L I mi GIAM DAU SAU PHAU THUAT LONG NGIH;
i^m Um ^^^^r L b.^HACAINE - FENTANYL QUA CATHETER NGOAI MANG CIING
TOM TAT
Nqliii'ii CIIII d.inh •ii.i liirii <iii.i <ii,iiii d.iii :,.iii plh'iii thii.U li'iini initn iii:i hon hop hupiv.u.uiU! Uuil-Miyl qu.i (j/Zfr/iv fKjojf /(I.ini; ninti l.ii IU}nli vidn 74 Tninij iio'im lii-n 67 hOnli nhnn llico 2 nlinin Nlidm I gom 32 bOnh nirdn dune giani tUiii r-mi nn) luiiu]
phuvng phip Iniyon nioipliino diinmi lmh iii.icli dn bdnh nhin Iwdiiii khidn (PCA) nhom II qoiii 35 l>(!iih nhan duoc gi^m dau sau mo banq phuxyiHi phiip tmydn lidn luc hdn hop bupivacnino-fanUinyl ()Uii Ciilhetei ngoai ming cung. Ket qui nghidn LIIU cho thiy Ihdi didm T,, diem VAS ciia ci 2 nhOm ddu liOn 6 diem, Sau khi licm Ihudc 15 phut. miir. do (jiiiin d.iii ciia nhdm II giim i6 rdi (VAS < 4 didm) cOn 6 nlidm I, dicm VAS cd giam nhuvg vin ldn hon 4 dicm Tgi cic Ihdi didm cdn lai tir Tosoddn TJH, didm VAS ciia 2 nhdm vin lidp luc giam cd sw khic bid! so v&i Ihdi diim To M5t khic. didm VAS ciia nhdm II giim nhidu han ding ke so vdi nhdm I lai cic thdi diem luong ung Khi b^nh nhan ging sire (ho, thay doi Iw ttid).
diem VASgi„g;^,^ cua niidm I tai cic th&i didm tuy c6 giim nhwng van > 4. cdn d nhdm li. tir tli&i didm T, tra dl. VASgi„g^u^ < 4 diem, die biet (d Te ddn 7jg thi VASgingsut: ^ 2 diSm Nhw vay, mic du da duvc giim dau nhung d nhdm I khi ging sire benh nhan vin dau nhieu han nhdm II Dieu nay cho thiy d nhdm bdnh nhan sir dung phuang phip dung hdn hop bupivacaine-fentanyl qua catheter ngoai ming cOvg cho hieu qua giam dau tot han nhdm benh nhin dux^c giam dau bSng PCA morphine tinh mach Cic tic dung khdng mong mudn & nhdm II thip han so vdi nhdm I (p<0 05)
Tir khda: giim dau. bupivacaine-fentanyl.
catheter ngoai mang ciing SUMMARY
Studies evaluating (he effectiveness of pain after thoracic surgery mixture of bupivacaine-fentanyl via the epidural catheter at 74 Central Hospital of 67 patients in two groups. Group I included 32 patients for postoperative pain relief inconvenlional method of intravenous morphine patient-controlled (PCA), gioup II included 35 patients for postoperative pain relief by means of continuous infusion bupivacaine-fentanyl mixture through an epidural catheter Research results show that the time To, VAS scores of the two groups were on a 6-point, 15 minutes after injection, the level of group II significantly reduced pain (VAS
<4 points) were in group I, VAS decreased but remained greater than 4 points. In the remaining time To.3o- T48, VAS scores of the two groups continued to decrease differences compared with To On the other
TRAN THANH TRUNG - Benh vidn 74 Trung img TRjNH V A N DONG - Benh vien Hu-u nghi Vi^tDiK Ihuid, llic VAS 1)1 group II significantly coiiip.iHul In qidiip I at Ihe corresponding time When puliuni nfloil (cough, change posture). Point group VAS„,i,„i I at times have reduced but slili> 4, wtiilein qioiip II. from T, onwards VAS,,„on lime <4 points, especially from T^ to 7JB, VAS..i,^i <2 points Thus, despite the pain, but patient in group I exertion still mora pain group II This suggests that in patients using mixed methods using bupivacaine-fentanyl via epidural catheter for effective pain patients betterpm leliof hy intravenous PCA morphine The unwanteii (.'Ifi.-cl.'; lowoi in group II than group I (p <Q 05)
Keywordsibupivacaine-fentanyl, epidural catheter DAT V A N D ^
Ptiau thuat Idng nguc du'oc coi la phau thuat gay dau nhieu nhdt do co bi cat, xuong sudn bi keo hay gdy, thdn kmh lien suon bi ton thuang Do vay, sau md bdnh nhan can duoc giam dau mpt cacli hieu qua Mdt khac, giam dau tot cho benh nhan la 6\h kidn quan trpng de thuc hien ly lieu phap som sau md[4]
Vide iya chon cdc phuang phdp giam dau saj phdu thudt long ngyc phu thuoc vdo sy thdnh Uiao, thoi quen ciia ngydi gay me va kha ndng theo doi cLia tu'ng khoa phong Trong do giam dau rgoai mang cii'ng duac coi la phuong phap tot uu nhat
Tren the gidi da co nhieu cong trinh nghien ciru dp dung cac bien phap giam dau cho bdnh nhan sau phau thuat Idng nguc 6' Viet Nam, viec nghien ciJu vd dp dung cac phuong phap giam dau sau mo da du'pc quan tam Tuy vay cac phu'ong phap giam ilau do benh nhan ty dieu khidn (PCA) bdng dudng tinh mach hay qua catheter ngoai mang cdng mdi dii dupc ap dung tai cac trung lam phdu thudt Idn.
Do vay, chung toi lien hanh de tai nay nhim muc tidu "Dinh gii hidu qui giam dau sau phau Itiu^l long nguc ciia hdn hop bupivacaine-fentanyl qua catheter ngoai ming cirng tgi Bdnh vidn 74 Trung uxyng"
D 6 | T l / a N G VA P H t / a N G PHAP NGHIEN ClW 1. o d i typ-ng nghien c d u
Nghidn cii-u du'pc tien hanh tren 67 bdnh nhfin c6 chi dmh phdu thudt ldng ngyc tai khoa Gdy me - Hoi sdc, bdnh vi$n 74 Trung y a n g t d thdng 1 ndm 2011 ddn thang 12 ndm 2012
Cdc benh nhdn cd benh man tinh kdm theo, c6 chdng chi djnh gdy me npi khi quan vd gay td NMC dyp'c loai khdi nghien cdu.
Bdnh nhdn du tidu chudn Iya chpn du'pc chia thdnh 2 nhdm
• Nhdm r Gdm 32 BN d y a c giam dau sau
mi
Y HQC THV'C HANH (858) - SO 2/2013
bdng phycng phdp truydn morphine dudng tTnh mgch do bdnh nhan t y didu khidn (PCA)
- Nbdm II: Gdm 35 bdnh nhdn dup-c gidm dau sau md bdng phyang phdp truydn lidn tyc hdn hpp bupivacaine-fentanyl qua catheter NMC
2. Phycng phdp nghidn c d u
2.1, Tbidt kd nghidn cdu: Nghidn cdu tidn cdu ean thidp Idni sdng, cd so sdnh hai nbdm,
Ca bai nhdm ddu dypc tidn hdnh ngay sau rut NKQ khi b$nh nhdn tinb hodn todn vd cd didm dau VAS>4
2.2. Cdc cht tidu theo ddi vd ddnh gid - Cdc chr tidu vd d$c didm chung cua nhdm nghidn cdu: Tudi, gidi, cdn ndng, chidu eao, ASA, thdi gian phdu thudt, thdi gian thdng khi mfit phdi, phuang phdp phdu thudt
- Cdc tidu chl ddnh gid hidu qud gidm dau sau md + Lidu lypng thudc gidm dau, thdi gian chd tde dyng giam dau
+ Ddnh gia tdc dyng gidm dau dya thep thang didm VAS vdo luc ngbt vd li:ic gdng sdc khi ho
+ Thdi didm tinh thang didm VAS la To, To,,s, To30. Tl, T2, T4, TB, TI2,T24 va T4B tyang dng cae thdi didm ngay tnj-dc khi tidm thudc gidm dau, sau tidm 15 phOt, 30 phdt, 1 gid, 2 gid, 4 gid, 6 gid, 12 gid, 24 gid vd 48 gid.
+ Ddnh gia anh hudng gidm dau ddi vdi chde nang hd hdp, tudn hoan sau md tgi cac thdi didm trdn
+ Theo ddi cdc tdc dyng khdng mong mudn 3. Xi> l^ s d ll$u: Theo phyang phdp thdng kd y hoc
KtT QUA NGHliN Ct>U
1. E)$c didm Chung ciJia nhdm nghidn c d u Bang 1. Tudi, gidi, chidu cao, cdn ndng, ASA cua nhdm nghidn cdu
^ Nh6m Tu6i (nam) ( X±SD)
1 Nam (n, %) GiftI 1 NO (n, %)
CSn n$ng (kg), ( X±SD) Chi^u cao (cm),
( X±SD]
Nhiml 46.4± 17,33
24. (75%) 8, (25%) 49,6±7,2 164,6±5,7
Nh6m II 44,5±18.19
26, (78,9) 7, (21.1) 51,2±6,1 162,9±6,2
P
>0.05
>0.05
>0.05
>0,05
>0,05
Nhdn xdt: S y khdc bidt gida cdc chl sd gidi, tudi trung binh, chidu cao va can ndng cua 2 nhdm nghidn cdu khong c6 y nghTa thdng kd
Bang 2 Phyang phdp phdu thudt
Logi ph^LTttiudi., cat thuy phdi cat phfin thuy
ph6i B6c vo 6cdn
m^nq ph6i Nh6ml (n=32) 9, (28 1%) 11,(34 4%) 12,(37 5%)
Nh6m It (n=35) 10,(28 6%) 12,(34 3%) 13,(37.1%)
P
>0 05
>0 05
>0 05
Nhdn xdt, Khdng ed s y khdc bidt vd phuang phdp p h i u thudt gida 2 nhdm nghidn cdu (p>0,05)
2. Tdc dyng gidm dau
Bidu dd 1. Didn bidn VASgingsi>c sau md
3, Anh t i l l i n g CHA gidm dau ddi v&i lid hdp vi tudn lioiln BSng 3. Tdc dunq cua qldm dau d6i v&i tuSn hodn
^-,—G!lis6 ThSigIam.,._
To To,,5 To.30 T, T2 T.
T, T,2. • . Ta , f ' T 4 .
Nh NhiSml 87,4±5,6 85.1±5,2 S3.6±4,7"
81,9±5,4*
81,3±4,6*
80,7±4,4*
78.9±6,1*
79,1±4,7«
79.3±4,5' 78.4±3,6'
p tim ( X±SD) Nhdm II 87.6±5,2 82.6±4,9- 81,7±4.3*
81,1±4,7*
80,6±4,r 80,3±4,6*
80,1±4,2"
79,8±4,3*
78,9±4,1*
79,4±3,2*
P
>0.06
<0,05
>0.05
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
•'JSW • S(f khSc biet cfi y nqma thonq k«
Huyfet dp tmnq binh ( X+SD) Nhdmi
94,7+4.8 93,4±6.2 90,9+5.4' e6.3M.7' e4.1±4,7"
81,7±3.7*
82,6±3.r 82.1±3,4*
81.a±3,2*
80.7±4,0*
Nh«m II 96,2±5.4, 90.H4.6- 89.7+4,1*
84.5±4,3*
83.6+3,9' 61.1±3,5*
81.(M:3,9' 81.9*3.2*
81.1±3.6*
80,4+3.9*
v&i p < 0.05 so vAi To
D
>0.05
<0.05
>005
>0.06
>0.05
>0 05
>0 05
>0,05
>0.05
>0 05
HANH (858)-SO 2/2013
Nhdn xdt: Tgi tdt cd cdc thdi didm t d TD,3O ddn H^B, nh|p tim vd HATS ddu gidm han cd y nghTa thdng kd so vdi thdi didm TQ. Tuy nhidn khdng thdy cd s y khdc bidt cd y nghTa thdng kd giO-a 2 nhdm tgi cdc thdi didm ndy Tai thdi didm To,i5, nhip tim va HATB eua nhdm II gidm ban so vdi nhdm I cd y nghTa thdng kd
Bdng 4. Tac dyng cCia gidm dau ddi vdi hd hdp T h S g l a n ^
To T o , , To.so T , T2 T , T , T , ! T i . T «
Tdn N h b m l 24,6+2,7 16,4+1,9*
16,911,6' 17,111.7*
18,6±1.9*
18,3±1,6*
1 8 , 4 i 1 , 7 ' 16,6+1,1*
18,0+1,3*
18,2+1,6*
s 6 t h 6 ( X l S D ) Nhdm li 25,1-11.7 21.7J0,9*
21,110,8*
19,3±1,2*
18,8+1,4*
18,0+0,9*
18,2+0,8*
18,1+1,2*
18,5J0,9*
17,9J1,0*
> 0 , 0 5
< 0 . 0 1
< 0 , 0 1
> 0 , 0 5
> 0 , 0 5
> 0 , 0 6
> 0 , 0 6
> 0 , 0 5
> 0 , 0 5
> 0 , 0 5
S p O , ( X i S D ) N h d m l
98,6±1,7 98,5+0.9 99,1+0,8 98.3+1,2 98,6±1,4 99,1+0,9 99,2+0,8 98,7+1,2 99,1±0,9 99,4+0,8
• S i / khSc bi$t c6 ^ nghla thdng kd v 6 i p<0,05 so v d i To N h d m il 9 8 4 +1. 2 9 8 6 + 1 1 9 8 7+1 4 9 9 1+1.6 9 9 3+0 9 9 9 2+1 1 9 9 4 + 1 4 9 9 1±0 9 99 4+0 9 99.3+0.9
> 0 05
> 0 . 0 5
> 0 , 0 5
> 0 - 0 5
> 0 0 5
> 0 . 0 5
> 0 . 0 5
» 0 , 0 5
>0.05
> 0 05
Nhdn xdt. Tai thdi didm To, tdn sd thd vi Sp02 eua 2 nhdm khdng cd s y khdc bidt. Tgi cdc thdi didm t d Tois ddn T4a, tdn sd thd cua 2 nhdm ddu gidm han so vdi To- Tgi thdi didm To,5 va To.30, tdn sd thd cua nhdm I gidm nhidu ban so vdi nhdm II (p < 0.01)
SpO; tgi cac thdi didm nghidn cdu vd gida 2 nhdm khdng cd s y khae bidt
3. Cic tAc d{ing khdng mong muon
Non, Bl ti«u Ngi>a Thir budn ch^m
ndn • NhOmM
D Nhdm I Bidu dd 3.Tac dyng khdng mong mudn BAN LUAN
1. Tdc di^ng gidm dau sau md
Bdnh nhan sau p h l u thudt Idng ngyc thudng rdt dau do tdn thyang ea thdnh ngyc vd cdc ddy thdn kinh lidn sudn, do dd vide dp dyng cde bidn phdp giam dau sau md cho bdnh nhdn Id rdt cdn thidt. Ket qud bidu ad 1 cho thdy tgi thdi didm To, didm VAS cCia cd 2 nhdm ddu trdn 6 didm, Sau khi tidm thudc 15 phut, mdc dd gidm dau cOa nhdm II gidm rd r$t (VAS < 4 didm) cdn d nbdm I, didm VAS cd gidm nhung vdn Idn ban 4 didm. s y khdc bi$t cd y nghTa thdng kd vdi p < 0.01. Tai cdc thdi ffidm cdn Igi t d To.30 ddn T^a, didm VAS cua 2 nbdm vdn tidp tyc gidm cd s y khdc bidt so vdi thdi didm To. Mdt khac, ffidm VAS cua nhdm II gidm nhldu ban ddng kd so vdi nhdm I tgi cdc thdi didm tyang dng.
Khi bdnh nhdn gdng sdc (ho, thay ddi t y thd), didm V A S j i ^ s ^ cua nhdm I tgi cac thdi didm tuy cd giam nhyng v l n > 4, cdn d nhdm II, t d thdi didm T, trd di, VASpinpssc < 4 didm, dac bi^t t d T j ddn T^g thi
VASgSngs^ < 2 didm. Nhy v$y, mdc du dd dug'c giam dau nhung d nhdm I khi gang sdc b$nh nhdn vdn dau nhidu ban nhdm II. Oidu ndy eho tbdy d nhdm bdnh nhan s d dyng phyang phdp dung hdn hgp bupivacaine-fentanyl qua catheter ngodi mdng cdng cho hidu qud gidm dau tdt ban nhdm b$nh nhdn 6wgc gidm dau bdng PCA morphine tTnh mgch. Oo vdy bdnh nhdn cd the ho, vdn ddng cOng nhy ly lidu phdp sdm gidm nguy ed x§p phdl, thidu oxy cQng nhif giup qud trinh phyc hdi sau md sdm han
Kdt qua nghidn cdu cua chung tdi cOng tyang dyang vdi nghidn cdu cua Hodng XuSn Qudn [4], Nguydn Vdn Quy [3]. Theo Vigdis Hansdottir [6] khi so sanh gidm dau PCA qua dudng NMC vd giam dau PCA diing morphin dudng tinh mgch trong md ngyc lgi cho rSng ca 2 phyang phdp ddu cd mdc dd giam dau tdt, tuy nhidn VAS nhdm NMC vd nbdm tTnh mgch khdng khac nhau ca luc nghi va llic gdng sdc (p>0,05).
2. Anh h u ^ n g cua gidm dau d6] vd'i hd hdp \k tuan hodn
- Kdt qud bang 3 cho thdy, sau tidm 15 philt, nhjp tim va huydt ap tmng binh cua 2 nhdm ddu giam han so vdi thdi didm TQ. Mat khdc, tai thdi didm ndy, nhip tim vd huydt dp trung binh cua nbdm II giam cd y nghTa thdng kd (p < 0.05) so vdi nhdm I. Tgi cdc thdi didm cdn Igi t d TQ.M ddn T48, cdc chl sd ndy v l n tidp tyc gidm ban so vdi thdi didm To (p < 0.05), tuy nhidn khdng thdy cd s y khdc bidt cd y nghla thdng ke gida 2 nhdm tgi cac thdi didm tuang dng
- Tdc dyng cua gidm dau ddi vdi hd hdp, tgi tiidi didm TO, tdn sd thd va SpOj cua 2 nhdm khdng c6 s y khac bidt. Tgi cdc thdi didm t d To 15 ddn T48. tdn sd thd cOa 2 nhdm ddu gidm ban so vdi To (p < 0.05).
Ddy cd le do b^nh nhSn sau md thydng rdt dau, khdng ddm thd mgnh, kbi 6w<}fc gidm dau mi bdnh nhan cd thd thd sdu ddn ddn tSng bidn dd thd, tSng thd tich khi |yu thdng vd ldm gidm nhjp thd. Tai thdi didm Tois vd TO,M, tdn sd thd cda nhdm I gidm nhidu han so vdi nhdm II (p < 0.01), didu ndy do tdc dyng dc chd tmng tdm hO hdp cda morphine Idm bdnh
Y HQC THV'C HANH (858) - SO 2/2013
nhdn thd ch^m. Sp02 tgi cdc thdi didm nghidn cdu vd gida 2 nhdm khdng thdy cd s y khdc bidt cd y nghTa thdng kd (p > 0.05)
3. Cdc tdc dyng khdng mong mudn thu'dng - Ndn, budn ndn vd bi tidu Id nhdng bidn chdng thudng g$p khi sd dyng cdc thude ddng ho morphine, nghien cdu chiing tdi gdp t j Id ndn, budn ndn d nhdm I la 25% cao ban b i n so vdi nhdm II (11.4%) vdi p < 0.05. Kdt qud nay cOng phCi hyp vdi nghien cdu cua Nguydn v a n Quy[2], thdp ban Ld Todn Thdng[1]. Ty Id b$nh nhan bj ngda vCing mdt vd cdnh mui d nhdm I la 12.5% eung cao ban han nhdm II (5.7%)
- Trong nghidn edu eua chiing tfll cd 4 trydng hp'p thd chdm 10-12 Idn/phiit, gdp d nhdm diing morphine dudng tTnh mgch. Tuy nhidn. cbiing tdi khdng phdi can thidp va chi cdn nhdc bdnh nhan thd sau vd nhanh. Chiing tdi khdng g^p trydng hq-p nhidm trOng do dat catheter NMC ndo
K t T LUAN
Qua nghidn cdu trdn 67 trydng hgp giam dau sau p h l u thudt Idng ngyc tgi Bdnh vidn 74 Trung yang, chiing tdi cd mdt sd kdt ludn sau
- Phyang phdp giam dau sau phlu thudt idng ngyc bdng mjydn lidn tyc bdn hyp bupivacaine- fentanyl qua catheter ngoai mang cdng cd hidu qud giam dau sau md tdt (cd VASnghi va VASgi„gsic ddu nhd han 4 didm Tgi tdt ca cdc thai didm, didm VAS cua nhdm II ddu thdp ban nhdm I ed y nghTa thdng kd)
- Cdc tdc dyng khdng mong mudn gdp d nhdm II
thdp han so vdi nhdm I (p < 0 05) TAI LIEU THAM KHAO
1 Ld Todn Thdng (2006), "nghidn cdu tdc dyng giam dau d y phdng sau md byng trdn cda nefopam truydn tTnh mgch trydc md & bdnh nhdn cd diing PCA vdi morphine sau md", Lu$n vSn Thgc s^ y hyc- Dgi hoe Y Hd Ndi
2. Nguydn Diyc Lam(2004), "nghidn cdu phyang phdp giam dau do bdnh nhan t y didu khidn vdi morphine ttnh mgch sau md tim hd", Luin in tdt nghidp nOi tnJ, Dgi hpc Y Hd Ndi
3 Nguydn Vdn Quy (2006), "nghidn cdu gidm dau sau md ung thy dg day bang hdn hyp bupivacaine- fentanyl qua catheter ngoai mdng cdng do bdnh nhdn t y didu khidn", Luin vin Thac s^ Y hgc- Trydng Dgi hpc Y Hd Ndi
4 Hodng Xudn Qudn (2011). "so sdnh hidu qud giam dau sau p h i u thuat Idng ngyc do bdnh nhdn t y didu khidn dung hdn hyp bupivaeaine-sulfentanyl qua catheter NMC vdi ddng morphine dydng tTnh mgch", Lu$n in Tidn sy Y hgc, Vidn nghidn cdu khoa hpc y- dyyc idm sang 108
5. Scott D.A, Beilby D.S (1995), " postoprrative analgesia using epidural in fusion of fentanyl with bupivacaine A postoprrative analysis of 1014 patients". Anesthesiology, vol.83, pp 727-737.
6, Vigdis Hansdottir, Julia Philip, Monika Fagevik Olsen, Christina Eduard, Erik Houltz, Sven-Enk Ricksten (2006), "Thoracic Epidural versus Intravenous Patient-controlled after Cardiac Surgery"; Anesthesia- logy 2006, 104:142-51.
PHAN TICH CHI PHJ KHAM CHUTA BENH NGOAI TRU TAI BENH VIEN Bini DIEN HA NOI
TOM T A T
Myc tidu: phdn tich chi phi khim chO'a b$nh ngogi tm tgi Bdnh vidn Buv Bidn Hi NOi. xic dinh cic ydu td lidn quan vdi sw hii Idng cOa ngwdi bdnh vi de xuit tridn khai hogt ddng bdnh vidn cd hidu qui han. Doi ((«mg vd phuxmg phAp: nghidn ciru didn dt ngang;
chon m§u ngiu nhidn dan theo ty' Id cdn xOng. N^i dung nghidn cvu: bdm gid vi thdng kd mdt sd chlsd dinh gii hi$u qui bdnh vidn: thdi gian chd khim, chi phi khim chwa bdnh, kdt qui didu trj; didu tra si/ hii Idng cOa ngwdi bdnh vi tinh chl sd OR, xic dinh mdi lidn quan cda mdt sd ydu td ciu thdnh hi$u qui bdnh vidn vdi si/ hii Idng cOa ngwdi bdnh. Kdt qui: Tdng chi phi cho mdt lin khim c/iOa bdnh ngogi tri) 338.22
± 76.99a, thip han so v&i cdc bdnh vidn khu vi/c Hi Noi li 656.1216. Kdt qui didu tri ngogi tnj khi tdt, dgt 87,76% khdi vd dn djnh bdnh sau mdt lidu trinh didu tri:thdi gian didu tri tmng binh ngin, 5,44±1,98 ngiy cho khdi bdnh vi 6.03 ± 1,85 ngiy cho dn djnh
TRjNH HOANG HA KhoaYDvgK, Dai hgc Quoc gia HA Npi bdnh. Th&i gtan chd dgi tmng binh cho mdt lin khim ChO'a bdnh ngoai tn) 95,79±22.48 phut, liu han cic dan vj khic tir 17,96 ddn 44,18 phOt; din ddn ty 1$ hii ldng cda ngwdi bdnh chwa cao, chl dat 55,88%.Td chde khim chira bdnh tdt hii Idng cao gip 10,1 lin td chirc khim chO^ bdnh chwa tdt (khoing tin c$y 95% li 5,9 -17,2); Thdi gian chd dgi khim chwa bdnh nhanh hii Idng cao gip 15,7 tin thdi gian khim c/iOa bdnh Idu (khoing tin cdy 95% la 6,8 - 33.3). Kdt lu$n: qua phin tfch chi phi khim chwa bdnh ngogi tni t^i Bdnh vidn Bwu Didn Hi Ndi. chung ta thiy chi phi thip, t^ Id khdi vi dn dinh bdnh cao, thdi gian didu tq dwgc rut ngin. Tuy nhidn, thdi gian chd dgi khim c/iOa bdnh Idu di inh hw&ng ding ki din si/ hii Idng cda ngu^
bdnh. VI v$y trong didu kidn cic ngudn Iwc c6 hgn, chOng ta a§c bidt wu tidn giii quydt tnj&c cic vin de cd lidn quan ddn s y hii Idng cOa ngwdi bdnh, nhim ning cao hidu qui bdnh vidn. cQng c6 Idng tin cOa xa hdi ddi vdi Nginh y td.
BHpC THV'C HANH (858) - SO 2/2013
