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JSSN 1859 • 1663 JPM 2(1034) 2017 TAP CHI Y HOC THtfC HANH • • • JOURNAL OF PRACTICAL MEDICINE KY Nl|M 87 NAM THANH LAP BANG C0N8 SAN VlfT NAM (3/2/1930 - 3/2/2017) Nam thtr sau hai So (1034) 2017 Bp Y te xuat ban va phat hanh hang thang The 62st year No (1034) 2017 Ministry of health publishes and releases monthly MUC LUC TAP CHI Y HOC THI/C HANH BO Y T E XUAT BAN JOURNAL OF PRACTICAL MEDICINE PUBLISHED BY MINISTRY OF HEALTH B o trudng B o Y te Tong Bien tap PGS TS N g u y l n Th'j Kim Tien Pho Tong Bien tap TS Nguyen Vinh Hung T h u ky T o a s o a n Ths Bui Nam Trung B a n Bien tap: GS TS Le Ngoc Trpng GS TS Ngo Quy Chau GS TS Ha Van Quyet GS TSKH Nguyen Van Dip GS TSKH Ha Huy Khoi GS TS Tran O u t Thp GS TS N g u y l n Viet Tien GS TS N g u y l n Anh Tri PGS TS Ngo Van Toan PGS TS N g u y l n Qud'c Tuan PGS TS Phan Van Tudng PGS TS N g u y l n Thi Bich Lien PGS TS Luang Ngoc Khue PGS TS Tran Quy T u c n g PGS TS Pham Thuc Hanh TS Vu Van Du TS Nguyen Bao Ngoc Trinh bay: N g u y l n Thai, Hai Yen Toa s o a n : 138A G i a n g V - HN OT: 04.38460728; 04.37368092 Fax:04.38464098; E-mail: info@yhth.vn Banbientap@yhth.vn Website: www.yhth.vn V a n phong dai dien phia Nam 109A P a s t e u r - Q u a ' n 1, TP H C M * Giay phep s o : 108/GP-BVHTT Cap 29-3-2001 ISSN 1859-1663 * Giay phep sura doi, bo s u n g thang ky so: 256/GP-SDBS-GPHOBC 7/6/2004 * In tai: Cong ty CP In Sao Viet * In xong va nop luu chieu 2/2017 S6 TRAN DlEP KHOA, DO QUANG HUAN • NGUYEN THI X U Y E N • NGUYEN XUAN HUY, TRAN VAN THANH • NGUYEN KHAC MINH, NGUYEN VAN SONG, TRAN OlNH T R U N G •NGUYEN HUNG CU'&NG, NGO QUANG DLCONG, TRAN Q U A N G CANH, HIROSHI ICHIMURA, PHAM VAN THLFC • NGO Q U A N G DUONG NGUYEN VAN KHAI • T A V A N TRAM, PHAM T H E HIEN •NGUYEN VAN DUNG, TRjNH BAO NGOC, TRAN TH| THOA, PHAM DUY T l / O N G • L E DiNH PHAN, NGUYEN TUAN HUNG, OAO VAN DUNG, TRAN VAN H I K I N G •V0 TH| H6NG, NGUYEN THANH H6l, NGUYEN VAN DO AN •TRAN DIEP KHOA, DO QUANG HUAN • L E THI HUONG, VO THI THU THUY • NGUYEN O U C MINH • NGO QUANG DUONG, NGUYEN VAN KHAI •TA VAN TRAM, PHAM T H E HlEN Gia 50.000d Y H O C T H l T C H A N H (1034) - SO 2/2017 1034 => D a c diem va cac y l u t l lien quan r l i loan nhip nhl a benh nhan tang h u y l t ap T h y c trang va giai phap hieu qua kham c h u a benh bang y hoc co t r u y l n tinh Thai Binh d i n nam 2020 => Nghien c u u tac dung cua mot so loai khang sinh v d i vi k h u l n d u c n g sinh san a nCr cong nhan khu cong nghiep tinh Hai D u o n g nam 2016 => Nghien c u u k i l n t h u c thai dp hanh vi v l s u e khoe sinh san va cac y l u t l lien quan a hoc sinh trung hoc thong tai p h i D a N l n g => Ti le n h i l m va phan b l genotype cua Human papillomavirus tren benh nhan ung t h u sinh due n u => K i l n thuc, t h y c hanh va mot s i y l u t l l i l n quan d i n benh giun d u c n g ruot cua phu huynh hoc sinh co hoc tai 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 chan t h u o n g bung kin tai Benh vien Da khoa Trung tarn T i l n Giang => Danh gia tinh trang thai t r u hoa chat bao ve t h y c vat qua s u a m e va n u d e tieu cua phu n u dang cho bu d u d i 12 thang t u l i tai mot s i quan p h i Ha Npi nam 2013 => Hieu qua can thiep mo hinh tram y t l xa tai huyen, p h i tinh Hda Binh, 2016 => Nghien c u u tinh hinh kiem soat hen p h i quan va mot s i y l u t l nguy c o lien quan theo gina 2015 tai Benh vien Dai hoc Y Hai Phong D a c diem va cac y l u t l lien quan r l i loan nhip t h l t d benh nhan tang h u y l t ap => Phan u n g cd hai tren than kinh trung u o n g va tarn than lien quan d i n EFV d benh nhan dilu tri phac dl DF/3TC/EFV => Gdp phan nghien c u u nguyen nhan va c o c h l b i n h sinh cua benh viem k h d p dang thap theo quan d i l m y hoc c l truyln => K i l n thuc va t h y c hanh nudi bang sua m e cua cac ba me cd d u d i t u l i tai mot xa huyen mien, tinh Hai D u o n g nam 2016 => Cac y l u t l lien quan den loang x u o n g d n g u d i cao t u l i cd benh p h l i t i c man tinh tai Benh vien Da khoa T i l n Giang MUC LUC (S6 1034) • L E DINH PHAN, NGUYEN TUAN HUNG, OAO VAN DUNG, TRAN VAN H U ^ N G •NGUYEN TH| THANH HUONG, HOANG T R U N G KlEN, L U U THI ANH T U Y E T , NGUYEN THU TRANG, NGO TH| T U Y E T •NGUYEN HUY ANH, L E THj HOAN, T R U O N G OINH B A C •NGUYEN THj NGA, KIM BAO GIANG, NGUYEN THANH HA •PHAN Q U O C HOI => So sanh k i t qua trirdc - sau can thiep mo hinh tram y te xa tai huyen, tinh Hda Binh, 2016 52 => Khao sat thai do, k i l n thi>c doi v d i s y co y khoa khdng mong muon cua d i l u d i r d n g , hq sinh tai Benh vien Da khoa Trung i r c n g Thai Nguyen nam 2016 56 => D a n h gia cua cac ba me co d i r d i t u l i sir dung tiem chung dich vu tai tinh Nghe An nam 2016 59 => T i n h gia trj va dp tin cay cua mot so cdng cu thu nhan phan h l i t i r 62 => T h y c trang u l n g mryu, bia cua nam gidi dp tuoi t i r 15 - 60 tai xa Tay Thanh, Yen Thanh, Nghe A n nam 2015 65 •OAO TH| DUNG, NGUYEN ANH CHI, NGUYEN QUANG TRUNG •TRAN TUAN ANH, L E THI KIM DUNG, DO THAI SON, NGUYEN TH| HA, L Y THUY MINH, PHAM TRUNG KlEN, VU VAN DU •OINH NGOC SON, NGUYEN L E BAO TIEN => M6 ta t h y c trang benh sau rang va viem l y i cua hoc sinh Trung hoc thong Chu Van An quan Ba D i n h , Ha Ndi 68 => D a c diem benh nhi cd tang ap l y c ddng mach p h l i tai Benh vien Da khoa Trung i r c n g Thai Nguyen 71 => D a n h gia k i t qua c h a m sdc benh nhan sau p h i u thuat benh ly 75 giang vien va sinh vien tmrp't dot song that lirng, that lumg cung tai Benh vien H d u nghi Niet Ode • L E THj H U O N G => Hieu qua can thiep n h a m cai thien mot so chi s i danh gia chat 77 l i r g n g d i l u tri HIV/AIDS tai Benh vien Da khoa huyen T h u a n Chau, tinh S e n La •TRAN NGQC Q U E => T h y c trang va giai phap phat then nguon nhan l y c y hoc co 79 t r u y l n tinh Quang Binh den nam 2020 •NGUYEN HOANG LONG, OAO THU THUY •TRAN TH| KIM LIEN •HOANG TRUNG KlEN, NGUYEN TH| THANH HUONG, NGUYEN XUAN TUNG •TA VAN TRAM, PHAM THE HlEN •TRUONG VIET T R U O N G , NGUYEN TH| QUYNH HOA •PHAM TUNG LAM, BANG XUAN KET, NGUYEN D U C TAI •PHAM TH| T U Y E T NGA, HOANG TH| THU TRANG, PHAM THj HANH QUYEN •DO VAN DUNG, BANG TH| NGOC BICH => K i l n t h d c va t h y c hanh tiem an toan cua d i l u d i r d n g vien Benh 82 vien Da lieu Trung i r a n g n a m 2012 => Oanh gia t h y c trang sau rang bu binh d Ida tuoi m i m non 84 => K i l n thdc va hanh vi t y bao ve s d c khde 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 90 man tinh tai B i n h vien Da khoa Trung tarn Tien Giang => T h y c trang s d c khoe va benh t h i r d n g gap d cdng nhan lao dpng 94 mdi tmrdng vi hau nong tai Cdng ty Gang thep Thai Nguyen => Nghien c d u dieu kien lao ddng va mdi tmrdng anh h i r d n g d i n s d c 96 khde va cot s i n g cua ngirdi lao ddng b l c xep tai cac b i n cang nganh Giao thong Van tai, d l xuat giai phap d y phdng => Oac d i l m ton t h i r c n g md c d n g viing c l rang 100 => Cac yeu t l nguy c c benh cham tay cua nhan vien y t l 102 Y H O C THlTC HANH (1034) - SO 2/2017 •PHAM NHUHUNG, NGUYEN QUANG TUAN T h a m dien sinh ly hoc tim tren benh nhan co dien tarn 66 Brugada •VO THj LAN, DO QUANG HUAN •MAI THj HlEN, D GIA TUYEN, DANG THI VIET HA •PHAN Q U C HOI => Benh dpng mach vanh tren n h d n g benh nhan co b#nh van tim d i r a c p h l u thuat van tim tai Vien Tim Ho Chi Minh •OAO TH| DUNG, NGUYEN ANH CHI, NGUYEN QUANG TRUNG => Hieu qua dieu trj Corticoid tren mot s6 benh nhan benh than Iga => Xac djnh y l u to lien quan d i n sir dung n r g u , bia cua nam gidi dp tuoi tir 16 - 60 tai xa Tay Thanh, Yen Thanh, Nghe An nam 2015 => M l i lien quan giCra k i l n thdc, thai dp, hanh vi c h a m sdc rang mieng vdi benh sau rang, viem lei ciia hoc sinh t r a d n g Trung hoc p h i thong Chu Van An, quan Ba B i n h p h i Ha Ndi • L E TH| THANH HUONG, CHU VAN THANG VU DlEN, L E THj THANH XUAN •NGUYEN TH| HOAI, DOAN TH| HUONG, L U U THj ANH T U Y E T => Sir tham gia cua giao vien tieu hoc cdng tac y te t r i r d n g hoc tai quan Thanh Xuan, nam 2012 •NGUYEN THAI HUNG D U O N G MINH D U C => D a n h gia m d c dp h i l u cua can bp y t l v d i bp cdng cu l i r d n g mdi t r i r d n g lam viec ( C O A C H ) tai Quang Ninh => Phan d n g cd hai tren than lien quan den T D F d benh nhan dieu trj phac dd TDF/3TC/EFV • L E TH| HUONG, VO TH| THU THUY •NGUYEN D U C MINH •HOANG TH| P H U O N G •NGUYEN VAN S O N => Khao sat sir tuan thu d i l u trj d benh nhan suy than man giai doan c u l i tai Khoa Ndi Tieu hda - T i l t nieu Benh vien Da khoa Trung i r a n g Thai Nguyen => Vai trd va djnh h i r d n g phat trien p h i r a n g phap dieu trj giam dau ben ngoai d l i v d i benh ly x i r a n g k h d p b l n g t h u l c Y hoc c l t r u y l n => T i l p can c h i n doan benh Mycobacteria khdng lao •DANG HUNG MINH D a n h gia nguy c c va ty le hien mac benh n h i l m doc hda chat bao ve thirc vat d n g i r d i lao ddng ndng nghiep 2012 => Nghien c d u dac d i l m lam sang va can lam sang d benh nhan tran mang p h l i d i r d i 30 t u l i tai Trung tarn Hd h i p Benh vien Bach Mai •PHAM THj THU THUY, DAU XUAN CANH, NGUYEN TH| B A C H T U Y E T => Danh gia m l i lien quan giira trieu c h d n g lam sang, hinh anh ndi soi, md benh hoc, HP va PH djch vj cua benh ly da day - ta trang tren benh nhan x a gan •TRAN VAN THANH, NGUYEN VAN LANH => Nghien c d u k i l n thCrc, thai dp, thirc hanh va mot s i y l u t l lien •TRAN THj MAI OANH, NGUYEN TH| HUONG, PHAN L E THU HANG •DOAN TH| N G A O A O T l E N TH|NH, LA VAN LUAN •TRAN ANH VU, NGUYEN TH| S O N •BINH QUANG HUY, TRjNH HOANG HA, VU NGQC •BUI TH| VAN ANH, NGUYEN XUAN HIEP •BP NGOC SON, NGUYEN VAN CHI, NGUYEN DANG O U C •VU TUAN ANH, NGUYEN D U Y A N H quan d i n phdng cum gia e l m trirdc va sau can thiep cua ngizdi dan tai cac hp cd nudi gia c a m huyen Vj Thuy, tinh Hau Giang nam 2014 => K i l n thdc, thai dp ciia hoc sinh p h i thong v l HIV/AIDS tai tinh Hai Dirang => K h l o sat k i t qua thirc hien mot s i can thiep dieu d i r d n g tren benh nhan sau m l ndi soi tang sinh lanh tinh t u y l n tien liet tai Khoa Ngoai T i l t nieu, Benh vien Da khoa Trung i r a n g Thai Nguyen nam 2016 => Cac y l u t l anh h i r d n g d i n thirc hien hoat ddng the lire tren benh nhan tang h u y l t ap tai Benh vien Trung i r a n g Thai N g u y l n nam 2016 => Tinh trang dinh d i r d n g t h l hien qua chi s i BMI va trang thai huyet ap cua sinh vien nam t h d n h l t Dai hoc Q u l c gia Ha Npi, nam hoc 2014-2015 152 => T r i r d n g h g p co rut mi tren sau p h l u thuat cat be 161 => Hieu qua ciia thir nghiem t h d tir nhien b l n g may t h d cd mode "SBT" cho benh nhan d g t c l p C O P D 163 Thai dp x d tri v d i thai du thang t h i l u l i tai Benh vien Phu san Ha 165 Ndi 156 158 •DANG HUNG MINH, TRAN VAN CITONG => Nghien cCru dot b i l n E G F R va mot so yeu t l lien quan d benh nhan ung thir p h l i the bieu mo t u y l n d i l u tri tai Trung tarn Ho h i p Benh vien Bach Mai PHAM TH! THU THUY OAU XUAN CANH NGUYEN THI B A C H T U Y E T •NGUYEN L E BAO TlEN, DINH NGOC SON, NGUYEN DUY LUAT •D6 THjOlEP, PHAM VIET C U O N G , L U O N G MAI ANH, TRAN QUANG D U C HA ANH D U C •TO THANH P H U O N G , DANG HOANG ANH • L E TH| HUONG, OOAN THUY LINH •NGUYEN THAI HUNG D U O N G MINH D U C •NGUYEN D U C MINH •NGO QUANG DUONG, NGUYEN VAN KHAI •NGUYEN L E BAO TlEN, DINH NGOC SON, NGUYEN DUY LUAT •VU XUAN TUYEN, NGUYEN ANH TUAN • NGUYEN VAN VAN TRAN VAN THANH •NGUYEN XUAN THUC, VU O U C MINH •DO VAN DUNG, DANG THj NGOC BICH •NGUYEN VAN LANH, TRAN VAN THANH •NGUYEN VIET QUANG, CHU VAN THANG, NGUYEN THj QUYNH HOA •NGUYEN XUAN T H U C => Gia trj npi soi da day phat hien s d m ung thir da day •DANG HUNG MINH, BUI T U O N G LAN •PHAM THj THU THUY, DAU XUAN CANH , N G U Y E N THj B A C H T U Y E T •TRAN TH! MAI OANH, N G U Y E N THI H U O N G , PHAN L E THU HANG •CHU TRAM ANH, PHAM THj THU HIEN •NGUYEN MANH C U O N G , L E HOANG TUAN •HOANG NGQC SON, NGO HUU HANH => Dac diem r l i loan c h d c nang ho h i p t n r d c m l cua benh nhan cot s i n g n g y c d i r g e phau thu|t chinh hinh tai Benh vien HOm nghj Viet Dire 171 => Bao Igc dien tir va mot s i y l u t l lien quan tai T r i r d n g Trung hoc p h i thong C h i r c n g My A - C h i r c n g My - Ha Npi 173 => D i l u trj t r i m cam nang co loan t h i n b l n g kich thich tir xuyen so 177 k i t h g p v d i t h u l c an t h i n kinh va c h l n g t r i m cam => T u l n thu d i l u trj d b i n h nhan HIV/AIDS tre e m tai Benh vien Nhi 178 Trung i r c n g => D a n h gia dp tin cay kiem tra lai bp cong cu lirdng mdi trirdng 182 lam viec (COACH) tren can bo y t l tai Quang Ninh => Mo hinh gay viem k h d p gut cai tien tren ddng vat t h g c nghiem 186 => T h g c trang suy dinh d i r d n g d tre d i r d i t u l i tai huyen Thanh Mien 188 - Hai D i r c n g nam 2016 => Dac diem lam sang, can lam sang cua benh nhan xep than d l t 191 s i n g nggc, t h l t lirng loang x i r c n g tai Benh vien HCru nghj Viet Dire => Nghien ciru cac y l u t l thuan Igi lam x u l t hien com dau nira d l u 194 Migraine =>Tinh trang thieu mau d cac ba me va can nang cua tre s o sinh tai Benh vien huyen Tien Phirdc, tinh Quang Nam, nam 2012 =>Tinh trang quanh rang va nhu c l u d i l u trj d cac benh nhan dai thao d i r d n g typ tai Benh vien Da khoa tinh Ninh Binh, nam 2014 =>Ti le hien mac thdi khoang nam benh cham tay cua nhan vien y tl => K i l n thirc, thai dp, t h g c hanh phdng c h l n g tac hai n g h l nghiep cua cdng nhan tinh Tra Vinh nam 2013 198 201 205 207 = > T h g c trang sire khoe tarn t h i n cua hoc sinh T r i r d n g Trung hoc c c s d Quang Trung, p h i Thai Nguyen, tinh Thai Nguyen 211 =>Ket qua c l djnh rang va xiromg I rang bj sang c h i n bang nep composite => Nghien ciru v l nguyen nhan va cac dac diem lam sang, c|n lam sang cua tran djch da mang djch t i l t => Mot s i nhan xet 65 t r i r d n g h g p u vu da d i r c c c h i n doan mo benh hoc 214 = > K i l n thirc, thai dp, t h g c hanh ve Iga chpn gidi tinh sinh cua cac san phu tai Benh vien Da khoa Q u l c t l Hai Phong 221 => Nghien ciru dac diem lam sang, X quang va hinh thai I n g cua rang ham Idn thir hai h a m d i r d i =>Banh gia k i t qua sir dung fibrin giau tieu cau phau thuat n h l rang ham Idn t h d ba ham d i r d i => T r i r d n g h e p dieu trj gay x i r c n g got di lech d y e e n l n chinh c l djnh bang dinh steinmann (nhan xet cai tien cua f.kermad) 224 216 220 226 228 Y H O C THlTC HANH (1034) - SO 2/2017 •PHAM TH| THU HlEN •DUONG TRONG TAN, HOANG NGOC SON, NGUYEN THUY QUYNH •NGUYEN O U C NHU, TRAN ANH TUAN •OOAN TH! HUE =>Banh gia dac diem lam sang, X quang nhom rang phia t r u c e co s u dung c h i t soi = > K i l n t h u c va t h y c hanh ve tiem an toan cua sinh vien dieu d u o n g T r u c n g Cao d i n g Y te Thai Nguyen tai Benh vien A Thai Nguyen nam 2016 =>Banh gia cac yeu t l lien quan d i n giam dinh t i n t h u c n g c c the c n h u n g t r u c n g hep c h i n t h u c n g m l t 232 235 237 = > K l t qua can thiep nang cao nang l y c ciia ba me vk cham sdc ve sinh, u Im d tre s o sinh non thang d i l u tri tai Trung tarn Nhi khoa, Benh vien Trung u c n g Thai Nguyen 239 •TA VAN TRAM, PHAM THE HlEN • NGO THj D'?U MINH, D QUANG HUAN =>Tinh hinh c h u a rang tai Benh vien Da khoa T i l n Giang 242 => Nghien c u u r l i loan nhjp t h l t d benh n h l n suy tim man tinh t r u c e va sau d i l u tri bang t h u l c u c che beta 248 •NGUYEN TH! H N G VAN, HOANG BUI HAl, VIEN VAN DOAN OINH NGQC SON, NGUYEN L E BAO TIEN =>Tinh trang khang insulin va t i n t h u o n g m l t d cac benh nhan r l i loan glucose luc ddi cd tang h u y l t ap 252 => K i t qua cham sdc benh nhan sau m l tao hinh t h i n d l t s i n g ngyc, t h l t lung b l n g b o m cement sinh hoc tai Benh vien H u u nghj Viet D u e =>Danh gia k i t qua d i l u trj npi nha rang ham Idn t h u hai ham d u d i tai Benh vien Rang Ham Mat Trung u o n g Ha Npi 253 HOANG NGQC SON, NGUYEN TRONG TIN, NGUYEN THlilY QUYNH = > T h y c hanh va mot s i yeu t l lien quan d i n t h y c hanh phdng benh n h i l m xa nghe nghiep cua n h l n vien x-quang tai cac c o s o y te tren dja ban tinh Quang Ngai nam 2016 257 •HOANG THj PHUONG, B A C H VAN HO ANH => Nghien c u u mot s i y l u t l lien quan d i n mat dp x u o n g d benh nhan nam m l c benh p h l i tac man tinh tai Benh vien da khoa tinh Thai Binh =>Tinh hinh n h i l m doc mangan n g h l nghiep cua cdng nhan Cdng ty C l p h l n H o p kirn S i t - Gang Thep Thai Nguyen = > B a n h gia k i t qua d i l u trj ndi nha rang ham s u a 260 PHAM TH! THU HlEN •NGUYEN VAN SON, DINH THUC NGA • L E THj THUY LINH, L U O N G MINH HANG TRAN THj MY HANH, NGUYEN THj THU HlEN •DANG HUNG MINH •PHAM THj THU THUY, DAU XUAN CANH, NGUYEN THj B A C H T U Y E T •TRAN THj MAI OANH, NGUYEN THj HUONG, PHAN L E THU HANG •PHAN THj T NHU, NGUYEN THj H U O N G GIANG •NGUYEN L E BAO TlEN, OINH NGOC S O N •DANG HUNG MINH, BUI THj P H U O N G THAO •NGUYEN D U C NHU, TRAN ANH TUAN •NGUYEN THI H U O N G GIANG, PHAN TH! T NHU •YHTH 255 262 266 => Nghien c u u dac d i l m lam sang, can lam sang cua viem p h l i d benh nhan ung t h u phoi =>So sanh tac dung cua t h u l c ampelop va ampelop k i t h o p v d i amoxycilline + metronidazole d i l u trj loet da day - ta trang 270 =>Mdt s i y l u t l lien quan den viec l y a chpn gidi tinh sinh cua cac ba me den sinh tai Benh vien Da khoa Q u l c t l Hai Phdng 274 =>Xac djnh can nguyen va tinh khang khang sinh cua vi k h u l n d benh nhan n h i l m k h u l n huyet d u o c d i l u trj tai Benh vien Quan y 103 (2011-2015) =>Dac diem lam sang va can lam sang cua benh nhan t r u o t d l t s i n g t h l t lung, t h l t l u n g ciing Benh vien H u u nghj Viet D u e =>Dac d i l m lam sang, can lam sang, nguyen nhan hoi c h u n g thuy g i u a tai Trung t i m Hd h i p Benh vien Bach Mai => Nghien c u u mot s i dac diem c h i n t h u o n g m l t qua giam djnh t i n thuong co t h l =>Cac c h i t u c che SGLT2-nhdm t h u l c m d i d i l u trj benh dai thao d u o n g =>Thdng tin y hoc 276 Y H O C TH1/C HANH (1034) - SO 2/2017 272 279 282 285 287 290 nhip nhanh t h l t giua va dem Co s y t u o n g quan giua t u l i , thai gian THA, d u d n g kinh nh7 trai, chi s i k h l i c a t h l t trai, EF v d i s i l u g n g NTT t h l t 24 gid Nguy c a RLN t h l t day hoac p h d c tap d benh n h l n THA > 60 t u l i , thai gian THA > nam va cd benh D M V l l n l o o t la OR = 3,71 ( % C I : 1,54 - 8,92), OR = 6,53 ( % C I : 2,59 - 16,51) va OR = 2,78 ( % C I : 1,16 - 6,65) Nguy c a RLN t h l t day hoac p h d c tap d benh nhan THA cd PBTTr va EF < % l l n l o o t la OR = 2,48 ( % C I : 1,18 - 5,20) va OR = 4,89 ( % C I : 2,11 -11,09) TAI L I E U THAM K H A O Dao Thu Giang (2011), "Nghien ciru biSn thien nhip tim va rdi loan nhip tim d benh nhan tang huyit ap co thieu mau cue bo co tim", Y hoc thirc hanh 774(7), pp 119-121 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 Acharya T (2015), "Frequent atrial premature complex and their association with risk of atrial fibrillation", Am J Cardiol 116, pp 1852 - 1857 Barison A, Vergaro G (2011), "Markers of Arrhythmogenic Risk in Hypertensive Subjects", Curr Pharm Des 17, pp 3062 - 3073 PHAN LFNG CO HAI TREN THAN KINH TRUNG LTONG VA TAM THAN LIEN QUAN DEN EFV & BENH NHAN DIEU TRj PHAC DO DF/3TC/EFV L E TH| H U O N G , V O THj T H U T H U Y Cue Phong, chong HIV/AIDS, Twang Dai hoc Dope TOM T A T Muc tieu: Mo ta dac diim phan irng cd hai (ADR) tren he than kinh trung irong (TKTW) va tarn thin lien quan din EFV d benh nhan dieu tri phac dd TDF/3TC/EFV va xac dinh mot sd yiu td lien quan din ADR Phirong phap: Nghien cu>u thuin tap tiin ciru thong qua bao cao tir nguyen cd chu dich tren 841 benh nhan mdi dieu tri tir thang 03/2015 Kit qua: Cd mot ty le dang ke (38,7%) benh nhan gap ADR tren he TKTW & tarn thin lien quan din EFV 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 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 nhe nen dai da sd benh nhan vin tri phac dd diiu tri Vi vay, nhan vien y ti cin tw vin ky lirdng cho benh nhan trirdc va qua trinh diiu trj, dac biet la 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: lehuongvaac@gmail.com Ngay nhan: Ngay phan bien: Ngay duyet bai: Ngay xuit ban: 40 Ha Npi related factors about ADR of EFV on CNS & Metal in patients with TDF/3TC/EFV regiment Methods: This is a prospective cohort study through targeted spontaneous reporting on 838 new patients from May 03/2015 in An Giang, Dien bien, Lao Cai, Thai Nguyen, Ha Noi, Nghe An, Ho Chi Minh City Results: There is a significant percentage (38.7%) of patients experiencing the ADR on CNS and Metal related to EFV in patients with TDF/3TC/EFV Maily is anifested dizziness (29.5%), headache and fatigue (19.4%), feeling hot flushes (10.7%), nausea (9.8%>) The heavy ADR intend to commit suicide and depression have also been recorded at the rate of 0.1% Some factors related were: age, hemoglobin levels and clinical stage Conclusion: There is a significant percentage (38.7%) of patients experiencing CNS & Metal ADR related EFV in patients treated with TDF/3TC/EFV but mainly mild so the vast majority of patients still maintenance treatment Since, we need a thorough consultation for patients before and during treatment, especially during the first period to avoid treatment dropping out Keywords: ADR, CNS and metal,EFV O A T VAN O E T h u l c A R V da d e m lai nhieu loi fch cho benh nhan HIV/AIDS Tuy nhien, qua trinh s o dung van t h u d n g xay cac v i n d i lien quan den an t o l n t h u l c , dac biet la cac bien c l b i t loi nghiem tac dgng d i n tuan thu dieu trj [1] Trong phac d l chu yeu dang d i l u trj la TDF/3TC/EFV thi phan ung cd hai tren TKTW & tarn than cua EFV d u o c khuyen cao giam sat [2] Tai Viet Nam, s i l u o n g bao cao v l phan d n g cd hai cua t h u l c r l t han c h l va khdng phan anh dung t h y c t l d i l u trj [3] Vi vay, chung tdi t i l n hanh nghien c d u : 'Phan d n g cd hai tren than kinh trung u o n g va tarn t h i n lien quan t d i EFV tren benh nhan dieu trj phac TDF/3TC/EFV" Y H O C T H l T C H A N H (1034) - SO 2/2017 i D l T U Q N G VA P H U O N G PHAP NGHIEN C U U Doi tircmg nghien ciru Gom 841 benh nhan m d i dieu tri phac TDF/3TC/EFV tai tinh/thanh t h a i gian tir 16/03/2015 d i n 15/07/2016 Sau loai trir benh nhan khdng quay lai tai kham thi lai 838 benh nhan d u p e tham gia nghien c d u P h u a n g phap nghien c u i i Nghien c d u thuan tap tien c d u thong qua bao cao to nguyen cd chu dich Sd lieu thu thap d u p e lam sach, nhap b l n g Epidata 3.1, quan ly va phan tich b l n g S P S S 16.0 Sir dung ky thuat phan tich thong ke md ta, kiem dinh X2 va md hinh hoi quy logistic de t i m moi lien quan K E T Q U A VA BAN LUAN T h o n g tin c h u n g ve doi t u p n g nghien c u u Dac diem cua m i u benh nhan nghien c d u khdng cd s o khac biet nhieu v d i dac diem benh nhan n h i i m HIV/AIDS tai Viet Nam Trong 838 benh nhan dirge chgn thi nam gidi c h i l m ty le nhieu h o n vdi 66,9% P h l n ddng benh nhan dang d dd tuoi lao ddng, trung binh la 33,9 ± 7,5 tuoi Benh n h l n lay n h i i m HIV chu yeu qua d i r d n g tinh due ( , % ) va nghien chich ma (37,2%) Tai thdi diem bat dau theo doi, sd benh n h l n dang d giai doan lam sang c h i l m ty le cao n h l t , % 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 , % ) tren tong sd 838 benh nhan d i r g e nghien ciru gap b i l n cd tren T K T W va tarn t h i n Ty le t h l p h o n k i t qua nghien cdu cua Ruiz va cong s g ( % ) [4], Nelsona va cdng sy nam 2010 (46,2%) [5], S y khac biet cd the la t h i l t ke nghien ciru khac (co mau, tieu c h u l n lya chpn benh nhan, tieu c h u l n danh gia), c h i t lirgng cua cac p h i r o n g phap danh gia, each sir dung cac thuat n g u ("doc tinh tren t h i n kinh trung i r a n g " , "tarn t h i n " , "tarn than, than kinh trung i r a n g " ) Tuy nhien, d i l u dang chu y d day la ty le , % nghien ciru cua chung tdi v i n cao h o n nhieu so sanh v d i nghien ciru g i n day tai Viet Nam cua N g u y i n P h i r o n g Thuy nam 2013 (12,3%) Nghien ciru cua N g u y i n Phirong Thiiy la nghien ciru t i l n ciru theo p h i r o n g phap giam sat b i l n cd thuan tap (CEM) theo ddi t i t ca cac loai phac dd sir dung tren benh n h i n , t i t ca cac benh nhan d m l u theo ddi dinh ky hang thang d i u d u p e giri bao cao v l Trung tarn DI&ADR Qudc gia Nhir v i y , s y khac biet Idn cd the la 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 nen cd the bj bd qua, khdng d u p e ghi nhan vao hd s o benh an Trong dd, ddi vdi phirong phap TSR d nghien ciru cua chiing tdi, phan Idn cac bieu hien ddc tinh nhe, thoang qua tren t h i n kinh trung i r a n g va tarn than d i u d u p e bac s i chu y theo ddi, ghi n h l n Y HOC THlTC HANH (1034) - SO 2/2017 2.1 Tan suit gap ADR tren TKTW va tarn than Bang Cac bieu hien ADR tren T K T W va tarn t h i n STT 10 11 12 13 14 Bidn c6 co hai Chong mat Dau dau Met moi Cam giac nong bung Buon non Mo nhieu, g i l c mo rd rang M l t ngu Ac mong Lo ling Di cam: dau , ngira , rat, kiln bo Giam/mat tap trung Co y dinh t y tip T r i m cam Bieu hien khac n = 838 248 163 163 90 82 45 43 39 31 1 % 19 19,5 1n 9,3 5.4 5,1 4,7 3,7 0.7 0,6 0,1 0,1 0,7 Bang cho t h l y : Bieu hien ADR d u p e ghi nhan n h i l u n h l t la chdng mat (29,5%), t i l p d i n la dau d i u va met mdi (19,4%), cam giac ndng b u n g (10,7%) Mot sd ADR nang n h u cd y dinh t y tip va t r i m cam cung d u p e ghi n h l n v d i ty I I , % K i t qua t u o n g ddng vdi thong tin d u p e ghi nhan 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 T h d i gian t u dung thudc d i n x u l t hien ADR tren T K T W va tarn than Thai gian n Dudi t u l n 136 tuan - thang Thong so thong ke (ngay) Gia tri trung vi: Tir phan vi 25%: Tu phan vi 75%: 10 %_ 42,0 52,5 5,5 0,0 Bang cho t h l y : T h d i gian trung binh gap ADR tren T K T W va tarn t h i n la 9,3 ± 12,7 va t h u d n g x u l t hien s d m vdng t u l n (42,0%) den 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 1-3 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 cho t h l y , c l n phai chu theo ddi ADR tren T K T W va tarn t h i n sau d i l u trj de cd bien phap can thiep xir tri kjp thdi, h o p ly va hieu qua 2.3 Mire nang cua ADR tren TKTW va tarn than va each xCr tri Bang Mire dp nang cua ADR tren T K T W va tarn than Phan loai Muc (nhe) Muc (trung binh) Muc (nang) Muc (tu vong, de doa tinh mang) n 249 72 % 76,9 22,2 0,9 0,0 41 Bang Cac bien phap x u tri tren benh nhan co ADR tren TKTW va tarn t h i n Bien phap xir tri Tu van, tiep tuc ulng thuoc Dung them thulc xi> tri Giam lieu Ngimg thuoc Doi phac Chuyen tuyln n = 324 314 4 % 96,9 1,2 0,0 0,3 1,2 0_3_ Bang va cho t h l y : P h l n Ian cac ADR tren T K T W va tarn t h i n xay d m d c dp nhe (76,9%) va m d c dp trung binh (22,2%) Chi cd t r u d n g h p p b i l n co cd hai xay 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 , % va sau benh nhan v i n tri phac d l d i l u tri Cd benh nhan ( , % ) dung them thudc khac x u tri va chi cd t r u d n g h p p phai tarn n g u n g t h u l c bi phat ban va sau dd s u dung lai t h u l c EFV thi phan u n g khdng x u l t hien lai Cd benh nhan phai d l i phac d l ( c h i l m 1,2% t i n g s i benh nhan gap ADR) cd t r u d n g h p p d m u c dp nang, t r u d n g h p p d m u c d | trung binh Theo Ribaudo va cdng s u (2004), khoang % benh nhan phai d l i phac d l 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 dac diem benh nhan khac nhau, h a n n u a viec xac djnh m u c dp nghiem trpng cua cac b i l n c l tren he than kinh trung u a n g va tarn t h i n la mot v i n de khd d i n g n h l t d l i v d i cac bac s i quan niem/nhan thuc cua bac sy v i m u c dp nghiem trpng cua phan u n g cd hai khac nen cd q u y l t djnh khac Vi vay, ty le d l i phac cd the dao ddng g i u a cac nghien c u u C a c y e u t l lien quan den A D R tren T K T W v a tarn than c u a E F V Bang Phan tich d o n bien cac yeu t l anh h u d n g tdi t i n s u i t x u l t hien A D R Yeu to HR Tuoi (nam) Gidi (nam/nu) Can nang Giai doan lam sang Giai doan Giai doan Giai doan CD4 Hemoglobin ALT eGFR baseline [Cre) baseline 1,020 1,043 0,992 Khoang tin cay % Cl 1,006- 1,034 0,930- 1,170 0,980 - 1,005 1,460 1,451 1,136 1,000 1,008 0,999 0,997 1,000 1,022- 2,089 0,936 - 2,255 0,698 - 1,850 1,000- 1,001 1,003- 1,013 0,996 - 1,002 0,993 - 1,002 0,994 - 1,005 P 0,005 0,470 0,215 0,135 0,038 0,096 0,609 0,269 0,004 0,411 0,215 0,928 Bang cho t h l y : K i t qua phan tich d o n bien da phat hien yeu t l anh h u d n g t d i tan s u i t x u l t hien ADR tren T K T W va tarn t h i n d benh nhan la t u l i (p = 0,005), giai doan lam sang (p = 0,038) va gia trj hemoglobin h u y l t ban d i u (p = 0,004) N l u t u l i benh nhan bat dau d i l u trj tang d o n vj thi nguy c o x u l t hien ADR tang them % N l u ndng dp hemoglobin ban d i u tang them d o n vj thi nguy c o x u l t hien ADR tang them 0,8% Nguy c o m l c b i l n c l tren T K T W va tarn t h i n d nhdm benh nhan d giai doan lam sang cao h o n g l p 1,46 l l n so vdi benh nhan d giai doan lam sang Bang K i t qua phan tich da b i l n cac y l u t l anh h u d n g tdi t i n s u i t x u l t hien ADR Yeu to HR Khoang tin cay % Cl 1,008- 1,038 0,967-0,995 1,023 Tuoi Can nang 0,981 Giai doan lam sang 1,577 1,088-2,286 Giai doan 1,671 FF1.062-2,627 Giai doan 1,309 0,790-2,167 Giai doan Hemoglobin 1,010 1,004- 1,016 P 0,002 0,008 0,075 0,016 0,026 0,296 0,001 Bang cho t h l y : Cac y l u t l t u l i (HR = 1,023; % Cl: 1,008 - 1,038; p = 0,002), can nang (HR = 0,981; % Cl: 0,967 - 0,995; p = 0,008), ndng dp hemoglobin huyet (HR = 1,010; % Cl: 1,004 1,016; p = 0,001) va giai doan lam sang (p = 0,016) va giai doan lam sang (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 b i t d i u dieu trj tang them d o n vj thl nguy c o gap ADR tren T K T W giam 1,9% N g u p c lai, n l u t u l i benh nhan tang d o n vj thi nguy c a gap ADR tren T K T W va tarn t h i n tang , % va n l u gia trj hemoglobin ban d i u tang d o n vj thi nguy c o x u l t hien bien c l tren T K T W va tarn than tang 1,1% Benh nhan d giai doan lam sang va cd nguy c o gap ddc tinh tren T K T W va tarn t h i n cao h o n so vdi benh nhan d giai doan lam sang KET LUAN Tuy co mot ty le khdng nhd benh nhan bao cao cd gap tac dung phu ciia EFV tren T K T W va t i m t h i n nhung p h l n Idn x u l t hien s d m va d m u c dp nhe nen da s i benh nhan v i n t i l p tuc dieu trj ma khdng c l n den can thiep y te hay chuyen phac Ket qua chi r i n g nhan vien y te can t u v i n ky l u d n g cho benh n h l n t r u d c va qua trinh d i l u trj, dac biet la thdi gian d i u dung t h u l c de tranh viec benh nhan t y y bo t h u l c T A i L I E U THAM K H A O World Health Organization (2007), Pharmacovigilance for antiretrovirals in resource-poor countries World Health Organization (2013), Surveillance of antiretroviral toxicity: HIV/AIDS programme: Surveillance of antiretroviral treatment programmes 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 17 thang 11 nam 2016 Ruiz N M., B e s s e n L J , Manion D J , et al., "Potential adverse experiences associated with efavirenz (EFV, sustiva™) in adults", Conf Retroviruses Opportunistic Infect 1999 Chicago, IL, February 1999 [Abstract 655] Y H O C THlTC HANH (1034) - SO 2/2017 L ... 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... Pharm Des 17, pp 3062 - 3073 PHAN LFNG CO HAI TREN THAN KINH TRUNG LTONG VA TAM THAN LIEN QUAN DEN EFV & BENH NHAN DIEU TRj PHAC DO DF/3TC /EFV L E TH| H U O N G , V O THj T H U T H U Y Cue Phong,... nhan tang h u y l t ap => Phan u n g cd hai tren than kinh trung u o n g va tarn than lien quan d i n EFV d benh nhan dilu tri phac dl DF/3TC /EFV => Gdp phan nghien c u u nguyen nhan va c o c h