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 118
TAP CHi Y HOC VI^T NAM T ^ P 459 - THANG 10 • SO 1 - 2017 doan tir 2014 - 2016, ve chuyen mon ky thuat,
Benh v\%n HuXi nghj Viet DiTc da xay dutig du'dc mang lu'di 18 benh vien ve tinh, tong so chiTng chi da Ccip eho 978 bac sy, 1069 dieu du8ng viin, 267 ky thuat vien. Da chuyen giao 46 ky thuat, xay dyng, hoan' thien, chuan hoa 43 chu'dng trinh dao tao, bien scan in an 25 bp tai lieu chuyen mon, xay diTng du'dc 204 hu'dng dan dieu tn, to chiTc du'dc 112 khda dao tao nang cao nang ILTC eho cac benh vien ve tinh, benh vien tuyen du'di...
Oe danh gia ve hieu qua, thuan ldi, kho khan va de xuat nhuYig bien phap nang cao chat lu'dng dao tao, chuyen giao ky thuat cua Benh Vien HiiXi nghj Viet Ddc. Phong Dao tao - Trung tam Dao tao va Chi dao tuyen (TTDT&CDT) da tien hanh thu thap thong tin 30 phleu dieu tra tren hai nhdm doi tu'dng, gom can bp tham gia tiep nhan ky thuat va lanh dao ddn vi tiep nhan ky thuat chuyen giao du'a tren bp cong cu da du'dc lanh dao Trung tam Dao tao va Chi dao tuyen phe duyet.
II. OOI TU'ONG VA PHLTOIMG PHAP NGHIEN CLTU 30 can bp tiep nhan ky thuat theo cae chu'dng trinh de an, du' an va cac gdi dich vu ky thuat do Benh vien Hu\i nghj Viet Du'c dao tao, chuyen giao giai doan 2014 - 2016.
Dai dien U n h dao cac ddn vj tiep nhan ky thuat (06 can bp lanh dao).
III. KET QUA
1 . Danh gia ve chuyen giao ky thuat:
Hoat dpng chuyen giao ky thuat du'dc thu'c hien thong qua Quy trinh chuyen giao ky thuat gom 04 bu'dc; khao sat, xay di/ng de cu'dng, to chiTc chuyen giao va giam sat, fio trd sau chuyen giao.
Trong bao eao nay, Phong Dao tao - Trung tam Dao tao va Chi dao tuyen da phan tich va bao cao k^t qua theo tiJ'ng bu'dc eiia quy trinh, tuy nhien bu'dc khao sat se khong du'a ra ban luan trong bao cao nay.
2. To chii'c dao tao tai Benh vien HQ'u nghi Viet Du'c: Cd 33% la ky thuat mdi, chu'a du'dc trien khai tai ddn vi, 67% ia ky thuat da du'dc trien khai tuy nhien hpc vien chu'a co ChiTng chi nen tham gia tiep nhan ky thuat. Co 50% hoc vien da tiTng du'dc thdc hien, eon lai 50% hoc vien chu'a du'dc thiTc hien ky thuat tiep nhan tai dja phu'dng. Tru'dc khi nhan chuyen giao, cd 66% hoc vien chu'a du'dc dao tao cd ban ve kien thiTc, ky nang, thdc hanh. ^
100% hpc vien deu dUdc hu'dng dan chi tiet ve chu'dng trinh dao tao, chuyen giao ky thuat
qua eae hinh thii'c nhu';_tai lieu phat tay (83%), cac giang vien hu'dng d i n (66%) va qua trao doi vdi dong nghiep (83%).
Trong qua trinh hpc tap, luon luon du'dc Trung tam Dao tao va Chi dao tuyen - Benh vien Hulj nghj Viet Oii'c tao dieu kien toi da ve giang du'dng, phu'dng tien, dung cu giang day va tai lieu giang day, cung nhd giai quyet nhanh, du ve kinh phi ho trd eiia DLT an. Tuy nhien do_dieu kien ed sd vat chat cdn thieu nen chu'a ho trd du'dc eho nghi eho hpc vien.
Ve thdi lu'dng thiTc hanh lam sang cd 67%
hpc vien danh gia la du'dc thu'c hanh vira dii, 33% du'dc thdc hanh nhieu, khong cd tru'dng hdp nao phan anh la thdi lu'dng thu'c hanh cdn thieu. Hpc vien khong nhii'ng ren luyen tay nghe ma con trau doi, nam vi^ng ly thuyet hdn.
Ve ddi ngu can bp thdc hien dao tao, chuyen giao ky thuat cd phu'dng phap giang day, kien thiTc chuyen mdn sau, thao tac ky thuat, ky nang hu'dng dan lam viee ludn ed tae phong, thai dp lam viec hieu qua cao (du'dc danh gia moi tieu chi la rat tot tir 85% trd len). Ket qua nay cung du'dc da so lanh dao cac ddn vi danh gia "Benh vien Hthj nghi Viet Out la cai noi cua nganh ngoai khoa, ndi san sinh ra nhieu chuyen gia dau nganh ve ngoai khoa, luon dl dau trong cong tac trien khai cac ky thuat chuyen sau..." (Phdng van sau_Lanh dao Benh vien Bac Ninh).
3. Qua trinh to chu'c chuyen giao ky thuat tai dtfn vj thu hu'dng: Sau qua trinh to chiTc dao tao tai Benh vien HQ'u nghj Viet DiTc, can bp chuyen giao ky thuat se tri/c tiep tdi cac benh vien thu hu'dng de chuyen giao ky thuat, giam sat va nghiem thu, day la hinh thu'c rat quan trong, phii hdp vdi thdc te hien nay chiem 83%. Va cd tdi 95% lanh dao cae ddn vi va can bp tiep nhan ky thuat de xuat it nhat 03 ddt chuyen giao tai dja phu'dng trd len "Theo quan diem cua chiing toi, nen tang thdi gian chuyen giao ky thuat tai dia phu'dng - khi do hoc vien mdi CO nhieu cd hoi, dieu kien deti/ thdc Men ky thuat va cu the td 03 - 04 ddt' (Phong van sau_Lanh dao Benh vien Phii Tho).
4. Hi^u qua ciia chuyen giao ky thuat:
100% ky thuat tiep nhan du'dc trien khai thu'dng xuyen va eo hieu qua eao, so lu'dng benh nhan du'dc ap dyng ky thuat mdi tang len, qua do giam so lu'dng benh nhan phai chuye'n len tuyen tren, tuy nhien ket qua thi/c te cho thay cd 66%
hpc vien thiTc hanh dap u'ng du'dc ntiffng nhu cau cd ban, 37% hoc vien t i / t i n thi/e hien thanh thao ky thuat, khdng cd tru'dng hdp nao can phai dao tao them. Ket qua tren cung phii hdp vdi
VIETNAM MEDICAL JOURNAL N ' l - OCTOBER - 2017
: ^
quan diem ciia U n h dao eac ddn vl tiep nhan ky thuat" Tdkhi chung toi tiep nhan ky thuat, trang thiet bi da dddc sd dung thu'dng xuyen, dinh ky dddc bao dddng va dac biet la ngu'di benh khong phai chuyen len tuyen tren trd nhij'ng ca kho, phdc tap..." (Phong van sau_Lanh dao Benh vien Bac Ninh). 50% hoc vien eho rang eae ky thuat du'dc chuyen giao cho cac benh vien tuyen du'di la nhu'ng ky thuat hien dai, tien tien, phiTc tap hpc vien ed gang nhieu mdi co the tiep nhan, va trang thiet bi phai du'dc dau tu' kjp thdi de dat hieu qua cao nhat. Vdi su" dau tu' kip thdi cua nha nu'de, da cd 17% cae benh vien thanh lap ddn nguyen mdi de thdc hien ky thuat du'dc qhuyen giao.
Trong qua trinh tiT thiTc hien ky thuat mdi, cd 1 tru'dng hdp xay ra bien chu'ng, tuy nhien day la bien chii'ng nhe, hoc vien ed the xir ly dpc lap ma khdng can den giup dd chuyen mon eua dong nghiep cung nhu' sd giiip dd eua cac bac sy tuyen tren. Hoe vien sau tiep nhan ky thuat chuyen giao khong ehi du'dc SLT giiip dd trong qua trinh chuyen giao ky thuat, ma sau dd hpc vien luon du'dc sd trd giiip ciia cac giang vien qua email (33%), qua dien thoai (67%). Vdi nhu'ng kien thii'c du'dc cap nhat, cd den 85% eac hoc vien chia se cho cac dong nghiep thdng qua cac hinh thu'c nhu': cong viec hang ngay (66%), giao ban (33%), qua chia se tai lieu (50%).
Qua trinh chuyen giao ky thuat eiia Benh vien Hihj nghj Viet Dire luon nhan du'dc siT hai Idng eiia hpc vien, trong do ed 33% cam thay hai Idng tuyet ddi, 85% hpc vien cd mong muon du'dc tiep tuc hpc tap tai Benh vien HuXi nghi Viet DiTc khi md them cae idp dao tao, chuyen giao ky thuat chuyen sau.
Vai trd ciia Trung tam Dao tao va Chi dao tuyen la rat quan trpng (100%), kiiong chi ho trd hpc vien trong qua trinh chuyen giao ky thuat ma cdn ho trd phat trien ddn vj.
IV. NHU'NG THUAN LOI VA KHO KHAN 1 . Thuan ldi: Vdi chi'nh sach eiia nha nu'de, Bd Y te, Sd Y te va cae bp nganh lien quan, benh vien tiep nhan ky thuat da du'dc dau tu" nang cap ed sd ha lang, mua sam trang thiet bj cung nhu"
hoc vien du'dc nhan ho trd trong qua trinh hoc tap, thuoc cac diT an, de an nhu' DiT an Benh vien ve tinh, DLT an ho trd y te cae tinh Dong bang Song Hong va Dong Bac Bd, De an 1816.
\ ^ phia Benh vien Hil'u nghj Viet DiTc cd be day kinh nghiem va nang li/c chuyen mdn cao, ludn la ddn vj di dr.<j trong viec phat trien, trien khai cac ky thuat mdi, cung nhu' vai trd ciia
TTDT&CDT t d chiTe dao tao bai ban, ciing vdi dS ngu giang vien ed trinh dp eao, can bp chuyen giao nhiet tinh.
Ve phia ddn vj nhan chuyen giao nhan du'dc 51/ quan tam eiia Nha nu'de ciing cae Bp, Sd, Ban nganh cd lien quan da dau tu' trang thiet bj, dac biet la Ban Giam doe ludn iing hp va tao dliu kien trien khai vi du ky thuat CLVT eo lu'dng benh nhan sir dung cao, thu hiit du'dc ngu'cll benh. Thi/c te cho thay eae ddn vj luon eo gang tiTng bu'dc chuan bj va hoan thien ed sd vat chat, trang thiet bi cung nhu' thu hut nguon benh nhan de tiep can va du'a cac djch vu ky thuat eao ngay tai dia phu'dng.
2. Kho khan: Ben canh nhu'ng thuan lOi thi edn nhuTig khd khan, thach thiTc nhu" ve phi'a diinh sach ho trd nhu" bao hiem y te gidi han chi tra cho mot so trudng hdp benh do dieu trj khong diing theo danh muc benh du'dc dieu tri tai tuyen cdsci, day la ly do ma ngu'di benh vu'dt tuyet de nhan day dil thanh toan theo bao hiem y t&.
Ve phia Benh vien Hu'u nghj Viet Du'c: doaJ sd vat chat edn chat hep, ehu^ dii dieu Iden de Im trd an nghi va kinh phi dao tao; ciing veil do TTDT&CDT ehu^ cd dd kien ttidi gian md Idp de cac benh vien co the chii ddng trong viee ciT hpc vien.
Hau het benh vien tiep nhan k? thuat con tiiieu nhan lu'c tram trong, dac biet la tiiieu bac sy ai trinh dp chuyen khoa cao, ngoai ra thi cd sd vat chat, trang thiet bj con thieu, xuong cap, klwrig dong bp. Ngoai ra mdt so ky thuat mdi la ky thiat khd, nen ehu^ du'dc thi/c hien thudng xuyen.
V . D E X U A T - K I E N NGHj
Ve phia ehinh sach ho trd, de nghi co chinh sach ho trd, u'u dai ddi vdi can bp de can bo.
Ve phia Benh vien Hil'u nghi Viet Dire, nend^
kien thdi gian md idp dao tao tai trung u'dng de cac ddn vj ve tinh khdng bj dpng trong viec bo tri nhan li/c, han che tinh trang da dang ky hpc vien, song den thdi diem trieu tap hpc vien khdng the tham gia do dang tham gia khoa dao tao khac hoac ddn vi khdng sap xep du'dc do thieu nhan li/c. Tang them thdi gian eiia pha 2 (2 tuan/ddt), tang them thdi thi/c hanh. Ciing vdi dd TTDT&CDT can c6 to chirc chat che hdn, va cd SI/ ho trd ndi nghi eho hoc vien.
\ ^ phia benh vien tiep nlian ky thuat, a n tang cu'dng nhan liTc, can bp tiep nhan ky thuSt did ddng hdn trong viec phdi hdp vdi can bp ho tr^ Mil thdc hien pha 2 tai ddn vj, bo tri cho an nghi cho can bp ho trd pha 2 ngay tai ddn vj de ^ n g cu'dng hieu qua va tan dung thdi gian lam viec./.
120
TAP CHl Y HOC VIET NAM TAP 459 - THANG 10 - SO 1 - 2017 TAI LIEU THAIVI KHAO
1. Bo Y t&, Trung tSm Truyen thong GDSK TU" - Ban tin De an 1816 thang 7, thang 8, thang 9, thang 10 nam 2009.
2. Nghj quyet 46 - NQ/TU ngay 23/2/2005 eiia Bg Chinh tri ve cong tac bao ve, cham soc va nang cao sire khde ciia nhSn dan trong tinh hinh mcli.
3. Bo Y te, 2010, Cong van ^ 2950/BrT-KCB ngay 10/05/2010 ve viec hudng dan xSy duhg quy tnnh diuyoi giao ky thuat y te trong thut hien fie an 1816 4. Cue puan ly Kham chu'a b^nh. Bo Y te, 2012, Tai lieu Hoi thao tang cUdng thUc hieii De an Benh
vien ve tinh va De an 1816 nham gop phan giam tai benh vien
a. Quyet dinh so 30/2001/QD - TTg ngay 22/01/2005 ciia Thii tu'dng Chinh phii phe duyet Quy hoach phat trien mang ludi kham, chGS benh den narh 2010 va tam nhin den nam 2020.
6. Quyet djnh so 1816/QD-BYT( ngay 26/5/2008 cua Bo trirdn^ Bo Y te ve viec phe duyet De an "CiT can bo chyyen mon luan phien tir b^nh vien tuyen tren ve ho trO cac benh vien tuyen dUdi nham nang cao chat lu'dng kham, cHiJa benh".
7. Quyet djnh so •4028yQp-BYT n^ay 20/10/2010 eua Bo trVdng Bg Y te ve viec phan cong chi dao tuyen trong Itnh vi/c kham, chUa benh.
THai GIAN CH(y KHAM TAI KHOA KHAM BENH,
BENH VIEN Tir SaN, TINH BAC NINH NAM 2017
T O M TAT
Nghien edu mo ta eSt ngang dUpc thue hien tren 2102 nguicJi benh nham mo ta thdi gian chd kham ciia ngudi b|nh tai^^khoa kham benh, benh vien Da Khoa TU Sdiv tinh Bac Ninh nam 2017. Ket qua nghien ciTu cho thay tSng thdi gian chd kham trung binh la 118,16 phiit (trung vj la 152 phiit). Thdi gian chd kham ciia ngu'di chi kham lam sang dPn thuan la it nhat (73,88 phut), bang khoang 1/2 so vdi nhdm ngUdi benh kham lam sang+lCLS (149,5 phut) va bang khoang 1/3 so v6i nhom kham lam sang ket hop vdi td 2 CIS tre! len (190,5 phut). Trong tiihg bu'dc kham chiia benh cu the, thdi gian chd thi/c hien cac Cl^ la lau nhat (62,72 phiit) trong do dac biet la tai phong xet nghiem thdi gian chd lay ket qua la 68,8 phut.
td khoa: Thd\ gian chd kham, khoa kham benh, benh vien Da khoa TiT Sdn
SUIVIMARY
MEDICAL EXAMINAHON TEI^IE OF PATIENTS AT OUTPATIENr DEPARTMENT OF "TU SON DISTRICT
HOSPHAL, BAC NINH PROVINCE I N 2017 A cross-seebonal descriptive study was conducted on 2102 patients to assess the total time patients spent during their medical examinations at the Outpatient Department of Tu Son distnet hospital, Bac Ninh province in 2017. The result showed that the average total time of patients spent at department is 118.16 minutes (median=152 minutes). According to the number of medical techniques, the examination
^Benh vien Da Khoa TdSdn, tinh Bac Ninh,
^Benh Vien Mat TW
^fw&ng Dalhgc YHa Ngi ''Trudng Dai hgc Y tecong cong Ha Ngi Chiu trach nhiem chi'nh: Ngo Thi Hai Yen Email: [email protected] Ngay nhan bai: 28.7.2017 Ngay phan bien khoa hoe: 5.9.2017 Ngay duyet bai: 14,9.2017
Ngo Thi Hai Yen', Tr3n Thu Ha%
Hoang IMinh Hang^ Nguyen Thi Thuy Nga'*
time of patients who was examined using only the simple examination service was the shortest with 73,88 minutes or about VJ the time of patients who was examined more than one method of examinations. The patients who were examined by the simple examination plus two or more the two addlbonal medical methods took the longest examination time, with 190.5 minutes. In each medical examination step, the average time of waiting for the subclinical results was longer (mean=62.74 minutes), especially the waiting time at Laboratory department quite long (mean=68.8 minuts).
Keyword: Examinabon time, Patients, Tu Son district Hospital
I.OyjkTVANOE
Thdi gian chd kham la mot trong nhu'ng yeu to quan trong anh hu'dng tdi s i / hai long eiia ngu'di benh khi sd dung dich vu kham chu'a benh (KCB). Hien nay nhieu benh vien (BV) tir Trung u'dng den cd sd xuat hien tinh trang qua tai trong KCB. Qua phan anh ciia NB, cd quan truyen thong va ket qua kiem tra ciia Bp Y te tai khoa Kham benh d nhieu BV eho thay tlnh trang Chen lan khi lam thii tuc, ndi ngoi chd kham bat tien, ndng ni/c, thdi gian chd kham keo dai (vdi niiu'ng benh ddn thuan khong phai lam XN cung mat tir 6-8 tieng), chat lu'dng dich vu y te khong dap irng kip nhu cau ciia NB [ 1 ] . Vdi phu'dng cham lay ngu'di benh (NB) lam trung tam, nganh y te da cd nhieu de an, giai phap giam tiidi gian chd kham dap u'ng si/ hai long cua NB.
Tiii/c hien chii tru'dng khuyen khich cac BV nang cao QLCL cua Bp Y te, Uy ban nhan dan tinh Bac Ninh va Sd Y te tinh Bac Ninh, tir nam 2014 BV_ Da khoa (BVDK) TiT Sdn da da chii trpng trien khai edng tae quan ly chat lu'dng, cai tao nang cap ed sd ha tang trang thiet bj, cong
