Mô tả thực trạng cung cấp dịch vụ chăm sóc y tế chương trình dùng thuốc thay thế methadone can thiệp trong nhóm nghiện chích ma túy tại thành phố hà nội

Y HQC
VlgT
NAM
THANG 2 - SO 2/2014
MO TA THITC TRANG CUNG CAP
DICH
VU CHAM SOC Y TE
CHU'ONG TRINH
DONG
THUOC THAY THE METHADONE CAN THIEP
TRONG NHOM NGHIEN CHICH MA TUY TAI
THANH
PHO
HA
NOI
T6M
TAT
Nghien cuff mo ta cat ngang du'dc thyc hien tren
400 ngu'di nghien chich ma tuy (NCMT)
tai
02
cO
sd
dieu tn Methadone tai thanh pho Ha Ndi. Ket qua
nghien
ciru
cho thay: Lieu khdi Oau trung binh
ciia
cac
benh nhan tham gia nghien ciTu la 20 mg/ngay, lieu duy
tn trung binh la 105 mg/ngay,

T^n
suat sff dung Heroin
hSng
ngay
ciia
benh nhan giam
di
ro ret: trffdc dieu tri
1,24 in/ngay; giai doan dd lieu 1,07 fan/ngay sau 7
ngay, 0,33
lan/ngay
sau 30 ngay va sau 3 thang dieu trj
la 0,08 lan/ngay. Ty le benh nhan dffpc chuyen
giil
den
cac dich vu y te khac:
NhLr
dieu tri ARV la 44,5%, dieu
tri nhiem triing cd hpi 30,8%, cung cap
BKT
sach
2i,3%,
tu van xet nghiem ty nguyen 8,3%. Day chinh
la cac can thiep dff phong nham lam
giam
ty le lay
nhiem HIV trong nhom ngffdi nghien chfch ma tuy,
Tif khoa: HIV/AIDS, dieu
tri.
Methadone, nghien

chich
ma tuy, Ha Ngi.
SUMMARY
EVALUATION ON INJECTION DRUG USERS
(IDUS)
IN TWO METHADONE TREATMENT
CENTERS IN HANOI CITY
The cross-sectional descriptive study was done on
400 Injection drug users
(IDUs)
in 02 methadone
treatment centers in Hanoi city. The study results show
that: average initial dose for patients participating in
ttie study is 20mg/day; average maintenance dose is
105mg/day. The frequency of daily heroin use of
patients is considerably reduced: pretreatment
frequency is 1,24 times/day, dose-finding tnal
frequency after 7 days is 1,07 times/day, after 30
days:
0,33 times/day, after 3 months: 0,08 time/day.
The rate of patents being transferred to other health
services: antiretroviral therapy
is
44,5%; opportunistic
infection treatment
is
30,8%, clean needle provision is
21,3%;
voluntary counseling test is 8,3%, These are
preventive

intervenhon in
order to reduce HIV
prevalence among injection drug users.
I.
£)AT
VXN
0^
Tiem
chfch ma tuy da trd thanh mot van nan
toAn
cau, khdng loai trff mot qudc gia hay mdt
vung lanh tho nao, khdng chi anh hffdng tdi sffc
*
Tntng
tSm
phdng chdng HIV/AIDS
Ha
Ngi
'*B$
Yte
Phin
bl$n
khoa
hgc:JS.
NguySn
Quoc Tru'dng
Bui Thi
Nga=^,
Nguyen Anh Quang*,
Nguyen Thanh Long**

khoe cdng ddng ma cdn anh hu'dng tdi phat
trien kinh te va an ninh chfnh tri
ciia
mdi qudc
gia.
Tren the
gidi,
chffdng trinh dieu tri nghien
cae ehat dang thudc phien thay the bang
Methadone da dffdc trien khai cac qudc gia nhff:
LJc,
My, Ha Lan, An Op, Thai Lan, Trung Quoc.
Tai nhffng nffde nay chffdng trinh dffde trien khai
can thiep trong nhdm nghien chfch ma
tiiy
(NCMT) 6a gdp phan giam hanh vi tdi pham va
giam sff lay truyen HIV cdng dong.
Tai Viet Nam, lay truyen HIV
chii
yeu la con
dydng tiem chfch ma tuy vdi tren 50 % tong sd
ca nhiem tren toan qudc.
Viet
Nam mdi chi ap
dyng
mpt sd md hinh dff phdng lay nhiem cho
ngffdi NCMT nhff phan phat Bdm kim tiem (BKT)
sach,
phan phat Bao cao su (BCS), truyen thdng
thay ddi hanh vi, tff van thdng qua ban dong

dang,
hoat ddng
ciia
cae cau lac bo phdng chong
ma tuy. [1], [7]
Hien nay, tai Ha Ndi ed nhieu md hinh can
thiep dy phdng lay nhiem HIV eho nhdm NCMT
dang dffdc sff dung la chien
Iffdc
giam thieu tac
hai nhff chffdng trinh dieu tri nghien cac chat
dang thudc phien thay the bang Methadone. Tuy
nhien,
tai
Ha Ndi cung chffa cd danh gia de tong
ket va lya chpn dffdc md hinh ed hieu qua trong
phdng chdng lay truyen HIV, Do vay, nghien cffu
nay dffdc thyc hien nham muc tieu md ta ket
qua cua chu'dng trinh dieu tri nghien eae chat
dang thudc phien thay the bang Methadone can
thiep
dy
phdng lay nhiem HIV tren nhdm NCMT
[1]^ [3];
[4], [5], [6].
II.
OOI
TUpNG
VA PHU'aNG PHAP
NGHI!N

CUD
- Oja diem : 02 ed sd dieu tri methadone; huyen
Ty
Item,
quan Ha Ddng.
- Thdi gian nghien
cyu:
tff thang 1/ 2012 den
thang 12/2012
- Odi tffdng nghien
cffu;
La ngffdi nghien chfch
ma tuy sff dung cac loai ma
tiiy
bang BKT theo
tinh
maeh,
- Phffdng phap nghien
ciTu:
Ap dung thiet ke
nghien cuff md ta cat ngang. Cd mau dffdc
tinh
theo cdng thffc
tfnh:
Y HOC VIET NAM THANG 2 - SO 2/2014
Trong
do: n : la c5 mau
Z : la he sd tin cay, vdi ngffdng sac xuat
a =
5%,

tacd:
Z,,.^
,,=
1,96
P = 0,4 • Ty le nhiem HIV trong nhom
doi
t&dng
NCMT nam
2009 (theo dieu tra IBBS nam
2009 ciia TP
Ha Ndi).
d
=
0,023 sai sd cho phep
^
n = 370
ngffdi.
Dff phdng phieu khdng
hdp_le
10%, ffdc ti'nh bo
eude
va lam trdn ta cd cd mau nghien cffu la 400.
.KET
QUA NGHIEN CU'U
Bieu do 1. Ty le benh nhan trong giai doan dd lieu va dieu trj duy tri
87.5
100
50
0
12,5

Giai doan do lieu Giai doan
lieu
on dinh
Trong 400
binh
nhan
dang
tham gia
diiu tri
nghien cac
chit
dang
thudc phien bang
thudc Methadone
tai 2 quan/huyin Ha
Dong
va
T&Llim
vdi ty li
benh
nhan
trong
giai
doan
do lieu 12,5%
va giai doan
lieu
on dinh
87,5%.
Khoang

10% benh
nhan cho
rang thdi gian do lieu la
chu^
thich
hdp,
keo dai nen
benh nhan tlip
tuc
cd cac bleu hien cua hpi ch&ng
cat.
Tinh
trung binh ty le binh
nhan d&dc
xet
chgn
va tham gia
dieu tri
chiem
59%
tong so benh nhan
do
xa/ph&dng gu7 len Ban
xet
chpn.
Bieu do
ZT"/
le lieu dieu tri cho benh nhan Methadone
Kit
qua

nghiin
c&u cho
thiy
lieu
khdi
dau
trung^
binh cua cac
binh nhan
tham
gia
nghien c&u la 18,8
mg/ngay.
Lieu
duy tri trung
binh
la
43,5mg/ngay.
Bieu
do 3. Ty le BN sff dung Heroin khi dieu tri Methadone trong 3 thang qua
o.s
0.6
Tan
suit s&
dung Heroin
hang ngay
cua
binh
nhan
giam di ro ret: tr&dc dieu tri 1,24

lan/ngay;
gl3l
doan
do lieu
1,07
lan/ngay
sau 7
ngay,
0,33
lan/ngay sau
30 ngay
va
sau 3 thang la
0,08
lari/rtgay.^
Nh&
vay tinh
trang tiep tuc s&
dung
heroin trong qua trinh diiu tri
Methadone ctJa
nhom
NCMTchU
yiu
trong thdi
gian do lieu.
Y HOC VIET NAM THANG 2 - SO
2/2014
Bleu do 4. Ty le benh nhan bj tac dung phu khi dieu tn bang Methadone
80 71.3

60
40
20
0
1
'.
Tao bo
14.3
1 NgiJa
22.8
11 J
8.8
,
••• libriMid
Non Mat
ngii
Suy giam
tinh
due
1
1
21.5
'
_J
Khac
Trong cac tac dung
phu thi tao
bon
la trieu
chiing

phd biin nhit
d&dc BN bao cao
chiim
71,3%.
Ben
canh
do binh nhan co the gap mot sd tac dung khong mong mudn khac nh& suy giam tinh
due
22,8%,
non,
mitngtj va
ng&a t&8,8%
den
14,3%.
BieudoS.ly
le benh nhan tuan
thii
quy trinh dieu tri
Kit
qua cho
thiy
quan
diem cua binh
nhan
vi quy trinh xet
nghiem,
thdi
gian
nop ddn
va

quy trinh
don
dip binh
nhan
diu
chiem
ty le
i^
100%
dat tiiu chi hdp
ly.
Tuy nhien van con
2,4 % binh
nhan
cho
ring
quy trinh
xet
nghiem
la
ch&a thich
hdp,
keo
dai
Bieu do
6.
Ty le benh nhan hai Idng ve thai dp
ciia
nhan vien y te
Da sdb$nh nhan dude

dieu tn deu rit hai
Idng,
hai
long
vdi quy trinh don
tUp,
thai dp lam
viec cua
bac
sy,
thai
dp nhan
vtin t&
van
cOng
nh&
hai long
vdi thai dp
cua cac nhan vlin cong
tac tai cd sd
dieu
tri
fi chiem tyle dm&c cao
(t&95,0%
•
98,0%).
Tuy vay van co mot so nho
(chiim 2,5%) binh
nh$n cho kng
thdi gian tiep don

can
linh hoat
hdn,
do
ban
di
lam
nin
khong
din
udng thudc kip
gid
md
a/^
cua
cd sd
dieu
tri.
Y HOC VIET NAM THANG
2 -
SO 2/2014
IV. BAN LUAN
Chffdng trinh Methadone can thiep cho nhdm
benh nhan NCMT vdi giai doan lieu dn dinh
87,5%
va giai doan dd lieu 12,5%. Tai thdi diem
nghien cffu lieu khdi dau trung binh
ciia
cac benh
nhan tham gia nghien cffu la 20 mg/ngay, lieu

duy tri trung binh la 105 mg/ngay, Ben eanh viec
dieu tri thay the bang thudc Methadone thi mdt
trong sd nhffng yeu td lien quan tdi viec benh
nhan han ehe sff dung heroin khi da dat tdi lieu
duy tri phu thudc vao viec cung cap cac dich vu
ho trd. Lieu dieu tri Methadone cung cd vai trd
quan trpng trong viec dff phdng lay nhiem HIV,
ket qua nghien cffu cua cac tac gia nffdc ngoai
eho thay benh nhan dffdc dieu trj vdi lieu hdn
80mg/ngay cd ty le lay nhiem HIV thap hdn han
so vdi benh nhan dimg lieu thap hdn. Ve tae
dung phu
ciia
thudc Methadone cae benh nhan
ty bao eao cho thay tao bdn la trieu chyng phd
bien nhat chiem 71,3% sd benh nhan dieu tri.
Ben canh dd benh nhan cd the gap mdt sd tac
dung khdng mong mudn khac nhy suy giam tinh
due
22,8% va non, mat
ngii,
ngya
vdi ty le 8,8%
den 14,3%. Nghien cffu cua Bd Y te cijng
chi
ra
tren benh nhan dieu trj Methadone: tao bdn la
trieu
chiffig
phd bien nhat dffdc benh nhan bao

cao,
ehiem 60,8% sd benh nhan dieu trj va sd
benh nhan ed the gap mpt sd tac dung khdng
mong mudn khac nhff suy giam tinh due, non,
mat
ngii,
ngffa cac tac dung phu nay deu d
mffc 10 den
11%.
Da so benh nhan bao cao bleu
hien tao bdn da giam dan theo thdi gian dieu tri.
Dieu nay do benh nhan da thay ddi che dp an
udng,
the due va do benh nhan thfch nghi dan
vdi trang thai tao bdn sau khi dieu tri mpt thdi
gian dai [2].
Ket qua nghien cffu cho thay tan suat sff
dung heroin hang ngay
ciia
benh nhan giam di rd
ret: trydc dieu tn 1,24 lan/ngay; giai doan dd
lieu 1,07 lan/ngay sau 7 ngay, 0,33 lan/ngay sau
30 ngay va sau 3 thang
dieu
tri la 0,08 lan/ngay.
Nhy vay tinh trang tiep tuc
sy
dung heroin trong
qua trinh dieu trj Methadone cua nhdm ddi typng
nghien

cyu chii
yeu trong thdi gian dd
lieu.
Mdt
sd nghien cffu da cho thay dieu trj Metahdone
lam giam sff dung ma tuy bat hdp phap. Oe danh
gia chat Iffdng ve quy trinh ddn tiep benh nhan,
thai dp cua nhan vien y te trong nghien cffu
chimg tdi da sff dung bp cau hdi vdi cac tieu chf
hdp ly, khdng hdp ly,qua cac nhan xet
ciia
benh
nhan tham
gia
dieu tri cho thay quan diem eua
benh nhan ve thai dp cua nhan vien y te cung
nhff quy trinh dieu trj va ho trd dieu tn trong
dieu trj Methadone da gop phan Idn cho thanh
cdng trong dieu tri nghien cac chat dang thuoc
phien thay the bang Methadone. Benh nhan dffdc
thffdng xuyen tff van ve van de sffc khde, tinh
than,
cae van de xa hdi anh hffdng den viec dieu
trj trd giiip cho benh nhan tuan
thii
dieu trj, dac
biet hd trd dieu trj cho benh nhan khac phue tac
dung phu, nguy cd qua lieu
ciia
thudc. Nghien

cffu
ciia
Bd Y te cung chf ra 6a sd benh nhan
hien dang dffdc dieu tri
tai
cae cd sd cho biet ho
hai Idng vdi eae djch vu nhan dffdc cung nhff
hai
Idng vdi thai dp
ciia
cac nhan vien cdng tac tai cd
sd dieu tri. Tuy vay van cd hdn 10% benh nhan
cho rang thdi gian tiep ddn can linh hoat hdn, do
benh nhan cd the ban di lam nen khdng den
udng thudc kip gid md cffa
ciia
cd sd dieu trj,
Khoang 14% benh nhan cho rang thdi gian do
lieu
la chffa
thi'ch
hdp, keo dai nen benh nhan
tiep tuc cd eae bieu hien
ciia
hdi chffng cai
[2].
Tai cac cd sd dieu tri cd eac djch vu chuyen
gffi benh nhan den cac djch
vy
y te khac, cu the

viec chuyen girl benh nhan tdi dieu trj ARV la
44,5%,
dieu tri nhiem triing cd hpi 30,8%, ndi
cung cap BKT
sach,
BCS va cac djch
vy
khac. Tuy
nhien ty le benh nhan dffdc gidi thieu tdi cac djch
vu eon thap, dae biet la cac ho trd ve viec lam
hoac cac hd trd xa
hdi
khae danh cho ngffdi sau
cai nghien. Ket qua nhieu nghien cffu djnh tfnh
va djnh Iffdng tren the gidi cho thay, ben canh
viec dieu tri thay the bang thudc Methadone thi
mdt trong sd nhffng yeu td lien quan tdi viec
benh nhan han ehe sff dyng heroin khi da dat tdi
lieu duy tri phu thupc vao viec cung cap cac djch
vu
ho
trd.
Mpt nghien cffu tai Hong Kong cho thay
nhffng ngffdi NCMT khi dffdc dieu trj bang
Methadone ed
it
ban tinh va hanh vi tinh
due it
nguy ed hdn. Ngoai tae dung giiip ngffdi
nghien

ngffng hoac giam tan suat sff dung ma
tiiy,
Methadone cung la mdt yeu td gdp phan lam
giam hanh vl dung chung BKT khi tiem chich
trong nhdm nay [8],
[10].
V. KET LUAN
Hieu qua eua dieu trj thay the bang thuoc
Methadone can thiep dff phdng lay nhiem HIV
trong nhdm tiem chfch ma tuy la rat kha quan.
Ty le lieu khdi dau trung binh cita benh nhan la
20 mg/ngay, lieu duy tri trung binh la 105
Y HOC VIET NAM THANG 2 - SO
2/2014
mg/ngay. Tan suat sff dyng heroin hang ngay
eua benh nhan giam di rd ret: tru'dc dieu tri 1,24
lan/ngay;
giai
doan dd lieu 1,07 lan/ngay sau 7
ngay, 0,33 lan/ngay sau 30 ngay va sau 3 thang
dieu tri la 0,08 lan/ngay. Ty te benh nhan dffdc
chuyen girl den cac
dich
vu y te khac nhff: Dieu
trj ARV la 44,5%, dieu tn nhiem triing cd
hdi
30,8%,
cung cap BKT sach 21,3%, tff van xet
nghiem HIV ty nguyen 8,3%, Oa sd benh nhan
dang dffdc

dieu
trj tai cac cd sd deu cho biet hp
rat hai Idng, hai Idng vdi cac djch vy ddn tiep
benh nhan, thai dp bac sy lam viec, thai dp nhan
vien tff van cung nhff hai Idng vdi thai dp
eiia
cae
nhan vien cdng tac tai
cd
sd dieu trj Methadone.
TAILlgUTHAM
KHAO
1.
B$
Y te (2013), Bao cao ket qua hoat ddng
phong chdng HIV/AIDS 6 thang dau va phUOng
hffdng nhiem vu 6 thang cudi nam 2013.
Bo Y te (2009), Bao cao ket qua trien
khai
thi
diem
dieu tri nghien cac chat dang thuoc phien
bang thuoc Methadone tai TP. Hai Phong va TP,
Ho
Chi
Minh nam 2008, tr, 1- 9,
Bp Y te (2005), "Cac cong trinh nghien
CLAJ
khoa
hoc ve HIV/AIDS

giai
doan 2000-2005",
Tap
chi
Y
hoc thifc hanh nam 2006.
Bp Y te (2007), Hu'dng dan xay
di/ng
khung cac
can thiep
dPa
tren hoat dong cua cac cd sd dieu
tri
Methadone
,yi5
Noi, tr, 5- 24.
Bp Y te (2010), Hudng dan dieu tri thay the
nghien cac chit dang thudc phien bang thuoc
methadone,
Ha Noi, tr, 3- 25.
Trung tam phong chong
HIV/AIDS
Ha Npi
(2013),
Bao cao ket qua hoat dong phong chong
HIV/AIDS 5 thang dau va phUOng
hUdng
nhiem
vu 6 thang
cuoi

nam 2013,
Thu tu'dng Chinh phu
(2012),
Chien
\Mc
qudc
gia
phong chdng HIV/AIDS
d
Viet
Nam den nam
2020 va tam nhin 2030,
NGHIEN
Ciru
BIEN DOI SO LU'O'NG VA HINH THAI MAU TIEU CAU
6"
BENH NHAN
GIAM
TIEU CAU
JVlAU
NGOAI VI
T6M
TAT
Giam tieu cau thu'dng gap trong cac benh ly huyet
hpc cung nhU khong huyet hpc. Xet nghiem
tiiy
do
ddng mpt vai trd quan trong trong chan doan, Muc
tidu:
Tim hieu

sif
bien
ddi
sd
lUdng
va
hinh
thai mau
tieu rau d benh nhan giam
tieu
cau mau ngoai
vi.
Doi
tffdng
va phu'dng
phSp
nghien
cffu:
hoi cffu ket
hijp
tien
ciru,
mo ta, cat ngang
dUdc
thyc hien d
BVrWQD
108
ty
2008-2013, Ket qua: 400 trUdng hpp
giam tieu

au
mau ngoai
vi
ddn thuan hoac kem
giam
HC Tuoi trung binh la
53,2
tuoi
{14-94
tudi),
Oa so
cic BN nhom
tuoi
>45
tud'i,
Xuat huyet giam
tieu
cau
vo
c3n
(ITP)
la
nguyen nhan pho
bien
nhat
tiep
theoja
glim
sin
tiiy,

bach cau cap, 57,25% BN so lu'dng mau
tieu
c3u
trong
tiiy
binh thu'dng hoac giam nhffng hinh
thai vln binh thu'dng. Trong 97/400 BN tang so
lUdng
m§u
ti^u du
vdi
hinh thai dang non thi hau het la ITP
KSt
lu^n:
Tiiy
do la xet nghiem quan trong de chan
do^n
xac djnh nguyen nhan giam tieu cau.
Titldida:
Giam
teu
cau,
Chpc
hiit
bjy
xUOng
(tiiy
do)
•
Khoa

huyet
hpc lam
sang
Benh
vi$n
TWQD108
PhAn
bl$n
khoa hgc: PGS.TS Nguyen Lieu
Nguyen Thj Minh
Phuong*
SUMMARY
STUDY OF CHANGES IN NUMBER
AND MORPHOLOGY OF
THE MEGAKARYOCYTES IN PATIENT
WITH THROMBOCYTOPENIA
Thrombocytopenia
i5
commonly encountered in
haematological and
non-haematological
disorders.
Bone marrow aspiration plays a major role
in
diagnosis. Objective: to analyse the changes
in
number and morphology of the megakaryocytes
in
patient
with

Thrombocytopenia, Patients and
methods: This restrospective and prospective cross-
sectional study was carried out at 108 military central
hospital.
Results: 400 cases
with
thrombocytopenia.
Mean age of patients was 53,2 years. Maximum
number of cases was seen
in
age group of above 45
years. Idiopathic thrombocytopenic purpura (ITP) was
the commonest cause followed by hypoplastic marrow,
acute leukaemia respectively. Most patients increased
number of megacaryocyte
with
immature form is ITP.
Conclusion: bone marrow aspiration
is
an important
diagnostic modality to determine the aetiology of
thrombocytopenia.
Keywords: Thrombocytopenia, bone marrow
aspiration