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Cac chi sd'liSn quan tdi dinh dif9ng cua b§nh nhSn theo tinh trang dinh dtfdng tai Benh vidn
tinh Hai Dtf tfng
N g u y i n D O H u y '
Ngi dung bdi bdo Id mgt phdn trong nghiin ciiu "Thuc trgng suy dinh dudng cda binh nhdn, hiiu bie't, thdi d$ vd thue hdnh chdm sdc dinh dudng eda edn bg y te trong bfnh vifn" tgi bfnh vien da khoa tinh Hdi Duang. Bdi bdo trinh bdy kit qud nghiin ciiu so sdnh cdc ehi sd lien quan tdi dinh dudng theo nhdm dinh dudng tdt vd nhdm suy dinh dudng (SDD) bang phuang phdp ddnh gid ddi tugng toan diin Subjective Global Assessment (SGA). Thiii ki nghiin cdu tie'n cdu trin 280 bfnh nhdn nhgp vifn trong vdng 48 gid tgi binh vi$n da khoa tinh Hdi Dudng tU thdng 3-6/2009. Kit qud cho thdy cdc chi sd liin quan idi nguy ca dinh dudng eua nhdm binh nhdn SDD diu eao han so vdi b^nh nhdn dinh dudng tdt: Ty If gidm cdn >5% trong 6 thdng cda bfnh nhdn SDD la 52,9%, eao han so vdi t^ li ndy d binh nhdn dinh dudng tdt (22,0%) (p < 0.001). Ty li benh nhdn gidm khdu phdn dn khi nhdp viin d nhdm binh nhdn SDD Id 51,2%. cao han so vdi ty le ndy d nhdm binh nhdn dinh dudng tdt (42,8%) (p < 0,001). Ty li bfnh nhdn gidm chdc ndng vdn dgng cda nhdm binh nhdn SDD la 55,4%, cao han so vdi tj li ndy d nhdm benh nhdn dinh dudng tdt (50,9%) (p < 0,001).
Td khda: cM sd'liin quan dinh dudng, SGA, suy dinh dudng.
Differences of at risk indicators of malnutrition among patients by SGA groups
at Hai Duong provincial General hospital
N g u y e n D o H u y '
This article reports part of findings in a research entitled "Nutrition status of hospitalized patients and KAP status on nutrition of medical staff at Hai Duong provincial general hospital". Indicators related to assessment of nutrition status of hospitalized patients by SGAmethod are presented through comparison of well-nourished group and malnourished group by SGA. A prospective study was
40 T?p chi Y t^ Cdng c0ng, 6.2013, Sd 28 (28)
• Ngiy nhfn bai; 21.1.2013 sNgiy phinbi^n: S.2.2013 • Ngiy cbinh siJi: S.3 2013 • Ngiy dtfi^c chip nh|n dSng 5.4.2013
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conducted wilh involvement of 280 hospitalized patients at Hai Duong provincial general hospital from March loJune. 2009. The results show that the al risk indicators ofmalnutrition of malnourished patients were higher than those of well-nourished patients. The percentage of unintentional weight loss during last 6 months before admisssion of malnourished patients was 52.9% and higher than that of well-nourished patients (22.0%) (p < 0.001). The percentage of dietary intake change of malnourished patients was 51.2%. and was higherthan that of well-nourished patients (42.8%) (p <
0.001). The percentage of reduction of functional capacity of malnourished patients was 55.4%. arui was higher than that of well-nourished patienls (50.9%) (p < 0.001).
Key words: the at risk indicators ofmalnutrition, SGA method, malnutrition status.
Vien Dinh dtfdng QuOc gia
1. D $ t v S ' n d g
Suy dinh dtfdng (SDD) cua bgnh nhan lien quan Idi tang nguy cd mac bgnh, ttf vong va kgo dai thdi gian nSm vien. SDD khong chi la mot bgnh ddn ihuSn ma lign quan tdi nhidu vS'n de Irong bgnh vign, bSng chtfng la nhieu bgnh nhSn tig'p tuc bi SDD trong Ihdi gian nam vign [1].
Suy dinh du'dng la mpl iiign ttfdng phd big'n ciia bgnh nhSn nam vien d i n de'n tang big'n chtfng ddi vdi bgnh, keo dai thdi gian nam vign, tang ty le ttf vong, tang chi phi y tg'. Vigc \&c dinh nhffng bgnh nhSn c6 nguy cd cao c l n hd trd dinh dtfdng tich ctfc se Iam giam du'oc nhu^g vl'n de Iren. Vigc danh gia tinh trang dinh dtfdng (TTDD) cua bgnh nhSn trong bgnh vign chu'a dtfdc coi trpng, ng'u co Ihl chi danh gid TTDD qua c^c chi s d n h a n trac (chieu cao, can nang va chi sd BMI). Trong khi c i c cong cu danh gia TTDD nhilcong cu danh gia do'i ltfdng loan dien (SGA) cho ngirdi benh ttf 16 dg'n < 65 tudi dffdc stf dung rgng rai trong benh vien ciia c i c nffdc trgn ihe' gidi thi vigc stf dung cac cong cu nay con ra't xa la vdi hiu he'l cac benh vign d nffdc ta [2] [3] [4] [5].
De c6 the danh gia dffdc TTDD cho benh nhan nam vign, dg'n nay chffa c6 phffdng phap c h u l n , nhffng phffdng phap danh gia dinh dffdng bang chi sdnhan tr^c (can nsing, chieu cao, chi sd BMI) vk phffdng phap danh gia toan dign chu quan SGA la cdc cong cu danh gia TTDD hffu higu nha't [4]. Do vay, chiing tSi stf dung cac chi sd nhin tr^c (BMI) va cfing cu SGA de sang loc. d^nh gia TTDD bgnh nhan nh§p vign trong nghien ctfu nay.
Trong nam 2009, chung toi tign hanh nghign ctfu "So sdnh cac chi sdlien quan tdi dinh dtfdng ciia bgnh nhSn theo TTDD bang phtfdng phap danh gia t o i n dign chu quan SGA" tai Bgnh vign da khoa tinh Hai Dtfdng vdi muc tigu; X i c dinh lien quan giffa cac chl sd' nhtf: thay ddi cSn nang, thay ddi can n | n g , thay ddi k h i u phan an, cac trieu chtfng da day rudt, thay ddi chtfc nang vSn dfing, cac sang chin, cac da'u hieu SDD... dg'n TTDD ciia ngffdi bgnh theo phffdng phap SGA.
2. Phtfcfng p h a p n g h i d n cihi 2.1. Thiei ke nghien ctiu
Phffdng phap nghien ctfu lien ctfu, tidn hanh tu"
thang 3 dg'n thdng 6 nam 2009 tai bgnh vign da khoa tinh Hii Dtfdng.
Cd mau ffdc Iffdng cho mfit t^ Ig [6].
„ _ ^l-al2 P ( ^ ' P)
n Id sSlapng cin diiu tra; Z2 (l-OUI)- D^ lin c4y 95%. Z =1.96 p IA tl If suy dinh dudng trong bfnh vifn Id 40 % (nghiin ciiu
ndm 2008 ttfl b^nh vign B^ch Mai) d li sai s^ cho phip Id 5%, them 10% difpkdng.
n= 390 ddi tu<mg.
2.2. Bdi tU0tg nghien cdu
Tat cd cac bgnh nhan mdi nhap vign Irong vong 48 gid CO tudi ttf 16 dg'n 85 tudi (trff hgnh nhan gu veo cfil sdng, mac cac benh d p tfnh, d p ctfu).
Tap chf Y t§f Cfing c6ng, 6,2013, Sd 28 (28) 41
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2.3. Phuangphap nghien cdu va ky thu4t thu thgp sdlifu
Bgnh nhan dffdc danh gia TTDD khi mdi nhap vien (trong vdng 48 gid), thu th§p sd'lieu v l nhan tr^c va SGA vdi ngtfdi benh < 65 tuo'i.
* Thu thap, danh gia TTDD bang so do nhan trac (can n§ng, chieu cao): bang dung cu lieu chuan.
Can n | n g : cSn SECA dign ttf dp chinh xac 0,1 kg, can dtfdc didu chinh, kie'm tra trtfdc khi stf dung.
Chieu cao: do bang thffdc gd UNICEF vdi do chinh xac 0,1 cm. TTDD cua doi Iffdng dffdc phan loai theo chi sd BMI: BMI tff 18,5 deii 24.9 la binh thffdng, BMI dtfdi 18,5 la SDD (thidu nSng Itfdng trtfdng dien) [6].
* Thu thSp, danh g i i TTDD bang cfing cu SGA:
Danh gia SDD dtfa vko thay ddi can nang, thay ddi khau phan an, cdc trigu chtfng da day rugt, thay ddi chtfc nang v | n dfing, cdc sang chS'n, cdc dau higu SDD ( m i t ldp md dtfdi da, phtf, co trtfdng). Thdi diem xdc dinh cho nhtfng thay ddi nay la trong vong 6 thang va 2 tuan trtfdc khi nh$p vien. TTDD dtfdc danh gia theo 3 Ioai: A (tff 11-14 diem): dinh dtfdng binh thtfdng; B (6-10 die'm): Nguy C() SDD; C (0-5 diem): SDD [1].
Kho'ng chg' sai sfi': Sai sd do thu thSp so' ligu ttf phia ngtfdi thu thap va dung cu Ihu thSp dtfdc han chg' bang tap huan ky Itfdng, stf dung cic dung cu thie't bi c6 mtfc sai so' tha'p da dtfdc kiem tra va c h u l n hoa. Sai so do hdi ttfdng, nhd lai dtfdc gidi han bang cdch hdi trong khoang thdi gian khfing qua xa dg' han chg' sai so', hoi iheo trinh iff thdi gian vdi nhtfng mfi'c nha't dinh de dfi'i ttfdng de nhd lai.
Phan tich thfing kg: Sfi'ligu dtfdc nhap vao may tinh bang chffdng trinh EPI DATA. So ligu dffdc phan tich bang phan mdm SPSS 16.0. Stfdung kig'm dinh Student T test de so sanh big'n dinh Iffdng giffa hai nhom va stf dung kiem dinh Chi-Square hoac Fisher's Exact Test de so sanh cac ty le.
D a o dtfc nghien ctfu: Trtfdc khi tien hanh nghign ctfu, cdc can bfi nghign ctfu se lam viec chi tig't vi npi dung, muc dich nghign ctfu vdi lanh dao b e n h vign, cung vdi can bp ciia cac khoa lam skng, trinh bay va gidi thich ngi dung, muc dich nghien ctfli vdi ngtfdi bgnh, C i c do'i ttfdng tham gia phong v l n mfit each ttf nguygn, khong bat bupc va c6 quydn tilf bd khfing tham gia nghien ctfu ma khfing can b i t ctf ly do nao. Vdi bgnh nhan SDD se dtfdc ttf van dinh dtfdng, tff va'n stfc k h o e . Cac
thong tin v e do'i tffdng dtfdc gitf bi m a t va chi dtfdc stf dung vdi muc dich nghign ctfu, dem lai Idi ich cho cfing ddng.
3 . K ^ t q u a n g h i d n cihi
Trong tdng sd' 397 bgnh nhan Iham gia ngtiien ctfu, nghien ctfu tidn hanh trgn 280 bgnh nhan ludi ttf 16 dg'n 65 nhap vign trong vong 48 gid ttf Ihang 3-6/2009.
Bdng 1. Dgc diem cdn n^ng cua dot tUffng theo TTDD (SGA)
C . c « . - . Ciam cin noag 6 thiag qua.
Duiai5%
Tir5-I0»
>10%
Thay c6i cSn irong 2 uiin qiia.n(») Tang can Giim cin Kbong Ihay doi
TTDD tbeo SGA Binh thirdng
(n = 159)
124(78.0) 19(11.9) 16(10.1)
18(11.3) 43(27 0) 98(61.6)
SDD (B = 121)
57(47.1) 29(34.0) 35(28.9)
12(9.9) 67(55.4) 42(34.7)
Gui in p
0.001
0.001
Ty Ig giam can ttf 5-10% trong 6 thang qua d nhdm SDD la 19,5% cao hdn rd rgt so vdi d nhfjm dmh dtfdng tfit (3,3%. p < 0,001). Ty Ig giam can
>10% can nang trong 6 thang d nhom dinh dtfdng tfit khdng CO ddi ttfdng nao, con d nhdm SDD chie'm 6 . 1 % (p < 0,001). Ve TTDD trong 2 man trffdc khi nhap vien cho tha'y ty Ig giam can trong 2 tuan d nhdm SDD la 58,5% cao hdn nhdm dinh dtfdng tdt (22,5%) ( p < 0,001).
Ty Ig ngffdi benh nhSp vign khfing an dffdc binh thffdng, phai chuyen sang cac dang dinh dffdng nhtf chao, dich long hoac tham chi phai nhin ddi (trff nhiSng trffdng hdp bgnh ly dac bigt) la dieu can chu y. Danh gia stf thay ddi (giam) k h i u phan an khi nhap vign d nhdm SDD chig'm tdi 68,3% ddi ttfdng, cao hdn so vdi nhdm dinh dtfdng tdt la 13.1% (p <
0,001), Dac bigt nhi^u bgnh nhan nh§p vien khfing an dffdc binh thffdng, phai chuyen sang cac dang dinh dffdng khac nhff chao, dich long hoac tham chi nhin ddi (trtf nhtfng InTdng hdp bgnh ly dac biet).
Nhdm SDD phai chuyen sang an chao dac la 28,0%, an dich long du nang Iffdng nhff ufi'ng stfa cao nang
42 Tap chi Y t^ Cdng c^ng, 6.2013, Sd 28 (28)
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Bdng 2. D^c diem thay ddi khdu phdn cia ddi tUtfltg theo TTDD (SGA)
Bdng 4. Thay doi chdc ndng van d$ng theo TTDD (SGA)
Cac bjen Thay doi khiu phdn, a(%) Kh6ng Ihay <l6i Thayd^i
TTDD theo SGA Binh thtf jlng
(I* = 1591 91(57 J ) 6S(42,S)
SDD (n = 121)
59(48,8) 62(51.2}
Trang ibji Uiay d^i kblu phan, n(%) Chio dac
D|ch. du n9ne lif^g Dich. nang ]\lt^a£ Ihap Nhin 061 Kh6iig thay d&
32(20,1) 14<S.g) 3(1.9) 2(1.3) 108(67.9)
22(18,2) 19(16,7) 5(4.1) 11(9.1) 64(52.9)
Cid trip
0,001
0.001
Iffdng. Slip tai benh vign la 13,4%. an djch long nang Iffdng tha'p nhff udng nffdc c h i o , tff cho an la 6,1% va nhin ddi la 22%, deu cao hdn nhdm dinh dffdng tdt ( p < 0,001).
Bdng 3. Tri^u chdng dp ddy-ruQt theo TTDD (SGA)
Cic biifn
TTDD theo SGA Binh thUWnc 1 SlQ" dinh dtfSng
(n = 159) 1 In = 121) Tri^u chiShg dq dJy-ruOl. n(^l
Kh6ng c6 tn^u chi?ng Bufiiindn N6n Ch£n an TLfu chdy
139(87.41 8(5.0) 4(2.5) 2(1.3) 6(3.8)
83(68,6) 16(13,2) 6(5.0) 9(7,4) 7(5.8)
Cairip
0,001
Cac trigu chtfng ve da day-rufit cfing anh hffdng de'n qua trinh dinh dffdng ciia benh nhan. Cd idi 50% bgnh nhSn d nhdm SDD xua't hign c^c trigu chtfng da day-rupt, trong khi dd d nhfim dinh dffdng tfi'l ty Ig nay \k 24.5%. Nhdm SDD cd ty Jg chan an la 30,5%, budn non la 11,0%, ndn la 4,9% va tigu chay la 3,7%, cao hdn cd y nghTa tho'ng ke vdi p <
0,001 so vdi nhdm dinh dffdng tdt.
c a c thay ddi ve chtfc nang van dfing la n h i ^ g ye'u t d a n h hffdng trtfc tidp ddn qua trinh dinh dffdng cua bgnh nhSn. Nhdm SDD cfi t^ Ig giam chtfc nSng vSn dpng Ign tdi 76,8%. trong khi dd tJ Ig nay d nhdm dinh dtfdng td't la 26.4%. Nhfim SDD cd ty Ig
c&c bi£n
TTDD theo SGA Binb tbirimg 1 S i ? dinh ddSng
(B = 159) ! In = IZU Thai ''^i '^'^ '^^^ "^"S ^'^° ^°°S- " ( ^ ' Kheng Ihay Bt\
Gmm
78(49.1) 81(50.9)
54(44.6) 67(55.4) Trang thai thay A$i, ehSc nang van dpng, n(*) Dl lai HMc
Giam chiJc nang 50%
Niim tai gikfdng
]28(H0.5) 27(17,0) 4(2.5)
83(68.6) 26(21,5) 12r9,9)
Gid Hip
0,001
0.001
di lai dtfdc Ik 33,3%, t h i p hdn ty le n i y 6 nhfim dinh dtfdng binh thtfdng. Mot didu dang quan t i m la d nhom SDD cd Idi 50% bgnh nhSn phdi nam tai gitfdng, stf khac bigt cd "^ nghia thdng ke vdi p <
0,001 so vdi nhdm dinh dtfdng tfit.
Bdng 5. Mdc d$ sang chdn do bfnh tdt kem theo vd ddu hifu thUc the vi dinh du&ng theo TTDD (SGA)
Cdc bie'n
TTDD theo SGA Binh thuVng
(n = 159)
Suy dinh dtfSng
<B = 121) Sang chSn do bfnh ktm ibeo. nl%) Khdng cd irifu chdng Nhf Vi(a NSng
132(83,01 19(11.9) 6(3,8) 2(1.3)
76(62.8) 27(22,3) 13(10.7) 5(4.1) D-Tu hifu Ihtfc Ihl v^ dinh duang, n(%|
Kheng c6 dau hi^ugl Gi jm Idp md dUdi da Phil, giS nudc Gidm khoi ecj
149(93,7) 5(3,1) 3(1.9) 2(l..l)
97C80.2) 13(10,7) 7(5.8) 4(3.3)
Gid tnp
0,001
0,006
Co tdi 89% nfaom SDD c6 d3'u hieu sang chan chuydn hoa do bgnh kem theo 6 c5c mi?c dp khdc nhau, trong khi d6 vffi nh6m dinh ditSng tSt, ty 1?
nay chi 13 35%. Ty le sang chan chuyen h6a i mijc dp nang cila nhom SDD li 7 . 3 % cao han nhieu so vdi ty le nay d nhdm dinh dir3ng tot (0,6%) (p <
0,001). Cac dSa hieu thilc the v l giam m 3 dirdi da, giam CO a nhdm thieu dinh dudng M 19,5% va 11,0%, deu cao hdn nhdm dinh dtfdng tot vdi cSc gid
Tap chl Y tS Cdng cdng, 6.2013, Sd 28 (28) 43
iTONGIHIftN&IIGRlElietUi
tri ttfdng tfng ia 5,5% va 1,5%.
4. B a o iti^D
Phtfdng p h ^ p danh gi^ dinh dtfdng loan thg' (Subjective Global Assessment - SGA) cho ngtfdi <
65 tu^i \k cong cu sang loc dtfdc stf dung rong rai Iren the'gidi va btfdc dau da dtfdc ip dung d Viet Nam. Danh g i i SDD cua ngtfdi benh theo phtfdng p h i p SGA chii ye'u dtfa vao cac ye'u tfi've; thay ddi can nang khfing mong mufi'n, thay ddi vi khau phan an. c i c trieu chtfng da d^y ruSt, thay dd'i chtfc nang van dfing, c i c bgnh mac phai va anh htfdng cua c i c sang chan, cac d i u hieu SDD (mat ldp md dtfdi da, phii, co'chtfdng) [3] [5].
Ke't qua trong nghign ctfu nay cho t h i y ty Ig giam can >5 % trong 6 t h i n g cua bgnh nhan SDD la 52,9%, cao hdn so vdi ty le n^y d bgnh n h i n dinh dtfdng to't 22,0%), stf k h i c bigt cfi ^ nghia tho'ng ke (p < 0,001). Nhtf vay, ty Ig d6i ttfdng co giam trong Itfdng cd the ttf 5% trd len trong nghign ctfu cua chiing tfii (52,9%) vdi nhfim SDD, cao hdn ty Ig nay (27,5%) trong nghien ctfu trgn bgnh nhan ung Ihtf dang dtfdc hoa tri ligu tai Han Quo'c (2010) [6]. Khi xem xgt mtfc giam c i n trong 2 tuan trtfdc khi nh§p vien thi ty Ig giam can ciia bgnh nhan SDD l i 55,4%, cao hdn so vdi ty Ig nay d benh n h i n dinh dtfdng ifi'l (27,0%), stf k h i c bigt cd y nghia tho'ng ke ( p < 0,001).
T^ le benh nhan giam khau phan an khi nhap vign d nhom benh nban SDD la 51,2%, cao hdn so vdi ty Ig nay d nhdm benh nhan dinh dtfdng ifi't (42,8%), stf kh^c bigt cd J nghia thfi'ng ke (p <
0,001). Ty le benh nhan cd thay ddi vi khau p h i n an ufi^ng trong thdi gian mac benh ciia nhom SDD trong nghien ctfu cua chtfng tfii l i 59.3% va 42,8%
vdi nhdm dinh dtfdng td't, deu cao hdn ty Ig nay (33.15%) Irong nghien ctfu tai Han Qud'c (2010) [6].
I ^ o m benh n h i n SDD phai nhin ddi la 9 , 1 % . cao hdn ly le phai nhin doi ciia benh nhan dinh dtfdng td't (1,3%) (p < 0,001). Nhdm bgnh nhan SDD cd ty Ig c h i n an la 7.4%. cao hdn so vdi ty le nay & nhdm bgnh nhan dinh dtfdng to't (1,3%), stf khac biet cd y nghia thong kg (p < 0,001).
Ty le bgnh nhan giam cbtfc nang van dfing cua nhdm benh nhSn SDD la 55,4%, cao hdn so vdi ty Ig nay d nhdm bgnh nhan dinh dtfdng td't (50,9%), stf k h i c bigt cd y nghia thfing kg vdi p < 0,001.
Nhdm SDD cd tdi 9,9% benli n h i n phai n i m tai gitfdng, vdi nhdm bgnh n h i n dinh dtfdng tfit, ty Ig nay chl I i 2,5%, stf k h i c bigt cfi ^ nghta tho'ng kg vdi p < 0,001, Trong nghign ctfu cua chiing tfii, ty Ig do^i Itfdng bgnh nhan SDD cd x u l t hign sang c h i n t i m ly la 37,2%, cao hdn ly le nay (12,3%) trong nghign ctfu tai H i n Qudc (2010) [6].
Dieu tra trgn 280 bgnh nhan nhap vign trong vong 48 gid dau tai bgnh vign da khoa Hai Dtfdng cho thay cac chi so* lien quan tdi nguy cd dinh dtfdng ciia nhom bgnh nban SDD (theo SGA) deu cao hdn so vdi nhdm benh nhan dinh dtfdng lot lai thdi diem trong vdng 6 t h i n g va 2 luan trtfdc khi nh3p vign:
Ty Ig giam can >5 % trong 6 Ihing cua bgnh nhan SDD Ii 52,9%, cao hdn so vdi ty Ig nay d bgnh nhan dinh dtfdng tfi't (22,0%), stf khac biet cd y nghTa tho'ng kg (p < 0,001).
Ty Ig bgnh nhan giam khau p h i n i n khi nhap vien d nhdm bgnh nhan SDD la 51,2%, cao hdn so vdi t;y Ig nay d nhdm bgnh nhan dinh dtfdng tfi't (42,8%), stf k h i c biet cd y nghia thfi'ng kg (p <
0.001).
Ty Ie benh n h i n giam chtfc nang v | n dong ciia nhdm bgnh n h i n SDD l i 55,4%, cao hdn so vdi ty Ig n i y 6 nhom bgnh nhan dinh dtfdng tfi't (50,9%), stf k h i c bigt cfi ^ nghia thd'ng ke vdi p < 0,001.
Danh gi^ TTDD ciia bgnh nhan bang phtfdng phap SGA trong dd thu thap c i c chi tieu ve mtfc giam c i n khdng mong mudn, thay doi k h i u phan an, c i c d i u higu da day-rufit, sang c h i n , c i c dau higu SDD tren l i m s i n g ngn Ird thanh mfil boat dfing thtfdng quy trong benh vign.
Ldi c a m (fn
Cac b a c sy va dieu dtfdng cua benh vign da khoa tinh Hai Dtfdng da tao dieu kien cho nghign ctfu nay dtfdc tri^n khai thu$n Idi va higu qua.
44 Tap chl Y t^ Cdng c^ng, 6.^)13, Srf 28 (28)
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Tai li$a tham khao Tifng Vi^t
1. Pham Thu HUdng, Nguyen Thi LSm, NguySn Bich Ngoc, Tr^Q Cb&u QuySo, Nghi6m Nguyet Thu, Pham ThaDg. Tloh tr^ng dinfa dtfdng ciia b$nb obln nh§p vi^o khoa tieu hoa vk Dpi det tai b^nh vi^n Bach Mai. Tap chf dinh dtfSng v^ thtfc phlni,Stf3+4, 2006, 85-91.
Tifing Anb
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