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 majorit[r]
(1)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
(2)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
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N g u y l n Thai, Hai Yen
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ISSN 1859-1663
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so: 256/GP-SDBS-GPHOBC 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 thong tai 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 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 sua me 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
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
(3)• 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 52 huyen, 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 dirdi t u l i 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 thong Chu Van An quan Ba Dinh, 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 bu binh d Ida tuoi m i m non 84 => K i l n thdc va hanh vi t y bao ve sdc 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 sdc khoe va benh thirdng 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 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 benh cham tay cua nhan vien y t l 102
2
(4)•PHAM NHUHUNG, NGUYEN QUANG TUAN •VO THj LAN,
DO QUANG HUAN •MAI THj HlEN, D GIA TUYEN, DANG THI VIET HA •PHAN Q U 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,
NGUYEN TH| BACH T U Y E T •TRAN VAN THANH, NGUYEN VAN LANH •TRAN THj MAI OANH, NGUYEN TH| HUONG, PHAN L E THU HANG •DOAN TH| N G A OAOTlEN TH|NH, LA VAN LUAN •TRAN ANH VU, NGUYEN TH| SON •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 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 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 p h i Ha Ndi
=> Sir tham gia cua giao vien tieu hoc 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 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 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
(5)•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 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 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 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 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 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 tai Benh vien Da khoa tinh Ninh Binh, nam 2014
=>Ti le hien mac thdi khoang 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, 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 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 cua 224 rang ham Idn thir hai ham dirdi
=>Banh gia k i t qua sir dung fibrin giau tieu cau 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)
4
(6)•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 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 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 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 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 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 sinh cua 274 cac ba me den sinh 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 d i l u trj benh dai 287 thao d u o n g
(7)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 vdi s i lugng NTT t h l t 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 > 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 < % l l n loot la OR = 2,48 (95%CI: 1,18 - 5,20) va OR = 4,89 (95%CI: 2,11 - 1 , )
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 -
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 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:
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, 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 thulc, 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 luong bao cao v l phan dng 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 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"
40
Y H O C T H l T C H A N H (1034) - SO 2/2017
(8)D 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 TDF/3TC/EFV tai tinh/thanh thai 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 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 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 d i r d n g tinh due (58,1%) 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 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 t h l p hon 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 thilt 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 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 , % nghien ciru cua chung tdi v i n cao hon nhieu 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 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 so 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 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 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 Met moi 163 19,5 Cam giac nong bung 90 n Buon non 82 9,3 Mo nhieu, gilc mo rd rang 45 5.4 Mlt ngu 43 5,1 Ac mong 39 4,7 Lo ling 31 3,7 10 Di cam: dau , ngira , rat, kiln bo 0.7 11 Giam/mat tap trung 0,6 12 Co y dinh t y tip 0,1 13 T r i m cam 0,1 14 Bieu hien khac 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 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 , % 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 Thdi gian t u dung thudc d i n x u l t hien ADR tren TKTW va tarn than
Thai gian n % _ Dudi tuln 136 42,0 tuan - <1 thang 170 52,5 thang - thang 18 5,5
> thang 0,0 Thong so thong ke (ngay)
Gia tri trung vi: Tir phan vi 25%: Tu phan vi 75%: 10
Bang cho t h l y : Thdi gian trung binh gap ADR tren TKTW 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 TKTW va tarn t h i n sau d i l u trj de cd bien phap can thiep xir tri kjp thdi, hop 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 n %
(9)Bang 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 1,2 Giam lieu 0,0 Ngimg thuoc 0,3 Doi phac 1,2 Chuyen tuyln 0_3_
Bang va cho t h l y : P h l n Ian cac ADR tren TKTW va tarn t h i n xay d mdc dp nhe (76,9%) va mdc dp trung binh (22,2%) Chi cd trudng hpp 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 (1,2%) dung them thudc khac x u tri va chi cd trudng hpp phai tarn ngung t h u l c bi phat ban va sau dd s u dung lai t h u l c EFV thi phan ung 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 trudng hpp d muc dp nang, trudng hpp d muc 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, 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 quan niem/nhan thuc cua bac sy v i m u c dp nghiem trpng cua phan ung cd hai khac nen cd q u y l t djnh khac Vi vay, ty le d l i phac 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 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 % 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 1,460 1,022- 2,089 0,038 Giai doan 1,451 0,936 - 2,255 0,096 Giai doan 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 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 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 (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 TKTW va tarn t h i n d nhdm benh nhan d giai doan lam sang cao hon 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 P cay % 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 1,577 1,088-2,286 0,016 Giai doan 1,671 FF1.062-2,627 0,026 Giai doan 1,309 0,790-2,167 0,296 Hemoglobin 1,010 1,004- 1,016 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 TKTW 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 TKTW va tarn than tang 1,1% Benh nhan d giai doan lam sang va 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
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 Ket qua chi r i n g nhan vien y te can t u v i n ky ludng cho benh n h l n trudc 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
TAi LIEU THAM K H A O
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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 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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