VIETNAM MEDICAL JOURNAL N"1 - AKKIL - 12 tuoi; Cao nhat: 85 tuoi; Nhdm tuoi 40 - 60
chiem ty le 55,3%.
- Cd 19 TH (25%) mac benh ket hdp, trong do benh tieu dffdng chiem ty le 4 2 , 1 % .
- Hinh thai sdi S3 va S4 ehiem ty le cao hdn cac hinh thai sdi khac.
2. Ve cac yeu to lien quan den nguy cO sot soi sau mo
- Trong nghien cffu nay ty le sdt sdi sau phau thuat la 26,3 %.
- Nguy cd sdt sdi: Giffa than phai va than trai;
Giffa nam va nff khac nhau khdng cd y nghTa thong ke vdi p > 0,05.
- Hinh thai cua sdi; Mffc dp viem dfnh ciia than cd anh hffdng td' ty le sdt sdi sau mo, sff khac biet ed y nghTa thong ke vdi p < 0,05.
TAI UEU THAM KHAO
1. Nguyin Thdnh Dffc (1999); "Nghien cffu tai bien, bien chffng sdm trong phau thuat soi dudng tiet nieu tr§n va mot so yeu to lien quan"; Luan an
Tien sy Y hoc, Hpc vien Quan y. Ha Noi, 1999.
2. Nguyen Thanh DiTc, Ngo Kim Chung, Hoang Van Ky, Ngo Van Do (2004); "Nghien cilu ve bien doi mo hoc ciia than co soi"; Tap chi Y hac • thanh pho HS Chf Minh; 2004; tap 8; so 1 ' ^ 3. Tran Van Hinh (20pi)j "Nghien ciiU phau thuat iay^
tiian bang dudng mo be than ~ nhu mo mat sau"; bSi anTiensyYhpc, Hoc vien Quan y. Ha Npl, 2001. A 4. Tnidng Minh Khoa, Tru'dng Cong Tham
Nguyen Phu'dc Loc, Le Quang Dung, li Quang Trung, Tran Huynh Tuan, Nguyen Trung Hieu, Dam Van Cu'dng (2010); "D%
gia ket qua mo soi than san ho tai benh vien T r ^ u'dng Da khoa Can Thd"; Tap chf Y hoc thanh rife Ho Chi Hinh; 2010; tap 14; so 3.
5. Vu Sdn (1995);^ "Gop phan nghien CLTU SI/ phan bo mach mau vung cuong than - ci/c du'di bi/S:
d^u ffg dung c§t mot ph^n thin Sieii trj soi dai - be than"; Luan van Thac sy Y hoc; Ha NoJ 199S.
6. By Joseph A. Smith, Jr., MD, Stuart S.
Howards, MD, Edward 3. McGuire, MD and Glenn M. Preminger, MD; "Open stone surgery;
anatrophic nephrolithotomy and pyelolithotomy";
Hinmaan's Atlas of Urologic Surgery; Chapter 158.
THirC TRANG THai GIAN CHff CUA BENH NHAN TAI KHOA K H A M BENH, BENH VIEN VIET DU'C TIT 7 / 2 0 1 4 t)EN 6 / 2 0 1 5 vA GlAi P H A P BO TRI NHAN LITC
T O M TAT
Muc tieu: Tim hieu thdi gian chd cua benh nhan tai khoa Kham benh txi tnang_ 07/2014 - 06/2015, tff dd de xuat giai bo tri nhan Iu'c Phu'dng phap nghign cffu: Nghien cCiU c§t ngang tien hanh nham tim hieu th6i gian kham benh cua benh nhan tai Khoa Kham benh, Benh vien Vjet Dffc. Ket qua: thdi gian chd trung binh cua ngu'di benh (NB) tff khi dang ky den khi dUdc kham benh nam 2014 la 50.41 phut, thdi gian chd trung binh cua NB nam 2015 da giam xuong con 42.05 phut. Thdi gian chd lau nhat doi vdi NB cd BHYT la 81,54 phut, LTng vdi gicJ tiep ddn 6h30-7h.
Thdi gian chd ft nhat la thff 5, trong khi thdi gian chd lau nhat la thff ba. Doi vdi doi tu'dng co BHYT, thdi
• gian chd lau nhat rdi vao thang 7, 8, 9, trong khi thdi gian chd it nhat rdi vao thang 11, 12 va 2. Ooi vdi doi tu'dng khong cd BHYT, thdi gian chd lau nhat la thang 7, 8, 9 trong khi thdi gian chd it nhat la thang 12, 1, 2. Ket luan: Viee tim hieu thdi gian chd ddi ciia ngUdi benh tai phdng kham cd vai tro quan trong, lam cd sd
*BSnh vien Viet Dut
Chju trach nhigm chinh: Tran Dinh Tho Email: [email protected] Ngay nhan bai: 15.01.2017 Ngay phan bien khoa hoc: 14.3.2017 Ngay duyet bai: 21.3.2017
Tran Dinh Tho*, Nguyen Van Uy*
cho viec dB xuft cac gial phap bo tri nhan IUc va d^u t u cd sd ha tang phiJ hdp.
SUMMARY
W A n i N G TIME OF PATlEmS AT OinPATIEKr DEPARTMErrr, VIET-GERMANY HOSPHAL
FROM JULY 2014 TO JUNE 2015 Objective: Research the waiting time of patients at outpatient departement, Viet - Germany hospital from July 2014 to June 2015. Subjects and Methods: A cross-sectional study was conducted to identify the waiting time of patients at Outpatient Department in Vietnam-Germany Hospital. Result and Condusion:
shows that, the waiting time of patients from registration to finish examination in 2014 was 50.41 minutes, while the waiting time in 2015 was 42.05 minutes. For patients with health insurance, the highest waiting time was 81.54 minutes at the time from 6.30 a.m. to 7 a.m. Patients receiving examination on Thursday had the lowest waiting bme, while those on Tuesday had the highest waitirig time.
For patients with health insurance, the highest waiting time was on July, August and September while the lowest waiting time was on November, December and February. Meanwhile, for patients without healtti insurance, the highest waiting time was on JulVi August and September while the lowest waiting time was on December, January and February.
230
TAP CHl Y HOC VlgT HAM TAP 453 - THANG 4 • SO 1 • 2017
L O J O L T V A N D E
To chffc kham chffa benh hdp ly se rut ngan thdi gian kham benh cua ngu'di benh dac biet la thdi gian chd cua ngu'di benh [1], viec danh gia thdi gian kham benh cua ngu'di benh la tieu chf rat quan ffpng, da va dang du'dc de cap trong mot s5 nghien cffu gan day. Cac nghien cffu cho thSy thdi gian kham benh cua ngu'di benh tai eae benh vien la rat khac nhau v^: ed rat nhieu yeu to cd the anh huSng den thdi gian nay nhu' quy trinh lam viee, khoi Iffdng cong vice, nguon liTc [2], [4].
Benh vien Viet £»ffc Ja benh vien hang dae biet CO nhiem vu cham sdc sffc khde cho nhan dan khu VLTC phia Bac Viet Nam. Hang ngay, khoa Kham benh eiia Benh vien tiep ddn hang tram nghin lu'dt ngu'di benh kham, thu'dng xuyen trong tinh trang qua tai. Benh vien luon mong muon tim kiem nhffng gial phap thfch hdp de giup ngffdi dan thuan tien khi di kham chii^
b^nh, nang cao chat Iffdng phue vu ngffdi benh.
Tuy nhien, tai Benh vien chffa cd mdt nghien effu day du nao ve thdi gian kham benh eua ngffdi benh. Chinh vi vay nghien cffu du'dc tien hanh vdi hai muc tieu sau: Phan tfch thdi gian kham tienh aia benh nhan tai Khoa Kham iienh, Benh vien Viet D&c t& 7/2014 den 6/2015 va du^ ra mpt sd giai phap bd tri nhan Iu'c.
III. KET QUA NGHIEN CU'U
II. €>0I TU'ONG VA PHU'OIMG PHAP NGHIEN COV 1 . Thdi gian nghien cu'u: Tff 1.7.2014 den 1.7.2015
2. fi|a diem: Khoa Kham benh - Benh vien Viet Offe, Ha Npi
3. Dol tu'dng nghien cii'u la ngu'di benh den kham tai khoa Kham benh- Benh vien Viet Dffe, Ha NOI trong khoang thdi gian 07/2014 - 6/2015.
4. Thiet ke nghien cii'u: Nghien cffu md ta eat ngang
5. Thong tin thu thap:
• Tong thdi gian kham benh cua ngu'di benh:
thdi gian kham benh trung binh, thdi gian kham benh trung binh theo tffng giai doan, thdi gian trung binh theo ngay, buoi, loai hinh kham, phong kham va theo tffng tru'dng hdp kham.
• Thdi gian chd kham trung binh eua ngu'di benh: thdi gian chd trung binh tai benh vien, thdi gian chd trung binh theo ngay, buoi, loai hinh kham phdng kham va theo tffng tru'dng hdp kham.
• Phu'dng phap: quan sat, bam gid.
6. Xu" li v^ phan tich so lieu: So lieu diicic Iam saeh tru'dc khi nhap lieu. So lieu dieu tra dffde nhap vao may tfnh vdi phan mem EPI- DATA 3.1. Sff dung phan mem STATA 12.0 xff ly so lieu: Thdi gian trung binh (M±SD), cac tan suat, ty le %
Bang
Nam
20M 2015 Chunq
1 : Tong hdp sS benh nhan tir 1 / 7 / 2 0 1 4 den 3 0 / 6 / 2 0 1 5 Co BHYT
So lu'dng
(NB) 26174 12124 38298
T y l e
(%)
68,34 31,66 100,00
T h i i gian chd
(phut) 52,12 50,71 51,67
Khong BHYT So
li^dng (NB) 49192 50391 99583
T y l e
( % ) •
49,40 50,60 100,00
The*
gian chd (phut)
49,51 39,96 44,68
Chunq SS lu'dng
(NB) 75366 62515 137881
T y l e
( % ) •
54,66 45,34 100,00
Tlldi gian chd
(phut) 50,41 42,05 46,62 Bang 1 cho thay, so lu'dng NB difdc tiep nhan cd BHYT la: 38.298/137881 NB chiem ty le 27,77%
So lu'dng NB difdc tiep nhan khong cd BHYT la 99583/137881 NB chiem ty le 72,23%. Thdi gian chd trung binh cua NB tif khi dang ky den khi difdc kham benh nam 2014 la 50.41 phut, thdi gian chd trung binh cua ^Q nam 2015 da giam xuong cdn 42.05 phut.
Bang 2: Benh nhan phan phoi theo gid t/vng n^Jiy ftu' 1/7/2014 den 30/6/20X5)
Gid So
lu'dng (NB)
T y l e
(%)
Thdi gian chd (phut)
Khong BHYT So
lu'dng (NB)
T y l e
(%j
Thdi gian chd (phut)
Chung So iLfdng (NB)
T y l e
(%)
Thdi gian chd (phut)
11,498
10,631 5,238
9,16 13,68 6,11 1,90 5,68
81,54 60,95 47,34 40,84 39,08 74,87 34,32
13,704 26,512 24,506 15,165 5,891 1,418 6,140
13,76 26,62
70,63 55,01 38,48 32,85 30,06 60,21
17,211 38,010 35,137 2,145
12,48 27,57 25,48 14,80 5,97 1,56 6,03
72,85
65,18
14:00-15:00 15:00-16:00 16:00-16:30
1,336
774 71
38,2983,49 2,02 0,19 100,00
26,26 20,91 45,51 51,67
4,304 1,743
200
99,5834,32 1,75
,20
100,0020,56 24,71 87,48 44,68
5,640 2,517
271
137,8814,09 1,83
,20
100,002i,qi 2iM 764H 46,62 Bang 2 eho thay, so Iffdng NB dong nhat tap trung vao hai cung gid la 7h-8h va 8h-9h. So lirong MB thap nhat vao cac cung gid l l h - 1 2 h , 15h-i6h va 16h-16h30. Nhff vay, thdi gian chd lau nhat doi vdi NB cd BHYT la 81.54 phut, ffng vdi gid tiep ddn 6h30- 7h. Thdi gian chd lau nhat ddl vdi NB khong cd BHYT la 70.63 phut, cung ffng vdl gid tiep ddn 6h30- 7h.
Bang 3: Ty IS NB phan bdtheo cac ngay trong tuan
Ngay thu' Thir hai Thirba Thu-tu- Thir nam Thif sau Chung
Co BHYT So lu'dng
(NB) 8,655 9,647 8,123 6,440 5,433 38,298
Ty le
(%)'
22,60 25,19 21,21 16,82 14,19 100,00
•nidi gian chd
(phut) 52,38 55,00 48,89 47,98 53,18 51,67
Khong BHYT So
lu'dng (NB) 23,484 22,931 19,302 16,746 17,120 99,583
T y l e
(%)
23,58 23,03 19,38 16,82 17,19 100,00
Thdi gian chd
(phut) 46,50 46,91 43,25 42,21 43,22 44,68
Chung SS lu'dng
(NB) 32,139 32,578 27,425 23,186 22,553 137,881
T y l e
(%)
23,31 23,63 19,89 16,82 16,36 100,00
Thdi gian chd (phut) 48,08 49,30 44,92 43,81 45,62 46,62 Bang 3 cho thay, quy luat phan bo theo cac ngay trong tuan: Thff 2, thff 3 va thff 4 la dong nhat Thff 5 va thff 6 vang lidn. Thdi gian chd it nhat la thff 5, trong khi thdi gian chd lau nhat la thff ba.
Nam
20142015 Thang
Thang
6 7 8 9 10 11 12 1 2 3 4 5 6
CdBHYT So lu'dng
(NB) 3585 4212 3417 3524 4078 3667 3691 2042
796
2343 2082 2387 2474T y l e
(%)
13,70 16,09 13,05 13,46 15,58 14,01 14,10 16,84 6,57 19,33 17,17 19,69 20,41
Thdi gian chd (phut) 52,45 59,23 57,79 57,93 53,50 42,19 41,23 47,47 42,23 50,02 49,79 52,22 56,06
Khong BHYT So lu'dng (NB) 6966 8124 6925 6901 7541 6200 6535 7747 4574 9986 8557 9271 10256
T y i e
(%)
14,16 16,51 14,08 14,03 15,33 12,60 13,28 15,37 9,08 19,82 16,98 18,40 20,35
Thdi gian chd (phut) 51,69 58,77 58,20 56,55 4 7 , 4 1 36,90 33,38 33,02 33,93 37,72 39,93 43,40 47,00
Chunq So lu'dng
(NB) 10551 12336 10342 10425 11619 9867 10226 9789 5370 12329 10639 11658 12730
Tyle
(%)
14,00 16,37 13,72 13,83 15,42 13,09 13,57 15,66 8,59 19,72 17,02 18,65 20,36
Thcii gian chS (phiit 51,95 58,93 58,06 57,02 49,ib 38,8i 36,21 36,0^ 35,1( 40,01 41,» 4b,21 48,/l Bang 4 cho thay, quy luat phan bo theo eae thang trong nam: Cae thang hau nhff it co sff kha biet ve sff phan bo NB, duy nhat cd thang 2/2015 la so Iffdng NB it hdn han cac thang vi day la thani c d T e t a m lich.
IV. BAN LUJO^N
1 . Thu'c t r a n g t h d i g i a n c h d ciia b e n h nhan t a i khoa K h a m b e n h :
Ket qua nghien cffu cho thay tong thdi gian trung binh tff khi ngffdi benh dang ky kham den Iuc bae sy chan doan la 50,41 phut trong nam 2014 va 42,05 phut trong nam 2015. So sanh ket qua nghien cffu nay vdi ket qua ciia mot so tac gia cho thay, tong thdi gian trung binh cua ngffdi benh tdi kham 1 Iffdt trong nghien ciru nay thap
hdn so vdi nghien effu ciia Nguyin Thj Thu Ha >
benh vien da khoa Ha Oong [2], nghien cifuj binh vi§n Cap cu\j Trffng Vu'dng [3] va nghie cuff tai benh vien Nguyin Trai thanh pho Ho Q Minh [4]. Tuy nhien ket qua nghien cffu r\hf ca hdn so vdi nghien cffu cua Vu Minh Thuy b Benh vien Nhiet ddi Trung ffdng [1] va nghie cffu cua Frank. L. Cole tai Uc [5]. Oieu nay c the giai thfch la do tiiy tffng dia diem, tiiy tiiti dac trffng kham benh ma thdi gian 1 Iffdt khai
232
TAP CHi Y HQC VlgT NAM TAP 453 - THANG 4 - SO 1 . 2017 ciia ngffdi benh la khac nhau. Neu nhii d nghiin
cufu ciia F. Cole [5] chi nghien cffu d mot phong kham, nghien cffu ciia Vu I^inh Thuy [1] chi nghien cirtj^ d benh vien thupc ve chuyen khoa, CO dac thu rieng ciia mdt benh vien truyen nhiem nen thdi gian chd eua ngffdi benh se thap hdn nghien cffu nay. Mat khac, Khoa Kham benh Benh vien Viet Offe la cd sd kham ehffa b i n h cliat lu'dng cao, do dd ngu'di benh trffc tiep den cd sd de kham chffa benh ma khong thong qua tuyen cd sd, do dd thffdng bj qua tai.
Ket qua nghien ciTu cho thay sff khac nhau ve thdi gian trung binh d benh vien giffa ngay dong va ngay vang, giffa buoi sang va buoi chieu, giffa kham BHYT vdi kham thu phi, giffa eae phdng kham vdl nhau. Dieu nay cd the de hieu la do nhffng ngay dong ngffdi benh den kham thdi gian chd ddi nhieu hdn vi the tong thdi gian kham benh se nhieu hdn. Ket qua dffa ra cung tffdng dSng vdi nghien cifu ciia Vij Minh Thuy khi tac gia nay chi ra rang thdi gian kham trung binh ngay hanh chinh dai hdn ngay nghi [ 1 ] . Hien nay, ngffdi benh chi tap trung kham vao buoi sang la chu yeu, de co the thffc hien cae xet nghiem de dang hdn. Ket qua nay cung phu hdp vdl nghien ciiu ciia Nguyin Thj Nggc Han khi t^e gia ehi ra rang so Iffdng ngffdi benh dang ky vao cac buoi sang eao hdn buoi chieu: sang (trffdc 11 gid): 2929 (76,8%), chieu (sau 12 gid): 884 (23,2%) [ 6 ] . Cd Ie vi the thdi gian kham benh trung binii cua nhffng ngffdi benh tdi kham buoi sang cao hdn nhieu so vdi buoi chieu nhff vay.
Ooi vdi nhffng ngu'di benh kham thu phi, ngffdi benh thu phi lai cd thdi gian nop vien phi nhanh hdn do khong phai chd ddi d quay giff/tra the BHYTvi tfie thdi gian kham benh eung ngan hdn.
Tu'dng tff nhff y kien "Phdng giff the, thu phi ngffdi benh tap trung qua dong trong khong gian chat, d l gay tam Iy bffc boi cho ngffdi benh" [2].
Ket qua bang 3 cung cho thay thdi gian trung binh ciia ngffdi benh kham BHYT d ngay dong la cao hdn so vdi ngay vang va thdi gian trung binh cua ngu'di benh den vao ngay dong ed kham BHYT cao hdn kham thu phf. Oleu nay cho thay, ngffcfi benh can ton mot khoang thdi gian trong tong thdi gian kham benh de hoan thanh cae thii tuc hanh chfnh. Oleu nay cung tffdng dong vdi y kien trong nghien cffu trffdc dd "Nhffng thii tuc hanh chi'nh cd anh hffdng nhieu tdi thdi gian kham benh ciia ngffdi benh nhffng van phai thffc hien vi khong t h ^ thay doi dffdc" [ 2 ] .
Thdi gian trung binh thffc hien mot quy trinh kham ciia ngffdi benh vao buoi sang dai hdn
budi chieu. Tong thdi gian trung binh tai eiia ngffdi benh den kham BHYT va kham thu phi d buoi sang deu eao hdn buoi chieu. Viec tap trung dong ngu'di benh buoi sang khien elio thdi gian kham keo dai hdn. Vi vay, viec dieu dpng nhan Iffc hay td chffc kham buoi sang can diidc xem xet de giam thdi gian eho ngffdi benh.
2. De xuat giai phap bo tri nhan iu'c:
2 . 1 . Giai phap tru'dc m a t
> B 6 trf eae bac sT kham benh sdm hdn, thdi gian d d kien bat dau tff 6h sang (do thdi gian ngu'di benh chd nhieu nhat tap trung vao cung g i d t f f 6 h 3 0 d e n 9 h )
> Bo trf them moi phong kham mot bae sT tai eung gid tff 6h30 den 9h (ca phdng kh^m tong hdp va phdng kham chuyen khoa cd ngu'di benh dong).
>B6 trf nhan vien hu'dng dan ciia phdng Cong tae xa hpi de hu'dng dan ngffdi benh kham, lam xet nghiem, giam tap trung dong ngu'di anh hu'dng den tiidi gian chd ciia ngffdi benh).
> Bo trf bac sT can lam sang, KTV can lam sang tai eac phong chup XQ, sieu am, CT, MRI...
vao thdi diem cung gid 6h30 den 9h30).
2.2, Giai phap dai han
Oang ky kham benh qua mang, kham theo hen (viec lam nay lam giam chi phf cho ngffdi benh, giam ganh nang ve phan bo ngffdi kham benh cho Benh vien).
- Phan ti'ch thdi gian chd ngffdi benh dffa tren quy trinh kham benh, thdi gian ehd ngffdi benh dai nhat nhat d khau nao, tang cffdng nhan Iff'tai khu vffe do.
- Nang cap he thong phan mem quan ly va dff lieu de giam ganh nang ve hanh chfnh, hay thu'c hien ISO trong kham benh.,. tff do lam giam thdi gian ehd ddi eiia ngffdi benh.
V. KET L U A N
*Thdi gian chd trung binh cua NB tff khi dang ky den khi dffdc kham benh nam 2014 la 50.41 phut, thdi gian chd trung binh ciia NB nam 2015 da giam xuong cdn 42.05 phut.
- Thdi gian ehd lau nhat doi vdi NB ed BHYT la 81.54 phut, img vdi gid tiep ddn 6h30- 7h. Thdi gian chd lau nhat doi vdi NB khong co BHYT la 70.63 phut, cung irng vdi gid b'ep don 6h30- 7h.
Thdi gian chd it nheit la thff 5, trong khi thdi gian chd lau nhat la thff ba.
- Ddi vdi d a tuWng c6 BHYT, thdi gian chd lau nhat rdi vao thang 7, 8, 9, trong khi thdi gian ehd ft nhat rdl vao thang 11, 12 va 2. €>ol vdi doi tffdng khong co BHYT, thdi gian chd lau nhat la thang 7, 8, 9 trong khi thdi gian chd ft nhat la thang 12,1, 2.
VIETNAM MEDICAL JOURNAL N°1 - APRIL - 2017
*Giaiphap trffdc mat can bd trf tang nhan Iffc tang cddng tai thdi diem tff 6h30 den 9h30 hang ngay tai cae phdng kham.
*Giai phap lau dai tien hanh dang ky kham benh qua mang, kham theo hen de qua dd bo trf nlian Iffc phu hdp.
TAI UEU T H A M KHAO
1, Vu Minh Thuy (2010), Thdi gian ehd kham eua benh nhan tai Khoa Kham benh benh vien Nhiet ddi Trung ifdng t& thang 11/2009 den thing 2/2010, Khoa luan tot nghiep cff nhan y khoa, Dai hgc Y Ha Ngi, Ha Ngi.
I.. Nguyen Thj Thu Ha (2015), Thdi gian sit dung dich vu cua ngudi benh va mot so yeu tolien quan t^i khoa kham benli, benh vien da khoa Ha Dong, Ha Ngi, Luan van Thac sy Y hgc, Dai hgc Y Ha Npi.
,3. Le Thanh Chien, Huynh Thj Thanh Trang va Do Cong Tam va cac cong sU (2012), "Khao
sat quy trinh kham chffa benh tai Khoa Kham ijgfih a - benh vien cap cu^ TrUng Vu'dng'; Tap chi Ylic t Thanhj>hoHdChiMinh, 4(16).
4. Nguyen Thai Ha (2001), Sd hai ldng cua ngu&i binh s&dung die bao hiem yte ve chat ludng (M vu Y tetai benh vien Nguyen Trai thanii phdm \ Chl Minh nam 2001 va mot so yeu to lien quan, >
Luan van Thac sy y hgc, Dai hoc Y DUcJc Thanti pho Ho Chf Mmh, TP Ho Chf Mmh.
D. Frank.L.CoIe (2000), Detemiinants of parent ' waiting time in the general outpatient department of ' a tertiary health institution in Australia, Australia.
6. Nguyen Thj Ngoc Han, Nguyin Thj Hoang Van va Bui Hffu Minh Tri ([2012), Thdi gian chd ddi kham benh va sd hai long cua benh nhan tai khoa kham benh benh vien Tim mach An Giaiig, truy cap ngay, tai trang web http://123doc.org/document/3058252-thoi- gian- cho-va-hai-long-cua-nguoi-benh.htm.
DANH GIA s y HOT TAC CUA BENH NHAN GIITA PHiraNG PHAP AN THAN DO BENH NHAN TIT D I E U KHIEN SIT DUNG MIDAZOLAM
V a i GAY T £ D O N T H U A N T R O N G T H U THUAT NHA KHOA
TOIVI TAT
Mifc deu: danh gia ve sU hdp tac ciia benh nhan giffa phu'Ong phap an than do benh nhan tii dieu i<hien (PCS: patient controlled sedation) sff dung midazolam so vdi gay te ddn thuan (GTOT) trong thCi thuat nha khoa. Ddl tUdng phUdng phap: 7Q benh nhan co chi dmh phau thuat rang khon, tuoi 18 - 60, ASA I - II chia thanh 2 nhom ngau nhien. Nhom GT:
gay te dOn thuan bang lidoeaine 2% (n = 35) va nhom PCS: gay te ket hop vdi an than bang midazolam do benh nhan t u dieu khien bdm tiem dien (n = 35). Ketqua: nhom PCS so vdi GTDT khac nhau khong y nghTa thong ke (p > 0,05) ve: mffc do kho phau thuit 8,62 ± 2,11 diem so vdi 8,26 ± 1,73 diem;
thdi gian phau thuat 23,46 ± 3,71 phiit so vdi 23,94
± 3,91 phiit nhuVig nhom PCS so vdi GTDT khac nhau CO y nghTa thSng ke (p < 0,05 va p < 0,01) ve: sU hdp tac tot vdl phau thuat 91,43% so vdi 31,43%; benh nhan khong cu" dgng tnang mo 97,14 % so vdi 54,29%j mffc do hai long eua phlu thuat vien 8,23 ± 0,88 diem so vdl 6,74 ± 0,95 diem; mffc do hai Idng ciia benh nhan 8,26 ± 1,03 diem so vdi 6,63 ± 1,57 diem. Ket lu$n: phu'Ong phap PCS bSng midazolam ket hc^ vdi te tai cho lidoeain 2% co mffe do khd va thdi
*Benh vien Rang Ham Mat TWHa Noi Chiu trach nhiem chfnh: Nguyen Quang Binh Email: [email protected] Ngay nhan bai: 3.01.2017 Ngay phan bien khoa hoc: 3.3.2017 Ngay duyet bai: 10.3.2017
Nguyen Thuy Linh*, Nguyen Quang Binh*
gian phau thuat nhu* nhau nhuing co si/ hdp tac tot hdn vdl phau thuat, ft cff dgng hdn, b|nh nhan va F^au Hiuat vien hai long hdn so vdi phUdng phap chi gay te dAi thuan trong phlu thuat rang khon ham dudi.
T&khoa: An than, PCS, midazolam.
SUIVIMARY
TO ASSESSED THE PATIENT'S COOPERATION BETWEEN USING SEDATION METHODS
PATIENT CONTROLLED SEDAHON BY MIDAZOLAM W H H LOCAL ANESTHEHC IN
DENTAL SURGERY Objective: To assessed the patient's cooperation between using sedation methods patient controlled sedation by midazolam with local anesthetic in dental.
Methods: clinical trials, controlled study, conducted In 70 patients, aged 18 - 60, ASA I - II. ims group (n = 35): administered local anesthesia by lidoeaine 2%
with epinephrine 1/100,000 with a dose of 2 mg/kg and 5 minutes after the surgery. PCS group (n = 35);
0.5 mg midazolam intravenously 1 minute before the local anesthetic (such as LANS) and subsequent maintenance dose by installing electnc pump bolus injection: 0.5 mg midazolam and duration refractory period (lockout period) between 2 visits of bolus is 1 minute. Results: The group PCS and LANS (p > D.05) on the level of difficulty of the surgery 8.62 ± 2.11 points and 8.26 ± 1.73 points; duration of surgery 23.46 ± 3.71 minutes and 23.94 ± 3.91 minutes. 1 ^ groups on the good cooperation with surgery 91.43%, the movements during operation 97.14%, the level of
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