: TAP CHi NGHIEN CpTJ Y HOC h
DAC DI^M LAM SANG TRIEU CHLTNG OAUf TRONG MOT S6 R 6 | LOAN LIEN QUAN O^N STRESS
Trdn N g u y i n Ngyc Tn/dng Bai hgc Y Hi Ndi Dau la tridu chung thudng gip tmng cie rdi loan lien quan din stress. Nghien cuv nhim lam sing td dgc diem lim sing tridu chiing dau tmng cic roi loan Iiin quan din stress, gdp phan chin doin sdm vi (Mu trj kip thdi ngay tai tuyin dau. Kit qua cho thiy: vi tri thudng gip: diu mpt cd 65,5% trong r& ktpn lo iu. 85%
tmng cie roi loan dang ca thi. 100% tmng phan ung vdi stmss trim trmg: ftep dd, dau lung, dau bpng, dau ngwc vi dau cic khdp, vdi tinh chit mo hd. cam giic nang ni. cuong d^ dau ting tin khi dm xuc cing thing, khd chiu Kit luin: Tridu chOng dau phat sinh vi diin biin tmng dc rdi loan tim sinh cd ll§n quan din cie nhin td tim ly- xa h^. thudng gap d nhom tuoi 20 - 39 (44,7%). Bpnh dnh lim sang chiim uu thi la cic tridu Chung dau chde ning da dang, phong phu khdng cd bing chimg tdn thuong thuc thi.
Tir khda: dau t a m sinh
L DATVANOe
Dau Id trifiu chdng t h u d n g gdp trong Idm sdng h l u h i t cdc chuyfin khoa. Mdc d i u cd s y x u l t hifin khde nhau trong tdng bfinh ly, nhunp hfi qua cua dau dd anh hudng khfing nhd d i n c h i t l u y n g cufic s i n g hdng ngdy cua ngudi bfinh. Trong Idm sdng tdm than hpc, dau. mfit moi. r l i loan g i l c ngu lifin quan d i n t)finh ly ttiyc t h l vd chde ndng. Trong dd, mfit bfi phfin dang k l cdc rdi logn lidn qugn d i n stress d u y c tim ttily cac trifiu chdng dau vdi nhdng tinh c h i t vd b i l u hidn khd dfic ddo. Mdt s l nghifin c d u cho t h i y , trifiu chdng dau c h i l m tdi 4 5 % trong r l i logn lo du vd hoang sy. tiTsng dd 80% Id dau ngyc [4, 8]. Trong nghldri c d u cua Gay.C vd Boureau.F (1995) [6], d tdi 50% dau dong phdt vdi t r i m d m trong cde b | n h ly r l i logn dgng e y t h l . vd mang Hnh chdt man tinh. Trong cdc roi logn lifin quan d i n stress sau sang c h i n , dau d u y c phdt hifin c h i l m ti* Ifi 20%, chu y l u Id dau ddu, dau bung vd dau ngyc [4. 8]. Trong thyc hdnh tdm than hpc vd cdc chuyfin khoa. tridu ehdng dau gdp khd pho b i l n . nhung cho d i n nay van d l ndy vdn chua d c^ng trlnh ndo nghifin c d u d hfi ttilng.
Vdi mong m u l n Idm sdng to dfic d i l m Idm sdng tnfiu c h d n g dau trong cdc r l i logn lifin
qugn den stress, tdc gia t i l n hdnh nghifin cdu d l tdi vdi muc tifiu: Ldm sdng td ddc d i l m ldm sdng tiidu chdng dau trong cde r l i logn lifin quan d i n stress, gdp phan c h i n dodn sdm vd d i l u tri kip thdi ngay tai t u y i n dau.
II. D 6 | TU'gNG VA PHU'aNG PHAP
1. Ddi t u v n g
Thu nhdn nghifin euu 56 bgnh nhdn ed d e r l i logn lien quan d i n stress d u y c d i l u trj tgi vifin S u e khoe Tdm t h i n trong ndm 2010.
- Nhdng bfinh nhdn ndy du tifiu c h u l n c h i n dodn roi logn lifin quan d i n stress (ICD 10, 1992) [1] a i tiifiu Chung dau; vd nhdng trifiu chdng roi logn c h u c ndng thudc v l ca the than kinh ttiuc vfit ndi tgng d u y c xdc dinh t>di ede bae sT khoa lifin quan khdm xdt qua Idm sdng vd cdn Idm sdng
- Logi hT> nhdng bfinh nhdn cd tiidu ehdng dau ti^ng tifinh ly logn ttiln ndng n h u hoang tudng. do gidc. r l i logn hdnh vi tdc phong.
h d c cdc bfinh ly ttiue t h l . 2. Phiramg phdp
Nghifin ciru mfi ta Idm sdng tdng ca. cd p h i i hap s u dgng b-dc nghifim tdm ly BECK d l ddnh gid trgng ttidi t r i m cam, ZUNG d l ddnh gid tinh trang lo d u . D i n g t h d i . nghidn
100 TCNCYH 75 (4)-2011
cdu ddc dilm tinh cdch ngufii bfinh vd cdc rli togn c^Ctc ndng khdc tt^fin ti>ng b$nh nhdn ridng bifit.
Xu ty s l lifiu thu thdp ^i^dc blng phuang phdp todn thing kfi diing trong y hpc.
III. K £ T QUA
1.0$c dilm chung cua b|nh nhan
Bdng 1. Sy phdn bd b|nh nhdn dd khdm vd dilu trj d cdc chuyin khoa tru>dc dd Chuydn khoa
Chua khdm chuyin khoa ndo Tm mach
Thin kinh Co - xuong khdp Oingy Tiiu hod Phing khdm da khoa
n 7 13 20 10 9 9 27 •
%
12.5 23,2 35,7 17,8 16,1 16,1 48,2 Cdc bdnh nhdn cd cdc tridu chdng dau dd cd thdi gian ddi din cdc chuyfin khoa trude khi din vdi chuyin khoa tdm thin. Rli logn dau gdp nhilu d b|nh nhdn dd din khdm Phdng khdm da khoa (48.2%), tllp theo Id chuyfin khoa thin kinh (35,7%), tim mgch (23,2%), tifiu hod (16,1%).
Bdng 2. S^ phdn b l tuli vd thdi gian bi b|nh
Tuii ~-___Thdl 21-30 31-40 41-50
>60 Ting si
gian < Indm
a
9 3 .1 16 (28,57%)
1-2 ndm 9 ' 14
6 3 32 (67,14%)
> 2 n i m
-
4 2 2 8(14,28%) ,
Ting s6 % 12(21,42%) 27 (48,21%) 11 (19,64%)
6 (10,71%) 56 (100%) Li>aluii thudng gdp 10' 31 - 40 (48,21%), niu llnli ca li>a tuii 21-30 (21,42%), thl d i tuii 21 - 40 chiim Idi 69,63%. Ddy Id d i tuii cing hiin nhiiu siic lao ding nhit cho xd hii. Binh cd xu hudng kio ddi nhiiu ndm, trd nin man tinh: 2 - 5 ndm (57,14%), < 1 ndm (28,67%).
2. Oj^c diim tr<$u chinig dau trong cdc r«l lo^n Iiin quan din stress
Triiu chi>ng dau hay gdp nhit Id frong cdc rii loan to du (61,9%), tiip din Id rii loan dang co Ihi (35,7%), trong cdc phdn ling vdi stress trim tnjng, triiu chCrng dau gdp 12,5%.
S i liiu tO' bing 4 cho thiy, vj trl dau thudng gip nhiiu Id d diu - mdt - c i , tiip din Id d nguc cdc khi»p vd bung.
TCNCYH 75 (4) - 2011
I TAP CHi NGHIEN CUtl Y HOC F
Bang 3. Si^ phdn bd tri^u chdng dau trfin cdc ttil bgnh
Rii loan lo du
Roi loan dang co Ihi
Phan dng vdi stress tram trgng
Bang
Vitri Dau - mdt eo Lung, thit lung Cdo khdp Bung Ngyc
Thi binh Roi loan lo au lan toa Roi loan hoang so Rii loan CO thi hoa Rii loan dau dai dang Rii loan nghi binh Phan dng stress cap Rii loan stress sau sang Phan i>ng tram cam ngin 4. O^c diem vj tri dau tren
RL lo du N1 % 19 65,5 14 48,3 12 41,3 11 37,9 22 75,9 •
chin
& kio ddi cac benh RL dang
N2 17 15 11 6 11
n 27 2 12 5 3 1 2 4 ly (rdi loan) thu'dng gap CO thi
%
85 75 55 30 55
%
48,3 3,6 21,4 8,9 5,4 1,8 3,6 7,1
Phan U'ng vdi stress N3
7 1 2 2 5
%
100 14,3 28,6 28,6 71,4 IV. BAN LUAN
0|ic dilm Chung cua bgnh nhan nghien cdu
Tu kit qua nghifin cuu cho thay. roi logn dau chde ndng Id thudng gdp, vd dd cd mfit thdi gian dilu Iri theo dan tgi phdng khdm da khoa, hodc dieu tn npi tru d cdc chuyfin khoa thin kinh (35.7%), tim mgch (23,2%). lifiu hdg (16,1%), ca xuyng khdp (17,8%). Rli lojn dau chde ndng difin ra thudng xuyfin vd kfio ddi Idm cho bfinh nhdn khd chiu, hp tdi khdm vd dieu tri nhilu tiidng nhilu ndm tgi cdc chuyfin khoa So nhung it cd kit qua. Kit qua cua chung tdi phii hyp vdi nghifin cdu cua Bond MR, Hugles (1997) [4], Gallogher RM (2004) [8],
Nhan xdt vfi tuli va thdi gian bj b^nh Trong bang 2. tiifiu ehung dau thudng gdp y Ida tuli 31-40 tuli (48,21%), mfit phin nhd
d tuoi trudng thdnh 21 - 30 tuli (21.42%), rlt' It gdp d tuli trfin 50 (10,71%). Nghidn edu thdi gtan bj bfinh, ehiing tdi thiy b|nh dao ddng td 6 thdng din 5 ndm. Thudng gdp nhilu hyn d tu 1 - 2 ndm (57.14%). Khuynh hudng bfinh tiln triln lifin tye din din mgn tinh nhilu ndm vdi tri|u chdng dau chde ndng da dgng lufin thay dli. Ngudi b|nh dd trai qua nhilu dich vg y te ban d i u . k i t q u i khdm nghifim cdc chuyfin khoa diu binh thudng vd khfing giai thieh duyc mil tuang quan v l mdc dfi cua cdc trifiu chdng vdi sy bdn tdm qud muc cua ngudi bfinh. Kit qua nghifin cuu cua Chung tdi phij hyp vdl nghidn cdu eua Trin Hdu Binh (2004) [3], Gay C, Boureau F (1989)16].
Sir phdn b l trifu chipng dau vd d$c dilm kilu dau, tinh chit dau trong cdc rli logn lien quan din stresss
Trong cde rli logn lifin quan din stresss TCNCYH 75 (4)-2011
(bang 3), tiifiu chdng dau gdp nhilu trong rli logn lo du (51.9%). Nhilu nghifin cdu cho ttily cd mli lifin quan cua lo du vd stress; dau xult hifin trong cdc rli logn ndy sdm. cudng dfi dfi ttiay dli ttieo trgng thdi lo du. Ngudi bfinh than philn dau bdng rat hodc buot nhdi. xay ra tiJ'ng con, nhit thdi. ludn chuyin, lidn quan chdl che din d m xiic cdng thing [5. 7J. Trong cdc rli logn dgng ey thl, dgu chllm ti Ifi 35,7%, dau vdi d m gidc dfi ndng, dau lifin tyc hon Id tdng can, vdi d m gidc ma ho, Idm biln dli d m xuc trd nfin buIn chdn vd dau khi. Bdi vdy, mdt s l tdc gia cho ring, dau trong cdc rli logn dgng ca thl. ddc bi|t trong ca thl hod, thudng cd trifiu ehdng trim d m . vd d c tdc gll coi dd Id hifin tuyng "ca thl hod d m xiic" [2, 5, 6]. Trong nghifin cdu cua chiing tdi, tuy trifiu chdng dau gdp ti Ifi khdng cau (12,5%) trong phan dng vdi strass trim tiqng, nhung dde dilm kilu dau, tfnh chit dau, cudng dd dau ed nhieu bilu hidn nhy dau ttong rli logn lo du
Trong nghifin cdu ndy, chiing tdi khdng dug ra bang cdc sang chin tdm ly, nhung tim hieu trong liln sd cua cdc b|nh nhdn, chOng tdi nhdn thiy phin Idn d m xuc cua hp cd tinh chit dm tinh md hp phai trdi qua idu ddi trong qud khd. Ngudi b|nh phdi dc chl sy bdc Id nhdng d m xOc ciJa minh trong nhdng dilu kifin sinh hogt cOg ddi song gia dinh vd xd hdi.
Oilu dd dd din din sy cdng thing cua qud trlnh uc chl, hinh thdnh stress cam xiic.
Nhdng bifin giai ndy td s l li|u nghifin cdu cua Chung tdi, phii hyp vdi nhdng nhdn xdt ddnh gid cua mdl so tdc gid khi nghiin cdu v l stigss d m xiic [2, 5. 7].
Vific nghifin cdu mfit cdch thfin tnpng trifiu Chung dau trdn cd Hnh cua ngudi bfinh vd sy hinh thdnh d tinh dd; cQng nhu cdc nfit. cdc dd^ dilm cua sy phdn dng thufic v l d ' j triic d m xiic, dde bifit id sy biln dli ciia d m xOe vd nhdng tdc dfing eua.chiing din ca thl, dd duyc chiing tdi vdn dung khdo sdt trfin tdng bfinh nhdn rifing bifit Do vfiy. nhdng bilu hifin
I TAP CHt NGHISN CChJ Y HQfc I d m xuc v l mdt ca t h l gpi Id ca the hfia d m xuc t«>ng cde roi logn lifin quan din stresss khac nhau bleu hifin bdng nhdng trifiu chdng dau chde ndng, vd nhdng trifiu chdng thin kinh thyc vgt npi tang phong phCi vd da dgng trfin ngudi bfinh
Nhu vdy. rd rdng cdc tinh huong v l tinh ddc higu eac xung dfit d m xuc vd ddc ^ I m eua cdc nfit cam xCic trfin tdng ngudi bdnh dd hinh thdnh canh tuyng dau trong Idm sdng phong phu vd da dgng ve ddc dilm, tinh chit vd vj trl trdn cdc rli logn lifin quan din stresss.
Oilu dd dd khfing it gdy ra nhilu nhim lln trong chin dodn phdn bifit vd dilu trj khfing cd kit qua cho cdc thiy thulc ndi khoa vd chuyfin khoa tdm thin, Trong nghifin cuu eua GayC, Boureau F, (1989) vd Gallogher. RM (2004) [6. 8] cOng cd nhdng ddnh gid tuang ty nhu Chung tfii.
Nhan x i t chung v l d$c dilm Idm sdng cua trieu chdng dau trong cdc r l i logn lien quan d i n stresss
Thing kfi nhdng trifiu chdng Idm sdng cGa bfinh nhdn nghifin cdu, cho thiy bfinh d n h ldm sdng bieu hifin chu ylu trifiu chdng dau ehdc ndng phong phu vd da dgng trfin cdc vj tri. ca quan khdc nhau cua ca thl. Td dd, hinh thdnh nhdng phdc bd trifiu ehdng thufic ve cde chuydn khoa, phan dnh mil quan h | eua tdc dfing tdm thin vd ca thl bdng cdc nhdn t l llfin quan (sang chin tdm ly. ylu t l the chit vd dde tinh nhdn cdch).
Kdm theo dau Id sy biln dll d m xuc chu ylu Id trim d m nhg, khfing diln hinh. Sy dc chl d m xiic md nhgt, khfing nli bdt. ngudi bfinh ch! than philn trifiu chdng dau da dgng ve vj tri, ddc dilm, didn biln trfin cdc roi logn lifin quan din stresss. Trifiu ehdng dau du xly ra tdng can hay lifin tye vdi cdc tinh chit khdc nhau bdng rdt, chdy bull, hodc d m gidc dfi ndng,... diu gdy ra roi logn gilc ngii. gilm dn ngon mifing. gdy ra d m gidc m|t moi, chfim chgp v l tdm ly vfin dOng cho ngudi bfinh, Sy
TCNCYH 75 (4)-2011 103
I TAP CHl NGHigN CI>U Y HQcl xult hifin tiifiu chdng dau trong cdc rli logn lidn quan din stresss lifin quan den nhdng biln dli d m xiic cua ngudi b|nh, lifin quan den ttnh trgng rli togn kh( sic trong nhdng dilu kifin ddi sing tdm ly' khd chiu, nhdng khd khdn hay xung d|t. cCing vdi nhdng nfit bifin doi ve ddi sing tdm IJ cd nhdn md chiing toi nhdn ttily ttong cfing ti-lnh nghidn cdu.
C/ ddy, dilu ddng chd y Id trong lien sd cua b|nh nhdn. phin Idn diu ttm thiy yeu t l chin thuyng tdm ly. Ylu t l dd cd tinh chit khdi ddng vd Idm biln dli nhdng phin dng sinh \^
kfio ddi ttifing qua hfi thing than kinh ttiyc vdt vd ca quan nfii d m thy tde dfing din d e ey quan ndi tgng gdy ra nhdng biln dli chde ndng khdc nhau. Dilu dd cho thiy sy hinh thdnh tridu chdng dau theo mdt ea ehl tdm - sinh hpc phdc tgp, ddi hdi thiy thulc thyc hdnh phdi cd quan diem tdm - thl trong chan dodn vd dilu trj.
V. K^T LUAN
Nghl0n cdu dde diem Idm sdng trilu ehdng dau trfin 56 bfinh nhdn cd rli logn lifin quan din stress, chiing tfii n!it ra mdt s l nhdn xdt
Bfinh thudng gdp d dfi tuli dng hiln nhilu kha ndng lao ddng 20 - 40 (69.63%);
khuynh hudng tiln triln lifin tyc, 'trd ndn mgn tfnh: 6 ttidng - 1 ndm (28,5%), 2 - 5 ndm (57,14%).
Bfinh gdp nhilu d phdng khdm da khoa (48,2%). chuyfin khoa ttiln kinh (35,7%), tim
mgch (23,2%), tifiu hod (16,1%). Ldm sdng ttifiu Chung dau hay gdP nhll Id titing d c rli logn lo du (51.9%). bilu hifin nhilu d dlu-mdt- d , d ngyc. lung-thlt lung, d c khdp vd byng,
T A I LIEU THAM K H A O 1. T l chipc y t l t h l gidi (1992). Phdn logi bfinh quIc t l lln thd 10 v l d c rli logn tdm thin vd hdnh vl (lCD-10), Bin d|ch tilng Vi$t, Hd Ndi.
2. Y hoc gia dinh (1999), Nhd xult ban Y hpc, 194-398.
3. Trdn Hdu Binh (2004). Ddnh gid tdc dyng thulc ching trim d m trong dilu trj cdc chdng dau mgn tinh, Tgp chl Nghidn cdu Y hpc Trudng Ogi hpc Y Hd Ndi, T4, 45 - 51.
4. Bond M.R., Hugles. (1997). Psychotogi- eal aspects of chronic pain, in diatil stud, V9, NOI, 23-27.
5. Ferreri M. (1997). Stress td b§nh hpc tdm thin din cdch tilp cdn trong dilu trj.
NXB MQi Cd Mau, thdnh phi H i Chf Minh.
6. Gay C , Boureau F. (1989). Douieur et Depression. Autour de la Depression.
Numecro Special. 120-131.
7. Ghen J.H. (2001). Sinh ty hpc Idm sdng ey sd, NXBYH.
8'. Gallogher R.M. (2004). Mood anxiety disorders in chronic peine. Hand book for heath cari pro viders pnagrers in pain research an management Vol 27.
Summary
C L I N I C A L F E A T U R E S O F P A I N F U L S Y M P T O M IN S O M E R E L A T E D - S T R E S S D I S O R D E R
Pain is a common symptom in related-stress disorders. Objectives: To identify clinical features of painful symptoms in related-stress disorders, to help early diagnosis and timely treatment in primary care Results: Sttess-related disorders were most common in the age 20 - 39 (44.7%).
the male\female ratio: 1.7/1. The highest percentage of pamful symptoms was headache, which was 65.5% in anxiety disoders, 85% In somatofomi. disorders, 100% in reaction to severe stress and adjustinent disorders; tollowing are back pain, abdominal pain, chest pain and muscutoskeletal pain. All these symptoms are indefinite, with heavy sense and worsened when patients are
4
104 TCNCYH 75 (4)
i TAP CHi NGHigN CU'U Y HQC I wonied or nervous Conclusion: The onset and progress of painful symptoms in psychogenk;
disorders have association with psychological and sociological factors. The chief complaint Is functional pain which is multifomi and not explained by a physical cause.
Keywords: pychogenic pain
KI^N THLKC, T H y C HANH SIP DUNG NLFQC SACH C O A NGU'ai DAN 4 XA CO NGUY CO IWAC TIEU C H A Y C A O 6^ HA T A Y
Dao Thj Minh An Vidn dio t$o Y hgc di/phong vi Y ti cdng c^ng - Dai hgc Y Hi N0i Nghidn ciru duoc thuc hidn nhim md ti kiin thiic. thwe hinh su dung nudc spch vi mdi Iiin quan giua kien thCic vi thpc hinh eua ngudi din tpi mdt sd d?lm c6 nguy eo mic tidu chiy tpi tinh Hi Tiy. Kit qui:
Hiiu biit cua ngudi din ve ngudn nudc spch chua diy du theo dc tiiu chi' nudc tmng 73.0 - 83,3%; mau.
mili. vj 41,5 - 59,6%: nudc khdng sach giy tidu chiy 66.7- 77.6%; giy vidm da. dau mit 28,6 - 33.7%; giy binhphukhoa 12.5% -13,9%. Cd sw khie bidt vi thuc hanh su dung nudc spch giO^ cie ^a ban. Tylilpc nudc trong nhQng hd gia dmh (HGD) dung nudc giing khoan td38.7 - 96.3% Tylihpgia dinh dung nudc miy chi biin thwc phim cdn thip 27.3 - 38.3%. Tj^ 1$ thuc hinh udng nude dun sdi cao tu 83,9 - 91.5%.
Ngudi cd hiiu biit vi tiiu chuin nudc spch cd thwc hinh dun sdi nudc trudc khi udng vi sir dpng nudc S9Ch chi biin thwc phim tdt hon ngirdi khdng c6 hiiu biit. Ngudi cd hiiu biit vi tic hpi cda sd dpng nudc khdng spch cd thwc hinh sd dpng nudc miy tdt hon. Ngudi c6 hiiu biet sir dpng nudc ehua dun s6i giy Siu chiy cd thpc hinh chi biin thwc phim bing nudc spch cao hon cd y nghTa thdng kd.
Tir khod: n u ^ sgch, nguy ca tidu chdy I. OAT V A N Bt
Hd Tdy Id mdt tinh thudc Oing blng sdng Hing vdi ddn s l khoing 2,5 trifiu ngudi trong dd ddn s l nfing thfin chilm 91%, Ndm 2008, Nght quylt s l 15/2008 cd hifiu lyc thi hdnh ngdy 01/08/2008 dd sdt nhdp Tinh Hd Tdy vdo ttidnh phi Hd Ndi. Trudc vd sau thdi dilm sdt nhdp ndy. tifiu ehdy elp dd xay ra trfin dja bdn Idm Hd Tdy trd thdnh mdt trong nhdng dilm ndng v l djch tifiu chiy d p . Kinh dien dich tfi hpc, ndi din tifiu chay d p thi cdu hdi diu tifin Id nguin nudc sd dyng eho sinh hogt nhu t h l ndo? Hllu bilt cua ngudi ddn vd thye hdnh su dyng nude sinh hogt cua ngudi ddn nhu ttil ndo? VI vdy tgi thdi dilm sdt nhdp vdo Hd Nfii, nhdng thfing tin v l kiln thdc, ttiyc hdnh cua ngudi ddn Hd Tdy lidn quan din nudc sinh hogt td hit sdc d n thilt Trd Idi cdc cdu
hdi ndy se cung d p mfit phin thdng tin glup cdc nhd hogch dinh chlnh sdch cd cy sd cho xdy dyng ede chuang trinh can thifip thieh hyp gdp phin phdng ching dich tifiu chay d p ti'dn dia bdn Hd Tdy. Muc tidu:
- Md ta kiln thdc, thyc hdnh su dyng nguin nude sgeh.cua ngudi ddn Hd Tdy.
- Mo ta liln quan giua kiln thdc tdi thyc hdnh sd dyng nudc sgch cug ngudi ddn Hd Tdy.
II. D 6 | TU'Q'NG VA PHU'aNG P H A P
1.0|a dilm nghien cdu
Nhdng dilm cd nguy ey ego mdc tilu chay d p : 4 dja bdn duyc Idnh dgo d n g ding, ngudi ddn vd sd y t l Hd Tdy lya ehpn vdi tifiu chi dd luu hdnh hodc cd nguy ey eao mic tifiu chay d p nhu sau:
TCNCYH 75 (4)-2011 105