Y HOC VIET NAM THANG 3 - SO 2 0 0 1 4

V. KET LUAN
Qua phau thuat cho 22 trffdng hPp ^ n thu'dng
hpi chiitig De Quarvain, chiing tdi thay rang phau
thuat dem lai ket qua tdt, khdng cd bien chirtig Idn
tuy nhien a n chi djnh phau thuat diing.
T A I UEU T H A M KHAO
1. Ilyas AM, Ast M, Schaffer AA, Thoder J
f2007), De quervain tenosynovitis of the wrist. J
Am Acad Orthop Surq. 2007 Dec;15(12):757-64.
2. Moore JS (1997), De Quervain's tenosynovitis.
Stenosinq tenosynovitis of the first dorsal
compartment. J Occup Environ Med. 1997
Oct;39(10):990-1002
3. V^itt J, Pess G, Gelberman RH (1991),
Treatment of de Quervain tenosynovitis. A

prospective study of the results of injection of

steroids and immobilization in a splint. J Bone
Joint Surg Am. 1991;73:219-222.
Harvey FJ, Harvey PM, Horsley MW (1990),
De Quervain's disease: surgical or nonsurgical
treatment. 3 Hand Surg [Am]. 1990;15:83-87.
McMahon M, Craig SM, Posner MA (1991),
Tendon subluxation after de Quervain's release:
treatment by brachioradialis tendon flap. J Hand
Surg [Am]. 1991;16:30-32.
Leslie BM, Ericson WB Jr, Morehead JR
(1990), Incidence of a septum within the first
dorsal compartment of the wrist. J Hand Surg
rAml- 1990;15:88-91.
Zarin M, Ahmad I (2003), Surqical treatment of
de Quervain's disease. J Coll Physicians Surg
Pak. 2003 Mar;13(3):157-8.

DANH GIA HIEU QUA MOT SO BIEN PHAP CAN THIEP

NHAM N A N G CAO SU* HAI LONG COA NGU'O'I BENH
DOI V a i BENH V I I N CAP CU'U TRU'NG VUaNG
Le Thanh Chien*, Nguyen Van Hung**, Pham Van Thao**
T 6 M TAT
D$t van de: Oe danh gia ve hoat dpng kham,
chffa b?nh, Bp Y te d3 ban hanh bp tieu chi danh gia
sff hat long cua ngudi benh. Ket qua nghien ciru si/ hai
Idng cua ngu'di b?nh ddi vdi benli vi?n Cap cffu TruTig
VUOng (BVCCTV) nSm 2012, chiing toi da thifc hien
mpt sd bl^n phap can thi^p nhcim nang cao sff hai long
ciia ngudi b^nh. Myc tieu: Danh gia hi$u qua mot so
bl?n ph^p can thl?p nhSm nang cao su" h^i long ngffdi
b?nh doi vdl BVCCTV. Phu'dng phdp: Nghien ciru mo
t^ c3t ngang, phong van tn/c bep bSng bang hoi tren
401 nguifii b^nh (tru'de can thiep) va 425 ngu'di benh
(sau can thl?p)tren doi tu'dng la ngu'di ldn den kham
vh dieu trj t^l BVCCTV, tff thang 9/2011 den thang
3/2012 (trudc can thiep) va tff thang 12/2012 den
^iing 3/2013 (sau hoat dgng can thl^p). Ket qua:
Ngu'di b?nh hai long, rat hai Idng ve cd sd vat chat cua
b?nh vi?n sau can thiep chiem 33,2% so vdi trUdc can
thl?p 1^ 20,8%. Ngudi benh hai long, rat hai long ve
thil tyc hcinh chinh sau can thl^p chiem ty le 12,2% so
tnin 6,0% trudc can thiep. Ngudi b^nh khdng hai long
li rSt khong hai long sau can thiep chiem ty le 1,9%
50 vdl trulSc trudc can thl$p la 10,4%, khac biet co y
ighTa vdl p<0,05. Ket lu|in: Ty le hai long, rat hai

B^h vi^ Cap aiu Tn/tig Vudng Tp.HCM

" Hgc vi$n Quan Y
Phin bl$n khoa hpc: PGS. TS Li Vin Bio

long cua ngu'di benh sau can thiep ciia cac nhom yeu
to: cd sd vat chat, thii tuc hanh chinh, cong tac dieu
du9ng cao tidn trudc can thiep c6 y nghia v6i p <0.05.
Td khda: si/ hai long ngudi benb, cham soc dieu
duQng
SUMMARY
EVALUATION OF THE PATIENT
SATISFAaiON IN TRUNG VUONG HOSPITAL
Background; To evaluate the operation and
treatment, the Ministry of Health issued ttie critena for
evaluating patient satisfaction. The research results of
the patient sabsfaction with Trung Vuong Emergency
hospital (TVEH) in 2012, we have made a number of
interventions to improve
patient satisfaction.
Objectives: To assess the effectiveness of a number
of interventions to improve patient satisfaction for
TVEH. Methods: cross-sectional descriptive study,
direct interviews with questionnaires on 401 patients
(pre-intervention) and 425 patients (post-intervention)
on adult subjects are examined and treated at TVEH,
from thang 9/2011 to March 3/2012 (pre-intervention)
and from January 12/2012 to March 3/2013 (after
intervention). Results: Pabents sabsfied, very
satisfied with the facilities of the hospital after
Intervention 33.2% compared with 20.8 % before the
intervention. Patients sabsfied, very sabsfied with the

Y HOC VIET NAM THANG 3 - SO 2/2014

administrative
procedures
after
intervention
percentage of 12.2% compared to 6.0% before the
intervention. Patients dissatisfied and very dissatistied
after intervention percentage 1.9% vs. 10.4% before
the intervention, significant differences with p < 0.05.
Conclusions: The proportion satisfied, very satisfied
of the patient after the intervention of factors: physical
facilities, administrative procedures, the higher nursing
intervention before significant with p < 0.05
Keywords: patent satisfaction, nursing care

I. OAT VAN BE
Hal long la cam nhan ciia ngu'di tieu diing khi
du'de dap utig mong muon [6], la phan iTng ciia
khach hang ve su" khac biet gliJa mong muon va
mirc do cam nhan- sau khi sir dung dich vu, la
ham ciia sy khac biet giUa ket qua nhan du'de va
ky vgng [5][4], De danh gia ve hoat dong kham,
chu'a benh va cham soc su^c khoe doi vdi ngu'di
benh, Bp Y te da du'a tieu chuan danh gia su' hai
long ciia ngu'di benh vao bo tieu chuan chat
lu'dng benh vien [1]. Theo ket qua nghien cii'u su'
hai Idng ciia ngu'di benh doi vdi benh vien Cap
ciTu Tru'ng Vu'dng nam 2012, chung toi da thi/c
hien mpt so bien phap dau tu" cd sd vat chat,
trang thiet bi y te; cai each thii tuc hanh chinh,
ky nang giao tiep uTig xif; huan luyen dao tao
nham nang cao chat lu'dng kham, chiJa benh tai
benh vien Cap ciTu Tru'ng Vu'dng.
Muc tieu nghien cu'u: Danh gia hieu qui mgt
sd blen phip can thiep nham nang cao sd hai
long ngddi benh ddi vdl benh vien Cap cdu
Trutig Vddng.

W. D6\ T U O N G VA PHUdNiG PHAP NGHIEN CUU

2.1. Ooi tifong, thdi gian nghien cihi
826 ngu'di b|nh (NB) tir 16 tuoi trd len (trong
do: 401 NB tru'de ean thiep va 425 NB sau can
thiep) den kham, dieu trj va ra vien tai benh vien
Cap cull Tru'ng Vu'dng trong tinh trang tinh tao,
du nang lu'c hanh vi tra Idi bp cau hoi.
Thdi gian nghien cuU tru'de ean thiep: tif
thang 9/2011 den thang 3/2012. Nghien culi sau
hoat ddng can thiep: tir thang 12/2012 den
thang 3/2013.
2.2. Phu'tfng phap
- Nghien ciru mo ta eat ngang thong qua phong
van tri/e tiep ngu'di benh bang bp eong cu du'de
thiet ke sin.
- Noi dung va cae ehi so nghien ciTu:
+ Thong tin chung cua doi tu'dng nghien
ciru: ten, tuoi, gidi ti'nh, trinh do hpc van, ndi ctf
trii, nghe nghiep.
+ SLT hai Idng ciia ngu'di benh ve kham cJiOa
benh tai eae benh vien, bao gom:
Ngu'di benh hai Idng ve cd sd vat chat; ve
thil tuc hanh chi'nh; ve bac sy dieu trj; ve chn
sdc dieu du'dng va ve ve sinh, an ninh, trat ti/
- Mirc dp hai Idng du'de di/a tren thang do Likert,
vdi 5 mu'c do:
Mu'c I: Rat khong hai Idng, rat khong tot, rat
khong dong y
Mirc I I : Khong hai long, khong tot, khflng
dong y
Mure I I I : Chap nhan du'de
Mire IV: Hai long, tot, khang trang, dong ^
Mirc V: Rat hai Idng, rat tot, rat dong y
- Xu' ly so lieu bang phan mem SPSS 16.0

II. KET QUA NGHIEN CCrU

3.1. S\i h^i long cua ngifdi benh ve cO sd vSt chat
Bang 1. Ty le hai Idng ciia ngu'di benh ve cd sd vat chat
Trtfdc can thiep
Sau can thiep
CSHQ
Mi^c do hai long
(n= 401)
{n= 425)
P
(%)
TL%
SL
TL%
SL
Rat khong hai long (1)
0,7
13
3
<0,05
3,2
Khong hai long (2)
4,9
39
21
<0,05
9,7
61,2
Chap nhan difdc (3)
260
266
66,3
>0,05
31,6
Hai long (4)
134
81
20,3
<0,05
1,6
Rat hai long (5)
7
0,5
^0,05
2
33,2
141
Cong (4) va (5)
20,8
<0,05
83
59,6
Ve ca si vat chat: ty ie hai long va rat hai long ia 33,2% (sau can thiep) so vdi 20,8% (trutfc cm
thiep), CSHQ=59,6%, p<0,05. Ty ie ithong hai long va rat idiong hai long la 5,6% (sau can thiep) X
vdi 12,9% (trwdc can thiep), si/ichic biet cdy nghia vdip< 0.05.
90

Y HOC VIET NAM THANG 3 - SO 2/2014

3.2. Su* hai long cua ngu'di benh ve thu tuc hanh chinh
Bing 2.J<i le hai Idng ciia ngu'di benh ve thii tuc hanh chi'nh
Sau can thiep
Tru'de can thiep
CSHQ
Mu'c do hai long
(n= 425)
tn= 401)
P
(O/o)
SL
TL%
SL
TL%
Rat khonq hai lonq (1)
1
I'O
0,2
<0,05
2,5
Khong hai long 11)
81
56
20,2
13,2
<0,05
Chap nhan difOc (3)
286
71,3
316
74,4
>0,05
Hai long (4)
24
6,0
52
12,2
<0,05
Rat hai long (5)
0
0,0
0
0,0
Cong (4) va (5)
24
6,0
52
103,3
12,2
<0,05
Ve thu tuc hanh chinh: ty li hai long va rat hai long la 12,2% (sau can thiep) so vdl 6,0% (trudc c
thiep), CSHQ=103,3%, p<0,05. Ty li khong hai long va rat khong hai long la 12,4% (sau can th
so vdi22,7% (trddccan thiep), sd khac biet co y nghia vdl p < 0.05.

3.3. Su* hai long cua ngu'di benh ve ve bac sy dieu trj
Bang3.T<i lehai long cua ngu'di benh ve bac sy dieu tri
Tru'de can thiep
Sau can thiep
CSHQ
Mu'c do hai long
{n= 401)
(n= 425)'
P
(O/o)
TL%
SL
SL
TL%
Rat khonq hai long (1)
0,0
0
0,0
0
Khong hai long (2)
>0,05
18
4,2
21
5,2
75,3
>0,05
77,8
320
Chap nhan du'oc (3)
312
87
Hai long (4)
68
17,0
20,5
>0,05
0,0
0,0
0
Rat hai long (5)
0
20,5
>0,05
20,6
87
68
17,0
Cpng (4) va (5)
Ve bac si dieu tn: ty ie hai idng va rat hai long ii 20,5% (sau can thiep) so vdi 17,0% (tri/dc can
thi$p), CSHQ=26,6%, p>0,05. Ty ie idiong hai idng va rat i<hdng hai idng ia 4,2% (sau can thiep
vdi5,2% (tnrdc can thiep), sUichac biet khong cd y nghia vdip > 0.05.

3,4. S\f hh\ Idng cua ngu'di b6nh v'e ve chSm soc dfeu du'dng
Bang 4. Ty le hai long cua ngu'di benh ve cham soc dieu duSnq
Sau can thiep
Tru'de can thiep
CSHQ
Mu'c do hai
(n= 425)
(n= 401)
P
(O/o)
Idng
SL
U%
TL%
SL
0
0,0
0,2
1
Rat khonq hai long (1)
8
<0,05
10,2
1,9
41
Khong hai lonq (2)
76,3
343
80,7
>0,05
306
Chap nhan di/oc (3)
71
16,7
<0,05
13,2
53
Hai lonq f4)
3
0,7
0,0
0
Rat hai lonq (5)
74
17,4
<0JP5
13,2
31,8
53
Cong (4) v^ (5)
Ve chSm sdc dieu duSng: ty ie hai idng va rat hai idng ia 17,4% (sau can thiep) so vdi 13,2% (trW
:an thiep), CSHQ=31,8%, p<0,05. Ty ie ichong hai idng va rat ichong hai idng ia 1,9% (sau can
w vdi 10,2% (tnrdc can thiep), sif ichac biet cd y nghia vdip < 0.05.
3.5. S\f hii Idng cua ngu'di b^nh ve v? sinh, an ninh, trat tU
BangS.Ti le hai lonq cua nqu'di benh ve ve sinh, an ninh, trat ttf
Sau can thiep
TrUdc can thiep
(n= 425)
(n= 401)
Md'c do hai Idng
SL
Uo/o
SL 1 TL/o
1,2
4
0,9
5
Rat khong hai I6nq(l)
70
17,5
64
15,1
Khong hai lonq (2)

P
>0,05
>0,05

CSHQ
(O/o)

Y HOC VIET NAM THANG 3 - SO 2/2014

>0,05
69,2
Chap nhan du'de (3)
265
66,1
294
>0,05
Hai lonq (4)
15,2
62
14,6
61
0,2
Rat hai lonq f5)
0
0,0
1
>0,05
14,8
(-2,6)
Cong (4) va (5)
61
15,2
63
Vive sinh, an ninh, trat tit: ty le hai long va rat hai long la 14,8% (sau can thiep) so vdl 15,2% (tru^
can thiep), CSHQ la - 2,6%, p>0,05. Ty le khong hai long va rat khong hai long la 16,0% (sau c
thiep) so vdl 18,7% (tru'de can thiep), sd khac biet khong co y nghTa vdi p > 0.05.
IV. BAN LUAN
4.1. Sir hai long cua ngu'di benh ve cd
sd vat chat
Trong nhu'ng nam qua, dac biet sau nghien
cull thue trang ve si/ hai long cua ngu'di benh ve
cd sd vat efiat, benh -vien da dau tu* trang thiet bj
y te ehan doan va dieu trj hieu qua. Benh vien
dau tu" sira chiJa, xay du'ng them nha ciTa, buong
benh, trang bj them he thong quat mat tai khu
VLfc dong ngu'di benh nhu": Khoa Kham benh,
tirng buong benh...He thong chup mach so hoa
xoa nen (DSA) da chi'nh thiTc phuc vu ngu'di benh
vao thang 10 nam 2011. Day la ky thuat cao dau
tien trien khai tai Benh vien Cap ciru Tru'ng
Vu'dng da mang lai hieu qua tiep can chan doan
nhanh, chinh xac, Y.\i tri kjp thdi va hieu qua. Uy
tin, thu'dng hieu ciia benh vien du'de nang len.
Ket qua khao sat sau cac giai phap doi mdi,
tang cu'dng cd sd vat chat, trang thiet bi cho
thay, sau can thiep ty le ngu'di benh hai Idng va
rat hai Idng vdi ed sd vat chat ciia benh vien
chiem 33,1% eao hdn so vdi tru'de ean thiep la
20.8%. Ty le ngu'di benh khong hai Idng va rat
khong hai Idng sau ean thiep chiem 5,6% so vdi
tru'de can thiep la 12,9%, sir khac biet cd y nghia
vdi p < 0.05.
Ly do khien ngu'di benh khong hai Idng ve cd
sd vat chat, cd the ke den: phdng benh eu,
xuong cap, he thong thong gid chu'a dap irng
nhat la vao nhutig gnay nang ndng. Tien ich
chu'a day dii de thda man nhu cau ngu'di benh.
Viec qua tal, ngu'di benh phai nam hanh lang,
nam ghep... da lam ngu'di benh khong thoai mai.
Cae ket qua tren cho thay, mac dii da dat
du'de nhu'ng tien bp nhat dinh, nhuTig viec hoan
thien cd sd vat chat, dau tu* trang thiet bi, tang
cu'dng he thong thdng gid, quat mat trong benh
vien van la mpt trong nhij'ng yeu eau cap thiet
cua ngu'di benh ma benh vien can dap u'ng.
4.2, Su* hai long ciia ngu'di benh ve thii
tuc hanh chinh
Muc tieu cua cai each cac thii tuc hanh chinh
can du^ tren nguyen ^e dat \d\ ich ciia ngu'di benh

len tren, lay ngu'di benh lam trung tam. Cac bier
phap cai each thii tuc hanh ehinh, giam thdi glar
chd ddi cho ngu'di benh trong benh vien bao gom:
C^i tien quy trinh kham benh theo nguyer
tac ddn gian, tiet kiem thdi gian va hieu qua, bao
gom bang dien tir lay so kham tu" dpng, bo tri
nhan vien hu'dng dan ngu'di benh tai cac buog
kham, sap xep phdng xet nghiem va nha thuoc
ngoai tru hdp ly. Giam thdi gian chd ciia ngiTcl)
benh tai tat ca cac khau dang ky, kham, lam xet
nghiem, ehan doan hinh anh, thanh toan vien
phi, nhan thuoe... bang giai phap u'ng dung cong
nghe thong tin, ngu'di benh dang ky kham benh
quan td'ng dai 1080, lay benh pham tai cho, tra
ket qua xet nghiem nhieu lan trong ngay, dieu
chuyen ngu'di benh ngu'di benh den tai kham
vao buoi chieu, xap xep lai bp phan thanh toan
vien phi, hoat dpng 24/24 gid...Sau cai tien quy
trinh kham, chiJa benh gian lu'dc 2 den 3 glai
doan khong can thiet. Ngu'di benh den kham
benh cdn qua tir 7 den 12 giai doan trong quy
trinh, tiiy thupc vao ngu'di benh cd thdc hien xet
nghiem, chan doan hinh anh, tham dd chirc nang
hay khong [3]. Thdi gian hoan tat quy trinh tif
khi dang ky kham benh den khi nhan thuoc trung
binh Igid 30 phiit den 3gid 30 phut [2].
Sau khi tien hanh dong bp eae glai phap tren,
ket qua khao sat sir hai long eiia ngu'di benh ve
thil tue hanh chi'nh tai benh vien cho thay: ngiTcli
benh hai Idng, rat hai Idng ve thit tuc hanh chinfi
sau can thiep chiem ty le 12,2% so vdi 6,0%
tru'de ean tliiep. Ngu'di benh khong hai Idng va
rat khong hai Idng sau ean thiep chiem t/ le
13,4% so vdi tru'de tru'de can thiep la 22,7%, si/
khac biet ed y nghTa vdi p<0,05.
Mac dil vay, van cdn tdi 13.4% ngu'di b?nli
khong hai Idng vdi thii tyc hanh chinh ciia benh
vien, Dieu nay cd the do cae yeu to khach quan
nhu' tinh trang ngu'di benh den kham qua dong,
chii yeu tap trung vao buoi sang da tao nen qua
tai cue bp khien hp phai chd lau. Mpt so nhiJng
thil tyc quy djnh tir phia cd quan bao hiem y te
nhu" ngu'di benh phai ky vao cac phieu mdi diCclc

Y HOC VIET NAM THANG 3 SO 2/2014

nhan thuoc hay trong khau thnah toan vien

phi...Mat khac, mpt so ngu'di benh phan anh "Hp
khong hai Idng ve viec ddng tien lae nhac tru'de
khi thi/c hien xet nghiem, chup phim, sieu am...
Oieu nay da khien ho phai chdi dpi mat kha
nhieu thdi gian.
4 . 3 . Sit hai long ve bac sy dieu trj
Dich vu ky thuat y te la djch vu dac biet, cd
ham lirpng chuyen mdn cao ngu'di benh khong cd
kha nang danh gia ky thuat ma chii yeu danh gia
chat lu'dng djch vu y te thdng qua each thirc
nhan vien y te tiep xuc vdi hp, hay ndi mpt each
khac la theo each hp du'pc kham, chij^ benh va
cham sdc chu" khdng phai du'a tren ket qua kham
ehu^ benh cuoi ciing. Dieu nay mot lan nu^
khang dinh vai trd rat quan trpng ciia bac sy dieu
trj doi vdi s y hai Idng cua ngu'di benh.
Thdi gian qua, benh vien da cd nhUng giai
phap dong bp nham nang cao trinh dp, nang ly'c,
y dii'c, thai dp, ky nang giao tiep cho nhan vien y
te ndi chung va bac sy dieu trj ndi rieng.
Ket qua, ngu'di benh hai long, rat hai Idng ve
bac sy sau ean thiep chiem ty le 20,5% so vdi
17,0% tru'de can thiep. Ngu'di benh khdng hai
Idng va rat khdng hai Idng sau can thiep chiem ty
1$ 4,2% so vdi tru'de tru'de can thiep la 5,2%. Sy
khac biet tru'de va sau can thiep khdng nhieu va
khong cd y nghia vdl p > 0.05. Mac dii cd giam
nhuTig ty le ngu'di benh khdng hai Idng vdi bac sy
dieu trj van chiem tdi 4.2%. Phan Idn ngu'di benh
du'de phdng van deu ed ehung mpt nhan xet la
thdi gian tiep xiic vdl bac sy dieu tri qua ft, bac
sy t u van ve benh tat khdng chl tiet khien ngu'di
bnh thieu thdntg tin ve tinh trang benh ciia ban
than, lam hp lo lang. Ngoai ra, ngu'di benh mong
muon du'de bac sy giai thi'ch ky ve each sir dung
c^c loai tliuoc va cdng dyng eiia ehiing, ciing vdi
che dp dinh duQng, van dpng va sinh hoat...Tim
hieu nguyen nhan, chung tdi nhan thay, ben
canh nhu'ng yeu to khach quan nhu* benh nhan
dong, tinh trang qua tai ngu'di benh, cdng viec
ciia ngu'di b^c sy trd nen qua tal... Vi vay, hp
khdng cd du thdi gian de cung cap day dii thdng
tin cho tat ca cac ngu'di benh. Hdn nuci, mot so
tru'dng hdp benh hiem ngheo, neu cung cap
thongtin dung vdl tinh trang benh, se khien
ngu'di benh lo au, suy sup bnh th3n gay bat ldi
cho ngu'di benh, Trong mot so tru'dng hdp,
nhOtig chan dpng ve tam ly cd the lam ngu'di
b^nh n$ng hdn.
4.4. 51/ h^l Idng cua ngu'di b$nh v i dieu
du'ong
Dieu du@ng la s y phdl hop glQ^ dieu trj,
ChSm sdc, nudi duQng, phuc hoi chu'c chifc n3ng

va giao due siTc khoe, ngu'di dieu duSng sir dyng

kien thtfc, ky nang de giup dd ngu'di benh va
cpng dong trong viec duy tri, nang cao sii'c khoe,
phdng ngtfa benh tat, giam dau ddn ve the chat,
tinh than va giiip hp biet each ttf eham sdc nhu
eau ed ban eiia ban than. Ngu'di dieu difdng, nU
hd sinh ludn la ngu'di gan gui vdi ngu'di benh. Cd
the ndi, d benh vien ngu'di dau tien ddn em be
chao ddi la ngu'di niJ' hd sinh, ngu'di nang giac,
eham sde, an iii ngu'di benh liic dau yeu hoac
nhij'ng gid phut cuoi ddi tai benh vien chinh la
ngu'di dieu du^ng, cdng viec eiia ngu'di dieu
duSng, hp sinh mang dam net edng viec ciia
ngu'di me. Sy tan tam, tan tuy ciia dieu du^ng,
hd sinh giau Idng nhan ai ludn mang lai niem tin,
nghj lye giup ngu'di benh vu'cft qua sy hanh ha
eiia benh tat va neu nhtf benh nang khdng ctfu
chtfa du'pc thi giup dd ngtfdi benh cd mdt cai
chet trong trang thai nhe nhang, thanh than.
Vdi vai trd quan trqng nhtf vay, dong thdi vdi
ket qua khao sat tru'de can thiep cho thay, mtfc
dp hai Idng eiia ngu'di benh ve dich vu cua benh
vien phy thude nhieu nhat vao edng tae cham sdc
dieu dtfdng. Chinh vi vay, trong hang loat cac
glai phap dtfpc benh vien de ra nham nang cao
chat lu'dng ddi ngu, nang cao nang Itfc va pham
chat dao dtfc cua dpi ngu can bd dieu du^ng
du'pc dat u'u tien hang dau.
Ket qua, ngu'di benh hai Idng, rat hai Idng ve
chSm sdc dieu dung sau can thiep chiem ty le
17,4% so vdi tru'de can thiep 13,2%. Ngu'di benh
khdng hai Idng va rat khdng hai Idng sau can
thiep ehiem ty le 1,9% so vdi trtfdc trtfdc can
thiep la 10,4%, khac biet cd y nghia vdi p <
0,05. Tuy ty le ngtfdi benh khdng hai Idng cdn
kha thap 1.9%; nhtfng ty le ngu'di benh danh gia
d mtfc chap nhan dtfpc cdn rat cao 80.7%. Oieu
nay van tiep tuc dat ra nhiing ddi hdi cac nha
quan ly ciia benh vien can tiep tuc trien khai va
nhan rpng cae bien phap da ap dyng trtfdc dd
nham nang eao hdn ntfa stf hai Idng ciia ngtfdi
benh vdi dpi ngQ dieu dtfdng.
4.5. s y hai long ve ve sinh, an ninh, trat t y
Ve sinh mdi trtfdng, canh quan trong khuong
vien benh vien va ve sinh buong benh, la nhtitig
yeu to gdp phan tao nen sy thoai mai va gan giu,
than thien vdi ngtfdi benh. Viec dam bao an ninh,
trat ttf trong benh vien se lam eho ngu'di benh an
tam trong qua trinh kham va dieu tri. Hp cam
thay an toan trong luc dau 6m. Y thtfc tam quan
trong dd, benh vien da ky hdp dong vdi cong ty
lam sach chuyen nghiep dang trach cong tac ve

93

Y HOC VIET NAM THANG 3 - SO 2/2014

sinh buong benh, ngoai canh va ve sinh cong
cpng. Phoi hpp vdi cac Itfc Itfdng chtfc nang dja
phu'dng trong cdng tae an ninh, trat t y . Mac dii
vay, ket qua khao sat sau ean thiep cho thay,
ngu'di benh hai Idng, rat hai Idng ve ve sinh, an
ninh, trat t i / sau can thiep chiem ty le 14,6% so
vdi tru'de can thiep 15,2%. Ngu'di benh khdng hai
Idng va rat khdng hai Idng sau can thiep chiem ty
le 16,0% so vdi tru'de tru'de can thiep la 17,5%,
su' khac biet khdng cd y nghTa vdi p>0,05.
Dieu nay mpt lan ntfa dat ra nhtfng thaeh
thtfc khdng nhd cho cac nha quan ly benh vien
de ra nhtfng chfnh saeh va giai phap hpp ly nham
nang eao kha nang an ninh trat t y trong benh
vien Cling nhu' tao mpt canh quan mdi tru'dng
saeh dep, trong dieu kien cd sd vat ehat khong
the md rpng nhu'ng sd Itfpng ngu'di benh va
ngtfdi nha lai khong ngirng tang len.
V . KET LUyC^N
Ty le hai Idng, rat hai Idng ciia ngtfdi benh
sau ean thiep eiia cae nhdm yeu to: eP sd vat
chat, thil tuc hanh chinh, eong tac dieu duSng
eao hpn tru'de ean thiep ed y nghTa vdi p <0.05;

Chi sd hieu qua (CSHQ) dat tu'dng img la 69,6%;

103,3% va 31,8%.
TAI LIEU THAIVI KHAO
1. Bg Y te (2013), "Quyet dinh so 4858/ QD-BYT
ngay 03/12/2013 cua Bg irudng Bg Y te ve viec
ban hanh thidlem Bg tieu chi danh gii chatluifiig
benh vien". 2013.
2, B6 Y te (2013), "Quyet dinh sd 1313 / QD-BYT
ngay 22/4/2013 cua Bg trWdng Bg Y te ve ban
hanh hudng dan quy trinh kham benh tai khoa
kham benh cua benh vien
J . Le Thanh Chien, Huynh Thj Thanh Trang
(2012), "Khao sat quy trinh kham chOa benh tai
khoa Kham benh Benh vien Op cut/ Tmhg
Vu'dng". Tap chf Y hoc thanh pho Ho Chf Minh,
2012, Volume 16(4); p. 16 - 25.
4. Do Thj Phu'dng Thao (2011), "Nghien cuU thu'c
trang nhan lu'c y te va hoat dgng kham chda binh
cua mgt so Benh vien huyen thugc thanh pholU
Noi nam 2008 - 2010". Khda luan tot nghiep dai
hoc, Dai hoc Y Ha Noi, 2011.
5. Kotler, Philip & Keller K.L. (2006), Marketing
Management, Prentice Hall, Inc.
6. Oliver, R.L (1997), Satisfection: A Behavioral
Perspective on the Consumer, McGrawHill, New York.

K H O A N G CACH GIU'A CAC C H A N R A N G 6" M O T S O VI TRI

HAY CAM VIT NEO CHAN CHINH NHA TREN PHIM

CAT LOP VI TiNH TRITONG QUYET HINH NON
Nguyin Thi Thu Phirffng *

T6M TAT
Muc tieu nghien CLAJ: Nghien ctfu dupc thUc hien
tren 60 phim Cone beam CT ciia nhii'ng benh nhan tai
khoa rang ham mat Benh vien Viet Nam - Cu Ba vdi
muc tieu xac dinh khoang each gitfa cac chan rang d
mpt so Vj tri hay cam vit neo chan chinh nha. PhUdng
phap nghien ciru: mo ta cat ngang. Tren phim Cone
beam CT, do khoang each giij^ cac chan rang cat tai
cac vj tri chop chan rSng va khoang 1/2 giu'a chan
rSng. Ket qua: khoang each giii^ cac chan rang tai vj

Vien DT RSng Ham Mit

Phin bipn khoa hpc: PGS. TS l^ai Dinh HUng

tri chdp chan rang d ham tren la: giii'a rang 1-2; 5,5
1,3mm, rang 5-6; 7,1 1,6mm.... Khoang each glD^
cac Chan rang tai V| trf 1/2 gitfa chan r3ng d ham tren
la: gitfa ring 1-2:2,7 0,9mm, ring 5-6: 3,9
0,8mm.,. Ket luan: Khong gian an toan cho viec c3nt
vft neo Chan la d gitfa hai rang ctfa giij^ ham tren,
rang ham nhd thtf hai va rang ham Idn thtf nhat ham
tren... Khong gian nguy hiem nhat cSm vit neo chSn ta
giuS cac chan rang nhdm rSng ctfa ham diTdi.
Tdkhoa: khoang each giu^ cac chan r5ng tal ^
tn chop, khoang each giij^ cac chan rSng tai vj tri 14
gitfa chan ring, vft neo ch3n.