TAP CHI D U g C HOC ISSN 0866 - 7 8 6 1 —

MUC LUC

PHARMACEUTICAL JOURNAL ISSN 0866 - 7861

4/2017 (S6 492 NAtfifflB T A M Q, k m Qyjjj; ^ 4/2017 (N° 492 Vol. 57)

13-15 Le Thanh Tong • Hcan Kiem • H

NGHIEN C l f U - KY THUAT

• TRAN MINH LUAN, NGUYEN THANH VY, NGUYEN TH| THU T H O Y : Danh gia ky nang thyc hanh nghe nghiep cua ngiroi ban le thuoc tai cac nha thuoc dat tieu chuan GPP tren dja ban thanh pho Cao Lanh, tinh Bong Thap 2

• LE DIEN BUC, NGUYEN THANH HlEN, TRAN BiNH GIANG, NGUYEN M A I HOA. NGUYEN HOANG ANH: Banh gia viec sir dung nhdm thuoc ire che bom proton trong dp phong loet tieu hoa do stress tai mot benh vien tuyln trung pang 5

• BAM THANH XUAN, NGUYEN NGOC CHlEN: Nghien ciru kha nang bao ve Lactobacillus acidophilus ATCC 4356 cua vi nang alginat-tinh bot bao chitosan 10

• HOANG THY NHAC VU, VU THANH TUNG: So sanh dac diem sir dung khang sinh trong dieu trj ngoai tru va noi tru tai Benh vien Phoi tinh D6ng Nai 12

• CAO CONG KHANH, NGUYEN TUONG VY, NGUYEN XUAN TRUONG: Nghien ciru xac djnh da luang mot so chit nhom quinolon trong sua vai ky thuat xCr ly m lu QuERChERS 15

• TRAN TRONG BIEN, LE HUU HUY, NGUYEN VAN HAN: l ing dung nhua macroporous B101 trong phan lap geniposid ti> qua danh danh [Gardenia jasminoides Ellis) 20

• LE THI HUYEN TRANG, LE MINH HOANG, NGUYEN BUY BAC, NGO XUAN TRiNH, PHAM VAN HlEN, NGUYEN THJ THU HANG, VU BlNH BUONG: Nghien ciru xay dung quy trinh chiet xuit adenosin va cordycepin tir dong trung ha thao nuoi cay (Cordyceps militaris) 24

• BO TH| OANH, PHAM THANH KY, LE VIET DONG, PHUONG THIEN THUONG: Hai hop chit phan lap tir phin tren mat d l t cua cay soi Nhat (Chloranthus japonicus Sieb.) thu hai tai Viet Nam 29

• VU BINH CHINH, BAO TH| KIM OANH, NGUYEN HAl NAM: Nghien ciru tong hop minoxidil d quy mo phong thi nghiem 32

• NGUYEN QUANG HIEU, NGUYEN THANH TUNG, VU THU THUY, NGUYEN VlET THAN: Nghien ciru dac diem thuc vat cua hai loai Huperzia, ho Thong d i t (Lycopodiaceae) 36

. N G U Y E N T H | T H A N H HUONG, KlEU THI, T U Y E T M A I , LE T H U T H G Y :

Phan tich thuc trang bao cao tu nguyen phan irng co hai ciia thudc tai 16 benh vien 41

• PHAN NGUYEN TRUONG THANG, HA MINH HlEN: Nghien cuu dinh lupng nguyen lieu terpin hydrat bing phuang phap s ic ky khi cot mao quan 4 4

• BANG THI LE HANG, HUYNH NGUYEN TUAN ANH, NGUYEN BAI HAl, TRAN LE BAO HA, BOAN NGUYEN VG, TRAN NGOC QUYEN, NGUYEN TH| BlCH TRAM: Nghien cuu dieu ch i hydrogel nanocomposite tren ca sd chitosan va curcumin ung dung trong tai tao mo 47

• DUONG THI HONG ANH, HOANG VAN BUG, LE TH| THU HUYEN, NGUYEN VAN LONG, NGUYEN TRAN LINH: Nghien cuu xay dung va th im djnh phuang phap L C - M S / M S dinh luang ding thai curcumin va chit chuyen hoa tetrahydrocurcumin trong huyit tuang chuot 50

• HUYNH ANH DUY, LAM TH| NGOC GlAU, BUI MY LINH: Khio sat thanh phan hoa hoc cay rau ngo (Enhydra fluctuans Lour., Asteraceae) 53

• NGUYEN TIEN VUNG, VO BUG LOI: Chiet xuat phan lap mot so hgp chit tir re o i cua cay cat sam (Callerya speciosa Schot.) thu hai tai tinh Thai Nguyen 56

• TRAN ANH VG, NGUYEN BINH NGA, BUI NGUYEN NHU QUYNH: Banh gia tac dong khang n im, khang khuan cua tinh d iu que Tra My - Quang Nam (Cinnamomum obtusifolium - Lauraceae) dieu che bing hai phuang phap cat keo hai nude va C 0 2 sieu tdi han 6 0

• NGO KIM CHI, CHU QUANG TRUYEN, BANG NGOC PHUONG, NGUYEN MAI LINH, BO HUU NGH|, VO QUYET TiEN, TRAN NGOC LAN: Nghien cuu so sanh hieu qua chiit va thu nghiem hoat tinh sinh hoc che vang Quang Tri 62

• BOAN MINH SANG, NGUYEN CONG TRUONG, BINH THU HUONG, PHAM THI THU HANG, CHU VAN PHONG, NGUYEN BAO LQC, NGUYEN MINH TAN, NGO XUAN HOANG, BINH TH| THANH H A I : Nghien cuu tong hap va tham do tac dung sinh hoc cua 5-(2',4'-dihalogenobenzyliden) rhodanin va mot s i dan chit base Mannich 67

• TRAN ANH VG, LE TH| THU CUC: Nghien cuu di iu c h i cao toan phin tir duang cam cue di thuc [Matricaria chamomilla I.) 74

• NGUYEN T H | M Y A N , PHAM BiNH DUY: Bao che tieu phan nanolipid chua miconazol nitrat b ing phuang phap thay t h i dung mdi 77

C iv CONTENTS

RESEARCH - TECHNIQUES

TRAN MINH LUAN, NGUYEN THANH VY, NGUYEN TH| THU THUY: Professional skills in drug dispensation of pharmacists working in GPP retail drugstores in Cao Lanh City of Dong Thap province 2

i LE DIEN BUG, NGUYEN THANH HlEN, TRAN BiNH GIANG, NGUYEN MAI HOA, NGUYEN HOANG ANH: The use of proton pump inhibitors (PPI) for gastrointestinal stress ulcer prophylaxis in a central hospital of Vietnam 5

. D A M THANH XUAN, NGUYEN NGQC CHlEN: Protective potential of the chitosan coating of the alginate-starch microcapsule toward the probiotic bacteria Lactobacillus acidophilus ATCC 4356 10

. HOANG THY NHAC VU, VU THANH TGNG: Comparison of the actual use of antibiotics for outpatients and inpatients in the Provincial Hosptial for Lung Diseases of Dong Nai 12

. CAO CONG KHANH, NGUYEN TUGNG VY, NGUYEN XUAN TRUONG: QuERChERS technique for pre-treatment of milk samples in determination of the redidual quinolon compounds therein by HPLC-MS/MS 15

. TRAN TRONG BlEN, LE HUG HUY, NGUYEN VAN HAN: Column chromatographic isolation of geniposid from the fruits of Gardenia jasminoides (Ellis) using the resin of macroporous D101 20

. LE THI HUYEN TRANG, LE MINH HOANG, NGUYEN DUY BAC, NGO XUAN TRiNH, PHAM VAN HlEN, NGUYEN THI THU HANG, VO BiNH DUONG: Extraction of adenosine and cordycepin from artificially cultured Cordyceps militaris 24

» BO TH| OANH, PHAM THANH KY, LE VIET DUNG, PHUONG THIEN THUONG: Two phytochemical compounds from the aerial parts of the plant soi Nhat [Chloranthus japonicus Sieb.) grown in Vietnam 29

. VO BiNH CHINH, BAO TH| KIM OANH, NGUYEN HAl NAM: Laboratory synthesis of minoxidil 32

. NGUYEN QUANG_ HIEU, NGUYEN THANH TUNG, VU THU THUY, NGUYEN VlET THAN: Study on botanic characterization of two Huperzia species (Lycopodiaceae) 36

» NGUYEN THI THANH HUONG, KlEU TH| TUYET MAI, LE THU THUY: Analysis of the actual activities of reporting adverse drug reactions in 16 hospitals 41

» PHAN NGUYEN T R U I N G T H A N G , H A MINH HlEN: Quantitative determination of terpine hydrade in raw materials capillary gas chromatography 44

» BANG THI LE HANG, HUYNH NGUYEN TUAN ANH, NGUYEN BAI HAl, T R A N L E B A O H A , B O A N N G U Y E N VO, T R A N NGOC Q U Y E N , N G U Y E N

TH| BiCH TRAM: Preparation of a temperature-sensitive hydrogel of nanocurcumin with chitosan-pluronic for tissue regenation 47

» DUONG TH| HONG ANH, HOANG VAN BUC, LE TH| THU HUYEN, NGUYEN VAN LONG, NGUYEN TFtAN LINH: Development and validation of an LC-MS/MS method for simultaneous quantitative determination of curcumin and tetrahydrocurcumin in mouse plasma 50

» HUYNH ANH DUY, LAM TH| NGOC GlAU, BUI MY LINH: Phytochemical study on the plant Enhydra fluctuans Lour. (Asteraceae) 53

» NGUYEN TlEN VIJNG, VU BUC LOI: Extraction and isolation of some natural compounds from the tuberous roots of Callerya speciosa Schot. gathered in Thai Nguyen province 56

• TRAN ANH VO, NGUYEN BINH NGA, BUI NGUYEN NHU QUYNH: Comparison of the antimicrobial and antifungal activities of the cinammomum essential oils of Tra My (Quang Nam) [Cinnamomum obtusifolium -Lauraceae) prepared by steam-distillation and C 0 2 supercritical fluid 60

. NGO KIM CHI, CHU QUANG TRUYEN, BANG NGOC PHUONG, NGUYEN MAI LINH, BO HUU NGH|, VO QUYET TlEN, TRAN NGOC LAN: Study on extraction efficacy and bioactivity of the teas of Jasminum subtriplinerve Blume grown in Quang Tri province 62

• BOAN MINH SANG, NGUYEN CONG TRUONG, DINH THU HUONG, PHAM THI THU HANG, CHU VAN PHONG, NGUYEN BAO LQC, NGUYEN MINH TAN, NGO XUAN HOANG, BINH TH| THANH HAl: Synthesis and bioactivity of some base Mannich derivatives of 5-(2',4-dihalogenobenzyliden)rhodanine 67

• TRAN ANH VO, LE TH| THU CUC: Study on preparation of the total extracts of the domesticated plant Matricaria chamomilla L. 74

• NGUYEN TH| MY AN, PHAM BiNH DUY: Preparation nanolipid particles containing miconazole nitrate by solvent replacement technique 77

• Nghien cfru - Ky thuat

hay glucosamin va 11,7% nhan vien ban thuoc khac thay the bao gom thuoc giam dau, meloxicam. N h a vay, tuy vdi cung mot benh ly d o g e khai va c i ing mot ngad i mua thuoc nhang k i t qua ban thuoc khac nhau tuy theo tang nhan vien ban thuoc.

D a n h g ia cac ky n a n g Danh gia tong diem ky nang thgc hanh nghe nghiep

cua nhan vien ban le thuoc de tai ghi nhan k i t qua d a g c trinh bay trong hinh 1.

Diem

2,0

1,5 1.0 0,5 J

0.0

1,53 1,03

0.13 0,22

Tac phong Khai thac

thong tin

Tu van Ra le Tong cac ky

n&ig

Kv nang

Hinh 1 : Ky nang thuc hanh nghd nghiep Theo hinh 1, de tai ghi nhan diem ky nang thgc hanh

nghe nghiep trung binh cua ngod i ban le thuoc la rat thap va chi dat 1,53/20 d iem. Trong do diem tac phong co gia tri cao nhat (1,03/3 diem); cac ky nang con lai bao gdm khai thac thong tin, t o van va ra le co d iem rat thap vd i gia tri t a o n g d n g 0,13/6 d iem; 0,22/9 diem va 0,15/2 d iem.

{Ngay nhan bai: 16/01/2017- Ngay phan bien: 07/03/2017- Ngay duyet dang: 03/04/2017)

K e t l u a n

Ky nang thgc hanh nghe nghiep la mot trong nhdng yeu to quan trong ben canh kien thdc chuyen mdn de thgc hien t i t vai tro cua n g a d i d a g c sT ban le thudc. Quan sat t rgc tiep ky nang thgc hanh nghd nghiep cua nhan vien ban le thuoc tai 60 nha thudc GPP tren dia ban thanh pho Cao Lanh, tinh Dong Thap cho t h i y ky nang thgc hanh nghd nghiep cua n g a d i ban le thuoc con han chd vd i tong diem ky nang trung binh co gia trj rat thap (1,53/20 diem), khdng co nhan vien nao yeu cau trinh don thudc hay t d chdi ban le thudc ke d o n khong co d o n thuoc. Day la thgc trang dang bao dong ddi hoi phai thgc hien kiem tra g iam sat, x d phat nghiem ngat va tang c a d n g dao tao, tap huan ve chuyen mon va cac ky nang nghiep vu de thgc hien tot "Nguyen tac, tieu chuan thgc hanh tot nha thuoc - GPP" do Bo Y td ban hanh.

T a i l i e u t h a m k h a o 1. Bo Y td (2007), Quyet dinh 11/2007/QO-BYT cua Bo

tradng Bo Y te ve viec ban hanh nguyen t ic , tieu chuan "Thgc hanh tot nha thuoc"

2. Dinh Thu Trang (2014), "Phan tich hoat dong cua cac nha thuoc dat tieu chuan "Thgc hanh tot nha thuoc" GPP tren dia ban thanh pho Thu Dau Mot, tinh Binh Duong nam 2014", Luan van Dupe s/~ chuyen khoa I, Tnmng Dai hoc Dupe Ha Npi.

r

Danh gia viec sir dung nhom thuoc ifc che bom proton trong du* phong loet tieu hoa do stress tai mot benh vien tuyen trung irong

Le Dien Dire1, Nguyen Thanh Hien1, Tran Binh Giang1

Nguyen Mai Hoa2, Nguyen Hoang Anh2* 'Benh vien Hint nghi Viet Dire

-Trung tarn DI va ADR Quoc gia, Tru&ng Dai hoc Dupe Ha Npi *E-mail: anh90tk@yahoo.com

Summary The use of proton pump inhibitors (PPI) for gastrointestinal stress ulcer prophylaxis in Viet Due Hospital was

analyzed to identify factors predicting inappropriate prescribing practices. The defined daily doses (DDD) per 100 patient-days was estimated on the basis of the dispensing data for all PPI prescriptions and relevant population data from 2010 to 2015 and the financial burden of PPI was evaluated by the cost of main drug classes used in a surgical treatment. All medical records of the adult patients given at least 1 PPI for stress ulcer prophylaxis during 10-day period (January 2015) were analysed based on ASHP guideline (1999). Affecting factors to the inappropriate use of PPI was indentified by multivariate logistic regression model. PPI was not only one of the most commonly prescribed groups of drug (approximately 6% of total drug costs) but also enjoyed an increasing tendency during 2013-2015. The majority of medical records (84.02%) proved inappropriate in terms of PPI indication for prophylaxis. In the division of gastrointestinal surgery, surgical admission, age, and inpatient time were independently predictive factors of inappropriate use. These findings revealed the high frequency of irrational use of PPI for stress ulcer prophylaxis; this suggested actual necessity to take into account to exert better impact on the medication cost and improve patient safety.

Keywords: PPI, stress ulcer prophylaxis, drug use evaluation, ASHP guideline.

T A P C H I D lTOC H O C - 4/2017 (SO 492 N A M 57) 5

• Nghien CIFU - Ky thuat

Dat van de Loet t ieu hoa do stress la loai ton t h a a n g c i p

t inh t ren be mat n idm mac d a d n g t ieu hoa, co the t ien then nang va gay t d vong cho benh nhan. Loet t ieu hoa do stress pho bien d Khoa Hoi s d c t ich c g c (HSTC) , vd i khoang 76 - 1 0 0 % benh nhan co bang c h d n g npi soi cho t h i y x u i t hien loet sau khi nhap khoa H S T C tir 1 den 2 ngay W. Hien nay, tren the g id i , ch i co duy nhat h a d n g dan d g phong loet t ieu hoa do stress cua Hoi D o g e sT t rong He thong C h a m sdc Y te Hoa Ky (ASHP) cdng b6 nam 1999, cd khuyen cao day du ve cac yeu to nguy c a va ch ien l a g c d g phong d benh nhan d idu tri tai khoa H S T C m . Nhieu nghien c d u da ap dung h a d n g d i n nay de danh gia ch i d inh d g phong d g phdng loet t ieu hoa do stress. Ket qua cho thay ty le d g phong khdng phu h g p ve ddi t a g n g ch i d inh, lieu dung , d i r d n g dung va thd i g ian d g phdng dao ddng tir 5 0 % den 7 0 % [ 5 6 1 . Benh v ien H a u nghi Viet D d c la benh vien ngoai khoa tuyen cud i , t iep nhan so l a g n g Idn benh nhan t iem tang cac yeu to nguy c a loet t ieu hda do stress, n h a cd c h i n t h a a n g , benh nang va can can thidp phau thuat. Ngh ien c d u nay d i r g e t h g c hien n h i m khao sat dac d iem t ieu thu nhdm thuoc d c che b a m proton (PPI) , danh gia s g phi i h g p cua v iec s d dung nhdm thuoc nay t rong d g phdng loet t ieu hda do stress tai Benh vien H d u nghj Viet O d e , dong thd i , xac dinh cac yeu to anh h a d n g den viec chi d inh PPI khdng phu h g p t rong mau nghien c d u .

Doi tipong va phirong phap nghien c d u D o i t u ' g n g n g h i e n c d u Sd lieu tai chinh phuc vu cung dng thudc t d

01/01/2011 den 31/12/2014 ( lau tai Phdng Tai chinh - Kd toan BV. Viet Ode.) ; sd ngay - g i i rdng nam vien cua benh nhan ndi tru t d 01/2010 den 06/2015 (liru tai Phdng Ke hoach Tong hgp) ; so lieu s d dung thuoc PPI cua cac khdi khoa phdng theo tdng thang trong giai doan 01/2010 - 06/2015 (liru tai Khoa Di rge) d i rge s d dung de khao sat dac diem tieu thu nhdm thuoc PPI giai doan 2 0 1 0 - 2 0 1 4 .

De phan tich s g phu hgp cua viec d g phdng loet tieu hda do stress b i n g PPI tren benh nhan ng i rd i Idn va xac dinh cac yeu to anh h i rdng den chi djnh PPI khdng phu hgp trong m i u nghien c d u , nghien cdu Iga chgn benh an dieu tri ndi tru cd ngay ra vien t d 10/1/2015 den 20/1/2015. Loai t r d khoi nghien c d u cac benh an cua benh nhan d i rd i 18 tudi, benh nhan nam vien d i rd i 3 ngay, benh nhan khdng s d dung PPI, benh nhan d i rge chi dinh PPI de dieu tri cac benh ly d i rdng tieu hda (vidm loet da day, ta trang, thgc quan, hoi chdng Zoll inger - Elison, hdi chdng trao ng i rgc thgc quan va xuat huyet tieu hda) hoac phdi hgp vdi khang sinh trong dieu trj Helicobacter pylori d i r ge ghi rd trong chan doan cua bac sy dieu tri, benh nhan d i rge chi dinh PPI vd i muc dich d g phdng loet do s d dung NSAIDs hoac benh an khdng cd day du thong tin. Ly do s d dung PPI

d i rge xac dinh d g a tren phan loai nguy c a loet d benh nhan dang s d dung NSAIDs theo H i rdng d i n cua Hdi Tieu hda Hoa Ky p i .

P h u a n g p h a p n g h i e n c u u Hdi cdu d d lieu kdt hgp phan tich djnh l i rgng hai

ydu to: chi phi cua nhdm PPI theo tdng nam va chi so DDD/100 ngay g i i rdng theo tdng thang. Trong dd, chi phi tai chinh d i rge danh gia thong qua cac chi t ieu: chi phi tai chinh cua cac nhdm thuoc (tinh theo d a n vj ty dong); chi phi cua nhdm PPI so vd i nhdm thudc gay me - gay te, nhdm thudc can quang va nhdm thuoc giam dau d i rge s d dung tai BV. Chi so DDD/100 ngay-g i i rdng theo tdng nam d i rge s d dung de danh gia cac m d c dd va xu h i rdng s d dung PPI theo qui md toan BV va theo tdng khoi khoa phdng, vd i DDD - Defined Dose Daily - la lieu xac djnh trong ngay. Chi so DDD/100 ngay g i i rdng t inh theo cdng thdc:

So mg PPIs* 100 DDD/100 ngay - giirdng = : ;

DDD so ngay-gnrang nam vien

De danh gia s g phu hgp cua viec d g phdng loet tieu hda do stress bang PPI tren benh nhan ng i rd i Idn va xac djnh cac yeu to anh h i rdng ddn chi djnh PPI khdng phu hgp trong mau nghien c d u , hoi c d u d d lieu va md ta c l t ngang d g a tren cac thong tin thu thap t d ho s a benh an. S g phu hgp cua viec s d dung PPI d g phdng loet tieu hda do stress d i rge danh gia theo cac tieu chi : chi djnh, lieu dung va d i r dng d i ing. Chi djnh d g phdng loet tieu hda do stress d i rge danh gia la phu h g p khi benh nhan cd mot trong cac yeu to nguy c a theo h i rdng dan cua ASHP. Do h i rdng d i n nay chi de cap den lieu dung cua omeprazol , nhdm nghien c d u sir dung them tai lieu cua Anderson va CS. de danh gia t inh phu hgp ve lieu dung cua cac PPI con lai cd sir dung tai BV P 1 . Ve d i rdng dung, benh nhan sir dung PPI theo d i rdng t iem tTnh mach d i rge danh gia la phu hgp khi khdng the dung thudc qua d i r dng tieu hda, d i rge xac djnh trong t r i rdng hgp benh an ghi rd hoac khdng cd thuoc dung d i r dng udng nao khac d i rge chi djnh dung kern. Cac yeu td anh h i rdng den viec chi djnh PPI khdng phi i hgp d i rge danh gia bao gdm cac yeu to ve nhan khau hgc, t inh trang benh, t inh trang sir dung PPI, t inh trang benh nhan phan bd theo khoi khoa phdng.

X d ly ket q u a So lieu d i rge x i r ly theo ph i rang phap thong ke y

hgc b i n g phan mem R3.2.2 va Microsolf Excell 2010. Si r dung phan tich ANOVA, sau dd hau kiem bang test Tukey HSD va phan tich Mann Kendall de phan tich chi phi va xu h i rdng tieu thu PPI trong BV. D e xac djnh cac bien ddc lap anh h i rdng ddn chi djnh d g phdng loet tieu hda do stress khdng phu hgp , nhdm nghien c d u sir dung md hinh phan t ich hoi qui logistic. D e tranh gay nhieu cho md hinh hoi qui logistic da bien, kiem tra hien t i rgng da cdng tuydn t rade khi d a a vao md hinh phan t ich. Md hinh phan t ich hdi qui logistic da bien tdi au d a g c xac djnh bang p h a a n g phap Stepwise. Yeu to ddc lap d a g c ket luan cd anh h a d n g ddn vide d g phdng neu khoang tin cay 9 5 % cua O R khdng chda 1.

6 T A P C H I D U O C H O C - 4/2017 (SO 492 N A M 57)

• Nghien CLFU - Ky thuat

Ket qua T h g c t r ang s i r d u n g n h o m t h u o c PPI t h o n g qua

c o n s o tai c h i n h

Chi phi cua cac nhom thudc chinh d i rge sir dung trong Benh vien, trong dd cd PPI Kr thang 1/2011 den thang 12/2014 d i rge the hien trong hinh 1.

C * 0

U -o 3 C

•<<D

D.

o

• N h o m t h u o c c a n q u a n g

• N h d m t t i u O c g i a m d a u

- N h d m t h u o c g i a n c o

- N h o m t h u o c g a y m e - g a y t e

• N h d m t h u d c K h a n g s i n h

- N h d m t h u f i c u'c. c h 4 b a m p r o t o n

- D j c h l r u y e n

- N h d m c a c t h u d c k h a c

2011 2012 2013 2014 (nam)

Hinh 1 : Chi phi cua cac nhdm Nhdm PPI cd chi phi d i rge duy tri t i rang doi on djnh

trong thcri gian khao sat, dung t h d 3 trong sd cac thudc d i rge sir dung tai Benh vien, chi sau nhdm khang sinh va nhdm djch truyen. Chi phi trung binh hang nam cua nhdm thuoc nay khoang 15,35 ty dong chiem khoang 6% tong chi phi thudc trong toan Benh vien. Chi phi hang nam danh cho nhdm PPI t i rong diromg vd i chi phi cua cac nhdm thuoc dac tmrng cua benh vien ngoai khoa la thuoc gay me - gay te va thudc giam dau.

thuoc giai doan 2011 - 2014 T h i r c t r ang s i r d u n g n h o m t h u o c PPI t h o n g q u a

c h i s o DDD /100 ngay - g i i r d n g Xu h i rdng sir dung cua PPI toan Benh vien d i rge

danh gia bang phan t ich Mann-Kendal l trong hai giai doan: giai doan tir thang 1/2010 den thang 6/2015 va phan tich ridng cho giai doan t ir thang 1/2013 den thang 6/2015. Kdt qua d i rge tr inh bay trong hinh 2.

Phan tich Mann-Kendall

P-O.17

I t,m G i a n

Hinh 2: Xu hirdng tieu thu PPI trong toan BV tCr thang 1/2010 den thang 6/2015 MOc do sir dung PPI toan BV trong giai doan t ir

thang 1/2010 den thang 6 /2015 t i rong ddi on djnh, trung binh la 44,89 DDD/100 ngay-gi i rdng/ thang (khoang tin cay 95%: 43,59 -46,26). Trong giai doan tir thang 1/2013 den thang 6/2015, tieu thu PPI cd xu h i rdng tang, Kr 43,46 DDD/100 ngay-g i i rdng dau nam 2013

Giai doan 2010-2015

S P Xu hirdng

131 0,47 Khong

Giai doan 2013-2015

S P Xu hirang

131 0,049 Tang

131 0,049 Tang

tang Idn 52,46 DDD/100 ngay-g i i rdng trong nam 2015, vdi ty Id tang khoang 2 0 , 7 1 % .

M d c dp sir dung PPI theo t i rng khoi khoa phdng so vd i toan bd BV d i rge danh gia thong qua phan tich chi so DDD/100 ngay-g i i rdng, ket qua phan tich d i rge tr inh bay d hinh 3.

3 — i

1 n o

Hinh 3: Xu hirdng tieu thu PPI cua timg khoi khoa phdng tir thang 1/2010 den thang 6/2015

T A P C H f D l / O C H O C - 4/2017 (SO 492 N A M 57) 7

• Nghien cCm - Ky thuat

L u a n g PPI s u dung a khoi HSTC (gom cac d a n nguyen cua Trung tarn Gay me hoi sue) cao nhat trong BV, trung binh gap 5 Ian m u c do tieu thu PPI trong BV. Khoi Tieu hoa (gom Khoa P h l u thuat tieu hoa, Khoa P h l u thuat cap c u u tieu hoa, Khoa Phau thuat gan mat) va khoi Than kinh - Cot song (gom Khoa Phau thuat than kinh va Khoa Phau thuat cot song) co m u c dp s u dung PPI cao t h u hai sau khoi HSTC. M u c do tieu thu PPI d cac khoi khoa khac chi bang mot p h l n ba l ugng PPI s u dung toan Benh vien.

Phan t i ch s i r p h u h o p cua v iec d i r p h o n g loet t ieu hoa d o s t ress b a n g PPI t ren b e n h n h a n n g u d i I dn va xac d j n h cac y e u to a n h h u d n g d e n c h i d j n h PPI k h d n g p h u h o p t r o n g m a u n g h i e n c u u

T u tong so 786 ho s a benh an cd ngay ra vien tir ngay 10/1/2014 den ngay 20/01/2014, nhdm nghien cuu thu d u g c 388 benh an dua vao phan t ich, chiem 9 8 % sd benh an s u dung PPI va chidm 49 ,4% trong tong so benh an da thu thap ban dau. Ket qua danh gia t inh phu hap cua chi dinh d u phdng loet tieu hda do stress, lieu dung va d u d n g dung cua cac PPI d u g c trinh bay trong bang 1.

Bang 1: Danh gia so dung do phdng loet tieu hda do stress theo tieu chi cua ASHP

Tieu chi Phii hop vdi khuyen cao (so benh an/ty le %)

Chi djnh dy phong 62(15,98%)

Duong dung 296 (76,29%)

Lieu dung 380 (97,94%)

Ty le benh an cd chi dinh d u phdng phi i hgp chidm ty le nhd (15,98%). Trong khi dd, phan Idn benh nhan cd d u d n g dung va lieu dung PPI phu hgp, vd i ty le l l n lug t cua hai tieu chi nay la 76 ,29% va 97,94%. Cac yeu td nguy c a cua nhdm benh nhan d u g c chi djnh PPI phu hgp d u g c trinh bay trong bang 2.

Bang 2: Yeu td nguy co tren benh nhan Hen quan ddn chi dinh do phdng phu hop vbi khuyen cao

STT Yeu to nguy co Soloong Tyle%

1 Da chin thuong 29 46,77%

2 Chan thuorig so nao co diem Glasgow <10 6 9,68%

3 Suy gan: albumin huyet thanh < 41g/L 3 4,84%

4 Suy ho hap thd may £ 48 gid 5 8,06%

5 Roi loan dong mau INR >1,5 1 1,61%

6 Tidn su loet hoac chay mau tieu hda trong 01 nam gin day 1 1,61%

7 Cd ti> hai yeu to nguy co trd len 17 27.42%

Tong 62 100,00

Trong so nhung benh nhan cd chi djnh d u phdng phu hgp , so benh nhan cd yeu to nguy c a la da c h i n t h u a n g chiem ty le Idn nhat (46,77%). So benh nhan cd t u hai yeu to nguy c a t rd len c l n d u phdng la 14 benh nhan (27,42%).

Sau bien sd d u g c d u a vao phan t ich hdi qui logistic da bien bao gom tuoi, gidi (la bien cd didu chinh d u a vao phan t ich), t inh trang p h l u thuat, benh nhan khoi Than kinh - Cot song, khoi Tieu hda va thd i gian dung PPI. Ket qua phan tich d u g c tr inh bay trong bang 3.

Bang 3: Cac yeu to anh hodng din do phdng loet tieu hda do stress bdng PPI khdng phu hop qua phan tich da bien

Bien tien loong OR Khoang tin cay 95%

Khoi Than kinh cot song 0,62 0,32-1,18

Khoi Tieu hda 2,88 1,04- 7,97

Gidi tinh: NO- 1,39 0,71-2,72

Benh nhan cd phiu thuat 2,13 1,05-4,34

Tuoi (nam) 1,03 1.01-1,04

Thdi gian dung PPI (ngay) 0,89 0,82-0,96

Bon ydu to dpc lap anh h u d n g ddn viec d u phdng loet tieu hda do stress khdng phi i hgp b i n g PPI trong m l u nghien c u u la nhdm benh nhan d khoi Tieu hda (OR = 2,88; khoang tin cay 95%: 1,04- 7,97), benh nhan cd p h l u thuat (OR = 2,13; khoang tin cay 95%: 1,05 - 4,34), tuoi va thdi gian dung PPI. Tuoi tang them 01 nam thi nguy c a d u phdng khdng phu hgp tang 3% (OR = 1,03; khoang tin cay 95%: 1,01 - 1,04). Benh nhan them 01 ngay dung PPI, nguy c a d u phdng khdng phu hgp giam 1 1 % (OR = 0,58; khoang tin cay 95%: 0,82 -0,96).

Ban luan Loet t idu hda do st ress la bdnh ly xuat hidn pho

bidn d nhdm bdnh nhan nang . Do dd , v ide d u phdng loet t idu hda do stress rat can thiet gdp phan g iam nguy c a xay ra cac bien c h u n g nang n h u x u l t huyet, thung da day cd the de dga t inh m a n g bdnh nhan [ 4 7

H u d n g d i n cua A S H P nam 1999 ch i khuyen cao d u phdng cho doi t u g n g bdnh nhan HSTC, tuy nhidn nhieu nghidn c u u cho t h l y cac t idu ch i d u phdng cua h u d n g d i n nay da d u g c ap dung ca cho bdnh nhan dieu trj npi tru thong t h u d n g . Vide lam dung PPI lam gia tang ganh nang kinh te va tang nguy c a bdnh t i t cho bdnh nhan. Trong nghidn c u u cua chung td i , chi ph i s u dung nhdm PPI t u a n g d u a n g vd i cac nhdm thuoc can quang , n h d m thuoc gay m d - gay td va cao h a n nhdm thuoc g iam dau . O idu nay cho thay nhdm PPI dang t r d thanh n h d m thuoc dac t r u n g cua bdnh vidn ngoai khoa, vd i ganh nang tai ch inh khdng nhd . T h e m vao dd , kdt qua phan t ich s u dung thuoc PPI thong qua lidu DDD/100 n g a y - g i u d n g cho t h l y v ide t idu thu PPI cd xu h u d n g tang t rong giai doan 2013 - 2015. Trong dd , khoi H S T C , khoi T h i n kinh - Cot song va khoi Tidu hda la cac khoi khoa phdng s u dung PPI nhieu n h l t va quydt d jnh xu h u d n g s u dung PPI trdn toan Bdnh v idn . Nhan d jnh PPI la thuoc d u g c s u dung pho bien t rong Bdnh v idn cang d u g c k h l n g djnh t rong qua t r inh thu thap hd s a bdnh I n , t rung b inh , c u hai bdnh n h l n nhap v idn sd cd mot bdnh nhan n h l n d u g c ch i d jnh s u dung PPI .

8 T A P C H I D U O C H O C - 4/2017 (SO 492 N A M 57)

• Nghien e lm - Ky thuat

Ap dung va i h i r a n g d i n cua A S H P nam 1999 de danh gia t inh phi i h g p cua chi d jnh d g phdng loet t ieu hda do stress, k i t qua cho thay cd td i 8 4 , 0 2 % benh nhan t rong m l u ngh ien c d u cd chi d jnh d g phdng khdng phu h g p . K i t qua nay kha t i r a n g dong vd i k i t qua cua n h i i u nghien c d u khac d i r g e t i i n hanh tai Viet Nam cung nh i r t ren t h i g id i , nh i r nghien c d u cua Ngh iem Thj Thuy Linh va C S [ 1 3 ] , nghien c d u cua Perwaiz va C S [ 91 , nghien c d u cua Reid va C S [ 1 0 l v a nghien c d u cua T h o m a s va C S [ 1 2 ] , vd i ty l i ch i d jnh d g phdng khdng phi i h g p Ian l i rg t la 8 2 % ; 68 ,5%; 5 6 % va 68 ,8%. Mac du cd s g khac nhau g ida cac ty le do khac biet v i khoang thd i gian lay m l u va c d m l u g ida cac nghien c d u nh i rng nghien c d u cua chung tdi va cac nghien c d u t ren d i u cho t h i y ty le chi d jnh d g phdng loet t ieu hda do stress bang PPI khdng phu h g p d m d c dd t i r a n g ddi cao, d i u tren 5 5 % . Trong 62 benh an cd chi d jnh d g phdng phu h g p theo k h u y i n cao cua ASHP, cac y i u to nguy c a t h i r d n g gap bao g d m da c h i n t h i r a n g (46 ,77%) va c h i n t h i r ang cot song cd d i i m G lassgow < 10 (9 ,68%) . Dang chu y, cd 2 7 , 4 2 % b i n h nhan cd t d 2 y i u to nguy c a t r d len, d i y cung I I n h d n g t inh t rang t h i r d n g gap d benh vien chuyen khoa ngoai nh i r benh v ien chung tdi dang nghien c d u .

Benh nhan cd p h l u t h u i t , benh nhan thugc khoi Tieu hda va y i u t i tuoi cao cua benh n h i n lam tang nguy c a n h i n ch i d jnh khdng phu h g p , n g a g c lai tha i g ian s d dung PPI dai se g iam ty l i d g phdng khdng phu h g p . Theo nghien c d u cua Afif, tuoi cua benh n h i n cung d i r g e xac d jnh cd anh h i r d n g d i n d g phdng phu h g p loet t ieu hda do stress, t rong dd tuoi benh nhan cang cao thi ty le d g phdng phi i h g p cang g iam [ 2 ] Y i u t i benh nhan cd p h l u t h u i t t i r a n g t g y i u to " B i n h nhan d khoa ngoai" (OR - 2,71 khoang tin cay 9 5 % : 1,33 - 5,52) t rong nghien c d u cua Craig [ 5 ]

Ngoai t r d t i e gia Ngh iem Thj Thuy L inh, cac nghien c d u cua cac tac gia khac khdng danh gia y i u to " thdi g ian n l m v ien" hoac " thdi g ian s d dung PPI " anh h i r d n g d i n ch i d jnh d g phdng . K i t qua cua chung tdi cho thay thd i g ian dung PPI cang dai thi t inh phu h g p t rong ch i d jnh d g phdng cang cao. D ieu nay cd t h i giai th ich do n h d n g benh nhan cd thd i g ian nam vien dai t h i r d n g la n h d n g b i n h nang hoac b i n h n h l n HSTC, keo theo thd i g ian s d dung PPI keo dai .

Ket luan K i t qua nghien c d u cho thay n h d m PPI ndi len la

nhdm t h u i c cd chi ph i s d dung cao ( 6 % tong chi ph i thuoc) va cd xu h i r d n g t ieu thu PPI tang t rong giai doan 2013 - 2015. Benh n h l n cd chi d jnh d g phdng loet t ieu hda do stress khdng phu h g p theo k h u y i n cao cua A S H P (1999) c h i i m ty le cao (84 ,02%) . Benh nhan d i i u trj tai cac khoi cac khoa, phdng t ieu hda, benh nhan cd p h l u t h u i t , tuoi cao, thd i g ian s d dung PPI n g l n la cac y i u t i anh h i r d n g doc lap

d i n d g phdng loet t ieu hda do stress khdng phu h g p vd i h i r d n g d i n . K i t qua cua nghien c d u la c a s d d i xay d g n g va chuan hda cac c h i i n l i r gc d g phong loet t ieu hda do st ress tai benh v ien , qua dd , nang cao hieu qua s d dung t h u i c h g p ly, k inh t i t rong d g phdng b i i n co bat Igi ngh iem t rgng nay t rong t h g c hanh ngoai khoa.

Tai lieu tham khao 1. American Society of Health-System Pharmacists

(1999), "ASHP therapeutic Guidelines on stress ulcer prophylaxis. ASHP commission on therapeutics and approved by the ASHP board of directors on November 14, 1998", Am. J. Health-Syst Pharm., 56(4), pp. 347-379.

2. Afif W., Alsulaiman R., et al. (2006), "Predictors of inappropriate utilization of intravenous proton pump inhibitors: inappropriate use of IV PPI". Aliment Pharmacol. Ther, 25(5), 609-615.

3. Anderson M. E. (2003), "Stress ulcer prophylaxis in hospitalized patients", Hosp. Med. Clin., 2(1), pp. e32-e44.

4. Cook D. J., Fuller H. D., e ta l . (1994), "Risk factors for gastrointestinal bleeding in critically III patients", N. Engl. J. Med., 330(6), pp. 377-381.

5. Craig D. G. N., Thimappa R., et al. (2010), "Inappropriate utilization of intravenous proton pump inhibitors in hospital practice-a prospective study of the extent of the problem and predictive factors", QJM, 103(4), pp. 327-335.

6. Farrell C. P., Mercogliano G., et al. (2010), "Overuse of stress ulcer prophylaxis in the critical care setting and beyond", J. Crit. Care, 25(2), pp. 214-220.

7. Gurman G., Samri M., et al. (1990), "The rate of gastrointestinal bleeding in a general ICU population: a retrospective study", Intensive Care Med., 16(1), pp. 44-9.

8. Lanza F. L., Chan F. K., et al. (2009), "Guidelines for prevention of NSAID-related ulcer complications", Am. J. Gastroenterol, 104(3), pp. 728-738.

9. Perwaiz M. (2010), "Inappropriate use of intravenous PPI for stress ulcer prophylaxis in an Inner city community", Hospital. J. Clin. Med. Res., 2(5), pp. 215-219.

10. Reid M., Keniston A., et al. (2012), "Inappropriate prescribing of proton pump inhibitors in hospitalized patients: Inappropriate prescribing of PPIs", J. Hosp Med., 7, pp. 421-425.

11. Schuster D. P., Rowley H., et al. (1984), "Prospective evaluation of the risk of upper gastrointestinal bleeding after admission to a medical intensive care unit", Am. J. Med., 76(4), pp. 623-630.

12. Thomas L., Culley E. J., et al. (2010), "Longitudinal analysis of the costs associated with inpatient initiation and subsequent outpatient continuation of proton pump inhibitor therapy for stress ulcer prophylaxis in a large managed care organization", J. Manag. Care Pharm., 16(2), pp. 122-129.

13. Nghiem Thi Thuy Linh (2015), "Realise dans le centre national d'lnformation des Medicaments et de surveillance des effets indesirables des Medicaments du Vietnam et I'hopital Thanh Nhan, Hanoi, Vietnam", Luan van thac sT Mekong Pharma, Trirong OH. Dirge Ha Ngi, pp. 1-19.

(Ngay nhan bai: 05/12/2016 - Ngay phan bien: 28/02/2017- Ngay duyet dang: 03/04/2017)

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