Y HQC Vl&T NAM TAP 449-THAHG 12-502-2016 i f nao (OR: 6,14, p = 0,048). Trong dd yeu Id
> dudng m i u tinh mach trSn 10 mmol/i l i yeu t d
^ inh htfdng cao hdn d i d HSn Itfdng chuyen dang
^i; dliy mau nao trong dieu tri thuoc Ueu huyet if' Idldl alteplase dtfdng Unh mach.
* V. K f r LUAN
> Hal yeu t d la dtfdng mau tinh mach > 10 V mmoi/l luc vao vien va cd cac dau hieu sdm aia
> nhoi miu nao tren phim chup cat idp vi b'nh sp
? rfiocd IiSn quan den chuyen dang chiy m i u nao
^ d benh nhan nhdi mau nao dtfdc dung thudc tiSu sdi huyet alteplase b'nh mach liSu 0,6mg/kg.
i: T A I U I U T H A M K H A O
! U NINDS rt-PA Stitike Study Group (1995).
^ Tissue plasminogen activator for acute ischemic stroke. N EnglJ Med, 333 (24), 1581-1587.
.: 2. William N. Whiteley, Karsten Bruins Slot, Fernandg Peter (2012). Risk Factors for
" ^ ^ ^ ^ Hemorrhage in Acute Ischemic Sboke _ _ ^ ^ ^ r e a t e d v^itti Recombinant Tissue
Plasminogen AcHvahir: A Systematic Review and
Mete-Analysis of 55 Studies. Stmke, 43, 2904- 2909.
3. Hacke W, Kaste M, C Fiesdil (1995).
Intravenous ttirombolysis with recombinant tissue plasminogen activator for acute hemispheric sboke. The European Cooperative Acute Sboke SbKly (ECASS). JAMA NeumI, 274,1017-1025.
4. Maarten G. Lansberg, Gregory W, Albeis , Wijman Christine A.C (2007). Symptomatic Intracerebral Hemorrhage following Thromboiyti'c Therapy for Acute Ischemic Sboke: A Review of the Risk Factors.
a. Yasuyuki Iguchi Kazumi Kimura, Kensaku Shibazaki (2010). Early sboke treatinent wiBi IV t-PA assodated witti early recanalization. J NeumI Sd, 295, 53-57.
». Nishant Kumar M ishra, H ans-Christoph DIener, Lyden Patrick D. (2010). Influence of Age on Ouhxime From Thrombolysis in Acute Sboke A Controlled Comparison In Patients From the Virtual International Stioke Trials Archive (VISTA). Sboke, 41, 2840-2848.
7. Mai Duy Tdn (2013). Cic yeu to tiSn Itfpng ket cyc xau aia dieu bj nhSI miu nSo cSp tiding 3 gid dau bang thuoc tiSu huyet khoi dudng Bnh mpch alteplase lieu tilSp. THoc Vigt Nam, 405, 81-85.
DANH GIA VAI TR6 COA K* THUAT DO AP u r c THITC QUAN TRONG LVA CHON MD'C PEEP <S BENH N H A N ARDS
Duong Due IM^nh', Ngo Trpng Toin^
Nguyin Cdng Tka', D i o Xuan Cff', Nguyin Gia Binh'.
T(3MTAT
Ttf khoa: Thong khi tiieo diien iu^c EPVent (Esophageal Pressure-Guided Ventilation), Ong tiiong thut quin cd bdng (esophageal baloon catheter). Hgc diu. Oanh gia thay doi mpt so chi so iam sang, khf miu v i cd hpc phoi khi cii d|t mtfc PEEP theo ap Itfc ttiuC quan. OH tugng. bpnh nhan dupc chan doin doin suy ho hap cap tien tiien (ARDS) ttieo tieu chuin cua Beriln 2012 (vdl mtfc dp bung blnh: 100< PaOj /HO; s 200 vdl PEEP a 5. 14* dp ning: PaOj/ROj S.
100 vdi PEEP a. 5). Thd miy tiieo ARDSnet vdl ( vt thap ) khdng cii ttiifn. PhuUng phip nghiin cdu.
Bfn cuu md t i , o3 mlu ttiuSn ti|n. BSnh nhin lay tei Bioa Hoi silt tich cpc Bach Hal. K» qui. ttf tiling 'Binh vifn da khoa Uing Bl
'Bfnl, viin Lio khoa B^ vign Bach Mal
Oiju trich nhISm chfnh: Dudng Dtfc Manh Email: [email protected] Hgiy nhin bil: 6.10.2016 figiy phan biSn khoa hpc: 30.11.2016 Ngiy duyet bii: 6.12.2016
10/2015 den 9/ 2016 iH cd 27 bpnh nhin dii tiSu chuan chpn vao nghien cilu vdl tiioi hung blnh l i 56 ± 16 tiioi, cao hiS nhat 83 hioi tiiSp nhSl l i 21 tijgi, nam gidi chiem 59%. Tnldc khi bSnh nhin dtfoc thd may tiieo chien luBc ttiong khi EPVent tSt c i ' blnh nhan dtfpc thong khi tiieo ARDSnet vdi Vt ttiap. Ket qua l i oxy hda miu khong cii ttiipn. Bpnh nhin sg dtfpc Uiong khi tileo chien Itfdc EPVent. Qua nghiSn ctfu benh nhan ARDS dutfc d|t ong ttidng tiitfc quan o i bong vio ttigt quin dS do i p Itfc ttitfc quin tileo qui binh chuan chung toi khong ghi nhin b i t k j mpt tai bien but ti^ nio xay ra lien quan. Quy ttinh Uiyc hipn ddn gian, d l lim. Kei luin: Ky UiuSt do i p itfc tiipc quan lya dipn mtfc PEEP toi tfu cho nhiitig bpnh nhan ARDS phy ttiuoc vao tiilig c i ttiS, co hpc phoi cila timg ngtfdi.
_ f e n Off*/'Ap dyng ky ttiuit niy cho t i t c i cic bpnh nhan c6 hpl chung suy hd hap cSp tiSn ttlSn.
SUIVIMARY
EVALUATING THE ROIC OF ESOPHAGEAL l>RE5SURE MEASUREMENT TECHNIQUE Tt] FIND
THE OPTIMAL l>SP IN PATIENT WITH ARDS
VIETNAM MEDICAL JOURNAL N°2 - DECEMBER - 201B Objective: Evaluating the diiference of dinical
index, arterial bkiod gas and pulmonary mechanks after applying the PEEP fdtowing the esophageal pressure measurement. SUIt/ects IdentHying patients with ARDS by using oiteria fram Berlin 2012 (Average: 100< PaO, /RO; < 200 with PEEP > 5.
Seventy: PaOj/ROzS 100 with PEEP > 5). Patients did not Improve when supporting ARDSnet mechanical venlDatkin with tow VL Methods: Piospective, unconbolled Intenffinbon, convenience sampling.
Results: 27 patients who hospitalized in tiie intensive care una of Bach Mai hospital were enrolled,, tile mean age of patients was 55 ± 16 years dd, ttie highest afle was 83, and the towest one was 21, the proportion of man was 59 percent Before experiendng the Esophageal Pressure-Guided Ventilation, ail patients had been ventilated according ARDSnet prohicoi vwth tow VL If ttie results of arterial btood gas did not recover, patient's ventilation would be swihiied'to EPVent Trial. Vife did not reoonl any adverse events related hi esophageal balloon placement during the standard procedure and following tiie study "The procedure was simple and easy bi peribnn.
Conclusions; The rote of esophageal pressure measurement technique to find ttie optimal PEEP In patient witii ARDS depended on each patient's pulmonary mechanics. Recommendation: Applying tills technique for all patients with acute respiratory disbess syndrome.
„ j f ? ™ " " ' ' ' Esophageal Pressure-Guided Ventilation, esophageal baltoon cattieter, ttie techniques of esophageal pressure measuremenL I.S$TVJ!NC£
Hql chdhg suy ho hap cSp lien Men (Acule Respiiatoiy Distress Syndrome - ARDS) thu'dng g|p hdng khoa Hol siJc Cap a i d , cd tlnh chat nSng va a IS W vong cao cho dd cd nhieu tiSn bd trong dISu hi [l],t2],[6].
Oleu h i ARDS IS Sd phdi hdp dBng thdi nhlSu bl?n phap, hong cSc blen phap nay thong khi cd hpc ddng val bd ral quan hpng [1],[2],[6].
Thdng khi cd hpc cha benh nhan ARDS ngSy nay da cd nhiSu Uen bp: Sis dung Vt thap theo ARDSNet so vdi Vt cao theo fruySn thdng da chuhg minh dddc lpi ich cai thISn fi IS tis vong id rSt [6].^ Nhuhg sil d(ing PEEP the nao dong ARDS de loi ud hda ldi Ich? Thi cdn nhlSu tranh cai vS can phai HSp tuc nghlSn cuu. Trpng l|ch sif dS chi ra cd nhieu each luS chon PEEP tdl ud khac nhau (chpn PEEP thap nhat ma oxy mau van chap nhSn dudc theo thong khi duySn thdng, dga vao dudng cong ap iuc-lhe h'ch theo Amato v4 Borges, theo bang PEEP thap, banq PEEP cao ciJa nhdm ARDSneL..)[2],t6]. each dep c?n mdi cOa chiing tdl dya trSn quan diSm "PEEP
d m o i ca the ARDS la rat khac nhau vS khong mS tien doan dudc" nSn phai ca the hda trong Ius chpn PEEP ldi uU de phii hdp ddi vdl timg bSnh nhan ARDS[5]. Chiing tdi s j dung phuBng phSp do ap ldc thuc quan de dua vad dd lam cdng cy de thut hien chien luBc "ca the hda hong cai d|t PEEP toi uti trong thdng khi cd hpc d benh nhii AiyjS". Theo each tiept:Sn nay Talmor, SargedS thut hipn cdng trinh nghiSn cdu ndl tieng dudc dang tren tap chi NEll^ nSm 2006 budt dau dS chiiVig minh dudc hieu quan ciia phudng phSp chinh PEEP mdi nay d benh nhSn ARDS mang Ial sjf cai thien tot ti IS Pa02/R02[5]. Vi vay chijng loi muon thgt hien nghien ciiti nay de tim hieu Id ve phu'dng phap lua chpn PEEP ldi uu nay 11. o f i l TUIJNG v A PHITONG PHAP NGHIEN COU
2 . 1 . e d i tu'dng nghien c i h i a. Tieu ChuSn chgn binh nhin - BSnh nhan > 18 tuoi.
- Chan doan suy hd cSp USn trien mu'c dS trung bmh va nSng (Theo Blnh nghTa BERUN cua ARDS (2012)):
-t-Mfc dp trung binh: 100 mm Hg<
PaOj/FIOj < 200 mm Hg vdl PEEP > 5 cm H2O tMiJc dp n|ng: PaOi/FIOj < 100 mm Hg ho^c PEEP > 5 cm H2O
- Thd mSy theo ARDSnet vdi Vt thSp khong cSi thien.
b. Tiiu ChuSn logi trCt - BSnh phoi tac nghen man tinh.
- Co Iran khi mang phdi, tiiin khi trung tiiSt - Tut HA (HATB <60 mmHg) khong dip ilig vdi cScblSn phap hol Slit.
- Hpi chdng mpch vSnh cap.
- Cd chdng chi dlnh dting thudc an ttl8n, glan cd.
- Bpnh nhan ISng Sp ldc npi sp.
2.2. Phu'ong p h i p nghlSn c i h i
™ e r * « n p A / A i c i ( t / / N g h i S n cull tien ciili mots
0 3 ' m & ; Thuan tien
O/a digm: Khoa Hoi sii'c tfch cue, Benh vien Bach Mal.
Tieu tri nghiin cdv:
,.,J\Pi"'' B'^ ^HwYdSiiSm sing: M?di, nhlStdd, huyStap, SpOj....
» Binh gii sg- thay doi khi miu dfng m^ch cua b^nh nhim
' J!?y ^°"*> "^u dqng m^ {flH, fCOi, * P02, HCp3) tal thdl diem: TO, T l
^ ^ Dien blSn ty IS PaOj/RO! 1^1 dc thdl dlSn
Y H O C ^ ^ T NAH TAP 4 4 9 - T H A N G 1 2 - s o 2 - 2 0 1 6
•:• Binh gla chi so ca hgc phii: Ap li/c dhh, ap lut trung Wnh, compliance, Pl;rf^EP, PtpPlat.. tei thcfi diOT TO, T l .
2.3. Xu'l^sotleu: So MGU di/dc xu" ly theo phu'dng phap ttiong ke y hoc
2.4. Bao dii'c trong nghien dhi
• Cac quy trinh ky thuat da duUc Uiong qua t^i khoa Hoi siit tfch cyc, Hoi dong khoa hoc cua binh vien Bach Mai va khi tien hanh tr^n BN nghien ciitJ rfeu di/dc su" dong y cua benh nhan va gia dinh.
- Cac xet nghiem den hanh trong nghien cutJ la nhuYig xet nghisn thu'dng quy du'dc chi djnh trong qua trinh theo doi va dieu tri cho BN.
- Cac thong tin thu thap du'dc c i a BN chi du'dc dung cho muc didi nghien cOru.
lir. KET QUA NGHIEN CO'U
3 . 1 . Oac mim chung cua nhom benh nhan nghien cuti
Hinh 3.1.1. Dac diem phan bo tiieo lu'a tuSi, gidi
S ^ ^ g u Sn nhSn A R D ^ ^^" '^ "^"^ ^^^'^ ^ '^ ^^'''^' ^ ° ' *™"^ '''"^ ^^ ' " ° ' ' Hguven nhan ARDS
Vikhuan Wrut Sic nhiim khuin
viim tuv cap
13 (48.16%) 4 (14,815%) 6 (22.22%) . - _._, ..^^ 4 f 14 81%1
Bina 3.1.2 net sSdie digm chuna fhl *lA.. L..u;A 'j..—"*
Chi tieu nghiin Cdu VI khuan
V i r u l Sdc nhiem khuan
ViSm tuv cap SOFA APACHEn ARDSnanq"
ARDS trunq Mnh l^ach
Nhieldd
Huyet ap SPOi13 (48.16%) '14,81%)
6 (22,22%)4(14.81%)
8,4 J: 3,04
12,8 ± 5.22
6(22,2%)
21 (77.8%) 115,8 ± 15,36
37,8 ± 0.71
85,4 ± 12.93,5 ± 3.17
rtjt^-,^it^^'ir'' r''^" S^y.''?"'' * " y^" ^ •'< l*uan chlSm ly le 48%, a u do soc nhiem khuan n h i S' L I •; "suyen nhan l u vi rut va vISm luy cap la h/dng du'dng nhau chiem 15% nguySn man gSy benh. Trong nhom benh nhan nghiSn ciid diem bung binh SOFA 8 va APACHEII IS 13 vdi
tiphh nhan nSng chiem 22%. ' 3.2. Kel q u ^ u khi cai d | t PEEP theo hu'dng d i n cua if lu'e thu'c quan.
BSng 3.2.1.Thay Jol m f e PEEP tru'dc vh sau cai dat then P « ' f S 1 -—^i Chung
ARDS nanq ARDS tning binh
10,11 ± 2.82 10,29 ± 2.14 10,05 ± 3,07
Tl 14.44 ± 2,57 14,29 ± 3,35 14.45 ± 2,33
<0,05
<0,05
<0,05
VIETNAM MEDICAL JOURMAL N°2 - PECEMBER - 201B
. , . ' * ? ' ? ^^f-'Tiay doi miic cai dat PEEP Iheo Pes tru'dc va sau rat cd y nohla thdno kS Chunn rh.
ca hai nhdm PEEP tru'dc dieu chinh theo Pes la 10 sau dieu chinh la 14. ^ ' * ° Bang 3.2.2. Thay do ket qua khi mau tru'dc va sau Ichi cai dat PEEP theo Pes
TO I T l " I =—
PaO^Fio, PaCO,
122,9 ± 35,09 84,4 ± 26,64 44,3 ± 14,66 7,37 ± 0,09 _ 24,9 ± 7,13
Tl 196,3 ± 83,90 138,3 ± 79.67 47,7 ± 16,43 7,35 ± 0,11 25,8 ± 6,68
<0,05
<0,05
>0,05 ^
>0,05 , „ , . » ' " ' • ° ' ' . V S ' i ° ' PaOi/FiO;mau bu'dc va sau cai dat PEEP theo Pes thay ddi cd v nohTa p i i , PaCOj va PH tru'dc va sau cai dat theo Pes khong cd thay doi. " " y uoi co y nghia.
3.3. Thay doi chi sued hgc phdi sau cai dat PEEP theo Pes
I '^ .h „ ^ ' ' " " I " ' " ' ' ™ "''"'.'^''^'^ " 3 . ? ° " Ithi cai a a t PEEP theo P»« Thdi diem TO
-;: ,-..—.^».Mw«, WB anw i\ni ..qi Hat, | Po gian ntf cua phoi [compliance)
27,5 ± 2,06
J ' I . 30^2 ± 3 4 2 <(1.05
gih^s^T^isy^rpiypg^^^^'tr^-^^^^^^
T n o i d i e m B » « n e e n ' ~ 1 TO
Tl
PtpPEEP
0,3 ± 2,24
_E ,
<0,05 cdy™gfa ttidng^s!^' " " ' " ' ' " " " ' ""^ " " ^ ^ '^"''^^ " ^ =^" ^1^' -^^ "^'''^'='=1^ ^ P a thay doVrat
, Bang 3.3.3. Thav a& PtpPIat tru'dc vA sau khi c^l dSt PEEP theo Pes Thdl aiSm
TO PtpPIat
19,3 ± 4.69
P < 0,05
^-inr' ^ r ^ — ! 1 _ i a , 4 ± ?i,7fi I- ^ u,U3 n g h i S g ' ^ k S : " " ' " " ' ' ' " " " ^ " ° ' ""' " " '^'^"'^ " ^ = ° " " ' ^ ^ t ^ k p theo Pes thay doi J i y
I ° ^ " ^ fr.!i1i.I!lf'^ '^ P" '"'" " " " *^^ v^ « " fchl cai aat PEEP theo Pes Tl
AP Itfc ainh (Ppeakl 28,3 ± 4.86 32,7 ±4.49 Thtfl aiem I AP Itfc trunq binh (Pmean)
P < 0,05
20,04 ± 4.34
23,19 ± 4.17
<0,05- 3 ^ - 2 . . 1 . 1 ^ , 1 9 ± 4 , 1 7 <:u,uo
zTdr^l ^ T g h l X " " " '" ^ " ^ ^- =^" ^ ' '^ '^^' "• y ngwa thong kS.
Bang 3.4.1. chi so 13m sAno trtfdc va sau cdi aat PEEP theo P > . spo,
93,52 ± 3.16"
115,78 ± 15.3fi~
85,41 112.8S_
96,67 ± 2,34
116.70 ± 19,05
<0,05 >0,05lhiSnT^u5f4l'J«|^^f™^^:i3f^^^5^^^
D ^ » ^ « ,• -T « . ~ . ! r ' " y " ' " " l o n g Ke.; 5 ^ a f ^ f ^ ^ | ^ ^ f c t ! » o i ^ j 4 t e « ! u ^
T t ^ n L-hf MD * • n
Y HOC Vl&T NAM T^P 449 - THAHG 12 - SO 2 - 2016 IV. BAN L U A N
Tiy 15/10/2015 den 30/09/2016, co 27 benh nhSn du tieu chuan chon vao nghien cutJ.
Nghien d i l i thut hi&i tren 27 benh nhan, tiwig do 16 nam (59%) va 11 nff (41%). Tuoi trung binh Chung oia ca hai gidi la 54.69 ± 23.37 tuoi.
Trong rac nguyen nhan tim di/cfc, chii yeu gSp nguyen nhan tai phSi la 63%, hay gap nhat la vi khuan 13 benh nhan (48%), vi rut 4 benh nhan (14%). Ngoai phoi do soc nhiem khuan'co 6 benh nhan (22%). Viem tuy cap 4 benh nhan chiem (14%J
Viay doi oxy hpa mau vdi vdi PEEP dutA: cai dSt tiieo fjWdng dan ciJa ap lu'e diu'c quan.
Danh gia su" thay doi khf mau theo thdi gian, trong rac chi so, pH, pO;, pCOz, HC03" chi co su"
cSi thien dan v§ phan ap rieng phan oxy trong mau pOz, mang l?i su* khac biet co y nghia thong l(g (p > 0,05). PaOz CO xu hul5ng tSng dan tiT 84 (TO) Ign 138 (Tl).
TV % PaOz/ROa cOng du'dc cai thien, tang 'theo thcfi gian tff TO (122) den T l (196), sff
; biet co </ nghla thong ke (p<0,05) Ciing vdi su" tang dan cua ty le PaOVFi02, ty le PaOa/FiOa son^ song vdi t3ng dan do gian nd cua cd hpc piioi, phan anh sff trao doi khf dffdc cai thl§n dan, cac phe nang xep dffdc md t3ng dien trao m khi, rai thi|n lam tSng kha nSng trao ddi oxy qua ming khuech tan tai phoi.
V. Kfr LUAN
C^ 27 b^nh nhan ARDS dffdc d?t ong thong thi^ quein CO bong v^o t h y t quan de do ^p Iffc tlivt quSn theo qui trlnh chu^n chung toi khoiig gh! nh$n blft k/ mot tai blen, bien chu'ng trffc Mep ddng ke nao xSyra.
27 benh nh§n ARDS dffdc thong khf theo EPVent deu co sff cai thien dang ke ty ie P/F trong thdi gian thong khf ttieo EPVent theo doi du^csovdi mffc nen.
Day ia ky thuat ddn gian dat sonde da day CO bong chei do ap Iffc thut quan, tien hanh dat sonde giong nhff dat sonde da day blnh thffdng ky thuat ddn gian de thffc hien. Tat ca dffdc ket noi vdi may thd AVEA co bo chuyen doi KIEN NGHj: Ap dung do ap lut ttiffc quan cho tat ca cac benh nhan ARDS trong khoa hoi sut de tim PEEP toi Iftl cho tffng ca the.
TAI UEU THAM KHAO
1. v a j / i n Binh (2004), "Hoi chu^g suy ho hap c ^ tien trien", ^ " stfc cap ohi toan tap, Nha xuat ban Y hoc, tr. 78 - 95.
2.. Le Dut Nhan, N g u y ^ D^t Anh, Vu Van Dinh (2013), " N t f ^ cuU hieu qua aJa thong khi oJ hoc theo diiai luoc "Md fSiw' va thong khf aJ hoc W^IK network trong dieu tn suy ho hap CEip ti&i trieh". Hgi ttao toan_qua: tia sik-cap aJU^hSfy ddc lan tfii}"
XLV, Oa n3ng, ngay 18-19/4/2013, H6i f^i sut C3ip oAi va diohg doc Wet nam, tr. 42-48.
J. Benditt 3.0. (2005), "Esophageal and Gastric Pressure Measurements", Respit^toryCare, SOflV pp. 68-77. ^ "
•*. Miiic-Emili J., Mead J., Turner J.M, (1964),
"Improved technique for estimating pleural pressure from esophageal balloons", J Appl Ptiysiol, 19, pp. 207-211.
5. Talmor D., Sarge T., Malhotra A. et al (2008),
"Mechanical Ventilation Guided by Esophageal Pressure in Acute Lung Injury", Ttie new england Joumal of medidne, 359 (20), pp. 2095-2104 6. The ARDS Clinical Trials Networic, National
Heart - Lung - Blood Institute National Instibites of Health (2000), "Veneiatlon with lower tidal volumes as compared witi traditional tidal volumes for acute lung Injury and the acute respiratory distrKS syndrome", NEJM, 342 fl8>
pp. 1301-1308.
7. Zin W.A., Mtlic-Emili 3. (2005), "Esophageal pressure measurement, Physiological basis of Re^lratory disease, People's fledical Publishing House", pp. 639-647.
NGHIEN CU'U CHi SO FIBROSCAN TRONG BENH Xff GAN
LIT QUOC Hung*, Tr^n Vi?t Tii**
TOM TAT Nghien cilu mo (a c3t ngang, tien culj du'dc thyc hifn trong thcfi gian tiy thang 10 n3m 2012 deii th^ng 04 n5m 2015, chon mSu thuan ten, chung toi da thyt hien duWc 92 mau. Ket qua: 05 dan hoi gan (RbroKan). Tieu chuSn phan mffc d$ xd hoa gan 1^
FO tff 1- 5 Kpa, Fl tff 7,1 - < 8,7Kpa, F2 tff 8,7 - <
14,5 Kpa, F3 tff 14,5 - < 17,5 Kpa, H tff 17,5 Kpa trd len. Do dan hoi gan F4 co ty If cao nhat 45,65% trong khi Fl, F2, F3 ISn luUt \h 16,30%, 6,52% v^ 27,17%.
•B?nh vrifn Hanh PhCic An Giang
•• Bfnh vifn 103, Hpc vifn Quan Y Chiu trfdi nhifm chinh: Lu" Qu5c HCing Ernail: phdhung37@gmalLcom NgSy nh$n \AV. 5.9.2016 NgSy phSn b i ^ khoa hpc; 21.11.2016 Ngdy duyft bai: 30.11.2016
