Quan ly - Trao do!
Mot so y kien trao doi trong viec
•J r -y r
trien khai Chinh sach Quoc gia ve thuoc tai cac benh vien Bo Cong an
• • • • o
Dat van de
Ngay 20 thang 6 nam 1996, Chinh phu da co Nghi quyet so 37/CP ve "Dinh huang chidn lugc cong tac cham soc va bao ve sirc khoe nhan dan trong thai gian 1996 - 2000 va Chinh sach Qudc gia ve thudc cua Viet Nam".
Ddn ngay 19 thang 3 nam 2001. Thu tuo'ng Chinh phu tidp tuc co Quydt dinh sd 35/2001/QO-TTg vd viec phe duyet Chidn lugc cham soc va bao ve sirc khde nhan dan giai doan 2001-2010, trong do npi dung yeu c i u tiep tuc trien khai "Chinh sach qudc gia vd thudc" vai cac muc tieu ca ban:
Mot la bao dam cung trng thuang xuyen va du thudc co chit lugng den nguai dan, thuc hien sd' dung thuoc an toan, hgp ly, hieu qua
Hai la cung co va kien toan he thong td chtrc quan ly Nha nuac ve Dugc tCr trung uang den dia phuang,
Thuc td, dam bao su dung thudc hgp ly, an toan la mpt v i n dd dugc ca thd giai quan tam.
WHO luon coi su dung thudc hgp ly, an toan nhu la mpt trong nhiing npi dung quan trpng nhit trong Chuang trinh hoat dpng cua minh va day la mpt nguyen nhan lang phi dang ke nguon luc cua cpng ddng trong ilnh vuc y te. Nhu-'ng nam truac day, cac td chtr-c qudc td nhu WHO, SIDA, UNICEF,,, ddu da quan tam d i u tu cho nganh y td nuac ta giai quydt v i n dd nay,
Trong yeu c i u c i p thidt chung do, ngay 12/8/2005, Bp trudng Bp Cong an da phe duyet ban hanh Ke hoach sd 76/KH-BCA vd viec tnen khai CSQGT trong CAND ddn nam 2010.
Oe thay ro han ve thuc trang su dung thudc hgp ly. an toan tai cac Benh vien Bp Cong an, nam 2010, Cue Y td (Bp Cong an) da td chu-'c tien hanh danh gia c i t ngang su dung thudc tai
Nguyen Tien Dan Cite tnrcnig Cue Y te - Bg Cdng an
bdn benh vien: Benh vien 19/8. Benh vien 30/4.
Benh vien 199 va Benh vien Y hgc cd truyen.
Qua cupc danh gia da due k i t tim ra mpt sd v i n dd b i t cap cung nhirng hpc kinh nghiem trong cong tac su dung thudc didu tri tai cac benh vien thupc Bp Cong an,
PhLfcng phap danh gia
Chpn ngiu nhien vi binh 199 benh an tir thang 10/2009 ddn thang 4/2010 tai cac khoa iam sang cua bdn Benh vien Bp Cong an, gdm 55 benh an cua 5 khoa thupc Benh vien 19-8, 55 benh an tai 5 khoa cua Benh vien 30/4 va 40 benh an tai 4 khoa cua Benh vien 199, 49 benh an cua 4 khoa cua Benh vien Y hpc cd truydn.
Can cir- vao chinh c h i n doan cua benh vien de danh gia viec su dung thudc hgp ly, an toan.
Ket qua khao sat
Nhii'ng sai l i m thu'O'ng m i c phai trong cong tac SLP dung thudc hap ly, an toan
Kdt qua dgt khao sat cho thiy nhin chung du da cd ging, nhung cong tac su dung thudc hgp ly. an toan tai cac benh vien Bp Cong an v i n m i c phai mpt sd sai sot kha ca ban, phd bien nhu:
Sd dung thuoc khong chu y den tac dung khong mong muon cue thuoc
Day la mpt trong sd nhirng sai l i m thuang m i c phai trong sir dung thudc tai cac benh vien Bp Cong an. Cac bac sT khi ke dan thuang khong chti y ddn tac dung khong mong mudn ciia thudc lien quan ddn benh ly cua nguai benh.
Oiin hinh nhu truang hgp mpt benh nhan 51 tudi. Chan doan Itic vao vien: Suy than dp IV, Tidn su: Tang huyet ap, suy than man tir nam 1998. Trong thd'i gian n i m vien 12 ngay, cac bac sT ke dan co sir dung;
TAP CHi DUQC H QC - 2 / 20 1 1 ( S 0 418N.4M 51)
• Qu an ly - Trao do!
1 2 3 4 5 6
Amiodipin 5mg Dopegyt 250mg
Vastarel MR Calvit D Meditrol 0,25 mg Vitamin E400UI
Methyldopa Trimetazidin Calcicarbonat +
Caltriol
Uong 2 vien/24h Uong 2 vien/24h Uong 2 vien/24h Uong 2 vien/24h Uong 2 vien/24h Uong 2 vien/24h
8 h - 8 h - Sang Sang Sang Sang
17h 17h - chieu - chieu - chieu - chieu
Dopegyt 250mg (methyldopa) la thudc chdng tang huydt ap. Tuy nhien, thudc lai co nhieu tac dung khong mong mudn, Methyldopa dugc bai tidt vai sd lugng lo'n qua than. & diy benh nhan 51 tudi, suy than dp 4, kha nang dap trng thudc vai lieu nho han binh thuang, khi diing phdi hgp vai thudc didu tri tang huyet ap khac se iam tang cac phan trng b i t Igi.
Amiordipin 5mg: Thudc chdng tang huydt ap, chit ddi khang kenh caIci, sir dung lidu cao de gay phu, diing lau d i n den suy than. 0" day benh an lai SLT dung lieu 2 lin/ngay. Ngoai ra, dung calcitrol va calvit D ddi vai benh nhan suy than cOng khong hgp ly, do iam tang calci mau, dac biet la tren benh nhan cao tudi va suy than dp 4.
SCH dung thuoc khong phii hcrp v&i chan doan benh
Nguai ke dan thuang nhim lin ve tac dung cua thudc trong dieu trj benh c i p tinh va man tinh, Vi du mpt benh nhan 45 tudi, chin doan liic vao vien: Gout cip/tang huyet ap. Tidn sir tang huyet ap, Thd'i gian n i m vien 36 ngay. Ke thudc didu tri trong do co sir dung thudc: colchicin Img (udng tir 1-3 vien/ngay trong 35 ngay), meloxicam 7,5 mg (1 vien/ngay trong 5 ngay) va allopurinol 350 mg (1 vien/ngay trong 19 ngay).
Allopurinol chi sir dung trong dieu trj goute man, hoan toan chdng chi dinh trong didu trj goute c i p . Dii vay, cac bac sT v i n ke lidu dai ngay la r i t nguy hiem. Chua ke meloxicam khi phdi hgp vo'i colchicin cung tang tac dung didu tri goute, nhung ddng thai cung tang tac dung khong mong mudn, thong thuang chi nen sir dung 1 loai thudc, Han nira, colchicin cung r i t dpc khi sir dung lidu cao va dai ngay.
Ben canh do, sai l i m nay con thuang m i c phai khi bac sT khong n i m ro dugc lyc hpc cua thudc. Co truang hgp benh nhan 50 tudi, chin doan vao vien: can dau quan T, soi nieu quan 1/3 tren 2 ben. Phiu thuat npi sau sau phuc mac iiy soi NQ 2 ben benh nhan dugc phiu thuat. Ke dan didu tri trong do co: ceftriazol 1g
(diing 28 ngay), pefloxacin 400mg (15 ngay) va ofloxacin 200mg (10 ngay). Ceftnazol la thudc khang sinh, dugc chuyen hoa h i u hdt a gan (90%) nen duang nhien khi qua than h i u nhu khong con hoat tinh d i n ddn khong co nhidu tac dung ddi vai nhiem khuin a diy. Trong khi do, pefloxacin 400mg cung chi dung khi nhidm khuin tidt nieu la loai true khuin mu xanh.
Khong chii y den twcyng tac thuoc khi phoi hgp thuoc trong dieu tri:
oay cung la mpt tinh trang kha phd bidn trong qua trinh ke dan cua cac benh vien Bp Cong an.
Nhidu bac sT con chua luu y den qua trinh tuang tac thudc va chdng chi dinh cua thudc de dam bao su dung thudc hgp ly, an toan. Co truang hgp bac sT sir dung vitamin C trong didu tn soi than (diing vitamin C vo'i benh ly nay co the gay thieu mau, tan mau, suy than; diing lidu cao lau ngay co the gay tang oxalat nieu, acid hoa nuac tieu, gay tua urat vi cystein); sir dung ddng thai papaverin 40mg va motilium M (dompredion) trong dieu trj viem da day (papaverin 40mg co tac dung iam giam nhu dpng rupt, ngugc lai motilium M lai la thudc iam tang nhu dpng rupt Sir dung ddng thai 2 thudc nay vo hinh chung triet tieu tac dung cua nhau, r i t lang phi. O truang hgp nay nen bo papaverin vi thudc nay khien vet loet nong tra nen sau han do thtrc an trong da day khong dugc thao rong, acid dich vi khong dugc trung hoa het).
Lai CO truang hgp lai sir dung ca vitamic C va allopurinol trong didu tri benh nhan goute, khong chti y den viec vitamin C phdi hgp nguy hiem tai mtrc dp 4 vai allopurinol.
Lam dung thuoc
Trong sd 199 benh an dugc i i y m i u mpt each ngiu nhien, co kha nhidu benh an lam dung thudc. Vi du c h i n doan sdt sieu vi-tidn sir khde manh, ngoai eac thudc ke theo c h i n doan va dien bidn benh, bac sT con ke them mpt sd
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TAP CHi DUOC HOC - 2/2011 (SO 418 NAM 51)
Ve hanh ddng, can bd, vien chue Nganh Y td da tich cue thi dua, hoan thanh tdt cae nhiem vu tren tung cuang vi cdng tac, hoat dpng chuyen mdn. Kdt qua minh chung rd ret la trong 2 nam 2009-2010, toan nganh da dat vi vupt cac ehl tieu do Qudc hpi va Chinh phti giao. Dac biet, can bd cdng chuc nganh da tieh cue hudng ung Od an 1816, tang cudng luan phien can bp chuyen mdn cho viing sau, viing xa, vting khd khan. Sang kien xay dyng vi trien khai Od an 1816 "Ctr can bd chuyen mdn luan phien tir benh vien tuydn tren vd hd trp cae benh vien tuydn dudi nhim nang eao c h i t lupng kham, ehua benh" trong 3 nam qua la minh chung thuydt phue eho su sang tao dam nghT, dam iam etia Lanh dao nganh Y td dugc Oang vi Nha nude ting hd, coi day la ehu truang dting, triing trong dieu kien hien tai.
v d xay dung td chyc ea sd Dang, trong 4 nam qua, hiu hdt cac td chue ea sd Dang trong nganh ddu dat td chue ea sd dang trong saeh, vung manh, khdng ed td chuc ca sd dang ydu kem, vi pham ky luat dang. Trong nhieu nam lidn, Dang Bp Bd Y td dat danh hieu Dang bp trong sach vtrng manh. Oic biet, nam 2010, Cupc van dpng vdi chti dd "xay dung Dang ta that sy trong saeh.
vQ'ng manh, "la dao dire, la van minh" da gdp phin quan trpng vao cdng tac xay dung Dang, td chuc thanh cdng Dai hpi Dang bp Bd Y td, tidn tdi Dai hdi lan thtr XI cua Dang.
Cdng tac thi dua khen thudng ludn g i n lidn vdi Cupc van dpng "Hpe tap va iam theo t i m guang dao due Hd Chi Minh". Nhidu hinh thire tdn vinh khen thudng da duge Bd Y td td chirc thanh cdng nhu: tdn vinh 455 can bp y td ca sd tieu bieu xuit s i e trong ca nude, tdn vinh han 500 can bd dan sd ea sd tieu bieu xuit sie, tdn vinh bieu duang cac bac sy npi trti, cae sinh vien y duge tieu bidu xuit s i c trong nghien ciru khoa hpc tai Van midu Qudc Ttr Giam, phdi hpp vdi Trung uang Doan TNCS Hd Chi Minh, Bao Tudi tre khen thudng, bidu duang cic thiy thudc tre tieu bieu xuit s i e thupc Hpi Thiy thudc tre Viet Nam, binh ehpn khen thudng eae Benh vien xuit s i e toan dien, td chuc trao "giai thudng Oang Thuy Tram" eho can bp y td ea sd, viing sau, viing xa, viing khd khan hoan thanh nhiem vu... Cae hoat dpng tren thye sy tao cho hoat ddng thi dua khen thudng cua nganh Y td trong nhirng nam qua ludn ludn sdi dpng, thiet thyc va hieu qua.
V.L.
M o t s o y k i e n . . . (Tiip theo trang 05) thude dieu trj xa gan, viem gan man, ehdng mat, rdi loan can bing do xa eirng mach... Hay benh nhan chin doan goute cip/tang huyet ap: ngoai cae thude ke theo c h i n doan, benh vien edn ke them mdt sd thude khdng phu hgp vdi muc dich didu trj nhu kem thude thoai hda khdp (glucosamin), khang sinh (cefotaxim), thude didu trj xa gan, viem gan man, hdn me gan (arginin), thude giam tri nhd (ginkgo bloba), thudc didu trj gan mat, thudc ehl dinh viem da nay...
Chinh quan diem "diing thudc nao tdt thude diy", "chira thira cdn han bd sdt" nay khdng nhirng da gay ra sy lang phi Idn trong didu trj, ma nguy hien han la edn d i n ddn s y tuang tae thude ngoai mong mudn khidn giam hieu qua didu trj benh ly ehinh, trong trudng hgp x i u han edn ed the anh hudng ddn sue khde va tinh mang ngudi benh.
Lam dung khang sinh trong dieu trj Day ed the coi la mpt sai l i m mang tinh chit truyen thdng. Nd la he qua ctia viec qua dd cao tac dung dieu trj etia khang sinh trong mpt thdi gian dai. Nhidu trudng hpp benh nhan dupe str dung tdi vai loai khang sinh mpt each khdng e i n thidt trong didu tri.
Mdt thi du dien hinh: Benh nhan dupe c h i n doan dirt day ching cheo trudc gdi P (benh nhan cd tidn sti' khde manh), ehl djnh diing khang sinh: 2 ngay diing eeftazidim tiem b i p va gentamixin tiem bip, sau dd diing 5 ngay eefoperazon va sulbactam phdi hpp tobramyxin;
tiep dd lai dting 2 ngay amoxicillin vi aeid clavulanic. Nhu vay, ehl trong vdng 9 ngay benh nhan da thay ddi 3 l i n phac dd khang sinh, dii vdi benh an nay chi nen diing 1 khang sinh.
Trudng hgp khac, benh nhan dugc c h i n doan tdn thuang dam rdi t h i n kinh canh tay T, (tay trai hay la tay gi?) trong benh an khdng dd cap nhiim khuan gi tuy nhien v i n str dung 3 ngay khang sinh (ciprofloxacin va tinidazol).
Ngoai nhung nhdm sai l i m chinh vi mdt sd benh an minh hpa kd tren, cdng tac str dung thudc hpp ly, an toan eua eac benh vien Bp Cong an cdn m i e phai mpt sd v i n dd khac nhu sir dung phac do qua cu (diing amoxieylin kdt hpp klion de diet HP trong didu tri da day - ta trang; hien khong cdn dupc khuydn eao str dung do ty le khdi vi lidn seo thip); sil' dung nhieu loai thudc y hpc cd truydn trong 1 benh an (dung ca thudc thang, hoan, bdt... mpt each
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