Jovanovic C-reactive (2012), protein and APACHE II score in early assessment of severity and outcom of acute pancreatitis", Vojnosanit Pregl, 69(5), 425-431 57 Muller C A, Uhl W, Printzen G (2000), "Role of Procalcitonin and granulocyte colony stimulating factor in the early prediction of infected necrosis in severe acute pancreatitis", Gut, (46), 233-238 58 Nicholas S Solanki, Savio George Barreto (2011), "Fluid therapy in acute pancreatitis A systematic review of literature", JOP, 12(2), 205208 59 Nusrat Shafiq, Samir Malhotra, Deepak K Bhasin (2005), "Estimating the diagnostic accuracy of procalcitonin as a marker of the severity of acute pancreatitis: a meta-analytic approach", JOP, 6(2), 231-23 60 Peter A, Thomas L, Christos D (2013), "Classification of acute pancretitis-2012: revision of the Atlanta classification and difinitions by international consensus", gut, 62, - 1 Pezzilli R, Zerbi A, Di Carlo V (2010), Practical Guidelines for acute pancreatitis, Italia, 523-535 62 Raffaele Pezzilli, Lorenzo Fantini (2005), "The imaging assessment of the severity of acute pancreatitis may change in the near future", JOP, 6(5), 467-469 63 Scott Tenner, John Baillie, John De Witt (2013), "American College of Gastroenterology Guideline Management of acute Pancreatitis", The American Journal o f Gastroenterology, - 64 Seiki Kiriyama, Toshifumi Gabata (2010), "new diagnostic criteria of acute pancreatitis" ,Journal o f Hepato-Biliary-Pancreatic Sciences, ( ) , 24-36 65 Simona Bota, loan Sporea, Rosana Sirli (2013), "Predictive factor for severe evolution in acute pancretitis and a new score for predicting a severe outcome", Annals o f Gastroenterology, 26(2), - 66 Steven Black, Irving Kushner, and David Samo! (2004), "C-reactive Protein", Journal o fBiological Chemistry, 279(47), 48487-48490 67 Su Mi Woo, "Comparision Myung of serum Hwan Noh, procalcitonin Byung with Geun Kim Ranson, (2011), APACHE-II, glasgow and Balthazar CT severity index scores in predicting severity of acute pancreatitis", Korean Journal ofGastroenterology, 58(1), ­ 37 68 Suman Sharma, Chanchal Shrivastav, Suman Jain (2014), "Early prediction of severity of acute pancretitis role of C-reactive protein", International journal of current research, 6(8), 8 - 8 69 UK working party on acute pancreatitis (2005), "UK guidelines for the management of acute pancreatitis", Gut, 54, pp 1-9 70 Vishal Sharma, Arterial pH, Thingbaijam bicarbonate levels Shanti Devi, and base Ravi Sharma (2014), deficit at presentation as markers o f predicting mortality in acute pancreatitis: a single-centre prospe PHU LUC • • B~NG THU THAP S LIU • • A Hanh chinh: H� v� ten: Tu6i Gi6-i: Nam; Ma so n~ Dia chi: · NghS nghi�p : Trinh d9 van hoa B Chay~n m~n: I Ly v~o vi~n: Dau bung Non 6i Khac: ; II Ho~n c~nh kh~i ph~t Sau ~n Sau u~ng ruou Khac III Th~i gian tr l c kh~i ph~t b~nh d~n l c nh~p v i ~ n : g i ~ IV Lam sang + Dau bung: C6 kh6ng + Bun n~n, n~n: C6 kh6ng + Tieu ch~y: C6 khong + Nbi~t d' [@ : c + Huy~t ~ p : m mH g + Tinh trang bung: Bung m~m D~ kh~ng th~nh bung C~m (ng phuc mac + Di~m dau Mayo - Robson: C6 Kh6ng 94 V Can lam sang Si~u ~m bung: + Dich bung C6 khong + T~ng kich thu~c C6 kh0ng + M~t d~ng dang ch~ m~ ty C6 khong + Dich quanh C6 khong X~t nghi~m mu: X~t nghi~m Hct Bach c~u Ure Creatinin Duong huy~t Albumin m~u AST ALT Amylase m~u LDH CRP PCT Ca++ Triglyceride Pa0, HCO, VI Phan d@ vi~m cp Nhe Trung binh Nang Ket qu~ VII K~t qu~ di~u Kh~i Bi~n ching T~ vong tri: ' ' ' VIII T' ong so nam VIyn: ' IX Th~i gian h~t tri~u ch(ng lam s a n g n g ~ y DANH S~CH BENH NH~N STT M~ SO HO VA TEN TUOI GIOI DIA CHI TiNH 14162115 NGUY~N VAN T 43 Nam H~u Giang 14165991 NGUYEN THJ L 66 N Vinh Long 14165992 NGUYEN QUOC B 21 Nam Vinh Long 14170242 NGUY~N MONG T 35 Nu Bac Li~u 14173311 L~ H~U P 40 Nam Can Tho 14173263 TRAN HOANG H 32 Nam Can tho 14140294 NGUY~N VAN N 48 Nam Hu Giang 14210180 TRAN KIM B 50 Nam C~n Tho 14243705 HUYNH HOANG T 38 Nam H~u Giang 10 14242692 PHAM VAN N 45 Nam Can Tho 11 14260849 NGUYEN THI H 30 N Can Tho 12 14272562 NGUY~N V~N N 42 Nam Can Tho 13 14274379 NGUY~N VAN D 32 Nam S~c tr~ng 14 14274355 V~ HOANG N 38 Nam Can Tho 15 14281793 T O T O AN T 45 Nam Vinh Long 16 14296539 NGUYEN THJ T 68 N Ki~n Giang 17 14303918 NGUYEN HOANG G 34 Nam S6c Trang 18 14320607 DANG V~N T 48 Nam Can Tho 19 14318657 TRUONG HOANG G 48 Nam Vinh Long 20 14327564 NGUY~N VIET Q 40 Nam Bac Li~u 21 14329108 BUI DUC H 73 Nam S6c Tr~ng 22 14343193 LE V ~N L 66 Nam H~u Giang 23 14347688 NGUY~N TUNG D 52 Nam Hu Giang 24 14351935 MAI VAN D 39 Nam Vinh Long 25 14350684 VO T HI N 60 N H~u Giang 26 14361667 NGUYN THI D 47 Ntr H~u Giang 27 14366848 LAM NGQC A 46 N Bac Li~u 28 14366853 PHAM DO T 39 Nam Can Tho 29 14367915 NGUYEN PHU~C D 42 Nam Can Tho 30 15001164 PHAN THJ S 55 N Can Tho 31 15001025 DANG V~N MU~I H 68 Nam H~u Giang 32 15004759 L~ VAN Q 23 Nam Can tho 15007087 HUYNH TH] M 63 Ntr S6c Tr~ng - 8£N DA K ' TRUNG � ,, ,, • 34 15008554 L E T RANH T 27 Nam H~u giang 35 14367761 LE VAN T 68 Nam Can Tho 36 14370276 NGUY~N VAN T 83 Nam C~n Tho 37 15001121 NGUYEN HUNG T 24 Nam S6c Tr~ng 38 15001082 35 Nam H@u Giang 39 15000252 TRINH D 66 Nam Can tho 40 15010988 KIM THI T 35 Ntr Sdc Tr~ng 41 15012935 NGUYEN TRONG N 25 Nam H~u Giang 42 15013136 PHAM VAN D 54 Nam Can Tho 43 15027522 NGUY~N BA P 50 Nam Vinh Lon g 44 15027867 L E H O AN G T 19 Nam Can Tho 45 15026589 NGUY~N VAN C 42 Nam S~c Tr~ng 46 15027906 TRAN V~N N 57 Nam Vinh Long 47 15028996 TRAN VANG 47 Nam Tri Vinh 48 15030120 LE VAN D 57 Nam Vinh long 49 15037513 TRAN NGOC C 37 NU C~n Tho Vinh Long V VAN ~T A 50 15039600 LE TRONG N 47 Nam 51 15039579 NGUYEN T HI N 58 N~ Can Tho 52 15041636 NGUY~N HONG P 36 Nam Vinh Long 53 15040456 LUONG CHI T 36 Nam Can Tho 54 15045511 NGUYEN XUAN P 43 Nam Vinh Long 55 15045507 LE HONG K 37 Nam Can Tho 56 15053733 Q U A C H MINH M 49 Nam Bac Li~u 57 15046663 LE NGOC C 25 NU H~u Giang 58 15056620 N6-UYEN THANH S 35 Nam An Giang 59 15073308 PHAN VAN D 34 Nam H~u Giang 60 15073480 CAO HO~NG V 51 Nam Vinh Long 61 15073302 C HA U THUY D 25 N~ H~u Giang 62 15088565 DOAN TAT N 27 Nam Vinh Long 63 15088853 NGUY~N VAN D 47 Nam H~u Giang 64 15127635 TRAN VAN H 37 Nam Hau Giang · � '\ ' I/ i t G o/:, C~n Tho ng~y th~ng nam 20157 X~c nh~n ca khoa n~i ti~u h~a I. ,_ SCI.R Zee@petty BO Y T~ CONG H~A X~ HQI CH~ NGHiA NAM D @ e L ~ p - T u D o - H a n h Ph¢ TRUONG DH Y DUOC CAN THO $6: VI T /QD-DHYDCT C~n Tho, ngy.@.thdng 10 nm 2015 QUY~T DINH V/» th~nh l@p H6i dng chdm lun dn Chuy~n khoa cp II N6i khoa khod 2013-2015 HIEU TRU'~NG TRUONG DAI HOC Y DUOC CAN THO - Can c s v~o Quy~t djnh 58/2010/QD-TTg ng~y 22 thing 09 n~m ca Th tung chinh ph v~ vi&c ban h~nh Di~u l& Truong Dai hoc; - C~n c quy~t dijnh s~ 3271/QD-BYT 04 th~ng n~m ca B@ trur~ng B6 Y t~ v& vi¢c c~ng nh@n tring tuy~n Chuyen khoa cp II n~m ca Truong Dai hoc Y Duoc C~n Th; - Can cr Quy~t djnh s~ 1637/2001/QB-BYT 25 th~ng 05 nm 2001 ca B Y t~ v~ vi&c ban ha~nh Quy ch~ dao tao chuy~n khoa c~p II Sau Dai hoc v~ k~ hoach d~o tao Sau Dai hoc n~m 2014-2015; - Cn cr Quy~t dinh s6 2321/QD-BYT ng~y 15 thing n~m c~a B$ tr~ng Bo Y t~ v~ vi&c th~nh l~p Hi d~ng thi t~t nghi~p chuyen khoa II sau dai hoc n~m ca Truong Dai hoc Y Dugc Can Tho; - Xt d~ nghij ca Ong Uy vien Thu~ng trc, QUY~T DINH: DI~U 1: Th~nh l~p H@i dong ch~m lu~n an chuy~n khoa c~p II cho hoc vi~n: Ho v~ t~n: Mae Phu&c Ton Chuyen ng~nh: Ten lu~n ~n di~u tri n@i khoa N i khoa "Nghi~n c~a Cn b@ d~n: c u b~nh d c vi~m di i ~ m Ng~y sinh: 29/03/1981 Noi sinh: Bac Lieu Kha: 2013-2015 M~ s6: 62.72.20.40.CK l a m sang, c@n l a m sang, cc m c d@ n n g v a k ~ t qu~ cip" PGS.TS Tr~n D% Hing BS.CKII Kha Hiu Nh~n Ho v~ t~n Co quan c~ng t~c Nhi~m vu GS.TS Pham Van Linh Truong Dai hoc Y Dugc C~n Tho Ch tjch H~i d~ng PGS.TS Tr~n Ngoc Dung Truong Dai hoc Y Duoc C~n Tho Ph~n bi~n TS.BS L& Hoang Son Nguyen GD BV Nhi d~ng Can Tho TS.BS Dng Quang Tam B~nh vi~n Da khoa Trung uong BS.CKII Kha Htu Nhan Truong Dai hoc Y Dugc C~n Tho ~y vien TS.BS Ng6 Van Truy~n Truong Dai hoc Y Duoc C~n Tho ~y vi~n TS.BS Tr~n Vi~t An Truong Dai hoc Y Duoc C~n Tho ~y vien-Thu ky DI~U 2: H6i d~ng c~ nhi~m tao chuy~n khoa c~p II v~ vu tu gi~i Ph~n bi@n C n Tho ~y vi~n t~ ch'c bu~i ch~m lu~n ~n cho hoc vi~n theo dng Quy ch~ d~o tan sau ho~n th~nh nhi~m vu DI~U 3: C~c Ong (Ba) Truong phong Dao tao Sau dai hoc, H~nh ch~nh tng hop, Th~ trung c~c don vi c~ lien quan v~ cc vi~n H& , A A ~n chuy~n khoa II chju tr~ch nhi~m thi hanh Quy~t djnh prkTU'~NG Not nhdn: -Nhu di~u 3; 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