Y HOC VI^T N A M T H A N G 4 - S 6 2 / 2 Q 1 3
DO BAO PHU VA HOAT DONG CUA NHAN VIEN Y TE THON DAN TAI MOT SO TINH KHO KHAN
N g u y e n Hoang LongS T r a n Khanh ToSn'
T 6 M TAT
Nghien cu'u mo ta nhSm d^nh gia thi/c trgng bao phil va hoat dong ciia NVTITB thong qua phong van bSng bp cau hoi cau triic ket hop phong van sau v^
thao lu§n nhom vdi can bp quan ly y te, trUdng tram y te xa va NViTTB tai 10 tinh kho khSn. Ket qua cho thay ty le bao phii NVYTTB deu dat tren 80% song trinh do v3n hoa cua NVYTTB con thap. Tren 50%
NVYTTB chu^ du'dc dao tao hoac dao tao 3 thang.
Phan ldn NVYTTB chda dUOc trang cap tui YTTB va thuoc thong thudng; danti muc thiet bt lac hau.
NVYTTB chii yeu lam nhiem vu tuyen truyen giao due sire khoe, ve smh phong chong dich, ho trp cac chu'dng trinh muc tieu quoc gia chir chUa thUc hien du'dc viec sd cutJ, xir tri ban dau, Che do phu cap cho YTTB nliin chung con thap va rat khac nhau giO'a cac dia phu'dng. Can tang cu'dng viec tuyen chon va dao tao chuyen mon cho NVYTTB, cap tui YTTB vdi danh myc trang thiet bi dUdc cap nhat va tang che do phu cap cung vdi ho trd BHYT cho NVYTTB.
Td khoa: bao phii, hoat dong, y te thon ban, cac tinh kho khan.
SUMMARY
COVERAGE AND PERFORMANCE OF VILLAGE HEALTH WORKERS AT SOME DISADVANTAGED
PROVINCES
This descriptive study descnbes the coverage and performance of village health workers in some disadvantaged provinces. Results showed that the coverage of village health workers was above 90%, but their educational level was still low. More than 50% village health workers have not been trained or were trained for only 3 month. Most village health workers were not equipped with village medical bag and common medicines; the equipments were outdated. The main tasks of village health workers were health education, preventive hygiene, support the national targeted programs, but not performing first aid management, Allowance for village health workers varies between provinces and was generally.
Recruiment and training policy for village health workers should be strengthened; village medical bags with updated equipments should be provided. It is necessary to increase the allowance for village health workers and provide them with health insurance.
Keywords: coverage, performance, village health workers, and disadvantaged province.
I.
OAT VAN OENhan vien y te thdn, ban (NVYTTB) du'dc coi la canh tay nol dai ciia cac Tram y te (TYT) trong cdng tac cham sdc sifc khoe ban dau (CSSKB0)[1]. Tru'dc day, NVYTTB du'dc tra thu lao bang cong diem, boat dpng cd ne nep, da gdp phan tich cu'c vao cdng tac chSm sdc va bao ve sire khoe nhan dan tren dja ban. Tif khi thu'c hien Khoan 10, nhat la tir khi thyc hien chfnh sach Ooi mdi, mat trai ciia cti che thi tn/dng da cd anh hu'dng Idn doi vdi y te cd sd, trong do co y te thdn ban. Khdi phue va nang cao chat lu'dng hoat dpng ciia mang lu'di y te thdn ban la mot trong nhu'ng chl tieu trong Nghi quyet 37/CP ngay 20/6/1996 cua Chi'nh phu ve dinh hutfng chien ludc cham soc va bao ve siit khoe nhan dan den nam 2000 va 2020.
Den cuoi nhO'ng nam 1990, ciing vdi si/ hoi sinh cua y te xa, mang lu'di YTTB cung tiTng bulSc du'dc khoi phue. Nam 1999, Bo Y te da ban hanh quy dinh NVYTTB thtfc hien 5 nhiem vu la: (1}
truyen thdng GDSK; (ii) hu'dng dan thi/c hien ve sinh phdng benh; (iii) cham sdc sii'c khoe ba me tre em va KHHGO; (iv) sd culi ban dau va cham soc benh thong thu'dng; (v) thifc hien cac chu'dng trinh y t e . Mang lu'di y te thdn ban da tirtig bu'dc ddng vai trd ngay cang quan trpng trong cong tac CSSKBD d tuyen cd sd. Tuy nhien, dau tu' cho NVYTTB cdn chu:a tu'dng xifhg nhu cau va chifc nang nhiem vu trong bdi canh tac dpng ciia nen kinh te thj tru'dng, dan den hieu qua hoat dong ciia doi ngu NVYTTB d nhieu ndi cdn han che.
Nghien ctfu nay du'dc thu'c hien trong khuon kho Du" an Tang cu'dng nang life he thdng y teed sd mpt sd tinh trong diem do GAVI tai trd (giai doan 1, 2007-2010) vdi muc tieu danh gia ttii/c trang va hoat ddng ciia y te thdn ban tai 10 tinli khd khan, t i f dd de xuat cac giai phap doi mdi chat lu'dng va hieu qua hoat dpng YTTB, gop pl^n nang cao chat luttng cong tac cham sdc sufc khoe t a n dau tai tuyen y te cd sd tnDng tinh hinh mdi.
Bo Y te, ^Tru'dng Dai hgc Y Ha Nqi
Phan bien khoa hpc: PGS.TS. Nguyen Thj Ktm Chiic 96
Y HOC VigT NAM THANG 4 - s6 2/2013 II. DOI TUpNG VA PHUONG PHAP NGHIEN COu
2.1. Dia ban nghien cCfu: 10 tinh thupe dien khd khan trong dif an ho trd phat trien y te trong diem do GAVI tai trd, gom: Ha Giang, Cao BSng, Bac Kan, Bac Giang, Dien Bien, Ha Tay cu, Kon Tum, l i m Bong, Binh Djnh va Tra Vinh.
2.2. Thiet ke nghiSn cuTu: Nghien cifu md ta ket hdp djnh lu'dng va nghien cu'u djnh ti'nh, vdi cac ky thuat thu thap thdng tin sau: (1) Tong hdp cae thong tin so lieu sin cd; (2) Sif dung phieu thu thap thong tin tai 10 tlnh nghien cifu va (3) Phong van sau can bo quan ly y te, tru'dng
tram y te (21 cupc), va thao luan nhdm (14 cuoc) vdi cac NVYTTB va ngu'di dan tai 07 trong sd 10 tinh thupc du'an.
2.3. Npi dung thong tin du'dc thu thap:
bao phil NVYTTB, trinh dp ehuyen mdn, dao tao, trang thiet bj, eong viec thu'dng xuyen, che dp dai ngp, cac van de khd khan trong hoat ddng cua NVYTTB.
2.4. Phan tich so lieu: Sd lieu dinh lu'dng du'dc phan tfch theo phu'dng phap thong ke md ta va sd lieu djnh tinh du'dc phan tfch theo phu'dng phap ma nguon md.
III. KET QUA NGHIEN CUU 3.1 Dp bao phu NVYTTB
Tinh den cuoi nam 2007, ty le bao phii NVYTTB d eae tlnh nghien cifu deu tren 90%, trif Dien Bien 86,2%. Cac tinh Cao Bang, Ha Tay eu, Tra Vinh deu dat 100%.
3.2. Mot so dac diem ciia NVYTTB
Bang i. Thonq tin ca nhan cua NVYTTB (%)Ha Giang
B S C Can
Cao Bang
o i f n 1 Bac Bien 1 Giang
Ha Tav
Binh e i n h
Kon T u m
L3m Oong
Tra Vinh
GMi
Nam
NO-
7 2 , 7 27,3
36,0 6 4 , 0
3 6 , 1 63,9
71,7 28,3
22,5 77,5
26,6 73,4
28,5 71,5
69,9 3 0 , 1
18,3 8 1 , 7
46,2 53,8 0o tuoi
< 2 0 2 0 - 3 9 4 0 - 5 9
> = 6 0
Doc, Viet Tieu hoc THCS FTTH
4,3 71,6 23,8 0,2 10,2 3 6 , 3 4 5 , 0 8,5
0,7 72,2 26,8 0,3 5,9 2 4 , 0 4 7 , 6 22,5
2,3 75,3 22,2 0,3 3,9 2 9 , 5 3 2 , 1 34,5
0,8 71,8 2 6 , 5 0,8
0,3 37,5 6 0 , 0 2,2 Trinh do van h
15,3 5 1 , 7 31,0 2,0
0,8 10,9 6 8 , 7 19,6
0,7 4 5 , 3 50,3 3,7 ja
0,1 4 , 6 37,9 57,4
0,5 56,2 4 0 , 3 2,9 0,2 10,2 51,8 38,8
3,8 69,3 25,0 1,8 0,5 27,4 4 7 , 6 24,5
1,9 52,0 45,3 0,8 0,2 22,3 56,3 21,2
0,7 31,6 60,9 6,8
1,3 47,4 37,3 14,0
Tai phan Idn cac tinh, nhat la cac tinh mien nin nhu' Cao Bang, Bac Can, nhdm tud'i chiem ty le cao nhat la tif 20-40 tuoi, trong khi eae tinh dong bang nhu' Bac Giang, Tra Vinh, dp tudi tif 40-60 tuoi chiem da sd. Da so NVYTTB tai hau het cac tinh (trif Dien Bien) deu cd trinh dp tif pho thong cd sd trd len. Ty le NVYTTB chi mdi biet doe biet viet van ehiem ty le kha cao d Dien Bien (15,3%) va Ha Giang (10,2%).
3.3. Trinh do c huy
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Hinh 1. Trinh dp ehuyen mon cua y te thon ban
Y HQC VI$T NAM T H A N G 4 • 56' 2/2013 Ty le NVYTTB chu'a qua dao tao d nhieu tinh
van cdn tren 50%, nhat la d Ha Giang (87,4%) va Tra Vinh (79,6%). C^c tinh Dien Bien va B3C Can CO ty le NVYTTB du'dc dao tao cao (lan Iu'dt la 98,0% va 96,0%). Da so NVYTTB chi du'dc dao tao ngan han 3 thang.
3.4. Trang bi dung cu, thuSc cho NVYTTB
Viec cap till YTTB !^ rat can thiet. Trong 2 nam 2006-2007, chi ed 2 tinh la Kon Tum va B3C Giang da phat tui YTTB bang ngan sach ciia dja phu'dng vdi so lu'dng han ehe va danh muc da lac hau, mot sd dyng cu nhu" bdm tiem thiiy tinh, nep chan tay...da khong cdn phii hdp.
'Tai dia ban xa, trWdc day NVYTTB da dddc cap tui y te thon ban, nhdng hien nay da mat mat, hoac hong khong sd dung dddc. Van nen cap tlii y techo NVYTTB vi dfa ban xa rgng, nhan vien YTTB CO the ho trd cho TYTxa"
(Phong van Tram trddng TYTxSdKon Tum) Cae tinh nhu' Kon Tum, Ha Giang, Dien Bien da thu'c hien tu'dng ddi tdt viec cap phat thuoe thdng thu'dng (cam eiim, tieu chay...) thdng qua NVYTTB de giilp ngu'di dan viing sau, viing xa v.iS trf kip thdi mpt sd benh thdng thu'dng trong dieu kien phai di lam tren ray, tren nu'dng, each xa ban, lang, khu vu'c dan cu'.
3.5. Hoat dong cua nhan vien y t e thon ban NVYTTB tai cac tinh nghien eu'u da thtfc hien thu'dng xuyen cong tac tuyen truyen-glao due sdc khoe, ket hpp vdi hddng dan thdc hien ve sinh phdng benh long ghep trong trien khai cac chu'dng trinh muc tieu quoc gia tai cpng dong. Day eung la nhiem vu du'dc NVYTTB tal cac tinh nghien cifu trien khai nhieu nhat.
"Cong viec thddng xuyen la tuyen truyen ve sot xuat huyet (van dong cong tac ve sinh, ngu miing, diet aing quang..}, tuyen truyen va ho trd phat hien didi benh nhd aim gla cam, va cac dkii benh khac, cac diudng tnnh ciia TYT phan cong"
(Thao luan nhom can bg TYTxa d Tra Vinh) Cham sdc sifc khoe ba me tre em va KHHGD 1^
mpt nhiem vu thu'dng xuyen khac eiia NVYTB tai cac dja phu'dng dude khao sat, trong dd quan ly thai san, bem chiing md rpng, phdng chong suy dinh du8ng la cac cong viec hang dau. Cac-NVYTTB deu cd so theo doi hang thang cae sd lieu cd ban nhu* so phu nCf"
mang thai, so tre sinh ra, tre tiem chiing,...
"Tat ca cac thong tin i « so ngddi de, ten me, ten con, bao nhieu da tiem chiing, bao nhleu chua dem... tdl deu nhd het va co so ghi chep "
(Thao luan nhom NVYTTB d Ha Giang)
Ngoai viec quan !y thai san, theo doi cart nang tre em trong chu'dng trinh phong chong suy dinh du'dng mpt sd dia ban viing sau, viing JQ NVYTTB con dam nhiem ca vai trd ba d d .
"Ca xa CO khoang 20% ddi tddng de tai nha, do d nhuhg ban xa dl lai kho khBn, nhleu trddng hdp sd din TYT mat iien dl lai, Bn uong, ngon ngd bat dong, do phong tuc tap quan nen ^ phal ho trd. Khong dddc hpc hanh bai ban, nhuhg lam nhieu nen quen".
(Thao luan nhom NVYTTB d Dien Bm) Sd cihj ban dau va -VAS tri benh thocig thu'dng la mdt nhiem vu da du'dc quy djnh nhu'ng thi/e ^ cho thay phan ldn NVYTTB chua thtfc hien du'dc nhiem vu nay bdi vay tuyen truyen phong chong djcii benh, ho trp thi/c hien cac chu'dng trinh mgc tieu quoc gia van la nhiem vu chinh. Y kien eiia mdt can bp y te d Tra Vinh the hien dung chii'c nang, nhiem vu va kha nang thiTc te ciia NVYTTB tai cac tinh nghien cifu:
"Hien nay, tnnh do cua NVYTTB con kem, chua thdc hien dddc viec sd cuij ban dau, hay ho trd tiem chiing cho nhan dan. Tuy nhien viec tuyen truyen lai dddc thdc hien rat tdt, ho hp giam sat va quan ly dich benh, guan ly doi tudng tiem chiing".
(Thao luan nhom taiSd Yte Tra Vinh) 3.6. Chinh sach, che do dai ngp cho y te t h o n ban
Mifc phu cap du'dc ap dung d hau het cac tlnh deu du'di lOO.boOd/thang. Mot so dia phu'dng van gii? mifc phu cap 40.000 dong/thang theo quy dinh tiS nhieu nam nhu" Bac Kan, Cao Bang, Tra Vinh. Chi mpt so tinh quy djnh mii'c cao hdn nhu' Ha Tay (297.000 d cho mien mil va 189.000d cho virng dong bang), Binh Oinh (200.000d/thang). Hau het NVYTTB chu:a co the BHYT va can phai du'dc xem xet de dam bao khuyen khi'ch dpng vien mpi ngu'di lam viec.
Hau hit cac nhan vien y t i thon ban chui CO the BHYT. Niu co die BHYT thi rat tdt, cung la dgng vien cho chung toi cgng tic vdl nganh y te.
Chung Inl cung cd the la nhOhg ngddi tuyen truyen ve BHYT ma ban than lai khong c6 the thi rat I(h6 ^ tiiuy^phiic ba con tham gia BHYTtdnguy&i.
(Thao luan nhom NVYTTB d Tra Vinh)
IV. BAN LU/^N
Ty le bao phu NVYT d cac tinh nghien cifti dat cao hdn mu'c trung binh cua ca nUdc trong eiing ky [ 3 ] . Dieu nay cho thay sy* quan tam va
Y HOC VIET NAM T H A N G 4 • SO 2/2013 no It/c ciia nganh y te ndi chung va cae dja
phu'dng trong dien nghien cifu ndi rieng. Cung nhu' nhieu nghien cifu tru'dc day, nu' chiem ty le ldn trong cd cau NVYTTB d hau het cac tinli [5,7]. Tuy nhien trinh do v§n hoa ciia NVYTTB v i n con kha thap so vdi yeu can nhiem vu theo quy djnh [ 1 ] . Mac dii da sd cac NVYTTB deu da tot nghiep trung hpc cd sd trd len song ty le chl mdi tdt nghiep tieu hpc van cdn kha cao. Tham chi tai mpt so tinh nhu' Ha Giang, Dien Bien van con tren 10% NVYTTB chi mdi biet dpc, biet viet.
Trinh dp van hoa thap lam han ehe ed hpi du'dc dao tao va kha nang tiep thu kien thifc chuyen mon ciia NVYTTB. Ngoai viec dao tao kien thifc chuyen mon, nhieu tinh cdn phai ket hdp giang day van hoa eho NVYTTB. Tren thu'c te, phan Idn NVYTTB chu^ du'dc dao tao hoac mdi chl du'dc dao tao trong vong 3 thang. Mac du ket qua nay da cho thay nhutig chuyen bien dang ke so ydi con sd chua day 'A sd NVYTTB du'dc dao tao theo ket qua dieu tra y te qudc gia 2001-2002 [4] song van chu'a the dap ifng du'pc nhu cau tai cac tinh cd dieu kien dja ly kinh te khd khan. Ty le NVYTTB chifa qua dao tao chuyen mon d cac tinh nhu' Ha Giang, Tra Vinh van con chiem den 80%. Tang cu'dng tuyen chon va day manh dao tao can du'dc coi la mpt nhiem vu trong tam nham tang cu'dng hieu qua hoat dpng ciia mang lifdi NVYTTB tai cac tinh nghien cifu.
Ngoai viec dao tao chuyen mdn, trang thiet bi cung ddng vai trd quan trpng giup NVYTTB hoat dpng mot each cd hieu qua. Theo quy djnh CLia Bp Y te ve danh muc trang thiet bi chuan ciia Bp Y te [ 2 ] , moi NVYTTB ed mdt tiii YTTB vdi 17 dang muc bao gom cac dung eu y te thong thu'dng, mot so vat tu' tieu hao phue vu sd cifu ban dau tai cd sd. Viec trang bi tiii y te thdn ban la rat can thiet, dac biet la tai cae virng sau, viing xa, ndi dong b^o khd tiep can cac cd sd y te. Tui YTTB se giup NVYTTB ho t r d nhan dan trong sd cull ban dau, thifc hien mpt so dich vu y te ed ban...Viec b-ang bj tiii y te cho NVYT tai hau het cac dja phu'dng ctii thifc hien mot lan, qua nhieu n3m su" dung, phan ldn cac tiii y te da mat mat, hu" hong khong du'dc cap phat lai. Dieu nay dan den han ehe trong viee trien khai thu'c hien cac nhiem vu ciia NVYTTB, nhat la nhiem vu sd cap CLitj va xit tri ban dau cac benh thdng thu'dng.
Viec trang cap day dii tiii YTTB vdi cac danh muc thiet bi du'dc cap nhat la het sifc can thiet de dam bao hoat dpng ed hieu qua ciia NVYTTB.
ThLfc te khao sat cung cho thay cac NVYTTB chii yeu tap trung thifc hien cac nhiem vu ve tuyen truyen giao dye sifc khoe, ve sinh moi tru'dng, phong chong djeh benh va ho trd eae chu'dng trinh mue tieu y te quoc gia. Tu'dng tif nghien cifu ciia Vien Chien lu'dc ehinh sach y te, NVYTTB ddng vai trd quan trpng trong quan ly thai san, van dpng tiem chiing [ 7 ] , phdng chong suy dinh du'dng d tre em. Cong tac xif trf, cap cifu ban dau chu'a du'dc thy'c hien cd hieu qua do ban che ve trinh dp chuyen mdn cung nhu' thieu cac vat tu', thuoc men va trang thiet bj can thiet.
Can bp quan ly y te cac cap tai cac tlnh du'dc khao sat deu danh gia cao ddng gdp ciia NVYTTB trong viec thy'c hien cac chu'dng trinh myc tieu y te qudc gia tai tuyen cd sd.
Oieu kien d\ lai khd khan, ndi dung cong viee nhieu song che dp phu cap cho NVYTTB cdn qua thap nen chu'a khuyen khi'ch du'dc hoat dpng cua mang lu'di YTTB [ 7 ] . Nhieu tinh hien nay van ap dung mife phu cap 40.000 dong/thang du'dc quy djnh tif each day hdn 10 nam |;6] la khdng cdn phir hdp. Viec long ghep vdi cac chu'dng trinh muc tieu quoc gia va cac d i / an tai trd ciia nu'de ngoai la can thiet de tang d i e dp phu cap qua dd thuc day hieu qua hoat dpng ciia mang lu'di NVYTTB. Viee xem xet ho trd BHYT cho cac ddi tu'dng nay la mpt de nghi hdp ly trong boi canh chiing ta dang hu'dng den BHYT toan dan.
V. KET LUAN VA KIEN NGHj
Ty le bao phii NVYTTB d hau het eae tinh deu dat tren 90%, vdi do tuoi chii yeu la 20-39 d cac tinh mien nui va 40-59 d eae tinh dong bang.
Tuy nhien trinh dp NVYTTB van cdn han che. Ty le NVYTTB chu^ du'dc dao tao hoac chl mdi du'dc dao tao 3 thang ehiem tren 50%. Phan Idn NVYTTB chu'a du'dc trang bj tui y te thon ban va thudc thdng thu'dng, cae dung cu phan Idn da lae hau. Hoat dpng chinh ciia NVYTTB ehii yeu van la tuyen truyen van dpng ve sinh moi tru'dng phdng chong djcii va ho trd trien khai cac chu'dng trinh muc tieu qudc gia. Nhiem vy sd cifu va xif trf ban dau cdn rat han ehe. Che dp phu cap rat khac nhau giij^ cac tinh va nhin chung con thap, chu'a khuyen khi'ch NVYTTB hoat dpng tfch ei/c cd hieu qua.
Can tang cu'dng cdng tac tuyen chpn va dao tao chuyen mdn bai ban cho dpi ngu NVYTTB.
Moi NVYTTB can du'dc trang cap mpt tui y te thdn ban vdi danh myc trang thiet bj can du'dc
Y HQC VigT NAM T H A N G 4 - 56' 2/2013 Bp Y te xay du'ng lai eung vdi mot sd thuoc, vat
t l f do Sd Y te quy dinh phii hdp vdi nhu cau CSSK ciia dja phu'dng. Tang che dd dai ngp di doi vdi xem xet h5 t r d BHYT cho NVYTTB.
TAI LIEU THAM K H A O
1. B$ Y te (1999). Quyet dlnh ciia Bp tru'dng Bo Y te so 3653/1999/QD-BYT ngby 15/11/1999 quy djnh chifc nSng, nhiem vu ciia nhSn vien y te thon ban.
2. Bp Y te (2002). Quyet dinh so QO 437/2002 ciia Bg trUdng Bo Y te ve vi^c ban hanh danh myc trang thiet bj y te b^nh vi|n da khoa tuyen tinh, huyen, phong kham da khoa khu vUc, tram y te xa va tui y te thon ban.
3. BQ Y te (2008). Nien giam thdng ke y te 2008.
Bp Y te - Tong cyc thdng kg (2003). Bao c^c ket qua dieu tra y te qudc gia 2001-2002. Nhi xuat ban Y hoc.
Bui Thi Thu Hci, Nguyen Van Du'dng (2008), Hoat dpng ciia y te thon ban va mpt so yeu to li§n quan, T?p chi Y hoc thu'c hanh, so 5, tap 608+609, frang 88-90.
Vdn phdng Chinh phu ( 1 9 9 8 ) . Thong bao so 176/TB-VPCP ngay 14/10/1998 ciia VSn phong Chinh phil thong bao y kien ciia Pho Thii tudng Pham Gia Khiem ve viec chi phy cap cho nhan vien y te thon ban.
Vi^n Chiin lu'dc va chinh sach y te (2011).
Danh gla thy'c trang nhan lUc y te hoat ddng trong chu'dng trinh tiem chiing md rgng.
http://www.hspi.org.vn/vcl/danh-gia-thuc-trang- nhan-luc-y-te-hoat-dong-trong-chuong-tnnh-tiem- chung-mo-rong-t60-1176.html
N H A N XET K H O A N G THOn GIAN THICH HOP TUT LUC TAC IVIACH DEN KHI PHAU THUAT U MANG NAO.
Iran Van Viet"
TOM TAT
42 benh nhan (BN) u mang nao npi sp nhan hPn 50% mau cap tir dgng mach (DM) canh ngoai du'dc gay tac mach tru'dc khi phau thuat. Ghi lai mat dp ciia u tai thdl diem phau thuat. Quang thdi gian tif khi gay tac mach den khi phau thuat dUdc chia thanh cac giai doan <6 ngay, 7-9 ngay, va > 10 ngay. BN dUdc chia thanh 2 nhom: nhom 1 di/dc phau thuat vao mot ngay nhat djnh sau khi tac mach; nhom 2 du'dc phau thuat mugn hdn. Chiing toi so sanh mat dp u, lu'dng mau mat, thdi gian nam vien, thdi gian phau thuat, do Simpson khi phau thuat va ty le bien chifng d ca 2 nhom. Ket qua: U mem dat toi da vao ngay thu" 7-9 sau khi tac mach. Khi quang thdi gian sau tac mach lau hdn 10 ngay, khong lam u mem them. So vdi cac BN nhom 1, cac BN nhom 2 khong bi mat mau them, thdi^gian nam vien khong keo dai hdn hoSc khong co ty le bien chirng cao hOn. a nhom 2, phau thuat mat it tli6i gian hdn, va dp Simpson thap hdn. Ket lu^n: 6 cac khoi u mang nao co hdn 50% mau cap la tif DM canh ngoai, quari^ thdi gian toi ifu tif sau khi gay tSc mach den khi phau thuat la 7-9 ngay. Quang thdi gian nay cho phe^ mu'c do lam mem u cao nhat, lay bo u an toan va de dang.
* Tru&ng Dai hoc ky thuat y te'Hai DdOng Phan bien khoa hgc: PGS.TS. Nguyin Quoc Dung
SUMMARY
INTERVAL BETWEEN EMBOLIZATON AND SURGERY IN PATIENTS WITH MENINGIOMA
42 Patients with intracranial meningiomas that recceived more than 50% of their blood supply from the external carotid artery undenvent embolizatwn before surgery. The interval between embolization and the tumor consistency at the time of surgery were recorded. The inten/al between embolization and surgery was divided into periods such as < 6 days, 7-9 days, > 10 days and an average tumor consitency score was obtainned in segments. The patents were assigned to two groups, gnjup 1 undenvent surgery on a specified day after embolization, gnaup 2 undenvent surgery at a later. We compared tumor consistency, blood loss, length of hospitalization, surgical resection time, Simpson grade at surgery, and complication rate in both groups.
Results, on the polynomial regression curve, the greatest tumor softening occurred 7-9 days after embolization. When the postembolization inten/al exceedad 10 days occured. Compared with group 1 patients, groups 2 patients did not have an increased blood loss, a longer hospitalization, or a higher complicaton rate. In group 2 the surgical procedure
