' Nghien c i j u - Ky thuat
smh dupe chpn theo kinh nghipm d l phdng xdt nghidm thu dd nhgy cua khdng sinh dd.
Summary
Antibiotics use of the Internal Departement of Hue Central Hospital from January 2009 to August 2010 was investigated with 205 inpatients involved. Gram negative bacteria were the most common pathogens (82.1%), the typical ones were Klet)sielia pneumoniae (25.4%), Entem^ter cloacae (11.9%,), H. influenzae (10.2%), Pseudavonas aemginosa (8.9%i). Caution should be paid to the mnpencal use of cefuroxim. ceftriaxon.
amoxicilin/clavulanic, gentamiein and those antibiotics of high bacterial resistance. As bacterial resistance to ceftazidim, cefepim.
imipenem, amikacin and netilmicin were found relatively low. they could be used for patients with severe prognosis. Most antibiotics used were appropriate to bacterial pathogens as well
as their resistance and well observing the hospital drug lists and essential drug lists by the Ministry of Health.
Key words: antibiotics, bacterial resistance,
use of drug.
Tdi li$u tham khdo
1. Bd Y t l (2005), Hw&ng din diiu tq , tdp 1, NXB Yhpc,
2 BCii Xudn Tdm (2001). "Quan ni$m mdi vi chin dodn vd dilu In nhilm khuin dudng hd h^p dudi", Hdl thdo nhiSm khuin duttng hd hip vd m^tsd quan diim mdi, trang 1-11
3. Bartlett J. G., Scott F. D., Lionel A. M. and Fine M, J (2000), "Practice guidelines for the management of community-acquired pneumonia in adults', Infectious diseases socidy of America.
4. Beyan et al. (2001). "Acute community- acquired pneumonia". Current diagnosis and treatment. JSG Medicine association Jan.
Nghien ciru sy thay doi pH, ap lyc tham thau va SVC ben hong cau cua khoi hong cau bao
• ^
quan bang dung dich "AS-T" va Terumo
Dat van de
Truyen mdu tdng phin vdi mye tidu an todn.
kmh t l va hipu qud trong dilu trj nhung ndm gin day dang trd thdnh pho biln. Do dd ein phai cd nhung dung djch bdo quan ndng cho mil thdnh phan cua mdu, dgc bipt Id dung djch bdo qudn khoi hong clu. Vi vdy, nghidn cdu sdn xuit dung djch bao qudn khdi hing eau dang Id nhu clu bdc thilt cua ngdnh truyin mdu Vipt Nam. Dung djch bdo qudn khli hdng clu mang ten "AS-T" da dupe sdn xuit d qui md phdng thi nghipm.
Nhdm gdp phin danh gid khd nang bdo qudn hdng eau eua dung djch "AS-T" d l sdm dua dung dich ndy vdo thu nghipm Idm sdng vd su dung, nghien cuu: Khao sdt sy thay ddi v l pH, ap luc thim thiu va sue bin hdng clu cua khli
Traa Nhan Thing B^nh vi^n Bgch Mai
hing clu bdo qudn din 42 ngdy bing dung djch
"AS-T' vd Terumo da dup'c thyc hidn.
Doi t u v n g va phu'ong phap nghien ciru
Dii tuvng nghien cim
Khli hong clu bao quan bdng dung djch
"AS-T" (Additive system-Thang), sdn xuit t?i Bpnh vidn Bgch Mai, kilm nghipm tai Vidn Kiecn nghipm Bp Y t l va dung dich Terumo (Nti|t Bdn).
Thiet bj
- Mdy do dp lye tham thIu Osmometer cua hang Roebling (Ode).
- Mdy do pH Metre-Metrohm 961 eua Thuy Sy - Mdy ly tam Ignh Beekman Avanti 30 cua MJ
Phipo^g phdp nghien cuuTAP CHi DirpC HQC - 07/2012 (S6 435 NAM 52)
• Nghien ci>u - Ky thuat
Md hinh nghidn cUv
Thyc nghipm dupc tiln hdnh trdn mdu cua 10 ngudi tinh nguydn khdc nhau, c6 cung nhdm mdu B (theo phdn logi ABO), Mdu todn phin ciia m l i ngudi (350 ml), ching ddng bdng dung djch CPD
(citrat-phosphat-dextrose) cOa Nhdt Bdn
Mdt tCii dupc thdm vdo 40 ml dung djch "AS-T" vd tCii kia 40 ml Terumo
San xual khoi hdng cau theo qui trinh chuin cua Vidn Huylt hpc vd Truyin mdu dupc chia thdnh 2 tui
Bdo qudn d 4°C
Nghien cdu tgi 7 thdi dilm; khdi d i u (0), 7,14, 21, 28, 35 vd 42 ngdy v l cdc chi s6 pH, ALTT vd sdc bin hdng c l u
Ddnh gid khd nang bdo qudn khoi hdng c l u cua dung djch "AS-T' Xic djnh pH
Gid tn pH eua k h l i hong cau bao qudn b i n g dung djch "AS-T" va Tenjmo d u p c xdc djnh theo nguydn tdc dipn cue ehpn ipc.
Ap lye tham t h I u d u p c xdc djnh gidn t i l p qua do dp ha bang d i l m eua djch bao qudn so vdi nude'^'.
Xdc djnh sipc bin cOa hong cau L l y 2 ml cdc m i u nghidn c d u . tdch h u y l t t u o n g , l l y can h i n g c l u . C h u i n bi cae dd NaCI nhuoc truong pH 7,4 cd n i n g dp: 1%o. 2%o.
2,50%o, 2,75%c, 3%a, 3,25%o. 3,50%o, 3,75%.., 4%!,, 4,25%o, 4,50%o, 4,75%o, 5%o, 5,25%o. 5,50%o, 5.75%o. 6%o, 6,25%o, 6,50%o, 6,75%o, 7%o. 7,25%o, 7,50%o, 7,75%o vd 8%c. Cho vdo mdi I n g dung dieh natri dorid nhupe truong 2 gipt cgn hdng eau. Lac nhp nhdng 2-3 l i n , d l d nhidt dp phdng 60 phut trude khi dpc k i t qua. Khdng cd s y tan h i n g c l u : dung djch phan tren trong sudt. Mpt sd h i n g eau bdt dau tan: dung djch p h i n tren mau hoi hong. T i t ed h i n g c l u d i u tan: todn bd dung djch trong dng d i u cd mdu do trong su6t^^'.
Cae k i t qua nghien euu dup'c x u ly bdng toan thong ke theo chuong trinh S.P.S.S-10.05.
"p" la m d e y nghTa cua so sdnh hai trung binh glua cac mSu can nghien c d u b i n g test T. Muc p < 0.05 dup'c ghi nhdn la khac nhau cd y nghTa t h i n g kd.
TAP CHI DirOC HQC - 07/2012 (SO 435 N A M 52)
K e t q u a v a b a n l u a n
Svp thay d d i pH cua khoi hong cau t r o n g qud t r i n h bdo q u d n
d n djnh pH Id tidu chuan quan trpng d l ddnh gid khd nang bdo qudn hong cau.
Bang 1 : Kit qua nghien cuv vi thay doi pH cua khdi hong ciu bao quan
0 7 14 21 26 35
pH,(n Terumo 7.36 ± 0,04 7,33 ± 0,03 7,25 + 0,04 7,20 ± 0,04 7,12 ±0,05 7,03 ±0,06
± SD), n = 10
"AS-T"
7,39 ±0,06 7,37 ± 0,05 7,35 ± 0,05 7.32 ± 0,04 7,28 ± 0,04 7,21 ±0,04
P 0,341 0,117 0,005 0,002 0,001 0,001 6,78 ±0,08 7,13 ±0,04 0,001
Bieu do 1 : Gid tri pH cua khdi hdng ciu bao qudn bdng dung dich "AS-T" vd Terumo
• Nghien ciru - Ky thuat
K i t qud nghien c d u d bdng 1 cho t h i y : t u thdi d i l m khdi dau d i n ngdy thd 14. gid trj pH cua 2 m i u gidm dan nhung v i n ndm trong khodng gidi hgn sinh ly binh thudng cua mdu (7,4 ± 0,05)'^'^' vd khde nhau khdng ed y nghTa t h i n g kd (p > 0,05). Nguydn nhdn cy t h i do lupng acid lactic tgo ra d giai dogn ndy v i n chu y l u tich luy trong h i n g c l u , Tuy nhidn, t d sau ngdy t h u 14 cua qud trinh bdo qudn, s y ed mdt cua dinatri hydrophosphat da giCip dung djch
"AS-T" ludn duy tri d u p c pH ciia k h l i h i n g c l u bdo qudn d mue cao hon cd y nghTa t h i n g kd so vdi dung d|ch Terumo (p<0.01), Dinatri hydrophosphat (vdi bdn c h i t Id mdt k i l m y l u , ludng tinh) dd c h u y i n acid lactic thdnh lactat natri (trung tinh) vd dinatri hydrophosphat thdnh natri dihydrophosphat (Id mdt acid y l u hon a a d lactic)'"'. Chinh khd ndng dd da tgo ra nhdng u u t h i cho dung djch "AS-T" trong vipc I n djnh vd duy tri ede ehi s l hod sinh cd lidn quan d i n ehuyin hod d hong c l u trong qud trinh bdo qudni^>«'«',
Ve sy thay doi ALTT cua khii hing ciu trong qud trinh bao quan
Bieu d l 2: Sy thay doi ALTT cua khdi hing cau bao qudn bdng dung djch "AS-T" vd Terumo
K i t qud nghidn cdu d b i l u do 2 eho t h a y Ap lyc t h i m t h I u (ALTT) ed dnh h u d n g den s y vgn c h u y i n c h i t vd dgc bidt Id cdc ion qua mdng, dnh hudng ddn s y todn ven vd hinh ddng cua hong cau. Khi ALTT giam se cd xu hudng Idm hdng c l u bj truong n d , b i l n dgng vd de v d . N g u p c Igi, khi ALTT tang th) hong c l u se b i l n dgng theo hudng eo Igi, it v d . Cae qud trinh dd Idm thay doi t h i tich trung binh h i n g cau, thay d l l ddi phdn bd kich thudc hdng cau, anh hudng d i n kha ndng sdng va chuc nang cua h i n g c l u bdo quan. Cdc dung dieh bao quan khoi hong c l u t h u d n g d u p e thiet k l ed
ALTT cao hon binh t h u d n g d l c h i n g v d hing c l u '^'. Tuy nhidn, mOt gidi hgn khdng t h i vupt qua d u p c Id d m d e ALTT dd, cdc chi s l sinh ly, hod sinh cua h i n g c l u khdng dup'c v u p l qua cdc gidi hgn sinh ly binh t h u d n g . K i t qud nghidn edu cho t h i y : T d ngdy t h d 7 den cull qud trinh bdo qudn, ALTT cua ede m i u nghidn edu d i u tdng d i n vd ludn khde nhau khdng c6 'j nghTa t h i n g kd (p>0,05) d mpi thdi d i l m nghidn euu. N h u vdy. trong qud trinh bdo qudn ALTT tdng d i n phCi hpp vdi vide cd mdt ty Id nhd hing c l u bj v d vd gidi phdng ra h u y l t tuong cdc thdnh p h i n Idm tdng ALTT. Tuy nhidn, d nhung mdc ALTT dd, sue b i n hdng c l u v i n khdng vux7t qud gidi hgn sinh ly bInh t h u d n g nhu kit qud nghidn euu d b i l u d l 3. Tai thdi d i l m ngdy t h d 42, dung djch "AS-T" duy tri dup'c ALTT eda k h l i h i n g c l u d mde < 340 mosmol/kg.
v l sy thay dii SIPC bin hing ciu trong qud trinh bio qudn
B i l u d l 3: Sy thay ddi SBTT vd SBTD cUa hdng ciu trong qud trinh bdo qudn
Mdng h i n g eau cd tinh bdn t h i m vd dan hoi, giup cho hong c l u cd the b i l n dgng vd r l i lai trd v l hinh ddng ban d i u ' ' • ^ . Tuy nhidn, khd nang dd cung chi cd gidi hgn v d phy thupe vdo sire b i n ciia h i n g c l u (SBHC)'^'. SBHC phy thudc n h i l u y l u t l : tlnh trgng cua mdng, ALTT, ning dd ATP, pH...Sde b i n tdi t h i l u eiia h i n g clu (SBTT) theo n i n g dd %o cua natri dorid Id tai ndng dd dd cOa natri elorid hdng cau b i t d i u vd vd sdc bdn t i i da (SBTD) tgi n i n g do do t i t cd h i n g c l u d i u v o '^' ^' ^°\ Cdc dung djch bao qudn ndi chung vd dung djch "AS-T' ndi rieng phdi I n 6\nh vd duy tri d u p c sdc ben cua hing c l u . K i t qud nghidn c d u d b i l u do 3 cho thay:
Tgi thdi d i l m khdi d i u , ALTT cua cdc mdu nghidn c d u deu cao hon chi so ALTT binh t h u d n g cCia mdu (292-308 mosmol/kg)'^ va khde nhau khdng cd y nghTa thdng ke (p > 0.05).
28 T^P CHi DlTg^C HQC - 07/2012 (S6 435 NAM 52)
Ngnien cu'u - Ky thuat
Tgi thdi d i l m khdi dau, gid trj SBTT va SBTD eua hong c l u d hai mdu nghidn c d u ddu nam trong khoang gidi hgn sinh ly binh thudng (4,6 - 4,8 %o cua natri elorid)'^'' va khde nhau khdng cd y nghTa (p > 0,05); trong qud trinh bao qudn hong eau bdng dung djch "AS-T" vd Terumo, ehi so SBTT v d SBTD eua h i n g c l u d i u giam d i n ( b i l u hipn bang k i t qua ndng dp %• cua natri dorid tang dan). Tai thdi d i l m ngdy t h d 42, dung dich "AS-T" duy tri d u p e SBTT vd SBTD cua hdng c l u bdo quan t i t hon cd y nghTa thong kd so vdi Terumo (p < 0,05). Khd nang ndy phu hpp vdi dung djch "AS-T" khd ndng dn djnh pH tdt hon so vdi dung djch Terumo nhu k i t qua nghidn euu k l tren.
K e t l u a n
- Gid trj pH eua k h l i hdng c l u gidm d i n trong qua trinh bdo qudn; T u ngdy thd 14 d i n c u l l qua trinh bdo qudn, dung djch "AS-T" ludn duy tri d u p c pH eda khoi hdng cau d mire cao han cd y nghTa t h i n g kd so vdi dung djch Terumo ( p < 0,01).
- Ap lyc t h i m t h I u cua khoi hong eau bao qudn bang dung djch "AS-T" va Terumo tang dan theo thdi gian va khde nhau khdng ed y nghTa thdng ke (p > 0,05). Tgi thdi d i l m ngdy t h d 42, chi cd dung dich "AS-T" duy tri dupe dp l y c t h i m thdu d mdc < 340 mosmol/kg.
- Chi s l SII'C b i n toi thieu vd sue b i n tdi da cua hdng cau deu giam dan theo thdi gian bao quan, Tgi thdi a i m ngdy thd 42, dung dich "AS-P' duy tri d u p c cae chi sd nay giam chdm hon ed y nghTa thong ke so vdi dung djch Temmo (p < 0,05).
T u nhung k i t qud trdn, cd t h i t r i l n khai t i l p cac nghidn cdu can lam sang v l huylt hpe va hda sinh doi vdi k h l i h i n g c l u bdo quan bang dung dieh " A S - T d l cd c o sd khoa hpc dua dung djch nay vdo t h u nghipm Idm sang.
S u m m a r y
Variations in pH, osmotic pressure and stability of the erythrocyte masses during 42 days' storage in the system of "AS-T" (prepared in accordance with the standard protocol issued by National institute of Hematology and Blood Transfusion) and Terumo were followed up. The pH values were measured with selective electrodes; osmotic pressures were determined indirectly by freezing point transition. The T^P CHI DirpC HQC - 07/2012 (S6 435 NAM 52)
obtained data were analysed by model S.P.S.S- 10.5. pH values decreased after 42 days' storage. From the 14'^ day on to the end of the studied storage time, in the "AS-V system, the pH's were always statistically higher than in Terumo (p <0.01); osmotic pressure in both systems increased all over the time and did not differ significantly from each other (p> 0.05). On the day 42, only the system "AS-V showed ability to maintain osmotic pressure <
340 mo^nol/kg. Both minimum and maximum strength indexes of the RBCs were reduced through storage, however, on the day 42, the strength index preserved by system "AS-T" was significatly higher than by Terumo system (p<0.05).
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7 Gallagher P. G., Jarolim P. (2000), "Red cell membrane disorders". Hematology basic principles and practice. New York, 3"" edition, pp. 576-603.
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