VIETHAM MEDICAL JOURNAL H°1 • JANUARY - 2017
NGHIEN CU'U MOI LIEN QUAN GIU'A NHIEM K H U A N MAC PHAI VA DAT >
CATHETER TINH MACH TRUNG TAM TAI KHOA HOI SU'C CAP CtiV Nguyin van Chi*, Nguyin Thanh Son**, Lg Thi Binh**
T O M TAT
Muc tieu nghien cihi: Nghien ciJlJ moi lien quan glEfe tinh trang nhiem khuan mac phai vdi d i t va Iu'u catheter d cac benh nhan dieu trj tei khoa Hoi sffc h'ch cifc (ICU) benli vien Hffu Nghj. Dor tU^ng va phu'dng phap nghien cihr. Nghien cffu du'dc thiic hien tren 93 benh nhan dieu tri tai khoa Hoi sffc tich ci/c du'dc dat va lu\j catheter tinh mach trung tam (CVC) tren 48 gid, trong thdi gian nghien cffu tff 01/8/2014 - 1/9/2015. PhuWng phap nghien cffu mo ta cat ngang, so lieu thu thap duci tren bang theo ddi BN hang ngay, ho sd benh an, cac ket qua xet nghiem can lam sang. Ketqua:!^ le ty le nhiem khuan mac phai (NKMP) 6 ngUdi benh dat CVC chifm tdi 2,2%.
Co su" lien quan giii^ Benh nhSn dat CVC d cac khoa khac chuyen den bj NKMP cao hdn benh nhan du'dc dat CVC d Khoa Hoi sffc cap cffu (p < 0,05), giii^ so Hn dam kim > 1 fan co nguy cd NKMP cao hdn dam kim 1 lan idii d | t CVC (p < 0,05)., so lan thay bang chan CVC hai ngay/1 lan cd nguy cd NKMP cao hdn so vdi so IBn thay bang chan CVC 1 lan/tuan (p < 0,05).
Kei lu$n: Nhiem khuan mac phai gap ty le thap d b|nh nhan dSt catherter tTnh mach trung tam, nhuYig CO lien quan den (^ua tnnh cham soc cua iSeu di/9ng.
Tu'khoa: Nhiem khuan mac phai, tinh mach du'di don, catheter tinh mach trung lam
SUMIVIARY
RESEARCH O N PREVALENCE OF ACQUIRED INFECTION I N PATIENTS W I T H CENTRAL VENOUS CATHETER AND R I S K FACTORS AT
I N T E N S I V E CARE U N I T Objecthres of the study: The study of relationship the status of ao^uired infections with catheter placed and stored in ICU patients. Subjects and research methods: The study was performed on 93 patients treated at the Intensive Care Department, who have been set and saved central venous catheter (CVC) in 48 hours, during the study period flTjm 01/8/2014 - 09/01/2015. Research Methodology describe the cross, the data collected based on the daiiy monitoring of patients, medical records, the resuits of preclinical tests. Resuits:
Prevalence rate of infections in patients suffering from
* Benh win Bach Mai
** Dai hoc Thing Long
Chju trach nhiem chfnh: Nguyen VSn Chi Email: [email protected] Ngay nhan bai: 5.10.2016 Ngay phan bien khoa hoc: 2.12.2016 Ngay duyet bai: 29.12.2016
CVC accounted for 2.2%. There Is an association", between patients in other depart:ments placed CVCg were moved to higher than placed CVC patients Jn'- Department of intensive care and poison cPntrol (p
<0.05), between the give needle > 1 times, the risk of infection acquired a needle' is inserted 1 times higHier'- when patients in Central venous catheterisation (p
<0.05), between dressing changes of catheter two days/1 times will infection acquired times higher than the number of dressing changes the CVC 1 times,/™
week (p <0.05). Conclusion: The acquired infections of central venous catheter placing in patients were low, but is related to the pnxess of nursing care.
Keywords: acquired infections, subclavian vein, central venous catheter
I. DAT VAN DE
Dat catheter tTnh mach trung tam la mot thu thuat xam lan, ong thdng dffdc dat tru'c tiep vao mach mau nham muc dfch kiem soat huyet ddng, dffdng vao eua thuoc, djch, san pham mau va dinh duQng ngoai du'dng tieu hda day ding ih mot trong nhffng cong viec theo ddi va dieu tri benh nhan (BN) nang cua dieu dffSng vien (DDV) tai cac phdng cap cuff. Viec dat catheter tTnh mach trung t a m tren BN nang la vd cung can^thiet, tuy nhien day cung la mgt nguy uS gay, nhiem khuan mac phai. Nhiem khuan catheter tlnh mach trung t a m la mot trong nhffng loai nhiem khuan benh vien thffdng gap, bdi nhffng hau qua cua nd nhu" lam tang thdi gian nam vien, tang chi phi dieu trj va tang t i le tff vong. ':
_ Ngay nay^ nagg lu'c cua dieu dffdng Viet Nam-:
da du'de the hien trong cdng viec cham soc ngffdi benh, va tai Khoa ICU cua BV Hffu Nghj cd so Iffdng BN phai dat catheter tTnh mach triing tam nhieu hdn eae khoa khac trong BV, viec TDCS cua dieu duSng vien (DDV) de han die NKBV ludn du'de nhac nhd de phong triinh va day cung la ly do tien hanh nham muc tieu:
1. Danh gia thu'c bang nhiem khuan mac phai ben ngu'di benh co dit Catheter ffnh mach bvng tam tai Khoa Hoi sut: bch cut-BV Hihj Nghi.
2^ Xac dinh mpt yeu idiien guan den nhiem khuan mac phai tren ngu'di benh cd dat Catheter tinh mach bung tam.
II. OOI TU'ONG VA PHUONG PHAP NGHIEN CUU 2.1.{)|a d i e m v a t h d i g i a n nghien cuti -Dia diem: Khoa Hoi sffc tieh Cffc benh vien Hffu Nghj.
24
TAP CHJ Y HOC VlgT HAM TJ>P 450 - THANG 1 - SO 1 • 2017
-Thdigian nghien ci/i/;Tff thang 8 nam 2014 den thang 9 nam 2015.
2.2.11eu chuan chon benh nhan Nghien effu 93 benh nhan dieu tri tai Khoa Hoi sffc tich cffc, cd chi djnh dat va lffu CVC tren 48 gid. Khdng gidi han tuoi, gidi, nam, nff, tinh trang benh t^t cua ngu'di benh. Thdi gian tff ttiang 8 nam 2014 den thang 9 nam 2015.
2.3.Tieu chuan loai trCC benh nhan: Cd tang ehtfrig NKBV tai cac Benh vien hoac cac Khoa khac tai thcfi diem nhap Wioa Hoi sii'c ti'ch CLTC nhu": sdt, tang bach eau, cd d nhiem khuan...
2.4. Phu'dng phap nghien cii'u 2.4.1. Thiet ke nghiSn CIJXI: Md ta cat ngang Cd mau nghien ctht: Chon cd mau thulin Hen, bao gom tat ca cac benh nhan dffdc dat CVC tti" thang 8 nam 2014 den thang 9 nam 2015.
2.4.2. Phu'dng phap thu thap so [i$u Sff dung benh an mau, thu tiiap sd lieu tff cac bang theo ddi ngffdi benh, cac ket (^ua xet nghiem ca trong benh an: Theo dung mau thiet
kethl^t lap (dung protocol). Lay benh pham lam xet nghiem; lay mau benh pham dung qui trinh
2.4.3. Cac bi^n so va chi so thu thap Ten, tudi, gidi, nghii nghiep, dia chi, vi tri choc CVC: TTnh mach dffdi ddn, TTnh mach canh tnsng, thdi gian lffu catheter. Dau hieu tai vi tri dat: Xung huyet, dd, dau, cd djch, khd, saeh.
Than nhiet tai thcfi diem eay khuan: Khdng sdt:
nhiet do < 37°5., Sot: nhiet dp > 37°5./ket qua cay vi sinh.
2.4.4.Phu'dng phap lay b$nh phSm Thdi diem lay benh pham: Sau dat CVC 24 gid, theo chi dinh cua bac sy dieu trj.
2.3. Xuf ly sdl lieu: So lieu dffdc thu thap qua phieu thu th|p so lieu va xff ly Bang phan mem epiinfo 6.0 de tmh cac ty le %, trung binh trung va mdi lien quan giffa cac bien. ' 2.4. Han che cua de tai: Cd mau nghien cffu chffa du ldn, hau het la cao tuoi, dia dff chu yeu ia Ha Ngi
III.KETQUA NGHIEN CCTU
3.1. So ngay dat CVC trung binh cua benh nhdn
Bang 3.1: So ngay Iu'u CVC trung binh cua ddi tu'dng nghiencu'u Ngay dat CVC
So ngay Iu'u CVC trung
binh
NKMP d binh nhan CVC
Benh nhan dat CVC (n = 93)
11 ± 8,485
Khong NKMP d benh nhan CVC
• ±SD
9,98 ± 8,075 >0,05 Nhan xet i^ac du ehuS tim thay SLT khac biet giu^ sd ngay nam vien cua BN eo dat CVC bi Nl^P vi i so ngay nam vien ciia BN cd dat CVC khdng bi NKI^P. Tuy nhien, sd ngliy trung binh d BN bi NKf^P khi cd dat O/C ed xu hffdng cao hdn so ngay BN khdng bj NKMP (11 ± 8,485 ngay so vdi 9,98 ± 8,075).
3.2. Cac dau hieu lam sang tai vi tri dat CVC Bang 3.2: Bieu hien lam sang tai vl tri dat CVC
Dau hieu tai clian CVC Tay do, co dich tham bang
Xunq huyet, kho Tong
Benli nlian dat CVC Cn := 93) N
04 89 93
Ty le »/o 4,3%
95,7%
100 Nhanxet: Benh nhan dat CVC tai chan CVC khd va cd hdi bi xung huyet chiem ty le cao gap 22 lan so vdi benh nhan tai chan dat CVC cd tay do va cd djch tham bang (95,7% so vdi 4,3%).
3.3. Tyie nhiSm khuan mac phai d ngu'di benh cd dat CVC
I
Bieu do 1: Ty le nhiem khuan mac iihai d ngu'di benh dat CVC.
Nhan xet Trong 93 benh nhan cd dat CVCJhl ty le nhiem khuan mac phai khi dat CVC chi chi&n 2,2%
3.4. Mgtsoydu tff lien guan deh nhiem khuan Catheter tinh mach trung tam
VIETNAM MEDICAL JOURNAL N''1 - JANUARY -2017
Bing 3.3: Cic yeii ioiien quan din nhiim khuan Catheter tfnh mach irung Hm dngwdi benh dai CVC.
Bien s6i
Sif liin quart giu'a tudi cua NB vdi nhiim khuin CVC
NK mac phai Khonq NKMP
Lien quan giWa cac diu hiiu lim sanq vdi NKMP
NK mac phai Khonq NKMP Lien quan gida BN tWca,c khoa^
khic chuyen din vdi nhiem khuan CVC
NK mac phai Khonq NKMP Sit liin quan glWa sd lan dim kim
vdi nhiem khuan CVC NK mac phai Khonq NKMP Lien quan giii'a sd tin thay bang Catheter vdi NK mac phai tai CVC
NK mac phai Khonq NKMP
Ngu'di benh dat CVC (n =93) NKMP
< 75 tuoi 0 to,o%) 25 (27,5%) Xung huyet, Icha
0 (0,0%) 91 (100%) BN CO dat CVC tiJT
cac khoa ichac chuyen den
1 (50%) 7 (7,7%) So lan dam kim 1
ian 1 (50%) 86 (94,5%) So lan thay bang 2
ngay/ lan 1 (50%) 7 (7,7%)
Kh6nq NKMP a 75 tuoi 2 (100%) 65 (72,5%) Bb, CO djch
2 (100%) C (0,0%) BN dat CVC tai
khda HSCC 1 (50%) 84 (92,3%) So fan dam kim >
l i a n 1 (50%) 5 (5,5%) So lan thay bang 1
tuan/ lan 1 (50%) 84 (92,3%)
P
>o,o5 ;,
< 0,001* •
1
'^'
<0,a5 ,:
<0,05 }\
<0,05 Nhin xet: Chu^ tim thay su* l<hac biet giu'a
cac nhom tuoi cua ngi/di benh Ichong bj nhiem khuan CVC vdi nhom tu6i ngi/di benh bj nhiem khuan CVC vcli p > 0,05. Co sif khk biet ro ret giEfe benh nhan da du'dc dat CVC d cac khoa khac chuyen den Khoa ICU so vdi BN dat CVC tai khoa ICU p< 0,05., Cd str khac biet r5 ret giOi so ian dam kim chi 1 lan khi dat 6/C vdi so lan dam kim > 1 Sn khi BN dat CVC vdi p < 0,05., Co sir khac biet giu'a so lan thay bang chan CVC hai ngay/1 lan vdi so lan thay bang chan CVC 1 lan/tuan vdi p < 0,05.
IV.BAN LUAN
4.1. So ngay dat CVC trung binh cua doi tu'dng nghien cu'u: Ket qua bang 3.1 da thay rang, so ngay Iu'u CVC trung binh ciia benh nhan bi NKMP la 11 ± 8,485 (ngay) dai hdn so vdi BN khong bl VPTM la 9,98 ± 8,075 (ngay), chuS nhan thay su* khac biet giUci so ngay dat CVC lien quan den NKMP vdi thdi gian \\iM Oit d nhffng BN dat CVC khong bj NKMP (p > 0,05). Ket qua nay phii hdp vdi ket qua ciia Nguyen Ngoc Sao [- 6]. Do han che ciia doi tu'dng nghien cilu la nhieu nhffng can bo cao cap co dp tuoi cao, do vay KQNC chu^ chi ra du'dc su' lien quan giffa thdi gian iu'u CVC va tinh trang NKMP.
4.2. Cac dau hieu lam sang tai vi tri dat CVC Ket qua NC d bang 3.2 cho thay, phan idn tai chan CVC kho va cd hdi bj xung huyet cd ty le
cao gap rat nhieu lan so vdi BN co cac bieu hien lam sang tai chan dat 04C cd tay dd va co dich tham bang (95,7% so vdi 4,3%). Nghien cifti da chi ra rang, ty le NMP d nhifng BN cd thd may, cd dat CVC^d nhCfn_p BN cd bieu hien lam sang nguy cd nhiem khuan deu cd liSn quan den cong tac rira tay, KQNC ciia Nguyen Thi Tam [-5] tai khoa Can bo cao cap BV Trung Udng Quan dgi 108 cho thay Tinh trang NK ban tay nhan viSn y te (NVYT) d thdi diem da du'dc rifa tay bang nu'dc sach tru'dc khi cay khuan lan 1, nhffng chi cd 2% doi tu'dng NC cd ban tay sach khuan, con, lai la cac ban tay^nhiem khuan. Oieu nay cd the cho thay, day la con so dang bao dong trong boi canh ma NKBV ngay cang gia tang hien,nay, sif cd mat ciia vi khuan tren ban tay ciia NVYT tac dong rat Idn den qua trinh phdng chong NKBV.
Vdi ban tay nhiem khuan ciia minh, cac NVYT se ia ngffdi phat tan rang rai mam benh, dem vi khuan den do diing, dung cu y te va benh nhan.
Vdi mo hinh CS toan dien, cong tac CSBN ciia ODV tai Khoa HSTC va Chong doc BV Hu'u Nghi rat tot va BN da dffdc hffdng Idl the hien trong KQNC vdi ty le 95,7% chan CVC ciiia cac BN dffdc kho, mot so hdi tay dd, khong bj mac NKBV, cung bdi hang ngay BN dffdc sff dung bang dinh CO djnh trong CS thffdng quy CVC, va ap dung theo nghien cffu ciia Geraldo, nen ket qua cho thay chi cd 4,3% benh nhan bi NKMP khi dat CVC [-7].
TAP CHi Y HOC VllT HAM TAP 450 - THAHG 1 - s 6 1 - 2017 4.3. Ty IS nhiim khuan mac phai 6 ngu'di
benh co dat CVC: Ket qua NC cho thay, phan ldn ddi tu'dng HC khong bi NKMP (97,8%), t/ le NK bdi lien quan den CVC la 2,2 %. KQNC cua chung tdi thap hdn KQNC cua Ha Manh Tuan (9,3%) cd ty le NKMP tren BN cd dat'caterther TMTT va cang thap hdn rat nhieu so vdi KQNC tai BV Bach Mai cua Nguyen Nggc sao (chiem tdi 15,7%), gan 8 lan so vdi ket qua cua Doan Minh Tuan nam 2008 (16,5%) [-2]> [-3], [-6]. Tren the gidi, ty le NKMP d ngu'di benh cd dat CVC dao ddng tiJ" 4-16%. Nhu" vay, Icet qua nghien ClJu nay cd ty le NKMP lien quan den CVC thap hdn nhiJng ket qua tren. Dieu nay cd the giai thich rang, nghien cdu du'dc tien hanh tai khoa Hoi su'c ti'ch ci/c BV HiJu Nghj, ddi tu'dng NC du'dc CSTD. Dong thdi, qua trinh C^, thiTc hien can thiep thu thuat deu du'dc dam bao dung quy trinh va vd khuan tuyet doi. BN du'dc giam sat chat che chi'nh vi le dd ty le nhiem khuan lien quan den CVC chiem ty le thap (2,2%).
4.4. Mot SO yeu to lien quan den nhiem khuan mac phai ciia ngu'di benh c6 dat catheter ttnh mach trung tam
4.4.1. Sy'Jien quan giu'a tuoi cua ngu'di benh vdi nhilm khuSn CVC:
Ket qua nghien cu'u nay cho thay, chu^a tim thay su" khac biet giii'a 2 nhdm tuoi < 75 tuoi va
> 75 tudi cua BN vdi tinh trang nhiem khuan CVC (p > 0,05). Dieu nay cd ttie giai thich rang, vi ddi tu'dng NC deu thuoc nhdm ngu'di, cao tuoi, nhap vien do bi cac benh man tinh. 6 do tuoi nay, cac benh nhan thu'dng cd nhieu yeu td nguy cd nhu* dai thao du'dng, tim mach, huyet khdi tJnh mach sau,... su" khong cd khac biet giiJa 2 nhdm tuoi < 75 va > 75 cua BN vdi tinli trang nhiem khuan CVC cd le lien quan vdi cd mau nghien cu'u chu^ du Idn de phat hien du'dc sd khac biet cua 2 nhdm tudi nay.
4.4.2. Lign quan giu'a cac dau hieu lam sang tai chan catheter vdi NK mac phai
Ket qua NC cho thay du'dc mdi lien quan giu'a dau hieu lam sang tai cho choc CVC giii'a 2 nhdm BN cd dau hieu xung huyet, kho va nhdm BN co dau hieu dd, cd dich vdi tinh trang nhiem khuan, vdi p < 0,001. Ket qua nay phu hdp vdi NC cua Geraldo (2000) tren 116 benh nhan dat CVC [- 7]. Day cung giup khang dinh vai trd cua da, do tren da ludn ton tai nhieu loai vi khuan co the gay nhiem khuan CVC, cac bien phap nham han che viec tiep can qua da vdi cac vi sinh vat nliu' dung chat idid ixung manh, su' dung loai catheter cd tam khang sinh va dam bao thy'c hien dat catheter dung quy trinh va vo khuan tuyet doi.
Ngoai ra, viec cham soc vj tri dat Catiieter phai du'dc thyc hien nghiem ngat theo dung quy trinh khi thay bang, tuy td'ng tru'dng hdp cd the su' dung cac loai bang dan tai chan CVC khac nhau.
Gac, bang dfnh, mieng dan phai dam bao vd kliuan, che phu du'dc vi tri dat CVC va dLfdc thay the khi bj am, ban, idng leo, hay theo quy trinh cham sde thu'dng quy.
4.4.3. Su* lien quan giu^ nhiem khuan CVC tiT cac khoa dieu tri khac chuyen den
Ket qua bang 3.3 cho thay, cd sy" khac biet giiJa benh nhan dat CVC d cac khoa khac chuyen den Khoa Hoi su'c cap culi vdi cac BN dat O/C tai khoa Hoi su'c cap culi vdi tinh trang nhiem khuan CVC (p < 0,05). Cd the giai thich rang, dat CVC tai khoa Hoi su'c cap cu'u se dam bao quy trinh chuyen mdn ky thuat va vd khuan tuyet ddi bdi vi day la mgt trong nhiiYig thii thuat xam lain ma cac bac sTva dieu duSng thiTc hien thu'dng xuyen hang ngay, cac khoa khac cd hgi de lam thu thuat dat CVC it hdn, ngoai ra, quy trinh cham soc tai khoa ICU cung ludn dam bao nghiem ngat, chat che, day cung la mpt tu" te quan trong giup ly giai ket qua nghien cii'u. Cac BN cd dat CVC tilr khoa khac chuyen den cd the du'dc cham soc chu'a dung quy trinh, mat khac qua trinh thu'c hien ky thuat dat CVC cdn bi han che ve ky thuat vd khuan, do vay khi benh nhan chuyen den Khoa Hoi^su'c cap cu'u, benh nhan cd nguy cd bi mac nhiem Idiuan benh vien cao hdn so vdi BN dat CVC tai HSCC.
4.4.4. Su* lien quan giu'a so lan dam kim khi dat Catheter vdi NK mac phai d benh nhan dat CVC
Ket qua nghien cu'u da chi ra moi lien quan cd y nghla thong ke giiJa sd lan dam kim l_lan va so lan dam kim > 1 lan vdi tinh trang nhilm khuan mac phai do dat CVC (p < 0,05). Dieu nay cd the giai thich do tren da cua BN luon ton tai vi khuan cd the gay benh. Trong qua trinh thu'c hien thu thuat dat CVC, cd le ngu'di lam thit thuat chu^
thdc hien dirng ky thuat vd khuan, sat trung chu^ du rpng hoac dyng cu khdng dam bao vd khuan nen khi dam kim nhieu lan co the vo tinh da du^ vi khuan xam nhap qua da cua BN do dd dan den tinh trang nhiem khuan tai vi tri dat CVC.
4.4.5 Lien quari giu'a so lan thay bang Catheter vdi NK mac phai tai CVC
Ket qua bang 3.3 cho thay, cd sd khac biet giu^ sd lan thay bang chan CVC hai ngay/1 lan vdi so lan tha^ bang chan CVC 1 lan/tuan vdi tinh trang nhiem khuan CVC (p<0,05). Cd the giai thich nhu" sau thay bang Iam giam sir tich ty vi khuan tai chan CVC nhuYig cung rat de lann
VIETNAM MEDICAL JOURNAL N''1 - JANUARY - 2017 tang nguy cd nhiem khuan. Hien nay da cd nhieu
nghiSn cifu d cac nu'dc cho thay viec thay bang 1 lan/tuan vdi bang gac t o t nguy cd nhiem khuan mac phai se han che hdn. Ket qua nghien cuU cua chung toi cung cho thay viec thay bang 1 lan/tuan tai chan CVC khd hdn viec tiiay bang 2 ngay/lan. Ket qua nghien culi cua chung tdi lai ngu'dc lai vdi ket qua nghien CUIJ cda Nguyen Thj Hue nam 2013 ve thu'c trang NKMP d ngu'di benh sau md' sg nao, ket qua thay ranc^ khi tha^ bang vet tiiu'dng 1 lan/ngay by- le nhiem khuan mac phai It hdn khi thay bang vet mo so nao 2 lan/ngay [ - y . Hien nay, viec sd dung cac loai gac vo khuan trong sudt dan tai chan O/C 6a giup quan sat lien tyc vj trf dat, khdng bj tham u'dt, va khdng ddi hdi phai thay nhieu lan.
V. KIT LUAN
1. Dac diem NKMP phai tren BN cd dat cathter tinh mach trung t a m : Ty le NK mac phai d ngu'di benh cd dat Catheter la 2,2%.
2. Mgt sd yeu t d lien quan den nhiem khuan Catheter tTnh mach trung tam
Cd sy lien quan giiJa da dat CVC tai cac Mioa dieu trj khac chuyen den Khoa Hoi su'c cap ciru (vdi p < 0,05)
- Cd s y lien quan giu'a sd ISn dam kim > 1 Ian cd nguy cd NKMP cao hdn dam kim 1 lan khi benh nhan dat CVC vdi p < 0,05
- Cd s y lien quan giO^ so lan thay bang chan CVC hai ngay/1 lan cd nguy cd NKMP cao hdn so vdi sd lan tliay bang chan CVC i lan/tuan vdi p < 0,05
KIEN N G H !
- RCfa tay thu'dng quy bang dung djch r u ^ tay nhanh dung thdi diem quy dinh dac bidt tru'dc va sau khi cham soc benh nhan.
- Dieu duQng can phai tuan t h u nghiem ngat quy trinh cham soc cathter tlnh mach trung tamt de han che nhiem khuan.
- Xay dyng ke hoach trao ddi chuyen mon.
cho cac can bp y te ve cac nguyen tac vo khuSh*!
trong quy trinii dat Catiiter va cham sde Catheteri tmh mach trung t a m . '-
TAI L l | U T H A M KHAO M 1 . NguY^n Thj Hue ( 2 0 1 3 , Thut tiang rihl^m
khuan mac phai d ngUdl benh sau mo sg nad'^L cac yeus to anh hudng. I^da luan tot nghiep q ^ nhan Oieu Du'dng tru'dng Dal hoc Thang Long " « 2. Boan Minh Tuan ( 2 0 0 8 ) , Nghiin cuti cin
nguyin vi Idiuan, cac yeu to liin quan den nhim khuan catheter d hai vi ti-i tTnh mach canh trong i^ ^ tinh madi dudi don. Luan \ ^ n tat nghiep thac sy Tru'dng Dai Hpc Y Ha Npi.
3. Ha Manh Tuan ( 2 0 0 6 ) , Cac yeu td nguy a}
nhiem khuan benh viin fi?/ khc^ Hoi su'c cap cuti ' nhi iai benh vien Nhl dong 1 thanh pho Ho Oil i^inh. Ky yeu hgl nghj Idioa hoc ky tiiuSt Hoi siTc b'ch cu'c thanh pho Ho Chi Minh-2006.
4. Tri/diig Anh Thu* va CS ( 2 0 0 5 ) , Tinh hinh nhiem Wiuan benh vien hien mac tai benb vi§n Bach Mai - 2005
5. Nguyen Thi Tam ( 2 0 1 2 ) , Danh gia hieu qua nici tay nhanh bang con Manugel. Khoa luan tdt nghiep o r nhan Dieu Du'dng tru'dng Dai hpc Ttiang Long."
6. Nguyin Ngpc Sao ( 2 0 1 2 ) , Tinh trang nhi§m khuan mac phai trin binh nhin cd dit Catiie^^
tinh mach tivng tam talBenh viin Badi Mai. Khoa*
luan tdt nghiep cCr nhan Dieu DuBng tru'dng D?,i .
hpc Thang Long. '.,'-i 7. Sadovama Geraldo ( 2 0 0 0 ) , Comparixn,%
between tte jugular and subdavian vein ?s inseriiion site ibr central venous cathetirs:: 1^
microbiological aspects and risk Actors ibr colonization and infection. PMID: 12959686 [Pubmed-indexed for I^EDLINE].
NHAN XET CHI SO VE XirffNG TREN PHIM SO NGHIENG (f MOT NHOM BENH NHAN KHOP CAN ANGLE LOAI III D O TUOI TIT 1 8 TRO LEN
Nguyin Xu3n Thyc', Qu^ch Thi Th6y Lan^
' Benh viin B^di Mai
^ Trddng Dai hge YH^ Ngi
Oiiu trach nhi^m chi'nh: Nguyin Xuan Thu'c Email: [email protected] Ngay nhan bai; 10.10.2016 Ngay phan bien khoa hoc: 1.12.2016 Ngay duyet bai: 16.12.2016
'%
Muc tieu: Nghien culi dang gia cac chi so xi/tJng tren phim so nghieng d nhom b$nh nhan b'en 18 tm bj khdp can Angle loai I I I . Ddi tu^ng vS phu'dhg % phap: Nghien ciru stir dyng phu'dng phap hdi cOli, m6.i ta cat ngang tr6n 30 b@nh an ciia nhubg benh nhan khdp can Angle loai I I I , dieu b i tai khoa NSn chinh B?nh vien Rang Ham MSt Trung i>dng nSm 2011. Tren cd sd phan b'ch Steiner tren phim sp nghieng, du^ ra cac chi sd ve xu'dng trong benh khdp can Angle lo^i . I I I . Kit gua: Khong co doi tutfng niio co khdp cSn •
