CVv417S32018153.pdf

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TJNH TRANG DINH D U O N G CUA BENH NHAN MAC BENH PHOI TAC NGHEN MAN TINH DANG DlIu TRI TAI BENH VIEN PHOI THAI BINH NAM 2017

Nguyen Thj Thiiy Unh', Vu Phong Tuc', Ngo Thj Nhu^

T6MTAT

Sd dung phuang phap nghien cuu md td cdt ngang, mo la tinh trgng dinh dudng cda benh nhan COPD thdng qua cdc chi sd BMI, ehu vi vdng canh tay, ddnh gid tinh trang dinh dudng cua benh nhan qua bd cdng eg SGA, MNA, cdc chi sd hda sinh. Ty 1| b|nh nhdn mdc benh phdi tac nghen man tinh cd suy dinh dudng cao, chiSm 62,2% (tiieo BMI), ttln 50% (theo SGA), 93,4% tiieo MNA, Do chu vi vdng cdnh tay (MAC) cd 45,6% benh nhan c6 MAC d ngudng cd suy dinh duang. Ty lp benh nhan co Albumin gidm nhe chiim 25,4%., 5,3% b|nh nhan CO Albumin giam vda. VS tinh ttang Protein huyet thanh, CO 28,9% benh nhdn cd ehi sd Protein huyet thanh gidra.

Tir khoa: Tmh ttang dmh duang, COPD SUMMARY:

NUTRITIONAL STATUS OF HOSPITALIZED PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AT THAI BINH LUNG HOSPITAL IN 2017

Cross-sectional study was implemented to describe the nutritional status of patients with chronic obstructive puhnonary disease (COPD) by Body Mass Index (BMI), Mid-arm cttcumference (MAC), Subjective Global Assessment (SGA), Mini-Nutritional Assessraent (MNA);

and biochemical mdicators.

The majority of patients witii COPD were found to be mabourished according to BMI, SGA, MNA (62.2%), over 50% and 93.4% respectively). According to MAC, 45,6% of patients were identiiied as mahiourished. The rate of patients who had mild and moderate alburara reduction were 25.4% and 5.3% respectively. Protem stattis, 28.9% of patients with COPD had serura protein decline.

Keywords: Nutritional Status, COPD

I. DATVANDE

Theo Td ehdc Y ti thi gidi (WHO), din nara 1997 ttSn toan the gidi da cd khodng 600 tripu ngudi mac COPD, benh xip hang thu tu trong cac nguySn nhdn gdy td vong vd dung thd 12 ttong cae nguySn nhan gay tdn phi. Suy dinh dudng (SDD) Id vin dl thudng gap d benh nhdn COPD, chiim ty IS 30-60%) sd b|nh nhdn ndi tru va chiira ly IS 20-40%. sd benh nhdn ngoai trd. Ty 1| td vong d benh nhdn COPD thieu can cao ban so vdi b|nh nhdn COPD cd can nang binh thudng, beo phi hay thda cdn.

Tgi Viet Nam cd rit it ldc gia dl cap cung nhu nghiin cdu vi tinh ttang dinh dudng eua binh nhan COPD. Td thuc ti ttln, tdi thuc hien di tai nghiin cdu: "Tinh trang dinh dirdng eua benh nhan mdc b^nb phoi tac nghen man tinh dang diiu tri tai Benh vi^n PbSi Th^i Binh nam 2017"

Mgc tiSu nghien cdu: Xdc dink tinh trgng dinh duang cua binh nhdn mdc benh phoi tdc nghen mgn tinh dang dieu tri tgi Benh viin Phoi Thdi Binh.

n . D 6 I TirONG VA PHU'ONG PHAP NGHlfeN cCTu

1. D6i tuvng nghiSn cihi: Benh nhan lu 18 tudi ttd ISn dang diiu tti ndi trd tai Benh vien Phdi Thdi Binh dugc chin dodn COPD theo lieu chudn cda GOLD (2013).

2. Phutmg phap nghiin clhi

2.1. Thiit ki nghien cuu: Ld mdt nghiSn cdu dich tS hpc md ta cd phdn tich qua mdt eudc diSu tra cat ngang nhdm:

- Ddnh gia tinh ttang dinh dudng khi vao viSn vd cdc xet nghiim smh hda cua benh nhan COPD di gdp phin xay dgng ki hogch chara sdc dinh duang cho benh nhdn

- Md td dgc diim khiu phdn va radc dd lilu thy thgc phira eua benh nhan COPD

1. Benh vien Phoi Thai Binh

EmaU: nguyenthithuyUnhll091@gmail.com, SDT: 0127.629.7029 2. Trudng D^i hgc YDirprc Thai Binh

Ngdy nhan bai: 20/03/2018 | » NgayphanbiSn: 29/03/2018 | » Ngayduyetdang 12/04/2018 S 6 3 (44) - Thang 05-06/2018

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2.2. C& mdu: Toan bd bpnh nhan dugc chan dodn Id COPD theo lieu chuin cda GOLD (2013) dang diiu tri tgi Benh vien Phdi Thdi Binh td thdng 8/2017 din thdng 01/2018

2.3. Cdch chgn mdu: Chpn chu dich tdt cd cdc benh nhan dugc chin doan Id COPD nhgp vien Benh vien Phdi Thai Binh tu thang 8/2017 din thdng 01/2018

3. Ky thu^t thu thSip so lieu: Ky thudt can, do chieu cao, do chu vi vdng canh tay, phdng van benh nhan bang bang cdu hdi da dugc thiSt kS san, bd cdng eg sang loc SGA, MNA, cde xet nghiem sinh hda

Phan lich thdng kl: Sd li|u dugc lam sach trudc khi nhgp vao may tinh, su dgng chuong trinh Epi data de nhap sd lieu. Cac du Ulu dugc phan tich vdi ngdn ngu cua phdn

min Stata 10.0 tai Trudng Dai hpc Y Dugc Thai Bmh vdi cac test thdng kl y hpc.

Dgo dde nghiin cuu: Cac ddi tugng tham gia vao nghien cdu khdng phdi can thipp cac biln phdp ndo. Tuy nhiin cac ddi tugng tiiam gia nghien cdu dlu cd quyln tg nguyen tham gia hogc khdng tg nguySn thara gia. Cdc ky thugt nghiSn cdu dugc thao tac don gidn cho ngudi bpnh, ngodi ra cdn gidp ich cho chdn doan tinh trai-g dinh dudng vd dua ldi khuyen ttong qud trinh dieu hi. Ngudi benh thara gia nghiSn cuu dugc tu van ve cdch dinh dudng hgp ly, khdng phai ehi tta thira bdt cu khoan gi td cae boat ddng nghiin cdu.

III. KET QUA VA BAN LUAN Bdng I: Phdn logi tinh trgng dinh du&ng cua binh nhdn COPD iheo BMJ

Suy dinh duong Binh thudng Thita cSn/ Beo phi

< 6 5 t u 6 i (n = 54) SL

31 21 2

T y l e % 57,4 38,9 3.7

> 65 tu6i (n = 60) SL

40 20 0

Ty le % 66,7 33,3 0

Chung ( n = U 4 ) SL

71 41 2

T y l e % 62,2 36,0 1,8

Kit qua bdng 1 cho thdy ly IS suy dinh dudng cda benh nhdn COPD tiieo BMI chiira da sd (62,2%), ty lp suy dinh dudng cua benh nhan COPD d cac nhdra tudi <

65 tudi va >65 mdi Id nhu nhau. Tuy ohiln, vdn cdn 1,8%

(n=2) binh nhan COPD thda can/beo phi.

Theo BMI, da sd benh nhdn COPD cd suy dmh dudng (chiira 62,2%)), kit qua nay tuong duang vdi kSt qud nghiin cdu "Khao sdt tinh trang dinh duong d benh nhan dot cdp benh phdi tac nghen raan tinh tai B|nh vipn Bgch Mai" cua Dinh Thi Phuang Thao

(2015) (ty IS suy dinh dudng d benh nhdn COPD theo BMI la 69,3%) [1]. Ty le benh nhdn thua can chi cd l,8%o, ty 11 nay thap ban nhiiu so vdi cdc nghiSn cdu eua Ciric (2013) cho kit qua ty IS thua cdn Id 32,9%

vd beo phi la 17,6%. [2].Trln thi gidi, ngay cdng tdng sd lugng benh nhan COPD thua cdn, beo phi, ly do di gidi thich cho diSu nay cd thi Id do cac nude phat triin, ty 11 thda can beo phi tang trong dan sd ndi chung, do dd ly IS hrong dng la nhieu bpnh nhdn COPD thda cdn hoac beo phi.

Bdng 2. Tinh trgng dinh du&ng cua nhdm benh nhdn COPD ddnh gid bdng phuffng phdp SGA

Tinh trang dinh duong

Binh thuang Nguy CO SDD Suy dinh duong

N a n i ( SL 17 18 8

1 - 4 3 ) Ty IS %

39,6 41,9 18,5

Nu (n SL

6 3 2

= 11) Ty 16 %

54,5 27,3 18,2

Chung (n •= 54) SL T 23 21 ID

T y l ? % 42,6 38,9 18,5 Bdng 2 cho thiy trong 54 benh nhin dugc danh trln 50%. bpnh nhdn c6 nguy co suy dinh dudng vd suv gia linh trgng dinh dudng bing phuang phap SGA cd dinh dudng.

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Bdng 3. Unh trgng dinh du&ng cia nhom b^nh nhdn COPD ddnh gia bdng phuffng phdp MNA

Tinh tr^ng dinh duong

Budi thuong Nguy CO SDD Suy dinh duSng

Nam (n = 52) SL

4 25 23

T y l 5 % 7,7 48,1 44,2

Nii ( n - 8 ) SL

0 3 5

T y l | % 0 37,5 62,5

Chung ( 0 - 6 0 ) SL

4 28 28

T y l ? % 6,6 46,7 46,7 Kit qua bang 3 cho thay ttong 60 bfnh nhan COPD

dugc danh gid tinh trgng dinh dudng bang phuong phap MNAcd din 93,4% benh nhan cd nguy ca suy dinh dudng va suy dinh dudng.

TrSn 50%. benh nhan dugc ddnh gia bdng phudng

phap SGA va 93,4%. bpnh nhdn dugc danh gia bang phucmg phdp MNA cd nguy co suy dinh dudng vd suy dinh dudng. KSt qua nay, tuang duang vdi kit qua nghiSn cuu cua Vii Thi Thanh (2017) (chiira 96,6%) [3].

Bang

Muc do SDD

Bmh thucmg SDD viM. va nhe SDD nang

4. Tinh tr^ng dinh dudng cua bfnh nhdn theo chu vl vdng cdnh tay

< 65 tu6i (1) (n - 54) SL

38 14 2

Ty le % 70,4 25,9 3,7

> 65 tu6i (2) (n = 60) SL

. 24 34

2

T y l e % 40,0 56,7 3,3

Chung ( n - 1 1 4 ) SL 62 48 4

T y l e % 54,4 42,1 3,5

P(l,2)

<0,05

Ket qua bang 4 eho thay, theo chu vi vdng canh tay c6 42,1% benh nhan suy dinh dudng vda vd nhe, 3,5%

benh nhan cd suy dinh duong nang. Ty IS benh nhdn cd tinh ttgng suy dinh dudng vua vd nhp theo chu vi vdng cdnh tay d dd tuii < 65 mdi chiim 25,9%, >65 tudi chiim 56,7%, lmh ttgng suy dinh dudng ngng theo chu vi vdng canh lay d hai dp tudi nay Id nhu nhau, sg khac bill tten c6 y nghia thing ke.

KSt qua ndy cung tuang duang vdi nghiin cdu ciia Laaban (1993) ttong 50 benh nhan cd 42%. binh nhan suy dinh dudng [4], tuang duang vdi nghien cuu ciia Dinh Thi Phuang Thao (2015) 51,9% bpiA nhdn c6 chi sd MAC binh thudng, 48,1%. bpnh nhan cd suy

dmh dudng trong dd 41,4%) benh nhan suy dmh dudng nhp, chi ed 6,7% benh nhan suy dinh dudng nang. Ty Ip benh nhdn cd tinh ttgng suy dinh dudng vda va nhp theo chu vi vdng cdnh tay d dp tudi < 65 tuoi chilm 25,9%,

>65 mdi chiem 56,7%, tinh ttang suy dinh dudng nang theo chu vi vdng canh tay d hai dp mdi nay la nhu nhau, sg khdc biet ttln cd y nghia thdng kl. Tuy nhien, nlu chi dua vao chl sd MAC thi se ggp sai sdt trong cdc trudng hgp b|nh nhdn cd tinh ttang tyt can nhieu trong thdi gian ngdn nhung cdn nang va MAC van tten muc binh thudng nin chua dat vao ddi tugng dang cd suy dinh dudng tiin ttiln vd dan den bd sdt nhung benh nhan nay.

Bdng 5. Ty li b^nh nhdn gidm Albumin vd protein theo nhdm tuoi

Cac chi so

Tmh Irang Albumin

Tinh trang protein hityet thanh

Binh thuong Giam nhe G i ^ v i r a Bhih thucmg

Giam

< 65 tu6i (1) (n = 54) SL

39 12 3 41 13

T y l e % 72,2 22,2 5,6 75,9 24,1

> 65 ni6i (2) (n = 60) SL

40 17 3 40 20

Ty li % 66,7 28,3 5,0 66,7 33,3

Chung ( SL 79 29 6 81 33

n = 1 1 4 ) T y l ? %

69,3 25,4 5,3 71,1 28,9

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Bang 5 cho thdy ty lp b|nh nhan cd Albumin gidm nhp chiim 25,4%, 5,3% benh nhan cd Albumin gidra vua. Ket qud ndy thdp ban nhilu so vdi kit qud ciia Dinh Thi Phuang Thao (2015): 30,7% benh nhan cd albumin ttong gidi hgn bmh thudng, 69,3% benh nhdn ed albumin thap [1].

v i tinh trgng Protein huyit thanh, ed 28,9%. benh nhan cd chi sd Protein huySt thanh giara. Kit qud nay thdp hem so vdi kit qud cua NguySn Mdc Son (2012) nghiSn cdu ttln 187 benh nhdn ragn tinh cd 46%o benh nhan cd chi si protein dudi 60 g/1 [5].

IV. BAN LU^N

NghiSn cdu cua chung tdi cho thay ty le suy dinh duong cua b|nh nhan COPD theo BMI chiira ty II cao 62,2%, t^

IS suy dinh dudng ciia benh nhan COPD d cdc nhdra tudi

< 65 tudi vd >65 mdi Id nhu nhau. Ti lp ndy cao hon so vdi cdc nghien cmi d nude ngoai: Theo nghiSn cuu cda Gupta B vd cdng su ti IS suy dinh duang la 57,8%; nghien edu cua Schols, Vermeeren vd cdng su ti Ie suy duih dudng 25-40%;

nghiin cdu cda Sajal De vd cdng su Id 38%..

So sanh vdi cac nghiin cuu ttong nude cho thiy ti lp suy dinh duang la tuang duang. Nghiin cdu cua Nguyln Ddc Long (2014) ddnh gia tinh trgng dmh dudng tten 96 bSnh nhan BPTNMT ti 11 suy dinh dudng theo BMI<18,5 chilm 67,7%, nghiin cdu cda Le Thi DiSm Tuylt va cdng sg (2016) ddnh gid tinh ttgng dinh duang ttSn 150 benh nhan BPTNMT li le suy dinh duong vdi BMI < 18,5 chiim 69,3%. Nghien cdu cua Dinh Thi Phuang Thdo (2015) danh gia ttinh trang dinh dudng ttln 150 benh nhan BPTNMT ti 11 suy dmh dudng chiera 69,3% [5]. NghiSn cdu cda Vu Thi Thanh (2017), ti 11 suy dmh dudng chilm 73,7% [9].

Trong nghien cdu cua chdng tdi ty IS benh nhdn thda cdn chi ed 1,8%o, ty Ie ndy thip han nhiiu so vdi cac nghiin edu cda Ciric (2013) cho kSt qua ly IS thira cdn Id 32,9% va bio phi la 17,6% . Tuy nhiSn, so sanh vdi cdc nghien cdu trong nude tuong duong vdi kit qud nghiSn cdu cua Dinh Thi Phuang Thao (2015) tj-11 b|nh nhdn COPD thua cdn chiem 2,7% [5]. TrSn the gidi, ngdy cang tang sd lugng binh nhan COPD thda cdn, bio phi, 1;^ do dl giai thich cho dilu nay cd the la do cdc nude phdt trien, ty If thda can beo phi tang ttong dan sd ndi chung, do dd ty lp tuang dng Id nhilu benh nhdn COPD thda can hogc beo phi.

Phuang phap ddnh gia tdng thi SGA hien nay dugc nhiiu nghiin cdu trln thi gidi sd dyng de ddnh gid tinh trang dinh dudng cho bliih nhan benh phdi lac nghen man tinh.

Tuy nhien phuang phdp ndy chi ddnh gia cho ngudi <65 tudi.

Vi vay, di danh gia tinh trgng dinh dudng eho ngudi > 65

tudi chdng tdi da sd dgng phuang phap danh gid tuih trang dinh duong ldi tiiiiu (IVINA). Cd hai phuang phdp ndy dlu cd thi ddnh gid benh nhdn trong suit qua trinh mic bpnh bao gdm; Tbay ddi vi cdn nang, biiu hi|n cda tmh ttang dmh dudng kim, nhimg danh gia vi ldm sang cda thay thuoc.

Theo kSt qua nghiin cuu cda chdng tdi cd ttSn 50%.

benh nhdn dugc danh gid bdng phuang phap SGA vd 93,4% bpnh nhdn dugc ddnh gia bdng phuang phap MNA cd nguy co suy dinh duong vd suy dinh du5ng.

Theo nghien edu cua nude ngodi nhu: NghiSn cdu cda Gupta, B va cdng sg ttong tdng sd 106 h|nh nhan BPTNMT nhdp vien danh gid tiieo SGA cd 83%i cd nguy ca suy dinh dudng. Nghien cdu cda Yuceege va cpng su nguy CO suy dinh dudng cdc mdc dd la 41,7%.

Theo cdc nghien cdu ttong nude cho thiy: Dang Thi Phuang Thao [7] cd 92%. bpnh nhdn cd nguy ca suy dmh dudng, Nguyen Ddc Long benh nhdn cd nguy co suy dmh duang chiim 89,6%., nghiin cdu eua Vu Thi Thanh (2017) 96,6% benh nhdn cd nguy co suy dinh dudng [9], nghiin cuu Hogan, LS Thi Tuyet Lan vd cpng su (2016) danh gid tinh ttang dinh duong ttln 393 benh nhdn BPTNMT diiu tri ngoai tru tai phdng khdm hd hdp thdnh phi Ho Chi Minh.

Cd nguy ca suy dinh dudng radc dd nhe din vda chiira 31%, nguy CO suy dinh duong radc dp nang chiira 14%.

Theo bdng 4 ttong nghiSn cdu ciia chdng ldi thiy cd 54,4% bpnh nhan cd chi sd chu vi vdng cdnh tay binh thudng, 42,l%i benh nhan suy dinh dudng vua vd nhe, 3,5% benh nhdn cd suy dinh du&ng nang.

Kit qud nay hrang duang vdi nghien cdu cda Laaban (1993) ttong 50 b|nh nhan cd 42% bpnh nhan suy dinh duang, hrang duang vdi nghiin cdu cda Dinh Thi Phuang Thdo (2015) 51,9% binh nhan cd chi so MAC binh thudng, 48,1%. bpnh nhan cd suy dinh dudng ttong dd 41,4% benh nhan suy dinh dudng nhe, chi cd 6,7% b|nh nhdn suy dinh dudng nang [5], tuang duang vdi nghiin cdu cua NguySn Ddc Long (2014) 61,4% bpnh nhan c6 chi sd MAC binh thudng, 39,6% bpnh nhdn cd suy dinh dudng ttong dd 29,2% binh nhan suy dinh duang nhe, chi cd 9,4% binh nhan suy dinh dudng nang

Ty IS benh nhdn co tinh ttang suy dinh dudng vda vd nhe theo chu vi vdng cdnh tay d dd tudi < 65 ttidi chiira 25,9%, >65 ttidi chiim 56,7%, tinh trgng suy dinh duang nang flieo chu vi vdng canh tay d hai dp tudi nay Id nhu nhau, sg khdc bi^t trSn cd y nghia thing kl. Tuy nhiSn, niu chi dga vdo chi sd MAC thi se gap sai sdt ttoiig cac trudng hgp b|nh nhan cd tinh ttang tyt can nhiiu ttong tiidi gian ngin nhung can ngng va MAC vin ttln radc binh thudng nin chua dat vao ddi tugns da

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CO suy dinh dudng tiin triin vd dan d i n bd sdt nhirng bpnh nhdn nay.

' - Chi sd Albumin: Trong bang 5 cho thay ty 1§ bpnh nhdn cd Albumin gidm nhe chilm 25,4%, 5,3% bpnh nhan CO Albumin gidm vda.

Nghiin cuu ttong nude cda NguySn Ddc Long chi sd albumin gidm ngng<25g/I Id 16,6%, nghiin cdu Dang Thj Phuang Thdo Id 27,3% albumin gidm <28g/l [5], nghien cdu ciia Vu Thi Thanh (2017) Id albumm <21g/l chiim 2,7%, alburam 21-27g/l chiim 34,8%, albumin 28-34g/I chiem 52,7% [7].

Nghien cdu ttln thi gidi: Laaban (1993) ed 4%) bpnh nhan cd chi sd Albumin gidra nang.

Albumin mau trung binh la 37,8 ± 5,3g/I, d ddi tugng

< 65 tudi CO Albumin mdu trung binh Id 38,8g/l, d i i tugng

> 65 tuii cd Albumin man trung binh la 36,8 g/I, su khac bipt ve Albumin raau cda hai nhdm mdi nay cd y nghia thong kS

- Chi sd Protein todn phin: Trong bdng 3.8 cho tiiiy 28,9%. bpnh nhdn cd chi so Protein loan p h i n giam

NghiSn cuu ttong nude cua Dinh Thi Phuong Thao chi sd protem loan phin <60g/l Id 52,7%. [5], Nguyln Mdc Son nghien cdu trSn 187 bpnh nhdn mgn tinh dilu tri tgi khoa ICU chi sd protem todn phan <60g/l la 46%, Vu Thi Thanh chi so protem loan phdn <66g/I chiim 74,6%. [7].

V. K £ T L U ^

T>' If benh nhdn raac bpnh phdi tdc nghen ragn tinh cd suy dinh duang eao, chiim 62,2% (theo BMI), tten 50% (tiieo SGA), 93,4% tiieo MNA

Do chu vi vdng canh tay (MAC) cd 45,6% b | n h nhdn cd MAC d ngudng cd suy dinh dudng

Ty If benh nhan cd Alburam giam nhe chiSra 25,4%, 5,3% bpnh nhan cd Albumin gidm vua. Ve tinh ttgng Protein huylt thanh, ed 28,9%. benh nhdn cd chi sd Protein huylt thanh giam.

TAI LIEU THAM K H A O

1. Bd mdn sinh ly Trudng Dai hpc Y Hd Npi. ( 2007). Sinh ly hpc, NXB Yhpc, 140-141.

2. Do Thj Luang, Vu Van Giap, Phgm Duy Tudng (2016). Tinh ttang dinh dudng d benh nhan benh phdi t i e nghen man tmh giai doan dn dinh vd mdt s i yeu to liSn quan tgi BV bgch Mai nam 2015

3. Cai B, et al. (2003). Effect of supplementing a high-fat, low-carbohydrate enteral forraula in COPD patients.

Nutrition, 19, 229-32.

4. Cano, N.J., et al. (2002). Nutritional depletion ra pattents on long-termoxygen therapy and/or horae raechanical ventilation. Eur Respir J, 20,30-7.

5. Dinh Thj Phuang Thdo; L l Thj DiSra Tuyit; Trin Thj Phde Nguyet, (2015). Khdo sat tinh trgng dinh duong d h?nh nhan dgt cip benh phdi tdc nghen raan tinh tgi BV Bach Mai ndm 2014

6. Ciric, Z., et al. (2013). Nutrition disorder and systemic inflammation in patients with chronic obstructive pulmonary disease. Med Glas (Zenica), 10, 266-71.

7. Vu Thi Thanh (2017). Hipu qud c h i dp dinh duang gidu lipid ttong diiu tri benh nhan dgt cdp benh phdi tdc nghin mgn tuih thd mdy,

8. Laaban, J.P., et al. (1993). Nutiilional statiis of patients with chronic obsttuctive pulmonary disease and acute respiratoryfailure. Chest. 103,1362-8.

9. Nguyin Mpc San. (2012). Ddnh gia tinh ttgng dinh duang ciia benh nhan tgi khoa HSCC Benh viln Bgch Mai, kh6a l u ^ t i t nghif n bac sy da khoa, DH Y Ha Npi, Hd Ndi.

10. Trdn Thi Minh Hanh. (2011). Danh gia tinh ttang dmh dudng, Dmh dudng hpc, NXB Y hpc, 143 - 164.

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gp chi "Y H Q C C O N G D 6 N G " xudt bdn 06 sd/nara, dang tai cac cdng trinh nghiin cdu, cac bdi tdng quan ve Y, Dugc hpc cpng ddng. sdc khde mdi tnidng, y sinh hgc va y xa hdi hpc, nhflng thdng tm Y-Diicfe hpc trong nude vd qu6c ll^, thdng tin ve nghiin cdu va dao tao.

I. Mgt sd yeu cSu vi bai dang cdng trinh nghien cufu khoa hoc.

1. Bdi gdi ddng cong trinh nghiin cdu khoa hgc chtia ddng d hdt kj/ tgp chtquScgia ndo.

2. Cdc thugt ngit thSng nhdt theo td diin Bdch khoa Viit Nam.

Bai gdi dang danh may bdng tieng Viet, rd rang, each ddng, rapt bdi khdng dai qua 7 ttang kho A4, k^ ca bang bieu vd tai lieu tham khdo. Ch! sd dung nhdng bang, bi^u, hinh anh cdn thi^t va phdi cd chd thich rd. M6i bai viet khdng qua 5 hinh. Cudi bdi phai neu ro xuat xd cua cdng trinh, lam tgi dau, thdi gian, sd dien thogi can lien he, dia chi EmaiL 3. Cdc danh tii tiing Viet neu dich tii tieng nU&c ngodi viet kim theo tiingntidc ngodi. Cdc ckU viSt tdt phdi c6 chd thich cdc tii gSc cda cdc chU viet tdt.

4. Trinh tti cdc muc trong hdi:

a) Dau d l

b) Hg va ten tac gia: Khdng ghi hpc hdm, hpc vi, ehdc danh. Cd ghi chu dtfn vi cdng tac cda tdng tac gid d cudi trang thd nhSt bdi bao.

c) Ndi dung:

Tdm tal tiing Viet va tteng Anh (tdi da 150 td). Ghi td khda ti&ig Vilt va tiing Anh.

Dgt van de: bao gdm ca phdn rayc tieu nghien cdu.

Ddi tiigng va phUtfng phdp nghien cdu.

Ket qua nghien cdu va ban lugn.

Kit ludn.

Tdi lieu tham khdo

d) Tai lieu thara khdo (khdng qua 10 tai lilu)

Danh so thd tU tai lieu tieng Viet (van ABC theo ten tac gid) sau do den tai lilu tieng Anh, tieng Phap, tieng Ddc, tieng Nga (vin ABC theo hp)... Mdi lai lilu d^ hp, l l n tac gia, t i n bai, t i n tgp chi, nam xudt ban, sd trang. Ten sach: t i n tac gid, ten nha xuat bdn, nam xuat bdn, s6 trang.

Vi du: 1. Vu Trieu An, Nguyen Ngpc Lan: Dieu tra HLA d b d tdc ngUdi £de, Y hpc thUc hdnh, 1999,4,17-25.2. Wright P Krisnakone P Kobayashi A: "Using Immunoglobulin in treatment of Asthma". J.of Internet. I m m u n o l , 2005,17,19-20.

5. Tdc gid can gdi kim mgt thti xdc dinh hdi hdo Id cua minh, thim: "Toi cam doan chiu trdch nhiem hodn todn vesUxdc thtic cda cdc thi nghiim, cdc tin tdc, cdc tii liiu thu thgp dUdc vd sti phdn tich cdc da kiin, bdi viit ndy chtia dugc gdi ddng d bdo ndo khdc". Tdc gid se chiu trdch nhiem trUdc cong ludn vii dgc gid ve quyin tdc gid vd ndi dung gUi hdi ddng.

Moi tdc gid ddng t&n ddu cda bdi hdo chi dtidc ddng tSi da mdt hdi trong cung mgt s6.

IL Ddi vdi cac bai tdng quan, thdng tm, bai dich.

- Ddi vdi cac bdi tdng quan cSn cd ddy du cac tai lieu thara khao va ngudn sd lieu da duoc trich dan trong bdi Tac gid bdi long quan ghi rd ehdc danh, hpc hdm, hpc vi, chuyin nganh, ca quan vd hdi chuyen khoa d phan ghi chu cudi trang dau tien cda bai tdng quan. Bdi tong quan cung dUgc danh mdy tten khd A4 vd khdng ddi qua 7 trang ke cd bieu bdng vd tai lieu tham khao.

- Cdc thdng lin, bai dich can ghi rd xuat xd cda ngudn dd Iif u. Ddi vdi bai dich cSn chgp loan van bdi bao tiene nUdc ngoai gdi kira theo ban dich.

III. Le phi d i n g bai khoa hgc: 800.000 dong/bai (tam tram nghhi ddng), gdi v l tai khodn: Tgp chi Y hpc Cdng done- 0861100688668, Ngdn hdng TMCP Qudn ddi, chi nhanh Ba Dinh, Ha Npi. • • s g-

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