TAP CHi Y HQC VigT NAM TAP 464 - THANG 3 - S01 - 2018 ben. Ung thu' vii hai ben dong thdi cd tien lu'dng
xau hdn va la mot yeu td tien lu'dng ddc lap [5].
Nghien ciTu eua Sehmld tren 34 benh nhan ung thu' vii hai ben dong thdi giai doan sdm, tac gia cung nhan thay khdng cd sif khae biet ed y nghta thdng ke ve thdi gian song them khdng benh giii^ ung thu" vii hai ben ddng thdi va ung thu' vil mdt ben { HR: 0,932; 95% Q : 0,322 - 1,07; p = 0,9) [7].
Trong nghien cifu cua ehung tdi, tai thdi diem 1 nam, ty le sdng them khdng benh la 100%, tai thdi diem 2 nam, ty le song them khdng benh cho hai nhom ung thif vii hai ben ddng thdi va khdng ddng thdi la 94,44% va 85,71%. So sanh vdi eae nghien cu'u cimg thdi diem va giai doan ve ung thu' vu mdt ben tai benh vien K chiing tdi cung khdng nhan thay su' khac biet ve thdi gian sdng them khdng benh giifa ung thd vii hai ben va mpt ben. Ngoai ra, trong nghien cifu cung cho thay khdng cd sif khae biet ed y nghTa thong ke giCi'a hai nhdm ung thif vii hai ben ddng thdi va khdng ddng thdi.
V. KET L U A N
Trong nghien cifu chiing tdi nhan thay, khdng ed sif khae biet ve thdi gian song them khdng
benh gida ung thu' vii hai ben ddng thdi va khdng ddng thdi.
TAI UEU T H A M KHAO
1. Dawson L.A, Chow E, Goss P.E. (1998).
Evolving perspectives in contralateral breast cancer. Eur J Cancer, 34(13), 2000-9.
^. Dinh Thj Lan Anh (2016), Danh gia kit qua ddn tn lieu Viroreibin trong ung thu' vu tai phit di can, Tru'dng Oai hoc Y Ha Noi, Ha Noi.
3. Chen S.F, Du C W , Yang P, et al. (2013). The molecular and dinicopathologic charactenstics of bilateral breast cancer. SciR^, 3,2590.
t . Beckmann K.R, Buckingham J, Craft P, et al.
(2011). Clinical characteristics and outcomes of bilateral breast cancer in an Australian cohort.
Breast, 20(2), 158-64.
^. Vuoto H.D, Garcia A.M, Candas G.B, et al.
(2010). Bilateral breast carcinoma: clinical charactenstics and its impact on survival. Breast J, 16(6), 625-32.
6. Schwentner L, Wolters R, Wischnewsky M, et al. (2012). Survival of patients with bilateral versus unilateral breast cancer and impact of guideline adherent adjuvant treatment: a multi- centre cohort study of 5292 patients. Breast, 21(2), 171-7.
7. Schmid S.M, Pfefferkorn C, Myrick M.E, et al.
(2011). Prognosis of early-stage synchronous bilateral invasive breast cancer. Eur J Surg Oncol, 37(7), 623-8.
THANG DIEM DANH GIA NGUY Cff NHIEM KHUAN BENH VIEN TAI KHOA HOI SU'C TICH ClTC NHI
Ha Manh Tuan' TOM TAT
Myc tieu: xac dinh cae yeu to nguy cd nhiem kh_Lian benh vien (N1<BV) va^ hinh thanh mpt thang diem danh gta nguy cd nhiem khuan benh vien tai khoa hoi sCfc tich cifc nhi. Thiet ke nghien cu'u:
Nghien cinj doan he tien culi, thifc hien tai benh vien Nhi Dong 1 trong 14 thang. Bien so chinh: NKBV, dich te, dinh duBng, benh nen, PRISM, can thiep. Xac dinh yeu to nguy cd bang hoi quy logistic da bien, xac dinh gia tn cua thang diem bang du'dng cong ROC. Ket qua: Cd 671 benh nhan dii tieu chuan dUa vao nghien cifu. Ty le NKBV la 23%. Cac yeu td nguy cd NKBV la tudi < 1 tiuoi (RR = 1,9 (1,1 -3,4)); suy dinh duSng dp II, III (RR = 2,0 (1,1 -4,2)); PRISM > 10 (RR = 5,4 (2,4 - 11,9)); dat NKQ (RR = 2,3 (1,3 -4,0); nuoi an b'nh mach (RR = 2,8 (1,3-5,9); thdng tTnh mach trung tam (RR = 2,8 (1,3 - 5,9); thong tieu (RR = 5,7 (3,0 - 10,7)). Thang diem danh gia nguy cd NKBV = 6 x 1 'Dai hgc YDddc TP. HCM
Chiu trach nhiem chinh: Ha Manh Tuan Email: [email protected] Ngay nhan bai: 5.12.2017 Ngay phan bien khoa hpc: 2.2.2018 Ngay duyet bai: 12.2.2018
tuoi x) + (7x SDD > II z) + (27 x PRISM > 10 x) + (10 X thong TMTTx) + ^8 x NKQ x) + (17 x TT yj + (10 X NATM x) (x = 1 neu cd xuat liien ra yeu to nguy cd; -x=0 neu kiiong xuat hien), khi diem so > 32 thi nguy cd NKBV cao vdi dp dp nhay la 86,4% va dp dac hieu la 81,2%. Ket luan: Thang diem danh gia nguy cd NKBV bao gom 7 yeu to la tuoi 1<; suy dinh dii8ng
> I I ; Chi so PRISM > 10; thong tmh mach trung tam;
npi khi quan; thong heu; nuoi an tinh mach. Khi benii nhan co diem so > 32 thi se cd nguy cO cao NKBV.
Thang diem nay a n dUdc ciing co va ap dung de co the giup ich cho viec kiem soat NKBV tai khoa HStX nhi.
Td khoa: n\\ihx\ khuan benh^vien; hdi su'c tich cu'c nhi^ yeu to nguy cd; thang diem danh gia nguy cd nhiem khuan benh vien.
SUMMARY
RISK OF NOSOCOMIAL INFECTION SCALE FOR PEDIATRIC INTENSIVE CARE UNIT
Objective: identify risk factors of nosocomial infection and develop a risk of nosocomial infection scale in pediatric intensive care unit Risk factors were analysed with logistic regression, value of nsk of nosocomial infection. Study design: A prospective cohort study was carried out in Children's Hospital 1 within 14 months. Main variables were nosocomial
VIETNAM MEDICAL JOURNAL N'l - MARCH - 2018 infection, demographic, nutrition status, underlying
disease, PRISM, inten/ention. Risk factors were analysed with the logistic regression, the risk of nosocomial infecbon scale was identified cut-off value with ROC. Results: There were 671 patients enrolled in the study. The Incidence of nosocomial infecdon was 23%. The risk factors of nosocomial infection were: age
< 1 year (RR = 1,9 (1,1 -3,4)); malnutrition I I , III (RR = 2,0 (1,1 -4,2)); PRISM > 10 (RR = 5,4 (2,4 - 11,9));
intubation (RR = 2,3 (1,3 -4,0); parenteral nutntion (RR
= 2,8 (1,3-5,9); central venous catheter (RR = 2,8 (1,3- 5,9); bladder catheter (RR = 5,7 (3,0 - 10,7)). Risk of nosoajmial tnfecdon scale = 6 x < l year old x) + (7x malnutrition > II x) + (27 x PRISM > 10 x) + (10 x CVP x) + (8 X intubation x) + (17 x bladder catheter %) + (10 x parenteral nutrition x) (z = 1 if nsk factor appears;
X=0 if not), the risk of nosocomial infection is high with sensitivity of 86,4% and specificity of 81,2% if scale IS more than 32. Conclusion: The risk of nosocomial infection scale includes 7 factors: <1 year old; malnutrition > I I ; PRISM>10; CVP; intubabon;
bladder catheter; parenteral nutrition. The risk of nosocomial infection is high with value of scale more than 32. The risk of nosocomial infecbon scale needs to be enhanced and applied to help the control of nosocomial infection in the pediatric intensive care units.
Key notes: nosocomial in fed/on; pediatnc hospital infection; nsk lactor; risk of nosocomial infecbon scale.
\. O^T VAN OE
Nhilm khuan benh vien (NKBV) tai khoa hoi sijfe tieh eife (HSTC) nhi la mdt van d§ y te quan trong do tinh ehat thu'dng gap vdi ty le thay doi tijy theo qude gia 6,1 - 29% trong tong sd benh nhan nam tai HSTC nhi'^'^'^'^, va do nhu'ng liau qua cua NKBV gay ra dd la thdi gian dieu trj k^o dai, tang chi phi dieu tri va tang ty le tif vong. Co nhieu yeu td to nguy ed lien quan den NKBV dd la cd dia, benh ly nen, cac can thiep va dieu tri ddi vdi benh nhan. Mdt benh nhan nam HSTC nhi thu'dng bi anh hu'dng bdi nhieu yeu to nguy cd. Cac yeu to nguy cd khi xay ra tren cimg mot benh nhan se lam gia tang nguy ed NKBV ciia benh nhan len^"*', tuy nhien mife dp gia tang anh hu'dng nay nhu' the nao thi it diTde khao sat.
Nghien ciili nay nham hinh thanh mdt thang diem bao gom nhihig yeu t d nguy cd NKBV nham danh gia n^uy cd NKBV cua benh nhi khi nam HSTC nhi de giup eho ngu'di thay thudc cd the tien doan du'dc nguy cd NKBV va tCt dd cd bien phap phdng tranh hieu qua hdn. Muc tieu:
1. Xic dinh yeu to nguy cdgay NKBV tai khoa HSTC nhi;
2. Xac dfnh thang diem dinh gla nguy cd NKBV tai khoa HSTC nhi.
IL o d i TUpNQ VA PHUONG PHAP NGHIEN CLTU Thi^t ke nghien cu'u: Nghien cii'u doan he tien eihj.
Ddi tu'dng nghien cufu: Nhu'ng benh nlian dieu tri tai khoa HSTC nhi eiia benh vien Nhi
£>dng i , tif thang 10/2003 den 12/2004 tlioa nhu'ng dieu kien sau:
-Tliu chuan chpn benh: benh nhan tif I thang tudi den 15 tudi, dieu tri tai khoa HSTC tren 48 gid va khdng cd dau hieu ciia Nl®
trong vdng 48 gid sau khi nhap HSTC.
-Tieu chuan loai trd: nhUng benh nhan co NKBV tif tru'dc khi vao HSTC, hay benh nhi ti^
vong tron_g vdng 48 gid sau nhap HSTC.
0 3 mau: Cd mau dddc tinh theo cdng tiiifc tinh ed m l u trong nghien cifu doan he kiem djnh gia thuyet ve nguy cd tu'dng ddi, vdi P2 = 0,04, RR=2,25 '^^' mifc y nghia 5%, lu'c cua test la 90%, kiem djnh hai phia, cd n = 509.
Thu thap so lieu: Mau du'dc chpn lien tuc khdng ngau nhien. Benh nhan du'dc kham, danii gia tinh trang benh, danh gla chi so PRISM (Pediatric Risk of Mortality), benh cd ban theo phieu thu thap. Cac can thiep va dieu trj, NKBV cd xay ra hay khdng? ket qua cudi eiing cua benh nhan deu^du'dc ghi nhan theo phieu Uiu thap. Tieu chuan chan doan NKBV theo feu ehuan cua Cd quan phdng ngifa va kiem soat benh Hoa ky (CDC)'^'.
Xuf ly so lieu: Khi so sanh hai ty te diing pt^ep kiem x ^ so sanh hai trung binh diing phep kiem t. Gla tn p <0,05 vdi kiem dinh hai phia du'dc xem la ed y nghla thdng ke.
Cac so lieu dddc xd ly bang phan mem SPSS 10.5.
III. K f r QUA
Oac di€m cua benh nhan nghien cuti: Co tat ea 671 benh nhan dii tieu ehuan nghien cifU.
Tudi trung binh la 58 ± 57 thang (gan 5 tuoi);
nam chiem 58,7% va nil' chiem 41,3%. Benh cd ban cua benh nhan thu'dng gap la benh nhiem khuan 52%, ke den la tai nan, chan thu'dng ngo dpe 16,4%. Cac benh di kem thu'dng gap la tlm bam sinh, bai nao, hpi chulig Down, sanh non.
Chi so PRISI^I (Pediatric Risk of Mortality Score) trong vong 48 gid trung binh la 7,21 ± 4,5. Cac can thiep thu'dng gap nhat ngoai trif tiem tinh mach (gan 100%) la thdng da day, thd ap lut du'dng lien tuc qua mui (NCPAP), dat noi klii quan (NKQ), phau thuat, thdng tinh mach trung tam (TMTT). Cac dieu b-i thu'dng dude ehi dinh dio benh nhan theo thif tu" la khang sinh, truyen mau, nudi an tJnh mach (NATM), diing thudc khang tiiJ the H2, thude_gian cd va an than (bang 1). ^
Ty le n h i l m khuan benh vien: Ty l§ nhiem khuan benh vien la 23,0 %, trong do viem phS
TAP CHI Y HOC VIET NAM TAP 464 • THANG 3 - SO 1 - 2018 benh vien la 44,2%, nhiem khuan huyet benh vien
24,4% nhilm khuan vet mo la 11,1% (bang 2).
Yeu to nguy cti nhiem khuan benh vien Qua phan tich da bien hdi quy logistic cho thay cae yeu td ed lien quan den nguy cd NKBV la tudi < 1 tudi (RR = 1,9 (1,1 -3,4)); suy dinh duQng do I I , I I I (RR = 2,0 (1,1 -4,2)); PRISM >
10 (RR = 5,4 (2,4 - 11,9)); dat NKQ (RR = 2,3 (1,3 -4,0); nudi an tTnh mach (RR = 2,8 (1,3 - 5,9); thdng tmh mach trung tam (RR = 2,8 (1,3 - 5,9); thdng tieu (RR = 5,7 (3,0 - 10,7)). Cac yeu to nuoi an qua thdng da day, phau thuat, benh dl kem, khang sinh, thudc ife ehe thu the H2, truyen mau khdng cd y nghTa trong phan tich da bien mac dau cd y nghTa trong phan tich ddn bien (bang 3).
Ba/Kf 1. Bac diem aia benh nhan /mhiSn ah/
fiac diem Gidi: Nam
NQ- Tuoi trung binh Suy dinli duSnq I I . I I I
PMSM Binh cd ban Nhiem Idiuan Tai nan - ngo doc
Benii Iv tieu iioa S o c a (n = 6 7 1 )
3 M 277
T y l e
(%)
58,7 41,3 58 ± 57 thang
83 1 12,4 7,21 ± 4,5 349 110 72
52,0 16,4 10,7
U bu'du Benh ho hap
Benh tim Benh than kinh cd
Benh huvet hoc Benh l<hac Can tiiiep: Phau thuat
N6I khi quan Tilfl NCPAP Thong TI^TT Tiiong da day Thonq tieu Dieu tri: Khang sinh
Truven mau NUOI an tmh mach
An than Gian cd Corticoldes Khang thu the H;
23 23 17 18 13 46 137 192 251 130 310 74 579 231 130 80 85 53 129
3,4 3,4 2,5 2,7 1,9 6,9 20,4 28,6 37,4 19,4 46,2 11,0 86,3 J4,4 19,4 11,9 12,7 12,7 19,2 Bang 2. Ty IS nhiem Ithuan benh vien Loai ntiiem Idiuan benh
vien Nhiem khuan benh vien
Viem phoi benh vien Nhiem khuan huyet Nhiem khuan vet mo Nhiem khuan tiet nieu Nhiem khuan khac
Soca (n = 6 7 1 )
154 76 42 19 9 26
T y l e C/oj 23,0 11,3 6,3 2,8 1,3 3,9 Bang 3. Phan tich hoi quy da bien cac yeu
Yeu to nguy cd Tuoi < 1 Suv dinh duSnq 11,111
Chi so PRISM > 10 Thong tmh mach trung tam
N6I khiquan Nuoi an tinh mach
Thonq tieu Nuoi an qua thonq da dav
Piiau thuat Benh kem Khanq sinh He che thu the H2
Truyen mau
tdnguy cd nhiem khuan benh vl NKBV
n = 154 ( % ) 67 (23,3) 35 (42,2) 122 (61,3) 50 (38,5) 96 (50,0) 53 (40,8) 34 (45,9) 111 (35,8) 43 (31,4) 36 (33,6) 153 (26,4) 70 (54,3) 75 (32,5)
n = 517 ( % ) 220 (76,7) 48 (57,8) 77 (38,7) 80 (61,5) 96 (50,0) 77 (59,2) 40(54,1) 199 (64,2)
94 (68,5) 71 (66,7) 426 (73,6)
59 (45,7) 156 (67,5)
RR ( 9 5 % C I ) 1 , 9 ( 1 , 1 - 3 , 4 ) 2,0 (1,1- 4,2) 1 5 , 8 ( 8 , 9 - 2 8 , 1 )
2 , 8 ( l , 3 - 5 j 9 ) 2 , 3 ( 1 , 3 - 4 , 0 ) 2,8 (1,3 - 5,9) 5,7 (3,0 - 10,7) 1,4 (0,6 - 3,5) 2 , 1 ^ 0 , 8 - 5 , 2 ) 1,4 (0,7 - 2,8) 6,5 (0,8 - 52,5) 1,4 (0,8 - 2,6) 0,9 (0,5 - 1 , 6 )
S/l P 0,028 0,047 0,001 0,006 0,006 0,006 0,001 0,466 0,115 0,349 0,080 0,261 0,752 Thang diem danh gia nguy cd nhiem
khuan b i n h vien: Theo bang 3 cd cac yeu t d nguy ed NKBV cd y nghTa thong ke theo phan tieh hoi quy logistic la 1) Chi so PRISM ^ 10; 2) Nuoi an tTnh mach (NATM); 3) Thong tieu (TT);
4) Dat thdng tTnh mach trung tam (TMTT); 5) Npi khi quan (NKQ); 6) Suy dinh du'dng dp > I I (SDD); 7) Tudi < 1. Thang diem danh gia nguy
cd cua NKBV du'dc ti'nh theo cdng thu'c sau: = (6 X 1 tudi x) + (7x SDD > I I x) + (27 x PRISM >
10 x) + (10 X thdng TMTTx) + (8 x NKQ x) + (17 X TT x) + (10 X NATM z) (x = 1 neu CO xuat hien co yeu t d nguy cd; x=0 neu khdng xuat hien) (bang 4). Du'dng cong ROC ciia thang diem nguy ca NKBV cd diem cat thich hdp la 32. Khi benh nhan cd diem nguy cd NKBV la > 32 thi
VIETNAM MEDICAL JOURNAL H°1 - MARCH - 2018 kha nang du' bao NKBV vdi dp nhay la 86,4% va
dp dac hieu la 81,2% (bieu dd 1).
Ba/ig 4. Thang^ diem nguy cd cua cac biS'n lim quan d&i nhiem khuan benh vi&i (n=617)
Yeu t o nguy ctf Tuoi < 1 Suy dinh duSnq > I I Chi so fmSA
> 10 Thong tmh maci
trung tam NOI khi quan
Thong tieu Nuoi an tmh mach
He so hoi q u y logistic (3)
0,6 0,7 2,7 1,0 0,8 1,7 1,0
RR [ e x p (3)1 1,9 2,0 15,8 2,8 2,3 5,7 2,8
f>iem cho nguy ctf ( 1 0 X (3)
6 7 27 10 8 17 10 R O C Curve
Y
yf
i i ^ u y erf N K . B V =- 3 2 Thang diem nguy cdNKBV = 32
Hinh 1. Bleu do dddng cong ROC cua thang diem nguy cd nhiem khuan binh vien.
IV. BAN LUAN
£>a cd 671 benh nhan cd du tieu ehuan du'a vao nghien culj, 154 benh nhan du'dc ghi nhan la cd nhiem khuan benh vien trong thdi gian khao sat vdi ty le nhiem khuan benh vien la 23%. Ty le NKBV nay so vcfi cac khao sat tru'dc day tai Viet Nam va cac qudc gia dang phat trien la tu'dng t y ^'•^•^, nhutig cao hdn so vdi cac khao sat cua cac nu'dc nhu' My, Chau Au'^'. Dieu nay cd the du'dc giai thi'ch bdi cae ly do sau: 1) Hhd trong dae diem dan so nghien cii'u trong bang 1, benh nhan nam HSTC trong nghien cuTu nay nhij'ng benh nhan nang, thdi gian nam keo dai, cd nhieu can thiep tren benh nhan; 2) Mat do benh nhan cao hien tai la 5 m V l benh nhan,'thap hdn so vdi tieu chuan chdng nhiem khuan toi thieu la 9 m V l benh nhan; 3) Nhan lyc dieu du'dng cham sdc benh nhan thieu vdi ty so dieu du9ng/benh nhan la 1/4 thap hdn so vdi chuan la 1/1 ddi vdi khoa HSTC nhi'^^. Do dd de giam nguy cd NKBV tai khoa HSTC ben canh viec tSng
cu'dng thye hien cac bien phap phdng chong NKBV can phai lu'u y den giam mat dp benh nhan trong khoa, tang cu'dng nhan lye dieu du'dng va dieu tn tot cac benh nen, rut ngan thcii gian nam HSTC.
Cac yeu t d nguy cd gay NKBV trong khao sit nay la tudi < 1 tudi; suy dinh dddng dp I I , III;
chi sd PRISM > 10; can thiep xam lan: thong tTnh maeh trung tam, ndi khf quan va dat thong tieu; nudi an tTnh maeh. Tru'dc het tuo'i cang nho thi nguy cd NKBV eang tang do kha nang milii dich kem nen benh thu'dng nang va kha nang chdng dd benh thap*'''^^ Suy dinh du'dng eung If mdt yeu t d thudc yeu to cd dja tu'dng tu" nhi/tuoi cua benh nhan, benh nhan suy dinh dudng nang se cd sye de khang kem nen nguy ed nhiiiti khuan benh vien se tang len^'''^^ Chi sd PRISM I mpt chi sd bao gom 16 thdng so du'dc diing (^
tien lu'dng nguy ed tu" vong eua benh nhan khi nhap vao HSTC. Chi so nay cung du'dc dung de danh gia tinh trang nang eua benh nhan nen c|
the du'dc dung de tien Iddng nguy ed NKBV dfS vdi benh nhan nam HSTC. PRISM eang cao thi nguy cd NKBV cang tang. Can thiep va dieu tri cung la yeu t d nguy cd cua NKBV tai khoa HSTC nhi. Cac can thiep du'dc xac djnh la cd lien quan den NKBV la dat thdng tinh mach trung tam, dat npi khi quan, dat thdng tieu va nudi an tinh mach. Phat hien nay cung dddc ghi nhan trong nhiJng khao sat khac'"'. Cac can thiep xam lan nay lam pha vd hang rao bao ve binh thu'dng cua cd the, cung vdi nhu'ng thao tae cham soc khdng dam bao vo khuan nhieu lan khi tien hanh va duy tri cac can thiep, ngoai ra cdn cd the do kha nang tiet khuan kem eua cac dung cu can thiep la nhti'ng ly do lam cho nguy cd NKBV tang len khi cd cae can thiep xam lan tren benh nhan,
Cac yeu to nguy cd NKBV tren thyc te khong xay ra rieng re tren mpt benh nhan ma phoi hdp vdi nhau trgn cung mdt benh nhan. Khi ehung cung xay ra tren mpt benh nhan thi anh hu'dng eua cac yeu to nay den nguy cd NKBV cua b?nh nhan nhu" the nao? Vf du mot benh nhan i Ituoi, bi suy dinh du'dng, cd d5t thong tieu kfii nam HSTC thi anh hUdng cua nhutig yeu td nay len kha nang bi NKBV ciia benh nhan nhu* the nao? Dp idn cua sy phdi hdp nay nhu* the nao?
0 6 la^dieu ma nghien culi nay muon tim hieu.
Moi benh nhan cd diem sd nguy cd cua NKBV
= ( 6 x 1 tuoi x) + (7 X SDD > I I x) + (27 X PRISM > 10 x) + (10 X thdng TMTTx) + (^ >!
NKQ x) + (17 X TT x) + (10 x NATM x) (X = ^ neu cd xuat hiSn ed yeu to nguy cd; x=0 i^"
khdng xuat hien). Theo nghien eyu nay khi di&n
TAP CHi Y HOC VIET NAM TijiP 464 - THANG 3 - SO 1 - 2018 nguy cd NKBV cua benh nhan nam HSTC > 32 th)
ed the d y doan benh nhan cd nguy cd NKBV cao vdi dp nhay la 86,4% va dp dac hieu la 81,2%.
Ap dung thyc te nhu" sau: Vf du 1: benh nhan 1 < tuoi, cd dat thdng tieu, va suy dinh duSng ed diem nguy cd NKBV la 30, nen benh nhan nay cd nguy cd NKBV thap. Vi du 2; benh nhan ed chi so PRISM > 10, cd dat npi khf quan se cd diem nguy cd NKBV la 35 nen cd nguy cd cao NKBV.
Viec xay dyng md hinh tien doan NKBV cho benh nhan nam HSTC nhi eung da cd tien hanh bdi mpt so ft tae gia. Tuy nhien tac gia chu'a hinh thanh thang diem de danh gia nguy cd NKBV.
Cho den thdi diem nay hau nhu" chu^ cd nghien cu'u nao xay dyng eae thang diem danh gia nguy cd NKBV cho benh nhan dieu tn tai HSTC nhi tai Viet nam. Day la nghien eyu dau tien ve hinh thanh thang diem danh gia nguy ed NKBV eua benh nhi khi nam dieu tri tai HSTC nhi, va da xae djnh du'dc gia tri tien lu'dng nguy cd NKBV cua tliang diem vdi dp nhay va do dac hieu eao.
V. KET LUAN
Thang diem danh gia nguy ed NKBV bao gdm 7 yeu td la tuoi 1 < ; suy dinh duSng > I I ; Chi so PRISM > 10; thdng tmh mach trung tam; ndi khi quan; thdng tieu; nudi an tTnh mach. Khi benh nhan cd diem so > 32 thi se cd nguy cd cao NKBV. Thang diem nay cd kha nang ap dung trong thyc te de d y bao kha nang NKBV tai khoa HSTC nfii, do thang diem du'dc xay dyng tren dan sd nghien ciJu thyc va nhij'ng yeu t d nguy cd NKBV trong thang diem cung du'dc xae djnh bdi nhieu nghien ciJu tru'dc do''*'. Viee ap dung chi sd danh gia nguy cd NKBV se cd nhieu ich ldi trong thyc te lam sang. Tru'dc tien giup eho cae nha (am sang phan loai du'dc benh nhan cd nguy ed
cao NKBV de cd each phdng ng^a va xd tri tot hdn, ke den giup cho viee danh gia hieu qua eua bien phap can thiep plidng ngd^ NKBV khi so sanh cijng myc dp nguy cd NKBV.
Tuy nhien do day la nghien euli dau tien ve van de nay tren dan sd chpn Ipe, nen can ed eac nghien cyu them va vdi dan sd khac de cd nhu'ng ket qua khang dmh hdn nham ed the xay dyng mdt thang diem danh gia nguy cd NKBV tdt hdn de giup cho cdng tac phdng ehdng nhiem khuan benh vien hieu qua hdn.
TAI UEU T H A M KHAO
1. Abramczyk ML., Can/alho \NB, Eduardo 5.
Carvalho, Eduardo A. S. Medeiros (2003).
"Nosocomial Infection in Paediatnc Intensive Care Unit m a Developing Country". The Brazilian Journal of Infectious Diseases, 7 (6), pp: 375 -380.
z. Dang Van Qvy (2002). "Dac diem nhiem khui'n benh vien tai khoa hoi sii'c cap ciiu benh vien Nhi Dong 2". Luan van tot nghiep bic si noi tni Nhi, Dai hgc Y DUdc TP. Ho Chi Minh, TP. Ho Chf Mmh.
i. Gamer JS, Jarvis WR, Emori TG ET al (1996).
"CDC Definitions of Nosocomial Infections , APIC Infec&on Control and Appli&l Epidemiology: Pnnaples and Practices, pp: Al -A20, Mosby, St.Louis.
4. Gilio AE, Stape A, Pereira CR, Cardoso MF,Silva CV,Troster EJ. (2000). "Risk factors for nosocomial infections in a critically ill pediatric populaton: A month praspecbve cohort stud/'.
Infection Control Ho^ Epidemiol, 21{5), pp: 340 -342.
3. Hugonnet S, Harbarth S, Sax H, Duncan RA, Pittet D. (2004) "Nursing resources: a major determinant of nosocomial infection'". Curr Opin Infect DIS, 2004, 17, pp: 329 -333.
D. MiJhlemann K, Franzini C, Aebi C et al (2004). "Prevalence of nosocomial Infections in Swiss children's hospital". Infect Control Hosp Epidemiol, 25 (9), pp: 765 - 771.
/ . Nguyen Hoai Phong (2004). "Dac diem nhiem khuan benh vien tai khoa hoi su'c tang cu'dng benh vien Nhi Dong 1", Luan van tot nghiep bac sT ndi b-ij Nhi, Oai hpc Y DUdc TP. Ho Chi Minh.
NHAN XET KET QUA KH6^I PHAT CHUYEN DA TAI BENH VIEN PHU SAN TRUNG U'O'NG
T6M TAT
Muc tieu: Danh gia ket qua khdi phat chuyen da cd tuoi thai t y 37- 42 tuan. Phudng phap: Nghien CLTU tien ciiu thu'c hien tren 65 san phu cd tudi thai til
*B$nh vl0n Phu sin Tmng ddng.
Chju trach nhiim chfnh: Nguyen Quang Bae Email: drbaebvpsh«@yahoo.eom.vn Ngay nhlnb&i: 9.12.2017 Ngay phan bien khoa hoc: 2.2.2018 Ng&y duyet bai: 12.2.2018
Nguyen Quang Bac*
37 - 42 tuan du'dc khdi phat chuyen da tai khoa de Benh vien Phu san Trung u'dng. Ket qua: Phu'dng phap dat b6n_c| -t- truyen oxytocin gay khdi phat chuyen da chiem ty le 72,31%, phu'dng phap truyen oxytocin gay khdi phat chuyen da chiem ty le 27,69%.
T'f' le thanh concj ciia khdi phat chuyen da ta 83,08%, that bai khdi phat ehuyen da chiem^ty le 16,92%. Thdi gian trung binh t y khi gay chuyen da den het giai doan tiem tang la 8,25 ± 4,77 gid, trong do ngan nhat la i gid, dai nhat la 16 ^id. Kei luin: Khdi phat gay chuyen da chiem ty le thanh cong cao.
Tdkhda: Co tu' cung, khdi phat chuyen da.
