cheap jerseys Wholesale Jerseys Wholesale Jerseys nfl jerseys china wholesale nfl jerseys cheap nhl jerseys wholesale nhl jerseys cheap nba jerseys cheap mlb jerseys wholesale mlb jerseys cheap nike jerseys cheap nike jerseys free shipping cheap authentic nfl nike jerseys nfl football jerseys china cheap authentic football jerseys replica football jerseys cheap football jerseys authentic cheap football jerseys paypal cheap nfl football jerseys wholesale football jerseys cheap china replica football jerseys china nfl jerseys supply cheap replica jerseys china replica football jerseys china cheap jerseys Wholesale Jerseys China wholesale authentic jerseys nfl jerseys from china cheap nfl jerseys china buy cheap nfl jerseys wholesale nfl jerseys china cheap nhl jerseys china wholesale nhl jerseys china cheap nba jerseys china wholesale nba jerseys china cheap mlb jerseys china wholesale mlb jerseys china nike jerseys china cheap nike jerseys with free shipping nfl nike jerseys wholesale cheap custom football jerseys replica nfl football jerseys cheap authentic football jerseys china football jerseys replica replica football jerseys cheap wholesale nfl jerseys supply replica nfl jerseys nike replica nfl jerseys cheap jerseys for sale Wholesale Jerseys From China wholesale sports jerseys nfl jerseys free shipping cheap nfl jerseys from china where to buy cheap nfl jerseys wholesale nfl jerseys from china cheap nhl jerseys from china wholesale nhl jerseys from china cheap mlb jerseys from china wholesale mlb jerseys from china nike jerseys free shipping cheap nike jerseys china discount nfl nike jerseys cheap custom football jerseys cheap football jerseys for sale wholesale football jerseys usa wholesale football jerseys china buy football jerseys from china football jerseys from china wholesale cheap jerseys supply cheap replica sports jerseys replica jerseys nfl wholesale cheap jerseys wholesale jerseys from china free shipping wholesale jerseys supply cheap nfl jerseys wholesale cheap nfl jerseys paypal wholesale nfl jerseys paypal cheap nhl jerseys wholesale nhl hockey jerseys wholesale cheap nba basketball jerseys wholesale basketball jerseys cheap mlb jerseys paypal wholesale mlb jerseys paypal wholesale nike jerseys paypal wholesale authentic nike jerseys wholesale nfl nike jerseys china custom college football jerseys where to buy football jerseys cheap youth replica football jerseys cheap football jerseys kids cheap football jerseys nike authentic football jerseys wholesale nike football jerseys wholesale cheap blank football jerseys cheap nfl jerseys supply replica jerseys china wholesale replica jerseys cheap replica nfl football jerseys cheap nfl jerseys free shipping where to get cheap nfl jerseys wholesale nhl jerseys free shipping cheap nba jerseys free shipping wholesale nba jerseys cheap cheap mlb jerseys free shippping wholesale mlb jerseys free shipping wholesale nike jerseys cheap nike jerseys wholesale nfl nike jerseys china custom youth football jerseys cheap wholesale football jerseys cheap football jerseys for women wholesale cheap football jerseys football jerseys cheap authentic nfl football jerseys china wholesale jerseys supply wholesale replica jerseys cheap replica throwback jerseys football replica jerseys cheap authentic jerseys Wholesale Nike NFL Jerseys nfl jerseys supply cheap nfl jerseys online cheap nfl nike jerseys wholesale nfl jerseys cheap cheap nhl jerseys online wholesale nhl jerseys paypal cheap stitched nba jerseys wholesale nba basketball jerseys wholesale mlb jerseys usa wholesale nike jerseys china cheap wholesale nfl nike jerseys wholesale nike football jerseys cheap throwback football jerseys wholesale kids football jerseys wholesale football jerseys suppliers authentic football jerseys for cheap wholesale ladies football jerseys cheap football jerseys with free shipping supply cheap jerseys reviews cheap youth replica jerseys nfl jerseys replica cheap nfl jerseys usa cheap nfl jerseys from china wholesale authentic nfl jerseys cheap nhl jerseys wholesale hockey jerseys cheap nba authentic jerseys authentic nba jerseys wholesale cheap mlb replica jerseys wholesale mlb baseball jerseys nike jerseys cheap jerseys china chinese nfl nike jerseys wholesale blank football jerseys cheap throwback football jerseys for sale cheap football jerseys stitched wholesale football jerseys youth wholesale nfl nike football jerseys womens football jerseys wholesale supply jerseys cheap kids replica jerseys replica sports jerseys wholesale cheap jerseys canada wholesale jerseys usa Wholesale Jerseys From China nfl jerseys china wholesale cheap nfl authentic jerseys cheap nfl jerseys wholesale wholesale nike nfl jerseys cheap nhl jerseys canada china wholesale nhl jerseys cheap retro nba jerseys buy cheap jerseys online nba cheap custom mlb jerseys wholesale baseball jerseys nike jerseys wholesale chinese wholesale nike jerseys cheap nfl nike jerseys china blank football jerseys wholesale wholesale nfl football jerseys wholesale nfl football jerseys from china wholesale football jerseys from china wholesale youth nfl football jerseys wholesale nike nfl football jerseys china football jerseys wholesale wholesale jerseys supply reviews wholesale jerseys replica wholesale nike jerseys paypal cheap nfl nike jerseys from china cheap youth practice football jerseys cheap wholesale jerseys discount nfl football jerseys wholesale nike elite football jerseys wholesale replica football jerseys cheap stitched football jerseys wholesale nfl jerseys supply review wholesale replica jerseys china cheap nfl replica jerseys replica nfl jerseys China Wholesale Jerseys wholesale authentic football jerseys cheap jerseys paypal cheap ncaa jerseys paypal cheap mlb jerseys paypal chinese wholesale jerseys nike football jerseys china cheap nike jerseys usa Wholesale Jerseys China nfl football jerseys discount cheap football jerseys online nfl jerseys cheap china replica nfl jerseys wholesale china nike jerseys cheap football jerseys cheap replica nfl jerseys nfl replica jerseys china wholesale jerseys usa cheap replica football jerseys replica nfl jerseys china Wholesale Jerseys From China football jerseys wholesale china youth football jerseys wholesale nfl jerseys china wholesale nike jerseys wholesale cheap china nfl nike jerseys cheap nfl authentic jerseys wholesale nhl hockey jerseys cheap nba jerseys for sale cheap nfl jerseys wholesale wholesale jerseys nhl cheap nba jerseys online wholesale nike nfl jerseys cheap wholesale nfl jerseys where to buy cheap nhl jerseys cheap nhl jerseys canada cheap stitched nfl jerseys cheap nike nfl jerseys china wholesale nhl jerseys buy wholesale jerseys nfl jerseys china cheap cheap retro nba jerseys cheap replica jerseys cheap wholesale jerseys from china buy cheap jerseys online nba cheap youth football jerseys cheap fake football jerseys cheap custom mlb jerseys nfl wholesale nike jerseys cheap custom football jerseys nike jerseys wholesale cheap nba jerseys wholesale cheap authentic nba jerseys cheap jerseys from china buy cheap jerseys from china cheap nike nfl jerseys cheap sports jerseys Wholesale Jerseys China buy wholesale jerseys wholesale authentic jerseys nfl jerseys from china cheap nfl jerseys china cheap nfl jerseys usa cheap nike nfl jerseys nfl jerseys from china nfl jerseys supply nfl jerseys cheap china authentic nfl jerseys wholesale custom nfl jerseys cheap customized nfl jerseys cheap china nfl jerseys cheap cheap official nfl jerseys super bowl jerseys nike super bowl jerseys buy super bowl jerseys wholesale super bowl XLIX jerseys super bowl 49 jerseys wholesale super bowl jerseys sale super bowl jerseys from china 2015 super bowl jerseys form china where to buy super bowl jerseys cheap nfl draft jerseys nfl super bowl jerseys nike super bowl jerseys super bowl 49 jerseys cheap super bowl jersey super bowl 49 jerseys wholesale nfl super bowl XLIX jerseys super bowl 49 jerseys patch 2015 super bowl jerseys form china nike nfl draft jerseys wholesale blank jerseys cheap blank football jerseys wholesale wholesale youth football practice jerseys cheap jerseys authentic reviews supply cheap jerseys reviews cheap stitched jerseys for kids wholesale replica jerseys china wholesale jerseys for women cheap jerseys online free shipping buy wholesale jerseys china nike jerseys cheap cheap sports jerseys and hats wholesale jerseys and hats cheap kids jerseys china cheap sports jerseys china wholesale jerseys china nike wholesale cheap jerseys usa cheap jerseys from china kids cheap jerseys wholesale usa cheap wholesale jerseys authentic super bowl jerseys nike super bowl jerseys buy super bowl jerseys cheap super bowl jerseys super bowl jerseys wholesale super bowl jerseys china cheap nfl super bowl jerseys fake super bowl jerseys where to buy super bowl jerseys cheap nfl draft jerseys cheap nfl jerseys cheap mlb jerseys cheap nfl jerseys paypal wholesale nfl jerseys cheap wholesale nfl jerseys cheap nhl jerseys online cheap hockey jerseys wholesale hockey jerseys cheap stitched nba jerseys cheap nba jerseys wholesale nba jerseys cheap mlb jerseys cheap nike jerseys nfl jerseys from china cheap nfl jerseys supply wholesale nike jerseys nfl jerseys china wholesale wholesale nfl jerseys cheap nhl jerseys cheap nhl jerseys cheap nba jerseys cheap nba jerseys cheap mlb jerseys replica sports jerseys cheap jerseys buy cheap jerseys china cheap jerseys cheap jerseys paypal Wholesale Jerseys wholesale jerseys usa wholesale sports jersey nfl jerseys china cheap nfl jerseys free shipping cheap nfl jerseys buy cheap nfl jerseys wholesale nfl jerseys wholesale authentic nfl jerseys cheap nhl jerseys cheap mlb jerseys wholesale cheap nfl jerseys cheap jerseys from china buy cheap jerseys china cheap jerseys cheap jerseys paypal Wholesale Jerseys wholesale jerseys usa wholesale nba jerseys from china cheap nhl jerseys canada football jerseys for cheap nike super bowl jerseys nhl jerseys china fake oakleys Balenciaga arena high louboutin replica chinese nhl jerseys fake oakley sunglasses Balenciaga black replica louboutin shoes wholesale nhl jerseys fake oakleys White balenciaga shoes replica louboutin wedges cheap nhl jerseys fake oakleys Balenciaga arena suede replica louboutin boots cheap nfl jerseys Balenciaga monochromes cheap red bottom shoes sale cheap super bowl jerseys replica oakley sunglasses balenciaga arena shoe in white replica louboutin shoes wholesale nba jerseys replica louboutin boots fake oakleys Christian louboutin sale nfl jerseys from china cheap louboutin heels fake oakleys Christian louboutin red bottoms wholesale jerseys china nike replica christian louboutin boots fake oakleys Shoes free shipping fake oakley sunglasses Balenciaga mens shoes cheap louboutin pumps cheap nfl nike jerseys fake oakley sunglasses Balenciaga arena sneakers replica louboutin heels cheap nba jerseys china fake oakley sunglasses Red balenciaga sneakers louboutin replica shoes wholesale nba jerseys from china fake oakley sunglasses Balenciaga arena lambskin low Sneakers louboutin replica pumps super bowl jersey shop fake oakley sunglasses stitched jerseys from china cheap red bottom shoes sale cheap oakley sunglasses Louboutin store cheap sports jerseys usa cheap red bottom shoes cheap oakley sunglasses Louboutin shop online cheap stitched nfl jerseys cheap louboutin boots fake oakley sunglasses Mens christian louboutin cheap custom nfl jerseys cheap replica louboutin shoes fake oakley sunglasses Cheap louboutins wholesale pro jerseys replica louboutin heels fake oakley sunglasses Louboutin boutique wholesale nfl jerseys nfl jerseys supply cheap louboutin outlet fake oakleys Christian louboutin mens shoes cheap nfl super bowl jerseys cheap louboutin heels cheap oakley sunglasses Discount louboutin shoes cheap wholesale jerseys authentic cheap louboutin shoes online discount oakley sunglasses giuseppe zanotti for men cheap jerseys from china authentic buy cheap red bottom shoes cheap oakley sunglasses men giuseppe zanotti shoes authentic nfl jerseys wholesale louboutin replica pumps fake oakleys sneakers giuseppe zanotti china nfl jerseys cheap cheap louboutin wedges fake oakleys men giuseppe sneakers cheap official nfl jerseys red bottom shoes for cheap cheap oakleys giuseppe zanotti for men replica oakley sunglasses cheap nike jerseys replica louboutin heels giuseppe zanotti shoe nhl jerseys china cheap louboutin pumps oakley sunglasses discount giuseppe zanotti high tops nfl jerseys from china cheap red bottom shoes sale oakley sunglasses discount shop designer shoes online chinese nhl jerseys cheap louboutin shoes online cheap oakleys giuseppe shoes men wholesale nhl jerseys china cheap louboutin outlet white maison martin margiela margiela high tops wholesale nike jerseys buy cheap nhl jerseys martin margiela sneaker super bowl jerseys china margiela e boutique cheap nfl jerseys louis vuitton mens sneakers cheap mlb jerseys Louis Vuitton trainers cheap jerseys gucci shoes Wholesale Jerseys gucci leather shoes cheap nhl jerseys wholesale soccer jerseys nfl jerseys supply cheap christian louboutin high heels men giuseppe zanotti
QUẢNG CÁO
 
Truy cập
Đang online: 3
Tổng số: 387,840
CHI TIẾT
Giám sát tích cực phản ứng có hại của thuốc thông qua bộ công cụ phát hiện tín hiệu tại một đơn vị lâm sàng chuyên khoa tim mạch tuyến Trung ương
Detecting adverse drug reactions using a trigger tool in a cardiology department of a central hospital
Trần Ngân Hà, Cao Thị Thu Huyền, Bùi Thị Ngọc Thực, Nguyễn Thu Minh, Phạm Thị Tuyết Nga, Cẩn Tuyết Nga, Vũ Đình Hoà, Trần Nhân Thắng, Nguyễn Hoàng Anh
Số: 521 - Tháng 9/2019 - Trang 3-11

Phản ứng có hại của thuốc (ADR) là một trong những nguyên nhân làm tăng tỷ lệ mắc bệnh, tỷ lệ tử vong, kéo dài thời gian nằm viện, giảm tuân thủ điều trị và tăng chi phí điều trị cho bệnh nhân. Theo các nghiên cứu trên bệnh nhân nội trú, tỷ lệ ADR có thể phòng tránh được (pADR) dao động từ 0,3 - 30,7%, trong đó, thuốc tim mạch là nguyên nhân phổ biến nhất dẫn tới pADR. Đáng chú ý, chi phí tổn thất do ADR có thể phòng tránh được cao hơn so với những ADR không phòng tránh được. Vì vậy, nếu giảm thiểu được tỷ lệ ADR có thể phòng tránh được sẽ giúp giảm thiểu đáng kể hậu quả và gánh nặng của ADR. Viện Tim mạch Việt Nam, Bệnh viện Bạch Mai là viện chuyên khoa đầu ngành Tim mạch trong cả nước, với số lượng bệnh nhân vào nằm điều trị nội trú hàng năm đều tăng lên không ngừng (hơn 59.000 bệnh nhân trong năm 2017). Hoạt động giám sát phản ứng có hại của thuốc tại Viện Tim mạch được thực hiện theo quy trình chung của bệnh viện thông qua báo cáo tự nguyện theo quy định của Bộ Y tế nên số lượng báo cáo ADR còn hạn chế (16 báo cáo trong năm 2017). Con số này chưa thực sự phản ánh thực tế ADR bệnh nhân gặp phải trong điều trị tại Viện Tim mạch. Bên cạnh đó, các ADR ghi nhận được chủ yếu là phản ứng typ B như phản ứng trên da và mô dưới da (ngứa, ban đỏ, mẩn ngứa,...), rối loạn toàn thân (sốc phản vệ), trong khi các báo cáo ADR typ A là những báo cáo có thể phòng tránh được và thường liên quan đến các thuốc tim mạch được ghi nhận ở mức độ rất hạn chế. Với mong muốn thúc đẩy hoạt động phát hiện và báo cáo các phản phản ứng có hại của thuốc trên bệnh nhân tim mạch, đặc biệt là các phản ứng có khả năng phòng tránh được, chúng tôi thực hiện nghiên cứu này với mục tiêu xây dựng và đánh giá khả năng phát hiện ADR của bộ công cụ (trigger tool) tại một đơn vị lâm sàng chuyên khoa tim mạch thuộc Viện Tim mạch Việt Nam, Bệnh viện Bạch Mai thông qua hoạt động của dược sĩ tại khoa.

Đối tượng nghiên cứu

Triển khai áp dụng bộ công cụ phát hiện ADE đã xây dựng được thực hiện trên tất cả bệnh nhân nhập Khoa X từ tháng 11/2018 đến tháng 01/2019 với tiêu chuẩn lựa chọn là bệnh nhân nằm điều trị tại khoa ít nhất 24 giờ, trên 18 tuổi và tiêu chuẩn loại trừ là bệnh nhân tâm thần hay đang phục hồi chức năng. Bệnh nhân được theo dõi từ khi nhập Khoa X đến khi chuyển khoa hoặc xuất viện.

Phương pháp nghiên cứu

- Xây dựng bộ công cụ phát hiện biến cố bất lợi liên quan đến thuốc.

- Triển khai áp dụng bộ công cụ phát hiện biến cố bất lợi liên quan đến thuốc.

Kết luận

Nghiên cứu đã xây dựng được bộ công cụ phát hiện ADR trên bệnh nhân tim mạch và bước đầu đã triển khai áp dụng bộ công cụ này tại một đơn vị lâm sàng chuyên khoa tim mạch, ghi nhận một tỷ lệ đáng kể ADR và pADR cao hơn rõ rệt so với số báo cáo ADR từ hệ thống báo cáo tự nguyện. Kết quả này là cơ sở để nhân rộng phương pháp phát hiện ADR thông qua bộ công cụ phát hiện tín hiệu tại Viện Tim mạch Việt Nam cũng như trong Bệnh viện Bạch Mai, thúc đẩy hoạt động đảm bảo an toàn trong sử dụng thuốc cho người bệnh.

A trigger tool for detection of adverse drug reactions (ADRs) was developed, which was practically tested at X Department of Vietnam National Heart Institute. Based on systematically reviewing researches on “trigger tool” and drug use evaluation, a toolset of 30 triggers was constructed for ADRs  detection including 8 medication, 12 lab test, 9 general care and another one. The developed tool was used to prospectively monitor and identify suspected ADRs in patients admitted to the department in a period of 2 consecutive months. The study involved 245 hospital admissions with 237 patients at the median age of 62.5 (± 15.3), of which 132 were male (55.7%). In total, 194 triggers were detected in 103 patients, with a mean of 0.8 (194/237) triggers per patient (ranging 0 to 5 triggers). The rate of patients with ADRs was 30.2 per 100 admissions, and 25.3% of patients experienced at least 1 ADR. The most observed ADRs were hemorrhage (36.7%), dry cough (18.3%), hyperkalemia (11.7%), hypokalemia (11.7%) and diarrhea (11.7%). The most common medications were antithrombotics (40.0%), angiotensin-converting enzyme inhibitors (30.0%) and quinolone antibacterials (11.7%). Preventable adverse drug reaction (pADR) incidence was 7.2 per 100 patients. The main causes of pADR were inappropriate dosage (47.1%) and drug-drug interactions (41.2%). In conclusion, the proposed trigger tool proved helpful in identification of ADRs in cardiovascular patients. Also, these findings might motivate expansion of this activity in Vietnam National Heart Institute and other clinical departments of Bach Mai hospital as well, to ensure and promote drug safety.

Quay trở lại

Bản quyền thuộc về Tạp chí Dược học – Bộ Y tế

Địa chỉ: 138 A Giảng Võ - Quận Ba Đình - Thành phố Hà Nội

Điện thoại: 04.37367717 – 04.37368367 - E-mail: tapchiduocbyt@gmail.com