Nghiên cứu kiến thức và thái độ về hội chứng ngừng thở khi ngủ tắc nghẽn của học viên tại bệnh viện bạch mai

B GIO DC V O TO B Y T TRNG I HC Y H NI Lấ TH HNG NHUNG NGHIÊN CứU KIếN THứC THáI Độ Về HộI CHứNG NGừNG THở KHI NGủ TắC NGHẽN CủA HọC VIÊN TạI BệNH VIệN BạCH MAI LUN VN THC S Y HC H NI 2016 B GIO DC V O TO B Y T TRNG I HC Y H NI Lấ TH HNG NHUNG NGHIÊN CứU KIếN THứC Và THáI Độ Về HộI CHứNG NGừNG THở KHI NGủ TắC NGHẽN CủA HọC VIÊN TạI BệNH VIệN BạCH MAI Chuyờn ngnh: Ni khoa Mó s: 60720140 LUN VN THC S Y HC Ngi hng dn khoa hc: GS.TS Ngụ Quý Chõu H NI - 2016 LI CM N Trong quỏ trỡnh hc v hon thnh khúa lun tụi ó nhn c s ch bo tn tỡnh ca cỏc thy, cỏc cụ, s giỳp ca ngi thõn, bn bố v ng nghip Vi tt c s kớnh trng v lũng bit n chõn thnh, tụi xin gi li cm n ti: ng y, ban giỏm hiu, phũng o to Sau i hc, b mụn ni tng hp trng i hc Y H Ni ó to iu kin thun li cho tụi sut quỏ trỡnh hc ti trng v b mụn ng y, Ban giỏm c, phũng K hoch tng hp, Trung tõm hụ hp bnh vin Bch Mai ó luụn giỳp v to iu kin cho tụi quỏ trỡnh hc v lm nghiờn cu ng y, Ban giỏm c, th khoa ni tng hp bnh vin a khoa tnh Phỳ th ó to iu kin thun li cho tụi c hc v nghiờn cu c bit tụi xin by t lũng bit n sõu sc ti: GS.TS Ngụ Quý Chõu, thy ó tn tõm dy d v dỡu dt tng bc, giỳp tụi trng thnh sut quỏ trỡnh hc tp, nghiờn cu v hon thnh lun Tụi xin chõn thnh cm n nhng ý kin úng gúp quý bỏu ca cỏc thy, cụ Hi ng chm lun vn, lun ca tụi c hon thin hn Tụi xin chõn thnh cm n cỏc anh ch cỏc bn hc viờn ó tham gia nghiờn cu giỳp tụi hon thnh lun Vi tỡnh cm c bit nht ca mỡnh, tụi xin by t lũng bit n ti gia ỡnh, bn bố, ng nghip v ngi thõn ó ht lũng ng h, ng viờn tụi sut thi gian hc va qua H Ni, ngy 20 thỏng10 nm 2016 Hc viờn Lờ Th Hng Nhung LI CAM OAN Tụi xin cam oan õy l cụng trỡnh nghiờn cu tụi trc tip thc hin di s hng dn ca GS.TS Ngụ Quý Chõu Cụng trỡnh ny khụng trựng lp vi bt k nghiờn cu no khỏc ó c cụng b ti Vit Nam Cỏc s liu thụng tin nghiờn cu l hon ton chớnh xỏc, trung thc v khỏch quan Tụi xin hon ton chu trỏch nhim v nhng li cam oan ny./ H Ni, ngy 20 thỏng 10 nm 2016 Hc viờn Lờ Th Hng Nhung DANH MC CC CH VIT TT AHI : Apnea Hypopnea Index - ch s ngng gim th ASDA : American Sleep Disorders Association - Hi bnh lý gic ng Hoa K BMI : Body Mass Index - ch s c th BN : Bnh nhõn ECG : Electrocardiography - in tõm EEG : Electroencephalography - in nóo EMG : EMG-Electromyography - in c EOG : Electrooculography - in nhón ESS : Epworth sleepness scale - bng im Epworth FR : Nhp th KAP : Knowledge - Attitude Practice: kin thc - thỏi - thc hnh OSA : Obstructive Sleep Apnea - ngng th ng tc nghn OSAKA : (Obstructive Sleep Apnea Knowledge and Attitudes) Kin thc v thỏi ngng th tc nghn ng OSAS : Obstructive sleep apnea syndrome - Hi chng ngng th ng tc nghn PSG : Polysomnography - o a ký gic ng REM : Rapid eyes movements - c ng mt nhanh SAS : Sleep Apneas Syndrome - hi chng ngng th ng THA : tng huyt ỏp MC LC DANH MC BNG DANH MC BIU DANH MC HèNH 10 T VN Ng l mt nhng hot ng sinh lý ca ngi, i lp vi hot ng thc Nhng quan tõm v mt y hc i vi gic ng ó c nhc n y t 1000 nm trc Cụng Nguyờn Tuy nhiờn n th k 19 y hc nhõn loi mi thc s bc vo nghiờn cu v gic ng v phi n nhng nm cui th k 19 cỏc tỏc gi mi thc s mụ t ri lon gic ng ca hi chng ngng th ng Hi chng ngng th ng l mt cỏc ri lon liờn quan n gic ng khỏ thng gp Hi chng ngng th ng (SAS - Sleep Apneas Syndrome) c trng bi s xut hin nhng cn ngng th v/ hoc gim th ng Nhng bin c hụ hp ny c c trng bi vic ngng dũng khớ (ngng th) hay gim dũng khớ trờn 50% hn 10 giõy xut hin trờn ln/gi [1] Nú l nguyờn nhõn gõy cỏc suy gim v trung, nhn thc v cht lng cuc sng cng nh cht lng lao ng ca ngi Nú cng l nguyờn nhõn lm gia tng t l tai nn giao thụng triu chng bun ng ban ngy quỏ mc ca bnh nhõn cng nh s suy gim trung chỳ ý m hi chng ny gõy [2][3] ng thi cỏc tỏc gi cng nhn thy mi liờn quan rừ rt gia hi chng ny vi cỏc yu t nguy c tim mch v nóo b, nhn thc thn kinh v nhng tỏc ng kinh t Hi chng ngng th ng lm tng nguy c tng huyt ỏp, tng dao ng huyt ỏp ú lm tng nguy c nhi mỏu c tim, lon nhp tim, t qu v bnh tiu ng [4][5][6] Ti Vit Nam, cho n ó cú mt s cụng trỡnh nghiờn cu v hi chng ngng th ng tc nghn (OSA - Obstructive Sleep Apnea), nhiờn hi chng ny cha dnh c s quan tõm ỳng mc v s hiu 78 cu kin thc thỏi ca nhúm Bỏc s tim mch i vi ngng th tc nghn ng cho kt qu khụng cú mi tng quan gia tng im thỏi v gii tớnh, nhiờn cú s khỏc bit v thỏi nhn bit bnh nhõn cú ngng th ng v gii (p < 0,05) [50] 79 KT LUN Qua nghiờn cu 336 i tng l cỏc hc viờn sau i hc ti bnh vin Bch Mai cú tui trung bỡnh l 31,45,4 tui, gii n chim 58,6% v s nm kinh nghim trung bỡnh l 6,34,9 nm cho thy: Kin thc ca hc viờn sau i hc ti Bnh vin Bch Mai v hi chng ngng th ng tc nghn nm 2016 Tng im ca ngi tham gia dao ng t n 18 im trung bỡnh l 11,222,99 (62,3%16,6) v giỏ tr trung v l 12 Hai ngi tham gia cú tng im l bn ngi tham gia cú tng im l 18, v 278 (75,9%) ngi tham gia cú tng im t tr lờn (50%) Khụng cõu hi no c tr li ỳng hon ton bi nhng ngi tham gia nghiờn cu im trung bỡnh ca kin thc v dch t ngng th ng l 4,23 im, kin thc v triu chng l 1,44 im, kin thc v chn oỏn l 2,7 im v kin thc v iu tr l 2,84 im im kin thc trung bỡnh chung l 11,22 im Cú mi liờn quan dng tớnh mc yu gia kin thc v ngng th ng tc nghn vi s nm kinh nghim (r=0,137; p=0,012) Cú mi liờn quan gia chuyờn ngnh ca i tng nghiờn cu v im kin thc v ngng th ng tc nghn (p 0,05) - Cú s tng quan cú ý ngha thng kờ gia tng im thỏi vi gii, trỡnh v chuyờn ngnh ca i tng nghiờn cu (p < 0,05) 81 KIN NGH nõng cao nhn thc, hng ti sng lc v chn oỏn ca cỏc hc viờn sau i hc v hi chng ngng th tc nghn ng thỡ: - Cỏc chng trỡnh giỏo dc y khoa liờn tc v y hc gic ng cn c t chc thng xuyờn hn cung cp c hi ci thin kin thc ca cỏc bỏc s cng nh cỏc chng trỡnh giỏo dc ti cng ng v ri lon gic ng, cỏc yu t ri ro v hu qu lõu di ca OSA nu khụng c iu tr - Ci thin cỏc phng tin chn oỏn cỏc c s o to v cỏc bnh vin cú kh nng thỳc y s quan tõm v y hc gic ng, kớch thớch v h tr cn thit cỏc nghiờn cu v gic ng TI LIU THAM KHO DORTHO M.P (2010) Syndromes dapnộes du sommeil chez linsuffisant cardiaque Monographe - Pathologies du sommeil, Association Franco-Vietnamienne de Pneumologie 1, 135-141 Pack AI, Dinges D, Maislin G (2002) A study of prevalence of sleep apnea among commercial truck drivers Washington, DC: Federal Motor Carrier Safety Administration; Publication No DOT-RT-02-030 [accessed 2015 Jul 12] Available from: http://www.cpapsupplyusa com/PDFs/Prevalence-508.pdf Schr oder CM, OHara R (2005) Depression and obstructive sleep apnea (OSA) Ann Gen Psychiatry; 4:13 Somers VK, White DP, Amin R, et al (2008) Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing, in collaboration with the National Heart Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health) Circulation; 118:10801111 Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V (2005) Obstructive sleep apnea as a risk factor for stroke and death N Engl J Med; 353:20342041 Punjabi NM, Sorkin JD, Katzel LI, Goldberg AP, Schwartz AR, Smith PL (2002) Sleep-disordered breathing and insulin resistance in middleaged and overweight men Am J Respir Crit Care Med;165: 677-682 Gibson G.J (2005) Obstructive sleep apnea syndrome: underestimated and undertreated Oxford Journals Medicine 72(1), 49-64 Ramos Platún (1996) Sueủo y procesos cognitivos: Sớntesis Psicologớa, Editorial Sớntesis, Madrid, 99-101 Ryan C.M (2011) Influence of continuous positive airway pressure on outcomes of rehabilitation in stroke patients with obstructive sleep apnea Stroke, 42(4), 1062-1067 10 Mirrakhimov A.E (2013) Prevalence of obstructive sleep apnea in Asia adults: a systematic review of the literature Pulmonary Medicine, 13(2), 1-3 11 Liu S.A (2004) Prevalence of snoring in Taichung area: an epidemiological study J Chin Med Assoc, 67(3), 32-36 12 Chuang L.P (2008) Prevalence of snoring and witnessed apnea in Taiwanese adults Chang Gung Med J, 31(1), 175-181 13 Hui D.S (2006) Sleepdisordered breathing and continuous positive airway pressure compliance in a group of commercial bus drivers in Hong Kong Respirology, 11(2), 723730 14 Asaoka S (2010) Excessive daytime sleepiness among Japanese public transportation drivers engaged in shiftwork JOEM, 52(1), 813818 15 Chen R (2011) Daytime sleepiness and its determining factors in Chinese obstructive sleep apnea patients Sleep Breath, 15(2), 129135 16 Flemon W.W (2002) Obstructive sleep apnea N Engl J Med 347(7), 498-504 17 Nguyn Xuõn Bớch Huyờn (2010) Theo dừi bnh nhõn SAOS iu tr bng thụng khớ ỏp lc dng liờn tc ti Vit Nam Tp hi Phi Phỏp Vit chuyờn bnh lý gic ng 1, 248-253 18 Trn Th Dim Trang (2011) Bc u chn oỏn hi chng ngng th ng ti bnh vin Phm Ngc Thch Tp hi phi Phỏp - Vit, 6(2), 83-89 19 Nguyn Thanh Bỡnh (2012) Nghiờn cu c im lõm sng, a ký gic ng v hiu qu ca th ỏp lc dng liờn tc iu tr hi chng ngng th tc nghn ng Lun Tin s y hc, Trng i Hc Y H Ni 20 inh Th Thanh Hng (2014) c im lõm sng, cn lõm sng v kt qu o a ký hụ hp ca bnh nhõn ngng th ng ti Trung tõm Hụ hp bnh vin Bch Mai Lun thc s y hc, Trng i hc Y H Ni 57 21 Ngụ Quý Chõu (2012) Bnh hụ hp Nh xut bn giỏo dc Vit Nam 613-617 22 Young T., Shahar E., Nieto F J et al (2002) Predictors of SleepDisordered Breathing in Community-Dwelling Adults Arch Intern Med 162(8), 893-900 23 Lloberes P., Durỏn-Cantolla J., Martớnez-Garcớa M. et al (2011) Diagnosis and treatment of sleep apnea-hypopnea syndrome Arch Bronconeumol 47(3), 143-156 24 Walter T., Nicholas M.C (2009) Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea Overlaps in Pathophysiology, Systemic Inammation and Cardiovascular Disease American Journal of Respiratory and Critical Care Medicine 180, 692-700 25 Lam B.C (2007) Obstructive sleep apnea in Asia Tuberc Lung Dis, 11(1), 2-11 26 Martin F (2010) Sommeil et vigilance physiologie et exploration Monographe-Pathologies du sommeil, Association Franco-Vietnamienne de Pneumologie 1, 5-18 27 Bryant P.A., Trinder J., Curtis N (2004) Sick and tired: does sleep have a vital role in the immune system? Nat Rev Immunol 4(6), 457-467 28 Jain S.V., Glauser T.A (2014) Effects of epilepsy treatments on sleep architecture and daytime sleepiness: An evidence-based review of objective sleep metrics Epilepsia 55(1), 26-37 29 Martin F (2010) Quels enregistrements pour le diagnostic, de loxymộtrie la polysomnographie, principes pratiques - Indications respectives Monographe - Pathologies du sommeil, Association FrancoVietnamien de Pneumologie 1, 25-37 30 B Y T (2010) Bnh hc hụ hp Nh xut bn Y hc, H Ni, 725-733 31 Yoo Y.C (2014) Endoscopic Sedation: Risk Assessment and Monitoring Clinical Endoscopy 47(2), 151-154 32 Hi Tim Mch Hc Vit Nam (2006) Khuyn cỏo v cỏc bnh lý tim mch v chuyn húa Nh xut bn Y hc, H Ni, 14 33 Stradling J.R (1989) Sleep apnoea and systemic hypertension Thorax 44(12), 984-989 34 Kiselak J.M., Levison P.D., Mc Garvey S.T et al (1993) Adiposity and cardiovascular risk factors in men with obstructive sleep apnea Chest 103(5), 1336-1342 35 Michel P (2010) Apnộes obstructives du sommeil et maladies cardiovasculaires Monographe - Pathologies du sommeil, Association Franco Vietnamienne de Pneumologie 1, 112-122 36 Peppard P.E., Young T., Palta M et al (2000) Prospective study of the association between sleep-disordered breathing and hypertension New England Journal of Medicine 342(19), 1378-1384 37 Philip P., Guilleminault C (1993) ST segment abnormality, angina during sleep and obstructive sleep apnea Sleep 16(6), 558-559 38 Peker Y., Carlson J., Hedner J et al (2006) Increased incidence of coronary artery disease in sleep apnoea : a long-term follow-up Eur Respir J 28(3), 596-602 39 Grimm W., Hoffmann J., Menz V et al (1996) Electrophysiologic evaluation of sinus node function and atrioventricular conduction in patients with prolonged ventricular asystole during obstructive sleep apnea Am J Cardiol 77, 1310-1314 40 Garbarino S., Magnavita N (2014) Obstructive Sleep Apnea Syndrome (OSAS), Metabolic Syndrome and Mental Health in Small Enterprise Workers Feasibility of an Action for Health PLoS ONE 9(9), e97188 41 Yaggi H (2005) Trend Analysis for the Relationship between Increased Severity of the Obstructive Sleep Apnea Syndrome and the Composite Outcome of Stroke or Death from Any Cause (N=1022) N Engl J Med 2005 353, 2034-2041 42 Gami A.S., Howard D.E., Olson E.J et al (2005) Day-night pattern of sudden death in obstructive sleep apnea N Engl J Med 352, 1206-1214 43 Gami A.S., Somers V.K (2008) Implications of obstructive sleep apnea for atrial fibrillation and sudden cardiac death J Cardiovasc Electrophysiol 19(9), 997-1003 44 Bassetti C.L., Milanova M., Gugger M (2006) Sleep-disordered breathing and acute ischemic stroke: diagnosis, risk factors, treatment, evolution, and long-term clinical outcome Stroke 37(4), 967-72 45 Schotland HM, Jeffe DB (2003) Development of the Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA) questionnaire Sleep Med; 4:443450 46 Fernandez A, Cherrez Ojeda I, Calderon JC, et al (2014) Knowledge and attitude about obstructive sleep apnea among newly graduated physicians [abstract C110] Am J Respir Crit Care Med;189 (Meeting Abstracts):A5346 47 Obianuju B Ozoh, Sandra O Iwuala, et al (2015) "An Assessment of the Knowledge and Attitudes of Graduating Medical Students in Lagos, Nigeria, Regarding Obstructive Sleep Apnea", Annals of the American Thoracic Society, Vol 12, No 9, pp 1358-1363 48 Ivan Cherrez Ojeda, Donna B Jeffe, Thomas Guerrero, et al Attitudes and knowledge about obstructive sleep apnea among Latin American primary care physicians Sleep Medicine, 2013 Oct, Volume 14, Issue10, pp 973-977 49 Choi Seung Hoon (2007) traditional medicine strategy and activities, ed WHO 50 Clyde Southwell, Moallem M, Auckley (2008) Cardiologists knowledge and attitudes about obstructive sleep apnea: a survey study Sleep Breath, Nov; 12(4):295-302 51 Chun Lin Wang, Li XZ, Cai XL, Pan XL, Min J (2012) Anesthesiologists knowledge and attitudes about obstructive sleep apnea: a survey study Sleep Breath, Mar; 16(1):41-46 52 Mindell JA, Bartle A, Wahab NA, et al (2011) Sleep education in medical school curriculum: a glimpse across countries Sleep Med;12:928931 53 Almohaya A, Qrmli A, Almagal N, et al (2013) Sleep medicine education and knowledge among medical students in selected Saudi medical schools BMC Med Educ;13:133 54 Obianuju B Ozoh, Sandra O Iwuala, et al (2016) Is the knowledge and attitude of physicians in Nigeria adequate for the diagnosis and management of obstructive sleep apnea? Sleep Breath Sep 12 55 William NJ, Nunes JV, Zizi F, et al (2015) Factors associated with referrals for obtructive sleep apnea evaluation among community physicians J Clin Sleep Med Jan 15;11(1): 23-26 56 Firestone RT, Gander PH (2010) Exploring knowledge and attitudes of taxi drivers with regard to obstructive sleep apnea N Z Med J Aug 27;123(1321):24-33 57 Phan Thanh Thy (2015) c im ca hi chng ngng th ng bnh nhõn bnh phi tc nghn mn tớnh Lun tt nghip bỏc s ni trỳ, Trng i hc Y H ni 84 58 JansariM.R., Iyer K., Kulkarni S S (2015) The role of Sleep Apnea Clinical Score (SACS) as a pretest probability in obstructive sleep apnea International Journal of Biomedical Research 6(7), 479-481 59 Costa LE, Ucho CH, Harmon RR, Bortolotto LA, Lorenzi G, Drager LF (2015) Potential underdianosis of obstructive sleep apnea in the cardiology outpatient setting Heart Aug;101(16):1288-1292 60 Tamay Z, Akcay A, kilic G, Suleyman A, Ones U, Guler N (2006) Are physicians aware of obstructive sleep apnea in children? Sleep Med Oct;7(7):580-584 PH LC A: B CU HI OSAKA KIN THC V THI V NGNG TH DO TC NGHN KHI NG Vui lũng tr li nhng cõu hi sau (chn ỳng, Sai hoc Khụng rừ) ỳn Sai Khụng rừ g X X Ph n b ngng th tc nghn ng cú th ch cú nht biu hin mt mi Phu thut to hỡnh hng giỳp iu tr hon ton ngng th tc nghn ng a s bnh nhõn T l b ngng th tc nghn ng X X X X X ngi trng thnh c tớnh khong n 10% a s bnh nhõn ngng th tc nghn ng cú biu hin ng ngỏy Ngng th tc nghn ng cú liờn quan n tng huyt ỏp Nghiờn cu gic ng sut ờm l tiờu chun vng chn oỏn ngng th tc nghn ng iu tr bng liu phỏp CPAP (thụng khớ ỏp lc dng liờn tc) cú th gõy tc mi Phu thut to hỡnh hng cú laser h tr thớch X hp cho nhng trng hp ngng th ng X tc nghn mc nng Mt trng lc ng hụ hp trờn ng gúp phn gõy ngng th tc nghn ng 10 tr em nguyờn nhõn ph bin nht ca X ngng th tc nghn ng l quỏ phỏt amydal hng (amydal) v amydal vũm (VA) 11 Khỏm vựng s mt v hu hng cú ớch X ỏnh giỏ bnh nhõn ngng th tc nghn X X tỡnh trng ngng th tc nghn ng 13 Ngng th tc nghn ng khụng c iu tr s dn ti tng t l tai nn xe 14 nam gii, kớch thc vựng c ln hn X hoc bng 17 inch liờn quan n hi chng X X ng 12 Ung r trc i ng giỳp ci thin ngng th tc nghn ng 15 Hi chng ngng th tc nghn ng ph bin gii n hn gii nam 16 CPAP l bin phỏp iu tr c la chn u tiờn cho ngng th tc nghn ng mc nng 17 ngi trng thnh, cú t ln ngng th X X hoc th yu tr xung mi gi ng l bỡnh thng 18 Nhiu ri lon nhp tim cú liờn quan ti ngng th tc nghn ng khụng c iu tr Vui lũng ỏnh du vo mt cỏc la chn c a di cho mi cõu hi m bn cho l ỳng v hi chng ngng th tc nghn ng: A Ngng th tc nghn ng l mt bnh lý: Khụng quan trng Rt quan trng Phn no quan trng Quan trng Cc kỡ quan trng B Nhn bit bnh nhõn cú th cú ngng th tc nghn ng l: Khụng quan trng Phn no quan trng Quan trng Rt quan trng Cc kỡ quan trng C Tụi t tin cú th nhn bit bnh nhõn cú nguy c ca ngng th tc nghn ng: Rt khụng ng ý Hon ton khụng ng ý Khụng ng ý ng ý Rt ng ý D Tụi t tin cú th qun lý nhng bnh nhõn b ngng th tc nghn ng Rt khụng ng ý Hon ton khụng ng ý Khụng ng ý ng ý Rt ng ý E Tụi t tin vi kh nng ca mỡnh s kim soỏt c bnh nhõn iu tr bng CPAP (thụng khớ ỏp lc dng liờn tc) Rt khụng ng ý Hon ton khụng ng ý Khụng ng ý ng ý Rt ng ý Chỳng tụi quan tõm n bt kỡ yu t nhõn khu hc no giỳp tiờn lng kin thc v ngng th tc nghn ng Vui lũng tr li nhng cõu hi v thụng tin ca bn di õy: Gii: Tui: Nam _ _ tui N Bng cp: Bỏc s Bỏc s chuyờn khoa Nm tt nghip trng i hc y: _ _ Loi hỡnh o to ni trỳ Chuyờn khoa: _ Nm kt thỳc quỏ trỡnh hc ni trỳ: , o to chuyờn sõu: Cú Khụng Chuyờn khoa: _ Nm hon thnh o to chuyờn sõu (Nu cú): , Bng cp nc ngoi: Cú Khụng Chuyờn ngnh: S nm kinh nghim: nm ... O TO B Y T TRNG I HC Y H NI Lấ TH HNG NHUNG NGHIÊN CứU KIếN THứC Và THáI Độ Về HộI CHứNG NGừNG THở KHI NGủ TắC NGHẽN CủA HọC VIÊN TạI BệNH VIệN BạCH MAI Chuyờn ngnh: Ni khoa Mó s: 60720140 LUN... chng ngng th ng tc nghn ca hc viờn ti bnh vin Bch Mai vi mc tiờu: ỏnh giỏ kin thc v thỏi v hi chng ngng th ng tc nghn ca hc viờn ti bnh vin Bch Mai nm 2016 12 CHNG TNG QUAN TI LIU 1.1 Lch s phỏt... quỏ trỡnh hc ti trng v b mụn ng y, Ban giỏm c, phũng K hoch tng hp, Trung tõm hụ hp bnh vin Bch Mai ó luụn giỳp v to iu kin cho tụi quỏ trỡnh hc v lm nghiờn cu ng y, Ban giỏm c, th khoa ni tng