Phân tích thực trạng tuân thủ quy trình giám sát trị liệu áp dụng cho phác đồ methotrexat liều cao tại Bệnh viện K.

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Thông tin xuất bản: Tạp chí Khoa học và Công nghệ Việt Nam, 2020

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Mục tiêu của nghiên cứu này là phân tích mức độ tuân thủ TDM trong thực hành lâm sàng thường quy tại Bệnh viện K. Nghiên cứu được thực hiện từ tháng 7/2019 đến tháng 2/2020. Tổng cộng có 174 chu kỳ HDMTX, bao gồm các chu kỳ điều trị u lympho không hodgkin (66,7%), ung thư xương (30,4%) và bệnh bạch cầu cấp dòng lympho (2,9%) đã được đưa vào nghiên cứu, trong đó 137 chu kỳ dùng phác đồ HDMTX truyền trong 4 h và 37 chu kỳ dùng phác đồ HDMTX truyền trong 24 h. Kết quả cho thấy, không có chu kỳ nào tuân thủ đầy đủ các bước trong quy trình TDM. Phân tích sự tuân thủ trên từng khía cạnh của quy trình, tỷ lệ tuân thủ là: 47,1% cho đánh giá bệnh nhân trước truyền, 14,9% cho quy trình bù dịch và kiềm hóa nước tiểu, 58,6% cho định lượng MTX và 19,0% cho quy trình giải cứu bằng leucovorin. Từ thực trạng tuân thủ quy trình TDM áp dụng cho HDMTX tại Bệnh viện K còn thấp, cần có thêm những nghiên cứu khác để tìm ra lý do, những khó khăn trong việc tuân thủ quy trình hoặc các biến cố bất lợi xảy ra trên bệnh nhân khi không tuân thủ quy trình TDM để có thể cải thiện chất lượng sử dụng thuốc HDMTX tại Bệnh viện., Tóm tắt tiếng anh, Methotrexate is an important anti-cancer drug, which is listed in the World Health Organization's essential drugs. The therapies using high dose methotrexate (HDMTX) have been commonly used at the National Cancer Hospital (K Hospital) in Vietnam. In order to ensure the effectiveness and safety of this important drug, a therapeutic drug monitoring (TDM) protocol for HDMTX has been formulated by the Pharmacy department at K Hospital and was then approved by the Hospital Director in November 2018. The objective of this study was to examine the level of compliance with this TDM protocol in clinical practice at the hospital. The study was conducted from July 2019 to February 2020. A total of 174 cycles of HDMTX, including the ones of the treatment for non-hodgkin lymphoma (66.7%), osteosarcoma (30.4%), and acute lymphoblastic leukemia (2.9%), were included in the study. The administrations of 137 cycles were 4-hour transfusion and the remaining cycles' were 24-hour transfusion. The results showed that there was no cycle fully complied with the protocol. When considering steps in the protocol individually, the compliance percentages were 47.1% for pre-transfusion evaluation, 14.9% for the rehydration and urine alkalization procedure, 58.6% for methotrexate quantification, and 19.0% for rescue procedure with leucovorin. The research results indicated that the compliance proportions with the TDM protocol at K Hospital were low. More studies should be conducted to find out the reasons and difficulties in the adherence to the protocol, or the consequences on patients' outcomes of the non-compliance to protocol practice so that its adherence can be improved.

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