TAP CHI Y DU'QFC HQC CAN THQf-SO 13-14/2018
1. BQ Y te, 2005. Sir dung thuoc hgp ly tiong dieu tij, Tdi lieu ddo tao cho bac si, dugc si b?nhvi?n. HaNQi,tr 1 2 - 2 5 .
2. Trdn Nhdn Thdng (2012), "Khao sat tinh hinh kS don sd d\ing thu6c diSu fti ngoai tru tai b^nhvi^n Bach Mai nam 201 V'\ TgpchiYhgc Thgc hdnh (930).
3. World Health Organization (1993), How to investigate drug use in health facilities:
selected drug use indicators, Geneva: WHO/DAP/93.1
4. World Health Orgaiii2ation (2012), "The Pursuit of Responsible Use of Medicines: Sharing and Learning fi«m County Experiences", Geneve: WHO/EMP/MAR/^0123, p.78.
(Ngdynhdnbdi: 17/11/2017-Ngdy duyjt ddng: 08/01/2018)
KHAO SAT TINH HINH KE D O N T H U O C T R O N G DIEU TRJ NGOAI TRU 6 TRE E M DU*6l 6 T U 6 l TAI C A C B E N H VIEN D A KHOA CONG
L ^ P TREN DIA B A N T H A N H PHO CAN T H O N A M 2015 - 2016 Nguyen Phuc Himg*, Phgm Thdnh Trong, Nguyen Thi Nggc VSn
Trudng Dgi hgc YDugc Cdn Tha
* Email:[email protected] TOM T A T
Bgt van de: Hijn nay, dir liju ve ki dan thudc trong nhi khoa cdn hgn che. Nghien ciiu tim hiiu vijc ke dan thudc ngogi tru a tre em dudi 6 tudi nhdm phdt hien nhimg tdn tgi trong thgc hdnh ke dem. Muc tiiu: Khdo sdt viec thgc hijn quy chi ke dem trong dieu tri ngogi tru theo Quyet dinh sd 04/2008/QD-BYT ngdy 01/02/2008 cua Bd trudng Bd Y ti; ddnh gid tinh hgp ly, an todn trong thuc hdnh ki dan thudc ngogi tru. Boi tugng vd phuang phdp nghiin cuu: mdtd cat ngang trin 403 dan thudc dugc thu thgp tgi 9 bjnh vijn da khoa tren dia bdn thdnh phd Cdn Tha giai dogn 2015 - 2016. Kit qua: chi cd 5,2% dan thudc tudn thd cdc quy dinh trong quy che ke dan cua Bg Yti. Nhin chung, cdc chi sd ki dem thudc chua dgt miic khuyin cdo cda Td chirc Yte The gi&i. Sd thudc trung binh tiong dan thudc Id 4.2 vd sd dan thudc sir dung khdng sinh rdt cao (87,3%). Ty Ij dan thudc an todn hgp ly trin tung tii la 65.5%. Ket lugn: cdn cd nhiing can thi?p nhdm chdn chinh lgi vijc tudn thii cdc quy dinh tiong thgc thgc hdnh ke don thudc cua cdn bg y te.
Han niia. ki dem khdng sinh & tre em phdi ddm bdo tinh hgp ly an todn hiju qud.
Tu khda: ke dan thudc. ngogi tru, tre em dudi 6 tudi, chi sd ki dan ABSTRACT
OUTPATIENTS PRESCRIBING IN CHILDREN U N D E R SIX YEARS OF AGE FROM PUBLIC HOSPITALS IN C A N T H O CITY, VIET NAM FOR
T H E P E R I O D 2015 - 2016
Nguyen Phuc Hung, Pham Thanh Trong, Nguyen Thi Ngoc Van Can Tho University of Medicine andPharmacy Background: Currently, data with regard to pediatiic prescriptions in pediatiic population is limited. Objective: to investigatethe patterns outpatient prescription in children under six year age to detect shortcomings in prescribing practice. Materials and method: Total 403 pediatric prescriptions were collected from nine public hospitals in Can Tho city for the period 2015-2016. Results: The results showed that only 5.2% of prescriptions were in
TAP CHI Y DiraC HQC CAN THO ~ S 6 13-14/2018
compliance with the prescribing rule of the Ministry of Health. In general, drug use indicators do not reach the World Health Organization's recommendations. Average number of drugs per prescriptions was 4.2 and the number of prescriptions using antibiotics was very large (87.3%).
The proportion of rational and safe prescription drugs in particular case was 65.5%. Conclusion:
The study concluded that interventions were needed to rectify compliance of medical staff with rule in the practice of prescription medication. Moreover, using of antibiotics must warrant further attention by the prescribers for a more significantly rational prescribing.
Keywords: drug prescribing, outpatient, children under six years, prescribing indicators I. D ^ T VAN DE
Cham soc SIJTC khoe nguoi dan la nhiSm vu quan trpng, ddc bi^t trong linh vyc nhi khoa. Boi, dugc dong hpc vd dupe luc bpc cua thudc tren ca the tre em co nhidu diem khac biet so voi ngucri truong thdnh. Thuc trang lam dung cdc thuoc co nguang tri lieu hep, sil dung khdng sinh khong cdn thiet van con ton tai; ciing nhu thuc hien Quy che ke don thuoc trong dieu tri ngoai tru chua dugc quan tdm [1], Xudt phdt tir thuc tiin tren, chung toi tien hdnh de tai: "Khdo sdt tinh hinh ke dem thudc trong diiu tri ngogi trii a tre em du&i 6 tudi tgi cdc benh vijn da khoa cdng lap tren dia bdn thdnh phd Cdn Tha ndm 2015 - 2016". Voi cdc muc ti6u cu the:
1. Khdo sat viec thuc hien quy ch6 ke don trong dieu tri ngo^i tru theo Quyet dinh s6 04/2008/QD-BYT ngdy 01 /02/2008 cua Bp truang Bp Y t i
2. Danh gid tinh hop ly, an todn trong thuc hanh kS don thuoc ngoai tru.
II. PHU'ONG PHAP NGHIEN CUtJ 2.1. Doi tiTong nghien ciru
Dan thuoc diSu tri ngoai tni thu thdp tai phong kham nhi ngoai tru a tre em duoi 6 tu6i tai cdc benh vien da khoa cong lap trSn dia ban thdnh ph6 Can Tho ndm 2015 - 2016.
2.2. Phmmg phap nghiSn c ^ - ThiSt kg nghien cmi: mo td cdt ngang.
- Phuorng phdp chpn mau:Thu thdp 403 don diuoc UJ 9 benh vien da khoa (BVDK) tren dia ban thanh pho Cdn Tha tir thdng 10/2015 din thang 03/2016. Chpn mdu he tbSng trong cac ngdy khao sat.
Tieu chudn lua chpn: Don thu6c dugc ke cho benh nhi dudi 6 tuoi den kham ngoai tni tai cdc ca sa y tS dugc chgn; don thu6c dugc thu th$p trong ngdy tien hanh nghiSn cuu.
Tieu chudn loai trir: Nhimg benh nhdn din kham ngoai tru nhung dugc chuySn vdo npi tni hodc cdp ciiu tai benh vien; b6 me (nguoi thdn) cua tre tir ch6i cung cdp dan thuSc va thong tin cua tre.
- Phucmg phdp xu ly vd phan tich s6 lieu: Md hoa yd xu ly s6 lieu dua tren phdn mSm SPSS 22.0. Trinh bay kk qud dang biSu d6 bdng phdn mSm Microsoft Exel 2013.
Tuong tdc thudc dugc phdn tich va ddnh gia dua vdo Phdn mem tuong tdc thuoc Facts and Comparisons 4.0 (2013).
- D ^ diic nghien ciiu:d6 tdi dugc sir d6ng y va chap nh|in phoi hgp ciia gidm doc bSnh vien vd benh nhdn. Phuang phdp thuc hien nghien cuu phdi thuc hien dung theo cac nguyen tdc dao diic y sinh hpc.
2.3. Npi dung nghien cmi
Viec thuc hien quy chS ke dan trong di6u tri ngoai tni theo Quylt dinh so 04/2008/QD-BYT ngdy 01/02/2008 cua Bg trudng Bp Y tS
Tinh hgp ly, an todn trong thuc hdnh ke dan thu6c ngoai tni:
249
TAP CHf Y DU'QfC HQC CAN THa - s6 13-14/2018 - Cap vT mo: Cdc chi so ke don theo theo quy dinh cua WHO vd Bp Y tS.
- Cdp vi mo; Ke dan thuoc hgp ly an toan trSn mgt benh nhdn cu thk dugc biSu hien a diing benh, dung thuoc, diing liSu, each dung vd khong co tuang tdc thu6c [1], [2].
III. KJET QUA NGHIEN ClTU
3.1. Khao sat vifc thyc hifn quy che ke don trong di^u tri ngoai tru theo Quyet dinh s6 04/20D8/QD-BYT ngay 01/02/2008 cua Bp tni-dtig Bp Y t8
3.1.1. Ty le don thuoc dat cac quy dinh trong quy che ke don Bang 1. Ty le dan thu6c dat cac quy dinh trong uy che ke dan
STT 1 2 3 4
Ndi dung Mau don thuoc va cac muc trong don thuoc Thong tin ve benh nhan
Quy dinh ghi ten thuoc Ouy djnh ve hucfng dan dung thuoc
Bat 100%
12,4%
96,0%
33,3%
KhoDg d^t 0%
87,6%
4,0%
66,7%
Tong 100%
100%
100%
100%
100% dan diing quy dinh ve mau don thuoc va cac muc trong dan. Ty 18 don thuQc ghi ten thuflc la 96,0%. Chi co 33,3 % dan ghi diing quy dinh vS buong ddn dung thuoc vd 12,4% dan ghi ddy dii th6ng tin benh nhdn.
3.1.2. Don thuoc dung quy che ke dtm
• Don tiiuoc diing quy che
• Don tiiuoc kliong diuig quy die
Tthulc dung quy che ke dan
Ty le dan thuoc diing quy ch6 khd thdp 5,2%, ty IS khong diing quy che 94,8%.
3.2. Khao sat tinh hop ly, an todn trong thuc hdnh ke don thuoc ngoiai tru 3.2.1 Cap VI mo
Bdng 2. Cac chi so kS dan thu6c ngoai tni STT
1 2 3 4 5
Npi duDg So thuoc trung binh trong don Thuoc dugc ke theo ten goc Thuoc duac ke tu danh myc TTY Don thudc co ice Idiang sinh Don thu6c CO ice corticosteroid
WHO khuyen cao 2 - 3 100%
100%
<30%
-
Ket qua 4,2 (SI>0,973)
93,6%
80,2%
87,3%
39,7%
Cdc chi so ke dan ngoai tni khong dat muc khuyen cdo ciia WHO. Ty IS dan thuoc ke corticosteroid khd cao, 39,7%.
3.2.2. Cap vimd
TAP CHIY DirgfC HQC CAN THg - S6 13-14/2018
WJ^
I Don tlniocliop ly an toaii ' Don tliiioc kliong hop ly an toanBiSu do 2. Ty le dan thuoc hgp ly an todn
Dan ihuoc hgp Iy an toan la 65,3%, vdn con 34,7% dan thu6c khong hpp Iy an todn.
IV. BAN LUAN
4.1. Xac djuh dem thuoc dung theo quy che ke don trong dieu tri ngoai tru theo quyet djnh so 04/2008/QD-BYT ngay 01/02/2008 cua Bp tru&ng B6 Y te
Theo quy chS ke don ciia Bg Y tS ban hanh kem iheo quySt dinh s6 04/2008/QD- BYT, dem thuoc tai cdc ca sa khdm benh ngoai tni phai dugc thuc hipn diing mau phu luc 1,2 vd 5. Khoa kham benh nhi tai cdc BVDK trSn dia ban thanh ph6 Cdn Tha ciing khong ngoai le va chap hanh t6t quy dinh ndy. Qua khdo sdt, ty le dan diing mau Id 100% vd tuong duang voi kSt qud nghien cuu cua Ho Thi DiSm Thiiy tai benh vien Nhi Dong 2 nam 2012 [9].
Ty le don thuoc ghi dky dii thong tm benh nhdn Id 12,4%. Theo khdo sat ciia Dodn Tuan Kiet nam 2012, don thu6c ghi so thdng cua tre chi dat 26%, ghi ten b6 hoac me Id 0% [5]. Truac dp luc boi hang tram lugt benh khdm/ ngdy, can bp y te cho rang viec ghi 2 muc ndy khong quan trgng. Ddy Id quan niem sai ldm boi lieu dimg moi thuoc phu thugc vao timg dp tuoi cua tre, nSu khong sir dung diing co thS thdt bai dieu tri hodc ngp dpc.
Mat khdc, ghi tSn b6 me tre dS ddm bdo tinh phdp ly cua don thu6c.
Ty le dan diuoc ghi diing ten thuoc theo quy dinh la 96,03%. Ddy Id kSt qua khd quan boi nghiSn curu tai benh vien Nhi dong 2 nam 2012 cho ket qud 73,7% [9]. Nhdn thdy cac sai sot trong nghien ciiu t|.p tnmg o dan thuoc khong BHYT. Tdm ly benh nhdn tin tuang cac biet dugc pho bien cho do an todn hieu qud cao dan dSn tinh trang bdc sy co thoi quen kS ten thu6c theo ten biet dugc va bo qua ten thuoc goc.
Tai benh vien Nhi dfing 2, viec thuc hiSn quy dinh ghi day du huong ddn dimg diu6c rat t6t (100%) [9]. NghiSn ciiu ciia chiing toi ghi nhdn 66,7% don thuoc khong ghi ddy du, chii ySu la thiSu ham lugng vd cdch dimg thuoc. Su khdc biet dugc cho Id chdt lupng ciia he thfing phdn mSm tai cdc benh vien.
Khai qudt lai, ty IS don thu6c diing quy chS ke don thdp, chi dat 5,2 % chSnh lech ddng kS vai nghien ciiru truoc do a b?nh vien Nhi d6ng 2 (63,23%) [9], BVDK Khu Vuc Ngd Bay (13,5%) [5]. DS gidi quySt thuc trang ndy can thuc hien dong loat nhiSu bien phdp, ddc biet la cong tdc tu tuong cho can bg y te ve tdm quan trgng cua cac muc trong donthu6c [2].
4.2. Khao sat tinh hpp ly, an toan trong thux hanh ke don thuoc ngoai tni 4.2.1. C^pvl mo
Lugng thuoc tnmg binh trong dan tiiuoc la 4,2; cao ban miic khuySn cdo ciia WHO ( 2 - 3 thu6c) vd trong cac nghiSn ciiu 6 tre em, diSn hinh tai Nigieria (2,6 thudc -
TAP CHI Y Dl/QC HOC CXN THg - s 6 13-14/2018
2015) [3]; tai Cdn Tho giai doan 2014 - 2015 (3,8 thu6c) [6]. KS don nhieu loai tiiufic khong cdn tliiSt ldm tang chi phi dieu tri vd c6 thS dSn tinh trang khang thu6c.
Ty le cdc thuSc ke dan thuoc goc la 93,6%, cao hon mgt so nghien ciiu khdc, tai Saudi Aribia nam 2012 la 61,2% [7]. Qua timg nam, chi so phdn tram thuoc ke ten g6c dS vd dang cdi thien dang ke. Nguyen nhdn chinh phdi kS dSn Id viec dp dung cong nghg thong tin vao cong tdc qudn ly sir dung thuoc.
Ty le don thu6c ngoai tni co ke khdng smh la 87,3% va tucmg tu voi nghien cuu ciia NguySn Thi Bich NguySn (86,7%) t ^ Cdn Tho [6]; cao ban miic khuyen cdo ciia WHO. Dua vdo mo hinh benh tat cua mau nghien ciiu voi nhom benh h6 hdp, nhilm khudn chiSm ty trpng rdt lan, co thS thay ty IS sii dung khdng sinh 87,3% la hgp ly.
Su dung corticosteroid trong dan thu6c la mpt chi so phu nhung WHO khuySn khich khdo sdt doi vdi mdu nghien ciiu c6 ddu hieu lam dung. Trong nghiSn ciiu, don thuSc corticosteroid chiem 39,4% cao tuong duong voi miic sir dung tai khoa nhi benh vien Nhi dong 2 [9]. Tuy nhien, ket qua nay gdp 5,5 ldn so vai nghiSn ciiu tai Iran trSn 359.220 don thuoc ngogi tni cho doi tugng tre em [4]. Cdn nghien cihi chuyen sdu ve mat ldm sdng truoc thuc trang lam dung nh6m thuoc nay.
4.2.2. c d p vi mo
Ty le don thuoc hpp l^, an toan la 65,5% thdp hon khdo sdt tai BVDK Khu V\rc Ngd Bdy (87,75%) [5]. Theo nghiSn ciiru cua chiing toi, don thuoc hgp ly an todn gom 3 tiSu chi thu6c hgp ly (dung thu6c, diing b?nh, diing liSu, diing each) va 1 tieu chi an toan (khong tuong tdc thu6c). Vdn con nhung tieu chi khdc nhung d6i hoi co kiSn thirc chuyen sdu va thai gian de xdc dinh hieu qua dieu tri cung nhu cdc phdn img co hai xdy ra.
V. K£T LU^N
Nhin chung, t^' IS don thu6c dung quy chS ke don theo QuySt djnh so 04/2008/QD- BYT ngdy Oi/02/2008 ciia BO truang Bp Y tS khd thdp (5,2%). Da s6 cdc don tiiuoc chua tuan thu quy dinh vS ghi thong tin benh nhdn, ddc biet la thong tin so thang tuoi va tSn cha me tre. Tinh hgp i^, an toan trong thuc hdnh ke dan thu6c n g o ^ tni 6 cap dp vl m6 khong dat mure khuyen cdo ciia WHO. Lugng thuoc trung binh trong don Id 3,8 thuoc; cao hon nhieu so voi khuySn cao ( 2 - 3 thufic). S6 don thu6c sir dung khang sinh rdt cao (87,3%).
Ty IS don thuoc an toan hpp ly trSn timg tre cu the la 65,5%.
TAI LIEU THAM KHAO
1. Bp Y tS, 1997. Nghien ciiu tinh hinh sir dung hgp ly cm todn thudc tai Vijt Nam. De tai nghien ciiu truac khi trien khai thirc hi?n chinh sach quoc gia ve thuoc.
2. B6 Y tS, 2005. Sir dung thudc hcrp ly tiong diiu tij, Tdi lifu ddo t^o cho bdc si, dugrc sT bSnh vien. Ha Npi, tr 12 - 25.
3. Joseph Fadare,! Oladele Olatunya, 2015. Dmg Prescribing Pattern for Under-Fives in a Paedianic Clinic in South-Westem Nigeria. Ethiop J Health Sci, Jan 2015; 25(1), pp 73 - 7.
4. Karimi, Haerizadeh et al (2014), "Evaluation of medicine prescription pattern using World Health Organization prescribing indicators in Iran: A cross-sectional study", J Res Pharm Pract, 3(2), pp. 39-45.
5. Doan Tuan Kiet, 2012. Khdo sdt viec thuc hiin quy chi ki dan tiong khdm vd diiu trj tgi bjnh viin da khoa khu viec Ngd Bdy tinh Hgu Giang ndm 2012. Ludn van chuySn khoa cap I. Dili hpc Y dupe CJin Tha.
6. V5 Thi Bich Nguyen, 2015. Ddnh gid cdc chi sd ki dem a tie nhd han 6 tudi tgi cdc casd y ti nhd nude tren dia bdn thdnh phd Can Tha. Ludn van t6t nghiep Duac sT d?i hpc.
Tmcmg Dai hpc Y dupe Cdn Tho.
TiB^P CHI Y DUQC HQC CAN THg - s 6 13-14/2018
7. Raj Kumar Goel, Sanjay Khanna, Anoop Verma, 2003. Drug prescribing pattern in the outpatient department of pediatrics in Gbaziabad. Uttar Pradesh International Joumal of Pharma Sciences and Research, Vol 4 No 4 Apr 2013, pp. 78 - 80.
8. Suleiman 1. Sharif, 2015. Trends of Pediatric Outpatients Prescribing in Umm Al Quwain, United Arab Emirates. Pharmacology & Pharmacy, 6, pp. 9 - 16.
9. H6 Thi Diim Thiiy, 2012. Khdo sdt thyv trgng ki dan thudc lgi khoa khdm binh bjnh vijn Nhi Ddng 2. Luan vdn chuyen khoa cap 1. D^i hpc Y dupe Ho Chi Minh.
(Ngdynhdnbdi: 17/11/2017-Ngay duyjt ddng: 08/01/2018)
NGHIEN CUtJ M O I LIEN Q U A N N H A N - Q U A VA TOI UtJ H O A QUY T R i N H CHIET X U A T A N T H O C Y A N I N T f DAI H O A BUP GIAM (HIBISCUS SABDARIFFA LINN.) BANG PHAN MEM THONG MINH
Nguyin Bdo Nggc, Nguyin Ngpc The Trdn, Nguyin Ngpc Qitynh*
Trudng Dgi hgc Ydugc Cdn Tha
* Email: [email protected] TOM T A T
Bgt vdn di: Bup gidm (Hibiscus sabdariffa Linn.) Id mot logi cdy bui hang ndm. hoa ciia logi cdy ndy dd dirge sir dgng nhiiu trong y hgc cd truyin.Anthocyanins Id hgp chdttu nhiin trong dai hoa, cd vai trd quan trgng tgo nen mdu sdc ciia nhiiu bg phdn cdy trdng. Ngodi ra, anthocyanin cdn dugc qucm tdm do cd nhiiu lgi ich ve sue khoe nhu ldm gidm bjnh mgch vdnh, cai thien thi gidc, chdng oxy hda vd chdng ung thu... Bdi bdo ndy nghien ciiu ve dnh hudng cua cdc yiu td din qi^ trinh chiit xudt anthocyanin v&i su hd tig hieu qud cua hj thdng phdn mim thong minh. Trong qud trinh nghiin cuu, ky thudt tog do song song cho phep khdo sat mdi lien quan nhdn qud tir dH liju ddu vdo ciia quy trinh chiit xudt durrc liju ddi hoa blip gidm mgt cdch true quan, vd cdng nghj logic md-thdn kinh da dugc nhdn mgnh trong md hinh hda vd tdiuu hda cdc diiu kijn chiit xudt. Mgc tieu: Tdi uu hda quy tiinh chiit xudt ddi hoa Bup gidm gidu anthocyanin. Bdi tugng vd phucmg phdp: Dugc liju Bgp gidm y&i bg phdn dimg Id ddi hoa Ap dung cdc phdm mim thdng minh trong nghiin cuu quy trinh chiet xudt gdm: thiet ki md hinh thgc nghijm Taguchi OA bdng phdn mem Design-Expert, tdi iru hda thdng sd bai phdn mim BCPharsofi vd thuc nghijm kiim chung. Kit qua: Du lieu phdn tich cho thdy hdm lugng anthocyanin todn phdn bi dnh hudng b&i 4 yiu td khdo sdt la nhijt dg chiit. ty le dugc liju/dung mdi, thai gian chiit vd sd ldn chiit lgp lai Kit lugn: Cdc thdng sd tdi iru ciia quy tiinh da dugc xdc dinh bao gom: nhijt dg chiit (6(TC), ty Ij dirge liiu/dmg mdi 1:30 g/mL. thai gian chiet (15 phut), chiit lgp lgi 3 ldn cho hdm lugng anthocyanin todn phdn cao nhdt (1.2 78 mgC3G/g}.
Tu khda: Blip gidm, anthocycmin, chiet xudt, tdi uu hda, BCPharsofi ABSTRACT
C A U S E - E F F E C T STUDY A N D E X T R A C T I O N OPTIMIZATION OF A N T H O C Y A N I N S FROM HIBISCUS SABDARIFFA L. CALYCES USING
INTELLIGENT S O F T W A R E
Nguyen Bao Ngoc, Nguyen Ngoc The Tran, Ngi^en Ngoc Quynh Can Tho University of Medicine and Phamarcy Background: Hibiscus sabdariffa Linn, is an cmnual herbaceous shrub, itsfiowers hcrve been used in traditional medicine. Anthocyanins are naturally occurring compounds in calyces of 253
