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.. [1],
Trang 1MO TA THITC TRANG CUNG CAP DICH VU CHAM SOC Y TE
CHU'ONG TRINH D O N G THUOC THAY THE METHADONE CAN THIEP TRONG NHOM NGHIEN CHICH MA TUY TAI T H A N H PHO H A NOI
T 6 M 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
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
ngay, 0,33 lan/ngay sau 30 ngay va sau 3 thang dieu trj
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 t y 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 I N J E C T I O N DRUG USERS
(IDUS) I N T W O METHADONE TREATMENT
CENTERS I N H A N O I 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 after 7 days is 1,07 times/day, after 30
days: 0,33 times/day, after 3 months: 0,08 time/day
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 V X N 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
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 d y 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 d y phdng lay nhiem HIV tren nhdm NCMT [1]^ [ 3 ] ; [4], [5], [6]
II OOI T U p N G VA PHU'aNG PHAP N G H I ! N CUD
- Oja diem : 02 ed sd dieu tri methadone; huyen
T y 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:
Trang 2Trong 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
Trang 3Bleu 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$nh nhan dude dieu tn deu rit hai Idng, hai long vdi quy trinh don tUp, thai dp lam viec cua bac sy, thai dp nhan vtin t& van cOng nh& hai long vdi thai dp cua cac nhan vlin cong tac tai cd sd dieu tri f i chiem tyle dm&c cao (t&95,0% • 98,0%) Tuy vay van co mot so nho (chiim 2,5%) binh nh$n cho kng thdi gian tiep don can linh hoat hdn, do ban di lam nin khong din udng thudc kip gid
Trang 4IV 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
Trang 5mg/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
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
T A I L l g U T H A M 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 G I A M TIEU CAU JVlAU NGOAI VI
T 6 M TAT
Giam tieu cau thu'dng gap trong cac benh ly huyet
hpc cung nhU khong huyet hpc Xet nghiem tiiy do
tidu: Tim hieu sif bien ddi sd lUdng va hinh thai mau
tffdng va phu'dng phSp nghien cffu: hoi cffu ket
hijp tien ciru, mo ta, cat ngang dUdc thyc hien d
giam tieu a u mau ngoai vi ddn thuan hoac kem giam
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 d u 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
Nguyen Thj Minh Phuong*
S U M M A R Y STUDY OF CHANGES I N NUMBER AND MORPHOLOGY OF THE MEGAKARYOCYTES I N PATIENT
W I T H THROMBOCYTOPENIA
Thrombocytopenia i5 commonly encountered in haematological and non-haematological disorders
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 Mean age of patients was 53,2 years Maximum number of cases was seen in age group of above 45 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