VIETNAM MEDICAL JOURNAL M°1-OCTOBER-2017
SO SANH KET QUA DIEU TRI V a PHINH DONG MACH NAO BANG
PHiraNG PHAP P H A U T H U A T V A CAN THIEP NOI MACHNguyin Minh Anh*, Le Van Thmh**
Vu Dang Lu'u*,V6 H6ng Khoi**
dunng the hospitalization. Modifield Rankin Scale (mRS) was used to evaluate patients at discharge and 3 months later (by phone call). Results: At uie hospital discharge, a good outcome (mRS: 0-2) was observed in 71.4% of the patients undergone surgical clipping and in 76.7% of the patients to endovascular coiling (p = 0,117). After 3 months, this rate was 80%
and 83.3% (p=0,819), respectively. The percentage ijf well recovered patients with posterior circulaKop aneurysms in the surgical and endovascular group <M respectively 0% and 16% (p=0,028). There was no statistically significant difference of vanables betWMfe two groups: anthropometric characteristics, Hunt,j^
Hess scale, Fisher scale, aneurysms size and outcomfc' Conclusions: There was no proven difference W clinical outcome between two procedures as the evidence was based on a small number of patients.
We recommend further intervention studies with large sample sizes for a better evaluation of two modalities.
Keywords: ruptured intracranial aneurysms, surgical dipping, endovascular coiling.
1. ^%T VAN OE
Phinh dpng mach nao la mot binh kHa thu'dng gap, chlem khoang 2 den 5% dan so, khoang 0,7 den l,9%o tru'dng hdp khi vS gay chay mau du'di nhen [1]. Phinh dpng mach nao khi vd rat nguy hiem vi khoang 15% eae tru'dng hdp chay mau du'di nhen tir vong tru'dc Idii nhap vien va khoang 2 0 % tru'dng hdp chay mau tai phat trong vdng hai tuan dau [2], Hdn niis, hau qua ciia chay mau du'di nhen la t / le tu' vong va tan tat eao. Viec can thiep loai bd tiil phinh Ichoi vdng tuan hoan la uli tien hang dau trong dieu tri phinh mach nao vdi hai phu'dng phap la can thiSp' ndi mach va vi phlu thuat kep eo tui phinh [3].
Viec lu'a chpn phu'dng phap dieu tn cho b§nh nhan v3 phinh dpng mach nao hien nay van con la van de gay tranh eai d nhieu trung tam mach mau nao trong nu'de va tren the gidi. Cac thLf nghiem idn tren the gidi nhu" ISAT 2002 va BRAT 2012 da du'a ra cae ket luan ve hieu qua dieu tn, ciia hai phu'dng phap can thiep ndi mach ya phau thuat kep cd till phinh. Tuy nhien van con nhieu eau hdi ve ldi ich tu'dng ddi ciia hai phu'dng phap dieu tri, ddi hdi can cd nhieu nghien eiru chuyen biet hdn [4]. Hien nay,^tai Benh vien Bach Mai, dieu trj v9 tiii phinh_ dpng mach nao da ed nhu'ng ket qua dang khich 1|- Vdi mong muon du'dc gdp phan vao viee chan doan sdm, tien lu'dng benh, \da chpn phu'dng piiap dieu trj d benh nhan v3 phinh ddng mach nao T O M TAT
Muc tieu: Hi^n nay, viec li/a chpn phUdng phap dieu tri v9 phinh dgng mach nao van cdn la van de gay tranh cai. Muc dicli ciia nghien ciTu la so sanh ket qua dieu tr| vS phinh dgng mach nao bang phUOng phap phau thuat va can thiep npi mach, Phu'dng phap: Thir nghiem lam sang ngau nhien co doi chu'ng t)ao gom 65 benh nhan co v8 phinh dpng^mach nao, trong do co 35 benh nhan du'dc dieu tri phau thuat va 30 benh nhan dUpc can thiep npi mach, t\i thang 09 nam 2016 den thang 06 nam 20i7 tai Benh vien Bach Mai. Benh nhan dUdc kham lam sang tCr liic nhap vien va^^theo doi trong gua trinh nam vien. Sir dung thatig diem Rankin cai bien danh gia benh nhan d thdi. Ket qua: 6 thdi diem xuat vien, ty le benh nhan hoi phuc tot (mRS : 0-2) d nhom phau thuat va nhom can thiep noi mach la :71,4% va 76,7% (p= 0,117). a thdi diem 3 thang sau do, ty le nay tUOng irng la: 80 va 83,3%
{p= 0,819). Ty le hoi phuc tot 6 nhom benh nhan co phinh flpng mach thuoc he tuan hoan sau ciia nhdm phlu thuat va can tiiiep mach la 0% va 16% {p=
0,028). Khong c6 sU khac biet c6 y nghia thorig ke ve do phuc hoi tot tren lam sang vdi cac dac diem nhan trie hpc, thang diem Fisher, thang diem Hunt-Hess, kich thUdc tui phinh giij'a hai nhom nghien cuU. Ket luan: Do hoi phuc lam sang ciia hai nhom phau thuat va can thiep mach la nh^u" nhau. Can phai tien hanh cac nghien ciTu vdi c3 mau Idn hdn de khang dmh va danh gia hieu qua cua hai phUdng phap.
Tijrkh^a:\d phinh dpng mach nao, can thiep noi mach, phau thuSt dat kep (clip).
SUMIVIARY
COMPARISON OF RESULTS BETWEEN SURGICAL CLIPPING AND ENDOVASCULAR COILING FOR
RUPTURED INTRACRANIAL ANEURYSMS Objective: The most effective treatment of ruptured intracranial aneurysms is controversial in recent years. The purpose of this study is to compare the outcome of patients with acutely ruptured cerebral aneurysms treated by surgical clipping or endovascular coiling. Methods: A randomized controlled trial included 65 patients with ruptured intracranial aneurysms who undenAfent surgical clipping (35 patients) or endovascular coiling (30 patients) from 09/2016 to 06/2017 at Bach Mai Hospital. Patients in the study were examined on admission and followed
*Dai hgc Y Ha Ngi
**Benh vien Bach Mai
Chiu trach nhiem chinh: Nguyen Minh Anh Email: [email protected] Ngay nhan bai: 25.7.2017
Ngay phan bien khoa hgc: 8.9.2017 Ngay duyet bai: 14.9.2017 114
TAP CHI Y HOC VIET NAM TAP A59 - THANG 10 - SO 1 - 2017 chung tdi tien hanh nghien edu de tai: "So sanh ket
qua dieu tn phinh dgng mach nao vdtjang phudng phap phau thuat va can thiep noi mach "
II. 001TUQMG VA PHircrNG PHAP NGHIEN CU'U 2.1 Ooi tuTcrng nghien cihi: Chiing toi tien hanh nghien cii'u 65 benh nhan ed phinh dpng mach nao bj v3, trong do cd 35 benh nhan du'dc phau thuat kep co tui phinh va 30 benh nhan du'dc can thiep npl mach.
2.2 Phu'dng phap nghiSn cu'u: Chung tdi tien hanh nghien ciTu theo phu'dng phap thiT nghiem lam sang ngau nhien cd doi diiTng. Ddi tu'dng nghien eiru dddc tham kham tai thdi diem vao vien, chi lay nhii'ng benh nhan cd Hunt-Hess dp 1 den 3 va theo doi trong suot qua trinh nam vien, sir dung thang diem Rankin eai bien danh gia benh nhan d thdi diem xuat vien va 3 thang sau dd qua gpi dien thoai.
III. KET QUA
l.Danh gia hoi phuc Iam sanq d thdi diem xuat >rien theo t^ang diem Rankin cai bien (mRS).
Bang 1: Diem mRS thdi diem xuit vien
Hoi phuc tot
Diem mRS 0 1 2
Hoi phuc kem Tonq
3, 4, 5, 6
Phau thuat. So benh nhan ( t y le % )
1 (2,9%) 14 (40,0%) 10 (28,6%) 25 (71,4%) 10 (28,6%) 35 (100%)
Can thiep mach, So benh nhan (tV ie % )
4 (13,3%) 16 (53,3%) 3 (10%) 23 (76^7%)
7 (23,3%) 30 (100%)
P
0,117
Dp hoi phuc iam sang tot d thdi diem xuat vien eiia nhdm phau thuat la 71,4% so vdi nhdm can thiep mach la_76,7%. Trong dd, d miTc do mRS = 0 eiia nhdm can thiep mach la 13.3% so vdi 2.9%
ciia nhdm phau thuat (p= 0,117).
2. Danh gia hoi phuc lam sang d thdi diem sau 3 thang xuat vien theo thang diem Rankin cai bien.
Bang 2: Diem mRS thdi diem sau 3 thing xuit vien
Can thiep mach. So benh nhan [ t y le Vo) Diem
mRS
Phau thuat. So benh nhan (ty le % )
Hoi phuc tot
9 (25,7%) 16 (45,7%)
11 (36,7%) 3 (8,6%)
12 (40%)
Hoi phijc kem 3, 4, 5, 6
28 (80%)
2 (6,7%) 7 (20%)
25 (83,3%)
0,819 5 (16,7%)
Tong 35 (100%) 30 (100%)
Dp hoi phuc lam sang tdt d thdi diem xuat vien eiia nhom phau thuat la 80% so vdi 83,3% ciia nhdm can thep mach (p= 0,819)
3. Moi lien quan giCi'a dac diem nhan trac v6i ket qua dieu tri d hai nhom co mRS do phuc hoi tot d thdi diem sau 3 thang.
Bang 3: Diem mRS (0-2) va dacdiS'm nhan trac hgc
Gidi nam Gi6i nif
Tonq
< 50 tuoi 50 - 59 tuoi 60 - 69 tuoi
> 70 tuoi Tonq
Phau thuat (mRS = 0 , 1 , 2 )
10 (35,7%) IS (64,3%)
28 7 (25%) 12 (42,9%)
9 (32,1%) 0 (0%)
28
Can thiep mach (mRS = 0 , 1 , 2)
9 (36%) 16 (64%) 25 4 (16%) 11 (44%) 8 (32%) 2 (8%) 25
P
0,983
0,43
RR (95»/o C I ) 0,99 (0,48-2,04) 1,00 (0,67-1,50) 1,56 (0,52-4,71) 0,97 (0,53-1,80) 1,04 (0,48-2,28)
- Sir khac biet khdng cd y nghia thong ke ve gidi tinh^va tien trien iam sang tot ciia benh nhan.
- T^ le hoi phuc lam sang tot d nhdm benh nhan tuoi du'di 50 cua nhdm phau thuat va can thiep mach la: 25% v a ' l 6 % . 6 nhdm tuoi tren 70, ty le nay eiia nhom can thiep mach cao hdn nhdm phau thiiat: 8% va 0% (p= 0,43).
VIETNAM MEDICAL JOURNAL N°1 - OCTOBER - 2017
4. Moi lien quan giu'a thang diem Hunt-Hess vdi ket qua dieu trj d hai nhom c6 diem Rankin cai bien (mRS) phuc hoi tot sau 3 thang.
Bang 4; Olem mRS CO-2} va thang diem Hunt-Hess Thang di€m
Hunt - Hess D6 1 Do 2 Do 3 Tonq
Phau thuat (mRS = 0, i , 2)
17 (60,7%) 5 (17,9%) 6 (21,4%)
28
Can thiep mach (mRS = 0 , 1 , 2)
15 (60%) 5 (20%) 5 (20%) 25
P 0,977
RR ( 9 5 % CI) 1,01 (0,65-1,57) 0,89 (0,29-2.73) "
1,07 (0,37-3.081 SLT khac biet khdng cd y nghTa thong ke vS thang diem Hunt-Hess va dp phuc hdi lam sang tot cua benh nhan.
5. Moi lien quan giu'a thang diem Fisher vdi ket qua dfeu trj d hai nhom co diem mRS dd phuc hoi tot d thdi diem sau 3 thang.
' BingS: Thang diem Rankin cai biSn mRS (0-2) va thang diem Fisher Thang diem
Fisher D 6 1 0 6 2 Do 3 Do 4 Tong
Phau thuat (mRS = 0, i , 2)
1 (3,6%) 12 (42,9%)
5 (17,9%) 10 (35,7%)
28
Can thISp mach (mRS = 0 , 1 , 2 )
3 (12%) 7 (28%) 5 (20%) 10 (40%) 25
P
0,541
RR(95%CI) 1 0,30(0,03-2,68) » 1,53(0,72-3,27) j i 0,89 (0,29-2,73) ' 4 0,89(0,45-1,78) "
Dp phuc hoi lam sang d nhdm benh nhan cd diem Fisher do 1 ciia nhdm phau thuat thap hdn ^-
1
vdl nhdm can thiep mach la: 3,6% va 12%. Ngu'dc lai d nhdm benh nhan cd diem Fisher dp 2 ty le ; ciia nhdm phau thuat lai cao hdn: 42,9% va 28% (p= 0,541). _ '\
6. Moi lien quan giu'a vj tri tui phinh vdi ket qua dieu tri d hai nhom co diem mRS do phuc hoi tot it thdi diem sau 3 thang.
Bang 6: Ket qua phuc hoi cua 2 nhom va vi tri tui phinh V j t r i
Donq mach nao qiu^
Nqa 3 donq mach canh tronq Donq mach thonq tri/dc
Donq mach thonq sau Donq mach dot song
Phau thuat mRS 0-2 So benh nhan
(ty le %) 8 (72,7%) 2 (100%)
9 (90%) 4 (80%) 0 (0%)
mRS 3-6 So benh nhan
(tv le %) 3 (27,3%)
0 (0%) 1 (10%) 1 (20%) 2 (100%)
Can thiep mach mRS 0-2 So benh nhan
(tv le %) 3 (100%) 3 (100%) 7 (87,5%) 7 (100%) 4 (80%)
mRS 3-6 So benh nhan
(tJ le %) 0 (0%) 0 (0%) 1 (12,5%)
0 (0%) 1 (20%) Dp phuc hoi lam sang tot chiem u'u the rd ret d nhdm cd vj tri tui phinh d ddng mach nao giifa, nga 3 ddng mach canh trong, dpng mach thdng tru'dc, dpng mach thong sau d ca 2 phu'dng phap. 0 vi tri phinh ddng mach dot song, dp phuc hoi tdt d nhdm can thiep mach chiem ty le eao hdn: 80%
va 20%; cdn d nhdm phau thuat thi dp phuc hdi tot chiem ty le thap hdn.
Bang 7: Diem mRS (0-2) va vi tri tui phinh V j t r i
Donq mach nao qlu^
Donq mach thonq tru'dc Donq mach thonq sau Dong mach dot song
Phau thuat (mRS = 0, i , 2)
8 (28,6%) 9 (32,1%) 4 (14,3%) 0 (0%)
Can thiep mach (mRS = 0,1,'2)
3 (12%) 7 (28%) 7 (28%) 4 ( 1 6 % )
P 0,138 0,743 0,219 0,043
RR(95"/oCI) 2,38 (0,71-8,00).
1,15 (0,50-2,63) 0,51 (0,17-l,b4) - Op phuc hoi lam sanp tot d nhdm benh nhan ed phinh d vj tri ddng mach nao giij^ va dong thong tru'dc ciia nhdm phau thuat cao hdn nhdm can thiep mach lan lu'dt la: 28,6% va 12%; 32,l%r va 28%. Tuy nhien khac biet nay khong cd y nghia thong ke.
- Ty le nay d nhdm benh nhan cd phinh ddng mach dot song ciia nhdm phau thuat thap hdn so vdi nhdm can thiep mach: 0% va 16% (p= 0,043 < 6,05)
7. Moi lien quan giu'a kich thu'de tiii phinh vdi ket qua dieu tri 6 hai nhom co mRS do phuc hoi tot d thdi diem sau 3 thang.
TAP CHi Y HOC VI^T NAM TAP 459 - THANG 10 - SO Bang S: olem mRS fO-2) va kich thude tu
Dai tui < 5mm 5 < Dai tui < 10mm
Dal tui > 10 mm Tong Tv le day co < 1,2 1,2 < TV le dav CO < 1,5
Ty le day co > 1,5 Tong
Phau thuat (mRS = 0, i , 2)
14 (50%) 13 (46,4%)
1 (3,6%) 28 4 (13,4%) 10 (35,7%) 14 (50%)
28
-2017
phinh Can thiep mach (mRS = 0 , 1 / 2 )
10 (40%) 13 (52%) 2 (8%)
25 9 (36%) 7 (28%) 9 (36%) 25
P
0,659
0,184
RR (95<>/o CI) 1,25 (0,68-2,29) 0,89 (0,52-1,54) 0,45 (0,04-4,63) 0,40 (0,14-1,13) 1,28 (0,57-2,34) 1,39 (0,73-2,64) Sd khac biet khdng cd y nghTa thong ke giu^ dp dai tui cung nhd ty le day cd doi vdi dp phuc hoi lam sang cua Jiai nhdm.
IV. BAN LUAN
Dif lieu nghien ciTu eiia ehiing tdi cho thay, d thdi diem xuat vien, do phuc hoi lam sang tdt du'a vao diem Rankin cai bien (mRS) eiia nhdm BN ed can thiep npi mach eao hdn so vdi nhdm phau thuat kep ed' till phinh la 5,3%. Sau dd danh gia lai sau 3 thang qua gpi dien thoai cho benh nhan, ty le nay d hai nhdm ptiau thuat va can thiep lan lu'dt la 80% va 83,3%. Nhin chung, trong nghien cu'u ciia chung tdi, do phuc hdl cua nhdm can thiep tot hdn so vdi nhdm phau thuat, tuy nhien SLi khac biet khong cd y nghTa thong ke d day. Ket qua nay ciia chung tdi cung phii hdp vdi cac nghien eiru tru'dc day, trong nghien eiru ISAT 2002, ty le benh nhan ed diem Rankin eai bien (mRS) tiT 0 den 2 sau hai thang eiia
• nhdm can thiep npi mach la 73,9% eao hdn nhdm I phau ttiuat 10,8% [5]. Trong nghien ciTu BRAT I du'dc tien hanh tCi nam 2012, d ttidijJiem sau mot I nam, ty le benh nhan ed thang diem Rankin cai I bien (mRS) tiii 0 den 2 eiia nhdm can thiep mach t va phau thuat la 76,8% va 66,3% [4].
Trong nghien ciTu ciia chiing toi, gidi tinh I khong anh hu'dng den ket cue lam sang sau ba I thang ciia hai nhdm phau thuat va can thiep ndi
mach. Ve SLT lien quan giu'a tudi den ket eye dieu trj eiia hai nhdm, chung tdi thay d lira tuoi du'di
; 50, ty le hoi phuc tot ciia nhdm phau thuat cao ' hdn so vdi nhdm can thiep mach, hai ty ie nay i lan lu'dt la 25% va 16%. Ngu'dc lai d nhdm tuoi
! tir 70 trd len, ty le nay d nhdm can thiep mach f lai cao hdn 8%. Ket qua nay eiia chiing tdi cung ' tu'dng tiT vdi cac nghien cu'u tru'dc day, khi can I thiep mach la phii hdp hdn d nhdm benh nhan 1 ldn'tudi [5].
s y khac biet khdng cd y nghTa thong ke giu'a i cae mire dp cua thang diem Hunt-Hess doi vdi
• ket cue lam sang d hai nhdm. Ve thang diem J Fisher, trong nghien cu'u nay, chiing toi thay d
• nhom benh nhan cd Fisher dp 1 thi ty le diem
Rankin cai bien tir 0 den 2 ciia nhdm can thiep mach eao hdn so vdi nhdm phau thuat la 8,4%., tuy nhien sd khac biet nay eting khdng ed y nghTa thdng ke.
Dp phuc hoi lam sang tot d nhdm benh nhan ed phinh mach d vi tri ddng mach nao giu'a va ddng mach thdng tru'dc cua nhdm phau thuat cao hdn so vdi nhdm can thiep mach, cac ty le nay eao hdn lan lu'dt la 16,6% va 4 , 1 % (p >
0,05). Trong nghien eiiu ciia chung tdi, d cac benh nhan cd phinh dpng mach dot song, ty le diem Rankin eai bien tir 0 den 2 eiia nhdm can thiep mach eao hdn mot each ed y ngiiTa thong ke, cao hdn 16% so vdi nhdm phau thuat (p=0,043<0,05). Dieu nay, eijng phii hdp vdi cac khuyen eao hien nay, can thiep mach thu'dng du'dc u'u tien li/a chpn cho cae phinh mach vimg hd sau vdi eac bien chiTng cao neu phau thuat [6]. Trong nghien ciTu eua ehiing tdi, khdng ed sd khac biet gliJa kich thu'de tui pliinh va dp phuc hoi lam sang.
V. KET LUAN
Dd phuc hoi lam sang cua hai nhdm phau thuat kep tui phinh va can thiep npi mach khong ed su' khac biet. Can phai co them nhiJ^ng nghien eiru khac trong tddng lai vdi cae ed m l u ldn hdn de danh gia va khang dinh hieu qua eiia hai phu'dng phap nay.
TAI Ll|U T H A M KHAO
1. Varinder S. Alg, Reecha Sofat, Henry Houlden et al. (2013), "Genetic risk factors for intracranial aneurysms : A meta-analysis in more than 115,000 individuals'; Neurology, 80(23), pp.
2154-2165.
2. Stephan A. Mayer, Gary L. Bernardini and Robert A. Solomon (2015), Merrltt's neurology Subarachnoid hemorrhage, thirteenth edition, Vlfolters Kiuwer,Vol. 39.
3. Le Van Thinh (2010^, Chay mau dddi nhen, trong Tai bien mach mau nao Chan doan va dj^u tn, NXB Yhgc tr. 39-52.
VIETNAM MEDICAL JOURNAL N°1 - OCTOBER - 2017
coiling in 2143 patients with ruptured intrad
-^
aneurysms: a randomised trial'; Lancet 360(9342], pp. 1267-74. - ^ . American Heart Association (a Special
Group of the Stroke Council) (2012), "Guid!
for the Management of Aneurysmal Subarai Hemorrhage'; Stroke, 43, pp. 1711-1737.
. Robert F. Spetzler, Cameron G. McDougall, Joseph M. Zabramski et al. (2015), 'The Barraw Ruptured Aneurysm Trial: 6-year results'; J Neurosur, 123, pp. 609-617.
. Molyneux A, Kerr R, Stratton I et al. (2002),
"International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular
MOT SO KET QUA DAO TAO, CHUYEN GIAO KY THUAT TAI BfiNH VIEN HUTJ NGHI V I E T DU'C GIAI DOAN 2 0 1 4 - 2016
Nguyen Van Dirng', T r a n Thi Hong ThSm', Nguyen Trung Da', Tran Binh Giang', Nguyen Diic Ti^n' T O M TAT
Mucdich: Nham nang cao chat lUdng kham benh, chij'a benh (KBCB) tai cac ccJ sd y te tuyen dudi, 6\ia dich vu CO chat lUdng den gan vdi ngUdi dan va giam t^i cho cac benh vien tuyen tren, Benh vien HiJu nghi Vi^t Dire da to chifc dao tao (DT), chuyen giao ky thiiat (CGKT) cho can bp y te ciia cac benh vien tuyen du'di theo. Bai bao nham muc danh gia ket qua, thuan ldi - kho khan, de xuat - kien nghi trong viec thUc hien quy trinh DT, CGKT. Doi tWcfng va phu'dng piiap nghien cu'u: Nghien ciTu cat ngang tren 30 can bo va lanh dao ciia ddn vi tiep nhan k9 thuat dUa tren bd cong cu. Ketqua:Jron(i so k? thuat chuyen giao, CO 33% ia ky thuat chu^ dUOc tnen khai tai ddn yj.
83% doi tu'dng nghien ciTu danh gia qua trinh chuyen giao pha 2 la quan trpng va phu hdp vdi thUc te, 95%
d§ xuat tang them thdi gian chuyen giao pha 2. 100%
ky thuat tiep nhan dUdc tnen khai thu'dng xuyen va cd hieu qua cao. Da cd 17% cac benh vien thanh lap ddn nguyen mdi de thUc hien ky thuat dUdc tiep nhan.
Ket luan: Quy trinh dao tao, chuyen giao ky thuat dang dirde Benh vien HDu nghi Viet Dire thue hien la phii hdp va dap iitig du'dc nhu eau ciia cae ddn vi hep nhan k? thuat. Mang lai hieu qua cao trong viec nang cad chat ludng kham chij'a benh giiip eho ngu'di dan dUdc thu hudng cac dich vu y te chat lUdng cao ngay tai dia phUdng.
Tir khoa: Chuyen giao ky thuat; nang cao chat lUdng kham benh, chu'a benh; nang cao trinh do chuyen mon y khoa.
SUMIVIARY
SOME RESULTS OF TRAINING, TECHNOLOGY TRANSFER AT VIET DUC UNIVERSITY HOSPITAL FROM 2014 - 2016
Object: To improve the quality of medical examination and treatment at health agencies at lower level, to provide quality service to the people and
^Benh viin HOli nghj Viet Ddc Ch|U trach nhiem chinh: Nguyen Van Dung Email: [email protected] Ngay nhan bai: 13.7.2017 Ngay phan bien khoa hoc: 8.9.2017 Ngay duyet bai: 15.9.2017
reduce the pressure for higher level hospitals, tiie Viet Due University Hospital has impiement training, technology transfer for medical staffs of lower level hospitals. The article aims to evaluate the r^lts, advantage and disadvantage, suggestion and recommendation for the training, technology transfer process. Subject and mediodologies: Cross- sectional studies on 30 staffs and leaders of receiving hospitals base on the toolkit. Results: Vlfilhin the transferred techniques, 33% of the techniques'is not implemented at the receiving hospitals; 83% of tiie participants conciders the transfer process at phase!
IS important and relevant to the reality; 95% suggest to increase the transfer time in phase 2. 100%
received techniques is implemented regularly and highly effective. There are 17% of hospitals organized new unit to implement received techniques.
Conclusion: The training, technoiogy transfer process implemented at Viet Due University Hospital is suitable and meet the needs of receiving agendes.
Bring high efficiency in improving ttie quaiity of medical treatment to help people enjoy high quality health services locally.
Keywords: technology transfer, improve . ^ quality of medical examination and treatment, impi^
medical expertise. ^ I. DAT VAN DE
Nham nang eao chat lUdng kham benh, chja benh tai cac cd s6 y te tuyen du'di, du'a dich vu CO chat lu'dng den gan vdi ngu'di dan va giam tai cho cac benh vien tuyen tren; Bo Y te da tliut hien nhieu giai phap nang cao nang lu'c y te tuyen du'di thong qua day manh hoat dong cjii dao tuyen, luan phien can bp, dao tao, chuyen giao kl thuat... theo cac de an eua Chinh phiiya Bg Y te. Trong thdi gian qua, nhieu b?nh vl?n tuyen tinh va hau het cae benh vien tuyen huyen da du'dc dau tu' nang cap cd scf vat chat, trang thiet bi theo De an 225, De an 47, De an 930 ciia Chi'nh phu, tuy nhien eae benh vien nay cw thieu can bo chuyen mon cd trinh do phii lidp ^ sd dung ed hieu qua cd sd vat chat va trang this bj da du'dc dau tu'.
Ket qua thdc hien De an, D i ; an trong giai
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