5. Ho Nam va cflng su (2008). 'Kit qua diiu tri budu gi^ don nhan bang phiu thupt npi soi tgi bpnh ViSn Binh Dirf. Tgp chi y hpc TP. Ho Chi Minh, tdp 12.
phv ban sd 4.
6. Tran TTianh Phucmg (1998). Nghi&n cim chin doSn vS tSiu tri budu ^Sp don nhSn - Lugn van thgc sT Y hpc, Dgi hpc Y dugc TP. Ho Chi Minh.
7. Dgng Thanh (2007). NghiSn ct>u chin doSn vS (Siu tri ngogi khoa budu giSp don nhan nhieu nhSn - Ludn dn tidn sT Y hpc, Hpc vipn Quan y.
8 Truang Van Trudng (2003). Biin chirng phau thupt tuyin giSp - Ludn dn chuyen khoa cdp II chuydn
ngdnh Ung thu hpc, Dgi hpc Y dugc TP. Ho Chi Minh.
9. Kitano H, FujimuraM, Kinoshita T. el al (2002).
"Endoscopic thyroid resection using cutaneous elevation in lieu of insufflations". Surg EndosclO. pp.88 - 91.
lO.Miccoli P, Bellantone R. Mourad M (2002.
Multinstitutional expedenee. J Am Coll Surg 2002 May, 194(5): 6 1 0 - 4 .
ll.Park Yong Lai, Han Won Kon (2003). "100 cases of endoscopic thyroidectomy: Breast approach'. Surgical laparoscopy. endoscopy and percutaneous techniques VoM3. No.1,pp.20-25.
K^T QUA TOI UU HOA DIEU KIEN SAN XUAT NlAU NGOAI KIEM TRA CHAT LUUNG XET NGHIEM Vi SINH LAM SANG DANG BENH PHAM GIA DINH MAU, PHAN.
NUftC TIEU CHlta VI KHUAN GAY BENH THUANG GAP HOAC TAP N H I I M
TRAN H O U TAM, VO NGQC NGUYiN, TRUONG Q U A N THUY, N G U Y I N TH! THANH TAM, N G U Y £ N TH! HONG PHUONG, PHI X U A N TIEN.
Trung tim Kiim chuan Xit nghipm TP.HCM
T6M TAT
Ngogi kiim tm ehit lugng xdt nghipm (EQAs) dS dugc Bp Y ti ban hSnh thSnh quy dinh tmng qudn 1^
chit lugng xdt nghipm, vi mpt chuydn mdn, dSy IS mdt trong nhirng cdng c(; d ^ dSnh gii d ^ tin cpy cCia xdt nghipm. phSt hipn sai s6 [Ij. [3]. Di triin khai dugc hogt ddng ngogi kiim tm chit tu&ng xdt nghipm, cin phii cd cSc miu kiim chuin, dpe bipt IS tmng kiim tm chit lugng vl sinh ISm sSng, vl nhirng ly do khSch quan nhu an toSn sinh hgc, thdi gian sdng cua vi khuin,...ndn cSc miu bpnh phim giS djnh hiu nhu khdng cd eSe edng ty thuong mgi cung cip.
Dga trin kit qui khSo sSt eSc miu bpnh phim vS vi khuin thu&ng gpp tgi cSc phdng xit nghipm vl sinh ISm sSng [4], nhdm nghlSn cuu da xSy dung quy trinh sin xuit miu bdnh phim glS dinh mSu, phSn, nu&c tiiu chira vi khuin gSy bpnh thudng gpp vS vi khuin thu&ng tri (hope tgp nhiim), tiin hinh cSc thl nghipm sing lgc vS til uu hda theo ma trpn Plaekett - Bunnan, phuang phSp du&ng ddc nhit, phuong phSp hSm dip dng bimpt - ciu trOc cd tSm (RSM - CCD). Kit quS dS xie <^nh dugc diiu kipn sSn xuit vS tim ra du&c cdng thdc tii uu vdi cSc thSnh phin chi tiit cd thi Sp dgng sin xuit ba miu bpnh phim giS dmh chira vi khuin giy bpnh vi vi khuin thu&ng trO gdm: Miu mSu (Staphylococcus epldermldis, Acinetobacter baumannii, vl khuin tgp nhiim Buri<holderia cepacia), miu phSn (Shigella sonnel. Salmonella pamtyphl A, vi khuin thudng trO Pmteus vulgaris), miu nu&c tiiu (Pmteus vulgaris, Entenxxxeus faecalis).
Td- khPa: Ngogi kiim, phin, mSu, nu&c tiiu, Plaekett-Burman, RSM- CCD.
SUMMARY
External quality assessment scheme (EQAs) was declamd In the medical quality management
mgulatlon by Vietnam Ministry of Health, EQAs Is one of the tools for evaluating the mllabllity of diagnosis ['ll [3] To expanding the EQAs, we need the EQAs matenais, especially In clinical micmbiology. them Is almost no commemial materials because of the objective masons such as biosafety. lifetime of bacteria....
Based on the msults of a sun/ey the common samples and bacteria at the clinical micmbiology laboratories [4j, we set up the process for manufacturing of EQAs samples (blood, faeces, urine), which contain the malignant and contaminated bacteria, then we do the scmenlng experiments, optimize them following the Plaekett - Bunnan matrix, the steepest descent method, msponse surface methodology - centml composite design (RSM - CCD). Finally, we find out the condition for manufacturing and the ingmdient with the best selecting factors for manufacturing EQAs samples containing the malignant and contaminated bacteria:
blood (Staphylococcus epldermldis, Acinetobacter baumannii, contaminated Burkhglderia cepacia), faeces (Shigella sonnel. Salmonella pamtyphi A, contaminated Pmteus vulgaris), urine (Proteus vulgaris. Entemcoecus faecalis).
Keywords: EQAs. blood, faeces, urine, Plaekett -Burman, RSM-CCD.
DAT V A N Dt:
ok tridn khai ngogi kidm tra chdt luang xdt nghidm vi sinh Idm sang vdi myc tidu ddnh gid ndng lye thyc hidn eiia phdng xdt nghidm trdn tdng bdnh cdnh eg the. c i n phai ed mdu b$nh phdm gid d\nh chda cdc vi khudn thudng gdp (gdy bdnh. thudng tni hodc tgp nhidm). MOt trong nhdng ydu cdu quan trpng dd Id m i u phdi ddp dng tidu chf bdo qudn vi
Y HOC THUC H A N H (922) - S 6 6/2014
khudn theo quy t^nh cDa m$l mdu dCing cho ngoai kidm Ira chdt lugng xet nghidm. Tlieo dd, m i u phai duy tr) dugc ndng dp vi khudn d tinh trang ^ i uu trong thdi gian ydu cdu cua m i u ngogi kiem, dam bdo phdng xdt nghidm cd thd thyc hien d u g c cac xdt nghidm vi sinh tgi thdi diem nhdn mau [3], [8], [9].
Hidn nay, m i u bdnh pham gia djnh s d dung cho chuang trinh ngoai kiem tra chdt lugng xdt nghiem vi sinh Idm sdng tgi Vidt Nam ehua cd dan vj ndo eung cdp vi nhidu ly do nhu an toan sinh hpc, thdi gian sdng eua vi khudn, khdng cd lgi nhudn,... Vi vdy, chOng tdi dd tien hdnh nghidn cdu san xudt cdc mau b#nh phdm gia djnh phue vu cho kidm tra chdt lugng xdt nghidm vi sinh Idm sang tgi Vidt Nam. N h i m xdc djnh cdng thdc tdi uu cho viec san xuat mdu b$nh phdm gid i^nh nude tieu, mdu, phan phyc vu edng tdc ngogi kidm tra chat luang xdt nghidm. nhdm dd tidn hdnh cdc nghidn edu. vdi muc dich danh gid mdc dd anh hudng cua cdc yeu to tham gia vao qud trinh san xuat, mdi trudng ca chat, qua dd xac cfinh dugc nhung yeu to eg thd, vdi ndng dp, hdm luang tuang dng, dnh hudng den vide bao quan vi khudn trdn mdu. T d dd xdc djnh cdc didu kidn san xudt tdi uu dp dyng cho san xuat m l u benh phdm gia ^ n h nudc tidu, mdu. phdn ehda vi khuan thudng ggp.
D O I T U ' A N G , PHU'ONG P H A P NGHIEN CU'U:
1. Ddi t u g n g :
Miu bdnh phim gia dinh mau, phan, nu&c tiiu.
- Vi khuin Staphylococcus epldermldis, Acinetobacter baumannii, Burkholderia cepacia.
Shigella sonnel. Salmonella paratyphi A, Proteus vulgaris, Enterococcus faecalis.
- Thdi gian bao quan, nhiet dp bao quSn, ndng dp vi khuin ban diu, 11 thSnh phin tham gia tgo ca chit cda mdi tru&ng nudi ciy.
2. Phu'ang phdp:
SSng lgc vS tdi uu hda cac yiu to, thSnh phin di/a trdn vide thiit ki eSc md hinh thi nghiem: (i) thiit ki sSng lgc yiu td thl nghidm theo ma trpn Plackett- Burman; (ll) thiit ki thl nghldrii leo doc bSng phirang phSp tdi uu hda theo du&ng ddc nhat; (iii) thiet ki toi uu hda theo phirang phap ham dap irng be mat - du
trdc cd tim (RSM - CCD) {2], [5], [7].
- Nudi cSy vi khuan, dim vi tlnh toin ndng dp vi
khuin trin mdi tnr&ng nudi dy [6]. ^ PhSn tich cic so lipu thu du&c bing phin mmi
Design expert 7.0.0, Stata 10.0, Excel 2010. 4 Ktl QUA VA B A N LUAN:
Trong pham vi bdi viet, chiing tdi trinh bdy kdt qud chi tidt cua m i u nudc tidu, ddnh gid trdn kdt qud nuOi cdy ddi vdi Proteus vulgaris, doi vdi cdc ehung vi khudn khde hodc m i u mau, phdn thi cdch tidn hdnh
vd phdn tich, bien ludn tuang t y . ,, 1. Cdc ydu t d dnh h u ^ n g
Do ydu edu sdn xuat m i u dOng cho ngoai kidm trt chdt lugng xdt nghiem, do dd mdt so yeu td phdi ddp dng ydu ( ^ u b i t budc. Cg thd cdc yeu td sau 85 phdi ddp dng vd d u g c co dinh: Thdi gian bao qudn tdi inj Id 15 ngdy; nhidt dd bao quan Id 25 - 30 "C (phii hgp vdi nhi$t dp vdn chuydn mdu, gdi m i u bdng xe chuydn dung hoae gdi qua buu dien eho dan vj);
ndng do vi k h u i n gay benh Id 10° CFU/ml, ndng ddvi khudn thudng tni fd 10" CFU/ml. Nhu vdy cdn tdi iru hda 11 ydu to tham gia vao thdnh phdn ca chdt:
Bdng 1. Cdc yeu td cdn toi u u hda b i n g ede mO hinh thi nghidm
STT 1 2 3 4 5 6 7 8 9 10 11
T6n yfeu t6 NaCI (mg/ml) CaCl2.2H20 (mg/ml) MgCl2.2H20 (mg/ml) Sodium thiogiycoiate
(mg/ml) Sodium glycerophosphate
(mg/ml) Glycerol (%) Pepton thit (mg/ml) Cao ndm men (mq/ml)
Glucose (mg/ml) pH K2HPO4 (mg/ml)
Miic dird'i (-1)
2 0,05
0,1 05 5 5 2 0,5 0,5 5 1.5
Mt>ctrdn (•1)
6 01 0,5 2 15 10 4 2 2 7.S 2.5 2. Kdt qud thidt kd s a n g Igc ydu t d thi nghi$m theo ma trdn Plackett-Burman
Ket qud d y dodn t d ma trdn Plackett-Bunnan vd thyc nghidm theo bang 2.
Bang'.
Thl nghidm
1 2 3 4 5 6 7 8 9 10 11 12
. K^t qua sanq ioc theo Placi<ett-Burman (J6i v6i m i u Nu'dc tieu cht>a Proteus vulgaris Cdc yiu t6
X, 1 -1 1 -1 -1 -1 1 1 1 -1 1 -1
X, X, -1 1 1 -1 1 -1 -1 -1 1 1 1
X. Xs
-1 -1
X, 1 1 1 -1 1 1 -1 1 -1 -1 -1 -1
X, -1 1 1 1 -1 1 1 -1 1 -1 -1
x«
X, X„-1
Proteus vulgaris Log (CFU/mi) Thuc nqhidm
8,32 6.43 4,06 7.28 8,06 7.52 8.07 6.31 8.40 8.08 5.62 5,05
MAhlnh..
8.46 , 6.38 4.08 7.28 8.11 7.47 7.93 6.22 8.49 8.99 5.62 6.19
Y HOC THirc HANH (922) - s 6 6/2014
Ma trdn Plackett-Burman thu dugc ndng dp vi khuin Pmteus vulgaris tir 1.15 x 10* CFU/ml ddn 2,52 x 10' CFU/ml (td kdt qud log = 4,06 vd 8,40). Kdt qua ndy cho thdy s y khdc bi^t gida md hinh vd thuc nghidm cua ndng dp vi khudn gdy bdnh tgo thdnh dya trdn 11 ydu td theo ddi. T d dd Idm c a s d cho vide xde djnh nhung ydu id ndo dnh hudng nhdt ddi vdi chi tidu theo ddi ndy. Gid trj dnh hudng cOa cdc ydu td dugc t h l hien d Bdng 3 t)dn dudi:
Bdng 3. Mdc dnh hudng cda cdc ydu td khdo sdt ddi vdi mdu Nudc tieu chda Proteus vulgaris Ki hidu
X, X I X, X, XS X, X7 X.
X, Xio X„
Tdn y4u tfi NaCI (mg/ml) CaCl2.2H20 (mg/ml) MgCl2.2H20 (mg/ml) Na thiogiycoiate (mg/ml) Na glycerophosphate (mg/ml)
Glycerol (%) Pepton thit (mq/ml) Cao ndm men (mg/ml)
Glucose (mg/ml) PH K2HPO, (mg/ml)
Mtrc Thdo(-1)
2 0,05
0.1 0.5 5 5 2 0.5 0.5 5 1.5
Cao(+1) 6 0,1 0,5 2 15 10 4 2 2 7.5 2,5
Mdt dd vi khudn Proteus vulqaris Anh hi/ong
-0,27' 1,07*
-0.32"
-0,24°
0.73"
-0,30"
0,053"
0.087"
053"
2,28"
0.14"
Prob > F 0.0742 0.0018 0.0525 00990 0,0056 O0597 0.1000 0.3512 00137 00002 0.1846 Ghi chO: ^ Cd y nghTa d dd tin cdy a = 0 , 1 ; " Khdng ed y nghTa d dp tin cdy a = 0,1
Ba ydu td cd gid trj dnh hudng duang vd ldn sd dnh hudng tdi ctii tieu theo doi tren Id. pH, CaCl2.2H20 vd Na glycerophosphate (p < 0,1). Cdc ydu td edn lai ed dnh hudng khdng ddng kd ddn ndng dd Pmteus vulgaris (p < 0,1). Do dd, nhdm nghidn cdu chpn pH, CaCi2.2H20 vd Na glycerophosphate Id nhdng ydu td edn toi uu hda dd du-a vdo thidt kd cdc thi nghiem tidp tfieo.
Td kdt qua phdn tic^ ANOVA cOa ma trdn Plackett-Bumian, ta thu duac phuang trinh hdi quy bdc 1:
-^y = 6,933 + 0,537B + 0,363E + 1,142K
Trong dd: B: CaCl2.2H20 (mg/ml); E: Na glycerophosphate (mg/ml); K: pH
Tfnh todn lgi ngudng khdp sdt cua cdc ydu td dnh hudng t d kdt qud phdn tich ANOVA ciia ma trdn Plackett-Burman dya trdn vide lya chpn budc nhay (khodng bidn thidn) mdi.
Bdng 4. Kdt qud tlnh budc nhay mdi cho 03 yeu td anh hudng ddn Pmteus vulgaris Cdc thdng sd
Md'ccosd' Khodng bidn thidn Aj
Md-cdiyd-U-l) Mi>ctrdn(+1) Hd s6 b, Tich s6 bivd khodng bidn thidn (biAi)
Cdc ydu t6 B (mg/ml)
0.075 0.025 0.05 01 0.537 0.013
E (mq/ml) 10 5 5 15 0.363 1.815
K 6.25 1.25 5 7,5 1.142 1.428 Budc nhdy (khodng bidn thidn) mdi dugc lya chpn dua trdn hd sd b, nhd nhdt trong 03 ydu td dnh hudng.
Do dd, bude nhdy mdi se dugc lya chpn theo ydu td E (Na glycerophosphate) Id 0,4 Cdc budc nhdy cCia ydu td B, K dugc tlnh theo edng thuc bdn dudi, cd kdt qua tgi bdng 5:
fenin 0,013 f^K^K 1,42R Sg = 0.4 X ^ = 0,4 X ^^^^^ « 0,003 Slf = 0.4 X / - ^ = 0,4 x — — * 0,3
* fcfAf 1,815 ; " 6EA£ 1,815 Bdng 5. Budc nhay mdi ciia 03 ydu td dnh hudng ddn Pmteus vulgaris
Budc nhay Bu6c nhay cQ Budc nhay mdi
Y i i i t i B (mq/ml)
0.025 0,003
E (mq/ml) 5 0,4
K 1.25
0,3 3, K6t q u i thl nghiem leo ddc b i n g p h u v n g p h i p tdi iru h6a theo airtma <l6c nhit Bing 6. Thi6t k6 thl nqhiSm ieo d6c cCia m i u Nu'dc ti^u chO-a Proteus vulqaris Thl nghidm
1 (tai tdm) 2 3 4 5 6 7 8 9
Cdc ydu td anh hu-onq B (CaCli 2H2O)
0.08 0.083 0.086 0.089 0092 0095 O098 0,101 0.104
E (Na qlycerophosphate) 10 10.4 108 11.2 11.6 12.0 12.4 12.8 13.2
K (pH) 6.3 6.6 6.9 7.2 7.5 7.8 8.1 8.4 8.7
Proteus vulgaris (CFU/ml) 2.01 X 10'
6.7x10' 1.2x10"
1.56x10"
7.05 X 10"
5.1 x i o ' 8.05x10' 6,1x10' 4.05x10'
V HQC THVC HANH (922) - S6 (i/2014
Sau khi thyc hi$n 9 thi nghidm leo ddc lidn tidp. chOng t ^ £@ lya chgn lai n g v d n g khdo sdt mdi tdi uu hon dd tidn hdnh thi nghidm toi uu hda theo phuang phdp RSM-CCD. Phgm vi nghidn c d u cua 3 ydu td ddi vdi m i u Nudc tidu chda Pmteus vulgaris dugc thd hidn d Bang 7.
Bdng 7. Pham vi nghien cdu ciia 3 ydu to ddi vdi m i u Nudc tidu ehda Proteus vuiqans Ten
CaCla 2H2O (mq/ml) Na qlycerophosphate (mq/ml)
pH
Phgm VI nghidn cdu 0,087 - 0,097 10,93-12,27
7,0-8,0
Mdc -a
0,087 10,93 7,0
-1 0,089 11^20 7,2
0 0,092 11,60 7,5
+1 0,095 12,00 78
+a 0,097 12,27 8,0 4. Kdt qud tdi U'U theo RSM - CCD
So lieu sau khi dugc x u ly bang phdn mdm Design expert® 7.0.0, ta thu d u g c gid trl hdm ddp dng theo thyc nghidm vd tidn dodn theo md hinh. Ndng dp vi khuin gdy b^nh cd thd d u g c tidn dodn t d phuang trinh h^
quy sau:
''Y = 8,01 + 0.13^1 + 0,31^2 + 0,0913^3 - 0,13^1^2 - 0 , 4 6 ^ 2 ^ ^ 3 - 0 , 2 6 ^ 1 - 0.15^2 - 0.46^3 ^ Trong dd, Y Id ndng dp Pmteus vulgaris (Log (CFU/ml)); x,, X3, X3 ldn lugt Id t^'\p CaC!22H20 (mg/ml).
Sodium glycerophosphate (mg/ml) vd pH. He sd hdi quy (R^) tinh d u g c Id 0,9536.
Phan mdm dua ra 28 gidi phdp toi uu, trong dd edng thdc tdi uu nhdt, the hidn tren bidu do 3D vd ddp i^no bd mat RSM-CCD Mpt dap dng ttie hidn s y tuang tdc cua cap ydu to CaCl2.2H20 vd Na glycerophosphate tfl^
vdi nong dd Pmteus vulgans (Hinh 1), tuang t y cho cdc cdp tuang tdc khdc, t d bidu dd ndy cd thd xdc i^nh
•dugc gia tn tdi uu cOa tdng ydu td Idm cho hdm ddp dng c y c dai. I^d hinh dd d y dodn nong dd Pmteus vulgaris toi da dat duoc 8,24805 Log (CFU/ml) d gid tii cac ydu td: ty \p CaCl2.2H20 = 0,092 mg/ml, ty 1$
Sodium glycerophosphate = 12 mg/ml; vd pH = 7,35.
Proteus vulgaris
Hinh 1 M|t dap ung ndng fld Proteus vulgaris theo ty 1$ CaCl2.2H20 vd Na glycerophosphate Tuang t y ddi vdi chDng Enterococcus faecalis; mdu mdu (ddnh gid trdn tdng c$p vi khudn: Staphylocoa^
epldermldis + Buri<holderia cepacia vd Acinetobacter baumannii + Buriiholdena cepacia); m§u phdn (ddnh gid trdn tung cdp vi khudn Shigella sonnel + Pmteus vulgaris vd Salmonella paratyphi A + Pmteus vulgaris) tidn hdnh cdc thf nghiem sdng Ipc vd tdi u u hda nhu phuang phdp dd thyc hi§n ddi vdi mdu mu ndu fren, chung tM dd xde i^nh dugc cdc ydu td tdi uu tuang dng vdi hdm lugng nhu sau:
Bdng 8 Kdt qud tdi uu hda cdc yeu td dnh hudng ddi vdi cdc chOng vi khudn Logi m^u va vi khuan
Miu Nud'c tidu {Proteus vulgaris)
Ydu td anh hudng CaCl3.2H20 Sodium glycerophosphate
pH
0,092 mg/ml 12 mg/ml
7.35 M3u Nudc tidu
(Enterococus faecalis)
M^u phdn
{Salmonella paratyphi A * Pmteus vulgaris)
Sodium glycerophosphate Pepton thjt
1,51 mg/ml 3.63 mg/ml 8,06 CaCl2.2H20
Sodium thiogiycoiate K2HPO4
0,087 mg/ml 1,9 mg/ml 2,1s mq/ml MliTphdn
(Shigella sonnel + Pmteus vulgans) NaCI Sodium thiogiycoiate
Cao ndm men
4,79 mg/ml 1,71 mg/ml 1.7B mg/ml
Y HOC THVC HANH (922) - S6 6/2011
Mdu mdu
(>tcf netobacf er baumant^i + Burkholderia cepacia}
Mdu mdu
{Staphytococus e/xdermkiis + Burkhokleria cepacia)
Sodium glycemphosphate Glycerol
pH CaCb.2H20
Glycerol pH
13,22 mg/mt 14,30% v/v
7,3 0,084 mg/ml
8,30% v/v 7,05 KtJ LUAN
Qua nghidn cdu, chOng tdi dd tdi u u hda vd xdc dinh duoc hdm lugng, thdnh phdn ede ydu id tiiam gia vdo mdi trudng c o chdt tgo mdu benh p h i m gia djnh mO vd ddm dng v d i cdc chCing vi khudn gdy bdnh vd thudng tni gdm: mdu mdu (Staphylococcus epldermldis, Acinetobacter baumannii, vi Ichuln tap nhidm Burkholderia cepacia), mdu phdn {Shigella sonnel. Salmonella pamtyphl A, vi k h u i n thudng tni Pmteus vulgaris). m§u nudc tidu {Pmteus vulgaris, Entemcoecus faecalis). c6 djnh cde ydu td nhidt dd, tiidi gian bdo qudn ddp dng ydu cdu cua mdu dCing cho ngoai kidm. T d dd xdc djnh ede didu kidn tdi uu dd dp dung eho sdn xudt hai logi mdu bdnh p h i m gid djnh ndu trdn.
K I £ N NGH!
Ap dgng kdt qua tdi u u dk san xudt hai logi mdu bdnh phdm gid t^nh nude tidu, mdu, phdn d quy md phdng thi nghidm. Nghidn cdu sdn xudt d quy md ldn hon.
Ddnh gid d$ ddng nhdt vd 6P dn ffinh d thdi gian ddi han 6k xie djnh thdi gian tudi thg cao nhdt ciia m3u.
T A I Ligu THAM K H A O :
1. Bd Y td (2013), Thdng tu 01/2013/rr-BYT, hudng ddn thyc hi$n quan ly chdt lugng xet nghidm tai
ca sd khdm bdnh, chda bdnh.
2. Nguyen Canh (1993), Qui hogch thuc nghipm, Trudng Dgi hpc Bach khoa TP. Ho Chi Minh.
3. Tran Hdu Tam, Ld Thj Thijy Nhu, Le Tat Chdu, Nguyen Qdm Chau Bdo (2012), Ngogi Idem tra chit lugng xdt nghipm, Nhd xudt ban Y hpc, TP.HCM.
4. Tran Huu Tdm, Truong Quan Thgy, Le Tmng Phuang, Do T. M. Anh vd cs. (2013), "Khao sdt bdnh pham vd vi khuan gdy benh thudng gdp t^i cae phdng xet nghidm vi sinh lam sang', Tgp dil Y hgc Thgc hSnh, sd867,tr.147-150.
5. Enrique Del Castillo (2007), Pmcess op^mlzation:
a statistical appmaeh, Springer.
6. Jozef Vandepitte, Kraesten Engbaek, P. Rohner, Peter Plot, Claus C. Heuck (2003), Basic labomtory procedums In clinical bacteriology, Worid Health Organization, Geneva.
7. Robin L. Plaekett, J. Peter Bunnan (1946), T h e design of optimum multifactorial experiments".
Biometrika, 33 (4), 305-325
8. T. P. Whitehead, F. P. Woodfonl (1981),
"External quality assessment of clinical laboratories in the United Kingdom", Joumal of clinical pathology. 34 (9), 947-57.
9. Worid Health Organization (2007), Policy and pmcedums of the WHO/NICD Micmbiology Extemat Quality Assessment Pmgmmme in Africa, Geneva.
OAC DIEM DjCH TE, LAM SANG. CAN LAM SANG KiT QUA D i i u TRj HOI CHUMG GUILLAIN-DARRE AT TRE EM
PHAM VAN Dg'M'. N G U Y I N V A N T H A N G ' , O ^ N G DLTC NHU<
*Khoa y D t i g c - D^i hgc Quic gia Hi Npi, ^Tnr&ng D^i hgc Y Hi Npi T6M TAT
Myc tiiu: Nhpn xit d^c diim djch ti ldm sSng, cpn ldm sSng vS kit qui diiu tn cOa hpi chirng Gulllaln- Bani 6 tri em. SSi tirgng 168 bpnh nhin mic hpi Chung Gulllaln-Band du&c chin (todn vd diiu tn tai Bpnh vipn Nhi TW tir 1/2006 din 12/2011. Phwong phip: Nghiin cCiv ngang hdi cOv md tS vS nghidn cim ngang mdtiod dtnh hu&ng. Kit qui: 107 nam, 61 nC (^ lp nam/nCt - 2/1). Tuil tmng blnh 5 ±3,5 tu6l, 2/3 cd tiin s d nhiim triing tru&c khi phit bpnh, cd xu hudng tSng vio cic thing giao mOa. Tripu chung lim sSng hav gpp nhit li giim vpn dpna hai chin, 100% ed lipt mim, dii xOng. nggn chl nhidu hon, Hdt ludn dl kdm vdi glim hope mit phin xg gSn xuang. Cpn ISm sing cd giS tn li hipn tugng phSn ly dgm-ti bSo tmng dich nio. Diiu tn tmyin Gamaglobulin (IVIG) tim glim ty lp tu vong. Oidi gian phgc hdi chirc nSng vpn ddng nhanh hon.tylpdi lgi dl <^&ng thip han.
Tir khda: Hpi chirng Guillain-Band d trP em, Hpt mim mitphSn xg gSn xuang.
SUMMARY
Objective: To see the pattern and outcome of Guiilain-Band syndmme. Me^ods: A cross sectional descriptive study on 168 Guillain-Band childmn period fmm 1/1/2006-30/7/2011 in National hospital of paediatrics. Them wem two gmups (gmup 1: patients used IVIG in tmatment; gmup 2: patients did not use tVlG In tmatment). Results: Them wem 107 male and 61 female (male/female: 2/1). Age fmm 8 months to 15 years old, avemge aged wem 5 ± 3.5 years. Pmeeding events wem seen In 65% patients which wem In the form of upper mspimtory illnesses, diarrhoea or fiver Diagnosis based on dinical symptom accxirdlng to diagnostK criteria for Guillain-Bane syndmme. The most comon signs symtoms consisted of acute flaecid pamlysis 100% of the patients. 80 pement of eases
Y HOC THVC H A N H (922) - S6 6/2014
