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.......... ..... ..............................................
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gilicmnchnthnhtitpth ccthyc giovcnb cng tc ti Trung tm DI &
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11.CHNG1:TNG
QUAN.................................................................................21.1.
Thng tin
thuc...............................................................................................
21.1.1.Khi nim thng tin
thuc.....................................................................
21.1.2.Yu cu thng tin
thuc........................................................................
21.1.3.Vai tr ca thng tin
thuc....................................................................
21.1.4.Vai tr ca dc s trong hot ng thng tin
thuc............................ 31.2. C s d liu v thng tin
thuc.....................................................................
41.2.1.Vai tr ca CSDL v thng tin
thuc.................................................... 41.2.2.Mt
s loi hnh tra cu thng tin
thuc.............................................. 51.2.3.nh gi cht
lng cc CSDL v thng tin thuc............................... 71.3. Cc
c s d liu c nh gi trong nghin
cu............................................132.CHNG 2: I TNG V
PHNG PHP NGHIN c u ................ 172.1.i
tng.......................................................................................................
172.2. Phng php nghin
cn...................................................................................
172.2.1.nh gi kh nng cung cp thng tin
thuc........................................ 172.2.2.nh gi kh nng
cung cp thng tin v tng tc thuc................... 192.3. Phng php
nh
gi.......................................................................................
202.4. X l s
liu.......................................................................................................
213.CHNG 3:KT
QU.....................................................................................
223.1. nh gi kh nng cung cp thng tin
thuc.................................................... 223.2. nh
gi kh nng cung cp thng tin v tng tc
thuc............................. 254.CHNG 4:BN
LUN....................................................................................305.CHONG
5:KT LUNV
XUT........................................................
35MCLCTI LIU THAM
KHO...................................................................................PH
LC..............................................................................................................1.Phlc1Mt
s ngun thng tin cp 3xp theo lnh vc thng tincn tracu2.Ph lc 2 B cu
hi thng tin thuc3.Ph lc 3 p n v biu im cho b cu hi thng tin
thuc4.Ph c 4 Danh sch cp tng tc thuc s dng trong nghin cu5.Phlc5
Phn loi tng tc theomc nghim trng ca MIMSOnline v DRUGDEXEvaluation
(Micromedex)DANH MCCCK HIU V CH VIT
TTADRATCCCBCSDLDIHDTINNMIMMMMONXBOTCPDAPDRPNCTTBDTOVDYNLSAdverse
drug reaction - Phn ng c hi ca thuc Anatomical Therapeutic Chemical
(ATC) Classification System H thng phn loi gii phu - iu tr - ho hc
Cho con b C s d liuDnig Information handbook 8*' 2000-2001 Dc th
Quc gia Vit Nam 2009 International Nonproprietary Name - Tn quc t
khng c ng kbn quyn Mims cm nang s dng thuc 2007 DRUGDEXEvaluation
Mims online Nh Xut bnOver the counter -Khng k nPersonal digital
assistant (cng c h tr c nhn)Physician's Desk Reference 59'* 2005 Ph
n c thaiThuc bit dc v cch s dng 2009 thuocbietduoc.com. vn Vidal
Vit Nam 2007 ngha lm sngDANH MCCCBNGSTT Tn bng Trang1.1Mt s ngun
thng tin cp mt v cp hai hay c s dng trn th gii v ti Vit Nam62.1 Cc
CSDL thng tin thuc s dng trong nghin cu 173.1 im tnh phm vi ca cc
CSDL trong nghin cn 223.2 im tnh y ca cc CSDL trong nghin cu
233.3im tnh d s dng ca cc CSDL tra cu trc tuyn trong nghin cu243.4
Kh nng qun l thng tin v tng tc thuc 253.5 Kh nng pht hin tng tc lin
quan ti azithromycin 263.6 Kh nng pht hin tng tc lin quan ti
clarithromycin 263.7 Kh nng pht hin tng tc lin quan ti erythromycin
273.8 Kh nng pht hin tng tc lin quan ti omeprazol 273.9 Kh nng pht
hin tng tc i vi 4 thuc 29DANH MCCC HNH VSTT Tn hnh Trang3.1 im ton
phn ca cc CSDL trong nghin cu 24T
VNCungcpthngtinthucmtcchy,tincyvkpthilnhimv
quantrngcangidcslmsngnhmm bos dngthucan ton,hp
l.honthnlittnhimvny,ngidcslmsngcnctrangb ngun thng tin thucccht
lngcao.Do,trong thchnli tracu,c s d liu (CSDL) v ting tin thuc ng
vai tr quan trng.Sphttrincakhoahc,tnhadngvloihnhvnidungcacc
CSDLtoiukinthunligipcnbytcnhiuchihntrongvic tipcn v cp nht thng tin
thuc.Tuy nhin bn cnh,thc t nyng thi cngt rathchticln trongvicsdng
vxlthngtin.Lachn ngun thng tin no ph hp v m bo tnh chnh xc lun l cu
hi ln i vi cc cn b y t.Nhnthccvnny,nhiunghincutrnthgiicthc
hinnhmnhgivsosnhchtlnggiaccngunthngtinthucklic
nhau,baoquttrnnhiulnhvcthngtinvdatrnnhiutiuch[25],[32],
[36].Tuynhin,tiVit Nam,nhngnghincuny michkhu tr vicnh gi v so snh
kh nng tra cu v tng tc thuc ca mt s c s d liu [10],Xut pht
tthcttrn,vimong muncmtcinhn tngquthn v kh nngcung cp thng tin ca cc
CSDL trong thc hnh tra cu thng tin thuc tiVit Nam,chngtitin
hnhtiNghincunhgimtsco*s d
liuthngdngtrongthchnhtracuthngtinthuctiVitNamvi mc
tiu;-nhgivsosnhkhnngcungcpthngtinthuccamts CSDL
bngtingVitvCSDLbngtingAnhda trn3tiuch:tnh phm vi, tnh y v tnh d s
dng.-nhgivsosnhkhnngcungcpthngtinvlnhvccth (tng tc thuc) ca mt s
CSDL bng ting Vit v CSDL bng ting
Anh.Tktqucanghincuchngtimongmunarakinxutv kh nng p dng la chn CSDL
trong thc hnh tra cu thng tin thuc, cng nh cho vic xy dng b CSDL ca
Trung tm Quc gia v thng tin thuc v theo di phn ng c hi ca thuc
(Trung tm DI & ADR Quc gia) sau ny.ChuoTig1. TNG QUAN1.1.Thng
tn thuc1.1.1.Khi nim thng tn
thucMtsnphmthucphibaogmhaiyutcuthnhkhngththiul dc cht c tc dng dc l
lm sng v thng tin km theo v hng dn s dng thuc[4],Nh vy ththngtin
thucl nhngthngtingnlin vithuc, thng tin ny thng cin trong cc ti liu
tham kho hay cn gi l cc ngun thng tin thuc[48].Hotngthngtinthucl
hotngthuthpvcungcpcctintcc lin quan n thuc cho t chc,c nhn trc tip
hot ng y,dc hoc ngi s dng tiuc[2].1.1.2.Yu cu ca thng tin
thucMtthngtinthucyphimbocnhngyucuchungnh
sau;khchquan,chnhxc,trungthc,mangtnhkhoahc,rrngvdt khot. Ngoi ra,
thng tin thuc phi c tnh haichiu,c nhiucp thng tin v ph hp
viccitngtipnhnthngtinkhcnhau.Thngtindnhchocnbyt phi l cc thng tin
mang tnh chuyn su v thuc, c cung cp di nhiu hnh thc nh cung cp theo
yu cu bi cc trung tm thng tin thuc, thng tin qua hi thokhoa
hc,thngtintrongcctiliuthamkho,...Thngtindnhchobnh
nhn,vimcchgipngibnhhiurlich,tchica thucvtunth
iutr,cncnidungngngndhiuvihnhthcngin,tndngcc phng tin truyn thng c
sn [1].1.1.3.Vai tr ca thng tin
thucThngtinthuccnghaquantrngtrongvichngdnlachns dng thuc an ton v
hp l.Thngtin thuccungcpcc thng tinlinquann thucbaogmthng
tinvdngboch,tcdngdcl,liulngcchdng,chnh,chngch nh, tcdng khng mong
mun, thng tin lin quan n ccitng bnh nhn c bit,...Do ,cc cn b y t c
h tr trong vic la chn,a ra cc
quytnhsdngthuchpltrntngbnhnhncth.Ccthngtincpnhtv thucmi,tcdng
mi,phciutrhaycckhuyncogiphnchnhng ri ro trong qu trnh s dng thuc v
tng hiu qu iu tr.Viccungcpthngtinchnhxccnhnnhlchiuqutrong vic ci
thin tnh trng ca bnh nhn v gim thiu cc li mc phi trong iu
tr[23].Thiu thng tinthucsdn tihuqu khnlngdotcdng hai mt ca thuc.Thc
t thm ha thalidomide xyra vo u nhng nm 60ca th k trc l mtvdin
hnhvnhngtcdngchinguyhimkhngcphthin trctrongqutrnh th nghimlmsngca
thuc.Mtnghin cucngch ra rng thiu thngtin thucl nguyn nhn ch yu dn n
ccsaist trong iu tr, m nhng sai st ny lil nguyn nhn hng u dn ti tc
hicho bnh nhn [44].1.1.4.Vai tr ca dc s trong hot ng thng tin
thucThut ng thngtin thuc thngcgnlin vicc khinim trung
tmthngtinthucvchuyngiathngtinthuc,nghalninthngtin thucl nin vai tr
cadcs nh mt ngi t vn v thuctrongqu trnh s dvmg thuc trn lm sng
[48].Vo nhng nm 60 ca th k 20, s ra i ca nhiu thuc mi trong iu tr
ihingibcslmsngphibtnhpkpthivaranhngquytnh ng n. Kh khn t ra l kh
nng tip cn vi cc ngun thng tin cn kh hn ch.Do ,ngi dc s ng vai tr
nh mt cu ni a thng tin ti nhn vin y t[48].Cng vi kin thc v kh nng
tipcn, tm kim thng tin, ngidc s khng nhc vai trca mnhtrong
viccungcp thngtin en cc nhn vin y tcng nh bnh nhn nhm hngtis dng
thuc hpl, tng hiuqu
iutr[18],[37].Scnthitcavicphthinvtheodiccphnngchicathuc trc v sau
khilu hnh,tnh phc tp ca cc phc iu trcng nh s bng n ca cng ngh thng
tin l nhng yu t i hi ngi dc s cn pht huy kin thccng nh k nngca mnh
trong vic phi hp vi bcs nhm hn ch phnng c hi, thu thpv cp nht thng
tin miv thuc iu trng thi phn tch nh gi thng tin a ra nhng quyt nh s
dng thuc ng n [48].Ngy nay,tinhiunctrnthgii,ngidcs cchngquan trng
bn cnh bc s,h tr vic theo dis dng thuc v iu trca bri nhn. Ti Vit
Nam,khinimthng tin thuc,dcs lmsng btu c cp n trong nhng nm gn y.Vai
tr ca dc s cng dn c cao vi s raica ccn vthngtin thuc v
hotngdclmsngti bnh vinv
gnynhtlsraicaTrungtmQucgiavthngtinthucvtheodi phn ng c hi ca thuc
nm 2009.T nm1997 B y t lin tc ban hnh cc
vnbnlinquannvicthnhlpvhotngcanvthngtinthucti bnh vin[5],[15]. Hin
nay, tt c cc bnh vin ln u thnh lp on v thng
tinthuctuynhinhotngcaccnvnychahiuquvchapng c nhu cu thng tin ca y
bc s [14].1.2.C sd liu v thng tin thuc1.2.1.Vai tr ca COsdliu v
thng tin thucNunhdcscvaitrchchttronghotngthngtinthucth
CSDLvthngtinthuclcngcclckhngththiugipngidcs thc hin nhim v ca
mnh.CSDLvthngtiniuclutm vcpnhtccthngtinvmilnh vc lin quan nthucdi
nhiu hnh thc trnh by v tra cu khc nhau.Trong khi
khnngghinhcaconngichn,kin thcvsdngthuclilun thay
ivcbsungthccCSDLlugingunthngtinphongph,cpnht thng tin mi nht ticca
im khc nhau, thiim khc nhau,gipngitra cuccinhn tngqutvc
thvthngtinyhcvtnhhnhsdngthuc
trongiutrtrnthgii.Ngynay,visphttrinvcslngcngnh chiusu ca thng
tin,km theonhngbct ph trongcng ngh,ngy cng c nhiu cc CSDL v thng
tin thuc ni chung nh AHFS Drug information[19],
Martindale:thecompletedrugreference[55]vDcthQucgiaVitNam
[3],...;hayccCSDLchuyn bitvmtlnhvcthngtincthnh
tngtcthuc(Druginteractionfacts[54]hayStockleysdruginteractions[21],...),thuc
sdngchophncthaivchoconb(Drugusedinpregnancyandlactation
[62],...),thngtinvthuctim(HandbookonInjectabledrugs[57],...)vnhiu
lnh vc khc.Hnh thc tra cu cng a dng hn vi cc thng tin trn sch, bo,
tpch,phn mmacu trn mytnh,haycngc htr kn vduytn
(personaldigitalassistant,PDA)vthng tinqua mnginternet.Cc hnhthctra
cu ny gip tit kim thi gian tm kim,h tr vicla chn thuc trongiu tr
cng nh gim thiu cc ri ro khi s dng thuc[22],[40].1.2.2.Mt s loi hnh
tra cu thng tin thucNgunthngtinthucthngcchiathnli3loi:ngunthngtincp
mt, ngun thng tin cp hai v ngun thng tin cp ba.i-Ngun thngtincpmt:l
cc bi bo,cngtrnh gcngtiy
trncctpchhocmnginternet,ccbochuynmn,ccklialuntt nghip hay s tay
phng th nghim,...Cc thng tin ny thng do tc gi cng b m khngcs can
thipnhgi ca bn th hai.Ngun thng tin ny cungcp thng tin chi tit,y v
mt nghin cu,phong ph vcp nht.Tuy nhinn
thiutnhkhiqut,khitracukhngthchdavomtnghincuara c kt lun chnh xc m
khng tham kho cc bo co
khc[1],[48].i-Ngunthngtincphai:baogmhthngmclcccthngtin hoc cc bi tm
tt ca cc thng tin thuc ngun thng tin th nht. Khi mun tm
hiuvmtvncth,ngitacththamkhongunthngtincphai
tipcnvnmtcchtondinvidanhmcccthngtinlinquanhaybi tm tt. Nh vy th
ngun thng tin ny tng kt ccthng tin lin quan,giptm kim nhanh v c h
thng.Tuy nhin, khi mun tham kho thng tin chi tit ngi
tracucnphiquaylivingunthngtinthnht.Hinnayngunthngtin cp hai c lu tr
trong CD-ROM hoc a ln mng internet [1],[48].4
Ngunthngtincpba:lccthngtincxydngbngcch tng hp cc thng tin t hai
ngun trn, thng c cng b di dng sch gio khoa,ccbnhngdniu
trchun,...Thngtinccctcgi tng
hptccngun,ccnghincuklicnhaunnctnhtnghp,khiqut,yv
ngtincy.Tuynhin,tnhcpnht ca ngun tingtin nykmvchtlng thng tin
phthucvotcgi.Khicn tmhiu thngtinchi tit,ngisdng vn cn phiquay li
ngun thng tincp mt.Mts ngunthng tincp ba xp theo lnh vc thng tin
tra cu c nu c th trong ph lc1 [1],[48],[ph lc1].Bng 1.1: Mt s ngun
thng tin cp mt v cp hai hay c s dng trn th gii v ti Vit
Nam[14],[48]Ngun thng tin cp mt Ngun thng tin cp haiAnnals
phannacotherapy Medline (www.nlm.nih.gov)PharmacotherapyIOWA Drug
information service (http://itsntl4.its.uiowa.edu/)American Journal
of Health-system PharmacistsInternational Pharmaceutical Abstracts
(www.ashp.org)Clinical Phaiiiiacology and Therapeutics Adis
International (www.adis.com)Journal of Managed Pharmaceutical Care
Journal Watch (www.jwatch.org)Tp chi dc hc Lexisnexis
(www.lexisnexis.com)Bn tin Thng tin Dc lm sng Current content
(www.isinet.com)Thng tin thuc d thuc ngun thng tin no cng c th hin
di nliiu hnh thc khc nhau. Cc hnh thc tra cu bao gm sch, bo in, sch
in t, phn mm tra cu dng cho my tnh hay PDA, tra cu qua mng
internet.Mi loi hnh tra cu ny c th c xy dng da trn cng mt b CSDL
hoc cc CSDL khc nhau.Sch tracu yl ngun thng tin kinhin nht,thngl cc
tiliu thuc ngun thng tin cp ba.Tuy nhin hn ch ca hnh thc ny l mt
thi gian tracu,tnhcpnht kmdomt thigianchnhl,vicphbintiliuloi ny cng
kli khn.V th m dngsch in t ra i, bao hm nidung nh bn in, nhng kh
nng phn phi thng tin ln hn.Stay traculdngsch tracuvithngtin ngn
gnsctch,kchc nhgn,tincmtayvsdng,tracunhanhhndngschtracuy,thun tin
trong thc hnh lm sng. Nhc im ca loi sch tra cu ny l thng tin khng y
.Bo v tp ch ng ti cc thng tin ch yu thuc ngun thng tin cp mt,
cngcthl ngun thngtincpbanulccbibotngkt.Hinnay nhiu tp ch c dng in n
v bo in t. rt ngn thigian tracu,cng nh victra cu tr nn huch hn vi
thc t iu tr, phn mm thng tin thuc s dng cho my tnh hay cng c h tr
tra cu c p dng ngy cng ph bin vi cc tnh nng tm kim s dng t kha, tip
cn thng tin nhanh chng.Cng c ny to iu kin cho vic a ra cc quyt nh
trong tii gian ngn hn,p ng thc t rt nhiu cu hi thng tin
iuccngiiptrongqutrnhsdngthuc.Gny,vicngdngPDA (cngc h tr c
nhn)trongthc hnh sdngthuc manglinhiu tinch nh nh gn d dng b ti,cp
nht thng tin, tra cu nhanh chng v d dng,c
xuhnglmgimtiiuccphnngchicathucclinquannlik
thutvnhngsaisttrongiutrgipcithintnhtrngbnhnhn
[22],[45],[52].Mnginternetngycngtrnnphbin,adngvhuchtrongthc
hnhtracuthngtin.Cngnghnytoramtmnglilutr,cpnhtv
chiasthngtinrngln.Thngtincthn thun dng vnbn,hocc h tr hnh nh, m
thanh.Loi hnh tra cu ny c u im l thng tin a dng v
cpnlittkhpnitrnthgii,tracusdngnhiutkhakhcnhau,vi
nhiutinch(cngctmkim)nhmddngtipcn thngtinthuccclnh vckhcnhau.Thngtin
trn mnginternetcthl thng tincpmt (boin
t),thngtincphai(vd:Medline),thngtincpba(vd:Micromedex)
[18],[48],1.2.3.nh gi cht lng cc CSDL v thng tin
thucNgynay,slngccCSDLtnglnngk,thmvolccphin
bntracukhcnhaucacngmtbCSDLvigiaodinadng,cungcp
thngtinngycngphongphchongisdng.Vvyvicnhgivlachn ngun thng tin thuc
no ph hp v tin cy tr thnh mt yu t quan trng i vi ngidcs trong thc
hnh tra cu thng tin nhm a ra mt cu tr li ng n nht
[48],[49].Vicnhgiccngunthngtinthuc,trongchyulccngun
thngtinthuccpbactinhnhbinhiutcgivinhitiuchv phng phpkhc nhau,nh gi
trn nhiu lnh vc thng tin nh:kh nng cung
cpthngtinthuctondin,khnngphthintngtcthuc,kimtratnh
tnghpcathuctim,hockhnngnhndinthuc,htrthngtinthuc chomt bnh hayitngc
th[17],[25],[36],[51],[53],[58],[61].Ngoira,cc
nghincunycnnhgi,sosnhccCSDLvinhauhocsosnhccloi hnh tra cu klic
nhau[26].4-nh gikh nng cung cp thng till thuc:CSDL v thng tin thuc
tn ti di nhiu loi hnh tra cu khc nhau.Vic
lachncngcnophthucvonhiuyut.MtCSDLvthngtinthuc
ccholtondin,ngtincykliiCSDLbaohmccctiuchsau: cprit,y,linhhotkhitra
cu,gi trsdngcao,chnhxc,ctrchdn tiliu tham khocho michuyn
lun,ctnhngdngcao,ddngtra cu,v c th kim chng thng tin.[46]Cc nghin
cu ch yu tp trung nh gi phn mm tra cu thng tin thuc
sdngchoPDA,mtcngchtrtracungycngcsdngrngri[24].Nghin
cuutincEndersvcngstinhnhnm2002[29],nh gi 9 phn mm tracu dngchoPDA,s
dng b56cu hi baoqut 9lnh vc thng tin thuc, da trn 3tiu ch l bao ph
thng tin (liu thng tin cn tm c ccpn hay khng), tin cy(thng tin tmc
mcyno) vtnhdsdng(tnhbngthigiantmkimtccutrli).Nghin cu ny cho thy
LexiComp Platium l phn mmcung cp thng tiny v tin
cynht,MobileMicromidexvAtoZDrugFactslhaiphnmmt tincynht
lcbygi.Tuynhinthnghincunykhngcpnnhngthngtinsai lch trong qu trnh nh
gi.Nm2004,Clauson vcngs tinhnhnghin cunhgi10CSDL
thngtinthucsdngchoPDAdatrn3tiuch:tnhphmvi(thngtinc
ctmthytrongCSDLhaykhng),tnhycathngtinvtnhds
dng.Bcuhithngtinthucbaogm146cuhitrn14lnhvcthngtin khc nhau.Kt quca
nghin cu ny,tng t nghin cuca Enders,chothy LexiDrugon Hand Plantium
cungcpy thng tin nht;AtoZ Drugcho php tm kim thng tin nhanh nht
[27],CSDLvthngtinthucsdngchoPDAsaucnhgi khnng h tr vic k n da trn b
tiu ch Benchmark bao gm tnh cp nht,liu dng
datrnbngchngyhcchoccchnhcphduythocchacph duyt,cu trc thng tin v tc
dng c hi ca thuc, tng tc thuc, thng tin v
thuccngungcthinnhinvthcphmchcnng,cctnhnngkhcnh hng dn iu tr, thng
tinc ng hc,gi thuc,...Trong s11CSDL c tin hnh nghin cu,Lexi
Drugscnhgi l phn mm tt nht, mobilePDR l CSDL t thng tin nht.Khi xem
xt v tnh chnh xcca thng tin, nghin cu ny chra rng khngc thng tin
sai lch nghim -ng vchnh,dng boch
vtcdngph,CPOnHandcnhiulinhlplichuynlun,tcdngph
khngng.Khnngphthincctngtcthuccnghalmsnggprt
nhiuli,cbitlkhngcCSDLnophthinctngtcgia
ketoconazolverythromycin.Nhmtcgitinhnhnhgilisau15 thng, ch c
4/11CSDL c kh nng pht hin cp tng tc ny [39].Cc phn mm v thng tin
thucs dng cho PDA mt mt th hin u th trong vic h tr tm kim thng tin
nhanh chng vcp nht,mt khc do hnch v b nh m mt s phn mm phi rt gn v
nt dung so vi CSDL dng tra cn trc tuyn ca n[24]. Do Clauson v cng s
tin hnh cc nghin cu nh gi v so snh cc CSDL v thng tin thucs dng cho
PDA v tra cu trc
tuyn[25],[26].Cngnhgidatrnbcuhivtiuchgingnhau,ktqucc
nghincunhsau:ccCSDLtracutrctuyncimphihpcaonhtl
ClinicalPharmacology,Micromedex(DRGDEXandIdentidex),Lexi-Comp10online,
Facts & Comparisons 4.0; Eprocrates Free Cs im thp nht. Nhn
chung ccCSDLphitrphcungcpthngtinyhnvtincyhonCSDLmin ph[25].Trong
khi , kt qu ca cc CSDL dng cho PDA c s khc bit:Lexi-
Drugsngthnht,ClinicalPharmacologyOi-Handngthhai,saul
EpocratesRxProvmobileMicromedex,EpocratesRxbnminphvncim thp
nht.CcCSDL dng tra cu trc tuyn c im cao hn cc CSDL dng cho PDA,tuy
nhin chcs khc bitgia cccpCSDLca ClinicalPharmacology v Micromedex l
c ngha thng k [26],-nh gi kh nng pht hin tng tc thucTong tc thucl
mt trongnhng nguyn nhndnnsaist trongiu trvgia tngtl nhpvin ca bnh
nhn[35].V th vic pht hin v hnch tng tc trnlm sng l mt yu t rt quan
trng. pht hin tng tc,ngi tracus dng ccCSDL v thngtin thuc bao hm
phn thng tin v tng tc thuc,hocsdngccphnmm
phthintoTigtc,cctrnhduyttngtc trc tuyn.Tuy nhin,kh nng pht hin cc
tng tc cng nh a ra nhn nh v mc nghim trng ca toTig tc gia cc CSDL
li rt khc nhau.Mt s cch phn loi tng tc s dng trong mt vi ti liu nh
sau[31]:Phn loi theo5mc nghim trng, trung bnh,nh, khng tng tc, khng
c hiu.Phn loi thnh 4 mc (da theo mc quan trng trnlm sng ca tng
tc)xt trn 3yu t:nguyc gy nguy him ti bnh nhn, tnh thng xuyn xy ra v
d on c, tin cy v cht lng ti liu tham klio.Phnloitheomcnghimtrngca
tngtc;nghimtrng, trung bnh, nh.Mtnghincutinhnhtrn5tiliusau: s
pharmacopeiaDrug
information,AHFSDruginformation,Hanstensdruginteractionsanalysisand
management,Druginteraction factsv MicromedexDrug-Reax,sosnh danhsch
tngtcvphnloitngtcca5nhmthuc(thuccchenzymchuyn
dngangiotensin,thucchnbeta,benzodiazepin,thucchnknhcalci,thuc11chng
vim khng c cu trc steroid) ch ra rng trong s tt c cc nhm thuc
ckhost,cccptomgtcrthimkhiccpnngthitrong nhiu ti liu.Hn na, vic cc
cp tng tc c tm thyng thi trong nhiu ti liu ng ngha vi s khc bit v
phn loi mc nghim trng ca tng tc gia cc ti liu [30].Mcd kh nng pht
hin v phn loi tuofng tc l khc nhau,ktqu trungbnh imnhy vtrung
bnhchiuca8phn mm pht hin tong tc thuc ca cc nh thuc cng ng ln lt l
0,88(khong dao ng t 0,81-0,94) v 0,91(dao ng t 0,67 - 1,00). Trong
khi ,cc phn mm duyttngtccakhoadcbnhvinchttrungbnhnhyl0,3(dao ng t
0,15-0,94)[16].Cng s dng 6 bnh n nh nghin cu trn, Hazlet v cng s nh
gi 9phnmmtngtcthuccsdngti516hiuthuccngngti
Washington.Ktquchothyccphnmmnykhngphthinc1/3s tngtc c ngha
lmsng.Ktqu gia cc nh thucs dngcng mt phn mm c s khc nhau [36].Kh
nng pht hin cc cp tng tc trong hai nghin cu trn ca cc phn
mmdngchoPDAdaongt0,81n1,00.TrongePocratesRxv
eProcratesRxProcnhyvchiuttnhtvisim>90%, mobileMicromedex t im
nhy v c hiu ln lt l 0,94 v 0,71 [50],Mtstrnhduyt tngtchaycsdng
tiVit Namcnh gidatheotiuchcaJankel,GolbergvtiuchuncaMalonecngcngs
sausdngccn thuctibnh vinBchMainhgis ph hpca cc CSDL vi iu kinlu hnh
thuc nc ta.Kt qu ca nghin cu cho thy
rngcctrnhduyttoTigtcnybquartnhiuthuc(trungbnh29,7%),
MIMSInteractivelphnmmphthincnhiuthucnht.Martindalel chng trnh c kh
nng pht hin tng tc chnh xc nht [8].Mt nghin cu khc c tin hnh vi mc
ch nh trn cng cho kt qu
tngt:phnmmMimsInteractivephthincslnghotchtvbit
dcnhiunht,ngtiiphthincnhiutngtcnht,trongkhi12MartindalevDruginteractionfactCkhnngsnglcnhngtuofngtcc
ngha lm sng tt nht[9]. Mt nghin cu khc a ra kt qu khc bit, cc phn
mm pht hin ckhngqu50% tng tcthuc,trong l MimsInteractive pht hin c
t tng tc nht [12].Ccphnmmduyttngtcthucchyulcancngoivbng
tingAnh,vicngdngvotictsdngthuc nctagpnhiutr ngi nh: kh khn v ngn
ng, vic p dng cng ngh c bit l vi y t tuyn di, hn na li khng pht hin
c nhiu thuc c mt ti Vit Nam.4 nh gi khnng cung cp thng tn thuc mt s
lnh vc khcCho tr bm rtquan trngtrong viccungcp khngcn thitchotr
em.Trngngbcnguycmcccbnhcpvmntnhcngnhtngkh nng mc bnh ca ngi m[33].V
th vn thucan ton ivi ph n cho
conbtrnnthityu,ngimcngnhybcscnctvnthngtin chnh xc v vn
ny.Tuynhin,10CSDLcnh gi biAkus vcngs lia ranhngkhuyn cokhcnhauvmcan
tonca14thucdngcho ph n cho con b [17].Nghin cu sosnh 4CSDL vthng
tin liu dngcho bnh nhn suy thn cng chras khcbit v nhn nh
thngtinlinquannnhnghasuygim chc nng thn, hiu chnh liu v khong liu
gia cc CSDL [58].MtnghincukhcsosnhccCSDLvtnhtnghpcathuctim cho thy
t l ng thun v tng hp/ tng k ca 7 CSDL trong nghin cu t 79% cc cp
thuc s dng [53].Nh vy,vicnhgiccCSDL thngtinthuc trn thgii ctin hnh
trn nhiu lnh vc, tiu ch, c bit l tp trung nh gi cc CSDL ng dng
chomy tnh,PDAvonline.Nhngnghincu ny chngtccCSDL khc
nhauvnhnnhthngtincngnhkhnngcungcpthngtinthuc.Cc
nghincunhgikhnngphthintngtcthucchothykhngctrnh duyt tng tc no cho
kt qu ng tin cy khi s dng n l, nn s dng nhiu hn mt CSDL v tng tc
thuc tra cu [20].131.3.Cc CSDL c nhgi trong nghin
cuDcthQucgiaVitNam2009(NXBYhc)[3]:cbintpbi
BanchobinsonDcthQucgiavHingdcinVit Nam,bao gm600chuyn lun
thucvccchuynlunchung nhsdngthuccho ph ncthai,nguyntcsdng
thucgimau,nguyn tcsdngkhngsinh,... Ngi s dng c th tra cu bng tn hot
cht hoc tn bit dc.Nidungca mtchuyn lun thucgm;tnchuyn lun thuc,tn
thuc vit theoINN,mATC,loithuc(phnloi tieonhmtcdng),dngthucv hm lng,
dc l v c ch tc dng, ch nh, chng ch nh, thn trng, thi k mang
thai,thi k chocon b, tcdng kling mong mun,hng dn x tr ADR,
liulngvcchdng,tngtcthuc,nnhvboqun,tngk,qu liu v x tr v ting tin quy
ch.VidalVitNam2007[7];lmtsnphmcacngtyCMPmedicaPte Ltd, dng tham kho
cho vi MIMS Vit Nam, c cp nht mi nm mt ln.
Vidalgipngisdngnhndngcmtssnphmtrnthtnrng,tm kim thng tin v nh sn
xut v cng ty,thng tin v dc phm milu hnh cc nc trong khu vc, thng
tin lm sng h tr k n.Phn thng tin sn phm
ctrnhbytheothtbngchcitheotnbitdc.Ngoiracncphn thng tin hot cht nhm
bsung thng tin ca mt s hot cht cho phn thng tin sn phm.Nidungca
mtchuynlun thucbaogm:tnsn phm,nhsnxut, dng trnh by, thnh phn,dclc
hc,dc ng hc,chnh,chng chnh,
chphngvthntrnglcdng,lccthaivlcnuiconb,tngtc thuc, tc dng ngoi mun,
liu lng v cch dng, qu liu, bo
qun.Thucbitdcvcchsdng2009(NXBYhc)[13]:dodcs Phm Thip, dc s V Ngc
Thy v cng s bin tp, cp nht mi nm mt ln;
cungcpthngtinngngnsctchvthuccmttrnthtrngVitNam.
Thngtinvthucbaogmccchuynkhotngquanv33nhmthucv14chuyn kho ring ca
tng thuc. Hai cch tra cu l tm kim qua tn hot cht hoc tn bit
dc.Ccchuynkhothuc(chuynlunthuc)baogm:tnchuynlun(tn
thuctheoINN),bitdc,tnkhc,dngthuc,tcdng,chnh,liudng, chng ch nh v lu
; trong lu c tng tc thuc, tc dng ph, qu
liu.Physiciansdeskreference59*'2005(ThomsonPDR)[28]:lmtsn phm ca
Thomson Corporation,c cp nht hng nm. Ni dung bao gm thng tin vnhsn
xut,nhn dngsn phm,thng tinsn phm.Tracus dng tn hot cht hoc tn bit
dc.Phn thng tin sn phm sp xp theo th t bng ch ci theo tn bit
dc.Nidungcamtchuynlunthucbaogm;mt(mtdng,ng phn,cngthccu
tohotcht,thnh phn ch phm);thng tindclmsng baogm:tc dng dc l
chung,dc ng hc,dc lc hc,cci tng c bit (ngi gi, ph n c thai v cho
con b,suy chc nng gan thn, bo ph,...); chnh v s dng;cnh bo (cc
nguyc bin c bt li nghim trng c th gp
phivcchxtr);chngchnh(giithchvsaochngchnh,aracc bng chng lm sng); tc
dng bt li (cc tc dng bt li c th gp phi c bo co, tn s xy ra tc dng
bt li, cc nghin cu lm sng v tc dng bt li, tng tc thuc);quliu (s cqu
liu,cch x tr);ch phm vliu dng;cc
nghinculmsngtrnitngcbit:ngigi,trem,nhngngisuy
gansuythnvcchxtr(hiuchnhliu);hngdnsdngchphm(dng bo ch, ng gi, bo
qun, cc tng k khi s dng ch phm thuc tim, mt s hng dn v s dng ch
phm).Mims Cm nang s dng thuc 2007 [6]:mt phn ca h thng sch tham kho
MIMS, sn phm ca CMP medica, cp nht 4 thng mt ln.MIMScung cp thng
tin v thuc ang lu hnh ti th trng Vit Nam, bao gm:thng tin v cc
chphm mi,thngtin nhsn xut vcng ty,thucs dngan ton trongthai kv
thngtin chititcasn phm.Phnthng tin casn phmctrnh by15theo tn
bitdc,spxp theo nhm tcdng dcl, tra cu theo tn bit dc, tn hot cht
hoc tc dng iu tr.Nidungca mtchuynlunthucbaogm:tn bitdc,nhsnxut,
nhphnphi,thnhphn,chnh,liudng,cchdng,chngchnh,thn trng,phnng
ph,tngtc thuc,trnh by v gi.Ccthngtin ny ty tng chuyn lun m c th c
cp hoc khng.Druginformationhandbooks**" 2001-2002[42]:lmtsnphmca
LexiCompdidngstaytracunhanh,khngphil ngun thngtiny.
CSDLnycungcpthngtinvccthuchaycsdngvmtsthngtin lin quan nlmsng(nh mt
s phciu tr,nh gi chc nng gan,thn, bng so snh cc thuc,...).Ni dung
mt chuyn lun thuc bao gm; tn hot cht, hng dn pht m,
thngtinlinquan,tnbitdcluhnhtiM,tnbitdcluhnhti Canada, tn vit tt,
phn loi theo iu tr, tc dng, qun l (phn loi ca
DEA-Cquanchngmatyvcchotchtcn kimsot),phnloimcanton cho phn
cthai,thngtinchophncthai hocchocon b,chngchnh, ch v thn trng
khidng, tcdng khng mong mun,qu liu/ng c,tng tc thuc, n nh,c ch tc
dng,dc ng hc,dc lc hc,liu dng,ch
nung,cchdng,chscnkimsot,khongiutr,tngtcvixt
nghim,thngtinchobnhnhn,ingtinchoyt,thngtinbsung,dngbo ch, hng dn
pha ch.Mimsonline(http://mims.com/)[64]:lmtCSDLnmtrongchuisn
phmcaCMPmediaLtd.Mimsonlinecungcpcngctracuvthuc,nhn din hnh nh
thuc, pht hin tomg tc thuc,thng tin chun on, thng tin cho
bnhnhn,tmkimthngtinvnhsnxut.Tracuthuccthsdngt kha tn hot cht, tn
bit dc hay nhm thuc.Nidungmtchuynlun thucbaogm:tnchuyn lun(tn
iuctheo INN),phn loithuc,chnh,dngdng,cch dng,chngchnh,thntrng,
tcdngkhngmongmun,tngtcthuc,tngtcthuc-thcn,nhhng16n ktqu xt nghim,qu
liu,phnloimc an ton thucdng cho ph n c thai, bo qun, c ch tc dng, m
ATC.Thuocbietduoc.com.vn(http://thuocbietduoc.com.vn/)[65]:cung cp
dch vtracuthuc,tmkimnhthuc,bnhvin,cngty,cungcpvcpnht thng tin v y
hc, khoa hc thng thc, thuc mi ng k, ngoi ra cn cung cp dch v t
vnchia s kinh nghim.Tra cu thng tinlin quann thucs dng
tkhaltnhotchthoctnbitdc,tmkimtheochnhhocnhm
thuc.Nidungmtchuynlunthucbaogm:tnchuynlun(tnhotcht
theoINN),nhmdcl,tnbitdc,dngboch,thnh phn,dclchc,
dcnghc,tcdng,chnh,chngchnh,thntrnglcdng,tngtc thuc, tc dng ph, liu
lng, qu liu, bo
qun.DrugdexEvaluatioii(Micromedex)[66]:lmtCSDLthucMicromedex,cung
cp thng tin y v thuc.Tra cu s dng t kha tn hot cht hoc tn bit dc.Ni
dung mt chuyn lun thuc bao gm;(1) thng tin khi qut gm; phn
loithuc,liudng,chngchnh,tcdngph,ngdngtrnlmsng;(2) thng tin liu dng
baogm:c tnh ca thuc, boqun v n nh,liu dng
chongiln,liudngchotrem;(3)dcnghcbaogm:thiimklii pht vdi
tcdng,nngthuctrong mu vqu trnhhpthu-phn b- chuyn ha -thi tr
(ADME);(4)thn trng:chng chnh,thn trng, tcdng
ph,nhhngtiphncthai,chocon b,khnngsinhquithai,tomgtc thuc;(5) ng dng
trn lm sng:yu t cn kim sot, hng dn cho biih nhn,
vtrtrongphc,cchtcdng/dcl,phciutr,sosnhtc dng/nh gi so snh vi cc
thuc khc.17Chong 2. I TNG V PHNG PHP NGHIN cu2.1.i t ng
nghncuitngnghincugm9CSDLvthngtinthuc,trong6CSDL bngtingVitv3CSDL
bngtingAnh(Bng2.1).CcCSDLclachn datrn vics
dngrngritrongthchnhlmsngqua ghinhntcckho sttrn thgii[48],[60]vtiVit
Nam[14],ngthicngda vokhnng sn c ca ngun thng tin m nlim nghin cu c
th truy cp v tham klio.Bng 2.1:Cc CSDL thng tin thuc s dng trong
nghin cuTn CSDLVitttCpnhtNgn ngCSDL tra cu y Dc th Quc gia Vit Nam
DT 2009 Ting VitThucbitdcvcchs dngTBD 2009 Ting VitVIDAL Vit Nam VD
2007 Ting VitPhysicians Desk Reference 59* PDR 2005 Ting AnhCSDL
tra cu nlianhMIMScmnangsdngthuc Vit NamMIM 2007 Ting VitDrug
information handbook DIH 2001 Ting AnhCSDL tra cu trc tuynMIMS
online MO 16/12/09Ting Vit - Ting AnhThuocbietduoc. com. vn TO
17/12/09 Ting VitDRU GDEX Evaluation (Micromedex)MM 20/12/09 Ting
Anh2.2.PhoTigphpnghincu2.2.1.nhgikhnng cung cp thng tin thuc Thit k
b cu hi thng tin thuc v p n52cuhicxydngda trn
bcuhicaGaltvcngs[32],c saichophhpvitnhhnhsdngthuctiVitNam.Cccuhic
phn vo14nhmlnh vcthngtin khcnhau,slngcuhitrongminhmO18ph thuc vo tm
quan trng ca nhm thng tin trong thc hnh da trn y vn trong nc v nc
ngoi [11],[25],[ph lc 2].pnvbiuimchobcuhicxydngdatrnhaitiliu
chunlAHFSDruginformation2008[19]vMartindale:thecompletedrug
reference35*^[55],[phlc3].Ngoiravimtscuhichuyn bit,thngtin
cnckimnhbngmtstiliuchuynkliokhcnhHandbookon injectable drugs14*
[57], Drugs use in pregnancy and lactation 6[62].Mi cu tr li phi c
kim tra i chiu v ng thun bi t nht hai ti liu chun.Tiu ch nh
giSdng3tiuchnhgicxutbiClausonvcngs[25]bao gm tnh phm vi, tnh y v
tnh d s dng.-Tnhphmvicnhgibngvicctmthycutrlihaykhng, chm theo thang
im0 v1.Khng nh gi cu tr li hay thiu, nu tm thy cu tr li t1 im, nu
cu tr khng c t 0im.Trng hp khng tm thy
cutrlichophntnhphmvithphntnhyvtnhdsdngu0 im. im ca tnh phm vi cho
mi CSDL c tnh bng t l % theo cng thc:Tnli phm vi =^1 1----C^iqqo/
q0Ci-Tnhynhgi mcycacu trli,cchm theothangim t 0-3.Thang im c th cho
tng cu tr li c nu trong b pn, trli no ng vi pn s c im. Vi cu tr li
gm nhiu ,im cho micquynh trongpn da vo mcquan trngca n.im ca tnhy
cho mi CSDL c tnh bng t l % theo cng thc:tngim t n h y^Tnh y =._.**
'.-X100%imtnhphmviX3-Tnlidsdngctnhbngslnnhpchuttimccutrli, ch p dng
nh gi b CSDL tra cu trc tuyn. im tnh d s dng cho mi
CSDLthhinbngslnnlipchuttrungbnhivittccuhitmc cu tr li.-im ton phn =
0,7 XTnh phm vi + 0,3XTnh y -Tnh d s dng.192.2.2. nhgikhnng cung
cpthng tn v tng tc thuc La chncp
tongtcNghinculachn2nhmthuc:khngsinhmacrolidvcchbm proton.Hai nhm
thuc ny c bit n l c nhiu tng tc haygp trongiu trv c mt ti th trng
Vit Nam[3],[56].Danh sch cc tng tc thuc ca 2 nhm thuc ny c xy dng v
i chiu thng qua 2 ti liu l Drug Interaction Facts 2003[54] v
Stockleys Drug Interactions
8*[21],Cctngtccspxpthnh2nhm:tongtccnghalmsng gm51tngtcv toTig
tckhngcnghalmsng(YNLS)gm37tng tc[ph lc
4].CctngtccYNLSkhichngcDrugInteraction Factsphnloi mc1 v
2,ngthiStockleysDrugInteractions8*' nhnnh tng tcny
ltngtccYNLShoccnphitheoditrongqutrnhphihphoc chng ch nh phi hp[
59].Tong tc khng c YNLS khi Drug Interaction Facts nhn nh mc
3,4,5,ngthiStockleysDrugInteractionsnhninhrngtngtckhngc YNLS hoc
khng quan st thy tng tc khi phi hp[59],Tiuch nhgi4-Kh nng qun l
thng tin tng tc thucCcCSDLckhostvkhnngcungcpthngtinlinquann
tngtcbaogm:tcdng,cchtngtc,hngxtrtrnlmsng,phn loida trn
mcnghimtrngca tngtc,ctrchdn tiliuthamklio.
nhgidatrn3mcnhtnh:C(cbaohmthngtin),Khng
(khngnuthngtin)vKhngy(cnunhngkhng,tytngcp tng tc v chuyn lun).-nh
gi kh nng pht hin tng tc thucSdngcccptoTigtcxydng trnnhgi
khnngphthin tngtccaccCSDLthngquanhyvchiucaccCSDLny
[59],[31]:20-TP(truepositive)- gitrdngtnhtht:lstngtccYNLSm CSDL xc
nh ng.-TN (true negative) -gi tr m tnh tht:l s tng tc khngc YNLSm
CSDL xc nh ng hoc b qua c.-FP(false positive)-gitrdng tnhgi;lstng
tckhngcYNLS m CSDL xc nh sai l c YNLS.-FN (false negative) -gi trm
tnh gi:l s tng tc c YNLSm CSDL xc nh sai hoc khng pht hin
c.-Sensitivity -nhy:l tltng tccYNLSmCSDLxcnhng trn tng s tng tc c
YNLS,c tnh theo cng thc sau: nhy =TP+FNnhycgitrbng1
khiCSDLxcnhngttccctngtccYNLS.-Specificity - chiu:l tl
tngtckhngcYNLSmCSDLxc nh ng hoc b qua c, c tnh theo cng thc sau:TN
c hiu =- TN+FPc hiu nhn gi tr1 khiCSDL nhn nhng hoc bqua ttc cc tng
tc khng c YNLS.-Ch s Youden = nhy + c hiu - 1 [63]2.3.Phng
phpnhgiCcbCSDLcnhgithngquakhnngtrlibcuhi,c thc hin clp bi hai thnh
vin trong nhm nghin cu.Kt qu cui cng t c thng qua s ng thun gia hai
ngi chm.S dng cc cp tngtc trn khost ccCSDL v kh nng cung cp thng
tin v tng tc thuc. i vi cc CSDL (Vidal Vit Nam, Physicians Desk
Reference,Mimscmnangsdngthuc),mthotchtctrnhbytrong
nhiuchuynlunkhcnhauthimtnhbngimtrungbnhcaccchuyn lun v cng mt hot
cht.212.4. X l s liuS liu c x l bi phn mmSPSS16.0 v EXCEL
2007.Nghincusdngkimnhsosnhimtnhphmvi,phntch ANOVA so snh im tnh y v
tnh d s dng gia cc CSDL.Kh nng pht hin tng tc thuc c so snh thng
qua ch s nhy, c hiu v ch s Youden.22Chng 3. KT QU3.1. nh gi kh nng
cung cp thng tin thuc3.1.1. Tnh phm viBng 3.1: im tnh phm vi ca cc
CSDL trong nghin cun DT TBD VD PDR MIM DIH MO TO MMLiu dng 10 7 3 4
9 6 9 8 7 10Tng tc thuc 4 2 1 2 4 2 4 3 1 4ng dng/cch dng 3 3 2 2 1
2 2 2 2 2Tc dng ph 9 5 1 1 8 1 7 4 4 6Thuc OTC 1 0 1 1 0 1 0 1 1
1Ch nh 6 1 1 1 3 2 3 2 2 3Hoat cht v bit dc 4 2 3 4 3 4 2 3 3 4Dc
ng hc 3 2 0 1 3 0 1 1 0 3Tong k v n nh 2 1 0 0 0 0 2 0 0 2Chng ch
nh 2 1 1 1 2 2 2 2 1 1Hpphnbsungdinh dTig2 1 1 1 2 1 2 0 1 0Dc l/ c
ch tc dng2 1 0 2 2 0 2 2 1 2PNCT/CCB 3 3 1 1 3 3 2 2 1 3Ch phm thay
th 1 1 1 0 1 1 0 1 1 1Tng 52 30 16 21 41 25 38 31 25 42% 100 57,69
30,77 40,38 78,85 48,08 73,08 59,62 48,08 80,77C thnhnthy rngvi
banhmCSDL tracu y,tracu nhanh v tra cu trc tuyn th PDR, DIH, MM l
ba CSDL c im cao nht vi s im ln lt l:78,86,73,08 v80,77.s im ny
chnh lch r rt so viim ca TBD,
MIMvTOlbaCSDLcimthpnhttngngtrongbanhmCSDL (p0,05.Tuy nhin, vi thng
tinlin quann liudng th gia ccCSDL mcy kh24chnh lch.Trong khi PDR v
MM t 2,89 v 2,65/3im thTBD v VDcht 0,67 v 0,86/3im.3.1.3. Tnh d s
dngBng 3.3: im tnh d s dng ca cc CSDL tra cu trc tuyn trong nghin
cuMO TO MMLiu dng 2,86 3,43 3,00Tng tc thuc 3,67 3,00 3,50ng dng v
cch dng 2,50 2,00 2,00Tc dng ph 2,25 3,00 3,17Thuc OTC 1,00 1,00
2,00Ch inh 2,00 3,00 2,33Hot cht v bit dc 1,33 3,00 2,25Dc ng hc
2,00 0,00 3,33Tng k v n nh 0,00 0,00 3,50Chng ch nh 2,00 3,00
3,00Hp phn b sung dinh dng 0,00 1,00 0,00Dc l/ c ch tc dng 3,00
3,00 2,00PNCT/CCB 3,00 3,00 3,33Ch phm thay th 2,00 4,00 2,00Trung
bnh 2,48 2,92 2,88Ktquslnnhnchut trungbnhtmracutrlil2,48(MO);2,92
(TO);2,88(MM).SkhcbitgiaccCSDLtracutrctuynlkhngc ngha thng k (p
> 0,05).3.1.4. im ton phn82,88^74,OS^79,49--------51,3^TBD VD DT
PDR MIMS DIH TO MO MM CSDL tracuyDCSDLtra cunhanhiiCSDLtra cu trc
tuynHnh 3.1: im ton phn ca cc CSDL trong nghin
cu25BiuchoiybaCSDLcsimcaonhttrongbanhmCSDLln lt l PDR (82,88), DIH
(74,05), MM (79,49), u l cc CSDL bng ting Anh.Th t sp xp theoim ton
phn ging vi th t sp xp theoim tnh phm vi.iuny c th c gii thch
rng:im tnh y v tnh d s dng gia ccCSDL khc nhau khngc nghathngknnim
ton phn ch yu do im tnh phm vi quyt nh.SosnhimMIMSdngsch
vMIMSonline thy rngMIMSonlinec im ton phncao hn MIMSdng sch do
MIMSonline cho php tr li cu hi lin quan n Dc ng hc, dc l/ c ch tc
dng cn MIMSdng sch khng
baohmthngtinlnhvcny.TuynhinnhiuthngtinkhisdngMIMS online bt buc phi
tra cu bng ting Anh.3.2. nh gikh nng cung cp thng tin v tong tc
thuc3.2.1. Kh nng qun l thng tin v tng tc thucBng 3.4: Kh nng qun l
thng tin v tng tc thucTc dng C ch Hng x tr Phn loi theo mc nghim
trng ca tng tcTi liu tham khoDT C Khng y Khng y Khng KhngTBD Khng
Khng Khng Khng KhngVD Khng y Khng y Khng y Khng KhngPDR C C C Khng
KhngMIM Khng Khng Khng Khng KhngDIH C C Khng y Khng KhngMO C C C C
CTO C Khng y Khng y Khng KhngMM C C C C
CTrongs9CSDLchcMIMSonlinevDRGDEXlcungcpy thng tin nht. Nhn chung kh
nng cung cp thng tin v tong tc ca cc CSDL
dngschkhngy.CcCSDLdngschkhngphnloitngtc,ng thi vic a ra nhn nh v tc
dng, c ch v x tr tng tc cng hn ch.DT, TO ch bao hm thng tin v tc
dng ca tng tc m khng a ra y thng tinvcchvx
tr.Ccthngtinnyccpkhngthngxuyntrong26VidalVit Nam,ty tngchuyn lun v
tng tng tc.TBDv MIMchlit k tng tcm khng kmtheothngtinlinquan.PDR v
DIHbaohm thngtin vtcdng,c chvhngxchtngtcnhng hngx tr khngc cp y
trong DIH. p dng phng php nh gi ra, chng ti nhn nh v tng tc
trongccCSDLcnghincunhsau:nhngtngtcccoilcYNLS
khiMIMSonlinexpvomc4,5hocDRGDEXxpvonhm1,2theo phn loitng tc ca tng
CSDL[ph lc5];i vi cc CSDL khng phn loi
tngtcthnhngtngtcmCSDLcpccoiltngtccYNLS, nhng tng tc m CSDL b qua
hoc cp nhng xc nh l khng c YNLS.3.2.2. Kh nng pht hin tng tc
thucKhnng pht hin toTig tc i vi tng thuc:c th hin trong cc bng 3.5
- 3.8.Bng 3.5: Kh nng pht hin tng tc lin quan ti
azithromycintioSouX*sTiu ch DT TBD VD PDR MIM DIH MO TO MMTP 3 1
1,8 2,3 1,75 3 2 1 0TN 3 3 3 3 3 3 3 3 3FN 0 2 1,2 0,7 1,25 0 1 2
3FP 0 0 0 0 0 0 0 0 0 nhy 1,00 0,33 0,60 0,77 0,58 1,00 0,67 0,33
0,00 c hiu 1,00 1,00 1,00 1,00 1,00 1,00 1,00 1,00 1,00Bng 3.6: Kh
nng pht hin tng tc lin quan ti clarithromycinTiuch DT TBD VD PDR
MIM DIH MO TO MMsPMoTP3 1 0 12,5 18 5,5 13 19 1 0 1 1B0TN7 6 5,5 5
7 5 5 6 6uXFN17 10 7,5 2 14,5 7 1 1 0 9'rtFP1 2 2,5 3 1 3 3 2 2u
nhy 0,15 0,50 0,63 0,90 0,28 0,65 0,95 0,50 0,55c hiu 0,88 0,75
0,69 0,63 0,88 0,63 0,63 0,75 0,7527Bng 3.7:Kh nng pht hin tng tc
lin quan ti erythromycine2Tiu ch DT TBD VD PDR MIM DIH MO TO MMTP13
15 17 22 9,8 18 23 10 10TN9 12 12 10 12 11 9 11 9FN13 11 9 4 16,2 8
3 16 16FP3 0 0 2 0 1 3 1 3 nhy0,50 0,58 0,65 0,85 0,38 0,69 0,88
0,38 0,38 c hiu0,75 1,00 1,00 0,83 1,00 0,92 0,75 0,92 0,75Bng
3.8:Kh nng pht hin tng tc lin quan ti omeprazol"N2VS0Tiu ch DT TBD
VD PDR MIM DIH MO TO MMTP0 0 0,5 1 0,33 1 1 0 0TN9 11 11 9 9,8 14 5
10 12FN2 21,5 1 1,67 1 1 2 2FP5 3 3 5 4,2 0 9 4 2 nhy0,00 0,00 0,25
0,50 0,17 0,50 0,50 0,00 0,00 c hiu0,64 0,79 0,79 0,64 0,70 1,00
0,36 0,71 0 , 8 6Kh nng pht hin tng tc ca DT i vi 4 thuc l rt khc
bit.Trong khi DT pht hin c ng ht cc tng tc c YNLS vi azithromycin
likhng pht hinc tong tcca omeprazol.nhythayi trong khong0 - 1. c
hiu kh cao, dao ng trong khong 0,62 - 1,00.VD pht hin cc tng tc lin
quan n khng sinh macrolid kh ng u, nhytt0,6- 0,65.Khnngpht
hintngtccYNLSviomeprazol
cht0,25.KhnngbquatngtckhngcYNLSthayitrongkhong0,23-1,00.KhnngphthintngtccYNLScaPDRvinhmmacrolidkh
ng u v kh cao,dao ng t 0,77-0,90.Tuy nhin vi omeprazol th nhy ch t
0,50. c hiu ca PDR kh cao v khng chnh lch nhiu,t t 0,63-
1,00.28MIMphthintngtccYNLSca4thucvinhykhngcaov chnhlch t
0,17-0,58.Khnngbqua tng tckhngcYNLSkhcaot t 0,70-1,00.Nhn chung kh
nng pht hin tong tc c YNLSca TBD khng cao, vi
omeprazolTBDkhngphthinctngtccYNLSno.Vinhm macrolid, nhy t t 0,33-
0,58. c hiu t gi tr t 0,5- 0,93, cao nht l c hiu i vi
erythromycin.Kh nng pht hin tng tcc YNLSca DIH kh cao vi nhyt
t0,5-1,00,c hiut t0,63-1,00.Viazitliromycin,DIHc kh nng pht hinchnh
xc cc tng tcc YNLSng thi bqua ccc tomg tc khng c YNLS.MO c kh nng
pht hin tong tc c YNLScao, nhy thayi t 0,50-0,95v bqua tngtc
khngcYNLSivi nhmmacrolid khcao vi c hiu t 0,63-1,00. Vi omeprazol c
hiu ch t 0,38.Khnng phthintong tccYNLScaTOnhnchungl thp,cht
nhyt0,33-0,50vinhmmacrolidvviomeprazolthkhngphthin c tng tc c YNLS
no. c hiu t t 0,77 -1,00.SoviccCSDLkhcthkhnngphthintngtccaMMlkhng
cao.MMkhngphthinctngtccYNLSnocaazithromycinv omeprazol.Kh nng b qua
cc tng tc khng c YNLScao vi c hiu t0,75-1,00.Tm li, kh nng pht hin
tng tc lin quan ti omeprazol ca cc CSDL thp, nhy trung bnh t
0,21(dao ng t 0 - 0,50).Khnng pht hintng tclinquanti
c4thuc:CcCSDLphthinchnhxccctngtccYNLS bao gm
MO(nhy=0,88),PDR(nhy=0,85)vDIH(nhy=0,69),u lcc
CSDLbngtingAnhhocviMOththngtinvtngtcthucphitracubng ting
Anh.HaiCSDLcim nhy thpnht l DT(0,37)v
MIM(0,34).Cc29CSDLbquactngtckhngcYNLSvichiu trungbnhl0,80, cao nht
l DIH vi 0,89 im, thp nht l MO vi 0,59 im.Bng 3.9:Kh nng pht hin
tng tc i vi 4 thucTiu ch DT TBD VD PDR MIM DIH MO TO MMTP19 26,0
31,8 43,3 17,3 35,0 45,0 21,0 21,0TN28 32,0 31,5 27,0 31,8 33,0
22,0 30,0 30,0FN32 25,0 19,2 7,70 33,6 16,0 6,00 30,0 30,0FP9 5,00
5,50 10,0 5,20 4,00 15,0 7,00 7,00 nhy0,37 0,51 0,62 0,85 0,34 0,69
0,88 0,41 0,41 c hiu0,76 0,86 0,85 0,73 0,86 0,89 0,59 0,81
0,81Youden0,13 0,37 0,47 0,58 0,20 0,58 0,48 0,22
0,22DavochsYouden,chsnythngcsdngnhgitnh hiu qu ca cc test chun
on,Youden cng c gi trgn1 thtest chun on cng c ngha i vi vic phn bit
nhm tng tc c YNLS v nhm tng tc khng c YNLS[63],PDR v DIHl haiCSDL c
gi trYoudencao nht (0,58), MIMS online ng th hai vi Youden= 0,48.Dc
th c gi tr Youden thp nht ch t 0,13. Gi tr ny ca MM cng rt thp ch t
0,22.30Chng 4. BN LUNHin nay,trongthchnh thngtinthuctrn lmsng,vicm
bocht lng thng tinng vaitrquytnh.Thngtin thucnuccungcpchnh xc,kp
thiscnhhng tch ccn ktqu iu tr,gp phn tch ccthc
yvicsdngthucanton,hpl[34].tcmctiu,mtb
CSDLcnphibaoqutttccclnhvcthngtinlinquannvicsdng
thuc,ctincycao,ngthiddngtipcn,dtracuvthnthinvi ngi s dng. Ngoi ba
tiu ch chnh trn, mt s tiu ch khc nh tnh cp nht,
thngtincxydngtrncsyhcbngchng,cngvistchhpthm mt s chc nng nh tra cu
thng tin v bnh, t in y khoa, cc xt nghim lm
sng,cccngthctnhton,ccphciutr,...lnhngnhntcnthit cho mt b c s d liu
ton din v thng tin
thuc[46],TiVitNam,hotngthngtinthuccchtrngvphttrin trong nhng nm
gny.Ngois dng Dc th qucgia(vn bn chnh thng c tnh phplchovictracu
thngtintiVit Nam),mt stiliutingVit
khcnhMims,VidalvcctrangwebtracutrctuynbngtingVitcng ang c s dng rng
ri [14].Nghin cu ny nh gi v sosnh mt s bCSDLthng dng trong
thchnhtracuthngtinthuctiVitNam.Cctiuchrabaogm;tnli
phmvithhinkhnngbaoqutthngtinnhiulnhvckhcnhauca CSDL,tnhy thhin
khnngcungcpthng tiny chnh xc,tnh d
sdngthhincimtmkimcutrlinhanhchng.MtCSDLcim tnh phm vi v tnhy cao
ngha l CSDL c kh nng p ng nhu cu v nhiulnhvcthngtin
khcnhauvcungcpthngtinngtincy.Vicnh gi tnhdsdngchpdngviCSDLtracu
trctuyn.Mt vinghin cu khc s dng tiu ch tnh d s dng bao gm s ln nhn
chut hay s cas cn mravthigiantccutrli[29],Tuynhinnghincunychs
dngslnnhnchutvithigiantracuphthucvonhiuyutnhmy
tnh,tctruynmngcthnhhngntnhthngnhtcaktqu.Gia31trng ca 3tiu ch ny
trong im ton phn c kim tra li vi cc t l khc nhau.Ktqu nhn
thytlimtnh phmvi v tnhydl70/30,60/40 hay50/50 thth tspxpccCSDL cng
khng thayi.im ton phnnh gitnghpcbatiuchtrnchobitCSDLtctiuchramc
no.Kt qu nghin cu nh gicho thy cs khc bit v kh nng cung cp
thngtinthucgiaccCSDL,skhcbitnychyudotnhnngbaoqut
thngtinquytnh.Thmvo,ccCSDLbngtingAnhckhnngcung cp thng tin tt
hnccCSDL bng ting Vit.Trong s 6 CSDL bng ting Vit, chc DT v MOt im
tnh phm vi >50%.Hon na nhng thng tin lmsng linquann
liudng,tngtc,tcdng ph,dcl,dcng hcc cp rtt hockhngc
trongTBD,VD,MIM,TO v DT.Trong khi thyl nhng ting tin hu ch trn lm
sng c cc b y t rt quan tm[11]. Do m
CSDLbngtingVithinangcsdngkhngpngcnhucuv thng tin trn nhiu lnh vc
khc nhau.PDR, DIH v MM l 3CSDLng tin cy nht vis im ton phn lnlt
l82,88;74,05v 79,49.Kt qu ny tng t nh mt s nghin cu c tin hnh trc y
nhnn nh MMl CSDLng tincytrongthchnh tracuthngtin[26],[18].Da
voktqunhginy, vimtslnh vcthng tinnh tngtcthuc,liudng,chnh v tcdng
ph,ccCSDLkhcbitrrtvkhnngtrlicccuhilinquan.Vth chng ti tin hnh nghin
cu nh gi su hn kh nng cung cp thng tin v mt lnh vc c th, bc u l tng
tc thuc.Mt CSDL v tng tc thuc cn phi cung cp cc thng tin lin quan
hu ch trnlmsng.l thng tin v phn loi tng tc v hng x tr, thng tin
nygipngidcshocbcsaraquytnhcanthipchnhxcvkp thi. Ngoi ra thngtin cn
thit khcl tcdng v c ch tomg tc, trchdn ti liu tham kho gip ngi s
dng c th tra cu su hn, y hn v tng
tc.iuquantrngivimtCSDLvtngtcthuclphiphthin cchnhxccc tng
tccYNLS.Tiuchnycnhgi thng
quach32snhy.nhycngcaonghalCSDLcngphthincchnhcccc tng tc c YNLS. Tuy
nhin nu nh CSDL pht hin qu nhiu tng tc s gy ra yu t nhiu khin
ngitra cu c thbqua docnh boqu nhiu tng tc
mliltngtckhngcYNLS[47].Khnngbquatngtckhngc YNLSc nh gi bng chs c
hiu. c hiu cng cao th CSDL cng bquacnhiutngtckhngcYNLS.MtCSDLva tha
mn khnng pht hinng tng tcc YNLSng thi b qua tng tc khng c YNLS th
phic nhyv chiucao[38].NghincudngchsYoudennh gi tngqutkhnng
phnbittngtccYNLSv khngcYNLS.Youden cng gn1th CSDL cng ng tin cy
trong vic tra cu totig tc
thuc.Saukhinhgikhnngcungcpthngtinvtotigtcthucca9 CSDL, kt qu cho
thy ch c MO v MM cung cp y cc thng tin lin quan.
NhngCSDLbngtingVitkhngcyccthngtinny.Ngoirakli
nngphthintngtclinquantibn thucl rtkhcnhau mtsCSDL
(DT,MIM,MO).iunychothychtlngthngtinccchuynlunthuc khngngu.Xttrn
khnngcungcpthngtinvtngtcthucvpht hin tng tc thuc thccCSDL bng ting
Anh vn ng tin cyhn cc CSDL bngting Vit.PDR,DIH v MOl 3CSDLt chs
Youdencao nhtlnlt l 0,58, 0,58 v 0,48. Trong khi DT l CSDL t ch s
Youden thp nht (0,13). Ktqu m nghincu thuccs chnhlchsovinghin
cutrccho rngMicromedexlCSDLngtincykhitracutngtcthuc[43],Cth gii
thch do s khc nhau v nhn nh mc tng tc gia cc CSDL,hn na
nghincusdngtiliuchunlDrugInteractionFactscpnhtnm2003,
trongkhithMicromedexccpnhtrtthngxuyn.Mtkhc,phng phpnh gi khc nhau
cng c th dn n sai khc trong kt qu.Mt s nghin cu trc ys dng cng c nh
gi l cc bnh n c km sn tng tc thuc trong [50] hay cc bnh n ti bnh
vin [59]vi cc tiu ch tng t ti ny. Lam MV v cng s thc hin nh gi theo
thang im1-3cho mi tiu ch ra, vic khost nh gi c thc hin bidcs lmsng
v chuyn gia thng33tinthuc[43].Trongkhicngcnhgicatinylcccptngtc lin
quan n 2nhm thuc,vic chmimc thc hin thngqua khost v nh gi chuyn lun
ca tng thuc.Nhvy,ktqunhgichothykhnngcungcpthngtincacc CSDL bng ting
Vit rt hnchc bitl thng tin lin quann liu dng, tc dng ph,vchnh.Ngoi
ra kh nngcung cp thng tin v tng tccng rt km,khnghtrycho ngitracu v
mc tngtc,x tr,tcdng hay c ch tng tc.Cc CSDL bng ting Anh ng tin cy
hon, tuy nhin ngi traculigpphikhkhnvngnngcngnh victipcnvicctiliu
ny.iu ny cho thy thc hnh tra cu i hi mt CSDL bng ting Vit c kh nng
cung cp thng tin ng tin cy.Trongiukintinhnh,tinycntntimtshnchnhtnh.
Thnht,bcuhicbinsondatrnmtnghincutincngoi,n
khngphnnhcnhucuthngtinthucthcttiVitNam.Hnna,s lng cu hi hn ch khng
cho php a ra kt lun v kh nng tr li bt k cu hi thuc lnh vc thng tin
no.Tuy nhin, vic s dng b cu khi khc thay th c ths khng lm xo trn kt
qu mt cch ng k, v b cu hi ny c xy
dngdatrnsngthuncaccchuyngiackinhnghimtronglnhvc
thngtinthuc,baohmnhiulnhvcvnhiuvncquantm[32],
Nghincusdngngunhinhainhmthuclmcngcnhgivkli
nngcungcpthngtinvtngtcthuc.Vicsdngnhngtngtcthuc hay gp trongiu trti
Vit Nam sphnnhng hn chtlng ccCSDLso vi nhu cu thc t.Tuy nhin,cha c
nghin cu no thng k cc tng tc ny.
Thhai,itngthamgianhgiCSDLtrongnghincunylsinhvin Dcnmcui,kh nng tra
cu cng nh nhucu v thng tin cn hn ch[41].
Ngoira,tnhcpnhtcaccCSDLtrongnghincukhngngnht,ktqu c th khc i khi s
dng cc n bn khc nhau.Da vo ktqu cng nhcc hnch trn,nghin cu nycha
tha ra kt luncth v chnh xcvccCSDLtrn ttccclnh vcthngtin thuc,34nhng
c thcoiyl mt bngchng v kh nngcungcp thng tin tiuc hn chca
mtsCSDLhinangcs dngti Vit Nam.iunyl giicho
scnthitvtnhcpbchphixydngvhonthinCSDLthngtinthuc bng ting Vit c th
tr thnh CSDL v thng tin thuc ton din p ng nhu cu thc t. Vic xy dng
b CSDL ny cn khc phc nhng nhc im ca cc CSDLhin hnh,ng
thithamkhomtsCSDL cnhgi l ngtin
cy.KtquchothykhngcCSDLnot100%cctiuchra,dokhi
tracucnthamkhonhiuhnmttiliucbitkthptracucctiliu chuyn kliochotnglnh
vcthngtin.ehonthin nghincunyva ra
ktluncthhn,ccnghincunhgicnctinhnhda trnnhucu thngtinthucthcttiVit
Nam,nhgi trnnhiutiuchv phngphp khc nhau, nhmm bocc nhn vin y t
tipcn vi ngun thng tin thucc cht lng cao.35Chng 5. KT LUN V XUT5.1.
Kt lunQua khostnh giccCSDL tracu thng tin thuc thngdng trong thc
hnh tra cu ti Vit Nam, chng ti rt ra c kt lun nh
sau:-CskhcbitgiaccCSDLvkhnngtrlicccuhithngtin
thucnichung.Skhcbitnychyuldokhnngbaoqutcclnhvc thng tin quynh. Kh
nng cung cp thng tin lin quan n cc lnh vc nh liu
dng,chnh,tcdngphvtngtcthucgiaccCSDLcskhcbit.
PDR,DIHvMMl3CSDLcungcpthngtinyvngtincynht. Trong khi , TBD, VD l 2
CSDL c im ton phn thp nht.-v
khnngcungcpthngtinlinquanntngtcthuc,ccCSDL khc nhau kh nng pht hin
v pht hin ng cc tng tcc YNLS.Vi mt
sCSDL(DT,MIM,MO)khnngphthintngtciviccthuckhc nhau khng ng
nht.CcCSDL bng ting Vit cn hn ch trong vic cung cp
ccthngtinlinquanntngtcthuc(phnloitoTig tc,trchdn tiliu tham
kho,tcdng,c ch,hTig x tr tong tc).PDR v DIHl 2CSDL cho php tra cu
tng tc thuc tin cy nht.-CcCSDL bngtingAnhckh nngcungcpthng tin
thucnichung v thng tin v tng tc thuc ni ring tt hn cc CSDL bng ting
Vit.5.2. xutThngxuynnhgichtlngccngunthngtinthuckhngch dnhchocn
bytmc thng tinchongisdng,nhgi trnnhiulnh vc thng tinda trn nhiu
tiuch v phng php nghin cu,gn lin vi thc t nhu cu thng tin thuc ti
Vit Nam.Cn thitxydng bCSDL bngting Vit hon thin cungcp thng tin cp
nht v ng tin cy cho ngi s dng.TILIU THAMKHOTing Vit1.B mn Dclm sng,
trng H Dc HN (2006), Dc lm sng, NXBY
hc.2.BmnQunlvKinhtdc(2006),Phpchhnhnghdc,Trng i hc Dc H Ni.3.B y t
(2009), Dc th Quc giaVit Nam2009, NXB Y hc.4.By t(2005),Tiliutphun
s dng thuc hpl trong iutr(Ti liu o to lin tc cho bc s v dc s ti bnh
vin).5.Byt(1997),Thngts8/BYT-TT:Hngdnvictchc,chcnng nhimvca Hi ng
thuc viutr Bnhvin thc hinch th03/BYT- CT ngy25/3/1997caBtrng BY
tvvicchnchnhcngtccungng, qun l v s dng thuc ti bnh vin.6. CMP
Medica (2007), Mms cm nang s dng thuc 2007.I.CMP Medica
(2007),VidalVit Nam 2007.8.NgCh Dng (2006), Lachn phn mm duyt tng
tc thuc v ng dng khost bnhntimt s khoacabnhvinBch Mai,Lunvnthcs dc
hc kha 2004-2006, Trng H Dc
HN.9.VnhHin,HongThKimHuyn(2005),Sosnhkhnngphthin tng tc trong iu
trca mt s phn mm duyt tng tc thuc,Tp ch Dc
hc,(354),tr.23-26.10.HongKimHuyn,NgChDng,VnhHa(2007),Khostvnh gi mt
s phn mm tra cu tng tc thucOnline,Tp ch Dc /c,(378),tr.3-7.II.L
ThyLinh(2009),Khost thctrng v nhucuthngtin thuc
cacnbydchinnay,Kholunttnghipdcskha2004-2009, TrngHDc HN.12. Tun
Minh, V nh Hin (2003),Bc u nh gi cc phn mm duyt tng
tcthucvngdngtronglmsngtikhoaC1vin timmchqucgia, Thng tin khoa hc
cng ngh Dc, (1,2),tr. 122-131.13.Phm Thip,V Ngc Thy (2009),Thuc bit
dc v cch s dng, NXBY hc.14.TrungtmDI&ADRQucgia(2009), Khost nh
ginnglcquc gia v thng tin thuc v cnh gic
Dc.15.Viutr(2003),Cngvns10766/YT-Tr:Hngdntchc,chc nng,nhim v v hot
ng ca n v thng tin thuc trong bnh vin.Ting Anh16.Abarca J,Colon
LR,Wang v s et al(2006),Evaluation of the performance of
drug-druginteractionscreeningsoftwareincommunityandhospitalpharmacies,
Journal of Managed Care
p/armac)^,12(5),pp.383-389.17.AkusM,BartickM(2007),Lactationsafetyrecommendationsandreliability
compared10medicationresources,The Annalsof
Pharmacotherapy,4,PP-l^52-
1360.18.yilnalmLS,AbuelsoudNN(2007)Evaluationofelectronicinformation
resourcesforquestionsreceivedbyaCollegeofPharmacyDrugInformation
Center, Drug Information Jowma/,41,pp.441-448.19.American
hospitalfonnulary service (2008), AHFS Drug information
2008.20.Anderson PO, McGuinnessSP, Bourne PE (2010), Pharmacy
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Website64.http://Mims.com/65.http://thuocbietduoc.com.vn/66.www.thomsonhc.com.Phlc1Mt
sngunthng tincpbaxp theolnh vcthng tincn tracuLnh vc thng tin Ngun
thng tin cp baThng tin chung Facts and comparisons, Drug
Information Handbook, AHFS Drug information, Micromedex, Dc th Quc
gia Vit Nam.Tc dng bt li Facts and comparisons, Drug Information
Handbook, AHFS Drug information, DRUGDEX.Thng tin v bnh hc
Harrisons Principles of internal medicine, The Merk manual,
Pharmacotherapy.Liu dng Facts and comparisons, Drug Information
Handbook, AHFS Drug information, Dc th Quc gia Vit Nam.Liu dng cho
ngi cao tui Geriatric dosageHandbook, Facts and comparisons, AHFS
Drug information, DRUGDEX.Liu dng cho tr em Harriet Lane Handbook,
Pediatric dosage Handbook.Cch dng ng dng Facts and comparisons,
Drug Information Handbook, AHFS Dmg information, MicromedexTng tc
thuc Drug interaction facts, Evaluation of Drug interaction,
DRUGDEX.Thuc s dng cho PNCT/CCB Drugs in Pregnacy and lactation,
DRUGDEX, Drug Information Handbook.Thuc c ngun gc thin nhin PDR
Herbal, Review of nature products, Commision E MonographNhn din
thuc lu hnh American Drug Index, DRUGDEX, IDENTIDEX, Thuc bit dc v
cch s dng, Vidai Vit Nam, Mimsong nc cm nang s dng thuc.Nhn din
thuc nc ngoi DRUGDEX, Martindal: the extrapharmacopeia.Ch nh Facts
and comparisons, Drug Information Handbook, AHFS Drug information,
DRUGDEX, Dc i Quc gia Vit Nam.Thuc ang nghin cu DRUGDEX, Martindal:
the extrapharmacopeia.Thuc khng cn k n Handbook of Nonprescription
Drugs, Physicians Desk Reference for Non-prescription Drugs,
DRUGDEX, POISINDEX.Dc ng hc Basic Clinical Pharmacokinetics, AHFS
Drag information, DRUGDEX. Handbook of clinical drug data.Dc l
Goodman and Gilmans Pharmacologic Basic of therapeutics, AHFS Drug
information, DRUGDEX, Facts and comparisons. n nh/ tng k Guide to
Parental Admixtures, Handbook of Injectable Drugs, AHFS Drug
information, DRUGDEX.c tnh/ ng c Clinical Toxicology of Commercial
Products, POISINDEX, Poisoning and Toxicology Handbook.Phuluc2 B cu
hi thng tin thucSTT Phn loi Cccu hi khost T lLiu dng/ Hiu chnh liu
cho cc i tng c bit, liu trnh iu tr1.Liudngckhuyncocacaptopriltrong
iu tr cao huyt p bnh nhn nam 58 tui?2.Liu khi u ca glyburide cho
ngi ln vi triu chng giai on u ca bnh tiu ng?3.Da vo nng creatinin,
ti c tnh h s thanh thi creatinin ca bnh nhn vo khong 20ml/pht.
Ticnnchnhliuchobnlinhndng phenytoin
khng?4.LiudngcaAugmentindnghndchchomt b gi 4 tui nng 25kg (50
pound) b vim tai gia cp tnh l bao
nhiu?5.Liudngcadiazepamiutrchnglou mt ph n 85 tui?6.Liu dng hng ngy
ti a ca propoxyfen?7.Liudngtngnggiaatorvastatinv
simvastatintrongiutrtnglipidmungi
ln?8.Thigianiutrkhuyncobngciprofloxacin chovimngtitniukhngbinchngph
n?9.Liudngcacelecocibtrongiutrvima khp dng thp.10. Bnh nhn ung
warfarin 7,5 mg/ngy v phi nhp vin viINRl6.Trnghpnyphixlnh th
no?10/52Tng tc thuc11. Nhngtongtcthucnocnghalmsng cn ch vi bnh nhn
ang s dng perindopril?12. Ctngtcthucnogiawarfarinvgarlic khng?13.
Bnh nhn ca ti ang s dng warfarin. C tng tc thuc no gia warfarin v
vitamin E khng?14. Ctngtcnogianifedipinvitraconazol khng ? Tng tc c
ngha lm sng khng?4/52iig dng v cch s dng15. Trongtrng hp m bnhnhn
phiiu trbng khngsinhazithromycinnhngkhngthung
dngvinnang.Hicdngdngthaythkhc caazithromycin khng?16. Bnh nhn bau
khpgic thdng ketoprofen dng bi ti ch thay cho ng ung hay
khng?3/5217. Nhnglu quan trng nht khis dng bng dn qua da
nitroglycerin?_________________________18. Diltiazem c th gy ra tng
sn li hay khng?19. Cnxltnhhungsaunhthno:khimt bnh nhn ang iu tr vi
warfarin v s phi nh rng khn trong 2 tun na k t thi im ny?20.
Chcnngthnca bnh nhn bsuygimvbc schnhdngtobramycin.Cnhnglu gv tc dng
ph ca thuc ?21. Bnh nhnangciu trbngitraconazol,xt
nghimthymengantnglnnhanhchng.C nhnglu g v tcdng phca thuc v x tr
trng hp ny nh th no?22. Mtcub8tuilyhpFumafer(vinnnchaTc
dngstfiimarat)mcutrongbpvnkhongph40-50vin.Trnghpnyphixlnhthno?23.Rilonchc
nng tnh dc(gim khoicm)lin quan tifluoxetin s kodi baolu sau khi
ngng s dng n?24.Ngicchcnngthnbnhthngdngkali clorid bsung kalibngng
ung hng ngy viliutbaonhiutrlnthgy rachngtng kali mu?25.
Cctriuchngcatiucvnkhisdng atorvastatin?26.
Xtnghimlmsngnocntinhnhtrckhi bt u iu tr bng amiodaron?Ch nh / Ch nh
khng chnh thc9/52rr -27.
Cchphmthucnangcthnhphnlgarlic1ThucOTC/lu"01/52(chit xut t ti) trn
th trng khng r_________28. Bnhnhn83tuibsuy timsunghuyt,chs
thanhthicreatininkhong20- 25ml/pht. Hydrochlorothiazidcphillachn
phhp iu tr chng ph cho bnh nhn ny khng?29.
Saucnnhimuctimbaonhiungythmt bnh nhn nam 55 tui c th dng
wafarin?30. Liu azithromycin c tc dng vi trng hp vim6/52 phi mc phi
cng ng hay khng?31. Liufluoxetintrongvickimsotchngrilon tm thn tin
kinh nguyt hay khng?32. Cc ch nh ca gemfibrozil?33.Lamivudinecc
chnh phngnhim HIV sau khi v tnh dm phi bm kim tim khng?7Thng tin v
bit dc v hot cht34. Hot cht chnh ca ch phm Tobradex?35.
Bitdccanifedipindngvingiiphngko di?36.
Hmlnghydrochlorothiazidtrongbitdc Mycardis plus l bao nhiu?37.
Cnhngdng bochnoca cefiiroximv hm lng Cefuroxim trong cc dng bo ch
?4/528Dc ng hc38. Bnhnhnvamisinhemb2tuntrcv mun bt u s dng li
metformin.Liu thucc bi tit vo sa khng?39. So snh c tnh hp thu v thi
gian tc dng gia verapamilgiiphngchmvverapamilgii phng tc th?40. Bnh
nhn ng kinh cn ln c bt u ch nh phenytoin.Sau baonhiulu thcthnhlng
nng phenytoin trong mu trng thi n nh?3/529Tnh tung k v n nli41.
nnhca hndch ampicillinng ungs nh th no sau khi pha?42.
Gentamicincthcphavidungdchtim truyn no trong tim truyn qung
ngn?2/5210Chng ch nh43. Metforminccsdngbnhnhnsuytim khng?44.
Cthdngsumatriptancho bnh nhn tnghuyt p cha c kim sot khng?2/5211Cc
hp phn b sung dinh dng45. CchphmvitaminEliucaonoluhnh khng?46.
Calcicacbonatngungdngbsungcalci cho c th nn dng vo thi im
no?2/5212Dc l / C ch tc dng47. C ch tc dng ca Clopidogrel l g?48. C
ch tc dng ca azithromycin l g? 2/5213Ph n c thai, cho con b49.
Phenytoinccsdngongthigianmang thaikhng?Cbngchngvdtt bmsinh hay
khng?50. Verapamilcchngchnhchophncthai khng?51. Ciprofloxacin c dng
c cho ph n cho con b khng?3/5214Ch phm thay th52.
Cbitdcnoluhnhtrongnccthnh phn toTig t nh Rocephin hay khng?1/52Ph
lc 3p n vbiuimchob cuhi thng tin thucCuhi p n Biu im1.Liu khi u:
6,25 mg X2 ln/ ngy hoc12,5 mg X3ln/ ngy. 1Liu duy tr 25 -50 mg X2
ln/ ngy, khng nn qu 50 mg X3ln/ ngy. 1Nu vn khng p ng th cn phi hp
li tiu liu thp hoc thuc khc. 0,5Trng hp khng p ng vi liu thp c th
tng liu ln150 mg X3ln/ ngy. 0,52. Liu khi u l 2,5 -5 mg mt ngy.
Hoc1,25 mg vi bnh nhn c nguy c h ng huyt cao.
33.Khngcthngtincnchnhliu.Phenytoinlthucchuyn hachyuquagan,thitrch
yuqua mt.34.Liu 90 mg/kgamoxicillin and 6,4 mg/kg clavulanate mt
ngy 2Chia 2 ln. 1Hoc liu 40 -45mg/ kg/ ngy, nhng cc ti liu khuyn co
liu cao hon(3)5.Liu thng dng 2,5 mg ung1-2 ln mt ngy. 2Liu dng nn
tr liu thp nht c hiu qu, thi gian dng ngn nht c th, khng qu 4 tun v
phi gim liu t t.16. Liu ti a vi propoxyphen hydroclorid l 390
mg/ngy; propoxyphen napsylat l 600 mg/ngy. 37.Liu khi u:simvastatin
20-40mg/ngy, atorvastatin10-20mg1ln/ngy 1,5Liu duy tr:simvastatin
50-80mg/ngy, atorvastatin10-80mg1 ln/ngy1,58. 3ngy 39.100 -200 mg
X2 ln/ ngy. 2Vi ngi cao tui nn bt u vi liu thp nht. Gim liu vi bnh
nhn suy gan. 110.Tnrng hp ny nn dng s dng wafarin cho n khi INR di
5 2Nu bnh nhn c nguy c chy mu cao th nn dng phytomenadione1 n 2,5
mg ng ung hoc n 5mg.111.Cc tong tc cn ch
:+Ccthuclmtngnngkalitronghuyttng;thucliniugikali,indomethacin,heparin,
cyclosporin...+ Lithium.312.C tong tc gia warfarin v garlic.2Hu
qu:lm tng tc dng chng ng ca warfarin 113.C tng tc gia warfarin v
vitamin E 2Hu qu:lm tng tc dng chng ng ca warfarin. 114.C tng tc
gia nifedipin v itraconazol. 1Hu qu:lm tng nng nifedipin ong mu,
tng tc dng h p. 1Tong tc ny khng c ngha n lm sng. 115.Hn dch pha
ung 2Hm lng20 -40 mg/ml 116. Ketoprofen c dng gel bi ngoi. 317.Cch
dng:dn vo vng da sch, thng l vng da ngc hoc da tay. 1Khong thi gian
s dng thuc cch12h. 218.C nhng him gp hn cc tc dng ph khc (trn tim,
trn ng tiu ha, h thn kinh, da, gan)2L tc dng ph quan trng ca cc
thuc chn knh canxi. 1Ph thuc vo nguy c huyt khi ca ca bnh
nhn.119.Thng thng, vi cc phu thut nh (nha khoa) th khng cn dng iu
tr vi wafarin nhng cn c cc bin php tt cm mu trong v sau phu
thut.1Tuy nhin nh rng khn l mt phu thut mt nhiu mu, v thng vi cc
phu thut loi ny cn dng thuc khong 5ngy trc phu thut,cn thng bosm vi
bcs iu tr v k hoch phu thut c hng dn chi tit.1Tcdng phca thuc:tng t
nh ccaminoglycosid khc,thucthhinc tnh nhiu nht trn tai v trn
thn.2Thng gp bnh nhn suy thn 0.520.Trng hp bnh nhn suy thn cn phi
hiu chnh liu- Cn theo nng thuc trong mu chnh liu cho ph hp, trnh vt
qu nng gy c.- Nu khng kim tra c nng thuc trong mu,c th da vo thanh
thi ca thuc gim liu hoc gin thi gian dng thuc-Nuctnhtrn thn
xyra(nguyccaoxy rasuythncpivibnhnhnctinssuytin mn):cn thm tch
mu.0.5Tng men gan xy ra mt s bnh nhndn n vim gan, vng da mt,c bit l
nhng bnh nhn dng hn mt thng. Mt s trng hp b suy gim chc nng gan sau
t vong.221. Trong trng hp m bnh nhn ang iu tr bng itraconazol nu
thy men gan tng ln nhanh chng, x
ltrongtrnghpnyldngdngthucngaylptc.Nnxemxtlichvnguyckhidng
itraconazol trong trng hp ny.1Nhp vin. 122.iu tr triu chng v ra d
dy. 1Nungcnng(>3mcg/ml):onngny2h/lntheodi,nuthytnglnthdng
desfeioxamine trung ha (to phc chelat).cn thm cc bin php kim sot cc
triu chng c tnh1(trn chuyn ha v trn h tim mch)23. 1-3 ngy sau khi
ngng thuc 324.Liu b sung hng ngy cho ngi ln t 40-80 mEq 1Liu phng h
kali mu trung bnh khong 20mEq kali /ngy. 1Liu cho ngi kali mu thp:
40-100 mEq kali/ngy, ty thuc vo tng bnh nhn. 125.Triu chng lm sng:
au c, yu c, nc tiu sm mu 1.5Xtnghim:nngenzymCk huyt
thanhtngcao(gp10lnsovibnhthng),nngcreatinin cng tng, v c globin
niu.1.526.Lm xt nghim chc nng phi (kh nng khuch tn ca phi). 1Lm xt
nghim v chc nng tuyn gip (Nng TSH, T3, T4). 1Lm xt nghim v chc nng
th gic biamiodaron c th gylng ng cc cht nh gic mc v gp cc vn v thn
kinh th gic.127.C. 1Mt s ch phm thuc nang c tinh phn l garlic;
Kyolic, Garlimega, A Vogel Capsules a l'ail,...
228.Hydrochlorothiazidkhng phillachn phhpiu trphchobnh
nhnsuytimsung huytc clerance < 30ml/pht.329. Bnh nhn sau nhi mu
c tim c th s dng warfarin sau 2-4 tun xy ra bin c.
330.C1Azithromycins dng ng ung iu tr vim phi mc ti cng ng t mc nh
ti trung bnh ngi ln v tr em > 6 thng tui khi liu php ng ung c ch
nh.Vi vim phi mc ti cng ng mc trung bnh ti nng khng nn s dng
azithromycin dng ung m c th thay th bng azithromycin dng tim tnh
mch.231.Fluoxetin c s dng iu tr chng ri lon tm thn tin kinh nguyt,
kim sot triu chng v c th cht v tinh thn.3Tnglipid much yu
tngtriglycerid mu typ3,4,5s dng kt hp vichn nhng bnh nhn tng
triglyceride mu trm trngc nguyc b vimtycpm khngpng vichn vcc bin
php khng dng thuc khc.132.Tng lipid mu hn hp typ 2b, tng glycerid v
cholesterol bnh tim mch m c HDL-C thp v tng LDL-C mc trung
bnh1.5Phng nga cc bin c tim mch:+ phng nga nguyn pht: cc bnh nhn
tng lipid mu typ Ilb cha c bng chng lm sng v cc bnh tim mch.+phng
nga th pht nhng bnh nhn c bng chng lm sng v0.533. Lamivudin c c ch
nh phng nhim HIV sau khi v tnh dm phi borm kim tim.
334.tobramycindexamethason335. Adalat XL plus, Procardia XL, v.v.v
336. 12,5mg 3Vin nn: hm lng Cefuroxim:125 mg, 250mg, 500mg 137. Bt
pha tim: hm lng Cefuroxim: 750mg,1,5g, 7,5g. 1Hn dch ung: hm lng
ceiroxim:125mg, 250mg 1Metformin c th bi tit vo sa m. 138. Nhng kt
qu nghin cu trn ngi cha y . 1S dng thuc phi cn nhc li ch nguy c.
139.Sinh kh dng ca verapamil gii phng chm tng t vi verapamil dng
gii phng trung bnh. 1Tuy nhin tc hp thu khc nhau. 1Verapamil dng
gii phng trung bnh: thi gian t nng nh trong mu ll-2h.Verapamil gii
phng chm:thi gian t nng ri khi ung cng thc n l 7,7 Ih, khi ung lc
il 5,2 Ih.140.Sau t 5 t72- 7 1'/2 2Tl/2 bin thin gia cc c th.
(Sau10-21ngy.) 141.14 ngy nu bo qun nhit 2-8C. 1,57 ngy nhit
phng.1,542.dung dch NaCl 0,9%2(nu c1dung dch)3(nu c >= 2 dung
dch)dung dch dextrose 5%.ngoi r a :aminoacid 4,25% dextrose 25% (
c=80mg), dextrose 4,3% trong NaCl 0.18% (C=160mg/1), dextrose10%
trong nc (C=60mg/21.5ml,120/23ml), Fructose 5% trong nc (C=120mg),
invert sugar 7,5% with electrolytes (C=^50mg), mannitol
20%(C=120mg), ringer's injection (C=120mg)43.Metfomiin khng nn dng
cho bnh nhn suy tim xung huyt (suy tim xung huyt khng n nh hoc cp)
v c th dn n nhim acid lactic.344. Khng nn dng sumatriptan (chng ch
nh) cho bnh nhn cao huyt p cha c kim sot. 345.Vitamin E liu cao c
hm lng t 400I tr ln.C ch phm liu cao lu hnh 1400UI,500I,
600UI,lOOOI. 246. Thi im dng:cng hoc trc ba n. Nguyn nhn:CaC3 c
chuyn thnh CaCla nh acid d dy. 347.Clopidogrellcht i khng receptor
ca ADP,gncchnlcv khngcnh tranh vov trgnci lc thp ca receptor ca ADP
trn b mt tiu cu.348.c ch tng hp protein vi khun 2Bng cch xm nhp qua
thnh t bo vi khun sau gn vo tiu n v ribosom 50S 149.Phn loi mc an
ton cho PNCT : D (FDA)Vic s dng phi cn nhc yu t nguy c v li ch.2C
bng chng v d tt. 150.Phn loi mc an ton cho PNCT : c (FDA)Cha c
nghin cu c i. Vic s dng ch khi li ch lfn hon nguy
c.351.Nntrnhsdng.Chdng khilichca ngimln hnnguyc vitr.Nusdngnnchotr
ngng
b.(TuynhinAAPchorngthucphhpviPNCCBdolngthuchpthubitrt,khngquanst c
nh hng.)352.C. 2Mt s ch phm Vit Nam: Aciphin, Alcizon, Beecefrex
1Phlc 4Danhsch cptong tcthucs dng trong nghin cuTong tc c YNLS Tung
tc khng c YNLS1. azithromycin - ciclosporin 1. azithromycin -
atorvastatin2. azithromycin - theophyUin 2. azithromycin -
lovastatin3. azithromycin - warfarin 3. azithromycin -
simvastatin4. clarithromycin - alprazolam 4. clarithromycin -
amprenavir5. clarithromycin - astemizol 5. clarithromycin -
disopyramid6. clarithromycin - atorvastatin 6. clarithromycin -
fluoxetin7. clarithromycin - carbamazepin 7. clarithromycin -
omeprazol8. clarithromycin - ciclosporin 8. clarithromycin -
sertralin9. clarithromycin - cisaprid 9. clarithromycin -
zidovudin10. clarithromycin - digoxin 10. clarithromycin -
diazepam11. clarithromycin - dihydroergotamin 11. clarithromycin -
cimetidin12. clarithromycin - ergotamin 12. erythromycin -
ampicillin13. clarithromycin - lovastatin 13. erythromycin - acid
valproic14. clarithromycin- methylprednisolon 14. erythromycin -
antacid15. clarithromycin - midazolam 15. erythromycin -
clozapin16. clarithromycin - pimozid 16. erythromycin -
colchicin17. clarithromycin - repaglinid 17. erythromycin -
diazepam18. clarithromycin - rifabutin 18. erythromycin -
disopramid19. clarithromycin - simvastatin 19. erythromycin -
divalproex sodium20. clarithromycin - tacrolimus 20. erythromycin -
fluoxetin21. clarithromycin - terfenadin 21. erythromycin -
nadolol22. clarithromycin - triazolam 22. erythromycin -
penicillin23. clarithromycin - warfarin 23. erythromycin -
sertralin24. erythromycin - alprazolam 24. omeprazol - aspirin25.
erj^hromycin - alfentanyl 25. omeprazol - ciclosporin26.
erythromycin - aminophyllin 26. omeprazol - clarithromycin27.
erythromycin - astemizol 27. omeprazol - diazepam28. erythromycin -
atorvastatin 28. omeprazol - digoxin29. erythromycin - bromocriptin
29. omeprazol -flurazepam30. erythromycin - buspiron 30. omeprazol
- indinavir31. erythromycin - carbamazepin 31. omeprazol -
methotrexat32. erythromycin - ciclosporin 32. omeprazol -
nifedipin33. erythromycin - cilostazol 33. omeprazol - phenytoin34.
erythromycin - cisaprid 34. omeprazol - sodium salicylat35.
erytliromycin - digoxin 35. omeprazol - tolbutamid36. erythromycin
- dihydroergotamin 36. omeprazol - triazolam37. erythromycin -
ergotamin 37. omeprazol - warfarin38. erythromycin - felodipin39.
erythromycin - lovastatin40.erythromycin -
methylprednisolon41.erythromycin - midazolam42.erythromycin -
quinidin43.erythromycin - simvastatin44.erythromycin -
tacrolimus45.erythromycin - terfenadin46.erythromycin -
theophyllin47.erythromycin - triazolam48.erythromycin -
vinblastin49.erythromycin - warfarin50.omeprazol -
cilostazol51.omeprazol - ketoconazol________Ph lc 5Phn loitng tc
theomcnghimtrng ca MIMS Online v DRUGDEXEvaluation(Micromedex)Mims
Online phn loi tng tc theo mc nghim trng thnh 5 mc :+Mc5-Nghim
trng:Tng tc e da n tnh mng bnh nhn hoc gy tc hi lu di.Cc thuc ny
khng c s dng phi hp, c th cn n can thip y khoa.+Mc 4 -Trung bnh:Tng
tc nyc th lm xu i tnh trng ca bnh
nhn.Bnhnhncnctheodikhnngxuthintngtc.Cthcncan thip y khoa hoc thay i
thuc.+Mc3-Nh:Biuhinlmsngca tng tchnch hocc thgy khchunhngkhngcn
phithayithuc.Bnhnhncncgimst kh nng xut hin tofng
tc.+Mc2-Thntrng:Tngtcc thxyrada theoc chtngtc khi phi hp. Ch khi c
hin tng tng hoc gim tc dng do phi hp.+Mc 1-Khng c YNLS:Tng tc c th
xy ra nhng hu qu khng c YNLS.+Mc0- Chacngb;Tngtccthxyradatrnlthuytv
dc ng hc dc lc hc.Cha c bo co no v tng
tc.Drugdexevaluaton(MM)phnloitngtctheonghimtrngthnh5 mc:+Chng ch
nh:cc thuc chng ch nh phi
hp.+Nghimtrng:tngtcedantnhmngbnhnhn,cncanthipy khoa gim thiu hoc
ngn nga tc dng c hi nguy him.+Trung bnh: tng tc lm xu i tnh trng ca
bnh nhn, cn thay thuc.+Nh: tng tc c tc dng trn lm sng hnch, biu hin
ca tng tc c th gm s tng ln v mc v tn xut xut hin phn ng khng mong
mun.+Cha r.
