Chẩn đoán hình ảnh trong chẩn đoán chết não

cua phdp ludt giam xudng rit nhilu sau can thipp,

CSHQ dgt dupe tir 22,6% di n 95,4%, su khde biet gitra

trudc can thipp vd sau can thipp di u cd y nghTa thdng

ke vdi p<0,01.

Tren 90% cde y kiln di u cho ring hoat dpng ciia

Tieu ban quan ly HNYTN Id dupc vd tdt. Cdc giai phdp

quan ly HNYTN dupc dp dyng tai Da Ning cd th i trien

khai tai cac tinh, thdnh phd khde trong toan qudc d l

ndng eao hipu qua quan ly HNYTN.

TAI LIEU THAM KHAO

1 Le Van Bao (2002), Nghien cwu hoat ddng hinh nghe

y ttr nhan d Ha Ngi, de xuat mo hinh quan ly hanh nghe y tw

nhan a tuyen xa, Luan dn Tien sy y hoc, Hoc vien Quan y.

2 Nguyin Hod Binh (2001), Nghien ciru chat Iwgng

khim, chira bpnh ciia y te tuyen xa va xiy dyng mo hinh

dich VIJ chSm sdc sire kho§ tai nha & ngoai thanh Ha Ngi

(1994-2000), Luan an Tien sy y hoc, Hoc vipn Quan y, tr: 6-

20

3. Bo Chinh trj (2005), Nghi quyet so 46-NQ/rW ngay

23/2/2005 ciia BQ Chinh tn ve cong tic bao vp, chSm soc

va nang cao sire kho§ nhan dan trong tinh hinh m&i.

4 Bp Y te (2001j, Bio cio 7 nam thyc hi$n phip Ipnh

tianh nghe y dwgc tw nhan.

5. B$ Y t l (2001), Bio cio 10 nim cong tic thanh tra y

te (1991-2001), Nhd xuat ban Y hpc Hd Noi.

6. Bp Y te (2009), Bio cio chung Tong quan nganh Y ti

Vipt Nam 2008: Tii chinh Y te & Vipt Nam.

7. BO Y t l (2009), Bio cio bpnh vi$n tw nhin nim 2009.

Cyc Quan ly khdm chCra, benh.

8. Bo Y te (2007), Thong tw so 07/2007frT-BYT ngay

25/7/2007 cua Bo Y te hwong din hanh nghe y, y hpc c6

truyen va trang thiet bi y te tw nhan.

9. Bo Y te, Tong cue Thong ke (2003), Bio cio ket qua

dieu tra y te quoc gia 2001-2002.

10. BoY te (2003), Xay dwng y te Viet Nam cong bing

va phit then.

11. Oao Van Dung (2005), Dinh gii thwc trpng hoat

dong cua cac ca so hanh nghe y tw nhin va de xuat giai

phap quan ly, De tai NCKH c4p Bo, Tong hoi Y duoc hoc

Viet Nam. tr: 9 - 34.

12. So Y te thanh pho Od Ning (2009), Danh sich cac

ca sa hanh nghe y tw nhan tren dia bin thinh pho.

13. Thu tudng Chinh phii (2005), Chuong trinh hanh

dgng ciia Chinh phu, thwc hien Nghi quyet so 46-NQ/TW

ngiy 23/02/2005 cua Bg Chinh tn ve cong tic bao ve, cham

soc va nang cao sire khoe nhin din trong Vmh hinh moi

(ban hanh kem theo Quyet djnh so 243/2005/QO-TTg ngay

05/10/2005 cua Thu tudng Chinh phu).

14. Uy ban thudng vu Quoc hoi nude Cong hoa xa hoi

chu nghTa Viet Nam (1993), Phip lenh hinh nghi y dtrgc tw

nhan, Ha Noi, thing 10/1993

15. Uy ban thudng vu Quoc hoi nude Cong hod xd h0i

chu nghTa Viet Nam (2003), Phip Ipnh hinh nghe y dtrgc tw

nhan. Hi Ndi, thing 10/2003.

16. Bennan, P. (1998), Rethingking health care

systems: Private health care provision in India. World

Development: 26 (8): 1463-1479.

CHAN DOAN HINH ANH TRONG CHAN DOAN CHET NAO

NGUYEN DUY HUE, LE THANH DUNG,

NGUYI N QUOC KINH, DLfDl/C THIEN

DAT VAN Dfe:

Chet ndo dupe Mollaret vd Goudon (Phdp) dua ra

dinh nghTa Id sy hon me qud mire (coma depasse,

1959). Dgi hpc Y khoa Harvard djnh nghTa Id khong dap

irng vd sy mit nhgn bilt, khdng cir dpng, khdng thd,

mat cdc phan xg thdn ndo va rd nguyen nhdn gdy me

(1968). Hpi nghj Medical Royal Collegues and Faculties

d Anh (1971) dua ra dinh nghTa chit nao Id mat hodn

todn, khong hdi phyc chirc ndng than nao. Chin doan

chet ndo Id giai dogn quan trpng dau tien trong qui trinh

lay tang tir ngudi chit nao, ehin doan chit ndo phai tdn

trpng cde dam bao yeu d u bdi lugt phdp vd phai dupe

quyet djnh cdng sdm cdng tdt d l trdnh nhirng dilu tri

khong d n thilt vd cho phep lay tgng d l d y ghep. Mgc

du d mpt sd qudc gia ehi d n cdc di u hipu Idm sdng Id

dii de chan dodn nhung d mpt sd qudc gia Igi yeu d u

phai cd them cdc thdm khdm khdc, qui djnh cung khdc

nhau d edc nude v l sd lupng ngudi kham, chuyen khoa

ciia bdc sy khdm, thdi gian quan sdt vd thdm dd cgn Idm

sang xdc djnh chit ndo.

Chan dodn lam sdng dya vdo edc dau hipu: hdn me

sdu (Glasgovi/=3 dilm, mat cde phan xg thdn ndo vd

ngirng thd).

Chan doan cgn Idm sang:

• Dipn ndo dd: hinh anh dudng dang dipn tren dipn

nao de d hai lan thdm khde nhau. Dipn ndo dd anh

hudng nhilu bdi cdc yl u td nhilu

• Chin dodn hinh anh: chyp dpng mgch nao 4 tryc,

ghi hinh mach nao bdng ddnh dau ddng vi phdng xg,

chyp d t Idp vi tinh, chyp cpng hudng tir, sieu dm

Doppler xuyen sp.

Chyp mgch ndo 4 tryc la tham khdm ed gid tri nhat

ddi vdi hinh anh chit nao, cd th i coi nhu Id tieu chuan

vdng"Gold standard"dl ddnh gid tinh trgng tudi mdu ndo

Nghien ciru qui trinh ky thugt vd kit qua chyp mgch

mdu nao 4 tryc danh gid sy ngirng tuan hodn nao Id mpt

trong phuong phdp quan trpng trong chan dodn chit

ndo

I. T6NG QUAN TAI LIEU

Chan dodn hinh anh chit ndo dupe dua ra khi dau

hipu lam sdng vd dipn nao dd cho thay bpnh nhdn chit

ndo, ed nhilu phuong phdp chan doan hinh anh dupe

sir dyng d l phdi hpp bd xung chan dodn, vipc lua chpn

phuong phdp chin dodn hinh anh tiiy thupc vdo sy

thudn tipn cua eo sd nghien ciru vd nhdm nghien ciru

1. Chup dpng mach nao.

Trong sd cac ky thudt xdc djnh ddng chay mdu ndo

thi chup mach nao 4 true la thdm kham c6 gia trj nhat ddi

vdi hinh anh chit ndo. Id tieu chuan vdng de ddnh gid

tinh trgng tudi mau nao. Chyp mgch mau ndo thudng

dupe tiln hdnh theo phuong phap Seldinger qua dpng

mgch diii, ed the chyp true tiep tir quai dpng mgch ehu

hay ludn ehpn Ipc vdo tirng nhdnh dpng mgch, tdng lieu

thudc d n quang bom Id 40 ml, tdc dp bom 15 ml/s.

Y HOC THlJC HANH (755) - SO 3/2011 73