ISSN 1359 - 1663

2 (1034) JPM 2817

TAP CHI Y HOC THtfC HANH • • •

J , ' ; A \ • A : F R A C in A R L Ml ?JDi A N E

Kf NlfM 87 NAM THANH L|P BANS C0N8 8AN VlfT NAM (3/2/1930 - 3/2/2017)

Nam thur sau hai So 2 (1034) 2017. Bo Y te xuat ban va phat hanh hang thang

The 62st year No. 2 (1034) 2017. Ministry of health publishes and releases monthly

TAP CHI

Y HOC THUC HANH

BO Y TE XUAT BAN JOURNAL OF PRACTICAL MEDICINE PUBLISHED BY MINISTRY OF HEALTH

Bo tracing Bo Y te Tong Bien tap

PGS. TS. Nguyen Thi Kim Tien

Pho Tong Bien tap TS. Nguyen Vinh Hang

Tha ky Toa soan Ths. Bui Nam Trung

Ban Bien tap: GS. TS. Le Ngoc Trong GS. TS. Ngd Quy Chdu GS. TS. Ha Van Quyet GS TSKH. NguyinVanDip GS. TSKH. Ha Huy Khdi GS. TS. Tran Due Tho GS. TS. Nguyln Viet Tien GS. TS. Nguyen AnhTri PGS TS. Ngo V3n Toan PGS. TS. Nguyin Quoc Tuan PGS. TS. Phan Van Tudng PGS. TS. Nguyen Thi Bich Lien PGS TS Laong Ngoc Khue PGS. TS. Tran Quy Tudng PGS. TS. Pham Thuc Hanh TS. Vu Van Du TS. Nguyen Bao Ngoc

Trinh bay: Nguyen Thai. Hai Yen

Toa soan: 138A Giang V6 - HN DT: 04.38460728; 04.37368092

Fax:04.38464098; E-mail: info@yhth.vn Banbientap@yhth.vn

Website: www.yhth.vn

Van phong dai dien phia Nam 109A Pasteur-"Quan 1, TP. HCM

* Giay phep so: 108/GP-BVHTT Cap ngay 29-3-2001

ISSN 1859-1663

* Giay phep sua doi, bo sung thang ra 2 ky

so: 256/GP-SDBS-GPHDBC ngay 7/6/2004

* In tai: Cong ty CP In Sao Viet * In xong va nop luu chieu 2/2017

Gia 50.000d

• T R A N D I E P K H O A ,

D O Q U A N G H U A N

• N G U Y E N T H I X U Y E N

• NGUYEN XUAN HUY, TRAN VAN THANH

• NGUYEN KHAC M1NH, NGUYEN VAN SONG, TRAN OlNH TRUNG

• NGUYEN HUNG CU'ONG, NGO QUANG DU'O'NG, TRAN QUANG CANH, HIROSHI ICHIMURA, PHAM VAN THUC • NGO QUANG DU'O'NG, NGUYEN VAN KHAI

•TA VAN TRAM, PHAM THE HlEN

• N G U Y E N V A N D U N G ,

T R I N H B A O N G O C ,

T R A N T H I T H O A ,

P H A M D U Y T U ' O ' N G

• L E D I N H P H A N , N G U Y E N

T U A N H U ' N G , D A O V A N

D U N G , T R A N V A N H U O N G

• V U T H I H O N G ,

N G U Y E N T H A N H H O I ,

N G U Y E N V A N D O A N

. T R A N D I E P K H O A ,

O O Q U A N G H U A N

• L E T H I H U Q N G ,

V O T H I T H U T H U Y

• N G U Y E N D U C M I N H

• N G O Q U A N G D U ' O ' N G ,

N G U Y E N V A N KHAl

•TA VAN TRAM, PHAM THE HlEN

MUC LUC SO 1034

=> Dac diem va cac yeu t6 lidn quan roi 6 loan nhip nhi a bqnh nhan t3ng huydt ap s> Thu'c trang vd gi^i phap hi§u qua 9 khdm chu'a b§nh bSng y hoc co truyen tinh Thdi Binh ddn nam 2020 =5> Nghien cuu tac dung cua mOt sd 12 loai khang sinh vdi vi khuin ducrng sinh san d nu cong nhan khu cong nghiep tinh Hai Duong nam 2016 =• Nghien cuu kien thuc thai do hanh 15 vi v6 sue khoe sinh san va cac yeu to lien quan a hoc sinh trung h<?c ph6 thong tai thanh ph6 Da Nlng => Ti le nhiim va phan b6 genotype 19 cua Human papillomavirus tren b£nh nhan ung thtf sinh due nu

w Kien thii'C, thi/c hanh va mOt s6 y§u 22 to lien quan den benh giun dudng rupt cua phu huynh hoc sinh co con hoc tgi 4 trudng tieu hoc b Hai Duong => Dac di§m lam sang, can lam sang - 25 k i t qua dieu tri bao ton vd gan trong chan thuang bung kin tai Benh vien Da khoa Trung tarn Tiln Giang => Danh gia tinh trang thai tru hoa chit 27 bao ve thuc vat qua sua mp va nude tieu cua phq niu dang cho con bu dudi 12 thang tudi tai mot sd quan thanh pho Ha Ngi nam 2013 s> Hipu qua can thipp mo hinh trpm y 30 te xa tpi 3 huypn. thanh phd tinh Hoa Binh, 2016 s> Nghien cuu tinh hinh kiem soat hen 33 phe quan va mot sd y lu td nguy co lien quan theo gina 2015 tai Benh vien Dai hoc Y Hai Phong =» Dac diem va cac y§u td lien quan roi 36 loan nhip that d bpnh nhan tang huyet ap => Phan ung co hai tren than kinh trung 40 uong va tarn thin lien quan den EFV d bpnh nhan dieu tri phac do DF/3TC/EFV => Gdp phan nghien cuu nguyen nhan 43 va co che bpnh sinh cua bpnh viem khdp dang thip theo quan diem y hoc co truyen

Kien thu*c va thyc hanh nudi con 46 blng sO'a me cua cac ba me co con dudi 2 tuoi tai mot xa huydn thanh mien, tinh Hai Duong nam 2016 => Cac yeu to lien quan d in loang 48 xuong d ngudi cao tuoi cd bpnh phoi t i c nghen man tinh tai Benh vien Da khoa Ti in Giang

Y HOC THV'C HASH (1034) - SO 2/2017 I

• LE DiNH PHAN, NGUYEN TUAN HU'NG, DAO VAN DUNG, TRAN VAN HU'O'NG •NGUYEN TH! THANH HU'O'NG, HOANG TRUNG KIEN, LUU THI ANH TUYET, NGUYEN THU TRANG, NGOTHjTUYET • NGUYEN HUY ANH, LE TH| HOAN, TRU'O'NG OiNH BAC • NGUYEN THI NGA. KIM BAO GIANG, NGUYEN THANH HA .PHAN QU0C HOI

•OAO THI DUNG. NGUYEN ANH CHI, NGUYEN QUANG TRUNG .TRAN TUAN ANH, LETHI KIM DUNG, DO THAI SON, NGUYEN TH| HA, LY THUYMINH, PHAM TRUNG KIEN, VU VAN DU •OINH NGOC SON, NGUYEN LE BAO TIEN

• LE THI HU'O'NG

•TRAN NGOC QUE

•NGUYEN HOANG LONG, DAO THUTHUY • T R A N THI KIM LIEN • HOANG TRUNG KIEN, NGUYEN THj THANH HU'O'NG, NGUYEN XUAN TUNG •TA VAN TRAM, PHAM THE HlEN •TRU'O'NG VIET TRU'O'NG, NGUYENTHj QUYNH HOA • PHAM TUNG LAM, DANG XUAN KET, NGUYEN OU'C TAl • PHAM THj TUYET NGA. HOANG THj THU TRANG, PHAM TH! HANH QUYEN •DO VAN DONG, DANG TH! NGOC BICH

MUC LUC (SO 1034)

=• So sanh k i t qua truce - sau can thipp mo hinh tram y te xa tai 3 huypn. thanh pho tinh Hoa Binh. 2016

=> Khao sat thai dp, ki ln thuc d l i vdi su c6 y khoa khdng mong muin cua di lu dudng, hp sinh tai Binh vipn Da khoa Trung uang Thai Nguyen nam 2016

=> Oanh gia cua cac ba me cb con dudi 5 tuoi khi sir dung tiem chiing dich vu tai tinh Nghp An nam 2016

=> Tinh gia tri va do tin cay ciia mot so cong CM thu nhan phan hoi tu giang vien va sinh vien

=> Thp'C trpng ulng rugu, bia cua nam gidi dp tu l i tii' 15 - 60 tpi xa Tay Thanh, Yen Thbnh, Nghp An nam 2015

M6 ta thp'C trang benh sau rang va viem Ipi cua hoc sinh Trung hpc ph i thong Chu Van An quan Ba Dinh, thanh ph i Ha Noi

=s Dpc di lm bpnh nhi cb tang ap lye dpng mach phl i tai Bpnh vipn Da khoa Trung uong Thai Nguyen

=z Oanh gia ki t qua cham sdc benh nhan sau phau thuat benh ly trugt d l t s ing thlt lung, th l t lung cung tai Benh vien HQ'u nghi Nipt Due => Hipu qua can thiep nhlm cai thien mpt so chi s i danh gia chit lugng dieu tri HIV/AIDS tai Bpnh vipn Da khoa huypn Thuan Chau, tinh So n La => ThM*c trpng va giai phap phat tr i ln nguln nhan luc y hpc c l truyen tinh Quang Binh d in nam 2020 •=> Kien thuc va thyc hanh tiem an toan cua d i lu dudng vien Benh vipn Da lieu Trung uomg nam 2012 =s> Danh gia thyc trpng sau rang do bu binh d lua tuoi m lm non => Ki ln thuc va hanh vi ty bao vp sue khoe khi su dung thulc bao vp thpc vat ciia ngudi nong dan canh tac che tai Thai Nguyen nam 2016

—- Nghien cuu cac y lu t l tien lupng ttr vong bpnh phl i t i c nghen man tinh tai Bpnh vipn Da khoa Trung tarn Tien Giang => Thyc trang sire khoe va bpnh thu dng gap d cdng nhan lao dpng trong mdi t ru ing vi khi hpu nong tai Cong ty Gang thep Thai Nguyen => Nghi&n cuu dilu kipn lao dpng va mdi trudng anh hudng den sire khoe va cot sing cua ngudi lao dpng blc x lp tai cac ben cang nganh Giao thong Van tai, de xuat giai phap dy phbng

Dac diem t in thuong mo cung viing c l rang

=i> Cac y lu t l nguy CO trong bpnh cham tay cua nhan vien y t l

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2 Y HQC T H V C HANH (1034) - SO 2/2017

• P H A M N H U ' H U N G . _ N G U Y E N Q U A N G T U A N

* . V O T H I L A N , O O Q U A N G H U A N

• M A I T H | HlEN. - O O G I A T U Y E N .

° D A N G T H I V I E T H A

. P H A N Q U O C H O I

• O A O T H I D U N G ,

3 N G U Y E N A N H C H I ,

N G U Y E N Q U A N G T R U N G

• L E T H | T H A N H H U ' O N G ,

! C H U V A N T H A N G

V U DlEN, LE THj T H A N H X U A N

• N G U Y E N THI. H O A I ,

D O A N T H ! H U ' O ' N G ,

L O U THj A N H T U Y E T

• N G U Y E N T H A I HU'NG D U ' O ' N G MINH D U ' C

• LE THj HU'ONG,

V O THj THU THUY • N G U Y E N D U ' C M I N H

• H O A N G THj P H U ' O ' N G

• N G U Y E N V A N S O N

• D A N G H U N G M I N H

•PHAM TH! THU THUY, O A U X U A N C A N H ,

NGUYEN THJ BACH TUYET .TRAN VAN THANH, NGUYEN VAN LANH

•TRAN THj MAI OANH, NGUYEN TH! HU'O'NG, PHAN LETHU HANG •DOAN THj NGA, DAOTlEN TH!NH, LA VAN LUAN •TRAN ANH VU, NGUYEN TH! SON •DINH QUANG HUY, TRjNH HOANG HA, VU NGOC

• BUITH! VAN ANH, NGUYEN XUAN HIEP •DO NGOC SON, NGUYEN VAN CHI, NGUYEN DANG DU'C •VO TUAN ANH, NGUYEN DUY ANH

=> Tham do dien sinh ly hpc tim trdn bpnh nhan co dipn tarn d6 105 Brugada =» Bpnh dpng mach vanh tren nhung benh nhan cd bpnh van tim 107 dup-c phau thu^t van tim tpi Vipn Tim thanh pho Ho Chi Minh s» Hieu qua dieu tri Corticoid tren mot so bpnh nhan benh than iga 111

=> Xac dinh y lu t i lien quan d in sir dung rugu, bia ciia nam gidi do 113 tuoi tu 16 - 60 tpi xa Tay Thanh. Yen Thanh, Nghp An nam 2015 =» Mdi lien quan gida kiln thu-c, thai do. hanh vi cham sdc rang mieng 117 voi bpnh sau rang, viem Ipi ciia hpc sinh trudng Trung hpc pho thong Chu Vdn An, quan Ba Dinh thanh ph i Ha Ndi s» Sy tham gia ciia giao vien tieu hpc trong cdng tac y t l trudng hpc 120 tai quan Thanh Xuan. ndm 2012

=> Khao sat sy tuSn thu di lu tri a bpnh nhan suy th|n man giai doan 123 cuoi tai Khoa Nqi Tieu hda - Tilt nieu Benh vien Da khoa Trung uong Thai Nguyen => Danh gia mire dp hieu ciia can bp y t l vdi bp cdng cu do ludng 126 mdi trudng lam viec (COACH) tpi Quang Ninh => Phan Ceng cd hai tren than lien quan d in TDF d bpnh nhan dieu tri 130 phac do TDF/3TC/EFV => Vai trd va dinh hudng phat then phucng phap dieu tri giam dau 133 ben ngoai doi vdi benh ly xuomg khdp blng thuoc Y hpc co truyln

Ti lp c ln ch in doan bpnh do Mycobacteria khdng lao 135 =* Danh gia nguy cc va ty lp hipn mlc bpnh nhi lm dpc hda chit bao 138 vp thuc vat d ngudi lao dpng nong nghiep 2012 =s Nghien cii'u dac di lm lam sang va can lam sbng d bpnh nhan 142 tran khi mang phoi dudi 30 tuoi tai Trung tarn Ho h ip Bpnh vi$n Bach Mai =» Danh gia moi lien quan giua tridu chirng lam sang, hinh anh npi 145 soi, md bpnh hpc, HP va PH djch vi cua bpnh ly da day - ta trang tren bpnh nhan xc gan => Nghien ciru ki ln thirc, thai dp. thyc hanh va mpt sd y lu to lien 147 quan d in phong cum gia e lm trudc vb sau can thipp cua ngudi dan tai cac hp cd nudi gia cam huyen Vi Thuy. tinh Hau Giang nam 2014 => Kiln thuc. thai dp ciia hpc sinh pho thong ve HIV/AIDS tpi tinh Hai 150 Duong

Khao sat k i t qua thyc hipn mpt sd can thipp di lu dudng tren bpnh 152 nhan sau mo ndi soi tang sinh lanh tinh tuyln tien lipt tai Khoa Ngoai Ti l t nieu, Benh vipn Da khoa Trung uong Thai Nguyen nam 2016 => Cac y lu to anh hudng d in thyc hipn hoat dpng the lyc tren bpnh 156 nhan tang huylt ap tai Bpnh vipn Trung uong Thai Nguyen nam 2016 => Tinh trang dinh dudng the hien qua chi so BMI va trang thai huylt 158 ap cua sinh vien n3m thu nhlt Dai hpc Qudc gia Ha Npi, nam hpc 2014-2015 => Trudng hop co rut mi tren sau phau thuat c l t be 161

=» Hipu qua ciia thu- nghipm thd ty nhien blng may thd cd mode 163 "SBT" cho binh nhan dpi c lp COPD

=> Thdi dd xir tri vdi thai du thang thilu di tai Bpnh vipn Phu san Ha 165 Npi

• D A N G H U N G MINH, T R A N V A N C U ' O N G

• PHAM TH) T H U THLJY

D A U XUAN C A N H

NGUYEN THI B A C H T U Y E T

• N G U Y E N LE B A O TIEN,

D INH NGQC S O N ,

NGUYEN D U Y L U A T

• D 6 T H ! O I ? P ,

PHAM VIET CLKONG,

LU'O'NG MAI A N H ,

T R A N Q U A N G OU'C

H A A N H DU'C •T6 T H A N H PHU'O'NG,

D A N G H O A N G A N H

• L E T H ! HU'O'NG,

D O A N T H U Y L I N H

• N G U Y E N T H A I HU'NG

DU'O'NG MINH DU'C

• N G U Y E N OU'C M I N H

. N G O Q U A N G DU'O'NG,

NGUYEN V A N KHAl • N G U Y E N LE B A O T I E N , O I N H N G O C SON, N G U Y E N D U Y L U A T •VU XL'AN T U Y E N , N G U Y E N A N H T U A N

• N G U Y E N V A N V A N .

T R A N V A N T H A N H

• N G U Y E N X U A N T H U ' C ,

V U D U ' C M I N H

•DO VAN DUNG, OANGTHj NGQC BiCH • NGUYEN V A N L A N H , T R A N V A N T H A N H

• NGUYEN VIET Q U A N G , C H U V A N T H A N G , NGUYEN T H ! Q U Y N H H O A

• NGUYEN X U A N T H U ' C

•DANG HUNG MINH, BUI TU'ONG LAN • PHAM THj THU THUY, OAU XUAN CANH , NGUYEN TH! BACH TUYET •TRAN THj MAI OANH, NGUYEN THI HU'O'NG, PHAN LE THU HANG •CHU TRAM ANH, PHAM T H I T H U HlEN

• NGUYEN M A N H C U ' O N G , LE HOANG TUAN • HOANG NGOC SON. NGO HU'U HANH

=> Nghien cuu dot bi ln EGFR va mot s i yeu t l lien quan d benh nhan ung thu phl i the bi lu mo tuyln d i lu trj tai Trung tarn Ho h ip Benh vipn Bach Mai

Gia tri noi soi da day trong phat hipn sdm ung thu- da day

=> Dec di lm roi loan chuc nang ho h ip trudc m i cua benh nhan veo cot song ngyc dugc phiu thu|t chinh hinh tai Benh vien Hu-u nghi Viet Due =s> Bao lye di|n tir va mot s i y lu t l lien quan tai Trudng Trung hoc ph i thong Chu-cng My A - Chiro-ng My - Ha Npi

Oilu tri t r im cam nang co loan than blng kich thich ty xuyen so k i t hp-p vdi thulc an thin kinh va chlng tram cam => Tuan thu dieu tri d benh nhan HIV/AIDS tre em tai Binh vien Nhi Trung uong =z Danh gia dp tin cay ki im tra Ipi bp cdng cu do ludng mdi tru-cng lam viec (COACH) tren can bp y t l tai Quang Ninh => M6 hinh gay viem khdp gut cai tien tren dpng vat thyc nghipm

Thyc trang suy dinh dudng d tre dudi 5 tuoi tpi huyen Thanh Mipn - Hai Duong nam 2016

Dac diem lam sang, can lam sang cua b|nh nhan xep than dot s ing ngyc. that lung do loang xueng tai Benh vien Hu-u nghi Viet Due

=• Nghien ciru cac y lu td thuan Ipi lam xuat hien con dau nua dau Migraine =>Tinh trang thieu mau d cac ba me va c i n nang ciia tre so sinh tai B|nh vipn huyen Tien Phudc, tinh Quang Nam, nam 2012 =>Tinh trang quanh rang va nhu cau dieu tri d cac benh nhan dai thao dudng typ 2 tai B|nh vien Da khoa tinh Ninh Binh, nam 2014 =*Ti le hien mlc thdi khoang 1 nam bpnh cham tay cua nhan vien y t l

Ki ln thuc, thai dp, thyc hanh phdng chong tac hai nghe nghiep cua cong nhan tinh Tra Vinh nam 2013 =>Thyc trang sue khoe t im than cua hpc sinh Trudng Trung hoc cc sd Quang Trung, thanh ph i Thai Nguyen, tinh Thai Nguyen

=>Ket qua c l dinh rang va xuomg I rang b| sang chan bang npp composite => Nghien cuu v l nguyen nhan va cac dac d i lm lam sang, can lam sang cua tran dich da mang djch t i l t =• Mpt s i nhan xet 65 trudng hop u vu da dugc ch in doan md bpnh hpc

=>Kien thuc, thai dp, thyc hanh v i lya chpn gidi tinh khi sinh cua cac san phy tpi Bpnh vipn Da khoa Qulc t l Hai Phdng

Nghien cuu dac diem lam sang. X quang va hinh thai Ing tuy cua rang ham Idn thu hai ham dudi =>Banh gia k i t qua sir dung fibrin giau t i lu cau trong phau thuat nh l rang ham Idn thu ba ham dudi .2 Trudng hop di lu tri gay xuong got di lech dugc n ln chinh c l dinh blng dinh steinmann (nhan xet cai t i in ciia f.kermad)

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205

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216

220

221

224

226

228

4 Y HOC T i l l C IIANH (1034) - SO 2/2017

.PHAM TH| THU HlEN

• DU'O'NG TRQNG TAN, HOANG NGOC SON. NGUYEN THUYQUYNH • NGUYEN DU'C NHlf, TRAN ANH TUAN • DOAN THI HUE

•TA VAN TRAM. PHAM THE HIEN • NGO THI DIEU MINH, DO QUANG HUAN • NGUYEN TH( HONG VAN, HOANG Bill HAl, VIEN VAN DOAN •DINH NGQC SON, NGUYEN LE BAO TIEN .PHAM TH! THU HIEN

•HOANG NGQC SON, NGUYEN TRONG TIN, N G U Y E N T H G Y Q U Y N H

•HOANG TH! PHU'O'NG, BACH VAN HOANH

• NGUYEN VAN SON, DINH THUC NGA •LE THj THUY LINH, LU'ONG MINH HANG TRAN THj MY HANH, NGUYEN THI THU HIEN •DANG HUNG MINH

• P H A M T H I T H U T H U Y ,

DAU X U A N C A N H ,

N G U Y E N T H ; B A C H T U Y E T

•TRAN T H ! M A I O A N H ,

NGUYEN THj HU'ONG, PHAN LE THU HANG • PHAN THI TO NHU', NGUYEN THI HU'ONG GIANG

• NGUYEN LE BAO TlEN, DINH NGOC SON •DANG HUNG MINH, BUI THj PHU'ONG THAO • NGUYEN OU'C NHU', TRAN ANH TUAN •NGUYEN THj HUONG GIANG, PHAN TH! TO NHLF

• YHTH

=> Danh gia dac diem lam sang, X quang nhom rang phia trudc c6 sir 232 dyng chot spi = Kiln thuc va thyc hinh ve tiem an toan ciia sinh vien dieu dudng 235 Trudng Cao ding Y t l Thai Nguyen tai Benh vipn A Thai Nguyen nam 2016 => Danh gia cac y lu t l lien quan d in giam djnh ton thyong co th i b 237 nhung trudng hop chin thuong mlt => Ki t qu i can thidp nang cao nSng lyc cua ba me v i chdm sbc ve 239 sinh. u i m b tre so sinh non thang dieu trj tpi Trung tftm Nhi khoa, Benh vien Trung uang Thai Nguyen => Tinh hinh chu'a rang tai Benh vien Da khoa Tiln Giang 242

=-, Nghien cuu roi loan nhip thlt b benh nhan suy tim man tinh trudc 248 va sau di lu tri blng thuic Crc ch l beta =>Tinh trang khang insulin va ton thuong mat a cac benh nhan r l i 252 loan glucose liic doi co tang huyit bp

s» Ki t qua cham sdc benh nhan sau m l tac hinh thin d i t sing ngyc, 253 thlt lung bing bam cement sinh hoc tpi Benh vien Huu nghi Viet Due -.- Danh gia k i t qua dieu tri npi nha rang ham Ian thu hai ham dudi tai 255 Bpnh vipn Rang Ham Mat Trung uang Ha Npi = Thyc hanh va mpt so y lu t l l i ln quan d i n thuc hanh phdng b|nh 257 nhiem xa nghi nghi|p cua nhin vien x-quang tai cac ca sd y t l tren dia ban tinh Quang Ngai nam 2016 => Nghien cuu mpt s i y lu t l l i ln quan d in mat dp xuang d benh 260 nhan nam mlc benh phl i t i c nghen man tinh tpi Benh vipn da khoa tinh Thai Binh =>Tinh hinh nhidm dpc mangan nghi nghipp ciia cdng nhan Cong 262 ty C i phan Hop kim Si t - Gang Thep Thai Nguyin =: Danh gia ki t qu i di iu tri npi nha rang ham sda 266

a> Nghien cuu dac di lm lam sang, can lam sang cua viem phoi d 270 bpnh nhan ung thu phii - 2 So sanh tac dyng cua thulc ampelop va ampelop k i t hop vdi 272 amoxycilline + metronidazole trong dieu tri loet da day - ta trang

=•;• Mpt s i y iu t i lien quan d in vide lya chpn gidi tinh khi sinh cua 274 cac ba me ddn sinh con tai Bpnh vien Da khoa Qulc td Hai Phong

;=>Xac dinh cSn nguydn va tinh khang khang sinh cua vi khuan b 276 bpnh nhan nhiem khuin huyet duoc didu tri tai Benh vidn Quan y 103 (2011-2015) =>Oac diem lam sang va can lam sang cua bpnh nhdn truot d l t 279 sing thl t lung, thlt lung cung Benh vipn Huxi nghi Vipt Due =»D$C di lm lam sang, cdn lam sang, nguydn nhan hoi chung thuy 282 giua tai Trung tarn Ho hip Bdnh vidn Bach Mai =5 Nghidn cuu mpt s i dac diem chin thuong ml t qua giam djnh t in 285 thuong co th i => Cac chit uc ch i SGLT2-nhdm thuic mdi trong di iu tri bpnh dai 287 thao dudng s» Thong tin y hpc 290

Y HQC THL'C HANH (1034) - SO 2/2017

cac nghien cuu danh gia ve y lu to bdi canh tac dpng din viec ap dyng cac cham sbc sue khoe dya tren blng chung cua can bp y t l tpi Viet Nam co the su dung bo cong cu COACH d i d i lu tra.

TAl LIEU THAM KHAO 1. Bergstrom. A., et al. (2015). "Health system

context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) toot for low- and middle-income settings" Implement Sci. 10(1), p. 120.

2. Duong, D. M., et al. (2015), "Exploring the influence of context in a community-based facilitation intervention focusing on neonatal health and suivival in Vietnam: a qualitative study". BMC Public Health. 15(1), p. 814.

3. Graham, I. D., et al. (2006). "Lost in knowledge translation: time for a map?". J Contin Educ Health Prof.

26(1), pp. 13-24. 4. Grol, R. and Grimshaw, J. (2003). "From best

evidence to best practice: effective implementation of change in patients' care". Lancet. 362(9391), pp. 1225-30.

5. Mason, E. (2005). "Child survival: time to match commitments with action". Lancet. 365(9467), pp 1286-8.

6. McCormack, B., et al. (2002). "Getting evidence into practice: the meaning of 'context'". J Adv Nurs. 38(1), pp. 94-104.

7 McCormack, B., et al. (2009). "Development and testing of the Context Assessment Index (CAI)", Worldviews Evid Based Nurs. 6(1). pp. 27-35.

8. Stepurko, T., et al. (2010). "Empirical studies on informal patient payments for health care services: a systematic and critical review of research methods and instruments". BMC Health Sen' Res. 10. p. 273.

PHAN LTNG CO HAI TREN THAN LIEN QUAN DEN TDF 6 BENH NHAN OIEU TR| PHAC D6 TDF/3TC/EFV

LE TH| HU'O'NG, VO TH! THU THUY Cue Phong, chong HIV/AIDS. Tru'&ng Dai hoc Dupe Ha Ndi

TOM TAT Muc tieu: Mo fa dac diSm phan umg cd hai (ADR)

tren than lien quan den TDF a benh nhan dieu tri phac do TDF/3TC/EFV va xac dinh mot so yeu td lien quan den ADR. Phuxyng phap. Nghien cuv thuan tap lien cuv thong qua bao cao tu nguyen cd chu dich tren 2650 BN (1809 benh nhan cu va 841 benh nhan mdi) tir thang 03/2015. Kdt qua: Cd ghi nhan ty Ip nhd va twang ddng gap ADR tren than lien quan den TDF khi dieu tri phac dd TDF/3TC/EFV & ca nhdm bpnh nhan m&i (14.5%) va bpnh nhbn cu (14,1%). Da sd ADR tren than chlo muc dd nguy co. chiem 93.6% 6 nhung bpnh nhan m&i g$p ADR va 91.6% & nhwng bpnh nhan cu khi phan loai theo thang RIFL. Mot so ySu td lien quan la: Gia tri Hemogllobin huyet thanh va gia tri eGFP baseline. Kit luan: Cd ty 1$ nhd va tuvng ddng grip ADR tren than lien quan den TDF khi diiu trj phac do TDF/3TCEFV 6 ca nhdm bpnh nhan m&i (14.5%) va bpnh nhan cu (14.1%). Tuy nhien. da sd ADR tren than chi & muc do nguy co nen gin nhw toan bo benh nhan vin duy tri phac dd diiu tri. Vi vay. can hr vim ky lu&ng cho bpnh nhin iru&c va trong qua trinh dieu tri di tranh wee BN toy bo thuic.

Tbkhda:AND. Than. TDF

Chiu trach nhipm: Le Thi Huong Dja chi: Cue Phdng. ching HIV/AIDS Email: lehuongvaac@gmail. com Ngay nhpn: 5/1/2017 Ngay phan bipn: 16/1/2017 Ngay duyet bai: 7/2/2017 Ngay xuit ban: 28/2/2017

SUMMARY TDF- RELATED ADVERSE DRUG REACTION ON

KINEY OF PATIENT TREATED WITH TDF/3TC/EFV Objective: Describing characteristics and identifying

related factors about ADR of TDF on kidey in patients with TDF/3TC/EFV regiment. Methods: This is a prospective cohort study through targeted spontaneous reporting on 2650 patients (1809 olds and 841 news) from May 03/2015 in 5 provinces. Results: This is a small and the stmilary percentage of patient experiencing the ADR on kidey related to TDF in patient with TDF TDF / 3TC / EFV treatment. 14.5% in new patient group and 14.1 in the old. The majority of kidney ADR is at risk level, accounting for 93.6% in new group and 91.6% met ADR in old group when categorized by scale RIFL. Some relevant factors are: Value Hemogllobin EGFP serum and baseline value-Conclusion: This is a small percentage of patients experiencing the ADR on kidey related to TDF in patient with TDF TDF 13TC / EFV treatment. However, the majority of kidney ADR is at risk level. Since, we need a thorough consultation for patients before and during treatment to avoid treatment dropping out.

Keywords:ADR. kidney. TDF DAT VAN BE Thang 11/2011. Hudng dan di iu tri HIV/AIDS sua

dl i dupe ban hanh kern Quyit dinh sd 4139/QD-BYT thi TDF/3TC/EFV trd thanh phac dd uu tien. TO thai di im do d in nay. mpt sd lupng Idn bpnh nh&n da duoc sir dung phac do cd chira TDF. Mpt so phan irng cd hai dupe khuyen cao giam sat vdi phac dd mdi nay bao gdm doc tinh tren than cua TDF [1],

Tai Vipt Nam, so lupng bao cao ve phan irng co

130 Y HOC T i l l ( NANH (1034)- SO 2/201'

nai cua thuoc con rat han ch i va khdng phan anh dung thuc t l dieu trj [2], Vi v ly, chiing tdi t i ln hanh nghien cju.'Rhan ung cd hpi tren than lien quan t&i TDF tren penh nhan diiu tn phPc dd TDF/3TC/EFV".

D6l T U ' O ' N G V A P H U ' O ' N G P H A P N G H I E N C U U

1. Doi tupng nghien cuu Gdm 841 binh nhan mdi v l 1809 binh nhan cu

dieu trj phac do TDF/3TC/EFV trong thdi gian tu 16/03/2015 d in 15/07/2016. Sau khi loai trie cac binh nhan khdng cd xet nghiem ndng do creatinin huylt thanh trong vdng 90 ngay trudc khi b i t dau phac do TDF/3TC/EFV va benh nhln khdng cd xet nghiem nong dp creatinin huylt thanh sau khi tham gia nghien curu, cd 539 BN mdi va 1682 benh nhan cu, tire tong sd 2520 benh nhan dupe dua vao nghien cuu.

2. Phuong phap nghien cuu Nghien cuu thuan tap tien cuu thong qua bao cao

ty nguyen cd chu dich. S6 lieu thu thlp dupe iam sach. nh|p blng Epidata

3.1, quln ly va phan tich blng SPSS 16.0. Sir dung ky thuat phan tich thong ke md ta, ki lm dinh X2 va mo hinh hoi quy logistic de tim mdi lien quan.

K E T Q U A N G H I E N C U D

1. Thong tin chung v i doi tupng nghien cuu Dac di lm ciia mau benh nhan trong nghien cuu

Khdng cd su khac biet nhieu vdi dac di lm benh nhan nhiem HIV/AIDS tai Viet Nam. Binh nhln nam gidi (67,3%) chilm nhilu hon so vdi nO gidi. Dp tudi trung binh ciia bpnh nhan la 36,2 ± 7,7 (nam). Trong dd, dp tudi trung binh cua nhdm benh nhan cu la 37,3 ± 7,5 (nam), cao hon so vdi nhdm benh nhan mdi (33,9 t 7.5 nam). Tai thdi diem bat dau theo doi. so bpnh nhan dang d giai doan lam sang 1 chi lm ty le cao nhat

(90.7% benh nhin cu va 62,4% benh nhan mdi) Ty le bpnh nhan d giai doan l lm sang 2. 3. 4 tren nhdm b$nh nhan mdi cao hon d nhdm bpnh nhan cu. V i giai doan mien dich phln theo muc CD4, benh nhan cu d giai doan binh thuong chi lm ty lp cao nhlt (32.5%) trong khi dd benh nhan mdi d giai doan suy giam nang chilm ty le cao nhat (32.8%).

2. Dac diem ADR tren than lien quan den TDF 2.1. Ty le gap ADR tren than lien quan d i n TDF Bang 1. Ty le ADR tren thin lien guan den TDF

SO iupng Tong so Ty le (%) STT Nhdm benh nhan cpnh nhan

Mdi CO

78

237

539

1628

14.5

14,1

Bang 1 cho thay: Cd ty le nho va tuong ddng benh nhan gap ADR tren thin lien quan d in TDF khi dieu tri phac do TDF/3TC/EFV d ca nhom benh nhan mdi (14,5%) va b|nh nhln cu (14.1%). Day la mpt ty le kha cao so vdi k i t qua nghien cdu cua Nguyen Van Kinh v3 cpng sy nam 2013 vdi ty le 7.3% [4], Sy khac biet nay co th i do dinh nghia bien cd tren than, nghien cuu cua Nguyen Van Kinh su dung dinh nghTa doc tinh tren than xul t hien khi gia tri eGFR giam dudi 60 ml/phut [3]. Nghien cuu cua Chaisiri va cpng sy tai Thai Lan nam 2010 va nghien cuu cua Nishijima tai Nhat Ban vao nam 2011 va vdi dinh nghTa ve dpc tinh tren than tuong tu k i t qua nghien cuu cua chung toi , ty lp xult hipn dpc tinh tren than lien quan d in TDF l ln lupt la 19,3% va 19.6% [4]. [5]

2.2. Mux: do nang cua ADR tren than lien quan din TDF

Bang 2. Phan loai muc do nang cua ADR tren than

Thang phan loai.' Doi tupng Benh nhan mdi Benh nhan cu benh nhan So lupng Ty le % Ty le % So lupng Ty Id % Tylp%(n=1682)

(n=78) (n=539) (n=237) Phan loai theo muv dp tang ndng dp creatinin huyet thanh so ven gia tn binh thuvng trpn (thang WHO/

Muc dp 0 (nam trong gidi 60 76.9 11.1 146 61.6 8.7 h^n binh thudng)

Muc dp 1 (>t-1,5 l ln) 15 19,2 2.8 87 36,7 52 Muc dp 2 (>1,5-3 l ln) 3 3.8 0,6 2 0,8 0.1 Muc dp 3 (>3-6 l ln) 0 0.0 0,0 2 0,8 0.1 Mire dp 4 (>6 l ln) 0 0.0 0,0 0 0.0 0.0

Phan loai iheo muc do tang nong dp creatinin huyet thanh so vox gia tq baseline (thang AKIN) Giai dean 0: < 1.5 lan 40 51.3 7,4 143 60,3 8,5

Giai doan 1 > 1.5-2 l ln 11 39.7 5.8 69 29,1 4,1 Giai doan 2: > 2-3 lan 6 7.7 1 1 23 9.7 1,4 Giai doan 3: > 3 lan 1,3 0.2 2 0.8 0.1

Phan loai theo do giam eGFR so vox baseline (thang RIFL) Muc nguy co 73 93,6 13.5 217 91,6 12.9

(eGFR giam > 25%-50%; Muc t in thuong 5 6.4 0,9 19 8,0 1.1

(eGFR giam > 50%-75%) Muc suy thin 0 0,0 0.0 1 0,4 0.1

(eGFR giam >75%)

Bang 2 cho thay: Da so mire dp cua ADR tren than d nhdm benh nhan mdi va cu deu d muc dp deu d muc nhp. Neu phan loai theo mire dp tang nong dp creatin huyet thanh thi hau nhu khdng gap benh nhan co ADR tren than d mire dp 3 va 4 khi chi cd 0,1%

tdng so benh nhan cu d mire dd 3. Ket qua tuang tu ndu phan loai theo mire dp tang ndng dp creatin huyet thanh so vdi gia tri baseline khi chi co 0,2% bpnh nhan mdi va 0,1% benh nhln cu t ing d muc dp 3. Con khi phln loai theo thang RIFL thi k i t qua lam rd horn cho

Y HQC T i l l C HANH (1034) - SO 2/2017 131

nhan djnh tren khi chi co 1 trudng hpp (0,1%) benh nhan cu gap mire suy thin.

Do khoang each giira cac l in lam xet nghipm qua xa (9 thang) nen khdng the danh gia chinh xac dupe dien biin ciia dec tinh tren than va co the ton tai nguyen nhan khac ngoai thuoc gay ra Nhin chung, k i t qua v i mire do nghiem trpng cua dpc tinh tren than tuong ding vol kha nhiiu nghiin cuu tren th i gidi cho

Benh nhan mdi Benh nhan cu n=539 Ty le %

oo CO

II Ty le %

Benh nhan khdng can hieu cninh lieu 68 12.6 192 11.4 Benh nhan can giam lieu TDF 10 1.9 45 2.7

(10 ml/phut < eGFR < 50 ml/phut) 2 ngay 1 vien TDF 300 mg 9 1,7 43 2.6 1 tuin 2 vien TDF 300 mg 1 0.2 2 0.1

Benh nhan cin ngung TDF (eGFR < 10 ml/phut) 0 0,0 0 0,0 Benh nhan dupe hieu chinh lieu TDF (thuc te) 2 0,4 5 0,3

Benh nhan dupe chuyen phac d6 mdi khong chii'a TDF do dpc tinh tren 0 0,0 0 : o than iien quan TDF (thuc ti)

Bang 3 cho thay: Da so benh nhan mdi va cu d iu 3. Cac y i u to lien quan d i n ADR tren than ciia khong can hieu cninh li iu. Chi cd 1,7% benh nhan mdi T D F va 2.6% benh nhan cu can giam li iu va khdng co benh Bang 4, Phan tich dan bien cac y iu td anh hudng nhan nao can ngirng sir dgng TDF. tdi tan suit xuit hien ADR

thay doc tinh khi sir dung TDF thudn g chi a muc dp nhe hoac trung binh. cho du cd the co sy khac biet v i phuang phap nghien cii'u ciing nhu djnh nghTa dpc tinh tren than giua cac nghien cuu

2.3. XiFtri ADR tren than cua TDF Bang 3. Ty le binh nhan duac hieu chinh liiu/ddi

phac dd

Benh nhan mp'i Benh nhan cu Yeu td/Odi tupng benh nhan HR Khoang tin cay

95% Cl HR Khoang tin cay

95% C! p

Tuoi (nam) 1,013 0.985- 1.042 0.355 1,012 0.995 - 1.030 0.173 Gidi {nam'nu) 0.990 0,778- 1.259 0.933 1,048 0.780- 1.407 0,756

CSn nang 1.013 0.987-1.039 0,336 1.013 0.997 - 1,030 0.101 Giai doan ISm sing 0,747 0.905

Giai dogn 1 0.957 0,483- 1.897 0,900 1,327 0.597 - 2.950 0.487 Giai doan 2 0,854 0.362-2,013 0.718 1.208 0.409 - 3,562 0.733 Gia> doan 3 1.325 0,562 - 3.121 0.520 1.429 0.416-4.907 0,571

CD4 1,000 0.999 - 1.001 0.485 1.000 1.000- 1.001 0.384 Hemoglobin 0.993 0,985- 1.001 0.094 1.011 1,004- 1.019 0.002

ALT 1.001 0.996 - 1,006 0.749 0.999 0.996- 1.003 0.743 [Cre) baseline 0.949 0.936-0.962 <0.001 0.948 0.939- 0,957 < 0.001 eGFR baseline 1.016 1.012- 1,019 < 0,001 1.033 1.027- 1,039 < 0.001

eGFR baseline >80 ml/phut 3.138 1,730-5,695 <0.001 5,255 2.132- 12. 953 < 0.001 Thai gian sir dung TDF trudc khi theo d&i 1.004 0.995- 1.014 0,355

Kit qua bang 4 cho thiy: Ndng dp creatinin huyit thanh ban dau tru-dc di iu trj va mire Ipc cau thin eGFR ban diu la cac y iu td anh hudng tdi t in suit xuit hipn dpc tinh trin than (p < 0,001) d ca nhdm benh nhan mdi v i cu. Vdi nhdm bpnh nhan mdi, niu gia tri ndng dp creatinin huyit thanh tang 1 don vj thi nguy co xuit hipn doc tinh tren than giam 5 , 1 % va ngupc lai, n iu gia tri eGFR ban dau tang 1 don vj thi nguy co xuit hipn dpc tinh tren thin cua bpnh nhin tang them 1,6%. Tuong ty. vdi nhdm bpnh nhan cu,

gia tri nong dp hemoglobin huyet thanh cang tang. eGFR baseline cang tang, ndng dp creatinin huyit thanh ban dau trudc khi theo ddi cang giam thi nguy co gap dpc tinh tren than cang tang. Bpnh nhan co gia tri eGFR baseline 2 60 ml/phut cd nguy co gap dpc tinh tren than cao g ip 5.2 l in so vdi nhdm binh nhan cd eGFR baseline <60 ml'phut (p<0,001).

Bang 5. Ki t qua phin tich da bien cac y iu td anh hudng toi t in suat xuit hien ADR

Yeu td Doi tupng bpnh nhan

Hemoglobin eGFR baseline

3enh nhan mdi Benh nhan cu HR Khoang tin cay 95% Cl p HR

0.987 0.977 -0.997 0,012 1.011 1.016 1.012- 1.020 < 0.001 1 029

Khoang tin cay 95% Cl p 1.003- 1.019 0.005 1.022 - 1,036 < 0.001

6' nhdm bpnh nhan mdi gia tri hemoglobin (HR = 0.987; 95% Cl=0,977 - 0,997: p = 0.012) va eGFR ban dau trudc khi dung TDF (HR = 1,016; 95% Cl=1,012-

1,020: p < 0,001) la hai y iu td co inn hudng tdi tan suat xuat hipn dpc tinh tren than. Niu gia trj hemoglobin cua bpnh nhan trudc khi bit dau dieu tn

132 V HQC Ti l l , ( IIAMI (1034) - S6 2/2017

,j,ng 1 dan vj thi nguy ca gap doc tinh tren than giam 1,3%. Ngupc tat, neu gid tri eGFR ban dau tang 1 dan yj thi nguy ca xuit hien doc tinh tren than cua benh nhan tang them 1,6%.

Vdi nhdm benh nhan cu, k i t qua thu dupe tuong [if nhu phan ti'ch don bi in, g i i trj hemoglobin huyet tnanh (OR = 1.011; 95% Cl=1,003 - 1.019: p = 0.005) v'a eGFR baseline (OR = 1.029. 95% Cl=1.022 -1.036; p < 0,001) la cac y iu t i anh hudng tdi sy xuit hien dpc tinh tren than l i in quan TDF. Neu gia tri hemoglobin ban dau tang 1 don vi thi nguy co xuit nien doc tinh tren than tang 1,1% va neu gia tri eGFR ban dau tang 1 don vj thi nguy co xuit hien 6QC tinh tren thin cua benh nhan tang them 2.9%.

KET LUAN Tuy co ghi nhan mpt ty lp benh nhan bao cao gap

tac dung phu cua TDF tren than nhung phin idn d mire do nhe va da s i bpnh nhin van tiep tuc dieu tri ma khong can den can thiep y t i hay chuyin phac dd.

Kit qua nay chi ra rang nhdn vien y te can to v in ky ludng cho BN trudc va trong qua trinh di iu tri va giam sat theo dot thirdng xuyen tac dung phu ndy

TAI LIEU THAM KHAO 1. Trung tarn DI&ADR Qu6c gia (2013). Ting

ki t cong tac bao cao phan ung cd hai cua thuic (ADR) nam 2013, truy cap ngay 17 thang 11 nam 2016

2. Nguyen Van Kinh (2010). Nghien cou tac dung phu hay gap cua phac do ARV bac 1. Tap chi Y hpc thyc hanh. sd 3 (708). ndm 2010.

3. World Health Organization (2013), Surveillance of antiretrovira! toxicity: HIV/AIDS programme: Surveillance of antiretroviral treatment programmes.

4. Nishijima T, Komatsu H, Gatanaga H et al (2011), "Impact of small body weight on tenofovir-associated renal dysfunction in HIV-infected patients: a retrospective cohort study of Japanese patients", PLoS One, 6(7), p.226.

VAI TRO VA BINH HU'O'NG PHAT TRIEN PHUONG PHAP DIEU TR! GIAM OAU BEN NGOAI BOl VOI BENH LY XU'QNG KHOP

BANG THUOC Y HOC CO TRUYEN

N G U Y E N D U ' C M I N H

Benh vien Cham cuv Trung irang

TOM TAT Da dang hoa loai hinh va phuung phap diiu tn dau

dang la nhu ciu va hvong di dung din cua chuyen nganh xuvng khdp hien nay. Trong do. cac loai thudc dung diiu tn ben ngoai cung dang duuc nhiiu dan vi trong nganh y ti danh sy quan tarn nghien cuv. Y hqc cd truyin vol lich st> hang ngan ndm da va dang chung to vi the cua minh trong dieu tn chung benh nay vdi cac phuong phap doc dao. da dang, hieu qua.

Tu> khoa: chong dau. diiu tri bdn ngoai, y hgc co truyin

SUMMARY Diversifying the forms and methods which cure pain

is needed and the correct direction of majors in joints. In particular, the drugs used to treat external body is researching in some health care center. Traditional medicine for thousands of years of history has proven its position in the treatment of this disease with unique methods, diversity and efficiency.

Keywords: Analgesic. external treatment, traditional medicine

Chju trach nhiem: Nguyen Due Minh Dia chi: Benh vien Chdm cuv Trung uvng Email: drminhchamcuu@gmail. com Ngaynhpn: 19/12/2017 Ngay phan bien: 9/1/2017 Ngay duyet bai: 20/2/2017 Ngayxuk ban: 28/2/2017

DAT VAN DE Phuang phap dieu tri giam dau ben ngoai mpt so

bqnh ly xoong khdp bing thudc la mot trong nhung phuomg phap di iu tri cd hieu qua cua Y hpc co truyin (YHCT). Dan gian tir lau da quen vdi viec sir dyng cac san pham trong nude nhu cao sao vang. dau gid, dau Phat linh, ru'pu xoa bdp, thuic ngam. thuoc dip. xdng thuic... cho tdi cac san pham cua nude ngoai nhu cao dan, gei cua Hisamitsu (Nhit Ban): cao da chd. cao dan Nam tinh chi thing, Boneal Ci t thing linh (Trung quic)... de di iu tri giam dau trong nhieu benh ly ca xuong khdp. Cung vdi sy thay d i i theo chiiu hudng tich eye ciia dieu kien kinh t i . y thuc ty cham sdc sue khoe cua ngudi dan, sy quan tarn cua nha nude, h i thing Y t i .. tdi sue khde nhan dan, quan diem phdng va dieu tri Dinh tat cua con ngudi ngay cang cd nhiiu tien bo, vi vay di iu tri giam dau ben ngoai bing thuoc YHCT cung cd nhieu co- hpi de phat then.

Nhung nam gan day Phuong phap diiu tri giam dau ben ngoai mpt s i binh ly xuomg khdp bing thuic YHCT (sau day gpi t i t la Phuong phap dieu tfj giam dau ben ngoai bing thuic YHCT) ngay cang dupe coi trpng, tuy nhien cung ben canh dd cung con ton tpi mpt s i y iu t i han che, can nghiim tuc xem xet ddnh gia de xay dung cac d i i sach phu hpp.

Then vpng phat then cua phuong phap dieu trj giam dau ben ngoai bing thuic YHCT:

Dieu tn giam dau b in ngoai bang thuic YHCT vdi cac dac diem de sir dyng, an toan. dac biet la hipu qua diiu tri t it. la phuong phap ma hang nghin nam trudc

Y HOC I HI. C HANII (1034) - SO 2/2017 133